Using innovative group-work activities to enhance the problem-based learning experience for dental students.

Problem-based learning (PBL) in medical and dental curricula is now well established, as such courses are seen to equip students with valuable transferable skills (e.g. problem-solving or team-working abilities), in addition to knowledge acquisition. However, it is often assumed that students improve in such skills without actually providing direct opportunity for practice, and without giving students feedback on their performance. 'The Manchester Dental Programme' (TMDP) was developed at The University of Manchester, UK as a 5-year, integrated enquiry-led curriculum. The existing PBL course was redesigned to include a unique, additional PBL session ('Session 4') that incorporated an activity for the group to complete, based on the subject material covered during student self-study. A summative mark was awarded for each activity that reflected the teamwork, organisational and overall capabilities of the groups. This paper describes the different types of activities developed for the Session 4 and presents an analysis of the perceptions of the students and staff involved. The student response to the Session 4 activities, obtained via questionnaires, was extremely positive, with the majority finding them fun, yet challenging, and 'worthwhile'. The activities were perceived to enhance subject understanding; develop students' problem-solving skills; allow the application of knowledge to new situations, and helped to identify gaps in knowledge to direct further study. Staff found the activities innovative and exciting learning tools for the students. The Session 4 activities described here are useful educational resources that could be adapted for other PBL courses in a wide variety of subject areas.

Rapid stimulation of cyclic AMP production by aldosterone in rat inner medullary collecting ducts.

Aldosterone stimulates sodium transport in the inner medullary collecting duct (IMCD) via the classic genomic pathway, but it is not known whether it also acts via a rapid, non-conventional pathway in this part of the nephron. The IMCD regulates the final sodium content of urine and expresses vasopressin receptors coupled to adenylate cyclase. The recently reported rapid, non-genomic actions of aldosterone have been associated mainly with an increase in intracellular Ca(2+); however, it has also been shown to stimulate camp generation. Thus the aim of this study was to determine whether aldosterone stimulates rapid generation of cAMP in isolated IMCD segments. IMCD segments were microdissected from Sprague-Dawley rat kidneys and incubated at 37 degrees C for 4 min with aldosterone (10(-12) to 10(-6) M), vasopressin (10(-12) to 10(-6) M), or a combination of hormones in the presence of a phosphodiesterase inhibitor. cAMP was measured by radioimmunoassay. While corticosterone and dexamethasone were ineffective, aldosterone stimulated a dose-dependent increase in cAMP within 4 min (P<0.05). This action of aldosterone was not inhibited by the MR antagonist spironolactone. Co-incubation of aldosterone with vasopressin resulted in a further increase in cAMP generation above that induced by the neurohypophysial hormone alone. Aldosterone-mediated cAMP generation was not inhibited by a vasopressin V(1) or V(2) receptor antagonist. These data support a novel and rapid, non-genomic effect of aldosterone in IMCD. Aldosterone does not apparently interact with the vasopressin receptor to stimulate cAMP generation.

Direct and indirect modulation of rat cardiac sarcoplasmic reticulum function by n-3 polyunsaturated fatty acids.

Measurements were made of trans-sarcolemmal Ca(2+) fluxes and intracellular [Ca(2+)](i) in rat ventricular myocytes loaded with Indo-1 to determine how the n-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) suppresses spontaneous waves of Ca(2+) release. We report that in 10 microM EPA, the Ca(2+) efflux generated by individual waves increased by 11.3 +/- 4.9 % over control levels. However, wave-generated efflux per unit time fell overall by 19 +/- 5.3 %. On removal of EPA, wave frequency increased transiently such that Ca(2+) efflux was greater than normal and the cell lost 28.0 +/- 10.6 micromol l(-1) Ca(2+). This probably represents the loss of extra Ca(2+) accumulated by the sarcoplasmic reticulum (SR), while Ca(2+) release was inhibited. These results are evidence of inhibition of the SR Ca(2+)-release mechanism and reduced availability of Ca(2+) to the SR. From the relationship between average intracellular Ca(2+) and the frequency of spontaneous waves, we have calculated the relative contributions of these different mechanisms to the lower frequency of waves. In EPA, the frequency of spontaneous waves fell by 37.5 +/- 8.1 %, the majority of this (29.2 +/- 8.8 %) is due to inhibition of the Ca(2+)-release mechanism. In EPA, the rate of fall of Ca(2+) in the caffeine response (an indicator of surface membrane Ca(2+) efflux pathway activity) was not altered. We conclude, therefore, that the lower resting level of Ca(2+) observed in EPA is due to a lower influx of Ca(2+) across the surface membrane rather than increased activation of efflux pathways. How these effects might contribute to the anti-arrhythmic actions of EPA is discussed.

Swelling-induced changes in cytosolic [Ca2++] in insulin-secreting cells: a role in regulatory volume decrease?

Exposure of insulin-secreting cells to hypotonic solutions causes cell swelling followed by regulatory volume decrease (RVD). We have previously demonstrated that RVD is due to activation of a Cl(-) conductance. The present study investigates whether changes in cytosolic [Ca(2+)] play a role in these responses. Hypotonic swelling of RINm5F insulinoma cells caused a marked increase in cytosolic [Ca(2+)]. This effect was abolished by omission of extracellular Ca(2+), by the Ca(2+) channel blockers D600 or Gd(3+)and by 4,4'-dithiocyanatostilbene-2,2'-disulphonic acid (DIDS), an inhibitor of the volume-sensitive anion. RVD was markedly impaired in the absence of extracellular Ca(2+), but not by D600 nor by Gd(3+). RVD was also inhibited by the maxi-K(+) (BK(Ca)) channel blockers tetraethylammonium (TEA) and iberiotoxin (IbTx), whereas the K(ATP) channel blocker tolbutamide was ineffective. Cell swelling was accompanied by activation of a K(+) conductance which was sensitive to TEA and IbTx but not to tolbutamide. It is concluded that cell swelling causes activation of the volume-sensitive anion channel, leading to depolarization and Ca(2+) entry via voltage-gated Ca(2+) channels. RVD is a Ca(2+)-dependent process, requiring low 'resting' levels of intracellular [Ca(2+)]. However, the swelling-induced increase in cytosolic [Ca(2+)] is not required for RVD to occur. RVD depends upon simultaneous activation of Cl(-) and K(+) channels. We suggest that the BK(Ca) channel is the major K(+) conductance involved in RVD.

Cytotoxic action of methylglyoxal on insulin-secreting cells.

Methylglyoxal is a spontaneous product of glucose metabolism which is known to have cytotoxic actions and to be present in raised concentrations in hyperglycaemia. It could therefore play an important role in glucose toxicity. We have investigated the cytotoxic effects of methylglyoxal on insulin-secreting cells, which are particularly sensitive to glucose toxicity. Methylglyoxal caused a concentration-dependent increase in the number of apoptotic RINm5F cells within 4-6 hours. A similar effect was observed with rat pancreatic beta-cells. tert-butylglyoxal, which is a poor substrate for the glyoxalase pathway, exerted a similar, though more potent apoptotic action. Dexamethasone and NaF were also found to induce apoptosis in RINm5F cells. Flow cytometric analysis suggested a degree of necrosis in addition to apoptosis resulting from treatment with methylglyoxal. The cytotoxic effect of methylglyoxal could contribute towards glucose toxicity in insulin-secreting cells.

Selective inhibition of glucose-stimulated beta-cell activity by an anion channel inhibitor.

4,4'-Dithiocyanatostilbene-2,2'-disulfonic acid (DIDS), an inhibitor of the volume-sensitive anion channel, was used to investigate the role of this channel in the stimulation of rat pancreatic beta-cells by glucose and by tolbutamide. Glucose-stimulated electrical activity in beta-cells was markedly and reversibly inhibited by DIDS. The increase in cytosolic [Ca2+] and stimulated insulin release evoked by glucose were also inhibited by DIDS. In contrast to its inhibitory effect on glucose-induced beta-cell activity, DIDS had no effect on electrical activity, the rise in [Ca2+]i or insulin release induced by tolbutamide. DIDS failed to increase beta-cell input conductance, an index of whole-cell K(ATP) channel activity, or the rate of efflux of 86Rb+ from perifused islets, a measure of net K+ permeability. Furthermore, DIDS had no effect on intracellular pH or on regulatory volume increase following exposure of cells to hypertonic solutions, indicating that the effects of DIDS were not the result of inhibition of Cl- transport systems. It is suggested that the DIDS-induced repolarization is caused by inactivation of the volume-sensitive anion channel. The stimulation of beta-cell electrical and secretory activity by glucose, but not tolbutamide, may therefore involve activation of the anion channel.

External alkalinization decreases intracellular Ca++ and spontaneous contractions in pregnant rat myometrium.

OBJECTIVES: As plasma pH rises during pregnancy, the effect of raising external pH on spontaneous contractions in pregnant rat myometrium was investigated to test the hypothesis that elevated external pH depresses contraction. STUDY DESIGN: Strips of longitudinal myometrium were loaded with SNARF (seminaphthorhodafluor) or Indo-1 for simultaneous intracellular pH or Ca++ and force measurements. Results were obtained from a minimum of five animals in each group, and significant differences were tested for by paired Student t tests. RESULTS: Raising the external pH significantly reduced spontaneous force and calcium transient in the pregnant uterus. Raising the external pH led to a slow rise in intracellular pH, but this could not account for the functional effect. K+ rubidium 86-labeled efflux rates were unaffected by external pH, suggesting no hyperpolarization. The Ca++ channel agonist Bay K8644 (5 mumol/L) restored contractions abolished by raised external pH. CONCLUSIONS: Raised external pH reduces spontaneous contractions in the pregnant rat uterus, probably by an external effect on Ca++ entry. This effect may contribute to uterine quiescence before term.

Glucose-induced swelling in rat pancreatic beta-cells.

1. Changes in relative cell volume in response to hypotonic solutions and glucose were studied in single isolated rat pancreatic beta-cells using a video-imaging technique. beta-cell electrical activity was recorded under similar conditions using the perforated patch technique. 2. Exposure of beta-cells to hypotonic solutions (10 and 33% hypotonicity) caused an immediate increase in cell volume to relative values of 1.09 and 1.33, respectively. This was followed by a gradual regulatory volume decrease. 3. Raising the concentration of glucose from 4 to 20 mM or 12 mM (with substitution of mannitol) increased beta-cell volume by 12 and 10%, respectively. This effect of glucose persisted when CO2+ was added to inhibit insulin release. Glucose-induced volume increases were sustained for the duration of exposure to elevated hexose concentration. The addition of 16 mM 3-O-methylglucose, which is transported into the beta-cell but not metabolized, produced only a transient 5% increase in beta-cell volume. 4. Exposure of beta-cells to a 15% hypotonic solution resulted in a transient depolarization and electrical activity. Raising the glucose concentration to 20 or 12 mM caused a sustained depolarization and generation of electrical activity. However, the addition of 16 mM 3-O-methylglucose had no effect on beta-cell membrane potential. The glucose-induced increase in volume and induction of electrical activity, when measured in single beta-cells simultaneously, showed comparable kinetics. 5. The secretion of insulin from intact pancreatic islets was stimulated by exposure to hypotonic solutions (10-33% hypotonicity). A 15% hypotonic solution stimulated insulin release to a peak value comparable to that elicited by raising the glucose concentration from 4 to 20 mM. Whereas hypotonic solutions caused a transient stimulation of insulin release, the effect of glucose was sustained. 6. It is suggested that glucose increases the volume in rat pancreatic beta-cells by a mechanism dependent upon metabolism of the sugar. The extent of cell swelling evoked by raised glucose concentrations is sufficient to depolarize the cells and induce electrical and secretory activity and may involve activation of a volume-sensitive anion conductance.

A volume-activated anion conductance in insulin-secreting cells.

The whole-cell patch-clamp recording technique was used to measure volume-activated currents in K+-free solutions in RINm5F and HIT-T15 insulinoma cells and in dispersed rat islet cells. Cell swelling, induced by intracellular hypertonicity or extracellular hypotonicity, caused activation of an outwardly rectifying conductance which could be subsequently inactivated by hypertonic extracellular solutions. The conductance required adenosine 5'-triphosphate (ATP) in the pipette solution but was Ca2+ independent. Na+ and Cl- substitution studies suggested that the swelling-activated current is Cl- selective with a halide permeability sequence of Br > Cl > I. The conductance was reversibly inhibited by the anion channel inhibitors 4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid (DIDS) and by 5-nitro-2-(3-phenylpropylamino) benzoic acid (NPPB). Further evidence for a volume-activated anion conductance was provided by studies of volume regulation in insulin-secreting cells. When RINm5F cells were exposed to a hypotonic medium, the initial cell swelling was followed by a regulatory volume decrease (RVD). This RVD response was also inhibited by DIDS and by NPPB. These data therefore provide evidence for a volume-activated anion conductance in insulin-secreting cells which could be involved in the RVD following osmotic stress. A possible role for the conductance in hypotonically induced insulin release is also discussed.