Online learning for higher education in the medical schools | AMEP – Dove Medical Press

Introduction

An understanding of basic anatomy is vital for surgery and to focus on the relevant anatomical structures in medical imaging;1,2 however, it also appears to be a challenging subject for medical students.2,3 Human anatomy is a three-dimensional subject that requires a clear understanding of the relationships between structures, usually gained through the study of human cadavers, microscopic samples, and models.3

Due to the outbreak of the severe acute respiratory syndrome Coronavirus 2019 (COVID-19), physical anatomy education and face-to-face teaching have been adversely affected worldwide.4 The cadaver dissection rate during the pandemic was drastically reduced, likely due to the lockdown policy and fear of COVID-19, which prevented hospitals from accepting body donations.57

In terms of COVID-19 control measures, maintaining physical distance between individuals makes it impossible to conduct teaching activities with a large number of students in a classroom or laboratory. By converting conventional in-person learning strategies into a virtual form, the continuity of learning outcomes is ensured.8

To overcome the interruption in the learning environment caused by the prevailing situation, teaching and learning environments need to adapt to the new normal and technologies. Various e-learning methods using digital technologies are being used in tertiary education.9

However, it is difficult to teach anatomy online through virtual classes and distance learning. Switching to this virtual mode suddenly requires additional work as there is no physical autopsy of the corpse, embryological models, bone samples, microscope slides, or direct interactions with the teacher. Moreover, it has a big impact on students.4,10,11 The aims of this study were to examine students attitudes and perceptions regarding teaching anatomy as part of medical training before and after the lockdown period and the ways of improving the defects detected during this lockdown period.

A cross-sectional study was conducted at Imam Mohammad Ibn Saud Islamic University (IMSIU) after approval from the IMSIU IRB committee Approval No. 232020. Between June 2020 and June 2021; 455 first-year and second-year students from the Faculty of Medicine were informed about the purpose of the study and invited to participate. Participants provided written informed consent to participate in the study and 399 student respond to the study.

The study was conducted using two methods:

Before the COVID-19 pandemic, anatomy was taught face-to-face through lectures, laboratory classes, and seminars. The lectures were interactive in nature. The anatomy labs were covered by learning on cadavers, plastinated specimens, and anatomy tables. The histology labs were covered by learning on slides observed under a microscope. Seminars were conducted in the college classroom and they were divided into smaller groups, each group taking a particular objective and presenting a related project to a staff member who assessed the students.

During the spread of COVID-19, the college was constrained to switch its entire teaching guidelines online. Therefore, anatomy learning was secured for online learning. Through a college-sponsored orientation event, staff and students were taught how to register for the Zoom video-conferencing application. The lectures were introduced through live Zoom sessions. Figures from atlas anatomy textbooks and recorded online videos were used to cover the anatomy laboratories. Learning of figures from histology textbooks was used to cover the histology laboratories. Seminars were conducted online.

A structured questionnaire was administered to the students. The survey comprised 15 closed-ended questions based on volunteerism guidelines. Questions employed a 5-point Likert-type scale, with 5=strongly agree, 4= agree, 3= uncertain, 2= disagree, and 1=strongly disagree.

The questionnaire for this study was structured and designed based on the study conducted by Hanafy et al,12 where a pilot study was conducted on 13 students and chronbacks alpha was 0.73.

Depending on the data from the current questionnaire which was administered to students, students were classified into multiple groups; each group consisted of six to eight students, who discussed their opinions and provided suggestions to improve the online teaching process. Their ideas and concepts were coded and categorized and general themes were created.

Six main themes were identified: computer skills and technical Internet infrastructure (improving students technical and computer skills, improving technical Internet infrastructure), improving learning resources (providing students with textbooks, digital resources, and other teaching materials from multimedia and the Internet), staff communication (increasing communication time with staff on a weekly basis and encouraging small groups for discussion of different problems), administrative procedures (assigning administrative persons to communicate with students, help them, and solve any problems they face during the courses), examination (increasing time limit of and immediate feedback after online examinations, separate examination versions for each student to prevent cheating, and development of formative assessments for improving structure recognition), and general (development of blended learning, division of long courses into several parts, and increasing time limit for online lectures and seminars).

Students were then asked to give their opinions about such themes and how much they agreed to improve online learning using a 3-point Likert scale: with 3= agree, 2= neutral, and 1= disagree.

Data were analyzed using SPSS software version 23. A simple frequency distribution was used to express the distribution of different variables, and paired t-tests and Z tests were used for comparison of group means and proportions.

Out of 455 students who were invited to participate in the study, 399 (87.6%) responded. Their ages ranged from 1923 years; most of them were males (76%).

Table 1 indicates that the mean attitude scores for conventional lectures, seminars, and practical sessions were significantly higher than that of online lectures, seminars, and practical sessions, where t= 7.6, P=0.00; t= 5.5, p=0.00; and t= 9.2, p=0.00, respectively.

Table 1 Comparison of the Students Total Scores Means for the Scales: Conventional Lectures, Seminars and Practical Sessions versus Online Lectures Seminars and Practical Sessions

No significant difference was detected between men and women with regard to the mean attitude scores of the three teaching modules.

The two categories for the three attitude scales (strongly agree and agree) were combined and compared across the three teaching modules for conventional and online teaching. Results are illustrated in Tables 24.

Table 2 Comparison of Students Attitude Scales for Conventional and Online Lectures

Table 3 Comparison of Students Attitude Scales for Conventional and Online Seminars

Table 4 Comparison of Students Attitude Scales for Conventional and Online Practical Sessions

There was a significant discrepancy between conventional and online lectures, seminars, and practical sessions. The students expressed a positive attitude towards the three teaching modules. The highest discrepancy was observed for the statement about the association of teaching materials provided by conventional lectures with learning anatomy and basic science. Two other statements attained a high discrepancy, but to a lesser degree, that is, the effect of conventional lectures on recognition of the structure and construction of a comprehensive picture and integrating medical knowledge, and their attitude towards the correlation between fundamental basic sciences and clinical diseases.

With regard to practical sessions, there were significant differences in students attitudes between the conventional and practical online sessions. It ranged from 32.3% for the efficiency of conventional teaching materials in learning anatomy to 24.1% for the ability of conventional teaching to correlate fundamental basic sciences with clinical diseases (Table 4).

The second part of the study included obtaining students opinions on improving the process of online learning. A total of 362 (79.5%) students completed their responses. Students opinions that attained the highest and lowest agreement are listed in Table 5.

Table 5 Students Opinions Towards Improvement of Online Teaching Process

Table 5 describes students opinions towards the six themes, where they agreed that themes related to computer skills and technical Internet infrastructure (71.55%), administrative procedures (61.74%), learning resources (59.6%), and staff communication (59.76%) are essential for improving the online teaching process. The two themes with least agreement for improving the online learning process were the general theme (51.2%) and the one related to examination statements (54.4%).

The results of the current study indicated that the mean attitude scores for conventional lectures, seminars, and practical sessions were significantly higher than those for online lectures, seminars, and practical sessions. These results agree with those of Hanafy et al,12 who found that medical student interest was significantly higher toward conventional than online teaching of anatomy, physiology, and biochemistry. These results might be explained by some authors13 who stated that in classroom learning, students gain practical skills, acquire communication skills, and have the opportunity to interact with their teachers.

On the other hand, the results were different from those of Mahdy and Ewaida,14 where veterinary anatomy was taught remotely during the COVID-19 pandemic, and nearly two-thirds of the students expressed interest in learning anatomy online. Most of the students believed that this type of learning is most effective for both the theoretical and practical parts of the course. Another study15 evaluated the shift from face-to-face education at the University of Malta to remote teaching of human anatomy during the COVID-19 pandemic and found that almost half of the students thought that remote anatomy instruction was equivalent to face-to-face instruction.

The present study found that the highest discrepancy was observed for the statement about the association between teaching materials provided by conventional lectures and learning anatomy and basic science. The results are consistent with those of some studies4,16 that found that the majority of technologically advanced students did not favor learning anatomy exclusively online. An important reason for this is their inability to acquire the three-dimensional orientation of the structures needed to learn anatomy.

The current study observed that the students attitudes toward conventional practical sessions were significantly meaningful compared to the online sessions regarding the conventional teaching materials for anatomy (such as cadavers, plastinated models, anatomy tables, microscopes, and slides). These results agree with that of Khasawneh,17 who assessed medical students feedback regarding online teaching versus face-to-face teaching during the COVID-19 pandemic. According to his study, 79.14% of students found it difficult to understand histology without the benefit of seeing slides under a microscope. In addition, 69.28% of participants reported having difficulty understanding anatomy without viewing models in laboratories.

The second part of the study included students responses regarding the improvement of the online learning process. The students agreed that improvement of the themes related to computer skills and technical Internet infrastructure will improve online learning. These results were in line with those of Nazeefa,18 who discovered major limitations for live Zoom sessions because of varying Internet connectivity strength across the board. According to Yoo et al,6 network interruptions were the most severe restrictions for online learners.

The students agreed that the improvement of themes related to communication would improve online learning. Such communication can be obtained by increasing the scheduled live Zoom sessions with staff and small groups to discuss different problems. According to Totlis et al,19 students prefer traditional classroom lectures to online sessions owing to a lack of interaction between peers and lecturers; as a result, they perceive a decline in the effectiveness of online learning methods.

The students agreed that the improvement of themes related to learning resources would improve online learning. Textbooks and other teaching materials from multimedia and the Internet, digital resources, virtual dissection tables, and Argosy publishers Visible Body are useful tools. This suggestion was supported by one study,20 which stated that the Argosy publishers Visible Body, Elseviers full anatomy, virtual dissection tables, and other web-based 3D virtual resources are available to understand organ architecture and relationships. Zhao et al21 also mentioned that virtual reality-based technology is used to educate anatomy.

The students agreed that the improvement of the themes related to the examination would improve online learning. The suggestions include increasing the time limit and providing immediate feedback after the online examination, creating a separate examination version for each student to prevent cheating, and developing a formative assessment for improving structure recognition. Such suggestions are in line with Snekalatha et al,22 who assessed medical students perceptions of the reliability, usefulness, and practical challenges of online tests. Their results showed that medical students appreciated the usefulness of online formative assessment tests in enhancing learning. Kumar et al23 assessed perceptions of the advantages and disadvantages of electronic assessment among first-year medical students engaged in online learning. Among the advantages, students said that they were being exposed to new ways of learning and obtaining immediate results/feedback.

The students agreed that the development of blended learning in anatomy would improve their learning process. Puljak et al24 also found that 55.7% students preferred hybrid learning. In another national survey of 2721 students in the UK,25 the author recommended a combination of online and face-to-face classes.

This study has some limitations. First, it was a questionnaire-based survey set up on a non-probability voluntary sample and therefore entails typical pitfalls. Second, the participants were recruited from a single academic institution in one country. Our results could differ if the survey was distributed across multiple institutions in different countries. Third, the study depended on students attitudes, which might be influenced by their personal feelings and might affect their responses.

Conventional anatomy teaching is preferred over online teaching. However, improvements in different aspects, such as computer skills, technical Internet infrastructure, learning resources, staff communication, and examinations will aid the learning process and development of blended learning, especially during future challenges.

The protocol was approved by the ethics review board of the Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia. Approval No. 23-2020.

Participants provided written informed consent to participate in the study.

The authors would like to thank and acknowledge the Deanship of Scientific Research, Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia, for funding this research, Grant No. (21-13-18-015).

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

This research was supported by the Deanship of Scientific Research, Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia, Grant No. (21-13-18-015).

The authors declare no conflicts of interest in this work.

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2. Guimaraes B, Durado L, Tsisar S, Diniz JM, Madeira MD, Ferreira MA. Rethinking anatomy: how to overcome challenges of medical educations evolution. Acta Med Port. 2017;30(2):134140. doi:10.20344/amp.8404

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7. Bond G, Franchi T. Resuming cadaver dissection during a pandemic. Med Educ Online. 2021;26(1):1842661. doi:10.1080/10872981.2020.1842661

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13. Shetty S, Shilpa C, Dey D, Kavya S. Academic crisis during COVID 19: online classes, a panacea for imminent doctors. Indian J Otolaryngol Head Neck Surg. 2020;115. doi:10.1007/s12070-020-02224-x

14. Mahdy MAA, Ewaida ZM. Evaluation of the emergency remote learning of veterinary anatomy during the COVID19 pandemic: global students perspectives. Front Educ. 2022;6:728365. doi:10.3389/feduc.2021.728365

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22. Snekalatha S, Marzuk M, Meshram SA, Maheswari KU, Sugapriya G, Sivasharan K. Medical students perception of the reliability, usefulness and feasibility of unproctored online formative assessment tests. Adv Physiol Educ. 2021;45:8488. doi:10.1152/advan.00178.2020

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24. Puljak L, Civljak M, Haramina A, et al. Attitudes and concerns of undergraduate university health sciences students in Croatia regarding complete switch to e-learning during COVID-19 pandemic: a survey. BMC Med Educ. 2020;20:111. doi:10.1186/s12909-020-02343-7

25. Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open. 2020;10:e042378. doi:10.1136/bmjopen-2020-042378

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Online learning for higher education in the medical schools | AMEP - Dove Medical Press

Everything Greys Anatomy Stars Have Said About the Show Continuing Without Ellen Pompeo – Us Weekly

Is it time to say goodbye to Meredith Grey? Ellen Pompeo has hinted several times that she would be fine with Greys Anatomy coming to an end, but the TV show continues to live on.

The medical drama premiered on ABC in 2005 and Pompeo, has played the titular character, Meredith Grey, since the shows debut and remains on the show alongside her fellow original cast members Chandra Wilson (Miranda Bailey) and James Pickens Jr. (Richard Webber). In 2022 the series was renewed for a nineteenth season.

I didnt ever think that I would stay on the show this long, the actress said in an interview with Variety in April 2020. It happened, and here I am. Its been this incredible platform for me and allowed me to stay home with my kids so much and not travel and have the circus life of an actor.

In 2018, the medical dramas leading lady spoke to The Hollywood Reporter about her battle with the network for more money and contract negotiations with her former costar Patrick Dempsey.

For me, Patrick [Dempsey] leaving the show [in 2015] was a defining moment, deal-wise. They could always use him as leverage against me We dont need you; we have Patrick which they did for years, the actress revealed to THR. At one point, I asked for $5,000 more than him just on principle, because the show is Greys Anatomy and Im Meredith Grey. They wouldnt give it to me. Dempsey ended up exiting the show in April 2015 after portraying Derek McDreamy Shepherd for nearly 11 years.

After years of dedication, Pompeo went after what she wanted and what she deserved a hefty pay increase and producer credits. According to a report from Forbes in 2020, the television star earns $550,000 per episode but also receives about $6 million per year from syndication profits, producing fees and office space on the Disney lot for her Calamity Jane production company.

The mastermind behind the iconic medical show, Shonda Rhimes, said alongside Pompeo on several occasions that the long-running drama will end when the actress decides to walk away. Were getting there. Shonda and I will make that decision together, the Catch Me if You Can actress exclusively told Us Weekly in May 2018.

However, Rhimes took a step back and handed over showrunner responsibilities to executive producer Krista Vernoff when she decided to leave ABC to work for Netflix in 2017. Now, Vernoff has complete control of the series and will ultimately decide when it will be time to end the show.

Ive been trying to focus on convincing everybody that it should end, Pompeo told Insider during an interview in December 2021. I feel like Im the super naive one who keeps saying, But whats the story going to be, what story are we going to tell?

The Massachusetts native, who has been playing Dr. Meredith Grey on the ABC series for 16 years, noted that no one else seems to be worried about the storylines. Everyones like, Who cares, Ellen? It makes a gazillion dollars, she added.

After the season 19 renewal, she said the creative team was considering how Grey Sloan Memorial Hospital could live on without her. Listen, the show speaks to a lot of people, and the young people love the show, she told Entertainment Tonight in May 2022. Its inspired so many generations of healthcare workers, so, I think for the young people, its a really good piece of content and were going to try to keep it going for the young people, not necessarily with me, but keep it going beyond me.

In August 2022, it was reported that Pompeo would have a reduced role in season 19, appearing in just eight episodes. She will continue to executive produce and narrate each episode.

Scroll down to see everything that Greys Anatomy stars have said about the show continuing without Ellen Pompeo:

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Everything Greys Anatomy Stars Have Said About the Show Continuing Without Ellen Pompeo - Us Weekly

Hypospadias: A Comprehensive Review Including Its Embryology, Etiology and Surgical Techniques – Cureus

Hypospadias is a congenital deformity of the external genitalia in males. It is defined by the aberrant growth of the urethral fold and the ventral foreskin of the penis, which results in the incorrect location of the urethral opening [1]. In hypospadias, the external urethral meatus may be mispositioned to a different degree and may be accompanied by penile curving. Patients could have an extra genitourinary abnormality based on the location of the hypospadias [2,3]. It is considered among the most prevalent congenital abnormalities in males. Hypospadias occurs in one out of 150 to 300 live births [4,5]. After undescended testis, hypospadias is the second most common congenital abnormality [2]. Hypospadias is frequently characterized as posterior, penile, or anterior based on the preoperative location of the meatus. Nearly 70% of hypospadias are glandular or distally placed on the penis and are regarded as moderate variants, while the remaining are more severe and complicated. This classification was suggested by Duckett [6] (Figure 1).

The standards are used to define and evaluate hypospadias. Meatal position alone is widely regarded as a rudimentary method for classifying the severity of hypospadias since it does not consider the degree of tissue abnormality. In addition, the size of the penis, the size of the glans and urethral plate, the amount of separation of the corpus spongiosum, the existence of curvature, as well as abnormalities, and the location of the scrotum, have a substantial impact on the success of surgical correction. Consequently, a definitive classification can only be made following surgery [7].

This review article focuses on describing the embryological defects that cause hypospadias and the clinical characteristics of the condition. Outline the classification of hypospadias, its management options, the timing of surgery, and its results.

When penile growth is halted, it produces the three-fold classic triad of hypospadias, which includes a hooded dorsal foreskin, an inverted penile curvature on the dorsal side of the foreskin, and a proximal urethral meatus.

In the earliest weeks of embryonic development, the abnormal or incomplete closure of the urethra is the primary pathophysiological event that leads to hypospadias. Development of the external genitalia happens in two stages, which for both sexes are identical. In the first phase, which occurs between the fifth and eighth weeks of pregnancy, the primordial genitalia is formed in the absence of a hormonal stimulus. During this phase, mesodermal cells oriented laterally to the cloacal membrane produce the cloacal folds. These folds combine anteriorly to create the genital tubercle (GT), then break posteriorly into the urogenital and anal folds that surround the urogenital sinus. The GT is composed of three cell layers: the lateral plate mesoderm, the surface face ectoderm, and the endodermal urethral epithelium. This is the primary signaling center for GT's development, differentiation, and outgrowth [8].

In men with chromosomes XY, the second phase, a hormone-dependent stage, begins with the development of gonads into testes. Two of the most significant actions of testicular testosterone are the elongation of the GT and the formation of the urethral depression. The urethral plate, the distal section of the urethral groove, is delineated laterally by the urethral pleats and extends into the glans penis. The urethra is generated when the urethral folds merge, and the coat of the penis is created from the outer surface of ectodermal cells, which merge with the ventral part of the phallus to form the median raphe.

Various malformations, including hypospadias, an abnormal curve of the penis, and improper penile foreskin generation, can be caused by genetic disruption or change of signaling pathways in male external genital and urethral development.

Approximately 18.6 out of every 10,000 live births in Europe are affected by hypospadias. Registrations in 23 European registries between 2001 and 2010 demonstrated a steady number despite previously observed increases and decreases in temporal patterns [9]. North America has the highest prevalence, with 34.2 cases per 10,000 live births, whereas Asia has the lowest, at 0.6-69 cases per 10,000 live births. Even with more than 90 million screened newborns, the real global prevalence and trends are still difficult to quantify due to various methodological issues [5].

Given its frequency, hypospadias can place a significant strain on healthcare spending. A significant risk of complications may necessitate many procedures, particularly in the most severe instances. In addition, a substantial proportion of patients struggle with aesthetic or functional issues [2,10].

Concerning the genesis of hypospadias, several explanations have been offered, including genetic susceptibility, insufficient prenatal hormone stimulation, maternal-placental variables, and environmental impacts. Thus, it is plausible that hypospadias has several causes [11]. Premature birth, small-for-gestational-age newborns who are less than the 10th percentile for weight, length, and/or head circumference, and intrauterine growth restriction are risk factors. All of these have been linked to an increased chance of having a baby with hypospadias [12,13] (Table 1). Hypospadias rates have been linked to both inadequate placentas and the use of assisted reproductive technologies [14,15].

One in every seven occurrences of hypospadias is passed down through first, second, or third-degree family members. For anterior and middle forms, familial occurrence appears to be more prevalent than for posterior kinds. It is estimated that between 9 and 17% of the male siblings of a hypospadias-infected kid may get the condition [11]. One-third of hypospadias are directly linked to a genetic abnormality [16]. Nearly 200 disorders with recognized genetic etiology are connected with hypospadias. However, only a percentage of males with idiopathic variants have this condition [17]. The most common associations are WAGR syndrome, Denys-Drash syndrome, and Smith-Lemli-Opitz syndrome [2,18].

Another important factor in hypospadias is hormonal influence. Most hypospadias is solitary conditions, while uni-bilateral cryptorchidism and micropenis are related abnormalities [19]. These co-morbidities indicate a lack of hormonal effects during development. Androgens and estrogens both play a crucial role in genital development, and in the event of an imbalance, a range of congenital penile malformations, including hypospadias, micropenis, and ambiguous genitalia, can be observed [19]. A shortened anogenital distance in males with hypospadias as a consequence of a disturbance in embryonic androgen exposure [20] is a clinical observation that supports this notion. Other studies highlight the possible impact of so-called endocrine-disrupting environmental pollutants on the formation of hypospadias. Hypospadias was created in mouse models by the exposure of their mothers to synthetic estrogens. Due to the enormous variances across animals, it remains disputed whether someone has a significant effect on humans [21].

Hypospadias is among the most prevalent birth defects in males. A misplaced, ventrally-located urethral meatus; a ventral penile curvature; and an imperfect, dorsally-hooded foreskin are the physical exam criteria for diagnosing an ectopic urethral meatus. Hypospadias is a vast concept, however, and the degree of each symptom can vary significantly across boys. The second and third components are not usually present. Up to 5% of boys suffering from hypospadias have an undamaged prepuce, and the condition is not recognized till the foreskin becomes retractable or diminished during circumcision. Since an intact prepuce can conceal the existence of inadequate urethral growth in a newborn infant, it is essential to retract the foreskin before circumcision to prevent losing this oddity and presumably harming the imperfect urethra or expelling foreskin that could be incorporated into a subsequent urethral reconstruction [22].

Initial assessment of males with hypospadias must include a thorough medical history and physical examination. In conjunction with the trio of hypospadias, males may have related abnormalities such as penile torsion, penoscrotal webbing, and penoscrotal displacement, which must be taken into account while planning the surgery. On physical examination, boys with hypospadias may have dysplastic ventral tissue. On examination, a shortage of ventral axis skin may be instantly apparent.

The position of the urethral meatus has traditionally been used to determine the degree of hypospadias [7]. Using these criteria, almost 85% of males have a mild distal meatus variation [23]. Proximal hypospadias occurs in almost 15% of individuals and provides the surgeon with various distinct therapeutic issues [9].

A classification of hypospadias based only on the position of the urethral meatus is very simplistic and may even be deceptive. A classification system that incorporates the position of the urethral opening and the degree of penile curvature following degloving results in a more accurate and pertinent diagnosis.

The GMS score (glans meatus and penile shaft [curvature]) integrates physical exam outcomes in the operating room, evaluating the quality of the glans and urethral plate, the position of the urethral opening, and the degree of penile curvature, to objectively allocate scores for severity stratification (Table 2). The GMS score was designed for use in the operating room since office measures are less reliable in determining severity, namely the extent of ventral penile curvature [24,25].

Inguinal hernia, hydrocele, and cryptorchidism are the malformations most frequently linked with hypospadias. Inguinal hernia and/or hydrocele are up to 16% more prevalent [26]. Approximately 7% of individuals with hypospadias have cryptorchidism. With more proximal hypospadias, this jumps to approximately 10% [27]. Further diagnostic testing is recommended, such as an ultrasound of the urinary system and inner genital organs, to identify other nephro-urological anomalies [28]. Up to 14% of all hypospadias and up to half of the perineal hypospadias have a Mllerian remnant, resulting in catheterization difficulties, urinary blockage, or urinary tract infections (UTIs) following repair [29]. The majority of them are seen by ultrasonography. The American Urology Association cryptorchidism guideline suggests that all boys with unilateral or bilateral undescended testes and severe proximal hypospadias receive further testing to rule out a disorder of sexual differentiation (DSD), which is significantly more common in these situations.

The primary objective of hypospadias treatment is to restore both aesthetic and functional normalcy. Indications for correcting hypospadias comprise spraying of urine stream, inability to pee in a standing posture, curvature causing difficulties during intercourse, reproductive concerns due to trouble sperm deposition, and decreased pleasure with genital appearance [30].

The objectives of surgical repair in males with hypospadias comprise restoration of penile curvature to guarantee long, straight arousal, the extension of the urethra to enable proper flow of urine and sperm through the glans; and the development of an aesthetically normal penis. The surgeon must evaluate the defect's possible long-term importance and have an informed debate with the boy's parents about whether surgical intervention should be undertaken. In circumstances when the penis is straight when upright and the urethral opening is sufficiently distant to permit urination while standing, a repair may be of minimal value. To guarantee a satisfactory long-term outcome, continuing into maturity, repair should be performed with the fewest possible operations. This objective is attained by preparing the patient and family for the appropriate surgery, doing an accurate anatomic evaluation, and engaging in an open dialogue regarding the functional outcome and potential consequences.

Surgical timing is crucial. The timeframe of the repair should take into account the potential unfavorable psychological consequences of surgery, the anesthetic risk to the kid, the degree of penile growth that will assist a satisfactory repair, and the age-related changes in wound healing in boys [31]. The onset of genital awareness occurs at 18 months of life and increases with age [32]. Boys who had repair sooner (typically before 12 months of age) expressed less anxiety and had better psychosexual outcomes than boys who underwent repair later [33]. Boys who get corrective surgery at a younger age may also experience fewer problems, a result that underscores the need for early intervention [33]. In comparison, adult hypospadias surgery may be associated with a greater risk of complications [34]. In 1996, based on this research, the American Academy of Pediatrics Section on Urology advised that surgical intervention for hypospadias repairs be performed between both the ages of six and 12 months, with some exceptions in our current practice [35]. Given the seriousness and the necessity for numerous treatments, some standards place the best age for hypospadias correction within six and 18 months [30]. Those who did not recollect the operation were more likely to have a better body image and be content with their overall physical appearance. These findings relate to early-life surgery to reduce psychological load.

Aesthetic hazards, age-dependent tissue diameters, and emotional repercussions of genital surgery are all factors that have an impact [28]. When considering surgery for their young boy, many parents inquire about the appropriateness of anesthesia. In the last decade, disturbing discoveries about aesthetic-induced neurotoxicity in the growing central nervous system of rats have been reported. However, scientific concerns cast doubt on the applicability of these findings to people [36]. At two years of age, neurodevelopmental impairments were not detected in children subjected to anesthesia for hernia surgery, whether it was general anesthesia or regional anesthesia [37].

Therefore, the preoperative surgical evaluation with the boy's parents must include a thorough evaluation of the advantages of surgical repair against an age-appropriate explanation of the risks of general anesthesia.

Some anatomical characteristics, such as a short glans width and a thin urethral plate, are associated with greater postoperative problems and provide technical difficulty [38,39]. However, penile size is rarely considered a consideration in determining the ideal timing for hypospadias treatment, as penile development is minimal throughout the first few years of life. Therefore, delaying surgery appears to be without benefit [28].

In hypospadias surgery, the use of preoperative androgen stimulation is contentious. Some surgeons suggest testosterone supplementation for increasing anatomical proportions. Preoperative androgen stimulation in the form of dihydrotestosterone (DHT), human chorionic gonadotropin (hCG), or testosterone can be utilized to enhance the size of the glans and penis in preadolescent males [40,41]. It is believed that increasing glans size will reduce stress on the glansplasty and improve the amount of tissue accessible for urethroplasty, hence minimizing the risk of complications. Concerns associated with androgen stimulation in these boys involve abusive tendencies and behavior, enhanced erections, skin pigmentation, and secondary masculine characteristics. All traits are temporary and dissolve spontaneously, approximately six months following the final dosage [41]. Some surgeons omit preoperative testosterone as a consequence of the perceived greater risk of bleeding and enhanced angiogenesis. Others argue that the poor healing process may be attributable to subsequent androgen administration [42].

With more than 300 restorative surgical treatments documented in the present literature, it appears that a general strategy for hypospadias surgical correction is needed [43,44]. A reoperation rate of less than 5% is considered a good indicator of success. Hypospadias complications can occur in 5-10% of patients with mild variants and 15-56% of patients with severe forms, according to most estimates over the short term [3]. Short-term outcomes may not accurately represent the experiences of males throughout their adolescence. An accurate assessment of the long-term aesthetic and functional outcomes of the repaired penis cannot be made during a 12-month follow-up following surgery because psychosexual development and pubertal physical changes have not been completed [45,46].

Using magnification, atraumatic tissue manipulation, delicate equipment, suture materials, and proper hemostasis are the most fundamental prerequisites. In most cases, the anterior and middle hypospadias is corrected in a single procedure. On the other hand, a two-step treatment is frequently required for the posterior variant [3,28].

Intraoperative Assessment

Anesthesia does not signal the end of preoperative planning. Following antiseptic preparation and intravenous antibiotic treatment, the genitalia is scrutinized to decide the surgical strategy. Except for extremely severe cases of proximal hypospadias or subsequent surgical interventions, we do not perform cystoscopies on a normal basis. The preoperative evaluation of hypospadias should continue as described. The placement of the urethral meatus, the quality of the ventral shaft tissue, and the level of penile curvature are evaluated while the kid is sleeping. Depending on the extent of penile curvature, a circumferential incision is subsequently created, and the penis is partially or entirely degloved. Care must be taken to generate a mucosal collar by rotating inner glossy preputial tissue from the dorsolateral skin to the ventrum, where it is absent. This will help with ventral shaft skin covering and produce a more aesthetically pleasing outcome [47].

Penile Curvature: Diagnosis and Treatment

Whether or not hypospadias is present, a curved penile structure (chordee) may develop. The degree of curvature is a crucial factor in deciding between a one-stage and two-stage correction. The choice to treat men's scoliosis is based on their possible functional and aesthetic difficulties as they age into adulthood. Males suffering from untreated congenital curvature or Peyronie disease have been found to experience severe morbidity at even 20-30 degrees of ventral curvature, including difficulty with intercourse and patient displeasure with the look of the penis [48]. Curvature can be caused by reduced ventral skin, a small urethra, or the inherent curvature of the erectile body. Outside of surgery, it is exceedingly difficult to determine the source of curvature. The conclusive diagnosis is made with a simulated erection in the operating theatre after the penis has been degloved. Parents should be queried whether they see a history of penile curvature during erections and may even record this in their children with photographs. Before cutting the skin, the extent of curvature must be evaluated in the operating room. Through the insertion of a catheter into the meatus, the condition of the urethra and ventral skin may be determined. To remove dysplastic dartos tissue, a circumferential incision is created and the penis is degloved beyond the penoscrotal junction. Then, a mechanical erection should be conducted, often with a tourniquet inserted at the penoscrotal junction and a sterile normal saline injection [49]. Alternately, the surgeon can squeeze the corpora at the base of the penis to mimic an erection in tiny boys without the use of injections. In addition to saline injection, prostaglandin injection can be used to generate an erection [50]. Various approaches, such as unassisted visual examination and goniometry, which works as a protractor to reliably quantify the extent of penile curvature, are used to determine the degree of penile curvature. Other technological alternatives, such as tablets and applications, are beginning to appear.

Although there is no consensus about the treatment of particular degrees of curvature, the majority of surgeons appear to think that a dorsal plication is adequate for curvatures less than 30 degrees [51]. If the curvature is greater than 30 degrees, the urethra would need to be divided. A corporal curvature higher than 30 degrees at this point necessitates a corporal lengthening surgery that involves transection of the corpus spongiosum distal to the urethra or urethra transection [52]. As these males advance through puberty and experience more considerable penile development, their curvature may increase. Therefore, it is essential to diagnose and fix curvature during the first repair [53].

Distal Hypospadias Repair

Repair of distal hypospadias is one of the most frequent surgical operations performed by pediatric urologists, and several surgical approaches have been devised to treat this condition [47]. Different procedures are used to treat this condition.

There are a variety of repair operations that may be divided into advancement, tubularization, or the use of grafting and flap surgeries. Here, we are going to discuss the most commonly used surgical techniques in treating hypospadias.

The recommended surgical procedures for hypospadias correction may vary depending on the location of the meatus. Techniques such as the tabularized incised plate (TIP) urethroplasty, the Mathieu method, the meatal advancement and glanuloplasty incorporated (MAGPI), and the glans approximation procedure (GAP) are utilized to treat distal hypospadias.

It is possible to reconstruct the urethra in a single step or two. When feasible, the majority of surgeons now choose a single-stage operation. A single-stage technique is suitable for distal, mid-shaft, and proximal hypospadias without substantial chordee. When a single operation would not be adequate to correct a severe or perineal case of hypospadias with chordee, or when performing a difficult revision hypospadias surgery, a two-stage procedure may be necessary. The preponderance of surgeons now favors tubularization of the urethral plate as a one-step procedure [51].

The most prevalent single-stage technique is a Duplay-type operation with tubularization, with or without the vertical incision in the urethral plate, as described by Snodgrass [54].

The Thiersch-Duplay (TD) Repair

The Thiersch-Duplay (TD) repair, pioneered by Thiersch and later Duplay approximately 140 years ago, employs the brilliant notion of urethral tubularization of surrounding tissues distal to the misplaced meatus [55]. They completed their repair by producing a U-shaped incision from the penile shaft using vascularized skin and extending the meatus to the coronal edge. Later, for distant hypospadias, the restoration was covered with two layers of preputial skin [56]. This procedure comprises de-epithelialization of excess preputial skin and fastening across the repair to give a blood supply replacement. The next logical step was to stretch these U-incisions into the distal glans, tabularizing the glans itself over the repair, and providing a more aesthetically pleasing meatus at the penis tip [57]. The TD method requires a glans of sufficient width to accommodate a properly sized neourethral canal, at least one water-resistant layer, and glans flaps that may approximate over the repair. Parallel incisions are made 12 Fr in diameter lateral to the glans groove; the glans wings should be fully and extensively mobilized to enable tension-free covering. Under optical magnification, a dual running subcuticular suture is used to conduct neourethral reconstruction. If the child is circumcised, a de-epithelialized pedicle flap is harvested from the preputial tissue or the more proximal axis and placed over the complete neourethral restoration [58]. If the repair is more proximal, a double dartos flap can be obtained from the dorsal prepuce, with one flap running distally and the other flap running proximally. The circumcision defect is completed by approximating the glans wings into two layers (spongiosum and then epithelium), accompanied by the mucosal collar.

The Tabularized Incised Urethroplasty (TIP)

The TIP method, a variation of the TD, is a global standard surgical treatment for hypospadias. It was originally described in 1994 by Warren Snodgrass [59]. The surgical techniques are described below. A straight 8F sound is sent into the hypospadias meatus to evaluate skin covering across the urethra. In distal hypospadias, a demarcating incision is performed 2 mm proximal to the meatus, although a U-shaped incision may be prolonged proximally to healthy skin if necessary. Degloving the penis to the penoscrotal union. In every situation, an artificial erection is performed, as even coronal hypospadias is occasionally coupled with penile bending. If a minor chordee remains following skin release, dorsal plication is performed to rectify the corpora cavernosa's asymmetry. The tunica albuginea is incised longitudinally on either end just lateral to the neurovascular bundle opposing the point of curvature, followed by the placement of 6-0 Prolene sutures with the knots concealed. There is no need for substantial mobilization of the neurovascular bundle while performing dorsal plication. Next, 1:100,000 epinephrine is injected into the ventral glans at the visible intersection of the glans wings and urethral plate. Then, parallel incisions are made to detach the plate from the glans, and the glans wings are deployed laterally. Depending on its native groove, the plate is just 4 to 8 mm broad at this point. A linear relaxing incision is created from the inside of the meatus to the distal edge of the plate. This incision penetrates the epithelial surface of the plate and spreads deeper into the connective tissues underneath, reaching the corpus cavernosum. With the surgeon and helper maintaining counter-traction with tiny forceps, the plate is observed to be considerably widened upon division until further incisions offer no more mobility. Rather than a knife, tenotomy shears are indicated for this procedure so that an appropriate depth may be achieved without harming the corpus cavernosum. When the urethral plate is naturally grooved, the incision will be shallower than when the plate is naturally flat. Some surgeons perform the relaxing incision first, followed by parallel incisions to establish the plate's breadth. Despite this, this procedure regularly expands the plate to 13 to 16 mm, independent of its arrangement, assuring that the neourethra will be larger than 12F. If bleeding develops, epinephrine diluted 1:1000 is poured over the incision, and pressure is maintained for many minutes. If a tourniquet is required, it might be placed near the base of the penis. Electrocautery shouldn't be used to make holes in the plate or stop bleeding so that the plate's tissues and the corpora cavernosa underneath don't get hurt.

Next, a 6F stent is inserted into the bladder for urine diversion following surgery. The urethral plate is subsequently tabularized. To guarantee that the neo-meatus has a wide oval aperture, the initial stitch is always put at the level of the mid-glans, and no more than one or two stitches are removed distally. In this procedure, a single layer of 7-0 chromic catgut suture of full thickness is used. Those who prefer suture materials with a slower absorption rate might try subcuticular closures.

A thin dartos pedicle derived from the dorsal prepuce and shaft skin covers the whole neourethra. Glansplasty is then performed, commencing at the cornea and extending distally for a total of three stitches. Even though tiny sutures at the four and eight o'clock locations may evert the meatus somewhat for cosmetic purposes, securing the neourethra to the glans is not essential. The mucosal collar is approached in the midline, and the skin of the shaft is remodeled to resemble the median raphe. Subcuticular sutures are employed to avoid the suture tracts previously observed when 6-0 chromic catgut was put through the skin. After applying a dressing, the child is sent home [54].

Flap Methods

The Mathiew procedure is based on a meatal flap. This operation was documented for the first time in 1932, but it appears to have been performed earlier. The Mathieu method does not begin with penis degloving; rather, a penile shaft tissue flap is used to generate the neo-urethra. The Mathieu technique begins by determining the extent of the urethral gap from the meatus to the tip of the glans. Along the urethral plate, an equivalent distance is traced on the proximal penile shaft skin. An incision is created along these lines. For the proximal flap, an acceptable width of 7 to 8 mm is measured, with this width tapering to 5 to 6 mm towards the distal limit of the glans. After skin and glanular incisions, the shaft skin is degloved. The underlying tissue of the flap is dissected with care, enabling the flap to be advanced to the top of the glans. The flap is rolled over at the meatus and approximated to the lateral borders of the urethral plate with a running suture. Meatus has reached full maturity. The sutures are covered with a dartos flap of tissue, the glans wings are approached, and then a typical circumferential closure is done [60]. Concerns arise surrounding the vasculature of the utilized flap; if the flap's base is not adequately wide, the blood supply may be disrupted, hence increasing the prospect of fistula and stenosis. Others have expressed alarm at the fish-mouth look of the meatus. This method has been upgraded to the slit-like adjusted Mathieu (SLAM) process, which has shown favorable results, including an enhanced look of the meatus [61].

Advancement Techniques

Advancement methods do not necessitate tubularization of the urethral plate and are usually reserved for the most distal glanular meatus with minor penile curvature. Urethromeatoplasty employs the Heineke-Mikulicz concept, in which a longitudinal, vertical incision is made in the ectopic meatus and, subsequently, its margins are closed horizontally. This provides a cosmetically normal meatus and straightens the posterior urethral plate. This approach is especially beneficial in the presence of a stenotic, distal meatus with an accompanying blind-ending pit in the middle of a closed glans. The meatal advancement glanuloplasty would become one of the most often performed procedures to treat glanular hypospadias (MAGPI). The primary purpose of this operation is to distally advance the meatus without technically tabularizing the urethra [62]. The frequency of problems reported following the MAGPI technique complications occurs up to 10% [63]. Meatal stenosis and meatal regression are the most commonly encountered issues, while other uncommon complications consist of urethro-cutaneous fistulas and chordee.

The Glans Approximation Procedure (GAP)

The glans approximation method is a surgical approach developed for individuals with proximal glanular/coronal hypospadias who have a broad, steep glanular groove and a non-compliant or fish-mouth meatus, which is frequently found in the mega-meatus intact prepuce type [64].

Proximal Hypospadias Repair

The treatment of severe hypospadias has proven contentious. This disagreement persists as to the optimal treatment for proximal hypospadias. Numerous hypospadias correction procedures have been published, reflecting the difficulties of achieving optimal surgical outcomes for this illness [65]. Even though one-stage surgery has been shown to work for some types of proximal hypospadias, many people still prefer the more traditional two-stage method when moderate to severe chordee is present so that the length of the penis can be straightened during the first-stage repair.

One-stage proximal hypospadias correction often entails dorsal plication to restore ventral penile curvature and is one of many urethroplasty procedures. These can be differentiated according to the tissue employed in the repair, namely preputial skin, local skin, and buccal transplant. The preputial island flap is widely recognized as an innovation that Duckett contributed to [66]. In this procedure, the inner prepuce is elevated as a pedicle flap, translated ventrally, and used as an Onlay graft to cover the urethral plate following degloving the penis and straightening the chordee. Neo-urethras have a roof made up of the urethral plate. To prevent stricture development, the onlay excludes circular anastomosis. The inner prepuce is similarly employed as a pedicle flap in the Asopa variant of the technique, but the neo-urethra is left connected to the underside of the foreskin. Consequently, the skin and neo-urethra share a blood supply [67]. Higher complication rates were observed in the Duckett technique, and those included poor aesthetic results marked by excessive ventral bulkiness, penile torsion, and meatal anomalies; fistulas, strictures, total breakdown, and anterior urethral diverticuli formation [68].

The two-stage repair has been the preferred method of most surgeons for treating proximal hypospadias since the treatment of severe ventral penile curvature has shifted toward corporal lengthening techniques. Modern two-stage methods may be broadly classified, despite their many technical variants, into repair with free graft or repair with pedicle flap.

The Bracka two-stage repair is a urethroplasty technique that employs a free graft taken from the inner preputial skin or buccal mucosa [69]. STAG is an adaptation of Bracka's initial explanation [70]. In the first step, the penile curvature and urethral plate are rectified. A graft receiving bed is created by extending a midline incision into the glans. On the ventral penile shaft, compressive packing and patterning of the graft can reduce hematoma development and enhance graft uptake. Six months later, a U-shaped incision identical to the Thiersch-Duplay method is created, the urethra is tabularized, and glansplasty is carried out. Layered closure is performed to preserve vascular flow to promote healing [69]. The Byars flap treatment employs extra dorsal preputial skin, which is transferred ventrally with its vascular pedicle during the first surgery, as the urethral scaffold [71]. In the ventral part of the penis, the skin can be connected in the midline or positioned as a single unit, as in the STAG repair. In the second step, the neourethra is sealed by making a large U-shaped incision with a typical Thiersch-Duplay glansplasty. The development of a waterproof, two-layer closure and the establishment of a lumen of uniform diameter along the course of the urethroplasty are important technical elements. To guarantee that the neourethra retains a sufficient blood supply, several phases of closure are necessary. In particular, making a soft dartos bed above the clitoroplasty in the first step will ensure enough blood flow for the urethroplasty in the second step.

Regardless of the methodology, it is essential to evaluate the quality of the graft or flap during the second phase of the surgery. As an interim step, if skin deficit or tethering prevents safe closure, a dorsal inlay buccal mucosal transplant may be employed as an interim measure [72]. After graft harvesting, the urethra is rebuilt when all of the tissues are pliable. Alternately, the second step of repair can be performed simultaneously with a dorsal buccal graft inlay and a urethroplasty. It is essential to check that the penile curvature is rectified with a subsequent synthetic erection before urethroplasty. If needed, a dorsal plication or repeat corporal lengthening can be done to fix a slight curvature that keeps coming back.

The majority of early postoperative problems are caused by incorrect surgical techniques and may be readily avoided via improved procedure planning and tissue management.These problems include edema, hematoma development, wound dehiscence, flap decay, and fistula formation [73]. To prevent hematoma development, optimal hemostasis must be achieved. As previously stated, adequate tissue manipulation is required to prevent postoperative edema. A compression circumferential covering can also reduce postoperative edema.

There is a dearth of consistency in the literature when it comes to hypospadias correction procedures, as well as standardized definitions of problems and methods for evaluating outcomes [74]. Many questionnaires have been devised to evaluate the results of hypospadias treatment. Each questionnaire has its pros and limitations. These include the (Pediatric) Penile Perception Score (PPPS), the (Hypoplasia) Objective Scoring System, the (PedsQl), and the Hypoplasia Objective Penile Evaluation Score (HOPE) [75,76].

More than 70% of all patients who have hypospadias treatment are deemed cosmetically pleasing. More than 80% of males with repaired hypospadias had good sexual function [77]. However, these individuals are frequently prevented from initiating sexual interaction and frequently fear mockery due to the look of their genitals [77,78]. Symptoms of the lower urinary tract were twice as prevalent in individuals who had had hypospadias correction compared to controls [77]. After tabularized incised plate (TIP) urethroplasty, an obstructive urine flow pattern is usually observed, which may be due to aberrant elastic properties of the produced tube [79]. Almost 39% of patients who underwent proximal hypospadias surgery showed voiding problems, including hesitation and spraying [77]. Urinary problems (e.g., meatal stenosis, fistula, or urethral stenosis) may emerge years after the initial surgery; consequently, long-term follow-up is required [80].

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Hypospadias: A Comprehensive Review Including Its Embryology, Etiology and Surgical Techniques - Cureus

Woman gives birth to triplets with two-year age gaps between them – The Independent

A couple have finally welcomed the third baby in a set of IVF (in-vitro fertilisation) triplets, four years after the first sibling was born.

Karen and James Marks from Taunton, Somerset had had their first child a son named Cameron four years ago. Their daughter Isabella followed two years later.

Now, Karen has given birth to their final triplet, a daughter named Gabriella.

The children are considered triplets because they were all conceived on the same day, at the same time, and the same batch of embryos through IVF.

After Cameron was born in September 2018, the couple chose to keep the remaining embryos frozen so they could add to their family later.

Isabella was born in September 2020, and Gabriella on 3 July.

It feels so great to have all three of our children now, we feel so incredibly lucky, Karen said.

Some people go through IVF and sadly dont even get to have one baby, and weve managed to have three, so we just feel so lucky.

Gabi was our last embryo, so shes our last baby now. I knew I wasnt done before Gabi, so I told my husband if it didnt work, then we better get saving so we could have another one! I feel complete now, Im so happy. My heart is very full.

Around 390,000 babies have been born via IVF in the UK since records began in 1991, according to the Human Fertilisation and Embryology Authority.

Karen and James tried to conceive naturally for a year

( SWNS)

Karen said the couple turned to IVF after they tried to conceive naturally for a year but were unsuccessful.

Theres no specific reason. I dont ovulate regularly so thats the main thing, but other than that, theres no reason - we dont have any conditions, she explained.

The couple have shared their story to encourage others to try IVF if they are struggling to fall pregnant.

Infertility never leaves you, Karen said. Pregnancy announcements can still be painful, especially when someone has seemingly conceived easily.

Its a battle and a journey, and while part of me believes theres a reason we had to go through it, weve met so many wonderful people along the way.

If youve exhausted all other options, then crack on and go for it. Dont put it off or avoid it. Its the most likely fertility treatment to work, and it did for us.

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Woman gives birth to triplets with two-year age gaps between them - The Independent

Woman, 20, jailed in UK for taking abortion pills when abusive partner got her pregnant – The Mirror

The young mum says she was threatened with life imprisonment and a child destruction charge if she didn't plead guilty - and has described the horrors of her life inside

Image: Getty Images/iStockphoto)

A university student was jailed for two years after taking pills that caused her to have an abortion.

The young mum, who had a two year old daughter when she became pregnant again aged 20, told of her horror that she ended up behind bars.

She was charged with taking pills that caused her to have an illegal abortion.

I felt I had no other choice other than to (plead guilty), Laura, not her real name, told the Sunday Times.

The prosecution said if I didnt plead guilty, they would charge me with child destruction, and I would likely go to prison for life.

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Last month the director of public prosecutions, Max Hill, was urged to urgently stop the prosecution of women who end their own pregnancies.

The number of women reported to the police for criminalised abortions has been on the rise with 30 so far in 2022 - already higher than previous years.

In an open letter signed by 66 organisations and people, including the British Pregnancy Advisory Service, barristers and womens rights groups, called for the prosecutions to stop saying women targeted are often "vulnerable" and in "desperate situations".

They pointed out that two women are facing prosecution in England now.

Referring to the US developments which saw abortion rights destroyed, the letter said: It is our strong belief that in the 21st century, in the shadow of the overturning of Roe v Wade, it is never in the public interest to prosecute women in these circumstances.

In reply Mr Hill said that abortion cases will be given an additional level of scrutiny from their lawyers before charges are brought against women.

While abortion is accessible, it is still officially a criminal act in the UK except in Northern Ireland, where it was decriminalised in 2019.

Under the Abortion Act and the Human Fertilisation and Embryology Act 1990, abortion is allowed up to 24 weeks of pregnancy if there is a risk to the physical or mental health of the women or her existing children.

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While there is no time limit for abortions if there is evidence of a fatal foetal abnormality or a significant risk to the mothers life.

But before an abortion can proceed, two doctors must ensure that the requirements of the Abortion Act are fulfilled, and they must both sign the certificate.

If a woman procures a miscarriage through medication without going through this process, it can be a criminal offence under the 1861 Offences Against The Person Act (OAPA). The maximum penalty is life.

New laws passed during the pandemic allow abortion pills to be taken at home up to ten weeks into a pregnancy but later abortions must be carried out in a medical setting.

But Laura is also calling for a change in the law, saying that women who have an illicit abortion only do so where someones in a very awful place in which theyve been given really no other choice.

The young mum eventually went on to graduate after serving a two-year prison sentence but says she still has nightmares about her ordeal.

Id never even had a detention at school. It was awful, she said.

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She said an abusive boyfriend told her not to go to the doctor but pills bought online instead.

At the time she believed she was eight to ten weeks pregnant when she climbed into the bathtub and gave birth.

I almost died, she says. I remember the bath being filled with at least an inch of blood.

I wanted to die. Honestly, I just felt like the whole world had just ended in front of my eyes.

She called an ambulance and was taken to hospital, where medics told her she had given birth to a 30-week foetus. According to the NHS, a full pregnancy is 40 weeks.

She admitted to the medics how shed taken abortion pills and police were called who guarded her bedside.

They actually had a police officer with me in the hospital the whole time and wouldnt let me speak to anyone other than the police, she said.

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She was only allowed a visit from her partner for 30 seconds when he whispered in my ear that he would kill me if I told anyone that he was involved.

They literally took me from the hospital, straight to the police station, she said.

Talking about her time behind bars, she said: I have seen things that no human being should ever see. The quality of life that those women have is disgusting. And I would not wish it on any single human being.

Ive seen people hang themselves. I have seen people slit their wrists and their legs, and people attack each other and over something so, so, so small.

Were in an environment with people who are vulnerable, and then mixed in with people who are violent. And that to me is not a safe place for someone like myself who is classed as vulnerable and very easily manipulated.

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Woman, 20, jailed in UK for taking abortion pills when abusive partner got her pregnant - The Mirror

The earliest segmental sternum in a Permian synapsid and its implications for the evolution of mammalian locomotion and ventilation | Scientific…

Sternal morphology in Synapsida

The earliest-diverging synapsids, the paraphyletic pelycosaurs, do not preserve an ossified sternum in any known taxa23. However, a large, ossified interclavicle is always present. The broad interclavicle tends to be mostly uniform in shape (spoon-shaped asper Romer and Price23, with a cruciate anterior part and an elongate posterior rod). The first appearance of an ossified sternum in Synapsida occurs within the diverse and long-lived subclade Therapsida. Although some uncertainty exists as to the relationships between the major therapsid clades, the earliest-diverging group is generally considered to be Biarmosuchia24,25. Few biarmosuchian postcrania are known, but the sternum is preserved in a few taxa (e.g. Hipposaurus26), where it is unipartite and probably incompletely ossified. In known examples the sternum is relatively small compared to the interclavicle and roughly circular in outline (see Fig.1). No sternum is known in the Dinocephalia2,27. As several nearly complete dinocephalian skeletons are known e.g.28,29, it seems that the sternum, if present, must have been cartilaginous in this group, and the lack of discovered sterna is not simply due to incomplete preservation of the bony elements (likely also the case for pelycosaurs).

Anomodontia is the most diverse Permo-Triassic therapsid clade30, and also exhibits a diversity of sternal morphologies. Although an ossified sternum seems to be lacking in basal (non-dicynodont) anomodonts, as indicated by its absence in the well-preserved and fairly complete skeletons of Suminia31, Galechirus, and Galepus32, an ossified sternum is present in Dicynodontia30. In dicynodonts, it is always unipartite and generally a simple, plate-like element (e.g. in Diictodon20 and Eosimops33). However, the sternum is more complex in the burrowing dicynodont Cistecephalus (wide anteriorly, with a strongly tapering posterior edge and pronounced attachment sites for the ribs)19. In the largest known dicynodonts, the Late Triassic stahleckeriids, the sternum is extremely deep dorsoventrally, with a well-developed ventral keel6. The number of ribs attaching to the sternum varies in the clade, with one (e.g. Dinodontosaurus34), two (e.g. Aulacephalodon35), or three (e.g. Cistecephalus19) attachment sites per side.

Few well-described postcrania are known for Gorgonopsia. Previously-described gorgonopsian sterna consist of one element with up to three articulations for ribs on either side (i.e. in the holotypes of Lycaenops ornatus36, Aelurognathus tigriceps36, Aelurognathus microdon37, and Viatkogorgon ivakhnenkoi38). The discovery of an ossified and segmental abaxial sternal structure in Gorgonops torvus, however, raises the possibility that the apparently unipartite sterna of other species reflect incompleteness rather than the true absence of discrete sternebrae. With the exception of V. ivakhnenkoi, the aforementioned specimens were all collected and prepared in the early twentieth century, with damage to the more delicate parts of the anatomy. Also, although complete, well-preserved, and well-prepared, the skeleton of V. ivakhnenkoi is preserved on its side, and the base of the pectoral complex is poorly exposed, making the morphology of the sternum somewhat uncertain.

Similar to the condition in Gorgonopsia, few skeletons of Therocephalia are complete enough to determine whether a sternum was present. An ossified sternum appears to be absent in basal (non-eutherocephalian) therocephalians, as no trace of this element is present even in well-preserved, articulated skeletons of this grade (i.e. Glanosuchus39, Lycosuchus40). However, an ossified sternum is known in a number of eutherocephalian taxa (e.g. Regisaurus22 and Olivierosuchus21) and likely was present throughout that subclade41. In these taxa, the preserved portion of the sternum consists of a single element and is a remarkably large, plate-like structure dwarfing the interclavicle (Fig.1).

Prior to the discovery of the gorgonopsian specimen described here, the earliest record of an ossified multipartite sternum was in the Middle Triassic cynodont Diademodon tetragonus14. No ossified sternal elements are known in any earlier cynodonts (including taxa known from numerous complete skeletons, such as Thrinaxodon), suggesting that the sternum was cartilaginous in those taxa. Therefore, no conclusions can be drawn about the sternal shape in the earliest cynodonts. However, a multipartite sternum is known in several later-occurring non-mammalian cynodonts (e.g. the Jurassic Kayentatherium wellesi17 and Bienotheroides wansienensis18), in which the anteriormost section of the sternum is paired. Although rare, all the non-mammalian cynodont sterna thus far described consist of multiple elements. The connection between all these elements is assumed to have been cartilaginous18.

A fully-ossified multipartite sternum is known in several extinct mammaliaform taxa (e.g. Sinoconodon42, Maiopatagium43, Microdocodon9) (Fig.1) as well as all modern mammals44. Adult monotremes and non-crown group therians retain a distinct interclavicle, which acts as an anchor for the proximal attachment of the clavicle, and the first rib attaches to the largest anterior sternal element (the manubrium). Marsupials and placentals do not preserve an interclavicle as adults, as this element fuses with the manubrium during development. In these taxa, the clavicles and the first ribs both connect to the anteriormost sternal element on either side45.

The new multipartite sternum of a gorgonopsian presented here appears substantially earlier in geological time and is phylogenetically more stemward than any previous records of a mammalian-type sternum. The partial interclavicle shows some similarities to the interclavicles in other gorgonopsian specimens (see Supplementary Fig. S1) as well as those of Therocephalia (e.g. Olivierosuchus21), but the sternum of Gorgonops torvus is novel in its configuration.

The sternal variation within Synapsida discussed above allows us to distinguish between three morphologically differentiated groups:

Synapsids inferred to have an unossified sternum, such as pelycosaurs, dinocephalians, and basal anomodonts, therocephalians, and cynodonts. The lack of an ossified sternum in the predominantly large-bodied Dinocephalia demonstrates that sternal ossification is not necessarily correlated with body size.

Synapsids with usually large, unipartite (singular), and well-ossified sterna, for instance dicynodonts and eutherocephalians. Although it is possible that additional cartilaginous elements were present in life, the lack of a well-developed articular facet on the posterior margin of the sternum in these groups suggests that is unlikely.

Synapsids with segmental and ossified sterna such as Gorgonops torvus, Diademodon tetragonus, Mesozoic mammaliaforms, and extant mammals. The condition in close relatives of Gorgonops and Diademodon is uncertain, due to limited fossil data.

The discovery of the sternal complex of Gorgonops torvus now presents two equally possible hypotheses for the earliest evolution of the mammalian sternum: 1) the mammal-like condition arose first in gorgonopsians (as represented by Gorgonops torvus) but then was lost in eutheriodonts (therocephalians and cynodonts, in which the sternum ancestrally seems to have been cartilaginous) or 2) the condition in Gorgonops torvus evolved convergently to that of cynodonts, originating from a unipartite ancestral state common to both gorgonopsians and eutheriodonts. Until further discoveries of fossil taxa with different sternal conditions provide more evidence, it is impossible to test either of these hypotheses thoroughly, but functional considerations may provide some insight as to which is more likely (see below).

The sternum of extant mammals has several functions. Notably, it helps to reinforce the rib cage, with a more stable, enclosed rib cage offering better protection of the thoracic organs than one exposed abaxially46. Furthermore, an ossified (and hence stronger) sternum is functionally important for forelimb locomotor function, as the ventral surface of the thorax has major attachment sites for pectoral muscles47. These complementary functions of the sternum reflect its integral part in the entire system of the forelimb, the shoulder girdle, and the thorax. In synapsid evolution, there are two major morphologies of ossified sterna (Fig.1): the single, plate-like sternum present in earlier-diverging synapsids (e.g. dicynodonts) and the relatively narrow, segmental sternum seen in cynodonts such as Diademodon, some tritylodontids and mammaliaforms. The shift between these osteological configurations would have been part of a broader suite of functional changes occurring in this section of the synapsid tree.

The origin of mammals is associated with major changes in skeletal morphology, and the stepwise assembly of these changes in Permo-Triassic synapsids has historically been cited as one of the best bodies of evidence for macroevolution in the fossil record48,49. The inferred functional associations (and evolutionary drivers) of these changes can be roughly broken down into three areas: 1. dental (increasing complexity, both from differentiation in the heterodont tooth series, and from elaboration of individual teeth, particularly the postcanines, with multicusped and expanded crowns capable of occlusion); 2. cranial (formation of a complete secondary palate, loss of the postorbital bar, simplification of the jaw elements, increase in brain size/complexity); and 3. postcranial (increased regionalization of the axial column, changes in limb morphology associated with posture, origin of the segmental sternum). Each of these changes has functional implicationsmore efficient food processing driven by changes to the inferred muscular complement and jaw orientation for the craniodental characters50, and more active locomotion associated with an erect gait for the postcranial characters51. Each of these had downstream effects on portions of the anatomy not immediately subject to selection. For example, the expansion of jaw musculature attachment on the dentary is thought to have contributed to the decrease in size of the post-dentary bones and their eventual detachment to form middle ear bones52.

We offer a similar interpretation for the evolution of a segmental sternum in Permo-Triassic therapsids. On its own, this feature would have had little to do with improved gait in mammalsthe forelimbs themselves, the shoulder girdle, and the thoracic vertebral column all have more immediate influences on locomotion. However, the sternum bridges the girdle to the axial skeleton and it is thereforeconnected with shifts in locomotor evolution. And it is involved in two ways of particular note in the evolution of mammal-like morphologies and function: 1. increased regionalization of the axial skeleton and 2. increased posteriorization of thoracic elements. For the former, mammals are well known to have greater differentiation of the axial column into discrete regions than reptiles, although this transition is now thought to be more complex and to have occurred earlier in synapsid evolution than previously believed53. In the typical mammalian condition, the thorax is a highly discrete unit readily distinguished by vertebral morphology, and it also differs in range of motion from the cervical, lumbar, and caudal regions. By contrast, in many reptiles and even early synapsids, the distinction between the thoracic and lumbar regions is less evident, and the cervical-thoracic transition is also difficult to discern54. The origins of the mammal-like rib cage, a structure surrounding the thoracic organs (the heart, lungs and muscular diaphragm), are intimately associated with changes in gait that took synapsids from the lateral undulation of early amniotes to the primarily dorsoventral flexion of mammals47, in a divergent evolutionary path from the evolution of modern reptiles55. In the context of this paradigm shift in synapsid history, a massive, plate-like sternum broadly overlapping the interclavicle would have been a hindrance, a relic of the pelycosaurian condition with sprawling forelimbs in close association with the substrate. In the evolution of theriodonts (the group containing gorgonopsians, therocephalians, and cynodonts), even as early as gorgonopsians there is a shift towards more cursorial locomotion and more erect gaits, with a focus on dorsoventral rather than side-to-side motion51,55. To facilitate this style of locomotion, it was necessary to reduce the size of the pectoral girdle, thereby enhancing its mobility relative to the axial skeleton.

There are multiple ways to reduce the weight of bony elements, one being simply to not ossify them. This may have been the ancestral condition in eutheriodonts, given that the sternum seems to have been cartilaginous in the earliest therocephalians and cynodonts (although this would imply a reversal to the pre-theriodont condition in eutherocephalians). Another is to transform from a single solid plate to a series of connected elements, which can retain the protective function of the sternum without limiting mobility (similar transitions can be seen in the evolution of armor, with trends towards multipartite structures offering greater flexibility56). This latter approach appears to characterize sternal evolution in Gorgonopsia.

Greater flexibility of the thorax also has importance beyond permitting dorsoventral flexion during locomotion, as shown by Jones et al.53,55 in their studies of the axial skeletal evolution in Synapsida. Increased potential for axial twisting can also aid in behaviors such as grooming and fast locomotory maneuvers, but this requires vertebral specializations for torsion. In earlier non-mammalian synapsids (i.e. most non-cynodont taxa), the functional regions of the vertebral column are not as distinct as in later taxa such as advanced cynodonts (e.g. the Jurassic Kayentatherium55), and there is little evidence of selection for performance under torsion in the anterior vertebrae. However, a general phylogenetic trend towards more regionalization into pre- and post-diaphragmic areas of the vertebrate column can be observed even in more stemward portions of synapsid phylogeny55. A more flexible, segmental sternum, as seen in Gorgonops torvus, may represent a prerequisite for accommodating intervertebral torsion in the thorax.

Therefore, we hypothesize that the evolution of the ossified segmental sternum in Theriodontia is a part of the broad evolutionary shift towards more mammal-like locomotion, which may have facilitated the rise of this group as the dominant carnivores of the late Permian. Selection for a lighter, more flexible sternum in the context of changing posture, gait, and vertebral mobility can be inferred regardless of the homology of the segmental sternum in Gorgonopseither this morphology evolved convergently in gorgonopsians and eucynodonts, or it would represent an ancestral adoption retained in cynodont evolution (albeit cartilaginous in taxa other than eucynodonts).

However, posture and gait were not the only major changes in thoracic anatomy occurring in Permo-Triassic therapsids. The transition to a mammal-like thoracic morphology is also tied to the way for therapsids to break Carriers constraint: the respiratory limitation driven by dual use of the axial musculature during lateral flexion and costal breathing during rapid locomotion47. Dorsoventral flexion in mammals, and a more rigid thorax centered more anteriorly along the vertebral column, fundamentally altered synapsid ventilation, permitting both lungs to be expanded or compressed simultaneously, a metabolically more efficient method advantageous for active locomotion. For this to work, however, it is necessary that the dorsal and ventral limits (i.e. the vertebral column and sternum) of the bony enclosures of the lungs (i.e. the rib cage) are both strong and pliable, conferring functional advantage over a single stiff interclavicle-sternal plate in managing volume of the thoracic cavity57. A multipartite sternum with cartilaginous tissue between the manubrium and the sternebrae is consistent with this requirement. However, while this on its own would have helped to reduce the impact of Carriers constraint, actually breaking the constraint required an additional innovation: the diaphragm, a muscular sheet at the base of the thoracic cavity capable of pumping air through the lungs independently of locomotion.

Amongst the basic requirements for a diaphragm is that it must functionally be positioned caudad to the sternum, because by contracting during respiration, it creates negative pressure in the chest that is stabilized by the robust yet flexible complex of ribs, costal cartilages, and the segmental sternum. The origins of the diaphragm are obscure, however; it has been proposed to be unique to mammals or to have originated in some of the earliest pelycosaurs (e.g. caseids)58. Recent research taking data from developmental studies suggests that the diaphragm originated from ancestral pharygneal muscles of the cervico-thoracic region by posteriorization of elements associated with it, i.e. the forelimb bud during development and the brachial plexus nerve59. Accordingly, if the diaphragm did indeed originate from cervico-thoracic pharyngeal muscles, then the two requisite changes associated with the diaphragm may have been well underway in gorgonopsians: a) the posteriorization, evidenced by the likely presence of seven cervical vertebrae60 and the herein described elongate segmental sternum. And b) the elongate configuration itself of the sternum of Gorgonops, providing the needed caudad-positioned attachment for the diaphragm. This indicates that a mammalian-style diaphragm should already have been present in this taxon (and possibly, by inference, in theriodonts generally) to support the changes in ventilatory function.

Ontogenetic development of the sternum is well studied in extant mammals, with a particularly robust literature in the realms of human medicine and mouse embryology, demonstrating that formation of the characteristic segmental sternum is mediated by interactions with the developing ribs15,61. Specifically, the rib tips inhibit skeletal maturation, resulting in ossification of the intermediary regions but maintenance of cartilaginous connections between them62. As such, we must consider whether the segmental sternum would even have been selected for at all, or merely is an inherent consequence of developmental formation of a thoracic rib cage between the axial skeleton and sternum. Here, the fossil record is instructive. The plate-like sternum of dicynodonts has a variable number of rib attachments (see above), but a number of taxa clearly show multiple ribs attached to the single sternal element19. Therefore, it is apparently not an inherent developmental feature of Synapsida that rib attachments inhibit sternal growth and cause segments of the sternebrae to form. Rather, we propose that this system evolved through co-opting developmental mechanisms during a period of selection towards lighter and more jointed thoracic structures. Unfortunately, the cartilaginous nature of these elements in many synapsid groups (notably early cynodonts) makes it difficult to establish a precise understanding of the shift between dicynodont- and therocephalian-like structures and those of mammals. However, discoveries like that of the new Gorgonops specimen provide strong support for an early origin of the functional suite of derived mammalian locomotion and ventilation in the Permian antecedents of the clade.

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Similarity Between Schizophrenia and Dementia Discovered for the First Time – Neuroscience News

Summary: Study reveals striking similarities in both behaviors and neuroanatomical changes between people with schizophrenia and behavioral-variant frontotemporal dementia.

Source: Max Planck Institute

Researchers have, for the first time, compared schizophrenia and frontotemporal dementiadisorders that are both located in the frontal and temporal lobe regions of the brain.

The idea can be traced back to Emil Kraepelin, who coined the term dementia praecox in 1899 to describe the progressive mental and emotional decline of young patients. His approach was quickly challenged, as only 25% of those affected showed this form of disease progression.

But now, with the help of imaging and machine learning, scientists have found the first valid indications of neuroanatomical patterns in the brain that resemble the signature of patients with frontotemporal dementia.

It is rare that scientists in basic research go back to seemingly obsolete findings that are more than 120 years old. In the case of Nikolaos Koutsouleris and Matthias Schroeter, who are researchers and physicians, this was even a drive.

Its about Emil Kraepelin, founder of the Max Planck Institute for Psychiatry (MPI) as well as the psychiatric hospital of the Ludwig Maximilian University of Munich (LMU), and his term dementia praecox, coined in 1899.

This was his definition foryoung adultswho increasingly withdraw from reality and fall into an irreversible, dementia-like state. Kraepelin lived to see his concept refuted.

By the beginning of the 20th century, experts were beginning to use the term schizophrenia for these patients, since the disease does not take such a bad course in all persons concerned.

Kraepelin had the idea of a frontotemporal disease, he assumed that the reason for the sometimes-debilitating course of the patients is located in the frontal and temporal lobe areas of the brain. Thats where personality,social behaviorand empathy are controlled.

But this idea was lost as no pathological evidence for neurodegenerative processes seen in Alzheimers Disease was found in the brains of these patients, says Koutsouleris, who works at Kraepelins places of work, the MPI and LMU.

He continues: Ever since I became a psychiatrist, I wanted to work on this question. Fifteen years later, with sufficientlylarge data sets, imaging techniques andmachine learningalgorithms, the professor had the tools at hand to potentially find answers.

He had found the right partner in Matthias Schroeter, who studies neurodegenerative diseases, specifically frontotemporal dementias, at the Max Planck Institute for Human Cognitive and Brain Sciences.

Similarities between schizophrenia and frontotemporal dementia

Frontotemporal dementia (FTD), especially the behavioral variant (bvFTD), is difficult to recognize in its early stages because it is often confused with schizophrenia. Thus, the similarities are obvious: in sufferers of both groups, personality as well as behavioral changes occur.

An often dramatic development for affected persons and relatives sets in. Since both disorders are located in the frontal, temporal and insular regions of the brain, it was obvious to compare them directly as well.

They seem to be on a similar symptom spectrum, so we wanted to look for common signatures or patterns in the brain, Koutsouleris says, describing his plan.

With an international team, Koutsouleris and Schroeter used artificial intelligence to train neuroanatomical classifiers of both disorders, which they applied to brain data from different cohorts.

The result, just published in the journalJAMA Psychiatry, was that 41% of schizophrenia patients met the classifiers criteria for bvFTD.

When we saw this in schizophrenic patients as well, it rang a bellindicating a similarity between the two disorders, Koutsouleris and Schroeter recall.

The research team found that the higher the patients bvFTD score, which measured the similarity between the two disorders, the more likely they were to have a bvFTD-like phenotype and the less likely they were to improve their symptoms over two years.

A 23-year-old patient does not recover

I just wanted to know why my 23-year-old patient with onset symptoms of schizophrenia, such as hallucinations, delusions, and cognitive deficits, had not improved at all, even after two years, while another who started out just as bad was continuing his education and had found a girlfriend. Again and again, I saw these young people who did not recover at all, Koutsouleris says.

When the researchers also checked the correlations in high-risk patients such as the 23-year-old, they found confirmation at the neuroanatomical level of what Kraepelin had been the first to decisively describe: no improvement whatsoever in the condition of some patients, quite the opposite.

Similar neuronal structures were affected, in particular the so-called default mode network and the salience network of thebrain, responsible for attention control, empathy and social behavior, showed volume decreases in the gray matter area that houses the neurons. In bvFTD, certain neurons (von Economo neurons) perish; in schizophrenia, these neurons are also altered. This was reflected by the neuroanatomical score: after one year, it had doubled in these severely affected persons.

As a comparison, the scientists had also calculated the Alzheimers score using a specific classifier and did not find these effects there.

This means that the concept of dementia praecox can no longer be completely wiped away; we provide the first valid evidence that Kraepelin was not wrong, at least in some of the patients, Schroeter says.

Today, or in the near future, this means that experts will be able to predict which subgroup patients belong to.

Then intensive therapeutic support can be initiated at an early stage to exploit any remaining recovery potential, Koutsouleris says.

In addition, new personalized therapies could be developed for this subgroup that promote a proper maturation and connectivity of the affected neurons and prevent their progressive destruction as part of the disease process.

Author: Press OfficeSource: Max Planck InstituteContact: Press Office Max Planck InstituteImage: The image is credited to Koutsouleris

Original Research: Closed access.Exploring Links Between Psychosis and Frontotemporal Dementia Using Multimodal Machine Learning by Nikolaos Koutsouleris et al. JAMA Psychiatry

Abstract

Exploring Links Between Psychosis and Frontotemporal Dementia Using Multimodal Machine Learning

Importance

The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their relevance for patients in at-risk disease stages has not been explored so far.

Objective

To use machine learning to compare the expression of structural magnetic resonance imaging (MRI) patterns of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer disease (AD), and schizophrenia; estimate predictability in patients with bvFTD and schizophrenia based on sociodemographic, clinical, and biological data; and examine prognostic value, genetic underpinnings, and progression in patients with clinical high-risk (CHR) states for psychosis or recent-onset depression (ROD).

Design, Setting, and Participants

This study included 1870 individuals from 5 cohorts, including (1) patients with bvFTD (n=108), established AD (n=44), mild cognitive impairment or early-stage AD (n=96), schizophrenia (n=157), or major depression (n=102) to derive and compare diagnostic patterns and (2) patients with CHR (n=160) or ROD (n=161) to test patterns prognostic relevance and progression. Healthy individuals (n=1042) were used for age-related and cohort-related data calibration. Data were collected from January 1996 to July 2019 and analyzed between April 2020 and April 2022.

Main Outcomes and Measures

Case assignments based on diagnostic patterns; sociodemographic, clinical, and biological data; 2-year functional outcomes and genetic separability of patients with CHR and ROD with high vs low pattern expression; and pattern progression from baseline to follow-up MRI scans in patients with nonrecovery vs preserved recovery.

Results

Of 1870 included patients, 902 (48.2%) were female, and the mean (SD) age was 38.0 (19.3) years. The bvFTD pattern comprising prefrontal, insular, and limbic volume reductions was more expressed in patients with schizophrenia (65 of 157 [41.2%]) and major depression (22 of 102 [21.6%]) than the temporo-limbic AD patterns (28 of 157 [17.8%] and 3 of 102 [2.9%], respectively). bvFTD expression was predicted by high body mass index, psychomotor slowing, affective disinhibition, and paranoid ideation (R2=0.11). The schizophrenia pattern was expressed in 92 of 108 patients (85.5%) with bvFTD and was linked to theC9orf72variant, oligoclonal banding in the cerebrospinal fluid, cognitive impairment, and younger age (R2=0.29). bvFTD and schizophrenia pattern expressions forecasted 2-year psychosocial impairments in patients with CHR and were predicted by polygenic risk scores for frontotemporal dementia, AD, and schizophrenia. Findings were not associated with AD or accelerated brain aging. Finally, 1-year bvFTD/schizophrenia pattern progression distinguished patients with nonrecovery from those with preserved recovery.

Conclusions and Relevance

Neurobiological links may exist between bvFTD and psychosis focusing on prefrontal and salience system alterations. Further transdiagnostic investigations are needed to identify shared pathophysiological processes underlying the neuroanatomical interface between the 2 disease spectra.

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Your Brain Is a Prediction Machine That Is Always Active – Neuroscience News

Summary: The brain constantly acts as a prediction machine, continuously comparing sensory information with internal predictions.

Source: Max Planck Institute

This is in line with a recent theory on how our brain works: it is a prediction machine, which continuously compares sensory information that we pick up (such as images, sounds and language) with internal predictions.

This theoretical idea is extremely popular in neuroscience, but the existing evidence for it is often indirect and restricted to artificial situations, says lead author Micha Heilbron.

I would really like to understand precisely how this works and test it in different situations.

Brain research into this phenomenon is usually done in an artificial setting, Heilbron reveals. To evoke predictions, participants are asked to stare at a single pattern of moving dots for half an hour, or listen to simple patterns in sounds like beep beep boop, beep beep boop.

Studies of this kind do in fact reveal that our brain can make predictions, but not that this always happens in the complexity of everyday life as well. We are trying to take it out of the lab setting. We are studying the same type of phenomenon, how the brain deals with unexpected information, but then in natural situations that are much less predictable.

Hemingway and Holmes

The researchers analyzed the brain activity of people listening to stories by Hemingway or about Sherlock Holmes. At the same time, they analyzed the texts of the books using computer models, so called deep neural networks. This way, they were able to calculate for each word how unpredictable it was.

For each word or sound, the brain makes detailed statistical expectations and turns out to be extremely sensitive to the degree of unpredictability: the brain response is stronger whenever a word is unexpected in the context.

By itself, this is not very surprising: after all, everyone knows that you can sometimes predict upcoming language. For example, your brain sometimes automatically fills in the blank and mentally finishes someone elses sentences, for instance if they start to speak very slowly, stutter or are unable to think of a word. But what we have shown here is that this happens continuously. Our brain is constantly guessing at words; the predictive machinery is always turned on.

More than software

In fact, ourbraindoes something comparable tospeech recognition software. Speech recognisers usingartificial intelligenceare also constantly making predictions and are allowing themselves to be guided by their expectations, just like the autocomplete function on your phone.

Nevertheless, we observed a big difference: brains predict not only words, but make predictions on many different levels, from abstract meaning and grammar to specific sounds.

There is good reason for the ongoing interest fromtech companieswho would like to use new insights of this kind to build better language and image recognition software, for example. But these sorts of applications are not the main aim for Heilbron.

I would really like to understand how our predictive machinery works at a fundamental level. Im now working with the same research setup, but for visual and auditive perceptions, like music.

Author: Press OfficeSource: Max Planck InstituteContact: Press Office Max Planck InstituteImage: The image is credited to DALL-E, OpenAi Micha Heilbron

Original Research: Closed access.A hierarchy of linguistic predictions during natural language comprehension by Micha Heilbron et al. PNAS

Abstract

A hierarchy of linguistic predictions during natural language comprehension

Understanding spoken language requires transforming ambiguous acoustic streams into a hierarchy of representations, from phonemes to meaning. It has been suggested that the brain uses prediction to guide the interpretation of incoming input.

However, the role of prediction in language processing remains disputed, with disagreement about both the ubiquity and representational nature of predictions.

Here, we address both issues by analyzing brain recordings of participants listening to audiobooks, and using a deep neural network (GPT-2) to precisely quantify contextual predictions.

First, we establish that brain responses to words are modulated by ubiquitous predictions. Next, we disentangle model-based predictions into distinct dimensions, revealing dissociable neural signatures of predictions about syntactic category (parts of speech), phonemes, and semantics.

Finally, we show that high-level (word) predictions inform low-level (phoneme) predictions, supporting hierarchical predictive processing.

Together, these results underscore the ubiquity of prediction in language processing, showing that the brain spontaneously predicts upcoming language at multiple levels of abstraction.

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Your Brain Is a Prediction Machine That Is Always Active - Neuroscience News

The Cost of Loneliness – Neuroscience News

Summary: Researchers discuss the detrimental psychological, physical, and economic impact of loneliness.

Source: Particle

They say you cant put a price on friendship, butloneliness costs Australians $2.7 billion a yearaccording to a report by the Bankwest Curtin Economics Centre. Its an epidemic thats continued to grow during the COVID-19 pandemic.

Since the start of the pandemic, feelings of loneliness have increased all across Australia. Fortunately, Western Australian residents were feeling relatively alright. We had thesecond-highest scorewhen it came to social connectivity, just behind the Australian Capital Territory. In contrast, the states of Queensland and South Australia scored lowest in social connectedness.

The term loneliness itself is only afew hundred years old. The negative connotations attached to being lonely dont appear in literature until theend of the 18th century.

While the word is relatively new, its hard to say when the emotional experience of loneliness became common. In ShakespearesAlls Well That Ends Well, loneliness conflates with lovesickness. InHamlet,Ophelia may have drowned herself due to loneliness.

Loneliness is mentioned in the ancient Dharawal dreaming storyBahnaga and Mundah(The Goanna and the BlackSnake) retold by Sydney botanist Frances Bodkin.

BECAUSE OF HIS BAD TEMPER HE [BAHNAGA] WAS A VERY LONELY MAN, AND A WOMAN NEVER BEFORE SAID SOFT WORDS TO HIM.

So, have we placed modern emotions into ancient tales or did communal cultures suffer from loneliness too?

In Australia, the economic cost of loneliness is greater for women than men.

Curtin Universitys Associate Professor of Economics Astghik Mavisakalyan reports on theeconomic impacts of loneliness. She says its difficult to pinpoint why women feel lonelier than men.

Its likely that there are multiple and complex reasons behind the gender gaps in loneliness, says Astghik.

Data on loneliness is self-reported. It is possible that women simply face less stigma and are more comfortable to report that they are lonely.

BUT IT IS ALSO POSSIBLE THAT WOMEN ARE BROUGHT UP WITH HIGHER EXPECTATIONS FOR SOCIAL RELATIONSHIPS. THEY MAY BE MORE PRONE TO FEELING LONELY IF THESE ARE NOT MET.

Astghik says one factor may be that men have more opportunities to socialise through work. This often occurs during the years in which many women stay at home to care for their children.

According to the study, Australian women are most likely to feel lonely at the age of 17. And while reports of loneliness decrease during adulthood, they suddenly increase for women above the age of 65.

As for Australian men, reports of loneliness peak around the age of 50.

When we experience a high level of momentary loneliness, it triggers the body torelease more cortisol. And prolonged feelings of loneliness correlate to higher mean cortisol levels.

Cortisol,known as the stress hormone, prepares your body for a fight-or-flight response. It triggers your body to produce more glucose for extra energy. This increase in stress, and the unpleasant feelings associated with loneliness, may do two things.

For a social species like us, being lonely means being vulnerable to attack. The fight-or-flight response may be priming us for this attack. Secondly, the emotional pain associated with loneliness provides us with a biological hunger to connect with others.

This leads to a phenomenonDr Tim Dean describes as evolutionary mismatch. This mismatch occurs when behaviours that evolution ingrained in us for survival turn unhealthy in modern society. For example, our hunger for carbohydrates has turned into an obesity epidemic.

The2018Australian Loneliness Reportfound 25% of Australians feel lonely, while 30% feel they dont have a group of friends.

So how does this emotional experience impact our physical health? Loneliness correlates with a range of health issues. Its linked to cognitive decline (about 2%decrease in IQ over time) and an increase indementia risk.

In fact, the majority of the estimated $2.7 billion price tag is a result of medical costs associated with decreasing health.

But does chronic disease cause loneliness or does loneliness simply increase the risk of disease?

Professor Tegan Cruwys researches community psychology and mental health at the Australian National University. She says they are separate phenomena, which are often caused by similar social factors.

The overlap in who experiences depression and loneliness speaks to the fact that the social ills that lead to the experience of loneliness exclusion, discrimination and disadvantage are also critical determinants of clinical depression.

Astghiks research suggests loneliness is likely to lead to poor health outcomes and behaviours.

More than half of women and men aged 65 who feel lonely most of the time report poor health, says Astghik.

[This is] around twice the rate of those who do not feel lonely.

Chronic loneliness triggersbehavioural changesand kickstarts theimmune systems inflammation response. Chronic inflammation contributes to arange of diseasesincluding Alzheimers, diabetes, cancer, arthritis andheart disease.

Both Tegan and Astghik say the best way to combat loneliness is to participate in a community. If individualism helped create the loneliness epidemic,rediscovering our communitiesmay stop it.

Author: Thomas CrowSource: ParticleContact: Thomas Crow ParticleImage: The image is in the public domain

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The Cost of Loneliness - Neuroscience News