Duplicated and dilated ovarian vein with coexistence of persistent mesonephric artery.

During standard cadaveric dissection we encountered multiple vascular variations in the retroperitoneum: duplicated and dilated left ovarian vein with the coexistence of a persistent right mesonephric artery.

The effects of age, genotype and diet on hippocampal subfield iron dysregulation and Alzheimer's disease biomarkers in an ApoE mouse model.

Current theories regarding accumulation of Alzheimer's disease-related deposits of abnormal intra- and extracellular proteins include reactions to inflammation and mitochondrial dysfunction. In this study, we explored whether age, genotype and inflammation via diet have a greater effect on dysregulatory protein accumulation in any particular subfield of the hippocampus. We stained for ferritin, ferroportin, hyperphosphorylated tau and ß-amyloid proteins in the hippocampal region of Apolipoprotein E2 (ApoE2), ApoE3 or ApoE4 mice fed a control diet or a hypothesized inflammation-inducing methionine diet and euthanized at 3, 6, 9 or 12 months. We analysed stains based on hippocampal subfield and compared the protein accumulation levels within each group. We found significantly decreased ferritin expression in ApoE4 mice in the CA1 and Hi regions and decreased ferroportin expression in ApoE4 mice in the Hi region. There was also a significant effect on hyperphosphorylated tau protein levels based upon a given mouse genotype and diet interaction. Additionally, there were nonsignificant trends in each hippocampal subfield of increasing ferroportin and hyperphosphorylated tau after 6 months of age and decreasing ß-amyloid and ferritin with age. This study identified that there are changes in iron regulatory molecules based on genotype in the Hi and CA1 regions. Our findings also suggest a diet-genotype interaction, which affects levels of specific Alzheimer's disease biomarkers in the hippocampus. Additionally, we identified a trend toward increased ability to clear ß-amyloid and decreased ability to clear hyperphosphorylated tau with age in all subfields, in addition to evidence of increasing iron load with time.

Rural versus Urban Residence in Adulthood and Incident Cognitive Impairment.

INTRODUCTION: Rural versus urban living is a social determinant of cognitive health. We estimated the association of rural versus urban residence in the USA with incident cognitive impairment (ICI) and assessed effect heterogeneity by sociodemographic, behavioral, and clinical factors. METHODS: The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) is a population-based prospective observational cohort of 30,239 adults, 57% female, 36% Black, aged 45+ years, sampled from 48 contiguous states in the USA in 2003-2007. We analyzed 20,878 participants who at baseline were cognitively intact with no history of stroke and had ICI assessed on average 9.4 years later. We classified participants' home addresses at baseline as urban (population ≥50,000), large rural (10,000-49,999), or small rural (≤9,999) by Rural-Urban Commuting Area codes. We defined ICI as ≥1.5 SD below the mean on at least 2 of the following tests: word list learning, word list delayed recall, and animal naming. RESULTS: Participants' home addresses were 79.8% urban, 11.7% large rural, and 8.5% small rural. ICI occurred in 1,658 participants (7.9%). Small rural residents had higher odds of ICI than urban residents, adjusted for age, sex, race, region, and education (OR = 1.34 [95% CI: 1.10, 1.64]), and after further adjustment for income, health behaviors, and clinical characteristics (OR = 1.24 [95% CI: 1.02, 1.53]). Former smoking versus never, nondrinking versus light alcohol drinking, no exercise versus ≥4 times/week, CES-D depressive symptom score of 2 versus 0, and fair versus excellent self-rated health had stronger associations with ICI in small rural areas than in urban areas. For example, in urban areas, lack of exercise was not associated with ICI (OR = 0.90 [95% CI: 0.77, 1.06]); however, lack of exercise combined with small rural residence was associated with 1.45 times the odds of ICI compared with ≥4 bouts of exercise/week in urban areas (95% CI: 1.03, 2.03). Overall, large rural residence was not associated with ICI; however, black race, hypertension, and depressive symptoms had somewhat weaker associations with ICI, and heavy alcohol drinking a stronger association with ICI, in large rural areas than in urban areas. CONCLUSION: Small rural residence was associated with ICI among USA adults. Further research to better understand why rural residents are at higher risk for developing ICI and mechanisms to ameliorate that risk will support efforts to advance rural public health.

A novel scale for the evaluation of physician drawn medical illustrations.

Effective communication is a crucial component of patient-centered care and individuals with low health literacy face significant challenges in managing their health, leading to longer hospital stays and worse outcomes. Visual aids, such as medical illustrations and pictograms, can enhance patient understanding and memory retention; however, there is a lack in the medical field of tools for evaluating and improving a physician's ability to draw clinical illustrations for their patient. This article explores an aesthetic scale created in collaboration between Boston University Medical School and the Boston University Fine-Arts department. The scale scores basic design elements that could reasonably be improved in a clinical setting. A pilot study demonstrated interrater reliability between trained artists scoring images of varying concepts and visual quality with a Cronbach's alpha of 0.95. This scale has potential use in medical visual education and clinical evaluation.

Novel forms of prostate cancer chemoresistance to successful androgen deprivation therapy demand new approaches: Rationale for targeting BET proteins.

In patients with prostate cancer, the duration of remission after treatment with androgen deprivation therapies (ADTs) varies dramatically. Clinical experience has demonstrated difficulties in predicting individual risk for progression due to chemoresistance. Drug combinations that inhibit androgen biosynthesis (e.g., abiraterone acetate) and androgen signaling (e.g., enzalutamide or apalutamide) have proven so effective that new forms of ADT resistance are emerging. In particular, prostate cancers with a neuroendocrine transcriptional signature, which demonstrate greater plasticity, and potentially, increased predisposition to metastasize, are becoming more prevalent. Notably, these subtypes had in fact been relatively rare before the widespread success of novel ADT regimens. Therefore, better understanding of these resistance mechanisms and potential alternative treatments are necessary to improve progression-free survival for patients treated with ADT. Targeting the bromodomain and extra-terminal (BET) protein family, specifically BRD4, with newer investigational agents may represent one such option. Several families of chromatin modifiers appear to be involved in ADT resistance and targeting these pathways could also offer novel approaches. However, the limited transcriptional and genomic information on ADT resistance mechanisms, and a serious lack of patient diversity in clinical trials, demand profiling of a much broader clinical and demographic range of patients, before robust conclusions can be drawn and a clear direction established.

A case of abnormally dilated and tortuous arc of Buhler and pancreaticoduodenal arteries in the absence of celiac trunk stenosis.

INTRODUCTION: The Arc of Buhler is a rare vascular variant describing a persistent remnant of the embryologic ventral anastomosis between the celiac trunk (CT) and superior mesenteric artery (SMA), invariably reported in the context of CT stenosis. PURPOSE: To report a case of (1) a large and tortuous pancreaticoduodenal arcade and (2) a large and tortuous Arc of Buhler in the absence of celiac axis stenosis. METHODS: The variant was discovered during routine cadaver dissection. We acquired transverse biopsies of variant vessels and evaluated their wall thickness. RESULTS: The donor's anterior PDA, posterior PDA, and Arc of Buhler had larger diameters, and the common hepatic artery had a smaller diameter than the literature-reported values of a standard human body. The posterior PDA had significantly increased wall thickness compared to the other investigated vessels. CONCLUSIONS: The Arc of Buhler is a rare remnant of the embryologic ventral anastomosis that is estimated to be hemodynamically active in only half of cases. Previous reports have documented hemodynamically active Arcs of Buhler only in cases of CT stenosis. To the best of the authors' knowledge, this is a unique case of a persistent and hemodynamically active Arc of Buhler in the absence of CT stenosis. Clinicians should be aware of this variant as its abnormal position may increase risk of herniation and surgical complications, and its tortuosity may increase risk of clot formation.

Unusual bilateral variation of the flexor digitorum accessorius longus muscle and its relation on tarsal tunnel syndrome.

PURPOSE: During standard anatomical dissection for a medical anatomy course, we encountered an unusual bilateral variant of a unipennate flexor digitorum accessorius longus (FDAL) muscle, a supernumery muscle of the deep posterior leg and medial ankle. METHODS: We documented the muscles course and measured the diameter and length of the FDAL muscle belly, as well as the full length of its tendinous attachments. RESULTS: On both right and left legs, the FDAL originated from the proximal posterior fibula and distal one-third of the flexor hallucis longus muscle. The tendon had a distal attachment on the flexor digitorum longus (FDL) tendon and traveled with the FDL tendon as it inserted on the third distal phalanx. The left FDAL full length was 42.54 cm; the length of the muscle belly was 16.26 cm; and the circumference of the muscle belly was 4.44 cm. The right FDAL full length was 44.20 cm; the length of muscle belly was 12.06; and the circumference (belly) was 4.44 cm. Surrounding musculature and neurovasculature follow standard anatomical courses. CONCLUSION: This anatomical documentation provides opportunities for clinicians to consider mechanical influences of the FDAL on plantar foot function and further consider the accessory ankle muscles that have the potential to cause compressive neuropathies such as tarsal tunnel syndrome.

The brains of aged mice are characterized by altered tissue diffusion properties and cerebral microbleeds.

BACKGROUND: Brain aging is a major risk factor in the progression of cognitive diseases including Alzheimer's disease (AD) and vascular dementia. We investigated a mouse model of brain aging up to 24 months old (mo). METHODS: A high field (11.7T) MRI protocol was developed to characterize specific features of brain aging including the presence of cerebral microbleeds (CMBs), morphology of grey and white matter, and tissue diffusion properties. Mice were selected from age categories of either young (3 mo), middle-aged (18 mo), or old (24 mo) and fed normal chow over the duration of the study. Mice were imaged in vivo with multimodal MRI, including conventional T2-weighted (T2W) and T2*-weighted (T2*W) imaging, followed by ex vivo diffusion-weighted imaging (DWI) and T2*W MR-microscopy to enhance the detection of microstructural features. RESULTS: Structural changes observed in the mouse brain with aging included reduced cortical grey matter volume and enlargement of the brain ventricles. A remarkable age-related change in the brains was the development of CMBs found starting at 18 mo and increasing in total volume at 24 mo, primarily in the thalamus. CMBs presence was confirmed with high resolution ex vivo MRI and histology. DWI detected further brain tissue changes in the aged mice including reduced fractional anisotropy, increased radial diffusion, increased mean diffusion, and changes in the white matter fibers visualized by color-coded tractography, including around a large cortical CMB. CONCLUSIONS: The mouse is a valuable model of age-related vascular contributions to cognitive impairment and dementia (VCID). In composite, these methods and results reveal brain aging in older mice as a multifactorial process including CMBs and tissue diffusion alterations that can be well characterized by high field MRI.

The components of the adolescent brain and its unique sensitivity to sexually explicit material.

INTRODUCTION: The focus of this brief literature review is to explore whether there is a relationship between the unique anatomical and physiological paradigms of the adolescent brain and an increased sensitivity to sexually explicit material. METHODS: The EBSCO Research Data bases were searched using the following key terms: adolescence, adolescent brain development, neuroplasticity, sexually explicit material, sexualization, and pornography. RESULTS: The literature highlighted several components of the adolescent brain that are different than the mature brain. These include: an immature prefrontal cortex and over-responsive limbic and striatal circuits, heightened period for neuroplasticity, overactive dopamine system, a pronounced HPA axis, augmented levels of testosterone, and the unique impact of steroid hormones. The physiological response to sexually explicit material is delineated. The overlap of key areas associated with the unique adolescent brain development and sexually explicit material is noteworthy. A working model summary that compares the response of the adult and adolescent brain to the same sexually explicit stimulus is outlined. CONCLUSIONS: The literature suggests that the adolescent brain may indeed be more sensitive to sexually explicit material, but due to a lack of empirical studies this question cannot be answered definitively. Suggestions for future research are given to further advance the work in this applicable field of today.

Weave pattern of accessory heads to the anterior digastric muscle.

During routine anatomical dissection, we discovered bilateral superficial and deep heads of the anterior belly of the digastric muscle with concomitant accessory heads arranged in a weave pattern in the submental triangle. In addition, the left stylohyoid muscle coursed deep into the intermediate tendon of the digastric muscle bellies.

A Near-Peer Interprofessional Educational Fellowship Program for Training Pre-Clinical Medical Students in the Best Practices of Teaching and Learning.

Medical school often has opportunities for students to engage in peer or near-peer teaching, however structured teacher training is rarely conducted. We present an Educational Fellowship for rising M2 students as teaching assistants for first year Physician Assistant students. In this near-peer interprofessional teaching model, the M2 students learn pedagogical theory and best practices for teaching and learning. The curriculum and experience may be used by any healthcare profession. Since many healthcare professions have classes during the summer, we present our program as a conceptual model for other institutions.

Empowering the future: improving community wellbeing and health literacy through outreach and service-learning.

Institutions training future healthcare professionals in healthcare and community engagement play a crucial role beyond traditional classroom settings. Recognizing their potential to support under-represented groups and minorities, institutions increasingly encourage engagement with schools and community organizations. However, work remains to advance meaningful and impactful educational outreach and service-learning programs. This manuscript synthesizes the perspectives of a group of medical school educators to discuss developing sustainable programs to engage youth in Science, Technology, Engineering, Math, and Medicine (STEMM) education with a focus on biomedical science. Through near-peer education and service-learning, healthcare students can impart knowledge, provide mentorship, promote enthusiasm for STEMM fields, and nurture health-related self-efficacy within individuals and communities. Collaborative efforts through student-as-teacher approaches bridge health-related disparities and cultivate healthier, more empowered futures for all. We advocate for community outreach strategies that target future health professionals early in their education and support the scholarship of teaching and learning and program evaluation. Successful long-term programs must ensure that results are systematically assessed, measured, and perpetuated. This perspective aims to highlight the role of service learning and community outreach in increasing individual health literacy and fostering an enduring interest in STEMM careers, thereby empowering the next generation of elementary and secondary school students.

Evaluation of an Educational Scholarship Fellowship Program for Health Professions Educators.

Introduction: Historically, the requirement to produce scholarship for advancement has challenged health professions educators heavily engaged in teaching. As biomedical scientists or healthcare practitioners, few are trained in educational scholarship, and related faculty development varies in scope and quality across institutions. Currently, there is a need for faculty development and mentoring programs to support the development of these skills. Methods: The International Association of Medical Science Educators (IAMSE) established the Medical Educator Fellowship (MEF) Program to foster health professions educational scholarship. MEF addresses the following: curriculum design, teaching methods and strategies, assessment, educational scholarship, and leadership. Participants receive mentorship and faculty development, and complete an educational scholarship project. Using a logic model, we conducted a retrospective program evaluation with data from Program records, database searches, graduate surveys, and focus groups. Results: Over 14 years, MEF graduated 61 participants with diverse terminal degrees from five continents and six academic program areas. Graduate survey responses indicated enhanced post-Program skills in all focus areas, that the majority would recommend MEF to a colleague, and that mentorship, networking, and professional development were strengths. Focus group outcomes indicated professional growth, increased confidence, and increased sense of community. Conclusion: MEF addresses health professions educators' need for faculty development and mentorship in educational scholarship. Evaluation outcomes suggest that MEF effectively enhanced perceived skills across focus areas. Similar programs are essential to support faculty who dedicate significant time to teaching. Organizations like IAMSE can demonstrate the value of educational scholarship and positively impact health professions educator careers by supporting such programs.

Journal recommended guidelines for systematic review and meta-analyses.

Systematic reviews and meta-analyses aggregate research findings across studies and populations, making them a valuable form of research evidence. Over the past decade, studies in medical education using these methods have increased by 630%. However, many manuscripts are not publication-ready due to inadequate planning and insufficient analyses. These guidelines aim to improve the clarity and comprehensiveness of reporting methodologies and outcomes, ensuring high quality and comparability. They align with existing standards like PRISMA, providing examples and best practices. Adhering to these guidelines is crucial for publication consideration in Anatomical Sciences Education.

Journal recommended guidelines for survey-based research.

Survey-based research is vital in education and social sciences, offering insights into human behaviors and perceptions. The prevalence of such studies in medical education has risen by 33% over the past decade. Despite this growth, the utility of survey findings depends on the study design quality and measure validity. Many manuscripts are rejected due to poor planning and lack of validity evidence. These guidelines aim to improve the rigor and reporting of survey-based research, ensuring credibility and reproducibility. They apply to various survey tools and evaluations, setting a standard for manuscript quality and informing the review process for Anatomical Science Education.

Evidence for the functional compartmentalization of the temporalis muscle: a 3-dimensional study of innervation.

PURPOSE: The temporalis muscle is commonly used for functional transfer. It is architecturally complex, but few studies have examined its intramuscular innervation and none has used 3-dimensional modeling techniques. Understanding neuromuscular compartmentalization may allow the design of local muscle transfers to minimize donor-site morbidity. The purpose of the present study was to document the intramuscular innervation patterns throughout the volume of the temporalis muscle and define functional units within the muscle. MATERIALS AND METHODS: In 10 formalin-embalmed cadaveric specimens, the foramen ovale was exposed and the branches of the mandibular nerve were identified. Each branch was digitized in short segments extramuscularly and intramuscularly. Three-dimensional models were reconstructed from the digitized data using Maya software, and the innervation patterns were documented. RESULTS: The temporalis muscle was found to have superior and inferior parts that were further grouped by innervation into regions, with each receiving its innervation from 1 primary nerve. The nerves originated directly from the mandibular nerve, except in 3 specimens, where the posterior deep temporal nerve arose from the masseteric nerve. CONCLUSION: These results provide a detailed mapping of innervation patterns and suggest there are at least 5 functional compartments. Each of these has the capacity for selective activation, 3 of which have clinical value. These findings may allow for decreased donor-site morbidity and more functionally sophisticated designs in clinical practice.

The Prevention of Inflammation and the Maintenance of Iron and Hepcidin Homeostasis in the Gut, Liver, and Brain Pathologies.

The human gut microbiome consists of a variety of microorganisms that inhabit the intestinal tract. This flora has recently been shown to play an important role in human disease. The crosstalk between the gut and brain axis has been investigated through hepcidin, derived from both hepatocytes and dendritic cells. Hepcidin could potentially play an anti-inflammatory role in the process of gut dysbiosis through a means of either a localized approach of nutritional immunity, or a systemic approach. Like hepcidin, mBDNF and IL-6 are part of the gut-brain axis: gut microbiota affects their levels of expression, and this relationship is thought to play a role in cognitive function and decline, which could ultimately lead to a number of neurodegenerative diseases such as Alzheimer's disease. This review will focus on the interplay between gut dysbiosis and the crosstalk between the gut, liver, and brain and how this is mediated by hepcidin through different mechanisms including the vagus nerve and several different biomolecules. This overview will also focus on the gut microbiota-induced dysbiotic state on a systemic level, and how gut dysbiosis can contribute to beginnings and the progression of Alzheimer's disease and neuroinflammation.

Comparing the emotional experiences of students in similar dissection- and prosection-based medical gross anatomy courses: A mixed-methods study.

The anatomy laboratory can incite strong emotional reactions in students, which can in turn facilitate growth in empathy, care for vulnerable others, and professionalism. Despite this, little is known about the relative emotional impacts of different laboratory modalities. The response to the COVID-19 pandemic created an opportunity to compare the emotional experiences of students in similar courses in which one group of students dissected donors and the other group learned from prosected donors. The courses were otherwise the same in content, length, instructional design, and assessment. Students in the dissection-based (Fall 2019) and prosection-based (Fall 2020) courses completed a previously validated survey that used quantitative and qualitative questions to assess their feelings about the donors and the anatomy laboratory experience. Students in both cohorts reported overall appreciation for having had the experience. Negative themes experienced by both groups included feeling anxiety, worries about depersonalizing donors, and physical discomfort in the laboratory. Students in the dissection course reported stronger connections with the donors and the donors' families but also more frequently felt negative feelings such as disgust, anxiety, and feeling alone. Students in the prosection course reported more consistently positive responses but worried about not using the donors to the fullest extent possible. Regardless of pedagogical design, students have complex emotional experiences in the anatomy laboratory and our results indicate that these feelings may be more intense in the context of dissection. Anatomists should foster educational settings that enable students to learn to process complex or challenging emotions.