Human Brain is Two Separate Organs, New Research Finds

A new study led by Stanford Medicine found the brain is two separate organs adjacent to one another. The finding could aid research into devastating neurological diseases.

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For centuries, scientists have thought of the brain as a single, unified organ. But new research led by Stanford Medicine reveals that what we call the brain is two distinct organs that evolved independently over hundreds of millions of years.

The discovery overturns a prevailing model of brain development. For decades researchers have subscribed to the theory that there is a single progenitor cell early in development that gives rise to the entire brain. This model suggested all parts of the brain shared a common developmental origin.

The new research finding shows that the human brain consists of two ancient nervous systems cleverly packaged together — a more primitive part that regulates our hearts’ beating, our breathing and other functions, and another that makes us distinctly human, capable of poetry, mathematics and wondering about our own origins.

The discovery could help explain why scientists have struggled for decades to grow certain types of brain cells in the laboratory — and it opens new avenues for studying devastating diseases that affect the brain stem, such as spinal muscular atrophy (also known as SMA) and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease).

“We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain,” said Kyle Loh, PhD, associate professor of developmental biology. “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

The findings were published in Nature Neuroscience Sept. 18. Loh is the senior author. Graduate students Carolyn Dundes and Rayyan Jokhai are co-first authors of the research.

Two brains

The adult brain has three main regions: the forebrain, midbrain and hindbrain. The forebrain handles higher-level thinking — language, consciousness and abstract reasoning. In contrast, the hindbrain, located at the back of the skull and often called the brain stem, controls essential, automatic functions that keep us alive: breathing, sleeping, and regulating our heartbeat and hunger urges. The hindbrain neurons also control the muscles of the face, tongue and throat, which affect speech and swallowing.

Despite the critical importance of the hindbrain, scientists have struggled for decades to generate human hindbrain neurons in the laboratory. This gap has hampered research into devastating diseases affecting the brain stem, including spinal muscular atrophy and amyotrophic lateral sclerosis.

SMA is a leading genetic cause of death in children under 1 year of age. ALS, which is often diagnosed between the ages of 40 and 70, affects both the forebrain and the hindbrain. In both disorders, certain hindbrain neurons gradually cease to function, and the patient loses the ability to swallow, which can cause pneumonia when food or liquid is inhaled into the lungs; eventually, patients lose the ability to breathe.

The researchers’ breakthrough came from studying the earliest moments of embryonic development, during a stage called gastrulation when the body first takes shape. Jokhai and Dundes discovered that the hindbrain follows a separate developmental path, running in parallel to — rather than branching off from — the pathway that creates the forebrain and midbrain.

The researchers learned this from examining developing mouse embryos. They identified two different brain progenitor cells. One, which expresses a gene called Otx2, is destined to become the forebrain and midbrain. The other, which expresses a gene called Gbx2, is committed to forming the hindbrain. They showed that these two cell populations never overlap; they are mutually exclusive from the earliest stages of development.

The team then examined the DNA packaging, or chromatin, in these cells. Chromatin is a way cells determine which genes can be easily accessed and which are bundled away out of reach. What they found was striking: The anterior neural ectoderm (future forebrain and midbrain) and posterior neural ectoderm (future hindbrain) have fundamentally different chromatin configurations. These differences essentially locked each progenitor cell into its respective fate, like travelers on parallel tracks that never cross.

“Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible,” Jokhai said.

This revelation explained decades of frustration in the field — scientists had been trying to turn one type of progenitor cell into another that it is fundamentally incapable of becoming.

“In stem cell biology, people are always fixated with creating the end cell type, like the neuron,” Jokhai said. “But it’s important to begin at the earliest stages of embryonic development. Our careful attention to that early time point allowed us to find this fundamental split in brain development.”

Growing hindbrain neurons

Armed with this knowledge, the researchers for the first time successfully coaxed human pluripotent stem cells (a kind of cell that can create any cell in the human body) to become functional hindbrain motor neurons in the laboratory. These lab-grown neurons displayed all the hallmarks of authentic hindbrain cells: They exhibited waves of electrical activity called action potentials and made proteins that identify the segments of the hindbrain that control facial and swallowing muscles.

Finally, the researchers looked back over 550 million years of evolutionary time. They found the same two-origin brain pattern in chickens; zebrafish; and, remarkably, in acorn worms, tiny creatures living on the ocean floor that share a distant common ancestor with humans. Jellyfish, which diverged from humans about 600 to 700 million years ago, have two nervous systems at different ends of their body.

“Our research suggests that evolution took two existing neural systems and pushed them together spatially,” Loh said. “Having the brain as one organ would probably be more efficient, but we rely on this primordial way to make the brain as two separate pieces.”

“I was surprised at our findings because the word ‘brain’ implies a contiguous organ that likely has a singular origin,” Jokhai said. “But even 500 million years ago, there were these separate neural systems, which now almost operate as one, which is very cool.”

The research also has implications for investigating treatments for SMA, ALS and other conditions affecting the brain stem. Until now, studying these diseases has been nearly impossible because scientists cannot obtain brain stem tissue from living patients. The ability to grow these neurons in a dish opens new possibilities for understanding what goes wrong. There’s even an unexpected connection to obesity treatment: The hindbrain contains circuits that regulate hunger — which is precisely how weight-loss drugs like semaglutide work.

The researchers would like to extend their studies to determine the developmental origins of the spinal cord and to learn exactly how SMA and ALS compromise the function of hindbrain neurons.

“Now we have a model to better understand these devastating diseases, and work toward regenerative therapies for them,” Jokhai said. “This is a very exciting new frontier in brain research.”

Original written by Krista Conger

Source: Stanford Medicine

Can Vitamin C Improve Outcomes in People with Pre-cancer Blood Disorders?

Phase 2 trial results warrant further study in a phase 3 trial.

Photo by Diana Polekhina on Unsplash

Vitamin C boosts the activity of cellular proteins called TET enzymes that help control which genes are turned on or off. Because decreased function of TET enzymes is a common driver of certain forms of blood cancer, researchers tested the effects of vitamin C supplements in patients at risk of developing such malignancies. Results of the investigators’ phase 2 clinical trial are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

The randomised, double-blind, placebo-controlled EVITA trial enrolled 109 patients in Denmark and the United States who had either a blood condition that can turn cancerous or a low-risk form of blood cancer. At the start of the trial, 55 patients were randomly assigned to receive oral vitamin C (1000mg/day) and 54 were assigned to receive placebo, for a total of 12 months.

Although the primary endpoint (growth rate of precancerous or cancerous cells) was similar between groups, participants who received vitamin C experienced changes in inflammatory signaling that aligns with better outcomes. Also, anaemia, pneumonia, acute aseptic arthritis, and internal bleeding were less frequent (although gastrointestinal problems were more frequent) in patients taking vitamin C compared with those taking placebo.

At a median follow-up of 33.6 months (nearly 3 years) in the intention-to-treat population, 35 deaths were recorded, including 24 in the placebo group and 11 in the vitamin C group. An exploratory analysis of these data found that participants in the vitamin C group were more likely to survive during follow-up than those in the placebo group. This finding requires confirmation in a larger phase 3 clinical trial.

“The EVITA trial gives us a strong rationale to continue exploring if and how vitamin C might benefit people with certain pre-cancer or early-stage blood cancers. More work is needed but we are cautiously optimistic that these findings could inform future strategies to intercept leukemia development,” said co–senior author Peter A. Jones, PhD, DSc (hon), of Van Andel Institute, in Grand Rapids, Michigan. Jones is co-leader of the Van Andel Institute–Stand Up To Cancer (VAI–SU2C) Epigenetics Dream Team, which led the EVITA trial.

“We are encouraged by our findings and what they ultimately could mean for people with these early-stage blood disorders. Although it is too soon to make recommendations based on our results, we are hopeful that a larger study will give us more definitive answers,” added co–senior author Kirsten Grønbæk, MD, PhD, of Rigshospitalet, Copenhagen University Hospital in Denmark. Grønbæk is a longtime member of the VAI–SU2C Epigenetics Dream Team.

Source: Wiley

Is Aspen Betting on the Right HIV Prevention Product?

The potent antiretroviral medicine alimatravir is being evaluated in two ongoing clinical trials as a potential once-monthly HIV prevention pill. (Photo: Unsplash)

By Catherine Tomlinson for Spotlight

Aspen Pharmacare has announced that it will not be manufacturing the lenacapavir HIV prevention injection, and that it will instead focus on producing alimatravir, an experimental HIV prevention pill.

At the start of 2020, the only medicine approved to prevent HIV infection in people who are not living with HIV in South Africa was tablets containing the antiretroviral drug tenofovir. Apart from the tablets, ideally taken daily, HIV transmission could also be prevented by the correct use of condoms and reduced through medical male circumcision. Treating people living with HIV also helps a lot, since most people who are stable on antiretroviral treatment become non-infectious.

Since 2020, three more HIV prevention medicines have been registered in South Africa. Most prominent of these is the lenacapavir injection, which provides almost complete protection for six months at a time. The cabotegravir injection (CAB-LA) provides two months of protection and the dapivirine vaginal ring a month of partial protection. Several more products are in advanced clinical trials – including a new formulation of lenacapavir that may provide 12 months of protection and a tablet that could protect for a month.

Yet, despite the promise of new HIV prevention medicines, the rollout and uptake of these products in South Africa and globally has been slower than expected. Currently, only around 350 000 people are using HIV prevention tablets in South Africa, while in the region of 60 000 people have started taking the twice-yearly lenacapavir injections. At these levels, the number of people taking HIV prevention medicines in South Africa remains far too low to make a significant dent in the rate of new infections.

Cost has been a barrier 

HIV prevention tablets cost the health department around $40 (roughly R700) per person per year. This price is considered to be affordable and the tablets are currently available at almost all public sector clinics in the country.

But modelling shows that long-acting injections can prevent more HIV infections than daily tablets, because their efficacy is less reliant on people taking the tablets every day. There is also evidence that many people prefer long-acting injections over daily tablets.

The cost of these newer, long-acting products has been a challenge. The health department has not procured CAB-LA injections, which was registered in the country in 2022. This was largely due to the price of around $160 per person per year. It also didn’t help that the current formulation of CAB-LA provides only two months of protection, compared to lenacapavir’s six.

In June, the health department started rolling out lenacapavir injections to around 10% of public sector facilities – for now the potential demand by far outstrips supply. The limited scale of the rollout is due to both supply and affordability challenges. The health department is paying $60 per person per year for lenacapavir through a Global Fund procurement arrangement that is allowing donors to pay an additional confidential top-up amount to Gilead Sciences above what the health department pays. For now, Gilead is the only supplier of the jab.

Supply should however improve over the next 12 months and prices are likely to come down. Gilead has licensed six companies to manufacture generic lenacapavir and is considering granting additional licenses, possibly to South African companies through a process coordinated by the South African National AIDS Council. Deals are in place with Indian pharmaceutical companies Hetero and Dr Reddy’s that should ensure a generic price of $40 per person per year. Hetero has already filed its product for registration with the South African Health Products Regulatory Authority – although it is expected to only get the green light early in 2027.

Is a new highly affordable option on the way?

In light of these pricing and supply concerns, news from the 2026 International AIDS Society Conference about a monthly HIV prevention tablet under development has made waves. Health economists presented research showing that the monthly tablet, alimatravir, could be profitably produced for a price tag as low as $3 per person per year (a $15 price was indicated in a conference abstract and previously quoted by Spotlight, but the price presented in the conference session was $3).

Not only is this a fraction of the cost of long-acting injections, but it is also substantially cheaper than the cost of daily tablets.

“Alimatravir for $3 per year could be the cheapest HIV prevention drug the world has ever seen, affordable worldwide,” Dr Samuel Cross of Christchurch Hospital told delegates.

He told conference delegates that the methodology used to calculate the $3 per person per year price is the same methodology that has previously been used to predict the manufacturing cost of several medicines. He said that “[o]ver the past decade, this methodology has correctly predicted production costs for [several] drugs,” including drugs for HIV, TB, Hepatitis B and C, and other conditions.

Some caution would however be prudent, given that alimatravir’s safety and efficacy hasn’t been definitively proven. The final verdict will come from two ongoing Phase 3 clinical trials, called EXPrESSIVE-10 and EXPrESSIVE-11 – both expected to report in 2027. Regulators typically approve medicines only after positive findings from such phase 3 trials.

Alimatravir is already influencing the market

Despite the absence of phase III data, alimatravir is already making waves and affecting the market for HIV prevention products.

The most stark example of this is the recent announcement by Aspen Pharmacare that it will no longer pursue a license to locally manufacture lenacapavir and focus instead on developing its capacity to manufacture alimatravir.

Aspen, along with six other companies, are already licensed to produce generic versions of alimatravir. The unusually early licensing of these companies by MSD (known as Merck in the US and Canada) is a key factor as to why this product is expected to be affordable right out of the gate, if it is shown to be effective in preventing HIV.

No generic companies have yet indicated what price they will charge for alimatravir – but the $3 reference price will no doubt exert some downward pressure.

Why Aspen is no longer pursuing lenacapavir manufacturing

Stavros Nicolaou, senior executive for strategic trade at Aspen Pharmacare, this week told Spotlight that Aspen halted its pursuit of a license to manufacture generic lenacapavir because the South African government’s current pharmaceutical procurement policies and practices provide insufficient assurance that the company will be able to recoup its investments.

The absence of guaranteed procurement by the health department, the lack of a local preference procurement policy, and the existence of competitive products – such as alimatravir – coming down the pipeline all factored in Aspen’s decision, said Nicolaou.

He said that developing manufacturing capacity for tablets, such as alimatravir, is less costly than developing manufacturing capacity for injectables, such as lenacapavir.

“We need greater certainty before we make these investments,” Nicolaou told Spotlight.

He added that the early licensing of alimatravir to enable accelerated generic registration of the product following Phase III trials also made the product an attractive candidate for the company to pursue. He said it was premature to comment on the price they might charge for alimatravir.

Aspen’s decision comes against a broader debate regarding the obligations of the health department to support local pharmaceutical manufacturers, while also delivering on its obligations to maximise the benefits derived from the country’s constrained health budget.

What’s next?

A cheap monthly HIV prevention pill could be a game changer in the fight against HIV in the coming years. However, while data on alimatravir are awaited, its potential arrival has complicated the investment decisions facing pharmaceutical companies, governments, and donors regarding new HIV prevention medicines. It has also raised questions over how the state is, or is not, incentivising local production and procurement of locally produced pharmaceuticals.

The prospect of a monthly pill costing around $3 per year is undeniably exciting. Yet scientists have repeatedly shown that offering a range of prevention medicines—allowing people to choose the option that best suits their needs and lives—improves overall uptake. Even if alimatravir works as well as hoped, there will still be a role for six-monthly lenacapavir, let alone the potential 12-monthly version of the jab that is currently being evaluated in a phase 3 clinical trial.

Either way, while the health department must keep a close eye on the products in the pipeline as it plans for the future, it cannot afford to slow the rollout of the products already available.

*This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

Cardiac Rehabilitation Cuts Hospital Admissions and Heart Attack Risk

A new Cochrane review of 107 trials shows that exercise-based cardiac rehabilitation is associated with numerous benefits and helps people return to healthier, more active lives

Photo by Barbara Olsen on Pexels

Exercise-based cardiac rehabilitation reduces hospital admissions by a third and heart attack risk by more than a quarter, as well as remaining beneficial in the long term, a new Cochrane review finds. 

The evidence also suggests that newer home-based and digitally supported cardiac rehabilitation programmes can be just as effective as traditional centre-based services. 

Coronary heart disease is the single most common cause of death globally. It can lead to chest pain, heart attacks, or stroke. Cardiac rehabilitation programmes are widely recommended following a cardiac event, with exercise recognised as a core component.  

Effective and inexpensive intervention 

The researchers, led by the University of Glasgow, analysed 107 randomised controlled trials involving 26 886 people with coronary heart disease. Most participants had experienced a heart attack, undergone heart procedures, or experienced some sort of chest pain. Women were underrepresented, making up only 17% of participants despite being included in most studies.  

The overall results show that, compared with no programme, exercise-based cardiac rehabilitation reduces heart attacks by 28%, reduces all-cause hospital admissions by 35%, and probably reduces deaths. 

Participants also reported better physical functioning, general health, vitality, social functioning, and mental wellbeing. These benefits were seen across several validated quality-of-life measures.  

“Our review shows that exercise-based cardiac rehabilitation can reduce the risk of heart attack and hospital admission while helping people return to healthier, more active lives,” says Dr Grace Dibben, lead author from the University of Glasgow.  

“Many people lose confidence after a heart attack or cardiac procedure and worry that physical activity could be dangerous,” Dr Dibben adds. “Appropriately prescribed exercise is not only safe for most patients, but can play a vital role in recovery and long-term heart health.” 

Growing evidence for modern rehabilitation models

This new update included 22 new trials featuring just under 3500 participants, incorporating more recent data into the final results. The more recent studies included participants based in low- and middle-income countries (LMICs) and tested home-based and digital cardiac rehabilitation programmes.  

“This review confirms that exercise is a great tool for improving the overall health of people with coronary heart disease,” says Professor Rod Taylor, senior author from the University of Glasgow. “By adding newer studies to this update, we’re able to see that digital programmes work as well as in-person programmes, which really changes the game here. These approaches may help us reach people who cannot attend traditional centre-based services.” 

Several studies in this update were conducted in LMICs, examining different types of exercise in different countries; for example, yoga in India and tai chi in China. The authors suggest this not only improves the relevance of the evidence base, but that some populations may find rehabilitation built around traditional and cultural forms of exercise more appealing than conventional, machine-based rehab. 

Low uptake despite evidence-backed benefits 

Despite strong evidence supporting cardiac rehabilitation, uptake remains a challenge in many healthcare systems. Various guidelines, including NICE in the UK, recognise cardiac rehabilitation as a key component following a cardiac event. However, cardiac rehabilitation continues to be widely underused with generally low participation rates. According to the 2025 National Audit of Cardiac Rehabilitation (NACR) report, the uptake of cardiac rehabilitation for patients with acute coronary syndrome was 44.5% in England and 71.3% in Wales.

The authors explain that many patients face barriers to attending traditional hospital-based programmes, including work commitments, transport challenges, and caring responsibilities. This can disproportionately impact groups like women, older adults, and deprived communities the hardest.  
 

Exercise-based cardiac rehabilitation is an inexpensive and cost-effective intervention, but right now it’s underfunded and unprioritised.

We want this option to be available to everyone. This new research shows you don’t even have to go into a rehab centre to benefit – you can participate from home and still see the benefits.

 Dr Grace Dibben, University of Glasgow.  

Sex Differences in Attention are Present at Birth, Study Finds

Photo by Tim Bish on Unsplash

Cambridge scientists have shown that girls and boys show differences in what they pay attention to, even at birth. Since these differences are present so early, it is possible they emerge due to prenatal factors.

It’s nature and nurture, not nature or nurture

Simon Baron-Cohen

The findings suggest that some psychological differences between males and females (such the development of social skills) may be influenced by both prenatal biology as well as later experience.

The study, published today in Biology of Sex Differences, involved testing 130 newborn infants only hours after birth. It builds on previous research by the same lab and uses robust methods to demonstrate the differences.

For years, research has shown that girls, on average, learn to talk earlier and develop social skills faster than boys. Scientists have long debated whether these differences are due to culture or biology. One way to answer this question is to test if sex differences are present soon after birth, before society and culture have influenced a child’s development. 

A study from the University of Cambridge published in 2000 found girls at birth on average looked longer at faces, and boys on average looked longer at objects. Since then, scientists in the field called for a replication of this study. However, no research team has attempted this until now, since it is very challenging to carry out research on newborn infants.   

In this new study, infants were presented with side-by-side videos containing a social stimulus, namely a human face with natural movement, and a non-social object, namely a set of metallic balls swinging due to gravity and their mechanical properties (a Newton’s cradle). 

The team found that, regardless of sex, newborn infants generally preferred to look at the social stimulus. However, on average, female infants spent a greater proportion of the time looking at the social stimulus compared to male infants, while male infants spent a greater proportion of time looking at the non-social stimulus compared to female infants.

Since this is within hours of birth, before much postnatal experience (such as social expectations based on gender) has occurred, it is likely that prenatal biological factors that differ between the sexes during pregnancy (such as hormone levels and genetics) contribute to the observed on-average sex differences. 

Yumnah Khan, a PhD student at the Autism Research Centre, University of Cambridge and the lead researcher on the study, said: “Our recent research has also shown that on-average sex differences are present in brain structure at birth and emerge prenatally. This new study tells us that there are not only on-average sex differences in the brain but also in attention and behaviour.” 

Professor Sir Simon Baron Cohen, Director of the Autism Research Centre, University of Cambridge, who supervised the study, said: “This study addresses the age-old question of whether nature plays any role at all in shaping sex differences in the human mind and brain. The fact that we observe these differences within hours of birth, before extensive postnatal experience has occurred, suggests that prenatal factors play a role, and that these prenatal factors – sex hormones and/or genes – go on to interact with postnatal experience. In other words, it’s nature and nurture, not nature or nurture.”

The new study used more robust methods compared to the original 2000 study. In particular, it included more controlled experimental testing conditions as well as a more reliable method to monitor infant gaze. Crucially, the researchers who analysed the videos of the baby’s eyes were blind to the baby’s sex and whether the baby was looking at the social or the non-social stimulus, which ensured that they could not bias the results. 

Dr Alex Tsompanidis, Assistant Research Professor at the Autism Research Centre and a member of the research team, said: “Sex differences at birth are important as starting points, but we need to remember that they don’t fully determine how children learn and develop in later life. This is because biological and social factors always interact, contributing to the rich diversity of human societies.”

Professor Carrie Allison, Deputy Director of the Autism Research Centre and another member of the research team, said: “The differences we see don’t apply to all male or all female infants, and are only seen when you compare groups of male and female infants, on average. There’s a lot a variation within, and overlap between, each sex. Our future research needs to better understand that variation.” 

The team is now interested to find out if these early sex differences contribute to later differences in children’s minds, brains and behaviour. To test this requires a longitudinal (follow-up) study design, which is underway. The researchers hope that by understanding the origins of the earliest sex differences, scientists can better understand neurodiversity and conditions such as autism, which is diagnosed about twice as often in boys than in girls.

This research was supported by the Wellcome Trust, the Simon Foundation Autism Research Initiative (SFARI), and a PhD studentship from Trinity College, Cambridge and the Cambridge Trust. A follow-up study is funded by the K. Lisa Yang Centre for Autism Research at Cambridge, which is part of the Yang Tan Collective.

Reference

Khan, YT, Tsompanidis, A, Hymanson, E, Wickramanayake, S, APEX Consortium, Austin, T, Allison, C, & Baron-Cohen, S. Sex differences in social attention at birth. Biology of Sex Differences; 21 Sept 2026; DOI: 10.1186/s13293-026-00976-9

Republished from the University of Cambridge under a Creative Commons licence. Read the original article,

New Method Makes IUD Insertion Less Painful for Women

Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014“. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010ISSN 2002-4436. – Own work

A simple method involving local anaesthesia in the uterus can reduce pain during IUD insertion, according to a new study from the Karolinska Institutet, published in the journal JAMA. The method also increased the proportion of women who found the procedure tolerable. The results may encourage more women to choose an IUD as a method for contraception.

The IUD is an effective and long-acting contraceptive, but fear of pain during insertion make many women choose not to have one inserted. Currently, IUDs are inserted without local anaesthesia or, in some cases, with local anaesthesia administered via an injection into the tissue around the cervix – an injection that could be experienced as painful.

In the new randomised study, researchers investigated whether a small amount of local anaesthetic, introduced into the uterus via a thin plastic catheter a couple of minutes before the procedure, could make the procedure less painful.

The study involved 370 women aged between 18 and 31 who had not previously given birth. The participants were randomly allocated to receive either the local anaesthetic mepivacaine or a saline solution prior to IUD insertion. Neither the participants nor the healthcare staff knew which treatment was being administered.

The results show that pain was reduced in the group receiving active treatment. On a scale from 0 to 100, the average pain score was 43.8 compared with 58.6 in the control group – a reduction of around 15 units. At the same time, the proportion of participants who found the pain tolerable rose from 91.4 to 98.3 per cent.

“We can see that the method not only reduces pain, but also means that more people find the procedure acceptable,” says Helena Kopp Kallner, professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, and senior consultant at the Women’s Clinic at Danderyd Hospital, who is co-last author with Niklas Envall, a postdoctoral researcher at the same department.

The overall experience was also improved. More than half of the women in the treatment group found the procedure easier than expected, compared with around a third in the control group.

An important aspect of the study was that the administration of the anaesthetic itself should also be gentle. The results show that most participants found the administration to be only mildly painful.

“It is a simple method that does not require needles and is easy to use in everyday clinical practice,” says lead author Karin Elgemark, PhD student at the same department. 

The researchers point out that the study does not compare the method with other types of pain relief, which is a limitation. This means it is not possible to determine whether the method is more effective than alternative treatments. The results are also based on self-reported pain, which may be influenced by individual experiences.

“Our study shows that the method works when compared with no active treatment, but it also needs to be compared with other pain relief methods,” says Helena Kopp Kallner.

The study was carried out at eleven gynaecological clinics and youth health centres in Sweden. It was funded by the Swedish Research Council. Some of the researchers have reported receiving remuneration for lectures from companies that manufacture intrauterine devices (IUDs), but these organisations played no role in the conduct or analysis of the study.

Source: Karolinska Institutet

From Split Livers to Machine Perfusion: The 20‑year Evolution of Liver Transplants in South Africa

Jerome Loveland, University of the Witwatersrand

South Africa’s liver transplantation landscape has changed in the last 20 years. Donald Gordon Medical Centre

South Africa is no stranger to organ transplants. The world’s first heart transplant was performed in the country in the 1960s. There have been major developments in the decades since then. In the 1980s an organ donor registry was set up and local surgeons have been pushing the boundaries of what is possible. The Wits Donald Gordon Medical Centre recently marked a milestone of completing 1000 liver transplants since initiating its programme in 2004.

The Conversation Africa asked Jerome Loveland, head of transplant surgery at the centre and academic head of transplantation at the University of the Witwatersrand, about the current state – and future – of liver transplantation in the country.


How has the liver transplant landscape in South Africa changed?

In the 1980s, the University of Cape Town started to build a deceased donor liver transplant programme. It became the centre of liver transplantation in South Africa for decades.

When we at the Wits Donald Gordon Medical Centre started our own unit around 2004, it shifted the landscape. Obviously, it’s never smooth, and one of the most limiting factors around transplantation is the availability of deceased donor organs.

Right from the beginning we were looking for ways to optimise the use of the livers that did become available. Very early on we embarked on more complex transplants, like reducing a whole liver into a small piece to put into a child, or dividing a whole liver into two usable pieces where one piece goes to an adult and the other to a child. So “split liver” transplants allowed us to use those livers optimally.

From there, we expanded into living donor transplantation, typically from a parent to a child, and then transplants across the blood group barrier. We were the first in South Africa to perform transplants in patients with acute liver failure. All these key moments have allowed us to optimise the organs available and we’ve become a relatively high-volume centre.

What other developments have changed things?

The most recent game-changer is machine perfusion of the liver. This machine allows us to resuscitate and store donor organs more viably for extended periods of time. We have introduced this technology as the standard of care for our extended criteria donor livers, which include livers from older donors. Donald Gordon is currently the only unit in Africa using this technology.

It allows us to transplant an additional 10% to 15% of livers that we otherwise wouldn’t have used, as we would have most likely discarded them as unsafe to use. With the resuscitative component of machine perfusion, we can now use these livers with confidence.

Most importantly, the machine resuscitates the donor liver so that once it’s put into the recipient it functions much better and much sooner. It avoids what we call early graft dysfunction. It has a whole lot of benefits in terms of avoiding complications in the recipient, and reduces the costs of post-operative care.

We are excited to prove the cost-benefit to funders over the next 10 to 20 transplants.

With all these advancements, what challenges remain?

The availability of deceased donor organs is what drives the waiting list. We’ve got the capacity from a staffing and a hospital perspective to double our transplants per month very easily. We currently do about 50 to 60 liver transplants a year, or one a week.

There are still patients who fall off the waiting list because they get too ill or because they die.

My message for South Africans is to become organ donors when you die. By donating one’s organs you’re saving seven lives, probably more. There are seven recipients of those solid organs that will have a life-changing transplant. The register is run by the Organ Donor Foundation; people can sign up to be donors on their website.

South Africa runs a single waiting list for all transplant recipients, whether from the private or public sector. It’s estimated that more than 4,000 people in the country are waiting for an organ transplant. These patients are all discussed and listed at a collaborative weekly meeting, and deceased donor organs are allocated to the sickest patient on the list.

Has the demand for liver transplants increased over the last 20 years?

Yes. We have broadened our criteria for patients who are eligible for transplantation, such as transplanting for acute liver failure and for certain liver malignancies with strict criteria. These are categories of patients who benefit greatly, but it does add pressure to the system.

I think this increase is driven less by rising lifestyle diseases like obesity or alcohol use, and more by increased awareness. Physicians are better at diagnosing end-stage liver disease and referring patients, and patients themselves are becoming more self-aware. They are asking the right questions and self-referring to the hospital. Before, someone with end-stage disease might have just been palliated until the end, but now patients are seeking out transplantation. That is a very positive development.

Jerome Loveland, Head of Transplant Surgery at the Wits Donald Gordon Medical Centre, and Academic Head of Transplantation, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Managing Stiffness in Deep Calf Muscles Using Ultrasound Stimulation

Research shows ultrasound stimulation can reduce passive stiffness in the soleus, suggesting potential for non-invasive management of deep muscle stiffness

Ultrasound stimulation was applied to the calf for 10 minutes, and passive muscle stiffness was assessed using shear wave velocity. The study compared the superficial medial gastrocnemius (MG) and deeper soleus (SOL) muscles. Passive muscle stiffness decreased in the SOL after ultrasound stimulation, while no significant change was observed in the MG. Image credit: Mr Tomohiro Umeda from Doshisha University, Japan

Passive muscle stiffness is a risk factor for muscle strain injuries. Stretching, heat, and vibration have been evaluated on superficial muscles, but approaches for decreasing stiffness in deeper muscles remain unclear. In a recent study, researchers from Japan showed that 10 minutes of ultrasound stimulation can reduce stiffness in a deep calf muscle called the soleus, hinting at a promising non-invasive strategy for managing deep muscle stiffness, with potential future application in sports injury prevention.

Muscle strain injuries are a common problem in sports, and injuries to the triceps surae, the calf muscle group that includes the gastrocnemius and soleus, can significantly affect athletic performance and return to play. One factor that is thought to influence a muscle’s susceptibility to strain is passive muscle stiffness, which refers to the resistance of a relaxed muscle to being stretched. A recent genetic study has strengthened the idea that stiffer muscles are more prone to injury, suggesting that passive muscle stiffness is an important risk factor. Thus, finding safe and feasible ways to reduce this stiffness might help prevent associated injuries.

Several strategies, including stretching, heat, and vibration, can significantly reduce passive muscle stiffness. However, research on these approaches has focused on muscles located close to the skin. The soleus, one of the main muscles of the triceps surae, sits deep underneath the medial and lateral gastrocnemius, which makes it a difficult target. Ultrasound stimulation is used in sports and rehabilitation and produces both heating and mechanical effects in biological tissue. As lower-frequency ultrasound can penetrate relatively deep into tissue, it raises the question: Could ultrasound actually reduce the stiffness of a deep muscle like the soleus?

To this end, a research team including Ph.D. student Tomohiro Umeda, Professor Tatsuya Hojo, and Professor Taku Wakahara from the Graduate School of Health and Sports Science at Doshisha University, Japan, examined the effects of ultrasound stimulation on calf muscle stiffness in 20 healthy adults. Their work was published in the Journal of Biomechanics.

A randomly selected leg of each participant received 10 minutes of continuous ultrasound stimulation at a frequency of 1 megahertz (MHz) and an intensity of 2.0 W/cm², while the other leg served as an untreated control. The researchers then used shear wave elastography, an imaging technique that measures how quickly mechanical waves travel through tissue, to assess muscle stiffness before and immediately after the ultrasound stimulation. Faster shear waves generally indicate stiffer tissue, so a decrease in shear wave velocity (SWV) was interpreted as a decrease in passive muscle stiffness.

The results showed a clear difference between the soleus and the medial gastrocnemius. SWV, an indicator of passive muscle stiffness, decreased significantly in the soleus after the ultrasound stimulation, while no significant change was observed in the untreated leg. In contrast, no significant change in SWV was observed in the more superficial medial gastrocnemius. Interestingly, participants who initially had stiffer soleus muscles tended to show greater reductions in stiffness following ultrasound stimulation. “Our findings suggest that ultrasound stimulation may have the potential to non-invasively decrease passive stiffness in deep muscles such as the soleus,” remarks Mr Umeda, “In the future, this approach may contribute to the development of conditioning and rehabilitation strategies for the prevention of sports-related muscle injuries.”

The different responses of the soleus and medial gastrocnemius may be related partly to their anatomical locations. The soleus is located about 2.44cm below the skin, whereas the gastrocnemius is much closer to the surface at just about 0.53cm. Moreover, differences in the muscles’ tissue composition may also contribute to their different responses, although the underlying mechanisms remain unclear. “Future research could clarify the optimal ultrasound parameters for different muscles and identify which individuals respond most effectively to ultrasound stimulation. Such knowledge could lead to more individualised conditioning and rehabilitation strategies for athletes,” concludes Mr Umeda.

Overall, the results highlight the potential of ultrasound stimulation as a non-invasive approach for managing stiffness in deep muscles that can be difficult to target with other methods. Further research will be needed to determine whether this approach can be incorporated into individualised conditioning and rehabilitation strategies and ultimately contribute to the prevention of sports-related muscle injuries.

Source: Doshisha University

Hiring More Specialists won’t Fix Wait Times – And May Worsen Them

Harvard, NYU, and NEJM researchers draw on traffic engineering to explain why more physicians per capita is linked to longer waits

Photo by RDNE Stock project

A new analysis published in NEJM Catalyst Innovations in Care Delivery finds that the standard response to growing specialist wait times, hiring more physicians, is unlikely to solve the problem on its own, and may even worsen it. The article, Reducing Specialist Wait Times: What Can We Learn from Highway Traffic Engineers?, draws a direct parallel between specialist scheduling and highway congestion, where adding lanes fails to ease traffic because drivers simply adjust their behavior to take advantage of the new capacity. 

Wait times for new specialist appointments in the United States have been rising for two decades. A national survey of six specialties across 15 metropolitan areas found that average wait times reached 31 days in 2025, up 19% since 2022 and 48% since 2004. Longer waits carry real costs for patients, including psychological strain and, in some cases, worsening symptoms that lead to more hospitalizations and emergency department visits. 

Key Findings 

Examining wait-time and physician-density data across four referral specialties – cardiology, dermatology, obstetrics-gynaecology, and orthopaedic surgery – the authors found positive association between the number of specialists per capita in a metro area and how long patients waited for an appointment.  

The authors describe that this pattern mirrors “induced demand” in transportation economics: when road capacity increases, people drive more, quickly eroding any gains in travel time. In specialty care, the analogous dynamic is that more available specialists can lower the threshold at which primary care physicians refer patients, encourage patients to seek specialty care more readily, and lead specialists themselves to manage issues that primary care could otherwise handle. The result, the authors write, is that new specialists’ schedules fill quickly and wait times fail to fall. 

Rather than relying primarily on hiring, the authors outline three categories of tactics, adapted from how traffic engineers manage congestion, that health systems can use instead or in tandem: 

  • Expanding care options, such as building guidance into electronic health records so primary care physicians can manage more conditions themselves, expanding physician assistants’ and nurse practitioners’ role in specialty care, and offering virtual group visits to cut wait times. 
  • Adjusting financial incentives, including raising copayments for specialist visits relative to primary care, and reduced out-of-pocket costs for chronic disease care delivered by nurse and other provider teams. 
  • Giving patients better information tools, such as online self-scheduling, which reduces no-show rates and helps keep physician schedules full, and implementation of AI to answer patient questions and flag developing problems before they require a specialist visit. 

The authors caution that redesigning specialty care is difficult: seeing long-stable patients is often easier for specialists than taking on new, complex cases, and any redesign has to give specialists the support they need to handle the patients who most need their expertise. 

“Our argument is not against hiring more physicians, but for better leveraging the clinicians we have,” the authors write, adding that advanced practice providers in particular are “perpetually overlooked” in care redesign despite their central role on care teams. 

About the Research 

The analysis was authored by Leemore Dafny of Harvard Kennedy School & Harvard Business School, Sherry Glied of NYU Wagner Graduate School of Public Service, and Thomas H. Lee of NEJM Catalyst. It draws on wait-time and appointment-scheduling data from a national survey of physician offices in six specialties across 15 metropolitan areas, combined with physician density data from the Area Health Resources Files. 

Source: Harvard Kennedy School, EurekAlert

Angst as South Africa’s HIV & TB Healthcare Worker Hotline Goes Offline

South Africa’s HIV & TB Healthcare Worker Hotline service is run by the University of Cape Town’s Medicines Information Centre. (Photo: Unsplash)

By Adiel Ismail for Spotlight

A crucial hotline run for nearly 20 years from the slopes of Devil’s Peak in Cape Town for healthcare workers anywhere in South Africa, from the country’s busiest urban hospitals to far flung resource strained rural clinics, has been suspended due to a lack of funding.

Around two decades ago when Dr Laurel Giddy first started working with people living with HIV, they were already very ill. She remembers five of her patients that she put on antiretroviral treatment dying. She says it was heartbreaking.

“I was just at sea. I felt like I was in the deep ocean, and it was very difficult to get help. There just wasn’t a lot of knowledge going around at the time,” she tells Spotlight. “Getting trapped in an environment where you’re not sure what you’re doing and where people die and you feel unsupported is just demoralising.”

This is the kind of high-stakes situation that the team at the South African National HIV & TB Healthcare Worker Hotline responded to when South Africa’s antiretroviral rollout started gathering steam after the end of state-sponsored AIDS denialism.

And with their help, the milestones at Giddy’s HIV treatment clinic that she help set up at the Knysna Provincial Hospital followed: first 100 people on HIV medicine and a couple of years later, 5 000.

“I’m getting quite emotional, but they helped our programme just fly,” says Giddy.

18 years of national support

The free hotline has to date answered more than 86 000 queries from doctors, nurses and pharmacists in public and private healthcare facilities in all corners of the country. The service is run by the University of Cape Town’s Medicines Information Centre.

“Over 18 years, the hotline has provided trusted, evidence-based clinical support to healthcare workers across South Africa, contributing significantly to patient care and strengthening health system capacity,” Annoesjka Swart, manager of the Medicines Information Centre, tells Spotlight.

But now the phone lines have fallen silent.

“Regrettably, we no longer have the financial resources required to sustain the service, having received no funding support for the hotline since April 2025,” she says. “Although we submitted a bid for a tender that was released on 1 April 2026, to our knowledge the bid has not yet been awarded.”

SA’s troubled twins

The suspension of a free hotline service dedicated to providing clinical advice for the management of HIV and TB is particularly worrying in South Africa where the two diseases remain deeply intertwined public health crises.

South Africa has one of the highest TB incidence rates in the world and the largest HIV epidemic in any single country. TB and HIV is among South Africa’s leading causes of death. Each is estimated to claim over 50 000 lives per year, although there is substantial overlap between the two since TB is the top killer of people with HIV.

The connection between HIV and TB is relatively straightforward. People with untreated HIV infection typically suffer severe damage to their immune systems, which dramatically increases the risk of falling ill with TB and dying of it.

One study showed how usage of the hotline by nurses increased dramatically in its first few years. Such support for nurses is particularly important in the context of the health department’s decision to authorise specially trained nurses to diagnose HIV and prescribe antiretroviral medicines in terms of its NIMART (nurse-initiated Management of Antiretroviral Therapy) programme. NIMART has been lauded as one of the reasons why South Africa’s HIV treatment programme could grow as fast as it did in the 2010s. Prior to NIMART, only medical doctors could prescribe antiretrovirals.

The team behind the hotline has also been involved with research – such as this study on healthcare workers’ knowledge of interactions between a widely used antiretroviral and other medicines.

How the hotline works

Swart explains that queries received by phone, e-mail, WhatsApp and ‘please call me’ go directly to one of the specially trained information pharmacists, who record all the details in a password-protected database. “Details recorded include caller demographics – profession, sector, facility, province – and relevant patient details – antiretroviral therapy history, medical history, laboratory results and other conditions/treatment and the question.”

The pharmacist then researches the query using up-to-date, evidence-based references and, where necessary, consults an expert clinician. “All references used and clinician input is recorded on the database. Most queries are answered on the same day,” says Swart.

As the patient of a healthcare worker who calls the hotline, she says that patient can be assured that the best possible treatment has been discussed with a multi-disciplinary team, where needed, without having to leave their local clinic.

Swart adds that hotline pharmacists have access to many clinical experts, based at the University of Cape Town’s medical school, Groote Schuur Hospital, Red Cross Children’s Hospital and more.

“Up to the end of August 2026, the hotline had answered 86 672 queries,” she says. Over the last five years from 2020 to 2025, Swart says the hotline managed about 380 to 430 HIV/TB queries per month, around 18 to 20 healthcare worker consultations every working day, or an estimated 90 to 100 consultations every week.

Most queries are received from the Western Cape, Eastern Cape, Gauteng, and KwaZulu-Natal. “Over the past 5 years, we’ve seen a steady increase in calls from Mpumalanga – 347 in 2021 to 571 in 2025 – and Limpopo – from 90 in 2021 to 201 in 2025,” she says.

Practical resources

While the primary focus of the hotline is to provide clinical support to healthcare workers across South Africa, Swart says her team also develops and designs easy-to-use posters, booklets and tools based on national guidelines.

There is also an associated SA HIV/TB Hotline app available on Google Play and the Apple App Store. It includes a drug-drug interaction checker allowing healthcare workers to check multiple medicines against all HIV medicines, a step-by-step tool on how to manage skin, renal and liver adverse drug reactions to antiretrovirals and TB medicines, and a dosing tool for prescribing HIV medicines for children. “The app had over 6 000 active South African users between April and June 2026,” says Swart.

She adds that a Facebook page was created in 2016, which posts daily news and a weekly query of the week on Fridays to a following of over 12 500 people.

In one query posted on Facebook, a nurse from the Eastern Cape wanted to know if she should recall a patient earlier than the month she instructed. She initiated the 23-year-old male, who had been diagnosed with HIV three days earlier, onto the single-pill, once-a-day antiretroviral regimen of Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir. While he was clinically well, results for his CD4 count – the number of blood cells in a cubic millimetre of blood which gives an indication of the health of a person’s immune system – was 179 and he tested positive on a cryptococcal antigen test (CrAg).

The hotline’s experts advised the nurse to recall the client urgently, within 1 to 3 days and was pointed to the country’s guidelines which state that any client with a first or new CrAg-positive result should be called back for an urgent lumbar puncture and clinical assessment for meningitis, regardless of whether symptoms of meningitis are present. (Read Spotlight’s special briefing on cryptococcal meningitis, which is a serious fungal infection causing inflammation of the lining of the brain and one of the top killers of people living with HIV in South Africa.)

Swart says based on knowledge gaps that the pharmacists on the hotline pick up through the queries received, the hotline service has provided weekly WhatsApp-based microlearning sessions to three groups of healthcare workers. Since May 2025, 723 nurses, 915 pharmacists and doctors, and 375 community health workers joined these sessions on a wide spectrum of HIV and TB topics.

“The closure of the hotline will result in the unavailability of free clinical support for healthcare workers across the country managing people living with HIV and TB,” Swart says. “In addition, no posts will be added to the Facebook page, no new posters or tools will be designed, the weekly training has stopped, and the app will be maintained but not expanded.”

The funding conundrum

Swart explains that the hotline service has been funded throughout its existence, and most recently through a service level agreement with the National Department of Health from a Global Fund grant. “Our last Global Fund tranche finished in March 2025, and all documents to renew the contract were previously submitted in May 2024 for a new contract to start on 1 April 2025,” she says.

The Global Fund, established in 2002 to provide funding for HIV, TB and malaria programmes, announced in May last year that it was reducing funding to over 100 countries amidst shortfalls. It has indicated that it’s final grant to South Africa of around US$403 million will be for the period running from April 2031 to March 2034.

Swart says her team was informed in November 2024 that the team in charge of the Global Fund grant at the National Department of Health were planning to implement a tender process and was reassured that the hotline activities will still be supported.

“Several delays then ensued in combination with the global funding cuts across the board in February 2025. In April 2026, the service was put out on tender, and we successfully progressed through Phases 1 and 2 of the evaluation process. Following an invitation to present on 15 May 2026, we have unfortunately not received any further feedback, despite follow-up efforts made in a manner that respects the integrity and confidentiality of the procurement process. There has also been no information that another bidder was successful.”

Swart says the hotline’s activities came under strain in October 2025 when significant cuts in staff time were implemented and emergency funding was used to sustain the service.

“While we have always needed to seek and apply for funding, we have kept the service going and never had to face suspension before. Unfortunately, the massive budgetary constraints can no longer be overcome with emergency and cross funding endeavors,” she says. “It will remain suspended until alternative funding can be secured or the tender is awarded, so that we can reopen the hotline and continue all advisory activities.”

Spotlight sent questions to the National Department of Health, but had not received a response by time of publication.

What it means for healthcare workers

The news of the suspension of the National HIV and TB Healthcare Worker Hotline has prompted widespread concern.

Southern African HIV Clinicians Society CEO Dr Fiona Storie says it has promoted the use of the hotline to their extensive network of healthcare workers throughout the years.

“We believe the hotline provides an integral support service to clinicians in the country. The suspension of the hotline represents a significant loss of a valuable resource that enhances evidence-based HIV and TB management in South Africa.”

Noluthando Swartbooi, an occupational health nurse practitioner at Kwazakhele Clinic in Nelson Mandela Bay, tells Spotlight she has been using the hotline for about four years now. “HIV and TB management continues to require ongoing support, up to date knowledge and at times specialist guidance. Having access to experience through the hotline has been extremely helpful,” she says.

With chronic shortages of healthcare workers in the public sector among other challenges, she says she is worried about the suspension of the service. “The cases we deal with are not straight textbook examples so guidance from experts is beneficial. Suspending the hotline could place a strain on healthcare workers as they may have fewer options of teams that may assist in management of patient cases. This may affect the quality of care provided to patients,” she says.

A clinical pharmacist in Mpumalanga, who has been using the hotline for around five years, says she is daunted because most practitioners she works with don’t keep updated with current national treatment guidelines. She says it falls on her with the help of the hotline to ensure that all patients are taking appropriate treatment and the right doses.

“I do not know who I’ll be seeking help from moving forward, especially for patients that need dose adjustments according to the liver and kidney function tests as well as paediatrics since there’s some TB medication that’s out of stock. Their absence will make my workload even heavier than it already is right now,” she says.

For her part, Swart seems committed to limiting the disruption and finding a way to getting the hotline up and running again.

“While the suspension of services represents a significant and regrettable setback, we remain fully committed to preserving the hotline and are actively exploring funding opportunities that may allow us to resume operations in the future,” she says. “Should funding become available, we will work diligently to restore the service as soon as possible.”

Giddy says she is devastated that the hotline service is on its knees. “They supported us in our sorrows, and they rejoiced in our triumphs with us for years,” she says.

*This article was first published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.