Dissecting the multifactorial nature of demyelinating disease

Chondroitin sulfate proteoglycan-4(CSPG4) is a surface component of two key cell types(oligodendrocyte progenitor cells(OPCs) and myeloid cells) present in lysolecithin-induced lesions in mouse spinal cord.Two types of CSPG4 manipulations have been used to study the roles of these cells in myelin damage and repair:(1) OPC and myeloid-specific ablation of CSPG4,and(2) transplantation of enhanced green fluorescent protein(EGFP)-labeled progenitors to distinguish between bone marrow-derived macrophages and resident microglia.Ablation of CSPG4 in OPCs does not affect myelin damage,but decreases myelin repair,due to reduced proliferation of CSPG4-null OPCs that diminishes generation of mature oligodendrocytes for remyelination.Ablation of CSPG4 in myeloid cells greatly decreases recruitment of macrophages to spinal cord lesions,resulting in smaller initial lesions,but also in significantly diminished myelin repair.In the absence of macrophage recruitment,OPC proliferation is greatly impaired,again leading to decreased generation of myelinating oligodendrocytes.Macrophages may promote OPC proliferation via phagocytosis of myelin debris and/or secretion of factors that stimulate OPC mitosis.Microglia are not able to substitute for macrophages in promoting OPC proliferation.An additional feature of lesions in myeloid-specific CSPG4 null mice is the persistence of poorly-differentiated platelet-derived growth factor receptor α(PDGFRα) + macrophages that may prolong damage.     

Perceptions of professional role in community mental health nurses: The interplay of power relations between nurses and mentally ill individuals

Nurses' professional role perception is related to the quality and safety of care. Limited data exist regarding professional role perception in community mental health nurses (CMHNs). The aim of the present study was to investigate the living experience of Greek-Cypriot CMHNs of their professional role. A phenomenological approach based on Munhall's methodology was applied. According to purposive sampling, five Greek-Cypriot CMHNs participated, following informed consent. The interplay of power relations between participants and mentally ill individuals during CMHNs' house calls was revealed as the core theme contributing to the perception of their status within their professional role. Participants' perception of their status as visitors in patients' homes rather than authoritative figures, an image held within hospital mental health services, was deemed as the greatest challenge of their professional role. Moreover, the necessity for autonomous and rapid decision-making during home visits was described as an absolute prerequisite for professional effectiveness. Overall, the main themes were grouped as follows: professional role perceptions, perception of self within professional role, feelings and expectations about professional role. Non-power relations between participants and patients, along with efficacy, control and adequate clinical autonomy for effective professional practice were highlighted as major prerequisites during house calls. Interventions towards nurses' psychosocial and organizational empowerment, as well as strengthening patients' self-determination are proposed.     

Prognostic value of DNA ploidy and automated assessment of stroma fraction in prostate cancer

The combination of DNA ploidy and automatically estimated stroma fraction has been shown to correlate with recurrence and cancer death in colorectal cancer. We aimed to extend this observation and evaluate the prognostic importance of this combined marker in prostate cancer. DNA ploidy status was determined by image cytometry and the stroma fraction was estimated automatically on hematoxylin and eosin stained sections in three tumor samples from each patient to account for tumor heterogeneity. The optimal threshold for low (≤56%) and high (>56%) stroma fraction was identified in a discovery cohort (n = 253). The combined marker was validated in an independent patient cohort (n = 259) with biochemical recurrence as endpoint. The combined marker predicted biochemical recurrence independently in the validation cohort. Multivariable analysis showed that the highest risk of recurrence was observed for patients with samples that had both non-diploid ploidy status and a high stroma fraction (hazard ratio: 2.51, 95% confidence interval: 1.18–5.34). In conclusion, we suggest the combination of DNA ploidy and automatically estimated stroma fraction as a prognostic marker for the risk stratification of prostate cancer patients. It may also be a potential generic marker as concurrent results have been described in colorectal cancer.     

A longitudinal study of voice before and after phonosurgery for removal of a polyp

The aim of the present investigation was to evaluate the acoustic parameters, perceptual estimation, and self‐estimation of voice before, 1 month after, and 6 years after surgical removal of a vocal fold polyp. Subjects were five male patients who came to the Phoniatric Clinic because of breathiness. For all patients, a polyp of one vocal fold was diagnosed. The operation was performed using cold instruments based on the principles of contemporary phonosurgery aiming maximally at preserving the phonatory bridge of the vocal fold. The subjects were recorded in a sound‐proof booth three times: before surgery, 1 month post‐, and 6 years post‐operation. The patients read a short tale and they pronounced a sustained vowel /a/. The following variables were measured: clinical (the distance of the polyp from the anterior commissure, the width of the polyp base and the size of the polyp), and acoustic (F0, jitter, shimmer, harmonic‐to‐noise ratio, voice turbulence index, degree of voice breaks, and long‐term average spectrum). Acoustic variables were measured using the program Praat, while the estimation of voice quality was completed using the GRBAS scale and self‐estimation questionnaire of the voice quality, which were answered by the patients. The results showed significant improvement in the variables investigated and improved patients satisfaction with their vocal health after the surgery.