The aim of this study was to quantify the total number of neurons and glial cells in the mediodorsal nucleus of the thalamus (MD) of 8 newborn human brains, in comparison to 8 adult human brains. The estimates of the cell numbers were obtained using the stereological principles of the optical fractionator. In the case of the adults, the total number of neurons in the entire MD was an average of 41% lower than in the newborn, which was statistically highly significant (P < 0.001). The estimated average total number of neurons in MD thalamus of the newborns was 11.2 million (coefficient of variation [CV] = standard deviation/mean = 0.16), compared with the adults' 6.43 million (CV = 0.15). The glial cell numbers were substantially higher in the adult brains, with an increase of almost 4 times from 10.6 million at birth to 36.3 million in the fully developed adult brain. This is the first demonstration of a higher number of human neurons in the brain of newborns compared with the adult.
Several stereological studies of schizophrenic subjects have shown reduction in both the total number of neurons and in the total volume of the mediodorsal thalamic nucleus (MD). This is in contrast to other studies in that no differences have been found. Using systematic random sampling and an optical fractionator design, the total number of neuron and glial cells in the MD subdivisions: parvocellular (MD PC ), magnocellular (MD MC ), and densocellular (MD DC ) were counted in brains from 9 schizophrenic and 8 control subjects. The control subjects were age, height and body-weight matched to the schizophrenic subjects. We found the neuronal numbers in the schizophrenic subjects to range more than a factor of two, from 3.68 to 9.22 x 10 6 . This is in contrast to the control subjects, who ranged from 5.24 to 7.10 x 10 6 in neuronal cell numbers. Within our inhomogeneous sample, some schizophrenic subjects thus exhibited relative high total neuron numbers in MD, while others exhibited relative low neuron numbers. The result is in line with the heterogeneity of this severe mental disease and may help to explain why different research groups get different results. The major limitation in this study is the small number of brains of schizophrenic subjects with a high degree of inhomogeneity in length of disease and age of onset. The debates of the comparison of the neurons in the MD in brains of schizophrenic subjects and control subjects and the possible impact of this variance on the disease are still not complete.
Background: Many children and adolescents with incurable cancer and their families prefer to receive end-of-life care and to die at home. This implies a transition of care from hospital to home and presupposes the establishment of a well-functioning collaboration between the family and professionals across health care sectors. Aim: To identify and explore key elements of home-based end-of-life care collaboration for children with cancer, as experienced by their parents and grandparents and the hospital- and community-based professionals involved. Design: Descriptive qualitative multiple-case study. Data were collected by semi-structured interviews and written responses to open-ended questions, and analyzed inductively across cases using qualitative content analysis. Setting/participants: Cases comprised a criterion sample of five children (aged <18 years), who died of cancer at home. Cases were represented by the children’s bereaved parents ( n = 8) and grandparents ( n = 7), and community-based professionals ( n = 16). Also, hospital-based professionals ( n = 10) were interviewed about the children’s end-of-life care through group interviews. Results: We identified five main themes, describing key elements of the end-of-life collaboration: Establishing the collaboration, Bolstering family life, Elucidating organization and integration, Managing challenges, and Closing the collaboration. These themes all came under the overarching theme: A mutual trust-based collaboration. On this basis, we developed the “Home-Based Pediatric End-of-Life Care Model for Children with Cancer.” Conclusions: By highlighting key elements in the family-centered, intersectoral and interprofessional end-of-life care collaboration, our “Home-Based Pediatric End-of-Life Care Model for Children with Cancer” offers a framework for further optimization of home-based end-of-life care services for children with cancer and their families.
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