Complementary therapy support in cancer survivorship: a survey of complementary and alternative medicine practitioners' provision and perception of skills.

This study reviewed the confidence and perceived skills of complementary and alternative medicine (CAM) practitioners in providing care and symptom management for clients post cancer. An e-survey was mailed to approximately 21, 000 CAM practitioners, targeted at those working with clients who were experiencing consequences of cancer and its treatments. Questions were asked about the main symptoms and concerns of clients, the confidence and current skill levels of practitioners and additional training requirements. Six hundred and twelve practitioners responded to the survey, 507 of whom were working with individuals experiencing the consequences of cancer and its treatments. Forty-five per cent (n = 134) had undertaken training in cancer prior to working with cancer patients, 61% (n = 182) had undertaken courses or study days relative to cancer care in the past two years. The most often treated symptoms or concerns of patients were those of a psychosocial nature, pain management and lymphoedema. CAM practitioners with limited knowledge and training are providing support to cancer survivors, particularly in services where the National Health Service has limited provision. CAM practitioners may fulfil a future role in providing long-term support for cancer survivors; however, in order to properly safeguard patients they are in need of further training and development.

Scanning electron microscope studies of the endometrium of the cyclic mare.

Endometrial biopsies obtained from mares at different stages of the oestrous cycle, during anoestrus and in various abnormal conditions were examined with the scanning electron microscope. Preliminary observations suggest that the patterns of secretory and ciliary activity in the uterine epithelium are similar to those observed by electron microscopical techniques in laboratory and other large domestic animals. The response of the epithelial cells to hormonal variations and infections is compared with that of the endometrium as seen with the light microscope.

Ultrastructural studies of the equine uterus and placenta following parturition.

Post-partum placentae and uterine biopsy samples from mares after normal and abnormal foalings are described. After normal delivery there is little damage to fetal or maternal tissues. The villous epitheliochorial palcenta separates cleanly at the maternal-fetal interface and the afterbirth consists almost exclusively of fetal tissue. Uterine involution is well advanced by the 3rd and 4th days post partum and the changes are usually complete by the oestrus 7--10 days after parturition. Placental separation and involution of the uterus appear to proceed normally in malpresented foals and in otherwise viable foals with musculoskeletal defects. In aborted, stillborn or dysmature foals there are obvious signs of damage to both fetal and maternal tissues. It is generally accepted that the growth and development of the fetus is dependent upon a placenta of adequate functional capabilities. The observations suggest that the placenta is similarly dependent upon its association with a normal healthy fetus.

Ultrastructural changes in the placenta of the ewe after fetal pituitary stalk section.

Binucleate cells are a normal component of the ovine chorionic epithelium, but are usually separated from the fetal-maternal interface by a thin layer of cytoplasm derived from the principal or uni-nucleate cells of the trophoblast. They are distinguished not only by two distinct and separate nuclei, but also by conspicuous membrane-bound cytoplasmic inclusions in the form of haloed droplets. After fetal pituitary stalk section binucleate cells move up to and participate in the formation of the fetal-maternal interface; furthermore they extend clear blunt-ended pseudopodia into the maternal epithelial syncytium. These activities do not appear to be supppressed by fetal infusion of cortisol or ACTH. The apparent motility of binucleate cells, together with the presence of haloed droplets within the maternal epithelial syncytium, suggests that after fetal pituitary stalk section binucleate cells invade the uterine syncytium, lose their limiting membranes and discharge their contents into the syncytial cytoplasm. Large molecules such as ovine placental lactogen may be transported from fetal to maternal tissues by this mechanism.

Studies on the equine placenta. III. Ultrastructure of the uterine glands and the overlying trophoblast.

Ultrastructural studies of the uterine glands at intervals during pregnancy in the mare show that secretory activity continues after formation of the placental exchange units. The nature of the glandular secretion appeared initially to be proteinaceous, but cellular debris was also present during the last third of gestation. These secretions were absorbed by the trophoblast overlying the mouths of the glands. The fate secretions and their significance for the fetus and placenta are unknown.

Studies on the equine placenta II. Ultrastructure of the placental barrier.

In early pregnancy the equine placenta consists of a simple apposition of fetal and maternal epithelia, but it becomes more complex with the formation of microcotyledons between 75 and 100 days of gestation. Although the placental barrier maintains an epitheliochorial arrangement throughout the course of pregnancy, a thinning of the maternal epithelium and a progressive indentation of the chorionic epithelium by fetal capillaries shortens the length of the diffusion pathway and reduces the amount of placental tissue between fetal and maternal bloodstreams. These structural modifications may reflect the changing requirements of the fetus for O2 and other metabolites as gestation proceeds. During the first 200 days of pregnancy there is evidence of intense pinocytotic activity by the cells of the trophoblast. From the 100th day of pregnancy there is a pronounced development of smooth endoplasmic reticulum, while rough endoplasmic reticulum and irregular, dense, membrane-bound bodies are a prominent feature of the paranuclear cytoplasm from Day 200. These changes suggest that the cells of the trophoblast become more highly involved in synthetic processes with increasing gestational age.

PIP: The ultrastructure of the equine placenta was observed on gestation Days 46, 61, 75, 98, 101, 150, 200, 250, and 300 in Welsh Mountain Ponys mares. In early pregnancy, up to 75 days, when the placenta is epitheliochorial, the trophoblast forms a wide band of columnar epithelium with large nuclei, pinocytotic vesicles, and a defined basal lamina beneath the fetal vessels. Maternal epithelium has branched microvilli, spherical nuclei, droplets of mucopolysaccharide, and a moderately thick capillary endothelium. From Days 100-200 the villi and crypts of the microcotyledons develop. The trophoblast shows larger pin ocytocic vesicles (.5 MCM), extensive smooth endoplasmic reticulum (ER), and the fetal capillaries indent into the trophoblast. Maternal epithelium becomes progressively thinner. In the last trimester the trophoblast becomes thinner with nuclei and mitochondria near the indented capillaries, and dense bodies apical to the nucleus. By this time the maternal epithelium is only 1/3 its original thickness, with few organelles except Golgi, mitochondria, and an irregular and sometimes pyknotic nucleus. The ultrastructure supports the idea that the trophoblast may be synthesizing steroids in the later stages of pregnancy.

Ultrastructural studies of the placenta of the ewe: phagocytosis of erythrocytes by the chorionic epithelium at the central depression of the cotyledon.

Extravasated maternal blood, which escapes from capillaries and larger blood vessels within the tips of the maternal septa, is responsible for the characteristic pigmentation of the central depression of the ovine cotyledon in the last third of pregnancy. The chorionic epithelium of this region is actively engaged in the uptake and subsequent breakdown of maternal erythrocytes, which may represent an important source of iron for the foetus during the period of maximum intra-uterine growth.

Ultrastructural studies of the rabbit placenta in the last third of gestation.

Placental attachment and the ultrastructure of the decidua and placental labyrinth have been studied in rabbits during the final third of gestation. The placenta became progressively easier to separate from the uterine wall as gestation proceeded. This ease of separation was associated with degenerative changes in the decidual tissue, but disruption of the placental labyrinth was not observed until the last 24 hr of pregnancy. Two types of decidual cells were observed; smaller uninucleate glycogen-containing cells and larger multinucleate cells with lipid inclusions. The ageing placentae exhibited increasing decidual degeneration associated with deposition of extracellular fibrous materials. Glycogen became less widely distributed over the period of study and changed from the beta- to the alpha-configuration. In contrast to the observed disruption of the decidual tissue, the placental labyrinth maintained its integrity until the final stages of pregnancy. A dramatic increase in subcellular activity was observed in the syncytiotrophoblast after 28 days of gestation.

Development of pituitary and adrenal glands in the fetal horse.

The various cell types in the adult anterior pituitary may be distinguished at the ultrastructural level of the sizes of the secretory granules within the cytoplasm. In the fetal adenohypophysis, with the exception of prolactin-producing cells, all types may be identified after Day 100 of gestation. Morphological evidence suggests that they are producing and secreting trophic hormones. The three constituent layers of the adrenal cortex are also discernible by Day 100 of pregnancy. The cells of the zona glomerulosa have large numbers of darkly stained inclusions within the cytoplasm. The zona fasciculata shows changes consistent with the production and secretion of steroid hormones.

Ultrastructural development of the equine placenta.

Microcotyledons, which are a distinctive feature of the mature equine placenta, are fully formed by Day 150 of gestation. The fetal component of each microcotyledon is developed from several primary folds of trophoblast which become elaborately subdivided as gestation proceeds. These changes are reflected in the structure of the maternal crypts, which receive the fetal villi. Between Days 60 and 150 of gestation the maternal epithelium is greatly reduced in height. No such change occurs on the fetal side of the placenta, but between Days 100 and 250 a progressive indentation of the epithelium by fetal capillaries reduces the effective thickness of the placental barrier. The ultrastructural characteristics of fetal and maternal epithelia are described.

Anatomy of the placental barrier in the mare.

The study of the equine placenta, which began in Venice in 1598, has a long but discontinuous history. Early observations were purely morphological, but new techniques have stimulated a broader and more functional approach. Histological and ultrastructural observations at various stages of pregnancy have shown that the fetal side of the placenta comes to acquire certain features in common with the air-blood barrier of the mammalian lung. These changes may reflect the increasing O2 requirements of the fetus as gestation proceeds.