Seeing is believing: Identifying remyelination in the central nervous system.

Remyelination is the regenerative process by which lost myelin sheaths are restored to demyelinated axons. It is a key target in the treatment of chronic demyelinating disorders such as multiple sclerosis (MS), in which inflammation results in destruction of myelin. In the central nervous system (CNS), remyelination typically requires the differentiation of oligodendrocyte progenitor cells (OPCs) into the myelinating oligodendrocytes (OL). Following successes in preclinical studies, several putative pro-regenerative therapies aimed at enhancing remyelination are under clinical investigation. However, there is a translational barrier in identifying successful outcomes: preclinical measures of remyelination do not translate well to clinical studies, and the paraclinical measures currently deployed in trials are challenging to apply to small rodent models of remyelination. Here, we describe the current approaches to identifying remyelination both in preclinical and clinical settings and highlight exciting translational candidates, which may help to bridge the current impasse.

Clinical examination does not assist in the detection of systemic relapse of testicular germ cell tumour.

AIMS: Patients on follow-up after orchidectomy or chemotherapy for testicular germ cell tumours follow a protocol of outpatient appointments and investigations designed to detect relapse. We wanted to investigate the contribution of clinical examination to patient management. MATERIALS AND METHODS: The notes of 70 consecutive patients who suffered a first systemic relapse of their germ cell tumour within the last 10 years were studied to determine how the relapse was detected. Second testicular tumours were excluded. RESULTS: Of the 69 patients whose notes were available, only one had a significant finding on physical examination, concurrent with abnormal markers. CONCLUSIONS: We suggest that, for patients following a planned programme of appointments and investigations, physical examination rarely contributes to the detection of systemic relapse in the follow-up of testicular germ cell tumours. It may therefore be possible to reconfigure follow-up to focus on investigations and telephone contact. We estimate that this change might be appropriate for 40% of attendances and might be welcomed by patients, many of whom find follow-up burdensome. If such a change were considered, patient education would be essential to ensure continuing compliance with the follow-up protocol.