Showing papers by "Eric G. Neilson published in 2020"
TL;DR: The developmental origin and plasticity of fibroblasts, their molecular and functional definitions, the epigenetic control underlying their identity and activation, and the evolution of their immune regulatory functions are examined.
Abstract: The inherent plasticity and resiliency of fibroblasts make this cell type a conventional tool for basic research. But where do they come from, are all fibroblasts the same, and how do they function in disease? The first fibroblast lineages in mammalian development emerge from the ooze of primary mesenchyme during gastrulation. They are cells that efficiently create and negotiate the extracellular matrix of the mesoderm in order to migrate and meet their developmental fate. Mature fibroblasts in epithelial tissues live in the interstitial spaces between basement membranes that spatially delimit complex organ structures. While the function of resident fibroblasts in healthy tissues is largely conjecture, the accumulation of fibroblasts in pathologic lesions offers insight into biologic mechanisms that control their function; fibroblasts are poised to coordinate fibrogenesis in tissue injury, neoplasia, and aging. Here, we examine the developmental origin and plasticity of fibroblasts, their molecular and functional definitions, the epigenetic control underlying their identity and activation, and the evolution of their immune regulatory functions. These topics are reviewed through the lens of fate mapping using genetically engineered mouse models and from the perspective of single-cell RNA sequencing. Recent observations suggest dynamic and heterogeneous functions for fibroblasts that underscore their complex molecular signatures and utility in injured tissues.
123 citations
Journal Article•
TL;DR: Initial serum creatinine levels and responses to initial therapy with prednisone and short-term cyclophosphamide, as used in the LNCS, can guide further therapy and have a low risk for renal failure and may not require long-term treatment with cycloph phosphamide.
Abstract: ▪Objective:To describe the clinical course of severe lupus nephritis and to identify the risk factors for progression to renal failure among patients treated with prednisone and short-term...
122 citations
TL;DR: Faced with a looming new-normal, many educators are ruminating on how best to ensure rigorous medical training that produces a steady stream of competent physicians.
Abstract: In current circumstances one rightfully wonders if persistence of SARS-Cov-2 will fundamentally alter the landscape of medical education and hospital training. Absent a vaccine, the prevalence of this virus adds to annual respiratory illnesses caused by seasonal influenza, respiratory syncytial virus, rhinoviruses, and other coronaviruses. Faced with a looming new-normal, many educators are ruminating on how best to ensure rigorous medical training that produces a steady stream of competent physicians.
By way of background, the umbrella of medical education covers a highly structured curriculum in a variety of pre-clinical and clinical environments whose architecture and requirements are set by the Liaison Committee for Medical Education (LCME) ( 1 ) and the Accreditation Council for Graduate Medical Education (ACGME) ( 2 ). These requirements reflect established habits for producing quality outcomes. Capricious changes to these requirements can alter the carat of each uncut gem matriculating to medical school. And for this reason, students follow inviolate course work to their doctorate. Graduates can apply for state licensure to become physicians after receiving accredited training as interns and residents. Only later when seen serving a public good are physicians fully vested professionals. Such training can last 7-10 years.
Modern training encompasses a well-thought-out system of educational milestones …
69 citations
TL;DR: In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
Abstract: PURPOSE Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. METHOD All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. RESULTS Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P = .02). CONCLUSIONS In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
9 citations