The need for empathetic healthcare systems

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.publishedVersio

Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis

Objective This study aimed to estimate the effect of antenatal corticosteroid administration on neonatal mortality and morbidity in preterm small-for-gestational age infants through a systematic review and meta-analysis. Data Sources A predefined, systematic search was conducted through Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trial Registry Platform, and ClinicalTrials.gov yielding 5324 articles from 1970 to 2019. Study Eligibility Criteria Eligible studies compared neonatal morbidity and mortality among small-for-gestational age infants delivered preterm who received antenatal corticosteroids with those who did not. Methods The primary outcome was neonatal mortality. Secondary outcomes were respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia, bronchopulmonary dysplasia or chronic lung disease of prematurity, or neonatal sepsis. We assessed heterogeneity by means of Higgins I2 statistic and Cochran’s Q test and calculated pooled odds ratios with 95% confidence intervals using random effects models. Results A total of 16 observational cohort and case-control studies published from 1995 to 2018 met the selection criteria for the systematic review and included 8989 preterm small-for-gestational age infants. Antenatal corticosteroid administration was explicitly reported among 8376 small-for-gestational age infants; 4631 (55.3%) received antenatal corticosteroids and 3741 (44.7%) did not. Of note, 13 studies including 6387 preterm small-for-gestational age infants were then included in the meta-analysis. Neonatal mortality was significantly lower among infants who received antenatal corticosteroids than those who did not (12 studies: 12.8% vs 15.1%; pooled odds ratio, 0.63; 95% confidence interval, 0.46–0.86), with significant heterogeneity between studies (I2=55.1%; P=.011). There was no significant difference in respiratory distress syndrome (12 studies: odds ratio, 0.89; 95% confidence interval, 0.69–1.15), necrotizing enterocolitis (7 studies: odds ratio, 0.93; 95% confidence interval, 0.70–1.22), intraventricular hemorrhage and periventricular leukomalacia (10 studies: odds ratio, 0.82; 95% confidence interval, 0.56–1.20), bronchopulmonary dysplasia or chronic lung disease of prematurity (8 studies: odds ratio, 1.11; 95% confidence interval, 0.88–1.41), or neonatal sepsis (6 studies: odds ratio, 1.13; 95% confidence interval, 0.86–1.49). Conclusion These data indicate that antenatal corticosteroid administration reduces neonatal mortality in small-for-gestational age infants delivered preterm, with no apparent effect on neonatal morbidity. This supports the use of antenatal corticosteroids to reduce neonatal mortality in pregnancies with small-for-gestational age infants at risk of preterm birth

TOP2A and EZH2 Provide Early Detection of an Aggressive Prostate Cancer Subgroup.

Purpose: Current clinical parameters do not stratify indolent from aggressive prostate cancer. Aggressive prostate cancer, defined by the progression from localized disease to metastasis, is responsible for the majority of prostate cancer–associated mortality. Recent gene expression profiling has proven successful in predicting the outcome of prostate cancer patients; however, they have yet to provide targeted therapy approaches that could inhibit a patient\u27s progression to metastatic disease. Experimental Design: We have interrogated a total of seven primary prostate cancer cohorts (n = 1,900), two metastatic castration-resistant prostate cancer datasets (n = 293), and one prospective cohort (n = 1,385) to assess the impact of TOP2A and EZH2 expression on prostate cancer cellular program and patient outcomes. We also performed IHC staining for TOP2A and EZH2 in a cohort of primary prostate cancer patients (n = 89) with known outcome. Finally, we explored the therapeutic potential of a combination therapy targeting both TOP2A and EZH2 using novel prostate cancer–derived murine cell lines. Results: We demonstrate by genome-wide analysis of independent primary and metastatic prostate cancer datasets that concurrent TOP2A and EZH2 mRNA and protein upregulation selected for a subgroup of primary and metastatic patients with more aggressive disease and notable overlap of genes involved in mitotic regulation. Importantly, TOP2A and EZH2 in prostate cancer cells act as key driving oncogenes, a fact highlighted by sensitivity to combination-targeted therapy. Conclusions: Overall, our data support further assessment of TOP2A and EZH2 as biomarkers for early identification of patients with increased metastatic potential that may benefit from adjuvant or neoadjuvant targeted therapy approaches. ©2017 AACR

Distribution of an Invasive Aquatic Pathogen (Viral Hemorrhagic Septicemia Virus) in the Great Lakes and Its Relationship to Shipping

Viral hemorrhagic septicemia virus (VHSV) is a rhabdovirus found in fish from oceans of the northern hemisphere and freshwaters of Europe. It has caused extensive losses of cultured and wild fish and has become established in the North American Great Lakes. Large die-offs of wild fish in the Great Lakes due to VHSV have alarmed the public and provoked government attention on the introduction and spread of aquatic animal pathogens in freshwaters. We investigated the relations between VHSV dispersion and shipping and boating activity in the Great Lakes by sampling fish and water at sites that were commercial shipping harbors, recreational boating centers, and open shorelines. Fish and water samples were individually analyzed for VHSV using quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and cell culture assays. Of 1,221 fish of 17 species, 55 were VHSV positive with highly varied qRT-PCR titers (1 to 5,950,000 N gene copies). The detections of VHSV in fish and water samples were closely associated and the virus was detected in 21 of 30 sites sampled. The occurrence of VHSV was not related to type of site or shipping related invasion hotspots. Our results indicate that VHSV is widely dispersed in the Great Lakes and is both an enzootic and epizootic pathogen. We demonstrate that pathogen distribution information could be developed quickly and is clearly needed for aquatic ecosystem conservation, management of affected populations, and informed regulation of the worldwide trade of aquatic organisms

The Vehicle, Spring 1993

1993 Commemorative Edition: Celebrating 35 Years Table of Contents The Vehicle Editors\u27 Lineagepage 5 Milestonespage 6 THE SIXTIES Coverspage 7 Editors\u27 Notespage 8 Sureness is Never - excerptDon Shepardsonpage 9 SophisticationBenjamin Polkpage 10 A SonnetMignon Stricklandpage 11 The Twenty-Third ChannelBen Polkpage 11 Opposite AttractionsC.E.M. (Christine McColl)page 12 John F. KennedyJoel E. Hendrickspage 13 The Girl on the White PonyLarry Gatespage 14 The TimesW.D.M. (William Moser)page 16 Home ThoughtsJane Careypage 17 1966Roger Zulaufpage 18 Nagging ThoughtJanet Andrewspage 18 THE SEVENTIES Coverspage 19 Editors\u27 Notespage 20 RevolutionsSteve Siegelpage 21 UntitledKristine Kirkhampage 23 The Arithmetic ProblemJanice Forbuspage 23 Willie Seeverson Threw a Worm at MeMary Pipekpage 24 a love poem (by approximation)Ted Baldwinpage 25 Night and Summer in Two WorldsBarry Smithpage 26 Story of a Teenage PickleTerry Louis Schultzpage 27 Danny Lonely, Danny WildDevin Brownpage 28 Always TomorrowMary McDanielpage 29 THE EIGHTIES Coverspage 31 Having ChildrenDevon Flesorpage 33 What is Unnatural Is Sometimes MagicAngelique Jenningspage 34 If My Father Were A Writer, He Would Still BuildAngelique Jenningspage 35 Photo AlbumPatrick Peterspage 36 Poet Born in Pearl HarborAngelique Jenningspage 37 The History of High School BasketballPatrick Peterspage 38 Banana BreadGail Bowerpage 39 Cover LetterBob Zordanipage 40 Home MoviesBob Zordanipage 41 MigrationPatrick Peterspage 42 THE NINETIES Ba, Ba, Black SheepVictoria Bennettpage 45 Daily LessonsJennifer Moropage 49 Folding My OwnLaurie Ann Malispage 51 About the Authorspage 53 Editors\u27 Notespage 56https://thekeep.eiu.edu/vehicle/1062/thumbnail.jp

The Vehicle, Spring 1993

1993 Commemorative Edition: Celebrating 35 Years Table of Contents The Vehicle Editors\u27 Lineagepage 5 Milestonespage 6 THE SIXTIES Coverspage 7 Editors\u27 Notespage 8 Sureness is Never - excerptDon Shepardsonpage 9 SophisticationBenjamin Polkpage 10 A SonnetMignon Stricklandpage 11 The Twenty-Third ChannelBen Polkpage 11 Opposite AttractionsC.E.M. (Christine McColl)page 12 John F. KennedyJoel E. Hendrickspage 13 The Girl on the White PonyLarry Gatespage 14 The TimesW.D.M. (William Moser)page 16 Home ThoughtsJane Careypage 17 1966Roger Zulaufpage 18 Nagging ThoughtJanet Andrewspage 18 THE SEVENTIES Coverspage 19 Editors\u27 Notespage 20 RevolutionsSteve Siegelpage 21 UntitledKristine Kirkhampage 23 The Arithmetic ProblemJanice Forbuspage 23 Willie Seeverson Threw a Worm at MeMary Pipekpage 24 a love poem (by approximation)Ted Baldwinpage 25 Night and Summer in Two WorldsBarry Smithpage 26 Story of a Teenage PickleTerry Louis Schultzpage 27 Danny Lonely, Danny WildDevin Brownpage 28 Always TomorrowMary McDanielpage 29 THE EIGHTIES Coverspage 31 Having ChildrenDevon Flesorpage 33 What is Unnatural Is Sometimes MagicAngelique Jenningspage 34 If My Father Were A Writer, He Would Still BuildAngelique Jenningspage 35 Photo AlbumPatrick Peterspage 36 Poet Born in Pearl HarborAngelique Jenningspage 37 The History of High School BasketballPatrick Peterspage 38 Banana BreadGail Bowerpage 39 Cover LetterBob Zordanipage 40 Home MoviesBob Zordanipage 41 MigrationPatrick Peterspage 42 THE NINETIES Ba, Ba, Black SheepVictoria Bennettpage 45 Daily LessonsJennifer Moropage 49 Folding My OwnLaurie Ann Malispage 51 About the Authorspage 53 Editors\u27 Notespage 56https://thekeep.eiu.edu/vehicle/1062/thumbnail.jp

Ex vivo Drug Sensitivity Imaging-based Platform for Primary Acute Lymphoblastic Leukemia Cells

Resistance of acute lymphoblastic leukemia (ALL) cells to chemotherapy, whether present at diagnosis or acquired during treatment, is a major cause of treatment failure. Primary ALL cells are accessible for drug sensitivity testing at the time of new diagnosis or at relapse, but there are major limitations with current methods for determining drug sensitivity ex vivo. Here, we describe a functional precision medicine method using a fluorescence imaging platform to test drug sensitivity profiles of primary ALL cells. Leukemia cells are co-cultured with mesenchymal stromal cells and tested with a panel of 40 anti-leukemia drugs to determine individual patterns of drug resistance and sensitivity ("pharmacotype"). This imaging-based pharmacotyping assay addresses the limitations of prior ex vivo drug sensitivity methods by automating data analysis to produce high-throughput data while requiring fewer cells and significantly decreasing the labor-intensive time required to conduct the assay. The integration of drug sensitivity data with genomic profiling provides a basis for rational genomics-guided precision medicine. Key features Analysis of primary acute lymphoblastic leukemia (ALL) blasts obtained at diagnosis from bone marrow aspirate or peripheral blood. Experiments are performed ex vivo with mesenchymal stromal cell co-culture and require four days to complete. This fluorescence imaging-based protocol enhances previous ex vivo drug sensitivity assays and improves efficiency by requiring fewer primary cells while increasing the number of drugs tested to 40. It takes approximately 2-3 h for sample preparation and processing and a 1.5-hour imaging time. Graphical overview

Evidence that breast cancer risk at the 2q35 locus is mediated through IGFBP5 regulation.

GWAS have identified a breast cancer susceptibility locus on 2q35. Here we report the fine mapping of this locus using data from 101,943 subjects from 50 case-control studies. We genotype 276 SNPs using the 'iCOGS' genotyping array and impute genotypes for a further 1,284 using 1000 Genomes Project data. All but two, strongly correlated SNPs (rs4442975 G/T and rs6721996 G/A) are excluded as candidate causal variants at odds against >100:1. The best functional candidate, rs4442975, is associated with oestrogen receptor positive (ER+) disease with an odds ratio (OR) in Europeans of 0.85 (95% confidence interval=0.84-0.87; P=1.7 × 10(-43)) per t-allele. This SNP flanks a transcriptional enhancer that physically interacts with the promoter of IGFBP5 (encoding insulin-like growth factor-binding protein 5) and displays allele-specific gene expression, FOXA1 binding and chromatin looping. Evidence suggests that the g-allele confers increased breast cancer susceptibility through relative downregulation of IGFBP5, a gene with known roles in breast cell biology