Uterine NK cells are innate lymphoid cells (ILC) that populate the uterus and expand during pregnancy, regulating placental development and fetal growth in humans and mice. We have recently characterized the composition of uterine ILCs (uILCs), some of which require the transcription factor NFIL3, but the extent to which NFIL3-dependent cells support successful reproduction in mice is unknown. By mating Nfil3−/− females with wild-type males, here we show the effects of NFIL3 deficiency in maternal cells on both the changes in uILCs during pregnancy and the downstream consequences on reproduction. Despite the presence of CD49a+Eomes− uILC1s and the considerable expansion of residual CD49a+Eomes+ tissue-resident NK cells and uILC3s in pregnant Nfil3−/− mice, we found incomplete remodeling of uterine arteries and decidua, placental defects, and fetal growth restriction in litters of normal size. These results show that maternal NFIL3 mediates non-redundant functions in mouse reproduction.
Evidence shows dwindling levels of bedside teaching for medical students in the UK, especially in district general hospitals. Lack of individual responsibility has resulted in disengagement in teaching. Based on a quality improvement project (QIP) at a District General Hospital, we suggest some ways this could be addressed. We suggest here that harnessing support from the medical education lead, incentivizing teaching, allocating student-junior doctor groups to harbor personal responsibility, providing a supportive framework, and educating about barriers to teaching can all be used to develop an effective teaching program.
ContextVerbal descriptors are important in understanding patients' experience of breathlessness.
ObjectivesTo examine the association between selection of breathlessness descriptors, diagnosis, selfreported severity of breathlessness and self-reported distress due to breathlessness.
MethodsWe studied 132 patients grouped according to their diagnosis advanced COPD (n=69) or advanced cancer (n=63), self-reported severity of breathlessness: mild breathlessness (Numerical rating scale (NRS) ≤3, n=53), moderate breathlessness (4≤NRS≥6, n=59) or severe breathlessness (NRS ≥7, n=20), and distress due to breathlessness: mild distress (NRS ≤3, n=31), moderate distress (4≤NRS≥6, n= 44) or severe distress (NRS ≥7, n=57). Patients selected three breathlessness descriptors. The relationship between descriptors selected and patient groups was evaluated by cluster analysis.
ResultsDifferent combinations of clusters were associated with each diagnostic group; the cluster 'chest tightness' was associated with cancer patients. The association of clusters with patient groups differed depending on their severity of breathlessness and their distress due to breathlessness. The 'air hunger' cluster was associated with patients with moderate or severe breathlessness, the 'chest tightness' cluster was associated with patients with mild breathlessness. The 'air hunger' cluster was associated with patients with severe distress due to breathlessness.
ConclusionsThe relationship between clusters and diagnosis is not robust enough to use the descriptors to identify the primary cause of breathlessness. Further work exploring how use of breathlessness descriptors reflects the severity of breathlessness and distress due to breathlessness could enable the descriptors to evaluate patient status and target interventions.
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