Combatting professional burnout through creative writing Cronin, Megan; Hubbard, Victoria; Cronin, Terrence A. ...
Clinics in dermatology,
September-October 2020, 2020 Sep - Oct, 2020-09-00, Volume:
38, Issue:
5
Journal Article
Peer reviewed
Physician burnout is becoming an increasing problem. In fact, nearly half of all physicians feel completely depleted, to the point where one in seven has contemplated suicide. Causes for burnout ...development include: administrative overload, regulatory restrictions, loss of autonomy or control, workplace issues, decreased access to medicines for patients, and electronic medical records. On the opposite end of this spectrum is physician fulfillment. Creative writing can be a therapeutic method of self-fulfillment. This may provide not only focused relief from burnout but also another possible avenue for success for multitalented people such as physicians.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt ...identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The emergence of the COVID-19 pandemic has led to significant uncertainty among physicians and patients about the safety of immunosuppressive medications used for the management of dermatologic ...conditions. We review available data on commonly used immunosuppressants and their effect on viral infections beyond COVID-19. Notably, the effect of some immunosuppressants on viruses related to SARS-CoV2, including SARS and MERS, has been previously investigated. In the absence of data on the effect of immunosuppressants on COVID-19, these data could be used to make clinical decisions on initiation and continuation of immunosuppressive medications during this pandemic. In summary, we recommend considering the discontinuation of oral Janus kinase (JAK) inhibitors and prednisone; considering the delay of rituximab infusion; and suggesting the careful continuation of cyclosporine, mycophenolate, azathioprine, methotrexate, and biologics in patients currently benefitting from such treatments.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
Tight junctions (TJ) are important for skin barrier function and could be relevant in modulating allergen penetration in atopic dermatitis (AD). Humans with AD have been described to have ...decreased expressions of some TJ proteins in the skin.
Hypothesis/Objectives
This study aimed to investigate TJ protein expression using an experimental AD model in dogs.
Methods
Skin biopsies from six atopic (nonlesional skin) and five normal beagle dogs were stained for TJ proteins zonula occludens 1 (ZO‐1), occludin, claudin‐1 by immunohistochemistry. Staining intensity was evaluated both objectively using imaging software and subjectively. Six images/sections were randomized and blindly scored by six investigators for intensity, distribution, integrity and staining pattern.
Results
The intensity of ZO‐1 was significantly decreased in the atopic group objectively (P = 0.010) and subjectively (P = 0.002) relative to the normal group. Occludin was decreased significantly subjectively (P = 0.027) but not objectively. Claudin was not significantly different between groups by either quantification. Additionally, only ZO‐1 demonstrated a significantly patchier staining pattern in the atopic group. There was no consistent staining pattern in this study.
Conclusions and clinical importance
ZO‐1 and occludin, which have not been described to be associated with the development of AD in humans, could play a role in this atopic dog model. Further investigation on the expression and modulation of TJ proteins and their clinical relevance is needed.
Résumé
Contexte
Les jonctions serrées (Tight Junctions TJ) sont importantes pour la fonction barrière cutanée et pourraient également l'être dans la régulation de la pénétration antigénique de la dermatite atopique (AD). L'homme atopique a été décrit comme ayant une expression augmentée de certaines protéines de TJ dans la peau.
Hypothèses/Objectifs
Cette étude porte sur l'expression des protéines TJ à l'aide d'un modèle expérimental d'AD chez le chien.
Méthodes
Des biopsies cutanées de six chiens atopiques (peau non lésionnelle) et cinq chiens beagle sains ont été colorées par immunohistochimie pour les protéines de TJ zonula occludens 1 (ZO‐1), occludine, claudine‐1. L'intensité de coloration a été évaluée à la fois subjectivement et objectivement. Six images/sections ont été réparties et notées en aveugle par six investigateurs pour l'intensité, la distribution, l'intégrité et les patrons de coloration.
Résultats
L'intensité de ZO‐1 était significativement diminuée dans le groupe atopique objectivement (P = 0.010) et subjectivement (P = 0.002) comparé au groupe normal. L'occludine était diminuée significativement subjectivement (P = 0.027) mais pas objectivement. La claudine ne présentait pas de différence significative entre les groupes quelque soit la quantification. En outre, seule ZO‐1 montrait un patron de coloration en patch significatif dans le groupe atopique. Il n'y avait pas de patron de coloration significatif dans cette étude.
Conclusions et importance clinique
ZO‐1 et occludine, qui n'avaient pas été décrit comme étant associé au développement de l'AD humaine, pourraient jouer un rôle dans ce modèle de chien atopique. D'autres études sont nécessaires sur l'expression et la modulation des protéines de TJ et leur importance clinique.
Resumen
Introducción
las uniones oclusivas intercelulares son importantes para la función de barrera de la piel y pueden ser relevantes en la modulación de la protección de alergenos en casos de dermatitis atópica (AD). Los seres humanos con dermatitis atópica tienen una expresión disminuida de algunas proteínas en estas uniones.
Hipótesis/Objetivos
este estudio está enfocado a investigar la expresión algunas proteínas en los uniones oclusivas en un modelo experimental de dermatitis atópica en perros
Métodos
muestras de piel de seis perros tópicos (piel sin lesiones) y cinco perros normales de la piel se tiñeron para las proteínas de unión de las uniones oclusivas (zónula occludens ‐1 (ZO‐1), ocludina, claudina‐1) mediante inmunohistoquímica. La intensidad de la tinción se evaluó objetivamente utilizando un programa de análisis de imagen y subjetivamente. Seis imágenes/secciones fueron distribuidas al azar y valoradas a ciegas por seis investigadores en referencia a distribución, integridad, y patrón de tinción.
Resultados
la intensidad de ZO‐1 estuvo significativamente disminuida en el grupo atópico tanto de forma objetiva (P= 0,010) como subjetiva (P= 0.002) en relación al grupo normal. La ocludina estaba significativamente disminuida subjetivamente (P=0,027), pero no objetivamente. La claudina no fue significativamente diferente entre ambos grupos en ningún método cuantitativo. Además, sólo ZO‐1 demostró un patrón de tinción más granular en perros atópicos. No hubo un patrón de tinción consistente en este estudio.
Conclusión e importancia clínica
ZO‐1 y ocludina, que no han sido escritas como asociadas con el desarrollo de dermatitis atópica en humanos, podrían jugar un papel en este modelo de perros atópicos. Hace falta mayor investigación de la expresión y modulación de las proteínas de las zonas de unión oclusivas y de su importancia clínica
Zusammenfassung
Hintergrund
“Tight Junctions” (TJ) sind wichtig für die Schutzfunktion der Haut und könnten bei der Regulierung der Penetration der Allergene bei atopischer Dermatitis (AD) wichtig sein. Bei Menschen mit AD wurde eine verminderte Exprimierung einiger TJ Proteine in der Haut beschrieben.
Hypothese/Ziele
Das Ziel dieser Studie war eine Untersuchung der Exprimierung der TJ Proteine mit einem experimentellen AD Modell bei Hunden.
Methoden
Es wurden Hautbiopsien von sechs atopischen (nicht veränderte Haut) und fünf normalen Beagles mittels Immunhistochemie auf TJ Proteine gefärbt Zonula occludens 1 (ZO‐1), Occludin, Claudin‐1. Die Intensität der Färbung wurde objektiv mittels bildgebender Software und subjektiv beurteilt. Sechs Bilder/Schnitte wurden zufällig und geblindet von sechs UntersucherInnen auf Intensität, Verteilung, Integrität und Färbeverhalten bewertet.
Ergebnisse
Die Intensität von ZO‐1 war in der atopischen Gruppe im Vergleich zur normalen Gruppe objektiv (p=0,010) und subjektiv (p=0,002) vermindert. Occludin war subjektiv (p=0,027), aber nicht objektiv vermindert. Claudin war zwischen den Gruppen weder subjektiv noch objektiv signifikant unterschiedlich. Zusätzlich zeigte nur ZO‐1 eine signifikant fleckigere Anfärbung als die atopische Gruppe. Es bestand keine konstante Anfärbung in dieser Studie.
Schlussfolgerungen und klinische Bedeutung
ZO‐1 und Occludin, welche bisher nicht im Zusammenhang mit der Entstehung von AD beim Menschen beschrieben worden waren, könnten in diesem Modell des atopischen Hundes eine Rolle spielen. Es sind weitere Studien über die Exprimierung und die Modulierung der TJ Proteine und ihre klinische Relevanz nötig.
Background –Tight junctions (TJ) are important for skin barrier function and could be relevant in modulating allergen penetration in atopic dermatitis (AD). Humans with AD have been described to have decreased expressions of some TJ proteins in the skin. Hypothesis/Objectives –This study aimed to investigate TJ protein expression using an experimental AD model in dogs. Conclusions and clinical importance –ZO‐1 and occludin, which have not been described to be associated with the development of AD in humans, could play a role in this atopic dog model. Further investigation on the expression and modulation of TJ proteins and their clinical relevance is needed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Pentobarbital anesthetized dogs were subjected to 90 minutes of left circumflex coronary artery (LCCA) occlusion followed by 72 hours of reperfusion. Control or anti-Mo1 (904) F(ab')2 fragments of ...monoclonal antibodies were administered intravenously at a dose of 1 mg/kg beginning 45 minutes after occlusion and at a dose of 0.5 mg/kg at 12, 24, 36, and 48 hours after reperfusion. Myocardial infarct size expressed as a percentage of the area at risk (IN/AR) measured postmortem after 72 hours of reperfusion was significantly reduced by 904 F(ab')2 (21.6 +/- 2.8%, n = 8) compared with control F(ab')2 (37.4 +/- 5.8%, n = 8; p less than 0.025). There were no significant differences between groups in heart rate, mean arterial blood pressure, rate-pressure product, or LCCA blood flow that could account for a reduced infarct size. Regional myocardial blood flow (RMBF) was determined with 15-microns radiolabeled microspheres. Transmural blood flows (ml/min/g) within the region of myocardium at risk were not statistically different between treatment groups. Infarct size in both groups was related to regional myocardial blood flow, and the relation was shifted downward in the group treated with the anti-Mo1 F(ab')2 antibody (analysis of covariance, p = 0.01). Thus, anti-Mo1 F(ab')2 produces a sustained limitation of myocardial infarct size compared with controls under similar hemodynamic conditions and a similar degree of myocardial ischemia as determined by RMBF. These data suggest that inhibition of neutrophil adhesive interactions (as suggested by the inhibitory effect of anti-Mo1 on canine neutrophil aggregation) may be an effective mechanism for protection against myocardial injury secondary to myocardial ischemia and reperfusion.
Coronary artery rethrombosis can complicate initially effective thrombolytic therapy. Platelets interacting with injured vascular endothelium in a region along the coronary artery with reduced ...luminal cross-sectional area contribute to rethrombosis. The purpose of this study was to investigate the potential of the F(ab')2 fragment of the murine monoclonal antibody 7E3 7E3 F(ab')2 to prevent rethrombosis after intracoronary clot lysis with recombinant tissue-type plasminogen activator (rt-PA) in an experimental model. The 7E3 F(ab')2 binds to the platelet glycoprotein IIb/IIIa complex (GPIIb/IIIa), thereby preventing platelet-fibrinogen interaction and intravascular thrombus formation. Experimental coronary artery thrombosis was produced in the anesthetized dog by application of direct anodal current to the intimal surface of the left circumflex coronary artery in the region of an external stenosis. Lysis of the established intracoronary thrombus was achieved with the intravenous administration of rt-PA (25 mg) after which the animals were randomized into two groups. Group 1 (n = 10) served as the control, receiving the saline diluent, and group 2 (n = 9) received 7E3 F(ab')2, given as a single intravenous injection (0.8 mg/kg). The times required for occlusive thrombus formation, rt-PA-induced thrombolysis, and rethrombosis (if it occurred) were similar in the animals treated with saline and those treated with 7E3 F(ab')2. The initial left circumflex coronary artery blood flow was similar in both groups but decreased to a negligible level in group 1. In group 2, left circumflex coronary artery blood flow declined modestly (24 +/- 2 to 10 +/- 2 ml/min). Rethrombosis occurred in all animals in group 1 but in only two of nine animals in group 2 (p less than 0.05). Oscillations in coronary blood flow preceded rethrombosis in group 1, whereas 7E3 F(ab')2 stabilized left circumflex coronary artery blood flow patterns during the course of teh experimental protocol (5.2 +/- 0.9 vs. 0.7 +/- 0.4 oscillations, respectively; p less than 0.05). Thrombus mass recovered from the left circumflex coronary artery at the conclusion of each experiment was greater in group 1 as compared with group 2 (7.0 +/- 2.3 vs. 1.5 +/- 0.7 mg, respectively; p less than 0.05). The area of left ventricle at risk for infarction was similar in both groups but infarct size, infarction/at risk assessed histochemically, was larger in group 1 than group 2 (35 +/- 9% vs. 6 +/- 4%, respectively; p less than 0.05). Platelet aggregation induced by ADP and arachidonic acid was similar at baseline for all of the animals.
A brief statement by Roslindale, Massachusetts-based metalsmith and sculptor Megan Cronin with illustrations of her wall sculptures - 'Contained' (1998) and 'Offering' (1999).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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