Changes in Japanese Doctors’ Perspective after Battling Serious Illnesses and the Consequent Impact on their Medical Practice —The Wounded Healer

This study explored changes in the thinking and behavior of Japanese doctors who had personally battled serious illness. Doctors are often assumed to be physically and mentally healthy. When falling sick, they are prone to self-stigmatization. However, the positive outcomes of doctors battling illnesses have attracted scholarly attention. Psychiatrist Carl Jung advocated the concept of the “wounded healer,” a person who has endured an illness, gains wisdom from the experience, and uses it to heal others more effectively. We analyzed the aforementioned changes by narrowing down the “wounded healer” effect data group. We qualitatively analyzed verbatim transcripts of semi-structured interviews conducted with 14 doctors who had personally battled cancer, cerebrovascular disease, or heart disease using multilevel text condensation. After serious illness, doctors were more likely to believe that they had gained a lot from their experience. Changes in thinking related to medical practice included the acquisition of diverse knowledge. Such changes translated into behavioral changes; for example, understanding the patient’s perspective manifested in their improved communication with the patients. Most doctors diversified their activities outside of medical practice. Many also experienced significant changes in their views on life. The “wounded healer” effect was confirmed, bearing valuable implications for medical education

A rare distributive shock diagnosed only by medical history and inspection

Abstract A 78‐year‐old Japanese man was in a state of shock with skin flushing. Although he denied, his wife revealed his prescription disulfiram for alcoholism. Disulfiram‐ethanol reaction, even though it is a rare cause of distributive shock, could be easily and quickly differentiated only based on accurate medical history and inspection

The dual role of short fatty acid chains in the pathogenesis of autoimmune disease models

<div><p>Autoimmune diseases are influenced by both genetic and environmental factors. The gut environment has attracted much attention as an essential component that modulates immune responses, and therefore immune-mediated disorders, such as autoimmune diseases. Growing evidence suggests that microbiota and their metabolites are critical factors for immune modulation. Recently, we reported that the microbiome in patients with multiple sclerosis, an autoimmune disease targeting the myelin sheath of the central nervous system, is characterized by a reduction of bacteria belonging to <i>Clostridia</i> clusters IV and XIVa, which are potent producers of short-chain fatty acids (SCFAs) by fermentation of indigestible carbohydrates. In the present study, we investigated the role of SCFAs in the regulation of inflammation. We demonstrated that oral administration of SCFAs ameliorated the disease severity of systemic autoimmune inflammatory conditions mediated by lymphocytes such as experimental autoimmune encephalitis and collagen-induced arthritis. Amelioration of disease was associated with a reduction of Th1 cells and an increase in regulatory T cells. In contrast, SCFAs contributed to the exaggeration of K/BxN serum transfer arthritis, representing the effector phase of inflammation in rheumatoid arthritis. An increased understanding of the effect of microbiota metabolites will lead to the effective treatment and prevention of systemic inflammatory disorders.</p></div

T cell responses in mice orally administrated with SCFAs.

<p>(A) B6 mice were administrated with SCFAs and then immunized with MOG_35–55. Then, 10–11 days after immunization, draining lymph node cells were incubated with MOG_35–55. Supernatants were collected from the culture and measured for the concentrations of IFN-γ and IL-17 by ELISA. Data represent the mean ± SEM of samples pooled from four similar experiments (n = 13 mice). *<i>P</i><0.05, ** <i>P</i>< 0.01, control versus butyrate group. (B) The frequency of Tregs in spleen (SPN) and draining lymph node (LN) obtained from mice treated with SCFAs were measured using flow cytometry.*<i>P</i><0.05, ** <i>P</i>< 0.005 versus control.</p

Oral administration of SCFAs ameliorates the disease severity of CIA.

<p>(A) Clinical scores of CIA in DBA1/J mice with orally administrated SCFAs 3 weeks before immunization with CII and throughout the study. The data shown are pooled from two similar experiments. Data are expressed as the means ± SEM of 10 mice per group. ** <i>P</i><0.005, control versus butyrate group. (B) Representative histological features of joints in control and SCFAs-treated mice (H&E stained; original magnification ×40). Scale bar = 500 μm. (C) Quantification of histological assessment of joints 46–48 days after induction of CIA. Result shown is the mean + SEM of 5 mice per group. *<i>P</i><0.05, ** <i>P</i><0.005, versus control group.</p

High-fiber diet ameliorates the disease severity of MOG-induced EAE.

<p>(<b>A</b>) EAE was induced in B6 mice by immunization with MOG_35–55. Mice were fed a high-fiber, low-fiber or control diet 2 weeks before immunization and throughout the study. *<i>P</i><0.05, **<i>P</i><0.005, low-fiber versus high-fiber group. †<i>P</i><0.05, control versus high-fiber group. Data are expressed as the means ± SEM of 9–10 mice per group. <b>(B)</b> Histopathological assessment of the CNS in EAE-induced mice. Cellular infiltration of the spinal cord of mice on day 30 is shown. Paraffin-embedded spinal cords were stained with hematoxylin and eosin (H&E). Scale bar = 200 μm (upper panels) or 50 μm (lower panels). <b>(C)</b> HPLC quantification of SCFA levels in the cecal contents.</p