Shannon Sie

Fig. 2: Immune landscape and barrier regulation in the human oesophageal epithelium.

SEPTEMBER ISSUE | Our Featured PERSPECTIVE is on "The oesophagus as an immune organ"

www.nature.com/articles/s41...

#Gastrosky

Cover: Oesophagus as an immune organ, inspired by the Perspective on p657.

Our SEPTEMBER ISSUE is live! CRC health disparities, gut microbiome in MASLD, intestinal pH, oesophagus immunology, and much more!

www.nature.com/nrgastro/vol...

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I feel like the timing here could really matter for identifying therapeutic intervention windows, especially since early TNF-alpha blockade can prevent the formation of lymphoid aggregates (which likely precede TLS), but seems less effective once these structures are established.

4/
While it’s helpful to know that fully formed TLS are present in HS lesions, it would be valuable to clarify how early in lesion development these structures actually become fully formed — whether during the pre-exudative phase, or only once lesions progress to the exudative stage.

3/
To clarify — I’m referring to instances in general where fully formed TLSs are reported in HS lesions, including the ones cited here like Lowe et al., 2024 and Yu et al., 2024.

2/
Based on their association with keratinized epithelial tunnels, it seems likely they were collected during the exudative or post-exudative phase, and most likely during Hurley Stage II or III, when tunnel formation typically occurs—but I haven’t seen this explicitly stated.

Been reading about TLS in HS lesions—this is gold. I'm curious if it’s known at which inflammatory phase the samples showing fully formed TLS were taken. 1/4

So glad I found this paper.

It would be great to learn more about the distinct topographic patterns in chronic skin conditions and how they can help us better understand their pathogenesis, as well as inform more targeted treatment strategies—or even prevention.

doi.org/10.1111/jdv....

Oh, so you are at the peak of it right now. 😄 I guess every phase comes with its own mix of rhythms and surprises. In a way, the pandemic bought us the time we might otherwise have missed. It's nice that you have a pair 👫

Really admire how you’re committed to being present for your kids while juggling so much on your plate. It’s wonderful how you find ways to make memories with them—those years don’t come back, and one day your kids will remember how their mom was there in the big and small moments.

Thank you so much for sharing — sounds like you jumped right into motherhood during one of the most intense phases of training. Do you feel like it got any more manageable as you transitioned to postdoc/faculty, or did the challenges just shift in a different way?

🥼🔬📚If you don’t mind sharing, how did you typically divide your time across teaching, clinical work, and research before having children? Like, what was your rough mix in percentages? And how have you adjusted or tipped the balance since raising children came into the picture?🤰👩‍🍼👼

🙋🏼‍♀️ Do you see potential for skin microbiome sampling and analysis to eventually become part of routine dermatology practice in the future, like skin biopsies and dermatopathology are today?

Such a creative graphic!

Definitely adding this to my reading list! I just realized the picture wasn't in the paper 😅. Is this something that AI does whenever we post a link? I'm guessing "the EEC within the GI mucosa?"

To what extent does the skin #microbiome —at least at the epidermal level —influence the other organs? And to what extent do host-associated internal microbial communities shape the skin microbiome in return?

Where do local & systemic interventions meet?

Something to think about.

#dermsky #derm

And yet I wonder...
How many of these questions could the skin microbiome alone answer?

It can certainly take a village for many of them, especially those of more complex nature—a village of other microbiomes.

3/3

Why this location?

Why this process?

Why this lesion—its shape, color, texture, size?

Why this symptom?

Why so long—or so fast?

Why so easy to treat—or so resistant?

Why this trigger?

Why this patient?

Got more Whys?

2/2

There’s just something about the skin microbiome that begs for investigation.

With so many dermatologic conditions out there, I can't help but wonder:

1/2

📌 Meal timing is a potential modifiable lifestyle factor involved in the higher CVD risk in night workers. 5/5

▫️ Intriguingly, under light cycles of 22 h, which match their intrinsic period (i.e., in resonance), their cyclic behavioral patterns and heart structure and function normalized, indicating the importance of synchrony between the internal circadian clock with environmental and behavioral cycles. 4/

▫️ A point mutation in the circadian regulatory gene, casein kinase-1, results in an intrinsic circadian period of 22 h (instead of approximately 24 h in wildtypes), early-onset cardiomyopathy, extensive fibrosis, and severely impaired contractility. 3/

▫️Circadian disruption might induce hypofibrinolysis and increase cardiovascular risk by inducing PAI-1 gene expression following circadian misalignment. 2/

Interesting excerpts:

▫️Exposure to simulated night work with nightime and daytime eating decreased cardiac vagal modulation, with vagal (parasympathetic) activity typically considered cardioprotective. 1/

The problem is, it seems like AI doesn’t truly have an independent ability to discern whether a user is correct or whether certain data is trustworthy—and that creates a critical loophole. 2/4

So I'm not sure if it's working. It is still a lot different from saving a post privately though. And even if it works, typing a pin emoji is more than one click! Haha

📌

I haven't! Didn't know it existed (: will try thankss

Please create save or bookmark feature as well :)

Also, considering IM’s broader scope, in what ways does inpatient IM practice shape your approach to inpatient Derm?