NLRP3 Disturbs Treg/Th17 Cell Balance to Aggravate Apical Periodontitis

Apical periodontitis is an inflammatory condition that is considered an immunological reaction of the periapical tissue to invading bacteria and their pathogenic components. Recent research has revealed that NLR family pyrin domain containing 3 (NLRP3) is crucial to the pathogenesis of apical periodontitis and serves as a link between innate and adaptive immunity. The balance between regulatory T-cell (Treg) and T helper cell 17 (Th17 cell) determines the direction of the inflammatory response. Therefore, this study aimed to investigate whether NLRP3 exacerbated periapical inflammation by disturbing Treg/Th17 balance and the underlying regulatory mechanisms. In the present study, NLRP3 was raised in apical periodontitis tissues as opposed to healthy pulp tissues. Low NLRP3 expression in dendritic cells (DCs) increased transforming growth factor β secretion while decreasing interleukin (IL)-1β and IL-6 production. The Treg ratio and IL-10 secretion rose when CD4⁺ T cells were cocultured with DCs primed with IL-1β neutralizing antibody (anti-IL-1β) and specific small interfering RNA (siRNA) targeting NLRP3 (siRNA NLRP3), but the proportion of Th17 cells and IL-17 release dropped. Furthermore, siRNA NLRP3-mediated suppression of NLRP3 expression aided Treg differentiation and elevated Foxp3 expression as well as IL-10 production in CD4⁺ T cells. Inhibition of NLRP3 activity by MCC950 boosted the percentage of Tregs while decreasing the ratio of Th17 cells, leading to reduced periapical inflammation and bone resorption. Nigericin administration, however, exacerbated periapical inflammation and bone destruction with an unbalanced Treg/Th17 response. These findings demonstrate that NLRP3 is a pivotal regulator by regulating the release of inflammatory cytokines from DCs or directly suppressing Foxp3 expression to disturb Treg/Th17 balance, thus exacerbating apical periodontitis.

Acute Lower Extremity Fracture Management in Chronic Spinal Cord Injury: 2022 Delphi Consensus Recommendations

Our objective was to develop a clinical practice guideline (CPG) for the treatment of acute lower extremity fractures in persons with a chronic spinal cord injury (SCI).

METHODS

Information from a previous systematic review that addressed lower extremity fracture care in persons with an SCI as well as information from interviews of physical and occupational therapists, searches of the literature, and expert opinion were used to develop this CPG. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to determine the quality of evidence and the strength of the recommendations. An overall GRADE quality rating was applied to the evidence.

CONCLUSIONS

Individuals with a chronic SCI who sustain an acute lower extremity fracture should be provided with education regarding the risks and benefits of operative and nonoperative management, and shared decision-making for acute fracture management should be used. Nonoperative management historically has been the default preference; however, with the advent of greater patient independence, improved surgical techniques, and advanced therapeutics and rehabilitation, increased use of surgical management should be considered. Physical therapists, kinesiotherapists, and/or occupational therapists should assess equipment needs, skills training, and caregiver assistance due to changes in mobility resulting from a lower extremity fracture. Therapists should be involved in fracture management as soon as possible following fracture identification. Pressure injuries, compartment syndrome, heterotopic ossification, nonunion, malunion, thromboembolism, pain, and autonomic dysreflexia are fracture-related complications that clinicians caring for patients who have an SCI and a lower extremity fracture may encounter. Strategies for their treatment are discussed. The underlying goal is to return the patient as closely as possible to their pre-fracture functional level with operative or nonoperative management.

The ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis: A multicentre cross-sectional survey

AIM

To investigate the ability of critical care nurses to identify pressure injury and incontinence-associated dermatitis and analyse the possible influencing factors.

DESIGN

Cross-sectional survey.

METHODS

This study was conducted at 24 hospitals across 12 provinces in China. A self-made electronic questionnaire was used. Nurses identified and judged injuries according to the information provided.

RESULTS

The average identification score for pressure injury and incontinence-associated dermatitis was 9.00 ± 3.51 points, and only 2.16% of nurses scored ≥16 points. The average correct identification rate for pressure injury and incontinence-associated dermatitis was 45%. The correct identification rate for stage 1 pressure injury was the highest, while those for stage 3, stage 4, deep tissue pressure injury and unstageable pressure injury were all lower than 50%; incontinence-associated dermatitis was also easily misjudged. Nurses' educational backgrounds, professional titles, job positions, hospital levels and learning frequency were the factors that affected their ability to identify pressure injury and incontinence-associated dermatitis.

Multimodal Data for the Detection of Freezing of Gait in Parkinson's Disease

Freezing of gaits (FOG) is a very disabling symptom of Parkinson’s Disease (PD), affecting about 50% of PD patients and 80% of advanced PD patients. Studies have shown that FOG is related to a complex interplay between motor, cognitive and affective factors. A full characterization of FOG is crucial for FOG detection/prediction and prompt intervention. A protocol has been designed to acquire multimodal physical and physiological information during FOG, including gait acceleration (ACC), electroencephalogram (EEG), electromyogram (EMG), and skin conductance (SC). Two tasks were designed to trigger FOG, including gait initiation failure and FOG during walking. A total number of 12 PD patients completed the experiments and produced a length of 3 hours and 42 minutes of valid data including 2 hours and 14 minutes of normal gait and 1 hour and 28 minutes of freezing of gait. The FOG episodes were labeled by two qualified physicians. The multimodal data have been validated by a FOG detection task.

Measurement(s)	electroencephalography (EEG) • electromyography(EMG) • acceleration • skin conductance
Technology Type(s)	electroencephalography (EEG) • electromyography (EMG) • accelerometer • skin conductance

Dissecting B/Plasma Cells in Periodontitis at Single-Cell/Bulk Resolution

In recent decades, our understanding of periodontitis has evolved from that based on a gross/histologic level to one on a cellular/molecular level. Previous landscape studies have explored molecular subtyping, diagnosis, and gingival tissue cell decomposition in periodontitis, and meaningful results have been obtained at a transcriptomic level. However, current periodontitis transcriptomic studies lack a finer dissection of the intercommunication between immune cells and the biological processes of specific immune cell subtypes. In this study, we classified 15 immune cell types in periodontitis at a single-cell level and conducted a cell communication analysis based on a multicenter integrated single-cell transcriptome profile, in which plasma cell-generated macrophage migration inhibitory factor can communicate with most other immune cells in periodontitis. A pseudotime analysis focusing on B/plasma cell infiltration in periodontitis revealed 2 distinct cell fates (CFs) for B/plasma cells. In addition, at a bulk tissue level, a single-sample gene set enrichment analysis showed a similar immune cell infiltration trend, and a weighted gene coexpression network analysis identified an immune-related gene module. Combined with the above findings, we used machine learning methods to further narrow down potential gene candidates for developing and validating molecular diagnostic models of periodontitis. Multivariable logistic regression of a large public cohort (68 healthy vs. 235 periodontitis) and an independent validation cohort (12 healthy vs. 7 periodontitis) showed the CF1 signature provides a good discrimination and calibration performance with clinical benefits at a proper threshold probability. Furthermore, quantitative real-time polymerase chain reaction validation of the gene candidates was performed in both snap-frozen gingival tissues and gingival crevicular fluids. Our transcriptomic landscape analysis at both single-cell and bulk tissue resolutions thereby illustrates the B/plasma cell infiltration process in periodontitis and reveals a gene signature that may assist in molecular diagnosis of the disease.

Preoperative MRI of breast squamous cell carcinoma: diagnostic value of distinguishing between two subtypes

AIM

To retrospectively analyse the clinical and MRI data of primary squamous cell carcinoma (SCC), particularly pure squamous cell carcinoma (PSCC) and mixed squamous cell carcinoma (MSCC).

MATERIALS AND METHODS

The MRI data and clinicopathological characteristics of 20 patients with histopathologically confirmed SCC of the breast, including eight PSCC patients and 12 MSCC patients, from multiple centres between January 2013 and December 2020 were analysed retrospectively.

RESULTS

Nine of 12 patients in the MSCC group showed hyperintensity on T1-weighted imaging (WI), while this feature was not observed in the PSCC group (p=0.001). Most of the PSCC group showed rim enhancement, whereas most of the MSCC group showed heterogeneous enhancement (p=0.007). In addition, there was no significant difference in the thickness of the rim enhancement and the percentage of necrotic components in the tumours between the two types of SCCs of the breast (p=0.545 and p=0.662, respectively). Four patients (4/12) in the MSCC group had sentinel lymph node metastasis, while only one patient (1/8) in the PSCC group showed lymph node metastasis (p=0.603). Metastatic disease occurred in 25% of patients with PSCC and in approximately 41.7% of patients with MSCC.

CONCLUSION

The signal on T1WI and internal enhancement characteristics were the key features for differentiating PSCC and MSCC. Therefore, MRI phenotypes may provide additional information for the pathological classification of breast SCC.

Caloric restriction and Roux-en-Y Gastric Bypass promote white adipose tissue browning in mice

PURPOSE

Caloric restriction (CR) and Roux-en-Y Gastric Bypass (RYGB) are considered effective means of body weight control, but the mechanism by which CR and RYGB protect against high-fat diet (HFD)-induced obesity remains elusive. The browning of white adipose tissue (WAT) is a potential approach to combat obesity. Here we assess whether browning of WAT is involved in CR- and RYGB-treatment.

METHODS

The average size of adipocytes was determined by histological analysis. Expression of thermogenic genes in both human subjects and mice were measured by quantitative real-time PCR and immunohistochemical staining.

RESULTS

The average size of adipocytes was bigger, while the expression of thermogenic genes such as uncoupling protein 1 (UCP1), nuclear factor erythroid-2 like 1 (NRF1) and PPARγ coactivator-1 α (PGC1α) were lower in the WAT of obese subjects when compared to lean controls. Both CR and RYGB promoted weight and fat loss. Increment of the average adipocytes size and down-regulation of thermogenic genes were significantly reversed by both CR and RYGB in the WAT of obese mice.

CONCLUSIONS

Our findings showed that CR and RYGB significantly improved high-fat diet-induced lipid accumulation by promoting the browning of WAT.

Optical coherence tomography

Optical coherence tomography (OCT) is a non-contact method for imaging the topological and internal microstructure of samples in three dimensions. OCT can be configured as a conventional microscope, as an ophthalmic scanner, or using endoscopes and small diameter catheters for accessing internal biological organs. In this Primer, we describe the principles underpinning the different instrument configurations that are tailored to distinct imaging applications and explain the origin of signal, based on light scattering and propagation. Although OCT has been used for imaging inanimate objects, we focus our discussion on biological and medical imaging. We examine the signal processing methods and algorithms that make OCT exquisitely sensitive to reflections as weak as just a few photons and that reveal functional information in addition to structure. Image processing, display and interpretation, which are all critical for effective biomedical imaging, are discussed in the context of specific applications. Finally, we consider image artifacts and limitations that commonly arise and reflect on future advances and opportunities.

[Correlation of preoperative reconstruction of foramen ovale parameters and intraluminal balloon pressure during percutaneous balloon compression for trigeminal neuralgia]

Objective: To explore the relationship between the anatomic parameters of foramen ovale and intraluminal pressure during percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia. Methods: Twenty patients diagnosed with primary trigeminal neuralgia in the Department of Pain Medicine of the Third Xiangya Hospital, Central South University between November 2020 and April 2021 were enrolled. Three-dimensional (3D) high-resolution CT reconstruction of skull base was performed preoperatively to evaluate the parameters of foramen ovale. The intraluminal balloon pressure was continuously recorded during the PBC procedure. Correlation analysis was conducted between intraluminal pressure and foramen ovale parameters. Results: Eighteen patients had complete pain relief, 1 had obvious relief, and 1 had partial relief after PBC. The maximum cross-sectional length of the foramen ovale was (7.8±1.7) mm. The peak intraluminal pressure (P_M) during PBC was (194±27) kPa. The intraluminal pressure was (164±28) kPa at initial compression (P₀), and (135±20) kPa after compression for 120 seconds respectively. Correlation analysis showed that the P₀ was positively and significantly correlated with the length of foramen ovale (r=0.56, P<0.05), but not with the width of foramen ovale (r=0.24, P>0.05), the area of foramen ovale (r=0.36, P>0.05) and the degree of balloon filling (r=-0.09, P>0.05). Similarly, P₁₂₀ was significantly correlated with the length of foramen ovale (r=0.54, P<0.05). No significant correlation was observed between P₁₂₀ and the width of the foramen ovale (r=0.18, P>0.05), the area of the foramen ovale (r=0.28, P>0.05) or the width of balloon filling (r=-0.13, P>0.05). Conclusions: The length of foramen ovale correlates with the intraluminal pressure during PBC procedure in trigeminal neuralgia patients. Parameters of foramen ovale obtained via preoperative high-resolution CT reconstruction of skull base may provide reference for predicting targeted intraluminal balloon pressure during PBC.

[A novel attention fusion network-based multiple instance learning framework to automate diagnosis of chronic gastritis with multiple indicators]

Objective: To explore the performance of the attention-multiple instance learning (MIL) framework, an attention fusion network-based MIL, in the automated diagnosis of chronic gastritis with multiple indicators. Methods: A total of 1 015 biopsy cases of gastritis diagnosed in Fudan University Cancer Hospital, Shanghai, China and 115 biopsy cases of gastritis diagnosed in Shanghai Pudong Hospital, Shanghai, China were collected from January 1st to December 31st in 2018. All pathological sections were digitally converted into whole slide imaging (WSI). The WSI label was based on the corresponding pathological report, including "activity" "atrophy" and "intestinal metaplasia". The WSI were divided into a training set, a single test set, a mixed test set and an independent test set. The accuracy of automated diagnosis for the Attention-MIL model was validated in three test sets. Results: The area under receive-operator curve (AUC) values of Attention-MIL model in single test sets of 240 WSI were: activity 0.98, atrophy 0.89, and intestinal metaplasia 0.98; the average accuracy of the three indicators was 94.2%. The AUC values in mixed test sets of 117 WSI were: activity 0.95, atrophy 0.86, and intestinal metaplasia 0.94; the average accuracy of the three indicators was 88.3%. The AUC values in independent test sets of 115 WSI were: activity 0.93, atrophy 0.84, and intestinal metaplasia 0.90; the average accuracy of the three indicators was 85.5%. Conclusions: To assist in pathological diagnosis of chronic gastritis, the diagnostic accuracy of Attention-MIL model is very close to that of pathologists. Thus, it is suitable for practical application of artificial intelligence technology.