Single-Cell Analysis of the Periodontal Immune Niche in Type 2 Diabetes

Periodontitis (PD) is a common source of uncontrolled inflammation in obesity-associated type 2 diabetes (T2D). PD apparently fuels the inflammation of T2D and associates with poor glycemic control and increased T2D morbidity. New therapeutics are critically needed to counter the sources of periodontal infection and inflammation that are accelerated in people with T2D. The precise mechanisms underlying the relationship between PD and T2D remain poorly understood. Every major immune cell subset has been implicated in the unresolved inflammation of PD, regardless of host metabolic health. However, analyses of inflammatory cells in PD with human periodontal tissue have generally focused on mRNA quantification and immunohistochemical analyses, both of which provide limited information on immune cell function. We used a combination of flow cytometry for cell surface markers and enzyme-linked immunospot methods to assess the subset distribution and function of immune cells isolated from gingiva of people who had PD and were systemically healthy, had PD and T2D (PD/T2D), or, for flow cytometry, were systemically and orally healthy. T-cell subsets dominated the cellular immune compartment in gingiva from all groups, and B cells were relatively rare. Although immune cell frequencies were similar among groups, a higher proportion of CD11b⁺ or CD4⁺ cells secreted IFNγ/IL-10 or IL-8, respectively, in cells from PD/T2D samples as compared with PD-alone samples. Our data indicate that fundamental differences in gingival immune cell function between PD and T2D-potentiated PD may account for the increased risk and severity of PD in subjects with T2D. Such differences may suggest unexpected therapeutic targets for alleviating periodontal inflammation in people with T2D.

Feasibility of continuous transthoracic cardiac imaging using a novel ultrasound transducer

BACKGROUND

The feasibility of hands-free transthoracic continuous ultrasonic cardiac imaging has not been demonstrated previously. We developed a 2.5-MHZ spherical transducer mounted in an external housing to permit steering in 360 degrees (CONTISON). The external housing was attached to the chest wall using an adhesive patch.

METHODS AND RESULTS

The transducer was placed in the third or fourth interspace at the left sternal border to permit imaging of the left ventricle (LV) in its short axis and attached to the chest wall. The transducer then was attached to an ultrasound machine. Ten normal subjects and 20 patients with previous myocardial infarction were studied. The following maneuvers were performed at the beginning of the study: (1) The patient was rotated from the supine position (0 degrees ) in 20 degrees increments to the left lateral decubitus position (90 degrees ). The echocardiogram was displayed continuously and was recorded on videotape (parasternal short-axis view) at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees, and 90 degrees. (2) The patient was returned to the supine position and an echocardiogram was obtained. The patient was then seated up 20 degrees, 40 degrees, 60 degrees, 80 degrees, and 90 degrees by using the controls on the bed. (3) The patient then was returned to the supine position and the echocardiogram was displayed continuously on the monitor. The echocardiogram was recorded every 15 minutes for a period of 4 hours. All segments of the LV were visualized in the supine position and during lateral rotation (0 degrees -90 degrees ). Thus, body position did not affect the image. All segments of the LV were visualized during sitting up (0 degrees -90 degrees ), and all segments were visualized during the 4 hours of imaging. The patients were able to move around without distortion of the image.

CONCLUSION

The CONTISON transducer permitted continuous imaging of LV wall motion. Body position did not affect interpretation of wall motion. This device has potential applicability in monitoring LV function in the intensive care setting.

The role of fiberoptic nasopharyngoscopy in the management of the acute airway in angioneurotic edema

BACKGROUND

Angioneurotic edema of the upper aerodigestive tract (AEUAT) often challenges the otolaryngologist with the decision of surgical intervention versus observation.

OBJECTIVE

To develop a logical approach to the evaluation and management of the airway in patients with AEUAT, emphasizing fiberoptic examination (FOE) findings.

METHODS

A computer-based retrospective review of all patients diagnosed with AEUAT was performed. The charts were reviewed for demographics, etiology, medical history, presentation, physical examination, imaging studies, intervention, and outcome. Findings on FOE as well as other covariants were statistically compared.

RESULTS

Seventy patients with AEUAT were identified. The etiologies consisted of 24 cases of angiotensin converting enzyme inhibitor use (33%), 10 allergic reactions (17%), 1 hereditary (1.5%), and 35 idiopathic cases (48%). Fourteen patients underwent airway intervention, including 6 tracheotomies and 8 intubations. Of the 14 patients, 5 underwent emergent intervention before fiberoptic examination, 4 had laryngeal edema only, and 5 had both laryngeal and base of tongue edema. No patients with both laryngeal and base of tongue edema were observed. The remaining 52 patients were observed in a monitored setting and required no subsequent intervention.

CONCLUSION

FOE is an invaluable tool in the assessment of the compromised airway in patients with angioneurotic edema Laryngeal edema alone is an ominous physical finding. When laryngeal and pharyngeal edema are present together, the physician should consider immediate intervention. Our findings indicate that symptoms, including stridor, hoarseness, and dysphagia, do correlate with disease severity; however, they must be confirmed with fiberoptic visualization. Although sound clinical judgment should always be exercised, we present our results in the management of the acute airway in angioneurotic edema.

Failure to demonstrate a humoral mechanism in the antinatriuresis of acute caval constriction

Previous studies reported from this laboratory provided support for the hypothesis that the natriuresis of volume expansion is mediated in part by a humoral mechanism. In the present study we examined whether suppression of this factor participates in the antinatriuresis of acute constriction of the thoracic inferior vena cava. An isolated kidney was perfused by a second dog pretreated with deoxycorticosterone acetate. Expansion of the perfusion dog with equilibrated blood from a reservoir resulted in an increase in sodium excretion from 102+/-30 to 259+/-65 muEq/min, P < 0.001. Fractional sodium excretion increased from 2.3+/-0.6 to 6.2+/-1.2%, P < 0.01. Inulin clearance, plasma protein concentration, and packed cell volume remained constant; renal perfusion pressure and renal blood flow decreased. After the natriuresis was established, the thoracic inferior vena cava was constricted to decrease systemic arterial pressure in the perfusion dog 50 mm Hg. This maneuver suppressed urine output in the dog but did not significantly alter sodium excretion in the isolated kidney. During the period of caval constriction absolute sodium excretion in the isolated kidney measured 198+/-42 muEq/min and fractional sodium excretion measured 5.7+/-1.1%. Neither value is significantly different from that measured during volume expansion alone. The data suggest that the antinatriuresis of acute caval constriction probably does not require suppression of a humoral natriuretic factor and that other more rapidly acting mechanisms, presumably hemodynamic and neural, may be involved.

Evidence for a humoral mechanism in volume expansion natriuresis

The role of a humoral mechanism in the natriuresis induced by volume expansion was evaluated using an isolated dog kidney perfused by a second dog which had been pretreated with desoxycorticosterone acetate (DOCA). Expansion of the perfusion dog with an equilibrated volume of blood from a reservoir, resulted in an increase in UnaV (sodium excretion) from 153.6+/-27.9 (sem) to 345.5+/-57.8 muEq/min, P<0.001. FEna (fractional sodium excretion) increased from 3.4+/-0.6 to 8.1+/-1.2%, P<0.01. The natriuresis occurred in the face of a significant decrease in Cin, RBF, and renal arterial pressure, and in the absence of any change in plasma protein concentration or packed cell volume. In a control group of experiments, sodium excretion did not change when the perfusion dog was not volume expanded, although Cin (inulin clearance) and RBF (renal blood flow) decreased to the same degree as in the expanded group. These data support the conclusion that volume expansion of the perfusion dog either stimulated the release of a natriuretic factor or suppressed the release of an antinatriuretic factor which was manifested by an increase in sodium excretion in the isolated kidney.