Resident alveolar macrophages are replaced by recruited monocytes in response to endotoxin-induced lung inflammation

In the acute respiratory distress syndrome, recruitment of peripheral blood monocytes results in expansion of the total pool of resident alveolar macrophages. The fate of resident macrophages, or whether recruited monocytes are selectively eliminated from the alveolar airspace or differentiate into resident alveolar macrophages during the resolving phase of inflammation, has not been determined. Here, we analyzed the kinetics of resident and recruited macrophage turnover within the alveolar airspace of untreated and LPS-challenged mice. Using bone marrow chimeric CD45.2 mice that were generated by lethal irradiation of CD45.2 alloantigen-expressing recipient mice and bone marrow transplantation from CD45.1 alloantigen-expressing donor mice, we employed a flow cytometric approach to distinguish recipient from donor-type macrophages in bronchoalveolar lavage fluids. Our data show that resident alveolar macrophages of untreated chimeric CD45.2 mice are very slowly replaced by constitutively immigrating CD45.1 positive monocytes, resulting in a replacement rate of approximately 40% by 1 yr. In contrast, more than 85% of the resident CD45.2 positive alveolar and lung homogenate macrophages were exchanged by donor CD45.1-expressing macrophages within 2 mo after treatment with Escherichia coli endotoxin (LPS). Importantly, fluorescence-activated cell sorter analysis of increased annexin V binding to both recipient and donor-type macrophages revealed increased apoptotic events to underlie this endotoxin-driven inflammatory macrophage turnover. Collectively, the data show that under baseline conditions the alveolar macrophage turnover exhibits very slow kinetics, whereas acute lung inflammation in response to treatment with LPS triggers a brisk acceleration of recruitment of monocytes that replace the resident alveolar macrophage population.

Oral care post stroke: a scoping review

Health concerns post stroke may be the result of, or exacerbated by, neglected oral health care (OHC). However, OHC may be challenging post stroke due to hemiparesis, hemiplegia, a lack of coordination, and/or cognitive deficits. The objective of this study was to conduct a scoping review and summarise the current state of knowledge pertaining to OHC post stroke. A literature search was conducted using the multiple databases (MEDLINE, CINAHL, EMBASE, etc.). Combinations of multiple keywords were searched: oral, dental, health, care, hygiene, teeth, dentures, tooth brushing, stroke, cardiovascular health and cardiovascular disease. A grey literature search was also conducted. Articles included were those published in English between 1970 and July 2013, which focused on at least one aspect of OHC among a stroke population. For clinical trials, ≥50% of the sample must have sustained a stroke. In total, 60 articles met inclusion and focused on three primary area: (i) OHC Importance/Stroke Implications; (ii) Current Research; and (iii) Current Practice. It was found that OHC concerns are mainly related to mastication, dysphagia/nutrition, hygiene, prostheses and quality of life. Research indicates that there is limited specialised and individual care provided, and there are few assessment tools, guidelines and established protocols for oral health that are specific to the stroke population. Further, dental professionals' and nurses' knowledge of OHC is generally inadequate; hence, proper education for health professionals in acute and rehabilitation settings, patients, and caregivers has been discussed.

Screening questionnaires for substance abuse post brain injury: a review

OBJECTIVE

To assess the psychometric properties of the available assessment questionnaires for substance abuse studied within a brain injury population.

METHODS

A literature search was conducted on MEDLINE, PsycINFO, CINAHL, and Embase databases. Articles published in English from inception through March 2018 on the screening questionnaires used to identify substance abuse post brain injury were reviewed. Eligible primary studies had to include: adults (participants ≥18 years old) post brain injury; and report measures of diagnostic accuracy (e.g., sensitivity, specificity, and diagnostic odds ratio).

RESULTS

Six screening questionnaires were included: Alcohol Use Disorders Identification Test, Brief Michigan Alcohol Screening Test, CAGE, Drug Abuse Screening Test, Substance Abuse Screening Inventory and the Short Michigan Alcohol Screening Test (SMAST). All questionnaires, except the SMAST, used the Diagnostic and Statistical Manual of Mental Disorders as the criterion measure. While report measures of diagnostic accuracy were reported and summarized, none of the studies provided reliability information or subgroup analysis among those with brain injury.

CONCLUSIONS

Concerns of social desirability, population demographics, responsiveness to treatment effects, and administrative burden are important when selecting a questionnaire. Research examining the reliability of substance abuse screening questionnaires in the brain injury population is lacking and future research is warranted.

Telemedicine: application of telepathology-remote microscopy for intraoperative diagnoses on frozen sections

Due to the time delay, intraoperative consultations result in an extension of operation times, leading to prolonged anesthesia and idle time during surgery. Using a remote controlled microscope for telepathology, transfer times between hospital and pathologist can be eliminated and pathological expertise obtained independently of the geographic location of the hospital. In cooperation with a community hospital located 100 km apart from the Institute of Pathology of the Justus Liebig University Giessen, telepathological intraoperative consultations have been performed since 1999. After preparation and staining of the cryosection in the hospital, the slide was examined in our institute using a remote-controlled microscope (Leica DMRXA) and a special telepathological software (Leica TPS1). Data were transferred via two ISDN connections in parallel. The telepathology system contains an additional macroscopic examination equipment. Up to now more than 40 telepathological consultations have been done. Time required for the microscopic diagnosis ranged between 4 and 25 minutes. The amount of time saved, compared to the transfer to the next available pathologist, was approximately 45 minutes. In our experience, telepathological diagnoses were fully in accordance with conventional diagnoses routinely performed afterwards. The application of telepathology can lead to a significant shortening of surgery time if a pathologist is locally not available. In the study presented, no diagnostic errors occurred. The additional application of a macroscopic equipment allows inspection and interactive guidance for sampling, thus preventing sampling errors.

Frequency of Secondary Dislocations of Initially non Displaced and Minimally Displaced Fractures of the Lateral Humeral Condyle in Children - Surveillance of a Treatment Algorithm

AIM OF THE STUDY

The treatment of undisplaced fractures of the lateral humeral condyle is conservative. However, it is problematic that it is not possible to differentiate between a stable and an unstable, non-displaced fracture. A pragmatic approach is to X-ray the elbow without a cast 5 days after trauma and to compare those images with the initial ones. If there is a central increase of dislocation, then there is an indication of an unstable fracture. The dislocation can also be indicated by a translational movement, which is best observed in the border area. The aim of the study was to retrospectively determine the incidence of secondary dislocations of initially undisplaced and minimally dislocated fractures of the lateral humeral condyle in infants between 2010 and 2015.

METHODS

We performed a retrospective, non-randomized analysis of 75 children with initially undisplaced and minimally displaced fractures of the lateral humeral condyle between 2010 and 2015. The strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle was carried out by means of an X-ray without a cast 5 days after trauma. Further radiological controls were performed after 14 days, 4 weeks and after 10 to 12 weeks in operated children.

RESULTS

Seven initially undisplaced and minimally dislocated fractures (9,3%) showed a secondary dislocation 5 days after trauma when a radiological control without a cast was performed. At the control 14 days after trauma there was no further secondary dislocation. The immobilization took place in an upper arm cast for a period of 4 weeks.

CONCLUSION

90% of all non-dislocated fractures of the lateral humeral condyle can be treated conservatively. It is important to find out which about 10% of children will experience a secondary dislocation safely and effectively. It has been shown that the strategy for the evaluation of a stable and an unstable fracture of the lateral humeral condyle by means of a radiological control after 5 days without a cast can be effective and cost-saving. With a high degree of certainty, the unstable fracture can be detected at the radiological control 5 days after trauma. If, after 5 days, the radiological control reveals unsure finding regarding the dislocation, it is advisable to recheck the fracture in the second radiological control after 14 days.