Morbidly obese patient with non-alcoholic steatohepatitis-related cirrhosis who died from sepsis caused by dental infection of Porphyromonas gingivalis: A case report

Emerging Roles of Periodontal Pathogen-Derived Outer Membrane Vesicles in NAFLD

The rising incidence of nonalcoholic fatty liver disease (NAFLD) poses a great socioeconomic burden worldwide. Also, periodontitis is the most common chronic inflammatory disease caused by a group of oral pathogens, affecting both oral health and systemic conditions, especially liver disease. Although accumulating evidence has elucidated an association between periodontal pathogens and NAFLD, the role of periodontal pathogen-derived outer membrane vesicles (OMVs) has not yet been clarified. In this comprehensive review, we aim to address this gap by summarising the progression and pathogenesis of NAFLD and revealing the relationship between periodontal disease and NAFLD multidimensionally. Additionally, this review sheds light on the multifunctional roles of periodontal pathogens OMVs and emphasises that periodontal pathogen-derived OMVs promote the development of NAFLD by stimulating Kupffer cells to produce inflammatory factors and inducing the activation of Hepatic stellate cells. However, it is still controversial whether periodontal pathogen-derived OMVs can be transferred to the liver through the bloodstream route or the oral-gut-liver axis. This highlights the pressing need for continued research efforts to develop new and optimised research schemes to observe the formation of the systemic distribution pathway of periodontal pathogen-derived OMVs. Finally, it is notable that there are currently no relevant clinical treatment guidelines to make specific provisions on controlling the level of periodontal pathogen-derived OMVs in patients with NAFLD. Guidelines developed based on our findings may contribute to the standardisation of practices. It can also provide effective strategies and potential therapeutic targets for NAFLD patients with periodontitis to alleviate the development of NAFLD diseases by inhibiting periodontal pathogens OMVs.

Oral Pathogenic Bacteria and the Oral-Gut-Liver Axis: A New Understanding of Chronic Liver Diseases

Liver diseases have long been a prevalent cause of morbidity and mortality, and their development and progression involve multiple vital organs throughout the body. Recent studies on the oral-gut-liver axis have revealed that the oral microbiota is associated with the pathophysiology of chronic liver diseases. Since interventions aimed at regulating oral biological disorders may delay the progress of liver disease, it is crucial to better comprehend this process. Oral bacteria with potential pathogenicity have been extensively studied and are closely related to several types of chronic liver diseases. Therefore, this review will systemically describe the emerging role of oral pathogenic bacteria in common liver diseases, including alcoholic liver disease (ALD), non-alcoholic steatohepatitis (NASH), non-alcoholic fatty liver disease (NAFLD), cirrhosis, autoimmune liver diseases (AILD), and liver cancer, and bring in new perspectives for future research.

A rare cause of bacteremia due to Porphyromonas asaccharolytica in a patient with necrotizing fasciitis

Porphyromonas species are Gram-negative anaerobic bacilli mainly involved in human periodontal diseases. We report an uncommon case of bacteremia due to P. asaccharolytica in a patient with necrotizing fasciitis. A 52-year-old woman with a history of diabetes mellitus was admitted for an extensive necrotizing lesion on the left lower limb. After she developed septic shock, two sets of blood cultures were taken. Anaerobic bottles yielded a pure culture of a microorganism initially identified as P. uenonis by MALDI-TOF MS but with a low log score, and a gene sequencing technique was therefore applied, identifying the isolate as P. asaccharolytica. Only resistance to penicillin and clindamycin was documented. Treatment with meropenem was administered, and the patient was discharged following her recovery.

Association of periodontitis and tooth loss with liver cancer: A systematic review

A number of epidemiological studies have suggested a positive association between periodontal diseases and oro-digestive cancers, including liver cancer. The purpose of the present systematic review was to analyze the current evidence regarding the potential association between periodontitis and/or tooth loss and the risk of liver cancer. A comprehensive search of PubMed, Scopus and Web of Science databases was conducted in August 2019. The inclusion criteria comprised all observational studies that assessed the relationship between periodontitis or tooth loss and liver cancer. Case reports, animal studies, experimental studies, and reviews were excluded. Due to great heterogeneity among the included studies, no meta-analysis was conducted. Six studies (five prospective cohorts and one case-control) comprising 619,834 subjects (including 916 liver cancer cases) were included. The studies were conducted in the United States, Europe, and Asia. Three large-scale cohort studies reported a positive association between periodontitis or tooth loss and the risk of liver cancer. One case-control study found some association between liver cancer and loss of 12-23 teeth, but such association was not replicated in patients with greater number of tooth loss. Contrarily, two studies failed to report any association between periodontitis and/or tooth loss and the risk of liver cancer. The available evidence suggests a possible link between tooth loss/periodontitis and the risk of liver cancer. However, the evidence is not conclusive enough, a fact that drives to conduct more, well-designed, prospective cohort studies to further explore the potential association between periodontitis and the risk of liver cancer.

Knowledge of sepsis risk and management among dental professionals in Wales: a service evaluation

Aims Sepsis is a significant medical condition. This service evaluation aimed to investigate the current level of knowledge, confidence and educational requirements regarding sepsis among dental professionals in Wales.Design A convenience-sampled, self-administered electronic questionnaire.Setting All chairside dental professionals registered with Health Education and Improvement Wales, all Local Dental Committees, district general hospitals, Cardiff University Dental Hospital and Community Dental Services throughout Wales.Materials and methods A questionnaire was distributed electronically to an estimated 3,716 dental professionals working in Wales in late 2019. Responses were descriptively and statistically analysed.Results In total, 357 responses were received (9.6%), which achieves a 95% confidence interval (CI) with a 5% margin of error. The majority of respondents reported lack of knowledge or confidence in sepsis recognition and management. Approximately two-fifths of respondents did not access equipment to measure oximetry, temperature or blood pressure. More than three-quarters of respondents had not been trained in sepsis recognition and management. The majority of respondents requested online/distance training (42%), local/national conferences (27%) and local study days (16%) as postgraduate educational format.Conclusion There is a clear need for postgraduate education for dental teams regarding the identification and management of individuals with potential sepsis in Wales.Introduction.

High Fat Diets Composed of Palm Stearin and Olive Oil Equally Exacerbate Liver Inflammatory Damage and Metabolic Stress in Mice

SCOPE

People with fatty liver could be subject to acute infections such as sepsis. The aim of the study is to evaluate the effect of high fat diets (HFD) of olive oil and palm stearin on liver inflammation induced by lipopolysaccharides (LPS).

METHODS AND RESULTS

C57BL/6J male mice were treated with high fat diets with different sources of oils: palm stearin and olive oil for 8 weeks followed by LPS injection. The proinflammatory effect of olive oil was also studied using gavage treatment and IP injection of LPS. Animals fed with HFDs showed an increase in body weight, elevated blood glucose levels, and fatty liver phenotype. HFDs aggravated the effect of LPS treatment to induce inflammatory response compared to low fat diet (LFD) effect. Following HFD supplementation, LPS induced hyperinsulinemia, more liver damage than in animals that consumed LFD. In addition, both gavage and long-term feeding with high lipids in the presence of LPS resulted in inhibition of gluconeogenic genes expression.

CONCLUSION

HFDs of both monounsaturated and saturated fat potentiated liver inflammation induced by LPS treatment indicate that the total amount of fat consumed is the main proinflammatory factor rather than the type of fat.

Relationship between intestinal flora and inflammatory factors in patients with nonalcoholic steatohepatitis

This study was conducted to analyze the change in intestinal flora of patients with nonalcoholic steatohepatitis and its correlation to the levels of the inflammatory cytokines interleukin-10 (IL-10) and IL-17. We selected 90 patients that were diagnosed with and treated for nonalcoholic steatohepatitis as the patient group and 80 healthy cases as the control group. We then compared the intestinal flora in the subject feces and the intestinal colonization resistance (B/E, Bifidobacterium to Enterobacter) of both groups. Using RT-PCR, we also detected IL-10 and IL-17 mRNA levels in the peripheral blood mononuclear cells of both groups. Furthermore, we used the ELISA method to determine serum IL-10 and IL-17 levels in order to explore the correlation between IL-10, IL-17 and B/E. The number of Bifidobacterium and Lactobacillus were significantly lower in the patient group than the control group (P<0.05), while Enterobacter and Enterococcus pathogenic bacteria were significantly higher in the patient group than the control group (P<0.05). The B/E value was lower in the patient group than the control group (P<0.05). The relative expression of IL-10 and IL-17 mRNA in the patient group was significantly higher than in the control group (P<0.05). In the patient group, the serum IL-10 levels were 1.17±0.15 pg/ml, which is significantly higher than the control group serum IL-10 levels which were 0.32±0.04 pg/ml (P<0.05). The serum IL-17 levels in the patient groups were 0.96±0.11 pg/ml, which was significantly higher than the control group, which had an average of 0.28±0.01 pg/ml serum IL-17 levels (P<0.05). Pearson's correlation analysis showed that the change of B/E value of intestinal flora in the patients group were negatively correlated with serum IL-10 (r=−0.546, P<0.05), and negatively correlated with serum IL-17 (r=−0.535, P<0.05). Therefore, compared to healthy people, the expression of IL-10 and IL-17 in the peripheral blood of patients with non-alcoholic fatty liver is high. The changes in intestinal flora in patients with nonalcoholic steatohepatitis are closely related to the changes of serum IL-10 and IL-17 levels, and they are involved in the development of nonalcoholic steatohepatitis.