P-330 The immune cell population of the human fallopian tubes in health and benign pathology: a systematic review

Study question

What is the immune cell profile of the human fallopian tube in health and in benign pathological conditions?

Summary answer

The fallopian tubes have a distinct population of immune cells from the innate and adaptive subsystems. Variations have been observed in several tubal pathologies.

What is known already

The fallopian tubes play a key role in fertility; up to 30% of infertility cases have been reported due to tubal pathologies, which have been neglected due to the success of in vitro fertilisation (IVF). The fallopian tubes have been shown to harbour immune cell populations with the involvement of both the innate and adaptive arms of the immune system that provide surveillance against several pathogens.

Therefore, characterisation of this population is vital in promoting a better understanding of tubal pathogenesis, and its influence on infertility, leading to improvements in the sexual and reproductive health of women.

Study design, size, duration

This systematic review was conducted on the 1st November 2021 and reported in accordance to PRISMA statement, and preceded by a prospectively written protocol registered with PROSPERO (registration number: CRD42021288257). CINAHL, EMBASE and EMCARE, Scopus and PubMed databases were searched for relevant published material. All studies that concerning the immune cells of human fallopian tubes in health or benign pathology of pre-menopausal, pregnant and/or post-menopausal women that published in English language were included.

Participants/materials, setting, methods

The predefined search strategy identified 3767 publications. Following screening, a total of 42 studies were included and data was extracted. The findings are thematically reported based on: (1) menopausal status and/or cycle phase; (2) pathophysiology; (3) immune cell types. A risk of bias assessment was performed using Newcastle-Ottawa scale (NOS) and a modified version for case studies.

Main results and the role of chance

T lymphocytes, predominantly CD8+ cytotoxic T cells, represent the most abundant immune cell population within the healthy fallopian tube. B lymphocytes, macrophages, natural killer (NK) cells and dendritic cells have also been identified. The number of macrophages demonstrated a consistent and significant increase during the progesterone-dominant secretory phase compared to the proliferative phase. A similar distribution of lymphocytes was reported in tubal ectopic pregnancies to that in healthy tubes. Macrophages, dendritic cells, and natural killer (NK) cells were observed in tubal pregnancies with a significant increase in the number of CD56+ and CD3+ cells in cases of tubal rupture.

Salpingitis, hydrosalpinx and endometriosis are all characterised by an increased population of macrophages in comparison to healthy fallopian tubes.

Limitations, reasons for caution

Some studies scored poorly on the NOS, suggesting their findings to be treated with caution. The deficiency in published research into common tubal pathologies and inconsistent findings presented between studies only allowed limited conclusions to be formulated regarding these immune cell populations.

Wider implications of the findings

Comprehensive knowledge of the immune cell profile of the human fallopian tubes will provide greater understanding into the pathophysiology of common tubal disorders, potentially leading to innovative treatments in the future.

Trial registration number

not applicable

Use of CBCT Guidance for Tooth Autotransplantation in Children

Tooth autotransplantation (TAT) offers a viable biological approach to tooth replacement in children and adolescents. The aim of this study was to evaluate the outcome of the cone-beam computed tomographic (CBCT)–guided TAT compared to the conventional TAT protocol and to assess the 3-dimensional (3D) patterns of healing after CBCT-guided TAT (secondary aim). This study included 100 autotransplanted teeth in 88 patients. Each experimental group consisted of 50 transplants in 44 patients (31 males and 19 females). The mean (SD) age at the time of surgery was 10.7 (1.1) y for the CBCT-guided group. This was 10.6 (1.3) y for the conventional group. The mean (SD) follow-up period was 4.5 (3.1) y (range, 1.1 to 10.4 y). Overall survival rate for the CBCT-guided TAT was 92% with a success rate of 86% compared to an 84% survival rate and a 78% success rate for the conventional group ( P > 0.005). The following measurements were extracted from the 3D analysis: root hard tissue volume (RV), root length (RL), apical foramen area (AFA), and mean and maximum dentin wall thickness (DWT). Overall, the mean (SD) percentage of tissue change was as follows: RV gain by 65.8% (34.6%), RL gain by 37.3% (31.5%), AFA reduction by 91.1% (14.9%), mean DWT increase by 107.9% (67.7%), and maximum DWT increase by 26.5% (40.1%). Principal component analysis (PCA) identified the mean DWT, RV, and maximum DWT as the parameters best describing the tissue change after TAT. Cluster analysis applied to the variables chosen by the PCA classified the CBCT group into 4 distinct clusters (C1 = 37.2%, C2 = 17.1%, C3 = 28.6%, C4 = 17.1%), revealing different patterns of tissue healing after TAT. The CBCT-guided approach increased the predictability of the treatment. The 3D analysis provided insights into the patterns of healing. CBCT-guided TAT could be adopted as an alternative for the conventional approach. (Clinical trial center and ethical board University Hospitals, KU Leuven: S55287; ClinicalTrials.gov Identifier: NCT02464202)

The Road to Professionalism in Medical Informatics: A Proposal for Debate

Medical Informatics has not as yet reached professional status. However, as an expanding and increasingly important discipline in the delivery of healthcare, it is important that it strives towards professionalisation. In this article we consider the nature of professionalism, its potential benefits and associated costs. We examine the potential for Medical Informatics to become a professional discipline and how far it has succeeded in this to date, describing three possible scenarios for the future of the discipline. We suggest steps towards the professionalisation of Medical Informatics and the roles of key players, including academia, system developers, purchasers and users, and professional societies. We also put forward some possible criteria for a Medical Informatics Professional. Finally, we make some general observations concerning the way forward.

Philosophies for the Design and Development of Clinical Decision-Support Systems

Little significance is attached by medical informatics workers to the many practical issues which affect the development of clinical decision-support systems. We examine the current state of research in clinical decision-support, the characteristics and motivations of developers, and the perceptions of intended end-users. Factors which adversely affect the success of systems are highlighted and pointers to good practice discussed. We then propose a coherent approach to system development, consisting of requirements analysis, software design, implementation, testing, evaluation and maintenance.

Diabetic hepatosclerosis: another diabetes microvascular complication?

BACKGROUND

Liver disease in diabetes is common and is frequently the result of hepatic steatosis. Diabetic hepatosclerosis is a relatively recent description of sinusoidal fibrosis, without steatosis, observed in liver biopsies of people with diabetes presenting with cholestasis. Its association with other microvascular complications suggests it is a form of hepatic diabetic microangiopathy.

CASE REPORT

We report the case of a 50-year-old woman with longstanding Type 1 diabetes, complicated by nephropathy resulting in cadaveric renal transplant, retinopathy, gastroparesis and neuropathy with slowly healing ulceration to her right foot. She was noted to have deranged liver function tests: alanine aminotransferase, 162 IU/l; bilirubin, 44 IU/l; alkaline phosphatase, 5279 IU/l (isoenzymes; bone 1029 IU/l, liver 4250 IU/l); γ-glutamyl transferase, 662 IU/l. A non-invasive liver screen did not reveal the cause of the cholestasis. A liver biopsy demonstrated sinusoidal fibrosis without evidence of steatosis and thus a diagnosis of diabetic hepatosclerosis was made. Comparison with a biopsy performed 11 years previously at a different trust due to elevated alkaline phosphatase levels revealed slow progression of the sinusoidal fibrosis.

DISCUSSION

This case describes the longest reported clinical course of diabetic hepatosclerosis, spanning 11 years, in which time the patient did not develop evidence of cirrhosis or portal hypertension. It is difficult to estimate the clinical relevance of this condition because little is known regarding its clinical course and effect on morbidity and mortality. Identified patients should undergo low-intensity, long-term follow-up to improve understanding of its clinical sequelae and relevance.

Interspecies pair housing of macaques in a research facility

The eighth edition of The Guide for the Care and Use of Laboratory Animals establishes social housing as the 'default' for social species including non-human primates. The advantages of social housing for primates have been well established, but small research facilities housing few primates in indoor cages have struggled with social housing as a result of limitations on appropriate housing and availability of compatible monkeys. Here, we report a novel approach to pair housing macaques - crossing species. We have successfully pair housed an intact male rhesus macaque with an intact male cynomolgus macaque, and an adult female rhesus macaque with numerous subadult female cynomolgus macaques. Monkeys in these pairs established dominant-subordinate relationships similar to same-species pairs. Rhesus and cynomolgus macaques can be successfully paired for the purpose of social housing in facilities with limited numbers of monkeys.

Neonatal ultrasound results following very preterm birth predict adolescent behavioral and cognitive outcome

This study investigated the association between different neonatal ultrasonographic classifications and adolescent cognitive, educational, and behavioral outcomes following very preterm birth. Participants included a group of 120 adolescents who were born very preterm (<33 weeks of gestation), subdivided into three groups according to their neonatal cerebral ultrasound (US) classifications: (a) normal (N = 69), (b) periventricular hemorrhage (PVH, N = 37), and (c) PVH with ventricular dilatation (PVH + DIL, N = 14), and 50 controls. The cognitive functions assessed were full-scale IQ, phonological and semantic verbal fluency, and visual-motor integration. Educational outcomes included reading and spelling; behavioral outcomes were assessed with the Rutter Parents' Scale and the Premorbid Adjustment Scale (PAS). Adolescent outcome scores were compared among the four groups. A main effect for group was observed for full-scale IQ, Rutter Parents' Scale total scores, and PAS total scores, after controlling for gestational age, socioeconomic status and gender, with the PVH + DIL group showing the most impaired scores compared to the other groups. The current results demonstrate that routine neonatal ultrasound classifications are associated with later cognitive and behavioral outcome. Neonatal ultrasounds could aid in the identification of subgroups of children who are at increased risk of neurodevelopmental problems. These at risk subgroups could then be referred to appropriate early intervention services.

Accuracy and surgical feasibility of a CBCT-based stereolithographic surgical guide aiding autotransplantation of teeth: in vitro validation

The aims of this study were to determine the accuracy of a 3D computer model and stereolithographic (STL) replica when compared to the real tooth and to develop a cone beam computed tomography (CBCT)-based planning technique including surgical guide fabrication. A STL surgical guide and a tooth replica were fabricated using SimPlant Pro 12.1. To validate this process, tooth segmentation and replica design were prepared for comparison to an optical scan of the corresponding tooth. For surgical intervention, a dry dentate mandible was scanned using a Scanora CBCT and the donor tooth was segmented. The donor tooth was repositioned, and two guides were designed. These tooth replica and guides were used in socket preparation of the dry mandible. The 3D computer model of the segmented teeth and related STL models showed satisfactory results with an acceptable accuracy. The surfaces were within 0·25mm distance, but in some areas up to 2·5mm deviation were seen. The results showed that 79% of the points was between 0·25 and -0·25mm, 3% was overestimated (>0·25mm) and 18% was underestimated (<-0·25mm). The computer-based repositioning of the donor tooth and construction of tooth replica and guide allowed socket preparation before donor tooth extraction and optimization of the STL procedure for in vivo planning of CBCT-based autotransplantation.