Epithelial RANKL Limits Experimental Periodontitis via Langerhans Cells.

Due to its capacity to drive osteoclast differentiation, the receptor activator of nuclear factor kappa-ß ligand (RANKL) is believed to exert a pathological influence in periodontitis. However, RANKL was initially identified as an activator of dendritic cells (DCs), expressed by T cells, and exhibits diverse effects on the immune system. Hence, it is probable that RANKL, acting as a bridge between the bone and immune systems, plays a more intricate role in periodontitis. Using ligature-induced periodontitis (LIP), rapid alveolar bone loss was detected that was later halted even though the ligature was still present. This late phase of LIP was also linked with immunosuppressive conditions in the gingiva. Further investigation revealed that the ligature prompted an immediate migration of RANK-expressing Langerhans cells (LCs) and EpCAM+ DCs, the antigen-presenting cells (APCs) of the gingival epithelium, to the lymph nodes, followed by an expansion of T regulatory (Treg) cells in the gingiva. Subsequently, the ligatured gingiva was repopulated by monocyte-derived RANK-expressing EpCAM+ DCs, while gingival epithelial cells upregulated RANKL expression. Blocking RANKL signaling with monoclonal antibodies significantly reduced the frequencies of Treg cells in the gingiva and prevented gingival immunosuppression. In addition, RANKL signaling facilitated the differentiation of LCs from bone marrow precursors. To further investigate the role of RANKL, we used K14-RANKL mice, in which RANKL is overexpressed by gingival epithelial cells. The elevated RANKL expression shifted the steady-state frequencies of LCs and EpCAM+ DCs within the epithelium, favoring LCs over EpCAM+ DCs. Following ligature placement, heightened levels of Treg cells were observed in the gingiva of K14-RANKL mice, and alveolar bone loss was significantly reduced. These findings suggest that RANKL-RANK interactions between gingival epithelial cells and APCs are crucial for suppressing gingival inflammation, highlighting a protective immunological role for RANKL in periodontitis that was overlooked due to its osteoclastogenic activity.

γδ T Cells Differentially Regulate Bone Loss in Periodontitis Models.

γδ T cells are nonclassical T lymphocytes representing the major T-cell population at epithelial barriers. In the gingiva, γδ T cells are enriched in epithelial regions adjacent to the biofilm and are considered to regulate local immunity to maintain host-biofilm homeostatic interactions. This delicate balance is often disrupted resulting in the development of periodontitis. Previous studies in mice lacking γδ T cells from birth (Tcrd-/- mice) examined the impact of these cells on ligature-induced periodontitis. Data obtained from those studies proposed either a protective effect or no impact to γδ T cells in this setting. Here, we addressed the role of γδ T cells in periodontitis using the recently developed Tcrd-GDL mice, enabling temporal ablation of γδ T cells. Specifically, the impact of γδ T cells during periodontitis was examined in 2 modalities: the ligature model and the oral infection model in which the pathogen Porphyromonas gingivalis was administrated via successive oral gavages. Ablation of γδ T cells during ligature-induced periodontitis had no impact on innate immune cell recruitment to the ligated gingiva. In addition, the number of osteoclasts and subsequent alveolar bone loss were unaffected. However, γδ T cells play a pathologic role during P. gingivalis infection, and their absence prevented alveolar bone loss. Further analysis revealed that γδ T cells were responsible for the recruitment of neutrophils and monocytes to the gingiva following the exposure to P. gingivalis. γδ T-cell ablation also downregulated osteoclastogenesis and dysregulated long-term immune responses in the gingiva. Collectively, this study demonstrates that whereas γδ T cells are dispensable to periodontitis induced by the ligature model, they play a deleterious role in the oral infection model by facilitating pathogen-induced bone-destructive immune responses. On a broader aspect, this study highlights the complex immunopathologic mechanisms involved in periodontal bone loss.

γδT Cells Are Essential for Orthodontic Tooth Movement.

Sustained mechanical forces applied to tissue are known to shape local immunity. In the oral mucosa, mechanical stress, either naturally induced by masticatory forces or externally via mechanical loading during orthodontic tooth movement (OTM), is translated, in part, by T cells to alveolar bone resorption. Nevertheless, despite being considered critical for OTM, depletion of CD4+ and CD8+ T cells is reported to have no impact on tooth movement, thus questioning the function of αßT cells in OTM-associated bone resorption. To further address the role of T cells in OTM, we first characterized the leukocytes residing in the periodontal ligament (PDL), the tissue of interest during OTM, and compared it to the neighboring gingiva. Unlike the gingiva, monocytes and neutrophils represent the major leukocytes of the PDL. These myeloid cells were also the main leukocytes in the PDL of germ-free mice, although at lower levels than SPF mice. T lymphocytes were more enriched in the gingiva than the PDL, yet in both tissues, the relative fraction of the γδT cells was higher than the αß T cells. We thus sought to examine the role of γδT cells in OTM. γδT cells residing in the PDL were mainly Vγ6+ and produced interleukin (IL)-17A but not interferon-γ. Using Tcrd-GDL mice allowing conditional ablation of γδT cells in vivo, we demonstrate that OTM was greatly diminished in the absence of γδT cells. Further analysis revealed that ablation of γδT cells decreased early IL-17A expression, monocyte and neutrophil recruitment, and the expression of the osteoclastogenic molecule receptor activator of nuclear factor-κß ligand. This, eventually, resulted in reduced numbers of osteoclasts in the pressure site during OTM. Collectively, our data suggest that γδT cells are essential in OTM for translating orthodontic mechanical forces to bone resorption, required for relocating the tooth in the alveolar bone.

MHD effect on mixed convection of annulus circular enclosure filled with Non-Newtonian nanofluid.

The fluid flow and mixed convection heat transfer of a non-Newtonian (Cu-water) nanofluid-filled circular annulus enclosure in a magnetic field are investigated numerically for a two-dimensional, steady-state, incompressible, laminar flow using the Galerkin finite element method (GFEM). The Prandtl number (Pr = 6.2) and Grashof number (Gr = 100) are assumed to be constants, whereas the Richardson number varies within a range of 0 ≤ Ri ≤ 1, the Hartman number within a range of 0 ≤ Ha ≤60, the Power law index within a range of 0.2 ≤ n ≤ 1.4, and the volume fraction within a range of 0 ≤ φ ≤ 1. The enclosure consists of an outer rotating cylinder that is kept at a cold temperature (Tc) and an inner non-rotating cylinder kept at a hot temperature (Th). The ratio of the inner circular diameter to the annulus space length is kept constant at 2. The results depict that the stream function increases with increasing power law index, even up to n = 1, which causes the fluid to behave as a Newtonian fluid. The magnetic field has a critical impact on the fluid flow pattern. The average Nusselt number increases with decreasing Richardson number, owing to the improved heat transfer by forced convection.

Difference in perception between nurses and patients related to patients' health locus of control.

Patient's health locus of control (HLOC) belief associates with superior health outcomes and patient satisfaction. Higher levels of HLOC beliefs among patients and nurses contribute positively in developing the partnership model of care. The purpose of this study was to examine the differences between nurses and patients' perception of patient's health locus of control at the Jordanian general health-care settings. This study used cross-sectional, descriptive-correlation design to collect data using self-report questionnaires from 180 general nurses and 178 patients in general wards. Data collected were in regard to patient's perception of health locus of control. Patients and nurses expressed high level of externality and internality HLOC beliefs inferring the significance of partnership model of care. Chance was rated low among nurses and patients. The study emphasizes the role of nurses in enhancing their patient control and power over their health and participation in planning and implementation of health-care plans.

Influence of age on postoperative course in coronary artery bypass patients.

The average age of patients undergoing coronary artery bypass grafting (CABG) has increased. To determine influence of age on postoperative course, the authors reviewed the outcome of 199 consecutive patients who underwent primary, isolated, elective CABG. The 101 patients < 65 years (group I) and 98 patients > or = 65 years (group II) were similar in preoperative severity of symptoms, history of myocardial infarction, number of grafts received, and time on cardiopulmonary bypass. Comparison between the two groups revealed similar rates of operative mortality and morbidity. In group II patients, median rates of hospitalization and intensive or intermediate care unit stay were greater (P < 0.005), and there were significantly higher incidences of postoperative disorientation, transfusion of exogenous blood, and need for special discharge arrangements (P < 0.05). The authors conclude that CABG patients > or = 65 years of age have a longer and more complex postoperative course than younger patients and suggest that further nursing research be conducted to identify the specific needs of this patient population.