Blood immunophenotyping identifies distinct kidney histopathology and outcomes in patients with lupus nephritis.

Lupus nephritis (LN) is a frequent manifestation of systemic lupus erythematosus, and fewer than half of patients achieve complete renal response with standard immunosuppressants. Identifying non-invasive, blood-based pathologic immune alterations associated with renal injury could aid therapeutic decisions. Here, we used mass cytometry immunophenotyping of peripheral blood mononuclear cells in 145 patients with biopsy-proven LN and 40 healthy controls to evaluate the heterogeneity of immune activation in patients with LN and to identify correlates of renal parameters and treatment response. Unbiased analysis identified 3 immunologically distinct groups of patients with LN that were associated with different patterns of histopathology, renal cell infiltrates, urine proteomic profiles, and treatment response at one year. Patients with enriched circulating granzyme B+ T cells at baseline showed more severe disease and increased numbers of activated CD8 T cells in the kidney, yet they had the highest likelihood of treatment response. A second group characterized primarily by a high type I interferon signature had a lower likelihood of response to therapy, while a third group appeared immunologically inactive by immunophenotyping at enrollment but with chronic renal injuries. Main immune profiles could be distilled down to 5 simple cytometric parameters that recapitulate several of the associations, highlighting the potential for blood immune profiling to translate to clinically useful non-invasive metrics to assess immune-mediated disease in LN.

Self-Paced Versus Instructor-Paced Preclinical Training in Operative Dentistry: A Case Study.

Preclinical operative dentistry courses have traditionally involved a lockstep series of live lectures and laboratory exercises. The aims of this study were to assess the effects of an experimental self-paced operative dentistry course on students' perceptions and performance and to compare performance outcomes for this class with the classes two years prior and two years after, which were instructed with the traditional curriculum. In 2013, all lectures in one of three operative dentistry courses at the University of Minnesota School of Dentistry were placed online as narrated slide sequences. For the study, conducted in 2017, students' performance in the course in all five years was assessed, based on exams taken after the laboratory and lecture segments of the course and the practical exam. The experimental class was also invited to complete an end-of-course survey on perceptions of the learning experience. The number of students in classes using the traditional format (in 2011, 2012, 2014, and 2015) ranged from 103 to 108. In the experimental year (2013), 106 students were in the class; course assessments were done for all 106, and 104 responded to the survey (response rate 98%). The results showed no significant differences in assessments between the experimental class and the traditional classes. However, bench instructors reported feeling students in the experimental class were not as well prepared in laboratory sessions as were the traditionally trained students. On the survey, only 22% of students in the experimental class said they always viewed assigned material before the lab periods, with 78% viewing it often, sometimes, seldom, or never. In this class, 48% preferred the online lectures, 37% preferred live lectures, and 16% had no preference. These mixed results suggest caution when developing self-paced courses.

Recurrent acute otitis media associated meningitis in a patient with a contralateral cochlear implant and bilateral cochleovestibular dysplasia.

OBJECTIVE: To illustrate that a patient with a cochlear implant may be at increased risk of meningitis secondary to developmental anatomic abnormality associated with the underlying sensorineural hearing loss, as opposed to the implant itself. METHODS: Case report. RESULTS: Our 12-year-old patient has bilateral cochlear dysplasia, profound sensorineural hearing loss and no prior history of recurrent acute otitis media or meningitis. He underwent a left cochlear implant at 8 years of age and subsequently experienced three episodes of right acute otitis media and meningitis over the next 4 years. Middle ear exploration revealed a cerebrospinal fluid leak. A right radical mastoidectomy with closure of the external auditory canal, removal of the tympanic membrane, malleus, and incus, closure of the Eustachian tube, and obliteration of the mastoid and middle ear with abdominal fat has prevented further episodes. CONCLUSION: Meningitis in a patient with a cochlear implant is not necessarily related to the implant.

Interference of nontypeable Haemophilus influenzae and Moraxella catarrhalis by Streptococcus oralis in adenoid organ culture: a possible strategy for the treatment of the otitis-prone child.

The role of viridans group streptococci (Streptococcus oralis) in the prevention of colonization with nontypeable Haemophilus influenzae and Moraxella catarrhalis was investigated in an adenoid organ culture system. The adenoids from 100 patients who were undergoing adenoidectomy for either hypertrophy or recurrent otitis media were used. Streptococcus oralis Parker uniformly inhibited colonization with nontypeable H. influenzae or M. catarrhalis over a 24-hour period of incubation in adenoid organ culture. Streptococcus oralis Booth, a noninhibitory strain, did not significantly reduce colonization with nontypeable H. influenzae and M. catarrhalis. The results indicate that some strains of S. oralis may inhibit colonization with potential pathogens in the nasopharynx. It is therefore possible that colonization with inhibitory strains of viridans streptococci may be used in the nasopharynx as a relatively safe and inexpensive approach to prevention of recurrent otitis media in some children.