Liver dendritic cells (DCs), which may orchestrate the liver's unique immunoregulatory functions, remain poorly characterized. We used a technique of overnight migration from pieces of normal human liver and skin to obtain tissue-derived DCs with minimal culture and no additional cytokine treatment. Liver and skin DCs had a monocyte-like morphology and a partially mature phenotype, expressing myeloid markers, MHCII, and co-stimulatory molecules; but only the skin DCs contained a population of CD1a+ cells. Overnight-migrated liver DCs activated naïve cord blood T cells efficiently. Liver DCs produced interleukin (IL)-10 whereas skin DCs failed to secrete IL-10 even after stimulation and neither skin nor liver-derived DCs secreted significant amounts of IL-12p70. Compared with skin DCs, liver DCs were less effective at stimulating T-cell proliferation and stimulated T cells to produce IL-10 and IL-4 whereas skin DCs were more potent stimulators of interferon-gamma and IL-4. Monocyte-derived DCs were down-regulated after culture with liver-conditioned media, suggesting that local microenvironmental factors may be important. Thus we show for the first time clear tissue-specific differences in nonlymphoid DCs. Although it is not possible to conclude from our data whether liver DCs are more regulatory, or skin DCs more proimmunogenic, the ability of liver DCs to secrete IL-10 may be important for regulating local immune responses within the liver in the face of constant exposure to gut antigens.
Introduction
Molar-incisor hypomineralisation (MIH) presents as a spectrum, with severe cases becoming increasingly complex to manage. This study aimed to investigate the perceptions and experience of general dental practitioners (GDPs) in England when managing children with MIH.
Method
Semi-structured telephone interviews with GDPs who regularly treat children took place in May 2020. A sample of four male and six female GDPs with 1-15 years of experience was achieved through purposively sampling interested parties following advertisement via professional groups. Thematic analysis using a realist and inductive approach was used in analysis.
Results
The overarching theme was of managing uncertainty, with four subthemes: setting the scene; fighting the tooth; working within the system; and self and interpersonal insight. Despite being knowledgeable, participants expressed varying levels of confidence in many aspects while managing children with MIH. There was a great deal of uncertainty surrounding 'doing the right thing' across the themes. Systemic barriers to managing children with MIH within the general dental service were identified.
Conclusion
The challenges of managing children with MIH was experienced as 'uncertainty'. Barriers within the general dental service made managing children with MIH difficult and participants relied on colleagues in secondary care to manage severe cases.
Introduction Silver diamine fluoride (SDF) is an option for biologic caries management that is not well utilised in the United Kingdom (UK). Caries in the primary dentition is common in the UK, and despite current treatment options many children require invasive treatment and multiple extractions. SDF could provide an alternative and due to their clinical expertise paediatric dentists are well placed to discuss this. Methods Fourteen semi-structured interviews were carried out with paediatric dentists across the UK. This was a heterogeneous sample including working across different settings, with differing levels of experience and both academic and NHS primary employment. Thematic analysis was undertaken with respondent validation. Results Participants felt SDF could be useful where patients have caries in their primary dentition, are asymptomatic and cannot manage other treatment options. The five themes influencing their views were child factors, parental influence, external influences, the clinician’s knowledge, experience and beliefs and the properties of SDF. Conclusion Paediatric dentists interviewed feel that there is a role for SDF in caries management in the UK. They believe case selection and communication with families is important.
The foundation programme for training junior doctors officially started in August 2005, with one key component being assessment of competencies. This qualitative study examined the opinions of foundation programme trainees regarding the perceived use of the assessments for training purposes and where the difficulties lay in completing assessments. Early identification of possible pitfalls should help improve the system for future trainees.
Nicorandil, used as a treatment for angina pectoris, continues to be prescribed in the UK. The association between nicorandil and oral ulceration is well documented. Nicorandil-induced oral ulceration characteristically presents as a persistent, large, deep ulcer that can have a great impact on quality of life. A 63-year-old female was referred to the oral medicine department with a non-healing ulcer and associated paraesthesia of the left lower lip. Her drug history included nicorandil 30 mg once daily. A provisional diagnosis was made of nicorandil-induced oral ulceration with associated paraesthesia, secondary to mental nerve involvement. Following liaison with cardiology, and cessation of nicorandil medication, the ulceration healed, and the patient reported improved sensation to the lower lip. CPD/Clinical Relevance: Nicorandil-induced oral ulceration should be considered in the differential diagnosis of oral ulceration.
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