SummaryBacillus anthracis is a Gram-positive bacillus that is the causative agent of anthrax. The virulence of the bacillus is partly due to the production of a tripartite virulence factor: protective antigen (PA), lethal factor (LF) and edema factor (EF). Recognition of the bacillus and its toxins by the innate immune system is likely to play a key role following infection. In this study we set out to investigate whether anthrax cell wall (ACW) components as well as the lethal toxin are sensed by Toll-like receptors (TLRs). Our data suggest that ACW components as well as PA are sensed by TLR2/6 heterodimers triggering an inflammatory response. This recognition takes place on the cell surface within specialized microdomains for ACW, whereas PA seems to trigger responses intracellularly. Interestingly, LF does not trigger a proinflammatory response, and when combined with PA, the complex is not sensed by the innate immune system. Overall our data suggest that TLR2/6 heterodimers are responsible for sensing the ACW and PA, whereas the formation of the subsequent toxin (LF + PA) seems to evade detection by the innate immune system contributing to the virulence of the toxin.
IntroductionNeurophobia – ‘a fear of the neural sciences and clinical neurology’1 is an established phenomenon amongst medical students and physicians.1–3 Conclusions from previous studies indicate a need for more neurology teaching,2 3 with basic neuroscience felt to be extremely useful.2 This study examines whether a concise, focused tutorial integrating basic neuroscience with clinical neurology helps overcome neurophobia.MethodsStudents from the University of Bristol (n=56) were surveyed using quantitative and qualitative questions pre/post/1 month after a 15 minute tutorial on neurological examination, integrating the relevant anatomy and physiology with clinical findings.ResultsAnalysis was performed using Wilcoxon signed ranks and Freidman testing. Comparing pre and post surveys there was a statistically significant improvement (p<0.05) in knowledge, confidence and understanding of clinical signs. Importantly this increased confidence persisted when students were re-surveyed 1 month later. Responses to difficulties faced when learning neurology include the following themes (1) complex/overwhelming subject, (2) lack of teaching, (3) inability to correlate neuroanatomy with clinical presentation.ConclusionWhen teaching students (or even clinicians) with “neurophobia”, always commence with a review of basic neuroscience as a foundation on which to build an understanding of neurological function in health and disease.
We conclude that RX monorail systems seem to enhance the technical success of femoropopliteal angioplasty. Although smaller sheath sizes can be used due to the lower profile of the RX systems, there is only a tendency toward lower complication rates.
Background
The extraction of a femoral stem during the revision hip arthroplasty can be a daunting task and can lead to catastrophic complications for the patient. A sound technique employed intraoperatively helps in the speedy recovery of the patient and reduces the risk of future surgical interventions. In this study, we present a medium-term outcome of our novel Lancaster cortical window technique which can be used for the removal of cemented or uncemented femoral stems.
Methods
The study was conducted at a specialist centre in the north-west of the UK from January 2014 to May 2019. This is a retrospective case series where patients were treated surgically using the Lancaster cortical window technique for removal of the femoral implant during a revision hip arthroplasty. Patient’s electronic notes and radiographs were used to evaluate the functional and radiological outcome.
Results
In this study, 18 patients were managed surgically using the novel Lancaster window technique. The mean age of all the patients was 81.5 years, and the male to female ratio was 10:8. Fifteen patients underwent revision surgery for aseptic loosening of the femoral and acetabular components. The rest of the three patients had revision surgery for a broken femoral stem, intraoperative femoral canal perforation while implanting a total hip replacement femoral stem and infection. Twelve femurs were replanted with uncemented long femoral stems and six with long cemented stems. The cortical window osteotomy united in all the patients in 4.2 months (mean). The mean follow-up of these patients is 20.9 months, and none of them had any implant subsidence or loosening at the time of their last follow-up.
Conclusion
We believe Lancaster cortical window technique can be safely used for the removal of cemented stems during revision hip arthroplasty without the need for expensive equipment.
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