T cell expression of MyD88 is required for resistance to Toxoplasma gondii

Resistance to Toxoplasma gondii depends on dendritic cells to recognize this pathogen and secrete IL-12, in turn promoting IFN-gamma production from responding T cells. The adaptor protein, myeloid differentiation primary-response gene 88 (MyD88), is important for most Toll-like receptor (TLR) signaling, as well as IL-1R/IL-18R signals. There is considerable evidence that MyD88 is required for the innate sensing of T. gondii and IL-12 responses. Although Myd88(-/-) mice challenged with T. gondii have defective IL-12 and Th1 effector responses and succumb to disease, administration of IL-12 to Myd88(-/-) mice partially restores the Th1 response and yet fails to prolong survival. This finding suggested that MyD88 may mediate signals within T cells important for resistance to this pathogen. To evaluate the role of MyD88 in T cells under noncompetitive conditions, bone marrow chimeras were generated, in which the T cells lacked MyD88, but MyD88-dependent innate immune responses were intact. Upon challenge with T. gondii, these chimeric mice were more susceptible to disease, developing severe toxoplasmic encephalitis and succumbing within 30 days. Splenocytes and brain mononuclear cells isolated from infected chimeric mice produced less IFN-gamma when cultured with a T. gondii-derived antigen. The increase in susceptibility observed was independent of signals via the IL-1R and IL-18R, suggesting a role for TLRs in MyD88-mediated T cell responses to T. gondii. These observations show that, in addition to a role for MyD88 in innate responses, T cell expression of MyD88 is necessary for prolonged resistance to a pathogen.     

Histopathology of surgically treated renal tumours in young adults: a developing country perspective

Background  

There is no data on the histopathological characteristics of renal tumours in young adults in Pakistan.     

The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations

Introduction

The cerebral ventricles have been recognized since ancient medical history. Their true function started to be realized more than a thousand years later. Their anatomy and function are extremely important in the neurosurgical panorama.

Methods

The literature was searched for articles and textbooks of different topics related to the history, anatomy, physiology, histology, embryology and surgical considerations of the brain ventricles.

Conclusion

Herein, we summarize the literature about the cerebral ventricular system.     

Duplicated filum terminale in the absence of split cord malformation: a potential cause of failed detethering procedures

Introduction

A duplicated filum terminale appears to be a rare finding in the absence of a split cord malformation. Herein, we discuss this finding and its potential dysembryology.

Case reports

We report two cases of duplicated filum terminale without split cord malformation. The first case presented as an incidental finding with thickened filum terminale. At time of surgery, a thickened filum was resected and a smaller size filum was transected and both were confirmed with pathologic examination. The second case presented with a lumbar skin hemangioma. Screening MRI showed a duplicated filum terminale with fat signal in both structures. Pathology also confirmed the diagnosis of two fila terminalia.

Conclusions

The neurosurgeon should consider the possibility of two fila terminalia during operation to transect a single filum for tethered spinal cord.     

Therapeutic Efficacy of Neurostimulation for Depression: Techniques,Current Modalities,and Future Challenges

Depression is the most prevalent debilitating mental illness; it is characterized as a disorder of mood, cognitive function, and neurovegetative function. About one in ten individuals experience depression at some stage of their lives. Antidepressant drugs are used to reduce the symptoms but relapse occurs in ~20% of patients. However, alternate therapies like brain stimulation techniques have shown promising results in this regard. This review covers the brain stimulation techniques electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, vagus nerve stimulation, and deep brain stimulation, which are used as alternatives to antidepressant drugs, and elucidates their research and clinical outcomes.     

Assessing the status of intrauterine insemination before forming a medically assisted conception unit

A survey in 1996 of our female patients suggest that the three commonest causes of infertility were endometriosis, anovulation and idiopathic which comprises of about 70% of all the patients. In the male patients, sperm morphology evaluation by critical criteria showed that abnormal morphology was present in 71% while 87% of all the semen analysis were abnormal. The objective of this study was to assess the status of IUI before proceeding to formulate patient protocols for IVF in a tertiary infertility referral unit. A retrospective study of patients data was done from Jan 1995 to Dec 1996. Ovarian stimulation by clomiphene for anovulatory and idiopathic patients was performed on couples with at least one patent fallopian tube. Ovulation induction was by an intramuscular injection of 5000 i.u of HCG after follicular maturation. IUI was performed approximately 36-40 hours later. A total of 74 couples received 114 treatment cycles producing a total of 9 conceptions. The conception rate of IUI was therefore 7.89% per cycle and 12.16% per couple with the cumulative pregnancy rate of 28.21%. Associated success features of IUI found in this study were the age of the woman and the semen parameters of the husband.     

Comparative Study of Cefamandole versus Ampicillin plus Cloxacillin: Prophylactic Antibiotics in Cardiac Surgery

A randomized, prospective study of the efficacy of cefamandole naftate versus a combination of ampicillin and cloxacillin was undertaken in 109 adult patients operated on in Leeds during 1979. Sixty patients underwent valve replacement, and 49 had either aortocoronary bypass grafts or other forms of open-heart operation. The two groups matched well in age, sex, and type of operation. One gram of either antibiotic was given intravenously during the induction of anesthesia and every 6 hours thereafter for 48 hours. Two additional grams of antibiotic were placed in the prime of the heart-lung machine.The overall rate of infection was 7.5% for the entire series, with 1.7% for the group given cefamandole and 13.7% for the group given ampicillin plus cloxacillin (p < 0.05). The only patient with infection in the former group (1.7%) had sternal wound involvement. Major sternal wound infection occurred in 3 (5.9%) patients in the latter group. All wound infections were caused by Staphylococcus aureus. In 2 of these patients (ampicillin plus cloxacillin group) the infection proceeded to endocarditis. Urinary and respiratory tract infections occurred in 1.9% and 5.9%, respectively, of patients given ampicillin plus cloxacillin. The duration of hospital stay was shorter in the cefamandole group. The results of this study demonstrated that cefamandole confers effective prophylaxis in cardiac operations.     

Healing of arthroscopic portals: a randomised trial comparing three methods of portal closure

We carried out a single blind, randomised trial in which we examined the healing of portal wounds treated by three techniques: suturing, approximating the edges of the wound with sterile adhesive tapes (steristrips) or covering them with a simple sterile dressing. The study included patients who underwent arthroscopy of the knee joint, either for diagnostic purposes or for small therapeutic procedures. All patients were admitted as day cases. Outcome measures adopted were level of pain at the portal site, redness, swelling and cosmesis. The power of the study was designed to detect 10% difference with 95% confidence and p < 0.05. A total of 160 patients with an average age of 40 years were studied : 45 patients had their wounds covered with simple sterile dressing, 52 had steristrips, and 63 had sutures on the portals. The total numbers of portals were 380. No patient was lost to follow-up. There was significant difference between the three groups with regards to post operative swelling and redness : 29% patients in the suture group had swelling as compared to around 11% in the two other groups (p = 0.02); 37% patients in the suture group and 23% patients in the steristrips group developed redness while only 9% patients in the simple dressing group had redness at 4 weeks (p = 0.004). Patients in the suture group experienced more pain as measured by visual analogue scale; however there was no statistically significant difference (p = 0.37) in the number of patients who had pain. All patients in the steristrips and simple dressing group were satisfied cosmetically; 8% in the suture group were not. There were no major complications. The present study shows that suturing the portals has no additional advantage. There is little to choose between the other two methods and treating these wounds with either simple dressing or steristrips is easy and causes less discomfort to the patient.