P.M. Stott

The ultimate Aberdeen knot

INTRODUCTION The Aberdeen knot has been shown to be stronger and more secure than a surgeons knot for ending a suture line. No data exist as to the ideal configuration of the Aberdeen knot. The Royal College of Surgeons of England in their Basic Surgical Skills Course, 2002 recommended six throws. The aim of this experiment is to find the ideal combination of throws and turns. MATERIALS AND METHODS Aberdeen knots of various configurations were tied in 0-PDS suture (Ethicon, Johnson and Johnson). Each configuration was tied 10 times. A materials testing machine was used to test the knots to destruction in a standardised manner. RESULTS The knots were seen to behave in two ways. They either slipped and unravelled, or broke. Knots tied with fewer than three throws were unreliable. Knots tied with three throws and two turns appear to be the strongest configuration. Adding further throws and turns does not increase the strength of an Aberdeen knot. CONCLUSIONS An Aberdeen knot tied with three throws and two turns is the ultimate Aberdeen knot.

The Results of Total Hip Arthroplasty for Fractured Neck of Femur in Octogenarians

The role of total hip arthroplasty (THA) for fracture in octogenarians remains unclear. Over a two-year period, 354 patients aged > 80 years were admitted with a displaced intracapsular hip fracture. Using defined clinical guidelines, 38 patients underwent THA with a median age of 84 years, mean follow-up of 20 months. Primary outcomes were dislocation, 30-day and one-year mortality, revision surgery and periprosthetic fracture. There were no dislocations or periprosthetic fractures and patient survival was 97% at 30 days and 87% at one year. There was one revision for deep infection. This study demonstrates that THA for selected octogenarians can be performed safely, allows the majority of patients to return to independent living and has a low complication rate.

Oligodeoxynucleotide inhibition of Toll-like receptors 3, 7, 8, and 9 suppresses cytokine production in a human rheumatoid arthritis model

Toll‐like receptors (TLRs) are innate immune receptors that respond to both exogenous and endogenous stimuli and are suggested to contribute to the perpetuation of chronic inflammation associated with rheumatoid arthritis (RA). In particular, the endosomal TLRs 3, 7, 8, and 9 have more recently been postulated to be of importance in RA pathogenesis. In this study, pan inhibition of the endosomal TLRs by a phosphorothioate‐modified inhibitory oligodeoxynucleotide (ODN) is demonstrated in primary human B cells, macrophages, and RA fibroblasts. Inhibition of TLR8 was of particular interest as TLR8 has been associated with RA pathogenesis in both human and murine arthritis models. ODN1411 competitively inhibited TLR8 signaling and was observed to directly bind to a purified TLR8 ectodomain, suggesting inhibition was through a direct interaction with the receptor. Addition of ODN1411 to human RA synovial membrane cultures significantly inhibited spontaneous cytokine production from these cultures, suggesting a potential role for one or more of the endosomal TLRs in inflammatory cytokine production in RA and the potential for inhibitory ODNs as novel therapies.