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I suspect that quality control processes within the airline industry may be just as much internal. But if an airliner crashes there is public outcry and splashes all over the papers. If a similar number of people die each week through sloppy urology outpatient administration nobody even thinks...

The trafficking domains are based on adhesion molecule pairs. I forget but if I remember rightly maybe: VCAM-1 and VLA-4 (alpha4beta1 integrin) for 'everything else' MADCAM and alpha4-beta7 for gut CLA-4 and ligand for skin E-cadherin and another integrin for mucosa This is in addition to the...

I agree; once people are ill they realise how important it is. But so often they are then not in a position to argue. I think the point I am making is that none of us is in a position to buy a nuclear submarine or build an offshore wind farm but these things get done because the community as a...

Or maybe jus' the ornery patients on the committee, guv'ner.

They often see them once to tell them how successful the operation was (without asking the patient if it was). But quite often that is delegated to junior staff. Long term follow up is rare.

Ehlers-Danlos Syndrome: Immunologic contrasts and connective tissue comparisons That looks like quite a good review. What is odd is the title - and also the journal. There is essentially nothing about immunology - because there isn't any. I wonder if the journal editor commissioned this without...

I don't know, but that is a different issue. I am discussing re-circulatory trafficking, which applies to T cells and is tissue specific. It would not necessarily look like anything local. Lymphoid tissue is always full of lymphocyte so being full of more active lymphocytes might not be...

That was the point being made to us as students - that nobody knows. This article gives some idea of the complexity of the problem of tonsillectomy but perhaps the most salient message after reading it all is that still nobody knows. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883156/ There...

But that is what I am saying. People do not take healthcare seriously enough to make sure they get a good deal. They insist on safe airline pilots and aeroplanes but don't seem interested if there are unnecessary deaths to go unnoticed in health care systems. Doctors are only untouchable if...

Initial grading was prepared by the in house NICE team but was then reviewed by the committee. The final grading in the draft guideline came much later. I could not possibly comment on what caused what!

I am not sure that anybody else thinks it is worth writing about. When I was a student I 1970 I remember being taught how the operation of tonsillectomy that was done by the hundreds of thousands had been shown to be useless and that this was an illustration of the typical situation in surgery -...

Because surgery is run by people who want to make money and don't care about whether the operations actually work. Nobody has called them out. The physicians know all about it but it seems mostly they don't want to upset the apple cart either. You could ask why hasn't anybody called out a...

I am afraid this looks very much like the sort of guy who makes a big thing about weaknesses in methodology that actually everyone knows all about as if he was saying something dramatic. People like that tend to turn out not to have awfully good antennae in the end in my experience. So no...

She seemed to think she was but when people have tracked down names she does not seem to be there. Not sure. The idea that anyone should be defending PACE at this stage is horrendous.

As I indicated all B cells are essentially null trafficking because they do not function in a peripheral tissue. Their job is to be available for selection and expansion in lymphoid tissue in an environment rich in T cells and NK cells. If they carry useful Ig gene rearrangements they then send...

Not necessarily. I the trial was of a treatment for Covid-19 and open label there might be significant bias. Patients receiving the treatment someone wants to show is effective might be looked after better, put on ventilators earlier, and have increased survival. Bias can creep in a hundred...

The situation for T cell arthropathies is completely different. There is no evidence of any B cell involvement. That would predict that the T cells involved were not interacting via Class II (HLA-D) and so are likely to be CD8 rather than CD4 T cells. That fits perfectly with the fact that the...

I don't think so. The white pulp and red pulp probably function separately. T cell involvement in B cell autoimmunity is not in doubt. All the T cell steps mentioned in your citations are entirely consistent with hijacking of normal T cells. For the T cells to be abnormal or autoimmune...

Any tissue other than lymphoid tissue would come under the 'everything else' trafficking domain that is associated with ankylosing spondylitis. Lymphoid tissue is unique in that it is normally full of T cells so you cannot tell if has T cells when it shouldn't. It would also be the one place...

As I understand it in autoimmune thyroid disease we only have evidence of B cell autoimmunity. In the common autoimmune diseases there is in general no evidence for T cell autoimmunity or anything wrong with the T cells. Normal T cells are simply hijacked by the autoimmune B cells. The HLA...