Safety Outcomes for Autologous Stem Cell Transplant in Multiple Myeloma

Systems have been put in place in the Mayo Clinic Stem Cell Transplantation program to reduce day-100 all-cause mortality. Currently our mortality has been reduced to 0.3%. Patients can undergo transplant as an outpatient, with a median hospital duration of 0 days and only 25% of patients requiring a hospital stay of 5 days or greater. Outpatient transplantation is safe and reduces patient-incurred costs.     

Electrophysiological correlates of recollecting faces of known and unknown individuals

We recorded brain potentials from healthy human subjects during a recognition test in order to monitor neural processing associated with face recollection. Subjects first attempted to memorize 40 faces; half were accompanied by a voice simulating that person speaking (e.g., "I'm Jimmy and I was a roadie for the Grateful Dead") and half were presented in silence. In the test phase, subjects attempted to discriminate both types of old faces (i.e., "named" and "unnamed" faces) from new faces. Recognition averaged 87% correct for named faces, 74% correct for unnamed faces, and 91% correct for new faces. Potentials to old faces were more positive than those to new faces from 300 to 600 ms after face onset. For named faces, the old-new ERP difference was observed at anterior and posterior scalp locations. For unnamed faces, the old-new ERP difference was observed only at posterior scalp locations. Results from a prior experiment suggest that these effects do not reflect perceptual priming of faces. The posterior portion of the old-new ERP difference was thus interpreted as a neural correlate of retrieval of visual face information and the anterior portion as an indication of retrieval of person-specific semantic information.     

Surgical Management of Pelvic Organ Prolapse in Females: Functional Outcome of Mesh Sacrocolpopexy and Rectopexy as a Combined Procedure

Purpose Urogenital prolapse is relatively common compared with rectal prolapse and the combination of urogenital prolapse and rectal prolapse is still more infrequent. This study was designed to evaluate the functional outcome of a series of patients who have undergone open mesh sacrocolporectopexy surgery for combined vaginal and rectal prolapse. Methods Consecutive patients from June 2000 to June 2004 with confirmed vaginal and rectal prolapse subsequently underwent open mesh sacrocolporectopexy. The Cleveland Clinic Short Form-20 Pelvic Floor Distress Inventory questionnaire with Urinary Distress Inventory, Pelvic Organ Prolapse Distress Inventory, and Colorectal-Anal Distress Inventory subscales was completed by all patients preoperatively and at six months postoperatively. Results There were 29 patients with a median age of 66 (interquartile range, 59–73) years. Median period of follow-up was 26 (interquartile range, 15–33) months. Median global pelvic floor distress inventory scores were lower postoperatively compared with preoperatively (96.4 (interquartile range, 50.8–149.7) vs. 182.3 (interquartile range, 140.6–208.6; P = 0.001). All three median subscales scores also were significantly lower postoperatively compared with preoperatively. Conclusions In patients with concurrent vaginal and rectal prolapse, open mesh sacrocolporectopexy confers good symptomatic improvement for urinary-, vaginal-, and rectal-related symptoms. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.     

Food allergies and eosinophilic gastrointestinal illness

Eosinophilic gastrointestinal disorders are characterized by eosinophilic infiltration and inflammation of the gastrointestinal tract in the absence of previously identified causes of eosinophilia, such as parasitic infections, malignancy, collagen vascular diseases, drug sensitivities, and inflammatory bowel disease. These disorders include eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis. This article focuses mainly on eosinophilic esophagitis and eosinophilic gastroenteritis.     

Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy

Introduction  Laparoscopic techniques have been applied to the procedure of restorative proctocolectomy (RPC). The aim of this study was to compare the outcomes of patients after laparoscopic ileal pouch-anal anastomosis (IPAA) with restorative proctocolectomy (RPC) and without previous colectomy [restorative proctectomy (RP)] and to highlight some technical tips.
Method  Data were collected prospectively from all patients who underwent laparoscopic IPAA from July 2006 to December 2007.
Results  Thirty-six patients underwent IPAA either with total proctocolectomy ( n  = 25) or after previous emergency colectomy ( n  = 11). Postoperative morbidity occurred in 22% of patients. The overall median operative time was 210 (range 120–325), 240 (170–325) and 180 (120–240) min for RPC and RP respectively ( P  < 0.05). The median length of stay for all patients was 6 (3–26), 6 (4–26) and 4 (3–13) days for RPC and RP respectively ( P  < 0.05). There was no correlation between BMI, age, use of immunosuppressive agents and length of stay. The operative procedure was facilitated by the use of specific devices at particular stages of the operation.
Conclusion  Laparoscopic IPAA is not only safe and feasible for the virgin abdomen but also for patients with a previous emergency colectomy through a midline laparotomy incision.     

Human Milk Oligosaccharide Profiles over 12 Months of Lactation: The Ulm SPATZ Health Study

Human milk oligosaccharides (HMOs) have specific dose-dependent effects on child health outcomes. The HMO profile differs across mothers and is largely dependent on gene expression of specific transferase enzymes in the lactocytes. This study investigated the trajectories of absolute HMO concentrations at three time points during lactation, using a more accurate, robust, and extensively validated method for HMO quantification. We analyzed human milk sampled at 6 weeks (n = 682), 6 months (n = 448), and 12 months (n = 73) of lactation in a birth cohort study conducted in south Germany, using label-free targeted liquid chromatography mass spectrometry (LC-MS²). We assessed trajectories of HMO concentrations over time and used linear mixed models to explore the effect of secretor status and milk group on these trajectories. Generalized linear model-based analysis was used to examine associations between HMOs measured at 6 weeks of lactation and maternal characteristics. Results: Overall, 74%, 18%, 7%, and 1% of human milk samples were attributed to milk groups I, II, III, and IV, respectively. Most HMO concentrations declined over lactation, but some increased. Cross-sectionally, HMOs presented high variations within milk groups and secretor groups. The trajectories of HMO concentrations during lactation were largely attributed to the milk group and secretor status. None of the other maternal characteristics were associated with the HMO concentrations. The observed changes in the HMO concentrations at different time points during lactation and variations of HMOs between milk groups warrant further investigation of their potential impact on child health outcomes. These results will aid in the evaluation and determination of adequate nutrient intakes, as well as further (or future) investigation of the dose-dependent impact of these biological components on infant and child health outcomes.     

Barriers to the reporting and management of needlestick injuries among surgeons

Objective  Needlestick injuries are common within surgical practice and carry the risk of transmission of blood borne viruses. Key to reducing this risk is an accessible system of reporting and involvement of occupational health services. We aimed to identify surgeons’ attitude and experience dealing with such injuries and identify why in many cases needlestick injuries go unreported. Methods  70 questionnaires were hand delivered to surgeons and trainees across 3 UK hospitals and a variety of surgical specialties. The number of injuries and reporting practice was identified. Surgeons were asked to identify from a list the reasons why they did not report their injuries and record importance on a 5-point scale (0–4). Results  52 surgeons and trainees replied (75%). 42 (81%) had suffered at least 1 needlestick injury with 4 (8%) reporting more than 20. 8 (19%) had reported all their injuries to occupational health with no significant difference in reporting between consultants and trainees (P = 0.2). 12 (23%) felt that reporting of injuries helped to reduce transmission rates. 18 (35%) said that a needlestick had caused them moderate or significant anxiety. The top reasons for not reporting were (0–4). (1) Process too time consuming (2.7), (2) transmission risk very low (2.6), (3) do not want to disrupt operating list (2.0), (4) post exposure prophylaxis ineffective (1.3). Conclusions  Most surgeons and trainees do not report all their needlestick injuries to occupational health despite many reporting injury related anxiety. The process is felt to take too long and the perceived risk of viral transmission is low.