Ultrasound appearance of the normal Lisfranc ligament

This study aims to prospectively evaluate the ultrasound appearance of the normal Lisfranc’s ligament in 50 patients (100 ft) with no prior or current ligament injury. Fifty normal asymptomatic patients between the ages of 18 and 80 years were assessed. Three key features were recorded: ultrasound appearance, thickness, and length of the Lisfranc’s ligament. Patients excluded from this study included pediatric patients and those with history of injury or symptoms related to the foot. The mean right- and left-sided ligament (RT) thickness were 0.096 (0.021) and 0.104 (0.023), respectively. The mean right- and left-sided ligament RT length was 0.54 (0.11) and 0.57 (0.11), respectively. The appearance of the ligament was similar in all patients with a central thin band of hypoechogenicity lined by hyperechoic lines on either side. Understanding the normal appearance, thickness, and length of the Lisfranc’s ligament in a large sample is imperative to diagnose abnormal appearances of this ligament including sprains and tears by ultrasound. Ultrasound, with its easy accessibility, can be used in the emergency department to rapidly exclude injury of the ligament. Increased understanding and awareness of the Lisfranc’s ligament on ultrasound can allow for more accurate diagnosis and treatment.     

Evolución del cierre de ileostomía en una unidad de cirugía colorrectal. Análisis comparativo según la técnica

Introduction

The objective of this study is to assess whether the results of loop ileostomy closure in terms of morbidity and hospital stay are influenced by the type of anastomosis and suture used.

Method

All patients who underwent loop ileostomy closure were reviewed. A retrospective cohort study comparing morbidity and hospital stay according to the type of anastomosis (TT/LL) and the type of suture (hand sewn/mechanical) was performed.

Results

From January 2003 to November 2011 a total of 167 loop ileostomy closures were analized. The groups were: type of anastomosis (TT 95/LL 72) and type of suture (manual 105/stapled 62). In 76% of the observed population the underlying disease was cancer. Mortality occurred in one case. The stratified morbidity analysis by type of complications showed no significant differences between the groups in terms of local (7.4% TT, LL 8.3%, 6.7% hand sewn, stapled 9.7%), general (TT 9.5%, 16.7% LL, hand sewn 6.7%, 6.5% stapled) and surgical (TT 15.8%, 19.4% LL, hand sewn 17.1%, 17.7% stapled) complications, nor in the rate of reoperations (TT 6.3%, 6.9% LL, hand sewn 6.7%, 6.5% stapled) and hospital stay in days (TT 7.8, 8 LL, hand sewn 8.6, stapled 6.7)

Conclusions

Closure of loop ileostomy can be performed regardless of the type of suture or anastomosis used, with the same rate of morbidity and hospital stay.     

Synchronization during an internally directed cognitive state in healthy aging and mild cognitive impairment: a MEG study

Mild cognitive impairment (MCI) is a stage between healthy aging and dementia. It is known that in this condition the connectivity patterns are altered in the resting state and during cognitive tasks, where an extra effort seems to be necessary to overcome cognitive decline. We aimed to determine the functional connectivity pattern required to deal with an internally directed cognitive state (IDICS) in healthy aging and MCI. This task differs from the most commonly employed ones in neurophysiology, since inhibition from external stimuli is needed, allowing the study of this control mechanism. To this end, magnetoencephalographic (MEG) signals were acquired from 32 healthy individuals and 38 MCI patients, both in resting state and while performing a subtraction task of two levels of difficulty. Functional connectivity was assessed with phase locking value (PLV) in five frequency bands. Compared to controls, MCIs showed higher PLV values in delta, theta, and gamma bands and an opposite pattern in alpha, beta, and gamma bands in resting state. These changes were associated with poorer neuropsychological performance. During the task, this group exhibited a hypersynchronization in delta, theta, beta, and gamma bands, which was also related to a lower cognitive performance, suggesting an abnormal functioning in this group. Contrary to controls, MCIs presented a lack of synchronization in the alpha band which may denote an inhibition deficit. Additionally, the magnitude of connectivity changes rose with the task difficulty in controls but not in MCIs, in line with the compensation-related utilization of neural circuits hypothesis (CRUNCH) model.     

Haploidentical transplantation in high-risk pediatric leukemia: A retrospective comparative analysis on behalf of the Spanish working Group for bone marrow transplantation in children (GETMON) and the Spanish Grupo for hematopoietic transplantation (GETH)

A total of 192 pediatric patients, median age 8.6 years, with high-risk hematological malignancies, underwent haploidentical stem cell transplantation (haplo-HSCT) using post-transplantation cyclophosphamide (PT-Cy), or ex vivo T cell-depleted (TCD) graft platforms, from January 1999 to December 2016 in 10 centers in Spain. Some 41 patients received an unmanipulated graft followed by PT-Cy for graft-vs-host disease (GvHD) prophylaxis. A total of 151 patients were transplanted with CD3-depleted peripheral blood stem cells (PBSCs) by either CD34⁺ selection, CD3⁺CD19⁺ depletion, TCRαβ⁺CD19⁺ depletion or CD45RA⁺ depletion, added to CD34⁺ selection for GvHD prophylaxis. The PBSCs were the only source in patients following ex vivo TCD haplo-HSCT; bone marrow was the source in 9 of 41 patients following PT-CY haplo-HSCT. Engraftment was achieved in 91.3% of cases. A donor younger than 30 years, and the development of chronic GvHD were positive factors influencing survival, whereas positive minimal residual disease (MRD) before transplant and lymphoid disease were negative factors. The probability of relapse increased with lymphoid malignancies, a donor killer-cell immunoglobulin-like receptor (KIR) haplotype A and positive MRD pretransplant. No difference was found in overall survival, disease-free survival or relapse incidence between the two platforms. Relapse is still of concern in both platforms, and it should be the focus of future efforts. In conclusion, both platforms for haplo-HSCT were effective and could be utilized depending on the comfort level of the center.     

A comparative effectiveness study of lipegfilgrastim in multiple myeloma patients after high dose melphalan and autologous stem cell transplant

G-CSF administration after high-dose chemotherapy and autologous stem cell transplantation (ASCT) has been shown to expedite neutrophil recovery. Several studies comparing filgrastim and pegfilgrastim in the post-ASCT setting concluded that the two are at least equally effective. Lipegfilgrastim (LIP) is a new long-acting, once-per-cycle G-CSF. This multicentric, prospective study aimed to describe the use of LIP in multiple myeloma patients receiving high-dose melphalan and autologous stem cell transplantation (ASCT) and compare LIP with historic controls of patients who received short-acting agent (filgrastim [FIL]). Overall, 125 patients with a median age of 60 years received G-CSF after ASCT (80 patients LIP on day 1 post-ASCT and 45 patients FIL on day 5 post-ASCT). The median duration of grade 4 neutropenia (absolute neutrophil count [ANC] < 0.5 × 10 [9]/L) was 5 days in both LIP and FIL groups, whereas the median number of days to reach ANC ≥ 0.5 × 10 [9]/L was 10% lower in the LIP than in the FIL group (10 vs 11 days), respectively. Male sex was significantly associated with a faster ANC ≥ 0.5 × 10 [9] L response (p = 0.015). The incidence of FN was significantly lower in the LIP than in the FIL group (29% vs 49%, respectively, p = 0.024). The days to discharge after ASCT infusion were greater in patients with FN (p < 0.001). The study indicates that LIP had a shorter time to ANC recovery and is more effective than FIL for the prevention of FN in the ASCT setting.