Simulation of non-inherited maternal antigens acceptable HLA mismatches to increase the chance of matched cord blood units: Hong Kong’s experience

In Cord blood transplantation (CBT), the non-inherited maternal antigen (NIMA) virtual six HLA matched CB is found to have similar outcomes to six HLA inherited matched CB. Such virtual HLA matched CB units can be generated by substituting the inherited alleles with one to three NIMAs. In Hong Kong Cord Blood Bank, CB units have no NIMA defined. 100 CB samples were collected with NIMA defined. Retrospective searches of Hong Kong patients (n?=?520) were matched against the inherited and virtual HLA phenotypes of NIMA CB file. One to three NIMA matches was analyzed, virtual six HLA matches were identified for 31.7% patients, 29.4% from CB units with 5/6 HLA match with 1 NIMA match and 1.7% CB units with a 4/6 HLA match and 2 NIMA matches. However, searches in the 167,201 Bone Marrow Donors Worldwide CB units with defined NIMA did not yield similar increases, possibly due to the ethnicity differences between populations. The match performance rises from 26% to 60% after including the NIMA match. Comparing the match performance of 32% in a previous Dutch study, we calculated with 60% matching in this smaller size study. This provides a solid ground to considering NIMA in stem cell donor selection which was adopted in some centers, to be extended to Asian and local CB registries to increase the chance for matches and also to improve patient outcomes, increase the utilization of CB units, enhance clinical flexibility and signify economic intelligence.     

Alcohol consumption and blood lipids in elderly coronary patients

Alcohol may have a beneficial effect on coronary heart disease (CHD) that could be mediated by elevation of high-density lipoprotein cholesterol (HDLC). Data on alcohol consumption and blood lipids in coronary patients are scarce. We studied whether total ethanol intake and consumption of specific types of beverages are associated with blood lipids in older subjects with CHD. Blood lipids were measured in 1052 myocardial infarction patients aged 60 to 80 years (78% male). Intake of alcoholic beverages, total ethanol, and macronutrients was assessed by food frequency questionnaire. Seventy percent of the subjects used lipid-lowering medication. Total cholesterol was on average 5.14 mmol/L, and HDLC was on average 1.28 mmol/L. Among men, total ethanol intake was positively associated with HDLC (difference of 0.094 mmol/L for ≥15 g/d vs 0 g/d, P = .024), whereas the association with HDLC among women was not significant (difference of 0.060 mmol/L for ≥5 g/d vs 0 g/d, P = .560) after adjustment for dietary, lifestyle, and CHD risk factors. Liquor consumption was weakly positively associated with HDLC in men (P = .045). Beer consumption in men and wine consumption in women were also positively associated with HDLC, but were not significant in the fully adjusted model. In conclusion, moderate alcohol consumption may elevate HDLC in treated post-myocardial infarction patients. This may be due to ethanol and not to other beneficial substances in alcoholic beverages. Based on this finding, further research needs to be done to examine the effects of the residual substances from different types of alcoholic beverages on HDLC.     

Insight into the precuneus: a novel seizure semiology in a child with epilepsy arising from the right posterior precuneus

To date, there is limited understanding of the role of the precuneus. fMRI studies have suggested its involvement in a wide spectrum of highly integrated tasks, including spatially‐guided behaviour, visuo‐spatial imagery, and consciousness. We present a patient with intractable parietal lobe epilepsy arising from a lesion localized to the right precuneus. Two seizure types with distinct semiologies were captured on video‐EEG monitoring. The first type consisted of an urge described as a “feeling of wanting to move”. On video analysis, the patient is seen to turn his head and body to his left. He remains conscious, he is able to answer questions and when asked, he can look to his right. This seizure was associated with an ictal pattern localized to the right parieto‐occipital region. The second seizure type consisted of reading‐induced visual distortion with macropsia and micropsia. Interictally, intermittent rhythmic slowing and spikes were seen and localized to the parietal midline and the right parieto‐occipital regions. Our patient's seizures are positive phenomena of the right precuneus and its related processing network. They represent unique seizure semiologies that offer further insight into the role of the precuneus in spatial awareness, visuo‐spatial processing and consciousness.     

A configurational approach to the relationship between high-performance work practices and frontline health care worker outcomes

Objective

To identify high-performance work practices (HPWP) associated with high frontline health care worker (FLW) job satisfaction and perceived quality of care.

Methods

Cross-sectional survey data from 661 FLWs in 13 large health care employers were collected between 2007 and 2008 and analyzed using both regression and fuzzy-set qualitative comparative analysis.

Principal Findings

Supervisor support and team-based work practices were identified as necessary for high job satisfaction and high quality of care but not sufficient to achieve these outcomes unless implemented in tandem with other HPWP. Several configurations of HPWP were associated with either high job satisfaction or high quality of care. However, only one configuration of HPWP was sufficient for both: the combination of supervisor support, performance-based incentives, team-based work, and flexible work. These findings were consistent even after controlling for FLW demographics and employer type. Additional research is needed to clarify whether HPWP have differential effects on quality of care in direct care versus administrative workers.

Conclusions

High-performance work practices that integrate FLWs in health care teams and provide FLWs with opportunities for participative decision making can positively influence job satisfaction and perceived quality of care, but only when implemented as bundles of complementary policies and practices.     

Rapid analysis of -α3.7 thalassaemia and αααanti 3.7 triplication by enzymatic amplification analysis

Summary In this report we describe a PCR-based method for the diagnosis of the most common form of α thalassaemia, the –α^3.7 deletion which occurs throughout all tropical and subtropical regions of the world. The same procedure also identifies the reciprocal recombinant chromosome (ααα^{anti 3.7}). Restriction mapping of the PCR products has enabled us to distinguish between the type I (–α^3.7I), type II (–α^3.7II) and type III (–α^3.7III) deletions. This strategy will be very useful in screening programmes of α thalassaemia occurring on its own or in association with β thalassaemia and sickle cell disease.     

USE OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AS A BRIDGE TO TRANSPLANTATION IN FULMINANT HEPATIC FAILURE DUE TO BUDD CHURI SYNDROME

We report a case of fulminant hepatic failure in a 55-yr-old man due to Budd-Chiari syndrome in the setting of polycythemia rubra vera. The patient presented with acute hepatic failure, which rapidly progressed to grade IV hepatic encephalopathy. Placement of a transjugular intrahepatic portosystemic shunt resulted in marked improvement of the encephalopathy and stabilized the liver failure. Suhsequently, he underwent successful nonemergent orthotopic liver transplantation. Transjugular intrahepatic portosystemic shunt placement is a safe, effective, therapeutic option to bridge patients with fulminant Budd-Chiari to liver transplantation.