Serology to detect antibodies to Helicobacter pylori is not frequently used as a diagnostic tool in developing countries. When compared to a commercial ELISA, an ELISA constructed and validated in Thailand had a higher sensitivity (98% vs. 85%), specificity (76% vs. 66%), and negative predictive value (97% vs. 76%) for the detection of H. pylori infection among 104 patients with dyspepsia evaluated by endoscopy. The positive predictive value was 88% for both tests. Serum antibody levels fell significantly 5-8 months after eradication of infection in 8 Thai patients (P = .009). By 8 years of age, > 50% of Thai persons living in urban and rural locations were seropositive. The low negative predictive value of the commercial ELISA limits the usefulness of this assay as a diagnostic tool in Thailand and suggests a need to reevaluate H. pylori serologic tests when used in populations living in developing countries.

Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from “offers” to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The “offer” and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.

Study design: Systematic review. Objectives: The objective of this study is to systematically review the literature for pediatric cases of spinal cord injuries without radiologic abnormality (SCIWORA) to investigate any possible relationship between initial neurologic impairment and eventual neurologic status. Setting: A university department of orthopedics. Methods: Following the preferred reporting items for systemic reviews and meta-analysis (PRISMA) guidelines for systematic review, the databases of PubMed and OvidSP were electronically searched for articles that use individuals under 18 years old, have trauma resulting in spinal cord injury and have no fractures or dislocations on radiographs. When available, the patients' age, sex, mechanism of injury and spinal cord level were recorded. Individuals with cervical injury, who had specific information on cervical level and mechanism of injury, were recorded as well. Patients who reported specific magnetic resonance imaging findings and the time from the injury were also reported. When possible, the American Spinal Injury Association Impairment Scale (AIS) was determined initially after the injury and then at last follow-up. Results: A total of 433 pediatric patients were identified with SCIWORA. The most prevalent mechanism of injury was sports-related injury cases (39.83%) followed by fall (24.18%) and motor vehicle-related (23.18%) injuries. The mean improvement recorded for all patients was 0.89 AIS grades. Conclusion:The most common mechanism of injury was sports-related and cervical injury, which occurred more frequently than other levels. Initial AIS grade A showed poorer outcomes in the pediatric population compared with the adult population. Initial presentation of D showed the highest likelihood of no permanent neurologic impairment (AIS of E).

Donor-specific alloantibodies (DSA) to HLA-DP may cause antibody-mediated rejection (AMR), especially in re-transplants. We describe the immunization history of a patient who received 3 kidney transplants; the 3rd kidney was completely matched except at DPA1 and DPB1. Prior to the 3rd transplant, single antigen bead analysis (SAB) showed DSA reactivity against DPA1 shared by the 1st and 3rd donors, but B and T flow crossmatch (FXM) results were negative. Within 11 days the 3rd transplant underwent acute C4d+ AMR which coincided with the presence of complement (C1q)-binding IgG1 DSA against donor DPA1 and DPB1. Using HLAMatchmaker and SAB, we provide evidence that eplet (epitope) spreading on DPA1 and eplet sharing on differing DPB1 alleles of the 1st and 3rd transplants was associated with AMR. Since weak DSA to DPA1/DPB1 may induce acute AMR with negative FXM, donor DPA1/DPB1 high resolution typing should be considered in sensitized patients with DP-directed DSA.

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