Influence of breast feeding on subsequent reactivity to a related renal allograft

In a previous report the hypothesis that exposure of the neonate to maternal allogeneic cells via the process of breast feeding would result in hyporesponsiveness to a subsequent maternal donor-related renal transplant was examined. Support for this hypothesis was obtained after correlating results of maternal donor-related renal transplantation with the breast feeding status of the transplant recipient. In the present report this observation has been expanded upon and it was asked if a history of breast feeding was associated with improved results in a different patient population (HLA semi-identical sibling donors). Breast-fed patients showed dramatic improvements in graft function rates compared to non-breast-fed counterparts at all intervals studied (P [les] 0.001). Because a history of breast feeding correlated with improved results after sibling donor as well as maternal donor transplantation, it was concluded that the breast feeding effect is not entirely specific for maternal antigens. These observations underscore the importance of breast feeding as a variable in clinical-related renal transplantation.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24730/1/0000152.pd

Routine use of post-bronchodilator testing in pulmonary function testing labs

Purpose: Pulmonary function tests (PFTs), including spirometry with and without post-bronchodilator (post-BD) testing, are frequently performed in the assessment of asthma, along with other obstructive airway disorders. Multiple publications over the past 15 years have noted that one in three physician-diagnosed asthma cases are not in fact asthma. In this quality assurance project, we assess whether PFT labs in Alberta have policies on post-BD testing, as extraneous and unnecessary use of post-BD testing can lead to wasted staff and patient time and unnecessary expenses to the health care system. Methods: We reviewed, in collaboration with the College of Physicians and Surgeons of Alberta and Alberta Medical Association, all PFT labs in the province of Alberta (hospital-based private not-for-profit [NFP] and private for-profit [FP] labs). This health policy study of PFT labs involved identifying the proportions and regional distribution of NFP and private FP labs in the province of Alberta while assessing post-BD policies. Each PFT lab was asked for their policy regarding spirometry and asthma diagnosis from May 1 to August 31, 2017. Results: A total of 92 PFT labs were identified in Alberta, 74 of which were private FP (independent) labs, while 18 were private NFP (public) hospital-based labs. Policies were as follows: (i) post-BD policy existed (and if so routinely performed / not routinely done); (ii) no post-BD policy; and (iii) lab chose not to participate. All 18 hospital labs responded: 10 had no policy; six had a policy or algorithm; one did not perform post-BD testing (exercise testing) and one had multiple testing sites. Of the private FP labs, three had relevant policies and/or algorithm and 10 had none. No information was provided from 61 labs. Access to PFT labs in Northern Alberta was limited. Conclusions: Lab policies surrounding post-BD testing were found to be heterogeneous in Alberta. Low response rates, despite the use of a systems approach and requests in writing and in person from FP labs, were notable. Development of a standardized policy across the province would be beneficial. Further higher-level review of the appropriateness of post-BD use in both FP and NFP PFT labs is needed