C3d‐positive donor‐specific antibodies have a role in pretransplant risk stratification of cross‐match‐positive HLA‐incompatible renal transplantation : United Kingdom multicentre study

Anti‐HLA‐antibody characteristics aid to risk‐stratify patients and improve long‐term renal graft outcomes. Complement activation by donor‐specific antibody (DSA) is an important characteristic that may determine renal allograft outcome. There is heterogeneity in graft outcomes within the moderate to high immunological risk cases (cross‐match‐positive). We explored the role of C3d‐positive DSAs in sub‐stratification of cross‐match‐positive cases and relate to the graft outcomes. We investigated 139 cross‐match‐positive living‐donor renal transplant recipients from four transplant centres in the United Kingdom. C3d assay was performed on serum samples obtained at pretreatment (predesensitization) and Day 14 post‐transplant. C3d‐positive DSAs were found in 52 (37%) patients at pretreatment and in 37 (27%) patients at Day 14 post‐transplant. Median follow‐up of patients was 48 months (IQR 20.47–77.57). In the multivariable analysis, pretreatment C3d‐positive DSA was independently associated with reduced overall graft survival, the hazard ratio of 3.29 (95% CI 1.37–7.86). The relative risk of death‐censored five‐year graft failure was 2.83 (95% CI 1.56–5.13). Patients with both pretreatment and Day 14 C3d‐positive DSAs had the worst five‐year graft survival at 45.5% compared with 87.2% in both pretreatment and Day 14 C3d‐negative DSA patients with the relative risk of death‐censored five‐year graft failure was 4.26 (95% CI 1.79, 10.09). In this multicentre study, we have demonstrated for the first time the utility of C3d analysis as a distinctive biomarker to sub‐stratify the risk of poor graft outcome in cross‐match‐positive living‐donor renal transplantation

Diversity and abundance of solitary and primitively eusocial bees in an urban centre: a case study from Northampton (England)

The apparent reduction of solitary and primitively eusocial bees populations has remained a huge concern over the past few decades and urbanisation is considered as one of the factors affecting bees at different scales depending on bee guild. As urbanisation is increasing globally it necessitates more research to understand the complex community dynamics of solitary and primitively eusocial bees in urban settings. We investigated the urban core of a British town for diversity and abundance of solitary bees using standardized methods, and compared the results with nearby meadows and nature reserves. The study recorded 48 species within the town, about 22 % of the total species and 58 % of the genera of solitary bees in the United Kingdom. Furthermore we found the urban core to be more diverse and abundant in solitary and primitively eusocial bees compared to the meadows and nature re-serves. Of particular note was an urban record of the nationally rare Red Data Book species Coelioxys quadridentata and its host Anthophora quadrimaculata. This research demonstrates that urban settings can contribute significantly to the conservation of solitary and primitively eusocial bees in Britain

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

A quantitative review of pollination syndromes: do floral traits predict effective pollinators?

The idea of pollination syndromes has been largely discussed and no formal quantitative evaluation has yet been conducted across angiosperms. We present the first systematic review of pollination syndromes that quantitatively tests whether the most effective pollinators for a species can be inferred from suites of floral traits for 417 plant species. Our results support the syndrome concept, indicating that convergent floral evolution is driven by adaptation to the most effective pollinator group. The predictability of pollination syndromes is greater in pollinator-dependent species and in plants from tropical regions. Many plant species also have secondary pollinators that generally correspond to the ancestral pollinators documented in evolutionary studies. We discuss the utility and limitations of pollination syndromes and the role of secondary pollinators to understand floral ecology and evolution.Fil: Rosas Guerrero, Victor. Universidad Nacional Autonoma de Mexico. Centro de Investigaciones en Ecosistemas; México. Universidad Autónoma de Guerrero; MéxicoFil: Aguilar, Ramiro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); ArgentinaFil: Martén Rodriguez, Silvana. Instituto de Ecologia; MéxicoFil: Ashworth, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Instituto Multidisciplinario de Biología Vegetal (p); ArgentinaFil: Lopezaraiza Mikel, Martha. Universidad Nacional Autonoma de Mexico. Centro de Investigaciones en Ecosistemas; México. Universidad Autónoma de Guerrero; MéxicoFil: Bastida, Jesus. Universidad Nacional Autónoma de México. Centro de Investigaciones en Ecosistemas; MéxicoFil: Quesada, Mauricio. Universidad Nacional Autonoma de Mexico. Centro de Investigaciones en Ecosistemas; Méxic

Variações fenológicas das espécies do cerrado em Emas - Pirassununga, SP Phenological variations of the cerrado species in Emas (Pirassununga, SP)

Foi estudada a flora vascular de uma área de cerrado, situada no distrito de Emas, município de Pirassununga, Estado de São Paulo (aproximadamente, 22º02'S e 47º30'W). Entre abril de 1994 e abril de 1995, realizou-se um levantamento florístico, em que foram amostradas 358 espécies. A partir dos dados deste levantamento, estudaram-se as variações fenológicas das espécies, procurando analisá-las como estratégias adaptativas. Os componentes herbáceo-subarbustivo e arbustivoarbóreo comportaram-se de maneira distinta. As espécies arbustivo-arbóreas floresceram principalmente no início da estação chuvosa, enquanto que as herbáceo-subarbustivas produziram flores, de modo geral, apenas no final da estação úmida, após período de acúmulo de carboidratos. As espécies do componente herbáceo-subarbustivo tiveram pico de frutificação no final da estação chuvosa, qualquer que fosse a síndrome de dispersão de seus diásporos. Já as espécies do componente arbustivo-arbóreo apresentaram comportamentos distintos, conforme a síndrome de dispersão. As espécies zoocóricas frutificaram ao longo de toda estação úmida, enquanto que as anemocóricas e autocóricas produziram frutos, principalmente no início da estação seca.<br>The vascular flora of the cerrado in Emas district, Pirassununga municipality, São Paulo State (approximately 22º02'S and 47º30'W) was studied. Between April 1994 and April 1995 a floristic survey was carried out, when 358 species, representing 227 genera and 78 families, were found. During this survey, the phenologycal variations were observed and analysed as adaptive strategies. The woody and herbaceous components had distinct behaviours. The woody species flowered mainly at the beginning of the rainy season, while the herbaceous ones produced flowers generally at the end of that season, after a period of carbohydrate accumulation. The herbaceous species produced fruits specially at the end of the rainy season whatever its dispersion syndrome was. The woody ones showed different patterns depending on its dispersion syndrome. The zoochorous species fruited along the whole rainy season, while the anemochorous and autochorous ones produced fruits principally at the beginning of the dry season