Pre-operative immune cell numbers and ratios are associated with peri-operative adverse outcomes in transfused patients

Background and objectivesTransfusion-related immune modulation (TRIM) and associated adverse outcomes during major surgery are increasingly important to patients and health services internationally. A panel of pre-operative blood tests is an essential part of the pre-operative anaesthetic assessment. This panel of blood tests commonly considers numbers of immune cells (i.e., lymphocytes, monocytes, and neutrophils and cell ratios) that may be used as biomarkers to evaluate and potentially predict post-operative adverse outcomes.DesignThis retrospective data collection from eight hospital databases, within the Royal Brisbane and Women's Hospital, considered only patients who received blood transfusion during surgery (2016–2018) (n = 2,121). The association between pre-operative immune cell numbers and ratios and adverse outcomes were assessed. Adverse outcomes were coded using the International Classification of Diseases-10 (ICD-10) coding which specifically considered transfusion-related immune modulation. Results were adjusted for confounding factors.ResultsAfter adjustment, decreased pre-operative lymphocyte numbers and increased neutrophil/lymphocyte ratio (NLR) were associated with increased odds of developing infection; decreased NLR with decreased odds of developing adverse renal outcomes; and decreased lymphocyte numbers with decreased odds of developing adverse cardiovascular outcomes. Monocyte numbers, neutrophil numbers, and the lymphocyte/monocyte ratio (LMR) were not associated with increased adverse outcomes after adjustment.ConclusionPre-operative lymphocyte numbers and NLR are associated with adverse outcomes during peri-operative transfusion. Future assessment of peri-operative immune modulation should include the assessment of immune cell function and numbers

Intraoperative cell salvage: a technology built upon the failures, fads and fashions of blood transfusion

Transfusion, as we know it today, developed into a very sophisticated treatment modality as a result of centuries of experimentation. Intraoperative cell salvage is a transfusion technique where autologous blood lost during surgery is reinfused. The success of this process relies on specialised equipment and techniques to collect, process, anticoagulate filter and reinfuse blood. Through a literature review, we collected information about the early origins of specific techniques relevant to intraoperative cell salvage: the ability to collect lost blood, to prevent collected blood from clotting, to remove debris through processing and other harmful aspects through filtering, the benefits of autologous blood transfusion, reinfusion and traditional concerns and contraindications. A culmination of knowledge specific to each of these techniques over centuries provides the background to the safe intraoperative cell salvage technique used today. In addition, we aimed to identify the reasons why specific equipment and techniques developed, why practice changed and what is still unknown. This article reviews relevant allogeneic transfusion and autotransfusion history, starting in Roman times, and includes landmark events through the centuries

Nitrogen-fixing bacteria and Oxalis – evidence for a vertically inherited bacterial symbiosis

CITATION: Jooste, M., et al. 2019. Nitrogen-fixing bacteria and Oxalis – evidence for a vertically inherited bacterial symbiosis. BMC Plant Biology, 19:441, doi:10.1186/s12870-019-2049-7.The original publication is available at https://bmcplantbiol.biomedcentral.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Plant-endophyte symbioses often revolve around nitrogen metabolism, and involve varying degrees of intimacy. Although evidence for vertical inheritance of nitrogen-fixing endophytic bacteria is increasing, it is confined mostly to crop plants, and to date no such system has been reported for geophytes. Methods: Bacterial endophytes associated with Oxalis, the most species-rich geophytic genus form the Cape Flora in southern Africa was studied. Culturable endophytes were isolated from surface-sterilized vegetative and reproductive plant organs for six host species at three locations. Colonies of microbes on various artificial media were morphotyped, enumerated and identified using sequence data. Filter exclusion experiments were conducted to determine if endophytes were vertically transmitted to seeds, determine if mucilage plays a role to actively attract microbes from the soil and to assess microbial richness isolated from the mucilage of Oxalis seedlings. Fluorescent microscopy was implemented in order to visualize endophytic bacteria in cryo-sectioned seeds. Results: Evidence for a novel, vertically transmitted symbiosis was reported. Communities of nitrogen-fixing and plant growth-promoting Bacillus endophytes were found to associate with selected Oxalis hosts from nitrogen-deficient environments of the Cape. Bacillus endophytes were ubiquitous and diverse across species and plant bodies, and were prominent in seeds. Three common nitrogen-fixing Bacillus have known oxalotrophic properties and appear to be housed inside specialised cavities (containing oxalates) within the plant body and seeds. Conclusions: The discovery of vertical transmission and potential benefits to both host and endophyte suggest a particularly tight mutualism in the Oxalis-endophyte system. This discovery suggests unexpected ways in which geophytes might avoid nitrogen deficiency, and suggest that such symbioses are more common than previously expected.https://bmcplantbiol.biomedcentral.com/articles/10.1186/s12870-019-2049-7Publisher's versio

Urban environments provide opportunities for early detections of Phytophthora invasions

Globalization has increased the frequency of inadvertent introductions of plant pathogens. Many catastrophic invasions of both natural and agricultural systems have been initiated through anthropogenic dissemination pathways. Phytophthora species are a group of invasive plant pathogens causing many of the most important plant disease epidemics. A review of Phytophthora species descriptions published following the publication of the first DNA-based Phytophthora phylogeny was conducted to highlight patterns of recent introductions and to provide insights for early pathogen detection initiatives. Seventy-two publications from 2001 to 2016 describing 98 Phytophthora species were evaluated. Of the 91 species with data on geographic location isolation, 22% were described from type specimens isolated from urban environments, 33% from agricultural environments and 45% from natural environments. Within the urban environment, ornamental plant trading nurseries were the most important sources. Specifically, for Phytophthora ramorum, a species causing multiple epidemics globally, the largest proportion of first report publications were from urban environments, including nurseries. We therefore suggest that detection programs for invasive plant pathogens within the urban environment would be valuable. In this regard, specialized monitoring and citizen science projects that target urban areas where live plant-trading industries are concentrated would be particularly effective to both promote early detection and to facilitate a rapid response to new species invasions.An early version of this paper was presented at a workshop on ‘Non-native species in urban environments’ hosted and funded by the DST-NRF Centre of Excellence for Invasion Biology (C⋅I⋅B) in Stellenbosch, South Africa, in November 2016.The Department of Science and Technology (DST)-National Research Foundation (NRF) Centre of Excellence in Tree Health Biotechnology (CTHB; http://www.fabinet.up.ac.za/research-groups/dst-nrf-centre-of-excellence-in-tree-health-biotechnology) and also from support contributed to the crowd-funding campaign “Discovering Plant Destroyers in South Africa with Citizen Science” (doi: 10.18258/2066).http://link.springer.com/journal/105302018-12-23hj2018Forestry and Agricultural Biotechnology Institute (FABI

A prospective randomized comparison of airway seal using the novel vision-guided insertion of LMA-Supreme® and LMA-Protector®

The laryngeal mask airways supreme (LMA-Supreme™) and protector (LMA-Protector™) are generally placed blindly, often resulting in a less than optimal position and vision-guided placement has been recommended. This prospective, randomized controlled study compared the efficacy of airway seal by measuring the oropharyngeal leak pressure in 100 surgical patients who underwent a variety of non-thoracic surgery under general anaesthesia, suitable with a supraglottic airway device. Patients were allocated to either the LMA-Supreme (n = 50) or LMA-Protector (n = 50) group. All insertions were performed under vision of a videolaryngoscope using an ‘insert-detect-correct-as-you-go’ technique with standardized corrective measures. Our primary endpoint, mean oropharyngeal leak pressure, was significantly higher in the LMA-Protector (31.7 ± 2.9\ua0cm H O) compared to the LMA-Supreme (27.7 ± 3.5 cm H O) group (mean difference 4.0 cm H O, 95% confidence interval (CI) 2.7–5.3 cm H O, p < 0.001) after achieving a near-optimal fibreoptic position in the LMA-Protector (94%) and LMA-Supreme (96%) groups. No statistically significant differences were shown for secondary outcomes of alignment, number of insertion attempts and malpositions, and final anatomical position as scored by fibreoptic evaluation. Corrective manoeuvres were required in virtually all patients to obtain a correct anatomically positioned LMA. Position outcomes of the two devices were similar except for the proportion of procedures with folds in the proximal cuff (90% LMA-Supreme vs. 2% LMA-Protector, p < 0.001), the need for intracuff pressure adjustments (80% LMA-Supreme vs. 48% LMA-Protector, p = 0.001) and size correction (18% LMA-Supreme vs. 4% LMA-Protector, p = 0.025). In conclusion, a higher oropharyngeal leak pressure can be achieved with LMA-Protector compared to LMA-Supreme with optimal anatomical position when insertion is vision-guided

Datasheet1_Pre-operative immune cell numbers and ratios are associated with peri-operative adverse outcomes in transfused patients.docx

Background and objectivesTransfusion-related immune modulation (TRIM) and associated adverse outcomes during major surgery are increasingly important to patients and health services internationally. A panel of pre-operative blood tests is an essential part of the pre-operative anaesthetic assessment. This panel of blood tests commonly considers numbers of immune cells (i.e., lymphocytes, monocytes, and neutrophils and cell ratios) that may be used as biomarkers to evaluate and potentially predict post-operative adverse outcomes.DesignThis retrospective data collection from eight hospital databases, within the Royal Brisbane and Women's Hospital, considered only patients who received blood transfusion during surgery (2016–2018) (n = 2,121). The association between pre-operative immune cell numbers and ratios and adverse outcomes were assessed. Adverse outcomes were coded using the International Classification of Diseases-10 (ICD-10) coding which specifically considered transfusion-related immune modulation. Results were adjusted for confounding factors.ResultsAfter adjustment, decreased pre-operative lymphocyte numbers and increased neutrophil/lymphocyte ratio (NLR) were associated with increased odds of developing infection; decreased NLR with decreased odds of developing adverse renal outcomes; and decreased lymphocyte numbers with decreased odds of developing adverse cardiovascular outcomes. Monocyte numbers, neutrophil numbers, and the lymphocyte/monocyte ratio (LMR) were not associated with increased adverse outcomes after adjustment.ConclusionPre-operative lymphocyte numbers and NLR are associated with adverse outcomes during peri-operative transfusion. Future assessment of peri-operative immune modulation should include the assessment of immune cell function and numbers.</p

Intraoperative cell salvage as an alternative to allogeneic (donated) blood transfusion: a&nbsp;prospective observational evaluation of the immune response profile

Allogeneic blood transfusion (ABT) is associated with transfusion-related immune modulation (TRIM) and subsequent poorer patient outcomes including perioperative infection, multiple organ failure, and mortality. The precise mechanism(s) underlying TRIM remain largely unknown. During intraoperative cell salvage (ICS) a patient's own (autologous) blood is collected, anticoagulated, processed, and reinfused. One impediment to understanding the influence of the immune system on transfusion-related adverse outcomes has been the inability to characterize immune profile changes induced by blood transfusion, including ICS. Dendritic cells and monocytes play a central role in regulation of immune responses, and dysfunction may contribute to adverse outcomes. During a prospective observational study ( = 19), an model was used to assess dendritic cell and monocyte immune responses and the overall immune response following ABT or ICS exposure. Exposure to both ABT and ICS suppressed dendritic cell and monocyte function. This suppression was, however, significantly less marked following ICS. ICS presented an improved immune competence. This assessment of immune competence through the study of intracellular cytokine production, co-stimulatory and adhesion molecules expressed on dendritic cells and monocytes, and modulation of the overall leukocyte response may predict a reduction of adverse outcomes ( i.e., infection) following ICS

Bark beetle mycobiome : collaboratively defined research priorities on a widespread insect-fungus symbiosis

CITATION: Hulcr, J. et al. 2020. Bark beetle mycobiome : collaboratively defined research priorities on a widespread insect-fungus symbiosis. Symbiosis, 81:101–113, doi:10.1007/s13199-020-00686-9.The original publication is available at https://www.springer.com/journal/13199One of the main threats to forests in the Anthropocene are novel or altered interactions among trees, insects and fungi. To critically assess the contemporary research on bark beetles, their associated fungi, and their relationships with trees, the international Bark Beetle Mycobiome research coordination network has been formed. The network comprises 22 researchers from 17 institutions. This forward-looking review summarizes the group’s assessment of the current status of the bark beetle mycobiome research field and priorities for its advancement. Priorities include data mobility and standards, the adoption of new technologies for the study of these symbioses, reconciliation of conflicting paradigms, and practices for robust inference of symbiosis and tree epidemiology. The Net work proposes contemporary communication strategies to interact with the global community of researchers studying symbioses and natural resource managers. We conclude with a call to the broader scientific community to participate in the network and contribute their perspectives.Publisher's versio