Peritoneal catheters in neonates undergoing complex cardiac surgery: a multi-centre descriptive study.

BACKGROUND: The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described. METHODS: Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3-5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter. RESULTS: Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar. CONCLUSIONS: In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.

Spotted knapweed (Centaurea stoebe) creates a soil legacy effect by modulating soil elemental composition in a semi-arid grassland ecosystem.

Invasive plants such as spotted knapweed (Centaurea stoebe) are particularly detrimental to fragile ecosystems like semi-arid grasslands in the interior British Columbia, impacting aboveground and belowground ecology. Physical removal of C. stoebe has been one of the most popular invasive species management strategies, but the impact of C. stoebe removal on soil has hardly been studied. Here, we examine the legacy effect of C. stoebe on soil elemental composition and ecosystem function following its removal in the Lac Du Bios Grasslands Protected Area, British Columbia. First, we selected 40 paired C. stoebe invaded and control (uninvaded) plots and removed all vegetation from these plots. We planted Festuca campestris seedlings in these plots and harvested and weighed the biomass after four months. Additionally, we quantified total carbon and nitrogen in soil. We observed that C. stoebe invaded plots had significantly lower F. campestris biomass. Moreover, the total carbon and nitrogen content, and carbon/nitrogen ratio were significantly lower in C. stoebe invaded plots. We further analyzed 12 common soil elements and found the elemental composition was significantly different in C. stoebe invaded plots compared to controls. We investigated the impact of elemental composition on soil ecosystem functions (such as total soil carbon, total soil nitrogen, and F. campestris productivity). Our analysis revealed significant relationships amongst the elemental composition and total soil carbon and nitrogen, and F. campestris productivity. The results indicate that C. stoebe exerts a legacy effect by altering the soil elemental composition that may subsequently impacts soil ecosystem functions such as plant productivity and total carbon and nitrogen content.

Phenotypic plasticity masks range-wide genetic differentiation for vegetative but not reproductive traits in a short-lived plant.

Genetic differentiation and phenotypic plasticity jointly shape intraspecific trait variation, but their roles differ among traits. In short-lived plants, reproductive traits may be more genetically determined due to their impact on fitness, whereas vegetative traits may show higher plasticity to buffer short-term perturbations. Combining a multi-treatment greenhouse experiment with observational field data throughout the range of a widespread short-lived herb, Plantago lanceolata, we (1) disentangled genetic and plastic responses of functional traits to a set of environmental drivers and (2) assessed how genetic differentiation and plasticity shape observational trait-environment relationships. Reproductive traits showed distinct genetic differentiation that largely determined observational patterns, but only when correcting traits for differences in biomass. Vegetative traits showed higher plasticity and opposite genetic and plastic responses, masking the genetic component underlying field-observed trait variation. Our study suggests that genetic differentiation may be inferred from observational data only for the traits most closely related to fitness.

Temperature and pH define the realised niche space of arbuscular mycorrhizal fungi.

The arbuscular mycorrhizal (AM) fungi are a globally distributed group of soil organisms that play critical roles in ecosystem function. However, the ecological niches of individual AM fungal taxa are poorly understood. We collected > 300 soil samples from natural ecosystems worldwide and modelled the realised niches of AM fungal virtual taxa (VT; approximately species-level phylogroups). We found that environmental and spatial variables jointly explained VT distribution worldwide, with temperature and pH being the most important abiotic drivers, and spatial effects generally occurring at local to regional scales. While dispersal limitation could explain some variation in VT distribution, VT relative abundance was almost exclusively driven by environmental variables. Several environmental and spatial effects on VT distribution and relative abundance were correlated with phylogeny, indicating that closely related VT exhibit similar niche optima and widths. Major clades within the Glomeraceae exhibited distinct niche optima, Acaulosporaceae generally had niche optima in low pH and low temperature conditions, and Gigasporaceae generally had niche optima in high precipitation conditions. Identification of the realised niche space occupied by individual and phylogenetic groups of soil microbial taxa provides a basis for building detailed hypotheses about how soil communities respond to gradients and manipulation in ecosystems worldwide.

Are arthropod communities in grassland ecosystems affected by the abundance of an invasive plant?

Invasive plants cause changes to native plant communities and nutrient cycling, and by doing so, may alter the amount and quality of habitat available for animals at multiple trophic levels, including arthropods. Arthropods are generally abundant, diverse, and contribute to energy flow and nutrient cycling and are, therefore, an important group to study as a way of determining the effects of changes to ecosystem functioning. Spotted knapweed (Centaurea stoebe L.), a perennial forb native to Eastern Europe, is considered one of the most ecologically harmful invasive species in Western North America. Here, we test if spotted knapweed alters plant community, ground litter and ground temperature, and arthropod functional group structure and biomass in grassland habitats in British Columbia, Canada. Pitfall traps, installed at 20 sites that differed in spotted knapweed density, were sorted into herbivores, omnivores, predators, detritivores, and parasites. Decreases in herbivore and detritivore biomass was associated with increasing spotted knapweed density. The first two coordinates of a Principle Coordinates Analysis explained a cumulative 60% of the variation, and herbivores were separated from predators on both axes. The results suggest that spotted knapweed density may affect arthropod functional groups through changes in plant community composition, and surface soil temperatures. The results suggest that in terms of relative abundance and biomass, increasing knapweed density had positive effects on some arthropod functional groups, neutral effects on others, and negative effects on others. Thus, not all arthropod functional groups responded equally to knapweed invasion, and knapweed invasion does not necessarily decrease arthropod functional group diversity.

Rapid resolution of colitis related to immunosuppressive medication after infliximab administration.

Immunosuppression is necessary after solid organ transplantation. The non-infectious side effects associated with many of these agents are not well understood. We report a case of colitis, most resembling inflammatory bowel disease, that persisted despite withdrawal of tacrolimus and mycophenolate mofetil and transition to alternative agents. The patient was treated for clostridium difficile without improvement. Endoscopic biopsies demonstrated non-specific inflammation without evidence of active infection. An extensive immunologic and oncologic workup was negative. Ultimately, we trialed the administration of infliximab, a monoclonal antibody that inhibits TNF-alpha receptors that is commonly used in the treatment of inflammatory bowel disease. With infliximab treatment, the patient experienced rapid resolution of his disease and has remained in remission.

Transplantation and Arch Repair in Fontan 3 Years After HeartMate 3: Technical Considerations.

We previously reported the first successful implantation of the HeartMate 3 (Abbott Laboratories) in a Fontan patient. We now report his successful transplantation after 1104 days of support, the longest reported bridge to transplant of a Fontan patient. We describe our operative technique complicated by not only the Fontan anatomy and ventricular assist device but also by a >10-cm ascending and aortic arch aneurysm. Additionally the posttransplant hemodynamics of this patient appeared to demonstrate that effective ventricular assist device support may induce reversal of chronic effects of the failing Fontan circulation, which in this case was the elimination of his aortopulmonary collateral burden.

Successful Salvage of an Extracardiac Fontan in the Setting of Purulent Mediastinitis using Antibiotic-Impregnated Beads.

Post-cardiotomy mediastinitis is an especially serious complication after the implantation of prosthetic vascular grafts. Standard of care is irrigation, debridement, and removal of all prosthetic material present in the surgical field. The use of antibiotic impregnated beads at the site of infection has been reported in the salvage of vascular grafts in the adult population. We present the case of a 3-year-old child with hypoplastic left heart syndrome who developed mediastinitis following the Fontan operation. In a nontraditional approach, the Fontan conduit, which was surrounded by gross purulence, was successfully salvaged with the adjunctive use of vancomycin-impregnated beads.

Accuracy of a novel system for oxygen delivery to small children.

OBJECTIVE: Oxygen therapy for infants and small children in developing countries is often not available. Entrainment devices may provide an accurate and precise concentration of oxygen when used at the flow rates appropriate for infants and small children. METHODS: A continuously adjustable entrainment device was tested to determine the concentrations and flows of oxygen delivered by using low inlet flow rates suitable for therapy for infants and small children and 3 distinct oxygen delivery systems that varied in their resistive load. RESULTS: The use of long and large bore, low resistance tubing (similar to a mask) resulted in the delivery of oxygen concentrations that tracked closely (accurate and precise) to values indicated by the entrainment device. The directly connected system with lower resistance (similar to a hood) produced a similar profile of concentrations and flow rates to the large bore tubing but with even greater accuracy. The use of a long and narrow tubing with higher resistance (similar to a cannula) did not deliver accurate oxygen concentrations. In fact, this high-resistance system failed to work as intended, and instead of entraining air, a large proportion (sometimes >50%) of the oxygen delivered to the entrainment device was ejected through its vents. CONCLUSIONS: Entrainment devices can deliver accurate oxygen concentrations at low flow rates if used with low resistance delivery systems; however, entrainment devices are not suitable for use with high resistance delivery systems such as a standard nasal cannula.