[Mortality after high-risk surgery in Jehovah's Witness patients]. / Letalität nach operativen Risikoeingriffen bei Zeugen Jehovas.

BACKGROUND: Jehovah's Witness (JW) patients strictly refuse allogeneic blood transfusion for religious reasons. Nevertheless, JW also wish to benefit from modern therapeutic concepts including major surgical procedures without facing an excessive risk of death. The Northwest Hospital in Frankfurt am Main Germany is a confidential clinic of JW and performs approximately 100 surgical interventions per year on this patient group. MATERIAL AND METHODS: A retrospective analysis of closed medical cases performed in the years 2008-2018 at the Northwest Hospital aimed to clarify (1) the frequency of surgical procedures in JW patients associated with a statistical allogeneic transfusion risk (presence of preoperative anemia and/or in-house transfusion probability >10%) during this time period, (2) the degree of acceptance of strategies avoiding blood transfusion by JW and (3) the anemia-related postoperative mortality rate in JW patients. RESULTS: In the 11- year observation period 123 surgical procedures with a relevant allogeneic transfusion risk were performed in 105 JW patients. Anemia according to World Health Organization (WHO) criteria was present in 44% of cases on the day of surgery. Synthetic and recombinant drugs (tranexamic acid, desmopressin, erythropoetin, rFVIIa) were generally accepted, acute normovolemic hemodilution (ANH) in 92% and cell salvage in 96%. Coagulation factor concentrates extracted from human plasma and therefore generally refused by JW so far, were accepted by 83% of patients following detailed elucidation. Out of 105 JW patients 7 (6.6%) died during the postoperative hospital stay. In 4 of the 7 fatal cases the cause of death could be traced back to severe postoperative anemia. CONCLUSION: Given optimal management JW patients can undergo major surgery without an excessive risk of death. The 6.6% in-hospital mortality observed in this institution was in the range of the 4% generally observed after surgery in Europe. The majority of JW patients accepted a variety of blood conservation strategies following appropriate elucidation. This also included coagulation factor concentrates extracted from human plasma enabling an effective treatment of even severe bleeding complications. In this analysis postoperative hemoglobin concentrations below 6 g/dl in older JW patients were associated with a high mortality risk due to anemia.

Movement proteins (BC1 and BV1) of Abutilon mosaic geminivirus are cotransported in and between cells of sink but not of source leaves as detected by green fluorescent protein tagging.

Two movement proteins (BV1 and BC1) facilitate the intra- and intercellular transport of begomoviruses in plants. In contrast to other geminiviruses the movement protein BC1 of Abutilon mosaic virus (AbMV) remained in the supernatant after centrifuging plant extracts at 20,000 g. To test whether this unusual behavior results from a distinct intracellular distribution of the protein, the BC1 gene has been fused to the gene of green fluorescent protein (GFP). The resulting plasmids were delivered into nonhost plants (Allium cepa) as well as into mature and immature cells of host plants (Nicotiana tabacum, N. benthamiana) by biolistic bombardment for transient expression in planta. BC1 directed GFP to two different cellular sites. In the majority of nonhost cells as well as in mature cells of host leaves, BC1 was mainly localized in small punctate flecks at the cell periphery or, to a lesser extent, around the nucleus. In sink leaves of host plants, GFP:BC1 additionally developed disc-like structures in the cell periphery. Cobombardment of GFP:BC1 with its cognate infectious DNA A and B did not change their subcellular distribution patterns in source leaves but led to the formation of peculiar needle-like structures in sink leaves. The nuclear shuttle protein (BV1) of AbMV accumulated mainly inside the nuclei as shown by immunohistochemical staining and GFP tagging. In sink cells of host plants it was mobilized to the plasma membrane and to the nucleus of the neighboring cell by coexpressed BC1, GFP:BC1, BC1:GFP, or after cobombardment with the cognate viral DNA. Only under these conditions were GFP:BC1 and BC1:GFP also found in the recipient cell.