Patients' preferences on information and involvement in decision making for gastrointestinal surgery.

BACKGROUND: The relationship between physicians and patients has undergone important changes, and the current emancipation of patients has led to a real partnership in medical decision making. The present study aimed to assess patients' preferences on different aspects of decision making during treatment and potential complications, as well as the amount and type of preoperative information wanted before visceral surgery. METHODS: This was a prospective non-randomized study based on a questionnaire given to 253 consecutive patients scheduled for elective gastrointestinal surgery. RESULTS: In considering surgical complications or treatment in the intensive care unit, 64 % of patients wished to take an active role in any medical decisions. The respective figures for cardiac resuscitation and treatment limitations were 89 and 60 %. As for information, 73, 77, and 47 % of patients wish detailed information, information on a potential ICU hospitalization, and knowledge of cardiac resuscitation, respectively. Elderly and low-educated patients were significantly less interested in shared medical decision making (p = 0.003 and 0.015), and in receiving information (p = 0.03 and 0.05). Similarly, involvement of the family in decision making was significantly less important to elderly and male patients (p = 0.05 and 0.03, respectively). Neither the type of operation (minor or major) nor the severity of disease (malignancies versus non-malignancies) was a significant factor for shared decision making, information, or family involvement. CONCLUSIONS: The vast majority of surgical patients clearly want to get adequate preoperative information about their disease and the planned treatment. They also consider it crucial to be involved in any kind of decision making for treatment and complications. For most patients, the family role is limited to supporting the treating physicians if the patient is unable to participate in decision making.

Male reproductive success: paternity contribution to queens and workers in Formica ants

The relative number of workers and female sexuals fathered by two males mated with a queen were directly assessed using microsatellite and allozyme markers in field colonies of the ants Formica exsecta and F. truncorum. In both species one of the two males consistently fathered more offspring than the other. There was, however, no evidence that one male might be particularly successful in fathering a disproportionally high proportion of female sexuals relative to the proportion of workers. Moreover, in F. exsecta, the proportions of worker pupae and worker adults fathered by each male did not differ significantly between cohorts. The most likely explanation for this pattern is that females store different amounts of sperm from the two males they mated with.

Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women.

OBJECTIVE: To evaluate, during the first postoperative year in obese pre-menopausal women, the effects of laparoscopic gastric banding on calcium and vitamin D metabolism, the potential modifications of bone mineral content and bone mineral density, and the risk of development of secondary hyperparathyroidism. SUBJECTS: Thirty-one obese pre-menopausal women aged between 25 and 52 y with a mean body mass index (BMI) of 43.6 kg/m(2), scheduled for gastric banding were included. Patients with renal, hepatic, metabolic and bone disease were excluded. METHODS: Body composition and bone mineral density (BMD) were measured at baseline, 6 and 12 months after gastric banding using dual-energy X-ray absorptiometry. Serum calcium, phosphate, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, bilirubin, urea, creatinine, uric acid, proteins, parathormone, vitamin D(3), IGF-1, IGF-BP3 and telopeptide, as well as urinary telopeptide, were measured at baseline and 1, 3, 6, 9 and 12 months after surgery. RESULTS: After 1 y vitamin D3 remained stable and PTH decreased by 12%, but the difference was not significant. Serum telopeptide C increased significantly by 100% (P<0.001). There was an initial drop of the IGF-BP3 during the first 6 months (P<0.05), but the reduction was no longer significant after 1 y. The BMD of cortical bone (femoral neck) decreased significantly and showed a trend of a positive correlation with the increase of telopeptides (P<0.06). The BMD of trabecular bone, at the lumbar spine, increased proportionally to the reduction of hip circumference and of body fat. CONCLUSION: There is no evidence of secondary hyperparathyroidism 1 y after gastric banding. Nevertheless biochemical bone markers show a negative remodelling balance, characterized by an increase of bone resorption. The serum telopeptide seems to be a reliable parameter, not affected by weight loss, to follow up bone turnover after gastroplasty.

Job switching in ants: role of a kinase

Reproductive division of labour is a defining characteristic of eusociality in insect societies. The task of reproduction is performed by the fertile males and queens of the colony, while the non-fertile female worker caste performs all other tasks related to colony upkeep, foraging and nest defence. Division of labour, or polyethism, within the worker caste is organized such that specific tasks are performed by discrete groups of individuals. Ordinarily, workers of one group will not participate in the tasks of other groups making the groups of workers behaviourally distinct. In some eusocial species, this has led to the evolution of a remarkable diversity of subcaste morphologies within the worker caste, and a division of labour amongst the subcastes. This caste polyethism is best represented in many species of ants where a smaller-bodied minor subcaste typically performs foraging duties while larger individuals of the major subcaste are tasked with nest defence. Recent work suggests that polyethism in the worker caste is influenced by an evolutionarily conserved, yet diversely regulated, gene called foraging (for), which encodes a cGMP-dependent protein kinase (PKG). Additionally, flexibility in the activity of this enzyme allows for workers from one task group to assist the workers of other task groups in times of need during the colony's life.

Aberrant right hepatic artery with a prepancreatic course visualized prior to pancreaticoduodenectomy.

Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation.

Iron deficiency in infancy: is an immigrant more at risk?

QUESTIONS UNDER STUDY: Iron deficiency with or without anaemia is the most common deficiency in the world. Its prevalence is higher in developing countries and in low socioeconomic populations. We aimed at determining and comparing the prevalence of iron deficiency in an immigrant and non-immigrant population. METHODS: Every child scheduled for a routine check-up at 12 months of age was allowed to participate in the study. Haemoglobin, ferritin, anthropometric data, familial and nutritional status were measured. RESULTS: 586 infants were eligible and 463 were included in the study as they had assessment data at 12 months. Children were divided into two groups: immigrants' children and non-immigrants' children. The global prevalence of iron deficiency was 5.7% at 12 months. A significant difference for iron deficiency was noticed between the groups at 12 months (p = 0.01). Among risk factors, immigration (odds ratio 2.91; 95% CI 1.05-8.04) and unemployment (odds ratio 6.08; 95% CI 1.18-31.30) had the higher odds in the multivariable analysis. CONCLUSION: The prevalence of iron deficiency in the immigrant population is higher than in non-immigrants. Immigration and the category of employment are risk factors for iron deficiency, as starting baby cereals before 9 months is a protective factor. Good socioeconomic conditions in Switzerland, the quality of food for pregnant women and young infants may be the explanation. A study up to five years of age is necessary before drawing general conclusions on infancy.

Combined written and oral information prior to gastrointestinal endoscopy compared with oral information alone: a randomized trial.

BACKGROUND: Little is known about how to most effectively deliver relevant information to patients scheduled for endoscopy. METHODS: To assess the effects of combined written and oral information, compared with oral information alone on the quality of information before endoscopy and the level of anxiety. We designed a prospective study in two Swiss teaching hospitals which enrolled consecutive patients scheduled for endoscopy over a three-month period. Patients were randomized either to receiving, along with the appointment notice, an explanatory leaflet about the upcoming examination, or to oral information delivered by each patient's doctor. Evaluation of quality of information was rated on scales between 0 (none received) and 5 (excellent). The analysis of outcome variables was performed on the basis of intention to treat-analysis. Multivariate analysis of predictors of information scores was performed by linear regression analysis. RESULTS: Of 718 eligible patients 577 (80%) returned their questionnaire. Patients who received written leaflets (N = 278) rated the quality of information they received higher than those informed verbally (N = 299), for all 8 quality-of-information items. Differences were significant regarding information about the risks of the procedure (3.24 versus 2.26, p < 0.001), how to prepare for the procedure (3.56 versus 3.23, p = 0.036), what to expect after the procedure (2.99 versus 2.59, p < 0.001), and the 8 quality-of-information items (3.35 versus 3.02, p = 0.002). The two groups reported similar levels of anxiety before procedure (p = 0.66), pain during procedure (p = 0.20), tolerability throughout the procedure (p = 0.76), problems after the procedure (p = 0.22), and overall rating of the procedure between poor and excellent (p = 0.82). CONCLUSION: Written information led to more favourable assessments of the quality of information and had no impact on patient anxiety nor on the overall assessment of the endoscopy. Because structured and comprehensive written information is perceived as beneficial by patients, gastroenterologists should clearly explain to their patients the risks, benefits and alternatives of endoscopic procedures. Trial registration: Current Controlled trial number: ISRCTN34382782.

Vascular postpneumonectomy syndrome: inferior vena cava and pulmonary vein compression as unusual cause for platypnea-orthodeoxia following pneumonectomy

Background: Excessive mediastinal shift into the vacated thoracic cavity after pneumonectomy can result in dyspnea without hypoxemia by compression of the tracheobronchial tree, a phenomenon called postpneumonectomy syndrome. More rarely hypoxemia in upright position (platypnea-orthodeoxia syndrome, POS) after pneumonectomy can result from re-opening of an atrial right-to-left shunt through a patent foramen ovale (PFO) due to mediastinal distorsion. Review of literature also shows a unique report of pulmonary veins stenosis resulting in POS without intracardiac shunt after pneumonectomy. Methods: We report the case of a 32-year-old woman who presented POS 6 months after right pneumonectomy for destroyed lung post tuberculosis. Results: The patient described severe dyspnea disappearing when lying. SpO2 decreased from 94% when lying to 60% sitting. Transthoracic echocardiography (TTE) suspected a possible PFO. We first tried to highlight clinical repercussions of PFO by noninvasive exams. Hyperoxia shunt quantification was not tolerated because of increased dyspnea in sitting position. Contrast bubbles TTE was difficult because of the important mediastinal shift but identified only rare left heart bubbles with/without Valsalva both in lying and sitting position, excluding a significant right-to-left shunt. A lung perfusion scintigraphy (injection while sitting) confirmed the absence of systemic isotope uptake. Computed tomographic pulmonary angiography (angio-CT) revealed a stretched but not stenosed left main bronchus, while the shift of the heart into the right cavity was major. Pulmonary angiography did not show embolism but revealed compression of the inferior vena cava (IVC) with impaired venous return to the right heart, as well as compression of the left pulmonary veins. There was no arteriovenous shunt. Cardiac MRI showed torsion of IVC at the level of the diaphragm, and strong atrial contraction contributing to a passive filling of the RV, while the right ventricle was normal. Right catheterism showed major hemodynamic disturbances with negative diastolic pressure in right heart cavities (atrium -12 mm Hg ventricle pressure -7 mm Hg). SaO2 measured in the pulmonary artery decreased from 58% when lying to 45% sitting. Conclusion: We described here an exceedingly rare and complex mechanism explaining POS after right pneumonectomy. Mediastinal repositioning with a silicone breast implant of appropriate size has been scheduled.

Adherence to oral anticancer treatment: focus on quality of execution during continuous schema of treatment

Background and objective: Oral anti-cancer treatments have expanded rapidly over the last years. While taking oral tablets at home ensures a better quality of life, it also exposes patients to the risk of sub-optimal adherence. The objective of this study is to assess how well ambulatory cancer patients execute their prescribed dosing regimen while they are engaged with continuous anti-cancer treatments. Design: This is an on-going longitudinal study. Consecutive patients starting an oral treatment are proposed to enter the study by the oncologist. Then they are referred to the pharmacy, where their oral anticancer treatment is dispensed in a Medication Event Monitoring System (MEMSTM), which records date and time of each opening of the drug container. Electronically compiled dosing history data from the MEMS are summarized and used as feedback during semistructured interviews with the pharmacist, which are dedicated to prevention and management of side effects. Interviews are scheduled before each medical visit. Report of the interview is available to the oncologist via an on-line secured portal. Setting: Seamless care approach between a Multidisciplinary Oncology Center and the Pharmacy of an Ambulatory Care and Community Medicine Department. Main outcome measures: For each patient, the comparison between the electronically compiled dosing history and the prescribed regimen was summarized using a daily binary indicator indicating whether yes or no the patient has taken the medication as prescribed. Results: Study started in March 2008. Among 22 eligible patients, 19 were included (11 men, median age 63 years old) and 3 (14%) refused to participate. 15 patients were prescribed a QD regimen, 3 patients a BID and 1 patient switched from QD to BID during follow-up. Median follow up was 182 days (IQR 72-252). Early discontinuation happened in four patients: side effects (n = 1), psychiatric reasons (n = 1), cancer progression (n = 1) and death (n = 1). On average, the daily number of medications was taken as prescribed in 99% of the follow-up days. Conclusions: Execution of the prescribed dosing regimens was almost perfect during the first 6 months. Maintaining this high degree of regimen execution and persistence over time might however be challenging in this population and need therefore to be confirmed in larger and longer follow-up cohort studies.

Cutaneous benign mixed tumor (chondroid syringoma) of the eyelid: clinical presentation and management.

PURPOSE: To describe the clinical presentation of cutaneous benign mixed tumor of the eyelid and its management options. METHODS: Periocular cases of cutaneous benign mixed tumor were gathered from members of an oculoplastics specialty Internet discussion group. A total of 9 patients are described in this retrospective, interventional case series. The clinical presentation, histopathology, and management of these lesions is reviewed. RESULTS: Patients were typically asymptomatic, presenting with a slowly enlarging, nontender nodule of 2 to 8 years' duration. The lesions ranged from 4 mm to 17 mm in greatest dimension. Four of the lesions were on the eyelid margin, three in the sub-brow area of the upper eyelid, and two in the central lids. All six cases not involving the brow were fixed to the tarsus; one brow lesion was believed to be adherent to the skin. None of the lesions was associated with significant changes of the overlying epidermis, although one lesion showed overlying pigmentation. All patients underwent excisional biopsy for diagnostic or cosmetic reasons. On histopathologic examination, the tumors were biphasic, with an epithelial component exhibiting apocrine or hair follicle differentiation and a myxoid, adipocytic, chondroid, and/or fibrous stroma. The pathologic diagnoses were all consistent with cutaneous benign mixed tumor (chondroid syringoma, pleomorphic adenoma). Follow-up ranged from 2 weeks to 12 months, although several patients failed to keep scheduled follow-up appointments. No clinical recurrences were identified. CONCLUSIONS: Cutaneous benign mixed tumor may occur in the eyelid, and, although uncommon, should be included in the differential diagnosis of firm, nodular eyelid tumors. The histopathologic features are similar to those seen in this tumor type arising in other areas of the body. Preoperative consideration of this diagnostic possibility may allow the surgeon to plan for complete excision, thereby reducing the possibility of recurrence or malignant transformation.

Contribution to the conservation biology of the wood ant Formica lugubris (Hymenoptera, Formicidae) in Switzerland

Summary Among ants, wood ants are probably the most fascinating and studied species in temperate European forests. Unfortunately, due to several threats they are nowadays registered in red lists. Recent studies made in the Swiss Jura Mountains ended up in the description of a new sympatric sibling species of Formica lugubris (i.e. Formica paralugubris Seifert 1996). Because of this confusion the biology of F. lugubris is incomplete. Due to the extreme difficulties to distinguish morphologically F. lugubris from F. paralugubris we studied their cuticular hydrocarbons profiles. Irrespective of their geographic origin, we observed quantitative discrimination between species within each caste (workers, males and gynes =young alate female). Moreover, using a behavioural taxonomic approach (i.e. the pupa-carrying test) we showed that ants preferred conspecific worker pupae to those of the sibling species. These first results allowed us to consider the two species as two separate taxonomic units. To understand their coexistence, habitat distribution models were fitted with GIS predictors and factors known to influence wood ant distribution. In the Jura Mountains, although the two species share very similar habitats, they are spatially segregated. F. lugubris occurs more frequently at woodland borders than in forest interiors. We demonstrated with genetic and field data that Formica lugubris displays two different social forms in close proximity in alpine zone (e.g. unmanaged forests of the Swiss National Park). We discovered populations mostly monogynous to weakly polygynous (i.e. one to a few egg laying queens per colony) and monodomous (i.e. one nest per colony), and polygynous/polydomous populations (new nests being founded by colony budding). It is generally admitted that monogyne species disperse well in order to find suitable habitat to found new colonies whereas polygyne species have restricted dispersal and local mating within the nest. In order to compare reproductive strategies of F. lugubris and F. paralugubris (i.e. matings and dealation process) we conducted experiments with sexuals. F, lugubris gynes from monogynous/monodomous populations do not show a local strategy like the obligately polygynous F. paralugubris (i.e. early dealation even without mating, insemination without flight activity and low fat reserve). They always keep their wings, do not mate when not able to fly and have high amount of fat content revealing high survival capacities. On the other side, F, lugubris gynes from polygynous/polydomous populations have lower lipid reserves and displayed a reproductive behaviour close to the F. para lugubris one. After dispersal, wood ant gynes can either start new societies by temporary social parasitism of another species (i.e. subgenus Serviformica) or be adopted intraspecifically in an existing nest. In F. lugubris, we demonstrated that gynes from monogynous/monodomous colonies showed a high success for temporary social parasitism compare to the lower success of gynes from polygynous/polydomous colonies. However, physiological analyses suggested that only gynes from monogynous/ monodomous populations can efficiently disperse and found new nest by temporary social parasitism. Intraspecifically, gynes were accepted to a high degree in polygynous nest and in monogynous nests as long as these nests contained sexuals. In conclusion, Formica lugubris displays a social and dispersal polymorphism (mixed mating and founding system) representing a behavioural plasticity in relation to environmental and ecological conditions. Therefore, conservation measures directed toward this species should try to maintain a maximum of diversity at the habitat level. Résumé Les fourmis des bois sont probablement parmi les espèces de fourmis les plus fascinantes et les plus étudiées des forêts tempérées Européennes. Actuellement, du fait de différentes menaces, elles figurent malheureusement sur listes rouges. Plusieurs études menées au sein du Jura Suisse ont abouti à la description d'une nouvelle espèce jumelle et sympatrique de Formica lugubris (F. para- lugubris Seifert 1996). A cause de cette confusion la biologie de F lugubris est lacunaire. La distinction morphologique de F. lugubris et de F. para lugubris est si difficile que nous avons étudié leurs hydrocarbures cuticulaires. Indépendamment de l'origine géographique, nous avons observé une discrimination quantitative entre les espèces au sein de chaque caste (ouvrières, mâles et jeunes femelles ailées). De plus, à l'aide d'une approche taxonomique comportementale (le test de transport de cocons) nous avons montré que les fourmis préfèrent des cocons d'ouvrières conspécifiques à ceux de l'espèce jumelle. Ces premiers résultats nous permettent de considérer ces deux espèces comme deux unités taxonomiques distinctes et valables. Afin de comprendre leur coexistence, des modèles mathématiques ont été développés avec des données SIG et des facteurs écologiques influençant la répartition des fournis des bois. Dans le Jura, même si elles partagent des habitats fortement similaires, les deux espèces n'occupent pas les mêmes secteurs. F. lugubris est plus fréquente en lisière forestière plutôt qu'en pleine forêt. Nous avons démontré grâce à des données génétiques et de terrain que F. lugubris présente deux formes sociales au sein de la zone alpine (forêts protégées du Parc National Suisse). D'autre part, nous avons découvert des populations monogynes à faiblement polygynes (une à quelques reines pondeuses par colonie) et monodomes (colonies composées d'une seule fourmilière), et des populations polygynes/polydomes (les nouveaux nids étant produit par bourgeonnement). Généralement, les espèces monogynes dispersent sur de grandes distances et peuvent coloniser des habitats favorables à la fondation de nouvelles colonies alors que les espèces polygynes possèdent une dispersion limitée avec des accouplements à l'intérieur des nids. Afin de comparer les stratégies de reproduction de F. lugubris et de F. paralugubris (accouplements et perte des ailes) nous avons mené des expériences avec les sexués. Les jeunes femelles ailées de F. lugubris issues de populations monogynes/monodomes ne présentent pas de stratégie locale comparée à l'espèce obligatoirement polygyne F paralugubris (perte des ailes précoce même si il n'y a pas eu accouplement, insémination possible sans avoir volé activement et faibles réserves de graisse). Elles conservent toujours leurs ailes, ne s'accouplent pas lorsqu'elles sont empêchées de voler et possèdent de grandes quantités de graisse révélant de fortes capacités de survie. D'autre part, les jeunes femelles ailées de F. lugubris provenant de populations polygynes/polydomes ont peu de réserves lipidiques et ont un comportement de reproduction proche de celles de F. paralugubris. Après leur dispersion, les jeunes sexués femelles de fourmis des bois peuvent soit fonder une nouvelle société par parasitisme social temporaire d'un nid d'une autre espèce (sous-genre Serviformica) soit être adoptées dans un nid déjà existant de leur propre espèce. Chez F. lugubris, nous avons pu démontrer que les jeunes sexués femelles de colonies monogynes/monodomes présentent un succès élevé au parasitisme sociale temporaire en comparaison au plus faible succès obtenu avec des sexués provenant de colonies polygynes/polydomes. Cependant, les données physiologiques suggèrent que seules les jeunes sexués femelles de populations mono-gynes/monodomes peuvent disperser efficacement et fonder un nouveau nid par parasitisme social temporaire. Au niveau intraspécifique, les jeunes femelles sont acceptées à un taux élevé dans les nids polygynes mais aussi dans les nids monogynes tant que ces nids possèdent encore de jeunes sexués. En conclusion, F. lugubris est caractérisée par un polymorphisme dans ses structures sociales et ses stratégies de dispersion (système mixte d'accouplement et de fondation) ce qui représente une forte plasticité comportementale en relation avec les conditions environnementales et écologiques. Par conséquent, les mesures de conservation de cette espèce devraient s'attacher à maintenir un maximum de diversité au niveau des habitats.

Relaxed selection is a precursor to the evolution of phenotypic plasticity.

Phenotypic plasticity allows organisms to produce alternative phenotypes under different conditions and represents one of the most important ways by which organisms adaptively respond to the environment. However, the relationship between phenotypic plasticity and molecular evolution remains poorly understood. We addressed this issue by investigating the evolution of genes associated with phenotypically plastic castes, sexes, and developmental stages of the fire ant Solenopsis invicta. We first determined if genes associated with phenotypic plasticity in S. invicta evolved at a rapid rate, as predicted under theoretical models. We found that genes differentially expressed between S. invicta castes, sexes, and developmental stages all exhibited elevated rates of evolution compared with ubiquitously expressed genes. We next investigated the evolutionary history of genes associated with the production of castes. Surprisingly, we found that orthologs of caste-biased genes in S. invicta and the social bee Apis mellifera evolved rapidly in lineages without castes. Thus, in contrast to some theoretical predictions, our results suggest that rapid rates of molecular evolution may not arise primarily as a consequence of phenotypic plasticity. Instead, genes evolving under relaxed purifying selection may more readily adopt new forms of biased expression during the evolution of alternate phenotypes. These results suggest that relaxed selective constraint on protein-coding genes is an important and underappreciated element in the evolutionary origin of phenotypic plasticity.

Anesthesia prevents auditory perceptual learning.

BACKGROUND: An auditory perceptual learning paradigm was used to investigate whether implicit memories are formed during general anesthesia. METHODS: Eighty-seven patients who had an American Society of Anesthesiologists physical status of I-III and were scheduled to undergo an elective surgery with general anesthesia were randomly assigned to one of two groups. One group received auditory stimulation during surgery, whereas the other did not. The auditory stimulation consisted of pure tones presented via headphones. The Bispectral Index level was maintained between 40 and 50 during surgery. To assess learning, patients performed an auditory frequency discrimination task after surgery, and comparisons were made between the groups. General anesthesia was induced with thiopental and maintained with a mixture of fentanyl and sevoflurane. RESULTS: There was no difference in the amount of learning between the two groups (mean +/- SD improvement: stimulated patients 9.2 +/- 11.3 Hz, controls 9.4 +/- 14.1 Hz). There was also no difference in initial thresholds (mean +/- SD initial thresholds: stimulated patients 31.1 +/- 33.4 Hz, controls 28.4 +/- 34.2 Hz). These results suggest that perceptual learning was not induced during anesthesia. No correlation between the bispectral index and the initial level of performance was found (Pearson r = -0.09, P = 0.59). CONCLUSION: Perceptual learning was not induced by repetitive auditory stimulation during anesthesia. This result may indicate that perceptual learning requires top-down processing, which is suppressed by the anesthetic.

Evaluation of the Video Intubation Unit in morbid obese patients.

BACKGROUND: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non-obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video-optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population. METHODS: We studied 40 MO patients (body mass index >35 kg/m(2)) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO(2) achieved during the procedure, were measured. RESULTS: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO(2) post-intubation. CONCLUSION: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions.

Multiple mating and offspring quality in Lasius ants

Genetic diversity benefits for social insect colonies headed by polyandrous queens have received intense attention, whereas sexual selection remains little explored. Yet mates of the same queen may engage in sperm competition over the siring of offspring, and this could confer benefits on queens if the most successful sire in each colony (the majority sire) produces gynes (daughter queens) of higher quality. These benefits could be increased if high-quality sires make queens increase the percentage of eggs that they fertilize (unfertilized eggs develop into sons in social hymenopterans), or if daughters of better genetic quality are over-represented in the gyne versus worker class. Such effects would lead to female-biased sex ratios in colonies with high-quality majority gynes. I tested these ideas in field colonies of Lasius niger black garden ants, using body mass of gynes as a fitness trait as it is known to correlate with future fecundity. Also, I established the paternity of gynes through microsatellite DNA offspring analyses. Majority sires did not always produce heavier gynes in L. niger, but whenever they did do so colonies produced more females, numerically and in terms of the energetic investment in female versus male production. Better quality sires may be able to induce queens to fertilize more eggs or so-called caste shunting may occur wherever the daughters of better males are preferentially shunted to into the gyne caste. My study supports that integrating sexual selection and social evolutionary studies may bring a deeper understanding of mating system evolution in social insects.