Genetic patterns in Montipora capitata across an environmental mosaic in Kane'ohe Bay, O'ahu, Hawai'i.

Spatial genetic structure (SGS) is important to a population's ability to adapt to environmental change. For species that reproduce both sexually and asexually, the relative contribution of each reproductive mode has important ecological and evolutionary implications because asexual reproduction can have a strong effect on SGS. Reef-building corals reproduce sexually, but many species also propagate asexually under certain conditions. To understand SGS and the relative importance of reproductive mode across environmental gradients, we evaluated genetic relatedness in almost 600 colonies of Montipora capitata across 30 environmentally characterized sites in Kane'ohe Bay, O'ahu, Hawaii, using low-depth restriction digest-associated sequencing. Clonal colonies were relatively rare overall but influenced SGS. Clones were located significantly closer to one another spatially than average colonies and were more frequent on sites where wave energy was relatively high, suggesting a strong role of mechanical breakage in their formation. Excluding clones, we found no evidence of isolation by distance within sites or across the bay. Several environmental characteristics were significant predictors of the underlying genetic variation (including degree heating weeks, time spent above 30°C, depth, sedimentation rate and wave height); however, they only explained 5% of this genetic variation. Our results show that asexual fragmentation contributes to the ecology of branching corals at local scales and that genetic diversity is maintained despite strong environmental gradients in a highly impacted ecosystem, suggesting potential for broad adaptation or acclimatization in this population.

Síndrome de Bouveret: Presentación de Caso Clínico / Bouveret Syndrome: Clinical Case Presentation

RESUMEN Introducción: El íleo biliar es una patología poco frecuente caracterizada por obstrucción mecánica intestinal debido a la impactación de un cálculo biliar dentro del tracto gastrointestinal, caracterizado por la tríada de Rigler, se observa en pacientes de edad avanzada con antecedentes de colelitiasis o colecistitis, por la existencia de una fístula bilioentérica. Se asocia a alta morbilidad y mortalidad. Sus síntomas y signos en su mayoría son inespecíficos y su diagnóstico se basa en un enfoque radiológico. Si bien la cirugía abierta ha sido el pilar del tratamiento, recientemente se han empleado otros enfoques, incluyendo cirugía laparoscópica y litotripsia. Caso clínico:Paciente femenino de 100 años de edad con cuadro de dolor abdominal, náusea y vómito de varios días de evolución. El diagnóstico fue realizado por tomografía computarizada. Conclusión: El íleo biliar es una entidad clínica de difícil diagnóstico. El uso de técnicas de imagen puede mejorar la precisión diagnóstica y la toma de recursos terapéuticos. Palabras claves: Obstrucción Intestinal; Cálculos Biliares; Condiciones Patológicas, Signos y Síntomas; Tomografía Computarizada por Rayos X; Litotricia; Laparoscopía

ABSTRACT Introduction: Gallstone ileus is a rare pathology characterized by mechanical intestinal obstruction due to the impaction of a gallstone inside the gastrointestinal tract, characterized by the Rigler triad, it is observed in elderly patients with a history of cholelithiasis or chole-cystitis, due to the existence of a bilioenteric fistula. It is associated with high morbidity and mortality. Its symptoms and signs are mostly nonspecific and its diagnosis is based on a radiological approach. Although open surgery has been the mainstay of treatment, other approaches have recently been used, including laparoscopic surgery and lithotripsy. Clinical case: 100 year-old female patient, with ab-dominal pain, nausea and vomiting that lasted several days of evolution. The diagnosis was made by computed tomography. Conclusion: Gallstone ileus is a clinical entity difficult to diagnose. The use of imaging techniques can improve the diagnostic accuracy and the taking of therapeutic resources. Keywords: Obstrucción Intestinal; Cálculos Biliares; Condiciones Patológicas, Signos y Síntomas; Tomografía Computarizada por Rayos X; Litotricia; Laparoscopía

Impact of a pain protocol including hypnosis in major burns.

BACKGROUND: Pain is a major issue after burns even when large doses of opioids are prescribed. The study focused on the impact of a pain protocol using hypnosis on pain intensity, anxiety, clinical course, and costs. METHODS: All patients admitted to the ICU, aged >18 years, with an ICU stay >24h, accepting to try hypnosis, and treated according to standardized pain protocol were included. Pain was scaled on the Visual Analog Scale (VAS) (mean of daily multiple recordings), and basal and procedural opioid doses were recorded. Clinical outcome and economical data were retrieved from hospital charts and information system, respectively. Treated patients were matched with controls for sex, age, and the burned surface area. FINDINGS: Forty patients were admitted from 2006 to 2007: 17 met exclusion criteria, leaving 23 patients, who were matched with 23 historical controls. Altogether patients were 36+/-14 years old and burned 27+/-15%BSA. The first hypnosis session was performed after a median of 9 days. The protocol resulted in the early delivery of higher opioid doses/24h (p<0.0001) followed by a later reduction with lower pain scores (p<0.0001), less procedural related anxiety, less procedures under anaesthesia, reduced total grafting requirements (p=0.014), and lower hospital costs per patient. CONCLUSION: A pain protocol including hypnosis reduced pain intensity, improved opioid efficiency, reduced anxiety, improved wound outcome while reducing costs. The protocol guided use of opioids improved patient care without side effects, while hypnosis had significant psychological benefits.