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Malposition of central venous catheters is associated with important and underestimated risks. Although some factors have been related with malposition, its cause is generally not diagnosed, and it seems to have multifactorial origin. We present two cases of central venous catheter malposition due to unusual anatomical causes, diagnosed in the perioperative period. In the first case, superior vena cava agenesis was diagnosed during mitral replacement by sternotomy, which was logically associated with malposition of the inserted central line. The use of catheters and devices through jugular and subclavian veins in patients with this infrequent pathology is associated with important limitations and serious potential complications. In the second case, an undiagnosed goiter causes bilateral and simultaneous malpositioning of two inserted central venous catheters, in the context of an emergency situation, in both internal jugular veins. [ABSTRACT FROM AUTHOR]

Background: Indications for the ex utero intrapartum therapy (EXIT) procedure have evolved and nowadays in addition to secure the airway, obtain vascular access, administer surfactant and other resuscitation medications, EXIT is used to resect cervical or thoracic masses, for extracorporeal membrane circulation (ECMO) cannulation, as well as to rescue maximum intra-thoracic space for ventilation of the remaining functional lung tissue or in cases in which resuscitation of the neonate may be compromised. EXIT procedure in twin pregnancy has been rarely reported and some doubts have been raised about its strategy and safety in such cases. Methods: We reviewed the medical records of 3 twin pregnancy cases where the EXIT procedure have been performed in our center. Results: The mean gestational age at EXIT procedure was 34 + 4 weeks. In two out the three EXIT procedures, the affected twin was delivered first. The average time on placental bypass was 9 minutes. There were no fetal or maternal complications related to the EXIT procedure. All newborns are currently doing well. Conclusion: In twin pregnancies, prenatal diagnosis combined with the EXIT procedure permits the formulation of a controlled delivery strategy to secure both newborns outcome. In those pregnancies, if intervention can be accomplished without compromise of the normal twin, EXIT can be considered. Our results support that EXIT procedure, if properly planned, safely provides a good outcome for both the fetuses as well as the mother. [ABSTRACT FROM AUTHOR]

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery. [ABSTRACT FROM AUTHOR]

Which sex has a more determinant role in reproductive performance? This is a long standing question in evolutionary ecology. Theory predicts and several pieces of evidence have indicated that females are more determinant than males. However, a direct test of this hypothesis has never been made. Here we perform such a direct test by using an alternative analytical approach, controlling for age and/or individual experience, and a captive population of the house sparrow Passer domesticus, a monogamous bi‐parental dimorphic species in which both sexes contribute with approximately equal amounts of parental care. In this species, it has been demonstrated that contribution by males to offspring parental care is crucial to maximize reproductive success. Captive conditions with absence of predators and availability of food ad libitum allow us to control several important factors that may affect reproductive performance, such as environmental fluctuations in resource availability and differences in territory quality, without affecting reproductive performance. We consider four types of pairs, and our main prediction derived from the hypothesis is that mixed pairs involving an experienced female (FBM × EF) should present better reproductive performance than mixed pairs involving a first‐time breeder female (EM × FBF). Our results confirm the general pattern reported in other bird species that older or more experienced individuals enjoy a higher reproductive success than first‐time breeders. In addition, in agreement with our main prediction, we found that FBM × EF produced significantly more fledglings and had higher fledging success than EM × FBF. Our results, for the first time demonstrate the broadly accepted statement that females have a more determinant role than males in reproductive performance. [ABSTRACT FROM AUTHOR]

Background & Aims Patients with advanced liver fibrosis remain at risk of cirrhosis-related outcomes and those with severe comorbidities may not benefit from hepatitis C (HCV) eradication. We aimed to collect data on all-cause mortality and relevant clinical events within the first two years of direct-acting antiviral therapy, whilst determining the prognostic capability of a comorbidity-based model. Methods This was a prospective non-interventional study, from the beginning of direct-acting antiviral therapy to the event of interest (mortality) or up to two years of follow-up, including 14 Spanish University Hospitals. Patients with HCV infection, irrespective of liver fibrosis stage, who received direct-acting antiviral therapy were used to build an estimation and a validation cohort. Comorbidity was assessed according to Charlson comorbidity and CirCom indexes. Results A total of 3.4% (65/1,891) of individuals died within the first year, while 5.4% (102/1,891) died during the study. After adjusting for cirrhosis, platelet count, alanine aminotransferase and sex, the following factors were independently associated with one-year mortality: Charlson index (hazard ratio [HR] 1.55; 95% CI 1.29–1.86; p  = 0.0001), bilirubin (HR 1.39; 95% CI 1.11–1.75; p  = 0.004), age (HR 1.06 95% CI 1.02–1.11; p  = 0.005), international normalized ratio (HR 3.49; 95% CI 1.36–8.97; p  = 0.010), and albumin (HR 0.18; 95% CI 0.09–0.37; p  = 0.0001). HepCom score showed a good calibration and discrimination (C-statistics 0.90), and was superior to the other prognostic scores (model for end-stage liver disease 0.81, Child-Pugh 0.72, CirCom 0.68) regarding one- and two-year mortality. HepCom score identified low- (≤5.7 points: 2%–3%) and high-risk (≥25 points: 56%–59%) mortality groups, both in the estimation and validation cohorts. The distribution of clinical events was similar between groups. Conclusions The HepCom score, a combination of Charlson comorbidity index, age, and liver function (international normalized ratio, albumin, and bilirubin) enables detection of a group at high risk of one- and two-year mortality, and relevant clinical events, after starting direct-acting antiviral therapy. Lay summary The prognosis of patients with severe comorbidities may not benefit from HCV viral clearance. An algorithm to decide who will benefit from the treatment is needed to manage the chronic HCV infection better. [ABSTRACT FROM AUTHOR]

Digestive efficiency is one of the main factors affecting nestling growth and survival. Bird species vary in their ability to assimilate different nutrients, and current theory predicts that nestlings should be able to adjust their nutritional physiology to feeding frequency, thus increasing digestive efficiency in periods of lower food availability. Here, by using a brood parasite-host study system [great spotted cuckoo (Clamator glandarius)-magpie (Pica pica)], we tested several hypotheses and predictions of the adaptive digestive efficiency paradigm. A hand-feeding experiment was carried out in which we fed both great spotted cuckoo and magpie nestlings with exactly the same diet simulating food abundance vs. food deprivation periods, and biochemical analyses including the determination of faecal endogenous excretion of N and energy were conducted. The results showed that magpie nestlings had higher apparent and true N and energy digestibility values than cuckoo nestlings during both deprivation and abundance periods, and that apparent and true N and energy digestibility values of both species increased during the period of food deprivation. These results support the current theory but contradict some previously published studies of nestling passerines based on calculations of food intake and faecal weights. Thus, the study also supports the use of biochemical analyses as a more reliable methodology for the study of digestive efficiency of nestling passerines. [ABSTRACT FROM AUTHOR]

Introduction. epulis of the newborn is a granular cell tumor arising in the mucosa of the dental ridge. It presents as a pedunculated soft tissue mass that can be lobular or multinodular. It is more common in females than in males (8:1) perhaps due to hormonal factors. It may be accompanied by other congenital malformations. Anesthetic management is based on a potentially difficult intubation and the risk of bleeding. Objectives. To present the case of a newborn with congenital epulis and to review this pathology and its anesthetic management. Methods and Results. Clinical case presentation. Conclusions. Several types of anesthesia have been described depending, among other factors, on tumor size and on the professionals involved in excising the lesion. In our case, and given the characteristics of the tumor, we chose inhalation sedation with O2 / air / sevoflurane, lateral decubitus position and local infiltration at the base of implantation. Good collaboration between the surgeon and the anesthetist is critical for success. [ABSTRACT FROM AUTHOR]

Introduction. epulis of the newborn is a granular cell tumor arising in the mucosa of the dental ridge. It presents as a pedunculated soft tissue mass that can be lobular or multinodular. It is more common in females than in males (8:1) perhaps due to hormonal factors. It may be accompanied by other congenital malformations. Anesthetic management is based on a potentially difficult intubation and the risk of bleeding. Objectives. To present the case of a newborn with congenital epulis and to review this pathology and its anesthetic management. Methods and Results. Clinical case presentation. Conclusions. Several types of anesthesia have been described depending, among other factors, on tumor size and on the professionals involved in excising the lesion. In our case, and given the characteristics of the tumor, we chose inhalation sedation with O2 / air / sevoflurane, lateral decubitus position and local infiltration at the base of implantation. Good collaboration between the surgeon and the anesthetist is critical for success. [ABSTRACT FROM AUTHOR]

The egg-recognition processes underlying egg rejection are assumed to be based on an imprinting-like process (a female learning the aspect of her own eggs during her first breeding attempt). The imprinting-like process and the misimprinting costs have been the objective of many theoretical models and frequently have a leading role in papers published on brood parasitism; however, an experiment has never been undertaken to test the existence of this imprinting-like process by manipulating egg appearance in first-time breeding females. Here, we present the first such experimental study using the house sparrow (Passer domesticus), which is a conspecific brood parasite and which has a good ability to reject conspecific eggs, as a model species. We found that contrary to what the hypothesis predicts first-time breeding females did not reject their own eggs in their second breeding attempt. This lack of response against unmanipulated eggs could indicate that females have an innate preference for their own eggs. However, in a second experimental group in which first-time breeding females were allowed to learn the aspect of their (unmanipulated) own eggs, none ejected manipulated eggs during their second clutch either -- a finding that does not support the idea of recognition templates being inherited, but instead suggests that recognition templates could be acquired again at each new breeding attempt. Our results demonstrate that it is likely that egg discrimination is not influenced by egg appearance in the first breeding attempt. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Monitoring the brain in cardiac surgery - an evolving area for research." by H.P. Grocott in the 2012 issue.