Variation in the benefits of multiple mating on female fertility in wild stalk-eyed flies.

Polyandry, female mating with multiple males, is widespread across many taxa and almost ubiquitous in insects. This conflicts with the traditional idea that females are constrained by their comparatively large investment in each offspring, and so should only need to mate once or a few times. Females may need to mate multiply to gain sufficient sperm supplies to maintain their fertility, especially in species in which male promiscuity results in division of their ejaculate among many females. Here, we take a novel approach, utilizing wild-caught individuals to explore how natural variation among females and males influences fertility gains for females. We studied this in the Malaysian stalk-eyed fly species Teleopsis dalmanni. After an additional mating, females benefit from greatly increased fertility (proportion fertile eggs). Gains from multiple mating are not uniform across females; they are greatest when females have high fecundity or low fertility. Fertility gains also vary spatially, as we find an additional strong effect of the stream from which females were collected. Responses were unaffected by male mating history (males kept with females or in male-only groups). Recent male mating may be of lesser importance because males in many species, including T. dalmanni, partition their ejaculate to maintain their fertility over many matings. This study highlights the importance of complementing laboratory studies with data on wild-caught populations, where there is considerable heterogeneity between individuals. Future research should focus on environmental, demographic and genetic factors that are likely to significantly influence variation in individual female fecundity and fertility.

Evolution: sex or survival.

A classic paradox in sexual selection is how sexual traits under strong directional selection maintain underlying genetic variation. A new study has found that in Soay sheep a trade-off between reproductive success and survival maintains variation in horn size.

Use of methylnaltrexone for the treatment of opioid-induced constipation in critical care patients.

Gastrointestinal dysmotility and constipation are common problems in critical care patients. The majority of critical care patients are treated with opioids, which inhibit gastrointestinal (GI) motility and lead to adverse outcomes. We reasoned that methylnaltrexone (MNTX), a peripheral opioid antagonist approved for the treatment of opioid-induced constipation in patients with advanced illness receiving palliative care when response to laxative therapy has not been sufficient, could improve GI function in critically ill patients. The present study included all patients in our intensive care unit who required rescue medication for GI stasis during the 10-week period from September 1 to November 15, 2009. We compared conventional rescue therapy with subcutaneous MNTX. We performed a retrospective chart review of the 88 nonsurgical critical care patients receiving fentanyl infusions, 15 (17%) of whom met the criteria of absence of laxation within 72 hours of intensive care unit admission despite treatment with senna and sodium docusate. Eight of these 15 patients subsequently received conventional rescue therapy (combination of sodium picosulfate [5 mg] and 2 glycerin suppositories [4-g mold]), and 7 patients received MNTX (subcutaneous injection, 0.15 mg/kg). Laxation occurred within 24 hours in 6 of the 7 MNTX patients (86%) but in none of the 8 patients receiving conventional rescue therapy (P=.001). The median difference in time to laxation between the 2 groups was 3.5 days (P<.001). Although not statistically significant, all 7 patients treated with MNTX, but only 4 of 8 (50%) who received conventional rescue therapy, progressed to full target enteral feeding (P=.08). Intensive care unit mortality was 2 of 7 MNTX patients (29%) vs 4 of 8 (50%) in the standard therapy group (P=.61). We hypothesize that MNTX may play an important role in restoration of bowel function in critically ill patients.

Using imipenem and cilastatin during continuous renal replacement therapy.

AIM: To identify and review studies which have sought to define the pharmacokinetics of imipenem and cilastatin in patients receiving continuous renal replacement therapy (CRRT). METHOD: Literature was primarily identified using Pharmline, Embase and Medline databases using the search terms "imipenem," "haemofiltration," "haemodialysis" and "pharmacokinetics." Papers that discussed only intermittent haemodialysis were excluded. RESULTS: Seven papers were identified which described the pharmacokinetics of imipenem in patients receiving CRRT. Four different modes of CRRT were used. The methods of sampling, dosages used and assumptions made during pharmacokinetic calculations varied widely between the studies. Total body clearance of imipenem during CRRT in patients suffering from acute renal failure was found to range between 89 and 149 ml/min. Total body clearance of cilastatin ranged between 9 and 32 ml/min. Total body clearance of both imipenem and cilastatin was reduced in patients with chronic renal failure. Total body clearance of cilastatin was also reduced by impaired liver function. Dose recommendations made ranged between 500 mg 6-hourly and 500 mg 12-hourly. CONCLUSIONS: The heterogeneity of the studies identified prevents them being analysed as a single group. For meaningful dosage recommendations to be made, further studies are required using larger populations and with more detail regarding liver dysfunction and duration of renal failure.