A major goal in evolutionary biology is to understand the processes that shape the evolutionary trajectory of clades. The repeated and similar large-scale morphological evolutionary trends of distinct lineages suggest that adaptation by means of natural selection  is the major cause of parallel evolution, a very common phenomenon in extinct and extant lineages. However, parallel evolution can result from other processes, which are usually ignored or difficult to identify, such as developmental constraints. Hence, understanding the underlying processes of parallel evolution still requires further research.Herein, we present a possible case of parallel evolution between two ammonoid lineages (Auguritidae and Pinacitidae) of Early-Middle Devonian age (405-395 Ma), which are extinct cephalopods with an external, chambered shell. In time and through phylogenetic order of appearance, both lineages display a morphological shift toward more involute coiling (i.e. more tightly coiled whorls), larger adult body size, more complex suture line , and the development of an umbilical lid  in the most derived taxa. Increased involution toward shells with closed umbilicus has been demonstrated to reflect improved hydrodynamic properties of the shell and thus likely results from similar natural selection pressures. The peculiar umbilical lid might have also added to the improvement of the hydrodynamic properties of the shell. Finally, increasing complexity of suture lines likely results from covariation induced by trends of increasing adult size and whorl overlap given the morphogenetic properties of the suture.The morphological evolution of these two Devonian ammonoid lineages follows a near parallel evolutionary path for some important shell characters during several million years and through their phylogeny. Evolution of some traits  appears to be mainly driven by adaptation to improve the hydrodynamic properties of the shell, whereas other characters  evolved due to covariation with features that play a central role in the morphogenesis of mollusc shells. This example provides evidence that parallel evolution can be driven simultaneously by different factors such as covariation  and adaptation . Independent evolution of similar biological traits in two different lineages branching off from the same ancestor defines parallel evolution -3. It isEvolutionary steps in two independent lineages will never be absolutely identical ,16,23,24Parallel evolution is often difficult to differentiate from convergence  and somDrosophila is in genetics" )http://folk.uio.no/ohammer/past), as well as by scripts programmed by C.M. in MATLAB® (http://www.mathworks.com/).Before evaluating the parallel evolution of auguritids and pinacitids, we describe the patterns of morphological variation and evolution of these two lineages Figures , 6, 7, 8http://www.r-project.org/). The method evaluates the maximum likelihood of producing the observed trends for three evolutionary modes . The relative support of each of these three models is assessed using well-established statistical means such as Akaike weights , wh, whhttp:n Figure .Pinacites have thus been merged, as well as Foordites succedens with F. platypleurus and Achguigites with Fidelites. This constraint of the method reduces the power of the test since the species of different lineages cannot be considered as equivalent.In order to assess the parallel evolution of the two studied lineages, we use two different approaches, both based on a multivariate analysis using the subset of characters previously identified to be potentially involved in this case of parallel evolution. Note that univariate approaches can suffer from a "dimensionality bias" and similarities of trajectories in a morphospace should preferably be tested multivariately ,122. FirThe second method to test the parallel evolution of these Devonian ammonoids follows the approach proposed by  for compThe evolution of shell characters through the phylogenetic sequence of the lineage that includes the Auguritidae is described and reported in Figures Weyeroceras and Celaeceras both possess extensions of the lateral shell wall covering the umbilicus ; for Dmx, the last auguritid has the same value has the penultimate pinacitid but the last pinacitid is larger than the last auguritid; and for NLb, both lineages have at the end the same number of suture elements. This is also suggested graphically in Figure Both ammonoid lineages display empirical morphological evolutionary trends of some shell characters. Their statistical evaluation by means of the method of  is illussize = 0.103, Psize = 0.920) and in the direction  of phenotypic evolution between the two lineages . This difference in the shape of the two trajectories is, however, expected because the taxa of each lineage are not truly equivalent and do not necessarily represent the same evolutionary steps.Since auguritids and pinacitids originated from the same ancestor, had possible directional trends in UWI, Dmx and NLb, and finally ended with similar values for these three characters, auguritids and pinacitids may have a parallel evolution for three quantifiable traits . There is, however, also the evolution of the umbilical lid, which is a presence/absence character and does not influence the quantitative results. The hypothesis of parallel evolution of the measurable characters is tested by two permutation methods based on the character subset made by UWI, Dmx and NLb Figure . Using ts Figure . Howeverp = 0.019), but the value is low ; development of an oxyconic shell (more compressed shell and/or more acute venter); larger shell diameters (body size); and the terminal acquisition of an umbilical lid.The increasing body size of both studied lineages constitutes an example of Cope's rule, known as the widespread tendency of animal groups to evolve toward larger body size -129. ThiThe persistent increasing involution (i.e. more tightly coiled whorls toward a closed umbilicus) coupled with the oxyconic shell as displayed by the auguritids and pinacitids is surely one of the most frequently observed large-scale morphological evolutionary trends among ammonoids ,136-139.Finally, both studied lineages evolved a peculiar morphological trait, the umbilical lid. This shell modification occurred only among the most derived species of both studied evolutionary lineages. This umbilical lid represents an extension of the lateral shell wall, passing across the umbilical shoulder toward the coiling axis and consequently more or less completely occludes the umbilicus of the ammonoid shell. This construction of the umbilical lid is a unique feature of the two studied lineages and is not known in this form from any younger ammonoid group, not even in groups having similar shell shapes. Other ammonoid groups do occasionally possess morphological features occluding the umbilicus ,95,156, (1) The umbilical lid could represent an adaptation for the improvement of the hydrodynamic properties of the shell. Indeed, it has been shown repeatedly that the size and shape of the umbilicus in combination with the overall shell geometry has a profound influence on the hydrodynamic properties of the shell -63,142. Nautilus, the only extant cephalopod with an external shell, see [Nautilus [(2) In addition to the previous hypothesis, the umbilical lid could act as a device directing water into the mantle cavity from behind when swimming backwards by means of jet propulsion. Indeed, most cephalopods swim "backwards" by taking in water into the mantle cavity and by expelling this water by mantle cavity compression through the hyponome . Noell, see . This isNautilus ,63, thusNautilus .(3) Finally, the umbilical lid might have been caused by, or linked to, features unrelated to the hard parts . For instance, the parallel evolution of an umbilical lid may speculatively result from the repetitive loss of expression of regulatory Hox genes ,186185,1Weyeroceras angustum (Auguritidae) and Exopinacites singularis (Pinacitidae) the siphuncle shifted to a subventral position causing the formation of an additional lobe [Both studied lineages are no exception to this rule of covariation. The two lineages are characterized by the parallel and identical evolution toward an increasing number of lobes Figure . In the nal lobe ,92. BothVery early in the course of the evolution of the Ammonoidea, the two families Auguritidae and Pinacitidae evolved independently but display a striking pattern of probably parallel morphological evolution. These two families share several essential morphological traits such as shell shape, suture line course, and the presence of an umbilical lid, which is an extension of the lateral shell wall and is unknown in this form from any other ammonoid lineage. The similar and parallel evolution of both lineages toward large, involute shells with more complex suture lines and with closed umbilicus including the formation of an umbilical lid can be explained best by selection for enhanced hydrodynamic properties of the shell (selective/adaptive constraints). Speculatively, the umbilical lid might have facilitated the intake of water from the swimming direction during repulsion swimming. Some other shell parameters also show a parallel evolution, but most likely due to covariation . The increase in sutural complexity represents a typical case of covariation induced by the evolution toward involute and larger shells with acute venter and deep imprint zone.Covariation and adaptive constraints are thus not mutually exclusive and both can contribute to parallel evolution of ammonoid lineages. Constructional constraints belong therefore to the primary factors governing evolutionary trends of the ammonoid shell, indirectly triggered by adaptive trends. Furthermore, this underlines that form, and the controls upon it, can never be truly understood in isolation from functional adaptation and constructional covariation. Distinction between covariation and adaptation in the process of evolutionary trends is also important in order to avoid over-interpretation of the patterns; in such cases, detailed studies of convergent or parallel evolutionary trends can contribute important impetus toward a decision for either cause. For instance, recurrence of particular combinations of morphology and their strong independence of phylogeny are commonly regarded as strong arguments for functional constraints. The evolutionary recurrence of these combinations of characters depends partially on selection for certain functional aspects , and partially on shell morphogenesis and associated covariation following functional adaptations , thus representing "fabricational noise" ,196  and made the morphometric measurements. CM performed the quantitative analyses and edited the text. CM, CK and KDB wrote the paper. All authors participated in the interpretation of the data. All authors read, discussed and approved the final manuscript.


Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period.We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day) for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement.Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life. Total hip arthroplasty (THA) is a well-established treatment option for hip joint symptomatic osteoarthritis in elderly people. Although THA results in a significant reduction of hip pain and improved quality of life, serious complications, including loosening and migration of the hip implant, can occur. The THA surgical procedure includes resection of the inner lesion of the osteoarthritic acetabulum followed by settlement of a usually high-density polyethylene cup component that often is fixed with several screws and that is introduced from the outside of the acetabulum to the inner pelvic cavity. An improperly introduced acetabular cup-fixating screw usually results in breakage, loosening, or migration of the implant or a combination of these. However, infrequently, this part of the procedure causes injury to the vascular structures or soft tissues (or both), including muscles (iliac muscle) within the pelvic cavity. As we report here, an extremely rare late-stage complication of cup-fixating screws caused slowly expanding hematoma with resultant acetabular bone resorption and loosening of the acetabular component and required THA revision.An otherwise previously healthy 77-year-old Japanese woman was admitted to our university medical center with an approximately 4-month history of progressive right hip joint pain. She had a progressive stage of dysplastic hip osteoarthritis on both sides without any other congenital disease, blood disease, or rheumatoid arthritis. At the age of 64, she underwent right-side THA  at our institution  for atrial fibrillation but was otherwise in good disease-free condition, apart from the bilateral THA. She had a slightly limited range of movement on her right side, but her hip muscle strength on a manual muscle test was normal bilaterally: Harris hip score was 68 out of 100 points. Palpation of the right iliac and psoas muscles did not elicit any pain. Blood test results were unremarkable: leukocyte count of 5.8×10Plain radiographs taken on admission showed a massive osteolytic lesion Figure d, and maSurgical treatment was planned in a single session at two stages: anterior midline transperitoneal approach (first stage) to resect the low-density lesion followed by posterolateral acetabular implant re-settlement. The anterior transperitoneal midline approach was followed by a retroperitoneal incision to identify the internal and external iliac arteries and veins and their branches. The granulomatous lesion was identified posterolateral to the external iliac artery and vein but without any venous networks or major connection to the vasculature Figure a. The leAfter the left-side decubitus position was changed, the posterolateral address (second stage) was undertaken to explore the acetabular implant. The acetabular cup and three screws were easily removed. The inner cavity of the original acetabulum in the pelvic cavity contained the hematoma-like mass. A massive bone defect was observed at the base of the acetabulum, but the remaining acetabular structure provided enough support for the large cup. The acetabular bone defect was covered by a mesh  impacted with allogenic morcerized bone and this was followed by settlement of a 60mm inner diameter Trident® acetabular cup and outer liner X3 . A histological examination revealed minimal inflammatory macrophage infiltration but no metallosis. The post-operative course was uneventful, and our patient resumed daily activities soon after surgery Figure e.et al. [et al. [Failure of artificial joint implants is usually associated with improper use or settlement of implants or both, fixation failure with inappropriate fixation with screws, poor bone ingrowth in the hydroxyapatite-coated metal back of the cup or femoral stem, osteopenia in the host bone, infection, and osteolysis with metallosis in the surrounding tissues. Every effort has been made to enhance the early stable fixation with optimal adaptation of implant to the osteoarthritic hip through technical as well as material innovation of the THA assembly. In the acetabulum, anatomical incongruence of the ilium and the innominate bone is often one of the major causes of loose acetabular cup after THA. A shallow acetabulum and thin iliac bone in the dysplastic hip often require multiple-screw fixation, which could potentially increase the risk of penetration of the ilium and injury of the venous networks running interior to the ilium. Wasielewski et al.  reportedet al. . Hematom [et al.  designatIn our patient, obvious fracture  or migration of the cup or screws was not evident on the plain radiographs taken immediately after the fall or at follow-up, in spite of the expansion of the ilium and acetabulum. In contrast, CT images before THA revision showed penetration of the inner cortex of the acetabulum. The tip of the acetabular cup-fixating screw could have penetrated the inner cortex on the left side of the primary THA at the age of 64, although such a technical error was considered insignificant at the time. The accidental fall probably resulted in injury of the microvessels and venous networks in the soft tissues, including the periosteum or iliac muscles, by the screw tip without obvious fracture evident on the plain radiographs. A slowly growing expansive hematoma associated with anticoagulant therapy is likely to have developed during the subsequent 2-year period, both inside and outside the iliac bone, and to have resulted in resorption of the acetabular bone and loosening of the acetabular component. The screw tip in the actively contracting iliac muscle could have continued to cause a progressive increase in the size of the hematoma. The bony changes and destruction that appeared as osteolytic changes could also be the results of recurrent bleeding, as seen in patients with hemophilia . Local iThough rare, THA-related vascular complications are often serious and potentially affect the limb and quality of life. Previous studies have described THA-related iliac or retroperitoneal hematoma ,6-10 (TaIn the case described here, an extremely rare possibly late-stage complication of cup-fixating screws in THA caused progressive development of chronic expanding hematoma, resultant acetabular bone resorption, and loose acetabular component and required revision THA. Owing to the continued need for anticoagulant therapy in such cases, meticulous attention must be paid to avoid trauma that could produce a new hemorrhage around the THA implant.CT, computed tomography; THA, total hip arthroplasty.The authors declare that they have no competing interests.KU drafted the manuscript. YK was the main surgeon in charge. KN, TM, and AY were part of the surgical team and were responsible for the post-operative care. TY and HN revised the manuscript and provided clinical support. HB participated in the conceptualization and final version of the manuscript. All authors read and approved the final manuscript.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


In conventional functional near-infrared spectroscopy (fNIRS), systemic physiological fluctuations evoked by a body's motion and psychophysiological changes often contaminate fNIRS signals. We propose a novel method for separating functional and systemic signals based on their hemodynamic differences. Considering their physiological origins, we assumed a negative and positive linear relationship between oxy- and deoxyhemoglobin changes of functional and systemic signals, respectively. Their coefficients are determined by an empirical procedure. The proposed method was compared to conventional and multi-distance NIRS. The results were as follows: (1) Nonfunctional tasks evoked substantial oxyhemoglobin changes, and comparatively smaller deoxyhemoglobin changes, in the same direction by conventional NIRS. The systemic components estimated by the proposed method were similar to the above finding. The estimated functional components were very small. (2) During finger-tapping tasks, laterality in the functional component was more distinctive using our proposed method than that by conventional fNIRS. The systemic component indicated task-evoked changes, regardless of the finger used to perform the task. (3) For all tasks, the functional components were highly coincident with signals estimated by multi-distance NIRS. These results strongly suggest that the functional component obtained by the proposed method originates in the cerebral cortical layer. We believe that the proposed method could improve the reliability of fNIRS measurements without any modification in commercially available instruments. Continuous-wave functional near-infrared spectroscopy (CW fNIRS) is a simple technique used for cerebral functional imaging, particularly for subjects who are in relatively unrestrained conditions, such as infants without adequate head fixation In practice, however, the CW fNIRS signal is often contaminated by an optode contact error caused by motion and/or physiological activities other than cerebral function Cephalic blood circulation involves at least three different mechanisms: the activation of the systemic autonomic nervous system, intracranial autoregulation, and localized neurovascular hemodynamics. Changes in systemic circulation during task execution have been observed, including an increase in the heart rate (HR) and oxygen saturation degradation during a Valsalva maneuver Conventional techniques of noise reduction, for example, band-pass filter or block averaging, cannot remove such a task-evoked intrinsic contaminant. Thus, if we use CW fNIRS without any knowledge regarding the precise position of the activation area, we need a method to separate the observed signal into the cerebral functional signal and other physiological fluctuations.Methods to separate a signal into a functional signal and other systemic fluctuations have been proposed; however, both theoretical and practical drawbacks still exist. An adaptive filter Principal component analysis for multichannel fNIRS data Task-evoked systemic fluctuations can be reduced by a well-designed task To overcome the above-mentioned problems, selective detection of the cerebral cortical hemodynamics has been studied with diffuse optical tomography (DOT) As mentioned above, we do not have complete information about how the task execution evokes not only the functional hemodynamic response but also the systemic and global cerebral blood circulation changes. Also, even if a fully detailed theoretical model on cephalic blood circulation is given, some of the model's parameters, such as temporal changes in oxygen consumption, the tilt angle of the subject's body, the elasticity of vessels, the density and activity of sympathetic/parasympathetic nerves, or the carbon dioxide concentration may still require measurement by methods other than NIRS. Nonetheless, we can discuss how changes in a different aspect of blood circulation can cause a different hemodynamic result. Here we consider velocity and volume as important aspects of blood circulation. As discussed in later sections, if the velocity and volume of blood flow vary in different kinds of vasculatures , they will cause two distinctively different hemodynamic modalities: cerebral functional hemodynamics in the capillaries of the local cerebral region and a systemic fluctuation in other vessels of the other tissues. These two hemodynamic modalities are characterized by their negative and positive correlation between oxy- and deoxyhemoglobin changes, respectively. Thus, we can use these characteristics to separate the fNIRS signal into functional and systemic components. We simply assume that these correlations are linear, that the observed fNIRS signal is a mixture of the functional and systemic components, and we provide an empirical procedure to determine the coefficients of the linear relationship between the oxy- and deoxyhemoglobin changes of the two modalities. The observed signal was separated into two components based on these coefficients. The proposed method was validated by the simultaneous implementation of both proposed and CWMD methods for functional and nonfunctional tasks. A high congruence between the functional component of the proposed method and the cerebral signal obtained by the CWMD method was observed. We believe that researchers using commercially available systems can successfully separate their fNIRS data into the functional and systemic components and gain the experimental reliability using this simple method.The study was approved by the Institutional Review Board of the National Institute of Advanced Industrial Science and Technology (Japan). Written informed consent was obtained from the participants.We can use fNIRS to observe changes in oxy- and deoxyhemoglobin in tissues. In the past, researchers have attempted to ascertain typical shapes of the oxy- and deoxyhemoglobin changes during cerebral functional activation. Early studies reported that the increase in oxyhemoglobin is prominent while the deoxyhemoglobin change is unclear An increase in the regional cerebral blood flow (rCBF) due to neural activation in the corresponding cerebral region was reported more than a hundred years ago If changes in the regional blood volume (rCBV) occur during a neural-activation-evoked vascular response, they may lead to an increase in the From these findings, we represent the oxy- and deoxyhemoglobin changes evoked by a neural activation as the linear relationship There is another hemodynamic modality relevant to fNIRS signals. Some researchers have observed that physical activities such as posture change Based on the above discussion, the CW fNIRS signal  and (4), the coefficients of both hemodynamic modalities, The functional component originates mainly from the regional cerebral hemodynamics evoked by neural activation. We surveyed fNIRS studies from the past and utilized studies satisfying two conditions: (1) those that used an appropriate experimental design to exclude physiological signals other than cerebral hemodynamics and (2) those that provided a graph of both oxy- and deoxyhemoglobin changes from the beginning to the end of functional activation. We calculated the value of The coefficient The coefficient In our model, we assume that capillaries mainly generate the functional component and arteries and veins generate the systemic component. Since these components originate from different vessels and different hemodynamic modalities, we assumed a high statistical independence between them. Thus, we determined We used an OMM-3000 system  with our specially designed optodes and holder system Oxy- and deoxyhemoglobin changes in the CW fNIRS signals were calculated using a pseudo-inverse of the molar absorption coefficient matrix. The molar absorption coefficients were taken from the literature http://www.fil.iion.ucl.ac.uk/spm/). The activation area and the Cz position of an EEG 10–20 system were identified by overlying the T1-weighted image. Each optode array was located directly above the activation area relative to the Cz position.The study included seven healthy adult volunteers. The primary motor area of four participants  was initially identified by fMRI during a finger-tapping task (detailed below). The T1-weighted images and echo planar images were measured using MR equipment . The T-contrast images of left- and right-hand-finger tapping against rest periods were obtained using SPM5  and because of a metal implant (P3). These three participants participated with optodes set around positions C3 and C4 in the parietal area. Participant 3 participated only in the nonfunctional tasks. In total, the nonfunctional tasks were performed by seven participants and the functional task by six. Participants were seated in a chair and were instructed to perform the tasks described below.Two types of nonfunctional tasks were performed: voluntary tilting of the upper body forward by approximately 30 degrees and holding one's breath. In each task, the block conditions were alternated through a task period (20 s) and a rest period (20 s) using visual and auditory cues. A complete session consisted of an initial reference rest period (20 s) followed by five task/rest sequences.In the functional task, the participants were instructed to tap their thumb with the index finger at a frequency of 4 Hz. The block conditions were alternated using visual and auditory cues in the following order: a left-hand finger-stimulation period (20 s), a rest period (20 s), a right-hand finger-stimulation period (20 s), and a rest period (20 s). A complete session consisted of an initial reference rest period (20 s) and five repetitions of the block sequence  without any interruption.To evaluate the performance of the proposed method for detecting the cerebral functional activity, we conducted a paired t-test for the difference in oxyhemoglobin change between left and right finger tapping by the following procedure. We averaged oxyhemoglobin changes during tasks and their preceding rest periods (each was of 10 s duration), where we adopted a 10 s temporal offset in each period to take into account the transient phase of the functional hemodynamics. The difference between the task and rest was averaged for five trials of each tapping side. For the results, the difference between left- and right-tapping was examined by the paired t-test.To examine the agreement of the temporal shapes between the functional component of the proposed method and the hemodynamics obtained by the CWMD method, a Pearson product-moment correlation coefficient was calculated from the data of the finger-tapping task.To analyze the periodical characteristics of hemodynamic changes, we conducted Fast Fourier Transformation (FFT) on the data that had not been passed by a low-pass filter of 1.0 Hz.A histogram of the estimated The dependency of signal amplitude against the source-detector distance in the hemodynamic changes during the finger-tapping task by participant 1 is shown in The CWMD method can estimate hemodynamics in the cerebral gray matter layer. In a previous study The trajectories of the CWMD method consistently indicate a negative linear relationship between oxy- and deoxyhemoglobin changes, whereas those of the conventional method varied according to the task conditions and were different from those of the CWMD method. The trajectories of the functional component originated from the assumed linear relationship with a coefficient of We introduced two hemodynamic modalities in this study. If each modality originates from a different physiological activity, we may be able to find a frequency component in the spectrum that is specific to each activity. In our model of the two hemodynamic modalities, we did not introduce any assumption about the spatial origin of each modality. However, The same figure shows black lines as the source-detector distance dependency of the directly simulated partial optical path length in the scalp and the cerebral gray matter layers. These values were calculated at a wavelength of 780 nm by a Monte Carlo simulation. We used a public code In this study, we fixed As shown above, we examined the stability of the proposed method with regard to the stability of In pathological brains of ischemia Some researchers observed nonlocalized hemodynamic changes similar to the functional component in terms of time range and modality A systematic method for fNIRS data analysis such as SPM for fMRI data analysis has not been established yet. For example, researchers have different understandings on the grand average of data obtained from different subjects. In this study, we consistently used individual data instead of their grand averages. Because individual data are differently scaled owing to the difference in the optical path length of subjects or optode positions Since fNIRS is a less invasive, easy-to-use technique compared to fMRI or PET, users expect multichannel fNIRS to be an alternative to such functional neuroimaging techniques. In usual CW fNIRS, a source-detector distance of 30 mm is used to detect the hemodynamic change in the cerebral gray matter layer. For this reason, commercially available multichannel CW fNIRS systems usually have an optode lattice configuration with a 30 mm pitch. However, in this case, the detectable cerebral hemodynamics area is limited to an area approximately half the size of the source-detector distance Based on the results and discussion above, we believe that the proposed method can separate the conventional fNIRS signal into functional and systemic components even when the task involves motion. By this simple method, users will be able to increase the reliability of fNIRS measurements without any modification in commercially available CW fNIRS instruments.


Background. Microcystic variant of urothelial carcinoma is one of the new variants of urothelial carcinoma that was added to the WHO classification in 2004. Aims. To review the literature on microcystic variant of urothelial carcinoma. Methods. Various internet search engines were used to identify reported cases of the tumour. Results. Microscopic features of the tumour include: (i) Conspicuous intracellular and intercellular lumina/microcysts encompassed by malignant urothelial or squamous cells. (ii) The lumina are usually empty; may contain granular eosinophilic debris, mucin, or necrotic cells. (iii) The cysts may be variable in size; round, or oval, up to 2 mm; lined by urothelium which are either flattened cells or low columnar cells however, they do not contain colonic epithelium or goblet cells; are infiltrative; invade the muscularis propria; mimic cystitis cystica and cystitis glandularis; occasionally exhibit neuroendocrine differentiation. (iv) Elongated and irregular branching spaces are usually seen. About 17 cases of the tumour have been reported with only 2 patients who have survived. The tumour tends to be of high-grade and high-stage. There is no consensus opinion on the best option of treatment of the tumour. Conclusions. It would prove difficult at the moment to be dogmatic regarding its prognosis but it is a highly aggressive tumour. New cases of the tumour should be reported in order to document its biological behaviour. Since microcystic variant of urothelial carcinoma was added to the WHO classification, very few cases have been reported in the literature, and in view of this most practitioners would be unfamiliar with the biological behaviour of this rare type of tumour. The ensuing paper contains literature review of microcystic variant of urothelial carcinoma.Various internet search engines including Google, Google Scholar, PubMed, Educus. and UpToDate were used to identify the literature including case reports, case series, and review papers on microcystic variant of urothelial carcinoma for the review of the literature on microcystic variant of urothelial carcinoma. The key words that were used included microcystic variant of urothelial carcinoma and microcystic transitional cell carcinoma. In all 17 documentations were found which were relevant to the aetiology, presentation, diagnosis, management, and outcome of microcystic variant of urothelial carcinoma.Microcystic variant of urothelial carcinoma is one of the variants of urothelial carcinoma that was added to the WHO classification in 2004. Microcystic variant of urothelial carcinoma has predominant features of urothelial carcinoma. However, it has prominent inter- or intracellular lumina and no true glands. Microcystic variant of urothelial has been considered to be equivalent to urothelial carcinoma with gland-like lumens by AFIP authors ; neverthThe cyst-like structures may emanate from the ability of urothelium to form and line spaces as occurs in the urinary bladder.The cyst-like structures may result from cell degeneration which is based upon presence of luminal debris and necrotic cells .Postulates that have been put forward regarding the aetiology of the microcystic variant of urothelial carcinoma include the following.Paz and associates  describeProminent intracellular or intercellular lumina/microcysts which are surrounded by neoplastic urothelial or squamous cells.The lumina tend to be empty, but they may contain granular eosinophilic debris, necrotic cells, or mucin.The cysts may be variable in size; they may be oval or round; they may be up to 2 mm; they are lined by urothelium. The cells are flattened cells or low columnar cells; however, they are not colonic epithelium or goblet cells.The cysts tend to be infiltrative and they may invade the muscularis propria.The pattern of the tumour on microscopic examination mimics cystitis glandularis cystica.Elongated, irregular branching spaces can be seen on microscopic examination.Microscopic features of microcystic variant of urothelial carcinoma listed by Rugvedita  include Young and Zukerberg  in 1991 Based upon the report of Pacchioni and associates  it wouldβE12, p63, CK7, uroplakin, and thrombomodulin,positive staining with 34α-methyl-coenzyme A racemase,negative staining with Ki-67 and p53 overexpression in high-grade cancers [Some of the immunohistochemistry characteristics of microcystic variant of urothelial carcinoma includeSome of the conditions that may mimic microcystic urothelial carcinoma include the nested variant of urothelial carcinoma; urothelial carcinoma with glandular differentiation; adenocarcinoma; cystitis cystica and cystitis glandularis; mullerianosis; nephrogenic adenoma and nephrogenic metaplasia; and mucoid cytoplasmic inclusions.The nested variant of urothelial carcinoma may exhibit focal tubular differentiation. Urothelial carcinoma with glandular differentiation may look similar to microcystic variant of urothelial carcinoma; however, it has true glands which are lined by goblet cells or colonic epithelium, and it is primarily a urothelial tumour in contrast to adenocarcinoma . NephrogRugvedita  stated tWith regard to outcome of microcystic variant of urothelial carcinoma, Barresi and associates  stated tPaz and associates  stated tYoung and Zukerberg  reportedPacchioni and associates  reportedDonhuijsen and associates  undertooBarresi et al.  reportedAlvarado-Cabrero and associates  presenteLeroy and associates  stated tA 73-year-old man had a 5-year history of superficial transitional cell carcinoma of the urinary bladder. He had presented with visible haematuria. He underwent cystoscopy which did not reveal any abnormality in the urinary bladder; however, there was blood exuding from the right ureteric orifice. He underwent computed tomography scan and urography which did not show any tumour. A right nephrectomy was performed because of recurrent haematuria with anaemia. He died of his disease 18 months later with pulmonary metastases which was proven by transthoracic fine-needle biopsy.A 62-year-old woman presented with visible haematuria of a few weeks duration. She underwent cystoscopy and bladder biopsies and the histology was normal. Cytological examination of her urine revealed atypical urothelial cells. She had computed tomography scan and urography which revealed a tumour in the upper calyx of the left kidney. She underwent a left nephroureterectomy. She had remained well without evidence of recurrence 6 months after presentation.Macroscopic examination of the nephrectomy specimen in Microscopic examination in the first case revealed a proliferation of small tubules and numerous cysts in the lamina propria and muscularis propria Figures  and 2 anLeroy and associates  reportedVardar and associates  reportedSari and associates  reportedUp to 2007, 17 cases of microcystic variant of urothelial carcinoma had been reported in the literature.The characteristic features of microcystic variant of urothelial carcinoma were first comprehensively described on four cases by Young and Zukerberg .Twelve of the other cases which were published in the literature by Paz and associates  in the eLeroy and associates  were of There was no information regarding Ki-67 and p53 reactivity in microcystic variant of urothelial carcinoma. The neoplastic cells in their case exhibited high Ki-67 and p53 expression .Even though there was a need for a larger number of cases in order to determine the immunohistochemical profile of microcystic urothelial carcinoma, given the high Ki-67 and p53 proteins could be of help in diagnosing malignancy in small biopsy specimens.Sari and associates  iteratedYoung and associates , 14 statSari and associates  stated tRadopoulos and associates  reportedPomara and associates  stated tMicrocystic variant of urothelial carcinoma is a rare tumour and to the knowledge of the author less than 20 cases have been reported in the literature.In view of the limited number of reported cases of microcystic variant of urothelial carcinoma in the literature it would prove difficult at the moment to be dogmatic regarding its biological behaviour and prognosis following treatment.However, it would appear from the few reported cases of microcystic urothelial carcinoma that on the whole this tumour is a highly aggressive tumour.Urologists, pathologists, and oncologists throughout the world should be encouraged to report new cases of microcystic urothelial carcinoma in order to document the biological behaviour of such a rare tumour.


This book offers advanced treatment of a broad selection of topics in molecular medical mycology authored by leading investigators. It assumes a foundation of knowledge of mycotic pathogens and is suitable for the reader who is well-grounded in molecular microbiology. It is highly recommended for investigators planning to conduct medical mycology research. The book is divided into 5 sections: General Principles, Model Systems, Specific Pathogens, The Host, and Future Directions. Only selected highlights are described here because of space limitations.The book reviews the development of transforming and gene-silencing methods for identifying virulence determinants. An overview of Candida albicans virulence underlines that molecular subtyping has elucidated 3 major clades, which differ in their potential for producing superficial versus deep-seated infection. The first step in pathogenesis is adherence to host tissues. The endothelial and epithelial specificity of members of the C. albicans Als family of adherence molecules is defined by the adherence profile of null mutants. The discovery through the genome sequence of C. albicans mating type locus and the delineation of the unique pathway of a parasexual cycle are discussed. Although the population is largely clonal and seems locked in a diploid state, the species has a demonstrated ability to undergo recombination.The phylogenetic species concept has led to a better understanding of the lineage of pathogenic fungi, especially for the mitosporic fungi, which have no known sexual stage. The evolution of fungal species, shown by multilocus sequence typing, enabled construction of a phylogenetic tree of all known fungal pathogens with assignments to well-described families and orders.Mechanisms of resistance to antifungal agents are discussed, including insights from genome sequence analysis and recent clinical observations such as the role of transcription factors in upregulating efflux pumps in the presence of antifungal agents or steroids. How environmental fungi have acquired their pathogenic potential for humans, even those whose immune function is intact, is a puzzle, but clues come from the interaction of fungi with soil-dwelling amebae. Fungi escape endocytosis by converting from yeast to hyphal forms; this not only conditions them for intracellular survival but also suggests how dimorphism may have originated. Transcriptional profiling using microarrays is a powerful tool for identifying genes expressed during mold-to-yeast morphogenesis and host-fungus interactions in infected tissue cultures and biofilms. Interspersed in the book are examples of exploiting this technology to discover key regulatory pathways.No subject attracts more interest, yet is strewn with more pitfalls, than fungal vaccine development. Two major types of vaccine development are preventive vaccines and monoclonal antibody immunotherapy. Individual recombinant antigens have evoked mild to moderate protection. Interest in a potential attenuated live vaccine has been stimulated by the finding that targeted disruption of the Blastomyces dermatitidis gene, which encodes the surface adhesin BAD-1, renders the mutant avirulent.Of the chapters on specific pathogens, the one covering virulence mechanisms in Coccidioides immitis is notable. It discusses application of molecular approaches to identify key proteins expressed during arthroconidial and spherule morphogenesis at each stage of the disease process and to dissect the corresponding interactions with the immune system.


Fibroadenomas and phyllodes tumors may have similar cytological appearances. However, a detailed study of cytomorphology of stromal elements may be helpful in differentiation.To evaluate the cytological features of phyllodes tumor in our study with special reference to features that can help distinguishing it from fibroadenoma.The archival materials of our hospital were searched from January 2006 to January 2009 for histopathologically-diagnosed cases of phyllodes tumor. The cases in which previous cytopathology smears were available were included in the study. The cytomorphology of 10 such cases were compared with 25 cytologically-diagnosed and histopathologically-confirmed cases of fibroadenoma.The size, cellularity of stromal fragments, and the proportion of spindle cells in the background are important features in such differentiation. Phyllodes tumor is a rare fibroepithelial neoplasm accounting for less than 1% of all breast tumors. Thus, th57The archival files of Medical College Hospital were searched from 2006 to 2009 for histopathologically diagnosed cases of phyllodes tumor and 18 such cases were found, of which preoperative FNAC smear were available in 10 cases. The histopathology slides of these 10 cases were retrieved and reviewed to confirm the diagnosis. Only histopathologically confirmed cases of phyllodes tumor were included in the study. There were eight benign, one borderline and one malignant phyllodes tumor. The control group comprised 25 cytologically-diagnosed and histologically-confirmed cases of fibroadenoma. The cytological materials in all cases comprised air-dried May-Grünwald-Giemsa (MGG) stained and alcohol-fixed Papanicolaou-stained smears. The cytologic features of their epithelium and stromal components and the characteristics of the individual stromal cells constituting the background dispersed cell population were evaluated in detail. The epithelial cell clusters were studied for the following features: number of clusters and sheets, and architecture . Stromal fragments were assessed for number of fragments (more than 5 or less than 5), cellularity , presence of atypia in stromal cells, and blood vessels crossing stromal fragments. The background stromal cells were also studied in detail and the cellularity was graded as 1+, 2+, or 3+. The characteristics of the dispersed cells were studied and the percentage of the spindle cells noted. Presence of atypia and the giant cells within the dispersed cell population was also noted.Cytological features assessed for each tumor type are presented in Epithelial features did not vary much between the two tumor groups apart from more abundance of epithelial cells in fibroadenomas. Epithelial hyperplasia was noted in both the groups. The fibroadenomas commonly showed typical branching monolayered sheets of epithelial cells with myoepithelial cells within the clusters, and variable numbers of bare nuclei in the background .The number of stromal fragments varied but was in the lower range compared to phyllodes tumors. The stromal fragments were typically hypocellular with myxoid appearance and poorly-defined margins. However, two of the 25 cases of fibroadenomas showed stromal hypercellularity (3+) and all of these cases were under 20 years of age. On the other hand, the cellularity of stromal fragments as well as the presence of atypia in the stromal cells was found more frequently in the phyllodes tumors. Compared to fibroadenomas, the stromal fragments of phyllodes tumors were larger and hypercellular. The stromal fragments of phyllodes tumor showed well defined borders (6/10) compared to fibroadenomas (7/25).Strands of myxoid material were noted in seven cases of phyllodes tumor (70%). Sixty percent of phyllodes tumor showed 3+ stromal cellularity  and 50% In case of malignant phyllodes, the cytological features of malignancy were distinctly evident . We encoIn the background cellular elements, both fibroadenomas and phyllodes tumors showed predominance of round to oval nuclei. There was marked overlap in the degree of background cellularity in the two groups. However, the number of spindle cells in the background was more in cases of phyllodes tumorsBlood vessels crossing stromal fragments were found rarely in our study  and wereCytological features of phyllodes tumors have been well characterized. Criteria for the diagnosis of benign phyllodes tumor include at least two large stromal fragments, hypercellular fragments and moderate to large number of dissociated stromal cells. Fibroade58104113581011et al.[Scolyer et al. proposedet al. However In our study, we found stromal fragments of phyllodes tumor to be larger and hypercellular with more well-defined borders compared to fragments in fibroadenomas. Hypercellular stromal fragments may also be present in some cases of fibroadenoma. In these cases, the degree of background cellularity, the composition of these cells and the epithelium to stroma ratio may be useful features in differentiation. Studies comparing the cellularity of dispersed stromal cells between phyllodes tumor and fibroadenoma have shown that phyllodes tumor have more 1+ and fewer 2+ cellularity than fibroadenoma and 3+ cellularity was similar in both the groups. In our study, however, we found 3+ cellularity to be more common in phyllodes tumors than fibroadenoma (30% compared to 8%). The importance of spindle cells in the dispersed cell population has been emphasized by some workers,613 and w6Different studies have suggested epithelial features such as folded sheets, blunt sheets may be important in differentiation but in our study no epithelial feature was found useful in this regard. The important cytological feature of borderline and malignant histpathological subgroup of phyllodes tumor is the presence of abundant hypercellular stromal fragments that show variation in nuclear size and shape.13 There The improvements in core biopsy guns and refinements of image-guided techniques for sampling breast lesions have resulted in rapid acceptance of core needle biopsy in the preoperative diagnosis of breast lumps. Whether it should be used in conjunction with FNAC or should replace, it is a matter of debate. But core biopsy in cases of phyllodes tumor definitely helps in better diagnostic accuracy as the hurdle of sampling problem is overcome to some extent by acquiring multiple cores.


Gordon Smith argues for more and better research in screening for pregnancy outcomes, using the example of previous trials in pre-eclampsia. Screening low-risk women for the risk of adverse pregnancy outcome, such as pre-eclampsia, is still largely based on clinical assessment, due to negative trials of new methods.I argue that previous studies have weaknesses in their design and have focused on preterm pre-eclampsia despite the lack of clearly effective interventions to improve outcome.A significant proportion of severe pre-eclampsia occurs at term and could plausibly be prevented by novel screening tests and early term delivery of high-risk women.Novel screening programmes focused on preventing adverse pregnancy outcome at term are also more likely to be translatable into low-income settings, where the majority of maternal and perinatal deaths occur.Complications of pregnancy contribute to a substantial proportion of the global burden of disease Research on the biological pathways that lead to pre-eclampsia focus on the placenta. The current view is that impaired invasion of the maternal uterine resistance vessels by the invading extravillous trophoblast is a key determinant. Trophoblast invasion can be assessed clinically by Doppler flow velocimetry of the uterine arteries A successful screening programme consists of two components. The first is that women at high risk of a disease, or in the early phase of a disease, are identified. The second is that these women are then treated with an intervention that results in a better outcome than if treatment had been initiated when the disease became clinically apparent. A screening programme could, therefore, yield a negative result due either to failure of the screening test or failure of the intervention. A detailed analysis of the literature conducted for the NICE Guideline on Hypertension in Pregnancy demonstrated that, of the many candidate interventions evaluated , only low dose aspirin had been clearly shown to reduce the risk of pre-eclampsia in high-risk women The simplest way to evaluate a screening programme is to randomise women to be screened or not screened. However, an alternative approach is to screen all women and to randomise those who screen positive to the intervention or to having the result concealed see . The secReviewing the trials included in the meta-analysis of screening low-risk women using utero-placental Doppler indicates that all of them randomised women to being screened or not being screened. The power calculation in A key intervention in the management of women with established pre-eclampsia is to deliver the infant, but the effect depends on the gestational age. Routine delivery preterm increases neonatal morbidity without improving maternal outcome http://www.clinicaltrials.gov/ct2/show/NCT01322529) and SCOPE (http://www.scopestudy.net/) only assess screening tests up to 29 and 24 weeks gestational age, respectively.A significant body of work demonstrates that many complications of late pregnancy may be determined in the first trimester On the basis of the above, I propose that the current lack of progress in reducing the burden of morbidity and mortality in relation to pre-eclampsia  may be best addressed by the following approach. 1. High quality non-interventional studies should characterise the screening performance of existing and novel tests in low-risk populations. 2. The gestational age dependence of risk prediction should be assessed. 3. Measurements should be made in all three trimesters, including a late preterm assessment (34–36 weeks). 4. Initial efforts should focus on identifying women at high risk of developing severe disease at term. 5. Screening algorithms for severe disease at term should be evaluated in trials where all women are screened and high-risk women are randomly allocated to having the result revealed with a recommendation for delivery at 37 weeks, or having the result concealed. Such trials would allow proof of principle of both the screening test and the intervention, prior to larger and more expensive trials of screening versus no screening.Globally, approximately 350,000 women die during or shortly after pregnancy, 2.6 million babies are stillborn, and 3.2 million liveborn children die in the first month of life Table S1Sensitivity analyses: effect of study design on sample size with different screening test performance and treatment effects.(DOC)Click here for additional data file.


Bone marrow transplantation is a routine clinical activity offering salvage therapy in a number of hematological diseases and inborn errors. There are two obstacles that may delay or even postpone this curable treatment approach. The first is a lack of matched family donors, which affects up to 75% of patients. In this situation a search for unrelated donors, if successfully completed, makes this approach feasible. HLA genes of five loci  are currently considered as a basis for matching. Each day brings information of new alleles. Genetic typing can lead to detection of diversity at the single nucleotide level. It ensures that a level of matching is achieved resulting in transplant success rates similar to those seen among siblings sharing the same HLA genotype. While we wish to have a perfect match, also important is elapsing time during the search process, which is related to the presence in the patient of rare alleles and unusual B-C, DR-DQ associations. Having a primary typing of a patient we can predict the chance for a proper match. Each day new donors are recruited worldwide. Iterative searching must be applied in the latter situation. In some cases 6 or more potential donors are required to have a donor accepted by a clinician. Finally, a compromise must be reached between the aspiration of matching at the level of 10 alleles and the urgency of transplantation in patients suffering from relapsing disease. To facilitate the decision-making process, modern information technology must be at hand. The search process includes the complete donor pool which is screened for potential donors. The chosen potential donors must be activated for confirmatory typing which includes 5 loci specificities typed at the high resolution level with exchange of information between registries and the hospital iteratively coming to the optimal decision. The process must be reliable, safe, and transparent, and must operate efficiently in real time. The European Marrow Donor Information System (EMDIS), used in many countries worldwide, ensures fulfillment of the above requirements. The present volume illustrates the above points, supporting the rational basis for the decision-making process.NOD2 gene influences inflammatory response to the bacterial cell wall components that may induce advert effects. Both associations discussed in this volume document the significance of environmental factors including infections for the overt clinical manifestation of a primary alloreactive response. Indeed, in another paper in this volume, the associations between bacterial infections, NOD2 gene mutation associated features, and the vigorous immune response involving a proinflammatory T cell subpopulation producing IL-17 in mounting graft-versus-host disease are shown and illustrated. The role of non-genetic factors, useful during the donor-recipient matching process, is described using the example of seropositivity against CMV in donors and recipients. The absence of CMV IgG antibodies in donors constitutes a risk factor of reactivation of this virus and influences the incidence of aGvHD of patients post HSCT. Therefore, biological factors modifying the outcome of HSCT may include HLA and non-HLA genetic variant associated features. Identification of HLA alleles in populations with a genetic background composed of different ancestral gene compositions may depict the prevalent component in the ethnicity. The latter can not only facilitate the search process but also provide some information on the presence of factors modifying the risk of graft-versus-host disease. You can read about that in this volume. Non-HLA genetic factors influencing the natural history of hematological malignancies and also shaping the risk of post-HSCT complications are being investigated by several groups of investigators. Among non-HLA genetic factors, probably killer immunoglobulin-like receptors (KIRs) and factors associated with the NOD2/CARD15 polymorphism have the best reputation for influencing the outcome of HSCT. Described and then consequently typed in alloHSCT patients KIR haplotypes associate with the ability of an individual to mount an immune response. Single-nucleotide polymorphism of the Genetic diversity and non-genetic factors influence the outcome of HSCT, which renders the process of matching a very complex task. To facilitate the final decision it is important to recognize the presence of different factors and then to put them in an order depending on their weights. The present special issue of Bone Marrow Research presenting genetic and non-genetic factors affecting the outcome of HSCT may serve as a complementary tool in the decision-making process while choosing an optimal donor for a given patient. Each pair should be analyzed for the presence or absence of genetic traits or non-genetic characteristics which in a complementary fashion may influence the outcome of HSCT. We hope that the present volume contributes some additional information supporting this notion. Andrzej LangeColette RaffouxBronwen Shaw


The Strait of Gibraltar replenishes the Mediterranean with Atlantic waters through an intense eastward current known as the Atlantic Jet (AJ). The AJ fertilizes the southwestern Mediterranean and is considered to be the ultimate factor responsible for the comparatively high fish production of this region. Here, we perform an analysis of the available historical catches and catch per unit effort (CPUE), together with a long series of surface currents, kinetic energy and chlorophyll concentration. We show that the high kinetic energy of the AJ increases primary production but also negatively impacts the recruitment of anchovy. We contend that anchovy recruitment in the region is inhibited by the advection and dispersion of larvae and post-larvae during periods of strong advection by the AJ. The inhibitory impact of kinetic energy on anchovy landings is not a transient but rather a persistent state of the system. An exceptional combination of events creates an outbreak of this species in the Alboran Sea. These events depend on the Mediterranean-Atlantic exchange of water masses and, therefore, are highly sensitive to climate changes that are projected, though not always negatively, for fish landings. The Alboran Sea  is the door to replenish with Atlantic waters the Mediterranean basin, where evaporation rates and deep outflow cannot be compensated by river discharges and atmospheric precipitations. Replenishment occurs via an intense eastward current, commonly named the Atlantic Jet (AJ), through the Strait of Gibraltar. The persistence and energy of the AJ, with standard velocities of Circulation instabilities manifest as complex meso- and submesoscale processes that fertilize the surface waters of the basin Engraulis encrasicolus) has been the main target species for purse seines since the late 1960 s The elevated primary production of the Alboran Sea should result in potential fish landings that are comparatively high when contrasted to the oligotrophic Mediterranean, particularly for small pelagic species The fish in this area have most likely adapted to the prevailing hydrodynamic regime and narrow shelf. In the Alboran Sea, anchovy spawn from late spring to early autumn at In this paper, we perform an extensive analysis based on the joint signals provided by available historical fisheries records and data from remote sensors for surface currents, kinetic energy (KE), temperature and chlorophyll. Based on this analysis, we conclude that anchovy recruitment in the Alboran Sea is highly linked to the dynamics of the AJ and the associated circulation features in the basin. An anomalous environment results in success rather than failure in recruitment. The standard state of the basin is highly energetic because of the jet. This jet enhances primary production but consistently creates adverse conditions because it advects and disperses the early life-stages of anchovy. Anomalous years with lower levels of kinetic energy result in high recruitment and subsequent landings.The potential connection of this high-recruitment signal with enhanced primary production or a thermal change in the basin is explored in Chlorophyll in the western Alboran Sea is highly sensitive to the circulation of the AJ-WAG system There is no evident connection between proxies for abundance (CPUE) and chlorophyll at the time of spawning .c; , whery power .b; , and catches .d; . MorIn addition to this correlational analysis, a test for one outlier based on a chi-squared distribution of squared differences between the data and sample means The year 2001 stands out in the time series analyzed as a strong outlier in both circulation and anchovy recruitment. No coherent signal is observed in other small-pelagic fisheries like sardine and mackerel  or round sardinella These conditions do not easily occur together in the Alboran Sea. This basin is productive but as a result of the very intense dynamism forced by the AJ. Thus, the fertilization necessary to produce food for early stages is accompanied by strong currents that are able to advect these stages away from the spawning place. The intensity of this egg and larval transport is well known. There are reported cases of advection within the AJ of fish larvae from the north coast toward deep waters south in the basin We postulate that these reported cases and the results presented here reveal the tight control that the AJ exerts over the anchovy recruitment in the Alboran Sea. The field studies of ichthyoplankton in the area demonstrate beyond question the capacity of a strong AJ to sweep neritic larvae from the shelf. This capacity depends on the strength of the AJ-WAG system, as diagnosed in The amount of production during spawning cannot explain the successful recruitment of 2001 because the mean chlorophyll of that year is the lowest of the series . The phyHowever, the trophic environment becomes very adverse in autumn/winter because primary production collapses with the collapse of the AJ-WAG system . Post-lasensu Cury and Roy In summary, we contend here that anchovy recruitment in the region is inhibited by the advection and dispersion of larvae and post-larvae during periods of strong advection by the AJ. Food availability is not the primary limiting factor in the region. During standard years, the intense currents fertilize the region and sustain this anchovy stock but also keep recruitment very low. Exceptional years involve a weakening, but not a total collapse, of the AJ-WAG during spring and summer. This weakening provides adequate food and stability to larvae and postlarvae. The total collapse of the AJ-WAG after summer seems to have a positive effect on recruitment. These exceptional years open an optimal window . Since 1999, the fishery is affected by closures during March and April; thus, the data contain gaps for these months and are excluded from the seasonal analysis.The anchovy recruitment in the North Alboran Sea is strongly dependent on the 0 age-class, and both landings and CPUE are frequently used as abundance proxies in the area , covering the entire Mediterranean Sea and combining information from different missions, significantly improving the estimation of mesoscale signals The ADT data are delayed-time (dt) gridded and merged products with a spatial resolution of The KE is calculated as:To investigate the combined spatial and temporal covariability between ADT data and CHL, an SVD technique was employed http://podaac.jpl.nasa.gov/). We used the 4 km Pathfinder version 5 SST Project, which is a new reanalysis of the earlier AVHRR version of the Pathfinder data set that has been distributed since the early 1990s http://oceancolor.gsfc.nasa.gov). We used the monthly nighttime data with 4 km of spatial resolution for years comprised between 2010 and 2011.The SST data used in this study correspond to AVHRR Ocean Pathfinder SST and MODIS L3 SST http://www.globcolour.info/). This source produces global ocean color maps (Level-3) by merging data since 1998 from the three sensors SeaWiFS, MODIS and MERIS. Surface chlorophyll a data correspond to a product of chlorophyll a case I water based on the GSM merging method Sea surface chlorophyll a data were downloaded from the GlobColour Project (www.cgd.ucar.edu/cas/jhurrell/indices.html) The winter (December through March) index of the NAO is based on the difference of normalized sea level pressure between Lisbon, Portugal, and Stykkishol- mur/Reykjavik, Iceland, since 1864. The NAO index data were provided by the Climate Analysis Section(NCAR) , Click here for additional data file.Figure S2Evolution of the total GRT of purse seiners in the NW Alboran .(TIFF)Click here for additional data file.Figure S3Monthly composites of chlorophyll concentration Click here for additional data file.Figure S4Monthly composites of chlorophyll concentration Click here for additional data file.Figure S5Monthly composites of chlorophyll concentration Click here for additional data file.Figure S6Monthly composites of chlorophyll concentration Click here for additional data file.Figure S7Monthly composites of chlorophyll concentration Click here for additional data file.Figure S8Monthly composites of Sea Surface Temperature Click here for additional data file.Figure S9Monthly composites of Sea Surface Temperature Click here for additional data file.Figure S10Monthly composites of Sea Surface Temperature Click here for additional data file.Figure S11Monthly composites of Sea Surface Temperature Click here for additional data file.Figure S12Monthly composites of Sea Surface Temperature Click here for additional data file.Figure S13http://www.juntadeandalucia.es/agriculturaypesca/idapes/). Black and white circle are anchovy and sardine respectively while the white square is mackerel.Yearly catches of small pelagic fish in the NW Alboran Sea during the last decade (data only reliable since 2000). Source: Andalusian Regional Government IDAPES database ((TIFF)Click here for additional data file.Figure S14Monthly composites of geostrophic circulation and kinetic energy Click here for additional data file.Figure S15Monthly composites of geostrophic circulation and kinetic energy Click here for additional data file.Figure S16Monthly composites of geostrophic circulation and kinetic energy Click here for additional data file.Figure S17Monthly composites of geostrophic circulation and kinetic energy Click here for additional data file.Figure S18Monthly composites of geostrophic circulation and kinetic energy Click here for additional data file.


The population in Northern Uganda has been exposed to extreme levels of traumatic stress and thousands abducted forcibly became rebel combatants.Using structured interviews, the prevalence and severity of posttraumatic stress disorder (PTSD), depression and anxiety was assessed in 72 former abducted adults, 62 of them being former child soldiers.As retrospective reports of exposure to traumatic stress increased, anxiety and PTSD occurrence increased (r = .45). 49% of respondents were diagnosed with PTSD, 70% presented with symptoms of depression, and 59% with those of anxiety. In a multiple linear regression analysis four factors could best explain the development of PTSD symptoms: male respondents (sex) living in an IDP-Camp (location) with a kinship murdered in the war (family members killed in the war) and having experienced a high number of traumatic events (number of traumatic events) were more likely to develop symptoms of PTSD than others. In disagreement to a simple dose-response-effect though, we also observed a negative correlation between the time spent with the rebels and the PTSD symptom level.Former abductees continue to suffer from severe mental ill-health. Adaptation to the living condition of rebels, however, may lower trauma-related mental suffering. Humans are developing in a co-constructive way whereby the biological-genetic interface interacts with the cultural setting to form mind and brain and with it the potential for mental malfunctioning. Traumatic stressors evoke an alarm response, i.e., activate stages in a genetically prepared biological defence mechanism that thus appears in any culture. Research into the neurobiological foundations of traumatic experiences ,2 and daIn the Northern provinces of Uganda, since 1986, there has been a brutal and unrelenting war, led by a rebel army that named itself the Lord's Resistance Army (LRA). For 17 years members of the LRA have killed or mutilated thousands of innocent civilians and a significant proportion of children have been abducted. According to our own surveys in the camps of internally displaced people (IDP) in Gulu and Kitgum districts, nearly every other boy has been abducted, sometimes only for a few days, to help carry the stolen goods to the bush. Through analysing a database of more than 25.000 children who had been registered in a reception centre after returning from captivity, it can be estimated that 25.000 up to 38.000 children have been abducted between 1986 and 2006 with an average abduction time of 342 days . The feaThe majority of IDPs, currently settled in the country's northern emergency camps, has suffered or witnessed at least one, often several, traumatic experiences. The percentage is especially high within the group of formerly abducted children and young adults. Trauma-related illness compromise vital functioning and thus severely interferes with the ability of refugees and forced migrants to cope with the misery in IDP camps and also limits the capability in rebuilding their homes and lives, regaining ownership and dignity .A cross-sectional epidemiological study done by Roberts  among adJudith L. Herman  had defiIn May and June 2005, 72 interviews were performed with formerly abducted persons of the Gulu district in Northern Uganda. A minimum of 17 years of age was required for participation. The medium age was 23.7 years. The sample (n = 72) was recruited from two different locations: 42 respondents  were living at the time of interview in a Reception Centre (RC), having only escaped the rebel movement within the last few weeks. Thirty persons  living in IDP-camps participated in a follow-up program. The participants were randomly selected from a complete list of persons living in the reception centres at the moment of the study and from a list of people who had already returned home to the IDP-camp after leaving the reception centre (former beneficiaries of the reception centres). Almost all participants belonged to the ethnic group of the Acholi (94%) and all completed the full interview.Level of education was significantly lower for women than for men, with a third (32%) of the female sample having no education at all. In contrast, nearly two third of the men (61%) had at least a primary education. Men were abducted significantly more often than women, whereas abduction duration was significantly longer than for girls than for the boys (average of 7.7 years vs. 4.9 years). There was no significant difference between the different interview locations (Reception Centre vs. IDP-Camps) for any of the demographic variables.The questionnaire included a consent form, socio-demographic questions about the person, his/her family, educational level, ethnicity, religion, socioeconomic information, abduction time, trauma experiences, chronic diseases and physical conditions.Traumatic event types were assessed using a checklist consisting of possible non-war related traumatic event types , war related events  and LRA-specific traumatic event types . The checklist was partly taken from the survey "Demography of forced migration" assessed among Sudanese and Ugandan Nationals in the West Nile region ,16 and cPTSD was assessed using an interview Acholi version (Luo language) of the interview form of the Posttraumatic Stress Diagnostic Scale (PDS) . The PDSFor the assessment of depression and anxiety the 25 items from the short version of the "Hopkins Symptom Checklist" (HSCL-25) was used . This scThe questionnaire for this assessment was translated from the original English version into the local language Luo using the blind back-translation method by Flanagan . The iniInformed consent was obtained using a standardised form explaining the potential risk of participation and explaining that no compensation would be provided. Informed consent forms were signed by the interpreters assuring that s/he has read everything to the respondent and s/he did fully understand their rights. No financial incentives were provided and respondents were informed that no improvements in living conditions were to be expected as a result of participating in the survey. The study was approved by the Konstanz University Ethical Review Board and took place in cooperation with the World Vision Reception Centre for children, for men and child mothers.All interviewees had been abducted by LRA rebels and all of them have experienced a series of different traumatic event types,  were diagnosed with PTSD meeting the DSM-IV criteria. Data indicate that the prevalence of PTSD is higher in the IDP camps than when still in the reception centre. Such an effect is not observed for the women  fulfil the criteria for all three ascertained mental health disorders simultaneously.The total amount of trauma event types correlates significantly with the PTSD sum score . Unexpectedly and in contrast to an expected dose- or "building-block"-effect  of exposUsing a multiple linear regression, four factors can best explain the PTSD symptom sum score as dependent variable  resulting from a high number of experienced traumatic events (in average 16.5 traumatic event types per person). The reported atrocities that more than 70% of the interviewees experienced , and the duration respectively the re-occurrence of events. As for the traumatic events experienced by the present sample of this study, the classic definition for complex traumatic events postulated by Judith L. Herman  seems toSurprisingly, the duration spent in abduction is correlating negatively with the sum score of the PTSD symptoms. The longer a person is abducted, the lower the sum score of the symptoms gets, but still within a clinical significant range. One possible explanation would be that those who have greater symptoms are more likely to be killed in the bush, or more likely to escape. While we cannot completely rule out this possibility, it would require that fatalities were even higher than the worst estimates. Obviously, survivors who stayed in the bush have adapted to this life with some resilience against PTSD. This adaptation can be argued as a protective and coping mechanism of denial of ongoing horrifying events. Elbert, Weierstall and Schauer  though hEven though the sample is limited and not representative for the population of Northern Uganda, it can be shown that children in Northern Uganda - at the time of abduction (mean age of first abduction: 14 years), now youth and young adults (mean age at time of interview: 24 years) - are like other children, youth and adults living in war affected areas are highly affected by the mental health consequences resulting from their violent, cruel and life-threatening traumatic experiences during the war. The psychological suffering of productive symptoms like acted-out flashbacks and active avoidance or "quiet" symptoms like intruding memories or feelings of loneliness thus leads to dysfunctional behaviour in daily routine tasks, social life and work/scholastic life . Therefore they are in need of mental health interventions to relieve them from their suffering and make them functional again for their personal daily life tasks as well as in the interest of a society trying to recover from years of insurgencies.As an interesting tendency that this study's result have shown is the decrease of posttraumatic stress symptoms after a longer time spent in the bush. Although other studies have not found this negative relationship  - as thiThe authors declare that they have no competing interests.AP designed the study, collected the data, performed the statistical analyses and drafted the manuscript. TE supervised the design of the study and the work. All authors participated in revising the manuscript, and have read and approved the final version.


The increasing aridity during the Last Glacial Maximum (LGM) has been proposed as a major factor affecting Neotropical species. The character and intensity of this change, however, remains the subject of ongoing debate. This review proposes an approach to test contrasting paleoecological hypotheses by way of their expected demographic and genetic effects on Neotropical cloud forest species. We reviewed 48 paleoecological records encompassing the LGM in the Neotropics. The records show contrasting evidence regarding the changes in precipitation during this period. Some regions remained fairly moist and others had a significantly reduced precipitation. Many paleoecological records within the same region show apparently conflicting evidence on precipitation and forest stability. From these data, we propose and outline two demographic/genetic scenarios for cloud forests species based on opposite precipitation regimes: the dry refugia and the moist forests hypotheses. We searched for studies dealing with the population genetic structure of cloud forest and other montane taxa and compared their results with the proposed models. To date, the few available molecular studies show insufficient genetic evidence on the predominance of glacial aridity in the Neotropics. In order to disentangle the climatic history of the Neotropics, the present study calls for a general multi-disciplinary approach to conduct future phylogeographic studies. Given the contradictory paleoecological information, population genetic data on Neotropical cloud forest species should be used to explicitly test the genetic consequences of competing paleoecological models. The Pleistocene glacial periods have been regarded as major factors influencing the geographical distribution, demographic dynamics, and patterns of genetic diversity of species , using the following search terms combinations: cloud forests* AND phylogeography*. This resulted in only two studies dealing with plant species, both in Mexico and upper Central America. Given the paucity of information, we included other relevant studies for Neotropical montane forest taxa in the discussion.In the last section, we searched for relevant articles dealing with the intra-specific phylogeography of cloud forest taxa on the Web of Knowledge database . Many of these taxa, particularly those from cloud forests, probably inhabited areas of wet microclimates immersed in a matrix of dry conditions  were growing 500–800 m lower than their present range.It has been suggested that the summer precipitation regime was collapsed, resulting in arid conditions extending over much of Mexico, Central America, and the Caribbean  increased in abundance at lower elevations over cooler periods, suggesting stable humidity conditions. However, González et al. , which were subsequently displaced upslope during the Holocene and are today largely absent around Lake Consuelo. Taken together, these records show an expansion of montane taxa into lower elevations during the LGM. This is taken as evidence of prevailing cool and moist conditions in the region.The montane forests around Lake Pacucha (southern Peru) were replaced by grassland vegetation  and the inferred moist conditions have been confirmed by the high percentage of fresh water diatoms and low levels of carbonates in sediment cores from Lake Titicaca, Peru  and others had a significantly reduced precipitation . This is not surprising given the complex nature of the atmospheric-oceanic circulation system over the Neotropics  has been used to describe geographical patterns of genetic diversity. Nevertheless, the use of multiple genetic markers from different genomes would be advantageous to evaluate distinct attributes of the genetic structure and diversity of populations. In all cases, marker resolution would be the limiting factor when studying the demographic history of species. The choice of markers should be done bearing in mind relevant attributes of the molecular dynamics of distinct markers in particular taxa .For the cloud forests, still there are virtually no genetic data for testing the above predictions  in cloud forests of Mexico and upper Central America. Their results appear to support the dry refugia hypothesis and its demographic consequences. The authors found a high genetic differentiation among populations and several common alleles with widespread distributions in distinct regions. In this context, the different common alleles are present in populations located around Toledo's , a species inhabiting cloud forests in Mexico and upper Central America. There was significantly high population differentiation between populations within Toledo's  in Mexico and upper Central America. B. nelumbiifolia is a moist-adapted species living in altitudes from 70 to 1200 m, whereas B. heracleifolia is adapted to more seasonal conditions with an altitude range of 300-1700 m  and nuclear DNA (nDNA) lineages occupying separate mountain ranges. In this respect, the authors claim that populations from distinct mountain ranges were continually isolated during cold periods, including the LGM, as a result of enhanced dryness. The authors performed several demographic tests with inconsistent results, but in general there are no signs of population changes during the last glacial period. In conclusion, Barker et al. , the Atlantic tree rat (Phyllomis pattoni), lizards (Gymnodactylus darwinii), and the three-toed sloth (Bradypus variegatus). In the case of B. variegatus and G. darwinii, the authors observed higher levels of genetic diversity in inferred refugial populations than in populations outside refugia. In addition, these two species showed evidence of population expansions in accordance with the postulated history of refugia. Carnaval and Moritz , pitivers (Bothrops), the lesser wood creeper (Xyphorynchus fuscus), vampire bat (Desmodus rotundus), and frogs . Accordingly, de Mello-Martins  in eastern South America, a species confined to seasonally dry tropical forests (Caetano et al. The direct test of the refugia theory has also been applied for seasonally dry tropical forests (Caetano et al. It is clear that further genetic analyses are needed to establish the validity of the refugia hypothesis for cloud forests species. The inconsistency between studies can be the result of a differential response of species to climate change. The congruence among the inferred glacial dynamics of different species may be dependent on their distribution, ecology, or phylogenetic relationship. However, this inconsistency can also be the result of the difference in the analytical framework of distinct studies.In this respect, the few molecular studies show little refinement in explicitly testing the genetic expectations of the dry refugia model and thus provide ambiguous evidence regarding the effect of widespread aridity on cloud forest taxa. Most of these studies do not incorporate available paleoecological data in their discussions. So far, the most detailed tests of the dry refugia model have relied on the direct comparison of the geographical location of proposed refugia and genetic data. Although valuable, the direct geographical inspection of proposed refugia is by itself inconclusive because these proposals are based on limited and inaccurate paleoecological data. This highlights the difficulty in pinpointing the exact location of former refugia without incorporating sufficient paleoecological data in phylogeographic studies.The above discussion focuses on the genetic outcomes of the last glacial period and in doing so assumes that the genetic imprints of this period have overridden the effects of past glaciations. As observed in these studies, it is highly probable that the genetic divergence of many species pre-dates the last glacial period. However, the demographic events accompanying the LGM would have affected the distribution and frequency of mutations that occurred in the more distant past.The present study is not an exhaustive review of the literature. This review is intended to highlight the need of a general framework for conducting future studies on Neotropical phylogeography . DependiThe climatic history of the Neotropics might be more complicated than stated herein. We are aware that other hypotheses might be more fitting to the data (e.g., microrefugia; Rull Further genetic studies should deal with co-distributed species, in particular those living within ecologically narrow forest communities, such as cloud forests. This might prove useful in uncovering general ecological response patterns of species to climate change, particularly precipitation. There is need of detailed molecular studies of Neotropical cloud forest taxa that include species with distinct ecologies and that represent different lineages. A first requirement would be to undertake broad scale latitudinal and altitudinal surveys and test them against paleoecological data. This can provide evidence of multiple refugial lineages and diversity gradients. If there is evidence of refugia, studies on the genetic structure can be conducted on finer spatial scales to evaluate the location and extent of these forest refugia. On a wider level, comparative research across species from different biomes, such as seasonally dry forests and deserts, is needed to determine the universality of the refugia hypothesis.


This study aims to better understand the evolutionary processes allowing species coexistence in eusocial insect communities. We develop a mathematical model that applies adaptive dynamics theory to the evolutionary dynamics of eusocial insects, focusing on the colony as the unit of selection. The model links long-term evolutionary processes to ecological interactions among colonies and seasonal worker production within the colony. Colony population dynamics is defined by both worker production and colony reproduction. Random mutations occur in strategies, and mutant colonies enter the community. The interactions of colonies at the ecological timescale drive the evolution of strategies at the evolutionary timescale by natural selection. This model is used to study two specific traits in ants: worker body size and the degree of collective foraging. For both traits, trade-offs in competitive ability and other fitness components allows to determine conditions in which selection becomes disruptive. Our results illustrate that asymmetric competition underpins diversity in ant communities. A fundamental challenge in community ecology is to understand the mechanisms allowing species coexistence Trade-offs are frequently invoked to explain species coexistence Adaptive dynamics theory The challenge of modeling social insect colony fitness was first taken up by Macevicz and Oster In ant communities, coexisting species display differences in morphology and foraging behavior. However, the factors underpinning the evolutionary processes that drive such trait differentiation are poorly understood. The goals of the current paper are to: i/propose a theoretical model that would enable the identification of the factors allowing the emergence and maintenance of diversity in ant communities, and ii/use this model to study the diversity of both foraging strategies and worker body sizes. The model links colony population dynamics to evolutionary processes by applying the adaptive dynamics framework to ants. The basic idea stems from the model of Macevicz and Oster We propose an adaptive dynamics model of the phenotypic evolution of eusocial insects. This model is limited to clonal reproduction. Phenotypic variation stems from mutations. Mutations are assumed to be rare so that population dynamics attains its population dynamical attractor between mutation events.x. Each colony of eusocial insects represents an individual. Colony abundance is denoted by q (q for queen). Colony’s size (i.e. the number of workers within colonies) is designated as w (w for worker). The demography of population q (i.e. the number of colonies) depends on the interactions of the colonies with their surrounding environment. As the interacting agents are the workers, the colony growth rate depends on the number of workers per colony. Let the function t), whereas within colony dynamics, i.e. that of the worker population We considered a community composed of a single monomorphic population characterized by a quantitative scalar trait The dynamics of the community is described by the system . The resident-mutant community varied at the ecological timescale according to the population dynamics specified by system (RM). The within-colony dynamics was set to be 100 times faster than the colony dynamics. Strategies whose abundance dropped below a threshold  is maximized by medium sized worker  is strong relative to inter-specific competition, the initially monomorphic community becomes polymorphic, with different degrees of collective foraging coexisting. Regardless of the ancestral strategy, foraging evolves to become collective. However, when all colonies adopt this strategy, selection becomes disruptive, and negative frequency-dependent selection favors the appearance of divergent strategies. The stable community composition at the end of the evolutionary process depends on the strength of competition. Generally, the stronger the effect of competition, the higher the number of coexisting strategies. Furthermore, in environments in which collective foraging does not afford a distinct advantage in exploiting food resources, coexisting strategies might vary from completely individual to highly collective, as occurs in some Mediterranean ant communities that include foraging strategies such as individual foraging, tandem running, group recruitment, and mass recruitment Many studies on the optimality of collective foraging behavior agree on the importance of the number of individuals and conclude that collective foraging is optimal for large colonies Both examples presented emphasize the importance of competitive trade-offs for the emergence and coexistence of different strategies within the same community. Trade-offs between competitive abilities and other fitness components such as mortality This study focuses on social insects and considers the colony to be the unit of selection. Natural selection is modeled by assuming that the fitness of colonies depends explicitly on the energy accumulated by workers. This approach could be extended to the study of evolutionary processes in other social systems that comply with the following assumptions: i/reproduction can be represented as being carried out by a collective entity; ii/the reproduction of this collective entity occurs at a much slower rate than the production of its interacting agents.File S1The implicit function theorem applied to workers production allows to explicit analytical expressions of the partial derivatives of worker equilibrium.(PDF)Click here for additional data file.


Complications of restenosis or dilatation at the site of repair may occur late after initial repair of coarctation of the aorta (CoA). Cardiovascular magnetic resonance (CMR) is becoming the choice of imaging of patients after CoA. Using CMR, we studied the relation between these complications and outcome inn patients with previous CoA repair, and found that significant stenosis or dilatation at the repair site is a predictor of adverse outcome.Cardiovascular magnetic resonance (CMR) is becoming the method of choice for assessing repaired CoA patients, especially for identifying important long-term sequelae of restenosis or dilatation at the repair site. We examined the prevalence of restenosis and dilatation at the site of aortic coarctation (CoA) repair and their relation to long-term outcome in patients with repaired CoA.Data and imaging for adult CoA patients followed in our institution were analysed. CMR images of the aorta were studied, and the diameter of the aorta at the repair site was measured on CMR and its ratio to the aortic diameter at the diaphragm  calculated. Significant restenosis was defined as RDR≤50% and dilatation as RDR>150%. The relation of the CMR findings to the combined endpoint of death, stroke, surgery, intervention or escalation of antihypertensive therapy was assessed using Cox analysis.A total of 247 patients  were studied. Significant restenosis was present in 9.3% of patients, while 12.6% had significant dilatation. A discrete aneurysm at the repair site was observed in 8.5%. Restenosis was more likely in end-end anastomosis repairs and dilatation in patch repairs. Patients with restenosis were at higher risk of the combined endpoint , as were patients with dilatation . Hypertension was a significant predictor of outcome, even after exclusion of the “escalation of antihypertensive treatment” component .Restenosis or dilatation at the CoA repair site as assessed by CMR is a predictor of adverse outcome.This study did not have any supporting funding.


Derwent House is a government funded pilot treatment day program within an established eating disorder service that commenced operation in 2010. It is run by a multidisciplinary team of clinical psychologists, dietitians and an occupational therapist. The program is based on a cognitive behaviour therapy framework with patients attending four days per week. Admission lengths range from four to twelve weeks depending on their individual treatment plan. Fifty patients completed outcome measures at admission, discharge, six and twelve month follow-up. Measures collected included the Eating Disorder Examination Questionnaire; the Eating Attitudes Test; the Depression, Anxiety and Stress Scale; the Eating Disorder Quality of Life instrument; the Intuitive Eating Scale; the Rosenberg Self-Esteem Scale; and the Anorexia/Bulimia Stages of Change Questionnaires. The data has been analysed using hierarchical linear modelling. Findings suggested that this intervention was effective in reducing eating disorder symptoms. Results on the short and long-term treatment effectiveness of the day program will be presented.Adult Treatment and Services stream of the 2013 ANZAED Conference.This abstract was presented in the