New fossils from Kromdraai and Drimolen, South Africa, and their distinctiveness among Paranthropus robustus.

Most fossil hominin species are sampled with spatial, temporal or anatomical biases that can hinder assessments of their paleodiversity, and may not yield genuine evolutionary signals. We use new fossils from the Kromdraai (Unit P) and Drimolen sites (South Africa) to provide insights into the paleodiversity of the Lower Pleistocene robust australopith, Paranthropus robustus. Our focus is the morphology of the temporal bone and the relationships between size and shape (allometry) of the semi-circular canals (SCC), an aspect that has not yet been investigated among southern African australopiths. We find significant size and shape SCC differences between P. robustus from Kromdraai, Drimolen and Swartkrans. This site-related variation is consistent with other differences observed on the temporal bone. P. robustus from Kromdraai Unit P is distinctive because of its smaller temporal bone and SCC, and its proportionally less developed posterior SCC, independently of age and sex. We emphasize the importance of allometry to interpret paleodiversity in P. robustus as either the consequence of differences in body size, or as yet unknown factors. Some features of the inner ear of P. robustus represent directional selection soon after its origin, whereas the size and shape variations described here may result from evolutionary changes.

Cochlear shape distinguishes southern African early hominin taxa with unique auditory ecologies.

Insights into potential differences among the bony labyrinths of Plio-Pleistocene hominins may inform their evolutionary histories and sensory ecologies. We use four recently-discovered bony labyrinths from the site of Kromdraai to significantly expand the sample for Paranthropus robustus. Diffeomorphometry, which provides detailed information about cochlear shape, reveals size-independent differences in cochlear shape between P. robustus and Australopithecus africanus that exceed those among modern humans and the African apes. The cochlea of P. robustus is distinctive and relatively invariant, whereas cochlear shape in A. africanus is more variable, resembles that of early Homo, and shows a degree of morphological polymorphism comparable to that evinced by modern species. The curvature of the P. robustus cochlea is uniquely derived and is consistent with enhanced sensitivity to low-frequency sounds. Combined with evidence for selection, our findings suggest that sound perception shaped distinct ecological adaptations among southern African early hominins.

The foot of Homo naledi.

Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.

The Bolton Treovance abdominal stent-graft: European clinical trial design.

Endovascular aortic repair (EVAR) has emerged as a promising, less invasive alternative to conventional open surgery for the treatment of infrarenal abdominal aortic aneurysms (AAAs). In the last 20 years, the application rate of EVAR and its clinical results have significantly improved thanks to the evolution of stent-grafts and endovascular delivery systems. However, further development is still needed to reduce the incidence of complications and secondary re-interventions. The Treovance abdominal aortic stent-graft (Bolton Medical, Barcelona, Spain) is a new-generation endovascular device, developed to increase flexibility, lower profile, improve deployment and sealing mechanisms. In particular, it is provided with some innovative features as a double layer of proximal barbs (suprarenal and infrarenal) for supplemental fixation, dull barbs between modules to avoid potential leg disconnections, detachable outer sheath provided with a new-design hemostatic valve, and a double improved mechanism (slow motion and "pin and pull") for precise stent-graft deployment. A European prospective, non-randomized, multi-institutional, "first-in-human" trial (the ADVANCE trial) was conducted from March to December 2011 to assess the safety and performance of the Treovance stent-graft system before commercialization. Thirty patients with anatomically suitable non-ruptured AAAs were enrolled at five clinical sites in Italy, Spain, and Germany. EVAR was completed successfully in all patients. The stent-graft was delivered and deployed safely even in heavily angulated or calcified anatomies. No 30-day device-related complications nor deaths were observed. Preliminary experience with the Treovance abdominal stent-graft within the ADVANCE trial was satisfactory with regard to technical success and perioperative clinical results. Follow-up data are needed to assess mid- and long-term clinical outcomes, along with durability of this new-generation endovascular device.

[Results of endovascular repair of TAAA in the first 50  patients]. / Bericht über die ersten 50 endovaskulären thorako-abdominellen Behandlungen mit Seitenarmprothesen.

BACKGROUND: Developments with fenestrated and branched stent grafts have opened the way to treat complex aortic aneurysms involving the visceral arteries. First reports on endovascular treatment of thoracoabdominal aneurysms have demonstrated the feasibility of the technique. METHODS: A literature review and results of first 50  patients treated with a custom-made Zenith device with fixed branches are presented. Most of the patients were refused open surgery mainly for the extent of the disease combined with co-morbidity, which included in most patients a combination of several risk factors. Mean aneurysm size was 71 mm and extent of the aneurysm was type  I (n = 9), type  II (n = 13), type  III (n = 19), and type  IV (n = 9), respectively. RESULTS: Primary and primary assisted technical successes in our series were 88 % (44 / 50) and 92 % (46 / 50), respectively. One patient died on day  1 from an intraoperative aneurysm rupture. In two patients a renal artery was lost, one due to rupture and one due to malpositioning of the bridging stent graft. In a fourth patient, a celiac artery could not be catheterised and was lost. Finally, in two more patients, catheterisation of in total three renal arteries proved impossible. This was solved by a retrograde approach for two renal arteries via laparotomy in one patient, and a spleno-renal bypass in the other patient. Thirty-day mortality was 8 %. Estimated survival at 6  months, 1  year, and 2  years was 91.2 %, 79.8 %, and 69.7 %, respectively. Freedom of reintervention of all kinds at 1 and 2  years was 81.9 % and 73.7 %, respectively. CONCLUSION: Results of fully endovascular repair of thoracoabdominal aneurysms in a high-risk cohort are promising. A learning curve should be expected. Although longer term results need to be awaited, it is likely that endovascular repair of thoracoabdominal aneurysms will become a preferential treatment option for many patients in the future.

Thoraco-abdominal aortic aneurysm branched repair.

Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneurysms initially required an undilated portion of the aorta below the renal arteries to safely fixate the stent-graft. More complex abdominal artic aneurysms (i.e., short-necked, juxta- and suprarenal aneurysms) were later successfully treated with fenestrated grafts. The development of branched grafts opened the way to treat thoraco-abdominal aneurysms endovascularly. In this review, a comprehensive overview of technical aspects and results of the available literature is given. Mortality rates are below 10%, with spinal cord ischemia reported between 2.7% and 20%. Target vessel branch patency invariably has been reported between 95% and 100%, with first mid-term results demonstrating evidence for durability. Most series included high-risk patients, who were denied open repair. Nevertheless, risks associated with endovascular repair of thoraco-abdominal aneurysm should be acknowledged. Technique-specific complications including perforation of small vessels due to multiple catheterization resulting in retroperitoneal hematoma, and compartment syndrome of the lower limbs should be mentioned. Technical evolution of branched grafts is ongoing. Tapering down the main graft to allow for room for the branches has resulted in easier catheterization of target vessels and insertion of bridging stent-grafts. For the same reason, the branches for celiac artery and superior mesenteric artery are deliberately off-set in position. To stabilise the usually long devices, additional spiral wires have been added, to facilitate deployment in the correct orientation. Endovascular repair of thoraco-abdominal aneurysms will continue to evolve and gradually take over from open repair, in view of the much lower physical impact on the patient.

[Analysis of quality of endovascular treatment of thoracic aortic diseases]. / Qualitätsanalysen in der endovaskulären Therapie thorakaler Aortenerkrankungen.

In contrast to the uniform aneurysms of the infrarenal abdominal aorta endovascular therapy in the thoracic aorta deals with diverse aortic pathologies, which can be broadly grouped into aneurysms, dissections, traumatic ruptures and pseudoaneurysms. Further emergency situations such as free or contained rupture, impending rupture, aorto-bronchial fistula or malperfusion in acute dissections determine endovascular therapy, which is often considered the last therapeutic option in these situations. In this article published studies with relevant numbers of cases and our own results are analyzed. Especially regarding 30-day mortality marked differences are found between controlled multicenter studies, multicenter registries and single center studies due to differing study design and exclusion criteria. Depending on the proportion of emergency cases, 30-day mortality of between 5 and 13% is a clinical reality in thoracic stent grafting. The incidence of spinal cord ischemia is between 2 and 9% and incidence of perioperative stroke between 2 and 5%. To establish quality standards more data differentiated between the different aortic pathologies, emergency situations and sites of implantation are mandatory.

Early clinical experience with the E-vita thoracic stent-graft system: a single center study.

AIM: The aim of this study was to evaluate the safety and efficacy of a new endovascular thoracic stent-graft, which was designed to overcome the restrictions of previously used stent-grafts. METHODS: Between May 2004 and March 2008 a prospective evaluation was conducted in 126 consecutive patients (71% men; age 64 [19-86] years). A total of 138 implantations were performed. E-vita stent-grafts were implanted for type-B dissection (N.=56), degenerative aneurysm (N.=25), penetrating aortic ulcer (N.=17), blunt traumatic lesions (N.=10), mobile atheroma (N.=1), suture aneurysms (N.=7) and revisionary surgery following previous endograft implantation (N.=22). All patients eligible for stent-grafting were treated with this system regardless of their clinical status and aortic pathology. The percentage of emergency procedures was 52% (N.=72). Per implantation a mean of 1.3 segments was implanted with an effective total covered length of the aorta of mean 204 mm, median 230 mm (0-450 mm). In 32 of 39 cases with more than one segment, the entire descending aorta was included in the procedure. RESULTS: The 30-day mortality rate was 12.3% (17 patients). All deaths but one were in the group of emergency surgery patients. This results in mortality of 1.5% in the elective and 22% in the emergency procedures. Reversible procedure-induced spinal cord ischemia was observed in 2 cases. Stroke occurred in 2.8% (4 patients). Primary technical success was rated at 77 % (106 procedures) and secondary success at 89 % (124 procedures). CONCLUSION: All forms of thoracic aortic disease can be treated with this new stent-graft. It has proved particularly valuable in cases of difficult conditions in the aortic arch and extended aneurysms. In particular, it is possible to cover the entire thoracic aorta with two or three stent-graft segments, thus considerably reducing the number of connections.

[Stent-graft implantation in the thoracic aorta. Results of an interdisciplinary survey in Germany]. / Thorakale Aorten-Stentgraftimplantation. Ergebnisse einer interdisziplinären Umfrage in Deutschland.

BACKGROUND AND OBJECTIVE: Endovascular stent-graft placement is emerging as a novel therapeutic option in patients with disease of the descending thoracic aorta. Quality standards for performing stent-graft procedures as well as for pre- and postoperative patient management are lacking, so far. It was the aim of this present survey to assess the current therapeutic standard of thoracic aortic stent-graft placement in Germany. METHODS: In a nationwide survey, a total of 206 vascular surgical, radiologic, cardiologic, and cardiothoracic surgical departments were contacted. Data concerning preoperative procedure planning, logistics, practical/technical issues of stent-graft placement, and postoperative patient management were evaluated using a standardized questionnaire comprising 29 items. Data analysis was performed using univariate analysis. RESULTS: 184 (89.3 %) of the 206 departments participated in the survey. Of these, 71 centers reported intending to perform or having performed thoracic aortic stent-graft placement. The survey overall represents 2267 endovascular stent-graft procedures performed in Germany between 1997/98 and 2003. On average, 7.4 stent-graft procedures/year were performed by each center, with half the centers performing fewer than 5 procedures/year. Thoracic aortic aneurysms was the main indication for endovascular stent-graft placement, followed by aortic dissection. There were significant differences between the different medical specialties which perform stent-graft procedures with respect to indications, choice of preoperative and intraoperative imaging methods, and technical equipment. There was strong agreement between the different centers concerning the necessity of a life-long follow-up after stent-graft placement, with computed tomography being the preferred imaging technique (90 % of centers). CONCLUSION: The present survey documents an increasing use of endovascular stent-graft placement in patients with disease of the descending thoracic aorta. There were differences regarding the technical execution of this procedures between specialties with respect to indication, procedure planning, and practical-technical aspects of stent-graft placement.

Hominin first metatarsals (SKX 5017 and SK 1813) from Swartkrans: a morphometric analysis.

Two hominin metatarsals from Swartkrans, SKX 5017 and SK 1813, have been reported by Susman and Brain [1988. New first metatarsal (SKX 5017) from Swartkrans and the gait of Paranthropus robustus. Am. J. Phys. Anthropol. 79, 451-454] and Susman and de Ruiter [2004. New hominin first metatarsal (SK 1813) from Swartkrans. J. Hum. Evol. 47, 171-181]. They found these bones to have both primitive and derived traits indicating that, while being bipedal, these hominines had a unique toe-off mechanism. We have undertaken additional multivariate morphometric analyses, comparing the fossils to the first metatarsals of modern humans and extant apes. The largest proportion of discrimination lies in the different locomotor functions: apes on the one hand and the humans and fossils on the other. While the fossils have the closest affinity to humans, they have a unique biomechanical pattern suggesting a more facultative form of bipedalism. The implications of this are, while morphometric analyses do not necessarily directly capture the described primitive and derived traits, the associated functional pattern is held within the broader morphology of the bone.

Photoendocrine signal transduction in pineal photoreceptors of the trout. Role of cGMP and nitric oxide.

This study describes the presence and distribution of cGMP-immunoreactivity and of the nitric oxide (NO) synthesizing enzyme, NO synthase (NOS), as demonstrated by use of the NADPH-diaphorase technique in directly light sensitive pineal organ of the trout. Cyclic GMP immunohistochemistry revealed immunoreactivity in pineal photoreceptor cells that were identified by double-labeling with S-antigen, whereas NADPH-positive structures were located adjacent to these photoreceptor cells. Since NO is known to stimulate synthesis of cGMP, these results indicate a role for NO in pineal function, e.g. in cGMP related events in the phototransduction process as well as in the light-dark control of melatonin synthesis.

[Diagnosis of the abdominal vascular system by means of electron-beam computed tomography (EBT)]. / Diagnostik des abdominellen Gefässsystems mit der Elektronenstrahlcomputertomographie (EBT).

PURPOSE: To evaluate the potential of electron-beam computed tomography (EBT) in the pre- and postinterventional assessment of vascular abdominal pathologies. MATERIAL AND METHODS: Forty patients with implanted transjugular portosystemic shunt (TIPS), 12 patients with peripheral arterial occlusive disease and 8 patients with infrarenal abdominal aortic aneurysm after endovascular implantation of bifurcation stents were prospectively examined with contrast-enhanced EBT during one year. The evaluation included analysis of time-density curves (TDC) and 3D reconstructions. Results were compared with Doppler sonography and/or DSA. RESULTS: In 30 of 40 TIPS patients, identical results were found with EBT, Doppler sonography and/or DSA. Reduced perfusions of the TIPS, which were subsequently confirmed by DSA, could not be shown with EBT in 3 patients. Nine of 12 patients with peripheral arterial occlusive disease and angiographically proven stenosis (> 75%) showed a reduced and delayed peak density of the time-density curves. The quantification of arterial stenosis, however, did not follow the angiographic values. In all patients with the implanted bifurcation stents, EBT could correctly exclude a leakage of the stent. CONCLUSION: EBT has certain advantages over conventional spiral CT in the evaluation of abdominal vascular pathologies due to the additional assessment of perfusion parameters. Clinical indications for the use of EBT are seen especially in the postinterventional follow-up of patients with implanted stents.

[Endovascular reconstruction of the infrarenal abdominal aortic aneurysm--experiences with 3 endovascular stent prosthesis systems]. / Endovaskuläre Rekonstruktion des infrarenalen Bauchaortenaneurysmas (BAA)--Erfahrungen mit 3 Systemen endovaskulärer Stentprothesen.

Seventeen patients were treated with endovascular stent grafts for AAA (seven Stentor, two Vanguard, three Talent and three EVT grafts). Intraoperative conversion to open procedure was necessary in three cases. One patient had open operation 24 h postoperatively for graft thrombosis. All patients had uneventful recovery. During follow-up (1-35 months) nine patients did not require reintervention. One patient had open repair for persistent endoleak: within 2 months postoperatively one midgraft endoleak, one graft limb thrombosis and one groin infection were treated. We did not observe any late complications.