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Applying the phylogenetic species concept and the sexual selection theory we have reviewed some natal aspects of incipient species and their accelerated evolution. How can we recognise early stages of divergence? Which selection pressures are at work during speciation? Which pathways accelerate the speed of speciation? Which kinds of trait variabilities makes difficult to find initial split criteria? Elaborating the principles of Fine Structure Analysis (FSA) and the morphological Initial Split Criteria (ISP) it was discovered that the European spring dwelling caddisfly Potamophylax nigricornis doesn’tbelong to a single species. It represents an entire species group with seventeen peripatric species evolving on the southernperipheries of the distributional area. Four new species subgroups have been erected: Potamophylax nigricornis new species subgroup, P. elegantulus new species subgroup, P. horgos new species subgroup, P. simas new species subgroup. Eleven new species have been described: Potamophylax apados sp. nov., P. fules sp. nov., P. fureses sp. nov., P. hasas sp. novov., P. horgos sp. nov., P. kethas sp. nov., P. lemezes sp. nov., P. peremes sp. nov., P. simas sp. nov., P. tuskes sp. nov., P. ureges sp. nov. One Potamophylax sp. nov. has been differentiated and three new species status have been documented:Potamophylax elegantulus (Klapálek) stat. n., P. mista (Navás) stat. nov., P. testaceus (Zetterstedt) stat. nov.

Magnus Sundbom,1 Per Hellstrom,2 Wilhelm Graf1 1Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; 2Department of Medical Sciences, Uppsala University, Uppsala, SwedenCorrespondence: Magnus SundbomDepartment of Surgical Sciences, Entrance 78, University Hospital, Uppsala, SE-751 83, SwedenEmail magnus.sundbom@surgsci.uu.seBackground: Due to declining student ratings, a new teaching method was applied to a course in gastrointestinal diseases for undergraduate medical students. Problem-based learning was replaced with our new concept, consisting of a theory week with traditional lectures and case seminars.Methods: In this retrospective study, we compared student-ratings from the problem-based learning era to a new hybrid concept. The students evaluated the concepts by rating (1– 6, 6 = best) nine different subject areas. Additional free text comments were possible. Teachers working with both concepts did likewise. Statistical differences between the two periods were studied by Mann Whitney U-test.Results: The study group consisted 621 students (57% females, total response rate of 52%). Scores for lectures (4.9 vs.3.8) and teaching stimulation and feedback (4.6 vs 3.6, and 3.7 vs 3.4, respectively), and to what extent the contents reflected learning goals (5.2 vs 4.3, p< 0.05 for all) were instantly improved, which also prevailed in the following semesters. At the end of the study period, a significant improvement in case seminars (4.8 vs 4.3) and practical training (4.9 vs 3.8, p< 0.05 for both) was seen. Free text answers revealed that the students felt more prepared for their clinical rotation. Teachers rated the new hybrid concept higher (4.7 vs 3.5, p< 0.05) and especially praised the new lectures.Conclusion: The new learning concept resulted in both improved student-ratings and more satisfied teachers. We believe that the hybrid concept, combining lectures and case-seminars, facilitated learning and improved the learning climate. The subsequent uninterrupted practical training also received improved scores.Keywords: lectures, undergraduate, medical student, curriculum, case-based learning, problem-based learning

Author(s): EPICA Community Members; EPICA Community Members; C. Barbante [1, 2]; J.-M. Barnola [3]; S. Becagli [4]; J. Beer [5]; M. Bigler [6, 7]; C. Boutron [3]; T. Blunier [6]; [...]

Background Several different procedures have been described for surgical treatment of rectal prolapse and consensus on the optimal approach has not been reached. The Swedish Rectal Prolapse Trial was performed with the aim to compare the outcomes after the most common surgical approaches to rectal prolapse. Method A multicentre randomized trial was conducted from 2000 to 2009. Patients were randomized between a perineal or an abdominal approach for correction of rectal prolapse (randomization A) if eligible for any procedures. Patients considered unsuitable for random allocation were only included in randomizations B or C. Patients in randomization B (perineal group) were randomized to Delorme's or Altemeier's procedures and those in randomization C (abdominal group) to suture rectopexy or resection rectopexy. Primary outcomes were bowel function and quality of life, measured using Wexner incontinence score and RAND-36, and secondary outcomes were complications and recurrence at 3 years. Results During the study period, 134 patients were randomized: 18 in randomization A group, 80 in randomization B group and 54 in randomization C group; of these, 122 patients underwent surgery. Mean follow-up was 2.6 years. Improvements in Wexner and RAND-36 scores were seen but with no significant difference between the groups. Health change scores were significantly improved from baseline up to 1 year after surgery (P < 0.001). At 3 years, recurrence rates were two of seven patients for abdominal versus five of eight patients for perineal approach (P = 0.315), 18 of 31 patients (58 per cent) for Delorme's versus 15 of 30 patients (50 per cent) for Altemeier's (P = 0.611) and four of 19 patients (21 per cent) for suture rectopexy versus two of 21 patients (10 per cent) for resection rectopexy (P = 0.398). There were no significant differences regarding postoperative complications. Conclusion For all procedures, significant improvements from baseline in health change scores were noted after surgery. Recurrence rates were higher than previously reported. Registration number: NCT04893642 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]