It has been suggested that fish have more genes than humans. Whether most of these additional genes originated through a complete (fish-specific) genome duplication or through many lineagespecific tandem gene or smaller block duplications and family expansions continues to be debated. We analyzed the complete genome of the pufferfish Takifugu rubripes (Fugu) and compared it with the paranome of humans. We show that most paralogous genes of Fugu are the result of three complete genome duplications. Both relative and absolute dating of the complete predicted set of protein-coding genes suggest that initial genome duplications, estimated to have occurred at least 600 million years ago, shaped the genome of all vertebrates. In addition, analysis of >150 block duplications in the Fugu genome clearly supports a fish-specific genome duplication (Ϸ320 million years ago) that coincided with the vast radiation of most modern ray-finned fishes. Unlike the human genome, Fugu contains very few recently duplicated genes; hence, many human genes are much younger than fish genes. This lack of recent gene duplication, or, alternatively, the accelerated rate of gene loss, is possibly one reason for the drastic reduction of the genome size of Fugu observed during the past 100 million years or so, subsequent to the additional genome duplication that ray-finned fishes but not land vertebrates experienced.

PURPOSE Highly Active Anti Retroviral Therapy (HAART) has become an effective treatment modality to reduce HIV-infection to an undetectable viral load. These antiretroviral agents may, however, cause severe morbidity by inducing the syndrome of lipodystrophy. In the head and neck region antiretroviral agents generate an obtuse heavy neck in combination with an accelerated pattern of midfacial atrophy and ptosis. Modifying the antiretroviral therapy produces only limited improvement, therefore warranting a surgical approach. An extreme case of HAART-induced facial lipodystrophy is presented together with literature review to support the need for an extended surgical intervention in these patients. METHODS An overview of literature concerning the lipodystrophy effects of HAART and potential treatment modalities is carried out. This is illustrated with a case study of a 55-year old woman who received HAART therapy for 24 years and was particularly unhappy with her appearance due to cervical fat accumulation. Surgical technique and clinical results in this patient by means of deep-plane cervico-facial rhytidectomy including liposuction, subplatysmal lipectomy and platysma-digastric suspension are discussed. RESULTS The surgical technique has resulted in an aesthetically pleasing and predictable result with a quick recovery in this patient suffering from HAART-induced lipodystrophy. CONCLUSION The technique of deep-plane cervico-facial rhytidectomy including liposuction, subplatysmal lipectomy and platysma-digastric suspension is a valuable treatment modality in this patient group suffering from HAART-induced facial lipodystrophy. However, longitudinal studies of multiple subjects is required to assess stability of the outcome.