Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems. Historical Aspects. Portosystemic pathways form secondary to angioarchitectural changes in the liver in which the blood bypasses an occlusion or a distortion, flowing from high pressure to low pressure areas of vascular beds. Recanalization of embryonic channels and/or reversal of flow in venous systems lead to portosystemic collateral formation [ormation –3 In 190ormation . The porormation . Johns aormation . Ruzickaormation . The useormation . In 1981ormation . Identiformation . Computeormation . In the The venous blood from the esophagus drains into the submucosal plexus which in turn drains into the periesophageal venous plexus. From this second plexus, esophageal veins arise in a segmental manner, following the arterial supply. Ultimately the dense submucosal plexus drains into the superior vena cava (SVC) . With reGastric varices (GV) are defined according to their location and also to their relationship with the esophageal varices. Gastric varices at the hepatofugal collateral pathways can drain into the systemic circulation through two types of collateral systems: the gastrophrenic system or the gastroesophageal system . Apart from this, gastric variceal formation in a hepatopetal collateral circulation pathway can develop in case of isolated splenic vein (SV) occlusion. The most commonly used classification is the Sarin classification which does not account for the underlying vascular anatomy. However, the Japanese Society for Portal Hypertension classified GV into cardiac, fundal, or cardiofundal varices which is more refined from an anatomical point of view. In this system, Type 1 gastric  varices have a single feeding channel that arise from the SV and drain into the left renal vein (LRV) through the gastric cardia and/or fundus and Type 2 gastric varices follow a similar course to the LRV with multiple feeding tributaries –24. In SCollateral pathways associated with gastric varices can also be simply divided into those associated with gastroesophageal system or gastrophrenic system. In the former, varices develop between the LGV and azygous system in PHT and in the latter, gastric veins in and around posterosuperior part of gastric wall anastomose with left inferior phrenic vein at the region of gastrophrenic ligament, near the bare area of stomach . In majoSpontaneous portosystemic shunts  sided shunts. Left sided shunts are described based on their location (left of midline or left of the confluence of splenic and mesenteric vein). These shunts have hemodynamic involvement directly or indirectly with the SV or its branches, namely, the LGV, SGV, or PGVs. Left sided SPSS include the GRS occurring in 80 to 85% of patients in gastric varices, GCS, the least frequent type of left sided PSS, but associated with gastric varices and SRS which is not uncommon in cirrhosis patients and has no association with gastric varices. Gastrorenal shunts occur in 10% of patients with PHT. The communication is between GV and LRV, but in reality, it is a small part of the larger PSS communication that involves the SV along with LRV and GV. Hence, hemodynamically, this is a SRS. This whole complex is termed the gastric variceal system. Hence, the part of this complex, which encompasses the GRS, should be ideally called the splenogastrorenal shunt.Splenorenal shunt is not in true terms a hemodynamically described shunt. This shunt is more likely a morphologic or anatomical shunt and is not associated with gastric varices. It is tortuous, meandering direct communication between SV and the LRV without involvement of the gastrointestinal tract and is a vascular channel without variceal formation and without spontaneous bleeding risk.The gastric variceal system includes GRS and central part of GV with or without the afferent portal venous feeding collaterals. It is important to keep in mind that GRS is hemodynamically a part of a larger complex that is SRS and that morphologically the SRS is not associated with GV . It is also important to note that gastric varices may have a direct component that is part of the SRS but does not contribute to gastric varices formation, but, in reality, bypassing the stomach wall.The GV have an afferent limb , central part, and efferent limb (systemic venous outflow) portions. The portal inflow or afferent feeders supply GV. These feeders do not directly communicate with true GV  but do so with GVs outside the gastric wall and form the extragastric or false GVs .The feeders include LGV (or coronary vein), PGV, and SGVs. The PGV, which is usually single, can have a duplication and early bifurcation leading to multiple feeder profile, making it difficult to identify a laterally lying PGV from a medially lying SGV that could be acting as an afferent and is an important technical implication in interventional treatment.Left gastric vein is the right sided component of SPSS because it comes off from the PV near the midline. Posterior and SGVs are also left sided parts of the portosystemic system. The SGVs traverse forward medially towards the GVs from the splenic hilum and enter the varix at a level higher, anterior or ventral, than the PGVs. The dominance of portal inflow feeders is important. In some, the dominant feeder is the LGV, but PGV or SGVs can also act dominant. If the gastric variceal system is very complex, then all three feeders become equally dominant. The only condition in which the SGVs become the only dominant feeder is in presence of SV or PV thrombosis. If SGVs become the dominant feeder in portal hypertensive gastric variceal complex formation, the gastric varices extend over fundus, cardia, and also body, antrum, and gastric outlets. The central part of the gastric variceal system consists of true submucosal intragastric and false extragastric varices. Sometimes these also communicate with each other through a singular perforator vein. Gastric varices are also seen between prominent folds in the stomach, but they can also be confused with prominent gastric rugal folds or self-thrombosed GVs. Regarding extragastric varices that do not have an intragastric submucosal component, the afferent feeders usually drain into these and perforators commence from them to penetrate the gastric wall to form true GVs. The efferent or outflow system of GVs may be simple (only GRS) but can also be very complex, involving the inferior phrenic or pericardiophrenic veins. To understand the outflow system, it is important to understand the GRS and the pericardiophrenic collateral pathways. The GRS commences from false gastric (extragastric) varices and starts as small convolutions intraperitoneally in the lesser sac. It travels caudally and posteriorly and becomes retroperitoneal as the flow increases and it grows in size. This initial convoluted portion is termed the intraperitoneal transition zone. In the retroperitoneal region, the shunt becomes less convoluted and reaches the left adrenal vein (area of common stump). The entrance of the retroperitoneal portion of the shunt with the left adrenal vein occurs at different angles. The commonest angular relation of the shunt with the stump is between 10 and 12 o' clock positions. Less commonly, the angle between the shunt and the stump occurs at 12 and 1 o' clock positions. In rare situations, the retroperitoneal portion of the shunt joins the left gonadal vein instead of the left adrenal vein. More in rarity is the duplication of the GRS in which the LRV supply the shunt, forming anterior and posterior GRS. The phrenic vein or inferior phrenic vein has two parts, the infradiaphragmatic horizontal position and the vertical part (composed of ascending and descending regions). It is the descending part that forms a component of GRS by anastomosing with the left adrenal or left gonadal vein. The phrenic venous system can become complex in the presence of duplication, ecstatic trunk, or multiple isolated veins which then form a complicated system of collaterals. The pericardial vein traverses the left heart border and after travelling along the left hemidiaphragm, it anastomoses with the transverse part of inferior phrenic vein. The pericardial vein and the inferior phrenic vein are collectively called the pericardiophrenic vein , 36, 37.The new classification systems for GVs are descriptive for hemodynamics (based on efferent inflow or afferent outflow) of variceal system rather than just their location. These include the Saad-Caldwell Classification for gastric varices (inflow and outflow) and the Saad Classification for gastroduodenal and mesenteric variceal systems . Also important are the Kiyosue Efferent Classification System, Hirota-BORV Classification, Fukuda-Hirota Classification, and the Matsumoto Hemodynamic Classification Systems.The Kiyosue classification of gastric variceal system , except for Hirota-BORV Type V in which a gastrorenal shunt is too large for balloon occlusion procedures (no catheter size available) and maybe a cause of technical failure during BRTO treatment. For such shunts, Balloon Antegrade Transvenous Occlusion has been proposed. afferent inflow . They classified the degree of progression of gastric varices and collateral veins into five grades: Grade 1: gastric varices well opacified without any collateral vein evidence; Grade 2: contrast opacification in gastric varices for ≥3 minutes, in the presence of small and few collateral veins; Grade 3: contrast opacification of gastric varices partial and disappeared within 3 minutes with medium to large collateral veins which were few in number; Grade 4: noncontrast opacification of gastric varices and presence of many large collaterals; and Grade 5: in which shunt could not be occluded because of very large size of shunt and rapid blood flow [ood flow .The Fukuda Classification System of gastric varices is different from the Hirota Classification [fication  because Matsumoto et al. described a classification system for gastric varices for predicting the aggravation of esophageal varices after BRTO procedure [rocedure . This isGastric varices can also be differentiated as primary  and secondary  [n in 9%) .These are dilated splanchnic or mesoportal varicosities and/or portosystemic collaterals that are present along the gastrointestinal tract outside of the common variceal sites. These can be broadly divided into Type a (nonocclusive or oncotic) and Type b (occlusive) subdivided into Type 1 , Type 2 , and Type 3  as per Saad-Caldwell Classification . The por7.The first 2.5 cm  is drained by the prepyloric vein which drains into the PV and the rest of duodenum is drained by the superior pancreaticoduodenal veins that drain into the PV and the inferior pancreaticoduodenal veins that drain into the SMV (which is present to the right of superior mesenteric artery in front of third part of duodenum). The pancreaticoduodenal veins are four small veins that also drain the head of pancreas and adjacent second and third parts of the duodenum, forming a venous arcade (anterior and posterior) between the superior and inferior veins. It is the posterior superior pancreaticoduodenal vein that drains into the PV and the anterior superior pancreaticoduodenal and posterior inferior pancreaticoduodenal veins that drain into superior mesenteric vein. Duodenal varices (DV) were first reported in 1931 by Alberti. Duodenal variceal bleeding represents only 1/3rd of all ectopic variceal bleeding sources, even though in some studies, the prevalence of paraduodenal varices by angiography demonstration was as high as 40% . DuodenaDuodenal varices are portoportal or portosystemic retroperitoneal collaterals or a combination of both (see classification of ectopic varices below). The afferent  includes inferior and superior pancreaticoduodenal veins, cystic branches of superior mesenteric veins, pyloric vein, and gastroduodenal vein. The efferent or systemic drainage channels include gonadal vein (mostly the right) and capsular renal veins that ultimately drain into the inferior vena cava. The left gonadal vein, when involved, produces ectopic duodenal varices at third and fourth parts of the duodenum and is very rare. Rarely, direct drainage into inferior vena cava is also seen as is efferent drainage through paravertebral or innominate retroperitoneal veins. The pathways associated with DV differ in cirrhosis and in patients with extrahepatic portal hypertension. In cirrhosis, the efferents are formed in descending or transverse parts of duodenum, flowing hepatofugal through retroperitoneal veins of Retzius , finally into the IVC and also through subcostal and ascending lumbar vein into vertebral-lumbar azygous system and ultimately draining into the SVC. In patients with extrahepatic portal hypertension , the efferents are formed mostly in first 2.5 cm of the duodenum (bulb region) with a blood flow that is hepatopetal through portoportal collaterals into liver. These portoportal collaterals form from venous plexus around common bile duct or tributaries of PV that are patent above obstructed portion of the portal venous system. Next most common site of duodenal varices is the second part of duodenum and rarely in third and fourth parts , 55.8.The jejunal and ileal veins eventually drain into the SMV which drains into the IVC through the pelvic or retroperitoneal veins. There are many veins on the dorsal wall of the abdomen, called veins of Retzius that form anastomosis between the IVC and the SMV/IMV. This anastomosis can occur normally in the absence of PHT. The veins of Retzius group gives rise to various portosystemic pathways, such as mesenteric-caval, mesenteric-iliac, mesenteric-gonadal, or mesenteric-renal. Out of these, the commonest is an ileocolic vein draining into IVC or the right renal vein by way of the right gonadal vein, the mesenteric-gonadal pathway. Jejunoileal varices develop mainly at sites of prior surgeries or adhesions after surgery, mostly between the jejunum and the abdominal wall. The afferents of jejunoileal varices are mainly the tributaries of the superior mesenteric vein and the efferents are veins of the abdominal wall and also through the veins of Retzius –58.9.The venous supply of colon mirrors arterial supply. The ileocolic, right (draining ascending colon), and middle colic veins (draining transverse colon) are tributaries of the SMV and the superior and inferior left colic veins are tributaries of inferior mesenteric vein. The IMV drains into the SV and the SMV joins the SV to form the PV. The cecum is drained by the anterior and posterior cecal veins which arise from the ileocolic veins which are tributaries of the SMV. Colonic ectopic varices are normally seen in the cecal and rectosigmoid regions, found in a segmental distribution. The afferents to colonic varices include ileocolic vein, right colic and middle colic vein, and sigmoid colic vein while the efferents include right gonadal vein, right renal vein, and systemic lumbar veins that drain into the veins of Retzius and veins of the ascending colon that drain through renal capsular vein into IVC –61.10.The pectinate line (or dentate or mucocutaneous line) is an important landmark in defining certain anatomic points in the rectum and anal canal anatomy. It is present at the inferior most level of anal columns and defines the junction of superior part of anal canal and the inferior part of anal canal, both of which have different embryonic origins. The vascular supply to rectum and anal canal is defined by making pectinate line a landmark. The superior rectal vein divides into two branches, which enter the lateral wall of rectum, about 10 cm above the dentate line. The middle and inferior rectal veins drain into the caval system. The rectal veins form two plexuses, one lying in the submucosa (intrinsic) and the other lying outside the muscular wall of the bowel below the level of the peritoneal reflection (extrinsic). Above the pectinate line, the intrinsic rectal plexus drains into the superior rectal vein and below the pectinate line it drains into the inferior rectal veins. The intrinsic rectal venous plexus consists of two groups of veins draining in opposite direction. The inferior group passes down to form the inferior rectal veins, dilation of which leads to formation of external hemorrhoids. The vessels of the superior group in the anal columns dilate to form internal hemorrhoids and those in the rectum form rectal varices. Rectal varices (RV) were first reported in 1954. Rectal varices are dilated submucosal portosystemic collaterals that extend from midrectum to the anorectal junction and are considered distinct from internal hemorrhoids . Four distinct zones of mucosal circulation similar to those seen in esophagus occur in the rectum also: an inflow area analogous to the gastric zone, the downflow area analogous to the palisade zone, outflow area in the rectum which is analogous to the perforating zone, and the outflow area in anal canal which is analogous to the truncal zone of esophageal varices. The submucosal portosystemic communications of rectal varices have hepatofugal inflow. The flow to the intrinsic rectal venous plexus occurs through the wall of rectum by branches of superior rectal vein, a tributary of inferior mesenteric vein.From both the plexuses, the portal hemorrhoidal blood drains into systemic circulation through two portosystemic shunts . The rectogenital communication connects the rectal venous plexus with vesicoprostatic or vaginal venous plexus. Theinterrectal communications occur between the three rectal veins. Hemorrhoids occur independent of rectal varices. In a large series of cirrhotics, it was shown that RV were present in 44% and bleeding from rectal varices occurs in 8% and that the prevalence increased with increase in severity of PHT: 19% more in patients with cirrhosis and without esophageal varices, 39% in patients with esophageal without prior bleeding, and 59% in patients with prior bleeding. Thirty percent of patients can have concomitant hemorrhoids with RV and it is very important to differentiate rectal varices from hemorrhoids. 11.These are most commonly seen in extrahepatic obstruction of PV (EHPVO) and can cause extensive collateral venous circulation at porta hepatis. The description of portal biliopathy was first given in 1944 by Fraser and later on by Gibson in 1965. The term portal biliopathy or pseudosclerosing cholangitis was first coined in early 90s and used to describe abnormalities of extra- and intrahepatic biliary tract, gall bladder, and cystic ducts in patients of PHT. Even though biliary tract changes occur in 80 to 100% of EHPVO patients, symptomatic obstruction occurs in only 5 to 30% patients. Anatomical understanding of varices in the biliary tract stems from pristine description provided by Petren and Saint in 1932 and 1971, respectively. There are two venous systems that run along the biliary tract: the paracholedochal veins (of Petren) that run parallel to the common bile duct and the epicholedochal plexus (of Saint) forming a fine reticular network over the common bile duct. The former is a separate system from the bile duct, so much that variceal formation within this group produces extrinsic compression whereas dilatation of the latter group causes only mild to moderate irregularities of the biliary ductal system. The venous plexus of Petren is connected with the gastric, pancreaticoduodenal, and portal venous system and also to the liver directly. The right sided biliary plexus communicates with gastrocolic vein and pancreaticoduodenal vein to cystic vein or directly to liver. Left side biliary venous plexus communicates with jejunal veins, left and right gastric vein, and the left PV with flow moving towards branches of PV . EndoscoBurrow in 1838 described a pair of veins ascending from inferior epigastric veins along the umbilical vein and uniting into a single channel, draining into the upper part of umbilical vein. Sappey in 1883 noted that paraumbilical veins were distended in patients of PHT on postmortem studies. He referred to these veins as accessory PVs, which had superior and inferior divisions. The superior group drains the median part of diaphragm and traverses the falciform ligament in its upper part to reach the convex surface of liver, entering the sublobular branches of PV. The tributaries of the inferior group run alongside inferior part of falciform ligament, entering the hepatic fissure. Inferiorly they communicate with epigastric and cutaneous veins and become dilated in presence of PHT: one channel gets selectively dilated to connect the right epigastric vein with the liver , 74. LatUpper and lower part of falciform ligament.Left triangular ligament: left inferior phrenic vein and intercostal vein regions.Ligamentum teres, central portion of falciform ligament, and recanalized umbilical vein.Right triangular ligament: right inferior phrenic vein region.Diaphragmatic veins (near bare area of liver).Ligamentum venosum: patent ductus venosus.Gastrohepatic omentum: cystic veins and branches of left gastric vein region.Sappey's veins and their anatomical considerations are as follows:The current review describes various portosystemic collateral pathways pertinent to portal hypertension and their current classifications beyond traditional, with special emphasis on hemodynamics. It is very important that the Hepatologist and the interventional Radiologist know and understand the various patterns of portosystemic collateral channels for accurate diagnosis, sensible management, and prevention of accidental vascular injury during intervention.


This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease.The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) for the primary management of maxillary malignancy with surgical closure of the resultant maxillary defect and the installation of osseointegrated support for a zygomatic implant-supported maxillary fixed dental prosthesis.The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients. The surgical management and prosthodontic rehabilitation of the maxillectomy patient is complex with a variety of options available to the head and neck cancer team ranging from simple prosthodontic obturation  to reconThe development of highly specialised tools such as zygomatic, oncology and co-axis implants  have provided a platform for effective maxillary dental rehabilitation in a rapid manner following maxillary resective surgery. Boyes-Varley et al. (2007)  successfA 66-year-old male patient presented with an enlarging mass in the left maxilla Fig. . The masThe findings were discussed with the patient together with the treatment options for this malignant tumour requiring a low-level Brown class 2b maxillectomy . The patDental impressions were taken to allow construction of a maxillary complete denture template to both aid the placement of the zygomatic implants on the defect side and to act as an occlusal registration device during surgery. The occlusal vertical dimension was also measured between nasal tip and chin point to allow subsequent registration to occur at the correct level during surgery.The patient underwent tracheostomy, a limited left-sided selective neck dissection for node sampling and vessels preparation. The maxillary tumour was excised in a standard manner via an intra-oral approach with preservation of the left orbital floor Fig. . The resThe implant positions were then accurately registered by utilising light-cured resin tray material  and abutment level impression copings. The resin material was applied in sections around the impression copings and cured incrementally to ensure a rigid splinting of the impression copings Fig. . AbutmenThe radial forearm free flap (RFFF) was then disconnected from the arm and inset into the maxillary defect after creating a tunnel down into the left neck for the pedicle. The flap was carefully perforated over the zygomatic implant abutment protection caps using a short incision just through the skin layer followed by blunt dissection to allow the abutment and cap to perforate the flap ensuring a tight adaptation of the flap around the abutment Fig. . The flaThree weeks post-surgery, the patient was seen for review and to try-in the provisional prosthesis. Unfortunately, in the interim, the RFFF had overgrown the zygomatic implants Fig. . and so,2 surrounding the zygomatic oncology implants. Using a 5-mm tissue biopsy punch, holes were cut into the sheet corresponding to the positions of the abutments and the perforated polythene sheet was then placed over the abutments to keep the flap in a superior position during the initial healing phase prior to restoration. The polythene washer was then kept in place using conical abutment protection caps  was taken and a small disc cut out corresponding to an area of 1–2 cmaps Fig. , and thiaps Fig. . In viewIn order to reduce intra-operative time, the soft tissue free flap is harvested at the same time as the implant placement and prosthodontic procedures. On raising a skin island, it is appropriate to make it a little over-sized for the required defect to ensure that tension and possible dehiscence at the surgical margins during healing is reduced.In low-level maxillectomy (Brown class II), the need for bony reconstruction is questionable depending on the horizontal component. With the preservation of the orbital floor, zygomatic prominence and some bony support for the nose, facial appearance, in the experience of the authors and, as demonstrated by this case, is not significantly worsened despite low-level removal of the maxilla. The key issues in these low level defects are adequate clearance of tumour, dealing with the oro-nasal communication and reconstruction of the dentition. Whilst prosthodontic obturation can deal with these aspects in a simple manner, the stability of the obturator prosthesis and its ability to completely seal the oro-nasal defect has limitations. In addition, these prostheses require a significant amount of adjustments, clinic visits and on-going maintenance. The soft lining materials perish, discolour and harbour surface biofilm often resulting in some mal-odour and the need for regular replacement. For many patients, there is a psychological impact of retaining the maxillectomy defect and high anxiety related to the insertion and removal of the prosthesis as well as concerns relating to the handicap they would experience to speech, and eating should their prosthesis fracture or fail in some way. The use of implants to retain maxillary obturators certainly improves their stability and retention, but efficacy of the oro-nasal seal still requires regular maintenance and patients still often dislike the hygiene aspects of looking after the defect and their implant supra-structure within the defect.The use of soft tissue flaps to close a typical hemi-maxillectomy defect is an effective way of dealing with the oro-nasal communication, but in isolation, this technique works against dental rehabilitation as the bulk of the flap provides a very poor moveable foundation for a subsequent removable prosthesis. The move towards the use of composite reconstruction  has been facilitated by the use of digital planning in which dental implants can be inserted into the fibula flap at the time of harvest and inset facilitated by the use of stereolithographic guides. However, this procedure is not widely applicable for all patients due to financial, technological and medical restrictions and is not currently able to provide patients with an early loaded fixed dental prosthesis especially when post-operative radiotherapy is being utilised. Many older patients presenting with maxillary malignant tumours also have significant peripheral vascular disease and other significant medical co-morbidities which may prevent the harvest of a vascularised composite flap.In contrast, the use of a soft tissue flap such as the RFFF or antero-lateral thigh flap can often be safely employed in elderly patients with peripheral vascular disease without unduly lengthening the operation too significantly with two-team operating. In addition, the predictability of these flaps with their excellent pedicle lengths is ideal for closure of the resulting oro-nasal surgical defect. The use of a slightly oversized graft is recommended to ensure that any tension on the wound peripheries is kept to a minimum during the healing phase. In addition, for those patients undergoing post-operative radiotherapy, a degree of shrinkage and tightening of the flap tissues is to be expected.Immediate/early loading of zygomatic  and dentWhilst technically, it would be possible to construct and fit the prosthesis on the same day or even a week later, the need for microvascular flap monitoring in the immediate post-operative period, together with the significant recovery period required by the patient following surgery has lead the authors to delay the fitting of the prosthesis at the 4 to 6-week period post-operatively. In terms of ongoing clinical implant follow-up, no attempt was made at peri-implant probing for the oncology zygomatic implants perforating the soft-tissue flap as it was deemed important not to disturb the soft tissue seal of the skin flap around the implant abutments. No discharge or suppuration was noted during follow-up in this case. Periodontal probing around the conventionally placed zygomatic implants was undertaken periodically during follow up and remained within normal limits.The use of a soft tissue rather than composite reconstruction may also facilitate a shorter hospital stay and allow adjuvant radiotherapy to be delivered in a more rapid timescale with possible impact on overall cure rates of this very debilitating tumour. The initial experiences with this procedure in over ten cases have been extremely positive with excellent appreciation by patients who value being provided with a fixed dental prosthesis so quickly after major surgery.The ZIP flap technique represents an innovative approach to the management of patients presenting with low-level malignant maxillary tumours. It provides effective closure of the resulting maxillary defect restoring speech and swallowing functions and also establishing a high-quality fixed dental rehabilitation in a rapid timescale, thus facilitating a more timely return to function and restored facial appearance. This approach has now been adopted routinely in the unit and it is hoped that a cases series will be presented in due course with more detailed patient outcomes. Further work on the long-term results of the ZIP flap procedure is required together with an ongoing appreciation of the important case selection factors for this treatment protocol.


Erosional and sedimentary features associated with flooding have been documented in both modern and past cases. However, only a few studies have demonstrated the relationship between these features and the corresponding hydraulic conditions that produced them, making it difficult to evaluate the magnitude of paleo-flooding. This study describes the characteristics associated with inundation depth and flow direction, as well as the erosional and sedimentary features resulting from the disastrous flooding of the Kinu River, central Japan, in September 2015. Water levels rose rapidly due to heavy rainfall that eventually overtopped, and subsequently breached, a levee in Joso City, causing destructive flooding on the surrounding floodplain. Distinctive erosional features are found next to the breached levee, while depositional features, such as a sandy crevasse-splay deposit are found further away from the breach. The deposit can be divided into three units based on sedimentary facies. The vertical and lateral changes of these sedimentary facies may be the result of temporal and spatial changes associated with flow during the single flooding event. These observations and quantitative data provide information that can be used to reveal the paleohydrology of flood deposits in the stratigraphic record, leading to improved mitigation of future flooding disasters. The disastrous flooding along the Kinu River in September 2015 was the result of intensive rainfall in central Japan. Fluvial flooding is among the most destructive natural disasters, resulting in significant damages to densely populated areas located in or near low-lying river basinsThis study documents the patterns of erosional scour and sedimentary deposition that occurred on the floodplain during the September 2015 flooding of the Kinu River in central Japan. Erosional features and sedimentary deposits associated with modern3467The Kinu River in central Japan is the main tributary of the Tone River which discharges into the Pacific Ocean . The Kin3/s, which is the largest amount recorded at that location since 19362 area around Joso CityHeavy rainfall triggered by a tropical storm occurred on 9–11 September 2015, leading to catastrophic river flooding around Joso City, central Japan . A meteoThe water depth during flooding, deduced from water marks and water-borne debris , was genNumerous geomorphological features of erosion and sediment deposition resulting from the flooding were found within the study area. These features, including plunge pools, linear grooves and flood deposits, were exclusively found in a small area located next to the breached levee and were parallel to the main flow direction. Plunge pools, scoured by the flooding water, were several meters deep, 100 m wide and found at the toe of the breached levee’s back slope at P5 in  and 4E. The 2015 flood deposit overlay soil or semi-consolidated floodplain deposits, and the profile was characterized by a clear erosional boundary. The flood deposits were easy to distinguish because of their unique sedimentary facies and the abundance of fallen plants just below them. Grain-size analysis revealed that on average, the flood deposit was mainly composed of moderately-sorted, fine-skewed, medium sand  with a mud content of 15.19%. The underlying soil was a poorly-sorted, coarse-skewed, fine sand  with a much higher mud content of 62.55%  and 6. SThe latter could be divided into three sedimentary units based on depositional features and grain-size. The basal unit consists of a muddy deposit, while the lower and upper units consist of sandy material. The basal unit contained abundant plant fragments and a higher mud content compared to the other units at S3–5 B and 6. Sedimentary and erosional features found in the flood deposits were laterally variable across the study area . The basPlaconeis elginensis var. neglecta, Pinnularia subcapitata var. paucistriata, and Gomphonema parvulum. These assemblages abruptly changed at the contact between the underlying soil and the muddy basal unit. The basal unit was characterized by riverine benthic diatom species (Planothidium lanceolatum and Ulnaria lanceolata)Diadesmis contenta and Gomphonema parvulum). In the sandy lower and upper units, diatom assemblages were dominated by terrestrial taxa .Diatom analysis for the deposit found at station S4 revealed that freshwater species were generally dominant, but the species composition of the assemblages varied as a function of the sedimentary facies . The undFlow direction deduced from leaning plants and sedimentary features provides a way to reconstruct the dispersing process of the inundation flow. By contrast, the inundation depth  correspoSedimentary features found in the three units of the flood deposits are generally different. The differences between the three units may be related to the changes in inundation flow over the duration of the flood. The basal unit, characterized by high mud content, can be interpreted as deposition resulting from suspended load during the early stage of flooding when overtopping flow was unable to transport coarser sediments beyond the levee. By contrast, the sandy lower unit is characterized by inversely-graded sediments that were deposited by an increasing supply of suspended- and/or bed-load during the waxing flood stage when the concentration of fine sediments had relatively decreased212221Distinctive distributions of the erosional  and sedimentary features throughout the study area reflect the spatial variability of inundation flow. Flooding from the Kinu River was confined to a narrow area where flood water both overtopped and breached the levee, generating strong inundation flow. Near the levee, where inundation flow was the strongest, erosional features were found. As flood waters flowed outwards from the levee, they diverged and decreased in strength, at which point sediment began to deposit on the pre-flood surface. The limited distribution of the basal unit along Transect S implies that the overtopping river waters, containing higher mud concentrations flowed southward along Transect S during the early stage of flooding. The observed lateral thinning trend in the lower unit can be explained by spatial waning of the flow due to a reduction in transport capacity. The lateral thickening trend in the upper unit was likely the result of the formation, progradation and eventual halt of the lobe, although the possibility still remains that part of the basal and lower units were eroded by the same flow that formed the upper unit. The flood deposit as a whole shows a thickening-thinning pattern across the foreset slope of the prograding lobe, a pattern that has been reported in association with flood deposits elsewhereErosional and depositional features documented in this study are similar to other modern and past flood deposits. Erosional features that are limited to the area near the breached levee correspond to crevasse channel geometry2126Diadesmis contenta, Hantzschia amphioxys, and Luticola mutica). Such species are commonly found on the surface of wet soils and mosses, but not in coarse-grained sediments2829Distinct changes in diatom assemblages are recognized within the deposit at S4. The muddy basal unit of the flood deposit is characterized by a mixture of benthic, planktonic riverine and terrestrial freshwater diatom species. These assemblages were likely to be formed from suspended load due to the initial overtopping of the levee. Because diatom valves are known to exhibit the same depositional behavior as that of silt-sized sediment grains, the dominant species were probably incorporated with the fine fractions of the deposit. The sandy lower and upper units of the flood deposit were dominated by terrestrial diatom species  and Transect S (500-meter long) respectively. Using a handy geoslicer, we collected columnar sediment samples of the flood deposit at 13 stations  along the two transects, and single bulk samples at 4 stations . Samples were not collected at six stations  because there was no discernable flood deposit, except a thin mud drape.In the laboratory, all samples were photographed by soft X-ray after visual observation and subsampled at 1 cm intervals. All subsamples and bulk samples were sieved at 63 μm (4 phi) to remove the mud component, and analyzed for grain-size distributions for the sand fraction by using an image analyzer . A measuring range was set from −5.25 (pebble) to 6.25 (silt) at intervals of 0.25 in phi scale. Following analysis, the mean, sorting and skewness parameters of the grain-size distributions were calculated by using the logarithmic graphical methodAnalysis of diatom assemblages was conducted on the pretreated samples1529How to cite this article: Matsumoto, D. et al. Erosion and sedimentation during the September 2015 flooding of the Kinu River, central Japan. Sci. Rep.6, 34168; doi: 10.1038/srep34168 (2016).


It is currently accepted that the neural transduction pathways of gastrointestinal (GI) visceral pain include the peripheral and central pathways. Existing research on the neurological mechanism of electroacupuncture (EA) in the treatment of GI visceral pain has primarily been concerned with the regulation of relevant transduction pathways. The generation of pain involves a series of processes, including energy transduction of stimulatory signals in the sensory nerve endings , subsequent conduction in primary afferent nerve fibers of dorsal root ganglia, and transmission to spinal dorsal horn neurons, the ascending transmission of sensory signals in the central nervous system, and the processing of sensory signals in the cerebral cortex. Numerous peripheral neurotransmitters, neuropeptides, and cytokines participate in the analgesic process of EA in visceral pain. Although EA has excellent efficacy in the treatment of GI visceral pain, the pathogenesis of the disease and the analgesic mechanism of the treatment have not been elucidated. In recent years, research has examined the pathogenesis of GI visceral pain and its influencing factors and has explored the neural transduction pathways of this disease.  According to the International Association for the Study of Pain (IASP), “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.” A thorough understanding of pain has not been clearly elucidated in the medical field. Research on somatic pain and neuropathic pain tends to be improved and perfect. However, the pathogenesis of visceral pain has not yet been clearly elucidated despite significant progress of relevant research. Visceral pain occurs in the interior organs  and is commonly observed in celiac diseases, such as gastrointestinal (GI) disorders, in the clinic. The manifestation of visceral pain is most typical in irritable bowel syndrome (IBS), and this disease is the most commonly used animal model in experimental studies of visceral pain. Visceral pain refers to pain from noxious stimuli such as painful swelling, ischemia, and inflammation that act on visceral organs via peripheral and central pathways . There iVisceral pain is the most common symptom of functional bowel disorders and inflammatory bowel disease in the clinic. It is chronic in most cases and can be persistent or intermittent, which seriously affects the patient's life and work and costs substantial resources. Despite the excellent efficacy of EA in the treatment of GI visceral pain, the pathogenesis of this disease and the treatment mechanism of EA have not been investigated clearly. Over the past few years, research has examined the pathogenesis of GI visceral pain and its influencing factors and explored the neural transduction pathways of this disease. Visceral pain in IBS is a digestive disease commonly observed in clinical practice , but itsThe neurobiological mechanism is one of the most important analgesic mechanisms of acupuncture . EA stimIt has been accepted that the neural transduction pathways of GI visceral pain are divided into peripheral and central pathways. Existing research on the neurological mechanism of EA treatment for GI visceral pain has primarily focused on the regulation of these transduction pathways. (1) The peripheral pathway: noxious stimuli act on the receptors in the GI mucosa and are transmitted from primary afferent nerve fibers to primary sensory neurons in the dorsal root ganglia (DRG). Primary afferent nerve fibers include extrinsic and intrinsic afferent fibers that govern the GI tract. Extrinsic nerves refer to sympathetic and parasympathetic nerves, and sympathetic afferent fibers transmit signals to the spinal DRG. Parasympathetic afferent fibers include two pathways through the vagus and pelvic nerves, respectively. The afferent information from the vagus nerve is mainly relayed through the nucleus tractus solitarius (NTS) in the central nerves; the afferent information from the pelvic organs is mainly relayed through the sacral dorsal commissural nucleus (DCN) in the central nerves. Intrinsic nerves refer to the ENS, which mainly includes the submucosal plexus and the myenteric plexus. These nerves belong to vagal afferent fibers that directly transmit signals into the NTS of the medulla , 13 Fig. (2) TheEA analgesia has been applied in traditional Chinese medicine for thousands of years. It is now extensively used in clinical practice , and incRecent studies show that visceral hypersensitivity is one of the main pathophysiological bases of GI visceral pain. As described earlier, the pathogenesis of GI visceral pain includes the peripheral and central mechanisms. Previous research on the peripheral mechanism has primarily been concerned with how noxious stimulation acts on the receptors in the GI mucosa and activates mast cells to secrete various inflammatory mediators, such as 5-HT, prostaglandins, and bradykinin; these factors act on the corresponding receptors on the sensory nerve endings , thus trδ fibers (30–40%) and unmyelinated C fibers (60–70%) [δ fibers (class III) and C fibers (class IV), which transmit the needling sensation to the upper spinal center, thus achieving the analgesic effect [δ (class III) or C (class IV) fibers.Over the past few years, numerous studies have found that the brain-gut axis plays a critical role in the development and progression of visceral pain. The brain-gut axis refers to the physiological and pathological phenomenon in which the central nervous system (CNS) and the GI tract mutually affect and regulate one another through neurotransmitters and chemical or electrical signals. It has a role in various functionality-, motility-, and immune-related GI disorders  Figure . Meanwhi(60–70%) , 22. Durc effect . Howeverc effect –26, it cIn the peripheral pathway of GI visceral pain, the ENS functions independently of the CNS and is also known as the “gut cerebellum.” In the ENS, cholinergic neurons of the submucosal nervous plexus and the intestinal myenteric plexus can release an important neurotransmitter called acetylcholine (AchE). AchE is considered to be the primary neurotransmitter used to regulate GI motility  and to p3 receptors are massively distributed in the myenteric nerve plexus (primary afferent neurons) and participate in the regulation of abdominal discomfort symptoms in IBS VP [3 expression levels were markedly increased in the intestinal mucosa among patients with IBS; the application of a 5-HT3 receptor antagonist improved the threshold value of colonic CRD [3 expression in the brain-gut axis [α mRNA than normal controls [β-endorphin expression. Such effects were not observed in normal rats [5-HT, as a brain-gut peptide, is widely present in the CNS and GI tract and functions as an important neurotransmitter to regulate functions of the digestive tract . 5-HT3 rn IBS VP , 36. Clionic CRD , 38. EA gut axis –41, furtgut axis . Patientcontrols , 44. Thumal rats .In the body, the epithelial cells of tubular and saclike organs  release ATP upon mechanical distention stimulation. P2X3 and P2X2/3 receptors act on the submucous nerve plexus in the epithelium and induce pain signals to be transmitted towards the center , 47. P2XThe main pathogenetic mechanism of visceral pain is visceral hypersensitivity, and the pathogenesis of visceral hypersensitivity includes the peripheral and central mechanisms. However, central sensitization has been found to be a key factor in the development and progression of visceral hypersensitivity. If central sensitization is inhibited, then chronic visceral pain can be effectively relieved  Figure . CentralIn the central transduction pathway of visceral pain, the spinal cord is the first level in the integration center of pain signals after entry to the central nerves. It is the relay station of afferent pain information, and it directly modulates the pain sensation and also receives the descending regulatory signals of the upper spinal center; thus, the spinal cord is regarded as a key part in the regulation of pain stimulation . The DRGβ-endorphin expression in colonic mucosa; a similar effect of EA was found in the SDH [The SDH plays an important role in the transmission and regulation of visceral nociceptive information. It converges visceral afferent nerves from the periphery, descending projection nerves from the senior center, and SDH neurons, thus forming a complex neural network. The SDH contains abundant neurotransmitters and associated receptors, neuromodulators, and ion channels, which not only receive and transmit nociceptive information but also preliminarily process nociceptive information , 60, 61. the SDH . As desc the SDH . The spi the SDH . Thus, EThe spinal cord is the first level of the integration center for pain signals that enter the central nerves. It directly modulates pain sensation and simultaneously receives descending regulatory signals from the upper spinal center; thus, it also regulates the transmission of visceral nociceptive information. AP signals are conveyed through SDH neurons to reach the upper spinal center; once the descending modulation system of pain is activated, AP regulates the expression of SDH c-fos, p38, and 5-HT receptors to achieve an analgesic effect , 66. AddThe DCN is located in the dorsal central canal of the sacral spinal cord. It is the projection site of primary afferent signals from the pelvic organs. The DCN participates in the transmission and regulation of pain signals in the left semicolon and acts as a relay station of the brain-gut axis in the pain pathways. DCN neurons have been shown to be activated by the colonic inflammation-induced visceral pain response, and the activated neurons in turn can preliminarily integrate noxious stimuli from the colon, thereby regulating the visceral pain response –75. Moreβ-endorphin and SP expression [The thalamus and brainstem reticular formation are important centers for processing pain information and integrating pain sensation. Thalamic and brainstem reticular neurons are the third level of pain information transmission. AP can influence nociceptive information transmission of the thalamus and brainstem reticular formation in the upper spinal center , 80, 81 pression  and CRF pression , 85 in apression . This fipression . Additiopression .The electronic stimulation of skin receptive fields and acupoint Zusanli can inhibit the response of somatic and visceral convergence neurons of the thalamic ventrobasal nucleus to the CRD . The skiThe NTS is located in the dorsal medial part of the medulla oblongata. It acts as the relay nuclei of the visceral primary afferent fibers, which receive afferent information from the peripheral nerves and the spinal cord or medulla oblongata. Meanwhile, the NTS participates in the transmission of visceral nociceptive pain information and is an important central passageway for nociceptive afferent fibers and integration and regulation of visceral pain sensation . The c-fThe RVM is located at the central junction of the pontine reticular formation. It plays a critical role in the central regulation of pain and additionally serves as a common pathway of the upper spinal center for descending regulation of visceral noxious stimuli. The RVM has a dual role in regulating visceral pain, and it may inhibit or facilitate the input of noxious stimuli , 95. TheNerve nuclei such as the PFC, ACC, thalamic medial nuclei, amygdala, midbrain periaqueductal gray matter, and caudate nucleus that participate in pain sensation and modulation have extensive fiber links and are important centers of pain sensation –99. AfteUnder the rectal balloon distension plus electroacupuncture condition, stimulation by electroacupuncture at Tianshu (ST 25) manifested a decreased regional cerebral metabolic rate of glucose in the left cingulate gyrus, right insula, right caudate nucleus, fusiform gyrus, and hippocampal gyrus. Electroacupuncture therapy relieved abdominal pain, distension, or discomfort by decreasing glucose metabolism in the brain . A few sUnder physiological and pathological conditions, the processing of pain information by the body generally has cross-level features. Although research has been conducted on both the cellular and the molecular levels , there is also a higher level of exploration including serial and parallel processing of signals that eventually form sensory perception. With the continuous development of science and technology, research on EA analgesia has entered the molecular neurobiology level. This paper systematically discusses the major neurobiological mechanisms of EA analgesia for GI visceral pain from the aspects of the peripheral and central pathways. Various pathways and substances are involved in the mechanism of EA for alleviating visceral pain. Although both peripheral and central nerves participate in the analgesic mechanism, most of our information has been derived from elucidation of in vitro animal experiments. There remains a lack of verification by in vivo functional experiments and clinical trials. Further clarification is necessary to understand how these structures jointly function during the analgesic process of EA. Additionally, most existing studies have observed the regulatory effect of EA on neurotransmitters at the peripheral and central levels to discuss the possible mechanism of EA analgesia. However, relatively accurate neural pathways of EA analgesia have not yet been revealed because of the high complexity and diversity of nerve distribution in the transmission and modulation of visceral pain. Meanwhile, experimental research on EA for alleviating visceral pain is often focused on functional GI disorders, particularly IBS, as a model to investigate the underlying mechanism. Thus far, research has been lacking on AP analgesia of visceral pain in inflammatory GI disorders. Therefore, continuous investigation of the neural pathways of EA analgesia will be the priority of future research.


Despite the extensive geological and paleontological searches in the south Levant, no terrestrial fauna of late Neogene age was yet reported. Here, we report the first evidence of “ancient deer”–cervid in the late Miocene (Tortonian) lacustrine section of the Bira Formation at Hagal Stream, Jordan Valley, northern Israel. The section comprises rich assemblage of macrofauna fossils, mostly freshwater mollusks. The mammalian bone was discovered among the macrofauna fossils, and is described as an almost complete left humerus of an adult animal identified as an artiodactyls element probably of a cervid. This terrestrial mammal shares similar paleoenvironmental conditions with other contemporaneous localities, where cervids prevailed with bovids and other taxa. It appears that the freshwater lakes provided favorite habitat for the development of the cervids and possibly other mammals. The specific conditions of preservation of the cervid illuminate the role of post depositional processes (taphonomic constrains) in masking terrestrial fauna remains in the region. Accordingly, further efforts will be devoted to unveil the mute part of the southern Levant–east Mediterranean terrestrial faunistic realm at the end of the Miocene. The Miocene-Pliocene periods were distinguished by significant tectonic deformation and magmatic activity throughout the Arabian and African plates –3. The bIn this paper, we report the first evidence for terrestrial mammal in the late Miocene sedimentary sequence of the Bira Formation at Hagal Stream, located at western margin of the Jordan Valley, in the eastern Lower Galilee area . The BirDuring the late Miocene–early Pliocene times (~ 10 to 5 Ma) the morphological basins and the lowlands that extended over the areas of the Yizre’el Valley, lower Galilee, Kinnarot Basin and Jordan Valley  were occA sequence of sedimentary rocks termed the Bira and Gesher Formations was deposited in lacustrine water bodies that occupied during the late Miocene-early Pliocene periods the areas of the Lower Galilee, Yizre’el Valley and the Jordan Valley. The formations were deposited between the time of eruption of the Lower Basalt and the Cover Basalt Units (between ~10 and ~ 5.3 Ma)  Bira Formation, where the mammal remains were discovered, comprises limestones, dolomites, marls, gypsum sediments and basaltic rocks Figs  and 2 an Ma Bira Here, we focus on the Hagal section of the Bira Formation. The section is located at the eastern side of Hagal Stream, at the western escarpment of the Dead Sea Rift . The secTheodoxus spp.) and Unionidae are the most abundant gastropods and bivalves, respectively. The Bira Formation is divided into three units (HF1-3), according to the macrofaunal assemblages described below. Another unit (HF4) appears in the above-lying Gesher Formation  is the most abundant taxa, but with relatively low dominance of 47%. Other gastropod families include Cochliopidae, Bithyniidae, Thiaridae, Melanopsidae, and Planorbidae. Bivalves, mainly Unionidae, show increase in abundance towards the upper part of HF1, where they appear moderately fragmented in their original shells . The asl shells .Theodoxus spp.), comprising 97% of the assemblage. Most of the fossils in this nearly monospecific assemblage appear as external printings, sometimes with preserved colored sculptures, some appear as inner molds  as the dominant taxa in Hurvat Ze’ev, and Neritidae family (Theodoxus spp.) as the most dominant taxa in Hagal section. The more euryhaline and opportunistic nature of the Neriitida family, compared to the Thiaridae family, points to increased salinity-stressed conditions in the Hagal section.An important conclusion so far is that variations in salinity characterized Lake Bira at the Hagal Stream area, from periods of fresh to brackish conditions during which carbonate rock rich with macrofauna were deposited, to hypersaline-evaporated conditions during which gypsum beds were deposited. Similar conditions also prevailed in other areas, for example the Hurvat Ze’ev section, located east to Hagal section, at the Tabor Stream area . The macVenerupis sp. and Paphia sp.), indicating high levels of environmental stress during these saline episodes  su suDama  was mostly fresh, as indicated by the molluscan identification. A variety of organisms of Tortonian times undoubtedly used this lake as an important water source. The mammalian bone was found in unit HF3, in which a major decrease in water depth and increase in water energy is indicated by the extensive fragmentation and pulverizing of the fossils. The cervid probably died for some reason while drinking water from the lake shorelines. Thus, the finding of the mammalian bone reinforces the reconstruction of the depositional environment as shifting to shorelines conditions. The strong wave action rolled the outer surface of the bone and the changing shore water regime caused the sediment compaction. Further survey in the area might reveal auxiliary exposure richer in vertebrate fauna as expected from Tortonian localities.The development of fresh water-bodies during the late Miocene in the Levant and circum-Mediterranean area opened the route for the ancient deer expansion westward.


Ischnura senegalensis  was first found to produce strong photoluminescence (PL) emissions from various colored-body portions, such as the eighth abdominal segment of the tail. The colors of the colored-body portions can be enhanced or modified by the PL emissions for assistance in reducing intrasexual and male harassment, and improving mature mating and conspecific identity. Therefore, the PL emissions that contribute to the color modification and coloration are involved in the cuticle evolution of the damselflies. The micro-PL confocal images verify that the PL emissions can strongly influence the surface colors of the cuticle, and demonstrate why the damselfly Ischnura senegalensis is called a bluetail.In this study the damselfly  Ischnura senegalensis , such as the compound eyes and the eighth abdominal segment of the tail, because the males exhibit a color mono-morphismIschnura senegalensis , also known as the common bluetail, is a common type of damselfly that is widespread in Africa, the Middle East, and throughout southern and eastern Asia. They usually inhabit clean shallow water, and are easily found in running water and ponds.The American epic science-fiction film “Avatar”  takes place on a lush habitable moon named Pandora, which has a variety of fluorescent species. Actually, the Earth can be likened to the fictional Pandora, because it also has a large number of fluorescent species, including plants, animals and trees1345Ischnura senegalensis  exhibit color dimorphism  was first found to emit strong PL emissions from the various colored-body portions of the compound eyes, thorax front, wings, and eighth abdominal segment of the tail. There is an obvious difference in appearance of the colors of the colored-body portions in the PL image and those in the optical image, indicating that the PL emissions act as biological pigments and multilayer structures and can modify the colors or coloration of the colored-body portions. This PL phenomenon is strongly related to cuticle evolution in the damselflies. The ultrathin histological sections of the various specific body portions of the damselfly Ischnura senegalensis were examined by confocal fluorescence microscopy and TEM. Micro-PL confocal and TEM images of the ultrathin histological sections of the various specific body portions show that The cuticle PL does impact on the color morphism of a male damselfly Ischnura senegalensis, and it helps to reduce intrasexual and male harassment and to signal mature mating and conspecific identity.The Damselfly Ischnura senegalensis  is one of them, and can be easily seen and caught during the period from May to September. The male Ischnura senegalensis  specimens were collected in 2015. The various specific body portions of captured damselflies, whose names are indicated in A large number of species of damselflies and dragonflies inhabit the marshes along the lakeside of the campus of National Dong Hwa University, Hualien, Taiwan. Ischnura senegalensis . The ultrastructural analysis of the various specific body portions were carried using a transmission electron microscope . The ultrathin histological sections were loaded on 100-mesh copper grids in the TEM vacuum chamber, and then the cross-sectional structures of the ultrathin histological sections were observed at 80 kV accelerating voltages.The male damselfly specimens were dehydrated through a series of acetone and ethanol solutions, and then immersed in propylene oxide for 10 minutes to remove residual acetone and ethanol. The dehydrated damselfly specimens were infiltrated and embedded in a resin, and then were cut into thin histological sections of only 80 nm thick with an ultramicrotome (Leica EM UC6) for various specific body portions of the male damselfly The various specific body portions of captured damselflies were directly observed by a PL spectromicroscope. The schematic diagram in ® Imaging Software.The ultrathin histological sections of the various specific body portions were perceived by a confocal fluorescence microscope . The schematic diagram in How to cite this article: Chuang, C.-J. et al. Impact of cuticle photoluminescence on the color morphism of a male damselfly Ischnura senegalensis . Sci. Rep.6, 38051; doi: 10.1038/srep38051 (2016).Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


The general structure and action of all eukaryotic and archaeal RNA polymerases machinery have an astonishing similarity despite the diversity of core promoter sequences in different species. The goal of our work is to find common characteristics of DNA region that define it as a promoter for the RNA polymerase II (Pol II).The profiles of a large number of physical and structural characteristics, averaged over representative sets of the Pol II minimal core promoters of the evolutionary divergent species from animals, plants and unicellular fungi were analysed. In addition to the characteristics defined at the base-pair steps, we, for the first time, use profiles of the ultrasonic cleavage and DNase I cleavage indexes, informative for internal properties of each complementary strand.Schizosaccharomyces pombe has similar structural organization. Its mechanical and 3D structural characteristics have singular properties at the positions of TATA-box. The minor groove is broadened and conformational motion is decreased in that region. Special characteristics of conformational behavior are revealed in metazoans at the region, which connects the end of TATA-box and the transcription start site (TSS). The intensities of conformational motions in the complementary strands are periodically changed in opposite phases. They are noticeable, best of all, in mammals. Such conformational features are lacking in the core promoters of S. pombe. The profiles of Saccharomyces cerevisiae core promoters significantly differ: their singular region is shifted down thus pointing to the uniqueness of their structural organization. Obtained results may be useful in genetic engineering for artificial modulation of the promoter strength.DNA of the core promoters of metazoans and The online version of this article (doi:10.1186/s12864-016-3292-z) contains supplementary material, which is available to authorized users. In eukaryotes transcription initiation starts when Pol II in complex with transcription factors (TFs) interacts with the core promoter –3. TATA A. thaliana, S. cerevisiae and H. sapiens with oligonucleotides that contain octanucleotides TATAAAAG or TATAAAAA in their center show that eight base-pair TATA-element binds to the concave surface of TBP by bending towards the major groove , taken from DiPro DB or Additional file


Diandongosuchus fuyuanensis from the Middle Triassic of China as the oldest and basalmost phytosaur. The Middle Triassic age and lack of the characteristically-elongated rostrum fill a critical morphological and temporal gap in phytosaur evolution, indicating that the characteristic elongated rostrum of phytosaurs appeared subsequent to cranial and postcranial modifications associated with enhanced prey capture, predating that general trend of morphological evolution observed within Crocodyliformes. Additionally, Diandongosuchus supports that the clade was present across Pangea, suggesting early ecosystem exploration for Archosauriformes through nearshore environments and leading to ease of dispersal across the Tethys.Following the end-Permian extinction, terrestrial vertebrate diversity recovered by the Middle Triassic, and that diversity was now dominated by reptiles. However, those reptilian clades, including archosaurs and their closest relatives, are not commonly found until ~30 million years post-extinction in Late Triassic deposits despite time-calibrated phylogenetic analyses predicting an Early Triassic divergence for those clades. One of these groups from the Late Triassic, Phytosauria, is well known from a near-Pangean distribution, and this easily recognized clade bears an elongated rostrum with posteriorly retracted nares and numerous postcranial synapomorphies that are unique compared with all other contemporary reptiles. Here, we recognize the exquisitely preserved, nearly complete skeleton of  XilousuchusAsilisaurus99The Permian-Triassic mass extinction resulted in a colossal change in global vertebrate community structure13557Wannia scurriensis, Parasuchus, ‘Zanclodon’ arenaceus) known from the latest Carnian or earliest Norian161718Mesorhinosuchus fraasi, said to be from the Olenekian of Germany, but this age is controversial1516161718202149Phytosaurs are well known from a near global distribution in the Late Triassic514Diandongosuchus fuyuanensisUsing a holistic approach by examining the cranium and postcranium, we targeted the Middle Triassic Ladinian25 taxon Institutional Abbreviations –UCMP, University of California Museum of Paleontology, Berkeley, California, USA; USNM, Smithsonian National Museum of Natural History, Washington, D.C., USA; ZMNH, Zhejiang Museum of Natural History, Hangzhou, China.sensuArchosauriformes Gauthier 1986 sensuPhytosauria Jaeger 1828 et al. 2012.Diandongosuchus fuyuanensis Li ZMNH M8770, a nearly complete skeleton with most of the caudal vertebrae missing.West of Huangnihe River, southeast Fuyuan County, Yunnan Province: Zhuganpo Member (Ladinian) of the Falang Formation, late Middle Triassic .Diandongosuchus fuyuanensis differs from all other archosauriforms except members of Phytosauria in the possession of the following combination of character states ; squamosal with distinct ridge on dorsal surface along edge of supratemporal fossa (49-1); femoral head orientation anterior (60–90 degrees) (305-0).Diandongosuchus fuyuanensis differs from all other members of Phytosauria in the possession of : anterodorsal  process of premaxilla extending posteriorly well posterior external naris*; presence of a fossa expanded in anteroventral corner of external naris*; jugal with pronounced longitudinal ridge on lateral surface and anterior process much broader than the posterior process underlying anterior process of quadratojugal; premaxilla with nine teeth; more than one set of paramedian osteoderms dorsal to the cervical series.Diandongosuchus possesses many character states only found in phytosaurs, but also lacks some of the hallmark features present in the Late Triassic members of the clade. In Diandongosuchus, the position of the nares is retracted from the end of the rostrum (character 139-state 19); this appears to be an intermediate condition between that of archosauriforms  with nares at the anterior end of the rostrum and derived phytosaurs with the nares near the position of the antorbital fenestrae with the rostrum extended far anteriorly. However, the premaxillae are much shorter than the maxillae in Diandongosuchus (10-09), unlike the elongated premaxillae in all other known phytosaurs. The sutural contact between the premaxilla and maxilla is interdigitating (5-29), as in all other phytosaurs, though it does not have the derived ‘zigzag’ morphology  and basal phytosaursWannia scurriensis, Parasuchus hislopi, Mystriosuchus planirostris, and all descendents of their most recent common ancestorDiandongosuchus (150-09). The jugal bears a strong ridge that trends anteroposteriorly on its lateral surface (75-19) but does not have a row of nodes as is present in Parasuchus (44-117), and the anterior process of the element has a small pointed process of the maxilla inserted into the ridge. The jugal is excluded from the antorbital fenestra in Diandongosuchus by the lacrimal and maxilla (4-017), but it forms a large portion of the ventral and posteroventral edge of the orbit (5-117). A preorbital depression is present in the prefrontal, as observed in Parasuchus and MystriosuchusParasuchus (47-117). A slight dorsally expanded orbital ridge, commonly present in phytosaurs (6-117), is preserved along the left orbit in Diandongosuchus. No pineal foramen is present (63-19), consistent with the absence of this feature in other basal phytosaurs such as WanniaParasuchusParasuchus and other phytosaurs. The quadrate is wide across its ventral condyles in posterior view, a feature also uniquely shared with all other phytosaurs . The external mandibular fenestra is anteroposteriorly long and dorsoventrally shallow as in phytosaurs . The nearly homodont dentition of Diandongosuchus consists of recurved, pointed teeth, with the premaxillary and maxillary dentition completely overlapping the dentary teeth labially. All teeth have serrations on their mesial and distal edges; the teeth immediately near the premaxillary-maxillary suture are noticeably smaller than those more anterior or posterior, and the last maxillary tooth is spade-shaped . The coracoid has an anterodorsally tapered process with no coracoid foramen . The mediolaterally broad and robust interclavicle has short lateral processes and is flattened dorsoventrally as in other phytosaurs . The lateral surface of the humerus has a straight margin from the midshaft to the proximal portion  and possibly unique to phytosaurs. The sigmoidal femur has a 4th trochanter with a concave posterior margin, as also observed in Smilosuchus  and phytosaurs. Unlike other phytosaurs, which possess two sacral vertebraeDiandongosuchus possesses three sacral vertebrae in addition to 24 presacral vertebrae. Paramedian osteoderms are present as a left and a right column dorsal to the entire preserved length of the vertebral column as in other phytosaurs and most archosauriforms. However, there are approximately five osteoderms per two vertebrae as in some suchiansAlthough Diandongosuchus fuyuanensis among Triassic Period Archosauriformes in a modified version (79 taxa and 415 characters) of Nesbitt’sDiandongosuchus in the matrix of EzcurraDiandongosuchus fuyuanensis among Phytosauria were tested with a modified version of a recent datasetWe tested the phylogenetic position of Diandongosuchus as the sister taxon to all other phytosaurs in both of our analyses of archosauriform relationships and of phytosaurian ingroup relationships . Using the phytosaur-focused datasetWe recover Diandongosuchus adds to a growing body of evidence that early archosauriforms and their close relatives possessed a wide range of ecologies303132333435Diandongosuchus illuminates the order and mode of morphological evolution of Phytosauria through a combination of archosauriform character states and those known for Late Triassic phytosaurs. Several postcranial synapomorphies of Late Triassic phytosaurs are present in Diandongosuchus. The uniquely phytosaurian modifications of the pectoral girdle  remain essentially identical from this point on throughout the existence of the phytosaur lineage, similar to the general postcranial stasis observed in crocodylians363738Diandongosuchus, and we hypothesize the potential association of these features with enhanced prey acquisition. This includes the widening of the articulation surface between the skull and mandible through a medially expanded quadrate and articular. This mediolateral expansion and the broadness of the posterior end of the retroarticular process could signal an elongate muscle belly and a larger articulation area (=a bigger mass) for the m. depressor mandibulae and the m. pterygoideus40Diandongosuchus lineage from other phytosaurs, recalling the trend observed in crocodyliform evolution37Some cranial features of Late Triassic phytosaurs also are already present in Mesorhinosuchus fraasiDiandongosuchus as a Middle Triassic phytosaur reduces this ghost lineage by ~10 million years  occupied a wide distribution across PangeaDiandongosuchus further widens this early distribution by demonstrating that phytosaurs were present on the far eastern edge of the Pangean supercontinent, indicating additional depositional areas for intense targeted fieldwork to add to the fossil record of these early archosauriforms.Out of all Triassic archosauromorphs, phytosaurs have one of the richest fossil records, preserving one of the widest distributions of reptiles across Pangea. Over the evolutionary history of the clade, phytosaurs achieved a broad biogeographic distribution around the Tethys in humid zones in northern and southern Pangea largely corresponding to the ‘summer-wet-biome’747Mystriosuchus from the Upper Triassic of Europe based on both morphological and depositional data6465152Mystriosuchus bears elongated neural spines, which were cited as supporting a sculling tail for an aquatic ecologyDiandongosuchus . As the clade continued to evolve through the Late Triassic those taxa were continually replaced throughout central Pangea rather than forming endemic radiations. This widespread turnover involving redistribution suggests easy dispersal across large portions of the whole of Pangea. It may be tempting to assume that the broad distribution of the group is the result of marine adaptations of some kind as observed in some extant crocodylians474849Diandongosuchus into the latest iteration of the dataset of NesbittGracilisuchus and Turfanosuchus, the addition of Yonghesuchus, and the modifications of character 27 and the addition of character 413 from Butler et al.Prestosuchus combined, Lewisuchus/Pseudoseudolagosuchus combined, and removed Archosaurus, Parringtonia, and Erpetosuchus) and 415 characters . The rhynchosaur Mesosuchus browni was used as the outgroup to root the most parsimonious trees (MPTs). The dataset was analyzed in PAUP*4.0b10et al.Diandongosuchus fuyuanensis from Li et al.We incorporated Diandongosuchus, we also incorporated Diandongosuchus into the matrix of EzcurraTo test whether an alternative topology for Phytosauria within Archosauriformes affects the relationships of Diandongosuchus into the latest iteration of the phytosaur dataset of StockerEbrachosuchus neukami and Parasuchus angustifrons and three characters (44–46) and changes in character definitions and taxon scores of Butler et al.Parasuchus hislopi and characters (47–48) of Kammerer et al.Diandongosuchus, our final analysis includes 26 taxa and 48 characters. Euparkeria capensis was used as the outgroup to root the most parsimonious trees (MPTs). The dataset was analyzed in PAUP*4.0b10Wannia scurriensis from state (1) to (0) based on the description by StockerAdditionally, we incorporated How to cite this article: Stocker, M. R. et al. A Short-Snouted, Middle Triassic Phytosaur and its Implications for the Morphological Evolution and Biogeography of Phytosauria. Sci. Rep.7, 46028; doi: 10.1038/srep46028 (2017).Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


The peritoneal model could be kept viable in culture for several weeks. Cell migration was seen after 7-10 days in culture and could be further monitored over several weeks. The use of a human artificial model environment enabling the investigation of tissue/mesh integration has, to our knowledge, not been described previously. This proof-of-concept model was developed for the investigation of peritoneal biology and the integration between tissue and different mesh material. It has the potential to be useful in studies on other important biological mechanisms involving the peritoneum.Biological compatibility, in terms of implantation of foreign mesh material in hernia surgery, still needs experimental investigation. The present study develops an experimental model using human peritoneum to study the integration between tissue and different mesh material. The  Summary: This study developed a human experimental model for long-term studies using peritoneal tissue to evaluate integration with different materials, such as synthetic meshes. Most surgical repairs include use of meshes of different material, thereby introducing foreign material into the surgical field. It is well known that some meshes give rise to capsule formation, while others are integrated into the surrounding connective tissue. Our knowledge about biological integration of meshes in terms of compatibility, tissue remodeling and repair is insufficient. One reason for this is the lack of human experimental models.2 in an adult person . Single cells began to migrate towards the foreign material and this escalated with time .ex vivo model as described  at 37°C with 5% carbon dioxide. The culture medium was completely changed three times a week  unit . Monitoring of changes in the experimental model was performed using inverted phase-contrast microscopy and photographic documentation . Repeated photographic documentations of the experimental set-ups were performed individually and consecutively every second or third day until each set-up was completed. Each experiment was performed in duplicate in two or three independent experiments.ex vivo specimens was performed, including the observation of any living cells being exfoliated from the isolated peritoneal tissue. No sign of contamination was seen in the culture medium or tissue during the first days of culture in the ex vivo model. Samples were also taken for detection of bacterial contamination of the medium at Days 1 and 26. Monitoring and photographic documentation were performed using inverted microscopy and the Axiovision system (Carl-Zeiss).Regular monitoring of the ex vivo model described above. A large-pore monofilament polypropylene mesh  and an absorbable synthetic mesh  were investigated.In order to investigate integration between peritoneal tissue and foreign material, different types of mesh were placed on both the inside  and outside  of the peritoneal preparations produced in the The sampling of peritoneal tissue was conducted with the human patients’ understanding and consent, and was approved by the Local Ethics Committee .


Partial body weight support or loading sit-to-stand (STS) rehabilitation can be useful for persons with lower limb dysfunction to achieve movement again based on the internal residual muscle force and external assistance. To explicate how the muscles contribute to the kinetics and kinematics of STS performance by non-invasive in vitro detection and to nondestructively estimate the muscle contributions to STS training with different loadings, a wearable sensor system was developed with ground reaction force (GRF) platforms, motion capture inertial sensors and electromyography (EMG) sensors. To estimate the internal moments of hip, knee and ankle joints and quantify the contributions of individual muscle and gravity to STS movement, the inverse dynamics analysis on a simplified STS biomechanical model with external loading is proposed. The functional roles of the lower limb individual muscles (rectus femoris (RF), gluteus maximus (GM), vastus lateralis (VL), tibialis anterior (TA) and gastrocnemius (GAST)) during STS motion and the mechanism of the muscles’ synergies to perform STS-specific subtasks were analyzed. The muscle contributions to the biomechanical STS subtasks of vertical propulsion, anteroposterior (AP) braking and propulsion for body balance in the sagittal plane were quantified by experimental studies with EMG, kinematic and kinetic data. Sit-to-stand (STS) movement is a common, but critical action that almost every independent person performs every day, but millions of people have difficulty in STS motion due to neurological pathologies globally . STS movA greater understanding of the biomechanics of STS and muscle contributions to STS has important implications for rehabilitation training. It is valuable for clinicians to make a targeted, effective and efficient physical therapy plan in individual STS rehabilitation training with motor disability. In common STS movement, the primary mechanism to regulate joint moments is muscle force generation. Muscles accelerate body segments and generate ground reaction forces that alter joint moments about the segments’ center-of-mass (COM) to restore and maintain dynamic stability. In addition, gravity contributes to whole-body angular momentum through its contribution to the ground reaction force (GRF) . During McGowan et al.  offered In this paper, the differences of muscle excitation intensity in different phases during STS are identified. The purpose of the study is to identify the functional roles of the lower limb individual muscles during STS movement and the mechanisms by which muscles work together to perform STS-specific subtasks. The muscle contributions to STS motion at the individual muscle level were analyzed by experimental studies with EMG data, kinematic and kinetic data. The STS kinetics and kinematics were non-invasively estimated and analyzed using developed wearable inertial sensors. The patterns of five groups of the lower limb muscles during standing up were characterized by processed EMG to examine the relationship between the muscle activities and STS kinetics. Furthermore, to identify individual muscle contributions to the biomechanical STS subtasks of vertical propulsion, anteroposterior (AP) braking and propulsion and to analyze how individual muscles, EAF and gravity contribute to STS motion and body balance in the sagittal plane, a partial-muscle-actuated STS movement was generated with different loadings on the HAT of the subject. Based on inverse dynamics analysis of the STS biomechanical model, we estimated hip, knee and ankle joint moments from accelerations, angular velocities and angles measured on the lower limb segments  using inertial sensors. The results showed insight into the movement coordination of STS and had implications for the ongoing development and testing of more effective STS training techniques in the clinic.Compared to horizontal walking during which the COM of the body is predominantly propelled, STS motion requires an individual to propel the COM significantly more vertically and less horizontally. In addition, it is obvious that dynamic balance is more difficult to maintain after the body left the seat (seat-off). These differences suggest that STS motion likely requires altered muscle contributions relative to different phases before and after seat-off. To estimate the complex relationships between muscle excitation and resultant force, the muscle contributions to accelerate joints and segments in the STS biomechanical task should be analyzed based on the STS dynamic biomechanical model as shown in Mi  based on the inertial and static effects of STS motion as follows.In most tasks involving kinetic measurements of the STS subject, a direct measurement of internal moments acting on lower limb joints was not feasible for PBWS rehabilitation robot users. A dynamic STS biomechanical model of a trainee consisting of the HAT, thighs, shanks and feet is needed to estimate and analyze joint moments with external GRFs, loading forces and kinetic and kinematic parameters . In addition, initial feet position in the STS biomechanical model directly affects the distance that HAT must move forward in STS motion. It was proven that the amplitude of displacement and velocity at the hip could be significantly optimized when the feet are behind the knee in the AP direction ,32. ThusHip joint moment is shown with Equations (1)–(3):Knee joint moment is shown with Equations (4)–(6):i; j about the center of mass; j about the center of mass; i to the center of gravity of segment j; j; j.Ankle joint moment is shown with Equations (7)–(9):To quantify the causal relationships between the lower limb muscle excitation inputs and the resulting STS performance, the musculoskeletal modeling with explicit equations for the neuromuscular and musculoskeletal system dynamics should be utilized. Previous studies have used simulations to identify individual muscle contributions to tasks such as walking  and wheeThe mass and dimension of each segment of the subject were estimated based on the average current Chinese male inertia parameters of body segments according to Chinese national standards, as shown in A sensor system composed of two force plates, inertial sensor modules (IMUs) and EMG electrodes was developed. To measure the kinematic parameters of the segments for calculating joint moments according to Equations (1)–(9), three customized IMUs  were attached on the position of COM of the shank, thigh and HAT with Velcro, as shown in EMG signals from five lower limb muscles of the right leg, RF, GM, VL, TA and GAST, were monitored by bipolar surface electrodes (Meditrace 0.11-m self-adhesive Ag/AgCl electrodes). The electrode positions are indicated in Ten healthy male subjects  without any known musculoskeletal or neurological dysfunction participated in this study and received informed consent. The experimental protocol was approved by the Human Ethical Review Committee of Jilin University. After familiarization and practice, the subjects reported no serious impediment of the developed sensor system. Then, each subject performed three STS trials as a task and five STS tasks with different loadings  on the HAT at a self-selected preferred speed and movement pattern without any support. In each initial sitting posture of the STS trials, the feet position were located behind the knee in the anteroposterior direction with self-selected appropriate distance of about half the length of the foot. Therefore, 150 trials  were achieved. Although a task of three STS trials was performed by one subject, the STS time and the amount of captured data of each trial could not be absolutely the same. Three events provided reference points for kinematic data: movement onset (when the angular velocity of the COM of HAT being greater than 0.01 rad/s), seat-off (zero VCRF) and movement end . The three events enabled the action to be divided into two phases: a pre-stretch phase (movement onset to seat-off) and a stretch phase (seat-off to movement end). Therefore, the time of seat-off (zero VCRF) was designated as the referenced standard point (RSP) within whole STS to synchronize the kinematic, kinetic and EMG data derived from the three STS trials of a task to the same percentage metric, then the ensemble averages of a task were obtained. The kinematic data, VGRF, VCRF and the calculated joint moments were normalized to the subject’s height and weight, then were used to analyze the muscle contributions to body support in different-loading STS training compared with the five groups of EMG data captured from RF, GM, VL, TA and GAST.The wearable sensor system has been verified in our earlier research work . It was Voluntary muscle activity detection from EMG signals can be problematic due to spurious involuntary spikes produced by physiological and extrinsic/accidental origins . AccuratAs indicated in , faster The difference of the five muscles was due to their relative contributions to the horizontal and vertical GRFs and joint moments resulting in different kinematics of STS motions with different loadings. Referring to the joint angles of the hip, knee and ankle in the first column of In addition, with regard to the sum of MCI of each muscle before seat-off in different loading tasks in Kinetics analysis in the stretch phase: To control STS balance, the antagonistic muscles spanning the hip, knee and ankle joints distributed power from the leg to the remaining body segments. This also suggested that the uniarticular hip and knee extensors (GM and VL) and ankle dorsiflexors (TA) generated backward angular momentum while the ankle plantar flexors (GAS) generated forward momentum; therefore, the whole body began vertical propulsion with enough kinetic energy into the stretch phase, then the muscles’ co-contractions obviously reduced with less MCIs after seat-off. That RF and VL overlapped their activities in the early stretch phase just after seat-off (refer to the third column of In particular, there are still some uncommon and variable activities of the TA, RF and GM indicated by significant MCIs in the middle and terminal stretch phases before movement end (in the third column of The results and discussion could provide insight into STS balance and movement disorders and offer a reference for developing locomotor therapies that target specific muscle groups; meanwhile, it may provide further rationale for developing targeted STS rehabilitation robot control strategies to address patient-specific deficits in STS training. Although the selected lower limb muscles’ relative contributions to STS motion were compared and analyzed based on the muscle excitation intensities and durations and the kinetics and kinematics of STS motion, outcomes on muscle co-contraction and absolute contributions of more lower limb muscles should be confirmed and supported by further analysis. In addition, differences in designated loadings and self-selected STS speeds across subjects could introduce variability in muscle onset-offset times and co-contraction. Thus, STS speed and loadings could be acknowledged as a limitation of the study.Quantification of lower limb muscles’ co-contraction contributing to STS propulsion movement with different loadings was analyzed based on a self-developed wearable sensor system. How the muscles generate, absorb and/or transfer mechanical power between body segments to accelerate the whole-body COM was identified by quantitative assessment of five lower limb muscles’ contributions during able-bodied STS motion, in terms of variability of onset-offset muscular activation, excitation intensity indicated by MCI and the percentage occurrence of EMG signals and kinetic and kinematic information derived from the wearable sensor system. The results would contribute to further understanding of more muscles’ contributions and coordination during STS movement and provide additional insight for the development of effective, targeted rehabilitation programs aimed at improving an individual’s ability to STS rehabilitation training and useful in the clinical context for designing future STS or gait studies. In the future, partial body weight support or more specified loading would be tested on patients in rehabilitation by more motion models, including assisted standing motion with hands or weight support rehabilitation robots. Finally, the presented method of nondestructive estimation of muscle contributions to STS motion based on the wearable sensor system is expected to be applied to weight support or loading rehabilitation robot control or evaluation of STS rehabilitation therapy.


The caudal regression syndrome is defined as total or partial agenesis of the sacrum and lumbar spine, frequently associated with other developmental malformations . Prenatal diagnosis is possible through fetal ultrasound (US) and magnetic resonance imaging (MRI). A case of fetal caudal regression syndrome with omphalocele from a diabetic mother is presented, demonstrating the sonographic, MRI, CT and X-Ray features diagnostic. We will also discuss neonatal findings, risk factors and prognosis of this condition. The caudal regression syndrome is a rare congenital malformation . DefinedA 24-year-old woman, gravida 3, para 3, asthmatic for 13 years and diabetic with high dose of insulin for 2 years. The current unplanned pregnancy was poorly followed. The first ultrasound was performed at 28 weeks of gestation. It revealed an anterior medial mass of the anterior abdominal wall, well limited, surrounded by a thin membrane where passes the umbilical vein  a. It waThe lumbosacral agenesis also known as caudal regression syndrome is an abnormality of placement of the terminal part of the fetal spine occurring before the 9th week of development , 2 .EmbrRenshaw classified the spectrum of CRS into 5 types based on type of defect and articulation between bones. Type 1 has total or partial unilateral sacral agenesis. Type II has variable lumbar and total sacral agenesis and the ilia articulates with the sides of the lowest vertebra. Type III: has variable lumbar and total sacral agenesis and the caudal end plate of the lowest vertebra rests above fused ilia or an iliac amphiarthrosis. Type IV: has fusion of soft tissues in both lower limbs; and type V, also known as sirenomelia, has fused bones of lower limbs . Our newFetal MRI makes it possible to confirm the diagnosis and to determine the level of the terminal medullary cone, which will be a major prognostic factor . The spiThe caudal regression syndrome is a closed spinal dysraphy associated with a wide variety of malformations on which the subsequent prognosis of newborns depends. The balance of glycemic figures in periconceptional women with diabetes, the genetic study of families with an index case and the respect of the specifications of the antenatal screening will probably offer the opportunity for a better management of this condition whose diagnosis is based on ultrasound and MRI.The authors declare no competing interest.