Neuropelveology is a new specialty in medicine that has yet to prove itself but the need for it is obvious. This specialty includes the diagnosis and treatment of pathologies and dysfunctions of the pelvic nerves. It encompasses knowledge that is for the most part already known but scattered throughout various other specialties; neuropelveology gathers all this knowledge together. Since the establishment of the International Society of Neuropelveology, this discipline is experiencing an ever-growing interest. In this manuscript, the author gives an overview of the different aspects of neuropelveology from the management of pelvic neuropathic pain to pelvic nerves stimulation for the control of pelvic organ dysfunctions and loss of functions in people with spinal cord injuries. The latter therapeutic option opens up new treatments but also widens preventive horizons not only in the field of curative medicine (osteoporosis and cardio-vascular diseases) but also in preventive medicine and anti-ageing, all the way to future applications in the “Mars mission” project. In the 1990s, laparoscopy was introduced in the surgical treatment of pelvic cancers and deep endometriosis. The challenge then was to perform at least as well as in radically open surgery. The introduction of video-endoscopy allowed for perfect vision and a considerable improvement in the ergonomics of the laparoscopic surgeon, which was necessary for more complicated and longer procedures. Laparoscopic pelvic surgery has thus become an extensive and radical surgery with the consequence of the appearance of postoperative pain too often unexplained and neglected as well as often irreversible functional morbidities. Patients who presented to neurourologists and neurologists did not find much help, only neuroleptic treatments but without any effort to research or treat the cause of the symptoms. The term “minimally invasive surgery” thus became more and more paradoxical. The only possibility to reduce this morbidity seemed to be the in-depth study of the surgical anatomy of the pelvic nerves and their sparing as successfully as possible during interventions. However, although topographical anatomy is extensively described in anatomy textbooks, the operative functional anatomy of the pelvic nerves was, on the contrary, almost completely non-existent.Incidences of pelvic nerves pathologies are widely underestimated because of a lack of awareness that such lesions may exist, a lack of diagnosis and acceptance and a lack of declaration and reporting of such lesions. The most probable reasons for the omission of the pelvic nerves in medicine are the complexity of the pelvic nerve system, the difficulties of etiologic diagnosis and—probably the overriding reason—the limitations of access to the pelvic nerves for neurophysiological explorations and neurosurgical treatments. Neurosurgical procedure techniques are well established in nerve lesions of the upper limbs but pelvic retroperitoneal areas and surgeries to the pelvic nerves are still unusual for neurosurgeons. Few open-surgical approaches to the sacral plexus have been described by neurosurgeons for the treatment for traumatic pelvic plexopathies but these approaches are laborious and invasive, offer only limited access to the different pelvic areas and expose patients to the risk of severe vascular complications. Techniques of nerve neuromodulation to control pelvic pain syndromes and dysfunctions are for the same reasons limited to spinal cord and sacral nerves roots stimulation that considerably restrict their indications and effectiveness.The use of the endoscope in combination with neurofunctional surgical procedures to the pelvic nerves proved to be a decisive advantage in this development ,2,3,4 anNeuropelveology presents three consecutive aspects; the diagnostic stage followed by the therapeutic stage and the post-therapeutic follow-up of the patient. It covers four major areas:The diagnosis and treatment of pelvic neuropathic pain with particular new techniques of laparoscopic pelvic nerves decompression and neurolysis.The treatment of pelvic organ dysfunctions, in particular the stimulation of the genital nerves  therapy).The technique of laparoscopic implantation of neuroprothesis to the pelvic nerves (LION procedure) for the recovery of the loss of functions in people with spinal cord injuries.The stimulation of the pelvic autonomic nervous system for the prevention and/or treatment of general medical conditions such as osteoporosis, some cardio-vascular disease or control of sarcopenia (process of ageing).The diagnostic stage uses its own instruments and an anamnesis covering many aspects from gynecology, urology, orthopedics, pelvic vessel pathology and psychology of the chronic patient and parapleology. The clinical examination combines the examination of the pelvic organs and their functions, the neurological examination of the musculoskeletal system with a neuropelveological examination and the palpation of the pelvic nerves by the vaginal or rectal route . As somaNeuropelveolgy encompasses various medical treatments and surgery of the pelvic nerves. The latter includes neurosurgical techniques ranging from decompression, neurolysis, reconstruction and even nerve resection  to pelvic neurofunctional surgery.Chronic pelvic pain (CPP) is a common condition involving multiple, organ-specific medical specialties, each with its own approach to diagnosis and treatment. Its management requires a knowledge of the interplay between pelvic organ functions and neurofunctional pelvic anatomy and also of the neurological and psychological aspects. However, no current specialty field takes this approach into account. Neuropelveology is an emerging discipline focusing on the pathologies of the pelvic nervous system on a cross-disciplinary basis .The neuropelveological approach to pelvic neuropathies is primarily diagnostic with the application of neurological principles and an absolute knowledge of the pelvic neurofunctional anatomy. Patient history is the key with a focus not simply on the pain location but also on pain history, irradiation, aggravating factors, vegetative and somatic symptoms. The first step is to evaluate whether the pain is visceral or somatic .(1)Determination of the nerve pathways involved in the relay of pain information to the brain.(2)Determination of the location of the neurological irritation/injury .(3)Determination of the type of nerve(s) lesion: irritation vs. injury (neurogenic neuropathy).(4)Neurological confirmation of the suspected diagnosis by clinical examination with in particular the transvaginal or transrectal palpation of the pelvic somatic nerves with the reproduction of the trigger pain and Tinel’s sign  blockade).(5)Determination of a potential etiology based on patient history and diagnostic imaging.(6)Corresponding etiology-adapted therapy.Visceral pain by the lesion of the hypogastric plexuses is recognized due to the diffuse nature of pelveo-abdominal pain, irradiations proximal to the lower back and multiple vegetative symptoms including malaise, oppression, syncope, irritability, nausea, vomiting and fatigue. The clinical examination focuses on specific clinical details for vegetative disorders such as pupil dilation, salivation inhibition and tachycardia. In somatic pain, it is essential to adopt a neurological way of thinking since the location of the pain and the location of the etiology is mostly different. Somatic pain is located superficially at the skin and is described as allodynia or an electrical shock with a very specific location, caudal irradiations to the genito-anal areas or to the lower extremities (dermatomes) and lack of vegetative symptoms. The neuropelveological workup scheme follows these six steps:It is absolutely crucial to understand which nerves are involved in the pain and then to assess whether it is a nerve irritation secondary to compression or whether it is an axonal nerve lesion. In the first instance, the neuropelveological treatment is based on the laparoscopic exploration/decompression; in the second, on the neuromodulation of the affected nerves.Sacral radiculopathy by vascular or fibrotic entrapment ,10,11.Compression of the sacral plexus by hypertrophy or atypical insertion of the piriform muscle.Deep infiltrating endometriosis of the sacral plexus and the sciatic nerve ,12.Tumor of the sacral plexus  13,14] ,14 13,14The intervention in the area of the pelvic somatic nerves, which is covered by large vessels and a dense network of lymph nodes, has hitherto been hindered by the lack of minimally invasive surgical methods. However, developments in video-endoscopy enable the exploration of the retroperitoneal pelvic space with access to the lumbosacral plexus and possibilities for nerve decompression and neurolysis. The most frequent aetiologies treated in neuropelveology are:This endoscopic approach further allows in the case of an axonal lesion for the laparoscopic implantation of neuroprosthesis (LION procedure) where electrodes are selectively placed in contact with the injured pelvic nerves for the possible control of neuropathic pain .Post-therapy patient follow-up for pain management is essential. In nerve neuromodulation, the stimulation parameters must be calibrated at regular intervals. After laparoscopic nerve decompression, neuropathic pain first significantly increases while improvement usually does not set in until eight months after the operation. The follow-up of these patients is essential in order to adjust the medical treatment and to treat the pain-memory as successfully as possible. The latter, however, is much more difficult to direct.Various sites have been used for the implantation of electrodes to the pelvic nerves to treat pelvic organ dysfunctions. Sacral nerve stimulation was the first technique for pelvic nerves stimulation that typically involves the electrical stimulation of the nerve via a dorsal transformational technique of implantation. Sacral nerve stimulation (SNS) and pudendal nerve stimulation evolved as a widely used treatment for an overactive bladder (OAB) but does not completely resolve symptoms in the majority of patients. Both techniques are still unusual for most gynecologists so that the field of pelvic nerve stimulation is still extremely restricted in gynecology. There is definitively a need for a more suitable alternative for neuromodulative treatments; methods that cannot only be reserved for experts in this field but for all gynecologists dealing in daily practice with patients suffering from functional disorders of the bladder. This is why the LION procedure of the sacral plexus ,19 and tGenital nerves stimulation (GNS) is the surgical procedure developed for the stimulation of the DNP, an implantation technique adapted to the most classical surgical approach in gynecology, the vaginal approach. The procedure consists of two phases: a preoperative non-surgical test-phase and a second phase involving the surgical implantation of the neuroprothesis. In contrast to the classical technique of stimulation, the GNS-test-phase is the only one which does not require any interventional procedure. Due to the fact that the genital nerves are located just a few millimeters below the skin’s surface, test-stimulation can be obtained using skin surface electrodes .The effect of the stimulation can be tested by the patient in their daily, family and professional environment or alternatively at the practice under urodynamic testing or, if required, other electrophysiological testing.® NeuroGyn AG, Baar, Switzerland) with a spear from below, behind the pubic bone according to the classical tension-free vaginal tape (TVT) procedure: A sagittal incision of about 2 mm in length is made approximately 1 cm below the external urethral meatus. The curve needle driver is inserted into the incision. The tip is oriented at an angle of 5–10° from the midline towards the symphysis. The inserter tip is approximately in the 11 o’clock position (1 o’clock on the right side). The curve needle driver is advanced, contacting the inferior edge of the pubic ramus, until it transfixes the urogenital diaphragm, enters into the retropubic space and comes out through the skin in the suprapubic area . The first step of the procedure consists of the introduction of a hollow curve needle applicator  and emerges through the first vulvar incision. After removing the spear, the electrode cable is inserted retrograde into the applicator again a–c.To use the hollow needle driver for the retrograde introduction of the lead electrode enables the optimal placement of the lead electrode to the genital nerves without the need for any dissection, which, in turn, reduces considerably the risk of bleeding and nerve injury. The introduction of the curve needle driver from below belongs to standard urogynecology (TVT) procedure. As the  DNP perforates the perineal membrane laterally to the external urethral meatus at an average distance of 2.7 cm (2.4–3.0 cm) and then runs along the bulbous spongy muscle for a distance of 1.9 cm (1.8–2.2 cm) before penetrating the pillars of the clitoris , the secThe last step is then the connection of the lead electrode to the generator, which is finally fixed behind the pubic bone through a suprapubic mini-laparotomy. The fixation of the generator behind the pubic bone protects from external traumas and dislocation.No X-ray screening, neurophysiological monitoring or stimulation with (Electromyography) EMG electrodes are mandatory during the procedure for a proper implantation. Due to the fact that the presented procedure does not need two surgical procedures for both the test and the final implantation but only one for the final implantation, the presented protocol allows a considerable cost reduction in comparison with the usual procedures for sacral or pudendal nerves stimulation.The endoscopic approach allows in case of axonal lesion or dysfunction of the nerves the selective laparoscopic implantation of neuroprothesis (LION procedure) for electrical stimulation of the nerves .This procedure has been used for the treatment of nerve damage and pelvic organ dysfunctions as reported previously but probably the most impressive indication of this technique is the implantation in people with spinal cord injuries for the recovery of some walking functions . In 2006Video: LION procedure in SCI The crucial discovery we made with the LION procedure in people with SCI was undoubtedly the fact that some patients experienced enough recovery of supra-spinal control for some leg movement or even standing and walking ,29. In tn = 8; AIS B: n = 9; AIS C: n = 2) could walk >10 m (67.8%); eight of them only at the bar (28.5%) and eleven of them with the aid of crutches/walker and without braces (40%).26 patients could get to their feet when the pacemaker was switched on (92.8%). Five patients could walk <10 m (17.85%) at the bar . NineteeThe precise mechanism at work in people with SCI to recover walking functions after the LION procedure is still unknown. There is increasing evidence to suggest that neuromagnetic/electrical modulation promotes neuroregeneration and neural repair by affecting signaling in the nervous system but our findings suggest that the information signals to the brain might use not only anatomical nerve pathways but also functional pathways activated by a continuous low frequency stimulation of the low-motor neurons below the spinal cord lesion.Beyond the psychological impact and the gaining of some autonomy, the benefits of locomotion include improvement of contractures, prevention of deep venous thrombosis and oedema and amelioration of spasticity . StandinThe LION procedure to the pelvic somatic nerves has been further reported for treating urinary dysfunctions and improving locomotion in multiple sclerosis patients .The development of new technologies to assist paraplegics with their common problems associated with inertia when confined to a wheelchair may find revolutionary applications in preventive medicine and even in the world of space missions in the future. The LION procedure enables a continuous and passive electrical nerve stimulation (ENS) without the need for an external stimulation system, while the neuroprothesis is located within the body: the in-Body-ENS. This capability of continuous in-body electrical nerve stimulation may open the door to a whole new area of humanity in which implanted electronics may help the human body to a better performance and a longer life. The process of ageing, also called sarcopenia, is characterized by muscle atrophy along with a reduction in muscle tissue quality characterized by such factors as the replacement of muscle fibers with fat and the degeneration of the neuromuscular junction leading to a progressive loss of muscle function and frailty. Prevention of the aging process mainly focuses on the control and treatment of such a muscle atrophy. Several therapies have been proposed for preventing the aging process such as mental activity, muscle training and high-protein diet. A crucial factor in this is sustaining a high individual strength capacity: The elderly need strength training more and more as they grow older to stay mobile for their everyday activities. The crucial factor in maintaining strength capacity is an increase in muscle mass. As continuous passive stimulation of the pelvic somatic nerves enables muscle training and may reduce the process of muscle atrophy, the in-Body-ENS may become an option in the future for slowing down the aging process by preserving body muscle mass. This technique may be appropriate in elderly people who are not capable of active muscle training because of pain, motoric limitations or subcortical pathologies but also in people confined to bed for long periods of time (prophylaxis of decubitus).As sympathetic trunks travel downward outside the spinal cord and first anastomose to the sacral plexus, which build the sciatic nerve, continuous low frequency/low energy sciatic nerve stimulation  FES) permits neuromodulation of the sympathetic nervous system of the lower extremities and of the bottom. Due to the fact that there is further evidence of the role of the sympathetic innervation of bone tissue and of its role in the regulation of bone remodeling in humans, sympathetic nerve stimulation obtained by stimulation of the pelvic somatic nerves might also open new techniques for the prevention of osteoporosis not only in people with SCI as demonstrated in our study but also in elderly people ,35.In addition to this, the in-body-ENS may also find revolutionary applications in the world of space missions. Space is a dangerous, unfriendly place that requires daily exercise to keep muscles and bones from deteriorating. Calf muscle biopsies before flight and after a six month mission on the International Space Station show that even when crew members did aerobic exercise for five hours a week and resistance exercise three to six days per week, muscle volume and peak power both still deteriorated significantly. The in-body-ENS, by contrast, may allow muscle mass to be maintained even whilst the astronaut is at rest and provides an extremely effective and timesaving strength training program. During space flight, crew members also lose bone density; the calcium that is released ends up in the urine, which contributes to an increased calcium-stone forming potential. If the stone completely blocks the tube draining the kidney, the kidney could cease to function with catastrophic even life-threatening consequences for the astronaut. Due to the excruciating pain, affected astronauts could become incapacitated and missions may have to be aborted. Due to the fact that stimulation of pelvic sympathetic nerves may reduce this process of osteoporosis, as shown in our paraplegic study, in-Body-ENS may present a potential prophylactic for kidney stone formation in microgravity.


Following publication of the original article , it camePlease find the corrected names in the author list of this correction.The names have since been corrected in the published article.


Tactile intelligence has become increasingly important in the development of intelligent robots capable of dexterity skills that are comparable to those in humans. Recent advances in tactile sensors have fostered the implementation of artificial tactile sensation in robots, where tactile intelligence plays a key role in translating physical signals from tactile sensors to tactile percepts. Amid many possible approaches to the development of tactile intelligence, it is reasonable to translate the principles of information processing of the human nervous system into artificial robot intelligence. For instance, one may create artificial neural networks that mimic somatosensory nervous systems and integrate them with advanced machine learning techniques in order to have robots gain human-like dexterity skills. This Research Topic aims to highlight state-of-the-art research on the implementation of tactile intelligence in robots inspired by neural mechanisms of tactile information processing. It also emphasizes human studies on tactile perception to provide insight on robot learning for object manipulation tasks.Sun and Martius attempt to overcome this limitation by inferring tactile stimulations at virtual contacts from a limited number of strain-gauged sensor data using machine learning algorithms. They demonstrate the feasibility of reconstructing the location and force magnitudes of deformable objects at multiple contact points from sparse sensory configurations. They achieve this by leveraging machine learning algorithms for the inference of tactile information, clearly showing how robots gain the ability of inference from limited observations, akin to what human intelligence does.A number of studies contributed to the present Research Topic by providing the latest remarkable findings in tactile intelligence. One of the technical challenges in the implementation of tactile intelligence in robots is ensuring the robots can sense external mechanical stimulations with high fidelity. Unlike the widely distributed mechanoreceptors inside the human hand, the current tactile sensing technology in robotic hands often suffers from a sparseness of sensing points and a lack of spatial resolution. Richardson and Kuchenbecker contributing to this topic investigates more closely such connections between robot tactile sensing and human tactile perceptual attributes. They particularly focus on attribute intensity and perceptual variability in natural human tactile perception, which is not available in the current robot tactile intelligence. They collected haptic adjectives for a number of objects from human subjects as well as robotic tactile sensing data for the same objects. Then they successfully predicted the probability distribution of haptic adjectives from the tactile sensing data of an object using a machine-learning algorithm. The study demonstrates the possibility of modeling both the intensity and variability of human tactile perception using tactile intelligence in robots. This finding will enable artificial tactile intelligence to move closer to the human perceptual system.Another study by Seminara et al. reviewed sensorimotor coupling in the robotic control of hands and fingers with an emphasis on connections between human tactile perception and robotic tactile sensing. In particular, they highlight robotic behavior, goals, and tasks in active haptic exploration. This review offers a comprehensive review of the taxonomy of elements for the closed-loop sensorimotor control of robots and will be of great help to those who seek to design a robot with the ability to interact with various real environments adaptively and intelligently.Tactile intelligence will become increasingly important as robots begin to function in more open-ended environments, where they will have to adapt to the uncertainty of environmental states. In this regard, Beckerle et al. provides a critical review on the role of tactile perception of sensory feedback in the feeling of embodiment while using assistive robotic systems. Throughout the rigorous review, they suggest practical solutions to enhance embodiment by optimizing tactile feedback in human-robot interactions. This review will be of considerable value to those who aim to improve the usability of robotic assistive technology by providing real-time tactile feedback to the user.Closing the loop of motor control with sensory feedback can lead to the cognitive embodiment of external actuators in humans. This is especially important to the use of robots as an assistive technology in a daily life. Seminara et al. discusses the role of tactile intelligence in a closed sensorimotor loop for robotic control of hands and fingers, and the second review by Beckerle et al. deals with how such a sensorimotor loop could induce the feelings of embodiment when using robot-based assistive technology. So, the understanding of a sensorimotor loop using tactile feedback in the first review can provide a basis for the realization of embodiment in assistive technology in the second review. Based on these reviews, we believe that the upcoming issue in the field will be developing robotic upper limbs and tactile sensors that are equipped with the sophisticated model of the closed sensorimotor loop and practical applications of these advanced technologies to real-life situations, such as assistive environments.The first review by We believe that all the contributions to this topic will broaden our understanding of the neural underpinnings of tactile perception, foster the development of robots interacting with the world in a more intelligent way, and open a new avenue to integrate multiple disciplines in order to pave the way for next-generation human-robot interactions. We hope that readers will also find in this Research Topic useful insights and promising outlooks for their own research.S-PK edited and reviewed the contributions, and wrote the Editorial. CW and VD edited and reviewed the contributions. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In an increasingly dynamic, competitive and global environment, organizations in the twenty-first-century are required to accommodate to rapid changes .Lavee and Pindek. The authors focus on delineating the informal resources that are invested as part of OCBs directed toward customers (OCBCs), as well as the costs associated for employees. This study contributes to better understanding OCBCs and the growing trend to “do more with less in the workplace.”The negative impact of OCBs is addressed in the qualitative study conducted by Shukla and Kark provide a theoretical framework which examines both positive and negative impacts of prosocial behavior. The authors introduce pro-social behavior as an antecedent of creative deviance and develop a multi-level model of the moderators of this relationship. The model suggests that prosocial motivation can increase creative deviance, which ultimately increases both positive  and negative  outcomes.Contrary to the former studies, Lavy paper also contributes to a more balanced examination of prosocial behavior. The paper examines the daily dynamics of prosocial behaviors among a group of teachers and focuses on the interplay of daily perceived supervisor and colleague support, OCB, and daily positive and negative emotional experiences. The study presents new findings supporting the dual role of social support and emotions as both antecedents and outcomes of OCB.Reizer et al.'s paper explores the general mechanisms and moderators that explain the bright and dark sides of prosocial behaviors. Overall, findings from their two studies suggest that performing OCB can enhance work-family facilitation (WFF), with the effect being stronger for workers with low avoidance levels. However, OCB can be harmful in terms of work family facilitation among individuals who are higher on attachment avoidance.Finally, This special issue offers a more comprehensive perspective of prosocial behavior by providing both the positive and negative sides of the phenomenon. Given the increased importance of prosocial research in today's volatile environment, the current set of papers answers critical questions on direction and strength of the relationship between prosocial behaviors and workplace outcomes. We hope that the current set of papers will also inspire others to further explore these issues and contribute in developing a more integrative model of prosocial behavior in organizations.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The lesion of the accessory spinal nerve is often of iatrogenic origin. We report the case of an injury after a right jugulocarotid lymph node biopsy. A 30-year-old patient was referred for the treatment of right cervical lymphadenopathy suspected of tuberculosis. After the intervention and confirmation of tuberculosis diagnosis, the patient presented a functional impotence of the right shoulder and swarming of the right hand. The clinical examination found an active limitation of the shoulder, and a wasting of the upper bundle of the right trapezius muscle and the sternocleidomastoid. The EMG showed axonotmesis of the accessory spinal nerve and the MRI an amyotrophy of the trapezius with denervation edema. A simple rehabilitation has been scheduled. Damage of the accessory spinal nerve most often occurs after local surgery. EMG is essential for diagnosis. Rehabilitation is the first therapeutic option. Surgery can be considered if it fails. The surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery. The lesion of the accessory spinal nerve (ASN) is most often of iatrogenic origin [1]. It is responsible for a pure motor mononeuropathy. We report the case of an injury of the ASN after a cervical lymph node biopsy.A 30-year-old patient, with no previous medical history was referred for a right-sided jugular-carotid lymphadenopathy, without fever or deterioration in general condition. A biopsy was performed in ENT unit confirming the diagnosis of lymph node tuberculosis. There were no other locations of tuberculosis A 6 months anti-tuberculosis treatment has, therefore, been started. In the postoperative period, the patient began to complain of progressive partial functional impotence in the right shoulder accompanied by swarming in the right hand. The clinical examination showed an anterolateral clean scar on the right side of the neck , fall ofMononeuropathy of the accessory spinal nerve is a rare iatrogenic motor disorder [1]. Idiopathic paralysis of this nerve has been described [2-4]. It affects the upper bundle of the trapezius and sternocleidomastodian muscle. The lesion generates a muscular weakness of these two muscles causing a deficit of elevation of the shoulder and the lateral rotation of the cervical spine without repercussions on the rest of the member musculature. However, we would like to point out that this slight detachment of the scapula in our patient is secondary to the weakness of the stabilizing muscles of the scapula . This detachment is a consequence of the non use of the limb and functional muscular overload on this musculature. This slight detachment of the scapula should not be attributed to a damage affecting the long thoracic nerve. This damage constitutes the differential diagnosis of the ASN lesion. The swarming sensation reported by our patient may be due to irritation of the brachial plexus during movement. Shoulder drop and muscle imbalance in the shoulder may be exacerbated by excessive stretching of the plexus [3]. The edema found on the MRI probably explains the slight pain on pinching the trapezius. To regain a trapezian function, this patient will be referred to rehabilitation for a protocol to strengthen the stabilizing and elevating muscles of the scapula. In the event of manifest handicap, and of failure of the rehabilitation, a reparative surgery is possible with a neurotisation of the accessory spinal nerve. It must be performed by an experienced surgeon with a perfect understanding of the cervical and scapular anatomy. Several procedures can be followed: the use of bundles of the upper trunk of the brachial plexus ; the use of the lateral pectoral nerve [7]; or the use of the nerve fascicles of the C7 nerve [8]. The best treatment is of course preventive, and surgeons must consider the protection of the accessory spinal nerve in case of cervical lymph node surgery.Mononeuropathy of the accessory spinal nerve is often an iatrogenic condition, but spontaneous rupture is not rare. It requires a careful clinical examination of the shoulder musculature to recognize it. The electromyogram is mandatory. Functional treatment is the main therapeutic option, surgery is possible in case of failure. The best treatment remains the prevention with a necessary protection of the ASN in the lymph node biopsies.


The assessment and prediction of cognitive performance is a key issue for any discipline concerned with human operators in the context of safety-critical behavior. Most of the research has focused on the measurement of mental workload but this construct remains difficult to operationalize despite decades of research on the topic. Recent advances in Neuroergonomics have expanded our understanding of neurocognitive processes across different operational domains. We provide a framework to disentangle those neural mechanisms that underpin the relationship between task demand, arousal, mental workload and human performance. This approach advocates targeting those specific mental states that precede a reduction of performance efficacy. A number of undesirable neurocognitive states  are identified and mapped within a two-dimensional conceptual space encompassing task engagement and arousal. We argue that monitoring the prefrontal cortex and its deactivation can index a generic shift from a nominal operational state to an impaired one where performance is likely to degrade. Neurophysiological, physiological and behavioral markers that specifically account for these states are identified. We then propose a typology of neuroadaptive countermeasures to mitigate these undesirable mental states. A study of mental workload is fundamental to understanding the intrinsic limitations of the human information processing system. This area of research is also crucial for investigation of complex teaming relationships especially when interaction with technology necessitates multitasking or a degree of cognitive complexity.Mental workload has a long association with human factors research into safety-critical performance . Forty yThe lineage of mental workload incorporates a number of theoretical perspectives, some of which precede the formalization of the concept itself. Early work linking physiological activation to the prediction of performance  was formResearch into the measurement of mental workload has outstripped the development of theoretical frameworks. Measures of mental workload can be categorized as performance-based, or linked to the process of subjective self-assessment, or associated with psychophysiology or neurophysiology. Each category has specific strengths and weaknesses  and the There are a number of reasons that explain why mental workload is easy to quantify but difficult to operationalize. The absence of a unified framework for human mental workload, its antecedents, processes and measures has generated a highly abstract concept, loosely operationalized and supported by a growing database of inconsistent findings . The absFor the discipline of human factors, the study of mental workload serves two primary functions: (a) to quantify the transaction between operators and a range of task demands or technological systems or operational protocols, and (b) to predict the probability of performance impairment during operational scenarios, which may be safety-critical. One challenge facing the field is delineating a consistent relationship between mental workload measurement and performance quality on the basis of complex interactions between the person and the task. The second challenge pertains to the legacy and utility of limited capacity of resources as a framework for understanding those interactions.In the following sections, we detail some limitations of mental resources and advocate the adoption of a neuroergonomic approach  for the The concept of resources represents a foundational challenge to the development of a unified framework for mental workload and prediction of human performance. The conception of a limited capacity for information processing is an intuitive one and has been embedded within several successful models, e.g., multiple resources . But thiFor example, the theory of limited cognitive resources predicts that exposure to task demands that are sustained and demanding can impair performance due to resource depletion via self-regulation mechanisms at the neuron-level  is a brain structure often identified as the neurophysiological source of limited resources . The PFCThe existence of information processing resources can also be conceptualized as functional attentional networks in the brain. Michael Posner was the first to pioneer a network approach to the operationalization of resources in the early days of neuroimaging . His infThe capacity of the brain to monitor performance quality and progress toward task goals is another important function of the PFC during operational performance. The posterior medial frontal cortex (pMFC) is a central hub in a wider network devoted to performance monitoring, action selection and adaptive behavior . The pMFThis neuroergonomic approach provides a biological basis upon which to develop a concept of limited human information processing, with respect to competing neurological mechanisms, the influence of neuromodulation in the prefrontal cortex and antagonist directives between different functional networks in the brain. The prominence of inhibitory control coupled with competition between these neural networks delineate a different category of performance limitations during extremes of low vs. high mental workload, i.e., simultaneous activation of functional networks with biases toward mutually exclusive stimuli  or contradictory directives .The previous sections have highlighted the complexity of those brain dynamics and networks that can introduce inherent limitations on human information processing. On the basis of this analysis, it is reasonable to target neurophysiological states and their associated mechanisms that account for impaired human performance see . This reThe rationale for considering the dimension of task engagement is that performance is driven by goals and motivation . Goal-orArousal makes an important contribution to the conceptual space illustrated in Secondly, attentional states, such as inattentional deafness and blindness, result from the activation of an attentional network involving the inferior frontal gyrus, the insula and the superior medial frontal cortex . These rThirdly, measures of arousal are used to characterize high engagement and delineate distinct mental states within the category of low task engagement . Heart rFinally, behavioral metrics such as ocular behavior can complement the detection of low and high levels of engagement . Hence, These metrics provide some relevant prospects to identify the targeted deleterious mental states for especially for field studies as long as portable devices are concerned. It is worth noting that the extraction of several features  and the use of several devices is a way for robust diagnosis. Moreover, contextual information  should be considered as well as actions on the user interface and system parameters  if available so as to better quantify the user’s mental state.This review has identified some undesired mental states that account for degraded performance . A crucial step is to design cognitive countermeasures to prevent the occurrence of these phenomena. The formal framework that we proposed see  paves thms) and located information removal was an efficient mean to mitigate perseveration by forcing disengagement from non-relevant tasks. The first category of neuroadaptive countermeasure consists of triggering new types of notifications via the user interface to alert of impeding hazards. The design of these countermeasures is generally grounded on neuroergonomics basis so that these warning can reach awareness when other means have failed. Following this perspective, The second category of neuroadaptive countermeasure is the dynamic reallocation of tasks between humans and automation to maintain the performance efficacy of the operators . The undThe third and final category aims to warn the users of their mental state and “stimulate” neurological activity in order to augment performance. One of the most promising approach relies on the implementation of Neurofeedback see , mental The following illustration see  depicts The three types of neuroadaptive solutions offer promising prospects to mitigate the onset and likelihood of undesirable neurocognitive states. However, they should be delivered in a transparent, meaningful, and timely manner  so they are relevant and understood , otherwiper se. In both cases, explanations for performance breakdown are based upon neurological processes, such as dominance of specific neural networks or the heightened activity of specific mechanisms. We propose a two-dimensional framework of engagement and arousal that captures the importance of specific degraded mental sates associated with poor performance. The rationale for including the transactional concept of engagement in this scheme is to account for the goal-oriented aspect of cognition. The benefit of including the transactional concept of arousal is to make a distinction between two categories of disengagement, one that is accompanied by high arousal  and low arousal (mind wandering) – and to link this conceptual distinction to known neurophysiological effects (see This paper has argued that the concept of a limited resource provides a limited explanation for the breakdown of operational performance. Our neurophysiological analysis describes a number of additional mechanisms, such as perseveration and effort withdrawal, which do not represent finite resources ects see . NonetheThis neuroergonomic framework encompasses operationali- zations of these undesirable states that can be monitored continuously in an objective fashion. Such considerations eventually lead to propose a typology of neuroadaptive countermeasures and open promising perspectives to mitigate the degradation of human performance. However, to the authors’ very best knowledge, most of the neuroadaptive experimental studies have focused on human-machine dyad situations. We believe that recent research on hyperscanning , physiolAll authors have made a substantial and intellectual contribution to this review.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The years around menopause are the time that associates not only with hormonal changes but with psychological and social transitions, and previous studies have consistently revealed the relationship between menopause and depression. The present study examined the moderating effect of perceived partner responsiveness (PPR) on the association between menopausal symptoms (MS) and depressed affect (DA). The sample was middle-aged climacteric women  from the second wave of Midlife in the United States (MIDUSⅡ). Measurement for MS consisted of the frequency of five symptoms in the past 30 days . PPR was assessed using three items matched the core components of responsiveness . Results revealed that there were significant interactions between menopausal symptoms and PPR . Specifically, the level of elevation of DA in response to MS was smaller in women with higher levels of PPR  than in those with lower levels of PPR . According to the region of significance analysis, the coefficients of MS on DA were significant within the -2SD to +2SD range of PPR, but it decreased as the PPR increased. Findings suggest that partners’ careful responsiveness may mitigate the detrimental effects of MS on DA among climacteric women.


Four decades on from the publication of 'The Ageing Enterprise', this paper provides a critical review of the relationship between social theory and social policies for later life. To what extent do current theoretical perspectives in gerontology bear the influence of ideas laid out in that pioneering book? How has the ‘ageing enterprise’ fared given the dominant ideology of neo-liberalism and the precarious lives faced by people moving through the life course? The paper considers these questions in the context of globalization processes, and the imposition of austerity policies. The paper will consider the continuing importance of ‘The Ageing Enterprise’ by reviewing three main themes: first, assessing the changing relationship between the state and social policy; second, through examining current perspectives within critical gerontology; third, highlighting new forms of empowerment developing amongst older people, and the relationship of these to the values and ideas expressed in ‘The Ageing Enterprise’. Part of a symposium sponsored by the Women's Issues Interest Group.


Hydrothermal processes modify the chemical and mineralogical composition of rock. We studied and quantified the effects of hydrothermal processes on the composition of volcanic rocks by a novel application of the Shannon entropy, which is a measure of uncertainty and commonly applied in information theory. We show here that the Shannon entropies calculated on major elemental chemical composition data and short-wave infrared (SWIR) reflectance spectra of hydrothermally altered rocks are lower than unaltered rocks with a comparable primary composition. The lowering of the Shannon entropy indicates chemical and spectral sorting during hydrothermal alteration of rocks. The hydrothermal processes described in this study present a natural mechanism for transforming energy from heat to increased order in rock. The increased order is manifest as the increased sorting of chemical elements and SWIR absorption features of the rock, and can be measured and quantified by the Shannon entropy. The results are useful for the study of hydrothermal mineral deposits, early life environments and the effects of hydrothermal processes on rocks. Hydrothermal processes affect the chemical and mineralogical composition of rock by destabilizing and breaking down the primary rock mineralogy and by forming new secondary minerals ,2. The tEnrichment and depletion of elements and minerals play an important role in the formation of hydrothermal ore deposits. Enrichment of elements and minerals may lead to the formation of economic accumulations of metals and minerals . ChangesThe effects of hydrothermal processes on the composition of rocks are commonly studied by measuring the absolute or relative concentrations of chemical elements ,8 and byCHEM) and the spectral Shannon entropy (HSPEC), respectively. We will show that the Shannon entropy provides single quantitative measures of the effects of hydrothermal processes on the composition of rocks, and we will explain that the lowering of the Shannon entropy in the hydrothermally altered rocks is the result of sorting processes.In this study, we use a novel application of the Shannon entropy to study and measure the effects of hydrothermal processes on the composition of the rock. The Shannon entropy was originally developed in the context of digital transmission of information ,12. In iThree different rock sample sets were used in this study. One set represents the rocks that were altered by hydrothermal processes. The composition of the unaltered precursors could not be measured directly from these rocks because of the intense alteration. Therefore, two sample sets were used as analogs of the unaltered precursors to estimate the chemical and spectral mineralogical composition. The three sample sets are described below. The method of calculating the Shannon entropy of these rocks sets is also explained.The hydrothermally altered rocks are represented by a suite of 10 samples from volcanic lithologies of the Soansville greenstone belt of the East Pilbara Granite-Greenstone (EPGG) terrane in Western Australia . The samThe chemical composition of precursor analogs is represented by the analyses of a suite of 176 volcanic rocks from several Archean greenstone belts of the EPGG terrane in Western Australia . The selThe SWIR reflectance spectra of analogs of the unaltered precursor rocks are represented by spectra of a suite of 61 unaltered volcanics from the ASTER spectral library , rangingH) of a probability distribution (P) is defined as [m is the number of possible outcomes and ip is the probability of outcome i. The units of Shannon entropy are bits, because of the log2 term in the equation.The Shannon entropy HCHEM, and on SWIR reflectance spectra, HSPEC, of hydrothermally altered rocks and their assumed precursors. The Shannon entropy is used as a measure of uncertainty in probability distributions. Maximum uncertainty, or maximum Shannon entropy, occurs in a distribution where all possible outcomes have equal probabilities. Such a distribution resembles maximum heterogeneity or randomness. Minimum uncertainty is reached when one of the possible outcomes has a probability of one. In that case, there is no uncertainty and the Shannon entropy becomes zero. Such a situation can be regarded as a form of minimum randomness. Shannon entropies were calculated on distributions of the major element chemical compositions, HCHEM) were calculated from the whole-rock chemical compositions of the hydrothermally altered and metamorphic volcanic rocks from the EPGG terrane. This type of entropy was named the chemical Shannon entropy (HCHEM). The following 10 major elements, expressed in weight percentages of their oxides, were included in the calculations and normalized to 100%: Si, Ti, Al, Fe, Mn, Mg, Ca, Na, K and P. Less than detection values were replaced by half of the detection limit values following common practice. The element concentrations were first converted to molar percentages of the oxides and subsequently into molar percentages of the single elements. The chemical composition of each sample was then converted to a probability distribution by rescaling of the concentrations from a sum of 100% to 1. The HCHEM of the composition of each sample was calculated using Equation (1). Trace and volatile elements were not included in the calculation. Shannon entropies of the elemental chemical composition distribution  of the metamorphic volcanic rocks from the EPGG, was used to infer HCHEM of the actual precursor of the altered rock. The relationship between the HCHEM and the Zr/TiO2 ratio of the metamorphic volcanic rocks was calculated by linear regression of the means of the Zr/TiO2 ratios (predictor) on the HCHEM (predicted) of the different volcanic lithologies. Since the number of rock samples across the lithological groups is highly unbalanced, the means of each lithological group were used for this regression instead of the samples themselves. The resulting model was applied to estimate the HCHEM from the Zr/TiO2 ratios of the hydrothermally altered volcanic rocks . The reflectance spectra of the two sample sets were first resampled to a 1 nm spectral sampling and equal wavelength ranges. The resulting spectra covered the 1300–2500 nm range in 1201 discrete bands. This wavelength range contains diagnostic vibrational absorption features of many hydrothermal alteration minerals [SPEC following Equation (1) for each rock sample.Shannon entropies were calculated from the SWIR spectra of the hydrothermally altered rocks and the unaltered rocks from the ASTER spectral library. This type of entropy was named the spectral Shannon entropy  of hydrothermally altered rocks are lower than those of the unaltered precursor rocks  test confirmed that the mean HCHEM values of the four lithological and two alteration groups are not similar . A pairwise comparison using the Tukey’s range test showed that the differences between the six group are statistically significant for all pairs  except for the rhyolite and chlorite-quartz pair .The Shannon entropies calculated from major element chemical data (Hor rocks . Within g and Ca c–f. The ed rocks  is the rSPEC) of the hydrothermally altered rocks are lower than those of the unaltered precursor rocks ) are shown in CHEM and ΔHSPEC values that range between 0.969 and 1.232 bits and between 0.034 and 0.074 bits, respectively. The chlorite-quartz altered rocks show less elevated values of ΔHCHEM and ΔHSPEC values, which range between 0.363 and 0.612 bits and between 0.001 to 0.002 bits, respectively. The decrease in Shannon entropy of the hydrothermally altered rocks represents a lowering of the uncertainty in the probability distributions of the major element composition and the SWIR reflectance spectra from which the Shannon entropy was calculated. We interpret this decrease in uncertainty as a form of information that was measured using the distributions of rock measurements, and imposed on the rock itself, by the hydrothermal processes and which can be measured using the Shannon entropy.The differences in chemical and spectral Shannon entropy between the hydrothermally altered rocks and the unaltered precursor rocks (ΔHCHEM represents the uncertainty in the type of chemical element measured when one atom of the rock is sampled. The uncertainty with respect to the type of selected atom is larger when the distribution has equal probabilities than in the situation when the distribution has more varying probabilities. The latter occurs in the suite of hydrothermally altered rocks where selective enrichment and depletion resulted in distributions of high probabilities of Si and low probabilities of most of the other elements. A low chemical Shannon entropy is interpreted as the result of increased sorting of chemical elements in the altered volcanic rock.The chemical Shannon entropy HSPEC is interpreted as the uncertainty in wavelength of absorbed IR radiation when one IR-ray that has been absorbed by the rock is sampled and measured. The uncertainty in the wavelengths at which absorption occurs, decreases in SWIR spectra with deep absorption features in a few narrow wavelength ranges in bright rock. In these rocks, there is a dominance of absorption at a few narrow wavelength ranges. Flat horizontal spectra approach equal probabilities and produce high entropy values, indicating the absence of deep absorption features. The low spectral Shannon entropy is interpreted as the result of increased sorting of absorption features in the altered rock. From other studies [The spectral Shannon entropy H studies , it is kThe Shannon entropy provides quantitative estimates of the effects of sorting processes on the composition of rocks. It is important to note that the Shannon entropy is somewhat subjective since the values depend on the type and number of the measured variables. We do not normalize the Shannon entropy and therefore there is no maximum bound. For quantitative comparisons between rocks analyzed in different batches or from different areas, the measurement parameters have to be standardized. This means that parameters, such as the number and type of chemical elements or spectral bands and the units in which they are measured, must be equal. Different measurement parameters will give different Shannon entropy values of the same rock.By placing our results in a wider geological context of the study area, we found a relationship between the change in Shannon entropy of the hydrothermally altered rock and the heat of a cooling magma that drove the hydrothermal system in which the rocks were altered. The altered rocks in this study were originally deposited in a submarine seafloor environment where heat provided by a coeval sub-volcanic intrusion drove hydrothermal fluids through the volcanic sequence . TemperaCirculation of predominantly seawater-derived fluids caused large-scale alteration of the volcanic rocks, where the type and composition of the altered rock depend on the fluid composition and physicochemical conditions. The hydrothermal fluids destabilized the primary volcanic minerals, such as volcanic glass and ferromagnesian minerals, and produced quartz-sericite and chlorite-quartz as alteration minerals. Alteration reactions caused the liberation of Na and Ca, which were subsequently removed by hydrothermal fluids, and the accumulation of Si. Further depletion of Fe and Mg occurred in zones of sericite-quartz alteration. Fe and/or Mg in chlorite-quartz altered rock were retained in chlorite. The breakdown of precursor minerals and the formation of new minerals changed the chemical composition and increased the sorting of elements in the volcanic rock. Due to similarity between the Shannon entropy and the statistical thermodynamic entropy of Boltzmann ,24, i.e.Sorting processes play an important role in the formation of mineral deposits, where selective enrichment and depletion may lead to the accumulation of elements or minerals. The Shannon entropy is a measure of the degree of sorting of chemical elements in rock and can, therefore, be used to detect these accumulations. The Shannon entropy is insensitive to the types of elements that are enriched and depleted. The method is complementary to conventional methods of rock composition analysis and does not replace them. Many mineralized environments are formed by hydrothermal processes, where hydrothermally altered rocks are associated with economic accumulations of elements or minerals. The Shannon entropy can act as a proxy for mineralization by enabling the identification of zones of intense wall-rock alteration, independent of the type of alteration.Hydrothermal environments are considered favorable for developing and sustaining early life ,26. HydrWe conclude that the hydrothermal processes described in this study present a natural mechanism for transforming energy from heat to increased order in rock. The relationship between heat and Shannon entropy is indirect and based on changes in the probability distributions of rock measurements. The increased order is manifest as increased sorting of chemical elements and SWIR absorption features of the rock and can be measured and quantified by the Shannon entropy. The results are useful for the study of hydrothermal mineral deposits, early life environments and the effects of hydrothermal processes on rock.


The Mosquito: A Human History of Our Deadliest Predator  details Anopheles,” which delivered malaria to the Persians as they navigated swampy terrain, ultimately led to a victory by the Greeks during the Greco-Persian Wars. Mosquitoes aided the rise and the fall of the Roman Empire because the Pontine Marshes served as a barrier to enemies and a direct source of disease. Christianity spread across Europe and had a reputation as a healing religion that valued treating persons affected by the mosquitoborne diseases. Christians failed to capture the Holy Land during the Crusades partially because Plasmodium-infected mosquitoes attacked inexperienced Crusaders.This book describes how mosquitoes and their diseases have shaped the outcomes of war, the spread of religion, and the development of modern culture. Attacks from “General Winegard emphasizes the effect of mosquitoborne diseases on the development of the United States. European explorers delivered a lethal dose of mosquitoborne disease to the New World, contributing to the destruction of indigenous populations and the subsequent colonization of the Americas. Partial acquired and genetic immunity to vectorborne diseases drove the demand for enslaved persons from Africa, ensuring the productivity of plantation economies. Widespread malaria delayed the Union victory during the American Civil War, contributing to Abraham Lincoln’s decision to focus on the elimination of slavery. Without malaria, a rapid Confederate defeat might not have led to the Emancipation Proclamation of 1863. Although mosquitoes probably were not the sole reason for these historical outcomes, they most likely contributed substantially to the progression of events.Winegard emphasizes that, despite modern scientific advancements, the mosquito’s legacy to shape human history is not finished. The development of DDT and antimalarial drugs, such as atabrine and chloroquine during World War II, followed by the subsequent emergence of resistance to these treatments, provide evidence for the need to continue research of mosquitoborne diseases. This book also touches on the controversial topic of clustered regularly interspaced short palindromic repeats, an innovative technology that could genetically alter mosquitoes to prevent human diseases. Although Winegard describes the potential usefulness of this powerful tool, organisms and the environment may suffer unintended devastating consequences.This book is a fascinating account of the value of mosquitoes in shaping human culture and existence across time. Persons interested in the interplay between history and disease and future implications will learn much and enjoy the accumulation of knowledge and the exciting narrative presentation.


Functional disability leads to limitations in the older adults’ personal activities and social participation. The purpose of this study was to examine the International Classification of Functioning Disability and Health model in which personal activities and social participation influence functional disability in older adults who live alone and have experienced falls. The study used a secondary data analysis of the 2017 National Survey of Older Koreans. A total of 501 study participants met the inclusion criteria. The results of multiple linear regression indicated that gender and the number of acquaintances were significantly related to the functional disability of social participation while overnutrition, depressed symptom and cognitive dysfunction were related to the functional disability of personal activities. Lastly, poor muscle strength, old age and economic status were predictors of the functional disabilities of both personal activities and social participation. The findings of the study revealed that it is important to comprehensively evaluate not only personal activities but also social participation of older adults who live alone and have experienced falls. In addition, the ICF model may be useful in the development of intervention programs for preventing functional disability in the population.


Pancreatic fistula (PF) remains the primary source of morbidity after distal pancreatectomy (DP). There is currently no optimal stump closure technique to reduce PF rates. We present a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of Pancreas (CLASP). Five patients  with a median age of 65 years underwent DP and splenectomy for pancreatic body or tail tumour using the CLASP technique. Four of those operations were done laparoscopically. Only one patient developed grade A PF. No other postoperative complications were noticed. The mean length of stay was 5.4 days. The CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. The key points include mobilisation of the pancreatic body from the retroperitoneum and division of the parenchyma with energy device. The technique of pancreatic stump closure involves the isolation of the pancreatic duct (PD), application of a double ligaclip on the proximal duct, division of the PD and finally suturing of the pancreatic stump. The CLASP technique is an effective and safe alternative technique to the current traditional methods of pancreatic stump closure. Distal pancreatectomy (DP) was first performed by Billroth in 1884 and was further outlined by Mayo in 1913 . MultiplMany techniques have been proposed for the management of the pancreatic remnant to reduce the incidence of PF after DP. Stapler closure and handsewn closure of the pancreatic stump are the standard methods described in the literature ,6-8. SevWe present a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of the Pancreas (CLASP). We retrospectively reviewed a prospective database of five patients who underwent DP and splenectomy (DPS) using the CLASP technique by a single surgeon (K.M.). Clinicopathological data and outcomes of the patients were recorded and analyzed. Postoperative complications were classified according to the Clavien-Dindo methodology, and PF was graded according to the International Study Group of PF -19.The initial standard steps that we follow for the DPS include the division of the gastrocolic ligament and short gastric vessels, the mobilisation of the inferior and superior pancreatic borders, and the tunnelling below the pancreatic body/neck, proximally to the lesion. The splenic artery and splenic vein are identified, isolated and divided separately at the level of the planned parenchyma transection. The CLASP technique for the closure of the pancreatic stump is applicable for both open and laparoscopic surgery following the same principles and key points Figures -8. The p Overall, five patients underwent DPS using the CLASP technique. Table The main effort of all the techniques for the closure of the pancreatic stump is to decrease the incidence of PF. It is well known that the pancreatic leak from the pancreatic parenchyma and small pancreatic duct branches is usually self-controlled and rarely causes clinically relevant PF (grade B or C). On the contrary, leak from the MPD is the primary source of morbidity after DP . There iOur novel technique could be an alternative way of closing the pancreatic stump after DP, comparable to the traditional ones that have been described previously. The focus is on two key points: firstly the division of the pancreatic parenchyma using an energy device that seals the small pancreatic duct branches and secondly the identification and isolation of the pancreatic duct followed by the precise and accurate application of two or three metal clips on the proximal MPD. The pancreatic cut surface is oversewn with a continuous 4.0 prolene suture, closing the lips of the pancreatic remnant. No further adjunct, such as omental plug, falciform ligament patch or fibrin glue sealant, is necessary. We believe that the incidence of leak is reduced when the MPD is identified and directly clipped.The CLASP technique is applicable to both open and laparoscopic surgery, based on the same principles. It is easily reproducible using an energy device and ligaclips that are routinely used in laparoscopic DPS. We believe that the CLASP technique can be routinely used to close all pancreatic stumps, but also has two specific indications. The first indication is for bulky and thick pancreas where the application of a stapler could crush the parenchyma, increasing the risk of pancreatic leak . The secThe present study has limitations, which are mainly inherent to the small number of patients who underwent DPS using the CLASP technique. Moreover, the results should be validated using large cohorts comparing all the methods of pancreatic stump closure taking into consideration the appearance of the pancreas, the size of the duct and the anatomical and pathological characteristics of the lesion. The CLASP technique appears to be feasible, reproducible and safe alternative technique that can be used for the pancreatic stump closure, compared to the traditional methods of pancreatic stump closure. Particular indications include the presence of bulky pancreas and proximal pancreatic body or neck lesions. Further clinical studies including prospective randomised controlled trials could establish a standardised approach for the pancreatic stump closure.


One of the most frequent complications of the systematic lymph node dissection (SLND) is the injury of autonomic nervous system in the para-aortal region during the procedure. These injuries are supposed to be responsible for some of the postoperative bladder, bowel, and sexual dysfunctions. The poor anatomical understanding of the sympathetic nerves within the boundaries of an infra-renal bilateral template has limited the promulgation of a precise nerve-sparing surgery during such SLND. Therefore, the principal goal of the present study was to provide the first ever-comprehensive exposition of the anatomy of the female aortic plexus and superior hypogastric plexus and their variations. This exposition was achieved by strategic dissection of 19 human female cadavers and extrapolating the findings to develop a precise surgical technique for more accurate navigation into these structures during nerve-sparing SLND in 15 cervical cancer patients and 48 ovarian cancer patients.Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology. Dissection evaluation of pelvic and para-aortic lymph nodes has been an integral component of the surgical staging protocol for several gynaecologic malignancies for over a century ,2. HowevNevertheless, the significance of the prognostic value of the para-aortic lymph node status in locally advanced cervical cancer has been accentuated again in the new International Federation of Gynaecology and Obstetrics (FIGO) staging system for cervical cancer that classifies patients with a para-aortic lymph node involvement in stage FIGO IIIC2 .These developments in surgical management of gynaecological malignancies have given rise to austere diagnostic restrictions for a systematic lymph node dissection in such cases. Taking these facts and the potential additional treatment burden of a systematic lymph node dissection into account, all contentions are in place to avoid the complications of a lymph node dissection. One of the most frequent and vital complications of the para-aortic lymph node dissection that has perhaps never descended into the cognitive focus of many gynaecologic oncologists is the injury of autonomic nervous system in the para-aortal region during the procedure. The present study supposes that these nerve injuries are responsible for some of the postoperative bladder, bowel, and sexual dysfunctions.The present study also contends that a poor anatomical understanding of the sympathetic nerves within the boundaries of an infra-renal bilateral template has limited the promulgation of a precise nerve-sparing surgery during such systematic lymph node dissections. Since we already described the precise anatomy of pelvic autonomic nervous system (inferior hypogastric plexus) in our previous studies ,8,9, theThis exposition was achieved by strategic dissection of human female cadavers and extrapolating the findings to develop a precise surgical technique for more accurate navigation into these structures during nerve-sparing systematic lymph node dissections, especially in the para-aortic region.The abdominal aortic plexus is the sympathetic network of autonomic nerves overlying in the front and sides of the abdominal aorta in the infra-renal bilateral template and going along with the superior hypogastric plexus at the sacral promontory ,11. The The cadaver study has primarily shown that the easiest way to identify the lumbar splanchnic nerves is to prepare and dissect them from their caudal most part at the superior hypogastric plexus in the presacral area (the point of bifurcation of the common iliac arteries) and then to track carefully the deepest lumbar splanchnic nerve , to its point of origin at the second lumbar ganglion of the right sympathetic trunk. The study has also elucidated that it would be easy, in most cases , to identify a ganglion at the right side of the aorta around the inferior mesenteric artery or maximal 1 cm caudal from it (the inferior mesenteric ganglion). Successful identification of this ganglion allows the dissection to go laterocranial and dorsal to the vertebral column in the interaortocaval space above the middle lumbar vein and then behind the vena cava, at the level of the right lumbar artery  in the study. This accessory nerve originates in our cases from the third lumbar ganglion of the right sympathetic chain and joins the inferior right lumbar splanchnic nerve before reaching the inferior mesenteric ganglion.The superior right splanchnic nerve will be easy to identify when dissecting along to its origin from the first lumbar ganglion of the right sympathetic chain behind and lateral of vena cava at the level where the left renal vein inserts into vena cava crossing over the right superior lumbar vein. . In all of these cases, the superior lumbar splanchnic nerve is identified as crossing another even smaller ganglion directly caudal from the origin of right ovarian artery from the aorta. .By resecting the lymph node in the paracaval region, there is truly little or no chance to injure the right lumbar splanchnic nerves or the right sympathetic chain during the surgery. The dissection and resection of lymph nodes in the intra-aortocaval region, on the other hand, always leads to an injury to the right lumbar splanchnic nerves, the inferior mesenteric ganglion, the prehypogastric ganglion, and the ovarian  ganglion, if the surgeon does not pay sufficient attention to recognize, highlight, and carefully isolate these nervous components , and it obviously complicated the clear exposure of the first lumbar ganglion of the left sympathetic chain  during systematic lymph node dissection is the postoperative impairment of the sexual function. Impairment of the sexual function is, in fact, the most enduringly compromised quality-of-life (QOL) issue encountered after treatment for gynaecologic cancers, affecting up to 50% of the patients ,25,26. TIn the recently published data of a sub-protocol of the prospectively randomized LION trial, comparing two cohorts that differed only in the performance of a lymphadenectomy, the role of radical surgery in the retroperitoneal space has been prospectively substantially evaluated with reference to the sexual function (sub-study LION-PAW). It is imperative to mention that, in the LION trial, there have been no requirements for nerve-sparing surgical techniques . The subThe anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. Rigorous dissection protocol was in place to interpret the retroperitoneal para-aortic nervous connections to and from the contiguous anatomical structures, with specific reference to lymph node dissection in gynae-oncology. The new anatomical know-how from this cadaver study was utilized to enhance and develop a superior technique for para-aortic lymph node dissection and was efficaciously employed in locally advanced cervical cancer (a cohort of 15)  and in aWe aimed in this study to describe the whole components of abdominal aortic plexus anatomically and to develop a surgical technique to help us to spare them during systematic lymph node dissection (The video presents the technique of laparoscopic nerve-sparing lymph node dissection ). The foThe nerve-sparing systematic lymph node dissection is feasible in gynaecological malignancies by following the aforementioned anatomical depended surgical technique for dissection the aortic and superior hypogastric plexus. This might enhance the postoperative functional outcomes, especially the sexual complications after such surgeries.


The technological and scientific progress that we have experienced in recent years has contributed to characterization of the complex processes underlying human biology and evolution. In this regard, the studies performed on humans, both in pathological and physiological conditions, have been fundamental to improving knowledge of how genes, epigenetic modifications, aging, nutrition, drugs, and the microbiome affect the state of health and influence the onset of diseases . FurtherFrom a forensic field application point of view, the technological progress undergone by biology has allowed the development of innovative tools for scientific investigation. DNA analysis is no longer solely for comparative use but also for investigative use. In the last 30 years, alongside the development of increasingly sensitive techniques capable of typing biological samples consisting of even only a small number of cells, protocols and software have been developed for the interpretation of predictive markers of phenotypic, ancestral characteristics, and for the biostatistical evaluation of evidence ,3.Forensic Genetics and Genomics” focuses on the latest scientific achievements in the field of forensic biology, from the introduction of new technologies allowing DNA analysis at crime scenes to the use of big data from genome sequencing studies and the study of population genetics for the development of protocols with investigative and phylogenetic purposes.The Special Issue “This Special Issue features eleven high-impact scientific articles. One of the most up-to-date issues is the possibility of analyzing DNA directly at the crime scene. A drawback of current forensic DNA technology is the need for cumbersome equipment, making it difficult to operate outside the laboratory environment. Transitioning forensic DNA analysis from the laboratory to the scene of an incident should deliver wide-ranging benefits in terms of the speed of result delivery, reduced contamination risk, and more efficient staff training ,5. OxforNanopore Sequencing of a Forensic STR Multiplex Reveals Loci Suitable for Single-Contributor STR Profiling explores the possibility of using this new technology in detail, highlighting its current limitations though also proposing short-term solutions that could allow partial rapid application [The article lication . While tlication . Comparative Analysis of ANDE 6C Rapid DNA Analysis System and Traditional Methods compares the rapid analysis of DNA using the ANDE 6C with that of capillary electrophoresis [Continuing the topic of on-site genetic analysis, the work of Ragazzo M et al. In the field of new technologies, the article by Ragazzo et al. describes the application of NGS technology for DNA typing and for personal identification in the case of mixed biological evidence . The resA number of papers on population genetics have been published in this Special Issue ,10,11,12Ancestry Prediction Comparisons of Different AISNPs for Five Continental Populations and Population Structure Dissection of the Xinjiang Hui Group via a Self-Developed Panel selected 30 novel AISNPs able to discriminate between African, European, East Asian, and South Asian populations and developed a multiplex analysis based on the NGS platform, comparing the resulting ancestry resolutions with those provided by the other published AISNPs [The paper d AISNPs ,13,14,15d AISNPs . The resd AISNPs .Joint Genetic Analyses of Mitochondrial and Y-Chromosome Molecular Markers for a Population from Northwest China reports an interesting study of the Chinese population [The paper pulation . China cpulation . The genpulation . The happulation . Thus, mpulation . Howeverpulation . Characterizing Y-STRs in the Evaluation of Population Differentiation Using the Mean of Allele Frequency Difference between Populations describes the use of the mean of allele frequency differences (mAFD) from the Yfiler set and Yfiler Plus to determine any population sub-division [The paper division . These rdivision .Genetic Reconstruction and Forensic Analysis of Chinese Shandong and Yunnan Han Populations by Co-Analyzing Y Chromosomal STRs and SNPs reports a comparative study through the use of Y-STRs and low-resolution Y-SNPs in two Chinese populations—Shandong Han and Yunnan Han—to characterize the patrilineal patterns within these populations [The article ulations . As a reulations .A Highly Polymorphic Panel Consisting of Microhaplotypes and Compound Markers with the NGS and Its Forensic Efficiency Evaluations in Chinese Two Groups evaluates the use of a selection of 29 compound markers that are a combination of one InDel and one SNP in a genomic region [The paper c region . In partc region . This prc region .The STRidER Report on Two Years of Quality Control of Autosomal STR Population Datasets reports the two-year experience of STRidER, the STRs for the Identity ENFSI Reference Database [The paper Database . It is aDatabase . The repDatabase . It is wDatabase . Data acDatabase .Autosomal STR Profiling and Databanking in Malaysia: Current Status and Future Prospects details the progress of DNA profiling and DNA databanking in Malaysia [Criminal DNA databases are expanding around the world to support the activities of criminal justice systems. The paper Malaysia . The artMalaysia . Challenges in Human Skin Microbial Profiling for Forensic Science: A Review reports on the possible applications of microbiome analysis in the field of forensic science. It is well known that humans have an extremely diverse microbiome that can be useful in inferring ethnicity and personal identification [The paper fication . The forfication .In conclusion, the heterogeneity and quality of the works presented in this Special Issue represent the constant advancement of knowledge in the field of forensic genetics.The development of technologies that allow the analysis of huge portions of the genome or the whole genome is already promoting the transition between forensic genetics and forensic genomics. Alongside the classic typing of STR markers for personal identification and for the genetic characterization of biological evidence, we are witnessing the development of methods that analyze every element of the genome, the transcriptome, and the epigenome. The new achievements of omic sciences can be used in forensic sciences as long as technological evolution allows the validation and standardization of the results. We are likely at the dawn of a new forensic genomics era whose potential applications are limited only by the imagination of researchers.