Current Classification Research Articles

Abstract 5205: Beyond boundaries: ADRB3, a novel prognostic marker in pediatric neuroblastoma

Abstract Introduction: Neuroblastoma (NB) is a pediatric tumor arising from immature nerve cells originating from neural crest cells. This malignancy is characterized by a remarkably early onset, with only 10% of cases occurring beyond 5 years of age. According to the INRG classification, ~50% of patients are classified as low risk (L1/L2). Despite advances in treatment, around 20% of these experienced a relapse within 5 years with a mere 10% survival rate. Methods: We investigated the role of the adrenoceptor beta-3 (ADRB3) as a prognostic factor for NB. The samples provided by IRCCS Meyer Children’s Hospital allowed us to measure cytofluorimetric level expression of ADRB3 in tissue biopsies from 43 NBs, in the circulating tumor cells (CTCs) and in the bone marrow cells (BMCs) at onset and at the end of treatment. Further, to study the role of ADRB3 in NB, we used CRISPR-Cas9 to knock down ADRB3 expression in mice model. Results: Results indicate that ADRB3 levels in biopsy at the onset are significantly higher (Wilcoxon test, p = 0.026) in patients with negative outcome than those who achieved complete remission. The R package survival was used to perform Survival curve analysis to further assess the impact of ADRB3 at the onset in biopsy tissues. Results confirmed a significant separation (p = 0.031) between survival curves of patients with high levels and those with low levels, reinforcing its importance as a prognostic factor. Moreover, the same results were found in survival curves (p = 0.038) in low-risk patients, corroborating the importance of ADRB3 levels to discriminate between unfavorable or favorable prognosis. Moreover, post-chemotherapeutic treatment analysis, in both residual CTCs and BMCs, indicated statistically differences in ADRB3 levels between fully recovered patients and deceased. Survival curves, stratified by ADRB3 levels in CTCs post-chemotherapy, a favorable prognosis for patients with low levels (p = 0.0001). Finally, the expression analysis showed that ADRB3 levels in NB cells led to increment of processes associated with the cellular migration and metastasization and in metabolism. Conclusion: Our findings suggest that ADRB3 is a significant prognostic factor for NB. Patients with high ADRB3 expression in biopsy at the onset and after the treatment have a higher risk of unfavorable outcome, even for low-risk patients. In conclusion, our results challenge current classification and prognostic paradigms, highlighting ADRB3's crucial role in NB, contributing to refine risk stratification and unveil a new potential target for liquid biopsy of detecting, analyzing and monitoring CTCs. Citation Format: Gianluca Mattei, Cristina Banella, Francesco Carrozzo, Amada Pasha, Annalisa Tondo, Claudio Favre, Maura Calvani. Beyond boundaries: ADRB3, a novel prognostic marker in pediatric neuroblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5205.

Prediction uncertainty estimates elucidate the limitation of current NSCLC subtype classification in representing mutational heterogeneity

The heterogeneous pathogenesis and treatment response of non-small cell lung cancer (NSCLC) has led clinical treatment decisions to be guided by NSCLC subtypes, with lung adenocarcinoma and lung squamous cell carcinoma being the most common subtypes. While histology-based subtyping remains challenging, NSCLC subtypes were found to be distinct at the transcriptomic level. However, unlike genomic alterations, gene expression is generally not assessed in clinical routine. Since subtyping of NSCLC has remained elusive using mutational data, we aimed at developing a neural network model that simultaneously learns from adenocarcinoma and squamous cell carcinoma samples of other tissue types and is regularized using a neural network model trained from gene expression data. While substructures of the expression-based manifold were captured in the mutation-based manifold, NSCLC classification accuracy did not significantly improve. However, performance was increased when rejecting inconclusive samples using an ensemble-based approach capturing prediction uncertainty. Importantly, SHAP analysis of misclassified samples identified co-occurring mutations indicative of both NSCLC subtypes, questioning the current NSCLC subtype classification to adequately represent inherent mutational heterogeneity. Since our model captures mutational patterns linked to clinical heterogeneity, we anticipate it to be suited as foundational model of genomic data for clinically relevant prognostic or predictive downstream tasks.

Cost-revenue aspects of endovascular treatment of distal aortic arch pathologies with respect to the introduction of a new thoracic side-branch prosthesis

The standard vascular surgical procedure (SV) for the treatment of distal aortic arch pathologies involves ahybrid approach using aleft carotid-subclavian bypass and thoracic endovascular aortic repair. Considering the introduction of athoracic side branch prosthesis (TBE), the aim of this study was to analyze the cost-revenue aspects of both procedures. Aretrospective analysis was conducted on cases treated by SV from 2017 to 2022. To draw conclusions regarding the use of TBE, the main diagnoses and procedures of SV were recoded based on current classifications (ICD/OPS 2023) for revenue calculations and regrouped according to aG-DRG 2023. An OPS modification and regrouping were performed for modeling TBE revenues. Atotal of 13 cases were identified (mean age 62.5 ± 13.8 years; 10males). After regrouping, the following DRGs were obtained: F42Z in N = 5, F51A in N = 4, F08B in N = 2, and F07A and F36B each in N = 1. The total revenue after regrouping was € 666,514.13, including an additional payment (ZE) of € 132,729.14. With the modeled application of TBE, atotal revenue of € 659,212.19 was achieved. Compared to SV, this represents arevenue decrease of € 16,886.71 (changed DRG), but with an increase in ZE revenue by € 65,559.78 (different ZE). The use of TBE resulted in asaving of 74occupancy days, including 13.5 days in intensive care. Acost coverage seems probable with achange in the procedure, despite the yet to be determined pricing of TBE. This is highly dependent on the coding quality and the future development of ZE, given the annually changing DRG relative weights. Precise and transparent performance and cost documentation are essential for determining the pricing.

Risk Management and Preventive Conservation of Cultural Heritage: The Case of Karaman Hatuniye Madrasa and Karaman City Museum

Various methodologies have been developed to determine the risks of cultural properties that have been exposed to various risks since their construction and to make proposals for their preventive conservation. This study aims to protect the cultural, architectural, historical, and documentary values of historic buildings by identifying their threats and potential risks for risk management and preventive conservation studies and determining their risk levels considering the degree of vulnerability and frequency of occurrence in order to ensure their sustainability. Karaman Hatuniye Madrasa and Karaman City Museum were selected as case studies for cultural heritage risk management. The following standards were used to determine risk levels: the RE-ORG method for museum storage facilities, ICRROM’s (2016) “Guide to Risk Management of Cultural Heritage” and ISO 31000 (2018) for risk analysis, and UNI EN 16096 (2012) standard for current condition assessment, risk priority, urgency class, and recommendation classification. The hazards and potential risks were identified and classified through field observations, literature review, archival research, oral interviews, and data from national (AFAD) and international (EM-DAT) databases. The results showed that Karaman Museum has a medium risk level and RE-ORG is required in the building and collections only, on the other hand, Hatuniye Madrasa has a high-risk level. In particular, abandonment/underuse and faulty restoration works are the main factors that increase the risk level. The study is important for the protection and conservation of Hatuniye Madrasa and Karaman Museum and their collections through risk management and preventive conservation measures and is an example of systematic assessment of risks in cultural properties.

Molecularly defined sinonasal malignancies: an overview with focus on the current WHO classification and recently described provisional entities

Classification of tumors of the head and neck has evolved in recent decades including a widespread application of molecular testing in tumors of the sinonasal tract, salivary glands, and soft tissues with a predilection for the head and neck. The availability of new molecular techniques has allowed for the definition of multiple novel tumor types unique to head and neck sites. Moreover, an expanding spectrum of immunohistochemical markers specific to genetic alterations facilitates rapid identification of diagnostic molecular abnormalities. As such, it is currently possible for head and neck pathologists to benefit from a molecularly defined tumor classification while making diagnoses that are still based largely on histopathology and immunohistochemistry. This review covers the principal molecular alterations in sinonasal malignancies, such as alterations in DEK, AFF2, NUTM1, IDH1-2, and SWI/SNF genes in particular, that are important from a practical standpoint for diagnosis, prognosis, and prediction of response to treatment.

The International Classification of Functioning Disability and Health Framework (ICF): a new approach to enhance sport and physical activity participation among people with disabilities in Scotland.

This research provides a pilot study of the International Classification of Functioning Disability and Health Framework (ICF) involving persons with disabilities (PWD) with and without lived experience of sport participation in Scotland. National surveys in Scotland provide limited information on the nature of individual disability restricting the understanding of the relationship between disability and sport and physical activity participation. The ICF is a framework that aims to describe and classify functioning and thus can be used as a tool to provide a more detailed description of impairment for PWDs beyond their clinical condition. This knowledge has the potential to enhance the development of policies to increase the participation levels in this group. The ICF has also been used to inform the current IPC classification system at a competitive and elite level. As part of a larger study, 450 participants aged between 12 and 70 years completed an online questionnaire examining attitudes to, and participation in, sport and physical activity as well as completing the structural and functional components of the ICF. Subsequently, 18 people participated in focus groups aged between 13 and 61 years. The focus groups examined four meta-theme areas: physical, social, psychological, and sport-specific factors. The results confirm that the ICF provided a more detailed indicator of the key impairments that could have an impact on sport and physical activity participation. There was a clear lack of awareness of the links between the ICF and the classification system for competitive parasport. We concluded that a modified ICF-based assessment tool, incorporating social and environmental factors, has the potential to predict the likelihood of participation and offers a more comprehensive picture of both individual and national disability characteristics. This allows for the development of targeted policies and strategies to assist those with a disability to participate in sport. The overall framework presents a shift in thinking, in policy terms, for those in public health and in sport governance and delivery. The significance of this work is especially concerned with public health and wellbeing and sport development policy as pathways from recreational sport user to elite athlete parasport classification and performance.

Global conservation genomics of blue whales calls into question subspecies taxonomy and refines knowledge of population structure

AbstractBlue whales (Balaenoptera musculus) are the largest living animal and, like other baleen whales, became endangered due to whaling. Here, we used population genomics to infer the number, distribution and other characteristics of subspecies and populations. We used the largest DNA dataset in blue whales, both in terms of genomic markers (16,661 SNPs and mtDNA) and geographic coverage (n = 276 for SNPs; n = 531 for mtDNA). We found greatest divergence among the eastern Pacific, Indo‐western Pacific and Antarctic blue whales. There were indications that natural selection in different environments promoted divergence among these groupings. Within these regions, there was divergence between the eastern North and eastern South Pacific, and among the eastern Indian Ocean, the western South Pacific and the northern Indian Ocean. There was no divergence within the Antarctic. These findings are consistent with the current classification of Antarctic and Indo‐western Pacific blue whales in the Southern Hemisphere as different subspecies but call into question the subspecies taxonomy of eastern Pacific blue whales. The study shows that opposite breeding seasons on either side of the equator do not necessarily inhibit connectivity across the equator, and reinforces that population structure needs to be well understood to conserve the diversity within species.

Endo-Perio Lesions and Dentists' Treatment Approach: A Survey.

BACKGROUND Endo-perio lesions are a great challenge for dentists. The aim of this study was to evaluate the treatment approach of dental practitioners to endo-perio lesions by considering the current endo-perio classification. MATERIAL AND METHODS An online survey was prepared, consisting of questions about the treatment approach to 3 simulated cases with endo-perio lesions, shown on periapical radiography. Details of the patient's age, presence of systemic disease, smoking, and how the single- or multi-rooted tooth would affect the treatment plan were also included in the simulated cases presented in the survey. The survey was sent to 1500 dentists via e-mail, WhatsApp, and social media platforms. The chi-square test was used for comparison of data. Significance was evaluated at P<0.05. RESULTS In total, 338 dentists participated in the survey, including general dentists, endodontists, and periodontists. Fifty-three percent of participants stated that they would perform root canal treatment and initial periodontal treatment simultaneously, when both treatments were required. In cases classified as grade 3, most general dentists, endodontists, and periodontists answered that they would prescribe systemic antibiotics if there was diffuse extra-oral swelling (P<0.05). Moreover, in grade 3 cases, more general dentists chose the option "extraction" as the best choice, compared with endodontists and periodontists, who did not choose extraction as often (P<0.05). CONCLUSIONS According to the results of this study, general dentists, endodontists, and periodontists generally follow different approaches to endo-perio lesions. A consensus is needed on this issue to develop a successful multidisciplinary approach to endo-perio lesions.

Childhood and Adolescent Relapsed/Refractory Aggressive B-Cell Lymphomas With t(8;14) and BCL2 Expression, Burkitt Lymphoma Versus Diffuse Large B-Cell Lymphoma: A Diagnostic Challenge.

We present 2 diagnostically challenging cases of pediatric/adolescent relapsed/refractory aggressive mature B-cell non-Hodgkin lymphoma (B-NHL) within the spectrum of Burkitt lymphoma and diffuse large B-cell lymphoma and illustrate the different therapeutic regimens that are employed for pediatric and adult cancer centers. Both cases displayed varying-sized lymphoma cells with occasional single prominent nucleoli and heterogeneous BCL2 expression. Cytogenetics revealed complex karyotypes with t(8:14)(q24.2;q32) and IGH::MYC rearrangement by FISH. Next generation sequencing revealed deleterious TP53 and MYC mutations. We concluded that both could be diagnosed as "DLBCL-NOS with MYC rearrangement" using the current pathologic classifications, 2022 International Consensus Classification (ICC) and World Health Organization Classifications of Haematolymphoid Tumors (WHO-HAEM5). This report illustrates diagnostic challenges and treatment dilemmas that may be encountered, particularly for adolescent and young adults (AYA).

CAM based fine-grained spatial feature supervision for hierarchical yoga pose classification using multi-stage transfer learning

In this paper, we propose a technique for hierarchical yoga pose classification (YPC) in a multi-stage multi-tasking framework. We propose a three-stage transfer learning based end-to-end training methodology. Novelty lies in (a) proposed supervised contrastive combined loss function for stage-1 training, (b) proposed Encoder–Decoder network architecture with attention mechanism for stage-3 training, (c) proposed spatial context aware multi-tasking combined loss function for stage-3 training. Firstly, for stage-1 training, we propose the usage of linear combination of three loss functions: cross-entropy, self-supervised contrastive loss and supervised contrastive loss in a multi-tasking manner. We introduce radial and cosine margin into the formulation of self-supervised and supervised contrastive loss to pull feature embeddings of same class closer together compared to feature embeddings of different classes. Weights learned over stage-1 training are subsequently fine-tuned over cross-entropy multi-tasking loss in stage-2. These stage-2 weights are transfer learned and are further fine-tuned in stage-3 training. For stage-3 training, we propose the usage of spatial context aware multi-tasking combined loss function. This loss function leverages on the fine-grained spatial features obtained from HiResCAM. These are processed in parallel with features obtained from XGrad-CAM (sensitivity and conservation axioms satisfying features) to further supervise the learning of hierarchical yoga pose classifier. We exemplify our methodology on the publicly available Yoga-82 large-scale dataset. We report peak Top-1 YPC accuracy of 95.89% over 6 pose classes (Yoga-6), 93.85% over 20 pose classes (Yoga-20) and 90.0% over 82 pose classes (Yoga-82). Our proposed method achieves 6.1% improvement over Top-1 classification accuracy in Yoga-6 hierarchy, 9.3% improvement in Yoga-20 hierarchy and 10.9% improvement in Yoga-82 hierarchy in comparison with state-of-the-art (SOTA) methodology. We achieve the current best Top-1 classification accuracies in all the three YPC hierarchies.

Update on T-Cell Lymphoma Epidemiology.

T-cell lymphomas (TCLs) are a group of rare subtypes of non-Hodgkin lymphoma derived from mature T-lymphocytes. Recent updates in lymphoma classification based on the cell-of-origin pathogenesis have shed new light on TCL epidemiology and outcomes. Contemporary regional consortia and international studies, including those conducted recently in Asia and South America, have provided an updated delineation of the major subtypes across various global regions. Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), remains the most common subtype globally except in Asia, where extra-nodal NK-T cell lymphoma (ENKTL) has emerged as the most prevalent. Angioimmunoblastic T-cell lymphoma (AITL) is the second most common subtype globally except in South America where its incidence falls behind adult T-cell leukemia/lymphoma (ATLL) and ENKTL. ALK-negative anaplastic large cell lymphoma (ALCL) has been recognized as the second most common subtype in some parts of South America. Studies on the newly classified breast implant-associated ALCL (BIA-ALCL) are beginning to reveal its distribution and risk factors. Deciphering the epidemiology of TCLs is a challenging endeavor due to the rarity of these entities and ongoing refinement in classification. Collaborative efforts on prospective registries based on the most current WHO classifications will help capture the true epidemiology of TCL subtypes to better focus resources for diagnostic, prognostic, and therapeutic efforts.

A Unique Case of Appendiceal Intussusception (Inversion): A Case in Bloom.

A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation.

Mixed-Grade Urothelial Carcinoma: Insights Into Clinical Behavior and Prognostic Implications Compared to Pure Low-Grade and High-Grade Urothelial Carcinomas.

Low-grade urothelial carcinoma (LGUC) and high-grade urothelial carcinoma (HGUC) are distinguished based on architectural and cytological features, with the anticipation that HGUC exhibits more aggressive behavior and a worse prognosis compared to LGUC. The current World Health Organization classification recognizes mixed-grade urothelial carcinoma (MGUC, for the purposes of this study) as a separate category that behaves like LGUC if the high-grade component is <5% and states that any tumor with ≥5% high-grade component should be graded as HGUC. To evaluate the risk of tumor recurrence, grade, and stage progression of MGUC compared to LGUC and HGUC. A total of 150 de novo noninvasive polypoid urothelial carcinomas (41 cases of MGUC, 59 of LGUC, and 50 of HGUC) were included. Tumor recurrence, grade, and stage progression were compared among the MGUC, LGUC, and HGUC cases. Tumor recurrence was observed in 14 of 41 (34.2%) of MGUC, 33 of 59 (55.9%) of LGUC, and 28 of 50 (56%) of HGUC. Grade progression occurred in 5 of 41 (12.2%) of MGUC cases and 5 of 59 (8.5%) of LGUC cases. No stage progression was observed in LGUC or MGUC cases, while 7 of 50 (14%) of HGUC cases showed stage progression. MGUC was associated with lower odds and hazard of recurrence compared to LGUC. The rate of grade progression was higher in MGUC and occurred after a shorter interval compared to LGUC. MGUC showed a prognosis closer to LGUC. Our study supports the current recommendation to classify tumors with <5% high-grade component as MGUC, as these tumors display clinical characteristics and outcomes close to that of pure LGUC.

Proposal (36) to conserve the name Philonotidion seriatae Hinterlang 1992 for the species-poor, bryophyte-dominated, non-calcareous arctic-alpine spring vegetation of Europe

According to the International Code of Phytosociological Nomenclature, a younger name of a syntaxon may be conserved against its older name to improve the stability of the nomenclature and avoid misunderstandings in scientific communication. Here, we propose conserving the name Philonotidion seriataeHinterlang 1992 for arctic-alpine, bryophyte-dominated, non-calcareous spring vegetation against the names Cardamino-MontionBraun-Blanquet 1925, Cardamino-MontionBraun-Blanquet 1926, and MontionMaas 1959. In current vegetation classification systems, the two name-giving taxa of Cardamino-Montion no longer indicate the character of the vegetation corresponding to the nomenclatural type of this alliance and are instead characteristic of other currently distinguished alliances. Maintaining the oldest name Cardamino-Montion in strict adherence to the Code would be a source of errors. In the current vegetation classification systems, two similar but counter-intuitive names would then have to be used: Cardamino-Montion for arctic-alpine springs (although the name-giving taxa are more indicative of montane springs) and Epilobio nutantis-Montion for montane springs (although the name-giving taxon Epilobium nutans is indicative of arctic-alpine vegetation). Hence, there is a risk that the name Cardamino-Montion may gradually become ambiguous. We also propose conserving the name Philonotidion seriatae against Mniobryo-Epilobion hornemanniiNordhagen 1943 to prevent confusion in case of a merger of these alliances. (36) Philonotidion seriataeHinterlang 1992 Typus: Cratoneuro-PhilonotidetumGeissler 1976 (holotypus) (=) Cardamino-MontionBraun-Blanquet 1925 Typus: Bryetum schleicheriBraun-Blanquet 1925 [≡ Montio fontanae-Bryetum schleicheriBraun-Blanquet 1925 nom. corr. et invers. (alternative name)] (holotypus) (=) Cardamino-MontionBraun-Blanquet 1926 nom. superfl. [≡ Cardamino-MontionBraun-Blanquet 1925] (=) Mniobryo-Epilobion hornemanniiNordhagen 1943 Typus: Mniobryo-Epilobietum hornemanniiNordhagen 1943 (lectotypus selected by Zechmeister &amp; Mucina 1994) (=) MontionMaas 1959 nom. superfl. [≡ Cardamino-MontionBraun-Blanquet 1925] Taxonomic reference: Euro+Med PlantBase (http://europlusmed.org; accessed 4 January 2024)

Abstract PR002: Proteomic profiling of endometrial carcinomas

Abstract While endometrial cancer (EC) has an overall favorable prognosis, some patients do poorly and may benefit from refinements of current classification systems. The TCGA-inspired pragmatic molecular classification tool Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) has been integrated into international guidelines for EC risk stratification and management. ProMisE stratifies ECs into four prognostic groups: POLEmut, NSMP (no specific molecular profile), MMRd (mismatch repair deficient), and p53abn, where POLEmut has the best prognosis and p53abn has the worst prognosis. Our objective was to determine if proteomic profiling could provide additional prognostic or predictive information for EC patients, across or within ProMisE molecular subtypes. Global proteome profiling of FFPE samples, that had clinicopathologic and outcome data, was performed on 184 ECs encompassing all four ProMisE subtypes, including replicate samples of the same tumor, and both biopsy and final hysterectomy specimens. To ensure representation of each subtype, we aimed for an approximately equal distribution; 40 (27 %) MMRd, 33 (22 %) POLEmut, 42 (28 %) NSMP and 33 (22 %) p53abn, rather than the population-based distributions. There was high reproducibility in the proteomic profiles of intra-tumor replicate samples, and between matched biopsy and hysterectomy tumor samples (Pearson’s correlation &amp;gt;0.9). Consensus clustering generated four clusters, named ‘Adhesion’, ‘Immune’, ‘Proliferation’, and ‘Metabolic’ based on proteins enriched in each cluster. The Proliferation Cluster had the worst outcomes and the highest proportion of stage III/IV, serous, and p53abn tumors than the other clusters. The Immune Cluster had the most favorable outcomes, despite having a relatively substantial proportion of stage III/IV, serous, and p53abn tumors. We correlated protein expression with common mutations, including ARID1A mutations that cause loss of ARID1A protein expression, found in up to 60% ECs. ARID1A positive tumors also express proteins in the retinoic acid signaling pathway, while ARID1A-deficient tumors express proteins indicative of neutrophil infiltration. Comparing molecular subtypes, we found p53abn ECs were enriched in proteins associated with poor outcomes in many tumor types, such as GRB7. We validated elevated GRB7 expression in p53abn tumors using immunohistochemistry and found an association with worse disease specific survival (DSS) across the whole cohort (HR=2.39). Nucleolin expression was associated with worse prognosis in the NSMP subtype (DSS HR=9.88), while BABAM1 expression was associated with better prognosis within p53abn tumors (DSS HR=2.43). Knockout of BABAM1 (part of the BRCA complex) in cell lines resulted in increased sensitivity to PARP inhibition. Proteomic analysis of EC identifies candidate prognostic markers that may further refine current molecular classification and help guide treatment decisions. New therapeutic interventions could be developed to target proteins and pathways identified by EC proteomic profiling. Citation Format: Dawn R. Cochrane, Gian Luca Negri, Jutta Huvila, Juliana Sobral de Barros, Forouh Kalantari, Nissreen Mohammad, David Farnell, Emily Thompson, Amy Lum, Sandra E. Spencer, Amy Jamieson, Samuel Leung, Derek Chiu, Martin Koebel, Stefan Kommoss, Friedrich Kommoss, Blake Gilks, Lien Hoang, David Huntsman, Gregg B. Morin, Jessica N. McAlpine. Proteomic profiling of endometrial carcinomas [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr PR002.

Adoption and clinical outcomes of fenestrated endovascular aneurysm repair in a regional, multistate community hospital system

ObjectiveComplex endovascular abdominal aortic aneurysm (AAA) repair techniques have evolved over the last decade, yet patterns of physician and hospital system adoption of fenestrated endovascular aneurysm repair (FEVAR) remain poorly defined. We investigated clinical outcomes, use trends, and surgeon and hospital experience for FEVAR in a large community hospital system. MethodsWe conducted a retrospective cohort study of all FEVAR procedures within our 5-state hospital system between April 2012 and June 2021. AAA repair volumes (open, EVAR, and FEVAR) were captured at the hospital and surgeon levels using Current Procedural Terminology and International Classification of Diseases codes. Clinical and outcomes data were collected for FEVAR patients. To consider if surgeon or hospital experience influenced outcomes, sequential case number was used to divide patients into surgeon experience and hospital experience groups. Inverse probability weighted and generalized linear mixed models, adjusted for demographics and comorbidities, were built to examine risk-adjusted outcomes for surgeon and hospital experience groups. ResultsOf 3850 patients treated with AAA procedures of any kind between 2012 and 2021, 160 (4.2%) underwent FEVAR. FEVAR procedures were performed by 34 different surgeons at 12 hospitals, with intraoperative complications and unplanned adjunctive procedures occurring in 18.8% (n = 30) and 19.4% (n = 31) of patients, respectively. Among FEVAR patients, in-hospital mortality was 1.3% (n = 2) and postoperative morbidity was 16.9% (n = 27). Renal function decline occurred postoperatively in 5.1% of patients. Early (<30 day) postoperative endoleaks occurred in 15.3% of patients (n = 21). Target vessel patency was 95.6% on initial postoperative imaging. Surgeon and hospital experience had a small positive impact on outcomes after the first one to three cases. Significant decreases in operative time, fluoroscopy time, and estimated blood loss were observed with increased surgeon experience, relative to a surgeon's first case (P < .05). There were lower odds of intraoperative complications after a surgeon's first case (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03-0.77, for cases 2-3) or after a hospital's first one to three cases (OR, 0.19; 95% CI, 0.04-0.89, for cases 4-8; OR, 0.12; 95% CI, 0.03-0.55 for cases 9-49). ConclusionsClinical outcomes of FEVAR across our hospital system compare favorably with previously published reports. Although system-wide FEVAR adoption increased 3-fold over the last decade, FEVAR continued to be performed by a minority of hospitals in our system. The results from this cohort demonstrate low rates of adverse events, high rates of technical efficiency, and a small impact of surgeon and hospital experience, thereby supporting this advanced endovascular technology as a safe, efficacious, and generalizable treatment alternative to open repair for patients with complex aortic anatomy.

A Comprehensive Survey of Unmanned Aerial Vehicles Detection and Classification Using Machine Learning Approach: Challenges, Solutions, and Future Directions

Autonomous unmanned aerial vehicles (UAVs) have several advantages in various fields, including disaster relief, aerial photography and videography, mapping and surveying, farming, as well as defense and public usage. However, there is a growing probability that UAVs could be misused to breach vital locations such as airports and power plants without authorization, endangering public safety. Because of this, it is critical to accurately and swiftly identify different types of UAVs to prevent their misuse and prevent security issues arising from unauthorized access. In recent years, machine learning (ML) algorithms have shown promise in automatically addressing the aforementioned concerns and providing accurate detection and classification of UAVs across a broad range. This technology is considered highly promising for UAV systems. In this survey, we describe the recent use of various UAV detection and classification technologies based on ML and deep learning (DL) algorithms. Four types of UAV detection and classification technologies based on ML are considered in this survey: radio frequency-based UAV detection, visual data (images/video)-based UAV detection, acoustic/sound-based UAV detection, and radar-based UAV detection. Additionally, this survey report explores hybrid sensor- and reinforcement learning-based UAV detection and classification using ML. Furthermore, we consider method challenges, solutions, and possible future research directions for ML-based UAV detection. Moreover, the dataset information of UAV detection and classification technologies is extensively explored. This investigation holds potential as a study for current UAV detection and classification research, particularly for ML- and DL-based UAV detection approaches.

Vocal and genetic variation between a land-bridge island and mainland populations of the Black-crowned Antshrike (Thamnophilus atrinucha)

Island-mainland systems serve as natural laboratories for studying communication signals. We explored potential divergence in the song of the black-crowned antshrike between Gorgona Island, a land-bridge island off the Pacific coast of Colombia, and several mainland populations. We found that the perching song of this species, the so called loudsong, was distinctly different on Gorgona Island. This differentiation encompassed an increase in frequency bandwidth, a decrease in vocal performance, and a reduction in song duration. All are consistent with documented patterns of divergence observed in avian acoustic signals on oceanic islands. The observed distinctions in loudsong acoustics, including variations in frequency and temporal features, led to the inference that the population on Gorgona Island produces the least complex loudsong dialect across the entire species range. This pattern of how an innate vocalization manifests within a land-bridge island, which was connected to the mainland not long ago, lends support to the Character Release Hypothesis. To ensure an unbiased comparison, we considered genetic clusters and analyzed them by comparing ten acoustic signals between the land-bridge island and several mainland populations. Combined with the gene genealogy, this finding supports the validity of two geographic forms: Thamnophilus atrinucha atrinucha and Thamnophilus atrinucha gorgonae (island). However, they also reveal the existence of additional unrecognized dialects of loudsong that transcend current taxonomic classifications. We provide evidence that challenges the long-standing presumption suggesting minimal intraspecific geographic variation in the vocalization among non-vocal learning species.Significance statementSignificant evolutionary implications exist for an intriguing pattern of variation of the loudsong behavior in the Black-crowned Antshrike over a land-bridge island. Our gene tree does provide evidence of the enormous haplotypic diversity accumulated in the trans-Andean region long after the final uplift of the northern Andes. The acoustic divergence of the loudsong suggests substantial geographic variation within a non-vocal learning suboscine. Genetic and loudsong divergence on a land-bridge island add to document that evolution of acoustic traits may be relaxed in islands as compared to those observed on the species-rich mainland. The island-mainland system is one of the few definitive biogeographic contexts for understanding evolution of acoustic behavior.

How to classify forests? A case study from Central Europe

Aims: Inconsistent treatment of the vegetation layers is one of the main problems in the floristic classification of forests. In this study I investigate whether a classification based solely on woody species leads to units similar to the Braun-Blanquet system or to something completely different. Study area: Austria (Central Europe) and adjacent regions. Methods: 23,681 forest relevés from the Austrian Vegetation Database were classified using TWINSPAN. Spruce and pine plantations and stands with a cover of non-native woody species &amp;gt; 5% were excluded from the dataset. Only native tree and shrub species were used in the classification while herbs, dwarf shrubs, cryptogams and all records of woody species in the herb layer were omitted. Results: The TWINSPAN classification revealed elevation (i.e., climate) as the main floristic gradient in the data set. Within lowland communities, soil moisture was the dominant factor. The higher units of the Braun-Blanquet system were mostly well reproduced. Conclusions: The higher levels of the phytosociological forest classification (class, order, partly also alliance) can basically be defined by taking only the shrub and tree layer into account. However, all past and current classifications suffer from arbitrary exceptions to this rule. This leads to many inconsistencies and blurs the main biogeographical patterns within European forests. Here I argue that using the tree and shrub species for defining the higher levels and the understorey species for defining the lower ones is best suited to meet the properties that users would expect from a good forest classification. Taxonomic reference: Fischer et al. (2008). Syntaxonomic reference: Mucina et al. (2016) if not stated otherwise. Abbreviations: EVC = EuroVegChecklist (Mucina et al. 2016).

Anatomical variations of the atlas arches: prevalence assessment, systematic review and proposition for an updated classification system.

This study focuses on the atlas, a pivotal component of the craniovertebral junction, bridging the cranium and spinal column. Notably, variations in its arches are documented globally, necessitating a thorough assessment and categorization due to their significant implications in clinical, diagnostic, functional, and therapeutic contexts. The primary objective is to ascertain the frequency of these anatomical deviations in the atlas arches among a Colombian cohort using cone-beam computed tomography (CBCT). Employing a descriptive, cross-sectional approach, this research scrutinizes the structural intricacies of the atlas arches in CBCT scans. Analytical parameters included sex distribution and the nature of anatomical deviations as per Currarino's classification. Statistical analyses were conducted to identify significant differences, including descriptive statistics and Chi-square tests. A systematic review of the literature was conducted in order to enhance the current Currarino's classification. The study examined 839 CBCT images, with a nearly equal sex distribution (49.7% female, 50.3% male). Anatomical variations were identified in 26 instances (3%), displaying a higher incidence in females (X2 [(1, N = 839) = 4.0933, p = 0.0430]). The most prevalent variation was Type A (2.5%), followed by Type B (0.4%), and Type G (0.2%) without documenting any other variation. The systematic review yielded 7 studies. A novel classification system for these variations is proposed, considering global prevalence data in the cervical region. The study highlights a statistically significant predominance of Type A variations in the female subset. Given the critical nature of the craniovertebral junction and supporting evidence, it recommends an amendment to Currarino's classification to better reflect these clinical observations. A thorough study of anatomical variations of the upper cervical spine is relevant as they can impact important functional aspects such as mobility as well as stability. Considering the intricate anatomy of this area and the pivotal function of the atlas, accurately categorizing the variations of its arches is crucial for clinical practice. This classification aids in diagnosis, surgical planning, preventing iatrogenic incidents, and designing rehabilitation strategies.