Detailed Classification System Research Articles

Occurrence and risk factors for second-degree perineal tears: A prospective cohort study using a detailed classification system.

The amount of tissue trauma within second-degree perineal tears varies widely. Therefore, subcategorization of second-degree tears and a better understanding of their occurrence and risk factors are needed. The aim of this study was to assess the occurrence of perineal tears when second-degree tears were subcategorized. Furthermore, we aimed to assess the association between variables related to perineal anatomy and other potential risk factors, with second-degree tear subcategories. This prospective cohort study included 880 primiparous and multiparous women giving birth to one child vaginally. Perineal tears were categorized using the classification system recommended by the Royal College of Obstetricians and Gynaecologists. In addition, second-degree tears were subcategorized as 2A, 2B, or 2C according to the percentage of damage to the perineal body. Selected variables related to perineal anatomy were as follows: length of genital hiatus; perineal body length; and previous perineal trauma. Risk factors for second-degree tear subcategories were analyzed using a multinominal regression model. Perineal tears occurred as follows: first-degree: 35.6% (n = 313), 2A: 16.3% (n = 143), 2B: 9.1% (n = 80), 2C: 6.6% (n = 58), and third- or fourth-degree: 1.6% (n = 14). In total, 169/880 participants underwent an episiotomy. When episiotomies were excluded, the risk for 2B, or 2C tears increased with smaller genital hiatus, larger perineal body, previous perineal trauma, primiparity, higher gestational age, instrumental vaginal delivery and fetal presentation other than occiput anterior. The occurrence of second-degree tear subcategories was 16.3% for 2A tears, 9.1% for 2B tears, and 6.6% for 2C tears. Factors related to perineal anatomy increased the odds for experiencing a second-degree tear in a more severe subcategory.

Harmonising dietary datasets for global surveillance: methods and findings from the Global Dietary Database.

The Global Dietary Database (GDD) expanded its previous methods to harmonise and publicly disseminate individual-level dietary data from nutrition surveys worldwide. Analysis of cross-sectional data. Global. General population. Comprehensive methods to streamline the harmonisation of primary, individual-level 24-h recall and food record data worldwide were developed. To standardise the varying food descriptions, FoodEx2 was used, a highly detailed food classification and description system developed and adapted for international use by European Food Safety Authority (EFSA). Standardised processes were developed to: identify eligible surveys; contact data owners; screen surveys for inclusion; harmonise data structure, variable definition and unit and food characterisation; perform data checks and publicly disseminate the harmonised datasets. The GDD joined forces with FAO and EFSA, given the shared goal of harmonising individual-level dietary data worldwide. Of 1500 dietary surveys identified, 600 met the eligibility criteria, and 156 were prioritised and contacted; fifty-five surveys were included for harmonisation and, ultimately, fifty two were harmonised. The included surveys were primarily nationally representative (59 %); included high- (39 %), upper-middle (21 %), lower-middle (27 %) and low- (13 %) income countries; usually collected multiple recalls/ records (64 %) and largely captured both sexes, all ages and both rural and urban areas. Surveys from low- and lower-middle v. high- and upper-middle income countries reported fewer nutrients (median 17 v. 30) and rarely included nutrients relevant to diet-related chronic diseases, such as n-3 fatty acids and Na. Diverse 24-h recalls/records can be harmonised to provide highly granular, standardised data, supporting nutrition programming, research and capacity development worldwide.

Surgical Failure and Revision Strategy for Atlantoaxial Dislocation: A retrospective study of 109 Cases.

Retrospective study. To classify surgical failures following atlantoaxial dislocation, present strategies for revisions and evaluate the clinical results of revision surgery. With the increase in atlantoaxial dislocation surgery, the number of surgical failures has gradually risen. However, current reports on atlantoaxial surgical revision are limited in scope. There remains a lack of summary regarding the causes of surgical failure, a detailed classification system, and no proposed strategy for revision surgery. 109 cases of failed surgery following atlantoaxial dislocation were classified according to the reduction immediately after surgery and the fusion status before revision. The reduction, decompression, fusion status and outcomes following revision surgery were evaluated by X-ray, CT, MRI and JOA score. The data were analyzed statistically with a paired-samples t test and multivaraible logistic regression analysis. The 109 patients were classified into three categories of failure: non-reduction with non-fusion (NR-NF, 73 cases), non-reduction with fusion (NR-F, 19 cases), and reduction with non-fusion (R-NF, 17 cases). Sixty-four patients underwent anterior revision, 21 posterior revision, and 24 anteroposterior revision. Postoperative complications were the primary cause of early revisions. After revision, complete decompression was achieved in all cases, anatomical reduction in 89 cases, significant improvement of JOA score in 77 cases, and fusion achieved in 86 cases. Twelve cases experienced surgical complications and 3 underwent a second revision. We found that NR-NF was the most common type of failure following surgery for atlantoaxial dislocation. Revision strategies can be guided according to our descriptive classification of failure, and revision surgery should focus on achieving adequate reduction, appropriate fixation and reliable fusion to optimize post-surgical outcomes.

A Critical Review and Novel Classification Proposal for Kinetic Roof Structures

Kinetic structures have gained popularity in architecture and structural engineering due to their ability to meet environmental factors and user needs. Among these structures, kinetic roof structures hold an important place, as they are deployable and/or transformable structures that can change their forms between two or more different geometries. Various categorizations of kinetic roofs based on their material, mechanism, and geometry have been offered in the literature. However, in most studies, they are placed under the broader category of kinetic structures. This paper critically reviews existing classifications of kinetic roofs, highlighting their advantages and limitations. Subsequently, a novel detailed classification system for kinetic roof structures is proposed. The superiority, advantages, and shortcomings of this proposed classification are presented. A more comprehensive and tailored classification system for kinetic roofs is provided by this study, contributing to the literature in this area.

COVID-19-Induced Automation: An Exploratory Study of Critical Occupations.

The COVID-19 pandemic may have spurred automation, especially in critical occupations. This article explores the potential of each detailed Standard Occupational Classification System (SOC) occupation being automated due to COVID-19. The authors explore two key elements of each occupation: its exposure to diseases such as COVID-19 and the probability of that occupation being automated. The results reveal that food preparation, service, and cleaning-related occupations have a higher chance of pandemic-induced automation. Using monthly U.S. job postings from 2016 to 2021, the estimates show that the potential pandemic-induced automation is associated with a statistically significant decrease in job postings. A higher Automation Index is associated with fewer job postings since the pandemic. Such trends remain robust after accounting for posting duration and excluding health-related occupations. These findings contribute to the early assessment of the impact of COVID-19 on the potential integration of automation in the labor force and offer insights into building a resilient and labor-centric post-pandemic labor market.

Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma.

There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.

The use of multiplex imaging techniques to characterize tuberculous granuloma heterogeneity.

Caseous granulomas are pathological hallmarks of tuberculosis (TB), and increasing evidence suggests that TB granuloma composition is highly temporally and spatially heterogenous in both animal models and humans. Traditional pathological techniques are limited in their ability to reveal the heterogeneity present in TB granulomas. Multiplex tissue imaging tools combined with powerful, high resolution spatial analysis have enabled the detection of various cell phenotypes, aiding in the visualization of the granuloma complex and revealing the interactions between immune cells and nonimmune cells. This updated understanding of tuberculous granuloma heterogeneity offers vital insights for researchers aiming to uncover the immunoregulatory mechanisms underlying granuloma formation during TB pathogenesis. More detailed granuloma classification systems will also be of use for precision medicine, and for identifying biological targets for host-directed therapeutics in TB patients. This article is categorized under: Infectious Diseases > Genetics/Genomics/Epigenetics Infectious Diseases > Biomedical Engineering Infectious Diseases > Molecular and Cellular Physiology.

Detailed classification of second-degree perineal tears in the delivery ward: an inter-rater agreement study.

Second-degree perineal tears can vary widely as to the extent of trauma, which may be relevant for women's pelvic floor health postpartum. However, the short- and long-term consequences of second-degree perineal tears are poorly understood, likely due to the lack of a detailed classification system. Such a classification system for second-degree tears has been suggested but the inter-rater agreement has not yet been assessed. The aim of this study was to assess the inter-rater agreement of the already established classification system for perineal tears recommended by the Royal College of Obstetricians and Gynaecologists (RCOG classification) among midwives. Further, we aimed to assess the inter-rater agreement of a classification system that provides three sub-categories for second-degree perineal tears. This was an inter-rater agreement study, conducted at Akershus University Hospital in Norway from 31 August to 29 November 2020. All midwives working in the delivery ward participated in the study. Midwives classified the integrity of the perineum of all women delivering vaginally within the study period. During the first month of the study, tears were classified by two midwives who were blinded to each other's findings, and the agreement of the RCOG classification was assessed. The following month, the detailed classification system was introduced to the midwifery staff. The last month, perineal tears were classified by two midwives using the detailed classification system, and the agreement was assessed. Inter-rater agreement was measured using Fleiss multirater kappa (k) and Kendall's coefficient of concordance (KCCw ). The inter-rater agreement for the RCOG classification was good to very good, with k=0.705 (95% confidence interval [CI] 0.62-0.79, P < 0.001), KCCw =0.928 (P < 0.001). The inter-rater agreement for the detailed classification system was good to very good, with k=0.748 (95% CI 0.67-0.83, P < 0.001), KCCw =0.956 (P < 0.001). The inter-rater agreement among midwives using both the RCOG classification and the detailed classification system among midwives was good to very good. The detailed classification system provides additional information about the extent of tissue trauma in second-degree tears, warranted for future research on women's pelvic floor health postpartum.

The cerebrofacial metameric syndromes: An embryological review and proposal of a novel classification scheme.

The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.

Wound-healing capabilities of whale sharks (Rhincodon typus) and implications for conservation management.

Wound healing is important for marine taxa such as elasmobranchs, which can incur a range of natural and anthropogenic wounds throughout their life history. There is evidence that this group shows a high capacity for external wound healing. However, anthropogenic wounds may become more frequent due to increasing commercial and recreational marine activities. Whale sharks are particularly at risk of attaining injuries given their use of surface waters and wildlife tourism interest. There is limited understanding as to how whale sharks recover from injuries, and often insights are confined to singular opportunistic observations. The present study makes use of a unique and valuable photographic data source from two whale shark aggregation sites in the Indian Ocean. Successional injury-healing progression cases were reviewed to investigate the characteristics of injuries and quantify a coarse healing timeframe. Wounds were measured over time using an image standardization method. This work shows that by Day 25 major injury surface area decreased by an average of 56% and the most rapid healing case showed a surface area reduction of 50% in 4 days. All wounds reached a point of 90% surface area closure by Day 35. There were differences in healing rate based on wound type, with lacerations and abrasions taking 50 and 22days to reach 90% healing, respectively. This study provides baseline information for wound healing in whale sharks and the methods proposed could act as a foundation for future research. Use of a detailed classification system, as presented here, may also assist in ocean scale injury comparisons between research groups and aid reliable descriptive data. Such findings can contribute to discussions regarding appropriate management in aggregation areas with an aim to reduce the likelihood of injuries, such as those resulting from vessel collisions, in these regions or during movements between coastal waters.

Classification of Arabic-Speaking Website Pages with Unscrupulous Intentions and Questionable Language

This study aims to put forward a comprehensive and detailed classification system to categorize different Arabic-speaking website pages with unscrupulous intentions and questionable language. The methodology of this is based on a quantitative approach by using different algorithms (supervised) to build a model for data classification by using manually categorized information. The classification algorithm used to construct the model uses quantitative information extracted by Posit or SAFAR textual analysis framework. This model functions with (58) features combined from Posit – n-grams and morphological SAFAR V2 POS tools. This model achieved more than (94 %) success in the level of precision. The results of this study revealed that the best results reaching 94% precision have been achieved by combining Posit + SAFAR + (18 attributes Posit+ SAFAR N-Gram). Moreover, the most reliable results have been achieved by applying a Random Forest classification algorithm using regression. The research recommends working more on this topic and using new algorithms and techniques.

R-CHOP resistance in diffuse large B-cell lymphoma: biological and molecular mechanisms.

Although the first-line rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone regimen (R-CHOP) substantially improved outcomes for patients with diffuse large B-cell lymphoma (DLBCL), 40% of the patients suffered from relapsed/refractory disease and had poor survival outcomes. The detailed mechanism underlying R-CHOP resistance has not been well defined. For this review, we conducted a thorough search for literature and clinical trials involving DLBCL resistance. We discussed DLBCL biology, epigenetics, and aberrant signaling of the B-cell receptor (BCR), phosphatidylinositol 3-kinase (PI3K)/Akt, nuclear factor kappa light chain enhancer of activated B-cells (NF-κB), and the Janus kinase (JAK)/signal transducer and activator of transcription 3 (STAT3) pathways as defining mechanisms of DLBCL heterogeneity and R-CHOP resistance. The cell of origin, double- or triple-hit lymphoma and double-protein-expression, clonal evolution, tumor microenvironment, and multi-drug resistance help to contextualize DLBCL resistance in an (epi)genetically and biologically comparative manner. With better understanding of the biological and molecular landscape of DLBCL, a more detailed classification system and tailored treatments will ideally become available to further improve the prognosis of DLBCL patients.

HYDROCHEMICAL CLASSIFICATION OF AMAZONIAN RIVERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Water and soil chemistry provide important parameters for the study of river ecology and biogeochemical cycles. Furthermore, they determine management options of rivers and connected wetlands. The first scientific classification of Amazonian water bodies was elaborated in the 1950s by Harald Sioli. He used water color, as well as physical and chemical parameters, to explain limnological characteristics of the large Amazonian rivers and related these characteristics to the geological and geomorphological properties of their catchments. Today, an increasing amount of hydrochemical data indicate that the chemical composition of Amazonian water bodies varies much more than assumed by Sioli. Nevertheless, his simplified classification is useful for describing the natural physical and chemical variability of Amazonian rivers and wetlands. The electrical conductivity, pH-value and the distribution of major cations and anions allow to distinguish well among the three classical water types and to categorize other water bodies in order to subsidize a more detailed classification system of Amazonian fresh waters.

The Feasibility of Assessing the Cortical Bone Trajectory Screw Placement Accuracy Using a Traditional Pedicle Screw Insertion Evaluation System.

This was a retrospective observational study. We aimed to characterize the feasibility of assessing the accuracy of cortical bone trajectory (CBT) screw placement in midline lumbar interbody fusion using a traditional pedicle screw insertion accuracy evaluation system based on computed tomography (CT). Since Santoni and colleagues proposed CBT as an alternative approach for the treatment of lumbar degenerative disease, CBT has been biomechanically and clinically investigated in detail. The reported misplacement rate was 0%-12.5%. Therefore, these cortical screws may result in severe complications, such as nerve root, vascular, and spinal cord injuries. However, to the best of our knowledge, the accuracy of the current assessment system of cortical bone screw placement has not been described clearly. Overall, 342 cortical screws of 69 consecutive patients with lumbar degenerative disease who underwent midline lumbar interbody fusion surgery in one surgeon's initial phase were examined retrospectively. A comprehensive and detailed pedicle screw accuracy classification and grading system was introduced in our study, including 5 types of misplacement: (1) medial and (2) lateral cortical bone perforation (MCP and LCP) of the corresponding pedicle, (3) anterior cortical bone perforation of the vertebral body, (4) endplate perforation, and (5) foraminal perforation (FP). The degree of interobserver and intraobserver agreement with regard to the screw positions based on CT were used as indicators of the reliability of the modified classification system. All patients were retrospectively assessed for screw placement-related complications throughout the entire treatment course to evaluate the relationship between the procedure adequacy and neurological symptoms. The interobserver and intraobserver agreements were substantial-to-almost perfect (κ=0.78 and 0.88, respectively) in distinguishing the acceptable-placed pedicle screws from those with partial or complete cortical perforation. In the MCP and LCP-the most common types of misplacement-the interobserver agreement was substantial (κ=0.70 and 0.76, respectively), and the intraobserver agreement was almost perfect (κ=0.85 and 0.89, respectively). In total, there are 7 (2.05%) MCP and 65 (19.01%) LCP screws. The screw placement-related complication rate is significantly higher in the MCP and FP groups than that in the LCP group. Our study demonstrated that using a pedicle screw classification and grading system based on CT to assess the accuracy of CBT screw placement is feasible and practical. MCP and FP screws are more likely to cause neurological deficits with statistical significance, especially grade 2 MCP. We recommend inexperienced surgeons choose a lateral trajectory rather than a medial one if they cannot ensure accurate screw insertion. Level III.

Characterization of Aggregate Angularity in the Frequency Domain

The morphology of aggregate particles used for pavement construction plays an essential role in the structural capacity and safety performance of pavement structures. Each of the three main components of aggregate morphology (form, angularity, and texture) has a distinct effect on pavement performance and corresponds to a different frequency range. Considering the challenge in segregating form, angularity, and texture in the space domain, characterizing them separately in the frequency domain would be beneficial and would allow for a more objective and detailed classification system for aggregate morphology. This study focuses on the characterization of aggregate angularity in the frequency domain with the objective of obtaining a parameter that is free of individual subjectivity. Since aggregate angularity is a subjective visual descriptor of aggregate shape variations at corners, a survey was conducted of pavement engineers to collect visual ratings of aggregate angularities using a set of aggregates. Thereafter, using the average visual ratings from the survey responses as reference, three common aggregate angularity indexes were evaluated: roundness, the University of Illinois Aggregate Image Analyzer (UIAIA) angularity index, and the Aggregate Image Measurement System (AIMS) angularity index. In addition, with the aid of the discrete Fourier transform (DFT) algorithm, the contributing frequencies were acquired for visual rating, along with roundness and the UIAIA and AIMS angularity indexes. Based on the contributing frequencies identified, prediction models were successfully established for visual rating: roundness and the UIAIA and AIMS angularity indexes. It was concluded that DFT can be accurate in objectively assessing angularity and that roundness is the more robust parameter and can be accurately predicted by the models developed.

Crosslink‐Enhanced Emission Effect on Luminescence in Polymers: Advances and Perspectives

AbstractThe crosslink‐enhanced emission effect was first proposed to explore the strong luminescence of nonconjugated polymer dots possessing only either non‐emissive or weakly emissive sub‐luminophores. Interesting phenomena in recent research indicate such enhancement caused by extensive crosslinking appears in diverse luminescent polymers with sub‐luminophores (electron‐rich heteroatomic moieties) or luminophores (conjugated π domains). This enhancement can promote the emission from nonluminous to luminous, from weakly luminous to strongly luminous, and even convert the pathway of radiative transitions. The concept of the crosslink‐enhanced emission effect should be updated and extended to an in‐depth spatial effect, such as electron overlap and energy splitting in confined domains by effective crosslinking, more than initial immobilization. This Minireview outlines the development of the crosslink‐enhanced emission effect from the perspective of the detailed classification, inherent mechanism and applicable systems. An outlook on the further exploration and application of this theory are also proposed.

Crosslink-Enhanced Emission Effect on Luminescence in Polymers: Advances and Perspectives.

The crosslink-enhanced emission effect was first proposed to explore the strong luminescence of nonconjugated polymer dots possessing only either non-emissive or weakly emissive sub-luminophores. Interesting phenomena in recent research indicate such enhancement caused by extensive crosslinking appears in diverse luminescent polymers with sub-luminophores (electron-rich heteroatomic moieties) or luminophores (conjugated π domains). This enhancement can promote the emission from nonluminous to luminous, from weakly luminous to strongly luminous, and even convert the pathway of radiative transitions. The concept of the crosslink-enhanced emission effect should be updated and extended to an in-depth spatial effect, such as electron overlap and energy splitting in confined domains by effective crosslinking, more than initial immobilization. This Minireview outlines the development of the crosslink-enhanced emission effect from the perspective of the detailed classification, inherent mechanism and applicable systems. An outlook on the further exploration and application of this theory are also proposed.

Clinicopathologic study of 60 cases of urothelial neoplasms with inverted growth patterns: Reclassification by international consultation on urologic disease (ICUD) recommendations

BackgroundMost urothelial neoplasms of the bladder show an exophytic papillary pattern, but some show an inverted growth pattern. In 2004, the World Health Organization (WHO) released a detailed histologic classification system for papillary urothelial neoplasms, but not for inverted forms. The International Consultation on Urologic Disease (ICUD) recommendations of 2012 are applicable to inverted/endophytic papillary lesions as follows: 1) inverted papilloma (IP), 2) inverted papillary urothelial neoplasm of low malignant potential (IPUNLMP), 3) inverted papillary urothelial carcinoma, low grade, non-invasive (IPUCLG-NI), 4) inverted papillary urothelial carcinoma, high grade, non-invasive (IPUCHG-NI), 5) inverted papillary urothelial carcinoma, high grade, invasive (IPUCHG-I). However, only atypical cellular morphology was considered for classification in the 2012 ICUD recommendations, and data to support to validate this new grading system are lacking. MethodsSixty cases of inverted urothelial papillary tumors were classified into 5 categories according to 2012 ICUD and 2016 WHO/ISUP recommendations to evaluate their clinical, pathological, and immunohistochemical characteristics. Two subgroups were defined as subgroup 1, IP and IPUNLMP, and subgroup 2, IPUCLG-NI, IPUCHG-NI, and IPUCHG-I. Clinical features (age, sex, history of urothelial carcinoma, smoking history, size, and multifocality) and histologic features (nuclear pleomorphism, mitotic count, mitosis level, apoptosis, luminal necrosis, trabecular thickening, anastomosing trabeculae, hypercellularity, loss of polarity, peripheral palisading, palisading with central streaming, and discohesiveness) were evaluated. Immunohistochemical stains for CK20, CD44, P53, p16, Ki-67, cyclin D1 and c-erbB2 were performed. ResultsA total of 60 cases were classified as 10 cases of IP, 29 cases of IPUNLMPs, 15 cases of IPUCLG-NI, 4 cases of IPUCHG-NI, and 2 cases of IPUCHG-I. Compared to subgroup 1, subgroup 2 showed larger tumor size, more nuclear irregularity, higher mitotic count (hot spot and per 10 high power fields), more upper level mitosis (>1/2), and more frequent apoptosis, luminal necrosis, surface papillary component, trabecular thickening, anastomosing irregular trabeculae, hypercellularity, loss of polarity, peripheral palisading with central streaming, and discohesiveness, and absence of umbrella cells and urothelial eddies. CK20, Ki67, and c-erbB2 were the only markers that were differently expressed in the two subgroups, with more expression in subgroup 2. ConclusionsThe 2012 ICUD recommendations are valid to classify inverted papillary urothelial tumors. However, other histologic features besides atypical cellular morphology should also be considered to distinguish subgroup 1 and subgroup 2 inverted papillary urothelial tumors.

Interpreting and reporting fracture classification and operation type in hip fracture: implications for research studies and routine national audits.

This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of "highly improbable" combinations. The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than "fair" agreement. When the classification was collapsed to a single option for "extracapsular" fracture, only four centres failed to have at least "moderate" agreement. There was only "moderate" agreement for the subtypes of intracapsular fracture, which improved to "substantial" when collapsed to "intracapsular". Subtrochanteric fracture types were well reported with "substantial" agreement. There was near "perfect" agreement for internal fixation procedures. "Perfect" or "substantial" agreement was achieved when the type of arthroplasty surgery was reported at the level of "hemiarthroplasty" and "total hip replacement". When reviewing data submitted to the NHFD, a minimum of 5.2% of cases contained "highly improbable" procedures for the stated fracture classification. The complexity of collecting fracture classification data at a national scale compromises the accuracy with which detailed classification systems can be reported. Data around type of surgery performed show similar tendencies. Data capture, reporting, and interpretation in future studies must take this into account. Cite this article: Bone Joint J 2019;101-B:1292-1299.

Effect of Sphenoid Sinus Pneumatization on the Surgical Windows for Extended Endoscopic Endonasal Transsphenoidal Surgery

Little is known on the impact of the pattern and extent of pneumatization of the sphenoid sinus (SS) on the dimensions of the surgical windows used in extended endoscopic endonasal transsphenoidal approaches. We therefore investigated whether the distances between the 2 optic canals and between the paired paraclival carotid arteries are influenced by the pattern and extent of pneumatization of the SS. One hundred high-resolution computed tomography scans from 47 adult female and 53 adult male patients were analyzed. The pattern of SS pneumatization was classified into conchal, presellar, and sellar types. Sellar-type sinuses were then classified according to a newer detailed classification system. Maximal anteroposterior (AP), transverse (TR), and craniocaudal diameters of the SS, interoptic distance at the limbus sphenoidale (IODL) and at the entrance of the optic canal (IODE) and the intercarotid distance between the paraclival carotids (ICD) were measured. A 2-tailed Mann-Whitney Utest and Pearson correlation coefficient (R) were used for statistical analysis. A P value <0.05 was considered statistically significant. Positive correlation was found between IODL and both AP and TR diameters of the SS; between IODE and both AP and TR diameters of the SS; and between ICD and all diameters of the SS. The highest correlation for each of the IODL, IODE, and ICD was noted with the TR diameter of the SS. During the development of the SS, pneumatization progress likely exerts quantitative and direction-specific forces, which gradually increase the interoptic and intercarotid distances.