European Classification Systems Research Articles

Diagnostic performance of European and ACR-TIRADS classification systems in thyroid nodules over 20 mm in diameter

BackgroundThe challenge of selecting thyroid nodules for fine-needle aspiration (FNA) cytology has led to the development of the Thyroid Imaging Reporting and Data System (TIRADS), primarily in two formats: EU-TIRADS and ACR-TIRADS. Clinical observations suggest imperfect risk assessment for TIRADS 3 nodules ≥20 mm. This study aimed to evaluate the efficacy of TIRADS systems in distinguishing benign from malignant nodules in this subgroup. Materials and MethodsFrom May 2023 to March 2024, 1,094 patients with thyroid nodules were referred for ultrasound (US) at a University Hospital. Data on clinical, ultrasound, cytological, and histopathological parameters were collected. Nodules ≥20 mm were categorized by EU-TIRADS and ACR-TIRADS, and their predictive performance for malignancy was assessed through post-thyroidectomy histopathology or FNA cytology (Bethesda classification). Results267 patients (mean age 60.3 ± 14.3 years; 46 men, 221 women) with 308 nodules were analyzed. Twenty-two malignancies and 286 benign nodules were recorded. Recalculating EU-TIRADS 3 performance using 25 mm and 30 mm thresholds (ACR-modified EU-TIRADS) avoided 24% and 41% of FNAs, respectively, while ACR-TIRADS would prevent 26.6% (p>0.05). Two malignancies were missed. ConclusionEU-TIRADS and ACR-TIRADS show similar efficacy when using a 25 mm FNA threshold. Raising the cut-off for FNA in EU-TIRADS 3 nodules could reduce unnecessary procedures but may increase the risk of missed malignancies, impacting patient outcomes.

Harmonization of Nordic coastal marsh habitat classification benefits conservation and management

Coastal marshes are productive and diverse habitats that act as essential linkages between marine and terrestrial ecosystems. Although the Nordic region comprises diverse, unique marsh habitats along the Baltic coast and the Atlantic coast of Norway, they are not widely recognized as coastal marshes, e.g., salt marshes in other parts of the world. This may be partly due to inconsistency in habitat classification, use of terminology, and the heterogeneity of these habitats across the region, which limit overviews of their ecology, distribution, and management. Here, we aim to improve the basis for assessments of Nordic coastal marshes by providing an overview of terminology, distribution, area, and management practices of these habitats across the region. We use the general term coastal marsh to cover the variety of habitat types in the study area, which are covered mainly by the European Union's (EU's) Habitats Directive Annex I habitat classes 1310 Salicornia and other annuals colonizing mud and sand, 1320 Spartina swards (Spartinion maritimae), 1330 Atlantic salt meadows (Glauco-Puccinellietalia maritimae), and 1630 Boreal Baltic coastal meadows. Based on input from national environmental officers, an expert survey, a workshop, and reviewing environmental databases, we compiled a comprehensive database on coastal marsh habitats regarding their distribution, classification, conservation status, management, and monitoring practices in four Nordic countries (Denmark, Finland, Norway, Sweden) and Germany, covering wide environmental gradients in, e.g., salinity and tidal range. Overall, we found that the four Annex I classes cover an area of ∼900 km2 in the study region, one-fourth of the total area of these habitats in the EU, with an additional ∼450 km2 of other potential coastal marsh areas and 500 km2 of coastal reed beds. Beyond the variable terminology across the region, our study revealed a gap in the European habitat classification systems concerning the diversity of the Baltic Sea coastal marshes. Creating subtype(s) for the Annex I class 1630 would help to improve the conservation of the most threatened habitat types within the class. In addition, we found pronounced differences in monitoring and managing coastal marshes among countries, indicating that these important and diverse habitats between land and sea might receive insufficient attention and protection despite the multiple ecosystem services they provide. Coordinated harmonization of habitat classifications and monitoring across the Nordic countries could increase regional-scale coordination of the management of coastal marshes and facilitate comparative studies.

Therapeutic Vulnerabilities of Transcription Factors in AML.

Acute myeloid leukemia (AML) is characterized by impaired myeloid lineage differentiation, uncontrolled proliferation, and inhibition of proapoptotic pathways. In spite of a relatively homogeneous clinical disease presentation, risk of long-term survival in AML varies from 20% to 80% depending on molecular disease characteristics. In recognition of the molecular heterogeneity of AML, the European Leukemia Net (ELN) and WHO classification systems now incorporate cytogenetics and increasing numbers of gene mutations into AML prognostication. Several of the genomic AML subsets are characterized by unique transcription factor alterations that are highlighted in this review. There are many mechanisms of transcriptional deregulation in leukemia. We broadly classify transcription factors based on mechanisms of transcriptional deregulation including direct involvement of transcription factors in recurrent translocations, loss-of-function mutations, and intracellular relocalization. Transcription factors, due to their pleiotropic effects, have been attractive but elusive targets. Indirect targeting approaches include inhibition of upstream kinases such as TAK1 for suppression of NFκB signaling and downstream effectors such as FGF signaling in HOXA-upregulated leukemia. Other strategies include targeting scaffolding proteins like BrD4 in the case of MYC or coactivators such as menin to suppress HOX expression; disrupting critical protein interactions in the case of β-catenin:TCF/LEF, and preventing transcription factor binding to DNA as in the case of PU.1 or FOXM1. We comprehensively describe the mechanism of deregulation of transcription factors in genomic subsets of AML, consequent pathway addictions, and potential therapeutic strategies.

The Ngarrindjeri nomenclature of birds in the Lower Murray River region, South Australia

ABSTRACTThis paper is a literature-based study concerning avian nomenclature of the Ngarrindjeri language formerly spoken in the Lower Murray River region of temperate South Australia. Ngarrindjeri and modern European Australian classification systems for birds were structurally different. There was no single Ngarrindjeri word that covered all birds. Some species were clustered together under a single term, while others had separate gender-specific names. This study investigates how avian terms were incorporated into the naming of people and places. Analysis of avian classification adds to the understanding of early Aboriginal use and perception of the Australian environment. A detailed list of Ngarrindjeri names for birds is provided.

To what extent can prescriptions be meaningfully exchanged between primary care terminologies? A case study of four western European classification systems

The diversity of terminologies used in primary care causes significant challenges regarding semantic interoperability. Attempts to address these challenges usually focus on the creation of metaterminologies, with the peculiarities of national variations of terminologies being overlooked. In this study the extent to which primary care data can be meaningfully exchanged between nationally implemented terminologies is assessed using a rule-based approach. To determine this, a model comprising primary care terminologies and including axioms to define their relations was developed. Generic metrics were designed to determine the completeness and accuracy of any two arbitrary vocabularies within an ontological model. These metrics were used on an implementation of the model to determine the data quality that is preserved when expressing similar data in different primary care terminologies. The results show that values of terminologies which are closely related can express each other's concepts relatively well. The authors conclude that the current state of accuracy and completeness between primary care terminologies does not allow for sufficiently meaningful semantic interoperability, but that their approach of mapping lower-level terminologies to each other next to an ontological approach may yield better results than relying solely on the latter.

Discrimination ability of Santa Inês and crossbred Santa Inês × Dorper lamb heavy carcasses by the Brazilian and European classification systems

ABSTRACT The ability of discriminating carcass characteristics of different fat cover scores of heavy carcasses, according to the European (EUS) and Brazilian (BRS) classification systems, was assessed. Fifty-six lambs, weighing between 26.25 and 46.15 kg, of the Santa Ines and crossbred Santa Ines × Dorper genetic groups were evaluated. The level of adiposity was assessed through color photography of the carcasses after refrigeration according to the EUS and BRS. The carcasses were assigned to four groups by cluster analysis according [...]

Assessment of the therapeutic value of new medicines marketed in Australia.

Assessment of the therapeutic value of new medicines marketed in Australia.

Koncept geobiotopu ako možnej vyššej stanovištnej jednotky pre diferencovanie manažmentu lesov

The paper proposes and justifies an alternative concept of aggregation of forest site types in higher units for purposes of differentiation of forest management. Analysis of variance was performed for both: the natural occurrence of tree species in reserves, as well as the production potential of tree species measured on the representative plots according to Zlatnik´s altitudinal vegetation zones and edaphictrophic series. Based on the results of this analysis, an aggregation of forest site types was suggested along the elevation gradient of climatop, and along the edaphic-trophic and the edaphic-hydric gradients of edaphotop. By intersection of such created 32 categories of geotope with the basic formation groups of forest habitats by Braun-Blanquet geo-botanical school, 53 reconstructive geo-biotopes were formed. The proposed unit was compared using the F-test, Akaike information criterion (AIC), and the index of classification efficiency (EQ) with current typological units in terms of its ability to describe the variability of the analyzed parameters. Finally, the qualitative association of the compared classification models with the European classification systems was assessed. Based on the results obtained, it can be concluded that the site unit geo-biotop is at least comparable with currently used unit MGFT, with the number of categories

Boreal rich fen vegetation formerly used for haymaking

In the present study, we describe the variation in rich fen (brown moss‐dominated) vegetation of boreal uplands in Norway, based on studies in two nature reserves representing an oceanic and a more continental area. The vegetation description included 134 sample plots and 200 taxa, using TWINSPAN classification and DCA ordination. The main aims were to describe the rich fen vegetation used for traditional haymaking, to find important ecological gradients and to compare the fen vegetation to the main European classification systems. We classified the fen vegetation into six plant communities. Rich (including extremely rich) fen vegetation of lawns and open margins were most common, representing the alliances Caricion atrofuscae, including alpine/continental species like Equisetum variegatum and Pedicularis oederi and Schoenion ferruginei (Caricion davallianae), including lowland/oceanic species like Drosera longifolia and Narthecium ossifragum. A majority of the constant species were in common for the two alliances, e.g. Thalictrum alpinum, Trichophorum cespitosum, Campylium stellatum and Gymnocolea borealis. The lawn communities included 30–38 species per plot (12.5 m2). We classified the flat fens with carpet communities dominated by Scorpidium cossonii and S. scorpioides to the alliances Stygio–Caricion limosae and Caricion lasiocarpae. The carpets contained ca 30 species per plot. Shrub‐dominated fen margin represents Sphagno–Tomentypnion, with the highest species number, more than 50 species per plot, including Molinia caerulea as a constant and abundant species, and a large number of herbs as constants. The plots of the margin community were in an overgrowing process, invaded by shrubs and wet grassland species. The peak in floristic diversity in abandoned margin communities fits well with both the humped‐back model of species richness and the intermediate disturbance hypothesis.

Liquid limit of low- to medium-plasticity soils: comparison between Casagrande cup and cone penetrometer test

For liquid limit determination, the European Standards require the cone penetrometer technique or, alternatively, the Casagrande cup method; but the latter is widely used in practice. As most European soil classification systems are not adapted to the new European Standards, a systematic study was carried out to verify the differences between the two techniques for liquid limit determination, examining clayey soils from various geologic units. Comparison of 100 liquid limit values ranging between 20 and 50% indicates that the liquid limit obtained by the fall cone method is generally 2.2% points higher than that obtained by the hard base Casagrande apparatus. Comparison of data from different sources consistently indicates that the equation proposed in this study may be useful in revising existing soil classification systems, avoiding problems of soil classification due to the technique used for liquid limit determination.

A European morpho-functional classification of humus forms

In Europe an abundance of humus taxonomies exists starting with early approaches in the late 19th century. Frequently used in an international context, they do not cover all site conditions in the European area. Although having basic concepts and general lines, the European (and North American, Canadian) classification systems differ in important parameters used for the description and classification of humus forms. These discrepancies result in incongruities, so they require adjustments when exchanging partially compatible soil data, even between nearby countries. In 2003, 26 European specialists in humus forms met in Trento (Italy) and decided to formulate rules of classification based on morphogenetic descriptions and diagnostic horizons, adapted to European ecological conditions. Taking into account old and new European and North American systems of humus forms classification, six main references (Anmoor, Mull, Moder, Mor, Amphi and Tangel) were defined, each of them further divided into more detailed categories. This inventory assigned a strong discriminatory power to the action of soil animals. Both semiterrestrial (anoxic) and terrestrial (aerated) topsoils were classified. Descriptors of diagnostic horizons were conceived in accordance with recent international soil classifications. Assigning an ‘ecological value’ to each main humus form along a gradient from biologically active forms, degrading and incorporating all organic remains, to those characterized by the accumulation of poorly transformed organic matter, this European system of classification avoids a strong hierarchical structure and allows a flexible approach open to additional ecological contributions and renditions.

What Ophthalmologists Should Know About Sjögren’s Syndrome

About one-quarter of patients with dry-eye syndrome (DES) have an underlying rheumatic condition, most commonly Sjogren’s syndrome (SS). SS is a common, frequently underdiagnosed cause of dry eye with multisystemic involvement. The immunological background of SS involves activation of both innate and acquired immune systems. According to the 2002 American and European classification systems, presence of any four of the six criteria (i.e. symptoms of dry eye, symptoms of dry mouth, ocular signs of dry eye, objective salivary gland involvement, typical histopathology findings in minor salivary gland biopsy specimens and presence of serum autoantibodies) as long as either the biopsy or serology is positive or presence of any three of the four objective criteria is considered diagnostic of SS. The main goal of treatment of ocular involvement is the alleviation of dry-eye symptoms with replacement therapy, stimulation of tear secretion and supportive surgical procedures to conserve tears. Preservative-free tear substitutes, topical steroids, cyclosporine A, autologous serum eye-drops and punctal plugs are commonly used for this purpose.

Improving the Classification of Medically Unexplained Symptoms in Primary Care

Many patients in primary care complain of physical symptoms not attributable to any known conventionally defined disease, i.e. medically unexplained symptoms (MUS). Objectives: This paper aims to present the problems with our current classification of MUS in general practice and propose new criteria for the classification of Medically Unexplained Symptoms in a future edition of the International Classification of Primary Care (ICPC). Methods: Discussion of European classification systems in relation to current evidence about MUS in primary care. Results: At present, clinical care and research are hampered by the lack of a valid and reliable diagnostic classification of MUS. A particular problem in primary care is that the diagnostic category of somatoform disorders only includes persistent cases and therefore offers no opportunity for the classification of many patients with MUS in general practice. We propose new diagnostic criteria for MUS that can easily be integrated in a future edition of the ICPC. The criteria introduce mild to moderate MUS into the chapter of general and unspecified health problems if the patient has at least three MUS during an episode of care, whereas severe conditions are kept in the psychological chapter under the diagnoses applied until now. Conclusion: A diagnosis and classification of MUS is essential for the prediction of prognosis and the choice of appropriate care for these patients in general practice. It remains to be evaluated in epidemiologic research whether the proposed classification criteria fulfil this purpose

INF14 ERDDS-the european radiological data system setting up

The project objectives are to exploit the available digital contents of the Radiology Departments in the EU, to define an European Radiological Classification and to set up an European radiological digital data integration framework. The partners of the project are the radiological Societies of France, Italy and Spain, Radiological Departments from these countries and the Czech Republic, a Consulting company for the technical coordination and an IT provider for design and implementation of the website. The project encounteers different milestones over a 24 month period. We formed the Data model, with data analysis and started user context domain analysis. User requirements, including the description of the main services to be implemented are defined. The first prototype for implement of a subset of functionalities was presented and discussed during the last meeting of all the partners. The final prototype with its complete structure will be obtained in the next months. It is difficult, but possible to harmonize radiological data between the difefrent countries of the European union. It will help the communication and exchange of radiological information and allow a breakthrough of European radiology classification and taxonomy Systems.

Comparison of Japanese and European Fire Classification Systems for Surface Linings.

A comparison of the Japanese and European fire classification systems for surface linings is presented focusing on heat release. The fire test methods and criteria for product classes are described, as well as the background of the class limits.The Japanese and European fire classification systems have a common reference scenario: fire in a small room. The test methods used in the classification are different in Japan and Europe, but the basic principle in the definition of the product performance classes is the same. The main test methods for heat release of construction products in the Japanese and European fire classification systems are the cone calorimeter and the SBI test, respectively. A one-dimensional thermal flame spread model was applied to predict SBI test results on the basis of cone calorimeter data. A good correlation between the experimental and predicted Euroclasses was found. The Japanese and European classifications on the basis of the cone calorimeter and SBI tests were compared for a series of 33 building products. For the majority of products, the classification systems are well consistent. However, different test methods and classification parameters cause inconsistencies in certain cases. The correspondence of classifications can be found by examining the product type and composition, and considering the features of the main fire tests of the classification systems.