Standard Classification System Research Articles

Current Status and Future Perspective in Cholangiopancreatoscopy.

With the rapid growth of cholangiopancreatoscopy, several platforms of cholangiopancreatoscopy have been currently available. Since the introduction of digital single-operator cholangiopancreatoscopy, there have been several reports describing its efficacy for long-standing and novel applications. The purpose of this review is to show the current status and future perspective of cholangiopancreatoscopy. Meta-analysis of cholangiopancreatoscopy have demonstrated good diagnostic yield for visual impression; however, it should be noted that there is no standardized classification system used for distinguishing benign from malignant lesions. In contrast, utility of tissue sampling under direct vision for cholangiopancreatic disorders is inconclusive. This could be explained by the fact that available devices (e.g., biopsy forceps) are limited by the small diameter of accessory channel. Regarding therapeutic applications, several studies demonstrated efficacy and feasibility of electrohydraulic lithotripsy or laser lithotripsy for difficult bile duct stone and pancreatic duct stone under cholangiopancreatoscopic guidance. Additionally, ablation of tumors, selective guidewire placement, retrieval of migrated stents, and anterograde cholangioscopy-guided procedure by using cholangiopancreatoscopy have been reported. The recent development of digital single-operator cholangiopancreatoscopy enables easy access to the bile duct and pancreatic duct, contributing to expanding indications for cholangiopancreatoscopy. Improvement of devices or development of innovative devices is required to overcome the remaining problems of cholangiopancreatoscopy.

Geographic variation in compliance with Australian colorectal cancer screening programs: the role of attitudinal and cognitive traits.

Colorectal cancer (CRC) patients in regional and rural areas tend to be diagnosed at a more advanced stage than metropolitan patients and have poorer 5-year survival rates. Environmental and cultural factors in non-metropolitan areas often facilitate a more reactive approach to health care, which can result in lower participation in preventative health measures such as screening for early signs of cancer. Individual differences in attitudes and cognitive styles can also act as barriers to cancer screening. Currently, evidence regarding geographical disparity in CRC screening is inconclusive and based largely on test return in nationwide screening programs as opposed to compliance with program guidelines. This study investigates the effect of attitudinal and cognitive traits on compliance with, as opposed to participation in, population CRC screening programs in rural, regional and metropolitan environments. A representative cross-section of recipients (n=371, 71% female) of a faecal occult blood test as part of the National Bowel Cancer Screening Program were surveyed in 2017 (mean age = 61.26, standard deviation = 7.05). Participants were asked if they completed and returned the kit or had a valid reason not to (ie prior screening). Postcodes were used to identify participants as metropolitan, regional or rural using the Australian Standard Geographical Classification system. Fatalism, minimisation of problems and resignation (MPR), need for control and self-reliance, and consideration of future consequences (CFC) were measured as traits known to effect health-related help-seeking behaviour. Program compliance rates were compared between rural, regional and metropolitan areas, and logistic regression models with interaction terms were applied to test the differential effects of attitudinal and cognitive factors on program compliance across metropolitan, regional and rural groups. Compliance was significantly lower in regional compared to metropolitan areas (odds ratio (OR)=0.49, 95% confidence interval (CI)=0.29-0.84). Rural status significantly moderated the effect of MPR (OR=0.28, 95%CI=0.11-0.71) and CFC (OR=6.66, 95%CI=1.80-24.63) on compliance and regional status significantly moderated the effect of CFC on compliance (OR=3.41, 95%CI=1.37-8.44). Simple slopes analyses showed that high MPR was associated with lower bowel screening program compliance in rural (OR=0.26, 95%CI=0.11-0.59) and regional (OR=0.60, 95%CI=0.38-0.95) areas, but not in metropolitan areas. High CFC was associated with higher bowel screening program compliance in rural (OR=4.46, 95%CI=1.39-14.47) and regional (OR=2.30, 95%CI=1.19-4.43), but not metropolitan, areas. Sub-optimal compliance rates are evident in non-metropolitan areas with intervention most needed in regional areas where compliance is lowest, leaving residents at a potentially higher risk of CRCs going undetected. Efforts to increase CRC screening in rural and regional areas should promote the consideration of one's future and discourage attitudes that minimise health issues. This research highlights the way in which individual attitudes and thinking styles may impact preventive health behaviours differently in non-metropolitan communities.

The Underlying Stroke Etiology: A Comparison of Two Classifications in a Rural Setup.

IntroductionThis study compares the Trial of Org 10172 in Acute Stroke Treatment (TOAST) and the atherothrombosis, small vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification performed in a rural hospital setup. Stroke is the second leading cause of death after ischemic heart disease with over 9.5 million new cases of ischemic stroke in 2016. Stroke is a complex disease with numerous contributing factors. India needs a standardized stroke classification system, as without one it becomes difficult to collect data on stroke patients, perform follow-ups, and provide appropriate secondary prevention. A standardized stroke classification system would also help in building a nationwide database in order to note epidemiological trends of ischemic stroke. This would also create greater awareness regarding stroke in rural parts of India where healthcare is difficult to access. Aims and objectivesOur aim was to review all admitted stroke patients’ data and classify their etiology and mechanism based on the TOAST and ASCOD classification systems. The ASCOD classification has yet to be utilized in the Indian population. The two classifications are then compared in order to gain a better insight into which classification is a better fit for the Indian population. Both are based on the etiology of ischemic stroke but the ASCOD classification differs because it gives suitable secondary prevention measures based on the diseases linked to stroke. ASCOD also gives a proper indication of the patient’s present causative factor (similar to TOAST) and other factors that can possibly lead to further recurrences. This is different from TOAST, which denotes only a single cause for stroke and eliminates the possibility of other involved contributing factors.Materials and methodsAll patients involved in the study were admitted to a rural Indian hospital from January 2014 to July 2016. All the relevant clinical details of each patient were then retrieved from the hospital’s electronic medical record system for the study. We then classified all the patients based on the TOAST and ASCOD classification criteria.ResultsUsing the ASCOD classification, we found that 179 (86%) patients out of 209 had either atherothrombosis or small vessel disease. The ASCOD classification also showed substantial evidence that the determined stroke mechanism/etiology is interconnected to multiple causal factors in over 50% of patients. In contrast, the TOAST classification had identified a larger number of ischemic stroke patients as having an etiology of other and undetermined causes as compared to the ASCOD classification.ConclusionThe ASCOD classification is better to use in patients and helps decide the secondary prevention appropriately.

Perspectives on ICD-11 to understand and improve mental health diagnosis using expertise by experience (INCLUDE Study): an international qualitative study

Developed in collaboration with WHO Department of Mental Health and Substance Abuse, this study (conducted in India, the UK, and the USA) integrated feedback from mental health service users into the development of the chapter on mental, behavioural, and neurodevelopmental disorders for ICD-11. The ICD-11 will be used for health reporting from January, 2022. As a reporting standard and diagnostic classification system, ICD-11 will be highly influential by informing policy, clinical practice, and research that affect mental health service users. We report here the first study to systematically seek and collate service user perspectives on a major classification and diagnostic guideline. Focus groups were used to collect feedback on five diagnoses: depressive episode, generalised anxiety disorder, schizophrenia, bipolar type 1 disorder, and personality disorder. Participants were given the official draft diagnostic guidelines and a parallel lay translation. Data were then thematically analysed, forming the basis of co-produced recommendations for WHO, which included features that could be added or revised to better reflect lived experience and changes to language that was confusing or objectionable to service users. The findings indicated that an accessible lay language version of the ICD-11 could be beneficial for service users and their supporters.

A 3d platform for energy data visualization of building assets

With an exemplary role, the improvement of energy efficiency in public buildings is in the forefront of the European policies for smart and sustainable growth. However, very often the sector is characterized by large and old constructions that may also be marked by historical and cultural value and whose energy consumption is hard to be reduced, due to specific constraints. In order to operate in this field, the definition of a solid knowledge framework on the built environment appears to be the only viable starting point. Therefore, the analysis of the delicate balance between conservation and transformation should be investigated with a multi-scalar approach able to move from the city to the building elements. For this reason, it is extremely important to provide tools for monitoring and analysing the energy behaviour of the public building stocks to those actors that are involved in their management. The research here presented proposes a workflow to implement a web platform based on a three-dimensional GIS (Geographic Information System) interoperable with BIM (Building Information Modeling) and able to store, handle and display information on building assets and their energy consumption. With the aim of defining a repeatable model, the process starts from easily retrievable data on the built environment and uses standard data models and classification systems. The three-dimensional model is built in a semi-automated way from the combination of the two-dimensional GIS cartography of the municipality and from the point cloud resulting from a LiDAR (Light Detection And Ranging) national survey campaign. The set of thermal properties and energy data can be retrieved from the energy performance certificate of the buildings. In order to test and validate the process, an application on the building stock owned by the University of Pavia (Italy) is presented. Nine complexes distribute inside the historical centre of the city and heterogeneously dated from the X to the XX century are considered. After the definition of the model and its representation inside the web environment, an example of use is displayed with reference to a comparative energy analysis of different buildings.

Disaggregating Homicide: Changing Trends in Subtypes over Time

Due to the heterogeneity of homicide, certain subtypes of homicide might have remained stable or even increased over time in the overall context of decline. Adding to the research attempting to identify a standardized classification system of homicide, this study used a novel, sophisticated statistical approach (multilevel latent class analysis [MLCA]) and an inductive theoretical stance to identify subtypes of homicide in Scotland and to examine how these types have changed over time. Using variables relating to the victim, offender, and the incident of homicide, four between-level types with three within-level classes of offenders in each type were identified. The findings showed that while all homicide types demonstrated an absolute decrease, domestic homicides had demonstrated a relative increase over time. Implications for policy, theory, and practice are discussed.

Preterm birth subtypes, placental pathology findings, and risk of neurodevelopmental disabilities during childhood

IntroductionPreterm birth (PTB) and in-utero inflammation are recognized risk factors of neurodevelopmental disabilities (NDDs); however, their combined role in NDDs is unknown. We examined the independent and joint association of PTB and placental histological findings with the childhood risk of NDDs (overall and by subgroups including autism spectrum disorder (ASD) and ADHD). MethodsWe analyzed data from the Boston Birth Cohort, where mother-infant pairs were enrolled at birth and followed from birth onwards. Birth outcomes, placental pathology and NDDs were obtained from electronic medical records. Placental pathology was categorized using a standardized classification system proposed by the Amsterdam Placental Workshop Group. ResultsPTB (all, including spontaneous, medically indicated) was an independent risk factor for NDDs. Placental histological chorioamnionitis (CA) and PTB additively increased the odds of NDDs (aOR: 2.16, 95% CI: 1.37, 3.39), as well as ADHD (aOR: 2.75, 95% CI: 1.55, 4.90), other developmental disabilities (aOR: 1.96, 95% CI: 1.18, 3.25) and possibly ASD (aOR: 2.31, 95% CI: 0.99, 5.39). The above associations were more pronounced in spontaneous than medically indicated PTB. PTB alone in the absence of CA only had a moderate association with ASD and ADHD. Placental maternal vascular malperfusion alone or in combination with PTB was not associated with the risk of NDDs. DiscussionOur study provided new insights on PTB and NDDs by further considering preterm subtypes and placental histology. We revealed that children of spontaneous PTB along with histological CA were at the highest risk for a spectrum of NDDs.

Natural course of scoliosis and lifetime risk of scoliosis surgery in spinal muscular atrophy

To investigate the natural course of scoliosis and to estimate lifetime probability of scoliosis surgery in spinal muscular atrophy (SMA). We analyzed cross-sectional data from 283 patients from our population-based cohort study. Additional longitudinal data on scoliosis progression and spinal surgery were collected from 36 consecutive patients who received scoliosis surgery at our center. The lifetime probability of receiving scoliosis surgery was ≈80% in SMA types 1c and 2. Patients with type 2 who only learned to sit (type 2a) were significantly younger at time of surgery than those who learned to sit and stand (type 2b). The lifetime risk of surgery was lower in type 3a (40%) and strongly associated with age at loss of ambulation: 71% in patients losing ambulation before 10 years of age vs 22% losing ambulation after the age of 10 years (p = 0.005). In type 3a, preserving the ability to walk 1 year longer corresponded to a 15% decrease in lifetime risk of scoliosis surgery (hazard ratio 0.852, p = 0.017). Scoliosis development was characterized by initial slow progression, followed by acceleration in the 1.5- to 2-year period before surgery. The lifetime probability of scoliosis surgery is high in SMA types 1c and 2 and depends on age at loss of ambulation in type 3. Motor milestones such as standing that are not part of the standard classification system are of additional predictive value. Our data may act as a reference to assess long-term effects of new SMA-specific therapies.

NUTRICARE Application to Access Nutritional Status on Adults and Older People Combining Four Indicators (P16-052-19)

ObjectivesThe purpose of this study was to develop a free application to the whole population to access overall nutritional status in adults and older people from four indicators based on direct anthropometric measurements (height, weight, waist and hip circumferences). MethodsThe application was developed using the MIT App Inventor, a block-based mobile application development tool, so it is available to mobile in Android system only. The application shows measurements protocols of height, weight and waist and hip circumferences (Lohman (1988), and World Health Organization (WHO) (2011)). In the application, standard deviation classification system (z-score) for adults under 20 years of age is calculated and it is classified using the values of smooth curves (L), mean (M) and coefficient of variation (S) according to WHO (2007). For adults, Body Mass Index (BMI) is calculated according to the Quételet formula (1839) and it is classified according to the WHO (1997) for people from 20 until 59 years old, and according to the Pan American Health Organization (PAHO) (2002) for older people. The Body Adiposity Index (BAI) is calculated using the formula of Bergman et al., (2011) and the percentage of body fat is classified according to Gallagher et al., (2000). The application shows the individual epidemiological classification of each anthropometric variables and also it shows the nutritional status through of combinatorial analysis that results in 134 possibilities. ResultsThe free NUTRICARE application provides 4 individual indicators and an overall nutritional status. At phase test, the apk file was sent to 120 people, included Nutritionists, who agreed to test it. They’ve returned positive feedback reporting that application can be used by the whole population because it is simple to use and free. ConclusionsIn conclusion, the NUTRICARE application can be used to assess nutritional status of populations because it provided a result using simple measurements and four combined indicators to achieve more accuracy. We recommend further studies to validate its use in epidemiological studies. Funding SourcesLaboratory of Nutritional Assessment of Populations (LANPOP) Programa Unificado de Bolsas (PUB) - University of São Paulo scholarship program. Supporting Tables, Images and/or Graphs▪▪▪

Motorcycle active safety systems: Assessment of the function and applicability using a population-based crash data set

Objective: Motorcycles and mopeds, often referred to as powered 2-wheelers (PTWs), play an important role in personal mobility worldwide. Despite their advantages, including low cost, space occupancy, and fuel efficiency, the risk of sustaining serious or fatal injuries is higher than that for occupants of passenger cars. The development of safety systems specific for PTWs represents a potential way to reduce casualties among riders. With the proliferation of new active and passive safety technologies, the question as to which might offer the most value is important. In this context, a prioritization process was applied to a set of PTW active safety systems to evaluate their applicability to crash scenarios alone and in combination. The systems included in the study were antilock braking (ABS), autonomous emergency braking (AEB), collision warning, curve warning, and curve assist.Methods: With the functional performance of the 5 safety systems established, the relevance of each system to specific crash configurations and vehicle movements defined by a standardized accident classification system used in Victoria, Australia, was rated by 2 independent reviewers, with a third reviewer acting as a moderator where disagreements occurred. Ratings ranged from 1 (definitely not applicable) to 4 (definitely applicable). Using population-based crash data, the number and percentage of crashes that each safety system could potentially influence, or be relevant for, was defined. Applying accepted injury costs permitted the derivation of the societal economic cost of PTW crashes and the potential reductions associated with each safety system given a theoretical crash avoidance effectiveness of 100%.Results: In the 12-year period 2000–2011, 23,955 PTW riders and 1292 pillion passengers were reported to have been involved in a road crash, with over 500 killed and more than 10,000 seriously injured; only 3.5% of riders/pillion passengers were uninjured. The total economic cost associated with these injured riders and pillion passengers was estimated to be AU$11.1 billion (US$7.70 billion; €6.67 billion). The 5 safety systems, as single solutions or in combination, were relevant to 57% of all crashes and to 74% of riders killed. Antilock braking was found to be relevant to the highest number of crashes, with incremental increases in coverage when combined with other safety systems.Conclusions: The findings demonstrate that ABS, alone and in combination with other safety systems, has the potential to mitigate or possibly prevent a high percentage of PTW crashes in the considered setting. Other safety systems can influence different crash scenarios and are also recommended. Given the high cost of motorcycle crashes and the increasing number of PTW safety technologies, the proposed approach can be used to inform the process of selection of the most suitable interventions to improve PTW safety.

Structural Breaks, Biased Estimations, and Forecast Errors in a GDP Series of Canada versus the United States

A structural break was suspected for the Canadian gross domestic product (GDP) time series when the reporting system switched from the Standard Industrial Classification system to the North American Industry Classification System system in 1997, as was previously detected for the United States. Any failure to identify in-sample breaks not only will produce biased parameter estimates but may adversely affect the model’s out-of-sample forecasting performance. This study investigated the possibility of poor forecast performance and biased estimation in the presence of the 1997 structural break in Canadian GDP. We confirmed the detected break in Canadian GDP data (1973–2014). All statistics indicated that the coefficients were not stable over time. Three models were employed to provide more accurate forecasts of GDP. The results demonstrate gains in forecasting precision when out-of-sample models accounted for structural breaks. Decision and policy makers might benefit from more precise GDP anticipation if the models were corrected for the 1997 break.

182 Proposing a standard psychodermatological classification system for clinical and epidemiological communication and research

182 Proposing a standard psychodermatological classification system for clinical and epidemiological communication and research

Analysis of the caesarean section rate using the 10-Group Robson classification at Benha University Hospital, Egypt

BackgroundEgypt has the third highest caesarean section rate (54%) in the world and lacks a standard classification system to analyse caesarean section rates. The World Health Organization (WHO) recommends the Robson classification as an effective caesarean section analysis and monitoring tool. AimTo analyse the caesarean section rate of Benha University Hospital, Egypt using the standard 10-Group Robson classification system. MethodA prospective, cross-sectional study was conducted at the Benha University Hospital from 1 April to 30 June 2018. All women admitted for childbirth were categorised into Robson groups to determine the absolute and relative contribution made by each group to the overall caesarean section rate. Epi Data V.3.1 software programme was used to analyse the data. Findings850 women gave birth during the study period, 466 (55%) by caesarean section (CS). Robson Group 5 (multiparous, term, cephalic presentation and previous caesarean section) contributed the most (36%) to the overall CS rate. 175/308 (56%) women in this group had previously undergone one caesarean section. Group 6 (all nulliparous women with single breech pregnancy) and Group10 (cephalic preterm pregnancies) were the second and the third greatest contributors toward the overall CS rate, with 4.6% and 2.8% respectively. ConclusionsIn keeping with other studies, Groups 5, 6, and 10 were the main contributors to the overall caesarean section rate. We found Robson classification to be clinically relevant and an effective tool to analyse the caesarean section rate even in settings with limited resources.

Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review.

Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP. A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible. sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover. sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.

Localization, knowledge spillover, and R&D investment: Evidence of Chinese cities

We develop a simple Cournot type, two-stage competition model that reveals that firms tend to reduce their R&D investment more in denser locations than in lesser ones with the presence of knowledge spillover. This implies that local agglomeration increases the negative impact of knowledge spillover on firms' R&D efforts. We then use high-tech, firm-level data from China to test our theoretical predictions. We develop a technological similarity index as a proxy for knowledge spillover and use total employment in the same two-digit Chinese Standard Industry Classification System industry as a proxy for localization agglomeration. Our Tobit model yields estimated results that are consistent with our predictions. That is, R&D effort is negatively correlated with knowledge spillover, and the magnitude of the negative relationship increases with localization agglomeration. These results are robust by different subsamples and different estimators. We also find evidence suggesting that cost-saving, rather than expropriation-avoidance, is the primary reason for firms’ R&D investment reduction with knowledge spillover.

A Classification System for Spinal Cord Compression and its Association With Neurological Deficit in Spinal Epidural Abscess.

This was a retrospective case-control study. We aim to describe a novel 5-point grading system to determine the degree and severity of spinal cord compression secondary to a spinal epidural abscess (SEA). Secondarily, we aim to correlate the degree of compression with clinical presentation and outcomes. Mechanical compression plays an important role in the pathophysiology of neurological dysfunction in SEA. Unfortunately, no standardized classification system for describing the degree of spinal cord compression exists. The lack of a validated grading system makes it challenging to study and consistently report the relationship between cord compression and clinical presentation/outcomes in SEA. Patients 18 years and older admitted to our hospital system with a diagnosis of SEA located above the conus medullaris between 1993 and 2016 were included. Using pretreatment axial magnetic resonance images, we developed a 5-point classification scale to determine the degree of spinal cord compression. After assigning a compression grade to each abscess, we investigated the relationship between the degree of compression and presenting neurological symptoms. Furthermore, we assessed the association between compression grade and clinical outcomes. Three hundred thirty-nine patients were included in the study. Patients with high-grade cord compression (grades 4 and 5) were significantly more likely to present with pretreatment motor deficit, sensory changes, and bowel/bladder incontinence. With respect to clinical outcomes, increasing degree of compression was not associated with failure of nonoperative management, residual motor deficit, or 90-day mortality. We report a novel grading system for spinal cord compression in SEA with 5 progressively increasing grades of compression. High-grade abscesses with cord compression were significantly associated with neurological deficit at presentation but not with poor outcomes. We hope that this classification system will allow for greater consistency in reporting the association between cord compression and neurological deficit in SEA.

New classifications for Life-threatening foreign body airway obstruction

IntroductionForeign body airway obstruction (FBAO) is a common medical emergency; however, few studies of life-threatening FBAO have been reported and no standard classification system is available. MethodsWe retrospectively evaluated patients who presented to the emergency departments of two hospitals and were diagnosed with FBAO. The primary outcome was cerebral performance category (CPC) score at discharge. To establish a new classification system for FBAO, FBAO was classified into three types based on the anatomical and physiological characteristics of the obstructed airway. ResultsA total of 137 patients were enrolled. Median age was 79.0 years. The most common cause of FBAO was meat, followed by bread, rice cake, and rice. Of all patients, 65.7% suffered cardiac arrest and 51.1% died. In contrast, 28.5% had favorable neurological outcomes, defined as CPC 1 and 2. Upper airway obstruction (type 1) was the most common (type 1, 78.1%), while trachea and/or bilateral main bronchus obstruction (type 2, 12.4%) showed significantly higher mortality than type 1 obstruction (82.4% vs 47.7%, P = 0.0078). Patients with unilateral bronchus and/or distal bronchus obstruction (type 3, 9.5%) were significantly more likely to consume a dysphagia diet than type 1 patients (23.1% vs 0%, P < 0.0001). ConclusionThe majority of patients with life-threatening FBAO were elderly and had poor neurological outcomes. Our new classification system divides FBAO into three types, and revealed that mortality was significantly higher with type 2 than type 1 obstruction. This classification system may improve the management of patients with FBAO and assessment of patient outcomes.

04:21 PM Abstract No. 140 Uterine artery embolization for adenomyosis: a single-center experience

To examine the outcomes of UAE for patients with adenomyosis to determine efficacy and possible subgroups with superior outcomes. At a single-center, records of patients who underwent UAE for adenomyosis were identified. Patients with concurrent fibroids were included in this study; patients without complete records were excluded. Chart review, pelvic MRI, and procedure records were utilized to determine and classify the type of adenomyosis, primary symptom improvement, and embolic type/size. 183 patients with adenomyosis underwent embolization from 1999 to 2018. Of these, 74 patients had complete records and comprise our study. Five patients (6%) underwent UAE for pure adenomyosis. Average age was 45.5 years. Median time to follow-up was 3 months (range: 2- to 10-months). Overall, 63 patients (85%) reported symptom improvement and 11 (15%) reported inadequate symptom improvement. Seventeen patients were treated with smaller particles (300-500 um) than typically used for UAE for treatment of fibroids alone. Although this subset had greater symptom improvement when compared to the larger embolic group, it was without significance (p=0.14). Subgroups of adenomyosis were classified as focal (n=34), regional (n=17), and diffuse (n=19). An ANOVA analysis of adenomyosis types and symptom improvement demonstrated no statistically significant difference between these groups (p=0.52). Though UAE is increasingly utilized to treat symptomatic adenomyosis, there is not yet a standard embolization protocol or classification system for adenomyosis. This retrospective analysis supports UAE efficacy for the treatment of adenomyosis with an overall clinical improvement of 85%. There is continued lack of understanding regarding particular subtypes of adenomyosis in response to UAE, which may be due to the lack of a thorough classification of the varieties of adenomyosis. A staging system similar to the Figo classification for fibroids may be needed for adenomyosis. This analysis calls for further classification of adenomyosis and suggests that size of embolic used should be studied in a prospective fashion.Table 1Type of Adenomyosis and Clinical OutcomeType of Adenomyosisn =# Symptom Improvement% Symptom Improvement# No Symptom Improvement% No Symptom ImprovementFocal342882%618%Regional171694%16%Diffuse191684%211% Open table in a new tab

The correlation analysis of morphological parameters and postoperative prognosis in patients with idiopathic macular hole

Objective To evaluate the optical coherence tomograghy (OCT) morphological parameters for predicting anatomical outcomes and postoperative visual acuity in idiopathic macular hole (IMH) after pars plana vitrectomy (PPV). Methods A retrospective study. A total of 26 eyes in 23 IMH patients underwent PPV, internal limiting membrane (ILM) peeling and gas filling surgery were included in this study. The patients included 8 eyes of 7 males and 18 eyes of 16 females, with the mean age of (63.9± 9.4). All patients received the best corrected visual acuity (BCVA), slit lamp microscope, indirect ophthalmoscopy and three-dimensional optical coherence tomography (3D OCT) examinations. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution visual acuity. According to the standard classification system of International Vitreomacular Traction Study (IVTS) Group, 8 eyes were medium full-thickness macular hole (FTMH) and 18 eyes were large FTMH, none of which were with vitreomacular traction (VMT). The minimum diameter (MIN), base diameter (BASE), height (H), left and right arm length (LAL and RAL), diameter of ellipsoid zone absence (DEZA) were measured. Macular hole index (MHI), hole form factor (HFF), tractional hole index (THI), diameter hole index (DHI) were calculated. The average follow-up period were (9.2±9.7)months. The postoperative DEZA were measure at the last time. Anatomical outcomes were divided into 3 groups. The multiple factors related with predicting anatomical outcome and visual acuity were analyzed. Results In the 26 eyes, the hole was closed in 16 eyes of type 1, 7 eyes of type 2, 3 eyes of type 3. The mean pre- and post-operative logMAR BCVA were 0.9±0.3, 0.7± 0.3 respectively. The MIN, BASE, H were (533±176), (1 035±270), (462±138)μm respectively. The MHI, HFF, THI, DHI were 0.46±0.15, 0.72±0.19, 0.95±0.37, 0.52±0.11 respectively. The mean pre- and post-operative DEZA were (1 775±486), (960±138) μm respectively.Postoperative logMAR BCVA were correlated significantly with MHI, THI (all P 0.05). Anatomical prognosis types were significantly correlated with MHI, HFF, THI (all P 0.05). Conclusions For medium and large FTMH in IVTS classification system, MHI, THI have the best correlation with postoperative BCVA and can be considered as key indicators for predicting postoperative BCVA. MHI, HFF, THI have the best correlation with anatomical outcomes and can be considered as key indicators for predicting anatomical outcomes of IMH. Key words: Retinal perforations; Tomography, optical coherence; Vitrectomy; Retina

Defining a new neurosurgical complication classification: lessons learned from a monthly Morbidity and Mortality conference.

The absence of a commonly accepted standardized classification system for complication reporting confounds the recognition, objective reporting, management, and avoidance of perioperative adverse events. In the past decade, several classification systems have been proposed for use in neurosurgery, but these generally focus on tallying specific complications and grading their effect on patient morbidity. Herein, the authors propose and prospectively validate a new neurosurgical complication classification based on understanding the underlying causes of the adverse events. A new complication classification system was devised based on the authors' previous work on morbidity in endovascular surgery. Adverse events were prospectively compiled for all neurosurgical procedures performed at their tertiary care academic medical center over the course of 1 year into 5 subgroups: 1) indication errors; 2) procedural errors; 3) technical errors; 4) judgment errors; and 5) critical events. The complications were presented at the monthly institutional Morbidity and Mortality conference where, following extensive discussion, they were assigned to one of the 5 subgroups. Additional subgroup analyses by neurosurgical subspecialty were also performed. A total of 115 neurosurgical complications were observed and analyzed during the study period. Of these, nearly half were critical events, while technical errors accounted for approximately one-third of all complications. Within neurosurgical subspecialties, vascular neurosurgery (36.5%) had the most complications, followed by spine & peripheral nerve (21.7%), neuro-oncology (14.8%), cranial trauma (13.9%), general neurosurgery (12.2%), and functional neurosurgery (0.9%). The authors' novel neurosurgical complication classification system was successfully implemented in a prospective manner at their high-volume tertiary medical center. By employing the well-established Morbidity and Mortality conference mechanism, this simple system may be easily applied at other neurosurgical centers and may allow for uniform analyses of perioperative morbidity and the introduction of corrective initiatives.