Updated Classification Scheme Research Articles

RadioGraphics Update: Parathyroid CT and Primary Hyperparathyroidism.

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

Comparison of dental topography of marmosets and tamarins (Callitrichidae) to other platyrrhine primates using a novel freeware pipeline

Dental topographic metrics (DTMs), which quantify different aspects of the shape of teeth, are powerful tools for studying dietary adaptation and evolution in mammals. Current DTM protocols usually rely on proprietary software, which may be unavailable to researchers for reasons of cost. We address this issue in the context of a DTM analysis of the primate clade Platyrrhini (“New World monkeys”) by: 1) presenting a large comparative sample of scanned second lower molars (m2s) of callitrichids (marmosets and tamarins), previously underrepresented in publicly available datasets; and 2) giving full details of an entirely freeware pipeline for DTM analysis and its validation. We also present an updated dietary classification scheme for extant platyrrhines, based on cluster analysis of dietary data extracted from 98 primary studies. Our freeware pipeline performs equally well in dietary classification accuracy of an existing sample of platyrrhine m2s (excluding callitrichids) as a published protocol that uses proprietary software when multiple DTMs are combined. Individual DTMs, however, sometimes showed very different results in classification accuracies between protocols, most likely due to differences in smoothing functions. The addition of callitrichids resulted in high classification accuracy in predicting diet with combined DTMs, although accuracy was considerably higher when molar size was included (90%) than excluded (73%). We conclude that our new freeware DTM pipeline is capable of accurately predicting diet in platyrrhines based on tooth shape and size, and so is suitable for inferring probable diet of taxa for which direct dietary information is unavailable, such as fossil species.

Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation

Atrial fibrillation (AF) is a growing health problem that increases morbidity and mortality, and in most patients progresses to more advanced diseases over time. Recent research has examined the underlying mechanisms, risk factors, and progression of AF, leading to updated AF disease classification schemes. Although endocardial catheter ablation is effective for early-stage paroxysmal AF, it consistently achieves suboptimal outcomes in patients with advanced AF. Identification of the factors that lead to the increased risk of treatment failure in advanced AF has spurred the development and adoption of hybrid ablation therapies and collaborative heart care teams that result in higher long-term arrhythmia-free survival. Patients with non-paroxysmal AF, atrial remodeling, comorbidities, or AF otherwise deemed difficult to treat may find hybrid treatment to be the most effective option. Future research of hybrid therapies in advanced AF patient populations, including those with dual diagnoses, may provide further evidence establishing the safety and efficacy of hybrid endo-epicardial ablation as a first line treatment.

Surgeons’ perspectives for a future obstetric fistula classification system: exploring the key parameters

Background There is currently no unified classification scheme for accurately describing vesico-vaginal fistulas, thereby limiting communication between surgeons and the ability to compare research. Many factors related to surgical failure or success have not been explored, and surgeons currently do not universally use the same classifications. The objective of this study is to determine which factors are the most important to include in a future obstetric fistula classification scheme. Methods Members of the International Society of Obstetric Fistula Surgeons were surveyed using a non-validated questionnaire to explore their experience and factors they think were most important to include in an updated comprehensive obstetric fistula classification scheme. Based on the surgeons’ response, an average ranking of each determinant of obstetric fistula classification system was computed. Results The most critical factors that surgeons found necessary to include in an updated fistula classification system are the bladder size (88.9%, n=16, rank=8.53), degree of fibrosis of the vagina (83.3%, n=15, rank=8.12), degree of urethral damage (88.9%, n=16, rank=9.34), location of the fistula (100%, n=18, rank=9.22), urethral length (94.4%, n=17, rank=9.06), and whether the fistula is circumferential or not (94.4%, n=17, rank=9.18). The least important factors were how long the patient had had a fistula (11.1%, n=2, rank=2.28) and intraoperative complications (22.2%, n=4, rank=4.59). For most factors important in repair, there was a non-significant correlation between experience level and ratings from 0-10. Scores for urethral length showed a significant correlation between increased surgical experience and higher ratings of importance. Conclusions Three most commonly used classification schemes by Goh, Waaldjik, and the World Health Organization (WHO) only capture some important factors determined by the surveyed surgeons. Given the inconsistency between what experienced and expert surgeons deem to be important determinants for the classification of obstetric fistula and what is currently included in classification systems, we call for constructing a new, validated classification system.

RadioGraphics Update: Lung-RADS 2022.

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

Benign chondrogenic tumors

The fifth edition of the 2020 WHO classification of tumors of soft tissue and bone tumors provides an updated classification scheme and essential diagnostic criteria for bone tumors. We focused on major changes about chondrogenic tumors that represent one of the most common tumors of the bone. The management of these tumors is based on observation, curettage and excision or surgical resection. In rare cases, benign tumors can undergo to malignant transformation. The aim of this paper is to review common chondrogenic tumors, osteochondroma, enchondroma (including enchondromatosis) and chondroblastoma, and to discuss the problems of interpretation of well-differentiated cartilage tumors.

RadioGraphics Update: Pictorial Guide to CAD-RADS 2.0

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

RadioGraphics Update: New Follow-up and Management Recommendations for Polypoid Lesions of the Gallbladder

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new informaion such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

Investigator-Determined Categories for Fever of Unknown Origin (FUO) Compared With International Classification of Diseases-10 Classification of Illness: A Systematic Review and Meta-analysis With a Proposal for Revised FUO Classification.

Classifying fever of unknown origin (FUO) into categorical etiologies (ie, infections, noninfectious inflammatory, oncologic, miscellaneous, and undiagnosed disorders) remains unstandardized and subject to discrepancies. As some disease classifications change, a systematic review of studies would help physicians anticipate the frequency of illness types they may encounter that could influence care. We systematically reviewed prospective FUO studies published across the Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022. We performed a meta-analysis to estimate associated pooled proportions between the investigator-determined choice of disease category and those determined by the International Classification of Diseases, 10th edition (ICD-10), methodology. The proportion of patients with a difference between the investigator and ICD-10-adjusted noninfectious inflammatory disorder category was 1.2% (95% CI, 0.005-0.021; P < .001), and the proportion was similar for the miscellaneous category at 1.5% (95% CI, 0.007-0.025; P < .001). The miscellaneous and noninfectious inflammatory disorders categories demonstrated significant across-study heterogeneity in the proportions of patients changing categories, with 52.7% (P = .007) and 51.0% (P = .010) I2 , respectively. Adjusting FUO-associated diagnoses by ICD-10 methodology was associated with a statistically significant risk of over- or underestimation of disease category frequency approximation when using a 5 FUO category system. An FUO diagnostic classification system that better reflects mechanistic understanding would assist future research and enhance comparability across heterogenous populations and different geographic regions. We propose an updated FUO classification scheme that streamlines categorizations, aligns with the current understanding of disease mechanisms, and should facilitate empirical decisions, if necessary.

An updated phylogeny, biogeography, and PhyloCode-based classification of Cornaceae based on three sets of genomic data.

A major goal of systematic biology is to uncover the evolutionary history of organisms and translate that knowledge into stable classification systems. Here, we integrate three sets of genome-wide data to resolve phylogenetic relationships in Cornaceae (containing only Cornus s. l.), reconstruct the biogeographic history of the clade, and provide a revised classification using the PhyloCode to stabilize names for this taxonomically controversial group. We conducted phylogenetic analyses using 312 single-copy nuclear genes and 70 plastid genes from Angiosperms353 Hyb-Seq, plus numerous loci from RAD-Seq. We integrated fossils using morphological data and produced a dated phylogeny for biogeographical analysis. A well-resolved, strongly supported, comprehensive phylogeny was obtained. Biogeographic analyses support an origin and rapid diversification of Cornus into four morphologically distinct major clades in the Northern Hemisphere (with an eastern Asian ancestor) during the late Cretaceous. Dispersal into Africa from eastern Asia likely occurred along the Tethys Seaway during the Paleogene while dispersal into South America likely occurred during the Neogene. Diversification within the Northern Hemisphere likely involved repeated independent colonization of new areas during the Paleogene and Neogene along the Bering Land Bridge, the North Atlantic Land Bridge, and the Tethys Seaway. Thirteen strongly supported clades were named following the PhyloCode. Our study provides an example of integrating genomic and morphological data to produce a robust, explicit species phylogeny that includes fossil taxa, which we translate into an updated classification scheme using the PhyloCode to stabilize names. This article is protected by copyright. All rights reserved.

Atmospheric circulation types and floods' occurrence; A thorough analysis over Greece

Floods have a direct impact on the society and the environment, causing human losses, affecting individual incomes and national economic activity including infrastructure damages. Atmospheric circulation is strongly related to both mean and extreme climate, with the latter being the driving force of adverse phenomena, such as inundations. The overarching goal of the research is the identification of those atmospheric circulation patterns that are associated with catastrophic flood events over Greece. An updated atmospheric classification scheme consisted of 12 circulation types (5 anticyclonic and 7 cyclonic) is implemented to detect and highlight the flood-dominant circulation types over the domain of interest. It is established that for a 7-year period (from 2012 to 2018), where reliable flood inventories are available as a derivative of the European Union (EU) Flood Directive implementation process, the dominant circulation type is the cyclonic type C with its center to be located over the Cyclades area. The study also reveals that during the most severe floods, the prevailing cyclonic types are substantially deeper than their mean anomaly field. Finally, out of the 14 River Basin Districts of Greece, Thrace (EL14) is the more flood prone area, while Eastern Macedonia (EL11) is far less flood affected. The introduced Floods' Frequency Vulnerability index (FFVI) showed that in the case of significant floods, Western Peloponnese (EL01) and Epirus (EL05) are the most vulnerable River Basin Districts. The proposed methodology of coupling circulation types with flood occurrences can be applied in all EU Member-States and set the base of effective floods' prediction mechanisms at River Basin Districts scales.

Abstract 1448: Novel specific susceptibility loci identified for pediatric and adult ependymoma in first histology-specific genome-wide association study

Abstract Despite extensive research, a small proportion of the variants contributing to the genetic architecture of brain tumors have been reported. The published GWAS have been largely performed on pooled histological subtypes of glioma and most of these studies have been conducted primarily for adult tumors. Therefore, we aimed to perform the first GWAS specifically for ependymoma to identify the genetic variants associated with the risk of these tumors and to investigate the similarities/differences between the genetic architectures of adult and pediatric ependymomas. Germline SNP-array data of ependymoma cases were obtained from nine studies or biobanks across the United States and Europe. Controls were randomly selected with the ratio of 10:1 from three of those studies and a separate publicly available database. Additionally, germline whole genome sequencing data on cases and controls from St Jude Cloud were utilized. In total, 483 pediatric cases and 265 adult cases and 5592 controls were included. The same quality control procedures were applied to all studies. Data were imputed based on the Haplotype Reference Consortium using EAGLE. Meta-analyses were performed based on GMMAT and logistic regression. The results were adjusted for sex, ancestry and PCs. PAINTOR was used to identify the plausible causal variants, and eQTL and gene enrichment analyses were performed. We identified 16 independent significant SNPs which were specifically associated with pediatric ependymoma risk, of which 10 SNPs were plausible causal. The significant variants were located on 1q32.2 (KCNH1), 2p14 (MEIS1-AS3), 4p15.32 (LDB2), 6p21.32 (HLA-DQA), 6p21.33 (BX927178/CR759828), 7p21.3 (UMAD1), 11p12 (LRRC4C), 11q24.2 (KRT18P59), 14q24.3 (SPTLC2), and 21q11.2 (LOC112268283/FEM1AP1). The 18 identified independent significant SNPs associated with risk of adult ependymoma were located on 4p16.1 (SORCS2), 6p11.2, 6p21.31(KCTD20), 6p21.32 (HLA-DQA1), 7q31.32, 8p23.1 (LOC157273), 8q24.3 (PLEC), 10p13 (PTER), 11q23.3 (GRIK4), 19q13.11 (CEP89), and 22q11.1 (XKR3), of which 8 variants were plausible causal. One intronic variant associated with susceptibility of both pediatric and adult ependymomas was detected; rs68160486 (CCDC85A 2p16.1 PPediatric=3.41x10-8, PAdult=2.12x10-8). The genetic architectures of adult and pediatric ependymomas appear to largely differ from one another. We identified novel variants for these tumors that have not been previously reported for GWAS of combined glioma subtypes. This analysis highlights the need to conduct additional GWAS of more refined glioma subtypes, perhaps even utilizing newer data on molecularly defined subtypes that are emerging in updated pathological classification schemes. Citation Format: Maral Adel Fahmideh, Spiridon Tsavachidis, Stephen C. Mack, Xiao Xiangjun, Terri S. Armstrong, Mark R. Gilbert, NCI-Connect, iPSYCH Consortium, GICC, Lisa Mirabello, Smita Bhatia, Wendy M. Leisenring, Lindsay M. Morton, Gregory T. Armstrong, Jon Foss-Skiftesvik, Christian M. Hagen, Jonas Bybjerg-Grauholm, Manel Ghozal, Audrey Bonaventure, Jacqueline Clavel, Melissa L. Bondy, Christopher I. Amos, Michael E. Scheurer. Novel specific susceptibility loci identified for pediatric and adult ependymoma in first histology-specific genome-wide association study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1448.

Ambulatory Blood Pressure Monitoring in Children and Adolescents: 2022 Update: A Scientific Statement From the American Heart Association.

Use of ambulatory blood pressure monitoring in children and adolescents has markedly increased since publication of the last American Heart Association scientific statement on pediatric ambulatory blood pressure monitoring in 2014. In addition, there has also been significant expansion of the evidence base for use of ambulatory blood pressure monitoring in the pediatric population, including new data linking ambulatory blood pressure levels with the development of blood pressure-related target organ damage. Last, additional data have recently been published that enable simplification of the classification of pediatric ambulatory monitoring studies. This scientific statement presents a succinct review of this new evidence, guidance on optimal application of ambulatory blood pressure monitoring in the clinical setting, and an updated classification scheme for the interpretation of ambulatory blood pressure monitoring in children and adolescents. We also highlight areas of uncertainty where additional research is needed.

Classification of Uremic Toxins and Their Role in Kidney Failure.

Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.

Chicago classification version 4.0© technical review: Update on standard high-resolution manometry protocol for the assessment of esophageal motility.

The Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). A key feature of CCv.4.0 is the more rigorous and expansive protocol that incorporates single wet swallows acquired in different positions (supine, upright) and provocative testing, including multiple rapid swallows and rapid drink challenge. Additionally, solid bolus swallows, solid test meal, and/or pharmacologic provocation can be used to identify clinically relevant motility disorders and other conditions (eg, rumination) that occur during and after meals. The acquisition and analysis for performing these tests and the evidence supporting their inclusion in the Chicago Classification protocol is detailed in this technical review. Provocative tests are designed to increase the diagnostic sensitivity and specificity of HRM studies for disorders of esophageal motility. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification, decrease the proportion of HRM studies that deliver inconclusive diagnoses and increase the number of patients with a clinically relevant diagnosis that can direct effective therapy. Another aim in establishing a standard manometry protocol for motility laboratories around the world is to facilitate procedural consistency, improve diagnostic reliability, and promote collaborative research.

An updated generic classification of Cenozoic pleurotomariid gastropods, with new records from the Oligocene and early Miocene of India

AbstractAlthough taxonomically distinct, the Cenozoic pleurotomariids are the bottlenecked remnants of the Mesozoic members of the family in terms of morphology, with only conical forms surviving the end-Cretaceous mass extinction. Here, we propose an updated classification scheme for the Cenozoic representatives of this group, based on data from the entire Cenozoic pleurotomariid fossil record. We consider all conventional as well as several new characters so that this scheme can readily help to distinguish Cenozoic pleurotomariid genera. Following the new classification scheme, a revision of the generic status of Cenozoic species previously assigned to ‘Pleurotomaria’ Defrance, 1826 is presented.Only a few Cenozoic pleurotomariid gastropods have been reported from the Indian subcontinent. Here we report four species from the Oligocene of the Kutch Basin and the early Miocene (Burdigalian) of the Dwarka Basin of Gujarat, western India, of which two are described as new: Perotrochus bermotiensis n. sp., Entemnotrochus kathiawarensis n. sp., Entemnotrochus cf. E. bianconii, and Entemnotrochus? sp. 1.UUID: http://zoobank.org/89b6ff67-2834-477f-862b-67691104aca4

RadioGraphics Update: Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment.

Editor's Note.-Articles in the RadioGraphics Update section provide current knowledge to supplement or update information found in full-length articles previously published in RadioGraphics. Authors of the previously published article provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes. Articles in this section are published solely online and are linked to the original article. ©RSNA, 2021.

English

Avian paramyxoviruses (APMVs) are contagious viruses infecting multiple avian species around the globe. Subsequent to evolution, the emergence of new strains is considered to cause outbreaks worldwide. Using standard classification criteria, genotypic and sub-genotypic distribution of strains within APMV-1 is much elucidated across the globe. Nevertheless, despite a growing number of genome sequencing data for APMVs excluding those that are prototypes, there is an absolute paucity of an updated unified phylogenetic classification scheme for APMV-2, 4, and 6. Utilizing a well-recognized genetic marker (complete fusion gene), genotyping and sub-genotyping of under-studied of APMVs strains was proposed by the implementation of different reliable tools and criteria. The analysis categorized the strains of each APMV-2 and 6 into two distinct genotypes (I and II), whereas APMV-4 strains categorized into three genotypes (I, II, and III). Additionally, a total of four sub-genotypes within APMV-6 (I.1, I.2, II.1, and II.2) and five sub-genotypes (I.1, I.2, II.1, II.2, and II.3) within APMV-4 were also proposed in the current study. Though it may require a revision and update in the future with the abundance of genome sequences and subsequent analysis from wide geography, herein the outcomes are relevant to better elucidate the classification and molecular epidemiology of study-included APMVs to depict an evolution and epidemiological link among outbreaks caused by field circulatory strains.

The 2020 WHO Classification of Tumors of Bone: An Updated Review.

Bone tumors are a rare and heterogeneous group of neoplasms that occur in the bone. The diversity and considerable morphologic overlap of bone tumors with other mesenchymal and nonmesenchymal bone lesions can complicate diagnosis. Accurate histologic diagnosis is crucial for appropriate management and prognostication. Since the publication of the fourth edition of the World Health Organization (WHO) classification of tumors of soft tissue and bone in 2013, significant advances have been made in our understanding of bone tumor molecular biology, classification, prognostication, and treatment. Detection of tumor-specific molecular alterations can facilitate the accurate diagnosis of histologically challenging cases. The fifth edition of the 2020 WHO classification of tumors of soft tissue and bone tumors provides an updated classification scheme and essential diagnostic criteria for bone tumors. Herein, we summarize these updates, focusing on major changes in each category of bone tumor, the newly described tumor entities and subtypes of existing tumor types, and newly described molecular and genetic data.

Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©.

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.