Updated Classification System Research Articles

DO WE NEED THE GENUS LEVEL IN THE RUSSIAN SOIL CLASSIFICATION SYSTEM?

The level of genus in the “Classification and diagnostics of soils of the USSR”, 1977 is discussed as applied for diverse purposes. It was very often required in soil surveys to indicate details of soil processes, current or inherited features when compiling small- and medium-scale soil maps. In the recent classification of Russian soils, genus level is mostly used for the analytical characteristics of soils, whereas its former functions were transferred to the subtype level; for example, red color of parent material corresponds to “red-profile” subtype. In the updated classification system of soils of Russia, it is proposed to expand the sphere of the genus level application over a broader set of phenomena, to update the criteria for different genera, and to arrange genera in groups like those for genetic properties, which serve as criteria to identify subtypes. The following preliminary groups of genera may be specified: analytical including genera related to chemical soil pollution, lithological (particular parent materials), temporal for ephemeral features, pedogenetic – disclosing or indicating mechanisms of soil processes.

Recombinant identification, molecular classification and proposed reference genomes for hepatitis delta virus.

SummaryHepatitis delta virus (HDV), as a defective sub‐virus that co‐infects with hepatitis B virus, imposes an emerging global health burden. However, genetic characteristics and molecular classification of HDV remain under investigated. In this study, we have systematically retrieved and analysed a large set of HDV full‐length genome sequences and identified novel recombinants. Based on phylogenetic and genetic analyses, we have established an updated classification system for HDV when recombinants were excluded. Furthermore, we have mapped the global distribution of different genotypes and subtypes. Finally, we have compiled a complete set of reference genomes for each subtype and proposed criteria for future identification of novel genotypes and subtypes. Of note, the global distribution map indicates that currently available HDV genetic data remain limited, and thus our proposed classification will likely evolve as future epidemiological data will accumulate. These results will facilitate the future research on the diagnosis, screening, epidemiology, evolution, prevention and clinical management of HDV infection.

IP221. Updated Tibial TransAtlantic Inter-Society Consensus Classification System Fails to Show Improved Differentiation in Outcomes After Endovascular Intervention

IP221. Updated Tibial TransAtlantic Inter-Society Consensus Classification System Fails to Show Improved Differentiation in Outcomes After Endovascular Intervention

S179. The incidence of first seizures, new diagnosis of epilepsy and seizure mimics in county cork, Ireland; an Epidemiologic protocol and interim report

Introduction Incidence studies provide valuable information on etiology and natural history of epilepsy wihtin a population. The International League Against Epilepsy (ILAE) has proposed standards for epidemiological studies to ensure rigorous methodology and accurate collection of data ( Thurman et al., 2011 ). The incidence of epilepsy has not been investigated in Ireland. We are currently investigating the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in Cork city and county (population estimate 550,000) over the calendar year 2017 incorporating ILAE guidelines and seizure/epilepsy classifications ( Fisher et al., 2017 , Scheffer et al., 2017 ). Methods We applied multiple overlapping methods of case ascertainment to our study population from January 1st 2017 to identify all patients presenting with suspected first seizure or new diagnosis of epilepsy. Neonatal seizures and febrile seizures are excluded. Case ascertainment methods include daily review of emergency department (ED) triage, radiology, EEG databases, neurology outpatient/inpatient departments, neurosurgical ward, geriatrics wards, oncology wards, paediatric services and community surveillance through survey of general practice and residential care facilities. Results Two hundred and sixty-three cases met our inclusion criteria for the first three months of data collection (Jan-Mar 2017). EEG database review yielded the greatest number of novel cases (n = 60). 26% (n = 69) of cases met criteria for definite new diagnosis of epilepsy. Only 25 % (n = 16) of these had epileptiform abnormalities on routine EEG. The majority of cases were classified as focal epilepsy (75%, n = 52) followed by generalized epilepsy (16%, n = 11) and unknown epilepsy type (9%, n = 6). 40% (n = 114) of identified cases were classified as seizure mimics. Conclusion We present a rigorous study protocol, which is adherent to ILAE recommendations, for the investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in our study population and present interim results for the first three months of data collection with an emphasis on neurophysiological findings. Results demonstrate a greater proportion of focal epilepsy syndromes than previously reported, which may be in part due to application of the updated ILAE epilepsy classification system.

Central pancreatectomy with external drainage of monolayer pancreaticojejunostomy for prevention of postoperative pancreatic fistula: A retrospective cohort study

ObjectivePostoperative pancreatic fistula (POPF) remains a common problem and leading cause of morbidity and mortality after central pancreatectomy (CP). The aim of this study was to present a technique of external drainage of monolayer pancreaticojejunostomy for prevention of POPF. MethodsPatients received elective CP with external drainage of monolayer pancreaticojejunostomy between January 2010 and December 2016 were retrospectively analyzed. The occurrence and severity of POPF, overall complications, reoperation rate, in-hospital mortality, and length of postoperative hospital stay were measured. The 2016 updated definition and classification system of the International Study Group of Pancreatic Surgery (ISGPS) was used for POPF. In addition, a matched-pairs comparison with internal drainage of pancreaticojejunostomy was made. Results33 consecutive patients underwent CP with external drainage of monolayer pancreaticojejunostomy during this period. 4 (12.1%) cases developed grade B POPF, among which one patient was classified as having Clavien-Dindo classification IIIa complication. None of the patients developed grade C POPF, delayed gastric emptying, or postpancreatectomy hemorrhage. There was no reoperation or in-hospital mortality occurred. Matched-pairs comparison revealed that patients with external drainage of pancreaticojejunostomy had significantly lower incidence of POPF. ConclusionExternal drainage of monolayer pancreaticojejunostomy seems effective in prevention of POPF after CP.

Late sequelae and long-term outcomes of vascular anomalies

Vascular anomalies are classified as tumors and malformations depending on their clinical characteristics, pathological diagnosis and recent genomic information. Diagnosis can still be challenging because of the heterogeneity of clinical presentation. Thus, the best care is provided by an interdisciplinary team of specialists. An updated classification system has helped provide more consistent terminology with the addition of new diagnoses and genomic discovery. Historically, treatment of vascular anomalies was primarily surgical and or interventional with limited medical therapies. The field of vascular anomalies lacked prospective clinical trials in both medical treatments as well as surgical and interventional therapeutic options. Recent interdisciplinary collaboration has led to collaborative studies in which short- and long-term outcomes are being prospectively evaluated. Specifically, discoveries of pharmacologic agents effective in treating vascular anomalies have broadened our medical therapeutic options, which has led to innovative approaches in combined treatment of vascular anomalies and has stressed the need to prospectively assess long-term outcomes and sequelae for these patients which has been lacking in this field.

Advances in the Medical Management of Vascular Anomalies

Vascular anomalies comprise a spectrum of diseases that are broadly classified as tumors and malformations. Diagnosis is often challenging, given a wide range of clinical presentations with overlapping signs and symptoms. Accurate diagnosis is critical to determine prognosis and to generate a management plan, which frequently involves multiple subspecialists during different phases of treatment. An updated classification system provides structure and clear, consistent terminology, allowing for improved diagnosis, provider communication, and collaboration. Historically, treatment of vascular anomalies was primarily surgical and medical therapies were limited or ineffective. Recent discoveries of pharmacologic agents effective in treating vascular anomalies have broadened our medical therapeutic options, limiting the need for unnecessary or high-risk procedures and improving patients' quality of life.

Shock metamorphism of planetary silicate rocks and sediments: Proposal for an updated classification system

AbstractWe reevaluate the systematics and geologic setting of terrestrial, lunar, Martian, and asteroidal “impactites” resulting from single or multiple impacts. For impactites derived from silicate rocks and sediments, we propose a unified and updated system of progressive shock metamorphism. “Shock‐metamorphosed rocks” occur as lithic clasts or melt particles in proximal impactites at impact craters, and rarely in distal impactites. They represent a wide range of metamorphism, typically ranging from unshocked to shock melted. As the degree of shock metamorphism, at a given shock pressure, depends primarily on the mineralogical composition and the porosity of a rock or sediment sample, different shock classification systems are required for different types of planetary rocks and sediments. We define shock classification systems for eight rock and sediment classes which are assigned to three major groups of rocks and sediments (1) crystalline rocks with classes F, M, A, and U; (2) chondritic rocks (class C); and (3) sedimentary rocks and sediments with classes SR, SE, and RE. The abbreviations stand for felsic (F), mafic (M), anorthositic (A), ultramafic (U), sedimentary rocks (SR), unconsolidated sediments (SE), and regoliths (RE). In each class, the progressive stages of shock metamorphism are denominated S1 to Sx. These progressive shock stages are introduced as: S1–S7 for F, S1–S7 for M, S1–S6 for A, S1–S7 for U, S1–S7 for C, S1–S7 for SR, S1–S5 for SE, and S1–S6 for RE. S1 stands for “unshocked” and Sx (variable between S5 and S7) stands for “whole rock melting.” We propose a sequence of symbols characterizing the degree of shock metamorphism of a sample, i.e., F‐S1 to F‐S7 with the option to add the tabulated pressure ranges (in GPa) in parentheses.

Correlation of Aggressive Intracranial Lesions and Venous Reflux Patterns in Dural Arteriovenous Fistulas.

The association between venous reflux patterns with aggressive intracranial lesions (AILs), including intracranial edema (IE), intraparenphymal hemorrhage (IPH), and subarachnoid hemorrhage (SAH), has not been well established in cranial dural arteriovenous fistulas (DAVFs). We propose an updated classification system based on venous drainage. We retrospectively assessed the catheter angiography findings of venous drainage patterns. Cranial DAVFs with no reflux flow and those with reflux flow drainage into the sinus only, the bridge vein only, the bridge vein and pial vein, and the sinus, bridge vein, and pial vein were designated as types 1, 2, 3, 4, and 5, respectively. We analyzed the associations between venous reflux patterns with AILs in 73 patients with DAVFs. AILs were found in 43 patients (58.9%), including 8 (11%) with SAH, 8 (11%) with IPH, and 27 (36.9%) with IE. Our proposed classification scheme was significantly associated with AILs (P < 0.001). SAH was found in patients with type 3 (62.5%) and type 4 (37.5%), whereas IPH was seen mostly in those with type 4 (87.5%). The proportion of IE gradually increased from type 3 to type 5 (11.1% to 29.6% to 59.2%). Significant difference was found among each type between complete resolution and uncompleted resolution after endovascular treatment (P=0.034), which also demonstrated a gradually increasing proportion of uncompleted resolution from type 1 to type 5 (4.5%, 4.5%, 9.1%, 31.8%, and 50%). Our proposed classification system effectively demonstrates a correlation between venous reflux patterns and AILs and outcomes of endovascular treatment in patients with DAVFs.

Impact of the 2016 new definition and classification system of pancreatic fistula on the evaluation of pancreatic fistula after pancreatic surgery

Objective: To discuss the impact of updated definition and classification system of pancreatic fistula published in 2016 on the postoperative classification of pancreatic fistula. Methods: Retrospective analysis was made on patients who underwent pancreatic surgery at ward 1 in Department of General Surgery, Peking Union Medical College Hospital from January 2015 to December 2016.A total of 408 patients were included in this retrospective study, male/female was 184/224, aged from 9 to 81 years with mean age of 51.6 years.One hundred and fifty-two cases were performed pancreaticoduodenectomy, 125 cases for distal pancreatectomy, 43 cases for spleen preservation distal pancreatectomy, 61 cases for partital pancreatectomy or enucleation, 8 cases for middle pancreatectomy, 6 cases for pancreaticojejunostomy and 13 cases for other procedures.Clinical data including postoperative drainage fluid volume, amylase concentration, duration of hospitalization and drainage were obtained, revaluated and re-analyzed, classified grounded on 2005 edition and 2016 edition, respectively.t-test was adopted for data analysis. Results: According to the previous standards, the incident rate of pancreatic fistula was 57.4%, and the incident rate of B-level plus C-level pancreatic fistula was 35.8%, which decreased to 13.7% based on 2016 edition.Nine patients who received percutaneous puncture or endoscopic drainage was regraded from C-level to B-level. The average duration of postoperative hospitalization of patients without pancreatic fistula was (12.5±6.0)days, demonstrating no significant difference compared to (14.1±7.7)days, duration of postoperative hospitalization of A-level(under 2005 edition of criteria) pancreatic fistula group(t=1.66, P=0.09) and (12.4±6.1)days, duration of postoperative hospitalization of biochemical leakage group(t=0.14, P=0.89). Nevertheless, there was statistical significant difference between the average postoperative duration of hospitalization(30.7±16.9) days of B-level(under 2016 criteria) pancreatic fistula patients and pancreatic fistula-free patients as well as the biochemical leakage group patients (t=7.10, 7.13; both P<0.01). Conclusions: Based on the new diagnostic criteria, the incidence of postoperative pancreatic fistula decreased dramatically.New classification system downgraded part of cases graded C-level pancreatic fistula to B-level and some B-level to biochemical fistula.The new diagnostic classification and criteria facilitated clinical practice, accomplished better conformity to clinical reality and potentially enacted clinical outcome.

Prevalence and determinants of left ventricular geometric abnormalities in hypertensive patients: A study based on the updated classification system of left ventricular geometry

ObjectiveThis study was to determine whether different risk factors were associated with different type of left ventricular (LV) geometric abnormalities. MethodsThis retrospective analysis included 2290 hypertensive participants without other cardiovascular disease, valve disease and with ejection fraction ≥50%. The type of LV geometric abnormality was defined on the basis of the new classification system. ResultsLV geometric abnormalities were detected in 1479 subjects (64.6%), wherein concentric LV remodeling is the most common LV geometric abnormality (40.3%). Large waist circumference (WC) and neck circumference (NC) were positively associated with concentric LV remodeling, whereas body mass index (BMI) [odds ratio (OR) 0.89, 95% CI 0.85∼0.92, P ＜ 0.001] and systolic blood pressure (SBP) (OR 0.99, 95% CI 0.98∼0.99, P = 0.018) were inversely associated with concentric abnormalities. SBP and age were positively associated with eccentric dilated LVH, while male was inversely associated with eccentric dilated left ventricular hypertrophy (LVH). Age was the strongest risk factor for eccentric dilated LVH (OR 1.05, 95% CI 1.03∼1.07, P ＜ 0.001). Age, NC, SBP, hyperuricemia, and alcohol use were positively associated with concentric LVH, whereas BMI (OR 0.95, 95% CI 0.90∼0.99, P = 0.033) and male (OR 0.12, 95% CI 0.07∼0.18, P ＜ 0.001) were negatively associated with concentric LVH. ConclusionThe prevalence of hypertensive LV geometric abnormality in rural area of Southern China was obvious higher. Compared with eccentric LV geometric abnormalities, there were more risk factors, including large WC and NC, age, NC, SBP, hyperuricemia, alcohol use, BMI and gender, which were associated with concentric LV geometric abnormalities.

Food group consumption in an Italian population using the updated food classification system FoodEx2: Results from the Italian Nutrition & HEalth Survey (INHES) study

Background and AimDietary habits evolve over time, being influenced by many factors and complex interactions. This work aimed at evaluating the updated information on food group consumption in Italy. Methods and ResultsA total of 8944 (4768 women and 4176 men) participants aged >18 years from all over Italy recruited in 2010–13 (Italian Nutrition & HEalth Survey, INHES) was analyzed. The recruitment was performed using computer-assisted-telephone-interviewing and one-day 24-h dietary recall retrieved from all participants. The updated, second version, of FoodEx2 food classification system was applied to extract data on food group consumption. The participation rate was 53%; 6.2% of the participants declared to follow a special diet, the most prevalent being hypo-caloric diets (55.7% of special diets). Men compared to women presented significantly higher intakes of “grains and grain-based products”, “meat and meat products”, “animal and vegetable fats and oils and primary derivatives” and “alcoholic beverages” (P for all<0.001); moreover, men had lower intakes of “milk and dairy products”, “water and water-based beverages” and “products for non-standard diets, food imitates and food supplements” (P for all<0.001). Differences in food group intake among age groups, geographical regions and educational level groups were also identified (P for all<0.05). ConclusionsData on the consumption of more than 70 food groups and sub-groups were illustrated in different strata. The present analysis could be considered as an updated source of information for future nutrition research in Italy and in the EU.

Modern Theory of the Development of Adult Acquired Flat Foot and an Updated Spring Ligament Classification System

Traditionally tibialis Posterior Insufficiency is still considered the commonest cause of acquired adult flat foot. This is still considered as the primary cause and has influenced both treatment and the diagnosis of the condition. Foot surgeons are now questioning the whole classification and the fundamental errors within this that have not been challenge for over 30 years. In this review article we examine the emerging evidence that suggests a new and alternative pathogenesis to this disease process centred on failure of the spring ligament.

Revisions to the Tumor, Node, Metastasis staging of lung cancer (8th edition): Rationale, radiologic findings and clinical implications.

The Tumor, Node, Metastasis (TNM) staging system, adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), has been recently revised, with the new 8th edition of the staging manual being published in January 2017. This edition has few but important evidence-based changes to the TNM staging system used for lung cancer. Radiologists should be aware of the updated classification system to accurately provide staging information to oncologists and oncosurgeons. In this article, we discuss the rationale, illustrate the changes with relevance to Radiology, and review the clinical implications of the 8th edition of the UICC/AJCC TNM staging system with regards to lung cancer.

PP149 Assessment Of New Medical Devices With Administrative Databases

INTRODUCTION:Administrative data (for example, hospital discharge databases, HDDs) can be used as a real world source of clinical and economic evidence for assessing new medical devices (MDs), provided that their use can be identified in the data. In absence of updated classification systems for procedures and diagnoses, which allow to identify the use of new technologies in the data, traceability can still be achieved thanks to authorities coding guidelines (that is, indication on how to combine the existing codes for procedures and/or diagnoses when new technologies are used).In 2009 Italy adopted version 2007 of the International Classification System of Diseases (ICD-9-CM) and version 24 of Diagnosis Related Groups (DRGs), which are still in use. The aim of this work was to investigate the capacity of the classification system currently used in Italy, which is at high risk of obsolescence, to identify innovative MDs.METHODS:To achieve our goal, we performed a systematic search of all the national and regional coding guidelines published from 2009 (that is, the year of introduction of the new classification systems) to 2015. We extracted from each document the list of technologies for which the Ministry of Health and/or the Regional Authorities provided with coding indications.RESULTS:Our results show that only a few recent technological innovations can be identified in the Italian HDDs. This reduces the possibility for decision makers to measure new technologies outcomes and costs in the real world clinical practice.CONCLUSIONS:The traceability of new MDs' can support Heath Technology Assessment (HTA). Indeed, HTA programs should use real world evidence to re-assess MDs 2–3 years after their introduction in clinical practice. The use of routinely collected data, such as HDD, would allow to measure new technologies' “real” effectiveness in “real” world, on “real” patients in “real” hospitals to complement the evidence from Randomized Controlled Trials.

On a New Cannabinoid Classification System: A Sight on the Illegal Market of Novel Psychoactive Substances

Abstract Synthetic cannabinoids are one of the most rapidly expanding classes of novel psychoactive substances found in illegal markets. These substances have evolved to the point that many examples no longer fit with the traditional cannabinoid classification system, where assignment of these compounds is difficult and ambiguous, leading to inconsistencies in regard to their chemical structures. This and other drawbacks can result in misunderstandings between forensic scientists and legal disciplines, complicating efforts toward improving the inadequacies of current antidrug laws. After a critical review, we offer an updated yet simplified cannabinoid classification system with the intention to facilitate interdisciplinary communication.

Clinical and Histopathological Relevance of Helicobacter pylori BabA2 Genotype

Introduction: H. pylori BabA is an outer membrane protein that mediates bacterial adherence to the gastric epithelium, triggers several pathways during the course of infection, and thus contributes to the disease development. Considering the variability in the presence of BabA coding gene (babA2) among H. pylori clinical strains, the aim of this study was to assess the relationship between the genotype status of H. pylori babA2 and the severity of clinical and histopathological outcomes. Methods: Gastric mucosal biopsy specimens were collected from 30 CLO test-positive patients, 16 with gastritis and 14 with peptic ulcer disease. Polymerase chain reaction was carried out to detect the presence of H. pylori-specific glmM gene and BabA coding gene (babA2). Histopathological examination was performed to evaluate the severity of H. pylori-associated gastric disease according to the Updated Sydney Classification System. Results: The glmM and babA2 genes were present in 100% and 86.7% of the tested H. pylori strains, respectively. Although higher degrees of inflammatory activity and H. pylori density were noted in babA2-positive biopsy specimens, there was no statistically significant association between babA2 genotype status and the severity of gastric disease. Conclusion: The babA2 genotype status of H. pylori may not be considered as a sole marker for determining the infection outcomes.

Surgical pathology of early stage non-small cell lung carcinoma

The histologic classification of non-small cell lung carcinoma (NSCLC), particularly adenocarcinoma (ADC), has undergone extensive study in recent decades, ultimately resulting in an extensively updated classification system. The 2015 World Health Organization (WHO) classification of ADC provides greatly improved prognostic information in comparison to the 2004 WHO classification. Several issues still require further investigation: lepidic predominant ADC, prognostic significance of poor prognostic subtypes such as micropapillary carcinoma, the more recently described concept of spread of tumor through airspaces (STAS), and the utility of sublobar resections. While limited resection appears to be suitable for tumors with a ground glass radiographic appearance, which typically correspond to adenocarcinoma in situ (MIS) or minimally invasive adenocarcinoma (MIA) histologically, the role of sublobar resection in radiographic solid tumors is not as clear, and the impact of histologic subtypes with a poor prognosis needs further evaluation. Squamous cell carcinoma (SCC) has not been as extensively studied and the current classification lacks subclassification with significant prognostic information.

Updating and testing of a Finnish method for mixed municipal solid waste composition studies

More efficient recycling of municipal solid waste (MSW) is an essential precondition for turning Europe into a circular economy. Thus, the recycling of MSW must increase significantly in several member states, including Finland. This has increased the interest in the composition of mixed MSW. Due to increased information needs, a method for mixed MSW composition studies was introduced in Finland in order to improve the national comparability of composition study results. The aim of this study was to further develop the method so that it corresponds to the information needed about the composition of mixed MSW and still works in practice.A survey and two mixed MSW composition studies were carried out in the study. According to the responses of the survey, the intensification of recycling, the landfill ban on organic waste and the producer responsibility for packaging waste have particularly influenced the need for information about the composition of mixed MSW. The share of biowaste in mixed MSW interested the respondents most. Additionally, biowaste proved to be the largest waste fraction in mixed MSW in the composition studies. It constituted over 40% of mixed MSW in both composition studies. For these reasons, the classification system of the method was updated by further defining the classifications of biowaste. The classifications of paper as well as paperboard and cardboard were also updated. The updated classification system provides more information on the share of avoidable food waste and waste materials suitable for recycling in mixed MSW. The updated method and the information gained from the composition studies are important in ensuring that the method will be adopted by municipal waste management companies and thus used widely in Finland.

Manifestations of Complement-Mediated and Immune Complex-Mediated Membranoproliferative Glomerulonephritis: A Comparative Consecutive Series

Membranoproliferative glomerulonephritis (MPGN) recently was reclassified to reflect the underlying cause as a complement-mediated and immune complex-mediated disease. This classification is based on renal biopsy immunofluorescence examination, making the former electron-microscopy classification obsolete. In this report, we describe related eye findings in patients with MPGN based on the new classification. Retrospective case series. All Mayo Clinic Rochester patients with pathology-confirmed complement- and immune complex-mediated MPGN who had available ophthalmology records from 1997 through 2014 were included in this study. The medical and pathologic records of patients with MPGN and eye examination results were reviewed from years 1997 through2014. The number of patients and the number of eyes with MPGN-related pathologic features were examined. Visual acuity also was considered. There were 23 patients with complement-mediated MPGN and available eye examination results. Of these, 9 patients (39%) and 17 eyes (37%) had retinal pathologic features that likely were related to the same underlying pathophysiologic process as their renal disease. Five patients (22%) and 6 eyes (13%) had significant vision loss. There were 23 patients with immune complex-mediated MPGN and available eye examination results. Only 2 (9%) of these patients (4 eyes) had retinal pathologic features that potentially could be related to the same underlying pathophysiologic process as their renal disease, and neither had vision loss. Retinal abnormalities are more prominent among patients with complement-mediated MPGN when compared with patients with immune complex-mediated MPGN. It is critical for ophthalmologists to recognize the updated MPGN classification system, and all patients with complement-mediated MPGN require screening eye examinations.