Updated Classification Research Articles

Typification of the name Symphytum nodosum (Boraginaceae)

The name Symphytum nodosum (Boraginaceae) is typified based on the original Schur’s collection preserved in the herbarium of Ivan Franko National University of Lviv (LW). Availability of the original material of S. nodosum allows to clarify the identity of this poorly understood taxon. Morphological distinctiveness of S. nodosum justifies its recognition at the rank of subspecies of S. tuberosum. The updated infraspecific classification of S. tuberosum is proposed, with a new combination (S. tuberosum subsp. leonhardtianum) introduced to accommodate dodecaploid populations (2n=96) of S. tuberosum previously referred to either as S. tuberosum subsp. angustifolium or S. tuberosum subsp. nodosum.

BIOM-02. A HIGH-GRADE GLIOMA, NOT ELSEWHERE CLASSIFIED IN AN OLDER ADULT WITH DISCORDANT GENETIC AND EPIGENETIC ANALYSES

Abstract World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS) uses integrated diagnoses, which incorporates both histologic and molecular features of the neoplasms. With each new iteration, there is refinement and expansion of the diagnostic categories. DNA methylation profiling is a powerful technique to diagnose existing CNS tumors and define new tumor types. However, challenging diagnostic cases that do not conform to the updated WHO classification remain. We present a case of a 72-year-old male with a high grade glioma (HGG) suggestive of high grade astrocytoma with piloid features (HGAP), but it did not “match” to HGAP on DNA methylation profiling, which is essential diagnostic criterion for HGAP. This resulted in an HGG, not elsewhere classified (NEC) diagnosis. This lack of classification posed additional challenges for treatment decision-making.

Ependymal Tumors: Overview of the Recent World Health Organization Histopathologic and Genetic Updates with an Imaging Characteristic.

The 2021 World Health Organization Classification of Tumors of the Central Nervous System (CNS5), introduced significant changes, impacting tumors ranging from glial to ependymal neoplasms. Ependymal tumors were previously classified and graded based on histopathology, which had limited clinical and prognostic utility. The updated CNS5 classification now divides ependymomas into 10 subgroups based on anatomic location (supratentorial, posterior fossa, and spinal compartment) and genomic markers. Supratentorial tumors are defined by zinc finger translocation associated (ZFTA) (formerly v-rel avian reticuloendotheliosis viral oncogene [RELA]), or yes-associated protein 1 (YAP1) fusion; posterior fossa tumors are classified into groups A (PFA) and B (PFB), spinal ependymomas are defined by MYCN amplification. Subependymomas are present across all these anatomic compartments. The new classification kept an open category of "not elsewhere classified" or "not otherwise specified" if no pathogenic gene fusion is identified or if the molecular diagnosis is not feasible. Although there is significant overlap in the imaging findings of these tumors, a neuroradiologist needs to be familiar with updated CNS5 classification to understand tumor behavior, for example, the higher tendency for tumor recurrence along the dural flap for ZFTA fusion-positive ependymomas. On imaging, supratentorial ZFTA-fused ependymomas are preferentially located in the cerebral cortex, carrying predominant cystic components. YAP1-MAMLD1-fused ependymomas are intra- or periventricular with prominent multinodular solid components and have significantly better prognosis than ZFTA-fused counterparts. PFA ependymomas are aggressive paramedian masses with frequent calcification, seen in young children, originating from the lateral part of the fourth ventricular roof. PFB ependymomas are usually midline, noncalcified solid-cystic masses seen in adolescents and young adults arising from the fourth ventricular floor. PFA has a poorer prognosis, higher recurrence, and higher metastatic rate than PFB. Myxopapillary spinal ependymomas are now considered grade II due to high recurrence rates. Spinal-MYCN ependymomas are aggressive tumors with frequent leptomeningeal spread, relapse, and poor prognosis. Subependymomas are noninvasive, intraventricular, slow-growing benign tumors with an excellent prognosis. Currently, the molecular classification does not enhance the clinicopathologic understanding of subependymoma and myxopapillary categories. However, given the molecular advancements, this will likely change in the future. This review provides an updated molecular classification of ependymoma, discusses the individual imaging characteristics, and briefly outlines the latest targeted molecular therapies.

TP53 Mutation Status in Myelodysplastic Neoplasm and Acute Myeloid Leukemia: Impact of Reclassification Based on the 5th WHO and International Consensus Classification Criteria: A Korean Multicenter Study.

TP53 mutations are associated with poor prognosis in myelodysplastic neoplasm (MDS) and AML. The updated 5th WHO classification and International Consensus Classification (ICC) categorize TP53-mutated MDS and AML as unique entities. We conducted a multicenter study in Korea to investigate the characteristics of TP53-mutated MDS and AML, focusing on diagnostic aspects based on updated classifications. This study included patients aged ≥ 18 yrs who were diagnosed as having MDS (N=1,244) or AML (N=2,115) at six institutions. The results of bone marrow examination, cytogenetic studies, and targeted next-generation sequencing, including TP53, were collected and analyzed. TP53 mutations were detected in 9.3% and 9.2% of patients with MDS and AML, respectively. Missense mutation was the most common, with hotspot codons R248/R273/G245/Y220/R175/C238 accounting for 25.4% of TP53 mutations. Ten percent of patients had multiple TP53 mutations, and 78.4% had a complex karyotype. The median variant allele frequency (VAF) of TP53 mutations was 41.5%, with a notable difference according to the presence of a complex karyotype. According to the 5th WHO classification and ICC, the multi-hit TP53 mutation criteria were met in 58.6% and 75% of MDS patients, respectively, and the primary determinants were a TP53 VAF >50% for the 5th WHO classification and the presence of a complex karyotype for the ICC. Collectively, we elucidated the molecular genetic characteristics of patients with TP53-mutated MDS and AML, highlighting key factors in applying TP53 mutation-related criteria in updated classifications, which will aid in establishing diagnostic strategies.

Understanding prescribing errors for system optimisation: the technology-related error mechanism classification.

Technology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors (TREs) occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of TREs using prescribing error data from two adult hospitals. Our objective was to update the classification using paediatric prescribing error data and to assess the reliability with which reviewers could independently apply the classification. Using data on 1696 prescribing errors identified by chart review in 2016 and 2017 at a tertiary paediatric hospital, we identified errors that were technology-related. These errors were investigated to classify their underlying mechanisms using our previously developed classification, and new categories were added based on the data. A two-step process was used to identify and classify TREs involving a review of the error in the CPOE and simulating the error in the CPOE testing environment. The technology-related error mechanism (TREM) classification comprises six mechanism categories, one contributing factor and 19 subcategories. The categories are as follows: (1) incorrect system configuration or system malfunction, (2) opening or using the wrong patient record, (3) selection errors, (4) construction errors, (5) editing errors, (6) errors that occur when using workflows that differ from a paper-based system (7) contributing factor: use of hybrid systems. TREs remain a critical issue for CPOE. The updated TREM classification provides a systematic means of assessing and monitoring TREs to inform and prioritise system improvements and has now been updated for the paediatric setting.

PIT-1/SF-1 co-expression in pituitary neuroendocrine tumors (PitNETs) with comprehensive review of the literature: How should we best characterize these neoplasms?

The nomenclature and classification of neuroendocrine tumors of the anterior pituitary have undergone significant change over the last few years. Despite the updated classification system as devised by the World Health Organization, some tumors do not fit neatly into the currently defined categories. The most common tumor type not defined by the updated guidelines is a pituitary neuroendocrine tumor with co-expression of SF-1 and PIT-1. In this manuscript, we provide our institutional experience with such unusual cases and combine our findings with those in the available literature to provide the largest, most comprehensive dataset regarding clinical and pathologic information for these unique tumors. Based on our findings, we also propose a classification scheme for pituitary neuroendocrine tumors to integrate lineage, hormonal expression, and clinical function as we believe this constellation of information will best help the clinical teams treating these patients.

Long-term facial nerve outcome in surgically treated petrous bone cholesteatoma patients.

The term petrous bone cholesteatoma (PBC) represents a slow-growing epidermal lesion arising from the petrous part of the temporal bone. It is a rare incidence accounting for only 4-9% of all petrous bone lesions. PBC represents a real surgical challenge due to its complex relationship with critical neurovascular structures. To demonstrate our experience in using various options of facial nerve (FN) management during surgical treatment of PBC and analyze the long-term facial function outcomes. Retrospective medical record review in a quaternary skull-base center. Medical records of 298 PBC cases operated between the years 1983 and 2024 were thoroughly evaluated. Sanna's classification scheme was used to classify cases into the appropriate class and the House-Brackmann (HB) grading system of the FN was used to assess the facial function pre- and postoperatively. A total of 298 PBC cases were surgically treated at our center. Males constitute 68% (n = 203) of total operated PBC patients while the rest 32% (95) were females, making the male-to-female ratio 2.2:1. The age in this series ranged from 9 to 85. According to updated Sanna's PBC classification, 44% were supralabyrinthine, 33% were massive, 9% were infralabyrinthine-apical, 8% were infralabyrinthine, and 5% were apical. On preoperative FN function examination, 45% (n = 133) of patients had various degrees of paresis and complete paralysis whereas 55% (n = 165) had normal FN function. The commonest degree of paresis observed was HB-III (18.5%) followed by HB-IV (5.7%). A total of 40(13.4%) patients, however, had complete facial paralysis at the initial presentation. The facial function was compromised more frequently in supralabyrinthine and massive PBCs. Among the total patients who had an abnormal facial function at presentation, 52% had paresis/paralysis for less than a year whereas 48% had FN paresis/paralysis for greater than one year. The most commonly used surgical approaches at our center were transotic (TO), modified transcochlear type A (MTCA) with rerouting of the FN, and translabyrinthine (TLAB) with external auditory canal (EAC) closure. Intraoperatively an intact fallopian canal was found only in 33% (n = 99) cases whereas the rest 67% (n = 199) had erosion of the fallopian canal either with intact (n = 24) or infiltrated FN (n = 175). The FN was maintained in the bony fallopian canal in 35% (n = 104) cases. An active form of FN management, however, was required in 65% (n = 194) of cases either intraoperatively or as a second-stage procedure. Factors affecting postoperative FN function include age, preoperative FN function (HB), duration of paralysis, class of PBC, surgical approach, and method of active FN management. PBCs represent diagnostically and surgically challenging lesions of temporal bone which are usually frustrating to the treating surgeon. Preoperative anatomic classification of the lesion enables the physician to choose the appropriate surgical approach. Sanna's classification is the most widely accepted system used to classify PBC. This classification is based on the relation of the lesion to the labyrinthine block. Active FN management, including rerouting, end-to-end anastomosis, cable nerve grafting, and masseteric-to-FN anastomosis routinely come into play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

Modern Classification of Respiratory Diseases: Innovations in the International Classification of Diseases of the 11th Revision

A comprehensive analysis has been performed on the innovations in the classification of respiratory diseases introduced in ICD-11, comparing it with the previous ICD-10 version. This analysis underscores the critical importance of implementing a more detailed and systematic approach to categorizing diseases of the respiratory system. The enhancements found in ICD-11 have been proven to open up new opportunities for the timely and high-quality provision of medical and pharmaceutical care. This is particularly significant for patients suffering from various injuries, including those resulting from traffic accidents, participation in combat operations, and thoracic injuries. The updated classification system in ICD-11 allows for more precise diagnosis and treatment plans, which is essential for improving patient outcomes. By providing a more granular level of detail in disease categorization, healthcare professionals can better understand the nuances of respiratory conditions. This leads to more effective communication among doctors, pharmacists, and patients, thereby improving the legal and professional relationships within the healthcare system. Integrating the ICD-11 classification into educational and training programs is essential for advancing the qualifications of specialists. By incorporating it into curricula and professional development programs, medical practitioners can stay abreast of the latest advancements in disease classification and patient care. This integration is also vital for eliminating medical errors, as a more detailed classification system reduces the likelihood of misdiagnosis and improper treatment. Furthermore, adopting ICD-11 supports the ongoing development of the healthcare sector in Ukraine. It aligns the country's medical practices with international standards, facilitating better collaboration with global health organizations. This alignment is crucial for enhancing the overall quality of healthcare services provided to the population. In conclusion, the transition to ICD-11 represents a significant advancement in the classification of respiratory diseases. Its implementation is imperative for improving medical and pharmaceutical care, enhancing specialist training programs, and strengthening the doctor-pharmacist-patient relationship. Embracing this updated classification system will not only reduce medical errors but also contribute to the further development of Ukraine's healthcare sector.

Classes and phyla of the kingdom Fungi

AbstractFungi are one of the most diverse groups of organisms with an estimated number of species in the range of 2–3 million. The higher-level ranking of fungi has been discussed in the framework of molecular phylogenetics since Hibbett et al., and the definition and the higher ranks (e.g., phyla) of the ‘true fungi’ have been revised in several subsequent publications. Rapid accumulation of novel genomic data and the advancements in phylogenetics now facilitate a robust and precise foundation for the higher-level classification within the kingdom. This study provides an updated classification of the kingdom Fungi, drawing upon a comprehensive phylogenomic analysis of Holomycota, with which we outline well-supported nodes of the fungal tree and explore more contentious groupings. We accept 19 phyla of Fungi, viz. Aphelidiomycota, Ascomycota, Basidiobolomycota, Basidiomycota, Blastocladiomycota, Calcarisporiellomycota, Chytridiomycota, Entomophthoromycota, Entorrhizomycota, Glomeromycota, Kickxellomycota, Monoblepharomycota, Mortierellomycota, Mucoromycota, Neocallimastigomycota, Olpidiomycota, Rozellomycota, Sanchytriomycota, and Zoopagomycota. In the phylogenies, Caulochytriomycota resides in Chytridiomycota; thus, the former is regarded as a synonym of the latter, while Caulochytriomycetes is viewed as a class in Chytridiomycota. We provide a description of each phylum followed by its classes. A new subphylum, Sanchytriomycotina Karpov is introduced as the only subphylum in Sanchytriomycota. The subclass Pneumocystomycetidae Kirk et al. in Pneumocystomycetes, Ascomycota is invalid and thus validated. Placements of fossil fungi in phyla and classes are also discussed, providing examples.

Evaluation of the prognostic value of the new 9th edition Tumor-Node-Metastases (TNM) staging system for epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma patients with bone metastases

BackgroundThere are some changes in the new 9th edition Tumor-Node-Metastases (TNM) staging system for lung cancer, including subdividing M1c into M1c1 and M1c2 stage. The aim of this study was to assess the prognostic performance of the updated classification system and try to provide some real-world application data among advanced lung adenocarcinoma patients with bone metastases.MethodsAdvanced lung adenocarcinoma patients in M1c stage with bone metastases who receiving first-line first-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and T790M-guided osimertinib as the second-line therapy were retrospectively screened from December 2016 to December 2021. A total of 126 patients were enrolled in this study. 62 patients and 64 patients were subdivided into M1c1 and M1c2 groups according to the 9th edition of TNM staging system.The first-line real-world progression-free survival (1LrwPFS), the second-line real-world progression-free survival (2LrwPFS), post-progression survival (PPS) and real-world overall survival (rwOS) were analyzed.ResultsThe overall median rwOS was 40.1 months (95% CI 35.996–44.204). 1LrwPFS was 13.9 months (95% CI 12.653–15.147) and 2LrwPFS was 14.5 months (95% CI 11.665–17.335) for all patients.Patients in M1c2 stage was inferior to M1c1 stage patients in rwOS (35.2 months vs. 42.9 months, HR = 0.512, P = 0.005). 2LrwPFS was moderately correlated with rwOS (r = 0.621, R2 = 0.568, P = 0.000). Multivariate analysis showed performance status (PS) score ≥ 2 and TP53 alteration positive were independent prognostic factors of worse rwOS.ConclusionsMore refined stratification of M1c according to the 9th edition of TNM staging system is conducive to the judgment of prognosis and the implementation of precision medicine for patients.

Classification of amyloidosis and protein misfolding disorders in animals 2024: A review on pathology and diagnosis.

Amyloidosis is a group of diseases in which proteins become amyloid, an insoluble fibrillar aggregate, resulting in organ dysfunction. Amyloid deposition has been reported in various animal species. To diagnose and understand the pathogenesis of amyloidosis, it is important to identify the amyloid precursor protein involved in each disease. Although 42 amyloid precursor proteins have been reported in humans, little is known about amyloidosis in animals, except for a few well-described amyloid proteins, including amyloid A (AA), amyloid light chain (AL), amyloid β (Aβ), and islet amyloid polypeptide-derived amyloid. Recently, several types of novel amyloidosis have been identified in animals using immunohistochemistry and mass spectrometry-based proteomic analysis. Certain species are predisposed to specific types of amyloidosis, suggesting a genetic background for its pathogenesis. Age-related amyloidosis has also emerged due to the increased longevity of captive animals. In addition, experimental studies have shown that some amyloids may be transmissible. Accurate diagnosis and understanding of animal amyloidosis are necessary for appropriate therapeutic intervention and comparative pathological studies. This review provides an updated classification of animal amyloidosis, including associated protein misfolding disorders of the central nervous system, and the current understanding of their pathogenesis. Pathologic features are presented together with state-of-the-art diagnostic methods that can be applied for routine diagnosis and identification of novel amyloid proteins in animals.

A NOVEL WAY TO CLASSIFY THE SLAKE DURABILITY INDEX OF ROCKS

Slaking, the disintegration of rocks upon exposure to moisture and air, poses significant challenges in engineering applications, such as in slope stability and embankment design. This study improves the slake durability index test by introducing several enhancements to better reflect the field conditions of rocks. A new test methodology is developed which includes a revised slake durability classification table, a novel Discard Method for calculating weight retention in the test drum, and an updated classification chart. The improved methodology considers parameters such as porosity and strength, evaluated through index, Schmidt hammer rebound and point load tests. The new classification table categorizes rocks into durability classes according to the field observations and laboratory test results. The Discard Method improves accuracy by eliminating broken pieces from the durability calculation, addressing the limitations in the suggested method. A Configured Discard Method equation further defines the durability estimation by combining porosity, strength and slake durability data. Field investigations and laboratory tests conducted with various rock types demonstrate that the new classification system provides more accurate and practical assessments of rock durability. This study highlights the importance of effective porosity and strength impact which enhance the reliability of slake durability evaluations, offering a revised classification framework that simplifies field assessments while maintaining the accuracy. Future research should focus on developing these methods and expanding their applicability to diverse geological contexts by including more material to test.

HGGL-03 DIFFUSE MIDLINE GLIOMA IN GHANA-AN ILL-FATED DIAGNOSIS

Abstract PURPOSE Diffuse midline gliomas (DMG) based on the updated WHO classification are pediatric-type diffuse high-grade gliomas common in children and young adults. They are highly aggressive with dismal outcomes. Unfortunately, not much is known about these tumours in Ghana. This study seeks to provide initial data on the subject. METHODS A 2-year retrospective review of cases seen at the Pediatric Multidisciplinary Team and Radiotherapy Department yielded 9 cases. Their demographics, clinical presentation, radiologic features, and therapeutic outcomes were documented. RESULTS A total of nine cases, 55.6% males (n = 5), and 44.4% females (n = 4) were documented with a median age of 7 years. They presented with symptoms of vomiting in 44.4% of cases, multiple cranial nerve palsies (CN III, CN VI) in 55.6% of cases, and ataxia in 33.3 cases. None presented with paralysis. Imaging showed brainstem lesions in all 9 cases and thalamic involvement in 11.1%. Acute hydrocephalus was a feature in 44% of cases requiring CSF diversion. Up to 6 cases were lost to follow-up with 3 mortalities. CONCLUSION With DMG imaging is key for diagnosis due to the pathognomonic features, surgery plays a minimal role due to limited access to the lesion and related complications. In our series, the majority of lesions were localized within the brainstem with nearly half the number presenting with acute hydrocephalus. Overall, the outcomes were poor. Understanding the local picture is vital to addressing this devastating pathology.

Carbon envelopes around merging galaxies at z ∼ 4.5

Context. Galaxies evolve through a dynamic exchange of material with their immediate surrounding environment, the so-called circumgalactic medium (CGM). Understanding the physics of gas flows and the nature of the CGM is fundamental to studying galaxy evolution, especially at 4 ≤ z ≤ 6 (i.e., after the Epoch of Reionization) when galaxies rapidly assembled their masses and reached their chemical maturity. Galactic outflows are predicted to enrich the CGM with metals, although it has also been suggested that gas stripping in systems undergoing a major merger may play a role. Aims. In this work, we explore the metal enrichment of the medium around merging galaxies at z ∼ 4.5, observed by the ALMA Large Program to INvestigate [CII] at Early times (ALPINE). To do so, we study the nature of the [CII] 158 μm emission in the CGM around these systems, using simulations to help disentangle the mechanisms contributing to the CGM metal pollution. Methods. By adopting an updated classification of major merger systems in the ALPINE survey, we selected and analyzed merging galaxies whose components can be spatially and/or spectrally resolved in a robust way. This makes it possible to distinguish between the [CII] emission coming from the single components of the system and that coming from the system as a whole. We also made use of the dustyGadget cosmological simulation to select synthetic analogs of observed galaxies and guide the interpretation of the observational results. Results. We find a large diffuse [CII] envelope (≳20 kpc) embedding all the merging systems, with at least 25% of the total [CII] emission coming from the medium between the galaxies. Using predictions from dustyGadget, we suggest that this emission has a multi-fold nature, with dynamical interactions between galaxies playing a major role in stripping the gas and enriching the medium with heavy elements.

PALEOZOIC FORAMINIFERA: CURRENT STATE OF THE CLASSIFICATION AND PERSPECTIVES

An updated classification of Paleozoic foraminifera is proposed, consisting of three classes. Calcareous Paleozoic foraminifera are mainly included in the class Fusulinata but also represented in the classes Miliolata and Nodosariata. The current classification includes in the Fusulinata: 2 subclasses, 5 orders, 25 superfamilies, 65 families, 51 subfamilies, 572 genera, 14 subgenera, in the Miliolata: 1 order, 2 suborders, 2 superfamilies, 8 families, 9 subfamilies, 89 genera, and in the Nodosariata: 1 order, 2 superfamilies, 10 families, 2 subfamilies, 56 genera. Three other classes remain elusive: Allogromiata, Astrorhizata, and Textulariata. Four new replacement names are introduced: Leveniranella pro Iranella Leven in Leven and Vaziri Mohaddam, 2004, Tianshanellites pro Triticites (Tianshanella) Da in Da & Sun, 1983, Gublerites pro Gublerina Minato & Honjo, 1959 and Qinglongella pro Qinglongia Zhang & Dong in Xiao et al., 1986. The family Globoendothyridae is formally described as new.

807. A REVISED APPROACH TO THE ESOPHAGOGASTRIC JUNCTION: A MODIFIED SIEWERT CLASSIFICATION

Abstract Background Esophagogastric junction (EGJ) adenocarcinomas are challenging due to their anatomical and histopathological features and treated either as part of the esophagus or stomach cancers. Siewert (S) and Nishi classifications rely on the tumor’s epicenter to guide treatment decisions, which can lead to diagnostic and therapeutic inconsistencies. Moreover, recent studies helped define the optimal extent of lymphadenectomy for EGJ cancers. Here we present our standardized approach to EGJ cancers that integrates these insights, providing a framework to guide clinical decision-making. Methods Our modified classification relies on tumor extent rather than the epicentre, based on endoscopic measurement of the proximal and the distal limits, and the exact location of the EGJ. This approach classifies tumors based on their extent which results into six categories: SI, SI/II, SII, SII/III, SIII, and SI/II/III. Lower esophageal tumors whose distal limit lies between + 1cm and -2cm are classified as I/II. Cardia tumors whose proximal limit falls between those boundaries are II/III. Tumors that span more cephalad than + 1cm and more distally than – 2cm, are I/II/III. For Siewert I, I/II and II tumors, surgical management depends on the extent of esophageal involvement, mainly dictated by the probability of mediastinal basement nodal involvement, as defined by Kurokawa et al (2019). Additionally, a 3-field lymphadenectomy is performed when there is involvement of the cervical or recurrent laryngeal nerve lymph node stations. Results In SI, SI/II, and SI/II/III, with esophageal involvement exceeding 4 cm we favor a transthoracic esophagectomy (TTE) with total thoracic lymphadenectomy. If the involvement is between 1-4 cm, a transhiatal esophagectomy (THE) with lower mediastinal lymphadenectomy is performed. In SII, THE is done for 0-1 cm of involvement; absence of esophageal involvement permits a transhiatal extended total gastrectomy (eTG) with abdominal D2 lymphadenectomy and intra-operative margin status assessment via frozen sections. In SI/II/III and esophageal involvement of more than 4 cm, TTE is required; for esophageal involvement of 1-4 cm, we perform a THE and total gastrectomy with abdominal D2 lymphadenectomy based on distal margin findings. Conclusion This proposed modification to the classification of EGJ adenocarcinomas introduces a comprehensive framework that is tailored to the extent of tumor involvement. By addressing the limitations of existing systems and incorporating current insights, this updated classification aims to improve patient categorization and standardize treatment protocols, potentially leading to enhanced clinical outcomes.

RadioGraphics Update: The Ninth Edition TNM Staging System for Thymic Epithelial Tumors.

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.

Updated Taxonomy of Iris scariosa (Iridaceae) Inferred from Morphological and Chloroplast DNA Sequence Data with Remarks on Classification of Iris subg. Iris.

Iris scariosa is a rhizomatous perennial whose taxonomy and distribution range still remain unclear. The results of our examination of literature, specimens, and wild plants have shown that I. glaucescens, described from Kazakhstan, and I. timofejewii, considered to be endemic to the Republic of Dagestan, Russia, are very closely related to I. scariosa. We have carried out molecular phylogenetic analyses for the first time to clarify the taxonomy of I. scariosa. For this, we sequenced six chloroplast DNA regions of an extended sampling that comprised the accepted species I. glaucescens and I. timofejewii, which has revealed their strong affinity to the accession of I. scariosa from the vicinity of Astrakhan, Russia. A thorough revision of the morphological characters has confirmed the lack of evident differences between I. scariosa and I. timofejewii. Thus, the analyses support a broad species circumscription of I. scariosa. We here reduce I. timofejewii, as well as I. curvifolia, considered to be endemic to Xinjiang, western China, to synonymy of I. scariosa. Color illustrations, updated nomenclature, and data on distribution of I. scariosa are provided. A lectotype for I. astrachanica and a neotype for I. timofejewii are designated here. Also, the phylogenetic relationships within I. subg. Iris are outlined, and an updated classification of the subgenus is proposed. We have recovered six major lineages within four major clades which we recognize as sections. Here, we propose two new nomenclatural combinations, a revised taxonomic treatment, and a new identification key to I. subg. Iris.

The prognosis of pancreatic neuroendocrine tumors according to the WHO 2017 classification: The multi-center experience in Taiwan.

87 Background: The occurrence of pancreatic neuroendocrine tumors (PanNETs) remains infrequent, there is an upward trend in their diagnosis. Our retrospective study, conducted in Taiwan, focuses on exploring the interplay between clinical characteristics, treatment modalities, and prognosis in PanNET cases. Particularly, we aim to assess the implications of the updated WHO classification system on prognosis. Methods: We conducted a retrospective analysis of 176 PanNET cases from Chang Gung Medical Foundation, encompassing Linkou, Taoyuan, and Tucheng Hospitals, spanning the years 2009 to 2022. Pathology reports for all cases were reevaluated by pathologists according to the WHO 2017 classifications. Clinical features and overall survival outcomes were documented. Additionally, we examined the prognosis of distinct subgroups categorized by the WHO 2017 classification and their respective treatments. Results: The 5-year survival rate for all patients in the cohort stood at 58.7%. Among these, individuals diagnosed with NET G1 exhibited the highest survival rate (n = 78, 83.1%), followed by those with NET G2 (n = 57, 55.0%), NET G3 (n = 25, 14.6%), and NEC (n = 16, 9.4%). Univariate analysis highlighted several significant prognostic factors, including age, absence of symptoms at diagnosis, tumor size, lymph node involvement, distant metastasis, higher Ki-67 index, and cellular morphology. Comparative analysis between the WHO 2017 and WHO 2010 classifications revealed both systems as significant independent predictors of overall survival in PanNET cases. Notably, the 95% confidence interval for the WHO 2017 classification (2.892–9.703) showed a slight improvement in prognostic precision compared to the WHO 2010 classification (3.696–10.067). Under the WHO 2010 classification, NET G3 and NEC were combined, with NEC presenting higher rates of distant metastases, lymph node involvement, and Ki-67 index. Further investigation revealed that patients receiving somatostatin analogs, chemotherapy, or targeted therapy exhibited improved survival rates, particularly notable in NET G3 and NEC subgroups. Furthermore, NEC patients displayed extended treatment durations and higher objective response rates to first-line chemotherapy compared to the NET G3 group. Conclusions: Our retrospective analysis has illuminated the interrelation between prognostic factors and the overall survival rate. Furthermore, the updated WHO 2017 classification elucidates the distinctions between G3 and NEC, thus influencing the selection of clinical interventions.

Genomic data provide insights into the classification of extant termites

The higher classification of termites requires substantial revision as the Neoisoptera, the most diverse termite lineage, comprise many paraphyletic and polyphyletic higher taxa. Here, we produce an updated termite classification using genomic-scale analyses. We reconstruct phylogenies under diverse substitution models with ultraconserved elements analyzed as concatenated matrices or within the multi-species coalescence framework. Our classification is further supported by analyses controlling for rogue loci and taxa, and topological tests. We show that the Neoisoptera are composed of seven family-level monophyletic lineages, including the Heterotermitidae Froggatt, Psammotermitidae Holmgren, and Termitogetonidae Holmgren, raised from subfamilial rank. The species-rich Termitidae are composed of 18 subfamily-level monophyletic lineages, including the new subfamilies Crepititermitinae, Cylindrotermitinae, Forficulitermitinae, Neocapritermitinae, Protohamitermitinae, and Promirotermitinae; and the revived Amitermitinae Kemner, Microcerotermitinae Holmgren, and Mirocapritermitinae Kemner. Building an updated taxonomic classification on the foundation of unambiguously supported monophyletic lineages makes it highly resilient to potential destabilization caused by the future availability of novel phylogenetic markers and methods. The taxonomic stability is further guaranteed by the modularity of the new termite classification, designed to accommodate as-yet undescribed species with uncertain affinities to the herein delimited monophyletic lineages in the form of new families or subfamilies.