Updated Classification Research Articles

An updated subtribal classification of Compositae tribe Anthemideae based on extended phylogenetic reconstructions

An updated subtribal classification of the Compositae–Anthemideae is presented based on gene- and species-tree reconstructions considering sequence variation from the plastid (cpDNA ndhF, trnL-trnF) and nuclear genome (nrDNA ITS1-5.8S-ITS2, ETS; nDNA dual specificity phosphatase DSP, plus-3 domain-containing protein of the vernalization independence 5 complex VIP5, major facilitator superfamily protein of the Nitrate Transporter1/Peptide Transporter NPF3.1) for 113 of the 115 hitherto accepted genera of the tribe. As a result, six subtribes are newly circumscribed, i.e. Anthemidinae (including also Xylanthemum), Artemisiinae (including also Hulteniella, Lepidolopha, Opisthopappus and Tridactylina), Glebionidinae (including also Otoglyphis, Endopappus and Nivellea), Handeliinae (including Cancrinia, Polychrysum and excluding Xylanthemum), Leucantheminae (including also Daveaua, Heteromera and Otospermum) and Leucanthemopsidinae (including Phalacrocarpum). Additionally, five unigeneric subtribes (i.e. Brocchiinae, Inulantherinae, Lepidophorinae, Lonadinae and Vogtiinae) are described as new to science due to their phylogenetically isolated positions, resulting in 19 subtribes accepted for Compositae–Anthemideae. Three new combinations are proposed to accommodate the former Aaronsohnia factorovskyi Warb. & Eig and A. pubescens subsp. maroccana (Ball) Fennane & Ibn Tattou in the genus Otoglyphis Pomel (1874), which was found to have priority over Aaronsohnia Warb. & Eig (1927), and to accommodate the former Tanacetum paleaceum Podlech in the genus Xylanthemum Tzvelev. Citation: Oberprieler C., Töpfer A., Dorfner M., Stock M. & Vogt R. 2022: An updated subtribal classification of Compositae tribe Anthemideae based on extended phylogenetic reconstructions. – Willdenowia 52: 117–149. Version of record first published online on 18 May 2022 ahead of inclusion in April 2022 issue.

A worldwide phylogenetic classification of the Poaceae (Gramineae) III: An update

AbstractWe present an updated worldwide phylogenetic classification of Poaceae with 11 783 species in 12 subfamilies, 7 supertribes, 54 tribes, 5 super subtribes, 109 subtribes, and 789 accepted genera. The subfamilies (in descending order based on the number of species) are Pooideae with 4126 species in 219 genera, 15 tribes, and 34 subtribes; Panicoideae with 3325 species in 242 genera, 14 tribes, and 24 subtribes; Bambusoideae with 1698 species in 136 genera, 3 tribes, and 19 subtribes; Chloridoideae with 1603 species in 121 genera, 5 tribes, and 30 subtribes; Aristidoideae with 367 species in three genera and one tribe; Danthonioideae with 292 species in 19 genera and 1 tribe; Micrairoideae with 192 species in nine genera and three tribes; Oryzoideae with 117 species in 19 genera, 4 tribes, and 2 subtribes; Arundinoideae with 36 species in 14 genera and 3 tribes; Pharoideae with 12 species in three genera and one tribe; Puelioideae with 11 species in two genera and two tribes; and the Anomochlooideae with four species in two genera and two tribes. Two new tribes and 22 new or resurrected subtribes are recognized. Forty‐five new (28) and resurrected (17) genera are accepted, and 24 previously accepted genera are placed in synonymy. We also provide an updated list of all accepted genera including common synonyms, genus authors, number of species in each accepted genus, and subfamily affiliation. We propose Locajonoa, a new name and rank with a new combination, L. coerulescens. The following seven new combinations are made in Lorenzochloa: L. bomanii, L. henrardiana, L. mucronata, L. obtusa, L. orurensis, L. rigidiseta, and L. venusta.

Tyrosine kinase inhibitors for the treatment of indolent systemic mastocytosis: Are we there yet?

Indolent systemic mastocytosis (ISM) is the most prevalent form of systemic mastocytosis. Many patients with ISM suffer from mast cell (MC) mediator-related symptoms. In a small number of patients, hematologic progression is seen in the follow-up. In some patients with ISM, symptoms arising from MC-derived mediators including gastrointestinal symptoms, anaphylaxis, and neuropsychiatric symptoms are kept under control with conventional mediator-targeting drugs or MC-stabilizing agents. However, in a substantial number of patients, the symptoms are refractory to such conventional therapy. For these patients, novel drugs and targeted approaches are considered. One reasonable approach may be to apply tyrosine kinase inhibitors directed against KIT and other key kinase targets expressed in neoplastic MCs in ISM. Because MCs in more than 90% of all patients with typical ISM display the KIT D816V mutant receptor, clinically effective KIT-targeting drugs have to be active against this mutant form of KIT. The 2 such most effective and well-studied agents currently available are midostaurin and avapritinib. Other KIT-targeting drugs, such as imatinib or masitinib, are less effective or even noneffective against KIT D816V and are thus recommended for use only in patients with other KIT mutant forms (noncodon 816 mutations) or with wild-type KIT. In the present article, we review the current state in the treatment of ISM with tyrosine kinase inhibitors, with special emphasis on treatment responses and potential adverse effects. In fact, all of these agents also have unique and common adverse effects, and their use to treat patients with ISM should be balanced against their toxicity and short- and long-term safety.

Histopathological and Immunohistochemical Evaluation of Canine Nerve Sheath Tumors and Proposal for an Updated Classification.

Nerve sheath tumors are a group of tumors originating from Schwann cells, fibroblasts, and perineurial cells. In veterinary pathology, the terminology for nerve sheath tumors remains inconsistent, and many pathologists follow the human classification of such tumors in practice. Immunohistochemistry plays an important role in the diagnosis of nerve sheath tumors, but specific immunohistochemical and molecular biomarkers are lacking. In our study, we histopathologically reevaluated 79 canine nerve sheath tumors and assessed their reactivity for the immunohistochemical markers Sox10, claudin-1, GFAP, CNPase, and Ki-67. Based on the results, we classified the tumors according to the most recent human classification. Twelve cases were diagnosed as benign nerve sheath tumors, including six neurofibromas, three nerve sheath myxomas, two hybrid nerve sheath tumors (perineurioma/neurofibroma and perineurioma/schwannoma), and one schwannoma. Sixty-seven tumors were malignant nerve sheath tumors, including fifty-six conventional, four perineural, one epithelioid malignant nerve sheath tumor, and six malignant nerve sheath tumors with divergent differentiation. We believe that with the application of the proposed panel, an updated classification of canine nerve sheath tumors could largely follow the recent human WHO classification of tumors of the cranial and paraspinal nerves, but prospective studies would be needed to assess its prognostic value.

Global Alignment and Proportion (GAP) score in asymptomatic individuals: is it universal?

BACKGROUNDThe global alignment and proportion (GAP) score was established based on American and European subjects, which might limit its applicability to the Chinese population due to ethnicity-related difference of sagittal alignment. PURPOSETo analyze the applicability of GAP score in the Chinese population and to investigate the age- and gender-associated differences of spinopelvic and GAP score parameters. STUDY DESIGNA prospective cross-sectional radiographic study. PATIENTS SAMPLEOf 692 asymptomatic Chinese volunteers aged between 20 and 79 prospectively recruited between January 2017 and June 2019, 490 subjects were eventually included in this study. OUTCOME MEASURESThe pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L1-S1 lordosis, L4-S1 lordosis, sagittal vertical axis (SVA), T1 pelvic angle (TPA) and global tilt (GT) were measured on lateral X-rays. The GAP scores and its parameters including relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI) and relative spinopelvic alignment (RSA) were calculated for each subject. METHODSSubjects were divided into four groups: Group 1M: male subjects <60 years old; Group 1F: female subjects <60 years old; Group 2M: male subjects ≥60 years old and Group 2F: female subjects ≥60 years old. The GAP scores and categories were determined and compared between groups. The results of sagittal alignment were compared with the previous studies evaluating the normative sagittal alignment in other populations. Univariate linear regression analysis was carried out between pelvic incidence (PI) and sacral slope (SS), lumbar lordosis (LL) and global tilt (GT) in each group. RESULTSThe distributions of GAP categories and the updated Roussouly classification were statistically different from other populations. Significantly different distribution of GAP categories was observed between Group 1M and Group 2M, Group 1F and Group 2F, and Group 1M and Group 1F. Radiographic measurements and GAP parameters were significantly different between Group 1M and Group 2M, and Group 1F and Group 2F. Gender-related difference of parameters was more prominent between Group 1M and Group 1F. Linear relationship of PI with SS, LL and GT were different from the regression models of “ideal” sagittal alignment in GAP score. CONCLUSIONSThe GAP score might be inappropriate in Chinese population due to ethnicity-related alignment difference. Worse feasibility of GAP score was observed in female and old subjects.

Neuroendocrine Neoplasms of the Gynecologic Tract.

Simple SummaryNeuroendocrine refers to the cells that synthesize and secrete messenger chemicals such as neuropeptides and amines. Neuroendocrine neoplasms (NENs) are aggressive tumors arising from neuroendocrine cells, with an annual incidence of 6.98/100,000 and a prevalence of 170,000 in the United States. Primary gynecologic NENs constitute ≤2% of female reproductive tumors. NENs of the gynecologic tract are associated with high recurrence rates and dismal prognosis, making their treatment challenging. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of NENs of the gynecological tract.Gynecological tract neuroendocrine neoplasms (NEN) are rare, aggressive tumors from endocrine cells derived from the neuroectoderm, neural crest, and endoderm. The primary gynecologic NENs constitute 2% of gynecologic malignancies, and the cervix is the most common site of NEN in the gynecologic tract. The updated WHO classification of gynecologic NEN is based on the Ki-67 index, mitotic index, and tumor characteristics such as necrosis, and brings more uniformity in the terminology of NENs like other disease sites. Imaging plays a crucial role in the staging, triaging, restaging, and surveillance of NENs. The expression of the somatostatin receptors on the surface of neuroendocrine cells forms the basis of increasing evaluation with functional imaging modalities using traditional and new tracers, including 68Ga-DOTA-Somatostatin Analog-PET/CT. Management of NENs involves a multidisciplinary approach. New targeted therapies could improve the paradigm of care for these rare malignancies. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of gynecologic NENs of the cervix, ovary, endometrium, vagina, and vulva, emphasizing the relatively common cervical neuroendocrine carcinomas among these entities.

Modification of an extended total temporomandibular joint replacement (eTMJR) classification system

The aims of this paper were to validate a modification of an extended total temporomandibular joint replacement (eTMJR) classification system and develop a classification schematic for ease of reference. High-volume TMJ surgeons were asked to score 20 separate eTMJR devices using the updated classification system, and inter-rater variability was calculated. Using the modified classification system developed, a Conger’s kappa (κ) coefficient of 0.53 was returned, suggesting moderate to good levels of agreement. The final classification system was then developed in a series of standardised graphic illustrations as visual representations of the different subcategories of eTMJR devices.

The Nemestrinidae in Egypt and Saudi Arabia (Brachycera: Diptera)

BackgroundThe Nemestrinidae are a widespread group of moderate to large-sized rather stout flies. All known larvae of these flies are internal parasitoids of nymphs and adults of grasshoppers and larvae of scarabaeid beetles and have the potential to be used as biocontrol agents.ResultsAll known Egyptian and Saudi Arabian nemestrinid taxa are systematically catalogued in the present study. A total number of 13 species classified in only 2 genera, Nemestrinus (subfamily Nemestrininae) and Trichopsidea (subfamily Falleniinae), were investigated. Twelve of these species are represented in Egypt, out of which 5 species are represented in Saudi Arabia as well. Two of the treated species, Nemestrinus ater (Olivier) and N. rufipes (Olivier), are newly recorded herein from Saudi Arabia. Only one species, Trichopsidea costata (Loew), was recorded exclusively from Saudi Arabia. An updated classification, taxonomic data, world and local distributions with collection dates and coloured photographs of some species were provided. Hope that the results of this study will provide the basis for systematic studies and fauna analyses of future works on Nemestrinidae. It seems likely that further species will be discovered with more research involving a variety of collecting methods.ConclusionThirteen nemestrinid species belonging to 2 genera and 2 subfamilies were represented in both Egypt and Saudi Arabia. Two of these species are newly recorded herein from Saudi Arabia.

J-like protein family of Arabidopsis thaliana: the enigmatic cousins of J-domain proteins.

J-like proteins (JLPs) are emerging as ancillaries to the cellular chaperone network. They modulate functions of Hsp70:J-domain protein (JDP) systems in novel ways thereby having key roles in diverse plant processes. J-domain proteins (JDPs) form an obligate co-chaperone partnership with Hsp70s with their highly conserved J-domain to steer protein quality control processes in the cell. The HPD motif between helix II and helix III of the J-domain is crucial for JDP's interaction with Hsp70s. According to the most recent classification, J-like proteins (JLPs) form an extended class of the JDP family possessing a degenerate J-domain with the HPD motif non-conservatively replaced by other amino acid residues and hence are not able to interact with Hsp70s. Considering this most updated and acceptable JLP classification, we identified 21 JLPs in Arabidopsis thaliana that share a structurally conserved J-like domain (JLD), but lack the HPD motif. Analysis of publicly available gene expression data as well as real-time quantitative PCR performed for a few selected JLPs implicated some of these proteins in growth, development and stress response. Here, we summarize the current state of knowledge on plant JLPs and their involvement in vital plant cellular/metabolic processes, including chloroplast division, mitochondrial protein import and flowering. Finally, we propose possible modes of action for these highly elusive proteins and other DnaJ-related proteins (DNAJRs) in regulating the Hsp70 chaperone network.

Pre-operative mapping and structured reporting of pelvic endometriotic lesions on dynamic ultrasound and its correlation on laparoscopy using the #ENZIAN classification.

The objective of this study was to evaluate and compare the diagnostic performance of ultrasonography (USG) assessment using structured reporting with intraoperative laparoscopic assessment in deep infiltrating endometriosis (DIE) using the recent update of the #ENZIAN classification. This was a retrospective study conducted in Tertiary Multi-disciplinary Endometriosis Care Hospital over a period of 8months which included 50 patients who underwent a planned laparoscopic endometriosis excisional surgery after a dedicated USG assessment using International Deep Endometriosis Analysis (IDEA) protocol and #ENZIAN score (updated ENZIAN classification), between Feb 2021 and Sept 2021 at Apollo Hospitals, Hyderabad. The pre-operative USG findings were reported in a structured reporting format and intraoperative findings were classified using the standard #ENZIAN classification. No prospective interventions were done. A review of pre-operative ultrasound and laparoscopic findings as per the #ENZIANwas done. Sensitivity and the negative predictive value of ultrasound were 86% and 84.2% for peritoneal lesions, 97% and 93.3% for left ovarian lesions, 93% and 91.6% for right ovarian lesions, 91% and 84% for left tubal lesions, 90% and 86.3% for right tubal lesions, 93% and 75% for uterosacral ligaments, 93.3% and 97% for rectal lesions and sensitivity and negative predictive values were 100% for rectovaginal lesions, adenomyosis, and ureteric lesions as confirmed on laparoscopy. Dynamic ultrasound assessment with a structured report based on IDEA protocol and #ENZIAN score is accurate for mapping of pelvic endometriosis in all forms, and it correlates with laparoscopic findings, thus helps surgeon for better planning and providing a road map for surgeons. From a clinical perspective, a uniform and shared reporting system across imaging and therapeutic modalities will simplify communication, improving patient management by conservative or surgical treatments, avoiding multiple repeat surgeries, and improving quality of treatment.

Inclusion of open injuries in an updated Schenck classification of knee dislocations based on a global Delphi consensus study

ObjectivesKnee dislocations (KDs) are complex injuries defined as incongruity of the tibiofemoral joint, which leads to tears of two or more of the main stabilising knee ligaments, and they are often associated with damage to surrounding soft tissue or neurovascular structures. A classification system for these injuries should be simple and reproducible and allow communication among surgeons for surgical planning and outcome prediction. The aim of this study was to formulate a list of factors, prioritised by high-volume knee surgeons, that should be included in a KD classification system. MethodsA global panel of orthopaedic knee surgery specialists participated in a Delphi process. The first survey employed 91 orthopaedic surgeons to generate a list of patient- and system-specific factors that should be included in a KD classification system that may affect surgical planning and outcomes. This list was subsequently prioritised by 27 identified experts (mean 15.3 years of experience) from Brazil (n = 9), USA (n = 6), South Africa (n = 4), India (n = 4), China (n = 2), and the United Kingdom (n = 2). The items were analysed to find factors that had at least 70% consensus for inclusion in a classification system. ResultsOf the 12 factors identified, four (33%) achieved at least 70% consensus for inclusion in a classification system. The factors deemed critical for inclusion in a classification system included vascular injuries (89%), common peroneal nerve injuries (78%), number of torn ligaments (78%), and open injuries (70%). ConclusionConsensus for inclusion of various factors in a KD classification system was not easily achieved. The wide geographic distribution of participants provides diverse insight and makes the results of the study globally applicable. The most important factors to include in a classification system as determined by the Delphi technique were vascular injuries, common peroneal nerve injuries, number of torn ligaments, and open injuries. To date, the Schenck anatomic classification system most accurately identifies these patient variables with the addition of open injury classification. The authors propose to update the Schenck classification system with the inclusion of open injuries as an additional modifier, although this is only a small step in updating the classification, and further studies should evaluate the inclusion of more advanced imaging modalities. Future research should focus on integrating these factors into useful existing classification systems that are predictive of surgical treatment and patient outcomes.

Sinopsis de Digitaria (Paniceae, Panicoideae, Poaceae) en Mexico, incluyendo la nueva especie Digitaria michoacanensis

Se describe Digitaria michoacanensis una nueva especie del norte de Michoacán y áreas adyacentes del estado de México, en la región centro-oeste de México. En espera de una clasificación filogenética infragenérica actualizada, la nueva especie puede ser clasificada en el grupo Ternata con espiguillas en grupos de tres o más. Se provee una sinopsis y una clave para las especies mexicanas del género Digitaria.

Transungual Drug Delivery System for the Topical Treatment of Onychomycosis: A Review

Abstract: Onychomycosis is an infection caused by a fungus that causes discoloration and thicken-ing of the nail layer, and it is the most common nail infection in the world. Trichophyton rubrum and Trichophyton mentagrophytes var. interdigital is the most common anthropophilic dermato-phytes that trigger it. Onychomycosis is caused by yeasts such as Candida albicans and Candida parapsilosis, as well as moulds such as Aspergillus spp. Treatment is determined by the type of nail invasion, the fungus genus, and the number of nails affected. Approaches towards conventional methods showed certain drawbacks, which emphasizes the need for alternate approaches to produce better therapeutic efficacy of a product. The present review focused on reporting an updated classi-fication of Onchyomycosis, causative organisms, factors influencing drug permeation, novel treat-ment strategies for Onychomycosis, and drug permeation enhancement methods.

Confirmation of the Need for Reclassification of Neisseria mucosa and Neisseria sicca Using Average Nucleotide Identity Blast and Phylogenetic Analysis of Whole-Genome Sequencing: Hinted by Clinical Misclassification of a Neisseria mucosa Strain.

The taxonomy of the genus Neisseria remains confusing, particularly regarding Neisseria mucosa and Neisseria sicca. In 2012, ribosomal multi-locus sequence typing reclassified both as N. mucosa, but data concerning 17 N. sicca strains remain available in GenBank. The continuous progress of high-throughput sequencing has facilitated ready accessibility of whole-genome data, promoting vigorous development of average nucleotide identity (ANI) and high-resolution phylogenetic analysis. Here, we report that a Neisseria isolate, which caused native-valve endocarditis and multiple embolic brain infarcts in a patient with congenital heart disease, was misidentified as N. sicca by VITEK MS. This isolate was reclassified as N. mucosa by ANI blast (ANIb) and by phylogenetic analysis using whole-genome data yielded by the PacBio Sequel and Illumina NovaSeq PE150 platforms. The confusion evident in the GenBank and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) databases suggests that N. mucosa (n = 13) and N. sicca (n = 16) in GenBank should be reclassified using ANIb and high-resolution phylogenetic analysis. The whole-genome data of 30 strains (including the clinical isolate) were compared with the data of 27 type Neisseria strains (including one N. sicca and two N. mucosa type strains) as a genomic index. In total, 25 (8 originally identified as N. mucosa and 17 originally identified as N. sicca) and 7 (1 originally identified as N. sicca and 6 originally identified as N. mucosa) strains were reclassified into the N. mucosa and Neisseria subflava groups, respectively; 1 residual N. mucosa strain was reclassified as Neisseria meningitidis. In conclusion, a combination of ANIb and robust phylogenetic analysis reclassified strains originally identified as N. mucosa and N. sicca into (principally) the N. mucosa group and the N. subflava group. The misclassified N. sicca and N. mucosa strains in the GenBank and MALDI-TOF MS databases were supposed to be corrected. Updated genomic classification strategy for originally identified N. mucosa and N. sicca strains was recommended to be adopted in GenBank.

Overview of the 2022 WHO Classification of Parathyroid Tumors.

The 2022 WHO classification reflects increases in the knowledge of the underlying pathogenesis of parathyroid disease. In addition to the classic characteristic features of parathyroid neoplasms, subtleties in histologic features which may indicate an underlying genetic abnormality reflect increased understanding of the clinical manifestations, histologic, and genetic correlation in parathyroid disease. The importance of underlying genetic aberrancies is emphasized due to their significance to the care of the patient. Traditionally, the term "parathyroid hyperplasia" has been applied to multiglandular parathyroid disease; however, the concept of hyperplasia is generally no longer supported in the context of primary hyperparathyroidism since affected glands are usually composed of multiple "clonal" neoplastic proliferations. In light of these findings and management implications for patient care, the 2022 WHO classification endorses primary hyperparathyroidism-related multiglandular parathyroid disease (multiglandular multiple parathyroid adenomas) as a germline susceptibility-driven multiglandular parathyroid neoplasia. From such a perspective, pathologists can provide additional value to genetic triaging by recognizing morphological and immunohistochemical harbingers of MEN1, CDKN1B, MAX, and CDC73-related manifestations. In the current WHO classification, the term "parathyroid hyperplasia" is now used primarily in the setting of secondary hyperplasia which is most often caused by chronic renal failure. In addition to expansion in the histological features, including those that may be suggestive of an underlying genetic abnormality, there are additional nomenclature changes in the 2022 WHO classification reflecting increased understanding of the underlying pathogenesis of parathyroid disease. The new classification no longer endorses the use of "atypical parathyroid adenoma". This entity is now being replaced with the term of "atypical parathyroid tumor" to reflect a parathyroid neoplasm of uncertain malignant potential. The differential diagnoses of atypical parathyroid tumor are discussed along with the details of worrisome clinical and laboratory findings, and also features that define atypical histological and immunohistochemical findings to qualify for this diagnosis. The histological definition of parathyroid carcinoma still requires one of the following findings: (i) angioinvasion (vascular invasion) characterized by tumor invading through a vessel wall and associated thrombus, or intravascular tumor cells admixed with thrombus, (ii) lymphatic invasion, (iii) perineural (intraneural) invasion, (iv) local malignant invasion into adjacent anatomic structures, or (v) histologically/cytologically documented metastatic disease. In parathyroid carcinomas, the documentation of mitotic activity (e.g., mitoses per 10mm2) and Ki67 labeling index is recommended. Furthermore, the importance of complete submission of parathyroidectomy specimens for microscopic examination, and the crucial role of multiple levels along with ancillary biomarkers have expanded the diagnostic workup of atypical parathyroid tumors and parathyroid carcinoma to ensure accurate characterization of parathyroid neoplasms. The concept of parafibromin deficiency has been expanded upon and term "parafibromin deficient parathyroid neoplasm" is applied to a parathyroid neoplasm showing complete absence of nuclear parafibromin immunoreactivity. Nucleolar loss is considered as abnormal finding that requires further molecular testing to confirm its biological significance. The 2022 WHO classification emphasizes the role of molecular immunohistochemistry in parathyroid disease. By adopting a question-answer framework, this review highlights advances in knowledge of histological features, ancillary studies, and associated genetic findings that increase the understanding of the underlying pathogenesis of parathyroid disease that are now reflected in the updated classification and new entities in the 2022 WHO classification.

Online calculator to predict early mortality in patient with surgically treated recurrent lower-grade glioma

PurposeThe aim of this study was to investigate the epidemiological characteristics and associated risk factors of recurrent lower-grade glioma [LGG] (WHO grades II and III) according to the 2016 updated WHO classification paradigm and finally develop a model for predicting early mortality (succumb within a year after reoperation) in recurrent LGG patients.MethodsData were obtained from consecutive patients who underwent surgery for primary LGG and reoperation for tumor recurrence. The end point “early mortality” was defined as death within 1 year after the reoperation. Predictive factors, including basic clinical characteristics and laboratory data, were retrospectively collected.ResultsA final nomogram was generated for surgically treated recurrent LGG. Factors that increased the probability of early mortality included older age (P = 0.042), D-dimer> 0.187 (P = 0.007), RDW > 13.4 (P = 0.048), PLR > 100.749 (P = 0.014), NLR > 1.815 (P = 0.047), 1p19q intact (P = 0.019), IDH1-R132H Mutant (P = 0.048), Fib≤2.80 (P = 0.018), lack of Stupp concurrent chemoradiotherapy (P = 0.041), and an initial symptom of epilepsy (P = 0.047). The calibration curve between the prediction from this model and the actual observations showed good agreement.Conclusion: A nomogram that predicts individualized probabilities of early mortality for surgically treated recurrent LGG patients could be a practical clinical tool for counseling patients regarding treatment decisions and optimizing therapeutic approaches. Free online software implementing this nomogram is provided at https://warrenwrl.shinyapps.io/RecurrenceGliomaEarlyM/

Bosniak Classification Version 2019: Point-Early Validation of the Updated Classification System Supports Clinical Application.

Bosniak Classification Version 2019: Point-Early Validation of the Updated Classification System Supports Clinical Application.

Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 2).

The aim of this second article was to complete part 1 review of nonsquamous lesions of the vulvar skin and subcutaneous tissue (Journal of Lower Genital Tract Disease, 2021), clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification. A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms "vulva," "lower genital tract," and "non-squamous lesions." The search was limited to "human gynecological pathology." Full article texts were reviewed, and reference lists were screened for additional articles. We excluded abstracts and articles written in the non-English language. An initial list of 400 articles was identified. Thirty-seven articles discussed clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.

Distal ulna fractures in adults—subcapitular, transverse fractures did not benefit from surgical treatment

IntroductionFractures of the distal ulna, excluding the styloid, are rare. The cause of injury is often a fall on an outstretched hand with an extended wrist, and in most cases there is a concomitant distal radius fracture. The aims of this retrospective study were to investigate the results of the current treatment of distal ulna fractures in adults, with or without a concomitant distal radius fracture, and if a recently presented fracture classification could predict outcome.Materials and methodsPatients, 18 years or older, treated for a fracture of the distal third of ulna in our county, were included. Fractures of the styloid tip were excluded. The radiographs of the fractures were independently classified by two specialists in radiology according to the 2018 AO/OTA classification. Follow-up was performed 5–7 years after the injury, through the questionnaire Patient-Rated Wrist Evaluation (PRWE) and new radiographs of both wrists.ResultsNinety-six patients with 97 fractures were included and filled out the PRWE. 65 patients also had new radiographs taken. 79 patients were women and the mean age at the time of injury was 63 years (SD 14.5). The most common fracture class was the extra-articular transverse fracture, 2U3A2.3 (42%). We found that 40% of the fractures had been treated by internal fixation and only 2 fractures had not healed, one conservatively treated and one operated. The median PRWE was 15 (IQR 33.5). The PRWE score was significantly worse in the operated ulna fractures (p = 0.01) and this was also true for extra-articular transverse fractures 2U3A2.3 (p = 0.001). Initial displacement was more common in operated transverse fractures, but it could not be proven that this was the reason for the inferior result.ConclusionsDistal ulna fractures almost always unite and the result is comparable to that of isolated distal radius fractures when measured by PRWE. Based on the opinions of the radiologists and how often a consensus discussion was needed for classification, we found the updated AO classification system difficult to use, if dependent only on standard radiographic views. In the present study, transverse extra-articular ulna fractures did not benefit from internal fixation regardless if associated with a distal radius fracture or isolated.

Clinical utility of the Bosniak classification version 2019: Diagnostic value of adding magnetic resonance imaging to computed tomography examination

PurposeTo assess the impact of the updated Bosniak classification (BC2019) for cystic renal masses (CRMs) on interobserver agreement between radiologists and urologists and the diagnostic value of adding MRI to CT examination (combined CT/MRI). MethodThis study included 103 CRMs from 83 consecutive patients assessed using contrast-enhanced CT and MRI between 2010 and 2016. Nine readers in three groups (three radiologists, three radiology residents, and three urologists) reviewed CT alone and the combined CT/MRI using BC2019. Bosniak category was determined by consensus in each group for diagnosing malignancy, with a cut-off category of ≧III. Interobserver agreement was assessed using Fleiss’ kappa values. The effect of CT or combined CT/MRI on the diagnosis of malignancy was assessed using McNemar’s test. ResultsInterobserver agreement of BC2019 for CT alone was substantial for radiologists and residents, moderate for urologists (0.77, 0.63, and 0.58, respectively). Interobserver agreement of BC2019 for combined CT/MRI was substantial for all three groups (radiologists: 0.78; residents: 0.65; and urologists: 0.61). Among residents, the sensitivity/specificity/accuracy rates of combined CT/MRI vs. CT alone were 82.1/74.7/76.7% vs. 75.0/66.7/68.9%, and specificity and accuracy were significantly higher for combined CT/MRI than that for CT alone (p = 0.03 and 0.008, respectively). Similarly, sensitivity/specificity/accuracy values were significantly higher for combined CT/MRI among urologists (78.6/73.3/74.8% vs. 64.3/64.0/64.1%, p = 0.04/0.04/0.008). However, sensitivity/specificity/accuracy did not significantly differ between the two among radiologists (89.3/74.7/78.6% vs. 85.7/73.3/76.7%, p = 0.32/0.56/0.32). ConclusionsCombined CT/MRI is useful for diagnosing malignancy in patients with CRMs using BC2019, especially for non-expert readers.