Updated Classification Research Articles

Updated WHO classification of tumors of the breast

In the fifth edition of the World Health Organization (WHO) classification of tumors of the breast, the histological features of the lesions continue to form the basis of the classification; however, molecular pathology nowadays provides approaches for improved diagnostics and prediction of prognosis and treatment response, which have been incorporated into the update of the classification. The most important changes are presented, which include changes in the histological classification of invasive carcinomas, the subtyping of lobular carcinoma in situ (LCIS) and the dignity criteria of phyllodes tumors.

Updated Diagnostic Criteria and Classification of Mast Cell Disorders: A Consensus Proposal.

Mastocytosis is a hematologic neoplasm characterized by expansion and focal accumulation of neoplastic mast cells (MC) in diverse organs, including the skin, bone marrow (BM), spleen, liver, and gastrointestinal tract. The World Health Organization classification divides the disease into prognostically distinct variants of cutaneous mastocytosis (CM) and systemic mastocytosis (SM). Although this classification remains valid, recent developments in the field and the advent of new diagnostic and prognostic parameters created a need to update and refine definitions and diagnostic criteria in MC neoplasms. In addition, MC activation syndromes (MCAS) and genetic features predisposing to SM and MCAS have been identified. To discuss these developments and refinements in the classification, we organized a Working Conference comprised of experts from Europe and the United States in August 2020. This article reports on outcomes from this conference. Of particular note, we propose adjustments in the classification of CM and SM, refinements in diagnostic criteria of SM variants, including smoldering SM and BM mastocytosis (BMM), and updated criteria for MCAS and other conditions involving MC. CD30 expression in MC now qualifies as a minor SM criterion, and BMM is now defined by SM criteria, absence of skin lesions and absence of B- and C-findings. A basal serum tryptase level exceeding 20 ng/mL remains a minor SM criterion, with recognition that hereditary alpha-tryptasemia and various myeloid neoplasms may also cause elevations in tryptase. Our updated proposal will support diagnostic evaluations and prognostication in daily practice and the conduct of clinical trials in MC disorders.

Current state of hybrid solutions for aortic arch aneurysms.

Since its inception in the early 2000s, hybrid arch repair (HAR) has evolved from a novel approach to a well-established treatment modality for aortic arch pathology in appropriately selected patients. HAR procedures have been proposed as a means to circumvent the perioperative morbidity and mortality associated with open total arch replacement. These procedures, all of which remain off-label applications of approved endograft technology, combine more conventional open surgical techniques, to create endograft landing zones, with thoracic endovascular aortic repair to exclude the aortic pathology from the circulation. The current classification system for HAR was proposed in 2013 and consists of three types, designated by the Roman numerals I, II and III. The current system has become outdated, however, with the advent of newer technologies, and herein we propose a new, updated classification system that is more encompassing with regards to the broad array of options available to treat aortic arch disease. Likewise, an institutional algorithm to guide patient and operative selection for HAR is presented. Patients are considered for HAR if they have either high-risk comorbidities or high-risk anatomy, with an important feature of the algorithm being that any decisions about repair strategy should be made by a surgical team with expertise in both open and endovascular techniques. Despite being performed for nearly two decades, the evidence around HAR consists mainly of single center series (level B-C evidence) with no randomized controlled trials. The data suggest HAR to be a safe alternative to open repair with acceptable short and mid-term results. As we as aortic surgeons continue to move towards less invasive approaches, both conventional open and hybrid techniques will remain important tools in the toolbox for arch repair, although the advent of multi-branched arch endografts will almost certainly reduce the extent of open or hybrid repair in many patients and eliminate it altogether in others.

UniLectin, A One-Stop-Shop to Explore and Study Carbohydrate-Binding Proteins.

All eukaryotic cells are covered with a dense layer of glycoconjugates, and the cell walls of bacteria are made of various polysaccharides, putting glycans in key locations for mediating protein-protein interactions at cell interfaces. Glycan function is therefore mainly defined as binding to other molecules, and lectins are proteins that specifically recognize and interact non-covalently with glycans. UniLectin was designed based on insight into the knowledge of lectins, their classification, and their biological role. This modular platform provides a curated and periodically updated classification of lectins along with a set of comparative and visualization tools, as well as structured results of screening comprehensive sequence datasets. UniLectin can be used to explore lectins, find precise information on glycan-protein interactions, and mine the results of predictive tools based on HMM profiles. This usage is illustrated here with two protocols. The first one highlights the fine-tuned role of the O blood group antigen in distinctive pathogen recognition, while the second compares the various bacterial lectin arsenals that clearly depend on living conditions of species even in the same genus. © 2021 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Searching for the structural details of lectins binding the O blood group antigen Basic Protocol 2: Comparing the lectomes of related organisms in different environments.

Usefulness of the QuantiFERON test for the diagnosis of tubercular uveitis and the predictions of response to antituberculosis treatment

AimsFew studies have evaluated the contribution of QuantiFERON test for the diagnosis of tubercular uveitis in non-endemic countries for tuberculosis (TB). The objective of the present study was to evaluate...

Risk Stratification for Revision Surgery Following Total Ankle Replacement

As a result of improved implants total ankle replacement (TAR) is becoming a more reliable option for end stage ankle arthritis. As with any surgery there are numerous complications that can occur intraoperatively and postoperatively with TAR. The primary aim of this study is to use recent data on implants currently on the market to develop a well-defined and comprehensive complication classification system which stratifies risk of subsequent surgery for TAR. A systematic review of studies on TARs from 2013 to 2018 was performed. Inclusion criteria were studies published between 2013 and August 2018, studies having at least 20 patients, data with at least 1-year follow-up and use of implants currently on the market. Studies were excluded if they involved revision cases, case reports, basic science articles and studies published in non-peer-reviewed journals. Sixteen studies fit inclusion criteria involving 3,305 implants. Overall survival of all implants was found to be 93% with a pooled complication rate of 75.6% using criteria for classifying complications by Glazebrook et al. Previously published classification systems did not clearly define complication categories leading to inconsistency in complication reporting and inaccurate complication rates. There are also several complications that are unclassifiable with the classifications developed by Gadd et al and Glazebrook et al. Our proposed updated classification system provides more inclusive tier profiles to capture the complications that can occur with implants currently on the market. Furthermore, this system provides a stratification of risk that these complications pose to ultimate procedure success.

Overview of Epidemiology and Management of Undescended Testis (Cryptorchidism)

Cryptorchidism (undescended testis, maldescendus testis) is a disorder in which one or together testes miscarry to slope into the bottommost of the scrotum. The study aimed to summarize the updated evidence regards, epidemiology, etiology, classification, diagnosis, and treatments of Cryptorchidism or undescended testis. Several causes can result in developing cryptorchidism. Disruption of any phase of testicular prolapse due to genetic hormonal, structural, ecological, or social issues can lead to cryptorchidism. The diagnosis of undescended testes is clinical. The test should be performed by an experienced person and should always be performed using a two-way technique. In some cases, imaging diagnostics for cryptorchidism may be helpful. The rationale for treating cryptorchidism is to reduce the risk of its long-term consequences. Current treatments for undescended testes include hormone therapy, orchopexy, and surgical correction.

СИСТЕМАТИЧЕСКИЙ АНАЛИЗ ВИДОВ РОДА QUERCUS L. В ДЕНДРОЛОГИЧЕСКОМ ГЕРБАРИИ ВУЗА

The results of the analysis of Quercus L. species stored in the herbarium of the Department of Botany and Plant Physiology of Federal State Budget Educational Institution of Higher Education VSUFT (Voronezh) are presented. This herbarium of historical plant collections of the genus Quercus L. is critical for tracking changes in the genus, including the introduction and distribution of species. We examined the belonging of the species to systematic units – subgenus, section, subsection, row, using the traditional classification and the updated intrageneric classification of oaks. Information about the life form, plant height, date and place of collection of the specimen was recorded. We entered information into the database, which will further simplify the work on registration, revision of the herbarium fund and when replenishing herbarium specimens. Conclusions were drawn based on the results of the workabout changes in the taxonomic nature and phylogenetic relationships of species in Quercus L. genus

Risk of malignancy associated with diagnostic categories of the proposed World Health Organization International System for Reporting Pancreaticobiliary Cytopathology.

The World Health Organization (WHO) has proposed an updated international classification system for reporting pancreaticobiliary cytology. Substantial changes to the prior Papanicolaou Society of Cytopathology (PSC) system have been recommended. Chiefly, the "neoplastic: benign" and "neoplastic: other" categories have been replaced by 2 new categories-"pancreatic neoplasia-low-grade" (PaN-Low) and "pancreatic neoplasia-high-grade" (PaN-High)-stratifying neoplastic mucinous cysts by cytological atypia. Low-grade malignancies are placed in the "malignant" category and benign serous cystadenoma in the "benign/negative" category. Risk of malignancy (ROM) associated with the diagnostic categories of the WHO system has yet to be defined. All patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for a pancreatic lesion at a single institution from January 2016 to December 2016, prospectively classified using the PSC system, were reclassified using the WHO system. Absolute ROM was determined by histologic outcome and/or clinical follow-up of at least 6months. A total of 334 EUS-FNA samples from 322 patients were reviewed and reclassified. Absolute ROM for the WHO system was 7.7% for "insufficient/inadequate/nondiagnostic" category, 1.0% for "benign/negative for malignancy," 28.0% for "atypical," 4.8% for "PaN-Low," 60.0% for "PaN-High," 100% for "suspicious for malignancy," and 100% for "malignant;" the absolute ROM for the same cohort using the PSC system was 7.7% for "nondiagnostic" category, 1.0% for "negative (for malignancy)," 28.0% for "atypical," 0.0% for "neoplastic: benign," 30.3% for "neoplastic: other," 100% for "suspicious (for malignancy)," and 100% for "positive or malignant." The WHO international system achieves improved stratification by associated ROM compared to the PSC system.

ОЦЕНКА АКТУАЛЬНОСТИ ПЕРСПЕКТИВНОЙ КОНСТРУКЦИИ ДИСТАНЦИОННО УПРАВЛЯЕМОГО ЛЕСОВОЗНОГО АВТОМОБИЛЯ С РАЗДВИЖНОЙ РАМОЙ И УПРАВЛЯЕМЫМИ КОЛЕСНЫМИ МОДУЛЯМИ

The tendency of development of timber trucks in the world is considered. Possible ways of increasing their efficiency at the present time are described. The results of the analysis of scientific works of foreign scientists in the field of increasing the productivity of timber trucks are presented. It was revealed that the duration of the process of loading and unloading timber has a significant effect on the productivity of timber trucks and on the final cost of the timber they export. The importance of reducing the labor intensity of unloading timber by improving the means for self-unloading of timber trucks has been substantiated. The goal of the research is formulated, which consists in the development of a promising design of a remotely controlled logging vehicle with a sliding frame and controlled wheel modules. Two groups of loading and unloading mechanisms used for loading and unloading timber on timber trucks are considered. The classification of devices for loading and unloading timber trucks by individual cranes, rope installations and self-propelled unloaders is presented. The dependences of the change in the residence time of timber trucks at the points of loading and unloading and their movement in an empty state on the number of timber trucks used in the link without self-loading and self-unloading means are described. The analysis of existing devices used for self-loading and self-unloading of timber trucks is presented. On the basis of the identified shortcomings, in order to eliminate them, a schematic diagram of a remotely controlled logging vehicle with a sliding frame and controlled wheel modules is proposed. A technological map of unloading a remotely controlled timber truck with a sliding frame and controlled wheel modules and an updated classification of means for self-unloading timber trucks are presented

Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 1).

This article aimed to review "nonsquamous lesions of the vulvar skin and subcutaneous tissue" 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 "nonsquamous lesions." The search was limited to "humans," "gynecopathology," and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. We excluded articles written in the non-English language and abstracts. A list of 600 articles was identified. Another screening identified 68 articles for clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. In the first part of this review, we cover 5 major groups of nonsquamous lesions of the vulvar skin and subcutaneous tissue including (1) glandular tumors and cysts, (2) adenocarcinomas of other types, (3) germ cell tumors of the vulva, (4) neuroendocrine neoplasia, and (5) hematolymphoid hyperplasia and neoplasia. The rest of the major topics including mesenchymal tumors of the lower genital tract, melanocytic lesions, and metastasis will be discussed in the second part of this review. Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.

TO DRAIN OR NOT TO DRAIN: A THERAPEUTIC CONUNDRUM IN A PATIENT WITH PERICARDIAL TAMPONADE AND EISENMENGER SYNDROME

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: PAH is diagnosed when mean pulmonary artery pressure is greater or equal to 20 mmHg at rest with a pulmonary vascular resistance =3 Wood units. In regions without endemic schistosomiasis, it is commonly idiopathic (1). Eisenmenger syndrome (ES) is the most advanced form of pulmonary arterial hypertension (PAH) and is associated with several congenital heart defects such as ASDS, VSDS etc. CASE PRESENTATION: We present the case of a 30-year-old patient with a past medical history of Trisomy-21, unrestricted ventricular septal defect (VSD) complicated by Eisenmenger Syndrome, PAH (On Treprostinil and Bosentan), chronic hypoxia and Hashimoto's Thyroiditis, who presented from his group home for acute on chronic shortness of breath and fever. Initially, he was hypoxic and hypotensive with signs of severe volume overload on physical exam. Oxygen saturations improved mildly on high flow nasal cannula (HFNC). CT chest and bedside echocardiogram showed a massive pericardial effusion (4.5 cm at the largest point) with tamponade physiology, and pulsus paradoxus (Figure 1,2,3). He was started on vasopressors, inotropes, intravenous prostacyclin and inhaled epoprostenol. Extracorporeal membrane oxygen (ECMO) was planned to stabilize him and drain the effusion, but the family refused ECMO. A Swanz Ganz catheter was placed under fluoroscopic guidance to help guide management but it crossed the VSD and inadvertently ended up in the aorta after which it was removed. After multiple discussions with adult congenital heart disease experts, it was decided that draining the pericardial effusion was not an option given the concern for acute right ventricular failure which could precipitate hemodynamic collapse and cardiac arrest. Another concern was bleeding complications especially bleeding into the pericardial cavity from inadvertently puncturing the multiple collateral vessels that such patients develop. The patient gradually developed increasing vasopressor requirements and eventually passed away. DISCUSSION: A pericardial effusion develops when fluid accumulates between the two layers of pericardium. In PAH, it may develop due to elevated right atrial pressures or underlying connective tissue disease. Its presence in PAH is associated with a significantly increased risk of death and the decision to drain such an effusion remains highly controversial. Multiple studies have reported dismal prognosis of patients who have had such effusions drained (2). The Euro heart survey reported that mortality was particularly high in patients with Eisenmenger's, and they had an increased frequency of major bleeding events as well (2). CONCLUSIONS: Pericardial effusion drainage in patients with pulmonary arterial hypertension is controversial and is associated with poor outcomes. Mortality is particularly high in patients with Eisenmenger's, and a multidisciplinary approach should be utilized to manage such patients. REFERENCE #1: Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019;53(1):1801913. REFERENCE #2: Engelfriet PM, Duffels MG, Möller T, et al. Pulmonary arterial hypertension in adults born with a heart septal defect: the Euro Heart Survey on adult congenital heart disease. Heart. 2007;93(6):682-687. DISCLOSURES: No relevant relationships by Saad Farooq, source=Web Response No relevant relationships by ELLIOT SULTANIK, source=Web Response No relevant relationships by Guy Weigold, source=Web Response No relevant relationships by Omar Yacob, source=Web Response

Magnetic resonance imaging (MRI) and Computed topography (CT) analysis of Schatzker type IV tibial plateau fracture revealed possible mechanisms of injury beyond varus deforming force

BackgroundSchatzker type IV tibial plateau fractures (type IV TPFs) are known for complex fracture morphology and high frequency of knee subluxation. Varus deforming force has been believed to be the cause but which fails to explain the lateral tibial plateau comminution and the lateral femoral condyle bone edema observed on injury MRI. The purpose of this study is to further explore the mechanisms of injury of type IV TPFs by synthetically analysing the information obtained from MRI and CT of a cohort of patients. MethodsBetween 2010 and 2019, 49 type IV TPFs were surgically treated in our hospital. The patients with complete preoperative CT and MRI were enrolled. They were classified according to OTA/AO and Luo's updated three-column classification (uTCC) after fracture morphology analysing and measuring. Then the injuries of cruciate/collateral ligaments and bone contusion were studied on MRI. The discrepancy between obvious fracture and occult bone contusion/soft tissue disruption among the groups of uTCC were compared and analysed. ResultsThirty patients were eligible for this study. Under uTCC system, all the cases were caused by varus force according to the tibial plateau angle and were classified into three groups of uTCC referring the posterior tibial slope angle: 4 were into hyperextension-varus, 21 into the extension-varus and 5 into the flexion-varus group. Fracture morphology analysis found in the extension-varus group, there were two distinct subgroups: OTA/AO 41B1.2 (medial+posteromedial columns disruption) and 41B3.3f (41B1.2 +posterolateral column disruption). Injury MRI revealed 28 of the 30 cases had more than 2 ligamentous injuries. The incidences of anterior and posterior cruciate injury were 96.7% and 43.3% respectively while 70% for medial collateral ligament (MCL). Eighteen out of 30 demonstrated apparent lateral femoral condyle bone contusion sign. Chi-square analysis found in the extension-varus group, the posterolateral column comminution was closely associated with lateral femoral condylar contusion (p<0.05) and MCL injuries (p<0.05). This finding and the absence of medial femoral condylar contusion was unlikely caused by uTCC proposed varus deforming force. ConclusionIn contrast to varus impaction, some type IV TPFs was probably caused by valgus or rotation force.

Progress in the pathological arena of gynecological cancers.

This review covers the significant new developments in the pathological classification of gynecological tumors. Many of these were included in the updated World Health Organization Classification of Female Genital Tract Tumours, published in 2020. Topics include the compelling evidence that a large majority of extrauterine high‐grade serous carcinomas arise from the fallopian tube; the Cancer Genome Atlas (TCGA) Classification of endometrial carcinomas; the discovery that most so‐called synchronous endometrial and ovarian endometrioid carcinomas represent metastasis from the endometrium to the ovary; and the division of cervical, vaginal, and vulval carcinomas into clinically meaningful HPV‐associated and HPV‐independent types. Newly described tumor types are covered, including endometrial and ovarian mesonephric‐like adenocarcinoma, uterine sarcoma types associated with specific molecular abnormalities, and gastric (gastrointestinal)‐type adenocarcinomas of the endometrium and vagina. Important molecular events in ovarian sex cord–stromal tumors are also discussed.

Revisiting the Global Seasonal Snow Classification: An Updated Dataset for Earth System Applications

AbstractTwenty-five years ago, we published a global seasonal snow classification now widely used in snow research, physical geography, and as a mission planning tool for remote sensing snow studies. Performing the classification requires global datasets of air temperature, precipitation, and land-cover. When introduced in 1995, the finest resolution global datasets of these variables were on a 0.5° × 0.5° latitude-longitude grid (approximately 50 km). Here we revisit the snow classification system and, using new datasets and methods, present a revised classification on a 10-arcsecond × 10-arcsecond latitude-longitude grid (approximately 300 m). We downscaled 0.1° × 0.1° latitude-longitude (approximately 10 km) gridded meteorological climatologies (1981-2019, European Centre for Medium-Range Weather Forecasts [ECMWF] ReAnalysis, 5thGeneration Land [ERA5-Land]) using MicroMet, a spatially distributed, high-resolution, micro-meteorological model. The resulting air temperature and precipitation datasets were combined with European Space Agency (ESA) Climate Change Initiative (CCI) GlobCover land-cover data (as a surrogate for wind speed) to produce the updated classification, which we have applied to all of Earth’s terrestrial areas. We describe this new, high-resolution snow classification dataset, highlight the improvements added to the classification system since its inception, and discuss the utility of the climatological snow classes at this much higher resolution. The snow class dataset (Global Seasonal-Snow Classification 2.0) and the tools used to develop the data are publicly available online at the National Snow and Ice Data Center (NSIDC).

Increased Plasma Levels of lncRNAs LINC01268, GAS5 and MALAT1 Correlate with Negative Prognostic Factors in Myelofibrosis.

Simple SummaryMyelofibrosis (MF) displays the worst prognosis among Philadelphia-negative chronic myeloproliferative neoplasms. There is no curative therapy for MF, except for bone marrow transplantation, which however has a consistent percentage of failure. There is thus an urgent need of novel biomarkers to complement current stratification models and to enable better management of patients. To address this issue, we herein measured the plasma levels of several long noncoding RNAs (lncRNAs). Circulating lncRNAs has been already largely described as potential non-invasive biomarkers in cancers. In our study we unveiled that LINC01268, MALAT1 (both p < 0.0001) and GAS5 (p = 0.0003) plasma levels are significantly higher in MF patients if compared with healthy donors, and their increased plasma levels correlate with several detrimental features in MF. Among them, LINC01268 is an independent variable for both OS (p = 0.0297) and LFS (p = 0.0479), thus representing a putative new biomarker suitable for integrate contemporary prognostic models.Long non-coding RNAs (lncRNAs) have been recently described as key mediators in the development of hematological malignancies. In the last years, circulating lncRNAs have been proposed as a new class of non-invasive biomarkers for cancer diagnosis and prognosis and to predict treatment response. The present study is aimed to investigate the potential of circulating lncRNAs as non-invasive prognostic biomarkers in myelofibrosis (MF), the most severe among Philadelphia-negative myeloproliferative neoplasms. We detected increased levels of seven circulating lncRNAs in plasma samples of MF patients (n = 143), compared to healthy controls (n = 65). Among these, high levels of LINC01268, MALAT1 or GAS5 correlate with detrimental clinical variables, such as high count of leukocytes and CD34+ cells, severe grade of bone marrow fibrosis and presence of splenomegaly. Strikingly, high plasma levels of LINC01268 (p = 0.0018), GAS5 (p = 0.0008) or MALAT1 (p = 0.0348) are also associated with a poor overall-survival while high levels of LINC01268 correlate with a shorter leukemia-free-survival. Finally, multivariate analysis demonstrated that the plasma level of LINC01268 is an independent prognostic variable, suggesting that, if confirmed in future in an independent patients’ cohort, it could be used for further studies to design an updated classification model for MF patients.

Low Frequency of Human Papillomavirus in Strictly Site-Coded Oral Squamous Cell Carcinomas, Using the Latest NHI/SEER-ICD Systems: A Pilot Observational Study and Critical Review.

Simple SummaryThe incidence of oropharyngeal squamous cell carcinomas (OPSCCs) has increased in the last decades, and this seems to be correlated to the infectious epidemiological trend of human papillomavirus (HPV). The prevalence of HPV-positive OPSCCs is approximately 70%, with involvement mainly of the tonsillar area. On the role of HPV in oral squamous cell carcinoma (OSCC), very few studies have investigated the prevalence of HPV in strictly site-codified OSCC, excluding the base of the tongue as distinct oropharyngeal entity. As a result, an inappropriate estimation of HPV infection in OSCC has been observed. We investigated HPV status, using a combination of detection methods, in a sample of 40 subjects with OSCC coded by the latest site classifications. Moreover, we performed a critical review of the studies with the same outcomes. The main finding of our investigation was a low frequency of HPV-positive OSCC, suggesting no significant HPV role in strictly oral carcinogenesis.The aim of this study was to evaluate HPV status in oral squamous cell carcinoma (OSCC), as coded by the latest classifications and applying a combination of detection methods used in clinical practice. Forty-two patients with suspect OSCC were consecutively recruited. Patients underwent an incisional biopsy for histological OSCC diagnosis and HPV identification by PCR DNA and p16 IHC. All lesions were coded by the latest ICD-0-3.2 site/histology classifications, as proposed for OSCC by the National Cancer Institute Surveillance, Epidemiology and End Results Programs. Moreover, a comparative analysis review, critically evaluated by the same site-coded systems and HPV detection methods, was performed. In 40 confirmed cases of OSCC, the frequency of HPV infection was 10% (4/40). Among positive patients, two cases were PCR DNA/p16 IHC positive (high-risk HPV 51, high-risk HPV 67), two cases were PCR DNA positive/p16 IHC negative (high-risk HPV 31 + 68, high-risk HPV 66). Applying the latest site coding systems for OSCC, the frequency of HPV infection in this study and in similar, reviewed investigations was low (from 3.3% to 12.5%). These results suggested no significant HPV role in oral carcinogenesis, particularly where an updated site-coded classification of OSCCs (categorically excluding the base of the tongue) had been performed.

Systematic Review and Meta-analysis of Histological Gastric Biopsy Aspects According to the Updated Sydney System in Children.

A descriptive and comparative study of gastric histological aspects according to the updated Sydney classification (USC), obtained from Helicobacter pylori-positive versus H pylori-negative children referred for upper gastrointestinal endoscopy. The Prisma method was used to perform a systematic review and meta-analysis. Selection criteria were based on following key words USC, H pylori, children, endoscopy, or biopsy. Publication biases were assessed according to the Newcastle-Ottawa Scale, and a meta-regression analysis was done. The study was registered on the PROSPERO platform. Between 1994 and 2017, 1238 references were found; 97 studies were retained for the systematic review with a total number of 25,867 children; 75 studies were selected for the meta-analysis concerning 5990 H pylori-infected and 17,782 uninfected children.H pylori-positive versus H pylori-negative children, according to the USC, showed significantly higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, and of lymphoid follicles, and gastric mucosa atrophy, whereas, intestinal metaplasia showed a significantly higher RR only in antral biopsies. The meta-regression analysis showed that H pylori-positive versus H pylori-negative children had significantly higher risk only for corpus activity according to age, recurrent abdominal pain, and geographical area of low H pylori prevalence. H pylori infection in children was associated with higher relative risk for gastric antral and corpus chronic inflammation, presence of neutrophils, lymphoid follicles, and rare gastric mucosa atrophy, whereas, rare intestinal metaplasia was only significantly higher in the antral area.

Neuroimaging of Pediatric Brain Tumors − A Review

Brain tumors are the second most common malignancy and the most common solid tumors in the pediatric population. Most brain tumors in the pediatric population are primary in origin contrary to the adult population. The various factors useful for establishing the diagnosis include the age of the patient, imaging characteristics, and location of the tumor. Infratentorial tumors are more common between 4 and 10 years of age, whereas supratentorial tumors are common in neonates and infants up to 3 years. Conventional computed tomography and magnetic resonance imaging are of paramount importance in the diagnostic evaluation of these tumors which help in their characterization and allow accurate assessment of their extent. The updated World Health Organization classification of brain tumors has incorporated various genetic and molecular parameters. It is essential for the radiologists to be familiar with the imaging features of genetic tumor subtypes as it plays a role in patient management and prognostication. Advanced neuroimaging provides additional information regarding the metabolism and physiology of these lesions, thereby aiding in their diagnosis and follow-up.

1447Gastric histopathology by Helicobacter pylori cagA status in Arctic Canada

Abstract Background Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. Community research partners wished to learn whether bacterial characteristics determine severity of Hp-related disease in their communities. We aimed to describe gastric histopathology by cagA genotype of Hp isolated from residents of 7 Indigenous communities in the Northwest Territories and Yukon. Methods Participants underwent gastroscopy with 5-6 biopsies taken for histopathological assessment and 2 biopsies taken for tissue culture during 2008-2017. We used multiple PCR reactions and DNA sequence analysis to classify Hp genotypes as cagA+ or cagA-. A single pathologist used the updated Sydney classification system to grade severity of 5 gastric pathology outcomes: Hp density; chronic gastritis; active gastritis; atrophy; and intestinal metaplasia. We estimated prevalence of each outcome with 95% confidence intervals (CI) by gastric subsite and cagA status. Results Of 262 Hp isolates assessed, 142 (54%) were cagA+. Prevalence of moderate-high Hp density, severe chronic gastritis, moderate-severe active gastritis, atrophy, and metaplasia were (%[CI]): respectively, 78[70-85], 44[36-53], 65[56-72], 55[46-63], 25[18-33] in cagA+ participants and 61[52-70], 35[27-44], 31[23-40], 32[23-41], 8[4-15] in cagA- participants. cagA+ participants had higher prevalence of all outcomes in antrum and corpus. Conclusion Hp-infected Indigenous residents of Arctic Canada who harbored cagA-positive strains had higher prevalence of more severe gastric pathology than those with cagA-negative strains. Key messages Community-driven research answers questions posed by those who bear the disease burden.