scholarly journals Fractures around Trochanteric Nails: The “Vergilius Classification System”

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Giuseppe Toro ◽  
Antimo Moretti ◽  
Daniele Ambrosio ◽  
Raffaele Pezzella ◽  
Annalisa De Cicco ◽  
...  
Keyword(s):  
Research Group ◽  
Classification System ◽  
Unmet Needs ◽  
Treatment Strategies ◽  
Fracture Morphology ◽  
Steering Committee ◽  
Orthopaedic Surgeon ◽  
Critical Issues ◽  
Fracture Localization ◽  
Huge Challenge

Introduction. The fractures that occurred around trochanteric nails (perinail fractures, PNFs) are becoming a huge challenge for the orthopaedic surgeon. Although presenting some specific critical issues (i.e., patients’ outcomes and treatment strategies), these fractures are commonly described within peri-implant ones and their treatment was based on periprosthetic fracture recommendations. The knowledge gap about PNFs leads us to convene a research group with the aim to propose a specific classification system to guide the orthopaedic surgeon in the management of these fractures. Materials and Methods. A steering committee, identified by two Italian associations of orthopaedic surgeons, conducted a comprehensive literature review on PNFs to identify the unmet needs about this topic. Subsequently, a panel of experts was involved in a consensus meeting proposing a specific classification system and formulated treatment statements for PNFs. Results and Discussion. The research group considered four PNF main characteristics for the classification proposal: (1) fracture localization, (2) fracture morphology, (3) fracture fragmentation, and (3) healing status of the previous fracture. An alphanumeric code was included to identify each characteristic, allowing to describe up to 54 categories of PNFs, using a 3- to 4-digit code. The proposal of the consensus-based classification reporting the most relevant aspects for PNF treatment might be a useful tool to guide the orthopaedic surgeon in the appropriate management of these fractures.

scholarly journals Management strategies of pediatric ipsilateral olecranon with associated radial neck fractures based on multicenter experience

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jin Li ◽  
◽  
Sheng Ping Tang ◽  
Guo Xin Nan ◽  
Ming Li ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Classification System ◽  
Forearm Fracture ◽  
Pediatric Trauma ◽  
Treatment Strategies ◽  
Treatment Result ◽  
Level Of Evidence ◽  
Radial Neck ◽  
Radial Neck Fractures

Abstract Background The ipsilateral olecranon with associated radial neck fractures does not include in the Bado classification of Monteggia fractures and equivalent lesions. The primary aims of this retrospective multicenter study were to characterize this type of injury and, noting its unique properties, evaluate the results of the treatment, determine the prognostic factors that influence the radiological and clinical outcome, and also give treatment strategies. Methods Between July 2011 and July 2016, forearm fracture patient charts were retrospectively reviewed from seven pediatric trauma centers. Patients diagnosed with ipsilateral olecranon with associated radial neck fractures and followed up for at least 24 months were included. Fracture characteristics, treatment, outcome, and complications were assessed. The clinical outcome of treatments was evaluated by the Mayo Elbow Performance Score (MEPS) and the Flynn criteria. Fisher’s exact test and ANOVA test were used; significance was defined as P < 0.05. Results One hundred thirty-seven consecutive patients (54 girls and 83 boys) from 8292 forearm fractures patients, the mean age of 7.5 years (1.5 to 14.8), with fractures of the ipsilateral olecranon with associated radial neck fractures were identified. One hundred twenty-five patients had radiologic and clinical follow-up. According to a simplified classification system with “operate” and “don’t operate” groups, including five subtypes proposed in this study, ipsilateral olecranon with associated radial neck fractures subtypes could be classified with significantly different characteristics and outcome in treatment and complications. Conclusions Fractures of the ipsilateral olecranon associated with the radial neck are not so rare as previously reported. Complications and poor outcomes were easy to encounter without knowing this type of fracture. Appropriate treatment strategies could be made according to a simple classification system based on the treatment result of follow-up. Level of evidence Retrospective comparative study; Level III

Mania and Depression: What's New?

2017 ◽  
Vol 41 (S1) ◽  
pp. S15-S15
Author(s):  
A. Fagiolini ◽  
G. Amodeo
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Unmet Needs ◽  
Glycogen Synthase ◽  
Treatment Strategies ◽  
Opiate Receptor ◽  
Glycogen Synthase Kinase 3 ◽  
Sustained Effects ◽  
Precise Understanding ◽  
Cellular Apoptosis

Despite the high burden of bipolar disorder and the noticeable progress in its treatment, the disorder still goes frequently misdiagnosed, unrecognized, or not optimally treated. To date, no medication has been specifically developed on the basis of a precise understanding of the pathophysiology of the disorder, or based on the unique characteristics of several subtypes of bipolar disorder or on the medication mechanism of action. Lithium remains on of the gold standard treatments for bipolar disorder. Its mood-stabilizing properties are thought to occur via specific cellular signaling pathways, such as inhibition of glycogen synthase kinase 3, which is considered to regulate cellular apoptosis. Divalproex, carbamazepine and several atypical antipsychotics are also approved for bipolar disease Evidence also suggests that antipsychotics show the ability to treat and prevent mania and/or depression but are often burdened by side effects such as sedation, hortostatic hypotension and weight gain. Hence, while it is clear that there still are several unmet needs especially for what pertains tolerability, efficacy for specific subtypes, and predictability. Novel and more effective treatments are needed and researchers are currently engaging in targeted drug development for bipolar illness, aimed at improving pharmacological strategies with marked and sustained effects. A variety of newer medications are being tested. Some of these drugs target pathways that are similar to those targeted by lithium, while others focus on newer targets, such as opiate receptor and N-methyl-D-aspartate (NMDA) receptors. Newer and older treatment strategies for bipolar disorder will be presented and critically reviewed.Disclosure of interestAndrea Fagiolini is/has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Astra Zeneca, Boehringer Ingelheim, Pfizer, Eli Lilly, Ferrer, Janssen, Lundbeck, Novartis, Otsuka, Roche.

scholarly journals The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

2019 ◽  
Vol 12 (4) ◽  
pp. 254-265 ◽  
Author(s):  
Paul A. Mittermiller ◽  
Serena S. Bidwell ◽  
Florian M. Thieringer ◽  
Carl-Peter Cornelius ◽  
Amber W. Trickey ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Mandibular Fractures ◽  
Condylar Process ◽  
Accuracy Study ◽  
Level 3 ◽  
Comprehensive Classification ◽  
Level 2 ◽  
Condylar Neck

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.

scholarly journals Expert consensus on a standardised definition and severity classification for adverse events associated with spinal and peripheral joint manipulation and mobilisation: protocol for an international e-Delphi study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e050219
Author(s):  
Martha Funabashi ◽  
Katherine A Pohlman ◽  
Lindsay M Gorrell ◽  
Stacie A Salsbury ◽  
Andrea Bergna ◽  
...  
Keyword(s):  
Adverse Events ◽  
Scoping Review ◽  
Classification System ◽  
Delphi Study ◽  
Best Practice ◽  
Descriptive Analysis ◽  
Research Priorities ◽  
Steering Committee ◽  
Eligibility Criteria ◽  
Severity Classification

IntroductionSpinal and peripheral joint manipulation (SMT) and mobilisation (MOB) are widely used and recommended in the best practice guidelines for managing musculoskeletal conditions. Although adverse events (AEs) have been reported following these interventions, a clear definition and classification system for AEs remains unsettled. With many professionals using SMT and MOB, establishing consensus on a definition and classification system is needed to assist with the assimilation of AEs data across professions and to inform research priorities to optimise safety in clinical practice.Methods and analysisThis international multidisciplinary electronic Delphi study protocol is informed by a scoping review and in accordance with the ‘Guidance on Conduction and Reporting Delphi Studies’. With oversight from an expert steering committee, the study comprises three rounds using online questionnaires. Experts in manual therapy and patient safety meeting strict eligibility criteria from the following fields will be invited to participate: clinical, medical and legal practice, health records, regulatory bodies, researchers and patients. Round 1 will include open-ended questions on participants’ working definition and/or understanding of AEs following SMT and MOB and their severity classification. In round 2, participants will rate their level of agreement with statements generated from round 1 and our scoping review. In round 3, participants will rerate their agreement with statements achieving consensus in round 2. Statements reaching consensus must meet the a priori criteria, as determined by descriptive analysis. Inferential statistics will be used to evaluate agreement between participants and stability of responses between rounds. Statements achieving consensus in round 3 will provide an expert-derived definition and classification system for AEs following SMT and MOB.Ethics and disseminationThis study was approved by the Canadian Memorial Chiropractic College Research Ethics Board and deemed exempt by Parker University’s Institutional Review Board. Results will be disseminated through scientific, professional and educational reports, publications and presentations.

scholarly journals Artificial intelligence for the classification of fractures around the knee in adults according to the 2018 AO/OTA classification system

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248809
Author(s):  
Anna Lind ◽  
Ehsan Akbarian ◽  
Simon Olsson ◽  
Hans Nåsell ◽  
Olof Sköldenberg ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Knee Joint ◽  
Classification System ◽  
Plain Radiograph ◽  
Treatment Strategies ◽  
University Hospital ◽  
Complication Rates ◽  
Radiographic Images ◽  
Femur Fractures

Background Fractures around the knee joint are inherently complex in terms of treatment; complication rates are high, and they are difficult to diagnose on a plain radiograph. An automated way of classifying radiographic images could improve diagnostic accuracy and would enable production of uniformly classified records of fractures to be used in researching treatment strategies for different fracture types. Recently deep learning, a form of artificial intelligence (AI), has shown promising results for interpreting radiographs. In this study, we aim to evaluate how well an AI can classify knee fractures according to the detailed 2018 AO-OTA fracture classification system. Methods We selected 6003 radiograph exams taken at Danderyd University Hospital between the years 2002–2016, and manually categorized them according to the AO/OTA classification system and by custom classifiers. We then trained a ResNet-based neural network on this data. We evaluated the performance against a test set of 600 exams. Two senior orthopedic surgeons had reviewed these exams independently where we settled exams with disagreement through a consensus session. Results We captured a total of 49 nested fracture classes. Weighted mean AUC was 0.87 for proximal tibia fractures, 0.89 for patella fractures and 0.89 for distal femur fractures. Almost ¾ of AUC estimates were above 0.8, out of which more than half reached an AUC of 0.9 or above indicating excellent performance. Conclusion Our study shows that neural networks can be used not only for fracture identification but also for more detailed classification of fractures around the knee joint.

scholarly journals Clinical outcomes of muscle invasive bladder Cancer according to the BASQ classification

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
Kyung Chul Moon ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Classification System ◽  
Expression Patterns ◽  
Treatment Strategies ◽  
Invasive Bladder Cancer ◽  
Molecular Characteristics ◽  
Muscle Invasive Bladder Cancer ◽  
Cancer Specific Survival ◽  
Muscle Invasive

Abstract Background We evaluated the clinical efficacy and prognosis of muscle-invasive bladder cancer according to the basal/squamous-like (BASQ) classification system based on immunohistochemical staining [CK5/6(+), CK14(+), GATA3(−), and FOXA1(−)]. Methods One hundred patients diagnosed with muscle-invasive bladder cancer (cT2-4 N0-3 M0) were included in the study. All patients underwent radical cystectomy after transurethral removal of bladder tumor. Immunostaining was performed for CK5/6, CK14, FOXA1, and GATA3 antibodies on tissue microarray slides, and expression patterns were quantitatively analyzed using a scanning program. Results The median follow-up time was 77.4 (interquartile range: 39–120.9) months. The mean age of the patients was 65.1 ± 11.2 years. FOXA1 or CK14 expression greater than 1% was respectively positively and negatively correlated with overall survival (OS; p = 0.011 and p = 0.042, respectively), cancer-specific survival (CSS; p = 0.050 for both), and recurrence-free survival (RFS; p = 0.018 and p = 0.040, respectively). For CK5/6+ and GATA3- or FOXA1- expression, 10% CK5/6+ cells were negatively correlated with OS (p = 0.032 and p = 0.039, respectively) and with RFS in combination with FOXA1- only (p = 0.050). Conclusions In this study, CK14 expression was associated with a poor prognosis. The new classification system of bladder cancer based on molecular characteristics is expected to helpful tool for the establishment of personalized treatment strategies and associated prediction of therapeutic responses.

Update on the development of the international neuroblastoma risk group (INRG) classification schema

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 9503-9503 ◽  
Author(s):  
S. L. Cohn ◽  
W. B. London ◽  
T. Monclair ◽  
K. K. Matthay ◽  
P. F. Ambros ◽  
...  
Keyword(s):  
Classification System ◽  
Risk Group ◽  
Diagnostic Category ◽  
Treatment Strategies ◽  
Staging System ◽  
Mycn Amplification ◽  
Tumor Differentiation ◽  
Treatment Groups ◽  
Ultra High Risk ◽  
Pre Treatment

9503 Background: Modern treatment strategies for neuroblastoma (NB) are tailored according to patient risk. However, it is not currently possible to compare the results of clinical studies conducted around the globe because the criteria used to define risk are not uniform. A committee of international investigators with expertise in NB have worked during the past 2 years to develop a uniform International NB Risk Group (INRG) Classification System for pre-treatment stratification. Methods: Investigators from North America and Australia (COG); Europe (SIOPEN and Germany), and Japan collated data on 8,800 children with NB diagnosed between 1990 and 2002. Survival tree regression analyses tested 13 potential prognostic factors. Tumor differentiation, MKI, and diagnostic category were evaluated individually in lieu of the International NB Pathology Classification (INPC) system to determine if these histologic features had prognostic value independent from age. To stage patients at the time of diagnosis prior to surgery, a new staging system was developed (INRGSS) based on the presence or absence of image-defined risk factors (IDRFs) and metastases. Results: Since statistical analyses demonstrated support for an optimal age cut- off between 14–19 months, 18 months was selected. In addition to age, stage, MYCN amplification, tumor differentiation, ploidy, and genetic aberrations of 11q were found to be the most highly prognostically significant factors. These clinical and biological factors were combined to define 15 INRG pre-treatment groups. Patients with low- (3 groups), intermediate- (4 groups), high- (4 groups), or ultra-high-risk NB (4 groups) had EFS of ≥85%, >70–85%, >50–70%, or <50%, respectively. Conclusion: International collaborative studies in NB will be greatly facilitated by the INRG classification system which will allow comparisons of different risk-based therapeutic approaches in homogeneous patient cohorts. No significant financial relationships to disclose.

scholarly journals European identity: roots and scope

2019 ◽  
pp. 27-34
Author(s):  
Carlos Espaliú Berdud
Keyword(s):  
Human Rights ◽  
International Society ◽  
Research Group ◽  
European Identity ◽  
Special Issue ◽  
Research Project ◽  
Critical Issues ◽  
International University ◽  
Multidisciplinary Perspective ◽  
Shed Light

The current landscape of Europe requires an urgent reflection on whether a European identity exists or not, and on the consequences the answers to this question may hold. For two years, we members of the Research Group on critical issues of contemporary international society of the Faculty of Law of the International University of Catalonia, together with a number of professors from other Spanish and international universities, have attempted to provide answers to these questions. This special issue of Cuadernos Europeos de Deusto is the result of this research project. We have approached the topic from a multidisciplinary perspective, and more specifically Philosophy, History and Law. In particular, we have focused on the roots and scope of the European identity, which, once determined, can shed light on the relations between people and groups of different races, religions, cultures, etc. in Europe. Several of the authors have addressed the issue of human rights, a key element of that European identity.Published online: 27 February 2019

Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture

2020 ◽  
Author(s):  
Ding-Jun Hao ◽  
Jun-Song Yang ◽  
Yuan Tuo ◽  
Chao-Yuan Ge ◽  
Bao-Rong He ◽  
...  
Keyword(s):  
Classification System ◽  
Dynamic Instability ◽  
Interobserver Reliability ◽  
Fracture Morphology ◽  
Thoracolumbar Fracture ◽  
Initial Assessment ◽  
Imaging Data ◽  
New Classification ◽  
Wide Clinical Application ◽  
Standard Classification

Abstract ObjectiveThis study proposed a new classification system for Chronic Symptomatic Osteoporotic Thoracolumbar Fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years. However, the lack of a standard classification system has resulted in inconveniences regarding communication, research and treatment. Previous studies of CSOTF classification exhibit different defects, and none of these studies are widely accepted.MethodsWe collected 368 cases of CSOTF in our hospital from January 2010 to June 2017 and systematically analyzed the imaging data of all patients to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans and magnetic resonance imaging. Ten investigators systematically studied and fully understood the classification system grading 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability.ResultsThe new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively).ConclusionsThe new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The system is convenient for communication and research, but wide clinical application are needed to confirm its effectiveness and guide clinical treatment.

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