External validation of a new classification of spinal lipomas based on embryonic stage

2020 ◽  
Vol 25 (4) ◽  
pp. 394-401 ◽  
Author(s):  
Steven Tominey ◽  
Chandrasekaran Kaliaperumal ◽  
Pasquale Gallo
Keyword(s):  
External Validation ◽  
Radical Resection ◽  
Classification Systems ◽  
New Classification ◽  
Improve Patient Selection ◽  
Patient Representatives ◽  
Type 3

OBJECTIVEContention exists regarding appropriate classification and management of spinal lipomas (SLs). Given the heterogeneity of SLs, omissions and overlap between surgically incomparable groups exist in conventional classification systems. The new classification of spinal lipoma (NCSL) recently proposed by Morota et al. delineates morphology by embryological pathogenesis and the resultant operative difficulty. Here, the authors aimed to validate the NCSL by applying it to patients who had been operated on at their institution.METHODSAll children who had undergone resection for SL between 2014 and 2018 were included in this analysis. MRI studies were independently reviewed and classified by three adjudicators. Baseline characteristics, inter-adjudicator agreement, coexisting anomalies and/or malformations, and postoperative outcomes and complications were analyzed.RESULTSThirty-six patients underwent surgical untethering for SL: NCSL type 1 in 5 patients (14%), type 2 in 14 patients (39%), type 3 in 4 patients (11%), and type 4 in 13 patients (36%). All classification was agreed on first assignment by the adjudicators. Radical or near-radical resection, which was attempted in all patients, was always possible in those with type 1 and 4 SL, but never in those with type 2 and 3 SL. Neurological stabilization and/or improvement were observed in all patients at the last follow-up.CONCLUSIONSThe NCSL was found to be a logical and reproducible system to apply in this SL population. All cases were successfully classified with a high degree of inter-assessor agreement. Widespread establishment of a commonly adopted and clinically useful classification system will enable clinicians to improve patient selection as well as discussion with patient representatives during the decision-making process.

scholarly journals New classification of spinal lipomas based on embryonic stage

2017 ◽  
Vol 19 (4) ◽  
pp. 428-439 ◽  
Author(s):  
Nobuhito Morota ◽  
Satoshi Ihara ◽  
Hideki Ogiwara
Keyword(s):  
Clinical Utility ◽  
Radical Resection ◽  
Embryonic Stage ◽  
New Classification ◽  
Failure Type ◽  
Secondary Neurulation ◽  
Type 3

OBJECTIVE Spinal lipomas are generally thought to occur as a result of failed primary neurulation. However, some clinical features cannot be explained by this theory. The authors propose a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation. METHODS A total of 677 patients with occult spinal dysraphism underwent 699 surgeries between August 2002 and May 2015 at the National Center for Child Health and Development and Tokyo Metropolitan Children's Medical Center. This group of patients had 378 spinal lipomas, including 119 conus spinal lipomas, 27 lipomyelomeningoceles, and 232 filum lipomas, which the authors classified into 4 types based on neural tube formation during embryonic development. Type 1 is defined as pure primary neurulation failure; Type 2 ranges from primary to secondary neurulation failure; Type 3 consists of secondary neurulation failure (early phase); and Type 4 is defined as secondary neurulation failure (late phase). The authors also review embryogenesis in secondary neurulation and analyze the clinical utility of the new classification. RESULTS There were 55 Type 1 spinal lipomas, 29 Type 2, 62 Type 3, and 232 Type 4. All filum lipomas fell into the Type 4 spinal lipoma category. Association with anorectal and/or sacral anomalies was seen in none of the Type 1 cases, 15 (52%) of Type 2, 35 (56%) of Type 3, and 31 (13%) of Type 4. Urogenital anomalies were observed in none of the Type 1 or Type 2 cases, 1 (2%) of Type 3, and 28 (12%) of Type 4. Anomaly syndromes were present in none of the Type 1 cases, 6 (21%) of Type 2, 3 (5%) of Type 3, and 16 (7%) of Type 4. Associated anomalies or anomaly syndromes were clearly observed only for Type 2–4 spinal lipomas encompassing failed secondary neurulation. Radical resection was feasible for Type 1 spinal lipomas. CONCLUSIONS Secondary neurulation of the spinal cord gives rise to the conus medullaris and filum terminale, which are often involved in spinal lipomas. Formation of spinal lipomas seems to be a continuous process overlapping primary and secondary neurulation in some cases. Association with other anomalies was higher in Type 2–4 spinal lipomas, which included failed secondary neurulation, than in Type 1 lipomas, with failed primary neurulation. On the other hand, radical resection was indicated for Type 1, but not for Type 2, spinal lipomas. The new classification of spinal lipomas based on embryonic stage has the potential for clinical use and agrees well with both clinical and surgical findings. The classification proposed here is still preliminary. Further studies and verification are necessary to establish its clinical utility.

scholarly journals A novel classification for medial malleolar fracture based on the 3-D reconstruction CT

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fangke Hu ◽  
Guoyun Bu ◽  
Jun Liang ◽  
Haijing Huang ◽  
Jinquan He
Keyword(s):  
Medial Malleolus ◽  
The Novel ◽  
New Classification ◽  
Surgical Decision ◽  
Posterior Malleolus ◽  
Type 3 ◽  
Surgical Decision Making

Abstract Background Fracture of the medial malleolus is one of the most frequent injuries treated surgically; however, the classification of the fracture has not attracted much attention and a good classification system is still lacking. Methods Consecutive cases of medial malleolus fractures were prospectively enrolled. Based on the 3-D reconstruction CT morphology and centered on the posterior colliculus of the medial malleolus, we classified the fractures into 4 types: type 1 with no involvement of the posterior colliculus, type 2 with partial involvement of posterior colliculus, type 3 with the entire involvement of posterior colliculus, and type 4 with the fracture line 4 vertically extended from the intercollicular groove to the comminuted fracture of the posterior malleolus. Statistical analyses were performed to evaluate the clinical significance of the classification. Results There were 273 cases prospectively enrolled. The distribution of the cases was type 1 of 12.1%, type 2 of 41.0%, type 3 of 30.0%, and type 4 of 16.8%. Statistics showed that the new classification had significant associations but did not totally depend on the classical ankle fracture classifications. Results showed that the new classification had implications in the severity of ankle fractures. From type 1 to type 4, the ankle joint was more and more unstable. Furthermore, comminuted medial malleolar fractures could be subdivided, and the new classification could provide useful information for surgical decision-making. Conclusions The novel classification was a useful system to describe the 3-D geometry of the fractured medial malleolus.

scholarly journals Analysis of EPID Transmission Fluence Maps Using Machine Learning Models and CNN for Identifying Position Errors in the Treatment of GO Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Guyu Dai ◽  
Xiangbin Zhang ◽  
Wenjie Liu ◽  
Zhibin Li ◽  
Guangyu Wang ◽  
...  
Keyword(s):  
Machine Learning ◽  
Error Type ◽  
Imaging Device ◽  
Linear Discriminant ◽  
Position Errors ◽  
Dose Monitoring ◽  
Type 3

PurposeTo find a suitable method for analyzing electronic portal imaging device (EPID) transmission fluence maps for the identification of position errors in the in vivo dose monitoring of patients with Graves’ ophthalmopathy (GO).MethodsPosition errors combining 0-, 2-, and 4-mm errors in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions in the delivery of 40 GO patient radiotherapy plans to a human head phantom were simulated and EPID transmission fluence maps were acquired. Dose difference (DD) and structural similarity (SSIM) maps were calculated to quantify changes in the fluence maps. Three types of machine learning (ML) models that utilize radiomics features of the DD maps (ML 1 models), features of the SSIM maps (ML 2 models), and features of both DD and SSIM maps (ML 3 models) as inputs were used to perform three types of position error classification, namely a binary classification of the isocenter error (type 1), three binary classifications of LR, SI, and AP direction errors (type 2), and an eight-element classification of the combined LR, SI, and AP direction errors (type 3). Convolutional neural network (CNN) was also used to classify position errors using the DD and SSIM maps as input.ResultsThe best-performing ML 1 model was XGBoost, which achieved accuracies of 0.889, 0.755, 0.778, 0.833, and 0.532 in the type 1, type 2-LR, type 2-AP, type 2-SI, and type 3 classification, respectively. The best ML 2 model was XGBoost, which achieved accuracies of 0.856, 0.731, 0.736, 0.949, and 0.491, respectively. The best ML 3 model was linear discriminant classifier (LDC), which achieved accuracies of 0.903, 0.792, 0.870, 0.931, and 0.671, respectively. The CNN achieved classification accuracies of 0.925, 0.833, 0.875, 0.949, and 0.689, respectively.ConclusionML models and CNN using combined DD and SSIM maps can analyze EPID transmission fluence maps to identify position errors in the treatment of GO patients. Further studies with large sample sizes are needed to improve the accuracy of CNN.

scholarly journals Surgical Management of Tumors Involving the Cerebello-Medullary Angle: Anatomical Classification, Technique and Retrospective Analysis of 90 Pediatric Patients

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jaafar Basma ◽  
Paul Klimo
Keyword(s):  
Posterior Fossa ◽  
Residual Disease ◽  
Radical Resection ◽  
Extent Of Resection ◽  
Postoperative Mri ◽  
Mri Scans ◽  
Prior Surgery ◽  
Type 3

Abstract INTRODUCTION Extent of resection (EOR) remains the most crucial factor in determining long-term and progression-free survivals for most pediatric posterior fossa tumors. The lateral cerebello-medullary region harbors complex anatomical relationships, making radical resection challenging. Indeed, the cerebella-medullary angle (CMA) was found to be a common area for residual disease in ependymomas and medulloblastomas. We examine a series of pediatric tumors in the region, and classify them anatomically regardless of their pathological diagnosis. METHODS We reviewed preoperative MRI scans of 347 elective posterior fossa craniotomies performed at Le Bonheur Children's Hospital between January 2010 and June 2018. We defined the lateral cerebellomedullary angle (CMA) as the region involving the foramen of Luschka (FL) and/or the cerebellomedullary cistern (CMC). Tumors in that area were classified according to their extension: type 1 (FL), 2 (CMC), 3A (premedullary cistern), 3B (cerebellopontine angle), and 3C (all compartments). Demographic, preoperative, intraoperative, and postoperative data were recorded. The primary endpoints were EOR and any resultant surgical complications. RESULTS A total of 90 patients met inclusion criteria, of which 37 (41%) had prior surgery with residual disease. Ependymomas (45%) and medulloblastomas (27%) formed the majority of tumors. There were 25 type 1 tumors, 23 type 2, and 42 patients type 3 tumors. Cerebella-Medullary fissure dissection was necessary in all cases, but type 2 and 3 tumors were more likely to be treated using an extended or a lateral sub occipital approach (P = .04). Residual disease on intraoperative and immediate postoperative MRI requiring re-exploration was consistent with the anatomical type, and occurred more frequently in type 3 (P = .043). However, gross-total or near-total resection was achieved in 81% of cases, with no intergroup difference. Group 3 had more postoperative cranial nerve (CN) deficits (P = .0003) with longer ICU stays (P = .01). CONCLUSION Although modern research is shifting towards molecular and genomic subtyping, anatomical factors remain the most crucial determinant of EOR. Lateral tumors can exhibit different genetic, anatomic and clinical characteristics compared to median tumors, but may be sub-classified further based on their anatomical extension. Such sub-classification has implications on residual disease in predictable anatomical blind spots, approach selection, and expected postoperative deficits.

scholarly journals CLASSIFICATION OF MAGNETOSPHERIC RESPONSES TO INTERACTION WITH DIAMAGNETIC STRUCTURES OF SLOW SOLAR WIND

2020 ◽  
Vol 6 (4) ◽  
pp. 24-36
Author(s):  
Vladimir Parkhomov ◽  
Viktor Eselevich ◽  
Maxim Eselevich ◽  
Aleksey Dmitriev ◽  
Alla Suvorova ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Solar Wind ◽  
Vertical Component ◽  
Slow Solar Wind ◽  
Solar Wind Density ◽  
Main Determinants ◽  
Type 3

We propose a possible classification of the responses of the magnetosphere to the interaction with diamagnetic structures (DS), which form the basis of the slow solar wind. The main determinants of the classification are the value and orientation of the vertical component Bz of the interplanetary magnetic field (IMF) and the solar wind density N. We have identified three types of magnetospheric responses. Type 1 has two subtypes whose main difference is the presence or absence of auroras on the day side of the magnetosphere. Within an hour before DS arrival, Bz has a positive value (up to 12 nT) or fluctuates about 0 in the range from –1 to +1 nT. For both subtypes, the duration of substorm disturbances approximately coincides with the duration of DS, and their intensity does not exceed AE~500 nT. Type 2 is characterized by the fact that before the contact with DS positive IMF Bz (0–10 nT) is recorded for an hour, and at the interface of DS a rapid (≤2 min) change in the orientation of the IMF vertical component from north to south occurs. For type 3, Bz within an hour before the contact with DS is negative (from –10 to 0 nT). We address the problem of DS energy transfer to the magnetosphere.

scholarly journals Surgical Configurations of the Pectoralis Major flap for Reconstruction of Sternoclavicular Defects: A Systematic Review and New Classification of Described Techniques

2019 ◽  
Author(s):  
Jude Opoku-Agyeman ◽  
David Matera ◽  
Jamee Simone
Keyword(s):  
Classification System ◽  
English Language ◽  
Pectoralis Major ◽  
Cochrane Library ◽  
New Classification ◽  
Pectoralis Major Flap ◽  
Defect Reconstruction ◽  
Type 3

Abstract Objectives The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. Methods EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to November of 2018. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. Results The study included 5 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the TAA (type 3a) or the deltoid branch of the TAA (type 3b). Conclusion There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system will help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.

scholarly journals Four Bible Translation Types and Some Criteria to Distinguish Them

2007 ◽  
Vol 3 (2) ◽  
pp. 1-22
Author(s):  
Sebastian Floor
Keyword(s):  
Information Structure ◽  
Semantic Content ◽  
Sentence Length ◽  
Bible Translation ◽  
Dynamic Equivalent ◽  
Type 3 ◽  
Key Terms

The purpose of this paper is to contribute to the discussion on the classification of Bible translation types. This paper proposes four types instead of the traditional two: literal and idiomatic or dynamic equivalent. The four types are Type 1) close (or literal) resemblance, Type 2) open resemblance, Type 3) close (or limited) interpretative, and Type 4) open interpretative. There are several continua of criteria: the degree of resemblance to the original semantic content, the degree of explicitness, and the type of adjustments needed to unpack the meaning. Eight criteria of adjustments are proposed to distinguish these four types: 1) order of clauses and phrases, 2) sentence length, 3) reference disambiguation and tracking, 4) concordance of lexical items, 5) key terms and unknown terms, 6) figurative usage and idioms, 7) transition marking, and 8) information structure.

scholarly journals The Arterial Supply of the Distal Part of the Pancreas

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
S. Covantev ◽  
N. Mazuruc ◽  
O. Belic
Keyword(s):  
Splenic Artery ◽  
Distal Part ◽  
Type I ◽  
Type Iv ◽  
Distal Pancreas ◽  
Corrosion Cast ◽  
Type 3

The pancreatic surgery field has evolved greatly over the previous years. Nevertheless, the vascularization of the pancreas remains a difficult subject and requires further attention. The study was conducted using macroscopical dissection and corrosion cast methods. The total number of organ blocks was 72 (50 for dissection and 22 for corrosion cast). Based on the data obtained by dissection, we can distinguish three major types of vascularization of the distal pancreas. In type one, the pancreas was vascularized only by the short branches of the splenic artery and was encountered in 18 cases (36%). In type two, the pancreas was vascularized by the long and short branches of the splenic artery and was encountered in 20 cases (40%). In type three, the pancreas was vascularized only by the long branches of the splenic artery in 12 cases (24%). Compared to that, the corrosion cast method demonstrated type 1 in 8 cases (36.36%), type 2 in 10 cases (45.46%), and type 3 in 4 cases (18.18%). During the dissection, there were no arteries to the tail of the pancreas in 13 (26%) cases, one artery in 15 (30%) cases, two arteries in 19 (38%), and three arteries in three (6%) cases. The 22 corrosion cast specimens were also evaluated based on the classification of Roman Ramos and coworkers. Type I (small arcades) was in 9 (40.90%) cases, type II (small and large arcades) was in 7 (31.82%) cases, type III (large arcades) was in 5 (22.73%) cases, and type IV (straight branches) was in 1 (4.55%) case. The corrosion cast method allowed us to determine no arteries to the tail in 4 (18.18%) cases, one artery in 6 (27.27%) cases, two arteries in 10 (45.46%) cases and three arteries in two (9.09%) cases. The vascularization of the distal part of the pancreas is highly variable and should be taken into consideration during surgery.

Analisis Kapasitas Galangan Kapal Ikan Untuk Memenuhi Rencana Pengadaan Kapal Ikan Hibah

2019 ◽  
Vol 13 (1) ◽  
pp. 25-36
Author(s):  
Agus Lubis Fitriansyah ◽  
Heri Supomo
Keyword(s):  
Fishing Vessel ◽  
Fishing Vessels ◽  
Score Method ◽  
The Government ◽  
The Right ◽  
Type 3 ◽  
Selection Of

The government through the Ministry of Marine and Fisheries offers assistance of fishing vessel to achieve fisheries production targets. This procurement plan must be supported by the ability and selection of the right shipyard. Beacuse the information of the capability and capacity of fiber shipyards in Indonesia is unclear, so the realization of the procurement of fishing vessel in previous years did not met the planned targets. The purpose of this study was to analyze shipyard capacity to meet the planned procurement of KKP fishing vessels grant in 2019. First classification of fishing vessels is based on the size of each GT, which is 5 GT (type 1), 5-10 GT (type 2), and 20-30 GT (type 3). The second is the minimum shipyard criteria for building fishing boats. Third, an assessment of the shipyard is based on the criteria that have been made. Fourth, shipyard selection was carried out on each WPPN-RI using the load score method. The fifth calculates the number of ships that can be built by the shipyard. The results of the shipyard assessment found that 43% of shipyards have the ability to build type 1 vessels, around 38% of shipyards have the ability to build type 2 vessels, and around 19% of shipyards have the ability to build type 3 vessels. is 1625 units / period. Referring to shipyard capacity, it can be said that the entire shipyard is able to fulfill the plan to procure assistance for KKP fishing vessels in the 2019 budget year.

scholarly journals CLASSIFICATION OF MAGNETOSPHERIC RESPONSES TO INTERACTION WITH DIAMAGNETIC STRUCTURES OF SLOW SOLAR WIND

2020 ◽  
Vol 6 (4) ◽  
pp. 26-41
Author(s):  
Vladimir Parkhomov ◽  
Viktor Eselevich ◽  
Maxim Eselevich ◽  
Aleksey Dmitriev ◽  
Alla Suvorova ◽  
...  
Keyword(s):  
Magnetic Field ◽  
Solar Wind ◽  
Vertical Component ◽  
Slow Solar Wind ◽  
Solar Wind Density ◽  
Main Determinants ◽  
Type 3

We propose a possible classification of the responses of the magnetosphere to the interaction with diamagnetic structures (DS), which form the basis of the slow solar wind. The main determinants of the classification are the value and orientation of the vertical component Bz of the interplanetary magnetic field (IMF) and the solar wind density N. We have identified three types of magnetospheric responses. Type 1 has two subtypes whose main difference is the presence or absence of auroras on the day side of the magnetosphere. Within an hour before DS arrival, Bz has a positive value (up to 12 nT) or fluctuates about 0 in the range from –1 to +1 nT. For both subtypes, the duration of substorm disturbances approximately coincides with the duration of DS, and their intensity does not exceed AE~500 nT. Type 2 is characterized by the fact that before the contact with DS positive IMF Bz (0–10 nT) is recorded for an hour, and at the interface of DS a rapid (≤2 min) change in the orientation of the IMF vertical component from north to south occurs. For type 3, Bz within an hour before the contact with DS is negative (from –10 to 0 nT). We address the problem of DS energy transfer to the magnetosphere.

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