Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives.

Platelet concentrates for topical and infiltrative use - commonly termed Platetet-Rich Plasma (PRP) or Platelet-Rich Fibrin (PRF) - are used or tested as surgical adjuvants or regenerative medicine preparations in most medical fields, particularly in sports medicine and orthopaedic surgery. Even if these products offer interesting therapeutic perspectives, their clinical relevance is largely debated, as the literature on the topic is often confused and contradictory. The long history of these products was always associated with confusions, mostly related to the lack of consensual terminology, characterization and classification of the many products that were tested in the last 40 years. The current consensus is based on a simple classification system dividing the many products in 4 main families, based on their fibrin architecture and cell content: Pure Platelet-Rich Plasma (P-PRP), such as the PRGF-Endoret technique; Leukocyte- and Platelet-Rich Plasma (LPRP), such as Biomet GPS system; Pure Platelet-Rich Fibrin (P-PRF), such as Fibrinet; Leukocyte- and Platelet-Rich Fibrin (L-PRF), such as Intra-Spin L-PRF. The 4 main families of products present different biological signatures and mechanisms, and obvious differences for clinical applications. This classification serves as a basis for further investigations of the effects of these products. Perspectives of evolutions of this classification and terminology are also discussed, particularly concerning the impact of the cell content, preservation and activation on these products in sports medicine and orthopaedics.

Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry

High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.

Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.

BACKGROUND Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. METHODS We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. RESULTS Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011). CONCLUSION At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. LEVEL OF EVIDENCE Level IV, retrospective case series.

Assessment of the Hong Kong Liver Cancer Staging System in Europe.

BACKGROUND & AIMS European and American guidelines have endorsed the Barcelona Clinic Liver Cancer (BCLC) staging system. The aim of this study was to assess the performance of the recently developed Hong Kong Liver Cancer (HKLC) classification as a staging system for hepatocellular carcinoma (HCC) in Europe. METHODS We used a pooled set of 1693 HCC patients combining three prospective European cohorts. Discrimination ability between the nine substages and five stages of the HKLC classification system was assessed. To evaluate the predictive power of the HKLC and BCLC staging systems on overall survival, Nagelkerke pseudo R2, Bayesian Information Criterion and Harrell's concordance index were calculated. The number of patients who would benefit from a curative therapy was assessed for both staging system. RESULTS The HKLC classification in nine substages shows suboptimal discrimination between the staging groups. The classification in five stages shows better discrimination between groups. However, the BCLC classification performs better than the HKLC classification in the ability to predict OS. The HKLC treatment algorithm tags significantly more patients to curative therapy than the BCLC. CONCLUSIONS The BCLC staging system performs better for European patients than the HKLC staging system in predicting OS. Twice more patients are eligible for a curative therapy with the HKLC algorithm, whether this translates in survival benefit remains to be investigated. This article is protected by copyright. All rights reserved.

Validated sample ages from 823 EPD sites

The number of well-dated pollen diagrams in Europe has increased considerably over the last 30 years and many of them have been submitted to the European Pollen Database (EPD). This allows for the construction of increasingly precise maps of Holocene vegetation change across the continent. Chronological information in the EPD has been expressed in uncalibrated radiocarbon years, and most chronologies to date are based on this time scale. Here we present new chronologies for most of the datasets stored in the EPD based on calibrated radiocarbon years. Age information associated with pollen diagrams is often derived from the pollen stratigraphy itself or from other sedimentological information. We reviewed these chronological tie points and assigned uncertainties to them. The steps taken to generate the new chronologies are described and the rationale for a new classification system for age uncertainties is introduced. The resulting chronologies are fit for most continental-scale questions. They may not provide the best age model for particular sites, but may be viewed as general purpose chronologies. Taxonomic particularities of the data stored in the EPD are explained. An example is given of how the database can be queried to select samples with appropriate age control as well as the suitable taxonomic level to answer a specific research question.

Unsupervised system to classify SO2 pollutant concentrations in Salamanca, Mexico

Salamanca is cataloged as one of the most polluted cities in Mexico. In order to observe the behavior and clarify the influence of wind parameters on the Sulphur Dioxide (SO2) concentrations a Self-Organizing Maps (SOM) Neural Network have been implemented at three monitoring locations for the period from January 1 to December 31, 2006. The maximum and minimum daily values of SO2 concentrations measured during the year of 2006 were correlated with the wind parameters of the same period. The main advantages of the SOM Neural Network is that it allows to integrate data from different sensors and provide readily interpretation results. Especially, it is powerful mapping and classification tool, which others information in an easier way and facilitates the task of establishing an order of priority between the distinguished groups of concentrations depending on their need for further research or remediation actions in subsequent management steps. For each monitoring location, SOM classifications were evaluated with respect to pollution levels established by Health Authorities. The classification system can help to establish a better air quality monitoring methodology that is essential for assessing the effectiveness of imposed pollution controls, strategies, and facilitate the pollutants reduction.

Phylogeny of genes for secretion NTPases: Identification of the widespread tadA subfamily and development of a diagnostic key for gene classification

Macromolecular transport systems in bacteria currently are classified by function and sequence comparisons into five basic types. In this classification system, type II and type IV secretion systems both possess members of a superfamily of genes for putative NTP hydrolase (NTPase) proteins that are strikingly similar in structure, function, and sequence. These include VirB11, TrbB, TraG, GspE, PilB, PilT, and ComG1. The predicted protein product of tadA, a recently discovered gene required for tenacious adherence of Actinobacillus actinomycetemcomitans, also has significant sequence similarity to members of this superfamily and to several unclassified and uncharacterized gene products of both Archaea and Bacteria. To understand the relationship of tadA and tadA-like genes to those encoding the putative NTPases of type II/IV secretion, we used a phylogenetic approach to obtain a genealogy of 148 NTPase genes and reconstruct a scenario of gene superfamily evolution. In this phylogeny, clear distinctions can be made between type II and type IV families and their constituent subfamilies. In addition, the subgroup containing tadA constitutes a novel and extremely widespread subfamily of the family encompassing all putative NTPases of type IV secretion systems. We report diagnostic amino acid residue positions for each major monophyletic family and subfamily in the phylogenetic tree, and we propose an easy method for precisely classifying and naming putative NTPase genes based on phylogeny. This molecular key-based method can be applied to other gene superfamilies and represents a valuable tool for genome analysis.

Archaeal-eubacterial mergers in the origin of Eukarya: phylogenetic classification of life.

A symbiosis-based phylogeny leads to a consistent, useful classification system for all life. "Kingdoms" and "Domains" are replaced by biological names for the most inclusive taxa: Prokarya (bacteria) and Eukarya (symbiosis-derived nucleated organisms). The earliest Eukarya, anaerobic mastigotes, hypothetically originated from permanent whole-cell fusion between members of Archaea (e.g., Thermoplasma-like organisms) and of Eubacteria (e.g., Spirochaeta-like organisms). Molecular biology, life-history, and fossil record evidence support the reunification of bacteria as Prokarya while subdividing Eukarya into uniquely defined subtaxa: Protoctista, Animalia, Fungi, and Plantae.

Traditional knowledge of medicinal plants in the Serra de Mariola Natural Park, South-eastern Spain

The present study aims to inventory and analyse the ethnobotanical knowledge about medicinal plants in the Serra de Mariola Natural Park. In respect to traditional uses, 93 species reported by local informants were therapeutic, 27 food, 4 natural dyes and 13 handcrafts. We developed a methodology that allowed the location of individuals or vegetation communities with a specific popular use. We prepared a geographic information system (GIS) that included gender, family, scientific nomenclature and common names in Spanish and Catalan for each species. We also made a classification of 39 medicinal uses from ATC (Anatomical, Therapeutic, Chemical classification system). Labiatae (n=19), Compositae (n=9) and Leguminosae (n=6) were the families most represented among the plants used to different purposes in humans. Species with the most elevated cultural importance index (CI) values were Thymus vulgaris (CI=1.431), Rosmarinus officinalis (CI=1.415), Eryngium campestre (CI=1.325), Verbascum sinuatum (CI=1.106) and Sideritis angustifolia (CI=1.041). Thus, the collected plants with more therapeutic uses were: Lippia triphylla (12), Thymus vulgaris and Allium roseum (9) and Erygium campestre (8). The most repeated ATC uses were: G04 (urological use), D03 (treatment of wounds and ulcers) and R02 (throat diseases). These results were in a geographic map where each point represented an individual of any species. A database was created with the corresponding therapeutic uses. This application is useful for the identification of individuals and the selection of species for specific medicinal properties. In the end, knowledge of these useful plants may be interesting to revive the local economy and in some cases promote their cultivation.

Intelligent Decision-Making System Frameworks for a Digital Plan of Work: A Theoretical Investigation for the Construction Industry

The construction industry is characterised by fragmentation and suffers from lack of collaboration, often adopting adversarial working practices to achieve deliverables. For the UK Government and construction industry, BIM is a game changer aiming to rectify this fragmentation and promote collaboration. However it has become clear that there is an essential need to have better controls and definitions of both data deliverables and data classification. Traditional methods and techniques for collating and inputting data have shown to be time consuming and provide little to improve or add value to the overall task of improving deliverables. Hence arose the need in the industry to develop a Digital Plan of Work (DPoW) toolkit that would aid the decision making process, providing the required control over the project workflows and data deliverables, and enabling better collaboration through transparency of need and delivery. The specification for the existing Digital Plan of Work (DPoW) was to be, an industry standard method of describing geometric, requirements and data deliveries at key stages of the project cycle, with the addition of a structured and standardised information classification system. However surveys and interviews conducted within this research indicate that the current DPoW resembles a digitised version of the pre-existing plans of work and does not push towards the data enriched decision-making abilities that advancements in technology now offer. A Digital Framework is not simply the digitisation of current or historic standard methods and procedures, it is a new intelligent driven digital system that uses new tools, processes, procedures and work flows to eradicate waste and increase efficiency. In addition to reporting on conducted surveys above, this research paper will present a theoretical investigation into usage of Intelligent Decision Support Systems within a digital plan of work framework. Furthermore this paper will present findings on the suitability to utilise advancements in intelligent decision-making system frameworks and Artificial Intelligence for a UK BIM Framework. This should form the foundations of decision-making for projects implemented at BIM level 2. The gap identified in this paper is that the current digital toolkit does not incorporate the intelligent characteristics available in other industries through advancements in technology and collation of vast amounts of data that a digital plan of work framework could have access to and begin to develop, learn and adapt for decision-making through the live interaction of project stakeholders.

ELPA (European Leaf Physiognomic Approach): Grid data set of the leaf physiognomic composition of the extant European hardwood vegetation

Physiognomic traits of plant leaves such as size, shape or margin are decisively affected by the prevailing environmental conditions of the plant habitat. On the other hand, if a relationship between environment and leaf physiognomy can be shown to exist, vegetation represents a proxy for environmental conditions. This study investigates the relationship between physiognomic traits of leaves from European hardwood vegetation and environmental parameters in order to create a calibration dataset based on high resolution grid cell data. The leaf data are obtained from synthetic chorologic floras, the environmental data comprise climatic and ecologic data. The high resolution of the data allows for a detailed analysis of the spatial dependencies between the investigated parameters. The comparison of environmental parameters and leaf physiognomic characters reveals a clear correlation between temperature related parameters (e.g. mean annual temperature or ground frost frequency) and the expression of leaf characters (e.g. the type of leaf margin or the base of the lamina). Precipitation related parameters (e.g. mean annual precipitation), however, show no correlation with the leaf physiognomic composition of the vegetation. On the basis of these results, transfer functions for several environmental parameters are calculated from the leaf physiognomic composition of the extant vegetation. In a next step, a cluster analysis is applied to the dataset in order to identify "leaf physiognomic communities". Several of these are distinguished, characterised and subsequently used for vegetation classification. Concerning the leaf physiognomic diversity there are precise differences between each of these "leaf physiognomic classes". There is a clear increase of leaf physiognomic diversity with increasing variability of the environmental parameters: Northern vegetation types are characterised by a more or less homogeneous leaf physiognomic composition whereas southern vegetation types like the Mediterranean vegetation show a considerable higher leaf physiognomic diversity. Finally, the transfer functions are used to estimate palaeo-environmental parameters of three fossil European leaf assemblages from Late Oligocene and Middle Miocene. The results are compared with results obtained from other palaeo-environmental reconstructing methods. The estimates based on a direct linear ordination seem to be the most realistic ones, as they are highly consistent with the Coexistence Approach.

Vegetation of Asuncion : a volcanic Northern Mariana Island /

Includes bibliographical references (p. 11).

System des real-katalogs der Universitäts-biblothek Heidelberg,

Mode of access: Internet.

Riparian community type classification of Utah and southeastern Idaho /

"R4-Ecol-85-01."

Riparian community type classification for Humboldt and Toiyabe National Forests, Nevada and eastern California /

"R4-Ecol-95-01."