Analysis and Comparison of the Malignant Thyroid Nodules Not Recommended for Biopsy in ACR TIRADS and AI TIRADS With a Large Sample of Surgical Series.

OBJECTIVE: To determine if the artificial intelligence-based Thyroid Imaging, Reporting and Data System (AI TIRADS) would perform better than the American College of Radiology (ACR) TIRADS in monitoring malignant thyroid nodules not recommended for biopsy using follow-up thresholds. METHODS: A total of 3499 thyroid nodules with surgical histopathology and ultrasound features were retrospectively reviewed and categorized using ACR TIRADS and AI TIRADS. The recommendations for biopsy and follow-up divided nodules into three groups 1) fine needle aspiration (FNA), 2) follow-up ultrasound, and 3) no further evaluation. RESULTS: Of the total 1608 malignant nodules in this study, 974 malignant nodules would not be biopsied in ACR TIRADS compared with 967 in AI TIRADS. While 60.0% (584/974) of these non-biopsied malignancies could be followed-up by ultrasound in ACR TIRADS and 62.8% (607/967) in AI TIRADS. For the malignancies of no further evaluation, 97.4% (380/390) were sized <10 mm in ACR TIRADS and 93.3% (336/360) in AI TIRADS. Compared with ACR TIRADS, AI TIRADS had lower unnecessary FNA rate and missing cancer rate (41.0% vs 47.8% and 22.8% vs 27.5%, P < .05, respectively) while having higher specificity and AUC as well as lower sensitivity (65.0% vs 57.9%, 0.895 vs 0.881, and 96.1% vs 97.8%, all P < .05). CONCLUSIONS: Using the follow-up thresholds, more than half of the malignancies not being biopsied were monitored by ultrasound in both ACR TIRADS and AI TIRADS, and AI TIRADS had lower missing cancer rate. More than 90% of malignancies recommended for no further evaluation were <10 mm in diameter.

Relationship Between the Estimated Glomerular Filtration Rate and Visceral Fat Thickness Based on Ultrasound in Patients With Obesity Who Have Normal Renal Function Without Hypertension or Diabetes.

OBJECTIVES: To investigate the relationship between visceral fat thickness measured by US and the estimated glomerular filtration rate (GFR) in patients with obesity who did not have hypertension or diabetes and who had normal renal function. METHODS: Inclusion criteria included an estimated GFR of greater than 90 mL/min/1.73 m2 , blood pressure lower than 120/80 mm Hg, and a fasting blood glucose level of less than 126 mg/dL. Patients were divided into groups with (body mass index ≥28 kg/m2 ) and without (body mass index <28 kg/m2 ) obesity. Subcutaneous and visceral fat thicknesses were measured with ultrasound. RESULTS: A total of 95 patients were enrolled with an age range of 25 to 58 years. The patients were divided into groups with (n = 48) and without obesity (n = 47); patients with obesity were further divided into subcutaneous obesity (n = 23) and visceral obesity (n = 25) groups. The estimated GFR in the group with obesity was significantly lower than that in the group without obesity (P = .037), and the estimated GFR in the group with visceral obesity was significantly lower than that in the group with subcutaneous obesity (P = .006). Moreover, the estimated GFR was negatively correlated with visceral fat thickness (V1:r = -0.750;P7 < 0.001;V2:r = -0.824;P < 0.001) but not correlated with subcutaneous fat thickness. CONCLUSIONS: Ultrasound is an easy and accurate practical evaluation modality for measuring the thickness of fat. There was an inverse relationship between the estimated GFR and visceral fat thickness in patients with obesity who did not have hypertension or diabetes and who had normal renal function. This result suggests that as visceral fat increases, the estimated GFR may be reduced accordingly.

An economically efficient strategy for diagnosing atypia of undetermined significance or follicular lesion of undetermined significance thyroid nodules with ultrasound-based risk stratification systems and BRAFV600E testing.

Background: The management of thyroid nodules classified as atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) has been a subject of ongoing debate. Therefore, the aim of this study was to investigate a cost-effective approach for managing these nodules by combining BRAFV600E mutation analysis with the guidelines provided by the American Thyroid Association (ATA) or the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TIRADS). Methods: This study included 762 AUS/FLUS nodules in 551 patients with a postoperative pathology. A preoperative BRAFV600E gene test and an evaluation using the ATA guidelines and ACR-TIRADS were performed. Two combined diagnostic approaches were employed: In method 1, all nodules underwent BRAFV600E gene testing, and nodules testing positive for BRAFV600E or for risk stratification systems (RSSs) were diagnosed as malignant, while those with negative results in both tests were considered benign. In method 2 (modified combination method), nodules were reclassified into low-risk (category 2 and 3 in the ATA guidelines and ACR-TIRADS), medium-risk (category 4), and high-risk (category 5) groups based on the malignancy rate of the RSSs. BRAFV600E gene testing was applied only with the medium-risk group. Nodules with positive BRAFV600E mutation were upgraded to the high-risk group, while negative cases remained in the medium-risk group. Results: Both malignancy rates and positive BRAFV600E mutation rates increased with the increase in RSS category (P<0.001). The combination of ACR with BRAFV600E gene testing significantly improved the area under the curve (AUC) compared to the use of ACR or BRAFV600E alone (the AUCs for ACR combined with BRAFV600E, modified ACR combined with BRAFV600E, ACR alone, and BRAFV600E alone were 0.875, 0.878, 0.832, and 0.839, respectively; P<0.05 for both combinations vs. ACR or BRAFV600E alone). Similarly, ATA combined with BRAFV600E showed significant improvements in AUC compared to ATA alone (the AUCs for ATA combined with BRAFV600E, modified ATA combined with BRAFV600E, and ATA alone were 0.851, 0.846, 0.809, respectively; P<0.001 for both combination methods vs. ATA alone), but there was no significant difference observed compared to using BRAFV600E alone (P=0.450 and P=0.680 for both combination methods vs. BRAFV600E). Notably, the AUC of ACR combined with BRAFV600E was greater than that of ATA combined with BRAFV600E (P=0.047 and P=0.007 for both combination methods, respectively). There were no significant differences in diagnostic performance between the two combination approaches (P=0.428 for ACR combined with BRAFV600E and P=0.314 for ATA combined with BRAFV600E). Performing BRAFV600E gene testing only on the medium-risk groups (modified combination method) significantly reduced the rate of BRAFV600E gene testing (P<0.001) without increasing the false-negative rate (P=0.818 and P=0.394 for ACR and ATA, respectively). Conclusions: Incorporating the BRAFV600E gene test exclusively for nodules in the medium-risk group significantly improved diagnostic efficacy, reduced the utilization of gene tests, and maintained a consistent false-negative rate.

[Catalytic ozonation of nitrobenzene in water by acidification-activated red mud].

Red mud as one kind of aluminum industrial wastes was used as raw material for catalyst preparation. It was activated by acidification in order to enhance its catalytic activity in the system of catalytic ozonation. Furthermore, removal performance and reaction mechanism in degradation of organic pollutants were discussed. Results showed that acid modified red mud had more significant catalytic activity than the raw red mud. The removal efficiency of nitrobenzene by catalytic ozonation with acidified red mud (RM6.0) increased with the increasing ozone concentration. When the ozone concentration was increased from 0.4 mg x L(-1) to 1.7 mg x L(-1), the removal efficiency of nitrobenzene increased from 45% to 92%. There was a consistent effect of water pH on the removal efficiency and the ozone concentration variation. The variation of the removal efficiency depended on the initial water pH. This was because the concentration of OH(-) led to ozone decomposition to generate hydroxyl radicals. The higher water pH value led to the quenching of hydroxyl radicals, resulting in the reduction of catalytic activity of RM6.0. The experimental results of aqueous ozone concentration variation in the presence of RM6.0 and inhibition by hydroxyl radicals indicated that the main reaction mechanism was catalytic ozonation of NB. Firstly, aqueous ozone was absorbed onto the surface of RM6.0, and then the concentrated ozone oxidized NB in water which was with a combination of direct and indirect oxidation. In catalytic reaction, hydroxyl radicals were present, which were generated during the oxidation of NB on the surface of RM6.0.