Collaborative Enhancement of Consistency and Accuracy in US Diagnosis of Thyroid Nodules Using Large Language Models.

Background Large language models (LLMs) hold substantial promise for medical imaging interpretation. However, there is a lack of studies on their feasibility in handling reasoning questions associated with medical diagnosis. Purpose To investigate the viability of leveraging three publicly available LLMs to enhance consistency and diagnostic accuracy in medical imaging based on standardized reporting, with pathology as the reference standard. Materials and Methods US images of thyroid nodules with pathologic results were retrospectively collected from a tertiary referral hospital between July 2022 and December 2022 and used to evaluate malignancy diagnoses generated by three LLMs-OpenAI's ChatGPT 3.5, ChatGPT 4.0, and Google's Bard. Inter- and intra-LLM agreement of diagnosis were evaluated. Then, diagnostic performance, including accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC), was evaluated and compared for the LLMs and three interactive approaches: human reader combined with LLMs, image-to-text model combined with LLMs, and an end-to-end convolutional neural network model. Results A total of 1161 US images of thyroid nodules (498 benign, 663 malignant) from 725 patients (mean age, 42.2 years ± 14.1 [SD]; 516 women) were evaluated. ChatGPT 4.0 and Bard displayed substantial to almost perfect intra-LLM agreement (κ range, 0.65-0.86 [95% CI: 0.64, 0.86]), while ChatGPT 3.5 showed fair to substantial agreement (κ range, 0.36-0.68 [95% CI: 0.36, 0.68]). ChatGPT 4.0 had an accuracy of 78%-86% (95% CI: 76%, 88%) and sensitivity of 86%-95% (95% CI: 83%, 96%), compared with 74%-86% (95% CI: 71%, 88%) and 74%-91% (95% CI: 71%, 93%), respectively, for Bard. Moreover, with ChatGPT 4.0, the image-to-text-LLM strategy exhibited an AUC (0.83 [95% CI: 0.80, 0.85]) and accuracy (84% [95% CI: 82%, 86%]) comparable to those of the human-LLM interaction strategy with two senior readers and one junior reader and exceeding those of the human-LLM interaction strategy with one junior reader. Conclusion LLMs, particularly integrated with image-to-text approaches, show potential in enhancing diagnostic medical imaging. ChatGPT 4.0 was optimal for consistency and diagnostic accuracy when compared with Bard and ChatGPT 3.5. © RSNA, 2024 Supplemental material is available for this article.

Simulating the effects of optimizing sowing date and variety shift on maize production at finer scale in northeast China under future climate.

BACKGROUND: Global warming and the rising occurrences of climate extremes have become formidable challenges for maize production in northeast China. The optimization of sowing date and variety choice stand out as two economic approaches for maize to enhance its resilience to climate change. Nevertheless, assessment of the potential of optimizing sowing date and variety shift on maize yield at finer scale remains underexamined. This study investigated the implications of optimizing sowing date and implementing variety shift on maize yield from a regional perspective. RESULTS: Compared to the reference period (1986-2005), climate change would decrease by 11.5-34.6% (the range describes the differences among climate scenarios and agro-ecological regions) maize yield in the 2050s (2040-2059) if no adaption measure were to be implemented. The combined adaption (optimizing sowing date and variety shift) can improve maize yield by 38.8 ± 11.3%, 42.7 ± 9.7% and 33.9 ± 7.6% under the SSP1-2.6, SSP2-4.5 and SSP5-8.5 scenarios, respectively. The current sowing window typically falls within the projected optimal sowing window, defined as the period capable of achieving 90% of the maximum yield within the potential sowing window under future climate conditions. Consequently, the potential of the effect of optimizing sowing window on maize yield is limited. In contrast, variety shift results in higher yield improvement, as temperature rise creates favorable conditions for transplanting varieties with an extended growth period, particularly in high latitudes and mountainous regions. Under future climate, cumulative precipitation and compound drought and hot days during maize growing seasons are two key factors influencing maize production. CONCLUSIONS: The optimization of sowing date and variety choice can improve maize yield in northeast China. In addition, maize production should consider varieties with longer growth period and drought and heat tolerance to adapt to climate change. © 2023 Society of Chemical Industry.

US LI-RADS in surveillance for recurrent hepatocellular carcinoma after curative treatment.

OBJECTIVES: To investigate the performance of US LI-RADS in surveillance for recurrent hepatocellular carcinoma (RHCC) after curative treatment. MATERIALS AND METHODS: This study enrolled 644 patients between January 2018 and August 2018 as a derivation cohort, and 397 patients from September 2018 to December 2018 as a validation cohort. The US surveillance after HCC curative treatment was performed. The US LI-RADS observation categories and visualization scores were analyzed. Four criteria using US LI-RADS or Alpha-fetoprotein (AFP) as the surveillance algorithm were evaluated. The sensitivity, specificity, and negative predictive value (NPV) were calculated. RESULTS: A total of 212 (32.9%) patients in derivation cohort and 158 (39.8%) patients in validation cohort were detected to have RHCCs. The criterion of US-2/3 or AFP ≥ 20 µg/L had higher sensitivity (derivation, 96.7% vs 92.9% vs 81.1% vs 90.6%; validation, 96.2% vs 90.5% vs 80.4% vs 89.9%) and NPV (derivation, 95.7% vs 93.3% vs 88.0% vs 91.8%; validation, 94.6% vs 89.4% vs 83.6% vs 89.0%), but lower specificity (derivation, 35.9% vs 48.2% vs 67.6% vs 51.9%; validation, 43.5% vs 52.7% vs 66.1% vs 54.0%) than criterion of US-2/3, US-3, and US-3 or AFP ≥ 20 µg/L. Analysis of the visualization score subgroups confirmed that the sensitivity (89.2-97.6% vs 81.0-83.3%) and NPV(88.4-98.0% vs 80.0-83.3%) of score A and score B groups were higher than score C group in criterion of US-2/3 in both two cohorts. CONCLUSIONS: In the surveillance for RHCC, US LI-RADS with AFP had a high sensitivity and NPV when US-2/3 or AFP ≥ 20 µg/L was considered a criterion. CLINICAL RELEVANCE STATEMENT: The criterion of US-2/3 or AFP ≥ 20 µg/L improves sensitivity and NPV for RHCC surveillance, which provides a valuable reference for patients in RHCC surveillance after curative treatment. KEY POINTS: • US LI-RADS with AFP had high sensitivity and NPV in surveillance for RHCC when considering US-2/3 or AFP ≥ 20 µg/L as a criterion. • After US with AFP surveillance, patients with US-2/3 or AFP ≥ 20 µg/L should perform enhanced imaging for confirmative diagnosis. Patients with US-1 or AFP < 20 µg/L continue to repeat US with AFP surveillance. • Patients with risk factors for poor visualization scores limited the sensitivity of US surveillance in RHCC.

Quantitative flood disaster loss-resilience with the multilevel hybrid evaluation model.

The severity of global flood disasters is growing, causing loss of human life and property. Building a high-resilience social system, an important means of sustainable flood control, can address these flood-related issues. Numerous studies have carried out disaster resilience evaluations and explored the correlation between flood disaster loss and intensity, but neglected to analyze the role of resilience construction in disaster loss reduction. This study proposed a research route for linking flood loss and disaster loss to quantify the relationship between the two. Take Guangdong Province, China as a study case, the mixed-effects (ME) model and multilevel hybrid evaluation model (MHEM) were established to assess disaster loss and resilience of cities, respectively. Subsequently, disaster resilience curves were built to quantitatively evaluate disaster resilience and corresponding disaster loss. The results show that (1) the ME model can concurrently build the disaster intensity-loss curves of multiple cities with high fitting accuracy. The MHEM combines multiple methods to determine the evaluation result with the highest consistency, showing high reliability. (2) The central and southern regions of Guangdong Province have low disaster loss and high resilience, while the northern regions have high disaster loss and low resilience. (3) With the improvement of disaster resistance, the reduction in disaster loss gradually decreases. Disaster loss in low-resilience cities exhibits greater randomness than that in high-resilience cities, and increasing their resilience can more significantly reduce their level of loss. This study provides a quantitative basis and available methods for comprehensive responses to natural disasters and adaptation to global climate change.

A comprehensive meta-analysis of the impacts of intensified drought and elevated CO2 on forage growth.

Forage crops are used worldwide as key feed sources for dairy systems. However, their productivity and quality are limited due to intensified drought events, elevated carbon dioxide (CO2), and their interaction with climate change, with consequences for the security of animal husbandry and the agricultural economy. Although studies have quantified the impacts of such stresses on forage growth, these impacts have been less systematically investigated in a global context due to differences among various forage groups, regional microclimates, and environmental factors. Herein we employed nine forage growth-related variables involving three perspectives, i.e., photosynthetic parameters, production, and quality, from research articles published between 1990 and 2021 via a meta-analysis. A linear mixed-effect model was then used to explore the quantitative relationship between these factors in a restricted dataset. Decreasing trends in all four photosynthetic parameters were detected across different eco-geographical regions with increasing drought stress. The maximum decrease in DMY occurred in the Mediterranean, with 52.8% under drought conditions. Globally, eCO2 significantly increased photosynthetic rate (Pn) and instantaneous water use efficiency (WUEi) by 40.8% and 62.1%, respectively, which also had positive effects on forage dry matter yield (DMY) (+25.1%), especially for forage in Northern Europe. However, this stress would significantly decrease forage quality by decreasing crude protein (CP) (-19.7%) and nitrogen content (N content) (-13.5%). These negative impacts would be aggravated under the co-occurrence of drought and eCO2, including a significant increase in WUEi (+111.1%) and a decrease in DMY (-12.3%). Gramineae showed a more sensitive response to drought stress in photosynthetic parameters and DMY than Leguminosae, but the latter exhibited a better response in photosynthetic parameters and production under eCO2. Our analysis provides a consensus concerning how the growth parameters of forage have changed under environmental stresses.

RCAN1 deficiency aggravates sepsis-induced cardiac remodeling and dysfunction by accelerating mitochondrial pathological fission.

OBJECTIVE: Cardiac dysfunction and remodeling are serious complications of sepsis and are the main causes of death in sepsis. RCAN1 is a feedback regulator of cardiac hypertrophy. Here, we aim to investigate the role of RCAN1 in septic cardiomyopathy. METHODS: Mice were randomly divided into control-WT, control-RCAN1-/-, LPS-induced WT and LPS-induced RCAN1-/- groups, some with Midiv-1 or KN93 treatment. The protein levels of RCAN1, p-ERK1/2, NFAT3, Drp1, p-Drp1, p-CaMKII in mouse hearts or cultured cardiomyocytes were determined by Western blotting. Myocardial function was assessed by echocardiography. Cardiac hypertrophy and fibrosis were detected by H&E and Masson's trichrome staining. Mitochondrial morphology was examined by transmission electron microscope. Serum level of LDH was detected by ELISA. RESULTS: Our data show that RCAN1 was downregulated in septic mouse heart and LPS-induced cardiomyocytes. RCAN1-/- mice showed a severe impairment of cardiac function, and increased myocardial hypertrophy and fibrosis. The protein levels of NFAT3 and p-ERK1/2 were significantly increased in the heart tissues of RCAN1-/- mice. Further, RCAN1 deficiency aggravated sepsis-induced cardiac mitochondrial injury as indicated by increased ROS production, pathological fission and the loss of mitochondrial membrane potential. Inhibition of fission with Mdivi-1 reversed LPS-induced cardiac hypertrophy, fibrosis and dysfunction in RCAN1-/- mice. Moreover, RCAN1 depletion promoted mitochondrial translocation of CaMKII, which enhanced fission and septic hypertrophy, while inhibition of CaMKII with KN93 reduced excessive fission, improved LPS-mediated cardiac remodeling and dysfunction in RCAN1-/- mice. CONCLUSIONS: Our finding demonstrated that RCAN1 deficiency aggravated mitochondrial injury and septic cardiomyopathy through activating CaMKII. RCAN1 serves as a novel therapeutic target for treatment of sepsis-related cardiac remodeling and dysfunction.

Climatic determinants impacting the distribution of greenness in China: regional differentiation and spatial variability.

This study investigated climatic determinants for regional greenness in China and spatially variable correlations between climatic determinants and vegetation in specific regions using the geographical detector and geographically weighted regression (GWR) methodologies. The analyses were based on normalized difference vegetation index (NDVI) and interpolations of climatic determinants from 652 Chinese meteorological stations. The study period (1982-2013) was divided into two stages (T1-T2) before and after the inflection year identified by the accumulative anomaly of NDVI. Three typical regions (R1-R3) were then selected according to the same NDVI variation trend as China in the two periods. Precipitation was the dominant climatic factor of NDVI in China, and the effect of temperature on greenness increased with warming from T1 to T2. In a relatively arid region (R1), the effect of precipitation in T2 was further strengthened compared to T1. Meanwhile, the effect of minimum temperature in T2 also increased compared with T1 in a relatively humid region (R2), becoming the major climatic determinant. In addition to the regional differentiation, spatial variability was investigated by comparing normalized coefficients of GWR for climatic determinants; this showed significant spatial heterogeneity within each region. Temperature impact areas also existed within precipitation-dominated regions (R1 and R3), where areas of precipitation impact expanded from T1 to T2. Furthermore, regression coefficients between NDVI dynamics and climate variability revealed relationships between regional differentiation and spatial variability. For example, the increasing precipitation rate could mediate the adverse impacts on greenness caused by the higher warming rate in relatively arid regions (R1).

Spatial-temporal variations in the thermal growing degree-days and season under climate warming in China during 1960-2011.

Vegetation growth and phenology are largely regulated by base temperature (Tb) and thermal accumulation. Hence, the growing degree-days (GDD) and growing season (GS) calculated based on Tb have primary effects on terrestrial ecosystems, and could be changed by the significant warming during the last century. By choosing 0, 5, and 10 °C, three key Tb for vegetation growth, the GDD and GS in China during 1960-2011 were developed based on 536 meteorological stations with homogenized daily mean temperatures. Results show that both the GDD and GS showed positive sensitivity to the annual mean temperature. The start of the growing season (SOS) has advanced by 4.86-6.71 days, and the end of the growing season (EOS) has been delayed by 4.32-6.19 days, lengthening the GS by 10.76-11.02 days in China as a whole during 1960-2011, depending on the Tb chosen. Consistently, the GDD has totally increased 218.92-339.40 °C days during the 52 years, with trends more pronounced in those based on a lower Tb. The GDD increase was significant (Mann-Kendall test, p < 0.01) over China except for the north of Southwest China, while the significant GS extension only scattered over China. Whereas the extensions of GS0 and GS5 were dominated by the advance in SOS, the GS10 extension was closely linked to the delay in EOS. Regionally, the GS extension in the eastern monsoon zone and northwest arid/semi-arid zone was driven by the advance in SOS and delay in EOS, respectively. Moreover, each variation has a substantial acceleration mostly in 1987 or 1996, and a speed reduction or even a trend reversal in the early 2000s. Changes in the thermal growing degree-days and season are expected to have great implications for biological phenology, agricultural production, and terrestrial carbon cycle in the future.

Nonlinear variations of forest leaf area index over China during 1982-2010 based on EEMD method.

Variations in leaf area index (LAI) are critical to research on forest ecosystem structure and function, especially carbon and water cycle, and their responses to climate change. Using the ensemble empirical mode decomposition (EEMD) method and global inventory modeling and mapping studies (GIMMS) LAI3g dataset from 1982 to 2010, we analyzed the nonlinear feature and spatial difference of forest LAI variability over China for the past 29 years in this paper. Results indicated that the national-averaged forest LAI was characterized by quasi-3- and quasi-7-year oscillations, which generally exhibited a rising trend with an increasing rate. When compared with 1982, forest LAI change by 2010 was more evident than that by 1990 and 2000. The largest increment of forest LAI occurred in Central and South China, while along the southeastern coastal areas LAI increased at the fastest pace. During the study period, forest LAI experienced from decrease to increase or vice versa across much of China and varied monotonically for only a few areas. Focusing on regional-averaged trend processes, almost all eco-geographical regions showed continuously increasing trends in forest LAI with different magnitudes and speeds, other than tropical humid region and temperate humid/subhumid region, where LAI decreased initially and increased afterwards.

Recombinant human thrombopoietin in alleviating endothelial cell injury in sepsis.

Background: To evaluate the effect of recombinant human thrombopoietin (rhTPO) on clinical prognosis by exploring changes in endothelial cell injury markers and inflammatory factors in patients with sepsis after treatment with rhTPO. Methods: This retrospective observational study involved patients with sepsis (diagnosed according to Sepsis 3.0) admitted to Shanghai General Hospital intensive care unit from January 1, 2019 to December 31, 2022. Patients were divided into two groups (control and rhTPO) according to whether they received rhTPO. Baseline information, clinical data, prognosis, and survival status of the patients, as well as inflammatory factors and immune function indicators were collected. The main monitoring indicators were endothelial cell-specific molecule (ESM-1), human heparin-binding protein (HBP), and CD31; secondary monitoring indicators were interleukin (IL)-6, tumor necrosis factor (TNF)-α, extravascular lung water index, platelet, antithrombin III, fibrinogen, and international normalized ratio. We used intraperitoneal injection of lipopolysaccharide (LPS) to establish a mouse model of sepsis. Mice were randomly divided into four groups: normal saline, LPS, LPS + rhTPO, and LPS + rhTPO + LY294002. Plasma indicators in mice were measured by enzyme-linked immunosorbent assay. Results: A total of 84 patients were included in the study. After 7 days of treatment, ESM-1 decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=38.6 [interquartile range, IQR: 7.2 to 67.8] pg/mL vs. median=23.0 [IQR: -15.7 to 51.5] pg/mL, P=0.008). HBP and CD31 also decreased significantly in the rhTPO group compared with the control group (median=59.6 [IQR: -1.9 to 91.9] pg/mL vs. median=2.4 [IQR: -23.2 to 43.2] pg/mL; median=2.4 [IQR: 0.4 to 3.5] pg/mL vs. median=-0.6 [IQR: -2.2 to 0.8] pg/mL, P <0.001). Inflammatory markers IL-6 and TNF-α decreased more significantly in the rhTPO group than in the control group compared with day 1 (median=46.0 [IQR: 15.8 to 99.1] pg/mL vs. median=31.2 [IQR: 19.7 to 171.0] pg/mL, P <0.001; median=17.2 [IQR: 6.4 to 23.2] pg/mL vs. median=0.0 [IQR: 0.0 to 13.8] pg/mL, P=0.010). LPS + rhTPO-treated mice showed significantly lower vascular von Willebrand factor (P=0.003), vascular endothelial growth factor (P=0.002), IL-6 (P <0.001), and TNF-α (P <0.001) than mice in the LPS group. Endothelial cell damage factors vascular von Willebrand factor (P=0.012), vascular endothelial growth factor (P=0.001), IL-6 (P <0.001), and TNF-α (P=0.001) were significantly elevated by inhibiting the PI3K/Akt pathway. Conclusion: rhTPO alleviates endothelial injury and inflammatory indices in sepsis, and may regulate septic endothelial cell injury through the PI3K/Akt pathway.

Increased stress from compound drought and heat events on vegetation.

Compound drought and heat events (CDHEs), which are frequently occurring compound extreme climate events, have garnered considerable attention because of their detrimental effects on ecosystems. However, the intricacies of the spatial and temporal distributions of different durations of compound events, along with the variability in vegetation responses remain unclear. Here, we delineated the CDHEs based on meteorological observation data and investigated the spatial and temporal characteristics of CDHEs from 1993 to 2020 using the Theil-Sen trend test and Mann-Kendall nonparametric test. Furthermore, we utilized sliding correlation analysis to evaluate the impacts of CDHEs on vegetation among different climatic regions and ecosystems. Our findings indicate significant increasing trends in both the frequency and persistence of CDHEs from 1993 to 2020. The average trend of CDHEs frequency across different duration periods amounted to 13.80 %/decade. The fractional contribution of CDHEs lasting more than three days exhibited a significant increase, with an average trend of 2.00 %/decade. We also observed that vegetation is most significantly affected by compound events lasting 5-9 days. During the study period, the geographical extent of vegetation significantly impacted by CDHEs expanded by 0.89 %, correlation strength increased by 0.02, and lag time decreased by 0.25 months. These insights highlight the growing impact of CDHEs on vegetation under climate change, improving our understanding of vegetation responses to these compound events.

Comprehensive pharmacological and experimental study of Ginsenoside Re as a potential therapeutic agent for non-alcoholic fatty liver disease.

OBJECTIVE: Ginsenoside Re, a unique tetracyclic triterpenoid compound found in ginseng, has been suggested in previous reports to improve non-alcoholic fatty liver disease (NAFLD) by modulating lipid imbalance. This study aims to elucidate the potential mechanisms of Ginsenoside Re in treating NAFLD through a combination of bioinformatics analysis and biological experiments. METHODS: Network pharmacology methods were employed to systematically depict the effective components and mechanisms of Ginsenoside Re in improving NAFLD. Molecular docking was utilized to evaluate the binding affinity of Ginsenoside Re with NAFLD-related targets and identify potential targets. NAFLD-related target genes were obtained from the GEO database for gene enrichment analysis, revealing signaling pathways, biological processes, and gene differential expression. Finally, animal experiments were conducted to verify the mechanism of action of Ginsenoside Re in NAFLD. RESULTS: Network pharmacology analysis revealed that Ginsenoside Re improves NAFLD by modulating targets such as AKT1 and TLR4, findings corroborated by molecular docking, GEO database analysis, and experimental validation. Further investigation found that Ginsenoside Re ameliorates lipid metabolism disorders and inflammatory responses induced by NAFLD by modulating the PI3K/AKT and TLR4/NF-κB signaling pathways. CONCLUSION: Our study demonstrates the pharmacological effects of Ginsenoside Re in treating NAFLD, implicating multiple components, targets, and pathways. This provides a solid foundation for considering Ginsenoside Re as an alternative therapy for NAFLD, with promising clinical applications.

Refined revealing the chain path of multiple ecosystem services under diverse environmental factor gradients.

A fragile karst ecosystem presents ecosystem services affected by the environment and interactions between ecosystem services. However, the ecosystem in the karst area is characterized by low environmental capacity and low resistance to force disturbance. Current research mainly focuses on the trade-off/synergy of ecosystem services in the karst area yet it lacks inductive analysis of the multiple chain path among ecosystem services. This paper quantitatively identified dominant factors influencing spatial differentiation of surface runoff, soil moisture, sediment yield, and net primary productivity (NPP) and determined the chain path. The chain paths of surface runoff-soil moisture-NPP and NPP-surface runoff-sediment yield were analyzed. The results showed that land use and soil type were the dominant factors, and chain effects of ecosystem services were diverse under the various dominant factor gradients. The mediation effects of paddy soil (97.21 %) and mountain meadow soil (55.56 %) were high, and surface runoff had a greater impact on NPP by affecting soil moisture. Among the diverse land use types, the mediation effect of surface runoff on NPP affecting sediment yield varied greatly (from 5 to 100 %). In addition, its variation trend was consistent with that of the soil moisture as the mediation variable. The mediation effect of surface runoff on construction land was the highest (99.43 %). This study provides the scientific basis for selecting more effective water and soil conservation measures by analyzing the chain relationships of multiple ecosystem services under different environmental factor gradients.

Complementary Role of CEUS and CT/MR LI-RADS for Diagnosis of Recurrent HCC.

PURPOSE: We retrospectively compared the diagnostic performance of contrast-enhanced ultrasonography (CEUS) and contrast-enhanced computer tomography-magnetic resonance imaging (CT/MRI) for recurrent hepatocellular carcinoma (HCC) after curative treatment. MATERIALS AND METHODS: After curative treatment with 421 ultrasound (US) detected lesions, 303 HCC patients underwent both CEUS and CT/MRI. Each lesion was assigned a Liver Imaging Reporting and Data System (LI-RADS) category according to CEUS and CT/MRI LI-RADS. Receiver-operating characteristic (ROC) curves were computed to determine the optimal diagnosis algorithms for CEUS, CT and MRI. The diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC) were compared between CEUS and CT/MRI. RESULTS: Among the 421 lesions, 218 were diagnosed as recurrent HCC, whereas 203 lesions were diagnosed as benign. In recurrent HCC, CEUS detected more arterial hyperenhancement (APHE) and washout than CT and more APHE than MRI. CEUS yielded better diagnostic performance than CT (AUC: 0.981 vs. 0.958) (p = 0.024) comparable diagnostic performance to MRI (AUC: 0.952 vs. 0.933) (p > 0.05) when using their optimal diagnostic criteria. CEUS missed 12 recurrent HCCs, CT missed one, and MRI missed none. The detection rate of recurrent HCC on CEUS (94.8%, 218/230) was lower than that on CT/MRI (99.6%, 259/260) (p = 0.001). Lesions located on the US blind spots and visualization score C would hinder the ability of CEUS to detect recurrent HCC. CONCLUSION: CEUS demonstrated excellent diagnostic performance but an inferior detection rate for recurrent HCC. CEUS and CT/MRI played a complementary role in the detection and characterization of recurrent HCC.

Integration of Artificial Intelligence Decision Aids to Reduce Workload and Enhance Efficiency in Thyroid Nodule Management.

Importance: To optimize the integration of artificial intelligence (AI) decision aids and reduce workload in thyroid nodule management, it is critical to incorporate personalized AI into the decision-making processes of radiologists with varying levels of expertise. Objective: To develop an optimized integration of AI decision aids for reducing radiologists' workload while maintaining diagnostic performance compared with traditional AI-assisted strategy. Design, Setting, and Participants: In this diagnostic study, a retrospective set of 1754 ultrasonographic images of 1048 patients with 1754 thyroid nodules from July 1, 2018, to July 31, 2019, was used to build an optimized strategy based on how 16 junior and senior radiologists incorporated AI-assisted diagnosis results with different image features. In the prospective set of this diagnostic study, 300 ultrasonographic images of 268 patients with 300 thyroid nodules from May 1 to December 31, 2021, were used to compare the optimized strategy with the traditional all-AI strategy in terms of diagnostic performance and workload reduction. Data analyses were completed in September 2022. Main Outcomes and Measures: The retrospective set of images was used to develop an optimized integration of AI decision aids for junior and senior radiologists based on the selection of AI-assisted significant or nonsignificant features. In the prospective set of images, the diagnostic performance, time-based cost, and assisted diagnosis were compared between the optimized strategy and the traditional all-AI strategy. Results: The retrospective set included 1754 ultrasonographic images from 1048 patients (mean [SD] age, 42.1 [13.2] years; 749 women [71.5%]) with 1754 thyroid nodules (mean [SD] size, 16.4 [10.6] mm); 748 nodules (42.6%) were benign, and 1006 (57.4%) were malignant. The prospective set included 300 ultrasonographic images from 268 patients (mean [SD] age, 41.7 [14.1] years; 194 women [72.4%]) with 300 thyroid nodules (mean [SD] size, 17.2 [6.8] mm); 125 nodules (41.7%) were benign, and 175 (58.3%) were malignant. For junior radiologists, the ultrasonographic features that were not improved by AI assistance included cystic or almost completely cystic nodules, anechoic nodules, spongiform nodules, and nodules smaller than 5 mm, whereas for senior radiologists the features that were not improved by AI assistance were cystic or almost completely cystic nodules, anechoic nodules, spongiform nodules, very hypoechoic nodules, nodules taller than wide, lobulated or irregular nodules, and extrathyroidal extension. Compared with the traditional all-AI strategy, the optimized strategy was associated with increased mean task completion times for junior radiologists (reader 11, from 15.2 seconds [95% CI, 13.2-17.2 seconds] to 19.4 seconds [95% CI, 15.6-23.3 seconds]; reader 12, from 12.7 seconds [95% CI, 11.4-13.9 seconds] to 15.6 seconds [95% CI, 13.6-17.7 seconds]), but shorter times for senior radiologists (reader 14, from 19.4 seconds [95% CI, 18.1-20.7 seconds] to 16.8 seconds [95% CI, 15.3-18.3 seconds]; reader 16, from 12.5 seconds [95% CI, 12.1-12.9 seconds] to 10.0 seconds [95% CI, 9.5-10.5 seconds]). There was no significant difference in sensitivity (range, 91%-100%) or specificity (range, 94%-98%) between the 2 strategies for readers 11 to 16. Conclusions and Relevance: This diagnostic study suggests that an optimized AI strategy in thyroid nodule management may reduce diagnostic time-based costs without sacrificing diagnostic accuracy for senior radiologists, while the traditional all-AI strategy may still be more beneficial for junior radiologists.

Biopsy from the base and edge of gastric ulcer healing or complete healing may lead to detection of gastric cancer earlier: an 8 years endoscopic follow-up study.

BACKGROUND/AIMS: To assess the incidence of gastric cancer development in gastric benign ulcer patients and to evaluate the value of biopsy by taking specimens from both the base and edges of ulcers in contrast to the traditional biopsy which takes specimens from the edges of ulcers only. METHODOLOGY: An endoscopic followup of more than 1 year was conducted on 456 gastric ulcer patients in our hospital for a duration over 8 years. We collected clinical, endoscopic and pathological data and obtained at least 6 biopsies from both the edges and the bases of ulcers healing or complete healing, respectively and assessed H. pylori infection. RESULTS: Gastric cancers developed in 11 (2.41%) of 456 GU patients. In the experimental group, 3 cases that were diagnosed by histology showed adenocarcinoma with specimens taken from the ulcer bases and in the other 5 cases the specimens were taken from the ulcer edges. The detection rate of gastric cancer from gastric ulcer between experimental group and control group was statistically significant (4.57% vs. 1.07%, p<0.05). CONCLUSIONS: Gastric ulcer may develop into gastric cancer over a certain period of time in patients infected with H. pylori. Biopsies from ulcer bases and edges at the second or subsequent endoscopies may lead to defection of gastric cancer earlier and more effectively than the biopsies which take specimens from the edges of ulcers only.

Spatial Distribution of Soil Heavy Metals and Associated Environmental Risks near Major Roads in Southern Tibet, China.

Soil heavy metal pollution is becoming an increasingly serious environmental problem. This study was performed to investigate the contents of surface soil heavy metals (Cu, Zn, Pb, Cd) near six roads in the southern part of the Tibetan Plateau. Multivariate statistics, geoaccumulation index, potential ecological risk, and a human health assessment model were used to study the spatial pollution pattern and identify the main pollutants and regions of concern. The mean Igeo was ranked in the order Cd > Cu > Zn > Pb, with the average concentrations of Cd, Zn, and Cu exceeding their corresponding background levels 4.36-, 1.00-, and 1.8-fold, respectively. Soil Cd level was classified as posing a considerable potential risk near national highways and a high potential risk near non-national highways, whereas soil Cu, Zn, and Pb were associated with a low potential ecological risk for each class of roads. Furthermore, the non-carcinogenic risk due to soil heavy metals for each class of roads was within the acceptable risk level for three exposure pathways for both adults and children, but the carcinogenic risk attributable to soil Pb exceeded the threshold for children near highways G318, G562, and G219 and for adults near highway G318. Our work not only underscores the importance of assessing potential threats to ecological and human health due to soil heavy metal pollution on road surfaces but also provides quantitative guidance for remediation actions.

Clinical Value of Neutrophil CD64 Index, PCT, and CRP in Acute Pancreatitis Complicated with Abdominal Infection.

Objective: To study the clinical diagnostic value of neutrophil CD64 index, PCT, and CRP in patients with acute pancreatitis with abdominal infection. Methods: A number of patients with acute pancreatitis (n = 234) participated in the study. According to the infection and health conditions, they were further divided into the non-infection group (n = 122), infection group (n = 78), and sepsis group (n = 34), and 40 healthy subjects were selected in the control group (n = 40). Expression levels of infection indexes, such as CD64 index, PCT, and CRP, were detected and compared. ROC curves were drawn to compare the efficacy of each index in the diagnosis of acute pancreatitis with abdominal infection and sepsis. The study was retrospectively registered under the China Clinical Trial Registry as a trial number ChiCTR2100054308. Results: All indexes were significantly higher in three clinical groups than the healthy control group (p < 0.05). The CD64 index, CD64 positive rate, and PCT in the infected group were significantly higher than those in the uninfected group (ALL p < 0.05). The PCT of patients infected with Gram-negative bacteria was significantly higher than that of Gram-positive bacteria-infected patients (p < 0.05). CD64 index had the best diagnostic efficiency for acute pancreatitis infection, with 82.14% sensitivity, 88.51% specificity, and 0.707 Youden indexes. The CD64 Youden index (0.780) for sepsis diagnosis was the highest, while the AUC of PCT was the highest (0.897). Conclusion: CD64 index combined with PCT has good sensitivity and specificity in diagnosing acute pancreatitis infection and sepsis.

[Comparison of apical root resorption of maxillary incisors between adolescents and adults after orthodontic treatment].

PURPOSE: To compare apical root resorption of maxillary incisors between adolescents and adults after orthodontic treatment. METHODS: Patients receiving orthodontic treatment in Affiliated Hospital of Chifeng University from May 2014 to August 2016 were enrolled, and divided into two age groups: adolescent group (32) and adult group (36). The included subjects received orthodontic fixed appliance treatment with straight-wire technique combined with Hawley type retainer for one year. After treatment, all patients were followed up for one year. Then the apical root resorption of maxillary incisors was evaluated by cone-beam CT (CBCT) at 4 time points, including pre-treatment (T1), end of treatment (T2), 6 months after treatment (T3), and 12 months after treatment (T4). Data were processed by SPSS 20.0 software package. RESULTS: The external root volume of maxillary central incisor, lateral incisors, mandibular central incisors and mandibular lateral incisors of both sides at T2-T4 was significantly lower than that at T1(P<0.05). There was partial increase in root volume of both groups at T3 and T4, while no significant difference from that at T2 (P>0.05). △root volume T3-T2 and △root volume T4-T3 had no significant difference between the two groups (P>0.05). △root volume T3-T2 in the adolescent group was significantly smaller than that in the adult group (P<0.05). Correlation analysis showed that the △root volumeT1-T2 was significantly positively correlated with age (P<0.05), meanwhile △root volume T3-T2 and △root volume T4-T3 were negatively correlated with age (P<0.05). CONCLUSIONS: Age is an important factor affecting the volume of root after orthodontic treatment. Adolescent patients with Class II division 1 malocclusion have a strong ability of self-healing after orthodontic treatment.

Identification of key industries of industrial sector with energy-related CO2 emissions and analysis of their potential for energy conservation and emission reduction in Xinjiang, China.

As the world's largest greenhouse gas emitter, China bears an arduous task of energy conservation (EC) and emission reduction (ER). CO2 arising from energy consumption during industrial processes makes up the vast majority of greenhouse gas emissions in China. It is the key for the Chinese government to achieve its goal of emission reduction in 2030 by identifying key industries with CO2 emissions and probing into their potential for EC&ER. We used Xinjiang Province of China as a research area. Next, we proposed a method for identifying key industries with CO2 emissions in Xinjiang's industrial sector and analyzed their energy consumption and CO2 emission characteristics. Finally, the average energy efficiency index of national industries was used to explore the potential for EC&ER of key industries. Results indicated that (1) the CO2 emissions in industrial sector were 463.35 million tons in 2016, making up 90.72% of its total CO2 emissions from energy consumption, considerably higher than the global and national averages; (2) In 2016, the 8 key industries with energy-related CO2 emissions determined in this study are all heavy industries whose energy consumption and CO2 emissions were 119.65 million tce (tons carbon equivalent) and 445.36 million tons respectively, taken up 62.51% and 87.2% of the total amount in Xinjiang. These 8 key industries play a critical role in realizing EC&ER in Xinjiang; (3) In 2016, the eight key industries had the potential to save 74.65 million tce, accounted for 45.79% of the total EC. Their potential for ER were 272.07 million tons of CO2, equal to 53.27% of the total CO2 emissions. On this basis, it is recommended that the local government exploit the potential of key industries for EC&ER by improving their energy efficiency.