Machine Learning Model for Predicting Axillary Lymph Node Metastasis in Clinically Node Positive Breast Cancer Based on Peritumoral Ultrasound Radiomics and SHAP Feature Analysis.

OBJECTIVE: This study seeks to construct a machine learning model that merges clinical characteristics with ultrasound radiomic analysis-encompassing both the intratumoral and peritumoral-to predict the status of axillary lymph nodes in patients with early-stage breast cancer. METHODS: The study employed retrospective methods, collecting clinical information, ultrasound data, and postoperative pathological results from 321 breast cancer patients (including 224 in the training group and 97 in the validation group). Through correlation analysis, univariate analysis, and Lasso regression analysis, independent risk factors related to axillary lymph node metastasis in breast cancer were identified from conventional ultrasound and immunohistochemical indicators, and a clinical feature model was constructed. Additionally, features were extracted from ultrasound images of the intratumoral and its 1-5 mm peritumoral to establish a radiomics feature formula. Furthermore, by combining clinical features and ultrasound radiomics features, six machine learning models (Logistic Regression, Decision Tree, Support Vector Machine, Extreme Gradient Boosting, Random Forest, and K-Nearest Neighbors) were compared for diagnostic efficacy, and constructing a joint prediction model based on the optimal ML algorithm. The use of Shapley Additive Explanations (SHAP) enhanced the visualization and interpretability of the model during the diagnostic process. RESULTS: Among the 321 breast cancer patients, 121 had axillary lymph node metastasis, and 200 did not. The clinical feature model had an AUC of 0.779 and 0.777 in the training and validation groups, respectively. Radiomics model analysis showed that the model including the Intratumor +3 mm peritumor area had the best diagnostic performance, with AUCs of 0.847 and 0.844 in the training and validation groups, respectively. The joint prediction model based on the XGBoost algorithm reached AUCs of 0.917 and 0.905 in the training and validation groups, respectively. SHAP analysis indicated that the Rad Score had the highest weight in the prediction model, playing a significant role in predicting axillary lymph node metastasis in breast cancer. CONCLUSION: The predictive model, which integrates clinical features and radiomic characteristics using the XGBoost algorithm, demonstrates significant diagnostic value for axillary lymph node metastasis in breast cancer. This model can provide significant references for preoperative surgical strategy selection and prognosis evaluation for breast cancer patients, helping to reduce postoperative complications and improve long-term survival rates. Additionally, the utilization of SHAP enhancing the global and local interpretability of the model.

Study on diagnosing thyroid nodules of ACR TI-RADS 4-5 with multimodal ultrasound radiomics technology.

BACKGROUND: Explore the feasibility of using the multimodal ultrasound (US) radiomics technology to diagnose American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 thyroid nodules. METHOD: This study prospectively collected the clinical characteristics, conventional, and US elastography images of 100 patients diagnosed with ACR TI-RADS 4-5 nodules from May 2022 to 2023. Independent risk factors for malignant thyroid nodules were extracted and screened using methods such as the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) model, and a multimodal US radiomics combined diagnostic model was established. Using a multifactorial LR analysis and a Rad-score rating, the predictive performance was validated and evaluated, and the final threshold range was determined to assess the clinical net benefit of the model. RESULTS: In the training set, the US radiomics combined predictive model area under curve (AUC = 0.928) had higher diagnostic performance compared with clinical characteristics (AUC = 0.779), conventional US (AUC = 0.794), and US elastography model (AUC = 0.852). In the validation set, the multimodal US radiomics combined diagnostic model (AUC = 0.829) also had higher diagnostic performance compared with clinical characteristics (AUC = 0.799), conventional US (AUC = 0.802), and US elastography model (AUC = 0.718). CONCLUSION: Multi-modal US radiomics technology can effectively diagnose thyroid nodules of ACR TI-RADS 4-5, and the combination of radiomics signature and conventional US features can further improve the diagnostic performance.

The value of contrast-enhanced ultrasound for the diagnosis of metastatic cervical lymph nodes of papillary thyroid carcinoma: A systematic review and meta-analysis.

To investigate the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) for the diagnosis of cervical lymph nodes metastasis (CLNM) of papillary thyroid carcinoma (PTC), eight available datasets of seven qualified articles before March 31, 2021 were included after a comprehensive search. Meta-analysis results showed that CEUS demonstrated acceptable diagnostic performance in the diagnosis of CLNM of PTC. Furthermore, meta-regression analysis was conducted to identify the reasons for heterogeneity and the results indicated that the criteria of CEUS for the diagnosis of CLNM in PTC need to be unified.

Diagnosis of Prostate Cancer in Patients with Prostate-Specific Antigen (PSA) in the Gray Area: Construction of 2 Predictive Models.

BACKGROUND Two diagnostic models of prostate cancer (PCa) and clinically significant prostate cancer (CS-PCa) were established using clinical data of among patients whose prostate-specific antigen (PSA) levels are in the gray area (4.0-10.0 ng/ml). MATERIAL AND METHODS Data from 181 patients whose PSA levels were in the gray area were retrospectively analyzed, and the following data were collected: age, digital rectal examination, total PSA, PSA density (PSAD), free/total PSA (f/t PSA), transrectal ultrasound, multiparametric magnetic resonance imaging (mpMRI), and pathological reports. Patients were diagnosed with benign prostatic hyperplasia (BPH) and PCa by pathology reports, and PCa patients were separated into non-clinically significant PCa (NCS-PCa) and CS-PCa by Gleason score. Afterward, predictor models constructed by above parameters were researched to diagnose PCa and CS-PCa, respectively. RESULTS According to the analysis of included clinical data, there were 109 patients with BPH, 44 patients with NCS-PCa, and 28 patients with CS-PCa. Regression analysis showed PCa was correlated with f/t PSA, PSAD, and mpMRI (P<0.01), and CS-PCa was correlated with PSAD and mpMRI (P<0.01). The area under the receiver operating characteristic curves of 2 models for PCa (sensitivity=73.64%, specificity=64.23%) and for CS-PCa (sensitivity=71.41%, specificity=81.82%) were 0.79 and 0.87, respectively. CONCLUSIONS The prediction models had satisfactory diagnostic value for PCa and CS-PCa among patients with PSA in the gray area, and use of these models may help reduce overdiagnosis.

Imported Schistosomiasis, China, 2010-2018.

China has made remarkable progress in reducing schistosomiasis caused by Schistosoma japonicum over the past 7 decades but now faces a severe threat from imported schistosomiasis. Results from national surveillance during 2010-2018 indicate integrating active surveillance into current surveillance models for imported cases is urgently needed to achieve schistosomiasis elimination in China.

Diagnostic Performance of Acoustic Radiation Force Impulse Elastography for the Differentiation of Benign and Malignant Superficial Lymph Nodes: A Meta-analysis.

To estimate the diagnostic performance of acoustic radiation force impulse elastography in distinguishing between benign and malignant superficial lymph nodes, relevant articles published before October 31, 2018, in China and other countries were used. Conclusively, a total of 18 articles were analyzed. Sixteen studies used Virtual Touch tissue quantification (Siemens Healthineers, Erlangen, Germany), and 4 studies used Virtual Touch tissue imaging (Siemens Healthineers). After a meta-analysis, it was found that acoustic radiation force impulse elastography is an efficient method for detecting superficial lymph nodes. In addition, if the cutoff value for the shear wave velocity were less than 2.85 m/s, the summary sensitivity would increase, and the heterogeneity would be reduced.

[Analysis of schistosomiasis prevalence in endemic areas using retrospective space-time permutation scan statistics].

Objective: To analyze the characteristics of schistosomasis prevalence by using the spatial epidemiological method, and test the application of retrospective space-time permutation scan statistics in determining mountainous and lake-type endemic areas of schistosomiasis. Methods: The data of schistosomasis in humans, cattle and snails in Jiangxi Province during 2009-2014 and in Yunnan Province during 2004-2013 were collected and analyzed. The temporal and spatial distribution of schistosomiasis endemic areas in the two provinces was analyzed with retrospective space-time permutation scan statistics. Results: The prevalence of schistosomiasis in residents and Oncomelania snails showed a trend of decline in Jiangxi, from 0.21% and 0.03% in 2009 to 0.01% and zero in 2014. A similar trend was found in cattle, from 1.25% in 2012 to 0.12% in 2014. The average annual percentage change (APC) in residents was-47.36%(P < 0.05). The space-time permutation clustering analysis revealed a temporal and spatial clustering of schistosomiasis prevalence from 2009 to 2014 in residents, cattle, and snails, with 3,2 and 1 clustering areas, respectively, all distributed in Poyang Lake Region. A similar declining trend of schistosomiasis prevalence was found in residents, snails and cattle in Yunnan during 2004-2013, from 2.49%,0.70% and 3.76% in 2004 to no infection in residents and snails and 0.02% in cattle in 2013. The APC in residents was-49.17%(P < 0.05). There was a temporal and spatial clustering of schistosomiasis prevalence during 2004-2013 in residents, cattle, and snails, with 2,2 and 6 clustering areas, respectively. Conclusion: A declining trend of schistosomiasis prevalence is shown in lake-type endemic areas in Jiangxi during 2009-2014 and in mountainous endemic areas in Yunnan during 2004-2013. The retrospective space-time permutation scan statistics reveal a clustering of schistosomiasis in humans, cattle, and snails, suggesting its applicability in analyzing the temporal and spatial distribution of schistosomiasis.

Comparison of the miracidium hatching test and modified Kato-Katz method for detecting Schistosoma japonicum in low prevalence areas of China.

The diagnosis of Schistosoma japonicum (Sj) infection in low prevalence areas of the People's Republic of China is challenging due to the sensitivity of the detection methods, leading to an underestimation of the disease burden. We compared the sensitivities of the miracidium hatching test (MHT) with the modified Kato-Katz method (KK) and the combination of the two methods (KK-MHT) to detect Sj infection in low prevalence areas of China. The stool samples of 3,853 residents from 8 villages with a light to moderate prevalence (0-23%) of Sj infection were examined by KK, MHT and KK-MHT. The findings were inconsistent. The KK-MHT conbination gave more positives than either the KK or MHT alone. Using the KK-MHT, we determined the missed rates with the KK (mR(K)) and MHT (mR(H)) to be 30.1% and 10.2%, respectively. At light prevalence sites (infection rate < 10%) the mR(K) was 60.6%, significantly higher than the mR(K) of 22.3% found at moderate prevalence sites (10-23%). However, the mR(H) at the light and moderate prevalence sites were 11.54% and 9.90%, respectively (p > 0.05). The combination KK-MHT had the best sensitivity in low Sj prevalence areas in China and the KK method alone was the least sensitive. Using KK alone as a screening method will result in an underestimation of Sj infection disease burden.

[Assessment on the effect of joint effort for schistosomiasis control in Hubei Province].

OBJECTIVE: To analyze the progress of implementation of integrated strategy with emphasis on the control of infectious sources and effectiveness for joint-project of schistosomiasis control in Hubei province. METHODS: Data on the endemic status and implementation of each integrated intervention in 6 collaborated counties including Gongan, Hanchuan, Honghu, Jiangling, Xiantao and Yangxin during 2009-2013 were collected and analyzed. 18 administrative villages with a history of endemic schistosomisis from 6 counties were selected for field survey. Individuals aged 6-65 years received screening test by IHA, and feces of antibody positive inhabitants were collected and tested by miracidia hatching technique. Hatching technique was conducted to determine the infection rate of schistosomiasis in cattle if there was any cattle existed. RESULTS: Various interventions were conducted with adaption to the local situation by the Departments of Agriculture, Water Conservancy, Forestry, and Health. The total number of cattle decreased from 75 388 at the beginning of 2009 to 1 805 at the end of 2013 in 6 counties with a reduction rate of 97.5%, while the prevalence in cattle reduced to 0-0.3% in 2013. Snail-infested areas were stable but areas with infected snails decreased significantly, and no infected snails were found in 2012-2013. Meanwhile, the infection rate of human beings on county level were less than 1%. No infected snails and cattle were found in 18 selected villages and the prevalence in inhabitants was in the range of 0-0.8%. CONCLUSION: Cooperation between provincial government and the Ministries of Health and Agruiculture accelerates the process to reach the criteria of transmission control of schistosomiasis in Hubei Province. However, sustainable effort in needed as the current endemic situation of schistosomiasis is stillunstable.

[Evaluation of the comprehensive schistosomiasis control measures with emphasis on infection source of replacing cattle with machine].

OBJECTIVE: To evaluate the effect of comprehensive measures with an emphasis on schistosomiasis infection source control by replacing cattle with machine. METHODS: In 2011, 2 villages from each of Jingzhou District, Jianli County and Jiangling County, Hubei Province, were selected as intervention group where the comprehensive measures were implemented, while 2 villages from Shishou City served as control with routine control activities. A cluster random sampling was carried out in the 8 villages with more than 300 people in each village were sampled. Stool examination using modified Kato-Katz was applied for identification of the infected persons and hatching test for cattle survey. The systemic sampling was applied for snail survey, fecal specimens from the field were examined by hatching test. Each sample was examined three times. Data were collected for the analysis of control effect between intervention and control groups in 2007 (baseline), 2009 (before implementation of comprehensive measures) and 2011 (post-intervention). RESULTS: In intervention villages, the overall prevalence in human reduced significantly from 3.6% (135/3 772) in 2007 and 2.0% (63/3 116) in 2009 to 0.9% (21/2 396) in 2011 (chi2 = 43.411, chi2 = 11.840, P < 0.05). Until 2011, there were no cattle in intervention group; the prevalence decreased by 52.6% in human and about 100% in cattle from 2010 to 2011. In control group, the infection rate in residents in 2007, 2009 and 2011 was 4.5% (64/1 410), 2.6% (34/1 294) and 1.8% (24/1,320), respectively (chi2 = 16.178, P < 0.05), and 5.1% (8/158) in 2007, 1.6% (3/187) in 2009 and 1.6% (3/189) in 2011 in cattle, respectively (chi2 = 3.387, P > 0.05). The infection rate in human and cattle fell by 25.0% and 5.9% from 2010 to 2011, respectively. There was a significant difference in human infection rate between the intervention and control groups after intervention (chi2 = 6.309, P < 0.05). No infected snails were detected in intervention and control groups. No positive feces from the field was found in the intervention group, 7.5% positive rate was recorded in the control. CONCLUSION: The comprehensive measures focused on infection source control by replacing cattle with machine can effectively control Schistosoma japonicum transmission, with a significant decrease of the prevalence in human and cattle.

[Surveilance and response for Schistosomiasis japonica based on sentinel mice examination for cercariae-infested water in risk region, 2012].

OBJECTIVE: To monitor water body infestation in schistosomiasis high-risk areas with sentinel mouse technique. METHODS: A total of 72 surveillance sites from 47 counties were selected in Hunan, Hubei, Jiangxi, Anhui, Jiangsu, Yunnan, and Sichuan. The water infectivity of Schistosoma japonicum was determined in the surveillance sites by using sentinel mice during June-July and September, 2012. RESULTS: Among the 3,283 sentinel mice which were placed in 72 sites, 3,062 (93.3%) were recovered and dissected. Infected sentinel mice were found in six sites accounting for 8.3% (6/72) of the total surveillance sites, with an occurrence rate of sites with infected mice of 8.3% in June-July and 2.8% in September. 33 infected mice were discovered with a total infection rate of 1.08% (33/3,062). 1,085 adult worms were collected, with a mean worm burden of 32.9 worms per mouse in infected sentinel mice. 4 positive sites were in Hunan and 2 were in Jiangxi. Local acute schistosomiasis or suspected local acute cases which detected elsewhere were reported in 2 positive sites. Some follow-up activities were conducted in the 6 positive sites. CONCLUSION: Compared with those in 2010, the schistosomiasis risk areas are shrinking in 2012. However, some regions are still the schistosomiasis high-risk areas.

Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis.

BACKGROUND: Data-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels. METHODS: The raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries. RESULTS: The performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity. CONCLUSIONS: The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.

Artificial intelligence in thyroid ultrasound.

Artificial intelligence (AI), particularly deep learning (DL) algorithms, has demonstrated remarkable progress in image-recognition tasks, enabling the automatic quantitative assessment of complex medical images with increased accuracy and efficiency. AI is widely used and is becoming increasingly popular in the field of ultrasound. The rising incidence of thyroid cancer and the workload of physicians have driven the need to utilize AI to efficiently process thyroid ultrasound images. Therefore, leveraging AI in thyroid cancer ultrasound screening and diagnosis cannot only help radiologists achieve more accurate and efficient imaging diagnosis but also reduce their workload. In this paper, we aim to present a comprehensive overview of the technical knowledge of AI with a focus on traditional machine learning (ML) algorithms and DL algorithms. We will also discuss their clinical applications in the ultrasound imaging of thyroid diseases, particularly in differentiating between benign and malignant nodules and predicting cervical lymph node metastasis in thyroid cancer. Finally, we will conclude that AI technology holds great promise for improving the accuracy of thyroid disease ultrasound diagnosis and discuss the potential prospects of AI in this field.

Diagnostic value of multiple diagnostic methods for lymph node metastases of papillary thyroid carcinoma: A systematic review and meta-analysis.

Objective: This study compared the diagnostic value of various diagnostic methods for lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) through network meta-analysis. Methods: In this experiment, databases such as CNKI, Wanfang, PubMed, and Web of Science were retrieved according to the Cochrane database, Prisma, and NMAP command manual. A meta-analysis was performed using STATA 15.0, and the value of the surface under the cumulative ranking curve (SUCRA) was used to determine the most effective diagnostic method. Quality assessments were performed using the Cochrane Collaboration's risk of bias tool, and publication bias was assessed using Deeks' funnel plot. Results: A total of 38 articles with a total of 6285 patients were included. A total of 12 diagnostic methods were used to study patients with LNM of PTC. The results showed that 12 studies were direct comparisons and 8 studies were indirect comparisons. According to the comprehensive analysis of the area of SUCRA, US+CT(86.8) had the highest sensitivity, FNAC had the highest specificity (92.4) and true positive predictive value (89.4), and FNAC+FNA-Tg had higher negative predictive value (99.4) and accuracy (86.8). In the non-invasive method, US+CT had the highest sensitivity, and the sensitivity (SEN) was [OR=0.59, 95% confidence interval (CI): (0.30, 0.89]. Among the invasive methods, the combined application of FNAC+FNA-Tg had higher diagnostic performance. The sensitivity was [OR=0.62, 95% CI: (0.26, 0.98)], the specificity (SPE) was [OR=1.12, 95% CI: (0.59, 1.64)], the positive predictive value was [OR=0.98, 95% CI: (0.59, 1.37)], the negative predictive value was [OR=0.64, 95% CI (0.38, 0.90)], and the accuracy was [OR=0.71, 95% CI: (0.31, 1.12)]. Conclusion: In the non-invasive method, the combined application of US+CT had good diagnostic performance, and in the invasive method, the combined application of FNAC+FNA-Tg had high diagnostic performance, and the above two methods were recommended.

[The effect and influencing factors of schistosomiasis control by forbidding livestock denaturing on marshland with Oncomelania snails].

OBJECTIVE: To evaluate the effect of schistosomiasis control by forbidding livestock denaturing on marshland with Oncomelania snails and to analyse its influencing factors. METHODS: The village of Aiguo, Xinhe, Huangjia, Fanrong, Fengfu and Caomen and its respective nearby marshland, i.e., Aiguoniu, Liulingwei, Huangjianiu, Da, Goulian, and Litouzui, in Jinxian county, Jiangxi province were selected as the pilot areas for implementing the measures of forbidding livestock denaturing on the marshlands with Oncomelania snails during the period of the year 2005 to 2007. A total of 300 residents in each village were randomly chosen for stool examination with the Kato-Katz technique every year. The snail survey was carried out in spring and autumn every year on the marshlands close to the villages with systemic sampling method. The marshlands with a height 16.5 m above the sea level in Futian was selected for snail survey and planting with sesame. The residents aged 20 - 50 years old in Fengfu and Aiguo villages were studied by using questionnaire on the compliance of forbidding livestock pasturing on marshlands with Oncomelania snails. RESULTS: Before implementation of the measures, human infection rate with Schistosoma japonicum was 11.35% (90/793) in Aiguo, 4.00% (12/300) in Xinhe, 4.00% (6/150) in Huangjia, 8.00% (12/150) in Fanrong, 3.17% (4/126) in Fengfu and 6.64% (14/211) in Caomen. After implementation in 2008, human schistsome infection rate in the aforementioned 6 villages was declined to 0.18% (1/551), 0.00% (0/348), 0.00% (0/316), 2.27% (7/308), 1.17% (5/428) and 1.16% (5/430), respectively. Only in Fengfu village the decline of the human prevalence was not significant (χ(2) = 2.4, P = 0.12), while in the other 5 villages, human prevalence rate had been declined significantly (χ(2) = 126.77, P < 0.01; χ(2) = 16.31, P < 0.01; χ(2) = 18.79, P < 0.01; χ(2) = 10.39, P < 0.01; χ(2) = 14.17, P < 0.01, respectively). Infected snails were not found in 5 out of the 6 marshlands close to the villages. Three infected snails were founded in Da marshland because of poor environmental isolation. Before planting, the living snail density was 0.063/0.11 m(2) (34/540), and after planting, the living snail density was 0.0074/0.11 m(2) (4/538), a 88.25% reduction (Z = 12.47, P < 0.01) was recorded through economy crop planting at Futiandaan marshland in 2008. A total of 986 pieces of questionnaire were provided, and 968 valid ones were collected. The results of questionnaire indicate that compliance of forbidding livestock denaturing on marshland with Oncomelania snails in Aiguo and Fengfu villages was 84.38% (216/256) and 75.42% (537/712), respectively. Using logistic regression model, knowledge level on harmfulness of livestock denaturing on marshland with Oncomelania snails, willingness of culture with machine to substitute traditional cattle culture, and willingness of investment to marshland culture development are 3 varieties that affect residents' implementation of forbidding livestock denaturing on marshland with Oncomelania snails. CONCLUSION: The infected snail density and human schistosome infection rate were reduced on the marshlands of well environmental isolation after 2 - 3 years implementation of forbidding livestock denaturing on marshlands with Oncomelania snails. The key influencing factors of forbidding livestock denaturing on marshland with Oncomelania snails are knowledge level on harmfulness of livestock denaturing on the snail infested marshlands, the willingness of machine culture to substitute cattle culture, and the willingness of investment to marshland culture development.

Surveillance on schistosomiasis in five provincial-level administrative divisions of the People's Republic of China in the post-elimination era.

BACKGROUND: The People's Republic of China (P. R. China) has made significant progress on schistosomiasis control. Among the 12 provincial-level administrative divisions (PLADs) with schistosomiasis endemic in P. R. China, Guangdong, Shanghai, Fujian, Guangxi and Zhejiang PLADs (following as five PLADs) had successively eliminated schistosomiasis during 1985-1995. However, consolidation of the schistosomiasis elimination in these five PLADs remains challenging. In the current study, we sought to understand the epidemic situation in these post-elimination areas and their surveillance capabilities on schistosomiasis. METHODS: Annual data reflecting the interventions and surveillance on human beings, cattle and snails based on county level from 2005 to 2016 were collected through the national schistosomiasis reporting system and the data were analyzed to understand the epidemic status of schistosomiasis in the five PLADs. A standardized score sheet was designed to assess the surveillance capacity for schistosomiasis of selected disease control agencies in five PLADs and ten counties. Assessment on surveillance capacity including schistosomiasis diagnostic skills, identification of snails' living and infection status and knowledge about schistosomiasis and its control were made. Descriptive analysis was used to analyze the epidemic status and evaluation results on surveillance capacities. RESULTS: The assessments showed that no local cases in humans and cattle or infected snail were found in these five PLADs since 2005. However, from 2005 to 2016, a total of 221 imported cases were detected in Zhejiang, Shanghai and Fujian, and 11.98 hm2 of new snail habitats were found in Zhejiang, Shanghai and Guangxi. In addition, snail infestation reoccurred in 247.55 hm2 of former snail habitats since 2011. For the surveillance capacity assessment, the accuracy rate of IHA and MHT were 100 and 89.3%, respectively. All participants could judge the living status of snails accurately and 98.1% on the infection status of snails. The accuracy rate of the questionnaire survey was 98.0%. CONCLUSIONS: Elimination of schistosomiasis was consolidated successfully in five PLADs of P. R. China due to effective and strong post-elimination surveillance. Comprehensive consolidation strategies should be focused on the elimination of residual snails and the prevention of imported infection sources to consolidate the achievements of schistosomiasis control.

Interobserver agreement for contrast-enhanced ultrasound of liver imaging reporting and data system: A systematic review and meta-analysis.

BACKGROUND: Hepatocellular carcinoma is the most common primary liver malignancy. From the results of previous studies, Liver Imaging Reporting and Data System (LI-RADS) on contrast-enhanced ultrasound (CEUS) has shown satisfactory diagnostic value. However, a unified conclusion on the interobserver stability of this innovative ultrasound imaging has not been determined. The present meta-analysis examined the interobserver agreement of CEUS LI-RADS to provide some reference for subsequent related research. AIM: To evaluate the interobserver agreement of LI-RADS on CEUS and analyze the sources of heterogeneity between studies. METHODS: Relevant papers on the subject of interobserver agreement on CEUS LI-RADS published before March 1, 2020 in China and other countries were analyzed. The studies were filtered, and the diagnostic criteria were evaluated. The selected references were analyzed using the "meta" and "metafor" packages of R software version 3.6.2. RESULTS: Eight studies were ultimately included in the present analysis. Meta-analysis results revealed that the summary Kappa value of included studies was 0.76 [95% confidence interval, 0.67-0.83], which shows substantial agreement. Higgins I 2 statistics also confirmed the substantial heterogeneity (I 2 = 91.30%, 95% confidence interval, 85.3%-94.9%, P < 0.01). Meta-regression identified the variables, including the method of patient enrollment, method of consistency testing, and patient race, which explained the substantial study heterogeneity. CONCLUSION: CEUS LI-RADS demonstrated overall substantial interobserver agreement, but heterogeneous results between studies were also obvious. Further clinical investigations should consider a modified recommendation about the experimental design.

The value of S-Detect for the differential diagnosis of breast masses on ultrasound: a systematic review and pooled meta-analysis.

AIM: To evaluate the value of S-Detect (a computer aided diagnosis system using deep learning) in breast ultrasound (US) for discriminating benign and malignant breast masses. MATERIAL AND METHODS: A literature search was performed and relevant studies using S-Detect for the differential diagnosis of breast masses were selected. The quality of included studies was assessed using a Quality Assessment of Diagnostic Accuracy Studies (QUADAS) questionnaire. Two review authors independently searched the articles and assessed the eligibility of the reports. RESULTS: A total of ten studies were included in the meta-analysis. The pooled estimates of sensitivity and specificity were 0.82 (95%CI: 0.77-0.87) and 0.86 (95%CI: 0.76-0.92), respectively. In addition, the diagnostic odds ratios, positive likelihood ratio and negative likelihood ratio were 28 (95%CI: 16- 49), 5.7 (95%CI: 3.4-9.5), and 0.21 (95%CI: 0.16-0.27), respectively. Area under the curve was 0.89 (95%CI: 0.86-0.92). No significant publication bias was observed. CONCLUSIONS: S-Detect exhibited a favourable diagnostic value in assisting physicians discriminating benign and malignant breast masses and it can be considered as a useful complement for conventional US.

Construction and application of surveillance and response systems for parasitic diseases in China, led by NIPD-CTDR.

Parasitic diseases have been widely epidemic in China with a long history. Great endeavours made in past 70 years led to significant decrease in morbidity and mortablity caused by several major parasitic diseases, while challenges existed to eliminate parasitic diseases. Surveillance-response system has play a crucial role in identifying public health problems, ascertaining the distribution and epidemic dynamics, discovering outbreaks and epidemic anomalies, evaluating the effects of on-site intervention activities and identifying risk factors. In this article, we reviewed the progress of the surveillance system for parasitic diseases, analysed the role of NIPD in the construction and application of surveillance-response system of parasitic diseases through elaborating the surveillance activities and typical surveillance-response events led by NIPD. Suggestion and comments for improve the surveillance-response system were put forward for further control or elimination of parasitic diseases.

Contributions and achievements on schistosomiasis control and elimination in China by NIPD-CTDR.

Being a zoonotic parasitic disease, schistosomiasis was widely spread in 12 provinces of Southern China in the 1950s, severly harming human health and hindering economic development. The National Institute of Parasitic Diseases at the Chinese Center for Diseases Control and Prevention, and Chinese Center for Tropical Diseases Research (NIPD-CTDR), as the only professional institution focussing on parasitic diseases at the national level, has played an important role in schistosomiasis control in the country. In this article, we look back at the changes of schistosomiasis endemicity and the contribution of NIPD-CTDR to the national schistosomiasis control programme. We review NIPD-CTDR's activities, including field investigations, design of control strategies and measures, development of diagnostics and drugs, surveillance-response of endemic situation, and monitoring & evaluation of the programme. The NIPD-CTDR has mastered the transmission status of schistosomiasis, mapped the snail distribution, and explored strategies and measures suitable for different types of endemic areas in China. With a good understanding of the life cycle of Schistosoma japonicum and transmission patterns of the disease, advanced research carried out in the NIPD-CTDR based on genomics and modern technology has made it possible to explore highly efficient and soft therapeutic drugs and molluscicides, making it possible to develop new diagnostic tools and produce vaccine candidates. In the field, epidemiological studies, updated strategies and targeted intervention measures developed by scientists from the NIPD-CTDR have contributed significantly to the national schistosomiasis control programme. This all adds up to a strong foundation for eliminating schistosomiasis in China in the near future, and recommendations have been put forward how to reach this goal.