Diagnostic efficacy of the contrast-enhanced ultrasound thyroid imaging reporting and data system classification for benign and malignant thyroid nodules.

Background: The contrasted-enhanced ultrasound thyroid imaging reporting and data system (CEUS TI-RADS) is the first international risk stratification system for thyroid nodules based on conventional ultrasound (US) and CEUS. This study aimed to evaluate the diagnostic efficacy of CEUS TI-RADS for benign and malignant thyroid nodules and to assess the related interobserver agreement. Methods: The study recruited 433 patients who underwent thyroid US and CEUS between January 2019 and June 2023 at the Affiliated Hospital of Guangdong Medical University. A retrospective analysis of 467 thyroid nodules confirmed by fine-needle aspiration (FNA) and/or surgery was performed. Further, a CEUS TI-RADS classification was assigned to each thyroid nodule based on the CEUS TI-RADS scoring criteria for the US and CEUS features of the nodule. The nodules were grouped based on their sizes as follows: size ≤1 cm, group A; size >1 and ≤4 cm, group B; and size >4 cm, group C. Multivariate logistic regression was used to analyze independent risk factors for malignant thyroid nodules. Pathological assessment was the reference standard for establishing the sensitivity (SEN), specificity (SPE), accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) of CEUS TI-RADS in diagnosing malignant thyroid nodules. The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of the scoring system in predicting malignancy in three groups of nodules. The intragroup correlation coefficient (ICC) was adopted to assess the interobserver agreement of the CEUS TI-RADS score. Results: Out of the 467 thyroid nodules, 262 were malignant and 205 were benign. Logistic regression analysis revealed that the independent risk factors for malignant thyroid nodules included punctate echogenic foci (P<0.001), taller-than-wide shape (P=0.015), extrathyroidal invasion (P=0.020), irregular margins/lobulation (P=0.036), hypoechoicity on US (P=0.038), and hypoenhancement on CEUS (P<0.001). The AUC for the CEUS TI-RADS in diagnosing malignant thyroid nodules was 0.898 for all nodules, 0.795 for group A, 0.949 for group B, and 0.801 for group C, with the optimal cutoff values of the CEUS TI-RADS being 5 points, 6 points, 5 points, and 5 points, respectively. Among these groups of nodules, group B had the highest AUC, with the SEN, SPE, ACC, PPV, and NPV for diagnosing malignant nodules being 95.9%, 88.1%, 92.8%, 92.6%, and 93.2%, respectively. The ICC of the CEUS TI-RADS classification between senior and junior physicians was 0.862 (P<0.001). Conclusions: In summary, CEUS TI-RADS demonstrated significant efficacy in distinguishing thyroid nodules. Nonetheless, there were variations in its capacity to detect malignant nodules across diverse sizes, and it demonstrate optimal performance in 1- to 4-cm nodules. These findings may serve as important insights for clinical diagnoses.

[Spatial and Temporal Distribution Characteristics of Ozone Concentration and Population Health Benefit Assessment in the Yangtze River Delta Region from 2017 to 2020].

In recent years, the ozone (O3) concentration has showed a rising trend in China, becoming second only to PM2.5 as an important factor affecting air quality. To grasp the spatial-temporal variations characteristics of O3 and the associated health impacts during the implementation of the three-year plan on defending the blue sky in the Yangtze River Delta (YRD) region, data collected from 210 monitoring stations in the YRD from 2017 to 2020 were analyzed using the global Moran's index and Getis-Ord Gi* index methods, and the associated health benefits of reduced O3 exposure were evaluated using the health risk and environmental value assessment methods. The results showed that during the study period, the interquartile range (IQR) of the annual average O3 concentration and that of the warm season both presented a declining trend. The average O3 concentrations in both warm and cold seasons showed a similar spatial distribution pattern, with the northern part exhibiting the higher concentrations and the southern part showing the lower concentrations. Furthermore, the O3 concentrations in the warm season were characterized by high O3 concentrations clustering in the northern and central part of the region. The proportion of the population exposure to annual average O3 concentration over 160 µg·m-3 decreased from 72.3% in 2017 to 34.8% in 2020 in the YRD. Although the population-weighted annual mean O3 concentration in the whole YRD region showed a downward trend, some cities in western Anhui province, northern Jiangsu province, and central Jiangsu province showed fluctuations and even an increasing trend. In terms of health benefits, there were 3782 cases (95% CI:2050-5511 cases) of avoided premature deaths associated with reduced O3 concentrations in the warm season in 2020 compared to 2017. The total health benefit was 26198 million yuan (95% CI:14201-38175 million yuan). Compared to the cost of the main O3 precursor emission reduction, the cost-benefits ratio was 1:1.67 to 3.23.

The discriminatory diagnostic value of multimodal ultrasound combined with blood cell analysis for granulomatous lobular mastitis and invasive ductal carcinoma of the breast.

OBJECTIVE: To explore the discriminatory diagnostic value of multimodal ultrasound(US) combined with blood cell analysis(BCA) for Granulomatous Lobular Mastitis (GLM) and Invasive Ductal Carcinoma(IDC) of the breast. METHODS: A total of 157 breast disease patients were collected and divided into two groups based on postoperative pathological results: the GLM group(57 cases with 57 lesions) and the IDC group(100 cases with 100 lesions). Differences in multimodal ultrasound features and the presence of BCA were compared between the two groups. The receiver operating characteristic(ROC) curve was used to calculate the optimal cutoff values, sensitivity, specificity, 95% confidence interval(CI), and the area under the curve(AUC) for patient age, lesion size, lesion resistive index(RI), and white blood cell(WBC) count in BCA. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and AUC were calculated for different diagnostic methods. RESULTS: There were statistically significant differences(P <  0.05) observed between GLM and IDC patients in terms of age, breast pain, the factors in Conventional US(lesion size, RI, nipple delineation, solitary/multiple lesions, margin, liquefaction area, growth direction, microcalcifications, posterior echogenicity and abnormal axillary lymph nodes), the factors in CEUS(contrast agent enhancement intensity, enhancement pattern, enhancement range, and crab-like enhancement) and the factors in BCA(white blood cells, neutrophils, lymphocytes and monocytes). ROC curve analysis results showed that the optimal cutoff values for distinguishing GLM from IDC were 40.5 years for age, 7.15 cm for lesion size, 0.655 for lesion RI, and 10.525*109/L for white blood cells. The diagnostic accuracy of conventional US combined with CEUS(US-CEUS) was the highest(97.45%). The diagnostic performance AUCs for US-CEUS, CEUS, and US were 0.965, 0.921 and 0.832, respectively. CONCLUSION: Multifactorial analysis of multimodal ultrasound features and BCA had high clinical application value in the differential diagnosis of GLM and IDC.

[Characteristics of Nitroaromatic Compounds in PM2.5 in Urban Area of Shanghai].

Nitroaromatic compounds (NACs) are an important class of nitrogen-containing compounds in fine particles. The investigation of characteristics and seasonal variation of NACs in PM2.5 increases our knowledge about nitrogen-containing compounds and contributes to the scientific basis in formulating reduction policies of NOx in urban areas. In this study, we analyzed the chemical composition of PM2.5 samples collected from March 2018 to February 2019 in an urban location in Shanghai. A total of 2439-3695 organic molecular formulas were detected using UPLC-Orbitrap MS. Nine NACs were quantified using an internal standard method. In spring, ρ(NACs) ranged from 3.12 to 16.76 ng·m-3, and the average concentration was 9.31 ng·m-3. In summer, it ranged from 1.05 to 9.70 ng·m-3, and the average value was 4.16 ng·m-3. In autumn, it ranged from 2.87 to 36.27 ng·m-3, and its average was 9.84 ng·m-3. In winter, it ranged from 4.83 to 56.23 ng·m-3, and the average was 22.37 ng·m-3. 4-Nitrophenol accounted for more than 25% of the quantified NACs in different seasons. In summer, the concentration of 5-nitrosalicylic acid accounted for 36%, but it decreased to 19% in winter. NACs in summer mainly originated from secondary formation, as evidenced by their clear correlation with the oxidant level, whereas biomass burning became the main source of NACs in winter.

[Health Benefit Analyses of the Clean Air Action Plan Implementation in Shanghai].

To understand the public health benefits of the Clean Air Action Plan implemented in Shanghai from 2013-2017, the changes of the PM2.5 exposure levels and related health and economic benefits were quantitatively evaluated by using air quality numerical modeling, health risk assessment, and environmental valuation methods. The results show that the proportion of the population exposed to a mean annual PM2.5 concentration lower than or equal to 35 µg·m-3 has increased from 1.62% in the base year to 34.06% in the control year. The death risk attributable to ambient PM2.5 exposure decreased from 15.2% in the base year to 11.9% in the control year. The total health benefits are approximately 11.841 billion RMB(95% CI:5.024-17.819 billion RMB), accounting for 0.55%(95% CI:0.23%-0.82%)of Shanghai's GDP in 2013. The implementation of the action plan has a positive effect on the protection of the health of the population. Health benefits in areas with dense populations and high PM2.5 declines are more pronounced within the outer ring line of Shanghai City.

[Exposure Levels, Sources, and Health Risks of Heavy Metal Components of PM2.5 in Housewives in Rural Shanghai].

To investigate exposure characteristics and potential health risk of PM2.5-bound heavy metals in housewives in rural areas, 265 personal exposure samples from 143 subjects were collected in the Songjiang district, Shanghai from February 2017 to June 2018. Mass concentrations of 13 elements in PM2.5 were determined by energy-dispersive X-ray fluorescence spectrometry (ED-XRF). The sources of heavy metal components in PM2.5 were analyzed using positive matrix factorization (PMF). The inhalation health risks of exposure to Ni, V, Cr, Mn, As, and Pb were analyzed using the US EPA health risk assessment model. The results showed that the average concentration of personal exposure to PM2.5 was 40.61 µg·m-3 in housewives, which was higher than the concentration at peripheral monitoring stations. The carcinogenic risks of Cr(Ⅵ)and As exceeded the acceptable risk level (10-6). The non-carcinogenic risks of V, Cr(Ⅵ), Mn, Ni, and As were all below the safety threshold, while the total non-carcinogenic risks of these five elements were higher than the safety threshold (>1). The results of PMF indicated that resuspended dust and indoor dust(43.8%), the metallurgy industry(34.6%), coal combustion(14.5%), and fossil-fuel combustion(7.2%)were the major sources of ten elements (Al, Ti, V, Cr, Mn, Fe, Ni, Zn, As, and Pb) in PM2.5. Based on the results of health risk assessment of pollution sources, control measures on the metallurgy industry and fossil-fuel combustion should be further strengthened.

Acoustic radiation force impulse elastography of breast imaging reporting and data system category 4 breast lesions.

INTRODUCTION: This population-based study on early breast cancer detection in women aimed to evaluate acoustic radiation force impulse elastography to differentiate BI-RADS (Breast Imaging Reporting and Data System) category 4 lesions. METHODS: Acoustic radiation force impulse was performed on 95 patients with 122 BI-RADS 4 breast lesions diagnosed by conventional ultrasound. We calculated the area ratio of lesions by using virtual touch tissue imaging and gray-scale imaging. By using virtual touch tissue quantification, we calculated the ratio of shear wave velocity (SWV) in lesions and in surrounding glandular tissue at the same depth (SWV ratio). RESULTS: The mean area ratio of benign lesions (1.09 ± 0.17) differed from that of the malignant lesions (1.96 ± 0.64; P < .001). The mean SWV ratio of benign lesions (2.44 ± 1.27) was lower than that of malignant lesions (5.74 ± 1.68; P < .001). The cutoff for the area and SWV ratios for malignancy were estimated to be 1.37 and 3.65, respectively. CONCLUSIONS: Acoustic radiation force impulse provides quantitative elasticity measurements, which, combined with conventional ultrasound, can potentially improve the diagnostic accuracy of BI-RADS 4 breast lesions, and it is helpful to regulate the BI-RADS classification and avoid the need for unnecessary biopsies.