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.

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.

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.

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.

[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.

Aliskiren Improved the Endothelial Repair Capacity of Endothelial Progenitor Cells from Patients with Hypertension via the Tie2/PI3k/Akt/eNOS Signalling Pathway.

BACKGROUND: Studies show that aliskiren exerts favourable effects not only on endothelial progenitor cells (EPCs) but also on endothelial function. However, the mechanism of the favourable effect of aliskiren on EPCs from patients with hypertension is unclear and remains to be further studied. METHODS: The object of this study was to investigate and assess the in vitro function of EPCs pretreated with aliskiren. After treated with aliskiren, the human EPCs were transplanted into a nude mouse model of carotid artery injury, and the in vivo reendothelialization of injured artery was estimated by staining denuded areas with Evans blue dye via tail vein injection. RESULTS: We found that aliskiren increased the in vitro migration, proliferation, and adhesion of EPCs from patients with hypertension in a dose-dependent manner and improved the reendothelialization capability of these EPCs. Furthermore, aliskiren increased the phosphorylation of Tie2, Akt, and eNOS. After the blockade of the Tie2 signalling pathway, the favourable effects of aliskiren on the in vitro function and in vivo reendothelialization capability of EPCs were suppressed. CONCLUSIONS: This study demonstrates that aliskiren can improve the in vitro function and in vivo reendothelialization capability of EPCs from patients with hypertension via the activation of the Tie2/PI3k/Akt/eNOS signalling pathway. These findings further indicate that aliskiren is an effective pharmacological treatment for cell-based repair in hypertension-related vascular injury.

Shear Stress Triggers Angiogenesis of Late Endothelial Progenitor Cells via the PTEN/Akt/GTPCH/BH4 Pathway.

BACKGROUND: Shear stress is an effective modulator of endothelial progenitor cells (EPCs) and has been suggested to play an important role in angiogenesis. The phosphatase and tensin homolog (PTEN)/Akt and guanosine triphosphate cyclohydrolase (GTPCH)/tetrahydrobiopterin (BH4) pathways regulate the function of early EPCs. However, the role of these pathways in the shear stress-induced angiogenesis of late EPCs remains poorly understood. Therefore, we aim to investigate whether shear stress could upregulate the angiogenesis capacity of late EPCs and to further explore the possible underlying mechanisms. METHODS: Late EPCs were subjected to laminar shear stress (LSS), and their in vitro migration, proliferation, and tube formation capacity were determined. In addition, the in vivo angiogenesis capacity was explored, along with the expression of molecules involved in the PTEN/Akt and GTPCH/BH4 pathways. RESULTS: LSS elevated the in vitro activities of late EPCs, which were accompanied by downregulated PTEN expression, accelerated Akt phosphorylation, and GTPCH/BH4 pathway activation (all P < 0.05). Following Akt inhibition, LSS-induced upregulated GTPCH expression, BH4, and NO level of EPCs were suppressed. LSS significantly improved the migration, proliferation, and tube formation ability (15 dyn/cm2 LSS vs. stationary: 72.2 ± 5.5 vs. 47.3 ± 7.3, 0.517 ± 0.05 vs. 0.367 ± 0.038, and 1.664 ± 0.315 vs. 1 ± 0, respectively; all P < 0.05) along with the in vivo angiogenesis capacity of late EPCs, contributing to the recovery of limb ischemia. These effects were also blocked by Akt inhibition or GTPCH knockdown (P < 0.05, respectively). CONCLUSIONS: This study provides the first evidence that shear stress triggers angiogenesis in late EPCs via the PTEN/Akt/GTPCH/BH4 pathway, providing a potential nonpharmacologic therapeutic strategy for promoting angiogenesis in ischemia-related diseases.

[Projected changes in vegetation net primary productivity of grassland in Inner Mongolia, China during 2011-2050.] / 21ä¸–çºªä¸ŠåŠå¶å† è’™å¤è‰åœ°æ¤è¢«å‡€åˆçº§ç”Ÿäº§åŠ›å˜åŒ–è¶‹åŠ¿.

In this paper, the CENTURY-based modeling system (complying CENTURY model from a site-based model into spatial model) after being systematically calibrated was used to investigate future climate change under Representative Concentration Pathways Scenario (RCP, 4.5 and 8.5) driven spatio-temporal changes in vegetation net primary productivity (NPP) of Inner Mongolia grassland during 2011-2050. The simulation showed that Inner Mongolia grassland NPP would greatly decrease with a rate of 0.57 g C·m-2·a-1 (RCP4.5) and 0.89 g C·m-2·a-1 (RCP8.5). NPP of Inner Mongolia grassland appeared to decrease by approximately 11.6% (2020s), 12.0% (2030s) and 18.0% (2040s) under the RCP4.5 in relation to baseline period, while its reduction could be exacerbated as 23.8% (2020s), 21.2% (2030s) and 30.1% (2040s) in the RCP8.5 at the regional scale. In addition, grassland NPP induced by future climate changes varied between different grassland types and times, strongly correlating with climate scenario. Even for the RCP4.5, however, a great majority (89.7%) of the grassland exhibited a decreasing trend in annual NPP, with 15.6% of the area decreasing by more than 20% compared with the baseline term. Therefore, although future precipitation rising could benefit vegetation growth, it might be still not enough to compensate for the negative effect of warming on the NPP of Inner Mongolia grassland, and the sustainable development of grassland resources might face a greater challenge.

[Spatiotemporal variation of water source supply service in Three Rivers Source Area of China based on InVEST model].

The Three Rivers Source Area is the largest ecological function region of water source supply and conservation in China. As affected by a variety of driving factors, the ecosystems in this region are seriously degraded, giving definite impacts on the water source supply service. This paper approached the variation patterns of precipitation and runoff coefficient from 1981 to 2010, quantitatively estimated the water source supply of the ecosystems in the region from 1980 to 2005 based on InVEST model, and analyzed the spatiotemporal variation pattern and its causes of the water source supply in different periods. In 1981-2010, the precipitation in the Three Rivers Source Area had a trend of increase after an initial decrease, while the precipitation runoff coefficient presented an obvious decreasing trend, suggesting a reduced capability of runoff water source supply of this region. The potential evapotranspiration had a declining trend, but not obvious, with a rate of -0.226 mm x a(-1). In 1980-2005, the water source supply of the region represented an overall decreasing trend, which was most obvious in the Yellow River Source Area. The spatiotemporal variation of the water source supply in the Three Rivers Source Area was the results of the combined effects of climate and land use change, and the climate factors affected the water source supply mainly through affecting the precipitation and potential evapotranspiration. Climate and land use change induced the ecosystem degradation and underlying surface change, which could be the main driving forces of the declined water source supply in the Three Rivers Source Area.

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.

[Variation trends of natural vegetation net primary productivity in China under climate change scenario].

Based on the widely used Lund-Potsdam-Jena Dynamic Global Vegetation Model (LPJ) for climate change study, and according to the features of natural environment in China, the operation mechanism of the model was adjusted, and the parameters were modified. With the modified LPJ model and taking 1961-1990 as baseline period, the responses of natural vegetation net primary productivity (NPP) in China to climate change in 1991-2080 were simulated under the Special Report on Emissions Scenarios (SRES) B2 scenario. In 1961-1990, the total NPP of natural vegetation in China was about 3.06 Pg C a(-1); in 1961-2080, the total NPP showed a fluctuant decreasing trend, with an accelerated decreasing rate. Under the condition of slight precipitation change, the increase of mean air temperature would have definite adverse impact on the NPP. Spatially, the NPP decreased from southeast coast to northwest inland, and this pattern would have less variation under climate change. In eastern China with higher NPP, especially in Northeast China, east of North China, and Loess Plateau, the NPP would mainly have a decreasing trend; while in western China with lower NPP, especially in the Tibetan Plateau and Tarim Basin, the NPP would be increased. With the intensive climate change, such a variation trend of NPP would be more obvious.

[Responses of Pinus koraiensis tree ring cell scale parameters to climate elements in Changbai Mountains].

Based on the tree ring samples of Pinus koraiensis collected from the low altitude areas of Changbai Mountains, seven standard chronologies for tree ring width and cell scale parameters were constructed. Parts of the chronologies were chosen for the correlation analysis with the climate elements in 1959-2007 at Donggang meteorological station, and the changes of the correlations between tree ring indices and climate elements before and after 1988 in which the climate changed abruptly were discussed. In the seven standard chronologies constructed, cell number had the best correlation with tree ring width. Both precipitation and air temperature were the limiting factors for the growth of P. koraiensis, but the chronologies had better correlation with precipitation than with air temperature, mainly manifested in the significant correlation between the chronologies and the precipitation in previous September and current May and June. Comparing with tree ring width, cell size could reveal more climatic information, mainly manifested in the positive correlation between the chronologies and the air temperature in March and the precipitation in May, and the negative correlation between the chronologies and the air temperature in May. After the abrupt change of air temperature in 1988, the responses of cell size to climate elements had some changes, mainly manifested in the decreasing sensitivity to monthly climate elements and the earlier response time.

[Spatial pattern of vegetation landscape diversity in longitudinal Range-Gorge Region, southwestern China].

Based on the China 1:1000000 vegetation type map, and by using GIS spatial analysis, the spatial pattern of major vegetation landscape diversity indices and its relationships with environmental factors in Longitudinal Range-Gorge Region (LRGR) were analyzed. The proper scale for studying the vegetation landscape diversity in LRGR was 2000 m. In the study region, an obvious regional difference was observed in the vegetation landscape diversity indices, exhibiting typical longitudinal "corridor" and latitudinal "barrier" characteristics. The correlations between the vegetation landscape diversity indices and environmental elements were significant, and the regional difference in the environmental elements was the main factor controlling the spatial pattern of vegetation landscape diversity indices. The "corridor-barrier" function of the longitudinal range-gorge terrain made a spatial redistribution of hydro-thermal conditions, being the main cause of the special pattern of the vegetation landscape diversity in LRGR.

[Spatial patterns of eco-climatic factors on Tibetan plateau].

Based on the 1966-2005 observation data from 113 meteorological stations on the Tibetan Plateau and its surrounding areas, the spatial patterns of mean temperature of warmest month (TWM), mean temperature of coldest month (TCM), duration of mean daily temperature > or = 10 degrees C (DT10), annual precipitation (AP), mean annual potential evapotranspiration (PE), and annual arid index (AI), on the Plateau were analyzed. It was shown that the TWM was 7-20 degrees C, which decreased from eastern surrounding area to the central region, while TCM was--18.4 degrees C to 8 degrees C, being decreased from south to north. The DT10 decreased from eastern surrounding area ( > 150 days) to central region (50 days), and the AP decreased from southeast to northwest. The PE calculated by Thornthwaite model decreased from southeast to northwest, and was 330-750 mm in most parts of the study area. Arid area occupied a larger proportion and mainly located in the northwest of Tibetan Plateau, while humid area was smaller and mainly located in the east and southeast of the Plateau. The vegetation distribution on Tibetan Plateau had good correlations with the test eco-climatic factors, suggesting that these factors could better characterize the vegetation patterns on Tibetan Plateau.

[Research advances in vulnerability assessment of natural ecosystem response to climate change].

Climate change with global warming as the sign has been caught great attention by the governments, international organizations, and scientists in the world. Human society and natural ecosystem are both exposed to climate change, and more and more people are waked up by its increasing harm. Vulnerability analysis and assessment are the key and basis for adapting and mitigating climate change, being the highlight in the research fields of climate change and ecology in recent years. The vulnerability assessment of climate change is being carried out in various research fields and on different scales, and much progress has been made. This paper introduced the concept of vulnerability, and summarized the research progress in vulnerability assessment of climate change, with the focus on the frame and methodology of vulnerability assessment of natural ecosystem response to climate change. The existed problems and future prospects in this research area were also discussed.