<strong>Introduction:</strong> To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS<sup><s...<strong>Introduction:</strong> To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS<sup><span style="white-space:nowrap;">®</span></sup> and Bethesda<sup><span style="white-space:nowrap;">®</span></sup>. <strong>Materials and Methods:</strong> A prospective multicentric study in 10 radiological hospitals and institutions of Latin America was performed and 818 thyroid nodules were analyzed by ultrasound and classified by using both ACR TIRADS<sup><span style="white-space:nowrap;">®</span></sup> and Alpha Score;fine-needle aspiration biopsy was performed when needed and classified with Bethesda. The relationships between predictors were analyzed by using binary logistic regression, statistical significance was defined by a p-value of 0.05, with an error margin of 4% and 95% confidence intervals. <strong>Results:</strong> Alpha Score 2.0 establishes five types of malignant predictors: microcalcifications, irregular borders, taller-than-wide shape, predominant solid texture and hypoechogenicity;a diameter equal to or greater than 1.5 cm adds an extra point to the final score. Resulting classification divides TNs into 4 categories: benign (1.9%), low suspicion (8.7%), mild suspicion (13.6%) and high suspicion (75.7%) of malignancy probability;sensitivity of 82%, specificity of 74%, the positive predictive value of 94%, the negative predictive value of 51%, the statistical accuracy of 81%, odds ratio of 108.89 and correlation with ACR TIRADS of 0.77 and Bethesda of 0.91.<strong> Conclusions: </strong>Alpha Score 2.0 has superior diagnostic accuracy and performance compared to the previously published Alpha Score and is able to classify a benign TN in a precise, safe and accurate way, avoiding unnecessary FNABs or determining the necessity of FNAB in cases of moderate to high suspicion of malignancy.展开更多
Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine need...Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of ≥10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 ±1.87 vs. 3.74 ±1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.展开更多
The Tibetan Plateau(TP),known as the“Third Pole of Earth”,and its ecosystem is quite sensitive to climate change(Yao et al.,2012;Qiu,2008).In recent decades,the main TP has experienced warming and humidification(alt...The Tibetan Plateau(TP),known as the“Third Pole of Earth”,and its ecosystem is quite sensitive to climate change(Yao et al.,2012;Qiu,2008).In recent decades,the main TP has experienced warming and humidification(although there has been a drying trend in the southern region),and researchers anticipate that this change will continue in the future(Jiang et al.,2023;Sun et al.,2020;Chen et al.,2015).展开更多
The advent of artificial intelligence(AI)in recent years has brought about transformative changes across various sectors,including healthcare.In nursing practice,education,and research,AI has the potential to revoluti...The advent of artificial intelligence(AI)in recent years has brought about transformative changes across various sectors,including healthcare.In nursing practice,education,and research,AI has the potential to revolutionize traditional methodologies,enhance learning experiences,and improve patient outcomes.Integrating AI tools and techniques can provide clinicians with smarter clinical solutions and nursing students with more robust and interactive learning environments,while also advancing research capabilities in the field.Despite the promising prospects,the incorporation of AI into nursing practice,education,and research presents several challenges.Firstly,there is a concern about the potential displacement of human roles in nursing due to automation,which may affect the human-centric nature of nursing care.Secondly,there are issues related to the lag in AI competency among nurses.Many current nursing curricula do not include comprehensive AI training,leading to a lack of preparedness in utilizing these technologies effectively.Lastly,the ethical implications of AI in healthcare,such as data privacy,patient consent,and the potential for biased algorithms,need to be meticulously addressed.To harness the full potential of AI in nursing practice,education,and research,several strategic actions including reinvesting in humanistic practice,revising core competencies and curriculum,and developing new ethical guidelines.展开更多
We measured the content of six heavy-metal elements(Co,Cu,Zn,As,Cd,Pb)in 72 lake surface-sediment samples from the Xizang Autonomous Region(referred to as Xizang)of China,and calculated four indices:enrichment factor(...We measured the content of six heavy-metal elements(Co,Cu,Zn,As,Cd,Pb)in 72 lake surface-sediment samples from the Xizang Autonomous Region(referred to as Xizang)of China,and calculated four indices:enrichment factor(EF),geo-accumulation index(Igeo),pollution load index(PLI),and a comprehensive potential ecological risk index(RI)to explore the differences in the accumulation and the major sources of heavy metals,and to reveal the role of human activities in the ecological environment of high-elevation cold regions.Results show that the heavy-metal contents in lake surface sediment samples in eastern Xizang are much higher than those in central and western areas,and are also higher than the background value of surface soils.Their distribution can be related to regional sources of heavy metals:natural parent material(western Xizang),agriculture(eastern Xizang),mining-related industrial sources(central Xizang),and degree of development of road network(all of Xizang).The majority of lakes in Xizang have a relatively low risk of ecological harm,but there are notable regional peculiarities in the element content and evaluation indices and the lakes in eastern Xizang are at higher risk than those in central and western parts.Lakes at higher ecological risk(such as Lake Butuo(Lake 71)and Samu Co(Lake 68)),remind us that the potential influence of heavy-metal enrichment on lake sediments and aquatic plants should not be overlooked.展开更多
The existence of an intensifying shift in the East Asian summer monsoon(EASM)since~2000 years ago that differs from the decreasing trend of Northern Hemisphere summer insolation remains controversial.Therefore,we comp...The existence of an intensifying shift in the East Asian summer monsoon(EASM)since~2000 years ago that differs from the decreasing trend of Northern Hemisphere summer insolation remains controversial.Therefore,we compared and synthesized stalagmiteδ^(18)O records from eastern China to clarify the EASM trend during this period.A total of 30 caveδ^(18)O records that did not consistently indicate a depleted trend during 2-0 ka.Rather,they included increasing(14 caves),decreasing(8 caves),and non-significant(8 caves)trends.The spatially interpolated trends of caveδ^(18)O suggested spatial differences among three subregions:North China(NC),decreasing trend(5 caves);Central-East China/Yangtze River Valley(CEC),increasing trend(17 caves);South China(SC),decreasing trend(8 caves).The caveδ^(18)O evidence supports spatial differences in precipitation in eastern China that have been substantially demonstrated by observations and model simulations.The decreasingδ^(18)O anomaly from NC and SC was associated with the decreasing sea surface temperature over Pacific Decadal Oscillation region and increasing South Oscillation Index.The increasing CECδ^(18)O anomaly was linked to southward Intertropical Convergence Zone shift and decreasing solar irradiance.Consequently,EASM circulation is jointly forced by external and internal factors at various timescales.展开更多
The aim of this study was to develop a novel pharmaceutical excipient:an anion exchange resin.Initially,polystyrenedivinylbenzene(PS-DVB)microspheres were synthesized via suspension polymerization.Subsequently,these m...The aim of this study was to develop a novel pharmaceutical excipient:an anion exchange resin.Initially,polystyrenedivinylbenzene(PS-DVB)microspheres were synthesized via suspension polymerization.Subsequently,these microspheres served as a substrate for chloromethylation using methanol,formaldehyde,and chlorosulfonic acid.By optimizing the reaction conditions,the chloromethylated microspheres were characterized using infrared spectroscopy,scanning electron microscopy,and the Mohr method.Under optimal reaction conditions,the resulting products exhibited uniformity and spherical morphology,with an average particle size of approximately 190μm.The PS-DVB microspheres effectively incorporated chloromethyl groups,as evidenced by a chlorine content of 14.67%.Scanning electron microscopy analysis indicated that the appearance of the microspheres remained largely unchanged post-reaction.Overall,the research findings demonstrated the successful preparation of the anion exchange resin.Characterization and quality assessment confirmed that the ion exchange resin met the required standards.展开更多
文摘<strong>Introduction:</strong> To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS<sup><span style="white-space:nowrap;">®</span></sup> and Bethesda<sup><span style="white-space:nowrap;">®</span></sup>. <strong>Materials and Methods:</strong> A prospective multicentric study in 10 radiological hospitals and institutions of Latin America was performed and 818 thyroid nodules were analyzed by ultrasound and classified by using both ACR TIRADS<sup><span style="white-space:nowrap;">®</span></sup> and Alpha Score;fine-needle aspiration biopsy was performed when needed and classified with Bethesda. The relationships between predictors were analyzed by using binary logistic regression, statistical significance was defined by a p-value of 0.05, with an error margin of 4% and 95% confidence intervals. <strong>Results:</strong> Alpha Score 2.0 establishes five types of malignant predictors: microcalcifications, irregular borders, taller-than-wide shape, predominant solid texture and hypoechogenicity;a diameter equal to or greater than 1.5 cm adds an extra point to the final score. Resulting classification divides TNs into 4 categories: benign (1.9%), low suspicion (8.7%), mild suspicion (13.6%) and high suspicion (75.7%) of malignancy probability;sensitivity of 82%, specificity of 74%, the positive predictive value of 94%, the negative predictive value of 51%, the statistical accuracy of 81%, odds ratio of 108.89 and correlation with ACR TIRADS of 0.77 and Bethesda of 0.91.<strong> Conclusions: </strong>Alpha Score 2.0 has superior diagnostic accuracy and performance compared to the previously published Alpha Score and is able to classify a benign TN in a precise, safe and accurate way, avoiding unnecessary FNABs or determining the necessity of FNAB in cases of moderate to high suspicion of malignancy.
文摘Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of ≥10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 ±1.87 vs. 3.74 ±1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.
基金supported by the Basic Science Center for Tibetan Plateau Earth System(No.41988101)the Science and Technology Plan Project of the Xizang Autonomous Region(No.XZ202201ZD0005G01)。
文摘The Tibetan Plateau(TP),known as the“Third Pole of Earth”,and its ecosystem is quite sensitive to climate change(Yao et al.,2012;Qiu,2008).In recent decades,the main TP has experienced warming and humidification(although there has been a drying trend in the southern region),and researchers anticipate that this change will continue in the future(Jiang et al.,2023;Sun et al.,2020;Chen et al.,2015).
文摘The advent of artificial intelligence(AI)in recent years has brought about transformative changes across various sectors,including healthcare.In nursing practice,education,and research,AI has the potential to revolutionize traditional methodologies,enhance learning experiences,and improve patient outcomes.Integrating AI tools and techniques can provide clinicians with smarter clinical solutions and nursing students with more robust and interactive learning environments,while also advancing research capabilities in the field.Despite the promising prospects,the incorporation of AI into nursing practice,education,and research presents several challenges.Firstly,there is a concern about the potential displacement of human roles in nursing due to automation,which may affect the human-centric nature of nursing care.Secondly,there are issues related to the lag in AI competency among nurses.Many current nursing curricula do not include comprehensive AI training,leading to a lack of preparedness in utilizing these technologies effectively.Lastly,the ethical implications of AI in healthcare,such as data privacy,patient consent,and the potential for biased algorithms,need to be meticulously addressed.To harness the full potential of AI in nursing practice,education,and research,several strategic actions including reinvesting in humanistic practice,revising core competencies and curriculum,and developing new ethical guidelines.
基金Under the auspices of National Natural Science Foundation of China(No.42471179,42071107)。
文摘We measured the content of six heavy-metal elements(Co,Cu,Zn,As,Cd,Pb)in 72 lake surface-sediment samples from the Xizang Autonomous Region(referred to as Xizang)of China,and calculated four indices:enrichment factor(EF),geo-accumulation index(Igeo),pollution load index(PLI),and a comprehensive potential ecological risk index(RI)to explore the differences in the accumulation and the major sources of heavy metals,and to reveal the role of human activities in the ecological environment of high-elevation cold regions.Results show that the heavy-metal contents in lake surface sediment samples in eastern Xizang are much higher than those in central and western areas,and are also higher than the background value of surface soils.Their distribution can be related to regional sources of heavy metals:natural parent material(western Xizang),agriculture(eastern Xizang),mining-related industrial sources(central Xizang),and degree of development of road network(all of Xizang).The majority of lakes in Xizang have a relatively low risk of ecological harm,but there are notable regional peculiarities in the element content and evaluation indices and the lakes in eastern Xizang are at higher risk than those in central and western parts.Lakes at higher ecological risk(such as Lake Butuo(Lake 71)and Samu Co(Lake 68)),remind us that the potential influence of heavy-metal enrichment on lake sediments and aquatic plants should not be overlooked.
基金National Natural Science Foundation of China,No.42225105National Natural Science Foundation of China,No.42471177,No.42201175,No.41901099+1 种基金The Open Foundation of MOE Key Laboratory of Western China's Environmental System,Lanzhou Universitythe Fundamental Research Funds for the Central Universities,No.lzujbky-2022-kb04。
文摘The existence of an intensifying shift in the East Asian summer monsoon(EASM)since~2000 years ago that differs from the decreasing trend of Northern Hemisphere summer insolation remains controversial.Therefore,we compared and synthesized stalagmiteδ^(18)O records from eastern China to clarify the EASM trend during this period.A total of 30 caveδ^(18)O records that did not consistently indicate a depleted trend during 2-0 ka.Rather,they included increasing(14 caves),decreasing(8 caves),and non-significant(8 caves)trends.The spatially interpolated trends of caveδ^(18)O suggested spatial differences among three subregions:North China(NC),decreasing trend(5 caves);Central-East China/Yangtze River Valley(CEC),increasing trend(17 caves);South China(SC),decreasing trend(8 caves).The caveδ^(18)O evidence supports spatial differences in precipitation in eastern China that have been substantially demonstrated by observations and model simulations.The decreasingδ^(18)O anomaly from NC and SC was associated with the decreasing sea surface temperature over Pacific Decadal Oscillation region and increasing South Oscillation Index.The increasing CECδ^(18)O anomaly was linked to southward Intertropical Convergence Zone shift and decreasing solar irradiance.Consequently,EASM circulation is jointly forced by external and internal factors at various timescales.
基金2023 Nantong Jianghai Talents Project,the Nantong Social Livelihood Science and Technology Plan for 2023the 2022 New Drugs and Platform Enhancement Project of the Yangtze Delta Drug Advanced Research Institute.Additionally,support was provided by the Zhenjiang Science and Technology Project(Grant No.SH2020048)+2 种基金the China Postdoctoral Science Foundation(Grant No.2020M681532)the Jiangsu Planned Projects for Postdoctoral Research Funds(Grant No.2020Z209)the Natural Science Research Projects of Universities in Jiangsu Province(Grant No.20KJD350001).
文摘The aim of this study was to develop a novel pharmaceutical excipient:an anion exchange resin.Initially,polystyrenedivinylbenzene(PS-DVB)microspheres were synthesized via suspension polymerization.Subsequently,these microspheres served as a substrate for chloromethylation using methanol,formaldehyde,and chlorosulfonic acid.By optimizing the reaction conditions,the chloromethylated microspheres were characterized using infrared spectroscopy,scanning electron microscopy,and the Mohr method.Under optimal reaction conditions,the resulting products exhibited uniformity and spherical morphology,with an average particle size of approximately 190μm.The PS-DVB microspheres effectively incorporated chloromethyl groups,as evidenced by a chlorine content of 14.67%.Scanning electron microscopy analysis indicated that the appearance of the microspheres remained largely unchanged post-reaction.Overall,the research findings demonstrated the successful preparation of the anion exchange resin.Characterization and quality assessment confirmed that the ion exchange resin met the required standards.
