Observations reveal vertical transport induced by submesoscale front.

Submesoscale fronts, with horizontal scale of 0.1-10 km, are key components of climate system by driving intense vertical transports of heat, salt and nutrients in the ocean. However, our knowledge on how large the vertical transport driven by one single submesoscale front can reach remains limited due to the lack of comprehensive field observations. Here, based on high-resolution in situ observations in the Kuroshio-Oyashio Extension region, we detect an exceptionally sharp submesoscale front. The oceanic temperature (salinity) changes sharply from 14 °C (34.55 psu) to 2 °C (32.7 psu) within 2 km across the front from south to north. Analysis reveals intense vertical velocities near the front reaching 170 m day-1, along with upward heat transport up to 1.4 × 10-2 °C m s-1 and salinity transport reaching 4 × 10-4 psu m s-1. The observed heat transport is much larger than the values reported in previous observations and is three times as that derived from current eddy-rich climate models, whereas the salinity transport enhances the nutrients concentration with prominent implications for marine ecosystem and fishery production. These observations highlight the vertical transport of submesoscale fronts and call for a proper representation of submesoscale processes in the next generation of climate models.

Toward Earth system modeling with resolved clouds and ocean submesoscales on heterogeneous many-core HPCs.

With the aid of the newly developed 'Sunway' heterogeneous-architecture supercomputer, which has world-leading HPC (high-performance computer) capability, a series of high-resolution coupled Earth system models (SW-HRESMs) with up to 5 km of atmosphere and 3 km of ocean have been developed. These models can meet the needs of multiscale interaction studies with different computational costs. Here we describe the progress of SW-HRESMs development, with an overview of the major advancements made by the international Earth science community in HR-ESMs. We also show the preliminary results of SW-HRESMs with regard to capturing major weather-climate extremes in the atmosphere and ocean, stressing the importance of permitted clouds and ocean submesoscale eddies in modeling tropical cyclones and eddy-mean flow interactions, and paving the way for further model development to resolve finer scales with even higher resolution and more realistic physics. Finally, in addition to increasing model resolution, the development procedure for a non-hydrostatic cloud and ocean submesoscale resolved ESM is discussed, laying out the major scientific directions of such a huge modeling advancement.

A multi-institutional study of association of sonographic characteristics with cervical lymph node metastasis in unifocal papillary thyroid carcinoma.

Objective: Papillary thyroid carcinoma (PTC) is the most common pathological type of thyroid carcinoma, and is prone to cervical lymph node metastases (CLNM). We aim to evaluate the association between sonographic characteristics of PTC and CLNM before the initial surgery. Methods: Clinical information as well as ultrasonographic measurements and characteristics for 2376 patients from three hospitals were acquired in this retrospective cohort study. Univariate and multivariate logistic analysis were performed to predict CLNM in unifocal PTC patients. Receiver operating characteristic (ROC) curve was created to evaluate diagnostic performance. Results: Univariate analysis showed that gender, age, maximum tumor diameter and volume, cross-sectional and longitudinal aspect ratio, location, echogenicity, margin, and echogenic foci were independently associated with CLNM metastatic status (P < 0.05). Multivariate logistic analysis showed that gender, age, maximum tumor diameter and volume, cross-sectional aspect ratio (CSAR), location, echogenicity, margin, and echogenic foci were independent correlative factors; CSAR showed a significant difference for PTC2 to predict CLNM. The area under the curve (AUC) of the maximum tumor diameter, tumor volume, margin, and echogenic foci was 0.70, 0.69, 0.65, and 0.70, respectively. The multiple-variable linear regression model was constructed with an AUC of 0.77, a specificity of 73.4%, and a sensitivity of 72.3%. Kruskal-Wallis analysis for positive subgroups, maximum tumor diameter and volume, cross-sectional and longitudinal aspect ratio, margin, and echogenic foci showed statistical significance (P < 0.05). Conclusions: Younger age (< 55 years), male, larger tumor, and echogenic foci were high risk factors for CLNM in patients with unifocal PTC. CSAR had a more effective predictive value for CLNM in patients with larger thyroid tumors. A larger tumor with irregular and punctate echogenic foci was also more prone to the lateral neck, and both central and lateral neck metastasis.

Automated breast volume scanning combined with shear wave elastography for diagnosis of triple-negative breast cancer and human epidermal growth factor receptor 2-positive breast cancer.

OBJECTIVE: To explore the values of automated breast volume scanning (ABVS) combined with shear wave elastography (SWE) in the differential diagnosis of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2-positive breast cancers (HER2+BC). METHODS: In this study, 28 patients with TNBC and 32 patients with HER2+BC were enrolled. The characteristics of ABVS and virtual touch quantification (VTQ) in SWE of all patients were reviewed. The multivariate logistic regression analysis was carried out and the receiver operating characteristic curves of ABVS and ABVS+VTQ were drawn. RESULTS: In ABVS imaging, the microcalcification, posterior echo, internal echo, shape, and edge had significant difference between TNBC and HER2+BC groups (p<0.05). The regular shape was the independent factor for TNBC (p=0.04, odds ratio [OR]=4.479), and the microcalcification in mass was the independent factor for HER2+BC (p=0.01, OR=2.997). In VTQ imaging, the shear wave velocity (SWV)max, SWVmin, and SWVmean in TNBC group were significantly lower than those in HER2+BC group (p<0.001). The sensitivity, specificity, and accuracy of ABVS+VTQ in diagnosing TNBC were higher than those of ABVS alone. CONCLUSIONS: ABVS combined with SWE has certain advantages in differentiating TNBC from HER2+BC, which is helpful for the treatment planning and prognosis judgment.

Automated breast volume scanning combined with shear wave elastography for diagnosis of triple-negative breast cancer and human epidermal growth factor receptor 2-positive breast cancer

SUMMARY OBJECTIVE To explore the values of automated breast volume scanning (ABVS) combined with shear wave elastography (SWE) in the differential diagnosis of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2-positive breast cancers (HER2+BC). METHODS In this study, 28 patients with TNBC and 32 patients with HER2+BC were enrolled. The characteristics of ABVS and virtual touch quantification (VTQ) in SWE of all patients were reviewed. The multivariate logistic regression analysis was carried out and the receiver operating characteristic curves of ABVS and ABVS+VTQ were drawn. RESULTS In ABVS imaging, the microcalcification, posterior echo, internal echo, shape, and edge had significant difference between TNBC and HER2+BC groups (p<0.05). The regular shape was the independent factor for TNBC (p=0.04, odds ratio [OR]=4.479), and the microcalcification in mass was the independent factor for HER2+BC (p=0.01, OR=2.997). In VTQ imaging, the shear wave velocity (SWV)max, SWVmin, and SWVmean in TNBC group were significantly lower than those in HER2+BC group (p<0.001). The sensitivity, specificity, and accuracy of ABVS+VTQ in diagnosing TNBC were higher than those of ABVS alone. CONCLUSIONS ABVS combined with SWE has certain advantages in differentiating TNBC from HER2+BC, which is helpful for the treatment planning and prognosis judgment.

A high-resolution Asia-Pacific regional coupled prediction system with dynamically downscaling coupled data assimilation.

A regional coupled prediction system for the Asia-Pacific (AP-RCP) (38°E-180°, 20°S-60°N) area has been established. The AP-RCP system consists of WRF-ROMS (Weather Research and Forecast, and Regional Ocean Model System) coupled models combined with local observational information through dynamically downscaling coupled data assimilation (CDA). The system generates 18-day forecasts for the atmosphere and ocean environment on a daily quasi-operational schedule at Pilot National Laboratory for Marine Science and Technology (Qingdao) (QNLM), consisting of 2 different-resolution coupled models: 27 km WRF coupled with 9 km ROMS, 9 km WRF coupled with 3 km ROMS, while a version of 3 km WRF coupled with 3 km ROMS is in a test mode. This study is a first step to evaluate the impact of high-resolution coupled model with dynamically downscaling CDA on the extended-range predictions, focusing on forecasts of typhoon onset, improved precipitation and typhoon intensity forecasts as well as simulation of the Kuroshio current variability associated with mesoscale oceanic activities. The results show that for realizing the extended-range predictability of atmospheric and oceanic environment characterized by statistics of mesoscale activities, a fine resolution coupled model resolving local mesoscale phenomena with balanced and coherent coupled initialization is a necessary first step. The next challenges include improving the planetary boundary physics and the representation of air-sea and air-land interactions to enable the model to resolve kilometer or sub-kilometer processes.

A Control Study on the Value of the Ultrasound Grayscale Ratio for the Differential Diagnosis of Thyroid Micropapillary Carcinoma and Micronodular Goiter in Two Medical Centers.

OBJECTIVE: To investigate the value of ultrasound gray-scale ratio (UGSR) for the differential diagnosis of papillary thyroid microcarcinoma (PTMC) and micronodular goiter (MNG) in two medical centers. METHODS: Ultrasound images of 881 PTMCs from 785 patients and 744 MNGs from 687 patients in center A were retrospectively analyzed and compared with 243 PTMCs from 203 patients and 251 MNGs from 198 patients in center B. All cases were confirmed by surgery and histology. The grayscale values of thyroid lesions and surrounding normal tissues were measured, and the UGSR was calculated. The optimal UGSR threshold for identifying PTMCs and MNGs in two medical centers was determined by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared between the two medical centers. RESULTS: The UGSR values of PTMCs and MNGs in medical center A were 0.5537 (0.4699, 0.6515) and 0.8708 (0.7616, 1.0123) (Z = -27.691, P = 0), respectively, whereas those in medical center B were 0.5517 (0.4698, 0.6377) and 0.8539 (0.7366, 0.9929) (Z = -16.057, P = 0), respectively. The UGSR of PTMCs and MNGs did not differ significantly between the two medical centers (Z = -0.609, P = 0.543 and Z = -1.394, P = 0.163, respectively). The AUC, optimal UGSR threshold, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two medical centers were 0.898 vs. 0.918, 0.7214 vs. 0.6911, 0.881 vs. 0.868, 0.817 vs. 0.833, 0.851 vs. 0.834, 0.853 vs. 0.867, and 0.852 vs. 0.850, respectively. CONCLUSIONS: UGSR can quantify the echo intensity of PTMCs and MNGs and is therefore valuable for the differential diagnosis of the two diseases. The diagnostic efficacy was consistent between the two medical centers. This method should be widely promoted and applied.

Safety and efficacy of ultrasound-guided percutaneous thermal ablation in treating low-risk papillary thyroid microcarcinoma: A pilot and feasibility study.

OBJECTIVE: This study aimed to evaluate the safety and efficacy of thermal ablation in treating low-risk unifocal papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS: Patients with unifocal PTMC were enrolled in this study, and thermal ablations were performed. Contrast-enhanced ultrasound was used to estimate the extent of ablation immediately after thermal ablation; complications were recorded. The size and volume of the ablated area and thyroid hormones were measured, and the clinical evaluations were performed at 1, 3, 6, 12, and 18 months after thermal ablation. From July 2016 to July 2017, the prospective study was conducted involving 107 patients. Thermal ablation was well tolerated without serious complications. RESULTS: Compared with the volume immediately after thermal ablation, the mean volume reduction ratio (VRR) of ablated lesions was 0.457 ± 0.218 (range: 0.040-0.979), 0.837 ± 0.150 (range: 0.259-1), 0.943 ± 0.090 (range: 0.491-1), 0.994-0.012 (range: 0.938-1), and 0.999 ± 0.002 (range: 0.992-1) at 1, 3, 6, 12, and 18 months after thermal ablation, respectively. Significant differences in the VRR were found between every two follow-up visits (P < 0.01). Results of patients' thyroid function test before thermal ablation and at 1 month after thermal ablation were normal, and no significant differences were observed (P > 0.05). No tumor regrowth, local recurrence, or distant metastases were detected during follow-up visits. CONCLUSION: Thermal ablation is a short-term safe and effective method in treating low-risk small PTMCs, which can be considered a potential alternative therapy for patients with PTMC.

The clinical significance of ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules.

PURPOSE: This study explored ultrasound grayscale ratios (USGRs) for differentiating markedly hypoechoic and anechoic minimal thyroid nodules. MATERIALS AND METHODS: Longitudinal scan images of 193 markedly hypoechoic papillary thyroid microcarcinoma (PTMC) lesions from 184 patients were retrospectively reviewed using RADinfo and compared with 123 anechoic micronodular goiters (MNGs) from 110 patients. Final diagnosis was validated by pathological examination; MNGs predominantly manifested with cyst formation. Grayscale values of PTMC, MNG, and normal surrounding tissues were obtained from grayscale histograms; USGRs (grayscale ratios of pathologic tissue to surrounding normal tissue) of PTMC and MNG were calculated. Optimal USGRs for differentiating PTMC and MNG were determined with receiver operating characteristic (ROC) curves. RESULTS: Among 193 PTMC and 123 MNG lesions, USGRs were 0.24-0.51 (mean ± standard deviation [SD]: 0.41 ± 0.07) and 0.01-0.38 (mean ± SD: 0.12 ± 0.08), respectively. The area under the ROC curve for distinguishing markedly hypoechoic PTMC and anechoic MNG was 0.992. As USGRs decreased, sensitivity decreased and specificity increased for MNG diagnosis. At a USGR of 0.26, the Youden index was high (0.933), corresponding to 94.3% sensitivity and 99% specificity for predicting anechoic MNG. At a USGR of 0.23, sensitivity and specificity for diagnosing anechoic MNG were 92.7% and 100%, respectively. In contrast, as USGR increased, sensitivity decreased and specificity increased for predicting PTMC. At a USGR of 0.38, sensitivity and specificity for diagnosing markedly hypoechoic PTMC were 68.4% and 100%, respectively. CONCLUSIONS: USGRs could objectively quantize grayscale values of markedly hypoechoic and anechoic lesions, enabling accurate and quantitative determination of nodular properties.

Differential diagnosis value of the ultrasound gray scale ratio for papillary thyroid microcarcinomas and micronodular goiters.

BACKGROUND: To investigate the differential diagnosis value of the ultrasound gray scale ratio (UGSR) for papillary thyroid microcarcinomas (PTMCs) and micronodular goiters (MNGs). METHODS: A retrospective analysis was performed using ultrasound images from 521 PTMC patients (561 PTMC lesions) and 405 MNG patients (515 MNG lesions). All cases were surgically and histologically confirmed. Gray scale values of the thyroid lesions and the surrounding normal thyroid tissue were measured. The thyroid lesion to normal thyroid tissue (UGSR) was calculated. Statistical analysis was performed with Mann-Whitney test. Receiver operating characteristic curve determined the optimal UGSR threshold for differentiating PTMCs and MNGs. RESULTS: In 561 PTMCs, the mean UGSR was 0.54 (SD: 0.16; range: 0.24-1.26). In 515 MNGs, the mean UGSR was 0.87 (SD: 0.22; range: 0.34-2.06), with significant difference between values of PTMCs and MNGs (P<0.001). The UGSR area under the curve to differentiate PTMCs and MNGs was 0.895. When the UGSR decreased, the UGSR to PTMC sensitivity decreased and the specificity increased. When the UGSR was chosen to be 0.99, 0.72, 0.63 or 0.34, the sensitivity was 98.4% and 87.0%, 73.8% and 5.9% respectively, and specificity was 25.1% and 80.4%, 90.1% and 100.0% respectively. When the UGSR was 0.72, the Youden index maximum was 0.674. CONCLUSIONS: The UGSR allows potential differentiation PTMCs and MNGs.

Feasibility of fine-needle aspiration biopsy and its applications in superficial cervical lesion biopsies.

The aim of the study was to investigate the feasibility and value of clinical application of fine-needle aspiration histological biopsy via ultrasound-guided thyroid nodule and enlarged cervical lymph node fine-needle aspiration histological biopsy. Fine-needle aspiration cytological and histological biopsies and surgical treatments were performed on 982 patients with thyroid nodule and 1435 patients with enlarged cervical lymph nodes. A comparative study of the histological and cytological examination results and post-surgical etiology results was subsequently conducted. Among the 982 thyroid nodule patients, the acquisition rates were 89.8% (882/982) for fine-needle aspiration histological biopsy and 96.2% (945/982) for cytological biopsy, while among the 1435 patients with enlarged cervical lymph nodes, the acquisition rate for fine-needle aspiration cytological biopsy was slightly higher than that for histological biopsy, with values of 95.7% (1374/1435) and 91.4% (1312/1435), respectively. For the thyroid nodule patients, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 98.5%, 100%, and 98.9%, respectively, whereas those of the cytological results were 86.8%, 82.9%, and 85.6%, respectively; the differences between the 2 biopsy methods were statistically significant (P < 0.05). For the patients with enlarged cervical lymph nodes, when the acquired histological and cytological biopsy results were compared with the post-surgical etiology results, the sensitivity, specificity, and accuracy of the histological results were 96.3%, 99.8%, and 97.6%, respectively, whereas the those of the cytological results were 76.8%, 92.1%, and 82.2%, respectively; again, the differences between the 2 methods were statistically significant (P < 0.05). In conclusion, Fine-needle aspiration histological biopsy is a reliable and highly accurate examination method. It is simple and feasible, thus facilitating the discrimination of malignant and benign thyroid nodules and enlarged cervical lymph nodes and playing an important role in the establishment of reasonable clinical therapeutic regimens.

Ocean barrier layers' effect on tropical cyclone intensification.

Improving a tropical cyclone's forecast and mitigating its destructive potential requires knowledge of various environmental factors that influence the cyclone's path and intensity. Herein, using a combination of observations and model simulations, we systematically demonstrate that tropical cyclone intensification is significantly affected by salinity-induced barrier layers, which are "quasi-permanent" features in the upper tropical oceans. When tropical cyclones pass over regions with barrier layers, the increased stratification and stability within the layer reduce storm-induced vertical mixing and sea surface temperature cooling. This causes an increase in enthalpy flux from the ocean to the atmosphere and, consequently, an intensification of tropical cyclones. On average, the tropical cyclone intensification rate is nearly 50% higher over regions with barrier layers, compared to regions without. Our finding, which underscores the importance of observing not only the upper-ocean thermal structure but also the salinity structure in deep tropical barrier layer regions, may be a key to more skillful predictions of tropical cyclone intensities through improved ocean state estimates and simulations of barrier layer processes. As the hydrological cycle responds to global warming, any associated changes in the barrier layer distribution must be considered in projecting future tropical cyclone activity.

The dynamic face of HIV-1 subtypes among men who have sex with men in Beijing, China.

The rapid increase of HIV-1 prevalence among Chinese men who have sex with men (MSM) provides an impetus for the acquisition of molecular epidemiologic information from this population. We conducted four serial cross-sectional surveys during year 2005-2009 and observed that the composition of HIV-1 subtypes was dynamically changing with from clade B to CRF01_AE from years 2005-2009. HIV-1 infection in this population includes the persistent circulation of multiple HIV-1 subtypes and complex new recombinants.

[The development of the cognition and treatment of apoplexy in traditional Chinese medicine].

Surveying the developmental history of the cognition and treatment of apoplexy in traditional Chinese medicine, it could be divided into 3 phases, viz. the phase of "exogenous wind" before the Tang and Song dynasties, the phase of contention of "endogenous wind" during the Jin, Yuan and Ming dynasties, and the phase of compromising of traditional Chinese and consulting of western medicine of "equal importance of exogenous and endogenous wind" after the Qing dynasty. Through the development of these three phases, the cognition of cause of disease and pathogenesis of apoplexy was deepened continuously, and the method of treatment, prescription and materia medica were enriched further. Especially, with the introduction and usage of modern scientific technology, the diagnosis and treatment of apoplexy were more standardized, and the effect was improved constantly, reflecting the characteristic and superiority of traditional Chinese medicine.