Machine learning to predict the occurrence of thyroid nodules: towards a quantitative approach for judicious utilization of thyroid ultrasonography.

Introduction: Ultrasound is instrumental in the early detection of thyroid nodules, which is crucial for appropriate management and favorable outcomes. However, there is a lack of clinical guidelines for the judicious use of thyroid ultrasonography in routine screening. Machine learning (ML) has been increasingly used on big data to predict clinical outcomes. This study aims to leverage the ML approach in assessing the risk of thyroid nodules based on common clinical features. Methods: Data were sourced from a Chinese cohort undergoing routine physical examinations including thyroid ultrasonography between 2013 and 2023. Models were established to predict the 3-year risk of thyroid nodules based on patients' baseline characteristics and laboratory tests. Four ML algorithms, including logistic regression, random forest, extreme gradient boosting, and light gradient boosting machine, were trained and tested using fivefold cross-validation. The importance of each feature was measured by the permutation score. A nomogram was established to facilitate risk assessment in the clinical settings. Results: The final dataset comprised 4,386 eligible subjects. Thyroid nodules were detected in 54.8% (n=2,404) individuals within the 3-year observation period. All ML models significantly outperformed the baseline regression model, successfully predicting the occurrence of thyroid nodules in approximately two-thirds of individuals. Age, high-density lipoprotein, fasting blood glucose and creatinine levels exhibited the highest impact on the outcome in these models. The nomogram showed consistency and validity, providing greater net benefits for clinical decision-making than other strategies. Conclusion: This study demonstrates the viability of an ML-based approach in predicting the occurrence of thyroid nodules. The findings highlight the potential of ML models in identifying high-risk individuals for personalized screening, thereby guiding the judicious use of ultrasound in this context.

Screening of heat stress-related biomarkers in chicken serum through label-free quantitative proteomics.

Heat stress (HS) can result in sudden death and is one of the most stressful and costly events in chicken. Currently, biomarkers used clinically to detect heat stress state in chickens are not optimal, especially for living ones. Analysis of changes in serum proteins of heat-stressed chickens can help to identify some novel convenient biomarkers for this. Twenty-four chickens were exposed to HS at 42°C ± 1°C with a relative humidity of 65% for continuous 5 h in a single day, and 10 birds were used as controls (Con). During HS, 15 dead chickens were categorized as heat stress death group (HSD), and 9 surviving ones served as heat stress survivor group (HSS). Label-free quantitative proteomics (LFQP) was used to analyze differentially expressed proteins (DEPs) in serum of tested animals. Candidate proteins associated with HS were validated by enzyme-linked immunosorbent assay (ELISA). Diagnostic value of candidate biomarkers was assessed using receiver operating characteristic (ROC) curve analysis. Source of the selected proteins was analyzed in liver tissues with immunohistochemistry and in cell culture supernatant of primary chicken hepatocytes (PCH) using ELISA. In this study, compared to Con, LFQP identified 123 and 53 significantly different serum proteins in HSD and HSS, respectively. Bioinformatics analysis showed that XDH, POSTN, and HSP90 were potential HS biomarkers in tested chickens, which was similar with results from serum ELISAs and immunohistochemistry in liver tissues. The ROC values of 0.793, 0.752, and 0.779 for XDH, POSTN, and HSP90, respectively, permitted the distinction of heat-stressed chickens from the control. Levels of 3 proteins above in the cell culture supernatant of PCH showed an increasing trend as HS time increased. Therefore, considering that mean concentration of POSTN in serum was higher than that of HSP90, XDH, and POSTN may be optimal biomarkers in serum for detecting HS level in chickens, and mainly secreted from hepatocytes. The former indicates that heat-stressed chickens are in a damaged state, and the latter implies that chickens can repair heat stress damage.

Exploring the factors influencing the use of health services by people with diabetes in Northwest China: an example from Gansu Province.

BACKGROUND: Diabetes is associated with high morbidity, mortality and quality-of-life impairment in patients. In China, the number of people suffering from diabetes ranks first in the world. Gansu Province is located in northwest China and is an economically underdeveloped region of China. By analyzing the level of health service utilization of people with diabetes in Gansu Province, the degree of equity in health service utilization and its influencing factors were studied to provide scientific data to support the promotion of health equity for people with diabetes and the introduction of relevant policies by relevant authorities. METHODS: A sample of 282 people with diabetes who were 15 years old and above was chosen by multi-stage stratified sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Random forest and logistic regression analysis were used to demonstrate the effects of the explanatory variables on health seeking behaviors from predisposing, enabling and need variables. The concentration index was used to indicate the equity of health service utilization across households of different economic levels. RESULTS: The outpatient rate for the diabetic population surveyed was 92.91%, with 99.87% of urban patients, higher than the 90.39% of rural patients. The average number of hospital days per person was 3.18 days, with 5.03 days per person in urban areas, which was higher than the 2.51 days per person in rural areas. The study showed that the factors most likely to influence patients to seek outpatient services were frequency of taking diabetic medication, whether or not they were contracted to a household doctor, and living environment; the top three factors most likely to influence patients with diabetes to seek inpatient services were number of non-communicable chronic disease, self-assessment of health status, medical insurance. The concentration index for outpatient service utilization and inpatient service utilization were - 0.241 and 0.107, respectively, indicating that outpatient services were concentrated on patients at lower income levels and patients at higher income levels tended to favor inpatient services. CONCLUSION: This study found that the low level of health care resources available to people with diabetes, whose health status is suboptimal, makes it difficult to meet their health needs. Patients' health conditions, comorbidities of people with diabetes, and the level of protection were still important factors that hindered the use of health services. It is necessary to promote the rational use of health services by diabetic patients and further improve the corresponding policies to achieve the goal of chronic disease prevention and control in "Health China 2030".

Clinical observation of Yiqi Qingdu prescription on the treatment of intermediate-stage and advanced non-small-cell lung cancer.

OBJECTIVE: To observe the effects of the Yiqi Qingdu prescription () on intermediate-stage and advanced non-small-cell lung cancer (NSCLC). METHODS: In total, 300 patients with intermediate-stage or advanced NSCLC were randomly and equally divided into three groups using computer-generated random numbers as follows: Western medicine (WM), Chinese medicine (CM), and integrated Traditional Chinese and Western Medicine (IM). After 3 months of treatment, the overall response rate (ORR); disease control rate (DCR); symptom score (SS); Karnofsky performance status (KPS); adverse event score; counts of CD3 + , CD4 + , and CD8 + cells; CD4 + /CD8 + ratio; and carcinoembryonic antigen (CEA) level were compared among the groups. RESULTS: The ORRs were 30.36% , 20.24% , and 7.87% in the IM, CM, and WM groups, respectively, whereas the DCRs were 85%, 75%, and 73%, respectively. Compared to the CM group, the ORR was significantly higher in the WM and IM groups, whereas the DCR was significantly higher in the IM group (all P < 0.05). SS was obviously higher in the WM group than in the other two groups (both P < 0.01). KPS was significantly lower in the WM group after treatment (P = 0.005). The mean number of adverse events was significantly lower in the CM (2.2 ± 1.3) and IM (2.4 ± 1.3) groups than in the WM group (4.6 ± 1.7, both P < 0.05). CD3 + cell counts were significantly decreased in the WM group (P = 0.031). In the IM group, CD8+ cell counts were increased after treatment, whereas the CD4 + /CD8 + ratio was decreased (both P < 0.01). Compared with the WM group, CD3 + (P = 0.01), CD4 + (P = 0.044), and CD8 + (P = 0.009) cell counts were significantly higher in the IM group, whereas the CD4+ /CD8+ ratio was significantly lower (P = 0.011). Relative to the CM group, CD8 + cell counts were significantly higher (P = 0.001) and the CD4+ /CD8+ ratio was significantly lower in the IM group (P = 0.001). CEA levels were significantly increased in the CM group (P = 0.023). CONCLUSION: The Yiqi Qingdu prescription can improve the outcomes of WM in patients with NSCLC.

Yiqi Yangyin Huoxue Method in Treating IdiopathicPulmonary Fibrosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Idiopathic pulmonary fibrosis (IPF) is a common respiratory disease that can lead to respiratory failure in severe condition. Despite notable advances in its treatment, some patients show poor effect when treated with conventional western medicine (CWM). Traditional Chinese medicine with the Yiqi Yangyin Huoxue method (YQYYHXM) has been reported to be positive for IPF. In order to explore the effectiveness and safety of YQYYHXM in the treatment of IPF, we performed this meta-analysis. METHOD: We searched six databases including Embase, Cochrane, PubMed, CNKI, Wan Fang, and VIP database from their inception to June 1, 2019, and then selected eight studies. Two reviewers independently conducted methodological evaluation and data analysis by the software RevMan 5.3.3 and Stata 12.0. RESULTS: The meta-analysis revealed that when YQYYHXM was adopted in combination with CWM, cough, chest pain, and shortness of breath of IPF patients improved significantly. After treatment with YQYYHXM combined with CWM, the SGRQ of IPF patients substantially enhanced. YQYYHXM also has positive effect on 6MWD and TLC, but the improvement on FVC was not obvious. In addition, YQYYHXM has no significance in improving PaO2. All the adverse events were reported in the control group. CONCLUSION: YQYYHXM is more effective and safe as adjunctive treatment for patients with IPF. However, in the future, long-term, large-scale, and high-quality trials will be required to provide more convincing evidence of YQYYHXM due to some limitations of this review.

Chinese medicine for coronavirus disease 2019 as complementary therapy: A protocol for a systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analysis is to assess effectiveness and safety of Chinese medicine (CM) as complementary therapy in treating coronavirus disease 2019 (COVID-19). METHODS: The following databases will be searched: PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang database from October 1, 2019 to March 1, 2020. Randomized trials and quasi-randomized or prospective controlled clinical trials of CM that reported data on COVID-19 patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the CM and CWM using Review Manager version 5.3 when there is sufficient available data. RESULTS: The results will be disseminated through a peer-reviewed journal publication. CONCLUSION: This systematic review findings will summarize up-to-date evidence for that CM is more effective and safe as adjunctive treatment for patients with COVID-19. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a systematic review based on published articles. PROSPERO REGISTRATION NUMBER: CRD42020185382.

Association of Changes in Metabolic Syndrome Status With the Incidence of Thyroid Nodules: A Prospective Study in Chinese Adults.

Although several cross-sectional studies have shown an association of metabolic syndrome (MetS) with nodular thyroid disease, related prospective studies are scarce. This study investigated the association of MetS with thyroid nodule (TN) incidence in Chinese adults, and explored whether the development of or recovery from MetS is associated with changes in the risk of developing TNs. A total of 4,749 Chinese aged 18-65 years were involved in this 6-year prospective study. The association of MetS with TN prevalence was examined. TN-free individuals at baseline (n = 3,133) were further examined. TN incidence rates in groups with different MetS statuses (MetS-free, MetS-developed, MetS-recovery and MetS-chronic) were analyzed. Of all participants, 18.21 and 31.65% had MetS and TNs, respectively. MetS patients had a higher TN prevalence than the non-MetS group (31.08 vs. 19.81% in males, p < 0.01; 59.52 vs. 39.59% in females, p < 0.01). Sex, age and MetS were independent risk factors for TNs. At a median follow up of 5.94 years, the MetS-chronic group (4.37/100 person-years) had a higher risk of TNs (adjusted incidence rate ratio [IRR] = 1.288 [95% CI 1.014-1.636]) compared with the MetS-free group (2.72/100 person-years) in the whole cohort. In males, the MetS-chronic group (3.76/100 person-years) had a higher risk of TNs (adjusted IRR = 1.367 [95% CI 1.017-1.835]) compared with the MetS-free group (2.31/100 person-years). In females, the risk of TNs was significantly higher in the MetS-chronic (6.44/100 person-years) and MetS-developed (6.31/100 person-years) groups compared with the MetS-free group (3.23/100 person-years).

Chinese Herbs Medicine Huatan Huoxue Prescription for obstructive sleep apnea hypopnea syndrome as complementary therapy: A protocol for a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to assess effectiveness and safety of Chinese Herbs Medicine Huatan Huoxue Prescription (HTHXP) as complementary therapy in treating bronchiectasis. METHODS: The following databases will be searched: Embase, Cochrane, PubMed, China National Knowledge Infrastructure, Wan Fang, and VIP database from their inception to April 1, 2020. We performed and completed meta-analysis and methodologic evaluation by Review Manager 5.3.3 and statas 12.0 software. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the HTHXP and western medicine treatment using Review Manager version 5.3 when there is sufficient available data. RESULTS: The results will be disseminated through a peer-reviewed journal publication. CONCLUSION: These systematic review findings will summarize up-to-date evidence for that HTHXP is more effective and safe as adjunctive treatment for patients with bronchiectasis. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a systematic review based on published articles. PROSPERO REGISTRATION NUMBER: INPLASY202050079.

Lipopolysaccharide-enhanced early proliferation of insulin secreting NIT-1 cell is associated with nuclear factor-kappaB- mediated inhibition of caspase 3 cleavage.

BACKGROUND: Increased levels of plasma lipopolysaccharide (LPS) have been found in obesity and diabetes patients. This study was to investigate the effect of LPS on pancreatic beta-cell viability and the involvement of caspase 3 in NIT-1 cell line. METHODS: Mouse insulinoma NIT-1 cells were treated with LPS for the indicated time and dose. Cell viability was measured by cell counting kit-8 reagent. Toll-like receptor 4 (TLR4), caspase 3 and cleaved caspase 3 were detected by Western blotting. Insulin was determined by radioimmunoassay (RIA). RESULTS: LPS promoted NIT-1 cell proliferation at 1 µg/ml, peaked at 72 hours of incubation. A reduction in cleavage of caspase 3 was observed upon LPS treatment. Bay11-7082, a specific inhibitor of nuclear factor (NF)-κB, blunted LPS-induced inhibition of caspase 3 cleavage. Reduction in chronic insulin secretion was observed after treatment with LPS at 1 µg/ml for 48 and 72 hours, not for 24 hours. TLR4 protein was upregulated when NIT-1 cells were treated with LPS at 1 µg/ml for 24 hours. CONCLUSIONS: LPS promotes early NIT-1 cell proliferation in association with NF-κB-mediated inhibition of caspase 3 cleavage. LPS exerts a time-dependent inhibitory effect on chronic insulin secretion from NIT-1 cells.