背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of...背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。展开更多
This article explores the impact of the three-dimensional cultivation mode on the development of the Suzhou tea industry,focusing on the diversified estimation of the value of output per acre and sales mode.It introdu...This article explores the impact of the three-dimensional cultivation mode on the development of the Suzhou tea industry,focusing on the diversified estimation of the value of output per acre and sales mode.It introduces the history and traditional cultivation practices of tea in Suzhou,as well as the current challenges and problems faced by the industry.An in-depth analysis was conducted on the overview and improvement plans of the three-dimensional cultivation mode,covering relevant technical methods.Based on this analysis,the impact of the three-dimensional cultivation on the value of output per acre was studied and predicted.Its potential and advantages were explored and compared with the effectiveness of traditional cultivation models.Additionally,the impact of the three-dimensional cultivation mode on sales was analyzed,examining its market adaptability and competitiveness,as well as its advantages in expanding sales channels and market coverage.The study also focused on the promoting effect of diversified sales models on the Suzhou tea industry,including direct consumption market development,tea processing product development and promotion,and the integration of tea culture and the tourism industry.To ensure sustainable development,the article evaluates the environmental impact,economic feasibility,social benefits,and farmer benefits of the three-dimensional cultivation model.Finally,the prospects for the development of the Suzhou tea industry were discussed,and the positioning and response strategies of the threedimensional cultivation model were proposed.展开更多
文摘背景BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断一直是临床医师面临的挑战,BRAF(V600E)基因检测常用于术前评估,其特异度高,但敏感度低;美国放射学会和中华医学会超声分会分别提出了美国放射学会甲状腺影像报告和数据系统(American College of Radiology Thyroid Imaging Reporting and Data System,ACR-TIRADS)和中国甲状腺影像报告和数据系统(Chinese Thyroid Imaging Reporting and Data System,C-TIRADS);将TIRADS与BRAF(V600E)基因检测相结合,旨在提高BethesdaⅢ/Ⅳ/Ⅴ类结节的诊断率,并避免不必要的手术和穿刺活检。目的比较ACR-TIRADS与C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断效能,并探讨BARF(V600E)检测的附加价值。方法纳入2020年1月—2023年7月于解放军总医院第一医学中心接受细针穿刺活检并行BRAF(V600E)基因检测的484例患者(484个甲状腺结节),以病理组织学为“金标准”,比较ACR-TIRADS、C-TIRADS单独及联合BRAF(V600E)基因检测对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节的诊断价值。结果两种超声分层系统中甲状腺结节的恶性风险随着分级的升高逐渐增加(趋势χ2检验,P均<0.001),ACR-TIRADS、C-TIRADS的最佳截断值分别为5类、4c类。BRAF(V600E)基因检测在不降低诊断特异度的基础上显著提高了ACR-TIRADS(0.809 vs 0.778,P<0.001)和C-TIRADS(0.815 vs 0.783,P<0.001)对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断效能。ACR-TIRADS与C-TIRADS单独及联合BRAF(V600E)基因检测的曲线下面积(area under the curve,AUC)差异无统计学意义(0.778 vs 0.783,P=0.755;0.809 vs 0.815,P=0.675),但C-TIRADS单独及联合BRAF(V600E)基因检测的敏感度(88.83%vs 83.90%,P<0.001;95.33%vs 90.13%,P<0.001)和准确度(84.50%vs 81.41%,P<0.001;89.67%vs86.36%,P<0.001)高于ACR-TIRADS单独及联合诊断,而ACR-TIRADS单独及联合诊断的特异度相等,均高于C-TIRADS(71.72%vs 67.68%,P<0.001)。结论BRAF(V600E)基因检测可以在不降低特异度的基础上显著提高ACR-TIRADS、C-TIRADS对BethesdaⅢ/Ⅳ/Ⅴ类甲状腺结节良恶性的诊断性能,其中C-TIRADS单独及联合整体诊断性能最佳,在临床实践中具有一定的应用潜力。
基金Suzhou Agricultural Vocational and Technical College Young Teachers Research Ability Enhancement Program“Research and Screening of Bacteria for Fermented Beverages of Vice Tea and Loquat Flower”(Project No.QN[2022]01)。
文摘This article explores the impact of the three-dimensional cultivation mode on the development of the Suzhou tea industry,focusing on the diversified estimation of the value of output per acre and sales mode.It introduces the history and traditional cultivation practices of tea in Suzhou,as well as the current challenges and problems faced by the industry.An in-depth analysis was conducted on the overview and improvement plans of the three-dimensional cultivation mode,covering relevant technical methods.Based on this analysis,the impact of the three-dimensional cultivation on the value of output per acre was studied and predicted.Its potential and advantages were explored and compared with the effectiveness of traditional cultivation models.Additionally,the impact of the three-dimensional cultivation mode on sales was analyzed,examining its market adaptability and competitiveness,as well as its advantages in expanding sales channels and market coverage.The study also focused on the promoting effect of diversified sales models on the Suzhou tea industry,including direct consumption market development,tea processing product development and promotion,and the integration of tea culture and the tourism industry.To ensure sustainable development,the article evaluates the environmental impact,economic feasibility,social benefits,and farmer benefits of the three-dimensional cultivation model.Finally,the prospects for the development of the Suzhou tea industry were discussed,and the positioning and response strategies of the threedimensional cultivation model were proposed.
