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Background: We aimed to investigate the value of a machine learning (ML) algorithm in the preoperative prediction of lymph node metastasis in patients with rectal cancer. Methods: Based on the histopathological results, 126 rectal cancer patients were divided into two groups: lymph node metastasis‐positive and metastasis‐negative groups. We collected clinical and laboratory data, three‐dimensional endorectal ultrasound (3D‐ERUS) findings, and parameters of the tumor for between‐group comparisons. We constructed a clinical prediction model based on the ML algorithm, which demonstrated the best diagnostic performance. Finally, we analyzed the diagnostic results and processes of the ML model. Results: Between the two groups, there were significant differences in serum carcinoembryonic antigen (CEA) levels, tumor length, tumor breadth, circumferential extent of the tumor, resistance index (RI), and ultrasound T‐stage (P < 0.05). The extreme gradient boosting (XGBoost) model had the best comprehensive diagnostic performance for predicting lymph node metastasis in patients with rectal cancer. Compared with experienced radiologists, the XGBoost model showed significantly higher diagnostic value in predicting lymph node metastasis; the area under curve (AUC) value of the receiver operating characteristic (ROC) curve of the XGBoost model and experienced radiologists was 0.82 and 0.60, respectively. Conclusions: Preoperative predictive utility in lymph node metastasis was demonstrated by the XGBoost model based on the 3D‐ERUS finding and related clinical information. This could be useful in guiding clinical decisions on the selection of different treatment strategies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic performance of contrast‐enhanced ultrasound (CEUS) combined with thyroglobulin (Tg) levels in fine‐needle aspirates (FNA) washout fluid (FNA‐Tg) in diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC) patients. Methods: Data from 190 LNs in 167 patients suspected of metastasis from the US between November 2018 and September 2020 were included. All subjects underwent FNA, CEUS, and FNA‐Tg examinations. The final outcomes were confirmed by histopathological or cytological examination or follow‐up imaging. Data were analyzed using the Wilcoxon rank‐sum or chi‐squared test. The diagnostic efficacy of FNA, CEUS, and FNA‐Tg in diagnosing LNs was compared. Results: A cutoff value of 6.15 ng/ml (AUC 0.925, 95% confidence interval (CI) 0.885–0.966) successfully identified metastatic LNs. FNA missed 58 LN metastases, of these, 94.8% (55/58) were correctly diagnosed using the combination of CEUS and FNA‐Tg. FNA‐Tg showed higher sensitivity (90.2%), NPV (86.1%) and accuracy (88.9%) than either FNA (48.2, 57.4 and 69.5%, respectively) or CEUS (82.1, 67.7 and 70.5%, respectively) alone. The combination of CEUS, FNA and FNA‐Tg resulted in maximal sensitivity (100%) and NPV (100%) but reduced specificity (51.3%) and overall diagnostic accuracy (80.0%). After adding FNA‐Tg to discordant samples between CEUS and FNA, 81.9% of LNs (77/94) were correctly diagnosed. Conclusions: The combination of FNA, FNA‐Tg and CEUS was found to be a promising imaging tool in detecting metastatic LNs in PTC patients. [ABSTRACT FROM AUTHOR]

Background: Stability of the nursing workforce is considered a key factor for high-quality healthcare. Satisfaction and burnout are reported to be closely related to staff turnover. This study investigates satisfaction and burnout of ED nurses in Shanghai and association of these factors with intention to stay on the job.Methods: This is a cross-sectional descriptive survey study conducted between October and December 2015. Our own questionnaire and the Maslach Burnout Inventory were used to construct the survey. The convenience sampling method was used. The survey targeted ED nurses in 30 Shanghai hospitals. Data were analysed using descriptive, non-paired t-tests, analysis of variance and multivariable logistic regression to decipher possible causes for burnout and identify reasons for continued interest in staying on the job by ED nurses.Results: Of 1137 nurses who received surveys, 976 (87%) responded. Among the respondents, 75% reported being very satisfied or satisfied with their jobs, but there was a high level of burnout, and 22.5% of the nurses expressed their intention to leave the ED within the following year (p<0.05). Nurses' satisfaction and burnout were associated with intention to leave. Salary, nurse-patient relationships, nurse staffing and work environment were areas where nurses were less satisfied, while group cohesion was associated with greater satisfaction.Conclusion: ED nurses in Shanghai report a high level of burnout, which is associated with an intention to leave their jobs. Interventions are needed to improve satisfaction and reduce burnout to maintain the stability of the nursing workforce. [ABSTRACT FROM AUTHOR]

Background: Acute Type A Aortic Dissection (AAAD) is one of the most life-threatening diseases, often associated with transient hyperglycemia induced by acute physiological stress. The impact of stress-induced hyperglycemia on the prognosis of ST-segment elevation myocardial infarction has been reported. However, the relationship between stress-induced hyperglycemia and the prognosis of AAAD patients remains uncertain., Methods: The clinical data of 456 patients with acute type A aortic dissection were retrospectively reviewed. Patients were divided into two groups based on their admission blood glucose. Cox model regression analysis was performed to assess the relationship between stress-induced hyperglycemia and the 30-day and 1-year mortality rates of these patients., Results: Among the 456 patients, 149 cases (32.7%) had AAAD combined with stress-induced hyperglycemia (SIH). The results of the multifactor regression analysis of the Cox model indicated that hyperglycemia (RR = 1.505, 95% CI: 1.046-2.165, p  = 0.028), aortic coarctation involving renal arteries (RR = 3.330, 95% CI: 2.237-4.957, p  < 0.001), aortic coarctation involving superior mesenteric arteries (RR = 1.611, 95% CI: 1.056-2.455, p  = 0.027), and aortic coarctation involving iliac arteries (RR = 2.034, 95% CI: 1.364-3.035, p  = 0.001) were independent influences on 1-year postoperative mortality in AAAD patients., Conclusion: The current findings indicate that stress-induced hyperglycemia measured on admission is strongly associated with 1-year mortality in patients with AAAD. Furthermore, stress-induced hyperglycemia may be related to the severity of the condition in patients with AAAD.

Objective: To explore the diagnostic value of ultrasonography for Kimura's disease (KD)., Methods: Retrospectively analyzed the results of two dimension and color Doppler of 21 Kimura's disease carried by 19 patients who were resected and confirmed by pathologhy., Results: Twenty-one KD cases were detected by the ultrasound while none of them was diagnosed by ultrasonography. 21 cases were showed in the lymph nodes (42.9%, 9/21), parotid gland (4.8%, 1/21) and soft tissues (52.4%, 11/21). The masses both in the lymph and in the parotid gland marked hypoechogenicity and round or like-round. Cases in the soft tissues marked hypoechogencity or hyperechogenicity. Color Doppler flow pattern II to III were showed in 19 cases (90.5%, 19/21)., Conclusion: Ultrasonography enables a confident preoperative diagnosis of Kimura's disease.