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Background: Several US risk stratification score systems (RSSs) have been developed to standardize a thyroid nodule risk of malignancy. It is still a matter of debate which RSS is the most reliable. The purpose of this study is to evaluate: (1) the concordance between the American College of Radiology TI-RADS (ACR TI-RADS) and fine needle aspiration cytology (FNAC), (2) the cancer rate in the ACR TI-RADS categories, (3) the characteristics of nodules evaluated by FNAC even if not formally indicated according to ACR TI-RADS (‘not indicated FNACs”). Methods: From January 2021 to September 2022, patients attending the Endocrinology Unit of the CTO Hospital of Rome for evaluation of thyroid nodules were included. Results: 830 nodules had negative cytology, belonging to TIR2 and TIR1C. One hundred and thirteen nodules were determined to be suspicious for or consistent with malignancy belonging to TIR3B/TIR4/TIR5. Of this last group, 94% were classified as TR4/TR5 nodules. In total, 87/113 underwent surgery. Among these, 73 had histologically proven cancer, 14 turned out to be benign. “Not indicated FNACs” was 623. Among these, 42 cancers were present. Conclusions: This study confirmed the diagnostic power of ACR TI-RADS. In addition, these data suggest revising the ACR TI-RADS indication to FNAC, especially for TR4.

Attribution studies on recent global warming by Global Climate Model (GCM) ensembles converge in showing the fundamental role of anthropogenic forcings as primary drivers of temperature in the last half century. However, despite their differences, all these models pertain to the same dynamical approach and come from a common ancestor, so that their very similar results in attribution studies are not surprising and cannot be considered as a clear proof of robustness of the results themselves. Thus, here we adopt a completely different, non-dynamical, data-driven and fully nonlinear approach to the attribution problem. By means of neural network (NN) modelling, and analysing the last 160 years, we perform attribution experiments and find that the strong increase in global temperature of the last half century may be attributed basically to anthropogenic forcings (with details on their specific contributions), while the Sun considerably influences the period 1910–1975. Furthermore, the role of sulphate aerosols and Atlantic Multidecadal Oscillation for better catching interannual to decadal temperature variability is clarified. Sensitivity analyses to forcing changes are also performed. The NN outcomes both corroborate our previous knowledge from GCMs and give new insight into the relative contributions of external forcings and internal variability to climate.

A novel statistical downscaling system for seasonal predictions is presented, based on an ensemble of neural networks with Bayesian regularization. The system SIBILLA (Statistical Integrated Bayesian Information system for Large to Local area Analysis) is able to take multiple predictor fields and/or time series as inputs. Gridded fields are compressed using empirical orthogonal functions, and a canonical correlation analysis is performed between predictors and each predictand. The first canonical variates are used as effective predictors in a neural network ensemble system. Final outputs for each parameter are expressed as a probability distribution for each station/grid point in the space of observations, as a result of the convolution of Gaussian mixtures. A first example of application in the Italian area is presented. An overall increase in skill score performances with respect to European Centre for Medium-Range Weather Forecasts (ECMWF) System 4 direct model output for the period 1981–2010 was found, even if probably not as high as desirable in a fully operational system.

In recent years, meteo-climatic changes contributed to the geographical expansion and modifications of habitat that become more suitable to phlebotomine vectors. Among these vectors, the role of Sergentomyia minuta in the circulation of mammalian leishmaniases has been recently discussed. Here we apply a neural network model (specifically developed for modelling relationships among variables in small datasets) to estimate the population abundance of S. minuta starting from meteo-climatic variables only, during three capturing seasons (2014–2016) in an Italian site. The results show that we are able to explain a wide majority of the variance in the data of population density (R2 = 0.632). This is obtained through the application of a neural model driven in input by averaged mean temperature, relative humidity and temperature at 10 cm belowground during oviposition, larval and adult stages. A modelling pruning activity shows the major role of humidity in driving the number of captures, but also an important nonlinear role of temperature, which highlights the importance of possible heat waves on population density of S. minuta.

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The influence of climatic changes on migrations around the world is a topic widely discussed in the scientific literature, but investigations are often limited to particular regions. The possible causes of migration flows from Africa to Europe due to landings in Italy, a peninsula which can be considered as a 'bridge' between these two continents, have not been investigated in detail even if, at present, this problem is at the top of the political agenda in Europe. Here a simple linear model and a fully nonlinear one (neural networks—NNs) are applied to the study of possible climatic influences on migration flows from the Sahel to Italy during the period 1995–2009. The results show the ability of the NN model to explain the majority of the variance found in the data and permit the identification of the major climatic drivers affecting the amount of yields in Sahelian countries and the migrations flows from them to Italy. In particular, the use of a NN model fully identifies both linear and nonlinear influences. We can explain much of the variance in the migration data (R2 = 0.775). Agriculture (harvest yields) is shown to link climatic changes and migration, and poor yields can enhance this latter phenomenon. Heat waves (during the cereal growing season) have an important nonlinear role. The annual temperature, however, is most likely the dominant climatic factor influencing migrations in this region.

In thyroid nodule management, ultrasound (US) features, such as hypoechogenicity of the lesion, irregular margins, microcalcifications, and intralesional vascular signal, alone or combined, have to be considered as suggestive for malignancy. Because of the low prevalence of medullary thyroid cancer (MTC), a few papers analyzed US characteristics associated with this cancer in small series, with controversial results. Aim of this study was to evaluate in MTC the US risk factors of thyroid nodule. In this order, a series of nodules histologically proven as MTC and a group of nodules with histology of papillary cancer (PTC) were retrospectively compared with a control group of benign nodule. Fifty percent MTC were solid hypoechoic and 16% showed microcalcifications with significant difference with respect to the benign group (p

Core needle biopsy (CNB) has been recently described as an accurate second-line test in thyroid inconclusive cytology (FNA). Here we retrospectively investigated the potential improvement given by Galectin-3, Cytokeratin-19, and HBME-1 on the accuracy of CNB in thyroid nodules with prior indeterminate FNA report. The study included 74 nodules. At CNB diagnosis, 15 were cancers, 40 were benign, and 19 had uncertain/non-diagnostic CNB report. The above immunohistochemical (IHC) panel was analyzed in all cases. After surgery, 19 malignant and 55 benign lesions were found. All 15 cancers and all 40 benign nodules diagnosed at CNB were confirmed at final histology. Regarding the uncertain CNB group, 4 (21 %) were malignant and 15 (79 %) benign. When we considered all the series, the most accurate IHC combination was Galectin-3 plus HBME-1, while HBME-1 was the most sensitive marker in those nodules with uncertain CNB report. The combination of CNB plus IHC could indentify 19/19 cancers and 53/55 benign lesions. Sensitivity and specificity of CNB increased from 79 to 100 % and from 73 to 96 %, respectively, by adding IHC. CNB can diagnose the majority of thyroid nodules with previous indeterminate FNA cytology, while the accuracy of CNB is increased by adding Galectin-3, Cytokeratin-19, and HBME-1 panel. We suggest to adopt CNB as a second-line approach to indeterminate thyroid FNA, and apply IHC in those lesions with uncertain/non-diagnostic CNB report. This approach should improve the pre-surgical diagnosis of patients. These results should be confirmed in larger prospective series.

Starting from Humanism this paper retraces the exegetical history of ser. num. 548B7-C4 and examines the semantic problems of the text. The main issue is the meaning of the verb μύνασθαι, whose semantic value is determined by the anecdote, just-mentioned by Timon, about the Spartan king Brasidas.

Aim of the study was to evaluate the elastographic appearance of medullary thyroid carcinoma (MTC) by a retrospective evaluation of 18 nodules histologically proven as MTC. Free-hand qualitative elastography was performed using Hitachi Logos EUB 7500. The elasticity score (ES), was assessed based on a colour elastogram, the blue colour being correlated with hard tissue, red colour with soft tissue, and green with intermediate hardness. Nodules were classified into four classes. A alleged diagnosis of malignancy was assigned to nodules with ES3 or 4 and a presumptive diagnosis of benignity was assigned to nodules with an ES1 or 2. More than half (55.6 %) of MTCs have a low-intermediate grade of elasticity. The hardest lesions (ES4) were those with ultrasonographic features highly suspicious for malignancy. In conclusion, most of MTCs present an elastographic pattern of benignity. Therefore, qualitative elastography does not add useful information in pointing out MTC on the basis of its hardness. Our data suggest a marginal role for this technique in MTC evaluation.

Recently, the core needle biopsy (CNB) has been proposed as a complementary test for thyroid nodules with inconclusive cytology by fine-needle aspiration (FNA). However, there have been no reports regarding patient comfort during and after CNB or tolerability of this procedure. Here we aimed to investigate and compare comfort with and tolerability of the CNB and FNA procedures. A 21 gauge needle was used for collection in CNB procedures, and a 23 gauge needle was used for collection in FNA procedures. Sixty-one consecutive patients underwent both biopsies and were asked to evaluate their comfort during and after these procedures by a structured questionnaire. A total of 58 (95 %) patients reported local pain during both biopsies. Two patients reported pain only during CNB, and one reported no pain. Mild pain was reported in 87 % of CNB cases. Local pain after biopsy was reported in 29 % of FNA and 45 % of CNB. The occurrence of pain in the first minutes following CNB was significantly higher than FNA (p = 0.008), while there was not a significant difference in pain at later time points after the procedures. Finally, patients were asked to evaluate the degree of tolerability of the two sampling techniques, and FNA and CNB were reported as tolerable in 82 and 83 %, respectively. The results from a questionnaire evaluating patients’ comfort level showed no significant difference between the tolerability of CNB and FNA. This finding suggests that CNB may be performed with a reasonable level of patient comfort.

Background The reported reliability of core needle biopsy (CNB) is high in assessing thyroid nodules after inconclusive fine-needle aspiration (FNA) attempts. However, first-line use of CNB for nodules considered at risk by ultrasonography (US) has yet to be studied. The aim of this study were: 1) to evaluate the potential merit of using CNB first-line instead of conventional FNA in thyroid nodules with suspicious ultrasonographic features; 2) to compare CNB and FNA as a first-line diagnostic procedure in thyroid lesions at higher risk of cancer. Methods Seventy-seven patients with a suspicious-appearing, recently discovered solid thyroid nodule were initially enrolled as study participants. No patients had undergone prior thyroid fine-needle aspiration/biopsy. Based on study design, all patients were proposed to undergo CNB as first-line diagnostic aspiration, while those patients refusing to do so underwent conventional FNA. Results Five patients refused the study, and a total of 31 and 41 thyroid nodules were subjected to CNB and FNA, respectively. At follow-up, the overall rate of malignancy was of 80% (CNB, 77%; FNA, 83%). However, the diagnostic accuracy of CNB (97%) was significantly (P