Study Objective: The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure. Design: Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence. Study Eligibility Criteria: Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block. Main Results: Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12 h [weighted mean difference (WMD) −1.51 cm on a 10 cm visual analogue scale for pain, 95% CI −2.02 to −1.00; risk difference (RD) for achieving mild pain or less (≤3 cm), 41%, 95% CI 17–65) and 24 h (WMD −1.07 cm, 95% CI −1.83 to −0.32; RD 26%, 95% CI 9–37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12 h (WMD −3.42 cm, 95% CI −4.47 to −2.37; RD 46%, 95% CI 12–80) and at 24 h (WMD −1.73 cm, 95% CI −3.24 to −0.21; RD 32%, 95% CI 5–59), intraoperative opioid use [WMD −28 milligram morphine equivalent (MME), 95% CI −42 to −15], postoperative opioid consumption (WMD −17 MME, 95% CI −29 to −5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95% CI 140–314), and intensive care unit (ICU) length of stay (WMD −13 h, 95% CI −21 to −6). Conclusion: Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.

BACKGROUND: Mulberry leaf extract (MLE) extracted from mulberry leaves is rich in a variety of bioactive ingredients and can be used as feed additives of weaned piglets. The present study was conducted to evaluate the effects of dietary MLE supplementation on intestinal barrier function, colon microbial numbers and microbial metabolites of weaned piglets. RESULTS: MLE supplementation increased the villus height and the villus height/crypt depth ratio in jejunum and ileum (P < 0.05), increased the mRNA expression of ZO-1, Claudin-1 and MUC-2 in the ileal mucosa (P < 0.05), and decreased the serum level of lipopolysaccharide (P < 0.01). Meanwhile, MLE reduced the mRNA expression of tumor necrosis factor-⊍ and interleukin-1⊎ (P < 0.05) and increased secretory immunoglobulin A level in the ileal mucosa (P < 0.05). In addition, MLE increased the numbers of beneficial bacteria Bifidobacterium and Lactobacillus (P < 0.05) and decreased the number of potential pathogenic bacteria Escherichia coli (P < 0.05) in the colon. Correspondingly, MLE supplementation reduced the pH value of colonic digesta (P < 0.05) and altered the microbial fermentation pattern of the colon by increasing the concentrations of microbial metabolites derived from carbohydrates fermentation such as lactate, acetate, butyrate and total short-chain fatty acids (P < 0.05), and decreasing the concentrations of microbial metabolites derived from amino acid fermentation such as p-cresol, skatole, spermine, histamine and tryptamine (P < 0.05). CONCLUSION: MLE supplementation improved intestinal barrier function and displayed beneficial effects on colon microbes and microbial metabolism in weaned piglets.

Objective To determine if the artificial intelligence‐based Thyroid Imaging, Reporting and Data System (AI TIRADS) would perform better than the American College of Radiology (ACR) TIRADS in monitoring malignant thyroid nodules not recommended for biopsy using follow‐up thresholds. Methods A total of 3499 thyroid nodules with surgical histopathology and ultrasound features were retrospectively reviewed and categorized using ACR TIRADS and AI TIRADS. The recommendations for biopsy and follow‐up divided nodules into three groups 1) fine needle aspiration (FNA), 2) follow‐up ultrasound, and 3) no further evaluation. Results Of the total 1608 malignant nodules in this study, 974 malignant nodules would not be biopsied in ACR TIRADS compared with 967 in AI TIRADS. While 60.0% (584/974) of these non‐biopsied malignancies could be followed‐up by ultrasound in ACR TIRADS and 62.8% (607/967) in AI TIRADS. For the malignancies of no further evaluation, 97.4% (380/390) were sized <10 mm in ACR TIRADS and 93.3% (336/360) in AI TIRADS. Compared with ACR TIRADS, AI TIRADS had lower unnecessary FNA rate and missing cancer rate (41.0% vs 47.8% and 22.8% vs 27.5%, P < .05, respectively) while having higher specificity and AUC as well as lower sensitivity (65.0% vs 57.9%, 0.895 vs 0.881, and 96.1% vs 97.8%, all P < .05). Conclusions Using the follow‐up thresholds, more than half of the malignancies not being biopsied were monitored by ultrasound in both ACR TIRADS and AI TIRADS, and AI TIRADS had lower missing cancer rate. More than 90% of malignancies recommended for no further evaluation were <10 mm in diameter.

At present, there is still controversy over whether to perform fine needle aspiration (FNA) on sub-centimeter thyroid nodules with high suspicion of malignancy. Our aim was to estimate the feasibility of reducing the original thresholds for biopsy in American College of Radiology Thyroid Imaging Reporting and Data System (ACR TIRADS) and Artificial Intelligence TIRADS (AI TIRADS). A total of 3201 thyroid nodules with definitive histology obtained were included. Ultrasound categories were assigned according to each TIRADS. We lowered the original FNA thresholds of TR3-TR5 in ACR and AI TIRADS and estimated whether the decreased FNA thresholds could be accepted and used to modified ACR and AI TIRADS. Then, we estimated and compared the diagnostic performance between modified TIRADS and original TRADS to determine if the decreased thresholds could be an effective strategy. 1474 (46.0%) thyroid nodules were diagnosed as malignant after thyroidectomy. Modified ACR TIRADS had higher sensitivity and lower specificity, unnecessary biopsy rate, missed malignancy rate compared with original ACR TIRADS (all P< 0.05). Similar trends were seen in modified AI TIRADS versus original AI TIRADS (all P < 0.05). In conclusion, biopsy of all nodules with TR5 in both ACR TIRADS and AI TIRADS might be an effective strategy, regardless of the nodules dimension. This paper contributes to the contradictory concerning whether perform FNA for the nodules smaller than 10 mm.