Series Combination Research Articles

TPAFNet: Transformer-Driven Pyramid Attention Fusion Network for 3D Medical Image Segmentation.

The field of 3D medical image segmentation is witnessing a growing trend in the utilization of combined networks that integrate convolutional neural networks and transformers. Nevertheless, prevailing hybrid networks are confronted with limitations in their straightforward serial or parallel combination methods and lack an effective mechanism to fuse channel and spatial feature attention. To address these limitations, we present a robust multi-scale 3D medical image segmentation network, the Transformer-Driven Pyramid Attention Fusion Network, which is denoted as TPAFNet, leveraging a hybrid structure of CNN and transformer. Within this framework, we exploit the characteristics of atrous convolution to extract multi-scale information effectively, thereby enhancing the encoding results of the transformer. Furthermore, we introduce the TPAF block in the encoder to seamlessly fuse channel and spatial feature attention from multi-scale feature inputs. In contrast to conventional skip connections that simply concatenate or add features, our decoder is enriched with a TPAF connection, elevating the integration of feature attention between low-level and high-level features. Additionally, we propose a low-level encoding shortcut from the original input to the decoder output, preserving more original image features and contributing to enhanced results. Finally, the deep supervision is implemented using a novel CNN-based voxel-wise classifier to facilitate better network convergence. Experimental results demonstrate that TPAFNet significantly outperforms other state-of-the-art networks on two public datasets, indicating that our research can effectively improve the accuracy of medical image segmentation, thereby assisting doctors in making more precise diagnoses.

Methanol, the ICE Green Maker

AbstractGreen methanol is a renewable fuel with great advantages when used in a spark ignition combustion process. Methanol has a comparatively high enthalpy of vaporization, leading to lower combustion temperatures as compared to gasoline combustion, and, hence, lower wall heat losses as well as a reduced tendency to pre‐ignition. Therefore, a brake efficiency of more than 40 % (this is comparable to diesel engines!) and furthermore minimal emissions, even at cold start, are possible. The serial combination with an electric powertrain provides a disconnection of the load demand of the powertrain and the operating point of the combustion engine. In this case, a high volumetric and gravimetric power density, easy energy storage and proven infrastructure of fuel distribution are combined with electric driving, high efficiencies, minimal emissions, and a closed carbon cycle for the energy provision.

Innovative heat management method and metaheuristic algorithm optimized power supply-demand balance for PEMFC-ASHP-CHP system

The evolution of distributed building energy systems fuels the growing demand for sustainable energy solutions. In this paper, Proton Exchange Membrane Fuel Cell (PEMFC) and Air Source Heat Pump (ASHP) were integrated to form PEMFC-ASHP-CHP systems in three combination methods, i.e., Direct Combination (DC), Parallel Combination (PC), Series Combination (SC). And compared the energy management strategies and power balance of the system. To further improve reliability and flexibility, a diversion PEMFC-ASHP-CHP system was proposed by combining PC and SC's system advantages. Additionally, an iterative algorithm addressed the mismatch between power supply and demand. An empirical formula was proposed to improve iterative convergence speed for practical control situations. The coefficients were optimized using six metaheuristic algorithms, and the outcomes were summarized into an optimized operational plane to enhance the system control response speed further. The results show that the PC method performs better than DC and SC. It achieves a power consumption reduction of 52.8% and a COP improvement of 111.4% compared with the ASHP system. Meanwhile, the diversion system can more effectively utilize waste heat from the PEMFC and further improve the system's performance. The Queuing Search Algorithm (QSA) demonstrates superior accuracy for coefficient optimization. By using the established empirical formula, the convergence speeds of global and local iterative methods are improved by 26.10% and 41.78%, respectively, compared to the direct iterative algorithm. Ultimately, the optimized operational plane can achieve a maximum 37.16% hydrogen consumption reduction compared to the unoptimized system.

Mitochondrial Dysfunction of Peripheral Platelets as a Predictive Biomarker for Postoperative Delirium in Elderly Patients.

To determine the association between the preoperative Bioenergetic Health Index (BHI) of platelets and the occurrence of postoperative delirium (POD) in elderly patients. Elderly patients scheduled for major abdominal surgery under general anesthesia were included. The presence of POD was assessed within the 3 days after surgery. Seahorse XF analysis and transmission electron microscopy were utilized to evaluate the mitochondrial metabolism and morphology of platelets. A total of 20 out of 162 participants developed POD. Participants with POD showed lower preoperative Mini-Mental State Examination scores and total protein levels, fewer educational years, longer surgery duration, higher mean platelet volume, and lower platelet BHI compared with those without POD. Damaged mitochondria with swollen appearance and distorted cristae was detected in platelets from participants with POD. Preoperative platelet BHI was independently associated with the occurrence of POD after adjusting for age, education, preoperative Mini-Mental State Examination score, preoperative mean platelet volume and total protein levels, surgical type and duration, and lymphocyte counts on the first postoperative day (OR 0.11, 95% CI 0.03-0.37, p < 0.001). The areas under the receiver operating curves for predicting POD were 0.83 (95% CI 0.76-0.88) for platelet BHI. It showed a sensitivity of 85.00% and specificity of 73.24%, with an optimal cutoff value of 1.61. Using a serial combination (mean platelet volume followed by BHI) yielded a sensitivity of 80.00% and specificity of 82.39%. Preoperative platelet BHI was independently associated with the occurrence of POD in elderly patients and has the potential as a screening biomarker for POD risk. ANN NEUROL 2024;96:74-86.

Online assessment of short-term voltage stability based on hybrid model and data-driven approach

With the continuously increasing integration of renewable energy sources into power grids, the dynamic response of a power system is becoming more complex. For example, the interaction between the dynamic loads and low-voltage ride-through of renewable energy generators makes the voltage response more rapid and unpredictable. Ensuring the accuracy and speed of traditional voltage stability assessment methods is difficult. This study developed a novel hybrid model and data-driven voltage stability assessment approach. First, the equivalent parameters of a power system were calculated based on the measured data, and the parameters were constantly modified based on the response data. To further improve the accuracy of the approach, a data-driven method was introduced to correct the assessment results using a Thevenin equivalent-based assessment. The difference between the Thevenin and system impedances, which better reflects the system stability, was included in the data-driven input data. Finally, by combining the clear physical mechanism of the model-driven method and high accuracy of the data-driven method, the final the assessment process was a serial combination of the model- and data-driven methods. The effectiveness of the method was verified using an IEEE New England 10-generator 39-bus test system and a 100-bus actual system in China. The results showed that the method developed was more accurate and had higher robustness under data loss and noise conditions than other methods.

Elastic programmable properties and dynamic dissipation of gradient unstable structures

Metamaterials derive promising properties mainly from an internal micromechanical mechanism, rather than their chemical composition. Many interesting mechanical behaviors can be obtained by orderly assembling buckling elements. Elastic programmable properties, corresponding potential energy landscape and dynamic dissipation mechanism of elastic beam structures are studied in detail. To accomplish this work, a combination of theoretical models and extensive numerical calculations are applied to investigate a single element as well as homogeneous and gradient structures. This comprehensive investigation not only provides insights into the complex internal buckling behaviors and mechanisms of a specific unstable structure but also establishes conclusions that are applicable to other unstable structures having similar buckling behaviors. The potential energy of a serial combination of unstable elements is extremely wiggly, enabling multiple equilibrium configurations and resulting in multistable transformations and energy dissipation with elastic deformation and loading timescale independence. To the best of our knowledge, the most of programming properties investigated in this paper, the complex energy landscape, the deformation of internal elements, and programmable dynamic responses of gradient unstable structures have not been reported in previous papers.

Free-Cog revisited: the diagnostic contribution of cognitive and executive function.

Aim: To examine Free-Cog, a recently described, hybrid screening instrument, as separate tests of cognitive (Free-Cog-Cog) and executive function (Free-Cog-Exec) to see if this improved screening accuracy for cognitive impairment compared with standard Free-Cog. Materials & methods: Free-Cog-Cog and Free-Cog-Exec were combined using Boolean logical 'AND'and 'OR'operators (serial and parallel combination), and also used to construct a stepwise decision tree. Results: Serial combination improved specificity and positive predictive value whereas parallel combination improved sensitivity, typical findings with these operators. Stepwise application identified groups with high and low probability of cognitive impairment but failed to differentiate adequately those in the intermediate uncertain diagnosis group. Conclusion: Study findings suggest limited benefit from reformulations of Free-Cog compared with the standard instrument.

Mechanics and validation tests of a post-tensioned self-centering brace with adjusted stiffness and deformation capacities using disc springs

Self-centering braces have been developed to reduce the residual deformation of steel frames in earthquakes. The brace has a higher elastic axial stiffness before the activation, which may result in a higher base shear for frame design. This work was aimed to develop a new post-tensioned self-centering brace (PT-SCB) with adjusted stiffness and deformation capabilities such that the brace could be designed based on a specified yield or ultimate frame drift. Combining disc springs and one of the compression members together in the original SCB could achieve new structural characteristics, providing an alternative to tune the axial stiffness and deformation. This work first introduces the mechanics and deformation mechanism of the proposed SCB and performs a parametric study to investigate the effect of disc spring stacks on the hysteretic response of SCBs. A test program is then conducted on cyclic tests of disc spring stacks in different serial and parallel combinations and two PT-SCBs. Each 3800 mm-long brace is composed of high-strength steel tendons, compression steel members, disc spring stacks, and bolted friction device. The hysteretic responses of the new SCB with different design parameters are used to validate the mechanics and ability of the axial stiffness and deformation adjustment.

Influence of coaxial cable resistance on impedance measurements at low frequency and guidelines for phase determination of ac electrical signals.

We present an experimental study on ac measurements at low frequencies (below 1MHz) when the coaxial cables used for the measurement are resistive, as in cryogenic conditions. More precisely, we are interested in admittance or impedance measurements and the accurate determination of the phase. Our experiments were completed using an auto-balancing bridge impedance analyzer and various standard coaxial cables, as well as their serial combinations. We characterize the experimental setup, and then, we analyze and measure the phase shift introduced in impedance measurements by lead resistance. Using basic equations for electrical signal propagation in coaxial cables, we calculate phase shift in the whole frequency range and explain our data in the low frequency limit of our model. We propose a quantitative criterion to determine whether the experimental context is appropriate. If not, we show that by using an original calibration procedure, the imaginary part can be accurately recovered, avoiding artifacts. The calibration procedure can be applied to any ac voltage or current measurement, whatever the detection technique is, with known accuracy.

Analysis of factors with low positive predictive value in the diagnosis of urinary tract infection by flow cytometry.

Culture-negative urine specimens can be rapidly screened by urine flow cytometry (UFC), while low positive predictive value (PPV) limits the clinical application. We explored the factors associated with a low PPV. A total of 5095 urine specimens were analyzed with UFC and culture. Diagnostic performance of leukocytes, bacteria, and BACT-info flags was evaluated by sensitivity, specificity, PPV, and negative predictive value (NPV). The association of contaminated culture and squamous epithelial cell count and BACT-info flag was performed by logistic regression analysis. The NPVs of parallel combination of bacteria and leucocytes were 98.9% in males and 97.9% in females, and PPVs of serial combination were 86.6% and 77.8% in men and women, respectively. The PPV of Gram-negative flag was higher than that of Gram-positive flag. The proportions of contamination in the urine culture results of false positive specimens were 86.9% in males and 98.5% in females at the cutoff points of the serial combination, and these parameters were 53.2% in males and 85.6% in females for the Gram-positive flag. There was a statistically significant association between contaminated cultures and squamous epithelial cells count in females, but not in males. Associations between contaminated cultures and Gram-positive flags or Gram-pos/-neg flags were statistically significant, but there was no association between contaminated cultures and Gram-negative flags. A serial combination of leukocytes and bacteria may maximize PPV in the diagnosis of bacterial urinary tract infection by urine flow cytometry, and contamination is the main reason for a low PPV.

Serially Combining Epidemiological Designs Does Not Improve Overall Signal Detection in Vaccine Safety Surveillance.

Vaccine safety surveillance commonly includes a serial testing approach with a sensitive method for 'signal generation' and specific method for 'signal validation.' The extent to which serial testing in real-world studies improves or hinders overall performance in terms of sensitivity and specificity remains unknown. We assessed the overall performance of serial testing using three administrative claims and one electronic health record database. We compared type I and II errors before and after empirical calibration for historical comparator, self-controlled case series (SCCS), and the serial combination of those designs against six vaccine exposure groups with 93 negative control and 279 imputed positive control outcomes. The historical comparator design mostly had fewer type II errors than SCCS. SCCS had fewer type I errors than the historical comparator. Before empirical calibration, the serial combination increased specificity and decreased sensitivity. Type II errors mostly exceeded 50%. After empirical calibration, type I errors returned to nominal; sensitivity was lowest when the methods were combined. While serial combination produced fewer false-positive signals compared with the most specific method, it generated more false-negative signals compared with the most sensitive method. Using a historical comparator design followed by an SCCS analysis yielded decreased sensitivity in evaluating safety signals relative to a one-stage SCCS approach. While the current use of serial testing in vaccine surveillance may provide a practical paradigm for signal identification and triage, single epidemiological designs should be explored as valuable approaches to detecting signals.

Validation of Calcein Violet as a New Marker of Semen Membrane Integrity in Domestic Animals.

Many fluorochromes routinely used in semen quality analysis emit in the green and red channels, limiting their possible combination for multiple parameter analysis. The use of fluorophores emitting in different light channels broadens the possibilities of combination to expand the range of simultaneously evaluated criteria. This is of great interest in cases of small ejaculated volumes, such as those naturally occurring in roosters, small dog breeds and drones (Apis mellifera). The purpose of this experiment is to establish Calcein Violet (CaV), a blue fluorochrome, as a marker of viability and acrosomal integrity in domestic animals in order to free the red and green channels. SYBR®14/Propidium Iodide (PI) was used as reference dye, heat-treated samples as negative controls, serial staining combination for validation and epifluorescence microscopy for observation. Dead spermatozoa marked in red with PI showed no blue fluorescence either from the head or the tail. Live spermatozoa showed a decreasing blue emission from head to tail when single stained with CaV. Unreacted acrosomes showed intense blue fluorescence irrespective of plasma membrane integrity. This needs to be further confirmed for species with small and difficult to observe heads. Establishment of CaV as a marker of membrane integrity by fluorescence microscopy is a decisive first step towards further technical development and use with flow cytometry.

Thermodynamic optimization of 10–30 kA gas-cooled current leads with REBCO tapes for superconducting magnets at 20 K

Thermodynamic optimization is carried out to minimize the refrigeration work of gas-cooled current leads at a current level of 10–30 kA for superconducting magnets at 20 K. The binary HTS lead is a serial combination of REBCO (rare-earth barium copper oxide) tapes as cold part and copper conductor as warm part. In gas-cooled leads, liquid nitrogen is not used, but cold helium gas is supplied for forced-flow cooling through the channel between spiral fins of copper conductor. A special attention is paid to the conditions of gas-cooling, which can be integrated with a closed refrigeration cycle without any heat intercept or boil-off loss of liquid. The input power for refrigeration is rigorously calculated with the temperature-dependent properties of conductors. When a safety margin is selected on the critical current of REBCO, it is proven that there exists a unique optimum in the cooling-gas temperature and the dimensional size of copper conductor to minimize the required work for refrigeration. The results are compared with the optimized cases of conduction-cooled and vapor-cooled binary leads for 20 K magnets. The details of optimization procedure and design data are presented for practical application.

Combinatorial protein dimerization enables precise multi-input synthetic computations

Bacterial transcription factors (TFs) with helix-turn-helix (HTH) DNA-binding domains have been widely explored to build orthogonal transcriptional regulation systems in mammalian cells. Here we capitalize on the modular structure of these proteins to build a framework for multi-input logic gates relying on serial combinations of inducible protein–protein interactions. We found that for some TFs, their HTH domain alone is sufficient for DNA binding. By fusing the HTH domain to TFs, we established dimerization dependent rather than DNA-binding-dependent activation. This enabled us to convert gene switches from OFF-type into more widely applicable ON-type systems and to create mammalian gene switches responsive to new inducers. By combining both OFF and ON modes of action, we built a compact, high-performance bandpass filter. Furthermore, we were able to show cytosolic and extracellular dimerization. Cascading up to five pairwise fusion proteins yielded robust multi-input AND logic gates. Combinations of different pairwise fusion proteins afforded a variety of 4-input 1-output AND and OR logic gate configurations.

Serum sirtuin-1 a potential marker in the diagnosis of rheumatoid arthritis

Introduction: To explore the value of serum sirtuin-1 (SIRT1) in the diagnosis and evaluation of joint mobility of rheumatoid arthritis (RA). Materials and Methods: Serum was randomly obtained from 212 RA patients,210 non-RA patients and 58 healthy controls in a large tertiary first-class hospital in Jiangxi province from November 2021 to June 2022. The level of serum Sirt1,anti-cyclic citrulline polypeptide antibody (anti-CCP), anti-mutant citrulline vimentin antibody (anti-MCV), rheumatoid factor (RF),high-mobility group box 1 (HMGB1), collagen triple helix repeat containing 1 (CTHRC1), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were detected by ELISA, to explore the correlation between them and their value in the diagnosis and evaluation of joint range of motion of RA and statistically analyse their diagnostic efficiency. Results: ① The level of all markers was higher in the RA group than in the non-RA group and the healthy controls (p < 0.05). ② The AUC of the SIRT1 was 0.882, second only to the anti-MCV and anti-CCP. ③ The anti-CCP showed the highest sensitivity to RA diagnosis of 0.948. The specificity and positive predictive value of SIRT1 for the diagnosis of RA were the highest, which are 0.959 and 0.934 respectively. ④ In serial combination, SIRT1/anti-CCP、SIRT1/anti-MCV showed the highest specificity.SIRT1/anti-CCP in parallel combination had the highest sensitivity. ⑤ SIRT1 showed a significant correlation with other markers and DAS28 scores (p < 0.01). Conclusion: SIRT1 can be used as a new serological marker for RA diagnosis, which has a significant correlation with RA joint mobility and has a certain reference value in RA differential diagnosis, providing a new detection basis for RA differential diagnosis.

Test of a novel self-centering brace using SMA slip friction damper

This paper reports an experimental work on a novel self-centering brace, which is a serial combination of shape memory alloy slip friction damper and steel tube. The study initiates with describing the axial behavior, in-plane rotational behavior and global buckling behavior of the brace, and deriving the corresponding analytical equations. Then, cyclic loading tests are conducted to obtain the hysteresis behavior of shape memory alloy bolt and the coefficient of kinetic friction of the sliding surfaces, both of which are critical to the behavior of the brace. In what followed, four tests are carried out on a 1/3-scaled specimen, corresponding to four loading protocols. The testing results indicate that the brace exhibits a flag-shaped hysteresis, which is characterized by excellent self-centering capability and satisfactory damping capacity. Using the experimental data, this work quantifies the peak strength, secant stiffness, energy dissipation and equivalent damping ratio, and analyzes the local strains and deformations. Furthermore, three-dimensional finite element models are established for numerical simulations. The finite element models capture the global and local behavior of the brace. Both the analytical equations and numerical simulations agree reasonably well with the experimental data.

Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients with Adnexal Masses.

This study compared the diagnostic performance of different ultrasound-based models in discriminating between benign and malignant ovarian masses in a Filipino population. This was a prospective cohort study in women with findings of an ovarian mass on ultrasound. All included patients underwent a physical examination before level III specialist ultrasonographic and Doppler evaluation using the different International Ovarian Tumor Analysis (IOTA) Group’s risk models. Serum CA-125 and a second-generation multivariate index assay (MIA2G) were also determined for all patients. The ovarian imaging and biomarker results were correlated with the histological findings. A total of 260 patients with completed ultrasound, CA-125, MIA2G, and histopathologic results was included in the study. The presence of papillae with blood flow and irregular cyst walls during the ultrasound were significantly associated with a 20-fold (OR: 20.13, CI: 8.69−46.67, p < 0.01) and 10-fold (OR: 10.11, CI: 5.30−19.28, p < 0.01) increase in the likelihood of a malignant lesion, respectively. All individual sonologic procedures performed well in discerning malignant and benign ovarian lesions. IOTA-LR1 showed the highest accuracy (82.6%, 95% CI: 77.5−87%) for identifying ovarian cancer. IOTA-ADNEX showed the highest sensitivity (93.3%, 95% CI: 87.2−97.1%) while IOTA-LR2 exhibited the highest specificity (84.4%, 95% CI: 77.3−90%). Among the different serial test combinations, IOTA-LR1 with MIA2G and IOTA-LR2 with MIA2G showed the highest diagnostic accuracy (AUROC = 0.82). This study showed that all individual ultrasound-based models performed well in discerning malignant and benign ovarian lesions, with IOTA-LR1 exhibiting the highest accuracy.

A GENERAL RETURN-MAPPING FRAMEWORK FOR FRACTIONAL VISCO-ELASTO-PLASTICITY.

We develop a fractional return-mapping framework for power-law visco-elasto-plasticity. In our approach, the fractional viscoelasticity is accounted through canonical combinations of Scott-Blair elements to construct a series of well-known fractional linear viscoelastic models, such as Kelvin-Voigt, Maxwell, Kelvin-Zener and Poynting-Thomson. We also consider a fractional quasi-linear version of Fung's model to account for stress/strain nonlinearity. The fractional viscoelastic models are combined with a fractional visco-plastic device, coupled with fractional viscoelastic models involving serial combinations of Scott-Blair elements. We then develop a general return-mapping procedure, which is fully implicit for linear viscoelastic models, and semi-implicit for the quasi-linear case. We find that, in the correction phase, the discrete stress projection and plastic slip have the same form for all the considered models, although with different property and time-step dependent projection terms. A series of numerical experiments is carried out with analytical and reference solutions to demonstrate the convergence and computational cost of the proposed framework, which is shown to be at least first-order accurate for general loading conditions. Our numerical results demonstrate that the developed framework is more flexible, preserves the numerical accuracy of existing approaches while being more computationally tractable in the visco-plastic range due to a reduction of 50% in CPU time. Our formulation is especially suited for emerging applications of fractional calculus in bio-tissues that present the hallmark of multiple viscoelastic power-laws coupled with visco-plasticity.

MARGINAL: An Automatic Classification of Variants in BRCA1 and BRCA2 Genes Using a Machine Learning Model.

Implementation of next-generation sequencing (NGS) for the genetic analysis of hereditary diseases has resulted in a vast number of genetic variants identified daily, leading to inadequate variant interpretation and, consequently, a lack of useful clinical information for treatment decisions. Herein, we present MARGINAL 1.0.0, a machine learning (ML)-based software for the interpretation of rare BRCA1 and BRCA2 germline variants. MARGINAL software classifies variants into three categories, namely, (likely) pathogenic, of uncertain significance and (likely) benign, implementing the criteria established by the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP). We first annotated BRCA1 and BRCA2 variants using various sources. Then, we automatically implemented the ACMG-AMP criteria, and we finally constructed the ML model for variant classification. To maximize accuracy, we compared the performance of eight different ML algorithms in a classification scheme based on a serial combination of two classifiers. The model showed high predictive abilities with maximum accuracy of 92% and 98%, recall of 92% and 98% and specificity of 90% and 98% for the first and second classifiers, respectively. Our results indicate that using a gene and disease-specific ML automated software for clinical variant evaluation can minimize conflicting interpretations.

Combination of thyroid ultrasound examination (TIRADS) and survivin gene mRNA expression to determine the type of thyroid nodule

Background: Ultrasound plays a significant role in determining the diagnosis of thyroid nodules. The thyroid ultrasound examination is operator dependent, so the Thyroid Imaging Reporting and Data System (TIRADS) method were developed. However, until now TIRADS has not been able to replace the Fine Needle Aspiration (FNA) examination in determining the type of benign or malignant thyroid nodule, so it is necessary to find alternative biomarkers that can be used to increase the sensitivity and specificity of TIRADS. In this study, the mRNA expression of the survivin gene in thyroid nodules was examined in combination with TIRADS so that it is expected to increase the diagnostic value. Method: This study is a diagnostic test with a cross sectional design on 51 patients with thyroid nodules in 5 hospitals on the island of Lombok. Subjects who met the inclusion and exclusion criteria were subjected to TIRADS examination using an ultrasound machine and mRNA expression of the survivin gene using cubital vein blood samples with polymerase chain reaction (PCR). Result: The characteristics of the research subjects were dominated by female sex with age 40 years, TIRADS 3 and histology of benign thyroid nodules. Analysis using the ROC curve obtained TIRADS has a sensitivity of 94.4%, specificity 39.4%, accuracy 58.82%, Positive Predictive Value (PPV) 45.9%, Negative Predictive Value (NPV) 92.9%. While Survivin has 100% sensitivity, 60.6% specificity, 58.1% accuracy, 58.1% PPV, 100% NPV. In the serial combination of TIRADS and survivin, there was an increase in the diagnostic value, namely sensitivity 94.4%, specificity 75.8%, accuracy 82.35%, PPV 68%, NPV 96.2%. Conclusion: The combination of TIRADS and survivin can increase the diagnostic value in determining the type of thyroid nodule