Feasibility of a clinical-radiomics combined model to predict the occurrence of stroke-associated pneumonia.

PURPOSE: To explore the predictive value of radiomics in predicting stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients and construct a prediction model based on clinical features and DWI-MRI radiomics features. METHODS: Univariate and multivariate logistic regression analyses were used to identify the independent clinical predictors for SAP. Pearson correlation analysis and the least absolute shrinkage and selection operator with ten-fold cross-validation were used to calculate the radiomics score for each feature and identify the predictive radiomics features for SAP. Multivariate logistic regression was used to combine the predictive radiomics features with the independent clinical predictors. The prediction performance of the SAP models was evaluated using receiver operating characteristics (ROC), calibration curves, decision curve analysis, and subgroup analyses. RESULTS: Triglycerides, the neutrophil-to-lymphocyte ratio, dysphagia, the National Institutes of Health Stroke Scale (NIHSS) score, and internal carotid artery stenosis were identified as clinically independent risk factors for SAP. The radiomics scores in patients with SAP were generally higher than in patients without SAP (P < 0. 05). There was a linear positive correlation between radiomics scores and NIHSS scores, as well as between radiomics scores and infarct volume. Infarct volume showed moderate performance in predicting the occurrence of SAP, with an AUC of 0.635. When compared with the other models, the combined prediction model achieved the best area under the ROC (AUC) in both training (AUC = 0.859, 95% CI 0.759-0.936) and validation (AUC = 0.830, 95% CI 0.758-0.896) cohorts (P < 0.05). The calibration curves and decision curve analysis further confirmed the clinical value of the nomogram. Subgroup analysis showed that this nomogram had potential generalization ability. CONCLUSION: The addition of the radiomics features to the clinical model improved the prediction of SAP in AIS patients, which verified its feasibility.

Trend analysis and prediction of the incidence and mortality of CKD in China and the US.

BACKGROUND: Currently, limited research is available on the comparative analysis of chronic kidney disease (CKD) incidence and mortality rates between China and the United States. This study aimed to explore the trends in CKD incidence and mortality rates in both countries, as well as make some future predictions. METHODS: The data on CKD incidence and mortality in China and the US from 1990 to 2019 were derived from the 2019 Global Burden of Disease database. A Joinpoint regression model was used to analyze temporal trends in CKD incidence and mortality. An age-period-cohort model was used to assess the effects of age, period, and birth cohort on CKD risk and forecast the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of CKD in China and the US over the next 15 years. RESULTS: CKD incidence in China and the US showed an upward trend. Its mortality rate showed a downward trend in China but an upward one in the US. The relative risk (RR) of CKD incidence and mortality increases with age. The RR of CKD incidence in the 0-5 age group exceeds that in the 5-55 age group, and the RR for mortality surpasses that in the 5-35 age group. Over time, the RR of CKD incidence has gradually increased in China and the US. Individuals born in later birth cohorts had a lower RR of CKD incidence and mortality. The ASIR of CKD may increase in both China and the US, whereas its ASMR may decline over the next 15 years. CONCLUSION: Screening measures should be strengthened among populations at high risk of CKD; prenatal examinations of pregnant women should be emphasized to reduce CKD incidence in newborns. It is imperative to increase health education and encourage individuals to adopt healthy lifestyles.

General framework of a two-dimensional complex wavelet for fringe projection profilometry.

Single-shot high-accuracy reconstruction of three-dimensional (3D) objects plays an essential role in many fields. Wavelet-based fringe projection profilometry (WFPP) is a popular single-shot imaging method due to its multiple-resolution analysis and non-contact property. However, the construction of mother wavelets for high-accuracy WFPP is still challenging. In this paper, a general framework of two-dimensional (2D) compact support complex wavelet employing the dual-tree concept combined with the one-dimensional (1D) asymmetric wavelet function is proposed. The constructed wavelet has an asymmetric frequency envelope in the radial direction and concentrated energy in a single quadrant of the frequency domain. A method that the constructed wavelet applied in dual-angle rotation-based 2D WFPP is presented for higher accuracy. The theoretical analysis of the proposed method is presented, and a comparison of frequency characteristics between the constructed wavelet and other popular wavelets is conducted. Computer simulations and experiments have demonstrated that the proposed method provides a better reconstruction of 3D shapes in single-shot WFPP.

Low infrared emissivity and broadband wide-angle microwave absorption integrated bi-functional camouflage metamaterial with a hexagonal patch based metasurface superstrate.

This work proposed and demonstrated a bi-functional metamaterial to implement the multispectral camouflage in infrared and microwave bands. Aiming at integrating broadband, wide-angle and low infrared emissivity into one structure, the bi-functional structure is made up of three metasurface layers with different functions. Specifically, a metasurface superstrate based on hexagonal metallic patch was deployed to achieve a low infrared emissivity and a high transmittance of microwave simultaneously. In the framework of equivalent circuit model, the bi-functional structure was designed and optimized. A dielectric transition layer was introduced into the structure to obtain better microwave absorption performances. A sample of such structure was prepared based on optimized geometric parameters and tested. The simulated and measured results indicate that the novel hexagonal patch metasurface superstrate significantly reduces infrared emissivity and the measured emissivity of the structure is about 0.144 in 8-14µm infrared band. Meanwhile, the multilayered structure has a broadband absorption band from 2.32 GHz to 24.8 GHz with 7  mm thickness and is equipped with good angular stability under oblique incidence. In general, the method and specific design proposed in this work will benefit utilizing metasurface to implement bi-functional microwave and infrared camouflage materials with outstanding performances, which are promising for extensive applications.

Biomimetic synthesis of hydroxytyrosol from conversion of tyrosol by mimicking tyrosine hydroxylase.

Hydroxytyrosol, one of the most powerful natural antioxidants, exhibits certificated benefits for human health. In this study, a biomimetic approach to synthesize hydroxytyrosol from the hydroxylation of tyrosol was established. EDTA-Fe2+ coordination complex served as an active center to simulate tyrosine hydroxylase. H2O2 and ascorbic acid were used as oxygen donor and hydrogen donor, respectively. Hydroxy radical and singlet oxygen contributed to active species. The biomimetic system displayed analogous component, structure, and activity with TyrH. Hydroxytyrosol titer of 21.59 mM, and productivity of 9985.92 mg·L-1·h-1 was achieved with 100 mM tyrosol as substrate. The proposed approach provided efficient and convenient route to quickly produce high amount of hydroxytyrosol.

Short-term efficacy and safety of personalized antiplatelet therapy for patients with acute ischaemic stroke or transient ischaemic attack: A randomized clinical trial.

AIMS: The aim of this study was to determine whether the testing strategy for clopidogrel and/or aspirin resistance using CYP2C19 genotyping or urinary 11-dhTxB2 testing has an impact on clinical outcomes. METHODS: A multicentre, randomized, controlled trial was conducted at 14 centres in China from 2019 to 2021. For the intervention group, a specific antiplatelet strategy was assigned based on the CYP2C19 genotype and 11-dhTxB2, a urinary metabolite of aspirin, and the control group received nonguided (ie, standard of care) treatment. 11-dhTXB2 is a thromboxane A2 metabolite that can help quantify the effects of resistance to aspirin in individuals after ingestion. The primary efficacy outcome was new stroke, the secondary efficacy outcome was a poor functional prognosis (a modified Rankin scale score ≥3), and the primary safety outcome was bleeding, all within the 90-day follow-up period. RESULTS: A total of 2815 patients were screened and 2663 patients were enrolled in the trial, with 1344 subjects assigned to the intervention group and 1319 subjects assigned to the control group. A total of 60.1% were carriers of the CYP2C19 loss-of-function allele (*2, *3) and 8.71% tested positive for urinary 11-dhTxB2- indicating aspirin resistance in the intervention group. The primary outcome was not different between the intervention and control groups (P = .842). A total of 200 patients (14.88%) in the intervention group and 240 patients (18.20%) in the control group had a poor functional prognosis (hazard ratio 0.77, 95% confidence interval [CI] 0.63 to 0.95, P = .012). Bleeding events occurred in 49 patients (3.65%) in the intervention group and 72 patients (5.46%) in the control group (hazard ratio 0.66, 95% CI 0.45 to 0.95, P = .025). CONCLUSIONS: Personalized antiplatelet therapy based on the CYP2C19 genotype and 11-dhTxB2 levels was associated with favourable neurological function and reduced bleeding risk in acute ischaemic stroke and transient ischaemic attack patients. The results may help support the role of CYP2C19 genotyping and urinary 11-dhTxB2 testing in the provision of precise clinical treatment.

Real-time assay of invertase activity using isoquinolinylboronic acid as turn-on fluorescent sensor.

Invertase is the key enzyme involved in several crucial biological processes by hydrolyzing sucrose for production of glucose and fructose. Invertase plays important roles in the fields of food, pharmacy, cosmetics, biofuels, and agriculture. Detection of invertase activity is urgently necessary for scientific research and industrial processes. Herein, a continuous fluorometric method was developed for real-time detection of invertase activity. 8-Isoquinolinylboronic acid responded to fructose by formation of a fluorescent complex in turn-on manner, and served as a fluorescent sensor to selectively recognize fructose in ternary enzymatic mixture containing sucrose and glucose. The limit of detection (LOD) for fructose was 0.07 mM. Progress curve for fructose production was established by directly and continuously monitoring the fluorescence for invertase reaction with sucrose as substrate. Initial velocity was obtained to characterize invertase activity. LOD for invertase assay was 0.10 U·mL-1. Km and υmax for invertase were determined as 7.70 mM and 0.86 mM·min-1, respectively. Copper ion was demonstrated to inhibit the invertase activity with IC50 of 33.61 mM. Applicability in high-throughput screening for inhibitor was demonstrated. The proposed method allows for real-time, simple, and rapidly monitoring the invertase activity. It has a broad range of potential applications for kinetics and screening inhibitor.

Multi-omics perspective on studying reproductive biology in Daphnia sinensis.

Daphnia sinensis is a widespread freshwater microcrustacean. The assembled D. sinensis genome totaled 131.58 Mb with 92.23% of the assembly anchored onto 10 chromosomes. Based on the whole genome information, we further compared the transcriptomic and epigenomic characterization among parthenogenetic females, sexual females and males in D. sinensis. Transcriptomic analysis showed that the up-regulated genes in males were mainly grouped into the cuticle, sex differentiation and methyl farnesoate synthesis, which might play a pivotal role in steering development and reproduction processes. By comparison, the highly expressed genes in parthenogenetic females were mainly grouped into energy metabolism, mitosis, and DNA replication, which might contribute to maintaining rapid production of parthenogenetic females, and nutrient uptake for the growth of neonates. The whole-genome DNA methylation analysis showed that the methylation rate in parthenogenetic females was higher than that in sexual females and males, which might contribute to its rapid response to environment stress.

Electromyographic activities of the jaw and facial muscles in subjects with different vertical skeletal patterns and breathing modes.

BACKGROUND: Mouth breathing (MB) can affect morphological changes in the craniofacial structures, electromyography is widely used for quantitative analysis of muscle function. OBJECTIVE: The aim was to evaluate the electromyographic (EMG) activities of the anterior temporalis (TA), masseter muscle (MM), orbicularis oris superior (OOS) and mentalis muscle (MT) in children with different vertical skeletal patterns and breathing modes during rest and various functional mandibular movements. METHODS: BioEMG III was used to measure the variations in EMG activities of TA, MM, OOS, and MT in 185 subjects aged 6-12 years during continuous clenching, rest, maximal intercuspation, lips closed lightly and swallowing. RESULTS: The results of logistic regression analysis showed that the model with vertical skeletal patterns as the dependent variable was ineffective (p = .106), while the model with breathing modes as the dependent variable was effective (p = .000). When considering both vertical skeletal patterns and breathing modes, the following significant differences were found. (1) In the normal-angle group, the EMG ratio in OOS with lips closed lightly of MB was significantly higher than NB (p = .005). (2) In the low-angle group, EMG ratios in TA and MM during the swallowing of MB were significantly lower than NB (p = .020, p = .040, respectively). (3) In the high-angle group, EMG ratios of MB were significantly higher in MT during continuous clenching, rest, lips closed lightly and swallowing (p = .038, p = .036, p = .005, p = .028, respectively), and OOS with lips closed lightly compared to NB (p = .005). CONCLUSION: Breathing modes and vertical skeletal patterns interacted to alter maxillofacial EMG activities, with breathing modes having a greater effect.

The performance and mechanism of iron-mediated chemical oxidation: Advances in hydrogen peroxide, persulfate and percarbonate oxidation.

Many studies have successfully built iron-mediated materials to activate or catalyze Fenton-like reactions, with applications in water and wastewater treatment being investigated. However, the developed materials are rarely compared with each other regarding their performance of organic contaminant removal. In this review, the recent advances of Fenton-like processes in homogeneous and heterogeneous ways are summarized, especially the performance and mechanism of activators including ferrous iron, zero valent iron, iron oxides, iron-loaded carbon, zeolite, and metal organic framework materials. Also, this work mainly compares three O-O bond containing oxidants including hydrogen dioxide, persulfate, and percarbonate, which are environmental-friendly oxidants and feasible for in-situ chemical oxidation. The influence of reaction conditions, catalyst properties and benefits are analyzed and compared. In addition, the challenges and strategies of these oxidants in applications and the major mechanisms of the oxidation process have been discussed. This work can help understand the mechanistic insights of variable Fenton-like reactions, the role of emerging iron-based materials, and provide guidance for choosing appropriate technologies when facing real-world water and wastewater applications.

Dual-angle rotation two-dimensional wavelet transform profilometry.

The two-dimensional continuous wavelet transform (2D CWT) has been widely used in single-shot fringe projection profilometry (FPP) because of its multi-resolution characteristics and anti-noise ability. This Letter aims to develop a novel 2D wavelet transform model in FPP. Dual-angle rotation operation on a 2D wavelet is performed to improve the directional selectivity and frequency localization of the wavelet. The proposed method improves the accuracy of the phase calculation of wavelet transform profilometry (WTP) for higher accuracy reconstruction from the single-shot fringe. We present mathematical expressions, theoretical analysis, and the comparison to traditional 2D WTP. The experiments demonstrate the effectiveness of the proposed method.

Monophenolase assay using excitation-emission matrix fluorescence and ELMAN neural network assisted by whale optimization algorithm.

Tyrosinase plays a vital role for melanogenesis and inherently involves both monophenolase activity and diphenolase activity. Monophenolase catalyzes hydroxylation of tyrosine to l-DOPA (L-3,4-dihydroxyphenylalanine). Real-time monophenolase assay method is of outstanding interest for both scientific research and industrial application. A combined strategy of three-dimensional excitation-emission matrix (EEM) fluorescence spectra and artificial neural network was developed to determine monophenolase activity. A quantitation system for tyrosine in presence of l-DOPA was designed based on ELMAN neural network. Principal component analysis (PCA) was conducted to reduce the dimensionality of fluorescence spectra. Four principal components was used as input variables. Whale optimization algorithm (WOA) was implemented to optimize the initial weights and threshold network. Real-time concentration of tyrosine in monophenolase reaction was monitored to calculate the initial velocity for tyrosine consumption. The exclusive monophenolase activity without interference from diphenolase reaction was determined. Limit of detection (LOD) for monophenolase assay is 0.0113 U mL-1. Using the proposed method, enzyme kinetics for monophenolase was investigate. Km was calculated as 14.16 µM. Inhibitor for monophenolase was screened by using model molecule kojic acid with IC50 of 3.49 µM. The assay method exhibited a promising prospect to characterize the kinetics and inhibitor of monophenolase.

With or without human interference for precise age estimation based on machine learning?

Age estimation can aid in forensic medicine applications, diagnosis, and treatment planning for orthodontics and pediatrics. Existing dental age estimation methods rely heavily on specialized knowledge and are highly subjective, wasting time, and energy, which can be perfectly solved by machine learning techniques. As the key factor affecting the performance of machine learning models, there are usually two methods for feature extraction: human interference and autonomous extraction without human interference. However, previous studies have rarely applied these two methods for feature extraction in the same image analysis task. Herein, we present two types of convolutional neural networks (CNNs) for dental age estimation. One is an automated dental stage evaluation model (ADSE model) based on specified manually defined features, and the other is an automated end-to-end dental age estimation model (ADAE model), which autonomously extracts potential features for dental age estimation. Although the mean absolute error (MAE) of the ADSE model for stage classification is 0.17 stages, its accuracy in dental age estimation is unsatisfactory, with the MAE (1.63 years) being only 0.04 years lower than the manual dental age estimation method (MDAE model). However, the MAE of the ADAE model is 0.83 years, being reduced by half that of the MDAE model. The results show that fully automated feature extraction in a deep learning model without human interference performs better in dental age estimation, prominently increasing the accuracy and objectivity. This indicates that without human interference, machine learning may perform better in the application of medical imaging.

Microheterogeneous Triplet Oxidation of Hydrophobic Organic Contaminants in Dissolved Black Carbon Solutions under Simulated Solar Irradiation.

Dissolved black carbon (DBC) is proven to accelerate the triplet-mediated photodegradation of hydrophobic organic contaminants (HOCs). However, its photosensitization mechanisms are not clear. In this study, five HOCs including 2,4,6-trimethylphenol, N,N-dimethylaniline, 17ß-estradiol, 17α-ethinylestradiol, and bisphenol A were selected as model compounds to explore the triplet-mediated phototransformation of HOCs in illuminated DBC solutions. All five HOCs presented high organic carbon-water partition coefficient (KOC) values in DBC solutions, indicating the strong sorption capacity of DBC for HOCs. When reaching sorption equilibrium, the apparent pseudo-first-order rate constants of HOCs vs log[DBC] were well fitted with a sorption-enhanced phototransformation model (R2 > 0.98). Using the sorption-enhanced phototransformation model, the degradation rates of HOCs determined at intra-DBC (kDBC,HOCs') were 1-2 orders of magnitude higher than those observed in aqueous bulk solution (kHOCsaq). Moreover, typical triplet quenchers (2,4,6-trimethylphenol and oxygen) exhibited a microheterogeneous quenching effect on the triplet-mediated photodegradation of 17ß-estradiol. Therefore, our results suggested that HOCs underwent a microheterogeneous photooxidative degradation process in DBC solutions. Furthermore, a sorption-enhanced phototransformation mechanism was proposed to elucidate the microheterogeneous photooxidative behavior of HOCs in DBC solutions. This study provides new insights into the fate and transport of HOCs in aquatic environments.

An Improved Circular Fringe Fourier Transform Profilometry.

Circular fringe projection profilometry (CFPP), as a branch of carrier fringe projection profilometry, has attracted research interest in recent years. Circular fringe Fourier transform profilometry (CFFTP) has been used to measure out-of-plane objects quickly because the absolute phase can be obtained by employing fewer fringes. However, the existing CFFTP method needs to solve a quadratic equation to calculate the pixel displacement amount related to the height of the object, in which the root-seeking process may get into trouble due to the phase error and the non-uniform period of reference fringe. In this paper, an improved CFFTP method based on a non-telecentric model is presented. The calculation of displacement amount is performed by solving a linear equation instead of a quadratic equation after introducing an extra projection of circular fringe with circular center translation. In addition, Gerchberg iteration is employed to eliminate phase error of the region close to the circular center, and the plane calibration technique is used to eliminate system error by establishing a displacement-to-height look-up table. The mathematical model and theoretical analysis are presented. Simulations and experiments have demonstrated the effectiveness of the proposed method.

Efficiency evaluation of maxillary molar distalization using Invisalign based on palatal rugae registration.

INTRODUCTION: This study aimed to compare the predicted maxillary molar distalization with the achieved clinical outcome using the palatal rugae area for registration and superimposition of digital models. Understanding Invisalign efficiency may assist clinicians in predicting changes, thus applying specific measures to minimize the chance of midcourse correction later. METHODS: The study sample included 38 patients with a mean age of 25.4 years, eligible for Invisalign treatment and requiring distalization of maxillary molars. Two digital models were acquired using iTero intraoral scanner (Align Technology, Santa Clara, Calif) before treatment and after maxillary first and second molar distalization. The 2 digital models were superimposed using the palatal rugae area for registration. The predicted tooth movement compared to the achieved values. One hundred forty-two maxillary molars (71 first molar and 71 second molar) were measured for distal movement, and 228 maxillary anterior teeth were evaluated for anterior anchorage loss. RESULTS: The predicted distal movement of the maxillary first molar (P <0.0001) and maxillary second molar (P <0.0001) differed significantly from the actual values. There was a statistically significant correlation between the amount of distal molar movement and the amount of anchorage loss (r = 0.3900, P <0.008) for the central incisor, and (r = 0.3595, P <0.013) for the lateral incisor. CONCLUSIONS: Invisalign can be used successfully for adult patients requiring maxillary molar distalization when a mean distalization movement of 2.6 mm was prescribed. Clinicians should be aware of the countereffect if maxillary molars are planned to move distally, especially if the patient presented initially with a large overjet, so the need to prescribe overcorrection or the use of auxiliaries can be addressed earlier.

RhANP attenuates endotoxin-derived cognitive dysfunction through subdiaphragmatic vagus nerve-mediated gut microbiota-brain axis.

BACKGROUND: Atrial natriuretic peptide (ANP) secreted from atrial myocytes is shown to possess anti-inflammatory, anti-oxidant and immunomodulatory effects. The aim of this study is to assess the effect of ANP on bacterial lipopolysaccharide (LPS)-induced endotoxemia-derived neuroinflammation and cognitive impairment. METHODS: LPS (5 mg/kg) was given intraperitoneally to mice. Recombinant human ANP (rhANP) (1.0 mg/kg) was injected intravenously 24 h before and/or 10 min after LPS injection. Subdiaphragmatic vagotomy (SDV) was performed 14 days before LPS injection or 28 days before fecal microbiota transplantation (FMT). ANA-12 (0.5 mg/kg) was administrated intraperitoneally 30 min prior to rhANP treatment. RESULTS: LPS (5.0 mg/kg) induced remarkable splenomegaly and an increase in the plasma cytokines at 24 h after LPS injection. There were positive correlations between spleen weight and plasma cytokines levels. LPS also led to increased protein levels of ionized calcium-binding adaptor molecule (iba)-1, cytokines and inducible nitric oxide synthase (iNOS) in the hippocampus. LPS impaired the natural and learned behavior, as demonstrated by an increase in the latency to eat the food in the buried food test and a decrease in the number of entries and duration in the novel arm in the Y maze test. Combined prophylactic and therapeutic treatment with rhANP reversed LPS-induced splenomegaly, hippocampal and peripheral inflammation as well as cognitive impairment. However, rhANP could not further enhance the protective effects of SDV on hippocampal and peripheral inflammation. We further found that PGF mice transplanted with fecal bacteria from rhANP-treated endotoxemia mice alleviated the decreased protein levels of hippocampal polyclonal phosphorylated tyrosine kinase receptor B (p-TrkB), brain-derived neurotrophic factor (BDNF) and cognitive impairment, which was abolished by SDV. Moreover, TrkB/BDNF signaling inhibitor ANA-12 abolished the improving effects of rhANP on LPS-induced cognitive impairment. CONCLUSIONS: Our results suggest that rhANP could mitigate LPS-induced hippocampal inflammation and cognitive dysfunction through subdiaphragmatic vagus nerve-mediated gut microbiota-brain axis.

Two-dimensional complex wavelet with directional selectivity used in fringe projection profilometry.

The continuous wavelet transform (CWT) has been used in fringe projection profilometry (FPP) to recover a three-dimensional surface from a single-frame fringe. This Letter constructs a two-dimensional (2D) continuous complex wavelet employing a 2D real Mexican hat wavelet function, combined with the single-orthant analytical 2D Hilbert transform. The 2D complex wavelet has an asymmetric frequency envelope in the radial direction and the ability of direction selectivity, which results in better matching between the local fringe and daughter wavelets. We provide a complex wavelet construction model, present a theoretical analysis, and conduct experimental validation. The experiments demonstrate that the proposed method provides high phase accuracy in the single-frame FPP method.

Two-dimensional complex wavelet with directional selectivity used in fringe projection profilometry: publisher's note.

This publisher's note contains corrections to Opt. Lett.46, 3653 (2021)OPLEDP0146-959210.1364/OL.420460.

Accurate age classification using manual method and deep convolutional neural network based on orthopantomogram images.

Age estimation is an important challenge in many fields, including immigrant identification, legal requirements, and clinical treatments. Deep learning techniques have been applied for age estimation recently but lacking performance comparison between manual and machine learning methods based on a large sample of dental orthopantomograms (OPGs). In total, we collected 10,257 orthopantomograms for the study. We derived logistic regression linear models for each legal age threshold (14, 16, and 18 years old) for manual method and developed the end-to-end convolutional neural network (CNN) which classified the dental age directly to compare with the manual method. Both methods are based on left mandibular eight permanent teeth or the third molar separately. Our results show that compared with the manual methods (92.5%, 91.3%, and 91.8% for age thresholds of 14, 16, and 18, respectively), the end-to-end CNN models perform better (95.9%, 95.4%, and 92.3% for age thresholds of 14, 16, and 18, respectively). This work proves that CNN models can surpass humans in age classification, and the features extracted by machines may be different from that defined by human.