Development and validation of a novel colonoscopy withdrawal time indicator based on YOLOv5.

BACKGROUND AND AIM: The study aims to introduce a novel indicator, effective withdrawal time (WTS), which measures the time spent actively searching for suspicious lesions during colonoscopy and to compare WTS and the conventional withdrawal time (WT). METHODS: Colonoscopy video data from 472 patients across two hospitals were retrospectively analyzed. WTS was computed through a combination of artificial intelligence (AI) and manual verification. The results obtained through WTS were compared with those generated by the AI system. Patients were categorized into four groups based on the presence of polyps and whether resections or biopsies were performed. Bland Altman plots were utilized to compare AI-computed WTS with manually verified WTS. Scatterplots were used to illustrate WTS within the four groups, among different hospitals, and across various physicians. A parallel box plot was employed to depict the proportions of WTS relative to WT within each of the four groups. RESULTS: The study included 472 patients, with a median age of 55 years, and 57.8% were male. A significant correlation with manually verified WTS (r = 0.918) was observed in AI-computed WTS. Significant differences in WTS/WT among the four groups were revealed by the parallel box plot (P < 0.001). The group with no detected polyps had the highest WTS/WT, with a median of 0.69 (interquartile range: 0.40, 0.97). WTS patterns were found to be varied between the two hospitals and among senior and junior physicians. CONCLUSIONS: A promising alternative to traditional WT for quality control and training assessment in colonoscopy is offered by AI-assisted computation of WTS.

Transcutaneous Electrical Acupoints Stimulation Improves Spontaneous Voiding Recovery After Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

BACKGROUND: Facilitating the recurrence of spontaneous voiding is considered to be a way to prevent urinary retention after surgery, which is of great importance in cholecystectomy. This study aimed to assess the effect of transcutaneous electrical acupoint stimulation (TEAS) on spontaneous voiding recovery after laparoscopic cholecystectom. METHODS: Participants who underwent elective laparoscopic cholecystectomy were randomly assigned to either the TEAS group or the sham group. Active TEAS or sham TEAS at specific acupuncture points was conducted intraoperatively and postoperatively. The primary outcome was the recovery speed of spontaneous voiding ability after surgery and secondary outcomes included postoperative urinary retention (POUR), voiding dysfunction, pain, anxiety and depression, and early recovery after surgery. RESULTS: A total of 1,948 participants were recruited and randomized to TEAS (n = 975) or sham (n = 973) between August 2018 and June 2020. TEAS shortens the time delay of the first spontaneous voiding after laparoscopic cholecystectomy (5.6 h [IQR, 3.7-8.1 h] in the TEAS group vs 7.0 h [IQR, 4.7-9.7 h] in the sham group) (p < 0.001). The TEAS group experienced less POUR (p = 0.020), less voiding difficulty (p < 0.001), less anxiety and depression (p < 0.001), reduced pain (p = 0.007), and earlier ambulation (p = 0.01) than the sham group. CONCLUSIONS: Our results showed that TEAS is an effective approach to accelerate the recovery of spontaneous voiding and reduce POUR which facilitates recovery for patients after laparoscopic cholecystectomy.

Cesarean delivery and risk of childhood obesity.

OBJECTIVE: To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity. STUDY DESIGN: Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics. RESULTS: Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m(2) vs 22.5 kg/m(2)), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29). CONCLUSION: Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood.

Food intake and overweight in school-aged children in Germany: Results of the GINIplus and LISAplus studies.

OBJECTIVE: To investigate the cross-sectional association between food intake and overweight in children. METHODS: Height and weight were measured in 2,565 school-aged children. Intakes of 11 food groups were categorized (low, medium and high) using specific tertile cutoffs. Multivariate energy partition models were applied. Adjustment included energy intake from other food groups, city, family income, parental education and 'screen' time. Possible underreporters were identified and used in sensitivity analyses. RESULTS: Compared to low intake, high intakes of meat, fish, beverages and bakery products were associated with greater BMI z-scores [ß (95% CI) = 0.32 (0.21, 0.42), 0.13 (0.03, 0.24), 0.23 (0.11, 0.35) and 0.10 (-0.01, 0.20)] and increased risk of being overweight [odds ratio (OR) (95% CI) = 2.08 (1.58, 2.73), 1.39 (1.08, 1.80), 1.36 (1.01, 1.84) and 1.62 (1.24, 2.11)]. Conversely, medium and high intakes of confectionery were associated with smaller BMI z-scores [ß = -0.18 (-0.28, -0.07) and -0.22 (-0.33, -0.12)] and decreased risk of being overweight [OR = 0.64 (0.50, 0.83) and 0.53 (0.40, 0.68)]. These associations were robust to sensitivity analyses. CONCLUSIONS: Intakes of meat, fish, beverages and bakery products correlate with body weight status.

Piezoelectricity, Pyroelectricity, and Ferroelectricity in Biomaterials and Biomedical Applications.

Piezoelectric, pyroelectric, and ferroelectric materials are considered unique biomedical materials due to their dielectric crystals and asymmetric centers that allow them to directly convert various primary forms of energy in the environment, such as sunlight, mechanical energy, and thermal energy, into secondary energy, such as electricity and chemical energy. These materials possess exceptional energy conversion ability and excellent catalytic properties, which have led to their widespread usage within biomedical fields. Numerous biomedical applications have demonstrated great potential with these materials, including disease treatment, biosensors, and tissue engineering. For example, piezoelectric materials are used to stimulate cell growth in bone regeneration, while pyroelectric materials are applied in skin cancer detection and imaging. Ferroelectric materials have even found use in neural implants that record and stimulate electrical activity in the brain. This paper reviews the relationship between ferroelectric, piezoelectric, and pyroelectric effects and the fundamental principles of different catalytic reactions. It also highlights the preparation methods of these three materials and the significant progress made in their biomedical applications. The review concludes by presenting key challenges and future prospects for efficient catalysts based on piezoelectric, pyroelectric, and ferroelectric nanomaterials for biomedical applications.

An Efficient Multi-Task Synergetic Network for Polyp Segmentation and Classification.

Colonoscopy is considered the best diagnostic tool for early detection and resection of polyps, which can effectively prevent consequential colorectal cancer. In clinical practice, segmenting and classifying polyps from colonoscopic images have a great significance since they provide precious information for diagnosis and treatment. In this study, we propose an efficient multi-task synergetic network (EMTS-Net) for concurrent polyp segmentation and classification, and we introduce a polyp classification benchmark for exploring the potential correlations of the above-mentioned two tasks. This framework is composed of an enhanced multi-scale network (EMS-Net) for coarse-grained polyp segmentation, an EMTS-Net (Class) for accurate polyp classification, and an EMTS-Net (Seg) for fine-grained polyp segmentation. Specifically, we first obtain coarse segmentation masks by using EMS-Net. Then, we concatenate these rough masks with colonoscopic images to assist EMTS-Net (Class) in locating and classifying polyps precisely. To further enhance the segmentation performance of polyps, we propose a random multi-scale (RMS) training strategy to eliminate the interference caused by redundant information. In addition, we design an offline dynamic class activation mapping (OFLD CAM) generated by the combined effect of EMTS-Net (Class) and RMS strategy, which optimizes bottlenecks between multi-task networks efficiently and elegantly and helps EMTS-Net (Seg) to perform more accurate polyp segmentation. We evaluate the proposed EMTS-Net on the polyp segmentation and classification benchmarks, and it achieves an average mDice of 0.864 in polyp segmentation and an average AUC of 0.913 with an average accuracy of 0.924 in polyp classification. Quantitative and qualitative evaluations on the polyp segmentation and classification benchmarks demonstrate that our EMTS-Net achieves the best performance and outperforms previous state-of-the-art methods in terms of both efficiency and generalization.

Course and clinical severity of the SARS-CoV-2 Omicron variant infection in Tianjin, China.

There is limited information describing the course and severity of illness in subjects infected by the severe acute respiratory syndrome coronavirus 2 Omicron variant, especially in children. In this population-based cohort study, subjects with Omicron variant infection during the outbreak between January 8 and February 12, 2022 in Tianjin, China were included (n = 429). The main outcomes were the distribution of asymptomatic, mild, moderate, and severe patients, and clinical courses including the interval from positive polymerase chain reaction (PCR) test to the onset, aggravation or relief of symptoms, and the interval of reversing positive PCR-test into negative, and length of hospital stay. Of the 429 subjects (113 [26.3%] children; 239 [55.7%] female; median age, 36 years [interquartile range 15.0 to 55.0 years]), the proportion (95% CI) of symptomatic subjects on admission was 95.6% (93.2%, 97.2%), including 60.4% (55.7%, 64.9%) mild, 35.0% (30.6%, 39.6%) moderate, and 0.2% (0.0%, 1.3%) severe. Compared with adults, children had lower proportion of moderate Covid-19 (8.8% vs 44.3%). On discharge, 45.9% (41.3%, 50.7%) and 42.2% (37.6%, 46.9%) of the subjects were diagnosed as having experienced mild and moderate Covid-19. The median (interquartile range) length of hospital stay was 14.0 (12.0, 15.0) days. The median interval of reversing positive PCR-test into negative was 12.0 (10.0, 13.0) days. Symptomatic and moderate Covid-19 in Omicron infections was common in adults and children, recovery from Omicron infections took around 2 weeks of time. The severe acute respiratory syndrome coronavirus 2 Omicron infection in this study was not as mild as previously suggested.

Two-Dimensional Nanomaterial-based catalytic Medicine: Theories, advanced catalyst and system design.

Two-dimensional nanomaterial-based catalytic medicines that associate the superiorities of novel catalytic mechanisms with nanotechnology have emerged as absorbing therapeutic strategies for cancer therapy. Catalytic medicines featuring high efficiency and selectivity have been widely used as effective anticancer strategies without applying traditional nonselective and highly toxic chemodrugs. Moreover, two-dimensional nanomaterials are characterized by distinctive physicochemical properties, such as a sizeable bandgap, good conductivity, fast electron transfer and photoelectrochemical activity. The introduction of two-dimensional nanomaterials into catalytic medicine provides a more effective, controllable, and precise antitumor strategy. In this review, different types of two-dimensional nanomaterial-based catalytic nanomedicines are generalized, and their catalytic theories, advanced catalytic pathways and catalytic nanosystem design are also discussed in detail. Notably, future challenges and obstacles in the design and further clinical transformation of two-dimensional nanomaterial-based catalytic nanomedicine are prospected.

Viral RNA Load in Symptomatic and Asymptomatic COVID-19 Omicron Variant-Positive Patients.

Objectives: Viral load is important when evaluating viral transmission potential, involving the use of a polymerase chain reaction (PCR) cycle threshold (Ct) value. We aimed to analyze the PCR Ct values of respiratory tract samples taken from patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant strains to evaluate these strains' viral dynamics. Methods: This study comprised 361 patients. The Ct values of SARS-CoV-2-related respiratory samples were compared between symptomatic and asymptomatic patients. Results: The median (25th percentile and 75th percentile) nasopharynx and oropharynx SARS-CoV-2 Ct values were 30.5 (24.5-35.0) and 34.5 (30.0-37.0) in the symptomatic group, respectively, and 27.8 (23.4-34.5) and 33.5 (26.0-35.0) in the asymptomatic group, respectively, without significance. In the symptomatic group, subgroup analyses according to age showed the mean nasal Ct value for patients aged >18 years was 29.0 (23.5-34.5), which was significantly lower than that of patients aged 0-4 years and 5-13 years (36.0 (30.5-38.0) and 34.5 (31.0-39.0), respectively). The nasal Ct value for asymptomatic patients aged >18 years was 25.5 (20.9-28.4), which was significantly lower than of patients aged 5-13 years (34.5 (25.6-36.4)). Conclusion: Our findings suggest that the viral loads of asymptomatic and symptomatic patients did not differ significantly. However, adults infected with SARS-CoV-2 had higher nasal viral loads that those of young children.

Incidence of community-acquired pneumonia in urban China: A national population-based study.

BACKGROUND: Community-acquired pneumonia (CAP) is one of the major global health problems worldwide. However, the epidemiological information of CAP is limited in China. This study aimed to estimate the incidence rate of CAP and describe the epidemiologic characteristics among the Chinese population. METHODS: We conducted a retrospective analysis of CAP incidence using the Chinese Urban Basic Medical Insurance database of 23 provinces in 2016, which covered 427.52 million urban beneficiaries of all age groups in Mainland China. CAP episodes were identified using a diagnosis-term-derived algorithm, and multiple CAP records of one single person within 90 continuous days were considered as one single episode. The incidence rates were calculated and described by sex, age, region, and season. RESULTS: A total of 1.42 million patients were identified as having one or more CAP episodes, and finally a sum of 1.48 million CAP episodes were counted. The overall incidence of CAP was 7.13 (95% CI: 6.11-8.15) per 1000 person-years, in males 7.32 (95% CI: 6.28-8.35) and females 6.93 (95% CI: 5.92-7.94) per 1000 person-years, respectively. The incidence varied by age with a U-shaped curve peaking in children aged < 5 years old [65.80 (95% CI: 62.52-69.08)] and elderly population aged ≥ 80 years old [14.98 (95% CI: 13.63-16.34)]. The incidence varied markedly by regions. Furthermore, the rate showed a clear seasonal trend, which peaked in spring, decreased in summer and autumn, and re-ascended in winter. CONCLUSION: This study reveals a relatively high level of CAP incidence in China. These findings provide baseline data for establishing effective prevention strategies, targeted at susceptible populations, regions, and seasons in China.

Estimating mortality among inpatients with acute exacerbation of chronic obstructive pulmonary disease using registry data.

The study aimed to investigate the demographic characteristics, clinical features, diagnoses, and treatments of hospitalized exacerbation COPD patients, as well as their disease prognoses and economic costs. The study planned to enroll 7600 hospitalized patients (aged ≥18 years with main diagnosis as AECOPD). Study patients were recruited since September 2017, followed up with a 3-year observing period. In the baseline visit, information on demographic characteristics, clinical features, diagnoses, and treatments were collected. In the following visits, treatments and examinations, recurrence of AECOPD, re-admission to hospital, complications, and mortality were recorded. Several validated questionnaires were applied at specific visits. This study included data from 1 September 2017 until 31 December 2022. The data would be used to estimate all-cause mortality during hospital stay, AECOPD recurrence within 1 month after discharge, all-cause and cause-specific mortality, frequency of AECOPD recurrence, lung function, life quality, healthcare costs in the study period, etc.

Caesarean Section has no impact on lung function at the age of 15 years.

BACKGROUND: Epidemiological studies and meta-analyses have shown an increased risk of childhood asthma for children born by Caesarean Section (C-Section). OBJECTIVE: To investigate the effect of delivery by C-Section on lung function and asthma in adolescence in a population-based prospective birth cohort of healthy full term newborns. METHODS: Questionnaire data on mode of delivery and asthma as well as spirometric measurements were available for 1850 adolescents at the age of 15 years, who participated in a follow-up examination of the GINIplus study. Linear regression models were used to examine associations between mode of delivery and lung function parameters. Two reference populations (Lunokid and GLI) were used to calculate the standardized z-scores of lung function parameters. RESULTS: The mean difference in lung function parameters for adolescents born by C-Section, compared to vaginal delivery was not statistically significant. The risk for developing asthma by the age of 15 years was not higher in children born by C-Section-OR: 0.87 (95% CI: 0.57, 1.33) adjusted for sex, age, study center, and parental education level. CONCLUSION: C-Section was not associated with impaired lung function or an increased risk of asthma at the age of 15 years in our birth cohort of healthy full term neonates.

[Physical activities and dietary intervention on metabolic syndrome in children].

OBJECTIVE: To study the effect of physical activities and dietary intervention on metabolic syndrome (MS) in primary school students. METHODS: Either one-year physical activities (PA) or dietary intervention was conducted in Grade 1-5 children from eight primary schools in Haidian district, Beijing. A 'happy 10 minutes' program was held in the PA group, while the dietary group receiving nutrition lectures. Baseline and post-intervention data on height, weight, waist circumference, serum lipids, glucose, and blood pressure were collected. RESULTS: The prevalence of MS at baseline was 9.0%. After intervention programs were carried out, improvements on triglyceride, high density lipoprotein, fasting blood glucose, diastolic blood pressure and waist circumference in the dietary group or PA group were seen, with the dietary group showed better effects than the PA group. The prevalence of MS decreased from 10.4% to 4.6% in the dietary group with statistically significant difference, while it increased in both the PA group and the control group. Girls showed better effects in the dietary group. Older students showed better effects than the younger students in the PA group. In non-overweight and overweight students of the dietary intervention group, the MS related components were significantly improved. CONCLUSION: The prevalence of metabolic syndrome was relatively high in the primary school students in Beijing. Education on nutrition could reduce the prevalence and improve the related components, which seemed to be more effective than in the PA intervention. Sex, age and nutritional status were the confounding factors for intervention programs.