Rotation-Oriented Collaborative Self-Supervised Learning for Retinal Disease Diagnosis

The automatic diagnosis of various conventional ophthalmic diseases from fundus images is important in clinical practice. However, developing such automatic solutions is challenging due to the requirement of a large amount of training data and the expensive annotations for medical images. This paper presents a novel self-supervised learning framework for retinal disease diagnosis to reduce the annotation efforts by learning the visual features from the unlabeled images. To achieve this, we present a rotation-oriented collaborative method that explores rotation-related and rotation-invariant features, which capture discriminative structures from fundus images and also explore the invariant property used for retinal disease classification. We evaluate the proposed method on two public benchmark datasets for retinal disease classification. The experimental results demonstrate that our method outperforms other self-supervised feature learning methods (around 4.2% area under the curve (AUC)). With a large amount of unlabeled data available, our method can surpass the supervised baseline for pathologic myopia (PM) and is very close to the supervised baseline for age-related macular degeneration (AMD), showing the potential benefit of our method in clinical practice.

Epidemiology of Foodborne Disease Outbreaks Caused by Nontyphoidal Salmonella in Zhejiang Province, China, 2010-2019

Nontyphoidal Salmonella infection is a common cause of bacterial foodborne illness in Zhejiang Province, China. This study aimed to summarize the epidemiological and etiological characteristics of the outbreak of nontyphoidal Salmonella infection in Zhejiang Province. Data collected over a 10-year period (2010-2019) from the China National Foodborne Diseases Surveillance Network (NFDSN) were analyzed. A total of 78 outbreaks due to nontyphoidal Salmonella, causing 1450 illnesses and 353 hospitalizations with no deaths, were reported. The outbreak rate from May to October was about four times as high as that in other months. In addition, 33.3% (25/78) outbreaks occurred in household settings, and 41.8% (606/1450) cases were exposed at bakery product-processing factories (or shops). Moreover, food vehicles were identified in 75.6% (59/78) of Salmonella outbreaks. Of these, 30.5% (35/59) were caused by cooked meat products, followed by cold-processed cakes and sandwiches usually containing meat and/or eggs (28.81%, 17/59). Salmonella Enteritidis (56.9%, 33/78) and Salmonella Typhimurium (17.2%, 10/78) were the dominant strains. Outbreaks were most frequently attributed to cross-contamination (88.1%) and improper storage temperature (61.0%). Outbreaks caused by Salmonella are important targets for public health intervention efforts, and improving the safety and quality of cooked meat products, cold-processed cakes, and sandwiches should be a priority.

CBD Promotes Oral Ulcer Healing via Inhibiting CMPK2-Mediated Inflammasome

Oral ulcer is a common oral inflammatory lesion accompanied by severe pain but with few effective treatments. Cannabidiol (CBD) is recently emerging for its therapeutic potential in a range of diseases, including inflammatory conditions and cancers. Here we show that CBD oral spray on acid- or trauma-induced oral ulcers on mice tongue inhibits inflammation, relieves pain, and accelerates lesion closure. Notably, the enrichment of genes associated with the NOD, LRR, and NLRP3 pyrin domain-containing protein 3 (NLRP3) inflammasome pathway is downregulated after CBD treatment. The expression of cleaved-gasdermin D (GSDMD) and the percentage of pyroptotic cells are reduced as well. In addition, CBD decreases the expression of cytidine/uridine monophosphate kinase 2 (CMPK2), which subsequently inhibits the generation of oxidized mitochondria DNA and suppresses inflammasome activation. These immunomodulating effects of CBD are mostly blocked by peroxisome proliferator activated receptor γ (PPARγ) antagonist and partially antagonized by CB₁ receptor antagonist. Our results demonstrate that CBD accelerates oral ulcer healing by inhibiting CMPK2-mediated NLRP3 inflammasome activation and pyroptosis, which are mediated mostly by PPARγ in the nucleus and partially by CB₁ in the plasma membrane.

Umbilical cord serum perfluoroalkyl substance mixtures in relation to thyroid function of newborns: Findings from Sheyang Mini Birth Cohort Study

BACKGROUND

The epidemiological evidence on the associations between prenatal exposure to perfluoroalkyl substances (PFAS) and thyroid hormones in newborns was inconclusive.

OBJECTIVES

We aimed to estimate associations of fetal exposure to PFAS individually and in mixtures with thyroid function of newborns.

METHODS

A total of 490 mother-newborn pairs were included from Sheyang Mini Birth Cohort Study (SMBCS), a prospective cohort that recruited between June 2009 and January 2010. 12 PFAS and 7 thyroid function indicators were quantified in umbilical cord serum. We examined associations of prenatal exposure to individual and a mixture of PFAS with thyroid function indicators using multivariable linear regression and weighted quantile sum (WQS) regression models with adjustment for potential confounders, respectively.

RESULTS

Higher cord serum concentrations of PFAS mixtures were related to increases in TT4 and FT4 levels, and reductions in TSH concentrations of newborns. Combining single-chemical models with multiple-chemical models, PFOS, PFNA and PFUnDA were associated with increased TT4 levels with contributing to the mixture effects of 46.4%, 22.8%, and 16.7%, respectively. PFOS exposure was in positive association with cord serum FT4 concentrations and contributed 28.9% to the joint effects of mixtures. PFNA and PFHpA were the most important contributors to the decreases of TSH levels of newborns with 46.3% and 45.0% among the mixtures, respectively.

CONCLUSIONS

The current findings indicated the thyroid disruption of individual PFAS and their mixtures in cord serum. Additional studies are warranted to explore the underlying biological mechanisms, particularly for PFAS mixtures.

CT texture analysis for the presurgical prediction of superior mesenteric-portal vein invasion in pancreatic ductal adenocarcinoma: comparison with CT imaging features

AIM

To investigate the value of computed tomography (CT) texture analysis (TA) and imaging features for evaluating suspected surgical superior mesenteric-portal vein (SMPV) invasion in patients with pancreatic ductal adenocarcinoma (PDAC).

MATERIALS AND METHODS

Fifty-four patients with PDAC in the pancreatic head or uncinate process with suspected SMPV involvement were analysed retrospectively. SMPV invasion status was identified by surgical exploration. For each patient, 396 texture features were extracted on pretreatment CT. Non-parametric tests and minimum redundancy maximum relevance were used for feature selection. A CTTA model was constructed using multivariate logistic regression, and the area under the receiver operating characteristic (AUROC) of the model was calculated. Two reviewers evaluated qualitative imaging features independently for SMPV invasion and interobserver agreement was investigated. The diagnostic performance of the imaging features and the CTTA model for SMPV invasion was compared using the McNemar test.

RESULTS

Of the 54 patients with PDAC, SMPV invasion was detected in 23 (42.6%). The CTTA model yielded an AUROC of 0.88 (95% confidence interval, 0.76-0.97) and achieved significantly higher specificity (0.90) than the two reviewers (0.61 and 0.65; p=0.027 and 0.043). Interobserver agreement was moderate between the two reviewers (κ = 0.517). Of the 13 cases with disagreement between the two reviewers, 11 cases were predicted accurately by the CTTA model.

CONCLUSION

CTTA can predict suspected SMPV invasion in PDAC and may be a beneficial addition for qualitative imaging evaluation.

Immigration and Oral Health in Older Adults: An Integrative Approach

The aim of this study was to develop an integrative framework on aging, immigration, and oral health. The methodology was a critical review that used immigration as a social determinant framework through which to evaluate its impact on the oral health of older immigrants. We reviewed recent empirical evidence on factors related to oral health in older immigrants. In a systematic search across multiple databases, we identified 12 eligible studies in this review. Among the eligible studies, most were conducted among East Asian immigrants (8 articles), followed by non-Hispanic White/European origin (2 articles), Mexican origins (1 article), and Iran and other Middle East regions (1 article). The research revealed knowledge gaps in the evidence base, including the dynamic relationship between acculturation and oral health, the role of environmental factors on oral health for immigrants, psychosocial stressors and their relationship with oral health, and oral health literacy, norms, and attitude to dental care utilization and oral hygiene practices. The development of the integrative framework suggests the pathways/mechanisms through which immigration exerts influences on oral health in later life. This provides opportunities for researchers, practitioners, and policy makers to gain greater insights into the complex associations between immigration and oral health among older adults.

Gated Path Selection Network for Semantic Segmentation

Semantic segmentation is a challenging task that needs to handle large scale variations, deformations, and different viewpoints. In this paper, we develop a novel network named Gated Path Selection Network (GPSNet), which aims to adaptively select receptive fields while maintaining the dense sampling capability. In GPSNet, we first design a two-dimensional SuperNet, which densely incorporates features from growing receptive fields. And then, a Comparative Feature Aggregation (CFA) module is introduced to dynamically aggregate discriminative semantic context. In contrast to previous works that focus on optimizing sparse sampling locations on regular grids, GPSNet can adaptively harvest free form dense semantic context information. The derived adaptive receptive fields and dense sampling locations are data-dependent and flexible which can model various contexts of objects. On two representative semantic segmentation datasets, i.e., Cityscapes and ADE20K, we show that the proposed approach consistently outperforms previous methods without bells and whistles.

Effect of Polyphenols on Cognitive Function: Evidence from Population-Based Studies and Clinical Trials

Due to progressive population aging, a new dementia case occurs at every 3 seconds, placing a heavy burden of disease. Identifying potential risk or preventive factors is emphasized owing to a lack of effective treatment for dementia. There has been emerging evidence on the link of certain dietary components, particularly polyphenols, to brain wellness and cognitive outcomes. Findings from animal and in vitro studies appear more consistent and conclusive. However, such an association has not been investigated in depth in human beings. In this review, we examined studies on the effect of dietary polyphenols (including flavonoids, curcumin, and resveratrol) on cognitive function. Intervention in early stages of dementia/Alzheimer's disease might be a target to slow down age-related cognitive decline before disease onset. We summarized 28 epidemiological studies (8 cross-sectional and 20 cohort studies) and 55 trials in this review. Preliminary evidence from epidemiological data provides the necessity for intervention trials, even though the measures of polyphenol intake tend to be less precise. Clinical trials are in favor of the role of some polyphenols in benefiting specific domains of cognition. This review also describes the divergence of results and current limitations of research in this field.

Prenatal exposure to multiple phenolic compounds, fetal reproductive hormones, and the second to fourth digit ratio of children aged 10 years in a prospective birth cohort

Select phenols are known to possess hormone-disrupting properties, but no previous study has addressed the potential effects of prenatal exposure to phenol mixtures on fetal reproductive hormones and children's second to fourth digit (2D: 4D) ratio, a marker for in utero testosterone (T) exposure. We aimed to explore interrelations of prenatal phenol exposures individually and in mixtures, cord serum reproductive hormones, and 2D: 4D ratio of children aged 10 years. Urinary 11 phenol concentrations were determined from 392 pregnant women participating in a longitudinal birth cohort. We estimated associations of prenatal phenol exposures individually and in mixtures with cord reproductive hormones and children's 2D:4D ratio using three statistical approaches, including generalized linear models (GLMs), elastic net regression (ENR) models and Bayesian kernel machine regression (BKMR) models. In female newborns, the three models showed that maternal triclosan (TCS) concentrations were significantly negatively associated with cord serum T levels [regression coefficient (β) = -0.076, 95% confidence interval (CI): 0.138, -0.013; p = 0.018]. Additionally, maternal urinary bisphenol A (BPA) levels were related to decreases in 2D:4D ratio of the left hand in girls by GLMs (β = -0.003, 95% CI: 0.007, -0.001; p = 0.024) and ENR models, but not BKMR models. We provided evidence that prenatal TCS exposure predicted lower cord serum T levels, and maternal BPA exposure was related to decreased 2D:4D ratio of the left hand in females.

Early-life carbamate exposure and intelligence quotient of seven-year-old children

BACKGROUND

Early-life carbamate exposure during developmental period has been linked with adverse health effects and attracted attention.

METHODS

Three hundred and three children at age of seven were included in the current study. Urinary carbofuranphenol concentrations were measured using gas chromatography-tandem mass spectrometry. Verbal, performance and full-scale intelligence quotients (IQ_V, IQ_P, and IQ_FS) were assessed using Wechsler Intelligence Scale for Children-Chinese Revised. Generalized linear models were used to explore the associations between carbofuranphenol levels and IQs. Generalized estimating equations were used to explore long-term health effect and sensitive time window.

RESULTS

Carbofuranphenol was detected in 96.6% of the seven-year-old urinary samples, the geometric mean, median, and inter quartile range of the carbofuranphenol concentrations were 0.67 μg/L, 0.30 μg/L, and 0.09-3.72 μg/L, respectively, which were similar with the level of three-year-old children from the SMBCS cohort. Seven-year-old carbofuranphenol level was negatively associated with IQ_P [β = -0.044; 95% confidence interval (CI): -0.087, -0.001; p = 0.045]. Three-year-old carbofuranphenol level was negatively associated with IQ_P (β = -0.100; 95% CI: -0.186, -0.014; p = 0.022) and IQ_FS (β = -0.087; 95% CI: -0.173, -0.001; p = 0.047). Carbamate exposure of maternal and children at both three and seven years old had negative associations with IQ_P (β = -0.089; 95% CI: -0.171, -0.007; p = 0.034), and IQ_FS (β = -0.064; 95% CI: -0.127, -0.000; p = 0.049) of children at age of seven.

CONCLUSION

Results of the present study verify that children in an agricultural region of China were widely exposed to carbamate pesticides. Carbamate exposure in utero and at three and seven years may adversely impact children's neurodevelopment.

Maternal and childhood urinary phenol concentrations, neonatal thyroid function, and behavioral problems at 10 years of age: The SMBCS study

BACKGROUND

Environmental phenols, bisphenol A (BPA), triclosan (TCS), and benzophenone-3 (BP-3), are known as emerging endocrine-disrupting chemicals; however, their impacts on thyroid hormones and children's neurobehaviors are still unclear.

OBJECTIVES

We aimed to examine the associations of prenatal and childhood exposure to phenols with neonatal thyroid function and childhood behavioral problems aged 10 years.

METHODS

A total of 386 mother-singleton pairs were included from Sheyang Mini Birth Cohort Study (SMBCS), a longitudinal birth cohort in China. We quantified urinary BPA, TCS and BP-3 concentrations in maternal and 10-year-old children's urine samples using gas chromatography tandem mass spectrometry and thyroid function parameters in cord serum samples. Caregivers completed the Strength and Difficulties Questionnaire (SDQ) for their children at 10 years of age. Multivariable linear regression models and logistic regression models were applied to estimate associations of urinary phenol concentrations with thyroid hormones and risks of children's behavioral problems, respectively.

RESULTS

The median values of urinary BPA, TCS and BP-3 concentrations for pregnant women were 1.75 μg/L, 0.54 μg/L and 0.37 μg/L, while 1.29 μg/L, 6.64 μg/L and 1.39 μg/L for children, respectively. Maternal urinary BPA concentrations were in associations with 1.00% [95% confidence interval (CI): 0.20%, 1.92%] increases in cord serum FT4 concentrations and significantly associated with increased risks of total difficulties [odds ratio (OR): 1.45, 95% CI: 1.07, 1.97], while maternal urinary levels of BP-3 were significantly related to poorer prosocial behaviors (OR: 1.58, 95% CI: 1.04, 2.39) of children at 10 years of age. In sex-stratified analyses, maternal urinary BPA concentrations were related to increased total difficulty subscales only in boys.

CONCLUSIONS

The findings indicated that higher prenatal urinary BPA concentrations were associated with increased risks of total difficulties, especially in boys and maternal urinary BP-3 concentrations were related to poorer prosocial behaviors at 10 years.

Patterns of left ventricular longitudinal myocardial dysfunction in mitral valve prolapse and effects of valve repair

Background

Regional longitudinal left ventricular (LV) dysfunction in patients with mitral regurgitation (MR) due to valve prolapse (MVP) with normal ejection fraction has been recently described, with data pointing at dysfunction of the LV base related to dilatation of the mitral annulus.

Purpose

To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP and severe acute (MRa, n=27) or chronic (MRc, n=41) MR and no coronary disease, undergoing surgical valve repair with 3 months follow-up (FU); 20 normal subjects were used as controls (N).

Methods

Speckle-tracking echocardiography was performed pre- (Bas), 1 week (1w) and 4 months (4mo) post-operatively to measure longitudinal global (GLPSS, %), regional (RPSS, %) and segmental (SPSS) peak systolic strain. Maximum and minimum mitral annulus (MA) diameters were measured with 3D echo at Bas. We also evaluated: LV end-diastolic volume index (EDVi, ml/m2); ejection fraction (EF, %); left atrial end-systolic volume index (LAVi, ml/m2); non-invasive pulmonary systolic pressure (PSP, mmHg).

Results

Risk factors (hypertension, diabetes, atrial fibrillation, smoke and previous stroke) were similar in MRc and MRa. At Bas EDVi was larger by definition in MRc (MRc: 102±21, MRa: 67±10 ml/m2, p<0.001) as LAVi (101±46 vs 76±31 ml/m2, p=0.035). Both EF (65±8 vs 64±8 ml/m2) and GLPSS (−20±4 vs −21±5%) were normal, but RPSS was reduced, only at the base (−13±6 vs −13±6%, p= ns; N: −18±2, p<0.03 vs MRc and MRa) in MRc and MRa, with reduced SPSS localized at anterior, lateral and posterior – but not septal – segments. At 1w, EF decreased in both MRc (47±14%, p<0.001 vs Bas) and MRa (56±10%, p=0.014 vs Bas), together with GLPSS (MRc: −11±4%, p<0.001 vs Bas; MRa; −13±4, p<0.001 vs Bas) driven by a prevalent marked decrease in RPSS (MRc: −7±4%, p<0.001 vs Bas; MRa; −8±5, p<0.001 vs Bas) of the LV base. All patients were alive at 3 months with no MACEs, similar reduction of mean MR grade (MRc: 4±0 to 1.9±0.7, p<0.001; MRa: 3.9±0.3 to 0.9±0.9, p<0.001) and PSP (MRc: 50±23 to 29±5 mmHg, p<0.001; MRa: 42±22 to 32±6 mmHg, p=0.039), normal EDVi (MRc: 70±27, MRa: 49±10 ml/m2), dilated LAVi (MRc: 101±46, MRa: 54±13 ml/m2), and reduced GLPSS (MRc: −12±5%, p<0.001 vs Bas; MRa; −15±3, p=0.001 vs Bas) and base RPSS (MRc: −7±6%, p=0.004 vs Bas; MRa; −10±4, p= ns vs Bas). At multivariate analysis, regional dysfunction was not related to the prolapsing scallop, presence of flail, commissure involvement, dimension and geometry of the MA, EF or pulmonary pressures.

Conclusions

In patients with MVP and severe MR, there is a specific regional longitudinal dysfunction pattern prevalent at the LV base which may be related to the duration of MR but not to annular dilatation or morphology of the prolapsing leaflets. The dysfunction worsens greatly following acute reduction of preload after surgical repair and is still significant at 4mo FU.

Funding Acknowledgement

Type of funding source: None

Umbilical cord serum PBDE concentrations and child adiposity measures at 7 years

BACKGROUND

Polybrominated diphenyl ethers (PBDEs) exist extensively in the environment. Toxicological studies suggested PBDEs may interfere with adipogenic pathways. However, few human evidence addressed PBDE exposures in utero related to childhood adiposity.

OBJECTIVE

We assessed associations between PBDEs concentrations in cord serum and childhood adiposity measures at 7 years.

METHODS

Among 318 mother-child pairs from Sheyang Mini Birth Cohort Study (SMBCS) in China, nine PBDE congener concentrations were quantified in umbilical cord serum using gas chromatography-negative chemical ionization mass spectrometry (GC-NCI-MS). Anthropometric indicators of children aged 7 years were measured, including weight, height and waist circumference. Age and sex-specific body mass index (BMI) z scores were calculated based on World Health Organization (WHO)'s child growth standards. Multivariate linear and logistic regression models adjusted for putative confounders were performed to examine associations between PBDE congeners and adiposity parameters.

RESULTS

BDE-209 was the most abundant congener of PBDEs with a median value of 19.5 ng/g lipid. The geometric mean values of nine PBDE congeners ranged from below limit of detection (LOD) to 18.1 ng/g lipid, and the detection rates were 46.5%~96.5%. Cord serum BDE-153 and BDE-154 concentrations were associated with lower childhood BMI z score (regression coefficient, β=-0.15, 95% confidence interval: -0.29, -0.02; p=0.02; β=-0.23, 95%CI: -0.43, -0.03; p=0.03, respectively) and lower waist circumference (β=-0.75 cm, 95%CI: -1.43, -0.06; p=0.03; β=-1.22 cm, 95%CI: -2.23, -0.21; p=0.02, respectively), after controlling for potential confounders. Moreover, prenatal BDE-154 exposure was related to a decreased obesity risk of children aged 7 years (odds ratio, OR=0.46, 95%CI: 0.22, 0.94; p=0.03). These effects were only observed among boys in sex-straitified analyses.

CONCLUSIONS

Cord serum BDE-153 and BDE-154 concentrations were related to reduced adiposity measures at 7 years of age. Further evidence regarding the impacts of prenatal PBDE exposures on childhood development is warranted.

The probiotic Lactobacillus casei Shirota attenuates symptoms of vestibular migraine: a randomised placebo-controlled double-blind clinical trial

Vestibular migraine (VM) has emerged as one of the major vestibular syndromes. Although probiotics have exhibited beneficial effects on migraine headache, its effect on VM is not clear. This trial aimed to investigate the treatment efficacy of the probiotic Lactobacillus casei Shirota (LcS) on symptoms of VM. 247 VM patients were enrolled, of which 204 eligible patients receiving either LcS or placebo on a daily basis completed the 4 month study. They were re-visited at 2 and 4 months after study initiation to assess treatment outcomes. The primary endpoints were vestibular symptoms, evaluated by the number of vertiginous attacks during the past week, the Vertigo Severity Score (VSS), and Dizziness Handicap Inventory (DHI) scores. The secondary endpoints were anxiety and depressive symptoms, evaluated using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) scores. Efficacy of LcS over placebo was not obvious at 2 month follow-up. At 4 month follow-up, while both LcS and placebo groups of VM patients displayed alleviated symptoms, the extents of the improvements were significantly better in LcS group than those of placebo group, with regard to vestibular symptoms using DHI and VSS, as well as anxiety and depressive symptoms using BAI and BDI. Although placebo effect cannot be ignored in intervention for VM patients, the probiotic LcS still exhibits considerable efficacy against VM symptoms over a 4 month study period, supporting further clinical study of a larger and more diverse cohort.