Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-based computer-assisted detection(CADe)techniques were established from small single-center datasets,and unrepresentative learning materials might confine their application and generalization in wide practice.Although CADes have been reported to identify polyps in colonoscopic images and videos in real time,their diagnostic performance deserves to be further validated in clinical practice.AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.METHODS With high-quality screening and labeling from 55 qualified colonoscopists,a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe.In addition,the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps.Finally,we conducted a selfcontrolled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.RESULTS The CADe was able to identify polyps in the test dataset with 95.0%sensitivity and 99.1%specificity.For colonoscopy videos,all 86 polyps were detected with 92.2%sensitivity and 93.6%specificity in frame-by-frame analysis.In the prospective validation,the sensitivity of CAD in identifying polyps was 98.4%(185/188).Folds,reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies.Colonoscopists can detect more polyps(0.90 vs 0.82,P<0.001)and adenomas(0.32 vs 0.30,P=0.045)with the aid of CADe,particularly polyps<5 mm and flat polyps(0.65 vs 0.57,P<0.001;0.74 vs 0.67,P=0.001,respectively).However,high efficacy is not realized in colonoscopies with inadequate bowel preparation and withdrawal time(P=0.32;P=0.16,respectively).CONCLUSION CADe is feasible in the clinical setting and might help endoscopists detect more polyps and adenomas,and further confirmation is warranted.

化学课堂新知识:新型碳材料--石墨炔

我国科学家李玉良院士首次用化学方法成功制备了石墨炔,得到了不同领域科研工作者的广泛关注并迅速发展成为新研究领域和热点。作为一种新型的碳材料,石墨炔具有独特的孔洞结构和电子结构,研究表明它在能源、催化等领域具有重要的潜在应用。本文介绍了石墨炔的理论预测、实验制备及其在储能方面和催化方面的研究现状和发展趋势。将这种具有中国自主产权的新型碳材料引入到大学化学的相关课堂教学中,可以拓展学生的科研学术视野,提高本科生的学习兴趣及科研素养。

Prevention and control of HIV/AIDS in China:lessons from the past three decades

In the past 37 years,human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)has undergone various major transmission routes in China,with the world most complex co-circulating HIV-1 subtypes,even the prevalence is still low.In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection,China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing,which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection.China has been providing free antiretroviral therapy(ART)since 2003,which covered>80%of the identified patients and achieved a viral suppression rate of 91%.To bend the curve of increasing the disease burden of HIV and finally end the epidemic,China should consider constraining HIV spread through sexual transmission,narrowing the gaps in identifying HIV cases,and the long-term effectiveness and safety of ART in the future.

Pediatric reference intervals in China(PRINCE):design and rationale for a large,multicenter collaborative cross-sectional study

There is a lack of accurate pediatric reference intervals(RIs) in China, with most commonly used RIs established without consideration of the effect of age and gender. The Pediatric Reference Intervals in China(PRINCE) project aims to establish and verify pediatric RIs for 31 common laboratory measurands.The project will be a large, multicenter cross-sectional study:14,490 healthy children and adolescents aged up to 19 years will be surveyed by 10 children's hospitals and one pediatric department of a university hospital. To evaluate the feasibility and efficiency of the study methods, 602 children were surveyed in the pilot phase of the PRINCE study in April 2017: it found that some measurands were distinctly age dependent and that there were differences between values for males and females. The results of the pilot study affirmed the necessity of the PRINCE project for Chinese pediatrics. The pilot also indicated potential difficulties in the full survey, e.g., difficulties in recruiting children aged under 3 years and insufficient collection of blood samples from infants. The operation of the PRINCE project has been modified based on the findings in the pilot study toward improving the validity of the PRINCE project and promoting its openness and transparency.

Molecular network-based intervention brings us closer to ending the HIV pandemic

Precise identification of HIV transmission among populations is a key step in public health responses.However,the HIV transmission network is usually difficult to determine.HIV molecular networks can be determined by phylogenetic approach,genetic distance-based approach,and a combination of both approaches.These approaches are increasingly used to identify transmission networks among populations,reconstruct the history of HIV spread,monitor the dynamics of HIV transmission,guide targeted intervention on key subpopulations,and assess the effects of interventions.Simulation and retrospective studies have demonstrated that these molecular network-based interventions are more cost-effective than random or traditional interventions.However,we still need to address several challenges to improve the practice of molecular network-guided targeting interventions to finally end the HIV epidemic.The data remain limited or difficult to obtain,and more automatic real-time tools are required.In addition,molecular and social networks must be combined,and technical parameters and ethnic issues warrant further studies.

High HIV incidence epidemic among men who have sex with men in china: results from a multi-site cross-sectional study

Background:Recent upsurge of new HIV infections among men who have sex with men(MSM)is a major concern in China.Paucity of national-level information regarding the burden and predictors of this progressive epidemic of new infections called for a multi-centric,timely and comprehensive investigation.Methods:Mixed methods were used to recruit MSM from seven cities in China between 2012 and 2013.Recent and established HIV infections were estimated by Western Blot and BED HIV-1 capture enzyme immunoassay.Syphilis and herpes simplex virus-2(HSV-2)were also tested.Results:A total of 4496 eligible MSM were recruited.The majority was aged≤35 years(77.5%),migrants(60.3%),never married(69.8%),and played receptive role in anal sex(70.5%).The HIV prevalence was 9.9%,and 41.9%were recently infected,with sensitivity/specificity adjusted HIV incidence of 8.9(95%CI:7.6-10.2)/100 Person-Years.The prevalence of history HSV-2 and syphilis were 12.5%and 8.5%,respectively.Recent HIV infection was associated with having multiple male partners(aOR=1.4,95%CI 1.1-1.9),recreational drug use(aOR=2.2,95%CI 1.6-3.0),anal bleeding(aOR=2.1,95%CI 1.4-3.0),syphilis infection(aOR=2.8,95%CI 1.9-4.3)and history HSV-2 infection(aOR=2.3,95%CI 1.5-3.3).Conclusion:High rate of recent HIV infection is potentially resulting in progressive deterioration of the overall HIV epidemic among MSM in China.Targeted interventions to address high-risk MSM including those having multiple partners,history of recreational drug use and syphilis or HSV-2 infection seemed to be the need of the hour.

Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China:a multicentre cross-sectional survey

Background:Delayed or inappropriate treatment for sexually transmitted diseases(STDs)increases the risk of HIV acquisition and may cause other harmful outcomes.However,studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men(MSM)are scarce.This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM.Methods:During 2012-2013,a multicentre cross-sectional study was conducted in 7 Chinese cities.Participants completed an interview-questionnaire and gave venous blood samples,which were then tested for antibodies to HIV,syphilis,and herpes simplex virus-2(HSV-2).MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM.Results:Of the 4496 eligible MSM who completed this survey,24.4%(1096/4496)were categorized as suspected STD-infected MSM.35.7%(391/1096)of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months.Among MSM who did not attend STD clinics for treatment,the prevalence of syphilis and HSV-2 was significantly higher;the HIV prevalence and incidence within this subpopulation reached as high as 14.5%and 12.2/100 person-years,respectively.Multivariate logistic regression analysis indicated that having 7-12 years of education(vs.≤6 years;aOR,2.5;95%CI,1.0-6.1),≥13 years of education(vs.≤6 years:aOR,2.8;95%CI,1.2-7.0),monthly income>500 USD(vs.≤500 USD:aOR,1.5;95%CI,1.1-2.1),obvious STD-related symptoms within last 12 months(aOR,5.3;95%CI,3.7-7.5),being HIV infected(aOR,1.7;95%CI,1.1-2.6),currently syphilis infected(aOR,0.6;95%CI,0.4-0.9)and HSV-2 infected(aOR,0.6;95%CI,0.5-0.9)were independent correlates with seeking STD treatment in clinics among Chinese MSM.Conclusions:The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM.Models that prioritize better screening for and education about STDs should be urgently implemented,especially among low-income MSM.

Disparity of human immunodeficiency virus incidence and drug resistance in college student,non-student youth and older men who have sex with men:a cross-sectional study from seven major cities of China

Background:Human immunodeficiency virus(HIV)prevalence among student men who have sex with men(MSM)in college is more than 5.0%and keeps on increasing in China.This study aims to clarify the proportion of HIV recent infection,its propeller and the source among college student MSM.Methods:We conducted a multicenter cross-sectional study in seven major Chinese cities during 2012-2013.HIV recent infections(≤168 days)and incidence was measured and estimated by BED HIV-1 capture enzyme immunoassay(BED-CEIA)testing strategy.HIV-related behaviors and transmitted drug resistance(TDR)were investigated and compared between the college student MSM,<25-year-old non-student youth MSM(NSYM),and≥25-year-old non-student non-youth MSM(NSNYM),using structured survey,and analyses of drug resistance.Results:Overall,4496(4496/4526,99.3%)were eligible for enrollment,comprising 565 college student MSM,1094 NSYM,and 2837 NSNYM.The proportion of HIV recent infection were 70.3%(26/37),50.8%(65/128)and 35.1%(95/271),the HIV incidence rate were 10.0(95%CI:6.2-13.9)/100 person-year(PY),12.9(95%CI:9.8-16.1)/100PY,6.8(95%CI:5.4-8.2)/100 PY,and TDR prevalences were 7.4%(2/27),2.0%,(2/98)and 4.9%(11/226),among student MSM,NSYM,and NSNYM,respectively.Among HIV positive student MSM with age<21 years,the proportion of HIV recent infection is 90.9%(10/11).Factors independently associated with HIV recent infection in student MSM was usage of recreational drug in the past 6 months(adjusted odds ratio[aOR]:2.5;95%CI:1.0-5.8).Conclusions:College student MSM had higher proportion of HIV recent infection and TDR than the youth and older MSM in China during 2012-2013.The HIV infections were more likely to happen during the early year of college life among student MSM.

Characteristics of language impairment in Parkinson’s disease and its influencing factors

Background:Language impairment is relatively common in Parkinson’s disease(PD),but not all PD patients are susceptible to language problems.In this study,we identified among a sample of PD patients those pre-disposed to language impairment,describe their clinical profiles,and consider factors that may precipitate language disability in these patients.Methods:A cross-sectional cohort of 31 PD patients and 20 controls were administered the Chinese version of the Western Aphasia Battery(WAB)to assess language abilities,and the Montreal Cognitive Assessment(MoCA)to determine cognitive status.PD patients were then apportioned to a language-impaired PD(LI-PD)group or a PD group with no language impairment(NLI-PD).Performance on the WAB and MoCA was investigated for correlation with the aphasia quotient deterioration rate(AQDR).Results:The PD patients scored significantly lower on most of the WAB subtests than did the controls.The aphasia quotient,cortical quotient,and spontaneous speech and naming subtests of the WAB were significantly different between LI-PD and NLI-PD groups.The AQDR scores significantly and positively correlated with age at onset and motor function deterioration.Conclusion:A subset group was susceptible to language dysfunction,a major deficit in spontaneous speech.Once established,dysphasia progression is closely associated with age at onset and motor disability progression.

Natural history of HIV infection in former plasma donors in rural China

Patients infected through commercial bloodselling practices(former plasma donors,FPDs)in China represent a unique patient population compared to individuals infected through sexual contact or intravenous drug use.FPDs all have an approximate time of human immunodeficiency virus(HIV)infection during the mid-1990s.Few studies about the natural history of HIV infection in these patients were performed.The current study focuses on characterizing the duration of asymptomatic infection as well as the time to disease and mortality of infected FPDs in China.A retrospective cohort study was conducted based on data collected from 5484 HIV-1 infected FPDs in Shangcai county,Henan province.Kaplan-Meier analysis was applied to estimate the asymptomatic duration from the time of infection to the onset of AIDS as well as the survival period from the onset of AIDS to the time of death.The estimated median asymptomatic phase was about 9.21 years,which is similar to that reported in other developing countries in Africa.The estimated median life span after the onset of symptoms was about 9.91 months,which is notably shorter than life spans reported elsewhere.This is the first large-scale retrospective study on the natural history of HIV infection in FPDs in rural China.The findings not only provide valuable insight into an understudied population,but should also serve as an important reference for patient management and care.

Expanding human immunodeficiency virus testing:whole society participation and multilevel promotion

Human immunodeficiency virus(HIV)testing is the only way to find people living with HIV(PLWH).Early diagnosis and early treatment of HIV can extend the life of PLWH and reduce the subsequent transmission of HIV.Therefore,HIV testing plays a crucial role in public health.The global scale of HIV testing has expanded significantly over the past 10 years.Of the estimated 37 million people with HIV worldwide,approximately 79%knew their HIV status in 2018,compared with 12%in 2005.By 2018,68.9%of PLWH in China had received a diagnosis.[1]This number is far from the target of 90%of PLWH knowing their HIV status,which is advocated in the implementation plan for containing the spread of HIV/acquired immuno-deficiency syndrome(AIDS)(2019–2022).[2]Expanding HIV testing has become an essential and challenging issue for China’s current HIV/AIDS prevention and control.

Consensus statement on human immunodeficiency virus pre-exposure prophylaxis in China

Introduction Although the global human immunodeficiency virus(HIV)epidemic has been effectively curbed,preventing and managing HIV infection in high-risk populations remains challenging.[1]In China,HIV is primarily transmitted through sexual contact.[1,2]Pre-exposure prophylaxis(PrEP)is a new and effective method for preventing HIV infection using antiretroviral drugs[3];data from multiple clinical trials worldwide have shown that using antiretroviral drugs for PrEP can limit HIV transmission.[4,5,6,7]The World Health Organization(WHO)issued guidelines in 2015 recommending PrEP in populations with an HIV incidence above 3/100 person-years(PY)and in individuals engaging in high-risk behaviors.[3]According to existing studies,the HIV incidence among key populations in China was 5.6/100 PY for men who have sex with men(MSM),[8]1.6/100 PY for intravenous drug users(IDUs),[9]and 1.4/100 PY for female sex workers.[10,11]As of July 2020,54 countries and regions have issued PrEP guidelines for adults to prevent HIV infection,and 36 of these have also published guidelines for children and adolescents.However,there are no PrEP guidelines or related consensus statement in China.As such,there is a strong need for standardized guidance on the implementation of PrEP pertaining to medical selection criteria,PrEP timing,drug safety,and consultation and testing programs.Here we present the consensus statement on the implementation of PrEP in China based on the opinions and suggestions of health policy-makers,scientists,clinical experts,community-based organizations of key populations,and the latest reports in PrEP researches.

The Establishment and Spatiotemporal History of A Novel HIV-1 CRF01_AE Lineage in Shenyang City, Northeastern China in 2002–2019

Dear Editor,In China,HIV-1 CRF01_AE has always been one of the most prevalent subtypes,especially among sexually active population,since it was initially reported in Yunnan and Guangxi Provinces during the early 1990s(Cheng et al.1994;Yu et al.1998;Chen et al.1999).Multiple independent introductions of CRF01_AE have led to the establishment of at least eight epidemic lineages in China,which have been circulating among different high-risk populations and have variable prevalence and geographic distribution(Li et al.2017).