The Maillard reaction is a complex process in which amine compounds such as amino acids， peptides， and proteins undergo condensation， polymerization， and other reactions with carbonyl compounds such as reducing sugars， ketones， and aldehydes at room temperature or under heating conditions， ultimately producing substances such as melanoidins and aromatic compounds. The processing of traditional Chinese medicine（TCM） often involves heating and the addition of auxiliary materials， providing complete conditions for the occurrence of the Maillard reaction. The Maillard reaction is affected by various factors such as temperature， pH， moisture， substrate， reaction time and pressure， the progress of the reaction also affected by different processing technologies of TCM and the addition of different excipients. The Maillard reaction involves multiple substances， most of which have significant physiological activity or toxicity， affecting the efficacy and pharmacological effects of TCM. It can also produce various flavor substances and browning products that change the flavor and color of TCM. The Maillard reaction mechanism， influencing factors， related components， and the impact of Maillard reaction on various aspects of TCM processing are reviewed from multiple perspectives in this article， providing reference for the further improvement of processing mechanism and quality control of TCM.

Objective To explore the status quo of medication belief in the patients with myasthenia gravis and analyze their influencing factors,so as to provide reference for health care professionals to develop targeted interventions.Methods A total of 145 patients with myasthenia gravis visiting the First Affiliated Hospital of Guangzhou University of Chinese Medicine from July 2021 to March 2022 were selected.The Be-liefs about Medicines Questionnaire(BMQ)was used to investigate.The multiple linear regression was used to analyze the relevant influencing factors.Results The scores of medication belief,necessity belief and con-cern belief in 145 patients were(4.17±1.23)points,(19.52±3.45)points and(18.29±4.26)points respec-tively.There was statistically significant difference between the scores of necessity belief and concern belief(P＜0.05).The education level,financial burden,duration of illness,length of medication,number of recur-rent hospitalizations,and inappropriate medication-induced exacerbations had influence on the medication be-lief scores of the patients with myasthenia gravis(P＜0.05).The duration of illness,length of medication and number of recurrent hospitalizations had the influence on the medication necessity scores of patients with my-asthenia gravis(P＜0.05).The financial burden had the influence on the medication concerns scores of the patients with myasthenia gravis(P＜0.05).Conclusion The medication belief in the patient swith myasthe-nia gravis is at a low level,and the number of recurrent hospitalizations and financial burden are the independ-ent risk factors affecting the medication belief scores in the patients with myasthenia gravis.The number of recurrent hospitalizations is an independent risk factor for the score of medication necessity dimension.

Objective:To explore the association between insulin resistance (IR) and genome-wide DNA methylation based on Shanghai twin study.Methods:Monozygotic twins (MZ) from Shanghai were recruited during 2012-2013, 2017-2018, and 2022-2023. Data were collected by questionnaire survey, physical examination and laboratory tests. Genome-wide DNA methylation was quantified. Generalized linear mixed effect model was applied to analyze the association between methylation level at each site and homeostatic model assessment 2-insulin resistance (HOMA2-IR). Non-paired and paired designs were used to assess the association between DNA methylation and phenotype of IR. Cluster analysis was conducted to identify the clusters of top significant sites. Generalized linear regression was performed to examine the differential methylation patterns from clusters.Results:A total of 100 MZ pairs were included in this study. Hypermethylated cg10535199-2q23.1 ( β=0.74%, P=1.51×10 -7, OR=1.06, 95% CI: 1.03-1.09) and ch.17.49619327- SPOP ( β=0.23%, P=7.54×10 -7, OR=1.17, 95% CI: 1.08-1.28) were identified with suggestive significance. After correcting for multiple testing, no sites reached genome-wide significance. There was no statistical significance in the paired analysis. Two clusters with hypomethylated ( β=-0.39%, P<0.001) and hypermethylated ( β=0.47%, P<0.001) patterns were observed for HOMA2-IR. Conclusions:IR was significantly associated with DNA methylation, and genetic factors might contribute to the association.

Objective·To compare the performance of various deep learning methods in the segmentation and classification of colorectal polyp endoscopic images,and identify the most effective approach.Methods·Four colorectal polyp datasets were collected from three hospitals,encompassing 1 534 static images and 15 videos.All samples were pathologically validated and categorized into two types:serrated lesions and adenomatous polyps.Polygonal annotations were performed by using the LabelMe tool,and the annotated results were converted into integer mask formats.These data were utilized to train various architectures of deep neural networks,including convolutional neural network(CNN),Transformers,and their fusion,aiming to develop an effective semantic segmentation model.Multiple performance indicators for automatic diagnosis of colon polyps by different architecture models were compared,including mIoU,aAcc,mAcc,mDice,mFscore,mPrecision and mRecall.Results·Four different architectures of semantic segmentation models were developed,including two deep CNN architectures(Fast-SCNN and DeepLabV3plus),one Transformer architecture(Segformer),and one hybrid architecture(KNet).In a comprehensive performance evaluation of 291 test images,KNet achieved the highest mIoU of 84.59％,significantly surpassing Fast-SCNN(75.32％),DeepLabV3plus(78.63％),and Segformer(80.17％).Across the categories of"background","serrated lesions"and"adenomatous polyps",KNet's intersection over union(IoU)were 98.91％,74.12％,and 80.73％,respectively,all exceeding other models.Additionally,KNet performed excellently in key performance metrics,with aAcc,mAcc,mDice,mFscore,and mRecall reaching 98.59％,91.24％,91.31％,91.31％,and 91.24％,respectively,all superior to other models.Although its mPrecision of 91.46％was not the most outstanding,KNet's overall performance remained leading.In inference testing on 80 external test images,KNet maintained an mIoU of 81.53％,demonstrating strong generalization capabilities.Conclusion·The semantic segmentation model of colorectal polyp endoscopic images constructed by deep neural network based on KNet hybrid architecture,exhibits superior predictive performance,demonstrating its potential as an efficient tool for detecting colorectal polyps.

Objective To develop deep learning models for colonoscopy quality control using various deep learning architectures,and to delve into the decision-making mechanisms.Methods The colonoscopy images were selected from two datasets separately constructed by the HyperKvasir and Changshu Hospital Affiliated to Soochow University,encompassing intestines of varying degrees of cleanliness,polyps,and cecums.After image preprocessing and enhancement,transfer learning was carried out using the pre-trained models based on convolutional neural network(CNN)and Transformer.The model training adopted cross-entropy loss functions and Adam optimizer,and simultaneously implemented learning rate scheduling.To enhance model transparency,a thorough interpretability analysis was conducted using Grad-CAM,Guided Grad-CAM,and SHAP.The final model was converted to ONNX format and deployed on various equipment terminals to achieve real-time colonoscopy quality control.Results In a dataset of 3 831 colonoscopy images,EfficientNet model outperformed the other models on the test set,achieving an accuracy of 0.992 which was higher than those of the other models based on CNN(DenseNet121,ResNet50,VGG19)and Transformer(ViT,Swin,CvT),with a precision,recall rate,and F1 score of 0.991,0.989,and 0.990.On an external test set of 358 images,EfficientNet model had an average AUC,precision,and recall rate of 0.996,0.948,and 0.952,respectively.Although EfficientNet model is high-performing,some misjudgments still occurred.Interpretability analysis highlighted key image areas affecting decision-making.In addition,EfficientNet model was successfully converted to ONNX format and deployed on multiple platforms and devices,and it ensured real-time colonoscopy quality control with an inference speed of over 60 frames per second.Conclusion Among the 7 models developed for colonoscopy quality control based on CNN and Transformer,EfficientNet demonstrated exemplary performance across all categories and is deployed for real-time predictions on multiple terminals,aiming to provide patients with better medical care.

Background Children and adolescents drink sugar-sweetened beverages (SSBs) frequently. Research has confirmed that SSBs associate with weight gain and overweight or obesity. However, it is unclear whether high SSBs intake associates with abnormal changes in physical growth and glucolipid metabolism before causing adverse health outcomes such as overweight and obesity. Early identification of associated health risks of overconsumption of SSBs have important public health implications. Objective To investigate the differences in physical growth and glucolipid metabolism between different SSBs intake frequency groups in normal weight children and adolescents aged 6-17 years, and to evaluate the early effects of SSBs intake on physical growth and glycolipid metabolism before causing overweight and obesity, aiming to provide a scientific basis for the prevention and control of childhood overweight and obesity and related chronic diseases, and for the formulation of policies on the control of SSBs consumption. Methods Data were from the Shanghai Diet and Health Survey (SDHS) among primary and secondary school students. The participants were normal weight children and adolescents aged 6-17 years. Propensity scores were calculated according to energy intake and physical activity factors, after stratifying by age and gender. Participants were 1:1 matched with the closest propensity scores in the high-frequency (≥1 time·d⁻¹) and the low-frequency (≤1 time·week⁻¹) SSBs intake groups. The outcome indicators were physical measurements such as height, weight, percent of body fat, and waist circumference, and metabolic indicators such as fasting blood glucose, total triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Body mass index (BMI) was calculated. Food frequency questionnaire was used to collect SSBs consumption in the past three months through face-to-face interview. A paired t-test was used to compare the differences in physical and glycolipid metabolic indicators between the high-frequency intake group and the low-frequency intake group of SSBs. Results A total of 431 pairs were obtained. For children and adolescents in grades 6-9, overall height (difference=2.92 cm, P=0.002), weight (difference=2.53 kg, P=0.003), and waist circumference (difference=1.34 cm, P=0.035) were higher in those who consumed SSBs ≥1 time·d⁻¹ than in those who consumed ≤1 time·week⁻¹. For children and adolescents in grades 10-12, overall weight (difference=2.27 kg, P=0.041) was higher in those who consumed SSBs ≥1 time·d⁻¹ than in those who consumed ≤1 time·week⁻¹. Over 95% of the study subjects reported blood glucose and lipid test results within the normal range; but girls in grades 1-5 who consumed SSBs ≥1 time·d⁻¹ had a higher total cholesterol (difference=0.20 mmol·L⁻¹, P=0.027) and low-density lipoprotein cholesterol (difference=0.19 mmol·L⁻¹, P=0.010) than those who consumed ≤1 time·week⁻¹; boys in grades 6-9 who consumed SSBs ≥1 time·d⁻¹ had a lower high-density lipoprotein cholesterol (difference=-0.10 mmol·L⁻¹, P=0.039) than those who consumed ≤1 time·week⁻¹. Conclusion High-frequency intake of SSBs may be associated with higher total cholesterol and low-density lipoprotein cholesterol in normal weight children and adolescents in grades 1-5, and higher weight in normal weight children and adolescents in grades 6-12. There is an urgent need to educate children and adolescents about nutritional health, enhance their ability to make healthy food and beverage choices, and take early interventions to control the intake of SSBs in children.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Objective:To compare the efficacy of lower extremity three dimensional CT venography (CTV) and lower extremity ascending phlebography in evaluating recurrent varicose veins.Methods:A retrospective analysis was conducted on clinical data from 235 patients with unilateral recurrent varicose veins who were treated at the Department of Vascular Surgery,Beijing Shijitan Hospital,Capital Medical University, between January 2015 and December 2020.There were 112 males and 123 females, with an age of (62.5±11.4)years (range:24 to 75 years).Patients were stratified into two groups based on preoperative imaging examination:the CTV group (utilizing lower extremity venous ultrasound+lower extremity CTV) and the control group (employing lower extremity venous ultrasound+lower extremity ascending phlebography).The two groups were matched in a 1∶1 ratio using propensity score matching, resulting in 43 cases per group.Comparative analyses between the groups at the one-year postoperative follow-up were performed using independent sample t tests, Wilcoxon rank-sum tests, χ2 tests, and linear regression analysis. Results:One year post-surgery,the CTV group exhibited a lower venous clinical severity score (VCSS) compared to the control group( M(IQR),3.0(4.3) vs.4.0(5.8), Z=-2.038, P=0.040).Additionally, the chronic venous insufficiency patients′ quality of life questionnaire (CIVIQ-20) scores were significantly higher in the CTV group than in the control group (89.0(8.0) vs.82.5(17.0), Z=-2.627, P=0.010).Patients in the CTV group also experienced a shorter ulcer healing time compared to the control group (4.0(4.0) weeks vs.12.0(7.0) weeks, Z=-3.217, P<0.01).Both groups showed no clinically symptomatic recurrent varicose veins or ulcers.However, they exhibited ultrasound-detectable varicose vein recurrence, with no statistically significant difference ( χ2=0.453, P=0.500).The number of diseased vessels requiring management based on ultrasound supplemented by CTV was 16, while the number supplemented by ascending phlebography was 7,with a statistically significant difference ( χ2=4.800, P=0.030).Linear regression analysis demonstrated that clinical-etiology-anatomy-pathology clinical grading and the preoperative imaging examination method exerted independent influences on VCSS and CIVIQ-20 during the one-year postoperative assessment. Conclusions:CTV-assisted ultrasound enables a direct and comprehensive evaluation and localization of diseased veins in patients with recurrent varicose veins.The utilization of lower extremity vein ultrasound combined with CTV-guided management of lower extremity vessels in minimally invasive treatment significantly improves patient prognosis, surpassing the assessment provided by ascending phlebography.

Peutz-Jeghers syndrome (PJS) presents in early childhood, and children have a higher risk of intussusception due to a smaller abdominal space than adults. Double-balloon enteroscopy (DBE) has been proven to be a safe and effective method for the diagnosis and treatment of small bowel lesions, but the efficacy and safety of its prophylactic polypectomy in children with PJS need to be determined. Data of 6 children (median age 10.6 years) diagnosed as having PJS from 2018 to 2020 were reviewed. DBE was performed 14 times, and 3 children were successfully relieved of intussusception after DBE treatment. The sizes of the resected intussusception polyps were 50 mm×60 mm, 40 mm×35 mm, and 50 mm×40 mm. Symptoms associated with polyps (abdominal pain, intussusception and obstruction) relieved after DBE in all children. No direct complications such as bleeding or perforation were found during the operation, and no recurrence of intussusception was found during follow-up. It can be seen that DBE polypectomy is safe and effective in the treatment of intussusception caused by PJS.

ObjectiveTo determine the situation and challenges of innovation platforms in China， and to explore the construction strategy of Shanghai Nutrition Innovation Platform， which is suitable for Shanghai and may achieve the research and transformation of nutrition innovation and population health， so as to coordinate， unite and gather the superior resources of all parties and promote nutrition innovation. MethodsConstruction scheme and operational mechanism of Shanghai Nutrition Innovation Platform were explored by literature review， expert consultation and questionnaire. ResultsThere were various forms of innovation platforms in China. However， challenges were identified， such as decentralizing force， resource rearrangement and insufficient sharing effect. Shanghai Nutrition Innovation Platform adopted a modular organizational structure， which was divided into central group， node group， and subject group. Shanghai Center for Disease Control and Prevention， as the central organization， is responsible for the platform operation management. The expert database as an academic committee selected key organizations from nutrition-related universities， research institutes， academic associations， centers for disease control and prevention， hospitals and the industry. Based on the opening of its own innovation resources， the platform made effective use of external innovation resources and formed a closely integrated nutrition innovation network of multiple disciplines. ConclusionThis study promotes the construction of innovation platform model of cooperation， co-construction and resource sharing， and provides reference for the construction of innovation platform in China.