Smartwatch Photoplethysmography-Derived Heart Age via ECG-Guided Cross-Modal Pretraining as a Digital Biomarker of Vascular Aging

Digital biomarkers of cardiovascular aging, often termed heart or vascular age, have been widely studied, but most rely on resting electrocardiography (ECG), imaging, or specialized vascular assessments. Evidence linking wearable photoplethysmography (PPG) to arterial stiffness and hypertension remains limited. We developed an ECG-guided cross-modal framework that uses synchronized smartwatch ECG to enhance PPG representation learning during pretraining while requiring only PPG at inference. The study included three OPPO cohorts across China, comprising 581,804 participants and 7,452,131 recordings. The Vascular Health Study cohort supported ECG-PPG self-supervised pretraining, fine-tuning, and internal validation, while two external cohorts assessed associations with pulse wave velocity (PWV) and prevalent hypertension. Combining subject-aware learning with ECG-PPG contrastive alignment, the PPG-only model achieved subject-level mean absolute errors of 5.895 years (Pearson r=0.819) in the PWV cohort and 4.344 years (r=0.800) in the home blood pressure monitoring cohort. Aggregating repeated recordings further improved short-term stability. After adjustment for chronological age, heart age gap was associated with PWV (partial r=0.2627, P<0.001); each 1-year increase corresponded to 0.062 m/s higher PWV, and accelerated versus decelerated heart aging was associated with 0.91 m/s higher adjusted PWV. Each 1-SD increase in adjusted heart age gap was associated with greater odds of prevalent hypertension (OR 1.72, 95% CI 1.49-1.99), while the highest versus lowest quartile had an OR of 4.25. These findings support smartwatch PPG-derived heart age gap as a scalable digital biomarker of arterial stiffness and prevalent hypertension.

A Smart Classroom Behavior Analysis Framework with a New Highly Congested Classroom Dataset

Student behavior detection is important for intelligent classroom analysis but remains challenging in large-class scenarios due to dense instance co-occurrence, asymmetric occlusion, depth-wise scale variation, and fine-grained semantic degradation in distant targets. Existing classroom behavior datasets and general-purpose detectors are insufficient to characterize and address these challenges. This paper constructs the Highly Congested Classroom Behavior (HCCB) dataset, containing 50,229 student behavior instances across seven categories: reading, writing, heads up, sleeping, looking around, bowing head, and using phone. HCCB provides a challenging benchmark that integrates dense distributions, severe occlusion, scale variation, and fine-grained behavioral semantics. To address these issues, we propose ODER-HSFNet, a YOLO-based detection framework tailored to highly crowded classrooms. At its core, ODER-HSFNet introduces three task-specific innovations: the Occlusion-aware Deformable Edge Rectifier (ODER), which strengthens boundary evidence under occlusion; the Hypergraph-State Spatial Fusion (HSSF) module, which integrates local structure enhancement, state-space contextual modeling, and high-order relation aggregation; and the Occlusion-Calibrated Detection Head (OCDetect), which suppresses low-quality Pre-NMS candidates and reduces false positives from occlusion boundaries and neighboring instances. Experiments on two classroom behavior detection datasets show that ODER-HSFNet outperforms mainstream YOLO-series methods, achieving 60.60%/80.12% mAP50:95/mAP50 on HCCB and 57.36%/74.65% on SCB-D3-S. Ablation studies further verify the effectiveness of the proposed design for highly crowded classroom behavior detection.

HD-DinoMoE: A Class-Aware Hierarchical Dual Mixture-of-Experts Network for Scleral Anomaly Segmentation in Complex Acquisition Scenarios

Traditional Chinese Medicine (TCM) ocular inspection provides empirical cues for assessing scleral surface anomalies, but its clinical use remains subjective and difficult to quantify. To support intelligent and quantifiable ocular inspection, this study presents the TCM-inspired Artificial Intelligence Ocular Auxiliary Diagnosis System (TAO) and focuses on pixel-level scleral surface anomaly segmentation. For clinical and user-acquired images affected by multi-source distributional discrepancies, diverse anomaly morphologies, and scleral specular reflection (SSR), we propose HD-DinoMoE, a class-aware hierarchical dual mixture-of-experts network. HD-DinoMoE combines class-aware dual-stream DINOv3 feature fusion with class-specific multi-expert decoding to segment Vessels, Yellow and Black Spots, and Blood Spots. A three-stage backbone-frozen routing strategy stabilizes dual-backbone adaptation; Progressive Confidence Penalty (PCP) Loss reduces high-confidence false positives and segmentation leakage in SSR regions; and Class-Aware Adaptive Sample Weighting (CA-ASW) balances sample- and class-level training contributions. We further construct the Multi-label Scleral Anomaly Segmentation Dataset (ML-SASD), a new benchmark with Clinical, Wild, and Mix settings and pixel-wise annotations for three anomaly categories. On ML-SASD-Mix, HD-DinoMoE achieves a mean Dice of 72.11% and a mean Intersection-over-Union of 58.44%, while maintaining favorable boundary localization and specular-region false-positive control. It also shows competitive generalization on the Vessels subset of the public SBVPI dataset. These results indicate that HD-DinoMoE provides a feasible segmentation solution for TAO under complex acquisition scenarios. The code and data access information are available at https://github.com/FX-CMX/HD-DinoMoE.