Volume 138 · Issue 06 · 2025

妇女健康是一个至关重要、复杂和多方面的领域，包括妇科疾病、生殖健康问题、受激素差异影响的疾病以及卵巢癌和宫颈癌等严重疾病。妇科手术是该领域的重要组成部分，由于解剖病变和患者特定要求的可变性，提出了独特的挑战。近年来，信息技术，特别是人工智能（AI）的快速发展，为妇科手术在临床实践、研究和教育中的发展提供了许多机会。^[1]这篇社论旨在介绍人工智能在妇科手术中的应用现状，讨论技术和临床挑战，并概述该领域的未来前景。

Poly(ADP-ribose) polymerase (PARP) inhibitors (PARPis) have emerged as critical agents for cancer therapy. By inhibiting the catalytic activity of PARP enzymes and trapping them in the DNA, PARPis disrupt DNA repair, ultimately leading to cell death, particularly in cancer cells with homologous recombination repair deficiencies, such as those harboring BRCA mutations. This review delves into the mechanisms of action of PARPis in anticancer treatments, including the inhibition of DNA repair, synthetic lethality, and replication stress. Furthermore, the clinical applications of PARPis in various cancers and their adverse effects as well as their combinations with other therapies and the mechanisms underlying resistance are summarized. This review provides comprehensive insights into the role and mechanisms of PARP and PARPis in DNA repair, with a particular focus on the potential of PARPi-based therapies in precision medicine for cancer treatment.

Artificial intelligence (AI), particularly deep learning, has demonstrated remarkable performance in medical imaging across a variety of modalities, including X-ray, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET), and pathological imaging. However, most existing state-of-the-art AI techniques are task-specific and focus on a limited range of imaging modalities. Compared to these task-specific models, emerging foundation models represent a significant milestone in AI development. These models can learn generalized representations of medical images and apply them to downstream tasks through zero-shot or few-shot fine-tuning. Foundation models have the potential to address the comprehensive and multifactorial challenges encountered in clinical practice. This article reviews the clinical applications of both task-specific and foundation models, highlighting their differences, complementarities, and clinical relevance. We also examine their future research directions and potential challenges. Unlike the replacement relationship seen between deep learning and traditional machine learning, task-specific and foundation models are complementary, despite inherent differences. While foundation models primarily focus on segmentation and classification, task-specific models are integrated into nearly all medical image analyses. However, with further advancements, foundation models could be applied to other clinical scenarios. In conclusion, all indications suggest that task-specific and foundation models, especially the latter, have the potential to drive breakthroughs in medical imaging, from image processing to clinical workflows.

Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory condition with chronic and relapsing manifestations and is characterized by a disturbance in the interplay between the intestinal microbiota, the gut, and the brain. The microbiota-gut-brain axis involves interactions among the nervous system, the neuroendocrine system, the gut microbiota, and the host immune system. Increasing published data indicate that psychological stress exacerbates the severity of IBD due to its negative effects on the microbiota-gut-brain axis, including alterations in the stress response of the hypothalamic-pituitary-adrenal (HPA) axis, the balance between the sympathetic nervous system and vagus nerves, the homeostasis of the intestinal flora and metabolites, and normal intestinal immunity and permeability. Although the current evidence is insufficient, psychotropic agents, psychotherapies, and interventions targeting the microbiota-gut-brain axis show the potential to improve symptoms and quality of life in IBD patients. Therefore, further studies that translate recent findings into therapeutic approaches that improve both physical and psychological well-being are needed.

Iron deposition plays a crucial role in the pathophysiology of Parkinson’s disease (PD), yet the distribution pattern of iron deposition in the subcortical nuclei has been inconsistent across previous studies. We aimed to assess the difference patterns of iron deposition detected by quantitative iron-sensitive magnetic resonance imaging (MRI) between patients with PD and patients with atypical parkinsonian syndromes (APSs), and between patients with PD and healthy controls (HCs).

A systematic literature search was conducted on PubMed, Embase, and Web of Science databases to identify studies investigating the iron content in PD patients using the iron-sensitive MRI techniques (R2^* and quantitative susceptibility mapping [QSM]), up until May 1, 2023. The quality assessment of case-control and cohort studies was performed using the Newcastle-Ottawa Scale, whereas diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Standardized mean differences and summary estimates of sensitivity, specificity, and area under the curve (AUC) were calculated for iron content, using a random effects model. We also conducted the subgroup-analysis based on the MRI sequence and meta-regression.

Seventy-seven studies with 3192 PD, 209 multiple system atrophy (MSA), 174 progressive supranuclear palsy (PSP), and 2447 HCs were included. Elevated iron content in substantia nigra (SN) pars reticulata (P <0.001) and compacta (P <0.001), SN (P <0.001), red nucleus (RN, P <0.001), globus pallidus (P <0.001), putamen (PUT, P = 0.021), and thalamus (P = 0.029) were found in PD patients compared with HCs. PD patients showed lower iron content in PUT (P <0.001), RN (P = 0.003), SN (P = 0.017), and caudate nucleus (P = 0.017) than MSA patients, and lower iron content in RN (P = 0.001), PUT (P <0.001), globus pallidus (P = 0.004), SN (P = 0.015), and caudate nucleus (P = 0.001) than PSP patients. The highest diagnostic accuracy distinguishing PD from HCs was observed in SN (AUC: 0.85), and that distinguishing PD from MSA was found in PUT (AUC: 0.90). In addition, the best diagnostic performance was achieved in the RN for distinguishing PD from PSP (AUC: 0.86).

Quantitative iron-sensitive MRI could quantitatively detect the iron content of subcortical nuclei in PD and APSs, while it may be insufficient to accurately diagnose PD. Future studies are needed to explore the role of multimodal MRI in the diagnosis of PD.

PROSPERO (CRD42022344413).

Congenital heart disease (CHD) is a leading cause of birth defect-related mortality. However, more recent CHD mortality data for China are lacking. Additionally, limited studies have evaluated sex, rural-urban, and region-specific disparities of CHD mortality in China.

We designed a population-based study using data from the Dataset of National Mortality Surveillance in China between 2008 and 2021. We calculated age-adjusted CHD mortality using the sixth census data of China in 2010 as the standard population. We assessed the temporal trends in CHD mortality by age, sex, area, and region from 2008 to 2021 using the joinpoint regression model.

From 2008 to 2021, 33,534 deaths were attributed to CHD. The period witnessed a two-fold decrease in the age-adjusted CHD mortality from 1.61 to 0.76 per 100,000 persons (average annual percent change [AAPC] = -5.90%). Females tended to have lower age-adjusted CHD mortality than males, but with a similar decline rate from 2008 to 2021 (females: AAPC = -6.15%; males: AAPC = -5.84%). Similar AAPC values were observed among people living in urban (AAPC = -6.64%) and rural (AAPC = -6.12%) areas. Eastern regions experienced a more pronounced decrease in the age-adjusted CHD mortality (AAPC = -7.86%) than central (AAPC = -5.83%) and western regions (AAPC = -3.71%) between 2008 and 2021. Approximately half of the deaths (46.19%) due to CHD occurred during infancy. The CHD mortality rates in 2021 were lower than those in 2008 for people aged 0-39 years, with the largest decrease observed among children aged 1-4 years (AAPC = -8.26%), followed by infants (AAPC = -7.01%).

CHD mortality in China has dramatically decreased from 2008 to 2021. The slower decrease in CHD mortality in the central and western regions than in the eastern regions suggested that public health policymakers should pay more attention to health resources and health education for central and western regions.

Electroacupuncture (EA) treatment is efficacious in patients with respiratory disorders, although the mechanisms of its action in lung-function protection are poorly understood. This study aimed to explore the neuroanatomical mechanisms of EA stimulation at the BL13 acupoint (Feishu, EA-BL13) improvement in asthma.

Allergic asthma was induced by intranasal 2.0% ovalbumin (OVA) instillation combined with intraperitoneal injection of the 10.0% OVA. The levels of interleukin (IL)-4 and IL-5 were detected by enzyme-linked immunosorbent assay. Hematoxylin and eosin and periodic acid-schiff stain were used to evaluate inflammatory cell infiltration and mucus secretion. Cellular oncogene fos induction in neurons after EA stimulation was detected by immunofluorescent staining. The messenger RNA expression levels of adrenergic receptors were quantified with real-time polymerase chain reaction.

EA improved airway inflammation and mucus secretion mainly by activating somatosensory-sympathetic pathways (P <0.001). Briefly, the intermediolateral (IML) nuclei of the spinal cord received signals from somatic EA stimulation and then delivered the information via the sympathetic trunk to the lung. Excited sympathetic nerve endings in lung tissue released large amounts of catecholamines that specifically activated the β2 adrenergic receptor (β2AR) on T cells (P <0.01) and further decreased the levels of IL-4 and IL-5 (P <0.001) through the cyclic adenosine monophosphate/protein kinase A signaling pathway.

This study provided a new explanation and clinical basis for the use of EA-BL13 as a treatment for allergic asthma in both the attack and remission stages and other respiratory disorders related to airway inflammation.

The global rise in diabetes prevalence is a pressing concern. Despite initiatives like "The Healthy Beijing Action 2020-2030" advocating for increased awareness, treatment, and control, the specific situation in Beijing remains unexplored. This study aimed to analyze the trends in diabetes prevalence, awareness, treatment, and control among Beijing adults.

Through a stratified multistage probability cluster sampling method, a series of representative cross-sectional surveys were conducted in Beijing from 2005 to 2022, targeting adults aged 18-79 years. A face-to-face questionnaire, along with body measurements and laboratory tests, were administered to 111,943 participants. Data from all survey were age- and/or gender-standardized based on the 2020 Beijing census population. Annual percentage rate change (APC) or average annual percentage rate change (AAPC) was calculated to determine prevalence trends over time. Complex sampling logistic regression models were employed to explore the relationship between various characteristics and diabetes.

From 2005 to 2022, the total prevalence of diabetes among Beijing adults aged 18-79 years increased from 9.6% (95% CI: 8.8-10.4%) to 13.9% (95% CI: 13.1-14.7%), with an APC/AAPC of 2.1% (95% CI: 1.1-3.2%, P <0.05). Significant increases were observed among adults aged 18-39 years and rural residents. Undiagnosed diabetes rose from 3.5% (95% CI: 3.2-4.0%) to 7.2% (95% CI: 6.6-7.9%) with an APC/AAPC of 4.1% (95% CI: 0.5-7.3%, P <0.05). However, diabetes awareness and treatment rates showed annual declines of 1.4% (95% CI: -3.0% to -0.2%, P <0.05) and 1.3% (95% CI: -2.6% to-0.2%, P <0.05), respectively. The diabetes control rate decreased from 21.5% to 19.1%, although not statistically significant (APC/AAPC = -1.5%, 95% CI: -5.6% to 1.9%). Overweight and obesity were identified as risk factors for diabetes, with ORs of 1.65 (95% CI: 1.38-1.98) and 2.48 (95% CI: 2.07-2.99), respectively.

The prevalence of diabetes in Beijing has significantly increased between 2005 and 2022, particularly among young adults and rural residents. Meanwhile, there has been a concerning decrease in diabetes awareness and treatment rates, while control rates have remained stagnant. Regular blood glucose testing, especially among adults aged 18-59 years, should be warranted. Furthermore, being male, elderly, overweight, or obese was associated with higher diabetes risk, suggesting the needs for targeted management strategies.

At present, biopsy is essential for the diagnosis of prostate cancer (PCa) before radical prostatectomy (RP). However, with the development of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and multiparametric magnetic resonance imaging (mpMRI), it might be feasible to avoid biopsy before RP. Herein, we aimed to explore the feasibility of avoiding biopsy before RP in patients highly suspected of having PCa after assessment of PSMA PET/CT and mpMRI.

Between December 2017 and April 2022, 56 patients with maximum standardized uptake value (SUVmax) of ≥4 and Prostate Imaging Reporting and Data System (PI-RADS) ≥4 lesions who received RP without preoperative biopsy were enrolled from two tertiary hospitals. The consistency between clinical and pathological diagnoses was evaluated. Preoperative characteristics were compared among patients with different pathological types, T stages, International Society of Urological Pathology (ISUP) grades, and European Association of Urology (EAU) risk groups.

Fifty-five (98%) patients were confirmed with PCa by pathology, including 49 (89%) with clinically significant prostate cancer (csPCa, defined as ISUP grade ≥2 malignancy). One patient was diagnosed with high-grade prostatic intraepithelial neoplasia (HGPIN). CsPCa patients, compared with clinically insignificant prostate cancer (cisPCa) and HGPIN patients, were associated with a higher level of prostate-specific antigen (22.9 ng/mL vs. 10.0 ng/mL, P = 0.032), a lower median prostate volume (32.2 mL vs. 65.0 mL, P = 0.001), and a higher median SUVmax (13.3 vs. 5.6, P <0.001).

It might be feasible to avoid biopsy before RP for patients with a high probability of PCa based on PSMA PET/CT and mpMRI. However, the diagnostic efficacy of csPCa with PI-RADS ≥4 and SUVmax of ≥4 is inadequate for performing a procedure such as RP. Further prospective multicenter studies with larger sample sizes are necessary to confirm our perspectives and establish predictive models with PSMA PET/CT and mpMRI.

The role of inflammation in the development of gestational diabetes mellitus (GDM) has recently become a focus of research. The systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), novel indices, reflect the body’s chronic immune-inflammatory state. This study aimed to investigate the associations between the SII or SIRI and GDM.

A prospective birth cohort study was conducted at Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2020, recruiting participants in their first trimester of pregnancy. Baseline SII and SIRI values were derived from routine clinical blood results, calculated as follows: SII = neutrophil (Neut) count × platelet (PLT) count/lymphocyte (Lymph) count, SIRI = Neut count × monocyte (Mono) count/Lymph count, with participants being grouped by quartiles of their SII or SIRI values. Participants were followed up for GDM with a 75-g, 2-h oral glucose tolerance test (OGTT) at 24-28 weeks of gestation using the glucose thresholds of the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Logistic regression was used to analyze the odds ratios (ORs) (95% confidence intervals [CIs]) for the the associations between SII, SIRI, and the risk of GDM.

Among the 28,124 women included in the study, the average age was 31.8 ± 3.8 years, and 15.76% (4432/28,124) developed GDM. Higher SII and SIRI quartiles were correlated with increased GDM rates, with rates ranging from 12.26% (862/7031) in the lowest quartile to 20.10% (1413/7031) in the highest quartile for the SII (P_trend <0.001) and 11.92-19.31% for the SIRI (P_trend <0.001). The ORs (95% CIs) of the second, third, and fourth SII quartiles were 1.09 (0.98-1.21), 1.21 (1.09-1.34), and 1.39 (1.26-1.54), respectively. The SIRI findings paralleled the SII outcomes. For the second through fourth quartiles, the ORs (95% CIs) were 1.24 (1.12-1.38), 1.41 (1.27-1.57), and 1.64 (1.48-1.82), respectively. These associations were maintained in subgroup and sensitivity analyses.

The SII and SIRI are potential independent risk factors contributing to the onset of GDM.

Visual input significantly influences cerebral activity related to locomotor navigation, although the underlying mechanism remains unclear. This study aimed to analyze the effects of chronic visual impairment and its rehabilitation on sensorimotor integration during level walking in patients with age-related cataract.

This prospective case series enrolled 14 female patients (68.4 ± 4.7 years) with age-related cataract, scheduled for consecutive cataract surgeries at the Department of Ophthalmology in Peking University Third Hospital from June 2019 to June 2020. Electroencephalogram (EEG) signals during level walking were recorded using a portable EEG system before and 4 weeks after visual restoration. Walking speed was assessed using the Footscan system. Spectral power of the theta and alpha bands was analyzed with repeated-measures analysis of variance, with Assignment (rest and walking), Phase (preoperative and postoperative), and Electrode sites (F3, Fz, F4, O1, and O2) as within-subject factors.

Compared to the visual impairment state, theta band power significantly decreased after visual restoration (13.16 ± 1.58 μV²vs. 23.65 ± 3.48 μV², P = 0.018). Theta activity was notably reduced during walking (17.24 ± 2.43 μV²vs. 37.86 ± 6.62 μV², P = 0.017), while theta power at rest was not significantly different between the two phases (9.44 ± 1.24 μV²vs. 9.08 ± 1.74 µV², P = 0.864). Changes in walking speed were correlated with alterations in theta power at electrode sites of O1 (r = -0.574, P = 0.032) and O2 (r = -0.648, P = 0.012). Alpha band power remained stable during walking and was unaffected by visual status.

Chronic visual impairment from age-related cataract triggers enhanced cerebral activation of sensorimotor integration to compensate for visual decline during locomotion. This cerebral over-activation is effectively alleviated by visual restoration.

致编辑：中草药（CHMs）是传统中药（TCM）的重要成分，^[1]其冷热性质是指导临床应用和确保治疗效果的基础。^[2]然而，传统的中医寒热鉴别方法严重依赖中医医师的主观经验和临床实践，往往导致不确定性和不一致性。因此，迫切需要更精确、快速和客观的策略来准确识别CHMs及其活性成分的冷和热性质。^[3]

致编辑：大约30-50%的弥漫性大B细胞淋巴瘤（DLBCL）患者在接受嵌合抗原受体T（CAR-T）细胞治疗后出现疾病进展或复发，联合治疗可能是降低复发风险的可行策略。恶性B细胞维持B细胞受体(BCR)在细胞表面的表达，并受益于BCR触发的增殖、存活和迁移途径。Bruton酪氨酸激酶（BTK）是BCR信号通路的重要组成部分，抑制BTK通路产生的抗淋巴瘤功能使其成为B细胞恶性肿瘤和炎性疾病中一个很有前途的治疗靶点。此前的基础研究表明，在培养物中加入第一代BTK抑制剂伊布替尼显著增加了CAR-T细胞的数量，并导致更少的耗竭标志物表达，促进了CAR-T细胞动员和淋巴瘤细胞的识别。此外，伊布替尼与较少的细胞因子释放综合征（CRS）相关细胞因子和较低的CRS严重程度相关。尽管如此，脱靶效应相关的不良事件限制了伊布替尼的使用，约23%的临床患者和49%的社区患者中断伊布替尼治疗。

致编辑：视网膜成像已越来越多地用作非侵入性工具来直接评估脑动脉粥样硬化中微血管系统的细微异常。^[1]光学相干断层扫描血管造影（OCTA）是一种新的眼科成像技术，可提供视网膜微血管系统的深度分辨可视化，具有接近组织学水平的分辨率。^[2]由于视网膜微血管系统与脑微循环具有共同的解剖学、胚胎学和生理学特征，并且是颈内动脉（ICA）的延伸，因此视网膜微血管系统的变化可以反映脑微循环和ICA的变化。因此，研究视网膜微血管的变化可能为理解动脉粥样硬化的病理生理学提供线索。以眼动脉（OA）为关键点，我们使用OCTA研究了颅外动脉狭窄（ECAS）和颅内动脉狭窄（ICAS）个体的视网膜微血管差异。

致编辑：自噬是真核细胞中进化上保守的溶酶体介导的降解过程，对于在正常条件下维持细胞稳态至关重要。自噬涉及新月形吞噬体（或隔离膜[IM]）的形成，其扩张和闭合以形成双膜自噬体。自噬体被递送至晚期内体/溶酶体以降解隔离的物质。自噬功能障碍可导致肿瘤和神经退行性、心血管和自身免疫性疾病。^[1]无名指蛋白115(RNF115)是RAB7靶蛋白，也称为乳腺癌相关基因2(BCA2)。^[2]越来越多的研究表明，RNF115在浸润性乳腺肿瘤、肺腺癌和胃癌中过表达。RNF115水平与此类患者的预后呈负相关。最近的研究表明，RNF115负调节吞噬体成熟和宿主对细菌感染的反应。^[3]此外，RNF115缺乏通过促进自噬和抑制炎症反应减轻小鼠急性肝损伤。^[4]然而，关于RNF115在肝细胞癌中的功能的信息仍然不清楚。在本研究中，我们报道了RNF115是肝癌细胞基础自噬的负调节因子。HepG2和HEK293T细胞系获自美国典型培养物保藏中心(Manassas，VA，USA)。BEL-7402获自中国典型培养物保藏中心（中国上海）。对于本研究，使用短串联重复序列（STR）分析鉴定所有细胞系，并检查无支原体。