Volume 105 · Issue 42 · 2025

Cerebrovascular diseases, neurodegenerative diseases, epilepsy, and brain tumors are major brain disorders that pose significant threats to human health. Multimodal imaging technologies serve as crucial tools for diagnostic workup of major brain diseases. However, they present challenges such as massive data, labor-intensive manual interpretation, and difficulties in extracting cross-modal features. The advancement of artificial intelligence (AI) has introduced new opportunities. This article reviews the current applications of novel AI technologies, including deep learning, generative models, and large language models. These technologies have enabled key advances, such as automated lesion segmentation and quantification, early and differential diagnosis, non-invasive prediction of molecular subtypes, and intelligent prognosis assessment, collectively driving a paradigm shift in neuroimaging-based diagnosis and treatment. Currently, AI faces challenges including data heterogeneity, ethical and regulatory issues, and an underdeveloped industrial ecosystem. Moving forward, it is essential to establish standardized data-sharing mechanisms, improve full-cycle regulatory frameworks, and promote industry-academia-research collaborative innovation to further advance the clinical translation of AI in the precision diagnosis and treatment of brain diseases.

On May 30, 2025, World Health Organization (WHO) position paper on immunization to protect infants against respiratory syncytial virus (RSV) disease, May 2025 was published (hereinafter referred to as the position paper). The WHO recommends that countries use RSV vaccines or long-acting monoclonal antibodies to prevent severe RSV-related diseases. It provides guidance on immunization schedules and timing, safety and contraindications, product choice, health system integration, surveillance, vaccination of special-population, and research priorities. This paper analyzes the position paper′s implications for RSV immunization in China: (1) expanding the application of approved monoclonal antibodies; (2) speeding up the research, development, and introduction of immune products; (3) clarifying vaccination strategies and implementation paths; (4) improving monitoring and evaluation;(5) strengthening professional training and public education; (6) optimizing inter-departmental cooperation.

To investigate the relationship between synaptic density quantified by ¹⁸F-SynVesT-1 PET and plasma neurofilament light chain (NfL) levels in patients with Alzheimer′s disease (AD).

A retrospective study included 174 subjects from September 2021 to July 2024 at Huashan Hospital Affiliated with Fudan University who concurrently underwent ¹⁸F-SynVesT-1 PET-MRI targeting synatic vesicle glycoprotein 2A (SV2A), ¹⁸F-Florbetapir PET-CT imaging targeting β-amyloid (Aβ), plasma NfL measurement, and neuropsychological assessments. The cohort comprised 50 cognitively unimpaired (CU) healthy controls, 62 patients with mild cognitive impairment (MCI), and 62 patients with AD. This study compared the differences in global cortical (GC) SV2A-PET standardized uptake value ratios (SUVR) and plasma NfL levels among the CU, MCI, and AD groups. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the performance of SV2A-PET and plasma NfL in optimizing the diagnosis of cognitive impairment (CI) based on Aβ PET. Partial correlation analyses were performed to assess the relationships between SV2A-PET, plasma NfL, Aβ deposition, and cognitive function. Linear regression models were utilized to analyze the association between plasma NfL levels and GC SV2A-PET SUVR.

The mean age of the 174 participants was (68.1±7.8) years old, with 32.8% (57 cases) being male. The mean ages of the CU, MCI, and AD groups were (68.8±7.4), (69.7±7.6), and (65.3±7.9) years old (P=0.008). The GC ¹⁸F-SynVesT-1 SUVR values were lower in both the AD and MCI groups than the CU group [(1.4±0.1) vs (1.5±0.1) vs (1.6±0.1)](P<0.001), with pairwise comparisons revealing significant differences between CU and MCI (P<0.001), CU and AD (P<0.001), and MCI and AD (P=0.007). Plasma NfL levels were higher in both the AD and MCI groups than the CU group [(3.1±0.6) vs (2.8±0.5) vs (2.5±0.5)](P<0.001); pairwise analyses showed significant differences between CU and AD (P<0.001) and between MCI and AD (P=0.008). When using Aβ-PET alone, the area under the curve (AUC) for distinguishing CU individuals from CI individuals was 0.762 (95%CI: 0.687-0.837); an AUC of 0.814 (95%CI: 0.748-0.881) was obtained when combining SV2A-PET. In the whole cohort, SV2A-PET was significantly negatively correlated with Aβ-PET (r=-0.353, P<0.001) and significantly positively correlated with Mini-Mental State Examination (MMSE) scores (r=0.441, P<0.001). Plasma NfL levels were significantly positively correlated with Aβ-PET (r=0.216, P=0.005) and significantly negatively correlated with MMSE scores (r=-0.296, P<0.001). Linear regression analysis showed that each 1-unit increase in plasma NfL level was associated with a 0.204 (95%CI:-0.369--0.039) decrease in SV2A-PET SUVR (P=0.016).

¹⁸F-SynVesT-1 PET-MRI quantifies changes in synaptic density during the progression of AD. Elevated plasma NfL levels indirectly reflect synaptic loss.

To investigate the characteristics of brain functional and glucose metabolic alterations in patients with heart failure using integrated PET-MRI.

A total of 54 patients with heart failure who visited Xuanwu Hospital, Capital Medical University between October 2020 and December 2022 were retrospectively enrolled, along with 14 age-, sex-, and education-matched healthy controls. All participants underwent integrated ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) cerebral PET-MRI and Mini-Mental State Examination (MMSE). According to left ventricular ejection fraction (LVEF), patients were divided into a preserved LVEF group (n=27, LVEF≥50%) and a reduced LVEF group (n=27, LVEF<50%). Regional homogeneity (ReHo) from resting-state fMRI and standardized uptake value ratio (SUVR) from ¹⁸F-FDG PET were calculated using the DPARSF and SPM toolkits to assess brain functional and metabolic changes. Partial correlation analysis was used to examine associations between ReHo, SUVR, and MMSE scores.

There were no significant differences in age or sex among the control group, preserved LVEF group, and reduced LVEF group [age: (60.4±6.0), (60.4±11.5), and (61.7±11.2) years, respectively, P=0.876; males: 85.71%, 77.78%, and 81.48%, respectively, P=0.825]. ¹⁸F-FDG PET/MRI revealed that, compared with the control group, the preserved LVEF group showed reduced ReHo values in the bilateral orbital parts of the inferior frontal gyrus (left: 0.32±0.04 vs 0.28±0.03; right: 0.33±0.06 vs 0.30±0.04; all P<0.05). The reduced LVEF group exhibited decreased ReHo values in the right pericalcarine cortex (0.46±0.07 vs 0.40±0.06, P<0.05). Compared with controls, the reduced LVEF group also showed lower SUVR in the right insula (1.87±0.18 vs 1.69±0.21, P<0.05). ReHo and SUVR values in the altered brain regions of patients with heart failure were positively correlated with MMSE scores (r=0.462-0.668, all P<0.05). ReHo and SUVR values in these altered brain regions were positively correlated with MMSE scores (r=0.462-0.668, all P<0.05).

Patients with HF demonstrate altered local brain activity and glucose metabolism. Furthermore, distinct characteristics of brain alterations are observed across different HF subtypes compared to healthy controls. These findings offer imaging insights into brain involvement in HF.

To evaluate the efficacy of the deep progressive reconstruction (DPR) algorithm in optimizing brain PET-MR images for neurodegenerative diseases patients.

It was a cross-sectional study. A total of 28 patients with neurodegenerative diseases were selected from the First Affiliated Hospital of Dalian Medical University between October 2024 and January 2025. All patients underwent brain ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET-MR examination. PET images were reconstructed using both ordered subsets expectation maximization (OSEM) and DPR algorithms. Matrix sizes of 256×256 and 192×192 were selected for reconstruction. Within the DPR group, patients were divided into five subgroups based on different DPR intensity levels (1-5): DPR_1, DPR_2, DPR_3, DPR_4, and DPR_5 groups. Image quality was qualitatively evaluated using a 5-point Likert scale, and the optimal DPR reconstruction intensity was selected based on the evaluation results. Using the optimal DPR intensity, data were grouped according to simulated scan times, representing different dose conditions: 12.5 min (DPR_1/2 dose group), 8.3 min (DPR_1/3 dose group), and 6.3 min (DPR_1/4 dose group). These were compared with the OSEM group (25 min, 0.1 mCi/kg). Gray matter, white matter, and cerebrospinal fluid were selected as regions of interest to calculate contrast ratios to compare between OSEM and DPR groups, and DPR groups with different dose conditions.

A total of 28 patients were enrolled [11 males and 17 females, aged (67.4±11.3) years]. Compared with the OSEM group, when the matrix size was 256×256, the overall image quality scores of the DPR_1 group [(3.89±0.21) score], DPR_2 group [(3.91±0.20) score], DPR_3 group [ (3.95±0.16), score], DPR_4 group [ (4.02±0.25) score], and DPR_5 group [(4.36±0.38) score], which were all higher than the OSEM group [(3.77±0.25) score], the differences were statistically significant (all P<0.05). The comparisons between the OSEM full-dose group and the simulated low-dose groups (DPR_1/2 dose group, DPR_1/3 dose group, and DPR_1/4 dose group) showed statistically significant differences in the following metrics (all P<0.05): gray matter-to-cerebrospinal fluid contrast (2.53±0.57 vs 2.73±0.69, 2.65±0.68, 2.76±0.69), white matter-to-cerebrospinal fluid contrast (1.76±0.45 vs 1.86±0.51, 1.86±0.50, 1.86±0.54), and gray matter-to-white matter contrast (1.46±0.13 vs 1.48±0.11, 1.49±0.11, 1.50±0.11).

The DPR algorithm is an effective technical approach for optimizing brain PET-MR images in patients with neurodegenerative diseases.

To investigate the efficacy and safety of laparoscopic-assisted renal denervation (RDN) in the treatment of resistant hypertension.

A retrospective analysis was conducted on 13 patients with resistant hypertension who underwent laparoscopic bilateral RDN at the Department of Urology, the Second Affiliated Hospital of Soochow University between April 2023 and April 2024 (10 via laparoscopy, 3 assisted by the da Vinci robotic system). Follow-up assessments were performed at 1, 3, 6, and 12 months postoperatively, with the final follow-up extending until October 2025. Relevant laboratory parameters, blood pressure levels, and usage of antihypertensive medications were compared before and after the procedure, and surgical complications were evaluated.

A total of 13 patients (11 males, 2 females) with a mean age of (46.1±15.0) years and body mass index of (26.6±5.1) kg/m² were included. All procedures were successfully completed with an operative time of (233.8±83.8) min, estimated blood loss of (22.3±11.8) ml, and median hospital stay of 11.0 (9.5, 12.5)d. Only one case of lymphatic leak was observed, which resolved after treatment, with no other adverse events during follow-up. At one week postoperatively, plasma renin activity was significantly reduced compared to preoperative levels [(13.8±10.6) vs (28.6±20.8) mU/L, P=0.007], while no significant differences were found in aldosterone concentration, angiotensin Ⅱ, serum cortisol, adrenocorticotropic hormone, estimated glomerular filtration rate, creatinine, or serum potassium (all P>0.05). Both the number of antihypertensive medications (2.2±1.4 vs 3.4±1.5) and medication burden score (7.1±6.6 vs 15.5±12.6) showed significant reductions postoperatively (all P<0.05). Significant improvements were also observed in office blood pressures at 1, 3, and 6 months [systolic: (149.3±15.3), (149.7±14.2), (140.7±14.3) vs (170.9±14.8) mmHg(1 mmHg=0.133 kPa); diastolic: (89.8±13.8), (86.1±10.1), (84.2±12.7) vs (103.3±19.0) mmHg] and home blood pressures [systolic: (147.7±16.7), (139.8±19.4), (136.5±13.2) vs (170.5±15.9) mmHg; diastolic: (89.5±12.7), (87.4±12.6), (85.0±8.1) vs (101.9±18.3) mmHg] compared to preoperative values (all P<0.05).

Laparoscopic RDN is a safe and effective intervention for reducing blood pressure and the need for antihypertensive medications, providing a viable and well-tolerated surgical option for patients with resistant hypertension.

To develop and validate a prediction model using machine learning algorithms based on pre-treatment and early-treatment functional MRI (fMRI) to forecast the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) in adolescents with major depressive episode (MDE).

A total of 62 adolescent inpatients with MDE from the Affiliated Nanjing Brain Hospital of Nanjing Medical University [17 males and 45 females with a mean age of (15.2±1.6) years] admitted between September 2020 and December 2022 were retrospectively enrolled as the discovery set. They were randomly split into a modeling group and an internal validation group in a 7∶3 ratio. An additional 26 MDE inpatients [19 males and 7 females with a mean age of (15.5±2.1) years] admitted between March 2023 and April 2024 were collected as the external validation group. Resting-state brain fMRI scans were performed at baseline (T₀) and after 10 rTMS sessions (T₁). The 17-item Hamilton Depression Rating Scale (HAMD-17) was used to assess depressive symptom severity at T₀ and after 20 rTMS sessions (T₂). Treatment effectiveness was evaluated using the HAMD-17 reduction rate. Amplitude of the low-frequency fluctuation (ALFF) features were screened using Pearson correlation analysis and LASSO regression. A prediction model was constructed using the support vector machine-radial basis function (SVM-RBF) algorithm and underwent internal and external validation. Model performance and clinical applicability were assessed using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, calibration curves, and decision curve analysis.

LASSO regression identified 20 efficacy-related ALFF features each from T₀, T₁, and the change between these timepoints (ΔALFF). Among these, ALFF features in the ventral visual pathway at T₀, the anterior cingulate cortex and medial prefrontal cortex at T₁, and ΔALFF in the orbitofrontal cortex and frontal pole showed the strongest correlations with the HAMD-17 reduction rate (r=-0.362, -0.430, and 0.380, respectively; all P<0.05). A prediction model built using these 60 ALFF features achieved AUC of 0.996 (95%CI: 0.986-1.000), 0.786 (95%CI: 0.566-0.962), and 0.825 (95%CI: 0.607-0.935) in the modeling, internal validation, and external validation groups, respectively. Calibration and decision curves indicated good model consistency and net benefit.

The model developed using the SVM-RBF algorithm, based on pre-treatment and early-treatment fMRI data, can effectively predict the efficacy of rTMS in adolescents with MDE, demonstrating favorable predictive value and clinical application potential.

To evaluate the mid-and long-term outcomes of thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) in patients with Marfan syndrome.

Operative and follow-up data of patients with Marfan syndrome and TBAD who underwent TEVAR at the Zhongshan Hospital of Fudan University and the Jinshan Hospital of Fudan University from January 2009 to December 2024 was collected and analyzed retrospectively. The primary endpoint includes technical success rate of TEVAR. Secondary endpoints include cumulative survival rate, complications, and reintervention status postoperatively..

A total of 61 patients were included, of whom 40 were male. The median age was 35 (30.0, 43.8) years. Technical success was achieved in 58 patients (95.1%), and the 30-day mortality was 4.9%(3/61). The median follow-up time was 64.5 (36.3, 97.9) months. The cumulative survival was 87.4% (95%CI: 79.0%-96.7%) at 5 years and 84.2% (95%CI: 74.3%-95.4%) at 10 years. The freedom from re-intervention rate at 5 years was 56.9% (95%CI: 44.1%-73.2%). Eleven patients were bothered by complications in the mid-to long-term follow-up.

TEVAR is safe for treating patients with Marfan syndrome with TBAD and demonstrates favorable mid-to long-term efficacy.

To explore the risk factors for erectile dysfunction (ED) in patients with benign prostatic hyperplasia (BPH) and to develop and validate a predictive model for the occurrence of ED.

We prospectively selected patients who visited the Affiliated Hospital of Xuzhou Medical University due to BPH from June 2023 to September 2024 as research subjects. These patients were divided into a simple BPH group and a BPH with ED group, and clinical characteristics were compared between the two groups of patients. Logistic regression analysis was employed to identify the risk factors for ED in patients with BPH and a nomogram risk prediction model was constructed. Internal validation was performed using the bootstrap method, with 1 000 resamplings. The predictive efficacy was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

A total of 211 patients aged (67.9±8.7) years were included in the study, with 71 cases (33.6%) in the simple BPH group and 140 cases (66.4%) in the BPH with ED group. The BPH with ED group demonstrated significantly higher values in age, alcohol consumption, duration of BPH, prostate specific antigen (PSA) level, pulse pressure index, International Prostate Symptom Score (IPSS), Quality of Life (QoL) score, and Patient Health Questionnaire-9 (PHQ-9) score compared to the simple BPH group (all P<0.05). Conversely, body mass index (BMI) and serum total testosterone level were significantly lower in the BPH with ED group (all P<0.05). Multivariable logistic regression analysis revealed that age≥55 years [Using the<55 years group as the reference, the OR (95%CI) for the≥55 to<65 years,≥65 to<75 years, and≥75 years groups were 7.575 (95%CI: 1.728-33.210), 21.951 (95%CI: 5.207-92.547), and 36.345 (95%CI: 7.491-176.345), respectively], pulse pressure index≥0.4 (OR=3.159,95%CI: 1.482-6.731), serum total testosterone level<12 nmol/L (OR=3.427,95%CI: 1.638-7.172), and depressive status (OR=4.360, 95%CI: 1.802-10.550) were risk factors for predicting ED (all P<0.05). The ROC curve indicated that the model had strong predictive performance, with an area under the curve (AUC) of 0.827 (95%CI: 0.766-0.888). The slope of the calibration curve for the nomogram model was close to 1, indicating good fit (χ²=7.893, P=0.444). Within a risk threshold range of 15%-95%, the nomogram model provided a clinically meaningful net benefit for predicting the risk of erectile dysfunction in BPH patients.

Age≥55 years, pulse pressure index≥0.4, serum total testosterone level<12 nmol/L, and depressive status are risk factors for ED in patients with BPH. The nomogram risk prediction model constructed based on the four risk factors demonstrates an excellent predictive performance.

To investigate the value of performing duodenal papilloplasty after removing bile duct stone through endoscopic retrograde cholangiopancreatography(ERCP), a retrospective study was conducted on 1 804 patients with common bile duct stones who underwent ERCP in the Cholelithic Center of East Hospital Affiliated to Tongji University from January 2020 to December 2024. The patients were followed up for one to three months after ERCP and divided into an intervention group and a control group based on whether duodenal papilloplasty was performed after complete bile duct stone removal by ERCP. There were 435 patients in the intervention group with an age of (56.5±9.9) years and 183 males (42.1%). There were 1 369 patients in the control group with an age of (57.2±9.7) years and 529 males (38.6%). The incidence of postoperative duodenal papilla bleeding rate and the incidence of post-ERCP pancreatitis (PEP), as well as the biliary stent detachment rate, the incidence and the severity score of intestinal bile reflux at one month after ERCP were compared between the two groups. There was no statistically significant difference in the general information between the two groups(all P>0.05). The incidence of postoperative duodenal papilla bleeding [0 vs 1.17% (16/1 369)], the biliary stent detachment rate[27.8% (121/435) vs 41.9% (573/1 369)], the incidence[4.8% (15/314) vs 27.5% (219/796)] and the severity score of intestinal bile reflux [2 (1, 2) vs 2 (2, 2)] in patients with non dislodged biliary stent in the intervention group were all lower than those in the control group (all P<0.05). There were no statistically significant differences between the two groups in the incidence of PEP or in the proportion of patients with intestinal bile reflux after biliary stent detachment (both P>0.05). Performing duodenal papilloplasty after removing bile duct stone through ERCP can not reduce the incidence of postoperative duodenal papillae bleeding, but also decrease the incidence and severity of intestinal bile reflux in patients with non dislodged bile duct stents.

Lysine-specific demethylase 1 (LSD1), as a histone demethylase, plays a key role in tumor occurrence, development and regulation of tumor microenvironment (TME). This paper systematically expounds the core mechanism of LSD1 regulating the tumor immune microenvironment, focusing on revealing that LSD1 regulates the immune microenvironment by inhibiting CD8⁺T cell activation, natural killer (NK) cytotoxicity and promoting macrophage polarization and other multi-dimensional immunosuppressive effects, and further demonstrate the synergistic effect of LSD1 inhibitors to enhance the efficacy of immune checkpoint inhibitors by restoring antigen presentation and enhancing T cell infiltration. Based on the latest basic and clinical research progress, a new idea of tumor immunotherapy based on LSD1 regulation is proposed, in order to provide certain reference value for future tumor immunotherapy.

Menopausal genitourinary syndrome (GSM) is a common disease in postmenopausal women, characterized by recurrent and chronically progressive symptoms of atrophy of the reproductive and urinary tracts, which seriously affects the physical and mental health of patients. Because the pathophysiological mechanism of GSM is still unclear and the clinical manifestations are complex and diverse, there is still a lack of unified and effective treatment methods. At present, low-dose vaginal estrogen preparations are the main treatment. This article will expound the pathogenesis of GSM, analyze the correlation between the micro-ecology of reproductive tract and urinary tract and GSM, discuss the effectiveness and safety of hormone therapy, vaginal lubricants and moisturizers, physical therapy, pelvic floor therapy and other emerging therapies, and summarize their research progress and development prospect.

Membranous nephropathy (MN) is a common primary glomerular disease characterized by podocyte injury. Programmed cell death (PCD) is an active death process regulated by endogenous genes, including apoptosis, autophagy, pyroptosis, ferroptosis, necrotizing apoptosis, etc. Recent studies have shown that PCD plays a key role in MN progression. This paper aims to summarize the role and mechanism of PCD in kidney and podocyte injury in MN, in order to provide a new theoretical basis for the clinical diagnosis and treatment of MN.

Drug therapy is an important intervention for patients with glaucoma. However, there are many kinds of anti-glaucoma drugs, and the best choice is a common problem in clinical practice. According to different chemical structures and pharmacological effects, intraocular pressure lowering drugs can usually be divided into seven categories: cholinomimetic drugs, adrenergic receptor blockers (beta blockers), adrenergic receptor agonists, carbonic anhydrase inhibitors, prostaglandomimetics (PGAs), compound preparations and hypertonic agents. The purpose of this article is to systematically comb and summarize the above commonly used intraocular pressure lowering drugs, in order to provide reference for clinical medication decision-making.

The concept of cardiovascular-renal-metabolic (CKM) health staging proposed by the American Heart Association aims to elucidate the pathophysiological association of metabolic risk factors, chronic kidney disease and cardiovascular disease. However, the association of CKM staging with long-term cardiovascular disease risk lacks large-scale population evidence. Therefore, a cohort study of cardiovascular diseases in many provinces and cities in China systematically analyzed the predictive value of CKM staging on long-term cardiovascular risk.

Chinese Journal of Medicine, Volume 105, Issue 36, September 23, 2025, article "Chinese Adult Cancer Pain Diagnosis and Treatment Guidelines (2025 Edition)", bottom right corner, page 3153 "Recommendation 15: TFP rotation: (1) Recommended conversion ratio for conversion of oral morphine to TFP: 200 mg/24 h oral morphine =100 mg/h TFP." should read "Recommendation 15: TFP rotation: (1) Recommended conversion ratio for conversion of oral morphine to TFP: 200 mg/24 h oral morphine =100 μ g/h TFP." It is hereby corrected.