1.Application advances, ethical dilemmas, and future directions of large language models in lung cancer diagnosis and treatment
Zhizhen REN ; Yufan XI ; Xu ZHU ; Yijie LUO ; Geting HUANG ; Junqiao SONG ; Xiuyuan XU ; Nan CHEN ; Qiang PU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(03):353-362
Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide. Coupled with the substantial workload, the clinical management of lung cancer is challenged by the critical need to efficiently and accurately process increasingly complex medical information. In recent years, large language models (LLMs) technology has undergone explosive development, demonstrating unique advantages in handling complex medical data by leveraging its powerful natural language processing capabilities, and its application value in the field of lung cancer diagnosis and treatment is continuously increasing. The paper systematically analyzes that the exceptional potential of LLMs in lung cancer auxiliary diagnosis, tumor feature extraction, automatic staging, progression/outcome analysis, treatment recommendations, medical documentation generation, and patient education. However, they face critical technical and ethical challenges including inconsistent performance in complex integrated decision-making (e.g., TNM staging, personalized treatment suggestions) and "black box" opacity issues, along with dilemmas such as training data biases, model hallucinations, data privacy concerns, and cross-lingual adaptation challenges ("data colonization"). Future directions should prioritize constructing high-quality multimodal corpora specific to lung cancer, developing interpretable and compliant specialized models, and achieving seamless integration with existing clinical workflows. Through dual drivers of technological innovation and ethical standardization, LLMs should be prudently advanced for holistic lung cancer management processes, ultimately promoting efficient, standardized, and personalized diagnosis and treatment practices.
2.Similarities and Differences between Myofascial Trigger Points and Sinew Knot:from the Perspective of the Channel Sinew Theory
Zijie CHEN ; Haohan ZHU ; Xingke SONG ; Xue PU ; Junying WANG
Journal of Traditional Chinese Medicine 2026;67(9):1023-1026
Myofascial trigger points, as hyperirritable spots within taut bands of skeletal muscle, can induce local or referred pain, and show a high degree of similarity to acupoints in traditional Chinese medicine (TCM), particularly the so-called sinew knot lesion point. From the perspective of channel sinew theory, and by examining the correlations of myofascial trigger points with acupoints and channel sinew disorders, this study aims to compare the similarities and differences between MTrPs and sinew knot lesion points in terms of pathological mechanisms, needling analgesic mechanisms, and therapeutic approaches. The goal is to deepen the understanding of MTrPs and dry needling, and provide a modern scientific perspective on channel sinew theory and the sinew knot lesion point.
3.Similarities and Differences between Myofascial Trigger Points and Sinew Knot:from the Perspective of the Channel Sinew Theory
Zijie CHEN ; Haohan ZHU ; Xingke SONG ; Xue PU ; Junying WANG
Journal of Traditional Chinese Medicine 2026;67(9):1023-1026
Myofascial trigger points, as hyperirritable spots within taut bands of skeletal muscle, can induce local or referred pain, and show a high degree of similarity to acupoints in traditional Chinese medicine (TCM), particularly the so-called sinew knot lesion point. From the perspective of channel sinew theory, and by examining the correlations of myofascial trigger points with acupoints and channel sinew disorders, this study aims to compare the similarities and differences between MTrPs and sinew knot lesion points in terms of pathological mechanisms, needling analgesic mechanisms, and therapeutic approaches. The goal is to deepen the understanding of MTrPs and dry needling, and provide a modern scientific perspective on channel sinew theory and the sinew knot lesion point.
4.Discussion on Technical Characteristics of National Drug Standards for Traditional Chinese Medicine Dispensing Granules
Shengjun CHEN ; Song LI ; Kejia GUO ; Yuntian ZHANG ; Haiqin ZHOU ; Xianglan PU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(10):256-264
On the premise of respecting the objective law of the occurrence and development of traditional Chinese medicine(TCM) dispensing granules, relevant national departments have gradually formed the research and formulation ideas of national drug standards for dispensing granules based on the experiences and lessons learned in the development process of quality standards, as well as the formation mechanism of national standards for dispensing granules. This has certain reference significance for the formulation path of TCM quality standards. Combined with the general situation of the published standards and specific cases, the research concepts of the national standards for dispensing granules were analyzed and summarized in this paper, and the analysis of the technical characteristics of the issued national standards was focused, including the introduction of standard decoction, the overall quality control of TCM, the whole process quality control and other research ideas. At the same time, it summarized the industry common problems in the research and development process of national standards for dispensing granules, such as the source and process control of medicinal materials, and strived to solve them together, encouraging the demonstration and application of new technological means in the field of TCM dispensing granules. Finally, based on the literature analysis, the shortcomings of the current national standards were discussed, and relevant suggestions were put forward to further improve the national standards for dispensing granules. Through the overall analysis, it is helpful to comprehensively understand the technical characteristics of the national standards for TCM dispensing granules, and provide reference for the scientific exploration and practice of quality control methods for TCM.
5.Nano-drug delivery strategies affecting cancer-associated fibroblasts to reduce tumor metastasis.
Linghui ZOU ; Peng XIAN ; Qing PU ; Yangjie SONG ; Shuting NI ; Lei CHEN ; Kaili HU
Acta Pharmaceutica Sinica B 2025;15(4):1841-1868
Tumor metastasis is the leading cause of high mortality in most cancers, and numerous studies have demonstrated that the malignant crosstalk of multiple components in the tumor microenvironment (TME) together promotes tumor metastasis. Cancer-associated fibroblasts (CAFs) are the major stromal cells and crosstalk centers in the TME of various kinds of tumors, such as breast cancer, pancreatic cancer, and prostate cancer. Recently, the CAF-induced pro-tumor metastatic TME has gained wide attention, being considered as one of the effective targets for tumor therapy. With in-depth research, CAFs have been found to promote tumor metastasis through multiple mechanisms, such as inducing epithelial-mesenchymal transition in tumor cells, remodeling the extracellular matrix, protecting circulating tumor cells, and facilitating the formation of a pre-metastatic niche. To enhance the anti-tumor metastasis effect, therapeutic strategies designed by combining nano-drug delivery systems with CAF modulation are undoubtedly a desirable choice, as evidenced by the research over the past decades. Herein, we introduce the physiological properties of CAFs, detail the possible mechanisms whereby CAFs promote tumor metastasis, categorize CAFs-based nano-drug delivery strategies according to their anti-metastasis functions and discuss the current challenges, possible solutions, as well as the future directions in order to provide a theoretical basis and reference for the utilization of CAFs-based nano-drug delivery strategies to promote tumor metastasis therapy.
6.Rapid discovery of drug-introduced multiple organ dysfunction via NIR-II fluorescent imaging.
Pu JIANG ; Ruihu SONG ; Yue HU ; Xin HE ; Zewei ZHANG ; Xuemei WEI ; Zhiming WANG ; De-An GUO ; Hao CHEN
Acta Pharmaceutica Sinica B 2025;15(8):4285-4299
The precise and rapid monitoring of multiple organ dysfunction is crucial in drug discovery. Traditional methods, such as pathological analysis, are often time-consuming and inefficient. Here, we developed a multiplexed near-infrared window two (NIR-II) fluorescent bioimaging method that allows for real-time, rapid, and quantitative assessment of multiple organ dysfunctions. Given that existing probes did not fully meet requirements, we synthesized a range of NIR-II hemicyanine dyes (HDs) with varying absorption and emission wavelengths. By modifying these dyes, we achieved high spatial and temporal resolution imaging of the liver, kidneys, stomach, and intestines. This method was further applied to investigate disorders induced by cisplatin, a drug known to cause gastric emptying issues along with liver and kidney injuries. By monitoring the metabolic rate of the dyes in these organs, we accurately quantified multi-organ dysfunction, which was also confirmed by gold-standard pathological analysis. Additionally, we evaluated the effects of five aristolochic acids (AAs) on multiple organ dysfunction. For the first time, we identified that AA-I and AA-II could cause gastric emptying disorders, which was further validated through transcriptomics analysis. Our study introduces a novel approach for the simultaneous monitoring of multi-organ dysfunction, which may significantly enhance the evaluation of drug side effects.
7.A study on the correlation between regional hemodynamics and plaque morphology of middle cerebral artery in atherosclerotic stenosis using four-dimensional flow MRI
Yuanbin ZHAO ; Xiaoyan BAI ; Chao ZHANG ; Xue ZHANG ; Tong CHEN ; Xun PEI ; Yuehua PU ; Ligang SONG ; Binbin SUI
Chinese Journal of Radiology 2025;59(3):261-268
Objective:To explore the hemodynamic characteristics of the middle cerebral artery (MCA) in atherosclerotic stenosis using four-dimensional flow (4D Flow) MRI, and combining high-resolution magnetic resonance vessel wall imaging (HR VW-MRI) to analyze the relationship between hemodynamics and the degree of stenosis, as well as the morphological characteristics of plaques.Methods:The study was a cross-sectional study. A total of 24 patients with middle cerebral artery(MCA) M1 atherosclerotic stenosis and 10 age and sex matched healthy controls (HC group) were prospectively recruited from September 2018 to March 2021 at Beijing Tiantan Hospital, Capital Medical University. All subjects underwent MRI examination. The hemodynamic of MCA were collected by 4D Flow MRI, and the hemodynamic parameters of proximal and distal MCA stenosis were calculated by blood flow post-processing software, including average blood flow rate (FR avg), average blood flow velocity (V avg), peak blood flow velocity (V pk), time average wall shear stress (TAWSS), minimum wall shear stress (WSS min) and oscillatory shear index (OSI). The differences in hemodynamic parameters among the proximal and distal ends of MCA stenosis and the HC group were compared using one-way ANOVA or Kruskal-Wallis H test. The stenosis rate and characteristics of MCA plaque were analyzed by HR VW-MRI, including remodeling index (RI), normalized wall index (NWI) and plaque length. Pearson or Spearman correlation analysis was used to explore the correlation between stenosis rate and hemodynamic parameters. Taking the stenosis rate as the control variable, partial correlation analysis was used to explore the correlation between plaque morphological characteristics and hemodynamic parameters. Results:There were statistically significant differences in FR avg, V avg, V pk, TAWSS, OSI, WSS min among the proximal and distal stenosis of MCA and HC groups ( P<0.05). The proximal end of the MCA stenosis had significantly higher FR avg, V avg, TAWSS and WSS min than those of the distal end of the stenosis ( P<0.01). The FR avg, V avg, V pk, TAWSS, and WSS min in the distal end of MCA stenosis were lower than those in the HC group, while the OSI was higher than that in the HC group ( P<0.01). The correlation analysis results showed that the MCA proximal V pk ( r=-0.425, P=0.027) and distal V pk ( r=-0.538, P=0.004) were negatively correlated with the diameter stenosis rate. When the stenosis rate was taken as the control factor, in the MCA proximal stenosis, V avg ( r=0.553, P=0.003), TAWSS ( r=0.543, P=0.004) and WSS min ( r=0.547, P=0.004) were positively correlated with RI, proximal OSI was negatively correlated with RI ( r=-0.492, P=0.011), and was positively correlated with the plaque length ( r=0.437, P=0.026). At the distal end of the stenosis, V pk was negatively correlated with NWI ( r=-0.556, P=0.003), OSI was negatively correlated with RI ( r=-0.511, P=0.008), NWI ( r=-0.390, P=0.049). TAWSS was positively correlated with RI ( r=0.393, P=0.047). Conclusions:The 4D Flow MRI demonstrates characteristic hemodynamic changes in the proximal and distal ends of the stenotic MCA. The local hemodynamic characteristics of the stenotic MCA are correlated with plaque morphological parameters, including lumen stenosis, plaque load, and RI. It suggests an interaction between the occurrence and development of MCA plaque and local hemodynamic changes.
8.Fetal intracranial toxoplasmosis: MRI findings in a case report
Yan SONG ; Yunlu MO ; Hongbo PU ; Hongyu YIN ; Xi CHEN ; Qiyan WANG ; Yangmei PU ; Min KANG
Chinese Journal of Perinatal Medicine 2025;28(10):899-901
Toxoplasmosis is a zoonotic disease caused by infection with Toxoplasma gondii. Congenital toxoplasmosis is a common form of intrauterine infection and is associated with severe neurological sequelae such as cerebral palsy and cognitive impairment. This report presented the magnetic resonance imaging (MRI) features of a fetal intracranial toxoplasmosis case, including bilateral ventriculomegaly, multiple intracranial cystic lesions, and parenchymal calcifications, without concurrent retinal abnormalities or hepatosplenomegaly. Post-termination analyses confirmed the presence of T.gondii DNA in amniotic fluid and umbilical venous blood, with histopathology revealing necrosis and eosinophilic infiltration. MRI demonstrates superior soft-tissue resolution in evaluating the extent of cerebral lesions and parenchymal damage, underscoring its diagnostic value in fetal toxoplasmic encephalopathy.
9.The value of radiomics nomogram based on multiparameter MRI in predicting human epidermal growth factor receptor 2 status in endometrial cancer
Jing SONG ; Haiping LI ; Li LI ; Zengxin LIANG ; Yongqiang PU
Journal of Practical Radiology 2025;41(6):989-993
Objective To explore the predictive value of radiomics nomogram based on multiparameter MRI for the status of human epidermal growth factor receptor 2(HER-2)in endometrial cancer(EC).Methods A total of 154 patients with pathologically proved EC were retrospectively selected and randomly divided into training set(108 cases)and validation set(46 cases)according to the ratio of 7∶3.Radiomics features were extracted from the preoperative multiparameter MRI images of the patients.The predictive performance of different machine learning algorithms was evaluated by receiver operating characteristic(ROC)curves,and the nomogram was constructed in combination with clinical risk factors.Results The degree of differentiation and depth of myometrial invasion were clinical risk factors for predicting HER-2 positivity in EC patients.The support vector machine(SVM)was selected as the best radiomics model.The nomogram showed the highest predictive performance in the training and validation sets,with area under the curve(AUC)of 0.926 and 0.897,respectively.Conclusion The radiomics nomogram based on multiparameter MRI can accurately predict the HER-2 status of EC patients before surgery and can be used to guide clinical treatment decisions.
10.Predictive Value of Residual Quantitative Flow Ratio for Long-term Vessel-oriented Composite Endpoints
Rui ZHANG ; Yanpu SHI ; Changdong GUAN ; Yanyan ZHAO ; Shengxian TU ; Bo YU ; Guosheng FU ; Yujie ZHOU ; Jian'an WANG ; Yundai CHEN ; Jun PU ; Kefei DOU ; Weixian YANG ; Yongjian WU ; Shubin QIAO ; Lei SONG
Chinese Circulation Journal 2025;40(9):862-869
Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

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