Objective To investigate the correlation between serum levels of long non-coding RNA(Ln-cRNA)-prostate androgen regulated transcript 1(PART1),LncRNA-nucleolar ribonucleic acid host gene 14(SNHG14)and disease stage,cognitive impairment and motor function in patients with Parkinson's disease(PD).Methods A total of 100 PD patients(PD group)who admitted to the Department of Neurology in the hospital from January 2021 to December 2023 and 100 healthy subjects(control group)who underwent the physical examination during the same period of time were selected.According to Hoehn-Yahr staging,PD pa-tients were divided into early stage group(grade 1.0-2.5,20 cases),middle stage group(grade 3.0,48 ca-ses)and late stage group(grade 4.0-5.0,32 cases).According to the Montreal Cognitive Assessment(Mo-CA)score,the patients were divided into normal cognitive group(MoCA score≥26 points,33 cases),PD-mild cognitive impairment group(MoCA score 21-＜26 points,46 cases)and PD dementia group(MoCA score＜21 points,21 cases).According to the Unified Parkinson's Disease Rating Scale(UPDRS)-Ⅲ score,the pa-tients were divided into mild dyskinesia group(0-15 points,29 cases),moderate dyskinesia group(＞15-40 points,46 cases)and severe dyskinesia group(＞40-56 points,25 cases).Real-time fluorescence quantitative PCR was used to detect serum LncRNA-PART1 and LncRNA-SNHG14 levels.Spearman method was used to analyze the correlation between serum LncRNA-PART1,LncRNA-SNHG14 levels and Hoehn-Yahr staging,MoCA score and UPDRS-Ⅲ score in PD patients.Results The level of serum LncRNA-PART1 in PD group was lower than that in control group(P＜0.05),and the level of LncRNA-SNHG14 was higher than that in control group(P＜0.05).The serum levels of LncRNA-PART1 in the middle stage group and late stage groups were lower than those in the early stage group(P＜0.05),and the levels of LncRNA-SNHG14 were higher than those in the early stage group(P＜0.05).In addition,the serum level of LncRNA-PART1 in the late stage group was lower than that in the middle stage group(P＜0.05),and the level of LncRNA-SNHG14 was higher than that in the middle stage group(P＜0.05).The serum LncRNA-PART1 levels in the PD-mild cognitive impairment group and PD dementia group were lower than those in the normal cognitive group(P＜0.05),while the LncRNA-SNHG14 levels were higher than those in the normal cognitive group(P＜0.05).Additionally,the serum LncRNA-PART1 level in the PD dementia group was lower than that in the PD-mild cognitive impairment(P＜0.05),while the LncRNA-SNHG14 level was higher than that in the PD-mild cog-nitive impairment group(P＜0.05).The serum levels of LncRNA-PART1 in the moderate dyskinesia group and severe dyskinesia group were lower than those in the mild dyskinesia group(P＜0.05),and the levels ofLncRNA-SNHG14 were higher than that in the mild dyskinesia group(P＜0.05).In addition,the serum level of LncRNA-PART1 in the severe dyskinesia group was lower than that in the moderate dyskinesia group(P＜0.05),and the level of LncRNA-SNHG14 was higher than that in the moderate dyskinesia group(P＜0.05).Spearman method results showed that serum LncRNA-PART1 level was negatively correlated with Hoehn-Yahr staging and UPDRS-Ⅲ score in PD patients,and positively correlated with MoCA score(P＜0.05).The level of serum LncRNA-SNHG14 was positively correlated with Hoehn-Yahr staging and UPDRS-Ⅲ score in PD patients,and negatively correlated with MoCA score(P＜0.05).Conclusion The level of ser-um LncRNA-PART1 in PD patients is decreased,and the level of LncRNA-SNHG14 is increased,both of them are related to the disease stage,cognitive impairment and motor function of PD patients,which may be-come evaluation indicators for PD progression.

Objectives:To evaluate the performance of AVEIR VR single chamber leadless pacemaker(AVEIR VR)in the real world in China and the predictive factors of pacing threshold to assess the feasibility of AVEIRTM VR implantation in the domestic population.Methods:All patients who underwent AVEIR VR implantation by experienced operators from Peking University People's Hospital in multiple domestic hospitals from June 2024 to October 2024 were consecutively included,and their baseline characteristics,procedural data(including pacemaker electrical measurements at various stages),and follow-up results were observed,recorded,and statistically analyzed.Results:This study included 20 patients who met the indication for pacemaker implantation and underwent AVEIR VR implantation.Their mean age was(71.40±13.37)years,body mass index(BMI)was(23.05±3.71)kg/m2,body surface area(BSA)was(1.70±0.16)m2,all 20 patients were successfully implanted with pacemakers,there were no major complications(newly occurred pericardial effusion during the perioperative period,cardiac tamponade,poor pacemaker function,pacemaker dislocation/perforation,tricuspid valve injury,myocardial infarction,stroke,pulmonary embolism,and clinical death).One patient developed new frequent ventricular premature contractions after pacemaker release.The pacing threshold(PCT)at one week after implantation was correlated with PCT in tether mode(r=0.650,P=0.009)and PCT in release phase(r=0.596,P=0.019),but not with the sensing and impedance in each phase.Conclusions:This preliminary exploration study show that AVEIRTM VR implantation demonstrates satisfactory performance among real world patients in China,especially in elderly and low weight populations,confirming its safety.

Objective:To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE).Methods:This was a retrospective study. Consecutive patients who underwent S-ICD implantation at Peking University People′s Hospital between June 2015 and October 2023 were enrolled. Patients were divided into the TLE group and the newly implanted group based on whether they received TLE prior to S-ICD implantation. Baseline characteristics, S-ICD indication, defibrillation threshold test results, complications, and postoperative follow-up data were collected and compared between the two groups.Results:A total of 27 patients were included, aged (49.2±14.2) years, including 19 males. There were 12 patients in the TLE group and 15 in the newly implanted group. Compared with the TLE group, patients in the newly implanted group were younger ((43.3±13.7) years vs. (55.6±12.0) years, P=0.013). The main S-ICD indication in the TLE group was high infection risk (9/12), whereas in the newly implanted group it was younger age (11/15). All patients underwent successful S-ICD implantation, with 18 patients completing defibrillation threshold testing (all successful). Additionally, the TLE group had longer follow-up duration than the newly implanted group (42 (19, 60) months vs. 12 (3, 28) months, P=0.001). No complications or deaths occurred during follow-up, with normal device function in both groups. A total of 17 ventricular tachycardia or fibrillation events were recorded, of which 7 met defibrillation criteria and all received effective therapy. Conclusion:S-ICD demonstrates safety and efficacy as a therapeutic option for patients after TLE, with comparable device functionality and follow-up outcomes to patients with newly implanted S-ICD.

Objective:To evaluate the incidence and frequency of inappropriate shocks caused by defibrillation lead failure in patients with implantable cardioverter-defibrillators (ICD), and to explore methods for reducing the incidence and frequency of such inappropriate shocks.Methods:This was a single-center retrospective study involving patients treated for defibrillation lead failures at Peking University People′s Hospital between March 2015 and May 2024. Patients were divided into an alarm function group and a non-alarm function group based on whether their ICDs were equipped with lead alarm functions. Clinical data, lead data, and the incidence and frequency of inappropriate shocks were collected and compared between the two groups. A multivariate logistic regression model was used to analyze factors influencing the incidence and frequency of inappropriate ICD shocks. Kaplan-Meier survival curves were plotted to compare the trends in the incidence and frequency of inappropriate shocks over time since ICD implantation between the two groups.Results:A total of 59 patients were enrolled, with a age of (56.7±15.2) years, including 42 males (71%). The lifespan of the failed leads in the entire cohort was 64.0 (36.0, 96.0) months. There were 26 patients in the alarm function group and 33 in the non-alarm function group. The most common manifestations of lead failure were oversensing (85%, 50/59) and abnormal pacing impedance (42%, 25/59). A total of 33 patients (56%, 33/59) experienced inappropriate shock therapy, with an average of 27.3 shocks per patient. The frequency of inappropriate ICD shocks in the non-alarm function group was higher than that in the alarm function group (25.0 (10.0, 60.0) times/year vs. 5.0 (2.8, 7.8) times/year, P=0.001). Multivariate logistic regression analysis showed that oversensing ( OR=2.057, 95% CI 1.125-6.763, P=0.019) was an influencing factor for incidence of inappropriate shocks, while the lead alert function ( OR=0.062, 95% CI 0.005-0.719, P=0.001) was a factor influencing the frequency of inappropriate shocks. Kaplan-Meier survival analysis revealed that the incidence and frequency of inappropriate shocks increased with the duration of ICD implantation in both groups, but the differences were not statistically significant (incidence: log-rank P=0.908; frequency: log-rank P=0.767). Conclusion:The lead alert function can reduce the frequency of inappropriate shocks caused by lead failure.

Recent advances in large models demonstrate significant prospects for transforming the field of medical imaging. These models, including large language models, large visual models, and multimodal large models, offer unprecedented capabilities in processing and interpreting complex medical data across various imaging modalities. By leveraging self-supervised pretraining on vast unlabeled datasets, cross-modal representation learning, and domain-specific medical knowledge adaptation through fine-tuning, large models can achieve higher diagnostic accuracy and more efficient workflows for key clinical tasks. This review summarizes the concepts, methods, and progress of large models in medical imaging, highlighting their potential in precision medicine. The article first outlines the integration of multimodal data under large model technologies, approaches for training large models with medical datasets, and the need for robust evaluation metrics. It then explores how large models can revolutionize applications in critical tasks such as image segmentation, disease diagnosis, personalized treatment strategies, and real-time interactive systems, thus pushing the boundaries of traditional imaging analysis. Despite their potential, the practical implementation of large models in medical imaging faces notable challenges, including the scarcity of high-quality medical data, the need for optimized perception of imaging phenotypes, safety considerations, and seamless integration with existing clinical workflows and equipment. As research progresses, the development of more efficient, interpretable, and generalizable models will be critical to ensuring their reliable deployment across diverse clinical environments. This review aims to provide insights into the current state of the field and provide directions for future research to facilitate the broader adoption of large models in clinical practice.
Humans ; Diagnostic Imaging/methods* ; Precision Medicine/methods* ; Image Processing, Computer-Assisted/methods*

Objectives:To analyze the clinical characteristics,strategies,success and complication rates of lead extraction and re-implantation during the upgrade of cardiovascular implantable electronic devices(CIED)in non-infectious patients.Methods:This retrospective study collected and analyzed the baseline clinical data and surgical data of 66 non-infected patients who had their existing CIEDs(including cardiac pacemaker,implantable cardioverter defibrillator[ICD],cardiac resynchronization therapy pacemaker[CRT-P])upgraded to ICD or CRT-P or cardiac resynchronization therapy defibrillator(CRT-D)or subcutaneous implantable cardioverter defibrillator(S-ICD)in Peking University People's Hospital from March 2018 to March 2024.We analyzed the strategies of lead extraction and reimplantation as well as the operation success rate and complication rate.Results:Among the 66 patients,preoperative imaging revealed that 12 patients(18.2%)had severe stenosis/occlusion of the venous access route,with lead wear/perforation in 26 patients(39.4%).32 patients(48.5%)underwent transvenous lead extraction(TLE),of which all leads were removed in 27 patients(84.4%),and only non-functional leads were removed in 5 patients(15.6%).The success rate of the TLE procedure was 100%and no complication occurred.Among the 66 patients,functional leads retained and new leads were implanted on the same side in 28 patients(42.4%),all leads were removed and new leads were reimplanted on the opposite side in 22 patients(33.3%),only non-functional leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),all leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),and 6 patients(9.1%)had the leads abandoned and then were re-implanled.The success rate of the upgrade surgery was 100%,no complications were reported.Conclusions:When the existing CIEDs(including cardiac pacemaker,ICD,CRT-P)of non-infected patients are upgraded to ICD,CRT-P,CRT-D or S-ICD,lead extraction and reimplantation are safe and feasible,and reimplantation can be performed on the ipsilateral or contralateral side.

Objectives:To analyze the clinical characteristics,strategies,success and complication rates of lead extraction and re-implantation during the upgrade of cardiovascular implantable electronic devices(CIED)in non-infectious patients.Methods:This retrospective study collected and analyzed the baseline clinical data and surgical data of 66 non-infected patients who had their existing CIEDs(including cardiac pacemaker,implantable cardioverter defibrillator[ICD],cardiac resynchronization therapy pacemaker[CRT-P])upgraded to ICD or CRT-P or cardiac resynchronization therapy defibrillator(CRT-D)or subcutaneous implantable cardioverter defibrillator(S-ICD)in Peking University People's Hospital from March 2018 to March 2024.We analyzed the strategies of lead extraction and reimplantation as well as the operation success rate and complication rate.Results:Among the 66 patients,preoperative imaging revealed that 12 patients(18.2%)had severe stenosis/occlusion of the venous access route,with lead wear/perforation in 26 patients(39.4%).32 patients(48.5%)underwent transvenous lead extraction(TLE),of which all leads were removed in 27 patients(84.4%),and only non-functional leads were removed in 5 patients(15.6%).The success rate of the TLE procedure was 100%and no complication occurred.Among the 66 patients,functional leads retained and new leads were implanted on the same side in 28 patients(42.4%),all leads were removed and new leads were reimplanted on the opposite side in 22 patients(33.3%),only non-functional leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),all leads were removed and new leads were reimplanted on the same side in 5 patients(7.6%),and 6 patients(9.1%)had the leads abandoned and then were re-implanled.The success rate of the upgrade surgery was 100%,no complications were reported.Conclusions:When the existing CIEDs(including cardiac pacemaker,ICD,CRT-P)of non-infected patients are upgraded to ICD,CRT-P,CRT-D or S-ICD,lead extraction and reimplantation are safe and feasible,and reimplantation can be performed on the ipsilateral or contralateral side.

Objectives:To evaluate the performance of AVEIR VR single chamber leadless pacemaker(AVEIR VR)in the real world in China and the predictive factors of pacing threshold to assess the feasibility of AVEIRTM VR implantation in the domestic population.Methods:All patients who underwent AVEIR VR implantation by experienced operators from Peking University People's Hospital in multiple domestic hospitals from June 2024 to October 2024 were consecutively included,and their baseline characteristics,procedural data(including pacemaker electrical measurements at various stages),and follow-up results were observed,recorded,and statistically analyzed.Results:This study included 20 patients who met the indication for pacemaker implantation and underwent AVEIR VR implantation.Their mean age was(71.40±13.37)years,body mass index(BMI)was(23.05±3.71)kg/m2,body surface area(BSA)was(1.70±0.16)m2,all 20 patients were successfully implanted with pacemakers,there were no major complications(newly occurred pericardial effusion during the perioperative period,cardiac tamponade,poor pacemaker function,pacemaker dislocation/perforation,tricuspid valve injury,myocardial infarction,stroke,pulmonary embolism,and clinical death).One patient developed new frequent ventricular premature contractions after pacemaker release.The pacing threshold(PCT)at one week after implantation was correlated with PCT in tether mode(r=0.650,P=0.009)and PCT in release phase(r=0.596,P=0.019),but not with the sensing and impedance in each phase.Conclusions:This preliminary exploration study show that AVEIRTM VR implantation demonstrates satisfactory performance among real world patients in China,especially in elderly and low weight populations,confirming its safety.

Objective:To evaluate the clinical feasibility of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation following transvenous lead extraction (TLE).Methods:This was a retrospective study. Consecutive patients who underwent S-ICD implantation at Peking University People′s Hospital between June 2015 and October 2023 were enrolled. Patients were divided into the TLE group and the newly implanted group based on whether they received TLE prior to S-ICD implantation. Baseline characteristics, S-ICD indication, defibrillation threshold test results, complications, and postoperative follow-up data were collected and compared between the two groups.Results:A total of 27 patients were included, aged (49.2±14.2) years, including 19 males. There were 12 patients in the TLE group and 15 in the newly implanted group. Compared with the TLE group, patients in the newly implanted group were younger ((43.3±13.7) years vs. (55.6±12.0) years, P=0.013). The main S-ICD indication in the TLE group was high infection risk (9/12), whereas in the newly implanted group it was younger age (11/15). All patients underwent successful S-ICD implantation, with 18 patients completing defibrillation threshold testing (all successful). Additionally, the TLE group had longer follow-up duration than the newly implanted group (42 (19, 60) months vs. 12 (3, 28) months, P=0.001). No complications or deaths occurred during follow-up, with normal device function in both groups. A total of 17 ventricular tachycardia or fibrillation events were recorded, of which 7 met defibrillation criteria and all received effective therapy. Conclusion:S-ICD demonstrates safety and efficacy as a therapeutic option for patients after TLE, with comparable device functionality and follow-up outcomes to patients with newly implanted S-ICD.

Objective:To evaluate the incidence and frequency of inappropriate shocks caused by defibrillation lead failure in patients with implantable cardioverter-defibrillators (ICD), and to explore methods for reducing the incidence and frequency of such inappropriate shocks.Methods:This was a single-center retrospective study involving patients treated for defibrillation lead failures at Peking University People′s Hospital between March 2015 and May 2024. Patients were divided into an alarm function group and a non-alarm function group based on whether their ICDs were equipped with lead alarm functions. Clinical data, lead data, and the incidence and frequency of inappropriate shocks were collected and compared between the two groups. A multivariate logistic regression model was used to analyze factors influencing the incidence and frequency of inappropriate ICD shocks. Kaplan-Meier survival curves were plotted to compare the trends in the incidence and frequency of inappropriate shocks over time since ICD implantation between the two groups.Results:A total of 59 patients were enrolled, with a age of (56.7±15.2) years, including 42 males (71%). The lifespan of the failed leads in the entire cohort was 64.0 (36.0, 96.0) months. There were 26 patients in the alarm function group and 33 in the non-alarm function group. The most common manifestations of lead failure were oversensing (85%, 50/59) and abnormal pacing impedance (42%, 25/59). A total of 33 patients (56%, 33/59) experienced inappropriate shock therapy, with an average of 27.3 shocks per patient. The frequency of inappropriate ICD shocks in the non-alarm function group was higher than that in the alarm function group (25.0 (10.0, 60.0) times/year vs. 5.0 (2.8, 7.8) times/year, P=0.001). Multivariate logistic regression analysis showed that oversensing ( OR=2.057, 95% CI 1.125-6.763, P=0.019) was an influencing factor for incidence of inappropriate shocks, while the lead alert function ( OR=0.062, 95% CI 0.005-0.719, P=0.001) was a factor influencing the frequency of inappropriate shocks. Kaplan-Meier survival analysis revealed that the incidence and frequency of inappropriate shocks increased with the duration of ICD implantation in both groups, but the differences were not statistically significant (incidence: log-rank P=0.908; frequency: log-rank P=0.767). Conclusion:The lead alert function can reduce the frequency of inappropriate shocks caused by lead failure.