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  • Yajun YOU, Yan CHEN, Dujuan HUANG, Lin JIANG, Yuhui DENG, Yuning ZHOU, Yong TANG, Qian XIAO
    Journal of Army Medical University. 2026, 48(4): 394-406.
    Objective

    To investigate the effects of selective overexpression of hippocampal cannabinoid receptor 1 (CB1R) on newly generated cells and newly matured neurons in the hippocampus of stress-induced rats.

    Methods

    Thirty-two 6-8 week-old male SD rats (body weight 180 to 220 g) were randomly assigned to a Control group (n=10) and a Stress group (n=22). After the Stress group underwent 3 weeks of chronic restraint stress (CRS), 11 rats were randomly selected to form the Stress+CB1R-OE group, receiving hippocampal injections of an adeno-associated virus (AAV) for CB1R overexpression via stereotaxic surgery. The Control group and the remaining Stress group received a null AAV, designated as Control+AAV-NC and Stress+AAV-NC groups, respectively; viral transfection lasted 3 weeks. Body weight was measured every Sunday morning for weeks 1 to 7. Behavioral levels were assessed using the novel environment feeding suppression test. Immunofluorescence staining was used to detect the expression of 5-bromo-2'-deoxyuridine (BrdU), Neuronal Nuclei (NeuN), and CB1R in the hippocampal dentate gyrus (DG) (n=5 per group, 3 slices per rat). A NOVEL confocal microscope was used for scanning. Imaris software calculated the density of BrdU⁺ and BrdU⁺/NeuN⁺ cells per unit volume in the DG, while Image J software measured the mean fluorescence intensity of CB1R and NeuN in the DG. Western blot assay was used to detect hippocampal CB1R protein expression levels.

    Results

    After 3 weeks of CRS, the body weight of the Stress+AAV-NC group was significantly lower than that of the Control+AAV-NC group (P=0.001). Selective hippocampal CB1R overexpression for 3 weeks partially ameliorated body weight gain in the Stress+CB1R-OE group, but their weight remained significantly lower than the Control+AAV-NC group (P=0.004). The novel environment feeding suppression test showed that compared to the Control+AAV-NC group, the Stress+AAV-NC group had a significantly prolonged feeding latency (P<0.001), with no significant difference in feeding amount within 5 min. After selective CB1R overexpression, the Stress+CB1R-OE group showed a significantly shortened feeding latency (P=0.039), with no significant differences in feeding amount among the three groups. Immunofluorescence results indicated that compared to the Control+AAV-NC group, the Stress+AAV-NC group had a significantly reduced mean fluorescence intensity of CB1R⁺ cells in the DG (P=0.008). After selective CB1R overexpression, the Stress+CB1R-OE group showed a significantly increased mean CB1R fluorescence intensity in the DG compared to the Stress+AAV-NC group (P<0.001). Western blotting results showed that hippocampal CB1R protein expression was significantly lower in the Stress+AAV-NC group than in the Control+AAV-NC group (P=0.001). Compared to the Stress+AAV-NC group, the Stress+CB1R-OE group had a significantly increased hippocampal CB1R expression level (P<0.001). Compared to the Control+AAV-NC group, the Stress+AAV-NC group had reduced densities of BrdU⁺ newborn cells (P=0.003) and BrdU⁺/NeuN⁺ newly matured neurons (P=0.001) in the DG. After selective CB1R overexpression, the Stress+CB1R-OE group showed significantly increased densities of BrdU⁺ cells (P=0.035) and BrdU⁺/NeuN⁺ neurons (P=0.028) in the DG. No significant difference was observed in the mean NeuN fluorescence intensity in the DG among the three groups.

    Conclusion

    Selective overexpression of hippocampal CB1R can alleviate stress-mediated reduction in hippocampal neurogenesis and subsequently improve behavioral deficits in stress-induced rats.

  • Mingxing LUO, Rui LIAO, Shan GUAN, Weijun ZHANG, Ping LUO, Yi ZHANG, Ping CHENG, Yang LI, Quanming ZOU
    Journal of Army Medical University. 2026, 48(4): 407-419.
    Objective

    To construct an engineered milk-derived exosome (mExos) vector for efficient messenger RNA (mRNA) delivery to the respiratory tract by systematically screening cationic modification materials.

    Methods

    mExos were isolated via ultracentrifugation, followed by electroporation-mediated loading of firefly luciferase (Fluc) or enhanced green fluorescent protein (EGFP) mRNA. Chitosan (CS), polyethyleneimine (PEI), poly(beta-amino ester) (PBAE), cationic lipid (DOTAP), and protamine were used to modify mRNA-loaded mExos. Dynamic light scattering, nanoparticle tracking analysis, flow cytometry and luciferase reporter assay were employed to evaluate particle size, zeta potential, colloidal stability, cellular uptake, transfection efficiency, and cytotoxicity. Fifty female BALB/c mice (6 to 8 weeks, about 20 g) received intranasal administration of dye-labeled or Fluc-mRNA-loaded formulations. In vivo distribution and pulmonary transfection kinetics were monitored by IVIS imaging, while histopathology and serum biochemistry of major organs were analyzed at 24 h post-administration.

    Results

    Cationic-modified mExos were successfully constructed. CS-modified mExos (CS-mExos) demonstrated surface charge reversal while maintaining optimal size and stability (PDI unchanged within 48 h). In vitro, CS-mExos enhanced cellular uptake in 16HBE and A549 cells by 2.56-fold (P<0.001) and 4.56-fold (P<0.001), respectively, and increased Fluc-mRNA transfection efficiency by 28.9-fold (P<0.001) and 26.5-fold (P<0.001) versus unmodified mExos, with >95% cell viability. In vivo imaging revealed CS-mExos specifically accumulated in the lungs with sustained retention >72 h, mediating 9.5-fold higher peak Fluc-mRNA expression at 6 h post-administration. Histopathology and serum biochemistry confirmed no significant organ damage or abnormal hepatic/renal indices.

    Conclusion

    Systematic screening identified chitosan as the optimal cationic material for engineering milk exosomes. The developed CS-mExos vector enables efficient targeted mRNA delivery to the respiratory tract with enhanced pulmonary transfection and favorable biosafety.

  • Pan WANG, Chenzhen BAO, Ting ZHU, Yanyan CEN, Xichun PAN
    Journal of Army Medical University. 2026, 48(4): 420-432.
    Objective

    To investigate the effect and mechanism of a novel artemisinin derivative, disuccinate artemisinin (DA), in enhancing bacterial clearance by upregulating antibacterial autophagy in macrophages through targeting host mitochondrial respiration.

    Methods

    The experiment utilized E. colistrains ATCC 35218 and FITC-labeled K12 to infect the mouse macrophage cell line RAW264.7. Phagocytosis of bacteria by macrophages under different time points and doses was assessed via fluorescence imaging to determine the optimal drug dosage and time point. The impact of the drug on antibacterial autophagy in macrophages was evaluated using colony counting, Western blotting and immunofluorescence co-localization assay. Autophagy inhibitors 3-methyladenine (3-MA) and bafilomycin A1 were employed to examine the effect of autophagy suppression on drug efficacy through colony counting and immunofluorescence co-localization. Glucose deprivation was induced using low-glucose medium, and its influence on drug action was observed via fluorescent bacterial counting and immunofluorescence co-localization. Glycolytic intervention was investigated using the glycolytic activator oligomycin A and inhibitor 2-deoxy-D-glucose (2-DG), with effects monitored through fluorescent bacterial counting and immunofluorescence co-localization. Mitochondrial respiration was modulated with the activator carbonyl cyanide 4-trifluoromethoxy phenylhydrazone (FCCP) and inhibitor rotenone, and its impact on drug action was assessed via fluorescent bacterial counting and immunofluorescence co-localization. The effect of the drug on mitochondrial respiration in macrophages was determined by measuring the oxygen consumption rate (OCR) using cellular energy metabolism assays.

    Results

    DA concentration-dependently enhanced macrophage phagocytosis and clearance of both drug-resistant ATCC35218 and sensitive K12 E. coli (P<0.05). Immunofluorescence and immunoblotting demonstrated DA upregulated antibacterial autophagy (P<0.01), remaining effective when autophagy initiation was blocked (P<0.01) but losing efficacy upon autophagic flux inhibition (P<0.01). Under glucose deprivation, DA retained its autophagy-enhancing effect (P<0.01). Both activation and inhibition of glycolysis limited DA’s efficacy (P<0.01). Maximizing mitochondrial respiration with FCCP abolished DA’s pro-phagocytic and autophagy-enhancing effects (P<0.01), whereas respiratory blockade with rotenone preserved them (P<0.01). Metabolic analysis showed DA restored infection-impaired maximal mitochondrial respiration, spare respiratory capacity, and ATP production (P<0.01).

    Conclusion

    DA enhances bacterial clearance by upregulating antibacterial autophagy through restoration of mitochondrial respiration in infected macrophages, representing a host-directed anti-infective candidate targeting mitochondrial metabolism.

  • Jiangyi LI, Bo ZHENG, Yuxin WANG, Ling GUO, Guirong DING
    Journal of Army Medical University. 2026, 48(4): 433-444.
    Objective

    To investigate the ameliorative effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) on radiation-induced reproductive damage in male mice and its potential mechanisms.

    Methods

    After obtaining informed consent and signed consent forms from healthy full-term pregnant women in the Department of Obstetrics and Gynecology at Xijing Hospital of Air Force Medical University, umbilical cord tissue approximately from 6 to 8 cm in length from healthy full-term newborns was collected under sterile conditions in the operating room for isolating and culturing hUC-MSCs; 45 healthy male C57BL/6 mice aged from 6 to 8 weeks with a body weight of 22±2 g were divided into Control+PBS (n=3), Control+MSCs (n=6), Rad+MSCs (n=6), Control (n=10), Rad (n=10), and Rad+hUC-MSCs (n=10) groups using a random number table method; the Rad, Rad+MSCs, and Rad+hUC-MSCs groups were subjected to whole-body single-dose irradiation using 60Co γ-ray at a dose rate of 1.28 Gy/min and a total dose of 6 Gy; immediately after irradiation, the Rad+MSCs and Rad+hUC-MSCs groups received a single tail vein injection of hUC-MSCs suspension (2×10⁶ cells/200 μL); the distribution of hUC-MSCs in testicular tissue was observed using a multimodal in vivo imaging system and confocal fluorescence microscopy; at 12 weeks post-irradiation, bilateral testes were harvested and weighed to calculate the testicular coefficient; sperm quality was assessed under a microscope; testicular morphology and structure were evaluated using Hematoxylin and Eosin (HE) staining; reactive oxygen species (ROS) and mitochondrial membrane potential (MMP) levels in testicular tissue were measured by flow cytometry; malondialdehyde (MDA), total superoxide dismutase (T-SOD), and catalase (CAT) contents were detected by colorimetry; testicular cell apoptosis was assessed using TUNEL staining; and Western blot was used to detect the expression levels of Parkin RBR E3 ubiquitin-protein ligase (Parkin), PTEN-induced putative kinase 1 (PINK1), Beclin1, OPA1 mitochondrial dynamin-like GTPase (OPA1), dynamin-related protein 1 (Drp1), Bcl2-associated X protein (Bax), and B cell lymphoma-2 (Bcl-2).

    Results

    At 24 h and 48 h post-irradiation, multimodal in vivo imaging showed no fluorescent signals in the testicular tissue of the Control+PBS group, while fluorescent signals were observed in the Control+MSCs and Rad+MSCs groups; further confocal fluorescence microscopy revealed red fluorescence in the interstitial regions of testicular tissue in the Control+MSCs and Rad+MSCs groups, detecting fluorescence dye labeled MSCs signals; at 12 weeks post-irradiation, compared to the Control group, the Rad group showed significantly decreased sperm count (P<0.05) and motility (P<0.01), significantly increased malformation rate (P<0.001), vacuolization and disordered arrangement of spermatogenic cells, reduced seminiferous tubule diameter and spermatogenic epithelium thickness (P<0.001), elevated testicular tissue ROS levels (P<0.05), significantly decreased MMP levels (P<0.001), increased MDA content (P<0.001), elevated T-SOD activity (P<0.05), decreased CAT activity (P<0.05), increased protein expression of Parkin (P<0.01), PINK1 (P<0.05), Beclin1 (P<0.05), OPA1 (P<0.01), and Drp1 (P<0.05), increased TUNEL-positive cells (P<0.001), and decreased Bcl-2/Bax ratio (P<0.01); compared to the Rad group, the Rad+hUC-MSCs group exhibited significantly increased sperm count and motility (P<0.05), significantly decreased malformation rate (P<0.001), improved vacuolization and arrangement of spermatogenic cells, increased spermatogenic epithelium thickness (P<0.01), reduced testicular tissue ROS levels (P<0.05), significantly increased MMP levels (P<0.01), decreased MDA content (P<0.001), reduced T-SOD activity (P<0.05), increased CAT activity (P<0.05), decreased protein expression of Parkin (P<0.05), PINK1 (P<0.05), Beclin1 (P<0.05), OPA1 (P<0.05), and Drp1 (P<0.05), reduced TUNEL-positive cells (P<0.001), and increased Bcl-2/Bax ratio (P<0.05).

    Conclusion

    hUC-MSCs may alleviate radiation-induced male reproductive damage by mitigating mitochondrial damage, reducing testicular tissue oxidative stress injury and cell apoptosis.

  • Mengqiu HUANG, Hang ZHONG, Yuan QIU, Quanming ZOU, Liusheng PENG, Daiyuan MA
    Journal of Army Medical University. 2026, 48(4): 445-452.
    Objective

    To detect the infiltration level of CD103+CD39+CD8+ T cell subsets in gastric cancer tissues and analyze their response characteristics, clarifying the clinical relevance of this subset.

    Methods

    Surgical specimens (tumor tissues, adjacent tissues, and peripheral blood) were collected from gastric cancer patients at the Department of General Surgery, Second Affiliated Hospital of Army Medical University between January 2023 and May 2024. Flow cytometry and immunofluorescence staining quantified the proportion and number of CD103+CD39+CD8+ T cells in tumor versus adjacent tissues. Flow cytometry further analyzed CD69, PD-1, and IFN-γ expression in this subset. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured in vitro to assess TGF-β1-induced differentiation. Correlation with disease stage was analyzed by detecting the infrltration level of CD103+CD39+CE8+ T Cell subsets via flow cytometry.

    Results

    Compared with adjacent tissues, gastric cancer tissues showed significantly increased proportions of CD103+CD39+CD8+ T cells (P<0.05); immunofluorescence confirmed higher numbers in tumor tissues. Relative to CD103+CD39- and CD103-CD39-CD8+ T subsets, CD103+CD39+CD8+ T cells exhibited elevated CD69 and PD-1 expression (P<0.05) but reduced IFN-γ (P<0.05). In vitro TGF-β1 stimulation upregulated co-expression of CD103 and CD39 in CD8+ T cells (P<0.05). Moreover, advanced gastric cancer patients had higher tumor infiltration of this subset than early-stage patients (P<0.05).

    Conclusion

    CD103+CD39+CD8+ T cell subsets display increased infiltration and functionally impaired responses in gastric cancer, facilitating tumor immune escape.

  • Shuang WU, Xin LI, Chunlin TANG, Ping CHEN, Jun ZHANG, Haiyun HUANG, Yanli GUO
    Journal of Army Medical University. 2026, 48(4): 453-460.
    Objective

    To evaluate the diagnostic performance of combining sonographic features with BRAFV600E mutation for differentiating benign and malignant Bethesda category Ⅲ thyroid nodules.

    Methods

    This retrospective cohort study included 275 patients (278 nodules) diagnosed as Bethesda category Ⅲ by ultrasound-guided fine needle aspiration cytology (US-FNAC) at First Affiliated Hospital of Army Medical University between January 2020 and December 2024, with final confirmation via surgical pathology or repeated US-FNAC. Nodules were classified as benign or malignant based on pathological results. Diagnostic efficacy of age, sex, 9 sonographic features, ACR TI-RADS score, US-FNAC nuclear morphology, and BRAFV600E mutation was analyzed using multivariate logistic regression.

    Results

    Significant differences existed in age, nodule margin, aspect ratio, maximum diameter, echogenicity, Adler blood flow grading, ACR TI-RADS classification, US-FNAC nuclear morphology, and BRAFV600E status between benign and malignant nodules (all P<0.05). Independent risk factors for malignancy included age≤52 years (OR=7.444), BRAFV600E mutation (OR=108.218), ground-glass nuclei (OR=5.389), and abnormal cervical lymph nodes (OR=13.351, P<0.05). The combined model demonstrated accuracy was 0.823, sensitivity was 0.863, specificity was 0.925, positive predictive value was 0.977, negative predictive value was 0.649, and AUC was 0.955.

    Conclusion

    Integration of sonographic features and BRAFV600E mutation provides high diagnostic performance for Bethesda category Ⅲ thyroid nodules.

  • Juntao HU, Sui LI, Yun LIU
    Journal of Army Medical University. 2026, 48(4): 461-469.
    Objective

    To investigate the feasibility of reducing radiation dose in cerebral perfusion CT (CTP) while maintaining diagnostic accuracy by optimizing temporal resolution.

    Methods

    This retrospective cohort study included 117 stroke-suspected patients undergoing CTP at the First Affiliated Hospital of Army Medical University from January to September 2025. Three protocols were designed: Protocol 1 (full temporal resolution, 21-phase acquisition, baseline), Protocol 2 (every-other-phase sampling),Protocol 3 (peak-enhancement +1/-1 phase retention with every-other-phase sampling for remaining phases). Radiation reduction percentages relative to Protocol 1 were calculated. Regions of interest (ROI) were placed in ischemic core/penumbra to measure mean±SD of perfusion parameters: time to maximum of the residue function (Tmax), mean transit time(MTT), cerebral blood volume(CBV) and cerebral blood flow(CBF). Inter-protocol differences were assessed, and ischemic penumbra volume discrepancies were also analyzed.

    Results

    Protocol 2 and 3 reduced radiation dose by 50.0% and 42.9% versus Protocol 1, respectively. For perfusion parameters: Tmax SD differed significantly across protocols [F(1.92,222.42)=11.17, P<0.001, partial η²=0.09]; post hoc tests showed significant mean differences between Protocol 1 vs 2 (P<0.016 7) and Protocol 1 vs 3 (P<0.016 7), but not Protocol 2 vs 3. MTT means showed no significant difference [F(1.88,218.11)=0.47, partial η²=0.004] , though SD differed significantly between Protocol 1 vs 2 and 1 vs 3 (P<0.016 7). CBV SD differed significantly [F(1.98,229.25)=22.97, P<0.001, partial η²=0.17] with no mean difference (Friedman test). CBF means showed no significant difference (Bonferroni-adjusted) but SD differed significantly between Protocol 1 vs 2 and 1 vs 3 (P<0.016 7). Ischemic penumbra volumes differed significantly across all protocols (P<0.016 7).

    Conclusion

    Temporal resolution optimization significantly reduces CTP radiation dose while minimally impacting core perfusion parameters (MTT, CBV, CBF means). CBF remained stable across reduced-dose protocols and may serve as a reliable diagnostic criterion for infarct core delineation.

  • Jingyuan FAN, Jing LI, Weimin PAN, Longguo ZHANG, Huan FENG, Xiaoyu WEI, Yan HUANG, Yingpeng JIANG, Min LIU
    Journal of Army Medical University. 2026, 48(4): 470-478.
    Objective

    To compare the effects of 2 different blood flow restriction (BFR) rehabilitation protocols versus classic high-load eccentric resistance training on the morphology and biomechanical properties of the Achilles tendon in healthy adults, and to provide alternative training strategies for preventing Achilles tendon injuries in military training.

    Methods

    A randomized controlled trial was conducted. Fifty-five healthy adults from a university in Xi’an were enrolled between December 20 and 23, 2024, and randomly assigned to one of three groups using a random number table: a high-load eccentric resistance training group (HL, n=18), a low-load eccentric resistance training with calf-applied BFR group (C-BFR, n=16), and a low-load eccentric resistance training with thigh-applied BFR group (T-BFR, n=19). All groups completed an 8-week training program. Achilles tendon cross-sectional area was assessed using color Doppler ultrasonography at baseline, 6 weeks and 8 weeks. Achilles tendon stiffness and Young’s modulus were evaluated using color Doppler ultrasonography and a wireless microFET3 dynamometer. The maximal voluntary isometric contraction (MVIC) of the medial gastrocnemius was simultaneously measured using the wireless microFET3 and surface electromyography. Countermovement jump (CMJ) height and drop jump (DJ) ground contact time were measured using a three-dimensional force platform.

    Results

    After 8 weeks of intervention, color Doppler ultrasonography assessment revealed that the cross-sectional area of the Achilles tendon significantly increased in all three groups compared to baseline (P<0.01, η²=0.847), with a greater increase in the C-BFR group than in the T-BFR group. Tendon stiffness significantly increased in all three groups compared to baseline (P<0.01, η²=0.722), and the increase was greater in the C-BFR group than in the HL and T-BFR groups. For Young’s modulus, no statistically significant change was observed in the T-BFR group compared to baseline (P>0.05), while both the C-BFR and HL groups showed significant increases (P<0.05, η²=0.181), with a greater increase in the C-BFR group than in the HL and T-BFR groups. The MVIC of the medial gastrocnemius significantly increased in all three groups compared to baseline (P<0.01, η²=0.775), with a greater increase in the C-BFR group than in the T-BFR group. CMJ height significantly increased in all three groups (P<0.01, η²=0.569), with a greater increase in the C-BFR group than in the T-BFR group. DJ ground contact time significantly shortened in all three groups (P<0.01, η²=0.518), and the shortening was greater in the C-BFR group than in the T-BFR group.

    Conclusion

    Both C-BFR and T-BFR combined with low-load eccentric resistance training can achieve improvements in Achilles tendon morphology, biomechanical properties, and kinematic performance similar to those achieved with classic high-load eccentric resistance training. Furthermore, compared to the T-BFR protocol, the C-BFR protocol demonstrates superior benefits.

  • Hualong LI, Yanling WEI, Guangcong RUAN, Wei MENG, Yi WU, Ying LI, Jiajie TANG, Jingjing LIU, Yongjian NIAN
    Journal of Army Medical University. 2026, 48(4): 479-492.
    Objective

    To leverage deep learning technology to assist endoscopists in accurately diagnosing colonoscopy images of Crohn’s disease (CD), ulcerative colitis (UC), and Normal tissue.

    Methods

    A total of 24 492 colonoscopy images from 1 309 subjects were collected from Department of Gastroenterology, Daping Hospital, Army Medical University, and Sir Run Run Shaw Hospital between January 2018 and November 2020. The dataset included 4 729 CD images from 424 cases, 7 074 UC images from 605 cases, and 12 689 Normal images from 280 cases. The images were randomly split by case in a 7∶1∶2 ratio into a training set (915 cases, 17 136 images), an internal test set (131 cases, 2 626 images), and an external validation set (263 cases, 4 730 images). To address feature fusion between CNN and Transformer architectures and correct endoscopic image distortion, we constructed a Ring-Feature Fusion Network (RFFNet) based on ResNeSt50 and MViTv2. The network employs bidirectional channel-spatial attention for cross-stage feature fusion, effectively combining the local feature extraction strengths of CNN with the global modeling capabilities of Transformer. An innovative ring-feature mechanism was introduced to handle barrel distortion and depth-of-field phenomena in colonoscopy images, enhancing the model’s adaptability to the geometric properties of the distal intestinal lumen. RFFNet was compared with five existing deep learning models. Recognition results on the external validation set were visualized using confusion matrices, and performance was evaluated using accuracy, sensitivity, specificity, F1-score, and area under the curve (AUC). Ablation studies were conducted on the external validation set using metrics like accuracy and F1-score to validate the effectiveness and necessity of each improvement in RFFNet. Gradient-weighted class activation mapping (Grad-CAM) was used to generate heatmaps, visually demonstrating the model’s focus areas and improving interpretability.

    Results

    On the external validation set, RFFNet achieved an overall accuracy of 95.68% (95%CI: 94.14% to 98.58%) and an overall AUC of 0.987 (95%CI: 0.985 to 0.990). For CD, UC, and Normal classes, the AUCs were 0.982 (95%CI: 0.979 to 0.986), 0.981 (95%CI: 0.977 to 0.984), and 0.997 (95%CI: 0.995 to 0.998), respectively; sensitivities were 93.35% (95%CI: 91.67% to 94.71%), 94.00% (95%CI: 92.60% to 95.16%), and 98.56% (95%CI: 97.99% to 98.97%), respectively; specificities were 94.58% (95%CI: 93.81% to 95.27%), 94.20% (95%CI: 93.36% to 94.94%), and 98.61% (95%CI: 98.05% to 99.01%), respectively; F1-scores were 87.81% (95%CI: 86.28% to 89.25%), 90.05% (95%CI: 89.00% to 91.25%), and 98.58% (95%CI: 98.22% to 98.92%), respectively. These results indicate that RFFNet achieved high diagnostic precision. Compared to using CNN or Transformer models alone, RFFNet’s overall accuracy improvement was statistically significant (P<0.05). Ablation studies confirmed that the model, through a dynamic spatial attention mechanism, deeply integrates CNN’s local fine-grained feature extraction with Transformer’s global contextual modeling advantages. The CNN-Transformer architecture improved overall accuracy by 0.11% compared to using CNN alone, respectively. The ring-feature mechanism corrected endoscopic optical distortion and depth-of-field attenuation, enhancing modeling of the distal lumen geometry, and improved RFFNet’s overall accuracy by 0.57%. Grad-CAM heatmaps demonstrated the model’s adaptive ability to capture structural features in colonoscopy images.

    Conclusion

    RFFNet, through its dual-backbone architecture that deeply couples CNN’s local texture perception with Transformer’s global dependency modeling, and explicit correction of endoscopic distortion via ring-features, enables high-accuracy real-time classification of CD, UC, and normal mucosa.

  • Wei LI, Hualong LI, Xiaoke ZENG, Lijun HE, Feifei ZHONG, Yuan LIU, Yi YANG, Xin YANG, Yongjian NIAN, Yali XU
    Journal of Army Medical University. 2026, 48(4): 493-503.
    Objective

    To develop and validate a deep learning model for real-time identification and localization of 17 common abdominal anomalies on ultrasound images, providing reliable technical support for primary care sonography.

    Methods

    Retrospectively collected 39 530 B-mode ultrasound images from 18 947 patients with abdominal anomalies at the Second Affiliated Hospital of Army Medical University from January 2017 to September 2024). A stratified random sample of 1 891 images formed an independent testing set; the remaining 37 639 images were split 7:1:2 into training (26 258), validation (3 840), and internal test (7 541) sets. After standardized annotation, RetinaNet, Faster R-CNN, RT-DETR, and YOLOv13 were compared on the internal test set using IoU, precision, recall, F1-score, and mAP@50. The optimal model was further evaluated against 6 sonographers (3 novice, 3 intermediate) and novice sonographers assisted by the model on the independent test set.

    Results

    YOLOv13 achieved superior performance on the internal testing set: mAP@50 0.653 (95%CI:0.608 to 0.669) versus RetinaNet 0.546 (95%CI:0.511 to 0.563), Faster R-CNN 0.578 (95%CI:0.531 to 0.591), RT-DETR 0.627 (95%CI:0.585 to 0.643); precision 0.633 (95%CI:0.624 to 0.643), recall 0.715 (95%CI:0.704 to 0.725), F1-score 0.671 (95%CI:0.663 to 0.681). On the independent testing set (IoU=0.5), YOLOv13’s F1-score (0.624) exceeded all novice sonographers’ mean F1-score (0.484; P<0.001). Model assistance improved novice sonographers’ mean F1-score from 0.484 to 0.644 (33.1% improvement; P<0.001), approaching intermediate-level performance (0.656); mean precision increased 20.6% (0.529 to o 0.638), mean recall increased 42.8% (0.472 to 0.674), and mean interpretation time decreased 24.4% (213.33 min to 161.33 min).

    Conclusion

    The YOLOv13 model demonstrates optimal performance for detecting 17 abdominal ultrasound anomalies and significantly enhances diagnostic efficiency of novice sonographers, serving as an effective assistive tool for abdominal ultrasound screening in primary care settings.