Will Artificial Intelligence and Digital Impressions Erode the Art of Clinical Intuition?

Erectile dysfunction (ED) is a common male reproductive disorder characterized by the persistent inability to attain or maintain a penile erection sufficient for satisfactory sexual performance. It markedly impairs quality of life and is typically associated with psychological distress, decreased self-esteem and impaired partner relationships (). ED is a multifactorial disorder involving vascular, neurological, endocrine, metabolic and psychological components, which complicates both its diagnosis and treatment. Diabetes mellitus (DM) is one of the notable risk factors for ED. Epidemiological and clinical studies have shown that patients with DM have a markedly higher risk of developing ED than non-diabetic individuals (,), and 35-75% of diabetic patients are affected by DM-induced ED (DMED) (). The pathogenesis of DMED is closely associated with chronic hyperglycemia-induced endothelial injury, oxidative stress, inflammatory activation, impaired nitric oxide/cyclic guanosine monophosphate signaling and cavernosal structural remodeling (,). In addition to endothelial dysfunction, corpus cavernosum smooth muscle cells (CCSMCs), which represent a notable cellular component of the CC, are essential for penile relaxation and blood trapping during erection (-). Under diabetic or high-glucose (HG) conditions, CCSMCs may undergo phenotypic transformation from a contractile phenotype toward a synthetic phenotype, characterized by decreased α-smooth muscle actin and desmin expression, increased osteopontin expression and enhanced proliferative and migratory activity (,). These pathological changes contribute to impaired cavernosal relaxation, fibrosis and erectile failure. Circular RNAs (circRNAs) are a class of endogenous non-coding RNAs generated by back-splicing of precursor mRNAs. Owing to their covalently closed-loop structure, circRNAs are resistant to exonuclease-mediated degradation and are typically more stable than their corresponding linear transcripts (,). circRNAs regulate gene expression through multiple mechanisms, including acting as microRNA (miRNA or miR) sponges, interacting with RNA-binding proteins and modulating transcriptional or post-transcriptional processes (,). circRNAs participate in the pathogenesis of diabetes, cardiovascular disease and cancer (-). However, the expression profile and functional significance of circRNAs in DMED remain insufficiently characterized.