Diabetic retinopathy (DR) grading plays a critical role in early clinical intervention and vision preservation. Recent explorations predominantly focus on visual lesion feature extraction through data processing and domain decoupling strategies. However, they generally overlook domain-invariant pathological patterns and underutilize the rich contextual knowledge of foundation models, relying solely on visual information, which is insufficient for distinguishing subtle pathological variations. Therefore, we propose integrating fine-grained pathological descriptions to complement prototypes with additional context, thereby resolving ambiguities in borderline cases. Specifically, we propose a Hierarchical Anchor Prototype Modulation (HAPM) framework to facilitate DR grading. First, we introduce a variance spectrum-driven anchor prototype library that preserves domain-invariant pathological patterns. We further employ a hierarchical differential prompt gating mechanism, dynamically selecting discriminative semantic prompts from both LVLM and LLM sources to address semantic confusion between adjacent DR grades. Finally, we utilize a two-stage prototype modulation strategy that progressively integrates clinical knowledge into visual prototypes through a Pathological Semantic Injector (PSI) and a Discriminative Prototype Enhancer (DPE). Extensive experiments across eight public datasets demonstrate that our approach achieves pathology-guided prototype evolution while outperforming state-of-the-art methods. The code is available at https://github.com/zhcz328/HAPM.

Understanding how the brain responds to external stimuli and decoding this process has been a significant challenge in neuroscience. While previous studies typically concentrated on brain-to-image and brain-to-language reconstruction, our work strives to reconstruct gestures associated with speech stimuli perceived by brain. Unfortunately, the lack of paired {brain, speech, gesture} data hinders the deployment of deep learning models for this purpose. In this paper, we introduce a novel approach, fMRI2GES, that allows training of fMRI-to-gesture reconstruction networks on unpaired data using Dual Brain Decoding Alignment. This method relies on two key components: (i) observed texts that elicit brain responses, and (ii) textual descriptions associated with the gestures. Then, instead of training models in a completely supervised manner to find a mapping relationship among the three modalities, we harness an fMRIto- text model, a text-to-gesture model with paired data and an fMRI-to-gesture model with unpaired data, establishing dual fMRI-to-gesture reconstruction patterns. Afterward, we explicitly align two outputs and train our model in a self-supervision way. We show that our proposed method can reconstruct expressive gestures directly from fMRI recordings. We also investigate fMRI signals from different ROIs in the cortex and how they affect generation results. Overall, we provide new insights into decoding co-speech gestures, thereby advancing our understanding of neuroscience and cognitive science.