Inspection constitutes an ancient and fundamental diagnostic method in medicine, its scientific value rooted in a highly complex, evidence-based cognitive system. It is not mere observation; beneath its superficial appearance, there is profound philosophical reflection and artistic insight. It serves as the starting point of clinical reasoning and an irreplaceable source of wisdom. Its artistry transcends quantifiable techniques, relying on experience and intuition to enable practitioners to empathically comprehend patients′ suffering. Its philosophical dimension instructs clinicians to approach life′s complexities with humility. In this era of rapid advancement in modern medical technology, the challenge lies in adeptly integrating inspection into clinical practice. By organically combining technical proficiency with the art of observation, it evolves into a diagnostic practice that is both scientific and humanistic. Practitioners must remain acutely aware that the most crucial diagnostic tools remain the trained eye, the contemplative mind, and the empathetic heart, which constitute the enduring value of medicine.

To explore the value of combined detection of arginylsuccinic acid (Asa) and citrulline (Cit) levels by flow injection tandem mass spectrometry (MS/MS) in the screening of neonatal arginylsuccinic aciduria (ASLD).

A retrospective analysis was conducted. Among a total of 621 686 newborns screened using the first-generation MS/MS kit by detecting Cit level at the Nanjing Neonatal Screening Center from January 1, 2014 to March 21, 2024, 1 case of ASLD was diagnosed. From March 2024 to August 2025, a total of 87 729 newborns were screened using the second-generation MS/MS kit by detecting Asa and Cit levels, and 1 case of ASLD was diagnosed. Genetic testing was adopted for screen-positive children, and the clinical data were comprehensively evaluated to determine the value of Asa in screening for ASLD.

Among 87 729 newborns, 8 were initially screen-positive for Asa, of whom 1 was confirmed to have ASLD after recall and confirmatory testing. The initial screening positivity rate for Asa was 0.01%, with a sensitivity of 100.00%, specificity of 99.99%, and positive predictive value of 12.50%. In the confirmed case, Asa level was elevated, whereas Cit remained within the reference range.

Asa demonstrates favorable screening efficacy for ASLD. It can indicate risk even when Cit is within the reference range and may help reduce the risk of missed detection when using Cit alone.

To explore the application value of a fecal analysis instrument with morphological artificial intelligence (AI) recognition in the screening of intestinal parasites in feces.

A retrospective analysis was conducted using 9 845 fecal specimens collected from health examination participants in various towns of Tianmen City and received by the Laboratory Department of the First People′s Hospital of Tianmen from November 2023 to June 2025. Conventional manual microscopic examination and an AI based fecal analyzer were used to compare the detection rates of intestinal parasites. The consistency between the 2 methods was evaluated using the Kappa test. In addition, detection rates by sex, parasite species, and township distribution were analyzed.

The AI fecal analyzer identified a total of 294 positive samples for parasites, with a positive rate of 2.99% (294/9 845). After manual re-inspection, 80 cases were confirmed positive, with a positive rate of 0.81%. The false positive rate of AI identification was 2.19% (214/9 765). The positive rate of conventional manual microscopic examination was 0.56% (55/9 845), and the missed detection rate was 31.25% (25/80). There was a statistically significant difference in the detection rates between the two methods (χ²=21.330, P<0.01). There was no statistically significant difference in parasite detection rates between males and females for either the AI+ manual re-inspection method or the manual microscopic examination (χ²=0.109, 0.110, all P>0.05). The detection rates of parasites by simple AI identification and AI identification+ manual re-inspection reached a moderate consistency (Kappa=0.417, P<0.01), with a sensitivity of 98.75%, a specificity of 97.80%, a positive predictive value of 26.87%, and a negative predictive value of 99.99%. The detection rates of parasites by simple manual microscopic examination and AI identification+ manual re-inspection were highly consistent (Kappa=0.800, P<0.01), with a sensitivity of 67.50%, a specificity of 99.99%, a positive predictive value of 98.18%, and a negative predictive value of 99.73%. Both methods successfully detected the Clonorchis sinensis eggs, Giardia lamblia, pinworm eggs, and Blastocystis hominis, AI identification was also able to detect the Strongyloides stercoralis, Trichuris trichiura eggs, hookworm eggs, Entamoeba histolytica, and Entamoeba coli.

The morphology-based AI recognition system achieved a high detection rate for intestinal parasite screening and effectively reduced the risk of missed diagnoses. However, relying solely on AI recognition has a certain rate of false-positive results and therefore requiring manual verification.

Recurrence and metastasis remain the main causes of mortality in patients with solid tumors after curative treatment, largely driven by clinically undetectable minimal residual disease (MRD). Conventional imaging and serum biomarkers lack sufficient sensitivity and specificity for MRD detection, leading to delayed or passive clinical decision-making. Advances in circulating tumor DNA (ctDNA)-based liquid biopsy technology now enable highly sensitive and real-time monitoring of MRD.This study proposes a ctDNA-guided " monitoring-intervention" closed-loop clinical management model for solid tumors. The model integrates sequential processes encompassing postoperative MRD baseline assessment, recurrence risk stratification, early molecular warning, therapeutic intervention selection, and longitudinal efficacy evaluation. We analyze the core technological platforms supporting this framework, compare the strengths and limitations of different ctDNA detection strategies and outline system architecture and implementation approaches for the closed-loop model.Using colorectal and lung cancers as representative examples, this paper comprehensively reviews the supporting clinical evidence, ongoing controversies, and major challenges in translating this model into clinical practice. Furthermore, we provide forward-looking perspectives on standardizing key technologies, enriching clinical data, assessing cost-effectiveness, and developing intelligent decision-making systems to enable personalized, dynamic, and prospective precision treatment for solid malignancies.

To explore the differences in biomechanical load of the lumbar vertebrae-lumbar muscle system and their association mechanism with pain score (PS) in patients with low back pain under 2 postures: upright and bending at 15° with a load of 20 kg.

A total of 1 400 patients diagnosed with low back pain at the Dongnan Hospital Affiliated to Xiamen University from May 2018 to May 2021 were selected and stratified and grouped according to age (21-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years old) and gender. Based on the principle of biomechanical circular stress, a mathematical and physical analytical stress model was constructed to analyze the stress PS distribution of L₃-L₄ and L₄-L₅ intervertebral discs under different genders, ages and postures (upright/bending at 15° with a load of 20 kg). Independent sample t-test was used to compare the PS differences between male and female groups. Pearson correlation analysis was used to analyze the correlation between PS and age. Linear trend test was used to test the linear trend between PS and age. Two-factor analysis of variance was used to compare the differences in the PS ratio of intervertebral disc stress between L₄-L₅ and L₃-L₄ in each age group between males and females.

Under the posture of bending 15° with a load of 20 kg, the stress PS of intervertebral discs at L₃-L₄ and L₄-L₅ in females were higher than those in males, and the differences were statistically significant (L₃-L₄: t=297.51, 58.77, 70.40, 36.57, 54.39, 73.86, 31.40, all P<0.01. L₄-L₅: t=60.00, 49.19, 31.28, 64.42, 180.81, 38.69, 64.35, all P<0.01) . In the upright position, the stress PS of the L₃-L₄ intervertebral discs in females were higher than those in males (t=78.31, 28.29, 71.04, 26.55, 24.40, 23.87, 28.38), but the stress PS of the L₄-L₅ intervertebral discs were lower than those in males (t=43.24, 40.98, 29.14, 4.61, 10.20, 67.22, 12.62), and the differences were statistically significant (all P<0.01). In the upright position, female age was correlated with the stress PS of intervertebral discs at L₃-L₄ and L₄-L₅, and there were significant linear trends (r=0.914, r²=0.835; r=0.939, r²=0.882; all P<0.01). However, for males in the upright position and the state of bending at 15°with a load of 20 kg, age was correlated with the stress PS of L₃-L₄ intervertebral discs, and there were significant linear trends (r=0.883, r²=0.780; r=0.973, r²=0.947; all P<0.01). The comparison of the PS ratio of intervertebral disc stress between L₄-L₅ and L₃-L₄ in the upright position between male and female genders (1.410±0.004, 1.180±0.004) showed a statistically significant difference (F=1.265, P<0.01).

Regardless of gender, the stress PS of L₃-L₄ and L₄-L₅ intervertebral discs is significantly positively correlated with age, suggesting that the biomechanical load tolerance capacity of the lumbar vertebrae-lumbar muscle system gradually decreases with age.

To explore the value of machine learning models constructed based on CT habitat radiomics in non-invasive preoperative prediction of anaplastic lymphoma kinase (ALK) gene fusion expression in lung adenocarcinoma.

A total of 130 patients with lung adenocarcinoma who completed ALK gene testing and preoperative chest CT examination in the Imaging Department of the First People′s Hospital of Zhangjiagang from March 2015 to November 2023 were retrospectively included (45 cases were ALK positive and 85 cases were ALK negative). They were randomly divided into the training set (n=90) and the test set (n=40) in a 7∶3 ratio. The lesions were divided into two habitat subregions (Habitat 1 and Habitat 2) by K-means clustering, and 14 key habitat radiomics features were extracted and screened. Subsequently, models were constructed respectively using 6 algorithms: autoencoder (AE), genetic programming (GP), linear discriminant analysis (LDA), logistic regression (LR), Lasso logistic regression (LRLasso), and support vector machine (SVM). The receiver operator characteristic (ROC) curve was used to evaluate the model efficacy, and the DeLong test was used to compare the differences in area under the curve (AUC).

The AUCs of the machine learning model training set constructed based on the LR and LRLasso algorithms were 0.862 (0.788-0.935) and 0.854 (0.778-0.930), respectively, and the AUCs of the test set were 0.830 (0.678-0.930) and 0.802 (0.646-0.911), respectively. There were no statistically significant differences in the AUC between the LR model and the LRLasso model or the AE model (P=0.182, 0.104), but there were statistically significant differences in the AUC between the LR model and the remaining models (all P<0.05). In the test set, the sensitivity and specificity of the LR model were 71.4% and 96.2%, respectively, while those of the LRLasso model were 64.3% and 88.5%, respectively.

The CT image-based habitat radiomics shows a certain predictive capability and potential clinical utility for identifying ALK gene fusion in lung adenocarcinoma. The machine learning model based on LR has a good generalization ability and a potential clinical applicability, and may be used as a new non-invasive imaging tool for predicting ALK gene fusion in lung adenocarcinoma.

To explore the ultrasonic characteristics and diagnostic pitfalls of neonatal intestinal malrotation with midgut volvulus.

Fourteen cases of neonatal intestinal malrotation with midgut volvulus admitted to the Department of Pediatric Surgery of the Affiliated Hospital of Jining Medical University from January 2020 to November 2024 and confirmed by surgery were retrospectively included. The ultrasound images were analyzed to summarize the diagnostic features and analyze the causes of missed and misdiagnosed cases.

Among the 14 cases, 9 cases were diagnosed clearly and 5 cases were missed or misdiagnosed. In the ultrasound examinations of 5 misdiagnosed or missed cases, the direct signs of neonatal intestinal malrotation with midgut volvulus were: 0 cases of " vortex sign" , 3 cases of " coffee bean sign" , and 1 case of " cut sign" . Indirect signs: 2 cases of pyloric spasm, 3 cases of intestinal wall thickens, 2 cases of intestinal dilation, 2 cases of complex peritoneal effusion, and 1 case of severe flatulence.

Ultrasonography plays an important role in the diagnosis of neonatal intestinal malrotation with midgut volvulus. Typical direct signs are crucial for diagnosis, while indirect signs provide additional diagnostic clues. Improved recognition of these sonographic features can help reduce missed and misdiagnosed cases.

To explore the diagnostic value of ultrasonocardiography (UCG) combined with serum cardiac troponin I (cTnI) and N-terminal brain natriuretic peptide precursor (NT-proBNP) in myocardial injury after multiple injuries.

A total of 160 patients with multiple injuries who were admitted to the Emergency Department of Wujin People′s Hospital in Changzhou City from May 2023 to August 2025 were enrolled, including 84 cases with myocardial injury and 76 cases without myocardial injury. According to the degree of myocardial injury, they were divided into mild injury (n=39), moderate injury (n=25) and severe injury (n=20). Compared left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), and serum cTnI and NT-proBNP levels between patients with and without myocardial injury, as well as among patients with different degrees of myocardial injury after multiple injuries, the Pearson correlation analysis was used to analyze the correlation between LVEDD, LVESD and LVEF and serum cTnI and NT-proBNP. The diagnostic efficacy of single indicator and combined detection for myocardial injury after multiple injuries was evaluated by receiver operator characteristic (ROC) curve.

The LVEDD, LVESD, cTnI, and NT-proBNP levels in the group with myocardial injury were (52.85±4.12)mm, (41.58±5.23)mm, (1.25±0.26)μg/L, and (1 856.32±185.47)ng/L, respectively, which were higher than those in the group without myocardial injury [(43.25±4.61)mm, (35.12±4.35)mm, (0.04±0.01)μg/L, and (97.56±10.82)ng/L]. The LVEF [(45.23±4.65)%] was lower than that in group without myocardial injury [(55.68±4.21)%] (t=13.910, 8.444, 40.532, 82.517, 14.845, all P<0.01). In patients with multiple injuries, LVEDD and LVESD were positively correlated with cTnI (r=0.472, 0.460), and both were positively correlated with NT-proBNP (r=0.394, 0.401). LVEF was negatively correlated with cTnI and NT-proBNP (r=-0.498, -0.385). The LVEDD, LVESD, cTnI, and NT-proBNP in the severe myocardial injury group after multiple injuries were significantly higher and the LVEF was significantly lower than those in the moderate and mild group. The moderate group also had higher LVEDD, LVESD, cTnI, and NT-proBNP and lower LVEF than those in the mild group (all P<0.05). ROC curve analysis showed that among the single indicator, the diagnostic efficacy of cTnI was the best (AUC=0.830), the AUC of the combined detection indicators was 0.956, respectively greater than those of the individual indicator.

Patients with myocardial injury after multiple injuries exhibit structural and functiond cardiac abnormalities and elevated serum markers, and the trend of indicator changes is consistent with the degree of injury. UCG combined with serum cTnI and NT-proBNP detection can significantly improve the diagnostic efficiency of myocardial injury after multiple injuries.

To explore the echocardiographic features of Loffler′s endocarditis.

A retrospective analysis was conducted on the clinical data, laboratory tests, ultrasound examinations and diagnosis and treatment course of a patient with Loffler′s endocarditis admitted to the Department of Cardiology of Air Force Medical Center on October 18, 2023. The echocardiographic features were summarized in combination with the literature.

The patient was a 25-year-old male, who suffered cardiac involvement due to severe eosinophilia. Echocardiography showed significant thickening of the endocardium and reduced ventricular heart cavity size. Myocardial contrast echocardiography showed visible blood flow distribution within the thickened endocardium. Enhanced magnetic resonance imaging of the heart indicated an enlarged right atrium, thickened endocardium of the right ventricle with extensive delayed enhancement. After myocardial biopsy, Loffler′s endocarditis was diagnosed. The patient responded well after immunosuppressive therapy. Ultrasound showed that the degree of endocardial thickening gradually decreased and improved.

Echocardiography serves as the preferred imaging method for the clinical diagnosis and for evaluating the therapeutic efficacy in patients with Loffler′s endocarditis.

To investigate the relationship between apolipoprotein E (ApoE) gene polymorphism and diabetic retinopathy (DR) and plasma lipid levels in type 2 diabetes mellitus (T2DM).

A case-control study was conducted, including 112 patients with T2DM complicated by DR (DR group) and 96 patients with T2DM without DR (T2DM group), who were admitted to Xuzhou No.1 People′s Hospital between January 2022 and May 2024. The ApoE gene polymorphisms were detected using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The genotypes and allele frequencies between the two groups were compared using the chi-square test or Fisher′s exact test, while analysis of ANOVA was performed to compare serum lipid levels among patients with different genotypes. Logistic regression analysis was applied to identify risk factors associated with the development of DR in patients with T2DM.

By comparison, the total cholesterol (TC) level [(5.02±0.98)mmol/L] and triglyceride (TG) level [(2.92±1.07)mmol/L] in the DR group were higher than those of the T2DM group [(4.51±1.33)mmol/L, (2.36±0.25)mmol/L]. The overall distributions of ApoE genotypes and alleles differed significantly between the two groups (all P<0.01). After Bonferroni correction, significant differences were observed in the distributions of the ε3/3, ε3/4, and ε4/4 genotypes between the DR and T2DM groups (all P<0.0083). The frequencies of the ApoE ε3 and ε4 alleles in the DR group were significantly lower than those in the T2DM group (all P<0.0167). There were differences in TC and TG levels among patients with different alleles of ApoE in the DR group (F=3.429, 4.947, all P<0.05). Logistic regression analysis indicated that TC (OR=1.467, 95%CI: 1.080-1.993), TG (OR=2.761, 95%CI: 1.756-4.342), and ApoE ε4 allele (OR=0.056, 95%CI: 0.018-0.176) were all independent risk factors for the development of DR in patients with T2DM (all P<0.05).

The TC, TG, and ApoE ε4 alleles in lipid levels are strongly associated with T2DM complicated with DR and may be one of the major factors in its pathogenesis.

To investigate the imaging and pathological characteristics of cystic juvenile granulosa cell tumor (CJGCT) of the ovary.

A retrospective analysis of the clinical symptoms, signs, imaging, and pathological characteristics of 2 patients with CJGCT treated at Nanjing Drum Tower Hospital in 2025, and a review of the relevant literature to summarize the key diagnostic points.

Case 1: a 12-year-old girl presented with lower abdominal discomfort and vomiting for several days. Ultrasonography revealed a large unilocular cystic mass in the abdominopelvic cavity (approximately 20.6 cm × 20.9 cm × 9.7 cm), with the right ovary not visualized; the cyst volume had increased by about 10% within 12 days. Case 2: a 16-year-old girl presented with a rapidly enlarging abdominal mass within 5 days, palpated up to 1 cm above the umbilicus, without abdominal pain or vaginal bleeding. Transrectal color Doppler ultrasound showed a cystic lesion in the pelvis (13.8 cm × 7.0 cm × 16.4 cm). On CT, both tumors appeared as homogeneous low density cystic masses. Serum tumor markers and sex hormone levels were within normal limits.Histopathology demonstrated entirely cystic tumors with smooth external surfaces and cyst walls measuring 0.3-0.5 cm in thickness, containing clear or slightly mucoid fluid. Immunohistochemistry showed steroidogenic factor 1 (+ + ), inhibin-α (weak + ), and calretinin (-). Reticulin staining highlighted a positive network surrounding tumor cell nests. The final pathological diagnosis was CJGCT in both cases. Both patients underwent fertility sparing excision of the ovarian lesion and were followed up for 4-6 months without recurrence.

CJGCT is characterized by complete cystic change, is clinically rare, and may be easily misdiagnosed by imaging examination. Definitive diagnosis relies on postoperative histopathological confirmation in conjunction with clinical and imaging findings. Fertility sparing conservative surgery is the preferred treatment, while the necessity of adjuvant chemotherapy or secondary surgery should be determined based on tumor stage and pathological high risk factors.

To investigate the clinical diagnostic features and treatment approaches of anti-N-methy-D-aspartate (NMDA) receptor encephalitis with initial presentation of mental and behavioral symptoms.

A retrospective analysis was conducted on the medical records of a patient with anti-NMDA receptor encephalitis with initial presentation of mental and behavioral symptoms who was admitted to the Department of Child Psychology and Behavior of Linyi Municipal Mental Health Center on July 24, 2024. The clinical characteristics, diagnosis and treatment were analyzed, and relevant literature was reviewed.

A 16-year-old female patient first visited the Department of Psychiatry due to behavioral and speech disorders for 4 days. She was diagnosed with " acute and transient psychotic disorder" . After treatment with antipsychotic drugs, her mental symptoms were still progressively worsen, with the symptoms of fever, confusion, and paroxysmal involuntary convulsions of the mouth, face and limbs developing. The tests for anti-glutamate receptor (NMDA type) antibodies in her serum and cerebrospinal fluid were both positive. The final diagnosis was anti-NMDA receptor encephalitis.

The misdiagnosis rate of anti-NMDA receptor encephalitis with initial presentation of mental and behavioral symptoms is extremely high. Clinicians should enhance their understanding of this disease to avoid misdiagnosis and missed diagnosis, so as to guide treatment and improve prognosis.

As a master regulator of humoral immunity, T follicular helper (Tfh) cells play an indispensable role in germinal center formation and B cell differentiation and maturation. Dysregulation of Tfh cell function and quantity is critically implicated in the pathogenesis of various lymphomas. Beyond T cell lymphomas directly originating from Tfh cells, such as angioimmunoblastic T cell lymphoma, in B cell lymphoma, Tfh cells can support the survival of malignant B cells and shape an immunosupressive microenvironment via co-stimulatory signals and cytokines. This review summarizes the biology of Tfh cells, their roles and mechanisms in lymphomagenesis, and discusses therapeutic strategies targeting Tfh-related pathways, aiming to provide new perspectives for lymphoma immunotherapy.

Artificial intelligence (AI) technology is deeply revolutionizing the medical education model. The DeepSeek-R1 large language model, with its open-source nature, hybrid expert architecture and complex reasoning ability, provides a new path to break through the traditional bottleneck for case-based learning (CBL) in nephrology education. Traditional CBL faces challenges such as scarce case resources, insufficient personalized guidance and low teaching efficiency during nephrology internships. DeepSeek can empower CBL through dynamic case generation, intelligent interactive question and answer, and precise scoring and evaluation. It not only significantly improves teachers′ teaching efficiency, but also effectively exercises students' clinical decision-making ability. However, key challenges such as AI reliance, data privacy, and the training of teachers and students should be dealt with caution. In the future, virtual reality multimodal technology can be further integrated, and a cross-school case sharing system can be constructed. This AI-integrated CBL model is expected to become one of the core teaching tools for cultivating high-quality clinical nephrology specialists.