Olfactory reference disorder （ORD） is a psychiatric condition characterized by a persistent and false belief that one emits a foul or unpleasant body odour. This belief leads significant distress and impaired social functioning. It is often accompanied by referential thinking and repetitive behaviours aimed at concealing， changing or avoiding the perceived odour. Its diagnosis should be distinguished from various physical diseases （such as periodontitis， trimethylaminuria， rectal abscess， anal fistula， and temporal lobe epilepsy）， social anxiety disorder， obsessive-compulsive disorder， body dysmorphic disorder， delusional disorder， and other primary psychotic disorders， mood disorder， avoidant personality disorder， and bodily distress disorder. Evidence for the treatment of ORD primarily comes from case reports， while large-sample randomized controlled studies are lacking. The treatment for ORD includes antidepressants， antipsychotic drugs， antipsychotic drugs combined with antidepressants， and psychotherapy. Multi-center， randomized controlled trials are needed to further validate the efficacy of these treatments. This paper systematically reviews the clinical characteristics， diagnosis， differential diagnosis and treatment of ORD， providing scientific evidence for the clinical diagnosis and treatment of ORD.
Diagnostics is a fundamental discipline for developing clinical reasoning and diagnostic skills in medical education， playing a crucial role in clinical education. The current instructional model mainly relies on classroom theoretical learning and clinical interships， which faces challenges such as limited opportunities for clinical practice and inadequate learner engagement. The virtual patient system （VPS）utilizes advanced computational technologies to simulate realistic clinical scenarios， allowing medical trainees to engage in repetitive training within controlled environments. This approach significantly enhances their clinical reasoning abilities and diagnostic skills. Additionally， the VPS feedback mechanism effectively assists educators in optimizing teaching plans. This systematic review assesses the implementation of the VPS in diagnostics education， aiming to better integrate the VPS into traditional teaching methods and improve the quality of diagnostics teaching.
To explore the application and effects of outcomes-based education （OBE）combined with the presentation-assimilation-discussion （PAD） teaching mode in the experimental teaching of diagnostics.
Methods
From September to December 2023， 168 students from classes 1 to 4 of the 2021 clinical majors at Hunan University of Chinese Medicine were selected as participants. Eighty-four students in classes 1 and 2 were assigned to the control group， and 84 students in classes 3 and 4 were selected as the experimental group. The control group were taught by the traditional teaching mode， and the experimental group were taught by OBE and PAD teaching mode. The final clinical skill assessment scores， classroom performance， and attendance rates of the 2 groups were compared. Additionally， the learning effects were analyzed， and the teaching satisfaction was investigated through multi-dimensional questionnaires.
Results
In the experimental group， the total score ［（86.94±5.35）points］， operational assessment score［（87.84±4.14）points］， and routine classroom performance ［（82.53±2.77）points］ were higher than those of the control group ［total score （68.26±4.73） points， operational assessment score （72.31±6.73）points， and routine classroom performance （41.25±2.03）points］， and the differences were all statistically significant （t=3.88， 2.60， 3.22， all P＜0.05）. There was no statistically significant difference in classroom attendance scores between the experimental group ［（92.41±2.36） points］ and the control group［（91.62±3.74） points］ （t=0.62， P＞0.05）. A total of 168 questionnaires were distributed and collected from 2 groups. The results showed that the experimental group outperformed the control group in increasing classroom engagement ［96.43%（81/84）， 76.19%（64/84）］， facilitating mastery of key knowledge points［95.24%（80/84）， 82.14%（69/84）］， maintaining a well-paced classroom environment ［91.67%（77/84）， 80.95%（68/84）］， promoting group interaction ［92.86%（78/84）， 77.38%（65/84）］， enhancing learning interest ［90.48%（76/84）， 79.76%（67/84）］， clarifying learning objectives ［94.05%（79/84），71.43%（60/84）］， improving clinical practice skills ［91.67%（77/84）， 78.57%（66/84）］， and stimulating divergent thinking ［91.67%（77/84）， 75.00%（63/84）］. All differences were statistically significant（χ2=8.31， 7.42， 8.52， 8.28， 11.24， 12.42， 8.53， 8.37， all P＜0.05）.
Conclusion
The combined OBE and PAD teaching mode in diagnostics laboratory teaching effectively improves students′ academic performance， enhances the comprehensive quality of medical students， and elevates the quality of medical personnel talent training.
To investigate the clinical utility of the combination of ultrasound features and clinicopathologic factors for the early prediction of pathologic complete response （pCR） after neoadjuvant chemotherapy （NAC） in breast cancer patients.
Methods
A retrospective was conducted on imaging and clinical data from 304 breast cancer patients who received NAC at Zhejiang Cancer Hospital between October 2020 and March 2022. According to the postoperative pathological results， patients were divided into the pCR group and the non-pathologic complete response （non-pCR） group. The differences in ultrasound and clinical pathological characteristics between the 2 groups were compared. Binary Logistic regression analysis was performed to identify independent predictors of pCR. The diagnostic ability of each model for pCR was evaluated by receiver operating characteristics （ROC） curve. A nomogram model for predicting pCR was established using R software， and the goodness-of-fit was assessed with the Hosmer-Lemeshow test.
Results
There were statistically significant differences in the scores of lateral acoustic shadow， margin characteristics，calcification patterns and blood flow scores between the pCR group and the non-pCR group before NAC （χ2=12.001， 18.135， 12.991， 9.327， all P＜0.05）. The reduction rate of the maximum tumor diameter in the pCR group was greater than that in the non-pCR group after 2 cycles of NAC， and the difference was statistically significant （Z=4.182， P＜0.01）. Before NAC， there were statistically significant differences in clinical T stage， estrogen receptor （ER） expression， progesterone receptor （PR） expression and human epidermal grouth factor receptor 2 （HER2） expression between the 2 groups （χ2=8.553， 23.293， 30.333，38.384， all P＜0.05）. Binary Logistic regression analysis showed that lateral acoustic shadow （OR=2.782，95%CI：1.534-5.045）， calcification （OR=0.395， 95%CI：0.170-0.920）， margin （OR=0.244， 95%CI：0.104-0.572）， blood flow score （OR=0.527， 95%CI：0.295-0.941）， clinical T stage ［T2（OR=0.371，95%CI：0.153-0.902）、T3（OR=0.212，95%CI：0.066-0.684）、 T4（OR=0.146，95%CI：0.039-0.555）］， maximum diameter reduction rate （OR=5.988， 95%CI： 1.923-18.645）， and HER2 expression （OR=4.977， 95%CI：2.740-9.041） were independent predictors of pCR in breast cancer （all P＜0.05）. Based on the above factors， a combined model was constructed， and the area under the ROC curve for predicting pCR was 0.821 （95%CI： 0.796-0.872）. A nomogram was also constructed， and the Hosmer-Lemeshow goodness-of-fit test showed that the nomogram model had a good fit （χ2=4.144， P＞0.05）.
Conclusion
Lateral acoustic shadows， calcifications， margins， blood flow scores， maximum diameter reduction rate， as well as clinical T stage and HER2 expression measured by ultrasound are independent predictors for obtaining pCR after NAC in patients with breast cancer， and ultrasound features combined with clinicopathology factors can provide an imaging basis for the development of clinical treatment plans for patients with breast cancer.
To investigate the imaging characteristics of hepatic lipid-poor perivascular epithelioid cell tumor （PEComa）.
Methods
A retrospective analysis was conducted on the clinical， pathological and imaging data of 12 patients with hepatic lipid-poor PEComa diagnosed by surgical pathology in the Department of Hepatobiliary Surgery at Xiangyang Central Hospital from January 2016 to December 2024，and the relevant literatures were reviewed.
Results
All 12 patients with hepatic lipid-poor PEComa were female， with a mean age of （48.58±10.96） years old. The tumors were all solitary， among which 4 cases were located in the left lobe of the liver， and 8 cases were located in the right lobe. The clinical manifestations included abdominal distension and discomfort （2 cases）， abdominal pain （1 case） and back pain （1 case）， and while 8 cases were asymptomatic. In terms of imaging， all cases showed significant enhancement during the arterial phase of enhanced scan. Among them， the enhancement degrees of 10 cases gradually diminished in the portal vein phase and delayed phase， which was in line with the typical "fast-in and fast-out" or "fast-in and slow-out" enhancement patterns. The remaining 2 cases showed persistent enhancement during the portal vein stage and the delayed stage， and were classified as the "persistent"enhancement pattern. In the arterial phase of enhanced scanning， thickened vascular shadows could be seen in or around the lesions in 9 patients with PEComa. Pathologically， the tumor tissue lacked mature adipocytes and was mainly composed of a large number of epithelioid cells， which were radially arranged around the vascular lumen. Immunohistochemical staining showed positive expressions of HMB-45， Melan-A and smooth muscle actin.
Conclusion
Hepatic lipid-poor PEComas exhibit unique imaging and pathological characteristics， which are of significant clinical value for the early diagnosis and differential diagnosis of this disease.
To explore the diagnostic value of 18F-fluorodeoxyglucose （18F-FDG） positron emission tomography computed tomography （PET/CT） combined with enhanced CT in testicular malignant tumors.
Methods
A retrospective analysis was conducted on the clinical data， PET/CT and enhanced CT image results of 49 patients with testicular malignant tumors confirmed by biopsy or surgical pathology in Guangdong Provincial People′s Hospital from April 2008 to July 2020. The patients were divided into hematological testicular tumors （n=26） and non-hematological testicular tumors （n=23）. The Mann-Whitney U test was used to compare the differences in the maximum standard uptake value （SUVmax） of PET metabolic parameters and the SUVmax lesion/background ratio （SUVmax L/B） between the two groups. The chi-square test was used to compare the intergroup differences in enhanced CT features between patients with seminoma and those without seminoma.
Results
Among the 49 patients， the SUVmax level of patients with hematological systemic tumors was higher than that of patients with non-hematological tumors ［9.2（6.9，13.4），7.8（4.8，9.1）］， and the difference was statistically significant （Z=-2.02， P＜0.05）；SUVmax L/B values were ［3.5（1.9， 6.1）， 2.5（1.7， 3.1）］， there was no statistically significant difference （Z=-0.71， P＞0.05）. CT enhancement in 26 cases of hematological testicular tumors and 11 cases of seminoma showed uniform enhancement， no necrosis， clear boundaries， and varying degrees of increased FDG metabolism. CT enhancement in 12 cases of non-seminoma showed significantly heterogeneous enhancement， necrosis， unclear boundaries， and slightly increased FDG metabolism. The enhanced CT features of seminoma and non-seminoma were compared. There were statistically significant differences in the degree of the enhancement degrees ［6 cases （mild）， 4 cases （moderate）， 1 case （obvious）；0 case（mild）， 4 cases （moderate）， and 8 cases （obvious）， respectively］， necrosis （3 cases， 10 cases）， and unclear boundaries （0 cases， 5 cases） （χ2=11.42， 5.32， 11.24，all P＜0.05）. The SUVmax and SUVmax L/B of the two groups of patients were compared， and the differences were not statistically significant（Z=0.77， -0.92， all P＞0.05）. Among the 49 patients， 11 cases were in stage Ⅰ， 19 cases in stage Ⅱ，6 cases in stage Ⅲ， and 13 cases in stage Ⅳ.
Conclusion
18F-FDG PET/CT combined with contrastenhanced CT has high value in the diagnosis， differential diagnosis， and staging of testicular malignant tumors.
To explore the characteristics of glucose metabolism and influencing factors in patients with bipolar disorder （BD） comorbid with type 2 diabetes mellitus （T2DM）.
Methods
A randomized controlled study design and convenience sampling method were employed. A total of 50 hospitalized patients with BD comorbid with T2DM， who admitted to the Fifth People′s Hospital of Kaifeng from January 2024 to February 2025， were enrolled as the study group. Based on clinical subtypes of BD （BD-Ⅰ and BD-Ⅱ）， they were further divided into comorbidity group Ⅰ （n=24） and comorbidity group Ⅱ （n=26）.Concurrently， the inpatients hospitalized during the same period were recruited as the control group， subdivided into non-comorbidity group Ⅰ （n=25） and non-comorbidity group Ⅱ （n=25）. Demographic data and family history of mood disorders and/or T2DM in first-degree relatives were collected. Height， weight， waist circumference （WC）， fasting blood glucose （FBG）， fasting insulin （FINS）， and then body mass index（BMI）， homeostatic model assessment of insulin resistance （HOMA-IR）， and waist-to-height ratio（WHtR） were calculated. Cognitive function was assessed using the Montreal cognitive assessment（MoCA）. Statistical comparisons between comorbidity and non-comorbidity groups were performed using chi-square tests， t-tests， and Mann-Whitney U tests. Pearson or Spearman correlation analyses were conducted to examine associations between comorbidities and influencing factors.
Results
The comorbidity group exhibited significantly higher proportions of family history of mood disorders ［22.00%（11/50）］ and diabetes ［26.00%（13/50）］， as well as elevated WC ［（89.48±7.12）cm］， HOMA-IR（3.48±1.47），WHtR（0.53±0.05）， and FBG［（7.15±1.93）mmol/L］ compared to the non-comorbidity group ［6.00%（3/50）， 8.00%（4/50）， （85.26±8.16）cm， （2.59±1.12）， （0.51±0.05）， （5.46±0.57）mmol/L］，with statistically significant differences （χ2=5.316， 5.741， t=2.755， 3.383， 2.217， 5.943， all P＜0.05）. The comorbidity group had significantly lower scores than the non-comorbidity group on the MoCA scale in visuospatial and executive function ［2 （2， 3），3（2， 3）］， attention ［3.5（3， 4）， 4.5（4， 5）］，and total score ［18（16， 20）， 19（18， 22）］， with all differences being statistically significant （Z=-2.044， -4.105， -2.909， all P＜0.05）. No significant differences were observed in other MoCA domains（P＞0.05）. Within the comorbidity group， significant differences in WC ［（95.06±6.75）cm， （86.61±5.46）cm］， FBG［（8.19±2.29）mmol/L， （6.62±1.50）mmol/L］ and WHtR［0.56（0.53， 0.61）， 0.51（0.49， 0.54）］ were observed between patients with and without a family history of mood disorders and/or T2DM （t=-4.782， -2.905， Z=-3.687， all P＜0.05）. Correlation analysis in the comorbidity group revealed that family aggregation of mood disorders was positively associated with WC （r=0.423， P=0.002）， FBG（r=0.384， P=0.006）， WHtR（r=0.392， P=0.005）， and HOMA-IR（r=0.385， P=0.006）. Family aggregation of diabetes showed positive correlations with BMI（r=0.316， P=0.025）， FBG（r=0.305， P=0.031）， WC（r=0.548， P=0.000） and WHtR （r=0.499， P=0.000）. A significant positive association was found between family histories of diabetes and mood disorders （r=0.456， P=0.001）.
Conclusions
Patients with BD comorbid with T2DM demonstrate higher FBG， more pronounced insulin resistance， abdominal obesity， and worse cognitive function. First-degree relatives of comorbid patients should prioritize monitoring glucose metabolism and WC to mitigate the risk of mood disorders and T2DM. WHtR is recommended as a key monitoring indicator.
To investigate the clinical diagnostic characteristics and potential pathophysiological mechanisms of Guillain-Barré syndrome （GBS） manifesting with unilateral limb weakness as the initial presentation.
Methods
A retrospective analysis was conducted on the clinical data of a GBS patient with unilateral limb weakness who was admitted to the Department of Neurology of the Affiliated Hospital of Jining Medical University on July 24， 2024， and the relevant literature was reviewed.
Results
The patient was a 66-year-old female who was admitted mainly due to "left lower extremity weakness for 5 hours". Her past medical history included thoracic compression fracture （T12） surgery and left breast cancer surgery.Four days before the onset of the disease， she had fever accompanied by diarrhea. No new infarction foci were found on the cranial MRI upon admission， and no improvement was noted after treatment with antiplatelet therapy， cerebral circulation enhancement， and mitigation of brain tissue injury. On the fourth day after admission， the weakness of the left lower extremity worsened， and weakness of the right lower extremity occurred. Cerebrospinal fluid analysis showed a white blood cell count of 4×106/L and a protein concentration of 0.51g/L. Gram staining， acid-fast staining， fungal staining， and India ink staining of the cerebrospinal fluid revealed no abnormalities. Anti-ganglioside （GM1， GM1b， GalNAc-GD1a， GD1a， GD1b， GQ1b，and GT1a） IgG antibodies were negative. Electrophysiological studies of the lower limbs demonstrated a significant reduction in the amplitudes of the left tibial and left common peroneal nerves， with mildly decreased conduction velocity in the left tibial nerve. The patient was finally diagnosed with GBS. After plasma exchange， the patient′s symptoms were significantly relieved.
Conclusion
GBS that begins with unilateral limb weakness needs to be differentiated from cerebral infarction.
To explore the diagnostic characteristics of invasive pulmonary fungal infection（IPFI）caused by Alternaria spp.
Methods
The clinical data of a patient with IPFI caused by Alternaria spp. infection， diagnosed and treated in the Pulmonary and Critical Care Medicine Department of Western Theater General Hospital on May 31， 2024 were retrospectively analyzed， and relevant literature was reviewed.
Results
The patient was an 84-year-old female who presented with cough， sputum production，and left-sided chest pain. Chest CT showed multiple patchy and exudative lesions in both lungs. Conventional anti-infection treatment was ineffective， with no significant absorption of the lesions. Bronchoscopy revealed no abnormalities， but metagenomic next-generation sequencing （mNGS） of the lavage fluid identified Alternaria spp. as the pathogen. The patient was treated with nebulized amphotericin B combined with intravenous voriconazole for antifungal therapy. After 10 days of treatment， symptoms significantly improved，and follow-up chest CT showed slight absorption of the lesions. After discharge， the patient continued taking oral voriconazole. Three months later， the patient′s cough， sputum production， and chest pain completely resolved， with chest CT showed significant absorption of the lesions.
Conclusion
mNGS can effectively diagnose IPFI caused by Alternaria spp.， and the combination of amphotericin B and voriconazole can achieve favorable therapeutic outcomes.
Hypertension is one of the most prevalent chronic diseases worldwide， with a continuously increasing incidence influenced by multiple factors， including environmental and genetic factors. Recent studies have demonstrated that gut microbiota and its metabolites play a crucial role in the pathogenesis and progression of hypertension. This review summarizes the relationship between gut microbiota， its metabolites，and hypertension， with a particular focus on gut microbiota-based prevention and treatment strategies，including probiotic supplementation， dietary regulation， antibiotic intervention， and fecal microbiota transplantation. Furthermore， future research directions are discussed to provide new insights into the precise management of hypertension.
The classical Wnt signaling pathway， namely Wnt/β-catenin signaling pathway， is involved in promoting embryo and tissue development， neural function integration and other physiological effects. With the establishment of the complex pathway structure network in the study， the positive and negative regulatory mechanisms of the Wnt/β-catenin pathway in various pathophysiological processes have been gradually discovered. The biological effects of distinct ligands vary significantly， including neuroprotective effects， oxidative stress and neuroinflammatory regulation， autophagy and apoptosis， etc. It is widely present in the occurrence and development of neurological diseases such as ischemic stroke，Alzheimer disease and Parkinson disease. Studies have shown that targeted regulation of the Wnt/β-catenin signaling pathway shows significant potential in restoring neurobiological function and treating central nervous system diseases. This review focuses on the research progress of Wnt/β-catenin signaling pathway involved in central nervous system diseases.
Acute Stanford type A aortic dissection （ATAAD） frequently involves the branch arteries after onset， leading to impaired organ perfusion. When complicated with mesenteric malperfusion syndrome（mesMPS）， the diagnosis is likely to be delayed due to non-specific clinical manifestations and the lack of specific laboratory tests and imaging findings. In-hospital mortality remains high for this condition. There is no consensus among scholars at home and abroad on the treatment strategy of this acute and critical disease，and emergent open aortic repair is a traditional treatment measure. However， this approach is associated with high rates of postoperative complications and poor long-term prognosis. Therefore， there is controversy over whether aortic repair or restore superior mesenteric artery perfusion restoration should be prioritized. This article reviews the current research on the pathogenesis， diagnosis and treatment strategies for ATAAD complicated with mesMPS， aiming to provide a basis for clinicians to diagnose and accurately treat this disease.
