OBJECTIVE This study investigated the clinical implications of endothelial cell-specific molecule 1(ESM-1)in obstructive sleep apnea(OSA)patients,with particular focus on its dynamic correlation with adhesion molecules,aiming to elucidate the regulatory role of ESM-1 in OSA-associated vascular endothelial impairment.METHODS This cross-sectional study enrolled participants undergoing polysomnography(PSG)at the Sleep Medicine Center of Beijing Anzhen Hospital,Capital Medical University between March 2017 and January 2018.Based on the inclusion criteria,161 participants were ultimately included and divided into OSA group(n=118)and control group(n=43).Demographic data and polysomnography parameters were collected.We used a powerful high-throughput Multiplex Immunobead Assay technology to simultaneously test plasm cytokines levels of ESM-1,inter-cellular adhesion molecule 1(ICAM-1),vascular cell adhesion molecule 1(VCAM-1).Circulating C-reactive protein(CRP)and homocysteine(Hcy)were detected by routine blood chemistry panel.RESULTS Circulating ESM-1 levels were significantly elevated in patients with OSA compared with healthy controls[819.73(612.36-1393.47)pg/ml]vs.[286.17(114.48-513.81)pg/ml,P<0.001].After adjusting for confounding factors,we found that circulating ESM-1 levels were an independent risk factor for OSA(odds ratio=2.162,95%CI=1.522-3.072,P<0.001)and circulating ESM-1 levels were positively associated with ICAM-1 and VCAM-1 levels(β=1.977,95%CI=1.429-2.734,P<0.001).CONCLUSION Circulating ESM-1 levels were significantly increased in patients with OSA,which is closely related with adhesion molecules levels.ESM-1 may be a surrogate endothelial dysfunction marker and an independent risk factor for OSA.

This article reports the case of an adolescent patient presenting with recurrent epistaxis and orthostatic hypoxemia. Chest imaging revealed multiple bilateral pulmonary nodules of varying sizes and mixed densities. The presence of intrapulmonary right-to-left shunting was confirmed through bubble contrast echocardiography, pulmonary first-pass perfusion imaging, and the pure oxygen inhalation formula method. Whole-genome sequencing identified a mutation in the SMAD4 gene, and subsequent family analysis confirmed the diagnosis of hereditary hemorrhagic telangiectasia (HHT). Currently, there is no international consensus on the management of such rare presentations. Based on relevant case reports in the literature, the patient was empirically treated with a combination of amlodipine and thalidomide. After one year of follow-up, significant improvement in hypoxemia was observed. The diagnostic and therapeutic process of this case offers valuable insights for the clinical management of patients with mixed-type PAVMs caused by HHT.

Objective:To explore the alterations in gray matter morphology and contributing factors in patients with post-infectious olfactory dysfunction (PIOD) using voxel-based morphometry (VBM) and surface-based morphometry (SBM), thereby providing scientific insights into the neuropathological mechanisms underlying PIOD.Methods:A total of 46 PIOD patients (PIOD group) and 46 normosmic volunteers (control group) were recruited from the Smell and Taste Disorders Clinic of Beijing Anzhen Hospital, Capital Medical University, between January 2020 and December 2024. All participants underwent olfactory psychophysical tests (Sniffin′ Sticks) and olfactory event-related potential (oERP) examination. High-resolution T1-weighted 3D MRI structural images were obtained for both groups. VBM was employed to analyze inter-group differences in gray matter volume, while SBM was used to assess cortical thickness and folding index. Correlations between gray matter volume in significant difference brain regions and disease duration, Sniffin′ Sticks scores, oERP parameters were analyzed. A two-tailed P<0.05 was considered statistically significant. Results:No significant differences were observed in age, sex, education level, or Mini-Mental State Examination (MMSE) scores ( t=1.80, χ2=0.41, t=0.17, t=1.77, all P>0.05). Compared with controls, the PIOD group showed significantly lower Sniffin′ Sticks scores ( t=28.70, P<0.001), prolonged oERP latencies and reduced amplitudes (all P<0.001). VBM revealed significantly reduced gray matter volume in the right orbitofrontal cortex (OFC) in the PIOD group ( t=5.38, P<0.001). SBM demonstrated decreased cortical thickness in the right OFC ( t=5.27, P<0.001), with no significant differences in folding index. The gray matter volume in the right OFC was negatively correlated with disease duration ( r=-0.61, P<0.001), but no significant correlations were found with Sniffin′ Sticks scores or oERP parameters. Conclusion:Patients with PIOD show atrophy in the right OFC, which correlates with disease duration, suggesting that persistent olfactory dysfunction may be associated with neurodegenerative changes.

Objective:To construct and validate a prognostic model of colon cancer based on differentially expressed anoikis-related genes, and to preliminarily investigate the relationship between anoikis-related genes and the tumor immune microenvironment of colon cancer.Methods:A total of 472 cancer tissues samples of patients with colon cancer, RNA sequencing data and clinical data of 41 normal tissues samples were downloaded from the Cancer Genome Atlas (TCGA) database between the establishment time and July in 2024. A total of 919 genes related to anoikis were screened out from GeneCards database, and the common genes were selected from the RNA sequencing gene datasets of colon cancer and normal colon tissues in the TCGA database, among which the differentially expressed anoikis-related genes of colon cancer and normal colon tissues were screened out based on P < 0.05. Furthermore, genes related to the prognosis of 446 colon cancer patients with prognostic data in the TCGA database were screened by using univariate Cox proportional risk model; the genes with P < 0.05 were further screened out and a colon cancer prognosis model was constructed by using LASSO-Cox proportional risk model. The risk score of the above 446 colon cancer patients in the TCGA database was calculated according to the prognostic model, and the patients were divided into high-risk (≥ median value) group and low-risk (< median value) group according to the median risk score, and the overall survival of the 2 groups was analyzed by using the Kaplan-Meier method. The risk score based on R software-based time ROC program package was used to predict 1-year, 2-year, 3-year overall survival therapeutic efficacy of colon cancer patients in the TCGA database. According to the median risk score of colon cancer patients in the TCGA database, the patients in the International Cancer Genome Consortium (ICGC) database were divided into high-risk group and low-risk group. Kaplan-Meier method and receiver operating characteristic (ROC) curve were used to verify the predictive effect of the prognostic model. The differentially expressed genes between low-risk group and high-risk group stratified by prognostic model risk score in the TCGA database were used to perform single sample gene set enrichment analysis (ssGESA) of immune cells and immune function by using R software related programs. The differences in risk scores of patients with different immunophenotypes (including inflammator response type, wound healing type, interferon gamma dominant type and lymphocyte depletion type) were compared; and correlation analysis of infiltration and risk scores between immune cells and stromal cells in tumor microenvironment was made. Based on the tumor immune function and rejection (TIDE) database, the relationship between the prognostic model risk score and programmed death receptor ligand 1 (PD-L1) gene expression level was analyzed. Results:Based on anoikis-related genes in the GeneCards database, 236 differentially expressed anoikis-related genes between colon cancer tissues and normal tissues were obtained from the TCGA database. LASSO Cox regression was applied to establish a prognostic model constructed by 7 differentially expressed anoikis-related genes in cancer tissues and normal colon tissues related to the prognosis of colon cancer. Risk score = 0.366×TIMP1-0.404×NAT1+0.207×LTB4R2+0.075×INHBB+0.140×CD36-0.109×MMP3+2.994×OFCC1. The median risk score of 446 colon cancer patients in the TCGA database was 1.754 719 545. Survival analysis showed that the overall survival of colon cancer patients in high-risk group of the TCGA database was worse than that in low-risk group ( P < 0.001); ROC curve analysis showed that the area under the curve for predicting 1-year, 2-year and 3-year overall survival of patients in the TCGA database based on the prognostic model risk score was 0.705, 0.731 and 0.723, respectively. Kaplan-Meier method analysis showed that in the ICGC database, the overall survival of colon cancer patients in high-risk group was worse than that in low-risk group ( P = 0.041); ROC curve analysis showed that the area under the curve of prognostic model risk score for predicting 1-year and 2-year overall survival of colon cancer patients in the ICGC database was 0.663 and 0.966, respectively. ssGESA analysis showed that macrophage level in high-risk group was higher than that in low-risk group, helper T (Th) 1 cell and Th2 cell levels in high-risk group were lower than those in low-risk group (all P < 0.01). In terms of immune function, the cell killing activity and histocompatibility complex Ⅰ level in high-risk group were lower than those in low-risk group, and type Ⅱ interferon response score in high-risk group was higher than that in low-risk group (all P < 0.05). The analysis of immunophenotype showed that the risk score of inflammatory response type was higher than that of wound healing type ( P < 0.05), and there was no statistically significant difference in risk score between the other 2 types (all P > 0.05). Risk score was positively correlated with stromal cell infiltration score ( R = 0.340, P < 0.001) and immune cell infiltration score ( R = 0.148, P < 0.05); the expression level of PD-L1 in high-risk group was higher than that in low-risk group in the TCGA database ( P = 0.048), and the expression level of PD-L1 was positively correlated with risk score ( R = 0.130, P = 0.009). Conclusions:A prognostic model of colon cancer constructed by anoikis-related genes can better predict the prognosis of colon cancer patients, and anoikis-related genes may play an important role in tumor immunity of colon cancer.

Objective:To explore the alterations in gray matter morphology and contributing factors in patients with post-infectious olfactory dysfunction (PIOD) using voxel-based morphometry (VBM) and surface-based morphometry (SBM), thereby providing scientific insights into the neuropathological mechanisms underlying PIOD.Methods:A total of 46 PIOD patients (PIOD group) and 46 normosmic volunteers (control group) were recruited from the Smell and Taste Disorders Clinic of Beijing Anzhen Hospital, Capital Medical University, between January 2020 and December 2024. All participants underwent olfactory psychophysical tests (Sniffin′ Sticks) and olfactory event-related potential (oERP) examination. High-resolution T1-weighted 3D MRI structural images were obtained for both groups. VBM was employed to analyze inter-group differences in gray matter volume, while SBM was used to assess cortical thickness and folding index. Correlations between gray matter volume in significant difference brain regions and disease duration, Sniffin′ Sticks scores, oERP parameters were analyzed. A two-tailed P<0.05 was considered statistically significant. Results:No significant differences were observed in age, sex, education level, or Mini-Mental State Examination (MMSE) scores ( t=1.80, χ2=0.41, t=0.17, t=1.77, all P>0.05). Compared with controls, the PIOD group showed significantly lower Sniffin′ Sticks scores ( t=28.70, P<0.001), prolonged oERP latencies and reduced amplitudes (all P<0.001). VBM revealed significantly reduced gray matter volume in the right orbitofrontal cortex (OFC) in the PIOD group ( t=5.38, P<0.001). SBM demonstrated decreased cortical thickness in the right OFC ( t=5.27, P<0.001), with no significant differences in folding index. The gray matter volume in the right OFC was negatively correlated with disease duration ( r=-0.61, P<0.001), but no significant correlations were found with Sniffin′ Sticks scores or oERP parameters. Conclusion:Patients with PIOD show atrophy in the right OFC, which correlates with disease duration, suggesting that persistent olfactory dysfunction may be associated with neurodegenerative changes.

Objective:To construct and validate a prognostic model of colon cancer based on differentially expressed anoikis-related genes, and to preliminarily investigate the relationship between anoikis-related genes and the tumor immune microenvironment of colon cancer.Methods:A total of 472 cancer tissues samples of patients with colon cancer, RNA sequencing data and clinical data of 41 normal tissues samples were downloaded from the Cancer Genome Atlas (TCGA) database between the establishment time and July in 2024. A total of 919 genes related to anoikis were screened out from GeneCards database, and the common genes were selected from the RNA sequencing gene datasets of colon cancer and normal colon tissues in the TCGA database, among which the differentially expressed anoikis-related genes of colon cancer and normal colon tissues were screened out based on P < 0.05. Furthermore, genes related to the prognosis of 446 colon cancer patients with prognostic data in the TCGA database were screened by using univariate Cox proportional risk model; the genes with P < 0.05 were further screened out and a colon cancer prognosis model was constructed by using LASSO-Cox proportional risk model. The risk score of the above 446 colon cancer patients in the TCGA database was calculated according to the prognostic model, and the patients were divided into high-risk (≥ median value) group and low-risk (< median value) group according to the median risk score, and the overall survival of the 2 groups was analyzed by using the Kaplan-Meier method. The risk score based on R software-based time ROC program package was used to predict 1-year, 2-year, 3-year overall survival therapeutic efficacy of colon cancer patients in the TCGA database. According to the median risk score of colon cancer patients in the TCGA database, the patients in the International Cancer Genome Consortium (ICGC) database were divided into high-risk group and low-risk group. Kaplan-Meier method and receiver operating characteristic (ROC) curve were used to verify the predictive effect of the prognostic model. The differentially expressed genes between low-risk group and high-risk group stratified by prognostic model risk score in the TCGA database were used to perform single sample gene set enrichment analysis (ssGESA) of immune cells and immune function by using R software related programs. The differences in risk scores of patients with different immunophenotypes (including inflammator response type, wound healing type, interferon gamma dominant type and lymphocyte depletion type) were compared; and correlation analysis of infiltration and risk scores between immune cells and stromal cells in tumor microenvironment was made. Based on the tumor immune function and rejection (TIDE) database, the relationship between the prognostic model risk score and programmed death receptor ligand 1 (PD-L1) gene expression level was analyzed. Results:Based on anoikis-related genes in the GeneCards database, 236 differentially expressed anoikis-related genes between colon cancer tissues and normal tissues were obtained from the TCGA database. LASSO Cox regression was applied to establish a prognostic model constructed by 7 differentially expressed anoikis-related genes in cancer tissues and normal colon tissues related to the prognosis of colon cancer. Risk score = 0.366×TIMP1-0.404×NAT1+0.207×LTB4R2+0.075×INHBB+0.140×CD36-0.109×MMP3+2.994×OFCC1. The median risk score of 446 colon cancer patients in the TCGA database was 1.754 719 545. Survival analysis showed that the overall survival of colon cancer patients in high-risk group of the TCGA database was worse than that in low-risk group ( P < 0.001); ROC curve analysis showed that the area under the curve for predicting 1-year, 2-year and 3-year overall survival of patients in the TCGA database based on the prognostic model risk score was 0.705, 0.731 and 0.723, respectively. Kaplan-Meier method analysis showed that in the ICGC database, the overall survival of colon cancer patients in high-risk group was worse than that in low-risk group ( P = 0.041); ROC curve analysis showed that the area under the curve of prognostic model risk score for predicting 1-year and 2-year overall survival of colon cancer patients in the ICGC database was 0.663 and 0.966, respectively. ssGESA analysis showed that macrophage level in high-risk group was higher than that in low-risk group, helper T (Th) 1 cell and Th2 cell levels in high-risk group were lower than those in low-risk group (all P < 0.01). In terms of immune function, the cell killing activity and histocompatibility complex Ⅰ level in high-risk group were lower than those in low-risk group, and type Ⅱ interferon response score in high-risk group was higher than that in low-risk group (all P < 0.05). The analysis of immunophenotype showed that the risk score of inflammatory response type was higher than that of wound healing type ( P < 0.05), and there was no statistically significant difference in risk score between the other 2 types (all P > 0.05). Risk score was positively correlated with stromal cell infiltration score ( R = 0.340, P < 0.001) and immune cell infiltration score ( R = 0.148, P < 0.05); the expression level of PD-L1 in high-risk group was higher than that in low-risk group in the TCGA database ( P = 0.048), and the expression level of PD-L1 was positively correlated with risk score ( R = 0.130, P = 0.009). Conclusions:A prognostic model of colon cancer constructed by anoikis-related genes can better predict the prognosis of colon cancer patients, and anoikis-related genes may play an important role in tumor immunity of colon cancer.

Hepatic cholesterol accumulation is an important contributor to hypercholesterolemia, which results in atherosclerosis and cardiovascular disease (CVD). ATP-citrate lyase (ACLY) is a key lipogenic enzyme that converts cytosolic citrate derived from tricarboxylic acid cycle (TCA cycle) to acetyl-CoA in the cytoplasm. Therefore, ACLY represents a link between mitochondria oxidative phosphorylation and cytosolic de novo lipogenesis. In this study, we developed the small molecule 326E with an enedioic acid structural moiety as a novel ACLY inhibitor, and its CoA-conjugated form 326E-CoA inhibited ACLY activity with an IC₅₀ = 5.31 ± 1.2 μmol/L in vitro. 326E treatment reduced de novo lipogenesis, and increased cholesterol efflux in vitro and in vivo. 326E was rapidly absorbed after oral administration, exhibited a higher blood exposure than that of the approved ACLY inhibitor bempedoic acid (BA) used for hypercholesterolemia. Chronic 326E treatment in hamsters and rhesus monkeys resulted in remarkable improvement of hyperlipidemia. Once daily oral administration of 326E for 24 weeks prevented the occurrence of atherosclerosis in ApoE^-/- mice to a greater extent than that of BA treatment. Taken together, our data suggest that inhibition of ACLY by 326E represents a promising strategy for the treatment of hypercholesterolemia.

Objective:To analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Methods:This was a retrospective analysis. Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled, including 22 males and 66 females, with the age of (48.1±11.3) years old(Mean±SD). Sniffin′ Sticks olfactory test, Lund-Mackay score and modified sinus CT olfactory cleft score, nasal resistance and acoustic reflex examination, blood routine and blood biochemistry test, serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery. According to bilateral total TDI score, the patients were divided into normal olfactory function group and olfactory disfunction group. The clinical baseline data were compared between the two groups. According to the results of single factor analysis, factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis, then a model predicting olfactory disfunction in patients with CRSwNP was initially established. P<0.05 was considered statistically significant. Results:Among 88 patients with CRSwNP, 32 (36.4%) patients were with normal olfaction and 56 (63.6%) patients were with olfactory disfunction, including 40 (45.5%) of hyposmia and 16 (18.2%) of anosmia. Tissue eosinophil count, blood eosinophil percentage and blood urea concentration had significant difference between the two groups (12.7[2.0, 52.3]/HP ( M[ P25, P75]) vs 38.6[16.2, 87.0]/HP, 2.75[1.60, 4.80]% vs 4.35[2.50, 6.60]%, (5.56±1.15) mmol/L vs (4.98±1.33) mmol/L, all P<0.05). Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant, in addition, the bilateral and total olfactory cleft score was a risk factor ( OR=2.108, 95 %CI: 1.407-3.159, P<0.001) and blood urea within a certain concentration was a protective factor ( OR=0.461, 95 %CI: 0.240-0.884, P=0.020). Further studies found that the area under the ROC curve of the model with tissue eosinophil count, blood eosinophil percentage, bilateral and total olfactory cleft score, total inspiratory volume and blood urea concentration was 0.888 ( P<0.01), which had good predictive value for olfactory disorders in CRSwNP. Conclusions:The modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP. A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.

Objective: To observe the disease type and the changes of symptom load during treatment of patients with Ph chromosome/BCR-ABL fusion gene negative myeloproliferative neoplasm (MPN). Methods: A total of 84 patients with MPN diagnosed from May 2017 to January 2019 in People′s Hospital of Longhua District of Shenzhen were selected, and were divided into polycythemia vera (PV) group, essential thrombocyhemia (ET) group, and myelofibrosis (PMF) group according to their subtypes, with 28 cases in each group. The scores of MPN-SAF-TSS were compared among the three groups. Besides, the scores of the scale (myeloproliferative neoplasm symptom assessment form total symptom score, MPN-SAF-TSS) in different treatment periods (at the time of the visit, when the disease progressed, when the disease was stable, when the clinical improvement was made, when the partial remission was completed, at the time of remission and recurrence) were also compared. Results: At the time of initial diagnosis, there were significant differences in the incidences of symptom burdens among the three groups of MPN patients with abdominal fullness (χ²=6.095, P=0.047), abdominal discomfort (χ²=7.342, P=0.025), poor mobility (χ²=13.029, P=0.001), inattention (χ²=6.099, P=0.047), pruritus (χ²=6.956, P=0.031), bone pain (χ²=7.807, P=0.020), fever (χ²=8.000, P=0.018) and weight loss (χ²=27.340, P<0.001). The incidences of poor mobility (85.71%, 24/28), inattention (67.86%, 19/28) and weight loss (82.14%, 23/28) in PMF group were significantly higher than those in PV group [42.86% (12/28), 39.29% (11/28), 35.71% (10/28)] and ET group [46.43% (13/28), 39.29% (11/28), 14.29% (4/28)] (all P<0.05). The incidences of abdominal discomfort (75.00%, 21/28) and bone pain (60.71%, 17/28) in PMF group were higher than those in PV group [39.29% (11/28), 25.00% (7/28)] (both P<0.05). The incidences of abdominal fullness (89.29%, 25/28) and fever (42.86%, 12/28) in PMF group were higher than those in ET group [60.71% (17/28), 10.71% (3/28)] (both P<0.05). The incidence of pruritus in PV group (71.43%, 20/28) was higher than that in ET group (42.86%, 12/28) and PMF group (39.29%, 11/28) (both P<0.05). Symptom load scores of patients with fatigue (χ²=368.594, P<0.001), abdominal fullness (χ²=261.312, P<0.001), abdominal discomfort (χ²=195.629, P<0.001), poor mobility (χ²=217.862, P<0.001), lack of concentration (χ²=280.664, P<0.001), night sweats (χ²=239.650, P<0.001), pruritus (χ²=254.418, P<0.001), bone pain (χ²=180.291, P<0.001), fever (χ²=231.613, P<0.001) and weight loss (χ²=227.831, P<0.001) were significantly different during different therapeutic periods. The fatigue symptom load score was higher when the disease progressed than that at the time of the visit (P<0.05), and the symptom score of abdominal fullness was lower than that at the time of visit (P<0.05). Symptom load scores of weakness and pruritus when the condition was stable was lower than those when the disease progressed (both P<0.05). When the clinical improvement was made, symptom load scores of weakness, abdominal discomfort, inattention, night sweats, weight loss were lower than those when the disease was stable (all P<0.05). Symptom load scores of abdominal fullness, poor mobility, inattention, night sweats and pruritus in partial remission period decreased compared to temporary improvement period (all P<0.05). Compared to the partial remission period, the symptom load scores of weakness, abdominal fullness, night sweats, pruritus, bone pain and weight loss in complete remission period were lower (all P<0.05). At last, symptom load scores of weakness, abdominal fullness, abdominal discomfort, poor mobility, inattention, night sweats, pruritus, bone pain, fever and weight loss in recurrence period were higher than those in complete remission period (all P<0.05). Conclusion There are several differences in the main clinical symptoms among patients with different MPN subtypes, and there are significant changes in the main clinical symptoms as the disease progresses or turns around.

Objective: To investigate the brain volume alterations in patients with hyposmia using voxel-based morphometry (VBM) and to correlate these alterations with the degree and duration of hyposmia. Methods: Forty patients with hyposmia from Department of Otorhinolaryngology Head and Neck Surgery, Beijing Anzhen Hospital since 2013 to 2016 and forty age and sex matched normal subjects were recruited in this study. Sniffin′ Sticks olfactory test was performed to evaluate the olfactory function of all subjects. We acquired T1-weighted magnetic resonance images from all subject on a 3T scanner. VBM was performed using VBM8 toolbox and SPM8 in a Matlab environment. Independent sample t test analysis was used to compare the volume of gray and white matter between the controls and patients. In addition, the Pearson or Spearman correlation analysis was used for the correlation between the voxel value of cerebral volume alterations area and the degree and duration of hyposmia on patients (threshold discrimination identification, TDI). Results: Compared with the controls, patients showed significantly decreased volume in the gray matter of right orbitofrontal cortex (number of voxel in clusters was 226, t=-4.46, P<0.001, uncorrected). There was negative correlation between decreased gray matter volume of the right orbitofrontal cortex with significantly decreased area and the TDI results (r=-0.40, P=0.01), but positive correlation with duration of hyposmia (r=0.37, P=0.02). Conclusions The patients with hyposmia show gray matter atrophy of the right orbitofrontal cortex. The duration may be an important risk factor for decreased gray matter in patients with hyposmia.