Forensic science is a cross discipline,involving both the subjects of natural sciences and the humanities & social sciences.It needs not only the application of forensic techniques and other theoretical results of natural sciences,but also be bounded by moral and ethical guidance.This paper discusses ethical issues involved in the teaching of forensic medicine in medical colleges,exploring the relationship between the teaching of forensic medicine and ethics,so as to promote the development of forensic science education.

Objective To explore the relationship of plasma level of B-type natriuretic peptide (BNP) with cardiovascular risk,the severity of coronary heart disease(CHD),and the short-term prognosis in patients with type 2 diabetes. Methods 154 patients with type 2 diabetes,of them 95 cases complicated with CHD and 65 with hyper-tension were selected in this study. The CHD patients were diveded into 3 groups: AMI(n=32), UAP(n=33) and SAP(n=30). The relationship of the plasma BNP levels with cardiovascular risks, with each coronary heart disea-ses,were observed. The patients were followed up for 6 months to study the predicting role of BNP on the death in pa-tients accompanied with CHD. Results The plasma BNP level was (397.34±217.79) ng/L, which was correlated with age, CRP, hypertension and CHD (r=0.631,0.672, 0.762,0.857, P<0.05 for each);the plasma BNP levels increased with age(r=0.896,P<0.01):(57.6±12.3) ng/L in patients <50 years old,(146.2±53.4)ng/L in patients 50≤and < 59 years old, (388.4±67.5) ng/in patients 60≤and < 69 years old, and (423.8±132.6) ng/L in patients≥70 years old (P<0.01 or P<0.05). The plasma BNP levels, was higher in patients with hyper-tension than that in patients without hypertension [(314.7±125.3) ng/L vs (136.8±98.7) ng/L, P<0.01];Higher in patients with CHD than that in patients without CHD [(425.03±200.80)ng/L vs (37.64±21.57) ng/L,P<0.01)]. The short-term prognosis of patients with CHD was correlated with the levels of BNP, and BNP levels≥485 ng/L may be an independent predicting factor for cardiac death within one month. Conclusions Plas-ma levels of BNP were associated with some cardiovascular risks,which may be one of biomarkers for cardiovascular risks in patient complicated with CHD.

Objective To investigate the characteristics and influencing factors leading to sudden cardiac death (SCD) of incarcerated prisoners. Methods Seventy-five SCD cases of prisoners between 2000 and 2013 in Henan province were collected, and environment, psychological and physical factors were retro-spectively analyzed. Combined with histopathological results, specific factors of SCD were also studied. Results In the 75 cases, 21 cases (28%) had definite chronic past medical histories, and 75 cases (100%) had cardiovascular disease confirmed by autopsy. Conclusion Due to presence of the potential cardiac diseases, special incarcerated environment, psychological stress, and body-restraint might be the precipitat-ing factors in SCD of those prisoners.

Scientific research is the essence of the comprehensive competitiveness in promoting medical development and progress.The county-level public hospitals are to improve all the medical staffs' scientific research awareness and level and the development and progress of clinical medical science by establishing an incentive mechanism and a platform for scientific research and combining the specialties of the hospitals to carry out relative scientific research.

Objective To estimate the characteristics of gastroesophageal reflux (GER) and its clinical association with pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) patients.Methods Two hundred and five patients with SSc,who fulfilled the American College of Rheumatology criteria were consecutively recruited.GER was recognized in patients with symptom of heartburn or regurgitation.Demographic,clinical,and laboratory data were analyzed.A six minute walk test,pulmonary function test and modified Rodnan's skin score (mRSS) were also calculated for GER and non-GER groups.x2 test,Fisher's exact test and t-test were used for statistical analysis.Logistic regression test was used for the analysis of risk factors.Results There were 90 patients with GER among 205 patients,the prevalence of GER was 43.9％.The presence of PAH (23.3％ vs 9.6％),Raynaud's phenomenon (98.9％ vs 92.2％ ) and fingertip ulcers (56.7％vs 51.3％) were significantly higher in patients with GER than those without GER.There was no difference in autoantibody profile between GER patients and non-GER patients (P＞0.05).The New York Heart Association (NYHA) functional class of SSc-related GER was worse than patients without GER (P=0.015).Pulmonary function test showed that diffuse capacity (DLCO)％,forced vital capacity (FVC)％,and forced expiratory volume (FEV1)％ were lower and the FVC％/DLCO％ ratio was higher in patients with GER than non-GER (P＜0.05).GER was an independent risk factor of PAH in SSc patients (P=0.047,OR=3.41 ).Conclusion GER frequently occurs in SSc patients,SSc patients presenting with GER should be screened for PAH.Targeting the underlying vascular dysfunction might prevent not only PAH,but also GER in SSc patients.

Objective To analyze the clinical characteristics of pneumomediastinum in patients with dermatomyositis and polymyositis for demonstrating its pathogenesis and for predicting its prognosis. Methods The clinical records of 96 patients with PM/DM were reviewed, focusing on for perdicting its pneumomediastinum. Five patients with pneumomediastinum are described in detail. Case reports of pneumomediastinum in PM/DM in English publications are reviewed. Results Five DM cases complicated by pneumomediastinum all had lung infections. Twenty-nine cases (including our five cases) of DM/PM with pneumomediastinum have taken methylprednisolone, four cases alive, and six died. Nine cases have taken CsA,seven cases alive and two died. Conclusion The infections was strongly suspected as being responsible for the pneumomediastinum. Methylprednisolone has poor effect. CsA can be an effective therapeutic agent in PM/DM.

ObjectiveTo investigate the clinical and laboratory characteristics of systemic sclerosis (SSc) patients with digital ulcer(DU) in China.MethodThe data of 166 consecutive SSc patients in EUSTAR DATABASE in Peking Union Medical Colloge Hospital from February 2009 to August 2010 were prospectively collected,and patients with DU were compared with those without DU.All patients fulfilled the ACR classification criteria for SSc in 1980.Results① Forty-nine patients (29.5％) had DU in 166 SSc patients.The disease onset age was(36±12) years(8.1-61.7 years) for those patients with DU.All had Raynaud's phenomenon(RP).② Demographic data:there were significant differences between patients with and without DU in sex (F/M 40/9 vs 112/5,P=0.005),age [(40±12) years old vs(46±12) years old,P=0.005],the onset age of RP [(33±12) years vs(39±13) years,P=0.005] and the duration from RP to the first non-RP presentaion[ (18±15) months vs(115±307) months,P=0.002 ].③ Clinical manifestations and laboratory findings:there were more diffuse SSc patients and more esophageal involvement in patients with DU (P＜0.05).ConclusionsDU in SSc patients is common,especially in man and patients with diffuse SSc.SSc patients with DU usually are younger when RP onsets and the non-RP manifestations usually present earlier when compared with those patients without DU.

Objective To evaluate the diagnostic accuracy of contrast-enhanced harmonic EUS (CH-EUS)for pancreatic cancer.Methods Patients with pancreatic occupying lesion underwent CH-EUS with ultrasonic contrast medium Sonovue.Pathological diagnoses by EUS-FNA or surgery and the follow-up results were made as the final diagnosis to evaluate the accuracy of CH-EUS for pancreatic cancer.Character-istics of CH-EUS in different pancreatic tumors were analysed.Results A total of 76 patients were en-rolled,with an average age of 53. 1 ±14. 2.Thirty-five were finally diagnosed as having pancreatic cancer, 21 local mass-type pancreatitis,10 pancreatic neuroendocrine tumor,6 cystadenoma,4 intraductal papillary mucinous neoplasm.Tumor diameter was 3. 4 ±1. 4 cm and there were 18 less than 2 cm.The sensitivity and specificity,positive and negative predictive value of CH-EUS for pancreatic cancer was 97. 1%, 92. 9%,91. 7% and 97. 5% respectively.The sensitivity was 100% combined with FNA.Conclusion CH-EUS is safe,convenient for pancreatic cancer with high accuracy and can be used as an additional diag-nostic method to EUS-FNA.

Objective To investigate the levels, phenotypes and functions of regulatory T cells (Treg) and Th17 cells in systemic sclerosis (SSc) patients and assess the role of imbalance between Treg and Th17 cells in the pathogenesis of SSc. Methods Peripheral blood mononuclear cells (PBMCs) of 31 SSc patients and 33 healthy controls were analyzed for the expression of CD4, CD25, CD45RA, the cytotoxic T-lymphocyte antigen-4 (CTLA-4), FoxP3, and IL-17 using flow cytometry. Treg immunosuppression capacities were measured in co-cultured experiments. The expressions of IL-17A, IL-22, IL-6 and IL-1β were measured by FlowcytoMix. The expression of FoxP3, CTLA-4, IL-17A, and RORC mRNA were measured by real-time polymerase chain reaction (PCR). The independent samples t-test was used to compare data between the groups. Results The frequency of Treg cells was significantly elevated in SSc [(3.6 ±1.1)%] compared with controls [(2.0±0.8)%, t=6.88, P<0.01)] and the expression of CTLA-4 was lower in Treg cells of SSc (P=0.034). The expression of CTLA-4 and FoxP3 mRNA was lower in SSc compared with controls (P<0.05), the immunosuppressive capacity of Treg cells were diminished in SSc (P=0.034). Th17 cells were increased in SSc (P<0.01); the levels of IL-17A, IL-22, IL-6 and IL-1β in the serums of SSc were higher than the controls (P<0.05). In SSc, CD25+FoxP3+IL-17+cells were increased[0.075%±0.032)%vs (0.049±0.027)%, t=3.52, P=0.029], but no difference of CD25+FoxP3+IL-17- was observed when compared with control. The expression of IL-17A and RORC mRNA were increased in SSc (P<0.01, respectively). Conclusion Both Treg and Th17 cells are increased in patients of SSc. Treg increases along with the deficiency of phenotype and function. FoxP3+IL-17+co-express cells are increased, and the balance between Treg and Th17 cells is broken.

Objective To analyze the clinical features,laboratory tests,treatments and outcome of patients with scleroderma renal crisis (SRC).Methods We retrospectively reviewed the clinical and laboratory data of 16 patients with scleroderma renal crisis in Peking Union Medical College Hospital from May 2004 to May 2013.The treatment and outcome of SRC patients were also retrospectively analyzed.Results There were a total of 16 SRC patients including 5 male patients and 11 females.The median age at SRC onset was (49.9 ± 12.3) years.It usually took 3.2 years from the diagnosis of systemic sclerosis(SSc) to SRC attack.Ten SRC patients belonged to diffuse cutaneous systemic sclerosis (dcSSc),and 6 patients were limited cutaneous systemic sclerosis (lcSSc).Among SRC patients,16/16 were negative of anticentromere antibodies(ACAs).All these 16 patients had hypertension and renal insufficiency,including 8 dialysis dependent after the onset of SRC and 7 with thrombotic microangiopathy.There were 3 patients receiving renal biopsy.The pathological findings were mainly summarized as intimal thickening and stenosis of renal arterioles.Among 13 patients with long-term followed-up,11 patients received angiotensin converting enzyme inhibitors(ACEI),5 patients died,2 patients were dialysis dependent.Only 1 patient stopped dialysis after the combination treatment of ACEI and endothelin receptor antagonist.Another 5 patients didn't need dialysis.Conclusion SRC usually occurred at the early course of SSc.dcSSc was more frequent than lcSSc.ACAs were rarely found in SRC patients.The immediate and sufficient use of ACEIs was still the cornerstone of SRC treatment.Future studies are needed to evaluate the efficacy of endothelin receptor antagonist in the treatment of SRC.