ObjectiveTo explore the current situation of forensic ethics practice and education by designing a questionnaire on forensic ethics， with a view to exploring the path of forensic ethics education construction. MethodsA total of 667 valid questionnaires were collected using the online survey method， basically covering various regions across the country and all sub-specialties of forensic medicine. Descriptive analysis was used to analyze the relevant data. ResultsMost practitioners had relevant ethical reflections in the process of forensic practice. 69.12% of the respondents indicated that they had studied the relevant rules， but approximately half stated that there were no corresponding ethical norms or standard operating manuals. The specific behaviors violating ethics in different units were diverse. 23.04% of the respondents reported that they had encountered unethical behaviors， but only 4.9% of them reported such violations. In terms of forensic ethics education， 87.75% of the respondents believed that there were issues with the current model of forensic ethics education. Meanwhile， the respondents showed a high degree of recognition for receiving forensic ethics education， with 84.15% of respondents expressing willingness to participate in relevant courses. More than half of respondents were willing to participate in forensic ethics education during undergraduate studies， new employee training， and regular post-employment training. ConclusionCurrently， there is a problem of ethical neglect in forensic work in China. Combining ethics courses with professional courses at the practitioner training stage and providing regular training at the practice stage are effective measures to popularize forensic ethics knowledge， enhance ethical awareness， and improve the quality of practice.

Objective To study the effect of different types of renal puncture needles on the risk of bleeding after renal puncture.Methods A retrospective analysis was performed on 428 patients who under-went renal biopsy in the Third Affiliated Hospital of Chongqing Medical University and Jiulongpo District People's Hospital of Chongqing from January 2020 to December 2022.Different types of puncture needles were used to compare the occurrence of postoperative bleeding complications(hematoma,hematuria).Results The incidence of bleeding complications after renal puncture in 428 patients was 21.0％(90/428),of which the incidence of hematoma was 18.9％(81/428),the incidence of hematuria was 2.1％(9/428),the median decrease in hemoglobin(Hb)was 5 g/L,and the incidence of serious complications such as blood transfusion and interventional therapy was 0.7％(4/428).The patients with different types of renal puncture needles were grouped(16G group,18G group).There was no significant difference in baseline data and distri-bution of renal pathological types between the two groups(P＞0.05).The incidence of postoperative bleeding in 16G group and 18G group was 22.4％(52/232)and 19.4％(38/196),respectively.The incidence of hema-toma was 20.6％(48/232)and 16.8％(33/196),respectively.The incidence of hematuria was 1.7％(4/232)and 2.6％(5/196),respectively.The decrease of Hb was 6(0,16)g/L and 4(0,17)g/L,respectively.There was no significant difference(P＞0.05).There was no significant difference in the incidence of serious compli-cations such as blood transfusion,interventional therapy and Hb decrease＞10 g/L between the two groups(P＞0.05).Conclusion Ultrasound-guided renal biopsy is safe and has a low incidence of serious complica-tions.There was no significant relationship between different puncture needle types and postoperative bleeding risk.

Objective:To construct an explainable artificial intelligence(AI) model of risk characteristics of papillary thyroid carcinoma(PTC), and to explore its value of it combined with clinical features in predicting cervical lymph node metastasis(CLNM) in PTC patients.Methods:From January 2021 to September 2022, 422 patients(422 nodules) with pathologically confirmed PTC underwent thyroidectomy and neck lymph node dissection in the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively collected, the patients were randomly divided into training set and test set according to the ratio of 7∶3. Ultrasonographic features highly correlated with PTC risk characteristics were extracted by traditional machine learning method, and an intelligent prediction model with optimal probability of risk characteristics was established. Then, a risk model for predicting CLNM of PTC patients was constructed in combination with clinical features. The diagnostic effectiveness of the model was evaluated by drawing a ROC curve and calculating the area under curve (AUC).Results:In the AI explaineable model of PTC risk characteristics in the test set, the intelligent diagnosis model of calcification based on logistic regression classification showed the highest diagnostic efficiency, with an AUC of 0.87 ( P<0.05). Compared with the probability model of risk characteristic of PTC alone, the comprehensive model combined with clinical characteristics showed higher diagnostic efficiency in predicting CLNM of PTC patients, with AUC of 0.97, diagnostic critical value of 0.15, corresponding accuracy, sensitivity and specificity of 92.65%, 92.76% and 92.54%, respectively (all P<0.05). Conclusions:The explaineble risk characteristics of PTC AI model combined with clinical features can effectively predict the cervical lymph node metastasis of PTC, and then provide effective information for clinical decision-making of PTC patients.

18F-FDG PET/CT is one of the most advanced diagnostic methods for lymphoma, which plays an important role in the diagnosis, efficacy evaluation, prognosis prediction and clinical decision-making of lymphoma. Radiomics, which uses complex bioinformatics methods to extract quantitative information from medical images to characterize tumor heterogeneity, has blossomed over the past decade. Radiomics has been applied to 18F-FDG PET/CT to quantify the heterogeneity within tumors, which has great potential and value in the study of lymphoma. This article reviews the research progress and application of 18F-FDG PET/CT radiomics in lymphoma.

Objective:To select and obtain evidence on oral health management for dementia patients, and summarize the best evidence.Methods:The best clinical practices, guidelines, expert consensus, evidence summary, recommended practices, and systematic reviews on oral health management for patients with dementia and cognitive impairment were electronically retrieved from British Medical Journal Best Practice, Australia Joanna Briggs Institute Evidence-Based Health Care Center Database, Agency for Healthcare Research and Quality, and National Institute for Health and Clinical Excellence, Cochrane Library, PubMed, Alzheimer's Association, China Biomedical Database, China National Knowledge Infrastructure, WanFang Data and VIP and so on. The search period was from database establishment to October 31, 2023. Two to four researchers evaluated the quality of the included literature and extracted evidence from the literature that met the quality standards.Results:A total of 11 articles were included, including two guidelines, five evidence summaries, one recommended practice, and three systematic reviews. A total of 31 best pieces of evidence were summarized from eight aspects, including team work, personnel training, oral assessment, oral cleaning procedures, denture management, communication and behavior management, interventions for special oral problems, and health education.Conclusions:The oral health management of dementia patients has its particularity and the incidence of oral complications is high. It is necessary to strengthen the awareness and training of medical and nursing staff, pay attention to oral assessment, oral care, and communication skills, actively prevent and handle special oral problems, so as to improve the oral health of patients. In addition, it is recommended to evaluate patient cultural differences, clinical environment of the medical institution, patient willingness and so on before applying evidence in clinical practice, and then implement targeted evidence measures.

Objective:To perform FLASH irradiation experiments on cells and animals with carbon ion beams by updating the beam conditions and testing the performance of a clinical carbon ion therapy system.Methods:By using the vertical beam of the carbon ion therapy system and shortening the synchrotron beam extraction time to increase the current intensity, ultra-high dose rate beam could be achieved. Spreading the high current beam in the depth direction using a ridge filter and expanding it horizontally using point scanning technology could form the required field for cellular and animal experiments. The field flatness, penumbra, absorbed dose, average dose rate and other parameters were measured to verify whether the beam performance met the requirements.Results:The spread-out Bragg peak in the depth direction was consistent with the design, and the parameters such as field flatness and penumbra obtained by the measured lateral dose curve met the experimental requirements. After expansion, within a target volume of 20 mm×20 mm×10 mm, the absorbed dose in the field reaches 8 Gy, with the equivalent field dose rate of over 60 Gy/s and the maximum could reach 100 Gy/s. Within a target volume of 30 mm×30 mm×10 mm, the absorbed dose in the field is 4 Gy, and the equivalent filed dose rate of some energy in the field is greater than 40 Gy/s. In the experiment, the energy with a suitable dose rate can be selected for irradiation.Conclusion:After beam optimization, the carbon ion FLASH irradiation conditions for cytology and animal experiments can be realized on synchrotrons, and the beam performance parameters can meet the experimental requirements.

Objective:To analyze the factors affecting delayed chemotherapy in children with Burkitt lymphoma (BL) and their influence on prognosis.Methods:Retrospective cohort study. Clinical data of 591 children aged ≤18 years with BL from May 2017 to December 2022 in China Net Childhood Lymphoma (CNCL) was collected. The patients were treated according to the protocol CNCL-BL-2017. According to the clinical characteristics, therapeutic regimen was divided into group A, group B and group C .Based on whether the total chemotherapy time was delayed, patients were divided into two groups: the delayed chemotherapy group and the non-delayed chemotherapy group. Based on the total delayed time of chemotherapy, patients in group C were divided into non-delayed chemotherapy group, 1-7 days delayed group and more than 7 days delayed group. Relationships between delayed chemotherapy and gender, age, tumor lysis syndrome before chemotherapy, bone marrow involvement, disease group (B/C group), serum lactate dehydrogenase (LDH) > 4 times than normal, grade Ⅲ-Ⅳ myelosuppression after chemotherapy, minimal residual disease in the interim assessment, and severe infection (including severe pneumonia, sepsis, meningitis, chickenpox, etc.) were analyzed. Logistic analysis was used to identify the relevant factors. Kaplan-Meier method was used to analyze the patients' survival information. Log-Rank was used for comparison between groups.Results:Among 591 patients, 504 were males and 87 were females, the follow-up time was 34.8 (18.6,50.1) months. The 3-year overall survival (OS) rate was (92.5±1.1)%,and the 3-year event-free survival (EFS) rate was (90.5±1.2)%. Seventy-three (12.4%) patients were in delayed chemotherapy group and 518 (87.6%) patients were in non-delayed chemotherapy group. The reasons for chemotherapy delay included 72 cases (98.6%) of severe infection, 65 cases (89.0%) of bone marrow suppression, 35 cases (47.9%) of organ dysfunction, 22 cases (30.1%) of tumor lysis syndrome,etc. There were 7 cases of chemotherapy delay in group B, which were seen in COPADM (vincristine+cyclophosphamide+prednisone+daunorubicin+methotrexate+intrathecal injection,4 cases) and CYM (methotrexate+cytarabine+intrathecal injection,3 cases) stages. There were 66 cases of chemotherapy delay in group C, which were common in COPADM (28 cases) and CYVE 1 (low dose cytarabine+high dose cytarabine+etoposide+methotrexate, 12 cases) stages. Multinomial Logistic regression analysis showed that the age over 10 years old ( OR=0.54,95% CI 0.30-0.93), tumor lysis syndrome before chemotherapy ( OR=0.48,95% CI 0.27-0.84) and grade Ⅲ-Ⅳ myelosuppression after chemotherapy ( OR=0.55,95% CI 0.33-0.91)were independent risk factors for chemotherapy delay.The 3-year OS rate and the 3-year EFS rate of children with Burkitt lymphoma in the delayed chemotherapy group were lower than those in the non-delayed chemotherapy group ((79.4±4.9)% vs. (94.2±1.1)%, (80.2±4.8)% vs. (92.0±1.2)%,both P<0.05). The 3-year OS rate of the group C with chemotherapy delay >7 days (42 cases) was lower than that of the group with chemotherapy delay of 1-7 days (22 cases) and the non-delay group (399 cases) ((76.7±6.9)% vs. (81.8±8.2)% vs. (92.7±1.3)%, P=0.002).The 3-year OS rate of the chemotherapy delay group (9 cases) in the COP (vincristine+cyclophosphamide+prednisone) phase was lower than that of the non-chemotherapy delay group (454 cases) ((66.7±15.7)% vs. (91.3±1.4)%, P=0.005). Similarly, the 3-year OS rate of the chemotherapy delay group (11 cases) in the COPADM1 phase was lower than that of the non-chemotherapy delay group (452 cases) ((63.6±14.5)% vs. (91.5±1.3)%, P=0.001). Conclusions:The delayed chemotherapy was related to the age over 10 years old, tumor lysis syndrome before chemotherapy and grade Ⅲ-Ⅳ myelosuppression after chemotherapy in pediatric BL. There is a significant relationship between delayed chemotherapy and prognosis of BL in children.

Objective:To investigate the predictive value of plasma exosomal microRNA (miR)-124-3p in the risk of chronic cerebral hypoperfusion (CCH).Methods:A case-control study. Thirty patients who were diagnosed with CCH (CCH group) based on cranial artery spin labeling (ASL) in the neurology outpatient clinic of Sichuan Provincial People′s Hospital from March 2022 to June 2022 and 30 healthy volunteers (control group) were included. Age, gender, smoking history, alcohol consumption history, diabetes history, hypertension, hyperlipidemia history, uric acid, fasting blood glucose, homocysteine and plasma exosomal miR-124-3p expression level were compared between the two groups. Comparisons of categorical variables were analyzed by either χ2 test or Fisher′s exact test. If the data of continuous variables followed a normal distribution, they were expressed as mean±standard deviation (SD) and compared by t-test for two independent samples; otherwise, the data were expressed as M( Q1, Q3), and analyzed by Mann-Whitney U test for comparison between two groups. The correlation between cerebral blood flow and exosomal miR-124-3p levels was analyzed by Pearson′s correlation. Binary multifactorial logistic regression analysis was used to determine the risk factors associated with CCH, and corresponding odds ratios ( OR) and 95% confidence intervals ( CI) were calculated. P<0.05 was considered significant. Results:There was no significant difference in age (64±8 vs. 60±8 years old), gender (33.3% vs. 30.0%), history of smoking (20.0% vs. 3.3%), alcohol consumption (20.0% vs. 6.7%), diabetes mellitus (13.3% vs. 13.3%), hypertension (53.3% vs. 30.0%), history of hyperlipidemia (46.7% vs. 36.7%), uric acid (288±60 vs.319±67 μmol/L), and fasting glucose [4.99(4.63, 5.91) vs. 5.28(5.09, 6.05) mmol/L] and homocysteine [11.35(10.18, 13.08) vs.11.00(9.78, 13.03) μmol/L] between the CCH and control groups ( P>0.05). Plasma exosomal miR-124-3p expression was significantly higher in the CCH group than in the control group [13.08 (8.59, 21.55) vs. 2.85 (1.44, 5.10), respectively; U=169.50, P<0.001]. Pearson′s correlation test showed that the level of exosomal miR-124-3p was negatively correlated with cerebral blood flow in the hypoperfused region in patients with CCH ( r=-0.932, P<0.001). Multi-factor logistic regression analysis showed that plasma exosomal miR-124-3p was independently associated with the risk of CCH ( OR=1.169,95% CI 1.063-1.286, P=0.001). Conclusions:The expression of plasma exosomal miR-124-3p is negatively correlated with cerebral blood flow in areas of low perfusion and is an independent risk factor for CCH. Plasma exosomal miR-124-3p may thus serve as a valid biomarker for CCH risk prediction.

Objective To investigate the infection status and epidemiological characteristics of viral pathogens in hospitalized patients with severe acute respiratory infection (SARI) in Guangdong Province from 2019 to 2021, so as to provide reference for clinical diagnosis and prevention. Methods The respiratory tract samples of SARI patients collected from 2019 to 2021 were detected and analyzed for respiratory syncytial virus (RSV), adenovirus (ADV), human rhinovirus/enterovirus (HRV/EV), human metapneumonic virus (HMPV) and other common respiratory viruses using Luminex respiratory multi-pathogen detection technology. Results A total of 1 948 influenza-negative cases were collected, of which 24.28 % were positive detection of virus infection. HRV/EV was the highest (10.32%), followed by RSV (4.31%). The detection rates were statistically significantly different among different age groups (χ²=176.186，P<0.05), and the highest detection rate was found in the group aged at 0 to 4 years (41.50%). There was no statistically significant between the male virus detection rate and the female virus detection rate (χ²=0.042，P>0.05). The detection peaks of RSV were mainly concentrated in summer and autumn, while HMPV was prevalent in winter, and HRV/EV and ADV had no obvious seasonality. Mixed infection was found in 39 samples, and the mixed infection rate was 2.00%. In the mixed infection cases, HPIV and HRV/EV combined infection was the most common. Conclusion HRV/EV, RSV, HMPV and ADV are predominant viral pathogens in SARI influenza-negative hospitalized cases in Guangdong Province from 2019 to 2021. It is recommended to strengthen the surveillance of SARI cases in children under 5 years old.

OBJECTIVES: The aims of this study were to update the latest data on the prevalence of hypertension (HTN) in the elderly Chinese population and to assess relationships between new anthropometric indices and HTN. METHODS: Data were obtained from the Basic Public Health Service (BPHS) survey for Jiangsu Province, China. A total of 944,760 people aged 65 years and older were included in this study. Blood pressure was measured by trained investigators. Body weight, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), conicity index (COI), body roundness index (BRI), and a body shape index (ABSI) were included in the analysis as anthropometric indices. Logistic regression analysis and restricted cubic splines were used to evaluate the association of anthropometric indices with HTN. RESULTS: The prevalence of HTN among elderly residents of Jiangsu Province was 64.7% (95% confidence interval, 64.6 to 64.8). After adjusting for multiple covariates, all anthropometric indices except ABSI showed significant non-linear positive dose-response associations with HTN across sex (pnonlinear<0.001). Among participants with BMI <28 kg/m2, abnormal weight, WC, WtHR, BRI, COI, and ABSI were positively associated with HTN. CONCLUSIONS The prevalence of HTN in the elderly in Jiangsu Province is gradually increasing. It is necessary to consider the combination of ABSI and COI with BMI for screening elderly individuals for HTN in follow-up prospective studies.