Insulin is an important protein hormone that participates in multiple metabolic pathways.Biosynthetic insulin has been widely used in the treatment of type 1 and type 2 diabetes.Currently,the number of reported cases of insulin overdose both at home and abroad is gradually increasing,and insulin homicide is no longer a means of"committing murder without leaving a trace".At present,there are no systematic protocols for the identification of insulin overdose in the field of forensic medi-cine in China.This article introduces the causes,toxicological characteristics,forensic examination,labo-ratory testing methods and indicator reference of insulin overdose.Based on the identification practice and research results and referring to relevant studies on insulin overdose at home and abroad,this pa-per aims to provide recommendations and references for the formulation of forensic identification guide-lines for insulin overdose cases.

Wastewater-based epidemiology has emerged as a transformative surveillance tool for estimating substance consumption and monitoring disease prevalence, particularly during the COVID-19 pandemic. It enables the population-level monitoring of illicit drug use, pathogen prevalence, and environmental pollutant exposure. In this perspective, we summarize the key challenges specific to the Chinese context: (1) Sampling inconsistencies, necessitating standardized 24-hour composite protocols with high-frequency autosamplers (≤ 15 min/event) to improve the representativeness of samples; (2) Biomarker validation, requiring rigorous assessment of excretion profiles and in-sewer stability; (3) Analytical method disparities, demanding inter-laboratory proficiency testing and the development of automated pretreatment instruments; (4) Catchment population dynamics, reducing estimation uncertainties through mobile phone data, flow-based models, or hydrochemical parameters; and (5) Ethical and data management concerns, including privacy risks for small communities, mitigated through data de-identification and tiered reporting platforms. To address these challenges, we propose an integrated framework that features adaptive sampling networks, multi-scale wastewater sample banks, biomarker databases with multidimensional metadata, and intelligent data dashboards. In summary, wastewater-based epidemiology offers unparalleled scalability for equitable health surveillance and can improve the health of the entire population by providing timely and objective information to guide the development of targeted policies.
China/epidemiology* ; Humans ; Wastewater/analysis* ; COVID-19/epidemiology* ; Public Health ; Wastewater-Based Epidemiological Monitoring ; SARS-CoV-2

Objective:To outline and analyze the core elements of the coordinated development and governance of China's tripartite system,and to provide policy optimization recommendations to promote its coordinated development and governance.Method:Using grounded theory research methodology,this study constructs a path model for the coordinated development and governance of the tripartite system based on interview records from 28 participants.The process involves three levels of coding:open coding,axial coding,and selective coding.Results:The path of the coordinated development and governance of the tripartite system was summarized into 20 initial categories,8 main categories and 3 core categories(departmental coordination mechanism,construction of a service-oriented government,publicity and guidance),and then a theoretical model was formed with the long-term development of the coordinated development and governance of the tripartite system as the result and the protection of people's health as the ultimate goal.Conclusions:It is suggested to enhance the awareness of departmental coordination,consolidate the foundation of coordinated development and governance;try to change the thinking angle,and constantly improve the service awareness;strengthen public publicity and education,and attach importance to public opinion early warning and response.

Objective:To evaluate the outcomes of short-segment pedicle screw fixation after vertebroplasty augmentation using polymethylmethacrylate (PMMA) and laminectomy for stage Ⅲ Kümmell's disease with neurological symptoms.Methods:A retrospective study was conducted to analyze the clinical data of the 23 patients who had been treated at Department of Spinal Surgery, Beijing Jishuitan Hospital from January 2016 to August 2022 for single level stage Ⅲ Kümmell's disease with neurological symptoms by short-segment pedicle screw fixation after vertebroplasty augmentation using PMMA and laminectomy. There were 9 males and 14 females, with an age of (69.7±3.8) years. The visual analogue scale (VAS) for low back pain, Oswestry disability index (ODI) for low back pain, kyphotic Cobb angle of the fixed segment, and loss of the anterior vertebral body height were compared between preoperation, 2 weeks after operation, 2 years after operation, and the last follow-up. The improvements in American Spinal Injury Association (ASIA) impairment grading at the last follow-up compared to the preoperative levels, bone graft fusion rates at the last follow-up and complications were recorded.Results:All patients were followed up for (57.4±17.7) months after operation. The VAS pain scores [(2.2±0.3) points, (1.8±0.6) points and (1.6±0.5) points], ODIs (23.9%±4.5%, 21.6%±4.5% and 19.1%±3.8%), kyphotic Cobb angles of the fixed segments (12.2°±2.7°, 12.5°±2.6° and 12.8°±2.8°) and losses of the anterior vertebral body height (20.0%±3.4%, 20.2%±3.5% and 20.3%±3.5%) at 2 weeks after operation, 2 years after operation, and the last follow-up were significantly improved compared to the pre-operative values [(7.8±0.5) points, 79.7%±5.1%, 40.2°±6.2°, and 60.4%±14.2%, respectively] ( P<0.05). However, there were no significantly differences in the above values between 2 weeks after operation, 2 years after operation and the last follow-up ( P>0.05). Of the 2 patients with grade C, the ASIA grading at the last follow-up improved to grade D in one and to grade E in the other; of the 12 patients with grade D, the ASIA grading at the last follow-up improved to grade E in 11. The complications included 2 asymptomatic cases of bone cement leakage from the upper endplate of the affected vertebra, 1 asymptomatic case of bone cement leakage from the lower endplate of the affected vertebra, 1 asymptomatic case of bone cement leakage from the spinal canal, and 1 case of distant vertebral compression fracture. The last follow-up showed good bone graft fusion in all patients. Conclusion:In the treatment of stage Ⅲ Kümmell's disease with neurological symptoms, short-segment pedicle screw fixation after vertebroplasty augmentation using PMMA is a relatively minimally invasive, safe, and effective treatment, because it can alleviate back pain, improve neurological function and daily function, correct thoracolumbar kyphosis, restore vertebral height and reconstruct spinal stability without significant complications.

Osteoarthritis(OA)is a common joint disease in clinical practice,and cartilage damage is a typical pathological change.The pathogenesis of OA is complex,and various adverse factors can lead to the occurrence of OA.Mitochondria are im-portant organelles within cells and play important roles in cellular physiological and pathological activ-ities.Mitochondrial quality control is an important regulatory mechanism in the body to maintain nor-mal mitochondrial structure and function,mainly including mitochondrial biogenesis,mitochondrial dynamics,mitochondrial autophagy,mitochondrial oxidative stress,and other forms.The imbalance of mitochondrial quality control in chondrocytes is closely related to the occurrence and development of osteoarthritis,and regulating the balance of mi-tochondrial quality control is a potential therapeu-tic point for osteoarthritis.The author reviewed rel-evant research literature in recent years to provide a review of the relationship between mitochondrial quality control and the occurrence and develop-ment of osteoarthritis,in order to provide new ideas and directions for the research and diagnosis and treatment strategies of osteoarthritis.

AIM To study the chemical constituents from Vespa basalis(Smith)and their anti-inflammatory activity.METHODS Sephadex LH-20 gel and silica gel column chromatography were used for separation and purification,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The RAW264.7 cell model was utilized to assess its anti-inflammatory activity in vitro.RESULTS Eleven compounds were isolated and identified as pyrrole-2-carboxylic acid(1),3-indolecarboxylic acid(2),p-hydroxybenzoic acid(3),phenylacetic acid(4),5α,8α-epidioxy-cholest-6-en-3β-ol(5),(2R,3S)-2-(3′,4′-dihydroxyphenyl)-3-acetylamino-7-(N-acetyl-2″-aminethylene)-1,4-benzodioxane(6),(2R,3S)-2-(3′,4′-dihydroxyphenyl)-3-acetylamino-6-(N-acetyl-2″-aminoethyl)-1,4-benzodioxane(7),N-acetyldopamine(8),p-hydroxyphenylacetic acid(9),(R)-N-[2-(3,4-dihydroxyphenyl)-2-methoxyethyl]acetamide(10),(±)-cryptamide A(11).Compounds 3,5-6 and 10 inhibited the release of nitric oxide(NO)from RAW264.7 cell in a dose-dependent manner.CONCLUSION Compounds 1,2,and 5 are isolated from insects for the first time,while 6,7,10,and 11 are first isolated from the insects of Vespa genus.Compounds 3,5,6 and 10 have anti-inflammatory activity.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Objective:To develop a treatment-related quality of life scale for Chinese patients with multiple myeloma (MM) and to test its reliability and validity.Methods:The initial scale was constructed through a literature search, Delphi expert correspondence, and cognitive testing. This study conducted a preliminary survey of 379 patients with MM and a formal survey of 865 patients from the hematology departments of 155 hospitals nationwide from February 2024 to March 2024. The final scale was obtained after conducting item analysis and reliability and validity tests on the initial scale.Results:The constructed scale contains 36 items covering six domains: physiological, psychological, social, treatment side effects, general health, and others. In the preliminary survey, the Cronbach’s alpha coefficient of each item ranged from 0.597 to 0.939, and the test-retest reliability was 0.747 ( P<0.001). Exploratory factor analysis extracted eight common factors with a cumulative variance contribution of 60.058%. In the formal survey, the Cronbach’s alpha coefficient of each item ranged from 0.484 to 0.930, and the test-retest reliability was 0.835 ( P<0.001). Confirmatory factor analysis revealed a comparative fit index of 0.750, a root-mean-square error of approximation of 0.090, and a root-mean-square residual of 0.067. Conclusion:The treatment-related quality of life scale for Chinese patients with MM designed in this study exhibited good reliability and validity, reflecting the impact of treatment on the quality of life of patients. This scale can provide a reference to clinicians for assessing the disease status of patients.