The accuracy of medical imaging diagnosis will directly impact the clinical forensic evaluation's scientific validity and objectivity.This study systematically analyzed the primary causes of misdiagnosis and missed diagnosis in imaging examinations,focusing on representative cases,including rib fractures,traumatic subarachnoid hemorrhage,joint injuries with ligament damage,nasal fractures,congenital skeletal variations,and epiphyseal injuries.Key contributing factors encompassed limitation of imaging technologies,the insufficient interpretive experience of examiners,the complexity of injury mechanisms,and inadequate post-traumatic dynamic imaging follow-up.To address these issues,improvement strategies are proposed,which were establishing standardized imaging review protocols,implementing multimodal imaging approaches,rigorous evaluation of original imaging data,and enhancing professional knowledge regarding anatomical variations and injury differentiation.These measures aim to elevate the quality of forensic imaging diagnosis,providing more precise and reliable strategies for forensic clinical identifications.

This study was aimed at establishing a method of ultra-fast quantitative PCR for Brucella detection.We used an exogenous recombinant plasmid as the internal reference and targeted the T4SS secretion system,an important Brucella viru-lence factor,to design specific primers and probes.The sensitivity,specificity,and repeatability of this method were evaluated,and a standard curve was constructed.The coincidence rate of detection findings with this method versus quantitative PCR was determined.This method markedly decreased the detection time to only 10 minutes.The standard curve demonstrated a good linear relationship(Y=-3.410 7x+38.357,R2=0.998 5)with a low minimum detection limit of 10 copies/μL.The method exhibited good specificity and did not specifically amplify several common clinical bacteria other than Brucella.The de-tection of three concentrations of positive plasmids yielded coefficients of variation(CVs)of 0.20％to 0.91％,thus demonstra-ting the method's excellent repeatability.Furthermore,140 clinical samples were analyzed concurrently with the fluorescence PCR method,which yielded a 100％compliance rate and consistent results.Our findings indicated that the Brucella ultra-fast quantitative PCR was ultrafast;had high sensitivity,high specificity,and good specificity;and can be used for the clinical de-tection of Brucella and emergency investigation of epidemics.Therefore,this method is valuable for the early diagnosis of Bru-cella.

Objective:Explore the effect of modified position on correction of breech presentation and the ma-ternal and infant outcomes in primiparas at 30-34 weeks of gestation in the midwifery clinic.Methods:From Jan-uary to December2024,274 primiparas at30-34 weeks of gestation who visited the midwifery clinic of The Gener-al Hospital of Northern Theater Command were selected.They were randomly divided into two groups according to the coin-tossing method.Through the inclusion exclusion,and elimination criteria,the selected pregnant women were finally categorized into the knee-chest position group(control group,n=126)and the modified position group(observation group,n=140).The success rate of breech presentation correction,delivery mode,duration of labor,1-minute and 5-minute Apgar scores of vaginally delivered infants,umbilical artery blood gas,postpartum re-covery,and postpartum depression incidence were compared between the two groups.Results:The success rate of breech presentation correction in the observation group was significantly higher than that in the control group(77.9%vs 58.7%,P<0.05).After breech presentation correction,the vaginal delivery rate was higher in the ob-servation group than in the control group(80.7%vs 66.2%,P<0.05).Among women who achieved vaginal de-livery,the intrapartum complication rate was significantly lower in the observation group than in the control group(22.7%vs.46.9%,P<0.05).The duration of the first stage of labor(557.7±195.5 min vs.629.6±208.2 min)and the second stage of labor(67.7±11.4 min vs.79.6±10.3 min)was significantly shorter in the observation group than in the control group(P<0.05).The pH of umbilical artery blood gas of newborns in the observation group delivered vaginally was significantly higher than that in the control group(7.367±0.028 vs.7.322±0.027,P<0.05).There were no statistically significant differences in the1-minute and5-minute Apgar scores of vaginally delivered infants,base excess,and lactate between the two groups(P>0.05).The initial time of lactation(21.7±4.4 h vs.23.5±4.1 h),time to ambulation(8.2±1.2 d vs.9.2±1.4 d),time for lochia to subside(29.6±4.8 d vs.34.1±4.8 d),and postpartum hemorrhage(298.1±56.1 ml vs.362.9±42.6 ml)in the observation group were significantly lower than those in the control group(P<0.05).There were no statistically significant differ-ences in the depression scores(EPDS)at 1 week and 6 weeks postpartum between the two groups of women with vaginal delivery(P>0.05).Conclusions:The modified position in the midwifery clinic significantly improves the success rate of breech presentation correction for primiparas at 30-34 weeks of gestation,good maternal and infant outcomes,and could be widely applied in clinical practice.

Objective:To investigate the current status of clinical nurses' knowledge, attitudes, and practices (KAP) regarding geriatric frailty syndrome in a general hospital and to analyze the influencing factors.Methods:Using convenience sampling, 319 clinical nurses from the First Affiliated Hospital of Wenzhou Medical University, were recruited between May and September 2024. A KAP questionnaire on geriatric frailty syndrome was developed through literature review and the Delphi method. Data were collected with a demographic questionnaire and the KAP questionnaire. Multiple linear regression was performed to identify factors influencing KAP levels.Results:The finalized KAP questionnaire consisted of three dimensions and 27 items. Cronbach's α coefficients for the total scale and the knowledge, attitudes, and practices subscales were 0.974, 0.981, 0.974, and 0.967, respectively. The overall KAP score among 319 nurses was (96.65±20.83). The average scores for each dimension were (4.08±0.82) for attitudes, (3.84±0.84) for practices, and (3.12±1.00) for knowledge. Multiple linear regression indicated that age and positions were respective significantly influenced the total KAP score and attitudes score ( P<0.05) ; frailty-related training was also a significant factor for KAP score and dimension scores ( P<0.05) . Conclusions:Clinical nurses demonstrated a moderate overall KAP level regarding geriatric frailty syndrome, with relatively high attitudes but insufficient professional knowledge. Hospital managers should provide effective education and training for frontline nurses to improve KAP levels and to promote early identification, assessment, and intervention of geriatric frailty.

Objective To explore the clinical,radiological,and arthroscopic outcomes of anterior cru-ciate ligament(ACL)reconstruction combined with posterior tibial slope(PTS)reducing osteotomy in patients with increased PTS and excessive anterior tibial subluxation(ATS)due to primary ACL inju-ry.Methods This retrospective study included patients who underwent ACL reconstruction between 2016 and 2022 in our department.The inclusion criteria were PTS≥15° and ATS≥6 mm,and all pa-tients received ACL reconstruction combined with PTS reducing osteotomy with a follow-up of more than 2 years.Before and after the operation,they were assessed KT-1000 side-to-side difference(KT SSD),pivot shift grade,Lachman test,anterior tibial subluxation of the medial and lateral compart-ments(ASMC and ASLC),magnetic resonance imaging(MRI),and arthroscopic findings of associat-ed injuries.Moreover,graft laxity was defined as graft laxity observed on MRI or arthroscopy,KT SSD>3 mm,or pivot>1+,while graft failure was defined as graft rupture on MRI or arthroscopy,KT SSD>5 mm,or pivot>2+.Meanwhile,clinical outcomes were compared preoperatively and post-operatively,and graft status and associated injuries were described.Results A total of 30 patients were included,with an average age of 31 years,and 23%of female.The inter-observer reliability for mea-surements of PTS and ATS was greater than 0.80.Compared to preoperative values,postoperative PTS(18.2° vs.6.8°,P<0.001),KT SSD(7.8 mm vs.1.2 mm,P<0.001),ASLC(7.5 mm vs.4.5 mm,P=0.002),and ASMC(5.0 mm vs.2.7 mm,P=0.034),all showed significant improvements.In addi-tion,the proportion of patients with postoperative pivot grade of 2+to 3+(73.3%vs.6.7%,P<0.001)and Lachman grades Ⅱ-Ⅲ(70%vs.3.3%,P<0.001)reduced significantly.At the last follow-up,the incidence of graft laxity was 20%,and that of the graft failure was 13.3%.Among all pa-tients,1 patient(3.3%)had graft roof impingement or cyclops lesion,and 3(10%)suffered from concomitant cartilage injury,with 4(13.3%)undergoing intercondylar notchplasty due to intercondylar notch hyperplasia.However,no complications related to osteotomy,such as infection,non-union,or fixation failure,were observed.Conclusion Over a follow-up period of at least 2 years,for primary ACL injury patients with steep PTS and excessive ATS,combined ACL reconstruction with PTS reduc-ing osteotomy improves knee stability,but significantly reduces PTS,the incidence of severe pivot grade,anterior tibial subluxation in both medial and lateral compartments,and delays the occurrence of graft laxity and failure.

Objective:To investigate the dynamic characteristics of human papillomavirus (HPV) genomic integration during cervical lesion progression and the clinical value of HPV integration detection in stratify HPV-positive women, and to explore its molecular mechanisms in cervical carcinogenesis.Methods:A prospective cohort study was designed to enroll high-risk HPV (HR-HPV) positive women who underwent cervical cancer screening in Drum Tower Hospital Affiliated to Nanjing University Medical School and Nanjing Maternity and Child Health Care Hospital from July 2022 to July 2024. Cervical exfoliated cells samples were collected, and HPV whole genome targeted capture and high-throughput sequencing technology were used. The HPV integration patterns, host gene functional region distribution and pathway enrichment characteristics of 157 samples with different cervical lesions grades were analyzed, including 31 cases of normal cervix, 40 cases of cervical intraepithelial neoplasia (CIN) Ⅰ, 32 cases of CIN Ⅱ, 42 cases of CIN Ⅲ, and 12 cases of cervical cancer.Results:HR-HPV integration was detected in 80.2% (126/157) of the 157 HR-HPV positive samples. The incidence of HR-HPV integration in cervical cancer patients was 12/12, which was higher than that in normal women (77%, 24/31). The incidence of HPV16 integration was significantly higher in high-grade lesions, and the incidence of HPV16 integration was 43% (18/42) in CIN Ⅲ patients and 8/12 in cervical cancer patients ( P<0.001). A total of 14 438 integration events were detected in 126 samples with HPV integration. The integration sites were mainly distributed in the host intergenic region (51.0%, 7 359/14 438) and intronic region (38.1%, 5 494/14 438), and the integration frequency of viral L1 gene was the highest (28.4%, 4 498/16 781). Functional enrichment analysis showed that HPV integration-related host genes were significantly enriched in transport of small molecules,cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG) signaling pathway, and purine ribonucleotide biosynthetic process, which synergistically drove carcinogenesis through multiple mechanisms. Conclusions:HPV integration events are significantly associated with the progression of cervical lesions. HPV integrated detection based on cervical exfoliated cells is expected to optimize the current screening strategy, reduce excessive intervention of HPV positive women and facilitate their accurate triage management.

Objective To establish an expert consensus on in-hospital transfer safety management for patients undergoing invasive mechanical ventilation,providing guidance for clinical medical teams to conduct standardized transfers,reduce transfer risks,and ensure patient safety.Methods Through systematic searching,screening,evaluation,and summary of evidence related to in-hospital transfer safety management for patients on invasive mechanical ventilation,we extracted recommendations to form a preliminary draft of the expert consensus.From July to October 2024,totally 2 rounds of expert consultations,and 2 rounds of expert reviews were conducted,and the content was refined and finalized based on expert feedback.Results The final consensus encompasses 9 aspects,including transfer assessment and decision-making,pre-transfer preparation of medical staff,pre-transfer patient preparation,pre-transfer equipment preparation,pre-transfer medication preparation,monitoring and intervention during transfer,emergency events and management,transfer handover and documentation,and post-transfer management.Conclusion This consensus demonstrates strong practicality and operability,offering professional guidance for enhancing the safety of in-hospital transfers for patients on invasive mechanical ventilation.

In proton therapy,prompt gamma-ray imaging is considered as one of the most promising methods for assessing proton beam range.Prompt gamma-ray imaging detector evaluates the proton beam range based on the prompt gamma-ray distribution obtained by the prompt gamma-ray imaging system,which enables high-precision measurement of the proton beam range.Herein a proton beam range verification algorithm is designed for the newly developed prototype of the range verification detector(pixelated prompt gamma-ray imaging detector),which verifies the range estimation accuracy of the prototype for different phantoms and different energies of homogeneous media through Monte Carlo simulation.The results show that the accuracy of the proton beam range verification algorithm is within 0.5 mm of the safety margin error of the Bragg peak,and the measurement accuracy is significantly improved with the increase of the number of protons,indicating that the prototype algorithm is feasible for proton beam range verification.

Objective To explore the association between knee torsion and multiple bony abnormali-ties of the lower limb in patients with recurrent patellar dislocation(RPD).Methods The preoperative imaging data of RPD patients treated in our institution between May 2020 and October 2024 were col-lected retrospectively.A total of 238 patients were included in this study,with 83.6%being females.All patients underwent standard hip-knee-ankle CT scans,and lower limb bony structural parameters were reconstructed and measured using Mimics 20.0,focusing on variables such as knee torsion,femo-ral anteversion(FAA),femoral distal torsion angle(DFTA),supratrochlear spur,tibial tuberosity to trochlear groove distance(TT-TG),Caton-Deschamps index,and tibial torsion.Bony abnormalities were categorized based on previously established risk thresholds.Moreover,chi-square tests were em-ployed to compare the composition ratio differences between knee torsion and multiple lower limb osse-ous abnormalities.Results Among all affected knees,the proportion of excessive knee torsion was 33.6%,while in cases with osseous abnormalities,the value was over 40%.Compared with cases of low knee torsion,patients with excessive knee torsion showed significantly higher proportions of FAA(41.3%vs.27.2%,P=0.028),excessive DFTA(60%vs.32.9%,P<0.001),supratrochlear spur(55%vs.38.6%,P=0.016),trochlear dysplasia(93.8%vs.73.4%,P<0.001),excessive TT-TG(68.8%vs.43.7%,P<0.001),and patella alta(50%vs.22.2%,P<0.001).Additionally,95%of knees with excessive torsion exhibited two or more bony risk factors,whereas 55%had four or more bony structural abnormalities,which was significantly higher than those of low knee torsion(55%vs.21.5%,P<0.001).Conclusion In RPD patients,excessive knee torsion is associated with multiple low-er limb bony abnormalities.Moreover,patients with high knee torsion(>12°)are significantly more likely to have multiple bony abnormalities than those with low torsion.Therefore,in surgical decision-making for such patients,lower limb bony abnormalities should be assessed comprehensively.

Objective:Explore the effect of modified position on correction of breech presentation and the ma-ternal and infant outcomes in primiparas at 30-34 weeks of gestation in the midwifery clinic.Methods:From Jan-uary to December2024,274 primiparas at30-34 weeks of gestation who visited the midwifery clinic of The Gener-al Hospital of Northern Theater Command were selected.They were randomly divided into two groups according to the coin-tossing method.Through the inclusion exclusion,and elimination criteria,the selected pregnant women were finally categorized into the knee-chest position group(control group,n=126)and the modified position group(observation group,n=140).The success rate of breech presentation correction,delivery mode,duration of labor,1-minute and 5-minute Apgar scores of vaginally delivered infants,umbilical artery blood gas,postpartum re-covery,and postpartum depression incidence were compared between the two groups.Results:The success rate of breech presentation correction in the observation group was significantly higher than that in the control group(77.9%vs 58.7%,P<0.05).After breech presentation correction,the vaginal delivery rate was higher in the ob-servation group than in the control group(80.7%vs 66.2%,P<0.05).Among women who achieved vaginal de-livery,the intrapartum complication rate was significantly lower in the observation group than in the control group(22.7%vs.46.9%,P<0.05).The duration of the first stage of labor(557.7±195.5 min vs.629.6±208.2 min)and the second stage of labor(67.7±11.4 min vs.79.6±10.3 min)was significantly shorter in the observation group than in the control group(P<0.05).The pH of umbilical artery blood gas of newborns in the observation group delivered vaginally was significantly higher than that in the control group(7.367±0.028 vs.7.322±0.027,P<0.05).There were no statistically significant differences in the1-minute and5-minute Apgar scores of vaginally delivered infants,base excess,and lactate between the two groups(P>0.05).The initial time of lactation(21.7±4.4 h vs.23.5±4.1 h),time to ambulation(8.2±1.2 d vs.9.2±1.4 d),time for lochia to subside(29.6±4.8 d vs.34.1±4.8 d),and postpartum hemorrhage(298.1±56.1 ml vs.362.9±42.6 ml)in the observation group were significantly lower than those in the control group(P<0.05).There were no statistically significant differ-ences in the depression scores(EPDS)at 1 week and 6 weeks postpartum between the two groups of women with vaginal delivery(P>0.05).Conclusions:The modified position in the midwifery clinic significantly improves the success rate of breech presentation correction for primiparas at 30-34 weeks of gestation,good maternal and infant outcomes,and could be widely applied in clinical practice.