Forensic medicine has been designated as a first-level discipline,presenting new opportunities and challenges for the development of forensic medicine.Since the 1980s,the establishment of foren-sic medicine discipline and the cultivation of high-level forensic talents have become hot topics in the development of forensic medicine in China.Since the 13th Five-Year Plan,the forensic team of Shanxi Medical University has been aiming at the forefront,proposing the development goals of"Five First-class"and the discipline development path"Six Major Achievements".It has selected benchmark disci-plines,identified gaps in disciplinary development,unified thoughts,formulated completion timelines,concentrated superior resources,assigned tasks to individuals,and created an"Organized Fill-in-the-Blank Format"forensic medicine discipline construction model with the characteristics of the new era.The construction model of forensic medicine has achieved good results in the goals,discipline frame-work,scientific research,talent cultivation,discipline team and platform construction,forming a rela-tively complete discipline construction and management system,and accumulating valuable experience for the construction of first-level discipline and high-level talent cultivation of forensic medicine.

Following the core outcome set standards for development(COS-STAD), this study aims to construct core outcome set(COS) for clinical research on traditional Chinese medicine(TCM) treatment of simple obesity. Firstly, a comprehensive review was conducted on the randomized controlled trial(RCT) and systematic review(SR) about TCM treatment of simple obesity that were published in Chinese and English databases to collect reported outcomes. Additional outcomes were obtained through semi-structured interviews with patients and open-ended questionnaire surveys for clinicians. All the collected outcomes were then merged and organized as an initial outcome pool, and then a preliminary list of outcomes was formed after discussion by the working group. Subsequently, two rounds of Delphi surveys were conducted with clinicians, methodology experts, and patients to score the importance of outcomes in the list. Finally, a consensus meeting was held to establish the COS for clinical research on TCM treatment of simple obesity. A total of 221 RCTs and 12 SRs were included, and after integration of supplementary outcomes, an initial outcome pool of 141 outcomes were formed. Following discussions in the steering advisory group meeting, a preliminary list of 33 outcomes was finalized, encompassing 9 domains. Through two rounds of Delphi surveys and a consensus meeting, the final COS for clinical research on TCM treatment of simple obesity was determined to include 8 outcomes: TCM symptom scores, body mass index(BMI), waist-hip ratio, waist circumference, visceral fat index, body fat rate, quality of life, and safety, which were classified into 4 domains: TCM-related outcomes, anthropometric measurements, quality of life, and safety. This study has preliminarily established a COS for clinical research on TCM treatment of simple obesity. It helps reduce the heterogeneity in the selection and reporting of outcomes in similar clinical studies, thereby improving the comparability of research results and the feasibility of meta-analysis and providing higher-level evidence support for clinical practice.
Humans ; Obesity/therapy* ; Medicine, Chinese Traditional ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Drugs, Chinese Herbal/therapeutic use*

Sishen Pills and its separated prescriptions are classic prescriptions of traditional Chinese medicine to treat intestinal diseases. In this study, a high-performance liquid chromatography-electrospray ionization tandem mass spectrometry(HPLC-ESI-MS/MS) technology was used to identify the components of Sishen Pills, Ershen Pills, and Wuweizi Powder. The positive and negative ion sources of electrospray ionization were simultaneously collected by mass spectrometry. A total of 11 effective components were detected in Sishen Pills, with four effective components detected in Ershen Pills and eight effective components detected in Wuweizi Powder, respectively. To explore the effects of Sishen Pills and its separated prescriptions on the human intestinal flora, an in vitro anaerobic fermentation model was established, and the human intestinal flora was incubated with Sishen Pills, Ershen Pills, and Wuweizi Powder in vitro. The 16S rDNA sequencing technology was used to analyze the changes in the intestinal flora. The results showed that compared with the control group, Sishen Pills, and its separated prescriptions could decrease the intestinal flora abundance and increase the Shannon index after fermentation. The abundance of Bifidobacterium was significantly increased in the Sishen Pills and Ershen Pills groups. However, the abundance of Lactobacillus, Weissella, and Pediococcus was significantly increased in the Wuweizi Powder group. After fermentation for 12 h, the pH of the fermentation solution of three kinds of liquids with feces gradually decreased and was lower than that of the control group. The decreasing amplitude in the Wuweizi Powder group was the most obvious. The single-bacteria fermentation experiments further confirmed that Sishen Pills and Wuweizi Powder had inhibitory effects on Escherichia coli, Staphylococcus aureus, and Enterococcus faecalis, and the antibacterial activity of Wuweizi Powder was stronger than that of Sishen Pills. Both Sishen Pills and Ershen Pills could promote the growth of Lactobacillus brevis, and Ershen Pills could promote the growth of Bifidobacterium adolescentis. This study provided a more sufficient theoretical basis for the clinical application of Sishen Pills and its separated prescriptions.
Humans ; Gastrointestinal Microbiome/drug effects* ; Drugs, Chinese Herbal/chemistry* ; Fermentation/drug effects* ; Bacteria/drug effects* ; Chromatography, High Pressure Liquid ; Tandem Mass Spectrometry ; Intestines/microbiology*

Purpose To investigate the incidence and risk of malignancy(ROM)of the Bethesda class Ⅰ/Ⅲ di-agnosis of thyroid nodules due to insufficient number of follicular cells,and to analyze the correlation between their in-sufficient cell volume and the characteristics of the nodules themselves from the perspective of ultrasound and histology.Methods Clinical data were collected from fine needle aspiration cytology(FNAC)of the thyroid gland.Review and statistical analysis was performed on cases with the Bethesda class Ⅰ/Ⅲ diagnosis due to insufficient cell volume.The incidence and the ROM of Bethesda class Ⅰ/Ⅲ diagnosis were calculated.BRAF V600E(+)or postoperative patho-logical indicating papillary thyroid carcinoma(PTC)was used as the criterion for malignancy.Then,we matched the Bethesda class Ⅱ/Ⅵ cases with sufficient cell volume as the control group.The ultrasound characteristics and histo-logical images of the two groups were compared and analyzed in order to reveal the correlation between the insufficient amount of penetrating cells and the objective characteristics of the nodule itself.Results There were 39 solid thyroid nodules with the Bethesda class Ⅰ diagnosis,with an incidence of 3.3％and a ROM of 38.5％,and 160 nodules with the Bethesda class Ⅲ diagnosis,with an incidence of 13.5％and a ROM of 59.4％.The incidence and ROM of nod-ules with C-TIRADS ≥4b(22.4％,67.6％)were higher than those of C-TIRADS ≤4a(12.7％,39.8％),and the differences were statistically significant(P＜0.001).Compared to the Bethesda class Ⅱ/Ⅵ nodules with sufficient cell volume,occurrence of the Bethesda class Ⅰ/Ⅲ nodules were significantly correlated with small nodules(maximal diameter＜5 mm),vertical growth(aspect ratio ≥ 1)and poor blood supply(no or little blood flow signals)(r=0.131,-0.230,0.237,P=0.008,＜0.001,＜0.001).They were also significantly correlated with the pathologic histologic structure of diffuse significant fibrosis of the interstitium and low parenchyma/interstitium composition ratio(about 1:1)(r=-0.269,-0.396,P=0.019,＜0.001).Conclusion Thyroid Bethesda class Ⅰ/Ⅲ nodules have a high ROM,and BRAF V600E detection is recommended as a tool of tiered management.Bethesda class Ⅰ/Ⅲ diagnosis of insufficient cell volume is more likely when the nodules are too small,grow vertically and lack blood sup-ply,presumably associated with extensive interstitial fibrosis and sparse parenchymal cells.

OBJECTIVE: To evaluate the dynamic changes of glucocorticoid (GC) dose and the feasibility of GC discontinuation in rheumatoid arthritis (RA) patients under the background of Chinese medicine (CM). METHODS: This multicenter retrospective cohort study included 1,196 RA patients enrolled in the China Rheumatoid Arthritis Registry of Patients with Chinese Medicine (CERTAIN) from September 1, 2019 to December 4, 2023, who initiated GC therapy. Participants were divided into the Western medicine (WM) and integrative medicine (IM, combination of CM and WM) groups based on medication regimen. Follow-up was performed at least every 3 months to assess dynamic changes in GC dose. Changes in GC dose were analyzed by generalized estimator equation, the probability of GC discontinuation was assessed using Kaplan-Meier curve, and predictors of GC discontinuation were analyzed by Cox regression. Patients with <12 months of follow-up were excluded for the sensitivity analysis. RESULTS: Among 1,196 patients (85.4% female; median age 56.4 years), 880 (73.6%) received IM. Over a median 12-month follow-up, 34.3% (410 cases) discontinued GC, with significantly higher rates in the IM group (40.8% vs. 16.1% in WM; P<0.05). GC dose declined progressively, with IM patients demonstrating faster reductions (median 3.75 mg vs. 5.00 mg in WM at 12 months; P<0.05). Multivariate Cox analysis identified age <60 years [P<0.001, hazard ratios (HR)=2.142, 95% confidence interval (CI): 1.523-3.012], IM therapy (P=0.001, HR=2.175, 95% CI: 1.369-3.456), baseline GC dose ⩽7.5 mg (P=0.003, HR=1.637, 95% CI: 1.177-2.275), and absence of non-steroidal anti-inflammatory drugs use (P=0.001, HR=2.546, 95% CI: 1.432-4.527) as significant predictors of GC discontinuation. Sensitivity analysis (545 cases) confirmed these findings. CONCLUSIONS RA patients receiving CM face difficulties in following guideline-recommended GC discontinuation protocols. IM can promote GC discontinuation and is a promising strategy to reduce GC dependency in RA management. (Trial registration: ClinicalTrials.gov, No. NCT05219214).
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Arthritis, Rheumatoid/drug therapy* ; Glucocorticoids/therapeutic use* ; Medicine, Chinese Traditional ; Retrospective Studies

Purpose To investigate the incidence and risk of malignancy(ROM)of the Bethesda class Ⅰ/Ⅲ di-agnosis of thyroid nodules due to insufficient number of follicular cells,and to analyze the correlation between their in-sufficient cell volume and the characteristics of the nodules themselves from the perspective of ultrasound and histology.Methods Clinical data were collected from fine needle aspiration cytology(FNAC)of the thyroid gland.Review and statistical analysis was performed on cases with the Bethesda class Ⅰ/Ⅲ diagnosis due to insufficient cell volume.The incidence and the ROM of Bethesda class Ⅰ/Ⅲ diagnosis were calculated.BRAF V600E(+)or postoperative patho-logical indicating papillary thyroid carcinoma(PTC)was used as the criterion for malignancy.Then,we matched the Bethesda class Ⅱ/Ⅵ cases with sufficient cell volume as the control group.The ultrasound characteristics and histo-logical images of the two groups were compared and analyzed in order to reveal the correlation between the insufficient amount of penetrating cells and the objective characteristics of the nodule itself.Results There were 39 solid thyroid nodules with the Bethesda class Ⅰ diagnosis,with an incidence of 3.3％and a ROM of 38.5％,and 160 nodules with the Bethesda class Ⅲ diagnosis,with an incidence of 13.5％and a ROM of 59.4％.The incidence and ROM of nod-ules with C-TIRADS ≥4b(22.4％,67.6％)were higher than those of C-TIRADS ≤4a(12.7％,39.8％),and the differences were statistically significant(P＜0.001).Compared to the Bethesda class Ⅱ/Ⅵ nodules with sufficient cell volume,occurrence of the Bethesda class Ⅰ/Ⅲ nodules were significantly correlated with small nodules(maximal diameter＜5 mm),vertical growth(aspect ratio ≥ 1)and poor blood supply(no or little blood flow signals)(r=0.131,-0.230,0.237,P=0.008,＜0.001,＜0.001).They were also significantly correlated with the pathologic histologic structure of diffuse significant fibrosis of the interstitium and low parenchyma/interstitium composition ratio(about 1:1)(r=-0.269,-0.396,P=0.019,＜0.001).Conclusion Thyroid Bethesda class Ⅰ/Ⅲ nodules have a high ROM,and BRAF V600E detection is recommended as a tool of tiered management.Bethesda class Ⅰ/Ⅲ diagnosis of insufficient cell volume is more likely when the nodules are too small,grow vertically and lack blood sup-ply,presumably associated with extensive interstitial fibrosis and sparse parenchymal cells.

Piperazines are a class of new psychoactive substances with hallucinogenic effects that af-fect the central nervous system by affecting the level of monoamine neurotransmitters.Abuse of pipera-zines will produce stimulating and hallucinogenic effects,accompanied by headache,dizziness,anxiety,insomnia,vomiting,chest pain,tachycardia,hypertension and other adverse reactions,and may even cause cardiovascular diseases and multiple organ failure and lead to death,seriously affecting human physical and mental health and public safety.The abuse of new psychoactive substance piperazines has attracted extensive attention from the international community.The study of its pharmacological toxi-cology and analytical methods has become a research hotspot in the field of forensic medicine.This paper reviews the in vivo processes,sample treatment and analytical methods of existing piperazines,in order to provide reference for forensic identification.

Objective:To detect the expression of autophagy-associated genes (ATGs) involved in the early stage of autophagy in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS) and analyze the results with clinical data. To explore the association between the early stage of autophagy and AS and the clinical significance of ATGs involved in the early stage of autophagy in assessing the disease and inflammatory status of AS.Methods:①Clinical data and peripheral blood samples of 90 patients with AS (AS group) who were admitted to the Rheumatology and Immunology Department of the Affiliated Hospital of North Sichuan Medical College from March 2021 to August 2022 were collected, including 32 patients in the active stage (ASA group) and 58 patients in the stable stage (ASS group). In addition, clinical data and peripheral blood samples of 30 patients who were treated with secuchiumab for 24 weeks were also collected. The clinical data and peripheral blood samples of 45 healthy control (HC group) who underwent physical examination at the Affiliated Hospital of Sichuan Northwest Medical University at the same time served as controls for clinical data and peripheral blood specimens were used as controls. RT-qPCR was used to detect the mRNA expression levels of 8 ATGs (ATG13, ATG14, ATG17, ATG18, ATG101, Beclin1, ULK1, mTOR) involved in the early stage of autophagy in all PBMCs of peripheral blood samples, and compared between different groups. Data that follows a normal distribution is tested using the t-test, while data that does not follow a normal distribution is tested using the Wilcoxon rank sum test. Correlation analysis is performed using Spearman's rank correlation coefficient.②Receiver operating curve (ROC) was used to evaluate the value of ATGs with differential expression between AS group and HC group in detecting AS disease.Results:①Compared with HC group, the level of ATG13, ATG14, ATG17, ATG18, ATG101 and Beclin1 mRNA in AS group were significantly lower than those in HC group[ATG3:3.52(1.95, 5.09)×10 -3, 7.21(5.49, 9.16)×10 -3, Z=-5.64, P<0.001; ATG14:2.48(1.85, 3.64)×10 -3, 6.16(4.27, 7.80)×10 -3, Z=-6.44, P<0.001; ATG17: 6.45(3.29, 9.48)×10 -3, 18.52(12.30, 22.51)×10 -3, Z=-6.18, P<0.001;ATG18:2.97(1.77, 4.37)×10 -3, 4.61(3.27, 5.59)×10 -3, Z=-3.88, P<0.001; ATG101: 2.07(1.11, 3.33)×10 -3, 3.65(2.41, 5.20)×10 -3, Z=-3.87, P<0.001; Beclin1: 3.50(0.63, 6.14)×10 -3, 4.17(2.82, 7.93)×10 -3, Z=-1.82, P=0.027]. ②Comparison between ASA and ASS groups: The levels of ATG17, ATG 101 and Beclin1 mRNA in ASA group were significantly lower than those in ASS group[ATG17: 4.61(2.75, 7.85)×10 -3, 6.86(3.85, 11.28)×10 -3, Z=-2.16, P=0.030; ATG101:0.93(0.40, 1.67)×10 -3, 2.15(1.17, 3.20)×10 -3, Z=-3.94, P=0.002; Beclin1: 1.24(0.52, 3.94)×10 -3, 3.86(1.55, 5.45)×10 -3, Z=-2.26, P=0.024]. ③Spearman correlation analysis showed that the mRNA expression levels of ATG13 and Beclin1 in AS were negatively correlated with ESR and hs-CRP, respectively ( r=-0.22, P=0.038; r=-0.30, P=0.006; r=-0.34, P=0.004; r=-0.241, P=0.037), ATG18 mRNA expression ESR was positively correlated ( r=0.22, P=0.041). ④ROC curve showed that ATG13, ATG14, and ATG17 had a good ability to predict AS, and their area under the curve (AUC) was 0.821, 0.866, and 0.851, respectively. The mRNA expression levels of ATG13, ATG14, and ATG18 in AS were significantly increased after 24 weeks of secuchiumab treatment[ATG13: 3.09(0.17, 4.48)×10 -3, 3.50(3.42, 3.57)×10 -3, Z=-3.45, P=0.001; ATG14: 2.49(1.43, 4.03)×10 -3, 5.62(2.28, 6.77)×10 -3, Z=-3.01, P=0.003; ATG18: 2.91(1.61, 4.37)×10 -3, 4.53(2.91, 5.73)×10 -3, Z=-3.34, P=0.001]. Conclusion:①The different expressions of ATG13, ATG14, ATG17, ATG18, ATG101, and Beclin1 between HC and AS suggest that these 6 genes may related to the pathogenesis of AS, among which Beclin1 and ATG13 are closely related to the levels of inflammatory indicators ESR and hs-CRP in patients. It may affect the inflammatory state in AS. ②IL-17Ai may be a potential regulator of autophagy, which can play a therapeutic role by affecting the early autophagy process in AS, but the specific mechanism needs to be further explored. ③ Genes related to the early stage of autophagy are expected to be biological indicators for monitoring the occurrence of AS.

As artificial intelligence technology rapidly advances, its deployment within the medical sector presents substantial ethical challenges. Consequently, it becomes crucial to create a standardized, transparent, and secure framework for processing medical data. This includes setting the ethical boundaries for medical artificial intelligence and safeguarding both patient rights and data integrity. This consensus governs every facet of medical data handling through artificial intelligence, encompassing data gathering, processing, storage, transmission, utilization, and sharing. Its purpose is to ensure the management of medical data adheres to ethical standards and legal requirements, while safeguarding patient privacy and data security. Concurrently, the principles of compliance with the law, patient privacy respect, patient interest protection, and safety and reliability are underscored. Key issues such as informed consent, data usage, intellectual property protection, conflict of interest, and benefit sharing are examined in depth. The enactment of this expert consensus is intended to foster the profound integration and sustainable advancement of artificial intelligence within the medical domain, while simultaneously ensuring that artificial intelligence adheres strictly to the relevant ethical norms and legal frameworks during the processing of medical data.
Artificial Intelligence/legislation & jurisprudence* ; Humans ; Consensus ; Computer Security/standards* ; Confidentiality/ethics* ; Informed Consent/ethics*

Objective:To detect the expression of autophagy-associated genes (ATGs) involved in the early stage of autophagy in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS) and analyze the results with clinical data. To explore the association between the early stage of autophagy and AS and the clinical significance of ATGs involved in the early stage of autophagy in assessing the disease and inflammatory status of AS.Methods:①Clinical data and peripheral blood samples of 90 patients with AS (AS group) who were admitted to the Rheumatology and Immunology Department of the Affiliated Hospital of North Sichuan Medical College from March 2021 to August 2022 were collected, including 32 patients in the active stage (ASA group) and 58 patients in the stable stage (ASS group). In addition, clinical data and peripheral blood samples of 30 patients who were treated with secuchiumab for 24 weeks were also collected. The clinical data and peripheral blood samples of 45 healthy control (HC group) who underwent physical examination at the Affiliated Hospital of Sichuan Northwest Medical University at the same time served as controls for clinical data and peripheral blood specimens were used as controls. RT-qPCR was used to detect the mRNA expression levels of 8 ATGs (ATG13, ATG14, ATG17, ATG18, ATG101, Beclin1, ULK1, mTOR) involved in the early stage of autophagy in all PBMCs of peripheral blood samples, and compared between different groups. Data that follows a normal distribution is tested using the t-test, while data that does not follow a normal distribution is tested using the Wilcoxon rank sum test. Correlation analysis is performed using Spearman's rank correlation coefficient.②Receiver operating curve (ROC) was used to evaluate the value of ATGs with differential expression between AS group and HC group in detecting AS disease.Results:①Compared with HC group, the level of ATG13, ATG14, ATG17, ATG18, ATG101 and Beclin1 mRNA in AS group were significantly lower than those in HC group[ATG3:3.52(1.95, 5.09)×10 -3, 7.21(5.49, 9.16)×10 -3, Z=-5.64, P<0.001; ATG14:2.48(1.85, 3.64)×10 -3, 6.16(4.27, 7.80)×10 -3, Z=-6.44, P<0.001; ATG17: 6.45(3.29, 9.48)×10 -3, 18.52(12.30, 22.51)×10 -3, Z=-6.18, P<0.001;ATG18:2.97(1.77, 4.37)×10 -3, 4.61(3.27, 5.59)×10 -3, Z=-3.88, P<0.001; ATG101: 2.07(1.11, 3.33)×10 -3, 3.65(2.41, 5.20)×10 -3, Z=-3.87, P<0.001; Beclin1: 3.50(0.63, 6.14)×10 -3, 4.17(2.82, 7.93)×10 -3, Z=-1.82, P=0.027]. ②Comparison between ASA and ASS groups: The levels of ATG17, ATG 101 and Beclin1 mRNA in ASA group were significantly lower than those in ASS group[ATG17: 4.61(2.75, 7.85)×10 -3, 6.86(3.85, 11.28)×10 -3, Z=-2.16, P=0.030; ATG101:0.93(0.40, 1.67)×10 -3, 2.15(1.17, 3.20)×10 -3, Z=-3.94, P=0.002; Beclin1: 1.24(0.52, 3.94)×10 -3, 3.86(1.55, 5.45)×10 -3, Z=-2.26, P=0.024]. ③Spearman correlation analysis showed that the mRNA expression levels of ATG13 and Beclin1 in AS were negatively correlated with ESR and hs-CRP, respectively ( r=-0.22, P=0.038; r=-0.30, P=0.006; r=-0.34, P=0.004; r=-0.241, P=0.037), ATG18 mRNA expression ESR was positively correlated ( r=0.22, P=0.041). ④ROC curve showed that ATG13, ATG14, and ATG17 had a good ability to predict AS, and their area under the curve (AUC) was 0.821, 0.866, and 0.851, respectively. The mRNA expression levels of ATG13, ATG14, and ATG18 in AS were significantly increased after 24 weeks of secuchiumab treatment[ATG13: 3.09(0.17, 4.48)×10 -3, 3.50(3.42, 3.57)×10 -3, Z=-3.45, P=0.001; ATG14: 2.49(1.43, 4.03)×10 -3, 5.62(2.28, 6.77)×10 -3, Z=-3.01, P=0.003; ATG18: 2.91(1.61, 4.37)×10 -3, 4.53(2.91, 5.73)×10 -3, Z=-3.34, P=0.001]. Conclusion:①The different expressions of ATG13, ATG14, ATG17, ATG18, ATG101, and Beclin1 between HC and AS suggest that these 6 genes may related to the pathogenesis of AS, among which Beclin1 and ATG13 are closely related to the levels of inflammatory indicators ESR and hs-CRP in patients. It may affect the inflammatory state in AS. ②IL-17Ai may be a potential regulator of autophagy, which can play a therapeutic role by affecting the early autophagy process in AS, but the specific mechanism needs to be further explored. ③ Genes related to the early stage of autophagy are expected to be biological indicators for monitoring the occurrence of AS.