Objective To explore the characteristics of incorrect opinions in re-examination cases,analyze the reasons,characteristics,and commonalities of different forensic opinions in the same injury case during re-examination,and provide references for similar case acceptance,forensic procedures,analysis and argumentation,and the application of relevant provisions.Methods A retrospective analysis was conducted on the re-examination cases of human injury degree accepted by the Forensic Judicial Appraisal Center of Guizhou Medical University and West China Forensic Medical Appraisal Center of Sichuan University from January 2020 to December 2024.Results Among the 81 collected re-examination cases of human injury degree,the injury types mainly included fractures,soft tissue injuries,tendon injuries,craniocerebral injuries,nerve injuries,joint injuries,and organ injuries.Of these,74 cases were entrusted by the public security system,and 72 cases used primary injuries as the basis for assessment.Seven cases had more than 3 appraisals and 74 cases had two appraisals,of which 53 cases had inconsistent opinions between the previous and current appraisals,including 29 cases with an upgraded injury grade and 24 cases with a downgraded injury grade.Conclusion When accepting re-examination cases,forensic experts need to choose relevant objective examination techniques in forensic clinical medicine,such as clinical imaging techniques,to determine whether imaging data serves as key evidence in the case,and seek assistance from experts in related fields when necessary.In the case acceptance stage,it is necessary to collect and review key assessment materials such as medical records,the first assessment opinion,and interrogation records.Forensic experts should also enhance their understanding of legal provisions,timing of assessment,their image-reading ability,and work to standardize the forensic assessment process.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.

Objective:To explore the feasibility of transvaginal core needle biopsy for pelvic masses under finger guidance during a vagino-recto-abdominal examination.Methods:The clinicopathological data and follow-up information of 29 patients with pelvic masses who underwent transvaginal core needle biopsy under finger guidance during a vagino-recto-abdominal examination at Affiliated Hospital of Southwest Medical University from January 2020 to July 2024 were collected, and the safety and diagnostic accuracy of the procedure were retrospectively analyzed.Results:(1) A total of 29 patients with pelvic masses were enrolled in this study, with a median age of 50 years (range: 29-73 years), and a median tumor diameter of 3.9 cm (range: 2.7-13.3 cm). Among these patients, 7 were newly diagnosed, and 22 were follow-up. The pre-procedure disease types included 21 patients (72%, 21/29) cervical cancer, 6 patients (21%, 6/29) epithelial ovarian cancer, and 2 patients (7%, 2/29) other suspected gynecologic tumors. (2) Among 29 patients with pelvic masses, 8 cases (28%, 8/29) were diagnosed with benign diseases according to core needle biopsy pathological findings, and 1 case suggested possible residual cervical cancer in the parametrial region by contrast-enhanced magnetic resonance imaging after radical chemoradiotherapy 3 months, while the result of core needle biopsy for this patient was negative, with follow-up after 1 year revealed progression of the lesion in the right parametrial area. Another patient underwent fine-needle aspiration cytology, which suggested gastrointestinal stromal tumor, requiring differentiation from endometriosis, and core needle biopsy pathology confirmed endometriosis, with follow-up at 6 months revealed no evidence of malignancy in this patient. The remaining 6 patients with benign diagnoses had follow-up periods exceeding 1 year without imaging or clinical evidence of local lesion progression or malignancy. Among the 21 patients (72%, 21/29) diagnosed with malignant tumors by core needle biopsy, 14 cases were suspected cases of residual or recurrent cervical cancer, 6 cases had advanced ovarian cancer, and 1 case had rectal cancer metastasis, with all biopsy diagnoses being consistent with preoperative clinical findings and imaging results. The overall diagnostic accuracy of the core needle biopsy was 97% (28/29). Among the 7 newly diagnosed patients, the diagnostic accuracy was 7/7, while it was 95% (21/22) for the 22 follow-up patients, with no statistically significant difference observed between the two groups ( P=1.000). (3) All 29 patients with pelvic masses successfully underwent transvaginal core needle biopsy guided by vagino-recto-abdominal examination. Among them, 28 cases (97%, 28/29) reported tolerable pain during the procedure, while 1 case (3%, 1/29) experienced transient syncope at the end of the procedure due to pain, which resolved within seconds. Vaginal bleeding exceeding 50 ml occurred in 3 patients (10%, 3/29) during paracervical tissue sampling, with the maximum blood loss being 150 ml, and hemorrhage was successfully controlled using vaginal tamponade. The overall incidence of adverse events during the core needle biopsy procedure was 14% (4/29). Conclusion:Transvaginal core needle biopsy for pelvic masses guided by vagino-recto-abdominal examination is a simple, safe, and accurate diagnostic method, suitable for patients with gynecologic malignancies, non-gynecologic malignancies suspected of pelvic mass metastasis, and other benign pelvic lesions.

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 investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Central memory T (Tcm) cells are a crucial subset in T cell development, playing an important role in long-term immune responses. Tcm cells exhibit strong proliferative capacity, long-term survival characteristics, and re-activation potential, enabling them to rapidly differentiate into effector T cells (Teff) upon antigen re-exposure, thus providing robust immune protection. The function of Tcm cells is regulated by various factors, including antigen exposure, cytokines, and metabolic conditions. A deeper understanding of their metabolic and epigenetic mechanisms under different pathological conditions will contribute to the development of more precise and effective immunotherapeutic strategies. This review elaborates on the origin and characteristics of Tcm cells, as well as their roles in antiviral responses, tumor immunity, and immunotherapy.
Humans ; Memory T Cells/cytology* ; Animals ; Immunologic Memory ; Neoplasms/therapy* ; Immunotherapy

Objective:To explore the feasibility of transvaginal core needle biopsy for pelvic masses under finger guidance during a vagino-recto-abdominal examination.Methods:The clinicopathological data and follow-up information of 29 patients with pelvic masses who underwent transvaginal core needle biopsy under finger guidance during a vagino-recto-abdominal examination at Affiliated Hospital of Southwest Medical University from January 2020 to July 2024 were collected, and the safety and diagnostic accuracy of the procedure were retrospectively analyzed.Results:(1) A total of 29 patients with pelvic masses were enrolled in this study, with a median age of 50 years (range: 29-73 years), and a median tumor diameter of 3.9 cm (range: 2.7-13.3 cm). Among these patients, 7 were newly diagnosed, and 22 were follow-up. The pre-procedure disease types included 21 patients (72%, 21/29) cervical cancer, 6 patients (21%, 6/29) epithelial ovarian cancer, and 2 patients (7%, 2/29) other suspected gynecologic tumors. (2) Among 29 patients with pelvic masses, 8 cases (28%, 8/29) were diagnosed with benign diseases according to core needle biopsy pathological findings, and 1 case suggested possible residual cervical cancer in the parametrial region by contrast-enhanced magnetic resonance imaging after radical chemoradiotherapy 3 months, while the result of core needle biopsy for this patient was negative, with follow-up after 1 year revealed progression of the lesion in the right parametrial area. Another patient underwent fine-needle aspiration cytology, which suggested gastrointestinal stromal tumor, requiring differentiation from endometriosis, and core needle biopsy pathology confirmed endometriosis, with follow-up at 6 months revealed no evidence of malignancy in this patient. The remaining 6 patients with benign diagnoses had follow-up periods exceeding 1 year without imaging or clinical evidence of local lesion progression or malignancy. Among the 21 patients (72%, 21/29) diagnosed with malignant tumors by core needle biopsy, 14 cases were suspected cases of residual or recurrent cervical cancer, 6 cases had advanced ovarian cancer, and 1 case had rectal cancer metastasis, with all biopsy diagnoses being consistent with preoperative clinical findings and imaging results. The overall diagnostic accuracy of the core needle biopsy was 97% (28/29). Among the 7 newly diagnosed patients, the diagnostic accuracy was 7/7, while it was 95% (21/22) for the 22 follow-up patients, with no statistically significant difference observed between the two groups ( P=1.000). (3) All 29 patients with pelvic masses successfully underwent transvaginal core needle biopsy guided by vagino-recto-abdominal examination. Among them, 28 cases (97%, 28/29) reported tolerable pain during the procedure, while 1 case (3%, 1/29) experienced transient syncope at the end of the procedure due to pain, which resolved within seconds. Vaginal bleeding exceeding 50 ml occurred in 3 patients (10%, 3/29) during paracervical tissue sampling, with the maximum blood loss being 150 ml, and hemorrhage was successfully controlled using vaginal tamponade. The overall incidence of adverse events during the core needle biopsy procedure was 14% (4/29). Conclusion:Transvaginal core needle biopsy for pelvic masses guided by vagino-recto-abdominal examination is a simple, safe, and accurate diagnostic method, suitable for patients with gynecologic malignancies, non-gynecologic malignancies suspected of pelvic mass metastasis, and other benign pelvic lesions.

Objective To explore the characteristics of incorrect opinions in re-examination cases,analyze the reasons,characteristics,and commonalities of different forensic opinions in the same injury case during re-examination,and provide references for similar case acceptance,forensic procedures,analysis and argumentation,and the application of relevant provisions.Methods A retrospective analysis was conducted on the re-examination cases of human injury degree accepted by the Forensic Judicial Appraisal Center of Guizhou Medical University and West China Forensic Medical Appraisal Center of Sichuan University from January 2020 to December 2024.Results Among the 81 collected re-examination cases of human injury degree,the injury types mainly included fractures,soft tissue injuries,tendon injuries,craniocerebral injuries,nerve injuries,joint injuries,and organ injuries.Of these,74 cases were entrusted by the public security system,and 72 cases used primary injuries as the basis for assessment.Seven cases had more than 3 appraisals and 74 cases had two appraisals,of which 53 cases had inconsistent opinions between the previous and current appraisals,including 29 cases with an upgraded injury grade and 24 cases with a downgraded injury grade.Conclusion When accepting re-examination cases,forensic experts need to choose relevant objective examination techniques in forensic clinical medicine,such as clinical imaging techniques,to determine whether imaging data serves as key evidence in the case,and seek assistance from experts in related fields when necessary.In the case acceptance stage,it is necessary to collect and review key assessment materials such as medical records,the first assessment opinion,and interrogation records.Forensic experts should also enhance their understanding of legal provisions,timing of assessment,their image-reading ability,and work to standardize the forensic assessment process.

Objective This study aims to investigate controversial cases of forensic clinical re-identification of fractures,exploring the characteristics,causes,and countermeasures related to identification errors in primary bone injuries,complications,and subsequent changes.The goal is to provide identification strategies for similar cases regarding the collection of identification materials,timing,and examination method selection,ultimately establishing a paradigm for such identifications.Methods A total of 103 cases of clinical re-identification of fractures accepted by the West China Forensic Identification Center from 2020 to 2024 were collected,and the data from initial identifications and re-identifications were retrospectively analyzed.Results Male cases accounted for 69.90%of the re-identifications,with disability grade(67.96%)and injury degree(30.10%)being the primary concerns.Individual requests represented a high proportion(92.86%)in the initial assessment of disability levels,while unit or joint requests dominated the re-assessment(92.86%).The agreement rates for disability grade and injury degree were 55.26%and 59.38%,respectively.The reassessment of disability grades primarily involved fractures of limb long bones,spine,and ribs,with 75.53%of opinions resulting in downgraded disability levels.Rib,orbital,and nasal bone fractures were the main focus in injury degree reassessments,with 84.62%of opinions indicating aggravated injuries.The consistency rates for fracture identification in disability grade assessments was 92.21%,while rates for injury degree and sequelae were 65.63%and 48.94%,respectively.Inconsistencies in identifying damage facts—including the presence of fractures,distinguishing between fresh and old fractures,and determining the nature of fractures and sequelae—were primarily noted in rib,orbital,and nasal bone fractures.The utilization rate of CT metadata in initial evaluations(25.00%)was significantly lower than in re-evaluations(95.00%).The identification time for joint mobility dysfunction after fracture in re-identifications was significantly longer than in initial identifications(P=0.0002),and the identification time for cases with agreement was significantly shorter than for cases with disagreement(P=0.036).Conclusion Image data type and identification timing are critical factors that may influence the accuracy and consistency of forensic clinical identification of bone injuries.When necessary,dynamic CT metadata in conjunction with image post-processing technology can be routinely employed to identify fractures of the ribs,orbital bones,or nasal bones,thereby reducing the risk of misidentification.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.