ObjectiveTo clearly identify the difference between rescue injuries and agonal injuries and to avoid duplicate identifications and misidentifications. MethodsBased on the forensic pathological data of 5 923 cases of death cause identification from 2013 to 2022 in Sun Yat-sen University Forensic Identification Center and Guangzhou Tianhe District Branch of Guangzhou Public Security Bureau， this study retrospectively studied the characteristics of rescue injuries and agonal injuries seen in cause of death identification and their influence on cause of death identification. ResultsAmong all the 5 923 cases， 640 cases were found to have rescue injuries or agonal injuries， and 624 cases received treatment， of which 609 cases were found to have rescue injuries （97.60%）， 44 cases were found to have agonal injuries， and 13 cases were found to have both types of injuries. Among the 640 cases， 441 were male and 199 were female. The age of death was discontinuously distributed from 0 to 95 years old. The leading cause of death was disease， followed by mechanical injury and asphyxia. The main manifestations of rescue injuries were rib and sternum fractures， soft tissue injuries in the prechest area or face， and pericardial rupture. The most common injuries in agonal stage were falling after unconsciousness， inhalation of foreign body in respiratory tract or multiple violent injuries. Among the 640 cases， 19 cases were repeatedly identified， including 15 cases of rescue injuries， 6 cases of agonal injuries， and 2 cases of both types of injuries. Compared with the cases where neither type of injuries was detected， the repeated identification rate of treatment injuries and agonal injuries was significantly increased （χ²=4.04， P=0.044； χ²=43.49， P<0.001）. Among the 640 cases， 11 cases （1.72%） were misidentified as the initial injuries in the first identification， and 13 cases had combined rescue injuries or agonal injuries that were involved in death. ConclusionsBy elucidating the epidemiological characteristics of the two types of injuries， this study proved that the two types of injuries were associated with higher rates of repeated identification and misidentification， which provided a reference for reducing repeated identification and misidentification and improving the accuracy of cause of death identification.

AIM: To investigate the application of optical coherence tomography angiography(OCTA)in observing the relationship between corneal topographic changes and retinal vessel density and thickness in myopic adolescents after wearing orthokeratology lenses.METHODS:Myopic adolescents who treated and wore orthokeratology lenses in our hospital between January and December 2023 were selected for the study, and their clinical data were retrospectively analyzed. Totally 50 cases(50 eyes)of toric orthokeratology lenses(toric group)and 50 cases(50 eyes)of spherical orthokeratology lenses(spherical group)were selected. Changes in corneal topographic indices, retinal vascular density and retinal thickness were examined in the two groups before and at 3 and 6 mo after wear. The relationship between corneal topographic indexes and retinal vessel density and thickness was analyzed.RESULTS: Compared with the pre-wear, average value of ks and kf(Avek)was significantly lower(all P<0.05), and surface regularity index(SRI)and surface asymmetry index(SAI)were significantly increased(both P<0.05)in the two groups at 3 and 6 mo post-wear. Compared with the pre-wearing period, deep retinal vessel density in whole macular area and superficial retinal vessel density in paracentral retina of macula were significantly higher in the two groups at 3 and 6 mo after wearing(both P<0.05), and the superficial retinal vessel density in macular fovea and paracentral fovea of macula of the toric group was significantly higher(all P<0.05), and the superficial retinal vessel density in paracentral macular fovea of the spherical group was significantly increased(all P<0.05). Compared with the pre-wearing period, the thickness of retina in whole macula and paracentral retina of the macula was significantly increased in the both groups at 3 and 6 mo post-wearing(all P<0.05). After wearing lenses for 3 mo, the Avek of the toric group was negatively correlated with the deep vascular density in whole macular area and paracentral macular fovea, the superficial vascular density in macular fovea and paracentral macular fovea, and the thickness of whole macular and paracentral macular fovea(all P<0.05). The SRI and SAI were positively correlated with the superficial retinal vascular density in macular fovea and paracentral macular fovea, and the retinal thickness in whole macular area and paracentral macular fovea(all P<0.05). The spherical group showed a negative correlation between Avek and the deep retinal vessel density in whole macular area and paracentral macular fovea, as well as the superficial retinal vessel density in paracentral macular fovea after wearing lenses for 3 mo(all P<0.05). SRI and SAI were positively correlated with the deep retinal vessel density in whole macular area, macular fovea and paracentral macular fovea, and the superficial retinal vessel density in paracentral macular fovea(all P<0.05). SRI was positively correlated with the retinal thickness in whole macular area(P<0.05), and SAI was positively correlated with the retinal thickness in paracentral macular fovea(P<0.05).CONCLUSION: After wearing toric and spherical corneal orthokeratology lenses, the corneal topography of myopic adolescents changes, and the retinal blood flow density and retinal thickness increase significantly, improving retinal blood circulation. Moreover, there is a significant correlation between changes in corneal topography and retinal blood flow density and retinal thickness, which has certain guiding significance for the control of myopia.

BACKGROUND:The type of graft selected during anterior cruciate ligament revision is considered one of the main factors affecting the postoperative outcome,but there are few reports on the comparison between different graft materials. OBJECTIVE:To explore the medium-to-long-term clinical efficacy after anterior cruciate ligament revision with autologous ligament,allogeneic ligament,and LARS artificial ligament. METHODS:A total of 67 patients with the first anterior cruciate ligament revision admitted to the Department of Joint and Sports Medicine,The Second Hospital of Tangshan from May 2011 to May 2020 were selected,including 41 males and 26 females,with a mean age of(45.83±7.39)years.They were divided into three groups according to different grafts used:autologous ligament group(n=24),allogeneic ligament group(n=22),and LARS artificial ligament group(n=21).Follow-up for more than 36 months after revision was performed to evaluate the effect of revision. RESULTS AND CONCLUSION:(1)International Knee Documentation Committee(IKDC)score,Lysholm knee score,and Tegner motor score 1 year after surgery and at the last follow-up in the three groups were higher than those before surgery(P<0.05).There were no significant differences in IKDC score,Lysholm knee score,and Tegner motor score among the three groups 1 year after surgery and the last follow-up(P>0.05).(2)The lateral differences of KT-1000 at 1 year after surgery and the last follow-up among the three groups were lower than those before surgery(P<0.05).The lateral difference of KT-1000 and the positive rate of the axial shift test in the last follow-up of the LARS artificial ligament group were higher than those in the autologous ligament group and allogeneic ligament group(P<0.05).(3)At the last follow-up,X-ray films showed no obvious enlargement of the reconstructed bone tunnel and no obvious failure of the graft fixation device.There was no obvious aggravation of osteoarthritis,but bone density decreased significantly in some elderly patients.(4)These findings suggest that anterior cruciate ligament revision with LARS artificial ligaments can obtain good initial stability,but with the extension of time,the stability of partial cases tends to decrease,even with reconstructed ligament failure.Both allogeneic and autogenous ligaments can obtain good clinical efficacy in anterior cruciate ligament revision.

Objective To evaluate the value of rs61330082 and rs4730153 polymorphisms of Visfatin locus for the diagnosis of type 2 diabetes mellitus(T2DM)in a high-risk population.Methods SNPscanTM high-throughput single nucleotide polymorphism typing technique was used to genotype Visfatin gene loci rs61330082 and rs4730153 in 346 T2DM patients(T2DM group)and 1426 normal controls(NC group).Logistic regression analysis was used to analyze T2DM risk factors.ROC curves were used to analyze the optimal cut-off values of Visfatin gene rs61330082 and rs4730153 for the diagnosis of T2DM.Results The proportion of women,age,obesity,smoking,hypertension,FPG,HbA1c and TG were higher in T2DM group than those in NC group(P<0.01)and HDL-C was lower than in NC group(P<0.01).The frequency of G allele and GG genotype was higher in T2DM group compared with NC group(P<0.05).Logistic regression analysis showed that age,female,obesity,hypertension,TG,and GG genotype at rs4730153 locus were risk factors for T2DM,HDL-C was a protective factor for T2DM.The area under the ROC curve of GG genotype at Visfatin rs4730153 mutation for diagnosis of T2DM was 0.668 and the optimal cut-off point for predicting T2DM was 20.04%,with sensitivity 60.1%and specificity 66.1%,respectively.Conclusion The GG genotype of Visfatin gene rs4730153 locus is associated with the risk of T2DM and can beused as a candidate gene for predicting phenotype of T2DM.

This paper reports the maternal and fetal outcomes of three twin pregnancies with chronic hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS) who were treated with continuous positive airway pressure (CPAP). All three women with twin pregnancies were diagnosed with chronic hypertension. Furthermore, symptoms such as snoring and apnea assisted the diagnosis of OSAHS through polysomnography monitoring. Case 1 was treated with CPAP at 28 gestational weeks. The blood pressure increased gradually after the first month of CPAP treatment, with an elevated urine protein concentration. At 34 gestational weeks, the pregnant woman underwent a cesarean section due to the development of hemolysis, elevated liver enzymes, and low platelet syndrome. Case 2 was treated with CPAP at 11 gestational weeks, with stable blood pressure throughout the pregnancy, and was delivered through cesarean section at 37 weeks of pregnancy. Case 3 started CPAP at 13 gestational weeks for four months, and increased blood pressure and urine protein were observed. Medication brought the blood pressure down, and urine protein became negative. At 32 gestational weeks, a cesarean section was performed because of premature rupture of the membrane. Her CPAP treatment continued till delivery with good maternal and infant outcomes. The treatment outcomes of the three cases suggest that CPAP may prolong the time of blood pressure rise among twin pregnancies where chronic hypertension and OSAHS coexist, which potentially reduces the occurrence of adverse maternal and infant outcomes.

Objective:To investigate the correlation between blood lipid variability and recurrence of cerebrovascular events in patients with ischemic stroke.Methods:Patients with ischemic stroke admitted to Qingdao Municipal Hospital from June 1, 2020 to December 31, 2022 were prospectively enrolled and followed up for 30 months. The standard deviation (SD) and coefficient of variation (CV) of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were calculated during follow-up, and the attainment rate of blood lipid before and after follow-up were compared. The recurrence of cerebrovascular events was monitored, including ischemic stroke, cerebral hemorrhage, and transient ischemic attack. Cox proportional hazards regression model was used to analyze the correlation between the variability of TC, LDL-C, HDL-C, and TG and the recurrence of cerebrovascular events.Results:A total of 142 patients with ischemic stroke were enrolled, including 81 males (57.0%), aged 63.4±5.8 years. During follow-up, 34 patients (23.9%) experienced recurrent cerebrovascular events. At the end of the follow-up, TC, TG, and LDL-C levels decreased significantly compared to before the follow-up (all P<0.05), and the attainment rate of blood lipid increased significantly compared to before the follow-up (51.4% vs. 12.7%; P=0.001). CV of LDL-C in the recurrent group was significantly higher than that in the non-recurrent group ( P=0.005). Cox proportional hazards regression analysis showed that after adjusting for age, gender, body mass index, baseline blood lipids, and baseline blood pressure, LDL-C variability (SD: hazard risk [ HR] 4.051, 95% confidence interval [ CI] 2.671-5.687, P=0.034; CV: HR 3.785, 95% CI 2.356-5.013, P=0.041) and TC variability (SD: HR 3.821, 95% CI 2.450-5.224, P=0.039; CV: HR 3.715, 95% CI 2.401-5.036, P=0.042) during follow-up were independently associated with the recurrence of cerebral vascular events. Conclusions:LDL-C and TC variability are the independent influencing factors for the recurrence of cerebrovascular events in patients with ischemic stroke. Monitoring the variability of LDL-C and TC in patients with ischemic stroke and intervening in a timely manner may reduce the risk of recurrence of cerebrovascular events.

Objective:To evaluate the clinical efficacy of allogeneic hematopoietic stem cell transplantation（allo-HSCT）in children with severe aplastic anemia（SAA）.Methods:Twenty-seven cases with SAA who had been treated with allo-HSCT from January 2020 to December 2022 were retrospectively analyzed and reviewed.Results:（1）A total of 27 SAA patients were enrolled，including 18 males and 9 females，with a median age of 8 (2-15) years.There were 20 cases of SAA-Ⅰ type,7 cases of SAA-Ⅱ type.Based upon donor sources，three cases of matched sibling donors hematopoietic stem cell transplantation,and 24 cases of haploidentical hematopoietic stem cell transplantation were adopted.（2）Hematopoietic reconstruction was achieved in all 27 cases.The median implantation time of neutrophils and platelets was 10（9-20）days and 12（7-26）days respectively.The cumulative incidence of acute graft-versus-host disease（GVHD）was 66.67%（18/27）.The incidence of grade Ⅰ-Ⅱ was 55.56%（15/27）and that of grade Ⅲ-Ⅳ was 11.11%（3/27）.The incidence of chronic GVHD was 7.41%（2/27）.Transplant-associated thrombotic microangiopathy (TA-TMA) occurred in 7.41%（2/27）patients,cytomegalovirus viremia in 62.96%（17/27）patients,epstein-barr virus infection in 33.33%（9/27）patients,and 14.81%（4/27）patients progressed to post-transplant lymphoproliferative disorder (PTLD).（3）The median follow-up time was 12 (2-28) months.The overall survival rate was 96.29%.Twenty-six patients survived,and one patient died due to multiple complications of severe acute GVHD,TA-TMA,cytomegalovirus infection,PTLD and secondary epilepsy.Conclusion:Allo-HSCT is an effective therapy for SAA in children.The effective rate of this research is 96.29%.Acute GVHD is still the key to therapy.The incidence rate of acute GVHD is 66.67% in this study.The blood incompatibility of donor and recipient may affect the incidence of GVHD.The intensity of GVHD prevention should be reduced after HLA-matched sibling donor-hematopoietic stem cell transplantation so as to avoid the complications of virus recurrence and PTLD.

Objective:To analyze the clinical characteristics of eosinophilic lung diseases(ELD) in children to enhance pediatricians′ understanding of ELD.Methods:In this retrospective cross-sectional study, a total of 149 children with ELD were recruited from Beijing Children′s Hospital, Capital Medical University between April 1, 2007 and March 31, 2022.Chi-square test, Fisher′s exact test, Mann-Whitney U test and Kruskal-Wallis test were used to analyze data and conclude clinical characteristics.Spearman correlation was used to analyze the correlation between eosinophils in peripheral blood and bronchoalveolar lavage fluid.Chi-square test and Kappa consistency test were used to compare the differences and consistency in diagnostic results between bronchoalveolar lavage fluid or lung biopsy and eosinophil elevation with chest imaging abnormalities. Results:(1)The isolated lung involvement was mostly caused by allergic bronchopulmonary aspergillosis(9 patients), and other system involvement by idiopathic hypereosinophilic syndrome(89 patients).(2)The main respiratory manifestations included coughing(90 cases, 60.4%) and expectoration(41 cases, 27.5%), while 23.5%(35 cases) of patients had no respiratory symptoms; 50.3% had digestive system involvement, and 40.9% had skin involvement.These were the two most commonly affected organs.(3)Spearman correlation was performed between eosinophils in peripheral blood and bronchoalveolar lavage fluid( r=0.3, P<0.05).Chi-square test was performed to compare ELD diagnosed by bronchoalveolar lavage fluid or lung biopsy with peripheral blood eosinophilia accompanied by abnormal chest imaging( P<0.05).Kappa consistency test(Kappa<0.2) showed poor consistency between the two diagnostic methods. Conclusions:ELD are present in children, and multiple etiologies may be pathogenic.Among children with ELD, the isolated lung involvement is mainly caused by allergic bronchopulmonary aspergillosis.The digestive system and skin are the most commonly affected organs, except for lungs.The correlation between eosinophil levels in peripheral blood and bronchoalveolar lavage fluid is poor.

Purpose To investigate the value of pre-treatment relative cerebral blood flow(rCBF)and relative cerebral blood volume histogram of dynamic susceptibility contrast-enhanced perfusion weighted imaging in predicting the chemotherapy response of primary central nervous system lymphoma(PCNSL)patients.Materials and Methods Thirty-eight PCNSL patients with fifty-seven lesions treated with high-dose methotrexate chemotherapy from September 2016 to October 2023 were retrospectively involved in the study.The patients were divided into response group of 30 patients and non-response group of 8 patients.Region of interest was drawn in cerebral blood flow and cerebral blood volume images,and histogram paraments were extracted.Univariate and multivariate Logistic regression analysis were performed to identify the independent predictors for chemotherapy response in PCNSL,and then combined prediction model was constructed.The area under the receiver operating characteristic curve was used to compare the predictive performance of different paraments and combined model.Results The number of lesions(OR=9.726,95％CI 1.070-88.397,P=0.043)and rCBF90(OR=0.224,95％CI 0.072-0.704,P=0.010)were the independent predictors for chemotherapy response with the area under the curve of 0.681 and 0.798,respectively.The combined model of rCBF90 and the numbers of lesions showed the best predictive performance with the area under the curve of 0.846.Conclusion The pre-treatment quantitative parameters rCBF and relative cerebral blood volume of dynamic susceptibility contrast-enhanced perfusion weighted imaging could be used for predicting the response to high-dose methotrexate chemotherapy in PCNSL patients,and the rCBF90 is an independent predictor of chemotherapy response.

Purpose To construct the model of differentiating primary central nervous system lymphoma(PCNSL)and atypical glioblastoma(GBM)by combining multi-parameter MRI radiomics and six machine learning algorithms,thus to compare the diagnostic efficacy of different machine learning algorithms.Materials and Methods The clinical and imaging data of 77(125 lesions)PCNSL and 90 atypical GBM(108 lesions)from PLA General Hospital and public databases were retrospectively analyzed from January 2013 to December 2023,and all patients were randomly divided into a training set(163 cases)and a validation set(70 cases)according to 7∶3.T1WI,T2WI and T1-weighted contrast-enhanced sequences were selected for tumor segmentation,and 1 132 radiomics features were extracted from each region of interest.The intraclass correlation coefficient(ICC)was used for the consistency test,and image features with ICC≥0.85 were selected.ICC and recursive feature elimination were used to select the best radiomics features.Six classifiers were used to train and verify three single sequence feature sets,three double-sequence sets and one multi-sequence set.The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the model.Results The combination model of the support vector machine of radial basis function classifier and multi-sequence feature set were the best model for differentiating PCNSL and atypical GBM.The area under the curve of the training set and the validation set were 0.969 and 0.913,respectively;and the accuracy were both 0.886.Conclusion Noninvasive extraction of multiparametric MRI features combined with machine learning algorithms can effectively differentiate PCNSL and atypical GBM,which provides support for the development of individualized treatment plans for patients.