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.

Objective To analyze the correlation between the lung allocation score (LAS) and the risk of early death and complications in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 275 patients with IPF were retrospectively analyzed. The correlation between LAS and the risk of early death in IPF patients after lung transplantation and the correlation between LAS and complications at postoperative 1 year was assessed by univariate and multivariate Cox regression analyses. Results Among 275 recipients, 62, 83, 95 and 108 cases died within postoperative 30, 90, 180 and 365 d, respectively. LAS was correlated with 30-, 90-, 180- and 365-d fatality of IPF patients (all P<0.05), whereas it was not correlated with the incidence of primary graft dysfunction (PGD) and acute kidney injury (AKI) at 365 d after lung transplantation (both P>0.05). Conclusions LAS is correlated with the risk of early death of IPF patients after lung transplantation. While, it is not correlated the incidence of PGD and AKI early after lung transplantation. Special attention should be paid to the effect of comprehensive factors upon PGD and AKI.

Objective To analyze the interaction between voriconazole(VRC)and immunosuppressants such as tacrolimus and cyclosporine and the effect of CYP2C19 gene polymorphism on the interaction and adverse reactions(ADR)based on the results of CYP2C19 gene polymorphism and therapeutic drug monitoring,so as to provide a basis for the development of individualized VRC combined with immunosuppressants.Methods Two-dimensional liquid chromatography and pyrosequencing was used to detect the concentration of VRC and the CYP2C19 gene pol-ymorphism,respectively.And the concentration of immunosuppressants was detected at the same time.The rela-tionship among CYP2C19 gene polymorphism,the concentration of VRC and immunosuppressant and ADR was an-alyzed.Results A total of 61 patients were enrolled in this study,and the mutation rates of CYP2C19*2 and CYP2C19*3 were 54.1％(33/61)and 9.84％(6/61),respectively.The concentrations of VRC in patients with extensive metabolism(EMs),intermediate metabolism(IMs)and poor metabolism(PMs)were(4.44±3.46),(3.62±3.02)and(10.05±1.46)μg/ml(P＜0.05),respectively.The concentration of tacrolimus af-ter combined with VRC significantly increased compared to tacrolimus alone[(13.4±9.2)ng/ml vs(6.5±3.6)ng/ml;P=0.002],and the concentration of tacrolimus increased along with an increasing of VRC concentration.The concentration of VRC in patients combined with tacrolimus was lower than that in patients without immunosup-pressants[(3.81±3.48)μg/ml vs(5.84±3.71)μg/ml;P=0.032].The concentration of VRC inpatients with cyclosporine significantly decreased(P＜0.01),while tacrolimus and mycophenolate mofetil had no signifi-cant effect on the concentration of VRC.45.90％(28/61)of the patients had adverse reactions,the concentration of VRC in patients with ADR was significantly higher than that in patients without ADR[(7.07±3.43)μg/ml vs(3.06±2.90)μg/ml;P＜0.001].And the concentration of VRC in patients with ADR was higher than patients without ADR with based on CYP2C19 genotype.Conclusion CYP2C19 gene polymorphism can significantly affect the concentration and adverse reactions of VRC,and VRC has significant interaction with immunosuppressants such as tacrolimus.CYP2C19 gene polymorphism combined with therapeutic drug monitoring can improve the individual-ized treatment of tacrolimus and voriconazole,and is expected to minimize toxicity and improve treatment effects.

Objective To develop a highly sensitive and rapid nucleic acid detection method for the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2). Methods We designed,developed,and manufactured an integrated disposable device for SARS-CoV-2 nucleic acid extraction and detection.The precision of the liquid transfer and temperature control was tested.A comparison between our device and a commercial kit for SARS-Cov-2 nucleic acid extraction was performed using real-time fluorescence reverse transcription polymerase chain reaction(RT-PCR).The entire process,from SARS-CoV-2 nucleic acid extraction to amplification,was evaluated. Results The precision of the syringe transfer volume was 19.2±1.9 μL(set value was 20),32.2±1.6(set value was 30),and 57.2±3.5(set value was 60).Temperature control in the amplification tube was measured at 60.0±0.0 ℃(set value was 60)and 95.1±0.2 ℃(set value was 95)respectively.SARS-Cov-2 nucleic acid extraction yield through the device was 7.10×106 copies/mL,while a commercial kit yielded 2.98×106 copies/mL.The mean time to complete the entire assay,from SARS-CoV-2 nucleic acid extraction to amplification detection,was 36 min and 45 s.The detection limit for SARS-CoV-2 nucleic acid was 250 copies/mL. Conclusion The integrated disposable devices may be used for SARS-CoV-2 Point-of-Care test(POCT).

Objective:This study aimed to develop a rapid and accurate integrated nucleic acid detection method tailored for the influenza virus.Methods:We designed primers and probes targeting the predominant influenza virus strains circulating in China in recent years. These were integrated with extraction and amplification reagents and a point of care testing (POCT) system to facilitate a seamless and expedited process involving nucleic acid extraction, reaction system preparation, amplification, and result interpretation for the influenza virus. The specificity of the POCT system was evaluated using cultured influenza viruses, while its cross-reactivity was assessed against common respiratory pathogens, including adenovirus and respiratory syncytial virus.Results:Our study successfully developed duplex amplification primers and probes for both influenza A and B viruses, achieving a detection threshold as low as 500 copies/ml. Specificity tests confirmed that the detection reagents did not show cross-reactivity with other respiratory pathogens such as adenovirus and respiratory syncytial virus. The POCT-based rapid nucleic acid detection method for influenza virus was established, it is capable of completing the entire process from nucleic acid extraction to amplification and result interpretation within 50 minutes, while enabling real-time data upload.Conclusions:The POCT-based rapid influenza virus detection kit developed in this study offers a " sample in, results out" convenience, making it suitable for rapid influenza virus detection in primary care settings. This innovation has significant potential for clinical application.

Objective:To conduct a phased summary and analysis of the operation and quality control (QC) of the first human milk bank (HMB) in East China over a ten-year period.Methods:Data on the operation of the HMB at Women's Hospital of Nanjing Medical University, characteristics of donors and recipients, clinical application of donated milk, and operational costs from August 1, 2013, to July 31, 2023, were collected, organized, analyzed, and described. Quality and safety management of the HMB began in 2016, with QC measures implemented. Chi-square tests were used to compare data related to the operation of the HMB, donors, and recipient infants before QC (2013-2015) and after QC (2016-2023). Results:Over the ten-year period since its establishment, the HMB received donor human milk (DHM) from 1 974 donors, totaling 9 390.41 liters. The qualification rate of donors was 86.47% (1 707/1 974), with a qualification rate of DHM of 98.01% (9 203.21/9 390.41) and 21 757 donation instances, with the highest individual donation count reaching 195 times. In the past 10 years, due to the epidemic of the new coronavirus in 2020, the number of milk donors, the amount of DHM and the total number of milk donations decreased significantly, but the amount of DHM per capita and the number of milk donations per capita showed a continuous upward trend. Compared to the period before QC, the qualification rate of donors [96.75% (1 253/1 295) vs. 66.86% (454/679), χ 2=340.33, P<0.001] and the qualification rate of DHM [98.19% (8 366.76/8 521.08) vs. 96.22% (836.45/869.33), χ 2=16.33, P<0.001] both improved after QC. A total of 11 197 recipients received 6 615.38 liters of DHM, with a utilization rate of 71.88% (6 615.38/9 203.21). The current operation mode of the HMB is "voluntary donation, free use". Over ten years, the costs for consumables, testing, labor, energy, and fixed assets amounted to 9.36 million CNY, with an operational cost of 996.32 CNY per liter (9.36 million/9 390.41 L) and approximately 1.00 CNY per milliliter of DHM. Conclusions:The hospital's HMB has been operating stably for ten years, and abundant DHM benefits many newborns. QC measures have effectively increased the qualification rates of both donors and DHM, providing better nutritional support for the treatment of critically ill infants. However, the operational costs of the HMB are relatively high, necessitating the exploration of an operational model suitable for China's national conditions.

Epilepsy is often comorbid with other neuropsychiatric conditions,which are known as epilepsy comor-bidities.Among these conditions,the comorbidity of epilepsy and migraine is very common.Although they are two differ-ent diseases,they overlap in terms of pathophysiological features and clinical symptoms,and several anti-seizure medica-tions(ASMs)have been proved to be effective in migraine.However,there are still controversies over the concept of epi-lepsy comorbid with migraine,and there is often a lack of effective treatment for migraine due to missed diagnosis or misdi-agnosis.In order to improve the ability for identification and precise treatment of epilepsy comorbid with migraine among clinicians,this article elaborates on the possible mechanism of epilepsy comorbid with migraine and discusses the con-cept,identification,and diagnosis and treatment regimens for epilepsy comorbid with migraine by considering the tempo-ral association between headache symptoms and epileptic seizures,with reference to the classification of epilepsy comorbid with migraine and related diagnostic criteria in Chinese expert consensus(2019)and the ICHD-3-2018 guidelines issued by the International Headache Society.

Breast cancer has been the second most common solid tumor that metastasizes to the central nervous system after lung cancer.Triple-negative breast cancer(TNBC)has an earlier occurrence and high incidence of brain metastasis with its associated poor prognosis and limited treatment options due to the presence of the blood-brain barrier and lack of targeted drugs.Local treatment,including surgery and radiation therapy,are still the main therapy for brain metastasis.Surgical resection can not only relieve neurologic impairment of brain metastasis patients,but also can clarify the pathological type.Moreover,surgical resection combined with radiotherapy can improve the prognosis of brain metastasis patients compared to surgery or radiotherapy alone.By now,whole-brain radiation therapy(WBRT)is still considered the gold standard for multiple brain metastases,and meningeal metastases,but it will lead to neurocognitive decline,so hippocampal avoidance is essential.For selected patients with oligometastases,stereotactic radiotherapy has replaced WBRT to reduce cognitive toxicity.However,local treatment of TNBC brain metastasis cannot control the progress of brain metastasis and has significant side effects,so systemic therapy is needed.Chemotherapy drugs such as capecitabine and cisplatin can penetrate the blood-brain barrier,but their efficacy is limited.Therefore,the research and development of new targeted drugs and the exploration of new targets are necessary for TNBC brain metastasis.Research has found that patients carrying germline BRCA1/2 mutations have a higher risk of brain metastasis.Currently,the poly adenosine diphosphate ribose polymerase(PARP)inhibitor demonstrated antitumor activity in patients with advanced breast cancer and a germline BRCA1/2 mutation,and it can penetrate the blood-brain barrier.The phase Ⅲ trial EMBRACA reported that the PARP inhibitor talazoparib can prolong the progression-free survival of TNBC patients with brain metastasis.In addition,antibody drug conjugates(ADCs)trastuzumab deruxtecan(T-DXd)can also penetrate the blood-brain barrier.Studies such as DEBBRAH have shown that T-DXd has significant therapeutic effects in HER2 positive brain metastasis patients,while research on HER2 low expression patients has not yet reached the endpoint,and its role in TNBC brain metastasis is worth looking forward to.Sacituzumab govitecan(SG)is also an ADC composed of an antibody targeting the human trophoblast cell-surface antigen 2.The phase Ⅲ ASCENT study showed that in the full population(including 61 patients with brain metastasis),SG could significantly prolong the progression-free survival of advanced TNBC patients compared to the patients who received chemotherapy.ANG1005,a novel taxane derivative,can cross the blood-brain barrier as well.A multicenter,open-label phase Ⅱ study revealed that ANG1005 could prolong overall survival of patients with brain metastasis.In addition,phosphoinositide3-kinase,(PI3K)/protein kinase(AKT)/mammalian target of rapamycin(mTOR)pathway inhibitors,fatty acid synthase inhibitors,and the drugs with new delivery systems have become potential treatment options for TNBC brain metastasis patients.Although the Impassion 130 reported that no benefit trend for immunotherapy in TNBC brain metastasis,basic research has shown that radiotherapy combined with immunotherapy has a synergistic effect.Currently,multiple clinical trials(NCT03483012,NCT03449238,etc.)are exploring the efficacy of radiotherapy combined with immunotherapy in brain metastasis,and the results are promising.This article reviewed the research progress of TNBC brain metastasis treatment.

Sonodynamic therapy is a novel treatment for killing malignant tumors with sonic sensitizers and low-intensity ultrasound,which via ultrasonic mechanical stress,the effects of ultrasonic cavitation and the combined production of ultrasound and acoustic sensitizers produce reactive oxygen species induces apoptosis co-destructing target cells.Compared with traditional approaches for the treatment of malignancy,sonodynamic therapy has advantages of greater accuracy,deeper tissue penetration,better patient dependency,and less side effects.Ultrasound microsphere contrast agents can significantly enhance the effects of cavitation as synthetic cavitation nuclei,and precise regulation of the effects of cavitation is a key factor in improving the efficiency of sonodynamic therapy.The combination of ultrasonic microspheres and adjustable cavitation have broad prospects in the field of sonodynamic therapy for malignant tumors.

Objective To explore the correlation between moderate to severe bronchopulmonary dysplasia (BPD) and early breastfeeding in preterm infants with a gestational age of ≤32 weeks. Methods A retrospective analysis was conducted on the clinical data of 220 preterm infants with a gestational age of ≤32 weeks. The preterm infants were dividedinto moderate to severe BPD group (37 cases) and control group (183 cases) based on whether moderate to severe BPD occurred or not. The clinical characteristics, breastfeeding volume, and mother's own milk (MOM) feeding rate were compared between the two groups, and the relationship between breastfeeding and the occurrence of moderate to severe BPD in preterm infants was analyzed. Results Univariate analysis showed that the moderate to severe BPD group had a higher proportion of infants with birth weight < 1 500 g, gestational age < 28 weeks, vaginal delivery, Apgar score ≤ 7 at 1 minute after birth, and mechanical ventilation time ≥ 7 days compared to the control group(P < 0.05). The duration of intravenous nutrition was longer in the moderate to severe BPD group (P < 0.05). The moderate to severe BPD group had lower breast milk intake from 0 to 7 days after birth, MOM intake, MOM feeding rate, and breast milk intake from 8 to 14 days after birth compared to the control group (P < 0.05). Multivariate Logistic regression analysis showed that a high volume of breastfeeding from 0 to 7 days after birth was an independent protective factor for the occurrence of moderate to severe BPD in preterm infants (OR=0.865, 95%CI, 0.767 to 0.976, P < 0.05). Gestational age < 28 weeks (OR=5.238, 95%CI, 1.158 to 23.686, P < 0.05), and mechanical ventilation time ≥7 days (OR=22.386, 95%CI, 6.769 to 74.030, P < 0.05) were independent risk factors for the occurrence of moderate to severe BPD in preterm infants. Conclusion Early breastfeeding after birth can significantly reduce the risk of moderate to severe BPD in preterm infants with a gestational age of ≤32 weeks, and clinical measures should be actively implemented to promote early breastfeeding.