Research progress on ethical issues in the process of fertility preservation in tumor patients / 中国医学伦理学

Fertility preservation technology provides an effective method for protecting the reproductive resources of patients with malignant tumors. At the same time， it is inevitable to face great ethical dilemmas in the process of technological implementation. From an ethical perspective， this paper sorted out the research on fertility preservation in tumor patients abroad， as well as analyzed the ethical issues faced by tumor patients in the communication decision-making and implementation stages of fertility protection. Specifically， these included informing and discussing the reproductive information and preservation choices of tumor patients， fertility decision-making of adolescent tumor patients， psychological support for fertility in tumor patients， ownership and use rights of reproductive materials and their disposal methods， fairness in the allocation of social health resources and other ethical issues. Combining with the actual situation in China， this paper further discussed how to put forward corresponding countermeasures based on following ethical principles such as favorable without harm， informed consent， cautious application， and ethical supervision， with a view to promoting the further development and application of fertility preservation technology in clinical practice.

Types analysis and coping suggestion of medical disputes arising from medical remarks / 中国医学伦理学

The language expression level of doctors directly affects the effectiveness of information transmission and communication. In the past 20 years， a large number of studies have conducted questionnaire surveys related to “doctor-patient communication” among medical staff and patients in the form of scales， but there were few studies on the practical application of doctor-patient communication and case analysis of doctor-patient disputes. Using the Complaint Register Book of a tertiary A hospital as research material， this paper summarized five causes of medical disputes caused by medical remarks， namely， stiff tone and improper body language of the medical staff， unclear communication of treatment plans， unable to answer patients’ questions， different doctors’ statements are contrary each other， and a large gap between disease prediction and disease development. This paper aimed to analyze the handling points of such disputes， with a view to applying them in doctor-patient communication courses for medical students or language skills training for doctors in the future， optimizing doctor-patient communication， and promoting the development of doctor-patient relationships.

Cultivation of "Emotion" Element in Red Doctors Spirit in Medical Students’ Humanistic Quality / 中国医学伦理学

The red doctors spirit is a special cultural form formed by the Chinese Communist Party in the long-term revolutionary struggle practice, and it has important practical significance and value of the times in the new era. Medicine is a subject integrating natural science and humanities. The element of "emotion" is the embodiment of traditional Chinese medical culture. It plays a role in cultivating doctors’ spirit and solving practical problems in current medical activities. By digging the four aspects of the "emotion" element in red doctors spirit of political loyalty to the party, the moral sentiment of saving the dying and healing the wounded, the rational decision-making under the transformation of medical situation, the response and processing ability of bad public opinion, and integrating it into the humanistic education of medical students. This paper explored the effective ways and promotion models of the element of "emotion" education in the growth of medical talents, so as to promote the cultivation of medical talents’ moral cultivation and ethical decision-making ability, enhance the professionalism and humanistic cultivation of medical students, and cultivate a group of medical talents with political firmness and reasonable consideration for the country.

Restriction and Protection of Personal Freedom of Medical Staff in Emergency Response to Public Health Emergencies / 中国医学伦理学

In the emergency response to public health emergencies, a series of ethical issues will be faced. One of the core issues is that the ethical conflict between personal freedom of medical staff and common good has not been effectively resolved, and the moral responsibility boundaries of medical staff have not been clearly defined. The personal freedom rights of medical staff are constrained in the emergency response to public health emergencies due to the prior moral requirements and regulations for them that emphasizes the priority of safeguarding public interests. Therefore, it is important to consider elements such as voluntariness, proportionality, priority, and fairness when balancing the tension between personal freedom of medical staff and common good. It is recommended to establish a rating system that endangers the life safety of medical staff, list the ethical list of "legitimate reasons" by the health administrative department, and improve the reward system of "moral and welfare consistency" to solve the ethical conflict between personal freedom of medical staff and common good, so as to better achieve common good.

Progress in the Application of Magnetic Nanoparticles in Forensic Trace Analysis / 法医学杂志

Given the complexity of biological samples and the trace nature of target materials in forensic trace analysis, a simple and effective method is needed to obtain sufficient target materials from complex substrates. Magnetic nanoparticles (MNPs) have shown a wide range of application value in many research fields, such as biomedicine, drug delivery and separation, due to their unique superparamagnetic properties, stable physical and chemical properties, biocompatibility, small size, high specific surface area and other characteristics. To apply MNPs in the pretreatment of forensic materials, maximize the extraction rate of the target materials, and minimize interference factors to meet the requirements of trace analysis of the target materials, this paper reviews the application of MNPs in the fields of forensic toxicological analysis, environmental forensic science, trace evidence analysis and criminal investigation in recent years, and provides research ideas for the application of MNPs in forensic trace analysis.

Efficacy and survival outcomes of dose-dense carboplatin plus paclitaxel as neoadjuvant chemotherapy for triple-negative breast cancer / 中华肿瘤杂志

Objective: To evaluate the efficacy and survival outcomes of dose-dense (biweekly) carboplatin plus paclitaxel (PC) as neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC), and to explore an optimal neoadjuvant chemotherapy regimen for TNBC. Methods: Patients diagnosed as TNBC(cT1-4N0-3M0) in Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Between January 2008 and September 2018 who received dose-dense PC and standard 3-weekly PC as NAC were 1∶1 matched using propensity score matching (PSM) to compare the efficacy, safety and survival outcomes. Results: One hundred of TNBC patients were enrolled (50 patients were divided in dose-dense group, 50 patients in standard group). The objective response rate (ORR) of dose-dense group and standard group were both 90.0% (45/50). The grade 3-4 neutropenia in dose-dense group was less than that of standard group (32.7% vs. 68.0%, P=0.001), while the rate of ALT/AST elevation in dose-dense group was higher than that of standard group (57.1% vs. 32.0%, P=0.012). The pathological complete response (pCR) rates were 34.0% (17/50) in dose-dense group and 38.0% (19/50) in standard group, without statistically significance (P=0.677). The median follow-up time was 55 months (3-150 months). The 5-year recurrence-free survival (RFS) in dose-dense group and standard group were 83.5% and 75.2%, respectively the 5-year overall survival (OS) in dose-dense and standard group were 87.9% and 84.5% the difference were not statistically significant (P=0.322 and 0.647, respectively). Patients with residual disease (tumor size≥1 cm or lymph node positive) had poor prognosis, the 5-year RFS and OS were 59.3% and 68.5%, respectively. Conclusions: Dose-dense PC has similar efficacy with standard 3-weekly PC and has a good safety profile. Since dose-dense regimen can shorten the duration of therapy, it can be an alternative in TNBC.

A real world study on the relationship between drug resistance of targeted therapy and prognosis of HER-2-positive advanced breast cancer / 中华肿瘤杂志

Objective: To explore the effect of primary and acquired resistance to anti-human epidermal growth factor receptor 2 (HER-2) on the overall survival of patients with HER-2 positive advanced breast cancer. Methods: The clinical characteristics of HER-2 positive patients with advanced breast cancer admitted to Cancer Hospital of Chinese Academy of Medical Sciences from January 1998 to December 2018 were collected, and their neoadjuvant/adjuvant and advanced three-line chemotherapy were summarized. Among them, targeted drugs for HER-2 included trastuzumab, pertuzumab, T-DM1, RC48-ADC, lapatinib, pyrotinib, allitinib, sipatinib, seratinib. Based on the duration of benefit from anti HER-2 treatment, the patients were divided into two groups: primary anti HER-2 resistance group and acquired anti HER-2 resistance group. In this study, the overall survival (OS) was used as the main end point. Kaplan-Meier analysis and Cox proportional risk regression model were used to analyze the effects of different drug resistance mechanisms on the overall survival. Results: The whole group of 284 patients were included. The median age of recurrence and metastasis was 48 years old, 155 (54.6%) were hormone receptor (HR) positive and 129 (45.4%) were HR negative, 128 cases (45.1%) were premenopausal and 156 cases (54.9%) were postmenopausal, 277 cases (97.5%) had a score of 0-1 in ECoG PS and 7 cases (2.5%) had a score of more than 2 in the first diagnosis of relapse and metastasis. There were 103 cases (36.3%) in the primary drug resistance group and 181 cases (63.7%) in the secondary drug resistance group. The median overall survival time of the two groups was 24.9 months and 40.4 months, respectively, with statistical significance (P<0.001). Conclusion: Primary resistance to HER-2 is one of the factors of poor prognosis in HER-2 positive breast cancer, and its mechanism needs to be further explored.

Cultivation of "Emotion" Element in Red Doctors Spirit in Medical Students’ Humanistic Quality / 中国医学伦理学

The red doctors spirit is a special cultural form formed by the Chinese Communist Party in the long-term revolutionary struggle practice, and it has important practical significance and value of the times in the new era. Medicine is a subject integrating natural science and humanities. The element of "emotion" is the embodiment of traditional Chinese medical culture. It plays a role in cultivating doctors’ spirit and solving practical problems in current medical activities. By digging the four aspects of the "emotion" element in red doctors spirit of political loyalty to the party, the moral sentiment of saving the dying and healing the wounded, the rational decision-making under the transformation of medical situation, the response and processing ability of bad public opinion, and integrating it into the humanistic education of medical students. This paper explored the effective ways and promotion models of the element of "emotion" education in the growth of medical talents, so as to promote the cultivation of medical talents’ moral cultivation and ethical decision-making ability, enhance the professionalism and humanistic cultivation of medical students, and cultivate a group of medical talents with political firmness and reasonable consideration for the country.

Sequential Changes of Total Adenine Nucleotide and Adenylic-Acid Energy Charge in Muscles of Rats after Death / 法医学杂志

Objective To determine the purine adenylate [adenosine triphosphate （ATP）, adenosine diphosphate （ADP）, adenosine monophosphate （AMP）] content in the muscles of both hind limbs of rats at different postmortem interval （PMI）, calculate the changes in the total adenine nucleotide （TAN） content and the adenylic-acid energy charge （AEC）, and explore their relationship with PMI. Methods Healthy rats were sacrificed by cervical dislocation and kept at 20 ℃. The muscles of their hind limbs were extracted at 0, 24, 48, 72, 96, 120, 144, and 168 h after death. Reversed-phase high performance liquid chromatography was used to determine the content of purine adenylates, the TAN and AEC of the muscles of the both hind limbs were calculated, and the related regression equations of their relationship with PMI were established. Results Within 168 h of death of rats, the trend of ATP change was different from ADP, and the content of AMP continuously increased. The TAN value gradually increased with the extension of PMI, and the AEC showed a downward trend within 168 h after death. Among them, the patterns of AEC changes with PMI were obvious, the correlation coefficient was high （ R2=0.903）, and the curve fitting relationship was good; the fitting relationship between ATP, ADP, AMP, TAN and PMI was poor （ R2=0.198-0.754）. Conclusion The postmortem change patterns of AEC provide new research ideas for PMI estimation in the forensic field.

Research Progress on Accumulated Degree Days for PMI Estimation / 法医学杂志

Among many factors that affect postmortem interval （PMI）, temperature is undoubtedly the most important factor, but simply considering temperature in estimation of PMI has limitations. Accumulated degree days （ADD） is an important indicator related to biological growth and development, which considers two major variables, environmental temperature and elapsed time. Therefore, the establishment of mathematical model of ADD and some evaluation indicators to estimate PMI, is obviously better than single temperature variable. This article briefly describes the research history of ADD, its application in PMI estimation, and the problems it faces, to provide reference for the further development of ADD to improve the accuracy of PMI estimation.

Research Progress on the Determination of Electrical Conductivity in Forensic Science / 法医学杂志

Electrical conductivity （EC） is an important physical and chemical index in electrochemical analysis. In recent years, with the penetration and reference of transformation medicine and interdisciplinary theory and technology in the forensic field, new applications of EC in the field of forensic science have been developed. This paper reviews three aspects of the application of EC, the determination of biological tissue freshness, postmortem interval estimation and the application in forensic taphonomy, in order to provide reference for relevant scientific research and related practices.

Analysis of 28S rRNA and COⅠ Gene Sequence of Nine Necrophagous Calliphorid Flies from Luoyang / 法医学杂志

Objective To assess the feasibility of using 28S ribosomal RNA （28S rRNA） and mitochondrial cytochrome c oxidase subunit Ⅰ （COⅠ） gene sequences of nine necrophagous Calliphorid flies for the identification of common necrophagous Calliphorid flies, and to provide technical support for postmortem interval （PMI） estimation. Methods Twenty-three Calliphorid flies were collected and identified morphologically, and DNA were extracted from legs. The gene fragments of 28S rRNA and COⅠ were amplified and sequenced, then the sequence alignment was performed with BLAST. The composition of obtained sequences was analyzed and evolutionary divergence rate between species and intraspecies were established. The phylogeny tree was constructed with neighbor-joining method. Results The 23 necrophagous Calliphorid flies were identified to 9 species of 5 genera. The 715 bp from 28S rRNA and 637 bp from COⅠ gene were obtained and the online BLAST result showed more than 99% of similarity. The phylogeny tree showed that the necrophagous flies could cluster well into 9 groups, which was consistent with morphological identification results. The intraspecific difference in 28S rRNA was 0 and the interspecific difference was 0.001-0.033. The intraspecific difference in COⅠ was 0-0.008 and the interspecific difference was 0.006-0.101. Conclusion Combined use of 28S rRNA and COⅠ gene sequence fragments can effectively identify the nine Calliphorid flies in this study. However, for closely related blowfly species, more genetic markers should be explored and used in combination in future.

Relationship between Electrical Conductivity and Related Biochemical Indicators of Rat Cerebrum Tissues and Postmortem Interval / 法医学杂志

Objective To explore the relationship between the electrical conductivity （EC） and biochemical indicators of rat cerebrum tissues and postmortem intervals （PMIs） and discuss the mechanism of applying EC to infer PMI. Methods Forty healthy Sprague-Dawley rats were sacrificed and stored in an environment of about 25 ℃. The whole cerebrum tissues of rats were removed respectively at different PMIs of 0, 1, 2, 3, 4, 5, 6, and 7 d, and then made into homogenized impregnation solution. The EC and related biochemical indicators （potassium, sodium, chloride, calcium, inorganic phosphorus, magnesium, uric acid, urea nitrogen and creatinine） in cerebrum tissue impregnation solution were determined, and the relationships among EC in impregnation solution, related biochemical indicators and PMI were analyzed. Results The EC in cerebrum tissues increased gradually with the extension of PMI, and the content of uric acid, urea nitrogen and inorganic phosphorus in its impregnation solution also increased gradually with the extension of PMI. The correlation of EC, uric acid, urea nitrogen, and inorganic phosphorus with PMI was relatively good （R2 was 0.95-0.99）, and there was a linear correlation between the content change of uric acid, urea nitrogen, inorganic phosphorus and EC （R2 was 0.97-0.99）. The changes of the other 6 kinds of biochemical indicators with the extension of PMI within 7 d after the rats' death were non-significant （P>0.05）. Conclusion The correlation between EC in cerebrum tissues, uric acid, urea nitrogen, inorganic phosphorus and PMI were relatively good, and combining various indicators can also improve the accuracy of PMI estimation.

Relationship between Electrical Conductivity and Chemical Content of Rat Skeletal Muscle Impregnating Solution and Postmortem Interval / 法医学杂志

Objective To study the mechanism of change of the electrical conductivity （EC） of rat skeletal muscle impregnating solution that occurs with the change of postmortem interval （PMI）. Methods Healthy Sprague-Dawley rats were killed and kept at about 25 ℃. Skeletal muscles were extracted at different PMI--immediate （0 d）, 1 d, 2 d, 3 d, 4 d, 5 d, 6 d, and 7 d, then mixed with deionized water to make impregnating solution with a mass concentration of 0.1 g/mL. The solution's EC and nine common chemicals in it, such as potassium ion, calcium ion, and chloride ion, were determined. Results EC increased gradually with the extending of PMI （P=0.024） during the 7 days after the rats' death. The content of uric acid （P=0.032）, urea nitrogen （P=0.013） and phosphorus （P=0.022） also increased during the extension. However, the content of magnesium ions decreased with extending of PMI （P=0.047）. The correlation between potassium ion, sodium ion, chlorine ion, calcium ion, creatinine and PMI were weak （P>0.05）. Conclusion The molecular basis of skeletal muscle EC change in rats after their death is the changes of uric acid, urea nitrogen, inorganic phosphorus and other chemical components. Furthermore, combine use of various indicators can improve the accuracy of the EC method to infer PMI.

Relationship between Early Postmortem Interval and Electrical Conductivity of Rat Liver, Spleen and Kidney after Death in Rats / 法医学杂志

OBJECTIVES@#To determine the electrical conductivity （EC） of the liver, spleen and kidney of rats at different postmortem intervals （PMIs） within 24 hours for investigating the relationship between EC of different organs and early PMI.@*METHODS@#Totally 45 SD rats were sacrificed by cervical dislocation and kept at a constant temperature of 25 ℃. Tissues were taken from the liver, spleen, and kidney of rats at 0, 3, 6, 9, 12, 15, 18, 21 and 24 h. Impregnating solution with a mass concentration 0.1 g/mL was prepared using deionized water. The EC value of impregnating solution with different organs was separately determined. The regression equations of EC and PMI for different organs were established, respectively. The relationship between EC of different organs and early PMI was analysed in deceased rats.@*RESULTS@#The relationship between PMI and EC of the liver and spleen was well fitted with the linear equation. The liver showed the best fitting degree followed by the spleen, while the EC of the kidney showed no significant changes within 24 h. There was a good linear relationship between early PMI and the EC of the liver and spleen.@*CONCLUSIONS@#A good linear relationship between early PMI and the EC of the liver and spleen can be found in rats after death, which can be used for the early PMI estimation.

Molecular Identification of Sarcosaphagous Flies in Luoyang Based on 28S rRNA Gene Sequence / 法医学杂志

Objective To detect 715 bp sequence of 28S rRNA in sarcosaphagous flies, and to identify their common species for solving the problem of morphological identification, as well as providing technical support for postmortem interval (PMI) estimation. Methods Twenty-nine common sarcosaphagous flies were collected in Luoyang and classified by morphological characteristics. The DNA was extracted from the fly's legs by Chelex-100 method and then the fragments of 28S rRNA were amplified and sequenced. The results were compared with twenty-eight corresponding fly species of GenBank and EMBL databases. All the sequences were analyzed by MEGA7.0 software, and sequence alignment was performed by the searching in BLAST. The nucleotide composition was analysed, and the intraspecific and interspecific ge-netic distance and phylogenetic tree were established. Results Twenty-nine sarcosaphagous flies were classified into 6 species of 5 genera, 3 families by morphological characteristics. In the obtained 715 bp sequence of 28S rRNA , the comparison result of online BLAST showed that the similarity was 100％. Five species were well clustered by a phylogenetic tree. Between different groups, the interspecific and intraspecific differences ranged from 0.007 to 0.045 and 0 to 0.001, respectively. Conclusion The 28S rRNA target gene sequences shows a good identification capability, which can be a new genetic marker for the identification of sarcosaphagous flies.

Relationship between Electrical Conductivity and Decomposition Rate of Rat Postmortem Skeletal Muscle / 法医学杂志

OBJECTIVES@#To analyze the relationship among electrical conductivity （EC）, total volatile basic nitrogen （TVB-N）, which is an index of decomposition rate for meat production, and postmortem interval （PMI）. To explore the feasibility of EC as an index of cadaveric skeletal muscle decomposition rate and lay the foundation for PMI estimation.@*METHODS@#Healthy Sprague-Dawley rats were sacrificed by cervical vertebrae dislocation and kept at 28 ℃. Muscle of rear limbs was removed at different PMI, homogenized in deionized water and then skeletal extraction liquid of mass concentration 0.1 g/mL was prepared. EC and TVB-N of extraction liquid were separately determined. The correlation between EC (x₁) and TVB-N (x₂) was analyzed, and their regression function was established. The relationship between PMI (y) and these two parameters were studied, and their regression functions were separately established.@*RESULTS@#The change trends of EC and TVB-N of skeletal extraction liquid at different PMI were almost the same, and there was a linear positive correlation between them. The regression equation was x₂=0.14x₁-164.91(R²=0.982). EC and TVB-N of skeletal muscle changed significantly with PMI, and the regression functions were y=19.38x₁³-370.68x₁²+2 526.03 x₁-717.06(R²=0.994), and y=2.56x₂³-48.39x₂²+330.60x₂-255.04(R²=0.997), respectively.@*CONCLUSIONS@#EC and TVB-N of rat postmortem skeletal muscle show similar change trends, which can be used as an index for decomposition rate of cadaveric skeletal muscle and provide a method for further study of late PMI estimation.

Ethical Self-Discipline for Researchers Initiating Clinical Trial / 中国医学伦理学

Clinical research initiated by researchers is one of the important means to promote new understanding of drugs and treatment methods.At this stage,the clinical researches initiated by the researchers frequently appear all kinds of irregularities.In order to solve out this problem,the paper points out suggestions about strengtheningself-discipline of researchers,self-regulation of conscience,and self-responsibility of carefulness.Meanwhile,it is also important to abide by the relevant ethical codes and consciously accept the third party supervision of IRB.Joint efforts should be made to protect safety and rights of human subjects.

Discussion on Reconstruction of Modern Doctor-patient Moral Emotion / 中国医学伦理学

Doctor-patient moral emotion is an important factor of doctor-patient relationship.However,in the current society,due to the change of medical models and social transformation,relationship between doctors and patients is facing the phenomenon of less affection or ruthlessness,which also causes the tension of doctor-patient relationship.This emotional crisis is closely related to doctor's moral image and the establishment of trust between doctor and patient,and must be solved by the reconstruction of modem doctor-patient moral emotion.Current reconstruction of the doctor-patient moral emotion has occupational necessity and realistic feasibility,and it is mainly constructed in two aspects of having emotion to patient and doing things reasonably.In this process,medical workers,social workers,medical colleges,medical institutions,management departments should cooperation mutually and jointly promote.

"From ""Human Nature"" to ""Medicine Nature""- Analysis of Moral Emotion Education of Medical Students" / 中国医学伦理学

Moral emotion education of medical students should begin with arousing human nature of students and making them to have the sense of consciousness to patients, which takes sympathy as the core. However, when faced with the increase of doctor-patient contradiction, students are easy to suspect the general sense. So students should be guided to understand the necessity of moral emotion in professional activity of doctors, and thus to adhere to treat patients with emotion due to responsibility. On this basis, through combining the education of having emo-tion to patient with working reasonably, medical students will gradually take treating patients with emotion as their own compulsory emotion, and to realize the transformation from human nature to medicine nature.