Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.

Application of Digital Evidence in Criminal Cases: Dilemma and Optimization

The judicial application of digital evidence in criminal cases(criminal digital evidence)is an inevitable trend for the digital transformation of criminal proceedings in the macro context of the digital economy.It is characterized by digitization,diversification,and traceability.The application of criminal digital evidence can be divided into two main scenarios:the vertical scenario involving phases such as filing,prosecution,and trial;the horizontal scenario related to specific types of crimes.Criminal digital evidence is primarily applied to handling non-contact crimes,such as cybercrimes.However,the application of such evidence may infringe upon the basic rights of suspects,including their rights to privacy,rights to know,and rights to defense.Furthermore,the diversified and non-systematic nature of digital evidence may lead to challenges in applying the law,particularly with algorithmic“black boxes,”which can result in judicial discrimination and other drawbacks.Therefore,it is necessary to formulate or improve the regulatory framework for criminal digital evidence to ensure its lawful and standardized application.Additionally,judicial authorities must strengthen collaboration in case handling to ensure smooth coordination in collecting and applying digital evidence,thereby realizing its efficient litigation value.Furthermore,it is essential to check and balance the algorithm-based conviction and sentencing to protect the legitimate rights and interests of the parties involved,achieving high-quality human rights protection.

An Investigation of the First Case of Human Rabies Caused by a Fox in China in May 2016

This study assesses the causes and prevention measures of rabies through epidemiological investigation and analysis. A field epidemiological survey was conducted to investigate a case of rabies by fox bite. The onset of symptoms began 50 days after the bite. The patient did not receive standard treatment, rabies vaccination, or rabies immunoglobulin injection. The fox was killed on the spot. Saliva and pre-death blood samples were collected at different periods, and only blood RT-PCR tests yielded positive results. Wild fox bite is a major risk factor of rabies infection in Xinjiang Province, China.

Nonhypertensive male with multiple paragangliomas of the heart and neck:A case report

BACKGROUND Paraganglioma is a rare disease that can be lethal if undiagnosed.Thus,quick recognition is very important.Cardiac paragangliomas are found in patients who have hypertension.The classic symptoms are the triad of headaches,palpitations,and profuse sweating.We describe a very rare case of multiple paragangliomas of the heart and bilateral carotid artery without hypertension and outline the management strategies for this disease.CASE SUMMARY A 46-year-old man presented with the chief complaint of recently recurrent chest pain with a history of hemangioma of the bilateral carotid artery that had been surgically removed.He was found to have an intracardiac mass in the right atrioventricular groove and underwent successful excision.The final pathology demonstrated that the intracardiac mass was a cardiac paraganglioma,and the patient had an increased level of normetanephrine in the blood.The pathology and immunohistochemistry results showed that the bilateral carotid masses were also paragangliomas.During the 3 mo follow-up period,the patient did not experience recurrence of chest pain.CONCLUSION To our knowledge,this is the first case of multiple paragangliomas of the heart and neck without hypertension.This rare disease can be lethal if left undiagnosed.Thus,quick recognition is very important.The key to the diagnosis of cardiac paraganglioma is the presence of typical symptoms,including headaches,palpitations,profuse sweating,hypertension,and chest pain.Radiology can demonstrate the intracardiac mass.It is important to determine the levels of normetanephrine in the blood.The detection of genetic mutations is also recommended.Surgical resection is necessary to treat the disease and obtain pathological evidence.

The Practice and Exploration of Applying EBM to Bilingual Teaching of Medical Genetics at OSBCM

In the process of teaching medical genetics of undergraduate clinical medicine, the practice and exploration of applying EBM to the bilingual teaching of OSBCM medical genetics are carried out. Using CBL and PBL as the carrier can make up for the shortcomings of a single teaching mode, synthesize the advantages of multiple teaching modes. It starts from integrating the basic theoretical knowledge of medicine and clinical practice knowledge, improving students’ bilingual level of medical genetics, cultivating students’ literature retrieval ability, and promoting early clinical, multi-clinical and repeated clinical consciousness for medical students. Therefore, it is more conducive to cultivate students’ ability to learn independently, accurately analyze and solve problems, improve medical students’ clinical thinking ability and scientific research awareness, improve medical students’ ability of international communication, and lay a solid foundation for improving medical students’ future post competence, innovative spirit and lifelong learning ability.

The Substantive Reform of Court Trials: A Transformation of Logic in the Methods of Evidence Investigation——Summary of the Reform Pilot Project in Chengdu

In the pilot project of the substantive reform of court trials,“unexpected” judgments appeared constantly because the traditional documentary investigation mode has been replaced by an investigation mode under the principle of directness and verbalism. This change in the logic of factual judgments has caused a change in the methods of evidence examination. In traditional evidence examination, evidence obtained from investigations is supposed to be genuine and reliable. In the substantive reform of court trials, it is presumed that evidence obtained from investigations cannot be fully trusted and it is easier to ascertain the facts of the case by investigating using the principles of directness, verbalism and individualized judging methods for evidence examinations. In practice, there are three main factors affecting the genuineness of evidence: the cognitive rules of testifiers, the motivation of the subjects who provide evidence, and the methods used by investigators to obtain evidence. Based on any one of these three factors, it cannot be concluded that evidence obtained from investigations is superior to evidence presented in court. The substantive court investigation is more advantageous to establishing the facts of a case than the traditional court investigation. The essential characteristics of the substantive reform of court trials are pursuing reality in essence instead of in form, and using the files of the court trials instead of the files of the investigation to avoid the evidence obtained through investigations from playing a decisive role in the adjudication thus making criminal procedures trial-centered rather than investigation-centered.

Factors Undermining the Investigation of Child Contacts of TB Patients： The Case of FCT, Abuja, Nigeria

Facility records of 320 TB （tuberculosis） patients were examined over a one-year-period; January-December 2009 to ascertain the screening of children under 6 years of age who have had contacts with sputum smear positive TB patients as stipulated in the NTBLCP （National Tuberculosis and Leprosy Control Program） guidelines. In addition, semi-structured questionnaires were administered to 28 DOTS （directly-observed treatment strategy） clinicians to elicit information to help explain findings from the analysis of the routine data. Over 60% of children less than 6 years of age who had contacts with TB patients were not investigated in the health facilities included in the survey. The level of educational attainment of DOTS providers was associated with the screening of TB patients＇ contacts （P = 0.008）. Forgetfulness by clinicians to ask for or screen children of TB patients in the facilities is the singular most important factor undermining contact investigation. The proportion of under 6 years TB contacts screened or not screened for TB in the facilities was similar according to the age and gender of TB patients, and the type of health facilities where treatment was accessed by patients （P = 0.325）. The study underscored the need for the state program to evaluate the quality of service provision as well as counseling provided to TB patients at the facilities.

Using clinical cases to guide healthcare

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

Study of the Authenticity and Credibility of QQ Chat Records

Digital evidence investigation in QQ software is the current research focus.In order to identify the authenticity and credibility of QQ chat records,the method based on attacking QQ chat records is proposed.Firstly,an evaluation model on checking the authenticity of QQ chat records is proposed.The cases on kinds of changing QQ chat records are discussed.The challenge in identifying the authenticity of QQ chat records is raised.Secondly,case study on attacking QQ chat records is proposed to check the relationship between the authenticity of QQ chat records and the difficulty of changing them.A couple of experiments on changing QQ chat records are finished to find how difficult changing records is and whether there are clues left on changing them or not.Finally,a kind of QQ chat forensic process is presented,which can help for digital evidence investigation in the authenticity and credibility of QQ chat records.The practices in QQ forensic cases show that it works well.

Application of Dog STR Technology in Case Investigation

Taking the dog DNA database of Nanchang Police Dog Base of the Ministry of Public Security as an example, this paper introduced the typical cases solved with STR technology, in order to provide reference for correct understanding and rational use of animal material evidence to solve cases.

Recommendations for Solving Difficulties in Investigation of Environmental Pollution Cases in China

Environmental pollution has caused wide social concern,and it demands immediate attention to striking at the crime in the environmental pollution. At present,there are difficulties of putting a case on file,collecting evidence,judicial identification,and presumption of causal relationship in investigation of environmental pollution cases. In accordance with current situations,it came up following recommendations:(i) widely collecting case clues to solve the difficulty of putting a case on file;(ii) improving the ability of collecting evidence and standardizing the evidence collection,to solve the difficulty of evidence collection.(iii) including the environmental pollution judicial identification system,and unifying the identification standards,to solve the difficulty in identification. It is recommended to use the epidemiological causal relationship theory combined with enough high-quality evidences to solve the difficulty in presumption of causal relationship.

Risk of group aggregative behavior during COVID-19 outbreak: A case report

BACKGROUND At the end of 2019,a new epidemic of viral pneumonia emerged in China and was determined to be caused by a novel coronavirus,which was named coronavirus disease 2019(COVID-19)by the World Health Organization.The epidemic quickly spread,causing a worldwide pandemic.Scientists and clinicians across the globe have shifted their research efforts towards understanding the virus itself and its epidemiology.CASE SUMMARY In mid-January 2020,a Chinese family made a visit to a local city,and within the next 2 wk one after another fell ill with COVID-19.At the beginning of their first illness onset,the family had eaten in a restaurant,which led to the subsequent illness onset in another two families.All cases were diagnosed as COVID-19 by real-time fluorescent reverse transcription-polymerase chain reaction.Epidemiological investigation showed that the transmission chain was complete.CONCLUSION This chain of social exposure highlights the danger of group aggregative behavior for spread of COVID-19.

Group Investigation in a College English Program at a Chinese University:A Case Study

This study investigated the application and the effect of Group Investigation(GI) in the College English Program in a Chinese University. A qualitative case study method was used to understand the GI system used by Chinese instructors as well as the achievements acquired and challenges met by the participants. Three instructors and fifteen second-year-undergraduates taking a course titled Sources of European Culture participated. Interviews, observations, and documents were used to collect the data. Data analysis showed Chinese instructors applied a GI technique similar to that discussed by Johnson and Johnson(1999); however, GI in the Chinese context demanded more effort from the teacher for designing tasks and provided help in modeling uses of English and in preparing visual, especially Power Point, presentations. Although participants used their mother tongue at some stages, their autonomy over English learning was activated, and horizons in the course content were broadened.

基于证据的熔融金属作业Safety Case方法

为定量表征熔融金属作业安全状态,采用Safety Case,GSN方法,对熔融金属作业影响因素、生产周期、作业区段等进行安全性分析,构建1种基于证据的熔融金属作业Safety Case方法框架;在此基础上,基于证据理论,构建安全论证数学模型,提出熔融金属作业Safety Case方法。最后,以某熔融金属作业系统为实例,对其安全状态进行论证,得出该熔融金属作业系统安全状态量值及安全状态。结果表明该方法在熔融金属作业安全论证方面具有一定的可行性与有效性,可为熔融金属作业安全论证提供思路与方法。

A three-year clinical investigation of a Chinese child with craniometaphyseal dysplasia caused by a mutated ANKH gene

BACKGROUND Craniometaphyseal dysplasia(CMD)is a rare genetic disorder.Autosomal dominant CMD(AD-CMD)is caused by mutations in the ANKH gene.Affected individuals typically have distinctive facial features including progressive thickening of the craniofacial bones.Treatment for AD-CMD primarily consists of surgical intervention to release compression of the cranial nerves and the brain stem/spinal cord.To alleviate progression of the clinical course and improve the quality of life in children waiting to undergo the necessary surgery,we investigated clinical changes in a diagnosed patient with AD-CMD over three years.CASE SUMMARY A 17-mo-old boy presented with progressive nasal obstruction,snoring and hearing loss symptoms.Physical examination showed enlargement of the head circumference and clinical features such as wide nasal bridge,paranasal bossing,widely spaced eyes with an increased bizygomatic width,and a prominent mandible.The patient underwent otolaryngological examination,endoscopy,hearing test,laboratory examination of phosphorus and bone metabolism,cranial and femoral computed tomography,X-ray and next-generation sequencing.The patient was diagnosed with AD-CMD due to p.Phe377 deletion(c.1129_1131del)on exon 9 of the ANKH gene.After adherence to a prescribed low-calcium diet,the boy’s alkaline phosphatase(ALP)levels continuously decreased to within the normal range.However,after 14 mo of dietary intervention,his parents altered his diet to an intermittent low-calcium diet to include milk and eggs.The patient’s ALP was slightly higher than normal after the dietary change but remained close to the normal range.His serum osteocalcin changed to within normal levels after dietary regulation for 33 mo.His serum combined beta C-terminal telopeptide of type I collagen also continuously decreased after the nutritional intervention,although still slightly higher than normal levels.Despite fluctuating blood test results,the boy’s nasal symptoms were markedly relieved and steadily improved after dietary intervention.No significant changes were found in the craniofacial bones by cranial radiography.Close monitoring of clinical features is still ongoing.Calcitriol treatment is currently under consideration and a surgical procedure is planned as necessary in the future.CONCLUSION We herein report the first Chinese case of AD-CMD with heterozygous mutation of p.Phe377 deletion(c.1129_1131del)on the ANKH gene.Biochemical alterations were significantly improved after dietary intervention indicating that a lowcalcium diet may be applied in pediatric AD-CMD patients with ANKH mutations to help alleviate phenotypic manifestations and improve the quality of life before surgical intervention.Further large scale studies are needed to replicate these findings and to establish the appropriate timing for nutritional and surgical interventions。

NUMERICAL INVESTIGATION OF AXIAL FLOW COMPRESSOR CASING TREATMENT

Using an inviscid model with inlet total pressure gradient and a J. D. Denton scheme, this paper for the first time numerically solves the 3D flow field of compressor casing treatment, and also explores some boundary singularities and numerical stability. Agreement is attained in qualitative explanations of some, casing treatment test results and its mechanism.

Three novel homozygous ITGB2 mutations among two patients with leukocyte adhesion defect type-1:Two case reports

BACKGROUND A leukocyte adhesion defect(LAD) is a rare primary immunodeficiency disorder. LAD type 1(LAD-1) is the most common, which is caused by ITGB2 mutation resulting in dysfunction of β2 integrin, which impairs leukocyte adherence to the endothelium.CASE SUMMARY The first two cases of LAD-1 in Thailand presented with recurrent omphalitis, soft tissue infection, marked leukocytosis, and neutrophilia. One patient experienced delayed umbilical cord separation. Mutation analysis was performed by direct DNA sequencing of the ITGB2 gene. The results revealed two novel homozygous missense mutations, c.920C>T(p.Leu307Pro) in exon 8 and c.758G>A(p.Arg-253His) in exon 7, and one novel homozygous nonsense mutation, c.262C>T(p.Gln88Ter) in exon 4, in the genomic DNA of the first and second patients, respectively. Heterozygous mutations were identified in the parents of both patients, suggesting a carrier status. The patients were administered intravenous antibiotics for infections with good clinical responses. Hematopoietic stem cell transplantation could not be performed due to the unavailability of matched donors. However, a significant decline in infections was observed after antibiotic prophylaxis. Several follow-up visits were conducted for both patients. They are currently 6 years old.CONCLUSION Molecular analysis is essential for definitive diagnosis, early treatment implementation, and prevention of LAD-1 in future pregnancy.

循证视域下小学数学听评课教研活动实施的个案研究

基于循证教研视角,以北京市A小学数学学科教研组为个案,采用访谈法、观察法和实物分析法,探讨教师的听评课教研活动现状。结果发现,听评课教研活动存在过程清晰但形式松散、要素健全但流于浅表等问题,如活动主题未契合教师现实需求、教师缺乏基于问题和围绕证据的专业合作等。这些问题主要是由教研活动主题需求错位,教师证据意识匮乏、循证能力薄弱,制度文化抑制以及缺乏专家引领等引起。建议:优化流程,明晰听评课的可视化路径;调研教研需求,提高教师的批判反思能力;促进教师树立循证意识,寻找证据观照;搭建循证合作支持系统。

普外科腹腔镜手术发生皮下气肿个案报道的系统评价

目的:对普外科腹腔镜手术发生皮下气肿个案报道进行系统评价。方法:计算机检索维普数据库、万方数据库、中国知网、PubMed、Web of Science、the Cochrance Library等数据库中关于普外科腹腔镜手术发生皮下气肿的个案报道,检索时限为建库至2024年4月1日。采用SPSS 27.0对皮下气肿消失时间进行聚类分析。结果:共纳入20篇文献,中文文献16篇,英文文献4篇;发表时间为1991—2023年,涉及20例病人。聚类分析结果显示,皮下气肿消失时间可分为两类,一类皮下气肿消失时间为20 min至30 h,胆囊手术7例、胃手术1例;二类皮下气肿消失时间为2~4 d,包括胆囊手术3例、直肠手术3例、结肠手术2例、胰十二指肠手术1例。结论:现有证据表明,普外科腹腔镜手术发生皮下气肿受多种因素影响,临床应加强腹腔镜手术病人术前评估和术中观察,并及时处理,以减少术中皮下气肿的发生。