Environmental pollution is a significant public health challenge worldwide, and investigating the causal relationship between environmental exposure and population health outcomes is a key objective of environmental epidemiology research. In recent years, the complexity of environmental exposures has increasingly come to the forefront, making it challenging for observational studies that dominate environmental epidemiology to accurately estimate causal effects. Causal inference methods are particularly advantageous in controlling for confounding factors, thus holding great potential in environmental epidemiology research. Researchers can use appropriate causal inference methods to simulate the process of randomization, providing strong support for revealing the causal relationship between environmental exposure and health outcomes. However, there is a lack of reviews on the application of causal inference methods in environmental epidemiology studies in China. Therefore, this study introduced the basic principles of common causal inference statistical methods in environmental epidemiology, summarized the applicable conditions, advantages and disadvantages of various methods, and provided R software implementation codes for these methods, aiming to offer guidance for optimizing research design and practicing causal inference statistical methods.

Objective To evaluate the changes in serum bilirubin levels in children with IgA vasculitis(IgAV)nephritis(IgAVN)and its role in the diagnosis of IgAVN.Methods The clinical data of 134 patients with IgAV who were admitted to the First Affiliated Hospital of Xinxiang Medical College from October 2021 to July 2023 were retrospectively analyzed.They were divided into IgAV group(89 cases)and IgAVN group(45 cases)according to the presence or absence of renal involvement.During the same period,40 children with idiopathic short stature who were hospitalized for examination were selected as the control group.Variance analysis was used to statis-tically analyze the differences in clinical parameters and serum total bilirubin levels among the groups.Spearman correlation analysis and multivariate Logistic regression analysis were used to evaluate the correlation of the parameters.ROC curve was used to evaluate the sensi-tivity and specificity of diagnosis.Results The levels of TBIL and IBIL in the IgAV and IgAVN groups were significantly lower than those in the control group(P＜0.05),and the levels of TBIL,IBIL and DBIL in the IgAVN group were significantly lower than those in the IgAV group(P＜0.05).TBIL and IBIL levels were negatively correlated with IgAVN.The specificity of TBIL and IBIL for diagnosing IgAVN was 86.5％and 68.5％,with sensitivities of 46.7％and 51.1％,respectively.When combined with other variables,the serum bilirubin prediction model achieved an AUC of 0.817(95％CI:0.744-0.891,P＜0.001),with a sensitivity of 79.8％and specificity of 66.7％.Conclusion The determination of serum bilirubin level has a certain clinical value in predicting the occurrence of renal in-volvement(IgAVN)in children with IgAV.

Objective:To investigate the status of leisure crafting and post competence and their correlation among anesthesia specialist nurses.Methods:A convenience sampling method was used to conducted a questionnaire survey on 280 anesthesia specialist nurses at grade A tertiary hospitals in 19 provinces of China. Data were collected using a general information questionnaire, the Chinese version of Leisure Crafting Scale, and the Post Competency Scale for Anesthesia Specialist Nurses. SPSS 24.0 was used for t test and one-way analysis of variance. A Pearson correlation analysis was used to assess relationships between variables. Results:The total score of leisure crafting was (30.41±6.69) and the average score was (3.38±0.74). The total score of post competency was (141.76±21.76) and the average score was (3.73±0.57). A positive correlation was observed between leisure crafting and post competency ( r=0.215, P<0.01). Conclusions:Managers should encourage anesthesia specialist nurses to actively engage in leisure crafting and provide diverse opportunities for leisure crafting to improve their post competence and ultimately the quality of anesthesia nursing.

Objective To explore the mechanism of Luzhongjiangu Decoction in treating Osteonecrosis of the femoral head(ONFH).Methods Animal experiments were conducted to validate the therapeutic effect of Luzhongjiangu Decoction on ONFH.Network pharmacology was employed to screen potential targets,and molecular docking was used to verify the affinity between ligands and receptors.Fifty rats were randomly divided into blank group,model group,high-dose Luzhongjiangu Decoction groups,medium-dose Luzhongjiangu Decoction groups and low-dose Luzhongjiangu Decoction groups.After treatment,the therapeutic effect was evaluated by bone histomorphometry,bone histopathology and the expression of osteogenic related proteins.The serum metabolic differences were detected by UHPLC-QE-MS non-targeted metabonomics technique,followed by metabolic pathway enrichment analysis.Network pharmacology and metabolomics were integrated,and molecular docking was employed to further investigate the underlying mechanisms..Results The experimental results showed that Luzhongjiangu Decoction can significantly increase the expression of OCN,OPN and other osteogenic related factors,increase bone mineral density,alleviate the destruction of bone trabeculae,compared with that in the model group(P<0.01).The metabolomics test showed that compared with model group,Luzhongjiangu Decoction could callback 34 kinds of serum metabolic differences,involving 21 metabolic pathways,the main metabolic pathways were arachidonic acid metabolism,steroid hormone biosynthesis,primary bile acid biosynthesis,lysine degradation and so on.Network pharmacological results suggested that 185 active components and 1040 targets,551 disease targets and 76 intersection targets were obtained.The key pathways of Luzhongjiangu Decoction in the treatment of ONFH,which were analyzed by KEGG,involved HIF-1 signaling pathway,thyroid hormone signaling pathway,Calcium signaling pathway and so on.Integrated analysis showed that Luzhongjiangu Decoction may treat ONFH through seven metabolic pathways including arginine and proline metabolism,arachidonic acid metabolism,and steroid hormone biosynthesis;the molecular docking results also revealed correlation between potential pharmacodynamic substances and core target genes.Conclusion Luzhongjiangu Decoction can regulate the balance between proliferation and apoptosis of bone cells in a hypoxic environment by affecting the metabolic pathways such as arachidonic acid metabolism and HIF-1 signaling pathway,thereby exerting a therapeutic effect on osteonecrosis of the femoral head.

[Purpose]To analyze the incidence and mortality of malignant tumors in cancer regis-tration areas of Heilongjiang Province in 2019 and the trend from 2013 to 2019.[Methods]The incidence and mortality data of malignant tumors reported by the Heilongjiang provincial cancer registries from 2013 to 2019 were collected,and the quality of data was assessed.The crude in-cidence/mortality rate,age-standardized incidence/mortality rate by Chinese standard population(ASIRC/ASMRC)and world standard population(ASIRW/ASMRW),0～74 years old cumulative rate were calculated.Joinpoint 4.6.0 software was used to calculate the average annual percentage change(AAPC)of ASIRC/ASMRC for the trend analysis from 2013 to 2019.[Results]In 2019,there were 16 732 new cases of malignant tumors in the cancer registration areas of Heilongjiang Province,including 8 639 males and 8 093 females.The crude incidence rate was 295.37/105,with an ASIRC and ASIRW of 167.10/105 and 164.18/105,respectively.There were 10 988 malig-nant tumor deaths,including 6 540 males and 4 448 females.The crude mortality rate was 193.97/105,with an ASMRC and ASMRW of 101.22/105 and 101.66/105,respectively.The inci-dence and mortality of malignant tumors increased rapidly after the age of 55,and the incidence and mortality of males were slightly higher than those of females.The top five malignant tumors of high incidence were lung cancer,female breast cancer,colorectal cancer,liver cancer and thy-roid cancer,and the top five malignant tumors of high mortality were lung cancer,liver cancer,colorectal cancer,stomach cancer and female breast cancer.From 2013 to 2019,the ASIRC of malignant tumors in cancer registration areas increased from 153.08/105 in 2013 to 167.10/105 in 2019,and the ASMRC increased from 92.22/105 in 2013 to 101.22/105 in 2019,but there was no statistical difference in the change trend.[Conclusion]The incidence and mortality of malignant tumors in Heilongjiang Province remain high.Lung cancer,female breast cancer,colorectal can-cer,liver cancer and stomach cancer should be the focus of cancer prevention and control.

Objective To evaluate the changes in serum bilirubin levels in children with IgA vasculitis(IgAV)nephritis(IgAVN)and its role in the diagnosis of IgAVN.Methods The clinical data of 134 patients with IgAV who were admitted to the First Affiliated Hospital of Xinxiang Medical College from October 2021 to July 2023 were retrospectively analyzed.They were divided into IgAV group(89 cases)and IgAVN group(45 cases)according to the presence or absence of renal involvement.During the same period,40 children with idiopathic short stature who were hospitalized for examination were selected as the control group.Variance analysis was used to statis-tically analyze the differences in clinical parameters and serum total bilirubin levels among the groups.Spearman correlation analysis and multivariate Logistic regression analysis were used to evaluate the correlation of the parameters.ROC curve was used to evaluate the sensi-tivity and specificity of diagnosis.Results The levels of TBIL and IBIL in the IgAV and IgAVN groups were significantly lower than those in the control group(P＜0.05),and the levels of TBIL,IBIL and DBIL in the IgAVN group were significantly lower than those in the IgAV group(P＜0.05).TBIL and IBIL levels were negatively correlated with IgAVN.The specificity of TBIL and IBIL for diagnosing IgAVN was 86.5％and 68.5％,with sensitivities of 46.7％and 51.1％,respectively.When combined with other variables,the serum bilirubin prediction model achieved an AUC of 0.817(95％CI:0.744-0.891,P＜0.001),with a sensitivity of 79.8％and specificity of 66.7％.Conclusion The determination of serum bilirubin level has a certain clinical value in predicting the occurrence of renal in-volvement(IgAVN)in children with IgAV.

Objective To investigate the protective effect and mechanism of schisandrin A(SA)on hydrogen peroxide(H2O2)-induced oxidative stress injury in renal tubular epithelial cells(HK-2).Methods HK-2 cells were cultured in vitro and divided into five groups:blank control group,model control group(treated with 600 μmol·L-1 H2O2 for 2 h),low-dose SA group(0.125 μmol·L-1 SA,24 h pretreatment+H2O2),medium-dose SA group(0.5 μmol·L-1 SA,24 h pretreatment+H2 O2),high-dose SA group(0.75 μmol·L-1 SA,24 h pretreatment+H2O2).The cell survival was assessed by CCK-8 assay;apoptosis level was tested by Annexin V-FITC/PI double staining;cell cycle distribution was detected by propidium iodide staining;oxidative markers(ROS,SOD,MDA,GSH,LDH)was determined with commercial kits;and apoptosis-related proteins(Bax,Bcl-2,Caspase-3,Cytochrome C)was evaluated by Western blot.Results Compared with the blank control,the model group reduced in cell viability and increased in apoptosis(P＜0.01),elevated in the ratio of G0/G1-phase cells and decreased in S-phase cells(P＜0.05),decreased in SOD activity and GSH content(P＜0.01),and increased in the levels of ROS,LDH,and MDA levels(P＜0.01).In all SA dose,cell apoptosis reduced(P＜0.01).In medium/high dose groups,the G0/G1-phase arrest reduced(P＜0.05).In high dose group,the S-phase cells ratio increased(P＜0.05).And in medium/high dose groups,ROS(P＜0.01)decreased in a dose-dependent manner.The SOD activity increased non-significantly in all SA groups.In SA medium/high dose groups,the LDH activity decreased in a dose-dependent manner.In all SA groups,GSH increased(P＜0.01)and MDA decreased,both in a dose-dependent manner.The Bax/Bcl-2 ratio significantly decreased(P＜0.05)in all SA groups.The caspase-3 activity decreased in medium/high dose group(P＜0.05);and Cytochrome C reduced in all SA groups(P＜0.05).Conclusion SA protects HK-2 cells against H2O2-induced oxidative injury by modulating oxidative stress,inhibiting apoptosis,and ameliorating cell cycle arrest.

Objective To investigate the protective effect and mechanism of schisandrin A(SA)on hydrogen peroxide(H2O2)-induced oxidative stress injury in renal tubular epithelial cells(HK-2).Methods HK-2 cells were cultured in vitro and divided into five groups:blank control group,model control group(treated with 600 μmol·L-1 H2O2 for 2 h),low-dose SA group(0.125 μmol·L-1 SA,24 h pretreatment+H2O2),medium-dose SA group(0.5 μmol·L-1 SA,24 h pretreatment+H2 O2),high-dose SA group(0.75 μmol·L-1 SA,24 h pretreatment+H2O2).The cell survival was assessed by CCK-8 assay;apoptosis level was tested by Annexin V-FITC/PI double staining;cell cycle distribution was detected by propidium iodide staining;oxidative markers(ROS,SOD,MDA,GSH,LDH)was determined with commercial kits;and apoptosis-related proteins(Bax,Bcl-2,Caspase-3,Cytochrome C)was evaluated by Western blot.Results Compared with the blank control,the model group reduced in cell viability and increased in apoptosis(P＜0.01),elevated in the ratio of G0/G1-phase cells and decreased in S-phase cells(P＜0.05),decreased in SOD activity and GSH content(P＜0.01),and increased in the levels of ROS,LDH,and MDA levels(P＜0.01).In all SA dose,cell apoptosis reduced(P＜0.01).In medium/high dose groups,the G0/G1-phase arrest reduced(P＜0.05).In high dose group,the S-phase cells ratio increased(P＜0.05).And in medium/high dose groups,ROS(P＜0.01)decreased in a dose-dependent manner.The SOD activity increased non-significantly in all SA groups.In SA medium/high dose groups,the LDH activity decreased in a dose-dependent manner.In all SA groups,GSH increased(P＜0.01)and MDA decreased,both in a dose-dependent manner.The Bax/Bcl-2 ratio significantly decreased(P＜0.05)in all SA groups.The caspase-3 activity decreased in medium/high dose group(P＜0.05);and Cytochrome C reduced in all SA groups(P＜0.05).Conclusion SA protects HK-2 cells against H2O2-induced oxidative injury by modulating oxidative stress,inhibiting apoptosis,and ameliorating cell cycle arrest.

Objective The aim of this study was to explore the predictive value of the systemic inflammatory immune nutri-tion score(SIINS)for the prognosis of immunotherapy for advanced gastric cancer.Methods A retrospective analysis was conducted on the clinical data of 202 patients with advanced gastric cancer who received treatment with programmed death-1(PD-1)inhibitors at the Harbin Medical University Cancer Hospital from October 2018 to July 2022.The LASSO regression analysis was used to screen prognostic indicators,construct SIINS indicator,determine the optimal cutoff value for predicting prognosis using subject operating characteristic curves,and divide patients into the high SIINS and low SIINS groups.Independent prognostic factors for overall survival(OS)were determined using univariate and multivariate Cox regression analyses.Results Four indicators,including lymphocyte count,lactate dehydrogenase,and neutrophil lymphocytes,were selected to construct the SIINS index.The prognosis of patients in the high SIINS group was significantly lower than that in the low SIINS group(P<0.05).The results of the multifactorial Cox regression a-nalysis showed that the Eastern Cooperative Oncology Group(ECOG)score,Geriatric Nutritional Risk Index(GNRI),SIINS,treatment regimen,and number of treatment lines(P<0.05)could serve as the independent predictive prognosis of immunotherapy for advanced gastric cancer.Conclusion SIINS can predict the prognosis of patients with advanced gastric cancer treated with PD-1 inhibitors.

Objective To provide reference for future basic research and clinical research,the research status and trend of podophyllotoxin were explored.Methods Based on Citespace and R software,the co-occurrence map,keyword clustering and burst analysis of the English literature on podophyllotoxin in the Scientific Core Collection(WoSCC)were carried out to explore the research hotspots and analyze the frontier progress.Results A total of 1220 papers on podophyllotoxin published by 531 institutions from 77 countries and regions were retrieved.The number of published papers showed an overall upward trend.The analysis of the author 's cooperation network map showed that there was cooperation and communication between the authors,but it was relatively scattered,and the cooperation was not close.This phenomenon also existed in the relationship between research institutions.The country with the largest number of papers was China,and the institution was Lanzhou University.869 authors participated in the research in this field,and 422 academic journals published papers on podophyllotoxin.Among them,podophyllotoxin,derivatives,analogues,biological evaluation and etoposide had a high frequency of occurrence,indicating that these fields had high attention and great research potential.Conclusion In recent years,the research on podophyllotoxin and its derivatives in the treatment of tumors has developed rapidly.In addition,the pharmacological effects and gene regulation of podophyllotoxin are also new research trends.The research hotspots show a trend of diversification,which provides strong evidence for further exploring the molecular mechanism of podophyllotoxin in the treatment of various diseases.However,the lack of relatively in-depth basic research has limited the development of clinical research.