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.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To provide basis for personalized health interventions for military pilots by analyzing the longitudinal variation trend of waist circumference and its correlation with BMI and lipid metabolism indicators among military pilots.Methods:A retrospective analysis was used on the base of collecting the physical examination data of 323 pilots who had been consecutively recuperated for 3 times and completed 3 health indicator examinations in Air Force Healthcare Center for Special Services Hangzhou from January of 2017 to January of 2022. The pilots were divided into waist circumference <85 cm group, ≥85-90 cm group, and ≥90 cm group. According to their waist circumference change trend, they were divided into increased group (difference of waist circumference >0 cm) and decreased group (difference of waist circumference ≤0 cm). According to the 5-year change rate of waist circumference (Δ5), they were divided into waist circumference relative increased group (Δ5>3%), relative stable group (-3%≤Δ5≤3%), and relative decreased group (Δ5<-3%). The stratification of different waist circumference, the 5-year change rate of waist circumference and BMI, blood lipid indexes and abnormal rate of hyperlipidemia were compared. Waist circumference was measured and determined according to the relevant standards for flying personnel and adults.Results:①The mean waist circumference of 323 pilots was close to the value of pre-central obesity. The mean BMI had reached the overweight standard, and the mean TG and TC were at high end of normal values.②During the 5-year period, the values of blood lipid metabolism indicators were repeatedly measured 3 times, and the mean values of TG, TC, and LDL-C showed an increasing trend, with significant differences ( F=7.39, 9.49, 3.67, P=0.001,<0.001, =0.026) and the mean values of TG and TC of the third measurement had approached to high limit. ③The results of BMI, TG in 3 measurements, LDL-C in the first and third measurements, TC in the first measurement and the incidence of hyperlipidemia were all increased with the increase of waist circumference and the differences were significant ( F=3.06-133.39, χ2=9.08-22.99, all P<0.05); HDL-C decreased with the increase of waist circumference, with significant differences ( F=6.32, 9.78, 10.86, P=0.002, <0.001, <0.001). The mean BMI of the ≥85-90 cm group reached the overweight level in the 3 measurements. The mean values of TG and TC in the first 2 measurements were at high end of normal value, but the mean values in the third measurement were higher than the normal range. The mean values of BMI, TG, and TC in ≥90 cm group were all within the abnormal range. ④ The 5-year change rate of BMI and LDL-C in the waist circumference increased group were higher than those in the waist circumference decreased group ( F=26.02, 14.95, both P<0.001). ⑤The waist circumference relative stable and relative increased group had a higher incidence of new hyperlipidemia, with 27 cases (21.77%) and 24 cases (20.00%) respectively. The waist circumference relative decreased group had the highest improvement rate of hyperlipidemia in 5 cases (6.33%), but the difference was not significant (all P>0.05). Conclusions:The abnormal rates of waist circumference, BMI, and blood lipids in military pilots are relatively high and show an increasing trend. The changes in waist circumference are closely related to BMI and blood lipids, and maintaining waist circumference within a normal range helps to maintain stability of blood lipid metabolism.

Objective Intracerebral hemorrhage(ICH),the second most common type of stroke,can cause long-lasting disability in the afflicted patients.The study was conducted to examine the patterns of change in endogenous neural stem cells(eNSCs)and in the regenerative microenvironment after ICH,to observe the relationship between the migration of eNSCs and the pattern of change in the polarization state of immune cells in the microenvironment,and provide a research basis for research on clinical nerve repair.Methods The collagenase injection method was used for modeling.The ICH model was induced in adult female Sprague-Dawley(SD)rats by injecting type Ⅶ collagenase(2 U)into the brain tissue of rats.All the experimental rats weighed 280-300 g.In order to simulate the ICU at different time points,including the acute phase(within 1 week),subacute phase(1-3 weeks),and the chronic phase(over 3 weeks),brain tissues were harvested at 3 day post injection(3 DPI),10 DPI,20 DPI,and 30 DPI to evaluate the modeling effect.Immunofluorescence staining of the brain tissue sections was performed with DCX antibody to observe the pattern of change in the migration of eNSCs in the brain tissue at different time points.Immunofluorescence staining of brain tissue sections was performed with CD206 antibody and CD86 antibody for respective observation of the pattern of change in pro-inflammatory(M1-type)and anti-inflammatory(M2-type)immune cells in the regenerative microenvironment of the brain tissue after ICM.Results Spontaneous ICH was successfully induced by injecting type Ⅶ collagenase into the brain tissue of SD rats.The volume of the hematoma formed started to gradually increase at 3 DPI and reached its maximum at 10 DPI.After that,the hematoma was gradually absorbed and was completely absorbed by 30 DPI.Analysis of the pattern of changes in eNSCs in the brain tissue showed that a small number of eNSCs were activated at 3 DPI,but very soon their number started to decrease.By 10 DPI,eNSCs gradually began to increase.A large number of eNSCs migrated to the hemorrhage site at 20 DPI.Then the number of eNSCs decreased significantly at 30 DPI(P<0.01).Analysis of the immune microenvironment of the brain tissue showed that pro-inflammatory(M1 type)immune cells increased significantly at 10 and 20 DPI(P<0.01)and decreased at 30 DPI.Anti-inflammatory(M2 type)immune cells began to increase gradually at 3 DPI,decreased significantly at 20 DPI(P<0.05),and then showed an increase at 30 DPI.Conclusion After ICH in rats,eNSCs migrating toward the site of ICH first increase and then decrease.The immune microenvironment demonstrates a pattern of change in which inflammation is suppressed at first,then promoted,and finally suppressed again.Inflammation may have a stimulatory effect on the migration of eNSCs,but excessive inflammatory activation has an inhibitory effect on the differentiation and further activation of eNSCs.After ICH,the early stage of repair and protection(10 d)and the subacute phase(20 d)may provide the best opportunities for intervention.

Objective:To provide basis for personalized health interventions for military pilots by analyzing the longitudinal variation trend of waist circumference and its correlation with BMI and lipid metabolism indicators among military pilots.Methods:A retrospective analysis was used on the base of collecting the physical examination data of 323 pilots who had been consecutively recuperated for 3 times and completed 3 health indicator examinations in Air Force Healthcare Center for Special Services Hangzhou from January of 2017 to January of 2022. The pilots were divided into waist circumference <85 cm group, ≥85-90 cm group, and ≥90 cm group. According to their waist circumference change trend, they were divided into increased group (difference of waist circumference >0 cm) and decreased group (difference of waist circumference ≤0 cm). According to the 5-year change rate of waist circumference (Δ5), they were divided into waist circumference relative increased group (Δ5>3%), relative stable group (-3%≤Δ5≤3%), and relative decreased group (Δ5<-3%). The stratification of different waist circumference, the 5-year change rate of waist circumference and BMI, blood lipid indexes and abnormal rate of hyperlipidemia were compared. Waist circumference was measured and determined according to the relevant standards for flying personnel and adults.Results:①The mean waist circumference of 323 pilots was close to the value of pre-central obesity. The mean BMI had reached the overweight standard, and the mean TG and TC were at high end of normal values.②During the 5-year period, the values of blood lipid metabolism indicators were repeatedly measured 3 times, and the mean values of TG, TC, and LDL-C showed an increasing trend, with significant differences ( F=7.39, 9.49, 3.67, P=0.001,<0.001, =0.026) and the mean values of TG and TC of the third measurement had approached to high limit. ③The results of BMI, TG in 3 measurements, LDL-C in the first and third measurements, TC in the first measurement and the incidence of hyperlipidemia were all increased with the increase of waist circumference and the differences were significant ( F=3.06-133.39, χ2=9.08-22.99, all P<0.05); HDL-C decreased with the increase of waist circumference, with significant differences ( F=6.32, 9.78, 10.86, P=0.002, <0.001, <0.001). The mean BMI of the ≥85-90 cm group reached the overweight level in the 3 measurements. The mean values of TG and TC in the first 2 measurements were at high end of normal value, but the mean values in the third measurement were higher than the normal range. The mean values of BMI, TG, and TC in ≥90 cm group were all within the abnormal range. ④ The 5-year change rate of BMI and LDL-C in the waist circumference increased group were higher than those in the waist circumference decreased group ( F=26.02, 14.95, both P<0.001). ⑤The waist circumference relative stable and relative increased group had a higher incidence of new hyperlipidemia, with 27 cases (21.77%) and 24 cases (20.00%) respectively. The waist circumference relative decreased group had the highest improvement rate of hyperlipidemia in 5 cases (6.33%), but the difference was not significant (all P>0.05). Conclusions:The abnormal rates of waist circumference, BMI, and blood lipids in military pilots are relatively high and show an increasing trend. The changes in waist circumference are closely related to BMI and blood lipids, and maintaining waist circumference within a normal range helps to maintain stability of blood lipid metabolism.

Long non-coding RNAs (lncRNAs) are a group of non-coding RNAs with a length of over 200 nucleotides. Recently, studies have shown that lncRNAs can regulate gene expression at the epigenetic, transcriptional, and post-transcriptional levels, affect the proliferation, migration, and infiltration of tumor cells, and participate in the occurrence and development of benign and malignant proliferative skin diseases, such as keloids, hemangioma, squamous cell carcinoma and melanoma. This review summarizes roles of lncRNAs in the pathogenesis of benign and malignant proliferative skin diseases.

Objective:To investigate the value of single sperm sequencing combined with PCR-reverse dot blot (PCR-RDB) technology in preimplantation genetic testing (PGT) of Southeast Asian deletion type α thalassemia.Methods:A couple of Southeast Asian deletion type α thalassemia carrier was selected in this case, who asked for assisted reproduction in the Department of Obstetrics and Gynecology of the Third Affiliated Hospital of Guangzhou Medical University on April 24, 2020. The male carrier was subjected to single sperm isolation by the swim-up method combined with micropipette due to his incomplete pedigree. Five single sperm samples were isolated and their whole-genome were amplified. The genotype of thalassemia of single sperm samples were determined by PCR-RDB. SNPs were selected as genetic markers in the range of 1 Mb upstream and downstream of -- SEA region to construct chromosomal haplotype. Next, we performed whole-genome amplification on six blastocyst biopsy samples, and then next-generation sequencing was carried out to detect the carrier status of the embryos. Finally, the non-pathogenic blastocysts were selected for transplantation, and the preimplantation genetic testing for monogenic (PGT-M) results were confirmed by the prenatal genetic diagnosis during pregnancy. Results:The pathogenic variant in the female was inherited from her mother, and four of the five single sperm samples were wild-type. Ten male informative SNP markers were identified by single sperm sequencing, and six female informative SNP markers were identified by linkage analysis of female family. PGT-M results indicated that four blastocysts were αα/-- SEA and two were -- SEA/-- SEA. The result of prenatal diagnosis revealed that the fetus was a carrier of -- SEA , which was consistent with PGT-M result, and a healthy girl was delivered at 40 weeks of gestation. Conclusion:For male carriers of Southeast Asian deletion type α thalassemia with incomplete pedigree, single sperm sequencing combined with PCR-RDB technology can be used to select SNP sites, and PGT-M can be performed by linkage analysis.

Objective:To investigate the value of single sperm sequencing combined with PCR-reverse dot blot (PCR-RDB) technology in preimplantation genetic testing (PGT) of Southeast Asian deletion type α thalassemia.Methods:A couple of Southeast Asian deletion type α thalassemia carrier was selected in this case, who asked for assisted reproduction in the Department of Obstetrics and Gynecology of the Third Affiliated Hospital of Guangzhou Medical University on April 24, 2020. The male carrier was subjected to single sperm isolation by the swim-up method combined with micropipette due to his incomplete pedigree. Five single sperm samples were isolated and their whole-genome were amplified. The genotype of thalassemia of single sperm samples were determined by PCR-RDB. SNPs were selected as genetic markers in the range of 1 Mb upstream and downstream of -- SEA region to construct chromosomal haplotype. Next, we performed whole-genome amplification on six blastocyst biopsy samples, and then next-generation sequencing was carried out to detect the carrier status of the embryos. Finally, the non-pathogenic blastocysts were selected for transplantation, and the preimplantation genetic testing for monogenic (PGT-M) results were confirmed by the prenatal genetic diagnosis during pregnancy. Results:The pathogenic variant in the female was inherited from her mother, and four of the five single sperm samples were wild-type. Ten male informative SNP markers were identified by single sperm sequencing, and six female informative SNP markers were identified by linkage analysis of female family. PGT-M results indicated that four blastocysts were αα/-- SEA and two were -- SEA/-- SEA. The result of prenatal diagnosis revealed that the fetus was a carrier of -- SEA , which was consistent with PGT-M result, and a healthy girl was delivered at 40 weeks of gestation. Conclusion:For male carriers of Southeast Asian deletion type α thalassemia with incomplete pedigree, single sperm sequencing combined with PCR-RDB technology can be used to select SNP sites, and PGT-M can be performed by linkage analysis.

Objective:To investigate the expression of promyelocytic leukemia zinc finger (PLZF) in human peripheral blood with asthma and its clinical significance.Methods:Forty patients with stable asthma from May 2021 to October 2021 in the Department of Respiratory Medicine of the Shanghai Fifth People's Hospital were enrolled, and forty healthy controls were recruited in the study. The levels of cytokines in serum were measured by enzyme-linked immunosorbent assay (ELISA). Quantitative real-time PCR (qPCR) was used to detect the expression of PLZF mRNA in plasma. The level and distribution of PLZF+ cells in PBMCs were detected by flow cytometry after isolating peripheral blood mononuclear cells (PBMCs). Independent sample t test, Mann-Whitney U test, χ 2 test, ROC curve and Logistic regression were used to analyze the results with SPSS 26.0 and Graphpad Prism 7.0. A P<0.05 was considered statistically significant. Results:The levels of cytokines IFN-γ, IL-2, IL-4, TNF-α and IL-17 in human peripheral blood from the asthma group were obviously higher than those in the control group ( P<0.05), whereas there was no significant difference in the level of cytokine IL-10 between the two groups. The level of PLZF mRNA in PBMCs from the asthma group was significantly up-regulated compared to that in the control group [(3.40%±2.52%) vs. (1.23%±0.78%), P<0.05]. CD8+PLZF+ and Vβ11+PLZF+T cells in the asthma group were significantly outnumbered than those in the control group ( P<0.05). Logistic regression and ROC curve analysis showed that PLZF expression in PBMC was a risk factor for the development of asthma ( OR =3.67, AUC=0.87, P<0.05). Conclusions:The high expression of PLZF in peripheral blood may play an important role in the development of asthma, which needs to be further confirmed by large sample studies.

【Objective】 To explore the safety of RhD-positive red blood cells (RBCs) immunization schedules in RhD-negative volunteers, so as to facilitate the development of domestic anti-D immunoglobulin. 【Methods】 From January 2018 to April 2020, 23 RhD negative volunteers with informed consent were enrolled and divided into initial immunization group and booster immunization group. The initial immunization included first immunization, second immunization and third immunization. Four groups, i. e. 3 cases of 20 mL, 8 of 30 mL, 6 of 40 mL, and 6 of 50 mL, were involved in initial immunization. After the initial immunization response, booster immunizations were performed every 3 months. According to the anti-D titer before each immunization, the booster immunization doses were set to 0.5, 1 and 2 mL. Whole blood samples of 5mL/ person (time) were collected 24 h and 1 week after each infusion, and the blood routine, liver, kidney and blood coagulation function and anti-D titer were detected. The differences of detection (index) values at 24 h and 1 week after the first immunization and booster immunization in each (dose) group were compared. 【Results】 No statistically significant differences were observed in hemolysis index values (all within the range of medical reference values) 24 h or 1 week after initial immunization among RhD positive RBCs of 20, 30, 40 and 50mL(P>0.05). The differences between the hemolysis index values and the basic values before the immune response (all within the range of medical reference values) after 0.5 or 1 mL booster immunizations were also not statistically different (P>0.05). However, the differences (μmol/L)between total bilirubin levels and the basic values before the immune response (1.55±1.87, 6.29±2.66) were significantly different after 2 mL booster immunization (P<0.05). 【Conclusion】 No risks affecting the safety of RhD negative volunteers was found in the immunization schedule proposed in this study.