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 investigate the short-term efficacy, safety and factors affecting recurrence of intermediate-risk and high-risk non-muscle invasive bladder cancer (NMIBC) treated with intravesical instillation of domestic Bacillus Calmette-Guérin (BCG) infusion.Methods:This study was a retrospective cohort study. We collected the data of 163 patients with NMIBC treated with domestic BCG after transurethral resection of bladder tumor (TURBT) from October 2016 to October 2020 in the Department of Urology, the Affiliated Hospital of Qingdao University. There were 140 males and 23 females, the age was(67.3±10.3) years old. 23 cases had only been received BCG and 140 cases received other chemotherapy drugs before. The induction scheme of instillation was started after the TURBT at once a week for 6 consecutive weeks, continue instillation at every two weeks for 3 doses, then maintenance instillation once a month for 10 consecutive times, for a total of 19 instillations. Kaplan-Meier analysis was used to calculate recurrence-free survival. Binary Logistic regression was used to analyze factors and stepwise regression (backward method) was employed to identify independent risk factors for recurrence after BCG instillation. The incidence of adverse reactions was recorded. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), measurement data with skewed distribution were expressed as M( Q1, Q3), and count data were expressed as frequency and percentage(%). Results:A total of 23 cases experienced recurrence within the 13-month of instillation, of which 7 cases were found to have progressed by pathological biopsy, and the cumulative recurrence-free rate was 85.9%. The results of binary logistic regression analysis showed that the history of re-TURBT ( P=0.010) was an independent predictor for recurrence after BCG intravesical instillation. Adverse events occurred in 110 cases. The main symptoms of the 65 cases were urgency of urination, pollakiuria and dysuria with urinary irritation, urinary tract infection in 15 cases, hematuria in 10 cases, and other symptoms in 20 cases. Instillation was terminated in 7 cases due to side effects, no serious adverse events such as spread of tuberculous bacteria were observed in the cases. Conclusions:Patients with NMIBC treated with intravesical instillation of domestic BCG have significant short-term efficacy, while patients who have previously received re-TURBT is an independent predictor for recurrence. The domestic BCG have the characteristic of slight side effect, good efficacy and safety.

Objective To analyze the clinical features and surgical treatment strategies of T4a thyroid cancer.Methods We retrospectively analyzed patients with thyroid cancer treated in the Department of Head and Neck Surgery of Sichuan Cancer Hospital from January 2004 to May 2021.A total of 303 cases were included and statistically analyzed for pathological type,invaded organs,surgical approach,survival time,and overall survival rate.The postoperative survival curves of the patients were analyzed using the Kaplan Meier method.Results Of the 303 patients enrolled,53 patients were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 98.4％(246/250),97.0％(224/231)and 90.2％(92/102),respectively.Of the 94 patients with recurrent laryngeal nerve invasion only,13 were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 100％(81/81),98.7％(77/78)and 97.4％(38/39),respectively.There were 151 patients with invasion of recurrent laryngeal nerve and tracheal/laryngeal/esophageal nerve,31 of them were lost to follow-up,and the 1-year,3-year and 5-year overall survival rates were 96.7％(116/120),95.3％(101/106)and 82.2％(37/45),respectively.According to the survival curve analysis,the group with recurrent laryngeal nerve invasion only had an advantage in overall survival time over the group with recurrent laryngeal nerve and tracheal/laryngeal/esophageal invasion.Conclusion Surgical resection is supposed to be preferred for T4a thyroid cancer if there is a chance of surgery.A reasonable surgical strategy,radical surgery while preserving the vital tissues and organs,and one-stage repair and reconstruction can bring patients a better quality of life and prognosis.

Objectives:To investigate the prognostic value of soluble growth stimulation expressed gene 2 protein(sST2)combined with N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PCI). Methods:A total of 206 patients who were diagnosed with STEMI for the first time and underwent emergency PCI from August 2020 to February 2021 in the People's Hospital of Liaoning Province were enrolled.Patients were followed up for 3 years and divided into major adverse cardiac event(MACE,a composite endpoint event including cardiac death,stroke,heart failure,and ischemia-driven revascularization)group and MACE-free group.Multivariate cox analysis was performed to determine the independent risk factors for the prognosis of primary PCI in STEMI patients;the predictive value of sST2 and NT-proBNP for the occurrence of MACE in STEMI patients undergoing primary PCI was assessed by ROC analysis and the prediction of MACE by each factor by itself and the combined variables was analyzed with the Delong test. Results:There were 62 cases of MACE during the 3-year follow-up.Compared with the MACE-free group,patients in the MACE group had higher levels of sST2 and NT-proBNP,higher proportion of patients with left anterior descending branch lesions,anterior wall myocardial infarction,lower LVEF,and higher proportion of coronary artery slow flow(all P<0.05).Multivariate Cox analysis showed that sST2(HR=1.018,95%CI:1.012-1.024,P<0.001)and NT-proBNP(HR=1.001,95%CI:1.000-1.010,P<0.001)were independent predictors of MACE.According to the statistical analysis of ROC and Delong test,the AUC of combined sST2 and NT-proBNP in predicting MACE was 0.854,the sensitivity was 64.5%,the specificity was 93.1%,and the combined prediction of prognosis was better than that of individual prediction,with statistically significant difference(Z=2.119,P=0.034;Z=2.178,P=0.029). Conclusions:Serum sST2 and NT-proBNP are valuable predictors of MACE after emergency PCI in patients with STEMI,and the predictive efficacy increases with combined assessment of both sST2 and NT-proBNP.

OBJECTIVE： To provide scientific evidence for establishing perfect rationality evaluation indicator system of antibiotics. METHODS： On the basis of literature research， Delphi method was used to conduct several rounds of consultations on 30 experts in related fields with E-mail and questionnaire field investigation. After several rounds of consultations， rationality evaluation index system for antibiotics was determined. The effective recovery rate of expert consultation questionnaire was used to express the positive coefficient of experts； the authoritative coefficient was used to express the authoritative degree of experts； the index importance assignment and the full score ratio were used to reflect the concentration degree of experts’ opinions； the coefficient of variation and the coefficient of coordination were used to express the coordination degree of experts’ opinions. RESULTS & CONCLUSIONS： After two rounds of consultations， response rates of the questionnaire in two rounds of surveys were 100％ and 96.67％， indicating experts were highly motivated. The authoritative coefficients were 0.91 and 0.88， indicating experts had a high degree of authority. Finally， an evaluation index system for rationality of antibiotics was established， which included four first-level indicators （indications， drug selection， medication process， management indicators） and 35 second-level indicators. Among them， the mean value of importance scoring of first-level indicators ranged from 4.28 to 5.00， the full score ratio from 0.93 to 1.00， the coefficient of variation from 0.00 to 0.15 and the coefficient of coordination was 0.446 （P＜0.001）. While， the mean value of importance scoring of second-level indicators ranged from 3.83 to 4.79； the full score ratio from 0.67 to 1.00； variation coefficient from 0.10 to 0.26 and the coefficient of coordination was 0.115 （P＜0.001）， which indicating the system was reliable.

PURPOSE: This study aimed to evaluate the prognostic impact of lymphovascular invasion (LVI) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: We collected data from 180 patients who were treated with RNU from 2005 to 2013 at our institution. The Kaplan-Meier method with log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses. RESULTS: LVI was present in 28 patients (15.6%), which was associated with higher pathological tumor stage (p < 0.001), tumor necrosis (p=0.012), lymph node metastasis (p=0.017) and multifocality (p=0.012). On multivariate analysis, LVI was an independent prognostic factor of recurrence-free survival [RFS: hazard ratio (HR)=2.954; 95% confidence interval (CI)=1.539–5.671; p=0.001] and cancer-specific survival (CSS: HR=3.530; 95% CI=1.701–7.325; p=0.001) in all patients. In patients with node-negative UTUC, LVI was also a significant predictor of RFS (HR=3.732; 95% CI 1.866–7.464; p < 0.001) and CSS (HR=3.825; 95% CI=1.777–8.234; p=0.001). CONCLUSION: LVI status was an independent predictor in patients with UTUC who underwent RNU. The estimate of LVI could help physicians identify high-risk patients and make a better medication regimen of adjuvant chemotherapy.
Carcinoma, Transitional Cell ; Chemotherapy, Adjuvant ; Humans ; Lymph Nodes ; Methods ; Multivariate Analysis ; Necrosis ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Prognosis ; Urinary Tract

Objective To investigate the effect of olmesartan medoxomil on osteoprotegerin and serum inflammatory factor expression in atherosclerosis model rat.Methods From 2015 April in Jiangsu Institute of schistosomiasis control,24 Sprague-Dawley rats were randomly divided into the following three groups:the control group was fed with standard food,the model group was fed with high fat diet based on standard food(normal food +2％ cholesterol +5％ goat fat +0.2％ acid +7×105 IU/(kg·d) Vitamin D3),and the olmesartan group was given 3 mg/(kg·d) olmesartan gavage daily on the basis of high fat diet.On the fourth week of experiment the level of serum high sensitivity C reactive protein and serum lipids include total cholesterol,low density lipoprotein,high density lipoprotein and triglyceride were detected.The structure and changes of aortic pathology was observed.The expression of osteoprotegerinin in aortic was detected by immunohistochemistry staining and Western blot.Results Within the model group,the level of serum lipid and high-sensitivity C reactive protein increased significantly,endometrial thickness,intima-to-media thickness ratio and osteoprotegerin expression in aorta was significantly higher than that of normal group,the difference was statistically significant(P<0.05).The serum high density lipoprotein increased significantly,the level of other serum lipids and high sensitive C reaction protein decreased significantly,endometrial thickness,intima-to-media thickness ratio and osteoprotegerin expression in aorta of the olmesartan treated rats were significantly lower than those of model animals,the difference was statistically significant(P<0.05).Conclusion Olmesartan may suppress the development of atherosclerosis in model rats by decreasing the expression of osteoprotegerin and the level of serum inflammatory cytokines.

DHA (22:6n-3) is a Ω-3 polyunsaturated fatty acid with 22 carbon atoms and 6 double bonds, which has important biological functions in human body. Human and other mammals synthesize only limited amounts of DHA, more requirements must be satisfied from food resources. However, the natural resources of DHA (Mainly deep-sea fish and other marine products) are prone to depletion. New resources development is still insufficient to satisfy the growing market demand. Previous studies have revealed that the mammals can increase the synthesis of DHA and other long-chain polyunsaturated fatty acids after transgenic procedures. In this study, mammalian cells were transfected with Δ6, Δ5 desaturase, Δ6, Δ5 elongase, Δ15 desaturase (Isolated from nematode Caenorhabditis elegans) and Δ4 desaturase (Isolated from Euglena gracilis), simultaneously. Results show that the expression or overexpression of these 6 enzymes is capable of conversion of the o-6 linoleic acid (LA, 18:2n-6) in DHA (22:6n-3). DHA content has increased from 16.74% in the control group to 25.3% in the experimental group. The strategy and related technology in our research provided important data for future production the valuable DHA (22:6n-3) by using genetically modified animals.
Animals ; Caenorhabditis elegans ; enzymology ; Cells, Cultured ; Docosahexaenoic Acids ; chemistry ; Euglena gracilis ; enzymology ; Fatty Acid Desaturases ; biosynthesis ; Linoleic Acid ; chemistry ; Mammals ; Transfection

Objective To explore the set-up errors of position fixation with simple perforated foam pad in colorectal cancer radiotherapy and their causes as well as the improvement measures.Methods Sixty cases of color-ectal cancer patients undergoing radiotherapy were collected.Prone position was adopted with the position fixed by perforated foam pad and membrane.CBCT imaging was taken weekly before treatment,setup errors were corrected if necessary.Errors throughout the course of treatment for each patient were recorded and compared between patients, followed by analyzing the reasons of errors.Results Before calibration,the maximum errors on the direction of left and right (X-axis),front and back (Z),upside and downside (Y)in these 60 patients were 0.5cm,0.9cm and 0.7cm respectively with the average errors of (0.22 ±0.03)cm,(0.38 ±0.03)cm and (0.27 ±0.04)cm respec-tively.Conclusion The method of applying perforated foam pad and thermoplastic mask in colorectal cancer radio-therapy is currently the most commonly used in the clinical position fixation techniques,by which the small intestine, bladder and other pelvic tissues can be well protected.Due to poor comfort prone position,it is necessary to further improve perforated foam pad through improving the quality of the foam pad,thus improving patients comfort and posi-tioning repeatability and reducing position fixation errors.

Three long-chain polyunsaturated fatty acids, docosahexaenoic acid (DHA, 22:6n-3), eicosapentaenoic acid (EPA, 20:5n-3) and arachidonic acid (ARA, 20:4n-6), are the most biologically active polyunsaturated fatty acids in the body. They are important in developing and maintaining the brain function, and in preventing and treating many diseases such as cardiovascular disease, inflammation and cancer. Although mammals can biosynthesize these long-chain polyunsaturated fatty acids, the efficiency is very low and dietary intake is needed to meet the requirement. In this study, a multiple-genes expression vector carrying mammalian A6/A5 fatty acid desaturases and multiple-genes expression vector carrying mammalian Δ6/Δ5 fatty acid desaturases and Δ6/Δ5 fatty acid elongases coding genes was used to transfect HEK293T cells, then the overexpression of the target genes was detected. GC-MS analysis shows that the biosynthesis efficiency and level of DHA, EPA and ARA were significantly increased in cells transfected with the multiple-genes expression vector. Particularly, DHA level in these cells was 2.5 times higher than in the control cells. This study indicates mammal possess a certain mechanism for suppression of high level of biosynthesis of long chain polyunsaturated fatty acids, and the overexpression of Δ6/Δ5 fatty acid desaturases and Δ6/Δ5 fatty acid elongases broke this suppression mechanism so that the level of DHA, EPA and ARA was significantly increased. This study also provides a basis for potential applications of this gene construct in transgenic animal to produce high level of these long-chain polyunsaturated fatty acid.
Acetyltransferases ; genetics ; metabolism ; Arachidonic Acid ; biosynthesis ; Docosahexaenoic Acids ; biosynthesis ; Eicosapentaenoic Acid ; biosynthesis ; Fatty Acid Desaturases ; genetics ; metabolism ; Fatty Acid Synthases ; genetics ; metabolism ; Fatty Acids, Unsaturated ; biosynthesis ; Genetic Vectors ; HEK293 Cells ; Humans ; Transfection