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.

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality, characterized by poor prognosis due to its high proliferative and invasive potential. Tumor metabolic reprogramming, particularly involving glucose metabolism, is essential for tumor survival. This study investigates the role of the Hippo pathway effector transcriptional co-activator with PDZ-binding motif (TAZ) in regulating gluconeogenesis and promoting tumorigenesis in HCC. Methods: TAZ expression in HCC was analyzed using The Cancer Genome Atlas data and validated in clinical samples and cell lines. TAZ was overexpressed or silenced in HCC cell lines to evaluate its effects on cell proliferation, apoptosis, migration, and invasion. The expression and prognostic relevance of the gluconeogenesis-related genes phosphoenolpyruvate carboxykinase 1 (PCK1) and glucose-6-phosphatase (G6PC) were examined, along with their correlation with TAZ expression. Tumor growth was assessed in nude mice. Interactions between TAZ and the glucocorticoid receptor (GR) were investigated using co-immunoprecipitation, immunofluorescence, and chromatin immunoprecipitation assays. Results: TAZ was significantly upregulated in HCC tissues and cell lines. TAZ overexpression enhanced proliferation, reduced apoptosis, and promoted migration and invasion. In contrast, PCK1 and G6PC were downregulated in HCC and showed a negative correlation with TAZ expression. Conclusion TAZ modulates gluconeogenesis and accelerates tumor growth, whereas its knockdown attenuates tumor progression. TAZ interacts with GR, suppressing its transcriptional activity on gluconeogenic gene promoters.

On June 27， 2026， the Asian Pacific Association for the Study of the Liver （APASL） released updated management guidelines for chronic HBV infection， which systematically elaborates on screening， vaccination， antiviral treatment， and hepatocellular carcinoma surveillance and other aspects in 13 key areas， and provides comprehensive recommendations. This article summarizes and makes an excerpt of the key recommendations from the updated guidelines.

The aim of this study is to establish a rapid,efficient,and sensitive method for detecting the infectious laryngotracheitis virus(ILTV).The DNA of ILTV was extracted and used as a tem-plate to develop a recombinant enzyme-mediated isothermal amplification(RAA)fluorescence de-tection method for ILTV through optimization of conditions,sensitivity analysis,and repeatability assessment.Additionally,the nucleic acids of avian influenza virus(AIV),IBV,and Newcastle dis-ease virus(NDV)were detected to verify the specificity of this method.Finally,this method was applied to analyze 59 clinical samples collected from multiple large-scale chicken farms in Hebei Province,and the results were compared with those obtained from real-time fluorescence quantifi-cation(qPCR)and PCR methods according to national standards.The results showed that the RAA detection method established in this study had a reaction system of 25.0 μL buffer,2.1 μL primer,0.6 μL probe,5.0 μL magnesium acetate,and 5.0 μL template.The reaction temperature was 39 ℃ and the amplification time was within 20 minutes.The sensitivity of this method was 101 copies/μL,and the specificity detection was 100％.Testing of 59 clinical samples showed that 17 were detected positive by both RAA fluorescence and qPCR,and 12 were detected by PCR,and the detection rate of RAA(fluorescence)was consistent with real-time fluorescence quantification and qPCR,which was higher than that of the PCR assay.The research results indicate that the RAA fluorescence method has a short detection time,good specificity and sensitivity,and can be used for rapid detection of ILTV.

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 investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

Objective:To develop a rapid assessment scale for healthy aging suitable for the Chinese population.Methods:Based on existing healthy aging assessment scales, national standards, and expert consensus, an initial Healthy Aging Rapid Assessment Scale was drafted through two rounds of expert consultation. A pre-survey was conducted with 3 220 subjects recruited from Guangzhou between July 2023 and July 2024. Items were screened through item analysis and exploratory factor analysis to form the final scale. Reliability and validity of the final scale were validated across five cities: Guangzhou, Dongguan, Shenzhen, Baoding, and Chuxiong.Results:The initial version comprised 36 items, while the finalized scale contained 18 items across three dimensions: metabolic health, mental health, and cognitive health. Test-retest reliability ranged from 0.71 to 0.81 across all study sites. The Spearman-Brown coefficient varied between 0.91-0.96, Cronbach′s α between 0.77-0.83, comparative fit index (CFI) between 0.90-0.98, goodness-of-fit index (GFI) between 0.90-0.99, and root-mean-square error of approximation (RMSEA) between 0.03-0.09. For the three dimensions, reliability and validity metrics demonstrated consistency: Spearman-Brown coefficients 0.87-0.99, Cronbach′s α 0.77-0.83, CFI 0.90-0.98, GFI 0.90-0.99, and RMSEA 0.03-0.09 across four regions.Conclusion:The developed Healthy Aging Rapid Assessment Scale for the Chinese population exhibits robust reliability and validity.

Objective:To develop an artificial intelligence (AI)-based platelet review strategy to identify abnormal platelet histograms with no significant difference between initial impedance platelet count (PLT-I) and PLT-F results.Methods:This study included 5 119 routine blood analysis in Nanfang Hospital of Southern Medical University and its Ganzhou branch from July 2023 and March 2024. Specimens exhibiting abnormal platelet histograms and an initial platelet count >40×10?/L underwent review using the fluorescent platelet count (PLT-F) channel. Consistency of the results was defined as a difference between impedance platelet count (PLT-I) and PLT-F less than ±20% of the PLT-F results. A deep learning model was developed using platelet and red blood cell histogram data from a training set of 3 807 specimens. The model′s diagnostic performance was evaluated on an independent external validation set ( n=805) using receiver operating characteristic (ROC) curve analysis. Changes in the number of reviewed samples and sample turnaround time were analyzed to assess its clinical utility. Results:The deep learning model based on platelet and red blood cell histograms achieved an area under the ROC curve (AUC) of 0.854 in the training set. At a cutoff value of 0.1, the sensitivity was 0.954 and specificity was 0.358. The model could reduce review by 16.80% (190/1 131). In the validation set, the AUC was 0.805, with a sensitivity of 0.955 and specificity of 0.307, corresponding to a reduction of 17.41% (47/270) in reviewed specimens.Conclusion:The platelet review prediction model developed based on deep learning technology can efficiently identify samples with consistent results before and after review, reducing unnecessary reviews and shortening specimen testing time, thereby improving the efficiency of platelet test.

Sinopodophyllum hexandruma is a traditional Chinese medicine in China,which is mostly distributed in Gansu,Shaanxi,Sichuan,Qinghai,Yunnan and Xizang,etc.In recent years,with the gradual deepening of the research on the chemical composition and pharmacology-toxicology of Sinopodophyllum hexandruma,its antitumour and antiviral pharmacodynamic evaluation has increasingly become a research hotspot in the industry.Based on the chemical structure,pharmacological properties and the theoretical basis of quality markers(Q-markers),this paper presents an in-depth literature review and analysis of the chemical composition,pharmacological activities and Q-markers of Sinopodophyllum hexandruma,and systematically explores and predicts the Q-markers of Sinopodophyllum hexandruma.It is proposed that Podophyllotoxin,picropodophyllotoxin,podophyllotoxinone,quercetin,kaempferol,quercetin-3-O-β-glucoside can be used as the Q-marker of Sinopodophyllum hexandruma.In the later stage,these index components can be selected to control the whole quality of Sinopodophyllum hexandrum,and provide some data support and theoretical reference for the quality evaluation of Sinopodophyllum hexandrum.

Stiff person syndrome (SPS) is a rare neuro-immune disorder characterized by exaggerated startle responses and muscle spasms in response to minor stimuli. SPS is often misdiagnosed as panic disorder or agoraphobia. This paper reported a case of a patient with SPS presenting symptoms similar to panic attack. The patient had been misdiagnosed as dystonia, anxiety disorder and panic attack. The patient was finally correctly diagnosed through multiple disciplinary team discussions. This study integrates a comprehensive understanding of symptomatology and patient-reported experiences with targeted neurological evaluations and supplementary diagnostic tools to improve the accuracy of etiological diagnoses. This study aims to enhance the ability of psychiatrists to recognize somatic diseases presenting with psychiatric symptoms and to improve clinical diagnostic and treatment levels.