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.

Platelet-derived exosomes (PLT-Exos) are a subgroup of nanoscale extracellular vesicles released by platelets upon activatin. As key intercellular signaling mediators, they precisely regulate target cells through the delivery of functional molecules, exerting multiple biological effects that promote tissue repair. Accumulating evidence has demonstrated that PLT-Exos significantly facilitate the repair of various tissue injuries by modulating inflammatory responses, stimulating angiogenesis, activating key repair signaling pathways, and mediating stem cell homing. Furthermore, owing to their inherent targeting capacity and low immunogenicity, PLT-Exos have emerged as a promising platform for novel drug delivery carriers in tissue repair. This article systematically reviews the biological characteristics of PLT-Exos, their isolation and identification techniques, the underlying mechanisms of action, and recent advances in clinical application. It also addresses the current challenges in clinical translation, including standardized preparation, subpopulation heterogeneity, scalable production, and clinical implementation, aiming to provide a theoretical reference for both basic research and clinical translation of PLT-Exos in tissue repair.

Objective:To analyze the changes in the costs of hospital rehabilitation after the reform of health insurance payments in the past 6 years, and to identify relevant factors which can provide a reference for the reform of the health insurance payment system in rehabilitation department.Methods:Information on 16, 827 patients hospitalized in the rehabilitation department of The First Affiliated Hospital of Xi′an Jiaotong University between May 2018 and May 2024 was collected and subjected to non-parametric analysis.Results:The average hospitalization cost of rehabilitation department patients over the six years was Y14, 574.92±10, 524.79. During that time the proportion of the cost attributable to Western medicine decreased from 17.1% in 2018 to 7.6% in 2024. The proportion of the patients with hypertension was 51.94%, followed by diabetes mellitus (20.10%). Those with infections had the highest total hospitalization costs. Motor disorders were the most common dysfunction (59.02%), followed by speech disorders (17.45%). Patients with swallowing disorders had the highest hospitalization costs. After the payment system shifted from fee-for-service (FFS) to payment by diagnosis-related group (DRG) in 2023, the average daily inpatient expenditures for rehabilitation patients with all types of diseases gradually declined, reaching its lowest level in 2024.Conclusions:After the health insurance payments shifted from FFS to DRG, the proportion of in patients′ total drug costs decreased annually, and the average daily costs of patients with different types of diseases also decreased significantly, but the comprehensive service fee and diagnostic costs increased.

Circulating tumor cells (CTCs) have the ability to sow tumors and can be found in the peripheral blood of patients with precancerous lesions and healthy people. However, CTCs are not currently screened in the donors blood. A large number of allogeneic blood transfusions occurred worldwide each year, and allogeneic blood transfusions expose recipients to the risk of transmission and affect tumors associated with donor CTCs. Although leukocyte filtration can not completely remove tumor cells in the blood, it can effectively reduce the number of white blood cells in the blood and reduce their proliferation ability. Blood irradiation can effectively destroy the DNA of CTCs in the blood, and inhibit the occurrence and metastasis of tumors caused by the infusion of allogeneic blood containing CTCs. Therefore, we should pay attention to the potential risk of CTCs on clinical transfusion, and strengthen the preclinical treatment of blood to avoid donor-related tumor infection in blood recipients due to clinical transfusion.

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by synovial inflammation, cartilage loss. Often manifesting as joint pain and limited mobility, it severely affects the quality of life of patients. Traditional treatment methods such as pharmacological injections and surgical interventions primarily aim to alleviate symptoms but have limited effects on cartilage repair. Human umbilical cord mesenchymal stem cells (hUC-MSCs), due to their anti-inflammatory and chondrogenic capabilities, is considered a new hope for the treatment of KOA. This article synthesizes the latest research findings from both domestic and international sources to discuss the theoretical basis for the clinical application of hUC-MSCs in treating KOA, clinical study design, and efficacy evaluation. It also addresses the challenges in the clinical application of hUC-MSCs and explores future directions, in the hope of providing feasible theoretical support for the treatment of KOA with hUC-MSCs.

[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

Objective To investigate the association between butyrate metabolism-related genes(BMRGs)and the prognosis of lung adenocarcinoma(LUAD),construct a prognostic model,and evaluate its predictive value.Methods Differentially expressed BMRGs(BMR-DEGs)were screened from the TCGA-LUAD dataset.Cox and LASSO regression analyses were employed to establish a risk scoring model,stratifying patients into low-and high-risk groups.The model's performance was assessed using Kaplan-Meier(K-M)and receiver operating characteristic(ROC)curves,with external validation conducted using the GSE68465 dataset.In vitro experiments included RT-PCR and Western blotting to measure insulin-like growth factor binding protein 1(IGFBP1)expression.IGFBP1 was knocked down using siRNA,and its effects on cell proliferation,migration,and invasion were evaluated via CCK-8,colony formation,Transwell,and wound healing assays.Gene Set Enrichment Analysis(GSEA)was performed to explore IGFBP1-related regulatory mechanisms.Results We identified a total of 51 BMR-DEGs,primarily involved in biological processes such as cell proliferation,migration,and invasion,and associated with the PI3K-Akt and MAPK signaling pathways.The constructed 5-gene risk scoring model demonstrated that high-risk patients had significantly worse overall survival(OS)than low-risk patients(P＜0.05).IGFBP1 was highly expressed in LUAD tissues and correlated with poor prognosis.Knockdown of IGFBP1 significantly suppressed cancer cell proliferation,migration,and invasion(P＜0.05).GSEA revealed that IGFBP1 was linked to lipid metabolism-related pathways.Conclusion BMRGs are associated with LUAD prognosis,and the established risk scoring model exhibits strong predictive performance.High IGFBP1 expression correlates with unfavorable outcomes,and its knockdown inhibits cancer cell proliferation,migration,and invasion.

Objective To investigate the value of fragmented QRS complex(fQRS)in the electro-cardiogram,heart rate variability(HRV)and LVEF in evaluating the prognosis in patients with dilated cardiomyopathy(DCM).Methods A retrospective analysis was conducted on 59 DCM pa-tients admitted in the Second Affiliated Hospital of Wannan Medical College from January 2020 to December 2023.According to the occurrence of MACE during 6-month follow-up period,they were classified into a poor prognosis group(26 cases)and a good prognosis group(33 cases).Clin-ical baseline data,positive rate of fQRS,HRV and LVEF were compared between the two groups.Time-domain measurements of HRV included standard deviation of normal NN intervals(SDNN),standard deviation of the averages of NN intervals in all 5 min segments of the entire recording(SDANN),mean of the standard deviation of NN intervals for all 5 min segments of the entire recording(SDNN index),root mean square of standard deviation of NN intervals(r-MSSD)and HRV triangular index.Spearman/Pearson correlation analysis was performed to analyze the correlation of prognosis of DCM with positive rate of fQRS,HRV and LVEF.ROC curve was drawn to analyze the efficiency of fQRS,HRV and LVEF in predicting the prognosis of DCM.Results The poor prognosis group exhibited significantly higher positive rate of fQRS and obvi-ously reduced SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF when compared with the good prognosis group(P＜0.01).Correlation analysis suggested that poor prognosis of DCM was positively correlated with the positive rate of fQRS(P＜0.01),and negatively with SDNN,SDANN,SDNN index,r-MSSD,triangular index and LVEF(P＜0.05,P＜0.01).ROC curve analysis revealed that the AUC value of above indicators in turn in predicting the prognosis of DCM was 0.718,0.7 56,0.7 62,0.807,0.858,0.805 and 0.747,respectively,and the AUC value of their combination was 0.980(P＜0.01).Conclusion fQRS,HRV and LVEF have important cor-relation with poor prognosis of DCM patients.Their combination can be used as an effective mark-er for clinical evaluation and prediction of poor prognosis of DCM.

Objective The purpose of this study is to investigate the expression of histone lysine-specific demethylase 1 (KDM1A) and ubiquitin carboxyl-terminal hydrolase L3 (UCHL3) in thyroid cancer (TC) tissue and its relationship with clinical features and prognosis. Methods 94 TC patients diagnosed and treated at the Third Hospital of Heilongjiang Province from January 2017 to January 2019 were retrospectively selected as the study subjects. Immunohistochemistry was used to detect the expression of KDM1A and UCHL3 in tissues. Spearman correlation analysis was used to investigate the correlation between KDM1A and UCHL3. Kaplan-Meier survival curve was used to analyze the relationship between the levels of KDM1A and UCHL3 and the 5-year progression-free survival rate of TC patients. Multivariate COX regression model was used to analyze the prognostic factors of TC patients. Results The positive rates of KDM1A (68.09％) and UCHL3 (65.96％) in cancer tissues were higher than those in adjacent tissues(10.64％,8.51％),and the differences were statistically significant(x2=64.984,66.369,all P<0.001). The protein expression of KDM1A and UCHL3 was significant protein correlation (r=0.714,P<0.001). The positive rates of KDM1A (87.50％,90.91％) and UCHL3 (85.00％,87.88％) in TNM stage Ⅲ～Ⅳ and lymph node metastatic TC cancer tissues were higher than those in stage Ⅰ～Ⅱ(53.70％,53.85％)and non-lymph node metastatic(55.74％,54.10％) cancer tissues,and the differences were statistically significant(x2=9.985～12.191,all P<0.001). The 5-year progression-free survival rates of TC patients in the KDM1A positive and negative groups were 62.50％ (40/64) and 86.67％ (26/30),with significant differences,the 5-year progression-free survival rates of UCHL3 positive and negative patients were 58.06％ (36/62) and 90.63％ (29/32),with significant differences (Log-Rankx2=5.670,9.724,P=0.017,0.002). KDM1A positive,UCHL3 positive,TNM stage Ⅲ～Ⅳ,lymph node metastasis were risk factors affecting the prognosis of TC patients (Waldx2=1.315～1.697,all P<0.001). Conclusion KDM1A and UCHL3 are upregulated in TC,and played a pro-cancer role. They are new tumor markers for evaluating the prognosis of TC patients.

The clinical data of an infant with chondrodysplasia accompanied by early-onset epilepsy and medial temporal lobe dysgenesis due to the FGFR3 gene mutation, who was treated in the Affiliated Hospital of Jining Medical University in March 2024 were retrospectively analyzed.The 9-day-old male infant presented with frequent apnea at 5 hours after birth and experienced first seizure at 24 hours after birth.Physical examination revealed short limbs.Magnetic resonance imaging (MRI) showed abnormal changes in bilateral temporal lobes, hippocampal structure and bilateral lateral ventricular temporal angles, so cerebral developmental abnormalities were considered in this child.Whole exome sequencing confirmed a heterozygous variation in the FGFR3 gene [c.1620C>A(p.Asn540Lys)].After receiving Phenobarbital monotherapy, the child still had frequent seizures, but the seizure was completely controlled after the additional use of Lvetiracetam.To August 2024, a total of 14 patients with achondroplasia, epilepsy, and medial temporal lobe dysplasia caused by FGFR3 gene mutations were identified.These patients typically experienced frequent seizures in early infancy, which could be accompanied by apnea and psychomotor retardation.MRI consistently showed abnormal development of bilateral temporal lobes and hippocampus.Seizures were hardly controlled by anti-seizure medications, and Phenobarbital was effective in some cases.Whole exome sequencing revealed gene variations of c.1620C>A or c. 1620C>G (p.Asn540Lys).Patients with achondroplasia caused by FGFR3 gene mutations may present with early-onset epilepsy and medial temporal lobe dysplasia.Early seizures are frequent and difficult to control, and Phenobarbital is effective in some cases.