The proportion of asthma patients with mild to moderate exacerbations is far greater than the number who experience episodes that are severe enough to require emergency room visits or hospital admission. However the routinely collected data from hospitals is absent in the past.To evaluate associations between short-term exposures to air pollutants and hospital outpatient visits for asthma in China.We obtained data for 143,057 asthma outpatient visits from the largest hospitals in 17 Chinese cities, between Jan 01 2013 and Dec 31 2015. We used daily concentrations of air pollutants measured by the China National Environmental Monitoring Centre. We used a time-stratified case-crossover design, and fitted conditional logistic regression models to determine the associations.Particulate matter ≤10μm in diameter (PM10) and nitrogen dioxide (NO2) were associated with increased risks of hospital outpatient visits for asthma on the same day, while the effects were delayed for particulate matter ≤2.5μm in diameter (PM2.5) and sulphur dioxide (SO2). For the cumulative effect model at lag05 days, 10 μg/m3 increase in air pollutants concentrations were correlated with hospital outpatient visits for asthma with odds ratios (ORs) and 95% confidence intervals 1.004 (1.000-1.008) for PM2.5, 1.005 (1.002-1.008) for PM10, 1.030 (1.021-1.040) for NO2, and 1.015 (1.008-1.021) for SO2. Almost one in nine (10.9%; 7.7, 13.9%) hospital outpatient visits for asthma were attributable to NO2.Short-term exposures to PM2.5, PM10, NO2 and SO2 were associated with hospital outpatient visits for asthma in China.

The purpose of this study is to investigate the potential associations between air pollution and dry eye disease (DED). Data of outdoor air pollutants and meteorology as well as outpatient visits for DED were collected. A time-stratified case-crossover approach was used to analyze the associations between ambient air pollutants and outpatient visits for DED. Among the 5062 DED patients studied, 65.45% were female and 34.55% were male. In the single-pollutant model, significant associations were observed between an increase of 10 μg/m³ in the concentrations of fine-particulate matter with a median aerometric diameter of less than 10 μm (PM₁₀), fine-particulate matter with a median aerometric diameter of less than 2.5 μm (PM₂.₅), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), and carbon monoxide (CO) and outpatient visits for DED. These results were consistent with those of the multipollutant model. The strongest associations between air pollutants and patient visits were observed during the cold season and in patients aged 21–40. The significant association between air pollutants (PM₁₀, PM₂.₅, SO₂, NO₂, and CO) and DED outpatient visits indicates the importance of increased environmental protection.

Circadian rhythm is believed to play important roles in atherosclerosis. The gut microbiota is found to be closely related to atherogenesis, and shows compositional and functional circadian oscillation. However, it's still unclarified whether circadian clock and intestinal microbiota are involved in the progression of atherosclerosis induced by environmental pollutant acrolein. Herein, patients with atherosclerosis showed higher MMP9, a promising biomarker for atherosclerosis, and lower Bmal1 and Clock expression in the plasma. Interestingly, acrolein exposure contributed to the increased MMP9, decreased Clock and Bmal1, and activated MAPK pathways in human umbilical vein endothelial cells (HUVECs). We found that knockdown of Clock or Bmal1 lead to upregulation of MMP9 in HUVECs, and that Clock and Bmal1 expression was elevated while MAPK pathways were blocked. Atherosclerotic apolipoproteinE-deficient mice consumed a high-fat diet were used and treated with acrolein (3 mg/kg/day) in the drinking water for 12 weeks. Upregulation of MMP9, and downregulation of Clock and Bmal1 were also observed in plasma of the mice. Besides, acrolein feeding altered gut microbiota composition at a phylum level especially for an increased Firmicutes and a decreased Bacteroidetes. Additionally, gut microbiota showed correlation with atherosclerotic plaque, MMP9 and Bmal1 levels. Therefore, our findings indicated that acrolein increased the expression of MMP9 through MAPK regulating circadian clock, which was associated with gut microbiota regulation in atherosclerosis. Circadian rhythms and gut microbiota might be promising targets in the prevention of cardiovascular disease caused by environmental pollutants.

Male fertility is progressively declining in many developed countries, but the relationship between male infertility and environmental factors is still unclear.To assess the influence of environmental temperature and air pollution on semen parameters, using a big-data approach.A big data analysis of parameters related to 5131 men, living in a province of Northern Italy and undergoing semen analyses between January 2010 and March 2016 was performed. Ambient temperature was recorded on the day of analysis and the 90 days prior to the analysis and the average value of particulate matter (PM) and NO2 in the year of the test. All data were acquired by geocoding patients residential address. A data warehouse containing 990,904,591 data was generated and analysed by multiple regressions.5573 semen analyses were collected. Both maximum and minimum temperatures registered on the day of collection were inversely related to total sperm number (p < .001), non-progressive motility (NPrM) (p < .005) and normal forms (p < .001). Results were confirmed considering temperature in the 30 and 60 days before collection, but not in the 90 days before collection. Total sperm number was lower in summer/autumn (p < .001) and was inversely related with daylight duration (p < .001). PM10 and PM2.5 were inversely related to PrM (p < .001 and p < .005) and abnormal forms (p < .001).This is the first evaluation of the relationship between male fertility-related parameters and environment using a big-data approach. A seasonal change in semen parameters was found, with a fluctuation related to both temperature and daylight duration. A negative correlation between air pollution and semen quality is suggested. Such seasonal and environmental associations should be considered when assessing changes of male fertility-related parameters over time.

The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health.Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM10, NO2, and O3) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups.Ambulance calls peaked at 10am for all groups, except those aged <15 years at 19pm, while temperature was hottest at 13pm. The hourly heat-ambulance calls relationships were non-linear for all groups, with thresholds between 27 °C and 31 °C. The associations appeared immediately, and lasted for about 24 h. There were no significant modification effect by sex and age.The findings suggest that hot hourly temperatures (>27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures.

Previous studies investigating health conditions of individuals living near livestock farms generally assessed short time windows. We aimed to take time-specific differences into account and to compare the prevalence of various health conditions over seven consecutive years. The sample consisted of 156,690 individuals registered in 33 general practices in a (rural) area with a high livestock density and 101,015 patients from 23 practices in other (control) areas in the Netherlands. Prevalence of health conditions were assessed using 2007–2013 electronic health record (EHR) data. Two methods were employed to assess exposure: 1) Comparisons between the study and control areas in relation to health problems, 2) Use of individual estimates of livestock exposure (in the study area) based on Geographic Information System (GIS) data. A higher prevalence of chronic bronchitis/bronchiectasis, lower respiratory tract infections and vertiginous syndrome and lower prevalence of respiratory symptoms and emphysema/COPD was found in the study area compared with the control area. A shorter distance to the nearest farm was associated with a lower prevalence of upper respiratory tract infections, respiratory symptoms, asthma, COPD/emphysema, allergic rhinitis, depression, eczema, vertiginous syndrome, dizziness and gastrointestinal infections. Especially exposure to cattle was associated with less health conditions. Living within 500m of mink farms was associated with increased chronic enteritis/ulcerative colitis. Livestock-related exposures did not seem to be an environmental risk factor for the occurrence of health conditions. Nevertheless, lower respiratory tract infections, chronic bronchitis and vertiginous syndrome were more common in the area with a high livestock density. The association between exposure to minks and chronic enteritis/ulcerative colitis remains to be elucidated.

Environmental low-dose melamine exposure has been associated with urolithiasis risk in adults, but it is unclear if this exposure can cause early renal damage. This cross-sectional study investigated the association of this exposure and early renal damage in patients with calcium urolithiasis. We recruited patients diagnosed with upper urinary tract calcium urolithiasis from three hospitals in southwestern Taiwan between November 2010 and January 2015. All patients completed a structured questionnaire and provided one-spot urine samples for the measurement of melamine level and markers of early renal injury, including N-acetyl b-d-glucosaminidase (NAG), β2-microglobulin (β2-MG), and microalbumin. We used urinary melamine levels as an indicator of environmental melamine exposure. A total of 309 patients (mean age of 54.7 ± 12.8 years) were studied. Median urinary melamine level (μg/mmol Cr) was 1.26 (interquartile range 0.48–3.29). A significant and positive correlation was found between urinary melamine concentration and urinary NAG levels (Spearman correlation coefficient, r = 0.157, p = 0.006, n = 309). With urinary melamine levels categorized into quartiles, multivariate regression results showed the same relationship, particularly in those with first stone episode. In this group, patients with the highest quartile of urinary melamine concentration had a 3.95-fold risk (95% confidence interval = 1.43–10.94) of high NAG levels (dichotomized by median), compared to the lowest quartile after adjustment. No association was found between urinary melamine concentration and urinary microalbumin levels. In conclusion, urinary melamine is significantly associated with urinary marker of early renal tubular injury, NAG, in urolithiasis patients, especially ones with first stone episode.

With increased industrial development, cadmium is an increasingly important environmental pollutant. Studies have identified various adverse effects of cadmium on human beings. However, the relationships between cadmium pollution and the pathogenesis of preeclampsia remain elusive. The objective of this study is to explore the effects of cadmium on immune system among preeclamptic patients and rats. The results showed that the cadmium levels in the peripheral blood of preeclamptic patients were significantly higher than those observed in normal pregnancy. Based on it, a novel rat model of preeclampsia was established by the intraperitoneal administration of cadmium chloride (CdCl2) (0.125 mg of Cd/kg body weight) on gestational days 9–14. Key features of preeclampsia, including hypertension, proteinuria, placental abnormalities and small foetal size, appeared in pregnant rats after the administration of low-dose of CdCl2. Cadmium increased immunoglobulin production, mainly angiotensin II type 1-receptor-agonistic autoantibodies (AT1-AA), by increasing the expression of activation-induced cytosine deaminase (AID) in B cells. AID is critical for the maturation of antibody and autoantibody responses. In addition, angiotensin II type 1-receptor-agonistic autoantibody, which emerged recently as a potential pathogenic contributor to PE, was responsible for the deposition of complement component 5 (C5) in kidneys of pregnant rats via angiotensin II type 1 receptor (AT1R) activation. C5a is a fragment of C5 that is released during C5 activation. Selectively interfering with C5a signalling by a complement C5a receptor-specific antagonist significantly attenuated hypertension and proteinuria in Cd-injected pregnant rats. Our results suggest that cadmium induces immune abnormalities that may be a key pathogenic contributor to preeclampsia and provide new insights into treatment strategies of preeclampsia.

COVID-19 induced pandemic situations have put the bio-medical waste (BMW) management system, of the world, to test. Sudden influx, of COVID-infected patients, in health-care facilities, has increased the generation of yellow category BMW (Y-BMW) and put substantial burden on the BMW-incineration units of India. This study presents the compromising situation of the BMW-incineration units of India, in the wake of COVID-19 pandemic, from 21st March 2020 to 31st August 2020. This analysis revealed that on an average each COVID-infected patient in India generates approximately 3.41 kg/d of BMW and average proportion of Y-BMW in it is 50.44%. Further, it was observed that on 13th July 2020, the total Y-BMW, generated by both the normal and COVID-infected patients, fully utilized the BMW-incineration capacity of India. Also, it was made evident that, during the study period, BMW-incineration emitted several pollutants and their concentration was in the order: NOₓ > CO > SOₓ > PM > HCl > Cd > Pb > Hg > PCBs > Ni > Cr > Be > As. Subsequently, life time cancer risk assessment depicted that with hazard quotient >10⁻⁶, Cd may induce carcinogenic health impacts on both the adults and children of India. Therefore, to mitigate the environmental-health impacts associated with the incineration of BMW, evaluation of various options, viz., alternative technologies, substitution of raw materials and separate treatment of specific wastes, was also done. It is expected that the findings of this study may encourage the global auditory comprising scientific community and authorities to adopt alternate BMW-management strategies during the pandemic.

This study aimed to determine if there is a co-elevation of human blood arsenic and mercury levels in the Midwestern population of the United States (U.S.) and to determine any geographical patterns and variation of arsenic and mercury that may exist in Michigan. 58,800 blood specimens along with associated demographic/geographic data from the contiguous United States were reviewed. Univariate and multivariable logistic regression were used to analyze demographic/geographic variables associated with elevated arsenic concentrations. Furthermore, blood data from patients in Michigan were aggregated to the ZIP code tabulation area (ZCTA) in order to assess geographic variation using spatial regression models. SaTScan software was also used to analyze potential clustering of arsenic and mercury across Michigan ZCTAs. Within the contiguous United States, elevated mercury blood concentrations, older age, female sex, and coastal status were all associated with elevated arsenic blood concentrations (elevated mercury odds ratio (OR) 3.18 (3.04–3.33); female sex OR 1.06 (1.02–1.11); +10 yr age OR 1.12 (1.11–1.14); coastal state OR 1.33 (1.27–1.40). Within the state of Michigan, as with the continuous U.S., elevated mercury blood concentrations and older age were associated with elevated arsenic blood concentrations (elevated mercury OR 2.75 (2.38–3.18); female sex OR 1.06 (0.95–1.19); +10 yr age OR 1.10 (1.06–1.13). Using spatial regression, it was determined that within Michigan, economic inequality (measured via the Gini coefficient) was also associated with elevated concentrations of mercury in the blood. Clinical reference laboratory data, in conjunction with spatial analysis methods, may enhance our understanding of how elemental exposure affects human health and should be considered for studying how environmental contaminants, socioeconomics and geography affect the health of populations.