Pulmonary Benefits of Intervention with Air Cleaner among Schoolchildren in Beijing: A Randomized Double-Blind Crossover Study.

We conducted a crossover study employing air cleaner intervention among 125 schoolchildren aged 9-12 years in a boarding school in Beijing, China. The PM concentrations were monitored, and 27 biomarkers were analyzed. We used the linear mixed-effects model to evaluate the association of intervention/time-weighted PM concentrations with biomarkers. The outcomes showed that air cleaner intervention was associated with FeNO, exhaled breath condensate (EBC) IL-1ß, and IL-6, which decreased by 12.57%, 10.83%, and 4.33%, respectively. Similar results were observed in the associations with PMs. Lag 1 day PMs had the strongest relationship with biomarkers, and significant changes were observed in biomarkers such as FEV1, FeNO, EBC 8-iso, and MCP-1. Boys showed higher percentage changes than girls, and the related biomarkers were FeNO, EBC 4-HNE, IL-1ß, IL-6, and MCP-1. The results showed that biomarkers such as FeNO, EBC IL-6, MCP-1, and 4-HNE could sensitively reflect the early abnormal response of the respiratory system under short-term PM exposure among healthy schoolchildren and indicated that (1) air cleaners exert a protective effect on children's respiratory system. (2) PM had lag and cumulative effect, lag 1 day had the greatest effect. (3) The boys were more sensitive than the girls.

Regulatory Approaches and Implementation of Minimally Addictive Combusted Products.

INTRODUCTION: A joint meeting was held by the World Health Organization (WHO) and the Convention Secretariat of the WHO Framework Convention on Tobacco Control to examine the potential effects of a regulatory policy to reduce nicotine in cigarettes to minimally addictive levels. This paper reviews the feasibility of and approaches to implementing a nicotine product standard. METHODS: Prior WHO reports on this topic were consulted and a systematic review of the scientific literature was conducted. The paper was reviewed by the participants at the aforementioned meeting and their feedback was incorporated. RESULTS: The nicotine dose most likely to consistently reduce smoking behavior and dependence is ≤0.4 mg nicotine/g tobacco. An immediate rather than a gradual nicotine reduction approach appears to be more beneficial. Smokers are likely to seek nicotine from alternate sources (e.g., nicotine replacement therapies, e-cigarettes) or potentially, the illegal market. As such, the availability of alternative products, as well as strong policies against illegal markets, can potentially mitigate unintended consequences. An effectively reduced nicotine regulation must be imbedded in a comprehensive and strong tobacco control program that includes public education and surveillance. Barriers and challenges to implementing a nicotine product standard exist, particularly in low-capacity countries. CONCLUSIONS: Not all countries will have the capacity to implement a regulation to reduce nicotine in cigarettes (and preferably other combusted tobacco products) to minimally addictive levels. However, for the countries that choose to implement it, such a policy could potentially dramatically reduce the burden of tobacco use. IMPLICATIONS FOR TOBACCO REGULATORY SCIENCE: Article 9 of the Framework Convention on Tobacco Control provides signatory governments the authority to implement a product standard for reducing nicotine in tobacco products to minimally addictive levels. This product standard has the potential to result in a dramatic reduction in cigarette and other combusted tobacco use and therefore, smoking-caused mortality and morbidity. This article describes the growing scientific evidence to support nicotine regulation in cigarettes, potential regulatory approaches and describes the infrastructure and tobacco control policies needed to implement a reduced nicotine product standard.

Is hand-to-mouth contact the main pathway of children's soil and dust intake?

Children (n = 240) between the ages of 2 and 17 years were randomly selected from three cities in China. The total amount of soil and dust (SD) on their hands was measured and ranged from 3.50-187.39 mg (median = 19.49 mg). We screened for seven elements (Ce, V, Y, Al, Ba, Sc, and Mn), and Ce levels were used to calculate hand SD by variability and soil elements. The main factors affecting SD amount were location and age group, as identified using a conditional inference tree. Hand SD and the hand SD intake rate were highest in Gansu Province, followed by Guangdong and Hubei provinces, respectively. Hand SD and the hand SD intake rate were highest among children in primary school, followed by kindergarten and secondary school, respectively. The hand SD intake rate of the three typical areas was 11.9 mg/d, which was about 26.6% of the children's soil intake rate (44.8 mg/d), indicating that hand-to-mouth contact is not the main route for children's soil intake in the three areas of China.

Research on the Establishment and Application of the Environmental Health Indicator System of Atmospheric Pollution in China.

To understand the health impact represented by exposure to current atmospheric pollution in China, an environmental health indicators (EHIs) system of atmospheric pollution was established. The EHIs were based on comprehensive consideration of environment, population, economy and diseases associated with atmospheric pollution. An EHIs evaluation system of atmospheric pollution, based on corresponding EHIs data collection and weighting coefficients determined using principal component analysis, was applied to major provinces and regions in China to evaluate the environmental health status. Results showed that the EHIs of atmospheric pollution in Central and East China were low, indicating a serious environmental health condition. Prevention and management of atmospheric pollution in these regions should be strengthened and protective measures taken to improve human health. Compared with other methods, the EHIs evaluation system was more intuitive, which facilitated users to identify the environmental health status and provided support for health management and pollution prevention.

[Risk assessment of excess mortality attribute to PM_(2.5) exposure in 5 cities in China in 2018].

OBJECTIVE: To assess the risk of excess mortality caused by exposure to PM_(2.5) in 5 cities in China. METHODS: Surveillance data on daily concentration of PM_(2.5), meteorology and death-causes were collected from 2015 to 2018 in Harbin, Xi& apos; an, Nanjing, Chengdu and Guangzhou cities. Generalized additive model(GAM) was used to analyze acute exposure-response coefficients of PM_(2.5) exposure on the mortality. Using daily 24-hour average concentration of PM_(2.5) in 2018 to estimate the exposure levels of the population, with PM_(2.5) 24-hour average concentration limit of the ambient air quality standard(GB 3095-2012) for reference concentration(75 µg/m~3), and applicating the health risk assessment model, the excess deaths attribute to PM_(2.5) exposure in the 5 cities in 2018 was estimated. RESULTS: Attribute to PM_(2.5) exposure, the excess cases of death caused by circulatory system diseases in Harbin and Guangzhou were 35 and 92, the excess cases caused by respiratory diseases in Xi& apos; an was 70, the excess cases of caused by non-accident in Nanjing was 69, and the excess cases caused by non-accidental, respiratory and circulatory diseases in Chengdu were 588, 210 and 134 in 2018. CONCLUSION: PM_(2.5) exposure could increase the excess mortality risk, which varies among different cities.

[Effects of PM_(2. 5) acute exposure on 3 inflammation and oxidative stress indexes in healthy children].

OBJECTIVE: To determine the acute effects of exposure to fine particulate matter(PM_(2. 5))on children's respiratory inflammation and oxidative stress. METHODS: This study was a cross-sectional study. A total of 115 9-12 year-old children in boarding schools were selected as the research objects. The PM_(2. 5) exposure concentration was continuously monitored for 5 days, and the individual exposure level was estimated by using the time activity mode and the PM_(2. 5) microenvironment concentration. Exhaled breath condensate(EBC) and urine samples were collected on the 5 th day. Fractional exhaled nitric oxide(FeNO) was detected by a FeNO detector, EBC pH was measured by microelectrode potential analysis method, urine 8-hydroxydeoxyguanosine(8-OHdG) was detected by ELISA kit, and the effect of PM_(2. 5) on three effect indicators was analyzed by a linear model. RESULTS: The highest individual exposure concentration was 102 µg/m~3 4 days before the physical examination, and the lowest individual exposure concentration was 9. 19 µg/m~3 2 days before the physical examination. The FeNO of boys was higher than that of girls, and the difference was significant(P<0. 05). There were no significant differences between gender in other indicators. Correlation analysis found that there was a significant correlation between the exposure concentration of PM_(2. 5) and FeNO, and the strongest correlation was 0 to 2 days before the physical examination with each 10 µg/m~3 increase in PM_(2. 5) caused a 29. 7% increase in FeNO, other indicators did not change significantly. Gender subgroup analysis found that PM_(2. 5) had a significant effect on boys' FeNO, every 10 µg/m~3 increase in PM_(2. 5) during the study period can cause an increase in boys' FeNO of 3. 47%-50. 97%, but had no significant effect on all three indicators of girls. CONCLUSION: PM_(2. 5) had significant effects on FeNO in healthy children with immediate and delayed effects, especially on boys.

Association between outdoor PM2.5 and prevalence of COPD: a systematic review and meta-analysis.

There were conflictions and differences among the results of cross-sectional studies association between PM2.5 and COPD prevalence. We aimed to explore the real association between outdoor PM2.5 and COPD prevalence, analyze the possible cause to the differences and conflictions in previous cross-sectional studies. Cross-sectional literatures about the association between outdoor PM2.5 and COPD prevalence were selected up to 12 September 2018. Subgroup analysis was performed to explore the source of the heterogeneity. Publication bias was tested via funnel plot. Leave-one-out method was used to conduct influential analysis. Variance analysis was used to analyze the influence of concentration, literature quality and age (over 60 or not) on the ln (aOR) values. The initial search revealed 230 studies, of which 8 were selected. The heterogeneity in this study was significant (I2=62, P<0.01), and random effects model was used. The pooled OR for the association between PM2.5 and COPD prevalence is 2.32(95%CI, 1.91-2.82). There was no evidence of publication bias. Subgroup analysis showed the subgroup of age seemed to be the source of heterogeneity (P=0.0143, residual I2=0%). Variance analysis showed that the differences of ln (aOR) among each concentration group(p=0.0075) were statistically significant, the same as age groups(P=0.0234). This meta-analysis study demonstrated a conclusive association between PM2.5 and prevalence of COPD (OR: 2.32, 95%CI 1.91-2.82). The significant heterogeneity among selected studies was mainly caused by age (over 60 or not). High PM2.5 concentration should be needed in further research of the relationship between PM2.5 and chronic diseases.

Acute effect of ambient air pollution on hospitalization in patients with hypertension: A time-series study in Shijiazhuang, China.

Although numerous studies have investigated the association between air pollution and hospitalization, few studies have focused on the health effect of air pollution on populations with hypertension. In this study, we conducted a time-series study to investigate the acute adverse effect of six criteria ambient air pollutants (fine particulate matter [PM2.5], inhalable particulate matter [PM10], nitrogen dioxide [NO2], sulfur dioxide [SO2], ozone [O3], and carbon monoxide [CO]) on hospitalization of patients for hypertension in Shijiazhuang, China, from 2013 to 2016. An over-dispersed Poisson generalized addictive model adjusting for weather conditions, day of the week, and long-term and seasonal trends was used. In addition, we evaluated the effect of modification by season, sex, and age. A total of 650,550 hospitalization records were retrieved during the study period. A 10 µg/m3 increase of PM2.5 (lag06), PM10 (lag06), NO2 (lag03), O3 (lag6), and CO (lag04) corresponded to 0.56% (95% confidence interval [CI]: 0.28-0.83%), 0.31% (95% CI: 0.12-0.50%), 1.18% (95% CI: 0.49-1.87%), 0.40% (95% CI: 0.09-0.71%), and 0.03% (95% CI: 0.01-0.05%) increments in hospitalization of patients for hypertension, respectively. We observed statistically significant associations with PM2.5, PM10, NO2, O3, and CO, while positive but insignificant associations with SO2. The effects of PM2.5, PM10, NO2, O3, and CO were robust when adjusted for co-pollutants. We found stronger associations in the cool season than in the warm season. Moreover, there were non-significant differences in the associations between air pollution and sex or age group. This study suggests that patients with hypertension had an increased risk of hospital admission when exposed to air pollution.

[Application of AirQ+ software in air pollution acute health risk assessment in China].

OBJECTIVE: To promote the application of software AirQ +developed by WHO in the air pollution health risk assessment in China. METHODS: Introduced the calculation principle, scope of application, required data, results output and application examples of the model. Meta-analysis result of exposure-response relationship coefficients of acute health risks of air pollution in China are also provided in this paper. RESULTS: The air quality and other related parameters of the study area in China can be input into AirQ+ software to obtain the attributable risk value of the health outcome of the exposed population compared with the reference concentration. CONCLUSION: The AirQ + software can be used for quantitative assessment of acute health risks of air pollution in China.

[Application of COBRA tool in health risk and comprehensive benefits assessment].

OBJECTIVE: To introduce the application of COBRA in health risk assessment of air pollution, and provide reference for the development of similar tools in China. METHODS: The software overview, scope of application and application literature, data requirements and software operation, calculation principles, model construction was introduced, and put forward the reference significance to China. RESULTS: Health and economic benefits can be quickly obtained by entering the type and value of change in pollutant concentration into the software. CONCLUSION: COBRA can be used to quickly evaluate the health effects and economic benefits of pollutant changes, and provide reference for the development of relevant tools in China, applied in many ways, such as rapid assessment of health benefits of pollution prevention and control programs in different cities, regions or nationwide, and screening the policies and measures with lower costs and greater benefits.

[Application of BenMAP-CE software in health risk assessment of air pollution in China].

OBJECTIVE: To promote the application of air pollution health risk assessment software BenMAP-CE developed by the US Environmental Protection Agency in China's air pollution health risk assessment. METHODS: According to China's air quality and health impact monitoring data characteristics, the software's operational analysis process and principle, scope of application, required data, export and import settings and application examples are systematically introduced. RESULTS: Through the software, the parameters of the research area of China can be input into the module, and the health benefit analysis can be carried out according to the change of air quality. CONCLUSION: The software is suitable for China's air pollution health risk assessment, and has guiding significance and reference value for the formulation of environmental policies.

[Effects of ambient air pollution on acute respiratory diseases and symptoms among adults in three cities in the Yangtze River Delta in 2015].

OBJECTIVE: To understand the effects of ambient air pollution on the prevalence of acute respiratory diseases and symptoms among adults in three cities in the Yangtze River Delta. METHODS: During September to November 2015, 4144 permanent residents aged 18 years and above from four investigation sites in three cities in the Yangtze River Delta were randomly surveyed by questionnaire. Daily concentrations of air pollutants, including PM_(2. 5), NO_2、O_3、CO and SO_2 nearest to the investigation sites were collected from the department of environmental protection. Logistic regression was used to analyze the association between air pollution and acute respiratory diseases and symptoms after other risk factors were adjusted. RESULTS: The prevalence of acute respiratory diseases and symptoms in two weeks among adults were 0. 99% and 3. 88%, respectively. Chemicals related to air pollution(OR=2. 339, 95%CI 1. 156-4. 734) and allergy(OR=4. 857, 95%CI 2. 279-10. 350) were the risk factors of acute respiratory diseases in two weeks among adults while occupational hazards such as toxic chemicals and high temperature(OR=1. 796, 95%CI 1. 220-2. 644), family history of respiratory diseases(OR=2. 670, 95%CI 1. 865-3. 823) and allergy(OR=3. 703, 95%CI 2. 395-5. 725) were the risk factor of respiratory symptoms in two weeks among adults. In addition, the average exposure level of PM_(2. 5)in two weeks was associated with acute respiratory diseases(OR=1. 014, 95%CI 1. 000-1. 028) and symptoms(OR=1. 025, 95%CI 1. 018-1. 033) in two weeks among adults. CONCLUSION: The increases of the prevalence of acute respiratory diseases and symptoms among adults are associated with ambient air pollution in three cities in the Yangtze River Delta.

Acute effects of ambient air pollution on outpatient children with respiratory diseases in Shijiazhuang, China.

BACKGROUND: Associations between ambient air pollution and child health outcomes have been well documented in developed countries such as the United States; however, only a limited number of studies have been conducted in developing countries. This study aimed to explore the acute effects of five ambient air pollutants (inhalable particles [PM10], fine particles [PM2.5], sulfur dioxide [SO2], nitrogen dioxide [NO2] and 0zone [O3]) on children hospital outpatients with respiratory diseases in Shijiazhuang, China. METHODS: Three years (2013-2015) of daily data, including cause-specific respiratory outpatient records and the concentrations of five air pollutants, were collected to examine the short-term association between air pollution and children's respiratory diseases; using a quasi-Poisson regression generalized additive model. Stratified analyses by season and age were also performed. RESULTS: From 2013 to 2015, a total of 551,678 hospital outpatient records for children with respiratory diseases were collected in Shijiazhuang, China. A 10 µg/m3 increase in a two-day average concentration (lag01) of NO2, PM2.5, and SO2 corresponded to an increase of 0.66% (95% confidence interval [CI]: 0.30-1.03%), 0.13% (95% CI: 0.02-0.24%), and 0.33% (95% CI: 0.10-0.56%) in daily hospital outpatient visits for children with respiratory diseases, respectively. The effects were stronger in the transition season (April, May, September and October) than in other seasons (the hot season [June to August] and the cool season [November to March]). Furthermore, results indicated a generally stronger association in older (7-14 years of age) than younger children (< 7 years of age). CONCLUSIONS: This research found a significant association between ambient NO2, PM2.5, and SO2 levels and hospital outpatient visits in child with respiratory diseases in Shijiazhuang, China.

[Implementation and application of the new information system of air pollution and health impact monitoring].

OBJECTIVE: To establish a new information system of air pollution and health effects surveillance including of data collection, data management, data quality control and statistics and visual display. METHODS: To integrate the limits of authority, process management, quality control into the whole process of data collecting, data processing, data auditing and statistics through B/S framework according to the design concept of separating the professional applications from permissions management, and the data centralized management. RESULTS: The key functions of the information system including data collection, three level auditing, statistics, visual display and system management have been implemented. The system has been applied in the national project of 31 provinces, 65 cities and 126 monitoring points. Up to now there is more than 16 million business records stored in the system and the amount of the data has reached more than 10 G. CONCLUSION: The new information system has run well since it is online. It has not only met the monitoring requirements but also provided the foundational support for the research and policy making.

[Application of classified protection of information security in the information system of air pollution and health impact monitoring].

OBJECTIVE: To study the application of classified protection of information security in the information system of air pollution and health impact monitoring, so as to solve the possible safety risk of the information system. METHODS: According to the relevant national standards and requirements for the information system security classified protection, and the professional characteristics of the information system, to design and implement the security architecture of information system, also to determine the protection level of information system. RESULTS: Basic security measures for the information system were developed in the technical safety and management safety aspects according to the protection levels, which effectively prevented the security risk of the information system. CONCLUSION: The information system established relatively complete information security protection measures, to enhanced the security of professional information and system service, and to ensure the safety of air pollution and health impact monitoring project carried out smoothly.

[Designing and implementation of the data quality control in the information system of air pollution and health impact monitoring].

OBJECTIVE: To implement the data quality control in the information system of air pollution and health impact monitoring, and improve the data quality. METHODS: Building the rule database recognized by the computer through summarizing and refining data quality verification rules to control the data quality through off-line quality control and on-line quality control. RESULTS: The data quality control in the whole process is realized, which includes data collection, toolkit verification, document verification, data checking and data auditing. CONCLUSION: The information system of air pollution and health impact monitoring has realized the automatic data quality control, which can provide the experience and demonstration for the other surveillance and scientific research.

[Design and implementation of online statistical analysis function in information system of air pollution and health impact monitoring].

OBJECTIVE: To implement the online statistical analysis function in information system of air pollution and health impact monitoring, and obtain the data analysis information real-time. METHODS: Using the descriptive statistical method as well as time-series analysis and multivariate regression analysis, SQL language and visual tools to implement online statistical analysis based on database software. RESULTS: Generate basic statistical tables and summary tables of air pollution exposure and health impact data online; Generate tendency charts of each data part online and proceed interaction connecting to database; Generate butting sheets which can lead to R, SAS and SPSS directly online. CONCLUSION: The information system air pollution and health impact monitoring implements the statistical analysis function online, which can provide real-time analysis result to its users.

Autophagy Induced FHL2 Upregulation Promotes IL-6 Production by Activating the NF-κB Pathway in Mouse Aortic Endothelial Cells after Exposure to PM2.5.

Epidemiological and clinical studies have increasingly shown that fine particulate matter (PM2.5) is associated with cardiovascular morbidity and mortality, which share the common feature of PM2.5-induced vascular inflammation; however, the underlying mechanisms of how PM2.5 triggers increased inflammatory response in vascular endothelial cells are not well understood. After treating mouse aortic endothelial cells (MAECs) with different concentrations of PM2.5, we assessed interleukin (IL)-6 and four and a half LIM domains 2 (FHL2) expression in cell supernatant by enzyme-linked immunosorbent assay and Western blot, respectively, as well as activation of nuclear factor (NF)-κB and immune-response signaling pathways. Additionally, changes in pathway activation, IL-6 expression, and autophagy were evaluated under PM2.5 exposure, following FHL2 knockdown with small interfering RNA. Our results indicated that PM2.5 exposure induced FHL2 expression and IL-6 secretion, as well as activation of pathways associated with immune response. Additionally, following FHL2 knockdown, the activation of NF-κB-related pathways and IL-6 secretion was inhibited under PM2.5 exposure, although the Akt- and p38-signaling pathways were not affected. Furthermore, PM2.5 exposure induced autophagy, whereas autophagy inhibition eventually inhibited PM2.5-induced FHL2 expression. These findings suggested a novel link between autophagy induced FHL2 upregulation and IL-6 production in MAECs under PM2.5 exposure.

[Method for continuous measurement of personal exposure to fine particulate matter].

OBJECTIVE: To develop a new accurate method for continuous measurement of personal exposure to fine particulate matter( PM_(2. 5) ) by integrating the advantage of both light scattering and gravimetric method. METHODS: The PM_(2. 5) concentrations were measured by both light scattering and gravimetric method simultaneously. The ratio of time-weighted average concentrations from gravimetric method to the responding values from light scattering method was calculated as coefficient of correction and used to calibrate the real-time PM_(2. 5) concentrations from light scattering method. RESULTS: The limit of detections( LOD) for 3, 10, 30 and 60 min time-weighted average concentrations of PM_(2. 5) were 4. 6, 4. 0, 3. 9 and 3. 7 µg/m~3, respectively. The precision( relativestandard deviation, RSD) was from 2. 1% to 9. 5%. The 30 min time-weighted average concentrations from this method were highly related to the results from TEOM method which was considered as reference method( Pearson r = 0. 934, P < 0. 001, n = 233), and no significantly bias between these two methods was detected by paired t test( P =0. 957). Zero drift was detected for 3 out of 10 devices with drift values in the range of- 5-- 3 µg/m~3 in the experiment of continuous 24 h monitoring conducted in the lab. And zero shift was also investigated in 7. 5%( 31 /412) field monitoring events, but most of the values shifted were within the range of- 3- 3 µg/m~3. The direction and scale of zero shift were not influenced by PM_(2. 5) concentrations. CONCLUSION: The developed method in this study that combines the advantages of both light-scattering and gravimetric method is validated to measure real-time concentrations of personal exposure to PM_(2. 5) .

[Acute effects of particulate matter pollution on daily emergency ambulance dispatches due to neurological diseases in one haze polluted city of the North China].

OBJECTIVE: To access the relationship between ambient particulate matter( PM_(2. 5)and PM_(10)) concentration and daily emergency ambulance dispatches due to neurological diseases in one city of the North China. METHODS: Semi-parametric generalized additive model was used to analyze the relationship between particulate matter( PM_(2. 5)and PM_(10)) concentration and daily emergency ambulance dispatches due to neurological diseases from January 1, 2013 to December 31, 2015 after adjustment for time trends, weather conditions and "days of the week". RESULTS: An 10 µg/m~3 increase in the lag 03 day concentration of PM_(2. 5)corresponded to increase of 0. 75%( 95% CI0. 34%-1. 17%) in daily emergency ambulance dispatches due to neurological diseases, and an 0. 35%( 95% CI 0. 05%-0. 66%) increase correspondence for PM_(10) in the lag04. CONCLUSION: Outdoor particulate matter( PM_(2. 5)and PM_(10)) concentration is significantly associated with increased risk of emergency ambulance dispatches due to neurological diseases in the North China.