Association of air pollution with incidence of late-onset seborrhoeic dermatitis: a prospective cohort study in UK Biobank.

BACKGROUND: Late-onset seborrhoeic dermatitis seriously affects patients' quality of life. Studies have shown an association between air pollution and other inflammatory skin diseases. However, associations between air pollution exposures and the incidence of late-onset seborrhoeic dermatitis have not been elucidated. OBJECTIVES: To investigate air pollution's role in the incidence of late-onset seborrhoeic dermatitis. METHODS: We engaged a prospective cohort analysis utilizing the UK Biobank database. Exposure data spanning various years for specific air pollutants, namely particulate matter [PM; with an aerodynamic diameter of ≤ 2.5 µm (PM2.5), between 2.5 and 10 µm (PM2.5-10), ≤ 10 µm (PM10)] along with nitrogen oxides (NO plus NO2, denoted NOx) and NO2, were incorporated. Through a composite air pollution score constructed from five pollutants and employing Cox proportional hazards models, the relationship between air pollution and seborrhoeic dermatitis was delineated. RESULTS: Our examination of 193 995 participants identified 3363 cases of seborrhoeic dermatitis. Higher concentrations of specific pollutants, particularly in the upper quartile (Q4), were significantly linked to an elevated risk of seborrhoeic dermatitis. Notably, PM2.5, PM10, NO2 and NOx exhibited hazard ratios of 1.11, 1.15, 1.22 and 1.15, respectively. The correlation was further solidified with a positive association between air pollution score increments and onset of seborrhoeic dermatitis. Intriguingly, this association was accentuated in certain demographics, including younger men, socioeconomically deprived people, smokers, daily alcohol consumers, and those engaging in regular physical activity. CONCLUSIONS: Our findings revealed that air pollution exposures were associated with incidence of late-onset seborrhoeic dermatitis. These results emphasize the importance of preventing environmental air pollution exposures to mitigate the risk of developing the condition.

Real-world effectiveness of Azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19: A retrospective cohort study.

Chinese guidelines prioritize the use of Azvudine and nirmatrelvir-ritonavir in COVID-19 patients. Nevertheless, the real-world effectiveness of Azvudine versus nirmatrelvir-ritonavir is still lacking, despite clinical trials showing their effectiveness compared with matched controls. To compare the effectiveness of Azvudine versus nirmatrelvir-ritonavir treatments in real-world clinical practice, we identified 2118 hospitalized COVID-19 patients, with a follow-up of up to 38 days. After exclusions and propensity score matching, we included 281 Azvudine recipients and 281 nirmatrelvir-ritonavir recipients who did not receive oxygen therapy at admission. The lower crude incidence rate of composite disease progression outcome (7.83 vs. 14.83 per 1000 person-days, p = 0.026) and all-cause death (2.05 vs. 5.78 per 1000 person-days, p = 0.052) were observed among Azvudine recipients. Azvudine was associated with lower risks of composite disease progression outcome (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.32-0.94) and all-cause death (HR: 0.40; 95% CI: 0.16-1.04). In subgroup analyses, the results of composite outcome retained significance among patients aged <65 years, those having a history of disease, those with severe COVID-19 at admission, and those receiving antibiotics. These findings suggest that Azvudine treatment showed effectiveness in hospitalized COVID-19 patients compared with nirmatrelvir-ritonavir in terms of composite disease progression outcome.

Adenosine 5'monophosphate-activated protein kinase activation reduces the risks of psoriasis and its comorbidities: a mendelian randomisation study in the UK Biobank.

OBJECTIVE: Whether metformin and its adenosine 5'monophosphate-activated protein kinase (AMPK) activation protect from psoriasis risk is unconcluded. We investigated the effect of AMPK, a pharmacological target of metformin, on the risk of psoriasis and its comorbidities and mortality among participants in the UK Biobank(UKB). METHODS: To avoid immortal-time-biases in pharmacoepidemiologic studies, Mendelian randomisation was used to infer the AMPK pathway-dependent effects. The cut-off age for distinguishing early-onset/late-onset psoriasis (EOP/LOP) was set at 60 years, based on the incident psoriasis peak in UKB. A genetic instrument comprising 44 single-nucleotide polymorphisms associated with HbA1c, serving as a proxy for AMPK genetic risk score (negatively associated with AMPK activation), was employed as previously reported in the literature. Log-binomial models were used to estimate the effect size of AMPK regarding relative risk (RR) and 95% confidence interval (CI). RESULTS: A total of 407 159 participants were analyzed, including 9,126 EOP and 3,324 LOP. The AMPK-genetic-risk-score was associated with a 12.4% increase in the risk of LOP in men (RR = 1.124, 95% CI: 1.022-1.236). This association was not significant for EOP or women. AMPK genetic risk score exhibited an elevated risk of ischemic heart disease (RR = 1.217, 95% CI 1.062-1.395) in male psoriasis patients. CONCLUSIONS: AMPK activation may protect against LOPs and associated ischemic heart disease in men. A sex-specific, comorbidity-targeted intervention for psoriasis is needed.

Arsenic exposure and pruritus: Evidence from observational, interventional, and mendelian randomization studies.

BACKGROUND: Pruritus is identified as an adverse drug reaction to arsenic trioxide, but the association of arsenic exposure with pruritus has not been investigated. METHODS: A cross-sectional study was conducted in Shimen, China. A Mendelian randomization analysis was conducted to confirm the causal relationship between genetically predicted percentages of monomethylated arsenic (MMA%) and dimethylated arsenic (DMA%) in urine with chronic pruritus in UK Biobank. A case-control study was then conducted to determine the biomarker for pruritus. Arsenite-treated mice were used to confirm the biomarker, and von Frey test was used to induce scratching bouts. Last, a randomized, double-blind, placebo-controlled trial was conducted to test the efficacy of naloxone in arsenic-exposed patients with pruritus in Shimen. RESULTS: Hair arsenic (µg/g) showed a dose-response relationship with the intensity of itch in 1079 participants, with odds ratios (OR) of 1.11 for moderate-to-severe itch (p = 0.012). The Mendelian randomization analysis confirmed the causal relationship, with ORs of 1.043 for MMA% (p = 0.029) and 0.904 for DMA% (p = 0.077) above versus under median. Serum ß-endorphin was identified as a significant biomarker for the intensity of itch (p < 0.001). Consistently, treatment with arsenite upregulated the level of ß-endorphin (p = 0.002) and induced scratching bouts (p < 0.001) in mice. The randomized controlled trial in 126 participants showed that treatment with sublingual naloxone significantly relieved the intensity of itch in arsenic-exposed participants in 2 weeks (ß = -0.98, p = 0.04). CONCLUSION: Arsenic exposure is associated with pruritus, and ß-endorphin serves as a biomarker of pruritus. Naloxone relieves pruritus in patients with arseniasis.

Disease specific air quality health index (AQHI) for spatiotemporal health risk assessment of multi-air pollutants.

While significant reductions in certain air pollutant concentrations did not induce obvious mitigations of health risks, a shift from air quality management to health risk prevention and control might be necessary to protect public health. This study thus constructed an Air Quality Health Index (AQHI) for respiratory (Res-AQHI), cardiovascular (Car-AQHI), and allergic (Aller-AQHI) risk groups using mixed exposure under multi-air pollutants and portrayed their distribution and variation at multiple spatiotemporal scales using spatial analysis in GIS with the medical big data and air pollution remote sensing data by taking Hunan Province in China as a case. Results showed that the AQHIs constructed for specific health-risk groups could better express their risks than common AQHI and AQI. Moreover, based on the spatiotemporal association of health and environmental information, the allergic risk group in Hunan provided the highest health risk mainly affected by O3. The following cardiovascular and respiratory risk groups can be significantly attributed to NO2. Moreover, the spatiotemporal heterogeneity of AQHIs within regions was also evident. On the annual scale, the population in the air health risk hotspots for respiratory and cardiovascular risk decreased, while allergic risks increased. Meanwhile, on seasonal scale, the hotspots for respiratory and cardiovascular risks expanded significantly in winter while completely disappearing for allergic risk. These findings suggest that disease specific AQHIs effectively disclose the health effects of multi-air pollutants and their subsequently varied spatiotemporal distribution patterns.

Exposure to ambient air pollutants is associated with an increased incidence of hyperuricemia: A longitudinal cohort study among Chinese government employees.

BACKGROUND: It is widely recognized that ambient air pollution can induce various detrimental health outcomes. However, evidence linking ambient air pollutants and hyperuricemia incidence is scarce. OBJECTIVES: To assess the association between long-term air pollution exposure and the risk of hyperuricemia. METHODS: In this study, a total of 5854 government employees without hyperuricemia were recruited and followed up from January 2018 to June 2021 in Hunan Province, China. Hyperuricemia was defined as serum uric acid (SUA) level of >420 µmol/L for men and >360 µmol/L for women or use of SUA-lowering medication or diagnosed as hyperuricemia during follow-up. Data from local air quality monitoring stations were used to calculate individual exposure levels of PM10, PM2.5, SO2 and NO2 by inverse distance weightingn (IDW) method. Cox proportional hazard model was applied to evaluate the causal relationships between air pollutant exposures and the risk of hyperuricemia occurrence after adjustment for potential confounders and meanwhile, restricted cubic spline was used to explore the dose-response relationships. RESULTS: The results indicated that exposures to PM10 (hazard ratio, HR = 1.042, 95% conficence interal, 95% CI: 1.028, 1.057), PM2.5 (HR = 1.204, 95% CI: 1.141, 1.271) and NO2 (HR = 1.178, 95% CI: 1.125,1.233) were associated with an increased HR of hyperuricemia. In addition, a nonlinear dose-response relationship was found between PM10 exposure level and the HR of hyperuricemia (p for nonlinearity = 0.158) with a potential threshold of 50.11 µg/m3. Subgroup analysis demonstrated that participants usually waking up at night and using natural ventilation were more vulnerable to the exposures of PM10, PM2.5, NO2, and SO2. CONCLUSION: Long-term exposures to ambient PM10, PM2.5 and NO2 are associated with an increased incidence of hyperuricemia among Chinese government employees.

Long-term exposure to low levels of ambient UVB are associated with a decreased risk of moderate-to-severe acne: A retrospective cohort study in college students.

BACKGROUND: As a crucial component of solar radiation, the association between exposure to ambient ultraviolet (UV) radiation and acne remains unclear. METHODS: This was a multicenter retrospective cohort study of incoming college students in five universities of China. Previous exposure (6 years prior to enrollment) to different wavelengths of ambient UVs were obtained from public repositories by linking to individual hometown addresses. Logistic models were applied to assess the relationship between ambient UV exposure and acne. Subgroup analysis was conducted by sun protection behaviors and time of daily sun exposure. Overall effect and single effect of exposure to four different wavelengths of UVs (305, 310, 324, and 380 nm) were estimated by Bayesian kernel machine regression (BKMR). RESULTS: A total of 19,939 participants was included for analysis. Analysis in all participants showed a significant association between log-transformation levels of exposure to UV at 305 nm (log (UV 305 nm)) and acne (OR = 0.77, p = .021). The effect size was stronger in participants reporting no sun protection habit. Both UVs at 305 nm (OR = 0.51, p = .001) and 310 nm (OR = 0.50, p = .012) were associated a decreased risk of acne in participants reporting no sun protection habit. This inverse association was also observed in those exposed to low levels of UV (<1 h/day). The BKMR indicated consistent results that low levels of exposure to UVs combination and UVs at 305 and 310 nm were associated with a lower risk of acne. CONCLUSION: Long-term exposure to relatively low levels of ambient UVB are associated with a decreased risk of moderate-to-severe acne in college students.

Association of air pollution and genetic risks with incidence of elderly-onset atopic dermatitis: A prospective cohort study.

BACKGROUND: Elderly-onset atopic dermatitis (AD) is a remarkable subtype and has been put on the agenda owing to its difficulty to control. Understanding the influence of genetic and environmental exposures is crucial to preventing elderly-onset AD. OBJECTIVES: To explore the association between genes and air pollution on incident elderly-onset AD. MATERIAL AND METHODS: This study was based on UK Biobank that recruited over 500,000 participants. The genetic risks were categorized into low, intermediate, and high groups according to tertiles of polygenic risk scores. Mixed exposure to various air pollutants was assessed using the weighted quantile sum (WQS) and also categorized based on tertiles. Within each genetic risk group, whether air pollutant mixture was associated with incident elderly-onset AD was estimated. RESULTS: 337,910 participants were included in the final analysis, and the mean age was 57.1. The median years for follow-up were 12.0, and the incident cases of AD were 2545. The medium and high air pollution mixture was significantly associated with incident AD compared with the low pollution group, with HRs of 1.182 (P = 0.003) and 1.359 (P < 0.001), respectively. In contrast, HR for medium and high genetic susceptibility was only 1.065 (P = 0.249) and 1.153 (P = 0.008). The population-attributable fraction of air pollution and genetic risk was 15.5 % (P < 0.001) and 6.4 % (P = 0.004). Additionally, compared with low genetic risk and low air pollution, high genetic risk and high air pollution was significantly associated with the incidence of elderly-onset AD with a HR of up to 1.523 (P < 0.001). There were no interactive effects between each group of genetic risks and air pollution. When grouped by sex, females could observe a stronger effect by genetic and air pollutant mixture exposure. CONCLUSION: Air pollution and genetics both independently enhance the risk of newly developed AD, and the effect of air pollutants is stronger than the investigated genes.

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Chronic kidney disease (CKD) is suffered progressive loss of kidney function lasting more than 3 months and is classified according to the degree of kidney damage (level of proteinuria) and the decreased glomerular filtration rate (GFR). The most severe form of CKD is end-stage renal disease. The prevalence of CKD is high with fast growth rate and the disease burden has become increasingly serious. CKD has become an important public health problem threatening human health. The etiology of CKD is complex. In addition to genetic factors, environmental factors are an important cause of CKD. With the development of industrialization, environmental metal pollution has become increasingly severe, and its impact on human health has received widespread attention. A large number of studies have shown that metals such as lead, cadmium, and arsenic can accumulate in the kidney, which can cause damage to the structure and function of the kidney, and play an important role in the development of CKD. Therefore, summarizing the epidemiological research progress in the relationship between arsenic, cadmium, lead, and other metal exposures and kidney diseases can provide new ideas for the prevention and control of kidney diseases caused by metal exposure.

Microcystin-LR Combined with Cadmium Exposures and the Risk of Chronic Kidney Disease: A Case-Control Study in Central China.

Increasing evidence indicates that exposure to microcystin-LR (MC-LR) can cause kidney damage. However, the association between MC-LR exposure and chronic kidney disease (CKD) risk in humans has not been studied. Therefore, we conducted a population-based case-control study involving 135 CKD cases and 135 matched controls in central China and analyzed the effects of MC-LR alone as well as combined with the known risk factor cadmium (Cd). Compared to the lowest quartile of MC-LR exposure, the highest quartile had a 6.56-fold (95% confidence interval [CI]: 2.46, 17.51) significantly increased risk for CKD, displaying a dose-response relationship (ptrend < 0.001). Our animal study also showed that MC-LR exposure induced kidney injury via the PI3K/AKT/mTOR signaling pathway. Comparing the highest Cd quartile to the lowest, the adjusted odds ratio for CKD was 3.88 (95% CI: 1.47, 10.28), exhibiting a dose-response relationship (ptrend < 0.006). Furthermore, a positive additive interaction was observed between MC-LR and Cd (relative excess risk due to interaction = 1.81, 95% CI: 0.42, 3.20; attributable proportion of interaction = 0.70, 95% CI: 0.35, 1.05). Our study firstly revealed that MC-LR exposure is an independent risk factor for CKD and has a synergistic relationship with Cd. MC-LR and Cd exposures are associated with CKD risk in a dose-response manner.

Associations of combined lifestyle and genetic risks with incident psoriasis: A prospective cohort study among UK Biobank participants of European ancestry.

BACKGROUND: Whether the lifestyle is associated with the risk of psoriasis in the presence of different genetic risk levels remains unknown. OBJECTIVE: To examine the gene-behavior interaction in association with incident psoriasis. METHODS: This study is based on the data from the UK Biobank, which recruited 500,000 participants. Genetic risk was categorized into low, intermediate, and high groups. The lifestyle score comprised the body mass index, smoking, physical activity, and diet and was also categorized into the ideal, intermediate, and poor groups. Within each genetic risk group, the risks of incident psoriasis associated with each lifestyle level were investigated and compared with the low genetic risk and ideal lifestyle group. RESULTS: Compared with the low genetic risk and ideal lifestyle group, the poor lifestyle and high genetic risk group was associated with a hazard ratio of up to 4.625 (95% confidence interval [CI], 2.920-7.348) for psoriasis. There was no interaction between genetic risk and lifestyle. The population attributable fractions of lifestyle and genetic risk were 32.2% (95% CI, 25.1%-38.6%) and 13.0% (95% CI, 3.2%-21.8%), respectively. LIMITATIONS: No verification in other independently ascertained populations. CONCLUSION: Lifestyle factors are predictive of the risk of incident psoriasis independent of genetic risk, and the relative impact of lifestyle factors was greater than that of genetic risk.

Prevalence and factors associated with overweight or obesity among 2- to 6-year-old children in Hunan, China: a cross-sectional study.

OBJECTIVE: To compare the prevalence of overweight or obesity (ow/ob) with WHO BMI cut-off points, International Obesity Task Force (IOTF) cut-off points and Chinese BMI criteria and examine its potential factors among preschool children in Hunan Province. DESIGN: A cross-sectional survey including anthropometric measurements and questionnaires about children's information, caregivers' socio-demographic characteristics and maternal characteristics. χ2 tests and univariate and multivariate binary logistic regression were performed to evaluate the possible factors of ow/ob. SETTING: Hunan, China, from September to October 2019. PARTICIPANTS: In total, 7664 children 2 to 6 years of age. RESULTS: According to Chinese BMI criteria, about 1 in 7-8 children aged 2-6 years had ow/ob in Hunan, China. The overall estimated prevalence of ow/ob among 2- to 6-year-old children was significantly higher when based on the Chinese BMI criteria compared with the WHO BMI cut-off points and IOTF cut-off points. According to Chinese BMI criteria, ow/ob was associated with residing in urban areas, older age, male sex, eating snacking food more frequently, macrosomia delivery, caesarean birth, heavier maternal prepregnancy weight and pre-delivery weight. CONCLUSION: The prevalence of ow/ob in preschool children in Hunan Province remains high. More ow/ob children could be screened out according to Chinese BMI cut-offs compared with WHO and IOTF BMI criteria. In the future, targeted intervention studies with matched controls will be needed to assess the long-term effects of intervention measures to provide more information for childhood obesity prevention and treatment.

Phototherapy for atopic dermatitis: Systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Phototherapies could represent an efficient option for the treatment of atopic dermatitis (AD), but the evidences available for clinical choices were contradictory. OBJECTIVE: This study aimed to evaluate the efficacy of different phototherapies on AD. METHODS: This systematic review and network meta-analysis included randomized controlled trials (RCTs) through searching keywords from PubMed, EMBASE, and the Cochrane library. We summarized different phototherapy types and scoring systems. Scoring Atopic Dermatitis (SCORAD) absolute score changes were estimated by mean differences (MDs) and standard deviations (SDs) and then included in the network meta-analysis. The effect sizes of comparison of different phototherapies were presented as MDs and 95% confidence intervals (CIs). Egger's test was used to evaluate publication bias. RESULTS: Eleven RCTs were included in the systematic review and 4 studies in the network meta-analysis. Based on the pooled estimates, medium-dose ultraviolet A1 (UVA1) cold light was superior to medium-dose UVA1 (MD 8.92; 95% CI: 5.60-12.24) but no significant difference between high-dose (UVA1) and medium-dose UVA1 cold light (MD 0.66; 95% CI: -5.57 to 6.90). Publication bias was not supported by Egger's test (P = .168). CONCLUSIONS: Due to possible long-term adverse effects of high-dose UVA1, medium-dose UVA1 cold light appears to be the superior form for AD.

Clinical and personal recovery for people with schizophrenia in China: prevalence and predictors.

BACKGROUND: Recovery from schizophrenia is a multidimensional construct that includes two categories: clinical recovery (symptomatic and functional remission) and personal recovery. AIMS: To investigate the overlap between clinical and personal recovery and identify correlates of each. METHODS: A cross-sectional study was conducted with 356 people living with schizophrenia and randomly selected from 12 communities in China. Clinical recovery was assessed using both the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF). Personal recovery was assessed using the 8-item Recovery Assessment Scale (RAS). Disability and quality of life were assessed using the WHODAS 2.0 and WHOQOL-BREF-2, respectively. RESULTS: Our results showed a recovery proportion of 36.52% for clinical recovery (66.57% for symptomatic remission and 40.73% for functional remission), and 17.42% for personal recovery. Only 8.99% of individuals achieved overall recovery (i.e. they met criteria for both clinical and personal recovery), and there was only a modest correlation (r = 0.26) between these two types of recovery. Overall recovery was only correlated with the quality of life (OR = 1.46, 95% CI: 1.05, 2.03), but there were various correlates for clinical recovery and personal recovery separately. CONCLUSIONS: Recovery from schizophrenia involves both clinical and personal recovery, but when examined in the same sample, personal recovery, and thus overall recovery, is less common, particularly among people with schizophrenia in China.

The plasma exosomal miR-1180-3p serves as a novel potential diagnostic marker for cutaneous melanoma.

BACKGROUND: Exosomes are a promising tool in disease detection because they are noninvasive, cost-effective, sensitive and stable in body fluids. MicroRNAs (miRNAs) are the main exosomal component and participate in tumor development. However, the exosomal miRNA profile among Asian melanoma patients remains unclear. METHODS: Exosomal miRNAs from the plasma of melanoma patients (n = 20) and healthy individuals (n = 20) were isolated and subjected to small RNA sequencing. Real-time PCR was performed to identify the differential miRNAs and to determine the diagnostic efficiency. Proliferation, scratch and Transwell assays were performed to detect the biological behavior of melanoma cells. RESULTS: Exosomal miRNA profiling revealed decreased miR-1180-3p expression as a potential diagnostic marker of melanoma. The validation group of melanoma patients (n = 28) and controls (n = 28) confirmed the diagnostic efficiency of miR-1180-3p. The level of miR-1180-3p in melanoma cells was lower than that in melanocytes. Accordingly, the level of miR-1180-3p was negatively associated with the proliferation, migration and invasion of melanoma cells. Functional analysis and target gene prediction found that ST3GAL4 was a potential target and highly expressed in melanoma tissues and was negatively regulated by miR-1180-3p. Knockdown of ST3GAL4 hindered the malignant phenotype of melanoma cells. CONCLUSIONS: This study indicates that reduced exosomal miR-1180-3p in melanoma patient plasma is a promising diagnostic marker and provides novel insight into melanoma development.

Potential liver damage due to co-exposure to As, Cd, and Pb in mining areas: Association analysis and research trends from a Chinese perspective.

There is global concern regarding the public health hazards of environmental exposure to multiple toxic heavy metals. The effects of toxic heavy metals on liver function have been suggested in previous reports, but the association between exposure to multiple toxic heavy metals and liver function has not been elucidated. The aim of this study was to investigate the effects of exposure to multiple toxic heavy metals, arsenic(As), lead(Pb), and cadmium(Cd), on liver function through population-based and animal studies. A total of 3590 participants were enrolled from the mining areas in Western Hunan Province. The concentrations of As, Pb, and Cd in the urine and plasma samples were determined using quadrupole inductively coupled plasma mass spectrometry (ICP-MS). Bayesian kernel machine regression (BKMR) was employed for the joint association assay. An animal study was conducted to further verify the cumulative effects of metals on liver damage-related parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels. Research trends regarding toxic metals were also explored to obtain in-depth understanding of the current knowledge in this field. Typically, for single-exposure analysis, in most mines, Pb exhibited a significantly negative association with ALT levels, whereas for cumulative effects analysis, when As, Pb, and Cd concentrations were at the 50thpercentile, a significantly negative effect on liver ALT levels was observed. Furthermore, animal studies have shown that co-exposure to As, Pb, and Cd could aggravate liver dysfunction in mice compared to that in the single-metal treated group (p < 0.05). From 1990 to 2019, 1965 projects relating to As, Pb, and Cd research have been initiated, and the total RMB(RenMingBi) funded was approximately 800 million in China, as opposed to 2500 projects in the US with an approximate amount of US$ 1 billion, which is substantially greater than that of China. Finally, from a global viewpoint, scientists should continue to substantially contribute to the field of heavy metal contamination through more extensive academic investigation, global cooperation, and the development of novel control methods. Overall, this study identified that elevated combined concentrations of As, Pb, and Cd were significantly negatively associated with liver function.

Single-cell transcriptomics uncovers phenotypic alterations in the monocytes in a Chinese population with chronic cadmium exposure.

BACKGROUND: Cadmium is the most prevalent form of heavy metal contaminant globally and its exposure rises serious health concern. Chronic exposure to cadmium causes immune disturbances. However, few studies have addressed how it affects circulating immune cells, one of the most essential elements for the host defense system, at both population and molecular level. Therefore, this is the first single-cell transcriptomic analysis of the response of the human circulating immune system to plasma cadmium level. METHODS: We conducted a cross-sectional study in Hunan province, which has the highest level of cadmium land contamination in China. A total of 3283 individuals were eligible for analyzing the association between plasma cadmium levels and the monocyte counts and its subgroups. Another 780 individuals were assigned for validation. Thirty propensity-matched individuals without chronic disease from the lowest- and highest-quartile groups according to serum cadmium levels were selected for single-cell RNA sequencing (scRNA-seq) and flow cytometry analyses. Moreover, the monocyte phenotypic alterations in the heavy metal-exposed population were validated with a cecal ligation and puncture sepsis mouse model. RESULTS: From August 2016 to July 2017, we conducted a cross-sectional study to identify phenotypic alterations in peripheral immune cells in cadmium polluted areas in China. Monocyte percentages were negatively associated with plasma cadmium levels in multivariable linear regression analysis. Peripheral blood mononuclear cell scRNA-seq revealed that the CD14+ monocyte subset was dramatically reduced in the highest-quartile cadmium-exposed group. Moreover, we assessed different hallmarks of immune cell dysfunction-such as host defense capability, apoptotic signaling, cellular diversity and malignant gene expression in monocytes. Importantly, cadmium induced phenotypic alterations in the immune system were validated in the cecal ligation and puncture sepsis mouse model, in which chronic exposure to cadmium not only increased the death rate but also decreased monocyte numbers and the ability to clear bacterial infections. CONCLUSION: This transcriptomic analysis provides molecular information about how the most important hallmarks of immune cell dysfunction are affected by plasma cadmium level. The significant phenotypic alterations in monocytes serving as early indicators of increased susceptibility to infectious and malignant diseases.

Depressive symptoms, anxiety symptoms, and their co-occurrence among people living with schizophrenia in China: Prevalence and correlates.

BACKGROUND: The current study examines the prevalence of depressive symptoms, anxiety symptoms, their occurrence, and key socio-demographic and clinical correlates among people living with schizophrenia. METHODS: A cross-sectional study was conducted on 390 schizophrenia individuals. Depressive and anxiety symptoms, patient symptoms, functioning, and disability were assessed using standard assessment tools. RESULTS: People living with schizophrenia had a prevalence of 40.51% for depressive symptoms, 29.74% for anxiety symptoms, and 26.41% for their co-occurrence. More symptoms (odds ratio [OR]: 1.04-1.06, 95% confidence interval [CI]: 1.01-1.10) and higher disability (OR: 1.06, 95% CI: 1.03-1.09) were associated with increased risk of depressive symptoms, anxiety symptoms, and their co-occurrence. In addition, having middle school or high school education (OR: 2.48-2.61, 95% CI: 1.15-5.53), and being unemployed (OR: 4.98-9.08, 95% CI: 1.09-69.87) were associated with increased risk for anxiety symptoms and its co-occurrence with depressive symptoms. CONCLUSIONS: Depressive and anxiety symptoms are relatively common. Interventions should carefully assess these symptoms to distinguish them from schizophrenia to target them in the treatment.

Association of previous treatment with anti-tumour necrosis factor inhibitors with the effectiveness of secukinumab in the treatment of psoriatic arthritis: systematic review and meta-analysis.

OBJECTIVES: We sought to systematically investigate the effectiveness of secukinumab in psoriatic arthritis (PsA) patients who previously received TNFs inhibitor (TNFi) treatment and those who were TNFi naïve. METHODS: Databases (PubMed, EMBase and Cochrane library) and ClinicalTrials.gov were searched from inception to 22 May 2020 for randomized control trails and observational studies of secukinumab, with or without a history of previous anti-TNFi treatment, in PsA. Effectiveness data were extracted and combined using a random-effects meta-analysis. The ACR20 and ACR50 (20% and 50% improvement in American College of Rheumatology response criteria) responses were the endpoints. RESULTS: Six randomized controlled trials that reported the effectiveness of secukinumab by previous anti-TNFi treatment were included. Among patients exposed to a prior anti-TNFi treatment (n = 738), 33.7% (249/738) of patients achieved an ACR20 response. In contrast, in the anti-TNFi-naïve group (n = 1754), 49.8% (873/1754) of patients achieved an ACR20 response. Prior treatment with anti-TNFi was significantly associated with a poorer response to secukinumab compared with the anti-TNFi-naïve group with an effect size of 2.09 (95% CI: 1.69, 2.58). CONCLUSION: Some patients benefit from switching from TNFi to secukinumab, but previous anti-TNFi treatment is associated with poorer effectiveness of secukinumab.