Who has the greatest influence on adolescent gaming disorder: parents, teachers, or peers? An interpersonal relationships network model of gaming disorder.

Introduction: Gaming disorder (GD) in adolescents is associated with impaired interpersonal relationships, including those with parents, teachers and peers. However, the interpersonal relationships most strongly associated with GD-related maladaptive behaviors are not well established. This study aimed to investigate the associations between these three types of relationships and the manifestation of GD in adolescents. Methods: In this cross-sectional study, 1920 Chinese adolescents participated in a survey that assessed interpersonal relationships (parent-child, teacher-student, and peer relationships) and demographic variables (e.g., gender, grade, duration of gaming), and 1414 participants were ultimately included. A network analysis approach was utilized to evaluate the key network metrics of edge weight and node centrality. Results: The findings revealed that peer fear and inferiority (r = 0.12) and teacher-student conflict were most strongly correlated with GD, followed by parent-child conflict (r = 0.09). Peer fear and inferiority exhibited the highest strength centrality (0.84), followed by teacher-student conflict (0.83) and parent-child conflict (0.35). Moreover, the duration of gaming was significantly and positively correlated with GD (r = 0.19). Conclusions: The present study underscores the significant role of conflict and rejection within interpersonal relationships, particularly among peers, in the manifestation of GD-related behaviors in Chinese adolescents.

Long-Term Outcomes of dMMR/MSI-H Rectal Cancer Treated With Anti-PD-1-Based Immunotherapy as Curative-Intent Treatment.

BACKGROUND: Neoadjuvant anti-PD-1 therapy has shown encouraging efficacy in patients with deficient DNA mismatch repair (dMMR)/microsatellite instability-high (MSI-H) locally advanced rectal cancer (LARC), which suggests its potential as a curative-intent therapy and a promising treatment option for organ preservation. We aimed to investigate the long-term outcomes of patients with dMMR/MSI-H LARC who experienced clinical complete response (cCR) after anti-PD-1 therapy. METHODS: We retrospectively analyzed patients with dMMR/MSI-H LARC who achieved cCR and received nonoperative management following neoadjuvant anti-PD-1-based treatment from 4 Chinese medical centers. Patients were followed up for at least 1 year after they achieved cCR, their clinical data were collected, and survival outcomes were analyzed using the Kaplan-Meier method. RESULTS: A total of 24 patients who achieved cCR and received nonoperative management from March 2018 to May 2022 were included, with a median age of 51.0 years (range, 19.0-77.0 years). The median treatment course to reach cCR was 6.0 (range, 1.0-12.0). Fifteen patients (62.5%) continued their treatments after experiencing cCR, and the median treatment course was 17.0 (range, 3.0-36.0). No local regrowth or distant metastasis was observed in a median follow-up time of 29.1 months (range, 12.6-48.5 months) after cCR. The 3-year disease-free and overall survivals were both 100%. CONCLUSIONS: Patients with dMMR/MSI-H locally advanced or low-lying rectal cancer who achieved cCR following anti-PD-1-based therapy had promising long-term outcomes. A prospective clinical trial with a larger sample size is required to further validate these findings.

Green roof development knowledge map: A review of visual analysis using CiteSpace and VOSviewer.

Green roofs are generally acknowledged as environmentally sustainable roof systems with several environmental, economic, and social benefits, as well as an effective and practical strategy for mitigating the negative consequences of urbanization. In this paper, we used CiteSpace and VOSviewer bibliometric software for visual analysis, citation analysis, co-authorship network, co-citation analysis, and keyword analysis for descriptive statistics on 3986 articles on "green roofs" published in the Web of Science core database since 2000. Descriptive statistics were used for citation analysis, co-authorship network, co-citation analysis, and keyword analysis. According to a review of green roofing-related research literature, (1) Through analysis from three dimensions of country, institution, and author, it was found that China, the United States, and Italy ranked among the top three countries in terms of green roof publication volume; All but three of the top 10 institutions in terms of publications are from China and all are from developed countries; A large-scale collaborative network has not yet formed among authors. (2) Through keyword clustering analysis, it was found that "green roof," "performance," and "UHI" were the three keywords with the highest frequency. The research direction of this theme mainly includes five primary themes: rainwater management, urban biodiversity, building energy efficiency, alleviating urban heat islands and improving air quality, sustainable development, and public health. Through keyword hot words, it is found that the frequency of occurrence is relatively high, mainly involving energy conservation, alleviating urban heat islands, biodiversity, and sustainable development. The research on sustainable development, its impact on urban microclimate, and air quality remains a hot topic through keyword highlighting. (3) Co-citation analysis was used to identify the most influential journals, highly cited publications, and authors. (4) Three potential study objectives have been identified: synergistic development with other green infrastructures from an urban planning standpoint, localized research on green roofs, and photovoltaic green roofs.

The effects of oxaliplatin-based adjuvant chemotherapy in high-risk stage II colon cancer with mismatch repair-deficient: a retrospective study.

BACKGROUND: For high-risk stageIImismatch repair deficient (dMMR) colon cancers, the benefit of adjuvant chemotherapy remains debatable. The principal aim of this study was to evaluate the prognostic value of high-risk factors and the effect of oxaliplatin-based adjuvant chemotherapy among dMMR stageIIcolon cancers. METHODS: Patients with stage II dMMR colon cancers diagnosed between June 2011 and May 2018 were enrolled in the study. Clinicopathological characteristics, treatment, and follow-up data were retrospectively collected. The high-risk group was defined as having one of the following factors: pT4 disease, fewer than twelve lymph nodes harvested (< 12 LNs), poorly differentiated histology, perineural invasion (PNI), lymphatic vascular invasion (LVI), or elevated preoperative carcinoembryonic antigen (CEA). The low-risk group did not have any risk factors above. Factors associated with disease-free survival (DFS) were included in univariate and multivariate Cox analyses. RESULTS: We collected a total of 262 consecutive patients with stage II dMMR colon cancer. 179 patients (68.3%) have at least one high-risk factor. With a median follow-up of 50.1 months, the low-risk group was associated with a tended to have a better 3-year DFS than the high-risk group (96.4% vs 89.4%; P = 0.056). Both elevated preoperative CEA (HR 2.93; 95% CI 1.26-6.82; P = 0.013) and pT4 disease (HR 2.58; 95% CI 1.06-6.25; P = 0.037) were independent risk factors of recurrence. Then, the 3-year DFS was 92.6% for the surgery alone group and 88.1% for the adjuvant chemotherapy group (HR 1.64; 95% CI 0.67-4.02; P = 0.280). Furthermore, no survival benefit from oxaliplatin-based adjuvant chemotherapy was observed in the high-risk group and in the subgroups with pT4 disease or < 12 LNs. CONCLUSIONS: These data suggests that not all high-risk factors have a similar impact on stage II dMMR colon cancers. Elevated preoperative CEA and pT4 tumor stage are associated with increased recurrence risk. However, oxaliplatin-based adjuvant chemotherapy shows no survival benefits in stage II dMMR colon cancers, either with or without high-risk factors.

Application of exponential smoothing method and SARIMA model in predicting the number of admissions in a third-class hospital in Zhejiang Province.

OBJECTIVE: To establish the exponential smoothing prediction model and SARIMA model to predict the number of inpatients in a third-class hospital in Zhejiang Province, and evaluate the prediction effect of the two models, and select the best number prediction model. METHODS: The data of hospital admissions from January 2019 to September 2022 were selected to establish the exponential smoothing prediction model and the SARIMA model respectively. Then compare the fitting parameters of different models: R2_adjusted, R2, Root Mean Square Error (RMSE)、Mean Absolute Percentage Error (MAPE)、Mean Absolute Error(MAE) and standardized BIC to select the best model. Finally, the established model was used to predict the number of hospital admissions from October to December 2022, and the prediction effect of the average relative error judgment model was compared. RESULTS: The best fitting exponential smoothing prediction model was Winters Addition model, whose R2_adjusted was 0.533, R2 was 0.817, MAPE was 6.133, MAE was 447.341. The best SARIMA model is SARIMA(2,2,2)(0,1,1)12 model, whose R2_adjusted is 0.449, R2 is 0.199, MAPE is 8.240, MAE is 718.965. The Winters addition model and SARIMA(2,2,2)(0,1,1)12 model were used to predict the number of hospital admissions in October-December 2022, respectively. The results showed that the average relative error was 0.038 and 0.015, respectively. The SARIMA(2,2,2)(0,1,1)12 model had a good prediction effect. CONCLUSION: Both models can better fit the number of admissions, and SARIMA model has better prediction effect.

Update on Familial Adenomatous Polyposis-Associated Desmoid Tumors.

Desmoid tumors (DT) represent the second high risk of tumor in familial adenomatous polyposis (FAP) patients. Although FAP-associated DTs (FAP-DT) are caused by germline mutations in the adenomatous polyposis coli (APC) gene, extracolonic manifestations, sex, family history, genotype, and the ileal pouch anal anastomosis procedure are all linked to the development of DTs in FAP patients. Multidisciplinary management has replaced aggressive surgery as the preferred treatment of DTs. There is growing evidence to support the use of active surveillance strategy as first-line treatment for FAP-DT patients. Radiotherapy for intra-abdominal desmoids is now rarely used because of severe late toxicity. Pharmacotherapy, however, represents a promising future with the improvement of traditional cytotoxic drugs and the investigation of targeted drugs. Although nonsurgery treatment has been used widely nowadays, surgery remains the mainstay when symptomatic or life-threatening DTs are present. Further research will be needed for more optimal clinical practice.

Application of problem based learning (PBL) and case based learning (CBL) in the teaching of international classification of diseases encoding.

To study the application of PBL combined with CBL teaching mode in the teaching of international classification of diseases (ICD) encoding, so as to improve students' grasp of ICD encoding knowledge. From March 2020 to June 2020, 50 students majoring in health information management who were interns in a Grade A general hospital were selected as the research participants and randomly divided into experimental group and control group, 25 in each group. The experimental group and the control group adopted the PBL combined CBL teaching mode and the traditional teaching mode respectively to carry out the classification and coding teaching. The academic achievement of the two groups of students was evaluated by means of achievement assessment and questionnaire survey based on information processing theory. The scores of theoretical knowledge in the experimental group and the control group were 79.78 ± 8.55 and 70.92 ± 10.81, respectively, and the scores of skill operation in the two groups were 79.76 ± 8.28 and 70.00 ± 10.41, respectively. The test scores of the experimental group were higher than those of the control group, and the difference was statistically significant (P < 0.05). The scores of knowledge acquisition ability of experimental group and control group were 16.72 ± 1.79 and 16.60 ± 2.36, the scores of knowledge sharing ability were 24.20 ± 2.61 and 21.00 ± 2.65, the scores of knowledge storage ability were 20.80 ± 2.47 and 17.24 ± 4.90, respectively. The scores of knowledge application ability were 14.00 ± 1.80 and 11.00 ± 2.69, the scores of knowledge innovation ability were 20.16 ± 2.34 and 18.08 ± 3.70, and the total scores were 95.88 ± 6.08 and 83.92 ± 11.30, respectively. The scores of all questionnaires in the experimental group were higher than those in the control group. The scores of knowledge sharing ability, knowledge storage ability, knowledge application ability, knowledge innovation ability and total score between the two groups were higher than those of the control group, and the differences were statistically significant (P < 0.05). PBL combined with CBL teaching model has good academic achievement in ICD encoding teaching, which can significantly improve academic performance and learning ability, and is worthy of promotion.

Efficacy of PD-1 inhibitors for colorectal cancer and polyps in Lynch syndrome patients.

BACKGROUND: Programmed death-1 (PD-1) inhibitor is effective for colorectal cancer (CRC) with deficient mismatch repair (dMMR) or high microsatellite instability (MSI-H). We aimed to explore its effects on CRCs and colonic polyps in Lynch syndrome (LS) patients. METHODS: LS patients with CRC who had evaluable tumours and received at least 2 cycles of PD-1 inhibitors were retrospectively included. PD-1 inhibitors were given as a monotherapy or in combination with other therapies, including anticytotoxic T-lymphocyte-associated antigen-4 treatment, radiotherapy, chemotherapy, and targeted therapy. Correlations of treatment responses with clinicopathological characteristics and genomic profiles were analysed. RESULTS: A total of 75 LS patients were included, with a median age of 39 years. The median duration of follow-up was 27 months (range, 3-71). The objective response rate (ORR) was 70.7%, including 28.0% (n = 21) complete responses and 42.7% (n = 32) partial responses. Four of five cases of LS CRCs displaying proficient MMR (pMMR) or microsatellite stable (MSS) were not responsive. Mucinous/signet-ring cell differentiation was associated with a lower ORR (P = 0.013). The 3-year overall survival and progression-free survival were 91.2% and 82.2%, respectively. A polyp was detected in 26 patients during surveillance. Seven adenomas disappeared after treatment, and they were all larger than 7 mm. CONCLUSION: PD-1 inhibitors are highly effective for dMMR and MSI-H LS CRCs, but not for pMMR or MSS LS CRCs or mucinous/signet-ring cell CRC. Large LS adenomas may also be eliminated by anti-PD-1 treatment. DATA AVAILABILITY STATEMENT: Due to the privacy of patients, the related data cannot be available for public access but can be obtained from Pei-Rong Ding (dingpr@sysucc.org.cn) upon reasonable request. The key raw data have been uploaded to the Research Data Deposit public platform (www.researchdata.org.cn).

The role and application of fibroblast activating protein.

Fibroblast activation protein-α (FAP), a type-II transmembrane serine protease, is rarely expressed in normal tissues but highly abundant in pathological diseases, including fibrosis, arthritis, and cancer. Ever since its discovery, we have deciphered its structure and biological properties and continue to investigate its roles in various diseases while attempting to utilize it for targeted therapy. To date, no significant breakthroughs have been made in terms of efficacy. However, in recent years, several practical applications in the realm of imaging diagnosis have been discovered. Given its unique expression in a diverse array of pathological tissues, the fundamental biological characteristics of FAP render it a crucial target for disease diagnosis and immunotherapy. To obtain a more comprehensive understanding of the research progress of FAP, its biological characteristics, involvement in diseases, and recent targeted application research have been reviewed. Moreover, we explored its development trend in the direction of clinical diagnoses and treatment.

Growth Differentiation Factor-15 Predicts Mortality and Heart Failure Exacerbation But Not Ventricular Arrhythmias in Patients With Cardiomyopathy.

Background Heart failure (HF) has been increasing in prevalence, and a need exists for biomarkers with improved predictive and prognostic ability. GDF-15 (growth differentiation factor-15) is a novel biomarker associated with HF mortality, but no serial studies of GDF-15 have been conducted. This study aimed to investigate the association between GDF-15 levels over time and the occurrence of ventricular arrhythmias, HF hospitalizations, and all-cause mortality. Methods and Results We used a retrospective case-control design to analyze 148 patients with ischemic and nonischemic cardiomyopathies and primary prevention implantable cardioverter-defibrillator (ICD) from the PROSe-ICD (Prospective Observational Study of the ICD in Sudden Cardiac Death Prevention) cohort. Patients had blood drawn every 6 months and after each appropriate ICD therapy and were followed for a median follow-up of 4.6 years, between 2005 to 2019. We compared serum GDF-15 levels within ±90 days of an event among those with a ventricular tachycardia/fibrillation event requiring ICD therapies and those hospitalized for decompensated HF. A comparator/control group comprised patients with GDF-15 levels available during 2-year follow-up periods without events. Median follow-up was 4.6 years in the 148 patients studied (mean age 58±12, 27% women). The HF cohort had greater median GDF-15 values within 90 days (1797 pg/mL) and 30 days (2039 pg/mL) compared with the control group (1062 pg/mL, both P<0.0001). No difference was found between the ventricular tachycardia/fibrillation subgroup within 90 days (1173 pg/mL, P=0.60) or 30 days (1173 pg/mL, P=0.78) and the control group. GDF-15 was also significantly predictive of mortality (hazard ratio, 3.17 [95% CI, 2.33-4.30]). Conclusions GDF-15 levels are associated with HF hospitalization and mortality but not ventricular arrhythmic events.

Acinar ATP8b1/LPC pathway promotes macrophage efferocytosis and clearance of inflammation during chronic pancreatitis development.

Noninflammatory clearance of dying cells by professional phagocytes, termed efferocytosis, is fundamental in both homeostasis and inflammatory fibrosis disease but has not been confirmed to occur in chronic pancreatitis (CP). Here, we investigated whether efferocytosis constitutes a novel regulatory target in CP and its mechanisms. PRSS1 transgenic (PRSS1Tg) mice were treated with caerulein to mimic CP development. Phospholipid metabolite profiling and epigenetic assays were performed with PRSS1Tg CP models. The potential functions of Atp8b1 in CP model were clarified using Atp8b1-overexpressing adeno-associated virus, immunofluorescence, enzyme-linked immunosorbent assay(ELISA), and lipid metabolomic approaches. ATAC-seq combined with RNA-seq was then used to identify transcription factors binding to the Atp8b1 promoter, and ChIP-qPCR and luciferase assays were used to confirm that the identified transcription factor bound to the Atp8b1 promoter, and to identify the specific binding site. Flow cytometry was performed to analyze the proportion of pancreatic macrophages. Decreased efferocytosis with aggravated inflammation was identified in CP. The lysophosphatidylcholine (LPC) pathway was the most obviously dysregulated phospholipid pathway, and LPC and Atp8b1 expression gradually decreased during CP development. H3K27me3 ChIP-seq showed that increased Atp8b1 promoter methylation led to transcriptional inhibition. Atp8b1 complementation substantially increased the LPC concentration and improved CP outcomes. Bhlha15 was identified as a transcription factor that binds to the Atp8b1 promoter and regulates phospholipid metabolism. Our study indicates that the acinar Atp8b1/LPC pathway acts as an important "find-me" signal for macrophages and plays a protective role in CP, with Atp8b1 transcription promoted by the acinar cell-specific transcription factor Bhlha15. Bhlha15, Atp8b1, and LPC could be clinically translated into valuable therapeutic targets to overcome the limitations of current CP therapies.

Paracrine-mediated rejuvenation of aged mesenchymal stem cells is associated with downregulation of the autophagy-lysosomal pathway.

Age-related differences in stem-cell potency contribute to variable outcomes in clinical stem cell trials. To help understand the effect of age on stem cell potency, bone marrow-derived mesenchymal stem cells (MSCs) were isolated from young (6 weeks) and old (18-24 months) mice. HUVEC tubule formation (TF) induced by the old and young MSCs and ELISA of conditioned media were compared to one another, and to old MSCs after 7 d in indirect co-culture with young MSCs. Old MSCs induced less TF than did young (1.56 ± 0.11 vs 2.38 ± 0.17, p = 0.0003) and released lower amounts of VEGF (p = 0.009) and IGF1 (p = 0.037). After 7 d in co-culture with young MSCs, TF by the old MSCs significantly improved (to 2.09 ± 0.18 from 1.56 ± 0.11; p = 0.013), and was no longer different compared to TF from young MSCs (2.09 ± 0.18 vs 2.38 ± 0.17; p = 0.27). RNA seq of old MSCs, young MSCs, and old MSCs following co-culture with young MSCs revealed that the age-related differences were broadly modified by co-culture, with the most significant changes associated with lysosomal pathways. These results indicate that the age-associated decreased paracrine-mediated effects of old MSCs are improved following indirect co-culture with young MSC. The observed effect is associated with broad transcriptional modification, suggesting potential targets to both assess and improve the therapeutic potency of stem cells from older patients.

Short-term exposure to six air pollutants and cause-specific cardiovascular mortality of nine counties or districts in Anhui Province, China.

Recently, the burden of cardiovascular disease (CVD) has attracted global attention. Meanwhile, CVD has become the leading cause of death in China. Some epidemiological studies have indicated that ambient air pollution may contribute to increased mortality from CVD diseases. Many studies have found a strong association between air pollutants and the risk of CVD deaths in some big cities, but few have focused on the effects of six pollutants in rural areas. Our study aimed to investigate the effects of six air pollutants (CO, NO2, O3, PM2.5, PM10, and SO2) on CVD deaths of rural areas in Anhui Province and to further clarify which populations were susceptible to air pollution. First, the generalized additive models were combined with the distributed lag nonlinear models to evaluate the individual effects of air pollution on CVD deaths in each area. Then, random-effects models were used to aggregate the associations between air pollutants and CVD mortality risk in nine regions. Overall, all six pollutants had a statistically significant effect on the risk of CVD deaths on the lag 07 days. The associations between PM2.5, PM10, and SO2 and daily CVD deaths were strongest, with maximum cumulative RR (lag 07) of 1.91 (1.64-2.18), 2.27 (1.50-3.05), and 2.13 (1.44-2.82). In general, we found that six air pollutants were the important risk factors for CVD and specific CVD deaths in Anhui Province. The elderly were susceptible to PM2.5, PM10, and SO2.

Surgery combined with photodynamic therapy versus surgery alone for the treatment of non-melanoma skin cancer and actinic keratosis: A retrospective cohort study.

Photodynamic therapy (PDT) is an effective treatment for some non-melanoma skin cancers (NMSC) and actinic keratosis. To compare recurrence-free survival (RFS) rates between surgery alone and surgery with postoperative PDT in patients with NMSC in China. This retrospective cohort study included patients with pathologically confirmed NMSC or actinic keratosis treated by surgical excision with/without PDT. A total of 125 patients were included, including 72 patients (43 females) aged 57-75 years in the surgery alone group and 53 patients (32 females) aged 61-76 years in the surgery+PDT group. The most common NMSC types were squamous cell carcinoma and basal cell carcinoma, the most common lesion site was the head and neck, and the vast majority of patients had a primary disease and solitary lesions. There were no significant differences between groups in baseline characteristics. RFS rates in the surgery alone and surgery+PDT groups were, respectively, 100.0% and 98.1% at 1 week, 98.6% and 98.1% at 4 weeks, 97.2% and 98.1% at 8 weeks, 97.2% and 98.1% at 12 weeks, and 90.3% and 90.4% at 24 weeks, with no significant differences between groups. Adjuvant PDT after surgical excision of NMSC or actinic keratosis does not provide short-term improvement in RFS, but the results need to be confirmed by a formal randomized controlled trial.

St13 protects against disordered acinar cell arachidonic acid pathway in chronic pancreatitis.

BACKGROUND: Early diagnosis and treatment of chronic pancreatitis (CP) are limited. In this study, St13, a co-chaperone protein, was investigated whether it constituted a novel regulatory target in CP. Meanwhile, we evaluated the value of micro-PET/CT in the early diagnosis of CP. METHODS: Data from healthy control individuals and patients with alcoholic CP (ACP) or non-ACP (nACP) were analysed. PRSS1 transgenic mice (PRSS1Tg) were treated with ethanol or caerulein to mimic the development of ACP or nACP, respectively. Pancreatic lipid metabolite profiling was performed in human and PRSS1Tg model mice. The potential functions of St13 were investigated by crossing PRSS1Tg mice with St13-/- mice via immunoprecipitation and lipid metabolomics. Micro-PET/CT was performed to evaluate pancreatic morphology and fibrosis in CP model. RESULTS: The arachidonic acid (AA) pathway ranked the most commonly dysregulated lipid pathway in ACP and nACP in human and mice. Knockout of St13 exacerbated fatty replacement and fibrosis in CP model. Sdf2l1 was identified as a binding partner of St13 as it stabilizes the IRE1α-XBP1s signalling pathway, which regulates COX-2, an important component in AA metabolism. Micro-PET/CT with 68Ga-FAPI-04 was useful for evaluating pancreatic morphology and fibrosis in CP model mice 2 weeks after modelling. CONCLUSION: St13 is functionally activated in acinar cells and protects against the cellular characteristics of CP by binding Sdf2l1, regulating AA pathway. 68Ga-FAPI-04 PET/CT may be a very valuable approach for the early diagnosis of CP. These findings thus provide novel insights into both diagnosis and treatment of CP.

Multiple environmental exposures and obesity in eastern China: An individual exposure evaluation model.

Obesity has caused a huge burden of disease. Few studies have explored individuals' environmental exposure level and the impact of multiple environmental exposures on obesity. The aim of this study was to explore individual air pollution exposure evaluation, and the association between and multiple environmental factors and obesity among adult residents in rural areas of China. In this study, 8400 residents of 14 districts and counties in eastern of China were selected by multistage stratified cluster sampling, and a total of 8377 residents were included in the final analysis. We adopted BMI (Body Mass Index) > 28 kg/m2 as the definition of obesity. First, an individual air pollution evaluation model was established based on the monitoring data of air pollution stations closest to residential address, different demographic characteristics of residents and daily living habits using generalized linear model and random forest model. Then, we used Bayesian Kernel Machine Regression (BKMR) and Quantile g-Computation (QgC) models to explore multiple environmental exposures on obesity. The results showed that six air pollutants were significantly positively associated with obesity, and green space had a significant protective effect on obesity. The BKMR model showed that the effects of different air pollutants on obesity were significantly enhanced by each other, while green space significantly reduced the positive effect of air pollution on obesity. The QgC model showed a significant positive association with obesity when all environmental factors were exposed as a whole, especially in males, higher household incomes and young people. It suggested that relevant authorities should improve regional air quality and green space to reduce the burden of disease caused by obesity.

Effects of carbon dioxide and green space on sleep quality of the elderly in rural areas of Anhui Province, China.

Sleep quality leads to many healthy problems, which has caused global concern. Most studies have focused on the sleep quality in some large cities, ignoring the elderly in rural areas who may have more serious sleep problems. Therefore, this study aimed to understand the sleep status of the elderly in rural areas of Anhui Province and the influence of environmental factors on it. The data of carbon dioxide (CO2) concentrations for this study were obtained from the Dalhousie University atmospheric composition analysis group. The data of normalized differential vegetation index (NDVI) in 2014 was produced and processed by remote sensing inversion on the basis of medium resolution satellite images. The 2686 individuals were selected from rural areas of Anhui Province by multi-stage stratified cluster sampling. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The independent, interactive, and mediating effects of CO2 and green space on sleep quality were evaluated by generalized linear model, interaction model, and mediating effect model, respectively. In this study, we found that the prevalence of sleep disturbance in the elderly was 58.40%. In the univariate model, we found that the risk of sleep disturbance increased by 1.6% for each 1 µg/m3 increase in concentrations of CO2, while decreased by 1.5% for every 0.1 increase in NDVI. In the interaction model, the negative correlation between green space and sleep quality decreased with concentrations of CO2 increased. In addition, green space was a mediating factor between CO2 and sleep quality in the mediating effect model.

Associations of combined exposures to ambient temperature, air pollution, and green space with hypertension in rural areas of Anhui Province, China: A cross-sectional study.

Hypertension (HTN) was a major preventable cause of cardiovascular disease (CVD), contributing to a huge disease burden. Ambient temperature, air pollution and green space were important influencing factors of HTN, and few studies have assessed the effects and interactions of ambient temperature, air pollution and green space on HTN in rural areas. In this study, we selected 8400 individuals randomly in rural areas of Anhui Province by a multi-stage stratified cluster sampling. A total of 8383 individuals were included in the final analysis. We collected particulate pollutants and meteorological data from the local air quality monitoring stations and National Center for Meteorological Science from January 1 to December 31, 2020, respectively. The normalized differential vegetation index (NDVI) of Anhui Province in 2020 was produced and processed by remote sensing inversion on the basis of medium resolution satellite images. The average annual mean exposure concentrations of air pollution, meteorological factors, and NDVI were calculated for each individual based on the geocoded residential address. HTN was defined according the Chinese Guidelines for Prevention and Treatment of HTN. The effects and interactions of ambient temperature, air pollution and green space on HTN were evaluated by generalized linear model and interaction model, respectively. In this study, the prevalence of HTN was 24.14%. The adjusted odd ratio of HTN for each 1 µg/m3 increasing in PM2.5 and PM10, 1 °C of ambient temperature, and 0.1 of NDVI were:1.276 (1.013, 1.043), 1.012 (1.006, 1.018), 0.862 (0.862, 0.981) and 0.669 (0.611, 0.733), respectively. The results showed that air pollutants were positively correlated with HTN, while ambient temperature and green space were negatively correlated with HTN. Meanwhile, the negative associations of green space on HTN could decrease with the increasing concentrations of air pollution, but increase with the rising of ambient temperature.

Six air pollutants and cause-specific mortality: a multi-area study in nine counties or districts of Anhui Province, China.

Air pollution and its negative effects on health of people have been a global concern. Many studies had found a strong association between air pollutants and risk of death, but few had focused on the effects of six pollutants and rural areas. Our study aimed to investigate the effects of six air pollutants (CO, NO2, O3, PM2.5, PM10, and SO2) on non-accidental and respiratory deaths in rural areas of Anhui Province by adjusting for confounding factors, and to further clarify which populations were susceptible to death associated with air pollution. In the first phase of the analysis, the generalized additive models were combined with the distributed lag non-linear models to evaluate the individual effects of air pollution on death in each area. In the second stage, random-effects models were used to aggregate the associations between air pollutants and mortality risk in nine areas. Overall, six pollutants had the strongest effects on the risk of death on the lag 07 days. The associations between PM2.5 and NO2 and daily non-accidental deaths were strongest, with maximum RR (lag 07): 1.63 (1.37-1.88) and 1.67 (1.37-1.96). The maximum pooled effects of association between six air pollutants and RD were PM2.5, with RR (lag 07): 1.89 (1.45-2.34). PM2.5 and PM10 had significant differences between the elderly and the non-elderly with respectively, RRR: 1.22 (1.04-1.41) and 1.26 (1.11-1.42). In general, we found that six air pollutants were the important risk factors for deaths (deaths from respiratory disease and non-accidental) in rural areas of Anhui Province. PM10 and PM2.5 had a considerable impact on the elderly.