Dose-response relationship between lung function and chest imaging response to silica exposures in artificial stone manufacturing workers.

BACKGROUND: Occupational exposure to artificial stone, a popular material used for countertops, can cause accelerated silicosis, but the precise relationship between silica dose and disease development is unclear. OBJECTIVES: This study evaluated the impact of silica exposure on lung function and chest imaging in artificial stone manufacturing workers. METHODS: Questionnaire and spirometry assessments were administered to workers in two plants. A high-exposure subset underwent further evaluation, including chest CT and DLco. Weighting factors, assigned as proxies for silica exposure, were based on work tasks. Individual cumulative exposures were estimated using area concentration measurements and time spent in specific areas. Exposure-response associations were analyzed using linear and logistic regression models. RESULTS: Among 65 participants, the mean cumulative silica exposure was 3.61 mg/m3-year (range 0.0001 to 44.4). Each 1 mg/m3-year increase was associated with a 0.46% reduction in FVC, a 0.45% reduction in FEV1, and increased lung function abnormality risk (aOR = 1.27, 95% CI = 1.03-1.56). Weighting factors correlated with cumulative exposures (Spearman correlation = 0.59, p < 0.0001), and weighted tenure was associated with lung function abnormalities (aOR = 1.04, 95% CI = 1.01-1.09). Of 37 high-exposure workers, 19 underwent chest CT, with 12 (63%) showing abnormal opacities. Combining respiratory symptoms, lung function, and chest X-ray achieved 91.7% sensitivity and 75% specificity for predicting chest CT abnormalities. CONCLUSION: Lung function and chest CT abnormalities occur commonly in artificial stone workers. For high-exposure individuals, abnormalities on health screening could prompt further chest CT examination to facilitate early silicosis detection.

Fungal Spore Richness and Abundance of Allergenic Taxa: Comparing a Portable Impactor and Passive Trap Indoors and Outdoors in an Urban Setting.

Fungal spores are common airborne allergens, and fungal richness has been implicated in allergic disease. Amplicon sequencing of environmental DNA from air samples is a promising method to estimate fungal spore richness with semi-quantification of hundreds of taxa and can be combined with quantitative PCR to derive abundance estimates. However, it remains unclear how the choice of air sampling method influences these estimates. This study compared active sampling with a portable impactor and passive sampling with a passive trap over different durations to estimate fungal spore richness and the abundance of allergenic taxa. Air sampling was conducted indoors and outdoors at 12 residences, including repeated measurements with a portable impactor and passive traps with 1-day and 7-day durations. ITS2 amplicon sequence data were transformed to spore equivalents estimated by quantitative PCR, repeated active samples were combined, and abundance-based rarefaction was performed to standardize sample coverage for estimation of genus-level richness and spore abundance. Rarefied fungal richness was similar between methods indoors but higher for passive traps with a 7-day duration outdoors. Rarefied abundance of allergenic genera was similar between methods but some genera had lower abundance for passive traps with a 1-day duration, which differed indoors and outdoors indicating stochasticity in the collection of spores on collocated samplers. This study found that similar estimates of fungal spore richness and abundance of allergenic taxa can be obtained using a portable impactor or a passive trap within one day and that increased passive sample duration provides limited additional information.

The differential impact of Type D personality on the prognosis of patients with stable coronary artery disease.

OBJECTIVE: This study investigated the association between Type D personality and prognoses in stable coronary artery disease (CAD) patients by mode of endpoints, age, and methodological debates to explain substantial heterogeneity among Type D studies. DESIGN: The prospective study was designed to recruit 590 stable CAD patients in Taiwan. Main outcome measures: Demographic and clinical characteristics, and the 14-item Type D scale-Taiwanese version were recorded at discharge. RESULTS: Hierarchical logistic regression analyses showed, regardless of the methodological debates, Type D personality was significantly associated with MACEs though not non-cardiac outcomes in stable CAD patients after adjusting for possible confounders. Furthermore, Type D personality was especially associated with MACEs in stable CAD patients with younger age (<65 y), rather than older age (≥65 y). Subgroup analysis also showed the adverse effect of Type D personality on MACEs was larger among males, those living in the rural region, those with PTCA or stent, those with heart failure, hypertension, diabetes, and those who were smokers. CONCLUSIONS: Regardless of whether the methodological debate is dichotomous or continuous, Type D personality was significantly associated with MACEs in stable CAD patients, some of whom had younger age, were males, smokers, or had comorbidities.

Air pollution enhance the progression of restrictive lung function impairment and diffusion capacity reduction: an elderly cohort study.

BACKGROUND: Some evidences have shown the association between air pollution exposure and the development of interstitial lung diseases. However, the effect of air pollution on the progression of restrictive ventilatory impairment and diffusion capacity reduction is unknown. This study aimed to evaluate the effects of long-term exposure to ambient air pollution on the change rates of total lung capacity, residual volume, and diffusion capacity among the elderly. METHODS: From 2016 to 2018, single-breath helium dilution with the diffusion capacity of carbon monoxide was performed once per year on 543 elderly individuals. Monthly concentrations of ambient fine particulate matters (PM2.5) and nitric dioxide (NO2) at the individual residential address were estimated using a hybrid Kriging/Land-use regression model. Linear mixed models were used to evaluate the association between long-term (12 months) exposure to air pollution and lung function with adjustment for potential covariates, including basic characteristics, indoor air pollution (second-hand smoke, cooking fume, and incense burning), physician diagnosed diseases (asthma and chronic airway diseases), dusty job history, and short-term (lag one month) air pollution exposure. RESULTS: An interquartile range (5.37 ppb) increase in long-term exposure to NO2 was associated with an additional rate of decline in total lung volume (- 1.8% per year, 95% CI: - 2.8 to - 0.9%), residual volume (- 3.3% per year, 95% CI: - 5.0 to - 1.6%), ratio of residual volume to total lung volume (- 1.6% per year, 95% CI: - 2.6 to - 0.5%), and diffusion capacity (- 1.1% per year, 95% CI: - 2.0 to - 0.2%). There is no effect on the transfer factor (ratio of diffusion capacity to alveolar volume). The effect of NO2 remained robust after adjustment for PM2.5 exposure. CONCLUSIONS: Long-term exposure to ambient NO2 is associated with an accelerated decline in static lung volume and diffusion capacity in the elderly. NO2 related air pollution may be a risk factor for restrictive lung disorders.

Effects of a novel inclined-adaptive footwear on change-of-direction performance in male athletes.

BACKGROUND: Although enhancing change of direction (COD) performance is a crucial factor for improving athletic performance in many sports, few studies have explored its effective methods. RESEARCH QUESTION: This study aimed to investigate the effects of inclined-adaptive footwear (IAF) on force-time characteristics during a COD task. METHODS: Thirteen male team sport athletes were randomly assigned to wear IAF or footwear without adaptive technology to perform a COD60° task at their best effort. A three-dimensional force plate was used to obtain the force-time curve and related parameters at the turning step (plant foot). RESULTS: IAF led to a significantly higher resultant ground reaction force (GRF), horizontal GRF, vertical GRF, and horizontal/vertical ratio during the braking phase, followed by a significantly shorter contact time and higher resultant horizontal GRF and vertical GRF during the propulsive phase. SIGNIFICANCE: This indicated that a greater GRF output, redistributed GRF, and shorter contact time occurred with the IAF. Therefore, IAF has the potential to enhance COD performance for sports involving multi-directional footwork and contribute to the development of new functional footwear.

Validity of the Favero Assioma Duo Power Pedal System in Maximal-Effort Cycling Tests.

PURPOSE: The pedal-based power meter has its advantages, so it has become a popular monitoring tool in cycling. This study aimed to examine the validity of the Favero Assioma Duo power pedal system (FAD) in comparison with the SRM, which is considered the gold standard under maximal-effort cycling conditions, and a widely used cycling test, the 20-minute Functional Threshold Test. METHODS: Fourteen male adolescent cyclists completed a series of cycling intervals including 5, 15, 30, 60, 240, 600, and 1200 seconds (20-min Functional Threshold Test) with their maximal-effort performance on 2 separate days. Power output data were collected from the FAD and the SRM for analysis. RESULTS: Extremely strong correlations and excellent intraclass correlation coefficients (ICCs) were found between the power output values registered with the FAD and the SRM overall (r > .999, ICC = .996) and each power test (r > .98, ICC > .91). A low bias was found in power tests of longer durations (-3.2% at 240-s test, -3.3% at 600-s test, and -3.1% at 20-min Functional Threshold Test), while the bias augmented in shorter intervals (-2.7% at 5-s test, -3.6% at 15-s test, and -2.6% at 30-s test and -3.3% at 60-s test). A regression equation was proposed as y = -2.943 + 0.976x to diminish the bias (-0.2 W) with increased r value (>.98) and ICC (>.98). CONCLUSION: The FAD appears to be a valid tool for the measures of maximal-effort performance. The recorded power value reflects the true value with proposed regression equation.

The impact of sources of perceived social support on readmissions in patients with heart failure.

BACKGROUND: Lower levels of perceived social support have been known as an independent predictor of hospital readmissions in patients with heart failure (HF). However, the impact of sources of perceived social support on readmissions remain unexplored. PURPOSE: The main purpose of this study was to investigate and compare the relative importance of social support from significant other, family, and friends on all-cause readmission and cardiac readmission in patients with HF. METHODS: The prospective cohort study was used to recruit a total of 299 patients with HF in Taiwan between May 2012 and December 2014. Demographic and clinical characteristics, Multidimensional Perceived Social Support Scale (MPSSS), and 18-month follow-up readmissions were recorded during the hospital stay. Univariate and multivariate logistic regressions were constructed to determine the impact of levels and sources of perceived social support with all-cause readmission and cardiac readmission. RESULTS: A total of 158 patients (52.8%) and 118 patients (39.5%), respectively, had all-cause readmission and cardiac readmissions within 18 months. Multivariate logistic regression yielded inverse associations between levels of perceived social support and readmissions by 18-months. Importantly, social support from significant other was significantly associated with a lower risk of readmissions, both of all-cause readmission and cardiac readmission, in patients with HF, even after controlling for possible covariates, social support from family and friends. CONCLUSIONS: Social support from significant other, rather than from family and friends, was relatively and inversely associated with 18-month all-cause readmission and cardiac readmission in patients with HF, which is consistent with the hierarchical compensatory model.

Fungal Spore Richness in School Classrooms is Related to Surrounding Forest in a Season-Dependent Manner.

Airborne fungal spores are important aeroallergens that are remarkably diverse in terms of taxonomic richness. Indoor fungal richness is dominated by outdoor fungi and is geographically patterned, but the influence of natural landscape is unclear. We aimed to elucidate the relationship between indoor fungal spore richness and natural landscape by examining the amount of surrounding forest cover. Passive sampling of airborne fungal spores was conducted in 24 schools in Taiwan during hot and cool seasons, and amplicon sequencing was used to study fungal spore (genus) richness targeting the internal transcribed spacer 2 (ITS2) region. In total, 693 fungal genera were identified, 12 of which were ubiquitous. Despite overall similarity of fungal spore richness between seasons, Basidiomycota and Ascomycota richness increased during the hot and cool seasons, respectively. Fungal spore richness in schools had a strong positive correlation with the amount of surrounding forest cover during the cool season, but not during the hot season. Fungal assemblages in schools were more similar during the hot season due to the increased ubiquity of Agaricomycetes genera. These observations indicate dispersal limitation at the kilometer scale during the cool season and increased long-distance dispersal during the hot season. Several allergenic fungi were commonly identified in schools, including some previously overlooked by conventional methods, which may be targeted as sensitizing agents in future investigations into atopic conditions. More generally, the relative importance of fungal spore richness in the development, chronicity, and severity of atopic conditions in children requires investigation.

Does Use of Acupuncture Reduce the Risk of Type 2 Diabetes Mellitus in Patients With Rheumatoid Arthritis? Evidence From a Universal Coverage Health Care System.

Objectives: Although acupuncture is often advocated for patients with rheumatoid arthritis (RA), its efficacy for type 2 diabetes mellitus (T2DM), a common metabolic disease among RA cohorts, has not yet been established. This retrospective cohort study aimed to determine the association between acupuncture use and the development of T2DM among them. Methods: Data were collected from 1999 through 2008 for individuals aged 20-70 years in the nationwide insurance database of Taiwan. From them, we extracted 4,941 subjects within newly diagnosed RA and being T2DM free at baseline. A total of 2,237 patients had ever received acupuncture, and 2,704 patients without receiving acupuncture were designated as a control group. All of them were followed to the end of 2013 to identify T2DM incidence. The Cox proportional hazards regression model was utilized to obtain the adjusted hazard ratio (HR) for acupuncture use. Results: Compared with the RA subjects without use of acupuncture, the incidence of T2DM was lower for those who received acupuncture, with the incidence rates of 24.50 and 18.00 per 1,000 person-years (PYs), respectively. After adjusting for potential confounders, use of acupuncture was significantly related to the lower T2DM risk, with the adjusted HR of 0.73 [95% confidence interval (CI) 0.65-0.86]. Those who used acupuncture for more than five sessions had the greatest benefit in lowering the susceptibility to T2DM. Conclusion: Adding acupuncture into conventional treatment for RA was found to be related to lower risk of T2DM among RA patients. Further clinical and mechanistic studies are warranted.

The Biomechanical Characterization of the Turning Phase during a 180° Change of Direction.

The aim of this study was to characterize the turning phase during a modified 505 test. Forty collegiate basketball students, divided into faster and slower performers and high-playing-level and low-playing-level groups, were evaluated for the force-time characteristics (braking and/or propulsive phase) of the penultimate foot contact (PFC), final foot contact (FFC), and first accelerating foot contact (AFC), and for completion time and approach velocity. Based on the composition of the AFC, trials were classified as braking/propulsive or only propulsive. Regression analysis for the prediction of completion time was performed. The AFC contributed to reacceleration through shorter contact times and step length, and lower braking force production (p < 0.05). Faster performers and the high-playing-level group demonstrated (p < 0.05): lower completion times, higher approach velocities, longer steps length in the PFC and FFC, greater braking forces and impulses in the PFC; greater braking and propulsive forces, braking impulses, lower contact times in the FFC; greater braking and propulsive horizontal forces, horizontal impulses, lower contact times and vertical impulses in the AFC. Kinetic variables from only the FFC and AFC and approach velocity predicted 75% (braking/propulsive trials) and 76.2% (only-propulsive trials) of completion times. The characterization of the turning phase demonstrated the specific contribution of each foot contact and the possible implications for training prescription.

Acute Exacerbation of a Chronic Obstructive Pulmonary Disease Prediction System Using Wearable Device Data, Machine Learning, and Deep Learning: Development and Cohort Study.

BACKGROUND: The World Health Organization has projected that by 2030, chronic obstructive pulmonary disease (COPD) will be the third-leading cause of mortality and the seventh-leading cause of morbidity worldwide. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with an accelerated decline in lung function, diminished quality of life, and higher mortality. Accurate early detection of acute exacerbations will enable early management and reduce mortality. OBJECTIVE: The aim of this study was to develop a prediction system using lifestyle data, environmental factors, and patient symptoms for the early detection of AECOPD in the upcoming 7 days. METHODS: This prospective study was performed at National Taiwan University Hospital. Patients with COPD that did not have a pacemaker and were not pregnant were invited for enrollment. Data on lifestyle, temperature, humidity, and fine particulate matter were collected using wearable devices (Fitbit Versa), a home air quality-sensing device (EDIMAX Airbox), and a smartphone app. AECOPD episodes were evaluated via standardized questionnaires. With these input features, we evaluated the prediction performance of machine learning models, including random forest, decision trees, k-nearest neighbor, linear discriminant analysis, and adaptive boosting, and a deep neural network model. RESULTS: The continuous real-time monitoring of lifestyle and indoor environment factors was implemented by integrating home air quality-sensing devices, a smartphone app, and wearable devices. All data from 67 COPD patients were collected prospectively during a mean 4-month follow-up period, resulting in the detection of 25 AECOPD episodes. For 7-day AECOPD prediction, the proposed AECOPD predictive model achieved an accuracy of 92.1%, sensitivity of 94%, and specificity of 90.4%. Receiver operating characteristic curve analysis showed that the area under the curve of the model in predicting AECOPD was greater than 0.9. The most important variables in the model were daily steps walked, stairs climbed, and daily distance moved. CONCLUSIONS: Using wearable devices, home air quality-sensing devices, a smartphone app, and supervised prediction algorithms, we achieved excellent power to predict whether a patient would experience AECOPD within the upcoming 7 days. The AECOPD prediction system provided an effective way to collect lifestyle and environmental data, and yielded reliable predictions of future AECOPD events. Compared with previous studies, we have comprehensively improved the performance of the AECOPD prediction model by adding objective lifestyle and environmental data. This model could yield more accurate prediction results for COPD patients than using only questionnaire data.

Respiratory health effects of the fiberglass-reinforced plastic lamination process in the yacht-building industry.

Objectives Fiberglass-reinforced plastics (FRP) manufacturing has been related to cases of severe airway obstruction and elevated risk of respiratory mortality. But the specific job content risk is not clear. This study evaluated the respiratory health effects of the FRP lamination process. Methods A questionnaire was used to evaluate respiratory symptoms of workers in two yacht-building plants. Pre-shift (07:30-08:30 hours) and post-shift (17:00-18:00 hours) lung function was measured, while post-shift induced sputum was collected on the first day of the week. The participants were grouped into FRP laminators and non-laminators. Linear and logistic regression was used to investigate the effects of the lamination process on lung function. Results Laminators had a higher prevalence of chronic cough, lower pre-shift forced expiratory volume in first second (FEV1) and FEV1/force vital capacity (FVC) (-3.3% and -1.5%), lower post-shift FVC and FEV1 (-3.6% and -4.9%), and larger post-shift reduction of FVC (-2.1%) compared to non-laminators. The laminators also had higher risk of early obstructive and overall (obstructive plus restrictive) lung function impairment, and post-shift reduction of FVC >10% [odds ratio (OR) 5.98, 4.98, and 3.87, respectively). They also had higher percentages of neutrophils and lymphocytes in the induced sputum. Conclusion Laminators should undergo regular check-ups of respiratory symptoms and lung function. Further toxicologic studies are warranted to identify the specific causal agent in the FRP lamination process.

Ambient air pollution and asthma onset in Taiwanese adults.

BACKGROUND: Ambient nitrogen dioxide is associated with asthma occurrence in adults in Western countries. However, two recent large-scale studies have provided inconclusive results regarding this association. Moreover, the association remains unknown in an Asian population. OBJECTIVE: We aimed to investigate the association between ambient air pollution exposure and incident adult asthma. METHODS: From 2016 to 2017, we conducted a cross-sectional self-administered questionnaire survey with retrospective follow-up of incident asthma cases among schoolchildren's parents from 41 schools within 1 km of air monitoring stations distributed throughout the main island of Taiwan. To estimate participants' exposure, air pollution data of air monitoring stations within 1 km of schools from where participants were sampled were inputted into the proximity model. We used mixed logistic regression models to determine the association between air pollution exposure and asthma onset within five years prior to the survey. RESULTS: The questionnaire was completed for a total of 11 585 participants out of 13 424 candidates (response rate, 86.3%). Among 9131 participants aged from 26 to 50 years, 101 were diagnosed with asthma within the five years prior to the survey. The prevalence of incident asthma cases was 2.2 per 1000 person-years. Those exposed to higher ambient nitrogen dioxide (odds ratio = 1.20 per interquartile [5.7 ppb] of nitrogen dioxide, 95% CI = 1.02-1.42) were more likely to develop adult-onset asthma. CONCLUSION: In an Asian population, exposure to higher ambient nitrogen dioxide is associated with increased prevalence of incident asthma cases among adults aged 26-50 years.

Validity and Reliability of a Photoelectric Cells System for the Evaluation of Change of Direction and Lateral Jumping Abilities in Collegiate Basketball Athletes.

The validity and reliability of the Optojump system were investigated for jumping height and flight time in vertical jump tests. Conversely, the purpose of the present study was to investigate the validity and reliability of the Optojump system for measuring contact time and lateral displacement in change of direction and lateral jump tests. Thirty basketball collegiate athletes were tested on two 10 m sprints with a 60° (COD60) or 180° (COD180) change of direction, lateral controlled (CLRJ) and maximal (MLRJ) rebound jump, and lateral countermovement (LCMJ) and squat (LSJ) jump with the concomitant use of two force plates and the Optojump system for the measurement of contact time in COD60, COD180, CLRJ, MLRJ, and lateral jumping distance in all the lateral jump tests. Almost perfect coefficients (r ≥ 0.95) emerged for contact time in COD60, COD180, CLRJ, MLRJ, although a systematic bias was found for COD60 (-0.01 s). Good-to-excellent reliability was found for almost all the measurements of contact time and lateral jumping distance for change of direction and lateral jump tests. Therefore, the use of Optojump system for testing change of direction and lateral jumping abilities should be executed with caution, avoiding misinterpretation of data.

Changes in the relationship between ambient fine particle concentrations and childhood lung function over 5 years.

BACKGROUND: Exposure to ambient fine particles, particulate matter with an aerodynamic diameter of ≤2.5 µm (PM2.5), is a public health concern. Concentrations of ambient PM2.5 have changed temporally in the past 10 years after a series of action policies for improving air quality were implemented in Taiwan. In this study, temporal changes in the relationship between PM2.5 and lung function among children were investigated. METHODS: A nationwide respiratory health survey was conducted among Taiwanese elementary and middle school students in 2011 and again in 2016-2017. A questionnaire was administered to students, for whom forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured using spirometry. During the study period, monthly concentrations of ambient PM2.5 were obtained from the monitoring stations of the Environmental Protection Administration. Lung function measurements were compared with ambient PM2.5 exposure using mixed-effects models. RESULTS: In the 2011 survey (mean PM2.5: 40.6 µg/m3), exposure to PM2.5 in the preceding 1-2 months was associated with a 2.2% decrease (95% confidence interval [CI]: -4.1%, -0.3%) in FVC and a 2.3% decrease (95% CI: -4.0%, -0.5%) in FEV1. By contrast, a significant relationship between PM2.5 concentrations and lung function was not observed in the 2016-2017 survey (mean PM2.5: 30.0 µg/m3). CONCLUSIONS: As improvement in air quality over time, the negative relationship between PM2.5 and childhood lung function tend to be not significant.

The effects of fine and coarse particulate matter on lung function among the elderly.

Impaired lung function is associated with morbidity and mortality in the elderly. However, there is a paucity of data regarding the long-term effects of particulate matter (PM) on lung function among the elderly. This study evaluated the exposure-response relationship between ambient PM and different lung function indices among the elderly in Taiwan. A cross-sectional survey of individuals aged ≥65 years was conducted in Taiwan from October 2015 to September 2016. Those who attended the annual health examination for the elderly in five hospitals of varying background PM concentrations were enrolled. The long-term (2015 annual mean concentration) exposure to air pollution was estimated by the Kriging method at the residence of each subject. The association between ambient PM exposure and lung function was evaluated by linear regression modeling, with adjustments for age, sex, height, weight, educational attainment, presence of asthma or chronic obstructive pulmonary disease, smoking status, season, and co-pollutants. There were 1241 subjects (mean age, 70.5 years). The mean residential PM2.5 and PM2.5-10 in 2015 was 26.02 and 18.01 µg/m3, respectively. After adjustments for confounders and co-pollutants, the FVC decrease was best associated with fine particles (PM2.5), whereas the FEV1, FEF25-75%, FEF25% and FEF50% decreases were best associated with coarse particles (PM2.5-10). An IQR (10 µg/m3) increase in PM2.5 decreased FVC by 106.38 ml (4.47%), while an IQR (7.29 µg/m3) increase in PM2.5-10 decreased FEV1 and FEF25-75% by 91.23 ml (4.85%) and 104.44 ml/s (5.58%), respectively. Among the Taiwanese elderly, long-term PM2.5 exposure mainly decreases the vital capacity of lung function. Moreover, PM2.5-10 has a stronger negative effect on the function of conductive airways than PM2.5.

Effects of PM2.5 on Skeletal Muscle Mass and Body Fat Mass of the Elderly in Taipei, Taiwan.

Loss of skeletal muscle mass is common with aging and can cause morbidity and mortality in the elderly. The effects of particulate air pollution on skeletal muscle mass is not known. The study aims to assess the chronic effects of ambient fine particulates (PM2.5) on the body composition of the elderly. From October 2015 to November 2016, a cross-sectional survey on 530 elderly (age > = 65 years) was conducted in the Taipei Basin, Taiwan. The body composition was measured by bioelectrical impedance analysis (InBody 120). One year exposure to air pollution was estimated using the Kriging method at the participant's residence. Multiple linear regression analysis, after adjustments for demographics and co-pollutants, was used to examine the effects of PM2.5 on body composition indices and force of handgrip. Changes in body composition for an interquartile (1.4 µm/m3) increase in PM2.5 concentration included a 0.4 kg (95% confidence interval (CI): -0.31, -0.58; p < 0.0001) decrease in skeletal muscle mass (2.0%) and a 0.7 kg (95% CI: 0.47, 0.91; p < 0.0001) increase in body fat mass (3.6%). While PM2.5 reduced fat free mass in the upper extremities and trunk, but not in the lower extremities, it increased body fat mass in the three parts. There was no significant effect of PM2.5 on handgrip force. Higher physical activity (versus lower than median) was associated with less detrimental effect of PM2.5 on skeletal muscle mass and body fat mass (p values for interaction term: 0.009 and 0.013, respectively). Long-term PM2.5 exposure is associated with decreased skeletal muscle mass and increased body fat mass in the elderly, which can be ameliorated by physical activity.

Prognostic Value of Anxiety Between Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction.

Background Evidence suggests differences in clinical characteristics, causes, and prognoses between heart failure with reduced ejection fraction ( HF r EF ) and heart failure with preserved ejection fraction (HFpEF). Most studies have failed to support the prognostic relevance of anxiety in HF r EF or unclassified HF with mean left ventricular ejection fraction <40%. Meanwhile, the association between anxiety and prognoses in HF p EF remains unexamined. This study compared the prognostic value of anxiety between HF r EF and HF p EF . Methods and Results A total of 158 patients with HF r EF (left ventricular ejection fraction=28.51±7.53%) and 108 patients with HFpEF (left ventricular ejection fraction=64.53±9.67%) were recruited between May 2012 and December 2014. Demographic and clinical characteristics, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory- II scale, and 18-month follow-up outcomes were recorded during the hospital stay. There were significant differences in age, sex, comorbidities, laboratory biomarkers, discharge medications, and unhealthy behaviors, which supported the contention that HF r EF and HF p EF represent 2 distinct phenotypes, although there were no significant differences in anxiety and 18-month outcomes. Multiple logistic regression yielded no significant associations between anxiety and 18-month outcomes in HF r EF . By contrast, trait anxiety could predict 18-month all-cause mortality (odds ratio, 1.429; 95% CI, 1.020-2.000; P=0.038), all-cause readmission or death (odds ratio, 1.147; 95% CI , 1.036-1.271; P=0.008), and cardiac readmission or death (odds ratio, 1.133; 95% CI , 1.031-1.245; P=0.010) in HF p EF after adjusting for possible confounders. Conclusions Trait anxiety was independently associated with 18-month all-cause mortality, all-cause readmission or death, and cardiac readmission or death in HF p EF , but not in HF r EF .

Changes in the relationship between childhood asthma and ambient air pollution in Taiwan: Results from a nationwide survey repeated 5 years apart.

BACKGROUND: Childhood asthma is a common disease whose prevalence is changing. Shift in environmental exposure was one of the plausible explanations. This study investigated changes in the association between childhood asthma and ambient air pollution occurring over time. METHOD: A nationwide questionnaire survey concerning respiratory illness and symptoms was administered to Taiwanese elementary and middle school students in 2011 and repeatedly in 2016-2017. During the study period, the concentrations of ambient air pollutants were obtained from the Environmental Protection Administration (EPA) monitoring stations. Generalized estimating equation models were applied to examine the association between air pollution in the past year and the risk of current asthma. RESULTS: A total of 6346 children from the 2011 survey and 11 585 children from the 2016-2017 survey attended schools located within a 1-km radius of Taiwan EPA monitoring stations. The prevalence of childhood current asthma (children with physician-diagnosed asthma and persistent asthma symptoms in the past year) increased from 7.5% to 9.6% during this period. The level of exposure to particulate matter with an aerodynamic diameter of ≤2.5 µm (PM2.5 ) in the past year was found to be associated with current asthma both in the 2011 survey (odds ratio (OR): 1.90, 95% confidence interval (CI): 1.41-2.57) and in the 2016-2017 survey (OR: 1.24, 95% CI: 1.04-1.48). CONCLUSION: Improved air quality has reduced the effect of PM2.5 on childhood asthma, but air quality remains a health concern in Taiwan.

Atrial deformation correlated with functional capacity in mitral stenosis patients.

BACKGROUND: Left atrial (LA) dysfunction, expressed as impaired LA deformation using two-dimensional (2D) strain imaging, has been observed in association with rheumatic mitral stenosis (MS). However, the clinical role of speckle tracking echocardiography (STE)-derived LA strain has rarely been studied in MS. AIM: This study aimed to identify the determinants of New York Heart Association (NYHA) functional class in patients with mitral stenosis and to investigate the relationship between left atrial deformation as measured by two-dimensional STE-derived LA strain and heart failure symptoms. METHODS: Sixty-nine consecutive patients (20 males and 49 females; mean age: 61 ± 14 years) with rheumatic MS were evaluated using comprehensive 2D and color Doppler echocardiography including STE-derived LA strain (LAS) and peak positive filling strain rate (LASRr) during the LA reservoir phase. Those results were then correlated with NYHA functional class. RESULTS: There were 15 (22%) patients in functional class I, 42 (61%) in functional class II, and 12 (17%) in functional class III. There were no significant differences in mitral valve area, pressure gradient, pulmonary artery pressure, LA emptying fraction, or left ventricular ejection fraction between functional classes. Upon multivariate analysis (controlling for diuretics usage), LAS (ß = -0.233, P = .045) and LASRr (ß = -0.277, P = .014) were independent factors in determining NYHA functional class. CONCLUSIONS: In stable patients with MS, NYHA functional class independently correlated with LAS and LASRr. Left atrial (LA) deformation correlated with heart failure symptoms in patients with MS.