Shift work and nonalcoholic fatty liver disease incidence among Chinese rail workers: a 4-year longitudinal cohort study.

PURPOSE: Occupational harmful factors, such as shift work, are attracting increasing attention as a potential cause of nonalcoholic fatty liver disease (NAFLD). In this study, we aimed to identify the association between shift work and NAFLD incidence in Chinese rail population. METHODS: A cohort study was conducted among 14,112 rail workers for 4-year follow-up. Shift work frequency and other potential variables were recorded by questionnaires, including demographic, lifestyle, and occupation information. Besides, body mass index, blood pressure, fasting blood glucose, total cholesterol, triglyceride, alanine aminotransferase, and aspartate aminotransferase were measured by anthropometric measurement and blood test. Diagnosis of new NAFLD case was based on abdominal ultrasonography. Cox proportional hazards regression model was used to determine whether shift work has effect on occurrence of NAFLD. RESULTS: The incidence of NAFLD was 30.43% in total subjects. After adjustment for possible confounders, the RRs of NAFLD were 1.069 (95% CI 0.998-1.146) and 1.179 (95% CI 1.059-1.312) in occasionally shift work group and frequently shift work group respectively, compared to the seldom shift work group. In stratified analyses, the RRs of NAFLD incidence linked to shift work exposure seems increase among female and elder. The results of three sensitivity analyses were similar with main analysis. CONCLUSIONS: This research provided further evidence of positive harmful effect of shift work on NAFLD incidence in Chinese rail workers, particularly in frequently shift work population. The risk estimate of shift work on NAFLD was higher in female and elder.

Clinical Features and Prognosis of Coronavirus Disease 2019-Related Psychosis: A Retrospective Case Series.

Background: It has been reported that coronavirus disease 2019 (COVID-19) may cause psychiatric disorders, but there are too many confounding factors in the various studies, making it difficult to draw accurate conclusions. Methods: We analyzed the clinical features and treatment of patients with non-severe COVID-19 who were hospitalized in neurology and psychiatry departments due to acute psychiatric disorders and performed a descriptive analysis. Results: Of the 57 patients included, 65% were hospitalized in the neurology department. Eighty-two percent of the patients exhibited abnormal mental behavior 1 week or less after COVID-19 diagnosis, and more than 60% of the patients had normal electroencephalogram (EEG), head imaging, autoimmune encephalitis antibody, and cerebrospinal fluid (CSF) results. Abnormal EEG results included an increase in nonspecific slow waves, abnormal imaging results included small ischemic areas and lacunar infarctions, and abnormal CSF results included a slight increase in cell numbers and protein levels and an increase in pressure. After administering antipsychotic drugs and/or immunotherapy, 67% of the patients experienced improvement in their psychiatric disorders by the time of discharge. Thirty-nine percent of the patients were discharged without antipsychotic medication and experienced no relapse of psychiatric symptoms. Conclusion: Patients with non-severe COVID-19 and psychiatric disorders usually have a good prognosis and do not require long-term antipsychotic medication. Patients with uncontrollable mental symptoms experienced rapid remission after immunotherapy, suggesting that inflammation or the immune response may play an important role in the occurrence of simple acute psychiatric disorders caused by COVID-19.

Reexamining the Environmental Kuznets Curve in Chinese Cities: Does Intergovernmental Competition Matter?

Since China's central authority began enforcing the environmental target responsibility system and introduced environmental indicators to the official ranking tournament in 2007, an ecological transformation has emerged in the intergovernmental competition (IGC) among localities. Because the extant literature on the environmental Kuznets curve (EKC) remains unclear regarding how that ecological IGC transformation changes the EKC economy-pollution correlation, this research investigates the degree to which the transformed IGC changes the form of the EKC, and how that altered EKC varies for different pollutants (i.e., SO2 and CO2) and in different regions (i.e., the eastern, central, and western regions). The results demonstrate a consistently inverted U-shaped relationship between income and SO2 emissions in all three regions, whereas when CO2 emissions are taken as the pollution indicator, the EKC hypothesis holds only in the eastern and central cities, and a positive linear income-CO2 nexus is found in the western region. Spatial analysis reveals that whereas the IGC flattens the inverted U-shaped curves between income and SO2 emissions, it has led to a higher economic cost, corresponding to the turning point of the EKC for CO2 emissions. The findings indicate that the ecological transformation of the IGC has facilitated a positive up-down yardstick competition in the strategic interactions of sustainable development across local Chinese governments, which can lead to a kind of balance between centralization and decentralization by inspiring local officials' adaptability and activity in reducing pollutant emissions and strengthening the officials' responsiveness to performance rankings. This study elucidates the environmental impacts of IGC in China and provides an institutional explanation for the strategic interactions among local governments when they are tackling the environment-economy nexus under multitask conditions.

Long-term PM2.5 exposure in association with chronic respiratory diseases morbidity: A cohort study in Northern China.

Several literatures have examined the risk of chronic respiratory diseases in association with short-term ambient PM2.5 exposure in China. However, little evidence has examined the chronic impacts of PM2.5 exposure on morbidity of chronic respiratory diseases in cohorts from high pollution countries. Our study aims to investigate the associations. Based on a retrospective cohort among adults in northern China, a Cox regression model with time-varying PM2.5 exposure and a concentration-response (C-R) curve model were performed to access the relationships between incidence of chronic respiratory diseases and long-term PM2.5 exposure during a mean follow-up time of 9.8 years. Individual annual average PM2.5 estimates were obtained from a satellite-based model with high resolution. The incident date of a chronic respiratory disease was identified according to self-reported physician diagnosis time and/or intake of medication for treatment. Among 38,047 urban subjects analyzed in all-cause chronic respiratory disease cohort, 482 developed new cases. In CB (38,369), asthma (38,783), and COPD (38,921) cohorts, the onsets were 276, 89, and 14, respectively. After multivariable adjustment, hazard ratio and 95% confidence interval for morbidity of all-cause chronic respiratory disease, CB, asthma, and COPD were 1.15 (1.01, 1.31), 1.20 (1.00, 1.42), 0.76 (0.55, 1.04), and 0.66 (0.29, 1.47) with each 10 µg/m3 increment in PM2.5, respectively. Stronger effect estimates were suggested in alcohol drinkers across stratified analyses. Additionally, the shape of C-R curve showed an increasing linear relationship before 75.00 µg/m3 concentrations of PM2.5 for new-onset all-cause chronic respiratory disease, and leveled off at higher levels. These findings indicated that long-term exposure to high-level PM2.5 increased the risks of incident chronic respiratory diseases in China. Further evidence of C-R curves is warranted to clarify the associations of adverse chronic respiratory outcomes involving air pollution.

The impact of prolonged exposure to air pollution on the incidence of chronic non-communicable disease based on a cohort in Tianjin.

Evidence on the associations of prolonged ambient pollutants exposure with chronic non-communicable diseases among middle-aged and elderly residents is still limited. This prospective cohort study intends to investigate the long-term effects of ambient pollution on hypertension and diabetes incidence among relatively older residents in China. Individual particulate matter exposure levels were estimated by satellite-based model. Individual gaseous pollutants exposure levels were estimated by Inverse Distance Weighted model. A Cox regression model was employed to assess the risks of hypertension and diabetes morbidity linked to air pollutants exposures. The cross-product term of ambient pollutants exposure and covariates was further added into the regression model to test whether covariates would modify these air pollution-morbidity associations. During the period from 2014 to 2018, a total of 97,982 subjects completed follow-up. 12,371 incidents of hypertension and 2034 of diabetes occurred. In the multi-covariates model, the hazard ratios (HR) and 95% confidence interval (CI) were 1.49 (1.45-1.52), 1.28 (1.26-1.30), 1.17 (1.15-1.18), 1.21 (1.17-1.25) and 1.33 (1.31-1.35) for hypertension morbidity per 10 µg/m3 increment in PM1, PM2.5, PM10, NO2 and SO2, respectively. For diabetes onsets, the HR (95% CI) were 1.17 (1.11-1.23), 1.09 (1.04-1.13), 1.06 (1.02-1.09), 1.02 (0.95-1.10), and 1.24 (1.19-1.29), respectively. In addition, for hypertension analyses, the effect estimates were more pronounced in the participants with age <60 years old, BMI ≥24 kg/m2, and frequent alcohol drinking. These findings provided the evidence on elevated risks of morbidity of hypertension and diabetes associated with prolonged ambient pollutants exposure at relatively high levels.

Breast microbiome associations with breast tumor characteristics and neoadjuvant chemotherapy: A case-control study.

Background: Commensal microbiota have been proven to colonize the mammary gland, but whether their composition is altered in patients with breast cancer (BC) remains elusive. This study intends to explore the breast microbiome differences between benign and malignant diseases and to investigate the impact of neoadjuvant chemotherapy (NAC) on the breast microbiota in patients with BC. Methods: Breast normal adipose tissues (NATs) were collected from 79 patients with BC and 15 controls between July 2019 and November 2021. The BC group consisted of 29 patients who had received NAC and 50 who were non-NAC patients. Participants diagnosed with benign breast disease were recruited as controls. 16S rRNA gene sequencing was used to analyze the bacterial diversity of NATs. Results: The community structure of the NAT microbiome was significantly different between the BC and control groups. Proteobacteria decreased (47.40% versus 39.74%), whereas Firmicutes increased (15.71% versus 25.33%) in patients with BC when compared with that in control tissues. Nine genera were enriched in BC NATs, and four genera levels increased in the control group. The associations between differential bacterial genera and breast tumor grade were calculated by Spearman's correlation. The results showed that tumor grade was positively associated with the relative abundance of Streptococcus and negatively related to Vibrio, Pseudoalteromonas, RB41, and Photobacterium. Moreover, menopause was associated with the microbiota composition change of non-NAC BC patients and related to the significant reduction in the abundance level of Pseudoalteromonas, Veillonella, and Alcaligenes. In addition, NAC was related to the beta diversity of patients with BC and associated with the decrease of Clostridium_sensu_stricto_7 and Clostridium_sensu_stricto_2 in postmenopausal patients. Of note, Tax4Fun functional prediction analysis revealed that the metabolic state was more exuberant in the BC group with upregulating of multiple metabolism-related pathways. Conclusion: Our results offer new insight into the relationship between NAC and breast microbiota and help to better characterize the breast microbial dysbiosis that occurs in patients with BC. Further epidemiological studies with larger sample size and well-designed animal experiments are required to elucidate the role of breast microbiota in the therapeutic outcome of BC.

Sex Differences in Cardiovascular Risk Associated With Long-Term PM2.5 Exposure: A Systematic Review and Meta-Analysis of Cohort Studies.

BACKGROUND: Established evidence suggests risks of developing cardiovascular disease are different by sex. However, it remains unclear whether associations of PM2.5 with cardiovascular risk are comparable between women and men. The meta-analysis aimed to examine sex differences in associations of ischemic heart disease (IHD) and stroke with long-term PM2.5 exposure. METHODS: PubMed, EMBASE and Cochrane Library were searched until May 2, 2021. We included cohort studies reporting sex-specific associations of long-term PM2.5 exposure (e.g., ≥1 year) with IHD and stroke. The primary analysis was to estimate relative risk (RR) of PM2.5-outcome in women and men separately, and the additional women-to-men ratio of RR (RRR) was explored to compare sex differences, using random-effect models. RESULTS: We identified 25 eligible studies with 3.6 million IHD and 1.3 million stroke cases among 63.7 million participants. A higher level of PM2.5 exposure was significantly associated with increased risk of IHD in both women (RR = 1.21; 95% CI, 1.15-1.27) and men (RR = 1.12; 95% CI, 1.07-1.17). The women-to-men RRR of IHD was 1.05 (95% CI, 1.02-1.08) per 10 µg/m3 increment in PM2.5 exposure, indicating significant excess risk of IHD in women. The significant risks of stroke associated with PM2.5 were obtained in both women (RR = 1.11; 95% CI, 1.08-1.13) and men (RR = 1.11; 95% CI, 1.07-1.14), but no significant women-to-men RRR was observed in stroke (RRR = 1.00; 95% CI, 0.96-1.04). CONCLUSIONS: The study identified excess risk of IHD associated with long-term PM2.5 exposure in women. The findings would not only have repercussions on efforts to precisely evaluate the burden of IHD attributable to PM2.5, but would also provide novel clues for cardiovascular risk prevention accounting for sex-based differences.

Associations between ambient air pollutants and blood pressure among children and adolescents: A systemic review and meta-analysis.

OBJECTIVE: Numerous epidemiological studies have investigated the effects of short-term and long-term exposure to ambient air pollution on hypertension and blood pressure among children and adolescents. However, the results were controversial. To provide researchers reliable evidence, this meta-analysis was performed. METHODS: We searched all published studies in four databases examining the effects of particulate matter (PM10, PM2.5 and PM1.0), nitrogen oxide (NO2), sulfur dioxide (SO2), ozone (O3) and carbon monoxide (CO) on hypertension and blood pressure in children and adolescents. Overall risk estimates associated with per 10 µg/m3 increase of air pollution were analyzed by a random-effect model for articles with significant heterogeneity, otherwise, a fixed-effect model was applied. Subgroup analysis was conducted for studies with significant heterogeneity. RESULTS: Of 3918 identified literatures, 154 were evaluated in-depth with 15 satisfying inclusion criteria. Increased risk of hypertension was associated with long-term PM10 exposure (OR = 1.17, 95% confidence interval [CI]:1.13, 1.21). For systolic blood pressure (SBP), significant results were found for short-term PM10 (ß = 0.26, 95% CI: -0.00, 0.53) exposure, long-term PM2.5 (ß = 1.80, 95% CI: 0.94, 2.65) and PM10 (ß = 0.50, 95% CI: 0.19, 0.81) exposure. The corresponding estimates of diastolic blood pressure (DBP) were 0.32 mmHg (95% CI: 0.19, 0.45) for short-term PM10 exposure, 1.06 mmHg (95% CI: 0.32, 1.80), 0.34 mmHg (95% CI: 0.11, 0.57) and 0.44 mmHg (95% CI: 0.25, 0.63) for long-term PM2.5, PM10 and NO2 exposure, respectively. Stratified analyses showed stronger effects of PM10 on blood pressure among studies with ≥50% boys' percentage (0.57 mmHg [95% CI: 0.44, 0.70] for SBP, 0.44 mmHg, [95% CI: 0.34, 0.54] for DBP, respectively) and articles using models to estimate exposure (0.90 mmHg [95% CI: 0.20 1.59] for SBP). CONCLUSION: Ambient air pollution was associated with higher hypertension prevalence and elevated blood pressure in children and adolescents.

Long-term exposure to ambient PM2.5 and stroke mortality among urban residents in northern China.

Evidence is still limited for the role of long-term PM2.5 exposure in cerebrovascular diseases among residents in high pollution regions. The study is aimed to investigate the long-term effects of PM2.5 exposure on stroke mortality, and further explore the effect modification of temperature variation on the PM2.5-mortality association in northern China. Based on a cohort data with an average follow-up of 9.8 years among 38,435 urban adults, high-resolution estimates of PM2.5 derived from a satellite-based model were assigned to each participant. A Cox regression model with time-varying exposures and strata of geographic regions was employed to assess the risks of stroke mortality associated with PM2.5, after adjusting for individual risk factors. The cross-product term of PM2.5 exposure and annual temperature range was further added into the regression model to test whether the long-term temperature variation would modify the association of PM2.5 with stroke mortality. Among the study participants, the annual mean level of PM2.5 concentration was 66.3 µg/m3 ranging from 39.0 µg/m3 to 100.6 µg/m3. For each 10 µg/m3 increment in PM2.5, the hazard ratio (HR) was 1.31 (95% CI: 1.04-1.65) for stroke mortality after multivariable adjustment. In addition, the HRs of PM2.5 decreased gradually as the increase of annual temperature range with the HRs of 1.95 (95% CI: 1.36-2.81), 1.53 (95% CI: 1.06-2.22), and 1.11 (95% CI: 0.75-1.63) in the low, middle, and high group of annual temperature range, respectively. The findings provided further evidence of long-term PM2.5 exposure on stroke mortality in high-exposure settings such as northern China, and also highlighted the view that assessing the adverse health effects of air pollution might not ignore the role of temperature variations in the context of climate change.

Long-term exposure to high particulate matter pollution and incident hypertension: a 12-year cohort study in northern China.

Numerous cohort studies have reported the association of long-term exposure to particulate matter <10 µm in diameter (PM10) and hypertension in American and European countries. However, these results have been inconsistent and subject to various confounding factors. The study aimed to explore the effect of long-term exposure to high-level concentrations of PM10 on incident hypertension in a large-scale cohort from northern China. A retrospective cohort study of 39,054 participants aged between 23 and 98 years old from four cities in northern China was followed from 1998 to 2009. Excluding those with hypertension, 37,386 non-hypertensive participants (overall population) were followed for self-reported hypertension. The individuals' exposure to PM10 was the mean concentration during the follow-up period, according to the data of local environmental monitoring centers. Hazard ratios (HRs) were calculated by Cox proportional hazards models. The adjusted potential confounding factors included sociodemographic information, lifestyle, and diet. There were 2619 (7.0%) incident cases of hypertension among the overall population. In multivariable models, the HR (95% CI) of incident hypertension was 1.537 (1.515, 1.560) for each 10 µg/m3 increase in PM10. Stratified analyses showed individuals (age <65) were prone to developing hypertension. Moreover, the effects of PM10 increased and produced an HR (95% CI) of 1.555 (1.527, 1.584) for the healthy population in the sensitivity analysis. We found that the association between long-term exposure to PM10 air pollution and incident hypertension was significantly positive.

Association between long-term exposure to Sulfur dioxide pollution and hypertension incidence in northern China: a 12-year cohort study.

Several studies have researched the short-term effect of sulfur dioxide (SO2) exposure on hypertension. However, no evidence has provided the relationship between long-term high pollution exposure of SO2 and morbidity of hypertension in cohort studies in China. This retrospective cohort study aimed to evaluate this association. We used Cox proportional hazards regression models to examine the hazard ratios (HR) for hypertension risks from 1998 to 2009 associated with accumulative exposure of air SO2 among adults in northern China. Annual average concentrations of sulfur dioxide (SO2) were obtained from 15 local environmental monitoring centers. Hypertension was identified according to self-reported diagnostic time and treatment for hypertension with anti-hypertensive medication. Among 37,386 participants, 2619 new cases of hypertension were identified during 426,334 person-years. In the fully adjusted model, HR and 95% confidence interval (CI) of hypertension incidence for each 10 µg/m3 increase in SO2 were 1.176 (1.163 and 1.189). Results from stratified analyses suggested that effects of SO2 on hypertension morbidity were more pronounced in participants < 60 years old, tea drinkers, and those with high education, high poultry consumption, and active (occasional and frequent) exercise. We found that long-term exposure to high levels of SO2 increased the risk of incidence of hypertension in China.

Associations between the incidence and mortality rates of type 2 diabetes mellitus and long-term exposure to ambient air pollution: A 12-year cohort study in northern China.

BACKGROUND: Ambient air pollution has recently been related to type 2 diabetes mellitus (T2DM), a disease that has caused an economic and health burden worldwide. Evidence of an association between air pollution and T2DM was reported in the United States and Europe. However, few studies have focused on the association with high levels of air pollutants in a developing country. OBJECTIVES: We conducted a 12-year cohort study to assess the incidence and mortality of T2DM associated with long-term exposure to PM10, SO2, and NO2. METHODS: A retrospective cohort with participants from four cities in northern China was conducted to assess mortality and incidence of T2DM from 1998 to 2009. Incidence of T2DM was self-reported, and incident intake of an antidiabetic drug or injection of insulin simultaneously and mortality of T2DM was obtained from a family member and double checked against death certificates provided from the local center for disease control and prevention. Individual pollution exposures were the mean concentrations of pollutants estimated from the local environmental monitoring centers over the survival years. Hazard ratios (HRs) were estimated using Cox regression models after adjusting for potential confounding factors. RESULTS: A total of 39 054 participants were recruited into the mortality cohort, among which 59 subjects died from T2DM; 38 529 participants were analyzed in the incidence cohort, and 1213 developed new cases of T2DM. For each 10 µg/m3 increase in PM10, SO2, and NO2, the adjusted HRs and 95% confidence interval (CI) for diabetic incidence were 1.831 (1.778, 1.886), 1.287 (1.256, 1.318), and 1.472 (1.419, 1.528), respectively. Similar results can be observed in the analysis of diabetic mortality with HRs (95% CI) up to 2.260 (1.732, 2.950), 1.130 (1.042, 1.225), and 1.525 (1.280, 1.816), respectively. CONCLUSIONS: Our results suggested that long-term exposure to high levels of PM10, SO2, and NO2 increase risk of incident and mortality of T2DM in China.

BDE-47 Decreases Progesterone Levels in BeWo Cells by Interfering with Mitochondrial Functions and Genes Related to Cholesterol Transport.

Polybrominated diphenyl ethers (PBDEs) have been reported to exert reproductive endocrine toxicity, but the mechanisms for this process remain unclear. Currently available studies have concentrated on the enzymatic reactions during steroidogenesis, but the results are not consistent. In this study, we explored the effects of 2,2',4,4'-tertrabromodiphenyl ether (BDE-47) on progesterone biosynthesis and the potential mechanisms in human placental choriocarcinoma cells. The results showed that BDE-47 decreased progesterone production in a dose-dependent manner but had no effect on key enzymes (Cyp11a1 and 3ß-HSD). BDE-47 exposure depolarized the mitochondrial membrane potential and downregulated adenosine triphosphate levels. The gene expression levels of Mfn2, Tspo, Atad3, Vdac1, Fis1, and Drp1, which are involved in mitochondrial dynamics and cholesterol transport, were disturbed. The demethylation of some CpG loci of mitochondrial biomarkers (Drp1, Opa1, Vdac2, and Atad3) was induced in the 1 µM BDE-47 exposure group, but no methylation change was observed with 50 µM treatment. Our findings unveiled that the reduction of progesterone synthesis induced by BDE-47 might be associated with cholesterol transportation, mitochondrial dynamics, and mitochondrial functions. These findings provide substantial data on the reproductive endocrine toxicity of PBDEs.