A multicenter single-arm trial of neoadjuvant pyrotinib and trastuzumab plus chemotherapy for HER2-positive breast cancer.

The objective of this multicenter, single-arm trial (ChiCTR1900022293) was to explore the efficacy and safety of neoadjuvant therapy with epirubicin, cyclophosphamide, and pyrotinib followed by docetaxel, trastuzumab, and pyrotinib (ECPy-THPy) in the treatment of patients with stage II-III HER2-positive breast cancer. The present study enrolled patients with stage II-III HER2-positive breast cancer. Epirubicin and cyclophosphamide were administrated for four 21-day cycles, followed by four cycles of docetaxel and trastuzumab. Pyrotinib was taken orally once per day throughout the treatment period. The primary endpoint was total pathological complete response (tpCR, ypT0/is ypN0) rate in the modified intention-to-treat (mITT) population. In total, 175 patients were included. The tpCR rate was 68.6% (95% CI, 60.7-75.8%), while the objective response rate was 89.1%. In the post-hoc subgroup analysis, no association between clinical characteristics and the tpCR rate was observed. The most common grade ≥3 adverse events were diarrhea (54.3%), followed by white blood cell count decreased (5.1%), and neutrophil count decreased (4.6%). In conclusion, the neoadjuvant regimen with ECPy-THPy showed promising pathological response and clinical benefits with an acceptable safety profile in patients with stage II-III HER2-positive breast cancer.

dl-Methionine-Mediated Reversible Deactivation Radical Polymerization of Styrene and Methyl Methacrylate.

Reversible deactivation radical polymerization (RDRP) is a facile and highly efficient technique for the synthesis of well-defined polymer with precise structure. dl-Methionine (Met) as a RDRP control agent is described and assessed for RDRP of styrene (St) and methyl methacrylate (MMA) with AIBN as radical initiator at 75 °C, which enables excellent control of this polymerization. The addition of dl-Methionine significantly decreased the dispersity (D) of the polymers for both monomers and first-order linear kinetic plots of polymethyl methacrylate (PMMA) are observed in DMSO. Considering the heat resistance of dl-Methionine, kinetic studies indicate that polymerization develops at a faster rate at higher reaction temperature (100 °C) with the same dl-Methionine content. Well-defined polymethyl methacrylate-block-polystyrene (PMMA-block-PSt) is successfully achieved by the chain extension reaction that demonstrates the high end fidelities of this polymerization approach. The system allows the use of dl-Methionine, a rich source and easily synthesized agent, to mediate RDRP strategy.

Combination of ultrafast dynamic contrast-enhanced MRI-based radiomics and artificial neural network in assessing BI-RADS 4 breast lesions: Potential to avoid unnecessary biopsies.

Objectives: To investigate whether combining radiomics extracted from ultrafast dynamic contrast-enhanced MRI (DCE-MRI) with an artificial neural network enables differentiation of MR BI-RADS 4 breast lesions and thereby avoids false-positive biopsies. Methods: This retrospective study consecutively included patients with MR BI-RADS 4 lesions. The ultrafast imaging was performed using Differential sub-sampling with cartesian ordering (DISCO) technique and the tenth and fifteenth postcontrast DISCO images (DISCO-10 and DISCO-15) were selected for further analysis. An experienced radiologist used freely available software (FAE) to perform radiomics extraction. After principal component analysis (PCA), a multilayer perceptron artificial neural network (ANN) to distinguish between malignant and benign lesions was developed and tested using a random allocation approach. ROC analysis was performed to evaluate the diagnostic performance. Results: 173 patients (mean age 43.1 years, range 18-69 years) with 182 lesions (95 benign, 87 malignant) were included. Three types of independent principal components were obtained from the radiomics based on DISCO-10, DISCO-15, and their combination, respectively. In the testing dataset, ANN models showed excellent diagnostic performance with AUC values of 0.915-0.956. Applying the high-sensitivity cutoffs identified in the training dataset demonstrated the potential to reduce the number of unnecessary biopsies by 63.33%-83.33% at the price of one false-negative diagnosis within the testing dataset. Conclusions: The ultrafast DCE-MRI radiomics-based machine learning model could classify MR BI-RADS category 4 lesions into benign or malignant, highlighting its potential for future application as a new tool for clinical diagnosis.

Optimized design of windowed-sinc anti-aliasing filters for phase-preserving decimation of hydrophone data.

Passive acoustic monitoring generates large data sets for which decimation is beneficial to analysis and portability for data sharing. Among the goals for effective decimation are avoidance of aliasing in the passband, accurate and complete control of the attenuation profile, phase preservation, and high efficiency in processing. We present an approach to decimator design that addresses each of these goals, and we demonstrate its application to ocean audio recordings. Anti-aliasing is achieved by windowed-sinc filters that also preserve phase. Control of the passband attenuation profile is based on the specification of the maximum allowed attenuation at a certain percentage of the final output Nyquist frequency. The window type is selected to meet the stopband attenuation requirement. Efficiency is achieved through optimization of the anti-aliasing filters applied in each decimation stage, and through parallelization of processing. The best combination of the sinc function's cutoff frequency and the mainlobe bandwidth of the window function generates the shortest qualifying filter, optimizing the trade-off between filter performance and computational load. Parallelization is enabled by applying the overlap-add method to contiguous segments of audio data, consistent with the commonly used storage of contiguous audio data in files of limited duration. Beyond addressing common goals for effective decimation of audio data, the approach presented is deployable in open-source environments.

Effect of ambient temperature on outpatient admission for osteoarthritis and rheumatoid arthritis in a subtropical Chinese city.

BACKGROUND: Current findings on the impact of weather conditions on osteoarthritis (OA) and rheumatoid arthritis (RA) are sparse and not conclusive. This study aimed to investigate the relationship between temperature change and OA/RA admission. METHODS: Daily OA/RA admission, meteorological data and pollutants from 1 January 2014 to 31 December 2017 in Hefei, China, were collected. We quantified the relationship between ambient temperature and OA/RA admission using a distributed lag nonlinear model (DLNM). Stratified analyses by gender and age were also examined. RESULTS: Temperature decrease was significantly associated with RA admission (25th percentile of temperature versus 50th percentile of temperature), with the acute and largest effect at current days lag (RR: 1.057, 95%CI: 1.005-1.111). However, no significant association between temperature and OA admission was observed. When conducting subgroup analyses by individual characteristics, we found that females and patients aged 41-65 years were more vulnerable to temperature decrease than males, patients aged 0-40 and ≧66 years, respectively. CONCLUSIONS: This study suggested that temperature decrease was a risk factor for increases in RA admission. Females and patients aged 41-65 years were particularly vulnerable to the effect of temperature decrease.

A system of coordinated autonomous robots for Lagrangian studies of microbes in the oceanic deep chlorophyll maximum.

The deep chlorophyll maximum (DCM) layer is an ecologically important feature of the open ocean. The DCM cannot be observed using aerial or satellite remote sensing; thus, in situ observations are essential. Further, understanding the responses of microbes to the environmental processes driving their metabolism and interactions requires observing in a reference frame that moves with a plankton population drifting in ocean currents, i.e., Lagrangian. Here, we report the development and application of a system of coordinated robots for studying planktonic biological communities drifting within the ocean. The presented Lagrangian system uses three coordinated autonomous robotic platforms. The focal platform consists of an autonomous underwater vehicle (AUV) fitted with a robotic water sampler. This platform localizes and drifts within a DCM community, periodically acquiring samples while continuously monitoring the local environment. The second platform is an AUV equipped with environmental sensing and acoustic tracking capabilities. This platform characterizes environmental conditions by tracking the focal platform and vertically profiling in its vicinity. The third platform is an autonomous surface vehicle equipped with satellite communications and subsea acoustic tracking capabilities. While also acoustically tracking the focal platform, this vehicle serves as a communication relay that connects the subsea robot to human operators, thereby providing situational awareness and enabling intervention if needed. Deployed in the North Pacific Ocean within the core of a cyclonic eddy, this coordinated system autonomously captured fundamental characteristics of the in situ DCM microbial community in a manner not possible previously.

Silencing long non-coding RNA HNF1A-AS1 inhibits growth and resistance to TAM of breast cancer cells via the microRNA-363/SERTAD3 axis.

Long non-coding RNAs (lncRNAs) can exert effects on drug resistance of cancer cells. This study investigated the role of lncRNA HNF1A-antisense 1 (HNF1A-AS1) in growth and Tamoxifen (TAM) sensitivity of breast cancer (BC) cells. HNF1A-AS1 expression was promoted in BC cells and tissues. BC cells with HNF1A-AS1 silencing were constructed to detect cell proliferation. TAM resistant cell line with HNF1A-AS1 silencing and parent cell line with overexpressed HNF1A-AS1 were constructed to measure drug resistance. Silencing HNF1A-AS1 reduced proliferation and TAM resistance of BC cells. The downstream microRNAs (miRs) of HNF1A-AS1 and its targets were figured out and their functions in TAM resistance of BC cells were identified. HNF1A-AS1 sponged miR-363 to promote SERTAD3 expression. Downregulation of miR-363 or upregulation of SERTAD3 stimulated TAM resistance of BC cells. The findings in vitro were reproduced in in vivo experiments. It could be concluded that silencing HNF1A-AS1 inhibited growth and drug resistance to TAM of BC cells through the miR-363/SERTAD3 axis and the inactivation of the TGF-ß/Smad pathway.

Carvacrol affects breast cancer cells through TRPM7 mediated cell cycle regulation.

As the most prevalent cancer for females, breast cancer is also the second most popular cancer type overall. More efforts are needed to research new drugs and combination therapies for this disease. A naturally derived transient receptor potential melastatin-like 7 channel (TRPM7) inhibitor, carvacrol, was found to have anti-cancer potentials. We hypothesized that carvacrol affects breast cancer cells through TRPM7 mediated cell cycle regulation. Cell viability and apoptosis of breast cancer cell lines BT-483, BT-474, MCF-7, MDA-MB-231, and MDA-MB-453 were determined using the CCK-8 assay and ELISA respectively. TRPM7 in MDA-MB-231, MCF-7 was knocked down. Functional TRPM7 in MDA-MB-231, MCF-7, and HEK293 cells were tested with western blotting, patch-clamp, and fura-2 quench assay. The cell cycle and the regulatory proteins were determined by flow cytometry and western blotting. Results showed that carvacrol inhibited the viability of breast cancer cells with different potency. At 200 µM, MDA-MB-231 was the most sensitive, and MCF-7 was the least sensitive. At >200 µM, the apoptosis was dramatically induced. Carvacrol inhibited TRPM7 functions in MDA-MB-231, MCF-7, and HEK293. Carvacrol at 200 µM increased cells in the G1/G0 phase and decreased cells in the S and G2/M phase by regulating some cyclin proteins in MDA-MB-231. These effects were blocked by the knockdown of TRPM7. This study demonstrated that carvacrol suppresses breast cancer cells by cell cycle regulation and the TRPM7 pathway is one of the pharmacological mechanisms.

Durational effect of particulate matter air pollution wave on hospital admissions for schizophrenia.

BACKGROUND: Short-term exposure to high level of ambient particulate matters (PM) concentrations has been linked with increased hospital admissions (HA) for schizophrenia. However, evidence is inconclusive about the added effect of multi-day exposure to high-level PM concentration on schizophrenia. This study aims to evaluate the durational effect of PM air pollution wave on schizophrenia. METHOD: Data on daily HA for schizophrenia, PM (PM2.5 and PM10) and meteorological variables over the period of 2014-2017 was collected in Jining, Shandong, China. Air pollution wave of PM was defined as ≥2 or ≥3 or ≥4 consecutive days with PM concentration ≥90th or ≥92.5th or ≥95th or ≥97.5th percentiles, respectively. A time-series Poisson regression model with duration as the variable of interest was used to evaluate the associations of PM air pollution wave with HA for schizophrenia. RESULTS: A total of 14650 hospital admissions for schizophrenia were identified. Under various air pollution wave definitions, both PM2.5 and PM10 had significant adverse effects on schizophrenia HA. PM2.5 wave defined as ≥2 consecutive days with concentration ≥90th, ≥92.5th, ≥95th and ≥97.5th percentile was associated with 4.8% (2.0%-7.6%), 4.9% (1.9%-7.9%), 5.5% (2.0%-9.2%), and 7.6% (2.9%-12.6%) increase of HA for schizophrenia at lag 6. PM2.5 waves defined as ≥3 consecutive days with concentration ≥90th, ≥92.5th, ≥95th and ≥97.5th percentile respectively corresponded to 5.0% (2.3%-7.8%), 5.1% (1.9%-8.4%), 6.9% (3.0%-10.8%) and 12.0% (5.3%-19.1%) increases in HA for schizophrenia at lag 6. The most significant associations were observed on the sixth day in different lag models. CONCLUSIONS: PM air pollution wave was associated with increased risk of hospital admissions for schizophrenia, with stronger associations among married and female patients.

Association between floods and hospital admissions for schizophrenia in Hefei, China: The lag effects of degrees of floods and time variation.

BACKGROUND: Schizophrenia is a serious mental disorder, endangering 7.5 million patients in China. Floods, as the adverse consequence of temperature-rise, have a negative influence on mental health. However, the relationship between floods and schizophrenia is still insufficient. This study aimed to quantitative the relationship between floods and the admissions for schizophrenia in Hefei, China. METHODS: A Poisson generalized linear model (GLM) combining a distributed lag non-linear model (DLNM) was used to quantify the lag effects of floods on schizophrenia and subgroups (male, female; ≤40 y, >40 y; the married, the unmarried) from 2005 to 2014, Hefei, China. We further explored the effects of different degrees (moderate and severe) of floods and their temporal changes on schizophrenia. RESULTS: There was a significant association between floods and admissions risk for schizophrenia. And the lag effects for schizophrenia lasted ten days (lag 5-lag 14), with the greatest effect on lag 9 (RR = 1.036, 95% confidence interval (CI): 1.014-1.058). The married, ≤40 y were sensitive to floods. The significant difference wasn't found for genders. The effects of the severe flood were higher than moderate floods, with the largest RR of 1.073 (95%CI: 1.029-1.119). The adverse effects were found in the middle and late period with a decreasing trend in the later period. CONCLUSIONS: This study suggests a significant association between floods and schizophrenia with ten days of lag effects in Hefei, China. Male, female, <40 y and the married are vulnerable to both moderate and severe floods. The findings might be used to allocate medical resources of mental health after floods.

Knockdown of circDENND4C inhibits glycolysis, migration and invasion by up-regulating miR-200b/c in breast cancer under hypoxia.

BACKGROUND: Hypoxia is a key feature of breast cancer, which affects cancer development, metastasis and metabolism. Previous studies suggested that circular RNAs (circRNAs) could participate in cancer progression and hypoxia regulation. This study aimed to investigate the role of circRNA differentially expressed in normal cells and neoplasia domain containing 4C (circDENND4C) in breast cancer progression under hypoxia. METHODS: Forty-three patients with breast cancer were involved in this study. Breast cancer cell lines MDA-MB-453 and SK-BR-3 were cultured under hypoxia (1% O2) for experiments in vitro. The expression levels of circDENND4C, microRNA-200b (miR-200b) and miR-200c were measured by quantitative real-time polymerase chain reaction. Glycolysis was investigated by glucose consumption, lactate production and hexokinase II (HK2) protein level. Migration and invasion were evaluated via trans-well assay and protein levels of matrix metallopeptidase 9 (MMP9) and MMP2. The interaction between circDENND4C and miR-200b or miR-200c was explored by bioinformatics analysis, luciferase assay and RNA immunoprecipitation. Murine xenograft model was established to investigate the anti-cancer role of circDENND4C in vivo. RESULTS: circDENND4C highly expressed in breast cancer was up-regulated in response to hypoxia. Knockdown of circDENND4C decreased glycolysis, migration and invasion in breast cancer cells under hypoxia. circDENND4C was validated as a sponge of miR-200b and miR-200c. Deficiency of miR-200b or miR-200c reversed the suppressive effect of circDENND4C knockdown on breast cancer progression. Moreover, silence of circDENND4C reduced xenograft tumor growth by increasing miR-200b and miR-200c. CONCLUSION: circDENND4C silence suppresses glycolysis, migration and invasion in breast cancer cells under hypoxia by increasing miR-200b and miR-200c.

Impacts of heat and cold on hospitalizations for schizophrenia in Hefei, China: An assessment of disease burden.

BACKGROUND: Compared with risk data (e.g., RR or OR), attributable fraction (AF) provides more information on the formulation of policies and measures in the field of public health. However, to date, existing AF evidence is scarce for the relationship between temperature and the hospitalizations for SCZ. OBJECTIVES: Our primary goal is to estimate the attributable burden of hospitalizations for SCZ related to cold and heat, respectively. Furthermore, to identify vulnerable populations due to heat and cold. METHODS: Poisson generalized linear models combined with DLNMs were used to estimate the association between hospitalizations for SCZ and temperature from 2005 to 2014. The minimum risk temperature (MRT) was used as a reference, to calculate the burden of disease caused by cold and heat. RESULTS: We found that the majority hospitalizations attributed to heat (70.9%). In different individual levels, men are more sensitive to heat exposure while women are more vulnerable to cold. Among different age groups, the results showed that the attributable risk was slightly higher in the over-40s than in the under-40s. Besides, under different marital conditions, it showed that the unmarried had a little higher attributional risk than the married. CONCLUSIONS: We should pay attention to the impact of heat on hospitalizations for SCZ, especially in those over 40 years old, men and non-married. Our research will provide a basis for policymakers to develop intervention strategies to minimize the impact of adverse temperatures on hospitalizations for SCZ, thereby reducing the burden of disease.

Impacts of exposure to humidex on the risk of childhood asthma hospitalizations in Hefei, China: Effect modification by gender and age.

BACKGROUND: With global climate change, there is growing concern about the effects of temperature changes on childhood asthma. However, current research only focuses on the effects of temperature, while ignoring the adverse effects of humidity on children. OBJECTIVES: Our study aimed to quantify the impact of humidex on childhood asthma hospitalizations, which combined temperature and humidity, and further to assess how the effect is modified by individual-factors, such as age and gender. METHODS: Poisson generalized linear models combined with distributed lag nonlinear models were used to estimate the association between daily childhood asthma hospitalizations and humidex from 2013 to 2016. Air pollutions (CO, O3, and NO2) and wind velocity were modelled simultaneously using DLNM, as well as day of week, seasonality and long-term trend. RESULTS: Low humidex was associated with an increased risk of admissions for asthma in children. The adverse effect appeared on the 4th day, with the RR of 1.045 (95%CI: 1.007-1.084) and lasted until the 7th day (RR: 1.045, 95%CI: 1.006-1.085). Compared with the male, there was an immediate effect on female exposed to low humidex. And the female seems to be more sensitive to low humidex. Besides, the significant effects of humidex on children asthma were detected in the children with preschool and school-age, whereas not for the subgroup of infants. And the school-age children are most sensitive to low humidex. CONCLUSIONS: Low humidex was associated with the increased risk of admissions for childhood asthma in Hefei. Children suffering from asthma should avoid exposure to the low humidex environment, especially in female and school-age children. In addition, the index of humidex was more significant for disease prevention and public health than the average temperature. These findings may provide epidemiology evidence for formulating precaution guidelines to reduce the risk of childhood asthma hospitalizations.

Examining the association between apparent temperature and admissions for schizophrenia in Hefei, China, 2005-2014: A time-series analysis.

BACKGROUND: Many studies have investigated the association between schizophrenia and daily mean temperature, but the conclusions were not consistent. Apparent temperature (AT), a comprehensive indicator of temperature and humidity, reflected human thermal sensation more objectively than temperature. We aimed to investigate the relationship between high/low AT and schizophrenia hospitalizations in Hefei, China, and further to identify vulnerable subpopulations. METHODS: Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was applied to quantify the relationship between AT and schizophrenia hospitalizations, compared with the AT of minimum admissions (3.3 °C). Stratified analysis was conducted by sex, marital status and age. Separate models for AT and temperature were compared as well. RESULTS: The high AT (90th, 28.3 °C) exerted the greatest effect at lag0, with RR = 1.062 (95%CI, 1.019-1.106). The effect of the low AT (10th, -4.7 °C) was first observed at lag3 (RR = 1.007, 95%CI: 1.000-1.015), and increased to the maximum at lag7 (RR = 1.018, 95%CI: 1.009-1.027). The male patients, the married patients and patients aged 41-60 years appeared to be more vulnerable to both high and low ATs. The values of Akaike Information Criterion and mean squared error (MSE) in model with AT were smaller than that with temperature. CONCLUSIONS: Both high and low ATs were associated with increase in schizophrenia hospitalizations. More protective measures should be taken to avoid adverse AT exposure in susceptible groups.

Risk effects of high and low relative humidity on allergic rhinitis: Time series study.

BACKGROUND: The relationship between environmental factors and allergic rhinitis (AR) has become a focal point recently. However, few studies have investigated the adverse effects of both high relative humidity (RH) and low relative humidity. Moreover, the laged effect and disease burden of RH on AR were also neglected. OBJECTIVES: To explore the association of both high and low RH on daily AR hospital outpatients, and to quantify the corresponding disease burden attributable to RH. METHODS: In our study, we define 95th as high RH and 5th as low RH. A distributed lag non-linear model (DLNM) combined with a Poisson generalized linear regression model were applied to analyze the relationship between RH and hospital outpatients for AR. All patients were retrieved from Anhui Provincial Children's Hospital (n = 37,221) from January 2015 to December 2016. Daily meteorological and air pollutant data were collected by Hefei Meteorological Bureau and Environmental Protection Agency. Subgroup analyses were conducted by gender and occupational groups. RESULTS: Acute adverse effects of high and low RH on AR were explored respectively, with an increase of daily AR outpatients when encountered high and low RH. The low RH presented a risk effect at current day and lasted up to the eighth day. However, high RH began to appear a risk effect on the fourth day. Notably, the fraction of hospital outpatients attributable to low RH was 5.22% (95% CI: 1.92%, 8.33%) and high RH was 4.07% (95% CI: 1.13%, 7.30%) in the backward perspective. Additionally, male and students apparent to be more sensitive to the effects of low RH. CONCLUSION: This study suggests that both high and low RH are potential trigger for AR hospital outpatients in Hefei, China. Our studies might offer valuable messages to health practitioners and useful direction to decisions-makers respectively.

The association between cold spells and admissions of ischemic stroke in Hefei, China: Modified by gender and age.

BACKGROUND: Some studies have discovered that low ambient temperatures were associated with increased risk of the incidence of ischemic stroke. Although the frequency of extreme weather events is increasing, few studies have studied the effects of cold wave on ischemic stroke. OBJECTIVE: The purpose of this study was to explore the association between cold waves and ischemic stroke onset and further to explore how this association was modified by cold spell characteristics and individual-level factors. METHODS: A Poisson regression with a distributed lag nonlinear model was used to investigate the association between cold spells under 9 different definitions and daily admissions of ischemic stroke in 2013-2015 in Hefei. RESULTS: By comparing the attribution risk and the results of the sensitivity analysis of different models, the local optimal cold spell was defined as the day between November to March when daily mean temperature was less than 10th for 2 or more consecutive days (backward attributable risk fraction (b-AF) = 4.19%, 95% empirical confidence intervals (eCI): 0.87%, 6.66%, backward attributable number (b-AN) = 278). On the basis of optimal model, the single-day effect of cold waves on ischemic stroke occurred on 5th day after exposure and continued until 17th day, and the maximum effect appeared on the 5th day with relative risk (RR) = 1.050 (95% confidence interval (CI) = 1.008, 1.094). The significant cumulative effect lasted from day 9 after exposure to cold spells to day 21. The maximum cumulative effect was observed on the 21st day with RR = 2.378 (95% CI = 1.304, 4.337). The female and the young and middle-aged people were susceptible to the local cold waves. CONCLUSION: This study suggests that cold spell is a risk factor for ischemic stroke in Hefei, and there is a certain lag effect. Targeted measures should be taken to protect susceptible populations during cold spell days, including women and young and middle-aged people.

The short-term effects of cold spells on pediatric outpatient admission for allergic rhinitis in Hefei, China.

BACKGROUND: Some studies have reported that cold weather is associated with the development of allergic rhinitis (AR), but the study of extreme cold temperatures and AR is scarced. This study was conducted to find out the optimal definition of the cold spells in Hefei and to explore the relationship between cold spells and childhood AR, further to identify potential susceptible populations. METHODS: Data of daily AR, meteorological variables and air pollutants from January 1, 2014 to December 31, 2016 were collected in Hefei. Poisson generalized linear regression with a distributed-lag nonlinear model (DLNM) was used to explore the relationship between cold spells and daily pediatric outpatient with allergic rhinitis, by comparing the number of the admission during the cold spells with those during non-cold spells in cold seasons (December to April), after adjusting for relative humidity, air pollutants, seasonality, long-term trends, calendar month, holiday and day of the week (DOW). RESULTS: All definitions of cold spells both had a certain impact on children with allergic rhinitis, and the trend of their effects was similar. The optimal cold spells was defined as the daily average temperature for below 10th with two consecutive days during the study period, and the greatest impact of cold spells was at lag0, with a 12.5% (95%CI: 6.3%-19.1%) increase of AR than non-cold spell days, and its impact could last for 2 days. Male children, children aged 5-18 years and non-scattered children were considered to be more vulnerable to AR in cold spell days. CONCLUSIONS: There was evidence showed that the cold spells may significantly increase the pediatric outpatient admission for allergic rhinitis, especially for male children, children aged 5-18 years and non-scattered children. For the serious threat posed by cold spells, caregivers and health practitioners should strengthen their awareness of the prevention of vulnerable people.

Ambient temperature, sunlight duration, and suicide: A systematic review and meta-analysis.

BACKGROUND: The relationship between sunlight hours, temperature, and suicide has been investigated in many previous studies, but with inconsistent findings. We conducted this meta-analysis aiming at providing clear evidence about whether sunlight hours and temperature can affect the risk of suicide. METHODS: Relevant literature published before 7 Jul 2018 was searched in three electronic database of PubMed, Web of science and Cochrane. Between-study heterogeneity in the effect estimates were examined by study design (i.e., exposure time resolution, temperature measure and suicide classification) and population vulnerability (i.e., sex, national income level, climate zone and study location). RESULTS: Regarding temperature-suicide association, we identified 14 studies that provided 23 effect estimates for meta-analysis. Our random-effects model showed that each 1 °C increase in temperature was significantly associated with a 1% increase in the incidence of suicide (Incidence Rate Radio (IRR) = 1.01; 95%CI = 1.00-1.02; p < 0.05). As for sunlight duration and suicide, 11 effect estimates from 4 studies were pooled using a fixed-effects model. Significant association between sunlight duration (per 1 h increase) and the risk of suicide was not observed, and the pooled IRR was 1.00 (95%CI = 0.99-1.01; p > 0.05). There was significant heterogeneity between previous studies' effect estimates, and significantly lower heterogeneity was noted for the female group, for studies that did analyses at daily scale, and for studies using mean temperature as the exposure indicator. CONCLUSION: Our findings suggest a significant and positive association between temperature rises and incidence of suicide, and a non-significant association between sunlight duration and incidence of suicide. Populations living in tropical and temperate zones or at middle-income level may be particularly vulnerable to temperature increase.

Trimester-specific association between antibiotics exposure during pregnancy and childhood asthma or wheeze: the role of confounding.

PURPOSE: We conducted the meta-analysis to respectively evaluate the risk of prenatal antibiotics use during specific trimesters (first, second, and third trimester) on childhood asthma or wheeze and to explore whether the association was biased by potential confounding. METHODS: The quality of included articles was assessed according to Newcastle-Ottawa Quality Assessment Scale and the Strengthening the Reporting of Observational Studies in Epidemiology. A random effects model was used to calculate pooled risk ratios and corresponding 95% confidence interval (CI), and publication bias was tested by Egger statistical test. RESULTS: Eight studies were included finally. We found a crude positive association of prenatal antibiotics use during each pregnancy trimester and risk of childhood asthma or wheeze with RRs of 1.28 (95% CI, 1.09-1.51) for the first trimester of pregnancy, 1.25 (95% CI, 1.02-1.52) for the second trimester, and 1.25 (95% CI, 1.05-1.49) for the third trimester. However, when considering potential factors of maternal infections and presence of siblings, the relationship for each trimester was insignificant. CONCLUSIONS: This systemic review and meta-analysis proposed a crude positive association between prenatal antibiotic use in every specific trimester and risk of childhood asthma or wheeze. However, adjustment for confounders decreased the relative risk estimates, supporting the concept that these associations are, at least in part, because of confounding by indication.

The short-term association between air pollution and childhood asthma hospital admissions in urban areas of Hefei City in China: A time-series study.

BACKGROUND: The impacts of air pollution on asthma attacks have become a hotspot. Previous studies mainly focused on the developed countries or cities. There have been very limited studies in less-developed region to quantify the effects of air pollutants on asthma admissions in children. This study aims to assess the short-term impact of air pollutants on asthma hospital admissions for children in Hefei, China. METHODS: Poisson generalized linear regression combined with distributed lag non-linear model (DLNM) were applied to investigate the effects of air pollutants on daily childhood hospital admissions of asthma from 2015 to 2016, controlling for meteorological factors. Subgroup analyses by sex and age were performed. RESULTS: There were a total of 17,227 asthma admissions during 2015-2016. We found positive correlations between childhood asthma hospital visits and concentrations of NO2, O3, PM10 and PM2.5. Significantly, NO2 exhibited robust positive correlations with cumulative effects 1.551 (95% CI: 1.306-1.841, lag0-3 days) in single-pollutant model and 1.580 (95% CI: 1.315-1.899, lag0-3 days) in multiple-pollutant model. CONCLUSIONS: Air pollutants had adverse effects on childhood asthma. NO2 presented the greatest effect, followed by PM2.5. Results will be important for health authority and guardians to realize the severity of air pollution on the increased risk of asthma, so as to develop relevant strategies and health interventions to meet the challenges of childhood asthma and reduce air pollution.