Impacts of discriminated PM2.5 on global under-five and maternal mortality.

Globally, it was estimated that maternal and under-five deaths were high in low-income countries than that of high-income countries. Most studies, however, have focused only on the clinical causes of maternal and under-five deaths, and yet there could be other factors such as ambient particulate matter (PM). The current global estimates indicate that exposure to ambient PM2.5 (with ≤ 2.5 microns aerodynamic diameter) has caused about 7 million deaths and over 100 million disability-adjusted life-years. There are also several health risks that have been linked PM2.5, including mortality, both regionally and globally; however, PM2.5 is a mixture of many compounds from various sources. Globally, there is little evidence of the health effects of various types of PM2.5, which may uniquely contribute to the global burden of disease. Currently, only two studies had estimated the effects of discriminated ambient PM2.5, that is, anthropogenic, biomass and dust, on under-five and maternal mortality using satellite measurements, and this study found a positive association in Africa and Asia. However, the study area was conducted in only one region and may not reflect the spatial variations throughout the world. Therefore, in this study, we discriminated different ambient PM2.5 and estimated the effects on a global scale. Using the generalized linear mixed-effects model (GLMM) with a random-effects model, we found that biomass PM2.5 was associated with an 8.9% (95% confidence interval [CI] 4.1-13.9%) increased risk of under-five deaths, while dust PM2.5 was marginally associated with 9.5% of under-five deaths. Nevertheless, our study found no association between PM2.5 type and global maternal deaths. This result may be because the majority of maternal deaths could be associated with preventable deaths that would require clinical interventions. Identification of the mortality-related types of ambient PM2.5 can enable the development of a focused intervention strategy of placing appropriate preventive measures for reducing the generation of source-specific PM2.5 and subsequently diminishing PM2.5-related mortality.

Ambient Particulate Matter Exposure and Under-Five and Maternal Deaths in Asia.

The Asian region is one of the major emission sources of air pollution. Although ambient PM2.5 has been linked to several health risks in high-, low-, and middle-income countries, the further analysis of type impact is still rare but significant. The PM2.5 distribution retrieved from MODIS (Moderate Resolution Imaging Spectroradiometer) aerosol optical depth products within 16 years thus explored the associations between under-five and maternal mortality for 45 countries in Asia. Both the nonparametric (Generalized Additive Mixed-Effect) and parametric (Generalized Linear Mixed-Effect) models were employed to analyze the collected datasets. The results show that the levels of PM2.5 in Asian sub-regions were higher than the Global Air Quality Standards. Biomass PM2.5 concentrations was associated with increased the rate of under-five (Incidence Rate Ratio, IRR = 1.29, 95% CI, 1.13-1.47) and maternal (IRR = 1.09, 95% CI: 1.08-1.10) deaths in Asia. Anthropogenic PM2.5 was associated with increased rate of under-five deaths in Asia by 12%. The nonparametric method revealed that dust PM2.5 was positively associated with the under-five (ß = 0.04, p < 0.001) and maternal (ß = 0.07, p < 0.001) deaths in Asia. The rate of maternal deaths was increased by biomass/dust (IRR = 1.64, 95% CI: 1.63-1.65) and anthropogenic/dust (IRR = 1.22, 95% CI: 1.19-1.26) mixture types. In summary, long-term exposure to different types of ambient PM2.5 in high concentration increased the rate of under-five and maternal deaths, suggesting that policies focusing on preventive and control measures is imperative for developing an improved maternal, newborn, and child health in Asia.

Aerosol pollution and its potential impacts on outdoor human thermal sensation: East Asian perspectives.

Aerosols affect the insolation at ground and thus the Aerosol Optical Depth (AOD, a measure of aerosol pollution) plays an important role on the variation of the Physiological Equivalent Temperature (PET) at locations with different aerosol climatology. The aerosol effects upon PET were studied for the first time at four East Asian cities by coupling a radiative transfer model and a human thermal comfort model which were previously well evaluated. Evident with the MODIS and AERONET AOD observations, the aerosol pollution at Beijing and Seoul was higher than at Chiayi (Taiwan) and Hong Kong. Based on the AERONET data, with background AOD levels the selected temperate cities had similar clear-sky PET values especially during summertime, due to their locations at similar latitudes. This also applied to the sub-tropical cities. Increase in the AOD level to the seasonal average one led to an increase in diffuse solar radiation and in turn an increase in PET for people living in all the cities. However, the heavy aerosol loading environment in Beijing and Seoul in summertime (AODs > 3.0 in episodic situations) reduced the total radiative flux and thus PET values in the cities. On the contrary, relatively lower episodic AOD levels in Chiayi and Hong Kong led to strong diffuse and still strong direct radiative fluxes and resulted in higher PET values, relative to those with seasonal averaged AOD levels. People tended to feel from "hot" to "very hot" during summertime when the AOD reached their average levels from the background level. This implies that in future aerosol effects add further burden to the thermal environment apart from the effects of greenhouse gas-induced global warming. Understanding the interaction between ambient aerosols and outdoor thermal environment is an important first step for effective mitigation measures such as urban greening to reduce the risk of human heat stress. It is also critical to make cities more attractive and enhancing to human well-being to achieve enhancing sustainable urbanization as one of the principal goals for the Nature-based Solutions.

Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.

Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.

The Associations between Types of Ambient PM2.5 and Under-Five and Maternal Mortality in Africa.

Exploring the effects of different types of PM2.5 is necessary to reduce associated deaths, especially in low- and middle-income countries (LMICs). Hence we determined types of ambient PM2.5 before exploring their effects on under-five and maternal mortality in Africa. The spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products from 2000 to 2015 were employed to determine the aerosol types before using Generalized Linear and Additive Mixed-Effect models with Poisson link function to explore the associations and penalized spline for dose-response relationships. Four types of PM2.5 were identified in terms of mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. The findings indicate the types of ambient PM2.5 are significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization's (WHO) standards. Appropriate policy actions on protective and control measures are therefore suggested and should be developed and implemented accordingly.

Parkinson disease and musculoskeletal pain: an 8-year population-based cohort study.

The aim of this study was to evaluate the incidence and clinical features of musculoskeletal pain (MSP) in patients with Parkinson disease (PD) compared with a control group without the disease. The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on 1 million beneficiaries randomly sampled from the entire population of Taiwan. A total of 490 patients aged 50 and above with newly diagnosed Parkinson disease were identified during a period from 2000 to 2005. Among them, 199 developed MSP after PD. The control group consisted of 1960 participants without PD over the study period randomly selected by matching PD cases according to the date of PD incidence, age, and sex. The study groups were then followed to the end of 2007. Musculoskeletal pain was the end point. The incidence rate ratios of MSP were higher in the PD group than in the control group, representing an adjusted hazard ratio of 1.31 (95% confidence interval 1.09 to 1.58). PD was associated with a significantly elevated risk of MSP in all sex and age stratifications, with the highest hazard ratio noted for middle-aged male patients with PD, followed by older male patients with PD. This study showed that the PD may significantly increase the risk of developing MSP. The risk of developing MSP seems to be greatest for middle-aged male patients with PD. Clinicians should be more alert for MSP in patients with PD, and early intervention should be considered.

Attenuation of Isoflurane Preconditioning-Induced Acute Cardioprotection in Hypertensive Hypertrophied Hearts.

OBJECTIVES: To evaluate the efficiency of isoflurane-induced anesthetic preconditioning and the role of mitochondrial manganese superoxide dismutase (MnSOD) in hypertensive hypertrophied hearts. DESIGN: A prospective animal investigation. SETTING: Medical center hospital research laboratory. PARTICIPANTS: Male spontaneously hypertensive rats (SHRs) and normotensive control Wistar-Kyoto (WKY) rats. INTERVENTIONS: All pentobarbital-anesthetized open-chest rats were subjected to a 45-minute left coronary artery occlusion followed by a 120-minute reperfusion. Before ischemia, both SHR and WKY rats were assigned randomly to receive a 30-minute exposure to 0.9% saline or 1.0 minimum alveolar concentration isoflurane. MEASUREMENTS AND MAIN RESULTS: The myocardial infarct size, assessed as a percentage of the area at risk, was significantly greater in the hypertrophied SHRs than in the WKY rats (65.3%±8.7% v 51.8%±7.2%, p<0.05). Isoflurane preconditioning appreciably reduced the infarct size in the WKY hearts (30.9%±10.5%, p<0.05) but not in the SHR hearts. MnSOD protein expression and enzymatic activity were increased drastically in response to isoflurane exposure in the hearts of the WKY rats (p<0.05) but not in the SHRs. CONCLUSIONS: Isoflurane-induced anesthetic preconditioning is attenuated in hypertensive hypertrophied hearts. This impairment may be associated with the loss of MnSOD augmentation during ischemia and reperfusion.