Greenness mitigate cause-specific mortality associated with air pollutants in ischemic and hemorrhagic stroke patients: An ecological health cohort study.

BACKGROUND: Air pollution is one of the most serious environmental risks to mortality of stroke. However, there exists a noteworthy knowledge gap concerning the different stroke subtypes, causes of death, the susceptibility of stroke patient, and the role of greenness in this context. METHODS: We analyzed data from an ecological health cohort, which included 334,261 patients aged ≥40 years with stroke (comprising 288,490 ischemic stroke and 45,771 hemorrhagic stroke) during the period 2013-2019. We used Cox proportional hazards models with time-varying exposure to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to assess the associations of annual average fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) with both all-cause and cause-specific mortality. Additionally, we conducted analyses to examine the effect modification by greenness and identify potential susceptibility factors through subgroup analyses. RESULT: In multivariable-adjusted models, long-term exposure to PM2.5 and NO2 was associated with increased risk of all-cause mortality (HR: 1.038, 95% CI: 1.029-1.047 for PM2.5; HR: 1.055, 95% CI: 1.026-1.085 for NO2, per 10 µg/m3, for ischemic stroke patients; similar for hemorrhagic stroke patients). Gradually increasing effect sizes were shown for CVD mortality and stroke mortality. The HRs of mortality were slightly weaker with high versus low vegetation exposure. Cumulative exposures increased the HRs of pollutant-related mortality, and greater greenness decreased this risk. Two subtypes of stroke patients exhibited diverse patterns of benefit. CONCLUSION: Increasing residential greenness attenuates the increased risk of mortality with different patterns due to chronic air pollutants for ischemic and hemorrhagic stroke, offering valuable insights for precise tertiary stroke prevention strategies.

Association of ambient ozone exposure and greenness exposure with hemorrhagic stroke mortality at different times: A cohort study in Shandong Province, China.

Evidence on the association between long-term ozone exposure and greenness exposure and hemorrhagic stroke (HS) is limited, with mixed results. One potential source of this inconsistency is the difference in exposure time metrics. This study aimed to investigate the association between long-term exposure to ambient ozone, greenness, and mortality from HS using exposure metrics at different times. We also examined whether greenness exposure modified the relationship between ozone exposure and mortality due to HS. The study population consisted of 45771 participants aged ≥40 y residing in 20 counties in Shandong Province who were followed up from 2013 to 2019. Ozone exposure metrics (annual mean and warm season) and the normalized difference a measure of greenness exposure, were calculated. The relationship between environmental exposures (ozone and greenness exposures) and mortality from HS was assessed using time-dependent Cox proportional hazards models, and the modification of greenness exposure was examined using stratified analysis with interaction terms. The person-years at the end of follow-up were 90,663. With full adjustments, the risk of death from hemorrhagic stroke increased by 5% per interquartile range increase in warm season ozone [hazard ratio =1.05; 95 % confidence interval: 1.01-1.08]. No clear association was observed between annual ozone and mortality HS. Both the annual and summer NDVI were found to reduce the risk of HS mortality. The relationships were influenced by age, sex, and residence (urban or rural). Furthermore, greenness exposure was shown to have a modifying effect on the relationship between ozone exposure and the occurrence of HS mortality (P for interaction = 0.001). Long-term exposure to warm season O3 was positively associated with HS mortality, while greenness exposure was inversely associated with HS mortality. Greenness exposure may mitigate the negative effects of warm season ozone exposure on HS mortality.

Greenness, air pollution, and mortality risk: a retrospective cohort study of patients with lung cancer in China.

The association between long-term exposure to air pollution and mortality from lung cancer has been established, yet evaluations of the potential mitigating effects of greenness on this impact are scarce. We conducted a cohort study in Pingyi County. A two-level Cox proportional hazards regression model was used to examine the associations among long-term exposure to air pollution, residential greenness, and lung cancer mortality. Among the examined pollutants, nitrogen dioxide exhibited the most significant adverse effects and highest risk of lung cancer mortality, with hazard ratio (HR) = 2.783 (95% confidence interval [CI]: 1.885-4.107) for all-cause mortality, HR = 2.492 (95%CI: 1.659-3.741) for tumour-related mortality, and HR = 2.431 (95%CI: 1.606-3.678) for lung cancer mortality. Higher greenness values were associated with a reduced risk of lung cancer mortality. These findings suggest the importance of implementing strategies for increasing greenness to reduce the health impacts of air pollution.

Effects of greenness in university campuses on test anxiety among Chinese university students during COVID-19 lockdowns: a correlational and mediation analysis.

The purpose of this study is to investigate the correlations of greenness exposure with test anxiety among university students during COVID-19 lockdowns and to explore their mechanisms. We conducted a cross-sectional study with 2609 university students in Anhui and Shandong provinces, China. We assessed perceived campus greenness using a five-point Likert scale for quality, visibility, abundance, usage, and accessibility. Objective greenness was estimated via average normalised difference vegetation index (NDVI) in 1,000-, 1,500-, and 2,000-m radius zones around each of the campuses. A generalised linear mixed model examined the associations between greenness and test anxiety and to evaluate the mediation effects of physical activity, body mass index (BMI), and air pollution. Results showed that higher NDVI1500-m correlated with lower test anxiety (OR = 0.871; 95% CI: 0.851, 0.891), physical activity may partially mediate this association. Increased campus greenness may alleviate test anxiety among Chinese university students.

City-level greenness exposure is associated with COVID-19 incidence in China.

Accumulating studies have suggested an important role of environmental factors (e.g. air pollutants) on the occurrence and development of coronavirus disease 2019 (COVID-19). Evidence concerning the relationship of greenness on COVID-19 is still limited. This study aimed to assess the association between greenness and COVID-19 incidence in 266 Chinese cities. A total of 12,377 confirmed COVID-19 cases were identified through February 29th, 2020. We used the average normalized difference vegetation index (NDVI) during January and February 2020 from MOD13A2 product, to represent the city-level greenness exposure. A generalized linear mixed-effects model was used to estimate the association between NDVI exposure and COVID-19 incidence using COVID-19 cases as the outcome. We evaluated whether the association was modified by population density, GDP per capita, and urbanization rate, and was mediated by air pollutants. We also performed a series of sensitivity analyses to discuss the robustness of our results. Per 0.1 unit increment in NDVI was negatively associated with COVID-19 incidence (IRR: 0.921, 95% CI: 0.898, 0.944) after adjustment for confounders. Associations with COVID-19 incidence were stronger in cities with lower population density, lower GDP per capita, and lower urbanization rate. We failed to detect any mediation effect of air pollutants on the association between NDVI and COVID-19 incidence. Sensitivity analyses also indicated consistent estimates. In conclusion, our study suggested a beneficial association between city-level greenness and COVID-19 incidence. We could not establish which mechanisms may explain this relationship.

Exercise Preconditioning Ameliorates Cognitive Impairment in Mice with Ischemic Stroke by Alleviating Inflammation and Modulating Gut Microbiota.

Several studies have demonstrated that exercise preconditioning is an effective means of alleviating poststroke cognitive impairment (PSCI). Mechanisms of regulating cognitive function have not been fully elucidated. Herein, the present study is aimed at exploring the effect of the microbiota-gut-inflammasome-brain axis in the process of exercise preconditioning moderating cognitive impairment after ischemic stroke. We observed that exercise preconditioning decreased infarct size, reduced the degree of neuronal damage, and alleviated cognitive impairment in mice with ischemic stroke. In addition, exercise preconditioning also reduced the expression of inflammatory cytokines, as well as NLRP3, Caspase-1, IL-18, and IL-1ß protein expressions. Ischemic stroke could downregulate the abundance of Roseburia while increasing the abundance of the Helicobacter at the level of genus. As a comparison, exercise preconditioning increased the abundance of the Lactobacillus, which was beneficial for mice at the genus level. In conclusion, exercise preconditioning can improve cognitive dysfunction after ischemic stroke through alleviating inflammation and regulating the composition and diversity of the gut microbiota, which might provide a new strategy for the prevention of PSCI.

Exploring the relationship between depression and different multimorbidity patterns among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Depression is common in patients with multimorbidity, but little is known about the relationship between depression and multimorbidity. The purpose of our research was to investigate multimorbidity patterns and their association with depression in a sample of older people covered by long-term care insurance in Shanghai, China. METHOD: This was a population-based cross-sectional study, with 1871 participants aged ≥60 years old who are covered by Shanghai long-term care insurance. Multimorbidity was defined as the presence of two or more chronic diseases at the same time. We collected information on chronic conditions using a self-reported medical history, and we used the 30-item Geriatric Depression Scale (GDS-30) to evaluate depressive symptoms. Patterns of multimorbidity were identified with exploratory factor analysis, using oblimin rotation. Logistic regression was used to estimate the relationship between multimorbidity patterns and depressive symptoms. RESULTS: Among the participants, the prevalence of multimorbidity was 64.7%, and the prevalence of depression was 64.6%. Hypertension, cardiovascular disease, cerebrovascular disease (CVD), and cataracts showed strong associations with depression when co-occurring with other conditions. Three patterns of multimorbidity were identified: a musculoskeletal pattern, cardiometabolic pattern, and degenerative disease pattern. Among these, the cardiometabolic (adjusted odds ratio (AOR) 1.223; 95% confidence interval (CI) 1.102, 1.357) and degenerative disease (AOR 1.185; 95% CI 1.071, 1.311) patterns were associated with a higher risk of depressive symptoms. CONCLUSION: Two of three multimorbidity patterns were found to be associated with depression. Physical and psychological dimensions require greater attention in the care of older adults who are covered by long-term care insurance.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. METHODS: We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. RESULTS: Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72). CONCLUSIONS: Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

Dysregulation of the miR-325-3p/DPAGT1 axis supports HBV-positive HCC chemoresistance.

BACKGROUND: Chemotherapeutic resistance in hepatitis B virus (HBV)-positive hepatocellular carcinoma (HCC) patients is an unfortunate side effect of standard chemotherapy. This situation necessitates a better understanding of the molecular pathways underlying HBV + HCC chemoresistance in order to aid the development of novel chemotherapeutic targets. METHODS: We generated two doxorubicin (DOX)-resistant HBV + HCC sublines HepG2.2.15 and Huh7-1.3. qRT-PCR was used to evaluate dysregulation in hexosamine pathway genes in chemosensitive and chemoresistant HBV + HCC cell lines in vitro. Western blots, luciferase reporter assays, and in vivo xenograft tumor studies were conducted to reveal the role of the miRNA-325-3p/DPAGT1 axis in HBV + HCC chemoresistance. RESULTS: The hexosamine pathway gene dolichyl-phosphate N-acetylglucosamine phosphotransferase 1 (DPAGT1) was found to be upregulated in both DOX-resistant cell lines. Enhancing DPAGT1 activity significantly improved the survival of DOX-resistant cells. Silencing or pharmacological inhibition of DPAGT1 inhibited xenograft tumor growth under DOX-treated conditions. DPAGT1 upregulation was associated with higher levels of stemness-related markers and ATP-binding cassette (ABC) drug efflux transporters in DOX-resistant cell lines. miR-325-3p was found to negatively modulate DPAGT1 expression and phenocopied the effects of DPAGT1 silencing in vitro and in vivo. In HBV + HCC patients treated with transarterial chemoembolization (TACE), high and low levels of tumor DPAGT1 and miR-325-3p expression, respectively, were associated with a poor chemotherapeutic response. CONCLUSIONS: Our findings provide novel insights into the role of miR-325-3p/DPAGT1 axis dysregulation in supporting HBV + HCC chemoresistance.

Cardiovascular diseases in middle aged and older adults in China: the joint effects and mediation of different types of physical exercise and neighborhood greenness and walkability.

BACKGROUND: Both physical exercise and the built environment are associated with cardiovascular diseases (CVDs). Yet, the influence of the multiple dimensions of the built environment and different types of physical exercise on CVDs is not well understood. Further, little is known about the joint effects of physical exercise and the built environment, nor whether one mediates the effect of the other on the risk of CVDs. We aim to investigate the risk of CVDs on middle aged and older Chinese adult populations by analyzing the independent effects, as well as potential interactions and mediation effects of different types of physical exercise and two dimensions of the built environment; namely, greenness and walkability. METHODS: Data were collected from a community-based cross-sectional study (n = 1944). The study participants, aged 40 years or older, came from 32 communities across urban, suburban, and rural areas in Longzihu district of Bengbu, a typical second-tier city in eastern China. Physical exercise data were obtained from the International Physical Activity Questionnaire (IPAQ) question survey. We used a satellite-based Normalized Difference Vegetation Index (NDVI) score to assess greenness exposure. We used both the Walk Score index and the Neighborhood Environment Walkability Scale (NEWS) to assess walkability. Multilevel logistic regression, also known as mixed-effects logistic regression, was used to estimate the associations between physical exercise and the built environment (greenness and walkability) on CVD outcomes while accounting for within-community and within-subdistrict correlations. We followed Baron and Kenny's framework and used bootstrapping to quantify the mediation of physical exercise between built environment and CVD outcomes. Stratified analysis was conducted by age (middle aged and older adults) and gender. RESULTS: Compared to the reference group with little to low physical activities, we found a significantly reduced risk of hypertension (about 20-45% reduction) and coronary heart disease (about 35-55% reduction) among those with moderate to high activities in walking/square dancing or morning exercising/Tai Chi, and a significantly reduced risk of stroke (about 25% reduction) among those with moderate to high activities in walking/square dancing. Compared to the reference group with low NDVI-based greenness exposure, we found a significant reduction in risk of hypertension (about 55-85% reduction), coronary heart disease (about 75% reduction) and stroke (about 45% reduction) among those with moderate to high levels of exposure. Compared to the reference groups with low walkability, we observed about 30-60% lower risk of hypertension and coronary heart disease associated with moderate to high levels of Walk score, and about 20-30% lower risk of hypertension and stroke associated with moderate to high levels of NEWS-based walkability. We found no interactions between physical exercise and the built environment. The associations of greenness and walkability with CVDs were partially explained by physical exercise (up to 55% of the total effect). CONCLUSIONS: Both physical exercise and built environment factors were associated with the risk of CVDs. Our observed association between CVDs and neighborhood greenness exposure and walkability was explained, in part, by physical exercises. Such a role, if confirmed in future studies, could have important implications for policies and programs aimed at increasing green spaces and improving walkability in both urban and rural settings as strategies to promote physical exercise in middle aged and older population.

Ultrasound-Guided versus Thoracoscopic Pleural Biopsy for Diagnosing Tuberculous Pleurisy Following Inconclusive Thoracentesis: A Randomized, Controlled Trial.

BACKGROUND Traditional diagnostic methods for tuberculosis (TB) cannot be reliably applied to tuberculous pleurisy. Therefore, this prospective, randomized, controlled trial was performed to compare the diagnostic sensitivity and safety of ultrasound-guided cutting-needle pleural biopsy versus thoracoscopic pleural biopsy in patients suspected of tuberculous pleurisy following inconclusive thoracentesis. MATERIAL AND METHODS A total of 196 adult patients with acid-fast bacillus (AFB)-negative exudative pleural effusions clinically suspected of tuberculous pleurisy were recruited. Enrollees were randomized into 2 cohorts: ultrasound-guided cutting-needle pleural biopsy (n=96) or thoracoscopic pleural biopsy (n=96). The overall diagnostic yields, diagnostic sensitivities for tuberculous pleurisy, and post-procedural complications for both cohorts were statistically compared. RESULTS Ultrasound-guided pleural biopsy displayed an overall diagnostic yield of 83%, while thorascopic pleural biopsy displayed a similar overall diagnostic yield of 86% (χ²=1.88, df=1, p=0.17). There were 127 patients conclusively diagnosed with tuberculous pleurisy, resulting in a tuberculous pleurisy prevalence of 65% in this patient population (66% in the ultrasound cohort vs. 63% in the thoracoscopy cohort; p>0.05). Ultrasound-guided pleural biopsy displayed a sensitivity of 82% in detecting tuberculous pleurisy, while thorascopic pleural biopsy displayed a similar sensitivity of 90% (χ²=1.05, df=1, p=0.30). The sensitivities of these 2 modalities did not significantly differ based on the degree of pleural thickening (p>0.05). Post-procedural complications were minor. CONCLUSIONS Ultrasound-guided and thoracoscopic pleural biopsy both display strong (>80%) but statistically similar overall diagnostic yields for diagnosing pleural effusions following inconclusive thoracentesis. Both modalities also display strong (>80%) but statistically similar sensitivities in detecting tuberculous pleurisy.

[A case-control study on the relationship between food preference and lung cancer and mesothelioma in a rural area with naturally occurring asbestos].

OBJECTIVE: To understand the relationship between food preference and lung cancer or malignant pleural mesothelioma and the interactive effect between food preference and asbestos exposure in a rural area with naturally occurring asbestos. METHODS: At the basis of the cohort of Dayao in Yunnan, we performed a 1 ∶ 2 casecontrol study including 53 cases( 23 cases for lung cancer and 26 cases for mesothelioma)and 106 age-and sex-matched normal healthy controls. In order to study the protective effect of food preference and the interactive effect between food preference and asbestos exposure, conditional logistic regression was used to estimate adjusted odds ratios( OR)and their 95% confidence intervals( CI) in both unvaried and multivariate analyses. RESULTS: Both green tea and wild mushroom were inversely associated with lung cancer ormalignant pleural mesothelioma, and the adjusted ORs were: 0. 88( 95% CI 0. 66-0. 87) for green tea, 0. 85( 95% CI 0. 23- 0. 95) for wild mushroom intake. Food preference to wild mushroom modified the associations of Crocidolite ' s contacting, Respectively, relative excess risk due to interaction( RERI), attributable proportion due to interaction( API), synergy index( S) were 0. 86, 0. 26 and 0. 61. CONCLUSION: Both green tea and wild mushroom might serve as protective factors on lung cancer or malignant pleural mesothelioma.

[A case-control study on the relationship of crocidolite pollution in drinking water with the risk of gastrointestinal cancer in Dayao County].

OBJECTIVE: To explore the relationship of crocidolite pollution in drinking water with the risk of gastrointestinal cancer's death in Dayao County. METHODS: A 1:2 matched case-control study involving 54 death cases of gastrointestinal cancer from a population-based cohort of twenty-seven years and 108 controls matched by age, gender, death time, etc was conducted to analyze the effect of local water condition on the risk of gastrointestinal cancer in Dayao County. RESULTS: Results from logistic regression analysis suggested the longer of asbestos furnace use over time, the higher the mortality risk of gastrointestinal cancer (6 - 10 years: OR = 2.920, 95% CI 1.501 - 5.604. 11 - 15 years: OR = 3.966, 95% CI 2.156 -7.950. Over 15 years: OR = 4.122, 95% CI 1.211 - 7. 584). Drinking unboiled water leaded to an increased risk of gastrointestinal cancer (OR = 1.43, 95% CI 1.07 - 1.88). Type of drinking water was associated with gastrointestinal cancer. When compared with drinking tap water, OR for drinking well water was 1.770 (95% CI 1.001 - 2.444), 2.442 for drinking river water (95% CI 0.956 - 3.950), 2.554 for drinking house and field ditch water (95% CI 1.961 - 6.584), and 3.121 for drinking pond water (95% CI 1.872 - 6.566). CONCLUSION: Related factors of drinking water in crocidolite-contaminated area in Dayao County were significantly associated with the mortality of gastrointestinal cancer.

Concentrations of asbestos fibers and metals in drinking water caused by natural crocidolite asbestos in the soil from a rural area.

Asbestos fibers and metals in drinking water are of significant importance to the field of asbestos toxicology. However, little is known about asbestos fibers and metals in drinking water caused by naturally occurring asbestos. Therefore, concentrations of asbestos fibers and metals in well and surface waters from asbestos and control areas were measured by scanning electron microscopy (SEM), inductively coupled plasma (ICP) optical emission spectrometer, and ICP-mass spectrometry in this study. The results indicated that the mean concentration of asbestos fibers was 42.34 millions of fibers per liter by SEM, which was much higher than the permission exposure level. The main compositions of both asbestos fibers in crocidolite mineral and in drinking water were Na, Mg, Fe, and Si based on energy dispersive X-ray analysis. This revealed that the drinking water has been contaminated by asbestos fibers from crocidolite mineral in soil and rock. Except for Cr, Pb, Zn, and Mn, the mean concentrations of Ni, Na, Mg, K, Fe, Ca, and SiO2 were much higher in both surface water and well waters from the asbestos area than in well water from the control area. The results of principal component and cluster analyses indicated that the metals in surface and well waters from the asbestos area were significantly influenced by crocidolite mineral in soil and rock. In the asbestos area, the mean concentrations of asbestos fibers and Ni, Na, Mg, K, Fe, Ca, and SiO2 were higher in surface and well waters, indicating that asbestos fibers and the metals were significantly influenced by crocidolite in soil and rock.

Multiple Impacts of Urban Built and Natural Environment on Lung Cancer Incidence: A Case Study in Bengbu.

Tumours are the main disease affecting the health of the Chinese population, and lung cancer is the malignancy with the highest incidence. Hence, the need to study and analyse the population of lung cancer incidence in order to effectively control and prevent it. In this research, we discuss the demographic characteristics of lung cancer incidence population of 2014 to 2020 from the perspective of multiple urban environmental factors, taking Bengbu city in the Huaihe River Basin of China as the research area, analyse the correlation between environmental indicators and lung cancer incidence population through the Spearman's rank correlation assessment model, and analyse the interaction between the influence factors of a geographic detector to analyse the influence of urban environmental factors. The results showed the followings: (1) The distribution characteristics of lung cancer incidence population were mainly geriatric population and spatially mainly fell in the old urban area of the study area, and the population distribution had clustered characteristics. (2) Through Spearman's rank correlation analysis, the land use, road traffic, spatial form, service facilities, and the open space of green space of the urban-built environment as well as the natural environment are all correlated with the incidence of lung cancer. (3) Factor detection and interaction analysis revealed a greater effect of spring and winter on lung cancer prevalence. In addition, the road intersection density and the distance to industrial are the most important potential influencing factors, and the interaction of any two factors will increase the risk of lung cancer.

Association of greenness with the disease burden of lower respiratory infections and mediation effects of air pollution and heat: a global ecological study.

Exposure to greenness is increasingly linked to beneficial health outcomes, but the associations between greenness and the disease burden of lower respiratory infections (LRIs) are unclear. We used the normalized difference vegetation index (NDVI) and the leaf area index (LAI) to measure greenness and incidence, death, and disability-adjusted life years (DALYs) due to LRIs to represent the disease burden of LRIs. We applied a generalized linear mixed model to evaluate the association between greenness and LRI disease burden and performed a stratified analysis, after adjusting for covariates. Additionally, we assessed the potential mediating effects of fine particulate matter (PM2.5), ozone (O3), nitrogen dioxide (NO2), and heat on the association between greenness and the disease burden of LRIs. In the adjusted model, one 0.1 unit increase of NDVI and 0.5 increase in LAI were significantly inversely associated with incidence, death, and DALYs due to LRIs, respectively. Greenness was negatively correlated with the disease burden of LRIs across 15-65 age group, both sexes, and low SDI groups. PM2.5, O3, and heat mediated the effects of greenness on the disease burden of LRIs. Greenness was significantly negatively associated with the disease burden of LRIs, possibly by reducing exposure to air pollution and heat.

Associations of air pollution and greenness with global burden of breast cancer: an ecological study.

Despite the significance of the associations of air pollution and greenness with the risk of breast cancer, this topic has not been investigated on a global scale. We conducted an ecological study using 7 years of data from 162 countries. Disability-adjusted life years (DALYs) and incidence data were used to represent the breast cancer disease burden. Particulate matter with a diameter < 2.5 µm (PM2.5), ozone (O3), nitrogen dioxide (NO2), and the normalized difference vegetation index (NDVI) were adopted as our exposures. We employed generalized linear mixed models to explore the relationship between air pollution and greenness on breast cancer disease burden. The rate ratio (RR) and its 95% confidence interval (CI) indicate the effect size. There is a positive association between air pollution and the burden of breast cancer disease. Contrarily, per interquartile range increment in NDVI was negatively associated with DALYs and incidence. In terms of air pollutants and breast cancer, NDVI seems to have a significant influence on the relationship between these two conditions. A higher amount of greenness helps to alleviate the negative association of air pollution on breast cancer. PM2.5 and O3 play a mediating role in the relationship between greenness and breast cancer disease burden. In areas with higher levels of greenness, there is a possibility that the inverse association between air pollutants and the burden of breast cancer may be influenced.

Effect of neighbourhood greenness on the association between air pollution and risk of stroke first onset: A case-crossover study in shandong province, China.

BACKGROUND: Higher neighbourhood greenness is associated with beneficial health outcomes, and short-term exposure to air pollution is associated with an elevated risk of stroke onset. However, little is known about their interactions. METHODS: Daily data on stroke first onset were collected from 20 counties in Shangdong Province, China, from 2013 to 2019. The enhanced vegetation index (EVI) and concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and sulfur dioxide (SO2) were calculated for each individual at the village or community level based on their home address to measure their neighbourhood exposure to greenness and air pollution. EVI was categorised as low or high, and a time-stratified case-crossover design was used to estimate the percent excess risk (ER%) of stroke associated with short-term exposure to air pollution. We further stratified greenness on the basis of EVI values into quartiles and introduced interaction terms between air pollutant concentrations and the median EVI values of the quartiles to assess the effect of greenness on the associations between short-term exposure and stroke. RESULTS: Individuals living in the high-greenness areas had weaker associations between total stroke risk and exposure to NO2 (low greenness: ER% = 1.765% [95% CI 1.205%-2.328%]; high greenness: ER% = 0.368% [95% CI -0.252% to 0.991%]; P = 0.001), O3 (low greenness: 0.476% [95% CI 0.246%-0.706%]; high greenness: ER% = 0.085% [95% CI -0.156% to 0.327%]; P = 0.011), and SO2 (low greenness: 0.632% [95% CI 0.138%-1.129%]; high greenness: ER% = -0.177% [95% CI -0.782% to 0.431%]; P = 0.035). CONCLUSION: Residence in areas with higher greenness was related to weaker associations between air pollution and stroke risk, suggesting that effectively planning green spaces can improve public health.

Associations of ambient temperature with mortality for ischemic and hemorrhagic stroke and the modification effects of greenness in Shandong Province, China.

BACKGROUND: Evidence is scant on the relative and attributable contributions of ambient temperature on stroke subtypes mortality. Few studies have examined modification effects of multiple greenness indicators on such contributions, especially in China. We quantified the associations between ambient temperature and overall, ischemic, and hemorrhagic stroke mortality; further examined whether the associations were modified by greenness. METHODS: We conducted a multicenter time-series analysis from January 1, 2013 to December 31, 2019. we adopted a distributed lag non-linear model to evaluate county-specific temperature-stroke mortality associations. We then applied a random-effects meta-analysis to pool county-specific effects. Attributable mortality was calculated for cold and heat, defined as temperatures below and above the minimum mortality temperature (MMT). Finally, We conducted a multivariate meta-regression to determine associations between greenness and stroke mortality risks for cold and heat, using normalized difference vegetation index (NDVI), soil adjusted vegetation index (SAVI), and enhanced vegetation index (EVI) as quantitative indicators of greenness exposure. RESULTS: In the study period, 138,749 deaths from total stroke were reported: 86,873 ischemic and 51,876 hemorrhagic stroke. We observed significant W-shaped relationships between temperature and stroke mortality, with substantial differences among counties and regions. With MMT as the temperature threshold, 17.16 % (95 % empirical CI, 13.38 %-19.75 %) of overall, 20.05 % (95 % eCI, 16.46 %-22.70 %) of ischemic, and 12.55 % (95 % eCI, 5.59 %-16.24 %) of hemorrhagic stroke mortality were attributable to non-optimum temperature (combining cold and heat), more mortality was caused by cold (14.94 %; 95 % eCI, 11.57 %-17.34 %) than by heat (2.22 %; 95 % eCI, 1.54 %-2.72 %). Higher levels of NDVI, SAVI and EVI were related to mitigated effects of non-optimum temperatures-especially heat. CONCLUSIONS: Exposure to non-optimum temperatures aggravated stroke mortality risks; increasing greenness could alleviate that risks. This evidence has important implications for local communities in developing adaptive strategies to minimize the health consequences of adverse temperatures.

Effect of Rho-Kinase and Autophagy on Remote Ischemic Conditioning-Induced Cardioprotection in Rat Myocardial Ischemia/Reperfusion Injury Model.

OBJECTIVE: Remote ischemic conditioning (RIC) is a cardioprotective method in ischemia/reperfusion (I/R) injury. This study investigated the mechanism of Rho-kinase-mediated autophagy in RIC. METHODS: Sixty male Sprague-Dawley rats were randomly divided into six groups: sham, I/R, RIC, I/R+fasudil, RIC+wortmannin, and RIC+fasudil+wortmannin. Throughout the experiment, mean arterial pressure and heart rate were continuously monitored. Histopathology and ultrastructure and myocardial enzymes' expression were evaluated to determine the degree of cardiac injury. The protein expression of the Rho-kinase substrates myosin light chain (MLC) and myosin phosphatase target subunit 1 (MYPT1), autophagy-related protein light chain 3-II (LC3-II) and Beclin 1, and protein kinase B (AKT) was measured in the myocardial tissue. RESULTS: Compared with the sham group, the mean arterial pressure and heart rate were decreased, myocardial enzyme levels were increased, and myocardial damage was aggravated in the I/R group; however, RIC improved these alterations. The expression of phosphorylated MLC and MYPT1 was lower, while LC3-II, Beclin 1, and phospho-AKT expression levels were higher in the RIC group compared with the I/R group. Obviously, treatment of the I/R group rats with fasudil, a Rho-kinase inhibitor, significantly ameliorated the I/R effects, whereas treatment of the RIC group rats with wortmannin, a phosphatidylinositol-3 kinase (PI3K) inhibitor, inhibited the RIC protective effects. Moreover, the rats in the RIC+fasudil+wortmannin group showed similar changes to those in the RIC+wortmannin group. CONCLUSION: These results showed that RIC protected the myocardium from I/R injury by suppressing Rho-kinase and the underlying mechanism may be related to enhancing autophagy via the PI3K/AKT pathway.