Ambient air pollution and daily outpatient visits for cardiac arrhythmia in Shanghai, China.

BACKGROUND: Cardiac arrhythmias are cardiac rhythm disorders that comprise an important public health problem. Few prior studies have examined the association between ambient air pollution and arrhythmias in general populations in mainland China. METHODS: We performed a time-series analysis to investigate the short-term association between air pollution (particulate matter with an aerodynamic diameter less than 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) and outpatient visits for arrhythmia in Shanghai, China. We applied the over-dispersed Poisson generalized additive model to analyze the associations after control for seasonality, day of the week, and weather conditions. We then stratified the analyses by age, gender, and season. RESULTS: We identified a total of 56 940 outpatient visits for cardiac arrhythmia. A 10-µg/m3 increase in the present-day concentrations of PM10, SO2, and NO2 corresponded to increases of 0.56% (95% CI 0.42%, 0.70%), 2.07% (95% CI 1.49%, 2.64%), and 2.90% (95% CI 2.53%, 3.27%), respectively, in outpatient arrhythmia visits. The associations were stronger in older people (aged ≥65 years) and in females. This study provides the first evidence that ambient air pollution is significantly associated with increased risk of cardiac arrhythmia in mainland China. CONCLUSIONS: Our analyses provide evidence that the current air pollution levels have an adverse effect on cardiovascular health and strengthened the rationale for further limiting air pollution levels in the city.

Study on lead-induced activation of rat renal interstitial fibroblasts and the related mechanisms.

CONTEXT: Lead is a common industrial toxicant and has been proved to be associated with the kidney damage. OBJECTIVE: To investigate the effect and mechanism of lead on expression of rat renal interstitial fibroblast activation related protein. MATERIALS AND METHODS: The expression of activation related protein mRNA was measured by real-time PCR in the NRK/49F treated by lead acetate with different concentrations (0, 0.5, 1 and 2 µmol/L). The effects of lead acetate on the level of fibronectin (FN) and signal transduction factors (Smads protein) expression were observed by Western blot. RESULTS: The mRNA expression of activation-related protein increased significantly after the cells were stimulated by lead acetate for 24 h. The lead acetate-treated group could upregulate the p-Smad2, p-Smad3 and FN protein expression compared with the control group. The level of Smad2/3 protein expression did not change in all groups, the expression of SnoN decreased significantly compared with the control group. DISCUSSION AND CONCLUSION: Lead acetate could increase the mRNA expression of activation-related factors. It could promote inflammatory reaction induced by TGF-ß via Smad signaling pathway. Lead acetate has the effect on inducing the renal fibrosis.

Serum PCDD/F levels in metropolitan populations living near a municipal solid waste incinerator in Eastern China.

Ambient exposure to polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) is suspected to cause adverse human health outcomes. Herein, serum samples from 40 residents in the neighborhood of a municipal solid waste incinerator (MSWI) in the metropolitan area were measured for PCDD/Fs. The mean toxic equivalent (TEQ) concentration of total PCDD/Fs in human serum samples was 16.8 pg TEQ/g lipid. Serum PCDD/F levels were significantly higher in residents adjacent to the MSWI than in those from areas far from the emission source (p < 0.01). In addition, there were no significant associations between serum PCDD/Fs levels and factors, such as gender, age, and BMI in donors. For non-occupationally exposed populations, OCDD and 1,2,3,7,8-PeCDD in serum are available as indicators of total PCDD/Fs and total TEQ, respectively. The atmospheric PCDD/Fs levels were within a relatively low range in areas upwind and downwind of the MSWI. The results of the principal component analysis showed a distinct difference in PCDD/F congener patterns between air and serum samples, suggesting inhalation exposure could have a limited influence on the human body burden. Our findings will deepen the current knowledge of endogenous PCDD/F exposure in urban populations, and also facilitate public health protection strategies near MSWIs.

High Urine Albumin-to-Creatinine Ratio is Associated with Increased Arterial Stiffness in Diabetes: A Chinese Cross-Sectional Study.

Purpose: Elevated urine albumin-to-creatinine ratio (UACR) is an established risk factor for microvascular disease in the general population. However, it is unclear whether UACR is associated with arterial stiffness in diabetes. We aimed to assess the relationship between UACR levels and the risk of arterial stiffness in patients with diabetes. Methods: From July 2021 to February 2023, a total of 1039 participants were assessed for the risk of arterial stiffness, which was evaluated by brachial-ankle pulse wave velocity (baPWV). The value of UACR≥30 mg/g was defined as high UACR. The UACR level had an abnormal distribution and was log2-transformed for analyses to reduce skewness and volatility. High baPWV was evaluated as categorical variables divided by the highest quartile of the values by sex. The relationship between UACR and arterial stiffness was analyzed by linear curve fitting analyses. Multiple logistic regression models were used to analyze the crude and adjusted odds ratio (OR) of UACR for high baPWV with 95% confidence interval (CI). In addition to applying non-adjusted and multivariate-adjusted models, interaction and stratified analyses were also carried out. Results: The baPWV level was significantly higher in the high UACR group compared with that in the normal UACR group (1861.84 ± 439.12 cm/s vs 1723.13 ± 399.63 cm/s, p<0.001). Adjusted smoothed plots suggested that there are linear relationships between log2-transformed UACR and high baPWV, and Spearman correlation coefficient was 0.226 (0.176-0.276, p<0.001). The OR (95% CI) between log2-transformed UACR and high baPWV were 1.26 (1.19-1.33, p<0.001), and 1.16 (1.08-1.25, p<0.001) respectively in diabetic patients before and after adjusting for potential confounders. Conclusion: The elevated UACR was associated with arterial stiffness in Chinese patients with diabetes.

1. The mean baPWV level was significantly higher in the high UACR group compared with that in the normal UACR group.2. The sex-specific hierarchical analysis revealed that baPWV levels and the incidence of high baPWV were significantly elevated with increased UACR.3. Curvilinear relationships between log2-transformed UACR and the risk of high baPWV.4. Positive association between UACR and high baPWV in patients with diabetes.

[Effects of oxidative stress and NF-kappaB levels in peripheral blood mononuclear cells on development of silicosis].

OBJECTIVE: To investigate the change of indicators of oxidative stress in serum and NF-kappaB in peripheral blood mononuclear cells of patients with silicosis, and explore the mechanism of the development of silicosis. METHODS: The subjects were divided into (1) 200 workers exposed to SiO2 for at least 1 years in a foundry served as the dust-exposure group; (2) 130 cases with silicosis (I phase silicosis 64 cases, II phase 46 cases III phase 20 cases) served as the silicosis group; (3) 32 cases with 0+ phase silicosis in the foundry served as the observed group,(4)100 subjects from a hotel served as the control group. The serum including superoxide dismutase (SOD), nitric oxide (NO), serum glutathione peroxidase (GSH-Px), total antioxidant capacity (T-AOC), nitric oxide synthase (NOS), lipid malondialdehyde (MDA) and NF-kappaB protein levels in peripheral blood mononuclear cells were determined, respectively. RESULTS: Compared with the control group, NO levels in dust-exposed group and silicosis group significantly increased, and SOD decreased significantly (P < 0.05 or P < 0.01). Compared with the control group and dust-exposed group, T-AOC, NOS, MDA levels in silicosis group significantly increased (P < 0.05 or P < 0.01). GSH-Px in dust-exposed group and silicosis group were (231.164 +/- 36.484) and (270.469 +/- 39.228)U/ml, respectively which were significantly than that [(223.360 +/- 46.838) U/ml] in control group (P < 0.05 or P < 0.01), and there was significant difference of GSHPx between the silicosis group and the dust-exposed group significantly (P < 0.01) . GSH-Px level [(290.750 +/- 39.129) U/ml] in III phase silicosis group were significantly higher than those [(256.906 +/- 21.41) and (259.594 +/- 34.79) U/ml] in observation group and I phase silicosis group (P < 0.05). NF-kappaB levels [(72.06 +/- 9.12) and (85.25 +/- 11.64) ng/L] in dust-exposed group and silicosis group were significantly higher than that [(59.71 +/- 9.27) ng/L] in control group (P < 0.01), and there was significant difference of between the silicosis group and the dust-exposed group (P < 0.01). There was a positive correlation between serum GSH-Px level and the silicosis stages (r = 0.507, P < 0.01). Also there was a positive correlation between NF-kappaB level and silicosis stages, age, GSH-Px or NO levels (r = 0.376, 0.243, 0.233, 0.221, P < 0.01). CONCLUSION: The imbalance of oxidative and anti-oxidation system and the activation of NF-kappaB are related with the occurrence and development of silicosis. The monitoring of oxidative stress indicators and NF-kappaB is beneficial to the prediction and prognosis assessment of silicosis.

[Application of the national diagnostic criteria of occupational mercury poisoning].

OBJECTIVE: To investigate the clinical manifestation of patients with renal injury induced by chronic mercury intoxication and the application of the diagnostic criteria of occupational mercury poisoning. METHODS: The clinical data of 8 patients with chronic occupational mercury intoxication were analysed and evaluated. RESULTS: All the observed clinical signs of chronic mercury intoxication correspond with the items of the diagnostic criteria of occupational mercury poisoning. The increasing beta2-MG was one of the clinical manifestations of renal injury induced by chronical mercury intoxication. The renal injury obviously was dose-dependent and reversible. CONCLUSIONS: The national diagnostic criteria of occupational mercury poisoning is practically valuable. The renal injury induced by chronic mercury intoxication should not be neglected.

Effect of PM2.5 exposure on circulating fibrinogen and IL-6 levels: A systematic review and meta-analysis.

BACKGROUND: Ambient fine particulate matter (PM2.5) pollution poses a great threat on global health. Previous studies have reported that PM2.5 regulates circulating fibrinogen and IL-6 levels in the development of cardiovascular and respiratory disease. However, the correlation between PM2.5 exposure and both biomarkers remains inconsistent. METHODS: We searched related articles through PubMed, Web of Science and ScienceDirect. Random effects model was used to obtain a pooled estimate effect of both biomarkers as PM2.5 concentration increased by every 10 µg/m3. Meta-regression analysis, sensitivity analysis and publication bias test were conducted to evaluate the heterogeneity, stability and reliability of this meta-analysis. RESULTS: A total of 22 articles were included. Each 10 µg/m3 increase in PM2.5 concentration was significantly correlated with a 1.76% increase in circulating fibrinogen level (95% CI: 0.38%-3.14%, P = 0.013) and a 4.66% increase in IL-6 level (95% CI: 1.14%-8.18%, P = 0.010). Subgroup analysis revealed that high-level PM2.5 exposure had a more significant association with circulating IL-6 level (11.67%, 95% CI: 0.66%-22.69%, P = 0.038) than low-level exposure, but this association was not observed in fibrinogen (2.50%, 95% CI: -0.78%-5.77%, P = 0.135). Sensitivity analysis and publication bias test confirmed the stability of the results. CONCLUSION: Circulating fibrinogen and IL-6 significantly increased with exposure to PM2.5, may serve as promising biomarkers for PM2.5-related adverse effects.

Correlation between environmental low-dose cadmium exposure and early kidney damage: A comparative study in an industrial zone vs. a living quarter in Shanghai, China.

To investigate heavy metal exposure in an industrial zone vs. a living quarter in Shanghai and explore the relationship between the heavy metal source and urine cadmium (Cd) and early kidney damage. Blood lead and urine Cd, manganese (Mn), mercury (Hg), arsenic (As) and EKD indexes were compared between residents in Exposure group (n = 168) and Control group (n = 168). It was found that PM2.5 level in Exposure group was significantly higher than that in Control group, and serum Cys-C and urine Cd, NAG, mAlb, KIM-1 and Cd-MT levels in Exposure group were also significantly higher than those in Control group, suggesting that differences in urine Cd and heavy metal levels between the residents of the two groups may be due to different PM2.5 concentrations in the environments of the two areas. Cd accumulation within the human body can induce kidney damage, probably through its potential hazard to the proximal tubular epithelial cells.

Rate and peak concentrations of off-gas emissions in stored wood pellets--sensitivities to temperature, relative humidity, and headspace volume.

Wood pellets emit CO, CO(2), CH(4), and other volatiles during storage. Increased concentration of these gases in a sealed storage causes depletion of concentration of oxygen. The storage environment becomes toxic to those who operate in and around these storages. The objective of this study was to investigate the effects of temperature, moisture, and the relative size of storage headspace on emissions from wood pellets in an enclosed space. Twelve 10-l plastic containers were used to study the effects of headspace ratio (25, 50, and 75% of container volume) and temperatures (10-50 degrees C). Another eight containers were set in uncontrolled storage relative humidity (RH) and temperature. Concentrations of CO(2), CO, and CH(4) were measured by gas chromatography (GC). The results showed that emissions of CO(2), CO, and CH(4) from stored wood pellets are more sensitive to storage temperature than to RH and the relative volume of headspace. Higher peak emission factors are associated with higher temperatures. Increased headspace volume ratio increases peak off-gas emissions because of the availability of oxygen associated with pellet decomposition. Increased RH in the enclosed container increases the rate of off-gas emissions of CO(2), CO, and CH(4) and oxygen depletion.

Effects of headspace and oxygen level on off-gas emissions from wood pellets in storage.

Few papers have been published in the open literature on the emissions from biomass fuels, including wood pellets, during the storage and transportation and their potential health impacts. The purpose of this study is to provide data on the concentrations, emission factors, and emission rate factors of CO(2), CO, and CH(4) from wood pellets stored with different headspace to container volume ratios with different initial oxygen levels, in order to develop methods to reduce the toxic off-gas emissions and accumulation in storage spaces. Metal containers (45 l, 305 mm diameter by 610 mm long) were used to study the effect of headspace and oxygen levels on the off-gas emissions from wood pellets. Concentrations of CO(2), CO, and CH(4) in the headspace were measured using a gas chromatograph as a function of storage time. The results showed that the ratio of the headspace ratios and initial oxygen levels in the storage space significantly affected the off-gas emissions from wood pellets stored in a sealed container. Higher peak emission factors and higher emission rates are associated with higher headspace ratios. Lower emissions of CO(2) and CO were generated at room temperature under lower oxygen levels, whereas CH(4) emission is insensitive to the oxygen level. Replacing oxygen with inert gases in the storage space is thus a potentially effective method to reduce the biomass degradation and toxic off-gas emissions. The proper ventilation of the storage space can also be used to maintain a high oxygen level and low concentrations of toxic off-gassing compounds in the storage space, which is especially useful during the loading and unloading operations to control the hazards associated with the storage and transportation of wood pellets.

Characterization and kinetics study of off-gas emissions from stored wood pellets.

The full potential health impact from the emissions of biomass fuels, including wood pellets, during storage and transportation has not been documented in the open literature. The purpose of this study is to provide data on the concentration of CO(2), CO and CH(4) from wood pellets stored in sealed vessels and to develop a kinetic model for predicting the transient emission rate factors at different storage temperatures. Five 45-l metal containers (305 mm diameter by 610 mm long) equipped with heating and temperature control devices were used to study the temperature effect on the off-gas emissions from wood pellets. Concurrently, ten 2-l aluminum canisters (100 mm diameter by 250 mm long) were used to study the off-gas emissions from different types of biomass materials. Concentrations of CO(2), CO and CH(4) were measured by a gas chromatograph as a function of storage time and storage temperature. The results showed that the concentrations of CO, CO(2) and CH(4) in the sealed space of the reactor increased over time, fast at the beginning but leveling off after a few days. A first-order reaction kinetics fitted the data well. The maximum concentration and the time it takes for the buildup of gas concentrations can be predicted using kinetic equations.

[Activity of esterases and effect of genetic polymorphism in workers exposed to organophosphorus pesticides].

OBJECTIVE: To study the activity of esterases, including butyrylcholinesterase (BchE), carboxylesterase (CarbE), paraoxonase (PonE) and acetylcholinesterase (AChE), and to explore the effect of genetic polymorphism on the activity of esterase for workers exposed to organophosphorus pesticides (OPs). METHODS: Two hundred and forty-one long term OPs directly exposed workers and 151 indirectly exposed workers in the same factory were taken as study group. One hundred and sixty unexposed persons were taken as control group. The activity of serum enzymes was measured and the polymorphic distribution was detected using 7900 genotype detecting system and CMOS Chip technique. The effect of long-term exposure to organophosphorus pesticides was analyzed. RESULTS: The activities of BchE, CarbE and PonE were independent on the gender or age in control group. Average values of Carb and BchE activities of directly and indirectly exposed workers were lower than those in control group respectively. PonE activity in directly exposed group was lower than that in control group. AChE activity in directly exposed group was lower than that in indirectly exposed group. All the differences were significant (P < 0.01). In the direct exposure group, the frequency of three variants of butyrylcholinesterase gene K (BCHE-K) polymorphism was 74.3%, 24.1% and 1.6% for UU, UK and KK respectively. Frequency of allele U and K was 0.863 and 0.137 respectively in the same group. Frequency of three variants of PON192 polymorphism was 15.0%, 45.5% and 39.5% for AA, AB and BB respectively in direct exposure group. Gene frequency of low activity (PON*A) and high activity (PON*B) was 0.378 and 0.622 respectively. Frequency of three variants of PON55 polymorphism was 96.2%, 3.8% and 0% for MM, LM and LL respectively in direct exposure group. Frequency of allele M and L was 0.981 and 0.019 respectively in the same group. The activity of PON was different in various genotypes of PON192 and PON55. CONCLUSION: The long-term exposure to OPs could inhibit the activities of CarbE, BchE, PonE and ACh E in different level. The genetic polymorphisms of PON192 and PON55 affect the activity of PonE, which is related to the detoxification of OPs and health impact.

The Impact of the 2013 Eastern China Smog on Outpatient Visits for Coronary Heart Disease in Shanghai, China.

There have been relatively few opportunities to examine the cardiovascular effects of an extreme air pollution event in China. We aimed to examine the impact of the 2013 Eastern China Smog occurring from 2 to 9 December 2013, on outpatient visits for coronary heart diseases (CHD) in a typical hospital in Shanghai, China. We used the over-dispersed, generalized additive model to estimate the relative risk (RR) of the 2013 Eastern China Smog on the outpatient visits by comparing the smog period (2-9 December 2013; 8 days) to the non-smog period (1 November-1 December 2013, and 10 December-28 February 2014; 112 days). This model also controlled for time trends, days of the week, holidays, and meteorological factors. A stratification analysis was performed to estimate sex- and age-specific RRs. The daily average PM2.5 (fine particulate matter with an aerodynamic diameter less than 2.5 µm) concentrations during the smog period were 212 µg/m³, which were three times higher than during the non-smog period (76 µg/m³). The smog in Eastern China in 2013 was significantly associated with an increased risk of outpatient visits for CHD. For example, the RR was 1.18 (95% CI: 1.04, 1.32) on lag 0 day. There were similar effects on males and females. Our analyses provided preliminary evidence that smog constituted a significant risk factor of CHD in China.

Urinary KIM-1: a novel biomarker for evaluation of occupational exposure to lead.

Chronic occult lead poisoning often develops ensuing occupational lead exposure. Early diagnosis of lead poisoning is critical for timely discontinuation of lead exposure and for prognosis. This study explored the value of urinary kidney injury molecule-1 (KIM-1) in diagnosing renal injury induced by lead at an early stage. We retrospectively analyzed 92 workers exposed to occupational lead and demonstrated a better correlation ship between blood lead levels and urine excretion of KIM-1 than other traditional renal injury biomarkers following creatinine adjustment. Receiver operating characteristic curve analysis of the ability of diverse biomarkers for predicting kidney injury in lead-exposed workers demonstrated that the order of predicting accuracy of the studied biomarkers is as follows: urinary KIM-1-to-creatinine ratio > urinary N-acetyl-ß-(D)-glucosaminidase-to-creatinine ratio > urinary ß2-microglobulin-to-creatinine ratio > urinary α1-microglobulin-to-creatinine ratio, with the Youden index being 16.59 ng/g, 14.01 U/g, 0.15 mg/g, and 4.63 mg/g, respectively. Collectively, our findings suggest that short-period occupational lead exposure may cause injury of renal tubules. Urinary excretion of KIM-1 correlates with blood lead levels better than other traditional renal injury biomarkers, including N-acetyl-ß-(D)-glucosaminidase, α1-microglobulin, and ß2-microglobulin. Longitudinal surveillance of urinary KIM-1 may aid for early diagnosis of renal tubular injury in workers with occupational lead exposure.

Temperature and daily mortality in Suzhou, China: a time series analysis.

The evidence concerning the association between ambient temperature and mortality is limited in developing countries, especially in China. We assessed the effects of temperature on daily mortality between 2005 and 2008 in Suzhou, China. A Poisson regression model combined with a distributed-lag nonlinear model was used to examine the association between temperature and daily mortality. We investigated effect modification by individual characteristics, including gender, age and educational attainment. We found significant non-linear effects of temperature on total and cardiovascular mortality. Heat effects were immediate and lasted for 1-2 days, whereas cold effects persisted for 10 days. The relative risk of total morality associated with extreme cold temperature (1st percentile of temperature, -0.3 °C) over lags 0-14 days was 1.75 [95% confidence interval (CI): 1.43, 2.14)], compared with the minimum mortality temperature (26 °C). The relative risk associated with extremely hot temperature (99th percentile of temperature, 32.6 °C) over lags 0-3 days was 1.43 (95% CI: 1.31, 1.56). We did not observe significant modifying effect by gender, age or educational level. This study showed that exposure to both hot and cold temperatures was associated with increased mortality in Suzhou. Our findings may have implications for developing intervention strategies for extreme cold and hot temperatures.

Acute effects of diurnal temperature range on mortality in 8 Chinese cities.

Diurnal temperature range (DTR) is a meteorological indicator closely associated with global climate change. There have been no multicity studies in China addressing the DTR-related health impact. We hypothesized that an increase of DTR is associated with higher daily mortality with a potential lag of effect, and investigated the acute effects of DTR on total, cardiovascular, and respiratory mortality in 8 large Chinese cities from 2001 to 2010. We first calculated city-specific effect of DTR in the full year, the cool season (November to the next April) and the warm season (May to October) separately using a semi-parametric generalized additive model; then we pooled the city-specific estimates with meta analysis. After adjusting for long-term and seasonal trends, temperature, relative humidity and air pollution levels, we found statistically significant associations between DTR and daily mortality, especially in cool seasons. A 1 °C increment of DTR on lag-day 1 corresponded to a 0.42% (95% CI, 0.14 to 0.70) increase in total non-accidental mortality, 0.45% (95% CI, 0.26 to 0.65) increase in cardiovascular mortality, and a 0.76% (95% CI, 0.24 to 1.29) increase in respiratory mortality in cool seasons. Deaths among females and elderly (≥ 65 years) were more strongly associated with DTR than among males and younger people (<65 years). Our analysis suggests that DTR is a potential trigger for death in China. Our findings may have important implications for the climate policies in the country.

Particulate air pollution and mortality in a cohort of Chinese men.

Few prior cohort studies exist in developing countries examining the association of ambient particulate matter (PM) with mortality. We examined the association of particulate air pollution with mortality in a prospective cohort study of 71,431 middle-aged Chinese men. Baseline data were obtained during 1990-1991. The follow-up evaluation was completed in January, 2006. Annual average PM exposure between 1990 and 2005, including TSP and PM10, were estimated by linking fixed-site monitoring data with residential communities. We found significant associations between PM10 and mortality from cardiopulmonary diseases; each 10 µg/m(3) PM10 was associated with a 1.6% (95%CI: 0.7%, 2.6%), 1.8% (95%CI: 0.8%, 2.9%) and 1.7% (95%CI: 0.3%, 3.2%) increased risk of total, cardiovascular and respiratory mortality, respectively. For TSP, we observed significant associations only for cardiovascular morality. These data contribute to the scientific literature on long-term effects of particulate air pollution for high exposure settings typical in developing countries.