China is one of the largest producers and consumers of coal in the world. The National Action Plan on Air Pollution Prevention and Control in China (2013-2017) particularly aimed to reduce emissions from coal combustion. Here, we show whether the acute health effects of PM2.5 changed from 2013 to 2018 and factors that might account for any observed changes in the Beijing-Tianjin-Hebei (BTH) and the surrounding areas where there were major reductions in PM2.5 concentrations. We used a two-stage analysis strategy, with a quasi-Poisson regression model and a random effects meta-analysis, to assess the effects of PM2.5 on mortality in the 47 counties of BTH. We found that the mean daily PM2.5 levels and the SO42- component ratio dramatically decreased in the study period, which was likely related to the control of coal emissions. Subsequently, the acute effects of PM2.5 were significantly decreased for total and circulatory mortality. A 10 μg/m3 increase in PM2.5 concentrations was associated with a 0.16% (95% CI: 0.08, 0.24%) and 0.02% (95% CI: -0.09, 0.13%) increase in mortality from 2013 to 2015 and from 2016 to 2018, respectively. The changes in air pollution sources or PM2.5 components appeared to have played a core role in reducing the health effects. The air pollution control measures implemented recently targeting coal emissions taken in China may have resulted in significant health benefits.

UNASSIGNED: Body fat percentage were positively correlated with arterial stiffness, but the acute change in arterial stiffness after aerobic exercise in individuals with different body fat percentages remains unclear. This study was aimed to determine the effect of acute aerobic exercise on arterial stiffness in individuals with different body fat percentages.
UNASSIGNED: Individuals who both participated in the seventh survey of the Kailuan study and the fifth iteration of National Physical Fitness Monitoring were enrolled in our study. All participants underwent measurement of brachial-ankle pulse wave velocity, blood pressure, and heart rate before and after a two-stage load test on cycle ergometry. Additionally, the generalized linear model was established to analyse between-group differences of the change in brachial-ankle pulse wave velocity before and after exercise for individuals with different body fat percentages.
UNASSIGNED: The participants (N = 940, 36.8 ± 7.7years old, all male) were divided into: Q1 10.0-19.3%, Q2 19.3-23.3%, Q3 23.3-27.1% and Q4 27.1-37.7% by body fat percentage quartile. Overall, after exercise, brachial-ankle pulse wave velocity decreased significantly (before, 1,375.1 ± 209.1; after, 1,341.5 ± 208.0cm/s; p < 0.01). After adjusting for confounding factors, the generalized linear model showed that the β values and 95% confidence interval (CI) of Q1, Q2 and Q3 groups were -38.1 (95% CI: -57.3, -19.0), -8.5 (95% CI: -25.8, 3.7),-3.7 (95% CI: -20.5, 13.0), respectively, when compared with Q4. For an increase in body fat percentage by one standard deviation (5.8%), β = 14.5 (95% CI: 7.3, 21.6). Similar results were obtained in sensitivity analyses.
UNASSIGNED: Acute aerobic exercise had a positive effect on the arterial stiffness of adults with different body fat percentages. Compared with individuals with high body fat percentages, the arterial stiffness of people with low body fat percentages had significant reduction after exercise.

Evidence is needed to elucidate the association of blood pressure (BP) changes with metal constituents in fine particulate matter (PM2.5). Therefore, we designed a longitudinal panel study enrolling 70 healthy students from Wuhan University in the context of the seventh World Military Games (the 7th WMG) from September 2019 to January 2020. A total of eight visits were conducted before, during, and after the 7th WMG. During every visit, each participant was asked to carry a personal PM2.5 monitor to measure hourly PM2.5 levels for three consecutive days. Questionnaire investigation and physical examination were completed on the fourth day. We analyzed ten metal constituents of ambient PM2.5 collected from the fixed station, and blood pressure was recorded during each visit. The linear mixed-effects models were performed to evaluate associations of metal constituents and blood pressure measurements. We observed a dramatic variation of PM2.5 concentration ranging from 7.38 to 132.04 μg/m3. A 10 μg/m3 increment of PM2.5 was associated with an increase of 0.64 mmHg (95% CI: 0.44, 0.84) in systolic BP (SBP), 0.40 mmHg (0.26, 0.54) in diastolic BP (DBP), 0.31 mmHg (0.15, 0.47) in pulse pressure (PP) and 0.44 mmHg (0.26, 0.62) in mean artery pressure (MAP), respectively. For metal constituents in PM2.5, robust positive associations were observed between BP and selenium, manganese, arsenic, cadmium, and thallium. For example, for an IQR (0.93 ng/m3) increment of selenium, SBP and MAP elevated by 0.98 mmHg (0.09, 1.87) and 0.71 mmHg (0.03, 1.39), respectively. Aluminum was found to be robustly associated with decreased SBP, DBP, and MAP. The study indicated that exposure to PM2.5 total mass and metal constituents including selenium, manganese, arsenic, cadmium, and thallium were associated with the elevated BP.

Evidence of an association between acute air pollution exposure and lung function in the elderly is limited. This study is cross-sectional. We quantified the effects of air pollution exposure on lung function among 256 elderly by using a linear mixed model. The results revealed that air pollutants had lag effects on lung function after adjusting for confounders. PM2.5 (Lag03, Lag 03 was defined three-day moving average, and so forth), PM10, NO2 (Lag04-Lag05) were significantly associated with reduced FEV1. PM2.5 (Lag01-Lag02), PM10 (Lag0-Lag07), NO2 (Lag0, Lag04), and SO2 (Lag0) were significantly associated with reduced Forced vital capacity (FVC). PM2.5 (Lag04-Lag07) and NO2 (Lag01-Lag07) were significantly associated with reduced FEF25%-75%. The results showed the adverse change was stronger after adjusting for other pollutants in the PM models, and women were more susceptible to air pollutants. Therefore, we should pay attention to the problem of air pollution in the elderly, especially in women.

Epidemiological evidence of short-term fine particulate matter (PM2.5) exposure on blood pressure (BP), heart rate (HR) and related inflammation biomarkers has been inconsistent. We aimed to explore the acute effect of PM2.5 on BP, HR and the mediation effect of related inflammation biomarkers. A total of 32 healthy college students were recruited to perform 4 h of exposure at two sites with different PM2.5 concentrations in Wuhan between May 2019 and June 2019. The individual levels of PM2.5 concentration, BP and HR were measured hourly for each participant. Blood was drawn from each participant after each visit and we measured the levels of inflammation markers, including serum high-sensitivity C-reactive protein and plasma fibrinogen. Linear mixed-effect models were to explore the acute effect of PM2.5 exposure on BP, HR, and related inflammation biomarkers. In addition, we evaluated related inflammation biomarkers as the mediator in the association of PM2.5 and cardiovascular health indicators. The results showed that a 10 μg/m3 increment in PM2.5 concentration was associated with an increase of 0.84 (95% CI: 0.54, 1.15) beats/min (bpm) in HR and a 3.52% (95% CI: 1.60%, 5.48%) increase in fibrinogen. The lag effect model showed that the strongest effect on HR was observed at lag 3 h of PM2.5 exposure [1.96 bpm (95% CI: 1.19, 2.75)], but for fibrinogen, delayed exposure attenuated the association. Increased fibrinogen levels may account for 39.07% (P = 0.44) of the elevated HR by PM2.5. Null association was observed when it comes to short-term PM2.5 exposure and BP. Short-term exposure to PM2.5 was associated with elevated HR and increased fibrinogen levels. But our finding was not enough to suggest that exposure to PM2.5 might induce adverse cardiovascular effects by the pathway of inflammation.

Day-to-day change in ambient temperature is associated with acute myocardial infarction (AMI) attacks, but evidence is scarce about the effects of extreme temperatures on the risk of AMI within hours of exposure. This study investigated the hour-level associations between extreme temperatures and AMI occurrence. State-wide data on AMI patients and temperature during winter and summer of 2013-2015 were obtained for Queensland state of Australia. We employed a fixed time-stratified case-crossover analysis to quantify the risk of AMI associated with temperature within 24 h after exposure. Subgroups analyses by age, gender and disease history were also conducted. We observed a very acute effect of cold on men (occurred 9-10 h after exposure), women (19-22 h after exposure), and the elderly (4-20 h after exposure). Cold was associated with elevated AMI risk for men within 9 h (OR = 2.1, 95 % CI: 1.2-3.6), women within 19 h (OR = 2.5, 95 % CI: 1.0-6.0), and the elderly within 4 h (OR: 2.0, 95 % CI: 1.0-4.0). However, elevated risk of AMI associated with heat occurred 15 h later for men (OR: 3.9; 95 % CI: 1.1-13.9) and 23 h later for adults (OR: 4.1, 95 % CI: 1.1-15.4). People never suffered AMI and the elderly with diabetes or hyperlipidaemia were particularly vulnerable to cold. Those that were particularly vulnerable to heat were men never experienced AMI or having hypertension or having hyperlipidaemia as well as women ever suffered AMI. Effects of temperature on AMI risk at sub-daily timescales should be considered to prevent cardiac events.

While the effects of ambient pollutants on adverse perinatal outcomes have been studied, most studies have focused on preterm birth, stillbirth, and low birthweight. Few studies have examined the effects of ambient pollutants on prelabor rupture of membranes (PROM). This study was designed to explore the acute effects of ambient pollutants on both term PROM (TPROM) and preterm PROM (PPROM). We enrolled pregnant women receiving antenatal care between October 2013 and December 2019 at the International Peace Maternity and Child Health Hospital (IPMCHH). The effects of ambient pollutants (including PM2.5, PM10, SO2, CO, NO2, and 8-h O3) on TPROM and PPROM were estimated using generalized additive models (GAMs). Exposure-response relationship curves were also evaluated using GAMs after adjustment for confounding factors. Potential lagged effects were examined using various lag models. The data of 100,200 pregnant women who delivered at IPMCHH were analyzed. The fitted spline curves for PPROM were similar to the temporal trends of PM2.5, PM10, SO2, CO and NO2 but not O3, while those for TPROM were different from the temporal trends of all six air pollutants. An increased risk of PPROM was associated with increased concentrations of PM2.5, PM10, SO2 and CO on lag days 2 and 3, while no association was found between PPROM and daily concentration of O3. After adjustment for confounding factors, there was a shift in the exposure-response curves, indicating associations between PPROM and PM2.5, PM10, SO2, and CO on lag days 2-3. Interaction effects of PM2.5, PM10, SO2, and CO were also found to increase the risk of PPROM. In conclusion, acute exposures to six critical air pollutants were not associated with an increased risk of TPROM; however, PM2.5, PM10, SO2, and CO were found to interact, increasing the risk for PPROM on lag days 2 and 3.

OBJECTIVE: As the largest organ of the human body, the skin is the major exposure route of NO2. However, the evidence for a relationship between NO2 exposure and dermatologic diseases (DMs) is limited. This time-series study was conducted to assess the short-term effect of nitrogen dioxide (NO2) exposure on DMs outpatient visits in Xinxiang, China.
METHODS: Daily recordings of NO2 concentrations, meteorological data, and the outpatient visits data for DMs were collected in Xinxiang from January 1st, 2015, to December 31st, 2018. The analysis method used was based on the generalized additive model (GAM) with quasi-Poisson regression to investigate the relationship between NO2 exposure and DMs outpatient visits. Several covariates, such as long-term trends, seasonality, and weather conditions were controlled.
RESULTS: A total of 164,270 DMs outpatients were recorded. A 10 μg/m3 increase in NO2 concentrations during the period was associated with a 1.86% increase in DMs outpatient visits (95% confidence intervals [Cl]: 1.06-2.66%). The effect was stronger (around 6 times) in the cool seasons than in warmer seasons and younger patients (< 15 years of age) appeared to be more vulnerable.
CONCLUSIONS: The findings of this study indicate that short-term exposure to NO2 increases the risk of DMs in Xinxiang, China, especially in the cool seasons. Policymakers should implement more stringent air quality standards to improve air quality.

Betel quid (BQ) is the fourth most commonly consumed psychoactive substance in the world. However, comprehensive functional magnetic resonance imaging (fMRI) studies exploring the neurophysiological mechanism of BQ addiction are lacking. Betel-quid-dependent (BQD) individuals (n = 24) and age-matched healthy controls (HC) (n = 26) underwent fMRI before and after chewing BQ. Multivariate pattern analysis (MVPA) was used to explore the acute effects of BQ-chewing in both groups. A cross-sectional comparison was conducted to explore the chronic effects of BQ-chewing. Regression analysis was used to investigate the relationship between altered circuits of BQD individuals and the severity of BQ addiction. MVPA achieved classification accuracies of up to 90% in both groups for acute BQ-chewing. Suppression of the default-mode network was the most prominent feature. BQD showed more extensive and intensive within- and between-network dysconnectivity of the default, frontal-parietal, and occipital regions associated with high-order brain functions such as self-awareness, inhibitory control, and decision-making. In contrast, the chronic effects of BQ on the brain function were mild, but impaired circuits were predominately located in the default and frontal-parietal networks which might be associated with compulsive drug use. Simultaneously quantifying the effects of both chronic and acute BQ exposure provides a possible neuroimaging-based BQ addiction foci. Results from this study may help us understand the neural mechanisms involved in BQ-chewing and BQ dependence.

Epidemiologic studies have reported associations between short-term exposure to particulate matter <2.5 μm in aerodynamic diameter (PM2.5) and mortality, but the role of modifiers remains unclear with studies reporting inconsistent results. We evaluated the impact of individual (age, gender and education) and township (geographic area, socioeconomic status, background air pollution and road density) level factors on the relationship between short-term variation in PM2.5 with cause-specific mortality in Beijing (population: 21.7 million in 2016), China.
Daily PM2.5 concentrations in each township (n = 327; township population: 2000-359,400; township area: 1-392 km2) within Beijing were estimated by kriging with external drift using measurements from 35 air quality monitoring stations and geographic variables. Time-stratified case-crossover analysis with township-level mortality data from Oct. 1st, 2012 to Dec. 31st, 2013 was then used to examine associations between PM2.5 exposure estimates and cause-specific mortality, stratified by the potential effect modifiers.
A 10-μg/m3 increase in PM2.5 concentration was associated with a 0.17% [95% confidence interval (CI): 0.05%-0.29%] and 0.27% (95%CI:0.01%-0.52%) increase in non-accidental and stroke mortality with no lag, a 0.81% (95%CI:0.39%-1.23%) and 0.96% (95%CI:0.35%-1.57%) increase in respiratory disease (RD) and chronic obstructive pulmonary disease (COPD) mortality at a lag of two-day moving average. For individual-level effect modifiers, the elderly showed higher effects for all the specific causes of mortality; those with lower education level showed higher effects for non-accidental, cardiovascular disease and stroke mortality; females showed higher effects for non-accidental and cause-specific cardiovascular diseases. For township-level effect modifiers, effect estimates tended to be larger for suburban areas, areas of lower road density, lower PM2.5 and lower socioeconomic status.
Short-term exposure to township-level ambient PM2.5 was associated with increased mortality in Beijing, with indications of effect modification by both individual and township-level factors.