The Dose-Response Association between Nitrogen Dioxide Exposure and Serum Interleukin-6 Concentrations

Manual therapy and exercise effects on inflammatory cytokines: a narrative overview

Background

Matching disease and treatment mechanisms is a goal of the Precision Medicine Initiative. Pro- and anti-inflammatory cytokines (e.g., Tumor Necrosis Factor-alpha, Transforming Growth Factor-beta, and Interleukin-2, 10, and 12) have gained a significant amount of interest in their potential role in persistent pain for musculoskeletal (MSK) conditions. Manual therapy (MT) and exercise are two guideline-recommended approaches for treating MSK conditions. The objective of this narrative overview was to investigate of the effects of MT and exercise on pro- and anti-inflammatory cytokines and determine the factors that lead to variability in results.

Methods

Two reviewers evaluated the direction and variabilities of MT and exercise literature. A red, yellow, and green light scoring system was used to define consistencies.

Results

Consistencies in responses were seen with acute and chronic exercise and both pro- and anti-inflammatory cytokines. Chronic exercise is associated with a consistent shift towards a more anti-inflammatory cytokine profile (Transforming Growth Factor-beta, and Interleukin-2 and 13, whereas acute bouts of intense exercise can transiently increase pro-inflammatory cytokine levels. The influence of MT on cytokines was less commonly studied and yielded more variable results.

Conclusion

Variability in findings is likely related to the subject and their baseline condition or disease, when measurement occurs, and the exercise intensity, duration, and an individual's overall health and fitness.

Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia

The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM10, PM2.5, O3, NO2, NO and NOX) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO2/FiO2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM10, NO2, NO and NOX, while higher exposure to NO2, NO and NOX was associated with lower SpO2/FiO2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO2/FiO2) in these patients were significantly related to exposure to air pollution.

Biomarkers of asthma relapse and lung function decline in adults with spontaneous asthma remission: A population-based cohort study

BACKGROUND

The extent to which biomarkers of asthma activity persist in spontaneous asthma remission and whether such markers are associated with future respiratory outcomes remained unclear. We investigated the association between sub-clinical inflammation in adults with spontaneous asthma remission and future asthma relapse and lung function decline.

METHODS

The Tasmanian Longitudinal Health Study is a population-based cohort (n = 8583). Biomarkers of systemic inflammation were measured on participants at age 45, and latent profile analysis was used to identify cytokine profiles. Bronchial hyperresponsiveness (BHR) and nitric oxide products in exhaled breath condensate (EBC NOx) were measured at age 50. Participants with spontaneous asthma remission at ages 45 (n = 466) and 50 (n = 318) were re-evaluated at age 53, and associations between baseline inflammatory biomarkers and subsequent asthma relapse and lung function decline were assessed.

RESULTS

We identified three cytokine profiles in adults with spontaneous asthma remission: average (34%), Th2-high (42%) and Th2-low (24%). Compared to the average profile, a Th2-high profile was associated with accelerated decline in post-BD FEV1 /FVC (MD -0.18% predicted per-year; 95% CI -0.33, -0.02), while a Th2-low profile was associated with accelerated decline in both post-BD FEV1 (-0.41%; -0.75, -0.06) and post-BD FVC (-0.31%; -0.62, 0.01). BHR and high TNF-α during spontaneous remission were associated with an increased risk of asthma relapse. In contrast, we found no evidence of association between EBC NOx and either asthma relapse or lung function decline.

CONCLUSION

BHR and serum inflammatory cytokines have prognostic value in adults with spontaneous asthma remission. At-risk individuals with BHR, Th2-high or Th2-low cytokine profiles may benefit from closer monitoring and on-going follow-up.

Changes in the Global Epidemiology of Type 1 Diabetes in an Evolving Landscape of Environmental Factors: Causes, Challenges, and Opportunities

The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and the risk of presentation of T1DM. However, the rapid increase in new cases of the disease raises the hypothesis that lifestyle factors, which have traditionally been associated with type 2 diabetes, such as obesity and unhealthy eating patterns could also play a role in the genesis of autoimmune diabetes. This article aims to highlight the changing epidemiology of T1DM and the importance of properly recognizing the environmental factors behind it, as well as the connections with the pathogenesis of the disorder and the need to prevent or delay T1DM and its long-term complications.

The relationship among air pollution, meteorological factors and COVID-19 in the Brussels Capital Region

In great metropoles, there is a need for a better understanding of the spread of COVID-19 in an outdoor context with environmental parameters. Many studies on this topic have been carried out worldwide. However, there is conflicting evidence regarding the influence of environmental variables on the transmission, hospitalizations and deaths from COVID-19, even though there are plausible scientific explanations that support this, especially air quality and meteorological factors. Different urban contexts, methodological approaches and even the limitations of ecological studies are some possible explanations for this issue. That is why methodological experimentations in different regions of the world are important so that scientific knowledge can advance in this aspect. This research analyses the relationship between air pollution, meteorological factors and COVID-19 in the Brussels Capital Region. We use a data mining approach that is capable of extracting patterns in large databases with diverse taxonomies. Data on air pollution, meteorological, and epidemiological variables were processed in time series for the multivariate analysis and the classification based on association. The environmental variables associated with COVID-19-related deaths, cases and hospitalization were PM_2.5, O₃, NO₂, black carbon, radiation, air pressure, wind speed, dew point, temperature and precipitation. These environmental variables combined with epidemiological factors were able to predict intervals of hospitalization, cases and deaths from COVID-19. These findings confirm the influence of meteorological and air quality variables in the Brussels region on deaths and cases of COVID-19 and can guide public policies and provide useful insights for high-level governmental decision-making concerning COVID-19. However, it is necessary to consider intrinsic elements of this study that may have influenced our results, such as the use of air quality aggregated data, ecological fallacy, focus on acute effects in the time-series study, the underreporting of COVID-19, and the lack of behavioral factors.

Potential Biological Mediators of Myocardial and Vascular Complications of Air Pollution-A State-of-the-Art Review

Ambient air pollution is recognised globally as a significant contributor to the burden of cardiovascular diseases. The evidence from both human and animal studies supporting the cardiovascular impact of exposure to air pollution has grown substantially, implicating numerous pathophysiological pathways and related signalling mediators. In this review, we summarise the list of activated mediators for each pathway that lead to myocardial and vascular injury in response to air pollutants. We performed a systematic search of multiple databases, including articles between 1990 and Jan 2022, summarising the evidence for activated pathways in response to each significant air pollutant. Particulate matter <2.5 μm (PM_2.5) was the most studied pollutant, followed by particulate matter between 2.5 μm-10 μm (PM₁₀), nitrogen dioxide (NO₂) and ozone (O₃). Key pathogenic pathways that emerged included activation of systemic and local inflammation, oxidative stress, endothelial dysfunction, and autonomic dysfunction. We looked at how potential mediators of each of these pathways were linked to both cardiovascular disease and air pollution and included the overlapping mediators. This review illustrates the complex relationship between air pollution and cardiovascular diseases, and discusses challenges in moving beyond associations, towards understanding causal contributions of specific pathways and markers that may inform us regarding an individual's exposure, response, and likely risk.

NO2 exposure contributes to cardiac hypertrophy in male mice through apoptosis signaling pathways

Nitrogen dioxide (NO₂) is one of the most common indoor and outdoor air pollutants. Inhalation of NO₂ is associated with an increased risk of health problems, especially cardiovascular diseases. However, the underlying pathogenic mechanisms still remain unclear. In this study, we exposed C57BL/6J mice to NO₂ (2.5 ppm, 5 h/d) for 28 days and found that NO₂ inhalation induced cardiac dysfunction in male mice, but not in female mice, including left ventricular dilation and cardiac systolic dysfunction. Pathological staining showed that NO₂ inhalation induced eccentric hypertrophy with enlarged individual cardiomyocytes, dilated left ventricle, and thinning of the left ventricular wall in male mice. The transcriptional analysis suggested that NO₂ exposure could disrupt Ca²⁺ homeostasis, actin cytoskeletal reorganization, myocardial contractility, and vascular dilation in male mice. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis indicated that differentially expressed genes (DEGs) were closely associated with the apoptotic signaling pathways. These findings suggested that NO₂ exposure caused cardiac eccentric hypertrophy and cardiac dysfunction through apoptotic signaling pathways, and contributed to cardiotoxicity.

Short-term ambient air pollution exposure and adult primary insomnia outpatient visits in Chongqing, China: A time-series analysis

Growing evidence suggest that air pollutants can be associated with sleep disorders. However, no study has explored the association of short-term air pollution exposure with primary insomnia, a specific type of sleep disorders. To evaluate the correlation of short-term air pollution exposure with adult primary insomnia outpatient visits in Chongqing, China, we collected data of adult primary insomnia outpatient visits and air pollutants' concentrations between 2013 and 2019 and the associations were estimated with single-day lags as well as moving average lags using a generalized additive model. Totally, 23,919 outpatient visits for adult primary insomnia were identified. The daily data of adult insomnia outpatient visits, air pollutants (NO₂, CO, SO₂, O₃, PM₁₀ and PM_2.5) and meteorological conditions (daily mean temperature and relative humidity) were gathered. Short-term exposure to multiple air pollutants, especially NO₂ and SO₂, was associated with adult primary insomnia visits. A 10 μg/m³ increase in NO₂ and SO₂ at lag 05 corresponded to increased primary insomnia outpatient visits 3.87% (95% CI: 1.50%-6.24%) and 7.22% (95% CI: 2.10%-12.35%), respectively. Moreover, stronger links were presented in females and cool seasons for NO₂ while in the elderly for SO₂. Collectively, this time-series study suggested that short-term exposure to air pollutants, especially to NO₂ and SO₂, was associated with higher risk of adult primary insomnia outpatient visits, and such association could to be sex-, age-, and season-modified.

Correlation between lung cancer markers and air pollutants in western China population

The relationship between serum lung cancer markers and the air pollution remains unclear. To further reveal the correlation between air pollutants and lung cancer, a retrospective analysis of 446,032 asymptomatic healthy people and symptomatic healthy people from the Health Management Center of the First Affiliated Hospital of Chongqing Medical University from 2014 to 2019 was performed. The distribution characteristics of serum lung cancer markers, cancer embryo antigens (CEA), cytokeratin 19 fragment (CYFRA211), squamous cell carcinoma antigen (SCC), and nerve-specific enolase (NSE) was analyzed in these population. Two independent sample man-Whitney U test was used to analyze the correlation of lung cancer markers and age, and a Chi-square test was used to analyze the relationship between lung cancer markers and gender. The daily change trend was profiled for six main air quality indicators PM₁₀, PM_2.5, SO₂, NO₂, CO, O₃ during the same period. The correlation between lung markers and air pollutants was investigated by Spearman and multiple linear regression. The results showed that CYFRA211 had the highest excess rate in the screening population. There were differences in the number of cases with concentrated expression of lung cancer markers in the different age groups. Among them, the people with NSE exceeding the standard were the youngest, and most of them were 40-55 years old. Besides SCC, the expression levels of other markers increased with age, and the expression levels of the four markers in males were significantly higher than those in females. Although the levels of PM₁₀ and PM_2.5 exceeded the WHO standard (World Health Organization. 2011), they were not correlated with lung cancer markers. Multiple comparisons showed that the air pollutants SO₂ and CYFRA211, as well as NO₂ and NSE were closely related, but there was no significant linear relationship between CEA, SCC, and air pollutants. In conclusion, among the four lung cancer markers, CYFRA211 had the highest abnormal excess rate in total screening population, and the expression levels of these markers varied by gender and age, with males showing significantly higher expression levels than females, and they increased significantly with age except for SCC. The differential expression of these lung cancer markers may provide more strategies for lung cancer screening in the corresponding population. Lung cancer markers, CYFRA211 and NSE, can be used as sensitive biomarkers for exposure to certain air pollutants and provide references for the prevention and management of air pollution.

Associations Between Symptoms of Depression and Air Pollutant Exposure Among Older Adults: Results From the Taiwan Longitudinal Study on Aging (TLSA)

Background: Little epidemiological research has investigated the associations of air pollutant exposure over various time windows with older adults' symptoms of depression. This study aimed to analyze the relationships of long- and short-term ambient air pollution exposure (to coarse particulate matter, O₃, SO₂, CO, and NO_x) with depressive symptoms in a sample of community-dwelling older adults.

Methods: A sample of older adults (n = 1,956) was recruited from a nationally representative multiple-wave study (Taiwan Longitudinal Study on Aging). Between 1996 and 2007, four waves of surveys investigated depressive symptoms by using the 10-item Center for Epidemiologic Studies Depression questionnaire. We approximated air pollutant concentrations from 1995 to 2007 by using daily concentration data for five air pollutants at air quality monitoring stations in the administrative zone of participants' residences. after adjusting for covariates, we applied generalized linear mixed models to analyze associations for different exposure windows (7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages).

Results: In a one-pollutant model, long- and short-term exposure to CO and NO_x was associated with heightened risks of depressive symptoms; the odds ratio and corresponding 95% confidence interval for each interquartile range (IQR) increment in CO at 7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages were 1.232 (1.116, 1.361), 1.237 (1.136, 1.348), 1.216 (1.128, 1.311), 1.231 (1.133, 1.338), 1.224 (1.124, 1.332), 1.192 (1.106, 1.285), 1.228 (1.122, 1.344), and 1.180 (1.102, 1.265), respectively. Those for each IQR increment in NO_x were 1.312 (1.158, 1.488), 1.274 (1.162, 1.398), 1.295 (1.178, 1.432), 1.310 (1.186, 1.447), 1.345 (1.209, 1.496), 1.348 (1.210, 1.501), 1.324 (1.192, 1.471), and 1.219 (1.130, 1.314), respectively. The exposure to PM₁₀, O₃, and SO₂ over various windows were not significant. In the two-pollutant model, only the associations of NO_x exposure with depressive symptoms remained robust after adjustment for any other pollutant.

Conclusions: Exposure to traffic-associated air pollutants could increase depression risks among older adults.

Temperature, humidity and outdoor air quality indicators influence COVID-19 spread rate and mortality in major cities of Saudi Arabia

There is an increasing evidence that meteorological (temperature, relative humidity, dew) and air quality indicators (PM_2.5, PM₁₀, NO₂, SO₂, CO) are affecting the COVID-19 transmission rate and the number of deaths in many countries around the globe. However, there are contradictory results due to limited observations of these parameters and absence of conclusive evidence on such relationships in cold or hot arid tropical and subtropical desert climate of Gulf region. This is the first study exploring the relationships of the meteorological (temperature, relative humidity, and dew) and air quality indicators (PM_10,CO, and SO₂) with daily COVID-19 infections and death cases for a period of six months (1st March to August 31, 2020) in six selected cities of the Kingdom of Saudi Arabia by using generalized additive model. The Akaike information criterion (AIC) was used to assess factors affecting the infections rate and deaths through the selection of best model whereas overfitting of multivariate model was avoided by using cross-validation. Spearman correlation indicated that exponentially weighted moving average (EWMA) temperature and relative humidity (R > 0.5, P < 0.0001) are the main variables affecting the daily COVID-19 infections and deaths. EWMA temperature and relative humidity showed non linear relationships with the number of COVID-19 infections and deaths (DF > 1, P < 0.0001). Daily COVID-19 infections showed a positive relationship at temperature between 23 and 34.5 °C and relative humidity ranging from 30 to 60%; a negative relationship was found below and/or above these ranges. Similarly, the number of deaths had a positive relationship at temperature ˃28.7 °C and with relative humidity ˂40%, showing higher number of deaths above this temperature and below this relative humidity rate. All air quality indicators had linear relationships with the number of COVID-19 infections and deaths (P < 0.0001). Hence, variation in temperature, relative humidity and air pollution indicators could be important factors influencing the COVID-19 spread and mortality. Under the current scenario with rising temperature and relative humidity, the number of cases is increasing, hence it justifies an active government policy to lessen COVID-19 infection rate.

Association between air pollution and chronic rhinosinusitis: a nested case-control study using meteorological data and national health screening cohort data

BACKGROUND

Inconsistent results about the effect of air pollution on chronic rhinosinusitis (CRS) have been reported. This study aimed to evaluate the impact of meteorological conditions/air pollution on the prevalence of CRS in adult Koreans.

METHODOLOGY

The data from the Korean National Health Insurance Service-Health Screening Cohort from 2002 through 2015 were used. A CRS group (defined as ICD-10 codes J32, n=6159) was matched with a control group (n=24,636) in 1:4 ratios by age, sex, income, and region of residence. The meteorological conditions and air pollution data included the daily mean, highest, and lowest temperature (°C), daily temperature range (°C), relative humidity (%), ambient atmospheric pressure (hPa), sunshine duration (hr), and the rainfall (mm), SO2 (ppm), NO2 (ppm), O3 (ppm), CO (ppm), and PM10 (μg/m3) levels before the CRS diagnosis. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for CRS were analyzed using logistic regression analyses.

RESULTS

When the NO2 level increased by 0.1 ppm, the odds for CRS increased 5.40 times, and when the CO level increased by 1 ppm and PM10 increased by 10 μg/m3, the odds for CRS decreased 0.75 times and 0.93 times, respectively. Other meteorological conditions, such as the mean/highest/lowest temperature, temperature range, rainfall and other air pollution, such as SO2 and O3, were not statistically significant. NO2 for 90 days before the index date increased the risk of CRS in all subgroups, except for the nasal polyp and older age subgroups.

CONCLUSION

CRS is related to high concentrations of NO2.

Ambient NO2 exposure sex-specifically impairs myelin and contributes to anxiety and depression-like behaviors of C57BL/6J mice

NO₂ is a common indoor and outdoor air pollutant, but its health effects are still controversial. Beside respiratory injury, more epidemiological studies show that inhalation of NO₂ is associated with an increased risk of anxiety and depression. However, the causal relationship at the molecular level remains unclear. In the present study, we exposed adult C57BL/6J mice to NO₂ (2.5 ppm, 5 h/day) for four weeks, and found anxiety and depression-like behaviors in male mice, but not female mice. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment indicated that differentially expressed genes (DEGs) in the prefrontal cortex and cerebellum were closely associated with signal transduction pathways, such as axon guidance. Importantly, NO₂ inhalation damaged the ultrastructure of myelin sheath and caused the abnormal expression of related genes in males, which partially contributed to mental disorders. We also found that prolactin (Prl), through its anti-inflammatory activity and remyelination, might play a major role in the sex-specific neurobehavioral disorder in male mice caused by NO₂ exposure.

Quantitative analysis of air pollution and mortality in Portugal: Current trends and links following proposed biological pathways

A wealth of studies focusing on the relationships between negative health outcomes and short-term and long-term exposures to environmental risk factors have produced estimates of the burden of disease attributable to air pollution, which have led to the implementation of air pollution control strategies. However, the call to expand those studies, in terms of geographical units of analysis to produce more accurate estimates of the burden of disease in the different countries has been made. Studies of the specific environment-health relationship concerning air pollution in Portugal are scarce and rather descriptive. Therefore, this work assesses the trends both in atmospheric levels of pollutants including particulate matter (PM₁₀), ozone (O₃), nitrogen dioxide (NO₂) and sulphur dioxide (SO₂), and in mortality rates for diabetes, malignant neoplasms and diseases of the respiratory, digestive and circulatory systems, and explores the links between exposure to air pollutants and mortality, following proposed biological pathways and using inferential statistics methods, for the period 2010 to 2017 in Portugal. The following major conclusions were drawn: (i) despite a somewhat initial downward trend in PM₁₀ and a peak in O₃ levels, fairly constant air pollution levels were mostly observed; (ii) concomitantly, increases in age-adjusted mortality rates were significant for all diseases except diabetes; (iii) lower atmospheric levels of pollutants were observed in rural areas, when compared to urban areas, except for ozone; (iv) age-adjusted mortality rates were higher in rural regions, for diabetes, and in urban regions, for malignant neoplasms; (v) for a 10 μg/m³ increase in atmospheric levels of PM₁₀, regression analysis estimated an increase of 0.30% in the mortality rate for diseases of the respiratory, digestive and circulatory systems, and malignant neoplasms combined.

COVID-19 in the environment

In recent months, the presence of an emerging disease of infectious etiology has paralyzed everyone, already being a public health problem due to its high rate of infection, a life-threatening disease. The WHO has named it COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2). New studies provide information of the role of the environment in COVID-19 transmission process, mortality related to this infectious disease and the impact on human health. The following review aims to analyze information on the implications of COVID-19 infection on human health and the impact of its presence on the environment, from its transmission capacity and the role of air pollutants and climatological factors to reducing the air pollution during confinement. Likewise, it provides a vision of the impact on the environment and human health of exposure to disinfectants and the presence of COVID-19 in wastewater, among other actions.

Why is the Incidence of Type 1 Diabetes Increasing?

Type 1 diabetes is a condition that can lead to serious long-term complications and can have significant psychological and quality of life implications. Its incidence is increasing in all parts of the world, but the reasons for this are incompletely understood. Genetic factors alone cannot explain such a rapid increase in incidence; therefore, environmental factors must be implicated. Lifestyle factors have been classically associated with type 2 diabetes. However, there are data implicating obesity and insulin resistance to type 1 diabetes as well (accelerator hypothesis). Cholesterol has also been shown to be correlated with the incidence of type 1 diabetes; this may be mediated by immunomodulatory effects of cholesterol. There is considerable interest in early life factors, including maternal diet, mode of delivery, infant feeding, childhood diet, microbial exposure (hygiene hypothesis), and use of anti-microbials in early childhood. Distance from the sea has recently been shown to be negatively correlated with the incidence of type 1 diabetes. This may contribute to the increasing incidence of type 1 diabetes since people are increasingly living closer to the sea. Postulated mediating mechanisms include hours of sunshine (and possibly vitamin D levels), mean temperature, dietary habits, and pollution. Ozone, polychlorinated biphenyls, phthalates, trichloroethylene, dioxin, heavy metals, bisphenol, nitrates/nitrites, and mercury are amongst the chemicals which may increase the risk of type 1 diabetes. Another area of research concerns the role of the skin and gut microbiome. The microbiome is affected by many of the factors mentioned above, including the mode of delivery, infant feeding, exposure to microbes, antibiotic use, and dietary habits. Research on the reasons why the incidence of type 1 diabetes is increasing not only sheds light on its pathogenesis but also offers insights into ways we can prevent type 1 diabetes.

Air Pollutants Interaction and Gender Difference on Bone Mineral Density T-Score in Taiwanese Adults

Osteoporosis is defined as a systemic skeletal disease characterized by a reduction in bone mass and microarchitectural deterioration of bone tissue. Previous studies have reported associations between air pollution and lower bone mineral density; however, few studies have investigated the association between air pollution and osteoporosis. In this study, we combined two databases, the first including 5000 individuals registered in the Taiwan Biobank, and the second containing detailed daily data on air pollution. After multivariable adjustments, ozone (O3) (unstandardized coefficient β, 0.015; p = 0.008) was significantly positively associated with T-score, whereas carbon monoxide (CO) (unstandardized coefficient β, -0.809; p < 0.001), sulfur dioxide (SO2) (unstandardized coefficient β, -0.050; p = 0.005), nitric oxide (NO) (unstandardized coefficient β, -0.040; p < 0.001), nitrogen dioxide (NO2) (unstandardized coefficient β, -0.023; p < 0.001), and nitrogen oxide (NOx) (unstandardized coefficient β, -0.017; p < 0.001) were significantly negatively associated with T-score. The interactions between CO and NOx (p = 0.001) and SO2 and NO2 (p = 0.004) on T-score were statistically significant. An increase in exposure to CO, NO and NOx was associated with a faster decline in T-score in the female participants compared to the male participants. In addition, an increase in O3 was associated with a faster increase in T-score in the female participants compared to the male participants. In conclusion, the air pollutants CO, SO2, NO, NO2, and NOx were associated with osteoporosis. In addition, there were interaction and synergetic effects between CO and NOx and SO2 and NO2 on T-score. We also observed differences in the associations between air pollutants and T-score between the female and male participants.

Role of the chronic air pollution levels in the Covid-19 outbreak risk in Italy

After the initial outbreak in China, the diffusion in Italy of SARS-CoV-2 is exhibiting a clear regional trend with more elevated frequency and severity of cases in Northern areas. Among multiple factors possibly involved in such geographical differences, a role has been hypothesized for atmospheric pollution. We provide additional evidence on the possible influence of air quality, particularly in terms of chronicity of exposure on the spread viral infection in Italian regions. Actual data on Covid-19 outbreak in Italian provinces and corresponding long-term air quality evaluations, were obtained from Italian and European agencies, elaborated and tested for possible interactions. Our elaborations reveal that, beside concentrations, the chronicity of exposure may influence the anomalous variability of SARS-CoV-2 in Italy. Data on distribution of atmospheric pollutants (NO2, O3, PM2.5 and PM10) in Italian regions during the last 4 years, days exceeding regulatory limits, and years of the last decade (2010-2019) in which the limits have been exceeded for at least 35 days, highlight that Northern Italy has been constantly exposed to chronic air pollution. Long-term air-quality data significantly correlated with cases of Covid-19 in up to 71 Italian provinces (updated April 27, 2020) providing further evidence that chronic exposure to atmospheric contamination may represent a favourable context for the spread of the virus. Pro-inflammatory responses and high incidence of respiratory and cardiac affections are well known, while the capability of this coronavirus to bind particulate matters remains to be established. Atmospheric and environmental pollution should be considered as part of an integrated approach for sustainable development, human health protection and prevention of epidemic spreads but in a long-term and chronic perspective, since adoption of mitigation actions during a viral outbreak could be of limited utility.

Can atmospheric pollution be considered a co-factor in extremely high level of SARS-CoV-2 lethality in Northern Italy?

This paper investigates the correlation between the high level of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) lethality and the atmospheric pollution in Northern Italy. Indeed, Lombardy and Emilia Romagna are Italian regions with both the highest level of virus lethality in the world and one of Europe's most polluted area. Based on this correlation, this paper analyzes the possible link between pollution and the development of acute respiratory distress syndrome and eventually death. We provide evidence that people living in an area with high levels of pollutant are more prone to develop chronic respiratory conditions and suitable to any infective agent. Moreover, a prolonged exposure to air pollution leads to a chronic inflammatory stimulus, even in young and healthy subjects. We conclude that the high level of pollution in Northern Italy should be considered an additional co-factor of the high level of lethality recorded in that area.

Air pollution by NO2 is associated with the risk of Bell's palsy: A nested case-controlled study

This study investigated the relationship of weather and air pollution with the onset of Bell’s palsy. The Korean Health Insurance Review and Assessment Service-National Sample Cohort (HIRA-NSC) data from 2002 through 2013 were used. The 3,935 Bell’s palsy patients were matched with 15,740 control participants. The meteorological data, including daily mean temperature (°C), daily mean highest temperature (°C), daily mean lowest temperature (°C), daily mean temperature difference (°C), relative humidity (%), spot atmospheric pressure (hPa), sulfur dioxide (SO₂) (ppm), nitrogen dioxide (NO₂) (ppm), ozone (O₃) (ppm), carbon monoxide (CO) (ppm), and PM₁₀ (particulate matter ≤ 10 μg/m³) for 60 days, 30 days, 14 days, 7 days, and 3 days prior to the index date were analyzed for Bell’s palsy cases and controls. Conditional logistic regression analysis was used to estimate the odds ratios (ORs) of the association between the meteorological data and Bell’s palsy. The mean NO₂ and PM₁₀ concentrations for 60 days were higher, while that of O₃ was lower in the Bell’s palsy group than in the control group (both P < 0.001). The Bell’s palsy group showed 16.63-fold higher odds of NO₂ for 60 days (0.1 ppm) than the control group (95% CI = 10.18–27.16, P < 0.001). The ORs of PM₁₀, and O₃ for 60 days showed inconsistent results according to the included variables. Bell’s palsy was related to high concentrations of NO₂.

Short-term exposure to ambient ozone and inflammatory biomarkers in cross-sectional studies of children and adolescents: Results of the GINIplus and LISA birth cohorts

BACKGROUND

While exposure to ambient particulate matter (PM) and nitrogen dioxide (NO₂) is thought to be associated with diseases via inflammatory response, the association between exposure to ozone, an oxidative pollutant, and inflammation has been less investigated.

AIM

We analyzed associations between short-term exposure to ozone and three inflammatory biomarkers among children and adolescents.

METHODS

These cross-sectional analyses were based on two follow-ups of the GINIplus and LISA German birth cohorts. We included 1330 10-year-old and 1591 15-year-old participants. Fractional exhaled nitric oxide (FeNO) and high-sensitivity C-reactive protein (hs-CRP) were available for both age groups while interleukin (IL)-6 was measured at 10 years only. Maximum 8-h averages of ozone and daily average concentrations of NO₂ and PM with an aerodynamic diameter <10 μm (PM₁₀) were adopted from two background monitoring stations 0 (same day), 1, 2, 3, 5, 7, 10 and 14 days prior to the FeNO measurement or blood sampling. To assess associations, we utilized linear regression models for FeNO, and logistic regressions for IL-6 and hs-CRP, adjusting for potential covariates and co-pollutants NO₂ and PM₁₀.

RESULTS

We found that short-term ozone exposure was robustly associated with higher FeNO in adolescents at age 15, but not at age 10. No consistent associations were observed between ozone and IL-6 in children aged 10 years. The relationship between hs-CRP levels and ozone was J-shaped. Relatively low ozone concentrations (e.g., <120 μg/m³) were associated with reduced hs-CRP levels, while high concentrations (e.g., ≥120 μg/m³) tended to be associated with elevated levels for both 10- and 15-year-old participants.

CONCLUSIONS

Our study demonstrates significant associations between short-term ozone exposure and FeNO at 15 years of age and a J-shaped relationship between ozone and hs-CRP. The finding indicates that high ozone exposure may favor inflammatory responses in adolescents, especially regarding airway inflammation.

Ambient air pollution exposure and risk of depression: A systematic review and meta-analysis of observational studies

Recent studies have reported an association between air pollution exposure and depression, with inconsistent results. To address this controversy, we conducted a systematic review and meta-analysis of published observational studies that investigated outdoor air pollution and depression. Five electronic databases were searched, and fifteen articles were finally identified. Pooled odds risks were calculated separately based on pollutant type, exposure duration and outcome. Subgroup analyses were conducted based on design, population, important potential confounders, and pollutants levels. We found a significantly increased risk of depression with long-term exposure to PM_2.5 and short-term exposure to PM₁₀, NO₂, SO₂, CO. No evidence was found in the association between exposure to O₃ and depression. Besides, exposure to high levels of pollutants indicates a higher risk of depression. Our results highlight the necessity of air pollution control for depression. However, further studies with standardized methods are still required to support the results due to the inconsistent results in stratified analyses and methodological limitations of the included studies.

Causal Modeling in Environmental Health

The field of environmental health has been dominated by modeling associations, especially by regressing an observed outcome on a linear or nonlinear function of observed covariates. Readers interested in advances in policies for improving environmental health are, however, expecting to be informed about health effects resulting from, or more explicitly caused by, environmental exposures. The quantification of health impacts resulting from the removal of environmental exposures involves causal statements. Therefore, when possible, causal inference frameworks should be considered for analyzing the effects of environmental exposures on health outcomes.

Diesel exhaust inhalation exposure induces pulmonary arterial hypertension in mice

Diesel exhaust (DE) is one of the main sources of urban air pollution. An increasing number of evidence showed the association of air pollution with cardiovascular diseases. Pulmonary arterial hypertension (PAH) is one of the most disastrous vascular diseases, which results in right ventricular failure and death. However, the relationship of DE inhalation exposure with PAH is still unknown. In this study, male adult mice were exposed by inhalation to filtered ambient air (negative control), 10% O₂ hypoxia (PAH-phenotype positive control), 350 μg/m³ particulate matter whole DE, or the combination of DE and hypoxic condition. DE inhalation induced PAH-phenotype accompanied with increased right ventricular systolic pressure (RVSP), right ventricle hypertrophy and pulmonary arterial thickening in a mouse model. DE exposure induced the proliferation of vascular smooth muscle cells (VSMCs) and apoptosis of endothelial cells in pulmonary artery. DE inhalation exposure induced an accumulation of CD45⁺ lymphocytes and CD68⁺ macrophages surrounding and infiltrating pulmonary arteriole. The levels of pro-inflammatory cytokines tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and IL-13 produced by T helper 17 (Th17) and Th2 cells were markedly elevated in lung tissues of mice after DE inhalation exposure. Our findings suggest DE exposure induces PAH by activating Th17-skewed and Th2-droved responses, stimulating VSMCs proliferation and inducing endothelial cell apoptosis by the production of multifunctional pro-inflammatory cytokines, especially IL-6 and TNF-α. Considering the adverse impact of air pollution on health care, it is imperative to understand air pollution-induced susceptibility of progressive cardiopulmonary disease, such as PAH, and also elucidate critical mechanistic pathways which mediate pulmonary artery vascular remodeling and may serve as targets for preventive measures.