Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

BACKGROUND

Within the normal range, elevated alanine aminotransferase (ALT) levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease (MAFLD).

AIM

To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.

METHODS

A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected. The incidence rate, cumulative times, and equally and unequally weighted cumulative effects of excess high-normal ALT levels (ehALT) were measured. Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.

RESULTS

A total of 83.13% of participants with MAFLD had normal ALT levels. The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group. Compared with those in the low-normal ALT group, the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651 [95% confidence interval (CI): 1.199-2.273] and 1.535 (95%CI: 1.119-2.106) in the third quartile and 1.616 (95%CI: 1.162-2.246) and 1.580 (95%CI: 1.155-2.162) in the fourth quartile, respectively.

CONCLUSION

Most participants with MAFLD had normal ALT levels. Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

Spatial and temporal variations of ecosystem water use efficiency and its response to soil moisture drought in a water-limited watershed of northern China

Drought synchronously affects the water cycle and interferes with the carbon cycle in terrestrial ecosystems. Ecosystem water use efficiency (WUE), serving as a vital metric for assessing the interplay between water and carbon cycles, has found extensively use in exploring how ecosystems responses to drought. However, the effects of soil moisture drought on WUE are still poorly recognized. Taking Ziya River Basin as an example, the spatial-temporal variations of WUE from 2001 to 2020 were estimated by the Penman-Monteith-Leuning Version 2 (PML-V2) data. Based on the Standardized Soil Moisture Index (SSI) calculated from Soil Moisture of China by in situ data, version 1.0 (SMCI1.0) data, the sensitivity and thresholds of different vegetation WUE to drought magnitudes were investigated, and the influences of both lagged and cumulative effects of drought on WUE were further analyzed. Results showed that the annual mean WUE was 2.160 ± 0.975 g C kg-1 H2O-1 in the Ziya River Basin, with a significant increasing trend of 0.037 g C kg-1 H2O-1 yr-1 (p < 0.05). For all the vegetation types, the WUE reached the maximum value at a certain drought threshold (SSI = -1.5 ± 0.1). The dominant factor controlling WUE sensitivity to drought changed from evapotranspiration (ET) to gross primary production (GPP) when severe drought transformed into extreme drought. Significant lagged and cumulative effects were found in the response of WUE to drought in nearly 58.64 % (72.94 %) of the study area, with an average time scale of 6.65 and 2.11 months (p < 0.05) respectively. Drought resistance in descending order was: forest > shrub > grassland > cropland. Our findings enrich the understanding of the coupled carbon and water cycle processes in terrestrial ecosystems and their response to soil moisture drought in the context of global climate change.

"Cumulative effect" of second harmonic Lamb waves in a lossy plate

The second harmonic Lamb waves have high sensitivity to microstructural defects in materials and are therefore promising for incipient damage detection and monitoring of thin-walled structures. Existing studies have shown that the second harmonic Lamb waves can be cumulative with increasing propagation distance under the internal resonance conditions, which is conducive to nonlinear wave measurements in view of structural health monitoring. However, when propagating in a lossy structure with damping, the cumulative properties of the second harmonic Lamb waves are affected by energy dissipation and thus need to be re-examined. In this paper, a method for predicting the cumulative characteristics of second harmonic Lamb waves in damped plates is proposed. Instead of using material damping parameters which are difficult to obtain in practice, the proposed method relies on the attenuation patterns of Lamb waves at fundamental and double frequencies while taking into account the influence of the wave beam divergence. The proposed methodology is validated by finite element simulations and experiments. The results show that the cumulative second harmonic Lamb waves in the damped plate tend to increase and then decrease, and a "sweet" zone of relatively large amplitude can be predicted using the proposed method. The elucidation of the cumulative characteristics of the second harmonic Lamb waves provides guidance for effective system design for structural damage detection and monitoring applications.

Satellite monitoring reveals short-term cumulative and time-lag effect of drought and heat on autumn photosynthetic phenology in subtropical vegetation

Comparing with the effect of the average climate change on vegetation phenology, the impacts of extreme climate events remain unclear, especially considering their characteristic cumulative and time-lag effects. Using solar-induced chlorophyll fluorescence (SIF) satellite records, we investigated the cumulative and time-lag effects of drought and heat events on photosynthesis, particularly for the end date of autumn photosynthesis (EOP), in subtropical vegetation in China. Our results showed a negative effect of drought on the delay of EOP, with the cumulative effect on 30.12% (maximum continuous dry days, CDD), 34.82% (dry days, DRD), and 26.14% (dry period, DSDI) of the study area and the general time-lag effect on 50.73% (maximum continuous dry days), 56.61% (dry days), and 47.55% (dry period) of the study area. The cumulative and lagged time were 1-3 months and 2-3 months, respectively. In contrast, the cumulative effect of heat on EOP was observed in 16.27% (warm nights, TN90P), 23.66% (moderate heat days, TX50P), and 19.19% (heavy heat days, TX90P) of the study area, with cumulative time of 1-3 months. The lagged time was 3-4 months, detected in 31.02% (warm nights), 45.86% (moderate heat days), and 36.52% (heavy heat days) of the study area. At the vegetation community level, drought and heat had relatively rapid impacts on EOP in the deciduous broadleaved forest, whereas evergreen forests and bushes responded to heat slowly and took a longer time. Our results revealed that drought and heat have short-term cumulative and time-lag effects on the EOP of subtropical vegetation in China, with varying effects among different vegetation types. These findings provide new insights into the effect of drought and heat on subtropical vegetation and confirm the need to consider these effects in the development of prediction models of autumn phenology for subtropical vegetation.

Combined effects of high sensitivity C-reactive protein and triglyceride-glucose index on risk of cardiovascular disease among middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND AND AIMS

High sensitivity C-reactive protein (hsCRP) and triglyceride glucose (TyG) index were proved to be independent risk factors of cardiovascular disease (CVD). However, individual hsCRP or TyG index might not provide sufficient predictive value on CVD risk. The current study aimed to evaluate the cumulative effect of hsCRP and TyG index on CVD risk prospectively.

METHODS AND RESULTS

A total of 9626 participants were enrolled in the analysis. The TyG index was calculated as ln(triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The primary outcome was new-onset CVD events (cardiac events or stroke), and the secondary outcomes were new-onset cardiac events and stroke, separately. Participants were divided into 4 groups through the median of hsCRP and TyG index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportion hazard models. From 2013 to 2018, 1730 participants experienced CVD (570 stroke and 1306 cardiac events). Linear associations were found between hsCRP, TyG index, hsCRP/TyG ratio and CVD (all p < 0.05). Compared to participants with low hsCRP/low TyG index, multivariable adjusted HRs (95% CIs) for those with high hsCRP/high TyG index were 1.17 (1.03-1.37) for CVD. No interaction of hsCRP and TyG index was found on CVD (p_-interaction ≥0.05). Furthermore, adding hsCRP and TyG index simultaneously to conventional risk model improved risk reclassification for CVD, stroke and cardiac events (all p < 0.05).

CONCLUSION

The present study suggested combination of hsCRP and TyG index might better improved the ability for risk stratification of CVD among middle-aged and older Chinese.

The effects of long-term cumulative HbA1c exposure on the development and onset time of dementia in the patients with type 2 diabetes mellitus: hospital based retrospective study (2005-2021)

AIMS

We examine cumulative effect of long-term glycemic exposure in patients with type 2 diabetes mellitus (T2DM) on the development of dementia.

METHODS

The study involved 20,487 records of patients with T2DM identified in the electronic medical record at Severance Hospital, Korea. Cumulative HbA1c (AUC_HbA1c) and mean HbA1c over time (HbA1c_avg) as measures of long-term glycemic exposure were compared for the development of dementia and the time to dementia.

RESULTS

AUC_HbA1c and HbA1c_avg were significantly higher in patients who later developed dementia than in those who did not dementia (AUC_HbA1c: 56.2 ± 26.4 vs. 52.1 ± 26.1 %*Year; HbA1c_avg: 7.0 ± 1.0 vs. 7.3 ± 1.0 %). Odds ratio of dementia increased when HbA1c_avg was 7.2% (55 mmol/mol) or above, and when AUC_HbA1c was 42 %*Year (e.g., HbA1c 7.0% maintained for 6 years) or above. Among those who developed dementia, as HbA1c_avg increased, the time to dementia onset decreased (β = -380.6 days, 95% confidence interval [CI]: -416.2 to -345.0).

CONCLUSIONS

Our results indicate poorly controlled T2DM was associated with an increased risk of developing dementia, as measured by AUC_HbA1c and HbA1c_avg. Higher cumulative glycemic exposure may lead to developing dementia in a shorter time.

The more developmental assets, the less internet gaming disorder? Testing the cumulative effect and longitudinal mechanism during the COVID-19 pandemic

The COVID-19 pandemic has triggered the dramatical development and prosperity of online games, while worldwide people are suffering from it. Considering the high prevalence, serious impacts, and huge development potential of internet gaming disorder (IGD), it is extremely necessary to develop a protective model to prevent and intervene with it among young people. Based on the developmental assets theory, the present study adopted a two-wave longitudinal design to evaluate the cumulative effects of developmental assets on IGD, as well as the underlying mechanisms during this specific period. Data were collected from a sample of 1023 adolescents in Hubei province, Central China through self-report questionnaires. The results indicated that (1) developmental assets were negatively associated with adolescents' IGD concurrently and longitudinally; (2) the overall developmental assets had cumulative effects in linear patterns on adolescents' IGD, concurrently and longitudinally; and (3) internal developmental assets mediated the relationship between external developmental assets and adolescents' IGD longitudinally. Theoretically, the present study supports the developmental assets theory and expands the literature about developmental assets and IGD in younger generations. Practically, the present study provides guidance for prevention and intervention of IGD among adolescents during and after the COVID-19 pandemic. Comprehensive measures should be taken to assist in developing positive internal and external resources to promote youth thriving.

Dietary variety relates to gut microbiota diversity and abundance in humans

PURPOSE

We aim to investigate the relationship between gut microbiota and dietary variety in a Chinese population using Dietary Variety Score (DVS), an index of dietary variety, as little has studied the relationship of dietary variety and gut microbiota in a general population.

METHODS

In this cross-sectional study, recruited participants were conducted with face-to-face interview to collect information on 24-h food intake and dietary consumption using a valid food frequency questionnaire. Subjects (n = 128) were divided as high and low DVS groups by the median of DVS after rigorously matching for confounding factors. The gut microbiota was assessed by 16S rRNA sequencing and the correlations between key phylotypes and DVS, Index of Nutritional Quality (INQ) and clinical indices were examined using generalized linear model in negative binomial regression.

RESULTS

Higher score of DVS, INQVB6, INQVE and INQZn exhibited higher α-diversity. DVS was correlated with INQ and six genera. Among the DVS-correlated genera, Turicibacter, Alistipes and Barnesiella were positively correlated with INQVE, INQZn and INQCu, individually or in combination, while Cetobacterium was negatively correlated with INQCu, INQZn and INQVE. The abundance of Coprococcus and Barnesiella increased with the elevated cumulative scores of INQVE, INQVB6 and INQZn. The combination of Alistipes, Roseburia and Barnesiella could moderately predict dietary variety status.

CONCLUSION

Higher DVS was correlated with higher microbial diversity and more abundance of some potentially beneficial bacteria but with less some potentially pathogenic bacteria. A high variety dietary, therefore, should be recommended in our daily life.

Working life job strain status and cognitive aging in Europe: A 12-year follow-up study

BACKGROUND

To examine the association of job strain with cognitive ability and the influence of life-course job strain on later life cognitive decline.

METHODS

Data were derived from six waves of the Survey of Health, Aging, and Retirement in Europe. The study sample consists of 13349 participants aged 50 to 98 years at wave 2 and has been followed up for 12-years. Job strain status across working life was assessed using a short demand-control job strain model containing two core dimensions: job demands and job control collected in wave 3. Cognitive abilities concerning episodic memory was assessed by immediate recall and delayed recall tests, executive function was evaluated by verbal fluency test collected in all waves (waves 2-7) except wave 3. Mixed-effects model was used to estimate working life job strain and its cumulative effect on cognitive decline.

RESULTS

Both passive and high strain jobs were associated with lower levels of cognitive ability (episodic memory and verbal fluency) in comparison with active job. Long exposure to active- or low strain-job was associated with higher cognitive ability whereas long exposure to passive job or moderate duration of high strain job was associated with lower cognitive ability. The rate of memory decline was positively related to moderate duration of passive job and negatively related to long-term exposure to low strain job.

LIMITATIONS

Information on working conditions was based on self-reported recollections.

CONCLUSIONS

Working life variation in job strain status and their duration may explain individual differences in cognitive ability in later life.

Assessment on the cumulative effect of pollutants and the evolution of micro-ecosystems in bioretention systems with different media

Bioretention system is one of the most used green stormwater infrastructures (GSI), and its media is a key factor in reducing runoff water volume and purifying water quality. Many studies have investigated media improvement to enhance the pollutant removal capacity. However, the long-term cumulative effect and microbial effect of pollutants in the modified-media bioretention system is less known. This study investigated the cumulative effect of pollutants and their influence on microbial characteristics in conventional and modified media bioretention system. The addition of modifiers increased the background content of pollutants in the media, and the accumulation of pollutants in planting soil (PS) and bioretention soil mixing + water treatment residuals (BSM+WTR) was relatively higher after the simulated rainfall experiment. The accumulation of pollutants led to a decrease in dehydrogenase activity, and an increase in urease and invertase activities. Ten dominant bacterial species at the phylum level were found in all bioretention systems. The relative abundances of the bacteria with good viability under low nutritional conditions decreased, while the species which could live in the pollutant-rich environment increased. The accumulation of pollutants in the bioretention system led to the extinction of some functional microorganisms. The better the effects of modified media on pollutant removal showed, the more obvious effect on the media micro-ecosystem was. To ensure the long-term efficient and stable operation of the modified-media bioretention system, we recommend balancing the pollutant removal efficiency and cumulative effect in modified-media bioretention systems.

Cumulative effect of risk and protective factors on unintentional injury for Chinese rural children: a nested case-control study

BACKGROUND

Childhood unintentional injuries are the leading cause of death and disability for children. Despite the risk factors that lead to the occurrence of injuries have been identified, the relationship between cumulative effect of risk/protective factors and unintentional injuries is unclear. The aim of this study was to explore the cumulative effect of risk factors as well as protective factors and their interaction on unintentional injury to rural children.

METHODS

We used a nested case-control study design from a cohort database. The study comprised 1696 children aged 6 to 14 years. Among them, 424 were cases with unintentional injury and 1272 were their matched control. After controlling for the significant sociodemographic variables, linear and logistic regression analyses were performed.

RESULTS

The risk of unintentional injury increased with the increasing number of risk factors - RFI from 1 to 3 (ORRFI(1) = 0.978, 95% CI 0.739-1.296), (ORRFI(2) = 1.720, 95% CI 1.233-2.397), (ORRFI(3) = 5.162, 95% CI 3.129-8.517). PFI (1) was associated with lower risk of injury, but this association was at the edge of significance (p = 0.052). The increased risk in those with PFI (2) was not significant (p = 0.254). The severity of the unintentional injury significantly increased with the increasing number of the risk factors (p < 0.01), and significantly decreased with both the increasing number of protective factors (p = 0.001) and interaction of the risk and protective factors (p < 0.01).The interaction of RFI and PFI could explain 32.2% of the unintentional injury severity.

CONCLUSIONS

According to the findings of the present study, cumulative risk factors and protective factors, as well as their interaction were associated with the occurrence and/ or severity of unintentional injury in children.

Why Do Some Adolescents Manage Despite Parental Illness? Identifying Promotive Factors

PURPOSE

This study aimed to examine the association between social support, leisure time, school experience, and well-being among adolescents with an ill parent. Moreover, we explored the cumulative effect of promotive factors in relation to well-being.

METHODS

The population included a subsample of 676 students reporting serious or chronic parental illness, selected from a nationwide Danish survey, the Well-being Despite Study. Well-being was measured by the five-item World Health Organization Well-Being Index. Social support included support from parents, siblings, and friends. A positive school experience encompassed trust in teachers, classroom community, and overall judgment of the school. Leisure time included frequency of activities and having enough time for friends and oneself. We performed multilevel logistic regression analyses using SAS 9.4.

RESULTS

Social support, a positive school experience, and leisure time were positively associated with well-being. For instance, for boys and girls who felt they had enough time to themselves, the odds ratio of moderate to high well-being was 3.7 (95% confidence interval [CI]: 1.8-7.7) and 2.9 (95% CI: 1.9-4.3) respectively, compared with boys and girls who did not. Cumulative analyses showed increasing odds of moderate to high well-being with increasing number of promotive factors, the odds ratio being 39.7 (CI 95%: 11.6-136.2) among adolescents with 10 promotive factors compared with adolescents with 0-5 promotive factors.

CONCLUSIONS

Social support, a positive school experience, and satisfying leisure time may be important promotive factors, and the results point toward a more ecological approach to improve well-being among adolescents with ill parents.

Current site planning of medium to large solar power systems accelerates the loss of the remaining semi-natural and agricultural habitats

The global transition to renewable energy sources has accelerated to mitigate the effects of global climate change. Sudden increases in solar power facilities have caused the physical destruction of wildlife habitats, thereby resulting in the decline of biodiversity and ecosystem functions. However, previous assessments have been based on the environmental impact of large solar photovoltaics (PVs). The impact of medium-sized PV facilities (0.5-10 MW), which can alter small habitat patches through the accumulation of installations has not been assessed. Here, we quantified the amount of habitat loss directly related to the construction of PV facilities with different size classes and estimated their siting attributes using construction patterns in Japan and South Korea. We identified that a comparable amount of natural and semi-natural habitats were lost due to the recent installation of medium solar facilities (approximately 66.36 and 85.73% of the overall loss in Japan and South Korea, respectively). Compared to large solar PVs, medium PV installations resulted in a higher area loss of semi-natural habitats, including secondary/planted forests, secondary/artificial grasslands, and agricultural lands. The siting attributes of medium and large solar PV facilities indicated a preference for cost-based site selection rather than prioritizing habitat protection for biodiversity conservation. Moreover, even conservation areas were developed when economic and topological conditions were suitable for energy production. Our simulations indicate that increasing the construction of PVs in urban areas could help reduce the loss of natural and semi-natural habitats. To improve the renewable energy share while mitigating the impacts on biodiversity, our results stress the need for a proactive assessment to enforce sustainable site-selection criteria for solar PVs in renewable energy initiatives. The revised criteria should consider the cumulative impacts of varied size classes of solar power facilities, including medium PVs, and the diverse aspects of the ecological value of natural habitats.

Distribution, bioaccessibility, and health risk assessment of heavy metals in PM2.5 and PM10 during winter heating periods in five types of cities in Northeast China

PM_2.5 and PM₁₀ samples were collected from the outdoor environment of five types of cities (provincial central cities, regional central cities, resource-based cities, agricultural cities, and forested cities) situated in Northeast China. Based on bioaccessibility and respiratory deposition fluxes, health risks of PM_2.5- and PM₁₀-bound six heavy metals [HM₆: Arsenic (As), Chromium (Cr), Cadmium (Cd), Nickel (Ni), Cobalt (Co), and Lead (Pb)] were studied. Cobalt (Co) and Cr were found to be the most abundantly bioaccessible fraction among HM₆ after extraction of simulated lung fluids. After inhalation exposure, among HM_6, Co mainly contributed 88.39-93.19% to the non-carcinogenic risk, while Cr account for 82.92-93.72% of cancer risk. The estimated daily intake of bioaccessible HM₆ in outdoor environment during the heating period was calculated to be 293.11 ± 121.03, 117.08 ± 32.46, 105.57 ± 32.49, 100.35 ± 25.58 and 83.11 ± 17.64 ng/h for provincial central cities, regional central cities, agricultural city, resource-based cities and forested cities, respectively, for local residents. During the heating period of 180 days, non-carcinogenic risks (As, Cr, Cd, Ni, Co) in outdoor environment of 0.5 residence time were below the safety threshold (HQ < 1). Cancer risks for Cr and Co were above 10^-5 in the five types of cities, but in the assumable range (< 10^-4). Our study highlighted the wide range of measures needed to cut airborne particles pollution to safer levels.

Forest management impacts on stream integrity at varying intensities and spatial scales: Do biological effects accumulate spatially?

The effects of forest harvesting on headwaters are quite well understood, yet our understanding of whether impacts accumulate or dissipate downstream is limited. To address this, we investigated whether several biotic indicators changed from smaller to larger downstream sites (n = 6) within three basins that had intensive, extensive or minimal forest management in New Brunswick (Canada). Biofilm biomass and grazer abundance significantly increased from upstream to downstream, whereas organic matter decomposition and the autotrophic index of biofilms decreased. However, some spatial trends differed among basins and indicated either cumulative (macroinvertebrate abundance, predator density, sculpin GSI) or dissipative (autotrophic index, cotton decomposition) effects downstream, potentially explained by sediment and nutrient dynamics related to harvesting. No such among-basin differences were observed for leaf decomposition, biofilm biomass, macroinvertebrate richness or sculpin condition. Additionally, results suggest that some of the same biological impacts of forestry observed in small headwaters also occurred in larger systems. Although the intensive and extensive basins had lower macroinvertebrate diversity, there were no other signs of biological impairment, suggesting that, overall, current best management practices protect biological integrity downstream despite abiotic effects.

External Validation of the PHASES Score in Patients with Multiple Intracranial Aneurysms

OBJECTIVES

This study sought to assess whether the Population, Hypertension, Age, Size, Earlier Subarachnoid Hemorrhage, Site (PHASES) score can do risk stratification of patients with multiple aneurysms (MIAs).

MATERIAL AND METHODS

Patients between January 1, 2016 and January 1, 2019 were recruited retrospectively. The PHASES score was applied to assess the theoretical risk of IA rupture. For patients-level analyses, four modes of the application of the score were used: largest IA PHASES score, highest PHASES score, sum PHASES score, and mean PHASES score.

RESULTS

A total of 701 patients with 1673 IAs were included in this study. At aneurysm-level analysis, the average PHASES score was 3.0 ± 3.0 points, with 2.8 ± 3.0 points and 4.1 ± 2.9 points in the unruptured and ruptured groups, respectively (p < 0.001). At the patient-level analysis, for the largest IA PHASES score, the areas under the curves (AUC) was 0.572. The discrimination performance of the largest IA PHASES score decreases as IA number increases, with AUCs were 0.597, 0.518, and 0.450 in the 2 IAs, 3 IAs and, 4 or more IAs subgroups, respectively. For highest PHASES score, sum PHASES score, and mean PHASES score, the AUCs were 0.577, 0.599, and 0.619, respectively.

CONCLUSIONS

In this study, PHASES score only serve as a weak tool in decision-making settings for MIAs patients; as such, more accurate models should be developed for MIAs patients and the cumulative effect of MIA may should be considered.

Forest management impacts on stream integrity at varying intensities and spatial scales: Do abiotic effects accumulate spatially?

Though effects of forest harvesting on small streams are well documented, little is known about the cumulative effects in downstream systems. The hierarchical nature and longitudinal connectivity of river networks make them fundamentally cumulative, but lateral and vertical connectivity and instream processes can dissipate the downstream transport of water and materials. To elucidate such effects, we investigated how a suite of abiotic indicators changed from small streams to larger downstream sites (n = 6) within three basins ranging in forest management intensity (intensive, extensive, minimal) in New Brunswick (Canada) in the summer and fall of 2017 and 2018. Inorganic sediments, the inorganic/organic ratios and water temperatures significantly increased longitudinally, whereas nutrients and the fluorescence index of dissolved organic carbon (DOC; indication of terrestrial source) decreased. However, some longitudinal trends differed across basins and indicated downstream cumulative (inorganic sediments, the inorganic/organic ratios and to a lesser extent DOC concentration and humification) as well as dissipative (temperatures, nutrients, organic sediments) effects of forest management. Overall, we found that the effects previously reported for small streams with managed forests also occur at downstream sites and suggest investigating whether different management practices can be used within the extensive basin to reduce these cumulative effects.

Multimorbidity, Function, and Cognition in Aging

Multimorbidity is a global health challenge. Here, we define multimorbidity, describe ways multimorbidity is measured, discuss the prevalence of multimorbidity and how it differs across different populations, examine mechanisms of disease and disability, and discuss the effects of multimorbidity on outcomes such as survival and function.

Dual diagnosis of osteogenesis imperfecta (OI) and short stature and advanced bone age with or without early-onset osteoarthritis and/or osteochondritis dissecans (SSOAOD) reveals a cumulative effect on stature caused by mutations in COL1A1 and ACAN genes

Short stature is a feature when a person's height is more than 2 SDS below the corresponding mean height for a given age, gender and population. It can be influenced by many factors essential to growth plate. Here we report a three-generation family with 13 patients affected by osteogenesis imperfecta (OI) type I, short stature and advanced bone age, with or without early-onset osteoarthritis and/or osteochondritis dissecans (SSOAOD) or both. Panel sequencing of the proband revealed mutations in two extracellular matrix related genes: COL1A1 and ACAN. When comparing the quantitative trait, height within the family of different mutation carrier groups, we found an interesting cumulative effect, the ones with both mutations manifest shortest stature. Dual diagnoses of the family also suggest the necessity of a comprehensive molecular diagnosis method, such as panel/exome sequencing, especially encountering patients with novel phenotype or extreme trait.

Suicide behavior and meteorological characteristics in hot and arid climate

BACKGROUND

Suicidal behavior is determined by the consequence of an interaction between biological, psychological and sociological factors, as well as between individual and environmental effects. Fluctuations in meteorological factors can modify human behavior and affect suicidal rates. We hypothesize that high temperatures can be associated with an increase rate of suicidal attempts.

METHODS

We included all the patients admitted to Soroka University Medical Center (SUMC) due to suicide attempts between the years 2002-2017 and were residents of Southern Israel. We computed two sets of regression models: first, a time stratified case-crossover design to control for seasonality and individual differences. Results are presented as odds ratio (OR) with confidence interval (CI); and then, time-series analyses to calculate the incidence rate ratio (IRR) and the cumulative effect of temperature on the daily incidences of emergency department (ED) admissions after suicide attempts. We stratified the analyses by demographic variables to identify significant individual differences.

RESULTS

We identified 3100 attempts, by 2338 patients who lived in Be'er Sheva between 16 and 90 years of age; 421 patients made 2+ attempts. Suicide attempts were associated with a 5 °C increase during the summer season (OR 1.59, 95% CI 1.22-2.08) and a 5 °C increase in all seasons was associated with those who have made multiple attempts (OR 1.18, 95% CI 1.0005-1.38). The cumulative effect of 5 °C increment is associated with more suicide attempts over 2 days (IRR 1.10, 95% CI 0.98; 1.24) and 5 days (IRR 1.04, 95% CI 1.00; 1.08). The associations were greater for patients with psychiatric diagnosis and patients with multiple attempts. In a stratified analysis by individual characteristics we didn't find significant association.

CONCLUSION

High temperatures and low amount of precipitations are evidently of great impact on people's susceptibility to suicidal behavior, especially for individuals who have had a prior suicide attempt. Our findings indicate the need for public health attention in the summer when temperature increases precipitously over days, especially for those who have made a prior suicide attempt.

Evaluating the cumulative and time-lag effects of drought on grassland vegetation: A case study in the Chinese Loess Plateau

The increased frequency of drought events in recent years is known to be responsible for significantly altering plant biodiversity in many of Earth's ecosystems, though the specifics of vegetation-drought interactions, especially the cumulative and time-lag responses, remains unclear. This study aimed to quantitatively investigate how grassland vegetation over the Chinese Loess Plateau (CLP) reacts to drought, specifically the observed cumulative and time-lag effects which are caused, using a combination of the Normalized Difference Vegetation Index (NDVI) and a multiple time-scale drought index (Standardized Precipitation and Evapotranspiration Index, SPEI). Our results revealed that while drought conditions have widespread cumulative impacts on grass growth in the CLP, the time lag effect of drought covered about half of the total area of the CLP. The cumulative effect of drought on grass was found to take place over various time scales, ranging from 5 to 10 months, while the time lag effect occurred within 2-3 months. The different response time of vegetation growth to the cumulative effect of drought in the CLP was found to be highly related to different water conditions. The accumulated months and mean r_max-cum both had a significant negative correlation with the mean annual SPEI (R² = 0.90, P < 0.001; R² = 0.70, P < 0.001, respectively). The lagged months and mean r_max-lag were also found to be negatively correlated with the mean annual SPEI (R² = 0.547, P < 0.05; R² = 0.785, P < 0.01, respectively).

Effects of benthivorous fish disturbance and snail herbivory on water quality and two submersed macrophytes

Benthivorous fish disturbance and snail herbivory are two important factors that determine the community structure of submersed macrophytes. We conducted an outdoor mesocosm experiment to examine the separate and combined effects of these two factors on water quality and the growth of two mixed-cultivation submersed macrophytes, Vallisneria natans and Hydrilla verticillata, with different growth forms. The experiment involved two levels of fish (Misgurnus anguillicaudatus) disturbance crossed with two levels of snail (Radix swinhoei) intensity. The results revealed that fish activity rather than snail activity significantly increased the overlying water concentrations of total suspended solids (TSS), total nitrogen (TN), ammonia nitrogen (N-NH₄), total phosphorus (TP) and phosphate phosphorus (P-PO₄). However, no differences among treatments were observed for chlorophyll a (chl a) concentrations. Fish disturbance or snail herbivory alone did not affect the relative growth rate (RGR) of H. verticillata, but their combined effects significantly decreased the RGR of H. verticillata. Although snail herbivory alone did not affect the RGR of V. natans, fish disturbance alone and the combined effects of these factors drastically reduced its RGR. Both species exhibited increased free amino acid (FAA) contents and decreased ramet numbers, soluble carbohydrate (SC) contents and starch contents in the presence of the fish. Moreover, compared to H. verticillata, V. natans showed exceedingly low ramet numbers and starch contents in the presence of the fish. H. verticillata had a higher RGR and summed dominance ratio (SDR₂) than V. natans in all treatments; H. verticillata also displayed a larger competitive advantage in the presence of fish disturbance. The present study suggests that (1) fish disturbance rather than snail activity increases water nutrient concentrations, (2) low snail density may be harmful to submersed macrophyte growth when the plants are under other abiotic stress conditions and (3) the competitive advantage of H. verticillata over V. natans is more preponderant in a turbid environment.

The effects of particulate matters on allergic rhinitis in Nanjing, China

Particulate matter pollution is a serious environmental problem. Individuals exposed to particulate matters have an increased prevalence to diseases. In the present study, we performed an epidemiological study to investigate the effects of particulate matter less than 10 μm in aerodynamic diameter (PM₁₀) and particulate matter less than 2.5 μm in aerodynamic diameter (PM_2.5) on allergic rhinitis in Nanjing, China. Daily numbers of allergic rhinitis patients (33,063 patients), PM₁₀, PM_2.5, and weather data were collected from January 2014 to December 2016 in Nanjing, China. Generalized additive models (GAM) were used to evaluate the effects of PM₁₀ and PM_2.5 on allergic rhinitis. We found that the interquartile range (IQR) increases in PM₁₀ (difference of estimates, 5.86%; 95% CI, 3.00-8.81%; P = 4.72 × 10^-5) and PM_2.5 (difference of estimates, 5.39%; 95% CI, 2.73-8.12%; P = 5.67 × 10^-5) concentrations were associated with the higher increased numbers of allergic rhinitis patients with 3-day cumulative effects in single-pollutant model. In addition, we found that the IQR increase in PM₁₀ (age ≥ 18 years: 7.37%, 3.91-10.96%, 2.14 × 10^-5; 0-17 years: 0.83%, - 4.00-5.91%, 0.740) and PM_2.5 (age ≥ 18 years: 7.00%, 3.78-10.32%, 1.40 × 10^-5; 0-17 years: 0.40%, - 4.10-5.10%, 0.866) increased the number of allergic rhinitis patients in adults, but not in children. In summary, our findings suggested that exposure to PM₁₀ and PM_2.5 was associated with the risk of allergic rhinitis.

Adaptation to Occupational Exposure to Moderate Endotoxin Concentrations: A Study in Sewage Treatment Plants in Germany

Acute or chronic inhalation of endotoxin may lead to changes of lung function and inflammatory markers in the airways. Adaptation to workplace exposure may be possible. In this study, we investigated the possible difference in inflammatory markers assessed in nasal lavage fluid (NALF) in chronical exposure compared to voluntary subjects exposed acutely to endotoxin. We sought to define the variability of inflammatory markers in NALF and the dose-related changes after moderate exposure in naïve subjects. Endotoxin exposure (4-1039 EU/m³) resulted from routine work during one shift in sewage treatment plants. Subjects were matched to pairs (8 workers escorted by 10 students). Inflammatory markers were investigated before, directly after, and 16 h after the shift end. Additional NALF samples were collected in students without any specific exposure after 3 days. In NALF, total cell count, and interleukin (IL)-8 and IL-1β concentrations were significantly higher in workers than in students at all times pointing to workplace-related long-lasting exposure resulting in adaptation. However, concentration of inflammatory markers without specific exposure in students showed a great variability, covering the whole range of values recorded in the workers. The findings of this study make us to recommend a repeated assessment of inflammatory markers in healthy volunteers before the investigation of exposure-related changes and a sample size adequate for statistical analysis.

Assessing the cumulative health effect following short term exposure to multiple pollutants: An evaluation of methodological approaches using simulations and real data

BACKGROUND

Assessment of the cumulative effect of correlated exposures is an open methodological issue in environmental epidemiology. Most previous studies have applied regression models with interaction terms or dimension reduction methods. The combined effect of pollutants has been also evaluated through the use of exposure scores that incorporate weights based on the strength of the component-specific associations with health outcomes.

METHODS

We compared three approaches addressing multi-pollutant exposures in epidemiological models: main effects models, the adaptive least absolute shrinkage and selection operator (LASSO) and a weighted exposure score. We assessed the performance of the methods by simulations under various scenarios for the pollutants' correlations. We further applied these methods to time series data from Athens, Greece in 2007-12 to investigate the combined effect of short-term exposure to six regulated pollutants on all-cause and respiratory mortality.

RESULTS

The exposure score provided the least biased estimate under all correlation scenarios for both mortality outcomes. The adaptive LASSO performed well in the case of low and medium correlation between exposures while the main effect model resulted in severe bias. In the real data application, the cumulative effect estimate was similar between approaches for all-cause mortality ranging from 0.7% increase per interquartile range (IQR) (score) to 1.1% (main effects), while for respiratory mortality conclusions were contradictive and ranged from - 0.6% (adaptive LASSO) to 2.8% (score).

CONCLUSIONS

Τhe use of a weighted exposure score to address cumulative effects of correlated metrics may perform well under different exposure correlation and variability in the health outcomes.

The cumulative effect of air pollutants on the acute exacerbation of COPD in Shanghai, China

BACKGROUND

Epidemiologic studies have shown the effect of air pollutants on acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, little is known regarding the dose-response relationship. This study aimed to investigate the cumulative effect of air pollutants on AECOPD.

METHODS

We collected 101 patients with AECOPD from November 2010 through August 2011 in Shanghai. Multiple logistic regression was used to estimate associations between air pollutants and AECOPD. Poisson regression was then applied to determine the cumulative effect of air pollutants including particulate matter 10 (PM10), PM2.5, nitrogen dioxide (NO₂), sulphur dioxide (SO₂) and ozone (O₃) on AECOPD, of which the seasonal variation was further explored.

RESULTS

The monthly episodes of AECOPD were associated with the concentrations of PM2.5 (r=0.884, p<0.05) and NO₂ (r=0.763, p<0.05). The cutoff value of PM2.5 and NO₂ for predicting AECOPD was 83.0μg/m³ and 53.5μg/m³, respectively. It showed that per 10μg/m³ increment in PM2.5 increased the relative risks (RR) for AECOPD was 1.09 with 3days cumulative effect in cold season, whereas 7days in warm season. The RR for AECOPD for per 10μg/m³ increment in NO₂ was 1.07, with a 5-day cumulative effect without seasonal variation.

CONCLUSIONS

High consecutive levels of PM2.5 and NO₂ increase the risk of developing AECOPD. Cumulative effect of PM2.5 and NO₂ appears before the exacerbation onset. These gradations were more evident in the PM2.5 during different seasons.

Cumulative effects of cascade hydropower stations on total dissolved gas supersaturation

Elevated levels of total dissolved gas (TDG) may occur downstream of dams during the spill process. These high levels would increase the incidence of gas bubble disease in fish and cause severe environmental impacts. With increasing numbers of cascade hydropower stations being built or planned, the cumulative effects of TDG supersaturation are becoming increasingly prominent. The TDG saturation distribution in the downstream reaches of the Jinsha River was studied to investigate the cumulative effects of TDG supersaturation resulting from the cascade hydropower stations. A comparison of the effects of the joint operation and the single operation of two hydropower stations (XLD and XJB) was performed to analyze the risk degree to fish posed by TDG supersaturation. The results showed that water with supersaturated TDG generated at the upstream cascade can be transported to the downstream power station, leading to cumulative TDG supersaturation effects. Compared with the single operation of XJB, the joint operation of both stations produced a much higher TDG saturation downstream of XJB, especially during the non-flood discharge period. Moreover, the duration of high TDG saturation and the lengths of the lethal and sub-lethal areas were much higher in the joint operation scenario, posing a greater threat to fish and severely damaging the environment. This work provides a scientific basis for strategies to reduce TDG supersaturation to the permissible level and minimize the potential risk of supersaturated TDG.

The Cumulative Effects of the MYH7-V878A and CACNA1C-A1594V Mutations in a Chinese Family with Hypertrophic Cardiomyopathy

AIMS

We investigated the pathogenesis of MYH7-V878A and CACNA1C-A1594V mutations in a Chinese family with hypertrophic cardiomyopathy.

METHODS

Clinical, electrocardiographic (ECG), echocardiographic, and cardiac magnetic resonance (CMR) examinations of members of a Chinese family were followed by exon and boarding intron analyses of 96 genes in the proband using second-generation sequencing. We confirmed the mutations by bidirectional Sanger sequencing in the members and in 300 healthy controls.

RESULTS

We detected MYH7-V878A and CACNA1C-A1594V mutations in this family. The members with both mutations showed inverted T-waves and ST-segment depression in ECG recordings, severe left ventricular (LV) hypertrophy in echocardiography, and myocardial fibrosis in CMR; subject II-11 did not show late gadolinium enhancement. Among those with only the MYH7-V878A mutation, subject III-7 showed abnormal ECG recordings, asymmetric septal hypertrophy, and myocardial fibrosis, and subjects II-13 and III-15 showed some abnormal repolarization, borderline LV wall thickness, and normal CMR findings. Those with only the CACNA1C-A1594V mutation showed nearly normal readings in all examinations. The members with both mutations displayed more severe LV hypertrophy and elevated LV filling pressure than those with 1 or no mutation (p < 0.05).

CONCLUSION

Our results suggest that the pathogenesis of MYH7-V878A and CACNA1C-A1594V mutations may have a cumulative effect.

The association between human perceived heat and early-stage syphilis and its variance: Results from a case-report system

BACKGROUND

The relationship between temperature and syphilis is poorly understood despite clues and suggestions from previous studies. We examined the association between human perceived temperature (humidex) and the relative risk of early-stage syphilis in the most affected area of China, as well as its variance across social-economic status and age groups.

METHODS

Information regarding early-stage (primary and secondary) syphilis cases reported to the China Case Report System between 2005-2013 from Guangdong province was analyzed in this study. Weather data were obtained from the National Meteorological Information Center. Distributed lag nonlinear models were applied to assess the relationship between humidex and the relative risk of early-stage syphilis. Results were further stratified by social-economic status and age groups.

RESULTS

The relative risks of early-stage syphilis mainly increased with increased humidex, and were elevated when the humidex was around 30 or greater than 38. The humidex-RR association for the 15-40 age group was similar to the scenario pooled across the age groups, particularly in the Pearl-River Delta Region. The relative risk of syphilis in the elderly for the non-Pearl-River Delta Region did not show a clear change with humidex, whereas that in the Pearl-River Delta Region substantially increased, particularly when humidex was above 25.

CONCLUSIONS

Human perceived temperature was positively related to the relative risk of early-stage syphilis. People in the Pearl-River Delta Region tended to be more sensitive, with relative risk elevated at potential comfortable times or under excessively hot conditions. The vulnerability of the elderly in the Pearl-River Delta Region is concerning.

Activation of hippocampal MEK1 contributes to the cumulative antinociceptive effect of electroacupuncture in neuropathic pain rats

Background

Electroacupuncture (EA) intervention can relieve a variety of pain; however, optimal EA protocols have not been clearly determined. In addition, although central mitogen-activated protein kinase kinase (MEK) signaling has been shown to be involved in the antinociceptive effect of acupuncture stimulation, its characteristics at different time-points of EA intervention have not been fully elucidated. Therefore, the present study investigated the relationship between the effects of different numbers of EA intervention sessions and the activation of MEK1 in the hippocampus and hypothalamus in a rat model of neuropathic pain.

Methods

After ligation of the left sciatic nerve, which induces chronic constriction injury (CCI), the acupoints Zusanli (ST36) and Yanglingquan (GB34) were applied. The thermal withdrawal latency of the hind paw was used to evaluate the effect of EA on pain thresholds. Intra-hippocampus microinjection of PD98059, a MEK inhibitor, was performed to validate the involvement of MEK in EA analgesia. The hippocampus and hypothalamus were harvested to examine the phosphorylation levels of MEK (pMEK) by western blotting.

Results

In CCI rats, the thermal pain threshold of the affected hind paw decreased significantly relative to the control. Following subsequent daily EA interventions, CCI-induced ipsilateral hyperalgesia was markedly improved from day 4 and the analgesic effect of EA lasted 3 days after cessation of EA. Four sessions of EA markedly suppressed CCI-induced decrease of hippocampal pMEK1 (normalized to the total MEK level). In contrast, successive sessions of EA intervention gradually down-regulated the CCI-induced up-regulation of hypothalamic pMEK1 along with the increase numbers of EA intervention. However, EA did not exert the same analgesic effect after microinjection of PD98059 into the contralateral hippocampus during the first 3 days of EA intervention.

Conclusions

EA intervention can induce time-dependent cumulative analgesia in neuropathic pain rats after 4 successive sessions of daily EA intervention, which is at least in part related to the activation of hippocampal MEK1.

Has the impact of temperature on mortality really decreased over time?

Many studies have reported that the temperature effect on mortality has decreased over time. However, most of those studies did not consider lag times longer than 10 days, which is frequently used to explore its effect net out compensatory effect (harvesting) and lag effects. We sought to examine the temporal variation of the temperature effect on mortality, considering both a lag effect and mortality displacement. Time-series analysis was conducted with lag of temperature up to 21 days on all-cause, cardiovascular, cerebrovascular, and respiratory deaths. We applied a series of time-windows, 8 years long, with which we compared the oldest to more recent intervals and took consecutive annual variation, excluding an interannual harvesting effect. At the 99th percentile (29°C), relative to the 90th percentile (25°C), we found a decreasing trend of heat effect on concurrent days whereas the risk of cardiovascular deaths increased over time. Cumulative risks of deaths increased recently except for respiratory disease. At the 10th percentile (-1°C) relative to the 25th percentile (4°C), cumulative cold effects on cardiovascular and respiratory mortality have emerged recently. Our study showed differences in the temporal variation in the temperature effect on mortality at concurrent day and in cumulative term. It is suggested that the time-varying nature of the temperature-mortality relationship depends not only on suggested factors, such as improvements in technology and infrastructure, and human physiological acclimatization, but also mortality displacement and lagged effects. Further studies on its complex nature are needed to provide relevant evidence for public health policy making.

Fish community responses to multiple municipal wastewater inputs in a watershed

Municipalities utilize aquatic environments to assimilate their domestic effluent resulting in eutrophication, anoxia, toxicity and endocrine disruption of aquatic biota. The objective of this study was to assess the potential cumulative impacts of municipal wastewater effluent (MWWE) discharges in the Grand River on the health status of a sentinel species and the fish community downstream of 2 MWWE discharges. The fish communities downstream of the MWWE outfalls demonstrated differences in the abundance and diversity, species and family richness, % tolerance and % vulnerability when compared to the fish community upstream or further downstream of these points of effluent discharge. In both years studied, the fish community exposed to MWWE in the riffle-run habitats demonstrated reductions in the proportion of the most prominent fish (Rainbow Darter, Ethoestoma caeruleum) downstream of the outfalls, and a significant increase in the proportion of large mobile, tolerant-omnivorous fish species such as suckers and sunfish. There was less variability in the responses of the fish community to MWWE in the same season between years than between seasons within the same year. An examination of how impaired health of a sentinel species exposed to MWWE discharges parallels changes in the fish community is also conducted. This study successfully demonstrates the cumulative impact of urban development, including multiple outfalls of treated wastewater effluents on fish populations and communities. Municipalities are the major source of nutrients and pharmaceuticals and personal care products to aquatic systems, and they need to consider their impacts carefully with increasing urban population growth and ageing demographics.

Cumulative effects of land use on fish metrics in different types of running waters in Austria

The catchment land-use composition of 249 fish sampling sites in Austrian running waters revealed effects on the biological integrity. Beyond correlative analysis, we investigated (1) which land-use category had the strongest effect on fish, (2) whether metrics of functional fish guilds reacted differently, (3) whether there were cumulative effects of land-use categories, and (4) whether effects varied in strength across river types. We fed 5 land-use categories into regression trees to predict the European Fish Index or fish metric of intolerant species (mainly Salmo trutta fario). Agriculture and urbanisation were the best predictors and indicated significant effects at levels of >23.3 and >2%, respectively. Model performance was R² = 0.15 with the Fish Index and R² = 0.46 with intolerant species. The tree structure showed a cumulative effect from agriculture and urbanisation. For the intolerant species metric, a combination of high percentages for agriculture and urbanisation was related to moderate status, whereas <7.3% agriculture were related to good status, although urbanisation was higher than 1.8%. Headwater river types showed stronger responses to land use than river types of lower gradient and turned out to be more sensitive to urbanisation than agriculture.