Long-term exposure to traffic-related air pollution and stroke: A systematic review and meta-analysis

BACKGROUND

Stroke remains the second cause of death worldwide. The mechanisms underlying the adverse association of exposure to traffic-related air pollution (TRAP) with overall cardiovascular disease may also apply to stroke. Our objective was to systematically evaluate the epidemiological evidence regarding the associations of long-term exposure to TRAP with stroke.

METHODS

PubMed and LUDOK electronic databases were searched systematically for observational epidemiological studies from 1980 through 2019 on long-term exposure to TRAP and stroke with an update in January 2022. TRAP was defined according to a comprehensive protocol based on pollutant and exposure assessment methods or proximity metrics. Study selection, data extraction, risk of bias (RoB) and confidence assessments were conducted according to standardized protocols. We performed meta-analyses using random effects models; sensitivity analyses were assessed by geographic area, RoB, fatality, traffic specificity and new studies.

RESULTS

Nineteen studies were included. The meta-analytic relative risks (and 95% confidence intervals) were: 1.03 (0.98-1.09) per 1 μg/m³ EC, 1.09 (0.96-1.23) per 10 μg/m³ PM₁₀, 1.08 (0.89-1.32) per 5 μg/m³ PM_2.5, 0.98 (0.92; 1.05) per 10 μg/m³ NO₂ and 0.99 (0.94; 1.04) per 20 μg/m³ NO_x with little to moderate heterogeneity based on 6, 5, 4, 7 and 8 studies, respectively. The confidence assessments regarding the quality of the body of evidence and separately regarding the presence of an association of TRAP with stroke considering all available evidence were rated low and moderate, respectively.

CONCLUSION

The available literature provides low to moderate evidence for an association of TRAP with stroke.

Long-term exposure to traffic-related air pollution and selected health outcomes: A systematic review and meta-analysis

The health effects of traffic-related air pollution (TRAP) continue to be of important public health interest. Following its well-cited 2010 critical review, the Health Effects Institute (HEI) appointed a new expert Panel to systematically evaluate the epidemiological evidence regarding the associations between long-term exposure to TRAP and selected adverse health outcomes. Health outcomes were selected based on evidence of causality for general air pollution (broader than TRAP) cited in authoritative reviews, relevance for public health and policy, and resources available. The Panel used a systematic approach to search the literature, select studies for inclusion in the review, assess study quality, summarize results, and reach conclusions about the confidence in the evidence. An extensive search was conducted of literature published between January 1980 and July 2019 on selected health outcomes. A new exposure framework was developed to determine whether a study was sufficiently specific to TRAP. In total, 353 studies were included in the review. Respiratory effects in children (118 studies) and birth outcomes (86 studies) were the most commonly studied outcomes. Fewer studies investigated cardiometabolic effects (57 studies), respiratory effects in adults (50 studies), and mortality (48 studies). The findings from the systematic review, meta-analyses, and evaluation of the quality of the studies and potential biases provided an overall high or moderate-to-high level of confidence in an association between long-term exposure to TRAP and the adverse health outcomes all-cause, circulatory, ischemic heart disease and lung cancer mortality, asthma onsetin chilldren and adults, and acute lower respiratory infections in children. The evidence was considered moderate, low or very low for the other selected outcomes. In light of the large number of people exposed to TRAP - both in and beyond the near-road environment - the Panel concluded that the overall high or moderate-to-high confidence in the evidence for an association between long-term exposure to TRAP and several adverse health outcomes indicates that exposures to TRAP remain an important public health concern and deserve greater attention from the public and from policymakers.

Relevance of the light line in planar photonic crystal waveguides with weak vertical confinement

The concept of the so-called light line is a useful tool to distinguish between guided and non-guided modes in dielectric slab waveguides. Also for more complicated structures with 2D mode confinement, the light lines can often be used to divide a dispersion diagram into a region of a non-guided continuum of modes, a region of discrete guided modes and a forbidden region, where no propagating modes can exist. However, whether or not the light line is a concept of practical relevance depends on the geometry of the structure. This fact is sometimes ignored. For instance, in the literature on photonic crystal waveguides, it is often argued that substrate-type photonic crystal waveguides with a weak vertical confinement are inherently lossy, since the entire bandgap including the line defect modes is typically located above the light line of the substrate. The purpose of this article is to illustrate that this argument is inaccurate and to provide guidelines on how an improved light line concept can be constructed.

[Philadelphia chromosome-positive chronic myeloid leukemia with washing out of Ph'-negative lymphoid blasts and with meningiosis: atypical blast crisis or a 2d leukemia?]

The case of a 53-year-old female with a Philadelphia-chromosome (Ph')-positive chronic myeloid leukemia (CML) is reported. In this patient, a first lymphoid blast crisis developed after a chronic period of 20 months. Treatment with vincristine and prednisone was successful. A few weeks later she presented with meningeal leukemia with lymphoid blastic cells in CSF and a facial nerve palsy, while the peripheral blood showed the typical picture of CML. Meningeal leukemia was successfully treated with cranial irradiation and intrathecal chemotherapy. Later on, a second lymphoid blast crisis (blasts of "common acute leukemia" type) was observed. Again, chemotherapy with vincristine and prednisone was successful. After 2 1/2 weeks, however, a third lymphoid blast crisis developed. At this moment, Ph'-chromosome was undetectable in unstimulated cells of the peripheral blood. The question of an additional leukemia is discussed.

[Megaloblastic vitamin B 12 deficiency anemia with erythroleukemic blood picture]

Report on a case of severe megaloblastic anemia in a vegetarian, associated with marked erythroleukemic blood findings probably caused by infections (bronchopneumonia, asthmatic bronchitis, urinary tract infection) and severe heart failure. Successful treatment of the above mentioned complications resulted in almost complete disappearance of pathologic cells from the blood even before vitamin B12 treatment was started. With this therapy complete recovery was achieved and the signs suspect for erythroleukemia in blood and bone marrow disappeared definitively. The case also fulfilled all the criteria of pernicious anemia (Schilling's test and determination of intrinsic factor were not done).