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Wen Y, Wang Y, Chen R, Guo Y, Pu J, Li J, Jia H, Wu Z. Association between exposure to a mixture of organochlorine pesticides and hyperuricemia in U.S. adults: A comparison of four statistical models. ECO-ENVIRONMENT & HEALTH 2024; 3:192-201. [PMID: 38646098 PMCID: PMC11031731 DOI: 10.1016/j.eehl.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/21/2024] [Accepted: 02/03/2024] [Indexed: 04/23/2024]
Abstract
The association between the exposure of organochlorine pesticides (OCPs) and serum uric acid (UA) levels remained uncertain. In this study, to investigate the combined effects of OCP mixtures on hyperuricemia, we analyzed serum OCPs and UA levels in adults from the National Health and Nutrition Examination Survey (2005-2016). Four statistical models including weighted logistic regression, weighted quantile sum (WQS), quantile g-computation (QGC), and bayesian kernel machine regression (BKMR) were used to assess the relationship between mixed chemical exposures and hyperuricemia. Subgroup analyses were conducted to explore potential modifiers. Among 6,529 participants, the prevalence of hyperuricemia was 21.15%. Logistic regression revealed a significant association between both hexachlorobenzene (HCB) and trans-nonachlor and hyperuricemia in the fifth quintile (OR: 1.54, 95% CI: 1.08-2.19; OR: 1.58, 95% CI: 1.05-2.39, respectively), utilizing the first quintile as a reference. WQS and QGC analyses showed significant overall effects of OCPs on hyperuricemia, with an OR of 1.25 (95% CI: 1.09-1.44) and 1.20 (95% CI: 1.06-1.37), respectively. BKMR indicated a positive trend between mixed OCPs and hyperuricemia, with HCB having the largest weight in all three mixture analyses. Subgroup analyses revealed that females, individuals aged 50 years and above, and those with a low income were more vulnerable to mixed OCP exposure. These results highlight the urgent need to protect vulnerable populations from OCPs and to properly evaluate the health effects of multiple exposures on hyperuricemia using mutual validation approaches.
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Affiliation(s)
- Yu Wen
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
| | - Yibaina Wang
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - Renjie Chen
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
| | - Yi Guo
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
| | - Jialu Pu
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
| | - Jianwen Li
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - Huixun Jia
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
- National Clinical Research Center for Ophthalmic Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai Key Laboratory of Fundus Diseases, Shanghai 200080, China
| | - Zhenyu Wu
- School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China
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Duan L, Zhang M, Cao Y, Du Y, Chen M, Xue R, Shen M, Luo D, Xiao S, Duan Y. Exposure to ambient air pollutants is associated with an increased incidence of hyperuricemia: A longitudinal cohort study among Chinese government employees. ENVIRONMENTAL RESEARCH 2023; 235:116631. [PMID: 37442260 DOI: 10.1016/j.envres.2023.116631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND It is widely recognized that ambient air pollution can induce various detrimental health outcomes. However, evidence linking ambient air pollutants and hyperuricemia incidence is scarce. OBJECTIVES To assess the association between long-term air pollution exposure and the risk of hyperuricemia. METHODS In this study, a total of 5854 government employees without hyperuricemia were recruited and followed up from January 2018 to June 2021 in Hunan Province, China. Hyperuricemia was defined as serum uric acid (SUA) level of >420 μmol/L for men and >360 μmol/L for women or use of SUA-lowering medication or diagnosed as hyperuricemia during follow-up. Data from local air quality monitoring stations were used to calculate individual exposure levels of PM10, PM2.5, SO2 and NO2 by inverse distance weightingn (IDW) method. Cox proportional hazard model was applied to evaluate the causal relationships between air pollutant exposures and the risk of hyperuricemia occurrence after adjustment for potential confounders and meanwhile, restricted cubic spline was used to explore the dose-response relationships. RESULTS The results indicated that exposures to PM10 (hazard ratio, HR = 1.042, 95% conficence interal, 95% CI: 1.028, 1.057), PM2.5 (HR = 1.204, 95% CI: 1.141, 1.271) and NO2 (HR = 1.178, 95% CI: 1.125,1.233) were associated with an increased HR of hyperuricemia. In addition, a nonlinear dose-response relationship was found between PM10 exposure level and the HR of hyperuricemia (p for nonlinearity = 0.158) with a potential threshold of 50.11 μg/m3. Subgroup analysis demonstrated that participants usually waking up at night and using natural ventilation were more vulnerable to the exposures of PM10, PM2.5, NO2, and SO2. CONCLUSION Long-term exposures to ambient PM10, PM2.5 and NO2 are associated with an increased incidence of hyperuricemia among Chinese government employees.
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Affiliation(s)
- Lidan Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Muyang Zhang
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Yuhan Cao
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Yuwei Du
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Meiling Chen
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Rumeng Xue
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Minxue Shen
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Yanying Duan
- Department of Occupational and Environmental Health, Xiangya School of Public Health, Central South University, Changsha, 410078, China.
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Fan G, Liu Q, Bi J, Fang Q, Qin X, Wu M, Lv Y, Mei S, Wang Y, Wan Z, Song L. Associations of polychlorinated biphenyl and organochlorine pesticide exposure with hyperuricemia: modification by lifestyle factors. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:106562-106570. [PMID: 37726631 DOI: 10.1007/s11356-023-29938-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
Recent research has reported positive associations of exposure to polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) with hyperuricemia. However, most of these studies have primarily focused on the individual effects of PCB/OCP exposure. We aimed to explore the associations of both individual and combined PCB/OCP exposure with hyperuricemia and examine whether such associations could be modified by lifestyle factors. The cross-sectional study recruited 2032 adults between March and May 2019 in Wuhan, China. Logistic regression and weighted quantile sum (WQS) regression were applied to explore the relationship of individual and combined PCB/OCP exposure with hyperuricemia, while considering the modified effects of lifestyle factors. Of the 2032 participants, 522 (25.7%) had hyperuricemia. Compared with the non-detected group, the detected groups of PCB153 and PCB180 exhibited a positive association with hyperuricemia, with OR (95% CIs) of 1.52 (1.22, 1.91) and 1.51 (1.20, 1.90), respectively. WQS regression showed that PCB/OCP mixture was positively associated with hyperuricemia (OR: 1.31, 95% CI: 1.08, 1.58). PCB153/PCB180 exposure, combined with an unhealthy lifestyle, has a significant additive effect on hyperuricemia. Overall, PCB/OCP mixture and individual PCB153/PCB180 exposure were positively associated with hyperuricemia. Adherence to a healthy lifestyle may modify the potential negative impact of PCBs/OCPs on hyperuricemia.
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Affiliation(s)
- Gaojie Fan
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Fang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiya Qin
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongman Lv
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Surong Mei
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengce Wan
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Guo LC, Lv Z, Zhu T, He G, Hu J, Xiao J, Liu T, Yu S, Zhang J, Zhang H, Ma W. Associations between serum polychlorinated biphenyls, halogen flame retardants, and renal function indexes in residents of an e-waste recycling area. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:159746. [PMID: 36306844 DOI: 10.1016/j.scitotenv.2022.159746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/22/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
E-waste handling activities release large quantities of polychlorinated biphenyls (PCBs) and halogen flame retardants (HFRs) into the surrounding area, creating a high exposure risk for local residents. However, the possibility of PCBs and HFRs exposure contributing to renal injury has not been extensively studied. To fill this knowledge gap, we conducted an epidemiological analysis of adolescents and adults recruited from an e-waste recycling area and a control area. Some PCBs and HFRs compounds were statistically significantly associated with the levels of β2-microglobulin (β2-MG), blood urea nitrogen (BUN), serum creatinine (SCr), and uric acid, with thyroid hormone-related genes found to partly mediate these associations. The interactions of PCBs and HFRs with metals also influenced renal function indexes. Exposure to high concentrations of PCBs and HFRs resulted in higher levels of β2-MG and lower levels of BUN and SCr in the exposed group. As indicated by the elevated β2-MG levels, high exposure to PCBs and HFRs may increase the risk of early renal injury for adolescents. These findings help to clarify the impacts of PCBs and HFRs on renal function and highlight the need to protect the health of residents in regions impacted by e-waste handling activities.
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Affiliation(s)
- Ling-Chuan Guo
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Zhanlu Lv
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Tingting Zhu
- State Environmental Protection Key Laboratory of Drinking Water Source Management and Technology, Shenzhen Key Laboratory of Emerging Contaminants Detection and Control in Water Environment, Guangdong Engineering Research Center of Low Energy Sewage Treatment, Shenzhen Academy of Environmental Sciences, Shenzhen 518001, China
| | - Guanhao He
- School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jianxiong Hu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Tao Liu
- School of Medicine, Jinan University, Guangzhou 510632, China
| | - Shengbing Yu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jinliang Zhang
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Han Zhang
- State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing 100012, China
| | - Wenjun Ma
- School of Medicine, Jinan University, Guangzhou 510632, China.
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5
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Zhang F, Wang H, Cui Y, Zhao L, Song R, Han M, Wang W, Zhang D, Shen X. Association between mixed dioxin exposure and hyperuricemia in U.S. adults: A comparison of three statistical models. CHEMOSPHERE 2022; 303:135134. [PMID: 35644240 DOI: 10.1016/j.chemosphere.2022.135134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/08/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Previous studies on the relationship between dioxin exposures and hyperuricemia have usually been based on multi-chemical linear models. However, the complex nonlinear relationship and interaction between mixed dioxin exposures and hyperuricemia have seldom been studied. In this study, we applied three different statistical models to assess the joint effect of 12 dioxins on hyperuricemia. METHODS A total of 7 dioxin-like polychlorinated biphenyls (DL-PCBs), 3 polychlorinated dibenzo-p-dioxins (PCDDs), and 2 polychlorinated dibenzofurans (PCDFs) were measured in the serum of adults by the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2004. We fitted multivariable logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models to estimate the association of individual and mixed dioxin exposures with hyperuricemia. RESULTS Among the 1008 individuals included in our analysis, 20.04% had hyperuricemia. In the multivariable logistic regression established for each single dioxin, PCB28, PCB74, PCB105, PCB118, and 1,2,3,4,6,7,8-HPCDD were positively associated with hyperuricemia. With including all dioxins in the multivariable logistic regression model simultaneously, only PCB28 and 1,2,3,4,6,7,8-HPCDD were positively associated with hyperuricemia. In the WQS regression model, the WQS index was significantly associated (OR (95% CI): 2.32 (1.26, 4.28)) with hyperuricemia, and 1,2,3,4,6,7,8-HPCDD (weighted 0.22) had the largest contribution. In BKMR analysis, a significant positive association was found between mixed dioxin exposure and hyperuricemia when all dioxins were at their 60th percentile or above, compared to their 50th percentile. The univariate exposure-response function showed that PCB105 and PCB118 were positively associated with hyperuricemia. CONCLUSION By comparing the three statistical models, we concluded that the whole-body burden of 12 dioxins was significantly positively associated with hyperuricemia. PCB105, PCB118, and 1,2,3,4,6,7,8-HPCDD played the most important roles in hyperuricemia.
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Affiliation(s)
- Fan Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Yixin Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Longzhu Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Ruihan Song
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Miaomiao Han
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Xiaoli Shen
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, Qingdao, 266071, China.
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Li M, Wang R, Su C, Li J, Wu Z. Temporal Trends of Exposure to Organochlorine Pesticides in the United States: A Population Study from 2005 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073862. [PMID: 35409545 PMCID: PMC8997618 DOI: 10.3390/ijerph19073862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
The current study aimed to investigate temporal trends of serum organochlorine pesticide (OCP) concentrations in the general United States population, approximately 30 years after the prohibition of OCP usage, by using National Health and Nutrition Examination Survey data. The least square geometric means and percent change in OCP concentrations were calculated by a survey weighted multiple linear regression model. Over 2005–2016, OCP concentrations showed significant downward temporal trends. Females had substantially higher concentrations of β-Hexachlorocyclohexane (β-HCH), p,p′-DDE and p,p′-DDT, but lower concentrations of Hexachlorobenzene (HCB) and trans-nonachlor. In addition, females had a more rapid decrease in p,p′-DDT levels over time than males. The overall OCP concentrations increased with age, and the two oldest age groups (aged 40–59 and 60+ years) had substantially lower rates of decrease than the younger age groups (aged 12–39 years). Concentrations and declines in OCPs (except for trans-nonachlor) were higher in Mexican Americans than both non-Hispanic Whites and non-Hispanic Blacks. There is a particular need for the ongoing monitoring of these banned chemicals, and measures should be taken to mitigate the exposure of vulnerable populations, including adults aged over 60, Mexican Americans, females for β-HCH, p,p′-DDE and p,p′-DDT, and males for HCB and trans-nonachlor.
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Affiliation(s)
- Mengmeng Li
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China;
| | - Rui Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (R.W.); (C.S.)
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China; (R.W.); (C.S.)
| | - Jianwen Li
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
- Correspondence: (J.L.); (Z.W.)
| | - Zhenyu Wu
- Department of Biostatistics, School of Public Health, Key Laboratory of Public Health Safety and Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China;
- Correspondence: (J.L.); (Z.W.)
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7
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Seo SH, Choi SD, Batterman S, Chang YS. Health risk assessment of exposure to organochlorine pesticides in the general population in Seoul, Korea over 12 years: A cross-sectional epidemiological study. JOURNAL OF HAZARDOUS MATERIALS 2022; 424:127381. [PMID: 34638073 DOI: 10.1016/j.jhazmat.2021.127381] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
This study evaluated the 12-year trends in serum levels of 28 organochlorine pesticides (OCPs) in 880 adults living in Seoul, Korea. The OCP levels decreased from 2006 to 2017, and p,p'-dichlorodiphenyldichloroethylene was a predominant compound. OCP levels were higher in females than in males, and showed positive associations with BMI and age. The OCP concentrations had inverted U-shaped associations with low-density lipoprotein cholesterol and total cholesterol. Concentrations of β-hexachlorocyclohexane were significantly higher in patients with hypertension than in participants that were normotensive. OCP levels showed positive associations with uric acid, creatinine, and thyroid-stimulating hormone, but negative associations with free thyroxine. Participants with diabetes had significantly higher OCP levels than those without it. Principal component analysis suggested possible differences in disease manifestation depending on the composition of OCPs. These results suggest that OCPs might disturb renal transport and thyroid homeostasis. To our knowledge, the inverted U-shaped associations of heptachlor epoxide and endosulfan with cholesterol, the epidemiological associations of trans-nonachlor and endosulfan with thyroid hormones, and the association of p,p'-DDE with hyperuricemia have not been previously reported in general population. This is the first long-term study to show trends of 28 OCPs in serum and associations with various health indicators in Korea.
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Affiliation(s)
- Sung-Hee Seo
- Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Sung-Deuk Choi
- Department of Urban and Environmental Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan 44919, Republic of Korea
| | - Stuart Batterman
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Yoon-Seok Chang
- Division of Environmental Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang 37673, Republic of Korea.
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Sun J, Fang R, Wang H, Xu DX, Yang J, Huang X, Cozzolino D, Fang M, Huang Y. A review of environmental metabolism disrupting chemicals and effect biomarkers associating disease risks: Where exposomics meets metabolomics. ENVIRONMENT INTERNATIONAL 2022; 158:106941. [PMID: 34689039 DOI: 10.1016/j.envint.2021.106941] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 10/12/2021] [Indexed: 05/27/2023]
Abstract
Humans are exposed to an ever-increasing number of environmental toxicants, some of which have gradually been elucidated to be important risk factors for metabolic diseases, such as diabetes and obesity. These metabolism-sensitive diseases typically occur when key metabolic and signaling pathways were disrupted, which can be influenced by the exposure to contaminants such as endocrine disrupting chemicals (EDCs), along with genetic and lifestyle factors. This promotes the concept and research on environmental metabolism disrupting chemicals (MDCs). In addition, identifying endogenous biochemical markers of effect linked to disease states is becoming an important tool to screen the biological targets following environmental contaminant exposure, as well as to provide an overview of toxicity risk assessment. As such, the current review aims to contribute to the further understanding of exposome and human health and disease by characterizing environmental exposure and effect metabolic biomarkers. We summarized MDC-associated metabolic biomarkers in laboratory animal and human cohort studies using high throughput targeted and nontargeted metabolomics techniques. Contaminants including heavy metals and organohalogen compounds, especially EDCs, have been repetitively associated with metabolic disorders, whereas emerging contaminants such as perfluoroalkyl substances and microplastics have also been found to disrupt metabolism. In addition, we found major limitations in the effective identification of metabolic biomarkers especially in human studies, toxicological research on the mixed effect of environmental exposure has also been insufficient compared to the research on single chemicals. Thus, it is timely to call for research efforts dedicated to the study of combined effect and metabolic alterations for the better assessment of exposomic toxicology and health risks. Moreover, advanced computational and prediction tools, further validation of metabolic biomarkers, as well as systematic and integrative investigations are also needed in order to reliably identify novel biomarkers and elucidate toxicity mechanisms, and to further utilize exposome and metabolome profiling in public health and safety management.
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Affiliation(s)
- Jiachen Sun
- College of Marine Life Science, Ocean University of China, Qingdao, China
| | - Runcheng Fang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China
| | - Hua Wang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China
| | - De-Xiang Xu
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China
| | - Jing Yang
- State Environmental Protection Key Laboratory of Quality Control in Environmental, Monitoring, China National Environmental Monitoring Center, Beijing, China
| | - Xiaochen Huang
- School of Agriculture, Sun Yat-sen University, Guangzhou, China
| | - Daniel Cozzolino
- ARC Industrial Transformation Training Centre for Uniquely Australian Foods, Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, Coopers Plans, Australia
| | - Mingliang Fang
- School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
| | - Yichao Huang
- Department of Toxicology, School of Public Health, Anhui Medical University, Hefei, China; Key Laboratory of Environmental Toxicology of Anhui Higher Education Institutes, Hefei, China.
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Zhang H, Li H, Green AP, Wang M, Yan F, Li M, He Y, Sun W, Yuan X, Lu J, Sun M, Merriman TR, Li C. Association of low-level environmental exposure to cadmium and lead with gout flare using a cohort study design. CHEMOSPHERE 2021; 280:130648. [PMID: 33932909 DOI: 10.1016/j.chemosphere.2021.130648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Abstract
Cadmium (Cd) and lead (Pb) are toxic heavy metals with endocrine-disrupting properties. We investigated the associations of low-level environmental exposure to Cd/Pb and gout status (intercritical gout, gout flare and combined gout) in a cohort study. We measured by ICP-MS the levels of Cd and Pb in blood (Cd-B and Pb-B) and urine (Cd-U and Pb-U) from 408 participants with blood and 346 participants with urine samples recruited from a hospital gout clinic. The median levels of Cd-B and Pb-B (in μg/L) in the gout flare group were 0.87 (range 0.41-2.49) and 31.54 (25.38-41.46), respectively, and the median levels of Cd-U and Pb-U in the gout flare group were 1.05 (0.69-1.91) and 3.86 (3.49-4.44), respectively. These medians were significantly higher than those in the control or intercritical groups (P < 0.05). For Cd-B in tertile 2 (T2) and Cd-U in tertile 3, Cd levels were significantly associated with gout flare status compared to the reference tertile 1 (OR = 4.3, P = 0.041 and OR = 25.1, P = 0.002, respectively) after adjustment under Model 3. For Pb-U, the risk of gout flare status was significantly higher in T2 (OR = 51.0, P = 0.002) compared to the T1 under Model 3. Our results show that median levels of Cd-B, Pb-B, Cd-U and Pb-U in the gout flare group were significantly higher than participants without gout or with gout but in the intercritical period. We provide evidence that the risk of gout flare status is associated with increased Cd levels, and that blood and urine levels of Cd are a risk factor for gout flare status.
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Affiliation(s)
- Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Hailong Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | | | - Ming Wang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Fei Yan
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Maichao Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Yuwei He
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Xuan Yuan
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Jie Lu
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China.
| | - Mingshu Sun
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, China.
| | - Tony R Merriman
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Department of Biochemistry, University of Otago, Dunedin, New Zealand; Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Alabama, USA.
| | - Changgui Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao, 266071, China; Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, the Affiliated Hospital of Qingdao University, China; Medical Research Center, The Affiliated Hospital of Qingdao University, China; Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, China.
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10
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De Falco M, Laforgia V. Combined Effects of Different Endocrine-Disrupting Chemicals (EDCs) on Prostate Gland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9772. [PMID: 34574693 PMCID: PMC8471191 DOI: 10.3390/ijerph18189772] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
Endocrine-disrupting chemicals (EDCs) belong to a heterogeneous class of environmental pollutants widely diffused in different aquatic and terrestrial habitats. This implies that humans and animals are continuously exposed to EDCs from different matrices and sources. Moreover, pollution derived from anthropic and industrial activities leads to combined exposure to substances with multiple mechanisms of action on the endocrine system and correlated cell and tissue targets. For this reason, specific organs, such as the prostate gland, which physiologically are under the control of hormones like androgens and estrogens, are particularly sensitive to EDC stimulation. It is now well known that an imbalance in hormonal regulation can cause the onset of various prostate diseases, from benign prostate hyperplasia to prostate cancer. In this review, starting with the description of normal prostate gland anatomy and embryology, we summarize recent studies reporting on how the multiple and simultaneous exposure to estrogenic and anti-androgenic compounds belonging to EDCs are responsible for an increase in prostate disease incidence in the human population.
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Affiliation(s)
- Maria De Falco
- Department of Biology, University of Naples ‘‘Federico II’’, 80126 Naples, Italy;
- National Institute of Biostructures and Biosystems (INBB), 00136 Rome, Italy
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
| | - Vincenza Laforgia
- Department of Biology, University of Naples ‘‘Federico II’’, 80126 Naples, Italy;
- National Institute of Biostructures and Biosystems (INBB), 00136 Rome, Italy
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11
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Jain RB. Trends in concentrations of selected dioxins and furans across various stages of kidney function for US adults. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:43763-43776. [PMID: 33840024 DOI: 10.1007/s11356-021-13844-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/05/2021] [Indexed: 05/26/2023]
Abstract
Exposure to dioxins and furans has the potential to affect kidney function and could be associated with chronic kidney disease. Data for US adults aged ≥ 20 years from the National Health and Nutrition Examination Survey for 1999-2004 (N = 4433) were analyzed to study trends in adjusted concentrations (AGM) of 1,2,3,7,8-pentachlorodibenzo-p-dioxin, 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin, 1,2,3,4,6,7,8-heptachlororodibenzo-p-dioxin, 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin, 2,3,4,7,8-pentachlorodibenzofuran, 1,2,3,4,7,8-hexachlorodibenzofuran, 1,2,3,6,7,8-hexachlorodibenzofuran, and 1,2,3,4,6,7,8-heptachlorodibenzofuran across the stages of kidney function (KF). Stages of KF were defined based on estimated glomerular filtration rate or eGFR expressed in mL/min/1.73 m2. For KF-1, eGFR was > 90, between 60 and 90 for KF-2, between 45 and 60 for KF-3A, and between 15 and 45 for KF-3B/4. AGMs for 1,2,3,7,8-pentachlorodibenzo-p-dioxin and 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin increased consistently across the full spectrum of kidney function. For example, AGMs for the total population for 1,2,3,7,8-pentachlorodibenzo-p-dioxin were 2.5, 4.5, 9.3, and 14.9 fg/g lipid for KF-1, KF-2, KF-3A, and KF-3B/4, respectively. For other six dioxins/furans, AGMs increased over KF-1 through KF-3A but then decreased for KF-3B/4, for example, 1,2,3,4,6,7,8-heptachlorodibenzofuran for males, and AGMs for KF-1, KF-2, KF-3A, and KF-3B/4 were 7.9, 8.4, 10.7, and 7.5 fg/g lipid, respectively. For 1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin and 1,2,3,6,7,8-hexachlorodibenzofuran, smokers were found to have lower AGMs than nonsmokers. For example, for 1,2,3,4,6,7,8-heptaachlorodibenzo-p-dioxin, smoker-nonsmoker AGMs were 22.2 vs. 39.4 fg/g lipid at KF-1, 29.5 vs. 51.4 fg/g lipid at KF-2, 61.6 vs. 72.8 fg/g lipid at KF-3A, and 34.9 vs. 66.4 fg/g lipid at KF-3B/4. The reverse more often than not, was, however, observed for other six dioxins/furans. Smoker-nonsmoker AGMs for 1,2,3,7,8-pentachlorodibenzo-p-dioxin were 2.4 vs. 2.6 fg/g lipid at KF-1, 5.1 vs. 4.0 fg/g lipid at KF-2, 12.7 vs. 6.7 fg/g lipid at KF-3A, and 18.6 vs. 11.9 fg/g lipid at KF-3B/4. In conclusion, lipid-adjusted serum concentrations of dioxins and furans continue increasing as kidney function keeps deteriorating until KF-3A. However, these increases in serum concentrations until KF-3A may be followed by substantial decreases for selected dioxins/furans during KF-3B/4.
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Tang YX, Bloom MS, Qian ZM, Liu E, Jansson DR, Vaughn MG, Lin HL, Xiao LW, Duan CW, Yang L, Xu XY, Li YR, Zhu L, Dong GH, Liu YM. Association between ambient air pollution and hyperuricemia in traffic police officers in China: a cohort study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2021; 31:54-62. [PMID: 31184496 DOI: 10.1080/09603123.2019.1628926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
To evaluate the association between ambient air pollution and hyperuricemia, we prospectively followed 1748 traffic police officers without hyperuricemia at baseline (2009-2014) from 11 districts in Guangzhou, China. We calculated six-year average PM10, SO2 and NO2 concentrations using data collected from air monitoring stations. The hazard ratios for hyperuricemia per 10 µg/m3 increase in air pollutants were 1.46 (95% CI: 1.28-1.68) for PM10, 1.23 (95% CI: 1.00-1.51) for SO2, and 1.43 (95% CI: 1.26-1.61) for NO2. We also identified changes in the ratio of serum uric acid to serum creatinine concentrations (ua/cre) per 10 µg/m3 increase in air pollutants as 11.54% (95% CI: 8.14%-14.93%) higher for PM10, 5.09% (95% CI: 2.76%-7.42%) higher for SO2, and 5.13% (95% CI: 2.35%-7.92%) higher for NO2, respectively. Long-term exposure to ambient air pollution was associated with a higher incidence of hyperuricemia and an increase in ua/cre among traffic police officers.
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Affiliation(s)
- Yong-Xiang Tang
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University , Guangzhou, China
- Departments of Environmental Health Sciences & Epidemiology and Biostatistics, University at Albany, State University of New York , Rensselaer, NY, USA
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University , Saint Louis, USA
| | - Echu Liu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University , Saint Louis, USA
| | - Daire R Jansson
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University , Saint Louis, USA
| | - Michael G Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University , Saint Louis, MO, USA
| | - Hua-Liang Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, China
| | - Lv-Wu Xiao
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Chuan-Wei Duan
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Lie Yang
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Xiao-Yun Xu
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Yan-Ru Li
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Ling Zhu
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University , Guangzhou, China
| | - Yi-Min Liu
- Key Laboratories in Guangzhou, Guangzhou Medical University Institute of Occupational and Environmental Health, Guangzhou Occupational Disease Prevention and Treatment Hospital , Guangzhou, China
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Kumar M, Sarma DK, Shubham S, Kumawat M, Verma V, Prakash A, Tiwari R. Environmental Endocrine-Disrupting Chemical Exposure: Role in Non-Communicable Diseases. Front Public Health 2020; 8:553850. [PMID: 33072697 PMCID: PMC7541969 DOI: 10.3389/fpubh.2020.553850] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 01/09/2023] Open
Abstract
The exponential growth of pollutant discharges into the environment due to increasing industrial and agricultural activities is a rising threat for human health and a biggest concern for environmental health globally. Several synthetic chemicals, categorized as potential environmental endocrine-disrupting chemicals (EDCs), are evident to affect the health of not only livestock and wildlife but also humankind. In recent years, human exposure to environmental EDCs has received increased awareness due to their association with altered human health as documented by several epidemiological and experimental studies. EDCs are associated with deleterious effects on male and female reproductive health; causes diabetes, obesity, metabolic disorders, thyroid homeostasis and increase the risk of hormone-sensitive cancers. Sewage effluents are a major source of several EDCs, which eventually reach large water bodies and potentially contaminate the drinking water supply. Similarly, water storage material such as different types of plastics also leaches out EDCs in drinking Water. Domestic wastewater containing pharmaceutical ingredients, metals, pesticides and personal care product additives also influences endocrine activity. These EDCs act via various receptors through a variety of known and unknown mechanisms including epigenetic modification. They differ from classic toxins in several ways such as low-dose effect, non-monotonic dose and trans-generational effects. This review aims to highlight the hidden burden of EDCs on human health and discusses the non-classical toxic properties of EDCs in an attempt to understand the magnitude of the exposome on human health. Present data on the environmental EDCs advocate that there may be associations between human exposure to EDCs and several undesirable health outcomes that warrants further human bio-monitoring of EDCs.
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Affiliation(s)
- Manoj Kumar
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Devojit Kumar Sarma
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Swasti Shubham
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Manoj Kumawat
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Vinod Verma
- Department of Stem Cell Research Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anil Prakash
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
| | - Rajnarayan Tiwari
- National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
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14
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Liu H, Wei X, Yang W, Reynolds GP. Agricultural work and reduced circulating uric acid are both associated with initial hospital admission for Parkinson's disease. J Neural Transm (Vienna) 2019; 127:779-783. [PMID: 31836905 PMCID: PMC7242276 DOI: 10.1007/s00702-019-02119-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/08/2019] [Indexed: 11/29/2022]
Abstract
Monoamine oxidase type B inhibitors act in Parkinson's disease (PD) via potentiation of dopamine, but may also have neuroprotective effects by reducing oxidative damage. Oxidative damage is also a feature of environmental toxins, including pesticides, that are an established risk factor for PD. Another risk factor is low circulating uric acid (UA), which may relate to UA being the major endogenous antioxidant in the human body. We have undertaken a study of 192 initial admissions for PD in a general hospital neurology department in a partly rural region of Southern China to determine if there is an increased rate of PD in agricultural workers who have a high risk of exposure to pesticides, and how it may relate to deficits in UA. We found a disproportionately high number of agricultural workers admitted with PD (66.7% vs. 54.3% of all neurology admissions) and that PD subjects have a substantial reduction in UA. This is further reduced in agricultural workers and thus may contribute to the increased vulnerability of this group to PD.
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Affiliation(s)
- Hanxiang Liu
- Department of Neurology, Puer People's Hospital, Puer, Yunnan, China.,Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB, UK
| | - Xianwen Wei
- Department of Neurology, Puer People's Hospital, Puer, Yunnan, China
| | - Wen Yang
- Department of Neurology, Puer People's Hospital, Puer, Yunnan, China
| | - Gavin P Reynolds
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB, UK.
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15
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Xu C, Su X, Xu Y, Ma S, Duan W, Mo X. Exploring the associations of serum concentrations of PCBs, PCDDs, and PCDFs with walking speed in the U.S. general population: Beyond standard linear models. ENVIRONMENTAL RESEARCH 2019; 178:108666. [PMID: 31472363 DOI: 10.1016/j.envres.2019.108666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/09/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Studies have shown that persistent organic pollutants (POPs) can have various health effects. However, little is known about the effects of multiple chemicals with possible common sources of exposure on walking speed, a proxy index reflecting lower limb neuromuscular function and physical function. We simultaneously applied multiple linear and nonlinear statistical models to explore the complex exposure-response relationship between a mixture of 22 selected POPs and walking speed. A total of 14 polychlorinated biphenyls (PCBs), 3 polychlorinated dibenzo-p-dioxins (PCDDs), and 5 polychlorinated dibenzofurans (PCDFs) were measured in the serum of participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2002. Walking speed was measured during a physical examination. Linear regression (LR), least absolute shrinkage and selection operator (LASSO), and group LASSO were used to evaluate the linearity of mixtures, while restricted cubic spline (RCS) regression, random forest (RF), and Bayesian kernel machine regression (BKMR) models were used to evaluate the nonlinearity of mixtures. Potential confounders were adjusted in the above models. A total of 436 subjects were included in our final analysis. The results of the LR model did not identify any POP exposure that was significantly associated with walking speed. The LASSO results revealed an inverse association of one PCDD congener and two PCDF congeners with walking speed, while the group LASSO analysis identified PCDFs at the exposure level and at the group level. In the RCS analysis, two PCB congeners presented significant overall associations with walking speed. The PCB congener PCB194 showed statistically significant effects on the outcome (P = 0.01) when a permutation-based RF was used. The BKMR analysis suggested that PCBs and PCDFs (probabilities = 0.887 and 0.909, respectively) are potentially associated with walking speed. Complex statistical models, such as RCS regression, RF and BKMR models, can detect the nonlinear and nonadditive relationships between PCBs and walking speed, while LASSO and group LASSO can identify only the linear relationships between PCDFs and walking speed. Fully considering the influence of collinearity in each method during modelling can increase the comprehensiveness and reliability of conclusions in studies of multiple chemicals.
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Affiliation(s)
- Cheng Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xiaoqi Su
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yang Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Siyu Ma
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Weiwei Duan
- Department of Bioinformatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 211166, China.
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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Arrebola JP, Ramos JJ, Bartolomé M, Esteban M, Huetos O, Cañas AI, López-Herranz A, Calvo E, Pérez-Gómez B, Castaño A. Associations of multiple exposures to persistent toxic substances with the risk of hyperuricemia and subclinical uric acid levels in BIOAMBIENT.ES study. ENVIRONMENT INTERNATIONAL 2019; 123:512-521. [PMID: 30622076 DOI: 10.1016/j.envint.2018.12.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/09/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
Hyperuricemia is becoming a serious public health issue, which is highly influenced by environmental factors, although there is still controversial information on the potential influence of the exposure to Persistent Toxic Substances (PTSs) in the general population. In this study we aimed to assess the association. PTS exposure with uric acid homeostasis in a sample of the Spanish population. Participants were recruited during 2009-2010 in all the main geographical areas of Spain. Exposure to 34 PTSs was estimated by chemical analyses of serum levels of 6 Polychlorinated Biphenyls (PCBs, n = 950), 13 Organochlorine Pesticides (OCPs, n = 453), 6 Perfluoroalkyl Substances (PFAs, n = 755), 7 Polybrominated Diphenyl Ethers (PBDEs, n = 365), urinary Cadmium (n = 926), and Lead in whole blood (n = 882). The two study outcomes were defined as the prevalence of hyperuricemia in the study population and uric acid levels, the latter only in individuals with no previous diagnosis of hyperuricemia. Statistical analyses were performed by means of binomial logistic regression and linear regression, and mixture effects were screened using Weighted Quantile Sum Regression (WQS). Serum concentrations of γ-HCH, o,p´-DDE, PCB-138, PCB-153, PFOA, and urinary Cadmium were associated with an increased risk of hyperuricemia, while PBDE-153 showed an inverse association with the effect. Furthermore, exposure to Cadmium, PCB-138, and to PCB-153 was positively associated with uric acid levels. Results were consistent after lipid adjustment or standardization. WQS analyses revealed a major contribution of PCB-153 within the PCB mixture on both the risk of hyperuricemia and uric acid levels. Sensitivity analyses were performed by adjusting for dietary habits, fasting glucose and estimated glomerular filtration rate. Overall, we found novel associations between human exposure to mixtures of PTSs and disturbances in uric acid homeostasis. However, we cannot completely rule out potential residual confounding effect or reversed-causality related to the cross-sectional design.
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Affiliation(s)
- Juan Pedro Arrebola
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, University of Granada, Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Oncology Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - Juan José Ramos
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Mónica Bartolomé
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Esteban
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Olga Huetos
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana I Cañas
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana López-Herranz
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Calvo
- Ibermutuamur, Ramirez de Arellano 27, Madrid, Spain
| | - Beatriz Pérez-Gómez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Argelia Castaño
- Centro Nacional de Sanidad Ambiental (CNSA), Instituto de Salud Carlos III, Madrid, Spain.
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Serum Bisphenol A is an independent risk factor of hyperuricemia: A 6-year prospective study. Semin Arthritis Rheum 2018; 48:644-648. [PMID: 29650240 DOI: 10.1016/j.semarthrit.2018.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aims to evaluate whether serum Bisphenol A (BPA) is a risk factor for hyperuricemia. METHODS In this prospective study, a total of 482 participants without hyperuricemia were enrolled at baseline and followed up for 6 years. Clinical characteristics were recorded, and serum levels of uric acid and BPA were measured. Participants were stratified into tertiles according to low, median, and high baseline serum BPA levels. Regression models were used to analyze associations of serum BPA with the change in uric acid and the risk of developing hyperuricemia. RESULTS At baseline, serum concentrations of BPA was 0.51 (0.24-2.37) ng/mL. After 6 years of follow-up, the change in serum uric acid concentration from baseline to the 6-year mark was significantly higher in subjects with higher baseline BPA concentration (0.03 ± 0.19, 0.07 ± 0.21, and 0.11 ± 0.25mg/dL for low, median, and high tertiles, respectively, P = 0.006). When adjusted for potential confounders, such as age, renal function, and history of diabetes and hypertension, multivariable logistic analyses showed that subjects in the median or high baseline BPA tertiles exhibited a twofold higher risk of 6-year hyperuricemia incidence compared to subjects in the low baseline BPA tertile [odds ratio (OR) = 2.28 (95% CI: 1.05-4.95) for the median tertile; 2.42 (1.07-5.48) for the high tertile, Pfor Trend = 0.043]. CONCLUSION In conclusion, serum BPA is an independent risk factor for hyperuricemia.
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Ma L, Hu J, Li J, Yang Y, Zhang L, Zou L, Gao R, Peng C, Wang Y, Luo T, Xiang X, Qing H, Xiao X, Wu C, Wang Z, He JC, Li Q, Yang S. Bisphenol A promotes hyperuricemia
via
activating xanthine oxidase. FASEB J 2018; 32:1007-1016. [DOI: 10.1096/fj.201700755r] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Linqiang Ma
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jinbo Hu
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Jiayu Li
- Laboratory of Lipid and Glucose MetabolismThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yi Yang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Linkun Zhang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lingyun Zou
- Department of MicrobiologyBioinformatics CenterThe Third Military Medical UniversityChongqingChina
| | - Rufei Gao
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Chuan Peng
- Laboratory of Lipid and Glucose MetabolismThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yue Wang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Ting Luo
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaojiao Xiang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hua Qing
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiaoqiu Xiao
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Laboratory of Lipid and Glucose MetabolismThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Chaodong Wu
- Department of Nutrition and Food ScienceTexas A&M UniversityCollege StationTexasUSA
| | - Zhihong Wang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Division of NephrologyDepartment of MedicineIcahn School of Medicine at Mount Sinai, New YorkNew YorkUSA
- Department of Pharmacological SciencesIcahn School of Medicine at Mount Sinai, New YorkNew YorkUSA
| | - John Cijiang He
- Division of NephrologyDepartment of MedicineIcahn School of Medicine at Mount Sinai, New YorkNew YorkUSA
| | - Qifu Li
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Shumin Yang
- Department of Endocrinology andThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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Lim JE, Nam C, Yang J, Rha KH, Lim KM, Jee SH. Serum persistent organic pollutants (POPs) and prostate cancer risk: A case-cohort study. Int J Hyg Environ Health 2017; 220:849-856. [DOI: 10.1016/j.ijheh.2017.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
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Park SH, Hong YS, Ha EH, Park H. Serum concentrations of PCBs and OCPs among prepubertal Korean children. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:3536-3547. [PMID: 26490932 DOI: 10.1007/s11356-015-5578-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
Although children are more vulnerable than adults to environmental hazards, due to their physiological and behavioral characteristics, few studies have assessed their internal exposure to persistent organic pollutants (POPs). The objective of this study was to determine the serum levels of certain polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) among pre-pubertal children in Korea and examine their variation with age and gender. We analyzed a total of 51 POPs in 214 children (age range, 7-9 years), using data from the Ewha Birth and Growth Cohort Study. To examine change over time, POP concentrations were measured at both 7 and 9 years of age in a sub-cohort of 26 children. The median and interquartile range (IQR, 25th to 75th percentiles) data for the sum of PCB congeners was 26.44 ng/g lipid (18.27-37.63 ng/g lipid). The median (IQR) concentration for the sum of OCPs was 74.82 ng/g lipid (51.11-112.45 ng/g lipid). Our results showed significant increases in serum concentrations of total PCBs with age (p = 0.0001), no gender dependence of total PCBs (p = 0.38) and total OCPs (p = 0.12), and strong correlations between individual POPs. Childhood exposure to POPs was relatively low compared to other studies carried out in different countries. However, even though the use of POPs has been banned since 2001, our results indicated that children in the general population are still exposed to various POPs. Because long-term, low-level exposure to POPs in the general population remains a concern for human health, future research should examine major routes of exposure and identification of risk factors.
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Affiliation(s)
- Su Hyun Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-ku, Seoul, 158-710, Republic of Korea.
| | - Young Sun Hong
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
| | - Eun-Hee Ha
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-ku, Seoul, 158-710, Republic of Korea.
| | - Hyesook Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-ku, Seoul, 158-710, Republic of Korea.
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Lim JE, Park SH, Jee SH, Park H. Body concentrations of persistent organic pollutants and prostate cancer: a meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:11275-84. [PMID: 25797015 DOI: 10.1007/s11356-015-4315-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/02/2015] [Indexed: 05/15/2023]
Abstract
There have been some concerns that persistent organic pollutants (POPs) may be associated with the risk of prostate cancer. Meta-analyses have not yet investigated the association between human-biomonitoring data for POPs and prostate cancer risk. The purpose of this study was to assess the association between body concentration of individual compounds or mixtures of POPs and prostate cancer risk in the general population by performing a meta-analysis. A literature search was performed using PubMed, EMBASE, and KoreaMed from the period 1950 through 2014. The odds ratio (OR) and its 95% confidence interval (CI) of prostate cancer associated with POPs were estimated using fixed-effects model or random-effects model where appropriate. Dose-response relationships were assessed by using the generalized least-squares method for trend estimation. A total of eight (six case-control, one cross-sectional, one nested case-control) studies including 1158 prostate cancer cases among 6932 subjects were selected for the meta-analysis. Total POPs of interest showed positive associations with statistical significance on prostate cancer (OR 1.31, 95% CI 1.13, 1.57). In dose-response meta-analysis, 1 μg/g lipid of PCBs was found to be associated with a 49% increased risk of prostate cancer (OR 1.49, 95% CI 1.07, 2.06). One nanogram per gram (1000 μg/g) lipid of trans-nonachlor was found to be associated with approximately 2% increased risk of prostate cancer (OR = 1.02/1 ng/g lipid of trans-nonachlor, 95% CI 1.00, 1.03). The available evidence suggests that body concentrations of POPs are positively associated with prostate cancer risk, which implies valuable evidence for prostate cancer prevention.
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Affiliation(s)
- Jung-eun Lim
- Institute for Health Promotion & Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
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Kataria A, Trasande L, Trachtman H. The effects of environmental chemicals on renal function. Nat Rev Nephrol 2015; 11:610-25. [PMID: 26100504 DOI: 10.1038/nrneph.2015.94] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The global incidence of chronic kidney disease (CKD) is increasing among individuals of all ages. Despite advances in proteomics, genomics and metabolomics, there remains a lack of safe and effective drugs to reverse or stabilize renal function in patients with glomerular or tubulointerstitial causes of CKD. Consequently, modifiable risk factors that are associated with a progressive decline in kidney function need to be identified. Numerous reports have documented the adverse effects that occur in response to graded exposure to a wide range of environmental chemicals. This Review summarizes the effects of such chemicals on four aspects of cardiorenal function: albuminuria, glomerular filtration rate, blood pressure and serum uric acid concentration. We focus on compounds that individuals are likely to be exposed to as a consequence of normal consumer activities or medical treatment, namely phthalates, bisphenol A, polyfluorinated alkyl acids, dioxins and furans, polycyclic aromatic hydrocarbons and polychlorinated biphenyls. Environmental exposure to these chemicals during everyday life could have adverse consequences on renal function and might contribute to progressive cumulative renal injury over a lifetime. Regulatory efforts should be made to limit individual exposure to environmental chemicals in an attempt to reduce the incidence of cardiorenal disease.
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Affiliation(s)
- Anglina Kataria
- Department of Pediatrics, Clinical and Translational Science Institute, New York University School of Medicine, 227 East 30th Street, Room #733, New York, NY 10016, USA
| | - Leonardo Trasande
- Department of Pediatrics, Clinical and Translational Science Institute, New York University School of Medicine, 227 East 30th Street, Room #733, New York, NY 10016, USA
| | - Howard Trachtman
- Department of Pediatrics, Clinical and Translational Science Institute, New York University School of Medicine, 227 East 30th Street, Room #733, New York, NY 10016, USA
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