Effects of ambient air pollution exposure on frequency of hospital admissions for appendicitis in Taipei, Taiwan

Impacts of short-term air pollution exposure on appendicitis admissions: Evidence from one of the most polluted cities in mainland China

Background

Emerging evidence indicates that air pollutants contribute to the development and progression of gastrointestinal diseases. However, there is scarce evidence of an association with appendicitis in mainland China.

Methods

In this study, Linfen city, one of the most polluted cities in mainland China, was selected as the study site to explore whether air pollutants could affect appendicitis admissions and to identify susceptible populations. Daily data on appendicitis admissions and three principal air pollutants, including inhalable particulate matter (PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) were collected in Linfen, China. The impacts of air pollutants on appendicitis were studied by using a generalized additive model (GAM) combined with the quasi-Poisson function. Stratified analyses were also performed by sex, age, and season.

Results

We observed a positive association between air pollution and appendicitis admissions. For a 10 μg/m3 increase in pollutants at lag01, the corresponding relative risks (RRs) and 95% confidence intervals (95% CIs) were 1.0179 (1.0129–1.0230) for PM10, 1.0236 (1.0184–1.0288) for SO2, and 1.0979 (1.0704–1.1262) for NO2. Males and people aged 21–39 years were more susceptible to air pollutants. Regarding seasons, the effects seemed to be stronger during the cold season, but there was no statistically significant difference between the seasonal groups.

Conclusions

Our findings indicated that short-term air pollution exposure was significantly correlated with appendicitis admissions, and active air pollution interventions should be implemented to reduce appendicitis hospitalizations, especially for males and people aged 21–39 years.

Is higher ambient temperature associated with acute appendicitis hospitalizations? A case-crossover study in Tongling, China

Existing studies suggested that ambient temperature may affect the attack of acute appendicitis. However, the identification of the quantitative effect and vulnerable populations are still unknown. The purposes of this study were to quantify the impact of daily mean temperature on the hospitalization of acute appendicitis and clarify vulnerable groups, further guide targeted prevention of acute appendicitis in Tongling. Daily data of cases and meteorological factors were collected in Tongling, China, during 2015-2019. Time stratified case-crossover design and conditional logistic regression model were used to evaluate the odds ratio (OR) of ambient temperature on hospitalizations for acute appendicitis. Stratified analyses were performed by sex, age, and marital status. The odds ratio (OR) of hospitalizations for acute appendicitis increased by 1.6% for per 1 ℃ rise in mean temperature at lag3[OR = 1.016, 95% confidence interval (CI): 1.004-1.028]. In addition, our results suggest it is in the women that increased ambient temperature is more likely to contribute to acute appendicitis hospitalizations; we also found that the married are more susceptible to acute appendicitis hospitalizations due to increased ambient temperature than the unmarried; people in the 21-40 years old are more sensitive to ambient temperature than other age groups. The significant results of the differences between the subgroups indicate that the differences between the groups are all statistically significant. The elevated ambient temperatures increased the risk of hospitalizations for acute appendicitis. The females, married people, and patients aged 21-40 years old were more susceptible to ambient temperature. These findings suggest that more attention should be paid to the impact of high ambient temperature on acute appendicitis in the future.

Probiotics, prebiotics, and synbiotics to prevent or combat air pollution consequences: The gut-lung axis

Air pollution exposure is a public health emergency, which attributes globally to an estimated seven million deaths on a yearly basis We are all exposed to air pollutants, varying from ambient air pollution hanging over cities to dust inside the home. It is a mixture of airborne particulate matter and gases that can be subdivided into three categories based on particle diameter. The smallest category called PM_0.1 is the most abundant. A fraction of the particles included in this category might enter the blood stream spreading to other parts of the body. As air pollutants can enter the body via the lungs and gut, growing evidence links its exposure to gastrointestinal and respiratory impairments and diseases, like asthma, rhinitis, respiratory tract infections, Crohn's disease, ulcerative colitis, and abdominal pain. It has become evident that there exists a crosstalk between the respiratory and gastrointestinal tracts, commonly referred to as the gut-lung axis. Via microbial secretions, metabolites, immune mediators and lipid profiles, these two separate organ systems can influence each other. Well-known immunomodulators and gut health stimulators are probiotics, prebiotics, together called synbiotics. They might combat air pollution-induced systemic inflammation and oxidative stress by optimizing the microbiota composition and microbial metabolites, thereby stimulating anti-inflammatory pathways and strengthening mucosal and epithelial barriers. Although clinical studies investigating the role of probiotics, prebiotics, and synbiotics in an air pollution setting are lacking, these interventions show promising health promoting effects by affecting the gastrointestinal- and respiratory tract. This review summarizes the current data on how air pollution can affect the gut-lung axis and might impact gut and lung health. It will further elaborate on the potential role of probiotics, prebiotics and synbiotics on the gut-lung axis, and gut and lung health.

Association between fine particulate air pollution and the risk of death from lung cancer in Taiwan

Airborne fine particulate matter (PM_2.5) has been classified as a Group I carcinogen leading to lung cancer in humans by the International Agency for Research on Cancer (IARC). In Taiwan, where there is a growing incidence of this disease, lung cancer is currently the leading cause of cancer-associated deaths in women and second leading cause of deaths in men. Because tobacco use is rare in Taiwan, especially amongst women, the high incidence of this type of cancer was suggested to be attributed to the other external contaminants, including airborne PM₂ pollution. In this ecologic study, a possible association between ambient air PM_2.5 exposure and likelihood of death attributed to lung cancer was examined in Taiwan in 66 municipalities. Annual PM_2.5 levels and age-standardized lung cancer mortality rates for male and female residents were calculated for years 2010 to 2019. Weighted-multiple regression was applied to analyze our data, adjusting for level of urbanization and physician density. For males, the adjusted risk ratios (RRs) for lung cancer mortality were 1.01 for municipalities with PM_2.5 levels 21.85-28.21 ug/m3 and 1.07 for municipalities with 28.22-31.23 ug/m3, compared to those with the lowest PM_2.5 levels. For females, these adjusted RRs were 0.99 and 1.06, respectively. Data demonstrated an association between chronic exposure to high levels of PM_2.5 and increased likelihood of death attributed to lung cancer for both men and women in Taiwan. Further studies are needed to explore the relationship between PM_2.5 air pollution exposure and risk of lung cancer histologic subtype.

The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP—appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.

Association between short-term exposure to fine particulate pollution and outpatient visits for ulcerative colitis in Beijing, China: A time-series study

Environmental factors play an important role in the development of ulcerative colitis (UC). However, only few studies have examined the effects of air pollution on UC occurrence. We conducted a time-series analysis to explore the association between short-term exposure to fine particulate matter (PM_2.5) and outpatient visits for UC in Beijing, China. In total, 84,000 outpatient visits for UC were retrieved from the Beijing Medical Claim Data for Employees between January 1, 2010 and June 30, 2012. Measurements of daily PM_2.5 concentrations were obtained from the United States Embassy air-monitoring station. A generalized additive model with quasi-Poisson link was applied to examine the association between PM_2.5 concentrations and outpatient visits for UC stratified by sex, age, and season. We found that short-term exposure to PM_2.5 was significantly associated with increased daily outpatient visits for UC at lag 0 day. A 10 μg/m³ increase in PM_2.5 concentration at lag 0 day corresponded to a 0.32% increase in outpatient visits for UC (95% confidence interval (CI), 0.05-0.58%; P = 0.019). There was a clear concentration-response association between daily outpatient visits for UC and PM_2.5 concentrations. The PM_2.5 effects were significant across all sex and season subgroups, without evidence of effect modification by sex (P = 0.942) or season (P = 0.399). The association was positive in patients younger than 65 years old but negative in those 65 years old or older, although the difference was not significant (P = 0.883). In conclusion, our study demonstrated that short-term exposure to ambient PM_2.5 was significantly associated with an increased risk of daily outpatient visits for UC, especially in younger people. Additional studies are warranted to confirm our findings.

Subchronic exposure to concentrated ambient PM2.5 perturbs gut and lung microbiota as well as metabolic profiles in mice

Exposure to ambient fine particular matter (PM2.5) are linked to an increased risk of metabolic disorders, leading to enhanced rate of many diseases, such as inflammatory bowel disease (IBD), cardiovascular diseases, and pulmonary diseases; nevertheless, the underlying mechanisms remain poorly understood. In this study, BALB/c mice were exposed to filtered air (FA) or concentrated ambient PM2.5 (CPM) for 2 months using a versatile aerosol concentration enrichment system(VACES). We found subchronic CPM exposure caused significant lung and intestinal damage, as well as systemic inflammatory reactions. In addition, serum and BALFs (bronchoalveolar lavage fluids) metabolites involved in many metabolic pathways in the CPM exposed mice were markedly disrupted upon PM2.5 exposure. Five metabolites (glutamate, glutamine, formate, pyruvate and lactate) with excellent discriminatory power (AUC = 1, p < 0.001) were identified to predict PM2.5 exposure related toxicities. Furthermore, subchronic exposure to CPM not only significantly decreased the richness and composition of the gut microbiota, but also the lung microbiota. Strong associations were found between several gut and lung bacterial flora changes and systemic metabolic abnormalities. Our study showed exposure to ambient PM2.5 not only caused dysbiosis in the gut and lung, but also significant systemic and local metabolic alterations. Alterations in gut and lung microbiota were strongly correlated with metabolic abnormalities. Our study suggests potential roles of gut and lung microbiota in PM2.5 caused metabolic disorders.

Review article: Epidemiological and animal evidence for the role of air pollution in intestinal diseases

BACKGROUND

Ambient air pollution is recognized as one of the leading causes of global burden of disease. Involvement of air pollution in respiratory and cardiovascular diseases was first recognized, and then cumulative data has indicated that the intestinal tract could be also damaged.

AIM

To review and discuss the current epidemiological and animal data on the effects of air pollution on intestinal homeostasis.

METHODS

An extensive literature search was conducted using Google Scholar and Pubmed to gather relevant human and animal studies that have reported the effects of any air pollutant on the intestine.

RESULTS

Exposure to several gaseous and particulate matter components of air pollution have been associated either positively or negatively with the onset of various intestinal diseases including appendicitis, gastroenteric disorders, irritable bowel syndrome, inflammatory bowel diseases, and peptic ulcers. Several atmospheric pollutants have been associated with modifications of gut microbiota in humans. Animal studies have showed that inhalation of atmospheric particulate matter can lead to modifications of gut microbiota, impairments of oxidative and inflammatory intestinal balances, and disruption of gut epithelial permeability.

CONCLUSIONS

Overall, the literature appears to indicate that the gut is an underestimated target of adverse health effects induced by air pollution. It is therefore important to develop additional studies that aim to better understand the link between air pollutants and gastro-intestinal diseases.

Relationship between fine particulate air pollution exposure and human adult life expectancy in Taiwan

Among the air pollutants, particulate matter with an aerodynamic diameter less than 2.5 um (PM_2.5) is of particular interest to environmental medicine as epidemiologic studies consistently reported that long-term exposure to PM_2.5 is associated with increased risk of premature death in adults. Life expectancy is a well-documented and important measure of overall public health policy. However, few investigators examined the relationship between PM_2.5 levels and adult life expectancy. In this Taiwan-wide study, county-level annual mean PM_2.5 concentrations data were collected concomitantly with potential confounding variables including demographic and socioeconomic status, as well as smoking prevalence. Subsequently, these PM_2.5 data were analyzed with respect to county-level adult life expectancy data for the period 2010 to 2017. Linear regression was used to determine the relationship between PM_2.5 and life expectancy in adults. Residents residing in the counties characterized as containing higher levels of PM_2.5 exhibited significantly reduced life expectancy after controlling for potential confounders. For each 10 ug/m³ increase in PM_2.5 there was an estimated mean decrease in life expectancy in adults of 0.3 years. The results of this study shed light on the relationship between fine particulate air pollution exposure and risk to human health in Taiwan.

Ambient Air Pollution and Hospital Admissions for Peptic Ulcers in Taipei: A Time-Stratified Case-Crossover Study

Very few studies have been performed to determine whether there is a relationship between air pollution and increases in hospitalizations for peptic ulcer, and for those that have occurred, their results may not be completely relevant to Taiwan, where the mixture of ambient air pollutants differ. We performed a time-stratified case-crossover study to investigate the possible association between air pollutant levels and hospital admissions for peptic ulcer in Taipei, Taiwan. To do this, we collected air pollution data from Taiwan's Environmental Protection Agency and hospital admissions for peptic ulcer data for the years 2009-2013 from Taiwan's National Health Insurance's research database. We used conditional logistic regression to analyze the possible association between the two, taking temperature and relative humidity into account. Risk was expressed as odds ratios and significance was expressed with 95% confidence intervals. In our single pollutant model, peptic ulcer admissions were significantly associated with all pollutants (PM₁₀, PM_2.5, SO₂, NO₂, CO, and O₃) on warm days (>23 °C). On cool days (<23 °C), peptic ulcer admissions were significantly associated with PM₁₀, NO₂, and O₃. In our two-pollutant models, peptic ulcer admissions were significantly associated NO₂ and O₃ when combined with each of the other pollutants on warm days, and with PM₁₀, NO₂, and O₃ on cool days. It was concluded that the likelihood of peptic ulcer hospitalizations in Taipei rose significantly with increases in air pollutants during the study period.