Is breathing our polluted air a risk factor for stroke?

Exploring the association between plasma lipids changes and embolization recurrence following intravenous thrombolysis with alteplase in acute ischemic stroke based on lipidomics

BACKGROUND

Alteplase is a widely used thrombolytic therapy for acute ischemic stroke (AIS). However, the efficacy of intravenous thrombolysis (IVT) with alteplase varies due to individual factors, and some patients are prone to embolization recurrence (ER) after IVT. The mechanisms underlying these variations are not fully understood.

METHODS

In this study, we analyzed changes in plasma lipid profiles of AIS patients treated with alteplase based on lipidomics, focusing on the association between plasma lipids changes and embolization recurrence.

RESULTS

Our findings revealed significant changes in several lipid species in patients who experienced ER, including triglycerides (TG), diglycerides (DG), phosphatidylcholine (PC), and sphingomyelin (SM). Notably, most TG and DG levels in ER group were significantly upregulated, PC and SM levels were downregulated. However, most PC was upregulated 24h after IVT treatment, while DG, SM, TG remained downregulated. These differential lipid metabolites are mainly involved in lipid metabolism, immune response inflammation-related, and insulin resistance signaling pathways.

CONCLUSION

This study demonstrates that lipid alterations, particularly in TG, DG, PC, and SM, may be associated with ER after alteplase treatment. However, further studies are needed to elucidate the exact mechanisms through which these lipids influence the onset and recovery of AIS.

Studying the Relationship Between Coal Consumption and Health of Rural Residents: Evidence from China

Due to the remoteness of rural areas, the impact of environmental pollution on residents' health has not received adequate attention. This study examined the relationship between coal consumption and residents' health status in rural areas in China between 2005 and 2021. We explored the impact of air pollution caused by coal combustion on the health of rural residents in China and provided associated countermeasures. The annual number of medical visits of rural residents was evaluated via multiple regression, and the Pearson correlation and Granger causality tests were used to evaluate the relationships between coal consumption and the changes in mortality rates of various diseases in rural areas. The results revealed that coal consumption for domestic use had a significant (P < .001) positive effect on the frequency of medical treatment, whereas this effect was not significant at the production end. Significant positive correlations existed between coal consumption in rural areas and increased mortality rates for 7 out of the 10 main diseases. Causal relationships were identified between coal consumption and increased mortality rates due to urogenital system diseases and nervous system diseases. The empirical results of this study suggest that the gradual promotion of clean energy replacement of coal with electricity and natural gas in rural areas should reduce the probability of exposure to gas emitted from coal combustion for rural residents. Related diseases in coal-consuming areas should be screened regularly to effectively protect the health and safety of rural residents.

Primary Prevention of Ischemic Stroke

Ischemic stroke is by far the most common type of cerebrovascular event and remains a major cause of death and disability globally. Despite advancements in acute stroke care, primary prevention is still the most cost-effective approach in reducing the burden of ischemic stroke. The two main strategies for primary stroke prevention include population-wide versus high-risk group interventions. Interventions such as increasing access to primary care, regulation of salt and sugar contents in processed foods, public education, and campaigns to control cerebrovascular risk factors are examples of population-wide interventions. High-risk group interventions, on the other hand, focus on recognition of individuals at risk and aim to modify risk factors in a timely and multifaceted manner. This article provides an overview on conventional modifiable risk factors for ischemic stroke and highlights the emerging risk factors and approaches for high-risk group identification and treatment.

Air Pollution and Its Devastating Effects on the Central Nervous System

Air pollution is a real public health problem, it being one of the five most common causes of mortality in developing countries. However, pollution studies have focused on the cardiovascular and pulmonary systems in recent decades. Recently, researchers have moved towards a new direction, tracing a direct link between pollution and stroke. Stroke has many known risk factors such as smoking, a sedentary lifestyle, and hypertension. Pollution is universally widespread, already a matter of public interest, so that, although intuitive, it is difficult to connect the two. The particles found in the air that we breathe, regardless of their origin, can attack the body in different ways, causing inflammation, and triggering a true cascade of phenomena that end up attacking the central nervous system and other organs. This article tries to explain the series of phenomena that determine the harmful effect of particles present in the air, with an increased focus on the central nervous system and especially on strokes. A deeper understanding of these phenomena helps in guiding future studies and finding viable solutions to protect people at risk.

Short-Term Effects of Low-Level Ambient Air NO2 on the Risk of Incident Stroke in Enshi City, China

Previous studies found that exposure to ambient nitrogen dioxide (NO₂) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO₂ pollution areas. In this study, the short-term effects of NO₂ on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO₂ exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO₂ had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO₂ still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO₂ on incident total stroke were still statistically significant after adjusting for other air pollutants (PM_2.5, PM₁₀, SO₂, CO, and O₃). In addition, the effects of NO₂ exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO₂ was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO₂, and the adverse effects might be promoted in the cold season.

Air pollution and cardiovascular disease: Can the Australian bushfires and global COVID-19 pandemic of 2020 convince us to change our ways?

Air pollution is a major global challenge for a multitude of reasons. As a specific concern, there is now compelling evidence demonstrating a causal relationship between exposure to airborne pollutants and the onset of cardiovascular disease (CVD). As such, reducing air pollution as a means to decrease cardiovascular morbidity and mortality should be a global health priority. This review provides an overview of the cardiovascular effects of air pollution and uses two major events of 2020-the Australian bushfires and COVID-19 pandemic lockdown-to illustrate the relationship between air pollution and CVD. The bushfires highlight the substantial human and economic costs associated with elevations in air pollution. Conversely, the COVID-19-related lockdowns demonstrated that stringent measures are effective at reducing airborne pollutants, which in turn resulted in a potential reduction in cardiovascular events. Perhaps one positive to come out of 2020 will be the recognition that tough measures are effective at reducing air pollution and that these measures have the potential to stop thousands of deaths from CVD.

Trends and Challenges of Wearable Multimodal Technologies for Stroke Risk Prediction

We review in this paper the wearable-based technologies intended for real-time monitoring of stroke-related physiological parameters. These measurements are undertaken to prevent death and disability due to stroke. We compare the various characteristics, such as weight, accessibility, frequency of use, data continuity, and response time of these wearables. It was found that the most user-friendly wearables can have limitations in reporting high-precision prediction outcomes. Therefore, we report also the trend of integrating these wearables into the internet of things (IoT) and combining electronic health records (EHRs) and machine learning (ML) algorithms to establish a stroke risk prediction system. Due to different characteristics, such as accessibility, time, and spatial resolution of various wearable-based technologies, strategies of applying different types of wearables to maximize the efficacy of stroke risk prediction are also reported. In addition, based on the various applications of multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS) on stroke patients, the perspective of using this technique to improve the prediction performance is elaborated. Expected prediction has to be dynamically delivered with high-precision outcomes. There is a need for stroke risk stratification and management to reduce the resulting social and economic burden.

Nrf2/HO-1 partially regulates cytoprotective effects of carbon monoxide against urban particulate matter-induced inflammatory responses in oral keratinocytes

INTRODUCTION

Exposure to airborne particulate matter (PM) increases the proportion of oral inflammatory diseases. During the formation of inflammatory conditions, the nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3) inflammasome activation plays an important regulator. Carbon monoxide (CO) arising from heme degradation, catalyzed particularly by heme oxygenase-1 (HO-1), has been shown to own cytoprotective effects including anti-inflammation and antioxidant. Here, we determined the novel mechanisms of carbon monoxide releasing molecule-2 (CORM-2) on PM-induced inflammatory responses in human oral keratinocytes (HOKs).

METHODS

The effects of CORM-2 on the expression of various inflammatory proteins induced by PM were determined by Western blot, real-time PCR, promoter assay, and ELISA. The involvement of signaling molecules in these responses was studied by using the selective pharmacological inhibitors and siRNAs.

RESULTS

We proved that PM enhanced C-reactive protein (CRP) levels, NLRP3 inflammasome and caspase-1 activation, and IL-1β release, which were reduced by preincubation with CORM-2. Transfection with PKCα siRNA and preincubation with the ROS scavenger (N-acetyl-cysteine, NAC), an inhibitor of NADPH oxidase (diphenyleneiodonium, DPI), or the mitochondria-specific superoxide scavenger (MitoTEMPO) inhibited PM-mediated inflammatory responses. In addition, PM-regulated PKCα and NADPH oxidase activation as well as NADPH oxidase- and mitochondria-derived ROS generation were inhibited by CORM-2, but not inactivate CORM-2 (iCORM-2) pretreatment. At the end, we confirmed that CORM-2 improved PM-induced inflammatory responses via the induction of Nrf2 activation and HO-1 expression.

CONCLUSION

We suggest that CORM-2 inhibits PM-induced inflammatory responses in HOKs via the inhibition of PKCα/ROS/NLRP3 inflammasome activation combined with the induction of Nrf2/HO-1 expression.