Health Effects of Ozone on Respiratory Diseases

Ozone therapy in musculoskeletal medicine: a comprehensive review

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Maternal Exposure to Ozone and the Risk of Birth Defects: A Time-Stratified Case-Crossover Study in Southwestern China

A few studies have explored the relationship between air pollution exposure and the risk of birth defects; however, the ozone-related (O3) effects on preconception and first-trimester exposures are still unknown. In this time-stratified case-crossover study, conditional logistic regressions were applied to explore the associations between O3 exposure and the risk of birth defects in Chongqing, China, and stratified analyses were constructed to evaluate the modifiable factors. A total of 6601 cases of birth defects were diagnosed, of which 56.16% were male. O3 exposure was associated with an increased risk of birth defects, and the most significant estimates were observed in the first month before pregnancy: a 10 ug/m3 increase of O3 was related to an elevation of 4.2% [95% confidence interval (CI), 3.4-5.1%]. The associations between O3 exposure and congenital malformations and deformations of the musculoskeletal system were statistically significant during almost all exposure periods. Pregnant women with lower education and income, and from rural areas, were more susceptible to O3 exposure, with the strongest odds ratios (ORs) of 1.066 (95%CI, 1.046-1.087), 1.086 (95%CI, 1.034-1.140), and 1.053 (95%CI, 1.034-1.072), respectively. Our findings highlight the health risks of air pollution exposure and raise awareness of pregnant women's vulnerability and the susceptibility window period.

The relationship between air pollutants and preterm birth and blood routine changes in typical river valley city

OBJECTIVE

To collect maternal maternity information on preterm births in two tertiary hospitals in the urban area of Baota District, Yan'an City, from January 2018 to December 2020, to explore the long-term and short-term effects of air pollutants (PM2.5, PM10, SO2, NO2, CO and O3) and preterm births, and to explore changes in blood cell counts due to air pollutants.

METHODS

Daily average mass concentration data of six air pollutants in the urban area of Yan'an City from January 1, 2017 to December 31, 2020 were collected from the monitoring station in Baota District, Yan'an City. Meteorological information was obtained from the Meteorological Bureau of Yan'an City, including temperature,relative humidity and wind speed for the time period. The mass concentration of air pollutants in each exposure window of pregnant women was assessed by the nearest monitoring station method, and conditional logistic regression was used to analyze the relationship between air pollutants and preterm births, as well as the lagged and cumulative effects of air pollutants. Multiple linear regression was used to explore the relationship between air pollutants and blood tests after stepwise linear regression was used to determine confounders for each blood test.

RESULTS

The long-term effects of pollutants showed that PM2.5, PM10, SO2, NO2and CO were risk factors for preterm birth. In the two-pollutant model, PM2.5, PM10, SO2 and NO2 mixed with other pollutants were associated with preterm birth. The lagged effect showed that PM2.5, PM10, SO2, NO, and CO were associated with preterm birth; the cumulative effect showed that other air pollutants except O3 were associated with preterm birth. The correlation study between air pollutants and blood indicators showed that air pollutants were correlated with leukocytes, monocytes, basophils, erythrocytes, hs-CRPand not with CRP.

CONCLUSION

Exposure to air pollutants is a risk factor for preterm birth. Exposure to air pollutants was associated with changes in leukocytes, monocytes, basophils and erythrocytes and hs-CRP.

Anti-Inflammatory Activity of No-Ozone Cold Plasma in Porphyromonas gingivalis Lipopolysaccharide-Induced Periodontitis Rats

Periodontitis is an inflammatory disease caused by Porphyromonas gingivalis (P. gingivalis) in the oral cavity. This periodontal disease causes damage to the periodontal ligament and alveolar bone and can cause tooth loss, but there is no definite treatment yet. In this study, we investigated the possibility of using no-ozone cold plasma to safely treat periodontitis in the oral cavity. First, human gingival fibroblasts (HGFs) were treated with P. gingivalis-derived lipopolysaccharide (PG-LPS) to induce an inflammatory response, and then the anti-inflammatory effect of NCP was examined, and a study was conducted to identify the mechanism of action. Additionally, the anti-inflammatory effect of NCP was verified in rats that developed an inflammatory response similar to periodontitis. When NCP was applied to PG-LPS-treated HGFs, the activities of inflammatory proteins and cytokines were effectively inhibited. It was confirmed that the process of denaturing the medium by charged particles of NCP is essential for the anti-inflammatory effect of NCP. Also, it was confirmed that repeated treatment of periodontitis rats with NCP effectively reduced the inflammatory cells and osteoclast activity. As a result, this study suggests that NCP can be directly helpful in the treatment of periodontitis in the future.

Environmental Determinants of Post-Discharge Acute Respiratory Illness among Preterm Infants with Bronchopulmonary Dysplasia

OBJECTIVE

To analyze the association of components of the Centers for Disease Control and Prevention (CDC) Environmental Justice Index (EJI) with respiratory health outcomes among infants with bronchopulmonary dysplasia (BPD) within one year after discharge from the neonatal intensive care unit.

METHODS

This was a retrospective cohort study of a cohort of preterm infants with BPD. Multivariable logistic regression models estimated associations of EJI and its components with medically attended acute respiratory illness, defined as an ED visit or inpatient readmission, within one year of discharge from the neonatal intensive care unit. A mediation analysis was conducted to evaluate how environmental injustice may contribute to racial disparities in acute respiratory illness.

RESULTS

Greater EJI was associated with an increased risk of medically attended respiratory illness (per EJI standard deviation increment, aOR 1.38, 95% CI: 1.12-1.69). Of the index's components, the Environmental Burden Module's Air pollution domain had the greatest association (aOR 1.44, 95% CI: 1.44-2.61). With respect to individual indicators within the EJI, Diesel Particulate Matter (DSLPM) and Air Toxic Cancer Risk (ATCR) demonstrated the strongest relationship (aOR 2.06, 95% CI: 1.57-2.71 and aOR 2.10, 95% CI: 1.59-2.78, respectively). Among non-Hispanic Black infants, 63% experienced a medically attended acute respiratory illness as compared to 18% of non-Hispanic White infants. DSLPM mediated 39% of the Black-White disparity in medically attended acute respiratory illness (p = 0.004).

CONCLUSIONS

Environmental exposures, particularly air pollution, are associated with post-discharge respiratory health outcomes among preterm infants with BPD after adjusting for clinical, demographic, and social vulnerability risk factors. Certain types of air pollutants, namely, DSLPM, are more greatly associated with acute respiratory illness. Environmental exposures may contribute to racial disparities in medically attended acute respiratory illness among infants with BPD.

Assessment of ground-level ozone pollution in Türkiye according to new WHO limits

Ground-level ozone is a secondary pollutant and is attributable to respiratory diseases and mortality. For this reason, the World Health Organization (WHO) implemented a new long-term (peak season) limit value for ozone. The previous studies related to ozone in Türkiye were spatially limited to certain locations. In this study, annual mean and peak season ozone concentrations, and limit exceedances were investigated for Türkiye for the year 2021. Moreover, ozone peak seasons were determined for the first time for 126 air quality monitoring stations. The annual mean ozone concentration was determined as 44.3 ± 19.3 µg/m3 whereas the peak season average ozone level was 68.4 ± 27.2 µg/m3. April-September period was the most frequently observed ozone peak season. Among all stations, Erzurum Palandöken was by far the most polluted station in terms of annual mean and limit exceedances of ozone. Ankara Siteler stations have the highest rank in peak season mean. 87 and 83 stations exceeded the short-term and long-term recommendations of WHO, respectively. Four hotspot regions were revealed in terms of peak season exceedance: Adana and surrounding provinces, the surroundings of Burdur and Isparta provinces, and the northeastern and northwestern parts of Türkiye. To protect public health, WHO recommendations for 8-h and peak season limits should be immediately implemented in Turkish regulations.

Transcriptomic-based roadmap to the healthy and ozone-exposed lung

The lung is constantly exposed to a myriad of exogenous stressors. Ground-level ozone represents a ubiquitous and extremely reactive anthropogenic toxicant, impacting the health of millions across the globe. While abundant, epidemiological, in vivo, and in vitro data focuses the ozone toxicity in individual cell types (e.g. epithelial type II, alveolar macrophages) or signaling pathways involved in the injury (e.g., akt, glutathione). When appropriately used, bulk and single cell RNA sequencing techniques have the potential to provide complete, and in certain cases unbiased, information of the molecular events taking place in the steady state and injured lung, and even capture the phenotypic diversity of neighboring cells. To this end, this review compiles information pertaining to the latest understanding of lung cell identity and activation in the steady state and ozone exposed lung. In addition, it discusses the value and benefits of multi-omics approaches and other tools developed to predict cell-cell communication and dissect spatial heterogeneity.

Involvement and repair of epithelial barrier dysfunction in allergic diseases

The epithelial barrier serves as a critical defense mechanism separating the human body from the external environment, fulfilling both physical and immune functions. This barrier plays a pivotal role in shielding the body from environmental risk factors such as allergens, pathogens, and pollutants. However, since the 19th century, the escalating threats posed by environmental pollution, global warming, heightened usage of industrial chemical products, and alterations in biodiversity have contributed to a noteworthy surge in allergic disease incidences. Notably, allergic diseases frequently exhibit dysfunction in the epithelial barrier. The proposed epithelial barrier hypothesis introduces a novel avenue for the prevention and treatment of allergic diseases. Despite increased attention to the role of barrier dysfunction in allergic disease development, numerous questions persist regarding the mechanisms underlying the disruption of normal barrier function. Consequently, this review aims to provide a comprehensive overview of the epithelial barrier's role in allergic diseases, encompassing influencing factors, assessment techniques, and repair methodologies. By doing so, it seeks to present innovative strategies for the prevention and treatment of allergic diseases.

Impacts of changes in climate, land use, and emissions on global ozone air quality by mid-21st century following selected Shared Socioeconomic Pathways

Surface ozone (O3) is a major air pollutant and greenhouse gas with significant risks to human health, vegetation, and climate. Uncertainties around the impacts of various critical factors on O3 is crucial to understand. We used the Community Earth System Model to investigate the impacts of land use and land cover change (LULCC), climate, and emissions on global O3 air quality under selected Shared Socioeconomic Pathways (SSPs). Our findings show that increasing forest cover by 20 % under SSP1 in East China, Europe, and the eastern US leads to higher isoprene emissions leading 2-5 ppb increase in summer O3 levels. Climate-induced meteorological changes, like rising temperatures, further enhance BVOC emissions and increase O3 levels by 10-20 ppb in urban areas with high NOx levels. However, higher BVOC emissions can reduce O3 levels by 5-10 ppb in remote environments. Future NOx emissions control reduces O3 levels by 5-20 ppb in the US and Europe in all SSPs, but reductions in NOx and changes in oxidant titration increase O3 in southeast China in SSP5. Increased NOx emissions in southern Africa and India significantly elevate O3 levels up to 15 ppb under different SSPs. Climate change is equally important as emissions changes, sometimes countering the benefits of emissions control. The combined effects of emissions, climate, and land cover result in worse O3 air quality in northern India (+40 %) and East China (+20 %) under SSP3 due to anthropogenic NOx and climate-induced BVOC emissions. Over the northern hemisphere, surface O3 decreases due to reduced NOx emissions, although climate and land use changes can increase O3 levels regionally. By 2050, O3 levels in most Asian regions exceed the World Health Organization safety limit for over 150 days per year. Our study emphasizes the need to consider complex interactions for effective air pollution control and management in the future.

The Oxygen-Ozone Adjunct Medical Treatment According to the Protocols from the Italian Scientific Society of Oxygen-Ozone Therapy: How Ozone Applications in the Blood Can Influence Clinical Therapy Success via the Modulation of Cell Biology and Immunity

BACKGROUND

Ozone is an allotrope of oxygen whose use in medicine has rapidly grown in recent years. Ozonated blood allows for the use of ozone in a safe modality, as plasma and blood cells are endowed with an antioxidant system able to quench ozone's pro-oxidant property and to elicit the Nrf2/Kwap1/ARE pathway.

METHODS

We present two clinical studies, a case-series (six patients) observational study adopting ozone as a major autohemotherapy and topical ozone to address infected post-surgical wounds with multi-drug resistant bacteria and an observational study (250 patients) using ozonated blood for treating knee osteoarthritis.

RESULTS

Ozonated blood via major autohemotherapy reduced the extent of infections in wounds, reduced the inflammatory biomarkers by more than 75% and improved patients' QoL, whereas ozonated blood via minor autohemotherapy improved significantly (p < 0.001) WOMAC and Lequesne's parameters in knee osteoarthritis.

CONCLUSIONS

The models described, i.e., ozone autohemotherapy in wound antimicrobial treatment and ozonated blood in knee osteoarthrosis, following our protocols, share the outstanding ability of ozone to modulate the innate immune response and address bacterial clearance as well as inflammation and pain.

Influence of age, habitat elevation, and distance to a thermal power plant on pathomorphological findings in the European brown hare (Lepuseuropaeus P.)

The lifespan of the European hare (Lepus europaeus P.) is affected by a number of negative factors, including pollutants. In this paper, the individual and joint influence of age and habitat (elevation and distance from the thermal power plant - TPP) on pathomorphological findings of hares shot during three hunting seasons was investigated. Pathomorphological changes were found in 95.12% of hares. In hares up to 1 year of age, the changes were predominant in the lungs, and in older hares, in the kidneys. Degenerative changes in kidneys and liver and inflammatory changes in kidneys and lungs were considered important most in discussing the influence of chemical pollution. The proximity of TPP influenced the type of changes in the liver. A significant joint effect of age and elevation on the type of changes in the lungs of adult hares and on the heart of young hares was found. Elevation and distance from TPP had a joint effect on the occurrence of changes in the lungs, intestines, and heart in hares from the field farther from TPP. The results indicate that the hares were highly exposed to chemical pollutants that may affect their immunity, and lifespan.

Inhaled toxicants and pulmonary lipid metabolism: biological consequences and therapeutic interventions

Inhaled toxicants drive the onset of and exacerbate preexisting chronic pulmonary diseases, however, the biological mechanisms by which this occurs are largely unknown. Exposure to inhaled toxicants, both environmental and occupational, drives pulmonary inflammation and injury. Upon activation of the inflammatory response, polyunsaturated fatty acids (PUFAs) are metabolized into predominately proinflammatory lipid mediators termed eicosanoids which recruit immune cells to the site of injury, perpetuating inflammation to clear the exposed toxicants. Following inflammation, lipid mediator class-switching occurs, a process that leads to increased metabolism of hydroxylated derivates of PUFAs. These mediators, which include mono-hydroxylated PUFA derivatives and specialized proresolving lipid mediators, initiate an active process of inflammation resolution by inhibiting the inflammatory response and activating resolution pathways to return the tissue to homeostasis. Exposure to inhaled toxicants leads to alterations in the synthesis of these proinflammatory and proresolving lipid mediator pathways, resulting in greater pulmonary inflammation and injury, and increasing the risk for the onset of chronic lung diseases. Recent studies have begun utilizing supplementation of PUFAs and their metabolites as potential therapeutics for toxicant-induced pulmonary inflammation and injury. Here we will review the current understanding of the lipid mediators in pulmonary inflammation and resolution as well as the impact of dietary fatty acid supplementation on lipid mediator-driven inflammation following air pollution exposure.

Global warming and implications for epithelial barrier disruption and respiratory and dermatologic allergic diseases

Global warming has direct and indirect effects, as well as short- and long-term impacts on the respiratory and skin barriers. Extreme temperature directly affects the airway epithelial barrier by disrupting the structural proteins and by triggering airway inflammation and hyperreactivity. It enhances tidal volume and respiratory rate by affecting the thermoregulatory system, causing specific airway resistance and reflex bronchoconstriction via activation of bronchopulmonary vagal C fibers and upregulation of transient receptor potential vanilloid (TRPV) 1 and TRPV4. Heat shock proteins are activated under heat stress and contribute to both epithelial barrier dysfunction and airway inflammation. Accordingly, the frequency and severity of allergic rhinitis and asthma have been increasing. Heat activates TRPV3 in keratinocytes, causing the secretion of inflammatory mediators and eventually pruritus. Exposure to air pollutants alters the expression of genes that control skin barrier integrity and triggers an immune response, increasing the incidence and prevalence of atopic dermatitis. There is evidence that extreme temperature, heavy rains and floods, air pollution, and wildfires increase atopic dermatitis flares. In this narrative review, focused on the last 3 years of literature, we explore the effects of global warming on respiratory and skin barrier and their clinical consequences.

Catalysts for highly water-resistant catalytic decomposition of ozone: Hausmannite Mn3O4 on exposed (101) crystal surface

Recently, ozone pollution has gradually replaced PM2.5 as the main pollutant affecting air pollution. In this study, we synthesized a series of Mn₃O₄ catalysts by hydrothermal method changing the precursors and tested their activities at different relative humidity, gas volume space velocity of 150,000 h^-1 and 5 ppm ozone. Remarkably, Mn₃O₄-SO₄ prepared with MnSO₄ as precursor showed excellent catalytic ozone decomposition activity, almost completely converting 5 ppm of ozone at different relative humidity ranges. Finally, the most active Mn₃O₄-SO₄ catalyst was tested for its usability limit at RH= 90%, after 28 h of testing under high humidity conditions, it had retained successfully the complete decomposition of low concentrations of ozone. The catalysts were characterized by XRD, Raman, HRTEM, XPS, BET, H₂O-TPD and in situ IR NH₃ adsorption. The characterization analysis revealed that the Mn₃O₄-SO₄ surface could exposed a highly active (101) crystalline surface with high specific surface area, excellent hydrophobicity as well as ozone adsorption capacity, which were highly favorable for ozone decomposition under high humidity conditions. In this work, Mn₃O₄ exhibits good catalytic activity, which provides an additional option for future studies of manganese oxides.

Relationship between air pollution exposure and the progression of idiopathic pulmonary fibrosis in Madrid: Chronic respiratory failure, hospitalizations, and mortality. A retrospective study

Introduction

Air pollution has a significant impact on the morbidity and mortality of various respiratory diseases. However, this has not been widely studied in diffuse interstitial lung diseases, specifically in idiopathic pulmonary fibrosis.

Objective

In this study we aimed to assess the relationship between four major air pollutants individually [carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and nitrogen oxides (NOx)] and the development of chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.

Methods

We conducted an exploratory retrospective panel study from 2011 to 2020 in 69 patients with idiopathic pulmonary fibrosis from the pulmonary medicine department of a tertiary hospital. Based on their geocoded residential address, levels of each pollutant were estimated 1, 3, 6, 12, and 36 months prior to each event (chronic respiratory failure, hospital admission and mortality). Data was collected from the air quality monitoring stations of the Community of Madrid located &lt;3.5 km (2.2 miles) from each patient's home.

Results

The increase in average values of CO [OR 1.62 (1.11–2.36) and OR 1.84 (1.1–3.06)], NO2 [OR 1.64 (1.01–2.66)], and NOx [OR 1.11 (1–1.23) and OR 1.19 (1.03–1.38)] were significantly associated with the probability of developing chronic respiratory failure in different periods. In addition, the averages of NO2, O3, and NOx were significantly associated with the probability of hospital admissions due to respiratory causes and mortality in these patients.

Conclusion

Air pollution is associated with an increase in the probability of developing chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.

Air pollution and its effects on emergency room visits in tertiary respiratory care centers in Delhi, India

Environmental pollution has harmful effects on human health, particularly the respiratory system. We aimed to study the impact of daily ambient air pollution on daily emergency room visits for acute respiratory symptoms. This study was conducted in two tertiary respiratory care centres in Delhi, India. Daily counts of emergency room visits were collected. All patients attending the emergency room were screened for acute onset (less than 2 weeks) of respiratory symptoms and were recruited if they were staying in Delhi continuously for at least 4 weeks and having onset (≤2 weeks) of respiratory symptoms. Daily average air pollution data for the study period was obtained from four continuous ambient air quality monitoring stations. A total of 61,285 patients were screened and 11,424 were enrolled from June 2017 to February 2019. Cough and difficulty in breathing were most common respiratory symptoms. Poor air quality was observed during the months of October to December. Emergency room visits with acute respiratory symptoms significantly increased per standard deviation increase in PM10 from lag days 2-7. Increase in wheezing was primarily seen with increase in NO2. Pollutant levels have effect on acute respiratory symptoms and thus influence emergency room visits. *************************************************************** *Appendix Authors list Kamal Singhal,1 Kana Ram Jat,2 Karan Madan,3 Mohan P. George,4 Kalaivani Mani,5 Randeep Guleria,3 Ravindra Mohan Pandey,5 Rupinder Singh Dhaliwal,6 Rakesh Lodha,2 Varinder Singh1 1Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India 2Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India 3Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India 4Department of Environment, Delhi Pollution Control Committee, Kashmere Gate, New Delhi, India 5Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India 6Department of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India.

Modification effects of ambient temperature on associations of ambient ozone exposure before and during pregnancy with adverse birth outcomes: A multicity study in China

BACKGROUND

Epidemiological studies suggest that both ambient ozone (O₃) and temperature were associated with increased risks of adverse birth outcomes. However, very few studies explored their interaction effects, especially for small for gestational age (SGA) and large for gestational age (LGA).

OBJECTIVES

To estimate the modification effects of ambient temperature on associations of ambient O₃ exposure before and during pregnancy with preterm birth (PTB), low birth weight (LBW), SGA and LGA based on multicity birth cohorts.

METHODS

A total of 56,905 singleton pregnant women from three birth cohorts conducted in Tianjin, Beijing and Maoming, China, were included in the study. Maximum daily 8-h average O₃ concentrations of each pregnant woman from the preconception period to delivery for every day were estimated by matching their home addresses with the Tracking Air Pollution in China (TAP) datasets. We first applied the Cox proportional-hazards regression model to evaluate the city-specific effects of O₃ exposure before and during pregnancy on adverse birth outcomes at different temperature levels with adjustment for potential confounders, and then a meta-analysis across three birth cohorts was conducted to calculate the pooled associations.

RESULTS

In pooled analysis, significant modification effects of ambient temperature on associations of ambient O₃ with PTB, LBW and LGA were observed (P_interaction < 0.05). For a 10 μg/m³ increase in ambient O₃ exposure at high temperature level (> 75^th percentile), the risk of LBW increased by 28 % (HR: 1.28, 95% CI: 1.13-1.46) during the second trimester and the risk of LGA increased by 116% (HR: 2.16, 95%CI: 1.16-4.00) during the entire pregnancy, while the null or weaker association was observed at corresponding low (≤ 25^th percentile) and medium (> 25^th and ≤ 75^th percentile) temperature levels.

CONCLUSION

This multicity study added new evidence that ambient high temperature may enhance the potential effects of ambient O₃ on adverse birth outcomes.

The impact of ambient air pollution on lung function and respiratory symptoms in elite athletes

BACKGROUND

Air pollution has become a significant public health concern. During exercise, many physiological factors are thought to increase the effects of air pollution. Air pollution most affects lung function and respiratory symptoms. We investigated the association between lung function, respiratory symptoms, and air pollutant concentration with meteorological factors in elite sports athletes.

METHODS

A total of 59 elite sports athletes from the Korea National Sports University participated in this prospective, observational study from September 2019 to June 2020. At ten visits, lung function and respiratory symptoms were obtained after a training session. We measured six air pollutants, including SO₂, CO, O₃, NO₂, PM₁₀, and PM_2.5, and two meteorological factors, including humidity and temperature. Air pollutants and meteorological factors were measured by two nearest depositories of the national air pollution information system in Korea.

RESULTS

In a single-pollutant model, PM_2.5, PM₁₀, NO₂, and CO were inversely associated with both FEV₁ and FEV₆, 10 μg/m³ in PM_2.5 was associated with a 32.31 mL decrease in FEV₁ and a 36.93 mL decrease in FEV₆. Meanwhile, O₃ and temperature had positive associations with both FEV₁ (13.00 and 3.15 mL) and FEV₆ (16.91 and 4.76 mL) and humidity with FEV₆ (11.98 mL). In the multi-pollutant model at lag 0, FEV₁ was associated negatively with O₃ and NO₂ (-50.68 and -6.87 mL) and positively with SO₂ and temperature (65.76 and 8.08 mL). In the multi-pollutant model at lag 6, temperature was associated with FEV₁ and FEV₆ (6.01 and 8.89 mL). PM_2.5, PM₁₀, NO₂, CO, and temperature were significantly associated with FEV₁ and FEV₆ through lag 0-6.

CONCLUSIONS

Air pollutants and meteorological factors are associated with lung function and respiratory symptoms and have cumulative effects among elite athletes. In the multi-pollutant model, temperature has the most significant effect on lung function.

Ozone Disinfection for Elimination of Bacteria and Degradation of SARS-CoV2 RNA for Medical Environments

Pathogenic bacteria and viruses in medical environments can lead to treatment complications and hospital-acquired infections. Current disinfection protocols do not address hard-to-access areas or may be beyond line-of-sight treatment, such as with ultraviolet radiation. The COVID-19 pandemic further underscores the demand for reliable and effective disinfection methods to sterilize a wide array of surfaces and to keep up with the supply of personal protective equipment (PPE). We tested the efficacy of Sani Sport ozone devices to treat hospital equipment and surfaces for killing Escherichia coli, Enterococcus faecalis, Bacillus subtilis, and Deinococcus radiodurans by assessing Colony Forming Units (CFUs) after 30 min, 1 h, and 2 h of ozone treatment. Further gene expression analysis was conducted on live E. coli K12 immediately post treatment to understand the oxidative damage stress response transcriptome profile. Ozone treatment was also used to degrade synthetic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA as assessed by qPCR CT values. We observed significant and rapid killing of medically relevant and environmental bacteria across four surfaces (blankets, catheter, remotes, and syringes) within 30 min, and up to a 99% reduction in viable bacteria at the end of 2 h treatment cycles. RNA-seq analysis of E. coli K12 revealed 447 differentially expressed genes in response to ozone treatment and an enrichment for oxidative stress response and related pathways. RNA degradation of synthetic SARS-CoV-2 RNA was seen an hour into ozone treatment as compared to non-treated controls, and a non-replicative form of the virus was shown to have significant RNA degradation at 30 min. These results show the strong promise of ozone treatment of surfaces for reducing the risk of hospital-acquired infections and as a method for degradation of SARS-CoV-2 RNA.

Short-term health impacts related to ozone in China before and after implementation of policy measures: A systematic review and meta-analysis

This paper presents a meta-analysis of the impacts of short-term exposure to ozone (O₃) on three health endpoints: all-cause, cardiovascular, and respiratory mortality in China. All relevant studies from January 1990 to December 2021 were searched from four databases. After screening, 30 studies were included for the meta-analysis. The results showed that a significant rise of 0.41 % (95 % confidence interval (CI): 0.35 %-0.48 %) in all-cause, 0.60 % (95 % CI: 0.51 %-0.68 %) in cardiovascular and 0.45 % (95 % CI: 0.28 %-0.62 %) in respiratory mortality for each 10 μg m^-3 increase in the maximum daily 8 h average O₃ concentration (MDA8 O₃). Moreover, results stratified by heterogeneous time periods before and after implementing a policy measure in 2013, showed that the pooled effects for all-cause and respiratory mortality before were greater than those after, while the pooled effects for cardiovascular mortality before 2013 were slightly smaller than those after. The finding that short-term exposure to O₃ was positively related to the three health endpoints was validated by means of a sensitivity analysis. Furthermore, we did not observe any publication bias. Our results present an updated and better understanding of the relationship between short-term exposure to O₃ and the three health endpoints, while providing a reference for further assessment of the impact of short-term O₃ exposure on human health.

Improvement of an In-Duct Two-Stage Electrostatic Precipitator via Diffusion Charging

An in-duct two-stage electrostatic precipitator (ESP) improved by ion diffusion effect was studied. We increased the collection efficiency of a two-stage electrostatic precipitator without additional energy input by adjusting the space arrangement of the charger and the collector, which increased the particle diffusion charging time. The collection efficiency and the particle charge were systematically investigated according to the occurrence of diffusion charging and electric field charging in the charger as generated by the negative ions. The collection efficiency of the separated two-stage ESP was 39% higher, on average, than the theoretical efficiency at the same power consumption. Through simulation, it was verified that the ions generated in the carbon fiber ionizer penetrated the charger. We proposed a modified charging mechanism assuming that the penetrated ions cause additional particle charge. The optimal separation distance between the charger and the collector, which showed the maximum collection efficiency, was derived through the modified charging model. Therefore, the in-duct two-stage ESP developed in this study is a promising energy-efficient and cost-saving design for indoor air management.

Low-to-moderate atmospheric ozone levels are negatively correlated with hospital visits by asthma patients

Asthma is a chronic illness of the airways that affects approximately 300 million individuals worldwide. While it is commonly accepted that high ozone levels exacerbate asthma symptoms, the impact of low to moderate ozone levels on asthma symptoms has received little attention. The purpose of this research was to determine the relationship between hospital visits by asthma patients showing the severity of their symptoms and moderate ozone levels. Statistical analyses were performed on hospital visit big data for asthma patients in Seoul, Korea, collected between 2013 and 2017. The data set includes outpatient hospital visits (n = 17,787,982), hospital admissions (n = 215,696), and emergency department visits (n = 85,482). The frequency of hospital visits by asthma patients was evaluated in relation to low ozone levels (< 0.03 ppm) and moderate ozone levels (0.03-0.06 ppm) in the Seoul environment. In comparison to low ozone levels, moderate ozone levels resulted in a reduction in outpatient hospital visits (t = 7.052, P < .001). When ozone levels were low to moderate, there was a negative correlation between ozone levels and outpatient visits (r = -0.281, 95% CI: -0.331 to -0.228). Negative associations were also identified between ozone levels and new hospital admissions (t = 2.909, P < .01; r = -0.125, 95% CI: -0.179 to -0.070) and emergency treatments (t = 2.679, P < .01; r = -0.132, 95% CI: -0.186 to -0.076). Additionally, it was verified that moderate ozone levels one day before the visits resulted in a reduction in outpatient visits (t = 5.614, P < .001; r = -0.207, 95% CI: -0.259 to -0.153). A strong relationship was identified between moderate atmospheric ozone levels and a reduction in asthma patient hospital visits.

Machine Learning-Based Analyses of the Effects of Various Types of Air Pollutants on Hospital Visits by Asthma Patients

Asthma is a chronic respiratory disorder defined by airway inflammation, chest pains, wheezing, coughing, and difficulty breathing that affects an estimated 300 million individuals globally. Although various studies have shown an association between air pollution and asthma, few studies have used statistical and machine learning algorithms to investigate the effect of each individual air pollutant on asthma. The purpose of this research was to assess the association between air pollutants and the frequency of hospital visits by asthma patients using three analysis methods: linear correlation analyses were performed by Pearson correlation coefficients, and least absolute shrinkage and selection operator (LASSO) and random forest (RF) models were used for machine learning-based analyses to investigate the effect of air pollutants. This research studied asthma patients using the hospital visit database in Seoul, South Korea, collected between 2013 and 2017. The data set included outpatient hospital visits (n = 17,787,982), hospital admissions (n = 215,696), and emergency department visits (n = 85,482). The daily atmospheric environmental information from 2013 to 2017 at 25 locations in Seoul was evaluated. The three analysis models revealed that NO₂ was the most significant pollutant on average in outpatient hospital visits by asthma patients. For example, NO₂ had the greatest impact on outpatient hospital visits, resulting in a positive association (r=0.331). In hospital admissions of asthma patients, CO was the most significant pollutant on average. It was observed that CO exhibited the most positive association with hospital admissions (I = 3.329). Additionally, a significant time lag was found between both NO₂ and CO and outpatient hospital visits and hospital admissions of asthma patients in the linear correlation analysis. In particular, NO₂ and CO were shown to increase hospital admissions at lag 4 in the linear correlation analysis. This study provides evidence that PM_2.5, PM₁₀, NO₂, CO, SO₂, and O₃ are associated with the frequency of hospital visits by asthma patients.

High-frequency devices effect in vitro: promissing approach in the treatment of acne vulgaris?

BACKGROUND

Acne vulgaris is an inflammatory skin disorder leading to an impairment of quality of life and is therefore not only a cosmetic issue. Its pathogenesis is multifactorial - of particular importance is the colonization with the bacterium Propionibacterium acnes. A wide range of different treatment options exists including topical and systemic treatments depending on severity. High Frequency (HF) therapy, historically developed in the 19^th century, claims antimicrobial effects on acne skin, but solid data on its efficacy and mechanism of action is lacking.

OBJECTIVES

The main objective of this study was to determine the efficacy of HF therapy on skin flora and P. acnes in vitro using a commercial device as well as to review studies on the mechanism of action.

METHODS

The plasma source was investigated regarding electrical settings, heat, and ozone development. Bacterial skin flora, fungal isolates, and P. acnes were exposed to HF in vitro and compared to unexposed controls by evaluating the number of colonies on agar plates. To further analyze bacterial species from normal skin flora, 16S-sequencing was performed. Statistical analyses were carried out using row analysis and unpaired t-test.

RESULTS

HF treatment led to a significant reduction of almost every bacterial and fungal species investigated in this study. Moreover, the number of colonies forming units was significantly decreased in P. acnes after HF treatment compared to controls in vitro.

STUDY LIMITATIONS

The experiments were performed in vitro only. To assess clinical effects further in vivo experiments are necessary.

CONCLUSIONS

The results collected in this study, although in vitro, provide a mechanistic basis for HF as a complementary treatment option for patients with acne. It might also have a beneficial effect on patients with superficial infectious skin of the skin.

Investigation of COVID-19-related lockdowns on the air pollution changes in augsburg in 2020, Germany

The COVID-19 pandemic in Germany in 2020 brought many regulations to impede its transmission such as lockdown. Hence, in this study, we compared the annual air pollutants (CO, NO, NO₂, O₃, PM₁₀, PM_2.5, and BC) in Augsburg in 2020 to the record data in 2010-2019. The annual air pollutants in 2020 were significantly (p < 0.001) lower than that in 2010-2019 except O₃, which was significantly (p = 0.02) higher than that in 2010-2019. In a depth perspective, we explored how lockdown impacted air pollutants in Augsburg. We simulated air pollutants based on the meteorological data, traffic density, and weekday and weekend/holiday by using four different models (i.e. Random Forest, K-nearest Neighbors, Linear Regression, and Lasso Regression). According to the best fitting effects, Random Forest was used to predict air pollutants during two lockdown periods (16/03/2020-19/04/2020, 1st lockdown and 02/11/2020-31/12/2020, 2nd lockdown) to explore how lockdown measures impacted air pollutants. Compared to the predicted values, the measured CO, NO₂, and BC significantly reduced 18.21%, 21.75%, and 48.92% in the 1st lockdown as well as 7.67%, 32.28%, and 79.08% in the 2nd lockdown. It could be owing to the reduction of traffic and industrial activities. O₃ significantly increased 15.62% in the 1st lockdown but decreased 40.39% in the 2nd lockdown, which may have relations with the fluctuations the NO titration effect and photochemistry effect. PM₁₀ and PM_2.5 were significantly increased 18.23% an 10.06% in the 1st lockdown but reduced 34.37% and 30.62% in the 2nd lockdown, which could be owing to their complex generation mechanisms.

Short-term effects of gaseous air pollutants on outpatient visits for respiratory diseases: a case-crossover study in Baotou, China

Air pollution is a major public health problem throughout the world. Although there have been several studies in this field, most of them have focused on particulate matter and only covered a few key cities. This study aimed to assess a potential association between exposure to gaseous air pollutants and outpatient visits for respiratory diseases in Baotou, China. Daily outpatient visits for respiratory diseases and daily averages of air pollutants and meteorological parameters from 2015 to 2020 were obtained. Time-stratified case-crossover design and restricted cubic splines were used to perform the analyses. Stratified analyses were performed in different hospital departments and districts. Significant association between the concentrations of air pollutants and outpatient visits for respiratory diseases was observed. The odds ratios of outpatient visits for respiratory diseases associated with per 10 μg/m³ increases in concentrations of NO₂ and SO₂, and per 10 mg/m³ increases in concentrations of CO were 1.033 (95% CI: 1.018 to 1.049), 0.965 (95% CI: 0.954 to 0.976), and 1.038 (95% CI: 1.006 to 1.071), respectively. Short-term exposure to NO₂, SO₂, and CO was positively associated with outpatient visits for respiratory diseases, with stronger effects among children. The relationship between O₃ and respiratory diseases varied at different concentrations.

Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease

Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.

Long-term exposure to ambient nitrogen dioxide and ozone modifies systematic low-grade inflammation: The CHCN-BTH study

The potential effect of long-term exposure to ambient air pollutants on low-grade systematic inflammation has seldom been evaluated taking indoor air pollution and self-protection behaviors on smog days into account. A total of 24,346 participants at baseline were included to conduct a cross-sectional study. The annual (2016) average pollutant concentrations were assessed by air monitoring stations for PM_2.5, PM₁₀, SO₂, NO₂, O₃ and CO. Associations between annual ambient air pollution and low-grade systematic inflammation (hsCRP>3 mg/L) were estimated by generalized linear mixed models. Stratification analysis was also performed based on demographic characteristics, health-related behaviors and disease status. Annual ambient NO₂ and O₃ were all associated with low-grade systematic inflammation in single-pollutant models after adjusting for age, sex, blood lipids, blood pressure, lifestyle risk factors, cooking fuel, heating fuel and habits during smog days (NO₂ per 10 μg/m³: OR = 1.057, P = 0.018; O₃ per 10 μg/m³: OR = 0.953, P = 0.012). The 2-year and 3-year ozone concentrations were consistently associated with lower systematic inflammation (2-year O₃ per 10 μg/m³: OR = 0.959, P = 0.004; 3-year O₃ per 10 μg/m³: OR = 0.961, P = 0.014). In two-pollutant models, the estimated effects of annual NO₂ and O₃ on low-grade systematic inflammation remained stable. The effect size of annual pollutants on inflammation increased in participants without air-purifier usage (NO₂ per 10 μg/m³: OR = 1.079, P = 0.009; O₃ per 10 μg/m³: OR = 0.925, P = 0.001), while the association was null in the air-purifier usage group. Thus, long-term exposure to ambient NO₂ and O₃ was associated with low-grade systemic inflammation, and the results were generally stable after sensitivity analysis. The usage of air purifiers on smog days can modify the association between gaseous pollutants and systematic inflammation.

Environment and lung diseases

Genetic and environmental risk factors influence the development of respiratory diseases. While cigarette smoking is a personal risk factor, ambient air pollution and chemicals such as asbestos are major environmental risk factors for respiratory diseases. In addition, the growth of children’s lung is also sensitively affected by environmental exposure to pollutants and heavy metals. Many studies have found that certain populations including children, elderly and residents near chemical factories are more susceptible to environmental lung diseases, which indicate the importance and benefits of strategic planning at the national level. Although genetic risk factors may be hard to control, many of the environmental risk factors can be prevented and managed by correct policy-making. Therefore, in-depth researches should be continued, and careful considerations should be given to policy-making in efforts to lower environmental risk factors and make a better environment for the future generation. Environmental exposure leads to epigenetic changes in airway and lung tissues as well as blood cells. Although not yet completely understood, the mechanism involved in such changes can act as biomarkers or therapeutic targets for the diagnosis and treatment of environmental lung diseases.

Reliability of Portable Spirometry Performed in the Korea National Health and Nutrition Examination Survey Compared to Conventional Spirometry

Background

The Korea National Health and Nutrition Examination Survey (KNHANES) is a well-designed survey to collect national data, which many researchers have used for their studies. In KNHANES, although portable spirometry was used, its reliability has not been verified.

Methods

We prospectively enrolled 58 participants from four Korean institutions. The participants were classified into normal pattern, obstructive pattern, and restrictive pattern groups according to their previous spirometry results. Lung function was estimated by conventional spirometry and portable spirometry, and the results were compared.

Results

The intraclass correlation coefficients of forced vital capacity (FVC) (coefficient, 9.993; 95% confidence interval [CI], 0.988–0.996), forced expiratory volume in 1 second (FEV₁) (coefficient, 0.997; 95% CI, 0.995–0.998), FEV₁/FVC ratio (coefficient, 0.995; 95% CI, 0.992–0.997), and forced expiratory flow at 25–75% (FEF25–75%; coefficient, 0.991; 95% CI, 0.984–0.994) were excellent (all p<0.001). In the subgroup analysis, the results of the three parameters were similar in all groups. In the overall and subgroup analyses, Pearson’s correlation of all the parameters was also excellent in the total (coefficient, 0.986–0.994; p<0.001) and subgroup analyses (coefficient, 0.915–0.995; p<0.001). In the paired t-test, FVC, FEV₁/FVC, and FEF25–75% estimated by the two instruments were statistically different. However, FEV₁ was not significantly different.

Conclusion

Lung function estimated by portable spirometry was well-correlated with that estimated by conventional spirometry. Although the values had minimal differences between them, we suggest that the spirometry results from the KNHANES are reliable.