Association between ambient temperature, PM2.5 and tuberculosis in Northwest China

   Existing evidence suggested that the risk of tuberculosis (TB) infection was associated to the variations in temperature and PM2.5. A total of 9,111 cases of TB were reported in Ningxia Hui Autonomous Region, China from 2013 to 2015 on a daily basis, and 57.2% of them were male. The TB risk was more prominent for a lower temperature in males (RR of 1.724, 95% CI: 1.241, 2.394), the aged over 64 years (RR of 2.241, 95% CI: 1.554, 3.231), and the high mobility occupation subpopulation (RR of 2.758, 95% CI: 1.745, 4.359). High concentration of PM2.5 showed a short-term effect and was only associated with an increased risk in the early stages of exposure for the female, and aged 36-64 years group. There were 15.06% (1370 cases) of cases of TB may be attributable to the temperature, and 2.94% (268 cases) may be attributable to the increase of PM2.5 exposures. Low temperatures may be associated with significantly increase in the risk of TB, and high PM2.5 concentrations have a short-term association on increasing the risk of TB. Strengthening the monitoring and regular prevention and control of high risk groups will provide scientific guidance to reduce the incidence of TB.

Examining health disparities and characteristics in general practice utilization: based on outpatient data from 2014 - 2018 in Shanghai

BACKGROUND

Since 2000, China has been developing primary care institutions to serve as the gateway to the healthcare system. However, the investment of resources in primary care institutions is not based on the actual medical demands of the public. This study analysed primary care utilization to provide targeted guidance for the improvement of primary healthcare delivery in China.

METHODS

We extracted outpatient visit data from all community healthcare centres in Shanghai from 2014 to 2018. Diseases were then classified according to ICD-10 codes. The disease spectrum (frequency, proportion, rank) was stratified by sex, age, and region.

RESULTS

Most primary care outpatients were female (58.20%), 60-79 years old (57.91%), and in suburban regions (62.18%). Chronic diseases accounted for the majority (91.41%). Hypertension, chronic ischaemic heart disease, diabetes, and acute upper respiratory tract infections were the top four disorders for primary care visits regardless of sex. In the group aged 0-18 years, symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified accounted for 37.96% of the top 20 reasons. Acute upper respiratory tract infections were the most common diseases in the groups aged 0-18 (11.20%) and 19-39 (11.14%) years. However, hypertension was the most common disease in the group aged > 39 years old (> 20%). There were more outpatients with respiratory and digestive diseases in suburban areas than in urban areas. In addition, problems associated with medical equipment and other healthcare deficiencies were relatively more common in suburban areas (suburban: 4.13%, rank 5; urban: 2.29%, rank 10).

CONCLUSIONS

To meet the patients' needs and to develop the primary care system, the Shanghai government should focus on diseases with regionally high proportions. Disease diagnosis and treatment should be improved in the younger and suburban populations.

Investigation of inflammation inducing substances in PM2.5 particles by an elimination method using thermal decomposition

The substances associated with PM2.5-induced inflammatory response were investigated using an elimination method. PM2.5 were heated at temperatures of 120, 250, and 360°C. The results demonstrated microbial substances such as LPS and b-glucan, and chemicals including BaP, 1,2-NQ, and 9,10-PQ were reduced drastically in PM2.5 heated at 120°C. On the other hand, DBA, 7,12-BAQ, and BaP-1,6-Q were not noticeably reduced. Most of these substances had disappeared in PM2.5 heated at 250°C and 360°C. Metals (eg, Fe, Cu, Cr, Ni) in PM2.5 exhibited a slight thermo-dependent increase. RAW264.7 macrophages with or without NAC were exposed to unheated PM2.5, oxidative stress-related and unrelated inflammatory responses were induced. PM2.5-induced lung inflammation in mice is caused mainly by thermo-sensitive substances (LPS, b-glucan, BaP, 1,2-NQ, 9,10-PQ, etc.). Also, a slight involvement of thermo-resistant substances (DBA, 7,12-BAQ, BaP-1,6-Q, etc.) and transition metals was observed. The thermal decomposition method could assist to evaluate the PM2.5-induded lung inflammation.

Spatial patterns and effects of air pollution and meteorological factors on hospitalization for chronic lung diseases in Beijing, China

Chronic obstructive pulmonary disease (COPD), lung cancer (LC) and tuberculosis (TB) are common chronic lung diseases that generate a large disease burden and significant health care resource use in China. The aim of this study was to quantify spatial patterns and effects of air pollution and meteorological factors on hospitalization of COPD, LC and TB in Beijing. Daily counts of hospitalization for 2010 were obtained from the Beijing Urban Employees Basic Medical Insurance (UEBMI) system. Bayesian hierarchical Poisson regression models were applied to identify spatial patterns of hospitalization for COPD, LC and TB at the district level and explore associations with inhalable particulate matter (aerodynamic diameter <10 μm, PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), mean temperature and relative humidity. There were 18,882, 14,295 and 2,940 counts of hospitalizations for COPD, LC and TB respectively, in Beijing in 2010. Clusters of high relative risk were in different locations for the three diseases. The effect of relative humidity on COPD hospitalization was most significant with a relative risk (RR) of 1.070 (95%CI: 1.054, 1.086) per one percent increase. For lung cancer hospitalization, exposure to ambient SO₂ was associated with a RR of 1.034 (95%CI: 1.011, 1.058) per μg m^-3 increase. For tuberculosis, the effect of mean temperature was significant with a RR of 1.107 (95%CI: 1.038, 1.180) per °C increase. Risk factors and spatial patterns were different for hospitalization of non-infectious and infectious chronic lung disease in Beijing. Even over a short time period (one year), associations were apparent with air pollution and meteorological factors.

PM2.5-induced oxidative stress increases intercellular adhesion molecule-1 expression in lung epithelial cells through the IL-6/AKT/STAT3/NF-κB-dependent pathway

BACKGROUND

Epidemiological studies have shown that ambient air pollution is closely associated with increased respiratory inflammation and decreased lung function. Particulate matters (PMs) are major components of air pollution that damages lung cells. However, the mechanisms remain to be elucidated. This study examines the effects of PMs on intercellular adhesion molecule-1 (ICAM-1) expression and the related mechanisms in vitro and in vivo.

RESULT

The cytotoxicity, reactive oxygen species (ROS) generation, and monocyte adherence to A549 cells were more severely affected by treatment with O-PMs (organic solvent-extractable fraction of SRM1649b) than with W-PMs (water-soluble fraction of SRM1649b). We observed a significant increase in ICAM-1 expression by O-PMs, but not W-PMs. O-PMs also induced the phosphorylation of AKT, p65, and STAT3. Pretreating A549 cells with N-acetyl cysteine (NAC), an antioxidant, attenuated O-PMs-induced ROS generation, the phosphorylation of the mentioned kinases, and the expression of ICAM-1. Furthermore, an AKT inhibitor (LY294002), NF-κB inhibitor (BAY11-7082), and STAT3 inhibitor (Stattic) significantly down-regulated O-PMs-induced ICAM-1 expression as well as the adhesion of U937 cells to epithelial cells. Interleukin-6 (IL-6) was the most significantly changed cytokine in O-PMs-treated A549 cells according to the analysis of the cytokine antibody array. The IL-6 receptor inhibitor tocilizumab (TCZ) and small interfering RNA for IL-6 significantly reduced ICAM-1 secretion and expression as well as the reduction of the AKT, p65, and STAT3 phosphorylation in O-PMs-treated A549 cells. In addition, the intratracheal instillation of PMs significantly increased the levels of the ICAM-1 and IL-6 in lung tissues and plasma in WT mice, but not in IL-6 knockout mice. Pre-administration of NAC attenuated those PMs-induced adverse effects in WT mice. Furthermore, patients with chronic obstructive pulmonary disease (COPD) had higher plasma levels of ICAM-1 and IL-6 compared to healthy subjects.

CONCLUSION

These results suggest that PMs increase ICAM-1 expression in pulmonary epithelial cells in vitro and in vivo through the IL-6/AKT/STAT3/NF-κB signaling pathway.

Crucial role of pro-inflammatory cytokines from respiratory tract upon PM2.5 exposure in causing the BMSCs differentiation in cells and animals

Fine particulate matter exposure may cause health risk, including cardiovascular diseases and cancer. Bone marrow mesenchymal stem cell (BMSC), a typical model for evaluating pollutant toxicity, has been closely linked to these diseases, due to its characteristics of differentiation. We therefore studied the BMSCs differentiation and its roles in inflammatory activation in the respiratory tract upon PM2.5 exposure using both in vitro and in vivo models. BMSCs differentiation into endothelial-like cells (ELCs) and cancer-associated fibroblasts cells (CAFs) was enhanced in response to conditioned medium from PM2.5-treated 16HBE cells. PM2.5 elevated inflammatory cytokines' expression and secretion in 16HBE cells. However, induction of differentiation markers was reduced when IL-1β, IL-6 and COX-2 neutralizing antibodies were added to the conditioned medium. Furthermore, PM2.5 induced ROS formation and NADPH oxidase (NOX) expression in 16HBE cells. DPI (inhibitor of ROS from NOX) or NAC (inhibitor of ROS) supplement reduced PM2.5-induced inflammatory activation and BMSCs differentiation. Likewise, a concomitant disorder of mitochondrial morphology and respiratory chain was observed. In addition, Rot or AA (inhibitor of mitochondrial complex I or III) supplement restored PM2.5-induced toxic effects. Moreover, the results coincided with the in vitro data obtained from SD rats post-exposed to different doses of PM2.5 for 30 days. PM2.5 enhanced the BMSCs differentiation and inflammatory cytokines' expression in respiratory organs of SD rats, including lung and trachea tissue. This study uncovers that PM2.5 promotes the BMSCs differentiation via inflammatory activation mediated by ROS induction from NOX and mitochondria in the respiratory tract.

The Characteristics of Air Pollutants during Two Distinct Episodes of Fireworks Burning in a Valley City of North China

Background

The elevation and dissipation of pollutants after the ignition of fireworks in different functional areas of a valley city were investigated.

Methods

The Air Quality Index (AQI) as well as inter-day and intra-day concentrations of various air pollutants (PM₁₀, PM_2.5, SO₂, NO₂, CO, O₃) were measured during two episodes that took place during Chinese New Year festivities.

Results

For the special terrain of Jinan, the mean concentrations of pollutants increased sharply within 2–4 h of the firework displays, and concentrations were 4–6 times higher than the usual levels. It took 2–3 d for the pollutants to dissipate to background levels. Compared to Preliminary Eve (more fireworks are ignited on New Year’s Eve, but the amounts of other human activities are also lesser), the primary pollutants PM_2.5, PM₁₀, and CO reached higher concentrations on New Year’s Eve, and the highest concentrations of these pollutants were detected in living quarters. All areas suffered from serious pollution problems on New Year’s Eve (rural = urban for PM₁₀, but rural > urban for PM_2.5). However, SO₂ and NO₂ levels were 20%–60% lower in living quarters and industrial areas compared to the levels in these same areas on Preliminary Eve. In contrast to the other pollutants, O₃ concentrations fell instead of rising with the firework displays.

Conclusion

Interactions between firework displays and other human activities caused different change trends of pollutants. PM_2.5 and PM₁₀ were the main pollutants, and the rural living quarter had some of the highest pollution levels.

Ambient Air Pollution and Morbidity in Chinese

The rapid economic growth in China is coupled with a severe ambient air pollution, which poses a huge threat to human health and the sustainable development of social economy. The rapid urbanization and industrialization over the last three decades have placed China as one of countries with the greatest disease burden in world. Notably, the prevalence rate of chronic noncommunicable diseases (CND), including respiratory diseases, CVD, and stroke, in 2010 reaches 16.9%. The continuous growth of the incidence of CND urgent needs for effective regulatory action for health protection. This study aims to evaluate the impact of rapid urbanization on status of ambient air pollution and associated adverse health effects on the incidence and the burden of CND and risk assessment. Our findings would be greatly significant in the prediction of the risk of ambient air pollution on CND and for evidence-based policy making and risk management in China.

Fine Particulate Matter and Sulfur Dioxide Coexposures Induce Rat Lung Pathological Injury and Inflammatory Responses Via TLR4/p38/NF-κB Pathway

Fine particulate matter (PM_2.5) and sulfur dioxide (SO₂) are 2 common air pollutants, but their toxicological effects of coexposure are still not fully clear. In this study, SO₂ exposure (5.6 mg/m³) couldn't cause obvious inflammatory responses in rat lungs. The PM_2.5 exposure (1.5 mg/kg body weight) increased inflammatory cell counts in bronchoalveolar lavage fluid (BALF) and some inflammation damage. Importantly, SO₂ and PM_2.5 (1.5, 6.0, and 24.0 mg/kg) coexposure induced pathological and ultrastructural damage and raised inflammatory cells in BALF compared with the control. Also, they significantly elevated the levels of pro-inflammatory cytokines, adhesion molecule, and nitric oxide (NO) and promoted the gene expression of nuclear factor kappa B (NF-κB), phosphorylated p38 (p-p38), and Toll-like receptor 4 (TLR4) in rat lungs treated with higher dose of PM_2.5 (6.0 and 24.0 mg/kg) plus SO₂ relative to the control or SO₂ group, along with the decreased inhibitor of NF-κBα and increased inhibitor of NF-κB kinase β expressions. The changes in the inflammatory markers in the presence of PM_2.5 plus SO₂ were not significant compared with the PM_2.5 group. The results indicated that inflammatory injury and pathological and ultrastructural damage in rat lungs exposed to PM_2.5 plus SO₂ were involved in TLR4/p38/NF-κB pathway activation accompanied by oversecretion of pro-inflammatory cytokine, adhesion molecule, and NO. It provides more useful evidence to understand the possible toxicological mechanism that PM_2.5 and SO₂ copollution exacerbate lung disease.

Differences in allergic inflammatory responses in murine lungs: comparison of PM2.5 and coarse PM collected during the hazy events in a Chinese city

Urban particulate matter (PM) is associated with an increase in asthma. PM2.5 (<PM2.5 μm) and coarse PM (CPM: PM2.5-PM10 μm) were collected from the air in a Chinese city during haze events. The amounts of polycyclic aromatic hydrocarbons (PAHs) were higher in PM2.5 than in CPM. Conversely, microbial elements LPS and β-glucan were much higher in CPM than in PM2.5. Concentrations of Si, Al, Fe, and Ti in CPM were greater than in PM2.5, while Pb, Cu and As concentrations were lower than in PM2.5. When RAW264.7 cells were treated with PM2.5 and CPM, the pro-inflammatory response in the cells was associated with the microbial element levels and attenuated partly by both polymyxin B (PMB) and N-acetylcystein (NAC). The expression of the oxidative stress response gene heme oxygenase1 was associated with PAHs levels. The exacerbating effects of the two-types of PM on murine lung eosinophilia were compared to clarify the role of toxic materials. When BALB/c mice were intratracheally instilled with PM2.5 or CPM (total 0.4 mg) + ovalbumin (OVA), both exacerbated lung eosinophilia along with allergy-relevant biological indicators, such as OVA-specific IgE in serum; enhancement of lung pathology when compared with counterpart samples without OVA. The exacerbating effects were greater in microbial element-rich CPM than in organic chemical-rich PM2.5. These results indicate that microbial elements have more potently exacerbating effects on the development of lung eosinophilia than do organic chemicals. In addition, oxidative stress and transition metals might be associated with the exacerbation of this negative effect.