Individual and joint associations of air pollutants exposure with semen quality: A retrospective longitudinal study in Wenzhou, China.

PURPOSE: The impact of air pollution on semen quality has been confirmed, yet the joint effect remains unclear. We evaluate the individual and joint associations of particulate (PM2.5 and PM10) and gaseous pollutants (NO2, SO2, O3 and CO) with semen quality. METHODS: We included 5,114 men in this study from 2014 to 2022. The individual and joint associations were measured by multiple linear regression models. RESULTS: Sperm motility and semen volume were inversely associated with pollutant concentrations during every stage of sperm development, especially at lag days 0-9 and 10-14 (all P < 0.05). Stratified analyses showed that the study pollutants (except CO) had a positive effect on semen concentration during the stage of sperm development, especially in spring and autumn, while a decreased total sperm number was associated with CO (all P < 0.05). However, joint associations of particulate and gaseous pollutants with semen quality parameters were not statistically significant (all P > 0.05). CONCLUSIONS: During all stages of sperm development, particulate and gaseous pollutants had individual negative impacts on sperm motility and semen volume, and these impacts were less pronounced in spring and autumn. Our findings highlight the importance and necessity of reducing the exposure to pollutants especially in the critical stage of sperm development to improve semen quality.

Machine learning-based prediction model and visual interpretation for prostate cancer.

BACKGROUND: Most prostate cancers(PCa) rely on serum prostate-specific antigen (PSA) testing for biopsy confirmation, but the accuracy needs to be further improved. We need to continue to develop PCa prediction model with high clinical application value. METHODS: Benign prostatic hyperplasia (BPH) and prostate cancer data were obtained from the Chinese National Clinical Medical Science Data Center for retrospective analysis. The model was constructed using the XGBoost algorithm, and patients' age, body mass index (BMI), PSA-related parameters and serum biochemical parameters were used as model variables. Using decision analysis curve (DCA) to evaluate the clinical utility of the models. The shapley additive explanation (SHAP) framework was used to analyze the importance ranking and risk threshold of the variables. RESULTS: A total of 1915 patients were included in this study, including 823 (43.0%) were BPH patients and 1092 (57.0%) were PCa patients. The XGBoost model provided better performance (AUC 0.82) compared with f/tPSA (AUC 0.75),tPSA (AUC 0.68) and fPSA (AUC 0.61), respectively. Based on SHAP values, f/tPSA was the most important variable, and the top five most important biochemical parameter variables were inorganic phosphorus (P), potassium (K), creatine kinase MB isoenzyme (CKMB), low-density lipoprotein cholesterol (LDL-C), and creatinine (Cre). PCa risk thresholds for these risk markers were f/tPSA (0.13), P (1.29 mmol/L), K (4.29 mmol/L), CKMB ( 11.6U/L), LDL-C (3.05mmol/L) and Cre (74.5-99.1umol/L). CONCLUSION: The present model has advantages of wide-spread availability and high net benefit, especially for underdeveloped countries and regions. Furthermore, these risk thresholds can assist in the diagnosis and screening of prostate cancer in clinical practice.

Will male semen quality improve with environmental quality?

Wenzhou has improved its environmental quality because of comprehensive environmental remediation; nevertheless, the semen quality of infertile males remains unclear. This study determined whether better environmental quality improved semen quality in this region. We recorded semen quality data from 22 962 infertile males from January 2014 to November 2019 at the Center for Reproductive Health of The First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China). Patients were predominantly 30-35 years old (33.1%) and workers (82.0%), with high school education or lower (77.6%); more than a half of the patients (52.6%) were Wenzhou household registration; and most patients (77.5%) had abnormal semen quality. Patients who were older than 40 years and workers, and those with Wenzhou household registration, had significantly worse semen quality (all P < 0.05). From 2014 to 2019, progressive sperm motility, total sperm motility, and semen volume showed increasing linear trends in all patients (P = 0.021, 0.030, and 0.005, respectively), yet normal sperm morphology showed a linearly decreasing trend (P = 0.046). Sensitivity analyses for subgroups yielded similar results. In conclusion, the improvement of environmental quality and better function of the accessory glands are associated with progressive sperm motility, total sperm motility, and semen volume. Normal sperm morphology is influenced by occupational exposures and personal lifestyle and does not improve with environmental quality.

Exposure to ambient particulate matter affects semen quality: A case study in Wenzhou, China.

BACKGROUND: Particulate matter (PM), including PM2.5 (PM ≤ 2.5 µm in aerodynamic diameter) and PM10 (PM ≤ 10 µm in aerodynamic diameter), is a component of air pollutants, which is linked to semen quality. However, the available evidence of association needs to be strengthened, and some studies have conflicting results. OBJECTIVES: To evaluate the potential impacts of PM on semen quality during the full (0-90 days before semen examination) and three key sperm development windows (0-9, 10-14, and 70-90 days before semen examination). METHODS: We included 1494 infertile men in the main urban area in Wenzhou, China, who had undergone semen examinations for fertility between 2014 and 2019. The impacts were assessed by multivariable linear regression models. RESULTS: Overall, during the full sperm development window, PM2.5 and PM10 exposures were associated with declined progressive sperm motility (%) (ß: -0.6; 95% confidence intervals (CIs): -1.07, -0.13 and -0.46; -0.59, -0.33) and total sperm motility (%) (-1.95; -2.67, -1.23 and -1.32; -1.82, -0.82), and associated with increased sperm concentration (106 /ml) (0.02; 0.006, 0.023 and 0.007; 0.001, 0.013) and total sperm number (106 ) (0.02; 0.01, 0.03 and 0.011; 0.004, 0.017). Furthermore, only PM2.5 exposure during the 10-14 days window was significantly associated with declined progressive motility (%) (-0.207; -0.395, -0.023). CONCLUSIONS: During the full sperm development window, PM exposure has an adverse impact on sperm motility and positive impacts on sperm concentration and total sperm number. The adverse impact was more severe in the 10-14 days window.

The Association between Spatial-Temporal Distribution of Prostate Cancer and Environmental Factors in Mainland China.

BACKGROUND: In China, the incidence and mortality of prostate cancer are increasing. In this study, we analyzed the spatial-temporal distribution characteristics of prostate cancer incidence and mortality in China and explored the potential associations of socioeconomic, ecological, and meteorologic conditions. METHODS: Spatial-temporal scan statistics were used to analyze the spatial-temporal patterns of prostate cancer in China from 2012 to 2016. Spatial regression models and the Geodetector method were used to explore the potential associations of anthropogenic and natural factors with prostate cancer. RESULTS: The incidence and mortality of prostate cancer in China from 2012 to 2016 rapidly increased. The high incidence and mortality clusters were concentrated in the economically developed Yangtze River Delta region along the southeast coast. Among the 14 selected environmental factors, gross domestic product (GDP) per capita, population density, comprehensive index of environmental pollution discharge, accessibility of health care resources, urbanization rate, and nitrogen dioxide (NO2) had significant positive correlations with prostate cancer incidence and mortality. GDP per capita, urbanization rate, and population density had high explanatory power. CONCLUSIONS: The high-concentration areas for prostate cancer are located in more economically developed cities. The index of environmental pollution discharge, NO2, and prostate cancer incidence and mortality were positively correlated. The government should advocate increasing the use of clean energy while strengthening the regulation of industrial production to reduce pollutant emissions. IMPACT: To inform the development of prevention and control strategies for prostate cancer in China.

Analysis of the distribution characteristics of prostate cancer and its environmental factors in China.

The high incidence and mortality and the increasing trend of prostate cancer has been one of the public health issues in many countries and regions. Meanwhile, the spatio-temporal heterogeneity of prostate cancer implies that lifestyle and ecological changes may be associated with prostate cancer, however, sufficient evidence is still lacking. This paper tried to reveal the spatial and temporal distribution characteristics of prostate cancer in China and explore the potential associations with related socioeconomic and natural condition factors. Data on prostate cancer incidence and mortality in 182 counties (districts) in mainland China from 2014-2016 were collected, and the distribution characteristics of prostate cancer were analyzed using spatiotemporal scan statistic. Spatial regression models and geodetector method were used to analyze the potential associations between meteorological conditions, socioeconomic development, and prostate cancer incidence and mortality. SaTScan, GeoDa, and GeoDetector were used for the above statistical analyses. The high-risk clusters for prostate cancer incidence and mortality were located in southeastern China, and the low-risk clusters were located in north-central China. Spatial regression models showed that the number of industrial enterprises/km2 (incidence: ß = 0.322, P < 0.001; mortality: ß = 0.179, P < 0.001), GDP (incidence:ß = 0.553, P < 0.001; mortality: ß = 0.324, P < 0.001), number of beds in medical and health institutions/1000 persons (incidence: ß = 0.111, P = 0.005; mortality: ß = 0.068, P = 0.021), and urbanization rate (incidence: ß = 0.156, P < 0.001; mortality: ß = 0.100, P < 0.001) were positively associated with the incidence and mortality of prostate cancer. The urbanization rate (incidence: q = 0.185, P < 0.001; mortality: q = 0.182, P < 0.001) has the greatest explanatory power, and the interaction of all factors was bivariate enhanced or nonlinearly enhanced. The distribution of prostate cancer in China has obvious spatial heterogeneity. The incidence and mortality rate of prostate cancer are on the rise, and special plans should be formulated in each region according to local conditions.

Prevalence of human papillomavirus in Wenzhou, China: a cross-sectional study of 127 938 outpatient women.

OBJECTIVES: Understanding the prevalence and genotype distribution of human papillomavirus (HPV) is critical for managing HPV vaccination programmes. Using a retrospective cross-sectional study, we examined long-term trends of HPV prevalence in Wenzhou, a coastal city in China. SETTING AND PARTICIPANTS: Cervical exfoliated cells were collected from 127 938 women who underwent cervical cancer screening at the gynaecology outpatient clinic of Wenzhou People's Hospital from January 2011 to December 2020. HPV infections and genotypes were determined. The HPV genotypes were 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 6, 11, 42, 43, 44 and 81. From 2011 to 2014, we used PCR and inflow hybridisation for typing assays. In 2015-2020, HPV genotyping was performed on the collected specimens using PCR and flow fluorescence hybridisation. RESULTS: The overall prevalence of HPV infection was 17.8%. Across age groups, the prevalence fluctuated between 15.9% and 37.4%, with two peaks in the ≤20 and ≥51 year groups. The annual prevalence varied between 12.2% and 28.8%, with a significant decrease in 2011-2018 and a flat trend in 2018-2020. The five most common HPV genotypes were HPV52 (3.6%), 16 (3.0%), 58 (2.5%), 53 (1.9%) and 81 (1.3%). The prevalence of high-risk gene subtypes HPV56, 59 and the low-risk subtype HPV44 increased. Single HPV infection was the most common. CONCLUSION: The prevalence of HPV in Wenzhou is low to mid-range; however, the high-risk genetic subtypes HPV56 and 59 have increased in recent years. We need to promote HPV vaccination and increase education regarding safer sex.

[PM2.5 exposure-caused damage to male reproductive function: Progress in research].

Particulate matter 2.5 (PM2.5) is considered to be a major harmful constitutent of air pollution. Animal experiments and epidemiological studies at home and abroad have shown that exposure to PM2.5 causes damage to male reproductive function in addition to direct impacts on the respiratory and cardiovascular systems. This review summarizes the results of animal experiments at home and abroad and population epidemiological investigations relating PM2.5-induced damage to male reproductive function as well as the mechanisms of PM2.5 causing the damage.

Gender Differences in Knowledge and Attitude towards HPV and HPV Vaccine among College Students in Wenzhou, China.

Objective: This study aimed to determine human papillomavirus (HPV)-related awareness and willingness to receive HPV vaccination among college students, in Wenzhou, and its associated factors. Methods: A cross-sectional epidemiological study was conducted among college students in Wenzhou to investigate their knowledge, attitude, and factors affecting their willingness to receive HPV vaccination. Results: A total of 1035 questionnaires were collected, of which 1002 were valid (males: 374, females: 628). In total, 904 (90.2%) college students had heard of HPV, with a lower rate among males than females (85.3% vs. 93.2%, p < 0.05) and 693 (69.2%) had heard of the HPV vaccine, with a significantly lower rate among males than females (53.7% vs. 78.3%, p < 0.05). Overall awareness of HPV and HPV vaccine among males and females was moderate, with lower awareness among males. A total of 55.9% of males and 80.4% of females indicated that they would be willing to receive the HPV vaccine, a significant difference (p < 0.001). The price, safety of HPV vaccine, and lack of knowledge about HPV and HPV vaccine were the major barriers to HPV vaccination for college students. Compared to females, inadequate knowledge of HPV was the main barrier factor for HPV vaccination among male college students. Conclusions: The overall knowledge level of males is lower than that of females. For male college students, providing more knowledge about HPV infection is helpful to promote their willingness to vaccinate. It is necessary to promote HPV-related knowledge for male and female college students, respectively.

[Impacts of Bisphenol A exposure on spermatogenesis in men: Advances in studies].

Bisphenol A (BPA), a common endocrine disrupting chemical, is becoming a focus of studies and receiving increasing attention. Because of its wide use in food packaging materials, receipt paper, dental sealant and other products, people contact it through the skin, respiratory tract, digestive system and other routes. A large number of studies at home and abroad have shown that BPA exposure can adversely affect male reproductive function, including semen quality, spermatogenesis, sperm epigenetic inheritance, etc. Its action mechanisms, however, remain unclear and require more studies. This review focuses on the impacts of BPA exposure on spermatogenesis in males.