Long-term PM2.5 exposure and peak expiratory flow in middle-aged and older people in China: A quasi-experimental study.

China's Clean Air Act (CCAA) has been demonstrated to reduce the public health burden of ambient air pollution. Few studies have assessed the health effects of CCAA on lung function. We aimed to investigate the effects of CCAA and PM2.5 exposures on peak expiratory flow (PEF) in middle-aged and older people in China. Three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study. We performed a difference-in-difference (DID) model and mixed effect method to assess the association between CCAA, PM2.5, and PEF. To increase the reliability, multiple environmental factors were considered, and spline function was utilized to fit the spatial autocorrelations. We found that the risk of decreased PEF in the policy intervention group was reduced by 46% (95% CI: 23%~62%). The estimate showed a 10µg/m3 increase in PM2.5 would increase the risk of decreased PEF by 10% (95% CI: 3%~18%). The results of the mixed effect model showed a 10 µg/m3 increase in PM2.5 concentration was associated with a 2.23% (95% CI: 1.35%~3.06%) decrease in the PEF. These results contributed to the limited epidemiology evidence on demonstrating the effect of PM2.5 on lung function.

Long-term effect of extreme temperature on cognitive function of middle-aged and older adults in China.

BACKGROUND: Several studies have explored the association between temperature and cognitive function. However, few studies have examined the effect of extreme temperature on cognitive function. In this study, we aimed to quantify the long-term effect of extreme temperature (e.g., heat waves, cold spells, and hot night excess (HNE)) on cognitive performance in middle-aged and older people in China. METHOD: We investigated 7915 aged >45 years people from the China Health and Retirement Longitudinal Study (CHARLS), surveyed in 2011 and 2015. A structured questionnaire was utilized to assess cognitive function, including four dimensions: episodic memory, attention, orientation, and visuo-construction. Hourly ambient temperature from the ERA5-Land datasets were used to calculate variables indicating extreme temperature. We performed difference-in-difference (DID) models to assess the potential causal relationship between extreme temperature and cognitive function. RESULTS: Non-linear analyses suggested that both sustained increases in temperature and excessive variability in temperature increased the risk of cognitive decline. Meanwhile, we observed the extra risk of global cognitive function decline was 2.3% (95% Confidence interval (95% CI): 0.2%, 4.4%) for heat waves (one unit increase) and 5.9% (95% CI: 0.6%, 11.6%) for HNE (one unit increase), while the association for cold spells was insignificant. Two cognitive dimensions, episodic memory and visuo-construction, were sensitive to these two heat-related factors. CONCLUSION: Extreme temperature was inversely related to cognitive performance in middle-aged and older adults, which was substantial for heat waves and HNE particularly. The effect size varied by cognitive dimensions.

Long-Term PM2.5 Exposure, Lung Function, and Cognitive Function Among Middle-Aged and Older Adults in China.

BACKGROUND: Long-term exposure to PM2.5 is related to poor lung function and cognitive impairment, but less is known about the pathway involved in this association. We aimed to explore whether the effect of PM2.5 on cognitive function was mediated by lung function. METHODS: A total of 7 915 adults older than 45 years old were derived from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011 and 2015. PM2.5 exposure was estimated using a geographically weighted regression model. Lung function was measured by peak expiratory flow (PEF). Cognitive function was evaluated through a structured questionnaire with 4 dimensions: episodic memory, attention, orientation, and visuoconstruction. Under the counterfactual framework, causal mediation analysis was applied to examine direct and indirect associations. RESULTS: An interquartile range (IQR) increase in PM2.5 change was significantly related to an 8.480 (95% confidence interval [CI]: 3.116, 13.845) decrease in PEF change and a 0.301 (95% CI: 0.100, 0.575) decrease in global cognitive score change. The direct and indirect effects of PM2.5 exposure on global cognitive performance were -0.279 (95% CI: -0.551, -0.060) and -0.023 (95% CI: -0.041, -0.010), respectively. The proportion of the indirect effect was 7.48% (p = .010). The same significant association appeared in only 2 dimensions, episodic memory and attention, which were both mediated by PEF. CONCLUSIONS: Lung function played a partially mediating role in the association between long-term PM2.5 exposure and cognition. More clean air actions should be undertaken to improve lung function and cognitive function in older adults.

The effect of PM2.5 levels on continuum functional capability among older adults: Potential cause-effect or statistical associations.

BACKGROUND: Since there is limited knowledge about health effects of the clean air policy (CAP, i.e., a series of emission-control actions) on continuum functional capacity (CFC) among the older adults on a large representative data, our research was to fill this gap. METHODS: We used a continuous variable of airborne fine particulate matter (PM2.5) particles as a proxy for the CAP to evaluate the linear and non-linear effect of PM2.5 exposure on CFC of older adults, under the quasi-experimental framework of the temporal contrast between 2011 (before the CAP) and 2015 (after the CAP). Multiple environmental factors were considered and spline function was utilized to fit the spatial autocorrelations. A competing risk model was constructed to qualify the impact of PM2.5 on multidimensional disability. RESULTS: After adjusting for potential confounders, a J-shaped association was found between PM2.5 concentration increase on CFC, with a threshold 2µg/m3. We also demonstrated that a 10-µg/m3 increase in PM2.5 concentration was related to a 14.0% (95% CI:0.00, 19.00%) increment risk in the functional decline. Similarly, the competing risk model presented a hazard ratio of multidimensional disability ranging from 1.707(0.928-4.141) at 40µg/m3 concentration of PM2.5 to 4.384 (1.970-9.755) over 80µg/m3. Stratified analyses showed that married men less than 80 years old in rural areas are more likely to be affected by PM2.5 exposure, where the influencing mechanism of air pollutant to outdoor and indoor activities might be the potential cause. CONCLUSION: Implementing CAP might improve CFC, prevent the occurrence of disability, and update the air policy.

Theoretical Insights into the Selective Separation of Am(III)/Eu(III) Using Hydrophilic Triazolyl-Based Ligands.

Designing ligands with efficient actinide (An(III))/lanthanide (Ln(III)) separation performance is still one of the key issues for the disposal of accumulated radioactive waste and the recovery of minor actinides. Recently, the hydrophilic ligands as promising extractants in the innovative Selective ActiNide Extraction (i-SANEX) process show excellent selectivity for Am(III) over Eu(III), such as hydroxylated-based ligands. In this work, we investigated the selective back-extraction toward Am(III) over Eu(III) with three hydrophilic hydroxylated triazolyl-based ligands (the skeleton of pyridine La, bipyridine Lb, and phenanthroline Lc) using scalar-relativistic density functional theory. The properties of three hydrophilic hydroxylated ligands and the coordination structures, bonding nature, and thermodynamic properties of the Am(III) and Eu(III) complexes with three ligands have been evaluated using multiple theoretical methods. The results of molecular orbitals (MOs), quantum theory of atoms in molecules (QTAIMs), and natural bond orbital (NBO) reveal that Am-N bonds possess more covalent character compared to Eu-N bonds. The thermodynamic results indicate that the complexing ability of Lb and Lc with metal ions is almost the same, which is stronger than that of La. However, La has the best Am(III)/Eu(III) selectivity among three ligands, which is attributed to the largest difference in covalency between Am-Ntrzl and Eu-Ntrzl bonds in MLa(NO3)3. This work provides an in-depth understanding of the preferential selectivity of the hydrophilic hydroxylated ligands with An(III) over Ln(III) and also provides theoretical support for designing potential hydrophilic ligands with excellent separation performance of Am(III)/Eu(III).

Association of long-term exposure to PM2.5 with hypertension and diabetes among the middle-aged and elderly people in Chinese mainland: a spatial study.

BACKGROUND: Epidemiological evidence has shown an association between long-term exposure to fine particulate matter (PM2.5) and hypertension and diabetes, but few studies have considered the spatial properties of the samples. This study aimed to investigate the long-term effect of PM2.5 exposure on hypertension and diabetes among middle-aged and elderly people in China based on a spatial study. METHODS: We conducted a national cross-sectional study of the most recently launched wave 4 2018 data of the China Health and Retirement Longitudinal Study (CHARLS) to calculate the prevalence of hypertension and diabetes. The exposure data of annual average PM2.5 concentrations were estimated combined with satellite observations, chemical transport modeling, and ground-based monitoring. A shared component model (SCM) was used to explore the association of PM2.5 with hypertension and diabetes, in which these two diseases borrowed information on spatial variations from each other. Then, we evaluated the effect variations in PM2.5 in different periods and smoking status on changes in outcomes. RESULTS: The prevalence of hypertension and diabetes was 44.27% and 18.44%, respectively, among 19,529 participants. The annual average PM2.5 concentration in 31 provinces ranged from 4.4 µg/m3 to 51.3 µg/m3 with an average of 27.86 µg/m3 in 2018. Spatial auto-correlations of the prevalence of hypertension and diabetes and PM2.5 concentrations were seen (Moran's I = 0.336, p = 0.01; Moran's I = 0.288, p = 0.03; Moran's I = 0.490, p = 0.01). An interquartile range (IQR: 16.2 µg/m3) increase in PM2.5 concentrations was significantly associated with a higher prevalence of hypertension and diabetes with odds ratios (ORs) of 1.070 [95% credible interval (95% CrI): 1.034, 1.108] and 1.149 (95% CrI: 1.100, 1.200), respectively. Notably, the effect of PM2.5 on both hypertension and diabetes was relatively stronger among non-smokers than smokers. CONCLUSION: Our nationwide study demonstrated that long-term exposure to PM2.5 might increase the risk of hypertension and diabetes, and could provide guidance to public policymakers to prevent and control hypertension and diabetes according to the spatial distribution patterns of the above effects in China.

Seasonal prediction of daily PM2.5 concentrations with interpretable machine learning: a case study of Beijing, China.

Machine learning (ML) has shown high predictive ability in environmental research. Accurate estimation of daily PM2.5 concentrations is a prerequisite to address environmental public health issues. However, studies on the interpretability of ML algorithms were limited. In this study, we aimed to estimate the daily concentrations of PM2.5 at a seasonal level, and to understand the potential mechanisms of ML algorithms' decisions with SHapley Additive exPlanations (SHAP). Daily ground PM2.5 concentrations and meteorological data were obtained from the Beijing Municipal Ecological and Environmental Monitoring Center, and China Meteorological Data Service Centre between December 2013 and 2019 November. We calculated correlation coefficient and variance inflation factor (VIF) to eliminate the variables with collinearity, and recursive feature elimination (RFE) was further used to selected more important predictors. A series of ML algorithms, including linear regression, the variants of linear regression (Ridge, Lasso, Elasticnet), decision tree (DT), k-nearest neighbor (KNN), support vector regression (SVR), ensemble methods (random forest: RF, eXtreme Gradient Boosting: XGBoost), and deep learning (long short-term memory network: LSTM), were developed to estimate seasonal-level daily PM2.5 concentrations. A 10-fold cross validation was used to tune hyperparameters, and root mean square error (RMSE), mean absolute error (MAE), ratio of performance to deviation (RPD), and Lin's concordance correlation coefficient (LCCC) were used to evaluate models' performance. SHAP was performed for local and global interpretability analysis. The results showed that the distribution of PM2.5 concentrations in Beijing showed obvious seasonal patterns. A total of five variables (Precipitation, Mean wind speed, Sunshine duration, Mean surface temperature, Mean relative humidity) were selected for final prediction. LSTM showed much higher accuracy than other traditional ML models, achieved the smallest RMSE of 19.58 µg/m3 and MAE of 15.11 µg/m3. In terms of selected data set, there was acceptable (LCCC = 0.41 ~ 0.52) agreement and accuracy (RPD = 0.97 ~ 1.92) for LSTM. The SHAP analyses revealed that the meteorological factors had different influences in specific predictions, and the complex interactions were also illustrated. These results enhance our understanding of meteorological factors-PM2.5 relationships and explain the mechanisms of ML algorithms' decisions.

Theoretical Insights into the Separation of Am(III)/Eu(III) by Hydrophilic Sulfonated Ligands.

In this work, we focused on the separation of Am(III)/Eu(III) with four hydrophilic sulfonated ligands (L) based on the framework of phenanthroline and bipyridine through scalar relativistic density functional theory. We studied the electronic structures of [ML(NO3)3] (M = Am, Eu) complexes and the bonding nature between metal and ligands as well as evaluated the separation selectivity of Am(III)/Eu(III). The tetrasulfonated ligand L2 with a bipyridine framework has the strongest complexing ability for metal ions probably because of the better solubility and flexible skeleton. The disulfonated ligand L1 has the highest Am(III)/Eu(III) selectivity, which is attributed to the covalent difference between the Am-N and Eu-N bonds based on the quantum theory of atoms in the molecule analysis. Thermodynamic analysis shows that the four hydrophilic sulfonated ligands are more selective toward Am(III) over Eu(III). In addition, these hydrophilic sulfonated ligands show better complexing ability and Am(III)/Eu(III) selectivity compared to the corresponding hydrophobic nonsulfonated ones. This work provides theoretical support for the separation of Am(III)/Eu(III) using hydrophilic sulfonated ligands.

Spatial analysis of the effects of PM2.5 on hypertension among the middle-aged and elderly people in China.

Hypertension is currently one of the most common chronic diseases with high global prevalence associated with a huge social and economic burden. In recent years, air pollution has become a focus of research, especially the effects of PM2.5 on hypertension. However, few studies have considered the spatial properties of the sample; thus, the results might be unreliable. Based on the China Health and Retirement Longitudinal Study (CHARLS) and the Environmental Status Bulletin for each province in China, we used the extended shared component model (SCM) to fit the spatial variation of hypertension risk and to reveal the impact of PM2.5 on hypertension in males and females. Our results revealed that the crude prevalence of hypertension for the whole population in China was 32.74% in 2015, with the prevalence in men experiencing slightly higher than that in women (32.92% vs. 32.58%). We found that the distribution of hypertension prevalence exhibited obvious spatial aggregation for the whole population in China (Moran's I = 0.39, P = 0.001), with similar results in both men (Moran's I = 0.18, P = 0.027) and women (Moran's I = 0.52, P = 0.001). Furthermore, the smoothed results obtained using the SCM indicated that some eastern and central provinces had relatively higher hypertension risk, while the risk in southeastern provinces was much lower. The risk was also relatively lower in most western provinces, except for some northwestern regions. Notably, our results showed that PM2.5 was a risk factor for hypertension, and the impact of PM2.5 on women was slightly greater than that on men, with odds ratios (OR) of 1.063 (1.041, 1.086) and 1.048 (1.025, 1.071), respectively. Our findings suggest the existence of distinct spatial differences in the prevalence of hypertension and small sex-related differences in the risk of hypertension in China.

Associations between modifiable lifestyle factors and multidimensional cognitive health among community-dwelling old adults: stratified by educational level.

ABSTRACTBackground:Cognition is multidimensional, and each domain plays a unique and crucial part in successful daily life engagement. However, less attention has been paid to multi-domain cognitive health for the elderly, and the role of lifestyle factors in each domain remains unclear. METHODS: We conducted a cross-sectional study of 3,230 older adults aged 60+ years in Xiamen, China, in 2016. The Montreal Cognitive Assessment (MoCA) was used to measure general cognition and six specific sub-domains. To account for educational effects, we adjusted the MoCA score and divided respondents into three education-specific groups (low, moderate, and high education groups with ≤5, 6~8, and ≥9 years of education, respectively). A series of proportional odds models were used to detect the associations between two categories of lifestyle factors - substance abuse (cigarette and alcohol) and leisure activity (TV watching, reading, smartphone use, social activity, and exercise) - and general cognition and the six sub-domains in those three groups. RESULTS: Among the 3,230 respondents, 2,617 eligible participants were included with a mean age of 69.05 ± 7.07 years. Previous or current smoking/drinking was not associated with MoCA scores in the whole population, but unexpectedly, the ex-smokers in the low education group performed better in general cognition (OR = 2.22) and attention (OR = 2.05) than their never-smoking counterparts. Modest TV watching, reading, and smartphone use also contributed to better cognition among elderly participants in the low education group. For the highly educated elderly, comparatively longer reading (>3.5 hours/week) was inversely associated with general cognition (OR = 0.53), memory (OR = 0.59), and language (OR = 0.54), while adequate exercise (5~7 days/week) was positively related to these factors with OR = 1.48, OR = 1.49, and OR = 1.53, respectively. For the moderately educated elderly, only modest reading was significantly beneficial. CONCLUSIONS: Lifestyle factors play different roles in multidimensional cognitive health in different educational groups, indicating that individual intervention strategies should be designed according to specific educational groups and different cognitive sub-domains.

Application of SCM with Bayesian B-Spline to Spatio-Temporal Analysis of Hypertension in China.

Most previous research on the disparities of hypertension risk has neither simultaneously explored the spatio-temporal disparities nor considered the spatial information contained in the samples, thus the estimated results may be unreliable. Our study was based on the China Health and Nutrition Survey (CHNS), including residents over 12 years old in seven provinces from 1991 to 2011. Bayesian B-spline was used in the extended shared component model (SCM) for fitting temporal-related variation to explore spatio-temporal distribution in the odds ratio (OR) of hypertension, reveal gender variation, and explore latent risk factors. Our results revealed that the prevalence of hypertension increased from 14.09% in 1991 to 32.37% in 2011, with men experiencing a more obvious change than women. From a spatial perspective, a standardized prevalence ratio (SPR) remaining at a high level was found in Henan and Shandong for both men and women. Meanwhile, before 1997, the temporal distribution of hypertension risk for both men and women remained low. After that, notably since 2004, the OR of hypertension in each province increased to a relatively high level, especially in Northern China. Notably, the OR of hypertension in Shandong and Jiangsu, which was over 1.2, continuously stood out after 2004 for males, while that in Shandong and Guangxi was relatively high for females. The findings suggested that obvious spatial-temporal patterns for hypertension exist in the regions under research and this pattern was quite different between men and women.

The association between renal sinus fat area and the progression-free survival in Chinese non-metastatic clear-cell renal cell carcinoma patients.

In this retrospective study, we evaluated the association between renal sinus fat area (RSFA) and survival in 268 Chinese non-metastatic clear-cell renal cell carcinoma (ccRCC) patients. Patients with high RSFA exhibited better progression-free survival than those with low RSFA in both univariable (HR: 0.240; 95% CI: 0.119-0.482; p < 0.001) and multivariable (HR: 0.432; 95% CI: 0.369-2.749; p = 0.027) analyses. A propensity-score matched (PSM) analysis using Kaplan-Meier curves confirmed our findings (log-rank test; p = 0.028). Based on the multivariable analysis, we constructed a prognostic nomogram with 4 factors, namely, RSFA, Fuhrman grade, AJCC stage and sarcomatoid component. The c-index values for the Leibovich scoring system and the nomogram were 0.762 (95%CI, 0.688-0.835) and 0.823 (95%CI, 0.759-0.888), respectively. These findings demonstrate that high RSFA is associated with better progression-free survival in non-metastatic ccRCC.

Orbicularis-levator-tarsus composite suture technique in double-eyelid operation.

OBJECTIVE: Fold loss and suture extrusion are fairly common in double-eyelid surgeries. We hereby explore a new composite suture technique that aims to reduce such complications and to improve the long-term aesthetic outcome. METHODS: Based on the conventional external incision procedure, the suture procedure in our technique involves three stitches that fixate the orbicularis oculi, the levator aponeurosis, and the tarsal plate. This modified upper-eyelid blepharoplasty was performed in 98 patients (91 female and seven male, 196 eyes) with either congenital absence of the upper-eyelid folds (n = 84) or loss of fold from previous procedures (n = 14). The patients were followed up for 6-30 months. The complications were documented, and the overall outcomes of upper-eyelid folds were evaluated by both surgeons and patients as excellent, good, fair, or poor. RESULTS: Among 98 patients, 89 (91%) had excellent results and nine (9%) had good results; no patient had fair or poor results. Four patients had scar formation at postoperative week 2, all resolved without particular treatments at 6 months. The buried sutures could not be seen or felt through the skin. In addition, no suture extrusion was noted. There was no case of faded or disappeared folds during the follow-up. All patients were satisfied with the outcome. CONCLUSIONS: The composite suture technique ensures a firmer fixation and improves the aesthetic outcomes. It is a highly applicable and reliable approach for upper-eyelid blepharoplasty.

Interface-induced superconductivity and strain-dependent spin density waves in FeSe/SrTiO3 thin films.

The record superconducting transition temperature (T(c)) for the iron-based high-temperature superconductors (Fe-HTS) has long been 56 K. Recently, in single-layer FeSe films grown on SrTiO3 substrates, indications of a new record of 65 K have been reported. Using in situ photoemission measurements, we substantiate the presence of spin density waves (SDWs) in FeSe films--a key ingredient of Fe-HTS that was missed in FeSe before--and we find that this weakens with increased thickness or reduced strain. We demonstrate that the superconductivity occurs when the electrons transferred from the oxygen-vacant substrate suppress the otherwise pronounced SDWs in single-layer FeSe. Beyond providing a comprehensive understanding of FeSe films and directions to further enhance its T(c), we map out the phase diagram of FeSe as a function of lattice constant, which contains all the essential physics of Fe-HTS. With the simplest structure, cleanest composition and single tuning parameter, monolayer FeSe is an ideal system for testing theories of Fe-HTS.

[Analysis of apoptosis-related gene expression in different serum level of insulin-like growth factor-1 in mice breast cancer tissue].

OBJECTIVE: A stable primary breast cancer model in liver-specific insulin-like growth factor 1 (IGF-1) deficient (LID) mice and control mice was established. To screen apoptosis related genes expression in different serum IGF-1 levels by gene chip and flow cytometry. METHODS: The LID mice and control mice were used. Induction of breast cancer was achieved by using the 7,12-dimethylbenz(a) anthracene. Ginsenoside Rg3 was used to interfering therapy treatment. The incidence of breast cancer in every group was compared, and expression of apoptosis associated genes was detected by gene chip and flow cytometry. RESULTS: The incidence of tumor in none ginsenoside Rg3 injected control mice was 66.7%. The incidence of tumor in ginsenoside Rg3 injected LID mice was 12.0% which was significantly lower than any other group (P < 0.05). The apoptosis percentage in none ginsenoside Rg3 injected control mice was (2.7 +/- 0.7)%. The apoptosis percentage in ginsenoside Rg3 injected LID mice was (14.0 +/- 1.7)%. The results of gene chip indicated that in contrast to LID mice, LTA, LTB, TNF-alpha, TRAIL, TRANCE, BLK, BOK, CASP8, TRAF5, and APAF1 genes were down-regulated, and LTBR, TRAF4 genes were up-regulated in the breast cancer tissues of control mice. Application of ginsenoside Rg3 therapy could change the expression of these genes. CONCLUSIONS: Circulating IGF-1 levels play a role in the onset and development of breast cancer. Degrade serum IGF-1 level is able to promote apoptosis by affecting the expression of a series of apoptosis related genes consequently inhibit the growth of breast cancer. There was a synergistic effect with the application of ginsenoside Rg3.