[Impact of Air Pollutants on Outpatient Visits for Pediatric Atopic Dermatitis in Lanzhou].

Objective To analyze the correlation between air pollutants and pediatric atopic dermatitis outpatient visits in Lanzhou,and provide scientific insights for the life guidance of the affected children and disease prevention by relevant departments.Methods A generalized additive model was employed to analyze the effects and lagged effects of air pollutants on pediatric atopic dermatitis outpatient visits in Lanzhou while controlling for confounding factors such as long-term trends,holiday effects,day of the week effects and meteorological factors.Results The effects of NO2,PM2.5,PM10,and SO2 on pediatric atopic dermatitis outpatient visits were most significant on the current day(Lag0),but were not statistically significant (all P>0.05);CO also had the most significant effect on Lag0,and for every 10 µg/m3 increase in its concentration,the excess risk (ER) for pediatric atopic dermatitis outpatient visits was 0.05% (95%CI=0-0.10%,P=0.049);and O3 exhibited the most significant effect on day 7 of the cumulative lag (Lag07),with a statistically significant increase in the ER for each 10 µg/m3 increase in its concentration of 7.40% (95%CI=5.31%-9.53%,P<0.001) for pediatric atopic dermatitis outpatient visits.Age stratification showed that children aged 0-3 years with atopic dermatitis were the most sensitive to CO,with an increased ER of 0.09% (95%CI=0.04%-0.15%,P<0.001) for every 10 µg/m3 increase in concentration,and children aged 7-14 years with atopic dermatitis were the most sensitive to O3,with an increased ER of 8.26% (95%CI=4.99%-11.64%,P<0.001) for every 10 µg/m3 increase in concentration.Seasonal stratification showed that CO exerted a stronger effect on pediatric atopic dermatitis outpatient visits in summer and fall,with ER values of 0.45% and 0.16% (both P<0.001),respectively,while O3 had a significant effect on outpatient visits in winter,with an ER value of 20.48% (P<0.001).Conclusion Elevated daily average concentrations of air pollutants CO and O3 in Lanzhou were positively correlated with the number of outpatient visits for atopic dermatitis in children,with significant seasonal effects and age-stratified sensitivities.

[Effects of Temperature on Outpatient Visits for Urticaria among Lanzhou Residents Based on Distributed Lag Non-linear Model].

Objective To evaluate the influence of temperature on the outpatient visits for urticaria in Lanzhou City and its hysteresis and to find out the sensitive populations by sex and age stratification.Methods We collected the urticaria outpatient data in three grade A class three hospitals as well as the meteorological data and air pollutant data in Lanzhou from January 2011 to December 2017.The distributed lag non-linear model(DLNM)was employed to analyze the influence of daily mean temperature on the outpatient visits for urticaria.Stratification analysis was performed for different age groups(0-14,15-59,≥60 years)and different sex populations.Results Temperature had a non-linear relationship with the outpatient visits for urticaria,and there existed hysteresis.During the research period,the average daily outpatient visits for urticaria at the three hospitals in Lanzhou was 25,ranging from 1 to 76.With the rise in the daily mean temperature within 0-10 ℃,the risk of outpatient visits for urticaria first increased and then decreased.When the daily mean temperature was 2 ℃,hysteresis occurred on the 18th day,and the relative risk(RR)reached the maximum(1.12,95% CI:1.04-1.20)at the lag of 21 days.The risk of urticaria increased with the rise in temperature at high temperature.In addition,the effect of high temperature on the outpatient visits for urticaria in Lanzhou presented hysteresis,and the hysteresis was more obvious at higher temperatures.At the lag of 21 days,when the temperatures were 19.9 ℃ and 25.5 ℃,the RR values were 1.20(95% CI:1.12-1.27)and 1.39(95% CI:1.31-1.48),respectively.The results of stratified analysis showed that the effect of high temperature was more sensitive for those of 0-14 years and 15-59 years as well as the female population,and the RR values at a lag of 21 days were 1.60(95% CI:1.45-1.71),1.34(95% CI:1.25-1.43),and 1.43(95% CI:1.33-1.53)for the population of 0-14 years,the population of 15-59 years,and female population,respectively.Low temperature mainly affected the people aged ≥60 years,with a maximum RR of 1.38(95% CI:1.03-1.85)when the daily mean temperature was -4.8 ℃ at a lag of 12 days.It did not affect other populations.Conclusions The daily mean temperature in Lanzhou share a close relationship with the outpatient visits for urticaria.High temperature will increase the risk of urticaria for people at the age of 0-14 years and 15-59 years,while low temperature will increase the risk of urticaria for people above 60 years.

[Effects of Air Pollutants on Outpatient Visits for Atopic Dermatitis in Lanzhou].

Objective To quantitatively evaluate the associations of PM2.5,PM10,NO2,and SO2 concentrations with the outpatient visits for atopic dermatitis in Lanzhou. Methods The data of outpatient visits,together with meteorological data and air pollutant data,from January 2013 to December 2017 were collected.The generalized additive model based on Poisson distribution was employed to study the lag effects of PM2.5,PM10,NO2,and SO2 concentrations on the visits of outpatients,with the seasonal and long-term trends and day-of-the-week effect controlled. Results The results of the single pollutant model showed that PM2.5 and PM10 had the most obvious while still insignificant impact on the outpatient visits for atopic dermatitis on the current day(lag0).NO2 also had the most obvious impact in the case of lag0 and showed a lag effect.For each 10 µg/m3 increase in NO2 concentration,the excess risk(ER)of outpatient visits for atopic dermatitis was 1.95%(95% CI=1.09%-2.82%,P=0.01).SO2 had the most significant effect on lag6,and the outpatient visits increased by 1.55%(95% CI=0.48%-2.54%)for every 10 µg/m3 rise in SO2 concentration(P=0.02).Females were more sensitive to PM10 and SO2 than males.For every 10 µg/m3 increase in PM10 and SO2,the female outpatient visits increased by 0.02% and 2.47%,respectively.Males were sensitive to PM2.5 and NO2,and the every 10 µg/m3 rise in PM2.5 and NO2 increased male outpatient visits by 0.47% and 1.78%,respectively.Gaseous pollutants(NO2 and SO2)had more significant effect on people ≤2 years old than on those of other ages.Every 10 µg/m3 rise in NO2 and SO2 would increase the ≤2-year-old outpatient visits by 2.35% and 1.57%,respectively(P=0.02).People of 13-59 years old were sensitive to NO2 concentration,and every 10 µg/m3 rise in NO2 concentration increased their visits by 1.39%.NO2 affected the outpatient visits during the cold and warm seasons,with the ER values of 2.35% and 1.89%,respectively(P=0.01).Particulate matter(PM2.5 and PM10)had the most obvious yet insignificant association with the outpatient visits in winter.The interactions between PM2.5 and NO2,between PM10 and NO2,and between SO2 and NO2 affected the total outpatient visits for atopic dermatitis.The results of double pollutant model showed that in the presence of PM2.5,PM10,or SO2,the effect of NO2 on the outpatient visits for atopic dermatitis enhanced compared with that predicted by single pollutant model(P=0.01). Conclusion The air pollutants(PM2.5,PM10,NO2,and SO2)in Lanzhou were closely related to the outpatient visits for atopic dermatitis,and the increased concentrations of NO2 and SO2 was more likely to increase the risk of atopic dermatitis.

[Effect of Gaseous Pollutant Concentration on the Number of Daily Outpatient Visits for Acne in Lanzhou].

Objective To determine the relationship between air pollutants [SO2,NO2,8 hours average concentration of ozone(O38h)] and outpatient visits for acne in Lanzhou,China. Methods Data of daily outpatient visits for acne and concentrations of air pollutants(SO2,NO2,and O38h)from January 2013 to December 2017 were collected.With the control of long-term trend and day-of-week effect,a distributed lag nonlinear model was used to analyze the lag and cumulative effects of air pollutants on the outpatient visits.The model was established based on the different groups of gender and age. Results During the study period,the average daily outpatient visits were 34.94±15.27,and the average concentrations of SO2,NO2,and O38h were 24.09,43.77,and 82.94 µg/m3,respectively.The Spearman's correlation analysis showed that the daily outpatient visits for acne were positively correlated with NO2 concentration while negatively correlated with O38h concentration;SO2 concentration was negatively correlated with O38h concentration;NO2 concentration was positively correlated with SO2 and O38h concentrations.A 10 µg/m3 increase in daily concentrations of NO2 and SO2 was respectively associated with 2.61%(95% CI=0.98%-4.27%)and 1.71%(95% CI=0.54%-2.89%)increase in the outpatient visits for acne.A 10 µg/m3 increase in O38h concentration was associated with -0.62%(95% CI=-1.12%--0.11%)increase in the outpatient visits.Multipollutant models indicated that air pollutant concentrations were significantly associated with the daily outpatient visits for acne. Conclusions SO2 and NO2 are positively associated with daily dermatological department visits for acne in Lanzhou,while O38h concentration has a negative correlation with the visits.The sensitivity of acne daily outpatient visits to changes in SO2,NO2,and O38h varies among patients of different genders and at different ages.

Chlorambucil for patients with primary biliary cirrhosis.

BACKGROUND: Chlorambucil has been used for patients with primary biliary cirrhosis as it possesses immunosuppressive properties. But it is unknown whether it benefits or harms these patients. OBJECTIVES: To evaluate the beneficial and any harmful effects of chlorambucil for primary biliary cirrhosis patients. SEARCH METHODS: Eligible trials were identified by searching the Cochrane Hepato-Biliary Group Controlled Trials Register (March 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2012, Issue 2), MEDLINE (1946 to March 2012), EMBASE (1974 to March 2012), Science Citation Index EXPANDED (1900 to March 2012), The Chinese Biomedical Database (1976 to March 2012), The Chinese Medical Current Contents (1994 to March 2012), The China Hospital Knowledge Database (1994 to March 2012), and a database of ongoing trials (http://www.controlled-trials.com/mrct/) (accessed 6 March 2012). The reference lists of the retrieved publications and review articles were also read through, and pharmaceutical companies known to produce chlorambucil were contacted. SELECTION CRITERIA: Randomised clinical trials, irrespective of language, year of publication, and publication status, comparing chlorambucil at any dose versus placebo, no intervention, another active drug, or one dose of chlorambucil with another dose. DATA COLLECTION AND ANALYSIS: We planned to assess continuous data with mean differences (MD), and dichotomous outcomes with relative risk (RR), both with 95% confidence intervals (CI). As we only identified one trial, Fisher's exact tests were employed. MAIN RESULTS: Only one randomised trial was identified and included in the review. The bias risk in the trial was high. The trial compared chlorambucil versus no intervention in 24 patients with primary biliary cirrhosis. Fisher's exact test did not show a significant reduction of mortality when comparing chlorambucil with no treatment (0/13 (0%) versus (2/11 (18.2%); P = 0.20). There was no significant difference regarding adverse events for chlorambucil compared with no treatment, but all patients receiving chlorambucil experienced adverse events (13/13 (100%) versus (3/11 (27%); P = 0.1). According to the authors of the trial, chlorambucil led to a significant improvement in mean serum levels of bilirubin (P < 0.05), albumin (P < 0.05), immunoglobulin M (P < 0.01), serum aspartate aminotransferase activity (P < 0.01), and hepatic inflammatory infiltrates (P < 0.01). AUTHORS' CONCLUSIONS: There is not sufficient evidence to support or reject the use of chlorambucil for patients with primary biliary cirrhosis. Chlorambucil may show benefit in some unvalidated surrogate outcome measures (for example, serum bilirubin and immunoglobulin M levels). Chlorambucil is, however, connected with a number of adverse events. Bone marrow suppression should be noted in particular. Further randomised clinical trials are necessary to assess the benefits and harms of chlorambucil in this indication.