Background: The relationship between the levels of various environmental chemicals and the high prevalence of neural tube defects (NTDs) in north China remains unclear. This study aimed to classify the associations of maternal exposure to polycyclic aromatic hydrocarbons (PAHs), passive smoking, and widely concerned trace metal elements with NTD risk. Methods: Our case-control study recruited a total of 828 subjects: 285 women who delivered a fetus with NTDs (cases) and 543 women a healthy newborn without NTDs (controls). We measured the concentrations of PAHs, nicotine/cotinine, and various trace metal elements in two hair sections grown near the early pregnancy. Findings: Overall, no significant associations were found between the risk of any NTD subtypes and the hair levels of PAHs, nicotine/cotinine, and some metals (i.e., Cd, Sb, Pb, Cr, Mn, Fe, Ni, Co, and Cu). According to the cross-validation results for the two hair sections, hair concentrations of Mo and Sn were inversely associated with anencephaly risk, and the hair concentration of Zn was inversely associated with the risk of spina bifida. Interpretation: We concluded that maternal exposure to either PAHs or passive smoking was not a significant risk factor for NTDs, whereas the maternal less intake of certain trace metal elements may contribute to the high NTD prevalence in north China. It suggested that much effort should be spent to improve the dietary quality of various essential trace metal elements to reduce NTD risk for population living in North China. Funding: This research was supported by grants from the National Key Research and Development Program, P.R. China (Grant No. 2016YFC1000501) and the National Natural Science Foundation of China (No. 41771527 and 81373014). Conflict of Interest: The authors declare they have no actual or potential competing financial interests. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Peking University (PU-IRB) and the signed consent was obtained from all subjects.
To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries.Population-based prospective observational study.Urban and rural communities in 20 high income, middle income and low income.119 894 community-dwelling middle-aged adults.Associations of social isolation with mortality, cardiovascular death, non-cardiovascular death and incident diseases.Social isolation was more common in middle-income and high-income countries compared with low-income countries, in urban areas than rural areas, in older individuals and among women, those with less education and the unemployed. It was more frequent among smokers and those with a poorer diet. Social isolation was associated with greater risk of mortality (HR of 1.26, 95% CI: 1.17 to 1.36), incident stroke (HR: 1.23, 95% CI: 1.07 to 1.40), cardiovascular disease (HR: 1.15, 95% CI: 1.05 to 1.25) and pneumonia (HR: 1.22, 95% CI: 1.09 to 1.37), but not cancer. The associations between social isolation and mortality were observed in populations in high-income, middle-income and low-income countries (HR (95% CI): 1.69 (1.32 to 2.17), 1.27 (1.15 to 1.40) and 1.47 (1.25 to 1.73), respectively, interaction p=0.02). The HR associated with social isolation was greater in men than women and in younger than older individuals. Mediation analyses for the association between social isolation and mortality showed that unhealthy behaviours and comorbidities may account for about one-fifth of the association.Social isolation is associated with increased risk of mortality in countries at different economic levels. The increasing share of older people in populations in many countries argues for targeted strategies to mitigate its adverse effects.
Abstract Background The Chiari network, a remnant of fetal anatomy, consists of a mesh-like structure within the right atrium. With advancements in cardiac interventions, complications associated with the Chiari network have increasingly been reported. However, there are few reports about guidewire or catheter entrapment in the Chiari network during the insertion of a dialysis catheter. Case presentation A 46-year-old male with end-stage renal disease was hospitalized and underwent a digital subtraction angiography-assisted catheterization of the right internal jugular vein tunnel-cuffed dialysis catheter. When the guide wire entered a depth of about 20 cm, it was difficult to advance, manifested as resistance when twisting the guide wire and inability to enter the inferior vena cava. After the peelable sheath was inserted, it was difficult to pull out the guide wire. After repeated attempts to rotate the guide wire, the guide wire was finally pulled out. A fibrous tissue was wrapped around the tip of the guide wire. Its length was 6 cm, with a smooth surface and tough texture. We considered that the tissue we pulled out was most likely a part of a Chiari network. Conclusions This case highlights the potential for the Chiari network to complicate surgical procedures, including difficulty with guidewire and catheter manipulation. Attention should be paid to Chiari networks. Echocardiography can be used to identify the Chiari network. During the surgery, forcefully pulling out a stuck guidewire is not suggested, to avoid the risk of tearing the atrial wall and causing pericardial tamponade. An urgent consultation with ultrasound doctors and cardiac surgeons might be helpful in such cases.
Numerous animal studies have shown that high arsenic exposure can induce neural tube defect (NTD) formation. However, epidemiological evidence related to this finding is scarce. The key objective of our study is to evaluate whether maternal arsenic exposure is associated with NTD risk in Northern China. Our case-control study was conducted in 11 countries or cities in Shanxi and Hebei provinces during 2003-2007. A total of 774 mothers were included as participants: 511 controls and 263 cases (including 123 with anencephaly, 115 with spina bifida, 18 with encephalocele, and 7 with other NTD subtypes). The arsenic concentration was measured in a specific section of hair that grew from 3 months before to 3 months after conception. We found a higher hair arsenic concentration in the NTD cases with median (inter-quartile range) of 0.093 (0.025-0.387) μg/g hair than that in the controls with a value of 0.082 (0.030-0.414) μg/g hair. Maternal hair arsenic concentration above its median of the controls was associated with an increased risk of the total NTDs with an adjusted odds ratio (OR) of 1.32 [95% confidence interval (CI): (0.91-1.92)], which was not statistically significant (p = 0.14), although the crude OR without adjusting for the confounders of 1.68 (95% CI: 1.24-2.27; p < 0.001) suggested that hair arsenic is a risk factor of NTDs. There was no dose-response relationship between maternal hair arsenic concentration and the risk of total NTDs. Similar phenomena were found for anencephaly and spina bifida, respectively. Overall, our findings showed that maternal periconceptional arsenic exposure may not significantly contribute to the risk of NTD development in Northern China; other risk factors need to be further examined in future studies.
Germanium (Ge) can induce certain neurotoxic effects and may affect the fetal neural tube development. We aimed to investigate its association with the risk of neural tube defects (NTDs) by adopting integrated evidence. The potential associations between maternal hair Ge concentrations were explored using a relatively large case–control study of 285 NTD cases (women delivering a birth affected by NTDs) and 543 controls (those delivering healthy fetus without NTDs). The potential toxicological pathways and the reliability of the exposure biomarker of hair Ge were confirmed using additional population study and rat model, respectively. The epidemiological study showed that there was a significantly positive association between maternal hair Ge and NTD risk, with odds ratios (95% confidence interval) of 1.91 (1.24–2.94) and 1.42 (1.00–2.00) for two concerned time-windows covering the early pregnancy period. Likewise, we found a significantly positive dose–response relationship between Ge intake and its concentration in rats' fur sample. By using a birth cohort, we found that maternal Ge exposure may increase oxidation stress and the likelihood of fever or flu among pregnant women, which were both related to NTD risk. We first concluded that maternal Ge exposure was positively associated with NTD risk with integrated evidence.
The effects of meteorological factors and air pollutants on respiratory diseases (RDs) were various in different populations according to the demographic characteristics, and children were considered a vulnerable population. Previous studies were mainly based in cities with serious air pollution. This study aimed to qualify the lag effects of meteorological factors and air pollution on respiratory diseases among children under 18 years old in Fuzhou.Meteorological data, air pollutants concentrations and hospital admission data of Fujian Maternity and Child Health Hospital between 2015 and 2019 were collected. A Distributed Lag Nonlinear Model (DLNM) was used to evaluate the nonlinear and lagged effect of meteorological factors and air pollutants on daily RDs number. A subgroup analysis was also conducted to evaluate the effect on different sex groups and age groups.A total number of 796 125 RDs visits was included during the study period. For meteorological factors, lower mean temperature and relative humidity were significantly associated with daily RDs number (peak relative risk (RR) = 1.032 (95% confidence interval (CI) = 1.011-1.053) and 1.021 (95% CI = 1.013-1.029)), while lower wind speed showed a significant association at low range (peak RR = 0.995 (95% CI = 0.992-0.999)). Temperature warming was a significant protective factor for RDs (peak RR = 0.989 (95% CI = 0.986-0.993)). For air pollutants, SO2, NO2, PM10 and PM2.5 were all significantly associated with RDs (peak RR = 1.028 (95% CI = 1.022-1.035), 1.024 (95% CI = 1.013-1.034), 1.036 (95% CI = 1.025-1.047), 1.028 (95% CI = 1.019-1.037)), and the relationship had no threshold. The estimated RR and peak lag day did not change extremely between subgroups.The findings provide statistical evidence for the prevention of child RDs. In addition, our findings suggested that even at low concentrations, air pollutants still have negative effects on the respiratory system.
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