BACKGROUND: Evidence on the combined effects of air pollutants and greenspace exposure on pulmonary tuberculosis (PTB) treatment is limited, particularly in developing countries with high levels of air pollution. OBJECTIVE: We aimed to examine the individual and combined effects of long-term exposure to air pollutants on PTB treatment outcomes while also investigating the potential modifying effect of greenspace. METHODS: This population-based study included 82,784 PTB cases notified in Zhejiang Province, China, from 2015 to 2019. The 24-month average concentrations of particulate matter with an aerodynamic diameter ≤2.5 µm (PM_2.5), ozone (O₃), nitrogen dioxide (NO₂), and sulfur dioxide (SO₂) before PTB diagnosis were estimated using a dataset derived from satellite-based machine learning models and monitoring stations. Greenspace exposure was assessed using the annual China Land Cover Dataset. We conducted analyses using time-varying Cox proportional hazards models and cumulative risk indices. RESULTS: In individual effect models, each 10 µg/m³ increase in PM_2.5, NO₂, O₃, and SO₂ concentrations was associated with hazard ratios for PTB treatment success of 0.95 (95% confidence interval (CI): 0.93-0.97), 0.92 (95% CI: 0.91-0.94), 0.98 (95% CI: 0.97-0.99), and 1.52 (95% CI: 1.49-1.56), respectively. In combined effect models, long-term exposure to the combination of air pollutants was negatively associated with PTB treatment success, with a joint hazard ratio (JHR) of 0.79 (95% CI: 0.63-0.96). Among the pollutants examined, O₃ contributed the most to the increased risks, followed by PM_2.5 and NO₂. Additionally, areas with moderate levels of greenspace showed a reduced risk (JHR = 0.81, 95% CI: 0.62-0.98) compared with the estimate from the third quantile model (JHR = 0.68, 95% CI: 0.52-0.83). CONCLUSIONS Combined air pollutants significantly impede successful PTB treatment outcomes, with O₃ and PM_2.5 accounting for nearly 75% of this detrimental effect. Moderate levels of greenspace can mitigate the adverse effects associated with combined air pollutants, leading to improved treatment success for patients with PTB.
Humans ; China/epidemiology* ; Air Pollutants/analysis* ; Tuberculosis, Pulmonary/drug therapy* ; Particulate Matter/adverse effects* ; Male ; Female ; Middle Aged ; Environmental Exposure/analysis* ; Ozone/adverse effects* ; Adult ; Sulfur Dioxide/adverse effects* ; Treatment Outcome ; Air Pollution/adverse effects* ; Aged ; Nitrogen Dioxide/adverse effects* ; Young Adult ; Adolescent

BACKGROUND: The effect of air pollution on annual change rates in grip strength and body composition in the elderly is unknown. OBJECTIVES: This study evaluated the effects of long-term exposure to ambient air pollution on change rates of grip strength and body composition in the elderly. METHODS: In the period 2016-2020, grip strength and body composition were assessed and measured 1-2 times per year in 395 elderly participants living in the Taipei basin. Exposure to ambient fine particulate matters (PM_2.5), nitric dioxide (NO₂), and ozone (O₃) from 2015 to 2019 was estimated using a hybrid Kriging/Land-use regression model. In addition, long-term exposure to carbon monoxide (CO) was estimated using an ordinary Kriging approach. Associations between air pollution exposures and annual changes in health outcomes were analyzed using linear mixed-effects models. RESULTS: An inter-quartile range (4.1 µg/m³) increase in long-term exposure to PM_2.5 was associated with a faster decline rate in grip strength (-0.16 kg per year) and skeletal muscle mass (-0.14 kg per year), but an increase in body fat mass (0.21 kg per year). The effect of PM_2.5 remained robust after adjustment for NO₂, O₃ and CO exposure. In subgroup analysis, the PM_2.5-related decline rate in grip strength was greater in participants with older age (>70 years) or higher protein intake, whereas in skeletal muscle mass, the decline rate was more pronounced in participants having a lower frequency of moderate or strenuous exercise. The PM_2.5-related increase rate in body fat mass was higher in participants having a lower frequency of strenuous exercise or soybean intake. CONCLUSIONS Among the elderly, long-term exposure to ambient PM_2.5 is associated with a faster decline in grip strength and skeletal muscle mass, and an increase in body fat mass. Susceptibility to PM_2.5 may be influenced by age, physical activity, and dietary protein intake; however, these modifying effects vary across different health outcomes, and further research is needed to clarify their mechanisms and consistency.
Humans ; Hand Strength ; Aged ; Male ; Female ; Environmental Exposure/adverse effects* ; Follow-Up Studies ; Taiwan ; Air Pollution/adverse effects* ; Particulate Matter/adverse effects* ; Muscle, Skeletal/drug effects* ; Air Pollutants/adverse effects* ; Ozone/adverse effects* ; Aged, 80 and over ; Adipose Tissue/drug effects* ; Body Composition/drug effects* ; Nitrogen Dioxide/adverse effects*

BACKGROUND: Children's respiratory health demonstrates particular sensitivity to air pollution. Existing evidence investigating the association between short-term ozone (O₃) exposure and childhood pneumonia remains insufficient and inconsistent, especially in low- and middle-income countries (LMICs). METHOD: To provide more reliable and persuasive evidence, we implemented a multi-city, time-stratified case-crossover design with a large sample size, using data from seven representative children's hospitals across major geographical regions in China. To avoid the impact of the COVID-19 pandemic, individual-level medical records of inpatient children under 6 years of age diagnosed with pneumonia during 2016-2019 were collected. Conditional logistic regression models were fitted for each city, and city-specific estimates were pooled through a meta-analysis using a random-effects model. RESULTS: In total, the study included 137,470 pediatric pneumonia hospital admissions. The highest pooled estimate for O₃ occurred at lag0-1, with a 10 µg/m³ increase in O₃ associated with a 1.57% (95% CI: 0.67%-2.48%) higher risk of pediatric pneumonia hospital admissions. Stratified analyses indicated that the effects of O₃ were robust across different sexes, age groups, and admission seasons. We also observed a statistically significant increase in risk associated with O₃ concentrations exceeding the World Health Organization Air Quality Guidelines (WHO-AQGs). CONCLUSIONS This study revealed a significant positive association between O₃ and pediatric pneumonia hospital admissions. Our findings substantially strengthen the evidence base for the adverse health impacts of O₃, underscoring the importance of O₃ pollution control and management in reducing the public health burden of pediatric pneumonia.
Humans ; Ozone/analysis* ; China/epidemiology* ; Pneumonia/chemically induced* ; Child, Preschool ; Male ; Female ; Infant ; Cross-Over Studies ; Air Pollutants/analysis* ; Hospitalization/statistics & numerical data* ; Child ; Cities/epidemiology* ; Air Pollution/adverse effects* ; Infant, Newborn ; Environmental Exposure/adverse effects*

BACKGROUND: Epidemiological studies have demonstrated a causal relationship between ambient ozone (O 3 ) and mortality from chronic obstructive pulmonary disease (COPD), which is the only outcome considered in the Global Burden of Disease Study 2021 for O 3 . This study aims to evaluate the temporal trend and spatial distribution of the COPD burden attributable to O 3 across China from 1990 to 2021. METHODS: The ambient O 3 concentrations in China were estimated. Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we estimated the annual number, age-standardized rate, and percentage of deaths and disability-adjusted life-years (DALYs) from COPD attributable to O 3 pollution during 1990-2021 at the national and provincial levels in China. RESULTS: In 2021, a total of 125.7 (95% uncertainty interval [UI], 26.4-228.3) thousand deaths and 1917.5 (95% UI, 398.7-3504.6) thousand DALYs from COPD were attributable to ambient O 3 pollution in China, accounting for 9.8% (95% UI, 2.1-17.0%) and 8.1% (95% UI, 1.8-14.1%) of the total COPD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in regions with worse health conditions. The age-standardized rates of COPD deaths and DALYs per 100,000 populations ranged from 0.5 (95% UI, 0-1.4) and 8.1 (95% UI, 0.7-20.9) in Hong Kong to 22.8 (95% UI, 3.9-43.5) and 396.6 (95% UI, 68.9-763.7) in Xizang. From 1990 to 2021, there was a notable decrease in the age-standardized rates of COPD-related deaths (68.2%, 95% UI, 60.1-74.9%) and DALYs (71.5%, 95% UI, 63.7-77.6%), especially in regions with poor health conditions. However, the attributable numbers and percentages changed relatively marginally. CONCLUSIONS Ambient O 3 pollution is a major contributor to the COPD burden in China. Our findings highlight the significant spatial heterogeneity across different provinces and underscore the implementation of geographically tailored policies to effectively reduce O 3 pollution and alleviate the associated disease burden.
Pulmonary Disease, Chronic Obstructive/etiology* ; Ozone/analysis* ; Humans ; China/epidemiology* ; Global Burden of Disease ; Male ; Air Pollution/adverse effects* ; Female ; Middle Aged ; Aged ; Air Pollutants/analysis* ; Disability-Adjusted Life Years ; Quality-Adjusted Life Years

Objective: This article aims to observe the changes in long noncoding RNA (lncRNA) expression profiles in rat hearts after ozone sub-chronic exposure. To provide scientific data to explore the role and mechanism of differentially expressed lncRNA in damaged hearts caused by ozone sub-chronic exposure. Methods: Eighteen Wistar rats were randomly divided into filtered air and ozone exposure groups, with nine rats in each group. The rats in filtered air group were exposed to filtered air, while the rats in ozone exposure group were exposed to ozone at 0.5 ppm(0.980 mg/m³)for 90 days at a frequency of 6 hours per day. After ozone exposure, cardiac tissues were collected and the total RNA was extracted. The expression level of lncRNA in the hearts of two groups was detected by microarray and qRT-PCR method and the potential functions of the differentially expressed lncRNA were analyzed by bioinformatics. Results: Compared with the filtered air group, lncRNA's expression profile was significantly altered in the rat hearts of ozone exposure group. A total of 167 lncRNA were up-regulated significantly and 64 lncRNA were down-regulated significantly. GO analysis indicated that the up-regulated lncRNA might involve in the process of regulating growth and development, and the down-regulated lncRNA might participate in nutrient catabolic. KEGG results showed that the up-regulated lncRNA might be involved in regulating the PI3K-Akt signaling pathway. The down-regulated lncRNA might regulate the metabolic processes of various vitamins and main energy-supplying substances. Conclusion: Ozone sub-chronic exposure can cause changes in the expression profile of lncRNA in rat hearts, which may regulate the effects of ozone sub-chronic exposure on the heart through the metabolism of energy and nutrients.
Animals ; Computational Biology ; Ozone/adverse effects* ; Phosphatidylinositol 3-Kinases ; RNA, Long Noncoding/genetics* ; Rats ; Rats, Wistar

OBJECTIVE: To investigate the roles of angiotensin-converting enzyme 2 (ACE2) in ozone-induced pulmonary inflammation and airway remodeling in mice. METHODS: Sixteen wild-type (WT) C57BL/6J mice and 16 ACE2 knock-out (KO) mice were exposed to either filtered air or ozone (0.8 ppm) for 3 h per day for 5 consecutive days. Masson's staining and HE staining were used to observe lung pathologies. Bronchoalveolar lavage fluid (BALF) was collected and the total cell count was determined. The total proteins and cytokines in BALF were determined by BCA and ELISA method. The transcription levels of airway remodeling-related indicators in the lung tissues were detected using real-time quantitative PCR. The airway resistance of the mice was measured using a small animal ventilator with methacholine stimulation. RESULTS: Following ozoneexposure ACE2 KO mice had significantly higher lung pathological scores than WT mice (P < 0.05). Masson staining results showed that compared with ozone-exposed WT mice, ozone-exposed ACE2 KO mice presented with significantly larger area of collagen deposition in the bronchi [(19.62±3.16)% vs (6.49±1.34)%, P < 0.05] and alveoli [(21.63±3.78)% vs (4.44±0.99)%, P < 0.05]. The total cell count and total protein contents in the BALF were both higher in ozone-exposed ACE2 KO mice than in WT mice, but these differences were not statistically significant (P > 0.05). The concentrations of IL-6, IL-1β, TNF-α, CXCL1/KC and MCP-1 in the BALF were all higher in ozone-exposed ACE2 KO mice than in ozone-exposed WT mice, but only the difference in IL-1β was statistically significant (P < 0.05). The transcription levels of MMP-9, MMP-13, TIMP 4, COL1A1, and TGF-β in the lung tissues were all significantly higher in ozone-exposed ACE2 KO mice (P < 0.01). No significant difference was found in airway resistance between ozone-exposed ACE KO mice and WT mice after challenge with 0, 10, 25, or 100 mg/mL of methacholine. CONCLUSION ACE2 participates in ozone-induced lung inflammation and airway remodeling in mice.
Airway Remodeling ; Angiotensin-Converting Enzyme 2 ; Animals ; Methacholine Chloride ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Ozone/adverse effects* ; Pneumonia

OBJECTIVE: To compare the effects of medical ozone oil and urea ointment for prevention and treatment of hand-foot skin reaction (HFSR) caused by sorafenib in patients with hepatocellular carcinoma (HCC). METHODS: A total of 99 patients diagnosed with advanced HCC according to National Comprehensive Cancer Network (NCCN) who were scheduled to receive sorafenib treatment for the first time were enrolled in this study between April, 2018 and January, 2020. The patients were randomized into medical ozone oil group ( RESULTS: Eight patients were excluded for poor compliance or protocol violations, leaving a total of 91 patients for analysis, including 44 in medical ozone oil group and 47 in urea ointment group. Sixteen (36.4%) of patients in ozone oil group developed HFSR, a rate significantly lower than that in urea ointment group (57.4%; CONCLUSIONS Medical ozone oil can significantly reduce the incidence and severity of HFSR to improve the quality of life of HCC patients receiving sorafenib treatment.
Antineoplastic Agents/therapeutic use* ; Carcinoma, Hepatocellular/drug therapy* ; Hand-Foot Syndrome/prevention & control* ; Humans ; Liver Neoplasms/drug therapy* ; Niacinamide/therapeutic use* ; Ozone/therapeutic use* ; Phenylurea Compounds/adverse effects* ; Quality of Life ; Sorafenib/therapeutic use*

OBJECTIVE: To clarify the genotoxicity induced by acute exposure of ozone with different concentrations on pulmonary cells in rats. METHODS: Thirty-six Wistar rats were randomly divided into control group (filtered air exposure) and ozone exposure group (0.12 ppm, 0.5 ppm, 1.0 ppm, 2.0 ppm, 4.0 ppm) with 6 in each group. After rats were exposed to different concentrations of ozone for 4 h, lung tissues were taken and single cells were isolated. Then, 8-hydroxydeoxyguanosine (8-OHdG) was quantitatively detected by enzyme-linked immunosorbent assay. Comet assay, micronucleus test and DNA- protein cross-linking assay were used to analyze DNA and chromosome damages. RESULTS: Compared with the control group, the content of 8-OHdG in lung tissue was increased significantly from the ozone exposure concentration of 0.12 ppm, reaching the highest value at 0.5 ppm. With the increase of ozone exposure concentration, the tail rate of comets was increased gradually, and there was a significant dose-effect relationship. The cross-linking rate of DNA- protein was increased first and then was decreased with a maximum value at 2.0 ppm group. Although the micronucleus rate of lung cells showed an upward trend, there was no significant difference compared with the control group. CONCLUSION Acute exposure of ozone at low concentrations (0.12 ppm) could lead to DNA damage in the pulmonary cells of rats, while no significant chromosome damage was found even in the group with ozone concentration reached to 4 ppm.
Animals ; Comet Assay ; DNA Damage ; Lung ; cytology ; pathology ; Micronucleus Tests ; Ozone ; adverse effects ; Random Allocation ; Rats ; Rats, Wistar

Previous studies suggest that air pollution has a negative effect on semen quality. However, most studies are cross-sectional and the results are controversial. This study investigated the associations between air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) and semen quality among sperm donation candidates, especially when the air pollution was artificially controlled in Beijing, China. We analyzed 8945 semen samples in the human sperm bank of Peking University Third Hospital (Beijing, China) from October 2015 to May 2018. Air pollution data during the entire period (0-90 days prior) and key stages (0-9, 10-14, and 70-90 days prior) of sperm development were collected from the China National Environmental Monitoring Centre. The association between air pollutants and semen parameters (sperm concentration and progressive motility) was analyzed by a mixed model adjusted for age, abstinence duration, month, and average ambient temperature. Only O₃during key stages of 0-9 days and 10-14 days and the entire period was negatively associated with sperm concentration between 2015 and 2018 (P < 0.01). During the period of air pollution control from November 2017 to January 2018, except for the increase in O₃concentration, other five pollutants' concentrations decreased compared to those in previous years. In this period, the sperm concentration decreased (P < 0.001). During the pollution-control period, O₃exposure 10-14 days prior was negatively associated with sperm concentration (95% CI: -0.399--0.111; P < 0.001). No significant association was found between the other five pollutants and semen quality during that period. Our study suggested that only O₃exposure was harmful to semen quality. Therefore, O₃should not be neglected during pollution control operation.
Adolescent ; Adult ; Air Pollutants/analysis* ; Air Pollution/adverse effects* ; Beijing ; Cross-Sectional Studies ; Environmental Monitoring ; Humans ; Longitudinal Studies ; Middle Aged ; Oxidants, Photochemical/adverse effects* ; Ozone/adverse effects* ; Particulate Matter/analysis* ; Semen Analysis ; Sperm Count ; Sperm Motility ; Young Adult

Epidural Space ; Female ; Headache Disorders, Primary ; etiology ; Humans ; Intervertebral Disc Displacement ; drug therapy ; Middle Aged ; Oxygen ; administration & dosage ; Ozone ; administration & dosage ; Spinal Puncture ; adverse effects