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Chinese children are exposed to broad environmental risks ranging from well-known hazards, such as pesticides and heavy metals, to emerging threats including many new man-made chemicals. Although anecdotal evidence suggests that the exposure levels in Chinese children are substantially higher than those of children in developed countries, a systematic assessment is lacking. Further, while these exposures have been linked to a variety of childhood diseases, such as respiratory, endocrine, neurological, behavioral, and malignant disorders, the magnitude of the associations is often unclear. This review provides a current epidemiologic overview of commonly reported environmental contaminants and their potential impact on children's health in China. We found that despite a large volume of studies on various topics, there is a need for more high-quality research and better-coordinated regional and national data collection. Moreover, prevention of such diseases will depend not only on training of environmental health professionals and enhanced research programs, but also on public education, legislation, and networking., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Large-for-gestational age (LGA), a marker of fetal overgrowth, has been linked to obesity in adulthood. Little is known about how infancy growth trajectories affect adiposity in early childhood in LGA., Methods: In the Shanghai Birth Cohort, we followed up 259 LGA (birth weight >90th percentile) and 1673 appropriate-for-gestational age (AGA, 10th-90th percentiles) children on body composition (by InBody 770) at age 4 years. Adiposity outcomes include body fat mass (BFM), percent body fat (PBF), body mass index (BMI), overweight/obesity, and high adiposity (PBF >85th percentile)., Results: Three weight growth trajectories (low, mid, and high) during infancy (0-2 years) were identified in AGA and LGA subjects separately. BFM, PBF and BMI were progressively higher from low- to mid-to high-growth trajectories in both AGA and LGA children. Compared to the mid-growth trajectory, the high-growth trajectory was associated with greater increases in BFM and the odds of overweight/obesity or high adiposity in LGA than in AGA children (tests for interactions, all P < 0.05)., Conclusions: Weight trajectories during infancy affect adiposity in early childhood regardless of LGA or not. The study is the first to demonstrate that high-growth weight trajectory during infancy has a greater impact on adiposity in early childhood in LGA than in AGA subjects., Impact: Large-for-gestational age (LGA), a marker of fetal overgrowth, has been linked to obesity in adulthood, but little is known about how weight trajectories during infancy affect adiposity during early childhood in LGA subjects. The study is the first to demonstrate a greater impact of high-growth weight trajectory during infancy (0-2 years) on adiposity in early childhood (at age 4 years) in subjects with fetal overgrowth (LGA) than in those with normal birth size (appropriate-for-gestational age). Weight trajectory monitoring may be a valuable tool in identifying high-risk LGA children for close follow-ups and interventions to decrease the risk of obesity., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Global health concerns about micro- and nanoplastics are increasing. The newly discovered beige adipocytes play a vital role in energy homeostasis through their high thermogenic capacity upon activation. However, the effects of micro- and nanoplastics on beige adipocytes have not yet been studied. We investigated whether the effects of oral exposure to polystyrene nanoparticles (PS-NPs) on systemic metabolic performance can be induced by disrupting beige adipocyte function, and the potential mechanism. In the present study, C57BL/6J male mice were fed a high-fat diet (HFD) with or without PS-NPs exposure for 12 weeks to investigate the differences in metabolic performance. We also isolated stromal vascular fraction from C57BL/6J male mice to differentiate and prepare primary beige adipocyte cultures. Primary beige adipocytes were treated with PS-NPs on the sixth day of differentiation. The results showed that oral intake of PS-NPs exacerbated metabolic disorders of mice under HFD, including suppressed energy expenditure, increased fat mass and liver steatosis, decreased insulin sensitivity, disrupted glucose homeostasis, and decreased cold-tolerance capability compared with the control group. Intriguingly, we observed that, after a 12-week exposure, PS-NPs accumulated in the inguinal white adipose tissue (iWAT), a fat depot rich in beige adipocytes, further suppressing thermogenic gene programs, particularly the level of uncoupling protein 1 (UCP1), a master regulator in the browning process of beige adipocytes. These effects ultimately led to decreased energy expenditure and subsequent disorders of glucolipid metabolism. Mechanistically, we revealed that PS-NPs disrupt mitochondrial function and induce oxidative damage and inflammation in beige adipocytes to inhibit their function. These negative metabolic effects of PS-NPs were ameliorated by antioxidant supplementation. Our study is the first to demonstrate that PS-NPs exposure exacerbates metabolic disorder in HFD-fed mice by disrupting beige adipocyte function., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024. Published by Elsevier B.V.)

Objective: The fetal brain is particularly plastic, and may be concurrently affected by chemical exposure and malnutritional factors. Selenium is essential for the developing brain, and excess manganese exposure may exert neurotoxic effects. However, few epidemiological studies have evaluated the interaction of manganese and selenium assessed in different prenatal stages on postnatal neurodevelopmental trajectories., Methods: This study contained 1024 mother-child pairs in the Shanghai-birth-cohort study from 2013 to 2016 recruited since early/before pregnancy with complete data on manganese and selenium levels in different prenatal stages and infant neurodevelopmental trajectories. Whole blood manganese and selenium in early pregnancy and around birth were measured by inductively-coupled-plasma-mass-spectrometry (ICP-MS), children's cognitive development was evaluated at 6, 12, and 24 months of age using Age & Stage-Questionnaire (ASQ)-3 and Bayley-III. Multiple linear regression was used to investigate the interaction of prenatal selenium and manganese on neurodevelopmental trajectories., Results: The prenatal manganese and selenium levels were 1.82 ± 0.98 μg/dL and 13.53 ± 2.70 μg/dL for maternal blood in early pregnancy, and 5.06 ± 1.67 μg/dL and 11.81 ± 3.35 μg/dL for umbilical cord blood, respectively. Higher prenatal Se levels were associated with better neurocognitive performances or the consistently-high-level trajectory (P < 0.05), with more significant associations observed in early pregnancy than around birth. However, such positive relationships became non-significant or even adverse in high (vs. low) manganese status, and the effect differences between low and high manganese were more significant in early pregnancy., Conclusions: Prenatal Selenium was positively associated with child neurodevelopment, but prenatal high manganese may mitigate such favorable effects. The effects were mainly observed in earlier prenatal stage., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Arsenic (As) and lead (Pb) are toxins found in the natural surroundings, and the harmful health outcomes caused by the co-exposure of such toxins have become a considerable problem. However, the joint neurotoxicity of As and Pb to neurodevelopment and the underlying mechanisms remain unclear. Pluripotent stem cell-derived human brain organoids are emerging animal model alternatives for understanding neurological-related diseases. Therefore, we utilized brain organoids with optic vesicles (OVB-organoids) to systematically analyze the neurotoxicity of As and Pb. After 24 h of As and/or Pb exposure, hematoxylin-eosin staining revealed that As and Pb exposure could cause disorders in the structure of the ventricular zone and general cell disarrangement in OVB-organoids. Immunostaining displayed that OVB-organoids are more susceptible to As and Pb co-exposure than independent exposure in apoptosis, proliferation, and cell differentiation. Meanwhile, even though As and Pb could both hinder cell proliferation, contrary to Pb, As could induce an increasing proportion of mitotic (G2/M) cells. The proteome landscape of OVB-organoids illustrated that Pb synergized with As in G2/M arrest and the common role of As and Pb in carcinogenesis. Besides, proteomics analyses suggested the consequential role of autophagy and Wnt pathway in the neurotoxicity of As and Pb co-exposure. Overall, our findings provide penetrating insights into the cell cycle, carcinogenesis, autophagy, and Wnt pathway underlying the As and Pb binary exposure scenarios, which could enhance our understanding of the mixture neurotoxicity mechanisms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Human cerebral organoids (COs), generated from stem cells, are emerging animal alternatives for understanding brain development and neurodegeneration diseases. Long-term growth of COs is currently hindered by the limitation of efficient oxygen infiltration and continuous nutrient supply, leading to general inner hypoxia and cell death at the core region of the organoids. Here, we developed a three-dimensional (3D) microfluidic platform with dynamic fluidic perturbation and oxygen supply. We demonstrated COs cultured in the 3D microfluidic system grew continuously for over 50 days without cell death at the core region. Increased cell proliferation and enhanced cell differentiation were also observed and verified with immunofluorescence staining, proteomics and metabolomics. Time-lapse proteomics from 7 consecutive acquisitions between day 4 and day 30 identified 546 proteins differently expressed accompanying COs growth, which were mainly relevant to nervous system development, in utero embryonic development, brain development and neuron migration. Our 3D microfluidic platform provides potential utility for culturing high-homogeneous human organoids., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: The aim of this study was to explore prospective relationships between changing patterns of BMI/waist to height ratio (WHtR) during adolescence and subsequent neurobehavioral development., Methods: In this prospective cohort study, randomized stratified sampling was used to recruit six middle schools and 609 students in Shanghai, China. In Grades 6, 7, and 9, the Youth Self Report scale was used to assess student neurobehavioral status and anthropometric measurements were conducted to calculate BMI z scores and WHtRs. Longitudinal data were analyzed using latent class mixture modeling to delineate trajectories of BMI z scores ("stable," "decreasing," "rapidly increasing") and WHtRs ("stable," "rapidly increasing"), and their associations with neurobehavioral status in Grade 9 were assessed., Results: In Grades 6 through 9 (ages 11-15 years), the prevalence of overall obesity and abdominal obesity ranged from 10.7% to 13.0% and 13.0% to 19.8%, respectively. Compared with the stable BMI z score trajectory, the rapidly increasing BMI z score trajectory was longitudinally associated with delinquent behavior, aggressive behavior, and externalizing problems (incidence rate ratio: 1.564-1.613, adjusted p < 0.05). Compared with the stable WHtR trajectory, the rapidly increasing WHtR trajectory significantly predicted increased risks of social problems and delinquent behavior (incidence rate ratios: 1.776-1.967, adjusted p < 0.05). Significant associations of the rapidly increasing BMI z score/WHtR trajectories with subsequent neurobehavioral deficits were observed among girls (adjusted p < 0.05) but not among boys (adjusted p > 0.05)., Conclusions: Rapid increases in BMI or WHtR during adolescence could predict subsequent neurobehavioral deficits, especially for externalizing behaviors. Timely intervention for weight control may be considered to promote adolescent mental health., (© 2023 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)

Background: The prospective associations between homework burdens and adolescent neurobehavioral problems, and whether sleep-durations mediated and sex modified such associations remained unclear., Methods: Using Shanghai-Adolescent-Cohort study, 609 middle-school students were recruited and investigations took place at Grade 6, 7 and 9. Information on homework burdens (defined by homework completion-time and self-perceived homework difficulty), bedtime/wake-up-time and neurobehavioral problems was collected. Two patterns of comprehensive homework burdens ('high' vs. 'low') were identified by latent-class-analysis and two distinct neurobehavioral trajectories ('increased-risk' vs. 'low-risk') were formed by latent-class-mixture-modeling., Results: Among the 6th-9th graders, the prevalence-rates of sleep-insufficiency and late-bedtime ranged from 44.0 %-55.0 % and 40.3 %-91.6 %, respectively. High homework burdens were concurrently associated with increased-risks of neurobehavioral problems (IRRs: 1.345-1.688, P < 0.05) at each grade, and such associations were mediated by reduced sleep durations (IRRs for indirect-effects: 1.105-1.251, P < 0.05). High homework burden at the 6th-grade (ORs: 2.014-2.168, P < 0.05) or high long-term (grade 6-9) homework burden (ORs: 1.876-1.925, P < 0.05) significantly predicted increased-risk trajectories of anxiety/depression and total-problems, with stronger associations among girls than among boys. The longitudinal associations between long-term homework burdens and increased-risk trajectories of neurobehavioral problems were mediated by reduced sleep-durations (ORs for indirect-effects: 1.189-1.278, P < 0.05), with stronger mediation-effects among girls., Limitations: This study was restricted to Shanghai adolescents., Conclusions: High homework burden had both short-term and long-term associations with adolescent neurobehavioral problems, with stronger associations among girls, and sleep-insufficiency may mediate such associations in a sex-specific manner. Approaches targeting appropriate homework-load/difficulty and sleep restoration may help prevent adolescent neurobehavioral problems., Competing Interests: Conflict of interest The authors declare that there are no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Inconsistent evidence exists about whether exposure to greenspace benefits childhood asthma. Previous studies have only focused on residential or school greenspace, and no research has combined greenspace exposures at both homes and schools to determine their link with childhood asthma. A population-based cross-sectional study was conducted among 16,605 children during 2019 in Shanghai, China. Self-reported questionnaires were used to collect information on childhood asthma and demographic, socioeconomic and behavioural factors. Environmental data including ambient temperature, particulate matter with aerodynamic diameter less than 1 µm (PM 1 ), enhanced vegetation index (EVI), and normalized difference vegetation index (NDVI) were collected from satellite data. Binomial generalized linear models with a logit link were carried out to evaluate the association between greenspace exposure and children's asthma, as well as the effect modifiers. An interquartile range increment of whole greenspace (NDVI 500 , NDVI 250 , EVI 500 , and EVI 250 ) exposure was associated with a reduced odds ratio of children's asthma (0.88, 95% CI: 0.78, 0.99; 0.89, 95% CI: 0.79, 1.01; 0.87, 95% CI: 0.77, 0.99; and 0.88, 95% CI: 0.78, 0.99, respectively) after controlling potential confounders. Low temperature, low PM 1 , males, vaginal delivery, suburban/rural area, and without family history of allergy appeared to enhance the greenspace-asthma association. Increased greenspace exposure was associated with a lower risk of childhood asthma, and the association was modified by a range of socio-environmental factors. These findings add to the body of evidence on the benefits of biodiversity and supporting the promotion of urban greenspace to protect children's health., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Prenatal single and combined exposure to lead (Pb) and stress (Ps) impairs neurodevelopment. Prenatal single exposure to Pb or Ps affects the composition of intestinal microbiota, and bidirectional communication between gut microbiota and central nervous system has been well recognized. However, whether gut microbiota mediated the effects of prenatal Pb+Ps co-exposure on neurodevelopmental deficits remains unclear. This study established rat models with prenatal single and combined exposure to Ps and Pb. We investigated the effects of such prenatal single and combined exposure on hippocampal structures using morphological analyses, on learning/memory using the Morris-water-maze test, and on fecal microbiota using 16S rRNA sequencing. The mediating roles of gut microbiota were analyzed using the bootstrap method. The study found both single and combined exposure affected hippocampal ultra-structures and spatial learning/memory, and the most significant impairments were observed in the Pb+Ps group. Prenatal Pb+Ps co-exposure decreased fecal microbial alpha/beta-diversity. Significantly lower levels of B/F-ratio, class-Bacteroidia, order-Bacteroidales, and family-S24-7, and significantly higher levels of class-Bacilli, order-Lactobacillales, family-Lactobacillaceae, and genus-Lactobacillus were observed in the co-exposure group, compared with the controls. Increased relative abundances of genus-Helicobacter mediated the detrimental effect of prenatal Ps+Pb co-exposure on learning/memory [β (95%CI) for the total and indirect effects: - 10.70 (-19.19, -2.21) and - 4.65(-11.07, -1.85)], accounting for 43.47% of the total effect. As a result, increased relative abundances of genus-Lactobacillus alleviated the adverse effects of the co-exposure on learning/memory, and the alleviation effect accounted for 44.55% of the direct effect [β (95%CI) for the direct and indirect effects: - 0.28(-0.48, -0.08) and 0.13(0.01, 0.41)]. This study suggested that prenatal combined exposure to Pb and Ps induced more impairments in offspring gut microbiota and neurodevelopment than single exposure, and alterations in fecal microbiome may mediate the developmental neurotoxicity induced by such prenatal co-exposure., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Interest in assessing the effects of exposure to greenspace on human health has been increasing due to rapid urbanization, and rising trends of physical inactivity and air pollution. However, findings on the link between greenspace and child respiratory health, especially asthma, are inconsistent. We investigated the association between greenspace surrounding residential addresses and asthma in children. A city-wide cross-sectional study was conducted, involving 16,605 children aged 3-12 years, in Shanghai, China. Data on asthma symptoms and covariates were collected from validated self-reported questionnaires. Residential greenspace was measured using satellite-derived normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Information on ambient temperature and particulate matter with dynamic diameter <1 μm (PM 1 ) and 2.5 μm (PM 2.5 ) was also collected from satellite data. Logistic regression models were performed to assess the associations of greenspace exposure with childhood asthma as well as the effect modification by covariates. The prevalence of current asthma in children was 4.8 % in this study. An interquartile range increase in mean NDVI from 2016 to 2018 was associated with decreased odds of asthma in 2019 at 500 m, and 250 m resolutions (0.82, 95 % confidence interval (CI): 0.74 to 0.93; and 0.82, 95 % CI: 0.72 to 0.94, respectively) after adjustment for covariates. The greenspace-asthma association was modified by ambient temperature and residential area. Sensitivity analyses using various models and EVI exposure showed the robustness of the results. In conclusion, higher individual-level exposure to greenspace was associated with decreased odds of asthma in children, and the association appeared to be modified by different environmental and socio-demographic factors. These findings provide additional evidence for promoting urban greenness to protect children's health and well-being., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: Epstein-Barr virus (EBV) infection has been shown to contribute to oncogenesis and often causes acute clinical manifestation of Infectious mononucleosis (IM). It is unknown whether IM could increase the risk of subsequent malignancies. We aimed to evaluate the association of IM caused by EBV (EBV-IM) with overall and subtypes of malignancy in a large population-based cohort study., Methods: This study included 1,419,407 individuals born in Denmark between 1973 and 2016 identified from national registers and 23,057 individuals had IM. The 5,394 of them had confirmed EBV-IM and they were birth date- and sex- matched (1:63) to 1,396,350 non-IM individuals. Cox regression was used to examine the associations of EBV-IM with malignancy., Results: Individuals with a history of confirmed EBV-IM had an 88% increased overall risk of malignancy (hazard ratio [HR]:1·88, 95% confidence interval [CI]: 1·42-2·49) and a five-fold risk of hematologic malignancies (HR 5·04, 95% CI: 3·07-8·25), compared to those without IM. Similar estimates were observed in the sibling analysis. The overall risk of malignancy was greater for EBV-IM with complications (HR 8·93, 95% CI: 3·35-23·81) than that for EBV-IM without complications (HR 1·35, 95% CI: 1·20-1·53). EBV-IM duration was related to increased risk of malignancy in a dose-response way. Notably, the significant elevated risk of overall malignancy was observed in the first two years after EBV-IM onset (rate ratio [RR] 4·44, 95% CI: 2·75-7·17) and attenuated thereafter., Conclusion: EBV-IM was associated with an increased risk in malignancy, particularly hematologic malignancies and in the first two years following IM exposure. Our findings suggest an important time-window for early screening of the EBV-attributed malignancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Cai, Zhou, Huang, Tao, Sun, Yan, Lee, Svendsen, Fu, Li and Huang.)

It is well documented that childhood lead exposure is associated with long-term decreases in intelligence quotients (IQ). Lesser known is the relationship with neurobehavioral domains, especially in adolescence. This study sought to identify cross-sectional and longitudinal associations between lead exposure and adolescent executive and visual-motor functioning and examine sex-based differences. Participants were 681 children from Jintan, China who had their blood lead levels (BLLs) assessed at age 3-5 years and 12 years old and neurobehavioral functioning assessed through the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB) platform http://www.med.upenn.edu/bbl at 12 years old. Mean BLLs were 6.41 mcg/dl at age 3-5 years and 3.10 mcg/dl at 12. BLLs at 3-5 years and 12 years were used as predictors for the individual neurobehavioral domains in general linear models while controlling for father and mother occupation and education, residence location, age, and adolescent IQ. Models were run separately for males and females. In adjusted models, males BLLs at 3-5 years were associated with increased time to correctly complete tasks in multiple domains including abstraction/flexibility (β = 19.90, 95% CI( 4.26, 35.54) and spatial processing (β = 96.00, 95% CI 6.18, 185.82) at 12 years. For females in adjusted models, BLLs at 3-5 years were associated with increasing time to correctly complete tasks on the episodic memory domain task (β = 34.59, 95% CI 5.33, 63.84) at 12 years. Two adolescent cross-sectional relationships remained in the adjusted models for males only, suggesting a positive association between BLLs and increasing time for correct responses on the attentional domain task (β = 15.08, 95% CI 0.65, 29.51) and decreasing time for correct responses on the episodic memory task (β = -73.49, 95% CI -138.91, -8.06) in males at 12 years. These associations remained with and without controlling for IQ. These results suggest that lead exposure is associated with overall deficits in male and female neurobehavioral functioning, though in different domains and different timing of exposure., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Competing interests The authors have no competing interests to declare., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Global climate change (GCC) is widely accepted as the biggest threat to human health of the 21st century. Children are particularly vulnerable to GCC due to developing organ systems, psychological immaturity, nature of daily activities, and higher level of per-body-unit exposure. There is a rising trend in the disease burden of childhood asthma and allergies in many parts of the world. The associations of CC, air pollution and other environmental exposures with childhood asthma are attracting more research attention, but relatively few studies have focused on CC adaptation measures and childhood asthma. This study aimed to bridge this knowledge gap and conducted the first systematic review on CC adaptation measures and childhood asthma. We searched electronic databases including PubMed, Embase, and Web of Science using a set of MeSH terms and related synonyms, and identified 20 eligible studies included for review. We found that there were a number of adaptation measures proposed for childhood asthma in response to GCC, including vulnerability assessment, improving ventilation and heating, enhancing community education, and developing forecast models and early warning systems. Several randomized controlled trials show that improving ventilation and installing heating in the homes appear to be an effective way to relieve childhood asthma symptoms, especially in winter. However, the effectiveness of most adaptation measures, except for improving ventilation and heating, have not been explored and quantified. Given more extreme weather events (e.g., cold spells and heatwaves) may occur as climate change progresses, this finding may have important implications. Evidently, further research is urgently warranted to evaluate the impacts of CC adaptation measures on childhood asthma. These adaptation measures, if proven to be effective, should be integrated in childhood asthma control and prevention programs as GCC continues., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Trace elements persist in the environment, and their early exposure may adversely affect children's intellectual development. To clarify the influence of blood trace element levels in newborns and school-aged children, we used Wechsler Intelligence Scale for children (WISC-CR) to explore intellectual development level of 148 school-aged children based on a population cohort study. Lead (Pb), selenium (Se), arsenic (As), copper (Cu), manganese (Mn) and chromium (Cr) in cord blood and Pb, As, Cu in venous blood were determined by inductively coupled plasma mass spectrometry (ICP-MS) and atomic absorption spectrometer (AAS). Our analysis of the correlation between children's mental development and trace element content found children's cognitive abilities negatively correlate with Pb (PIQ: β=-0.109, P=0.03737) and Cu (PIQ: β=-0.031, P=0.04431; FISQ: β=-0.031, P=0.02137) levels in cord blood. Prenatal low-level As exposure may negatively affect girls' performance intelligence quotient (PIQ) and verbal intelligence quotient (VIQ). There were differences in Se levels in cord blood and venous blood between boys and girls (P=0.010; P=0.073). High Se levels were associated with a lower VIQ in boys and a higher VIQ in girls. Prenatal exposure to Pb, As and Cu may weaken children's cognitive abilities at school age. Se exposure may have opposite effects on cognitive abilities affected by dose and gender., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To assess associations of single and combined exposures to lead and stress during different stages of pregnancy with offspring neurodevelopment., Methods: We measured prenatal lead (maternal blood-lead in early-pregnancy and umbilical-cord-blood-lead) and maternal stress levels in Shanghai-Birth-Cohort from 2013 to 2016. Maternal stress was assessed using Center-for-Epidemiological-Studies-Depression-Scale and Self-Rating-Anxiety-Scale during mid-pregnancy. The Ages-Stages-Questionnaires-3 (at 6/12-months-of-age) and Bayley-III (at 24-months-of-age) were both used to assess neurodevelopment., Results: A total of 2132 mother-child pairs with both prenatal lead and stress measurements were included. The geometric-means of blood-lead in early-pregnancy and cord-blood-lead were 1.46 μg/dL and 1.33 μg/dL, respectively. Among the study women, 1.89 % and 0.14 % were screened positive for depression and anxiety. Adjusting for related confounders, the combined exposures had stronger adverse associations with offspring social-emotional skills than single exposures; and the combined exposure in early-pregnancy was associated with greater neurodevelopmental differences than combined exposure around-birth, especially in social-emotion at 24 months-of-age [β (95 %CI): - 10.48(-17.42, -3.54) vs. - 5.95(-11.53, -0.36)]., Conclusions: Both single and combined prenatal exposures to lead/stress impaired infant neuro-development, and the effects of combined exposure may be more profound than single exposures. Combined exposure in early-pregnancy may be associated with worse neurodevelopmental outcomes than combined exposure around-birth, especially in social-emotional development., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

To investigate prenatal exposure to arsenic and its effect on birth size, we conducted a cross-sectional study in Wujiang City, Jiangsu, China, from June 2009 to June 2010. A total of 1722 mother-infant pairs were included in the study. A questionnaire was administered to the pregnant women and umbilical cord blood(UCB) samples were collected. Arsenic concentration in UCB was detected by inductively coupled plasma emission mass spectroscopy (ICP-MS). The birth size included birth weight, birth body length and head circumference of the newborns. The effects of arsenic exposure on birth size were assessed by multiple linear regression analysis. Arsenic concentrations in UCB ranged from 0.11 to 30.36 μg/L, the median was 1.71 μg/L. In this range of exposure, arsenic concentration was significantly negatively associated with birth weight, especially among male infants. Our results showed that prenatal exposure to arsenic level was low in Wujiang City, China. However, low prenatal arsenic exposure could have negative effects on birth weight. Our research provided evidence for the adverse effects of prenatal low-level arsenic exposure on the intrauterine growth of the fetus., (Copyright © 2022. Published by Elsevier Ltd.)

The Lancet Commission on pollution and health reported that pollution was responsible for 9 million premature deaths in 2015, making it the world's largest environmental risk factor for disease and premature death. We have now updated this estimate using data from the Global Burden of Diseases, Injuriaes, and Risk Factors Study 2019. We find that pollution remains responsible for approximately 9 million deaths per year, corresponding to one in six deaths worldwide. Reductions have occurred in the number of deaths attributable to the types of pollution associated with extreme poverty. However, these reductions in deaths from household air pollution and water pollution are offset by increased deaths attributable to ambient air pollution and toxic chemical pollution (ie, lead). Deaths from these modern pollution risk factors, which are the unintended consequence of industrialisation and urbanisation, have risen by 7% since 2015 and by over 66% since 2000. Despite ongoing efforts by UN agencies, committed groups, committed individuals, and some national governments (mostly in high-income countries), little real progress against pollution can be identified overall, particularly in the low-income and middle-income countries, where pollution is most severe. Urgent attention is needed to control pollution and prevent pollution-related disease, with an emphasis on air pollution and lead poisoning, and a stronger focus on hazardous chemical pollution. Pollution, climate change, and biodiversity loss are closely linked. Successful control of these conjoined threats requires a globally supported, formal science-policy interface to inform intervention, influence research, and guide funding. Pollution has typically been viewed as a local issue to be addressed through subnational and national regulation or, occasionally, using regional policy in higher-income countries. Now, however, it is increasingly clear that pollution is a planetary threat, and that its drivers, its dispersion, and its effects on health transcend local boundaries and demand a global response. Global action on all major modern pollutants is needed. Global efforts can synergise with other global environmental policy programmes, especially as a large-scale, rapid transition away from all fossil fuels to clean, renewable energy is an effective strategy for preventing pollution while also slowing down climate change, and thus achieves a double benefit for planetary health., Competing Interests: Declaration of interests MB reports institutional support from the Bill & Melinda Gates Foundation; JH also reports consulting fees from the German Ministry of Environment to develop ideas for advancing the Strategic Approach to Chemicals Management process; and JH reports fees from the UK Department for Environment, Food & Rural Affairs for teaching workshops. HH reports grants from the US National Institutes of Health for neuro-epidemiological research on the developmental neurotoxicity of pollutants; HH also reports consultant fees to law firms on cases related to the developmental neurotoxicity of pollutants; and HH serves as Chair of the Scientific Advisory Board of the Marilyn Brachman Hoffman Foundation and is a member of the Advisory Board for Physicians for Human Rights. PJL reports grants and contracts from the Centre Scientifique de Monaco, UN Environment, and the Barr Foundation, and consulting fees from the Centre Scientifique de Monaco; and PJL serves as President of the Collegium Ramazzini, Chair of the Scientific Advisory Board of the Collegium Ramazzini, and Treasurer for the Consortium of Universities for Global Health. BL reports grants from the US National Institutes of Health, Canadian Institutes of Health, and US Department of Housing and Urban Development for research projects and personal consulting to study the effects of toxic chemicals on human health; BL also served as an expert witness in cases related to lead and fluoride poisoning in the USA and Canada but received no personal compensation for these services; and his expert witness fees are deposited in a research and training fund at Simon Fraser University (Burnaby, BC, Canada). All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Subclinical hypothyroidism (SCH) is a very common preclinical condition during pregnancy. The adverse effect of maternal clinical hypothyroidism (CH) on the nervous system development of offspring is beyond doubt, but it is still controversial in SCH. The aim of this study was to investigate whether spatial learning and memory ability of offspring is inhibited in SCH rat model and its possible mechanism. 45 Wistar female rats were randomly divided into SCH, CH and control (CON) groups, which were induced by semi-thyroid electrocauterization, total thyroidectomy and sham operation, respectively. Rat pups were sacrificed at embryonic day 14 (E14), E18, postnatal day 1 (P1), P3, and P10, and pups' cerebellar tissues were collected. The proliferation, differentiation and migration of cerebellar cells were observed, and RNA level of the thyroid hormone receptor α (TRα) and TRβ in the cerebellum was detected by real-time PCR, respectively. Morris Water Maze (MWM) test was performed to detect the spatial learning and memory ability of pups at P40. Our data indicated that maternal SCH will significantly extend the offspring's escape latency time, and pups perform worse in the spatial probe test compared with the CON group. Except for E14, the proliferation of pups' cerebellar granule cells (GCs), and the migration of pups' Purkinje cells (PCs) in the SCH group was significantly inhibited compared with that in the CON group at other time points (P < 0.05 or P < 0.01), and the differentiation of cerebellar astrocytes (As) in SCH group was higher than that in CON group at P3 and P10. Except for E14, the expression of TRα mRNA in SCH group was significantly lower than that in CON group (P < 0.05 or P < 0.01). And the difference of the differentiation of As and the spatial learning and memory between SCH and CH groups was not statistically significant. Our findings suggested that SCH during pregnancy nuisances the offspring's spatial learning and memory. It may be related to the decrease of the expression of TRα in cerebellum, which may further inhibit the proliferation of GCs and the migration of PCs, and increase the differentiation of As., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Context: Observational associations between maternal polycystic ovary syndrome (PCOS) and offspring birth weight (BW) have been inconsistent and the causal relationship is still uncertain., Objective: We conducted a 2-sample Mendelian randomization (MR) study to estimate the causal effect of maternal PCOS on offspring BW., Methods: We constructed genetic instruments for PCOS with 14 single nucleotide polymorphisms (SNPs) which were identified in a genome-wide association study (GWAS) meta-analysis including 10 074 PCOS cases and 103 164 controls of European ancestry from 7 cohorts. The genetic associations of these SNPs with the offspring BW were extracted from summary statistics estimated by the Early Growth Genetics consortium (n = 406 063 European ancestry individuals) using the weighted linear model, an approximation method of structural equation model, which separated maternal genetic effects from fetal genetic effects. We used a 2-sample MR design to examine the causal relationship between maternal PCOS and offspring BW. Sensitivity analyses were conducted to assess the robustness of the MR results., Results: We found little evidence for a causal effect of maternal PCOS on offspring BW (-6.1 g, 95% CI -16.8 g, 4.6 g). Broadly consistent results were found in the sensitivity analyses., Conclusion: Despite the large scale of this study, our results suggested little causal effect of maternal PCOS on offspring BW. MR studies with a larger sample size of women with PCOS or more genetic instruments that would increase the variation of PCOS explained are needed in the future., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Household dust has been considered as an important pathway for children's environmental Pb exposure. Shanghai was one of the first cities in China that removed Pb from petrol and has been shown in our previous study to have the lowest childhood blood Pb levels in China. This study therefore examines household dust Pb (Pb HD ) in Shanghai in order to determine the extent and exposure risks of Pb HD . Household vacuum cleaner dust samples (n = 40) were collected and analyzed for total Pb concentration, bio-accessible Pb concentration and Pb isotopic compositions (Pb IC ). The mean concentration of Pb HD was 195 mg/kg, which is between 7 and 10 times the Pb concentration of background soil samples from Shanghai. Among the investigated homes, those living in neighborhoods with lower average estate prices have higher dust Pb exposure risks for children. Bio-accessibility of Pb in household dust ranged between 53 and 91%, with a mean value of 71%. Analysis of Pb IC of household dust samples ( 208 Pb/ 206 Pb: 2.1096 ± 0.0054; 207 Pb/ 206 Pb: 0.8648 ± 0.0025) are a close match to Pb IC of coal combustion and solid waste incineration and fit well with those of outdoor air Pb IC and urban surface soil Pb IC of Shanghai. The study shows that children living in Shanghai are subject to Pb HD exposure, with children living in the homes with lower average price having increased susceptibility to Pb HD exposure. The data indicate that Pb HD is derived primarily from contemporary coal combustion and solid waste incineration rather than common legacy Pb sources (e.g., Pb petrol and paint). Practices including closing doors and windows on days with poor air quality or high wind and preventing shoe wearing inside homes will aid in minimizing outdoor surface soil and ambient particulate intrusion indoors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: Short-term temperature variability (TV) is associated with the exacerbation of asthma, but little is known about the relative effects of intra- and inter-day TV. We aimed to assess the relative impacts of intra- and inter-day TV on childhood asthma and to explore the modification effects by season., Methods: A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was adopted to evaluate the nonlinear and lagged effects of TV on childhood asthma in Shanghai from 2009 to 2017. Intra- and inter-day TV was measured with diurnal temperature range (DTR) and temperature changes between neighboring days (TCN), respectively., Results: Increased DTR was associated with the elevated relative risk (RR) of daily outpatient visits for childhood asthma (DOVCA) in both the whole year (RR lag0-14 for the 99th percentile: 1.264, 95% confidence interval (CI): 1.052, 1.518) and cold season (RR lag0-12 for the 99th percentile: 1.411, 95% CI: 1.053, 1.889). Higher TCN in the warm season was associated with the increased RR of DOVCA (RR lag0-14 for the 99th percentile: 2.964, 95% CI: 1.636, 5.373). The number and fraction of DOVCA attributed to an interquartile range (IQR) increase of TCN were higher than those attributed to DTR in both the whole year period and warm season. However, the number and fraction of DOVCA attributed to an IQR increase of DTR were greater than those attributed to TCN in the cold season., Conclusions: Our results provide novel evidence that both intra- and inter-day TV might be a trigger of childhood asthma. Higher DTR appeared to have greater impacts on childhood asthma in the cold season while an increase in TCN seemed to have bigger effects in the warm season., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Subclinical hypothyroidism (SCH) in pregnancy has drawn an increasing amount of attention over the past two decades. However, the definition of it, including its clinical diagnosis and treatment, is still being revised. An increased risk of adverse pregnancy outcomes have been shown in most but not all studies. The objective of this study was to evaluate the origin, current trend and research hotspots on SCH in pregnancy., Methods: We obtained 630 records with 12,033 references, published between 1999 and 2018, from the online version of SCI-Expanded, Thomson Reuters Web of Science. The CiteSpace 5.3.R4 was used to perform the cooperation network analysis, key words co-occurrence and burst detection analysis, and reference cocitation analysis., Results: We identified that the number of publications on SCH in pregnancy was increasing over the past two decades. Teng WP and Shan ZY from the First Hospital of China Medical University, Shenyang, China, were found to be the most productive researchers in this field. USA was the leading country for publications. Subclinical hypothyroidism, pregnancy, hypothyroidism, dysfunction, disease, management, women, deficiency, association and hyperthyroidism were the top 10 high frequency keywords in all recruit documents. Follow up was the most strength burst key word in this field from 1999 through 2018, followed by maternal hypothyroxinemia, child, hypothyroidism complicating pregnancy, antithyroid antibody and fetal. Moreover, cocitation reference analysis revealed the top landmark articles and clusters in this field., Conclusion: This study provides the trends and frontiers in the field of SCH in pregnancy and valuable information for endocrine and/or obstetric researchers to identify new perspectives on potential collaborators and cooperative countries.

Emerging evidence suggests that prenatal exposure to ambient SO 2 or NO 2 induces fetal brain-damage. However, effects of prenatal exposure to SO 2 or NO 2 on toddler neurodevelopment and the effect-modification by ambient temperature remain unclear. Therefore, a prospective birth-cohort study was conducted from 2010 to 2012 in Shanghai, and 225 mother-child pairs were followed-up from mid-to-late pregnancy until 24-36 months postpartum. During the whole pregnancy, daily SO 2 /NO 2 and temperature levels were obtained for each woman. Gesell-Development-Schedule was used to assess toddler neurodevelopment in the domains of gross-motor, fine-motor, adaptive-behavior, language and social-behavior. Distributed-lag-nonlinear-models simultaneously accounting for exposure-response and lag-response associations were applied to assess the impacts of prenatal SO 2 /NO 2 exposure on neurodevelopment. Each 10-μg/m 3 increase in weekly average SO 2 concentrations had adverse associations with gross-motor in gestational-weeks 1-6, with adaptive-behavior in weeks 26-30, and with language in weeks 30-36 (developmental-quotient changes: - 1.17% to - 0.12%, P-values < 0.05). Each 10-μg/m 3 increase in weekly average NO 2 concentrations had adverse associations with gross-motor in gestational-weeks 33-36, with fine-motor in weeks 26-36 and with social-behavior in weeks 31-36 (developmental-quotient changes: - 0.91% to - 0.20%, P-values < 0.05). The cumulative effects for the whole pregnancy showed that each 10-μg/m 3 increase in SO 2 induced significant deficits in gross-motor and adaptive-behavior (developmental-quotient changes: - 4.71% and - 4.06%, respectively, P < 0.05). We found prenatal cumulative SO 2 exposure induced more deficits in low temperature in language and adaptive-behavior than in high/moderate temperature. Thus, prenatal ambient SO 2 /NO 2 exposure in specific time-windows (1st and 3rd trimesters for SO 2 ; 3rd trimester for NO 2 ) could impair toddler neurodevelopment and low temperature may aggravate the SO 2 -induced neurotoxicity., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Childhood atopic dermatitis (AD) is an inflammatory skin disease which sometimes predisposes to allergies. Environmental factors (low humidity, irritants, etc.) are prominent causative triggers of AD., Objectives: This study aims to explore the effects of both meteorological factors and air pollutants on childhood AD, and the modification effects by season in Shanghai, China., Methods: Quasi-Poisson generalized linear regression model, combined with a distributed lag nonlinear model was used to examine the nonlinear and lagged effects of environmental factors on childhood AD from 2009 to 2017 in Shanghai. We also performed a season-stratified analysis to determine the modification effects of environmental exposure by season on childhood AD., Results: There were 1,043,240 outpatient visits for childhood AD in total, at 3 major pediatric hospitals. Low temperature and relative humidity (RH), and high daily temperature difference (DTD) and air pollutants (i.e., NO2) increased the relative risks (RRs) of outpatient visits for childhood AD in the whole year. In the cold season, an increased risk of outpatient visits for childhood AD was associated with low RH (RR 2.26, 95% CI 1.69-3.02) and high NO2 (1.11, 95% CI 1.06-1.17). In the warm season, outpatient visits for childhood AD were associated with low temperature (3.49, 95% CI 3.22-3.77), low RH (1.89, 95% CI 1.74-2.06), high DTD (1.41, 95% CI 1.31-1.53), and high NO2 (1.05, 95% CI 1.03-1.06)., Conclusions: This study suggests that environmental exposure may be a key trigger for outpatient visits for childhood AD with apparent seasonal effects. Tailored preventive strategies to avoid environmental triggers of childhood AD should be developed., (© 2021 S. Karger AG, Basel.)

Although abundant evidence has suggested that early-life antibiotic exposure was associated with adipogenesis later in life, limited data were available on the effect of intrauterine antibiotic exposure on infant growth and growth speed. Additionally, few studies have investigated the role of the neonatal gut microbiota in the above association. In this study, we examined the association between intrauterine cumulative antibiotic exposure and infant growth and explored the potential role of the neonatal gut microbiota in the association. 295 mother-child pairs from the Shanghai Maternal-Child Pairs Cohort (MCPC) study were included, and meconium samples and infant growth measurements were assessed. Z-scores of length-for-age, weight-for-age (weight-for-age), and body mass index (BMI)-for-age (BMI-for-age) were calculated. Eighteen common antibiotics were measured in meconium. Multivariable linear regression models were applied to test the interrelationships between antibiotic exposure, diversity indicators, and the relative abundance of selected bacterial taxa from phylum to genus levels from least absolute shrinkage and selection operator (LASSO) and infant growth indicators. The detection rates of the 18 antibiotics, except for chlortetracycline, penicillin, and chloramphenicol, were below 10 %. Penicillin was found to be positively associated with infant growth at birth and with growth speed from 2 to 6 months. The Pielou and Simpson indexes were negatively associated with meconium penicillin. Nominally significant associations between penicillin and the relative abundances of several bacterial taxa from the phyla Proteobacteria, Bacteroidetes, and Firmicutes were found. The Pielou and Simpson indexes were also found to be negatively associated with infant growth. Among taxa selected from LASSO regression, the relative abundances of the phyla Actinobacteria and Firmicutes and order Bifidobacteriales were found to be significantly associated with weight and BMI growth speeds from 2 to 6 months. In conclusion, intrauterine antibiotic exposure can affect infant growth. The neonatal gut microbiota might play a role in the abovementioned association., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Cohort studies with biobanks that use strict quality standards are essential requirements, not only for the development of new diagnostic and prognostic markers, but also for improving the understanding of pathophysiology of disease development, which have drawn an increasing amount of attention over the past decades. However, a bibliometric analysis of the global research on cohort biobanks is rare. The objective of this study was to evaluate the origin, current trend, and research hotspots of cohort biobanks. Materials and Methods: We searched the Web of Science Core Collection (WoSCC) with "biobank" and "cohort" as the topic words to retrieve English language articles published from 2009 to 2018. The CiteSpace 5.5.R2 was used to perform the cooperation network analysis, key words co-occurrence and burst detection analysis, and reference co-citation analysis. Results: The number of publications on cohort biobanks has increased over the past decade. Tai Hing Lam from the Department of Community Medicine, University of Hong Kong, was found to be the most productive researcher in this field. The percentage of publications in England (38.30%) was the highest all over the world. Risk, biobank, meta-analysis, cohort, disease, and so on were the most frequent keywords. Metabolic syndrome was the strongest burst keyword in this field, followed by Hong Kong, Guangzhou biobank cohort and personalized medicine. Moreover, of all the references for 932 articles included in the study, the article titled "UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age" published in PLoS Med by Sudlow et al., was the most frequently co-cited reference in this field. The largest cluster was labeled as Guangzhou biobank cohort study. Conclusions: This study provides an insight into cohort biobanks and the valuable information for biobankers to identify new perspectives on potential collaborators and cooperative countries/territories.

Recent studies have reported that methylmercury (MeHg) induces neuronal apoptosis, which is accompanied by abnormal neurological development. Despite the important role of docosahexaenoic acid (DHA) in maintaining the structure and function of the brain, as well as improving neuronal apoptosis induced by MeHg, the exact mechanism remains unknown. The present study hypothesized that the reactive oxygen species (ROS)‑mediated JNK signaling pathway may be associated with the protective effect of DHA against MeHg‑induced PC12 cell apoptosis. Cell Counting Kit‑8, TUNEL staining, flow cytometry, ROS detection, PCR and western blot analysis were performed. The results demonstrated that MeHg inhibited the activity of PC12 cells, causing oxidative damage and promoting apoptosis; however, DHA significantly attenuated this effect. Mechanistic studies revealed that MeHg increased intracellular ROS levels and JNK protein phosphorylation, and decreased the expression levels of the anti‑apoptotic protein Bcl‑2, whereas DHA reduced ROS levels and JNK phosphorylation, and increased Bcl‑2 expression. In addition, the ROS inhibitor N‑acetyl‑l‑cysteine (NAC) was used to verify the experimental results. After pretreatment with NAC, expression levels of Bcl‑2, Bax, phosphorylated‑JNK and JNK were assessed. Bcl‑2 protein expression was increased and the Bcl‑2/Bax ratio was increased. Moreover, the high expression levels of phosphorylated‑JNK induced by MeHg were significantly decreased. Based on the aforementioned results, the present study indicated that the effects of DHA against MeHg‑induced PC12 cell apoptosis may be mediated via the ROS/JNK signaling pathway.

Background: Childhood asthma and allergic diseases are a significant global problem. There are inconsistent findings on the associations of delivery mode, the number of children in the household and breastfeeding with childhood asthma and allergic diseases. We assessed these associations and examined whether breastfeeding modified the effects of neonatal and familial risk factors on childhood asthma and allergic diseases., Methods: A population-based cross-sectional study was conducted in Shanghai, China. A total of 17 primary schools were randomly selected from 13 districts of Shanghai in this study. The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma and allergic diseases. Multivariable logistic regression models were used to evaluate the associations between neonatal and familial factors and childhood asthma and allergic diseases, and to examine the modification effects of breastfeeding on the associations assessed., Results: Of 10,464 primary school children aged 6-11 years, the overall prevalence of childhood asthma, allergic rhinitis, urticaria, food allergy and drug allergy was 13.9, 22.7, 15.3, 8.1 and 4.6%, respectively. Male sex, high socioeconomic status, cesarean section delivery, only one child in the household and having family history of allergy were associated with increased odds ratio (OR) of childhood asthma and allergic diseases while longer breastfeeding duration (> 6 months) was inversely associated with these diseases. Longer breastfeeding duration also attenuated the OR of neonatal and familial risk factors on childhood asthma and allergic diseases. For instance, the adjusted OR of childhood asthma in the group of vaginal delivery and breastfeeding duration > 6 months was lowest (0.78, 95% confidence interval: 0.66, 0.92)., Conclusions: Longer breastfeeding duration was inversely associated with childhood asthma and allergic diseases, and also reduced the OR of neonatal and familial risk factors on these diseases. Giving the prevalence of childhood asthma and allergic diseases is rapidly rising across the globe, these findings may have important clinical and public health implications.

As common environmental pollutants, persistent organic pollutants (POPs) that are widely applied in industry and agriculture have adverse effects on neurodevelopment. However, evidence on the neurotoxicity of POPs in neural development of offspring is limited. This study explored the relationship between prenatal exposure to POPs and neurodevelopment of 18-month-old toddlers in a mother-child cohort in Shanghai, China. In this study, we determined exposure levels of 37 POPs in cord blood serum collected at the time of delivery. The detection rate of pollutants HCB, β-HCH, and p,p'-DDE was higher than 60%, so these will be discussed in the following analysis. From birth to approximately 18 months, we followed up infants to longitudinally explore whether POPs influenced their language, motor, and cognitive development according to a Bayley-Ⅲ assessment . Based on multivariable regression analyses, the β-HCH concentration in cord serum was negatively related to motor development scores in children at 18 months by adjusting for the covariates, but there was no change in language and cognition. Further piecewise linear regression analysis showed that a cord serum β-HCH concentration greater than 0.2 μg/L had a significantly negative correlation with the motor development scores. p,p'-DDE was positively associated with language development at 18 months before and after adjusting for covariates. But prenatal HCB levels were not associated with any of the Bayley-Ⅲ subscales at 18 months. We concluded that prenatal exposure to β-HCH might have adverse effects on infants' motor development. The minimum harmful concentration of β-HCH was estimated at 0.2 μg/L in cord serum. The unexpected positive association between p,p'-DDT and language development could be due to live birth bias., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Globally, developed countries such as the United States, Canada, Germany, Korea, have carried out long-term and systematic biomonitoring programs for environmental chemicals in their populations. The China National Human Biomonitoring (CNHBM) was to document the extent of human exposure to a wide array of environmental chemicals, to understand exposure profiles, magnitude and ongoing trends in exposure in the general Chinese population, and to establish a national biorepository., Methods: CNHBM adopted three-stage sampling method to obtain a nationally representative sample of the population. A total of 21,888 participants who were permanent residents in 31 provinces were designed to interviewed in this national biomonitoring (152 monitoring sites × 3 survey units × 2 sexes × 6 age groups × 4 persons = 21,888 persons) in 2017-2018. Unlike the US National Health and Nutrition Examination Survey, the CNHBM will follow the same participants in subsequent cycles allowing for dynamic, longitudinal data sets for epidemiologic follow-up. Each survey cycle of CNHBM will last 2 years and each subsequent cycle will occur 3 years after the prior cycle's completion., Results: In 2017-2018, the CNHBM created a large cohort of Chinese citizens that included districts/counties questionnaire, community questionnaire collecting information on villages/communities, individual questionnaire, household questionnaire, comprehensive medical examination, and collection of blood and urine samples for measurement of clinical and exposure biomarkers. A total of 21,746 participants were finally included in CNHBM, accounting for 99.4% of the designed sample size; and 152 PSUs questionnaires, 454 community questionnaires, 21,619 family questionnaires, 21,712 cases of medical examinations, 21,700 individual questionnaires, 21,701 blood samples and 21,704 urine samples were collected, respectively. Planned analyses of blood and urine samples were to measure both inorganic and organic chemicals, including 13 heavy metals and metalloids, 18 poly- and per-fluorinated alkyl substances, 12 phthalate metabolites, 9 polycyclic aromatic hydrocarbons metabolites, 4 environmental alkylated phenols, and 2 benzene metabolites., Conclusions: CNHBM established the first nationally representative, prospective cohort in the Chinese population to understand the baseline and trend of internal exposure of environmental chemicals in general population, and to understand environmental toxicity., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In consideration of the potential roles of selenoproteins in thyroid function, we aimed to evaluate the association of low selenium status with hypothyroidism during pregnancy and the association of maternal low thyroid function with infant birth size. We conducted a prospective birth cohort study in Shanghai in 2010 and investigated 1931 pregnant mothers of gestational weeks 28-36. Maternal serum selenium and thyrotropin (TSH) levels were determined and birth weights and lengths of newborns were measured. Other covariates were obtained through maternal interviews and medical records. A non-linear association was observed between maternal selenium and TSH levels. Two-piecewise multivariable linear regression models were therefore applied to assess the association of serum selenium with TSH levels, and multivariable linear regression models were applied to assess the association of TSH levels with birth weight/length. Adjusting for potential confounders, when maternal serum selenium levels < 103.7 μg/L (P25th), each unit increase in selenium levels (μg/L) was significantly associated with a decrease of 0.014 μIU/mL in TSH levels (β = - 0.014, 95%CI - 0.025, - 0.002, P = 0.023). However, when selenium levels ≥ 103.7 μg/L, there were no significant relationships between selenium and TSH (β = 0.000, 95%CI - 0.001, 0.002, P = 0.859). Maternal TSH levels were significantly inversely associated with infant birth weight (β = - 0.060, 95%CI - 0.100, - 0.010, P = 0.010). We observed a non-linear association between maternal selenium status and TSH levels. Low selenium status during pregnancy may associate with low thyroid function that was related with low birth weights. Graphical abstract .

At the end of 2019, a novel coronavirus, designated as SARS-CoV-2, emerged in Wuhan, China and was identified as the causal pathogen of COVID-19. The epidemic scale of COVID-19 has increased dramatically, with confirmed cases increasing across China and globally. Understanding the potential affecting factors involved in COVID-19 transmission will be of great significance in containing the spread of the epidemic. Environmental and meteorological factors might impact the occurrence of COVID-19, as these have been linked to various diseases, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), whose causative pathogens belong to the same virus family as SARS-CoV-2. We collected daily data of COVID-19 confirmed cases, air quality and meteorological variables of 33 locations in China for the outbreak period of 29 January 2020 to 15 February 2020. The association between air quality index (AQI) and confirmed cases was estimated through a Poisson regression model, and the effects of temperature and humidity on the AQI-confirmed cases association were analyzed. The results show that the effect of AQI on confirmed cases associated with an increase in each unit of AQI was statistically significant in several cities. The lag effect of AQI on the confirmed cases was statistically significant on lag day 1 (relative risk (RR) = 1.0009, 95% confidence interval (CI): 1.0004, 1.0013), day 2 (RR = 1.0007, 95% CI: 1.0003, 1.0012) and day 3 (RR = 1.0008, 95% CI: 1.0003, 1.0012). The AQI effect on the confirmed cases might be stronger in the temperature range of 10 °C ≤ T < 20 °C than in other temperature ranges, while the RR of COVID-19 transmission associated with AQI was higher in the relative humidity (RH) range of 10% ≤ RH < 20%. Results may suggest an enhanced impact of AQI on the COVID-19 spread under low RH., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Non-optimal weather conditions and air pollution pose a significant threat to children's health. However, the relative impact of different environmental exposures on childhood allergic diseases remains unclear., Objectives: This study aimed to quantify the relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China., Methods: Data on clinical visits due to childhood asthma, allergic rhinitis (AR) and atopic dermatitis (AD) from 2007 to 2017 in Shanghai were collected from Shanghai Children's Medical Center and Xinhua Hospital. The meteorological data (i.e. daily mean temperature, temperature difference, air pressure, air pressure difference, precipitation, relative humidity, sunshine and wind speed) for the same period were obtained from the Shanghai Meteorological Center. Air pollution data (PM 10 , PM 2.5 , NO 2 , SO 2 and O 3 ) were provided by the Shanghai Environmental Protection Agency. Quasi-Poisson regression with distributed lag non-linear models and Poisson regression combined with generalized linear models were used to assess the relative impact of meteorological factors and air pollutants on childhood allergic diseases., Results: There were a total of 2,410,392 cases of childhood allergic diseases, including 975,771 asthma, 646,975 AR and 787,646 AD. Most of environmental factors were significantly associated with childhood allergic diseases. Daily mean temperature (standard β: -0.076 (95% confidence interval (CI): -0.086, -0.067)) and air pressure (standard β: 0.075 (95% CI: 0.068, 0.082)) seemed to play more important roles than other environmental factors in the occurrence of these allergic diseases. The numbers of these allergic diseases attributable to an interquartile range (IQR) change in meteorological factors also appeared to be greater than those attributable to an IQR change in air pollutants., Conclusions: Both climatic variation and air pollution were associated with childhood allergic diseases, but the former appeared to play a more important role in the occurrence of these diseases. These findings may have significant implications for the development of tailored strategies to prevent these rapidly-increasing diseases worldwide., (Copyright © 2019. Published by Elsevier B.V.)

Biobanks and cohort studies are a popular topic in China these days and even in the global scientific research field. Cohorts with biological material are necessary to investigate potential biological mechanisms behind a disease and its early detection. Establishing a biobank is expensive and the long-term sustainability of biorepositories is a key issue globally. There is some published information on tools to calculate the biospecimen user fee; however, they may not be suitable for China's biobanks (as most of the biobanks in China are not for profit and are funded by government or research grants, and as such, funding is a major constraint). The limited published data also tend to be highly variable and specific to the type of biobank. The authors of this article aim to present the basis of a cost analysis model for a biobank of human biological samples of a birth cohort in Shanghai, China. The results show that it is very practical for us to consider how to build a cost model for the birth cohort biobank from the direct funds, such as storage equipment, temperature monitoring system, information management system, and so on. We conclude that by comparing the similarities and differences between China's cost model and that of other countries, this paper provides valuable information for biobankers to identify new perspectives on potential collaborators and mutual learning opportunities., (Copyright © 2020 Wu, Wu, Hu and Yan.)

Objective: To explore the impacts of Pb exposure and the dimercaptosuccinic acid (DMSA) chelation therapy on bone metabolisms in young rats of different ages, as well as the potential mechanisms., Method: Young rats were exposed to 0.05%-0.1% Pb acetate for 19 days, during infanthood (postnatal day, PND2-20), childhood (PND21-39) and adolescenthood (PND40-58) respectively. In each developmental stage, rats were further divided into three subgroups: lead-exposed, one-course and two-course DMSA chelation therapy subgroups. Blood/bone lead concentrations, serum calciotropic hormones concentrations, and mRNA and protein expressions of bone turnover markers in the serum and bones were measured. Bone microstructures were analyzed using Micro-CT., Results: Compared with lead-exposed during childhood and adolescenthood, increases in blood/bone lead levels, and the changes of blood/bone lead and trabecular bone microstructures after one-course DMSA chelation were most significant in rats lead-exposed during infanthood (P < .05). The serum osteocalcin (OC) concentrations, mRNA/protein expressions of OC and runt-related transcription factor 2 (RUNX2) in bones all decreased after Pb exposure, along with significant increases in serum C-terminal telopeptide of type I collagen (CTX) concentrations (P < .05). These effects were accompanied by changes of serum parathormone (PTH) and 1,25-dihydroxyvitamin D 3 (1,25-(OH 2 )-D 3 ) concentrations. DMSA chelation partially reversed the changes of bone microarchitectures, bone formation and resorption markers, and calciotropic-hormones, and the efficiency was greatest when the therapy was provided during infanthood., Conclusion: Developmental Pb exposure impaired bone microstructures and interfered bone metabolism, and the exposure effect was more obvious during infanthood than during childhood and adolescenthood. Lead effects were partially reversed by chelation therapy, and the efficacy may be most significant when the therapy was provided at younger ages., (Copyright © 2019. Published by Elsevier Inc.)

Objective: This study aimed to report three representative childhood lead poisoning cases in China from domestic products exposure and to highlight their critical implications for practice, education, and policy in prevention and treatment of childhood lead poisoning by health care providers, especially public health nurses., Design and Sample: Three representative childhood lead poisoning cases occurring in 2017 were collected and analyzed., Results: The lead exposure sources of three cases were evaluated by experts in the field and determined to be tin pots, home factories for tinfoil, and contamination of folk medicine, respectively. These cases demonstrated that the lack of lead exposure risk assessment, insufficient knowledge of potential lead exposure sources, underdeveloped policy, and regulations were areas for improvement., Conclusions: The best strategies for preventing lead poisoning include an appropriate risk assessment of lead exposure, implementation of comprehensive parental health education, conduction of further research by public health providers, and the application of policy strategies by the government. It was determined that public health nurses are at the frontline of prevention of lead poisoning in children., (© 2019 Wiley Periodicals, Inc.)

Internal migration and urbanization are occurring on a global scale. Although the risk of exposure to stress/lead/low selenium is assumed to be high among migrant pregnant women, population-based evidence is limited. This study aims to explore the association of internal-migration status with maternal exposure to lead, low selenium, and stress among pregnant women. A total of 1931 pregnant women were investigated in 2010. The internal-migration status was grouped based on their hukou (registered residence) and length-of-residency in Shanghai. Maternal blood lead and serum selenium concentrations were assessed. Life event stress and emotional stress were evaluated using "Event-Stress-Scale-for-Pregnant-Women" and "Symptom-Checklist-90-R-Scale" (SCL-90-R), respectively. Logistic regression and general linear models were used to evaluate associations between migration status and lead/stress/low selenium exposure. Compared with the local (with Shanghai hukou and length-of-residency ≥ 5 years), new migrants (without Shanghai hukou and length-of-residency < 2 years) had lower social-economic-status (SES), higher lead, life event and emotional stress, and lower selenium levels. After adjusting for SES, new migrants had higher risks of emotional stress (for interpersonal sensitivity of SCL-90-R, OR = 2.10, 95% CI 1.22-3.64) and low selenium [lg(selenium): beta = - 0.08, 95% CI - 0.11, - 0.05], but no significant risks for life event stress and high lead. Compared with the local, migrant pregnant women in big cities may have emotional stress and low selenium independent of SES, and high lead and life event stress dependent on SES.

Background: The extent to which low-level, in utero mercury exposure affects child neurobehavioral development during early childhood has been inconclusive. In addition, the effects of sex and docosahexaenoic acid (DHA) on these relationships remain unclear and controversial., Objectives: This study aimed to explore the associations between prenatal low-level mercury exposure and child neurobehavioral development during the neonatal and toddler periods and to examine the potential confounding or interactive effects of sex and DHA status on these relationships., Methods: This longitudinal study included 286 mother-child pairs in Shanghai, China, whose cord blood samples were analyzed for total mercury, DHA, other nutrients and coexposure contaminants possibly due to maternal consumption of seafood. Children's neurobehavioral development was assessed with the Neonatal Behavioral Neurological Assessment (NBNA) three days after birth and the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) at 18 months of age., Results: Cord blood mercury concentration, with geometric mean of 2.00 μg/l, was related to poorer NBNA performance but unrelated to BSID-III scores with adjustment for DHA and other covariates. Cord serum DHA was positively associated with motor development assessed by the BSID-III. The interaction was found between mercury and DHA on the NBNA score, and the inverse relation of cord blood mercury with NBNA was significant only among the children with lower DHA levels (<45.54 μg/ml). Additional adjustment for DHA didn't change the associations between cord blood mercury and neurodevelopmental outcomes substantially. The mercury by sex interaction for language of BSID-III was borderline significant., Conclusions: Our research provides initial evidence for the negative effects of prenatal low-level mercury exposure on neonates' neurobehavioral development. Prenatal DHA status may modify the relationship between cord blood mercury level and neonatal neurobehavioral development, but the confounding effects of DHA were not observed. Further studies are warranted before the causality of the observed associations can be determined., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objective: Mounting evidence showed that lead exposure increased the risk of child attention-deficit-hyperactivity disorder (ADHD). Epidemiologic studies have typically used the blood-lead as a biomarker of lead exposure; blood-lead levels mostly reflect recent lead exposure. However, few studies have examined the relationship between bone-lead, a biomarker of cumulative exposure, and ADHD. Therefore, we aimed to compare the associations of bone-lead vs blood-lead levels with child ADHD symptoms and comorbidities., Methods: A total of 164 children aged 3-15 years were enrolled during 2014-2015. The Vanderbilt-ADHD-Diagnostic-Parent-Rating Scale (VADPRS) was used to evaluate the children's ADHD symptoms and comorbidities. Children's blood and bone lead concentrations were assessed, the latter using a non-invasive K-X-ray-fluorescence technique. According to blood-lead levels, children were classified into high (blood-lead ≥ 10.0 μg/dL) and low (blood-lead < 10.0 μg/dL) blood-lead groups. According to bone-lead levels, children were classified into high (bone-lead ≥ 2.66 μg/g) and low (bone-lead < 2.66 μg/g) bone-lead groups. We associated blood/bone lead with VADPRS data using multi-variable binary logistic regression models., Results: Children in the high blood-lead group had higher hyperactivity/impulsivity (P = 0.02) scores than the corresponding low blood-lead group. Children in the high bone-lead group had higher hyperactivity/impulsivity (P = 0.02) and oppositional-defiant-disorder (ODD) (P = 0.03) scores than the corresponding low bone-lead group. After adjusting for relevant confounders, children in the high bone-lead group were more likely to have ODD-behavior than the low group (OR = 6.7, 95%CI: 1.2-36.5). However, no adjusted association was observed between blood-lead and any ADHD-domain score., Conclusion: High levels of cumulative lead exposure in children may be an independent risk factor of ODD-behavior., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Sleep dysfunction has been speculated to be involved in the pathological mechanism of nocturnal enuresis (NE). However, results obtained from previous studies were conflicting. This study evaluated and compared the sleep patterns and problems between children with and without nocturnal enuresis (NE) across different age and gender groups in a large epidemiological study., Methods: A multi-center, cross-sectional, epidemiological study was carried out in which 21,439 primary school children (10,655 boys and 10,784 girls aged 5.1-12.9 years) and their parents participated. Chinese versions of the Children's Sleep Habits Questionnaire and the General Condition Questionnaire were used to identify nocturnal enuresis, sociodemographic characteristics, sleep patterns, and sleep problems in children. The sleep patterns and problems were compared between children with and without NE while controlling for a number of confounding factors in different age and gender groups., Results: It was observed that children with NE (especially boys aged 11-12 years with severe NE) slept for a shorter period and were more likely to have sleep problems such as bedtime resistance, sleep duration disorder, night awakening, sleep anxiety, sleep-disordered breathing, and daytime sleepiness than those without NE. Girls with NE were more likely to suffer from other types of parasomnias., Conclusion: Children with NE, especially older boys with severe NE, were more sleep compromised than those without NE. Our findings warrant further research on the mechanism of NE and may have clinical implications for the treatment of childhood sleep problems and NE., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Mounting evidence has linked postnatal antibiotic use with body mass index (BMI) in children, but the influence of prenatal antibiotic use on offspring obesity risk remains unclear. We aimed to assess the association between fetal exposure to antibiotics and obesity at ages 4 and 7 years among 43,332 children using a multicenter prospective cohort of the US Collaborative Perinatal Project (1959-1976). Antibiotic use was ascertained for mothers during pregnancy. Modified Poisson regression models were used to estimate risk ratios for obesity (BMI >95th percentile), and linear mixed models were applied to assess the association with BMI z score. Repeated prenatal exposure to antibiotics was associated with childhood obesity at age 7 years, and risk of obesity tended to increase with an increasing number of antibiotic exposures (for 2-3 exposures, risk ratio (RR) = 1.22, 95% confidence interval (CI): 1.04, 1.44; for ≥4 exposures, RR = 1.34, 95% CI: 1.03, 1.73). The magnitude of association was strongest for repeated exposures in the second trimester (RR = 1.40, 95% CI: 1.16, 1.71). Prenatal antibiotic use was not associated with obesity or BMI z score at age 4 years. These findings support an increased risk of mid-childhood obesity with repeated use of antibiotics during pregnancy.

To explore the potential environmental and dietary factors during pregnancy affecting low-level prenatal lead exposure, we conducted a longitudinal study in Wujiang City, China. A total of 1976 mother-infant pairs were included from 2009 to 2010. An interviewed questionnaire was conducted and cord blood samples were collected. The geometric means of cord blood lead level was 30.3 μg/L (95% CI, 29.8-30.8) with 99.24% below 100 μg/L. Maternal age, passive smoking, and living in the countryside were significantly associated with cord blood lead concentrations. Multiple logistic models showed that some family environmental factors including using firewood and electricity as kitchen fuel were positively correlated with increased cord blood lead levels. Among dietary sources recorded in this study, meat consumption (> 3 times/week), fish consumption (1-3 times/week), vegetables consumption (> 1 times/day), and fruit intake (> 1 times/day) had inverse relationship with cord blood lead levels. In general, our findings may have important implications for family environmental and dietary direction during pregnancy to decrease prenatal lead exposure.

Background: Maternal psychological stress during pregnancy has essentially been conceptualized as a teratogen. However, little is known about the effect of temperature on maternal stress during pregnancy. The aim of this study is to investigate the relationship between temperature and maternal stress during pregnancy., Methods: In 2010, a total of 1931 eligible pregnant women were enrolled across Shanghai from four prenatal-care clinics during their mid-to-late pregnancy. Maternal life-event stress and emotional stress levels during pregnancy were assessed by the "Life Event Scale for Pregnant Women" (LESPW) and "Symptom Checklist-90-Revised Scale" (SCL-90-R), respectively. Exposure to ambient temperature was evaluated based on daily regional average in different moving average and lag days. The generalized estimating equations were used to evaluate the relationship between daily average temperature/temperature difference and maternal stress., Results: After adjusting for relevant confounders, an U-shaped relationship was observed between daily average temperature and maternal Global-Severity-Index (GSI) of the SCL-90-R. Cumulative exposures to extremely low temperatures (< P5, 1.4-10.5℃, lag 0-1 days, 0-2 days and 0-5 days) and extremely high temperatures (≥ P95, 31.2-34.1℃, lag 0-1 days and 0-2 days), and acute exposures to extremely low (lag day 0, 1, 2 and 3) and high (lag day 0, 1) temperatures, all induced higher risks of high GSI (the highest tertile), compared to the risk induced by exposed to an optimal temperature range (20-25℃) (P< 0.05). Increased temperature difference was associated with high maternal GSI (P< 0.05). However, non-significant associations were observed between daily average temperatures/temperature differences and maternal log-transferred LESPW scores., Conclusions: Cumulative and acute exposures to extremely low/high temperatures may both induce emotional stress during pregnancy., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To evaluate the effects of maternal lead exposure during pregnancy on toddler cognitive development and the potential effect modification by maternal stress., Methods: We conducted a prospective birth-cohort study in Shanghai from 2010 to 2012 and investigated 225 mother-infant pairs. The mothers were recruited in mid-to-late pregnancy and children were followed up until 24-36 months old. A self-administered Symptom Checklist-90-Revised Scale (SCL-90-R) was used to assess maternal emotional stress during pregnancy. Maternal whole blood lead levels were measured during gestational weeks 28-36. The toddlers' cognitive levels were assessed using the Gesell Development Scale. Multiple linear regression models were established to explore the main effects of prenatal lead exposure on toddlers' cognitive abilities and the modifying effects of maternal stress. Covariate information was collected through interviews, questionnaires and medical records., Results: The mean maternal blood lead concentration was 3.30 (95%CI: 3.05, 3.57) μg/dL. After adjusting for relevant confounders, no significant associations of maternal blood lead concentrations with toddlers' cognitive levels were observed in all five domains of the Gesell scale (P>0.05). However, the interaction between prenatal maternal blood lead and stress was significant in the domains of adaptive behavior, language and social behavior. When stratified by maternal stress levels, compared with non-significant associations (P>0.05) among low (P1-P75) prenatal stress group, adverse associations between maternal blood lead concentrations (log10-transformed) and toddlers' cognitive levels were observed among high (P75-P100) prenatal stress group in the domains of language (β=-33.82, 95%CI: -60.04, -7.59), social behavior (β=-41.00, 95%CI: -63.11, -18.89) and adaptive behavior (β=-17.93, 95%CI: -35.83, -0.03)., Conclusion: Prenatal maternal stress may exacerbate the deleterious effects of prenatal exposure to lead on toddler cognitive development., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: The aim of the present study is to investigate the association of trace elements and the risk of type 2 diabetes mellitus., Design and Methods: The 1837 participants (637 men and 1200 women) aged 40-70 were from a cross-sectional community-based study performed in downtown Shanghai. All the participants without diabetes mellitus history underwent a 75-g OGTT. The participants with diabetes mellitus took 100g steamed bread as the substitute. The fasting and OGTT 2h or postprandial 2h venous blood samples were collected. Blood glucose levels, fasting serum insulin concentrations, lipid profiles, HbA1C and 19 trace elements including magnesium, copper, zinc and selenium and so on were assayed., Results: Of all the 1837 studied subjects, 510 subjects had diabetes mellitus (191 male, 319 female). Serum magnesium levels were decreased statistically (p<0.05), but serum copper, zinc and selenium levels were significantly increased in subjects with diabetes mellitus compared to non-diabetic subjects (p<0.01 for copper, p<0.001 for zinc and selenium). Logistic regression analysis showed that serum magnesium was negatively associated with diabetes (p<0.05) and serum copper, zinc, and selenium were all positively associated with diabetes (p<0.05 for copper, p<0.001 for both zinc and selenium). Correlation analysis showed a remarkable correlation between blood glucose, HbA1C and serum magnesium, copper, zinc, and selenium (p<0.01 for zinc, p<0.001 for copper, zinc and selenium)., Conclusions: Serum magnesium levels are decreased and serum copper, zinc and selenium levels are elevated in patients with type 2 diabetes mellitus., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Background: We investigated the clinical characteristics of a 3-month-old infant with acute mercury vapor poisoning. Clinical symptoms of acute mercury poisoning in infants include acute onset, rapid progression, severe illness with respiratory symptoms that may result in pneumothoraces and aspiration pneumonias., Case Presentation: A 3-month-old girl presented with pneumothoraces and respiratory failure to the hospital. Two days before hospitalization, the girl had stayed in a room containing mercury vapor for several hours. She was hospitalized for acute mercury poisoning. We used sodium dimercaptosulphonate (DMPS) for treatment., Conclusion: Pulmonary disease was mainly induced by the inhalation of mercury vapor. The disease was characterized by acute respiratory distress, pneumothorax and acute chemical pneumonitis. It responded to chelation therapy with the agent DMPS., (Copyright © 2016. Published by Elsevier B.V.)

To investigate the association of air pollution with maternal stress during pregnancy, we enrolled 1,931 women during mid-to-late pregnancy in Shanghai in 2010. The "Life-Event Scale for Pregnant Women" and "Symptom-Checklist-90-Revised Scale" (SCL-90-R) were used to evaluate life event stress and emotional stress, respectively. Air pollution data were collected for each district where pregnant women lived during pregnancy. We associated ambient air pollution with stress scores using multivariable logistic regression models. After adjusting for relevant covariates, an interquartile-range (IQR) increase in sulphur-dioxide (SO 2 ) (OR = 1.30, 95% CI: 1.11-1.52) and particulate-matter with an aerodynamic-diameter <10 μm (PM 10 ) (OR = 1.16, 95% CI: 1.02-1.34) concentrations on the recruitment day, and in the 5-day moving average concentrations of nitrogen-dioxide (NO 2 ) (OR = 1.34, 95% CI: 1.05-1.70) were associated with high Global-Severity-Indices (P75-P100) of the SCL-90-R. These associations were stronger among women bearing high levels (P25-P100) of air pollutants than among women experiencing low levels (P1-P25) of pollutants. The stronger associations and higher levels of pollutants were observed in the cool season than in the warm season. SO 2 increases on the recruitment day were also associated with an increased risk of high depression scores (P75-P100). Our findings supported a dose-dependent association between air pollution and emotional stress during pregnancy.

Objective . To determine the blood lead levels and identify related risk factors among preschool children in a lead polluted area (Taizhou, China) and provide theoretical support for prevention of lead pollution. Methods . A stratified-clustered-random sampling method was used to determine the survey sample. Blood lead levels were determined by the tungsten atomizer absorption spectrophotometer. Results . A total of 2,018 subjects (average age of 59 months; 1,087 boys and 931 girls) were included. The arithmetic mean, geometric mean, and median blood lead levels of the preschool children were 56.4  μ g/L, 48.9  μ g/L, and 46  μ g/L. A total of 8.8% children had blood lead levels >100  μ g/L and 43.9% had blood lead levels >50  μ g/L. Mother's education level, father's occupation, decorative tableware, exposure to makeup, and the residential floor were all risk factors for elevated blood lead levels (odds ratios of 1.42, 1.21, 1.11, 1.19, and 1.27, resp.), while hand washing before eating food was a protective factor (odds ratio of 0.88). Conclusions . The blood lead levels of preschool children in Taizhou were higher than in other areas in China and in developed countries. Therefore, policies ensuring lead-based industries are not placed in close proximity to residential areas are required.

Background: Maternal stress is associated with impairments in the neurodevelopment of offspring; however, the effects of the timing of exposure to maternal stress on a child's neurodevelopment are unclear., Methods: In 2010, we studied 225 mother-child pairs in Shanghai, recruiting mothers in mid-to-late pregnancy and monitoring offspring from birth until 30 months of age. Maternal stress was assessed prenatally (at 28-36 weeks of gestation) and postnatally (at 24-30 months postpartum) using the Symptom-Checklist-90-Revised Scale (SCL-90-R) and Life-Event-Stress Scale to evaluate mothers' emotional stress and life event stress levels, respectively. Children's cognition and temperament were assessed at 24-30 months of age using the Gesell Development Scale and Toddler Temperament Scale, respectively. Multi-variable linear regression models were used to associate prenatal and postnatal stress with child cognitive and temperamental development., Results: Maternal prenatal and postnatal Global Severity Index (GSI) of SCL-90-R were moderately correlated (ICC r=0.30, P<0.001). After adjusting for relevant covariates, the increase in prenatal GSI was associated with decreases in toddlers' gross motor, fine motor, adaptive and social behavior development independently of postnatal GSI, while the increase in postnatal GSI was associated with changes in multiple temperament dimensions independently of prenatal GSI. The effects of prenatal and postnatal depression scores of SCL-90-R were similar to those of GSI., Limitation: Relatively small sample size., Conclusions: Compared with postnatal exposure, children's cognitive development may be more susceptible to prenatal exposure to maternal emotional stress, whereas temperamental development may be more affected by postnatal exposure to maternal emotional stress compared with prenatal exposure., (Copyright © 2016 Elsevier B.V. All rights reserved.)