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Background: Previous studies showed that pre- and probiotics may enhance iron absorption. Probiotics combined with prebiotics (synbiotics), including human-identical milk oligosaccharides (HiMOs), are commonly added to infant and follow-up formula (FUF). Whether these additions enhance iron absorption from iron-fortified commercial milk formula is uncertain., Objectives: We determined the effect of adding 1) a synbiotic [galacto-oligosaccharide [GOS] + Limosilactobacillus reuteri (L. reuteri)] or 2) the HiMO 2'-fucosyllactose (2'FL) to iron-fortified FUF on iron absorption in young Thai children., Methods: In a randomized, controlled, single-blinded (participants) crossover study, 82 Thai children aged 8-14 mo were enrolled to consume single servings (235 mL) of FUF with isotopically labeled ferrous sulfate (2.2 mg iron) with 1) the synbiotic (400 mg/100 mL GOS and L. reuteri DSM 17938), 2) the HiMO 2'FL (100 mg/100 mL), and 3) without synbiotic and 2'FL (control) in random order and a 3-d washout period between administrations. Fractional iron absorption [FIA (%)] was assessed by measuring erythrocyte incorporation of isotopic labels 14 d (n = 26) and 28 d (n = 76) after consumption of the last test FUF., Results: Median (IQR) FIA from iron-fortified FUF with the synbiotic [8.2 (5.2, 12.9)%] and with 2'FL [8.4 (5.5, 14.1)%] did not differ from the control FUF [8.1 (4.8,14.7)%] (synbiotic compared with control, P = 0.24; 2'FL compared with control, P = 0.95). FIA from all FUF did not differ when measured after 14 and 28 d of erythrocyte incorporation (Time, P = 0.368; FUF, P = 0.435; Time × FUF, P = 0.937). Fecal pH and hemoglobin were negatively associated with FIA., Conclusions: In young Thai children, the addition of a synbiotic (GOS + L. reuteri) or 2'FL to iron-fortified FUF did not impact FIA from a single serving. The study was registered at clinicaltrials.gov as NCT04774016., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Advances in computer vision, driven by deep learning, allows for the inference of environmental pollution and its potential sources from images. The spatial and temporal generalisability of image-based pollution models is crucial in their real-world application, but is currently understudied, particularly in low-income countries where infrastructure for measuring the complex patterns of pollution is limited and modelling may therefore provide the most utility. We employed convolutional neural networks (CNNs) for two complementary classification models, in both an end-to-end approach and as an interpretable feature extractor (object detection), to estimate spatially and temporally resolved fine particulate matter (PM 2.5 ) and noise levels in Accra, Ghana. Data used for training the models were from a unique dataset of over 1.6 million images collected over 15 months at 145 representative locations across the city, paired with air and noise measurements. Both end-to-end CNN and object-based approaches surpassed null model benchmarks for predicting PM 2.5 and noise at single locations, but performance deteriorated when applied to other locations. Model accuracy diminished when tested on images from locations unseen during training, but improved by sampling a greater number of locations during model training, even if the total quantity of data was reduced. The end-to-end models used characteristics of images associated with atmospheric visibility for predicting PM 2.5 , and specific objects such as vehicles and people for noise. The results demonstrate the potential and challenges of image-based, spatiotemporal air pollution and noise estimation, and that robust, environmental modelling with images requires integration with traditional sensor networks., 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 B.V. All rights reserved.)

Cities in the developing world are expanding rapidly, and undergoing changes to their roads, buildings, vegetation, and other land use characteristics. Timely data are needed to ensure that urban change enhances health, wellbeing and sustainability. We present and evaluate a novel unsupervised deep clustering method to classify and characterise the complex and multidimensional built and natural environments of cities into interpretable clusters using high-resolution satellite images. We applied our approach to a high-resolution (0.3 m/pixel) satellite image of Accra, Ghana, one of the fastest growing cities in sub-Saharan Africa, and contextualised the results with demographic and environmental data that were not used for clustering. We show that clusters obtained solely from images capture distinct interpretable phenotypes of the urban natural (vegetation and water) and built (building count, size, density, and orientation; length and arrangement of roads) environment, and population, either as a unique defining characteristic (e.g., bodies of water or dense vegetation) or in combination (e.g., buildings surrounded by vegetation or sparsely populated areas intermixed with roads). Clusters that were based on a single defining characteristic were robust to the spatial scale of analysis and the choice of cluster number, whereas those based on a combination of characteristics changed based on scale and number of clusters. The results demonstrate that satellite data and unsupervised deep learning provide a cost-effective, interpretable and scalable approach for real-time tracking of sustainable urban development, especially where traditional environmental and demographic data are limited and infrequent., 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 B.V. All rights reserved.)

Growing cities in sub-Saharan Africa (SSA) experience high levels of ambient air pollution. However, sparse long-term city-wide air pollution exposure data limits policy mitigation efforts and assessment of the health and climate effects. In the first study of its kind in West Africa, we developed high resolution spatiotemporal land use regression (LUR) models to map fine particulate matter (PM 2.5 ) and black carbon (BC) concentrations in the Greater Accra Metropolitan Area (GAMA), one of the fastest sprawling metropolises in SSA. We conducted a one-year measurement campaign covering 146 sites and combined these data with geospatial and meteorological predictors to develop separate Harmattan and non-Harmattan season PM 2.5 and BC models at 100 m resolution. The final models were selected with a forward stepwise procedure and performance was evaluated with 10-fold cross-validation. Model predictions were overlayed with the most recent census data to estimate the population distribution of exposure and socioeconomic inequalities in exposure at the census enumeration area level. The fixed effects components of the models explained 48-69 % and 63-71 % of the variance in PM 2.5 and BC concentrations, respectively. Spatial variables related to road traffic and vegetation explained the most variability in the non-Harmattan models, while temporal variables were dominant in the Harmattan models. The entire GAMA population is exposed to PM 2.5 levels above the World Health Organization guideline, including even the Interim Target 3 (15 μg/m 3 ), with the highest exposures in poorer neighborhoods. The models can be used to support air pollution mitigation policies, health, and climate impact assessments. The measurement and modelling approach used in this study can be adapted to other African cities to bridge the air pollution data gap in the region., 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 B.V. All rights reserved.)

Background: Emerging evidence links outdoor air pollution and declined renal function but the relationship between household air pollution and renal function is not well understood., Methods: Using cross-sectional data from the multi-provincial INTERMAP-China Prospective Study, we collected blood samples and questionnaire information on stove use and socio-demographic factors. We calculated estimated glomerular filtration rate (eGFR) from serum creatinine to assess renal function. Participants with eGFR <60 mL/min per 1.73 m 2 were defined as having chronic kidney disease (CKD) in this analysis. Generalized estimating equations were used to estimate the association of household fuel with renal function and prevalent CKD in models adjusting for confounders., Results: Among the 646 enrolled adults (40-79y; 56% female), one-third exclusively used clean fuel (gas and electric) cookstoves and 11% of northern China participants (n = 49 of 434) used only clean fuel heaters, whereas the rest used solid fuel. In multivariable models, use of solid fuel cookstoves was associated with 0.17 ml/min/1.73 m 2 (95% CI: -0.30, 0.64) higher eGFR and 19% (0.86, 1.64) higher prevalence of CKD than exclusive clean fuel use. Greater intensity of solid fuel use was associated with 0.25 ml/min/1.73 m 2 (-0.71, 0.21) lower eGFR per 5 stove-use years, though the confidence intervals included the null, while greater current intensity of indoor solid fuel use was associated with 1.02 (1.00, 1.04) higher prevalent CKD per 100 stove-use days per year. Larger associations between current solid fuel use and intensity of use with lower eGFR and prevalent CKD were observed among participants in southern China, those with hypertension or diabetes (eGFR only), and females (CKD only), through these groups had small sample sizes and some confidence intervals included the null., Conclusion: We found inconsistent evidence associating household solid fuel use and renal function in this cross-sectional study of peri-urban Chinese adults., 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 The Authors. Published by Elsevier Inc. All rights reserved.)

Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop high-resolution land use regression (LUR) models to predict annual average noise levels (LAeq 24hr , L den , L day , L night ). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted day-evening-night (L den ) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted L den and night-time noise (L night ) surpassed World Health Organization guidelines for road-traffic noise (L den <53; and L night <45). The poorest areas in Accra also had significantly higher median L den and L night compared with the wealthiest ones, with a difference of ∼5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure inequalities within Accra., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Due to the adverse health effects of air pollution, researchers have advocated for personal exposure measurements whereby individuals carry portable monitors in order to better characterise and understand the sources of people's pollution exposure., Objectives: The aim of this systematic review is to assess the differences in the magnitude and sources of personal PM 2.5 exposures experienced between countries at contrasting levels of income., Methods: This review summarised studies that measured participants personal exposure by carrying a PM 2.5 monitor throughout their typical day. Personal PM 2.5 exposures were summarised to indicate the distribution of exposures measured within each country income category (based on low (LIC), lower-middle (LMIC), upper-middle (UMIC), and high (HIC) income countries) and between different groups (i.e. gender, age, urban or rural residents)., Results: From the 2259 search results, there were 140 studies that met our criteria. Overall, personal PM 2.5 exposures in HICs were lower compared to other countries, with UMICs exposures being slightly lower than exposures measured in LMICs or LICs. 34% of measured groups in HICs reported below the ambient World Health Organisation 24-h PM 2.5 guideline of 15 μg/m 3 , compared to only 1% of UMICs and 0% of LMICs and LICs. There was no difference between rural and urban participant exposures in HICs, but there were noticeably higher exposures recorded in rural areas compared to urban areas in non-HICs, due to significant household sources of PM 2.5 in rural locations. In HICs, studies reported that secondhand smoke, ambient pollution infiltrating indoors, and traffic emissions were the dominant contributors to personal exposures. While, in non-HICs, household cooking and heating with biomass and coal were reported as the most important sources., Conclusion: This review revealed a growing literature of personal PM 2.5 exposure studies, which highlighted a large variability in exposures recorded and severe inequalities in geographical and social population subgroups., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

Over the last decades, permanent crating of farrowing and lactating sows has led to serious public concerns with regard to sow welfare. As one alternative, it has been suggested to restrict crating to the period when suckling piglets are at the highest risk to die. Therefore, the aim of this study was to investigate live-born piglet mortality with regard to different confinement periods (CFP) as well as farrowing pen types. On three research farms (A, B and C), four confinement periods were compared: In CFP 0 (control), sows were not confined at all, sows in CFP 3 were crated after the end of farrowing for three days. In CFP 4, sows were confined one day before the due date of farrowing until three days after parturition and sows in CFP 6 were crated one day before expected farrowing until five days after parturition. Furthermore, five different pen types designed for temporary crating (PT; 5.5-7.3 m 2 ) were compared. In total, production data from 638 litters were analysed. For each piglet found dead (n = 1 580), the cause of death was determined by the farm personnel and verified by necropsy (all three farms) and additional video analysis (farms A and B only). Data were analysed using logistic mixed models with CFP 0 and pen type Fluegel as reference categories (CFP 0 was control and this pen type was present on all three farms and the largest number of litters was born in this pen type). Live-born piglet mortality was lower in temporarily crated sows than in sows without confinement (CFP 0; P < 0.015). Pairwise posthoc tests did not reveal differences between CFP 3, CFP 4 and CFP 6 (odds ratios 0.75, 0.59 and 0.69), nor between pen types. Additional factors associated with increasing live-born piglet mortality were larger litter size, higher sow parity as well as the administration of hormones around farrowing. Factors influencing mortality due to crushing were similar to those for total live-born mortality with the exception of CFP 3 not differing significantly from CFP 0. It can be concluded, that confinement of the sow for three days after farrowing is an effective measure to reduce live-born piglet mortality in the pen types tested. An extension of the confinement period to five days after parturition does not result in a further reduction of live-born mortality rate., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Iodine intake in populations is usually assessed by measuring urinary iodine concentrations (UICs) in spot samples. Hot climate conditions may reduce urine volume, thus leading to overestimations of UIC and thereby masking inadequate iodine intake., Objectives: We investigated the effects of season on UICs in 2 populations exposed to high-temperature climates., Methods: In this observational study, we examined women (18-49 years) in Tanzania (ncold = 206; nhot = 179) and South Africa (ncold = 157; nhot = 126) during cold and hot seasons. From each woman in both seasons, we obtained two 24-hour urine collections and 2 spot urine samples, as well as salt, water, and cow's milk samples. We measured the urine volume, UIC, and urinary creatinine concentration (UCC). The 24-hour urinary iodine excretion (UIE) was calculated and used to estimate the iodine intake. We used linear mixed-effects models to test for differences between seasons., Results: In Tanzanian women, we observed no seasonal effect on the urine volume, 24-hour UIE, 24-hour UIC, spot UIC, spot UIC:UCC ratio, or salt iodine concentration. In South African women, the median 24-hour urine volume was 1.40 L (IQR, 0.96-2.05 L) in the winter and 15% lower in the summer (P < 0.001). The median 24-hour UIE was 184 µg/day (IQR, 109-267 µg/day) in the winter and 34% lower in the summer (P < 0.001), indicating a lower iodine intake. As a result, UICs did not significantly differ between seasons in 24-hour collections and spot samples, whereas the spot UIC:UCC ratio differed by 21% (P < 0.001) and reflected the lower iodine intake. In both study populations, the within- and between-person variabilities in urine volume, 24-hour UICs, and spot UICs were higher than the variability between seasons., Conclusions: Spot UIC may slightly overestimate the iodine intake in hot temperatures due to concentrated urine, and methods to correct for urine volume may be considered. Local seasonal differences in iodine intakes may also occur in some populations. This trial was registered at http://www.clinicaltrials.gov as NCT03215680., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Economic and urban development in sub-Saharan Africa (SSA) may be shifting the dominant air pollution sources in cities from biomass to road traffic. Considered as a marker for traffic-related air pollution in cities, we conducted a city-wide measurement of NO x levels in the Accra Metropolis and examined their spatiotemporal patterns in relation to land use and meteorological factors. Between April 2019 to June 2020, we collected weekly integrated NO x (n = 428) and NO 2 (n = 472) samples at 10 fixed (year-long) and 124 rotating (week-long) sites. Data from the same time of year were compared to a previous study (2006) to assess changes in NO 2 concentrations. NO and NO 2 concentrations were highest in commercial/business/industrial (66 and 76 μg/m 3 , respectively) and high-density residential areas (47 and 59 μg/m 3 , respectively), compared with peri-urban locations. We observed annual means of 68 and 70 μg/m 3 for NO and NO 2 , and a clear seasonal variation, with the mean NO 2 of 63 μg/m 3 (non-Harmattan) increased by 25-56% to 87 μg/m 3 (Harmattan) across different site types. The NO 2 /NO x ratio was also elevated by 19-28%. Both NO and NO 2 levels were associated with indicators of road traffic emissions (e.g. distance to major roads), but not with community biomass use (e.g. wood and charcoal). We found strong correlations between both NO 2 and NO 2 /NO x and mixing layer depth, incident solar radiation and water vapor mixing ratio. These findings represent an increase of 25-180% when compared to a small study conducted in two high-density residential neighborhoods in Accra in 2006. Road traffic may be replacing community biomass use (major source of fine particulate matter) as the prominent source of air pollution in Accra, with policy implication for growing cities in SSA., 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 Elsevier B.V. All rights reserved.)

The Chinese government is replacing high-polluting, household coal heating stoves with electricity- and natural gas-powered heaters to improve ambient air quality. The evaluation of the intervention impact on outdoor PM 2.5 and personal exposure in community level are in their initial stages. We compared outdoor air pollution and personal exposure in two neighboring communities (~2 km) in northern China with contrasting household fuel use patterns: one where residents primarily used coal for cooking and heating ("coal village") and one where natural gas was the dominant fuel ("gas village"). We collected 24-h outdoor gravimetric PM 2.5 samples in each village and concurrently measured 48-h integrated exposures among 71 participants from 41 and 30 households in the coal and gas villages, respectively. PM 2.5 samples were analyzed for mass and chemical composition. Daily outdoor PM 2.5 concentrations in the coal village (mean ± standard deviation: 109 ± 41 μg/m 3 ) were, on average, 1.3 ± 0.2 times higher than in the gas village (88 ± 38 μg/m 3 ). However, personal PM 2.5 exposures were lower in the coal village (116 ± 121 μg/m 3 versus 156 ± 106 μg/m 3 ). PM 2.5 species that can serve as tracers for residential coal combustion (e.g., S, Se, Zn, Pb, etc.) and dust (Al, Ca, Mg, Fe, Si and Ti) were higher in the coal village, and the proportion of personal PM 2.5 of outdoor origin in the coal village was nearly 2 times higher than the gas village. Our results suggest that ambient PM 2.5 and its chemical composition can vary at relatively small spatial scales and may reflect community-level differences in the household energy use. However, personal PM 2.5 exposures may not mirror between-village differences in outdoor air pollution if only PM 2.5 mass is evaluated. Individual chemical composition of PM 2.5 exposure can provide important insight in future studies on the effectiveness of source-targeted air quality interventions., 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.)

Although a great deal of research work has been done by social scientists on walkability and playability, the focus to a large extent has been on the global north. Research work on the urban built environment and children's play has not engaged Africa in general and Ghana in particular. More importantly, there is limited evidence of policies in terms of community-based practices and governmental policies and programmes for the promotion of play. The limited effort in promoting physical activities have to a large extent focused on walkability, yet evidence to date indicates that walking only constitutes a small proportion of the physical activities of children. This is against the backdrop of growing urbanization and the increasing reported incidence of sedentary lifestyles, less physical activity and obesity among children and the youth. Our main objective in this paper is to contribute to the literature on Ghana, and by extension Sub-Saharan Africa, by examining the extent to which playability features in city and national policies and strategies in urban Ghana. We conclude that while there is dearth of public policies on children's play, with the situation in communities compounded by weak city government capacity to plan, implement and enforce development control to protect open spaces for children's play and recreational purposes. The paper recommends a change in policy and practice on creating spaces in urban built-environments for children's play in urban Ghana.

Background: Radiographic prediction of peritoneal carcinomatosis index (PCI) can improve patient selection for cytoreductive surgery. We aimed to determine the correlation of computed tomography (CT)-predicted PCI (CT-PCI) and magnetic resonance imaging (MRI)-predicted PCI (MRI-PCI) with intraoperative-PCI, and if a preoperative-PCI cutoff is associated with incomplete cytoreduction., Patients and Methods: Patients from the US HIPEC Collaborative (2000-2017) with appendiceal, colorectal, or peritoneal mesothelioma (PM) histology who underwent cytoreductive surgery were included. Pearson correlation coefficients were used to determine correlation between preoperative and intraoperative-PCI values. Fisher r-to-z transformation was used to compare correlations., Results: A total of 488 patients were included. Of these, 34% had noninvasive appendiceal, 30% invasive appendiceal, 28% colorectal, and 8% PM histology. CT-PCI was correlated with intraoperative-PCI for patients with noninvasive and invasive appendiceal and colorectal histologies (r = 0.689, 0.554, and 0.571; all P < .001), but not PM (r = 0.188; P = .295). MRI-PCI was correlated with intraoperative-PCI for all histologies (non-invasive appendiceal: r = 0.591; P = .002; invasive appendiceal: r = 0.848; P < .001; colorectal: r = 0.729; P < .001; PM: r = 0.890; P = .007). Comparing CT and MRI, correlations were similar in noninvasive appendiceal and colorectal histologies; MRI was better for invasive appendiceal and PM (P = .005 and P = .021, respectively). Twenty-eight (6%) patients underwent an incomplete cytoreduction (cytoreduction score, 2-3). PCI greater than 15 was associated with cytoreduction score of 2 to 3 for both CT and MRI (CT-PCI: odds ratio, 3.0; P = .033; MRI-PCI: odds ratio, 7.6; P = .071)., Conclusions: In this multi-institutional cohort, CT and MRI-PCI correlate well with intraoperative-PCI. MRI appears to be superior for invasive appendiceal and peritoneal mesothelioma. External validation in a larger population is needed., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Cardiovascular diseases are the leading contributors to disease burden in China and globally, and household air pollution exposure is associated with risk of cardiovascular disease., Objectives: We evaluated whether subclinical cardiovascular outcomes in adult Chinese women would improve after distribution of an energy package comprised of a semi-gasifier cookstove, water heater, chimney, and supply of processed biomass fuel., Methods: We enrolled 204 households (n = 205 women) from 12 villages into a controlled before- and after-intervention study on cardiovascular health and air pollution in Sichuan Province. The intervention was distributed to 124 households during a government-sponsored rural energy demonstration program. The remaining 80 households received the package 18 months later at the end of the study, forming a comparison group. One woman from each household had their blood pressure (BP), central hemodynamics, and arterial stiffness measured along with exposures to air pollution and demographic and household characteristics, on up to five visits. We used a difference-in-differences mixed-effects regression approach with Bayesian inference to assess the impact of the energy package on sub-clinical cardiovascular outcomes., Results: Women who did not receive the energy package had greater mean decreases in brachial systolic (-4.1 mmHg, 95% credible interval (95%CI e ) -7.3, -0.9) and diastolic BP (-2.0 mmHg, 95%CI e -3.6, -0.5) compared with women who received the package (systolic: -2.7, 95%CI e -5.0, -0.4; diastolic: -0.3, 95%CI e -1.4, 0.8) resulting in slightly positive but not statistically significant difference-in-differences effect estimates of 1.3 mmHg (95%CI e -2.5, 5.2) and 1.7 mmHg (95%CI e -0.3, 3.6), respectively. Similar trends were found for central BP, central pulse pressure, and arterial stiffness. Air pollution exposures decreased on average for both treatment groups, with a greater range of reductions among women who did not receive the package (with package: -30% to -50%; without package: +2% to -69%), likely as a result of increased use of gas fuel and electric stoves among this group. Outdoor air quality changed very little over time., Conclusions: Gasifier stoves have been widely promoted as the next generation of 'clean-cooking' technologies, however their effectiveness in improving health in real-world settings should be carefully evaluated and communicated before scaling up their implementation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Membrane-bound plasmin is used by immune cells to degrade extracellular matrices, which facilitates migration. The plasminogen receptor Plg-R KT is expressed by immune cells, including monocytes and macrophages. Among monocytes and macrophages, distinct subsets can be distinguished based on cell surface markers and pathophysiological function. We investigated expression of Plg-R KT by monocyte and macrophage subsets and whether potential differential expression might have functional consequences for cell migration. Proinflammatory CD14 ++ CD16 + human monocytes and Ly6C high mouse monocytes expressed the highest levels of Plg-R KT and bound significantly more plasminogen compared with the other respective subsets. Proinflammatory human macrophages, generated by polarization with lipopolysaccharide and interferon-γ, showed significantly higher expression of Plg-R KT compared with alternatively activated macrophages, polarized with interleukin-4 and interleukin-13. Directional migration of proinflammatory monocytes was plasmin dependent and was abolished by anti-Plg-R KT monoclonal antibody, ε-amino-caproic acid, aprotinin, and the aminoterminal fragment of urokinase-type plasminogen activator. In an in vivo peritonitis model, significantly less Ly6C high monocyte recruitment was observed in Plg-R KT -/- compared with Plg-R KT +/+ mice. Immunohistochemical analysis of human carotid plaques and adipose tissue showed that proinflammatory macrophages also exhibited high levels of Plg-R KT in vivo. Our data demonstrate higher expression of Plg-R KT on proinflammatory monocyte and macrophage subsets that impacts their migratory capacity., (© 2019 by The American Society of Hematology.)

Rapid and wide-ranging reductions in greenhouse gas emissions are required to meet the climate targets agreed upon at the 2015 Paris climate conference. There will be significant transition risks for health, livelihoods, and ecosystems associated with large-scale mitigation, but also opportunities. The aim of this study was to investigate the impacts, positive and negative, of climate policies on population health in China. We review the Intended Nationally Determined Contribution (INDC) that China took to the Paris meeting, link commitments in the INDC to national planning documents relevant to environment and health, and search the literature for Chinese publications on health trade-offs and synergies. Synergies are evident in the measures taken to reduce local air pollution in China: controls on coal burning have materially improved local air quality and benefited health. But there may be risks to health also, depending on how policies are implemented and what safeguards are provided. To date most assessments of the health impacts of climate policies in China have been modelling studies. We recommend work of this kind is complemented by observational research to identify unexpected impacts and vulnerabilities. It will become even more important to undertake this work as emission reductions accelerate to meet the Paris climate targets., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Fine particulate matter (PM 2.5 ) has health effects that may depend on its sources and chemical composition. Few studies have quantified the composition of personal and area PM 2.5 in rural settings over the same time period. Yet, this information would shed important light on the sources influencing personal PM 2.5 exposures. This study investigated the sources and chemical composition of 40 personal exposure, 40 household, and 36 ambient PM 2.5 samples collected in the non-heating and heating seasons in rural southwestern China. Chemical analysis included black carbon (BC), water-soluble components (ions, organic carbon), elements, and organic tracers. Source apportionment was conducted using organic tracer concentrations in a Chemical Mass Balance model. Biomass burning was the largest identified PM 2.5 source contributor to household (average, SD: 48 ± 11%) and exposures (31 ± 6%) in both seasons, and ambient PM 2.5 in winter (20 ± 4%). Food cooking also contributed to household and personal PM, reaching approximately half of the biomass contributions. Secondary inorganic aerosol was the major identified source in summertime ambient PM 2.5 (32 ± 14%), but was present in all samples (summer: 10 ± 3% [household], 13 ± 6% [exposures]; winter: 18 ± 2% [ambient], 7 ± 2% [household], 8 ± 2% [exposures]). Dust concentrations and fractional contribution to total PM 2.5 were higher in summer exposure samples (7 ± 4%) than in ambient or household samples (6 ± 1% and 2 ± 1%, respectively). Indoor sources comprised up to one-fifth of ambient PM 2.5 , and outdoor sources (vehicles, secondary aerosols) contributed up to 15% of household PM 2.5 . While household sources were the main contributors to PM 2.5 exposures in terms of mass, inorganic components of personal exposures differed from household samples. Based on these findings, health-focused initiatives to reduce harmful PM 2.5 exposures may consider a coordinated approach to address both indoor and outdoor PM 2.5 source contributors., (Copyright © 2018. Published by Elsevier B.V.)

Background: Air pollution from cooking with solid fuels is a potentially modifiable risk factor for increased blood pressure and may lead to eye irritation., Objectives: To evaluate whether a climate motivated cookstove intervention reduced blood pressure and eye irritation symptoms in Indian women., Methods: Households using traditional stoves were randomized to receive a rocket stove or continue using traditional stoves. Systolic (SBP) and diastolic blood pressure (DBP), and self-reported eye symptoms were measured twice, pre-intervention and at least 124 days post-intervention in women > 25 years old in control (N = 111) and intervention (N = 111) groups in rural Karnataka, India. Daily (24-h) fine particle (PM 2.5 ) mass and absorbance (Abs) were measured in cooking areas at each visit. Mixed-effect models were used to estimate before-and-after differences in SBP, DBP and eye symptoms., Results: We observed a lower SBP (-2.0 (-4.5, 0.5) mmHg) and DBP (-1.1 (-2.9, 0.6) mmHg) among exclusive users of intervention stove, although confidence intervals included zero. Stacking or mixed use of intervention and traditional stoves contributed to a small increase in SBP 2.6 (-0.4, 5.7) mmHg) and DBP (1.2 (-0.9, 3.3) mmHg). Exclusive and mixed stove users experienced higher post-intervention reductions, on average, in self-reported eye irritation symptoms for burning sensation in eyes, and eyes look red often compared to control. Median air pollutant concentrations increased post-intervention in all stove groups, with the lowest median PM 2.5 increase in the exclusive intervention stove group., Conclusions: Health benefits were limited due to stacking and lower-than-predicted efficiency of the intervention stove in the field. Stove adoption and use behavior, in addition to stove technology, affects achievement of health co-benefits. Carbon-financing schemes need to align with international guidelines that have been set based on health outcomes to maximize health co-benefits from cookstove interventions., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Ambient particulate air pollution is known to have detrimental effects on cardiovascular health but less is known about the specific effects of black carbon or elemental carbon (BC/EC) and ultrafine particles (UFP)., Methods: We present a narrative review of the epidemiological evidence related to the impact of exposure to BC/EC and UFP on blood pressure in adults. We searched PubMed and EMBASE in September 2017, using a predefined search strategy. Abstracts were screened using predefined inclusion criteria. Data collection was completed using a standard data extraction form. We focused on main effect estimates for associations between short (≤7 days) and long-term exposures to BC/EC and UFP and systolic (SBP) and diastolic blood pressure (DBP). Effect estimates were rescaled to enable direct comparisons between studies., Results: Thirty publications were included in the review: 19 studies examined outdoor exposure to BC/EC, 11 examined outdoor UFP, three studies examined indoor BC and one study examined indoor UFP. In general, existing evidence supports a positive association between BC/EC and blood pressure. Evidence for outdoor UFP exposures were less clear as effect estimates were small in magnitude and confidence intervals often included the null., Conclusions: Existing evidence supports a positive association between BC/EC and blood pressure in adults, whereas UFPs do not appear to have a meaningful impact on blood pressure., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Approximately three billion people are exposed to household air pollution (HAP) from solid fuel cookstoves. Studies from single settings have linked HAP with elevated blood pressure (BP), but no evidence exists from multi-country analyses., Objectives: Using nationally representative and internationally comparable data, we examined the association between solid fuel use and BP in 77,605 largely premenopausal women (aged 15-49) from ten resource-poor countries., Methods: We obtained data on systolic and diastolic BP, self-reported primary cooking fuel, health and socio-demographic characteristics from 12 Demographic and Health Surveys conducted in Albania, Armenia, Azerbaijan, Bangladesh, Benin, Ghana, Kyrgyzstan, Lesotho, Namibia, and Peru. We estimated associations between history of fuel use [solid fuel (coal or biomass) versus clean fuel (electricity or gas)] with systolic and diastolic BP and hypertension using a meta-analytical approach., Results: Overall, the country-level mean systolic and diastolic BP were 117 (range: 111-127) and 74 (71-83) mmHg, respectively. The country-level mean age of the women was 30.8 years (range: 28.4-32.9). The prevalence of solid fuel use was 46.0% (range: 4.1-95.8). In adjusted, pooled analyses, primary use of solid fuel was associated with 0.58mmHg higher systolic BP (95% CI: 0.23, 0.93) as compared to primary use of clean fuel. The pooled estimates for diastolic BP and pulse pressure were also positive, but the confidence intervals contained zero. The pooled odds of hypertension was [OR = 1.07 (95% CI: 0.99, 1.16)], an effect that was driven by rural participants for whom solid fuel use was associated with a 16% greater odds of hypertension [OR = 1.16 (95% CI: 1.01, 1.35)]., Conclusions: Cooking with solid fuels was associated with small increases in BP and odds of hypertension. Use of cleaner fuels like gas or electricity may reduce cardiovascular risk in developing countries, particularly among rural residents., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Low dietary calcium intake and bioavailability may adversely affect bone health. Reducing the size of calcium compounds increases their specific surface area (SSA, expressed as m 2 /g) and may increase calcium dissolution and bioavailability. Objective: We investigated the influence of SSA and chemical composition on the bioavailability of calcium and compared in vitro calcium dissolution with in vivo absorption. Methods: Calcium dissolution was measured in 0.1 M phosphoric acid, whereas color and pH changes of foods were assessed as indicators for potential sensory performance. Calcium absorption, retention, and fractional retention were measured over a 5-d balance study in growing Sprague-Dawley male rats after 21 d of feeding. Femoral and vertebral bone mineral density (BMD) and extensive tissue histology were assessed at study end. The influence of SSA on calcium bioavailability was assessed by comparing the groups fed pure calcium carbonate (CaCO 3 ) with increasing SSAs of 3, 36, and 64 m 2 /g (CaCO 3 &#95;3, CaCO 3 &#95;36 and CaCO 3 &#95;64), whereas chemical composition was assessed by comparing the smallest CaCO 3 &#95;64, a 50:50 wt:wt percent solution mixture of CaCO 3 and hydroxyapatite&#95;94, and pure hydroxyapatite&#95;100. Results: In vivo, fractional calcium retention from hydroxyapatite&#95;100 (mean ± SEM: 54.86% ± 0.95%/5 d) was significantly greater than from CaCO 3 &#95;64 (49.66% ± 1.15%/5 d) ( P = 0.044). Increasing SSA of the pure CaCO 3 did not significantly improve calcium retention. Across all 5 groups, there were no significant differences in BMD or tissue calcification by histology. In vitro calcium dissolution did not correlate with SSA or calcium absorption. In selected food matrixes, hydroxyapatite&#95;100 caused less color change and/or smaller pH increase than did the other calcium compounds. Conclusions: Our findings suggest that chemical composition rather than SSA is a predictor of nanostructured calcium bioavailability and that in vitro dissolution of nanostructured calcium does not predict in vivo absorption. Although its phosphorus content may limit use in some populations, nanostructured hydroxyapatite may be a promising calcium compound for food fortification., (© 2017 American Society for Nutrition.)

Background: Airborne particulate matter (PM) is a widespread environmental exposure and leading health risk factor. The health effects of PM may be mediated by its oxidative potential; however, the combustion and non-combustion sources and components of PM responsible for its oxidative potential are poorly understood, particularly in low- and middle-income rural settings where coal and biomass burning for cooking and heating contribute to PM exposure., Methods: We measured 24-h personal exposures to fine particulate matter (PM2.5) of 20 rural women in northern (Inner Mongolia) and southern (Sichuan) Chinese provinces who used solid fuels (i.e., coal, biomass). PM2.5 exposures were characterized for mass, black carbon, water-soluble organic carbon, major water-soluble ions, and 47 elements. The oxidative potential of PM2.5 exposures was measured using acellular (dithiothreitol-based) and cellular (macrophage-based) assays. We performed factor and correlation analyses using the chemical components of PM2.5 to identify sources of exposure to PM2.5 and their chemical markers. Associations between oxidative potential and chemical markers for major sources of PM2.5 exposure were assessed using linear regression models., Results: Women's geometric mean PM2.5 exposures were 249μgm(-3) (range: 53.9-767) and 83.9μgm(-3) (range: 73.1-95.5) in Inner Mongolia and Sichuan, respectively. Dust, biomass combustion, and coal combustion were identified as the major sources of exposure to PM2.5. Markers for dust (iron, aluminum) were significantly associated with intrinsic oxidative potential [e.g., one interquartile range increase in iron (ppm) was associated with an 85.5% (95% CI: 21.5, 149) increase in cellular oxidative potential (μgZymosanmg(-1))], whereas markers for coal (arsenic, non-sulfate sulfur) and biomass (black carbon, cadmium) combustion were not associated with oxidative potential., Conclusions: Dust was largely responsible for the intrinsic oxidative potential of PM2.5 exposures of rural Chinese women, whereas biomass and coal combustion were not significantly associated with intrinsic oxidative potential., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO 4 ) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead., Objectives: Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition., Design: In this 2 × 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) ∼8 mg Fe as FeSO 4 , 2) ∼8 mg Fe as NaFeEDTA that contained ∼41 mg EDTA, 3) ∼41 mg EDTA as sodium EDTA (Na 2 EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat., Results: The adjusted geometric mean BPb concentration at baseline was 4.3 μg/dL (95% CI: 4.2, 4.3 μg/dL), and at endpoint these values were 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for FeSO 4 , 2.9 μg/dL (95% CI: 2.7, 3.0 μg/dL) for NaFeEDTA, 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for EDTA, and 3.7 μg/dL (95% CI: 3.5, 3.9 μg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron × EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores., Conclusions: Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013., (© 2016 American Society for Nutrition.)

Background: Optimal iodine intake during infancy is critical for brain development, but no estimated average requirement (EAR) is available for this age group., Objective: We measured daily iodine intake, excretion, and retention over a range of iodine intakes in early infancy to determine the minimum daily intake required to achieve iodine balance., Design: In a dose-response crossover study, we randomly assigned healthy infants (n = 11; mean ± SD age 13 ± 3 wk) to sequentially consume over 33 d 3 infant formula milks (IFMs) containing 10.5, 19.3, and 38.5 μg I/100 kcal, respectively. Each IFM was consumed for 11 d, consisting of a 6-d run-in period followed by a 4-d balance period and 1 run-out day., Results: Iodine intake (mean ± SD: 54.6 ± 8.1, 142.3 ± 23.1, and 268.4 ± 32.6 μg/d), excretion (55.9 ± 8.6, 121.9 ± 21.7, and 228.7 ± 39.3 μg/d), and retention (-1.6 ± 8.3, 20.6 ± 21.6, and 39.8 ± 34.3 μg/d) differed among the low, middle, and high iodine IFM groups (P < 0.001 for all). There was a linear relation between daily iodine intake and both daily iodine excretion and daily iodine retention. Zero balance (iodine intake = iodine excretion, iodine retention = 0 μg/d) was achieved at a daily iodine intake of 70 μg (95% CI: 60, 80 μg)., Conclusion: Our data indicate the iodine requirement in 2- to 5-mo-old infants is 70 μg/d. Adding an allowance for accumulation of thyroidal iodine stores would produce an EAR of 72 μg and a recommended dietary allowance of 80 μg. This trial was registered at clinicaltrials.gov as NCT02045784., (© 2016 American Society for Nutrition.)

Background: Almost half the world's population is exposed to household air pollution from biomass and coal combustion. The acute effects of household air pollution on the cardiovascular system are poorly characterized. We conducted a panel study of rural Indian women to assess whether personal exposures to black carbon during cooking were associated with acute changes in blood pressure., Methods: We enrolled 45 women (ages 25-66 years) who cooked with biomass fuels. During cooking sessions in winter and summer, we simultaneously measured their personal real-time exposure to black carbon and conducted ambulatory blood pressure measurements every 10min. We recorded ambient temperature and participants' activities while cooking. We assessed body mass index, socioeconomic status, and salt intake. Multivariate mixed effects regression models with random intercepts were used to estimate the associations between blood pressure and black carbon exposure, e.g., average exposure in the minutes preceding blood pressure measurement, and average exposure over an entire cooking session., Results: Women's geometric mean (GM) exposure to black carbon during cooking sessions was lower in winter (GM: 40μg/m(3); 95% CI: 30, 53) than in summer (GM: 56μg/m(3); 95% CI: 42, 76). Interquartile range increases in black carbon were associated with changes in systolic blood pressure from -0.4mm Hg (95% CI: -2.3, 1.5) to 1.9mm Hg (95% CI: -0.8, 4.7), with associations increasing in magnitude as black carbon values were assessed over greater time periods preceding blood pressure measurement. Interquartile range increases in black carbon were associated with small decreases in diastolic blood pressure from -0.9mm Hg (95% CI: -1.7, -0.1) to -0.4mm Hg (95% CI: -1.6, 0.8). Associations of a similar magnitude were estimated for cooking session-averaged values., Conclusions: We found some evidence of an association between exposure to black carbon and acute increases in systolic blood pressure in Indian women cooking with biomass fuels, which may have implications for the development of cardiovascular diseases., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Although iron supplementation in malaria-free areas mostly reduces infectious morbidity, it can sometimes increase morbidity from infections as a result of the dependence of pathogenic microorganisms on iron. Supplementation with n-3 (ω-3) long-chain polyunsaturated fatty acids (LCPUFAs) improved morbidity in several human studies. However, information on the combined effect of iron and n-3 LCPUFA supplementation on infectious morbidity is limited., Objective: We determined whether n-3 LCPUFAs and iron supplementation, alone or in combination, affected absenteeism and illness in iron-deficient schoolchildren with low fish intake., Design: A total of 321 South African children (aged 6-11 y) with iron deficiency (ID) were randomly divided into 4 groups to receive 1) iron plus placebo, 2) a mixture of docosahexaenoic acid and eicosapentaenoic acid (DHA/EPA) plus placebo, 3) iron plus DHA/EPA, or 4) placebo plus placebo as oral supplements 4 times/wk for 8.5 mo. Morbidity was recorded, and iron-status indexes were measured. The total phospholipid fatty acid composition of peripheral blood mononuclear cell membranes was analyzed in a subsample (n = 130)., Results: Iron supplementation increased the number of days with illness when all symptoms were considered (B: 0.87; 95% CI: 0.71, 1.03) as well as illness that was specifically caused by respiratory symptoms (B: 1.45; 95% CI: 1.21, 1.70), whereas DHA/EPA reduced the number of days with illness at school (B: -0.96; 95% CI: -1.33, -0.59). The increases caused by iron were reduced to the levels seen in the placebo plus placebo group when iron was provided in combination with DHA/EPA as indicated by significant iron × DHA/EPA interactions (both P < 0.001)., Conclusion: Iron supplementation increased morbidity (mostly respiratory) in iron-deficient South African schoolchildren with low DHA/EPA intake, but when iron was given in combination with DHA/EPA, this effect was prevented., (© 2015 American Society for Nutrition.)

Purpose: To evaluate the value of a new multi-stage surgical procedure using bilateral intracranial electroencephalogram (iEEG) prior and post complete corpus callosotomy (CC) for epileptogenic focus localization., Method: Thirty patients with drug-resistant epilepsy underwent bilateral iEEG monitoring to localize epileptogenic focus for surgical treatment. Among them, bisynchronous epileptogenic activities were found in 9 pediatric patients. These 9 patients then received complete CC and continued bilateral iEEG monitoring for further seizure localization. Final surgical treatment decisions were made based on the bilateral iEEG findings post complete CC. The entire multi-stage procedure was performed during the same hospital stay. We retrospectively studied the data from the 9 patients., Results: Seizure onset was lateralized in 3 patients who later received functional hemispherectomy. In another 4 patients, seizure onset was localized, resulting in resective surgery. Bilateral multiple subpial transection was performed on 1 patient with identified bilateral independent seizure onset. One patient did not have seizures following complete CC leading to removal of electrodes without any further resection. Subsequent follow-up showed favorable outcome in all patients: seizure-free in 7, more than 90% reduction in 2. None of the patients experienced surgery related complications during the procedure and follow-up period., Conclusion: The multi-stage surgical procedure utilizing iEEG monitoring with CC is a viable option for select patients with catastrophic non-localizing epilepsy. Further study is necessary to find the optimal selection criteria for use of this novel approach., (Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Background: Biomass smoke at higher concentrations is associated with respiratory symptoms and, after years of exposure, increased risk of respiratory disorders in adults, but its effects on cardiovascular diseases are not well characterized, particularly compared with other pollution sources like tobacco smoke or traffic., Methods: We conducted a cross-sectional study and enrolled 25 women living in rural Sichuan, China. We measured integrated 24-h personal exposure to fine particulate matter (PM2.5) and black carbon, and measured PM2.5 and black carbon in their kitchens. We assessed participants' brachial and central blood pressure and arterial stiffness using pulse wave analysis, and analyzed dried blood spot and buccal cell samples for C-reactive protein and relative telomere length. We also evaluated the difference in these physiological and biomarker measures between individuals with high (≥median) versus low (

Background: Preliminary data from the baseline Prospective Urban Rural Epidemiology (PURE) study in South Africa indicated a higher prevalence of dyslipidemia than previous South African studies. The intake of specific individual dietary fatty acids may affect blood lipids differently than sub-groups of fat (i.e. polyunsaturated fatty acids). We investigated the dietary intake of different individual fatty acids and their associations with blood lipids, in relation to urbanization and gender., Methods: Cross-sectional data analysis within the PURE baseline study of healthy subjects (n=1950, 35-70 years) from rural and urban areas. Dietary data were collected and blood lipid analysis performed., Results: Intake of individual fatty acids was significantly higher in urban than rural dwellers. However, the intake of n-3 PUFAs was below recommendations in all groups. Total cholesterol and LDL were higher in females than in males, with no rural‒urban differences. Intake of alpha-linolenic acid (ALA) was positively associated with total cholesterol (β=0.143) and triglycerides (β=0.256) in males. The risk for having elevated LDL also increased with increased intake of ALA (OR 1.49, 95% CI 1.04, 2.14) in males. In females, arachidonic acid and eicosapentaenoic acid (EPA) were positively associated with total cholesterol and arachidonic acid was also positively associated with LDL, whereas docosahexaenoic acid was negatively associated with total cholesterol and LDL., Conclusions: These results suggest that specific individual dietary fatty acids may affect blood lipids in males differently than in females irrespective of rural or urban dwelling. The positive association between ALA and total cholesterol and triglycerides in males is a concern, because current advice aims to improve the dietary linoleic acid to ALA ratio by increasing ALA intake., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Little is known about the combined effects of iron and n-3 (omega-3) fatty acid (FA) supplementation on cognitive performance. The provision of either DHA/EPA or iron alone in rats with combined iron and n-3 FA deficiency has been reported to exacerbate cognitive deficits associated with deficiency., Objective: We investigated the effects of iron and DHA/EPA supplementation, alone and in combination, in children with poor iron and n-3 FA status., Design: In a 2-by-2 factorial trial, children with iron deficiency (ID) (n = 321; aged 6-11 y) were allocated to receive 1) iron (50 mg) plus DHA/EPA (420/80 mg), 2) iron plus placebo, 3) placebo plus a mixture of DHA and EPA (DHA/EPA), or 4) placebo plus placebo as oral supplements (4/wk) for 8.5 mo. Cognition was assessed at baseline and endpoint by using the Hopkins Verbal Learning Test (HVLT) and subscales of the Kaufman Assessment Battery for Children., Results: Both iron and DHA/EPA significantly increased weight-for-age z scores. Iron increased the number of words recalled at HVLT recall 2 (intervention effect: 0.90; 95% CI: 0.18, 1.62), and in anemic children, iron increased scores in the Atlantis Delayed test (1.51; 95% CI: 0.03, 2.99) and HVLT recall 2 (2.02; 95% CI: 0.55, 3.49). DHA/EPA showed no benefit in any of the cognitive tests but decreased Atlantis test scores (-2.48; 95% CI: -3.99, -0.96) in children who were anemic at baseline and decreased Atlantis delayed scores (-0.9; 95% CI: -1.45, -0.36) in girls with ID, whereas boys tended to perform better., Conclusions: In children with poor iron and n-3 FA status, iron supplementation improved verbal and nonverbal learning and memory, particularly in children with anemia. In contrast, DHA/EPA supplementation had no benefits on cognition and impaired working memory in anemic children and long-term memory and retrieval in girls with ID.

Deficiencies of iron (Fe) (ID) and (n-3) fatty acids (FA) [(n-3)FAD] may impair brain development and function through shared mechanisms. However, little is known about the potential interactions between these 2 common deficiencies. We studied the effects of ID and (n-3)FAD, alone and in combination, on brain monoamine pathways (by measuring monoamines and related gene expression) and spatial working and reference memory (by Morris water maze testing). Using a 2 × 2 design, male rats were fed an ID, (n-3)FAD, ID+(n-3)FAD, or control diet for 5 wk postweaning (postnatal d 21-56) after (n-3)FAD had been induced over 2 generations. The (n-3)FAD and ID diets decreased brain (n-3) FA by 70-76% and Fe by 20-32%, respectively. ID and (n-3)FAD significantly increased dopamine (DA) concentrations in the olfactory bulb (OB) and striatum, with an additive 1- to 2-fold increase in ID+(n-3)FAD rats compared with controls (P < 0.05). ID decreased serotonin (5-HT) levels in OB, with a significant decrease in ID+(n-3)FAD rats. Furthermore, norepinephrine concentrations were increased 2-fold in the frontal cortex (FC) of (n-3)FAD rats (P < 0.05). Dopa decarboxylase was downregulated in the hippocampus of ID and ID+(n-3)FAD rats (fold-change = -1.33; P < 0.05). ID and (n-3)FAD significantly impaired working memory performance and the impairment positively correlated with DA concentrations in FC (r = 0.39; P = 0.026). Reference memory was impaired in the ID+(n-3)FAD rats (P < 0.05) and was negatively associated with 5-HT in FC (r = -0.42; P = 0.018). These results suggest that the combined deficiencies of Fe and (n-3) FA disrupt brain monoamine metabolism and produce greater deficits in reference memory than ID or (n-3)FAD alone.

Concurrent deficiencies of iron (Fe) (ID) and (n-3) fatty acids [(n-3)FAD)] in rats can alter brain monoamine pathways and impair learning and memory. We examined whether repletion with Fe and DHA/EPA, alone and in combination, corrects the deficits in brain monoamine activity (by measuring monoamines and related gene expression) and spatial working and reference memory [by Morris water maze (MWM) testing] associated with deficiency. Using a 2 × 2 design, male rats with concurrent ID and (n-3)FAD [ID+(n-3)FAD] were fed an Fe+DHA/EPA, Fe+(n-3)FAD, ID+DHA/EPA, or ID+(n-3)FAD diet for 5 wk [postnatal d 56-91]. Biochemical measures and MWM performance after repletion were compared to age-matched control rats. The provision of Fe in combination with DHA/EPA synergistically increased Fe concentrations in the olfactory bulb (OB) (Fe x DHA/EPA interaction). Similarly, provision of DHA/EPA in combination with Fe resulted in higher brain DHA concentrations than provision of DHA alone in the frontal cortex (FC) and OB (P < 0.05). Dopamine (DA) receptor D1 was upregulated in the hippocampus of Fe+DHA/EPA rats (fold-change = 1.25; P < 0.05) and there were significant Fe x DHA/EPA interactions on serotonin (5-HT) in the OB and on the DA metabolite dihydroxyphenylacetic acid in the FC and striatum. Working memory performance was impaired in ID+DHA/EPA rats compared with controls (P < 0.05). In the reference memory task, Fe+DHA/EPA improved learning behavior, but Fe or DHA/EPA alone did not. These findings suggest that feeding either Fe or DHA/EPA alone to adult rats with both ID and (n-3)FAD affects the DA and 5-HT pathways differently than combined repletion and exacerbates the cognitive deficits associated with combined deficiency.

Introduction: Root canal irrigation carries a risk of extrusion of irrigant into the periapical tissues. The objective of this study was to compare different irrigation systems in matched pairs of teeth prepared to an apical size of 35.06 and 50.06 by measuring the frequency and extent of apical extrusion of sodium hypochlorite (NaOCl) into a simulated periapical environment. The null hypothesis was tested that there is no difference between systems., Methods: Bilaterally matched pairs (n = 10) of single-canal extracted human anterior teeth were instrumented to an apical size of either 35.06 or 50.06. Teeth were embedded in a gel containing the pH-sensitive dye M-cresol purple that changes from yellow at pH 7.4 to purple at pH 9. Root canals were irrigated with 6% NaOCl (pH 11) by using EndoActivator (EA), EndoVac (EV), Rispi-Sonic/MicroMega 1500 (MM), passive ultrasonic irrigation (PUI), and syringe irrigation with a slot-tipped needle (SN), so that each tooth underwent all irrigation procedures in a randomized crossover design. Apical extrusion was evaluated by image analyses., Results: The frequency of extrusion was less in teeth with apical preparation size 35.06 (36%) compared with 50.06 (60%) (P = .014) and was dependent on the irrigation system in 35.06 (P = .039) but not 50.06 groups. In the 35.06 group the frequency of extrusion was less for EV than for MM and SN (both P = .029). The extent of extrusion was less for MM compared with PUI (P = .024) and SN (P = .046) in the 35.06 group and greater for SN compared with all other systems in the 50.06 group (P < .05). The null hypothesis was rejected., Conclusions: The frequency of apical extrusion of NaOCl was dependent on the type of root canal irrigation system and apical preparation size. The extent of extrusion depended on the irrigation system, with syringe and slotted-needle irrigation resulting in the greatest extent of extrusion., (Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Micronutrient powders (MNP) are often added to complementary foods high in inhibitors of iron and zinc absorption. Most MNP therefore include high amounts of iron and zinc, but it is no longer recommended in malarial areas to use untargeted MNP that contain the Reference Nutrient Intake for iron in a single serving. The aim was to test the efficacy of a low-iron and -zinc (each 2.5 mg) MNP containing iron as NaFeEDTA, ascorbic acid (AA), and an exogenous phytase active at gut pH. In a double-blind controlled trial, South African school children with low iron status (n = 200) were randomized to receive either the MNP or the unfortified carrier added just before consumption to a high-phytate maize porridge 5 d/wk for 23 wk; primary outcomes were iron and zinc status and a secondary outcome was somatic growth. Compared with the control, the MNP increased serum ferritin (P < 0.05), body iron stores (P < 0.01) and weight-for-age Z-scores (P < 0.05) and decreased transferrin receptor (P < 0.05). The prevalence of iron deficiency fell by 30.6% (P < 0.01) and the prevalence of zinc deficiency decreased by 11.8% (P < 0.05). Absorption of iron from the MNP was estimated to be 7-8%. Inclusion of an exogenous phytase combined with NaFeEDTA and AA may allow a substantial reduction in the iron dose from existing MNP while still delivering adequate iron and zinc. In addition, the MNP is likely to enhance absorption of the high native iron content of complementary foods based on cereals and/or legumes.

Introduction: The purpose of this study was to compare the debridement efficacy of EndoVac irrigation versus conventional needle irrigation in vivo., Methods: Seven adult patients with a total of 22 matched pairs of single-canaled vital teeth with fully formed apices were recruited. Canals were instrumented to a master apical file size #40/.04 taper. One tooth from each matched pair was irrigated by using the EndoVac system. The other tooth was irrigated by conventional needle irrigation. Five additional teeth were used as positive controls. A #10 K-file was inserted into the control canals to determine working length (WL), with no other instrumentation or irrigation performed to confirm the presence of debris. The teeth were extracted, fixed, and decalcified. Six histologic slides each 6 μm thick were made from sections at 1 and 3 mm from WL and stained. The slide with the most debris was photographed at each level for each tooth. A Wilcoxon signed rank test was used to compare the percentage of debris remaining in the canals between the 2 irrigation techniques., Results: The median amount of debris remaining at 1 mm was 0.05% for the EndoVac group and 0.12% for the conventional irrigation group (P < .05). The median amount of debris remaining at 3 mm was 0.09% for the EndoVac group and 0.07% for the conventional needle irrigation group (P > .05)., Conclusions: EndoVac irrigation resulted in significantly less debris at 1 mm from WL compared with conventional needle irrigation. There was no significant difference at the 3-mm level., (Copyright © 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this investigation was to compare the antimicrobial efficacy of root canal irrigation with the EndoVac (Discus Dental, Culver City, CA) to endodontic needle irrigation in the apical 5 mm of root canals infected with Enterococcus faecalis., Methods: Bilaterally matched, extracted human teeth were sterilized and inoculated with E. faecalis. Specimens in the EndoVac group were irrigated using the EndoVac system, whereas those in the needle group were irrigated with a 30-G side-vented needle. After chemomechanical preparation, the apical 5 mm of the roots were removed, frozen in liquid nitrogen, and pulverized to expose E. faecalis in dentinal tubules or other morphologic irregularities. The number of colony forming units (cfus) of E. faecalis per mg dentin was determined., Results: The EndoVac Group had a mean of 31.6 cfu/mg, whereas the needle group had a mean of 157 cfu/mg. This represents a bacterial reduction of 99.7% in group A and 98.8% in group B when compared with positive controls., Conclusion: Although there were fewer cfu/mg when using the EndoVac, there was not a statistically significant difference between the EndoVac and needle groups., (Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study is to compare extrusion of irrigants delivered with a 27-G needle or the EndoVac system (Discus Dental, Culver City, CA) during instrumentation and final irrigation of teeth., Methods: Matched paired single canal teeth were divided into four sample groups and controls. The experimental groups were needle irrigation International Standards Organization (ISO) size #40 (N40) and #60 (N60) and EndoVac ISO size #40 (E40) and #60 (E60). Teeth were secured and embedded in 0.2% agarose gel (ph = 7.3-7.4) containing 1 mL 0.1% m-cresol purple, which changes color at a pH of 9.0. Teeth received NaOCl and EDTA irrigation with the 27-G slot needle or the EndoVac system. The amount of irrigation was controlled for each sample. Standardized digital photographs were taken 20 minutes after the first irrigant was used. Photographs were analyzed by using Adobe Photoshop 7 (Adobe, San Jose, CA) to determine the amount of extrusion expressed as percent of total pixels., Results: Data from sample groups show the following: N40 with 50% extrusion (6/12), E40 with 8.33% extrusion (1/12), N60 with 58.33% (7/12), and E60 with 8.33% (1/12). The overall extrusion frequency, regardless of apical preparation size, was 54.17% (13/24) for needle and 8.33% (2/24) for EndoVac. Analysis of N40 and E40 revealed p < 0.03. Analysis of N60 and E60 revealed p < 0.01. Comparison of needle irrigation versus EndoVac showed a significant p value of 0.0007., Conclusions: This study showed significantly less extrusion risk using the EndoVac system compared with needle irrigation., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to evaluate the push-out bond strengths of different obturating materials., Methods: Forty single-rooted human extracted teeth were used in this study. The teeth were instrumented and irrigated by using 5.25% NaOCl, 15% ethylenediaminetetraacetic acid, and sterile water. The teeth were then filled with Resilon/RealSeal, Resilon/RealSeal SE, Resilon/MetaSeal , or gutta-percha/Kerr EWT sealer. The roots were then sectioned into 1-mm-thick slices and subjected to vertical loading to displace the obturating material toward the coronal side of the slice. The bond strength was then calculated and subjected to statistical analysis. Slices were examined by using a stereomicroscope at 30x to determine the mode of failure., Results: The mean push-out bond strengths were as follows: Resilon/RealSeal, 1.45 +/- 0.99 MPa; RealSeal SE, 0.88 +/- 0.49 MPa; Resilon/MetaSeal, 2.41 +/- 1.7 MPa; and gutta-percha/Kerr EWT sealer, 2.32 +/- 0.74 MPa., Conclusions: The push-out bond strengths of Resilon/MetaSeal and gutta-percha/Kerr EWT were significantly (P < .05) higher than either Resilon/RealSeal or Resilon/RealSeal SE. Resilon/MetaSeal and gutta-percha/Kerr EWT did not differ significantly., (Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this in-depth investigation was to identify, clarify, and substantiate clinical terminology relative to apical/periapical/periradicular diagnostic states, which is used routinely in the provision of endodontic care. Furthermore, the information gleaned from this investigation was used to link diagnostic categories to symptoms, pathogenesis, treatment, and prognosis wherever possible, along with establishing the basis for the metrics used in this diagnostic process., Materials and Methods: Diagnostic terminologies and their relevance to clinical situations were procured from extensive historic and electronic searches and correlated with contemporary concepts in disease processes, clinical assessments, histologic findings (if appropriate), and standardized definitions that have been promulgated and promoted for use in the last 25 years in educational programs and test constructions and for third-party concerns., Results: In general, clinical terminology that is used routinely in the practice of endodontics is not based on the findings of scientific investigations. The diagnostic terms are based on assumptions by correlating certain signs, symptoms, and radiographic findings with what is presumed (not proven) to be the underlying disease process of a given clinical state. There were no studies that specifically tried to assess the accuracy of the metrics used contemporarily for the classification of clinical disease states., Conclusion: A succinct diagnostic scheme that could be described thoroughly, agreed on unanimously, coded succinctly for easy electronic input, and ultimately used for follow-up analysis would not only drive treatment modalities more accurately, but would also allow for future outcomes assessment and validation.

This paper constitutes a review on the welfare aspects of piglet castration that considers the scientific literature published after 2004. Castrating during the neonatal period (1 to 3 days of age) is clearly painful. In addition, inflammatory processes may take place at the sites of incision, thus adding further pain to the procedure. Surgical castration with general and local anaesthesia, in combination with long-term analgesia, has been shown to reduce pain but the additional handling and injection of the anaesthetic, the effectiveness and limited safety margins have to be thoroughly evaluated. Raising entire males during the whole fattening period or immunocastration of males towards the end of the fattening period are other alternatives with welfare benefits in young pigs compared to current surgical castration, but with some potential welfare drawbacks regarding handling stress and behaviour during fattening. Based on the current knowledge, it can be concluded that sperm sexing and raising entire males after genetic control of boar taint are potentially preferable alternatives to current practices, but need further research, as these methods are not yet available.

Introduction: The purpose of this study was to compare the accuracy of working length (WL) measurements by using the Root ZX II, Apex NRG XFR, and Mini Apex Locator with rotary nickel-titanium (NiTi) instruments., Methods: Twenty-eight teeth had their WLs determined with each electronic apex locator (EAL) by using 0.04 taper ProFiles sizes 40-20 in a crown-down technique until WL was reached. Four control teeth had their WL determined by using stainless steel hand files. The files were cemented at WL, and the teeth were extracted. The apical 4 mm of each root was shaved to the apical constriction, exposing the file. Photographs were taken under 15x and 30x magnification and projected at 360x and 720x for evaluation., Results: The accuracy of the Root ZX II, Apex NRG XFR, and Mini Apex Locator in locating the minor diameter within +/-0.5 mm was 50%, 46.43%, and 39.29%, respectively. There was no statistically significant difference between the EALs in locating the minor diameter. The determination of WL by using hand files in the control teeth was more accurate., Conclusions: The Root ZX II, Apex NRG XFR, and Mini Apex Locator used with rotary NiTi files were able to locate the apical constriction within +/-0.5 mm only 50% or less of the time.

The median urinary iodine concentration (UI) in school-aged children is recommended for assessment of iodine nutrition in populations. If the median UI is adequate in school-aged children, it is usually assumed iodine intakes are also adequate in the remaining population, including pregnant women. But iodine requirements sharply increase during pregnancy. In this study, our aim was to measure UI in pairs of pregnant women and their school-aged children from the same family, who were sharing meals, to directly assess whether a household food basket that supplies adequate iodine to school-aged children also meets the needs of pregnant women. UI was measured in spot urine samples from pairs (n = 302) of healthy pregnant mothers and their school-aged children in metropolitan Bangkok, Thailand. A dietary questionnaire was completed. The UI [median (range)] in the pregnant women {108 (11-558) microg/L [0.85 (0.086-4.41) micromol/L]} were lower than those of their school-aged children {200 (25-835) microg/L [1.58 (0.20-6.52) micromol/L]} (P < 0.001), indicating optimal iodine status in the children but mild-to-moderate iodine deficiency in their pregnant mothers. The estimated iodine intakes in the 2 groups were in the range of 130-170 microg/d. There was a modest positive correlation between UI in the pairs (r = 0.253; P < 0.01). A higher frequency of seafood meals was a significant predictor of UI in both groups, but household use of iodized salt was not. These data suggest the median UI in school-aged children should not be used as a surrogate for monitoring iodine status in pregnancy in central Thailand; pregnant women should be directly monitored.

Acute apical abscesses and cellulitis are severe endodontic diseases caused by opportunistic bacteria with possible coinfection with latent herpesviruses. The objectives of this study are to identify herpesviruses, including human cytomegalovirus (HCMV), Epstein-Barr virus (EBV), herpes simplex virus-1 (HSV-1), and Varicella zoster virus (VZV) in patients (n = 31) presenting with acute apical abscesses and cellulitis of endodontic origin. Primary and nested polymerase chain reaction (PCR) was conducted using virus-specific primers and DNA isolated from cell-free abscess fluid. From patients exhibiting concurrent spontaneous pain (n = 28), nine abscesses contained HCMV, two abscesses contained EBV, one abscess contained HSV-1, and no abscesses contained VZV. Control PCR using genomic or recombinant templates showed detection limits to a single genomic copy of HCMV, 100 genomic copies for EBV, and 1 to 10 copies for HSV-1 with no cross-amplification between herpesviral DNA targets. Nested PCR was required for detection of herpesviral DNA in the abscess specimens, indicating that these viruses were present in low copy number. Filtration of abscess specimens and virus transfer experiments using human fibroblastic MRC-5 cells confirmed the presence of HCMV particles in several abscess specimens. We conclude that herpesviruses are present but not required for the development of acute apical abscesses and cellulitis of endodontic origin.