Jingjie Fan

Epidemiological evidence on the risk of low Apgar score in newborns associated with ambient air pollutants, their joint associations, and sensitive exposure windows is limited. This study aimed to investigate the independent and joint associations between exposure to ambient air pollutants during different pregnancy trimesters and low Apgar score in newborns. Twenty thousand eight hundred ninety-four pregnant women were included in the prospective birth cohort in Shenzhen. Concentrations of PM_2.5, PM₁₀, NO₂, O₃, SO₂, and CO were assessed based on residential addresses of participants. Generalized additive model (GAM) was used to assess the independent associations of air pollutants exposure with low Apgar score, and restricted cubic spline (RCS) model was used to analyze the dose-response trends. Quantile g-computation (Qgcomp) and weighted quantile sum (WQS) regression models were further used to investigate the joint associations and constituent contributions. Second-trimester exposure to PM_2.5, PM₁₀, and NO₂ was associated with an increased risk of low 1-minute Apgar score (PM_2.5: OR = 1.64, 95% CI: 1.10, 2.44; PM₁₀: OR = 1.59, 95% CI: 1.01, 2.50; NO₂: OR = 1.48, 95% CI: 1.11, 1.98, per interquartile range increase). In the mixed-pollutant models, both Qgcomp and WQS models showed that each one-quartile increase in the air pollutant mixture was significantly associated with low 1-minute Apgar score (Qgcomp: OR = 1.48, 95% CI: 1.06, 2.07; WQS: OR = 1.15, 95% CI: 1.09, 1.21). PM_2.5 and NO₂ were the primary contributors to the risk (Qgcomp: 48.0%, 34.5%; WQS: 23.6%, 39.4%). Second-trimester exposure to air pollutants was associated with an increased risk of low 1-minute Apgar score, and PM_2.5 and NO₂ may be the key relative contributors. These findings support the need for further research and increased public health attention to air pollutant exposure during pregnancy to prevent adverse neonatal health outcomes. Not applicable.

Depression is a prevalent mental health condition with a significant global burden, yet its diagnosis remains challenging due to the inherent limitations of conventional assessment tools. The electroencephalography (EEG) could be a potential diagnostic modality of depression. This study aims to evaluate the diagnostic test accuracy of EEG in depression diagnosis. A systematic search was performed in the major academic databases from inception to January 25, 2025. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) checklist was used to assess the bias of all the included studies. Bivariate random-effect models and hierarchical summary receiver operating characteristic (HSROC) curve models were used to illustrate the diagnostic performance. The pooled sensitivity (SEN), specificity (SPE), and the Diagnostic Odds Ratio (DOR) were calculated to evaluate the diagnostic accuracy. Subgroup analyses were conducted to investigate the possible sources of heterogeneity. A total of 18 studies were included, contributing 58 reported results in total. The diagnostic test accuracy of EEG for depression was high across the studies, as the pooled SEN, SPE, and DOR were 0.939 (95% CI: 0.915–0.957), 0.898 (95% CI: 0.840–0.937), and 137.493 (95% CI: 62.383–303.038), respectively. This study shows that EEG has a good application prospect in depression diagnosis, which could provide a definitive and quantitative reference. However, the quality of evidence in this study is affected by factors such as patient selection bias in the original case–control studies, small sample sizes, and unexplained clinical and statistical heterogeneity, so the findings should be interpreted with caution.

Background: Nitrogen dioxide (NO2) and ozone (O3) exposure is associated with alterations in liver function, but epidemiological evidence in pregnant women remains limited, especially regarding the combined effects. This study aimed to investigate the associations of exposure to NO2 and O3 with maternal liver function and their roles in the combined effect of air pollutant mixture.Methods: A birth cohort study with 11,909 pregnant women was conducted in Shenzhen, China. Exposure concentration of air pollutants during the first trimester were assessed based on the residential addresses of the pregnant women. Generalized additive model was used to analyze the association of NO2 and O3 exposure with maternal liver function. Furthermore, quantile G-computation model was used to investigate the combined effects of air pollutant mixture and the contribution of each pollutant.Results: Each 10 µg/m3 increase in first-trimester NO2 exposure was associated with elevated alanine aminotransferase (ALT) and total bilirubin (TBIL) in both the second trimester (ALT: 15.45%, 95% CI: 10.12%, 21.04%; TBIL: 6.69%, 95% CI: 3.75%, 9.72%) and third trimester (ALT: 3.89%, 95% CI: 0.32%, 7.59%; TBIL: 9.27%, 95% CI: 6.52%, 12.10%). For O3, first-trimester exposure showed a positive association with second-trimester TBIL (2.03%, 95% CI: 1.25%, 2.81%), but was inversely associated with third-trimester ALT (−2.73%, 95% CI: −3.86%, −1.58%) and TBIL (−0.81%, 95% CI: −1.45%, −0.17%). These associations remained significant in the two-pollutant model. The Qgcomp analysis revealed that a one-quartile increase in the air pollutant mixture was associated with a 2.05% (95% CI: 0.56%, 3.56%) increase in third-trimester TBIL, with NO2 accounting for 55.6% of the positive weight in the model.Conclusions: First-trimester NO2 exposure was associated with elevated maternal liver function biomarkers in both the second and third trimesters, while O3 showed trimester-dependent associations. Exposure to air pollutant mixture was associated with increased third-trimester TBIL, and NO2 may be the predominant relative contributor. These findings highlight the need for further studies and public health attention to air pollution exposure during pregnancy to protect maternal and fetal health.

Background: Chinese nursing students face mental health challenges, with mindfulness‐based interventions (MBI) commonly utilized to mitigate these issues. Neurofeedback‐assisted MBI (NF‐MBI) might be a promising alternative. Aim: The study aims to explore the short‐ and long‐term effectiveness of the NF‐MBI and MBI in improving mental well‐being among Chinese nursing students. Methods: This three‐armed randomized controlled trial included 147 nursing students in Beijing, China. MBI and NF‐MBI groups completed a 6‐week online MBI, with NF‐MBI adding electroencephalogram‐based neurofeedback. Controls received general mental education. Mental health was evaluated four times at baseline and post‐intervention. Latent growth curve modeling was used to evaluate intervention effects. Results: In the short term, the NF‐MBI group exhibited decreased depression symptoms, anxiety symptoms, fatigue, and increased mindfulness. The MBI group showed increased mindfulness and decreased fatigue compared with the control group. In the long term, the MBI group showed increased depression symptoms, anxiety symptoms and fatigue. The NF‐MBI group observed decreased mindfulness compared with the control group. Conclusions: NF‐MBI and MBI can effectively improve the mental health of nursing students in China, with NF‐MBI performing better in certain indicators. Tailored interventions should be implemented to enhance their mental well‐being. Trial Registration: This study has been registered on the Chinese Clinical Trial Registry (ID: ChiCTR2400080314).

Background: Due to the Air Pollution Prevention and Control Measures issued by the Chinese government, air quality has significantly improved, particularly with respect to PM_2.5. However, studies on the relationship between low concentrations of PM_2.5 and preterm birth (PTB) remain limited in China. Objective: To examine the associations between low concentrations of PM_2.5 and its constituents and PTB. Methods: This retrospective cohort study was conducted from July 2021 to April 2023 in Shenzhen, China. Data on questionnaires and pregnancy outcomes were collected for each participant. Using the Tracking Air Pollution in China (TAP) dataset, we assessed the concentrations of PM_2.5 and its chemical constituents, including sulfate (SO₄ ²⁻), nitrate (NO₃ ⁻), organic matter (OM), black carbon (BC), and ammonium (NH₄ ⁺). We applied a generalized additive model (GAM) to evaluate the relationship. The relationship between exposure to PM_2.5 and its constituents and PTB was further examined using a method that combined dummy variable settings with trend tests. Stratified analysis was conducted to explore the potential factors. Results: Among 17,240 live-born infants, the rate of PTB was 6.0%, and the average exposure concentration of PM_2.5 was 20.24 μg/m³. There were positive associations between PM_2.5 and its constituents and PTB. With each interquartile range (IQR) increase in PM_2.5 during the third trimester, the risk of PTB increased by 2.23 times. The exposure effects of sulfate (SO₄ ²⁻) and organic matter (OM) were comparable to the total PM_2.5. The third trimester might be the critical susceptibility window. The risk was higher among women who conceived in the cold season and were exposed to higher temperatures during pregnancy. Conclusion: Even at low levels, PM_2.5 can still increase the risk of PTB, with varying health effects attributed to different constituents. This underscores the importance of further strengthening environmental management and characterizing the contributions of PM_2.5 sources.

Background: The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear. Objective: This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM2.5], carbon monoxide [CO], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects. Methods: We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children’s medical records. In addition, maternal and child exposures to air pollutants (PM2.5 CO, SO2, NO2, and O3) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model. Results: In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM2.5, CO, SO2, NO2, and O3) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO2 made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively. Conclusions: Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows. Trial Registration: Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n

BACKGROUND The first 1000 days of life, encompassing pregnancy and the first 2 years after birth, represent a critical period for human health development. Despite this significance, there has been limited research into the associations between mixed exposure to air pollutants during this period and the development of asthma/wheezing in children. Furthermore, the finer sensitivity window of exposure during this crucial developmental phase remains unclear. OBJECTIVE This study aims to assess the relationships between prenatal and postnatal exposures to various ambient air pollutants (particulate matter 2.5 [PM2.5], carbon monoxide [CO], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]) and the incidence of childhood asthma/wheezing. In addition, we aimed to pinpoint the potential sensitivity window during which air pollution exerts its effects. METHODS We conducted a prospective birth cohort study wherein pregnant women were recruited during early pregnancy and followed up along with their children. Information regarding maternal and child characteristics was collected through questionnaires during each round of investigation. Diagnosis of asthma/wheezing was obtained from children’s medical records. In addition, maternal and child exposures to air pollutants (PM2.5 CO, SO2, NO2, and O3) were evaluated using a spatiotemporal land use regression model. To estimate the mutual associations of exposure to mixed air pollutants with the risk of asthma/wheezing in children, we used the quantile g-computation model. RESULTS In our study cohort of 3725 children, 392 (10.52%) were diagnosed with asthma/wheezing. After the follow-up period, the mean age of the children was 3.2 (SD 0.8) years, and a total of 14,982 person-years were successfully followed up for all study participants. We found that each quartile increase in exposure to mixed air pollutants (PM2.5, CO, SO2, NO2, and O3) during the second trimester of pregnancy was associated with an adjusted hazard ratio (HR) of 1.24 (95% CI 1.04-1.47). Notably, CO made the largest positive contribution (64.28%) to the mutual effect. After categorizing the exposure according to the embryonic respiratory development stages, we observed that each additional quartile of mixed exposure to air pollutants during the pseudoglandular and canalicular stages was associated with HRs of 1.24 (95% CI 1.03-1.51) and 1.23 (95% CI 1.01-1.51), respectively. Moreover, for the first year and first 2 years after birth, each quartile increment of exposure to mixed air pollutants was associated with HRs of 1.65 (95% CI 1.30-2.10) and 2.53 (95% CI 2.16-2.97), respectively. Notably, SO2 made the largest positive contribution in both phases, accounting for 50.30% and 74.70% of the association, respectively. CONCLUSIONS Exposure to elevated levels of mixed air pollutants during the first 1000 days of life appears to elevate the risk of childhood asthma/wheezing. Specifically, the second trimester, especially during the pseudoglandular and canalicular stages, and the initial 2 years after birth emerge as crucial susceptibility windows. CLINICALTRIAL Chinese Clinical Trial Registry ChiCTR-ROC-17013496; https://tinyurl.com/2ctufw8n

Objectives: The aim of this study was to assess the association between axial length/corneal radius ratio (AL/CR ratio), AL, and refractive status and evaluate the accuracy of AL and AL/CR ratio for myopia assessment among Chinese children.Methods: A diagnostic trial was conducted in Shenzhen Eye Hospital from June 2020 to December 2020. Cycloplegic refraction and demographic characteristic survey were carried out, and AL and CR were measured. The Pearson correlation analysis between AL, AL/CR ratio, and spherical equivalent (SE) was carried out. The sensitivity, specificity, Youden index, positive predictive value, and negative predictive value of the AL/CR ratio and AL for myopia assessment were analyzed using cycloplegic refraction as the gold standard by drawing receiver operating characteristic (ROC) curves.Results: A total of 300 children aged 8–18 years participated in this study. The Pearson correlation coefficient between AL and SE was −0.667 (P < 0.05) and −0.754 (P < 0.05) between AL/CR ratio and SE. There were significant differences in SE, AL, and AL/CR ratio among different age groups (p < 0.05). SE decreased by 1.185 diopter (D) for every 1 mm increase in AL and decreased by 0.667 D for every 0.1 increase in the AL/CR ratio. Taking cycloplegic refraction SE ≤ −0.50 D as the gold standard for the diagnosis of myopia, the area under the ROC curve of AL for myopia assessment was 0.836 (95% confidence interval [CI]: 0.767–0.906), with specificity, sensitivity, and Youden index of 0.833, 0.767, and 0.600, respectively. The area under the ROC curve of AL/CR ratio for myopia assessment was 0.937 (95% CI: 0.878–0.996), with specificity, sensitivity, Youden index, positive predictive value, and negative predictive value of 0.703, 0.913, 0.622, 0.956, and 0.771, respectively. The area under the ROC curve of the combination of AL/CR ratio and parental myopia for myopia assessment was 0.976 (95% CI: 0.957–0.996).Conclusion: The correlation between SE and AL/CR ratio was stronger than that between SE and AL in children. The AL/CR ratio may be an alternative indicator for myopia assessment in children, and the combination of demographic factors and AL/CR ratio can improve the accuracy of myopia assessment.