A critical review of the epidemiological evidence of effects of air pollution on dementia, cognitive function and cognitive decline in adult population

Dementia is arguably the most pressing public health challenge of our age. Since dementia does not have a cure,identifying risk factors that can be controlled has become paramount to reduce the personal, societal and eco-nomic burden of dementia. The relationship between exposure to air pollution and effects on cognitive function,cognitive decline and dementia has stimulated increasing scientific interest in the past few years. This review ofthe literature critically examines the available epidemiological evidence of associations between exposure to am-bient air pollutants, cognitive performance, acceleration of cognitive decline, risk of developing dementia, neuro-imaging and neurological biomarker studies, following Bradford Hill guidelines for causality.The evidence reviewed has been consistent in reporting associations between chronic exposure to air pollutionand reduced global cognition, as well as impairment in specific cognitive domains including visuo-spatial abili-ties. Cognitive decline and dementia incidence have also been consistently associated with exposure to air pollu-tion. The neuro-imaging studies reviewed report associations between exposure to air pollution and whitematter volume reduction. Other reported effects include reduction in gray matter, larger ventricular volume,and smaller corpus callosum. Findings relating to ischemic (white matter hyperintensities/silent cerebralinfarcts) and hemorrhagic (cerebral microbleeds) markers of cerebral small vessel disease have been heteroge-neous, as have observations on hippocampal volume and air pollution. The few studies available on neuro-inflammation tend to report associations with exposure to air pollution. everal effect modifiers have been suggested in the literature, but more replication studies are required. Tradi-tional confounding factors have been controlled or adjusted for in most of the reviewed studies. Additional con-founding factors have also been considered, but the inclusion of these has varied among the different studies.Despite all the efforts to adjust for confounding factors, residual confounding cannot be completely ruled out, es-pecially since the factors affecting cognition and dementia are not yet fully understood.The available evidence meets many of the Bradford Hill guidelines for causality. The reported associations be-tween a range of air pollutants and effects oncognitive function in older people,including the acceleration of cog-nitive decline and the induction of dementia, are likely to be causal in nature.However, the diversity of study designs, air pollutants and endpoints examined precludes the attribution of theseadverse effects to a single class of pollutant and makes meta-analysis inappropriate

Advancement flap in the management of chronic anal fissure: A prospective study

Lateral internal sphincterotomy is the surgical treatment of choice of chronic anal fissure after failure of conservative measures. Several randomized trials identified an overall risk of incontinence of 10 % mostly for flatus. Fissurectomy is the most commonly used procedure to preserve the integrity of the anal sphincters. However, a possible complication is keyhole defect that may lead to faecal soiling. In this study, chronic anal fissure (CAF) was treated by fissurectomy and anal advancement flap to preserve the anatomo-functional integrity of sphincters and to reduce healing time and the risk of anal stenosis. In patients with hypertonia, surgical treatment was combined with chemical sphincterotomy by injection of botulinum toxin to enhance tissue perfusion. Forty eight patients with CAF underwent fissurectomy and anal advancement flap. In 22 subjects with hypertonia of the internal anal sphincter, intrasphincter injection of 30 UI of botulinum toxin at the completion of the surgical operation was used. All patients were followed up to 24 months. Since the first defecation, the intensity and duration of pain were significantly reduced. Two patients had urinary retention, five had infections and three had partial breakdowns. No anal stenosis, keyhole deformity or necrosis flap was recorded. At the 24 months follow-up visit, anal incontinence was similar to those detected preoperatively. Only four recurrences were detected at 18 and 20 months. After medical treatment failure, fissurectomy with advancement flap is a valid sphincter-conserving procedure for treatment of anterior or posterior CAF, regardless of hypertonia of the internal anal sphincter. © 2011 Springer-Verlag

Health effects of climate change (HECC) in the UK: 2023 report. Chapter 4. Impacts of climate change and policy on air pollution and human health

•Air pollution is one of the greatest environmental risks to public health in the UK and is associated with an estimated 29,000 to 43,000 deaths a year. Chapter 4 considers the relationship between climate change and outdoor air pollution and includes new analyses of the health burden from long-term and short-term exposure to air pollution. The chapter was led by expert scientists in the UK Health Security Agency (UKHSA), with contributions from experts in the University of Edinburgh, UK Centre for Ecology and Hydrology and University College London. •Key outdoor air pollutants include particulate matter (PM), nitrogen dioxide (NO2), and ozone (O3). Exposure to these is known to reduce life expectancy and is associated with a range of negative health effects, including respiratory and cardiovascular disease. People who live near busy roads are generally exposed to higher concentrations of air pollution. Some people are more susceptible to the health effects of air pollution including those with pre-existing cardiovascular and respiratory disease, young people, pregnant women, older people and low income communities. •Climate change will have an impact on air pollution. Changes in weather patterns, particularly temperature, rainfall and wind speed, are expected to have an effect on dispersal and concentrations of PM and O3. However, climate change mitigation measures that reduce emissions of greenhouse gases will help reduce air pollutants and lead to improvements in health outcomes. Evidence shows that emissions of air pollutants will be the dominant driver of air pollution concentrations over the coming decades. In this context, the analyses in the chapter focus on air pollutant emissions rather than climate change projections. •Future air quality in the UK will be determined by recent policy announcements and new legislation, such as the Environment Act 2021, the Environmental Improvement Plan 2023, and the Air Quality Strategy (England), the Environment (Air Quality and Soundscapes) (Wales) Bill, Cleaner Air for Scotland 2 strategy and Clean Air strategy for Northern Ireland. In 2018, the UK government published the 25 Year Environment Plan, which set out the framework and vision for reducing emissions of key air pollutants by setting or meeting legally binding targets. •Analysis of the impacts of air quality controls over the next 2 decades indicate that by 2050, exposure to PM2.5 will decrease by between 28% and 36%, and NO2 exposure will decrease by between 35% and 49%, depending on the region. By 2050, annual mortality attributable to the effects of long-term exposure to PM2.5 and NO2 is projected to decrease roughly by between 25% and 37% compared with a 2018 baseline, depending on future demographic change in the UK. Reducing emissions, therefore, results in benefits to population health. However, due to the complex chemistry in the air, as NO2 levels decrease, there can be local increases in O3 in urban centres, which may increase some harms to health. The analyses in the chapter show that annual estimated emergency respiratory hospital admissions associated with short-term Chapter 4. Impacts of climate change and policy on air pollution and human health 3 effects from O3 exposure are projected to increase by between 4% and 12% by 2050 from a 2018 baseline of 60,488, depending on demographic change. •Overall, these projections reflect significant improvements in outdoor air quality and associated reductions in the burden of long-term health impacts arising from recent and upcoming air quality controls, and the greater the efforts to mitigate emissions of air pollutants, the greater the improvement in air quality. •The results presented in the chapter have several implications for public health. Although air pollutant emission controls will reduce concentrations of some air pollutants (such as PM2.5 and NO2), there may be local increases in O3, which may be exacerbated during heatwaves. Therefore, provision of localised alerting and monitoring will become particularly important. Ensuring that public health professionals and other stakeholders have accessible and high quality information to provide health advice and raise awareness will continue to be important. •This chapter highlights several priority research gaps, including the need to: • develop modelling techniques that consider climate-driven changes in both pollutant emissions and meteorology at spatial resolutions sufficient to quantify exposures to improve health impact assessment projections • develop an evidence base estimating the economic benefits associated with improvements in health from air pollution reduction as a result of strategies to tackle climate change • undertake further work to consider the potential combined effects of air pollution and other environment stressors that may be affected by climate change, such as heat and aeroallergens • advance our understanding of how climate change-driven behavioural change could modify personal exposure to air pollution, such as increased time spent outdoors in warmer temperatures •The Department for Environment, Food and Rural Affairs (Defra), Department of Health and Social Care (DHSC) and UKHSA are undertaking a comprehensive review of how to communicate air quality information. The aim is to ensure members of the public, and vulnerable groups in particular, have what they need to protect themselves. UKHSA has also been developing an Air Pollution Exposure Surveillance (APES) vulnerability indicator which aims to indicate areas where population vulnerability to air pollution is elevated

Mediterranean diet and colorectal cancer risk : A pooled analysis of three Italian case-control studies

Background: Adherence to the Mediterranean diet (MD) is associated with a reduced risk of several cancers. However, studies conducted in Mediterranean regions are scanty. Methods: To investigate the relation between MD and colorectal cancer risk in Italy, we pooled data from three case-control studies, including a total of 3745 colorectal cancer cases and 6804 hospital controls. Adherence to the MD was assessed using an a priori Mediterranean Diet Score (MDS), based on nine components. Results: Compared with the lowest adherence to the MD (0-2 MDS), the odds ratio (OR) was 0.52 (95% confidence interval (CI) 0.43-0.62) for the highest adherence (7-9 MDS), with a significant inverse trend in risk (P<0.0001). The OR for a 1-point increment in the MDS was 0.89 (95% CI 0.86-0.91). The inverse association was consistent across studies, cancer anatomical subsites and strata of selected covariates. Conclusions: This Italian study confirms a favourable role of MD on colorectal cancer risk

Intestinal melanoma: A broad spectrum of clinical presentation

INTRODUCTION: Small intestine melanomas are rare and the most of them are metastases from primary cutaneous neoplasms. PRESENTATION OF CASE: Below, we report two cases of small intestine metastatic melanoma with very different clinical presentation. DISCUSSION: Still now, primary versus metastatic origin is often unclear. Small bowel melanoma is often asymptomatic. However, clinical picture can be various; it may occurs with non specific symptoms and signs of gastro-intetstinal involvement, like chronic abdominal pain, occult or gross bleeding and weight loss, or with an emergency picture due to intestinal intussusception, obstruction or, rarely, perforation. CONCLUSION: Small bowel melanoma is rare and the diagnosis done late. Imaging techniques are recommended in order to obtain early diagnosis of gastrointestinal metastases