Prenatal and postnatal exposure to Bisphenol A and Asthma: a systemic review and meta-analysis

BackgroundBisphenol A (BPA) is a plasticizer with high production and ubiquitous usage in polycarbonate plastics and epoxy resins. The association between prenatal or postnatal exposure to BPA and childhood wheeze/asthma has not been well established. Our study aimed to provide further justification for the current studies.MethodsStudies were searched from PubMed, Web of Science, Scopus and Embase from inception until Sep 15, 2020. Meta-analysis was performed to calculate pooled adjusted odds ratios (aOR). The methodological quality of included studies was assessed by using the Newcastle Ottawa Scale (NOS).ResultsOf 2,814 screened articles, 9 studies with 3,885 participants were included in the final analysis. When all studies were pooled, postnatal exposure to BPA was associated with a higher risk of childhood asthma (aOR =1.43; 95% CI: 1.28–1.59) or childhood wheeze (aOR =1.38; 95% CI: 1.18–1.62). Prenatal exposure to BPA had a small but significant increased risk of childhood asthma (aOR =1.17; 95% CI: 1.01–1.34). An increased risk of childhood wheeze was related to prenatal exposure to BPA at 16 weeks’ gestation (aOR =1.29; 95% CI: 1.07–1.55), but not at 26 weeks’ gestation (aOR =1.07; 95% CI: 0.88–1.29) nor at random-time gestation (aOR =1.02; 95% CI: 0.89–1.16).ConclusionsPrenatal and postnatal exposure to BPA was related to an increased risk of childhood asthma. However, only postnatal and early gestational exposure (at 16 weeks) to BPA could induce the risk of childhood wheeze, but not late gestational exposure (at 26 weeks).     

Urinary Bisphenol A Levels in Girls with Idiopathic Central Precocious Puberty

Ob­jec­ti­ve: Bisphenol A (BPA) is an industrial chemical, particularly used to harden plastics. BPA is thought to have negative health effects on both laboratory animals and humans. Consider ing the decline in age of onset of puberty noted in recent years, particularly among girls, the importance of BPA as an estrogenic endocrine disruptor has increased. In this study, we aimed to determine urinary BPA levels in girls with idiopathic central precocious puberty (ICPP).Methods: Non-obese girls newly diagnosed with ICPP (n=28, age 4-8 years) constituted the study group. The control group consisted of 25 healthy age-matched girls with no history of ICPP or any other endocrine disorder. Urinary BPA levels were measured by using high-performance liquid chromatography.Results: In the ICPP group, urinary BPA levels were significantly higher compared to the control group [median 8.34 (0.84-67.35) μg/g creatinine and 1.62 (0.3-25.79) μg/g creatinine, respectively (OR=8.68, 95% CI:2.03-32.72, p=0.001)]. There was no marked correlation between urinary BPA levels and body mass index in either group. In the ICPP group, no significant correlations were found between urinary BPA levels and serum luteinizing hormone, follicle-stimulating hormone and estradiol levels.Conclusions: To our knowledge, this is the first study evaluating the urinary BPA levels in Turkish girls with ICPP. Our results indicate that the estrogenic effects of BPA may be an etiologic factor in ICPP.     

Bisphenol A acts differently from and independently of thyroid hormone in suppressing thyrotropin release from the bullfrog pituitary

The objective of this investigation was to ascertain whether bisphenol A (BPA), which has a structural resemblance to thyroid hormone (TH), acts as a TH agonist or antagonist in terms of affecting the release of thyrotropin (TSH). To this end, we exposed adult bullfrog (Rana catesbeiana) pituitary cells to BPA and/or TH in the presence or absence of corticotropin-releasing factor (CRF), which is known to have a potent TSH-releasing activity in amphibians. BPA (10(-9)-10(-4)M) did not affect the basal release of TSH. However, it suppressed CRF-inducible TSH release at 10(-4)M, but not at 10(-5)M. Triiodothyronine (T(3)) at 10(-7)M and l-thyroxine (T(4)) at 10(-6)M also suppressed the CRF-inducible release of TSH. The combination of T(3) (10(-7)M) or T(4) (10(-6)M) with BPA (10(-4)M) had an additive effect in suppressing TSH release. A comparison of the suppressive effects of BPA and T(3) on the release of TSH following the addition of actinomycin D or cycloheximide to the culture medium revealed that both of the latter compounds blocked T(3)-inducible but not BPA-inducible suppression of TSH release. The results indicate that the mechanism of action of BPA is different from that of T(3) in that T(3) action involves RNA and protein synthesis, whereas BPA action does not involve either of these processes. Furthermore, BPA was found to suppress the thyrotropin-releasing hormone-inducible release of both prolactin (PRL) and TSH. Our results suggest that BPA acts not only as a blocker of TSH secretagogues but also as a blocker of a PRL secretagogue at the pituitary level. Estradiol affected neither the release of TSH nor the release of PRL in the presence or absence of their secretagogues, suggesting that the suppression of the release of TSH and PRL caused by BPA may not be derived from its estrogenic activity.     

Association of Bisphenol A Exposure With Hypertension and Early Macrovascular Diseases in Chinese Adults: A Cross-Sectional Study

Bisphenol A (BPA) is an environmental endocrine disruptor that has been associated with cardiovascular outcomes in previous observational studies. We aimed to examine the relationships of urinary BPA levels with hypertension and early macrovascular diseases.This is a cross-sectional study. From June through August 2009, 3246 participants ages 40 years or older were enrolled from Baoshan District, Shanghai, China. Logistic regression modes were used to estimate the odds ratios (ORs) for prevalent risk of hypertension, elevated carotid intima-media thickness (CIMT), arterial stiffness, and peripheral artery disease (PAD) with multivariable adjustment. We also performed stratification analysis by age and sex.The median (interquartile range) for BPA was 0.81 (0.48, 1.45) ng/mL, which is notably lower than previously reported in the United States and other Western countries. Urinary BPA concentrations were negatively associated with hypertension (multivariable-adjusted OR for the highest versus lowest BPA quartile = 0.61; 95% confidence interval [CI]: 0.46, 0.80), elevated CIMT (OR = 0.64; 95% CI: 0.47, 0.87), and arterial stiffness (OR = 0.62; 95% CI: 0.44, 0.87). The corresponding OR for PAD (60 cases total) was not significant (OR = 0.89; 95% CI: 0.28, 2.80). The negative associations of BPA with hypertension, elevated CIMT, and arterial stiffness were consistent by age and sex stratifications, and were stronger among participants ≥60 versus <60 years of age, and among women than men.In contrast with previous investigations, our study suggests negative associations of BPA exposure with hypertension and early macrovascular diseases among middle-aged and elderly Chinese. Future investigations are needed to draw more definite conclusions and generalize to other populations.     

Diaphragmatic Thickness and Excursion in Preterm Infants With Bronchopulmonary Dysplasia Compared With Term or Near Term Infants: A Prospective Observational Study

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Granulomatous mastitis in multiparae during pregnancy and lactation: Observational study (STROBE compliant)

The incidence of granulomatous mastitis (GLM) in multiparae as seriously affected the quality of life and breastfeeding of pregnant women after delivery, but the treatment is rarely reported. In this article, the development, healing, and lactation of 13 cases were reported and a retrospective analysis was performed. 10 cases of GLM were treated at the Breast Disease Prevention and Treatment Center of Haidian Maternal & Child Health Hospital of Beijing and 3 cases of GLM were treated in the Breast Department of Weihai Municipal Hospital of Shandong province from February 2017 to May 2019.Among the 13 patients, conservative symptomatic treatment was adopted during pregnancy and lactation: anti-infective therapy consisting of oral cephalosporin antibiotic for patients; ultrasound-guided puncture and drainage of pus or incision and drainage after abscess formation. Observation continued during the sinus tract phase. Postpartum breastfeeding was encouraged, especially on the affected side. In this study, the median healing time was 20 months and the average healing time was 30.4 months in 5 healthy breast lactation cases. In 8 cases of bilateral breast lactation, the median healing time was 30 months and the average healing time was 26.5 months. Linear regression test analysis: whether the affected breast was breast-fed after delivery had no effect on the postpartum wound healing time, P = .792. The wounds of 13 patients healed well after lactation, and none of them recurred since the last follow-up visit. There were no adverse events in all infants.Conservative symptomatic treatment for GLM of multiparous women during pregnancy and lactation and encouraging breastfeeding after delivery have no effect on infant health and the recovery time of patients.     

Phosphatidylethanol as Blood Biomarker of Alcohol Consumption in Early Pregnancy: An Observational Study in 4,067 Pregnant Women

Background

The teratogenic effects of alcohol are well documented, but there is a lack of screening methods to detect alcohol use during pregnancy. Phosphatidylethanol 16:0/18:1 (PEth) is a specific and sensitive biomarker reflecting alcohol intake up to several weeks after consumption. The aim of this study was to investigate the prevalence of positive PEth values as an indicator of early prenatal alcohol exposure in a general population of pregnant women.

Methods

Rhesus typing is routinely performed in Norway in all pregnancies around gestational week 12. Rhesus-negative women have an additional test taken around week 24. Blood samples submitted to St. Olav University Hospital in Trøndelag, Norway, for Rhesus typing during the period September 2017 to October 2018 were collected. A total of 4,533 whole blood samples from 4,067 women were analyzed for PEth (limit of quantification of 0.003 µM).

Results

Fifty-eight women had a positive PEth sample. Of these, 50 women were positive around gestational week 12, 3 women were positive around week 24, and in 5 cases, the timing was unknown. There were no significant differences in proportions of women with positive PEth values related to age, or rural versus urban residency.

Conclusion

In an unselected pregnant population in Norway, 1.4% had a positive PEth sample around gestational week 12, whereas 0.4% had a positive sample around week 24. The use of PEth as an alcohol biomarker should be further investigated as a diagnostic tool in the antenatal setting.

     

SARS-CoV-2 Vaccine Willingness among Pregnant and Breastfeeding Women during the First Pandemic Wave: A Cross-Sectional Study in Switzerland

As pregnant women are at high risk of severe SARS-CoV-2 infection and COVID-19 vaccines are available in Switzerland, this study aimed to assess the willingness of Swiss pregnant and breastfeeding women to become vaccinated. Through a cross-sectional online study conducted after the first pandemic wave, vaccination practices and willingness to become vaccinated against SARS-CoV-2 if a vaccine was available were evaluated through binary, multi-choice, and open-ended questions. Factors associated with vaccine willingness were evaluated through univariable and multivariable analysis. A total of 1551 women responded to questions related to the primary outcome. Only 29.7% (153/515) of pregnant and 38.6% (400/1036) of breastfeeding women were willing to get vaccinated against SARS-CoV-2 if a vaccine had been available during the first wave. Positive predictors associated with SARS-CoV-2 vaccine acceptance were an age older than 40 years, a higher educational level, history of influenza vaccination within the previous year, having an obstetrician as the primary healthcare practitioner, and being in their third trimester of pregnancy. After the first pandemic wave, Switzerland had a low SARS-CoV-2 vaccination acceptance rate, emphasizing the need to identify and reduce barriers for immunization in pregnant and breastfeeding women, particularly among the youngest and those with a lower educational level.     

Endotoxin Exposure and Childhood Wheeze and Asthma: A Meta-Analysis of Observational Studies

Background. Exposure to endotoxin has been widely investigated as a potential factor for asthma and associated symptoms in children with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of endotoxin exposure with wheeze and asthma in children. Methods. A search for relevant studies and reviews was conducted in MEDLINE, Highwire, CINAHL, and The Cochrane Library databases. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for endotoxin exposure and wheeze or asthma were retrieved and pooled to generate summary effect estimates in STATA 11.1. Results. Nineteen studies were included in the meta-analysis. The summary estimates suggested that endotoxin was positively associated with wheeze in infants and toddlers (meta-OR: 1.48, 95% CI: 1.10–1.98), but negatively related to asthma in school-aged children (meta-OR: 0.82, 95% CI: 0.69–0.97 for endotoxin concentration and 0.68, 95% CI: 0.50–0.93 for endotoxin load). Conclusions. Based on the studies evaluated, endotoxin is a risk factor for wheeze in younger children, but a protective factor for asthma in older children. Thus, this study supports the “hygiene hypothesis.”     

Serum Bisphenol A is an independent risk factor of hyperuricemia: A 6-year prospective study

Objective

This study aims to evaluate whether serum Bisphenol A (BPA) is a risk factor for hyperuricemia.

A New Paradigm in Gallstones Diseases and Marked Elevation of Transaminases: An Observational Study

Background. In clinical practice, it is assumed that a severe rise in transaminases is caused by ischemic, viral or toxic hepatitis. Nevertheless, cases of biliary obstruction have increasingly been associated with significant hypertransaminemia. With this study, we sought to determine the true etiology of marked rise in transaminases levels, in the context of an emergency department.Material and methods. We retrospectively identified all patients admitted to the emergency unit at Centro Hospitalar e Universitário de Coimbra between 1st January 2010 and 31st December 2010, displaying an increase of at least one of the transaminases by more than 15 times. All patient records were analyzed in order to determine the cause of hypertransaminemia.Results. We analyzed 273 patients – 146 males, mean age 65.1 ± 19.4 years. The most frequently etiology found for marked hypertransaminemia was pancreaticobiliary acute disease (n = 142;39.4%), mostly lithiasic (n = 113;79.6%), followed by malignancy (n = 74;20.6%), ischemic hepatitis (n = 61;17.0%), acute primary hepatocellular disease (n = 50;13.9%) and muscle damage (n = 23;6.4%). We were not able to determine a diagnosis for 10 cases. There were 27 cases of recurrence in the lithiasic pancreaticobiliary pathology group. Recurrence was more frequent in the group of patients who had not been submitted to early cholecystectomy after the first episode of biliary obstruction (p = 0.014). The etiology of hypertransaminemia varied according to age, cholestasis and glutamic-pyruvic transaminase values.Conclusion. Pancreaticobiliary lithiasis is the main cause of marked hypertransaminemia. Hence, it must be considered when dealing with such situations. Not performing cholecystectomy early on, after the first episode of biliary obstruction, may lead to recurrence.     

Perinatal exposure to earthquake stress increases the risks of hypertension and diabetes in subsequent adult life: A cross‐sectional study

The objective of the current study was to determine whether exposure to earthquake stress during pregnancy and infancy impacted on the risk of chronic adult health problems. All subjects were divided into three groups: the infant exposure group, the fetus exposure group, and the non‐exposure group. All subjects completed a standardized interview that included questions on demographic information, traumatic experiences during the earthquake, Anthropomorphic parameters such as body height, weight, and blood pressure were measured. Traumatic events in childhood and adulthood were assessed by the Childhood Trauma Questionnaire (CTQ) and Life Event Scale (LES), respectively. Totally1325 subjects were included; 399 subjects experienced the earthquake as fetuses, 374 subjects who experienced the earthquake as infants and 552 subjects did not experience the earthquake. The three groups were comparable in sociodemographic and baseline characteristics except age (Infant exposure vs Prenatal exposure vs No exposure = 39.5 ± 0.6 vs 38.5 ± 0.8 vs 37.5 ± 0.9, p < .001). Fetal and infant exposure to earthquakes was associated with elevated systolic blood pressure (both were + 3 mm Hg, p < .001). After adjustment for covariates, earthquake exposure in infants (odds ratio [OR] = 2.010, 95% confidence interval [CI] = 1.216 ~ 3.322) and fetuses (OR = 1.509, 95% CI = 1.014 ~ 2.248) was a significant and independent risk factor for hypertension. Earthquake expose in fetuses was a significant and independent risk factor for diabetes (OR = 2.307, 95% CI = 1.136 ~ 4.686). Earthquake exposure in infants and fetuses is a significant and independent risk factor for hypertension. Earthquake exposure in fetuses is significant and independent risk factor for diabetes.     

Leukocytosis and Tobacco Use: An Observational Study of Asymptomatic Leukocytosis

PurposeThis study aimed to characterize the white blood cell differential of tobacco smoking-induced leukocytosis and describe the longitudinal impact of smoking cessation on this peripheral blood abnormality.MethodsMedical records of patients undergoing evaluation by hematologists for persistent leukocytosis were reviewed. Patients in whom leukocytosis was determined to be secondary to tobacco use after exclusion of other causes were identified. Demographic and laboratory data were collected at time of diagnosis. Patients were longitudinally followed and information regarding smoking cessation and follow-up white blood cell values were recorded.ResultsForty patients were determined to have smoking-induced leukocytosis. The median age was 49.5 years (range: 28-75 years), 24 patients were female, and the mean body mass index (BMI) was 31.5 kg/m². The mean white blood cell count was 13.3 × 10⁹/L (range: 9.8-20.9 × 10⁹/L); 39 patients had absolute neutrophilia (98%), 21 had lymphocytosis (53%), 20 had monocytosis (50%), and 19 had basophilia (48%). During follow-up, 11 patients either quit (n = 9) or reduced (n = 2) tobacco use. Reduction in tobacco smoking led to a significant decrease in mean white blood cell count (13.2 × 10⁹/L vs 11.1 × 10⁹/L, P = 0.02). The median time to decrease in white blood cell count following reduction in tobacco use was 8 weeks (range: 2-49 weeks).ConclusionsTobacco-induced leukocytosis was characterized by a mild elevation in total white blood cell count and was most commonly associated with neutrophilia, lymphocytosis, monocytosis, and basophilia. Cessation of smoking led to improvement in leukocytosis. Tobacco history should be elicited from all patients presenting with leukocytosis to limit unnecessary diagnostic testing, and counseling regarding smoking cessation should be offered.     

Systematic Evaluation of Vascular Access by Color‐Doppler Ultrasound Decreased the Incidence of Emergent Vascular Access Intervention Therapy and X‐Ray Exposure Time: A Single‐Center Observational Study

Arteriovenous fistula has superior patency over other accesses, but vascular access intervention therapy (VAIVT) for stenosis or thrombosis still remain major reasons for hospital admission of dialysis patients. The aim of this study was to examine the usefulness of systematic evaluation of vascular access by color‐Doppler ultrasound (CDUS). This study was a single‐center observational design study. We planned screening CDUS to evaluate all vascular accesses once per year, and additionally, follow‐up CDUS of post‐interventional patients 1 month, 3 months and 6 months after their recent VAIVT. This systematic evaluation was started from September 2009. The observational period between September 2008 and August 2009 was defined as period A. The observational period between September 2009 and August 2010 was defined as period B. We compared the incidence of emergent VAIVT and X‐ray exposure time during the period A to B. 131 patients with AV fistula were assigned. 13 patients were excluded due to death, hospital transfer or re‐operation of their accesses. During period A, 57 VAIVTs were carried out, and 37 cases (65%) were emergent. During period B, 42 VAIVTs were carried out, and 11 cases (25%) were emergent. The incidence of emergent intervention therapy was lower during period B than period A (P < 0.001). The amount of X‐ray exposure time per patient was decreased in patients who received VAIVT during both periods (P < 0.03). Systematic evaluation of vascular access by CDUS decreased the incidence of emergent VAIVT and X‐ray exposure time.