The purpose of this study was to evaluate the effect of hearing aids on body balance function in a strictly controlled auditory environment.We recorded the findings of 10 experienced hearing aid users and 10 normal-hearing participants. All the participants were assessed using posturography under eight conditions in an acoustically shielded non-reverberant room: (1) eyes open with sound stimuli, with and without foam rubber, (2) eyes closed with sound stimuli, with and without foam rubber, (3) eyes open without sound stimuli, with and without foam rubber, and (4) eyes closed without sound stimuli, with and without foam rubber.p = 0.02). The maximum displacement of the center-of-pressure in the mediolateral axis improved with the auditory cues in the normal-hearing participants in the eyes closed condition . In the hearing aid users, this difference was not significant . The maximum displacement of the center-of-pressure in the anteroposterior axis improved in both the hearing aid users and the normal-hearing participants.The auditory cue improved the total path area and sway velocity in both the hearing aid users and normal-hearing participants. The analysis of variance showed that the interaction among eye condition, sound condition, and between-group factor was significant in the maximum displacement of the center-of-pressure in the mediolateral axis (F  = 6.19,  Body balance is maintained by multiple sensory systems, including the vestibular, visual, and proprioceptive systems. These systems deteriorate with age, resulting in persistent dizziness or instability. Balance dysfunction is a risk factor for falls, and is closely associated with multifaceted symptoms of frailty. Despite the high frequency and clinical importance of impaired balance functions, they are imperceptible to others and are easily underestimated. In addition, balance deficiency has no standard treatment besides rehabilitation.Recently, hearing compensation has been reported to improve the balance function; however, the benefits of hearing compensation on the balance function are still controversial ,2. RumalOne of the reasons for this discrepancy is the uncontrolled sound conditions in these studies. Auditory space perception is thought to contribute the body balance improvement. Auditory space perception is influenced by multiple factors, including the spectrum and azimuth. In addition, the echoic sound disrupts the auditory space recognition, which suggests that the control of reverberation decreases the heterogeneity of the effect of auditory cues on body balance. Only a limited number of studies have reported the reverberation properties of the examination environment ,9. PreciIn this study, we investigated the body balance function of HA users in an anechoic, sound-shielded room using posturography to clarify the effect of hearing compensation.We evaluated 10 hearing-loss patients with HAs on both sides. They were recruited at the Iwate Medical University . All the participants had been using HAs for more than 1 year . None of them showed abnormalities in vestibular test including vestibulo-ocular reflex test and head impulse test. Ten normal-hearing paid volunteers  with no history of neurological or muscular diseases and who showed normal hearing threshold were recruited as controls.All participants provided written informed consent, and the study protocol was approved by the Ethics Committee of Iwate Medical University (MH2019-158), in accordance with the Declaration of Helsinki.All the participants were assessed using posturography  in an anechoic room. All the participants were required to stand on a flat platform with their feet close together for 60 s. The medial surfaces of the toes and calcanei were aligned to the centerline of the platform. HA users wore their own HA during the experiment. The force transducers embedded in the platform continuously measured the displacement of the center-of-foot pressure (COP) with a sampling frequency of 20 Hz. The COP is approximately the same as the position of the center of gravity while standing still.In the HA users, the posturographic measurements were conducted under eight conditions: (1) eyes open on a foam pad, with and without HA, (2) eyes closed on a foam pad, with and without HA, (3) eyes open on a rigid surface, with and without HA, and (4) eyes closed on a rigid surface, with and without HA. The normal-hearing participants underwent a similar measurement with and without sound, instead of with and without HAs. The sequence of the eight conditions was counterbalanced among the participants. In conditions with sound stimuli, white noise (70 dBA at the position of the head center of each participant) was delivered from a loud speaker  placed 1 m anterior to the participants at their ear level. The position of the speaker was adjusted using a laser level  and a laser rangefinder . All the measurements were conducted in an anechoic room constructed by the Wakabayashi Acoustic Design Corporation . The size of the room was 5,400 mm (width) x 4,800 mm (length) x 3,000 mm (height). The ambient noise level was less than 15 dBA between 125 and 16,000 Hz. At the center of this room, the free-field decay of sound from a point source was verified to follow the inverse square law between 250 and 8,000 Hz. These were measured using a microphone, a preamplifier, and a measuring amplifier, calibrated with an acoustic calibrator .The total path area and the average sway velocity were examined by three-way repeated measures and mixed factorial analyses of variance (ANOVA) with a within-group factor of eye conditions (eyes open/eyes closed), sound conditions (with sound/without sound), and a foam condition (with foam/without foam), and a between-group factor . The total path area and the averaged velocity were further analyzed in the mediolateral (ML) and anteroposterior (AP) axes using the maximum displacement of the COP and the averaged velocity in the ML and AP axes. In addition, the same analysis was conducted in the HA users only using three-way repeated measures ANOVA to clarify the effect of HAs.p < 0.05. All the analyses were conducted using SPSS software .Post-hoc pairwise comparison with Bonferroni adjustment was conducted when the interaction among the conditions was significant. Statistical significance was set at The demographic data of the participants are summarized in p = 0.02), between sound condition and eye condition , and between eye and foam conditions . The pair-wise post-hoc analysis revealed that the sound significantly decreased the total area in the condition with foam  and in the condition with eyes closed . There were no significant differences between the HA users and normal-hearing participants.The ANOVA showed a significant interaction between the sound condition and foam condition .The analysis in HA users showed that the HAs decreased the total path area (10.95 cmp = 0.02). The pair-wise post-hoc analysis revealed that the sound decreased the maximum COP displacement in the ML axis of the normal-hearing participants in eyes closed condition . In HA users, this difference was not significant  . The interaction between foam condition and eye condition was also significant  = 167.32, p < 0.01).The ANOVA showed that the interaction among the eye condition, sound condition, and between-group factor was significant  . In the p = 0.37).The analysis in HA users showed that the HAs did not change the maximum COP displacement in the ML axis  = 0.88, p <0.01).In hearing aid users, the maximum displacement of the center of pressure did not change in the with and without sound conditions . In normThe COP is the center of pressure. The dashed line indicates a condition with a foam surface, and the rigid line indicates a condition with a rigid surface.p = 0.01) and a significant interaction between eye condition and foam condition  = 70.88, p < 0.01). The pair-wise post-hoc analysis revealed that the sound decreased the maximum COP displacement in the AP axis . There were no significant differences between the HA users and normal-hearing participants.The ANOVA showed a significant main effect of sound condition  = 7.95, p = 0.01).The analysis in HA users showed that the HAs decreased the maximum COP displacement in the AP axis  = 9.86, p < 0.01) and a significant interaction between the eye condition and foam condition  = 74.75, p < 0.01). The pairwise post-hoc analysis revealed that the sound decreased the average sway velocity . There were no significant differences between the HA users and normal-hearing participants.The ANOVA showed a significant main effect of sound condition  = 9.06, p = 0.02).The analysis in HA users showed that the HAs decreased the averaged sway velocity  = 8.51, p = 0.02) and a significant interaction between the eye condition and foam condition  = 66.08, p < 0.01). The pair-wise post-hoc analysis revealed that the sound decreased the averaged sway velocity in the ML axis . There were no significant differences between the HA users and normal-hearing participants.The ANOVA showed a significant main effect of sound condition  = 6.53, p = 0.03)  .In the hearing aid users, the average sway velocity in the mediolateral direction decreased in the group with sound condition. This change was statistically significant.The dashed line indicates a condition with a foam surface, and the rigid line indicates a condition with a rigid surface.p < 0.01). There were no significant differences between the HA users and normal-hearing participants.The ANOVA showed a significant main effect of sound condition  = 10.44, P < 0.01) and a significant interaction between the eye condition and foam condition  = 94.10, P < 0.01). The pair-wise post-hoc analysis revealed that the sound decreased the average sway velocity in the AP axis .The analysis in the HA users showed that the HAs decreased the averaged sway velocity in the AP axis . 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #1: YesReviewer #2: Yes**********5. Review Comments to the AuthorPlease use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #1: The study is interesting but it has some limitations such as small number of participants that authors mentioned. All of the normal hearing cases were female. why did the authors choose just females for normal hearing group?in table 2, its better to add "p values" in the table. Although the authors found significant difference in posturography values but they did not evaluate the balance status by other tests to show its "clinical importance". The figures are difficult to interpret. By the way the study is interesting for me.Reviewer #2: Please give more details for auditory distance perception , make sure that no other dual publication for this paper not occurred , you must follow the research ethical rules for privacy and honesty for patients**********what does this mean?). If published, this will include your full peer review and any attached files.6. PLOS authors have the option to publish the peer review history of their article  digital diagnostic tool,  23 Sep 2021Dear Professor Alimohamad Asghari and Professor Salwa Mahmoud,Thank you for positive and constructive comments. We revised the paper according to your recommendation.Reviewer #1: The study is interesting but it has some limitations such as small number of participants that authors mentioned. 1) All of the normal hearing cases were female. why did the authors choose just females for normal hearing group?Answer.Thank you for the suggestion. We recruited normal participants regardless of the gender. Most of the attendee were unexpectedly female. In addition, all the attended males did not fulfil our inclusion criteria (mainly high pure tone threshold). The following descriptions were added.L288“Second, the normal participants in the present study were all female. We recruited normal-hearing paid volunteers regardless of the gender. Most of the attendee were female, and none of the male attendees met the inclusion criteria. This may be due to the high prevalence of age-related hearing loss in men (18). Recent posturographic study showed that the gender difference was statistically significant (19). Despite that, females are known to be more prone to falls than males. It may be preferable to recruit gender-matched control participants in further studies.”2) In table 2, it is better to add "p values" in the table.Answer.We made the table according to the previous report . As the reviewer #1 suggested, it is better to include the result of statistics in the table. The problem is that we used three-way repeated measures and mixed factorial ANOVA. We like this procedure, but it is not easy to include the results of ANOVA in the table. The following is a reformatted table that include the results of ANOVA. This table is informative but I feel it too busy. I like the original table, but am ready to use the reformatted table if the reviewer like the new one.  HA users NH participants Mean (SEM) Mean (SEM) Sound(+) Sound(-) Sound(+) Sound(-)Total AreaSignificant interaction between the sound condition and foam condition , between sound condition and eye condition , and between eye and foam conditions  Eyes open-Rigid surface 3.04(0.87) 2.98(0.96) 2.21(0.30) 1.97(0.27) Eyes open-Foam surface 5.41(1.44) 5.76(1.35) 4.79(0.66) 5.56(0.63) Eyes closed-Rigid surface 5.48(1.04) 6.11(1.20) 4.09(0.69) 4.52(0.43) Eyes closed-Foam surface 25.47(3.73) 28.94(3.58) 18.66(1.65) 21.90(1.61)Maximum displacement, MLSignificant interaction among the eye condition, sound condition, and between-group factor  Eyes open-Rigid surface 2.25(0.33) 2.31(0.32) 1.98(0.18) 1.88(0.17) Eyes open-Foam surface 3.06(0.39) 3.24(0.50) 2.78(0.16) 3.27(0.19) Eyes closed-Rigid surface 3.62(0.36) 3.59(0.42) 2.80(0.29) 3.40(0.20) Eyes closed-Foam surface 7.83(0.49) 8.12(0.60) 6.54(0.41) 7.48(0.33)Maximum displacement, APSignificant main effect of sound condition  = 7.95, p = 0.01) and a significant interaction between eye condition and foam condition  =70.88, p < 0.01) Eyes open-Rigid surface 2.80(0.40) 2.79(0.52) 2.65(0.23) 2.41(0.16) Eyes open-Foam surface 3.76(0.40) 3.78(0.31) 3.69(0.36) 4.34(0.34) Eyes closed-Rigid surface 3.46(0.35) 3.66(0.37) 3.21(0.32) 3.32(0.22) Eyes closed-Foam surface 7.01(0.50) 7.88(0.58) 6.83(0.33) 6.99(0.54)Sway VelocitySignificant main effect of sound condition  = 9.06, p < 0.01) and a significant interaction between the eye condition and foam condition  =74.75, p < 0.01) Eyes open-Rigid surface 1.48(0.23) 1.73(0.30) 1.11(0.07) 1.11(0.08) Eyes open-Foam surface 2.29(0.35) 2.35(0.25) 2.08(0.11) 2.21(0.15) Eyes closed-Rigid surface 2.43(0.24) 2.55(0.20) 1.80(0.16) 2.01(0.19) Eyes closed-Foam surface 6.52(0.80) 6.93(0.80) 5.10(0.55) 5.27(0.30)Velocity, MLSignificant main effect of sound condition  = 6.53, p = 0.02) and a significant interaction between the eye condition and foam condition  =66.08, p < 0.01) Eyes open-Rigid surface 0.80(0.11) 0.94(0.14) 0.62(0.05) 0.64(0.05) Eyes open-Foam surface 1.21(0.17) 1.27(0.14) 1.12(0.05) 1.18(0.06) Eyes closed-Rigid surface 1.35(0.14) 1.43(0.15) 1.00(0.09) 1.23(0.12) Eyes closed-Foam surface 3.32(0.42) 3.61(0.43) 2.91(0.33) 2.92(0.14)Velocity, APSignificant main effect of sound condition  = 10.44, P < 0.01) and a significant interaction between the eye condition and foam condition  =94.10, P < 0.01) Eyes open-Rigid surface 0.80(0.15) 0.94(0.20) 0.62(0.05) 0.61(0.05) Eyes open-Foam surface 1.22(0.20) 1.25(0.08) 1.19(0.07) 1.28(0.11) Eyes closed-Rigid surface 1.31(0.16) 1.36(0.10) 1.02(0.11) 1.01(0.10) Eyes closed-Foam surface 3.51(0.38) 3.66(0.37) 2.80(0.18) 2.95(.019)3) Although the authors found significant difference in posturography values but they did not evaluate the balance status by other tests to show its "clinical importance". Answer.Thank you for the advice. I agree with the referee that it is better to include participants with vestibulopathy. We tested the participants with vestibulo-ocular reflex test and head impulse test to exclude severe vestibulopathy, as was conducted in the previous study . However, we found that participants with vestibulopathy cannot complete the experiment with foam surface . Based on this finding, we conducted the present study only in those with normal vestibular functions.The following descriptions were added.L79“None of them showed abnormalities in vestibular test including vestibulo-ocular reflex test and head impulse test.”L294“All the participants were of normal vestibular function. Further studies exploring dynamic and reverberant conditions and vestibulopathy participants are warranted.”4) The figures are difficult to interpret. Answer.In this study, we used three-way repeated measures and mixed factorial ANOVA. The figures were made to represent the results of the statistics. The figures can be made simple if we use the average and SEM, but it will reduce the individual information. We made the figures so as not to delete the raw data. In addition, we can compare the velocity and displacement in hearing aid users with eyes closed  and left column of Fig 2).I will appreciate it if the reviewers accept the figures in the present form. Reviewer #2: 1) Please give more details for auditory distance perception Answer.Thank you for the advice. We add more detail about the auditory distance perception.L286“Second, the normal participants in the present study were all female. We recruited normal-hearing paid volunteers regardless of the gender. Most of the attendee were female, and none of the male attendees met the inclusion criteria. This may be due to the high prevalence of age-related hearing loss in men (18). Recent posturographic study showed that the gender difference was not statistically significant (19). Despite that, females are known to be more prone to falls than males. It may be preferable to recruit gender-matched control participants in further studies.”2) Make sure that no other dual publication for this paper not occurredAnswer.I confirm that no other dual publication for this paper occurred.3) You must follow the research ethical rules for privacy and honesty for patientsAnswer.This study was conducted in accordance with the Declaration of Helsinki. All the identifying information were removed from the analyzed data.AttachmentResponse to Reviewers.docxSubmitted filename: Click here for additional data file. 1 Oct 2021Effect of hearing aids on body balance function in non-reverberant condition: A posturographic studyPONE-D-21-23190R1Dear Dr. Hiraumi,We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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There is growing evidence suggesting that air pollution may act as an important environmental risk factor in the development and aggravation of childhood atopic dermatitis (AD).We collected data from the Taiwan National Health Insurance (NHI) research database and linked the data to the Taiwan Air Quality-Monitoring Database. From January 1, 2000 to December 31, 2012; children aged below 18 years were selected from the database and followed longitudinally until the diagnosis of AD, withdrawal from the NHI, or December 31, 2012. Children with missing data or those diagnosed with AD before enrolment in this study were excluded. We measured the incidence rate and hazard ratios (HRs) for AD and stratified them by quartiles (Q1–Q4) of air pollutant concentration. Multivariable Cox proportional hazards models were also applied by adjusting for age, sex, monthly income, and level of urbanization.4) from 1.65  to 10.6 (95% CI: 5.85–7.07), from 1.14 (95% CI: 1.06–1.24) to 2.47 (95% CI: 2.29–2.66), and from 1.70 (95% CI: 1.52–1.89) to 11.9 (95% CI: 10.8–13.1), respectively. Patients exposed to higher levels of THCs, NMHCs, and CH4 exhibited greater incidence rates of childhood AD.When compared with the concentrations of pollutants in the Q1 quartile, the adjusted HR for AD increased with an increase in the exposure concentrations of total hydrocarbons (THCs), non-methane hydrocarbons (NMHCs), and methane (CH4 were associated with an increased risk of childhood AD.The present study demonstrated that exposure to higher concentrations of THCs, NMHCs, and CH Atopic dermatitis (AD) is a common chronic relapsing inflammatory skin disease associated with intense itching and recurrent eczematous lesions . Hanifinx); environmental tobacco smoke (ETS); traffic-related air pollution (TRAP) caused by pollutants such as PM, NO, NO2, SO2, CO, CO2, O3; and volatile organic compounds (VOCs) have been mentioned as risk factors for the development or aggravation of AD [3, has been observed to alter the resident skin flora and cause predisposition to S. aureus colonization [Over the past 30 years, the worldwide prevalence of AD has increased considerably, particularly in industrialized countries . Althougon of AD . Skin baon of AD , 16, 17.on of AD , 19. TRAnization . Other dx, representing a combined impact on human health. Selection bias was also observed due to potential misclassification in some cross-sectional studies, since the diagnosis of AD was not confirmed by a physician and was based simply on reports from the patients or their parents [Although several studies support the development or aggravation of childhood AD due to air pollutants, current evidence regarding the skin aspects of air pollution remains relatively scarce in contrast to that regarding airway diseases such as asthma . Moreove parents .4), are responsible for approximately 85% of the global energy consumption due to rapid industrialization and urbanization. It is unclear whether air pollutants released during combustion of hydrocarbons, particularly CH4, affect the body’s largest organ, the skin. Hence, we conducted this nationwide retrospective study using real-world data in Taiwan to evaluate the effect of exposure to these air pollutants on the risk of AD in children.In the present study, we focused on the association between hydrocarbons and the development of childhood AD. Total hydrocarbons (THCs), which are organic chemical compounds consisting of non-methane hydrocarbons (NMHCs) and methane  Research Database (NHIRD) for the year 2000. The NHIRD was established in 1995 and covers more than 99% of the total population in Taiwan . It cont2). Levels 1 and 7 referred to the most and the least urbanized areas, respectively. However, since very few patients were included in levels 5, 6, and 7; these three levels were combined with level 4. Monthly income was also classified into four groups: < 14,400 New Taiwan dollar (NT$); 14,400–18,300 NT$; 18,301–21,000 NT$; and ≥ 21,000 NT$.From January 1, 2000 to December 31, 2012; We obtained data from children aged below 18 years. Candidates with missing data or those diagnosed with AD before enrolment in this study were excluded. The diagnosis of AD by a physician in Taiwan relies on clinical features listed in the Hanifin and Rajka diagnostic criteria and the American Academy of Dermatology Consensus Criteria . City di4 using ultraviolet fluorescence. Air pollution data were extracted from all monitoring stations and averaged on each day. The databases of these air pollutants were obtained from the Taiwan Air Quality-Monitoring Database (TAQMD), released by the TEPA. We linked the NHIRD and the TAQMD data according to the residential areas of candidates and the location of air quality-monitoring stations. A residential area was defined based on the location of the clinic and the hospital that treated acute nasopharyngitis (common cold) (ICD-9-CM code 460). Since acute nasopharyngitis is a common health problem, patients tend to visit the local clinic or other medical institution nearest to their residential areas. The average daily concentrations of air pollutants were calculated by dividing the cumulative daily air pollutant concentration by the duration from enrolment in this study to the endpoint for each candidate. Air pollutant concentrations were categorized into four groups based on quartiles: Q1, Q2, Q3, and Q4. THC concentrations were categorized into Q1 (< 2.29 ppm), Q2 (2.29–2.40 ppm), Q3 (2.40–2.60 ppm), and Q4 (> 2.60 ppm). NMHC concentrations were categorized into Q1 (< 0.27 ppm), Q2 (0.27–0.35 ppm), Q3 (0.35–0.51 ppm), and Q4 (> 0.51 ppm). CH4 concentrations were categorized into Q1 (< 2.01 ppm), Q2 (2.01–2.06 ppm), Q3 (2.06–2.11 ppm), and Q4 (> 2.11 ppm).The Taiwan Air Quality Monitoring Network was established by the Taiwan Environmental Protection Administration (TEPA) in 1993 , 24. It p < 0.05 in all statistical tests.The demographic data in our study included age, sex, monthly income, level of residential urbanization, and daily average exposure to air pollutants. The chi-squared test was used to analyze the distributed difference among daily average concentrations for each air pollutant by quartile and urbanization. We used person-years as the denominator for estimating the incidence rate. The incidence rate of AD (per 1000 person-years) was calculated at four different air pollutant concentration levels. Cox proportional hazards regression models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for AD in Q2–Q4 levels of air pollutant concentrations when compared with the Q1 concentrations. The multivariable model was adjusted for age, sex, monthly income, and urbanization level. We also utilized the Kaplan–Meier method to estimate the cumulative incidence of AD during the follow-up. The log-rank test was used to analyze the difference among air pollutant concentration levels. All data analyses were performed using SAS 9.3  and SPSS 15.1 . The significance level was set at Altogether, 7304 children (2.96%) were diagnosed with AD within the cohort of 246,844 children . The demographic data of the patients are presented in Table 4 exposure based on the location of the Taiwan Air Quality Monitoring station. Concentrations of each air pollutant were categorized by quartiles, ranging from Q1 (the lowest concentration) to Q4 (the highest concentration). Tables 4 concentrations. Children with the highest THC, NMHC, and CH4 exposure concentrations lived in areas with higher urbanization.We collected the data of participants under conditions of THC, NMHC, and CH4 exposure concentrations, respectively. In the multivariable Cox proportional hazard regression, the adjusted HR for AD increased with an increase in the THC, NMHC, and CH4 exposure concentrations from 1.65 (95% CI: 1.47–1.84) to 10.6 (95% CI: 5.85–7.07), from 1.14 (95% CI: 1.06–1.24) to 2.47 (95% CI: 2.29–2.66), and from 1.70 (95% CI: 1.52–1.89) to 11.9 (95% CI: 10.8–13.1), respectively when compared with the corresponding exposure concentrations in the Q1 quartile (1.00)  [2 exposure (per 6.4 mg/m3) was associated with both physician-diagnosed AD and parental reports of AD symptoms  [2, NO2, and PM10 and childhood AD  [3 and PM2.5  [4 (from 1.70 to 11.9) when compared with exposure to the corresponding concentrations in the Q1 quartile.Taiwan is located in East Asia, the most polluted region in the world. Currently, it is facing severe air pollution, especially in major urban areas, due to rapid increase in population and industrial development as well as transportation demands. While the number of children with AD continues to increase in both developed and developing countries, the prevalence of AD in Taiwan appears to have grown dramatically over recent decades . Accordictively) . In a prctively) . In a crctively) . In 91,6ctively) . A few sctively) –34. In t4 are composed of THCs. Most of the hydrocarbons on earth are naturally derived from decomposition of organic matter in petroleum and are generated by human activity. NMHCs, often referred to as VOCs, are unstable forms of substances such as benzene and their derivatives.Rapid industrialization coupled with urbanization has led to accumulated global waste production due to the continuously increasing demand for energy. Hydrocarbons, which are organic chemical compounds consisting of hydrogen and carbon, form the basis of the majority of global energy production via fossil fuel combustion and evaporation of gasoline. Both NMHCs and CH4, a nontoxic greenhouse gas, have been scarcely reported except suffocation due to high concentrations. The present study is the first one to suggest that CH4 exposure contributes to an increased risk of AD development. Rapid industrialization and urbanization contribute to increased CH4 production. Increasing urbanization has been accompanied by a rise in larger cities with increasing population densities. Densely populated areas aggravate the spread of contagious infectious diseases. Emerging infectious diseases may worse skin inflammation caused by AD [A great number of animal and epidemiological studies have reported negative effects of VOCs on skin barrier function. A prospective study in Korea revealed that an increase of 1 ppb in outdoor benzene and total VOC concentrations was associated with a 27.38 and 25.86% increase in AD symptoms, respectively . Kim et Although our study was a large-scale population-based cohort study, it has several limitations. Although AD is a complex and multifactorial disorder, we did not consider other environmental factors such as temperature, humidity, and ultraviolet light that might interact with airborne pollutants . Other p4 might lead to an increased risk of AD development. Further studies are needed to gain a better understanding of the role of air pollutants in the pathogenesis of AD.Our findings indicated that exposure to higher concentrations of THCs, NMHCs, and CH


IntroductionChronic venous insufficiency (CVI) is characterized by inadequate functioning of venous valves in the lower limb. CVI is associated with a significant reduction in patient’s quality of life (QOL). The severity of CVI was determined by CEAP  classification and venous clinical severity score (VCSS). The study is aimed to evaluate and correlate Dermatology Life Quality Index (DLQI) with VCSS, CEAP in patients with CVI.MethodsA cross-sectional study of 57 patients with CVI was conducted over a period of 12 months. A sociographic survey, clinical and severity grading using CEAP classification, and VCSS were done for all venous doppler confirmed patients. QOL was evaluated by validated DLQI questionnaires using English and native languages Hindi and Marathi.ResultsA total of 57 patients with a male to female ratio of 6.1:1 and a mean age of 51.68 years were included in the study. CEAP grading in patients showed 49.12% (C4a), 21.05% (C6), 15.7% (C4b), 7.01% (C3), 3.50% (C2 and C5). Mean VCSS and DLQI were 11.47 and 10.12, respectively; 49.12%, 40.35%, 10.53% of patients had a moderate, very large, and small impact on DLQI respectively, positively correlating to VCSS (P < 0.001).ConclusionFrom this study, it was observed that VCSS and CEAP positively correlated with DLQI, and the impact increases in proportion with the seriousness of the disease. Chronic venous disease is defined as abnormalities of the venous system’s morphology and functions, which are presented by various clinical signs and manifestations suggesting the necessity for investigation and management. The word chronic venous insufficiency (CVI) is used for leading signs of venous hypertension that have advanced to edema, various alterations in the skin, and venous ulcers . Many faVCSS is a dynamic scoring system consisting of 10 components which are pain, varicose veins, edema, pigmentation, inflammation, induration, ulcer size, number of ulcers, duration of ulcer, and use of stockings which are graded from zero, one, two, three corresponding to absent, mild, moderate and severe respectively to produce a 30-point maximum score . Finlay This cross-sectional study was done over a period of one year from November 2019 to October 2020 among 57 patients with chronic venous insufficiency in a tertiary care center. Venous Doppler ultrasound scanning was performed in all patients after institutional ethics committee approval and informed consent from patients, VCSS was evaluated . Correlation between VCSS and DLQI was assessed by Spearman’s rank correlation coefficient. To investigate the relationship between VCSS and impact on quality of life (QoL), logistic regression was performed. P-value <0.05 is observed ‘to indicate a statistically significant difference.Inclusion criteria: Clinically and Venous Doppler confirmed cases of CVI who have not received treatment in the last six months.Exclusion criteria: Age <18 years, arterial disease, deep vein thrombosis, congenital venous disease.A total of 57 patients were included in this study. The age of patients ranged from 26 to 80 years with a mean of 51.68 ± 14.53 years. Most of the patients were between the age of 40-60 years (40.35%). 26.31% and 33.33% of patients were between age 20-40 years and 60-80 years, respectively. The mean duration of the disease was 45.91 ± 9.41 months. Most of the patients were males (86%) with a ratio of male to female being 6.1:1. The average BMI was 27.18 ± 4.33 with 51% being overweight, 19% being obese and 30% being normal weight. Almost all patients gave a history of long-standing hours at work. Half of the female patients  in this study had three or more pregnancies. Occupational diversification among the study group showed predominant involvement of security guards (15.8%), followed by shopkeepers (12.3%) and others  of CEAP grade C2, four patients 7.01%) of grade C3, 28 patients (49.12%) of grade C4a, nine patients (15.7%) of grade C4b, two patients (3.50%) of grade C5, 12 patients (21.05%) of grade C6. Among the 10 aspects of VCSS, varicose veins , 28 patients (49.12%), 23 patients (40.35%) had a small, moderate, and very large effect on their daily lives, respectively. None of the patients had any effect or an extremely large effect on DLQI. A strong positive correlation was found between DLQI and VCSS in which the value of Spearman’s rank correlation coefficient 'r' = 0.840 and the ‘p' value obtained is <0.05 /various dermatological outcomes/features. Identification of these cutaneal findings is extremely advantageous in detecting the most frequently seen chronic vascular diseases and starting early management . The CEA2) [Epidemiologic studies have shown that varicose veins are more common in patients with increased body mass index (BMI)  , varicos2) . This st2)  showed iThe main limitation in using the CEAP classification is that it responds poorly to changes over time and many of its components are relatively static and do not change significantly after treatment . The advChronic venous insufficiency adversely affects the quality of life by influencing the psychosocial wellbeing of the patients. In our study, mean VCSS positively correlates with DLQI in patients with CVI. Hence more severe the disease, the more it affects the DLQI. Assessment of DLQI in patients with CVI improves the effectiveness of the treatment and also addresses other psychosocial consequences of the disease which need to be managed giving more accurate insight to the clinicians.


Moringa oleifera leaf extract powder (MOLEP) (CMO) and another dipping solution with CA at 2.0%, MOLEP at 0.1% and potassium sorbate (PS) at 0.2% (CMOP) on the storage stability over 3 months and consumer acceptability of dried apple slices were evaluated. Microbiological testing  and total acidity testing were performed and physical tests, namely moisture analysis, water activity (Aw), texture analysis and colour were performed at day 0, day 60 and day 120. Moisture increased over the shelf-life period, which affected the extensibility of the pre-treated dried sliced apples negatively. The CMO pre-treatment was effective in reducing browning and inhibiting microbial growth on the dried apple slices over the storage period. A consumer acceptability test was performed using the nine-point hedonic scale. The dried sliced apples pre-treated with the 2% CA and 0.1% MOLEP powder water solution were acceptable to consumers with regards to colour, texture and taste.The effects of a dipping solution containing 2.0% citric acid (CA) and 0.1%  All foods contain moisture, from minute quantities in dehydrated products to an excess in cold or hot drinks. There is a direct link between the speed at which food spoils and its water content, which makes it vital in the stability and shelf-life of foods [w is obtained by the removal of moisture (dehydrating) or by adding a component . Most spoilage bacteria and moulds do not proliferate at Aw levels below 0.91 and 0.80 [To fully comprehend the storage life of foods, it is imperative to recognise that foodstuffs are dissimilar; they are multifaceted living systems where physicochemical, microbiological and enzymatic reactions are taking place simultaneously. The storage period, taste and texture of foods are greatly influenced by these reactions . A produof foods . The reqand 0.80 . Xerophyand 0.80 . Accordiand 0.80  water acOxidation is one of the main spoilage mechanisms responsible for the spoilage in food sensory characteristics. It frequently results in inferior texture, colour and flavour of the food products . PhysicaFood producers use sensory studies as quality criteria, to determine product attributes and shelf life and to measure the acceptability of a product when developing new products. The sensory characteristics usually evaluated are appearance, odour, taste and texture . SensoryTogether with taste, odour and trigeminal sensations are referred to as flavour. In the food industry, sensory statistics or information are used to determine quality standards, consumer acceptability, for product development and shelf-life studies. Sensory science allows food manufacturers to consistently produce and develop good quality products ,5,10,12.A sensory evaluation has two major classifications namely, analytical and hedonic or affective testing. Analytical assessments are used to assess if an overall difference exists between two or more products, where no characteristic can be recognised as being affected. The most renowned analytical sensory test is the difference or discrimination test such as difference from control and paired comparison and triangle tests ,11,12. THedonic tests have two classifications namely, preference and acceptability tests. As the names indicate, these tests merely measure the degree of liking and preference. If the objective of the research is to set one product against another, then the preference test should be used. Two or more samples may be used; consumers are asked to rank their preference if a sample size greater than two are used ,11. The A study by  showed tMoringa oleifera leaf extract powder was bought in South Africa from Dohler Pty (Ltd.) (Paarl), CA from Savanna Fine Chemicals (Pty) Ltd., Cape Town, South Africa) and PS from Bragan Chemicals CC, South Africa (Johannesburg)). A cabinet dehydrator  was used to dried the sliced apples. The dehydrator was composed of a fan , ten trays, a heating element and a thermostat situated at the rear of the dryer. Cold air was drawn in, warmed and circulated uniformly across every tray [The apples (Granny Smith) were bought from a store in South Africa (Cape Town). The apples were stored at 4 °C + 1 °C until required for the trial ,15,16,17ery tray .Before drying the apples, they were physically washed and sanitised in a 200 ppm sodium chlorite solution . The appThe untreated and pre-treated dried apple slices were packed in pouches , heat-sealed and stored under ambient/room temperature ,21. The The dehydrated sliced apple’s (pre-treated and control) surface colour was measured with a spectrophotometer (Spectrocolorimeter Datacolor 600). This equipment determines the trichromatic coordinates CIELAB (L* a* b*) using a spectrophotometer with measurement geometry d/8  and D65 illuminant. A black trap and a white tile were used to calibrate the equipment before analyses. The dried sliced apple was positioned completely flat on the instrument’s reading surface. The analysis was performed on ten randomly selected dried sliced apple pieces. The colour was documented as L*, a*, and b* values. L* (lightness) ranges from 0–100, 0 being black (no light) and 100 white (upper limit). The a* is green (negative) to red (positive). The b* is blue (negative) to yellow (positive) ,26. The The total acidity of the dried apple slices was determined using an automatic titrator (METROHM). The analysis was performed on 10 randomly selected dried apple slice pieces. The apple slices were ground, and 4 g was weighed and dissolved in boiled distilled water and titrated with NaOH 0.1 N at room temperature using an automatic titrator. Total acidity was recorded as g citric acid monohydrate/100 g.w in the dried apple slices at 25 °C. The instrument was calibrated using salt solution standards with known water activity. A representative sample was placed in a cup placed in the instrument  and sealed. The final aw reading was displayed on the screen of the instrument. The analysis was based on the correlation between the air dew point in equilibrium with the sample and its free water content. The ISO 21807:200 method for foodstuffs which measure dew point was used to determine the AMoisture was determined using the Karl Fischer titration method. The analysis was performed on 10 randomly selected dried apple slice pieces which were ground, and a 4 g sub-sample was weighed and dissolved in 40 g of methanol formamide mixture and titrated with Karl Fischer reagent at room temperature. The final titration mark was determined electronically. Escherichia coli [The dried apple slices were tested for yeast and mould, osmophilic yeast and hia coli . A 10 g Texture analysis was done with a texture analyser . The analysis was performed on 10 randomly selected dried apple slice pieces. A metallic cylinder probe 4 mm in diameter, a force of 5 g and a test speed of 1 mm/s was used to test the extensibility of the dried apple slices. The extensibility results were reported in millimeters.The dried apple slices pre-treated with CMO and CMOP and the control were weighed (20 g/sample) and packed in aluminum foil pouches and heat sealed. The samples were labelled with random number codes. An acceptability test was done using the nine-point hedonic scale. Fifty-six consumers participated in the study. The participant’s pool consisted of Cape Peninsula University of Technology (CPUT) staff and students as well as external consumers. The sensory test was conducted in CPUT’s sensory facility. The sensory test room was regulated with an air-conditioner, run at 18 °C, with white light. The consumers each received on a tray three  20 g randomly coded dried apple sliced samples, packed in aluminum foil pouches as indicated in p < 0.05. Sensory ratings were expressed as mean ± standard deviation. The data were tested for normality using the Shapiro–Wilk test and homogeneity of variance by the Levene’s test in IBM SPSS version 26. Where normality assumption was violated, sensory differences between samples was estimated using the non-parametric analysis of variance equivalent, the Kruskal–Wallis test. Results were analysed using DesignExpert version 12 software.Significant differences between treatments were evaluated by multi variate analysis of variance (MANOVA). Duncan’s multiple range test was used to separate the means where differences existed at p = 0.00, redness F  = 25.7; p = 0.00 and yellowness F  = 132.6; p = 0.00. The lightness of the dehydrated sliced apples pre-treated with CMO (2.0% CA and 0.1% MOLEP), L* = 85.6 was significantly (p = 0.000) higher than the CMOP , L* = 80.8 and the control (L* = 79.6) at day 0. Similarly, the lightness of the CMO (L* = 80.1) dried apple slices was significantly (p = 0.022) higher than CMOP (L* = 78.4) and the control (L* = 75.0) at day 120. The redness of the CMO (a* = 1.5) dried apple slices was significantly (p = 0.000) lower than the CMOP (a* = 4.0) and the control (a* = 4.8) at day 0.p = 0.018) lower than the CMOP (a* = 6.2) and the control (a* = 7.0) at day 120. Yellowness of the CMO (b* = 17.9) dried apple slices was significantly (p = 0.000) lower than the CMOP (b* = 20.5) and the control (b = 33.3) at day 0. At day 120, yellowness of the CMO (b* = 28.4) and the CMOP (b* = 25.1) dehydrated sliced apples were significantly (p = 0.000) less than the control (b = 33.8). Likewise, the redness of the CMO (a* = 3.9) dried apple slices was significantly  higher than at day 120 (L* = 80.1). Similarly, the redness of the dried apple slices pre-treated with CMO at day 0 (a* = 1.5) and day 60 (a* = 0.9) was significantly (p = 0.000) lower than at day 120 (a* = 3.9). It was observed that the yellowness of the CMO sliced apples at storage day 0 (b* = 17.9), day 60 (b* = 21.7) and day 120 (b* = 28.4) was significantly (p = 0.00) different. The yellowness of the CMO dried apple slices at day 0 was significantly lower than at day 120. Therefore, the CMO dried apple slices were significantly lighter and less red at day 0 and day 60 of storage than at the end (day 120), whereas the yellowness significantly increased over the storage time. p = 0.139). However, the redness of the CMOP dried apple slices was significantly higher (p = 0.007) at day 120 (a* = 6.2) than at 60 (a* = 3.9) and day 0 (a* = 4.0). Similarly, the yellowness of the CMOP apple slices was significantly (p = 0.000) higher at day 120 (b* = 25.1) than at day 60 (b* = 21.5) and day 0 (b* = 20.5). Therefore, the CMOP dried apple slices were more red and yellow at the end of the storage time while no significant change in the lightness over the storage period was observed. The lightness of the dried apple slices pre-treated with CMOP at day 0 (L* = 80.8), day 60 (L* = 80.1) and day 120 (L* = 78.4) was not significantly different (p = 0.000) different over the storage time. The BI of the CMO dried apple slices was 23.9 at storage day 0, 29.4 at day 60 and 46.4 at day 120. However, BI for the CMO dried apple slices was significantly (p = 0.000) lower than the BI of CMOP  which was 32.0 at day 0 and 34.0 at day 60 while at day 120 (BI = 43.6) there was no significant difference between CMO and CMOP. The CMO dehydrated sliced apples BI were significantly (p = 0.000) less than the control, which was 57.5 at day 0, 61.0 at day 60 and 66.1 at day 120 (p = 0.001). Even though the browning index of the CMO and CMOP dried apple slices increased overtime it was significantly less brown than the control at the beginning (p = 0.000) and end (p = 0.001) of the storage time. The effect of the pre-treatment on the browning and whitening index of the dried apple slices is shown in p = 0.000) different over the storage period. The WI for CMO was 76.9 at day 0, 73.6 at day 60 and 65.0 at day 120. Though the CMO dried apple slices WI was significantly higher than CMOP at day 0 and 60 which were 71.6 at day 0 and 70.4 at day 60 there was no significant difference observed at day 120 (WI = 66.2). The WI of the CMO dried apple slices was significantly higher than the control which were 60.6 at day 0, 58.6 at day 60 and 57.2 at day 120. Thus, the WI of the CMO and CMOP dried apple slices decreased over the storage time but was more evident at day 120. Although the CMO and CMOP dried apple slices whitening index decreased over time it was significantly whiter than the control at the start (p = 0.000) and the end (p = 0.001) of the storage time. The whitening index (WI) of the CMO dehydrated sliced apples was significantly (p = 0.000) lower than day 120 (BI = 46.4 ± 11.0). Similarly, the BI of CMOP at day 0 (BI = 32.0) and day 60 (BI = 34.0) was significantly (p = 0.000) lower than day 120 (BI = 43.6 ± 7.5). The BI of the control was not significantly (p = 0.421) different over the storage time. The dried apple slices pre-treated with CMO at day 0 (23.9) and 60 (29.4) BI was lower than CMOP (day 0 = 32.0 and day 60 = 34.0). However, at day 120 the dried apple slices pre-treated with CMO (BI = 46.4) was higher than CMOP (BI = 43.6) though not significantly (p = 0.001). The effect of storage time on the BI and WI of the dried apple slices is indicated in p = 0.000) higher than day 120 (WI = 65.0). Likewise, the WI of CMOP at day 0 (WI = 71.6) and day 60 (WI = 70.4) was significantly (p = 0.002) higher than day 120 (WI = 66.2), whereas that of the control was not significantly (p = 0.371) different over the storage time. An observation was made that the WI of the dehydrated sliced apples pre-treated with CMO at days 0 and 60 was higher than CMOP. However, the WI of the dried apple slices at day 120 pre-treated with CMOP was higher, though not significantly (p = 0.001). Thus, dried apple sliced pre-treated with the 2.0% CA and 0.1% MOLEP (CMO) were whiter at days 0, 60 and 120 compared to the control over the same storage period. Additionally, CMO dried apple slices were whiter than the CMOP  at days 0 and 60 with no significant difference at day 120 observed. The CMO dried apple slices showed a significantly higher value in lightness, and a lower value in redness and yellowness over the storage time compared to the control. The browning index (BI) of the CMO dried apple slices increased significantly while that of the whitening index (WI) declined significantly over the storage period. However, the BI of the CMO dehydrated sliced apples were significantly lower and the WI significantly higher than the control. It was observed that the BI of the CMO dehydrated sliced apples was less than that of the control at day 0 (57.5), day 60 (61.0) and 120 (66.1). Thus, dried apple sliced pre-treated with the 2% citric acid and 0.1% Moringa oleifera (CMO) were less brown at days 0, 60 and 120 compared to the control over the same period. Furthermore, CMO dried apple slices were less brown than the CMOP  at days 0 and 60 with no significant difference noted at day 120. The whitening index (WI) of the dried apple slices pre-treated with CMO (2.0% CA and 0.1% MOLEP) at day 0 (WI = 76.9) and day 60 (WI = 73.6) was significantly (The favourable results of CA on the colour (a* and b*) of the dehydrated sliced apples can be attributed to its ability to lower pH and chelate metals ,32. The The study by  reportedThe CMOP pre-treatment indicated better lightness and yellowness compared to the control for the storage period; however, CMO dried apple slices showed significantly higher lightness and lower redness when compared to the CMOP dried apple slices. The difference in yellowness between the CMO and CMOP dried apple slices was not significant during the storage time. Initially, the BI (day 0) and WI (day 0 and 60) of the CMO dried sliced apples was superior to that of CMOP; however, at the end of the storage, the difference was not noticeable. According to , sorbic E. coli at storage days 0, 60 and 120 are presented in E. coli count for the control, CMO (2.0% citric acid and 0.1% MOLEP) and CMOP  dried apple slice samples were <10 cfu/g over the storage period. The initial (day 0) yeasts count for the CMO (<100 cfu/g) dried apple slices showed a one log reduction and CMOP pre-treated dried apple slices showed a 2 log (<10 cfu/g) reduction compared to the control (<1000 cfu/g). The mould count of the CMO (140 cfu/g) dried apple slices at storage day 0 showed a 2 log reduction and the CMOP (40 cfu/g) pre-treated sample showed an even further reduction when compared to the control  at the same storage time. At 120 days, the yeasts and moulds count for all three samples  were <10 cfu/g. Yeasts and moulds are the leading cause of microbial spoilage in dried fruit [The microbial count for osmophilic yeasts, yeasts and moulds and ed fruit ,41. ThisMicroorganisms react to low pH stress by stopping a harmful decrease in intercellular acid levels below the limit required for viability. One such strategy microbes practise to avert a serious fall in the pH level is to employ enzyme-catalysed reactions that use protons . Thus, aw and the moisture of the dehydrated sliced apples over time is presented in w of the dehydrated sliced apples ranged for CMO from 0.3–0.5, for CMOP from 0.3–0.4, and the control remained unchanged at 0.4 over the storage period. The summary of the mean values for the impact on the total acidity, Aw = 0.3) and CMOP (Aw = 0.3) dried apple slices was lower compared to the control (Aw = 0.4). A substantial increase of 32.4% in the Aw of the CMO dried apple slices was noted while that of CMOP increased by 9.1% and that of the control decreased by 2.7% over the storage period. The moisture of the dried apple slices for the control over the storage period ranged from 7.3–7.8%, for CMO, from 6.0–10.4% and for CMOP, from 6.1–7.7%. A decrease in the initial moisture of the CMO (6.0 %) and CMOP (6.1%) dried apple slices was observed when compared to the control (7.3%) with CMO showing the highest increase over time. The moisture of the CMO dried apple slices showed a considerable increase of 73.6% while CMOP increased by 26.9% and the control increased by 6.5% over the storage period. The initial (day 0) water activity of the CMO  and 2% citric acid, 0.1% Moringa oleifera and 0.2% potassium sorbate (CMOP) increased; this can be ascribed to the presence of CA and PS in the pre-treatment solutions. According to [As expected, the total acidity of the dried apple slices pre-treated with 2% citric acid, 0.1% rding to , the aciThe moisture of the control, CMO and CMOP samples increased over the storage period, which may be a result of samples absorbing moisture from the environment. Even though the moisture of the CMO dried apple slices increased considerably over the storage period, it was still within the moisture limit of <27% as prescribed by regulation 653, relating to the quality, packing and marketing of dried fruit intended for sale in the Republic of South Africa. p = 0.099) different at day 0. It was noted that the CMO (5.1 mm), CMOP (6.3 mm) and control (4.5 mm) dried apple slices extensibility was significantly (p = 0.000) different at day 60 with the CMO and CMOP showing higher results than the control. However, the extensibility of the CMO dried apple slices were significantly lower than CMOP at the same time. However, this changed at day 120 with the CMO (8.0 mm) dehydrated sliced apples showing a significantly (p = 0.000) higher extensibility than the CMOP (7.0 mm) and the control (6.9 mm). Thus, the dried apples pre-treated with 2.0% citric acid and 0.1% MOLEP (CMO) and 2.0% citric acid, 0.1% MOLEP and 0.2% potassium sorbate (CMOP) became less crispy and chewier during the storage period.The effect of the pre-treatment on the extensibility of the dried sliced apples is presented in p = 0.000). It was noted that the CMO dehydrated sliced apples’ extensibility significantly (p = 0.000) increased over the storage time . Likewise, the CMOP dried apple slices also significantly (p = 0.000) increased over the storage period . Therefore, the CMO and CMOP dried apple slices are less crunchy and leatherier over time.The impact of storage period on the extensibility of the dehydrated sliced apples is indicated in Research by  stated tp = 0.00) higher than the colour of CMOP and the control. Similarly, for texture, the CMO acceptability was significantly (p = 0.029) higher than CMOP and the control dried apple slices. Fifty-six consumers completed the questionnaire, of which 51.8% were female, 48.2% were male, 16.1% were in the age group 18–25, 8.9% were ages 26–30, 10.7% were ages 31–35 and 64.3% were >36 years of age. All the panelists indicated their consumption frequency of dried apples as once a month. The mean values of the consumer’s acceptability scores for colour, texture and taste are shown in p = 0.161) of the dried apple slices negatively. The pairwise comparison of the dehydrated sliced apples indicated no significant difference (p = 0.663) in colour for CMOP compared to the control; however, colours of the control and CMO were significantly different (p = 0.000). The data analysis showed that the acceptability of the dried apple slices colour between the CMO and CMOP was significantly (p = 0.000) different. A statistically significant (p = 0.000) difference in colour between the pre-treated  and untreated (control) dried apple slices were observed with the mean colour ranking score for CMO being the highest at 109.52, followed by CMOP at 73.97 and the control at 70.01 (The study showed that the pre-treatment did not impact the taste (at 70.01 a. p = 0.203) difference for CMOP compared to the control as well as no significant (p = 0.164) difference between the CMO and the control sample. A significant (p = 0.008)) difference was noted between the CMO and CMOP dried apple slices for texture. The average ranking results for texture between the pre-treated (CMO and CMOP) and untreated (control) dried apple slices were also significant (p = 0.029). The CMO dried apple slices are ranked highest for texture (96.75), followed by CMOP at 84.14, and the control at 72.61 (p = 0.161) differences across the control, CMO and CMOP dehydrated sliced apples. The colour of CMO dehydrated sliced apples was liked moderately (6.8) and texture liked slightly (6.1), whereas the colour of the control was neither liked nor disliked (5.1), though the texture was liked slightly (5.6) by the consumers. The colour (5.3) and the texture (5.2) of the CMOP dried apple slices were neither liked nor disliked. The taste of the CMO dried apple slices was liked moderately (6.5), while the taste of both CMOP (5.9) and control (6.1 + 1.8) was liked slightly by the consumers. The CMO dried apple slices were ranked the highest for colour (109.52) and texture (96.75). The CMOP dried apple slices ranked second highest for colour (73.97) whereas the control (84.14) was ranked the second highest for texture. The colour (p = 0.000 < 0.05) and texture (p = 0.029) across samples  were significantly different, whereas for taste it was not significantly different (p = 0.161). The pairwise comparison results for texture indicated no significant , of which the highest concentration is found in the leaves [The key physical properties of dried fruit are physical appearance and colour, which are the initial assumptions of food quality by consumers . Accordie leaves . Thus, te leaves ,32. ThisMoringa oleifera leaf powder can result in unfavourable consumer acceptability due to its unfamiliar sensory characteristics. The same study indicated that an increase in Moringa oleifera leaf powder resulted in a decrease in acceptability of maize porridge, but at a 1% dosage of Moringa oleifera leaf powder, the soft porridge was acceptable by consumers. A study by [Moringa oleifera leaf extract addition to goat patties was sensorially acceptable. Also, according to [p = 1.61) affected by the 2.0% CA and 0.1% MOLEP contained in the pre-treated (CMO and CMOP) water solutions. According to , Moringastudy by  showed trding to , citric E. coli of the CMO and CMOP were within the limits as prescribed by the Codex Alimentarius Commission (2003) at the beginning and end of the storage time and therefore the dried apple slices were safe for consumption. The Aw of the dehydrated sliced apples pre-treated with CMO was below the limit conducive to microbial growth and thus is an additional guarantee of food safety for dried sliced apples pre-treated with 2.0% CA and 0.1% MOLEP (CMO). Furthermore, the shelf life of 3 months (120 days) was accomplished. The consumer acceptability test established that colour and taste of the dehydrated sliced apples pre-treated with the 2.0% CA and 0.1% MOLEP (CMO) water solution were liked moderately, and the texture was liked slightly, and therefore acceptable to consumers. Therefore, the objectives to establish storage stability and consumer acceptability of dried sliced apples pre-treated with the combination of the weak acid and Moringa oleifera leaf extract powder were accomplished.The combination of 2.0% CA and 0.1% MOLEP (CMO) effectively minimized the redness and yellowness of the dried apple slices over the storage period. Even though the CMOP dried apple slices showed some positive results in minimizing the colour over the storage time, the CMO dried apple slices demonstrated better results. The CMO and CMOP pre-treatments effectively decreased the yeast and mould count of the dehydrated sliced apples. The increase in moisture during the storage period affected the extensibility of the pre-treated dried apple slices negatively. The osmophilic yeasts, moulds and


The aim of this ecological study based on a 12.5-year time series was to investigate the association of short-term exposure to PM with aerodynamic diameter ≤ 2.5 μm  for each 10 μg/m3 increase in the level of each class of PM was associated with increased total respiratory diseases when the lag time was 0 day . The PM2.5 and PM10 levels also had positive associations with admissions for COPD, asthma, and pneumonia. Stratified analyses demonstrated stronger effects in patients more than 45 years old and during the cold season. Total respiratory diseases increased linearly with PM concentration from 0 to 100 μg/m3, and increased more slowly at higher PM concentrations.There were 1,960,361 hospital admissions for respiratory diseases in Shanghai during the study period. A 10 μg/mThis time-series study suggests that short-term exposure to PM increased the risk for hospital admission for respiratory diseases, even at low concentrations. These findings suggest that reducing atmospheric PM concentrations may reduce hospital admissions for respiratory diseases.The online version contains supplementary material available at 10.1186/s12940-021-00828-6. Respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, and pulmonary sarcoidosis, are major public health problems that impose a huge disease burden on society . The disChina is now faced with severe air pollution due to rapid urbanization and industrialization, especially in the more populous areas. According to the global burden of disease study 2017 , 1.24 mi2.5) and with an aerodynamic diameter less than or equal to 10 μm (PM10). Longtime exposure to PM can cause multiple health problems that reduce human longevity [The most common pollutants are particulate matter (PM) with an aerodynamic diameter less than or equal to 2.5 μm  in Shanghai.Shanghai is the most populous megacity with a permanent population of 24.8 million in the seventh national census. It is also one of the heaviest polluted cities in China. The present study used time-series data for 12.5 years from all the medical insurance designated hospitals from Shanghai Healthcare Security Database for Urban Employees and Urban and Rural Residents. The database covers more than 95% of the adult population in Shanghai according to statistics released by the National Healthcare Security Administration, resulting in having a large number of hospitalizations and therefore providing good statistical power to examine the respiratory disease subcategories. We have investigated the association of short-term exposure to PMDaily hospital admissions data were from the Shanghai Medical Insurance System for the period January 1, 2008 to July 31, 2020. The clinical diagnostic criteria for respiratory diseases were from the International Classification of Diseases, 10th Revision as J00 to J99. This included COPD (J40–J44), asthma (J45), and pneumonia (J12–J18). Patients’ basic information included gender and age . Prior to data collection, this study was approved by the Ethics Committee of the School of Public Health, Fudan University.https://sthj.sh.gov.cn/), namely PM2.5, PM10, nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO). Of these, the daily concentrations of PM10, NO2, and SO2 were available from January 1, 2008 to July 31, 2020. While, daily PM2.5, O3, and CO concentrations were only available after the establishment of the ground monitoring network after January 1, 2013.There are 19 environmental monitoring stations in Shanghai .We collected six of the most common air pollutants from the Shanghai Municipal Bureau of Ecological Environment  lag 0, the present day; (ii) lag 1, the previous day; (iii) lag 2, the day before lag 1; (iv) lag 3, the day before lag 2; (v) lag 4, the day before lag 3; (vi) lag 5, the day before lag 4, and three moving average exposure lags: (i) lag 01, the 2-day moving average of the present and previous day; (ii) lag 02, the 3-day moving average of the present and previous 2 days; (iii) lag 03, the 4-day moving average of the present and previous 3 days.A generalized additive model (GAM)  with a qi) a natural spline function of calendar time with 7 degrees of freedom per year (to exclude unmeasured time trends); (ii) a natural spline function with 6 degrees of freedom for present-day mean temperature and 3 degrees of freedom for present-day relative humidity (to control for the nonlinear confounding effects of weather conditions); and (iii) indicator variables for day of the week (DOW) and public holidays (PH). Therefore, the main model was:E(Yt) is the estimated daily hospital admissions for respiratory diseases, Zt is the PM concentration on day t, β is the regression coefficient for Zt, and α is the intercept. All results were presented as percentage change with a 95% confidence interval (CI) for each 10 μg/m3 increase of PM. Percentage change was calculated using the following formula [β is the regression coefficient of PM from the GAM model.Based on previous studies , 13, the formula :\documenβ1and β2 are the effect estimates of the two subgroups, SE1 and SE2 are their corresponding standard errors.Effect modification by individual characteristics was investigated using stratified analyses. The subgroup variables included gender , age , and season . The subgroup differences were tested using a Z statistic :\documen2.5 and PM10 concentrations and hospital admissions for respiratory diseases.A cubic spline smoothing method was used to evaluate the exposure-response relationship between PMAF is the daily attributable fraction, AN is the daily attributable number of hospital admissions due to PM, N is the daily hospital admissions, β is the regression coefficient (from the main model above), C is the daily PM concentration, and C0 is the reference PM concentration. The reference concentrations were from the air quality guidelines of the WHO: 24-h mean: 15 μg/m3 for PM2.5 and 45 μg/m3 for PM10. The total attributable number was estimated by summing daily AN.The attributable fraction (AF) and attributable number (AN) of hospital admissions due to PM exposure were estimated using the following formula based on a previous study :\documen2.5, PM10 with O3, SO2, NO2, CO) was fitted. Second, we changed the degrees of freedom for the calendar time from 5 to 9 per year. Third, we excluded the data from 2020 due to the coronavirus disease 2019 pandemic.We also performed three sensitivity analyses to determine the robustness of the results. First, a two-pollutant model .There were 1,960,361 hospital admissions for total respiratory diseases  in Shanghai from January 1, 2008 to July 31, 2020 included in our analysis , SO2 , and CO . There were inverse correlations of PM2.5 and PM10 concentrations with temperature  and relative humidity .We calculated Spearman correlation coefficients to examine the relationships of air pollution variables and meteorological factors Table S . The res2.5 and PM10 on hospital admissions for respiratory diseases using different lag times . These associations decreased as the lag time increased to lag 5, but were increasingly greater for moving average exposure lags of lag01, lag02, and lag03. Analysis of each cause-specific respiratory disease indicated similar trends as total respiratory diseases. The percentage change seemed to be greater for COPD and asthma at lag 1. PM2.5 had a greater effect than PM10 for all lag times.We examined the effects of PMes Figs. . Overall2.5 and PM10 were similar in males and females , but PM concentrations above 100 μg/m3 had less of an effect. Among the cause-specific respiratory diseases, PM2.5 level had a nearly linear association with COPD up to 160 μg/m3, PM10 level had a nearly linear relationship with asthma up to 200 μg/m3, and asthma appeared to increase exponentially with PM2.5 level up to 160 μg/m3.Exposure-response curves indicated that the percentage change of all types of respiratory diseases increased as PM concentrations increased Figs.  and 5; t2.5 and PM10 levels that exceeded the limits established by the WHO  due to PM10. There were also trends of decreasing annual admissions for respiratory diseases from 2013 to 2020.We also assessed the excess number of respiratory diseases due to PM Table S . From 202.5 and PM10 with total respiratory diseases and individual diseases remained statistically significant after adjusting for other pollutants, although these effect estimates were not significant after adjusting for NO2. Our second sensitivity analysis indicated almost no change of the effect estimates after changing the degrees of freedom for calendar time  was close to the national secondary standard limit of the Chinese National Ambient Air Quality Standard (35 μg/m3). However, the concentrations were still significantly higher than the Air Quality Guidelines 2021 for PM2.5 (5 μg/m3). The health risks from exposure to PM should not be ignored.China is one of the most polluted countries in the world due to the rapid industrialization and urbanization . In 20132.5 and PM10 increased the risk of COPD [The present ecological study found that short-term exposure to PM was significantly correlated with an increased risk of hospital admissions for total respiratory diseases and cause-specific respiratory diseases. Several previous studies also suggested an association of PM with respiratory diseases. For example, three studies , 17, 18  of COPD , 20. Thr of COPD –23 exami of COPD  found a  of COPD .2.5 had a greater impact on respiratory diseases than PM10 at all lag structures. Compared to PM10, PM2.5 adsorbs toxic substances and heavy metals more readily due to its larger relative surface area, it remains suspended in the atmosphere for longer periods, and it enters the terminal alveoli and even the bloodstream more easily [In line with previous studies , 26, we e easily .2.5 due to their weaker immune responses [Our age-stratified analysis found a significantly greater effect of PM on total respiratory diseases, asthma, and pneumonia in patients aged 45 years or more. The effect was especially strong in those aged 65 years or above, in accordance with previous studies –27. Agedesponses , 29. In 2.5 levels due to heavy pollution were greater during the cold season than the warm season (55.42 μg/m3 vs. 35.41 μg/m3). Second, low temperatures prolong the survival of respiratory viruses in the environment [We found a significant association of PM with respiratory diseases during the cold season, but not during the warm season, in line with previous studies of PM and respiratory diseases , 31. Theironment . Third, ironment .3. These results are similar to those of a time-series study of 245,442 respiratory visits in Nanjing, China that examined the association of PM with respiratory system diseases [2.5 level and pneumonia, with a weaker effect at higher concentrations. This nonlinear relationship may be because people avoid spending time outside or wear a dust mask when outside when the air is heavily polluted. The exposure-response curves suggested no discernible thresholds of PM. Exposure to PM2.5 and PM10 even at concentrations below the current regulatory limits is associated with increases in daily admissions, suggesting that tightening the current air quality guidelines of PM for greater public health benefit is necessary.Our analysis of exposure-response relationships indicated a linear association between PM and total respiratory diseases at lower concentrations, but a progressively weaker effect of PM on respiratory diseases at concentrations above 100 μg/mdiseases  also rep2. Previous studies reported similar results. For example, Tian et al. [2. Liu et al. [2. Tsai et al. [2.5 was not statistically significant after adjusting for NO2 or CO. It is possible that a high correlation among pollutants weakened the effect estimation. Therefore, the independent effect of PM on respiratory diseases should be examined.Our two-pollutant model indicated the associations between PM and respiratory diseases remained positive, but not significant after adjusting for NOn et al.  reportedu et al.  suggestei et al.  found th2.5 can easily adsorb organic pollutants, such as polycyclic aromatic hydrocarbons and heavy metals, which promote the production of reactive oxygen species in lung cells, consume antioxidant substances, trigger oxidative stress reactions, and induce lung inflammation [2.5 was associated with an increased level of malondialdehyde, a biomarker of oxidative stress. Second, PM2.5 induction of a local or systematic inflammatory reaction is the major pathologic basis for the onset and progression of several related diseases [The potential biological mechanism linking the exposure to PM and hospital admissions for respiratory diseases are not fully understood, but there are several plausible mechanisms. First, exposure to PM may lead to oxidative stress. For example, PMammation . A meta-ammation  of epidediseases . Evidencdiseases  also sho2.5 concentrations based on modeling techniques to represent individual exposure levels and to examine the potential effect on several diseases, including asthma [Compared with previous studies, we used a larger sample size and examined a longer time period, resulting in greater statistical power. However, this study had several limitations. First, our study was a one-city observational study, and multi-city studies are necessary to validate our conclusions. Second, due to unavailability of residential location where each patient lived, we used average concentrations of daily air pollutants from fixed environmental monitoring stations as an indicator of exposure. This might result in measurement error, which tends to be non-differential and underestimate the effect of the PM effects . Previoug asthma  and poorg asthma . Third, 3), but had a weaker as PM concentrations increased. Reducing atmospheric PM concentrations may reduce hospital admissions for respiratory diseases. These findings have important implications for policymakers to take concrete actions to reduce atmospheric PM concentrations. Further studies conducted on nationwide regions are required to validate our results.The main result of this study is that short-term exposure to PM in Shanghai was significantly associated with hospital admissions for total respiratory diseases and cause-specific respiratory diseases — COPD, asthma, and pneumonia. These associations were especially stronger for patients more than 45 years old and during the cold season. PM level had a nearly linear relationship with total respiratory diseases at low concentrations (0 ~ 100 μg/mAdditional file 1: Table S I. The annual average concentrations of PMs in Shanghai. Table S II. Spearman correlation coefficients among air pollution variables and meteorological factors. Table S III. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations. Table S IV. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations. Table S V. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in males. Table S VI. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in females. Table S VII. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in males. Table S VIII. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in females. Table S III. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in < 45 years. Table S IX. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in 45 ~ 64 years. Table S X. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in 65 ~ 74 years. Table S XI. The attributable number of respiratory diseases admissions due to exceeding PM2.5 concentrations in ≥75 years. Table S XII. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in < 45 years. Table S XIII. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in 45 ~ 64 years. Table S XIV. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in 65 ~ 74 years. Table S XV. The attributable number of respiratory diseases admissions due to exceeding PM10 concentrations in ≥75 years. Table S XVI. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM2.5 and PM10 using two-pollutant models. Table S XVII. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases associated with a 10 μg/m3 increase in concentrations of PM2.5 and PM10 through changing degrees of freedom for the calendar time. Table S XVIII. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases associated with a 10 μg/m3 increase in concentrations of PM2.5 and PM10 through excluding the data from 2020 due to the coronavirus disease 2019 pandemic. Fig. S I. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM2.5 stratified by genders. All the models were adjusted by public holidays, DOW, and calendar day. Fig. S II. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM10 stratified by genders. All the models were adjusted with public holidays, DOW, and calendar day. Fig. S III. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM2.5 stratified by age groups. All the models were adjusted with public holidays, DOW, and calendar day. Fig. S IV. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM10 stratified by age groups. All the models were adjusted with public holidays, DOW, and calendar day. Fig. S V. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM2.5 stratified by season. All the models were adjusted with public holidays, DOW, and calendar day. Fig. S VI. Percentage change with 95% confidence interval in hospital admissions for respiratory diseases per 10 μg/m3 increase in concentrations of PM10 stratified by season. All the models were adjusted with public holidays, DOW, and calendar day.