The effect of imputation of exposure estimates on the association between fine particulate matter and mortality

PURPOSE: The Harvard Six Cities Study (HSCS) found a small but significant association between daily PM2.5 and daily mortality count. The HSCS findings have been used as the basis for new EPA regulations, requiring lower levels of PM2.5. We feel that there are unresolved issues regarding the HSCS that should be fully evaluated prior to its findings being used as the basis of new regulation, including how the extent and method of imputing exposure data affect the association with daily mortality counts.METHODS: We examined the association between PM2.5 levels and daily mortality count, comparing the results from the HSCS methods with results based on an alternate imputation method, and with non-missing data.RESULTS: Overall, approximately 30% of the data points used in the HSCS were imputed. The method of imputation affected the association between particulate matter and mortality to a substantial degree in most of the cities. When the model using the HSCS method was compared to the model using the alternate method, in two areas the coefficients decreased substantially and lost significance. In two areas they changed little; in one area it rose substantially and became significant; and in one area it declined substantially but remained significant. When compared to the model based on the non-missing data, somewhat different patterns were observed. In both comparisons there were some large changes in the magnitude of the effect, but these were not consistent with the model used.CONCLUSIONS: We are concerned about the degree of data imputation and the effect that the method of imputation has on the association between particulate matter levels and mortality. In the case of the HSCS it appears that the imputed data are more strongly associated with the outcome than other methods of imputation and than the non-missing data. The reasons for these observations are not readily apparent, but the differences in effect should be explored and explained.

Utility of percentage of births to teenagers as a surrogate for the teen birth rate

OBJECTIVES

The teen birth rate is commonly used in comparing regional variation in teen pregnancies, but local teen birth rates are not always available. In this study the percentage of all births that are to teens was evaluated for its utility as a surrogate for the teen birth rate.

METHODS

Rank correlation and sensitivity and specificity analyses were used.

RESULTS

The Spearman rank correlations between percentage of teen births (PTB) and teen birth rate (TBR) were .995, .906, and .841 for the 3 age groups suggesting that it may be reasonable to employ PTB to prioritize zip codes. Zip codes with upper quartile levels of percentages of teen births identified zip codes with upper quartile levels of TBR with a sensitivity of 83.8%, 68.8%, and 65%; a false-positive rate of 2.1%, 8.6%, and 10%; and a positive predictive value of 89.3%, 67.6%, and 67.5% for the age groups 10 through 14, 15 through 17, and 18 through 19 years.

CONCLUSIONS

The percentage of births to teens is a useful surrogate for teen birth rate in California, especially among younger teenagers.

Cyclic stretching force selectively up-regulates transforming growth factor-beta isoforms in cultured rat mesangial cells

Glomerular distention from increased intraglomerular pressure stretches mesangial cells (MCs). Stretching MCs in culture stimulates extracellular matrix accumulation, suggesting that this may be a mechanism for glomerular hypertension-associated glomerulosclerosis. We examined whether mechanical stretching serves as a stimulus for the synthesis and activation of the prosclerotic molecule transforming growth factor (TGF)-beta, thus providing a potential system for auto-induction of extracellular matrix. Rat MCs cultured on flexible-bottom plates were subjected to cyclic stretching for up to 3 days and then assayed for TGF-beta mRNA, secretion of TGF-beta, and localization of active TGF-beta by immunostaining. MCs contained mRNA for all three mammalian isoforms of TGF-beta. Cyclic stretching for 36 hours increased TGF-beta1 and TGF-beta3 mRNA levels approximately twofold, without altering the levels of TGF-beta2 mRNA. This was followed at 48 to 72 hours by the increased secretion of both latent and active TGF-beta1. Latent, but not active, TGF-beta3 secretion also increased whereas the levels of TGF-beta2 were unaffected by mechanical force. The stretching force in this system is unequally distributed over the culture membrane. Localization of active TGF-beta by immunostaining demonstrated that the quantity of cell-associated cytokine across the culture was directly proportional to the zonal amplitude of the stretching force. These results demonstrate that stretching force stimulates MCs to selectively release and activate TGF-beta1. This mechanical induction of TGF-beta1 may help explain the increased extracellular matrix associated with intraglomerular hypertension.

Immunogold localization of high-affinity glucose transporter isoforms in normal rat kidney

BACKGROUND

Facilitative glucose transporters (GLUT) have unique kinetic characteristics and distributions suited to the functions of the tissues in which they reside. However, little is known about their individual roles in renal glucose metabolism, and previous investigations of renal GLUT expression have been extensive only with respect to their mRNA levels. We provide here a complete analysis of three GLUT isoforms along the nephron using a sensitive immunodetection method.

EXPERIMENTAL DESIGN

Normal rat kidneys were harvested, fixed in paraformaldehyde, and embedded in either paraffin or resin as required for immunogold labeling of individual GLUT Isoforms 1, 3, and 4. Samples were evaluated by light microscopy and selected regions analyzed by high resolution optical scanning with computer-assisted detection of immunogold-labeled GLUT at the subcellular level. We describe, compare, and related to the local patterns of glucose metabolism the cellular and subcellular expression patterns of these GLUT along the nephron.

RESULTS

GLUT1 was most intensely labeled in the medullary thick ascending limbs of Henle, cortical collecting ducts, and inner medullary collecting ducts. In contrast, GLUT3 was most prominent in the inner medullary collecting ducts and GLUT4 in medullary thick ascending limbs of Henle. All three GLUT were detected in glomerular tufts, and GLUT1 was also detected in parietal epithelial cells. The predominant subcellular distributions in tubule cells were: basolateral and basolateral/cytoplasmic for GLUT1; basolateral and cytoplasmic for GLUT3; and perinuclear/cytoplasmic for GLUT4. GLUT 1 and 3 expressions were confirmed in specific regions by immunoblotting.

CONCLUSIONS

1) GLUT 1, 3, and 4 are expressed in both glomeruli and renal tubules. 2) The unique GLUT expression patterns along the renal tubules suggests unique functional roles for these isoforms. 3) The renal cortex demonstrates lesser labeling intensity for the high-affinity GLUT compared with the medulla, where higher rates of glucose oxidation and glycolytic metabolism are paralleled by higher GLUT labeling intensities.