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Levitte S, Peale FV, Jhun I, McBride J, Neighbors M. Local Pentraxin-2 Deficit Is a Feature of Intestinal Fibrosis in Crohn's Disease. Dig Dis Sci 2023:10.1007/s10620-023-07909-1. [PMID: 36884186 DOI: 10.1007/s10620-023-07909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Pentraxin-2 (PTX-2) is a homo-pentameric plasma protein showing evidence of antifibrotic activity in Phase 2 clinical trials in idiopathic pulmonary fibrosis (IPF). Whether PTX-2 plays a role in other fibrotic diseases, including intestinal fibrosis which commonly occurs in inflammatory bowel disease (IBD), remains unknown. AIMS This study aimed to qualitatively and quantitatively assess PTX-2 expression in fibrostenotic Crohn's disease (FCD) and determine whether expression is correlated with postsurgical restenosis. METHODS Immunohistochemistry was performed in histologic sections of small bowel resected from patients with fibrostenotic Crohn's disease (FCD), comparing strictured segments with adjacent surgical margins from the same patient. Ileal resections from patients without inflammatory bowel disease were examined as controls. RESULTS PTX-2 signal was analyzed in 18 patients with FCD and 15 patients without IBD and localized predominantly to submucosal vasculature, including arterial subendothelium and internal elastic lamina, and perivascular connective tissue. PTX-2 signal in the surgical margins from patients with FCD strictures (where tissue architecture was normal) was consistently lower than non-IBD samples. Fibrostenotic regions showed increased PTX-2 signal relative to surgical margins from the same patient in 14/15 paired samples. Submucosal/mural PTX-2 signal in fibrostenotic tissue was lower in patients who subsequently experienced re-stenosis (P = 0.015). CONCLUSIONS This exploratory study is the first analysis of PTX-2 within the intestine, and demonstrates that PTX-2 signal is reduced in the architecturally normal bowel of patients with FCD. Lower submucosal PTX-2 levels in patients with re-stenosis raises the possibility of a protective role of PTX-2 in intestinal fibrosis.
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Affiliation(s)
- Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Stanford University, 750 Welch Rd Ste 116, Palo Alto, CA, 94304, USA.
| | - Franklin V Peale
- Research Pathology, Genentech Inc., South San Francisco, CA, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | - Jacqueline McBride
- OMNI Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - Margaret Neighbors
- OMNI Biomarker Development, Genentech Inc., South San Francisco, CA, USA
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2
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Rojansky R, Jhun I, Dussaq AM, Chirieleison SM, Nirschl JJ, Born D, Fralick J, Hetherington W, Kerr AM, Lavezo J, Lawrence DB, Lummus S, Macasaet R, Montine TJ, Ryan E, Shen J, Shoemaker J, Tan B, Vogel H, Waraich PS, Yang E, Young A, Folkins A. Rapid Deployment of Whole Slide Imaging for Primary Diagnosis in Surgical Pathology at Stanford Medicine: Responding to Challenges of the COVID-19 Pandemic. Arch Pathol Lab Med 2023; 147:359-367. [PMID: 35802938 PMCID: PMC9904534 DOI: 10.5858/arpa.2021-0438-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Stanford Pathology began stepwise subspecialty implementation of whole slide imaging (WSI) in 2018 soon after the first US Food and Drug Administration approval. In 2020, during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services waived the requirement for pathologists to perform diagnostic tests in Clinical Laboratory Improvement Amendments (CLIA)-licensed facilities. This encouraged rapid implementation of WSI across all surgical pathology subspecialties. OBJECTIVE.— To present our experience with validation and implementation of WSI at a large academic medical center encompassing a caseload of more than 50 000 cases per year. DESIGN.— Validation was performed independently for 3 subspecialty services with a diagnostic concordance threshold above 95%. Analysis of user experience, staffing, infrastructure, and information technology was performed after department-wide expansion. RESULTS.— Diagnostic concordance was achieved in 96% of neuropathology cases, 100% of gynecologic pathology cases, and 98% of immunohistochemistry cases. After full implementation, 8 high-capacity scanners were operational, with whole slide images generated on greater than 2000 slides per weekday, accounting for approximately 80% of histologic slides at Stanford Medicine. Multiple modifications in workflow and information technology were needed to improve performance. Within months of full implementation, most attending pathologists and trainees had adopted WSI for primary diagnosis. CONCLUSIONS.— WSI across all surgical subspecialities is achievable at scale at an academic medical center; however, adoption required flexibility to adjust workflows and develop tailored solutions. WSI at scale supported the health and safety of medical staff while facilitating high-quality patient care and education during COVID-19 restrictions.
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Affiliation(s)
- Rebecca Rojansky
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Iny Jhun
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Alex M Dussaq
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Steven M Chirieleison
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jeffrey J Nirschl
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Don Born
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jennifer Fralick
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - William Hetherington
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Alison M Kerr
- Clinical Operations (Kerr), Stanford Health Care, Stanford, California
| | - Jonathan Lavezo
- The Department of Pathology, Health Sciences Center, Texas Tech University, El Paso (Lavezo)
| | - Daniel B Lawrence
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Seth Lummus
- The Department of Human Physiology and Nutrition, University of Colorado, Colorado Springs (Lummus)
| | - Ronald Macasaet
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Thomas J Montine
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Emily Ryan
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jeanne Shen
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Jonathan Shoemaker
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Brent Tan
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Hannes Vogel
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - Puneet Singh Waraich
- Information Technology (Lawrence, Shoemaker, Waraich), Stanford Health Care, Stanford, California
| | - Eric Yang
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
| | - April Young
- Anatomic Pathology and Clinical Laboratories (Fralick, Hetherington, Macasaet, Young), Stanford Health Care, Stanford, California
| | - Ann Folkins
- From the Department of Pathology, School of Medicine, Stanford University, Stanford, California (Rojansky, Jhun, Dussaq, Chirieleison, Nirschl, Born, Montine, Ryan, Shen, Tan, Vogel, Yang, Folkins)
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3
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Huang AC, Ebel NH, Romero D, Martin B, Jhun I, Brown M, Enns GM, Esquivel C, Bonham C. Outcomes after liver transplantation in MPV17 deficiency (Navajo neurohepatopathy): A single-center case series. Pediatr Transplant 2022; 26:e14274. [PMID: 35466509 DOI: 10.1111/petr.14274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND MPV17-related mitochondrial DNA maintenance defect (MPV17 deficiency) is a rare, autosomal recessive mitochondrial DNA depletion syndrome with a high mortality rate in infancy and early childhood due to progression to liver failure. Liver transplantation for children with MPV17 deficiency has been considered controversial due to uncertainty about the potential progression of extrahepatic manifestations following liver transplantation. METHODS We describe our institution's experience for two infants diagnosed with infantile MPV17 deficiency who presented in acute on chronic liver failure, but with normal development and normal neurological status who successfully underwent liver transplantation. RESULTS Both patients underwent successful liver transplantation with normal development and neurological status at 3 years and 16 months post-transplant, respectively. CONCLUSIONS In this rare disease population, we describe two infants with MPV17 deficiency who underwent liver transplantation for acute on chronic liver failure who continue to have normal development, without progression of neurological disease. MPV17 deficiency should not be considered a contraindication to liver transplantation.
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Affiliation(s)
- Alice C Huang
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Noelle H Ebel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Danielle Romero
- Department of Pediatric Liver Transplant, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Brock Martin
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Palo Alto, California, USA
| | - Megan Brown
- Department of Pediatric Liver Transplant, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Gregory M Enns
- Division of Medical Genetics, Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Stanford University, Palo Alto, California, USA
| | - Carlos Esquivel
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Clark Bonham
- Division of Abdominal Transplantation, Department of Surgery, Stanford University, Palo Alto, California, USA
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4
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Fann N, Coffman E, Jackson M, Jhun I, Lamichhane A, Nolte CG, Roman H, Sacks JD. The Role of Temperature in Modifying the Risk of Ozone-Attributable Mortality under Future Changes in Climate: A Proof-of-Concept Analysis. Environ Sci Technol 2022; 56:1202-1210. [PMID: 34965106 PMCID: PMC9359214 DOI: 10.1021/acs.est.1c05975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Air pollution risk assessments typically estimate ozone-attributable mortality counts using concentration-response (C-R) parameters from epidemiologic studies that treat temperature as a potential confounder. However, some recent epidemiologic studies have indicated that temperature can modify the relationship between short-term ozone exposure and mortality, which has potentially important implications when considering the impacts of climate change on public health. This proof-of-concept analysis quantifies counts of temperature-modified ozone-attributable mortality using temperature-stratified C-R parameters from a multicity study in which the pooled ozone-mortality effect coefficients change in concert with daily temperature. Meteorology downscaled from two global climate models is used with a photochemical transport model to simulate ozone concentrations over the 21st century using two emission inventories: one holding air pollutant emissions constant at 2011 levels and another accounting for reduced emissions through the year 2040. The late century climate models project increased summer season temperatures, which in turn yields larger total counts of ozone-attributable deaths in analyses using temperature-stratified C-R parameters compared to the traditional temperature confounder approach. This analysis reveals substantial heterogeneity in the magnitude and distribution of the temperature-stratified ozone-attributable mortality results, which is a function of regional variability in both the C-R relationship and the model-predicted temperature and ozone.
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Affiliation(s)
- Neal Fann
- U.S. EPA Office of Air Quality Planning and Standards,
Research Triangle Park NC 27711 USA
| | - Evan Coffman
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
| | | | - Iny Jhun
- Stanford Health Care, San Francisco, CA 94305 USA
| | - Archana Lamichhane
- U.S. EPA Office of Air Quality Planning and Standards,
Research Triangle Park NC 27711 USA
| | - Christopher G. Nolte
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
| | - Henry Roman
- Industrial Economics Inc, Cambridge, MA 02140 USA
| | - Jason D. Sacks
- U.S. EPA Office of Research and Development, Research
Triangle Park, NC 27711 USA
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5
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Synn AJ, Margerie-Mellon CD, Jeong SY, Rahaghi FN, Jhun I, Washko GR, Estépar RSJ, Bankier AA, Mittleman MA, VanderLaan PA, Rice MB. Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography. Pulm Circ 2021; 11:20458940211061284. [PMID: 34881020 PMCID: PMC8647266 DOI: 10.1177/20458940211061284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
Pulmonary hypertension is characterized histologically by intimal and medial
thickening in the small pulmonary arteries, eventually resulting in vascular
“pruning.” Computed tomography (CT)-based quantification of pruning is
associated with clinical measures of pulmonary hypertension, but it is not
established whether CT-based pruning correlates with histologic arterial
remodeling. Our sample consisted of 138 patients who underwent resection for
early-stage lung adenocarcinoma. From histologic sections, we identified small
pulmonary arteries and measured the relative area comprising the intima and
media (VWA%), with higher VWA% representing greater histologic remodeling. From
pre-operative CTs, we used image analysis algorithms to calculate the small
vessel volume fraction (BV5/TBV) as a CT-based indicator of pruning (lower
BV5/TBV represents greater pruning). We investigated relationships of CT pruning
and histologic remodeling using Pearson correlation, simple linear regression,
and multivariable regression with adjustment for age, sex, height, weight,
smoking status, and total pack-years. We also tested for effect modification by
sex and smoking status. In primary models, more severe CT pruning was associated
with greater histologic remodeling. The Pearson correlation coefficient between
BV5/TBV and VWA% was –0.41, and in linear regression models, VWA% was 3.13%
higher (95% CI: 1.95–4.31%, p < 0.0001) per standard deviation lower BV5/TBV.
This association persisted after multivariable adjustment. We found no evidence
that these relationships differed by sex or smoking status. Among individuals
who underwent resection for lung adenocarcinoma, more severe CT-based vascular
pruning was associated with greater histologic arterial remodeling. These
findings suggest CT imaging may be a non-invasive indicator of pulmonary
vascular pathology.
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Affiliation(s)
- Andrew J Synn
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Farbod N Rahaghi
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - George R Washko
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Department of Radiology, University of Massachusetts Medical School, Worchester, MA, USA
| | - Murray A Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mary B Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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6
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van der Wal D, Jhun I, Laklouk I, Nirschl J, Richer L, Rojansky R, Theparee T, Wheeler J, Sander J, Feng F, Mohamad O, Savarese S, Socher R, Esteva A. Biological data annotation via a human-augmenting AI-based labeling system. NPJ Digit Med 2021; 4:145. [PMID: 34620993 PMCID: PMC8497580 DOI: 10.1038/s41746-021-00520-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Biology has become a prime area for the deployment of deep learning and artificial intelligence (AI), enabled largely by the massive data sets that the field can generate. Key to most AI tasks is the availability of a sufficiently large, labeled data set with which to train AI models. In the context of microscopy, it is easy to generate image data sets containing millions of cells and structures. However, it is challenging to obtain large-scale high-quality annotations for AI models. Here, we present HALS (Human-Augmenting Labeling System), a human-in-the-loop data labeling AI, which begins uninitialized and learns annotations from a human, in real-time. Using a multi-part AI composed of three deep learning models, HALS learns from just a few examples and immediately decreases the workload of the annotator, while increasing the quality of their annotations. Using a highly repetitive use-case-annotating cell types-and running experiments with seven pathologists-experts at the microscopic analysis of biological specimens-we demonstrate a manual work reduction of 90.60%, and an average data-quality boost of 4.34%, measured across four use-cases and two tissue stain types.
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Affiliation(s)
| | - Iny Jhun
- Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA
| | - Israa Laklouk
- University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Jeff Nirschl
- Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA
| | - Lara Richer
- University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | | | - Talent Theparee
- University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Joshua Wheeler
- Stanford University, 450 Serra Mall, Stanford, CA, 94305, USA
| | - Jörg Sander
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | - Felix Feng
- University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Osama Mohamad
- University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Silvio Savarese
- Salesforce AI Research, 575 High St, Palo Alto, CA, 94301, USA
| | - Richard Socher
- Salesforce AI Research, 575 High St, Palo Alto, CA, 94301, USA
| | - Andre Esteva
- Salesforce AI Research, 575 High St, Palo Alto, CA, 94301, USA.
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7
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Jhun I, Shepherd D, Hung YP, Madrigal E, Le LP, Mino-Kenudson M. Digital Image Analysis for Estimating Stromal CD8+ Tumor-Infiltrating Lymphocytes in Lung Adenocarcinoma. J Pathol Inform 2021; 12:28. [PMID: 34447608 PMCID: PMC8359732 DOI: 10.4103/jpi.jpi_36_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Stromal CD8+ tumor-infiltrating lymphocytes (TILs) are an important prognostic and predictive indicator in non-small cell lung cancer (NSCLC). In this study, we aimed to develop and test the feasibility of a digital image analysis (DIA) workflow for estimating stromal CD8+ TIL density. Methods: A DIA workflow developed in a software platform (QuPath) was applied to a specified region of interest (ROI) within the stromal compartment of dual PD-L1/CD8 immunostained slides from 50 lung adenocarcinoma patients. A random tree classifier was trained from 25 training cases and applied to 25 test cases. The DIA-estimated CD8+ TIL densities were compared to manual estimates of three pathologists, who independently quantitated the percentage of CD8+ TILs from predefined ROIs in QuPath. Results: The average estimated total stromal cell count per case was 520 (range: 282–816) by QuPath and 551 (range: 265–744) by pathologists. The DIA-estimated CD8+ TIL density (mean = 16.9%) was comparable to pathologists' manual estimates (mean = 15.9%). A paired t-test showed no statistically significant difference between DIA and pathologist estimates of CD8+ TIL density among both training (n = 25, P = 0.55) and test (n = 25, P = 0.34) cases. There was an almost perfect agreement between QuPath and each pathologist's estimates of CD8+ TIL density (κ = 0.85–0.86). Conclusions: These findings demonstrate the feasibility of applying a DIA workflow for estimating stromal CD8+ TIL density in NSCLC. DIA has the potential to provide an efficient and standardized approach for estimating stromal CD8+ TIL density.
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Affiliation(s)
- Iny Jhun
- Department of Pathology, Stanford Health Care, Palo Alto, CA, USA
| | - Daniel Shepherd
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Emilio Madrigal
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Long P Le
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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8
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Jhun I, Levy D, Lim H, Herrera Q, Dobo E, Burns D, Hetherington W, Macasaet R, Young AJ, Kong CS, Folkins AK, Yang EJ. Implementation of Collodion Bag Protocol to Improve Whole-slide Imaging of Scant Gynecologic Curettage Specimens. J Pathol Inform 2021; 12:2. [PMID: 34012706 PMCID: PMC8112341 DOI: 10.4103/jpi.jpi_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/20/2020] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Digital pathology has been increasingly implemented for primary surgical pathology diagnosis. In our institution, digital pathology was recently deployed in the gynecologic (GYN) pathology practice. A notable challenge encountered in the digital evaluation of GYN specimens was high rates of scanning failure of specimens with fragmented as well as scant tissue. To improve tissue detection failure rates, we implemented a novel use of the collodion bag cell block preparation method. Materials and Methods: In this study, we reviewed 108 endocervical curettage (ECC) specimens, representing specimens processed with and without the collodion bag cell block method (n = 56 without collodion bag, n = 52 with collodion bag). Results: Tissue detection failure rates were reduced from 77% (43/56) in noncollodion bag cases to 23/52 (44%) of collodion bag cases, representing a 42% reduction. The median total area of tissue detection failure per level was 0.35 mm2 (interquartile range [IQR]: 0.14, 0.70 mm2) for noncollodion bag cases and 0.08 mm2 (IQR: 0.03, 0.20 mm2) for collodion bag cases. This represents a greater than fourfold reduction in the total area of tissue detection failure per level (P < 0.001). In addition, there were no out-of-focus levels among collodion bag cases, compared to 6/56 (11%) of noncollodion bag cases (median total area = 4.9 mm2). Conclusions: The collodion bag method significantly improved the digital image quality of fragmented/scant GYN curettage specimens, increased efficiency and accuracy of diagnostic evaluation, and enhanced identification of tissue contamination during processing. The logistical challenges and labor cost of deploying the collodion bag protocol are important considerations for feasibility assessment at an institutional level.
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Affiliation(s)
- Iny Jhun
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - David Levy
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Harumi Lim
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Quintina Herrera
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Erika Dobo
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Dominique Burns
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - William Hetherington
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Ronald Macasaet
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - April J Young
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Christina S Kong
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Ann K Folkins
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Eric Joon Yang
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, USA
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9
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King DA, Pineda G, Jhun I, Fisher G. Marked Decrease in CA 19-9 Level Belies Rapidly Progressive Lymphangitic Carcinomatosis in a Case of Metastatic Pancreatic Cancer. J Pancreat Cancer 2020; 6:102-106. [PMID: 33269335 PMCID: PMC7703254 DOI: 10.1089/pancan.2020.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/12/2022] Open
Abstract
Background: The CA 19-9 tumor marker is commonly used alongside imaging to trend chemotherapy response in patients with pancreatic ductal adenocarcinoma. Presentation: We describe an unusual clinical case of metastatic pancreatic cancer who achieved a marked decline in CA 19-9 but paradoxically developed widespread pulmonary lymphangitic carcinomatosis leading to rapid clinical decline and death. Conclusions: This case highlights the limitations of using the CA 19-9 tumor marker in isolation.
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Affiliation(s)
- Daniel A King
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Gino Pineda
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Stanford, California, USA
| | - George Fisher
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
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10
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Borge R, Requia WJ, Yagüe C, Jhun I, Koutrakis P. Impact of weather changes on air quality and related mortality in Spain over a 25 year period [1993-2017]. Environ Int 2019; 133:105272. [PMID: 31675571 DOI: 10.1016/j.envint.2019.105272] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/02/2019] [Accepted: 10/14/2019] [Indexed: 05/02/2023]
Abstract
Climate change is a major public health concern. In addition to its direct impacts on temperature patterns and extreme weather events, climate change affects public health indirectly through its influence on air quality. Pollution trends are not only affected by emissions changes but also by weather changes. In this paper we analyze air quality trends in Spain of important air pollutants (C6H6, CO, NO2, NOx, O3, PM10, PM2.5, and SO2) recorded during the last 25 years, from 1993 to 2017. We found substantial reductions in ambient concentration levels for all the pollutants studied except for O3. To assess the influence of recent weather changes on air quality trends we applied generalized additive models (GAMs) using nonparametric smoothing; with and without adjusting for weather parameters including temperature, wind speed, humidity and precipitation frequency. The difference of annual slopes estimated by the models without and with adjusting for these meteorological variables represents the impact of weather changes on pollutant trends, i.e. the 'weather penalty'. The analyses were seasonally and geographically stratified to account for temporal and regional differences across Spain. The results were meta-analyzed to estimate weather penalties on ambient concentration trends at a national level as well as the impact on mortality for the most relevant pollutants. We found significant penalties for most pollutants, implying that air quality would have improved even more during our study period if weather conditions had remained constant. The largest weather influences were found for PM10, with seasonal penalties up to 22 μg⋅m-3 accumulated over the 25-year period in some regions. The national meta-analysis shows penalties of 0.060 μg⋅m-3 per year (95% Confidence Interval, CI: 0.004, 0.116) in cold months and 0.127 μg⋅m-3 per year (95% CI: 0.089, 0.164) in warm months. Penalties of this magnitude would correspond to 129 annual deaths (95% CI: 25, 233), i.e. approximately 3200 deaths over the 25-year period in Spain. According to our results, the health benefits of recent emission abatements for this pollutant in Spain would have been up to 10% greater if weather conditions had remained constant during the last 25 years.
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Affiliation(s)
- Rafael Borge
- Harvard University, School of Public Health, 401 Park Drive, Landmark Center 4th Floor West, Boston, MA 02115, United States; Universidad Politécnica de Madrid (UPM), Environmental Modelling Laboratory, Department of Chemical & Environmental Engineering, C/ José Gutiérrez Abascal 2, 28006 Madrid, Spain.
| | - Weeberb J Requia
- Harvard University, School of Public Health, 401 Park Drive, Landmark Center 4th Floor West, Boston, MA 02115, United States
| | - Carlos Yagüe
- Department of Earth Physics and Astrophysics, University Complutense of Madrid, Faculty of Physical Sciences, E-28040 Madrid, Spain
| | - Iny Jhun
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02215, United States
| | - Petros Koutrakis
- Harvard University, School of Public Health, 401 Park Drive, Landmark Center 4th Floor West, Boston, MA 02115, United States
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11
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Requia WJ, Jhun I, Coull BA, Koutrakis P. Climate impact on ambient PM 2.5 elemental concentration in the United States: A trend analysis over the last 30 years. Environ Int 2019; 131:104888. [PMID: 31302483 DOI: 10.1016/j.envint.2019.05.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 05/02/2023]
Abstract
Weather impacts on the chemical composition of PM2.5 varies significantly over space and time given the diversity of particle components and the complex mechanisms governing particle formation and removal. In this study, we employed generalized additive models (GAMs) to estimate weather-associated changes in PM2.5 composition in the US during 1988-2017. We considered seven components of ambient PM2.5, which included elemental carbon (EC), organic carbon (OC), nitrate, sulfate, sodium, ammonium, and silicon. The impact of long-term weather changes on each PM2.5 component was defined in our study as "weather penalty". During our study period, temperature increased in four regions, including the Industrial Midwest and Northeast during the warm and cold season; and Upper Midwest and West in the cold season. Wind speed decreased in the both seasons. Relative humidity increased in the warm season and decreased in the cold season. The weather changes between 1988 and 2017 were associated with most PM2.5 components during both warm and cold seasons. The direction and the magnitude of the weather penalty varied considerably over the space and season. In the warm season, our findings suggest a nationwide weather penalty for EC, OC, nitrate, sulfate, sodium, ammonium, and silicon of 0.04, 0.21, 0.04, 0.35, -0.01, 0.05, and 0.01 μg/m3, respectively. In the cold season, the estimated total penalty was 0.04, 0.21, 0.06, 0.04, -0.01, -0.02, and 0.02 μg/m3, respectively.
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Affiliation(s)
- Weeberb J Requia
- Harvard University, Department of Environmental Health, School of Public Health, Boston, MA, United States.
| | - Iny Jhun
- Harvard University, Harvard Medical School, Boston, MA, United States
| | - Brent A Coull
- Harvard University, Department of Biostatistics, School of Public Health, Boston, MA, United States
| | - Petros Koutrakis
- Harvard University, Department of Environmental Health, School of Public Health, Boston, MA, United States
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12
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Jhun I, Kim J, Cho B, Gold DR, Schwartz J, Coull BA, Zanobetti A, Rice MB, Mittleman MA, Garshick E, Vokonas P, Bind MA, Wilker EH, Dominici F, Suh H, Koutrakis P. Synthesis of Harvard Environmental Protection Agency (EPA) Center studies on traffic-related particulate pollution and cardiovascular outcomes in the Greater Boston Area. J Air Waste Manag Assoc 2019; 69:900-917. [PMID: 30888266 PMCID: PMC6650311 DOI: 10.1080/10962247.2019.1596994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/11/2019] [Indexed: 05/24/2023]
Abstract
The association between particulate pollution and cardiovascular morbidity and mortality is well established. While the cardiovascular effects of nationally regulated criteria pollutants (e.g., fine particulate matter [PM2.5] and nitrogen dioxide) have been well documented, there are fewer studies on particulate pollutants that are more specific for traffic, such as black carbon (BC) and particle number (PN). In this paper, we synthesized studies conducted in the Greater Boston Area on cardiovascular health effects of traffic exposure, specifically defined by BC or PN exposure or proximity to major roadways. Large cohort studies demonstrate that exposure to traffic-related particles adversely affect cardiac autonomic function, increase systemic cytokine-mediated inflammation and pro-thrombotic activity, and elevate the risk of hypertension and ischemic stroke. Key patterns emerged when directly comparing studies with overlapping exposure metrics and population cohorts. Most notably, cardiovascular risk estimates of PN and BC exposures were larger in magnitude or more often statistically significant compared to those of PM2.5 exposures. Across multiple exposure metrics (e.g., short-term vs. long-term; observed vs. modeled) and different population cohorts (e.g., elderly, individuals with co-morbidities, young healthy individuals), there is compelling evidence that BC and PN represent traffic-related particles that are especially harmful to cardiovascular health. Further research is needed to validate these findings in other geographic locations, characterize exposure errors associated with using monitored and modeled traffic pollutant levels, and elucidate pathophysiological mechanisms underlying the cardiovascular effects of traffic-related particulate pollutants. Implications: Traffic emissions are an important source of particles harmful to cardiovascular health. Traffic-related particles, specifically BC and PN, adversely affect cardiac autonomic function, increase systemic inflammation and thrombotic activity, elevate BP, and increase the risk of ischemic stroke. There is evidence that BC and PN are associated with greater cardiovascular risk compared to PM2.5. Further research is needed to elucidate other health effects of traffic-related particles and assess the feasibility of regulating BC and PN or their regional and local sources.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jina Kim
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Diane R. Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Mary B. Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Murray A. Mittleman
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eric Garshick
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Pulmonary, Allergy, Sleep and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
| | - Marie-Abele Bind
- Faculty of Arts and Sciences, Science Center, Harvard University, Cambridge, MA
| | - Elissa H. Wilker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
- Sanofi Genzyme, Cambridge, MA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Helen Suh
- Tufts University, Department of Civil and Environmental Engineering, Medford, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
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13
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Blomberg AJ, Coull BA, Jhun I, Vieira CLZ, Zanobetti A, Garshick E, Schwartz J, Koutrakis P. Effect modification of ambient particle mortality by radon: A time series analysis in 108 U.S. cities. J Air Waste Manag Assoc 2019; 69:266-276. [PMID: 30230977 PMCID: PMC6391221 DOI: 10.1080/10962247.2018.1523071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 05/21/2023]
Abstract
Numerous studies have reported a positive association between ambient fine particles and daily mortality, but little is known about the particle properties or environmental factors that may contribute to these effects. This study assessed potential modification of radon on PM2.5 (particulate matter with an aerodynamic diameter <2.5 μm)-associated daily mortality in 108 U.S. cities using a two-stage statistical approach. First, city- and season-specific PM2.5 mortality risks were estimated using over-dispersed Poisson regression models. These PM2.5 effect estimates were then regressed against mean city-level residential radon concentrations to estimate overall PM2.5 effects and potential modification by radon. Radon exposure estimates based on measured short-term basement concentrations and modeled long-term living-area concentrations were both assessed. Exposure to PM2.5 was associated with total, cardiovascular, and respiratory mortality in both the spring and the fall. In addition, higher mean city-level radon concentrations increased PM2.5-associated mortality in the spring and fall. For example, a 10 µg/m3 increase in PM2.5 in the spring at the 10th percentile of city-averaged short-term radon concentrations (21.1 Bq/m3) was associated with a 1.92% increase in total mortality (95% CI: 1.29, 2.55), whereas the same PM2.5 exposure at the 90th radon percentile (234.2 Bq/m3) was associated with a 3.73% increase in total mortality (95% CI: 2.87, 4.59). Results were robust to adjustment for spatial confounders, including average planetary boundary height, population age, percent poverty and tobacco use. While additional research is necessary, this study suggests that radon enhances PM2.5 mortality. This is of significant regulatory importance, as effective regulation should consider the increased risk for particle mortality in cities with higher radon levels. Implications: In this large national study, city-averaged indoor radon concentration was a significant effect modifier of PM2.5-associated total, cardiovascular, and respiratory mortality risk in the spring and fall. These results suggest that radon may enhance PM2.5-associated mortality. In addition, local radon concentrations partially explain the significant variability in PM2.5 effect estimates across U.S. cities, noted in this and previous studies. Although the concept of PM as a vector for radon progeny is feasible, additional research is needed on the noncancer health effects of radon and its potential interaction with PM. Future air quality regulations may need to consider the increased risk for particle mortality in cities with higher radon levels.
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Affiliation(s)
- Annelise J. Blomberg
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Brent A. Coull
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Iny Jhun
- Harvard Medical School, Boston, MA, USA
| | - Carolina L. Z. Vieira
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, VA Boston Healthcare System, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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14
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Ogino S, Jhun I, Mata DA, Soong TR, Hamada T, Liu L, Nishihara R, Giannakis M, Cao Y, Manson JE, Nowak JA, Chan AT. Integration of pharmacology, molecular pathology, and population data science to support precision gastrointestinal oncology. NPJ Precis Oncol 2017; 1. [PMID: 29552640 PMCID: PMC5856171 DOI: 10.1038/s41698-017-0042-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Precision medicine has a goal of customizing disease prevention and treatment strategies. Under the precision medicine paradigm, each patient has unique pathologic processes resulting from cellular genomic, epigenomic, proteomic, and metabolomic alterations, which are influenced by pharmacological, environmental, microbial, dietary, and lifestyle factors. Hence, to realize the promise of precision medicine, multi-level research methods that can comprehensively analyze many of these variables are needed. In order to address this gap, the integrative field of molecular pathology and population data science (i.e., molecular pathological epidemiology) has been developed to enable such multi-level analyses, especially in gastrointestinal cancer research. Further integration of pharmacology can improve our understanding of drug effects, and inform decision-making of drug use at both the individual and population levels. Such integrative research demonstrated potential benefits of aspirin in colorectal carcinoma with PIK3CA mutations, providing the basis for new clinical trials. Evidence also suggests that HPGD (15-PDGH) expression levels in normal colon and the germline rs6983267 polymorphism that relates to tumor CTNNB1 (β-catenin)/WNT signaling status may predict the efficacy of aspirin for cancer chemoprevention. As immune checkpoint blockade targeting the CD274 (PD-L1)/PDCD1 (PD-1) pathway for microsatellite instability-high (or mismatch repair-deficient) metastatic gastrointestinal or other tumors has become standard of care, potential modifying effects of dietary, lifestyle, microbial, and environmental factors on immunotherapy need to be studied to further optimize treatment strategies. With its broad applicability, our integrative approach can provide insights into the interactive role of medications, exposures, and molecular pathology, and guide the development of precision medicine.
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Affiliation(s)
- Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Iny Jhun
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Douglas A Mata
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thing Rinda Soong
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Hamada
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Li Liu
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reiko Nishihara
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marios Giannakis
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yin Cao
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan A Nowak
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Jhun I, Lai PS, Phipatanakul W. Reply. J Allergy Clin Immunol Pract 2017; 5:1165-1166. [PMID: 28689836 DOI: 10.1016/j.jaip.2017.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Iny Jhun
- Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Mass; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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16
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Hanyuda A, Cao Y, Hamada T, Nowak JA, Qian ZR, Masugi Y, da Silva A, Liu L, Kosumi K, Soong TR, Jhun I, Wu K, Zhang X, Song M, Meyerhardt JA, Chan AT, Fuchs CS, Giovannucci EL, Ogino S, Nishihara R. Body mass index and risk of colorectal carcinoma subtypes classified by tumor differentiation status. Eur J Epidemiol 2017; 32:393-407. [PMID: 28510098 DOI: 10.1007/s10654-017-0254-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/06/2017] [Indexed: 12/19/2022]
Abstract
Previous studies suggest that abnormal energy balance status may dysregulate intestinal epithelial homeostasis and promote colorectal carcinogenesis, yet little is known about how host energy balance and obesity influence enterocyte differentiation during carcinogenesis. We hypothesized that the association between high body mass index (BMI) and colorectal carcinoma incidence might differ according to tumor histopathologic differentiation status. Using databases of the Nurses' Health Study and Health Professionals Follow-up Study, and duplication-method Cox proportional hazards models, we prospectively examined an association between BMI and the incidence of colorectal carcinoma subtypes classified by differentiation features. 120,813 participants were followed for 26 or 32 years and 1528 rectal and colon cancer cases with available tumor pathological data were documented. The association between BMI and colorectal cancer risk significantly differed depending on the presence or absence of poorly-differentiated foci (Pheterogeneity = 0.006). Higher BMI was associated with a higher risk of colorectal carcinoma without poorly-differentiated foci (≥30.0 vs. 18.5-22.4 kg/m2: multivariable-adjusted hazard ratio, 1.87; 95% confidence interval, 1.49-2.34; Ptrend < 0.001), but not with risk of carcinoma with poorly-differentiated foci (Ptrend = 0.56). This differential association appeared to be consistent in strata of tumor microsatellite instability or FASN expression status, although the statistical power was limited. The association between BMI and colorectal carcinoma risk did not significantly differ by overall tumor differentiation, mucinous differentiation, or signet ring cell component (Pheterogeneity > 0.03, with the adjusted α of 0.01). High BMI was associated with risk of colorectal cancer subtype containing no poorly-differentiated focus. Our findings suggest that carcinogenic influence of excess energy balance might be stronger for tumors that retain better intestinal differentiation throughout the tumor areas.
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Affiliation(s)
- Akiko Hanyuda
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yin Cao
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tsuyoshi Hamada
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Jonathan A Nowak
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhi Rong Qian
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yohei Masugi
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Annacarolina da Silva
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Li Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Keisuke Kosumi
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Thing Rinda Soong
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Iny Jhun
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA. .,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Reiko Nishihara
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Broad Institute of MIT and Harvard, Cambridge, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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17
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Keum N, Yuan C, Nishihara R, Zoltick E, Hamada T, Martinez Fernandez A, Zhang X, Hanyuda A, Liu L, Kosumi K, Nowak JA, Jhun I, Soong TR, Morikawa T, Tabung FK, Qian ZR, Fuchs CS, Meyerhardt JA, Chan AT, Ng K, Ogino S, Giovannucci EL, Wu K. Dietary glycemic and insulin scores and colorectal cancer survival by tumor molecular biomarkers. Int J Cancer 2017; 140:2648-2656. [PMID: 28268248 DOI: 10.1002/ijc.30683] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/12/2017] [Accepted: 02/27/2017] [Indexed: 12/31/2022]
Abstract
Accumulating evidence suggests that post-diagnostic insulin levels may influence colorectal cancer (CRC) survival. Yet, no previous study has examined CRC survival in relation to a post-diagnostic diet rich in foods that increase post-prandial insulin levels. We hypothesized that glycemic and insulin scores (index or load; derived from food frequency questionnaire data) may be associated with survival from specific CRC subtypes sensitive to the insulin signaling pathway. We prospectively followed 1,160 CRC patients from the Nurses' Health Study (1980-2012) and Health Professionals Follow-Up Study (1986-2012), resulting in 266 CRC deaths in 10,235 person-years. CRC subtypes were defined by seven tumor biomarkers (KRAS, BRAF, PIK3CA mutations, and IRS1, IRS2, FASN and CTNNB1 expression) implicated in the insulin signaling pathway. For overall CRC and each subtype, hazard ratio (HR) and 95% confidence interval (95% CI) for an increase of one standard deviation in each of glycemic and insulin scores were estimated using time-dependent Cox proportional hazards model. We found that insulin scores, but not glycemic scores, were positively associated with CRC mortality (HR = 1.19, 95% CI = 1.02-1.38 for index; HR = 1.23, 95% CI = 1.04-1.47 for load). The significant positive associations appeared more pronounced among PIK3CA wild-type cases and FASN-negative cases, with HR ranging from 1.36 to 1.60 across insulin scores. However, we did not observe statistically significant interactions of insulin scores with PIK3CA, FASN, or any other tumor marker (p interaction > 0.12). While additional studies are needed for definitive evidence, a high-insulinogenic diet after CRC diagnosis may contribute to worse CRC survival.
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Affiliation(s)
- NaNa Keum
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Chen Yuan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Reiko Nishihara
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Biostatics, Harvard T.H. Chan School of Public Health, Boston, MA.,Division of MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Emilie Zoltick
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Tsuyoshi Hamada
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Akiko Hanyuda
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Li Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.,Department of Epidemiology and Biostatistics and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Keisuke Kosumi
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Jonathan A Nowak
- Division of MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Iny Jhun
- Division of MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - T Rinda Soong
- Division of MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Fred K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Zhi Rong Qian
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Charles S Fuchs
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Department of Medicine, Yale School of Medicine, New Haven, CT.,Smilow Cancer Hospital, New Haven, CT
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.,Division of MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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von Rundstedt FC, Mata DA, Kryvenko ON, Shah AA, Jhun I, Lerner SP. Utility of Clinical Risk Stratification in the Selection of Muscle-Invasive Bladder Cancer Patients for Neoadjuvant Chemotherapy: A Retrospective Cohort Study. Bladder Cancer 2017; 3:35-44. [PMID: 28149933 PMCID: PMC5271426 DOI: 10.3233/blc-160062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Level I evidence supports the use of cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer prior to radical cystectomy (RC). On average, 30–40% of patients achieve a complete pathologic response (i.e., stage pT0) after receiving NAC. Some centers risk-stratify patients, suggesting that there may be a higher-risk population that would derive the most benefit from NAC. Recently, a risk-stratification model developed at M.D. Anderson Cancer Center (MDACC) specified criteria for clinical staging and patient selection for NAC. We applied this model to our own RC patient cohort and evaluated our own experience with clinical risk stratification and the effect of NAC on post treatment risk categories. Methods: We retrospectively reviewed the charts of consecutive patients who underwent RC at two institutions between 2004 and 2014 and noted whether or not they received NAC. We determined the clinical stage by reviewing the exam under anesthesia, transurethral resection biopsy (TURBT) pathology, and preoperative imaging. Patients with cT2-T4a node-negative disease were included. Those with sarcomatoid features or adenocarcinoma were excluded. Patients were classified as high risk if they had tumor-associated hydronephrosis, clinical stage≥T3b-T4a disease, variant histology (i.e., micropapillary or small cell), or lymphovascular invasion (LVI), as specified by the MDACC model. Variables were examined for associations with cancer-specific survival (CSS), overall survival (OS), and risk-category reclassification. Results: We identified 166 patients with a median follow-up time of 22.2 months. In all, 117 patients (70.5%) did not receive NAC, 68 (58.1%) of whom we classified as high risk. Among patients not receiving NAC, CSS and OS were significantly decreased in high-risk patients (log-rank test p = 0.01 for both comparisons). The estimated age-adjusted hazard ratios of high-risk classification for cancer-specific and overall death were 3.2 (95% CI: 1.2 to 8.6) and 2.2 (95% CI: 1.1 to 4.4), respectively. On post-RC final pathology, 23 (46.9%) low-risk patients were up-classified to high risk and 17 (25.0%) high-risk patients were down-classified. Complete pathologic responses (pT0) were achieved in 7 (6.0%) patients and partial responses (pT1, pTa, pTis) were achieved in 28 (23.9%) patients. Of the 49 patients who did receive NAC, 43 (87.8%) received cisplatin-based and six (12.2%) received carboplatin-based regimens. Applying the MDACC model, we categorized 41 (83.7%) patients as high risk prior to NAC treatment. On final pathology, 3 (37.5%) low-risk patients were up-classified and 17 (41.5%) high-risk patients were down-classified. Complete pathologic responses (pT0) were seen in 13 (26.5%) patients and partial responses were seen in 10 (20.4%) patients. Although the utilization of NAC was not statistically significantly associated with CSS or OS (log-rank test p > 0.05 for both comparisons), it was associated with a 1.2 times increased odds (95% CI: 0.4 to 2.1) of post-RC reclassification from high to low risk on age-adjusted logistic regression. Conclusions: We found similar results using the clinical risk-stratification model in our cohort and showed that the high-risk category was associated with lower CSS and OS. NAC was associated with a higher probability of risk reclassification from high to low risk.
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Affiliation(s)
- Friedrich-Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Urology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, MA, USA
| | - Oleksandr N Kryvenko
- Departments of Pathology and Urology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , FL, USA
| | - Anup A Shah
- Department of Urology, University of Pittsburgh Medical Center , PA, USA
| | - Iny Jhun
- Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, MA, USA
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine , Houston, TX, USA
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Jhun I, Gaffin JM, Coull BA, Huffaker MF, Petty CR, Sheehan WJ, Baxi SN, Lai PS, Kang CM, Wolfson JM, Gold DR, Koutrakis P, Phipatanakul W. School Environmental Intervention to Reduce Particulate Pollutant Exposures for Children with Asthma. J Allergy Clin Immunol Pract 2017; 5:154-159.e3. [PMID: 27641483 PMCID: PMC5222771 DOI: 10.1016/j.jaip.2016.07.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/29/2016] [Accepted: 07/25/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting. OBJECTIVE We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma. METHODS In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 children with asthma (13 control, 12 intervention) aged 6 to 10 years. Classroom air pollutant measurements and spirometry were completed once before and twice after randomization. Asthma symptoms were surveyed every 3 months. RESULTS Baseline classroom levels of fine particulate matter (particulate matter with diameter of <2.5 μm [PM2.5]) and black carbon (BC) were 6.3 and 0.41 μg/m3, respectively. When comparing the intervention to the control group, classroom PM2.5 levels were reduced by 49% and 42% and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (P < .05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV1) and asthma symptoms. CONCLUSIONS In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.
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Affiliation(s)
- Iny Jhun
- Harvard Medical School, Boston, Mass
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Mass; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass
| | - Brent A Coull
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Michelle F Huffaker
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Sachin N Baxi
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Choong-Min Kang
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Jack M Wolfson
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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20
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Affiliation(s)
- Iny Jhun
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Massachusetts, USA Division of Allergy and Immunology, Department of Pediatrics, Boston's Children's Hospital, Boston, Massachusetts, USA
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21
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Hauptman M, Phipatanakul W, Jhun I, Petty C, Gold DR, Savage JR. Urinary Triclosan Levels and Asthma Exacerbations in Inner-City School Children. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Jhun I, Coull BA, Schwartz J, Hubbell B, Koutrakis P. The impact of weather changes on air quality and health in the United States in 1994-2012. Environ Res Lett 2015; 10:084009. [PMID: 27570539 PMCID: PMC4996129 DOI: 10.1088/1748-9326/10/8/084009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Air quality is heavily influenced by weather conditions. In this study, we assessed the impact of long-term weather changes on air quality and health in the US during 1994-2012. We quantified past weather-related increases, or 'weather penalty', in ozone (O3) and fine particulate matter (PM2.5), and thereafter estimated the associated excess deaths. Using statistical regression methods, we derived the weather penalty as the additional increases in air pollution relative to trends assuming constant weather conditions (i.e., weather-adjusted trends). During our study period, temperature increased and wind speed decreased in most US regions. Nationally, weather-related 8 h max O3 increases were 0.18 ppb per year (95% CI: 0.06, 0.31) in the warm season (May-October) and 0.07 ppb per year (95% CI: 0.02, 0.13) in the cold season (November-April). The weather penalties on O3 were relatively larger than PM2.5 weather penalties, which were 0.056 µg m-3 per year (95% CI: 0.016, 0.096) in warm months and 0.027 µg m-3 per year (95% CI: 0.010, 0.043) in cold months. Weather penalties on O3 and PM2.5 were associated with 290 (95% CI: 80, 510) and 770 (95% CI: 190, 1350) excess annual deaths, respectively. Over a 19-year period, this amounts to 20 300 excess deaths (5600 from O3, 14 700 from PM2.5) attributable to the weather penalty on air quality.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA
| | - Bryan Hubbell
- Office of Air Quality, Planning, and Standards, US Environmental Protection Agency, 109 TW Alexander Drive, Research Triangle Park, NC27711, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Boston, MA 02215, USA
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23
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Jhun I, Coull BA, Zanobetti A, Koutrakis P. The impact of nitrogen oxides concentration decreases on ozone trends in the USA. Air Qual Atmos Health 2015; 8:283-292. [PMID: 27547271 PMCID: PMC4988408 DOI: 10.1007/s11869-014-0279-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Ozone (O3) has harmful effects on human health and ecosystems. In the USA, significant reductions of O3 precursors-nitrogen oxides (NOx) and volatile organic compounds (VOCs)-have not yielded proportionate decreases in O3. NOx is a major precursor of O3 as well as a quencher of O3 through NOx titration, which is especially important during the night and wintertime. In this study, we investigated the potential dual impact of NOx concentration decreases on recent O3 trends by season and time of day. We analyzed hourly O3 and NOx measurement data between 1994 and 2010 in the continental USA. Nationally, hourly O3 concentrations decreased by as much as -0.38 ppb/year with a standard error of 0.05 ppb/year during the warm season midday, but increased by as much as +0.30±0.04 ppb/year during the cold season. High O3 concentrations (≥75th percentile) during the warm season decreased significantly, however, there were notable increases in the cold season as well as warm season nighttime; we found that these increases were largely attributable to NOx decreases as less O3 is quenched. These O3 increases, or "penalties", related to NOx reductions remained robust at a wide range of O3 concentrations (5th to 99th percentile), and even after accounting for VOC reductions and meteorological parameters, including temperature, wind speed, and water vapor pressure. In addition, we observed O3 penalties across rural, suburban, and urban areas. Nonetheless, peak O3 concentrations (99.9th percentile) were mitigated by NOx reductions. In addition, there was some suggestive evidence that VOC reductions have been more effective in reducing O3.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Landmark 4 West (Rm 412J), Boston, MA 02215, USA
| | - Brent A. Coull
- Department of Biostatistics, Harvard School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Landmark 4 West (Rm 412J), Boston, MA 02215, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard School of Public Health, 401 Park Drive, Landmark 4 West (Rm 412J), Boston, MA 02215, USA
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Jhun I, Fann N, Zanobetti A, Hubbell B. Effect modification of ozone-related mortality risks by temperature in 97 US cities. Environ Int 2014; 73:128-34. [PMID: 25113626 DOI: 10.1016/j.envint.2014.07.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 05/22/2023]
Abstract
Many time-series studies have characterized the relationship between short-term ozone exposure and adverse health outcomes, controlling for temperature as a confounder. Temperature may also modify ozone effects, though this has been largely under-investigated. In this study, we explored whether temperature modifies the effect of short-term ozone exposure on mortality. We used the database developed for the National Morbidity and Mortality Air Pollution Study to estimate ozone mortality risks in 97 US cities in May through September, 1987-2000. We treated temperature as a confounder as well as an effect modifier by estimating risks at low, moderate, and high temperature categories. When temperature was treated as a confounder, a 10-ppb increase in daily 24-h ozone was associated with a 0.47% (95% CI: 0.19%-0.76%) increase in mortality. When we assessed effect modification by temperature, the interaction between ozone and temperature was not statistically significant. However, there was a U-shaped pattern in mortality risk, which was greater at the low (<25th percentile) and high (>75th percentile) temperature levels than moderate temperature levels. At the high temperature category, a 10% increase in AC prevalence mitigated mortality risk associated with 10-ppb of ozone exposure by -0.18% (95% CI: -0.35%, -0.02%). Furthermore, ozone mortality risk in the high temperature category increased as we restricted our analyses to hotter days. On days where temperatures exceeded the 75th, 90th, and 95th percentile temperatures, a 10-ppb increase in ozone was associated with a 0.65% (95% CI: 0.20%-1.09%), 0.83% (95% CI: 0.17%-1.48%), and 1.35% (95% CI: 0.44%-2.27%) increase in mortality, respectively. These results suggested that high temperatures may exacerbate physiological responses to short-term ozone exposure.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, United States.
| | - Neal Fann
- Office of Air Quality Planning and Standards, US Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, United States
| | - Bryan Hubbell
- Office of Air Quality Planning and Standards, US Environmental Protection Agency, Research Triangle Park, NC, United States
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25
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Calvo JA, Moroski-Erkul CA, Lake A, Eichinger LW, Shah D, Jhun I, Limsirichai P, Bronson RT, Christiani DC, Meira LB, Samson LD. Aag DNA glycosylase promotes alkylation-induced tissue damage mediated by Parp1. PLoS Genet 2013; 9:e1003413. [PMID: 23593019 PMCID: PMC3617098 DOI: 10.1371/journal.pgen.1003413] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/11/2013] [Indexed: 12/21/2022] Open
Abstract
Alkylating agents comprise a major class of front-line cancer chemotherapeutic compounds, and while these agents effectively kill tumor cells, they also damage healthy tissues. Although base excision repair (BER) is essential in repairing DNA alkylation damage, under certain conditions, initiation of BER can be detrimental. Here we illustrate that the alkyladenine DNA glycosylase (AAG) mediates alkylation-induced tissue damage and whole-animal lethality following exposure to alkylating agents. Aag-dependent tissue damage, as observed in cerebellar granule cells, splenocytes, thymocytes, bone marrow cells, pancreatic β-cells, and retinal photoreceptor cells, was detected in wild-type mice, exacerbated in Aag transgenic mice, and completely suppressed in Aag−/− mice. Additional genetic experiments dissected the effects of modulating both BER and Parp1 on alkylation sensitivity in mice and determined that Aag acts upstream of Parp1 in alkylation-induced tissue damage; in fact, cytotoxicity in WT and Aag transgenic mice was abrogated in the absence of Parp1. These results provide in vivo evidence that Aag-initiated BER may play a critical role in determining the side-effects of alkylating agent chemotherapies and that Parp1 plays a crucial role in Aag-mediated tissue damage. Alkylating agents are genotoxic chemicals that induce both toxic and mutagenic DNA damage through addition of an alkyl group to DNA. Alkylating agents are routinely and successfully used as chemotherapeutic therapies for cancer patients, with one major disadvantage being the significant toxicity induced in non-tumor tissues. Accordingly, identifying factors that modify susceptibility to alkylation-induced toxicity will provide valuable information in designing cancer therapeutic regimens. This study used mouse genetic experiments to investigate whether proteins important in the base excision repair pathway modulate susceptibility to alkylating agents. In addition to whole-animal toxicity at high doses, treatment of mice with alkylating agents resulted in severe damage to numerous tissues including the cerebellum, retina, bone marrow, spleen, thymus, and the pancreas. We illustrate that the DNA glycosylase Aag can actually confer, rather than prevent, alkylation sensitivity at both the whole-animal and tissue level; i.e., Aag transgenic animals are more susceptible than wild type, whereas Aag-deficient animals are less susceptible than wild type to alkylation-induced toxicity. Further genetic experiments show that the Aag-mediated alkylation sensitivity is dependent on Parp1. Given that we observe a wide range of human AAG expression among healthy individuals, this and other base excision repair proteins may be important factors modulating alkylation susceptibility.
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Affiliation(s)
- Jennifer A. Calvo
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Catherine A. Moroski-Erkul
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Annabelle Lake
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Lindsey W. Eichinger
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Dharini Shah
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Iny Jhun
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Prajit Limsirichai
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Roderick T. Bronson
- Department of Pathology, Harvard Medical School, Cambridge, Massachusetts, United States of America
| | - David C. Christiani
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Lisiane B. Meira
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Leona D. Samson
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Center for Environmental Health Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- * E-mail:
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Jhun I, Oyola P, Moreno F, Castillo MA, Koutrakis P. PM2.5 mass and species trends in Santiago, Chile, 1998 to 2010: the impact of fuel-related interventions and fuel sales. J Air Waste Manag Assoc 2013; 63:161-169. [PMID: 23472300 DOI: 10.1080/10962247.2012.742027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Improving air quality in Santiago has been a high priority for the Chilean government. In this paper we examine trends of fine particulate matter (PM2.5) mass and species concentrations during the period 1998 to 2010 and explore the impact of fuel-related interventions and fuel sales on concentration changes. Smoothing spline functions were utilized to characterize and account for nonlinear relationships between pollutant concentrations and different parameters. Meteorology-adjusted PM2.5 concentrations were lower by 21.8 microg/m3 in 2010 compared to 1998. In this model, wind speed was the most important determinant of PM2.5 levels. A decrease in 24-hr average wind speed below 1.0 m/s was associated with a significant increase in daily PM2.5 levels, indicating a high sensitivity of PM2.5 concentrations to the accumulation of local emissions. The same regression model framework was applied to examine the trends of lead, bromine, and sulfur concentrations. Removal of lead and bromine from gasoline achieved dramatic decreases in their atmospheric concentrations. Nonetheless, both elements continue to persist, likely in the form of PbBrCl. The reduction of diesel sulfur content from 1,500 to 50 ppm corresponded to a 32% decrease in particulate sulfur levels. Lastly, a surge in PM2.5 was observed in 2005-2008. Further regression analyses suggested this was prompted by a rise in monthly petroleum-based fuel sales. IMPLICATIONS In this paper, we elucidate meteorology-adjusted trends of PM2.5 mass and species concentrations in Santiago and assess the efficacy of fuel-related interventions, such as the removal of lead from gasoline and reduction of sulfur content in diesel. In addition, we explore the impact of fuel sales on PM2.5 trends. Given that fuel consumption is likely to increase further in this rapidly growing city, understanding its impact on PM2.5 trends can inform future air quality control efforts in Santiago.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02215, USA.
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