[Urban particulate air pollution: from epidemiology to health impact in public health]

Major air pollution accidents which occurred in the 1950s led to public awareness of the health hazards involved. Since that period, levels of air pollution have decreased, but several studies conducted in North America and Europe indicate that particulate air pollution is linked to increased cardiorespiratory morbidity and mortality. Despite this evidence, several questions were raised concerning the interpretation of the results (threshold effect, harvesting effect and biological plausibility). The aim of this review is to present the link between epidemiological findings and their use in health impact assessment. We review the main causal criteria applied to epidemiology in light of scientific evidence currently available. Some causality criteria are more important than others, but they all support the causal nature of the relationship between air pollution and health, and thus justify the feasibility of health impact assessment calculations. Recent studies on relative risk assessment show that even if the risk linked to worsening air quality is low, public health consequences are high. Such information must be made accessible to policy makers and the population in general so that, together with the public health workers, they can all contribute to improving air quality and health in their communities.

Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons > or = 65 yrs were investigated. Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) and black smoke (BS), as well as the daily number of deaths among persons > or = 65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied. The per cent increase (95% confidence intervals), associated with a 10 microg x m(-3) increase in PM10, in the elderly daily number of deaths was 0.8%, (0.7-0.9%) and the corresponding number for BS was 0.6%, (0.5-0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects). These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.

Short-term effects of particulate air pollution on cardiovascular diseases in eight European cities

STUDY OBJECTIVE

As part of the APHEA project this study examined the association between airborne particles and hospital admissions for cardiac causes (ICD9 390-429) in eight European cities (Barcelona, Birmingham, London, Milan, the Netherlands, Paris, Rome, and Stockholm). All admissions were studied, as well as admissions stratified by age. The association for ischaemic heart disease (ICD9 410-413) and stroke (ICD9 430-438) was also studied, also stratified by age.

DESIGN

Autoregressive Poisson models were used that controlled for long term trend, season, influenza epidemics, and meteorology to assess the short-term effects of particles in each city. The study also examined confounding by other pollutants. City specific results were pooled in a second stage regression to obtain more stable estimates and examine the sources of heterogeneity.

MAIN RESULTS

The pooled percentage increases associated with a 10 micro g/m(3) increase in PM(10) and black smoke were respectively 0.5% (95% CI: 0.2 to 0.8) and 1.1% (95% CI: 0.4 to 1.8) for cardiac admissions of all ages, 0.7% (95% CI: 0.4 to 1.0) and 1.3% (95% CI: 0.4 to 2.2) for cardiac admissions over 65 years, and, 0.8% (95% CI: 0.3 to 1.2) and 1.1% (95% CI: 0.7 to 1.5) for ischaemic heart disease over 65 years. The effect of PM(10) was little changed by control for ozone or SO(2), but was substantially reduced (CO) or eliminated (NO(2)) by control for other traffic related pollutants. The effect of black smoke remained practically unchanged controlling for CO and only somewhat reduced controlling for NO(2).

CONCLUSIONS

These effects of particulate air pollution on cardiac admissions suggest the primary effect is likely to be mainly attributable to diesel exhaust. Results for ischaemic heart disease below 65 years and for stroke over 65 years were inconclusive.

Cerebrospinal fluid levels of thiamine in patients with Alzheimer's disease

Thiamine is an essential cofactor for several important enzymes involved in brain oxidative metabolism, such as the alpha-ketoglutarate dehydrogenase complex (KGDHC), pyruvate-dehydrogenase complex (PDHC), and transketolase. Some investigators reported decreased thiamine-diphosphate levels and decreased activities of KGDHC, pyruvate-dehydrogenase complex and transketolase in the brain tissue of Alzheimer's disease (AD) patients. We measured cerebrospinal (CSF) levels of thiamine-diphosphate, thiamine-monophosphate, free thiamine, and total thiamine, using ion-pair reversed phase high performance liquid chromatography, in 33 patients with sporadic AD and 32 matched controls. The mean CSF levels of thiamine-derivatives did not differ significantly from those of controls, while the mean plasma levels of thiamine-diphosphate, free and total thiamine were significantly lower in the AD-patient group. CSF and plasma thiamine levels were not correlated with age, age at onset, duration of the disease, and scores of the MiniMental State Examination, with the exception of plasma thiamine-diphosphate with MiniMental State Examination (r = 0.41, p < 0.05) in the AD-patients group. CSF and plasma values did not predict dementia progression, assessed with the MiniMental State Examination scores. These results suggest that CSF thiamine levels are not related with the risk for and the progression of AD.

Neuropeptide Y effects on murine natural killer activity: changes with ageing and cAMP involvement

Changes in the bidirectional interaction between the nervous and the immune systems have been proposed as a cause of ageing. Neuropeptides, such as neuropeptide Y (NPY), could show different effects on immune function with age. In the present work, we have studied the in vitro action of a wide range of NPY concentrations, i.e. from 10(-13) to 10(-7) M, on natural killer (NK) activity, a function which decreases with age. Spleen, axillary nodes, thymus and peritoneum leukocytes from mice of different ages: young (12+/-2 weeks), adult (24+/-2 weeks), mature (50+/-2 weeks) and old (72+/-2 weeks) were used. Stimulation by NPY of NK activity was observed in adult and mature animals in axillary nodes and thymus, and an inhibition in the spleen from young mice. The specificity of the NPY effect on cytotoxic activity was confirmed using a C-terminal fragment of NPY. Furthermore, cAMP levels in leukocytes were found to be decreased by NPY in adult mice, suggesting an involvement of this messenger system in the NK modulation by this neuropeptide.

[Short-term relationships between urban atmospheric pollution and respiratory mortality: time series studies]

Time series studies conducted in the field of air pollution aim at testing and quantifying short-term relations which can exist between daily air pollution levels and daily health effects. The method used for this type of survey has sometimes been misunderstood mainly because individual factors and indoor exposure to air pollutants were not taken into account. The adjustment on these individual confounding factors commonly used in classic epidemiologic studies (case-control studies, cohort studies) is not adequate to times series studies which are based on aggregate data. This is different for those factors that change over time according to the levels of air pollution (meteorological conditions, influenza epidemics, trend of health cases) which, when being analysed, must be taken into account either indirectly through time modelling or directly through non-linear modelling processes. During this last decade, numerous studies using the time series method have been published and have found short-term associations between daily levels of air pollution commonly observed and daily respiratory mortality. The consistency of the numerous results published in the international literature are more arguments in favour of non-confounding short-term relations between air pollution and respiratory mortality.

Cytogenetic and molecular characterization of a congenital mesoblastic nephroma

A newborn baby boy was diagnosed with the mixed form of congenital mesoblastic nephroma (CMN) representing both classic and cellular histology features in the renal tumor. Additionally, the patient had skin and bone lesions consistent with multifocal involvement of a generalized infantile fibromatosis (IFS). Both skin and bone lesions were distinctly different from CMN and did not represent metastasis. The primary tumor cell line (MCH-MN-1), established from the resected right kidney tumor, had a diploid DNA content. Cytogenetic studies revealed deletion on the long arm of chromosome 3 (q21q24) and duplication on the short arm of chromosome 11 (p15). MCH-MN-1 cells expressed ETV6-NTRK3 gene fusion transcripts, characteristic of cellular and mixed forms of CMNs. The cells had high p21 and low Bax mRNA expression in the reverse transcriptase-polymerase chain reaction (RT-PCR) assay. The high level of proliferative marker (Ki67) mRNA expression correlated well with the pluripotent nature of MCH-MN-1 in tissue culture (cell doubling time = 12.4 h). Our results showed that MCH-MN-1 might be a good model cell line for investigations on mesoblastic nephroma.

Assessment of deaths attributable to air pollution: should we use risk estimates based on time series or on cohort studies?

Epidemiologic studies are crucial to the estimation of numbers of deaths attributable to air pollution. In this paper, the authors present a framework for distinguishing estimates of attributable cases based on time-series studies from those based on cohort studies, the latter being 5-10 times larger. The authors distinguish four categories of death associated with air pollution: A) air pollution increases both the risk of underlying diseases leading to frailty and the short term risk of death among the frail; B) air pollution increases the risk of chronic diseases leading to frailty but is unrelated to timing of death; C) air pollution is unrelated to risk of chronic diseases but short term exposure increases mortality among persons who are frail; and D) neither underlying chronic disease nor the event of death is related to air pollution exposure. Time-series approaches capture deaths from categories A and C, whereas cohort studies assess cases from categories A, B, and C. In addition, years of life lost can only be derived from cohort studies, where time to death is the outcome, while in time-series studies, death is a once-only event (no dimension in time). The authors conclude that time-series analyses underestimate cases of death attributable to air pollution and that assessment of the impact of air pollution on mortality should be based on cohort studies.

Changes with aging in the modulation by neuropeptide Y of murine peritoneal macrophage functions

Some age-related changes in immune function may be due, at least in part, to a disturbance in the communication between the nervous and immune systems. In the present work, the effects in vitro of neuropeptide Y (NPY) (10(-13) to 10(-7) M) on different peritoneal macrophage functions (adherence to substrate, chemotaxis, phagocytosis, superoxide anion production, and the release of TNFalpha and IL-1beta) have been studied on cells from young (12+/-2 weeks), adult (24+/-2 weeks), mature (50+/-2 weeks) and old (72+/-2 weeks) BALB/c mice. The specificity of these actions was confirmed using two C-terminal fragments of NPY, and the intracellular messengers (protein kinase C and cAMP) involved in the action of the neuropeptide were also analyzed. The results show that the functions studied change with aging and that the effects of NPY on each function, which are carried out through specific receptors, as well as on intracellular pathway, differ depending on age, maintaining the immune functions at physiologically adequate levels in old animals.

Investigating regional differences in short-term effects of air pollution on daily mortality in the APHEA project: a sensitivity analysis for controlling long-term trends and seasonality

Short-term effects of air pollution on daily mortality in eight western and five central-eastern European countries have been reported previously, as part of the APHEA project. One intriguing finding was that the effects were lower in central-eastern European cities. The analysis used sinusoidal terms for seasonal control and polynomial terms for meteorologic variables, but this is a more rigid approach than the currently accepted method, which uses generalized additive models (GAM). We therefore reanalyzed the original data to examine the sensitivity of the results to the statistical model. The data were identical to those used in the earlier analyses. The outcome was the daily total number of deaths, and the pollutants analyzed were black smoke (BS) and sulfur dioxide (SO(2)). The analyses were restricted to days with pollutant concentration < 200 microg/m(3) and < 150 microg/m(3) alternately. We used Poisson regression in a GAM model, and combined individual city regression coefficients using fixed and random-effect models. An increase in BS by 50 microg/m(3) was associated with a 2.2% and 3.1% increase in mortality when analysis was restricted to days < 200 microg/m(3) and < 150 microg/m(3), respectively. The corresponding figures were 5.0% and 5.6% for a similar increase in SO(2). These estimates are larger than the ones published previously: by 69% for BS and 55% for SO(2). The increase occurred only in central-eastern European cities. The ratio of western to central-eastern cities for estimates was reduced to 1.3 for BS (previously 4.8) and 2.6 for SO(2) (previously 4.4). We conclude that part of the heterogeneity in the estimates of air pollution effects between western and central-eastern cities reported in previous publications was caused by the statistical approach used and the inclusion of days with pollutant levels above 150 microg/m(3). However, these results must be investigated further.

[Surveillance of short-term effects of urban air pollution on mortality. Results of a feasibility study in 9 French cities]

BACKGROUND

This study aims at quantifying air pollution effects on mortality and at evaluating the feasibility of a standardized epidemiological surveillance system of air pollution in 9 French cities.

METHODS

Data collection and analysis followed a standardized protocol. Data pollution depended on the development of local air quality surveillance networks (number of indicators, number of stations.). The Generalised Additive Models (GAM) were used to quantify the association between air pollution and mortality.

RESULTS

In the 9 studied areas, associations between all causes, cardiovascular and respiratory mortality, and air pollution indicators were observed. These associations were linear without threshold. Depending on the pollutants, excess in mortality related to an interquartile increase in acid-particulate pollution varied between 0.3 and 3.5% for total mortality, 0.5 and 6.3% for cardiovascular mortality, and between 0.1 and 12% for respiratory mortality. Photochemical air pollution varied between 0.4 and 7.3% for total mortality, 1.4 and 6.7% for cardiovascular mortality, and between 1.7 and 30.4% for respiratory mortality.

CONCLUSION

In spite of a standardized common protocol, some disparities, inherent to the local characteristics, were noted (length of time series, numbers of ambient urban stations selected and pollutants available.). Nevertheless, this pilot study showed that multicentric epidemiological monitoring of air pollution effects on health was feasible. Yet, this requires to validate the results obtained through a re-analysis of the mortality data on a longer period of study. It also requires to study the feasibility and the relevance of the use of other health indicators, such as hospital admissions.

The NPY effects on murine leukocyte adherence and chemotaxis change with age. Adherent cell implication

The two-way communication between the nervous and immune system is currently well-known, but the age-related changes in this communication have been scarcely studied. In the present work, we have investigated the in vitro effects of neuropeptide Y (NPY) at concentrations ranging from 10(-13) to 10(-7) M on the adherence and chemotaxis capacities of spleen, axillary node, thymus and peritoneum leukocytes from BALB/c mice. The NPY effect on these functions was examined on cells from animals of four different ages, i.e. young (12+/-2 weeks old), adult (24+/-2 weeks old), mature (50+/-2 weeks old) and old (72+/-2 weeks old). In young animals, NPY stimulates the adherence of leukocytes from spleen, axillary nodes and thymus and inhibits it in cells from peritoneum. In adult animals NPY inhibits the adherence of leukocytes from thymus. These effects disappear with ageing in all locations. Chemotaxis is stimulated by this neuropeptide at all ages in cells from axillary nodes and peritoneum, but this effect is absent in old mice. NPY exerts an inhibitory effect on the chemotaxis of leukocytes from thymus at all ages studied. These NPY effects on leukocytes seem to be carried out through adherent cells.

Effect of aging on the modulation of macrophage functions by neuropeptides

The existence of a functional connection between the nervous and the immune system is supported by increasing recent evidence. In previous work we have shown that peptides from the nervous system, such as gastrin-releasing peptide (GRP), neuropeptide Y (NPY) and sulfated cholecystokinin octapeptide (CCK-8s), have modulatory effects on the immune functions in adult animals. Since the immunodepression found in aging organisms may be related to changes in the neuroimmune network, the aim of the present work was to study the changes with aging in the effect of CCK-8s, GRP and NPY on peritoneal macrophage functions (adherence to tissues, mobility, ingestion of foreign particles and superoxide anion production) from BALB/c mice of three different ages: adult (24+/-2 weeks old), mature (50+/-2 weeks old) and old (72+/-2 weeks old). The results show that the increase in adherence capacity produced by neuropeptides in cells from adult and mature animals disappears in old mice. The stimulatory effect of GRP and NPY on mobility, ingestion and superoxide production in macrophages from adult mice disappears (GRP) or changes to inhibition (NPY) in cells from old animals. The decrease of these functions caused by CCK-8s in adult or mature animals continues in old mice. These data suggest that the modulation by neuropeptides of the macrophage function changes with the age of animals.

Public-health impact of outdoor and traffic-related air pollution: a European assessment

BACKGROUND

Air pollution contributes to mortality and morbidity. We estimated the impact of outdoor (total) and traffic-related air pollution on public health in Austria, France, and Switzerland. Attributable cases of morbidity and mortality were estimated.

METHODS

Epidemiology-based exposure-response functions for a 10 microg/m3 increase in particulate matter (PM10) were used to quantify the effects of air pollution. Cases attributable to air pollution were estimated for mortality (adults > or = 30 years), respiratory and cardiovascular hospital admissions (all ages), incidence of chronic bronchitis (adults > or = 25 years), bronchitis episodes in children (< 15 years), restricted activity days (adults > or = 20 years), and asthma attacks in adults and children. Population exposure (PM10) was modelled for each km2. The traffic-related fraction was estimated based on PM10 emission inventories.

FINDINGS

Air pollution caused 6% of total mortality or more than 40,000 attributable cases per year. About half of all mortality caused by air pollution was attributed to motorised traffic, accounting also for: more than 25,000 new cases of chronic bronchitis (adults); more than 290,000 episodes of bronchitis (children); more than 0.5 million asthma attacks; and more than 16 million person-days of restricted activities.

INTERPRETATION

This assessment estimates the public-health impacts of current patterns of air pollution. Although individual health risks of air pollution are relatively small, the public-health consequences are considerable. Traffic-related air pollution remains a key target for public-health action in Europe. Our results, which have also been used for economic valuation, should guide decisions on the assessment of environmental health-policy options.

Age-related changes in the neuropeptide Y effects on murine lymphoproliferation and interleukin-2 production

Neuropeptide Y (NPY) modulates several aspects of the immune response but it is not known whether NPY responsiveness is altered with aging. In this work, the in vitro effect of NPY at concentrations ranging from 10(-)(14) M to 10(-)(7) M on lymphoproliferation has been studied in spleen, axillary node and thymus leukocytes from young, adult, mature and old BALB/c mice. The spontaneous proliferation of spleen lymphocytes from young mice was significantly stimulated by NPY. In response to the mitogen Con A, lymphoproliferation and IL-2 release by lymphocytes were inhibited significantly by NPY, these effects disappearing with aging. The results show that NPY is a modulator of lymphoproliferation and that this effect disappears progressively with age. Moreover, this regulatory role of NPY may be carried out through a decrease in IL-2 production.

[Relevance and feasibility of a surveillance system of the effects of atmospheric pollution]

New regulations on the quality of air together with the epidemiological results obtained in the last 10 years on the short-term effects of air pollution on health have led the InVS to set up a program of epidemiological surveillance in 9 French cities. The first phase of this program was dedicated to the study of feasibility of such a surveillance system. Metrological and health data collection was conducted at both local and national levels in order to obtain significant data in close collaboration with experts of each field. The analysis of the relationship between temporal variations of daily series of the two types of indicators have allowed to obtain dose-response relationships between air pollution and mortality. The organisational and technical feasibility of such a surveillance system was confirmed in the first phase of the program.

Detection of choledocholithiasis with MR cholangiography: comparison of three-dimensional fast spin-echo and single- and multisection half-Fourier rapid acquisition with relaxation enhancement sequences

PURPOSE

To compare the performance of three pulse sequences commonly used at magnetic resonance (MR) cholangiography in the diagnosis of choledocholithiasis.

MATERIALS AND METHODS

MR cholangiography was performed in 57 patients who were suspected of having choledocholithiasis and referred for endoscopic retrograde cholangiography. Non-breath-hold three-dimensional fast spin-echo, breath-hold single-section half-Fourier rapid acquisition with relaxation enhancement (RARE), and breath-hold multisection half-Fourier RARE sequences were compared. Two radiologists independently interpreted the MR cholangiograms. Evaluated diagnostic performance parameters included sensitivity, specificity, receiver operating characteristic (ROC) curves, and interobserver agreement (kappa statistics). Endoscopic retrograde cholangiography was the standard of reference.

RESULTS

Eight patients were excluded because of incomplete MR examinations (n = 4) or failure in the cannulation of the bile duct at retrograde cholangiography (n = 4). In 49 patients, the three MR cholangiographic sequences were completed successfully. In 24 (49%) of these patients, retrograde cholangiography demonstrated stones. Sensitivity and specificity of MR cholangiography exceeded 90%, and the area under the ROC curve was greater than 0.95 for both radiologists and for the three sequences. Interobserver agreement for presence of bile duct stones was at least 0.80 (very good) for the three sequences.

CONCLUSION

The three MR cholangiographic sequences had similarly high sensitivities and specificities for the detection of choledocholithiasis.

Ascorbic acid modulates in vitro the function of macrophages from mice with endotoxic shock

The toxic effects of oxygen radicals produced by immune cells can be controlled to certain degree by endogenous antioxidants because of their scavenger action. This control is specially important in a type of immune cell, i.e., the phagocyte, which produces oxygen-free radicals and uses antioxidants in order to support its functions. Antioxidants, such as ascorbic acid (AA), are free radical scavengers and improve the immune response. In the pathogenesis of endotoxic shock, a disease with high mortality caused by gram-negative bacterial endotoxin, the reactive oxygen species (ROS) produced by phagocytes have been implicated. In a previous study, we observed in peritoneal macrophages from BALB/c mice suffering lethal endotoxic shock caused by intraperitoneal (i.p.) injection of Escherichia coli lipopolysaccharide (LPS; 100 mg/kg) a high production of superoxide anion. Therefore, in the present work, we have studied the in vitro effect of AA, at different concentrations (0.001, 0.01, 0.1, 1 and 2.5 mM), on the various steps of the phagocytic process, i.e., adherence to substrate, chemotaxis, ingestion of particles and superoxide anion production of murine peritoneal macrophages obtained from BALB/c mice with that of endotoxic shock, at 2, 4, 12 and 24 h after LPS injection. The increased adherence, ingestion and superoxide anion production by macrophages from animals with endotoxic shock were lower in the presence of AA, reaching similar values to those of the control animals. The most effective AA concentration in cells from mice with endotoxic shock was 0.01 mM. These data suggest that AA can regulate the phagocytic process in endotoxic shock, principally decreasing free radical production and thus it could reduce endotoxic shock severity.

Exposure to 2500 lux increases serum melatonin in Venezuelan equine encephalomyelitis

When mice infected with the Venezuelan equine encephalomyelitis (VEE) virus were exposed to 2500 lux with a 12 h light: 12 h dark photoperiod, the serum levels of melatonin (MLT) remained constantly elevated. In mice exposed to 400 lux low levels of serum MLT were detected during the day and high levels during the night. An increase in the survival rate of the infected mice from 6 to 13 days after virus inoculation was also observed. The significant increment in the concentration of serum MLT produced by the high intensity light could be responsible for the longer survival rate of mice infected with the VEE virus.