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Ogawa Y, Kobayashi T, Honda Y, Kessoku T, Tomeno W, Imajo K, Nakahara T, Oeda S, Nagaoki Y, Amano Y, Ando T, Hirayama M, Isono O, Kamiguchi H, Nagabukuro H, Ogawa S, Satomi Y, Saigusa Y, Takahashi H, Hyogo H, Yoneda M, Saito S, Yamanaka T, Aishima S, Eguchi Y, Kage M, Chayama K, Nakajima A. Metabolomic/lipidomic-based analysis of plasma to diagnose hepatocellular ballooning in patients with non-alcoholic fatty liver disease: A multicenter study. Hepatol Res 2020; 50:955-965. [PMID: 32455496 DOI: 10.1111/hepr.13528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
AIM Liver biopsy is still required for the diagnosis of hepatocellular ballooning and inflammation, which are important histological features of non-alcoholic steatohepatitis. We undertook this multicenter, cross-sectional study to identify novel blood markers for the diagnosis of hepatocellular ballooning. METHODS We enrolled 176 patients, of whom 132 were proven by liver biopsy as having non-alcoholic fatty liver disease (NAFLD) and classified as non-ballooning (ballooning grade 0) (n = 83) or ballooning (ballooning grade 1 and 2) (n = 49) by a central pathology review. We carried out gas chromatography-mass spectrometry, hydrophilic interaction liquid chromatography tandem mass spectrometry, and lipidomics with plasma. RESULTS As correlates of hepatocellular ballooning, among the clinical parameters, serum type IV collagen 7S correlated most significantly with the ballooning grade (correlation coefficient [CC] = 0.463; P < 0.001). Among the metabolic/lipidomic markers, phosphatidylcholine (PC) (aa-44:8) correlated most significantly with the ballooning grade (CC = 0.394; P < 0.001). The area under the receiver operating characteristic curve of type IV collagen 7S, choline, and lysophosphatidylethanolamine (LPE) (e-18:2), was 0.846 (95% confidence interval, 0.772-0.919). CONCLUSIONS Plasma levels of PC were positively correlated, and those of lysophosphatidylcholine and LPE were negatively correlated with hepatocellular ballooning in NAFLD patients. These non-invasive metabolic/lipidomic-based plasma tests might be useful to distinguish between cases of NAFLD with and without hepatocellular ballooning.
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Lin YK, Sung FC, Honda Y, Chen YJ, Wang YC. Comparative assessments of mortality from and morbidity of circulatory diseases in association with extreme temperatures. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 723:138012. [PMID: 32217384 DOI: 10.1016/j.scitotenv.2020.138012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study evaluated vulnerable subpopulation on mortality, emergency room visits (ERVs) and outpatient visits associated with ambient daily temperature from 2000 to 2014 using vital statistics and insurance claims of Taiwan. METHODS We used the distributed lag non-linear model to assess circulatory disease-specific deaths, ERVs, and outpatient visits by mean temperature after controlling particulate matter (PM10) and other covariates. Lag effect of temperature changes on health risks accumulated for 0-10 days associated with low temperature and for 0-5 days for high temperature were evaluated. Cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) were estimated for the whole population of Taiwan using random-effects meta-analysis. RESULTS We used reference temperatures of 60th percentiles for mortality from circulatory diseases, 99th percentile for ERVs of circulatory diseases, 2nd percentile for ERVs of heart diseases and ischemic heart disease, 53th percentile for ERVs of cerebrovascular disease, and 12-16th percentiles for outpatient visits of circulatory diseases. The lag effects peaked at lag 4-5 day for low temperature exposure and at lag 0 for high temperature exposure. Pooled cold related health risk was the highest for mortality from and ERV of circulatory diseases with RR of 1.41 (95% CI: 1.34, 1.49) and 1.41 (95% CI: 1.35, 1.48), respectively, as daily mean temperatures was at 1st percentile (12.8 °C). Heat related health risk was significant for mortality from heart diseases [RR = 1.12 (95% CI: 1.07, 1.18)] and ischemic heart diseases [RR = 1.13 (95% CI: 1.06, 1.20)] as daily mean temperatures was at 99th percentile (29.9 °C). CONCLUSIONS Health authority should evaluate the effectiveness of adaptive policy, strategy, and actions responding to extreme temperatures to prevent mortality from circulatory diseases.
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Varquez ACG, Darmanto NS, Honda Y, Ihara T, Kanda M. Future increase in elderly heat-related mortality of a rapidly growing Asian megacity. Sci Rep 2020; 10:9304. [PMID: 32518364 PMCID: PMC7283254 DOI: 10.1038/s41598-020-66288-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
Urban dwellers are at risk of heat-related mortality in the onset of climate change. In this study, future changes in heat-related mortality of elderly citizens were estimated while considering the combined effects of spatially-varying megacity’s population growth, urbanization, and climate change. The target area is the Jakarta metropolitan area of Indonesia, a rapidly developing tropical country. 1.2 × 1.2 km2 daily maximum temperatures were acquired from weather model outputs for the August months from 2006 to 2015 (present 2010s) and 2046 to 2055 (future 2050s considering pseudo-global warming of RCP2.6 and RCP8.5). The weather model considers population-induced spatial changes in urban morphology and anthropogenic heating distribution. Present and future heat-related mortality was mapped out based on the simulated daily maximum temperatures. The August total number of heat-related elderly deaths in Jakarta will drastically increase by 12~15 times in the 2050s compared to 2010s because of population aging and rising daytime temperatures under “compact city” and “business-as-usual” scenarios. Meanwhile, mitigating climate change (RCP 2.6) could reduce the August elderly mortality count by up to 17.34%. The downwind areas of the densest city core and the coastal areas of Jakarta should be avoided by elderly citizens during the daytime.
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Hashizume M, Kim Y, Ng CFS, Chung Y, Madaniyazi L, Bell ML, Guo YL, Kan H, Honda Y, Yi SM, Kim H, Nishiwaki Y. Health Effects of Asian Dust: A Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:66001. [PMID: 32589456 PMCID: PMC7319773 DOI: 10.1289/ehp5312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Potential adverse health effects of Asian dust exposure have been reported, but systematic reviews and quantitative syntheses are lacking. OBJECTIVE We reviewed epidemiologic studies that assessed the risk of mortality, hospital admissions, and symptoms/dysfunction associated with exposure to Asian dust. METHODS We performed a systematic search of PubMed and Web of Science to identify studies that reported the association between Asian dust exposure and human health outcomes. We conducted separate meta-analyses using a random-effects model for mortality and hospital admissions for a specific health outcome and assessed pooled estimates for each lag when at least three studies were available for a specific lag. RESULTS We identified 89 studies that met our inclusion criteria for the systematic review, and 21 studies were included in the meta-analysis. The pooled estimates (percentage changes) of mortality from circulatory and respiratory causes for Asian dust days vs. non-Asian dust days were 2.33% [95% confidence interval (CI): 0.76, 3.93] increase at lag 0 and 3.99% (95% CI: 0.08, 8.06) increase at lag 3, respectively. The increased risk for hospital admissions for respiratory disease, asthma, and pneumonia peaked at lag 3 by 8.85% (95% CI: 0.80, 17.55), 14.55% (95% CI: 6.74, 22.94), and 8.51% (95% CI: 2.89, 14.44), respectively. Seven of 12 studies reported reduced peak expiratory flow, and 16 of 21 studies reported increased respiratory symptoms associated with Asian dust exposure. There were substantial variations between the studies in definitions of Asian dust, study designs, model specifications, and confounder controls. DISCUSSION We found evidence of increased mortality and hospital admissions for circulatory and respiratory events. However, the number of studies included in the meta-analysis was not large and further evidences are merited to strengthen our conclusions. Standardized protocols for epidemiological studies would facilitate interstudy comparisons. https://doi.org/10.1289/EHP5312.
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Ozaki A, Kessoku T, Iwaki M, Kobayashi T, Yoshihara T, Kato T, Honda Y, Ogawa Y, Imajo K, Higurashi T, Yoneda M, Taguri M, Yamanaka T, Ishiki H, Kobayashi N, Saito S, Ichikawa Y, Nakajima A. Comparing the effectiveness of magnesium oxide and naldemedine in preventing opioid-induced constipation: a proof of concept, single institutional, two arm, open-label, phase II, randomized controlled trial: the MAGNET study. Trials 2020; 21:453. [PMID: 32487150 PMCID: PMC7268242 DOI: 10.1186/s13063-020-04385-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/06/2020] [Indexed: 12/18/2022] Open
Abstract
Background Patients taking opioids are known to develop opioid-induced constipation (OIC), which reduces their quality of life. The aim of this study is to compare magnesium oxide with naldemedine and determine which is more effective in preventing OIC. Methods This proof-of-concept, prospective, randomized controlled trial commenced in Japan in March 2018. Initially, a questionnaire-based survey will be conducted targeting adult patients with cancer who concomitantly commenced opioid treatment and OIC prevention treatment. Patients will then be randomly allocated to a magnesium oxide group (500 mg thrice daily) or a naldemedine group (0.2 mg once daily). Each drug will be orally administered for 12 weeks. The primary endpoint is defined as any improvement in scores on the Japanese version of Patient Assessment of Constipation Quality of Life questionnaire (JPAC-QOL) from baseline to 2 weeks of treatment. Discussion The primary endpoint is change in JPAC-QOL score from baseline to 2 weeks of intervention. The key secondary endpoint will be change in spontaneous bowel movements at 2 and 12 weeks of intervention. This study will determine whether magnesium oxide or naldemedine is more effective for the prevention of OIC. Trial registration University Hospital Medical Information Network (UMIN) Clinical Trials Registry, UMIN000031891. Registered March 25, 2018.
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Tomida N, Muramatsu N, Niiyama M, Ahn JK, Chang WC, Chen JY, Chu ML, Daté S, Gogami T, Goto H, Hamano H, Hashimoto T, He QH, Hicks K, Hiraiwa T, Honda Y, Hotta T, Ikuno H, Inoue Y, Ishikawa T, Jaegle I, Jo JM, Kasamatsu Y, Katsuragawa H, Kido S, Kon Y, Maruyama T, Masumoto S, Matsumura Y, Miyabe M, Mizutani K, Nagahiro H, Nakamura T, Nakano T, Nam T, Ngan TNT, Nozawa Y, Ohashi Y, Ohnishi H, Ohta T, Ozawa K, Rangacharyulu C, Ryu SY, Sada Y, Sasagawa M, Shibukawa T, Shimizu H, Shirai R, Shiraishi K, Strokovsky EA, Sugaya Y, Sumihama M, Suzuki S, Tanaka S, Tokiyasu A, Tsuchikawa Y, Ueda T, Yamazaki H, Yamazaki R, Yanai Y, Yorita T, Yoshida C, Yosoi M. Search for η^{'} Bound Nuclei in the ^{12}C(γ,p) Reaction with Simultaneous Detection of Decay Products. PHYSICAL REVIEW LETTERS 2020; 124:202501. [PMID: 32501086 DOI: 10.1103/physrevlett.124.202501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/11/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}N→ηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2 nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}N→ηN process and/or a shallow η^{'}-nucleus potential.
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Sera F, Armstrong B, Tobias A, Vicedo-Cabrera AM, Åström C, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Matus Correa P, Cruz JC, Dang TN, Hurtado-Diaz M, Do Van D, Forsberg B, Guo YL, Guo Y, Hashizume M, Honda Y, Iñiguez C, Jaakkola JJK, Kan H, Kim H, Lavigne E, Michelozzi P, Ortega NV, Osorio S, Pascal M, Ragettli MS, Ryti NRI, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tong S, Zanobetti A, Gasparrini A. How urban characteristics affect vulnerability to heat and cold: a multi-country analysis. Int J Epidemiol 2020; 48:1101-1112. [PMID: 30815699 DOI: 10.1093/ije/dyz008] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The health burden associated with temperature is expected to increase due to a warming climate. Populations living in cities are likely to be particularly at risk, but the role of urban characteristics in modifying the direct effects of temperature on health is still unclear. In this contribution, we used a multi-country dataset to study effect modification of temperature-mortality relationships by a range of city-specific indicators. METHODS We collected ambient temperature and mortality daily time-series data for 340 cities in 22 countries, in periods between 1985 and 2014. Standardized measures of demographic, socio-economic, infrastructural and environmental indicators were derived from the Organisation for Economic Co-operation and Development (OECD) Regional and Metropolitan Database. We used distributed lag non-linear and multivariate meta-regression models to estimate fractions of mortality attributable to heat and cold (AF%) in each city, and to evaluate the effect modification of each indicator across cities. RESULTS Heat- and cold-related deaths amounted to 0.54% (95% confidence interval: 0.49 to 0.58%) and 6.05% (5.59 to 6.36%) of total deaths, respectively. Several city indicators modify the effect of heat, with a higher mortality impact associated with increases in population density, fine particles (PM2.5), gross domestic product (GDP) and Gini index (a measure of income inequality), whereas higher levels of green spaces were linked with a decreased effect of heat. CONCLUSIONS This represents the largest study to date assessing the effect modification of temperature-mortality relationships. Evidence from this study can inform public-health interventions and urban planning under various climate-change and urban-development scenarios.
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Kim SE, Xie Y, Dai H, Fujimori S, Hijioka Y, Honda Y, Hashizume M, Masui T, Hasegawa T, Xu X, Yi K, Kim H. Air quality co-benefits from climate mitigation for human health in South Korea. ENVIRONMENT INTERNATIONAL 2020; 136:105507. [PMID: 32006761 DOI: 10.1016/j.envint.2020.105507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/16/2019] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
Climate change mitigation efforts to reduce greenhouse gas (GHG) emissions have associated costs, but there are also potential benefits from improved air quality, such as public health improvements and the associated cost savings. A multidisciplinary modeling approach can better assess the co-benefits from climate mitigation for human health and provide a justifiable basis for establishment of adequate climate change mitigation policies and public health actions. An integrated research framework was adopted by combining a computable general equilibrium model, an air quality model, and a health impact assessment model, to explore the long-term economic impacts of climate change mitigation in South Korea through 2050. Mitigation costs were further compared with health-related economic benefits under different socioeconomic and climate change mitigation scenarios. Achieving ambitious targets (i.e., stabilization of the radiative forcing level at 3.4 W/m2) would cost 1.3-8.5 billion USD in 2050, depending on varying carbon prices from different integrated assessment models. By contrast, achieving these same targets would reduce costs by 23 billion USD from the valuation of avoided premature mortality, 0.14 billion USD from health expenditures, and 0.38 billion USD from reduced lost work hours, demonstrating that health benefits alone noticeably offset the costs of cutting GHG emissions in South Korea.
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Vicedo-Cabrera AM, Sera F, Liu C, Armstrong B, Milojevic A, Guo Y, Tong S, Lavigne E, Kyselý J, Urban A, Orru H, Indermitte E, Pascal M, Huber V, Schneider A, Katsouyanni K, Samoli E, Stafoggia M, Scortichini M, Hashizume M, Honda Y, Ng CFS, Hurtado-Diaz M, Cruz J, Silva S, Madureira J, Scovronick N, Garland RM, Kim H, Tobias A, Íñiguez C, Forsberg B, Åström C, Ragettli MS, Röösli M, Guo YLL, Chen BY, Zanobetti A, Schwartz J, Bell ML, Kan H, Gasparrini A. Short term association between ozone and mortality: global two stage time series study in 406 locations in 20 countries. BMJ 2020; 368:m108. [PMID: 32041707 PMCID: PMC7190035 DOI: 10.1136/bmj.m108] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess short term mortality risks and excess mortality associated with exposure to ozone in several cities worldwide. DESIGN Two stage time series analysis. SETTING 406 cities in 20 countries, with overlapping periods between 1985 and 2015, collected from the database of Multi-City Multi-Country Collaborative Research Network. POPULATION Deaths for all causes or for external causes only registered in each city within the study period. MAIN OUTCOME MEASURES: Daily total mortality (all or non-external causes only). RESULTS A total of 45 165 171 deaths were analysed in the 406 cities. On average, a 10 µg/m3 increase in ozone during the current and previous day was associated with an overall relative risk of mortality of 1.0018 (95% confidence interval 1.0012 to 1.0024). Some heterogeneity was found across countries, with estimates ranging from greater than 1.0020 in the United Kingdom, South Africa, Estonia, and Canada to less than 1.0008 in Mexico and Spain. Short term excess mortality in association with exposure to ozone higher than maximum background levels (70 µg/m3) was 0.26% (95% confidence interval 0.24% to 0.28%), corresponding to 8203 annual excess deaths (95% confidence interval 3525 to 12 840) across the 406 cities studied. The excess remained at 0.20% (0.18% to 0.22%) when restricting to days above the WHO guideline (100 µg/m3), corresponding to 6262 annual excess deaths (1413 to 11 065). Above more lenient thresholds for air quality standards in Europe, America, and China, excess mortality was 0.14%, 0.09%, and 0.05%, respectively. CONCLUSIONS Results suggest that ozone related mortality could be potentially reduced under stricter air quality standards. These findings have relevance for the implementation of efficient clean air interventions and mitigation strategies designed within national and international climate policies.
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Fujii N, McGarr GW, Kenny GP, Amano T, Honda Y, Kondo N, Nishiyasu T. NO-mediated activation of K ATP channels contributes to cutaneous thermal hyperemia in young adults. Am J Physiol Regul Integr Comp Physiol 2020; 318:R390-R398. [PMID: 31913684 DOI: 10.1152/ajpregu.00176.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Local skin heating to 42°C causes cutaneous thermal hyperemia largely via nitric oxide (NO) synthase (NOS)-related mechanisms. We assessed the hypothesis that ATP-sensitive K+ (KATP) channels interact with NOS to mediate cutaneous thermal hyperemia. In 13 young adults (6 women, 7 men), cutaneous vascular conductance (CVC) was measured at four intradermal microdialysis sites that were continuously perfused with 1) lactated Ringer solution (control), 2) 5 mM glibenclamide (KATP channel blocker), 3) 20 mM NG-nitro-l-arginine methyl ester (NOS inhibitor), or 4) a combination of KATP channel blocker and NOS inhibitor. Local skin heating to 42°C was administered at all four treatment sites to elicit cutaneous thermal hyperemia. Thirty minutes after the local heating, 1.25 mM pinacidil (KATP channel opener) and subsequently 25 mM sodium nitroprusside (NO donor) were administered to three of the four sites (each 25-30 min). The local heating-induced prolonged elevation in CVC was attenuated by glibenclamide (19%), but the transient initial peak was not. However, glibenclamide had no effect on the prolonged elevation in CVC in the presence of NOS inhibition. Pinacidil caused an elevation in CVC, but this response was abolished at the glibenclamide-treated skin site, demonstrating its effectiveness as a KATP channel blocker. The pinacidil-induced increase in CVC was unaffected by NOS inhibition, whereas the increase in CVC elicited by sodium nitroprusside was partly (15%) inhibited by glibenclamide. In summary, we showed an interactive effect of KATP channels and NOS for the plateau of cutaneous thermal hyperemia. This interplay may reflect a vascular smooth muscle cell KATP channel activation by NO.
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Honda Y, Momosaki R, Ogata N. Nasogastric Tube Feeding Versus Total Parenteral Nutrition in Older Dysphagic Patients with Pneumonia: Retrospective Cohort Study. J Nutr Health Aging 2020; 24:883-887. [PMID: 33009540 DOI: 10.1007/s12603-020-1414-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Many older patients with pneumonia cannot intake orally after admission and may need nutritional care such as nasogastric tube feeding or total parenteral nutrition. This study sought to compare in-hospital outcomes between patients receiving nasogastric tube feeding and total parenteral nutrition. DESIGN This is a retrospective cohort study. SETTING A hospital-based database constructed by the Diagnosis Procedure Combination survey data comprising more than 100 acute-care hospitals. PARTICIPANTS The study included consecutive older inpatients aged >65 years admitted to participating hospitals with a diagnosis of pneumonia from 2014 through 2017. MEASUREMENTS We compared patients who received total parenteral nutrition and those who received nasogastric tube feeding in terms of characteristics and outcomes. RESULTS Among the included inpatients, a total of 336 (73.2%) patients received total parenteral nutrition and 123 (26.8%) patients received nasogastric tube feeding. Patients with nasogastric tube feeding had less in-hospital mortality (13.8% vs 27.1%, p = 0.003) and a smaller number of complications (mean; 0.71 vs 1.44, p <0.001), shorter length of hospital stay (mean; 27.6 vs 48.9, p <0.001), more discharges home (72.4% vs 35.1%, p <0.001), and more discharges without oral intake (65.9% vs 45.8%, p <0.001) than patients with total parenteral nutrition. The same results were obtained in propensity score analysis. CONCLUSIONS Older patients with pneumonia treated with total parenteral nutrition were significantly more likely to have higher in-hospital mortality than those receiving nasogastric tube feeding.
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Ozaki A, Yoneda M, Kessoku T, Iwaki M, Kobayashi T, Honda Y, Ogawa Y, Imajo K, Sakai E, Taguri M, Yamanaka T, Iwasaki T, Kurihashi T, Saito S, Nakajima A. Effect of tofogliflozin and pioglitazone on hepatic steatosis in non-alcoholic fatty liver disease patients with type 2 diabetes mellitus: A randomized, open-label pilot study (ToPiND study). Contemp Clin Trials Commun 2019; 17:100516. [PMID: 31956725 PMCID: PMC6956674 DOI: 10.1016/j.conctc.2019.100516] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background The incidence of nonalcoholic fatty liver disease (NAFLD) has increased recently and is related to obesity and the associated surge in type 2 diabetes mellitus (DM) and metabolic syndrome diagnoses. We aim to compare the effectiveness of tofogliflozin and pioglitazone treatment on hepatic steatosis in patients with NAFLD with type 2 DM. Methods This is an open label, prospective, randomized exploratory study. Patients who meet the inclusion criteria and do not meet any exclusion criteria will undergo magnetic resonance imaging (MRI)-based proton density fat fraction (MRI-PDFF). Patients with ≥10% liver fat content on MRI-PDFF will be randomly assigned to receive tofogliflozin 20 mg per day (n = 20) or pioglitazone 15–30 mg per day (n = 20). MRI will be performed after 24 weeks following initiation of medication therapy. Then, patients will take tofogliflozin and pioglitazone in combination in both groups for 24 weeks. MRI will be performed again at 48 weeks (24 weeks after initiation medication in combination). Results Our study's primary endpoint will be change in hepatic steatosis measured by MRI-PDFF at 24 weeks after medication therapy. The secondary endpoint will be change in alanine aminotransferase at 24 weeks of medication therapy and the main exploratory endpoint will be changes in liver fat content and liver sclerosis at 48 weeks of medication. Conclusions We will compare the effectiveness of tofogliflozin and pioglitazone treatment using MRI for improving hepatic steatosis in patients with NAFLD complicated by DM and investigate if the combination of these two medications is effective for treating NAFLD. Trial registration This trial is registered in the Japan Registry of Clinical Trials (jRCTs031180159). Protocol version 1.2, 14 December 2018.
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Key Words
- AE, adverse event
- ALT, alanine aminotransferase
- CRF, case report form
- DM, diabetes mellitus
- Diabetes mellitus
- FAS, full analysis set
- HbA1c, glycated hemoglobin
- Hepatic steatosis
- MRI-Based proton density fat fraction
- MRI-PDFF, magnetic resonance imaging-based proton density fat fraction
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- Non-alcoholic fatty liver disease
- PPS, per protocol set
- Pioglitazone
- SPIRIT, the Standard Protocol Items: Recommendations for Interventional Trials
- Tofogliflozin
- jRCTs, the Japan Registry of Clinical Trials
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Fujii N, Amano T, Kenny GP, Honda Y, Kondo N, Nishiyasu T. Nicotinic receptors modulate skin perfusion during normothermia, and have a limited role in skin vasodilatation and sweating during hyperthermia. Exp Physiol 2019; 104:1808-1818. [DOI: 10.1113/ep088072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022]
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Lee W, Choi HM, Kim D, Honda Y, Leon Guo YL, Kim H. Synergic effect between high temperature and air pollution on mortality in Northeast Asia. ENVIRONMENTAL RESEARCH 2019; 178:108735. [PMID: 31539825 DOI: 10.1016/j.envres.2019.108735] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/09/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
High temperature and air pollutants have been reported as potential risk factors of mortality. Previous studies investigated interaction between the two variables; however, the excess death risk due to the synergic effect (i.e. interaction on the additive scale) between the two variables has not been investigated adequately on a multi-country scale. This study aimed to assess the excess death risk due to the synergism between high temperature and air pollution on mortality using a multicity time-series analysis. We collected time-series data on mortality, weather variables, and four air pollutants (PM10, O3, NO2, and CO) for 16 metropolitan cities of three countries (Japan, Korea, and Taiwan) in Northeast Asia (1979-2015). Quasi-Poisson time-series regression and meta-analysis were used to estimate the additive interaction between high temperature and air pollution. The additive interaction was measured by relative excess risk due to interaction (RERI) index. We calculated RERI with relative risks (RR) of the 99th/10th, 90th/90th, and 99th/90th percentiles of temperature/air pollution metrics, where risk at the 90th/10th percentiles of temperature/air pollution metrics was the reference category. This study showed that there may exist positive and significant excess death risks due to the synergism between high temperature and air pollution in the total population for all pollutants (95% lower confidence intervals of all RERIs>0 or near 0). In final, we measured quantitatively the excess death risks due to synergic effect between high temperature and air pollution, and the synergism should be considered in public health interventions and a composite warning system.
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Kim Y, Kim H, Gasparrini A, Armstrong B, Honda Y, Chung Y, Ng CFS, Tobias A, Íñiguez C, Lavigne E, Sera F, Vicedo-Cabrera AM, Ragettli MS, Scovronick N, Acquaotta F, Chen BY, Guo YLL, Seposo X, Dang TN, de Sousa Zanotti Stagliorio Coelho M, Saldiva PHN, Kosheleva A, Zanobetti A, Schwartz J, Bell ML, Hashizume M. Suicide and Ambient Temperature: A Multi-Country Multi-City Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:117007. [PMID: 31769300 PMCID: PMC6927501 DOI: 10.1289/ehp4898] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Previous literature suggests that higher ambient temperature may play a role in increasing the risk of suicide. However, no multi-country study has explored the shape of the association and the role of moderate and extreme heat across different locations. OBJECTIVES We examined the short-term temperature-suicide relationship using daily time-series data collected for 341 locations in 12 countries for periods ranging from 4 to 40 y. METHODS We conducted a two-stage meta-analysis. First, we performed location-specific time-stratified case-crossover analyses to examine the temperature-suicide association for each location. Then, we used a multivariate meta-regression to combine the location-specific lag-cumulative nonlinear associations across all locations and by country. RESULTS A total of 1,320,148 suicides were included in this study. Higher ambient temperature was associated with an increased risk of suicide in general, and we observed a nonlinear association (inverted J-shaped curve) with the highest risk at 27°C. The relative risk (RR) for the highest risk was 1.33 (95% CI: 1.30, 1.36) compared with the risk at the first percentile. Country-specific results showed that the nonlinear associations were more obvious in northeast Asia (Japan, South Korea, and Taiwan). The temperature with the highest risk of suicide ranged from the 87th to 88th percentiles in the northeast Asian countries, whereas this value was the 99th percentile in Western countries (Canada, Spain, Switzerland, the UK, and the United States) and South Africa, where nearly linear associations were estimated. The country-specific RRs ranged from 1.31 (95% CI: 1.19, 1.44) in the United States to 1.65 (95% CI: 1.40, 1.93) in Taiwan, excluding countries where the results were substantially uncertain. DISCUSSION Our findings showed that the risk of suicide increased with increasing ambient temperature in many countries, but to varying extents and not necessarily linearly. This temperature-suicide association should be interpreted cautiously, and further evidence of the relationship and modifying factors is needed. https://doi.org/10.1289/EHP4898.
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Sugisaka J, Sugawara S, Toi Y, Ogasawara T, Aso M, Tsurumi K, Ono K, Shimizu H, Domeki Y, Aiba T, Kawana S, Saito R, Terayama K, Kawashima Y, Nakamura A, Yamanda S, Kimura Y, Honda Y. Pembrolizumab plus chemotherapy versus pembrolizumab monotherapy for PD-L1-positive advanced non-small cell lung cancer in the real world. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz438.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Armstrong B, Sera F, Vicedo-Cabrera AM, Abrutzky R, Åström DO, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Correa PM, Dang TN, Diaz MH, Dung DV, Forsberg B, Goodman P, Guo YLL, Guo Y, Hashizume M, Honda Y, Indermitte E, Íñiguez C, Kan H, Kim H, Kyselý J, Lavigne E, Michelozzi P, Orru H, Ortega NV, Pascal M, Ragettli MS, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tobias A, Tong S, Urban A, De la Cruz Valencia C, Zanobetti A, Zeka A, Gasparrini A. Erratum: "The Role of Humidity in Associations of High Temperature with Mortality: A Multicountry, Multicity Study". ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:109001. [PMID: 31584291 PMCID: PMC6867192 DOI: 10.1289/ehp6302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 05/23/2023]
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Lee JY, Kim H, Gasparrini A, Armstrong B, Bell ML, Sera F, Lavigne E, Abrutzky R, Tong S, Coelho MDSZS, Saldiva PHN, Correa PM, Ortega NV, Kan H, Garcia SO, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti NRI, Pascal M, Goodman PG, Zeka A, Michelozzi P, Scortichini M, Hashizume M, Honda Y, Hurtado M, Cruz J, Seposo X, Nunes B, Teixeira JP, Tobias A, Íñiguez C, Forsberg B, Åström C, Vicedo-Cabrera AM, Ragettli MS, Guo YLL, Chen BY, Zanobetti A, Schwartz J, Dang TN, Do Van D, Mayvaneh F, Overcenco A, Li S, Guo Y. Predicted temperature-increase-induced global health burden and its regional variability. ENVIRONMENT INTERNATIONAL 2019; 131:105027. [PMID: 31351381 DOI: 10.1016/j.envint.2019.105027] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
An increase in the global health burden of temperature was projected for 459 locations in 28 countries worldwide under four representative concentration pathway scenarios until 2099. We determined that the amount of temperature increase for each 100 ppm increase in global CO2 concentrations is nearly constant, regardless of climate scenarios. The overall average temperature increase during 2010-2099 is largest in Canada (1.16 °C/100 ppm) and Finland (1.14 °C/100 ppm), while it is smallest in Ireland (0.62 °C/100 ppm) and Argentina (0.63 °C/100 ppm). In addition, for each 1 °C temperature increase, the amount of excess mortality is increased largely in tropical countries such as Vietnam (10.34%p/°C) and the Philippines (8.18%p/°C), while it is decreased in Ireland (-0.92%p/°C) and Australia (-0.32%p/°C). To understand the regional variability in temperature increase and mortality, we performed a regression-based modeling. We observed that the projected temperature increase is highly correlated with daily temperature range at the location and vulnerability to temperature increase is affected by health expenditure, and proportions of obese and elderly population.
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Honda Y, Imajo K, Kobayashi T, Kessoku T, Ogawa Y, Tomeno W, Yoneda M, Kobayashi N, Saito S, Nakajima A. Autotaxin is a valuable biomarker for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. Hepatol Res 2019; 49:1136-1146. [PMID: 31144415 DOI: 10.1111/hepr.13382] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022]
Abstract
AIM We investigated the characteristics of serum autotaxin (ATX) and its diagnostic performance for liver fibrosis in a large cohort of patients with non-alcoholic fatty liver disease (NAFLD). METHODS We compared the usefulness of ATX and other fibrosis markers in 307 biopsy-confirmed NAFLD patients. In addition, in 145 participants with NAFLD, we compared the diagnostic performance of ATX with that of non-invasive imaging methods (vibration-controlled transient elastography and magnetic resonance elastography [MRE]). RESULTS Serum ATX concentration was significantly correlated with fibrosis stage in male and female NAFLD patients. In male patients, the area under the receiver operating characteristic (AUROC) curve values of ATX for the diagnosis of ≥stage 1, ≥stage 2, ≥stage 3, and ≥stage 4 fibrosis were 0.65, 0.75, 0.81, and 0.95, respectively. In female NAFLD participants, the AUROC values were all >0.81. The sensitivity of ATX was highest for the diagnosis of ≥stage 2 and ≥stage 3 fibrosis in both men and women with NAFLD. In the comparison between ATX and non-invasive imaging methods, the AUROC for MRE was the highest at every stage of fibrosis. CONCLUSIONS Serum ATX concentration is significantly correlated with fibrosis stage in NAFLD patients. The diagnostic accuracy of ATX for liver fibrosis is lower than that of MRE, but the sensitivities of ATX for the diagnosis of ≥stage 2 and ≥stage 3 were highest. We conclude that ATX is useful for the selection of patients requiring further evaluation for liver fibrosis.
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Inoue M, Yoshida J, Oka S, Honda Y, Chikaishi Y, Yasuda D. P1.04-53 A High PD-L1 Expression in Non-Small Cell Lung Cancer Correlates with Expression of SPOP and CD8 Tumor-Infiltrating Lymphocytes. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Toi Y, Sugawara S, Aso M, Tsurumi K, Ono K, Sugisaka J, Shimizu H, Ono H, Domeki Y, Aiba T, Kawana S, Saito R, Terayama K, Kawashima Y, Nakamura A, Yamanda S, Kimura Y, Honda Y. P1.16-29 Profiling Immune-Related Adverse Events (irAEs) in Patients with Anti-PD-1 for Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Onozuka D, Gasparrini A, Sera F, Hashizume M, Honda Y. Future projections of temperature-related excess out-of-hospital cardiac arrest under climate change scenarios in Japan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 682:333-339. [PMID: 31125746 DOI: 10.1016/j.scitotenv.2019.05.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/29/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Recent studies have reported associations between global climate change and mortality. However, future projections of temperature-related out-of-hospital cardiac arrest (OHCA) have not been thoroughly evaluated. Thus, we aimed to project temperature-related morbidity for OHCA concomitant with climate change. METHODS We collected national registry data on all OHCA cases reported in 2005-2015 from all 47 Japanese prefectures. We used a two-stage time series analysis to estimate temperature-OHCA relationships. Time series of current and future daily mean temperature variations were constructed according to four climate change scenarios of representative concentration pathways (RCPs) using five general circulation models. We projected excess morbidity for heat and cold and the net change in 1990-2099 for each climate change scenario using the assumption of no adaptation or population changes. RESULTS During the study period, 739,717 OHCAs of presumed cardiac origin were reported. Net decreases in temperature-related excess morbidity were observed under higher emission scenarios. The net change in 2090-2099 compared with 2010-2019 was -0.8% (95% empirical confidence interval [eCI]: -1.9, 0.1) for a mild emission scenario (RCP2.6), -2.6% (95% eCI: -4.4, -0.8) for a stabilization scenario (RCP4.5), -3.4% (95% eCI: -5.7, -1.0) for a stabilization scenario (RCP6.0), and - 4.2% (95% eCI: -8.3, -0.1) for an extreme emission scenario (RCP8.5). CONCLUSIONS Our study indicates that Japan is projected to experience a substantial net reduction in OHCAs in higher-emission scenarios. The decrease in risk is limited to a specific morbidity cause, and a broader assessment within climate change scenarios should consider other direct and indirect impacts.
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Tsuji S, Matsuzaki H, Iseki M, Nagasu A, Hirano H, Ishihara K, Ueda N, Honda Y, Horiuchi T, Nishikomori R, Morita Y, Mukai T. Functional analysis of a novel G87V TNFRSF1A mutation in patients with TNF receptor-associated periodic syndrome. Clin Exp Immunol 2019; 198:416-429. [PMID: 31429073 DOI: 10.1111/cei.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/17/2022] Open
Abstract
Tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is an autoinflammatory disease that is caused by heterozygous mutations in the TNFRSF1A gene. Although more than 150 TNFRSF1A mutations have been reported to be associated with TRAPS phenotypes only a few, such as p.Thr79Met (T79M) and cysteine mutations, have been functionally analyzed. We identified two TRAPS patients in one family harboring a novel p.Gly87Val (G87V) mutation in addition to a p.Thr90Ile (T90I) mutation in TNFRSF1A. In this study, we examined the functional features of this novel G87V mutation. In-vitro analyses using mutant TNF receptor 1 (TNF-R1)-over-expressing cells demonstrated that this mutation alters the expression and function of TNF-R1 similar to that with the previously identified pathogenic T79M mutation. Specifically, cell surface expression of the mutant TNF-R1 in transfected cells was inhibited with both G87V and T79M mutations, whereas the T90I mutation did not affect this. Moreover, peripheral blood mononuclear cells (PBMCs) from TRAPS patients harboring the G87V and T90I mutations showed increased mitochondrial reactive oxygen species (ROS). Furthermore, the effect of various Toll-like receptor (TLR) ligands on inflammatory responses was explored, revealing that PBMCs from TRAPS patients are hyper-responsive to TLR-2 and TLR-4 ligands and that interleukin (IL)-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) are likely to be involved in the pathogenesis of TRAPS. These findings suggest that the newly identified G87V mutation is one of the causative mutations of TRAPS. Our findings based on unique TRAPS-associated mutations provide novel insight for clearer understanding of inflammatory responses, which would be basic findings of developing a new therapeutic and prophylactic approach to TRAPS.
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Armstrong B, Sera F, Vicedo-Cabrera AM, Abrutzky R, Åström DO, Bell ML, Chen BY, de Sousa Zanotti Stagliorio Coelho M, Correa PM, Dang TN, Diaz MH, Dung DV, Forsberg B, Goodman P, Guo YLL, Guo Y, Hashizume M, Honda Y, Indermitte E, Íñiguez C, Kan H, Kim H, Kyselý J, Lavigne E, Michelozzi P, Orru H, Ortega NV, Pascal M, Ragettli MS, Saldiva PHN, Schwartz J, Scortichini M, Seposo X, Tobias A, Tong S, Urban A, De la Cruz Valencia C, Zanobetti A, Zeka A, Gasparrini A. The Role of Humidity in Associations of High Temperature with Mortality: A Multicountry, Multicity Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:97007. [PMID: 31553655 PMCID: PMC6792461 DOI: 10.1289/ehp5430] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 09/06/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND There is strong experimental evidence that physiologic stress from high temperatures is greater if humidity is higher. However, heat indices developed to allow for this have not consistently predicted mortality better than dry-bulb temperature. OBJECTIVES We aimed to clarify the potential contribution of humidity an addition to temperature in predicting daily mortality in summer by using a large multicountry dataset. METHODS In 445 cities in 24 countries, we fit a time-series regression model for summer mortality with a distributed lag nonlinear model (DLNM) for temperature (up to lag 3) and supplemented this with a range of terms for relative humidity (RH) and its interaction with temperature. City-specific associations were summarized using meta-analytic techniques. RESULTS Adding a linear term for RH to the temperature term improved fit slightly, with an increase of 23% in RH (the 99th percentile anomaly) associated with a 1.1% [95% confidence interval (CI): 0.8, 1.3] decrease in mortality. Allowing curvature in the RH term or adding terms for interaction of RH with temperature did not improve the model fit. The humidity-related decreased risk was made up of a positive coefficient at lag 0 outweighed by negative coefficients at lags of 1-3 d. Key results were broadly robust to small model changes and replacing RH with absolute measures of humidity. Replacing temperature with apparent temperature, a metric combining humidity and temperature, reduced goodness of fit slightly. DISCUSSION The absence of a positive association of humidity with mortality in summer in this large multinational study is counter to expectations from physiologic studies, though consistent with previous epidemiologic studies finding little evidence for improved prediction by heat indices. The result that there was a small negative average association of humidity with mortality should be interpreted cautiously; the lag structure has unclear interpretation and suggests the need for future work to clarify. https://doi.org/10.1289/EHP5430.
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Liu C, Chen R, Sera F, Vicedo-Cabrera AM, Guo Y, Tong S, Coelho MSZS, Saldiva PHN, Lavigne E, Matus P, Valdes Ortega N, Osorio Garcia S, Pascal M, Stafoggia M, Scortichini M, Hashizume M, Honda Y, Hurtado-Díaz M, Cruz J, Nunes B, Teixeira JP, Kim H, Tobias A, Íñiguez C, Forsberg B, Åström C, Ragettli MS, Guo YL, Chen BY, Bell ML, Wright CY, Scovronick N, Garland RM, Milojevic A, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJK, Ryti NRI, Katsouyanni K, Analitis A, Zanobetti A, Schwartz J, Chen J, Wu T, Cohen A, Gasparrini A, Kan H. Ambient Particulate Air Pollution and Daily Mortality in 652 Cities. N Engl J Med 2019; 381:705-715. [PMID: 31433918 PMCID: PMC7891185 DOI: 10.1056/nejmoa1817364] [Citation(s) in RCA: 772] [Impact Index Per Article: 154.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias. METHODS We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration-response curves from each city were pooled to allow global estimates to be derived. RESULTS On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration-response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations. CONCLUSIONS Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.).
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