Exhalation of alternative tobacco product aerosols differs from cigarette smoke-and may lead to alternative health risks.

BACKGROUND: Variation in alternative tobacco product (ATP) constituents, heating potential, and consumer behaviors have made it difficult to characterize their health risks. To date, most toxicity studies of ATPs have used established cigarette endpoints to inform study design. Furthermore, to assess where ATPs fall on the tobacco harm continuum, with cigarettes representing maximum potential risk, studies have tended to compare the relative biological responses to ATPs against those due to cigarettes. OBJECTIVES: 1) To characterize the exhalation profiles of two popular ATPs: electronic cigarettes (e-cigarettes) and hookah waterpipes (hookah) and 2) to determine if ATP exhalation patterns were representative of cigarette exhalation patterns. METHODS: Exhalation patterns were recorded (mouth only, nose only, or both mouth and nose) among individuals observed in the New York City tri-state area using a recognizable tobacco product (cigarette, e-cigarette, or hookah). Cigarette smokers and e-cigarette vapers were observed on city streets; water-pipe smokers were observed inside Manhattan hookah bars. RESULTS: E-cigarette vapers practiced exclusive nasal exhalation at far higher rates than did cigarette smokers (19.5% vs 4.9%). Among vapers, e-cigarette device type was also significantly associated with exhalation profile. Overall, cigarette smokers exhaled from their nose approximately half to one-third as often as ATP users (hookah and e-cigarettes, respectively). CONCLUSIONS: Nasal exhalation of tobacco emissions appears to be a shared characteristic across several types of ATPs. It is therefore plausible that ATP-specific consumer behaviors may foster unique upper respiratory health consequences that have not been observed in smokers. Thus, product-specific behaviors should inform the prioritization of biological endpoints used in studies evaluating ATP toxicity and health effects.

PM2.5 Concentration and Composition in Subway Systems in the Northeastern United States.

OBJECTIVES: The goals of this study were to assess the air quality in subway systems in the northeastern United States and estimate the health risks for transit workers and commuters. METHODS: We report real-time and gravimetric PM2.5 concentrations and particle composition from area samples collected in the subways of Philadelphia, Pennsylvania; Boston, Massachusetts; New York City, New York/New Jersey (NYC/NJ); and Washington, District of Columbia. A total of 71 stations across 12 transit lines were monitored during morning and evening rush hours. RESULTS: We observed variable and high PM2.5 concentrations for on-train and on-platform measurements during morning (from 0600 hours to 1000 hours) and evening (from 1500 hours to 1900 hours) rush hour across cities. Mean real-time PM2.5 concentrations in underground stations were 779±249, 548±207, 341±147, 327±136, and 112±46.7 µg/m3 for the PATH-NYC/NJ; MTA-NYC; Washington, DC; Boston; and Philadelphia transit systems, respectively. In contrast, the mean real-time ambient PM2.5 concentration taken above ground outside the subway stations of PATH-NYC/NJ; MTA-NYC; Washington, DC; Boston; and Philadelphia were 20.8±9.3, 24.1±9.3, 12.01±7.8, 10.0±2.7, and 12.6±12.6 µg/m3, respectively. Stations serviced by the PATH-NYC/NJ system had the highest mean gravimetric PM2.5 concentration, 1,020 µg/m3, ever reported for a subway system, including two 1-h gravimetric PM2.5 values of approximately 1,700 µg/m3 during rush hour at one PATH-NYC/NJ subway station. Iron and total carbon accounted for approximately 80% of the PM2.5 mass in a targeted subset of systems and stations. DISCUSSION: Our results document that there is an elevation in the PM2.5 concentrations across subway systems in the major urban centers of Northeastern United States during rush hours. Concentrations in some subway stations suggest that transit workers and commuters may be at increased risk according to U.S. federal environmental and occupational guidelines, depending on duration of exposure. This concern is highest for the PM2.5 concentrations encountered in the PATH-NYC/NJ transit system. Further research is urgently needed to identify the sources of PM2.5 and factors that contribute to high levels in individual stations and lines and to assess their potential health impacts on workers and/or commuters. https://doi.org/10.1289/EHP7202.

Heterogeneity of Outcomes in D'Amico Intermediate-Risk Prostate Cancer Patients after Radical Prostatectomy: Influence of Primary and Secondary Gleason Score.

AIM: The aim of this study was to clarify and examine the outcomes of prostate cancer patients classified as intermediate risk (IR) using the D'Amico risk classification system, specifically focusing on the influence of primary and secondary biopsy Gleason score (BGS). PATIENTS AND METHODS: An institutional review board-approved database of robotic-assisted radical prostatectomies performed after 2006 was stratified by standard D'Amico criteria. IR patients were then sub-stratified by BGS. Pathologic and intermediate-term biochemical disease-free survival (BDFS) outcomes were analyzed. RESULTS: Overall, 1,090 patients were classified as D'Amico low-risk, 896 as IR, and 240 as high-risk. Of the 896 IR patients, 63 had BGS 6, 630 were 3 + 4 = 7, and 203 4 + 3 = 7. Among IR patients, as the BGS increased, there was an increasing likelihood of extracapsular extension (21, 28, and 38%, respectively; p = 0.005), positive surgical margins (14, 26, 31%; p = 0.048), and worse 3-year BDFS (96, 94, 88%; p = 0.01). Multivariable logistic regression and Cox regression analyses confirmed differences among IR groups. CONCLUSION: D'Amico IR patients demonstrate significant heterogeneity in both pathologic outcomes and BDFS. IR patients with a BGS of 6 appear to have similar intermediate-term BDFS as low-risk patients. An increasing BGS from 3 + 3 to 3 + 4 to 4 + 3 results in a higher likelihood of locally-advanced disease and intermediate-term biochemical failure.

Patient-perceived Causes of Prostate Cancer: Result of an Internet-based Survey.

OBJECTIVE: To assess patients' perceived causes of prostate cancer (PCa) and relation to treatment satisfaction, an Internet-based survey study was designed. PCa is a profoundly personal disease, considering the location and common sequelae of treatment. Deeply held patient self-perceptions regarding the etiology of a patient's PCa may generate lasting beliefs that impact satisfaction with treatment selection. MATERIALS AND METHODS: Third-party web-based surveys were sent to patients receiving radical prostatectomy for clinically localized PCa. Patients were queried regarding demographic characteristics, family history, socioeconomic status, sexual function, urinary control, and factors believed to cause their PCa. RESULTS: Among respondents (293 of 524, 55.9%), 237 (81.5%) provided primary causes for PCa. Evidence-based answers were provided by 128 (53.5%) patients, whereas a wide range of non-evidence-based responses were provided by 49 (20.5%) patients. Forty patients (16.7%) were undecided, and 20 (8.3%) offered belief-based responses. Evidence-based responses were more common in patients with a family history of PCa (P <.01); however, no significant differences were seen among race, educational level, or income. Patients providing an evidence-based cause of PCa were more likely to be potent (P <.01). Providing a non-evidence-based cause for PCa was associated with considering surgery as a wrong decision in treatment selection. CONCLUSION: Among men with localized PCa, there is a wide spectrum of patient beliefs regarding the etiology of their disease that may reflect background and information sources. Further research is warranted to determine whether patient counseling should incorporate these considerations.

Are magnetic resonance imaging undetectable prostate tumours clinically significant? Results of histopathological analyses.

OBJECTIVE: To investigate whether tumours at threshold values for detection on magnetic resonance imaging (MRI) represent clinically significant tumours or not, and therefore the utility of MRI in active surveillance (AS) protocols. PATIENTS AND METHODS: A retrospective analysis of a single institution database was performed after Institutional Review Board approval. Between 2010 and 2013, 1633 patients underwent robot-assisted laparoscopic prostatectomy (RALP) at a single institution by a single surgeon. Of these, 1361 had complete clinical data and were included in analysis. Multivariate logistic regression was used to assess histopathological grade compared to tumour size whilst controlling for biopsy Gleason score, prostate-specific antigen level, body mass index, race, and age. RESULTS: Of 120 tumours <5 mm in size, four were Gleason score 4 + 3. Of 276 tumours of 5-10 mm, 22 (8.1%) were Gleason score 4 + 3 and one (0.2%) was Gleason score 8. On multivariate regression analyses, tumours of <5 mm were much less likely to be high grade (Gleason score >3 + 4) at RALP compared to larger tumours (3.3% vs 25.1%, P < 0.001), or Gleason score ⩾8 (0.0% vs 7.6%, P < 0.001). Size was further shown to significantly correlate with grade on multivariate regression (P < 0.001). CONCLUSIONS: Prostate tumours below the detection threshold for MRI (5 mm) most probably represent clinically insignificant tumours, which alone would not necessitate leaving AS in favour of more aggressive therapy. These findings point to a possible role of MRI in modern AS protocols.

Clinical characteristics and outcomes of HIV-seropositive men treated with surgery for prostate cancer.

PURPOSE: The natural history and optimal management strategy for men with human immunodeficiency virus (HIV) and prostate cancer remain to be definitively characterized. This study was conducted to evaluate the clinical characteristics and outcomes of HIV-seropositive men treated with robotic-assisted radical laparoscopic prostatectomy for localized prostate cancer. METHODS: After Institutional Review Board approval, a prospective database of 2175 operative cases of clinically localized prostate adenocarcinoma was reviewed. Thirteen patients were identified as HIV-positive. Tumor characteristics, operative outcomes, postoperative outcomes, histology (Gleason score), local invasion, biochemical recurrence, and surgical complications were compared with HIV-negative patients. RESULTS: There were no preoperative demographic differences between the HIV-positive and HIV-negative patients. HIV-positive patients had higher prostate specific antigen (PSA) levels at time of diagnosis which was not statistically significant. However, HIV-positive patients had higher D'Amico risk assessment (p < 0.05). There was no postoperative complication. HIV-positive patients treated with robotic prostatectomy had similarly favorable perioperative and short-term biochemical recurrence-free survival outcomes. CONCLUSION: Our findings show that minimally invasive prostatectomy can be safely considered as a therapeutic option in otherwise eligible HIV-positive patients with clinically significant prostate cancer. Further research is necessary to outline a diagnostic and treatment guideline for HIV-positive men in detection and treatment of prostate cancer.

Robotic assisted laparoscopic prostatectomy in men with proctocolectomy and restorative ileal pouch-anal anastomosis.

We conducted a retrospective chart review of robotic prostatectomies done by a single surgeon between 2003 and 2012. During that time period, we identified two patients within the year 2012, with ileal pouch-anal anastomosis (IPPA) who also underwent robotic prostatectomies. The demographics and postoperative characteristics of the two patients were assessed. In both patients, prostatectomy, bilateral nerve sparing, and pelvic lymphadenectomy were successfully performed and the integrity of ileal pouch was maintained. There was a mean surgical time of 144.5 minutes, and an average estimated blood loss was 125 mL. Both patients were discharged on the second day postoperatively. In both patients there was a Gleason upgrade to 3 + 4, with negative margins, and preservation of fecal and urinary continence by their six-month followup. Owing to surgical modifications, these two surgeries represent the first successful robotic prostatectomies in patients with a J-pouch.