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As a well-known behavioral risk factor for human health, smoking is involved in carcinogenesis, tumor progression, and therapeutic interventions of head and neck squamous cell carcinoma (HNSCC). The stratification of disease subtypes according to tobacco use is expressively needed for HNSCC precision therapy. High-throughput transcriptome profiling by RNA sequencing (RNA-seq) from The Cancer Genome Atlas (TCGA) was collected and collated for differential expression analysis and pathway enrichment analysis to characterize the molecular landscape for non-smoking HNSCC patients. Molecular prognostic signatures specific to non-smoking HNSCC patients were identified by the least absolute shrinkage and selection operator (LASSO) analysis and were then verified via internal and external validation cohorts. While proceeding to immune cell infiltration and after drug sensitivity analysis was further carried out, a proprietary nomogram was finally developed for their respective clinical applications. In what it relates to the non-smoking cohort, the enrichment analysis pointed to human papillomavirus (HPV) infection and PI3K-Akt signaling pathway, with the prognostic signature consisting of another ten prognostic genes (COL22A1, ADIPOQ, RAG1, GREM1, APBA2, SPINK9, SPP1, ARMC4, C6, and F2RL2). These signatures showed to be independent factors, and the related nomograms were, thus, constructed for their further and respective clinical applications. While the molecular landscapes and proprietary prognostic signature were characterized based on non-smoking HNSCC patients, a clinical nomogram was constructed to provide better HNSCC patient classification and guide treatment for non-smoking HNSCC patients. Nonetheless, there are still significant challenges in the recognition, diagnosis, treatment, and understanding of the potentially efficient mechanisms of HNSCC with no tobacco use. [ABSTRACT FROM AUTHOR]

Objective(s): There has been a disproportionate increase in the incidence of young patients with squamous cell carcinoma of the oral tongue (SCCOT). The purpose of this study was to compare young patients to older patients with SCCOT without prior drinking or smoking history as this population is poorly characterized in the literature. Methods: A retrospective review of patients presenting to our institution with SCCOT was performed. The clinical and pathologic characteristics, as well as, outcomes were compared between younger patients (age ≤45) and older patients (age >45). Outcome analysis was performed using Kaplan Meier method. Multivariable Cox proportional hazard models were performed for age and stage. Results: Eighty‐two patients (38 young, 44 old) were included in this study. Median follow‐up was 29.4 months. When compared to the older cohort (age >45), the younger cohort (age ≤45) demonstrated lower rates of 5‐year locoregional control (LC) (79.6% vs. 52.5%, p = 0.043) and distant metastasis‐free survival (88.1% vs. 61.8%, p = 0.006). Both cohorts demonstrated similar overall survival rates (55.5% vs. 58.1%) and disease‐specific survival (66.2% vs. 58.1%). Of patients experiencing locoregional failure with available radiation therapy plans and PET scans in younger cohorts (n = 7), 100% demonstrated in‐field failures. Multivariable Cox proportional hazards demonstrated age was an independent predictor of DMFS (p = 0.004) and the advanced stage was a predictor of DSS (p = 0.03). Conclusions: Young, nondrinker, nonsmokers with SCCOT demonstrate high rates of locoregional recurrence, distant metastasis, and in‐field failures. Future studies are warranted to determine underlying mechanisms driving pathogenesis in this unique cohort. Level of Evidence: 3 Laryngoscope, 133:1110–1121, 2023 [ABSTRACT FROM AUTHOR]

Purpose: To explore the discrepancy in clinicopathological and prognostic features between smoking and alcohol drinking (SA) and non-smoking and non-alcohol drinking (NSNA) patients with laryngeal squamous cell carcinoma (LSCC). Methods: This retrospective study including 1735 patients with LSCC was conducted from January 2005 to December 2010, which were categorized into 4 groups, NSNA group, smoking only group, alcohol-drinking only group, and SA group. We compared overall survival (OS) and disease-free survival (DFS) using the Kaplan–Meier method and indicated clinicopathological features by Cox proportional hazards regression models before and after propensity score matching (PSM). Results: A total of 415 patients (23.92%) were identified as NSNA. The SA group was predominantly patients ≤60 years old (46.63%) while the NSNA group was more older (58.07%). NSNA group was more likely to present at earlier disease stage and more female. No significant difference in OS (P =.685) and DFS (P =.976) was found between the 2 groups. In addition to age and recurrence and metastasis being common independent prognostic factors in terms of OS in both groups of patients, NSNA group also exhibited other factors, namely tumor area >3.7 cm2 and positive resection margin. For DFS, N + stage, tumor size >3.7 cm2, and positive resection margin were prognostic features specific to NSNA group. Conclusion: The outcome is similar in LSCC patients with and without SA. NSNA group shows a distinct profile from that found in SA group. Clinicopathological features from NSNA group should be considered for LSCC management. [ABSTRACT FROM AUTHOR]

Background: Since the outbreak of COVID-19 in 2020, routine CT examination was recommended to hospitalized patients at some hospitals and discovered lung cancer patients at an early stage. This study aimed to investigate the detection efficacy of routine CT examination on early diagnosis of lung cancer, especially on pathological characteristics. Methods: The epidemic of COVID-19 outbreak in January 2020 in China, and routine CT examination was recommended to hospitalized patients in June 2020 and ended in July 2021. Based on the time points, we compared the diagnosis efficacy between three periods: pre-period, peri-period, and the period of routine CT examination. Results: During the period of routine CT examination, more early stages of lung cancer were detected and the tumor size was reduced to 2.14 cm from 3.21 cm at pre-period (p = 0.03). The proportion of lung adenocarcinoma and early stage adenocarcinoma was increased by 12% and 30% in the period of routine CT examination, with referral to the pre-period of CT examination (p < 0.05). A total of 61% of diagnosed patients had the wild type of TP53 gene during the period of routine CT examination, compared to 45% of patients at the pre-period of CT examination (p = 0.001). The median Ki-67 index was 15% among patients diagnosed at the period of routine CT examination and increased to 35% at the pre-period of CT examination (p < 0.001). The period of routine CT examination was associated with a 78% higher probability of detecting an early stage of adenocarcinoma (OR = 1.78, 95%CI 1.03, 3.08) but no significant association was observed for squamous cell carcinoma. From the pre-period to the period of routine CT examination, the proportion of female patients and non-smoking patients increased by 57% and 44%, respectively (p < 0.001). Conclusion: Routine CT examination could detect more lung cancer at an early stage, especially for adenocarcinoma, and detect patients with less aggressive features. Further studies were warranted to confirm the findings. [ABSTRACT FROM AUTHOR]

Oral cavity squamous cell carcinoma (OCSCC) is one of the most common head and neck cancers worldwide. It is well known that risk factors for OCSCC include tobacco and excess alcohol consumption. However, in recent years, OCSCC incidence has been increasing in patients without these traditional risk factors. The cause of this increase is unclear and various genetic, environmental, and infectious factors have been hypothesized to play a role. Additionally, there are expert opinions that oral cancer in non-smoking, non-drinking (NSND) patients have a distinct phenotype resulting in more aggressive disease presentation and poorer prognosis. In this review, we summarize the current state of knowledge for oral cavity cancer in patients without traditional risk factors. [ABSTRACT FROM AUTHOR]

Oral cavity squamous cell carcinoma (OCSCC) is one of the most common head and neck cancers worldwide. It is well known that risk factors for OCSCC include tobacco and excess alcohol consumption. However, in recent years, OCSCC incidence has been increasing in patients without these traditional risk factors. The cause of this increase is unclear and various genetic, environmental, and infectious factors have been hypothesized to play a role. Additionally, there are expert opinions that oral cancer in non-smoking, non-drinking (NSND) patients have a distinct phenotype resulting in more aggressive disease presentation and poorer prognosis. In this review, we summarize the current state of knowledge for oral cavity cancer in patients without traditional risk factors.

Introduction: The habit of smoking is common among Indonesian adults, teenagers, and even children. This research, therefore, aims to develop a non-smoking regional policy to protect children in Palu City, Indonesia. Methods: Data were systematically obtained from variousonline literature reviews, including reports, journals, and books from the last ten years. The journals were mostly from scholars, while the article was screened according to the research objectives. Research that is included in the systematic discussion not completely abstracted for inclusion in this paper is issued for the inclusion of selected study details in tabular format. Results: The result showed that the use of a non-smoking regional policy is effective in preventing children smoking habits. The bureaucratic structure has been adequately implemented, however, there are lots of errors associated with the communication, disposition, and resources used due to differences of opinion among policymakers, lack of human resources, and the poor commitment of stakeholders. All literature was selected and screened from scholars. Conclusion: In conclusion, a non-smoking regional policy is effective in preventing children smoking habits. [ABSTRACT FROM AUTHOR]

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Background Germline mutations play an important role in the pathogenesis of lung cancer. Nonetheless, research on malignant ground glass opacity (GGO) nodules is limited. Methods A total of 13 participants with malignant GGO nodules were recruited in this study. Peripheral blood was used for exome sequencing, and germline mutations were analyzed using InterVar. The whole exome sequencing dataset was analyzed using a filtering strategy. KOBAS 3.0 was used to analyze KEGG pathway to further identify possible deleterious mutations. Results There were seven potentially deleterious germline mutations. NM_001184790:exon8: c.C1070T in PARD3, NM_001170721:exon4:c.C392T in BCAR1 and NM_001127221:exon46: c.G6587A in CACNA1A were present in three cases each; rs756875895 frameshift in MAX, NM_005732: exon13:c.2165_2166insT in RAD50 and NM_001142316:exon2:c.G203C in LMO2, were present in two cases each; one variant was present in NOTCH3. Conclusions Our results expand the germline mutation spectrum in malignant GGO nodules. Importantly, these findings will potentially help screen the high-risk population, guide their health management, and contribute to their clinical treatment and determination of prognosis. [ABSTRACT FROM AUTHOR]

Abstract Background Both SOX2 promoter methylation and air pollution have been associated with lung cancer risk. However, little has been done to assess SOX2 promoter methylation in individuals living in air pollution areas. The aim of this study was to investigate SOX2 promoter methylation in non-smoking Taiwanese adults living in areas with different levels of air pollution especially particulate matter with diameter

Objective: To examine gender and socioeconomic differences in adolescents' reasons for not smoking cigarettes using self-reported data from Danish 14-year-olds (N = 1,559) collected in 2018. χ2-tests were used to assess whether the proportion of students who rated 12 statements as important reasons for not smoking cigarettes differed according to gender and family occupational social class (OSC). Results: More girls than boys stated that thinking the taste of cigarettes is disgusting, not being allowed to smoke by parents, knowing smoking is dangerous, not being allowed to smoke before the age of 18, not wanting to be addicted to smoking, and that smoking makes you smell bad were important reasons for choosing not to smoke cigarettes. More boys than girls reported exercising a lot and having a partner that does not smoke as important reasons for not smoking cigarettes. More students with a high OSC compared with a low OSC stated exercising a lot and that smoking makes you smell bad were important reasons. In conclusion, reasons for not smoking cigarettes differed substantially across gender and less according to socioeconomic position. [ABSTRACT FROM AUTHOR]

Objective: Few studies have used time perspective (TP) theory to examine the factors mediating the association between socio-economic status (SES) and health behaviours (i.e. the psychological mechanisms that underlie SES differences in health behaviours). The purpose of this study was to examine the mediating effects of TPs on the relationship between SES and health behaviours in older Japanese adults. Design: In total, 761 participants living in the Tokyo metropolitan area participated in face-to-face interviews in 2016. Outcome measures: Health behaviours were measured using three indicators: participation in exercise, healthy dietary habits and smoking status. SES was composed of educational attainment and annual income. TPs were measured using the Zimbardo Time Perspective Inventory, which consisted of five subcategories: the past-negative, past-positive, present-hedonistic, present-fatalistic and future perspectives. Results: Among these five subcategories, none mediated both SES and health behaviours. Conclusion: TPs might not contribute to the appearance of SES differences in health behaviours in older adults. [ABSTRACT FROM AUTHOR]

Objective: To explore the pathogenosis and prognostic markers for non-smoking female lung cancer patients with bioinformatics analysis and functional prediction of potential lung cancer associated genes in female non-smokers. Methods: Data for nonsmoking female patients with lung cancer were downloaded from the Gene Expression Omnibus (GEO) database and the differentially expressed genes (DEGs) were identified using GEO2R. DAVID online data base was used to perform gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG), and STRING online software was used to perform protein-protein interaction (PPI) analysis; then the plug-in (M-CODE) was used to screen the key DEGs; finally, GEPIA and Kaplan-Meier plotter were used to perform function prediction and prognosis analysis of key DEGs. Results: A total of 160 DEGs were screened, including 54 up-regulated and 106 down-regulated genes; GO enrichment analysis showed that these DEGs were mainly related to neovascularization, single cell adhesion, positive regulation of GTPase activity and signal transduction (all P<0.05). KEGG pathway analysis revealed that DEGs were mainly involved in cell adhesion molecules (CAMs), leukocyte transendothelial migration, tight junction and endocytosis (all P<0.05); PPI network analysis revealed 8 key DEGs, including TIE1, PECAM1, CLDN5, VEGFD, ICAM2, ESAM, EMCN and ROBO4. Conclusion: TIE1, CLDN5, ICAM2, ESAM, VEGFD and ROBO4 may be the research targets of the pathogenesis of non-smoking female lung cancer patients. PECAM1 and EMCN may be the new bio-markers to predict the progression and prognosis of nonsmoking female lung cancer patients. [ABSTRACT FROM AUTHOR]

Study Design: A prospective observational 10-year follow-up study.Objective: This study aimed to examine preoperative predictors for better surgical outcomes in patients with lumbar spinal stenosis (LSS) 10 years after surgery.Summary Of Background Data: LSS is a leading cause of low back surgery in patients older than 65 years. Limited data are available for predictors of long-term surgical outcomes in patients with LSS.Methods: At the baseline, 102 patients with LSS underwent decompressive surgery, and 72 of the original study sample participated in a 10-year follow-up study. Study patients filled out a questionnaire preoperatively, and follow-up data were collected at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years postoperatively. Surgical outcomes were evaluated in terms of disability with the Oswestry Disability Index (ODI) and pain with the visual analog scale (VAS). Predictors in the models were nonsmoking status, absence of previous lumbar surgery, self-rated health, regular use of painkillers for symptom alleviation, and BMI. Statistical analyses included longitudinal associations, subgroup analyses, and cross-sectional analyses.Results: Using multivariate analysis, statistically significant predictors for lower ODI and VAS scores at 10 years were nonsmoking status, absence of previous lumbar surgery, better self-rated health, and regular use of painkillers for <12 months. Patients who smoked preoperatively or had previous lumbar surgery experienced more pain and disability at the 10-year follow-up.Conclusion: These study results can enhance informed decision-making processes for patients considering surgical treatment for LSS by showing preoperative predictors for surgical outcomes up to 10 years after surgery. Smokers and patients with previous lumbar surgery showed a decline in surgical benefits after 5 years.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objective There has been an alarming increase of lung cancer, 3.4-fold at age 65-69 rate and 13-fold in total number in 35 years, among nonsmoking women in Taiwan, The worried well, concerned with their risk, demanded LDCT screening. However, current recommendation was limited to heavy smokers with 30 pack years. Screening low-risk individuals had the potential of causing substantial harms. Methods A cohort of 439,119 adults, who had complete medical work up during health surveillance program, between 1994 and 2008, had their IDs matched for lung cancer with National Cancer Registry. Higher lung cancer risk nonsmokers could be identified with prediction models. Results Significant risks were found among nonsmokers as follows: Personal history of any cancer or family history of lung cancer; body weight, Reduced spirometry such as FEV1; biomarkers, including elevated Alfa-feto-protean(AFP), Carcino-Embronic Antigen(CEA), and C-reactive Protean (CRP), low bilirubin, second hand smoking, abnormal chest X-ray and geo-coded PM2.5 for air pollution. With 1,307 incidence lung cancer, including nonsmokers (607), light smokers (274) and heavy smokers (426), a prediction model was developed, with ROC 0.806-0.847. A simple 5-year risk score was established for nonsmokers and light smokers to check their risk before LDCT. Conclusions With risk-data available, a small portion of nonsmokers (3%) and one fifth of light smokers (20%) could be found qualified for LDCT screening, as they reached 5-year lung cancer risk of heavy smokers, 1.5% in 5 years. This pre-screening model could save unnecessary LDCT procedures and avoid harms and cost associated with screening low risk individuals.

To examine differences in survival and clinical outcomes of elderly patients without traditional risk factors presenting with oral squamous cell carcinoma. Retrospective review of 287 consecutive patients divided into 2 treatment period cohorts treated for oral SCC between the 1st Jan 2007 and 31st Dec 2012. Patients were classified as either smoker-drinkers (SD) or non-smoking, non-drinking (NSND). Only patients with oral sub-site primaries according to ICD-10 were included. Carcinomas of the lip, tonsil, base of tongue and oro-pharyngeal subsites were excluded. Of the study population (N = 287), 24.4% were NSND and 9.75% were NSND elderly (older than 70 years) females. >50% of tumours arose from the oral tongue in NSND patients (p = 0.022) and there was a higher rate of recurrent and persistent disease (42.9% vs 27.6%, p = 0.005). Disease specific survival at 5 years was significantly reduced when NSND elderly females were compared to all other patients (p < 0.001) as well as age matched controls (p = 0.006). This effect was verified independently in each cohort.The results of this study suggest that NSND elderly females are a distinct patient population with poorer disease specific survival outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Besides direct exposure, indirect contact with tobacco smoke significantly contributes to numerous health issues. Unfortunately, people are unaware that the precautions taken in closed environments are inadequate to deal with this issue. We conducted this study to assess carbon monoxide (CO) levels of people exposed to tobacco smoke indoors and outdoors., Methods: Our study between May and June 2023 included individuals exposed to tobacco smoke indoors (n=100) and outdoors (n=100). Our control group included 100 people who had never been exposed to healthy tobacco smoke and agreed to participate in our research. The amount of CO exhaled was measured by observing how long people were in contact with tobacco smoke and how close they were to it. Questionnaires were asked of the study participants about the harms and awareness of tobacco smoke exposure., Results: Exhaled CO levels were 1.46 ± 0.1 ppm in people exposed to tobacco smoke indoors, 1.1± 0.03 ppm in people exposed to smoke outside, and 1.1± 0.02 ppm in the control group. The statistical analysis revealed that individuals exposed to tobacco smoke in the indoor environment had significantly higher exhaled CO levels than those in the outdoor and the control groups (p=0.006). In the correlation analysis of time and distance in the indoor environment with the exhaled CO level, there was no statistically significant difference between time and space (r= -0.168, p=0.09, r=0.09, p=0.37, respectively). While less than half of both groups were aware of second-hand tobacco smoke, individuals exposed to tobacco smoke in the outdoor environment were more familiar (p<0.001)., Conclusion: Despite the precautions, indoor tobacco smoke exposure is severe because of second- and third-hand smoke. Raising individual awareness and enhancing the steps should be our top concern to prevent future health problems., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Afşin et al.)

ABSTRACT Background and objective Bronchiectasis manifests as recurrent respiratory infections and reduced lung function. Airway dilation, which is measured as the ratio of the diameters of the bronchial lumen (B) and adjacent pulmonary artery (A), is a defining radiological feature of bronchiectasis. A challenge to equating the bronchoarterial ( BA) ratio to disease severity is that the diameters of airway and vessel in health are not established. We sought to explore the variability of BA ratio in never-smokers without pulmonary disease and its associations with lung function. Methods Objective measurements of the BA ratio on volumetric computed tomography ( CT) scans and pulmonary function data were collected in 106 never-smokers. The BA ratio was measured in the right upper lobe apical bronchus ( RB1) and the right lower lobe basal posterior bronchus. The association between the BA ratio and forced expiratory volume in 1 s ( FEV1 ) was assessed using regression analysis. Results The BA ratio was 0.79 ± 0.16 and was smaller in more peripheral RB1 bronchi ( P < 0.0001). The BA ratio was >1, a typical threshold for bronchiectasis, in 10 (8.5%) subjects. Subjects with a BA ratio >1 versus ≤1 had smaller artery diameters ( P < 0.0001) but not significantly larger bronchial lumens. After adjusting for age, gender, race and height, the BA ratio was directly related to FEV1 ( P = 0.0007). Conclusion In never-smokers, the BA ratio varies by airway generation and is associated with lung function. A BA ratio >1 is driven by small arteries. Using artery diameter as reference to define bronchial dilation seems inappropriate. [ABSTRACT FROM AUTHOR]

Background and objective The incidence of lung cancer in non-smokers is increasing in recent years. The aim of this investigation is to explore main risk factors of non-smoking primary lung cancers in Sichuan province in order to provide more accurate data for clinical. Methods One hundred and fourty-five non-smoking pairs of cases and 145 of controls were matched by age and sex. The patients were newly-diagnosed definitely as primary lung cancer at West China Hospital of Sichuan University from March to December 2009. Results Seventeen exposure factors were explored as epidemic agents for non-smoking lung cancer in Sichuan by using univariate analysis; mutivariate conditional Logistic regression analysis showed that passive smoking, moved into newly renovated homes over the past 10 years, family cancer history from second/third-degree relatives, lack of emotion regulation, heavy work pressure and poor quality of sleep were main risk agents for the non-smoking lung cancer incidence with OR 2.267 (95%CI: 1.231-4.177), 5.080 (95%CI: 1.632-15.817), 7.937 (95%CI: 1.815-34.705), 2.491 (95%CI: 1.230-4.738), 5.769 (95%CI: 2.030-16.396), 2.538 (95%CI: 1.277-4.861), respectively. While higher body mass index, eating fruit and vegetable and regular participating in physical exercise might be protective factors with OR 0.419 (95%CI: 0.226-0.779), 0.344 (95%CI: 0.155-0.762), 0.507 (95%CI: 0.274-0.937), respectively. Conclusion The occurrence of non-smoking primary lung cancer associated with a variety of exposure factors including passive smoking, history of exposure to harmful environmental, family cancer history, mental and psychological factors in Sichuan Province.

Objective To investigate the relationship between the mutation of epidermal growth factor receptor (EGFR) and the relative expression of miR-93-3p in lung adenocarcinoma tissues from non-smoking female patients. Methods Totally 149 cases of non-smoking female patients with lung adenocarcinoma were selected. The expression levels of miR-93-3p in lung adenocarcinoma tissues from 112 cases of 149 patients were detected by real-time quantitative PCR. EGFR mutations were detected in 149 patients using DNA sequencing, and then we analyzed correlations of miR-93-3p expression with the clinicopathological features, EGFR mutation and prognosis. Results The relative expression of miR-93-3p was associated with the clinical stage. The miR-93-3p EGFR mutations were found in 71 of 149 patients (47. 65%). The relative expression of miR-93-3p in patients with EGFR mutations were higher than that of patients with wild type (P < 0. 01). There was no significant difference in prognosis between the patients with high and low expression of miR-93-3p, although the patients with high expression showed a poorer prognosis (P > 0. 05). Stratified analysis revealed that for patients younger than 60 years old, higher levels of miR-93-3 pexpression indicated worse prognosis (P < 0. 05). Conclusion The expression of miR-93-3p is increased in patients with EGFR mutations, which suggests that miR-93-3p may be a new therapeutic target for the treatment of non-smoking female patients with lung adenocarcinoma, especially for young female ones. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to create and explore potential uses of a composite "Healthy Lifestyle" measure based on Healthy People 2020 (HP2020) Objectives for behaviors shown to be associated with morbidity and mortality.Methods: Data were from the 2013 Behavioral Risk Factor Surveillance System (N=412,942) on five modifiable behaviors with HP2020 Objectives (leisure time exercise, eating fruits and vegetables 5 or more times/day, getting ≥7h of sleep/24h, not smoking and not drinking excessively). These indicators were combined to form an all-or-none composite Healthy Lifestyle (HLS) measure. Associations between the HLS measure and demographic and other measures, plus details of component measures, were reported.Results: Results indicated that only 7.7% of adults reported a HLS with wide variation among states and demographic groups. Both unadjusted and logistic regression results found associations between a HLS and better health, lower rates of chronic disease and better access to health care. Over one fourth of all respondents (28.0%) needed to only improve fruit and vegetable consumption to be practicing a HLS.Conclusions: In conclusion, few adults were practicing five behaviors that are generally recognized as healthy. All-or-none metrics like this HLS measure offer a fresh perspective on modifiable behaviors and the need for improvement. Examination of measure components can help explain demographic differences and identify strategies for improvement. [ABSTRACT FROM AUTHOR]

Background and objective An estimated 25-40% of patients with chronic obstructive pulmonary disease ( COPD) have never smoked. We investigated the prevalence and patient characteristics of COPD in non-smokers from Vietnam and Indonesia. Methods This population-based cross-sectional survey of participants from urban and rural Vietnam and Indonesia used a stratified multistage cluster sampling design, with sample and population weights applied to ensure representativeness. Participants were female or male (recruited in the ratio 2:1) non-smokers, 40 years or older and able to perform a spirometry test. Spirometry was performed at a single study visit. Other clinical information was collected via standardized questionnaires. Results The 1506 evaluable participants were approximately equally distributed between Vietnam and Indonesia, and rural and urban areas. Overall prevalence of COPD was found to be 6.9% (95% confidence interval ( CI): 5.7-8.3), with almost three times higher prevalence in men than women (12.9% (95% CI: 9.1-18.0) vs 4.4% (95% CI: 3.0-6.5)). We found higher rates of COPD in Vietnam than Indonesia (8.1% (95% CI: 5.8-11.3) vs 6.3% (95% CI: 4.8-8.3)), with a particularly high prevalence in urban Vietnam (11.1% (95% CI: 8.1-15.1)). Very few participants (6%) diagnosed to have COPD during the study had been previously diagnosed with COPD. Respiratory symptoms and lower health-related quality of life were more common in participants with COPD. Conclusions The prevalence of COPD in non-smoking individuals from rural and urban Vietnam and Indonesia was 6.9%, of which a significant proportion (94%) were previously undiagnosed. [ABSTRACT FROM AUTHOR]

Numerous efforts have been made to elucidate the etiology and improve the treatment of lung cancer, but the overall five-year survival rate is still only 15%. Although cigarette smoking is the primary risk factor for lung cancer, only 7% of female lung cancer patients in Taiwan have a history of smoking. Since cancer results from progressive accumulation of genetic aberrations, genomic rearrangements may be early events in carcinogenesis. Results In order to identify biomarkers of early-stage adenocarcinoma, the genome-wide DNA aberrations of 60 pairs of lung adenocarcinoma and adjacent normal lung tissue in nonsmoking women were examined using Affymetrix Genome-Wide Human SNP 6.0 arrays. Common copy number variation (CNV) regions were identified by ⩾30% of patients with copy number beyond 2 ± 0.5 of copy numbers for each single nucleotide polymorphism (SNP) and at least 100 continuous SNP variant loci. SNPs associated with lung adenocarcinoma were identified by McNemar's test. Loss of heterozygosity (LOH) SNPs were identified in ⩾18% of patients with LOH in the locus. Aberration of SNP rs10248565 at HDAC9 in chromosome 7p21.1 was identified from concurrent analyses of CNVs, SNPs, and LOH. Conclusion The results elucidate the genetic etiology of lung adenocarcinoma by demonstrating that SNP rs10248565 may be a potential biomarker of cancer susceptibility. [ABSTRACT FROM AUTHOR]

Aim To evaluate the compliance of cigarette smokers with scheduled visits for supportive periodontal therapy ( SPT). Materials and Methods Qualitative and quantitative analyses of compliance with scheduled SPT visits were performed using retrospective data from patients undergoing dental hygiene treatment at the Medi School of Dental Hygiene ( MSDH), Bern, Switzerland 1985-2011. Results A total of 1336 patients were identified with 32.1% ( n = 429) being smokers, 23.1% ( n = 308) former smokers and 44.8% ( n = 599) non-smokers. Qualitatively, significantly less smokers returned for SPT than non-smokers or former smokers ( p = 0.0026), whereas 25.9% ( n = 346) never returned for SPT. Further quantitative analysis of patients returning twice or more ( n = 883) revealed that the overall mean %-compliance was 69.8% ( SD ±22.04),whereas smokers complied with 67.0% ( SD ±22.00), former smokers with 69.7% ( SD ±22.03), and non-smokers with 71.7% ( SD ±21.92) reaching statistical significance ( p = 0.0111). Confounder adjusted analysis, however, revealed that older age ( p = 0.0001), female gender ( p = 0.0058), longer SPT intervals ( p < 0.0001) and higher severity of periodontal disease ( p < 0.0001) had a much greater impact on %-compliance than smoking ( p = 0.7636). Conclusions This study suggests that qualitatively, smokers return less likely for SPT than non-smokers or former smokers while quantitatively, a lower mean %-compliance of smokers attending scheduled SPT visits may be attributed to confounders. [ABSTRACT FROM AUTHOR]

Background: There is a significant resumption of smoking following smoking cessation using varenicline. Both smoking cessation medications and counseling have been shown to increase smoking quit rates at one year. Thus, the combination of varenicline and interactive voice response (IVR) telephony followed by extended IVR may further improve smoking cessation rates at one and two years. Methods: 101 participants were recruited from the community via newspaper advertisement. They attended a group counseling session and were given smoking information booklets from the Canadian Cancer Society. After 12 weeks of varenicline and 9 IVR calls, all participants who had quit smoking were randomized into 2 groups matched by levels of motivation and addiction as per baseline questionnaire score. The intervention group continued to receive bi-weekly IVR support for weeks 13 - 52. The control group no longer received IVR. The primary end-point was self-reported abstinence and exhaled carbon monoxide levels of less than 10 ppm for weeks 12, 52 and 2 years. Data were analyzed by Fisher's exact test or Wilcoxon rank-sum test. Results: Of the 101 participants, 44 (43%) had stopped smoking after 12 weeks of varenicline and 9 IVR calls. Of these, 23 (52%) were randomized to receive IVR calls from weeks 13 to 52. At 52 weeks, 26 (59%) participants remained smoke-free. Of the 23 with IVR, 12 (52.2%) stopped smoking compared to 14 of 21 (66.7%) without IVR. At 2 years, 40 of the 44 (90.9%) randomized participants were contacted and 24 of the 44 (54.5%) came in for testing. Fourteen (13% of the original cohort, 30% who were abstinent at 12 weeks and 53% who were abstinent at 52 weeks) remained smoke-free. Five of the 23 (21.7%) randomized to IVR and 9 of the 21 (42.9%) randomized to no IVR remained smoke-free at 2 years. Conclusions: In this pilot study of an apparently healthy population, extended IVR did not affect abstinence rates. There was no relapse prevention benefit in offering 9 months of continued IVR to subjects who had stopped smoking after receiving 3 months of varenicline and IVR treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Chronic obstructive pulmonary disease (COPD) is an increasing cause of morbidity and mortality worldwide, and it has been strongly correlated to tobacco smoking. While a number of studies have concentrated on smokers only, recent published data demonstrate that at least one fourth of patients with COPD are non-smokers, and that the burden of COPD in non-smokers is also higher than previously believed. Risk factors of COPD in non-smokers may include genetic factors, long-standing asthma, outdoor air pollution (from traffic and other sources), environmental smoke exposure (ETS), biomass smoke, occupational exposure, diet, recurrent respiratory infection in early childhood, tuberculosis and so on. In Asian region, indoor/outdoor air pollution and poor socioeconomic status may play important roles in the pathogenesis of non-smoking-related COPD. The prevalence of COPD among never smokers varies widely across nations. Such a variation may arise from several aspects, including study design, definition of COPD, diagnostic criteria, age and gender distribution of the studied population, local risk factors and socioeconomic status. More investigations and efforts are required to elucidate the involved factors and their shared contributions to non-smoking-related COPD so as to achieve better estimation and reduction of the burden of this neglected entity worldwide. [ABSTRACT FROM AUTHOR]

Background: Co-occurrence of different behaviors was investigated using the theoretical underpinnings of the Transtheoretical Model, the Theory of Triadic Influence and the concept of Transfer. Purpose: To investigate relationships between different health behaviors' stages of change, how behaviors group, and whether study participants cluster in terms of their behaviors. Method: Relationships across stages for different behaviors were assessed in three studies with N = 3,519, 965, and 310 individuals from the USA and Germany by telephone and internet surveys using correlational analyses, factor analyses, and cluster analyses. Results: Consistently stronger correlations were found between nutrition and physical activity ( r = 0.16-0.26, p < 0.01) than between non-smoking and nutrition ( r = 0.08-0.16, p < 0.03), or non-smoking and physical activity ( r = 0.01-0.21). Principal component analyses of investigated behaviors indicated two factors: a 'health-promoting' factor and a 'health-risk' factor. Three distinct behavioral patterns were found in the cluster analyses. Conclusion: Our results support the assumption that individuals who are in a higher stage for one behavior are more likely to be in a higher stage for another behavior as well. If the aim is to improve a healthy lifestyle, success in one behavior can be used to facilitate changes in other behaviors-especially if the two behaviors are both health-promoting or health-risky. Moreover, interventions should be targeted towards the different behavioral patterns rather than to single behaviors. This might be achieved by addressing transfer between behaviors. [ABSTRACT FROM AUTHOR]

Background and objective The incidence of lung cancer in non-smokers is increasing in recent years. The aim of this investigation is to explore main risk factors of non-smoking primary lung cancers in Sichuan province in orde to provide more accurate data for clinical. Methods One hundred and fourty-five non-smoking pairs of cases and 145 of controls were matched by age and sex. The patients were newly-diagnosed definitely as primary lung cancer at West China Hospital of Sichuan University from March to December 2009. Results Seventeen exposure factors were explored as epidemic agents for non-smoking lung cancer in Sichuan by using univariate analysis; mutivariate conditional Logistic regression analysis showed that passive smoking, moved into newly renovated homes over the past 10 years, family cancer history from second/ third-degree relatives, lack of emotion regulation, heavy work pressure and poor quality of sleep were main risk agents for the non-smoking lung cancer incidence with OR 2.267 (95%CI: 1.231-4.177), 5.080 (95%CI: 1.632-15.817), 7.937 (95%CI: 1.815-34.705), 2.491 (95%CI: 1.230-4.738), 5.769 (95%CI: 2.030-16.396), 2.538 (95%CI: 1.277-4.861), respectively. While higher body mass index, eating fruit and vegetable and regular participating in physical exercise might be protective factors with OR 0.419 (95%CI: 0.226-0.779), 0.344 (95%CI: 0.155-0.762), 0.507 (95%CI: 0.274-0.937), respectively. Conclusion The occurrence of non-smoking primary lung cancer associated with a variety of exposure factors including passive smoking, history of exposure to harmful environmental, family cancer history, mental and psychological factors in Sichuan Province. [ABSTRACT FROM AUTHOR]

Objective: To recognize specific clinicopathological characteristics of non-smoking and non-drinking (NSND) head and neck squamous cell carcinoma (HNSCC) patients. This can increase our knowledge regarding a potentially different carcinogenesis in these patients. Study design/methods: Retrospective analysis of data for 195 NSND patients with HNSCC and comparison with data for patients with HNSCC obtained from the Netherlands Cancer Registry. Results: Compared with all HNSCC patients in the Netherlands, our NSND patients with HNSCC were typically female ( n = 142; 73% vs 26%), old at disease presentation (mean 73 years vs 64 years), and had tumors mainly of the oral cavity ( n = 130; 66% vs 25%). Most tumors were stage I ( n = 67; 34%) and stage IVA ( n = 59; 30%). The incidence of second primary tumors (SPTs) was high ( n = 32; 16%), mainly occurring in the oral cavity ( n = 26; 13%). Discussion/conclusion: Our study confirms that NSND HNSCC patients have different clinicopathological characteristics from those of the overall HNSCC population; however, the frequency of SPTs is as high in NSND patients as in patients who smoke and drink alcohol. More research, and particularly molecular data are needed to obtain a better understanding of head and neck cancer in NSND patients. [ABSTRACT FROM AUTHOR]

Introduction: Lower plasma levels of vitamins may result in hyperhomocysteinemia, a known risk factor in pregnancy. As smoking may alter nutrition, we were interested in its effect on folate and Vitamin B12 in pregnancy. Materials and methods: A cross-sectional study of 62 smoking and 76 non-smoking healthy pregnant women. Serum folic acid, Vitamin B12 and homocysteine were measured at four points in pregnancy: 0–10, 11–20, 21–30 and 31–40 weeks. Results: Folate concentrations of the smoking women decreased continuously during pregnancy, and were significantly lower than those of non-smoking women during the last 30 weeks. Vitamin B12 levels decreased significantly in both groups. The homocysteine levels were higher in the smoking group during the second-half of pregnancy. Discussion: Smoking women have lower and decreasing folate levels during pregnancy, possibly as a result of lower intake of these nutrients. Lower folate levels can lead to hyperhomocysteinemia, a known risk factor for several complications in pregnancy. This is an other important reason to convince pregnant women to refrain from smoking. [Copyright &y& Elsevier]

Background: Germline mutations play an important role in the pathogenesis of lung cancer. Nonetheless, research on malignant ground glass opacity (GGO) nodules is limited., Methods: A total of 13 participants with malignant GGO nodules were recruited in this study. Peripheral blood was used for exome sequencing, and germline mutations were analyzed using InterVar. The whole exome sequencing dataset was analyzed using a filtering strategy. KOBAS 3.0 was used to analyze KEGG pathway to further identify possible deleterious mutations., Results: There were seven potentially deleterious germline mutations. NM&#95;001184790:exon8: c.C1070T in PARD3 , NM&#95;001170721:exon4:c.C392T in BCAR1 and NM&#95;001127221:exon46: c.G6587A in CACNA1A were present in three cases each; rs756875895 frameshift in MAX , NM&#95;005732: exon13:c.2165&#95;2166insT in RAD50 and NM&#95;001142316:exon2:c.G203C in LMO2 , were present in two cases each; one variant was present in NOTCH3 ., Conclusions: Our results expand the germline mutation spectrum in malignant GGO nodules. Importantly, these findings will potentially help screen the high-risk population, guide their health management, and contribute to their clinical treatment and determination of prognosis., Competing Interests: The authors declare there are no competing interests., (©2021 Mao et al.)

Background: Non-smoking-related lung adenocarcinoma (LUAD) has its own characteristics. Genetic and microenvironmental differences in smoking and non-smoking LUAD patients were analyzed to elucidate the oncogenesis of non-smoking-related LUAD, which will improve our understanding of the underlying molecular mechanism and be of clinical use in the future., Methods: The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO) databases were used for clinical and genomic information. Various bioinformatics tools were used to analyze differences in somatic mutations, RNA and microRNA (miRNA) expression, immune infiltration, and stemness indices. GO, KEGG, and GSVA analyses were performed with R. A merged protein-protein interaction (PPI) network was constructed and analyzed. A miRNA-differentially expressed gene network was constructed with miRNet. qRT-PCR was used for validation of 4 most significantly differently expressed genes and 2 miRNAs in tumor samples obtained from 20 pairs of non-smoking and smoking patients., Results: Five hundred and one patients with LUAD were obtained, including 210 in the non-smoking group and 292 in the smoking group. A total of 174 significantly altered somatic mutations were detected, including mutations in tumor protein p53 and epidermal growth factor receptor, which were downregulated in non-smoking-related LUAD. At the RNA level, 231 significantly differentially expressed genes were obtained; 124 were upregulated and 107 downregulated in the non-smoking group. GSVA analysis revealed 42 significant pathways. Other functional and enrichment analyses of somatic mutations and RNA expression levels revealed that these genes were significantly enriched in receptor activity regulation and receptor binding. Differences in microenvironments including immune infiltration (e.g., CD8 + T cells and resting mast cells) and stemness indices were also found between groups. A 79-pair interaction was found between differentially expressed genes and miRNAs, of which miR-335-5p and miR-34a-5p were located in the center. Twenty-one genes, including vitronectin, neurotensin, and neuronatin, were differentially expressed in both non-smoking LUAD patients and DMSO-treated A549 cells. And the different expression of neurotensin, neuronatin, trefoil factor family2, regenerating family member 4, miR-377-5p, miR-34a were verified with the same tendency in our own samples., Conclusions: Non-smoking LUAD patients, compared to smokers, have different characteristics in terms of somatic mutation, gene, and miRNA expression and the microenvironment, indicating a diverse mechanism of oncogenesis., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-276). The authors have no conflicts of interest to declare., (2020 Translational Lung Cancer Research. All rights reserved.)

A 48-year-old woman with severe pain and numbness of her right leg and foot was admitted to our hospital. She had never smoked and had little exposure to passive smoking. Initially, polyarteritis nodosa with anti-phospholipid antibodies was considered. Combination therapy with methylprednisolone pulse therapy, intravenous cyclophosphamide pulse therapy, vasodilators, antiplatelet agents, and anticoagulants was not effective. Vasculopathy was progressive, and she presented with gangrene of the toes. She required amputation of her right leg. The pathological findings of the amputated leg revealed thromboangiitis obliterans (TAO). TAO should be considered even in non-smoking women. Non-response to immunosuppressant and anticoagulant therapies may be a clue to the diagnosis of TAO.

Background: DNA methylation is associated with cancer, metabolic, neurological, and autoimmune disorders. Hypomethylation of aryl hydrocarbon receptor repressor (AHRR) especially at cg05575921 is associated with smoking and lung cancer. Studies on the association between AHRR methylation at cg05575921 and sources of polycyclic aromatic hydrocarbon (PAH) other than smoking are limited. The aim of our study was to assess the pattern of blood DNA methylation at cg05575921 in non-smoking Taiwanese adults living in areas with different PM2.5 levels. Methods: Data on blood DNA methylation, smoking, and residence were retrieved from the Taiwan Biobank dataset (2008–2015). Current and former smokers, as well as individuals with incomplete information were excluded from the current study. The final analysis included 708 participants (279 men and 429 women) aged 30–70 years. PM2.5 levels have been shown to increase as one moves from the northern through central towards southern Taiwan. Based on this trend, the study areas were categorized into northern, north-central, central, and southern regions. Results: Living in PM2.5 areas was associated with lower methylation levels: compared with the northern area (reference area), living in north-central, central, and southern areas was associated with lower methylation levels at cg05575921. However, only methylation levels in those living in central and southern areas were significant (β= − 0.01003, P = 0.009 and β = − 0.01480, P < 0.001, respectively. Even though methylation levels in those living in the north-central area were not statistically significant, the test for linear trend was significant (P < 0.001). When PM2.5 was included in the regression model, a unit increase in PM2.5 was associated with 0.00115 (P < 0.001) lower cg05575921 methylation levels. Conclusion: Living in PM2.5 areas was inversely associated with blood AHRR methylation levels at cg05575921. The methylation levels were lowest in participants residing in southern followed by central and north-central areas. Moreover, when PM2.5 was included in the regression model, it was inversely associated with methylation levels at cg05575921. Blood methylation at cg05575921 (AHRR) in non-smokers might indicate different exposures to PM2.5 and lung cancer which is a PM2.5-related disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of dietary factors on tongue cancer in smoking and non-smoking population., Methods: A case-control study was performed including 251 tongue cancer patients with pathologically confirmed in a hospital in Fuzhou and 1382 healthy community controls from December 2011 to March 2016. Face-to-face interviews were used to collect the information about demographics characteristics, dietary habits, smoking, drinking, etc. Unconditional logistic regression analysis was used to calculate the odds ratios( ORs) and 95% confidence intervals( 95% CI) to examine thedietary factors related to tongue cancer and to assess multiplicative interactions., Results: Intake of fish ≥3 times/week, seafood ≥1 times/week, milk and dairy products ≥1times/week, green vegetables ≥1 times/day, non-green leafy vegetables ≥ 1 times/day and fruits ≥3 times/week were all associated with decreased risk of tongue cancer. When stratified by smoking, the protective effects of fish, seafood, green vegetables and nongreen leafy vegetables on tongue cancer were more obvious in smokers. And the statistically significant association between daily intake of meat ≥3 times/week and tongue cancer was only emerged in smokers( adjusted OR = 1. 55, 95% CI 1. 02- 2. 34). Moreover, there is a positive multiplicative interaction between smoking and meat intake( OR multiplicative = 2. 08, 95% CI1. 43-3. 03)., Conclusion: Moderate intake of fresh fruits and vegetables, fish and seafood, milk and dairy products, and low intake of meat( especially for smokers) may reduce tongue cancer risk to a certain extent.