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WOS: 000455820300007, PubMed ID: 30683027, Introduction: Smoking is the leading cause of chronic obstructive pulmonary disease (COPD) and cotinine is reliable marker of tobacco exposure. We aimed to investigate the relationship between pulmonary function tests (FVC%, FEV1 , FEV1/FVC and FEF25-75%), smoking history and blood cotinine levels in healthy volunteers as a control and patients who have COPD in our study. Materials and Methods: One hundred and two COPD patients and 106 healthy volunteers who admitted to our institution were included. Spirometric investigations of the patients and volunteers were performed. A simple, rapid and reliable gas chromatography-mass spectrometry (GC-MS) method was used for determination of cotinine levels in blood samples. Results: The cut-off value of cotinine was determined as 41.12 ng/mL (97.2% sensitivity and 100% specificity). A significant relationship was observed between average pack-year and cotinine level in current smoker group (p< 0.05). The mean cotinine levels were 6.1, 8.8, and 467.0 ng mL(-1) in never smokers, ex-smokers and current smokers, respectively. No relationship was observed between cotinine level and FVC%, FEV1 % and FEV1/FVC (p> 0.05). In patient group, there was also no relationship between FEF25-75% and cotinine level however, in control group-smokers a negative correlation was found (p< 0.05; r= -0.372). Conclusion: We observed once again with our study that cotinine is a reliable marker of tobacco exposure. The most obvious result is the negative correlation between FEF25-75% value and cotinine level and this result may be caused by the effect of smoking in the peripheral airways at early stages of COPD.

Background: Low back pain is a global health problem and it is a common form of muscluskeleton diseases. Low back pain interferes with the quality of life of the individuals, and it is a leading cause of medical consultation. Smoking, life style and physical activity had association with LBP.Aim of the Study: To measure prevalence of back pain among adult population in Asir Region.To assess back pain's correlation with age, gender, smoking and physical activity.To assess influence of times per day and years of smoking on back pain.Methods: The study is descriptive cross sectional study, it was performed during the period from April 2018 to May 2018 on adult educated population in Asir Region. A structured self-administered questionnaire was developed to investigate sociodemographics variables, smoking history, medical history and back pain history.Results: The study included 400 participants, 260 (65%) of them were males and 140 (35%) were females. There were 52.3% of participants reported having back pain, and 97 (24.3%) reported having continuous back pain. Several factors influenced the prevalence of back pain; it was found that being male was associated with suffering back pain (p-value= 0.03). Whereas performing sport activity was associated with having no back pain (p-value=0.02). Age had no significant correlation with back pain. The study included 217 (54.3%) current smoker and 43 (10.7%) ex-smoker. There were 89 (22.3%) smoking 1-3 times per day and 107 (26.8%) smoking since 4-6 years, also in this study we find a strong relation between smoking and back pain (p-value=0.001).Both of times of smoking per day and years of smoking positively associated with back pain (r=+0.3, p-value=0.004; r=+0.4, p-value=0.03 respectively). Persistence of back pain positively associated with years of smoking (r=+0.2, p-value= 0.02).Conclusion: There was moderate prevalence of back pain among our participants. The prevalence of back pain was found to be associated with gender, smoking state and physical activity. It was more prevalent in males and smokers, whereas performing sport activity was associated with having no back pain. The prevalence of back pain was found to be associated with times and years of smoking and the chronic back pain was positively associated with years of smoking.

Objective Prevention of postoperative cognitive dysfunction (POCD) in patients of advanced age remains unclear. Studies have shown that the cholinergic anti-inflammatory pathway contributes to a decreased risk of POCD and that nicotine stimulates the cholinergic anti-inflammatory pathway. We investigated whether patients of advanced age with a preoperative smoking history have a decreased risk of POCD. Methods In total, 382 patients (190 smokers, 192 nonsmokers) aged ≥60 years who underwent major noncardiac surgery were enrolled. Cognitive function was assessed, and multivariate logistic regression analyses were performed to identify risk factors. Results On postoperative days 5 and 7, 111 (29.05%) and 90 (23.56%) patients exhibited POCD, respectively. A preoperative smoking history was significantly correlated with a decreased risk of POCD. A high serum tumor necrosis factor-α (TNF-α) level on the operative day was significantly associated with an increased risk of POCD. Early POCD was significantly associated with the sufentanil dosage, age, and education level. The hospital stay in patients with and without POCD was 10.54 ± 2.03 and 8.33 ± 1.58 days, respectively. Conclusion A preoperative smoking history was associated with a decreased risk of early POCD, and a high serum TNF-α level was significantly associated with an increased risk of POCD.

Background Mexico City has air, water and food pollution problems; however, human exposure to cadmium and its sources have not been described. Objectives To determine the blood cadmium (BCd) level and its main exposure sources among males aged 40 years or older living in different areas of Mexico City. Methods After receiving informed consent, we interviewed 702 males aged ≥40 years to collect data on their sociodemographic characteristics, lifetime occupation, smoking history, and dietary habits, using a validated questionnaire. The BCd level (μg/L) was determined by atomic absorption spectrophotometry. Results The BCd mean level ± SD was 2.61 ± 0.82 μg/L, and 20% of men reported a potential cadmium occupational exposure. After adjusting for age and other potential confounders, the main determinants of the BCd level were the current smoking status at interview, with low (β≤8.5packs/year vs. non-smoker = 0.46; 95% CI: 0.28–0.64 μg/L; p 8.5 packs/year vs. non-smoker = 0.71; 95% CI: 0.56–0.87 μg/L; p 1–3servings/month vs. No = 0.14, 95% CI: 0.01–0.26 μg/L; p Conclusions The BCd levels observed in this population are high and only similar to those observed in workers from a sanitary landfill area in Southern Thailand. Potential environmental Cd exposure sources, such as industrial activity and previous land use, in the West and Center areas of the city should be explored in detail, especially in vulnerable population groups, such as children.

Recent progress in genomic analysis using next-generation sequencing technology has enabled the comprehensive detection of mutations and tumor mutation burden (TMB) in patients. A high TMB (TMB-H) tumor is defined as one with high somatic mutational rates, which correlates with clinical responses to certain treatments such as immunotherapies. We determined TMB in lung adenocarcinoma and clarified the characteristics of patients with TMB-H in relation to common driver mutations and smoking history.Genomic aberrations and TMB were determined in Japanese patients with lung adenocarcinoma (n = 100) using next-generation sequencing of 415 known cancer genes. TMB-H was defined as20 mutations per megabase (Mb) of sequenced DNA.The median TMB was 13.5 (5-33) mutations/Mb. Ten of 100 (10%) patients showed TMB-H, and the others showed low TMB (TMB-L). Only two of 10 (20%) patients with TMB-H had one of the common driver mutations (ALK and ERBB2 mutation), whereas 57 of 90 (63%) patients with TMB-L had one of the driver mutations, including ALK, EGFR, ERBB2, ROS, RET, and MET (P 0.05). Notably, no EGFR mutation was observed in patients with TMB-H. Eight of 10 (80%) patients with TMB-H had recent smoking history, whereas only 17 of 90 (19%) patients with TMB-L had recent smoking history (P 0.001).We found that TMB-H is associated with smoking history, whereas TMB-L is associated with the common driver mutations in lung adenocarcinoma, which may impact treatment strategies for these patients.

In colloquial English, a “grower” is a man whose phallus expands significantly in length from the flaccid to the erect state; a “shower” is a man whose phallus does not demonstrate such expansion. We sought to investigate various factors that might predict a man being either a grower or a shower. A retrospective review of 274 patients who underwent penile duplex Doppler ultrasound (PDDU) for erectile dysfunction between 2011 and 2013 was performed. Penile length was measured, both in the flaccid state prior to intracavernosal injection (ICI) of a vasodilating agent (prostaglandin E1), and at peak erection during PDDU. The collected data included patient demographics, vascular, and anatomic parameters. The median change in penile length from flaccid to erect state was 4.0 cm (1.0–7.0), and was used as a cut-off value defining a grower (≥4.0 cm) or a shower (4.0 cm). A total of 73 men (26%) fit the definition of a grower (mean change in length of 5.3 cm [SD 0.5]) and 205 (74%) were showers (mean change in length of 3.1 cm [SD 0.9]). There were no differences between the groups with regards to race, smoking history, co-morbidities, erectile function, flaccid penile length, degree of penile rigidity after ICI, or PDDU findings. Growers were significantly younger (mean age 47.5 vs. 55.9 years, p

Since publication of the National Lung Cancer Screening Trial (NLST) results early lung cancer detection has been widely studied, targeting individuals based on smoking history and age. However, over recent decades several changes in lung cancer epidemiology, including risk factors, have taken place. The aim of the current study was to explore smoking prevalence among lung cancer patients who had been treated surgically or undergone a diagnostic operation and whether these patients would have met the NLST inclusion criteria. All patients operated on for lung cancer in a university hospital in Estonia between 2009 and 2015 were included. Data were collected from hospital records. 426 patients were operated on for lung cancer, with smoking history properly documented in 327 patients (87 females; median age 67 years). 170 (52%) patients were smokers, 97 (30%) patients were ex-smokers and 60 (18%) patients were nonsmokers. The proportion of females among smokers was 15%, among ex-smokers was 9% and among nonsmokers was 87%. 107 of our patients would not have met the NLST age criteria and 128 of our patients would not have met the NLST smoking criteria. In total, 183 patients (56% (79% of females and 48% of males)) would not have met the NLST inclusion criteria. Only half of surgically treated lung cancer patients were current smokers and more than half did not meet the NLST inclusion criteria., Many currently surgically treated lung cancer patients, especially females, are not a target for lung cancer screening http://ow.ly/L9wY30kIQW0

We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro-organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram-positive and/or gram-negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro-organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.

Background and objective. The strategy aimed at overall cardiovascular risk reduction involves the assessment of patient’s personality and motivating him/her to change his/her lifestyle. Poor medication adherence and coping behavior of smokers with hypertension (HTN) indicate the need for improvements in therapeutic training and including into the training program both information on stress and the information related to stress coping behavior. The purpose of the study was the assessment of the efficacy of an optimized therapeutic training during the correction of modifiable risk factors among HTN smokers. Design and methods. We surveyed 102 male smokers with HTN; among them 52 male smokers with HTN (mean age 48,5 ± 1,05 years, disease duration of 7,9 ± 0,52 years and smoking history of 18,0 ± 1,16 years) attended an optimized program of the School for Patients with HTN, and 50 male smokers with HTN (mean age 49,7 ± 1,04 years, disease duration of 7,6 ± 0,47 years and smoking history of 19,2 ± 0,85 years) attended a standard structured program of the School for Patients with HTN. The enhancement of the training program of the School for Patients with HTN consisted in perfoming a person-oriented training at this School and introducing a modified stress coping skills training course. Results. The efficacy of the optimized therapeutic training of male smokers with HTN was determined. We found a number of advantages of the enhanced therapeutic training over the standard structured training with respect to the correction of modifiable risk factors among smokers with HTN. The optimized therapeutic training helps to maintain target blood pressure level, to reduce smoking intensity, to reduce the levels of nicotine dependence and triglyceride concentrations, as well as to extend the range of coping behavior strategies. Conclusions. The introduction of a modified stress coping skills training course and a person-centred model of therapeutic training in the program of the therapeutic training of smokers with HTN improves the efficiency of the correction of modifiable risk factors.

We investigated whether urine cotinine level, alone or combined with smoking status and cumulative smoking amount, could predict coronary calcium (CAC) score increase over time. The study population included 10,980 subjects. We analysed an association between CAC score increase over time and single or combined smoking-related factors. Urine cotinine level of ≥100 ng/mL, current or ex-smokers, and cumulative smoking amount of ≥1 pack-years (PY) showed significantly higher odds ratios (ORs) for CAC score increase over time. A combination of current smokers with10 PY and urine cotinine level of ≥100 ng/mL showed the highest OR. Irrespective of smoking status and cumulative smoking amount, all combinations with urine cotinine of ≥100 ng/mL showed higher ORs than other combinations with urine cotinine level of100 ng/mL. Urine cotinine levels can be useful to predict coronary artery calcification and encourage smokers to quit smoking.

Aim To determine whether long-term engagement in occupational diving causes significant changes in spirometric measurements. Method All divers with adequate spirometric records spanning at least 10 years were identified from the New Zealand occupational diver database. Changes in lung function over time were compared with normative values derived using published prediction equations. Any significant changes were tested for correlation with age, duration of occupational diving, gender, smoking history and body mass index (BMI). Results Spirometry data spanning periods of 10 to 25 years were analysed for 232 divers. Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) declined with increasing duration of diving, but slightly less than predicted with increasing age, while peak expiratory flow (PEF) declined more than expected for age in longer-term divers. The changes in PEF were statistically significant, and correlated with duration of diving exposure, initial age and final BMI. Nevertheless, the changes were small and probably clinically insignificant. Conclusion We compared changes in spirometric parameters over long periods of occupational diving with normative data and found no clinically significant differences that could be attributed to diving. We found no justification for routine spirometry in asymptomatic divers.

Introduction The association among smoking history, eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio and acute coronary syndrome (ACS) is yet to be investigated. The present study aimed to clarify the association between the EPA/AA ratio and ACS prevalence in patients admitted to the cardiology department based on their smoking history. Methods We enrolled 1733 patients from five cardiology divisions located in Tokyo, Japan, and measured their levels of polyunsaturated fatty acids, including EPA and AA, from January 2004 to May 2011. We assessed the association between the EPA/AA ratio and ACS in the subgroups stratified according to smoking history (never, former, current smokers) using multivariate logistic models. Results A high EPA/AA ratio was significantly associated with decreased odds of ACS among patients without a smoking history (adjusted odds ratio AOR=0.20, 95% CI: 0.04-0.86) but not in patients with a smoking history (former smoker, AOR=1.50, 95% CI: 0.44-5.03; current smoker, AOR=3.73, 95% CI: 0.34-40.6). Conclusions The EPA/AA ratio and ACS occurrence were found to be significantly associated in patients without a smoking history; however, no such association existed in patients with a smoking history. Abbreviations AA: arachidonic acid, ACS: acute coronary syndrome, CVD: cardiovascular disease, DGLA: dihomo-gamma-linolenic acid, DHA: docosahexaenoic acid, EPA: eicosapentaenoic acid, JELIS: Japan EPA Lipid Intervention Study, PUFA: polyunsaturated fatty acid, RAS: renin angiotensin system, TG: triglyceride.

Objetivo: Caracterizar a população atendida por um programa de tratamento do tabagismo e identificar os fatores emocionais associados ao hábito de fumar. Métodos: Estudo transversal, realizado em 2016, com dados secundários extraídos dos registros do programa de tratamento do fumante do município de Água Clara, Mato Grosso do Sul, Brasil. Os dados analisados referem-se a 173 participantes que realizaram a entrevista inicial do programa, de janeiro de 2012 a setembro de 2015. Foram estudadas as variáveis: sexo, idade, história tabagística, grau de dependência da nicotina, fatores emocionais e outras condições de saúde-doença. Analisaram-se os dados por meio de estatística descritiva, e a associação do grau de dependência aos fatores emocionais foi analisada pelo teste exato de Fisher. Resultados: Verificou-se a predominância do sexo feminino (63,6%, n=110); com idade média de 45,99 anos; média de idade de início do hábito de fumar de 14,38 anos; e média de tempo de uso do cigarro de 31,62 anos. Dos sintomas apresentados, predominaram os transtornos emocionais (75,1%, n=130), com confirmação de 38,2% (66) para depressão. Com relação ao grau de dependência da nicotina, 68,2% (118) apresentaram grau “elevado ou muito elevado”, sendo observada associação entre nível “elevado e muito elevado” de dependência e fatores emocionais, como ansiedade e depressão (p

Purpose: We determined the extent and nature of stigma exhibited by a sample of Canadian cardiorespiratory physiotherapists toward people with lung disease who had a smoking history. Method: A quantitative online survey was distributed to Canadian cardiorespiratory physiotherapists, and an anti-smoking attitudes questionnaire was used to measure explicit stigma. We used two case studies with questions to measure implicit stigma. The first involved a patient with chronic obstructive pulmonary disease (COPD) and a smoking history, and the second described a patient with COPD with no smoking history. Results: Of the respondents (n=50), 56% demonstrated mild explicit stigma and 44% demonstrated moderate to severe explicit stigma. The extent of explicit stigma was not associated with respondents' age, area of practice, personal smoking history, or family history of lung disease resulting from smoking. The results indicated no evidence of implicit stigma, and no significant differences were found between the participants' prospective treatments and their professional attitudes toward patient cases. Conclusions: Canadian cardiorespiratory physiotherapists demonstrated explicit stigma toward people with lung disease with a significant smoking history, but there was no evidence of implicit stigma. These findings suggest that further research is needed to investigate how stigma held by cardiorespiratory physiotherapists may affect the quality of care provided for patients with a smoking history.

Background Carotid endarterectomy (CEA) intervention needs a specific training and a sufficient learning curve to obtain optimal results in terms of outcome. A formative program was settled up in a single academic center to optimize training of standard CEA procedures. This study aims to evaluate the 11-year results of the teaching CEA program. Methods The trainees CEA teaching program is carried on during the 5-year vascular surgery residency period, and it is stratified as follows: learning theory and intervention assistance (minimum 50 procedures per year) in the first and second residency year; performing CEA as second operator in the third and fourth residency year (minimum 50 procedures per year); CEA execution as first operator with attending supervision in the last residency year. All CEA procedures from 2005 to 2015 were retrospectively collected and the 30-day results were compared according to the expertise of the first operator: experienced vascular surgeons (EVSs) versus trainees. All CEA procedures were performed in general anesthesia, with routine shunting and patching. Results In the study period, 1,379 (361 [26.2%] symptomatic; 1,018 [73.8%] asymptomatic) CEAs were performed. Trainees performed 199 (14.4%) CEAs as first operator. Patients submitted to CEA by trainees were similar in terms of preoperative clinical characteristics except for the patients' age (trainees 72.4 years versus EVS 70.8 years, P = 0.02) and smoking history (trainees 30.7% versus EVS 24.1%, P = 0.04). The 30-day complication rates were similar in CEA performed by trainees versus EVS: stroke 0.5% vs. 1.1%, P = 0.5; death 0.0% vs. 0.5%, P = 0.6; stroke/death 0.5% vs. 1.7%, P = 0.24; hematoma 3.0% vs. 2.2%, P = 0.48; and cranial nerve injury 9.0% vs. 7.8%, P = 0.47, respectively. The intervention time was significantly longer in CEAs performed by trainees compared with EVS: 104 ± 1.9 min versus 98 ± 1.0 min, P = 0.02. Conclusions With a defined CEA teaching program, trainees can obtain results similar to those of more experienced surgeons in terms of clinical outcome at the price of an increased intervention time.

Objectives Lung cancer screening with low dose computed-tomography (LDCT) is currently recommended for high-risk populations based on mortality benefit shown in the National Lung Screening Trial (NLST). This study evaluated performance of a community-based lung cancer screening program in a Histoplasma endemic region. Materials and Methods Demographic and clinical information was collected through retrospective review of patients in the Lung Cancer Screening program of a Kentucky (Histoplasma endemic region) health system from 2016 and 2017. A positive LDCT screen is defined as Lung-RADS version 1.0 assessment categories 3 or 4. Patients characteristics, initial screening results and follow up were analyzed and compared to NLST results. Results A total of 4500 LDCT screens were performed in 2016 (39%) and 2017 (61%) with 43% adherence rate to repeat annual screen in 2017. Mean age of patients was 64 years, with majority being females (54%) and current smokers (69%) with average 52-pack year smoking history. The rate of positive LDCT was 13.3% (600) varying based on baseline (14.6%) and annual (9.5%) screen. A total of 70 lung cancers were diagnosed among all positive LDCT screens (11.7%) with a false positive rate of 12%. Conclusions Baseline positive screens in our study are similar to NLST data with Lung-RADS criteria implementation (14.6% vs 13.6%, p = 0.15) despite being a Histoplasma endemic region. Our study shows a successful performance of a community-based lung cancer screening program in a Histoplasma endemic region.

A 62-year-old man with an extensive smoking history is diagnosed with oral cavity squamous cell carcinoma. After consultation, he is scheduled for radical resection with free flap reconstruction. The patient continues to smoke and is strongly advised to quit. When he returns for follow-up prior to his scheduled operation, the patient reluctantly discloses to his care team that he has not quit smoking. The surgeon considers withholding the operation until the patient has been tobacco-free for 4 weeks, consistent with evidence showing a significant decrease in surgical complications. Would it be ethically defensible to do so?

Background: Diabetes mellitus (DM) is rapidly becoming one of the main health issues among humans in the 21st century. The increase in the incidence of type 1 diabetes has been observed as a global public health problem in children and adolescents. This work was conducted aimed to estimate the prevalence of type I diabetes and to describe some related characteristics of cases in a sample of adolescent primary and secondary school girls of Riyadh city, KSA. Methods: A cross-sectional study was conducted during the academic year 2016-2017. Data were collected via a predesigned and pretested questionnaire to gather the relevant data. The total number of participants was 154 adolescent girls. Results: The overall prevalence of type I diabetes among the studied adolescent girls was 5.2% with Mean(±SD) age was 14.08 (± 3.4). All diabetic girls were Saudi. Only 25% of the cases were using a hormonal contraception. No smoking history or other chronic diseases was detected among them. Conclusion: The present study establishes the prevalence of type 1 DM among Saudi adolescent girls to be 5.2%. We suggest repeating this study periodically, with concentration on the various possible etiological and risk factors. Also we recommend conducting similar studies in other areas of Saudi Arabia to get more information about Diabetes. Awareness campaigns and continuous medical education is of utmost importance to detect the disease to guard against development of complications.

Introduction Cigarette smoking is associated with primary spontaneous pneumothorax (PSP). Electronic cigarettes (E-cigarettes) are touted as a healthier alternative to cigarettes; however, the impact E-cigarette use has on PSP management is not known. The goal of this study was to determine if E-cigarette use is associated with inferior outcomes after PSP, compared to never smokers and cigarette smokers. Methods We conducted a retrospective cohort study of patients in a large tertiary care hospital system in an urban area who presented with PSP from September 2015 through February 2019. Primary spontaneous pneumothorax patients were identified from the institutional Society of Thoracic Surgeon (STS) database. Patients with pneumothoraces from traumatic, iatrogenic, and secondary etiologies were excluded. Baseline clinical and demographic data and outcomes including intervention(s) required, length of stay, and recurrence were evaluated. Results Identified were 71 patients with PSP. Seventeen (24%) had unverifiable smoking history. Of the remaining, 7 (13%) currently vaped, 27(50%) currently smoked cigarettes, and 20(37%) were never smokers. Mean age was 33 years; 80% male. All vapers required tube thoracostomy vs 74% of current smokers and 75% of never smokers. Vaping was associated with increased odds of recurrence compared to never smokers (OR 2.00, 95% CI 0.35,11.44). Vapers had the shortest median time to recurrence after initial hospitalization (10 d[4,18] v 20 d[5,13] cigarette smokers v 27 d[13 275] never smokers, P < .001). Conclusion Vaping may complicate PSP outcomes. As vaping use increases, especially among adolescents, it is imperative that the manner of tobacco use is documented and considered when caring for patients, especially those with pulmonary problems.

Background Evidence for use of electronic cigarettes (e-cigs) as a potential aid in quitting or reducing combustible cigarette (c-cig) use is mixed. This study examined the extent to which e-cig initiation among smokers in their 30 s predicted quitting or reducing smoking or nicotine dependence symptoms by age 39, and whether the role of e-cigs in quitting differed by prospectively assessed moderators. Methods Data were from the Seattle Social Development Project (SSDP), a panel study of 808 diverse participants with high retention. A subsample of 221 smokers at age 33 was selected for analysis. Self-reports of c-cig use and dependence were assessed longitudinally at ages 33 and 39. Sixteen potential moderators were examined, including social demographics, smoking attitudes and desire to quit, other health behaviors and status, and adolescent and early adult assessments of smoking history. Results The use of e-cigs was consistently associated with a lower likelihood of quitting c-cigs by age 39, after accounting for frequency of prior c-cig use at age 33. This negative association persisted across all moderators examined, although it was nonsignificant among those with a definite desire to cut down. Among those who did not quit smoking, e-cig use had no association with decreases in either quantity of c-cigs used or dependence symptoms. Conclusions Results indicate that e-cigarette use was not helpful for quitting or reducing combustible cigarette use in the 30 s. Rather, across extensive tests of moderation, e-cig initiation consistently predicted less quitting during this important age period for successful cessation.

A 67-year-old man presented to our department with a 2-day history of dyspnoea and worsening voice hoarseness. He had a smoking history of 92 pack-years, and had been on chemotherapy for extensive small cell lung cancer for 7 months. His treatment history was complicated by a right vocal cord

BACKGROUND Survivin is an inhibitor protein of apoptosis and plays a role in oral carcinogenesis mechanism. METHODS The aim of this study was to evaluate the effect of smoking in survivin expression of oral mucosa of chronic smokers with and without oral squamous cell carcinoma (OSCC). The study was composed of three groups: Group 1-26 patients smoking more than 20 cigarettes/day/10 years without either history of oral malignant neoplasia or visible clinical signs in the examined site; Group 2-26 patients with OSCC; Group 3-22 patients surgically treated for OSCC for at least 1 month. The immunohistochemistry was performed with 1 smear for each group and analyzed by microscopy regarding extension, intensity of positive cells for survivin, and intracellular location. RESULTS The survivin expression was observed in 100% of the cases in Group 1, 88.5% in Group 2, and 100% in Group 3. Concerning to Groups 1 and 3, the survivin expression with cytoplasmic location occurred in 100%, while in Group 2 occurred in 87.5%. The cytoplasmic and nuclear expression was observed only in Group 2, with 7.69%. The results were correlated with clinical-pathological data by Fischer's exact test with significant relation between smoking cessation and intensity (P = .015) for Group 2. CONCLUSIONS The extension and intensity of survivin expression in the cytological smears were related to the smoking cessation in the group with OSCC. However, the smoking history (packs/years) did not influence the survivin expression.

Kazuyoshi Kurashima,1 Yotaro Takaku,1 Chie Ohta,1 Noboru Takayanagi,1 Tsutomu Yanagisawa,1 Tetsu Kanauchi,2 Osamu Takahashi3 1Department of Respiratory Medicine, 2Department of Radiology, Saitama Cardiovascular and Respiratory Center, Kumagaya, 3Center for Clinical Epidemiology, St Luke’s International Hospital, Tokyo, Japan Background: Emphysema is a distinct feature for classifying COPD, and smoking history (≥10 pack-years) is one of several newly proposed criteria for asthma–COPD overlap (ACO). We studied whether or not a smoking history (≥10 pack-years) and emphysema are useful markers for classifying ACO and differentiating it from asthma with chronic airflow obstruction (CAO). Methods: We retrospectively studied the mortalities and frequencies of exacerbation in 256consecutive patients with ACO (161 with emphysema and 95 without emphysema) who had ≥10pack-years smoking history, 64 asthma patients with CAO but less of a smoking history (

Objectives To evaluate the health effects of benzene exposure among smoking subjects from a prolonged flaring incident that occurred at the British Petroleum (BP) refinery in Texas City, USA. Material and methods The study included smoking subjects who had been exposed and unexposed to the benzene release. Using medical charts, clinical data including white blood cell (WBC) counts, platelet counts, hemoglobin, hematocrit, blood urea nitrogen (BUN), creatinine, alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) in the case of smoking subjects exposed to benzene was reviewed and analyzed. Results A total of 791 tobacco smoking subjects (benzene-exposed: N = 733, unexposed: N = 58) were included. Benzene-exposed subjects had significantly higher levels of WBC (×103/μl) counts (8±2.1 vs. 7.5±1.6, p = 0.003) and platelet (×103/μl) counts (263.7±69.7 vs. 222.9±44.3, p = 0.000) as compared with the unexposed subjects. The mean hemoglobin, hematocrit, BUN, and creatinine levels did not differ significantly between the benzene-exposed and -unexposed smoking subjects. Serum levels of ALP (IU/l) was significantly elevated in the benzene-exposed subjects compared with the unexposed subjects (84.5±16.9 vs. 73.8±15.9, p = 0.002). Similarly, benzene-exposed subjects had significantly higher levels of AST and ALT as compared with those unexposed subjects. Conclusions Despite a smoking history, residents exposed to benzene from the prolonged BP flaring incident experienced significant alterations in hematological and hepatic functions indicating their vulnerability to the risk of developing hepatic or blood related disorders. Int J Occup Med Environ Health 2017;30(6):849-860.

Background There is limited published scientific data on vaping recreational drugs other than cannabis. A recent review suggested that 15% of people vaping cannabis have also vaped a synthetic cannabinoid receptor agonist (SCRA) and identified over 300 Internet reports of e-liquid manufacture of recreational drugs and/or new psychoactive substances (NPS). Aim To determine the prevalence of use of electronic vaping devices for recreational drug and NPS delivery in the UK. Design A voluntary online survey using a convenience sample of UK adult participants (aged 16 years old and over) identified by a market research company. Methods Data was collected regarding demographics, smoking history, electronic vaping device history and recreational drug/NPS use and route of administration. Results There were 2501 respondents. The mean (±SD) age was 46.2 ± 16.8 years old. The commonest lifetime recreational drug used was Cannabis (818, 32.7%). The majority of respondents had smoked (1545, 61.8%) with 731 (29.2%) being current smokers. The most commonly used SCRA product was 'Spice Gold' (173, 6.9%) and SCRA compound was ADB-CHMICA (48, 1.9%). 861 (34.4%) had used an electronic vaping device; 340 (13.6%) having used them for recreational drug administration; 236 (9.4%) reporting current use. The commonest lifetime recreational drug to be vaped was cannabis (155, 65.7%), with electronic cigarettes (230, 48.2%) being the commonest reported route of SCRA compound administration. Conclusion 9.4% of respondents currently use electronic vaping devices for recreational drug administration with 6.2% reporting lifetime cannabis vaping use. Further larger scale studies are required to help inform the appropriate treatment and primary prevention strategies.

OBJECTIVES To reduce the shortage of organs for transplantation by expanding organ selection criteria as a means to increase the pool of potential lung donors. In this study, we sought to investigate the impact of using lungs from very old donors aged >70 years on outcomes after lung transplantation. METHODS Between January 2010 and November 2016, 96 patients with end-stage lung disease underwent lung transplantation in our centres. Lung donors were divided into 3 groups according to age (donor aged

Background: The purpose of the present study was to evaluate differences in lung damage in patients with paracoccidioidomycosis (PCM) in two endemic regions of Brazil (Botucatu, SP, in the southeastern region and Campo Grande, MS, in the west central region). Methods: The study sought to objectively quantify fibrosis and emphysema treated patients using high-resolution computed tomography (HRCT) that was performed according to an established and validated computational method. The analysis was based on clinical data that were associated with objective quantifications of pulmonary sequelae. We performed a retrospective analysis of HRCT exams from 32 successfully treated patients with the chronic form of PCM. The two groups had similar characteristics with regard to age, symptom duration, smoking history, and titers on a diagnostic serologic test. Results: The statistical analysis revealed more severe cases and a higher percentage of emphysema in the Campo Grande group. The mean percentages of emphysema were 40.2% and 13.6% in the Campo Grande and Botucatu groups, respectively. The percentage of fibrosis was significantly higher in the Botucatu group (11.3%) than in the Campo Grande group (2.3%). Conclusions: The present results may reflect differences in cryptic species of P. brasiliensis in these two geographic regions of Brazil. Further studies should be done to clarify the differences observed herein. Such findings may help unveil differences among cryptic species in terms of the pulmonary consequences that are caused by this disease, which would be highly beneficial to PCM patients.

Anaplastic lymphoma kinase ( ALK )-gene rearrangements work as an oncogenic driver in 3–8% of patients with non-small cell lung cancer (NSCLC) (1,2). These patients tend to be younger than those without driver mutations, and have no or little smoking history. ALK -rearranged tumors are usually adenocarcinomas, frequently with an acinar-predominant structure (3). In general, ALK rearrangements are mutually exclusive of other activating mutations such as epidermal growth factor receptor ( EGFR ) and KRAS mutations (2).

Rationale and Objectives Diaphragmatic motion in a standing position during tidal breathing remains unclear. The purpose of this observational study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants' demographic characteristics. Materials and Methods One hundred seventy-two subjects (103 men; aged 56.3 ± 9.8 years) underwent sequential chest radiographs during tidal breathing using dynamic chest radiography with a flat panel detector system. We evaluated the excursions of and peak motion speeds of the diaphragms. Associations between the excursions and participants' demographics (gender, height, weight, body mass index [BMI], smoking history, tidal volume, vital capacity, and forced expiratory volume) were investigated. Results The average excursion of the left diaphragm (14.9 ± 4.6 mm, 95% CI 14.2–15.5 mm) was significantly larger than that of the right (11.0 ± 4.0 mm, 95% CI 10.4–11.6 mm) ( P 0.001). The peak motion speed of the left diaphragm (inspiratory, 16.6 ± 4.2 mm/s; expiratory, 13.7 ± 4.2 mm/s) was significantly faster than that of the right (inspiratory, 12.4 ± 4.4 mm/s; expiratory, 9.4 ± 3.8 mm/s) (both P 0.001). Both simple and multiple regression models demonstrated that higher BMI and higher tidal volume were associated with increased excursions of the bilateral diaphragm (all P 0.05). Conclusions The average excursions of the diaphragms are 11.0 mm (right) and 14.9 mm (left) during tidal breathing in a standing position. The diaphragmatic motion of the left is significantly larger and faster than that of the right. Higher BMI and tidal volume are associated with increased excursions of the bilateral diaphragm.

Objectives: The present study assesses the association between smoking including ex-smokers and prevalence of stroke in South Korea. Methods: Data were obtained from the Korean Community Health Survey conducted in South Korea, 2012. Using generalized linear model, survey regression and meta-analysis were conducted to examine the relationship between smoking and stroke in each 17 metropolitan cities and provinces with 252 regional sites. Results: Stroke is positively associated with smoking history and there were differences in odds ratio between 17 cities and provinces. The most significant effect among 17 was an increase of 3.11(95% CI: 1.42- 6.84) and the effect size of overall 252 regions was an increase of 37% (95% CI: 9%-71%) for stroke. Conclusion: This study suggests that smokers are at higher risk of stroke. Considering the difference in risk between communities, public health programs to reduce cigarette smoking should be more supportive in vulnerable regions.

Made available in DSpace on 2018-12-11T17:30:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2017-03-05 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Introduction Smoking is currently considered one of the biggest risk factors for the development of various diseases and early death. Fourier transform infrared (FTIR) spectroscopy is a valuable tool for analysis of biofluids such as saliva and is considered useful for diagnostic purposes. The aim of this study was to evaluate the effect of smoking cessation on saliva composition by FTIR spectroscopy. Methods We analyzed the saliva of participants in two groups: a smoker group made up of 10 chronic smokers and a former smoker group made up of 10 individuals who had stopped smoking. Members of both groups had similar smoking history. Results The results showed few differences in spectral intensity between the groups; however, spectral peaks were slightly increased in the group of smokers in the bands for DNA, indicating modification of its content or cell necrosis. They were also increased for the mannose-6-phosphatase molecule, which is expressed in prostate and breast carcinomas. In the former smoker group, the peak of thyociante was decreased and the band referring to collagen increased in intensity, which indicates a better tissue regeneration capacity. Conclusion Considering these results and the fact that tobacco intake was similar between the groups, it can be concluded that there was recovery of tissue regeneration capacity with smoking cessation during the study period, although the effects found in smokers persisted in the bodies of those who had given up smoking. Department of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP – Univ Estadual Paulista Biologic & Materials Sciences Division of Prosthodontics University of Michigan Instituto de Pesquisa e Desenvolvimento Univ do Vale do Paraíba Department of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP – Univ Estadual Paulista Smoking Cessation Program Department Heart Institute University of Sao Paulo Medical School Centro de Ciências Naturais e Humanas Universidade Federal do ABC Department of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP – Univ Estadual Paulista Biologic & Materials Sciences Division of Prosthodontics University of Michigan Department of Biosciences and Oral Diagnosis Institute of Science and Technology UNESP – Univ Estadual Paulista FAPESP: 13/02168