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Introduction: Despite the recognized benefits of pulmonary rehabilitation (PR) for patients with COPD, the effects of smoking history on the results of a PR program are not well known. Aim: To investigate if smoking history is related to the improvement achieved with a 12-week PR program in patients with COPD. Methods: 45 patients with COPD (26 men; 66±7 years), all ex-smokers or smokers, were classified in three groups according to their smoking history: light smokers (LS: 0.1-20 pack/years; n=8); moderate smokers (MS: 20.1-40 pack/years; n=14) and heavy smokers (HS: >40 pack/years; n=23). Patients were questioned about their smoking history and had their lung function assessed by spirometry, exercise capacity by the 6-minute walk test (6MWT), dyspnoea by the modified Medical Research Council scale (mMRC) and peripheral muscle strength by the 1RM test. The PR program comprised 12 weeks of high-intensity endurance and strength training. Results: HS had worse baseline 6MWT than LS, as well as worse 6MWT and mMRC than MS, however with no baseline differences in lung function between the groups. LS, MS and HS significantly improved the 6MWT, strength of the quadriceps femoris, biceps and triceps brachii. There were no significant differences in the magnitude of improvement between the groups, and no correlation was found between smoking history and magnitude of improvement. Conclusion: Patients with COPD with a smoking history of >40 pack/years have worse exercise capacity and more dyspnea symptoms compared to patients with a less heavy smoking history; however, all groups demonstrated similar benefits after PR in terms of improving exercise capacity and peripheral muscle strength.

Introduction: Body mass index (BMI) has been used over the years has a nutritional surrogate. Few studies have been focused on it as a possible independent factor on cancer outcome. Aims: To characterize and analyse demographic and disease factors in early stage lung cancer patients and impact of pre-treatment BMI on outcomes. Methods: Patients with lung cancer diagnosis in a tertiary hospital over 3 years were selected and retrospectively analysed in terms of demographics, tumour characteristics, treatment, response to treatment, overall survival (OS) and progression free survival (PFS). Results: One hundred and forty nine patients were classified as early stage (I, II and IIIA). The median age was 67 years (44-90 years), the majority were male (n=113; 75,8%), smoking history in 110 (73,8%). Thirty-four patients died in the time of analysis (22,8%). We found that estimated OS and PFS were significantly different in the underweight group (UW, BMI Conclusion: Having into account the pitfalls of a small and heterogeneous sample, our analysis shows that maybe special concern with UW patients should be taken in their initial evaluation, as a way of changing outcomes in patients with early stage lung cancer.

Background: Thoracic imaging is frequently used in individuals at risk for Chronic Obstructive Pulmonary Disease (COPD), but the clinical relevance of incidentally noted emphysema has not been well defined. We sought to use data from two large cohort studies to evaluate the association between emphysema and COPD outcomes. Methods: COPDGene subjects (n=9,442) with smoking history ≥10 pack-years and SPIROMICS subjects (n=2,707) with ≥20 pack-years were analyzed. The relationship between CT-based emphysema and COPD outcomes including quality of life, risk of future exacerbations and all-cause mortality was examined. Results: Longitudinal COPDGene and SPIROMICS data demonstrated that a cut-point of emphysema ≥5% (defined as the percentage of voxels Conclusions: These data imply the presence of 5% emphysema or more on quantitative CT is a clinically significant finding, particularly if combined with the presence of airflow obstruction. These individuals are at greater risk for worse outcomes including respiratory symptoms, more frequent exacerbations and death.

Night work, or work outside of 7am to 6pm, causes chronobiologic rhythm disruption which may cause an increase in hypertension risk. To study this question, we assessed the association between night work and incident hypertension using three exposure metrics. A cohort of 2941 new hires at 9 aluminium smelter and fabrication facilities were followed from 2003 through 2013 for incident hypertension defined by insurance claim’s ICD-9 codes. Night shifts were classified as shifts with ≥3 hours between 12am-5am using time-registry data. Night work exposure in the previous year was defined three ways; two binary metrics adapted from previous studies: 1) Ever/Never, 2) Working ≥ or The association between hypertension and each exposure metric was estimated in separate Cox proportional hazards models, adjusting for age, sex, gender, facility, smoking history, annual BMI, annual health claims based risk score, and duration of past night work. The rate of incident hypertension among workers with night work in the previous year was 1.88 (95% CI [1.16–3.05]) and 1.40 (1.00–1.96) times the rate among workers with no recent night work using metric 1 and 2 respectively. Compared with workers with no recent night work exposure, the hazard ratio among workers with >0- Trend =0.004). Our results suggest recent degree of night shift exposure may be associated with higher rates of hypertension.

Background: The association between smoking and asthma remains controversial. In our previous study, we were not able to show an association between asthma and smoking in Korean adults. One Korean study demonstrated underreporting of smoking history by female adults. The aim of the present study was to investigate the effects of hidden female smoking on the association between asthma and smoking in Korean adults. Methods: Data were acquired from 23,483 men and women aged ≥19 years who participated in the Korean National Health and Nutrition Examination Surveys (KNHANES). Results: The prevalence of asthma was 1.5%, the self-reported smoking prevalence was 32.4%, and the cotinine-verified smoking prevalence was 30.3%. Of the male cotinine-verified smokers, 6.4% were self-reported nonsmokers (2.7% never smokers and 3.7% ex–smokers), whereas 48.8% of the female cotinine-verified smokers were self-reported nonsmokers (43.2% never smokers and 5.6% ex–smokers). In males, the adjusted odds ratio of the association between smoking and asthma was 0.738 (confidence interval, CI: 0.393–1.173) in self-reported and 0.767 (CI: 0.515–1.143) in cotinine-verified smoking; in females, the adjusted odds ratio was 1.945 (CI: 1.348–2.805) in self-reported and 1.531 (CI: 1.076–2.179) in cotinine-verified smoking. Conclusions: Our study showed smoking was associated with asthma in females but not in males.

As an idiopathic interstitial pneumonia, desquamative interstitial pneumonia (DIP) is an uncommon form of interstitial lung disease and is considered to be a smoking- or dust inhalation-related interstitial pneumonia in the majority of cases. However, the details regarding immunoglobulin G4 (IgG4)-related lung disease remain unclear and controversial. We herein report the first case of DIP complicated with IgG4-related lung disease. Even if a patient has a smoking history, we emphasize the importance of exploring the association between DIP and IgG4-related lung disease to clarify the pathogenesis of these two disorders.

Screening for lung cancer with low-dose computed tomography (LDCT) has been shown to reduce mortality and has been recommended by the U.S. Preventive Services Task Force for adults 55 to 80 years of age with a 30 pack-year smoking history who are either current smokers or those that quit within 15 years. However, the overwhelming majority of abnormalities detected are not from malignancy. We report a case of pulmonary Langerhans’ cell histiocytosis, here-to-fore thought of as extremely uncommon, and make readers aware that this may be increasingly found as LDCT is more widely adopted.

Aim The aim of the present study was to demonstrate the possible relation between periodontal health status and infections associated with osteosynthesis materials (OMs) used in the oral and maxillofacial reconstruction. Material and methods The study group consisted of 32 individuals which were subdivided into two groups regarding their PSI scores. After the removal of the osteosynthesis plates, microbial colonization was assessed via microbiological cultivation, fluorescence microscopy and scanning electron microscopy. In addition, samples obtained from gingival crevicular fluids were investigated by fluorescence microscopy. Results A total of 118 osteosynthesis plates were examined. 8.5% (n = 10) of the plates were associated at least one of the clinical signs of infection. There was a positive correlation between periodontal disease and clinical signs of infection (p = 0.022). Patients with infection signs also had a higher number of smoking history (pack years, p = 0.010). Intraorally placed osteosynthesis plates showed wide range of bacterial colonizations compared to extraorally inserted osteosynthesis materials (p = 0.004). Conclusion Patients with poor periodontal health might be potential candidates for OM related infections. Early removal of OMs in patients with poor periodontal health status and/or heavy smokers would have clinical benefits. In addition, preferation of extraoral access to the fracture line might decrease the possibility of plate related infections.

Introduction We compared the predictive value of prebronchodilator and postbronchodilator spirometry for chronic obstructive pulmonary disease (COPD) features and outcomes. Methods We analysed COPDGene data of 10 192 subjects with smoking history. We created regressions models with the following dependent variables: clinical, functional and radiographic features, and the following independent variables: prebronchodilator airflow obstruction (PREO) and postbronchodilator airflow obstruction (POSTO), prebronchodilator and postbronchodilator FEV 1 % predicted. We compared the model performance using the Akaike information criterion (AIC). Results The COPD prevalence was higher using PREO. About 8.5% had PREO but no airflow obstruction in postbronchodilator spirometry (POSTN) (PREO-POSTN) and 3% of all subjects had no aiflow obstruction in prebronchodilator spirometry (PREN) but POSTO (PREN-POSTO). We found no difference in COPD features and outcomes between PREO-POSTN and PREN-POSTO subjects. Although, both prebronchodilator and postbronchodilator spirometries are both associated with chronic bronchitis, dyspnoea, exercise capacity and COPD radiographic findings, models that included postbronchodilator spirometric measures performed better than models with prebronchodilator measures to predict these COPD features. The predictive value of prebronchodilator and postbronchodilator spirometries for respiratory exacerbations, change in forced expiratory volume in 1 s, dyspnoea and exercise capacity during a 5-year period is relatively similar, but postbronchodilator spirometric measures are better predictors of mortality based on AIC. Conclusions Postbronchodilator spirometry may be a more accurate predictor of COPD features and outcomes.

We present analyses relating cigarette type to lung cancer based on a case-control study in five European countries. The analyses involved 3561 cases and 2301 controls with diseases not associated with smoking. Subjects completed a detailed questionnaire, including a lifetime smoking history. Analyses included never smokers, and those who smoked for at least 80% of the “critical period” from 2 to 20 years before diagnosis, ignoring those who ever smoked pipes or cigars, or chewed tobacco. The main analysis compares risk in those who, in the critical period, smoked ultra-low tar (ULT) cigarettes (machine yield ≤3 mg tar/cigarette) for 8 + years, with those who only smoked full flavour (FF) cigarettes (≥10 mg tar/cigarette). After adjustment for sex, age, country, education, age of starting smoking, mean cigarette consumption and mean tar level 21–50 years before interview, the odds ratio (OR) was 0.73 (95% confidence interval (CI) 0.50–1.06). Other analyses showed a modest, not statistically significant, reduction in risk with tar reduction. Risk in ULT smokers for 8 + years was substantially higher than in never smokers (OR 16.27, 95% CI 10.14–26.09). The study was prematurely terminated due to cost overrun, limiting the power to detect an association. More evidence is needed, particularly on lifetime ULT smoking.

Introduction: Underdiagnosis of COPD seems to be a relevant clinical and social problem. We hypothesized that active public spirometry campaign may help identify subjects with airflow limitation consistent with COPD. The aim of the study was (1) to evaluate the willingness of random smokers to undergo public spirometry, (2) to assess the ability to obtain an acceptable quality spirometry during a public campaign, and (3) to assess the relationships between the presence and severity of respiratory symptoms and readiness to undergo spirometry. Material and methods: Pedestrians aged > 40 years and a smoking history > 10 pack-years were recruited by medical students to fill a questionnaire and perform spirometry. Those with obstructive or borderline ventilatory insuffciency were invited and encouraged to undergo stationary spirometry in a pulmonary outpatient department. Results: Nine hundred and five subjects meeting the inclusion criteria were invited to the study. Only 178 subjects agreed to complete the questionnaire and undergo spirometry. Airway obstruction and borderline spirometry result (classified as possible airway obstruction) were found in 22 and 37 subjects, respectively. Of these, only 15 patients attended follow-up visit to verify public spirometry results. Extrapolation of the limited data showed the incidence of newly diagnosed airway obstruction as 10.7%. Conclusions: Public spirometry campaign does not seem to be an effective way of COPD screening. Smokers are reluctant to undergo complimentary spirometry even in the presence of pronounced respiratory symptoms. Our observations may be helpful in elaborating future screening programs for COPD.

AIM To evaluate the association of body mass index (BMI) with the overall survival of pancreatic ductal adenocarcinoma (PDAC) patients. METHODS A retrospective analysis of PDAC patients diagnosed in the National Cancer Center of China between January 1999 and December 2014 was performed. These patients were categorized into four BMI groups (< 18.5, 18.5-22.9, 23-27.4 and ≥ 27.5 kg/m2). χ2 tests for comparison of the proportions of categorical variables, and Student's t-test or Mann-Whitney test for continuous variables were employed. Survival analysis was performed with the Kaplan-Meyer method. Their HRs of mortality and 95%CIs were estimated using the Cox proportional hazards model. RESULTS With a median age of 59.6 years (range: 22.5-84.6 years), in total 1783 PDAC patients were enrolled in this study. Their mean usual BMI was 24.19 ± 3.53 for the whole cohort. More than half of the patients (59.3%) experienced weight loss during the disease onset and progression. Compared with healthy-weight individuals, newly diagnosed patients who were overweight or obese had more severe weight loss during their disease onset and progression (P < 0.001). Individuals who were overweight or obese were associated with positive smoking history (P < 0.001). A significant difference in comorbidity of diabetes (P = 0.044) and coronary artery disease (P < 0.001) was identified between high BMI and normal-weight patients. After a median follow-up of 8 mo, the survival analysis showed no association between BMI and the overall survival (P = 0.90, n = 1783). When we stratified the whole cohort by pancreatic cancer stage, no statistically significant association between BMI and overall survival was found for resectable (P = 0.99, n = 217), unresectable locally advanced (P = 0.90, n = 316) and metastatic patients (P = 0.88, n = 1250), respectively. The results did not change when we used the BMI at diagnosis. CONCLUSION Our results showed no significance of BMI for the overall survival of PDAC patients.

The oncogenic function of gene translocations involving the anaplastic lymphoma kinase (ALK) was first reported in rare subtypes of non-Hodgkin's lymphoma almost two decades ago. More recently, aberrant ALK signaling was found to be an oncogenic driver in subsets of non-small cell lung cancer (NSCLC), particularly in patients with little or no tobacco smoking history. The advent of molecularly targeted therapies that inhibit ALK has allowed the pairing of ALK inhibitors such as crizotinib as treatment for ALK-positive NSCLC, yielding dramatic responses and long-term disease control. The clinicopathologic features of ALK-driven NSCLC, the clinical development of ALK inhibitors, and the genetic determinants of acquired resistance to ALK inhibition are among the topics covered in this review.

SETTING Multicentred hospital-based cases and control subjects in Korea. OBJECTIVE To evaluate the association between idiopathic pulmonary fibrosis (IPF) and hazardous materials to which people are occupationally exposed. DESIGN A multicentre, hospital-based, matched case-control study was performed. The ratio of IPF cases to controls was 1:1 (n = 78 in each group). IPF cases and controls were matched in terms of age group, sex and place of residence. Conditional logistic regression analysis was performed. RESULTS In simple logistic regression analysis, exposure to metal dust and any exposure for >1 year in an occupational setting were significantly associated with IPF (metal dust OR 4.00, 95%CI 1.34-11.97; any exposure OR 3.67, 95%CI 1.02-13.14). After adjustment for environmental and military exposures and smoking history, the OR for metal dust exposure was 4.97 (95%CI 1.36-18.17) in multiple logistic regression analysis. CONCLUSIONS Metal dust was associated with incident IPF in Seoul and Gyeonggi Provinces in Korea. This information will be used to support a tailored preventive strategy in specific industries or occupations.

INTRODUCTION . Streptococcus pneumoniae is a pathogen for humans that requires a prior pharyngeal colonization to cause disease, whose mortality is accentuated in children 6 years and older than 65 years of age. OBJECTIVE . To assess the prevalence of pharyngeal carriage of S pneumoniae in two population groups in Ciudad Bolivar, Bolivar State. METHODOLOGY . During the years 2009 and 2010, two groups were evaluated: one which included 66 senior individuals institutionalized in the asylum "San Vicente de Paul" and the geriatric "Carlos Fragachan", with an average of 75 years ± 6 years age and another that it comprised preschool and school aged 2 to 12 hospitalized in Pediatrics and the area of the University Hospital emergency services "Ruiz and Paez". Each individual took a pharyngeal sample, which was processed according to the guidelines established by the American society for of microbiology. 80 exudates from pharyngeal origin were studied. RESULTS . Between elderly individuals 10 cases were identified (15.15%) of S. pneumoniae pharyngeal carriers. 70% (n = 7) corresponded to the male gender. In all the ages were diagnosed cases, often observed in the group between 71 to 80 years of age (n = 4; 40%). 46.2% of pharyngeal carriers concerned smoking history. Were observed significant statistical differences between the pneumococcus`s state carrier and type II diabetes mellitus and vaccination´s state against the bacterium, In the group of preschool and school inpatients, 3 strains of S. pneumoniae that accounted for 3.75% of the total were isolated. The highest percentage of positive specimens was obtained in the group of 2 to 4 years, with a predominance of the male gender (2.5%). Statistically significant differences were observed in the hospitalized children, between the carrier´s state and personal history as asthma, cold common, urinary tract infection and infection of skin and tissue soft. They were not vaccinated against the pneumococcus or met only a single dose. Both studies identified 13 strains of Streptococcus pneumoniae , which showed a profile of resistance to penicillin, by method of disk Oxacillin, of 50%; While all of the isolates were with high resistance to macrolides and clindamycin, sulfonamides, and sensitive to Vancomycin. CONCLUSION : We identified a low prevalence of individuals colonized by Streptococcus pneumoniae , however should be consider the research of colonization of the pharynx by Pneumococcus as a good method to be simple and easy to obtain bacterial samples and to reflect the progression of bacterial resistance in risk groups. INTRODUCCION. Streptococcus pneumoniae es un patogeno para el ser humano que precisa de una previa colonizacion faringea para causar enfermedad, cuya morbimortalidad se acentua en los menores de 6 anos y los mayores de 65 anos de edad. OBJETIVO. Determinar la prevalencia de portadores faringeos de Streptococcus pneumoniae en dos grupos poblacionales en Ciudad Bolivar, Estado Bolivar. METODOLOGIA. Durante los anos 2009 a 2010, se evaluaron dos grupos: uno que incluyo a 66 individuos de la tercera edad institucionalizados en el Asilo “San Vicente de Paul” y Geriatrico “Carlos Fragachan”, con una edad promedio de 75 anos ± 6 anos y otro que abarco a preescolares y escolares de 2 a 12 anos hospitalizados en los Servicios de Pediatria y del area de emergencia del Complejo Hospitalario Universitario “Ruiz y Paez”. A cada individuo se le tomo una muestra faringea, la cual fue procesada segun los lineamientos establecidos por la Sociedad Americana de Microbiologia. Se estudiaron 80 exudados de origen faringeo. RESULTADOS. En el grupo de los individuos de la tercera edad se identificaron 10 casos (15,15%) de portadores faringeos de S. pneumoniae. El 70% (n=7) correspondia al genero masculino. En todas las edades se diagnosticaron casos, frecuentemente observados en el grupo entre 71 a 80 anos de edad (n=4; 40%). El 46,2% de los portadores faringeos de la tercera edad refirieron antecedentes tabaquicos. Se observaron diferencias estadisticas significativas entre el estado de portador de neumococo y la diabetes mellitus tipo II y estado de vacunacion contra la bacteria, En el grupo de los pacientes preescolares y escolares hospitalizados, se aislaron 3 cepas de S. pneumoniae que represento el 3,75% del total. El mayor porcentaje de muestras positivas se obtuvo en el grupo de 2 a 4 anos, con predominio del genero masculino (2,5%). En el grupo de la poblacion infantil hospitalizada, se observaron diferencias estadisticamente significativas entre el estado de portador y antecedentes personales como asma, resfriado comun a repeticion, infeccion urinaria e infeccion de piel y tejido blando. No estaban vacunados contra el neumococo o solo cumplieron una sola dosis. En ambas investigaciones se determinaron 13 cepas de Streptococcus pneumoniae, las cuales mostraron un perfil de resistencia a la Penicilina, por metodo del disco de Oxacilina, del 50%; mientras que la totalidad de las cepas aisladas resultaron con alta resistencia a Macrolidos, Clindamicina y Sulfamidas, y sensibles a Vancomicina. CONCLUSION : Se identifico una baja prevalencia de individuos colonizados por Streptococcus pneumoniae , sin embargo, se debe considerar la investigacion de colonizacion faringea por neumococo como un buen metodo por ser simple y facil de obtener muestras bacterianas y poder reflejar la progresion de la resistencia bacteriana en grupos de riesgo.

Smoking is a major risk factor that plays a role in the incidence of bladder cancer. Carcinogens from cigarettes are excreted through the urine, so direct contact with the urinary tract occurs and increases the risk of malignancy. Literature is obtained from the search results of PubMed, Medscape, and Science Direct electronic databases with some keywords used. Starting in 2009, 88 literature results were collected through the electronic databases of PubMed, Medscape, and Science Direct. After applying the exclusion criteria, 12 articles are included in this literature review with 536,989 bladder cancer patients and 52,753 controls in total. High clove cigarette smoking intensity (>40 cigarettes/day) is a risk of causing urothelial carcinoma bladder cancer. Clove cigarettes pose the highest risk of bladder cancer. Compared to clove cigarette, cigars, and tobacco pipes have relatively lower risk of causing bladder cancer. Meanwhile, other types of cigarettes, such as shisha and electronic cigarettes, do not eliminate the risk of bladder cancer. Smoking is a modifiable risk factor for bladder cancer. The current smoking history was associated with a higher risk of bladder cancer compared to the former history of smoking. Different types of smoking have different risks of bladder cancer.

Objectives: The objective was to determine the frequency of musculo-skeleton health problems among the coal miners and to assess the relation of musculo-skeleton with various demographic variables among cherat coal miners of District Nowshera Khyber Pukhtunkhwa Pakistan. Materials & Methods: A cross-sectional study design was conducted between July and December 2014 at the cherat coal mines of District Nowshera. A sample size of 400 was selected through cluster sampling technique, in which the study area was divided into four clusters and then from each cluster 40% coal miners were selected based on simple random technique. There are approximately 80-90 Cherat coal mines in which around 1000 of coal miners are working. Coal miners having more than one year of coal mining job were included in the study while those with less than one year or having any pathological problems were excluded from the study population. Field visits were conducted to collect relevant data from the study areas. The structured pretested questionnaire was used to collect data regarding history of musculo-skeleton problems and was evaluated with the selected demographic variables like age, duration of coal mining job, job satisfaction, and previous history of mine injuries. Results: Our study results showed that approximately 61% of coal miners had history of musculo-skeleton problems. Among those coal miners who gave history of musculo-skeleton problems, 76.64% were due to lack of training, 24.59% to early 1-4 years of coal mining job, 60.23% to less than 30 years of coal miner’sage, 75.00% to unsatisfied with job, 83.19% to poor/bad knowledge of mine safety measures; 58.87% for not using personnel protective measures; and 67.62% to positive smoking history while the remaining 32.38 were among non-smokers. Conclusion: The frequency of occupational musculo-skeleton problems among coal miners 61% more and had strong relationship with age, duration of coal mining job, smoking behavior, job satisfaction, coal mining training, knowledge regarding occupational safety and health practices, and with compliance of personnel protective devices.

Tobacco use, infection with HIV and active tuberculosis (TB) are important public health problems worldwide. Smoking affects susceptibility to TB, with an increased risk of infection, TB disease and TB death. An estimated 1.1 million of the 8.6 million people who developed TB in 2012 were HIV-positive. It has been estimated that smoking could cause 18 million excess cases of TB and 40 million excess deaths between 2010 and 2050, but little is known about the effect of smoking on the outcomes of people receiving care for both HIV and TB.

Objective Olfactory impairment is a potential marker for impending phenoconversion to Parkinson disease (PD) that may precede the development of disease by several years. Because of low specificity, it may be of greater predictive value in those with genetic mutations and its potential as a marker for developing LRRK2 PD should be evaluated. Methods We examined olfactory identification in 126 LRRK2 G2019S mutation carriers with PD, 125 mutation carriers not manifesting PD, 126 noncarriers with idiopathic PD, 106 noncarrier family members without PD, and 35 unrelated controls. We compared olfactory performance and performed mixture modeling to identify possible subgroups of olfactory performance in LRRK2 PD and nonmanifesting carriers. Results Adjusting for sex, age, cognitive score, site, and smoking history, LRRK2 PD had better olfactory scores compared to idiopathic PD (mean olfaction difference: −3.7, P

Cigarette smoking is an addictive and destructive behavior and it can cause serious health problems and most important preventable cause of death in the world. In the present study using questionnaire data of smokers (n = 323) and non-smokers (n=218)from the patients in the Out Patients Department (OPD) of civil hospital Quetta was collected. Based on smoking history, the study population was categorized into smokers (

The aim of the present study was to analyze the risk factors of postoperative pulmonary complications (PPCs) of elective craniotomy for patients presenting with brainstem tumors or tumors adjacent to the brainstem. A total of 162 consecutive patients with a brainstem tumor or adjacent brainstem tumor undergoing elective craniotomy were included and monitored. Potential risk factors were identified by data collection and monitoring of the PPCs, as well as the performance of single factor analysis (using the χ2 test). In addition, the independent risk factors of PPCs were screened by logistic analysis. A total of 39 cases of PPC were included in the current study, with an incidence rate of 23.9%. The analysis indicated that smoking history, previous pulmonary diseases, an American Society of Anesthesiologists classification >II and partial tumor resection were risk factors of PPC following an elective craniotomy. Smoking history and partial tumor resection were identified to be independent risk factors of PPCs.

A 58-year-old man with a 60-pack-year smoking history and a known 1.5-cm right upper lobe lung nodule comes to your office for evaluation after completing a CT/PET imaging study. The study demonstrates the FDG-avid right upper lobe nodule as well as abnormal enlargement and enhancement of aorto-pulmonary window and precarinal mediastinal lymph nodes (CT/PET is shown in Fig. 1). There is no evidence for distant metastatic disease on imaging or examination. The patient is otherwise healthy, and you believe hewould tolerate thoracic surgical resection if indicated. Which of the following is the next best management step?

Patients with human papillomavirus (HPV)-positive tumours had better 5-year disease-specific survival (DSS) than HPV-negative patients. TNM score only predicted prognosis among HPV-negative patients. A previous history of smoking and age at diagnosis predicted DSS among HPV-positive patients whereas operability at diagnosis predicted DSS among both HPV-positive and HPV-negative patients.HPV is a risk factor for oropharyngeal squamous cell carcinoma (OPSCC). The extent to which smoking, age and operability could play a role in HPV-positive surgically treated head and neck SCCs has not been extensively addressed previously and this study aimed to evaluate these factors.We identified 232 patients with OPSCC, of which 186 from the tonsil or base of the tongue region were treated in the period 1992-2008 in Western Norway. The 5-year DSS was recorded. Details on smoking history and whether the lesion was operable or not, as well as clinical information, were obtained retrospectively from the hospital records.TNM stage predicted survival only among HPV-negative patients. A previous smoking affected prognosis only among HPV-positive patients (relative risk (RR) = 2.5; confidence interval (CI) = 1.0-6.2; p = 0.05). Increasing age of the patient had a negative effect on survival in HPV-positive patients only, especially among the oldest quartile (RR = 4.4; CI = 2.0-9.0; p0.001). Whether the tumour was operable or not uniquely predicted DSS both among HPV-positive (RR = 0.34; CI = 0.13-0.93; p0.05) and HPV-negative (RR = 0.25; CI = 0.10-0.66; p0.01) patients with tonsil/base of the tongue SCC.

Objective Olfactory dysfunction is the most common pre-motor symptom in Parkinson's disease (PD), and smoking is known to be associated with lower risk of PD. This study tested the hypothesis that smoking is associated with better olfaction in PD. Methods Smoking history was obtained from 76 PD subjects (22 with a history of smoking [smokers], 54 who never smoked [nonsmokers]), and 70 controls (17 smokers, 53 nonsmokers). Olfaction was assessed using the 40-item University of Pennsylvania Smell Identification Test (UPSIT). The olfactory scores between groups and subgroups were compared using analysis of covariance with adjustment for age, gender, and monoamine oxidase B (MAO-B) inhibitor usage. Results Overall the olfactory score was lower in PD compared with controls (olfactory scores: 21.5 vs. 33.5, P

Lung transplantation (LTx) is significantly limited by donor organ shortage. Donor smoking history of more than 20 pack-years is considered an extended donor criterion. In this study, we retrospectively evaluated impact of donor smoking history and extent of smoking on midterm outcome after LTx.In all, 237 LTx were performed in our institution between 2007 and 2012. Patients were divided into three groups, receiving lungs from 53% nonsmoking donors, 29% smoking donors with fewer than 20 pack-years, and 18% heavy smokers with more than 20 pack-years.Preoperative donor and recipient characteristics among the groups were comparable. However, donors from the heavy smokers group were significantly older (p0.001). The overall presence of abnormal histology (inflammation or metaplasia) in donor main bronchi samples increased with the extent of smoking but did not reach statistical significance (p = 0.211). Although metaplasia was found in significantly more donors from the heavy smokers group (p = 0.037), this did not translate into inferior outcomes for the recipients. There were no statistically significant differences in PaO2/FiO2 ratio after LTx, duration of mechanical ventilation (p = 0.136), intensive care unit stay (p = 0.133), and total postoperative hospital stay (p = 0.322). One-year and three-year survival were comparable across all three groups (log rank p = 0.151). Prevalence of bronchiolitis obliterans syndrome (p = 0.616), as well as bronchiolitis obliterans syndrome free survival (p = 0.898) after LTx were also comparable.In our experience, history and extent of donor smoking do not significantly affect early and midterm outcomes after LTx. Although this finding does not obviate the need for longer-term observation, donor lungs from even heavy smokers may not per se contraindicate LTx and may provide a valuable avenue for expanding donor organ availability.

Patient Initials or Identifier Number Mr. C. (case 1) and Mr. T. (case 2) ### Relevant Clinical History and Physical Exam Case 1: Mr. C, a 45 y/o man without underlying disease but a smoking history for >20 years, presented with AMI and profound cardiogenic shock and then VT attacked. CPCR

An 85-year-old man presented to our hospital with breathlessness. He had no relevant medical history besides a smoking history of 48 pack-years and seldom sought medical attention. He was tachycardic, dyspnoeic, normotensive and auscultation demonstrated decreased breath sounds on the left. A chest

High PD-L1 expression (≥50%) is a routine biomarker but is incompletely predictive, with response rates to PD-1 monotherapy only 35-45% in patients with lung cancer. Beyond PD-L1, additional individual pre-treatment variables, including clinical (smoking history, BMI), genomic (TMB, STK11, EGFR), and laboratory features (baseline dNLR), individually associate with response but have not been comprehensively examined in combination. We hypothesized that a multifactorial model incorporating routinely available clinical, pathologic, and genomic variables could improve prediction of response in high PD-L1 patients receiving first line anti-PD-(L)1 monotherapy.

e14109 Background: The association between smoking history and benefit from treatment with immune checkpoint inhibitors (ICIs) was unclear. We performed a meta-analysis to assess the efficacy of ICIs in advanced cancers according to smoking status (never-smokers vs ever-smokers). Methods: We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) comparing immunotherapy with standard-of-care in the treatment of advanced cancers which reported overall survival (OS) as the outcome, stratified by smoking status. We calculated pooled hazard ratios (HRs) and 95% confidence interval (CIs) for OS using random-effect models and assessed the differences in OS between the two estimates (never smoker (vs) ever smoker). using a test of heterogeneity. We also performed prespecified subgroup analyses based on disease site, line of therapy, proportion of never-smokers in the trials and trial conclusion to assess the potential association of oncologic and methodologic factors in effect modification of smoking status with the efficacy of ICIs. Results: We identified ten RCTs on non-small cell lung cancer, head and neck, and urothelial cancers, including 4,245 ever-smokers and 972 never-smokers. The difference in the effects of ICIs on OS between ever-smokers (HR, 0.74; 95% CI, 0.66-0.84) and never-smokers (HR, 0.79; 95% CI, 0.61-1.02) was not statistically significant (interaction P-value = 0.69). There were no significant differences in the effects of ICIs on OS between ever-smokers and never smokers in the pre-specified subgroups. Conclusions: There was no significant association between smoking status and improved survival outcome with ICIs in the treatment of advanced cancers. Smoking status should not be used as a biomarker for guiding treatment with immunotherapy.

e20595 Background: Immune checkpoint inhibitors (ICIs) have changed the landscape of NSCLC therapy. In previous study, gender, smoking history, and PD-L1 status were found to influence the efficacy of ICI monotherapy in NSCLC. This meta-analysis evaluated the clinical and molecular factors predictive of benefit from the addition of ICIs to first-line (1L) chemotherapy in metastatic NSCLC. Methods: Using the random effect model, we computed and compared the pooled hazard ratio (HR) of progression-free survival (PFS) and overall survival (OS) among the selected subgroups. The correlation between PD-L1 expression level and outcome was analyzed by meta-regression. Results: 7 phase III randomized trials comparing CIT vs. chemo in the 1L treatment of stage 4 NSCLC were included. CIT evenly improved the PFS irrespective of age, gender, histology, smoking history and ECOG performance status (PS). While patients (pts) with liver metastasis or ALK/EGFR aberration had greater PFS with the addition of ICI to Bevacizumab (BEV) based chemo regimen, the derived benefit was no longer statistically significant among pts treated with non-BEV-based regimens. Whereas the PFS superiority conferred by CIT was noticed across all PD-L1 expression subgroups, the benefit correlated with PD-L1 level and was more pronounced in the “PD-L1 high” subset. Except for pts with EGFR/ALK abnormalities, squamous histology or liver metastasis, CIT yielded a consistent amelioration of OS across the other selected subgroups. Conclusions: Survival advantage associated with 1L CIT in metastatic NSCLC was observed in different pts population including those for which single-agent ICI has limited therapeutic benefit. Our findings support the role of chemo +/- VEGF blockade as enhancer of ICIs activity even in “less immunogenic” context. [Table: see text]

e14030 Background: Smokers with non-small cell lung cancer (NSCLC) respond better to the inhibition of programmed cell death-1 (PD-1) with pembrolizumab than non-smokers do, which may be accounted for by the fact that smoking induces higher neoantigens and increased immunogenicity. Our investigation sought to highlight the prognostic interaction of smoking history with circulating regulatory T cells (Treg), CD3+, CD4+, and CD8+ T cells in advanced NSCLC. Methods: Using flow cytometry, we assessed levels of circulating Treg cells, CD8+ T cells, CD4+ T cells, and CD3+ T cells in 106 eligible patients of 257 overall patients with advanced NSCLC. Results: Patients with high circulating Treg had shorter overall survival (OS) (12.5 vs. 27.5 months, P = 0.010) and progression-free survival (PFS) (7.1 vs. 16.9 months, P = 0.014) compared to patients with low Treg among non-smokers, but not among smokers (P = 0.211 for OS; P = 0.271 for PFS). Multivariate analysis showed Treg as an independent risk factor for outcomes of non-smoking patients [hazard ratio (HR): 2.71, P = 0.045 for OS; HR: 2.38, P = 0.047 for PFS], but not of smokers. Moreover, higher CD4+ T and lower CD8+ T cell counts, CD8/CD4 ratio, and CD8/Treg ratio were more abundant in non-smokers than smokers (all P < 0.05). Conclusions: Smoking impacts the prognostic value of circulating Treg in advanced NSCLC. The distribution of circulating immune cells in non-smokers and smokers was different. Assessing the effect of cigarette smoking on circulating immune cells could help individualized immunotherapy for advanced NSCLC.

Purpose Limited data exist on mortality rate after in-hospital cardiac arrest in heart transplant recipients. We sought to compare the mortality rate after in-hospital cardiac arrest in heart transplant recipients to the general population Methods National Inpatient Sample NIS database (2005-2014) was used to identify 199,366 hospital stays for adults (≥18 yrs) who had in-hospital cardiac arrest (ICD 9: 99.60 or 99.63). Heart transplant status was defined in 144 hospital stays using ICD 9 (V421). Hospital stays for heart transplant surgery were excluded. The primary outcome was in-hospital mortality rate. Results Heart transplant recipients in comparison to non-transplant patients were noted to be younger & have male gender predominance & a lower prevalence of chronic pulmonary disease, paralysis, renal failure, AFib, dementia & smoking history (p Conclusion Heart transplant recipients have a modestly higher risk-adjusted chance of death after in-hospital cardiac arrest.

Rationale Hepatoid adenocarcinoma of lung (HAL) is a rare malignant tumor, which can be defined as a primary alpha-fetoprotein (AFP)-producing lung carcinoma. The majority of hepatoid adenocarcinoma (HAC) expressed AFP in tumor cells, but AFP expression is not required for its diagnosis according to the modified diagnostic criteria. Despite that HAC exhibits a poor prognosis and ineffective treatment options, early diagnosis and aggressive treatment can result in long-term survival. Patient concerns We report a 70-year-old Chinese male patient with alcoholic intake over 30 years and smoking history of 60 cigarettes per day for 40 years. He sought medical consultation for productive cough and hemoptysis sputum. Diagnoses and interventions Chest CT scan revealed a mass (6.4 × 5.5 cm) in the left lower lobe of the lung. The patient underwent curative surgical resection, and subsequently diagnosed as HAL. Outcomes Eighteen months after primary diagnosis, the patient died of multiple organ failure caused by distant metastases. Lessons Familiarizing with the clinical features and modified diagnostic criteria of this rare tumor may increase awareness of the disease among clinicians and pathologists, thereby avoiding misdiagnosis and mistreatment.

95 Background: Identifying patients who will benefit from immune-checkpoint inhibitor therapy is a challenge as proven predicative indicators remain to be elucidated. High tumor mutational burden (TMB) represents a possible biomarker for response to PD1 blockade such as in nivolumab or pembrolizumab. Genomic analyses have shown that patients with heavy smoking history are more likely to have high TMB. However smoking status alone has not been examined independently in relation to treatment response. We sought to determine whether a relationship existed between smoking history and response to treatment in metastatic non-small cell lung cancer (NSCLC), metastatic renal cell carcinoma (mRCC) and metastatic melanoma (mMelanoma). Methods: A retrospective analysis was conducted of Ochsner Health System patients with mRCC, mMelanoma, and NSCLC receiving a minimum of two cycles of nivolumab or pembrolizumab between 12/2014 and 01/2018. Pre- and post-treatment target lesions were analyzed using RECIST criteria to calculate best response to treatment. Patient demographic information was gathered including age, sex, smoking history, and performance status pre and post treatment. Kaplan-Meier method was used to estimate progression free survival (PFS) and overall survival (OS) outcomes. Results: Heavy smokers (>10 pack-years) had a higher response to immunotherapy than light (< 10 years) and never smokers (p = 0.0500). Heavy smokers with NSCLC treated with immuno-therapy also had significantly improved OS compared to light smokers with NSCLC (p=0.003). mRCC immuno-therapy patients with heavy smoking history showed increased PFS compared to light/never smokers (p=0.026). Conclusions: In summary, in response to PD-1 blockade heavy smokers showed improved survival compared to light and never smokers suggesting smoking history may represent a potential predictor of treatment response to PD-1 inhibitor therapy.[Table: see text]

Objective: We aim to report on smoking history, mental and physical health, and the results of interventions provided by a Quit Smoking Clinic (QSC) at a Sydney homeless men’s shelter. Methods: We undertook an audit of questionnaires administered during the first QSC visit and a review of outcomes of QSC clients who attended the clinic more than once. Results: A total of 144 men were assessed at the QSC, with mean age 45.2 years (22–71) and mean smoking duration of 29 years. About half were receiving treatment for psychotic illness, and there were high rates of other psychiatric disorders, physical illness and substance use disorder. Carbon monoxide (CO) readings were significantly higher for those smoking discarded cigarette butts. Among the subset of clients who attended the clinic more than once ( n=56), only four quit for more than a month and one for a year. However, the reported number of cigarettes smoked per day was significantly lower ( p=0.001), with a significant reduction in CO ( pConclusions: This study confirms the difficulty that homeless men experience in quitting smoking, but demonstrates the potential to reduce the physical and financial harm of smoking through cessation support interventions in this setting.

SETTING Tuberculosis (TB) clinic in Tijuana, Mexico. BACKGROUND Chronic airway obstruction (CAO) can be a sequella of pulmonary tuberculosis (PTB), independently of smoking history. OBJECTIVE To determine the prevalence of CAO in subjects recently recorded as cured after treatment of PTB, and its impact on quality of life. DESIGN Cross-sectional study. RESULTS Overall, 34.3% of patients with a history of PTB had non-reversible CAO, defined as FEV1

Introduction: Carotid endarterectomy (CEA) is a well-established surgical technique in stroke prophylaxis. Long-term follow-up data on restenosis or recurrent neurological symptoms in Oriental patients are unclear. Methods: Patients’ notes from 1994 to 2011 were retrospectively reviewed and analyzed. A total of 301 cases of CEA were identified. Results: A lower restenosis rate was associated with the use of patch and never smokers in both univariate and multivariate analysis. Use of patch and never smokers were also found to be significantly associated with longer restenosis-free survival. Use of patch and postoperative use of statin were associated with better overall survival in both univariate and multivariate analysis. Conclusion: Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.