Association Between Smoking and Postoperative Delirium in Surgical Patients With Pulmonary Hypertension: a Secondary Analysis of a Cohort Study

Background: Previous studies have declared that smoking is a risk factor for postoperative delirium (POD), but others have inconsistent results. Up till now, the association between smoking and POD has not been verified. This study aims to investigate the relationship between smoking and POD in patients with pulmonary hypertension (PHTN) in the United States.Methods: This study is a secondary analysis of a retrospective cohort study completed by Aalap C. et al. Patients with PHTN who underwent non-cardiac, non-obstetric surgery were enrolled in the original study. We further excluded the patients undergoing intracranial surgery and the patients with sepsis and perioperative stroke to avoid interference with POD assessment. The generalized linear model and generalized additive model were used to explore the relationship between smoking and POD.Results: After adjusting the potential confounders (age, gender, BMI, poor functional status, PHTN severity, some comorbidities such as hypertension, angina, coronary artery disease, arrhythmia, COPD, asthma, diabetes and renal failure, length of surgery, open surgical approach, intraabdominal surgery, intrathoracic surgery, vascular surgery, some medications such as anticoagulant, antiplatelet, steroids, statin, and atropine, some inhalational anesthesia agent such as isoflurane and sevoflurane), a positive relationship was found between smoking status and POD (OR=5.61, 95% CI: 1.14 to 27.51, P=0.0334). In addition, the curvilinear relationship between smoking burden (pack-years) and POD is close to a linear relationship.Conclusion: Smoking shows a positive correlation with POD in patients with PHTN. Surgical individuals need to prevent POD especially those with a heavy smoking burden.

Likely Uptake of a Future a Lung Cancer Screening Programme in Hodgkin Lymphoma Survivors: a Questionnaire Study

Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n=165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64-21.44, p<0.01), living in an area with a high index of multiple deprivation (IMD) decile (deciles 6-10) (OR 8.22 CI 1.59-42.58, p<0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30-2.08 p<0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in in order to minimise barriers to participation.

Tobacco Smoking and Liver Cancer Risk: Potential Avenues for Carcinogenesis

Smoking a cigarette generates over 4000 chemicals that have a deleterious impact on each part of the human body. It produces three main severe effects on the liver organ: oncogenic, immunological, and indirect or direct toxic effects. It results in the production of cytotoxic substances, which raises fibrosis and necro-inflammation. Additionally, it also directs the production of pro-inflammatory cytokines tumour necrosis factor alfa (TNF-α) and interleukins (IL-1β, IL-6) that will be responsible for the chronic liver injury. Furthermore, it gives rise to secondary polycythemia and successively raises the turnover and mass of red cells, which might be a common factor responsible for the development of oxidative stress in the liver due to iron overload. It also produces chemicals that are having oncogenic properties and raises the risk of liver cancer especially in sufferers of chronic hepatitis C. Smoking modulates both humoral and cell-mediated responses by restricting the proliferation of lymphocytes and inducing their apoptosis and ultimately decreasing the surveillance of cancer cells. Moreover, it has been determined that heavy smoking impacts the response of hepatitis C patients to interferon (IFN) therapy through different mechanisms, which can be improved by phlebotomy. Efforts are being made in different nations in decreasing the prevalence of smoking to improve premature death and ill effects of their nation’s individuals.

Age at Smoking Onset and Risk of Heavy Cigarette Smoking Among Iranian Adult Male: An Application of Generalized Additive Model

Background: Because the age at which a person first starts smoking has such a strong correlation with future smoking behaviours, it's crucial to examine its relationship with smoking intensity. However, it is still challenging to accurately identify this relationship due to limitations in the methodology of the performed studies .Therefore the main purpose of this study is to evaluate this relationship and also to identify the other risk factors affecting smoking intensity using an appropriate model.Methods: Data from 913 Iranian male current smokers over the age of 18 was evaluated from a national cross-sectional survey of non-communicable disease (NCD) risk factors in 2016. Individuals were classified into: light, moderate, and heavy smokers. A generalized additive model (GAM) was used to assess the relationship.Results: 246 (26.9%) subjects were light smokers, 190 (20.8%) subjects were moderate smokers and 477 (52.2%) subjects were heavy smokers. According to the GAM results, the relationship was nonlinear and smokers who started smoking at a younger age were more likely to become heavy smokers. The factors of unemployment (OR = 1.364), retirement (OR = 1.217), and exposure to secondhand smoke at home (OR = 1.364) increased the risk of heavy smoking. but, smokers with high-income (OR = 0.742) had a low tendency to heavy smoking. Conclusions: GAM identified the nonlinear relationship between the age of onset of smoking and smoking intensity. Tobacco control programs should be focused on young and adolescent groups and poorer socio-economic communities.

Identification of Heavy Tobacco Smoking Predictors-Influence of Marijuana Consuming Peers and Truancy among College Students

Background: Poorly informed college students tend to adopt the habit of cigarette smoking. This habit often continues into their adulthoods, adversely affecting the population’s health and increasing the burden on healthcare systems. Aim: We aimed at exploring the predictors of the avoidable habit of smoking. We performed an analysis of the correlation between the potential predictors (marijuana use among peers and truancy) and the tobacco smoking statuses of the students. Material and method: Our study sample included 2976 students from colleges in Timis County, Romania, during the 2018–2019 period. The gender distribution of the participants was 62.5% girls and 37.5% boys, between the ages 18 and 25 years. A logistic regression test was performed to determine the impact of some personal and environmental factors, which are responsible for heavy smoking in this population. Results: Our findings suggest that the degree of marijuana smoking among friends and the frequency of college truancy are meaningful predictors of heavy smoking among young adults. The students with higher cigarette smoking rates had significantly more marijuana-smoking friends when compared to the students with average smoking rates. The truancy was higher among the students with higher cigarette smoking rates, compared to the students with average smoking rates.

Nicotine-mediated OTUD3 downregulation inhibits VEGF-C mRNA decay to promote lymphatic metastasis of human esophageal cancer

Nicotine addiction and the occurrence of lymph node spread are two major significant factors associated with esophageal cancer’s poor prognosis; however, nicotine’s role in inducing lymphatic metastasis of esophageal cancer remains unclear. Here we show that OTU domain-containing protein 3 (OTUD3) is downregulated by nicotine and correlates with poor prognosis in heavy-smoking esophageal cancer patients. OTUD3 directly interacts with ZFP36 ring finger protein (ZFP36) and stabilizes it by inhibiting FBXW7-mediated K48-linked polyubiquitination. ZFP36 binds with the VEGF-C 3-‘UTR and recruits the RNA degrading complex to induce its rapid mRNA decay. Downregulation of OTUD3 and ZFP36 is essential for nicotine-induced VEGF-C production and lymphatic metastasis in esophageal cancer. This study establishes that the OTUD3/ZFP36/VEGF-C axis plays a vital role in nicotine addiction-induced lymphatic metastasis, suggesting that OTUD3 may serve as a prognostic marker, and induction of the VEGF-C mRNA decay might be a potential therapeutic strategy against human esophageal cancer.

Spatial distribution and determinants of thyroid cancer incidence from 1999 to 2013 in Korea

We evaluated the spatial variation in thyroid cancer incidence and its determinants in Korea considering its importance in cancer prevention and control. This study was based on the ecological design with cancer incidence data by administrative district from the National Cancer Center and regional characteristics generated from the Korea Community Health Survey Data. We identified spatial clusters of thyroid cancer incidences based on spatial scan statistics. Determinants of regional variation in thyroid cancer incidence were assessed using the Besag-York-Mollie model with integrated nested Laplace approximations. Spatial clusters for low and high thyroid cancer incidences were detected in the northeastern and southwestern regions, respectively. Regional variations in thyroid cancer incidence can be attributed to the prevalence of recipients of basic livelihood security (coefficient, − 1.59; 95% credible interval [CI], − 2.51 to − 0.67), high household income (coefficient, 0.53; 95% CI, 0.31 to 0.76), heavy smoking (coefficient, − 0.91; 95% CI, − 1.59 to − 0.23), thyroid dysfunction (coefficient, 3.24; 95% CI, 1.47 to 5.00), and thyroid cancer screening (coefficient, 0.38; 95% CI, 0.09 to 0.67). This study presented the spatial variations in thyroid cancer incidence, which can be explained by the prevalence of socioeconomic factors, thyroid cancer screening, thyroid dysfunction, and smoking.

Association Between Cigarette Smoking and Ovarian Reserve Among Women Seeking Fertility Care

Background This study examined the association of smoking with ovarian reserve in a cross-sectional study of 207 women enrolled in the Louisville Tobacco Smoke Exposure, Genetic Susceptibility, and Infertility (LOUSSI) Study and assessed effect modification by NAT2 acetylator phenotype. Methods Information on current smoking status was collected using a structured questionnaire and confirmed by cotinine assay. Serum anti-Müllerian hormone (AMH) levels were used to assess ovarian reserve. Diminished ovarian reserve (DOR) was defined as AMH < 1ng/mL. Single nucleotide polymorphisms in the NAT2 gene, which metabolizes toxins found in cigarette smoke, were analyzed to determine NAT2 acetylator status. Linear and logistic regression were used to determine the effects of smoking on ovarian reserve and evaluate effect modification by NAT2. Regression analyses were stratified by polycystic ovary syndrome (PCOS) status and adjusted for age. Results Current smoking status, either passive or active, was not significantly associated with DOR. For dose-response assessed using self-report, the odds of DOR increased significantly for every additional cigarette currently smoked (odds ratio, OR:1.08; 95% confidence interval, 95%CI:1.01–1.15); additionally, every 1 pack-year increase in lifetime exposure was associated with an increased odds of DOR among women without PCOS (OR: 1.08 95%CI: 0.99–1.18). These trends appear to be driven by the heavy or long-term smokers. Effect modification by NAT2 genotype was not established. Conclusion A history of heavy smoking, but not current smoking status, may indicate increased risk of diminished ovarian reserve.