Brinkman Index Research Articles

Asian flush gene variant increases mild cognitive impairment risk: a cross-sectional study of the Yoshinogari Brain MRI Checkup Cohort.

The East Asian-specific genetic diversity, the rs671 variant of aldehyde dehydrogenase 2, causes the "Asian flush" phenomenon following alcohol consumption, resulting in an alcohol avoidance phenotype. The variant is suggested as a risk factor for Alzheimer's disease; however, its association with mild cognitive impairment (MCI), an effective target for secondary prevention of dementia, remains unclear. This cross-sectional study examined 430 individuals aged 60-80 years (251 women) without overt cognitive impairment in Yoshinogari, Japan. The effect of the rs671 variant on MCI, defined by scores <26 or <25 on the Japanese version of the Montreal Cognitive Assessment, was evaluated using multivariate logistic regression. The models included APOEε4, sex, age, education, history of habitual drinking, Brinkman index, hypertension, diabetes, and subclinical magnetic resonance imaging findings and consistently estimated the risk of the rs671 variant. Subsequently, stratified analyses by history of habitual drinking were performed based on an interactive effect between rs671 and alcohol consumption, and the rs671 variant significantly influenced MCI in participants who did not drink habitually, with odds ratios ranging from 1.9 to 2.1 before and after adjusting for covariates, suggesting an association independent of hippocampal atrophy and small vessel dysfunction. Conversely, no such association with the rs671 variant was observed in participants with a history of habitual alcohol use. Instead, hippocampal atrophy and silent infarcts were associated with MCI. This is the first study to demonstrate an association between the rs671 variant and MCI morbidity. The findings highlight the need for race-specific preventive strategies and suggest potential unrecognized mechanisms in dementia development.

Perbedaan Jenis Tugas Keluarga Sebagai Penentu Terhadap Fungsi Penglihatan Childhood Di Era Covid-19

In January-February 2022, there was a surge in Covid-19 cases due to the omicron virus mutation. Consequently, the government advised conducting remote learning for all students using internet-connected devices. Changes in vision function during childhood occurred globally in 2050 children, with 10% of Indonesia's 66 million children experiencing visual impairments. Maintaining eye health in this age group is facilitated through school health units, and the results are reported to parents during each semester's report card distribution. This study aimed to measure the differences in family developmental tasks concerning childhood vision function. The research design employed was a cross-sectional study using descriptive analysis involving 111 respondents: parents and elementary school students selected through accidental sampling. Data collection took place in October 2022. The measurement tool, developed from Dunst (1984), assessed family developmental tasks, converted into the Brinkman index. Student vision was measured using a Snellen card, and the level of difference was assessed using the Kruskal-Wallis test. The Brinkman index results showed that 38.14% had good vision function, 45.35% were adequate, and 16.51% were poor. The hypothesis test yielded a p-value of 0.316 0.05, indicating no significant difference between family developmental tasks and childhood vision function.Top of Form

Clinical Outcomes of Preserving Bronchial Arteries During Radical Esophagectomy: A Propensity-Score Matched Analysis.

Postoperative pneumonia is a common and major cause of mortality after radical esophagectomy. Intraoperative preservation of the bronchial arteries is often aimed at avoiding tracheobronchial ischemia; however, it is unknown whether this contributes to a reduction in postoperative pneumonia. We enrolled 348 consecutive patients who underwent radical esophagectomy for esophageal cancer at Toranomon Hospital from January 2011 to July 2018. We classified patients into a bronchial artery-resected (BA-R) group (n = 93) and a bronchial artery-preserved (BA-P) group (n = 255) and compared the incidence of postoperative pneumonia between the two groups. A propensity score-matching analysis for bronchial artery preservation versus resection was performed. Overall, 182 patients were matched. Univariate analysis of the propensity score-matched groups showed that Brinkman index ≥ 400, vital capacity (%VC) < 80%, and bronchial artery resection were associated with the development of postoperative pneumonia. Multivariate analysis revealed three significant factors associated with postoperative pneumonia: Brinkman index ≥ 400 [p = 0.006, odds ratio (HR) 3.302, 95% confidence interval (95% CI) 1.399-7.790], %VC < 80% (p = 0.034, HR 6.365, 95% CI 1.151-35.205), and bronchial artery resection (p = 0.034, HR 2.131, 95% CI 1.060-4.282). The incidence of postoperative complications (CD grade III) was higher in the BA-R group (BA-R 42.8% versus BA-P 27.5%, p = 0.030). There was no significant difference in overall survival between the two groups at 5 years (BA-R 63.1% versus BA-P 72.1%, p = 0.130). Preserving the bronchial artery is associated with a decreased incidence of postoperative pneumonia.

The effect of smoking on hearing: The invisible part of the iceberg

Objectives Previous studies have had conflicting results regarding the potential effect of smoking on hearing. One reason for the conflicting results may be the limited number of studies evaluating extended high-frequency hearing thresholds among these studies. Therefore, this study aims to evaluate the potential effect of smoking on hearing using extended high-frequency hearing thresholds. Materials and Methods A total of 80 participants aged 20-30 with normal hearing (0.125-8 kHz hearing thresholds ≤ 15 dB HL) were included in this study. Extended high-frequency hearing thresholds in each ear of all participants were evaluated in the range of 9-20 kHz. The cigarette consumption of smokers was determined according to the Brinkman Index. Results There was a significant difference between the study and control groups in pure-tone hearing thresholds. This difference started to increase after 9 kHz in the right ear and 10 kHz in the left ear. Also, there was a highly positive correlation between Brinkman Index and hearing thresholds at all extended high-frequencies. Conclusion The present study suggests that smoking has a potential effect on hearing, especially on high-frequency hearing thresholds. Also, this is the first study to show from which frequency pure tone hearing thresholds are affected in smoking. Clinicians should not be limited to the frequency range used in the routine audiological evaluation and should not ignore extended high-frequency hearing thresholds not to overlook possible conditions that may affect hearing.

Higher Prevalence and Severity of Eosinophilic Otitis Media in Patients with Asthma-COPD Overlap Compared with Asthma Alone

Introduction: Eosinophilic otitis media (EOM) is well-known to frequently co-exist with adult-onset asthma. Both diseases are similar type 2 inflammation and are considered to have a “one airway, one disease” relationship. Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO), characterized by airway obstruction caused by airway wall thickening (AWT), is a severe condition with a higher incidence of mortality compared to asthma alone or COPD alone. Based on the “one airway, one disease” concept, we hypothesized that the inflammatory pathophysiology of EOM differs depending on its comorbidity with ACO or with asthma alone. Methods: A total of 77 chronic rhinosinusitis (CRS) patients with asthma were enrolled in this study. The subjects were divided into 2 groups: a group with comorbid asthma alone (asthma group; 46 patients), and a group with comorbid ACO (ACO group; 31 patients). The 2 groups were compared and assessed with regard to various factors, including the patients’ clinical characteristics, prevalence rate of EOM, EOM severity, EOMs relationships with smoking and AWT, and the eosinophil and neutrophil cell counts in the middle ear effusion (MEE). Results: The ACO group included significantly more males (p < 0.05), was significantly older (p < 0.05), and showed significantly lower lung function values (FEV1 [L], FEV1 [%pred]) (p < 0.01) compared with the asthma group. The ACO group also had a significant history of smoking as shown by the Brinkman index (p < 0.01) and greater AWT as assessed by high-resolution computed tomography (p < 0.05). The EOM prevalence rate was significantly higher in the ACO group (p < 0.05), especially with increased ACO severity (p < 0.05). The EOM severity was also significantly higher in the ACO group (p < 0.05) and also correlated with the ACO severity (p < 0.05). The pretreatment ear clinical characteristics score and the average air conduction hearing level were significantly higher in the ACO group (p < 0.05). The eosinophil percentage in the MEE/otorrhea was significantly lower in the ACO group (25.3%) than in the asthma group (54.7%) (p < 0.05). Conversely, the neutrophil percentage was significantly higher in the ACO group (75.7% vs. 41.9%) (p < 0.05). Conclusions: Our findings suggest that, in CRS patients with asthma, comorbidity with ACO may be a clinical factor leading to increased EOM prevalence and severity, as well as a higher neutrophil infiltration percentage in the middle ear. Cessation of smoking and early therapeutic intervention for ACO may mitigate progression of bronchial remodeling (i.e., reduce AWT) and help reduce the prevalence and severity of EOM.

Is the Preoperative Prognostic Nutritional Index a Useful Marker for the Decision to Perform Limited Resection in High-risk Patients With Stage I Non-small Cell Lung Cancer?

The indications for limited resection in high-risk patients with stage I non-small cell lung cancer (NSCLC) remain controversial. The purpose of this study was to evaluate the prognostic impact of the preoperative prognostic nutritional index (PNI) in high-risk patients undergoing limited resection. High-risk patients undergoing limited resection for stage I NSCLC in our institution from 2005 to 2020 were retrospectively reviewed. Patients with clinical/pathological Tis/minimally invasive adenocarcinoma and multiple NSCLC were excluded. A multivariate Cox regression analysis was conducted to identify factors associated with overall survival (OS). Ninety eligible patients were included in this study. Grade ≥2 postoperative complications were significantly more frequent in the low-PNI group (6 cases, 16.6% vs. 7 cases, 12.9%; p=0.03). The rate of death due to other diseases was significantly higher in the low-PNI group than in the high-PNI group (14 cases, 50.0% vs. 11 cases, 25.0%; p=0.002). The multivariate analysis showed that male sex, Brinkman index ≥400, preoperative low PNI and pathological T factor ≥T1c/T2a were independent prognostic factors for OS. In high-risk patients undergoing limited resection for stage I NSCLC, low PNI was a poor prognostic factor, especially in relation to death from other diseases and lung cancer. The results may support thoracic surgeons in decision-making in relation to the indications for surgery.

Association Between Tobacco Smoking and Dental Caries in the Indonesian Population: Results of a National Study in 2018.

The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population. This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index. Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022). Tobacco smoking was associated with dental caries in the Indonesian population.

Prevalence of systemic and local risk factors for pulmonary non-tuberculous mycobacterial disease in Japan: a single-institution study.

Objective: To identify the prevalence of risk factors for pulmonary non-tuberculous mycobacterial (NTM) disease in a Japanese population. Patients and Methods: We reviewed 337 consecutive Japanese patients (210 women) with pulmonary NTM disease, including 225 patients with Mycobacterium avium complex (MAC) disease (95.8%) at our hospital during 2006-2017. We calculated the prevalence of risk factors reported in Western countries among mycobacterial species. Results: Pulmonary MAC disease cases comprised 78.2% of pulmonary NTM patients in their 40s, increasing to 100% at age ≥80 years. Body mass index (BMI) was <18.5 in approximately 40% of patients, which was significantly higher than the prevalence of underweight in the Japanese population. The percentage of male heavy smokers (Brinkman index ≥600) was 58.2% of pulmonary NTM disease and was high for all mycobacterial species. In pulmonary MAC disease, systemic factors were observed in the order of malignant tumors (other than lung cancer), diabetes, rheumatoid arthritis, and tuberculosis. Local factors were observed in the order of bronchiectasis, chronic obstructive pulmonary disease, lung cancer, and bronchial asthma. Conclusion: The risk factors reported in Western countries were relatively highly prevalent among Japanese pulmonary NTM disease patients. This observation may help elucidate disease onset mechanisms.

Current Developments of Smoking and Vaping, Is Vaping Safer?

Vape fans claim that vaping is the solution of smoking cessation, but this is still debatable. Even if vape is still considered new, numerous studies show vaping is associated with lung injury (EVALI). Despite this, the trend of vaping is still increasing. This study aims to review current understanding of conventional smoking and vaping and comparing both. Is vaping safer than smoking? Smoking has health risk for lung cancer, COPD, stroke, and others meanwhile vaping has been linked with lung injury (EVALI). Local perfusions were decreased in tobacco smokers after exposure. However, perfusion increased in vaping after exposure. Bronchoalveolar lavage in vape users showed increase of vitamin E acetate possibly causing impairment in lung structure and functionality of surfactant. This is the potential mechanism of EVALI in vape users. Smoking uses the Brinkman Index to determine severity of smoking but there’s no index for vaping because it depends not on how many sticks but how many e-liquids were used. It seems that vape is “safer” rather than smoking but between smoking and vaping both have their own risk in health aspects and it’s safe to assume that neither is safe for use. “Vape is the solution for smoking cessation” needs further research because researchers need years to understand conventional smoking in relation with other diseases. Prospective follow-up studies to determine the risk of vaping on other diseases are needed in the future.

The relationship between smoking dose with oxygen saturation and cardiorespiratory endurance on young adult men

Background: Healthy lifestyle can reduce the risk of disease. One of the unhealthy lifestyle patterns is consuming cigarettes. Smoking can also reduce the affinity of oxygen for hemoglobin so that it can affect oxygen saturation levels in the blood. This study aimed to determine the relationship between smoking dose, oxygen saturation, and cardiorespiratory endurance in adult men.&#x0D; Methods: The study design was a cross-sectional study with an adult male population in the Tampaksiring Village, Bali, Indonesia, in which they qualified for the inclusion and exclusion criteria. Adult men were selected by purposive sampling. It was obtained 52 samples. The measurement of smoking dose using the Brinkman index, the measurement of oxygen saturation using oximetry, and the measurement of cardiorespiratory endurance using the Harvard step test. Data were analyzed using computer software with the Spearman rank test to determine the relationship between smoking dose with oxygen saturation and cardiorespiratory endurance in adult men.&#x0D; Results: The results showed that from 52 adult men were obtained by analysis result of the relationship between smoking dose and oxygen saturation where p= 0.000 (p&lt;0.05) and the analysis result of the relationship between smoking dose and cardiorespiratory endurance with p= 0.000 (p&lt;0.05).&#x0D; Conclusion: There was a significant relationship between smoking dose with oxygen saturation and cardiorespiratory endurance in adult men in Tampaksiring Village, Bali, Indonesia

External beam radiotherapy combination is a risk factor for bladder cancer in patients with prostate cancer treated with brachytherapy

To investigate the risk of bladder cancer (BCa) in patients treated with brachytherapy for prostate cancer (PCa). We retrospectively analyzed 583 patients with PCa who underwent brachytherapy with or without external beam radiotherapy (EBRT). We analyzed the disease-free survival (DFS) of BCa in patients with PCa who underwent brachytherapy with or without EBRT. We performed multivariate Cox regression analyses of DFS using age, EBRT, and Brinkman index (BI) score (number of cigarettes smoked per day × number of years smoking) ≥ 200 as variables for BCa after brachytherapy. Fourteen patients (2.4%) developed BCa after brachytherapy with or without EBRT. The percentage of high-grade urothelial carcinoma (UC) was 63.6%. A total of 85.7% of patients had non-muscle invasive BCa, and 14.3% of patients had muscle invasive BCa. DFS was longer in brachytherapy monotherapy than in combination therapy (brachytherapy + EBRT). Multivariate Cox regression analysis showed that a BI score ≥ 200 (Hazard Ratio (HR 8.61; 95% Confidence Interval (CI) 1.12-65.98) and EBRT combination (HR 3.29; 95% CI 1.03-10.52) were significantly associated with BCa development in patients with PCa treated with brachytherapy. Furthermore, patients with BI score ≥ 200 and EBRT combination had a significantly higher risk of BCa compared with patients with BI score < 200 (HR Log-rank test P = 0.010). Most cases of BCa after brachytherapy with or without EBRT are high grade and invasive. We hypothesized that the EBRT combination might be a risk factor for BCa in patients with PCa who underwent brachytherapy.

The relationship of smoking habits to sleep quality and the risk of hypertension in adolescents in Banjar Adat Pande, Bangli district

Background: Adolescence is a period of transition and search for identity, which makes adolescents often follow trends that affect society and the environment. One of the adolescent behaviors caused by environmental exposure is smoking. Repeated smoking behavior will become a habit that can affect sleep quality and the risk of hypertension. This study aimed to determine the relationship between smoking habits and sleep quality with the risk of hypertension in adolescents.&#x0D; Methods: This study used a cross-sectional study design. The sample is determined by purposive sampling. The number of study participants was 52 adolescents. Smoking habits were measured using the Brinkman Index questionnaire, a Sphygmomanometer to measure blood pressure, and the Pittsburgh Quality Index Questionnaire (PSQI) to measure adolescent sleep quality. Computer software analyzed data using a chi-square test to determine the relationship between smoking habits to sleep quality and the risk of hypertension in adolescents.&#x0D; Results: The chi-square test of smoking habits and adolescent sleep quality was shown with a p-value of 0.008. The chi-square test results of smoking habits with risk of hypertension in adolescents were indicated by a p-value of &lt;0.001.&#x0D; Conclusion: There was a significant positive relationship between smoking habits to sleep quality and the risk of hypertension in adolescents.

Association of Respiratory Functional Indices and Smoking with Pleural Movement and Mean Lung Density Assessed Using Four-Dimensional Dynamic-Ventilation Computed Tomography in Smokers and Patients with COPD.

To correlate the ratio of the non-dependent to dependent aspects of the maximal pleural movement vector (MPMVND/D) and gravity-oriented collapse ratio (GCRND/D), and the mean lung field density (MLD) obtained using four-dimensional (4D) dynamic-ventilation computed tomography (DVCT) with airflow limitation parameters and the Brinkman index. Forty-seven patients, including 22 patients with COPD, 13 non-COPD smokers, and 12 non-smokers, with no/slight pleural adhesion confirmed using a thoracoscope, underwent 4D-DVCT with 16 cm coverage. Coordinates for the lung field center, as well as ventral and dorsal pleural points, set on the central trans-axial levels in the median and para-median sagittal planes at end-inspiration, were automatically measured (13-17 frame images, 0.35 seconds/frame). MPMVND/D and GCRND/D were calculated based on MPMV and GCR values for all the included points and the lung field center. MLD was automatically measured in each of the time frames, and the maximal change ratio of MLD (MLDCR) was calculated. These measured values were compared among COPD patients, non-COPD smokers, and non-smokers, and were correlated with the Brinkman index, FEV1/FVC, FEV1 predicted, RV/TLC, and FEF25-75% using Spearman's rank coefficients. MPMVND/D was highest in non-smokers (0.819±0.464), followed by non-COPD smokers (0.405±0.131) and patients with COPD (-0.219±0.900). GCRND/D in non-smokers (1.003±1.384) was higher than that in patients with COPD (-0.164±1.199). MLDCR in non-COPD smokers (0.105±0.028) was higher than that in patients with COPD (0.078±0.027). MPMVND/D showed positive correlations with FEV1 predicted (r=0.397, p=0.006), FEV1/FVC (r=0.501, p<0.001), and FEF25-75% (r=0.368, p=0.012). GCRND/D also demonstrated positive correlations with FEV1 (r=0.397, p=0.006), FEV1/FVC (r=0.445, p=0.002), and FEF25-75% (r=0.371, p=0.011). MPMVND/D showed a negative correlation with the Brinkman index (r=-0.398, p=0.006). We demonstrated that reduced MPMVND/D and GCRND/D were associated with respiratory functional indices, in addition to a negative association of MPMVND/D with the Brinkman index, which should be recognized when assessing local pleural adhesion on DVCT, especially for ventral pleural aspects.

Prevalence and Risk Factors of GERD among Stable COPD Patients

Introduction: Gastroesophageal reflux disease (GERD) is one of the most common causes of a chronic cough and is a potential risk factor for chronic obstructive pulmonary disease (COPD) exacerbation. This study aimed to determine the prevalence of GERD in COPD patients. Methods: This was a cross-sectional study involving 40 stable COPD patients recruited from outpatient asthma and COPD clinics at Persahabatan National Respiratory Referral Hospital, Jakarta, from May to November 2018. COPD was defined as having a ratio of post-bronchodilator FEV1/FVC &lt; 0.7 and no abnormality on a chest X-ray except emphysematous. Diagnosis of GERD was based on oesophageal mucosal lining break surrounding the distal esophageal sphincter through esophagogastroduodenoscopy (EGD). Asthma patients with known esophageal diseases such as cancer, achalasia, and active peptic ulcer and patients who had used proton pump inhibitors in the last 15 days were excluded. Results: Patients were divided into GERD (+) (16/40, 40%) and GERD (-) (24/40, 60%). Subjects were predominantly elderly (25/40, 62.5%) and had a smoking history (36/40, 90%). Exacerbation and COPD assessment test (CAT) score was significantly associated with GERD (p &lt; 0.05). No significant difference regarding age, sex, Brinkman Index, lung function, and body mass index (BMI) was found between groups. However, the GERD (+) group showed a slightly higher BMI and more severe airflow obstruction. Conclusion: The prevalence of GERD in COPD patients found in this study was as high as 40%. A cohort study and preventive strategy of GERD in COPD should be studied further.

Hematologic Paraneoplastic Syndrome in Newly Diagnosed Patients with Lung Cancer

Introduction: Lung cancer could have signs and symptoms generated by paraneoplastic syndromes. This study aimed to describe and analyze hematologic paraneoplastic syndrome in patients with lung cancer in Indonesia. Methods: This was a cross-sectional analytic study conducted in Persahabatan National Respiratory Referral Hospital, Jakarta, between September 2018 and February 2019, on all newly diagnosed patients with lung cancer whose diagnosis was established and who fulfilled the inclusion and exclusion criteria. Results: The mean age of subjects was 56.7 ± 11.4 years old. Most subjects were male, had normal nutritional status (42.6%), had a smoking history (75%), and had a moderate Brinkman Index (BI) value (52%). The most common type of histology was squamous cell carcinoma (SCC) (39.7%), with advanced stage (83.8%) and performance status &lt;2 (94.1%). Paraneoplastic anemia was 40.4%, associated with poor nutritional status and commonly normocytic normochromic anemia. The proportion of paraneoplastic leukocytosis was 39%, associated with males and smoking history. The proportion of paraneoplastic neutrophilia was 51.5%, and it was related to males, smoking history, and SCC histology type. Paraneoplastic hypereosinophilia and thrombocytosis proportions were 2.9% and 18.4%, respectively. The proportion of paraneoplastic hypercoagulability was 91.2%, which was caused by the elevated D-dimer level. Conclusion: The most common hematologic paraneoplastic syndromes in patients with lung cancer were hypercoagulability, neutrophilia, and anemia. The low hemoglobin (Hb) level of paraneoplastic anemia was associated with low body mass index (BMI). Male and smoking history in lung cancer patients were associated with paraneoplastic leukocytosis and/or neutrophilia.

Lipid biomarkers that reflect postoperative recurrence risk in lung cancer patients who smoke: a case–control study

BackgroundThe risk of postoperative recurrence is higher in lung cancer patients who smoke than non-smokers. However, objective evaluation of the postoperative recurrence risk is difficult using conventional pathological prognostic factors because of their lack of reproducibility. Consequently, novel objective biomarkers that reflect postoperative risk in lung cancer patients who smoke must be identified. Because cigarette smoking and oncogenesis alter lipid metabolism in lung tissue, we hypothesized that the lipid profiles in lung cancer tissues are influenced by cigarette smoking and can reflect the postoperative recurrence risk in smoking lung cancer patients. This study aimed to identify lipid biomarkers that reflect the smoking status and the postoperative recurrence risk.MethodsPrimary tumor tissues of lung adenocarcinoma (ADC) (n = 26) and squamous cell carcinoma (SQCC) (n = 18) obtained from surgery were assigned to subgroups according to the patient’s smoking status. The ADC cohort was divided into never smoker and smoker groups, while the SQCC cohort was divided into moderate smoker and heavy smoker groups. Extracted lipids from the tumor tissues were subjected to liquid chromatography-tandem mass spectrometry analysis. Lipids that were influenced by smoking status and reflected postoperative recurrence and pathological prognostic factors were screened.ResultsTwo and 12 lipid peaks in the ADC and SQCC cohorts showed a significant positive correlation with the Brinkman index, respectively. Among them, in the ADC cohort, a higher lipid level consisted of three phosphatidylcholine (PC) isomers, PC (14:0_18:2), PC (16:1_16:1), and PC (16:0_16:2), was associated with a shorter recurrence free period (RFP) and a greater likelihoods of progressed T-factor (≥ pT2) and pleural invasion. In the SQCC cohort, a lower m/z 736.5276 level was associated with shorter RFP and greater likelihood of recurrence.ConclusionsFrom our data, we propose three PC isomers, PC (14:0_18:2), PC (16:1_16:1), and PC (16:0_16:2), and a lipid peak of m/z 736.5276 as novel candidate biomarkers for postoperative recurrence risk in lung ADC and SQCC patients who are smokers.

Neuroimaging findings related to glymphatic system alterations in older adults with metabolic syndrome

ObjectiveThe glymphatic system is a glial-based perivascular network that promotes brain metabolic waste clearance. Reduced glymphatic flow has been observed in rat models of type 2 diabetes and hypertension, indicating the role of vascular risk factors in the glymphatic system. However, little is known about how vascular risk factors affect the human glymphatic system. The present study aims to assess the relationships between metabolic syndrome (MetS), a cluster of vascular risk factors, and the glymphatic system function using diffusion magnetic resonance imaging (MRI)-based measures of water diffusivity in the glymphatic compartments, including the brain interstitial space and perivascular spaces around the deep medullary vein. We hypothesized that vascular risk factors are associated with glymphatic dysfunction, leading to cognitive impairment in older adults. MethodsThis cross-sectional study assessed 61 older adults (age range, 65–82 years) who had participated in the Bunkyo Health Study, including 15 healthy controls (mean age, 70.87 ± 4.90 years) and 46 individuals with MetS (mean age, 71.76 ± 4.61 years). Fractional volume of extracellular-free water (FW) and an index of diffusion tensor imaging along the perivascular space (DTI-ALPS) were used as indirect indicators of water diffusivity in the interstitial extracellular and perivenous spaces of white matter, respectively. ResultsAfter adjusting for age, sex, years of education, total Fazekas scale, Pittsburgh sleep quality index (PSQI) score, and intracranial volume (ICV), a significantly (P = 0.030; Cohen's d = 1.01) higher FW was observed in individuals with MetS than in the healthy controls. Furthermore, individuals with MetS had a significantly (P = 0.031; Cohen's d = 0.86) lower ALPS index than the healthy controls, with age, sex, years of education, total Fazekas scale, PSQI score, ICV, fractional anisotropy, and mean diffusivity included as confounding factors. Higher FW was significantly associated with lower ALPS index (r = −0.37; P = 0.004). Multiple linear regression (MLR) with backward elimination analyses showed that higher diastolic blood pressure (BP; standardized β = 0.33, P = 0.005) was independently associated with higher FW, whereas higher fasting plasma glucose levels (standardized β = −0.63, P = 0.002) or higher Brinkman index of cigarette consumption cumulative amount (standardized β = −0.27, P = 0.022) were associated with lower ALPS index. The lower ALPS index (standardized β, 0.28; P = 0.040) was associated with poorer global cognitive performance, which was determined using the Japanese version of the Montreal Cognitive Assessment (MOCA-J) scores. Finally, partial correlation analyses showed a significant correlation between higher FW and lower MOCA-J scores (r = −0.35; P = 0.025) and between higher FW and higher diastolic BP (r = 0.32, P = 0.044). ConclusionThe present study shows the changes in diffusion MRI-based measures reflected by the higher FW and lower ALPS index in older adults with MetS, possibly due to the adverse effect of vascular risk factors on the glymphatic system. Our findings also indicate the associations between the diffusion MRI-based measures and elevated diastolic BP, hyperglycemia, smoking habit, and poorer cognitive performance. However, owing to the limitations of this study, the results should be cautiously interpreted.

Hubungan Derajat Merokok dan Aktifitas Fisik pada Masa Covid-19 dengan Tekanan Darah dan Kejadian Hipertensi di Kota Palangkaraya

Hypertension is a disease which there an increase in systolic and diastolic blood pressure of more than 140 mmHg and 90 mmHg (normal). This study aims to prove the relationship between physical activity and the degree of smoking with systolic and diastolic blood pressure. The research method used was a cross-sectional design with a total sample of 51 non-obese adult men. Sample selection using purposive technique. Physical activity was obtained by filling out the IPAQ (International Physical Activity Questionnaire. The degree of smoking obtained was measured using the Brinkman Index. The results showed that there was a significant relationship between the brinkman smoking index and systolic blood pressure and diastolic blood pressure and between physical activity and systolic blood pressure but not There is a significant relationship between physical activity and diastolic blood pressure.

The Influence of Preoperative Smoking Status on Postoperative Complications and Long-Term Outcome Following Thoracoscopic Esophagectomy in Prone Position for Esophageal Carcinoma.

Esophagectomy for esophageal carcinoma is associated with higher morbidity and mortality rates than other gastrointestinal surgeries. Smoking is an established risk factor for postoperative complications after esophagectomy. This study aimed retrospectively to investigate the impact of smoking status on short- and long-term outcomes for patients undergoing thoracoscopic esophagectomy in the prone position (TEP) for esophageal carcinoma. In this study, 234 patients with esophageal carcinoma who underwent TEP between 2012 and 2020 were divided into two groups based on smoking status (current or non-current smokers and the Brinkman index) by patients' declarations. Postoperative complications (Clavien-Dindo classification grade ≥2), overall survival (OS), and disease-free survival (DFS) were compared between smoking statuses. The rates of postoperative complications did not differ significantly between the two groups (current smoker vs non-current smoker; Brinkman index ≥800 vs <800). The rate of postoperative pneumonia was higher in the combination group of current and higher Brinkman index (≥800) smokers than in the other group (25.0 % vs 11.8 %; P = 0.036). Multivariate analysis showed that smoking status was an independent risk factor for postoperative pneumonia (hazard ratio, 0.41; 95 % confidence interval, 0.18-0.93; P = 0.037). According to the long-term outcomes, no significant differences in OS and DFS were observed between the smoking statuses. The combination of current smoking and heavy smoking history is a risk factor for postoperative pneumonia in patients who have esophageal carcinoma treated with TEP, although no correlation was observed between the long-term outcomes and smoking status.

Abdominal aortic calcification volume (AACV) is a predictive factor for postoperative complications associated with biliary tract cancer.

Curative surgical treatment of biliary tract cancer is highly invasive and involves postoperative complications. Abdominal aortic calcification is a parameter that is reportedly linked to systemic arteriosclerosis. We measured the abdominal aortic calcification volume (AACV), assessed the correlation between AACV and postoperative complications, and evaluated the clinical utility of AACV. We retrospectively evaluated 97 patients (ampullary carcinoma, n = 21; distal bile duct cancer, n = 43; hilar bile duct cancer, n = 33). We assessed the calcification volume of the abdominal aorta from the renal artery ramification to the common iliac artery bifurcation. The correlation between AACV, clinical factors, and postoperative complications was evaluated. The average AACV was 5.02cm3, and the median AACV was 3.74 (range 0-27.4)cm3. The AACV was significantly related to age (P = 0.009), Brinkman index (P = 0.007), and history of cardiovascular disease (P = 0.015). The AACV was strongly correlated with postoperative complications (P < 0.001) and Clavien-Dindo grade > III postoperative complications (P < 0.001). The AACV was also correlated with pancreatic fistula in pancreatectomy cases (P < 0.001). A multivariate analysis revealed that the AACV was an independent predictor of postoperative complications. The AACV was significantly associated with postoperative complications. The AACV could be used for the preoperative assessment of surgical risk.