Initial Cessation Research Articles

Mind the gap—What is the appropriate time interval between sequential dentine stimuli to elicit a dentine hypersensitivity pain response in clinical studies?

ObjectivesTo determine the time interval required for a tooth diagnosed with DH to recover from a stimulus (cold air-blast/tactile) and respond with a similar elicited pain response to a repeat stimulus. MethodsA single-centre, non-randomised, clinical study in healthy adult volunteers. Eligible participants with ≥1 tooth with either a qualifying Schiff score ≥2 following cold air-blast or tactile Yeaple score of ≤20 g were allocated to tactile or air-blast group. Following primary stimulation, the designated tooth was restimulated 10, 5, 2 min and immediately after initial pain cessation. Pain was recorded with participant VAS and investigator Schiff for air-blast. Results40 participants completed the study per group. There was a significant difference in VAS scores for tactile 4 delay intervals (p < 0.001) but not air-blast stimulus, and a significant difference in mean change in VAS score from immediate to two-minute delay between stimuli (8.0 tactile vs 0.8 air-blast, p = 0.011). VAS scores in response to either stimulus showed very wide variation between participants, but changes over delay intervals within participants were relatively slight. There was a significant progressive decrease in mean Schiff score with shortening delay intervals from 10 min (2.38) to stimulation immediately after pain cessation (2.15), p = 0.018. ConclusionsThe findings suggest healthy teeth recover after DH stimulation more quickly following an air-blast than tactile stimulus, with around 2 min allowing recovery from both. Many factors including habituation and pain measurement subjectivity need to be considered. It would be prudent for future studies to use of ≥3 min delays. Clinical significanceNo clinical study has attempted to determine the appropriate interval between successive stimuli in DH patients. The results will impact directly on the conduct of DH trials. These findings suggest the interval could be reduced to around 2-min, but the current standard of 5-min is sufficiently long to give valid results.

Tranexamic Acid for Bleeding Management in Adult Patients on Extracorporeal Membrane Oxygenation.

This study described the outcomes of patients receiving topical, nebulized, endobronchial, or systemic tranexamic acid (TXA) for bleeding events while on extracorporeal membrane oxygenation (ECMO). We performed a single-center case series including adult patients >18 years old supported on either venovenous (VV) or venoarterial (VA) ECMO from January 1, 2014, to April 21, 2021. The primary outcome was hemostatic control defined as a composite of initial cessation of therapeutic interventions to mitigate bleeding or resumption of anticoagulation if previously held. Secondary outcomes included changes in transfusion requirements and lysis at 30-minute (LY30) values, venous thromboembolism (VTE) events, and seizures. In total, 47 patients were included for full analysis. There were 19 patients with surgical bleeds, 18 patients with medical bleeds, and 10 patients with multiple bleeds. Overall, initial hemostatic control was achieved in 79%, 67%, and 90% of patients, respectively. Pre- and post-TXA transfusion requirements were not significantly different ( p = 0.2), although the intraindividual change in median LY30 was -5.1% compared with baseline (95% confidence interval [CI], -12.4% to -1.5%, p = 0.005). The occurrence of VTE and seizures was relatively low and similar among patient bleeding groups. Tranexamic acid provided initial hemostatic control in roughly three quarters of patients with bleeding events on ECMO and side effects were infrequent.

PB0881 Thrombin Generation after Initial Cessation of Bleeding is Required for Hemostatic Plug Stability via PAR-Mediated Platelet Activation

PB0881 Thrombin Generation after Initial Cessation of Bleeding is Required for Hemostatic Plug Stability via PAR-Mediated Platelet Activation

Mechanisms of feeding cessation in Helicoverpa armigera larvae exposed to Bacillus thuringiensis Cry1Ac toxin

Insecticidal proteins from the bacterium Bacillus thuringiensis (Bt) have been applied in sprayable formulations and expressed in transgenic crops for the control of pests in the field. When exposed to Bt proteins insect larvae display feeding cessation, yet the mechanism for this phenomenon remains unknown. In this study, we investigated the feeding behavior and underlying mechanisms of cotton bollworm (Helicoverpa armigera) larvae after exposure to the Cry1Ac protein from Bt. Three H. armigera strains were studied: the susceptible SCD strain, the C2/3-KO strain with HaABCC2 and HaABCC3 knocked out and high-level resistance to Cry1Ac (>15,000-fold), and the SCD-KI strain with a T92C point mutation in tetraspanin (HaTSPAN1) and medium-level resistance to Cry1Ac (125-fold). When determining the percentage of insects that continued feeding after various exposure times to Cry1Ac, we observed quick cessation of feeding in larvae from the susceptible SCD strain, whereas larvae from the C2/3-KO strain did not display feeding cessation. In contrast, larvae from the SCD-KI strain rapidly recovered from the initial feeding cessation. Histopathological analyses and qRT-PCR in midguts of SCD larvae after Cry1Ac exposure detected serious epithelial damage and significantly reduced expression of the neuropeptide F gene (NPF) and its potential receptor gene NPFR, which are reported to promote insect feeding. Neither epithelial damage nor altered NPF and NPFR expression appeared in midguts of C2/3-KO larvae after Cry1Ac treatment. The same treatment in SCD-KI larvae resulted in milder epithelial damage and subsequent repair, and a decrease followed by an initial increase in NPF and NPFR expression. These results demonstrate that the feeding cessation response to Cry1Ac in cotton bollworm larvae is closely associated with midgut epithelial damage and downregulation of NPF and NPFR expression. This information provides clues to the mechanism of feeding cessation in response to Bt intoxication and contributes to the mode of action of the Cry1Ac toxin in target pests.

Integrating Smoking Cessation Into Low-Dose Computed Tomography Lung Cancer Screening: Results of the Ontario, Canada Pilot

IntroductionLow-dose computed tomography screening in high-risk individuals reduces lung cancer mortality. To inform the implementation of a provincial lung cancer screening program, Ontario Health undertook a Pilot study, which integrated smoking cessation (SC). MethodsThe impact of integrating SC into the Pilot was assessed by the following: rate of acceptance of a SC referral; proportion of individuals who were currently smoking cigarettes and attended a SC session; the quit rate at 1 year; change in the number of quit attempts; change in Heaviness of Smoking Index; and relapse rate in those who previously smoked. ResultsA total of 7768 individuals were recruited predominantly through primary care physician referral. Of these, 4463 were currently smoking and were risk assessed and referred to SC services, irrespective of screening eligibility: 3114 (69.8%) accepted referral to an in-hospital SC program, 431 (9.7%) to telephone quit lines, and 50 (1.1%) to other programs. In addition, 4.4% reported no intention to quit and 8.5% were not interested in participating in a SC program. Of the 3063 screen-eligible individuals who were smoking at baseline low-dose computed tomography scan, 2736 (89.3%) attended in-hospital SC counseling. The quit rate at 1 year was 15.5% (95% confidence interval: 13.4%–17.7%; range: 10.5%–20.0%). Improvements were also observed in Heaviness of Smoking Index (p < 0.0001), number of cigarettes smoked per day (p < 0.0001), time to first cigarette (p < 0.0001), and number of quit attempts (p < 0.001). Of those who reported having quit within the previous 6 months, 6.3% had resumed smoking at 1 year. Furthermore, 92.7% of the respondents reported satisfaction with the hospital-based SC program. ConclusionsOn the basis of these observations, the Ontario Lung Screening Program continues to recruit through primary care providers, to assess risk for eligibility using trained navigators, and to use an opt-out approach to referral for cessation services. In addition, initial in-hospital SC support and intensive follow-on cessation interventions will be provided to the extent possible.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

IntroductionIdeal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. MethodsIn this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the “Success” group and opposed to the “Failure” group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. ResultsWe included 124 patients, 49 in the “Failure” group and 75 in the “Success” group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). ConclusionCreatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

УЧАСТЬ КНР У РОЗВИТКУ НАФТОГАЗОВОЇ ГАЛУЗІ КАЗАХСТАНУ, ТУРКМЕНІСТАНУ ТА ІНШИХ КРАЇН ЦЕНТРАЛЬНОЇ АЗІЇ 1990 – 2016 РР.: ЗОВНІШНЬОПОЛІТИЧНІ ТА ЕКОНОМІЧНІ ФАКТОРИ

In the late 1980s and early 1990s, the military- political and economic situation in the world had changed radically. The Berlin Wall fell ,The Warsaw Treaty Organization (WTO) stopped its existence, the socialist bloc of countries in Europe and the USSR collapsed. The world was no more bipolar. The PRC, led by the CCP, despite the ruling Communist Party ideology, strived to take advantage of these changes. China aimed to open for itself foreign markets, including energy resources. PRC’s rejection from complete isolationism, the initial cessation of confrontation with the United States and countries of the West, and then cessation of the struggle with the USSR and its allies for leadership in building a world socialist system, allowed Chinese government not only to save huge resources, including energy, which went to maintenance of a huge army and ambitious military-political projects, by directing them in a peaceful direction, but also by starting the introduction of market reforms, what changed China's image in the world from a negative to a positive one. Sinc the formation on the territory of the former Soviet Central Asia of the independent states of Central Asia – Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan – hydrocarbon resources of the region acquired key importance in the foreign policy of the new countries. China formed the priorities of its foreign energy policy in relation to Central Asia gradually. Energy expansion of Beijing was preceded by an active trade and economic policy, the results of which created preconditions for the foreign policy refocusing of the countries of the region. Pipelines became an important element of energy policy, proposed and implemented by Beijing for the supply of hydrocarbon resources in Chinese direction. Beijing achieves access to new oil and gas deposits, expecting due to their development, to realize promising plans to increase the exports volume of hydrocarbon raw materials from Central Asia countries.

Long-Term Results of Gamma Knife Radiosurgery for Trigeminal Neuralgia

Although the short- to medium-term efficacy of Gamma Knife therapy for drug-resistant essential trigeminal neuralgia has been reported, long-term evaluations are limited. We evaluated patient data obtained at least 10years post-treatment and examined the significance of this treatment using new end points. Among 249 consecutive patients with essential trigeminal neuralgia who were treated with Gamma Knife radiosurgery (retrogasserian target/4-mm single isocenter/90Gy at 100%) at our institution between January 2003 and October 2011, 103 patients who were followed up for at least 10years (mean, 174 [120-219] months) after treatment and whose data were amenable to accurate evaluation, were included in this retrospective study. Herein, we used the Barrow Neurological Institute (BNI) pain intensity scale as a clinical evaluation method for pain and the BNI numbness scale to evaluate complications (namely facial dysesthesia). The initial and final follow-up pain attack cessation (BNI pain intensity score I-IIIa) rate was 82.5% (85 of 103) and 58.2% (60 of 103), respectively. Furthermore, sensory impairment (BNI numbness score≥II) at the last follow-up was observed in 24.3% (25 of 103) of the cases, while very bothersome status (BNI numbness score IV) was observed in 2.9% of the cases. Gamma Knife radiosurgery for essential trigeminal neuralgia showed good therapeutic effects during long-term follow-up. Serious complications of significant concern in the short- to mid-term follow-up, resolved spontaneously. Therefore, the indications for treatment should be expanded to include patients who strongly desire Gamma Knife therapy.

Comparison of Buccal Midazolam with Rectal Diazepam in the treatment of prolonged seizures in children

Background : Seizure is common neurological disorder in children. It is one of the common causes of referral of child to hospital and often requires emergency intervention. Rectal diazepam is the established first line drug for this purpose, but seizure recurrence and respiratory depression are the two major side effects. Midazolam is a water-soluble benzodiazepine with anticonvulsive activity at physiologic PH, which facilitates its effects on brain tissue. Midazolam is also easy to use, and no adverse events were reported in relation to the route of administration. Objectives : To compare the efficacy and safety of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in children. Methodology : This prospective randomized study was conducted in the Department of pediatrics, Sir Salimullah Medical College (SSMC) and Mitford Hospital, from March 2018 to December 2018.Fifty (50) patients aged 3 months to12 months who were convulsing and experiencing prolonged seizure (lasted &gt;5 minutes) were included. Patients was randomly assigned to one of the two treatment arms: rectal diazepam and buccal midazolam. Primary and secondary outcome was compared between 2 treatment arms. Primary outcome was: 1. cessation of visible seizure activity within 10 minutes. 2. without recurrence of seizure in the subsequent hour. Secondary outcome included: 1. proportion with cessation of convulsion and exact time needed for cessation of convulsion within 10 minutes2. proportion of seizure recurrence in the sub sequent hours and within 24 hours after initial control and exact time of recurrence within the respective period. Also the safety and adverse effects were also compared. Results : The two groups did not differ significantly in sex, age, type of seizures, temperature, and baseline RBS, respiratory rate and blood pressure. Comparing the 2-treatment group, 13 (52%) patient experienced treatment failure who received rectal diazepam compared with 7 (28%) who received buccal midazolam (P&gt;0 .05). For initial cessation of seizures, 18 (72%) seizures terminated within 10 minutes in the diazepam group compared with 19 (76%) in the midazolam and mean time to cessation of the seizure was 4.02±1.03 minutes and 4.4 ± 1.09 minutes respectively (p&gt;0.05). Among the 18 children in whom seizure was initially controlled within 10 minutes by rectal diazepam, 6 (33.33%) of them experienced a seizure recurrence in the subsequent hour compared with 1 (5.26%) of 19 children in the buccal midazolam group (P&lt;0 .05). children who experienced a seizure recurrence within 1 hour after initial control, the mean time torecurrence was 20.0±5.0 vs 25±0.0 minutes in diazepam group and midazolam group respectively (P =0.478). Seizure recurrence after initial control during the 24 hours after treatment was 5 (41.36%)vs 6 (33.33%).The mean time to recurrence within 24 hours was114.00±39.11.53 vs 320.83±173.10 minutes which was highly significant (P&lt;0 .05) Conclusion : Buccal midazolam was as safe as and more effective with an improved efficacy over 1 hour (P&lt;0 Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 493-498

Pharmacist-led telehealth tobacco cessation services compared with usual care in a community health center

BackgroundPrevious studies regarding tobacco cessation services (TCS) concluded that pharmacist interventions lead to higher or similar quit rates compared with usual care; however, little is known about patient satisfaction with these services. ObjectivesThis study assessed 30-day point prevalence abstinence and patient satisfaction of TCS provided by pharmacists compared with primary care providers (PCPs) in a community health center. Secondary objectives assessed the number of encounters and time spent counseling and medications prescribed at each visit. MethodsPatients at the age of 18 years or older with tobacco use disorder and a new quit attempt were invited to complete a 9-question survey via e-mail, phone, and mail 7 months after their initial tobacco cessation visit. The survey assessed 30-day point prevalence abstinence and patient satisfaction. Chart reviews were conducted to assess time spent counseling and prescribing patterns. ResultsThe response rate was 38.8% (50/129) overall, 43.9% in the pharmacist group and 36.3% in the PCP group. A 30-day point prevalence abstinence was reached by 22.2% (4/18) in the pharmacist group and 9.4% (3/32) in the PCP group (P = 0.23). Patient satisfaction was significantly higher in the pharmacist group with regard to discussion around medications used to quit smoking (100% vs. 65.6%, P = 0.004), understanding how to properly use the medications (100% vs. 62.5%, P = 0.002), identifying behavioral changes to assist with quitting (94.4% vs. 65.6%, P = 0.036), and frequent follow-up visits (83.3% vs. 46.9%, P = 0.016). Pharmacists spent more time counseling patients and were more likely to prescribe dual nicotine replacement therapy and prescription medications. ConclusionsThere was not a statistically significant difference in abstinence rates, and patient satisfaction with TCS provided by pharmacists and PCPs was high. Pharmacists provide a more intensive service by spending more time counseling patients and providing more follow-ups and are more likely to diversify medications prescribed to quit smoking.

Patterns of lapses and recoveries during a quit attempt using varenicline and behavioral counseling among smokers with and without HIV.

Addressing tobacco use among HIV+ smokers is a priority. Lack of knowledge about how HIV+ smokers respond to tobacco use treatments limits our ability to effectively treat this population of smokers. Using data from 2 clinical trials that provided 12 weeks of varenicline and behavioral counseling, 1 with smokers with HIV (n = 89) and 1 with smokers without HIV (n = 179), we used mixed logistic regression modeling to compare point-prevalence abstinence rates and adherence to the initial target quit date (TQD) and Cox regression for repeated outcomes to evaluate lapse and recovery dynamics between the groups. Sixty percent of HIV- smokers refrained from smoking at the TQD while only 33% of HIV+ smokers did (odds ratio [OR] = 0.32, 95% CI [0.18, 0.56], p < .001). The point-prevalence abstinence rates at Week 12 were 31% (HIV-) and 28% (HIV+; OR = 0.7, 95% CI [0.42, 1.16], p = .16) and the point prevalence abstinence rates at Week 24 were 22% (HIV-) and 15% (HIV+; OR = 0.87, 95% CI [0.49, 1.57], p = .65). Although there was no interaction between HIV status and lapse risk, χ2(3) < 1, there was a significant interaction for the recovery model, (χ2(3) = 20.4, p < 0.001): as the number of events increased, the time to the next recovery became longer among smokers with HIV, compared to smokers without HIV. Although HIV+ smokers were treated effectively with varenicline, compared to HIV- smokers, they showed significantly lower initial cessation at the TQD and took increasingly longer to recover following lapses. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A new smoking cessation 'cascade' among women with or at risk for HIV infection.

The aim of this study was to define a smoking cessation 'cascade' among USA women with and without HIV and examine differences by sociodemographic characteristics. An observational cohort study using data from smokers participating in the Women's Interagency HIV Study between 2014 and 2019. We followed 1165 women smokers with and without HIV from their first study visit in 2014 or 2015 until an attempt to quit smoking within approximately 3 years of follow-up, initial cessation (i.e. no restarting smoking within approximately 6 months of a quit attempt), and sustained cessation (i.e. no restarting smoking within approximately 12 months of a quit attempt). Using the Aalen-Johansen estimator, we estimated the cumulative probability of achieving each step, accounting for the competing risk of death. Forty-five percent of smokers attempted to quit, 27% achieved initial cessation, and 14% achieved sustained cessation with no differences by HIV status. Women with some post-high school education were more likely to achieve each step than those with less education. Outcomes did not differ by race. Thirty-six percent [95% confidence interval (95% CI): 31-42] of uninsured women attempted to quit compared with 47% (95% CI: 44-50) with Medicaid and 49% (95% CI: 41-59) with private insurance. To decrease smoking among USA women with and without HIV, targeted, multistage interventions, and increased insurance coverage are needed to address shortfalls along this cascade.

Comparative assessment of outcomes of smoking cessation therapies and role of free medications in successful long-term abstinence.

INTRODUCTIONLong-term outcomes of smoking cessation treatments are crucial to optimize standards of cessation services, which are known to prevent excess morbidity and mortality. This study aimed to evaluate long-term outcomes of a smoking cessation program, to compare the success rates of interventions, to assess relapse rates after quitting, and to determine the duration until relapse.METHODSPatients admitted for smoking cessation between 2010–2018 were contacted to evaluate short- and long-term treatment outcomes. The patients were asked whether they were currently smoking, and whether they quit after smoking cessation treatment and the duration of abstinence.RESULTSThe study included 579 patients (341 males) with a mean age of 50±12 years. The median time from the date of visit to the smoking cessation clinic to analysis was 5 years (range: 2–10). Of the patient, 436 used medications, including varenicline, bupropion, and nicotine replacement therapy (NRT). The overall quit rate was 31.8% by the primary intervention (varenicline: 45.5%, bupropion: 38.2%, NRT: 33%, psychosocial support: 4.2%), and quit rate was similar in the intervention groups (p=0.073). In the long-term, the quit rates were 19.6, 22.5, 25.9, and 21.7%, respectively (p=0.405). About 9% of the patients failed to quit smoking initially but succeeded for a while after the first intervention at the cessation clinic. The relapse rate after initial cessation was 19%. The longest period of abstinence was in patients using NRT (14±17 months), followed by the patients using varenicline (9.5±12.7 months) and bupropion (8.2±14.8 months).CONCLUSIONSBoth short- and long-term quit rates with varenicline, bupropion, and NRT, were similar. The long-term quit rates among patients who did not use medication and received psychosocial support initially were comparable to those who used a smoking cessation drug.

The Case of Insertional Adductor Tendinopathy of an International-Level 3,000-m Steeplechase Runner.

Background: Groin pain is a frequent condition among athletes. One of the causes of groin pain is tendinopathy, a frequently diagnosed medical condition, which can also occur in the adductor muscles. Despite the high prevalence of this medical condition among athletes, it is infrequent to observe tendinopathic groin pain in steeplechase runners. The aim of this case study is to describe the case of an international-level 3,000-m steeplechase runner with groin pain, who was subsequently diagnosed with adductor insertional tendinopathy.Case Presentation: We present the case of an Italian 3,000-m steeplechase and long distance runner, Ala Zoghlami (180 cm, 57 kg), with groin pain, diagnosed as insertional adductor tendinopathy. The runner, after manifesting the painful symptomatology, underwent medical screening (ultrasound and MRI). The radiological investigations highlighted adductor tendinopathy. After refraining from training, the runner underwent medical and physical therapy which, in the first phase, did not improve the painful symptomatology. Further evaluation, after 6 months from the initial training cessation, highlighted a case of malocclusion. Such was treated from a dentistry perspective with the creation of a personalized dental bite.Results: A multidisciplinary approach which included medical and physical therapy, osteopathy, and dentistry, in adjunct with refraining from training, was able to reduce the symptomatology and allowed a correct return to run (after 9 months from the first painful manifestation) of the steeplechase runner. To date, Ala Zoghlami has fully recovered and was able to win the 3,000-m steeplechase race during the 2021 national Italian competition.

Shifts in behavioral allocation patterns as a natural recovery mechanism: Postresolution expenditure patterns.

Behavioral economics predicts that recovery from Alcohol Use Disorder involves shifts in resource allocation away from drinking, toward valuable nondrinking rewards that reinforce and stabilize recovery behavior patterns. Further, these shifts should distinguish nonproblem drinking (moderation) outcomes from outcomes involving abstinence or relapse. To evaluate these hypotheses, 5 prospective studies of recent natural recovery attempts were integrated to examine changes in monetary spending during the year following the initial cessation of heavy drinking as a function of 1-year drinking outcomes. Problem drinkers from Southeastern U.S. communities (N=493, 67% male, 65% white, mean age=46.5years) were enrolled soon after stopping heavy drinking without treatment and followed prospectively for a year. An expanded Timeline Followback interview assessed daily drinking and monetary spending on alcohol and nondrinking commodities during the year before and after recovery initiation. Longitudinal associations between postresolution drinking and spending were evaluated using MPlus v.8. Initial models evaluated whether changes in spending at 4-month intervals predicted drinking outcomes at 1 year and showed significant associations in 6 commodity categories (alcohol, consumable goods, gifts, entertainment, financial/legal affairs, housing/durable goods/insurance; ps<0.05). Cross-lagged models showed that the moderation outcome group shifted spending mid-year to obtain large rewards with enduring benefits (e.g., housing), whereas the abstinent and relapsed groups spent less overall and purchased smaller rewards (e.g., consumable goods, entertainment, and gifts) throughout the year. Dynamic changes in monetary allocation occurred during the postresolution year. As hypothesized, compared to the groups who abstained or relapsed, the moderation group shifted spending in ways that, overall, yielded higher value alcohol-free reinforcement that should reinforce recovery while they enjoyed some limited nonproblem drinking below heavy drinking thresholds. These findings add to evidence that moderation entails different behavioral regulation processes than abstinent and relapse outcomes, which were more similar to one another.

Characteristics and Predictors of Abstinence Among Smokers of a Smoking Cessation Clinic in Hunan China.

Background: More than 300 million smokers make China the largest cigarette consumer globally, which is a huge economic burden. Smoking cessation (SC) clinics can offer counseling and follow-up services. The operational experience of SC clinics in China needs to be summarized and improved based on research evidence.Purpose: The objectives of this study were to describe quit rates among attendees of SC clinics in Hunan and assess predictors of successful SC.Methods: The participants in this study were smokers who visited the SC clinic of Hunan Cancer Hospital from February 1, 2015 to September 30, 2018. Individuals who received individual counseling and assessment from the SC clinic staff and were willing to quit smoking were eligible for inclusion. Those with critical illness or cancer were excluded. Application of smoking cessation clinic registration form (unified by Chinese Center for Disease Control and Prevention) was used to assess participants at the consultation. Follow-ups and counseling were performed over telephone at 1 week, 1 month, and 3 months after the initial cessation consultation or in times of need. Successful SC was checked for at 3 months after the start of SC.Results: A total of 328 smokers (mean age 45.67 ± 12.38 years) had participated. The abstinence rate at 3 months was 28.4%. Binary regression analysis revealed significant independent predictors to be the total numbers of SC follow up sessions, previous SC attempts, and participants' decision on when to quit smoking (The relative to quit immediately group, quit within 30 days, quit after 30 days, and undecided quit were less likely to succeed in quitting. while quit within seven days had no statistical significance.Conclusion: SC clinics can achieve a desirably high quit rate. Participant's previous attempts at quitting, three or more follow-ups, and the decision to quit immediately or within seven days were factors helpful in predicting the success of SC.

Platelet Disorders.

After vascular injury and exposure of subendothelial matrix proteins to the intravascular space, mediators of hemostasis are triggered and allow for clot formation and restoration of vascular integrity. Platelets are the mediators of primary hemostasis, creating a platelet plug and allowing for initial cessation of bleeding. Platelet disorders, qualitative and quantitative, may result in bleeding signs and symptoms, particularly mucocutaneous bleeding such as epistaxis, bruising, petechiae, and heavy menstrual bleeding. Increasing evidence suggests that platelets have functional capabilities beyond hemostasis, but this review focuses solely on platelet hemostatic properties. Herein, normal platelet function as well as the effects of abnormal function and thrombocytopenia are reviewed.

Effects of Selective Early Magnesium Cessation Protocol on Preeclampsia With Severe Features [12L

INTRODUCTION: We evaluate the effect of a selective early postpartum magnesium cessation protocol in patients diagnosed with preeclampsia with severe features. METHODS: A standardized protocol was implemented in March 2017 identifying patients at lower risk of postpartum eclampsia, and thus eligible for early discontinuation of magnesium sulfate at 12 hours postpartum. An IRB approved, retrospective cohort study was performed of all patients with preeclampsia with severe features 25 months before and after protocol implementation. The primary outcome assessed was the incidence of postpartum readministration of magnesium sulfate after completion of the initial course. RESULTS: Preeclampsia with severe features was identified in 737 patients with exclusion of 58 patients due to postpartum preeclampsia diagnosis or eclampsia prior to initial magnesium cessation. While the rate of preeclampsia with severe features increased (3.9% vs 7.0%, p&lt;.001) in the pre and post-implementation groups, there was no difference in the rate of eclampsia (0.03% vs 0.05%, P=.59). Analysis included 272 patients pre and 407 patients post protocol implementation. Rates of early magnesium cessation, less than 23 hours of postpartum magnesium, were 11.1% vs 55.5% pre and post protocol implementation. In patients who underwent early magnesium cessation (n=226), there was no significant difference in postpartum readministration of magnesium (1.5% vs 3%, P=.25). There was no difference in readmission for hypertensive disorders of pregnancy (1.1% vs 2.5%, P=.20). CONCLUSION: In patients with preeclampsia with severe features who underwent selective early magnesium cessation there was no difference in postpartum readministration of magnesium sulfate or readmission for hypertensive disorders of pregnancy.

The time-varying effect of alcohol use on cigarette smoking relapse risk

BackgroundAlcohol consumption promotes lapses to smoking among smokers trying to quit, perhaps particularly among smokers with lower dependence. We assessed how the role of alcohol in lapses varies over time. MethodsThis is a secondary analysis of ecological momentary assessment data collected from 159 daily smokers (mean age = 43.90 (SD = 10.41), 56.60% female) who drink alcohol. During the 4 weeks following initial cessation (quit >24 h), a logistic time-varying effect model (TVEM) modeled momentary assessments of lapses and temptations to smoke compared to randomly-selected moments as a function of concurrently-assessed recent alcohol use (past 15 min). Time was examined continuously. ResultsRecent alcohol use was associated with smoking lapses, particularly for less nicotine dependent individuals, and the association varied across time. For individuals who did not smoke within 5 min of waking, alcohol use became a significant predictor of lapse on Day 1 post-quit, increased in strength until Day 7, then decreased such that alcohol use was no longer associated with lapse by Day 25. For this subgroup, the associations between alcohol use and temptations were relatively stable and significant from Day 1 to 22 post-quit. Results were similar when dependence was assessed by the Nicotine Dependence Symptom Scale. ConclusionsThe association between drinking and smoking lapse and temptations varies over time, peaking early in smoking abstinence and declining thereafter. This could reflect progressive relapse of most vulnerable individuals or habituation to alcohol as a smoking cue. Interventions to prevent alcohol-related lapses are essential early in the quit period.

1299 Sorafenib Induce Acute Pancreatitis: A Seldom Reported Side Effect

INTRODUCTION: Sorafenib is a multikinase inhibitor that has been used successfully in patients with hepatocellular carcinoma. Given its recent approval in the market, many of its side effects are still being uncovered. Here we present a rare case of Sorafenib induced acute pancreatitis. CASE DESCRIPTION/METHODS: The patient is a 60-year-old male with a medical history of hepatocellular carcinoma (stage IV with metastasis to bone), Hepatitis C virus, hypertension and rheumatoid arthritis who presented to the emergency department complaining of slowly progressive epigastric abdominal pain for 2 weeks. Of note the patient was started on Sorafenib 400 mg twice daily three weeks prior as an outpatient. Notable laboratory workup included a lipase of 189 U/L and a triglyceride level of 70 mg/dL. Notable imaging included a computed tomography of the abdomen which showed mild peri-pancreatic haziness consistent with acute pancreatitis and a ill defined hypodense lesion in the right hepatic lobe that was unchaged from previous imaging. The patient was then admitted under the impression of acute pancreatitis secondary to Sorafenib. Prior to reaching this diagnosis, alternate etiologies of acute pancreatitis were ruled out. This included ingestion of alcohol, hypertrigliceridemia, cholelithiasis and other medications. During his admission the patients diet was held and he was given early intravenous fluid resuscitation. Two days later his abdominal pain resolved and he was safely discharged home with follow up appointments. On follow up visit the patient was restarted on Soraenib at a lower dose (200 mg twice daily) with no recurrence of symptoms. DISCUSSION: Sorafenib induced pancreatitis is a rare complication that has seldom been reported in the literature and whose pathogenesis has not been completely elucidated. One theory suggests that it results from pancreatic ischemia that occurs secondary to sorafenib's anti-androgenic effect on vascular endothelial growth factor (VEGRF). A second theory suggests that sorafenib's effect on gastrointestinal dysmotility results in reflux of duodenal contents into the pancreatic duct. Diagnosis of sorafenib induced pancreatitis can be done after ruling out secondary causes of pancreatitis (ie: alcohol, hypertriglyceridemia). Treatment of sorafenib induced pancreatitis includes cessation of the offending agent. There have been reported cases where sorafenib was resumed at a lower dose after initial cessation, with no clinical sequelae as was the case with our patient.