Blood Nicotine Research Articles

Immune Cell Profile in Young Adults who Regularly Use E-cigarettes and the Role of Nicotine

Background: Cigarette smoking results in altered immune cell function and associated systemic inflammation, as observed in chronic obstructive pulmonary disease (COPD). Electronic (e-) cigarettes are novel, popular tobacco products frequently advertised as a safer alternative to traditional cigarettes; however, the effects of their regular use on immune cell function are currently unknown. Thus, the purpose of this study was to investigate the impact of e-cigarette usage and the role of nicotine on the immune cell profile of young, regular users. Methods: Twenty-five young, apparently healthy, regular users of e-cigarettes (EU, age: 23±3 y.) and twenty-two non-users (NU, age: 23±4 y.) participated in this study. A fasted venous blood sample was obtained from all participants for a complete blood count and nicotine concentrations. EU were randomized to either nicotine or nicotine-free products for fourteen days and completed a second assessment to investigate changes in the immune cell profile based on either increased (+C; n=11) or decreased (-C; n=9) nicotine usage accessed via cotinine levels. For comparison, the same assessments were completed in a group of 13 patients with a diagnosis of COPD (67±9 y., GOLD Stage II-IV). Results: Regular users of e-cigarettes exhibit significantly higher eosinophils (absolute, p=0.008, percentage, p=0.042) and platelets ( p=0.018) when compared to non-users but similar ( p≥0.431) to patients with COPD. White blood cell, neutrophil, monocyte, and lymphocyte counts were similar between the EU and NU. After fourteen days, despite significant changes in nicotine (Δ+C=+2±4 vs. Δ-C=-3±4 ng/mL, p=0.014) and cotinine (Δ+C=+28±27 vs. Δ-C=-141±120 ng/mL, p=0.001) between +C and -C groups, no differences in the immune cell profiles were observed. To note, no association between immune cells and nicotine levels at baseline or follow-up (nicotine: r≤0.352; p≥0.122; cotinine: r≤0.310; p≥0.126). Conclusions: Results of the study suggests that regular users of e-cigarettes present with altered immune cell profile in eosinophils and platelets when compared to non-users. The elevated immune cell markers were comparable to observed values in patients with COPD and have been associated with adverse effects on pulmonary and cardiovascular health. In addition, the elevated immune cell profile was not related to changes in nicotine, inferring that other e-liquid components may have an effect on innate immunity. Future studies are warranted to investigate the long-term effects of e-cigarette use and their components on immune cell profile. Supported in part by a Rapid Response Project NIDA/FDA (PRM). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Pharmacokinetics and Pharmacodynamics of Inhaled Nicotine Salt and Free-Base Using an E-cigarette: A Randomized Crossover Study.

Popular "pod-style" e-cigarettes commonly use nicotine salt-based e-liquids that cause less irritation when inhaled and can deliver higher nicotine concentrations than free-base nicotine. This study investigated the pharmacokinetic and pharmacodynamic effects of different nicotine formulations (salt vs. free-base) and concentrations that might influence systemic nicotine absorption and appeal of e-cigarettes. In this randomized, double-blind, within-subject crossover study, 20 non-nicotine-naïve participants were switched among three e-liquids (free-base nicotine 20 mg/mL, nicotine salt 20 mg/mL, nicotine salt 40 mg/mL) using a refillable pod system and a standardized vaping protocol (one puff every 30 seconds, 10 puffs total). Serum nicotine concentrations and vital signs were assessed over 180 minutes; direct effects, craving, satisfaction, withdrawal, and respiratory symptoms were measured using questionnaires. CYP2A6 genotypes and the nicotine metabolite ratio were also assessed. Eleven (55%) participants were male and the median age was 23.5 years (range 18-67). All three formulations differed significantly in peak serum nicotine concentration (baseline adjusted Cmax, median (range): 12.0 ng/mL (1.6-27.3), 5.4 ng/mL (1.9-18.7), and 3.0 ng/mL (1.3-8.8) for nicotine salt 40 mg/mL, nicotine salt 20 mg/mL and free-base 20 mg/mL, respectively). All groups reached Cmax 2.0-2.5 minutes (median) after their last puff. Differences in subjective effects were not statistically significant. No serious adverse events were observed. Free-base 20 mg/mL formulations achieved lower blood nicotine concentrations than nicotine salt 20 mg/mL, while 40 mg/mL nicotine salt yielded concentrations similar to cigarette smoking. The findings can inform regulatory policy regarding e-liquids and their potential use in smoking cessation. Nicotine salt formulations inhaled by an e-cigarette led to higher nicotine delivery compared to nicotine-free-base formulations with the same nicotine concentration. These findings should be considered in future regulatory discussions. The 40 mg/mL nicotine salt formulation showed similar nicotine delivery as combustible cigarettes, albeit at concentrations over the maximum limit for e-liquids allowed in the European Union. Nicotine delivery resembling combustible cigarettes might be beneficial for smokers willing to quit to adequately alleviate withdrawal symptoms. However, increased nicotine delivery can also pose a public health risk, raising concerns about abuse liability, especially among youth and nonsmokers.

The impact of high nicotine concentrations on the viability and cardiac differentiation of mesenchymal stromal cells: a barrier to regenerative therapy for smokers.

Background: Current treatment methods are not successful in restoring the lost cardiomyocytes after injury. Stem cell-based strategies have attracted much attention in this regard. Smoking, as a strong cardiovascular risk factor, not only affects the cardiac cells adversely but also deteriorates the function of stem cells. Since mesenchymal stem cells (MSCs) are one of the popular candidates in cardiovascular disease (CVD) clinical trials, we investigated the impact of nicotine on the regenerative properties (viability and cardiac differentiation) of these cells. Methods: MSCs were isolated from rat bone marrow and characterized based on morphology, differentiation capability, and the expression of specific mesenchymal markers. The MTT assay was used to assess the viability of MSCs after being exposed to different concentrations of nicotine. Based on MTT findings and according to the concentration of nicotine in smokers' blood, the growth curve and population doubling time were investigated for eight consecutive days. Cells were treated with 5-azacytidine (an inducer of cardiac differentiation), and then the expressions of cardiac-specific markers were calculated by qPCR. Results: MSCs were spindle-shaped, capable of differentiating into adipocyte and osteocyte, and expressed CD73 and CD90. The viability of MSCs was reduced upon exposure to nicotine in a concentration- and time-dependent manner. The growth curve showed that nicotine reduced the proliferation of MSCs, and treated cells needed more time to double. In addition, the expressions of GATA4 and troponin were downregulated in nicotine-treated cells on day 3. However, these two cardiac markers were overexpressed on day 7. Conclusion: Nicotine decreased normal growth and reduced the expression of cardiac markers in MSCs. This aspect is of eminent importance to smokers with cardiovascular disease who are candidates for stem cell therapy.

Examination of empathy-like behaviour in nicotine-preferring rat lines

Aim Addiction is an important global health issue, impacting also addicts environment and society. Empathy plays crucial role in establishing successful social relationships and is a fundamental component of social life. The aim of this study is to investigate how nicotine preferring (NP) strain and oral forced nicotine administration affects empathy-like behaviour in rats, with gender differences. Materials and Methods Sprague-Dawley NP rats (10 males/10 females) and wild-type control rats (10 males/10 females) were used. Behavioural tests were administered to all rats before and after oral forced nicotine administration. The behavioural tests were completed in the fourth week of nicotine administration. Anxiety levels that could affect empathy-like behaviour were evaluated with open field, elevated plus maze tests and with blood cortisol levels. Oxytocin receptor and arginine vasopressin (AVP) levels, which have been shown to be related to empathy-like behaviour, were examined in the prefrontal cortex and amygdala regions using the enzyme-linked immunoassay method. Results It was observed that males from the NP strain showed less empathy-like behaviour than all other groups, and nicotine administration did not cause a significant change in the results. Higher levels of locomotor activity (LA) were found in control females than in all other groups. Blood nicotine and corticosterone levels were higher in NP rats. No significant differences were found in AVP and oxytocin receptor levels in the prefrontal cortex and amygdala. Conclusions It was found that coming from an addicted strain particularly reduces empathy-like behaviour in males.

Pharmacological effects of nicotine salts on dopamine release in the nucleus accumbens.

With the growing number of individuals regularly using e-cigarettes, it has become increasingly important to understand the psychobiological effects of nicotine salts. Nicotine increases the release of dopamine (DA) into the nucleus accumbens (NAc), causing feelings of satisfaction. However, the differences in the DA-increasing effects of different nicotine salts have not been reported. In this study, we used a G protein-coupled receptor-activated DA fluorescent probe (GRABDA1m) and optical fiber photometric recording equipment to monitor the dynamic changes and kinetics of DA release in the NAc of mice exposed to different e-cigarette aerosols, including nicotine, nicotine benzoate, nicotine tartrate, nicotine lactate, nicotine levulinic acid, nicotine malate, and nicotine citrate. The results of this study were as follows: 1) Different types of nicotine salts could increase the release of DA in the NAc. 2) The slopes and half-effective concentrations of the fitted curves were different, suggesting that each nicotine salt had a difference in the efficiency of increasing DA release with concentration changes. 3) The absorption rates of different nicotine salts containing the same original nicotine concentration were significantly different by measuring the blood nicotine content. The effect of nicotine salts on increasing DA was directly proportional to the blood nicotine level. In conclusion, by observing the effects of nicotine salts on DA release in real time in vivo, differences in the pharmacological effects of nicotine salts are revealed to better understand the mechanism underlying the regulatory effects of nicotine salts on the brain.

Effects of Nicotine on the Progression and Metastasis of HumanOvarian Cancer cells by Exacerbating EMT

Does nicotine, a main constituent of toxicants in Cigarette Smoke, relate to EMT and contribute to the progression ofovarian cancer? Treat SK-OV3 xenograft mice with increasing nicotine and measure TGF-β in blood by ELISA assayand tumor cell metastasis by confocal microscopy, looking for cancer cells in the liver, bone, brain, stomach, ovary andthen measure xenograft tumor size by weight. A positive control is benzene treatment, and the negative control is PBS.The results will reveal the effects of nicotine on ovarian cancer cell proliferation, which will improve our understandingof the harm environmental toxicants can do to human health. At the same time, the physiological processes that lead tocarcinogenesis will also provide prevention awareness and treatment ideas for ovarian cancer caused by smoking.

Early detection methods of chronic diabetic nephropathy in diabetes mellitus patients in primary health services

Introduction: The prevalence of diabetic kidney disease increases along with the increase in the number of patients with diabetes mellitus. Early detection of diabetic nephropathy in DM patients is an essential step in preventing the incidence of diabetic kidney disease. The study aimed to obtain a method of early detection of diabetic kidney disease in DM patients in primary health care via identifying factors associated with decreased glomerular filtration rate (GFR). Methods: We conducted a case-controlled study at the public health center in Bantul. The research subjects were patients at Kasihan 1 public health center aged 18-75 years. In-depth interviews will be conducted to obtain clinical and social risk factors for GFR decreasing as an early detection tool for diabetic nephropathy (DN) incidence. The IGF-1 levels were checked using ELISA. The Pearson correlation test observed a significant association between patient risk factors and GFR. Results: This study is expected to obtain a model of the method of early detection of chronic diabetic kidney disease in diabetes mellitus patients in primary health services. The results showed that the GFR was related to systolic blood pressure, diastolic blood pressure, hyperglycemia, nicotine levels, and IGF-1 levels (P<0.00). Increased nicotine levels, increased blood pressure, hyperglycemia, and decreased levels of IGF-1 are associated with decreased GFR. Identifying factors related to the glomerular filtration rate can be used to predict impaired renal function. Conclusion: Reduced glomerular filtration rates are linked to higher nicotine levels, higher blood pressure, hyperglycemia, and lower IGF-1 levels.

Higher blood nicotine concentrations following smokeless tobacco (pituri) and cigarette use linked to adverse pregnancy outcomes for Central Australian Aboriginal pregnancies

BackgroundIn central Australia, Aboriginal women use wild tobacco plants, Nicotiana spp. (locally known as pituri) as a chewed smokeless tobacco, with this use continuing throughout pregnancy and lactation. Our aim was to describe the biological concentrations of nicotine and metabolites in samples from mothers and neonates and examine the relationships between maternal self-reported tobacco use and maternal and neonatal outcomes.MethodsCentral Australian Aboriginal mothers (and their neonates) who planned to birth at the Alice Springs Hospital (Northern Territory, Australia) provided biological samples: maternal blood, arterial and venous cord blood, amniotic fluid, maternal and neonatal urine, and breast milk. These were analysed for concentrations of nicotine and five metabolites.ResultsA sample of 73 women were enrolled who self-reported: no-tobacco use (n = 31), tobacco chewing (n = 19), or smoking (n = 23). Not all biological samples were obtained from all mothers and neonates. In those where samples were available, higher total concentrations of nicotine and metabolites were found in the maternal plasma, urine, breast milk, cord bloods and Day 1 neonatal urine of chewers compared with smokers and no-tobacco users. Tobacco-exposed mothers (chewers and smokers) with elevated blood glucose had higher nicotine and metabolite concentrations than tobacco-exposed mothers without elevated glucose, and this was associated with increased neonatal birthweight. Neonates exposed to higher maternal nicotine levels were more likely to be admitted to Special Care Nursery. By Day 3, urinary concentrations in tobacco-exposed neonates had reduced from Day 1, although these remained higher than concentrations from neonates in the no-tobacco group.ConclusionsThis research provides the first evidence that maternal pituri chewing results in high nicotine concentrations in a wide range of maternal and neonatal biological samples and that exposure may be associated with adverse maternal and neonatal outcomes. Screening for the use of all tobacco and nicotine products during pregnancy rather than focusing solely on smoking would provide a more comprehensive assessment and contribute to a more accurate determination of tobacco and nicotine exposure. This knowledge will better inform maternal and foetal care, direct attention to targeted cessation strategies and ultimately improve long-term clinical outcomes, not only in this vulnerable population, but also for the wider population.Note to readersIn this research, the central Australian Aboriginal women chose the term ‘Aboriginal’ to refer to themselves, and ‘Indigenous’ to refer to the broader group of Australian First Peoples. That choice has been maintained in the reporting of the research findings.

Overdose symptoms and positive affect in never-established smokers are moderated by nicotine patch type: A between-subjects experimental investigation

Background: A growing number of studies have assessed the effects of acute nicotine on affect, cognition, and brain activity in never-established smokers in attempts to identify mechanisms by which nicotine promotes progression to dependence. However, these acute administration studies have not adequately addressed the problem of potential adverse side effects due to lack of tolerance, such as nausea, feelings of sickness, lightheadedness, and general negative affect and malaise – a term referred to as nicotine overdose events (NODEs). Thus, we report the first study to carefully characterize the prevalence, intensity, and effects of NODEs in never-established-smokers after acute nicotine administration. Methods: We compared the subjective effects of two different 7 mg nicotine patches that have different pharmacokinetics on never-established smokers (n = 67). One patch produces gradual increases in blood nicotine and the other produces more rapid increases in blood nicotine. Results: The findings suggest that in never-smokers, the lowest dose (7 mg) of rapid blood nicotine-rise patches are associated with a high prevalence of NODEs (45.83%) and decreased positive affect (PA) (54.17%) compared to a placebo patch (8.34% for NODEs and 33.34% for PA). The slow-rise patch did not significantly affect nicotine overdose symptoms or PA. Conclusions: Fast blood-rise nicotine patches may not be an ecologically valid method of nicotine delivery to never-smokers, while slow-rise nicotine patches, lower dose, and self-paced dosing may be more appropriate in this population. Findings also highlight the importance of the careful assessment of NODES in this population.

Nicotine poisoning-related deaths in Seoul Capital Area, Korea, 2014–2021

For last 8 years, fatal nicotine intoxication cases have occurred constantly in Korea. Even though nicotine has been utilized for long time as a cigarette form, high concentration of liquid nicotine for e-cigarette became easily accessible after its global marketing in 2015. As a discrepancy of blood nicotine concentration between reported fatal cases and our postmortem cases was observed, we reviewed fatal nicotine poisoning cases in Seoul capital area from 2014 to 2021. All decedents in Seoul capital area from 2014 to 2021 whose cause of death was fatal nicotine poisoning were retrospectively studied; the route of administration included injection or ingestion of e-liquid, and attachment of nicotine transdermal patches. The autopsies were carried out at Seoul Institute of National Forensic Service (NFS), and heart bloods and/or femoral vein bloods were submitted for toxicological analysis. As a substitute of blood sample, liver tissues were collected and analyzed. The concentrations of nicotine from biological samples were quantitated with liquid chromatography-tandem mass spectrometry (LC-MS/MS) after sample preparation. The concentrations of nicotine were evaluated with several parameters; method of administration, co-administered drug or alcohol etc. Seventy-one fatal cases of nicotine were identified and analyzed. The average blood concentration of nicotine was 42 mg/L in heart blood (range: 0.69–250, n = 37) and 18 mg/L in femoral vein blood (range: 0.33–130, n = 64). The average nicotine concentration in liver tissue was 150 mg/kg (range: 1.6–610, n = 6). In a fatal case of poisoning with 70 nicotine transdermal patches, heart and femoral vein blood concentration of nicotine were 7.7 mg/L and 3.3 mg/L, respectively. The average femoral vein blood concentration was 19 mg/L in fatal nicotine cases with no other drug or alcohol co-administered (range: 1.27–87, n = 24), whereas that was 17 mg/L in fatal nicotine cases with drug(s) and/or alcohol co-administered (range: 0.33–130, n = 40). As a sub-group, the average femoral vein blood concentration was 11 mg/L in the cases with alcohol but no other drug co-administered (range: 0.33–58 mg/L, n = 16). In analysis of nicotine poisoning cases, the results should be interpreted with caution. Even though average value was presented here, the lethal blood concentration range was wide; from less than 1 mg/L to more than 100 mg/L. The tolerance at a certain concentration might be different whether the exposed person was a habitual smoker or a non-smoker. Also, co-administration of alcohol or drugs may increase the risk of death at lower nicotine concentration.

Novel rapid-acting sublingual nicotine tablet as a cigarette substitution strategy

Current nicotine replacement products provide a much slower onset of nicotine delivery than cigarettes, and hence are only marginally effective at supplanting cigarette smoking. Therefore, more effective forms of nicotine replacement are needed. This initial investigation characterized the pharmacokinetic (PK) and subjective effects of a novel sublingual (SL) nicotine tablet designed to deliver nicotine more rapidly to the bloodstream of smokers. Study 1 (N = 6) characterized the pharmacokinetics of a 2mg nicotine SL tablet in comparison to an FDA-approved, marketed 2mg nicotine lozenge. Study 2 (N = 24) assessed subjective responses of smokers to a single use of a 1mg and 2mg SL tablet. Study 1 found that the time to maximum blood nicotine concentrations was significantly shorter for the SL tablet (14min) than for the lozenge (82min), and the initial rate of nicotine absorption was higher (0.4ng/mL*min vs. 0.0ng/mL*min), supporting the hypothesis that the SL tablet delivered nicotine more rapidly. Study 2 found that participants reported immediate relief of nicotine withdrawal symptoms after tablet administration, and craving reduction after the 2mg tablet approached the degree reported for their usual brands of cigarettes (4.2 vs. 4.6 on a 7-point scale). Other subjective responses showed the tablet to be an appealing alternative to smoking. The novel SL tablet studied shows promise as a nicotine substitution strategy for tobacco harm reduction and smoking cessation treatment. Additional studies are warranted to further investigate the potential of this new approach.

Management of Cavernous Carotid Artery Aneurysms: A Retrospective Single-Center Experience.

Objective: While cavernous carotid aneurysms can cause neurological symptoms, their often-uneventful natural course and the increasing options of intravascular aneurysm closure call for educated decision-making. However, evidence-based guidelines are missing. Here, we report 64 patients with cavernous carotid aneurysms, their respective therapeutic strategies, and follow-up. Methods: We included all patients with cavernous carotid aneurysms who presented to our clinic between 2014 and 2020 and recorded comorbidities (elevated blood pressure, diabetes mellitus, and nicotine consumption), PHASES score, aneurysm site, size and shape, therapeutic strategy, neurological deficits, and clinical follow-up. Results: The mean age of the 64 patients (86% female) was 53 years, the mean follow-up time was 3.8 years. A total of 22 patients suffered from cranial nerve deficit. Of these patients, 50% showed a relief of symptoms regardless of the therapy regime. We found no significant correlations between aneurysm size or PHASES score and the occurrence of neurological symptoms. Conclusion: If aneurysm specific symptoms persist over a longer period of time, relief is difficult to achieve despite aneurysm treatment. Patients should be advised by experts in neurovascular centers, weighing the possibility of an uneventful course against the risks of treatment. In this regard, more detailed prospective data is needed to improve individual patient counseling.

Blood Nicotine Predicts the Behavioral Economic Abuse Liability of Reduced-Nicotine Cigarettes

Cigarette smoking continues to be a major health concern and remains the leading preventable cause of death in the US. Recent efforts have been made to determine the potential health and policy benefits of reducing nicotine in combustible cigarettes. The degree to which changes in blood nicotine relate to measures of the abuse liability of reduced-nicotine cigarettes is unknown. The current study examined the relation between blood nicotine and behavioral economic demand measures of cigarettes differing in nicotine content. Using a within-subject design, participants smoked a single cigarette during each experimental session. Cigarettes included the participant's usual-brand cigarette and SPECTRUM investigational cigarette differing in nicotine level (mg of nicotine to g of tobacco; 15.8 mg/g, 5.2 mg/g, 2.4 mg/g, 1.3 mg/g, and 0.4 mg/g). During each session, blood was collected at multiple timepoints and behavioral economic demand was assessed. Nonlinear mixed-effects models were used to estimate differences in derived intensity (Q0) and change in elasticity (α). Measures of blood nicotine decreased in an orderly fashion related to nicotine level and significantly predicted change in elasticity (α), but not derived intensity. No differences in demand parameters between the usual brand and 15.8mg/g cigarettes were observed. However, α was significantly higher (lower valuation) for 0.4mg/g than 15.8mg/g cigarettes. The lowest nicotine level (0.4mg/g) corresponded with the lowest abuse liability (α) compared to the full-strength control (15.8mg/g), with the 1.3mg/g level also resulting in low abuse liability. This is the first study examining the relative contributions of nicotine content in cigarettes and blood nicotine levels on the behavioral economic demand abuse liability of cigarettes ranging in nicotine content. Our results suggest blood nicotine and nicotine content both predict behavioral economic demand abuse liability. In addition, our results suggest a nicotine content of 1.3mg/g or lower may be effective at reducing cigarette uptake among first-time (naïve) smokers. Our results largely conform to previous findings suggesting a very low nicotine content cigarette maintains lower abuse liability than full-strength cigarettes.

Toxic mechanisms of cigarette smoke and heat-not-burn tobacco vapor inhalation on rheumatoid arthritis

Tobacco combustion exposure worsens rheumatoid arthritis (RA). Non-combustible tobacco devices, as heat-not-burn tobacco (HNBT), are emerging as harm reduction to smokers by releasing nicotine and lower combustible tobacco products. Nevertheless, HNBT toxicity remains unclear. Hence, here we investigated the impacts of the tobacco combustible product (cigarette smoke; CS) or HNBT vapor exposures on antigen-induced arthritis (AIA) in C57BL/6 mice. Animals were exposed to airflow, HNBT vapor, or CS during 1 h/twice a day, under the Health Canada Intense (HCI) smoking regime, between days 14 to 20 after the first immunization. At day 21, 16 h after the last exposures, mice were i.a. challenged and the AIA effects were evaluated 24 h later. CS- or HNBT-exposed mice presented equivalent blood nicotine levels. CS exposure worsened articular symptoms, pulmonary inflammation, and expression of lung metallothioneins. Nevertheless, CS or HNBT exposures reduced lymphoid organs' cellularity, splenocyte proliferation and IL-2 secretion. Additional in vitro CS or HNBT exposures confirmed the harmful effects on splenocytes, which were partially mediated by the activation of nicotine/α7nAchR pathway. Associated, data demonstrate the toxic mechanisms of CS or HNBT inhalation at HCI regime on RA, and highlight that further investigations are fundamental to assure the toxicity of emerging tobacco products on the immune system during specific challenges.

Abstract 50: Virtual Care via Mobile Application Using a Patient Electronic Health Record Portal is Feasible and Increases Stroke Patient Engagement - A Pilot Study

Introduction: Improving patient engagement in post-acute stroke cohort is challenging. Additional tools are necessary to help patients take an active role their health. Care Companion is an interactive patient engagement tool embedded within a patient’s EHR portal that can provide disease-specific education, symptom monitoring, medication reminders and patient self-reported outcomes. The application was created for patients within the existing Stroke Care Model who are followed for 90 days post-acute. As the first organization to pilot EPIC Care Companion for acute stroke patients, we aimed to evaluate the feasibility of a mobile application and its impact on patient engagement. Methods: We developed stroke specific content for Care Companion including automated alert parameters. Patients were selected based on co-morbidities, willingness and ability to participate and access to a mobile device. Individualized content was electronically sent to the patient via mobile device notifications at predetermined intervals. Patients responded to questionnaires, and input individualized data including blood pressure readings, exercise logs, glucose levels, and nicotine consumption. Patients were able to contact all members of the care team and request assistance to manage risk factors. Participants completed a Likert scale impact survey at day 90. We compared total number of patient-nurse navigator interactions between Care Companion users versus non-users with a t-test. Results: Since January 2020, 406 patients were enrolled in the Stroke Care Model and completed 90 days of follow up. We enrolled 39 patients in the pilot. Patient reported impact surveys were returned in 25 out of 39 patients (64% response rate). Most patients reported that it was easy to enroll in Care Companion (100%) and complete assigned tasks (96%). Patients found the educational content useful (91%) and made lifestyle changes based on the information (90%). Patients enrolled in Care Companion had significantly more interactions with their care team compared to non-enrolled patients (6.6 ± 4.6 vs 3.1 ± 1.9), p<.0001. Conclusion: Implementation of Stroke Care Companion was feasible and increased patient engagement with the stroke care team.

Sparking the Discussion about Vaping and Anesthesia: Comment.

I agree with Drs. Feinstein and Katz that little is known about perioperative vaping.1 The authors refer to an outbreak of 53 cases of e-cigarette and vaping–related lung injury, in which 84% of the cases admitted to the use of tetrahydrocannabinol products. The remaining 16% may have concealed the use of an illegal product, or not known what they were using. In those cases of e-cigarette and vaping–related lung injury where bronchoalveolar lavage was performed, 100% of the specimens were positive for vitamin E acetate, a dangerous contaminant in tetrahydrocannabinol oil.2 This outbreak is troubling but it is unrelated to the use of legal nicotine-based vaping products.They also refer to a letter that raises the hypothetical possibility that an anxious preoperative patient might vape “lavishly” to the point of nicotine intoxication, which could destabilize the cardiovascular system.3 However, they do not report any such cases.Vaping does not involve inhaling smoke, and it is tobacco-free. (Vaping supplies are legally categorized as “tobacco products” only because they may contain nicotine, usually derived from tobacco.) Public Health England estimates that the risk from vaping is unlikely to be more than 5% of the risk of smoking.4 In assessing the perioperative risks of vaping, anesthesiologists should be aware that vape may contain no nicotine, or it may contain an amount that produces similar blood nicotine levels to cigarette smoke. Vape does not contain carbon monoxide, and the levels of other toxins are 82 to 99% lower than in tobacco smoke.5Preoperatively, anesthesiologists should ask patients about smoking, vaping, and the use of cannabis and illegal drugs. Current vapers may have quit smoking but still suffer residual ill health due to their previous tobacco use. There is evidence that smokers benefit from switching to nicotine replacement therapy 6 to 8 weeks before surgery. Vaping can be considered a form of nicotine replacement therapy and therefore may be beneficial for smokers undergoing surgery. Patients who are addicted to nicotine, either from smoking or from vaping, should be offered nicotine replacement therapy while they are confined to a “No Smoking/No Vaping” area such as a hospital.E-cigarettes were patented in 2004, and there are now 42 million vapers globally, but I have been unable to find any reports of anesthesia complications due to vaping. Research is needed so that we can base our discussion of the risks of perioperative vaping on real data rather than supposition.The author declares no competing interests.

Validation of a nicotine vapor self-administration model in rats with relevance to electronic cigarette use.

The debate about electronic cigarettes is dividing healthcare professionals, policymakers, manufacturers, and communities. A key limitation in our understanding of the cause and consequences of vaping is the lack of animal models of nicotine vapor self-administration. Here, we developed a novel model of voluntary electronic cigarette use in rats using operant behavior. We found that rats voluntarily exposed themselves to nicotine vapor to the point of reaching blood nicotine levels that are similar to humans. The level of responding on the active (nicotine) lever was similar to the inactive (air) lever and lower than the active lever that was associated with vehicle (polypropylene glycol/glycerol) vapor, suggesting low positive reinforcing effects and low nicotine vapor discrimination. Lever pressing behavior with nicotine vapor was pharmacologically prevented by the α4β2 nicotinic acetylcholine receptor partial agonist and α7 receptor full agonist varenicline in rats that self-administered nicotine but not vehicle vapor. Moreover, 3 weeks of daily (1 h) nicotine vapor self-administration produced addiction-like behaviors, including somatic signs of withdrawal, allodynia, anxiety-like behavior, and relapse-like behavior after 3 weeks of abstinence. Finally, 3 weeks of daily (1 h) nicotine vapor self-administration produced cardiopulmonary abnormalities and changes in α4, α3, and β2 nicotinic acetylcholine receptor subunit mRNA levels in the nucleus accumbens and medial prefrontal cortex. These findings validate a novel animal model of nicotine vapor self-administration in rodents with relevance to electronic cigarette use in humans and highlight the potential addictive properties and harmful effects of chronic nicotine vapor self-administration.

Electrochemical determination of nicotine in smokers’ sweat

In this work, we report the demonstration of the capability of electrochemical sensors to provide measurements directly on the sweat of volunteers to successfully discriminate heavy smokers by light ones. Since its importance as pharmaceutical treatment-agent for nicotine replacement therapy for purposes of tobacco cessation, and since that is the key compound for the development of reduced-risk cigarettes by tobacco industry, nicotine is one of those markers that are of interest for monitoring in human sweat. Especially in therapies for purposes of smoking cessation, easy methods for an easy measure of nicotine on the patients is highly required for a fine adjustment of the nicotine dosage as release, e.g., by through therapeutic patches. Therefore, we have checked the use of a simple, inexpensive and very sensitive electrochemical sensor for quantification of nicotine in smokers’ sweat. Proposed sensor is capable for fast, label-free and pretreatment-free detection of nicotine in human sweat as collected directly from the skin of heavy and light smokers. Our finding demonstrates as we can detect nicotine from human skin with sweat-collecting patches thanks to its lower detection limit (0.59 µM) as compared to the physiological limit of nicotine in human blood (12.33 µM), while keeping under control the selectivity with respect various interfering compounds find in sweat too.

The electrochemical sensor based on graphene oxide nanosheets decorated by gold nanoparticles and polythiophene for nicotine sensing in biological samples and cigarette

A glassy carbon electrode (GCE) modified with graphene oxide (GO), Au nanoparticle, and polythiophene (PT) nanocomposites that were decorated by Au nanoparticles, (GO-4-ATP-Au-PT/Au) was prepared. Square wave voltammetry (SWV) revealed an accurate peak current at the potential of + 0.81 V versus Ag/AgCl. Under optimized experimental conditions, there is a linear relationship between peak current and nicotine concentration in the range from 1.00 × 10–6 to 3.00 × 10–5 mol L−1, and the detection limit is 1.7 × 10–7 mol mL−1. The GO-4-ATP-Au-PT/Au GCE was successfully used for the analysis of nicotine in cigarettes, serum blood, and urine samples and presented recoveries between 96.0 and 100.6%.

Nicotine Absorption Profile Among Regular Users of a Pod-Based Electronic Nicotine Delivery System

JUUL is a popular electronic nicotine delivery system (ENDS)1 that contains a liquid with a high nicotine concentration (59 mg/mL). While there are concerns about the rapid increase in use of this potentially addictive product,2 there are no independent published data, to our knowledge, on its blood nicotine absorption profile. This case series aimed to characterize nicotine absorption among regular adult users of this product and to evaluate subjective effects associated with use.