Positive Smoking History Research Articles

Neurofibromatosis and Esophageal Adenocarcinoma: A Single Case Study

Purpose: Introduction: Neurofibromatosis type-1, also known as von Recklinghausen's disease, is a common autosomal dominant condition manifesting in approximately one in 3000 births. It is well documented that neoplasms arise in up to 25 percent of these patients and are typically of neural-crest origin, including carcinoids, neurofibromas, and gangliomas. However, the occurrence of neurofibromatosis with esophageal adenocarcinoma is exceedingly rare and has not been documented in over twenty years. Case Report: We present a unique case of neurofibromatosis type-I and esophageal adenocarcinoma in a 62-year-old Caucasian male admitted with a three-month history of nausea, vomiting, and seventy-pound weight loss. Risk factors include male gender and positive smoking history of a half a pack per day for forty years. Comorbidities included, but were not limited to pulmonary neurofibromas, emphysema, bilateral nonmalignant adrenal lesions, and hyperplastic thyroid nodules. On admission, CT scan of the abdomen showed distal esophageal thickening concerning for malignancy. EGD revealed a six-centimeter distal esophageal mass obstructing the lumen and extending into the gastroesophageal junction, 32cm from the incisors. The mass had a friable, ulcerated area that was biopsied. Histological findings confirmed moderately differentiated adenocarcinoma. The patient was not a surgical candidate so an esophageal stent and percutaneous endoscopic gastrostomy tube were placed. The patient endured a lengthy and complicated hospital course, culminating with death six weeks after admission. Discussion: Only one case report by Desigan et al from 1985 has documented the presence of esophageal adenocarcinoma in a patient with neurofibromatosis. The coexistence of these two entities is either exceedingly rare or significantly under-reported. Because of the increased incidence of malignancy (including esophageal) in this population, esophageal adenocarcinoma must be considered in the evaluation of nausea, vomiting, and weight loss in patients with neurofibromatosis.

P92 Predictive factors for early cardiac events following liver transplantation

IntroductionCoronary artery disease (CAD) is associated with increased short-term morbidity and mortality following liver transplantation. As a result, the AASLD recommends that all high risk individuals should undergo CAD evaluation...

Prenatal and Perinatal Complications: Is It the Link Between Race and SES and Childhood Sleep Disordered Breathing?

Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones. Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort. Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES. These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood.

Productive cough is an independent risk factor for the development of COPD in former smokers

The presence of productive cough was an independent risk factor for the development of COPD in Japanese men, particularly former smokers. Stage 0 disease, as defined in GOLD 2001 guidelines, is relevant for the identification of subjects at risk of developing COPD. It has yet to be determined whether the presence of productive cough is a risk factor for the development of COPD. The aim of the present study was to obtain more information on this potential association in Japanese men. Seven hundred and eighty-three men with normal spirometry who did not have respiratory disease were recruited. The subjects were divided into three groups: group A, non-smokers; group B, those with a positive smoking history without productive cough; and group C, those with a positive smoking history and productive cough. The incidence rates of COPD were compared among the three groups and the relative risks for the development of COPD were assessed. During the mean follow-up period of 33.6+/-20.4 months, 19 (2.4%) subjects developed COPD. The incidence rate of COPD was significantly higher in group C than in group B (10.1 vs 2.2%, P=0.003). A multivariate analysis of data for all subjects, current smokers and former smokers revealed that productive cough was an independent risk factor for the development of COPD in all subjects and former smokers but not in current smokers. Productive cough was an independent risk factor for the development of COPD in Japanese men. In particular, former smokers who complain of this symptom should be regarded as being at high risk for the development of COPD. The data suggested that stage 0 disease, as defined in the Global Initiative for Chronic Obstructive Lung Disease 2001 guidelines, is relevant for the identification of subjects at risk of developing COPD.

Adolescent Caffeine Use, ADHD, and Cigarette Smoking

The purpose of this study was to describe the prevalence of adolescent caffeine use and its association with attention deficit hyperactivity disorder (ADHD) and cigarette smoking. A total of 448 adolescents between the ages of 13 and 21 years consecutively presenting for routine, well-child care were studied. Twenty-four percent had a pre-existing diagnosis of ADHD, and 47% reported a positive lifetime history of cigarette smoking. Eighty-five percent of participants reportedly consumed a caffeinated beverage within the past 30 days; 38% had consumed 1+ cups of caffeinated coffee, and 78% had consumed 1+ glasses of another caffeinated beverage other than coffee (e.g., tea or soft drinks). After controlling for sociodemographic and other potential confounding factors, an ADHD diagnosis and a positive lifetime smoking history were significantly associated with caffeine use: Adolescents with ADHD were nearly twice as likely to use more caffeine than were adolescents without ADHD (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.23, 3.50, p = .006); lifetime smokers were 80% more likely to use more caffeine than were adolescents who had never smoked (OR = 1.80; 95% CI = 1.16, 2.79, p = .009). Caffeine use is elevated among adolescents diagnosed with ADHD and those who have ever tried cigarette smoking. Although caffeine is a non-illicit psychostimulant, these findings add to the emerging data on substance use behaviors among adolescents with ADHD. Health care professionals who work with adolescents with ADHD should regularly screen for both cigarette and caffeine use among their patients.

Hepatitis B core antibody in blood donor in sistan-balutuestan province of Iran

Safety of blood donor is an important issue for a recipient of blood so all blood donors are to screened for viral such as HBV, HCV, and HIV. Nevertheless, infections sometime occur by blood and its products. Because we haven't got any awareness about isolated Hbc Ab from a blood donor who presented of occults B hepatitis which can transmit infection to blood recipient, we decided to evaluate HbcAb in a blood donor in this province. This is a cross-sectional study on a blood donor in Sistan-Balutuestan province in southeast of Iran in 2010. All individuals referred for blood donation recruited to this. After consent demographic data was recorded from each case, 5 ml blood sample was drawn and centrifuged to separate out the serum and then HbsAb, HbcAb was assayed. Data analyzed by SPSS 16 and frequency, chi- square test, and Fisher exact test was used and if P > 0.05 it was accented as significant association. All individuals were men with age 55 10.5 years. The number of people who had free job was 149 (34.6%) and the number of people whose education level was diploma was 159 (36.9%). About 423 (98.1%) lived in urban areas. The mean weight of men was 76.6 13.7; about 259 (60.1%) men were married. A total of 22 (5.1%) had a positive smoking history. HBc Ab was positive in 87 (20.2%). Nearly all people had HBsAb titer more than 10 IU/L. This study showed that some of the blood donors had isolated HbcAb positive therefore we recommend HbcAb screening for blood donation.

Cigarette Smoking as a Risk Factor for Uveitis

To determine the association between tobacco smoking history and uveitis. Retrospective, case-control study. A total of 564 patients with ocular inflammation seen in the Proctor Foundation uveitis clinic between 2002 and 2009, and 564 randomly selected patients seen in the comprehensive eye clinic within the same time period. A retrospective medical record review of all cases and controls. A logistic regression analysis was conducted with ocular inflammation as the main outcome variable and smoking as the main predictor variable, while adjusting for age, gender, race, and median income. The odds of a smoker having ocular inflammation were 2.2-fold that of a patient who had never smoked (95% confidence interval [CI], 1.7-3.0; P<0.001). All anatomic subtypes of uveitis were associated with a positive smoking history, with odds ratios (ORs) of 1.7 (95% CI, 1.2-2.4; P = 0.002) for anterior uveitis, 2.7 (95% CI, 1.4-5.6; P = 0.005) for intermediate uveitis, 3.2 (95% CI, 1.3-7.9; P = 0.014) for posterior uveitis, and 3.9 (95% CI, 2.4-6.1; P<0.001) for panuveitis. In patients with panuveitis and cystoid macular edema (CME), the OR was 8.0 (95% CI, 3.3-19.5; P<0.001) compared with 3.1 (95% CI, 1.8-5.2; P<0.001) for patients without CME. Patients with intermediate uveitis and CME also had a higher OR (OR 8.4; 95% CI, 2.5-28.8; P = 0.001) compared with patients without CME (OR 1.5; 95% CI, 0.6-3.8; P = 0.342). Patients with a smoking history were at greater odds of having infectious uveitis (OR 4.5; 95% CI, 2.3-9.0; P<0.001) than noninfectious uveitis (OR 2.1; 95% CI, 1.6-2.8; P<0.001), although both were associated with smoking. A history of smoking is significantly associated with all anatomic subtypes of uveitis and infectious uveitis. The association was greater in patients with intermediate uveitis and panuveitis with CME compared with those without CME. In view of the known risks of smoking, these findings, if replicated, would give an additional reason to recommend smoking cessation in patients with uveitis.

Gender differences in abdominal aortic aneurysms.

Abdominal aortic aneurysms (AAAs) comprise the tenth leading cause of death in Caucasian males 65 to 74 years of age and accounted for nearly 16,000 deaths overall in 2000. Therefore, understanding the pathophysiology of AAAs is an important undertaking. Clinically, multiple risk factors are associated with the development of AAAs, including increasing age, positive smoking history, and hypertension. Male gender is also a well-established risk factor for the development of an AAA, with a 4:1 male to female ratio. The reason for this gender disparity is unknown. The pathogenesis of AAAs formation is complex and multifactorial. Histologically, AAAs are characterized by early chemokine-driven leukocyte infiltration into the aortic wall. Subsequent destruction of elastin and collagen in the media and adventitia ensues owing to excessive local production of matrix-degrading enzymes and is accompanied by smooth muscle cell loss and thinning of the aortic wall. At present, no medical therapies are available to treat patients with aortic aneurysms, using only the crude measurement of aortic diameter as a threshold for which patients must undergo life-threatening and costly surgery. Defining the early mechanisms underlying gender-related differences in AAA formation is critical as understanding differences in disease patterns based on gender may allow us to develop new translational approaches to the prevention and treatment of patients with aortic aneurysms.

The Joint Impact of Smoking and Exercise Capacity on Clinical Outcomes among Women with Suspected Myocardial Ischemia: The WISE Study

Although extensive research has been conducted on both smoking and low exercise capacity alone, few studies have examined the joint impact or interaction of these two risk factors. We examined the joint and interactive effects of smoking and self-reported exercise capacity on subsequent clinical events (heart failure, myocardial infarction [MI], stroke, and cardiovascular-related mortality) among women with suspected myocardial ischemia. At baseline (1996-1999), 789 women completed angiographic testing of coronary artery disease (CAD) severity and provided self-report information about their smoking history and exercise capacity as well as demographic and other risk factor data. Incidence of clinical events among the women was tracked for a median of 5.9 years; this analysis was conducted in 2008. In an adjusted survival analysis, women with a positive smoking history and self-reported low exercise capacity had the greatest risk of experiencing a clinical event (HR = 7.7, 95% CI 2.3, 25.5), followed by women with a positive smoking history and self-reported high exercise capacity (HR = 6.9, 95% CI 2.0, 24.6) and those with a negative smoking history and self-reported low exercise capacity (HR = 4.9, 95% CI 1.5, 15.8), relative to women with a negative smoking history and self-reported high exercise capacity. Additional analyses revealed a significant interaction between smoking history and exercise capacity, such that (1) women with a positive smoking history did not experience an additional significantly greater risk due to low exercise capacity, unlike those with a negative smoking history, and (2) all women experienced a significantly greater risk due to a positive smoking history regardless of their exercise capacity. Among women with suspected myocardial ischemia, the combined protective health effects of self-reported high exercise capacity and a negative smoking history remained significant after controlling for preexisting CAD severity and other established risk factors. These findings highlight the importance of studying behavioral risk factors in combination.

Association between CRHR1 polymorphism and improved lung function in response to inhaled corticosteroid in patients with COPD

Inhaled corticosteroids are used to treat COPD and asthma. An association between sequence variants in the corticotrophin-releasing hormone receptor 1 (CRHR1) gene and improved lung function in asthmatics treated with inhaled corticosteroids was reported recently. This study investigated the association between the change in lung function in response to inhaled corticosteroids and single-nucleotide CRHR1 polymorphisms in patients with COPD. COPD patients (n = 87) with a positive smoking history were recruited from the pulmonary clinics of 11 hospitals in Korea. Patients were treated with fluticasone propionate and salmeterol for 12 weeks and lung function was measured at baseline and after the 12-week treatment. Eighty-four of the 87 subjects were successfully genotyped. Seventy-one patients with the wild-type GG genotype and 13 patients with the heterozygous GT genotype in rs242 941 were evaluated. After 12-week treatment, the change in FEV(1) was significantly higher in patients with wild-type GG genotype (6.0 +/- 0.8% of predicted FEV(1)) than in GT heterozygotes (-0.8 +/- 1.8, P = 0.003). Improved FEV(1) following inhaled corticosteroid and a long-acting beta2-agonist was associated with CRHR1 genetic polymorphism in patients with COPD.

Prognostic Factors for Survival in Extensive Stage Small Cell Lung Cancer (ED-SCLC): The Importance of Smoking History, Socioeconomic and Marital Statuses, and Ethnicity

: We investigated whether independent prognostic factors for overall survival (OS) in non-small cell lung cancer such as ethnicity, smoking history, socioeconomic, and marital statuses are also applicable to extensive stage small cell lung cancer (ED-SCLC). : SCLC patients diagnosed from 1991 to 2005 from 3 Southern California counties were identified. Prognostic factors for ED-SCLC patients were evaluated by univariate and multivariate analysis. : Of the 4782 SCLC patients analyzed, only 2.5% of the patients were never-smokers and 71.7% of patients presented with ED-SCLC. By multivariate analysis, a positive smoking status was a statistically significant poor prognostic factor for OS in ED-SCLC patients (versus never-smoker; hazard ratio [HR] = 1.310; p = 0.0125), in addition low socioeconomic status (SES) (from the lowest to the highest SES score; ptrend = 0.0128) and being unmarried (versus married; HR = 1.179; p < 0.0001). Asian ethnicity was a favorable prognostic factor in ED-SCLC (versus Caucasian; HR = 0.785; p = 0.0076). Female gender was another independent favorable prognostic factor (versus male; HR = 0.823; p < 0.0001). : A positive history of smoking, low SES, and being unmarried are independent unfavorable prognostic factors for OS in ED-SCLC while Asian ethnicity and female gender are independent favorable prognostic factors for OS in ED-SCLC by multivariate analysis.

Screening for Small-Cell Lung Cancer: A Follow-Up Study of Patients With Lambert-Eaton Myasthenic Syndrome

A small-cell lung carcinoma (SCLC) is found in 50% of patients with Lambert-Eaton myasthenic syndrome (LEMS). We evaluated screening to optimize screening strategy for SCLC. It is important to detect these tumors early in newly diagnosed patients with LEMS to offer optimal patient treatment. A large nationwide cohort study of consecutive patients in the Netherlands, seen between 1990 and 2007, were screened for the presence of a tumor using chest x-ray, computed tomography of the thorax (CT-thorax), [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET), bronchoscopy, and/or mediastinoscopy. SCLC was found in 54 patients, and in 46 patients, no tumor was found during a median follow-up of 8 years (range, 3 to 26 years). All patients with SCLC had a positive smoking history and 86% were still smoking at diagnosis. SCLC was found in 92% of these patients within 3 months and in 96% within a year. At first screening, CT-thorax detected an SCLC in 45 patients (83%), whereas chest x-ray found the tumor in only 23 patients (51%). An SCLC was found during secondary screening in another nine patients (median, 3 months; range, 1 to 41 months). In six patients, a lung tumor was found by CT-thorax or FDG-PET, and in three patients, extrapulmonary metastases were found, initially without identifiable tumor mass on CT-thorax. In almost all patients (96%), the SCLC was found within 1 year of diagnosis. CT-thorax scans detected most of the tumors (93%) and was far more sensitive than chest x-ray (51%). FDG-PET may have additive value in selected cases. We propose a screening protocol based on CT-thorax and FDG-PET.

Never-smokers with a positive family smoking history are more likely to be overweight or obese than never-smokers with a negative family smoking history

To shed light on the complex relationship between smoking and body weight, we used never-smokers stratified on family smoking history to model the effects of a diathesis for smoking on body weight without the potential confound of metabolic changes or decreased physical activity caused by chronic tobacco smoke exposure. Participants were 100 family history negative never-smokers (FH−; 2 never-smoking parents) and 71 family history positive never-smokers (FH+; 2 ever-smoking parents). Controlling for significant group differences in race and age, BMI was significantly higher in FH+ (26.7 ± .6) than in FH− (24.5 ± .4; F = 10.351 p < .01). Further analysis using logistic regression showed that FH+ were 2.7 times as likely to be overweight/obese (BMI ≥ 25; 95% C.I. 1.398–5.351; p < .01). FH+ scored significantly higher on the Dieting and Bingeing Severity Scale than FH− and were significantly more likely to score in the severe or at-risk range. FH+ drank significantly more alcohol than FH−; they scored significantly higher on the CAGE and on the Michigan Alcohol Screening Test. Our analyses provide support for the role of inherited and/or environmentally-driven tendencies towards disinhibited eating and/or risky behaviors in general in the observed differences in BMI. No group differences in BMI or likelihood of being overweight/obese emerged based on prenatal exposure to nicotine in FH+ smokers, although our sample was too small to rule out an association. Further research in larger samples, using more complex statistical models, will be needed to disentangle these issues and identify causal pathways.

Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus

Objectives In a large retrospective study, the association of smoking with human papillomavirus (HPV) genotype and vaginal intraepithelial neoplasia (VAIN) grade was analyzed. Methods A SNOMED search was performed for vaginal biopsy or resection specimens diagnosed as VAIN over an 11-year period. The diagnosis of VAIN grade was confirmed by histological review. HPV genotype was determined by GP5+/6+ PCR and dot blot hybridization with type-specific oligonucleotide probes. Smoking history was obtained by chart review. Statistical analysis was performed using the chi-square test. Results We identified specimens from 111 patients (age range 15–84); 64% ( n = 71) were diagnosed with high-grade VAIN (HGVAIN) and 36% ( n = 40) with low-grade VAIN (LGVAIN). High-risk (HR) HPV genotypes were identified in 83% of specimens ( n = 92), other types in 17% ( n = 19). Twenty-one different HPV genotypes were detected in total. Smoking history was available for 81% ( n = 90). Forty-one percent ( n = 37) had a positive smoking history. There was no significant difference in infection with HR vs. other types ( p = 0.92) among smokers when compared to non-smokers. In patients with HR HPV genotypes, smokers were at an increased risk for HGVAIN lesions when compared to patients who had never smoked (83% vs. 59%, p = 0.02). Conclusions These data indicate an increased risk for HGVAIN in HR HPV positive women who smoke compared to HR HPV positive non-smokers.

Smoking habits among cancer survivors

20699 Background: Smoking is a known risk factor for cancer, such as lung, head and neck. Studies showed that smoking can adversely affects outcome of different treatment modalities of cancer including radiation and chemotherapy treatment. Our current study examines the smoking habits among cancer survivors in an attempt to create a successful smoking cessation intervention. Methods: An observational cohort study was done by sending a questionnaire to randomly selected 1,000 patients who were diagnosed with cancer between 2003 and 2007 in our cancer center. Data were analyzed by SPSS (v15) to determine the likelihood of quitting smoking when patients were diagnosed with cancer. The likelihood of having a house-hold smoker was assessed. Patients were also surveyed about the best option to help quit smoking. Results: We received 187 responses of 1,000 surveys (18.7%). Of these, 166 were eligible for analysis. The mean age of patients was 63.9 years ± 13.1. Males were more likely than females to be past smokers (55.2% of males and 31.6% of females, respectively, p=0.003). There were 87/166 respondents who reported positive smoking history. There were 34 patients who were diagnosed with cancer while smoking. Only 15/34 (44%) reported quitting smoking after diagnosis with cancer, while 19/34 (56%) continued to smoke. Only 21/34 (61.8%) reports that they were informed of the dangers of smoking during cancer treatment. Also 47% of current smokers reported having a house-hold smoker. Unfortunately 15% of non-smokers are exposed to second-hand smokers at home. Among 5 different options, patients preferred ‘lifestyle change program’ or ‘individual counseling program’ to help quit smoking. Conclusions: Our data shows that more than half of smoking cancer patients continued to smoke after cancer diagnosis. Only about 60% of smoking cancer patients were told to quit by their doctors. Peer influence was evident in those who continued to smoke. Ideal intervention program for those patients could be either ‘lifestyle change program‘ or ‘individual counseling program’. However, further non-randomized prospective trial would best answer this question. No significant financial relationships to disclose.

Impact of smoking on pemphigus

A positive history of smoking is less common in patients with pemphigus than in healthy subjects. The aim of this case-control study was to compare the remission rate and clinical locations involved in smokers and nonsmokers with pemphigus vulgaris. Seventy patients with pemphigus vulgaris, treated with a uniform protocol, were enrolled. The sites of involvement, average time needed for disease control, and number of relapses were compared in smokers and nonsmokers. At the end of the first and second years of treatment, the rate of remission was compared in the two groups. Ten of the patients were current cigarette smokers, but the other 60 (85.7%) had no history of smoking. There was no difference in the rate of cutaneous or mucosal involvement between smokers and nonsmokers. The predominant subtype was the mucocutaneous type in both groups. Smokers with pemphigus vulgaris achieved partial remission more frequently than nonsmokers at the end of the first year of treatment. The number of patients in remission at the end of the second year of therapy was significantly higher for smokers with pemphigus than for nonsmokers. The main reason for disease activity in both groups was recurrence. Cigarette smoking may not affect the rate of cutaneous or mucosal involvement in pemphigus; however, the data indicate that remission may be achieved sooner in pemphigus patients who smoke.

Plasma DNA, Microsatellite Alterations, and p53 Tumor Mutations Are Associated with Disease-Free Survival in Radically Resected Non-small Cell Lung Cancer Patients: A Study of the Perugia Multidisciplinary Team for Thoracic Oncology

This prospective study examined association between circulating plasma DNA, microsatellite alterations (MA), p53 mutations with time to relapse and survival in surgically treated non-small cell lung cancer (NSCLC) patients (pts). Plasma samples, adjacent lung tissue, and lung tumor tissue specimens were collected from consecutive patients with stage I-III NSCLC. Blood samples of 66 matched healthy donors with positive smoking history were collected as controls. The plasma DNA amount was determined by real-time PCR. The analysis of MA at loci D3S1300, D3S1289, D3S1266, and D3S2338 on chromosome 3p was performed by radiolabeled PCR. p53 Mutations (exons 5, 6, 7, and 8) were detected by PCR-single-strand conformational polymorphism assay. There were 76 patients, 65 men; median age was 68 years (range, 42-86), 20 had stage I, 40 stage II, and 16 stage III, the majority of pts (48.7%) had squamous-cell histology. Sixty-nine (91%) were smokers and most had good Eastern Cooperative Oncology Group performance status (0/1:72/4). Mean circulating DNA of all pts was 60 ng/ml versus 5 ng/ml in smoker-matched controls (p < 0.0001). In pts without recurrence, mean circulating DNA was 48.5 ng/ml at baseline, 32.8 ng/ml at 3 month, and 20.6 ng/ml at 12 month after surgery. In pts with recurrence, mean circulating DNA at baseline was 97.1 ng/ml. At 3 month after surgery, mean DNA concentration was significantly lower in disease-free pts than in patients with recurrent disease (32.8 versus 292.7 ng/ml; p = 0.0016). MA in at least one locus was found in 39.5% of NSCLC tumors. p53 Genomic mutations were observed in 54.0% of tumor samples. Statistically significant associations were observed between MA and squamous-cell histotype (p = 0.007) and between p53 mutations and lymph node involvement (p = 0.012). MA and p53 mutations were found to be significantly associated with recurrence of disease (p = 0.033 and 0.026, respectively). Our results suggest that MA and p53 mutations in tumor DNA have a potential prognostic role for disease recurrence in NSCLC patients, and elevated levels of plasma circulating DNA identify patients with possible systemic disease at diagnosis. This might be proposed as an early detection test of disease recurrence.

Cardiovascular Disease, Chronic Kidney Disease, and Type 2 Diabetes Mellitus

<h3>Background</h3> Cardiac involvement is an uncommonly seen but might be a fatal clinical manifestation of Behcet’s syndrome (BS), if not recognized early and treated aggressively. <h3>Objectives</h3> Our aim was to retrospectively evaluate the characteristics of cardiac involvement in Behcet’s syndrome and investigate possible risk factors. <h3>Methods</h3> 800 patients with BS diagnosis according to International Study Group for Behcet’s Disease (ISG) criterias in our center were screened. 14 patients with cardiac involvement were included in this study. <h3>Results</h3> All the patients were male with positive smoking history. The age at the onset cardiac involvement was 32.5 ± 7.8 years. In 3 patients, diagnosis of BS was made simultaneously with cardiac involvement. Types of cardiac involvement were as following; intracardiac thrombosis (ICT) in 8, right coronary artery aneurysm in 2, and myocardial infarction in 4 patients. The majority of ICT was seen in right ventricle followed by right atrium (75% vs 25%). Deep vein thrombosis (DVT) was the most common accompanying other vascular involvement (57%).Thrombophilic factors were studied in 8 patients, whom only 2 cases were found positive for heterozygous factor V Leiden mutation. Cyclophosphamide was the most common used immunosuppressive agent and anticoagulation was used in 9 patients (Table 1). <h3>Conclusion</h3> Most common type of cardiac involvement is pericarditis, whereas intracardiac thrombosis has its unique characteristics (1). Male gender and smoking seems to be major significant risk factors. <h3>References</h3> [1]Wang H, Guo X, Tian Z, Liu Y, Wang Q, Li M, Zeng X, Fang Q (2016) Intracardiac thrombus in patients with Behcet’s disease: clinical correlates, imaging features, and outcome: a retrospective, single-center experience. Clinical Rheumatology 35(10):2501–2507 <h3>Disclosure of Interests</h3> None declared

Genetic Polymorphism of Glutathione S-transferase T1, M1 and Asthma, A Meta-analysis of the Literature

Published studies have confirming or refusing an association between either glutathione S-transferase T1 (GSTT1) or M1 (GSTM1) polymorphism and asthma risk. Therefore the present meta-analysis was done. Literature-based meta-analysis was supplemented by tabular data from investigators of all relevant studies of two GST polymorphism (GSTM1 and GSTT1) available before May 2006, with investigation of potential sources of heterogeneity. Included in the resent study were 14 studies, involving a total 2292 asthma patients and 5718 controls. We found substantial evidence of heterogeneity between the studies. Exclusion of two studies with lowest quality scores resulted in a dramatic decrease in heterogeneity. The overall OR of the asthma risk associated with GSTM1 null genotype was 1.20 (95% CI: 1.08-1.35). Stratifying the meta-analysis by age and smoking status of subjects, the pooled ORs for GSTM1 null genotype were 1.56 (95% CI: 1.25-1.94) in adults and 1.95 (95% CI: 1.21-3.13) in non-smokers. The GSTT1 null genotype was associated with asthma risk in non-smoker adults (OR = 2.06, 95% CI: 1.21-3.71). To investigate whether profile of GST genotypes are associated with the risk of the asthma, further analysis combining the GSTT1 and GSTM1 genotypes were also carried out. Subjects with null genotypes for both GSTM1 and GSTT1 were at a significant higher risk for developing asthma (OR = 2.15, 95% CI: 1.39-3.33) compared with subjects who had both active genes. The trend in risk associated with zero, one and two putative high-risk genotypes was significant (chi2 = 12.07, df= 1, p = 0.0005). Overall, our present meta-analysis revealed that the null genotypes of GSTM1 and GSTT1 are associated with risk of asthma in adults especially in non-smoker ones. It might be suggested that chronic smoking carries such a high dose of toxins into the body that overloads the capacity of either GSTM1 or GSTT1 detoxification system. It seems that the GSTM1 and GSTT1 lack their protective values against development of asthma in adults with positive history of smoking. Present results also suggested that there is an additive effect for GSTT1 and GSTM1 genotypes.

Abstract 1528: Gender Differences In The Effect Of Traditional Cardiac Risk Factors On Age At Presentation With Stemi

For coronary artery disease (CAD), female gender is ’protective’, so that women typically present with clinically apparent CAD a decade later than men. We examined the extent to which traditional cardiovascular risk factor influence the age at presentation with STEMI in men and women. The Cardiovascular Patient Outcomes Research Team (C-PORT) primary PCI registry includes 7197 patients (5070 males and 2109 females) who presented with STEMI at 33 participating hospitals. The table below depicts the average age at presentation with STEMI in males and females with and without diabetes, hypercholesterolemia, hypertension, a family history of coronary artery disease and smoking history (current or former). The effect of smoking, family history and hypertension on age at presentation remained significant in multivariate analysis in both men and women. In both males and females, a family history of CAD and a positive smoking history are associated with presentation with STEMI at a younger age. Both have a greater effect in females. This is particularly true of smoking with lowers the age of presentation by 9 years in women, compared with 3.8 years in men. Male and female patients with a history of hypertension are older at presentation with STEMI, perhaps because the anti-ischemic effects of anti-hypertensive medications. We conclude that while the effect of most traditional risk factors for CAD on age at presentation with STEMI are similar in men and women, smoking lowers the age at presentation to a much greater degree in women. In women who do not smoke, STEMI is delayed for a decade or more compared to men; for women who do, the protective effect of female gender is nearly obliterated.