Smoking Load Research Articles

Smoking cessation and atherosclerotic cardiovascular events and mortality in chronic kidney disease.

Smoking cessation is recommended to reduce excess atherosclerotic cardiovascular disease (ASCVD) and mortality in patients with chronic kidney disease (CKD). However, this recommendation is largely based on observational studies on the general population Therefore, we aimed to evaluate the association of smoking dose and smoking cessation duration with ASCVD and mortality in patients with CKD. We compiled a comprehensive pooled dataset comprising 66 245 participants with CKD from the KNOW-CKD and the UK Biobank cohort. Additionally, we included 307 353 participants without CKD from the UK Biobank cohort. Participants were categorized according to smoking dose and duration of smoking cessation base on a questionnaire. The primary outcome was a composite of ASCVD events or all-cause mortality. Over a median follow-up period of 13.2 years, 14 671 (22.1%) participants reached the primary outcome. In the pooled CKD cohort, compared to never smokers, former and current smokers exhibited a 1.30- and 2.14-fold higher risk of the primary outcome, respectively. Among former smokers, the hazard ratios (HRs) (95% confidence intervals [CIs]) for smoking loads<20 and≥20 pack-years were 1.05 (1.00-1.10) and 2.14 (2.05-2.25), respectively. The increased risk of the primary outcome was attenuated by longer smoking cessation. The HRs (95% CIs) for smoking cessation of<10 years, 10-20 years, and≥20 years were 1.75 (1.65-1.86), 1.43 (1.34-1.52), and 1.11 (1.06-1.16), respectively, compared with never smokers. This association was also observed in individuals without CKD, but the risk was comparable between former smokers with smoking cessation≥20 years and non-smokers, suggesting that a longer cessation is required in patients with CKD to offset the smoking-related adverse effects. Among former smokers with CKD, the risk of ASCVD or mortality was substantially attenuated with less smoking load and a longer duration of smoking cessation.

#1164 Smoking cessation and atherosclerotic cardiovascular events and mortality in chronic kidney disease

Abstract Background and Aims Smoking cessation is recommended to reduce excess atherosclerotic cardiovascular disease (ASCVD) and mortality in patients with chronic kidney disease (CKD). However, this recommendation is largely based on observational studies on the general population, involving participants with preserved kidney function. Therefore, we aimed to evaluate the association of smoking dose and smoking cessation duration with ASCVD and mortality in patients with CKD. Method We compiled a comprehensive pooled dataset comprising 66,245 participants with CKD from the KNOW-CKD and the UK Biobank cohort. Participants were categorized according to smoking dose and duration of smoking cessation base on a questionnaire. The primary outcome encompassed a composite of ASCVD or all-cause mortality. An ASCVD event was defined according to the ICD-10 codes in the claim and death register records. Results Over a median follow-up period of 13.2 years, 14,671 (22.1%) participants reached the primary outcome. Compared to never smokers, former and current smokers exhibited a 1.30- and 2.14-fold higher risk of the primary outcome, respectively. Among former smokers, the hazard ratios (HRs) (95% confidence intervals [CIs]) for smoking loads &amp;lt;20 and ≥20 pack-years were 1.05 (1.00–1.10) and 2.14 (2.05–2.25), respectively. The increased risk of the primary outcome was attenuated by longer smoking cessation. The HRs (95% CIs) for smoking cessation of &amp;lt;10 years, 10–20 years, and &amp;gt;20 years were 1.75 (1.65–1.86), 1.43 (1.34–1.52), and 1.11 (1.06-1.16), respectively, compared with never smokers. Conclusion Among former smokers with CKD, the risk of ASCVD or mortality was substantially attenuated with less smoking load and a longer duration of smoking cessation. Our findings support the preexisting recommendations for smoking cessation to improve clinical outcomes in patients with CKD.

Profile of malnourished COPD patients: A comparative study

Introduction: Malnutrition is frequently associated with chronic obstructive pulmonary disease (COPD) especially in severe stages. It is correlated with a poor prognosis. The aim of this study was to determine malnutrition prevalence in COPD patients and to compare the profile of malnourished COPD versus not-malnourished COPD patients. Patients and methods: Stable COPD patients benefited from nutritional evaluation by measuring body mass index (BMI). Subsequently, a comparative study was used to compare disease severity, number of acute exacerbations, modified Medical Research Council (mMRC) dyspnea scale score and exercise capacity by the 6 min walk test (6MWT) between malnourished and not malnourished COPD patients. Results: 175 COPD patients were recruited (9F; 166M) aged between 40 and 86 with an average age of 67.95 years. The mean smoke load of the patients was 35(20) packs/year, FEV1: 52(21) % pred, m MRC dyspnea scale: 2 (1). 41.14% of COPD patients were malnourished (BMI &lt; 20 Kg/m2). Two groups were individualized. · Group A: COPD with BMI &lt; 20 Kg/m2:72 patients, (4F; 68M), age: 67(9) years, FEV1: 48.5(21.44) % pred. · Group B: COPD with BMI≥ 20 Kg/m2: 103 patients, (5F, 98M), age: 68(9) years, FEV1: 55.25(21.42) % pred. Using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, the functional stages found in group A patients were GOLD I: 12%, GOLD II: 23%, GOLD III: 42%, GOLD IV: 23%. While for group B were GOLD I:25% GOLD II%:35%, GOLD III:28%, GOLD IV:12%. 72% of group A patients have an m MRC ≥ 2 Vs 63% of group B. 77.8% of group A patients have a history of hospitalization for at least one acute exacerbation in the last 12-month vs 63.1% of Group B patients. The 6-min walk average distance (6MWD) was 423.58 m in Group A vs 438.33 m in Group B. Conclusion: Nutritional assessment and appropriate management of undernutrition should be integrated into the treatment of COPD patients.

Inflammation Is a Histological Characteristic of Skeletal Muscle in Chronic Limb Threatening Ischemia

The loss of skeletal muscle is a prognostic factor in several diseases including in patients with chronic limb threatening ischemia (CLTI). Patients with CLTI also have a lower skeletal mass and area when compared to those with claudication. However, there are no currently available data regarding the histological characteristics of core muscles in patients with CLTI. This study aims to determine the differences in core skeletal muscles between patients with claudication and those with CLTI. The second aim is to evaluate the differences in myokines, which are molecules secreted by skeletal muscle, between patients with claudication and those with CLTI. An observational, prospective study was conducted from January 2018 to July 2022 involving consecutive patients with peripheral arterial disease (PAD). The clinical characteristics were registered. In PAD patients with surgical indication for common femoral artery approach, samples of sartorius skeletal muscle (and not from the limb muscles directly involved in the ischemic process) were collected. The samples were submitted to histological characterization on hematoxylin-eosin and to immunohistochemical analysis to detect CD45+ leukocytes and CD163+ macrophages. The extent of the inflammatory cells (leukocytes and macrophages) was semiquantitatively assessed using a 0-to-4 grade scale as follows: absent (0†), mild (†), moderate (††), severe (†††), and very severe (††††). Serum levels of myokines: irisin, myostatin, IL-8, and lL-6 were determined with multiplex bead-based immunoassay. 119 patients (mean age: 67.58±9.60years old, 79.80% males) 64 with claudication and 54 with CLTI were enrolled in the study. No differences were registered between patients with claudication and those with CLTI on age, gender, cardiovascular risk factors, and medication, except on smoking habits. There was a significantly higher prevalence of smokers and a higher smoking load in the claudication group. Samples of sartorius skeletal muscle from 40 patients (14 with claudication and 26 with CLTI) were submitted to histological analysis. No differences were found in skeletal muscle fibers preservation, trauma, or hemorrhage (on hematoxylin-eosin staining). However, in the immunohistochemistry study, we found more inflammatory cells CD45+ leukocytes in patients with CLTI when compared to those with claudication [CD45+≥moderate (††): claudication (n=14): 4; 28.57%; CLTI (n=25): 16; 64.00%; P=0.034]. Patients with CLTI also had higher tissue levels of CD163+ macrophages, but this difference was not significant [CD163+≥moderate (††): claudication (n=13): 7; 53.85%; CLTI (n=27): 21; 77.78%; P=0.122]. The serum levels of the myokines, irisin, and myostatin were below the lower limit of detection, in the majority of patients, so no valid results were obtained. However, patients with CLTI had a higher serum level of Interleukin (IL)-6 and IL-8. CLTI patients exhibit increased quantities of leukocytes in their sartorius muscle, as well as elevated serum levels of myokines IL-8 and IL-6. Inflamed skeletal muscle can contribute to the loss of muscle mass and account for the lower density of skeletal muscle observed in CLTI. Additionally, inflamed skeletal muscle may contribute to the development of systemic inflammation through the secretion of pro-inflammatory cytokines into the systemic circulation. Halting the inflammatory process could eventually improve the prognosis of CLTI patients.

The Affects of Smoking on Cataract Formation in Turkish Patients

Aims: To investigate whether smoking influences cataract formation age and cataract type in patients who underwent senile cataract surgery.&#x0D; Study Design: Retrospective cross-sectional.&#x0D; Place and Duration of Study: The study was conducted in the Department Of Ophthalmology, Ahi Evran Faculty Of Medicine between November 2014 and March 2018.&#x0D; Methodology: Five hundred eighty-one patients were included, who were operated on for senile cataracts. Age, gender, cataract type, and smoking status of patients were recorded. Congenital, traumatic, drug-induced, and uveitic cataracts were excluded from the study. The smoking status of patients was divided into three groups: currently smoking, never smoking, quitted smoking. The smoking load of patients was calculated as packages/year.&#x0D; Results: Of total of 581 patients, 47.8% (278) were female and 52.2% (303) were male and the mean ages were 66.68 ± 10.68 years and 66.17 ± 9.37 years, respectively. There was an association between gender and smoking status (p&lt;0.05). Smoking rate (both currently smoking and quit smoking) was higher among males. The mean age of cataract patients who were smokers was statistically lower than the mean ages of non-smokers and quitters (p &lt;0.001). There was a statistical association between cataract type of patients and smoking status (p=0.0152). This resulted from a lower incidence of cortical cataracts and higher incidence of posterior subcapsular and nuclear cataracts in smokers. Among these three groups, cortical cataract was the most frequent in the non-smoker group. It was found that smoking increases the posterior subcapsular cataract, but it has less effect on cortical cataract formation.&#x0D; Conclusion: Smoking causes cataract formation in younger ages and higher posterior subcapsular cataract rate. We suggest that this finding may prevent beginning of smoking and increase the motivation of individuals to quit smoking.

Lung Cancer Screening: Low-Dose Thoracic Computed Tomography Performed in a High-Risk Portuguese Population.

The Urgeiriça mines were once the main uranium producer in Portugal. The aim of this study was to estimate the benefit of low-dose chest computed tomography (LDCT) for lung cancer screening in former miners that were considered as being at high-risk. A subgroup of former miners of the Uranium National Company exposed to uranium and with a smoking load greater than 20 pack-years, agreed to perform a LDCT. The Fleischner Society Guidelines were used to classify the nodules and establish follow-up. Initially, 265 former employees of the Uranium National Company were included. The mean time of employment was 15 (0 - 45) years. The non-smokers represented 50.9% and 30.2% were ever smokers; the remaining chose not to respond. One diagnosis of lung cancer was initially made. In the second phase, a subgroup of 66 former miner underwent a LDCT, 37 of whom presented pulmonary nodules. Most computed tomography (CT) scans revealed one single nodule (n = 13) and the mean size was 5 (1 - 16) mm. A suspicious 16 mm spiculated nodule was evaluated with PET/CT, and percutaneous and surgical biopsies, ultimately revealing a benign lesion. The data highlights the importance of lung cancer screening in high-risk populations. This was, to the best of our knowledge, the first study performed in Portugal and can act as a bridge towards a wider implementation in the country.

Satellite observations of smoke–cloud–radiation interactions over the Amazon rainforest

Abstract. The Amazon rainforest routinely experiences intense and long-lived biomass burning events that result in smoke plumes that cover vast regions. The spatial and temporal extent of the plumes and the complex pathways through which they interact with the atmosphere have proved challenging to measure for purposes of gaining a representative understanding of smoke impacts on the Amazonian atmosphere. In this study, we use multiple collocated satellite sensors on board AQUA and TERRA platforms to study the underlying smoke–cloud–radiation interactions during the diurnal cycle. An 18-year time series for both morning and afternoon overpasses is constructed, providing collocated measurements of aerosol optical depth (AOD; column-integrated aerosol extinction), cloud properties, top-of-atmosphere radiative fluxes, precipitation, and column water vapour content from independent sources. The long-term time series reduces the impact of interannual variability and provides robust evidence that smoke significantly modifies the Amazonian atmosphere. Low loadings of smoke (AOD ≤ 0.4) enhance convective activity, cloudiness, and precipitation, but higher loadings (AOD &gt; 0.4) strongly suppress afternoon convection and promote low-level cloud occurrence. Accumulated precipitation increases with convective activity but remains elevated under high smoke loadings, suggesting fewer but more intense convective cells. Contrasting morning and afternoon cloud responses to smoke are observed, in line with recent simulations. Observations of top-of-atmosphere radiative fluxes support the findings and show that the response of low-level cloud properties and cirrus coverage to smoke results in a pronounced and consistent increase in top-of-atmosphere outgoing radiation (cooling) of up to 50 W m−2 for an AOD perturbation of +1.0. The results demonstrate that smoke strongly modifies the atmosphere over the Amazon via widespread changes to the cloud field properties. Rapid adjustments work alongside instantaneous radiative effects to drive a stronger cooling effect from smoke than previously thought, whilst contrasting morning and afternoon responses of liquid and ice water paths highlight a potential method for constraining aerosol impacts on climate. Increased drought susceptibility, land use change, and deforestation will have important and widespread impacts on the region over the coming decades. Based on this analysis, we anticipate that further increases in anthropogenic fire activity will associated with an overall reduction in regional precipitation and a negative forcing (cooling) on the Earth's energy budget.

Association of Multiple Cardiovascular Risk Factors with Musculoskeletal Function in Acute Coronary Syndrome Ward Inpatients.

This study explored the association of multiple risk factors with musculoskeletal function in adults hospitalized for acute coronary syndrome. Sixty-nine inpatients (55 ± 6 years; 67% male) admitted to the cardiology ward within <12 h were assessed regarding stress, smoking, alcoholism, hypertension, diabetes mellitus, and obesity. The musculoskeletal function was assessed by predicted values of handgrip strength of the dominant hand (HGS-D%) and maximal inspiratory and expiratory pressures (MIP% and MEP%, respectively). After adjustment by age and sex, drinking habits showed the strongest linear association with the total number of cardiovascular disease risk factors [standardized ß, p-value] (ß = 0.110, p < 0.001), followed by smoking load (ß = 0.028, p = 0.009). Associations were also observed for HGS-D% with mean blood pressure (ß = 0.019 [0.001; 0.037], p = 0.048); MIP% with mean blood pressure (ß = 0.025 [0.006; 0.043], p = 0.013); and MEP% with drinking habits (ß = 0.009 [0.002; 0.016], p = 0.013) and body mass index (ß = 0.008 [0.000; 0.015], p = 0.035). Peripheral and respiratory muscle strength must be interpreted in the context of its association with cardiovascular disease risk factors in adults hospitalized for acute coronary syndrome.

Smoking Induces the Circulating Levels of Matrix Metalloproteinase-9 and Its Association with Cardiovascular Risk in Young Smokers

Smoking causes cardiovascular risk, which may alter the stability between the production and degradation of the extracellular matrix. Matrix metalloproteinase-9 (MMP-9) is a zinc-containing endopeptidase that degrades the extracellular matrix and is involved in tissue remodelling and several physiological processes. As a result, smoking-induced elevated serum MMP-9 levels, particularly at a younger age, raise the risk of coronary heart disease (CHD). Thus, this study aimed to determine the possible relationship between smoking-induced circulating MMP-9 and the risk of cardiovascular disease in young smokers. In this cross-sectional study, the patients were divided into three groups. Each group contains 120 study participants. Group one consisted of 120 healthy individuals with no physical and mental illness, group two consisted of 120 active smokers with a heart disease, and group three consisted of 120 active smokers with a heart disease and diabetes, who attended Sri Ramaswamy Memorial Hospital for cardiology checkup at the age of 20-55 years. The serum MMP-9, high-sensitivity C-reactive protein (hs-CRP), and apolipoprotein-E (APO-E) levels were analyzed using the ELISA method, and the lipid levels were measured enzymatically using AU480 automatic analyzer (Beckman Coulter). Compared with non-smokers, the study shows that the mean serum MMP-9, hs-CRP, and APO-E levels were significantly higher in smokers (p<0.001). A strong relationship was also found between MMP-9 and hs-CRP, APO-E, smoking load, and smoking intensity. A significant association was found between cigarette smoking with MMP-9, and relative exposure to circulating inflammation markers plays a potential role in the pathogenesis of CHD.

Bronchiectasis associated with severe COPD: Clinical, functional, microbiological and tomographic features.

Bronchiectasis is frequently identified in patients with COPD, especially in severe patients, but the relevance of this finding remains unclear. We aimed to investigate the factors that would increase the chance of having bronchiectasis in patients with severe COPD. This is an analytical, observational, cross-sectional study. Patients with severe COPD with (BC group) and without bronchiectasis (NBC group) were clinically evaluated and performed spirometry, 6-minute walk test (6MWT), volumetric capnography (VCap) and high resolution computed tomography (CT). CT was scored for the findings, and multiple linear regression was performed to identify variables related to the score's severity and logistic regression in order to identify factors that could be associated with the presence of bronchiectasis. There was no significant difference between BC and NBC groups regarding clinical variables, except in the smoking load, which was lower in the BC group. In functional evaluation, NBC patients walked shorter distances in 6MWT (P < 0.005). In the BC group the distribution of CT findings was mostly bilateral and in lower lobes. Using the multiple linear regression analysis within the BC group, we found that the higher the bronchiectasis score, the higher ΔSpO2 during the 6MWT and the lower the FVC. The chance of having bronchiectasis was 4.78 times higher in the presence of positive isolates (sputum) (CI 1.35-16.865; P = 0.023). The higher the distance covered (6MWT) and Slp3 (VCap), (OR 1.01, CI 1.004; 1.0202, P = 0.0036; OR 1.04, CI 1.003; 1.077; P = 0.036), the greater are likelihood of bronchiectasis. In patients with COPD and bronchiectasis, higher CT scores were associated with worse lung function and a greater drop in oxygenation during exercise.

Smoking cessation after coronary angiography and percutaneous coronary intervention.

Smoking is a crucial modifiable risk factor for coronary artery disease. However, effective support in smoking cessation (SC) and data regarding factors related to SC are still inadequate. We aimed to assess SC rates and factors related to effective SC in patients after coronary angiography (CA). Patients who underwent CA between 2014 and 2018 at a single center in Poland were screened for active smoking. After at least 6 months after the procedure, the patients were contacted by telephone to obtain information about their current smoking status and history of smoking during the follow‑up. A total of 3719 consecutive patients were screened. Of these, 921 (24.8%) declared active smoking. At least 6 months after CA, 241 patients were available for a follow‑up interview. The mean (SD) age of the patients was 61.2 (9.3) years, 168 (69.7%) were men, and 115 (47.7%) had acute coronary syndrome. The mean (SD) duration of hospitalization was 6 (4.4) days, and 67 patients (27.8%) were scheduled for a second‑stage procedure. A total of 80 patients (33.2%) declared SC at the 6‑month follow‑up. The multivariable logistic regression analysis indicated that duration of hospitalization equal to or greater than 4 days (odds ratio [OR], 3.62; 95% CI, 1.9-6.89), the Fagerström score equal to or lower than 4 points (OR, 1.96; 95% CI, 1.01-3.79), a scheduled second hospitalization (OR, 2.54; 95% CI, 1.32-4.86), and a smoking load greater than or equal to 51 pack‑years (OR, 2.28; 95% CI, 1.16-4.47) increased the chance of SC. A substantial number of patients who underwent CA were current smokers, with low SC rates in the follow‑up. A prolonged hospital stay, scheduled second hospitalization, low nicotine dependence but also a high load of pack‑years increased the chances of SC, which underscores the need for intensive and repetitive in‑hospital counseling in the whole population of smokers.

Role of Cigarette Smoking on Serum Angiotensin-Converting Enzyme and Its Association With Inflammation and Lipid Peroxidation.

IntroductionCigarette smoking promotes angiotensin-converting enzyme (ACE) production and causes a substantial change in inflammation and oxidative stress, resulting in an increase in antioxidant activity and lipid peroxidation.ObjectiveThe study's goal is to determine the role of cigarette smoking on serum ACE and its relation with inflammatory markers and lipid peroxidation.MethodsThe cross-sectional study consists of three groups. The study participants are all men between the age group of 20 to 55 years. Group 1 includes 120 healthy controls as nonsmokers, Group 2 consists of 120 active smokers with coronary heart disease (CHD) and Group 3 includes 120 active smokers with diabetic CHD patients attending the SRM Medical College Hospital in Tamil Nadu for cardiology and medical Outpatient. Measurements of serum ACE, oxidized low-density lipoprotein (oxLDL), high-sensitivity C-reactive protein (hsCRP), and matrix metalloprotease-9 (MMP-9) were performed using the ELISA method (enzyme-linked immunosorbent assay). Using a spectrophotometric approach, the total antioxidant capacity and lipid peroxidation, particularly Malondialdehyde (MDA), were assessed.ResultsThe mean serum ACE (92.35±10.28), oxLDL (48.59±8.56), hs-CRP (5.87±1.62), MMP-9 (89.20±30.19), and MDA (1.146±0.198) levels were significantly (p-value <0.0001) higher in smokers with CHD and diabetes (group 3) when compared to group 1 and group 2. On the other hand, the total antioxidant capacity (0.413±0.097) of smokers of group 3 was found to be (p<0.0001) significantly lower than those of group 1 and group 2. The study also demonstrated a significant correlation between ACE with MDA, ox-LDL, total antioxidant capacity, hs-CRP, MMP-9, smoking load, and smoking intensity in smokers.ConclusionThe study concludes a substantial correlation exists in smokers owing to ACE modification, which results in inflammation and lipid peroxidation activation. This is strongly associated with an increased risk of major cardiovascular events.

Influence of smoke aerosols on low-level clouds over the Indian region during winter

The effect of smoke aerosols on the low-level clouds over the Indian landmass during the winter season is examined using 15 years (2005–2019) of long-term multi-satellite observations and reanalyses (MERRA-2 and ERA-5) datasets. Climatologically higher values of aerosol optical depth (AOD) (> 0.6), Angstrom exponent (> 1.5), UV-aerosol index (> 0.7), and black carbon and organic carbon (BC + OC) extinction aerosol optical thickness (EXTAOT) (> 0.18) are found over the Indo-Gangetic Plain (IGP) compared to the rest of India indicating the dominance of smoke aerosols over the region. However, considerable enhancements in AOD (~ 60%) and (BC + OC) EXTAOT (20–40%) are observed over some parts of eastern India (particularly Odisha and Chhattisgarh) and central-south India compared to IGP (< 10% and < 5% respectively) in the recent years. Also, fire activities are increasing over almost the same region where smoke aerosols increased considerably, suggesting a significant role of local biomass burning (BB) in the observed rise of smoke aerosols. However, prevailing wind patterns and HYSPLIT backward air mass trajectories indicate that long-range transport from the upper IGP regions and northwestern sides of India and beyond could also increase smoke loading over this region. Climatologically, distinct spatial patterns with moderate cloud fraction (CF) (0.5–0.6) and comparatively larger liquid cloud effective radius (CER) (16–17 μm) are found over the IGP region. This study suggests that mainly low-level clouds contribute to this distinct signature of cloud distributions. However, a significant increase in CF (50–60%) is observed over almost the same region where smoke aerosols showed a considerable rise, implying the possible influence of smoke aerosols on the low-level clouds. While CF and CER showed a noticeable increase in the polluted condition, cloud optical thickness and liquid cloud water path showed a consequent decrease with increased aerosol loading. CALIPSO images suggest that mostly a mixture of dust, polluted dust, and polluted continental/smoke aerosols showed clear dominance over the inland areas, mostly confined within 2 km altitude over almost the entire study domain. However, an elevated layer of absorbing aerosols (smoke and polluted dust) over the low-level cloud increased the cloud fraction through the ‘aerosol-cloud-boundary layer’ feedback mechanism.

Smoking cessation programme in hospitalised patients due to acute respiratory disease.

Hospital environment is generally propitious to smoking cessation for several reasons, such as a legal ban on smoking in hospital facilities, greater vulnerability facing acute illness and the continuous contact with healthcare professionals. To evaluate the effectiveness of intensive smoking cessation intervention during hospital admission due to acute respiratory disease and a 6-month follow up after hospital discharge. This prospective study included patients admitted at our Pulmonology Department due to acute respiratory disease - active smokers who consented to participate in smoking cessation counselling programme - between January and December 2019. After hospital discharge, the patients completed a 6-month follow up. Statistical analysis was performed with spss system version 24.0, using univariate analysis with Chi-squared and t-test. We included 30 patients, 86.7% male, with a mean age of 58.6 ± 13.6 years. The mean length of stay was 10 ± 11 days. The mean smoking time was 40.3 ± 14.4 years and the mean smoking load 40 ± 26 pack-year units. The mean level of nicotine dependence, measured by the Fagerström test, was 4.3 ± 2.8. None of the patients accepted smoking cessation pharmacological therapy. After hospital discharge, 19 patients were seen in consultation, 11 of whom maintained smoking cessation at 6 months, determining an overall smoking cessation rate of 36.7%. There was a statistically significant difference in the smoking cessation successful group regarding the motivation to quit smoking and the Richmond test compared to the unsuccessful group. Smoking cessation counselling behaviour programmes during hospitalisation, with regular follow up after hospital discharge, contribute to an increase in smoking cessation rate.

Optimization of Operational Method to improve sustainable Energy Efficiency of Auxiliaries in a CFBC coal fired Boiler- Result Analysis

The research paper provides details of the sultry dihydrogen monoxide heating system for power consumption such as aliment pump, victual pump motor, control valves etc; withal, details cognate to the test of the subsisting system power utilizing the 3-element mode method to control the drum level. Includes details about the sundry energy test equipment used during the potency test to quantify the sundry parameters such as flow, head, power haste, temperature and vibration. This study was conducted with the avail of 2 boiler and turbine engineers and 3 operators where there is an inch switch. During the study of the parameter sundry parameters were accumulated and designations were accumulated and the calculation was predicated on brake vigor and pressure disunion. In order to calculate it is consequential that one situation is sometimes engendered under the circumstances of each task. In cases of full volume, the drum pressure is customarily kg/cm2 above the maximum pressure. This denotes that when the total smoke load maximum pressure is ninety kg/cm2, then the corresponding drum pressure will be 100 kg/cm2. Ergo, while competitive calculations always engender the assurance that the pressure to aliment the victual in an economic rest area or aliment supply center is much more preponderant than the high pressure of the boiler drum suppleness for harmless operation.

Sunlight-absorbing aerosol amplifies the seasonal cycle in low-cloud fraction over the southeast Atlantic

Abstract. The mean altitude of the smoke loading over the southeast Atlantic moves from the boundary layer in July to the free troposphere by October. This study details the month-by-month changes in cloud properties and the large-scale environment as a function of the biomass burning aerosol loading at Ascension Island (8∘ S, 14.5∘ W) from July to October, based on island measurements, satellite retrievals, and reanalysis. In July and August, the smoke loading predominantly varies within the boundary layer. During both months, the low-cloud fraction is less and is increasingly cumuliform when more smoke is present, with the exception of a late morning boundary layer deepening that encourages a short-lived cloud development. The meteorology varies little, suggesting aerosol–cloud interactions explain the cloudiness changes. September marks a transition month during which midlatitude disturbances can intrude into the Atlantic subtropics, constraining the free tropospheric aerosol closer to the African coast. Stronger boundary layer winds on cleaner days help deepen, dry, and cool much of the marine boundary layer compared to that on days with high smoke loadings, with stratocumulus reducing everywhere but at the northern deck edge. The September free troposphere is better mixed on smoky days compared to October. Longwave cooling rates, generated by a sharp water vapor gradient at the aerosol layer top, encourage a small-scale vertical mixing that could help maintain the well-mixed smoky September free troposphere. The October meteorology primarily varies as a function of the strength of the free tropospheric winds advecting aerosol offshore. The free tropospheric aerosol loading is less than in September, and the moisture variability is greater. Low-level clouds increase and are more stratiform in October when the smoke loadings are higher. The increased free tropospheric moisture can help sustain the clouds through a reduction in evaporative drying during cloud-top entrainment. Enhanced subsidence above the coastal upwelling region, increasing cloud droplet number concentrations, may further prolong cloud lifetime through microphysical interactions. Reduced subsidence underneath stronger free tropospheric winds at Ascension Island supports slightly higher cloud tops during smokier conditions. Overall, the monthly changes in the large-scale aerosol and moisture vertical structure act to amplify the seasonal cycle in low-cloud amount and morphology. This is climatically important, as cloudiness changes dominate changes in the top-of-atmosphere radiation budget.

57-OR: Predictive Role of Atherosclerosis Biomarkers on Carotid Plaque Extension in Type 2 Diabetes

Matrix metalloproteinases (MMP) and tumor necrosis factor receptor superfamily members have been recently proposed as surrogate markers of atherosclerosis in the general population. The aim of this study was to examine their predictive role in type 2 diabetes (T2D). Plasma levels of MMP-12, MMP-7, CD40 and its ligand (CD40-L) were measured by Proximity Extension Assay in a well-characterized cohort of 1,144 patients with carotid atherosclerosis from the SUMMIT study (age= 69 [64 - 75], males 66.7%, T2D 66.5%). Carotid plaque area was measured by plaque contours using the ultrasound trace function. The associations were adjusted for age, sex, waist, hypertension, history of cardiovascular diseases (CVD), smoke load, plasma triglycerides, LDL-cholesterol (LDL-c) and HDL-cholesterol (HDL-c), and serum creatinine levels. All measured biomarkers were associated with carotid plaque area, independently of potential confounders, with CD40 showing the strongest effect and MMP12 showing a significant interaction with T2D. In subgroup analyses, the effect of MMP-12 and MMP-7 remained significant only in T2D, while the effect of CD40 and CD40-L was similar in both subgroups. This study demonstrates the ability of MMP-12, MMP-7, CD40, and CD40-L in predicting carotid atherosclerotic burden in a population at high cardiovascular risk and identifies MMP-12 as a specific biomarker for T2D. Disclosure S. Leonetti: None. D. Trico: None. I. Goncalves: None. A. Shore: None. F. Khan: None. J. Nilsson: None. A. Natali: None. Funding Innovative Medicines Initiative (IMI-2008/115006)

Smoking Cessation and Coronary Artery Calcification in CKD.

Smoking is associated with vascular calcification and a higher risk of cardiovascular disease. In this study, we investigated the association of smoking dose and cessation with coronary artery calcification (CAC) in patients with CKD. From a nationwide, prospective cohort of Korean patients with CKD, 1914 participants were included. Prevalent CAC was defined as an Agatston score >0, using computed tomography. CAC progression was defined as ≥30%/yr increase in Agatston score at the 4-year follow-up examination in patients with baseline CAC. Prevalent CAC was observed in 952 (50%) patients. Compared with never smokers, former smokers had a similar prevalence ratio for CAC, but current smokers had a 1.25-fold higher prevalence ratio (95% confidence interval [95% CI], 1.10 to 1.42). Among former smokers, a lower smoking load of <10 pack-years (prevalence ratio, 0.77; 95% CI, 0.65 to 0.90) and longer duration of smoking cessation (prevalence ratio for 10 to <20 years, 0.85; 95% CI, 0.73 to 0.98: prevalence ratio for ≥20 years, 0.83; 95% CI, 0.73 to 0.96) were associated with lower risk of prevalent CAC compared with current smoking. The prevalence ratios did not differ between never smoking and long-term cessation. However, short-term cessation with heavy smoking load was associated with a higher risk of prevalent CAC (prevalence ratio, 1.21; 95% CI, 1.03 to 1.40) compared with never smoking. CAC progression was observed in 111 (33%) patients with baseline CAC. Compared with never smokers, former smokers showed a similar risk of CAC progression, but current smokers had a higher risk (relative risk, 1.92; 95% CI, 1.30 to 2.86). In CKD, former smoking with a lower smoking load and long-term cessation were associated with a lower risk of prevalent CAC than current smoking. CAC progression was more pronounced in current smokers.

Smoking cessation after coronary angiography

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education Background Smoking cessation is crucial for risk reduction among patients with coronary artery disease (CAD). Effective support in smoking cessation (SC) and data regarding factors related to SC are still a matter of concern. Purpose To assess SC rates and factors related to effective smoking cessation in patients after coronary angiography (CA) Methods Patients scheduled to CA between 01.2014 and 11.2018 were screened for active smoking. Patients were contacted by phone after at least 6 months after procedure and investigated about current smoking, history of smoking and nicotine dependence. Results 3719 consecutive patients were screened, overall 921 (24.8%) patients declared active smoking within the last month before CA. 241 patients were contacted and questionnaired after at least 6 months. The mean age of patients was 61.2 ± 9.3, 168 (69.7%) patients were men, 115 (47,7%) patients had acute coronary syndrome (ACS). Mean hospitalization time was 6 ± 4.4 days, 67 (27.8%) patients were scheduled for the second stage procedure. 80 (33.2%) patients declared SC during follow-up. In multivariate logistic regression analysis hospitalization time ≥4 days (OR 3.62; 95% CI 1.9-6.89), Fagerstrome score ≤4 (OR 1.96; 95%CI 1.01-3.79), scheduled second hospitalization (OR 2.54; 95%CI 1.32-4.86), and unexpectedly smoking load with ≥51 pack-years (OR 2.28; 95%CI 1.16-4.47) increased the chance of SC. Conclusion Substantial group of patients scheduled to CA are current smokers. Self-reported SC rates after procedure are higher than in general population but still reasonably low. Prolonged in-hospital stay and repeated hospitalization increase chances for smoking cessation as well as low measured nicotine dependence. Paradoxically high load of packing-years also increase the chances of SC which may support repetitive attempts to SC in this group of patients.

The Impact of Lifetime Alcohol and Cigarette Smoking Loads on Amyotrophic Lateral Sclerosis Progression: A Cross-Sectional Study.

Background—Amyotrophic lateral sclerosis (ALS) is a devastating and untreatable motor neuron disease; smoking and alcohol drinking may impact its progression rate. Objective—To ascertain the influence of smoking and alcohol consumption on ALS progression rates. Methods—Cross-sectional multicenter study, including 241 consecutive patients (145 males); mean age at onset was 59.9 ± 11.8 years. Cigarette smoking and alcohol consumption data were collected at recruitment through a validated questionnaire. Patients were categorized into three groups according to ΔFS (derived from the ALS Functional Rating Scale-Revised and disease duration from onset): slow (n = 81), intermediate (80), and fast progressors (80). Results—Current smokers accounted for 44 (18.3%) of the participants, former smokers accounted for 10 (4.1%), and non-smokers accounted for 187 (77.6%). The age of ALS onset was lower in current smokers than non-smokers, and the ΔFS was slightly, although not significantly, higher for smokers of >14 cigarettes/day. Current alcohol drinkers accounted for 147 (61.0%) of the participants, former drinkers accounted for 5 (2.1%), and non-drinkers accounted for 89 (36.9%). The log(ΔFS) was weakly correlated only with the duration of alcohol consumption (p = 0.028), but not with the mean number of drinks/day or the drink-years. Conclusions: This cross-sectional multicenter study suggested a possible minor role for smoking in worsening disease progression. A possible interaction with alcohol drinking was suggested.