Smoking Patients Research Articles

Exploring Genomic Biomarkers for Pembrolizumab Response: A Real-World Approach and Patient Similarity Network Analysis Reveal DNA Response and Repair Gene Mutations as a Signature

Purpose: Single-agent immune checkpoint inhibitor (IO) therapy is the standard for non-oncogene-addicted advanced non-small cell lung cancer (aNSCLC) with PD-L1 tumor proportion score ≥ 50%. Smoking-induced harm generates high tumor mutation burden (H-TMB) in smoking patients (S-pts), while never-smoking patients (NS-pts) typically have low TMB (L-TMB) and are unresponsive to IO. However, the molecular characterization of NS-pts with H-TMB remains unclear. Experimental design: Clinical data of 142 aNSCLC patients with PD-L1 ≥ 50% treated with first line pembrolizumab were retrospectively collected. Next-generation sequencing was performed using the FoundationOne®CDx assay to correlate genomic alterations with clinical characteristics and response outcomes. Detected mutations were classified into eleven main pathways and enrichment analysis identified patient subgroups based on mutated pathways. Additionally, a patient similarity network was constructed to analyze molecular characterization. Results were validated using data from 853 aNSCLC patients in POPLAR and OAK trials. Results: Among the patients, S-pts had higher TMB than NS-pts. Interestingly, 11 (8%) NS-pts exhibited H-TMB and were enriched in β-catenin/Wnt and DDR pathway mutations. DDR pathway mutations were confirmed to be enriched in NS-pts with H-TMB using data from POPLAR and OAK trials. In the real-world cohort, the NS/H-TMB subgroup with DDR pathway mutations demonstrated improved IO outcome. Patient similarity network analysis confirmed the clustering of NS/H-TMB patients with DDR mutations and their association with improved overall survival in both the real-world cohort and the trials. Conclusions: The DDR signature has a potential role as an additional generator of H-TMB in NS-pts. This subgroup of IO-responsive NS-pts may have better prognosis. Our findings suggest that DDR-based mutational profiling may help identify NS-pts who could benefit from IO therapy.

Assessing the Effectiveness of A-PRF+ for Treating Periodontal Defects: A Prospective Interventional Pilot Study Involving Smokers.

Background and Objectives: This study aimed to evaluate the effects of advanced platelet-rich fibrin (A-PRF+) tissue regeneration therapy on clinical periodontal parameters in non-smokers and smoker patients. The anticipated biological mechanisms of A-PRF+ include stimulating angiogenesis, thereby promoting the formation of new blood vessels, which is essential for tissue healing. Additionally, A-PRF+ harnesses the regenerative properties of platelet-rich fibrin, contributing to the repair and regeneration of periodontal tissues. Materials and Methods: The study was conducted on 55 patients, divided into two groups: non-smoker patients (n = 29) and smoker patients (n = 26). A single operator conducted the surgical procedure. Following the administration of local anesthesia with articaine 4% with adrenaline 1:100,000 precise intracrevicular incisions were made, extending towards the adjacent teeth, until the interproximal spaces, with meticulous attention to conserving the interdental gingival tissue to the greatest extent possible. Extended, full-thickness vestibular and oral flaps were carefully lifted, and all granulation tissue was meticulously removed from the defect without altering the bone contour. After debridement of the defects, A-PRF+ was applied. BOP (bleeding on probing), PI (plaque index), CAL (clinical attachment loss), and probing depth (PD) were determined at baseline and six months post-surgery. Results: Significant reductions were observed in PD and CAL after six months. In the non-smokers group, PD decreased from 7.0 ± 1.0 mm to 3.1 ± 0.1 mm (p < 0.001), while in the smokers group, PD decreased from 6.9 ± 1.1 mm to 3.9 ± 0.3 mm (p < 0.001). CAL decreased in the non-smokers group from 5.8 ± 0.7 mm to 2.6 ± 0.2 mm and from 5.7 ± 0.9 mm to 3.2 ± 0.2 mm (p < 0.001) in smokers. Notably, the reductions in CAL and PD were statistically more significant in the non-smokers group. Conclusions: Even though the clinical periodontal improvements were considerable in smoker patients, they did not reach the level observed in non-smoker patients.

EL HÁBITO DE FUMAR Y SU INFLUENCIA EN LA CONSOLIDACIÓN ÓSEA: UNA REVISIÓN INTEGRADORA

Smoking is considered one of the risk factors for various diseases, not only related to the respiratory system but also influencing the physiological processes of various organs and body systems. This article aims to deepen the understanding of the effects of smoking on bone healing by analyzing its molecular, cellular, and clinical bases. This process is subject to possible direct or indirect interferences from chemical substances such as nicotine. It is important to note that, besides conventional cigarettes, there is also indiscriminate use of electronic cigarettes, which, according to an analysis conducted by Pérez and Duarte (2022), have considerably higher nicotine levels than traditional cigarettes. Another study conducted by González et al. (2021) highlights the increasing popularity of these devices among young people, underscoring the importance of preventive measures. According to the National Institute of Traumatology and Orthopedics (INTO), inhaling tobacco smoke increases bone tissue healing time by 60%, thus delaying the body's ability to heal injuries and compromising bone absorption. The clinical repercussions of smoking on the quality and speed of bone recovery after fractures and orthopedic procedures are identified to improve understanding and develop specific clinical strategies and interventions for smoking patients. The specific objectives of this research were to: investigate the molecular and cellular mechanisms of the bone healing process, analyze the effects of smoking on the quality of the formed tissue, evaluate the influence of smoking on the bone healing time in patients after fracture or orthopedic surgery, and finally propose therapeutic strategies and preventive measures to improve bone healing. To this end, a bibliographic search was conducted on articles relevant to the topic using various means. The selection of articles was based on three stages, choosing those that met the inclusion criteria. During the development of this article, it is observed that smoking is an extended and ancestral practice, being a constant and emerging health problem. Additionally, it is considered a modifiable risk factor for decreasing bone density. In conclusion, the need for specific strategies to address complications in bone healing in smoking patients is highlighted.

Abstract 4116300: Valvular Abnormalities and Risk of Abdominal Aortic Aneurysm Associated with Fluoroquinolone Use; A Retrospective Cohort Study

Introduction: Fluoroquinolones (FQ) are efficacious antibiotics whose antimicrobial effect is achieved through bacterial DNA gyrase inhibition. However, there is evidence suggesting that FQ may cause impaired collagen synthesis and an increase in tissue collagen degradation. Collagen serves as a predominant structural constituent of the aortic wall and heart valves. These structures undergo tissue maintenance, which necessitates the regulated expression of MMPs and TGF-β. In this study, we hypothesized that prolonged usage of FQs may increase risk of valvular abnormalities and abdominal aortic aneurysm. Methods: We conducted a retrospective cohort study utilizing de-identified patient data from the TriNetX platform, an extensive electronic health records (EHR) system. The cohorts consisted of smoker patients who used FQs for more than two consecutive weeks, Cohort A, N= 352,215 and smoker patients without a history of FQ use, Cohort B, N=350,912. Propensity score matching balanced baseline characteristics between cohorts: age, sex, ethnicity, and comorbidities. Results: The risk of developing AAA among smokers with a history of FQ use was 1.222% while the risk was 0.806% among smokers without history of FQ use (P&lt; 0.0001, 95% CI (0.63,0.691), Risk Ratio (RR)= 0.66). The risk of developing nonrheumatic (NR) aortic insufficiency among smokers with history of FQ use was 1.479% while smokers with no history of fluoroquinolone use had a 0.95% risk (P&lt;&lt;0.0001, 95% CI (0.616,0.67), RR= 0.643). The risk of developing NR mitral insufficiency in smokers with history of FQ use was 3.873% versus their smoker FQ naive counterparts risk of 2.317% (P&lt; 0.0001, 95% CI (0.582,0.615), RR= 0.598). NR tricuspid insufficiency in smokers with FQ usage was also increased versus their smoker FQ naive counterparts at 3.089% and 1.758%, respectively (P&lt; 0.0001, 95% CI (0.552,0.587), RR =0.569). Conclusions: This study uncovered a significant association between FQ use, risk of AAA, and NR-valvular insufficiencies among smokers. In particular, male smokers are at highest risk of developing AAA. This same population is at risk for prostatitis that would likely need treatment with FQs, further increasing their risk. Despite the efficacy of this class of antibiotics, caution is paramount when prescribing FQs in individuals who are actively smoking or have any connective tissue pathologies.

Evaluation of the Tobacco Heating System (THS) During Closed Lower Limb Fracture Healing in Trauma Smokers’ Patients

BACKGROUND: Since 1976, it's been recognized that increased cigarette consumption correlates with decreased bone density, hindering fracture healing and leading to prolonged hospitalization. Although prior research has shown the relatively less harmful effects of electronic nicotine delivery systems (ENDS) on bone cells in lab settings and animal models, clinical evidence regarding their impact on fracture healing remains scarce. This study aims to investigate whether switching to a tobacco heating system (THS) post-orthopedic surgery improves outcomes for smoking patients during tibia or femur fracture healing over a 6-month period. METHODS: The study is a prospective, open-label, non-parallel, single-center trial involving 150 patients from a Level 1 Trauma center, Germany, diagnosed and treated for closed tibia, closed femur shaft, or closed distal femur fractures (according to AO/OTA: 41A2-41C3, 42A-C, 43A-C, 32A-C, 33A2-3, 33B-C). Participants will be categorized into three groups based on smoking behavior: smokers (no intervention), THS (participants switching from cigarettes to THS), and ex-smokers (participants abstaining from cigarettes or ENDS during the study). Clinical, radiological, and laboratory data will be collected during preoperative and postoperative assessments at 6, 12, 18, and 24 weeks. The primary outcome will be the serum concentration of N-terminal propeptide procollagen type 1, a bone formation marker. Secondary outcomes include bone metabolism, healing, immunological, blood count, and clinical parameters. Approval for the study protocol and consent declarations was obtained from the ethics committee of the medical faculty of Eberhard Karls University (724/2022BO1). DISCUSSION: The study results will provide evidence that switching to THS previous orthopedic intervention improves clinical outcomes during closed tibia or femur fracture healing in smokers’ patients due to reduced bone resorption rate consequent to the diminished activity of cigarette smoke-activated osteoclast.

Comparison between Smokers and Non-Smokers receiving Non-Surgical Periodontal Therapy in Male Patients at Rehman Medical Institute, Peshawar

Background: Periodontal disease, a chronic inflammatory ailment, significantly impacts dental stability. Smoking has been identified as a critical risk factor, exacerbating periodontal disease severity and impeding treatment efficacy.Objective: To compare gingival health of non-surgical periodontal therapy between smokers and non-smokers, measuring specific outcomes such as plaque index reduction, bleeding on probing, and clinical attachment level improvements. Materials and Methods: This observational cohort study was carried over six-month duration. A total of 133 male subjects, aged 32- to 51-years, with chronic periodontitis were recruited. They were divided into smokers (n=65) and non-smokers (n=68). The major criterion for selection of both cohorts was a history of cigarette smoking. The study was conducted in three phases: baseline periodontal evaluations and follow-up evaluations at three and six months. Periodontal status was evaluated by measuring critical indicators of periodontal health: the presence of dental plaque, calculus, and gingival bleeding on probing and reduction in clinical attachment levels. Results: Non-smoker experienced a reduction in the plaque index from 2.1 ± 0.5 at baseline to 1.6 ± 0.3 at 6 months, p--0.005. However, smokers 2.4 ± 0.6 to 2.0 ± 0.4 experienced, if verified using this penultimate way it is p-0.018. Similarly, the bleeding index in non-smokers dropped from 2.9±0.6 down to 2.3 ± 0.3 (p-0.005), while smokers experienced this change 3.2±0.7 to 2.7±0.5 (p=0.018). Moreover, loss of attachment became better in non-smokers averaged 3.2±0.7 mm before and 2.7±0.5 mm after treatment (p-0.005), On the other hand an improvement was made while this could only be seen by smoking patients. Conclusion: Smoking significantly impedes the efficacy of non-surgical periodontal therapy. The findings reinforce the need for smoking cessation to enhance treatment outcomes in periodontitis patients.Keywords: Bleeding Index, Loss of Attachment, Non-Surgical Periodontal Therapy, Non-Smokers, Periodontal Disease, Plaque Index, Smoking.

Shared lung and joint T cell repertoire in early rheumatoid arthritis driven by cigarette smoking

ObjectivesSmoking has been associated with an increased risk of developing rheumatoid arthritis (RA) in individuals carrying shared epitope (SE) HLA-DRB1 alleles. Yet, little is known about the regional and systemic...

An exploration of attitudes regarding the use of a state tobacco Quitline for smoking cessation among low-income adults with a history of smoking.

Smoking rates among low-income smokers are significantly elevated. State tobacco quitlines offer free and evidence-based treatments for smokers living in that state. This study investigated knowledge, attitudes, and beliefs associated with engagement with the Illinois Tobacco Quitline among confirmed smoking patients at a Federally Qualified Health Center (FQHC). Further goals were to obtain recommendations for strategies to improve patient awareness and engagement. Data for this study were collected from August to October 2021 from patients receiving care in an FQHC in a large midwestern city in the USA. Clinic-based recruitment was used to enroll a sample of adult current smokers. In-depth interviews and brief surveys were completed with a volunteer sample of patients recruited from an FQHC. The interviews took approximately 60 minutes. Data analysis used descriptive statistics to summarize the responses to the study and deductive thematic analysis to analyze the qualitative interviews. Study participants (n=25) were primarily male, African American, and middle-aged (mean age: 52.5 years). The majority were daily smokers. Over half had heard about the Quitline from sources such as radio advertisements, but usage was low. Barriers to use included low motivation to quit, questions about effectiveness, and poor success with prior Quitline attempts. Participants described factors that would increase the appeal of the Quitline, including testimonials, personalization, and an empathetic approach. Participants were asked about the acceptability of receiving information about the Quitline via patient portals, and most were in support. Interventions are needed to raise awareness and utilization of Quitlines among patients receiving care in FQHC settings. Distribution of Quitline information via patient portals is an acceptable strategy for increasing awareness of services.

Long-Term Clinical Outcomes of Polymer-Free Sirolimus-Eluting Stent and Polymer-Coated Sirolimus-Eluting Stent in Patients with Type 2 Diabetes.

Polymer-free sirolimus-eluting stent (PF-SES) possess multiple properties improving targeted drug elution and in-stent reendothelialization without the presence of polymers. The long-term clinical performance comparison between PF-SES and the latest generation polymer-coated sirolimus-eluting stents (SES), particularly regarding intravascular imaging assessment and in the type 2 diabetes mellitus (DM) population, remains unexplored. We conducted a retrospective study involving 2646 diabetes patients meeting coronary artery disease (CAD) criteria underwent coronary stents in the real-world. All patients were divided into the PF-SES group and the SES group. Optical coherence tomography (OCT) was used to evaluate the imaging characteristics of in-stent reendothelialization. Patient information between the two groups was systematically compared in hospital and at 5-year follow-up. In terms of basic characteristics, the proportion of current smoker and stable angina patients in the PF-SES group was significantly higher than that in the SES group. The PF-SES group exhibited significantly higher rate of left anterior descending (LAD) lesion and more stents per patients compared to the SES group. The value of minimum lumen area (MLA), neointimal area (NA) and neointimal thickness (NT) were higher in the PF-SES group. Additionally, the occurrence rates of heterogeneous, lipid layer, intimal tears, thrombi, and micro-vessels were notably lower in the PF-SES group compared to the SES group. A higher all-cause mortality was observed in the SES cohort. PF-SES could effectively improve in-stent reendothelialization in patients with type 2 DM, with positive effects on survival rate and may, therefore, be considered as an alternative treatment option for improving clinical long-term outcomes.

Survival Outcomes of an Early Intervention Smoking Cessation Treatment After a Cancer Diagnosis

Smoking after a cancer diagnosis increases mortality and risk for a second cancer. To determine the association between time of entry into a smoking cessation intervention following a cancer diagnosis and survival outcomes. Using a prospective cohort study design, patients with cancer who smoked and received cessation treatment were assessed at 3 months, 6 months, and 9 months following tobacco treatment onset. Survival outcomes of tobacco treatment were measured and compared among patients at the MD Anderson Cancer Center Tobacco Research and Treatment Program. Treatment occurred between January 1, 2006, and March 3, 2022. Patients were excluded if they died before the tobacco treatment ended, received their diagnosis more than 6 months after beginning cessation treatment, or lacked staging information. The data analysis took place from September 2023 to May 2024. Cessation treatment consisted of 6 to 8 personalized counseling visits and 10 to 12 weeks of pharmacotherapy. More than 95% of visits were provided via telemedicine. The primary outcomes were survival as recorded in the MD Anderson Cancer Center tumor registry and 7-day point prevalence abstinence at each follow-up. The main analytical sample consisted of 4526 currently smoking patients diagnosed with cancer and receiving cessation treatment (2254 [49.8%] female; median [IQR] age, 55 [47-62] years). Survival over 15 years increased for those quitting smoking at 3 months (adjusted hazard ratio [aHR], 0.75 [95% CI, 0.67-0.83]), 6 months (aHR, 0.79 [95% CI, 0.71-0.88]), and 9 months (aHR, 0.85 [95% CI, 0.76-0.95]) of follow-up. The optimal survival outcomes were observed for patients who received tobacco treatment within 6 months of a cancer diagnosis. At the 75th percentile, their survival increased from 2.1 years (95% CI, 1.8-2.4 years) among continuing smokers (nonabstainers) vs 3.9 years (95% CI, 3.2-4.6 years) for patients who quit (abstainers). Similar but less pronounced outcomes were noted when tobacco treatment began within 6 months to 5 years following diagnosis, with survival at the 75th percentile of 4.8 years (95% CI, 4.3-5.3 years) for nonabstainers vs 6.0 years (95% CI, 5.1-7.2 years) for abstainers. The results of this prospective cohort study suggest that evidence-based smoking cessation treatment within 6 months following a cancer diagnosis maximizes survival benefit. This study supports smoking cessation as an important early clinical intervention for patients after being diagnosed with cancer.

Predictive Factors of Peripheral Arterial Disease in Home Care Patients

Objective: The aim of the present study was to investigate the predictive factors of peripheral arterial disease (PAD) in home care patients. Materials and Methods: This descriptive study was conducted in Istanbul with 285 homebound patients who applied for the first time to receive services from the Home Health Care Unit of a tertiary hospital between 01.07.2014 and 01.12.2014. The patients having known PAD diagnosis were excluded. Sociodemographic characteristics, home dependency duration, chronic diseases, medications used and smoking status were recorded. Then, deformities in the patients' toenails, peripheral hair loss, foot wounds were recorded, and the patients' functional status and skinfold thickness were evaluated peripheral arterial disease was evaluated by ankle–brachial index (ABI). An ABI below 0.9 was considered indicative of PAD. A chi-square test, Mann–Whitney U test and a logistic regression analysis were used in the statistical analysis. Results: The mean age of the participants was 75.84±1.17 years (34% M; 65% F). Peripheral artery disease was detected in 16.8% (n=48) of the patients. Current or former smoking (β: 4.09), peripheral hair loss (β: 3.42), deformity of toenails (β: 3.02), and increased skinfold thickness (β: 1.124) were identified as predictors of PAD. Conclusion: The findings of the present study suggest that home healthcare providers should inquire about the patient's smoking history, assess skinfold thickness, and examine the toes for hair loss and deformities, to predict PAD.

Immunoglobulin free light chain-kappa, a novel biomarker of inflammation and cardiovascular risk, decreases after smoking cessation in association with NT-proBNP

Abstract Introduction Inflammation plays an important role in the development and progression of cardiovascular diseases. Unhealthy diet, infection, and smoking coupled with genetic factors induce inflammation in the heart and blood vessels by activating nuclear factor kappa B, which regulates the transcription of immunoglobulin free light chain (FLC)-κ in B-cells and the production of multiple inflammatory molecules. FLCs are novel biomarkers of inflammation, and their levels are associated with overall mortality in a general population and with cardiovascular outcomes. Purpose This study aimed to investigate the effect of smoking cessation (SC) on levels of FLCs as well as of the inflammation and heart failure markers. Methods Inclusion criterion was first-visit smokers with desire to quit smoking at our outpatient clinic. Smoking patients with nicotine dependence were treated with transdermal nicotine patches or orally administrated varenicline. Various clinical parameters, including inflammatory markers such as FLC levels, were measured on their first visit to our outpatient clinic for SC and after 3 months of successful and unsuccessful SC. Paired t-test or Wilcoxon signed-rank test was performed to evaluate changes in these parameters before and after SC. Results Out of 96 patients who participated in this study, 76 patients (55 males and 21 females) succeeded in SC over a period of 3 months. Body mass index (BMI) significantly increased from baseline to 3 months after initiating SC (from 23.8 to 24.2, p=0.004) in patients with successful SC. On the other hand, levels of various inflammatory markers; FLC-κ, FLC-κ/FLC-λ, and the neutrophil-to-lymphocyte ratio) significantly decreased from baseline to 3 months (from 27.5 to 24.7 mg/L, p = 0.042; from 1.2 to 1.2 mg/L, p = 0.010; and from 2.0 to 1.9, p = 0.024, respectively). In contrast, no significant changes occurred in these parameters among patients with unsuccessful SC. Percent changes of FLC-κ levels from baseline to 3 months were significantly correlated with those of CRP (r=0.217, p=0.034) and NT-proBNP (r=0.335, p&amp;lt;0.001) levels. Conclusion The FLC-κ level, a novel inflammatory and cardiovascular risk biomarker, decreased in smoking patients after their SC despite the increase in body weight, suggesting that the beneficial effect of SC overcomes potential risks by body weight increase. The results also suggest that a decrease in the FLC-κ level after SC is associated with a reduction of load on the heart as well as decrease in inflammation.

Understanding smoking cessation process in Tunisia from 2020 to 2023: description of quit attempts

Abstract Background Many smokers attempt multiple cessation methods before seeking specialist intervention. This study aims to describe these prior cessation attempts and identify relapse factors to enhance support for these individuals. Methods Data from 440 patients consulting the Department of Epidemiology Statistics at Abderrahman Mami Hospital from 2020 to 2023 were analyzed. It included information on previous quit attempts, methods used, longest duration of abstinence, number of attempts, reaction to cessation, and reasons for relapse. Statistical description was conducted using IBM SPSS 25. Results Among participants, More than half of the smokers had previously attempted to quit smoking 63,4%, with an average of 2 attempts ± 1,7 (0-10 attempts) per patient. The majority of patients (86.8%) quit smoking without using substitution methods. Among those who resorted to substitution, nicotine replacement therapy was the most frequently used method (n = 30; 6.8%). The longest duration of abstinence averaged 8 years. The main reaction to smoking cessation among patients was an improvement in their health (9,1%). The most common reasons for relapse were psychosocial problems (5.5%), followed by relapses during social events (4.3%), and withdrawal symptoms (3%). Conclusions This study emphasizes the importance of considering each patient’s journey during their smoking cessation process. Analyzing these factors will enable better management of the cessation program with the patient, as well as a deeper understanding of their feedback regarding our program, ensuring long-term cessation success. Key messages • Failed spontaneous quit attempts prior to NRT initiation are prevalent among smoking patients. • Understanding failed spontaneous cessation attempts can guide the development of more effective strategies.

Score-2 in heavy smokers: are we underestimating the risk?

Abstract Background The shared diagnostic decision-making process in patients with atypical chest pain is challenging, especially when functional tests are negative. SCORE2 (1) can help in making decisions. In this score, the risk is assessed based on geographical origin, age, sex, current smoking, systolic blood pressure, cholesterol values. However, it does not take into account the quantity of cigarettes smoked but only the current binary value, yes or no. In our study we wanted to evaluate the impact of smoking on prognosis, considering the number of cigarettes smoked and in particular focusing on heavy smokers. Methods In the last 15 years we evaluated 3,588 outpatients aged &amp;gt;35 years (average 64±9, women 55%) for the presence of stable chest pain. We excluded 290 patients who had ECG changes compatible with recent ischemia, history of myocardial infarction or any other major cardiovascular event, evidence of heart failure, left ventricular dysfunction, or cardiomyopathies. In the other 3,298 cases we applied the traditional classification of typical, atypical angina and non-anginal pain. A functional test was performed in all patients. In 2,774 patients with atypical chest pain and negative functional test we evaluated the extent of cardiovascular risk based on SCORE2 and the number of cigarettes currently smoked. One year follow-up was carried out to evaluate vital status and any fatal and non-fatal cardiovascular events. Results Table 1 shows the events in patients classified according to the degree of cardiovascular risk of SCORE2 and in heavy smokers (≥ 20 cigarettes per day) aged &amp;lt;70 years as a cathegory in itself. In moderate smokers (&amp;lt;20 cigarettes/day) of any age, the risk was considered binary as in the conventional assessment. Tables 2 and 3 show the risk stratification in male and female patients. SCORE2 is unable to intercept the extremely high risk of heavy smokers aged &amp;lt;70 years. This happens both in males, considered at moderate risk in 76% of cases but with a rate of fatal events of 2.4% and as many non-fatal events, both in women with a risk considered moderate in 80% of cases but with a 12% rate of fatal events (as seen in Table 1). Conclusions SCORE2 does not consider the quantity of cigarettes smoked per day, so if we rely on it heavy smokers seem to have a moderate risk. On the contrary, based on our analysis, they all have an extremely high risk, regardless of other risk factors, and in any case higher than non-smoking or moderately smoking patients. Especially heavy smoking women aged &amp;lt;70 years with atypical chest pain and negative functional tests have an extreme risk of fatal cardiac events (12% at one year). Probably these patients (male and female), regardless of the outcome of functional tests, should be sent for an anatomical evaluation for the detection of high-risk stenosis, as well as firmly urged to improve lifestyles and treat risk factors .

Identification of Biomarkers and Molecular Pathways Implicated in Smoking and COVID-19 Associated Lung Cancer Using Bioinformatics and Machine Learning Approaches.

Lung cancer (LC) is a significant global health issue, with smoking as the most common cause. Recent epidemiological studies have suggested that individuals who smoke are more susceptible to COVID-19. In this study, we aimed to investigate the influence of smoking and COVID-19 on LC using bioinformatics and machine learning approaches. We compared the differentially expressed genes (DEGs) between LC, smoking, and COVID-19 datasets and identified 26 down-regulated and 37 up-regulated genes shared between LC and smoking, and 7 down-regulated and 6 up-regulated genes shared between LC and COVID-19. Integration of these datasets resulted in the identification of ten hub genes (SLC22A18, CHAC1, ROBO4, TEK, NOTCH4, CD24, CD34, SOX2, PITX2, and GMDS) from protein-protein interaction network analysis. The WGCNA R package was used to construct correlation network analyses for these shared genes, aiming to investigate the relationships among them. Furthermore, we also examined the correlation of these genes with patient outcomes through survival curve analyses. The gene ontology and pathway analyses were performed to find out the potential therapeutic targets for LC in smoking and COVID-19 patients. Moreover, machine learning algorithms were applied to the TCGA RNAseq data of LC to assess the performance of these common genes and ten hub genes, demonstrating high performances. The identified hub genes and molecular pathways can be utilized for the development of potential therapeutic targets for smoking and COVID-19-associated LC.

Functional Lung Disorders in Smoking Patients with Pulmonary Tuberculosis

Introduction. There is evidence that smoking affects the course and effectiveness of treatment of patients with pulmonary tuberculosis. At the same time, tobacco smoking and pulmonary tuberculosis are significant risk factors in the development of functional lung disorders.The purpose of the study to study the nature of changes in spirometry parameters and the peculiarities of the course of the tuberculosis process in smoking patients.Materials and methods. A retrospective cohort study, which included 102 patients with pulmonary tuberculosis. The patients were divided into two groups: 1 — smoking patients (47 people), 2 — non-smoking patients (55 people).Results. It is shown that men are significantly more common among the former, while women are more common among the latter (p = 0.001). Bilateral lung tissue lesions are more common among smokers compared to non-smokers. It is shown that a decrease in the volume of forced exhalation in the first second (OFV1) of an extremely severe degree is significantly more often observed among smokers (p = 0.028). At the same time, a mild degree is more common among non-smokers (p = 0.039).Discussion. Thus, the most important problem among smokers and non-smokers is a violation of the functional parameters of the lungs. Currently, there is a need to find optimal approaches to prevent a decrease in lung function. Conclusion. It has been shown that a decrease in lung function is observed more often among smoking patients. Also, respiratory symptoms and infiltrative pulmonary tuberculosis are more common among smokers compared to non-smokers.

Rotator Cuff Tear and Associated Risk Factors. The Mutual Role of Medical Conditions

■: Several medical conditions (diabetes, cardio-vascular diseases, hypercholesterolemia etc.) or modifiable behavioral habits (smoking habit and alcohol assumption) capable of causing a damage to the peripheral microcirculation are considered potential risk factors for degeneration/tear of the rotator cuff. The aim of the study was to analyse and quantify how the association of multiple known risk factors is more effective than the predisposing action of a single factor. 308 consecutive patients who underwent arthroscopic repair of a full-thickness Rotator Cuff Tear (RCT) represented the case group. The control group included 388 consecutive healthy asymptomatic subjects for shoulder pathologies. A multivariable prognostic model for the prediction of rotator cuff tear has been performed to analyse the mutual effect of multiple risk factors. With a correct classification estimated at 70.6% a smoker patient (OR=2.405; CI95%=1.645-3.516) with hypercholesterolemia (OR=1.976; CI95%=1.408-2.771), diabetes (OR=2.362; CI95%=1.241-4.493) and arterial hypertension (OR=1.630; CI95%=1.156-2.300) has a higher chance of developing a rotator cuff tear surgery compared to a peer non-smoker healthy subject. Probability of a smoker patient suffering from hypercholesterolemia, diabetes, and arterial hypertension to undergo rotator cuff repair surgery is not given by the sum of the probabilities of each condition but increases drammatically. Each pathology interacts with each other; dramatically increasing the risk of developing a cuff tear. Level of Evidence: III Retrospective Study

The state of rheological properties of blood in pregnant smokers with chronic nonspecific bronchial inflammation

Aim. To evaluate the effect of smoking on the blood rheology of pregnant smokers with chronic nonspecific bronchial inflammation. Materials and methods. The prospective study included 107 pregnant smoking patients and 136 non-smoking pregnant women who were observed in a polyclinic. The control group consisted of 42 non-smoking women without chronic diseases. The patients were examined according to the clinical guidelines for the treatment of chronic obstructive pulmonary disease. The speed and volume indicators of the function of external respiration, indicators of blood rheology were studied. The reliability of the results was assessed using the methods of parametric and nonparametric statistics. Before applying all statistical research methods, it was checked whether the sample obeys the Gaussian (normal) distribution law. A single-factor analysis of variance was used to determine whether there was a statistically significant difference between the averages of three or more independent groups. Results. Having refuted the null hypothesis about the absence of the effect of smoking on hemoglobin, using the Student's t-test method for dependent samples, it was established. Conclusion. The longer the period of tobacco use lasted, the more likely it was to develop changes in the viscosity qualities of blood, which undoubtedly affected the condition of patients and the fetus.

The Evaluation of the Genetic Polymorphisms of TERT (rs2736100) and MUC5B (rs35705950) in Idiopathic Pulmonary Fibrotic patients

Background: Polymorphisms of the TERT and MUC5B genes have been consistently associated with idiopathic pulmonary fibrosis (IPF) in recent genome-wide genetic studies. In Iraq, we did not find research on the role of these polymorphisms in respiratory disorders, so we conducted this study to evaluate the genetic polymorphisms of TERT (rs2736100) and MUC5B (rs35705950) in IPF patients in Iraq. Method: The current study was a case-control study that included 70 patients who were diagnosed with IPF, in addition to, 70 healthy control groups who had no history or clinical evidence of IPF or asthma. blood samples from participants were obtained for DNA extraction, and T-ARMS-PCR was used to determine genetic polymorphisms of TERT (rs2736100) and MUC5B (rs35705950). Result: Current study showed that the mutant/minor homogenous genotype AA and allele A of TERT (rs2736100) appeared at a higher rate in patients (47% and 87% respectively) compared to control (38.5% and 53% respectively), as this indicator appeared as an effective factor (EF = 0.139 and 0.242 respectively), while the wild/major homogenous genotype CC and allele C were appeared in control at a rate of 38.5% and 50% respectively and in patients at rate 23% and 50% respectively. The results of MUC5B (rs35705950) G/T polymorphism showed that the mutant/minor TT genotype and T allele were associated with the occurrence of the disease (EF = 0.177 and 0.192 respectively) while the wild /major GG genotype and G allele appeared as a protective factor (PF= 0.243 and 0.375 respectively) for the control group. Moreover, most of the smoking patients were carriers of the mutant homogenous genotypes of TERT (rs2736100) and MUC5B (rs35705950). Conclusion: TERT (rs2736100) and MUC5B (rs35705950) polymorphisms are significantly associated with IPF, especially among smokers patients.

Risk Factors for In-Stent Stenosis After Flow Diverter Treatment of Intracranial Aneurysms: A Systematic Review and Meta-Analysis of 2350 Patients.

Recent advances in flow diverter (FD) therapy for intracranial aneurysms have highlighted the need to evaluate risk factors for in-stent stenosis (ISS), a potentially serious complication. This meta-analysis aims to identify risk factors associated with an increased risk of ISS after FD treatment. PubMed, Web of Science, Embase, and SCOPUS databases were systematically searched for studies reporting ISS rates and risk factors after FD therapy for intracranial aneurysms. Odds ratios were calculated using random-effects models to assess potential risk factors associated with ISS. Ten studies involving 2350 patients with 2441 aneurysms were included. Younger age (P = .006) and male sex (P = .003) were associated with higher ISS risk. Smoking also increased the risk (P = .02). Aneurysm location in the posterior circulation (P < .00001) and fusiform morphology (P < .00001) were significant risk factors for ISS, as were ruptured aneurysms (P = .05). Hypertension, hyperlipidemia, diabetes, allergies, and alcohol abuse, as well as aneurysm size, neck width, and parent artery diameter, did not affect ISS risk. Procedural factors like balloon angioplasty, multiple FDs, or FD/coil combinations were not significantly associated with ISS. This meta-analysis identified both nonmodifiable (younger age, male sex) and modifiable (smoking) patient factors, as well as high-risk aneurysm characteristics (posterior circulation, fusiform, ruptured), associated with an increased risk of ISS after FD treatment. These findings highlight the importance of tailored monitoring and management approaches for optimizing outcomes in FD therapy.