Time Of Cessation Research Articles

Acute coronary syndrome: factors predicting smoking cessation.

Few randomized controlled trials have examined the efficacy time of smoking cessation in hospitalized patients with acute coronary syndrome, either during hospitalization or after discharge. To assess smoking cessation rates at 24 weeks among patients with acute coronary syndrome. Group A had begun nicotine replacement therapy during hospitalization, and Group B after discharge. We also determined factors predicting success. We conducted a randomized controlled trial in the Cardiology Department and Smoking Cessation Service at University Hospital of Monastir, Tunisia from January 2015 to June 2016. Participants were randomly assigned to the above 2 groups. The endpoint assessment was smoking abstinence at 24 weeks, defined as self-reported abstinence in the past week, confirmed by measured exhaled carbon monoxide (CO) ≤ 8 ppm. We analysed data by intention to treat. We used a binary logistic regression model to determine factors predicting abstinence. All participants were male and mean (standard deviation) age was 55 (11) years. At 24 weeks there was no significant difference in smoking cessation rate between the 2 groups: 54.5% [95% confidence interval (CI): 44.7-64.3%] in Group A and 45.5% (95% CI: 35.7-55.3%) in Group B (P = 0.81). High level of nicotine dependence [odds ratio (OR): 0.72; 95% CI: 0.54-0.96) and good compliance during follow-up (OR: 6.56; 95% CI: 2.07-20.78) were predictive factors for abstinence. Smoking cessation rate after acute coronary syndrome was high regardless of the start date. Good compliance during follow-up was the key predictive factor for success.

Age at period cessation and trajectories of cardiovascular risk factors across mid and later life

ObjectiveTo examine the association between age at period cessation and trajectories of anthropometry, blood pressure, lipids and glycated haemoglobin (HbA1c) from midlife to age 69 years.MethodsWe used data from the...

Abstract P3-08-36: The effects of smoking and smoking cessation on postmenopausal breast cancer recurrence -Results from the Cohort 05 of the Rainbow of KIBOU (ROK) study: A prospective breast cancer survivor cohort in Japan

Abstract [Background] Smoking is an established risk factor for breast cancer incidence. As for breast cancer prognosis, the effect of patient’s smoking on her mortality is also substantial. However, there are very few reports of investigating patient’s smoking and smoking cessation effects on breast cancer recurrence, especially those with controlling for treatment effects. [Methods] We conducted a prospective cohort study (Cohort 05 of the Rainbow of KIBOU study) for the patients enrolled in the N-SAS BC 05 trial (AERAS, UMIN:000000818). The N-SAS BC 05 trial is the randomized multi-center open-label phase III trial to assess the effect of the extended use of anastrozole for an additional 5 years where postmenopausal patients with stage I-III, hormone-receptor-positive breast cancer, disease-free after 5 years of either anastrozole alone or tamoxifen 2-3 years followed by anastrozole 3-2 years were randomized to continual group with anastrozole for an additional 5 years or stop group without an additional anastrozole. Our primary end point was disease-free survival. Since the data came from well controlled randomized trial of treatment comparison, precise recurrence and treatment data were available. [Results] We enrolled 1,510 women from the participants of the NSAS BC 05 trial. After a median follow up of 5.1 years, there were 144 events including breast cancer recurrences, secondary cancers, and deaths. The 5-year disease-free survival rates from the entry of the study (10 year from diagnosis) were 89.4% (95% confidence interval [CI], 87.4 to 91.5) in nonsmokers, 87.7% (95% CI: 82.0 to 93.4) in quitters (both before and after diagnosis), and 76.1% (95% CI, 62.7 to 89.4) in smokers (P=0.02 by a two sided log-rank test). Hazard ratios are 2.13 (95% CI, 1.14 to 3.97) for smokers and 1.35 (95% CI, 0.83 to 2.20) for quitters compared to nonsmokers after controlling treatment and age effects. If the quitters were divided into two groups by the time of cessation, hazard ratios are 1.31 (95% CI, 0.74 to 2.34) for those who quitted before diagnosis and 1.47 (95% CI, 0.64 to 3.34) for those who quitted after diagnosis. The results were not substantially changed if the events were restricted to recurrence. [Conclusion] Ten year disease-free survival for smokers was significantly worse than that of nonsmokers after almost perfectly controlling treatment effects. Compared to that, 10 year disease-free survival for quitters was not different from that of nonsmokers. The risk was decreased if they quit smoking even after diagnosis. Our study shows the importance of smoking cessation for breast cancer patients. Citation Format: Yuri Mizota, Takuji Iwase, Yasuo Ohashi, Hirofumi Mukai, Seiichiro Yamamoto. The effects of smoking and smoking cessation on postmenopausal breast cancer recurrence -Results from the Cohort 05 of the Rainbow of KIBOU (ROK) study: A prospective breast cancer survivor cohort in Japan [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-36.

Regime for cytomegalovirus retinitis based on aqueous virology and inflammatory cytokine determination

Objective To observe the safety and efficacy of regime that based on aqueous cytomegalovirus-DNA (CMV-DNA) load and IL-8 determination for therapeutic monitoring and local treatment cessation of cytomegalovirus retinitis (CMVR) patients after allogeneic hematopoietic stem cell transplantation (HSCT). Methods A prospective case series study. A total of 14 CMVR patients (22 eyes) after allogeneic HSCT diagnosed in Ophthalmology Department of Peking University People's Hospital between January 2016 and December 2018 were involved in this study. All patients were CMV-DNA seronegative at baseline and were treated with intravitreous injection of ganciclovir (IVG, 3 mg in 0.05 ml) twice per week for 4 times in the induction stage and once a week in the maintenance stage. Aqueous humor sample was collected during the first time of IVG every week. CMV-DNA and the level of IL-8 were measured by real time quantitative PCR and ELISA, respectively. During follow-up, negative CMV-DNA (<103/ml) or level of IL-8<30 pg/ml in aqueous sample was set as local treatment cessation. Then patients were followed every 2 weeks for at least 6 months. BCVA, intraocular pressure and fundus examination were taken for each visit. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. BCVA and intraocular pressure at the baseline and the last follow-up were compared by the Student t matching test. Results Of the 14 CMVR patients (22 eyes) after allogeneic HSCT, 8 patients (16 eyes) were bilateral, 6 patients (6 eyes) were unilateral. At the baseline, the mean logMAR BCVA was 0.814±0.563, the intraocular pressure was 17.2±7.8 mmHg (1 mmHg=0.133 kPa), the mean aqueous CMV-DNA load was (3.43±4.96)×105/ml, the mean level of IL-8 was 518±541 pg/ml. At cessation of local treatment, the median number of intravitreal injections was 5 times. Nine eyes showed negative CMV-DNA in aqueous humor, of which, 7 eyes showed negative IL-8 in aqueous. CMV-DNA could still be detected in 13 eyes, while IL-8 was negative. Only one eye’s retinal lesion was completely quiet. Six months after local treatment cessation, the mean logMAR BCVA was 0.812±0.691, the intraocular pressure was 14.8± 5.4 mmHg; which was not significantly different from baseline (t=-0.107, 1.517; P=0.916, 0.137). Recurrence of CMVR happened in only 1 eye because of systemic EB virus infection. Retinal lesions progressively improved and became completely quiet in all the remaining 20 eyes. In 22 eyes, iatrogenic vitreous hemorrhage occurred due to low platelet count during treatment (<30×109/ml) in 4 eyes. When the treatment was terminated for 6 months, the fundus of hematoma absorption was clearly visible. At the time of CMVR diagnosis, there were 2 eyes (9%) with posterior subcapsular opacity, which may be caused by systemic glucocorticoid therapy after allogeneic HSCT. Conclusion Aqueous CMV-DNA load and level of IL-8 could be used as quantitative variables for monitoring the therapeutic effect and determining time for local treatment cessation for CMVR after HSCT safely and efficiently. Key words: Cytomegalovirus retinitis; Aqueous humor; Virology; Intereukin-8

Advanced Treatments and Technology: Weaning and Deactivating (P09)

•Identify the ethical and legal principles that support withholding and withdrawing technology.•Incorporate a systematic process to cessation of technology.•Recognize and appropriately manage common symptoms that occur with cessation of technology. Science with treatment and technology advancement, such as inotropes, pacemakers/AICDs, ventilators, and VADs (ventricular assist devices) continues to offer patients opportunities for improved health and survival. With progressive illness, such technologies and treatments may no longer be associated with health and may in fact decrease quality of life and increase suffering with unclear or unwanted life prolongation. Moreover, advance care planning through an advance directive, clinical orders, or stated wishes by the patient or surrogate as part of a goals-of-care conversation often address the role of advanced treatments, including technology with considerations for its discontinuation. Such conversations with patients and families and among the clinical care team benefit from skilled communication that incorporates a sound legal and ethical framework. Discontiuation of advanced therapies and technology necessitates the adoption of a consistent approach to ensure adequate education of the patient and family so they know what to expect, consistent messaging among clinicians to minimize uncertainty, as well as a structure that helps avoid service failures. As part of the planning process, symptom management is the underpinning of clinical care with proactive management to prevent the emergence of symptoms at the time of therapy cessation and through the ensuing dying process. Attendees of this session will increase their understanding of the ethical and legal framework that supports treatment and technology discontinuation along with discussions about care protocols to standardize the process to mitigate adverse outcomes and improve symptom management.

Konjenital Hipotiroidi Olgularının Etiyolojik Değerlendirilmesi

INTRODUCTION: The aim of this study was to determine, (i) the cause of congenital hypothyroidism (permanent or transient), (ii) the etiological cause of persistent congenital hypothyroidism and (iii) to investigate the role of clinical and laboratory data in predicting persistent and transient congenital hypothyroidism. METHODS: Patients with congenital hypothyroidism who were started L-thyroxine treatment and discontinued at the age of 3 years were included in the study. The data of the cases were obtained retrospectively from the hospital records. Serum thyroid hormones were measured of the cases 4 weeks after discontinuation of treatment at the age of 3 years. Patients with TSH&gt; 10 mIU/mL were accepted as permanent hypothyroidism and those with normal TSH value for 6 months were accepted as transient hypothyroidism. RESULTS: A total of 63 patients were included in the study. Permanent congenital hypothyroidism was detected in 16 (25%: 9 females, and 7 males) and transient congenital hypothyroidism in 47 (75%: 22 females, and 25 males) cases. There was no difference between the permanent and transient groups in terms of gender, gestational week, birth weight, age at diagnosis, physical examination findings at the time of diagnosis, serum fT4, TSH levels, and initial L-thyroxine doses. While thyroid ultrasonography was normal in all patients in the transient hypothyroidism group, dysgenesis was detected in 9 (56%), and dyshormonogenesis in 1 (6%) patient. The mean thyroxin dose in permanent congenital hypothyroidism group was significantly higher than the transient group at the time of treatment cessation (2.8±0.9 and 1.2±0.5 mcg/kg/day, p&lt;0.001, respectively). L-thyroxin dose of &gt;2.1 mcg/kg/d was 81% sensitive and 90% specific for predicting permanent congenital hypothyroidism (p&lt;0.001). DISCUSSION AND CONCLUSION: It has been shown that the most common etiologic cause of congenital hypothyroidism is transient hypothyroidism. Thyroxine dose at the time of treatment cessation was found to be the most important determinant in the differentiation of permanent and transient congenital hypothyroidism.

Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention.

Selection of the optimal peri- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evidence on this topic. Non-vitamin K oral anticoagulants (NOACs) at standard doses are the preferred option in most of post PCI patients with AF, except those few with a clear indication for a vitamin K antagonist (VKA). Reduced NOAC doses should be considered in dabigatran- or rivaroxaban-treated patients with a high bleeding risk, which prevail over concerns about stent thrombosis or ischemic stroke. There is insufficient evidence to favor one NOAC over another in this setting. In the early post stenting period, triple therapy comprising a NOAC, clopidogrel and aspirin is recommended. Timing of post PCI aspirin cessation should be based on a careful analysis of the bleeding and ischemic risk. There is only low quality evidence regarding the optimal approach to elective or urgent/emergency PCI procedures in patients requiring oral anticoagulation. It is suggested that there is no need of interruption of VKA and PCI procedure should be performed via radial artery access with a lower dose of unfractionated heparin. On the other hand, NOACs are usually stopped before elective PCIs, while urgent/emergency procedures may be performed with the addition of low-dose parenteral anticoagulation.

A simple and convenient method for determination of entrance into dormancy in woody plants

BACKGROUND: Bud dormancy is a quantitative condition that is gradually acquired and lost. Better and more convenient methods for assessment of the time of dormancy entrance of woody plants are highly needed. OBJECTIVE: To demonstrate a simple and convenient method for determination of dormancy in woody plants. METHODS: We employed a seasonal series of soft tipping of vigorously growing annual shoots and used the loss of ability of subtending lateral buds to break and grow as a measure of entrance into dormancy. RESULTS: There was a gradual decline in the ability of the buds to burst and grow during the month of July and early August, culminating with a complete loss of this ability. This coincided with the known time of growth cessation and dormancy induction in shoots of intact plants and occurred in the berry shrubs raspberry and black currant and the forest tree silver birch. CONCLUSIONS: The decline and loss of ability of the buds to grow during late summer is a direct expression of the entrance of buds into the state of endodormancy, rendering the tipping method a simple and convenient method for precise determination of the time of entrance into dormancy in woody plants.

Awareness about benefits of breastfeeding among mothers in Tabuk City, KSA

Background: Breast milk is the ideal nutrition for infants as it contains a mixture of vitamins, protein, and fat, and everything the baby needs to grow. Breastfeeding also has benefits for mothers, such as decreasing the risk of breast cancer, cardiovascular disease, and rheumatoid arthritis. The study aimed to assess the awareness of mothers about the importance of breastfeeding in the Tabuk region. Methodology: A cross-sectional study was performed at King Khalid Hospital and Maternity and Children Hospital in Tabuk city, Saudi Arabia. The study investigated the demographics of mothers and their awareness of breastfeeding. The Statistical Package for Social Sciences program was used to analyze the data obtained from mothers. Results: This study included 266 mothers within the age range of 15-45 years. Among the participants, 63.2% reported breastfeeding, and 27.8% reported that they breastfed their children sometimes. Of all participants, 84.2% and 97.7% knew the benefits of breastfeeding, 18% reported using artificial milk; the most common reason for replacing breastfeeding was the lack of mother milk (52.6%). Significant associations were observed between each of age of mothers and replacing breastfeeding (p = 0.004), age of mothers and the time to replace breastfeeding (p = 0.007), age of mothers and the reason to replace breastfeeding (p = 0.005), education of the mother and time of breastfeeding cessation (p = 0.004), and time of replacing breastfeeding and the reason for cessation (p = 0.0001). Conclusion: An adequate level of awareness was observed among mothers about breastfeeding and the right attitude toward it, but some gaps were reported in the practice of breastfeeding.

Sequential Radiographic Evaluation During Closed Treatment of Distal Radius Fracture.

To test the null hypothesis that there is no significant change in radiographic parameters, which determines an acceptable reduction, beyond 3 weeks in distal radius fractures with closed treatment. Retrospective review of a prospectively gathered registry of distal radius fractures. Academic medical center. Patients who underwent closed treatment of distal radius fracture. Sequential radiographic evaluation. Change of radiographic measurement including radial inclination, radial height, ulnar variance, articular tilt, teardrop angle, anteroposterior distance, intra-articular gap, and step-off. We compared postreduction radiographic parameters once within 2 weeks, at the third week, at cessation of immobilization, and analyzed the interobserver reliability test. There was a statistically significant difference between radiographic measurements, which determined an acceptable reduction between radiographs performed within 2 weeks versus the third week. Radial inclination and ulnar variance were statistically different at the third week compared with the time of cessation of immobilization. Seventy-seven percent of patients who had an acceptable reduction after 2 weeks maintained acceptable alignment at cessation of immobilization. Eighty-five percent of patients with acceptable reduction after 3 weeks maintained acceptable alignment at cessation of immobilization. Radial shortening >1.8 mm at the third week predicts an unacceptable radiographic outcome at cessation of immobilization (sensitivity 94.5% and specificity 90%). Radiographic parameters that determine acceptable reduction for closed treatment of distal radius fractures change minimally after 3-week postacceptable closed reduction. Radial shortening at the third week can be used to predict an unacceptable radiographic outcome. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Nootropic activity of Ethanolic and Aqueous Root Extracts of Adhatoda vasica nees in Rodents

Objectives: The Present study was planned to evaluate the nootropic activity of ehanolic extract of Adhatoda vasica nees (EERAV) and aqueous extract of A. vasica (AQERAV) in experimentally induced amnesic models in mice and rats. Methods: AERAV and AQERAV were prepared successively with roots of A. vasica using soxhlet apparatus. LD50 studies for these two extracts were carried out in albino mice up to the dose level of 2000 mg/kg as per guidelines No. 425 of CPCSEA. EERAV and AQERAV were studied for their nootropic effect evaluated in five different experimental models like Active (Rats) and Passive avoidance, Diazepam, Scopolamine, Sodium nitrite induced amnesia and Sodium nitrite induced hypoxia models all in mice. The parameters studied in nootropic activity are Step Down Latency (SDL), Step Down Error (SDE), Time spent in Shock Zone (TSZ), Number of shocks, Transfer Latency (TL) and Time for cessation of respiration. Results: No mortality observed even at the highest dose tested (2000 mg/kg) and did not produce any significant effect on locomotor activity in mice. Experimental studies have shown that EERAV and AQERAV have exhibited a dose dependent nootropic activity. A Significant nootropic activity was recorded with both the extracts in Active and Passive avoidance, Scopolamine, Diazepam and Sodium nitrite induced amnesia models. AQERAV exhibited a significant nootropic effect with medium and high doses only in Active and Passive avoidance models, scopolamine and Diazepam induced amnesia models. Conclusion: The present study suggests that both extracts possessed a significant nootropic activity in mice and rats.

Branching Regulator BRC1 Mediates Photoperiodic Control of Seasonal Growth in Hybrid Aspen

Cessation of growth as winter approaches is a key adaptive trait for survival of perennial plants, such as long-lived trees native to boreal and temperate regions [1, 2]. The timing of growth cessation in these plants is controlled by photoperiodic cues. As shown recently, perception of growth-repressive short photoperiod (SP) mediated via components of circadian clock results indownregulation of the tree ortholog of Arabidopsis flowering regulator FLOWERING LOCUS T(FT), FT2[3, 4]. Downregulation of FT2 results in suppression of downstream components LAP1 (orthologousto the Arabidopsis floral meristem identity gene APETALA1) and AIL1 (orthologous to AINTEGUMENTA in Arabidopsis), culminating in induction of growth cessation and bud set [5-7]. Results presented here reveal that, in addition to the CO/FT pathway, a photoperiodically controlled negative feedback loop involving a tree ortholog of Arabidopsis BRANCHED1 (BRC1) (a member of TEOSINTE BRANCHED 1, CYCLOIDEA, PCF family), LAP1, and FT2 participates in regulation of seasonal growth in the model tree hybrid aspen. In growth-promotive long photoperiod, LAP1 suppresses expression of BRC1, but upon perception of growth-repressive SP, downregulation of LAP1 de-represses expression of its downstream target BRC1. BRC1 physically interacts with FT2, and BRC1-FT interaction further reinforces the effect of SP and triggers growth cessation by antagonizing FT action. Accordingly, BRC1 gain and loss of function result in early and retarded growth cessation responses to SP, respectively. Thus, these results reveal a regulatory feedback loop that reinforces responses to SP and induction of seasonal growth cessation.

Pilot Study on the Safety of Intravenous Arsenic Trioxide and Oral Realgar-Indigo Naturalis Formula Administrated in Children with Acute Promyelocytic Leukemia: A Single-Center Study

Objective Intravenous arsenic trioxide (ATO) and all-trans retinoic acid have become the front-line treatments for patients with acute promyelocytic leukemia (APL). Realgar-Indigo naturalis formula (RIF), an oral arsenic drug, not only shows a clinical efficacy comparable to ATO but also promotes incorporating an outpatient postremission therapy model into clinical practice for both low-risk and high-risk APL patients in China. However, the safety of ATO/RIF used in children with APL is unknown. To assess the safety of arsenic (ATO/RIF) administrated in children with APL, we designed the study. Methods Children with newly diagnosed APL treated with CCLG-APL2016 protocol (ChiCTR-OIN-17011227) in Beijing Children's Hospital from July 2016 to December 2018 were eligible for the study. The arsenic concentrations in different tissues, including plasma, urine, hair and nail, were measured at 10 time points: before ATO/RIF(D0), on the 7th, 14th and 28th day of ATO/RIF administration(D7, D14, D28), on the end of consolidation therapy (Con), during the 10 weeks of maintenance therapy (W10), on the cessation of therapy, after six months, one year and 1.5 years without arsenic administration. Adverse reactions were observed to evaluate the safety of arsenic received in children with APL. Results Nineteen patients with newly diagnosed APL were enrolled, including 9 boys and 7 girls with an onset average age of (10.9±3.7) years. There were 14 patients in low-risk group (white cell count &lt;10,000/ul) and 5 patients in high-risk group (white cell count≥10,000/ul). All of them got hematologic complete remission (HCR) and molecular complete remission (MCR). The time to get HCR and MCR were 31 days (range, 27~74days) and (72.2±16.4) days, respectively. Besides, there were 13 patients getting ATO and 6 patients getting RIF in induction phase, and all patients receiving RIF as an outpatient postremission therapy. It showed that plasma and urine arsenic levels were significantly elevated after ATO/RIF administration. The median plasma arsenic ranged from 38.4 ng/ml to 76.10 ng/ml on D7, D14, D28, Con and W10 while the median urine arsenic retention ranged from 1562.80ng/ml to 3791.00ng/ml on D7, D14, D28, Con and W10. Plasma arsenic level rapidly decreased to 1.01 ng/ml after six months without RIF administration, which was slightly higher than D0 (1.01ng/ml vs 0.60ng/ml, P=0.043) and decreased to normal after 1 year without arsenic administration compared with D0 (0.55 ng/ml vs 0.60ng/ml, P=0.655). Urine arsenic level decreased to normal within 0~6 months off therapy (25.80ng/ml vs 13.74ng/ml, P=0.866). Hair arsenic (6480.95ng/g, range 2616.20-14683.70ng/g) and nail arsenic levels (17896.85ng/g, range 400.00-30334.00ng/g) peaked at the time of cessation of therapy. Hair arsenic level decreased to normal within half a year off arsenic (156.50 ng/g vs 103.45 ng/g, P=0.345) while nail arsenic retention decreased to normal after 1 year off arsenic (P=0.655). In addition, Spearman rank correlation analysis showed that plasma arsenic concentration was positively correlated with urine (r=0.825, P&lt;0.001), hair (r=0.595, P&lt;0.001) and nail (r=0.584, P&lt;0.001) arsenic. Urine arsenic were also positively correlated with hair (r=0.624, P&lt;0.001), and nail (r=0.575, P&lt;0.001). And arsenic concentration in hair was positively correlated with nail (r=0.805, P&lt;0.001), too. Conclusions Through the detection of arsenic concentration in different periods and different tissues, it was found that the plasma arsenic concentration could be maintained within the effective concentration range in each treatment stage, and the arsenic concentration in plasma and hair gradually decreased to normal after six months off arsenic. Urine and nail arsenic went down to normal after 1 year off arsenic. Up to now, with a longest follow-up period of 34.7 months and the mean follow-up time of 19.6 months, the short-term response of arsenic disappeared after symptomatic therapy or arsenic reduction, and no chronic side effects of arsenic were observed. Therefore, the use of ATO/RIF in children with APL is safe, but it still needs long-term follow-up. Disclosures No relevant conflicts of interest to declare.

Effect of smoking cessation on tooth loss: a systematic review with meta-analysis

BackgroundSmoking is a major risk factor for periodontitis and tooth loss. Smoking cessation has a positive impact in periodontal treatment. However, so far, no systematic review has evaluated the effect of smoking cessation on tooth loss. Therefore, this review aimed to evaluate if smoking cessation reduces the risk of tooth loss.MethodsObservational (cross-sectional and longitudinal) studies that investigated the association between smoking cessation and tooth loss were included. MEDLINE, EMBASE and LILACS databases were searched for articles published up to November 2018. Pooled results for subgroups of current and former smokers were compared in meta-analysis. Meta-regression was used to test the influence of smoking status on estimates and explore the heterogeneity.ResultsOf 230 potentially relevant publications, 21 studies were included in the qualitative review and 12 in the quantitative analysis. Meta-analysis of cross-sectional studies did not show any differences between former and current smokers in the chance of losing 1 or more teeth (OR = 1.00; 95% CI = 0.80 to 1.24, I2 = 80%), losing more than 8 teeth (OR = 1.02; 95% CI = 0.78 to 1.32, I2 = 0%) or being edentulous (OR = 1.37; 95% CI = 0.94 to 1.99, I2 = 98%). Meta-analysis from longitudinal studies showed that, when compared to never smokers, former smokers presented no increased risk of tooth loss (RR = 1.15; 95% CI = 0.98 to 1.35, I2 = 76%), while current smokers presented an increased risk of tooth loss (RR = 2.60; 95% CI = 2.29 to 2.96, I2 = 61%). Meta-regression showed that, among former smokers, the time of cessation was the variable that better explained heterogeneity (approximately 60%).ConclusionsRisk for tooth loss in former smokers is comparable to that of never smokers. Moreover, former smokers have a reduced risk of tooth loss, when compared to current smokers.

Relationship of Cigarette Smoking and Time of Quitting with Incident Dementia and Cognitive Decline.

Understanding how dementia risk is impacted by timing of smoking cessation has public health implications for prevention efforts. We investigated the relationship of cigarette smoking and cessation with dementia risk and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study. Ongoing prospective cohort study. Begun in 1987-1989, ARIC was conducted in four US communities. A total of 13 002 men and women (25% African American) aged 52 to 75 years. All-cause dementia was defined using standardized algorithms incorporating longitudinal cognitive data, proxy report, and hospital and death certificate dementia codes. Cognitive decline was measured using a composite cognitive score created from three tests measured at two time points (1996-1998 and 2011-2013). Smoking and cessation status were defined by self-report using data from 1987-1989 (visit 1) and 1996-1998 (visit 4). Incident dementia risk and differences in cognitive change by smoking status were estimated with Cox proportional hazards and linear regression models, respectively. To address smoking-related attrition, cognitive scores were imputed for living participants with incomplete cognitive testing. The proportion of never, former, and current smokers was 44%, 41%, and 14%; 79% of former smokers quit 9 years or more before baseline. A total of 1347 participants developed dementia. After adjustment, compared with never smoking, the hazard ratio for all-cause dementia for current smoking was 1.33 (95% confidence interval [CI] = 1.12-1.59) and for recent quitting (<9 y before baseline) was 1.24 (95% CI = 1.01-1.52). Quitting 9 years or more before baseline was not associated with dementia. We found no differences in rates of cognitive decline by smoking status. Although quitting at any time suggested benefit, dementia risk depended on time since smoking cessation. Our study highlights the importance of early midlife cessation to decrease dementia risk. J Am Geriatr Soc 68:337-345, 2020.

Studying and modelling winter dormancy in olive trees

The abundance of scientific papers dealing with olive reproductive phenology contrasts with the scarce information available in relation to the winter dormant state of olive vegetative structures. In this study, three experiments with young olive trees were performed in Southern Spain, aiming to provide insight into some features of the winter rest period in this evergreen species. Experiment 1 evaluated the environmental cues triggering dormancy induction by measuring leaf appearance rates in trees subjected to different conditions of temperature and daylength over the course of the 2012 autumn. In Experiment 2, several sets of plants were placed into a greenhouse at different dates along the 2013/2014 winter, testing the ability of dormant plants to resume growth upon the return of favourable temperatures. Finally, Experiment 3 was carried out during the autumns of 2016 and 2017 in two locations, and was devoted to assess differences between five cultivars in the onset of dormancy under natural conditions. Our findings revealed that dormancy induction is not controlled by photoperiod, but by low temperatures. The subsequent winter rest state seems to be easily reversed after 1–2 weeks of exposure to warm conditions, irrespective of the initial date of exposure. With regard to cultivar variability, differences in the timing of growth cessation was found to be rather small. Finally, two simple models for predicting the onset of dormancy based on the accumulation of a certain amount of chilling (either considering or not a reversal of chilling by warm temperatures) are presented. Calibration and validation was performed with independent datasets from Experiments 1, 2 and 3. Validation tests highlighted the reliability of both models in reproducing the date of growth cessation.

1616O - 5-year adherence to adjuvant endocrine therapy among women with breast cancer: A nationwide study using group-based trajectory modeling

BackgroundAdjuvant endocrine therapy (AET) is an oral medication prescribed to women with hormone-sensitive breast cancer (BC). AET is recommended daily for at least 5 years to reduce recurrence and mortality risks. Studies showed that a high proportion of women do not take daily or do not persist with AET for the recommended duration. The objectives of this study were to identify: 1) AET adherence trajectories for the 5 years following AET initiation among women diagnosed with non-metastatic BC and 2) factors associated with these trajectories. MethodsWe used data from the French Cohorte Cancer which includes data on hospitalizations, ambulatory care and medication claims for all cancer cases diagnosed in metropolitan France (SNDS database) . Women diagnosed with a first non-metastatic BC in 2011 and who had ≥1 AET claim in the 12 months after surgery were included in this study. For each woman, we estimated the proportion of days covered (PDC) by an AET for each month in the 5 years after AET initiation. Monthly PDCs were used to model AET adherence trajectories using Group-based trajectory modeling (GBTM). Statistical criteria were used to select the number of trajectories and evaluate the adequacy of the selected model. Factors associated with trajectories were identified using multinomial logistic regressions comparing. Results33 260 women were included. A 6-trajectory model wasselected: 1) 6.6% stopped the treatment by the end of the first year of treatment, 2) 5.7% declined adherence around half-term treatment 3) 6.3% after around 3 years, 4) and 8.3% after 4 years, 5) adherence varied between 50% and 60% without ever stopping for 4.3% of women and 6) 68.8% had an optimal adherence over the whole duration of treatment. Factors associated with trajectories included age, switch of molecule of AET during the treatment and the type of surgery. ConclusionsTo our knowledge, this is the first nationwide study to describe 5-year AET adherence trajectories. By identifying the timing of AET decline and/or cessation and factors associated with longitudinal adherence patterns, results could guide the development of interventions aimed at supporting women having an AET. Legal entity responsible for the studyInstitut National du Cancer (INCa). FundingINCa. DisclosureAll authors have declared no conflicts of interest.

The intramontane Orava Basin – evidence of large-scale Miocene to Quaternary sinistral wrenching in the Alpine-Carpathian-Pannonian area

The Carpathian Orava Basin is a tectonic structure filled with Neogene and Quaternary deposits superimposed on the collision zone between the ALCAPA and European plates. Tectonic features of the south-eastern margin of the Orava Basin and the adjoining part of the fore-arc Central Carpathian Palaeogene Basin were studied. Field observations of mesoscopic structures, analyses of digital elevation models and geological maps, supplemented with electrical resistivity tomography surveys were performed. Particular attention was paid to joint network analysis. The NE-SW-trending Krowiarki and Hruštinka-Biela Orava sinistral fault zones were recognized as key tectonic features that influenced the Orava Basin development. They constitute the north-eastern part of a larger Mur-Mürz-Žilina fault system that separates the Western Carpathians from the Eastern Alps. The interaction of these sinistral fault zones with the older tectonic structures of the collision zone caused the initiation and further development of the Orava Basin as a strike-slip-related basin. The Krowiarki Fault Zone subdivides areas with a different deformation pattern within the sediments of the Central Carpathian Palaeogene Basin and was active at least from the time of cessation of its sedimentation in the early Miocene. Comparison of structural data with the recent tectonic stress field, earthquake focal mechanisms and GPS measurements allows us to conclude that the Krowiarki Fault Zone shows a stable general pattern of tectonic activity for more than the last 20 myr and is presently still active.

Smoking Cessation and Pregnancy: Timing of Cessation Reduces or Eliminates the Effect on Low Birth Weight.

Women who smoke cigarettes while pregnant are at elevated risk of having low birth weight infants (LBW, < 2500g) which increases risks of infant mortality and morbidity, including chronic conditions later in life. Smoking cessation during pregnancy can reduce the risk of poor birth outcomes. However, the effect that timing of smokingcessation has on the reduction of poorbirth outcomes in term pregnancies is unknown. This retrospective cohort study used birth certificate data from Missouri singleton, full-term, live births from 2010 to 2012 (N = 179,653) to examine the rates and timing of smoking cessation during pregnancy on birthweight. Smoking exposure was categorized as non-smoker, preconception cessation, first trimester cessation, second trimester cessation, and smoker. The outcome was low birth weight (LBW). Covariates included maternal race/ethnicity, age, education level, type of payment for the delivery, marital status, paternal acknowledgement, prenatal sexually transmitted infection (STI), comorbidities, and body mass index. Bivariate and multivariable analyses were used to assess relationships between smoking and LBW status. Preconception cessation did not have a statistically higher risk for LBW than mothers who never smoked (aOR 1.12; 95% CI 0.98, 1.28). First trimester cessation (aOR 1.26; 95% CI 1.05, 1.52), second trimester cessation (aOR 2.00; 95% CI 1.60, 2.67), and smoker (aOR 2.46; 95% CI 2.28, 2.67) had increasing odds for LBW relative to mothers who did not smoke. All covariates had significant relationships with the smoking exposure. Preconception cessation yielded LBW rates comparable to non-smokers. The risk for LBW increased as smoking continued throughout pregnancy among full term births, an important new finding in contrast with other studies.

Antihyperglycemic therapy during colonoscopy preparation: A review and suggestions for practical recommendations.

Patients with diabetes have distinct risks during precolonoscopy bowel preparation, caused by change of diet, change of antihyperglycemic medication regimens and diabetes-related complications and comorbidities. These risks include hypoglycemia, water and electrolyte imbalance, acute renal failure, lactic acidosis, ketoacidosis and low quality of bowel preparation. Here we review the existing literature and present recommendations from a subcommittee of the Israeli National Diabetes Council for primary care physicians and gastroenterologists. The instructions include general suggestions on diet and glucose monitoring and specific recommendations on timing of modification or cessation of each of the antihyperglycemic medication types to ensure patient safety during bowel preparation.