The Painless Stop Smoking Cure

How to Quit Smoking Cigarette

Mike Avery is the author of the quit smoking magic program. He is an ex-smoker (20 year habit) and a researcher who has carried out lots of tests on this topic for many years. He used himself as a test subject, after trying everything you can think of to stop smoking. He then tested his quit smoking magic theory on himself and got the results needed. Mike Avery's program of quit smoking magic has successfully helped hundreds of people all over the world quit smoking, including his family members and co- workers. He should be trusted because he has been in the shoes of being a smoker and has cured himself from smoking addiction. So if you are planning on doing the same, you should go to the one person who understands what you are going through. This program will provide you with information about smoking in general and ways on how to stop the smoking addiction from eating you up. Its contents are based on real-life experiences rather than theories that were imagined by someone. It is an e-book program on the subject of quitting smoking and comes with three different bonus e-books on the following topics; how to whiten your teeth, end bad breath and how to clean your lungs. Purchasing this program does not require you to have any technical skill to be able to use it, it only requires you to read and understand. Continue reading...

Quit Smoking Magic Summary


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I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

All the modules inside this e-book are very detailed and explanatory, there is nothing as comprehensive as this guide.

Videoassisted Thoracic Surgery for Lung Cancer

The majority of patients with pulmonary carcinoma present with extensive tumor burden that is centrally located. A minority of patients present with asymptomatic, peripheral tumors. Approximately 37 of solitary lung nodules represent primary lung carcinoma. Therefore these lesions require accurate histological diagnosis for effective treatment. The incidence of lung cancer increases with age and smoking habits. Early diagnosis is imperative as patients with solitary, peripheral lung lesions have the best outcomes following proper treatment. Most if not all operations performed through conventional thoracotomy are possible using VATS. Although technically more demanding initially, VATS is a reasonable surgical option for pulmonary carcinoma. Without 10-year survival data, many thoracic surgeons believe that VATS should be limited to patients with stage IA or IB tumors (T1N0 and T2N0, respectively). Stages I and II tumors are confined to lung parenchyma without mediastinal or...

Nicotine replacement therapy NRT

The advent of nicotine chewing gum in the 1970s provided the first specific pharmacologic treatment for smoking cessation. Grade B Subsequent development of transdermal nicotine patches, nicotine nasal sprays, and nicotine oral inhalers has increased the range of products available. The objective in using these nicotine replacement products is to provide a temporary alternative source of nicotine to allay withdrawal symptoms and so enhance the potential for smoking cessation. Large placebo-controlled trials have clearly demonstrated that the use of such products as an adjunct to advice from a health professional can approximately double smoking cessation rates, compared with placebo.21,22 Several systematic reviews of the many trials that have now been conducted with them have confirmed the benefits and shown that all preparations are effective, but the evidence is particularly substantial for nicotine gum and nicotine patches.23,24 Both appear to have similar effectiveness but,...

Evidence of benefits from smoking cessation

Many observational epidemiologic studies have investigated the effect of stopping smoking on smoking-related diseases, and there is a wealth of evidence that, not only is tobacco smoking a major risk factor for cardiovascular disease, but also stopping smoking reduces this risk. Grade B However, there is less agreement about the rate at which the risk attenuates after smoking cessation. In the 20 year follow up of the British Doctors Study, for example, excess risk was halved within 2 or 3 years of smoking cessation, and by 10 years the risk had returned to that of a non-smoker (Figure 11.1).6 However, follow up of the cohort men in the British Regional Heart Study indicates that attenuation of risk is much slower, and even men who had given up smoking for more than 10 years still had an increased risk, compared with non-smokers (Figure 11.2).7 Following myocardial infarction (MI), smoking cessation confers substantial benefits and is particularly important. In one observational...

Practical aspects of smoking cessation in clinical practice

The essential features of individual smoking cessation interventions in medical practice are to assess in any medical consultation the smoking status of the patient, whether a non-smoker, smoker or ex-smoker advise all smokers about the desirability and importance of stopping smoking because of health hazards, especially those who already have smoking-related diseases assist smokers to stop smoking, particularly those with smoking-related diseases and especially if expressing interest to do so follow up at subsequent consultations to assess the outcome and, if necessary, further assist those trying to stop smoking while encouraging ex-smokers to maintain their non-smoking status.32

Specialist smoking cessation clinics

Specialist smoking cessation clinics have been shown to deliver effective interventions and can make a useful contribution to the provision of individual interventions, usually by providing regular group treatments. There is some evidence that they can achieve enhanced attendance and abstinence rates as high as 20 or more, but interpretation of their success should take account of the fact that they recruit widely and participants are generally highly motivated to stop, compared with the majority of those expressing an intention to do so. When available, they offer a self-referral and secondary referral service and can provide valuable opportunities for smoking cessation research.31 However, as they are relatively few in number in relation to the huge need for such interventions, their overall contribution will inevitably be small.

Late Phase Ii Clinical Trial Of S1 In Lung Cancer

The objective of this clinical trial was to examine the antitumor activity and toxicity profile of S-1 in patients with stage Illb or IV lung cancer who underwent no treatment prior to the onset of this clinical trial. Sixty-two patients were enrolled in this clinical trial, and 61 patients were treated with S-1. Fifty-nine patients were eligible for the analysis of response and toxicities. S-1 was administered orally at a dose of 40 mg m2, twice daily, i.e., once after breakfast and once after dinner. One course consisted of 28-d consecutive oral administration and of subsequent 14-d withdrawal. This regimen was repeated in four courses unless the disease progressed. Twenty-two patients with stage IIIb lung cancer and 37 patients with stage IV lung cancer were enrolled in this clinical trial. As shown in Table 11, the response rate per protocol set was 22.0 (13 59). As shown in Fig. 15, the median follow-up was 281

Tobacco and Nicotine

Native American Psychotropic Drugs

Tobacco is one of the most powerful stimulant plants known, and nicotine its active principle is one of the most toxic of all drugs. An average cigar contains enough nicotine to kill several people. When tobacco is smoked, most of the nicotine is destroyed by the heat of burning. (To kill people with a cigar, you'd have to soak the cigar in water till it turned dark, then make people drink the liquid.) Nicotine is so strong and dangerous that the body very quickly develops tolerance to it to protect itself. If a person begins smoking regularly, tolerance to the poisonous effects of nicotine develops in a matter of hours (as compared to days or weeks for heroin and months for alcohol). In the form of cigarettes, tobacco is the most addictive drug known. It is harder to break the habit of smoking cigarettes than it is to stop using heroin or alcohol. Moreover, many people learn to use alcohol and heroin in nonaddictive ways, whereas very few cigarette smokers can avoid becoming addicts....

Lung cancer

Cancer of the lung is the leading cause of cancer-related death in males and the incidence is rising in females. Regrettably it is closely related to tobacco smoking and control in the future depends largely on government measures to reduce tobacco consumption. From a practical point of view, lung cancers are categorized as small or non-small cell cancers. Table 18.2. World Health Organization histologic classification of lung cancer.


Although -nicotine is the predominant natural isomer, the occurrence of some d-nicotine makes it of interest to develop enantioselective assays for this compound. A review of nicotine and cotinine assays has been given (42), An early report of an RIA for -nicotine described an immunogen prepared from 6-aminonicotine. This compound was converted to 6-(p-aminobenzamido)nicotine and conjugated to albumin Fig. 4 8b ) by diazotization (43), The enantiomeric purity of the 6-aminonicotine was not discussed, and the synthesis of 6-aminonicotine is reported to cause racemization (44). However, the antiserum eventually obtained showed only 6 cross-reaction with d-nicotine (43). A racemic nicotine analog, ra s-3 - h y d roxy methy 1 - n i coti ne, was converted to the hemisuccinate, which was conjugated to protein to form an immunogen (Fig. 4 8c ). The resulting antiserum was used with tritiated -nicotine as radioligand. With this radioligand the assay was highly selective for -nicotine, with...

Degradation Turnover and Factors that Induce Increased Requirements for Vitamin C

It remains largely a mystery why some people succumb to classical scurvy after a short period of virtually zero intake, whereas others survive for much longer. It has been speculated that some people may be able to produce all of the enzymes of the vitamin C synthetic pathway, including gulo-nolactone oxidase, which is normally absent from humans. However, this now seems unlikely, and it is more probable that the retention and recycling mechanisms for the vitamin are more efficient in some people than in others. We now know, for example, that smokers have a higher turnover of endogenous vitamin C than non-smokers, presumably because of the free-radical oxidant species in cigarette smoke. People with infections also have increased vitamin C turnover, which is associated with the liberation of pro-oxidant substances (such as hypochlorous acid) that are used by the body to kill bacteria. Some people have isoforms of certain blood proteins such as haptoglobins that are associated with...

The role of dairy products in preventing dental caries

An individual's dietary and social patterns are major contributors to one's oral health. The quality of life can be greatly impacted as a result of poor oral health leaving a negative impact on self-esteem, eating ability, and social functioning (Moynihan, 2005). Several oral diseases can be linked back to poor nutrition, and as teeth deteriorate the conditions are exacerbated. Studies (Johansson et al., 1994, Norlen et al., 1993) have shown edentulous individuals are more apt to have inadequate dietary intake (high carbohydrate, high fat, low nutrient density foods) than dentate individuals. Sugars, specifically sucrose, are recognized as being a major contributor to dental caries' etiology. Other social factors such as alcohol and tobacco use, drug abuse, poor hygiene, and poor nutrition are also cited as being major contributory factors to oral diseases.

The Anger Episode Model

Models Anger

The medical problems associated with anger are particularly problematic since they often are not linked to anger episodes by patients. Outcomes linked to a stimulus are likely to be those that are close in time. Thus, patients are most likely to see the interpersonal costs of anger. In contrast, many medical anger outcomes are like those associated with cigarette smoking they do not appear for years. Nevertheless, the data show that longer term, persistent anger is associated with hypertension, stroke, myocardial infarction, and cancer. For example, Williams and her associates (2000) completed a large-scale prospective study of the relationship of trait anger to cardiovascular heart disease (CHD). Middle-aged men and women (n 12,986), initially free of coronary disease, were followed for a mean of 53 months. Results indicated that among adults with normal blood pressure, the risk of coronary events increased directly with increasing levels of trait anger. High-anger adults were 2.6

The Mthfr Gene Product MTHFR

More recently, Dekou et al. reported that the frequency of the MTHFR 677T allele of the coronary heart disease high-risk town of Dewsbury was significantly higher than in the coronary heart disease low-risk town of Maidstone and was associated with increased total homocysteine plasma concentrations (21). This effect was seen in men but not in women and was not observed for MTHFR 1298A C. Furthermore, a higher susceptibility for malignant lymphoma has been observed in individuals with the combined MTHFR 677CC 1298AA genotype, as well as those with the MTR 2756GG genotype (22). Moreover, the MTHFR 677C T mutation, smoking, and folate status were strong interactive determinants of high-risk adenomas of the colorectum (23). In this study, the risk was particularly high in smokers with low folate and the MTHFR 677CT or the MTHFR 677TT genotype, and in smokers with high folate and the MTHFR 677CC genotype. This risk pattern was also observed for colorectal hyperplastic polyps. Together,...

The Problem of Toxins in the United States

Radiation is not the only risk factor for cancer Pesticides and other chemicals are implicated as well. A study showed that the mammary adipose tissue of women with breast cancer contained significantly more residues of chemicals associated with pesticides than did the mammary tissue of women with nonmalignant tumors (Falck et al.). Another study revealed that among white male scientists and engineers those who were members of the American Chemical Society had significantly more deaths from leukemia and lymphatic cancer (Arnetz et al.). A study of men from Iowa and Minnesota showed a link between elevated environmental chemical exposures that resulted from living near a factory and two types of cancer non-Hodgkin's lymphoma and leukemia (Linos et al.). Non-Hodgkin's lymphoma also has been linked to the use of certain pesticides (Weber). Foundry workers in Denmark who were exposed to elevated levels of silica dust, metallic fumes, carbon monoxide, and several organic chemicals had...

Personality Differences by Gender

Men are supposed to represent the family to the world outside the domicile, acting as the official host on ritual occasions they greet visitors and instruct the women to feed the guests. Men distribute shot glasses of refino (sugar cane alcohol) and cigarettes, and they occupy the main room of the house that usually contains the family altar. Women occupy the kitchen, a smaller room containing the hearth and attached to the main dwelling. However, it would be a mistake to conclude that men are the dominant personality in gender relations. Some women order their husbands around, speaking in harsh-sounding tones. Occasionally men lose control and hit their wives, but men are criticized when they act violently toward women and they are expected to control their ilihuiz.

Class Discovery And Correlates Of Disease Histology

There is now clear evidence that tumors of different histology from specific anatomic sites may often be discerned by their molecular profiles. For example, in lung cancer, clustering algorithms readily enable the distinction between squamous, large cell, small cell, and adenocarcinoma (43,44). Ono et al. (19) have assessed the molecular profiles of ovarian carcinomas with mucinous or serous papillary histologies using cDNA arrays comprised of 9121 distinct human genes. Using the Mann-Whitney test, the authors reported significant differential expression of 115 genes between histological subtypes. The identity of the genes do not readily pin-point a major underlying biological theme related to the distinction between the histological subtypes, and it is somewhat surprising that genes known to be differentially expressed, such as the mucin, MUC-2 (45), were not identified by this analysis. However, additional studies with these genes and their encoded proteins may reveal biologically...

Courtship and Marriage

When a girl reaches maturity with menarche, her public behavior is expected to conform to standards that reduce her sexual appeal and is absent of flirtatious gestures toward unrelated young men. However, there are opportunities for young people to meet and fall in love. Regular night songfests and festivals that last overnight are widely attended. During these times there is little supervision of unmarried girls and boys, as they perform competitive line singing and line dances, and share alcohol and cigarettes. It is not uncommon to hear about flirtations and liaisons that occur during the dark night hours. These special friends may meet in the forests, away from others' sight. They rarely result in marriage.

Results from Twin Studies of Other Disorders and Conditions

The twin study method has been used to try to determine the extent of genetic or environmental influence on a wide variety of traits and conditions. Among these are sense of humor, which appears to be largely environmentally determined, as MZ and DZ pairs have similar concordance. Examples of other diseases in which MZ concordance exceeds DZ concordance, suggesting a significant genetic component, include addictive behaviors such as cigarette smoking and alcohol drinking, mental illnesses such as schizophrenia, as well as stroke and certain types of high blood pressure. Twin studies of many other disorders are ongoing.

Conclusion Is Cholera a Signpost

Although cholera transmission and treatment reveal particular components of human behavior and thought, other modern epidemics have their own stories to tell AIDS, lung cancer, Mad Cow Disease, SARS, or any of dozens of other diseases also reveal how human groups are organized, ranked, managed, and sustained or exterminated over time. To explore this issue fully, and to learn what is unique and what general,

Initial patient education

Abstinence from alcohol, cigarettes, illicit drugs should be assessed. Information on the safety of commonly used nonprescription drugs, signs and symptoms to be reported should be discussed, as appropriate for gestational age (eg, vaginal bleeding, ruptured membranes, contractions, decreased fetal activity).

Tumor Markers in Human Neoplastic Disease

Notice from the table that a number of markers are still in the experimental stage, and actually only those so indicated are approved by the U.S. Food and Drug Administration for use in the United States. In mesenchymal neoplasms as well as lymphomas and leukemias, it is apparent that the cytogenetic markers are primarily for diagnostic purposes. Similarly, but not shown in the table, is the use of cytoskeletal proteins as tissue markers for a variety of different types of neoplasms that aid the pathologist in specific diagnoses (Virtanen et al., 1984 Table 16.4). If one analyzes the tumor markers associated with any specific type of neoplasm, a wide variety of different markers, both in tissue and body fluid, may be seen. Table 17.14 presents a short list of markers found in two different types of lung cancer at two different stages (Chapter 10). However, this is only a small part of the total number of markers that have been described in human bronchogenic carcinoma (e.g., Coombes...

Cessation of smoking Grade A

Cigarette smoking has many adverse health effects, including a significant risk of coronary disease. Given the addictive nature of smoking, most smoking cessation programs have limited success ( 6 more patients stop smoking in 12 months than do controls).21 As reviewed in previous chapters, observational data suggest that those who succeed in quitting experience a sharp decline in the high cardiovascular risk associated with smoking in the first 6 months, and their risk reaches the level of non-smokers after 1-2 years. This decrease in cardiovascular risk from smoking cessation has been estimated to increase life expectancy for each quitter by between 2 and 5 years.22 Furthermore, each smoker who quits is associated with an average reduction in CAD-related medical costs of about 900 over the ensuing 8 years.23 In a primary prevention study, Cummings and colleagues24 created a model to examine the cost effectiveness of physician counseling (versus no counseling) on smoking cessation....

Multiple risk factor interventions Grade B

The studies reviewed thus far have focused on the cost effectiveness of single risk factor interventions independent of other risk factors. In clinical practice patients have multiple risk factors that require multiple concurrent interventions. The Stanford Coronary Risk Intervention Program (SCRIP) evaluated the effect of multifactor risk modification on the progression of angiographic CAD in 300 patients.49 The intervention program consisted of exercise, dietary modifications, weight loss, lipid lowering pharmacotherapy and smoking cessation. After 4 years, patients in the intervention arm had on average a 20 increase in exercise capacity, a 4 decrease in weight, and a 22 reduction in LDL cholesterol compared with those receiving usual care. Angiographically, those in the risk intervention arm had significant attenuation of coronary disease progression. In addition, there was a decrease in the composite end point of death, non-fatal MI, PTCA and CABG (P 0-05). Based on these results...

Vitamin C Ascorbic Acid

In most situations, it has been associated with premature rupture of the membranes, increased risk of infections, preterm birth, and eclampsia. Smokers have lower levels of ascorbic acid in their serum and amniotic fluid. Based on the amount known to prevent infants from developing scurvy, the EAR is increased by 10mg day to 66mg day for those 14-18 years old and to 70mg day for adult women, and the RDA is 80 and 85mg day for these groups, respectively. The recommended intake is also increased by 10mg day in the United Kingdom. Women who smoke more than 20 cigarettes per day and regular aspirin users may require twice as much, as may heavy users of alcohol and street drugs. The UL of 2000mg day is based on prevention of diarrhea and gastrointestinal disturbances that occur with high intakes.

Anthropological Participation in Population Interventions

Health campaigns often rely on the authority of professionals to urge the populace to change its use of medications. Other public health campaigns urge the populace to stop smoking, drink responsibly, use condoms, wear seatbelts, brush teeth, or thoroughly cook meat. Intervention designers rely on various sources of authority when they call for these practices. They employ the authority of science - that scientific studies show that continuing practice X increases risk of outcome Y. They employ the authority of government, urging citizens to comply because policy X is more effective and less costly than policy Y. And they employ the authority of medicine, that doctors say practice Z is healthier.

The Mann Whitney test a nonparametric method

The defining characteristic of all non-parametric tests is that we take the data and convert it into ranks. To convert the toxin data we start with the actual quantities of toxin produced (forget about the log-transformed data for this test), and search through it looking for the lowest single value. This turns out to be the value of 2.5 p.g for the first of the non-smokers, so this is awarded the rank value of 1. The next lowest values (3.10, 3.90, 4.20, 4.25, 4.45 and 4.95) are also among non-smokers and get ranks of 2, 3, 4, 5, 6 and 7. The next value is then for one of the smokers (5.15) and it gets rank 8. This process continues simply enough for the lowest 12 values, but then we find that the next value (6.10) occurs twice (among Smokers Non-smokers Smokers Non-smokers the non-smokers). These are referred to as tied values. They should get ranks 13 and14, but there is no logical reason why one should be ranked higher than the other, so they each receive a rank of 13.5. We...

Bioethics Perspective I Health Disparities

Some observers attribute the health gap to biology, suggesting that excess infant deaths and disproportionate incidences of lung cancer and breast cancer deaths are due to genetic differences. Others attribute the high rate of sickness and death to irresponsible lifestyles. According to this explanation, African-American women and men refuse or neglect to get timely cancer screenings until it is too late to curb the spread of the condition, or they prefer to smoke high-nicotine content cigarettes and drink high-alcohol content liquor that increase lung and liver disease (Moore, Williams, and Qualls). Still others attribute the disparity in health

Spectrum Somatic Mutations in Retinoblastomas and Other Tumors

It is possible that all retinoblastomas have mutations in both alleles of the RB1 gene. RB1 gene mutations have also been identified in several other tumor entities including osteogenic sarcoma and small cell lung cancer. The spectrum of somatic mutations comprises that of germ-line mutations with two important additions

Empirical Studies

Even though extinction can be used to reduce a variety of behaviors in a wide range of individuals, extinction has characteristics that limit its utility. One limitation is that it may not be possible to arrange conditions so that the consequences that historically reinforced an inappropriate behavior are no longer available. For example, a middle-school student's swearing may be maintained by the laughter of peers. Trying to arrange the world so that the peers stopped laughing following jokes would be, at best, difficult. More likely, it would be impossible. Similarly, nicotine is a powerful positive re-inforcer that plays a major role in the maintenance of cigarette smoking. There is presently no way to eliminate nicotine as a consequence of smoking, although some pharmacological technique for producing such an effect may eventually be developed. Drugs such as nal-trexone block the physiological, subjective, and positively reinforcing effects of heroin, and have potential for the...

Acquired neuromyotonia Isaacs syndrome

Acquired neuromyotonia is a rare disorder characterized by widespread muscle twitching (myokymia) and cramps, sometimes associated with muscle hypertrophy, stiffness, weakness, increased sweating and central effects. Onset can be from adolescence to old age. There is an association with thymoma, with myasthenia gravis, and probably also with lung cancer.

Medications for the relief of dyspnoea at the end of life

A detailed overview of the characteristics of the palliative population with breathlessness is given in a prospective convenience sample study by Dudgeon and Lertzman.2 As a referral-based specialty, this may not represent all breathlessness at the end of life. The heterogeneity of the palliative population with breathlessness is underlined when 100 consecutive cancer patients with shortness of breath in two inpatient units were examined. Seventy per cent of people with breathlessness at the end of life had more than a 20 pack-year history of smoking. Primary lung cancer accounted for half of the patients admitted to this study, but a reproducible denominator for the whole population (not just those referred to specialized palliative services) is difficult to determine. Almost one third had current cardiac problems that would be likely to add to breath-lessness. Most patients had several identifiable contributing factors to their breathlessness on history, examination or from...

Research Approach for Determining the Health Impact of Micronutrient Supplements

Considerable preclinical evidence related to human health effects from in vitro laboratory research and in vivo animal studies exists for many micronutrients. In addition, many epidemiologic studies throughout the world have focused on the possible relationship between specific micronutrients and chronic disease. Small clinical studies related to chronic disease also have been carried out for many micronutrients, and human safety data are available for most micronutrients. A comprehensive review of epidemiologic studies and randomized controlled trials of vitamin supplementation to prevent either cancer or cardiovascular disease (CVD) was conducted by the US Preventive Services Task Force. The Task Force concluded that findings did not demonstrate a consistent or significant effect of any single vitamin or combination of vitamins on either incidence of CVD or death from this disease. Also, the Task Force concluded that -carotene supplements and combinations including -carotene...

Anthropology of Drug

The cultural contexts in which drug use occurs, however, may not lend themselves to the production of a definitive monograph. In most parts of the contemporary world, whether people are using tobacco, ayahuasca, or heroin, societies have multicultural components in highly interdependent systems of symbols and exchange. For this reason, the specialized study of drug use had to arise, and it began to do so by the middle of the 20th century. One of the earliest examples of this kind of specialized study was Lowie's (1919) monograph on the Crow Tobacco Society. It related tobacco use with many other aspects of Crow life, including religion, social structure, linguistics, and ethnobotany, demonstrating the aptness of the anthropological view in studying patterns of drug use. Lowie also exemplifies anthropologists who did not necessarily focus on drug use, but in the course of their investigations, characterized drug use in specific cultural contexts (cf. Honigmann & Honigmann, 1945 Mangin,...

DNA Oxidation and Damage

Protecting DNA from oxidative damage is thought to be an important mechanism in cancer prevention. Flavonoids may be important in reducing DNA damage, especially in smokers, who are exposed to significant, self-induced oxidative stress. For example, the rate of sister chromatid exchange in muta-gen-stimulated peripheral lymphocytes was higher in smokers than nonsmokers, but the rate in smokers was reduced to that of the nonsmokers after 6 months' consumption of two or three cups of green tea per day. Another marker of DNA oxidation is 8-hydroxy-2'-deoxyguanosine. White blood cell content and urinary excretion of 8-hydroxy-2'-deoxyguanosine are reduced in smokers and nonsmokers following consumption of green tea compared to no tea. Furthermore, the reduction is greater for smokers than for nonsmokers. However, not all results are consistent. For example, in a study of healthy subjects consuming a

Biomarkers of Diseases

Changes in cell signaling pathways, subclinical inflammation, and interactions of circulating cells with the endothelium. Some of these proteins have been identified as independent risk factors of cardiovascular disease and they remain important, emerging markers of disease. Despite the improvement in vascular reactivity associated with tea consumption, cell adhesion molecules do not appear to be altered by tea consumption in smokers and nonsmokers. These adhesion molecules are also related to endothelial function and are involved in the early etiology of atherosclerosis. Similar to tea, cocoa powder and chocolate consumption also do not alter proinflammatory cytokines, adhesion molecules, and acute phase proteins.

Broadening Perspectives on the Consequences of Drug

Acknowledgment that drug use may have different impacts under different cultural circumstances, regardless of the drug being consumed, provided an important perspective on the impact of drugs in different cultural settings. Heath (1958) and Carter (1977) concluded that problems related to alcohol consumption may have markedly different frequencies in cultural settings that restricted drinking to ritual contexts. Wilbert (1990) and Lowie (1919) made the same point about tobacco in traditional Native American cultural environments. On the other hand, in circumstances of poverty and marginaliza-tion, Singer (1986) made a convincing case for expecting increases in alcohol-related problems among Puerto Rican immigrants to the northeastern United States. Problems related to fully commercialized tobacco use, the most ruinous drug in terms of impact on the public health, have also drawn the attention of anthropologists attempting to find strategies for preventing the onset of addiction to...

Extraction Circuit Psepl Psep2

1) Purification of the feedstock The feed raw material is regarded as the product from which certain components must be removed during the extraction process. Examples being the production of decaffeinated coffee and of nicotine-free tobacco. Furthermore, it may be required to recover both the solids as well as certain extracted components. In addition, there are cases where the plant must be operated in two stages extracting one component from the feedstock, storing it temporarily and, after the extraction of second constituent, returning it to the bulk material. This procedure is adopted when a certain component A is to be selectively removed while retaining a component B in the feedstock which is more volatile than A. For example, in the high pressure extraction of tea, it is essential to remove the tea aroma from a batch fed into an extraction vessel in order to add this aroma to an already decaffeinated batch in another vessel. A similar situation exists in the case of tobacco,...

Clinical Significance

Like the adverse effects of thiazides on glucose metabolism, their effect on plasma lipids is reversible. Therefore, discontinuation of thiazides and use of alternative agents which either lower (e.g., ACE inhibitors, calcium channel blockers) or do not change plasma cholesterol should probably be used for treatment of hypertension in patients with preexisting hypercholesterolemia or combinations of other risk factors such as diabetes, left ventricular hypertrophy, and cigarette smoking.

Spontaneous pneumothorax

Spontaneous Pneumothorax Surgery

Spontaneous pneumothorax in its commonest form is a disease of young adults, occurring more frequently amongst males than females, and is due to rupture of a bleb. These are usually found at the apex of the upper lobes and, although their origin is still obscure, they probably follow minor infection with patchy fibrosis and contraction of areas on the surface of the lung creating blebs in between. Rarely, they may occur in women at the time of menses and may be associated with Marfan's syndrome, Pneumocystis carinii infection, particularly in patients with AIDS, granulomas and lymphangio-leiomyomatosis. It is commoner amongst smokers and seems particularly prevalent at times of sharp barometric change.

Confounded epidemiological data

Questionnaires are often used to record epidemiological rather than planned experimental data. To appreciate the difference between these, think about a situation where we want to compare some sort of outcome between smokers and non-smokers. You might find that your local ethics committee has certain reservations about the above approach, and in practice you would have to make do with an epidemiological study. Here, you simply accept that some folk have already elected to smoke and others not and you look at the relevant outcome in these two pre-existing groups. Your problem now is that people do not just randomly decide whether to smoke. It is very likely that smokers and non-smokers will differ in all sorts of other ways. The smokers maybe younger older, from different social classes, have different patterns of occupation, show a different ethnic mix, etc. So any difference in outcome might be due to smoking, but could also be due to differences in one of these other factors. We say...

In epidemiological studies an association is never proof of a cause and effect relationship

The classic example is smoking and lung cancer. The initial evidence was necessarily epidemiological and the tobacco barons were long able to muddy the waters with disingenuous arguments that the association might be confounded. Maybe there was a gene that tended to make the bearer more likely to choose to smoke and also induced lung cancer. People who smoked might also elect to indulge in other activities which were the real cause of the lung cancer. Now that we can identify the relevant chemicals in cigarette smoke and have elucidated the details of how they damage DNA, the case for a causal relationship is clear to all but a few diehard smokers (there are none so blind as those who do not wish to see). The great example of confounding (OK, it is probably mythical) was the survey that found that people who carried matches were more likely to contract lung cancer - a finding that might be perfectly credible, but needs to be interpreted with caution.

Selected Issues in Clinical Development

It is to be hoped that new medicinal treatments will, by virtue of their being effective, have a measurable impact on health-related QOL (Fig. 8.38). Historically, the basis for new drug approval has accepted this hope as a reality by implicitly assuming that when biological evidence of efficacy exists, there will be health-related benefits to the patient. QOL end points, either as add-ons to a traditional efficacy study or as free-standing studies, have become increasingly important in supporting comparative product claims and drug pricing and reimbursement. QOL is not, however, necessarily different from efficacy. QOL may serve as basis for approval. The best examples of this are in the area of oncology. Traditional biological oncology end points, such as tumor response and time to event variables (especially survival), have historically served as bases for new drug approval. Although FDA Oncology Division guidances over the past 20 years have invoked QOL end points as an acceptable...

Pesticide Residues In Food

The term pesticide is used to describe any chemical agent that controls pests. In the United States, more than 20,000 pesticide products are registered (1). Traditionally, pesticides are used in agriculture, but nonagricultural uses are also common and include garden and household pest control, sanitation, wood preservation, and mosquito abatement. Pesticides contribute large economic and health benefits to society through minimizing crop losses, protecting the nutritional integrity of food, ensuring year-round storage, and providing appealing foods (2). Since as early as 1000 B.c. the Chinese used sulfur as a fungicide to control mildew on fruit today sulfur remains an important fungicide. In the sixteenth century, arsenical compounds were popular insecticides and in the seventeenth century, nicotine, rotenone, and Chrysanthemum extracts were introduced as insecticides and are still in use (3). In the United States, widespread utilization of pesticides in agriculture occurred after...

Cancer Epidemiological Evidence

The Linxian, China, intervention trial provided evidence that nutritional supplementation may lower the risk of certain cancers. A modest but significant reduction in cancer mortality was observed in a general population trial in those receiving daily (for 5.25 years) a combination of ft-carotene (15 mg), vitamin E (30 mg), and selenium (50 mg). The subjects who received this mixture had a 13 lower incidence of cancer and a 10 lower mortality from stomach and oesophageal cancer than did the subjects who did not receive the mixture. In the ATBC study, male smokers who took vitamin E supplements had a 34 lower incidence of prostate cancer and 41 lower mortality from prostate cancer than did those who did not take the supplements. In the United States, in a nested case-control study conducted to examine the association of a-tocopherol, 7-tocopherol, and selenium with the incidence of prostate cancer, a striking fivefold reduction in risk was observed for the men in the highest quintile...

Chronic Stress and Depression 1 Animal Research

The results of studies examining immune consequences of chronic stress in humans largely parallel the findings in animals. Research across a range of chronic stress situations, including bereavement, caregiving for a relative with dementia, unemployment, and diagnosis with a life-threatening illness, reveals that stressed individuals have altered immune function in comparison with controls. In contrast to the acute stress literature, chronic stress is typically, although not always, associated with lower numbers of immune cells and weaker immune functioning. In particular, chronic stress associated with the loss or disruption of personal relationships has been shown to reliably alter immune activity. For instance, women who have been separated or divorced for less than 1 year have demonstrated poorer immune function than married women, and both men and women who reported poor marital quality had lower immune function than more happily married individuals. Research has also suggested...

Oral diseases and cariogenicity

Hydroxyapatite Ca10 Po4

Oral refers to the mouth, and includes the teeth and gums (gingival) and their supporting tissues, the hard and soft palate, the mucosal lining of the mouth and throat, the lips, salivary glands, chewing muscles, and upper and lower jaw bones. Digestion begins in the oral cavity, and there are numerous supporting structures for the mouth including the nervous, vascular, and immune systems. Humans contract oral diseases for a number of reasons including genetics, poor hygiene, poor nutrition, alcohol and tobacco use, drug abuse (Shaner et al., 2006), and complications from other diseases such as diabetes (Sandberg et al., 2000, Twetman et al., 2002), cancer (Woo et al., 1993), obesity (Ritchie and Kinane, 2003), and osteoporosis (Norlen et al., 1993). Oral infections themselves may play a role in progressing pathogenesis of many systemic diseases in healthy individuals, ill patients, and those immunocompromised (Ridker et al., 1998). The theory is that oral infections, specifically...

Epidemiology and Medical Anthropology

Epidemiologists describe disease patterns using data about the past or data collected from the present into the future. They use prospective study designs to follow a group of people over time, tracking their exposure to potential causes of disease and observing whether rates of disease differ according to whether or not a person was exposed. For example, a study might track oral contraceptive use in a group of nurses over 15 years and conclude that their likelihood of getting breast cancer was influenced by whether they took birth control pills. Retrospective studies look at records or reports of people who already have a disease, comparing the proportion of people who do not have a prior history of a particular behavior or exposure with the proportion of those who do. For example, researchers might begin with a group of adults with lung cancer and compare the proportion of smokers and nonsmokers. Epidemiologists make these types of

Pharmacodynamic PD properties

Anthracycline Semiquinone

In general, the antitumor activity of doxorubicin and epirubicin appears to be similar in various orthotopic tumor models as well as in human tumor xenografts in nude mice. Differences in the spectra of antitumor activity have been noted but it appears that the predictive value for clinical use remains uncertain. Both drugs, DOX and EPI, showed activity against breast carcinoma, small cell lung cancer, and sarcoma and were not active in colon tumors 13 . In non-small cell lung cancer the in vivo results showed activity in three quarters of tumors transplanted into nude mice with both anthracyclines, a result which does not correlate with clinical results. The same holds true for melanoma. For this reason in vivo evaluations in a large panel of human tumors in nude mice can only give a first indication for future clinical development. There is clearly a limitation of tumor in vivo models which do not reflect correctly the tumor biology in humans, e.g., host-tumor interactions in man...

Classification of neurotransmitter receptors

Muscarinic Receptor Camp

Sir Henry Dale noticed that the different esters of choline elicited responses in isolated organ preparations which were similar to those seen following the application of either of the natural substances muscarine (from poisonous toadstools) or nicotine. This led Dale to conclude that, in the appropriate organs, acetylcholine could act on either muscarinic or nicotinic receptors. Later it was found that the effects of muscarine and nicotine could be blocked by atropine and tubocurarine, respectively. Further studies showed that these receptors differed not only in their molecular structure but also in the ways in which they brought about their physiological responses once the receptor has been stimulated by an agonist. Thus nicotinic receptors were found to be linked directly to an ion channel and their activation always caused a rapid increase in cellular permeability to sodium and potassium ions. Conversely, the responses to muscarinic receptor stimulation were slower and involved...

Trigeminal chemosensitivity chemesthesis 241 Fibres and receptors

Several types of irritant-sensitive receptors have been identified. A neuronal nicotinic receptor (NnAChR) is involved in the response of the rat ethmoidal nerve to nicotine as shown by the use of blockers that decrease trigeminal responses to nicotine without affecting responses to another compound (cyclo-hexanone) (Alimohammadi and Silver 2000, 2003). Messenger RNA transcripts and proteins of purin receptors (P2X) - ion channels activated by ATP - have been identified in trigeminal neurons. Two subunits, P2X2 and P2X3, which can form homodimeric or heterodimeric receptors are predominantly expressed (Paul et al. 2002). In studies of the trigeminal system a few chemicals have been preferentially utilized, essentially nicotine, CO2 and capsaicin along with some other components of pungent spices. However, it is generally agreed that a wide variety of compounds, including olfactory stimuli, are potentially active on trigeminal endings. Early electrophysiological recordings indicated...

Bernard E Bulwer MD MSc and Scott D Solomon MD

At the time of presentation, his medications included captopril, lasix, digoxin, potassium chloride, aspirin, multivitamins, and unspecified dietary supplements. He had no known drug allergies. His family history was significant for coronary heart disease. He smoked more than two packs of cigarettes daily for more than 20 yr, and averaged almost a quart of alcoholic beverages of various descriptions. He admitted no intravenous drug use, but occasionally used cocaine.

Biochemistry Of Ne

Biochemistry The Brain

Involving the production of new TH enzyme occurs at the level of transcription and translation in response to various stimuli via three main second messengers cyclic AMP, diacylglycerol, and calcium. Nerve growth factor and cell-cell contacts are important during development to promote and maintain the catecholaminergic phenotype, and neurotransmitters and glucocorticoids mediate the activation of TH in response to environmental changes such as stress and exposure to certain drugs such as reserpine, nicotine, or cocaine.

Ethical Issues in Ecogenetics

Specific individual often will be unclear. The well-recognized interaction of cigarette smoking with workplace asbestos exposure in causing lung cancer reveals some of the scientific uncertainties and ethical problems associated with assignments of disease causation in individual cases. The mere fact that a person has a gene that predisposes him or her to a specific disease and then goes on to develop that disease does not establish that the genetic susceptibility was the cause of the disease. Other genetic or environmental factors, for example, may have contributed substantially to the outcome.

Clinical Features

In older patients, infections and nephrolithiasis remain common causes of hematuria, but after age 40 any hematuria, even with a clear diagnosis of urinary tract infection or stone, warrants close follow-up and retesting of urine because renal, bladder, and prostate cancer increase in frequency and may coexist with urinary tract infection or kidney stone. Risk factors for uroepithelial cancer in addition to age over 40 include excessive analgesic use, tobacco use, occupational exposures (e.g., to dyes, benzenes, or aromatic amines), pelvic irradiation, and cyclophosphamide use. Similarly, hematuria in a patient on oral anticoagulants should not be attributed to the anticoagulant alone, since the incidence of underlying disease may be as high as 80 percent. 8 Expanding abdominal aortic aneurisms (AAAs) may erode into the urogenital tract or cause inflammation or obstruction from direct pressure. Signs and symptoms include back or flank pain, with or without hematuria.

Analytical strategies

An intervention study is a type of prospective study that can be very conclusive as well as very expensive. In intervention studies, the epidemiologist intervenes with the study population, e.g., smokers given a pill containing vitamin E, vitamin C, and beta-carotene to test the effect of supplemental antioxidants on the incidence of lung cancer. Thus, the investigator exerts a degree of control over the risk factors of interest, i.e., intakes of antioxidants.

Degenerative valve disease

Standing Seam Panels

The results of these studies suggest that degenerative valve disease does not have to be regarded as an inevitable consequence of aging, and that these findings might be translated to preventive measures. Taking into consideration that atherosclerotic heart disease, at least coronary heart disease, is to a certain extent a preventable condition, in which efforts have to be made to modify the natural (or unnatural course), the same principles would apply to degenerative valve disease. Accordingly, early forms of aortic stenosis and, probably, of aortic sclerosis and mitral annulus calcification should be considered as indicators to implement measures generally used to treat atherosclerotic vascular disease, including diet modification, tobacco consumption cessation, plasma lipid determinations, and blood pressure control.

Aat Deficiency And Disease

Aat Deficiency

Adult life, particularly in cigarette smokers. 8 The Z variant is prevalent in northern Europeans, with a frequency of about 1.5 in Sweden and Norway, and greater than 2 in Denmark, Latvia, and Estonia. 9 It is extremely rare in Asian and African populations. The Z protein is synthesized normally, but tends to polymerize in The association with pulmonary emphysema is related to cigarette smoking, highlighting an important interaction between genetic and environmental factors. This is thought to arise from the action of neutrophil elastase, a major protease of neutrophils released during an inflammatory state. Deficiency of AAT, its major inhibitor,

Middle Age and Old Age

Retirement and or having grown children mark old age in Hungary. As of the late 1990s, 19 of the Hungarian population was over 60 years of age (15.8 of the total male population and 21.8 of the total female population) (Foldesi, 1998). While there are many reasons for the difference between men and women, a few contributing factors are that many more men than women in this age group smoke cigarettes, drink alcohol regularly, and remain unwilling to change their traditional diet for a healthier one. At the same time, only 1 more of the men in this age group (5 vs. 4 of women) have remained physically active into their old age, which might have

Classification And Properties

Most alkaloids are colorless crystalline solids with a defined melting point or decomposition range (eg, vindoline and morphine). Some alkaloids are amorphous gums and some are liquids (eg, nicotine and conine) and some are colored (eg, berberine is yellow and betanidine is red). Ornithine-derived alkaloids include the tropanes (atropine, Z-hyoscyamine, -scopolamine, and cocaine), the Senecio alkaloids, and nicotine.

Transforming data to a normal distribution

17.1.1 Production of a toxic metabolite in smokers and non-smokers In a small minority of users, an analgesic produces a serious side-effect -inflammation of the liver. It is suspected that this may be due to a very minor, but toxic metabolite. It has been noted that the reaction is about twice as frequent among smokers compared with non-smokers. A theory is advanced that, because smoking induces greater levels of certain metabolic enzymes in the liver, the increased susceptibility among smokers might be due to the production of greater quantities of the toxic metabolite. If this theory were correct, then it ought to be possible to detect increased production of the rogue metabolite in smokers. Table 17.1 shows the amount of the relevant metabolite recovered in the urine of 20 smokers and non-smokers, following the ingestion of an oral dose (50 mg) of the drug. For now, focus on the first two columns and ignore the log data. These quantities of metabolite are shown in Figure 17.1....

Chronic Obstructive Pulmonary Disease

Chronic bronchitis and emphysema are different pathologically but frequently co-exist as chronic obstructive pulmonary disease. A patient's condition may fall anywhere in a spectrum from solely chronic bronchitis to solely emphysema, with the majority of patients possessing symptoms and signs of both. The main feature of both diseases is generalised airflow obstruction. Chronic bronchitis is defined as daily cough with sputum production for at least three consecutive months a year for at least two consecutive years. It develops as a result of long standing irritation of the bronchial mucosa nearly always by tobacco smoke. The disease is more common in middle and later life, in smokers than in non smokers and in urban than in rural dwellers. Pathologically there is hypertrophy of mucus secreting glands and mucosal oedema, leading to irreversible airflow obstruction. Air becomes trapped' in the alveoli on expiration causing alveolar distension which may result in associated emphysema....

Impact Of Catecholamines On Behavior

The role of catecholamines in substance abuse has received substantial attention. Most drugs of abuse behaviorally work on the premise of being strong positive reinforcers. These include agents such as nicotine, morphine, cocaine, and the amphetamine group. Increased dopamine levels in mesocortical regions have been identified with the use of amphetamines, cocaine, and even nicotine. In the case of cocaine and the stimulants, the increase is produced by blocking the dopamine transporter system. As discussed previously, dopamine has also been implicated in the production of hallucinations. Many of the agents that increase dopamine levels, such as l-dopa, amphetamines, and cocaine, are also capable of inducing hallucinations.

TABLE 592 Prediction Rules for Pneumonia in Adult Patients with Cough

The differential diagnosis of patients with cough and radiographic abnormality includes a number of disorders, such as lung cancer, tuberculosis, pulmonary embolism, chemical or hypersensitivity pneumonitis, connective tissue disorders, granulomatous disease, and fungal infections.

Brassica Glucosinolates and Their Derivatives

Epidemiological data suggest that the relatively high content of glucosinolates and related compounds may be responsible for the observed protective effects of brassica vegetables in the majority of the 87 case-control studies and 7 cohort studies that have been carried out on the association between brassica consumption and cancer risk (Tables 3-5). In the case-control studies, 67 of studies showed an inverse association between consumption of brassica vegetables and risk of cancer at various sites. If individual brassica vegetables are considered, then the values for the number of studies that showed an inverse association between consumption of brassica vegetables and risk of cancer at various sites are as follows broccoli, 56 Brussels sprouts, 29 cabbage, 70 and cauliflower, 67 . The cohort studies showed inverse associations between broccoli consumption and the risk of all types of cancer taken together between the consumption of brassicas and risk of stomach cancer and the...

Eukaryotic Cell Structure And Function

Flagella and cilia are organelles of cell movement. Flagella are whiplike extensions of a cell, which may be many times longer than the main part of the cell. A cell can propel itself through a liquid by motion of a single flagellum. Examples of cells with a flagellum are the protist Euglena and the human sperm cell. Animal cells or some animal-like pro-tists may instead have cilia. Cilia are short hairlike projections covering the surface. They propel the cell by a coordinated beating action, like oarsmen on an ancient warship. The protist Paramecium is an example of a cell that propels itself this way. Cilia may have another function moving particles past stationary cells. This is their function in helping protists such as the stalked ciliates'' feed. Cilia also line the human respiratory tract, where they serve to expel inhaled particles. Damage to respiratory cilia from cigarette smoking impairs removal of harmful materials and causes smokers' cough.''

Neurotensin Receptor Implication in Cancer

Increasing evidence demonstrates that proNT and NTS1 are deregulated in several human cancers such as colon, pancreatic, prostate, and lung cancer, suggesting that NT may exert an autocrine activation of its own NTS1 receptor in cancer. Thus, the use of NT receptor antagonists to block the proliferative effect of NT on cancer cells is one of the promising prospects in cancer therapy. In this respect, it has been recently reported that SR 48692 could inhibit NT-stimulated growth of human colon, pancreatic, and lung cancer cell lines and, when administered alone to nude mice grafted with human NTS1-expressing colon cancer cells, could induce a reduction in tumor volume. It also seems that the proliferative effect of NT can be mediated not only by NTS1 but also by NTS3 since several of the cancer cells coexpressed both receptor subtypes. Selective

Monoclonal Antibodies to Soman

With the advent of hybridoma technology, the question arises as to whether, given a racemic immunogen, one would be able to generate hybridomas producing monoclonal antibodies to both isomers with high enantioselectivity. This is supported by the observed enantioselectivity of polyclonal antisera to racemic immunogens discussed earlier and the results obtained with nicotine (67), The selectivity of such antibodies was less clear cut with a diastereoisomeric compound. Monoclonal antibodies were developed to the nerve agent soman (Fig. 8 15a ) by immunizing mice with a phenyldiazonium analog of soman conjugated to keyhold limpet hemocyanin or bovine serum albumin (Fig, 8 15b ). Soman has two asymmetric centers one on carbon C( ) and one on phosphorus P( ) . One antibody-producing clone was obtained from each protein. A competitive inhibition enzyme assay was used to test binding affinity. The first monoclonal antibody had the following order of affinity C(+)P(+) S C(-)P(+) C(-)P(-)...

Communicating about Risk Menace and Safety

Equivalent rifts exist between the number of cases of some diseases and their perceived menace. The real number of cases of disease that are major news items such as anthrax, West Nile virus, and Ebola virus is much smaller than the total of deaths from the major killers like lung cancer and heart disease in industrialized settings, and childhood infectious diseases, malaria, and AIDS in developing countries. In sum, epidemiology is known and remembered by the public far more for its claims and metaphors than for its specific data about relative risk and incidence rates.

Drugs That Change Alertness A Stimulants

Psychomotor stimulants, which include amphetamine and related compounds, caffeine, and nicotine, increase alertness, whereas sedatives decrease alertness. The term ''psychomotor stimulant'' is of interest because it draws attention to the cognitive effects of the drugs and emphasizes that they do not merely stimulate the motor system, although motor stimulation is a feature of many of these drugs. Nicotine is an agonist at cholinergic nicotinic receptors, but by binding at presynaptic cholinergic receptors it has the indirect effect of causing the release of dopamine. Nicotine improves performance on a variety of tests of attention and cognitive function.

Ecogenetics Individual Variation in Susceptibility to Environmental and Chemical Agents

Ecogenetics examines how genes and environmental factors interact with each other to affect human health and disease. Genes are sequences of DNA in humans' twenty-three pairs of chromosomes in each nucleated cell. Genes specify the sequence of proteins, which are the main effector molecules of cells, serving as enzymes (catalysts), structural molecules (like collagen), antibodies to fight off infections, and binders of oxygen or xenobiotics (including pharmaceuticals or chemicals in the environment). Environmental factors include social and familial environment, intrauterine environment, cigarette smoking, alcohol, other substance abuse, stress, and exposures to chemical, physical, and biological agents. Some environmental exposures such as ultraviolet light, X rays, and certain industrial chemicals cause damage to DNA (genetic mutations), which alter gene function as well as the structure and function of the protein specified by that gene. Although many such mutations appear to be of...

Pathology Pathogenesis and Carcinogenesis

Other factors such as iodine deficiency, autoimmune thyroid disease, hyperthyroidism, sex hormone status and alcohol intake have all been implicated in the development of thyroid carcinoma, but remain unproven. Possible genetic patterns of differentiated thyroid carcinoma include patients with Gardner's syndrome (familial colonic polyposis) and Cowden's disease (familial goiter and skin hamartomas), but less than 3 of all papillary and or follicular thyroid carcinomas are truly familial.3 Cigarette smoking has not caused an increase in the incidence of thyroid carcinoma.

Results From Expression Profiling Studies Of Lung Carcinomas Reveals Distinct Adenocarcinoma Subclasses

It is of considerable interest to determine if a molecular classification recapitulates the existing histopathological classification of lung tumors and reveals previously undiscovered tumor classes. The existing classification of lung cancer as SCLC and NSCLC, and the subclassification of NSCLC, provides us with a framework for evaluating the significance of molecular classification of lung cancers (29-31). Transcriptional fingerprinting by microarray analysis of human lung tumors offers a wealth of information quite rapidly that was previously difficult to obtain. A key issue in lung tumor diagnosis is the discrimination of a primary lung tumor from a distant metastasis to the lung as the clinical course or treatment of the disease may differ from primary lung cancer. In our study (29), microarray analysis readily defined extra-pulmonary metastasis with non-lung expression signatures among putative lung adenocarcinomas, suggesting that expression analysis may serve as a diagnostic...

The Inhalation of Air Contaminants

Fiber This is an elongated or long solid particle with an aspect ratio (length width) more than 3 1. There are two types of fibers natural (e.g., asbestos), and synthetic or man-made (e.g., glass) fiber. Asbestos is the most important natural fiber, as it can induce asbestosis and lung cancer in workers who have experienced heavy exposure. Smoke This is a complex compound that involves solid and liquid aerosols, gases and vapors that usually result from the incomplete combustion of organic materials. For example, tobacco smoke contains thousands of chemical substances, most of which are toxic or carcinogenic. Although primary smoke particles are between 0.01 and 1 xm diameter, they can aggregate and produce extremely larger particles known as soot.

Macular Degeneration and Cataracts

However, the Linxian trial found no influence of vitamin supplementation on risk of cataract the ATBC trial found no reduction in the prevalence of cataracts with vitamin E, -carotene, or both among male smokers and the Health Physicians Study of more than 22 000 men showed no benefit from 12 years of supplementation with -carotene (50 mg on alternate days) on cataract incidence. In fact, current smokers at the beginning of this trial who received the supplement experienced an increased risk of cataract (by approximately 25 ) compared to the placebo group. The Vitamin E, Cataract and Age-Related Maculopathy Trial also reported no effect of supplementation with vitamin E for 4 years (500 IU day) on the incidence or progression of cataracts or AMD.

Cancer Causing Chemicals

In retrospect, it was fortuitous that soot was acknowledged as one of the first carcinogenic agents. Soot is a complex mixture of chemicals that arises from the combustion of organic material. As scientists and physicians separated soot's individual components, it became clear that chemicals called polycyclic aromatic hydrocarbons (PAHs) were among its principal carcinogenic compounds. The story became even more intriguing when it was shown that many PAHs behave as procarcinogens. Procarcinogens do not cause cancer per se, but they can be converted to active carcinogens by enzymes located in organs like the liver and lung. The implications of this discovery are noteworthy. For example, cigarette smoke contains a wide variety of procarcinogenic PAHs that are turned into active carcinogens in lung cells. Since smokers draw these PAHs deep into their lungs with each inhale on a cigarette, one reason that cigarette smoking correlates so highly with the induction of lung cancer becomes...

Cannabis and the cannabinoids

There are three main types of cannabis preparation in use. Herbal cannabis, known variously as ''grass'', ''pot'', ''joint'' or ''marijuana'', is prepared by collecting the flowering heads or the upper leaves of the plant, allowing them to dry, and then removing the stems and stalks by rubbing the dried material. The resultant material is then rolled into cigarettes, or placed in a pipe, and smoked. The cannabinoid content of herbal cannabis varies according to the climate and growing conditions, but it comprises up to 8 cannabinoids. Pulmonary function is impaired in chronic cannabis smokers, despite the clear evidence that the acute use of the drug results in a significant and long-lasting bronchodilatation. However, it should be noted that the tar produced by cannabis cigarettes is more carcinogenic than that obtained from normal cigarettes, so that the risks of lung cancer and heart disease are increased in chronic cannabis smokers.

Effects on Particular Organs or Organ Systems

Or chronic, depending on the level of exposure. Acute effects include bronchial constriction and pulmonary edema (accumulation of fluid in the airways). Arsenical compounds can cause irritation, but chronic exposure can result in lung cancer. Many types of particles also harm the lungs, including smoke from cigarettes or other combustion sources, or dusts from industrial operations producing particles of asbestos, silicates, coal or even cotton, flax, or hemp. In the disease called silicosis, particles of certain crystalline forms of silica are engulfed by macrophages in the lungs, which then attempt to sequester the particles in lysosomes. However, the particles rupture the lysosome membranes. This releases the lysosome enzymes into the cytoplasm and destroys the cell, as well as causing damage to the lung tissue. In addition, the particles are released to continue the cycle of damage. Ultimately, fibrosis results, making breathing more difficult. In late stages the heart is...

Edible Plants and Phytochemicals

Carotene reduces the blood levels of other carote-noids, some of which are more potent inducers of Connexin 43 than is beta-carotene. The unexpected and highly publicized increase in incidence of lung cancer among smokers taking beta-carotene supplements may be explained by this mechanism.

Heritability in Humans

Percent of their genes) are more likely to be alcoholics than the fraternal twins of alcoholics (who share only about 50 percent). Adoption study data suggest that the risk for developing alcoholism for adopted children is influenced more by whether their biological parents were alcoholics than whether their adopted parents are alcoholics, suggesting that genes contribute to alcoholism more than environment. Similar but less extensive data has been collected for nicotine addiction. Very little genetic epidemiological data has been collected for illegal drugs. The only genes that have been conclusively shown to affect susceptibility to addiction in humans are genes that encode proteins responsible for the metabolism of alcohol. In the body, ethanol ( drinking alchohol) is oxidized by enzymes to acetaldehyde and then to acetate. Certain alleles of aldehyde dehydrogenase genes that are common in some populations, such as Asians, lead to increased levels of acetaldehyde when alcohol is...

Computers And Behavioral Assessment

Several clinically applicable handheld software programs have been described in the literature in recent years. Newman, Kenardy, Herman, and Barr Taylor in 1996 used a Casio PB-1000 handheld computer to prompt patients with panic four times per day to report anxiety levels and occurrence of panic attacks. During the client's office visit, data were uploaded to a desktop computer, stored in a database, and then analyzed. Reports were generated that summarized client responses to the computer. Others have recently reported using handheld devices to record frequency of smoking behavior, measure reaction time during a prolonged, simulated submarine crisis, measure stress reactions in the natural environment, and assess obsessive-compulsive, fibromyalgia, and dementia symptoms.

The biochemical basis of important drug interactions

There are several important factors which may influence biotransformation reactions. Thus some drugs or toxins may induce the synthesis of microsomal oxidases by the liver (for example, a barbiturate) and thereby enhance the metabolism of the drug, or any other drug given concurrently which is metabolized by the same enzyme system (for example, warfarin). Nicotine in tobacco smoke is known to increase the activity of the cytochrome P450 1A2 isozyme which may predispose some individuals to a greater risk of cancer. Some drugs produce hepatotoxic metabolites which thereby impair the biotransformation of other drugs or toxins which may be present. For example, chronic alcohol intake can lead to the formation of hepatotoxic metabolites. Drugs may also selectively inhibit individual isozymes of the P450 system, thereby causing an unexpected rise in the blood and tissue concentrations of any drug given concurrently which is also metabolized by that isozyme. The SSRI antidepressants for...

Health benefits of whole foods over isolated components

Volunteers were given relatively high dose supplements of b-carotene for several years, which substantially raised plasma and, presumably, tissue concentrations. These studies showed one of two things, either supplementation with b-carotene was not effective with regard to CVD, cancer or all-cause mortality or, in susceptible individuals like smokers and asbestos workers, the mortality rate from lung cancer was significantly increased. On the other hand, plasma b-carotene concentration (reflecting the consumption of carotenoid-rich foods) before supplementation was inversely and significantly associated with lower cancer rate.

Drug Triggers The Brain Learns

While significant evidence supports the role of dopamine in the reward process, the neuroanatomy of withdrawal is not as clearly defined. However, a wide variety of abused drugs, with apparently little in common pharmacologically, have common withdrawal effects in certain areas of the brain. Opiates, benzodiazepines, nicotine, and alcohol have all had their withdrawal symptoms treated effectively with clonidine, a medication that works in an area of the brain called the locus coeruleus.

Hepatic Glucose Metabolism

During infection, the liver increases glucose production to defend against hypoglycemia. In fact, the increase in hepatic glucose production is the major reason why patients with infection have an elevated blood glucose concentration. For example, patients with active malaria can have an increase in fasting glucose concentration due to an increase in gluconeo-genesis and overall glucose production. Approximately 75 of cancer patients, like patients with infection, also have an elevated rate of glucose production. Cancer patients also have a mild form of injury approximately 75 have an elevated rate of hepatic glucose production. In 18 studies, hepatic glucose production for normals ranges between 1.6 and 3.0mg kg min, with an average of 2.1 mg kg min. Glucose production for cancer patients without weight loss ranges from 1.7 to 5.1 mg kg min, with a mean of 2.75 mg kg min. This is a 30 increase in the fasting rate of hepatic glucose production. For cancer patients with weight loss,...

Gender Differences In Pd And Clinical Endpoints

Gender differences in analgesic response have also been observed with nicotine and other cholinergic agents. Studies involving these agents have been rare in humans, but one group did investigate the analgesic effects of a nicotine patch in men and women (211). Ratings of electrocutaneous stimulation were obtained 2.5 hours after patch application from 30 male and 44 female smokers and non-smokers on either placebo or a nicotine patch (7-21mg 24hr transdermal). Nicotine increased the pain threshold and tolerance ratings of men, but had no effect on the pain ratings of women. Furthermore, there was no effect of smoking history on pain ratings among men, suggesting that the changes in pain perception reflect a direct inhibition of pain by nicotine, rather than relief from nicotine withdrawal symptoms.

Why are clinical trials unreliable for the detection of rare adverse events

When a new compound intended for chronic or life-long use is introduced into the market, approximately a few hundred patients will have been treated for one year or longer. If the agent is an inhaled steroid for treatment of asthma, a lipid-lowering statin, or an antihypertensive drug, one can assume that the medications will be prescribed for longer than one year, maybe even for decades. Thus, one could legitimately question whether the one-year experience with the compound is adequate to predict drug safety over 5, 10, or up to 30 years. Many serious adverse events may take several years to become apparent. For example, it may take more than a decade of tobacco use to cause lung cancer. A safety profile based on limited drug exposure is inadequate and can be very misleading.

Chronic Irritation And Trauma As Factors In Carcinogenesis

Although the general concept that chronic irritation is a carcinogenic stimulus is no longer accepted, in certain conditions chronic inflammation in humans may predispose to neoplasia. One of the best examples is the chronic draining sinus, usually resulting from chronic infections such as osteomyelitis. Such chronic infections are relatively rare today however, in the past, when bone infections were rather common, epidermoid carcinomas occasionally arose in the skin near chronic draining sinuses. The histology of these lesions before the production of the neoplasm demonstrated a peculiar type of hyperplasia of the squamous epithelium known as pseudo-epitheliomatous hyperplasia (Sommerville, 1953). Other sites of chronic inflammation considered to be associated with higher incidences of neoplasia are the lower lips of pipe smokers and nevi or moles in locations on the body subject to chronic irritation, such as the belt region or the back of the neck. As has already been suggested and...

Popular and Professional Ideas about Risk

Medicine Clinical Epidemiology Cartoons

Risk is the concept used by health scientists to transform a series of individual disease states (e.g., smokers who get lung cancer and nonsmokers who get lung cancer) into a single group measure (e.g., relative risk of getting lung cancer for smokers compared with nonsmokers). Based on some particular study of living or deceased members of some population, epidemiologists produce estimates of the likelihood of future disease or dysfunction. Yet risk is a particularly problematic vehicle for conveying scientific data because it has clear but divergent meanings to scientists and the general public. Risk for scientists is an estimate of probability or likelihood of occurrence based on comparisons. Risk for the general public is a synonym of menace and danger one takes risks, one risks one's life. The statistical probabilities used to express risk do not make a great deal of intuitive sense to most individuals. One may be told one has a 10-fold increased risk of developing lung cancer as...

Structure of IL7 and the IL7 receptor

Human IL-7Ra was cDNA cloned from a lung cancer cell line which bound recombinant IL-7, and the murine homolog was cloned from a pre-B leukemia cell line by using human IL-7 cDNA. Both encode 439 aa peptides and consist of extracellular, transmembrane and cytoplasmic regions. The presence of two fibronectin type III domains and a WSXWS motif indicates that this is a member of the cytokine receptor family. Although no domains with apparent enzymatic activity have been found in the cytoplasmic region, it shares a number of common motifs such as a box, acidic and serine-rich regions with other cytokine receptor family molecules. Evidence indicates that these regions play an important role for signaling through association with various other molecules. The homology between human and mouse IL-7Ra is about 60 at the amino acid sequence level, and human recombinant IL-7 is able to bind and stimulate the murine IL 7Ra.

Fat Distribution and Disease Risk

Since fat distribution is correlated with age as well other risk factors for disease, such as smoking, alcohol consumption, physical activity, and menopause in women, it is important to control for the effects of these variables in order to obtain an estimate of the independent effect of central obesity on morbidity. The impact of some of these correlates of fat distribution may be subtle and unlikely to seriously distort relationships between fat patterning and disease. However, age, the ultimate risk factor for disease and death, is sufficiently highly correlated with fat distribution to result in substantial distortion. Similarly, cigarette smoking is related adequately strongly to fat patterning and to various diseases and outcomes to make analyses that do not adjust for smoking difficult to interpret.

Increased standard of living leading to deleterious health behaviors

Study (1984-86, 1988-89), and the substantially higher levels of most CVD risk factors in urban population groups compared to rural population groups in India, provide evidence of such trends.26 The increasing use of tobacco in a number of developing countries will also translate into higher mortality rates from CVD, lung cancer and other tobacco related diseases, and undesirable alterations in diet and physical activity are also having adverse effects on cardiovascular health. The rising tobacco consumption patterns in most developing countries contrast sharply with the overall decline in the industrial nations.30 Recent projections from the World Health Organization suggest that by the year 2020 tobacco will become the largest single cause of death, accounting for 12 3 of deaths worldwide.24 India, China and countries in the Middle Eastern crescent will by then have tobacco contributing to more than 12 of all deaths. In India alone, the toll attributable to tobacco will rise from...

Historical Context of Interest in Drugs

The drugs targeted by prohibitionist fervor in the early 20th century, particularly opium, cocaine, and alcohol, in fact had extensive records of association with ruined lives, and therefore the cause of protecting people against ruin had legitimacy from a public health perspective. Curiously, tobacco, by far the most important killer among all drugs, slipped under the scrutiny of those who would police drug use in the world. Tobacco does not appreciably change users' behavior in the state of acute intoxication, and its sequelae either were missed altogether in the era when people did not live long enough to contract lung cancer or emphysema, or were confused with important killers such as pneumonia.

ACE Inhibition in Heart Failure

Coronary artery disease, stroke, peripheral vascular disease, or diabetes, plus at least one other cardiovascular risk factor (hypertension, elevated total cholesterol level, low high-density lipoprotein cholesterol level, cigarette smoking, or microalbuminuria). Patients were excluded if they had heart failure, were known to have a low ejection fraction, were taking an ACE inhibitor or vitamin E, had uncontrolled hypertension or overt nephropathy, or had had a myocardial infarction or stroke within 4 weeks before the study began. During a mean follow-up of 5 years ramipril reduced the primary outcome (composite of myocardial infarction, stroke, or death from cardiovascular causes) from 17.8 to 14.0 (relative risk 0.78, 95 confidence interval 0.70 to 0.86 P

Adrenal Incidentaloma

Patients should also be questioned in depth about a history of prior malignancy, change in bowel habits, blood in the stool or urine, previous mole removal, and tobacco use. Positive answers to these questions might suggest that the mass may be secondary to a metastases, especially from a breast, lung, colon, melanoma, or renal Additional radiographs should include a chest x-ray to rule out pulmonary pathology. The chest x-ray may demonstrate a primary lung cancer, which may have metastasized to the adrenal gland, or may demonstrate multiple metastases from another source (breast, colon, renal) which may also have metastasized to the adrenal gland. There is also the possibility that the chest x-ray may demonstrate a metastases from a primary adrenal gland carcinoma. In females, a mammogram may be necessary to rule out a primary breast cancer. Air contrast barium enema or colonoscopy may also be utilized in patients with guaiac positive stool to rule out a primary colon cancer.

Relapse prevention model

Relapse is a breakdown or setback in a person's attempt to change or modify target behaviour. The relapse prevention model was developed to treat addictive behaviours, such as alcoholism and smoking (Marlatt and Gordon, 1985). The model proposes that relapse may result from an individual's inability to cope with situations that pose a risk of return to the previous behaviour. For example, a former smoker finds himself or herself in a social situation with lots of smokers and is tempted to smoke. Thus, helping the individual to acquire strategies to cope with high-risk situations will both reduce the risk of an initial lapse and prevent any lapse from escalating into a total relapse. Simkin and Gross (1994) assessed coping responses to high-risk situations for exercise relapse (e.g. negative mood, boredom, lack of time) in 29 healthy women who had adopted exercise without formal intervention. The participants' activity levels were measured weekly for 14 weeks. The study found that 66...

Colorectal Cancer Background and aetiology

Each year colorectal cancer affects 32 000 people in the UK and is responsible for around 22 000 deaths. In males it is second only to lung cancer and in females it falls third behind lung and breast cancer. In the developed world, life-time risk of colorectal cancer is around 1 25 and this is increased by genetic predisposition and certain conditions such as chronic colitis. Colorectal cancer is mainly a disease of the elderly with a marked rise in incidence after age 70 years, however, 10 of individuals are under age 55 years at diagnosis.

Airway Defense Mechanisms

Top is moved up and out of the airways. Diseases such as cystic fibrosis and chronic bronchitis can affect mucous secretion. Second, alveolar macrophages provide an additional mechanism for removing particles deposited deeper in the lungs, where the blood-gas barrier must be very thin for gas exchange. Macrophages originate in the bone marrow and circulate in the blood as monocytes before settling in the respiratory zone of the lungs, where the epithelium is not ciliated. They roam the airway surfaces by ameboid action and engulf foreign particles by phagocytosis. Most foreign substances are destroyed by lysozymes inside the macrophage. However, carbon and mineral particles may be stored in residual bodies in the macrophage, which then settles in the interstitium. The effects of mineral dusts are especially insidious, leading to a progressive destruction of lung tissue, and even lung cancer in the case of asbestosis. Normal macrophages that do not settle in the interstitium leave the...

Managing dyspnea in COPD

Recent national guidelines have recommended a dyspnea disability driven paradigm for managing COPD.81-83 Thus, therapy is escalated on an individual basis with the goal being maximum possible symptom relief. Education and smoking cessation are the first steps in symptom management (Figure 4.6) and are regarded as one of the best strategies to reduce mortality in COPD patients. Treatment with bronchodilators is another initial approach to therapy as they provide symptomatic relief by improving airway function, enhancing lung emptying, and therefore, reducing lung hyperinflation.73-75,84 By improving ventilatory mechanics in this manner, a greater ventilatory output can be achieved for a given neural drive (i.e., enhanced neuromechanical coupling). Should patients remain symptomatic in spite of optimized bronchodilator therapy, exercise training, preferably in a supervised setting, is the next important step.81-83 Exercise training improves peripheral muscle function and reduces...

The Implications of Abortion

Another set of issues relates to the extent to which abortion rights may prevent government from intervening to enjoin or punish risky behavior by pregnant women who, for example, smoke cigarettes, consume alcohol, abuse drugs, and fail to heed medical advice. In a number of isolated cases in the United States, judges have jailed pregnant women they feared would abuse or neglect their fetuses. In Ferguson v. City of Charleston (2001), the United States Supreme Court struck down a program under which a hospital tested pregnant patients for illegal narcotics use without their informed consent and reported patients who refused prescribed rehabilitation to law enforcement authorities. A somewhat different concern is the legal implications of government intervention in the event that a pregnant woman refuses a blood transfusion needed to save her life, or a cesarean delivery physicians believe to be in the best medical interest of the unborn. Some view Roe v. Wade as holding by implication...

Other Major Risk Factors

Major risk factors other than LDL cholesterol and diabetes are listed in table 3.1. Age, blood pressure, and high density lipoprotein (HDL) cholesterol, as well as total cholesterol, are used as continuous variables to calculate CHD risk in the current Joint British Societies' guidelines, together with cigarette smoking and diabetes as categorical variables.5 Alternatively age, hypertension, low HDL cholesterol, and family history of premature CHD can all be used as categorical variables to calculate risk.4 A family history of death from CHD in either parent before age 55 conferred a relative risk of 1.3 in their progeny in the Framingham study,6 whereas in the US nurses health study

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