Biomarkers of Waterpipe Tobacco Smoke Exposure: A Systematic Review and Meta-Analysis.

INTRODUCTION: The prevalence of waterpipe tobacco smoking is increasing globally. Biomarkers of waterpipe tobacco smoke (WTS) exposure are less studied. AIMS AND METHODS: To identify the types of biomarkers of WTS exposure and estimate changes in biomarker concentrations pre- to post-WTS exposure. PubMed, Embase, Web of Science, CINAHL Plus, PsycINFO, and Cochrane Library were searched for studies up to April 24, 2023. The types of biomarkers were identified. Random-effects models were used to estimate changes in biomarker concentrations pre- to post-WTS exposure. RESULTS: Seventy-three studies involving 3755 participants exposed to WTS (49% male, mean age: 24.8 years) and 11 types of biomarkers of WTS exposure were identified. The biomarkers included tobacco alkaloids, expired carbon monoxide (eCO), carboxyhemoglobin (COHb), tobacco-specific nitrosamines, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), heavy metals, unmetabolized VOCs, unmetabolized PAHs, furan metabolites, and heterocyclic aromatic amines. Compared with pre-WTS exposure, eCO (breath; mean difference [MD] 27.00 ppm; 95% confidence interval [CI]: 20.91 to 33.08), COHb (blood; MD 4.30%; 95%CI: 2.57 to 6.03), COHb (breath; MD 7.14%; 95%CI: 4.96 to 9.31), nicotine (blood; MD 8.23 ng/mL; 95%CI: 6.27 to 10.19), and cotinine (urine; MD 110.40 ng/mL; 95%CI: 46.26 to 174.54) significantly increased post-WTS exposure. CONCLUSIONS: Biomarkers of WTS exposure were systematically identified. The similarity between the biomarkers of WTS exposure and those of cigarette smoke and higher concentrations of some biomarkers post-WTS exposure underscore the need for further research on applying biomarkers in surveillance, interventions, and regulations to mitigate the harms of waterpipe tobacco smoking. IMPLICATIONS: This study provides the first comprehensive overview of biomarkers investigated and available for assessing WTS exposure and their concentration changes in the human body. Researchers can use biomarkers such as eCO, COHb, nicotine, and cotinine to measure the health risks associated with WTS exposure and objectively evaluate the effectiveness of public health interventions aimed at reducing waterpipe tobacco smoking. Public health policymaking can also be informed through increased biomarker concentrations following WTS exposure, to implement regulations and public health education campaigns on limiting or preventing waterpipe tobacco smoking.

[Systematic review and Meta-analysis of efficacy and safety of Toutongning Capsules in treatment of tension-type headache].

This study aims to systematically evaluate the clinical efficacy and safety of Toutongning Capsules in the treatment of tension-type headache(TTH), so as to provide a corresponding basis for clinical treatment. Eight commonly used medical research databases and two clinical trial registration systems were retrieved with the time interval from the establishment of the database or system to November 2020. The randomized controlled trials of Toutongning Capsules in the treatment of TTH were screened out according to the pre-set criteria. The quality of the included papers was evaluated by the bias risk assessment tool in Cochrane Reviewers Handbook 6.1 and the data were statistically analyzed by RevMan v5.4 provided by Cochrane collaboration. A total of 13 studies were included and the quality of methodology was generally low. Meta-analysis showed that Toutongning Capsules assisted with western medicine therapy can effectively reduce the pain intensity(MD_(VAS)=-1.94,95%CI[-2.50,-1.38],P<0.000 01;MD_(NRS)=-0.83,95%CI[-0.86,-0.80],P<0.000 01), headache duration(SMD=-0.98,95%CI[-1.17,-0.79],P<0.000 01), headache frequency(MD=-1.01,95%CI[-1.16,-0.85],P<0.000 01), headache index(MD=-11.13,95%CI[-12.10,-10.16],P<0.000 01), anxiety and depression scale score(MD_(HAMA)=-4.02,95%CI[-6.58,-1.46],P=0.002;MD_(HAMD)=-2.67,95%CI[-4.04,-1.29],P=0.000 1), while Toutongning Capsules as monotherapy only reduced the headache score(MD=-2.24,95%CI[-2.97,-1.51],P<0.000 01). The available clinical studies demonstrate that Toutongning Capsules combined with western medicine in the treatment of TTH can improve the related outcome indicators, but the clinical safety and efficacy of Toutongning Capsules alone remain unclear. Due to the small number and low quality of the included studies, large-sample, multi-center, high-quality and strictly designed randomized controlled trials are still needed to verify the clinical efficacy in the future.

Surgical management of leiomyosarcoma of the inferior vena cava.

The optimal surgical management of patients with leiomyosarcoma of inferior vena cava remains a controversy. From 1975 and 2009, five patients with leiomyosarcoma of inferior vena cava were treated at the Chinese PLA General Hospital and Beijing Shijitan Hospital. The age ranged 39-61 years and the duration of symptoms ranged from 18 to 36 months. Abdominal and back pain are the most common complaints. A combination of various imaging modalities is essential for treatment planning. R0, R1, R2, and biopsy only were accomplished in 2, 1, 1, and 1 case, respectively. Combined resections included inferior vena cava, right kidney, adrenal gland, psoas, colon, duodenal, gallbladder, liver, and/or aorta, without inferior vena cava reconstruction. No inferior vena cava-related postoperative complication was seen in our series.

An efficient calcium-based sorbent for flue gas dry-desulfurization: promotion roles of nitrogen oxide and oxygen.

The development of sorbents for flue gas desulfurization in a dry mode is essential to control emission of sulfur dioxide. Based on the novel concept of "treating waste with waste", a low-cost and highly activated calcium-based sorbent (ACS) was prepared using coal fly ash, CaO and waste gypsum as the raw materials via the one-step incipient wetness impregnation method. Based on characterization using scanning electron microscopy and nitrogen adsorption-desorption, the ACS possessed a fibrous and netted structure with high porosity, which improved SO2 adsorption greatly. The SO2 adsorption capacity of ACS with coal fly ash/CaO/CaSO4 = 1/2/1 was high, up to 44.26 mg g-1, with 100% removal efficiency at 150 °C. In the absence of O2, SO2 was rapidly adsorbed on the sorbent to form CaSO3 according to in situ DRIFTS analysis, while when O2 was present in the flue gas, SO2/SO3 2- tended to be oxidized into SO4 2- species. Moreover, the presence of NO can further enhance the SO2 adsorption capacity of the ACS due to the formation of adsorbed NO2 or nitrate species with strong oxidizing properties. Therefore, the ACS can be considered as a sustainable sorbent with the advantage of employing fly ash for the removal of sulfur dioxide.

Comprehensive surgical approaches to management of various facial nevi.

OBJECTIVE: To investigate the effects of the flexible surgical approaches on therapeutic and cosmetic outcomes of facial nevi. METHODS: From August 2002 to January 2008, 16 cases with facial nevi had been treated in our wards with the selected approaches. Surgical approaches including serial excision or one-time radical excision, free skin graft, and expanded flap were adopted in accordance with the individual size and location of the facial nevi. RESULTS: All cases experienced complete excision and had satisfactory cosmetic appearance in the end. CONCLUSION: The flexible surgical measures help to minimize the risk of malignant transformation and achieve good cosmetic results.

Transclinoid-Transcavernous Approach to a Giant Cavernous Sinus Hemangioma: 2-Dimensional Operative Video.

This surgical video demonstrates a transclinoid-transcavernous approach for the resection of a cavernous sinus hemangioma (Video 1). The patient is a 42-year-old woman who presented with headache and blurred vision. Magnetic resonance imaging (MRI) demonstrated an enhancing mass in the right-side cavernous sinus and sella. The patient underwent an orbitozygomatic craniotomy, extradural anterior clinoidectomy, and transcavernous approach for tumor resection. Removal of the orbital roof, lateral orbital wall, zygomatic arch, and anterior clinoid process with a high-speed drill was performed. The lateral wall of the cavernous sinus was opened via interdural dissection, and a large reddish tumor was encountered. The tumor was resected after circumferential dissection and coagulation. The cranial nerves III, IV, and V were found and preserved. The surgical cavity was closed with abdominal fat to prevent cerebral-spinal fluid leak. The bone flap was put back and fixed with titanium mesh, plates, and screws; the wound was closed in layers using sutures. The blurred vision relieved immediately after surgery. The patient suffered temporary right-side oculomotor nerve palsy, which was partially resolved after 6 months. There were no other complications. Final pathology was consistent with a cavernous sinus hemangioma. Postoperative MRI demonstrated near total resection except for a small piece of residual in the sella, which was stable in 6-month follow-up MRI scan without further treatment. The patient has been back to normal life and work.

[Clinical study of combined treatment with compound Reinhartdt and Sea Cumber Capsule and donepezil for vascular dementia].

OBJECTIVE: To study the efficacy and safety of the combined treatment with compound Reinhartdt and Sea Cumber Capsule (RSC, a Chinese medicinal preparation consisted mainly of Reinhartdt and Sea Cumber) and Donepezil for vascular dementia (VD), and its effect on thyroid function axis. METHODS: Sixty-three patients with VD were treated respectively with RSC, Donepezil and the combined treatment. MMSE, ADAS-Cog and ADL scales were used to evaluate the condition of patients before treatment as well as at 3 months and 6 months after treatment. Meanwhile, levels of thyroid hormones, including (TSH, FT3, FT4, TT3, TT4) were measured with radioimmunoassay. RESULTS: As compared with the baseline, MMSE score increased, ADAS-Cog score and ADL score decreased significantly in all the three groups after 3 months and 6 months of treatment (P <0.05, P<0.01), the improvement in the Donepezil group was more significant than that in the RSC group after 6 months of treatment (P < 0.05), but the combined treatment group showed the best efficacy (P < 0.01). After 3 months of treament, the levels of FT3 and FT4 in the combined treatment group increased, but showed no statistical significance (P >0.05). However, significant changes were found at 6 months after combined treatment (P < 0.01). No significant changes were seen at all in levels of TSH, TT3 and TT4 (P > 0.05). FT3, FT4 increased without statistical significance after 6 months Donepezil treatment, TSH, TT3 and TT4 also showed no significant difference in the Donepezil group and no other significant changes of thyroid hormones was seen in patients treated with RSC (P > 0.05). No obvious adverse reaction occurred in any of the three groups. CONCLUSION: Combined treatment of RSC and Donepezil was effective and safe on VD patient, with the efficacy much better than either of them alone. No significant adverse reaction was observed. The regulation on thyroid hormones may one of the mechanisms of the combined treatment in improving cognitive function.

[Clinical and epidemiological features of the five kinds of new epileptic syndrome].

OBJECTIVE: To investigate the clinical and epidemiological feature of the five kinds of new epilectically syndrome. METHOD: A retrospective study was conducted, by computer inquiry and manual retrieval, on 5300 patients with complete history records who had been followed up regularly in the epilepsy center of the First Affiliated Hospital of Chongqing University in the past 20 years to discover the cases that could be diagnosed as with the five kinds of new epileptic syndromes. RESULTS: Survey was finished in 4894 of the 5300 patients. Two cases of familial temporal lobe epilepsy, one case of familial partial epilepsy with variable foci, fourteen cases with mesial temporal epilepsy, and five cases with startle-provoked epileptic were discovered. CONCLUSION: Patients with the five kinds of new epileptic syndrome have been discovered in China too. It is beneficial to study the clinical and epidemiological features of those new epileptic syndromes.

Effects of intravenous human albumin and furosemide on EEG recordings in patients with intracerebral hemorrhage.

OBJECTIVES: To characterize alterations in continuous EEG monitoring that occurs during and after intravenous infusion of human albumin or furosemide in patients with intracerebral hemorrhage. METHODS: Patients were rapidly administered 20% human albumin 50 ml or furosemide 40 mg intravenously with continuous EEG monitoring for 3h before and after drug infusion in the neurological intensive care unit. Visual and spectral analyses of EEG recordings before and after mannitol administration were carried out. RESULTS: The study consisted of 20 patients. Of 14 patients with human albumin treatment, a decrease in the slowing activity was visually noted in 9 cases after the drug infusion. The spectral analysis demonstrated that albumin-induced EEG changes increased in alpha power and decreased in delta power in the lesion hemispheres, especially in the central and middle temporal areas. The effects occurred after 30 min and were maximal 1h after the end of the infusion, then remained significant for 2h post-infusion. Of 6 patients with furosemide treatment, the EEG recordings before, during, and after the furosemide infusion were not statistically significantly different by visual and quantitative analyses. CONCLUSIONS: The results support the opinion that the available EEG monitoring techniques offer an inexpensive, non-invasive, and consistently reproducible technique for reflecting the therapeutic effects of therapeutics in lowering ICP and antiedema in stroke patients.

[Application of bi-pedicled frontal expanded flap for cervical cicatricial contracture].

OBJECTIVE: To investigate the therapeutic effect of bi-pedicled frontal expanded flap for cervical cicatricial contracture. METHODS: Tissue expanders were implanted under frontal muscle. After expansion, the frontal flaps were designed based on bilateral superficial temporal vessels and were transferred to the neck wound. The cervical spine movement and the mento-cervical angle was measured and analyzed by SPSS16.0 and t test. RESULTS: From September 2006 to May 2010, 7 patients were treated by this method. The range of active cervical movement was improved in all direction. The mento-cervical angle decreased from (152.7 +/- 1.9) to (90.7 +/- 2.2) degrees after operation. The patients were followed up for 5 months to 3 years with satisfactory result and no contracture recurrence. CONCLUSIONS: The bi-pedicled expanded frontal flap has a reliable blood supply and is very suitable for cervical cicatricial contracture with good functional and esthetic results, leaving less morbidity at donor site.

[Application of quantitative tissue expansion in ear reconstruction].

OBJECTIVE: To explore the application of tissue expander in ear reconstruction and to deal with the complications. METHODS: 50 ml kidney-shape tissue expanders were implanted subcutaneously in the mastoid area. The drainage tube was removed 3 days after operation. The suture was removed 10 days later. Since 7 days after operation, 5 ml NS was injected into the expander every time, three times a week. The total injection volume was about 60 ml. After that, the expander was maintained for one month. RESULTS: From January 1992 to December 2006, 5,248 patients of microtia were treated with 6,252 expander. After the maintaining period, the expanded skin was thin and well-vascularized. The complication rate was 7.79%, including hematoma, malunion and infection. CONCLUSIONS: The quantitative tissue expansion is easily manipulated with few complications. It can provide hairless, thin skin with reliable blood supply for ear reconstruction.

[Treatment of helical keloid with retroauricular skin expansion].

OBJECTIVE: To introduce a new technique for the treatment of helical keloid. METHODS: The procedure consisted of two steps. In the first step, a kidney-shaped expander of 50 ml was placed subcutaneously in the retroauricular area. Routine inflation with normal saline followed. In the second step, about two months afterwards, the expander was taken out and the helical keloid was excised. The expanded flap was advanced to cover the wound. RESULTS: The operation has been performed on 12 patients of 16 sites of helical keloid since 2000. Postoperative follow-up from 3 months to 2 years revealed satisfactory results. The reconstructed ear maintained a good contour. CONCLUSION: The technique creates a retroauricular flap rich in blood supply, which can be used to close the defect left by helical keloid excision. It provides a good treatment for the helical keloid replaced with normal skin from the mastoid region.