The effect of branded versus standardized e-cigarette packaging and device designs: an experimental study of youth interest in vaping products.

OBJECTIVES: Standardized ('plain') packaging is effective in reducing the appeal of cigarettes among young people. This study examined the impact of plain packaging and brand imagery on interest in trying e-cigarettes among youth. STUDY DESIGN: Experimental design. METHODS: Two online experiments were conducted in February 2020 as part of the ITC Youth Tobacco & Vaping Survey, conducted with 13,624 16- to 19-year-olds in Canada, England, and the USA. In the between-group Experiment 1, participants were randomized to view a set of 3 e-cigarette brands, in either their original external packaging ('branded' condition) or standardized olive-green packaging ('standardized' condition), and asked to select the product they would be most interested in trying. The within-group Experiment 2 examined brand imagery directly on devices, including potential differences in appeal among subgroups. Each participant viewed 4 pod-style e-cigarette devices: one 'plain' and 3 in colourful 'skins'. Logistic regression models were conducted to test the effect of condition, adjusting for demographics, smoking and vaping status. RESULTS: In Experiment 1, participants in the 'standardized' packaging condition were significantly more likely to indicate 'I have no interest in trying any of these products' (72.3%) than those in the 'branded' condition (66.9%, AOR 1.45, 95% CI 1.33-1.59). Experiment 2 results indicated differences in e-cigarette appeal by sex in the selection of male- and female-oriented designs, and by cannabis use for a Rastafarian-themed design. CONCLUSIONS: Brand imagery on e-cigarettes can target products to specific subgroups. Removal of imagery, in the form of standardized packaging, has the potential to reduce interest in trying e-cigarettes among young people.

Anti-inflammatory and antinociceptive activities of LQFM002 - A 4-nerolidylcatechol derivative.

AIMS: The current study describes the synthesis and pharmacological evaluation of (E)-N-(3,7-dimethylocta-2,6-dienyl)-1,3-dimethyl-1H-pyrazol-5-amine (LQFM002), a compound originally designed through a molecular simplification strategy from 4-nerolidylcatechol. LQFM002 was evaluated for preservation of the PLA(2) enzyme inhibitory effects of the lead compound, 4-nerolidylcatechol, using in vitro and in vivo models. MAIN METHODS: Rota-rod, open field and pentobarbital-induced sleeping tests were used to evaluate the effects of LQFM002 on the central nervous system. A gel plate assay of PLA(2) activity, carrageenan-induced pleurisy and TNF-α levels was used to assay anti-inflammatory activity. Antinociceptive activities of LQFM002 were evaluated with acetic acid-induced writhing, formalin and hot-plate tests, while involvement of the opioid pathway in the LQFM002 antinociceptive effect was investigated with naloxone pre-treatment. KEY FINDINGS: LQFM002 inhibited PLA(2) activity, cell migration into the pleural cavity, and capillary permeability (Evan's blue concentration) and reduced TNF-α levels in pleural exudates. LQFM002 also reduced acetic acid-induced writhing and the licking time in both phases of the formalin test and increased latency in the hot-plate test. Pre-treatment with 8.25 µmol/kg naloxone (3mg/kg) reversed the analgesic effects of LQFM002 in the early phase of the formalin test. SIGNIFICANCE: LQFM002 showed anti-inflammatory activity, which possibly involved reduction of leukocyte migration and TNF-α levels. LQFM002 also demonstrated inhibition of PLA(2) activity in vitro. LQFM002 had an antinociceptive effect that involved the opioidergic system.

Raiva bovina no estado de São Paulo e sua distribuição espacial entre 1992 e 2003 / Cattle rabies in the State of São Paulo and its spatial distribution from 1992 to 2003

Descreveu-se a influência do relevo, da precipitação, da temperatura e da sazonalidade na distribuição espacial da raiva bovina. Para a realização dessa análise, foi construído um banco geográfico de dados que possibilitou a geração de uma função kernel, com base no somatório anual dos diagnósticos de raiva laboratorialmente positivos entre 1992 e 2003, bem como a verificação da sua relação com as demais variáveis. Constatou-se que a região com relevo montanhoso, maiores índices pluviométricos e temperatura mais amena do planalto atlântico e da província costeira correspondeu às áreas com maior densidade da função, contrapondo-se à região do planalto ocidental com menores índices pluviométricos e áreas mais quentes. Não se observou, no estado, relação entre sazonalidade e raiva bovina no período estudado. A região plana da depressão periférica e o eixo de conurbação São Paulo-Campinas são óbices que dividem, respectivamente, a enfermidade entre as regiões leste-oeste e leste-sul do estado.

The influences of relief, precipitation, temperature, and seasonally was evaluated on the cattle rabies spatial distribution in the State of São Paulo. In that way, a Geographic Data Bank was developed in order to create a kernel function with the cases of cattle rabies from 1992 to 2003 and its relation with other variables. Results showed that the rainy hilly areas with low temperature in the "Planalto Atlântico" and "Província Costeira" were linked to areas with the higher density of the function in opposite to the plane areas of the "Planalto Ocidental" with low rainy index and high temperatures. There were no relations between seasonality and cattle rabies in the State of São Paulo. The flat region of the "Depressão Periférica" and urban area between São Paulo and Campinas are barriers that determine the disease occurrence in East-West and East-South regions of the State.

Raiva bovina segundo os mosaicos de uso e cobertura da terra no estado de São Paulo entre 1992 e 2003 / Cattle rabies according to the mosaics of land use and land cover in the state of Sao Paulo from 1992 to 2003

O objetivo deste trabalho foi descrever a influência dos mosaicos de uso e de cobertura da terra na distribuição espacial da raiva bovina na região de maior incidência do Estado de São Paulo, entre 1992 e 2003. Geotecnologias foram utilizadas para gerar três camadas sobrepostas: a enfermidade caracterizada por uma função kernel, os tipos de uso e classes de cobertura da terra obtidos por classificação de imagens de satélites e a altitude. A enfermidade esteve fortemente moldada pelas áreas de vegetação rasteira (pastagens). O relevo pareceu formar os mosaicos de uso e cobertura da terra, os quais acabaram determinando os locais de grassamento ou não da enfermidade. Grandes áreas contínuas do mesmo tipo de uso e classe de cobertura da terra tenderam a ser protetoras da raiva bovina, ou favorecedoras em áreas vizinhas.

The influence of the mosaics of land use and land cover in the spatial distribution of cattle rabies was described in the major incidence region of the State of Sao Paulo, from 1992 to 2003. Geotechnologies were used to build three layers: the disease established by a kernel function, the land use and land cover obtained by satellite images classification, and the altitude. The disease was hardly shaped by grasslands. The relief seems to form the land use and land cover, which determine the regions for the occurrence or not of the disease. Large continuous areas of the same land use and land cover tend to be a protection to cattle rabies or to favor it in the neighborhood areas.

Screening for congenital hypothyroidism in extreme premature and/or very low birth weight newborns: the importance of a specific protocol.

BACKGROUND: Neonatal screening for congenital hypothyroidism (CH) in premature infants is not as well established as in term newborns regarding age and number of samples. AIMS: 1. To evaluate the effectiveness of the protocol recommended by the Neonatal Screening Program of the State of Minas Gerais (PETN-MG) for CH neonatal screening in very low birth weight premature infants. 2. To estimate the prevalence of delayed TSH elevation and thyroid function alterations in the target population. METHODS: TSH was assessed by ELISA on the 5th, 10th and 30th days of life in all newborns with gestational age <32 weeks and/or very low birth weight (VLB) (<1,500 g) in the period from October 2004 to September 2006. RESULTS: Out of the 14,462 newborns screened, 2,647 were premature with gestational age <32 weeks and/or VLB. Forty-four cases of altered TSH were found and 11 infants underwent treatment. Delayed TSH elevation was detected in 66% of altered cases. Five out of the 11 cases were detected in the second sample and five cases were only detected in the third sample. CONCLUSION: The high prevalence of thyroid function alterations that demanded treatment (1:242) and delayed TSH elevation in VLB premature infants reinforce the need for a specific protocol, based on retesting procedures, for CH neonatal screening.

Management of aberrant subclavian artery aneurysms.

An aberrant subclavian artery is the most common congenital anomaly of the aortic arch. Aneurysms of these vessels are relatively rare lesions. A high clinical suspicion must be maintained in patients with an abnormal mediastinum on chest X-ray, especially in patients with dysphagia, dyspnea, or upper extremity ischemic symptoms not otherwise explained. Potentially disastrous complications, including spontaneous rupture and perforation into the esophagus may occur, and are invariably fatal. We present the case of an 1 asymptomatic 72-year-old male with an aberrant right c subclavian artery aneurysm presenting as a mediastinal mass on routine chest X-ray. Repair was by aneurysmectomy through a left thoracotomy and right common carotid artery to subclavian artery bypass via median sternotomy with resolution of his symptoms. We reviewed 74 cases in the English literature to February 1998. The pertinent anatomy is discussed and trends in surgical treatment are identified. Recent agreement on the surgical approach and choice of revascularization appears to exist, but advances in diagnostic and interventional radiologic capabilities have increased the number of asymptomatic lesions encountered and may alter the treatment of this lesion in the near future.

A comparison of the reliability of two techniques of left double-lumen tube bronchial cuff inflation in producing water-tight seal of the left mainstem bronchus.

UNLABELLED: A double-lumen endobronchial tube (DLT) bronchial cuff inflation technique that reliably ensures effective water-tight isolation of the two lungs has not been determined. In this study, 20 patients undergoing thoracic surgery requiring a left DLT had the bronchial cuff of the DLT inflated by one of two techniques. In Group 1, the cuff was inflated to produce an air-tight seal of the left bronchus using the underwater seal technique. In Group 2, the cuff was inflated to a pressure of 25 cm H2O. After bronchial cuff inflation in both groups, water-tight bronchial seal was tested by instilling 2 mL of 0.01% methylene blue (MB) above the bronchial cuff of the DLT. Fifteen minutes later, fiberoptic bronchoscopy was performed via the bronchial lumen of the DLT to determine whether MB had seeped past the bronchial cuff. Cuff volume was 0.75+/-0.64 and 0.76+/-0.46 mL, cuff pressure was 30.1+/-27.0 and 25.0+/-0.0 cm H2O (mean+/-SD), and MB was positively identified in two and five patients in Groups 1 and 2, respectively. The difference in cuff volume and pressure and the higher MB seepage in Group 2 compared with Group 1 was not statistically significant. In both groups, MB seepage occurred only when the bronchial cuff volume was <1 mL and when the patients were positioned in the left lateral decubitus position. These findings suggest that the risk of aspiration is greatest when the DLT is positioned in the dependent lung and when the bronchial cuff volume is <1 mL. IMPLICATIONS: Water-tight sealing of the left bronchus by DLT bronchial cuff was tested after cuff inflation using two different techniques. Neither air-tight bronchial seal nor cuff pressure of 25 cm H2O guaranteed protection against aspiration. The risk of aspiration was greatest when the DLT was positioned in the dependent lung and when the bronchial cuff volume was < 1 mL.

Solitary fibrous tumors: a series of lesions, some in unusual sites.

Solitary fibrous tumor (SFT) is a rare neoplasm that, in addition to its classic presentation as a pleural-based mass, can also be encountered in unusual sites. The main difficulty in making the diagnosis of SFTs results from the unfamiliarity with its diverse clinical and pathologic features. This series of SFTs, some with unusual clinicopathologic presentation, included nine women and two men, ranging in age from 28 years to 74 years (five in pleura, one in lung parenchyma, one in breast, and four in mediastinum). The tumors were locally excised in eight cases and were resected along with portions of lung parenchyma in three. A panel of immunohistochemical stains was used to characterize these tumors. They were all vimentin-positive and, with the exception of one case, CD34-positive. Tumors were negative with antibodies directed against cytokeratin, factor VIII-related antigen, S-100 protein, muscle-specific actin, and smooth-muscle actin. Various diagnoses were initially rendered for these clinically and pathologically diverse lesions by the examining pathologists. Awareness of the various gross and microscopic patterns of these tumors, the possibility of occurring in unusual sites, and the use of immunohistochemical stains, particularly CD34, should eliminate most of the difficulties in arriving at a correct diagnosis. One patient died of metastatic breast cancer; all other patients were alive and well with a median follow-up of 17 months.

Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe.

BACKGROUND: To fully evaluate patients with esophageal cancer by endoscopic ultrasonography (EUS), the transducer must pass through the entire tumor to the cardia to scan the celiac axis. Dilation may be necessary. Published information suggests that dilation with EUS carries a sizeable risk. METHODS: In order to assess the complication rate associated with dilation prior to EUS in patients with esophageal cancer and the clinical significance of dilation for complete EUS staging, we reviewed the records of all patients who had undergone EUS for esophageal cancer. RESULTS: Sixty-three patients underwent EUS staging of esophageal cancer. Thirty-nine (62%) had lesions through which the EUS scope was passable (Group I). Ten (16%) patients (Group II) had lesions through which an EUS scope (diameter 13 mm) was unable to pass even after dilation. Fourteen patients (22%) had lesions that were dilated to allow passage of the EUS scope (Group III). All patients in Groups II and III had confirmation of EUS staging by CT and/or surgery. In Group II, five patients had tumors defined as T4 (50%) and five as T3 (50%). In Group III, nine (64%) had T4 tumors, four (29%) had T3, and one (7.7%) had T2. No complications were encountered in any group. CONCLUSION: EUS, either alone or after dilation, is a safe procedure and the complete EUS examination with celiac node visualization adds prognostically significant information.

Diagnosis of aortic dissection: value of helical CT with multiplanar reformation and three-dimensional rendering.

OBJECTIVE: Twenty-three patients with suspected aortic dissection were evaluated in this preliminary study of helical CT to determine the usefulness of axial sections, multiplanar reformation, and three-dimensional (3D) rendering in assessing the presence of dissection and the extent of intimal flap. MATERIALS AND METHODS: Patients were referred for helical CT scanning because of chest pain or an abnormal chest radiograph. Scans were performed during bolus injection of nonionic contrast material at 2.0-2.5 ml/sec using a mean scan delay of 47 sec. Axial scans with 5-mm collimation were obtained in all patients. They extended from the great vessels to the distal thoracic aorta just above the hiatus. Delayed nonhelical sections were obtained through the upper abdomen. Multiplanar reformations and 3D models were reconstructed from the helical data in 13 patients and were compared to axial sections in 7 patients who proved to have documented dissection. The efficacy of CT was determined using surgery, angiography, or clinical outcome to establish the diagnosis. RESULTS: Of the 23 patients studied, axial sections resulted in 15 true-negative, 7 true-positive, and 1 false-positive interpretation. In three of seven patients with dissection, it was difficult to determine the extent of the intimal flap on axial sections; multiplanar reformation or 3D views clarified the relevant anatomy in all 3 cases. Among the 3D display methods, ray-sum projection views were superior to surface model or maximum-intensity-projection views. CONCLUSION: If studies of larger numbers of patients confirm our preliminary findings, multiplanar reformation and 3D rendering of helical CT scans will be a valuable addition to axial display of CT studies used to detect aortic dissection and to determine the extent of the intimal flap.

Abdominal aortic aneurysms: findings on three-dimensional display of helical CT data.

Excellent vascular opacification, reduction in misregistration artifacts, and the option of reconstructing overlapping scans from which three-dimensional (3D) models of the abdominal vessels may be rendered are among the benefits of helical CT [1-4]. The purpose of this essay is to illustrate the findings of 3D rendering of helical CT data in patients with abdominal aortic aneurysms.

Abdominal aortic aneurysms: evaluation with variable-collimation helical CT and overlapping reconstruction.

PURPOSE: To determine the value of variable collimation and overlapping reconstruction in helical computed tomography (CT) to evaluate abdominal aortic aneurysm. MATERIALS AND METHODS: Twenty-three patients (15 men and eight women, aged 59-85 years) underwent helical CT scanning, nine with fixed 5-mm collimation and 14 with 3- and 7-mm collimation combined. The ability to visualize main and accessory renal arteries, detect stenoses, and determine aneurysm extent were evaluated. RESULTS: Extent of aneurysm was accurately determined in 17 of 23 cases without overlapping sections; failure to detect ancillary findings such as accessory arteries or stenosis occurred in nine of these cases. With overlapping sections, determination of aneurysm extent improved to 19 of 23 cases and ancillary errors were reduced to four. Five errors occurred with fixed collimation and three errors with variable collimation. CONCLUSION: Overlapping, variable-collimation helical CT allows for a more complete evaluation of abdominal aortic aneurysms than does nonoverlapping, fixed-collimation CT.

Preoperative assessment of abdominal aortic aneurysm: the value of helical and three-dimensional computed tomography.

PURPOSE: The purpose of this study was to evaluate the utility of helical computed tomography (CT) in the preoperative assessment of abdominal aortic aneurysms (AAA) and to compare its accuracy with aortography and operative findings. METHODS: Thirty-two patients with suspected AAA were evaluated by helical CT with either 5 mm collimation (slice thickness) or a combination of 3 mm collimation through the renal and mesenteric arteries and 7 mm collimation through the remainder of the AAA. Three-dimensional reconstructions were performed with use of three different techniques, and results were compared with aortography and surgery. RESULTS: Twenty-five patients were found to have an aneurysm, and 19 subsequently underwent surgery. Standard angiography was also performed in 13. The location, size, and extent of the aneurysm, as well as the wall calcification and intraaneurysmal thrombus, were well depicted with helical CT. The visceral aortic branches, including the detection of renal artery stenosis and accessory renal arteries, were consistently seen with the 3 mm/7 mm collimation protocol and three-dimensional reconstruction. CONCLUSION: Helical CT with three-dimensional display of the aorta and its branches combines the advantages of conventional CT imaging and aortography. This technique appears to provide comprehensive preoperative evaluation of AAA.

Pedicled muscle flaps in the management of infected aortofemoral grafts.

Graft infection, although uncommon, is a serious complication of reconstructive vascular surgery, associated with a high mortality and limb loss in a large percentage of the survivors. Although débridement and drainage, specific systemic antibiotics, removal of the entire infected graft and revascularization by extra-anatomic bypass are the general principles of management, this technique has its limitations and in certain circumstances is not feasible. The use of well-vascularized autogenous tissue as coverage of infected grafts has been successful in the lower extremities, with graft and limb salvage, but not when the infection extends above the inguinal ligament. Instances where the infection at the inguinal area extends retrograde along the limb of the aortofemoral graft represent a greater therapeutic challenge. In two instances, a dual muscle flap was used successfully to cover the exposed prosthesis after complete débridement of the perigraft granulation tissue. Sartorius and rectus femoris muscles, with their blood supply, were mobilized and rotated to cover the distal anastomosis and the retroperitoneally exposed graft respectively, with primary wound closure. All flaps survived and the patent grafts were salvaged. There was no long-term functional deficit from the transposition of these muscles. Pedicled muscle flaps appear to be a well-tolerated method of achieving autogenous tissue coverage of an infected graft in the groin, and retroperitoneal portions and should be considered a satisfactory alternative when the traditional methods of management cannot be applied.

Salmonella aortitis. A report of a successfully treated case with a comprehensive review of the literature.

A successfully treated case of Salmonella infection of the thoracic aorta is described. Salmonella enteritidis was isolated from blood cultures and from operative cultures of the aorta. Computed tomography suggested the site of infection, and the resection of the thoracic aortic aneurysm with specific antibiotic therapy resulted in a satisfactory outcome. Although once invariably fatal, improved diagnostic roentgenographic techniques, more potent antibiotics, and surgical advances have resulted in at least 45 reported survivors over the last 15 years. The pathogenesis, clinical and laboratory characteristics, and the treatment of aortitis due to Salmonella species are reviewed in 98 cases reported in the English-language literature since 1948. Early diagnosis and a combination of prompt surgical intervention and antibiotic therapy are essential for survival.