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.

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.

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.

Severe aortic regurgitation secondary to idiopathic aortitis.

Clinical and morphologic features are described in two relatively young adults with aortic regurgitation secondary to chronic aortitis. The regurgitation in each was severe enough to require aortic valve replacement. Both patients had normochromic, normocytic anemia, considerable weight loss despite congestive cardiac failure, and negative serologic tests for syphilis. These systemic manifestations in association with the aortitis suggest that both had Takayasu's arteritis. In addition, one patient had total occlusion at the origin of one subclavian artery (classic pulseless disease). Takayasu's arteritis must be added to the list of causes of severe aortic regurgitation.

Intrapericardial bronchogenic cysts.

A rare case of large intrapericardial bronchogenic cyst with superior vena caval obstruction is reported. The cyst was successfully removed and the superior vena cava, which was narrowed by pressure fibrosis and thrombosis, was reconstructed satisfactorily and has maintained patency. In another case a large cyst of the same type without vena caval obstruction was successfully treated surgically. The features of these 2 cases are compared with those of 20 reported cases. The angiographic data in these cases appear to be sufficiently characteristic to suggest the nature of the lesion and the clinical finding of pericarditis early in the course of the disease may also suggest the diagnosis.

Severe aortic regurgitation from systemic hypertension (without aortic dissection) requiring aortic valve replacement: analysis of four patients.

Clinical and morphologic observations are described in four patients who had severe aortic regurgitation from severe systemic hypertension unassociated with aortic dissection; each patient underwent aortic valve replacement. Although aortic regurgitation of minimal or mild degree is well recognized to occur in patients with systemic hypertension, severe degrees of aortic regurgitation are rare in such patients; aortic valve replacement in such patients has not previously been reported. Why these four patient had such severe aortic regurgitation was not determined. Although systemic hypertension is rarely a cause, it nevertheless must be added to the list of causes of severe pure aortic regurgitation.

Late follow-up of ball-valve prostheses in the descending thoracic aorta.

Clincal and hemodynamic observations are reported in a group of five patients with free aortic regurgitation treated with insertion of a ball valve prosthesis in the descending aorta. Long-term follow-up ranging from 13 to 23 years illustrates the durability and biocompatibility of the valve and the validity of the concept that a moving prosthesis can function for indefinitely long periods of time. The prolonged survival of these patients at a normal level of activity without congestive failure is strong evidence of the efficacy of the prosthesis even though it did not entirely control all of the aortic insufficiency. All patients showed remarkable improvement of their symptoms from 11 to 21 years after surgery. Four of them have required complete correction of the aortic insufficiency with one postoperative death due to low output syndrome. The valves which have remained in place after insertion of a subcoronary valve are functioning well for 3 to 6 years. There was no evidence of hemolysis, valve malfunction, ball variance, or thrombbosis in any of these patients. The evolution of the technique made it possible to minimize complications which, it should be pointed out, were usually associated with faulty methods of insertion. These patients would appear to represent the longest period of insertion of any valvular prosthesis.

Echocardiographic features of traumatic disruption of the aortic valve.

The echocardiographic findings are presented of a patient who had evidence of aortic regurgitation one year after blunt trauma to the chest. Combined M-mode and 2-D imaging showed features suggestive of disruption of the posterior aortic leaflet, subsequently confirmed at operation, in the absence of infective endocarditis. Diagnosis of this uncommon cause of aortic regurgitation, heretofore confirmed only by direct visualization, may be made preoperatively by echocardiography.

Superior vena cava obstruction: a review of the literature and report of 2 cases due to benign intrathoracic tumors.

A review of the literature shows an increaseing number of cases of superior vena cava obstruction associated with malignancy and a marked decrease in the number of patients with caval obstruction of benign origin. In contrast to granulomatous diseases and aneurysms of the ascending thoracic aorta, which have decreased, the incidence of benign tumors is essentially unchanged. Clinical features of superior vena cava obstruction in relation to the anatomical site of obstruction and collateral pathways are correlated. Diagnostic approaches, including angiography and technetium scanning are usually definitive in outlining the site of obstruction. Experimental data and the numerous available techniques for surgical correction indicate that an entirely satisfactory procedure is not available for all patients. Methods include the use of venous bypass or Teflon prostheses and the addition of a small arteriovenous fistula proximally. Two new cases of superior caval obstruction due to benign tumor are reported. In 1 patient, who had intrapericardial bronchogenic cyst with fibrotic caval obstruction and thrombosis, a method for caval reconstruction while maintaining venous return to the right atrium is described. The second patient had an intrathoracic thyroid adenoma and caval obstruction without thrombosis.

Abdominal aortic aneurysms: diagnostic review and new technique.

A new technique of computed tomography (CT) applied to the diagnosis of abdominal aortic aneurysms is described, and the experience in 58 patients is reviewed. In all instances the abdominal aorta was clearly demonstrated, even when wall calcification was absent. A series of 37 patients with abdominal aortic aneurysm underwent evaluation by physical examination, abdominal roentgenograms, and ultrasonic and CT scanning. Measurements of the transverse diameter at the point of maximal dilatation were compared with the measurements made at operation. CT not only confirmed the diagnosis in all patients but the measurements obtained by this technique were the most accurate, correlating extremely well with the true dimensions of the aneurysm. The addition of contrast enhancement to CT scanning allowed clear delineation of the aortic lumen and intraaneurysmal thrombus, not possible with any other method, including ultrasonography. The technique appears useful as a screening procedure and in the differential diagnosis of a tortuous abdominal aorta. Patients with a small aortic dilatation can be followed accurately by scanning.

Mediastinal tracheostomy.

Upper airway obstruction in primary or recurrent carcinomas of the head and neck extending into the mediastinum may demand surgical intervention despite severe technical difficulties in patients with tumors previously considered inoperable. In fact, many of these tumors may be operable and some perhaps curable. A technique has been developed based in part on our experience with previously described procedures. A preliminary sternal split is used to demonstrate the extent of the mediastinal involvement as well as to provide enhanced exposure and proximal control of the great vessels. The pectoralis major muscle is used with a generous flap of overlying skin comprising nearly half of the anterior portion of the chest. A tracheostomy is then created in a fashion similar to the placement of a cardiac valvular prosthesis by creating a circular defect in the pectoralis major flap and suturing it to the tracheal remnant. This technique offers a reasonably safe and reliable means of creating a low anterior mediastinal tracheostomy for tumors previously considered inoperable. The preliminary sternal split makes the procedure safer and easier to perform, and the use of a very large pectoralis major island flap allows for reliable closure of the resulting mediastinal and sternal defects.

Assessment of major venous anomalies by computerized tomography.

Congenital anomalies of major venous structures are not common but their identification and relative position, particularly in relation to an abdominal aortic aneurysm, are of significant value in planning and conducting aortic operations. Computed tomography (CT) has become a common method of preoperative evaluation of aortic disease. Its reliability in providing accurate information regarding aneurysmal size, configuration, and extension, as well as the presence of intraluminal thrombus and involvement of the renal and iliac arteries, has been demonstrated. Simultaneous visualization of the major adjacent venous structures with the use of contrast enhancement is obtained, but anatomic variants can be overlooked because they are commonly subtle and considered incidental. The preoperative diagnosis of these venous abnormalities is significant to the vascular surgeon. Such information can be accurately and reliably acquired with the present CT techniques without the need for further diagnostic studies.

Infected aortic aneurysms: CT diagnosis.

Infected aortic aneurysms are uncommon but important because they can lead to uncontrolled sepsis and/or aortic rupture. Symptoms are frequently minimal during the early stages and a high index of suspicion is essential to make the diagnosis. The surgical literature suggests that survival is markedly improved by a prompt diagnosis and aggressive surgical intervention. Our recent experience with 5 cases who underwent arteriography and/or computed tomography (CT) prior to surgery was reviewed and these diagnostic methods compared. Traditionally, arteriography has been considered indispensable in the evaluation of infected aortic aneurysms but the aneurysm lumen must reach a certain size before it can be detected and, even then, the extraluminal component may be underestimated. CT, with contrast enhancement, was more sensitive in the early stages of the disease and provided a more complete depiction of the anatomic abnormalities. Mural enhancement preceded the increase in the aortic lumen with disruption of aortic wall calcification. An earlier and more accurate diagnosis can be provided by CT than by angiography without the disadvantages of its invasiveness and cost.

Present status of abdominal aorta imaging by computed tomography.

A seven-year experience with CT scanning in the diagnosis and evaluation of abdominal aortic aneurysms is reviewed. Two hundred twenty-six patients with suspected abdominal aortic aneurysms were studied, 12 being acute situations with possible rupture. In 15 no aortic pathology was seen. The diagnosis of an aneurysm regardless of its location was made in all instances and confirmed by other techniques and/or surgery. Location, size, extension and presence of thrombus were well delineated. Aortic rupture or leakage was demonstrated when present. Unsuspected involvement of the thoracic aorta, as well as the iliac arteries was shown. CT scanning is a technique that can safely, easily and accurately be used in the diagnosis of, follow-up and extension of aneurysmal disease regardless of its location or clinical situation and compares favorably with any other available technology.

Pre-operative evaluation of abdominal aortic aneurysms: ultrasound or computed tomography?

Evaluation of aortic aneurysms by ultrasound (US) or computed tomography (CT) is now commonplace and their use often reflects personal preferences given their similar diagnostic accuracy. Knowledge of anatomic details may be very helpful in the planning of the surgical procedure. Involvement of the supra-renal aorta, relative position of the renal arteries, intra-aneurysmal thrombus, and extension to the iliac arteries were retrospectively evaluated by both techniques to determine which modality was more valuable in the preoperative evaluation of abdominal aortic aneurysms. A group of 58 patients was reviewed. An infra-renal aortic aneurysm was identified in all instances by both methods. The supra-renal aorta was always well visualized by CT but not by US. The origin of at least one renal artery was seen in only 11% of the cases by US but in 100% by CT. CT demonstrated the left renal vein in all cases, while only 41% were demonstrated by US. Intra-aneurysmal thrombus was depicted by both methods but its distribution within the sac and the characteristics of the thrombus were apparent on CT but not on US. Aneurysmal involvement of the iliac arteries was present in 19% of the patients. CT detected all cases but only 14% were demonstrated by US. Both methods accurately diagnose abdominal aortic aneurysms. Supplementary data regarding proximal and distal extension, characteristics of the thrombus, relationship to the renal vessels, and adjacent major veins can be obtained by CT and usually not by US. This information is of value in the planning and execution of the indicated surgical procedure.

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.

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.