Cardiovascular effects of electronic cigarettes: A systematic review and meta-analysis.

AIMS: The electronic cigarette is marketed as a safe alternative to tobacco smoking, but electronic cigarette cardiovascular effects remain largely unknown. We systematically reviewed and meta-analysed published literature to investigate the cardiovascular effects and associated risk from electronic cigarette use. METHODS AND RESULTS: We searched PubMed from January 2000 to November 2017 for published studies assessing the cardiovascular effects of the electronic cigarette. Evidence suggests that the electronic cigarette negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are from single study reports and have not been confirmed in additional studies. Conflicting evidence exists on the effects of the electronic cigarette on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. The meta-analysis of 14 studies (N + 441 participants) suggested that despite the negative acute effects of the electronic cigarette on heart rate (pooled mean difference (MD) + 2.27, 95% confidence interval (CI): 1.64 to 2.89, p < 0.001), diastolic (pooled MD + 2.01 mmHg, 95% CI: 0.62 to 3.39, p + 0.004) and systolic blood pressure (pooled MD + 2.02 mmHg, 95% CI: 0.07 to 3.97, p + 0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to chronic electronic cigarette use (systolic blood pressure pooled MD + -7.00, 95% CI: -9.63 to -4.37, p < 0.001; diastolic blood pressure pooled MD + -3.65, 95% CI: -5.71 to -1.59, p + 0.001). CONCLUSIONS: The existing evidence on the cardiovascular effects of the electronic cigarette is concerning, with several unexplored issues. Unless supported by stronger evidence, the electronic cigarette should not be labelled as a cardiovascular safe product. Future studies should delineate whether electronic cigarette use is less hazardous to cardiovascular health than conventional cigarette smoking.

Bony landmarks of the medial orbital wall: an anatomical study of ethmoidal foramina.

The study determines the distribution patterns of ethmoidal foramina (EF) evaluate how they are affected by gender or bilateral asymmetry, and highlights the surgical implications on the anatomical landmarks of the orbit. Two hundred and forty-nine dry orbits were assessed. The number and pattern of EF were determined and distances between the anterior lacrimal crest (ALC), anterior (AEF) middle (MEF), posterior (PEF) ethmoidal foramina and between PEF and the optic canal (OC) were measured. The patterns of EF were classified as type I (single foramen) in 4 orbits (1.6%), type II (double foramina) in 152 (61%), type III (triple foramina) in 71 (28.5%), and type IV (multiple foramina) in 22 orbits (16.4%). Two orbits were found with five EF and a single orbit with six EF. A significant gender difference was observed for ALC-AEF distance (P ≤ 0.03), in males 23.53 ± 2.86 (20.67-26.39) versus females 22.51 ± 3.72 (18.79-26.23) mm. Bilateral asymmetry was observed for ALC-AEF distance (P ≤ 0.01). The distances ALC-AEF and ALC-PEF varied significantly according to EF classification (P ≤ 0.03 and P ≤ 0.02). The navigation ratio from ALC-AEF, AEF-PEF, and PEF-OC, in Greek population was "23-10-4 mm". A variation in the number of EF was found, ranging from 1 to 6, with the first report of sextuple EF. Although measures were generally consistent across genders and side, there are significant differences across ethnicities. These findings suggest that surgeons must consider population differences in determining the anatomical landmarks and navigation points of the orbit.

The ossified pterygoalar ligament: an anatomical study with pathological and surgical implications.

Mandibular nerve entrapment has great significance, as it may be responsible for the appearance of several neurological pathologies, such as chewing disorders, taste loss, facial or tongue paraesthesia and neuralgia. The ossified pterygoalar (Pta) bar is the result of calcification and/or ossification of the ligament extending from the pterygospinous process of the lateral pterygoid lamina to the infratemporal surface of the sphenoid bone. The ossified bar may act as the cause for this entrapment. One hundred and forty-five Greek adult dry skulls were examined for the existence of a complete or incomplete Pta bar and a relative foramen. The Pta bar appeared in 31.7% of the skulls, in total, in 4.1% completely and in 27.6% incompletely ossified. The mean sagittal and transverse diameters of Pta foramen were 3.21 ± 1.70 and 4.79 ± 1.39 mm, respectively. There was no statistical significant difference between the presence of Pta bar and the side or gender. Apart from the neurological interest, this study highlights the importance of the existence of Pta bar in neurosurgery, anaesthesiology, oral and maxillofacial surgery. The passage of the needle through the foramen ovale for the injection of anaesthetics, as a treatment for trigeminal neuralgia may not be achieved due to this anatomical obstacle. In this case, intra- or postoperative radiologic investigation may be helpful.