Nano-curcumin effects on nicotine dependence, depression, anxiety and metabolic parameters in smokers: A randomized double-blind clinical study.

Background: Smoking is clearly associated with metabolic profiles/abnormalities, psychological dysfunction, and symptoms of nicotine dependence. Nano-Curcumin (Nano-CUR) is a medicinal herb with antianxiety, antioxidant antidepressant-like effects, and anti-inflammatory properties. This RCT aimed to determine the therapeutic effects of Nano-CUR in smokers on clinical symptoms and metabolic parameters. Methods: This trial was conducted on 70 participants with cigarette smoking. Smokers in two arms received soft gel capsules Nano-CUR 80 mg/daily for 3 months (n = 35) and placebo (n = 35), respectively. Primary outcomes (Nicotine dependence syndrome scale, depression, and anxiety beck score), and secondary outcomes (glycemic, lipid, stress oxidative, and inflammation profiles) were analyzed before and 3-months after the intervention in smokers. Results: Nano-CUR supplementation significantly decreased nitric oxide, malondialdehyde, and C-reactive protein levels (P < 0.05), compared to the control. Furthermore, no significant effect change was shown in nicotine dependence syndrome, depression, anxiety, and other metabolic parameters (p > 0.05). Conclusion: Nano-CUR intake may have favorable effects on C-reactive protein, malondialdehyde, and nitric oxide in subjects with cigarette smoking. More RCT are required to evaluate the effectiveness of Nano-CUR supplementations in smokers in order to reject or support these conclude.

Antioxidant Intake and Biomarkers of Asthma in Relation to Smoking Status-A Review.

Asthma is considered a chronic inflammatory disorder associated with airway hyperresponsiveness (AHR). Increased oxidative stress (OS) is a clinical feature of asthma, which promotes the inflammatory responses in bronchial/airway epithelial cells. Smokers and nonsmokers with asthma have been shown to have increases in several OS and inflammatory biomarkers. However, studies suggest significant differences in OS and inflammation biomarkers between smokers and nonsmokers. A few studies suggest associations between antioxidant intake from diet/supplements and asthma in patients with different smoking status. Evidence is lacking on the protective role of antioxidant vitamin and/or mineral consumption against asthma by smoking status with respect to inflammation and OS biomarkers. Therefore, the aim of this review is to highlight current knowledge regarding the relations between antioxidant intake, asthma, and its associated biomarkers, according to smoking status. This paper can be used to guide future research directions towards the health consequences of antioxidant intake in smoking and nonsmoking asthmatics.

Omega 3 supplementation reduces C-reactive protein, prostaglandin E2 and the granulocyte/lymphocyte ratio in heavy smokers: An open-label randomized crossover trial.

Objectives: Given the current controversy concerning the efficacy of omega 3 supplements at reducing inflammation, we evaluated the safety and efficacy of omega 3 on reducing inflammation in people with a 6-year lung cancer risk >1.5% and a C reactive protein (CRP) level >2 mg/L in a phase IIa cross-over study. Materials and methods: Forty-nine healthy participants ages 55 to 80, who were still smoking or had smoked in the past with ≥30 pack-years smoking history, living in British Columbia, Canada, were randomized in an open-label trial to receive 2.4 g eicosapentaenoic acid (EPA) + 1.2 g docosahexaenoic acid (DHA)/day for 6 months followed by observation for 6 months or observation for 6 months first and then active treatment for the next 6 months. Blood samples were collected over 1 year for measurement of plasma CRP, plasma and red blood cell (RBC) membrane levels of EPA, DHA and other fatty acids, Prostaglandin E2 (PGE2), Leukotriene B4 (LTB4) and an inflammatory marker panel. Results: Twenty one participants who began the trial within the active arm completed the trial while 20 participants who started in the control arm completed the study. Taking omega 3 resulted in a significant decrease in plasma CRP and PGE2 but not LTB4 levels. Importantly, the effect size for the primary outcome, CRP values, at the end of the intervention relative to baseline was medium (Cohen's d = 0.56). DHA, but not EPA levels in RBC membranes inversely correlated with PGE2 levels. Omega 3 also led to a significant reduction in granulocytes and an increase in lymphocytes. These high-dose omega 3 supplements were well tolerated, with only minor gastrointestinal symptoms in a subset of participants. Conclusion: Omega 3 fatty acids taken at 3.6 g/day significantly reduce systemic inflammation with negligible adverse health effects in people who smoke or have smoked and are at high risk of lung cancer.ClinicalTrials.gov, NCT number: NCT03936621.

Targeted Next-Generation Sequencing Reveals Exceptionally High Rates of Molecular Driver Mutations in Never-Smokers With Lung Adenocarcinoma.

INTRODUCTION: Historically, high rates of actionable driver mutations have been reported in never-smokers with lung adenocarcinoma (ADC). In the era of modern, comprehensive cancer mutation sequencing, this relationship necessitates a more detailed analysis. METHODS: All Mount Sinai patients between January 1, 2015, and June 1, 2020, with a diagnosis of ADC of any stage with known smoking status who received genomic testing were included. Most patients were analyzed using the Sema4 hotspot panel or the Oncomine Comprehensive Assay version 3 next-generation sequencing (NGS) panel conducted at Sema4. Patients were considered fully genotyped if they were comprehensively analyzed for alterations in EGFR, KRAS, MET, ALK, RET, ROS1, BRAF, NTRK1-3, and ERBB2, otherwise they were considered partially genotyped. RESULTS: Two hundred and thirty-six never-smokers and 671 smokers met the above criteria. Of the never-smokers, 201 (85%) had a driver mutation with 167 (71%) considered actionable (ie, those with US Food and Drug Administration-approved agents). Among smokers, 439 (65%) had an identified driver mutation with 258 (38%) actionable (P < .0001). When comprehensively sequenced, 95% (70/74) of never-smokers had a driver mutation with 78% (58/74) actionable; whereas, for smokers, 75% (135/180) had a driver with only 47% (74/180) actionable (P < .0001). Within mutations groups, EGFR G719X and KRAS G12Cs were more common to smokers. For stage IV patients harboring EGFR-mutant tumors treated with EGFR-directed therapies, never-smokers had significantly improved OS compared to smokers (hazard ratio = 2.71; P = .025). In multivariable analysis, Asian ancestry and female sex remained significant predictors of (1) OS in stage IV patients and (2) likelihood of harboring a receptor of fusion-based driver. CONCLUSION: Comprehensive NGS revealed driver alterations in 95% of never-smokers, with the majority having an associated therapy available. All efforts should be exhausted to identify or rule out the presence of an actionable driver mutation in all metastatic lung ADC.

The effect of vitamin D supplementation on tobacco-related disorders in individuals with a tobacco use disorder: a randomized clinical trial.

Vitamin D deficiency in cigarette smokers (CS) might associate with several complications, including metabolic deficits, depression and anxiety. This study evaluated the effects of vitamin D on mental health symptoms, nicotine misuse, and biomarkers of metabolic diseases in individuals with a tobacco use disorder. A randomized, double-blind, placebo-controlled trial was conducted with 60 CS subjects receiving either 50,000 IU vitamin D supplements (n = 30) or placebo (n = 30) every 2 weeks for 24-weeks. Nicotine misuse, mental health scale, and metabolic parameters were measured before and after the intervention in the CS subjects. Compared with the placebo-group, after the 24-weeks intervention, serum 25 (OH) vitamin D levels increased in the intervention group (ß 2.96; 95% CI, 0.91, 5.01; P = 0.006). In addition, vitamin D supplementation significantly improved Beck Depression Inventory (BDI) (ß -2.06; 95% CI, -3.84, -0.28; P = 0.02). In addition, vitamin D administration significantly decreased fasting plasma glucose (FPG) (ß -4.56; 95% CI, -8.94, -0.19; P = 0.04), insulin (ß -0.50; 95% CI, -0.88, -0.13; P = 0.009), and homeostasis model of assessment-estimated insulin resistance (HOMA-IR) levels (ß -0.21; 95% CI, -0.33, -0.08; P = 0.001). Furthermore, vitamin D resulted in a significant elevation in total antioxidant capacity (TAC) (ß 81.20; 95% CI, 18.30, 144.11; P = 0.01), and plasma glutathione (GSH) levels (ß 73.05; 95% CI, 18.56, 127.54; P = 0.01), compared with the placebo-group. Administration of vitamin D for 24-weeks to CS subjects had beneficial effects on symptoms of depression and several metabolic biomarkers. While this preliminary study suggests that vitamin D might have beneficial effects, its clinical efficacy in individuals with a tobacco use disorder should be further validated in future clinical trials.

Exploring attitudes towards smoking behaviour and cessation among hospitalised smokers via a socio-ecological framework: A scoping review.

OBJECTIVES: Cigarette smoking is a leading cause of preventable mortality and disability. Smoke-free policies in healthcare settings have been implemented as a public health measure. This scoping review aims to explore attitudes on smokers' cessation in smoke-free healthcare settings using a socio-ecological framework. METHODS: Four databases were searched for terms: smoking cessation, patient attitudes, and smoke-free policy. Of 420 studies, 17 met full inclusion criteria. RESULTS: The review identified four socio-ecological aspects of smoking cessation in smoke-free healthcare settings: Intrapersonal factors (health literacy, health conditions, and self-efficacy), interpersonal factors (social support, peer pressure, and social responsibility), healthcare factors (perceived mixed messages, healthcare setting, clinical, psychosocial and health promotion supports), and societal factors (restrictions on smoking in a public place and social acceptability of smoking). Smoke-free policies effectively encouraged cessation in some patients but were ineffective in those that felt a loss of autonomy. Provision of smoke breaks within smoke-free policies was considered a mixed message. CONCLUSIONS: Holistic strategies are required to interconnect the four socio-ecological dimensions for successful smoking cessation.

Influence of dietary total antioxidant capacity on the association between smoking and hypertension in Brazilian graduates (CUME project).

BACKGROUND AND AIMS: Hypertension (HTN) is a chronic non-communicable disease influenced by non-modifiable risk factors, such as sex and age, as well as modifiable risk factors such as lifestyle, including diet and smoking. Moreover, diet quality among smokers is worse than that of non-smokers, mainly in terms of antioxidant content. Thus, the current study aimed to investigate whether dietary total antioxidant capacity (dTAC) influences the association between smoking and HTN. METHODS AND RESULTS: This cross-sectional study included 4303 graduates (69.35% women) from the Cohort of Minas Gerais Universities (CUME) project. An online food frequency questionnaire was administered to participants, and dTAC was estimated using the ferric reducing antioxidant power method. In the questionnaires, individuals reported smoking status, systolic and diastolic blood pressure values, previous HTN diagnosis, and use of antihypertensive drugs. Logistic regression models were used to estimate the odds ratio and 95% confidence interval between smoking and HTN, stratified by the median dTAC. Current and former smokers had higher dTAC values despite their lower fruit intake. Moreover, coffee was the main contributor to dTAC among them. Smoking was associated with a higher likelihood of HTN, mainly among individuals with a higher dTAC. However, after exclusion of coffee antioxidant capacity, there was an association between only smoking and HTN in individuals with lower dTAC. CONCLUSIONS: The controversial association between higher dTAC and HTN can result from high coffee intake. Higher dTAC without coffee intake may mitigate the association between smoking and HTN in this population.

Immediate effect of interscapular cupping on blood pressure, oxygen saturation, pulse rate and chest expansion in sedentary smoker students.

OBJECTIVES: Increased sympathetic stimulation in smokers may be a risk factor for pulmonary and cardiovascular diseases. This study was conducted to assess the immediate effect of interscapular cupping on blood pressure (BP), oxygen (O2) saturation, chest expansion (CE), pulse rate (PR) in sedentary male smoker students. METHODS: Forty sedentary male smoker students- aged 18-25 years -were divided randomly into two equal numbered groups; wet cupping (WC) and dry cupping (DC) groups. Systolic and diastolic BP, upper and lower CE, O2 saturation and PR were measured immediately before and after a single cupping session in both groups. RESULTS: Both WC and DC types showed improvements in all measurements with a high statistically significant difference (p<0.05). CONCLUSIONS: Interscapular cupping enhanced CE, O2 saturation, BP and PR in sedentary male smoker students.

Vitamins B-12 and C Supplementation Improves Arterial Reactivity and Structure in Passive Smokers: Implication in Prevention of Smoking-Related Atherosclerosis.

BACKGROUND: Atherosclerosis is an important medical problem of modern society. High environmental tobacco smoke in casino is associated with an accelerated atherogenic process. We have previously shown vitamin B12 and C supplementation improves vascular reactivity and may be beneficial in vascular protection. OBJECTIVE: To evaluate the impact of vitamin supplementation on atherosclerosis (brachial artery reactivity FMD and carotid intima-media thickness IMT) in subjects exposed to high environmental tobacco smoke. DESIGN: Double-blind 2x2 factorial design fashion. SETTING: Computer randomization in 4 treatment groups: placebo (n=24), vitamin B12 (n=21), vitamin C (n=23) and vitamin B12+C (n=23) groups. PARTICIPANTS: 91 passive-smoking casino employees (19.2% male, mean age 45.0±8.2 years). INTERVENTION: Subjects were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules for 1 year. MEASUREMENT: Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and on completion at 12 months. METHODS: 91 passive smoking casino employees (19.2% male, mean age 45.0±8.2 years) were randomized to receive vitamin B12 (500µg daily), vitamin C (200mg daily), vitamin B12+C or image-matched placebo capsules in double-blind 2 x 2 factorial design fashion for 1 year. Brachial FMD and carotid IMT (surrogate atherosclerotic markers) were measured by ultrasound at baseline and 12 months. RESULTS: Of the 78 (85.7%) passive-smoking employees completed the study, 11.5% had hypertension, 5.1% diabetes mellitus and 15.4% hypercholesterolemia. There were no significant changes in their blood pressures, lipid profiles, glucose and body mass index after supplementation for 1 year, but mild decrease in DBP (p<0.001) and blood creatinine (p<0.01) after combined vitamin B12 and C, and significant increase in blood B12 after vitamin B12 (p<0.01) and vitamin B12+C supplementations (p<0.001). Brachial FMD and cartotid IMT improved after the 3 vitamin supplementations (p<0.001), but not after placebo, being more significant after combined vitamin supplementations (p<0.0001). No adverse effects were reported. CONCLUSION: Vitamin B12 or C supplementation in passive smokers improved vascular reactivity and structures at 1 year, with implication in long term atherosclerosis prevention.

Effect of deep breathing exercises in healthy smokers: A pilot study.

OBJECTIVE: To determine the effect of deep breathing exercises on lung functions in apparently healthy smokers. METHODS: The pilot study was conducted at Isra University, Islamabad, Pakistan, from May to December, 2017, and comprised apparently healthy smokers aged 20-30 years with a minimum smoking history of 5 years. The participants were divided into control and experimental groups. The control group was not given any treatment, while the experimental group was trained on deep breathing exercise techniques. Baseline data was compared after two weeks of intervention. SPSS 21 was used for data analysis. RESULTS: Of the 30 subjects, there were 15(50%) in each of the two groups. In the experimental group, significant changes were found in vital capacity, inspiratory capacity, tidal volume, expiratory reserve volume, force expiratory volume, and forced vital capacity (p<0.05). Post-intervention, all parameters improved significantly in the experimental group (p<0.05). CONCLUSIONS: Deep breathing exercise techniques were found to be useful in healthy smokers for improving lung functions and delaying the development of chronic obstructive lung complications.

Protective effect of the medicinal herb infusion "horchata" against oxidative damage in cigarette smokers: An ex vivo study.

Cigarette smoking has been associated with an increase in oxidative stress (OS) and is considered a predisposing factor to chronic noncommunicable diseases, whilst dietary antioxidants has been proposed as an alternative to cope with this oxidative stress. In this study, 20 smokers and 20 non-smokers were studied with the aim of determining their antioxidant status, as well as the ability of an infusion of 23 medicinal plants, to counteract the damage caused by OS. The plasma, red blood cells (RBCs) and polymorphonuclear cells (PBMCs) of both groups were incubated or not with the horchata infusion extract and then the OS markers, genotoxicity, nanostructure of RBCs membrane and genes related to oxidative responses and cellular functionality were evaluated. Up to 33 different compounds, mainly quercetin glycosides, were identified in the extract. A significant deterioration in the antioxidant status in smokers compared to non-smokers was found. The horchata infusion extract improved the nanostructure of RBCs and DNA damage, as well as the activity of the endogenous antioxidant enzymes and markers of oxidative damage to lipid, and proteins in plasma, RBCs and PBMCs in both groups, whilst no significant changes were found in the expression of different genes related to OS response.

Effect of antioxidant supplements on sperm parameters in infertile male smokers: a single-blinded clinical trial.

INTRODUCTION: Naturally, in human body, there is a balance between free radicals and the antioxidant system. Yet, cigarette consumption in smokers increases free radicals and decreases antioxidants. A vast body of research showed that the ROS level of seminal fluid is reduced using oral antioxidant complements through enhancing the clearing capacity of free radicals. Thus, the present research aimed to explore the effect of vitamin complement consumption on changing male infertility indices among smokers. METHODS: In the present randomized clinical trial which was single-blinded, 50 infertile oligospermic and asthenospermic men participated. They were selected in a randomized convenient sampling method. Before the study began, a semen sample was taken from all participants for analysis. Subsequently, the patients received 30 mg of Q10 coenzyme, 8 mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 mg of folic acid for a whole duration of 3 months on a daily basis (once a day) and 200 mg of selenium every other day after lunch. A second sample of seminal fluid was taken from patients and semen parameters were compared between the pre- and post-test. The relevant statistical analyses were conducted in SPSS.23. RESULTS: A comparison of pre-test and post-test results revealed that all sperm parameters including the volume, morphology, motion, count and progressive motility were significantly increased after the intervention (p ≥ 005). Moreover, a statistically significant improvement was observed in the pH and concentration of seminal fluid. CONCLUSION: The present research showed that consuming vitamin complements (30 mg of Q10, mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 mg of folic acid) once a day as well as 200 mg of selenium every other day can effectively improve the qualitative parameters (pH and concentration) and quantitative parameters (volume, motion, morphology, count and progressive motility) in infertile male smokers.

Correlation between biomarkers of exposure, effect and potential harm in the urine of electronic cigarette users.

OBJECTIVES: To determine if urinary biomarkers of effect and potential harm are elevated in electronic cigarette users compared with non-smokers and if elevation correlates with increased concentrations of metals in urine. STUDY DESIGN AND SETTING: This was a cross-sectional study of biomarkers of exposure, effect and potential harm in urine from non-smokers (n=20), electronic cigarette users (n=20) and cigarette smokers (n=13). Participant's screening and urine collection were performed at the Roswell Park Comprehensive Cancer Center, and biomarker analysis and metal analysis were performed at the University of California, Riverside. RESULTS: Metallothionein was significantly elevated in the electronic cigarette group (3761±3932 pg/mg) compared with the non-smokers (1129±1294 pg/mg, p=0.05). 8-OHdG (8-hydroxy-2'-deoxyguanosine) was significantly elevated in electronic cigarette users (442.8±300.7 ng/mg) versus non-smokers (221.6±157.8 ng/mg, p=0.01). 8-Isoprostane showed a significant increase in electronic cigarette users (750.8±433 pg/mg) versus non-smokers (411.2±287.4 pg/mg, p=0.03). Linear regression analysis in the electronic cigarette group showed a significant correlation between cotinine and total metal concentration; total metal concentration and metallothionein; cotinine and oxidative DNA damage; and total metal concentration and oxidative DNA damage. Zinc was significantly elevated in the electronic cigarette users (584.5±826.6 µg/g) compared with non-smokers (413.6±233.7 µg/g, p=0.03). Linear regression analysis showed a significant correlation between urinary zinc concentration and 8-OHdG in the electronic cigarette users. CONCLUSIONS: This study is the first to investigate biomarkers of potential harm and effect in electronic cigarette users and to show a linkage to metal exposure. The biomarker levels in electronic cigarette users were similar to (and not lower than) cigarette smokers. In electronic cigarette users, there was a link to elevated total metal exposure and oxidative DNA damage. Specifically, our results demonstrate that zinc concentration was correlated to oxidative DNA damage.

Salivary, Plasma, and Gingival Levels of Melatonin and TNF-α in Nonsmokers and Current Smokers with and without Periodontal Disease.

AIM: The aim of this study was to quantify the levels of gingival, salivary, and plasma melatonin and tumor necrosis factor-α (TNF-α) in healthy individuals and chronic generalized periodontitis patients with and without cigarette smoking habit and to investigate whether a relationship exists between melatonin and TNF-α levels in the samples. MATERIALS AND METHODS: Blood of 5 mL, 5 mL of saliva, and gingival tissue samples were obtained from 30 periodontally healthy individuals without smoking habit (HP), 30 nonsmoking patients with chronic generalized periodontitis (CP), 30 periodontally healthy individuals with current smoking habit (SHP), and 30 current smoker patients with chronic generalized periodontitis (SCP). The levels of melatonin and TNF-α in the samples were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kit. The results obtained were statistically analyzed using SPSS statistical software (23.0 version). RESULTS: This study demonstrated the presence of melatonin and TNF-α in all the saliva, plasma, and gingival tissue samples. Gingival tissue melatonin levels were highest in the HP group and least in the SCP groups, while TNF-α levels were least in the HP group and highest in the SCP groups. No significant difference was observed between the groups with regard to salivary and plasma melatonin. An overall significant difference was also observed between the groups with regard to salivary TNF-α but not with regard to plasma TNF-α. Binary logistic regression analysis was carried out after dividing the study groups into current smokers and nonsmokers. Results revealed that a reduction in gingival melatonin and an increase in gingival TNF-α were associated with a transition from periodontal health to chronic generalized periodontitis in current smokers but not in nonsmokers. CONCLUSION: This study sheds light on the anti-inflammatory actions of melatonin in the gingival tissues in states of periodontal health and disease in current smokers. CLINICAL SIGNIFICANCE: Melatonin could be used as a supplement to boost anti-inflammatory mechanisms in periodontal therapy especially in cigarette smokers.

Efficacy of an herbal antioxidant as an adjunct to nonsurgical periodontal therapy on procalcitonin levels in smokers with chronic periodontitis.

CONTEXT: Smokers are at a higher risk of contracting periodontitis. This association is established and reported in many studies. Periodontitis is a polymicrobial disease, wherein smoking is an environmental factor which aggravates the damage caused to the tissues. Procalcitonin (ProCT) is a well-known marker for inflammatory and other infectious diseases and has been assessed in this study. It has been observed that the release of reactive oxygen species (ROS) is exaggerated in smokers. Antioxidants are administered to combat the harmful effects caused by the ROS, and Oxitard™ is a powerful herbal antioxidant that can counteract the action of free radicals. AIMS: As smokers are more prone to tissue injury due to excessive release of ROS, this study aimed to understand the benefits of systemic administration of Oxitard after scaling and root planing (SRP) on serum ProCT levels in smokers with chronic periodontitis (CP). SETTINGS AND DESIGN: This was a randomized interventional study, wherein forty patients participated. MATERIALS AND METHODS: Forty smokers with CP aged, between 35 and 60 years, were equally divided into Group A (SRP + Oxitard) and Group B (SRP only), selected from an outpatient ward of a referral care hospital in Hyderabad. A written informed consent was obtained from all the patients, and the study was approved by the institutional ethical committee (DN0026-15). STATISTICAL ANALYSIS USED: Data were analyzed by GraphPad Prism software version 6.01 (GraphPad software incorporation, California, USA). Comparison within the groups was made by paired t-test and between the groups by unpaired t-test. P < 0.05 was considered of statistical significance. RESULTS: Intragroup assessment showed an improvement in all the variables from baseline to 3 months, which was statistically significant (P < 0.0001). A comparison between the groups, however, yielded better results in Group A (Oxitard + SRP) over Group B. CONCLUSIONS: Oxitard administered systemically for 3 months after SRP was beneficial in improving both clinical and biochemical parameters.

Folic Acid Intake, Fetal Brain Growth, and Maternal Smoking in Pregnancy: A Randomized Controlled Trial.

BACKGROUND: Folic acid supplementation during pregnancy plays an important role in fetal growth and development. To our knowledge, no experimental study has examined the effect of folic acid on fetal brain growth in women who smoke cigarettes during pregnancy. OBJECTIVES: The aim of this study was to investigate the efficacy of higher-dose compared with standard-dose folic acid supplementation on prenatal fetal brain growth, measured by head circumference, brain weight, and brain-body weight ratio (BBR). DESIGN: In this randomly assigned, double-blind, controlled clinical trial, we recruited 345 smoking pregnant women attending a community health center in Tampa, FL between 2010 and 2014. Participants were randomly assigned in a 1:1 ratio to receive either 0.8 mg folic acid/d (standard of care at the study center) or 4 mg folic acid/d (higher strength). Participants were also enrolled in a smoking cessation program. A 2-level linear growth model was used to assess treatment effect and factors that predict intrauterine growth in head circumference over time. Multiple linear regression analyses were conducted to estimate the effect of higher-strength folic acid on head circumference at birth, fetal brain weight, and fetal BBRs. RESULTS: Mothers who received the higher dose of folic acid had infants with a 1.18 mm larger mean head circumference compared with infants born to mothers who received the standard dose, but this difference was not statistically significant (P = 0.2762). Higher-dose folic acid also had no significant effect on brain weight. The BBR of infants of mothers who received higher-dose folic acid was, however, 0.33 percentage points lower than that for infants of mothers who received the standard dose of folic acid (P = 0.044). CONCLUSIONS: Infants of smokers in pregnancy may benefit from higher-strength maternal folic acid supplementation. We noted a decrease in the proportion of infants with impaired BBR among those on higher-dose folic acid. This trial was registered at clinicaltrials.gov as NCT01248260.

Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform.

The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.

The Effects of Dietary Supplements on Asthma and Lung Cancer Risk in Smokers and Non-Smokers: A Review of the Literature.

Smoking is one of the major global causes of death. Cigarette smoke and secondhand (passive) smoke have been causally related to asthma and lung cancer. Asthma is a potential risk factor for developing lung cancer in both smokers and non-smokers. Prospective studies and randomized control trials (RCTs) of dietary supplements and lung cancer risk in adult smokers and non-smokers have yielded inconsistent results. A few prospective studies have shown that long-term use of high doses of some supplements, such as retinol, ß-carotene, B vitamins, and vitamin E, increase lung cancer risk in current and former smokers. Limited evidence from RCTs suggests that vitamin D supplementation is effective in improving lung function and reducing asthma risk in current/former smokers. The relationship between dietary supplements and lung cancer risk has never before been examined in asthmatic smokers and non-smokers. This short review aims to examine the evidence from existing studies for the effects of dietary supplements on asthma/lung cancer risk and mortality in smokers and non-smokers.

Preoperative Rehabilitation in Lung Cancer Patients: Yoga Approach.

Lung cancer is one of the leading causes of cancer death worldwide. Surgical removal remains the best option for most tumors of this type. Reduction of cigarette consumption in patients with lung cancer candidates for the surgery could limit the impact of tobacco on postsurgical outcomes. Breathing exercises appear to help combat cigarette cravings. Yoga exercise benefits have been studied in lung cancer survivors, rather than in the preoperative setting. In this study, we have recruited 32 active smokers affected by lung cancer and being candidates for pulmonary surgery. The patients were randomly assigned to two groups: one treated by standard breathing and the other treated by yoga breathing (YB). The groups were evaluated at times T0 (baseline) and T1 (after 7 days of treatment) to compare the effects of the two breathing treatments on pulmonary performance in a presurgery setting. Pulmonary and cardiocirculatory functions have been tested using a self-calibrating computerized spirometer and a portable pulse oximetry device. The findings demonstrate appreciable short-term improvement in lung function assessed by spirometry. We conclude that yoga breathing can be a beneficial preoperative support for thoracic surgery.

Pharmacological values and therapeutic properties of black tea (Camellia sinensis): A comprehensive overview.

Medicinal plants are essential parts of traditional medicine due to their phytochemical constituents having pharmacological values and therapeutic applications. Black tea have thousands of various biological compounds such as flavonoids (Thearubigins (TRs) and theaflavins (TFs) and catechins), amino acids (L.theanine), vitamins (A, C, K), phenolic acids (caffeic acid (CA), gallic acid (GA), chlorogenic acids (CGA) and cauramic acid), lipids, proteins, volatile compounds carbohydrates, ß-carotene and fluoride that illustrated many promising pharmacological effects regarded as growth promoter, cardioprotector, potent cholesterol-lowering effect, antioxidant and antimicrobial, etc inhuman. Although there is an exponential growth in molecular evidence of cholesterol-lowering and antioxidant effect in human, there is still a lack of information of the pharmacological effects of black tea. To fill this information gap, therefore, this review article underscores broadening the new insight pertaining to black tea that could be used as safe food additive. This article also illuminates the interesting role of black tea as an herbal medicine that is the future demand to get rid of synthetic health promoters in the human health practice. Moreover, this information would be useful in terms of the low-cost practice of natural medicines with no residual effects, and a natural protection of the human being. In addition, further studies at a molecular level are needed to reveal its mechanism of action particularly for the hypocholesterolemic effect of black tea to overcome the heart-related diseases, fewer side effects and being a natural safeguard of human health.