Effects of two triterpenoids from Nigella sativa seeds on insulin resistance of 3T3-L1 adipocytes.

Insulin resistance (IR) is a physiological abnormality that occurs when insulin fails to activate the signal transduction pathway in target organs. It was found that supplementation of Nigella sativa seeds with oral antidiabetic medicines helps improve blood glucose control by enhanced ß cells activity and alleviation of IR. However, the activities and related mechanisms of phytochemicals from N. sativa seeds have not been thoroughly explored. In this study, the effects of two triterpenoids, 3-O-[ß-D-xylopyranose-(1→3)-α-L-rhamnose-(1→2)-α-L-arabinose]-28-O-[α-L-rhamnose-(1→4)-ß-D-glucopyranose-L-(1→6)-ß-D-glucopyranose]-hederagenin (Hxrarg) and 3-O-[ß-D-xylopyranose-(1→3)-α-L-rhamnose-(1→2)-α-L-arabinose]-hederagenin (Hxra), on IR were studied by 3T3-L1 adipocytes model. The results demonstrated that Hxrarg and Hxra inhibited maturation of 3T3-L1 preadipocytes, dramatically stimulated glucose uptake of IR-3T3-L1 adipocytes, promoted transcription of IRS, AKT, PI-3K, and GLUT4 mRNA. Western Blot results suggested that Hxrarg and Hxra were able to markedly up-regulate expression of p-IRS, p-AKT, PI-3K, and GLUT4 proteins. These findings could provide a basic foundation for the continued development and application of N. sativa in medicine and functional foods.

The Immunomodulatory Effects of Active Ingredients From Nigella sativa in RAW264.7 Cells Through NF-κB/MAPK Signaling Pathways.

Nigella sativa is a valuable herb for its functional compositions in both food and medication. N. sativa seeds can enhance immunity, anti-inflammation and analgesia and hypoglycemia, but most of the related researches are related to volatile oil and extracts, and the activity and mechanism of compounds is not clear. In this study, Ethyl-α-D-galactopyranoside (EG), Methyl-α-D-glucoside (MG), 3-O-[ß-D-xylopyranose-(1 → 3)-α-L-rhamnose-(1 → 2)-α-L-arabinose]-28-O-[α-L-rhamnose-(1 → 4)-ß-D-glucopyranose-L-(1 → 6)-ß-D-glucopyranose]-hederagenin (HXRARG) and 3-O-[ß-D-xylopyranose-(1 → 3)-α-L-rhamnose-(1 → 2)-α-L-arabinose]-hederagenin (HXRA) were isolated and identified from N. sativa seeds. In addition, four compounds could activate NF-κB pathway by promoting the expression of phosphorylation of P65 and IκBα, promoting the phosphorylation of JNK, Erk and P38 to activate MAPK signaling pathway, enhancing the proliferation and phagocytic activity of RAW264.7 cells, and promoting the release of NO, TNF-α and IL-6 on RAW264.7 cell in vitro. The results showed that N. sativa can be used as dietary supplement to enhance immune.

Trends and characteristics of ocular exposures related to e-cigarettes and e-liquids reported to Poison Control Centers in the United States, 2010-2019.

INTRODUCTION: Ocular injuries and unintended exposures involving electronic nicotine delivery systems (ENDS), also known as e-cigarettes, have been reported. However, trends and characteristics of ENDS-related ocular exposures at the population level are not well documented. This study was designed to describe trends and characteristics of ENDS-related ocular exposure cases reported to poison control centers (PCCs) in the U.S. METHODS: We computed descriptive statistics of ENDS-related ocular exposure cases reported to PCCs between January 1, 2010 and December 31, 2019, including number of cases per year and the distribution of characteristics of those cases. We also summarized case narrative review findings. RESULTS: A total of 1,393 ENDS-related ocular exposure cases were reported to PCCs during the study period. Overall number of cases increased from two in 2010 to a peak of 389 in 2014, followed by a steady decline in 2015-2018. Of the 1,393 cases, 42.5% occurred among individuals aged 25 years and older; 20.4 and 17.7% occurred among young adults aged 18-24 years and children younger than five years, respectively. Nearly one quarter (23.8%) of the individuals experiencing ocular exposure sought or were recommended to seek medical attention. Case narrative review found that 59 of 127 (46.5%) cases were due, at least in part, to incorrect use or handling of the products. DISCUSSION AND CONCLUSIONS: Our study shows that more than 1,000 ENDS-related ocular exposure cases were reported to PCCs during the study period. Many of these cases involved young children; nearly half were due, at least in part, to incorrect use or handling of the products. Future efforts to prevent these exposures may focus on improving the awareness of the potential harmful effects of ENDS products and the importance of appropriate handling of ENDS products. Health care professionals may play an important role in educating patients and improving surveillance of ENDS-related ocular exposure cases.

Nigella sativa: A Dietary Supplement as an Immune-Modulator on the Basis of Bioactive Components.

Nutrients can be considered as functional foods, which exert physiological benefits on immune system. The seeds of Nigella sativa, which have many active constituents, are mainly used for medicine, food spice, and nutritional supplements in Egypt. Much attention has been paid to N. sativa seeds for their anticancer, antibacterial, anti-inflammatory, and immune properties. However, their active constituents and mechanisms underlying functions from N. sativa seeds is unclear. Thus, the bioactive constituents with immune regulation in N. sativa seeds were systematically studied. A new compound (3-methoxythymol-6-O-ß-D-apiofuranosyl-(1→6)-ß-D-glucopyranoside 1) and 11 known compounds (2-12) were separated from the N. sativa seeds by chromatographic methods. Their structures were then elucidated by spectroscopic analysis of MS, UV, IR, 1H-, and 13C-NMR. Furthermore, immunomodulatory effects of those compounds in RAW 264.7 cells were evaluated by phagocytosis, nitric oxide (NO) and cytokine release, related mRNA transcription, and key proteins expression in vitro. Monosaccharide derivatives, Ethyl-α-D-furaarabinose (5), and Ethyl-ß-D-fructofuranoside (8) were shown to played bidirectional regulatory roles in immunity and anti-inflammation through the regulation of nuclear factor-κB (NF-κB) signaling pathways. The results showed the active compounds and mechanisms of immune regulation in N. sativa, thus indicating that N. sativa seeds could be used as dietary supplements in immunomodulation.

Biomarkers of Inflammation and Oxidative Stress among Adult Former Smoker, Current E-Cigarette Users-Results from Wave 1 PATH Study.

BACKGROUND: Former smokers who currently use e-cigarettes have lower concentrations of biomarkers of tobacco toxicant exposure than current smokers. It is unclear whether tobacco toxicant exposure reductions may lead to health risk reductions. METHODS: We compared inflammatory biomarkers (high-sensitivity C-reactive protein, IL6, fibrinogen, soluble intercellular adhesion molecule-1) and an oxidative stress marker (F2-isoprostane) among 3,712 adult participants in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study by tobacco user groups: dual users of cigarettes and e-cigarettes; former smokers who currently use e-cigarettes-only; current cigarette-only smokers; former smokers who do not currently use any tobacco; and never tobacco users. We calculated geometric means (GM) and estimated adjusted GM ratios (GMR). RESULTS: Dual users experienced greater concentration of F2-isoprostane than current cigarette-only smokers [GMR 1.09 (95% confidence interval, CI, 1.03-1.15)]. Biomarkers were similar between former smokers who currently use e-cigarettes and both former smokers who do not use any tobacco and never tobacco users, but among these groups most biomarkers were lower than those of current cigarette-only smokers. The concentration of F2-isoprostane decreased by time since smoking cessation among both exclusive e-cigarette users (P trend = 0.03) and former smokers who do not currently use any tobacco (P trend = 0.0001). CONCLUSIONS: Dual users have greater concentration of F2-isoprostane than smokers. Exclusive e-cigarette users have biomarker concentrations that are similar to those of former smokers who do not currently use tobacco, and lower than those of exclusive cigarette smokers. IMPACT: This study contributes to an understanding of the health effects of e-cigarettes.

Cardiovascular Risk Factor and Disease Measures from the Population Assessment of Tobacco and Health (PATH) Study.

BACKGROUND: Cardiovascular disease is a key health condition associated with tobacco use; however, clinical measures are not typically possible in population-based studies. In this paper, we assess the reliability and validity of self-reported cardiovascular risk factors and diseases in a large nationally representative study of tobacco use and health outcomes. METHODS: This paper analyzes self-reported cardiovascular risk factors and disease among adults age 40 years and older based on U.S. nationally representative data from the Population Assessment of Tobacco and Health (PATH) Study. Prevalence of cardiovascular risk factors (self-reported high blood pressure, high cholesterol, diabetes and family history of premature heart disease, BMI ≥ 35, and tobacco use) and cardiovascular disease (self-reported heart attack, stroke and/or congestive heart failure (CHF)) were considered along with ratings of physical functioning, fatigue, and general health. RESULTS: Self-reported cardiovascular disease was found to be associated with functional health measures (walking up a flight of stairs) and general ratings of health. Prospective analyses found strong correlations between sequential data collection waves for history of hypertension, elevated cholesterol and CHF, while more modest correlations were noted for stroke and heart attack. The overall prevalence of cardiovascular disease and hypertension was comparable to those from the National Health and Nutrition Examination Survey (NHANES). CONCLUSIONS: These analyses suggest reliability and concurrent validity regarding self-reported cardiovascular risk factors and disease assessed in the PATH Study.

Activation of RAW264.7 cells by PCp-I, a polysaccharide from Psoralea corylifolia L, through NF-κB/MAPK signalling pathway.

PCp-I is a polysaccharide isolated and identified from the Psoralea corylifolia L. by our research group. In this study, the immunomodulatory effects of PCp-I on RAW264.7 cells was evaluated. PCp-I could enhance the level of NO along with up-regulation of iNOS mRNA in RAW264.7 cells. The PCp-I could significantly up-regulate the mRNA expression of TNF-α and IL-6 in RAW264.7 cells, and then the expression of TNF-α, IL-6, ROS and the phagocytic activity were increased. Additionally, PCp-I could significantly up-regulate the phosphorylation level of p65, p38, ERK and JNK proteins, which proved that PCp-I could activate the macrophages by MAPKs and NF-κB signalling pathway and the TLR4 may be one of the receptors of PCp-I regulate the RAW264.7 cells.

Glucose absorption regulation and mechanism of the compounds in Lilium lancifolium Thunb on Caco-2 cells.

In this paper, the Caco-2 cell was used to study the glucose absorption regulation and mechanism of kaempferol, caffeic acid and quercetin-3-O-ß-D-galactoside in Lilium lancifolium Thunb in vitro. Glucose oxidase-peroxidase (GOD-POD) method was used to measure glucose consumption in supernatant. The fluorescent D-glucose analog (2-NBDG) was used as a tracer probe to study the changes in the fluorescence intensity of 2-NBDG uptake by Caco-2 cells with an inverted fluorescence microscope. Western blotting and quantitative real-time PCR were used to detect the protein expression and mRNA transcription of SGLT1 and GLUT2. The results showed that caffeic acid and quercetin-3-O-ß-D-galactoside could significantly promote the absorption of glucose by normal Caco-2 cells compared with the control group (P < 0.001). Both caffeic acid and quercetin-3-O-ß-D-galactoside could significantly promote the uptake of glucose tracer 2-NBDG on Caco-2 cells. Caffeic acid and quercetin-3-O-ß-D-galactoside could significantly promote SGLT1 and GLUT2 protein expression levels and mRNA transcription (P < 0.001, P < 0.01, P < 0.05). The mechanism might be related to the promotion of SGLT1 and GLUT2 protein expression levels and mRNA transcription.

Transitions in frequency of hookah smoking among youth and adults: findings from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) study, 2013-15.

BACKGROUND AND AIMS: The prevalence of hookah smoking has increased in the United States since at least 2010, especially among youth and young adults. This study assessed self-reported reasons for hookah smoking cessation and transition to or maintenance of high-frequency hookah smoking among current hookah smokers. DESIGN: Separately analyzed data from the Population Assessment of Tobacco and Health (PATH) study, a longitudinal cohort study. Frequency of and reasons for hookah smoking were ascertained at wave 1 (2013-14); frequency of hookah smoking and past-year cessation were ascertained at wave 2 (2014-15). Weighted multivariable logistic and ordinal logistic regression models were fitted to predict hookah smoking cessation and frequency of hookah smoking at wave 2, respectively, accounting for demographic and behavioral risk factors, reasons for hookah smoking and frequency of hookah smoking at wave 1. SETTING: United States. PARTICIPANTS: A total of 693 youth and 4400 adult past-year hookah smokers. MEASUREMENTS: Self-reported tobacco-use patterns and associated health behaviors were measured via audio computer-assisted self-interviews (ACASI). FINDINGS: At wave 1, 5.9% of youth and 7.5% of adults were past-year hookah smokers. Among all age groups, the leading reasons for hookah smoking were enjoyment of socializing while smoking, the availability of appealing flavors and believing that it was less harmful than cigarette smoking. The odds of cessation were lower for adults who liked hookah flavors [adjusted odds ratio (aOR) = 0.40; 95% confidence interval (CI) = 0.26-0.62] compared with adults who did not like hookah flavors. The odds of transitioning to, or maintaining, monthly or more frequent hookah smoking at wave 2, compared with cessation or less than monthly smoking, were higher for adults who liked hookah flavors [adjusted proportional odds ratio (aPOR) = 2.10; 95% CI = 1.48-2.99 and enjoyed socializing while smoking hookah (aPOR = 1.82; 95% CI =1.13-2.94) compared with adults who did not like hookah flavors or socializing. CONCLUSION: The availability of appealing flavors, affordability and socialization while smoking hookah in the United States are associated with reduced likelihood of cessation and increased likelihood of high-frequency hookah smoking.

Anti-inflammatory and antioxidant effects of Chaetoglobosin Vb in LPS-induced RAW264.7 cells: Achieved via the MAPK and NF-κB signaling pathways.

There are few reports on the biological activities of chaetoglobosin Vb (Cha Vb) (a cytochalasin alkaloid). In this study, we investigated the molecular mechanisms underlying the anti-inflammatory and antioxidant effects of Cha Vb in the RAW264.7 cells stimulated lipopolysaccharide (LPS). LPS stimulation-induced oxidative stress (i.e. increase production of reactive oxygen species (ROS) and decreased expression of antioxidant superoxide dismutase (SOD)) was suppressed after a Cha Vb treatment. Cha Vb could significantly inhibit the upregulated expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) gene and protein induced by LPS whilst attenuating the production of pro-inflammatory cytokines TNF-α, IL-6 and IL-1ß. Such antioxidant and anti-inflammatory effects were achieved through the TLR4-mediated MyD88-dependent signaling pathways (via suppressing the phosphorylation of p38, ERK, JNK MAPK and translocation of the NF-κB p65 subunit into nucleus), and the TRIF-dependent signaling pathways (via reducing IFN-ß release without inhibiting interferon-regulated factor 3 (IRF3) and IRF7). At 25-100 µM (a concentration range with no cytotoxicity), Cha Vb dose-dependently influenced SOD enzyme activity and phosphorylation of p38, ERK1/2 and JNK, and at 100 µM, likely exerted the greatest inhibition towards LPS-induced oxidative stress and inflammatory response via the MAPK and NF-κB signaling pathway.

National Estimates of ENDS Liquid Nicotine Exposures, U.S., 2013-2017.

INTRODUCTION: Increased use of ENDS in the U.S. is related to acute adverse events from liquid nicotine exposure. This paper provides national estimates of U.S. hospital emergency department visits for exposures from liquid nicotine exposure in individuals aged ≥5 years. METHODS: In 2018-2019, data from the 2013-2017 National Electronic Injury Surveillance System All Injury Program were used to identify cases of liquid nicotine-related exposures in individuals aged ≥5 years. National estimates of exposures related to liquid nicotine exposure in ENDS for those aged ≥5 years by demographic characteristics, symptoms, diagnoses, and treatment dispositions were calculated. RESULTS: From 2013 to 2017, an estimated 2,718 cases related to liquid nicotine among those aged ≥5 years were treated in U.S. hospital emergency departments. Most exposures occurred among those who were aged ≥25 years (51.7%), white (74.1%), and male (51.9%). Most case patients were treated and released from the hospitals, and 7.5% were admitted. Poisoning was the most common diagnosis of these exposures (82.7%). The most common symptoms were cardiovascular (29.7%). CONCLUSIONS: This study provides national estimates of emergency department visits for injury and poisoning cases related to nicotine exposure from ENDS among individuals aged ≥5 years. Although long-term health outcome studies of liquid nicotine exposure are not available, these estimates provide some insight into the acute health effects. Findings from this study may inform education programs aimed at preventing exposures related to ENDS products.

National Estimates of hospital emergency department visits due to acute injuries associated with hookah smoking, United States, 2011-2019.

INTRODUCTION: Hookah (also known as waterpipe) smoking is associated with acute adverse health effects such as vomiting and fainting, symptoms related to carbon monoxide poisoning, and decreased pulmonary function, however, national estimates of hookah-related acute injuries are not currently available in the scientific literature. This study provides national estimates of United States hospital emergency department visits due to hookah-related acute injuries. METHODS: We analyzed 2011-2019 data from the National Electronic Injury Surveillance System to calculate national estimates of emergency department visits due to hookah-related acute injuries. National Electronic Injury Surveillance System data were gathered from approximately 100 United States hospitals selected as a probability sample of approximately 5000 hospitals with emergency departments. Each case contains information abstracted from all emergency department records involving injuries associated with consumer products. All individuals admitted to emergency departments who sustained hookah-related acute injuries were included in the study. RESULTS: During 2011-2019, an estimated 1371 (95% confidence interval: 505-2283) United States hospital emergency department visits were related to hookah-related acute injuries. The most common injuries were sustained from dizziness/light-headedness and syncopal episodes (54.8%), followed by burns (41.5%). Young adults aged 18-24 years accounted for 66.8% of hookah-related acute injuries admitted to United States emergency departments. CONCLUSIONS: This study provides national estimates of hospital emergency department visits due to hookah-related acute injuries. We found that hookah smoking related AIs mostly occurred among young adults. Study findings may inform public health policy and educational intervention efforts to prevent these events and complement other acute injury surveillance systems, such as the National Poison Data System.

Burn injuries related to E-cigarettes reported to poison control centers in the United States, 2010-2019.

BACKGROUND: United States (U.S.) national data indicate that 2035 individuals with burn injuries from e-cigarette explosions presented to U.S. hospital emergency departments (EDs) in 2015-2017. This national estimate is valuable for understanding the burden of burn injuries from e-cigarette explosions among individuals who presented to EDs. However, little is known about individuals who experienced e-cigarette-related burns but may not present to EDs or health care facilities. FINDINGS: We analyzed data from the National Poison Data System (NPDS) to describe frequency and characteristics of e-cigarette-related burn cases in the U.S. in 2010-2019. NPDS contains information collected during telephone calls to poison control centers (PCCs) across the U.S., including e-cigarette-related burns and other unintended events. During 2010-2019, 19,306 exposure cases involving e-cigarettes were documented in NPDS. Of those, 69 were burn cases. The number of burn cases increased from one in 2011 to a peak of 26 in 2016, then decreased to three in 2019. The majority of the burn cases occurred among young adults aged 18-24 years (29.0%; n = 20) and adults aged 25 years or older (43.5%; n = 30); 14.4% (n = 10) occurred among individuals ≤17 years old. Of the 69 burn cases, 5.8% (n = 4) were admitted to a hospital; 65.2% (n = 45) were treated and released; 15.9% (n = 11) were not referred to a health care facility (HCF); 4.4% (n = 3) refused referral or did not arrive at an HCF; and 8.7% (n = 6) were lost to follow-up or left the HCF against medical advice. Nearly one-third (30.4%; n = 21) of the cases had a minor effect (symptoms resolved quickly), 47.8% (n = 33) had a moderate effect (symptoms were more pronounced and prolonged than in minor cases, but not life-threatening), and 2.9% (n = 2) had a major effect (life-threatening symptoms). CONCLUSIONS: Approximately one-fifth of e-cigarette-related burn cases reported to PCCs were not referred to or did not arrive at an HCF. Some burn cases had serious medical outcomes. The burn cases mostly affected young adults and adults aged 25 years or older. The number of burn cases in NPDS represents a small portion of e-cigarette-related burn cases but it can serve as a complementary data source to traditional injury surveillance systems.

Back recursive estimation of unknown frequency sinusoidal disturbance in superconducting RF cavities.

A novel back recursive estimation (BRE) scheme is proposed for superconducting radio frequency (SRF) cavities. Microphonic,the main source of cavities detuning is modeled as unknown frequency sinusoidal disturbance. The disturbance property is excited by an auxiliary filter and the frequency information is estimated in observer framework. Furthermore, the sinusoidal disturbance is rearranged as a series of dynamics form using virtual disturbances. Back recursive signal is calculated according to the correlation between virtual disturbance and equivalent input disturbance. As a result, the asymptotic stability of estimation error can be obtained based on Lyapunov function, and robustness can be obtained if another external bounded disturbance exists. Simulations verify the effectiveness of the proposed method.

Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010-2018.

Introduction: Poisoning exposure cases involving e-cigarettes have increased since 2010, coinciding with increasing rates of e-cigarette use in the United States (US). Given the increasing prevalence of e-cigarette use and ever-changing product designs, particularly the development of new products with high nicotine levels, it is important to conduct ongoing surveillance of poisoning exposure cases involving e-cigarettes. The objective of this study is to describe trends and characteristics of poisoning exposure cases involving e-cigarettes and e-liquids reported to poison control centers in the US.Methods: We analyzed e-cigarette exposure cases from the National Poison Data System (NPDS) during 2010-2018 by year and other characteristics.Results: The annual number of e-cigarette exposure cases increased greatly between 2010 and 2014, reaching a peak of 3742 in 2014, and then decreasing each year between 2015 and 2017. Between 2017 and 2018, the overall number of e-cigarette exposure cases increased by 25.0% (from 2320 to 2901). Approximately two-thirds (64.8%) of all cases were in children under age five, and 14.7% were in children aged 5-17 years or young adults aged 18-24 years. A small proportion of cases developed life-threatening symptoms (0.1%); and cases with more serious medical outcomes tended to be exposed to a higher e-liquid or nicotine quantity.Conclusions: Annual declines in e-cigarette exposure cases between 2015 and 2017 did not continue in 2018. The rapid changes in the occurrence of poisoning exposure cases involving e-cigarettes coupled with the development of new tobacco products and ever-evolving tobacco use landscape underscore the importance of continued surveillance of these poisoning exposure cases. Continuous monitoring of these poisoning exposure cases may inform efforts aimed at preventing e-cigarette poisoning exposures.

Adverse Experience Reports of Seizures in Youth and Young Adult Electronic Nicotine Delivery Systems Users.

PURPOSE: Electronic nicotine delivery systems (ENDS) use poses significant and avoidable health risks to young people. Until recently, seizures were most often associated with cases of liquid nicotine ingestion. METHODS: We examined 122 voluntary reports of seizures (n = 114) and neurological symptoms (syncope, n = 7; and tremor, n = 1) in 123 ENDS users (one report contained information on two users) received by the Food and Drug Administration between December 1, 2010, and June 30, 2019. RESULTS: The median age (interquartile range) of users was 20 years (17-27); 67% of reports were in youth and young adults aged 14-24 years. Fifty-one (41%) reported other underlying medical conditions, including previous history of anxiety (n = 11), attention deficit hyperactivity disorder (n = 7), seizure (n = 6), and depression (n = 5). Of the 79 reports with available information, 67 (85%) reported seizure occurred within 24 hours of last use; 49 (62%) reported seizure within 30 minutes. The potential impact of concomitant use of marijuana or cannabidiol oil could not be evaluated from the eight reports that mentioned concomitant use. CONCLUSIONS: Findings suggest an association between ENDS use and seizures. Additional information will help to clarify the relationship between ENDS use and seizures and to understand how product attributes such as nicotine content, formulation, quantity, and other ingredients or contaminants may contribute to seizures. It is important that health care providers ask about ENDS use when evaluating neurological symptoms and that users, parents, school personnel, and health care providers report adverse experiences involving tobacco products to Food and Drug Administration via the Safety Reporting Portal (www.safetyreporting.hhs.gov).

National estimates of poisoning events related to liquid nicotine in young children treated in US hospital emergency departments, 2013-2017.

BACKGROUND: An estimated 2 million youth (in 2017) and 7.9 million adults (in 2015) reported currently using electronic nicotine delivery systems (ENDS). Reports of poisoning events related to liquid nicotine (e-liquids) in ENDS have been on the rise, but current, nationally-representative estimates of hospital-treated poisoning cases related to e-liquid nicotine exposure in the United States (US) are lacking. FINDINGS: We used National Electronic Injury Surveillance System (NEISS) data from 2013 to 2017 to calculate national estimates with 95% confidence intervals (CIs) of poisoning incidents related to e-liquid nicotine exposure. From 2013 to 2017, an estimated 4745 poisoning cases related to e-liquids among children under age five were treated in US hospital emergency departments; the number of cases increased from 181 (95% CI: 0-369) in 2013 to 1736 (95% CI, 871-2602) in 2015 and then decreased to 411 (95% CI, 84-738) in 2017. Most of the cases were treated and released; 4.1% were admitted to the hospital. The most common route of exposure was through ingestion (96.9%), and 2.6% of the cases were through dermal exposure. The highest amounts of e-liquids or nicotine ingested were 118.2mL, 1 bottle, and 100 mg, and the most common symptoms (63.6%) related to nicotine poisoning were nausea and vomiting. CONCLUSIONS: This study provides national estimates of poisoning cases associated with nicotine exposure from e-liquids among children under age five. Findings on e-liquid volume or nicotine dose, when available, provide important insights into exposures associated with toxicity in children. Since NEISS data do not include product codes specific to ENDS or provide information on poisoning severity, we used general keywords to capture these events, which might underestimate the population burden. Information from this study may complement efforts, such as public education, to prevent unintended exposure to nicotine in e-liquids among children.

Waterpipe or Hookah-Related Poisoning Events Among U.S. Adolescents and Young Adults.

PURPOSE: Waterpipe or hookah use is associated with carbon monoxide poisoning and effects such as nausea and vomiting. We examined the public health burden of poisoning events involving hookah tobacco in the U.S., especially among adolescents and young adults. METHODS: We analyzed events involving hookah tobacco that were reported to U.S. poison control centers between 2001 and 2017 by age and over time as well as by medical outcome, health care level, and clinical effects. RESULTS: A total of 276 relevant poisoning events involving hookah were reported. Among the 248 individuals with a specific age reported, 35 (14.1%) were aged between 10 and 17 years and 136 (54.8%) were aged between 18 and 24 years. Common clinical effects included dizziness/vertigo, nausea, headache, and vomiting. CONCLUSIONS: Hookah tobacco use is associated with poisoning events consistent with exposure to high levels of carbon monoxide.

Urinary Biomarkers of Carcinogenic Exposure among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study.

BACKGROUND: How carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood. METHODS: We randomly selected 165 participants of the Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC). We also quantified the same biomarkers in a second urine sample, obtained 5 years later, among continuing cigarette smokers and never tobacco users. RESULTS: Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations, which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than in all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over 5 years, particularly in continuing cigarette smokers. CONCLUSIONS: We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from nontobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort. IMPACT: Most of these biomarkers would be useful for exposure assessment in a longitudinal study.

Curiosity About and Susceptibility Toward Hookah Smoking Among Middle and High School Students.

INTRODUCTION: Hookah smoking has increased among young people. Curiosity and susceptibility may be associated with experimentation or established use. Because tobacco use behaviors are established primarily during adolescence, our objective was to examine factors that may increase the risk of future tobacco product use among youth. METHODS: We analyzed data from the 2016 National Youth Tobacco Survey, a nationally representative survey of US students. Analyses were restricted to youth who had never smoked a hookah and stratified by their ever having used other tobacco products. The prevalence of hookah curiosity and susceptibility was assessed by sociodemographic characteristics, perceptions of harmfulness and addictiveness of hookahs, and peer use of hookahs. Associations between covariates and curiosity and susceptibility were assessed by using multivariable-adjusted regression. RESULTS: Overall, 29.1% of students reported any hookah curiosity or susceptibility. Curiosity was reported by 14.6% of those who never used tobacco products and by 45.9% of those who ever used tobacco products. Hookah susceptibility was reported by 15.6% of never-users and 52.5% of ever-users. Regardless of ever having used other tobacco products, odds of curiosity and susceptibility were higher among students with perceptions of reduced hookah harmfulness and addictiveness and among those who perceived high levels of hookah use among peers. CONCLUSION: Nearly 3 in 10 youth who never smoked a hookah (6.9 million) reported hookah curiosity or susceptibility, and prevalence was highest among those who had ever used other tobacco products. These findings reinforce the importance of educating youth about the dangers of all tobacco products and dispel misperceptions about the harmfulness and addictiveness of hookah smoking. Continued surveillance of youth curiosity, susceptibility, and use of hookahs can inform public health policy and practice.