A WeChat mini-program-based approach to smoking cessation behavioral interventions: Development and preliminary evaluation in a single-arm trial.

Objective: This study sought to develop a WeChat mini-program for smoking cessation behavioral interventions (named the WQ mini-program) and evaluate its usability, acceptability, and preliminary efficacy among Chinese smokers. Methods: The WQ mini-program was designed based on behavioral change theories and clinical practice guidelines, and clinical smoking cessation experts participated in the development process. Fifty Chinese smokers and five software experts were involved in a single-arm trial. Smokers were asked to use the WQ mini-program at least once a day for 4 weeks and to complete a weekly online follow-up questionnaire. Software experts were asked to complete an online follow-up questionnaire after using all functions of the WQ mini-program. Primary outcomes were usability and acceptability of and satisfaction with the mini-program tested by the System Usability Scale (SUS) and the Mobile App Rating Scale (MARS). Self-reported 7-day point prevalence abstinence (PPA) was used to evaluate its preliminary efficacy for smoking cessation. Optimization suggestions for the mini-program were collected from all participants through an open-ended question at the last follow-up and were analyzed by thematic analysis. Results: The mean SUS and MARS total scores for the WQ mini-program as evaluated by smokers were 82.1 ± 13.8 and 84.5 ± 3.3 and by software experts were 4.21 ± 0.32 and 4.27 ± 0.15, respectively. Most smokers reported being willing to recommend this mini-program to other smokers (85.4%) and would continue to use it (95.8%). The mean satisfaction score for the mini-program was 4.23 ± 0.69 (out of 5 points) among smokers. Self-reported 7-day PPA among smokers at the 4-week follow-up was 50% (25/50). Conclusions: This study demonstrated that the WQ mini-program would be a feasible and potentially effective method to encourage Chinese smokers to quit smoking. However, future research is needed to confirm its efficacy through a randomized controlled trial.

Effectiveness and Acceptability of a Comprehensive Mobile Health-Based Modality for Smoking Cessation - Beijing Municipality, China, 2022.

What is already known on this topic?: Mobile health interventions have been demonstrated to be effective in aiding smoking cessation among smokers. Nevertheless, research on this topic remains limited in China. What is added by this report?: Following two months of utilizing the services of a comprehensive mobile health (mHealth)-based modality ("Way to Quit" modality) which integrated three online interventions through the WeChat application, 29.1% of participating smokers successfully quit smoking. Participants who used a greater number of online services were more likely to cease smoking. All services were scored highly for satisfaction among smokers. What are the implications for public health practice?: This study presents a practical and feasible method to assist Chinese smokers in quitting smoking. The results of this research suggest a promising direction for enhancing the accessibility and utilization of smoking cessation services. Additionally, these findings serve as a critical reference for addressing the obstacles faced by smoking cessation services in China.

Multicentre double-blind randomised controlled trial of systematic corticosteroid therapy in patients with acute exacerbations of chronic obstructive pulmonary disease admitted to hospital with higher eosinophil levels: the ECHO protocol.

INTRODUCTION: Corticosteroid is one of the most commonly used medications in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The increasing understanding of these side-effects of systematic corticosteroids and their better response to treatment among patients with COPD with higher blood eosinophil counts has led to an interest in a more targeted approach to systematic corticosteroid treatment. However, there is a lack of evidence from high-quality randomised controlled trial (RCT) studies about whether initial systematic corticosteroids should be given to patients with AECOPD with elevated eosinophilia. The aim of the present research was to test this hypothesis. METHODS AND ANALYSIS: This is a multicentre, double-blind, superiority RCT in the respiratory departments of 12 general hospitals in China. It is anticipated that 456 patients with AECOPD with a blood eosinophil count >2% or >300 cells/µL at admission will be recruited. Eligible patients will be randomised (1:1) to the intervention group receiving 40 mg oral prednisone daily or identical-appearing placebo (control group) for five consecutive days. Follow-up visits are performed during hospitalisation, followed by clinic interviews on days 30, 60 and 90 after discharge. The primary outcome is treatment failure rates comprising requiring or receiving invasive or non-invasive mechanical ventilation, requiring or transferring to intensive care unit during the index hospitalisation, length of index hospitalisation longer than 14 days, death during the index hospitalisation or within 30 days after discharge and readmission with acute exacerbations of COPD within 30 days after discharge. The results of this trial will provide insight into the value of using blood eosinophil counts as a biomarker of eosinophilic exacerbation and initiating systematic corticosteroid treatment for patients with AECOPD with higher eosinophil levels. ETHICS AND DISSEMINATION: This study was approved by Beijing Chaoyang Hospital Institutional Review Board (approval number: 2020-KE-544) and the main results and secondary results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05059873.

Evaluation of an innovative mHealth-based integrated modality for smoking cessation in Chinese smokers: protocol for a randomized controlled trial.

BACKGROUND AND AIMS: Developing accessible, affordable, and effective approaches to smoking cessation is crucial for tobacco control. Mobile health (mHealth) based interventions have the potential to aid smokers in quitting, and integrating treatments from multiple sources may further enhance their accessibility and effectiveness. As part of our efforts in smoking cessation, we developed a novel behavioral intervention delivery modality for smoking cessation that integrated three interventions using the WeChat app, called the "Way to Quit" modality (WQ modality). It is presented here the protocol for a randomized controlled trial evaluating the effectiveness, feasibility, and cost-effectiveness of the WQ modality in Chinese smokers. METHODS: Eligible participants (n = 460) will be recruited via online advertisement in Beijing, China. They will be randomly assigned to receive either quitline-based treatment (QT, n = 230) or WQ modality-based treatment (WQ, n = 230) using a block randomization method. Participants in the QT group will receive telephone-assisted treatment over a four-week period (multi-call quitline protocol), while those in the WQ group will receive integrated interventions based on the WQ modality for four weeks. A four-week supply of nicotine replacement therapy (gums) will be provided to all participants. Participants will be asked to complete phone or online follow-up at 1, 3, 6, and 12-months. At 1-month follow-up, individuals with self-reported smoking abstinence for more than 7 days will be invited to receive an exhaled carbon monoxide (CO) test for biochemical validation. The primary aim is to determine whether the WQ modality is effective in assisting smokers in quitting smoking. The secondary aims are to evaluate the acceptability, satisfaction, and cost-effectiveness of the WQ modality. DISCUSSION: If the WQ modality is determined to be effective, acceptable, and affordable, it will be relatively easy to reach and provide professional cessation treatments to the communities, thus helping to reduce the disparities in smoking cessation services between different regions and socioeconomic groups. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2200066427, Registered December 5, 2022.

Usage, acceptability, and preliminary effectiveness of an mHealth-based integrated modality for smoking cessation interventions in Western China.

INTRODUCTION: Many smokers have not accessed professional smoking cessation assistance due to limited smoking cessation services. We developed a novel mHealth-based integrated modality for smoking cessation (WeChat + Quitline modality, WQ modality) and applied it to a large public welfare project (China Western-QUIT Program) in western China. This study evaluated the usage, acceptability, and preliminary effectiveness of the WQ modality in the population of western China. METHODS: A prospective cohort study was conducted between April and August 2021. Smokers or their relatives were recruited through online advertisements and medical staff referrals. After using the services of the WQ modality for one month, the self-reported awareness, use, and satisfaction with each service among the participants were collected by a telephone interview. We also evaluated the self-reported 7-day point prevalence of abstinence (PPA) and quit attempt rate among baseline current smokers. The usage data of each service were downloaded from quitline and WeChat platforms. RESULTS: Of the 17326 people from western China using the WQ modality, the largest number of users was WeChat official account (11173), followed by WeChat mini program (3734), WeChat group (669), and quitline (541 inbound calls, 605 outbound calls). At one month follow-up, over 70% of participants who completed the baseline survey (n=2221) were aware of WeChat-based services, and over 50% used them. However, the awareness rate (11.1%) and utilization rate (0.5%) of quitline were relatively low. The median satisfaction scores across all services were 9 out of 10 points (IQR: 8-9). Among the baseline current smokers (n=1257), self-reported 7-day PPA was 41.8% (526/1257), and another 225 smokers (17.9%) reported making a quit attempt. CONCLUSIONS: The WQ modality could be well used and accepted, and it has great potential to motivate and aid short-term smoking cessation in smokers from western China.

Temporal trends in anxiety and depression prevalence and their association with adverse outcomes in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease in Beijing, China, from 2004 to 2020.

Aims: To investigate the temporal trend in anxiety and/or depression prevalence in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing and their association with adverse outcomes. Materials and methods: Hospital admission records from 2004 to 2020 with a primary discharge diagnosis of AECOPD were retrieved from Beijing Public Health Information Centre database. The anxiety and depression were identified from discharge diagnoses of each record. Joinpoint regression was used to analyze the temporal trend and calculate the annual percentage change (APC) for the prevalence of anxiety and/or depression. Generalized linear model was used to analyze the associations between anxiety and/or depression and patients' adverse outcomes. Results: A total of 382,125 records were included, most of which were male (66.0%) and aged ≥ 75 years (59.7%). Three segments in the temporal trend were observed, with a mild increase during 2004-2009 (APC: 5.9%, 95% CI: -14.9 to 31.7%), followed by a sharply increase during 2009-2012 (APC: 60.4%, 95% CI: 10.6 to 132.7%), then stabilized at about 3% during 2012-2020 (APC: 1.9%, 95% CI: -0.4 to 4.3%). On average, anxiety, and/or depression was more prevalent in females, the aged and those admitted in secondary hospitals (all P < 0.001). Patients with anxiety and/or depression had lower in-hospital mortality (IHM) (OR = 0.74, 95% CI: 0.63-0.88), but longer hospital stay (OR = 1.10, 95% CI: 1.07-1.13), more medical costs (OR = 1.12, 95% CI: 1.08-1.17) and higher risks of readmission for AECOPD at 30-, 90-, 180-day, and 1-year (ORs ranged from 1.22 to 1.51). Conclusion: The prevalence of anxiety and/or depression in patients hospitalized for AECOPD in Beijing stabilized at approximately 3% after 2012. Anxiety and/or depression is associated with a heavier burden on patients, health care, and medical insurance systems. Appropriate diagnosis and effective treatment of anxiety and depression is crucial for patients with AECOPD.

Secular trend and risk factors of 30-day COPD-related readmission in Beijing, China.

Readmission due to chronic obstructive pulmonary disease (COPD) exacerbation contributes significantly to disease burden. Trend in readmission rate among COPD patients in China is not well characterized. We described the secular trend and identify risk factors of COPD-related 30-day readmission in Beijing during 2012-2017. In this retrospective cohort study, we used data from a citywide hospital discharge database in Beijing. We included patients ≥ 40 years with a primary diagnosis of COPD from 2012 to 2017. A total of 131 591 index admissions were identified. COPD-related 30-day readmission was defined as the initial admission with a primary diagnosis of COPD that occurs within 30 days from the discharge date of an index admission. Overall and annual 30-day readmission rates were calculated in the total population and subgroups defined by patient characteristics. We used multivariable logistic models to investigate risk factors for readmission and in-hospital mortality within 30 days. The overall 30-day COPD-related readmission rate was 15.8% (n = 20 808). The readmission rate increased from 11.5% in 2012 to 17.2% in 2017, with a multivariable-adjusted OR (95% CI) for annual change to be 1.08 (1.06-1.09) (P trend < 0.001). The upward trend in readmission rate levelled off at about 17% since 2014. The readmission rate of men was higher and increased faster than women. Comorbid osteoporosis, coronary heart disease, congestive heart failure, and cancer were associated with an increased risk of 30-day COPD-related readmission. The 30-day COPD-related readmission rate in Beijing showed an overall increasing trend from 2012 to 2017. Future efforts should be made to further improve care quality and reduce early readmissions of COPD patients.

Developments in smoking cessation interventions for patients with chronic obstructive pulmonary disease in the past 5 years: a scoping review.

INTRODUCTION: Smoking cessation is the most effective strategy for slowing the progression of chronic obstructive pulmonary disease (COPD). However, COPD patients find it difficult to quit smoking with standard cessation interventions. AREAS COVERED: A scoping review of smoking cessation for COPD patients was conducted by searching the MEDLINE, Embase, and Cochrane Library databases for all studies published between 1 January 2016 and 22 September 2021. Four themes were set up and 47 studies were included eventually. The majority of the included studies (61.7%, 29/47) investigated efficacy and effectiveness, including new strategies for extended treatment and mobile health (mHealth) delivery approach. Studies examining accessibility and utilization (31.9%, 15/47), safety (10.6%, 5/47), and health economics (6.4%, 3/47) were also reviewed. The quality of the included randomized controlled trials was also evaluated. EXPERT OPINION: Pharmacotherapy combined with behavioral interventions delivered via mHealth may be a promising strategy to help COPD smokers quit. However, the overall quality of the current studies is poor, making it challenging for clinicians to make informed decisions. Future high-quality studies are needed to provide conclusive evidence on the optimal pharmacotherapies and the most cost-effective comprehensive smoking cessation interventions, particularly those integrated into disease management for smokers with COPD.

Metabolic Differences between Ex-Smokers and Nonsmokers: A Metabolomic Analysis.

The aim of this study was to compare changes in the metabolite levels of ex-smokers and nonsmokers using a metabolomics approach, accounting for the weight gain in ex-smokers. Volunteer ex-smokers and nonsmokers were recruited from two cohorts Shijingshan (174) and Xishan (78), respectively, at a 1 : 1 ratio for age and sex. Nontargeted metabolomics was performed on the volunteers' blood samples using liquid chromatography-mass spectrometry, and multivariate statistical analysis was performed using principal component analysis and orthogonal partial least squares discriminant analysis. Enrichment analysis was used to identify Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways associated with differential metabolites and weighted gene co-expression network analysis and maximal correlation coefficient (MCC) algorithms were used to identify key metabolites. The results revealed no significant differences between the distribution of blood metabolite levels in the ex-smokers and nonsmokers. The biosynthesis of valine, leucine, and isoleucine was determined to be associated with differential metabolites, and five key metabolites were identified. Further analysis revealed differences in weight gain and regained metabolite levels in ex-smokers, and 10 differential metabolites were identified that may be associated with weight gain in ex-smokers. These findings suggest that quitting smoking restores metabolites to almost normal levels and results in weight gain. The identified key metabolites and metabolic pathways may also provide a basis for clinical studies.

Air pollution and hospitalization of patients with idiopathic pulmonary fibrosis in Beijing: a time-series study.

BACKGROUND: A small number of studies suggested that air pollution was associated with idiopathic pulmonary fibrosis (IPF) exacerbation, incidence and mortality. However, no studies to date were conducted in regions where air pollution is substantial. We aimed to investigate whether there are associations between acute increases in air pollution and hospitalization of patients with a confirmed primary diagnosis of IPF in Beijing. METHODS: Daily count of IPF hospitalizations (International Classification of Disease-10th Revision, J84.1) was obtained from an administrative database for 2013-2017 while daily city-wide average concentrations of PM10, PM2.5, NO2, Ozone, SO2 were obtained from 35 municipal monitoring stations for the same period. The association between daily IPF hospitalization and average concentration of each pollutant was analyzed with a generalized additive model estimating Poisson distribution. RESULTS: Daily 24-h mean PM2.5 concentration during 2013-2017 was 76.7 µg/m3. The relative risk (RR) of IPF hospitalization per interquartile range (IQR) higher (72 µg/m3) in PM2.5 was 1.049 (95% CI 1.024-1.074) and 1.031 (95% CI 1.007-1.056) for lag0 and moving averages 0-1 days respectively. No significant associations were observed for other lags. Statistically significant positive associations were also observed at lag0 with SO2, Ozone and NO2 (in men only). Positive associations were seen at moving averages 0-30 days for PM10 (RR per 86 µg/m3: 1.021, 95% CI 0.994-1.049), NO2 (RR per 30 µg/m3: 1.029, 95% CI 0.999-1.060), and SO2 (RR per 15 µg/m3: 1.060 (95% CI 1.025-1.097), but not with PM2.5 or Ozone. CONCLUSIONS: Despite improvement in air quality since the implementation of clean air policy in 2013, acute exposure to higher levels of air pollution is significantly associated with IPF hospitalization in Beijing. Air quality policy should be continuously enforced to protect vulnerable IPF populations as well as the general public.

Lifelong smoking status, weight gain, and subsequent risk of major adverse cardiovascular events: Long-term follow-up of a middle-aged Chinese population.

OBJECTIVE: The aim of this study was to explore the association of lifelong smoking status with risk of major adverse cardiovascular events (MACE) accounting for weight change in a Chinese cohort. METHODS: The cohort of the People's Republic of China-United States of America (PRC-USA) Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology was established in 1983 to 1984, resurveyed during 1987 to 1988 and 1993 to 1994, and followed up to 2005. A total of 5,849 participants who survived in 1993 to 1994 were classified into never smokers, long-term quitters, short-term quitters, short-term relapsers and new smokers, long-term relapsers and new smokers, and persistent smokers according to the information on lifelong smoking status collected in all three surveys. The associations of lifelong smoking status with MACE in the subsequent 10 years were explored with Cox proportional hazards models. RESULTS: During a median follow-up of 10.2 years, 694 participants had MACE. Compared with persistent smokers, the multivariable-adjusted hazard ratio of developing MACE was 0.83 (95% CI: 0.61-1.12) for short-term quitters, 0.75 (95% CI: 0.54-1.02) for long-term quitters, and 0.68 (95% CI: 0.54-0.85) for never smokers (ptrend = 0.001). In comparison, the hazard ratio was 1.03 (95% CI: 0.77-1.35) for long-term relapsers and new smokers and 0.78 (95% CI: 0.46-1.22) for short-term relapsers and new smokers (ptrend = 0.018). These associations were not significantly altered by further adjusting for weight change in the past 10 years. CONCLUSIONS: Lifelong smoking status is significantly associated with risk of MACE. As time duration increased, health benefit to quitters would become close to that of never smokers, and harms to relapsers and new smokers would become close to that of persistent smokers.

Safety of varenicline as an aid to smoking cessation in professional drivers and its impact on driving behaviors: An observational cohort study of taxi drivers in Beijing.

INTRODUCTION: Varenicline is an effective smoking cessation medicine. However, the possible adverse neuropsychiatric events reported by Food and Drug Administration for varenicline may cause safety problems for professional drivers. We aimed to investigate its safety and impacts on driving behaviors among taxi drivers in Beijing, China. METHODS: An observational cohort study was conducted in a smoking cessation clinic in Beijing, China, between September 2017 and April 2018. Smokers with varenicline for smoking cessation were included and categorized into taxi-driver smokers (n=103) and non-taxi-driver smokers (n=119). All participants received varenicline up to 12 weeks and five standardized counseling sessions. Treatment-related adverse events (AEs) were collected in all participants and their impacts on driving behaviors were assessed in taxi-driver smokers. Multiple logistic regression analysis was used to examine potential risk factors for vareniclinerelated somnolence/fatigue. RESULTS: The incidence of most treatment-related AEs was similar between taxi-driver smokers and non-taxi-driver smokers, but treatment-related somnolence/ fatigue was more frequently reported in taxi-driver smokers (18.4% vs 6.7%; p=0.008). Most taxi-driver smokers (87.4%) reported that treatment-related AEs did not affect their driving behaviors, and no traffic accident was reported during treatment. CONCLUSIONS: Varenicline appears to be a well-tolerated smoking cessation aid for Beijing taxi drivers and has less impact on driving behaviors. However, taxi-driver smokers were more likely to report somnolence/fatigue during varenicline treatment and physicians should pay more attention to this occupational population.

Patients' self-reported receipt of brief smoking cessation interventions based on a decision support tool embedded in the healthcare information system of a large general hospital in China.

INTRODUCTION: Healthcare information systems (HIS) are used to aid healthcare providers delivering brief smoking cessation interventions. However, evidence regarding the effectiveness of intervention models in developing countries remains limited. A smoking cessation intervention model based on a decision support tool embedded in HIS (an 'e-information model', including Ask, Advise, Assess, Inform, Refer and Print components) was applied in a large urban general hospital in Beijing, China. The current study was a preliminary evaluation of the implementation and effectiveness of this model. METHODS: We conducted a retrospective investigation in the outpatient department of the hospital in the period June-July 2017. Using a paper questionnaire, patients' self-reported receipt of the e-information model in the past 2 months and their plans to quit within 1 month were collected. Multivariate logistic regression analysis was used to examine the association between receiving the e-information model and patients' plans to quit. RESULTS: Among 656 currently smoking patients, the proportion of patients receiving the Ask, Advise, Assess, Refer and Print components were 73.2%, 65.4%, 49.8%, 16.0% and 10.4%, respectively. The results revealed a dose-response relationship between the number of components received and the proportion of patients planning to quit (p-trend=0.006). The likelihood of patients planning to quit within 1 month was highest among those receiving all five components (OR=2.79, 95% CI: 1.31-5.94). Moreover, a simplified model composed of two or three components also revealed a potential effect on increasing the proportion of patients planning to quit. CONCLUSIONS: The e-information model was applied effectively in the study hospital and appeared to encourage patients to plan to quit smoking. This model could be generalized to other hospitals in China and other developing countries. However, many components of this model were less utilized, and comprehensive measures will be required to improve its application in the future.

Brain Structure Alterations in Respect to Tobacco Consumption and Nicotine Dependence: A Comparative Voxel-Based Morphometry Study.

The main purpose of this study is to examine the lifetime tobacco consumption and the degree of nicotine dependence related gray matter (GM) and white matter (WM) volume alterations in young adult-male smokers. Fifty-three long-term male smokers and 53 well-matched male healthy non-smokers participated in the study, and the smokers were respectively categorized into light and heavy tobacco consumption subgroups by pack-years and into moderate and severe nicotine dependence subgroups using the Fagerström Test for Nicotine Dependence (FTND). Voxel-based morphometry analysis was then performed, and ANCOVA analysis combined with subsequent post hoc test were used to explore the between-group brain volume abnormalities related to the smoking amount and nicotine dependence. Light and heavy smokers displayed smaller GM and WM volumes than non-smokers, while heavy smokers were found with more significant brain atrophy than light smokers in GM areas of precuneus, inferior and middle frontal gyrus, superior temporal gyrus, cerebellum anterior lobe and insula, and in WM areas of cerebellum anterior lobe. However, the contrary trend was observed regarding alterations associated with severity of nicotine dependence. Severe nicotine dependence smokers rather demonstrated less atrophy levels compared to moderate nicotine dependence smokers, especially in GM areas of precuneus, superior and middle temporal gyrus, middle occipital gyrus, posterior cingulate and insula, and in WM areas of precuneus, posterior cingulate, cerebellum anterior lobe and midbrain. The results reveal that the nicotine dependence displays a dissimilar effect on the brain volume in comparison to the cigarette consumption. Our study could provide new evidences to understand the adverse effects of smoking on the brain structure, which is helpful for further treatment of smokers.

Abnormal white matter microstructure among early adulthood smokers: a tract-based spatial statistics study.

Objectives Cigarette smoking is an important risk factor of central nervous system diseases. However, the white matter (WM) integrity of early adulthood chronic smokers has not been attached enough importance to as it deserves, and the relationship between the chronic smoking effect and the WM is still unclear. The purpose of this study was to investigate whole - brain WM microstructure of early adulthood smokers and explore the structural correlates of behaviorally relevant features of the disorder. Methods We compared multiple DTI-derived indices, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD), between early adulthood smokers (n = 19) and age-, education- and gender-matched controls (n = 23) using a whole-brain tract-based spatial statistics approach. We also explored the correlations of the mean DTI index values with pack-years and Fagerström Test for Nicotine Dependence. Results The smokers showed increased FA in left superior longitudinal fasciculus (SLF), left anterior corona radiate, left superior corona radiate, left posterior corona radiate, left external capsule (EC), left inferior fronto-occipital fasciculus and sagittal stratum (SS), and decreased RD in left SLF. There were significant negative correlations among the average FA in the left external capsule and pack-years in smokers. In addition, significant positive correlation was found between RD values in the left SLF and pack-years. Discussion These findings indicate that smokers show microstructural changes in several white-matter regions. The correlation between the cumulative effect and microstructural WM alternations suggests that WM properties may become the new biomarkers in practice.

Brain-volume changes in young and middle-aged smokers: a DARTEL-based voxel-based morphometry study.

INTRODUCTION: Many studies have reported brain volume changes in smokers. However, the volume differences of grey matter (GM) and white matter (WM) in young and middle-aged male smokers with different lifetime tobacco consumption (pack-years) remain uncertain. OBJECTIVES: To examine the brain volume change, especially whether more pack-years smoking would be associated with smaller gray matter and white matter volume in young and middle-aged male smokers. METHODS: We used a 3T MR scanner and performed Diffeomorphic anatomical registration through exponentiated lie algebra (DARTEL)-based voxel-based morphometry on 53 long-term male smokers (30.72 ± 4.19 years) and 53 male healthy non-smokers (30.83 ± 5.18 years). We separated smokers to light and heavy smokers by pack-years and compared brain volume between different smoker groups and non-smokers. And then we did analysis of covariance (ANCOVA) between smokers and non-smokers by setting pack-years as covariates. RESULTS: Light and heavy smokers all displayed smaller GM and WM volume than non-smokers and more obviously in heavy smokers. The main smaller areas in light and heavy smokers were superior temporal gyrus, insula, middle occipital gyrus, posterior cingulate, precuneus in GM and posterior cingulate, thalamus and midbrain in WM, in addition, we also observed more pack-years smoking was associated with some certain smaller GM and WM volumes by ANCOVA. CONCLUSION: Young and middle-aged male smokers had many smaller brain areas than non-smokers. Some of these areas' volume had negative correlation with pack-years, while some had not. These may due to different pathophysiological role of smokings.

Smoking cessation in Asians: focus on varenicline.

Smoking is a modifiable risk factor for morbidity and mortality caused by cancer, cardiovascular diseases, respiratory diseases, and many other diseases. Given the large population size and high prevalence of smoking in Asia, successful smoking cessation could potentially prevent the large number of premature deaths in Asians. However, most dependent smokers cannot successfully quit smoking due to nicotine addiction, and they need professional help and smoking cessation therapies. Varenicline is a highly selective partial agonist for the nicotinic acetylcholine receptor α4ß2 subtype, which is believed to be responsible for mediating the reinforcing properties of nicotine. This article is a narrative review, which summarizes the smoking cessation efficacy, side effects, and cost utilities of varenicline in Asians. From this review, we conclude that varenicline is an effective medication that could assist smoking cessation in the Asian populations. The adverse events of varenicline are tolerable, and the most common events were nausea and abnormal dreams. Both the efficacy and tolerance of varenicline in Asians are similar to that in Western populations. Considering the cost utilities, varenicline should be recommended for use in smoking cessation and be covered by medical insurance in most Asian countries.

Spontaneous brain activity in chronic smokers revealed by fractional amplitude of low frequency fluctuation analysis: a resting state functional magnetic resonance imaging study.

BACKGROUND: Nicotine is primarily rsponsible for the highly addictive properties of cigarettes. Similar to other substances, nicotine dependence is related to many important brain regions, particular in mesolimbic reward circuit. This study was to further reveal the alteration of brain function activity during resting state in chronic smokers by fractional amplitude of low frequency fluctuation (fALFF) based on functional magnetic resonance imaging (fMRI), in order to provide the evidence of neurobiological mechanism of smoking. METHODS: This case control study involved twenty healthy smokers and nineteen healthy nonsmokers recruited by advertisement. Sociodemographic, smoking related characteristics and fMRI images were collected and the data analyzed. RESULTS: Compared with nonsmokers, smokers showed fALFF increased significantly in the left middle occipital gyrus, left limbic lobe and left cerebellum posterior lobe but decreases in the right middle frontal gyrus, right superior temporal gyrus, right extra nuclear, left postcentral gyrus and left cerebellum anterior lobe (cluster size >100 voxels). Compared with light smokers (pack years ≤ 20), heavy smokers (pack years >20) showed fALFF increased significantly in the right superior temporal gyrus, right precentral gyrus, and right occipital lobe/cuneus but decreased in the right/left limbic lobe/cingulate gyrus, right/left frontal lobe/sub gyral, right/left cerebellum posterior lobe (cluster size >50 voxels). Compared with nonsevere nicotine dependent smokers (Fagerstrom test for nicotine dependence, score ≤ 6), severe nicotine dependent smokers (score >6) showed fALFF increased significantly in the right/left middle frontal gyrus, right superior frontal gyrus and left inferior parietal lobule but decreased in the left limbic lobe/cingulate gyrus (cluster size >25 voxels). CONCLUSIONS: In smokers during rest, the activity of addiction related regions were increased and the activity of smoking feeling, memory, related regions were also changed. The resting state activity changes in many regions were associated with the cumulative amount of nicotine intake and the severity of nicotine dependence.

Proteomic analysis for detecting serum biomarkers related to smoking in humans.

BACKGROUND: Smoking is the leading cause of death in the world. This study focused on the difference of the serum proteomic profiling between healthy smokers and nonsmokers in order to find smoking-specific serum biomarkers. METHODS: Pattern-based proteomic profiling of 100 serum samples (from 50 Chinese male smokers and 50 matched nonsmokers) was performed through magnetic bead fractionation coupled with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis (MALDI-TOF-MS) and resulting data were statistically analyzed by Ciphergen ProteinChip software 3.0.2. RESULTS: We found 72 serum peaks were significantly different between smokers and nonsmokers (P < 0.05). Marker peaks of mass-to-charge ratio (m/z) 3159.13, 7561.03 and 9407.32 were smoking-specific. CONCLUSION: The preliminary data suggested that smoking-specific serum biomarkers could be detected in humans.