The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population. MATERIALS AND METHODS: MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables. RESULTS: Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01). CONCLUSIONS: The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials. CLINICAL RELEVANCE: Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.

Intra-tracheal amikacin spray delivery in healthy mechanically ventilated piglets.

BACKGROUND: Nebulization during mechanical ventilation is impeded by large extra-pulmonary drug deposition and long administration durations which currently limit implementation of inhaled antibiotic therapy. Direct intra-tracheal delivery using a sprayer represents an appealing alternative investigated in small animal models, but large animal data are lacking. METHODS: Amikacin was administered through intravenous infusion (20 mg/kg), nebulization (60 mg/kg) and direct intra-tracheal spray (30 mg/kg) to 10 intubated piglets, in a randomized cross-over design. Amikacin concentrations were measured in the serum and pulmonary parenchyma. Anatomic deposition was investigated using immuno-histochemistry. RESULTS: Spray delivery resulted in higher amikacin outputs than nebulization and infusion. Pulmonary inhaled delivery techniques yielded much higher lung concentrations and much lower serum concentrations than intravenous infusion. However, unlike nebulization and infusion, intra-tracheal spray delivery was associated with more than 100- and 1000-fold variability in lung concentrations between and within animals. Amikacin specific immuno-histochemistry showed consistent bronchial and alveolar drug deposition with all modalities. CONCLUSION: Nebulization remains the most reliable and simple technique to deliver inhaled amikacin uniformly to the lung during mechanical ventilation. Further development of tracheal sprays is required to take advantage of potential benefits related to high drug output and low extra-pulmonary deposition in large animals.

An online survey of users of tobacco vaporizers, reasons and modes of utilization, perceived advantages and perceived risks.

BACKGROUND: Tobacco vaporizers heat tobacco without burning it, to produce an inhalable aerosol. Various models have recently appeared on the market, mostly manufactured by the tobacco industry, but few of the studies published on tobacco vaporizers are independent from the manufacturers. The goals of this study were to explore who uses tobacco vaporizers, how these products are used, reasons for utilization, perceived advantages and risks. METHODS: Online questionnaire collected from October 2016 to January 2018 in self-selected visitors aged > 18 to an anti-addiction website. RESULTS: We obtained 170 valid responses, of whom 104 were using tobacco vaporizers. For homogeneity, we included only the 102 users of the Brand 1 tobacco vaporizer in our analysis, as there were only two users of other vaporizers. Among these 102 vaporizer users, about half were current cigarette smokers (57%), the rest were former cigarette smokers. The median age was 41, and the median duration of utilization was 9 months. Most (88%) used the vaporizer daily, 8% were occasional users and 4% were past users. Among current smokers, 80% were currently trying to reduce their cigarette consumption and 29% were trying to quit. The vaporizer was used mainly to replace cigarettes (94%), because it was perceived to be less toxic than cigarettes (89%), to help stop smoking or to avoid starting smoking again (72%), or to reduce cigarette consumption (71%). Current smokers who were daily or occasional vaporizer users reported smoking a median of 8.0 cigarettes per day, compared with 20.0 per day before they started to use the vaporizer (p < .0001, Wilcoxon signed-rank test). CONCLUSIONS: In this online sample of early adopters, Brand 1 was by far the most frequently used tobacco vaporizer. It was used by current or former smokers only, mainly to replace cigarettes, and satisfaction ratings were good. Users considered the tobacco vaporizer to be less toxic than cigarette smoke and perceived it to be helpful for reducing or stopping smoking.

Vaped, Not Stirred: Vaporized Alcohol Knowledge, Use, and Susceptibility.

Background: Vaporized alcohol is an alternative method of ingesting alcohol that has received significant attention in the press. However, research on vaporized alcohol to date is limited. Objectives: The current study sought to assess vaporized alcohol knowledge, use, and future susceptibility in diverse sample of young adults in the Southwest United States. Method: A cross-sectional survey design was used to assess perception and use of vaporized alcohol in a sample of 986 young adults in college gathered in 2015 and 2016. Results: Overall, 26% of participants had heard of vaporized alcohol, 1.7% had used vaporized alcohol, and 33.5% were susceptible to future vaporized alcohol use. Contrary to our hypothesis, heavy drinkers were not more likely to have tried vaporized alcohol. Further, there were no significant differences in vaporized alcohol use across any sociodemographic groups. Conclusions/Importance: Ever use of vaporized alcohol was low, which was generally consistent with prior research, debunking media reports that vaporized alcohol is a widespread problem. However, ongoing monitoring of this method of alcohol ingestions appears warranted, especially with different populations (i.e., adolescents, and young adults not in college) where no empirical research has been published to date.

Optimizing target control of the vessel rich group with volatile anesthetics.

The ability to monitor the inspired and expired concentrations of volatile anesthetic gases in real time makes these drugs implicitly targetable. However, the end-tidal concentration only represents the concentration within the brain and the vessel rich group (VRG) at steady state, and very poorly approximates the VRG concentration during common dynamic situations such as initial uptake and emergence. How should the vaporization of anesthetic gases be controlled in order to optimally target VRG concentration in clinical practice? Using a generally accepted pharmacokinetic model of uptake and redistribution, a transfer function from the vaporizer setting to the VRG is established and transformed to the time domain. Targeted actuation of the vaporizer in a time-optimal manner is produced by a variable structure, sliding mode controller. Direct mathematical application of the controller produces rapid cycling at the limits of the vaporizer, further prolonged by low fresh gas flows. This phenomenon, known as "chattering", is unsuitable for operating real equipment. Using a simple and clinically intuitive modification to the targeting algorithm, a variable low-pass boundary layer is applied to the actuation, smoothing discontinuities in the control law and practically eliminating chatter without prolonging the time taken to reach the VRG target concentration by any clinically significant degree. A model is derived for optimum VRG-targeted control of anesthetic vaporizers. An alternate and further application is described, in which deliberate perturbation of the vaporization permits non-invasive estimation of parameters such as cardiac output that are otherwise difficult to measure intra-operatively.

Technology III: in-line vaporizer with reflector.

As the clinical advantages of vapor anesthesia (VA) for sedation of patients in ICU become more apparent, the ergonomics, economy and safety issues need to be better addressed. Here we describe the use of a new commercial digital in-line anesthetic vaporizer that can be attached to the inspiratory limb of a ventilator. If used with a simple, and easily assembled secondary circuit and anesthetic reflector, the circuit remains remote from the patient, the VA consumption approaches a physical minimum, VA level is controlled and monitored, and the tidal volume size is not limited.

Derivatization coupled to headspace programmed-temperature vaporizer gas chromatography with mass spectrometry for the determination of amino acids: Application to urine samples.

A new method based on headspace programmed-temperature vaporizer gas chromatography with mass spectrometry has been developed and validated for the determination of amino acids (alanine, sarcosine, ethylglycine, valine, leucine, and proline) in human urine samples. Derivatization with ethyl chloroformate was employed successfully to determine the amino acids. The derivatization reaction conditions as well as the variables of the headspace sampling were optimized. The existence of a matrix effect was checked and the analytical characteristics of the method were determined. The limits of detection were 0.15-2.89 mg/L, and the limits of quantification were 0.46-8.67 mg/L. The instrumental repeatability was 1.6-11.5%. The quantification of the amino acids in six urine samples from healthy subjects was performed with the method developed with the one-point standard additions protocol, with norleucine as the internal standard.

Comparison of different injection modes in edible oil minor components analysis.

Waxes and fatty acid alkyl esters are minor components used as official parameters to control the authenticity and quality of a high-value olive oil product. A poor measurement can lead to a misleading classification of the oil. The official method requires their analysis together by capillary gas chromatography equipped with a flame ionization detector and an on-column injector to avoid discrimination and thermal degradation. The degradation can occur to a different extent if different (and not properly optimized) injectors are used. However, other injection techniques, such as programmed-temperature vaporizer, are much more versatile and more widespread. The aim of the present work was to compare the performance of a programmed-temperature vaporizer injector, in on-column and splitless mode, with the on-column injector to analyze alkyl esters and waxes. Discrimination among high-boiling compounds was evaluated, as well as the occurrence of thermal degradation, especially of sterols and diterpene alcohol (phytyl and geranylgeraniol) esters. A proper optimization of a programmed-temperature vaporizer injection, with particular attention to the liner selection, was proven to provide comparable results to the traditional on-column injection. A performance comparison was carried out both on standard mixtures and on real oil samples.

Experiences of marijuana-vaporizer users.

BACKGROUND: Using a marijuana vaporizer may have potential harm-reduction advantages on smoking marijuana, in that the user does not inhale smoke. Little research has been published on use of vaporizers. METHODS: In the first study of individuals using a vaporizer on their own initiative, 96 adults anonymously answered questions about their experiences with a vaporizer and their use of marijuana with tobacco. RESULTS: Users identified 4 advantages to using a vaporizer over smoking marijuana: perceived health benefits, better taste, no smoke smell, and more effect from the same amount of marijuana. Users identified 2 disadvantages: inconvenience of setup and cleaning and the time it takes to get the device operating for each use. Only 2 individuals combined tobacco in the vaporizer mix, whereas 15 combined tobacco with marijuana when they smoked marijuana. Almost all participants intended to continue using a vaporizer. CONCLUSIONS: Vaporizers seem to have appeal to marijuana users, who perceive them as having harm-reduction and other benefits. Vaporizers are worthy of experimental research evaluating health-related effects of using them.

Delivery of sevoflurane to dogs using a Stephens anaesthetic machine.

OBJECTIVE: To investigate the sevoflurane concentrations produced within the Stephens anaesthetic machine circuit (vaporizer in-circle system) at different fresh gas flow rates (FGFRs), temperatures, vaporizer settings and vaporizer sleeve positions when used to anaesthetize dogs of different body sizes. STUDY DESIGN: Experimental non-blinded studies. ANIMALS: Eighteen mixed breed dogs, weights 4-39 kg. METHODS: Anaesthetic induction with propofol was followed by maintenance with sevoflurane in oxygen via the Stephens anaesthetic machine. In study 1, the vaporizer setting, temperature and circuit FGFRs were altered with the vaporizer sleeve down (n = 3), or in separate experiments, up (n = 3). Delivered (Fi'SEVO) and expired sevoflurane concentrations were recorded. Study 2 determined the vaporizer settings (sleeve up) required to achieve predetermined multiples of minimal alveolar concentration (MAC) of Fi'SEVO when sevoflurane was delivered to dogs (n = 12) of different bodyweights and at different FGFRs. RESULTS: Delivered concentrations of sevoflurane were sufficient to maintain anaesthesia in all dogs, regardless of bodyweight, FGFR, vaporizer temperature and sleeve position. Fi'SEVO increased with increasing temperature, when the vaporizer sleeve was down, when vaporizer setting was increased and when FGFR was decreased. As the FGFR increased or the dog's bodyweight decreased, higher vaporizer settings were required to produce the same Fi'SEVO. The median Stephens vaporizer settings to achieve an Fi'SEVO of 1.3 MAC ranged from 4.3 to 5.0 for a small dog (1-10 kg), 2.5 to 5.6 for a medium dog (15-25 kg) and 2.5 to 3.5 for a large dog (30-40 kg), depending on the FGFR. CONCLUSION AND CLINICAL RELEVANCE: The Stephens anaesthetic machine can deliver to dogs, weighing 4 kg and above, concentrations of sevoflurane sufficient or in excess of that required to maintain anaesthesia, at temperatures from 10 to 35 °C, FGFRs of 1 to 5 times the patient's estimated metabolic oxygen requirement and at any vaporizer sleeve position.

Comparative Pharmacokinetic Assessment of Innovative Sublingual, Rectal and Vaporizer Cannabis Products Versus Approved Cannabis Products in Healthy Volunteers.

Background: Over the last years, there is a dramatic increase in the use of medical cannabis products for an expanding range of clinical indications. The type of the drug product and its administration route affect substantially the rate and the extent of absorption of cannabinoids and the effects induced by them in the patients. The current challenge for the cannabis pharmaceutical industry is to develop formulations that allow predictable and stable absorption of cannabinoids. This article reports the results of the clinical trial that investigated the pharmacokinetics (PKs) of innovative cannabis products in healthy volunteers. Materials and Methods: This was a single-center study with a single-dose, randomized, crossover, partially blinded controlled design. Each of the 12 healthy volunteers received 8 different products, of the 10 products that were assessed in this trial: novel sublingual (SL) tablet, vaporizer, and rectal products, comparator products (Sativex® and oil-based oromucosal products), and placebo products. Serial blood samples were collected, plasma concentrations of the THC, 11-OH-THC, and CBD were quantified and subjected to noncompartmental PK analysis. Results: Novel medical cannabis products that were investigated in the study induced substantial exposure of the volunteers to the active ingredients, had more rapid absorption, and in some cases also less variable absorption of THC and CBD, in comparison with the approved comparison products. The bioavailability of the novel SL tablet-based and suppositories products was somewhat lower than that of the oromucosal products. The vaporizer provided immediate systemic absorption with highest maximal concentration. The safety profile of the novel cannabis products, namely vaporizer, SL tablets, and suppositories, was not inferior to the Sativex and oil-based oromucosal formulations. Conclusions: The novel cannabis products that were assessed in this study have PK properties that may be advantageous for management of specific medical conditions or in specific subgroups of patients that are prescribed medical cannabis.

Impairment of Endothelial Function by Aerosol From Marijuana Leaf Vaporizers.

BACKGROUND: Marijuana leaf vaporizers, which heat plant material and sublimate Δ-9-tetrahydrocannabinol without combustion, are popular alternatives to smoking cannabis that are generally perceived to be less harmful. We have shown that smoke from tobacco and marijuana, as well as aerosol from e-cigarettes and heated tobacco products, impair vascular endothelial function in rats measured as arterial flow-mediated dilation (FMD). METHODS AND RESULTS: We exposed 8 rats per group to aerosol generated by 2 vaporizer systems (Volcano and handheld Yocan) using marijuana with varying Δ-9-tetrahydrocannabinol levels, in a single pulsatile exposure session of 2 s/min over 5 minutes, and measured changes in FMD. To model secondhand exposure, we exposed rats for 1 minute to diluted aerosol approximating release of uninhaled Volcano aerosol into typical residential rooms. Exposure to aerosol from marijuana with and without cannabinoids impaired FMD by ≈50%. FMD was similarly impaired by aerosols from Yocan (237 °C), and from Volcano at both its standard temperature (185 °C) and the minimum sublimation temperature of Δ-9-tetrahydrocannabinol (157 °C), although the low-temperature aerosol condition did not effectively deliver Δ-9-tetrahydrocannabinol to the circulation. Modeled secondhand exposure based on diluted Volcano aerosol also impaired FMD. FMD was not affected in rats exposed to clean air or water vapor passed through the Volcano system. CONCLUSIONS: Acute direct exposure and modeled secondhand exposure to marijuana leaf vaporizer aerosol, regardless of cannabinoid concentration or aerosol generation temperature, impair endothelial function in rats comparably to marijuana smoke. Our findings indicate that use of leaf vaporizers is unlikely to reduce the vascular risk burden of smoking marijuana.

Knowledge, Attitudes and Behaviours of Adolescents and Young Adult Population on the Use of E-Cigarettes or Personal Vaporizer.

The use of electronic cigarettes (e-cig) or personal vaporizers (PV) has increased in recent years, especially among adolescents and adults, increasing risk factors for their health or being a starting point for other risk behaviours. The aim of our study is to learn the knowledge, attitudes and behaviours of the adolescent and young adult population on the use of e-cigarettes or PVs. A cross-sectional descriptive study was carried out among 375 subjects. The use of e-cigs or PVs was measured using a self-administered questionnaire. Overall, 13.33% of the respondents used e-cigarettes or PVs. A correlation could be established between vape use and age, with 14-18-year-olds being the highest users (25.9%). Additionally, 90.13% of the respondents answered that e-cig or PV use was harmful to health. Other behaviours, such as consumption of energy drinks (ED), increases the probability of vaping by 3.08 times (CI = 1.55-6.29; p = 0.001). Subjects aged 23-26 years and 27-34 years are less likely to vape than subjects aged 14-18 years (OR = 0.31: CI = 0.09-0.96; p = 0.044; OR = 0.07: CI = 0.00-0.63; p = 0.037). The same applies to subjects with secondary education (OR = 0.17: CI = 0.04-0.66; p = 0.011) and postgraduate education (OR = 0.07: CI = 0.06-1.19; p = 0.043), than subjects with primary education. The use of e-cigs and PVs starts at an early age, despite the known harmful effects of e-cigs and PVs. Their use may occur mainly in recreational situations and in association with other substances such as ED.

Inhaled Medication Errors During Hospitalization or on Hospital Discharge in Patients Living With Chronic Obstructive Pulmonary Disease: A Literature Review.

Inhaled medications, including beta-agonists, muscarinic antagonists, and corticosteroids, are the backbone of chronic obstructive pulmonary disease (COPD) treatment, and pharmacotherapy plans are frequently optimized during and following hospitalization. Clinical practice guidelines acknowledge that patients living with COPD may experience medication errors from inadequate inhaler technique or device faults, but inhaled medication errors within COPD pharmacotherapy plans remain unreported. This literature review aimed to collect and present studies describing medication errors occurring with inhaled medications in patients living with COPD during and following hospitalization. The databases searched included Ovid MEDLINE, Embase, and International Pharmaceutical Abstracts. One hundred forty-five unique studies were collected, and 10 studies were included. The rate of inhaled medication errors reported across the 10 studies ranged between 2.5% and 66% of patients living with COPD and who were hospitalized or discharged. The incidence and types of medication errors reported across the studies varied significantly. Standardization in categorizing and reporting inhaled medication errors is necessary for future studies to determine the true incidence of inhaled medication errors occurring in patients living with COPD who are hospitalized or discharged.

Tree-Inspired Aerogel with a Radial and Centrosymmetric Structure for Efficient Solar-Powered Water Purification.

Solar-powered water purification is one of the promising choices for clean water production. However, it remains challenging to develop aerogel solar evaporators that simultaneously possess enhanced light-to-heat conversion, optimal thermal management, and salt crystal deposition inhibition. Herein, to address this challenge, we have developed a 3D chitosan-reduced graphene oxide/polypyrrole (CS-RGO/PPy) aerogel vaporizer with a vertical and radially aligned structure through a directional freezing process, inspired by the featured structure of conifers. The radially porous walls and vertically arranged channels within the 3D aerogel were able to facilitate high light absorption, localizing converted heat, rapid water transport, and self-salt discharge. Under 1 sun irradiation, the aerogel vaporizer displayed an improved light absorption characteristic of 95% and a high-rate evaporation (∼3.19 kg m-2 h-1) that achieved continuous freshwater from the saturated brine production without solid salt crystallization. Besides achieving seawater desalination, the obtained aerogel could purify organic wastewater and emulsions through solar distillation with high-rate continuous water production.

Investigation of microorganisms in cannabis after heating in a commercial vaporizer.

Introduction: There are concerns about microorganisms present on cannabis materials used in clinical settings by individuals whose health status is already compromised and are likely more susceptible to opportunistic infections from microbial populations present on the materials. Most concerning is administration by inhalation where cannabis plant material is heated in a vaporizer, aerosolized, and inhaled to receive the bioactive ingredients. Heating to high temperatures is known to kill microorganisms including bacteria and fungi; however, microbial death is dependent upon exposure time and temperature. It is unknown whether the heating of cannabis at temperatures and times designated by a commercial vaporizer utilized in clinical settings will significantly decrease the microbial loads in cannabis plant material. Methods: To assess this question, bulk cannabis plant material supplied by National Institute on Drug Abuse (NIDA) was used to assess the impact of heating by a commercial vaporizer. Initial method development studies using a cannabis placebo spiked with Escherichia coli were performed to optimize culture and recovery parameters. Subsequent studies were carried out using the cannabis placebo, low delta-9 tetrahydrocannabinol (THC) potency and high THC potency cannabis materials exposed to either no heat or heating for 30 or 70 seconds at 190°C. Phosphate-buffered saline was added to the samples and the samples agitated to suspend the microorganism. Microbial growth after no heat or heating was evaluated by plating on growth media and determining the total aerobic microbial counts and total yeast and mold counts. Results and discussion: Overall, while there were trends of reductions in microbial counts with heating, these reductions were not statistically significant, indicating that heating using standard vaporization parameters of 70 seconds at 190°C may not eliminate the existing microbial bioburden, including any opportunistic pathogens. When cultured organisms were identified by DNA sequence analyses, several fungal and bacterial taxa were detected in the different products that have been associated with opportunistic infections or allergic reactions including Enterobacteriaceae, Staphylococcus, Pseudomonas, and Aspergillus.

Content analysis of instagram posts by leading cannabis vaporizer brands.

BACKGROUND: Cannabis vaporizer companies leverage social media to market their products, but little is known about the content of the messages being delivered to consumers. This study describes characteristics of Instagram posts from three popular cannabis vaporizer brands in the U.S. METHODS: A content analysis was performed on posts uploaded between October 2017 and October 2018 by the brands Kandypens (n = 731), G Pen (n = 454), and Pax (n = 71). Posts were coded for: characteristics of individuals pictured, health and risk statements, references to cannabis, co-marketing activities, cartoon images, and product price. Descriptive statistics highlight the prevalence of these characteristics and between-brand differences. RESULTS: Posts had a wide reach, with a total of 467,700 followers across brands. Two-thirds (68.0 %) of posts depicted someone using the product. Among posts featuring a person, (83.9 %) depicted female users. Overall, cannabis was rarely mentioned (8.9 %) or depicted (10.0 %) in posts. "Tagging" social media influencers (34.3 % of posts) and other companies or their products (31.9 % of posts) were popular promotional strategies. Few posts mentioned age restrictions (0.3 %), health risks (5.2 %), or health benefits (0.2 %). CONCLUSIONS: Cannabis vaporizer companies reach thousands of consumers through brand-owned social media accounts. Strategies to promote their products on these channels include posts that may appeal to sociodemographic groups and leveraging social media influencers and other companies to increase overall reach. As legalized recreational cannabis expands and a range of consumption methods become popular, an understanding of brands' social media marketing practices is needed to inform policies and interventions that promote population health.