Evaluación de la dependencia física y psicológica al tabaco en fumadores mexicanos adultos, Encodat 2016 / Evaluation of physical and psychological dependence in Mexican adult smokers, Encodat 2016

Resumen: Objetivo: Evaluar la dependencia física y psicológica de los fumadores mexicanos y su asociación con factores físicos, psicológicos y sociales. Material y métodos: A partir de la Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco 2016 (n=7 331), se analizó la escala de dependencia física a la nicotina de Fagerström (FTND) y la escala corta de dependencia psicológica al tabaco (TAPDSc). Se realizaron análisis bivariados y regresiones logísticas ordinales generalizadas para evaluar los factores asociados. Resultados: 82.3% de fumadores diarios y 98.8% de ocasionales reportaron dependencia física leve, mientras que 47.9 y 37.9%, respectivamente, presentaron dependencia psicológica moderada. La edad de inicio temprana de consumo de tabaco, uso de drogas, consumo alto de alcohol y malestar emocional se asociaron con niveles altos de dependencia psicológica en todos los fumadores. Conclusión: El uso exclusivo de FNTD no permite evaluar adecuadamente a los fumadores mexicanos. La dependencia física y psicológica al tabaco debe ser diagnosticada con escalas independientes y validadas en esta población.

Abstract: Objective: To evaluate the physical and psychological dependence to tobacco of Mexican smokers and its association with physical, psychological and social factors. Materials and methods: The 2016 National Alcohol and Tobacco Drug Consumption Survey (n=7 331) was analyzed using the Fagerström nicotine physical dependence scale (FTND) and the short scale of psychological dependence on tobacco (TAPDSc). Bivariate analyzes and generalized ordinal logistic regressions were performed to evaluate the associated factors. Results: 82.3% of daily smokers and 98.8% of occasional smokers reported mild physical dependence, while 47.9 and 37.9% respectively reported moderate psychological dependence. The age of initiation of tobacco use, drug use, high alcohol consumption and high emotional distress were associated with high levels of psychological dependence in all smokers. Conclusion: The exclusive use of FTND does not allow to adequately evaluate Mexican smokers. The physical and psychological dependence on tobacco should be assessed with independent and validated scales in this population.

Melatonin inhibits nicotinic acetylcholine receptor functions in bovine chromaffin cells

Melatonin is a neurotransmitter that modulates various physiological phenomena including regulation and maintenance of the circadian rhythm. Nicotinic acetylcholine receptors (nAChRs) play an important role in oral functions including orofacial muscle contraction, salivary secretion, and tooth development. However, knowledge regarding physiological crosstalk between melatonin and nAChRs is limited. In the present study, the melatonin-mediated modulation of nAChR functions using bovine adrenal chromaffin cells, a representative model for the study of nAChRs, was investigated. Melatonin inhibited the nicotinic agonist dimethylphenylpiperazinium (DMPP) iodide-induced cytosolic free Ca²⁺ concentration ([Ca²⁺](i)) increase and norepinephrine secretion in a concentration-dependent manner. The inhibitory effect of melatonin on the DMPP-induced [Ca²⁺](i) increase was observed when the melatonin treatment was performed simultaneously with DMPP. The results indicate that melatonin inhibits nAChR functions in both peripheral and central nervous systems.

Enfrentamiento del tabaquismo en el paciente hospitalizado / Smoking cessation in the hospitalized patient

Resumen La hospitalización es una oportunidad valiosa para el abandono del tabaquismo, desaprovechada en Chile. La necesidad de hospitalizarse está determinada por enfermedades muchas veces causadas por el consumo de tabaco, este escenario permite al paciente valorar no solo las consecuencias de esta adicción, si no también, la importancia de suspender el consumo. Es esperable que durante la hospitalización aparezca el síndrome de abstinencia de nicotina, cuyo reconocimiento y manejo es fundamental para evitar complicaciones habituales: ansiedad o delirium. Por todo lo anterior, resulta necesario el adecuado enfrentamiento del tabaquismo en el paciente hospitalizado, lo que es reconocido por organismos acreditadores internacionales como Joint Commission. Un metanálisis Cochrane 2012 concluyó que los dos pilares fundamentales de las intervenciones efectivas fueron el carácter multimodal (consejería y tratamiento farmacológico), y el seguimiento ambulatorio por más de un mes posterior al alta. Los elementos centrales de una consejería breve pueden resumirse en el ABC, siendo A: averiguar sobre el consumo de tabaco; B: dar un consejo breve indicando la importancia de dejar de fumar, y C: Ofrecer apoyo para la cesación a los pacientes que se muestren motivados. Si bien las intervenciones mencionadas involucran contar con recursos para apoyo farmacológico, no pareciera haber excusas para seguir sin implementar en los hospitales chilenos intervenciones sencillas como documentar el estado tabáquico de cada paciente y ofrecer consejería breve.

Hospitalization is a valuable opportunity for smoking cessation. In Chile this opportunity is wasted. The need to hospitalize is determined by diseases often caused by smoking, this scenario allows the patient to assess not only the consequences of this addiction, but also the importance of stopping tobacco consumption. During hospitalization, the nicotine withdrawal syndrome appears, whose recognition and management is essential to avoid habitual complications: anxiety or delirium. For all of the above mentioned reasons, it is necessary the adequate confrontation of smoking in the hospitalized patient, which is recognized by international accreditation bodies as Joint Commission. A Cochrane metaanalysis 2012 concluded that the two pillars of effective interventions were the multimodal character (counseling and pharmacological treatment), and ambulatory follow-up for more than one month after discharge. The central elements of a brief counseling can be summarized in ABC, where A: ask about smoking; B: give brief advice stating the importance of quitting, and C: provide support for cessation for motivated patients. Although the above-mentioned interventions involve resources for pharmacological support, there seems to be no excuse for implementing simple interventions in Chilean hospitals, such as documenting the smoking status of each patient and offering brief counseling.

A preliminary study on the autophagy level of human periodontal ligament cells regulated by nicotine / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To explore the effect of nicotine on the autophagy level of human periodontal ligament cells (hPDLCs).</p><p><b>METHODS</b>Periodontal tissues collected from premolars for orthodontic treatment reasons were used to culture hPDLCs. Western blot analysis was performed to test the most optimal time and concentration of nicotine on the autophagy level of the hPDLCs. Transmission electron microscope and immunofluorescence observation were carried out to detect the form of autophagosomes and expression of autophagy related protein LC3 in hPDLCs under this optimal condition.</p><p><b>RESULTS</b>Protein expression of LC3Ⅱ was up regulated with the 12 h nicotine stimulating. Besides that, the up regulation of the protein expression of LC3Ⅱ was concentration dependent and nicotine with a concentration of 1×10⁻⁵ mol·L⁻¹ was the most optimal condition. Transmission electron microscope and immunofluorescence observations indicated that nicotine would activate the autophagy level of hPDLCs by increasing the number of autophagosomes and up regulating the expression of autophagy related protein LC3.</p><p><b>CONCLUSIONS</b>Nicotine could increase autophagy level of hPDLCs, thus affecting the occurrence and development of smoking related periodontitis.</p>

Factores asociados con el éxito de la terapia antitabaco en pacientes tratados con vareniclina: 10 años de experiencia en un programa multidisciplinario / Factors associated with success of a smoking cessation program

Background: Smoking cessation therapies include counseling, psychological management and pharmacological therapy. Varenicline is the most effective and safe medication available. Aim: To study risk factors for the failure of pharmacological smoking cessation therapy with varenicline. Patients and Methods: Retrospective analysis of 281 patients aged 45 ± 11 years (65% males) with a mean consumption of 31 ± 22 packs/year. They completed a smoking cessation program comprising psychological support and use of varenicline in a private clinic. Patients were followed with telephonic interviews during one year. A complete abstinence during one year was considered as a success of the program. Results: The success rate of the program was 53.4%. The factors associated with failure were a high tobacco dependence rate determined with the Fageström test (Odds ratio (OR) 2.47, 95% confidence intervals (CI) 1.16-5.26, p = 0.02). An instruction level of more than 12 years was associated with a lower failure rate (OR 0.38 95% CI 0.18-0.82). Conclusions: A high tobacco dependence rate and a lower education were associated with a higher failure rate of this smoking cessation program.

Revisión sistemática de estudios de costo-efectividad y análisis de transferibilidad de intervenciones sanitarias para la cesación del hábito tabáquico / Systematic review of cost-effectiveness studies and transferability analysis of health interventions for cessation of smoking

Objetivo: El objetivo de este estudio fue conocer la eficiencia de las estrategias de consejería breve (CB), terapia de reemplazo de la nicotina (TRN) y el uso de medicamentos como el bupropión y la vareniclina. Para \r\nlo cual se plantearon las siguientes preguntas de investigación: Son la consejería breve, la terapia de reemplazo de nicotina en combinación con CB y/o las terapias farmacológicas con vareniclina o bupropión asociadas a CB, intervenciones costo-efectivas en la cesación del hábito tabáquico? Son transferibles los resultados de los estudios que evalúan la costo-efectividad de la consejería breve, terapia de reemplazo de nicotina y/o terapias farmacológicas con vareniclina o bupropión al contexto chileno? Metodología: Se realizó una búsqueda sistemática de la literatura en MEDLINE y CRD (Centre for Reviews and Dissemination) de estudios publicados entre los años 2004 y 2014, que evaluaran la costo-efectividad de la consejería breve, terapia de reemplazo de la nicotina y terapias farmacológicas con bupropión o vareniclina como estrategias para el cese del hábito tabáquico en población general. Conclusiones: Todas las intervenciones evaluadas fueron costo-efectivas al compararlas con CSA. Las terapias farmacológicas asociadas a CB demostraron ser más costo-efectivas que la CB por sí sola. Vareniclina +CB resultó ser una intervención dominante en relación a sus comparadores.Vareniclina domina todas las otras terapias, por lo que debiera ser considerada como la terapia de elección en fumadores en su primer intento para dejar de fumar. La inclusión de vareniclina asociada a consejería breve en el Sistema Nacional de Salud, reduciría la morbilidad y la mortalidad relacionada con el tabaquismo en Chile, resultando en importantes ahorros económicos en salud.

Analysis of effect isoxsuprine hydrochloride and nicotine in the Transverse Rectus Abdominis Myocutaneous flap (TRAM) in rats

PURPOSE: To evaluate the effects of isoxsuprine and nicotine on TRAM. METHODS: Forty eight 48 Wistar rats distributed into four Groups (n=12). All rats received medication managed daily for 20 days: saline solution (SA), nicotine solution (NI), isoxsuprine solution (IS) and nicotine solution (NI) + isoxsuprine solution (IS). On day 21st the rats were submitted to the caudally based, right unipedicled TRAM flap and after 48 hours, made the macroscopic evaluation of the surface of the flap, photographic documentation and collection of material for histology. Data from macroscopic evaluation were analyzed by ANOVA and microscopic evaluation by Kruskal-Wallis test, with significance level of 5%. RESULTS: In the macroscopic evaluation of isoxsuprine Group retail presented absolute numbers: final area (p=0.001*) and viable area (p=0.006*) with the highest values; necrosis (p=0.001*) had the lowest value. Microscopic examination revealed no significant findings in the study of TRAM under the action of isoxsuprine and nicotine to the percentage of necrosis in the left and right cranial and caudal regions. CONCLUSIONS: There was significant improvement in viability of TRAM using the isoxsuprine solution alone. No influence using nicotine alone and in association with isoxsuprine. .

Discovery of potential nicotinic acid receptor agonists from Chinese herbal medicines based on molecular simulation / 中国中药杂志

Nicotinic acid could increase high density lipoprotein and reduce serum total cholesterol, low density lipoprotein cholesterol and triglycerides in human bodies, thus is frequently applied in treating low high-density lipoprotein cholesterol and hypertriglyceridemia in clinic. However, according to the findings, nicotinic acid could also cause adverse effects, such as skin flush, beside its curative effects. In this study, bioisosterism, fragment-based search and Lipinski's Rule of Five were used to preliminarily screen out potential TCM ingredients that may have similar pharmacological effects with nicotinic acid from Traditional Chinese medicine database (TCMD). Afterwards, homology modeling and flexible docking were used to further screen out potential nicotinic acid receptor agonists. As a result, eleven candidate compounds were derived from eight commonly used traditional Chinese medicines. Specifically, all of the candidate compounds' interaction with nicotinic acid receptor was similar to nicotinic acid, and their docking scores were all higher than that of nicotinic acid, but their druggability remained to be further studied. Some of the eight source traditional Chinese medicines were used to lower lipid according to literature studies, implying that they may show effect through above means. In summary, this study provides basis and reference for extracting new nicotinic acid receptor agonists from traditional Chinese medicines and improving the medication status of hyperlipidemia.

Effectiveness of Varenicline with counseling programs on smoking cessation in a targeted clinical setting in China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of Varenicline for smoking cessation in a community-based smoking-cessation-clinic (SCC) in Chinese smokers.</p><p><b>METHODS</b>A prospective observational study was conducted in Beijing, China. 799 smokers (762 men and 37 women) were assessed on data gathered from structured questionnaires at baseline and follow up programs at 1, 3 and 6 months. Trained physician counselors provided free individual counseling and follow-up interviews with brief counseling for all the subjects. 272 subjects were additionally prescribed Varenicline according to their own choice and reported data were compared to those without Varenicline. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1, 3 and 6 month follow-up periods.</p><p><b>RESULTS</b>At 6-month and by intention-to-treat, the 7-day point prevalence on abstinence rate with Varenicline and counseling, was significantly higher than the group with counseling only (34.6% versus 23.1%; OR = 1.75, 95% CI: 1.27-2.42;P < 0.001). The 3-month continuous abstinence rate at 6 month was higher in the group with Varenicline(31.3% versus 18.2% ;OR = 2.04, 95% CI:1.46-2.86;P < 0.001). Varenicline also showed better outcomes at 1 and 3 month follow-up.</p><p><b>CONCLUSION</b>Varenicline prescription in the smoking cessation clinic appeared to be effective that doubled the rates of quitting among Chinese smokers in the practice at a community-based SCC.</p>

Análisis crítico de un artículo: terapia de reemplazo de la nicotina, efectividad en un escenario real / Critically appraised article: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation

Objective: To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions. Methods: A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed by 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined. Results: Almost one-third of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for > 6 weeks either with (p = 0.117) or without (p = 0.159) professional counseling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68). Conclusions: This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies.

Resultados de un programa multidisciplinario para el control del hábito tabáquico / Results of a multidisciplinary program to quit smoking

Background: Therapies to quit smoking are based on counseling, psychological therapy (PT), nicotine replacement therapy, bupropion or varenidine. Aim: To report the results of a multidisciplinary program to quit smoking Material and Methods: Patients agedl8years or more, motivated to quit smoking were admitted in a program based in counseling and PT, with or without pharmacological therapy. They were assessed by telephone during one year offollow up. Patients with unstable psychiatric diseases were excluded. Results were considered as "successful" when patients maintained abstinence during the year offollow up. A logistic regression analysis was done to identify factors associated with treatment success. Results: Between 2005 and 2011, 198 patients aged 45 ± 11 years (56% males), who smoked 31.5 ± 20.6 packages/year, were treated. Ofthese, 155 (78%) were treated with varenidine, 26 (13%) with bupropion and 17 (9%>) did not receive pharmacological therapy. One hundred sixty eightpatients completed the year offollow up. In 82 (49%>), treatment was successful and was negatively associated with a history of depression (odds ratio = 4 (95% confidence intervals 1.23-38.33). The main side effeets associated to varenidine and bupropion were nausea in 37 and 23%o, sleep disorders in 20 and 19%o and headache in 12 and 0%>, respectively Conclusions: A multidisciplinary program to quit smoking achieved a 49%> of abstinence during a year offollow up.

Effects of simultaneous exposure to stress and nicotine on nicotine-induced locomotor activation in adolescent and adult rats

Preclinical studies have shown that repeated stress experiences can result in an increase in the locomotor response to the subsequent administration of drugs of abuse, a phenomenon that has been termed behavioral cross-sensitization. Behavioral sensitization reflects neuroadaptive processes associated with drug addiction and drug-induced psychosis. Although cross-sensitization between stress- and drug-induced locomotor activity has been clearly demonstrated in adult rats, few studies have evaluated this phenomenon in adolescent rats. In the present study, we determined if the simultaneous exposure to stress and nicotine was capable of inducing behavioral sensitization to nicotine in adolescent and adult rats. To this end, adolescent (postnatal day (P) 28-37) and adult (P60-67) rats received nicotine (0.4 mg/kg, sc) or saline (0.9 percent NaCl, sc) and were immediately subjected to restraint stress for 2 h once a day for 7 days. The control group for stress was undisturbed following nicotine or saline injections. Three days after the last exposure to stress and nicotine, rats were challenged with a single dose of nicotine (0.4 mg/kg, sc) or saline and nicotine-induced locomotion was then recorded for 30 min. In adolescent rats, nicotine caused behavioral sensitization only in animals that were simultaneously exposed to stress, while in adult rats nicotine promoted sensitization independently of stress exposure. These findings demonstrate that adolescent rats are more vulnerable to the effects of stress on behavioral sensitization to nicotine than adult rats.

Combined postconditioning with ischemia and α7nAChR agonist produces an enhanced protection against rat myocardial ischemia reperfusion injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Inflammation is one of important mechanisms for myocardial ischemia reperfusion injury (IRI). Ischemia postconditioning (IPOC) can protect the heart against IRI by inhibiting inflammation, but its cardioprotection is weaker than that of ischemia preconditioning. Recently, the α7 subunit-containing nicotinic acetylcholine receptor (α7nAChR) agonist has shown anti-inflammatory effects in many diseases related to inflammation. This randomized controlled experiment was designed to evaluate whether combined postconditioning with IPOC and the α7nAChR agonist could produce an enhanced cardioprotection in a rat in vivo model of acute myocardial IRI.</p><p><b>METHODS</b>Fifty Sprague-Dawley rats were randomly divided into five equal groups: sham group, control group, IPOC group, α7nAChR agonist postconditioning group (APOC group) and combined postconditioning with IPOC and α7nAChR agonist group (combined group). Hemodynamic parameters were recorded during the periods of ischemia and reperfusion. Serum concentrations of troponin I (TnI), tumor necrosis factor α (TNF-α) and high-mobility group box 1 (HMGB-1) at 180 minutes after reperfusion were assayed in all groups. At the end of the experiment, the infarct size was assessed from excised hearts by Evans blue and triphenyl tetrazolium chloride staining.</p><p><b>RESULTS</b>As compared to the sham group, the infarct size in the other four groups was significantly increased, serum levels of TnI, TNF-α and HMGB1 in the control group and TNF-α, HMGB1 in the IPOC group were significantly increased. The infarct size and serum concentrations of TNF-α, HMGB1 and TnI in the IPOC, APOC and combined groups were significantly lower than those in the control group. As compared to the IPOC group, the infarct size in the combined group was significantly decreased, serum concentrations of TnI, TNF-α and HMGB1 in the APOC and combined groups were significantly reduced. Although the infarct size was significantly smaller in the combined group than in the APOC group, serum levels of TNF-α and HMGB1 were significantly higher in the combined group than in the APOC group.</p><p><b>CONCLUSIONS</b>In a rat in vivo model of acute myocardial IRI, combined postconditioning with IPOC and the α7nAChR agonist can produce enhanced protection against myocardial IRI by increasing the anti-inflammatory effect.</p>

Efectos cardiovasculares de la vareniclina: revisión sistemática y metaanálisis / Cardiovascular effects of varenicline: a systematic review and metaanalysis

La vareniclina es un medicamento efectivo para dejar de fumar, pero recientemente se ha planteado que su empleo se asociaría a un aumento de eventos cardiovasculares graves. Con la finalidad de verificar este aspecto se realizó una revisión sistemática y metaanálisis del impacto de la vareniclina sobre la muerte de causa cardiovascular, el infarto agudo de miocardio y el accidente cerebrovascular. Se realizó una búsqueda en Medline y en otras dos bases de datos, incluyéndose en el análisis a todos los ensayos clínicos randomizados que compararon vareniclina con placebo, los que fueron realizados en pacientes con enfermedad cardiovascular estable y en pacientes sin enfermedad cardiovascular. Hubo 0,3% (18/5.200) eventos cardiovasculares graves con vareniclina y 0,2% (8/3.656) con placebo, no siendo esta diferencia estadísticamente significativa: odds ratio 1,91 IC 95% 0,84-0,94. En conclusión, la vareniclina es un fármaco efectivo para la cesación de tabaquismo y su administración podría estar asociada con un leve aumento en el riesgo de eventos cardiovasculares graves, pero aún ante esta eventualidad mantendría un adecuado perfil de riesgo-beneficio

Qué deben saber los cardiólogos del tratamiento farmacológico para dejar de fumar? / What cardiologists should be aware of pharmacotherapy for smoking cessation?

El consumo de tabaco constituye el principal factor de riesgo reversible en la enfermedad cardiovascular isquémica y dejar de fumar rápidamente disminuye el riesgo de eventos cardiovasculares y de muerte por esta causa. Las intervenciones conductuales han demostrado ser efectivas para dejar de fumar, y si a ello se suman fármacos, al menos se duplican las tasas de abstinencia medidas al año. Los fármacos con efectividad demostrada son la terapia de reemplazo nicotínico en todas sus formas farmacéuticas, el bupropión y la vareniclina. Estos fármacos han sido estudiados en pacientes con enfermedad cardiovascular estable y tienen similar efectividad que en la población general y un adecuado margen de seguridad, por lo que se recomienda su prescripción junto a la terapia conductual. No hay evidencia de mayor efectividad al asociar diferentes fármacos ni tampoco de diferentes perfiles de seguridad. La relación riesgo-beneficio de los posibles riesgos psiquiátricos y cardiovasculares reportados y los beneficios de abandonar el consumo benefician ampliamente el uso de estos fármacos en las indicaciones recomendadas.