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Elsherif I, Jammah AA, Ibrahim AR, Alawadi F, Sadek IS, Rahman AM, Sharify GE, AlFeky A, Aldossari K, Roushdy E, ELBarbary NS, BenRajab F, Elghweiry A, Farah SIS, Hajjaji I, AlShammary A, Abdulkareem F, AbdelRahim A, Orabi A. Clinical practice recommendations for management of Diabetes Mellitus in Arab region: An expert consensus statement from Arab Diabetes Forum (ADF). Prim Care Diabetes 2024; 18:471-478. [PMID: 38955658 DOI: 10.1016/j.pcd.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/14/2024] [Accepted: 06/02/2024] [Indexed: 07/04/2024]
Abstract
Prevalence of diabetes in Arab region has significantly increased, resulting in a significant economic burden on healthcare systems. This surge can be attributed to obesity, rapid urbanization, changing dietary habits, and sedentary lifestyles. The Arab Diabetes Forum (ADF) has established localized recommendations to tackle the region's rising diabetes prevalence. The recommendations, which incorporate worldwide best practices, seek to enhance the quality of treatment for people with diabetes by raising knowledge and adherence among healthcare providers. The guidelines include comprehensive recommendations for screening, diagnosing, and treating type 1 and type 2 diabetes in children and adults for better overall health results.
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Affiliation(s)
| | - Anwar Ali Jammah
- Endocrinology and Diabetes Division, Medicine Department, King Saud University, Saudi Arabia
| | | | - Fatheya Alawadi
- Dubai Medical College - President of EDS emirates diabetes society, the United Arab Emirates
| | | | | | | | | | - Khaled Aldossari
- Department of family and community medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Eman Roushdy
- Internal medicine and Diabetes, Cairo University, Egypt
| | - Nancy Samir ELBarbary
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt
| | | | - Awad Elghweiry
- National Center for Diagnosis and Treatment of Diabetes, Benghazi, Libya
| | | | - Issam Hajjaji
- Endocrine & Diabetes Hospital, University of Tripoli, Libya
| | - Afaf AlShammary
- Department of Internal Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Saudi Arabia
| | - Faris Abdulkareem
- Internal medicine, diabetes and endocrinology, Alkindy College of Medicine, Iraq
| | - Aly AbdelRahim
- Internal medicine and Diabetes Department, Alex University, Egypt
| | - Abbass Orabi
- Internal medicine and Diabetes, Zagazig University, Egypt.
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Jung L, Buchwald IC, Hauck A, Lüthgen M, Jagomast T, Weckmann M, Drömann D, Franzen KF. The Impact of Heat-Not-Burn, E-Cigarettes, and Cigarettes on Small Airway Function. Tob Use Insights 2024; 17:1179173X241271551. [PMID: 39314801 PMCID: PMC11418371 DOI: 10.1177/1179173x241271551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/26/2024] [Indexed: 09/25/2024] Open
Abstract
Introduction E-cigarettes and heated tobacco products (HTPs) are gaining worldwide significance. The tobacco industry is promoting these products as healthier alternatives to conventional cigarettes. Methods In this four-arm crossover study, we examined the acute effects of cigarette smoking, vaping IQOS, or vaping e-cigarettes (with or without nicotine) on hemodynamics, arterial stiffness, and small airways. Twenty subjects (10 male, 10 female), all occasional smokers, completed each study arm. There was at least a 48 h washout period before each test day. Arterial stiffness and peripheral and central hemodynamics were assessed using Mobil-O-Graph™ (I.E.M., Germany), whereas tremoFlo® c-100 (Thoracic Medical Systems Inc) was used to evaluate the effects on the small airways and resistance. Results Cigarettes, IQOS, e-cigarettes containing nicotine, and nicotine-free e-cigarettes had similar effects on peripheral and central hemodynamics as well as on arterial stiffness. We observed a significant increase in all parameters. However, only nicotine-containing products lead to increased bronchial obstruction, higher reactance, and a higher tidal volume. Conclusion Therefore, we concluded that cigarettes, IQOS, and e-cigarettes have similar effects on hemodynamics. No differences were observed between the nicotine-containing and nicotine-free e-cigarettes. All nicotine-containing products also influence small airways. These findings suggest that e-cigarettes and HTPs are not healthier alternatives than conventional cigarettes.
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Affiliation(s)
- L. Jung
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
| | - I. C. Buchwald
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A. Hauck
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - M. Lüthgen
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
| | - T. Jagomast
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
| | - M. Weckmann
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
- Pediatrics, site Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Research Center Borstel, Leibniz Lung Center, Borstel, Schleswig-Holstein
| | - D. Drömann
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
| | - K. F. Franzen
- Medical Clinic III, Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- Airway Research Center North (ARNCN), German Center for Lung Research (DZL), Großhansdorf - site Lübeck, Germany
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Allen MR, Wightman GP, Zhu Z, Poliak A, Smith DM, Dredze M, Ayers JW. Pharmacovigilance in the Age of Legalized Cannabis: Using Social Media to Monitor Drug-Drug Interactions Between Immunosuppressants and Cannabis-Derived Products. Drug Saf 2024:10.1007/s40264-024-01481-x. [PMID: 39292423 DOI: 10.1007/s40264-024-01481-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION A clinical trial of Epidiolex®, the only US FDA-approved cannabis-derived consumer product (CDP), discovered an interaction with an immunosuppressant (tacrolimus) that led to drug toxicity, highlighting the unique intersection of prescription and commonly unregulated consumer products. OBJECTIVE We aimed to identify if similar drug-drug interactions (DDIs) are occurring among the consumer CDP market, even though they cannot be identified through trials. METHODS We searched Reddit for subreddits related to CDPs or health, resulting in 63,561,233 posts. From these, we identified 190 posts discussing both immunosuppressants and CDPs. Two blinded investigators evaluated the following. (1) Was there a concern about a potential DDI between consumer CDPs and immunosuppressants? (2) Was there a unique adverse event attributed to a DDI between consumer CDPs and immunosuppressants? RESULTS Of these, 66 posts (35%) expressed concern about a potential DDI, such as "Hey, my partner wants to try my edibles … she's on Prograf [tacrolimus] and wants to talk to a stoner who's had a heart transplant." Four posts (2%) reported a unique DDI, such as "I have clinical results that are semi-anecdotal, showing the coordination to my halting substance use … It's the CBD. Shot my prograf to 30 at like 4 mg." Two of the four reported DDIs are similar to those first reported for Epidiolex. The remaining two reported DDIs include a potential cannabidiol (CBD)/sirolimus or delta-9-tetrahydrocannabinol (THC)/sirolimus interaction and a THC/tacrolimus interaction, both resulting in drug toxicity. CONCLUSION This case study is the first to report on DDIs involving consumer CDPs, including both CBD and THC products, as well as a broader class of immunosuppressants. This demonstrates the risks associated with using consumer CDPs alongside prescription medications while highlighting the need for development of increased surveillance to monitor consumer CDPs for drug safety signals, as well as comprehensive regulations that take into account the unique characteristics of the consumer marketplace.
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Affiliation(s)
- Matthew R Allen
- School of Medicine, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Altman Clinical and Translational Research Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | | | - Zechariah Zhu
- Altman Clinical and Translational Research Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Qualcomm Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Davey M Smith
- Altman Clinical and Translational Research Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - John W Ayers
- Altman Clinical and Translational Research Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Qualcomm Institute, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, #333 CRSF 9500 Gilman Drive, La Jolla, CA, 92093, USA.
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Benam KH. Multidisciplinary approaches in electronic nicotine delivery systems pulmonary toxicology: emergence of living and non-living bioinspired engineered systems. COMMUNICATIONS ENGINEERING 2024; 3:123. [PMID: 39227652 PMCID: PMC11372223 DOI: 10.1038/s44172-024-00276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024]
Abstract
Technology-based platforms offer crucial support for regulatory agencies in overseeing tobacco products to enhance public health protection. The use of electronic nicotine delivery systems (ENDS), such as electronic cigarettes, has surged exponentially over the past decade. However, the understanding of the impact of ENDS on lung health remains incomplete due to scarcity of physiologically relevant technologies for evaluating their toxicity. This review examines the societal and public health impacts of ENDS, prevalent preclinical approaches in pulmonary space, and the application of emerging Organ-on-Chip technologies and bioinspired robotics for assessing ENDS respiratory toxicity. It highlights challenges in ENDS inhalation toxicology and the value of multidisciplinary bioengineering approaches for generating reliable, human-relevant regulatory data at an accelerated pace.
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Affiliation(s)
- Kambez H Benam
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Schiffman JS. Vaping-associated illness: a reassessment. Int J Emerg Med 2024; 17:107. [PMID: 39223452 PMCID: PMC11367922 DOI: 10.1186/s12245-024-00692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND In 2019, there was widespread presentation of respiratory distress as well as other organ system involvement in patients with a history of vaping. There continue to be reports of vaping-associated illness (VAI). This has come to be known as e-cigarette and vaping product associated lung injury (EVALI). The mechanism of injury remains unclear. OBJECTIVES This study reexamines the clinical characteristics of patients affected by vaping and suggests that lung injury may not be the primary organ dysfunction but be part of a larger systemic illness. METHODS This is a retrospective chart review of all patients presenting to one hospital identified as having vaping-associated illness RESULTS: Fourteen patients were identified ranging in age from 15 to 33 years. Patients had a broad range of clinical severity. Respiratory symptoms occurred in 64%, gastrointestinal symptoms in 57%, fever in 78%, neurological symptoms in 15% and other constitutional symptoms in 50%. 35% presented with no respiratory symptoms. CONCLUSION While the lungs are certainly involved in vaping-associated illness, recognizing the extent of involvement of other organ systems may provide insight into the pathophysiology of the disease. Providers should be aware that vaping-associated illness presents with a multitude of symptoms outside of lung injury, such as abdominal pain, headache or even fever.
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Affiliation(s)
- Jonathan S Schiffman
- Department of Emergency Medicine, Valley Hospital, 4 Valley Health Plaza, Paramus, NJ, 07652, USA.
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Harrell PT, England KJ, Barnett TE, Simmons VN, Handel RW, Paulson AC. Adolescent E-Cigarette Expectancies: Measure Development and Preliminary Validity of the Electronic Nicotine Vaping Outcomes Measure for Youth. Tob Use Insights 2024; 17:1179173X241266563. [PMID: 39193494 PMCID: PMC11348368 DOI: 10.1177/1179173x241266563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/14/2024] [Indexed: 08/29/2024] Open
Abstract
Background Electronic nicotine delivery systems ("e-cigarettes") are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure. Methods A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17 years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% Hispanic) in a large Southeastern metropolitan area in the United States. Results Exploratory Factor Analysis revealed a four factor solution: Negative Consequences (Cronbach's α = .92); Positive Reinforcement (α = .83); Negative Affect Reduction (α = .95); and Weight Control (α = .89). Subscales were significantly correlated with vaping susceptibility and lifetime vaping. Subscales successfully differentiated susceptible adolescents from confirmed non-susceptible adolescents, with susceptible adolescents reporting more positive expectancies, eg, Positive Reinforcement, M = 5.0, SD = 2.0 vs M = 3.0, SD = 2.1, P < .001, η2 = 0.19, and less negative expectancies, M = 5.5, SD = 2.3 vs M = 6.5, SD = 2.6, P = .001, η2 = 0.04. Similar results were found comparing adolescents who have never vaped nicotine with those who have vaped nicotine. Hierarchical linear regression demonstrated subscales were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. Conclusions A preliminary version of an adolescent expectancy measure appears reliable and valid based on expert input and pilot testing with adolescents. Promising results were found in the domains of concurrent validity, discriminant validity, and incremental validity. Future research and evaluation efforts will be able to use this tool to further prevention and treatment goals.
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Affiliation(s)
- Paul T. Harrell
- Department of Pediatrics, Division of Community Health and Research, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA
- Department of Psychiatry and Behavioral Sciences, EVMS, Norfolk, VA, USA
| | - Kelli J. England
- Department of Pediatrics, Division of Community Health and Research, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA
- Department of Psychiatry and Behavioral Sciences, EVMS, Norfolk, VA, USA
| | - Tracey E. Barnett
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Vani N. Simmons
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Richard W. Handel
- Department of Psychiatry and Behavioral Sciences, EVMS, Norfolk, VA, USA
| | - Amy C. Paulson
- Department of Pediatrics, Division of Community Health and Research, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA
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Wang P, Jacob P, Wang ZM, Fowles J, O'Shea DF, Wagner J, Kumagai K. Conditions Leading to Ketene Formation in Vaping Devices and Implications for Public Health. Chem Res Toxicol 2024; 37:1415-1427. [PMID: 39078936 PMCID: PMC11423956 DOI: 10.1021/acs.chemrestox.4c00190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
The outbreak of e-cigarette or vaping use-associated lung injury (EVALI) in the United States in 2019 led to a total of 2807 hospitalizations with 68 deaths. While the exact causes of this vaping-related lung illness are still being debated, laboratory analyses of products from victims of EVALI have shown that vitamin E acetate (VEA), an additive in some tetrahydrocannabinol (THC)-containing products, is strongly linked to the EVALI outbreak. Because of its similar appearance and viscosity to pure THC oil, VEA was used as a diluent agent in cannabis oils in illicit markets. A potential mechanism for EVALI may involve VEA's thermal decomposition product, ketene, a highly poisonous gas, being generated under vaping conditions. In this study, a novel approach was developed to evaluate ketene production from VEA vaping under measurable temperature conditions in real-world devices. Ketene in generated aerosols was captured by two different chemical agents and analyzed by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography with tandem mass spectrometry (LC-MS/MS). The LC-MS/MS method takes advantage of the high sensitivity and specificity of tandem mass spectrometry and appears to be more suitable than GC-MS for the analysis of large batches of samples. Our results confirmed the formation of ketene when VEA was vaped. The production of ketene increased with repeat puffs and showed a correlation to temperatures (200 to 500 °C) measured within vaping devices. Device battery power strength, which affects the heating temperature, plays an important role in ketene formation. In addition to ketene, the organic oxidant duroquinone was also obtained as another thermal degradation product of VEA. Ketene was not detected when vitamin E was vaped under the same conditions, confirming the importance of the acetate group for its generation.
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Affiliation(s)
- Ping Wang
- Environmental Health Laboratory, Center for Laboratory Science, California Department of Public Health, Richmond, California 94804, United States
| | - Peyton Jacob
- Department of Medicine, University of California San Francisco, San Francisco, California 94143, United States
| | - Zhong-Min Wang
- Environmental Health Laboratory, Center for Laboratory Science, California Department of Public Health, Richmond, California 94804, United States
| | - Jefferson Fowles
- Environmental Investigation Branch, California Department of Public Health, Richmond, California 94804, United States
| | - Donal F O'Shea
- Department of Chemistry, Royal College of Surgeons in Ireland, Dublin D02 YN77, Ireland
| | - Jeff Wagner
- Environmental Health Laboratory, Center for Laboratory Science, California Department of Public Health, Richmond, California 94804, United States
| | - Kazukiyo Kumagai
- Environmental Health Laboratory, Center for Laboratory Science, California Department of Public Health, Richmond, California 94804, United States
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Heywood J, Abele G, Langenbach B, Litvin S, Smallets S, Paustenbach D. Composition of e-cigarette aerosols: A review and risk assessment of selected compounds. J Appl Toxicol 2024. [PMID: 39147402 DOI: 10.1002/jat.4683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/17/2024]
Abstract
The potential harms and benefits of e-cigarettes, or electronic nicotine delivery systems (ENDS), have received significant attention from public health and regulatory communities. Such products may provide a reduced risk means of nicotine delivery for combustible cigarette smokers while being inappropriately appealing to nicotine naive youth. Numerous authors have examined the chemical complexity of aerosols from various open- and closed-system ENDS. This body of literature is reviewed here, with the risks of ENDS aerosol exposure among users evaluated with a margin of exposure (MoE) approach for two non-carcinogens (methylglyoxal, butyraldehyde) and a cancer risk analysis for the carcinogen N-nitrosonornicotine (NNN). We identified 96 relevant papers, including 17, 13, and 5 reporting data for methylglyoxal, butyraldehyde, and NNN, respectively. Using low-end (minimum aerosol concentration, low ENDS use) and high-end (maximum aerosol concentration, high ENDS use) assumptions, estimated doses for methylglyoxal (1.78 × 10-3-135 μg/kg-bw/day) and butyraldehyde (1.9 × 10-4-66.54 μg/kg-bw/day) corresponded to MoEs of 227-17,200,000 and 271-280,000,000, respectively, using identified points of departure (PoDs). Doses of 9.90 × 10-6-1.99 × 10-4 μg/kg-bw/day NNN corresponded to 1.4-28 surplus cancers per 100,000 ENDS users, relative to a NNN-attributable surplus of 7440 per 100,000 cigarette smokers. It was concluded that methylglyoxal and butyraldehyde in ENDS aerosols, while not innocuous, did not present a significant risk of irritant effects among ENDS users. The carcinogenic risks of NNN in ENDS aerosols were reduced, but not eliminated, relative to concentrations reported in combustible cigarette smoke.
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Affiliation(s)
- Jonathan Heywood
- Paustenbach and Associates, Denver, Colorado, USA
- Insight Exposure & Risk Sciences Group, Boulder, Colorado, USA
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Yagi B, Veuger S, Miller BJ, Larkin P. Lessons for cannabinoid regulation from electronic nicotine delivery system product regulation. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae101. [PMID: 39206436 PMCID: PMC11350284 DOI: 10.1093/haschl/qxae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/21/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
Cannabis legalization continues to spread, with 38 states permitting the use of medical marijuana, 22 states permitting recreational use, and growing political momentum for federal legalization. The last time the Food and Drug Administration (FDA) was tasked with regulating a new product occurred with 2009's Family Smoking Prevention and Tobacco Control Act, which created the Center for Tobacco Products (CTP). Thus, the time is ripe to review the history of CTP with particular attention to difficulties the nascent center faced in regulating novel products such as e-cigarettes or electronic nicotine delivery systems (ENDS). Specifically, FDA has struggled with defining its scope of authority, determining which review pathway(s) to utilize, and promulgating timely and transparent product standards for marketing authorization-all of which offer lessons for improving cannabis product oversight and enforcement.
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Affiliation(s)
- Brian Yagi
- Division of Hospital Medicine, Department of Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, United States
| | - Stan Veuger
- Division of Hospital Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Brian J Miller
- Division of Hospital Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
- American Enterprise Institute, Washington, DC 20036, United States
| | - Paul Larkin
- The Heritage Foundation, Washington, DC 20002, United States
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Williams BS, Kaye JT. Addressing Substance Use in the Adolescent Transplant Population. Pediatr Transplant 2024; 28:e14815. [PMID: 38924242 DOI: 10.1111/petr.14815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024]
Abstract
Adolescence is a unique period of physical and psychosocial changes as youth transition, over many years, to adulthood. The psychosocial changes that accompany adolescence include emotional separation from parents, greater influence of peer groups, an interest in self-identification and autonomy, and increased risk-taking behaviors. Substance use is a common form of risk-taking behavior in the adolescent developmental stage. Alcohol, nicotine, and cannabis are the most common types of substances used in the United States. In the adolescent transplant population, rates of substance use appear to be at, or slightly below, their peer counterparts. Substance use can lead to deleterious health outcomes for adolescent transplant patients as a result of impaired decision-making, reduction in medication and clinic visit compliance, increases in mental health disorders, and risk for developing dependence and a substance use disorder. Given the close relationship that many pediatric transplant providers have with their patients and families, transplant care teams are in an excellent position to help their patients by addressing adolescent substance use. This narrative review describes how providers can use proactive standardized approaches to identify and intervene with substance use behavior.
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Affiliation(s)
- Brian S Williams
- Division of Hospital Medicine and Complex Care, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jesse T Kaye
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Holt LJ, Ginley MK, Pingeon C, Feinn R. Primed for positive perceptions? Applying the acquired preparedness model to explain college students' e-cigarette use and dependence. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1734-1744. [PMID: 35816741 DOI: 10.1080/07448481.2022.2089846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 05/06/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence. PARTICIPANTS Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020. METHODS We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators. RESULTS Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use. CONCLUSIONS ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings.
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Affiliation(s)
| | | | | | - Richard Feinn
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
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12
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DiPasquale M, Marquardt D. Perceiving the functions of vitamin E through neutron and X-ray scattering. Adv Colloid Interface Sci 2024; 330:103189. [PMID: 38824717 DOI: 10.1016/j.cis.2024.103189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 06/04/2024]
Abstract
Take your vitamins, or don't? Vitamin E is one of the few lipophilic vitamins in the human diet and is considered an essential nutrient. Over the years it has proven to be a powerful antioxidant and is commercially used as such, but this association is far from linear in physiology. It is increasingly more likely that vitamin E has multiple legitimate biological roles. Here, we review past and current work using neutron and X-ray scattering to elucidate the influence of vitamin E on key features of model membranes that can translate to the biological function(s) of vitamin E. Although progress is being made, the hundred year-old mystery remains unsolved.
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Affiliation(s)
| | - Drew Marquardt
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, Ontario, Canada; Department of Physics, University of Windsor, Windsor, Ontario, Canada.
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13
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Wang P, Williams RJ, Chen W, Wang F, Shamout M, Tanz LJ, Herzig CT, Oakley LP, Peak CM, Heinzerling A, Al-Shawaf M, Melstrom P, Marynak K, Tynan MA, Agaku IT, Kumagai K. Chemical Composition of Electronic Vaping Products From School Grounds in California. Nicotine Tob Res 2024; 26:991-998. [PMID: 38407960 PMCID: PMC11262994 DOI: 10.1093/ntr/ntae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 12/27/2023] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The use of electronic vaping products (EVPs) containing nicotine, marijuana, and/or other substances remains prominent among youth; with EVPs containing nicotine being the most commonly used tobacco product among youth since 2014. However, a detailed understanding of the chemical composition of these products is limited. AIMS AND METHODS From February 25th to March 15th, 2019, a total of 576 EVPs, including 233 e-cigarette devices (with 43 disposable vape pens) and 343 e-liquid cartridges/pods/bottled e-liquids, were found or confiscated from a convenience sample of 16 public high schools in California. Liquids inside 251 vape pens and cartridges/pods/bottled e-liquids were analyzed using a gas chromatography/mass spectrometry (GC/MS). For comparison, new JUUL pods, the most commonly used e-cigarette among youth during 2018-2019, with different flavorings and nicotine content were purchased and analyzed. RESULTS For e-cigarette cartridges/pods/bottled e-liquids, nicotine was detected in 204 of 208 (98.1%) samples. Propylene glycol and vegetable glycerin were dominant solvents in nicotine-containing EVPs. Among 43 disposable vape pen devices, cannabinoids such as tetrahydrocannabinol (THC) or cannabidiol (CBD) were identified in 39 of 43 (90.1%) samples, of which three contained both nicotine and THC. Differences in chemical compositions were observed between confiscated or collected JUULs and purchased JUULs. Measured nicotine was inconsistent with labels on some confiscated or collected bottled e-liquids. CONCLUSIONS EVPs from 16 participating schools were found to widely contain substances with known adverse health effects among youth, including nicotine and cannabinoids. There was inconsistency between labeled and measured nicotine on the products from schools. IMPLICATIONS This study measured the main chemical compositions of EVPs found at 16 California public high schools. Continued efforts are warranted, including at the school-level, to educate, prevent, and reduce youth use of EVPs.
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Affiliation(s)
- Ping Wang
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Rebecca J. Williams
- California Tobacco Prevention Program, California Department of Public Health, Sacramento, CA, USA
| | - Wenhao Chen
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Flavia Wang
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
| | - Mays Shamout
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren J. Tanz
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carolyn T.A. Herzig
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa P. Oakley
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Corey M. Peak
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy Heinzerling
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Occupational Health Branch, California Department of Public Health, Richmond, CA, USA
| | - Maeh Al-Shawaf
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Melstrom
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristy Marynak
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael A. Tynan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Israel T. Agaku
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kazukiyo Kumagai
- Air Quality Section, Environmental Health Laboratory, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA, USA
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14
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Gaik C, Arndt C, Mand N, Bauck M, Schwerk N, Westhoff C, Bittmann I, Wulf H. Plasmapheresis as therapeutic option in a 16-year-old with EVALI: A case report. Eur J Anaesthesiol 2024; 41:530-534. [PMID: 38586903 DOI: 10.1097/eja.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Since 2019 when a cluster of cases with acute respiratory distress syndrome (ARDS) associated with e-cigarettes in the United States was reported, there have been increasing numbers of reports. Electronic-cigarette or Vaping Use-associated Lung Injury (EVALI) represents a recent entity of respiratory clinical syndromes, primarily in young adults. We report a previously healthy 16-year-old boy who developed severe ARDS following a brief nonspecific prodromal phase after excessive consumption of e-cigarettes. Despite maximum intensive care therapy, including several weeks of venovenous extracorporeal membrane oxygenation, plasmapheresis and repeated administration of immunoglobulins seemed the only way to achieve therapeutic success. Although many case reports have been published, to our knowledge, there are none to date on the therapeutic use of plasmaphoresis in severe EVALI. This case highlights the clinical features of EVALI and the diagnostic dilemma that can arise with EVALI occurring against the background of an expired SARS-CoV-2 infection, with a paediatric inflammatory syndrome (PIMS) as differential diagnosis. EVALI is a diagnosis of exclusion, and the medical history of vaping and e-cigarette use can provide valuable clues. Ethical approval for this case report (protocol number 23-145 RS) was provided by the Ethical Committee of the Department of Medicine, Philipps-Universität Marburg, Germany on 13 th of June 2023. Written informed consent to publish this case and the associated images was obtained from the patient and his mother.
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Affiliation(s)
- Christine Gaik
- From the Department of Anesthesiology and Intensive Care Medicine, University Hospital Giessen and Marburg, Campus Marburg, Philipps-University Marburg, Germany (CG, CA, HW), Neonatology and Pediatric Intensive Care Medicine, Department of Pediatrics, Philipps-University, Marburg, Germany (NM), Paediatric Pulmonology, Department of Pediatrics, Philipps-University, Marburg, Germany (MB), Clinic for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Centre for Lung Research, Hannover, Germany (NS), Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UKGM), Universitaetsklinikum Marburg, Marburg, Germany (CW), Institute of Pathology, Agaplesion Diakonieklinikum Rotenburg Wümme gGmbH, Germany (IB)
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15
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Yatera K, Nishida C. Contemporary Concise Review 2023: Environmental and occupational lung diseases. Respirology 2024; 29:574-587. [PMID: 38826078 DOI: 10.1111/resp.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Air pollutants have various effects on human health in environmental and occupational settings. Air pollutants can be a risk factor for incidence, exacerbation/aggravation and death due to various lung diseases, including asthma, chronic obstructive pulmonary disease (COPD), hypersensitivity pneumonitis or pneumonia (HP), pulmonary fibrosis such as pneumoconiosis and malignant respiratory diseases such as lung cancer and malignant pleural mesothelioma. Environmental and occupational respiratory diseases are crucial clinical and social issues worldwide, although the burden of respiratory disease due to environmental and occupational causes varies depending on country/region, demographic variables, geographical location, industrial structure and socioeconomic situation. The correct recognition of environmental and occupational lung diseases and taking appropriate measures are essential to their effective prevention.
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Affiliation(s)
- Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Chinatsu Nishida
- Department of Environmental Health Engineering, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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16
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Munger K, Anreise KM, Jensen RP, Peyton DH, Strongin RM. Mechanistic Rationale for Ketene Formation during Dabbing and Vaping. JACS AU 2024; 4:2403-2410. [PMID: 38938801 PMCID: PMC11200222 DOI: 10.1021/jacsau.4c00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
Ketene is one of the most toxic vaping emissions identified to date. However, its high reactivity renders it relatively challenging to identify. In addition, certain theoretical studies have shown that realistic vaping temperature settings may betoo low to produce ketene. Each of these issues is addressed herein. First, an isotopically labeled acetate precursor is used for the identification of ketene with enhanced rigor in vaped aerosols. Second, discrepancies between theoretical and experimental findings are explained by accounting for the effects of aerobic (experimental) versus anaerobic (simulated and theoretical) pyrolysis conditions. This finding is also relevant to explaining the relatively low-temperature production of aerosol toxicants beyond ketene. Moreover, the study presented herein shows that ketene formation during vaping is not limited to molecules possessing a phenyl acetate substructure. This means that ketene emission during vaping, including from popular flavorants such as ethyl acetate, may be more prevalent than is currently known.
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Affiliation(s)
- Kaelas
R. Munger
- Department
of Chemistry, Portland State University, Portland, Oregon 97217, United States
| | - Killian M. Anreise
- Department
of Chemistry, Portland State University, Portland, Oregon 97217, United States
| | | | - David H. Peyton
- Department
of Chemistry, Portland State University, Portland, Oregon 97217, United States
| | - Robert M. Strongin
- Department
of Chemistry, Portland State University, Portland, Oregon 97217, United States
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17
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Patel D, McElroy JP, Weng DY, Sahar K, Reisinger SA, Freudenheim JL, Wewers MD, Shields PG, Song MA. Sex-related DNA methylation is associated with inflammation and gene expression in the lungs of healthy individuals. Sci Rep 2024; 14:14280. [PMID: 38902313 PMCID: PMC11190195 DOI: 10.1038/s41598-024-65027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/17/2024] [Indexed: 06/22/2024] Open
Abstract
Lung cancer exhibits sex-biased molecular characteristics and epidemiological trends, suggesting a need for sex-specific approaches to understanding its etiology and treatment. DNA methylation alterations play critical roles in lung carcinogenesis and may serve as valuable biomarkers for precision medicine strategies. We employed the Infinium MethylationEPIC array to identify autosomal sex-related differentially methylated CpG sites (DM-CpGs) in lung epithelium of healthy individuals (32 females and 37 males) while controlling for age, BMI, and tobacco use. We correlated DM-CpGs with gene expression in lung epithelium and immune responses in bronchoalveolar lavage. We validated these DM-CpGs in lung tumors and adjacent normal tissue from The Cancer Genome Atlas (TCGA). Among 522 identified DM-CpGs, 61% were hypermethylated in females, predominantly located in promoter regions. These DM genes were implicated in cell-to-cell signaling, cellular function, transport, and lipid metabolism. Correlation analysis revealed sex-specific patterns between DM-CpGs and gene expression. Additionally, several DM-CpGs were correlated significantly with cytokines (IL-1β, IL-4, IL-12p70, and IFN-γ), macrophage, and lymphocyte counts. Also, some DM-CpGs were observed in TCGA lung adenocarcinoma, squamous cell carcinoma, and adjacent normal tissues. Our findings highlight sex-specific DNA methylation patterns in healthy lung epithelium and their associations with lung gene expression and lung immune biomarkers. These findings underscore the potential role of lung sex-related CpGs as epigenetic predispositions influencing sex disparities in lung cancer risk and outcomes, warranting further investigation for personalized lung cancer management strategies.
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Affiliation(s)
- Devki Patel
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Joseph P McElroy
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Daniel Y Weng
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Kamel Sahar
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Sarah A Reisinger
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Mark D Wewers
- Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, OH, USA.
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Min-Ae Song
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA.
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O'Brien TM. Acute eosinophilic pneumonia-like syndrome post-initiation of vortioxetine. Drug Ther Bull 2024:dtb.2024.e254254rep. [PMID: 38886023 DOI: 10.1136/dtb.2024.e254254rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
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Han H, Meister M, Peng G, Yuan Y, Qiao J, Yang JJ, Liu ZR, Ji X. Inhalation of nicotine-containing electronic cigarette vapor exacerbates the features of COPD by inducing ferroptosis in βENaC-overexpressing mice. Front Immunol 2024; 15:1429946. [PMID: 38947318 PMCID: PMC11211252 DOI: 10.3389/fimmu.2024.1429946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is currently listed as the 3rd leading cause of death in the United States. Accumulating data shows the association between COPD occurrence and the usage of electronic nicotine delivery systems (ENDS) in patients. However, the underlying pathogenesis mechanisms of COPD have not been fully understood. Methods In the current study, bENaC-overexpressing mice (bENaC mice) were subjected to whole-body ENDS exposure. COPD related features including emphysema, mucus accumulation, inflammation and fibrosis are examined by tissue staining, FACS analysis, cytokine measurement. Cell death and ferroptosis of alveolar epithelial cells were further evaluated by multiple assays including staining, FACS analysis and lipidomics. Results ENDS-exposed mice displayed enhanced emphysema and mucus accumulation, suggesting that ENDS exposure promotes COPD features. ENDS exposure also increased immune cell number infiltration in bronchoalveolar lavage and levels of multiple COPD-related cytokines in the lungs, including CCL2, IL-4, IL-13, IL-10, M-CSF, and TNF-α. Moreover, we observed increased fibrosis in ENDS-exposed mice, as evidenced by elevated collagen deposition and a-SMA+ myofibroblast accumulation. By investigating possible mechanisms for how ENDS promoted COPD, we demonstrated that ENDS exposure induced cell death of alveolar epithelial cells, evidenced by TUNEL staining and Annexin V/PI FACS analysis. Furthermore, we identified that ENDS exposure caused lipid dysregulations, including TAGs (9 species) and phospholipids (34 species). As most of these lipid species are highly associated with ferroptosis, we confirmed ENDS also enhanced ferroptosis marker CD71 in both type I and type II alveolar epithelial cells. Discussion Overall, our data revealed that ENDS exposure exacerbates features of COPD in bENaC mice including emphysema, mucus accumulation, abnormal lung inflammation, and fibrosis, which involves the effect of COPD development by inducing ferroptosis in the lung.
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Affiliation(s)
- Hongwei Han
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Maureen Meister
- Department of Nutrition, Georgia State University, Atlanta, GA, United States
| | - Guangda Peng
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Yi Yuan
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Jingjuan Qiao
- Department of Chemistry, Georgia State University, Atlanta, GA, United States
| | - Jenny J. Yang
- Department of Chemistry, Georgia State University, Atlanta, GA, United States
| | - Zhi-Ren Liu
- Department of Biology, Georgia State University, Atlanta, GA, United States
| | - Xiangming Ji
- Department of Nutrition, Georgia State University, Atlanta, GA, United States
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20
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Kolli AR, Veljkovic E, Calvino-Martin F, Esposito M, Kuczaj AK, Koumal O, Rose JE, Peitsch MC. Nicotine flux and pharmacokinetics-based considerations for early assessment of nicotine delivery systems. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 11:100245. [PMID: 38948427 PMCID: PMC11214420 DOI: 10.1016/j.dadr.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024]
Abstract
In the past few years, technological advancements enabled the development of novel electronic nicotine delivery systems (ENDS). Several empirical measures such as "nicotine flux" are being proposed to evaluate the abuse liability potential of these products. We explored the applicability of nicotine flux for clinical nicotine pharmacokinetics (PK) and 52-week quit success from cigarettes for a wide range of existing nicotine delivery systems. We found that the differences in nicotine flux for various nicotine delivery systems are not related to changes in PK, as nicotine flux does not capture key physiological properties such as nicotine absorption rate. Further, the 52-week quit success and abuse liability potential of nicotine nasal sprays (high nicotine flux product), and nicotine inhalers (nicotine flux similar to ENDS) are low, suggesting that nicotine flux is a poor metric for the assessment of nicotine delivery systems. PK indices are more dependable for characterizing nicotine delivery systems, and a nicotine plasmaC max T max > 1 could improve 52-week quit success from cigarettes. However, a single metric may be inadequate to fully assess the abuse liability potential of nicotine delivery systems and needs to be further studied. A combination of in vitro and in silico approaches could potentially address the factors influencing the inhaled aerosol dosimetry and resulting PK of nicotine to provide early insights for ENDS assessments. Further research is required to understand nicotine dosimetry and PK for ad libitum product use, and abuse liability indicators of nicotine delivery systems. This commentary is intended to (1) highlight the need to think beyond a single empirical metric such as nicotine flux, (2) suggest potential PK-based metrics, (3) suggest the use of in vitro and in silico tools to obtain early insights into inhaled aerosol dosimetry for ENDS, and (4) emphasize the importance of considering comprehensive clinical pharmacology outcomes to evaluate nicotine delivery systems.
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Affiliation(s)
- Aditya R. Kolli
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
| | - Emilija Veljkovic
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
| | | | - Marco Esposito
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
| | - Arkadiusz K. Kuczaj
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
| | - Ondrej Koumal
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
| | - Jed E. Rose
- Rose Research Center, 7240 ACC Blvd., Raleigh, NC 27617, USA
| | - Manuel C. Peitsch
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, Neuchâtel CH-2000, Switzerland
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Callahan SJ, Beck E, Blagev D, Harris D, Lanspa M, Brown S, Reilly CA, Paine R, Warren KJ. Vitamin E Acetate Is Associated with Select Proinflammatory Cytokines: An Analysis of a 2020-2022 Cohort of EVALI Patients. Am J Respir Crit Care Med 2024; 209:1404-1407. [PMID: 38530102 PMCID: PMC11146565 DOI: 10.1164/rccm.202311-2155le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 03/27/2024] Open
Affiliation(s)
- Sean J. Callahan
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | - Emily Beck
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | | | | | | | | | - Christopher A. Reilly
- Department of Pharmacology and Toxicology, College of Pharmacy, and
- Center for Human Toxicology, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Pulmonary Division, Department of Internal Medicine
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
| | - Kristi J. Warren
- Pulmonary Division, Department of Internal Medicine
- Department of Pharmacology and Toxicology, College of Pharmacy, and
- Center for Human Toxicology, University of Utah, Salt Lake City, Utah
- Pulmonary Research, George E. Wahlen VA Medical Center, Salt Lake City, Utah; and
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22
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Kassem NOF, Strongin RM, Stroup AM, Brinkman MC, El-Hellani A, Erythropel HC, Etemadi A, Exil V, Goniewicz ML, Kassem NO, Klupinski TP, Liles S, Muthumalage T, Noël A, Peyton DH, Wang Q, Rahman I, Valerio LG. A review of the toxicity of ingredients in e-cigarettes, including those ingredients having the FDA's "Generally Recognized as Safe (GRAS)" regulatory status for use in food. Nicotine Tob Res 2024:ntae123. [PMID: 38783714 DOI: 10.1093/ntr/ntae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Some firms and marketers of electronic cigarettes (e-cigarettes; a type of electronic nicotine delivery system (ENDS)) and refill liquids (e-liquids) have made claims about the safety of ingredients used in their products based on the term "GRAS or Generally Recognized As Safe" (GRAS). However, GRAS is a provision within the definition of a food additive under section 201(s) (21 U.S.C. 321(s)) of the U.S. Federal Food Drug and Cosmetic Act (FD&C Act). Food additives and GRAS substances are by the FD&C Act definition intended for use in food, thus safety is based on oral consumption; the term GRAS cannot serve as an indicator of the toxicity of e-cigarette ingredients when aerosolized and inhaled (i.e., vaped). There is no legal or scientific support for labeling e-cigarette product ingredients as "GRAS". This review discusses our concerns with the GRAS provision being applied to e-cigarette products and provides examples of chemical compounds that have been used as food ingredients but have been shown to lead to adverse health effects when inhaled. The review provides scientific insight into the toxicological evaluation of e-liquid ingredients and their aerosols to help determine the potential respiratory risks associated with their use in e-cigarettes. IMPLICATIONS The rise in prevalence of e-cigarette use and emerging evidence of adverse effects, particularly on lung health, warrant assessing all aspects of e-cigarette toxicity. One development is manufacturers' stated or implied claims of the safety of using e-cigarette products containing ingredients determined to be "Generally Recognized As Safe" (GRAS) for use in food. Such claims, typically placed on e-cigarette product labels and used in marketing, are unfounded, as pointed out by the United States Food and Drug Administration (FDA)1 and the Flavor and Extract Manufacturers Association (FEMA)2. Assessment of inhalation health risks of all ingredients used in e-liquids, including those claimed to be GRAS, is warranted.
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Affiliation(s)
- Nada O F Kassem
- Health Promotion and Behavioral Science, San Diego State University, San Diego, CA 92182, U.S
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | - Robert M Strongin
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Andrea M Stroup
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD 20850, U.S
| | - Marielle C Brinkman
- College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Ahmad El-Hellani
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, U.S
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, U.S
| | - Hanno C Erythropel
- Department of Chemical and Environmental Engineering, Yale University, New Haven, CT 06511, U.S
- Yale Center for the Study of Tobacco Products (YCSTP), Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, U.S
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD 20892, U.S
| | - Vernat Exil
- School of Medicine, St. Louis University, St. Louis, MO 63104, U.S
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14226, U.S
| | - Noura O Kassem
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Sandy Liles
- Hookah Tobacco Research Center, San Diego State University Research Foundation, San Diego, CA 92123, U.S
| | | | - Alexandra Noël
- Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, U.S
| | - David H Peyton
- Department of Chemistry, Portland State University, Portland, OR 97207-0751, U.S
| | - Qixin Wang
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Irfan Rahman
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, U.S
| | - Luis G Valerio
- Division of Nonclinical Science (DNCS), Office of Science/Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, U.S
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23
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Kishimoto A, Wu D, O'Shea DF. Forecasting vaping health risks through neural network model prediction of flavour pyrolysis reactions. Sci Rep 2024; 14:9591. [PMID: 38719814 PMCID: PMC11079048 DOI: 10.1038/s41598-024-59619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
Vaping involves the heating of chemical solutions (e-liquids) to high temperatures prior to lung inhalation. A risk exists that these chemicals undergo thermal decomposition to new chemical entities, the composition and health implications of which are largely unknown. To address this concern, a graph-convolutional neural network (NN) model was used to predict pyrolysis reactivity of 180 e-liquid chemical flavours. The output of this supervised machine learning approach was a dataset of probability ranked pyrolysis transformations and their associated 7307 products. To refine this dataset, the molecular weight of each NN predicted product was automatically correlated with experimental mass spectrometry (MS) fragmentation data for each flavour chemical. This blending of deep learning methods with experimental MS data identified 1169 molecular weight matches that prioritized these compounds for further analysis. The average number of discrete matches per flavour between NN predictions and MS fragmentation was 6.4 with 92.8% of flavours having at least one match. Globally harmonized system classifications for NN/MS matches were extracted from PubChem, revealing that 127 acute toxic, 153 health hazard and 225 irritant classifications were predicted. This approach may reveal the longer-term health risks of vaping in advance of clinical diseases emerging in the general population.
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Affiliation(s)
| | - Dan Wu
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland.
| | - Donal F O'Shea
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland.
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Khouja JN, Dyer ML, Havill MA, Dockrell MJ, Munafò MR, Attwood AS. Exploring the opinions and potential impact of unflavoured e-liquid on smoking cessation among people who smoke and smoking relapse among people who previously smoked and now use e-cigarettes: findings from a UK-based mixed methods study. Harm Reduct J 2024; 21:90. [PMID: 38702809 PMCID: PMC11067290 DOI: 10.1186/s12954-024-01003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/08/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Although electronic cigarettes (e-cigarettes) appear to be effective in helping people who smoke to stop smoking, concerns about use of e-cigarettes among young people have led to restrictions on non-tobacco flavoured e-liquids in some countries and some US states. These restrictions could reduce the appeal of these products to non-smoking youth but could have negative consequences for people who smoke or use e-cigarettes. METHODS In this mixed methods study, we recruited UK adults who smoked or used to smoke and subsequently vaped to explore their opinions of unflavoured e-liquids and their beliefs about how they would be impacted by hypothetical e-liquid flavour restrictions. Participants trialled an unflavoured e-liquid instead of their usual nicotine product for four hours and completed a survey and an online interview. RESULTS Using Interpretive Phenomenological Analysis and graphically presented data, we found differences in participants' opinions of unflavoured e-liquid. If only unflavoured, tobacco flavoured, and menthol flavoured e-liquids remained on the UK market, some people who smoke or vape may be unaffected, but some may relapse to smoking or continue smoking. Despite most wanting to prevent young people from initiating vaping, participants had varying opinions on whether flavour restrictions would be an effective method. CONCLUSIONS The findings highlight that people who smoke and vape could be impacted by flavour restrictions in a range of ways, some of which could have a potential adverse impact on harm reduction efforts in the UK (e.g., by making smoking more appealing than vaping).
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Affiliation(s)
- Jasmine N Khouja
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK.
| | - Maddy L Dyer
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
| | - Michelle A Havill
- Department of Health and Social Care, Office of Health Improvement and Disparities, London, SW1H 0EU, UK
| | - Martin J Dockrell
- Department of Health and Social Care, Office of Health Improvement and Disparities, London, SW1H 0EU, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, UK
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25
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DeGregorio MW, Kao CJ, Wurz GT. Complexity of Translating Analytics to Recent Cannabis Use and Impairment. J AOAC Int 2024; 107:493-505. [PMID: 38410076 DOI: 10.1093/jaoacint/qsae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
While current analytical methodologies can readily identify cannabis use, definitively establishing recent use within the impairment window has proven to be far more complex, requiring a new approach. Recent studies have shown no direct relationship between impairment and Δ9-tetra-hydrocannabinol (Δ9-THC) concentrations in blood or saliva, making legal "per se" Δ9-THC limits scientifically unjustified. Current methods that focus on Δ9-THC and/or metabolite concentrations in blood, saliva, urine, or exhaled breath can lead to false-positive results for recent use due to the persistence of Δ9-THC well outside of the typical 3-4 h window of potential impairment following cannabis inhalation. There is also the issue of impairment due to other intoxicating substances-just because a subject exhibits signs of impairment and cannabis use is detected does not rule out the involvement of other drugs. Compounding the matter is the increasing popularity of hemp-derived cannabidiol (CBD) products following passage of the 2018 Farm Bill, which legalized industrial hemp in the United States. Many of these products contain varying levels of Δ9-THC, which can lead to false-positive tests for cannabis use. Furthermore, hemp-derived CBD is used to synthesize Δ8-THC, which possesses psychoactive properties similar to Δ9-THC and is surrounded by legal controversy. For accuracy, analytical methods must be able to distinguish the various THC isomers, which have identical masses and exhibit immunological cross-reactivity. A new testing approach has been developed based on exhaled breath and blood sampling that incorporates kinetic changes and the presence of key cannabinoids to detect recent cannabis use within the impairment window without the false-positive results seen with other methods. The complexity of determining recent cannabis use that may lead to impairment demands such a comprehensive method so that irresponsible users can be accurately detected without falsely accusing responsible users who may unjustly suffer harsh, life-changing consequences.
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Affiliation(s)
- Michael W DeGregorio
- RCU Labs, Inc., 408 Sunrise Ave, Roseville, CA 95661-4123, United States
- Professor Emeritus, University of California, Davis, One Shields Avenue, Davis, CA 95616, United States
| | - Chiao-Jung Kao
- RCU Labs, Inc., 408 Sunrise Ave, Roseville, CA 95661-4123, United States
| | - Gregory T Wurz
- RCU Labs, Inc., 408 Sunrise Ave, Roseville, CA 95661-4123, United States
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26
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Sera L, Hempel-Sanderoff C. Cannabis Science and Therapeutics: An Overview for Clinicians. J Clin Pharmacol 2024; 64:499-513. [PMID: 38145388 DOI: 10.1002/jcph.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
Cannabis-based therapeutics have garnered increasing attention in recent years as patients seek alternative treatments for various medical conditions. This narrative review provides a comprehensive overview of the science behind the medical use of cannabis, focusing on the medical evidence for commonly treated conditions. In addition, the review addresses the practical considerations of using cannabis as a therapeutic agent, offering insights into dosing strategies, variations in cannabinoid formulation, and individual patient responses. Precautions, adverse consequences, and drug interactions are also discussed, with a focus on patient safety and the potential risks associated with cannabis use.
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Affiliation(s)
- Leah Sera
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Carrie Hempel-Sanderoff
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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27
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Myers MG, Dowling MA, Bohnert KM. Where Do Adults in the United States Obtain Cannabis? A Nationally Representative Study Examining the Relationships Between Sociodemographic Factors, Cannabis Use Characteristics and Sources of Cannabis. J Stud Alcohol Drugs 2024; 85:296-305. [PMID: 38206664 PMCID: PMC11095496 DOI: 10.15288/jsad.23-00254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE Characterization of population subgroups based on where they acquire cannabis is unexplored. We examine relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis. METHOD Analyzing a representative sample (unweighted n = 8,089) of U.S. adults living in medical cannabis-permitting states with past-year cannabis use from the 2021 National Survey on Drug Use and Health, we determined source of last cannabis used. Outcome groups were purchased from a dispensary, purchased from another source, or nonpurchased source. Incorporating the complex survey design, descriptive statistics and adjusted multinomial logistic regressions evaluated associations between sociodemographic, individual cannabis use characteristics, and source of cannabis. Secondary analyses described cannabis purchasing characteristics among the subsample who last purchased cannabis. RESULTS Purchasing from a dispensary was the most common source of cannabis (42.5%). Significant relationships between sociodemographic characteristics, cannabis use modality, risky cannabis use, and source of cannabis were found. Recent cannabis initiates and those with cannabis vaporizer use had an increased likelihood of purchasing cannabis from a dispensary. Purchasing from a nondispensary source was most likely among those with daily cannabis use, past-month blunt use, past-year driving under the influence, cannabis use disorder, and cannabis and alcohol co-use. Among those purchasing cannabis, joints and other forms of cannabis were more likely to be purchased from a dispensary than purchased from other sources. CONCLUSIONS We identified key sociodemographic and cannabis use characteristics that may influence where individuals obtain cannabis, which are important for cannabis behavior surveillance and cannabis use prevention and intervention strategies to consider.
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Affiliation(s)
- Matthew G. Myers
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Mari A. Dowling
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, Michigan
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Kipling M. Bohnert
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan
- Veterans Affairs (VA) Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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28
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Kolli AR, Kuczaj AK, Calvino-Martin F, Hoeng J. Simulated pharmacokinetics of inhaled caffeine and melatonin from existing products indicate the lack of dosimetric considerations. Food Chem Toxicol 2024; 187:114601. [PMID: 38493979 DOI: 10.1016/j.fct.2024.114601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/28/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Numerous commercially available inhalable products claim to improve sleep-wake cycle-related target indications by delivering a wide variety of chemicals like caffeine and melatonin. The resulting exposure-responses from inhaling different doses are unknown and obtaining early understanding of resulting pharmacokinetics is beneficial. This study applied a physiologically based pharmacokinetic modeling approach to predict the inhalation pharmacokinetics of caffeine and melatonin for different target indications related to the sleep-wake cycle. The model predicted rapid systemic delivery of caffeine and melatonin based on airway regional deposition of inhaled aerosol. A low inhaled dose of 1 mg of caffeine resulted in a 72.3-times lower plasma maximal concentration and was predicted to not improve cognitive performance task outcomes compared to oral consumption of coffee containing 80 mg of caffeine. Conversely, 2-mg oral and inhaled doses of melatonin under recommended directions of use result in more than 25.1- and 645-times higher plasma concentrations compared to endogenous melatonin, respectively. The recommended doses for inhalation products for potential improvement in the target indications vary widely. Additional research is needed to evaluate the human pharmacokinetics, efficacy, and safety of inhaled products. Given the lack of assessments, inhaled caffeine and melatonin must be consumed with caution as the toxicological concerns are not known and could outweigh the potential beneficial effects.
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Affiliation(s)
- Aditya R Kolli
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland.
| | - Arkadiusz K Kuczaj
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Florian Calvino-Martin
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Julia Hoeng
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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29
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Barker CK, Ghera P, Hsu B. The Evolution of a Pediatric Public Health Crisis: E-cigarette or Vaping-Associated Lung Injury. Pediatrics 2024; 153:e2023063484. [PMID: 38629169 DOI: 10.1542/peds.2023-063484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 05/02/2024] Open
Abstract
E-cigarettes and vaping products were first introduced in the United States around 2007, and quickly grew in popularity. By 2014, e-cigarettes had become the most commonly used tobacco product among youth in the United States. An e-cigarette, or vaping, product use-associated lung injury (EVALI) outbreak was identified by the Centers for Disease Control and Prevention (CDC) in 2019, with many cases in the adolescent population. The CDC opened a national database of cases and launched a multistate investigation; reported cases reached a peak in September 2019. The CDC investigation found that a vaping liquid additive, vitamin E acetate, was strongly linked to the EVALI outbreak but determined that the decline in cases was likely multifactorial. Due to decreased cases and the identification of a potential cause of the outbreak, the CDC stopped collecting data on EVALI cases as of February 2020. However, e-cigarettes and vaping products have continued to be the most popular tobacco product among youth, though state and national regulations on these products have increased since 2016. While pediatric case series and studies have shown differences in clinical presentation and medical histories between pediatric and adult EVALI cases, the fact that cases are no longer tracked at a national level limits necessary information for pediatric clinicians and researchers. We describe the available literature on the diagnosis, pathophysiology, treatment, and outcomes of EVALI in the pediatric population, and provide clinical and public health recommendations to facilitate prevention and management of EVALI specific to pediatrics.
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Affiliation(s)
| | - Princy Ghera
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benson Hsu
- University of South Dakota, Sioux Falls, South Dakota
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30
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Record RA, Groznik M, Sussman M. Communicative Processes Underlying DIY eJuice Mixing Among Young Adult International ENDS Users. HEALTH COMMUNICATION 2024; 39:666-674. [PMID: 36809903 DOI: 10.1080/10410236.2023.2179718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The use of electronic nicotine delivery systems (ENDS) is increasing around the world, with contemporary trends outpacing scientific understanding of the health implications. Such trends include do-it-yourself eJuice mixing (DIY eJuice), which involves the unregulated homemade mixing of fogging agents, nicotine salts, and flavorants to create personalized liquid for ENDS products. The purpose of this study was to employ a grounded theory approach to gather formative data on the communicative processes surrounding the behavior of DIY eJuice mixing among international, young adult ENDS users. Participants were recruited locally for mini focus group discussions via SONA (n = 4) and internationally for an open-ended survey via Prolific (n = 138). Questions explored experiences with the online DIY eJuice community, motivations for mixing, information seeking strategies, flavor preferences, and perceived benefits of mixing. Thematic analysis and flow sketching revealed the underlying processes of social cognitive theory to explain the communicative processes of DIY eJuice mixing behaviors. Specifically, environmental determinants emerged in the form of online and social influences; personal determinants in the form of curiosity and control; and behavioral determinants following a benefits/barriers analysis, particularly regarding cost. These findings provide theoretical implications for the role of health communication constructs in understanding contemporary trends in ENDS use and practical implications for tobacco prevention messaging and tobacco control regulations.
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Affiliation(s)
| | | | - Mark Sussman
- Department of Biology, San Diego State University
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31
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Taktikakis P, Côté M, Subramaniam N, Kroeger K, Youssef H, Badia A, DeWolf C. Understanding the Retention of Vaping Additives in the Lungs: Model Lung Surfactant Membrane Perturbation by Vitamin E and Vitamin E Acetate. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2024; 40:5651-5662. [PMID: 38437623 DOI: 10.1021/acs.langmuir.3c02952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Deviations from the normal physicochemical and functional properties of pulmonary surfactants are associated with the incidence of lung injury and other respiratory disorders. This study aims to evaluate the alteration of the 2D molecular organization and morphology of pulmonary surfactant model membranes by the electronic cigarette additives α-tocopherol (vitamin E) and α-tocopherol acetate (vitamin E acetate), which have been associated with lung injury, termed e-cigarette or vaping-use-associated lung injury (EVALI). The model membranes used contained a 7:3 molar ratio of DPPC (1,2-dipalmitoyl-sn-glycero-3-phosphocholine) and POPG (1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoglycerol) to which α-tocopherol and α-tocopherol acetate were added to form mixtures of up to 20 mol % additive. The properties of the neat tocopherol additives and DPPC/POPG (7:3) mixtures with increasing molar proportions of additive were evaluated by surface pressure-area isotherms, excess area calculations, Brewster angle microscopy, grazing incidence X-ray diffraction, X-ray reflectivity, and atomic force microscopy. The addition of either additive alters the essential phase balance of the model pulmonary surfactant membrane by generating a greater proportion of the fluid phase. Despite this net fluidization, both tocopherol additives have space-filling effects on the liquid-expanded and condensed phases, yielding negative excess areas in the liquid-expanded phase and reduced tilt angles in the condensed phase. Both tocopherol additives alter the stability of the fluid phase, pushing the eventual collapse of this phase to higher surface pressures than the model membrane in the absence of an additive.
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Affiliation(s)
- Panagiota Taktikakis
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Mathieu Côté
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Nivetha Subramaniam
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Kailen Kroeger
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Hala Youssef
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Antonella Badia
- Département de chimie and Institut Courtois, Université de Montréal, Complexe des sciences, C.P. 6128, succursale Centre-ville, Montréal, Quebec H3C 3J7, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
| | - Christine DeWolf
- Department of Chemistry and Biochemistry and Centre for NanoScience Research, Concordia University, 7141 Sherbrooke St. W., Montréal, Quebec H4B 1R6, Canada
- FRQNT Quebec Centre for Advanced Materials, 2101, rue Jeanne-Mance, Montréal, Quebec H2X 2J6, Canada
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McKenzie N, Glassman T, Dake JA, Na L, Maloney SM. Using the integrated behavioral model to explain and predict cannabis vaping among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-7. [PMID: 38498598 DOI: 10.1080/07448481.2024.2325923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
Background: Cannabis vaping has become increasingly popular among college students. The purpose of this study was to use the Integrated Behavioral Model to better understand students' motivations for engaging in this high-risk behavior. Methods: A survey instrument was developed to assess six IBM constructs, as well as past use of cannabis and nicotine, and cannabis vaping behavior changes related to COVID-19. A structural equation model was used to assess the effects of IBM predictors on Behavioral Intention. Results: The IBM predictors accounted for 54.2% of the variance in Behavioral Intention. The strongest path coefficients on Behavioral Intention were Perceived Norm and Experiential Attitude. Conclusion: The results from this study can be used to design interventions to decrease cannabis vaping use among college students. More specifically, social norm interventions and addressing other misconceptions about vaping cannabis, appears to be a promising theoretical approach to help ameliorate this unique public health challenge.
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Affiliation(s)
- Nicole McKenzie
- Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Tavis Glassman
- Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Joseph A Dake
- Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Ling Na
- Population Health, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - S Maggie Maloney
- Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
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Tao X, Zhang J, Meng Q, Chu J, Zhao R, Liu Y, Dong Y, Xu H, Tian T, Cui J, Zhang L, Chu M. The potential health effects associated with electronic-cigarette. ENVIRONMENTAL RESEARCH 2024; 245:118056. [PMID: 38157958 DOI: 10.1016/j.envres.2023.118056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/17/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
A good old gateway theory that electronic-cigarettes (e-cigarettes) are widely recognized as safer tobacco substitutes. In actuality, demographics also show that vaping cannibalizes smoking, the best explanation of the data is the "common liability". However, the utilization of e-cigarette products remains a controversial topic at present. Currently, there has been a widespread and substantial growth in e-cigarette use worldwide owing to their endless new flavors and customizable characteristics. Furthermore, e-cigarette has grown widespread among smokers as well as non-smokers, including adolescents and young adults. And some studies have shown that e-cigarette users are at greater risk to start using combustible cigarettes while e-cigarettes use was also observed the potential benefits to people who want to quit smoking or not. Although it is true that e-cigarettes generally contain fewer toxic substances than combustible cigarettes, this does not mean that the chemical composition in e-cigarettes aerosols poses absolutely no risks. While concerns about toxic substances in e-cigarettes and their widespread use in the population are reasonable, it is also crucial to consider that e-cigarettes have been associated with the potential for promoting smoking cessation and the clinically relevant improvements in users with smoking-related pathologies. Meanwhile, there is still short of understanding of the health impacts associated with e-cigarette use. Therefore, in this review, we discussed the health impacts of e-cigarette exposure on oral, nasal, pulmonary, cardiovascular systems and brain. We aspire for this review to change people's previous perceptions of e-cigarettes and provide them with a more balanced perspective. Additionally, we suggest appropriate adjustments on regulation and policy for e-cigarette to gain greater public health benefits.
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Affiliation(s)
- Xiaobo Tao
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiale Zhang
- The Second People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Qianyao Meng
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, USA
| | - Junfeng Chu
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Rongrong Zhao
- Department of Oncology, Jiangdu People's Hospital of Yangzhou, Yangzhou, Jiangsu, China
| | - Yiran Liu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Yang Dong
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Huiwen Xu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Tian Tian
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Jiahua Cui
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China
| | - Lei Zhang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
| | - Minjie Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu, China.
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MacCallum CA, Lo LA, Boivin M. Clinical Application of Cannabis Vaporization: Examining Safety and Best Practices. Cannabis Cannabinoid Res 2024. [PMID: 38394323 DOI: 10.1089/can.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Introduction: Cannabis vaporization is useful for individuals requiring fast-acting method of cannabis administration and for individuals using smoked cannabis as a harm reduction tool. There is a need for guidance on how to assess if a patient is a vaporization candidate and how to safely initiate and monitor cannabis vaporization. Methods: An overview of safe cannabis vaporization, including practical guidance and tactics to promote the lowest-risk use, is provided. This review was developed through a combination of expert clinical opinion and reviewing the available literature. Results: Dried cannabis vaporizers and metered-dose inhalers are recommended to be used over other vaporization devices. Assessing the benefit versus risks of vaporized cannabis and providing guidance for choosing a vaporization device, choosing a cannabis chemovar, and employing a mindful vaping technique are important steps in the safe utilization of vaporized cannabis. Dosing optimization and monitoring to limit adverse events and improve symptom control are essential. Discussion: The utilization of cannabis vaporization presents an important opportunity for clinicians and other health professionals to help facilitate safer cannabis administration and reduce the prevalence of smoked cannabis.
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Affiliation(s)
- Caroline A MacCallum
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay A Lo
- Department of Public Health Science, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Shruti T, Sharma P, Budukh A, Khanna D. Electronic nicotine delivery system: a narrative review on growing threat to tobacco control and health of the young Indian population. Int J Adolesc Med Health 2024; 36:17-24. [PMID: 38369380 DOI: 10.1515/ijamh-2023-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
The electronic cigarette (EC) was developed as an alternative to cigarette smoking. In less than a decade, the prevalence of past-month EC usage increased from 1.5 to 27.5 % among US high-school students. In the coming years, Asia-Pacific countries will have the highest sales of electronic nicotine/non-nicotine delivery systems (ENDS/ENNDS) after Western Europe. Based on the World Health Organization and Indian Council of Medical Research recommendations, India approved a complete ban on EC in 2019. Even though it has been three years since the ban, EC is still being sold in India's grey markets, where marketing is not regulated. In this narrative review, we discuss that vaping is not just a harm reduction strategy for tobacco smoking cessation but poses a serious threat to India's existing tobacco control efforts as well as the health of the country's young people.
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Affiliation(s)
- Tulika Shruti
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Priyanka Sharma
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Divya Khanna
- Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
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36
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Becker TD. A clinical overview of adolescent e-cigarette use (vaping). Minerva Pediatr (Torino) 2024; 76:108-118. [PMID: 37427959 DOI: 10.23736/s2724-5276.23.07131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
E-cigarette use (also known as "vaping") has become increasingly popular among adolescents over the past decade and grown into a significant public health concern in North America, the United Kingdom, and other countries. Concerns about this new trend have generated numerous new research studies. This aim of this study was to summarize recent scientific findings, with a focus on their relevance to clinicians working with adolescents. The first half covers epidemiology, risk factors for e-cigarette use, characteristics of e-cigarette use, youth perceptions of e-cigarettes, physical health risks of e-cigarettes, evidence for "gateway effects" of e-cigarette exposure on subsequent substance use, and the relationship between e-cigarette use and mental health. The review concludes with a clinical focus on assessment of youth who vape, psychoeducation for youth and families, clinical management of vaping, and regulatory considerations.
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Affiliation(s)
- Timothy D Becker
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Weill Cornell Medicine, New York, NY, USA -
- Division of Child and Adolescent Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA -
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Manna VJ, Dwyer S, Pizutelli V, Caradonna SJ. Utilizing primary human airway mucociliary tissue cultures to model ramifications of chronic E-cigarette usage. Toxicol In Vitro 2024; 94:105725. [PMID: 37884163 DOI: 10.1016/j.tiv.2023.105725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/27/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023]
Abstract
Electronic cigarettes are battery powered devices that use a vape-liquid to produce a vapor that is inhaled. A consequence of the rise in e-cigarette usage was the 2019 emergence of a vaping-induced respiratory disease denoted as 'e-cigarette or vaping use-associated lung injury' (EVALI). One of the suspected causes of EVALI is Vitamin E Acetate (VEA), which was found to be a diluent in certain illicit vape-pens, whereas nicotine is commonly diluted in equal parts propylene glycol and vegetable glycerin (PG:VG). The prevalent use of e-cigarettes and the emergence of a novel illness has made understanding how e-cigarette vapors affect our respiratory tissues a public health concern. We have designed and produced a simple device that can operate e-cigarettes and deliver the vapor to a chamber containing a standard cell culture multi-well plate. Here we utilize our device to model the response of human airway mucociliary tissue after chronic exposure to vapors produced from either PG:VG or VEA. We note several differences between how PG:VG and VEA vapors interact with and alter airway tissue cultures and suggest potential mechanisms for how VEA-vapors can exacerbate EVALI symptoms. Our device combined with primary human airway tissue cultures make an economical and compact model system that allows for animal-free investigations into the acute and chronic consequences of e-cigarette vapors on primary respiratory cells.
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Affiliation(s)
- Vincent J Manna
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States.
| | - Shannon Dwyer
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
| | - Vanessa Pizutelli
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
| | - Salvatore J Caradonna
- Department of Molecular Biology, Graduate School of Biomedical Sciences and School of Osteopathic Medicine, Rowan University, Stratford, NJ, United States
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38
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Seyler T, Blount BC, Wang L. High-performance liquid chromatography-tandem mass spectrometry method for measuring cotinine and trans-3'-hydroxycotinine in bronchoalveolar lavage fluid of patients with e-cigarette, or vaping, product use-associated lung injury. J Anal Toxicol 2024; 48:62-69. [PMID: 37769214 DOI: 10.1093/jat/bkad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 09/30/2023] Open
Abstract
In 2019, nearly 3000 U.S. residents developed severe lung injury associated with recent use of e-cigarette or vaping products. The Centers for Disease Control and Prevention responded to the outbreak, which was formally defined as e-cigarette, or vaping, product use-associated lung injury (EVALI). Centers for Disease Control and Prevention Laboratory rapidly developed assays to analyze potentially harmful and addictive substances in bronchoalveolar lavage (BAL) fluid collected from EVALI case patients. This report describes the development and validation of a high-throughput isotope-dilution high performance liquid chromatography-tandem mass spectrometry method for measuring two nicotine biomarkers, cotinine (COT) and trans-3'-hydroxycotinine (HCT), in bronchoalveolar lavage fluid samples. COT and HCT are the major metabolites of nicotine, the addictive alkaloid presents in tobacco products. This method had good specificity and sensitivity. The limit of detection is 0.033 and 0.0165 ng/mL for COT and HCT, respectively, using only 200 µL of sample volume. The within-run and between-run precision were 2-10%. The overall accuracy, calculated from recovery in three different sample matrices spiked at three concentrations, was 94.8% and 93.6% for COT and HCT, respectively. This novel HPLC-MS-MS method was utilized to characterize recent tobacco exposure in EVALI case patients. This method is useful for characterizing tobacco exposure that may be related to acute and chronic lung injury.
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Affiliation(s)
- Tiffany Seyler
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Benjamin C Blount
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Chandy M, Nishiga M, Wei TT, Hamburg NM, Nadeau K, Wu JC. Adverse Impact of Cannabis on Human Health. Annu Rev Med 2024; 75:353-367. [PMID: 37582489 PMCID: PMC10947506 DOI: 10.1146/annurev-med-052422-020627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Cannabis, the most commonly used recreational drug, is illicit in many areas of the world. With increasing decriminalization and legalization, cannabis use is increasing in the United States and other countries. The adverse effects of cannabis are unclear because its status as a Schedule 1 drug in the United States restricts research. Despite a paucity of data, cannabis is commonly perceived as a benign or even beneficial drug. However, recent studies show that cannabis has adverse cardiovascular and pulmonary effects and is linked with malignancy. Moreover, case reports have shown an association between cannabis use and neuropsychiatric disorders. With growing availability, cannabis misuse by minors has led to increasing incidences of overdose and toxicity. Though difficult to detect, cannabis intoxication may be linked to impaired driving and motor vehicle accidents. Overall, cannabis use is on the rise, and adverse effects are becoming apparent in clinical data sets.
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Affiliation(s)
- Mark Chandy
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Medicine, Western University, London, Ontario, Canada;
| | - Masataka Nishiga
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tzu-Tang Wei
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department and Graduate Institute of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Naomi M Hamburg
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine and Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kari Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA;
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
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Hofmann JJ, Poulos VC, Zhou J, Sharma M, Parraga G, McIntosh MJ. Review of quantitative and functional lung imaging evidence of vaping-related lung injury. Front Med (Lausanne) 2024; 11:1285361. [PMID: 38327710 PMCID: PMC10847544 DOI: 10.3389/fmed.2024.1285361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction The pulmonary effects of e-cigarette use (or vaping) became a healthcare concern in 2019, following the rapid increase of e-cigarette-related or vaping-associated lung injury (EVALI) in young people, which resulted in the critical care admission of thousands of teenagers and young adults. Pulmonary functional imaging is well-positioned to provide information about the acute and chronic effects of vaping. We generated a systematic review to retrieve relevant imaging studies that describe the acute and chronic imaging findings that underly vaping-related lung structure-function abnormalities. Methods A systematic review was undertaken on June 13th, 2023 using PubMed to search for published manuscripts using the following criteria: [("Vaping" OR "e-cigarette" OR "EVALI") AND ("MRI" OR "CT" OR "Imaging")]. We included only studies involving human participants, vaping/e-cigarette use, and MRI, CT and/or PET. Results The search identified 445 manuscripts, of which 110 (668 unique participants) specifically mentioned MRI, PET or CT imaging in cases or retrospective case series of patients who vaped. This included 105 manuscripts specific to CT (626 participants), three manuscripts which mainly used MRI (23 participants), and two manuscripts which described PET findings (20 participants). Most studies were conducted in North America (n = 90), with the remaining studies conducted in Europe (n = 15), Asia (n = 4) and South America (n = 1). The vast majority of publications described case studies (n = 93) and a few described larger retrospective or prospective studies (n = 17). In e-cigarette users and patients with EVALI, key CT findings included ground-glass opacities, consolidations and subpleural sparing, MRI revealed abnormal ventilation, perfusion and ventilation/perfusion matching, while PET showed evidence of pulmonary inflammation. Discussion and conclusion Pulmonary structural and functional imaging abnormalities were common in patients with EVALI and in e-cigarette users with or without respiratory symptoms, which suggests that functional MRI may be helpful in the investigation of the pulmonary health effects associated with e-cigarette use.
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Affiliation(s)
| | | | - Jiahai Zhou
- Robarts Research Institute, London, ON, Canada
| | - Maksym Sharma
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
| | - Grace Parraga
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
- Department of Medical Imaging, Western University, London, ON, Canada
| | - Marrissa J. McIntosh
- Robarts Research Institute, London, ON, Canada
- Department of Medical Biophysics, London, ON, Canada
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Cretu B, Zamfir A, Bucurica S, Scheau AE, Savulescu Fiedler I, Caruntu C, Caruntu A, Scheau C. Role of Cannabinoids in Oral Cancer. Int J Mol Sci 2024; 25:969. [PMID: 38256042 PMCID: PMC10815457 DOI: 10.3390/ijms25020969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Cannabinoids have incited scientific interest in different conditions, including malignancy, due to increased exposure to cannabis. Furthermore, cannabinoids are increasingly used to alleviate cancer-related symptoms. This review paper aims to clarify the recent findings on the relationship between cannabinoids and oral cancer, focusing on the molecular mechanisms that could link cannabinoids with oral cancer pathogenesis. In addition, we provide an overview of the current and future perspectives on the management of oral cancer patients using cannabinoid compounds. Epidemiological data on cannabis use and oral cancer development are conflicting. However, in vitro studies assessing the effects of cannabinoids on oral cancer cells have unveiled promising anti-cancer features, including apoptosis and inhibition of cell proliferation. Downregulation of various signaling pathways with anti-cancer effects has been identified in experimental models of oral cancer cells exposed to cannabinoids. Furthermore, in some countries, several synthetic or phytocannabinoids have been approved as medical adjuvants for the management of cancer patients undergoing chemoradiotherapy. Cannabinoids may improve overall well-being by relieving anxiety, depression, pain, and nausea. In conclusion, the link between cannabinoid compounds and oral cancer is complex, and further research is necessary to elucidate the potential risks or their protective impact on oral cancer.
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Affiliation(s)
- Brigitte Cretu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Alexandra Zamfir
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
| | - Sandica Bucurica
- Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Gastroenterology, “Carol Davila” University Central Emergency Military Hospital, 010825 Bucharest, Romania
| | - Andreea Elena Scheau
- Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania;
| | - Ilinca Savulescu Fiedler
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine and Cardiology, Coltea Clinical Hospital, 030167 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania; (B.C.); (A.Z.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.C.); (C.S.)
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Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev 2024; 1:CD010216. [PMID: 38189560 PMCID: PMC10772980 DOI: 10.1002/14651858.cd010216.pub8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol by heating an e-liquid. People who smoke, healthcare providers and regulators want to know if ECs can help people quit smoking, and if they are safe to use for this purpose. This is a review update conducted as part of a living systematic review. OBJECTIVES To examine the safety, tolerability and effectiveness of using electronic cigarettes (ECs) to help people who smoke tobacco achieve long-term smoking abstinence, in comparison to non-nicotine EC, other smoking cessation treatments and no treatment. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register to 1 February 2023, and Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO to 1 July 2023, and reference-checked and contacted study authors. SELECTION CRITERIA We included trials in which people who smoke were randomized to an EC or control condition. We also included uncontrolled intervention studies in which all participants received an EC intervention as these studies have the potential to provide further information on harms and longer-term use. Studies had to report an eligible outcome. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Critical outcomes were abstinence from smoking after at least six months, adverse events (AEs), and serious adverse events (SAEs). We used a fixed-effect Mantel-Haenszel model to calculate risk ratios (RRs) with a 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, we calculated mean differences. Where appropriate, we pooled data in pairwise and network meta-analyses (NMA). MAIN RESULTS We included 88 completed studies (10 new to this update), representing 27,235 participants, of which 47 were randomized controlled trials (RCTs). Of the included studies, we rated ten (all but one contributing to our main comparisons) at low risk of bias overall, 58 at high risk overall (including all non-randomized studies), and the remainder at unclear risk. There is high certainty that nicotine EC increases quit rates compared to nicotine replacement therapy (NRT) (RR 1.59, 95% CI 1.29 to 1.93; I2 = 0%; 7 studies, 2544 participants). In absolute terms, this might translate to an additional four quitters per 100 (95% CI 2 to 6 more). There is moderate-certainty evidence (limited by imprecision) that the rate of occurrence of AEs is similar between groups (RR 1.03, 95% CI 0.91 to 1.17; I2 = 0%; 5 studies, 2052 participants). SAEs were rare, and there is insufficient evidence to determine whether rates differ between groups due to very serious imprecision (RR 1.20, 95% CI 0.90 to 1.60; I2 = 32%; 6 studies, 2761 participants; low-certainty evidence). There is moderate-certainty evidence, limited by imprecision, that nicotine EC increases quit rates compared to non-nicotine EC (RR 1.46, 95% CI 1.09 to 1.96; I2 = 4%; 6 studies, 1613 participants). In absolute terms, this might lead to an additional three quitters per 100 (95% CI 1 to 7 more). There is moderate-certainty evidence of no difference in the rate of AEs between these groups (RR 1.01, 95% CI 0.91 to 1.11; I2 = 0%; 5 studies, 1840 participants). There is insufficient evidence to determine whether rates of SAEs differ between groups, due to very serious imprecision (RR 1.00, 95% CI 0.56 to 1.79; I2 = 0%; 9 studies, 1412 participants; low-certainty evidence). Due to issues with risk of bias, there is low-certainty evidence that, compared to behavioural support only/no support, quit rates may be higher for participants randomized to nicotine EC (RR 1.88, 95% CI 1.56 to 2.25; I2 = 0%; 9 studies, 5024 participants). In absolute terms, this represents an additional four quitters per 100 (95% CI 2 to 5 more). There was some evidence that (non-serious) AEs may be more common in people randomized to nicotine EC (RR 1.22, 95% CI 1.12 to 1.32; I2 = 41%, low-certainty evidence; 4 studies, 765 participants) and, again, insufficient evidence to determine whether rates of SAEs differed between groups (RR 0.89, 95% CI 0.59 to 1.34; I2 = 23%; 10 studies, 3263 participants; very low-certainty evidence). Results from the NMA were consistent with those from pairwise meta-analyses for all critical outcomes, and there was no indication of inconsistency within the networks. Data from non-randomized studies were consistent with RCT data. The most commonly reported AEs were throat/mouth irritation, headache, cough, and nausea, which tended to dissipate with continued EC use. Very few studies reported data on other outcomes or comparisons, hence, evidence for these is limited, with CIs often encompassing both clinically significant harm and benefit. AUTHORS' CONCLUSIONS There is high-certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate-certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain due to risk of bias inherent in the study design. Confidence intervals were for the most part wide for data on AEs, SAEs and other safety markers, with no difference in AEs between nicotine and non-nicotine ECs nor between nicotine ECs and NRT. Overall incidence of SAEs was low across all study arms. We did not detect evidence of serious harm from nicotine EC, but the longest follow-up was two years and the number of studies was small. The main limitation of the evidence base remains imprecision due to the small number of RCTs, often with low event rates. Further RCTs are underway. To ensure the review continues to provide up-to-date information to decision-makers, this review is a living systematic review. We run searches monthly, with the review updated when relevant new evidence becomes available. Please refer to the Cochrane Database of Systematic Reviews for the review's current status.
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Affiliation(s)
- Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ailsa R Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rachna Begh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tari Turner
- Cochrane Australia, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Tom Morris
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA
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Norman FF, Diaz J, Martin-Davila P, Tato M, García-San Miguel L, Gil E, Casas I, Gonzalez-Sanz M. Bilateral pulmonary infiltrates in a traveller from Saudi Arabia with probable electronic cigarette or vaping associated lung injury (EVALI). J Travel Med 2023; 30:taad133. [PMID: 37856529 DOI: 10.1093/jtm/taad133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
A Saudi traveller presented with fever and pulmonary infiltrates. Principal causes of infectious pneumonia were ruled out (including MERS-coronavirus) and a diagnosis of probable drug-induced pneumonitis due to vaping/electronic cigarettes was established. Professionals should be aware of international epidemiological alerts but also consider non-infectious causes of pneumonia in travellers.
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Affiliation(s)
- Francesca F Norman
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Jorge Diaz
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Pilar Martin-Davila
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Marta Tato
- Microbiology Department, Ramón y Cajal University Hospital, IRYCIS, CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Lucía García-San Miguel
- Centro de Coordinación de Alertas y Emergencias Sanitarias (CCAES), Ministerio de Sanidad, Madrid, Spain
| | - Elisa Gil
- Servicio de Alertas en Salud Pública, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad, Madrid, Spain
| | - Inmaculada Casas
- Laboratorio de Referencia e Investigación en Virus Respiratorios, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Marta Gonzalez-Sanz
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, Universidad de Alcalá, CIBER de Enfermedades Infecciosas, Madrid, Spain
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44
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Stein J, Kay HE, Sites J, Pirzadeh A, Joyner BL, Darville T, Bjurlin MA, Rose TL, Jaspers I, Milowsky MI. Electronic cigarette, or vaping, product use-associated lung injury (EVALI) in a patient with testicular cancer: A case report. TUMORI JOURNAL 2023; 109:NP11-NP13. [PMID: 37165581 DOI: 10.1177/03008916231172806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Electronic cigarette, or vaping, product use-associated lung injury (EVALI) is an increasingly recognized entity with the potential for severe pulmonary toxicity. We present the case of a young man first evaluated at a tertiary care center in the United States in 2019 with newly diagnosed testicular cancer with acute respiratory failure, which was initially attributed to possible metastatic disease but eventually determined to be related to EVALI. This case highlights the clinical features of EVALI, the potential diagnostic dilemma that can arise with EVALI when occurring in the setting of malignancy and the importance of inquiring about vaping use among patients with malignancy, especially in adolescents and young adults.
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Affiliation(s)
- Jacob Stein
- Department of Medicine, Division of Hematology/Oncology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Hannah E Kay
- Department of Urology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Jeremy Sites
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Afsaneh Pirzadeh
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Benny L Joyner
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Toni Darville
- Department of Pediatrics, Division of Pediatric Infectious Disease, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Marc A Bjurlin
- Department of Urology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Tracy L Rose
- Department of Medicine, Division of Hematology/Oncology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Ilona Jaspers
- Department of Pediatrics, Division of Microbiology and Immunology, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Matthew I Milowsky
- Department of Medicine, Division of Hematology/Oncology, UNC Chapel Hill, Chapel Hill, NC, USA
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Rahman M, Sompa SI, Introna M, Upadhyay S, Ganguly K, Palmberg L. Lipid from electronic cigarette-aerosol both with and without nicotine induced pro-inflammatory macrophage polarization and disrupted phagocytosis. J Inflamm (Lond) 2023; 20:39. [PMID: 37978397 PMCID: PMC10655339 DOI: 10.1186/s12950-023-00367-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Clinical cases and experimental evidence revealed that electronic cigarettes (ECIG) induce serious adverse health effects, but underlying mechanisms remain to be fully uncovered. Based on recent exploratory evidence, investigating the effects of ECIG on macrophages can broadly define potential mechanisms by focusing on the effect of ECIG exposure with or without nicotine. Here we investigated the effect of ECIG-aerosol exposure on macrophages (MQ) phenotype, inflammatory response, and function of macrophages.MQ were cultured at air liquid interface and exposed to ECIG-aerosol. Oxidative stress was determined by reactive oxygen species (ROS), heat shock protein 60 (HSP60), glutathione peroxidase (GPx) and heme oxygenase1 (HMOX1). Lipid accumulation and lipid peroxidation were defined by lipid staining and level of malondialdehyde (MDA) respectively. MQ polarization was identified by surface expression markers CD86, CD11C and CD206 as well as pro-inflammatory and anti-inflammatory cytokines in gene and protein level. Phagocytosis of E. coli by MQ was investigated by fluorescence-based phagocytosis assay.ECIG-aerosol exposure in presence or absence of nicotine induced oxidative stress evidenced by ROS, HSP60, GPx, GPx4 and HMOX1 upregulation in MQ. ECIG-aerosol exposure induced accumulation of lipids and the lipid peroxidation product MDA in MQ. Pro-inflammatory MQ (M1) markers CD86 and CD11C but not anti-inflammatory MQ (M2) marker CD206 were upregulated in response to ECIG-aerosol exposure. In addition, ECIG induced pro-inflammatory cytokines IL-1beta and IL-8 in gene level and IL-6, IL-8, and IL-1beta in protein level whereas ECIG exposure downregulated anti-inflammatory cytokine IL-10 in protein level. Phagocytosis activity of MQ was downregulated by ECIG exposure. shRNA mediated lipid scavenger receptor 'CD36' silencing inhibited ECIG-aerosol-induced pro-inflammatory MQ polarization and recovered phagocytic activity of MQ.ECIG exposure alters lung lipid homeostasis and thus induced inflammation by inducing M1 type MQ and impair phagocytic function, which could be a potential cause of ECIG-induced lung inflammation in healthy and inflammatory exacerbation in disease condition.
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Affiliation(s)
- Mizanur Rahman
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Shanzina Iasmin Sompa
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Micol Introna
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Lena Palmberg
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
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46
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Sahu R, Shah K, Malviya R, Paliwal D, Sagar S, Singh S, Prajapati BG, Bhattacharya S. E-Cigarettes and Associated Health Risks: An Update on Cancer Potential. Adv Respir Med 2023; 91:516-531. [PMID: 37987300 PMCID: PMC10660480 DOI: 10.3390/arm91060038] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
The potential cancer risk associated with electronic-cigarette (e-cigarette) use is ongoing and remains a subject of debate. E-Cigarettes work by heating a liquid that usually contains nicotine, flavorings, and other chemicals. When the liquid is heated, users inhale an aerosol into their lungs. While e-cigarettes are generally considered less harmful than traditional tobacco products, they still contain potentially harmful chemicals, which can damage DNA and lead to cancer. Several studies have investigated the potential cancer risk associated with e-cigarette use, while other studies have suggested that e-cigarette aerosol may contain carcinogenic chemicals that could increase the risk of lung and bladder cancer in humans. However, these studies are limited in their scope and do not provide conclusive evidence. Overall, the long-term cancer risk associated with e-cigarette use remains uncertain, more research is needed to fully understand the potential risks and benefits of e-cigarettes. However, this review will allow the investigator to get more recent updates about e-cigarettes.
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Affiliation(s)
- Rakesh Sahu
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura 281406, India;
| | - Kamal Shah
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura 281406, India;
| | - Rishabha Malviya
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Deepika Paliwal
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Sakshi Sagar
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida 201310, India; (R.M.); (D.P.); (S.S.)
| | - Sudarshan Singh
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Bhupendra G. Prajapati
- Shree S. K. Patel College of Pharmaceutical Education and Research, Ganpat University, Kherva 384012, India
| | - Sankha Bhattacharya
- Department of Pharmaceutics, School of Pharmacy & Technology Management, SVKM’S NMIMS Deemed-to-Be University, Shirpur 425405, India;
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Timberlake DS, Bruckner TA, Pechmann C, Soroosh AJ, Simard BJ, Padon AA, Silver LD. Cannabis Vape Product Sales in California Following CDC's Initial Advisory About Lung Injuries. Cannabis Cannabinoid Res 2023. [PMID: 37939267 DOI: 10.1089/can.2023.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Introduction: The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) is believed to have been caused by vitamin E acetate, an additive used in some cannabis vaporizer products. Previous studies have primarily focused on changes in sales of electronic nicotine delivery systems following the initial advisory issued by the Centers for Disease Control (CDC) on August 17, 2019. The present study is intended to examine variation by age groups in sales of regulated cannabis vape products in the state of California before, during, and after the outbreak. Methods: Weekly sales revenue of cannabis vape products (from January 1, 2018, to December 31, 2020) was obtained from a sample of recreational cannabis retailers licensed in California. An interrupted time series analysis, using AutoRegressive, Integrated, Moving Average methods, was employed to estimate changes in the sales and market share of cannabis vape products in the weeks following the CDC advisory. Results: The total volume of regulated cannabis vape product sales increased substantially over the 3-year study period (2018-2020). Sales and market share of cannabis vape products, however, declined in both young and older adults immediately following the advisory, rebounding to pre-EVALI levels only for the young adults. For sales, the potential EVALI effect following the CDC's advisory equates to an 8.0% and 2.2% decline below expected levels in the older and young adults, respectively. Conclusions: The differential age effect on sales may reflect concerns regarding health effects of cannabis vaping products and greater awareness of the outbreak among older adults. Findings highlight the importance of informing consumers about health risks associated with using cannabis vape products acquired from regulated versus illicit sources.
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Affiliation(s)
- David S Timberlake
- Department of Population Health and Disease Prevention, Society and Behavior, Program in Public Health, College of Health Sciences, University of California, Irvine, California, USA
| | - Tim A Bruckner
- Department of Health, Society and Behavior, Program in Public Health, College of Health Sciences, University of California, Irvine, California, USA
| | - Cornelia Pechmann
- The Paul Merage School of Business, University of California, Irvine, California, USA
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48
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Raduka A, Gao N, Chatburn RL, Rezaee F. Electronic cigarette exposure disrupts airway epithelial barrier function and exacerbates viral infection. Am J Physiol Lung Cell Mol Physiol 2023; 325:L580-L593. [PMID: 37698113 PMCID: PMC11068398 DOI: 10.1152/ajplung.00135.2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
The use of electronic cigarettes (e-cigs), especially among teenagers, has reached alarming and epidemic levels, posing a significant threat to public health. However, the short- and long-term effects of vaping on the airway epithelial barrier are unclear. Airway epithelial cells are the forefront protectors from viruses and pathogens. They contain apical junctional complexes (AJCs), which include tight junctions (TJs) and adherens junctions (AJs) formed between adjacent cells. Previously, we reported respiratory syncytial virus (RSV) infection, the leading cause of acute lower respiratory infection-related hospitalization in children and high-risk adults, induces a "leaky airway" by disrupting the epithelial AJC structure and function. We hypothesized chemical components of e-cigs disrupt airway epithelial barrier and exacerbate RSV-induced airway barrier dysfunction. Using confluent human bronchial epithelial (16HBE) cells and well-differentiated normal human bronchial epithelial (NHBE) cells, we found that exposure to extract and aerosol e-cig nicotine caused a significant decrease in transepithelial electrical resistance (TEER) and the structure of the AJC even at noncytotoxic concentrations. Western blot analysis of 16HBE cells exposed to e-cig nicotine extract did not reveal significant changes in AJC proteins. Exposure to aerosolized e-cig cinnamon or menthol flavors also induced barrier disruption and aggravated nicotine-induced airway barrier dysfunction. Moreover, preexposure to nicotine aerosol increased RSV infection and the severity of RSV-induced airway barrier disruption. Our findings demonstrate that e-cig exposure disrupts the airway epithelial barrier and exacerbates RSV-induced damage. Knowledge gained from this study will provide awareness of adverse e-cig respiratory effects and positively impact the mitigation of e-cig epidemic.NEW & NOTEWORTHY Electronic cigarette (e-cig) use, especially in teens, is alarming and at epidemic proportions, threatening public health. Our study shows that e-cig nicotine exposure disrupts airway epithelial tight junctions and increases RSV-induced barrier dysfunction. Furthermore, exposure to aerosolized flavors exaggerates e-cig nicotine-induced airway barrier dysfunction. Our study confirms that individual and combined components of e-cigs deleteriously impact the airway barrier and that e-cig exposure increases susceptibility to viral infection.
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Affiliation(s)
- Andjela Raduka
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Nannan Gao
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Robert L Chatburn
- Enterprise Respiratory Care Research Cleveland Clinic, Cleveland Clinic Children's, Cleveland, Ohio, United States
| | - Fariba Rezaee
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States
- Center for Pediatric Pulmonary Medicine, Cleveland Clinic Children's, Cleveland, Ohio, United States
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49
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Gong JY, Ghosh M, Hoet PH. Association between metal exposure from e-cigarette components and toxicity endpoints: A literature review. Regul Toxicol Pharmacol 2023; 144:105488. [PMID: 37657743 DOI: 10.1016/j.yrtph.2023.105488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
Electronic cigarette is often promoted and perceived as an 'healthy' alternative compared to conventional cigarettes. However, growing body of evidence indicate the possible adverse health effect associated with e-cigarette. Here we reviewed the literature with a focus on metal exposure in relation to e-cigarette use and related toxicity endpoints. Twenty-nine studies were identified for full text screening after applying the screening criteria of which 5 in vitro studies and 11 epidemiological studies were included for data extraction. Cr, Cu, Ni, Sn are the most found metal in all studies. In vitro, metal from e-cigarette (liquid or aerosols) induced cytotoxicity, oxidative stress, genotoxicity and pro-inflammatory responses. It was observed that the presence of nicotine can influence metal-induced in vitro toxicity. Based on epidemiological studies, the metal burden in e-cigarette users showed to be elevated in different populations (including e.g. NHANES). However, most often such studies were limited by the missing user characteristics, and information of other potential sources of metal exposure. In general, metals from e-cigarette use can be associated with toxicity endpoints but to uncover the metal related hazard of e-cigarette in users, more detailed data on metals in vapors and e-liquids; user habits and user demographics are needed.
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Affiliation(s)
- Jia-You Gong
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Manosij Ghosh
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
| | - Peter Hm Hoet
- Laboratory of Toxicology, Unit of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium.
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50
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Barber AT, Liptzin DR, Gower WA, Hinds DM. Pediatric Pulmonology 2022 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:2719-2724. [PMID: 37493100 DOI: 10.1002/ppul.26603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
The field of rare and diffuse pediatric lung disease continues to evolve and expand rapidly as clinicians and researchers make advancements in the diagnosis and treatment of children's interstitial and diffuse lung disease, non-cystic fibrosis bronchiectasis, and primary ciliary dyskinesia. Papers published on these topics in Pediatric Pulmonology and other journals in 2022 describe newly recognized disorders, elucidate disease mechanisms and courses, explore potential biomarkers, and assess novel treatments. In this review, we will discuss these important advancements and place them in the context of existing literature.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Deborah R Liptzin
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Daniel M Hinds
- Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA
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