A Dollars and "Sense" Exploration of Vape Shop Spending and E-cigarette Use

INTRODUCTION

Across the US, vape shops have emerged to provide e-cigarette users access to products not usually available at gas stations or retail stores. As vape shop sales have steadily increased, so have questions about the impact of marketing and price on e-cigarette use behaviors. In this exploratory analysis, we aim to characterize spending on e-cigarettes and evaluate the association with customer perceptions and use behaviors.

METHODS

In a cross-sectional survey of vape shop customers (n=78), perceptions and use of e-cigarettes and tobacco products were assessed. Descriptive statistics and multivariate logistic regression were used to evaluate the association between spending and socioeconomic factors, demographics, and use behaviors.

RESULTS

Overall, spending amounts ranged from less than $10/month to more than $250/month, with a median around $50-75/month. Males spent more than females (p=0.003), but spending did not significantly differ by age (p=0.13). Customers who spent more than $50/month used lower levels of nicotine (mg/ml) (p=0.003) but a greater quantity of e-liquid (ml/month) (p<0.0001) compared to customers who spent under that amount. Mod use and intention to use e-cigarettes as a cessation device were significantly associated with vape shop spending in the regression model (OR= 17.5; 95% CI= (4.3, 70.2) and OR=0.22; 95% CI= (0.06, 0.75), respectively).

CONCLUSIONS

Spending appears to be significantly associated with e-cigarette use behaviors. Making "sense" of the potential relationships between the dollars spent at vape shops and consumer use behaviors is important as regulations for e-cigarette sales are proposed.

Exercise peripheral oxygen saturation (SpO2) accurately reflects arterial oxygen saturation (SaO2) and predicts mortality in systemic sclerosis

BACKGROUND

Measures of oxygenation have not been assessed for prognostic significance in systemic sclerosis-related interstitial lung disease (SSc-ILD).

METHODS

83 subjects with SSc-ILD performed a maximal cardiopulmonary exercise test with an arterial line. The agreement between peripheral oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) was examined and survival differences between subgroups of subjects stratified on SpO2 were analysed. Cox proportional hazards analyses were used to examine the prognostic capabilities of SpO2.

RESULTS

At maximal exercise the mean (SD) difference between SpO2 and SaO2 was 2.98 (2.98) and only 15 subjects had a difference of >4 points. The survival of subjects with SSc-ILD whose maximum exercise SpO2 (Spo(2)max) fell below 89% or whose SpO2max fell >4 points from baseline was worse than subjects in comparator groups (log rank p = 0.01 and 0.01, respectively). The hazard of death during the median 7.1 years of follow-up was 2.4 times greater for subjects whose SpO2max fell below 89% (hazard ratio 2.4, 95% CI 1.1 to 4.9, p = 0.02) or whose SpO2max fell >4 points from baseline (hazard ratio 2.4, 95% CI 1.1 to 5.0, p = 0.02).

CONCLUSION

In patients with SSc-ILD, SpO2 is an adequate reflection of SaO2 and radial arterial lines need not be inserted during cardiopulmonary exercise tests in these patients. Given the ease of measurement and its prognostic value, SpO2 should be considered as a meaningful clinical and research outcome in patients with SSc-ILD.

Lansoprazole in adolescents with gastroesophageal reflux disease: pharmacokinetics, pharmacodynamics, symptom relief efficacy, and tolerability

OBJECTIVES

To evaluate the pharmacokinetics, pharmacodynamics, symptom relief efficacy, and tolerability of lansoprazole in adolescents between 12 and 17 years of age with gastroesophageal reflux disease (GERD).

METHODS

Adolescents with symptomatic, endoscopically and/or histologically proven GERD were enrolled in this multicenter, double-blind trial and randomized to lansoprazole 15 mg or 30 mg once daily for 5 days.

RESULTS

Sixty-three adolescents were enrolled in the study. After lansoprazole administration, T(max) occurred at 1.6 hours in those treated with lansoprazole 15 mg and at 1.7 hours in those treated with lansoprazole 30 mg. Dose-proportional increases in lansoprazole C(max) and AUC were observed in the treatment groups. Age, weight, and gender had no significant effect on T(max), C(max), or AUC. Lansoprazole produced significant increases (P < or = 0.05) in mean 24-hour intragastric pH and the percentages of time intragastric pH was above 3 and 4. The majority of adolescents treated with lansoprazole 15 mg (69%, 22/32) or lansoprazole 30 mg (74%, 23/31) demonstrated improvement in their reflux symptoms after 5 days of treatment. Adolescents in both dosage groups exhibited reductions from baseline in the percentage of days and nights with heartburn (or other predominant symptom of GERD), the severity of heartburn, the percentage of days antacids were used, and the number of antacid tablets used per day. Pharyngitis and headache were the most commonly reported side effects among adolescents treated with lansoprazole 15 mg and 30 mg, respectively. Five patients experienced adverse events considered to be possibly treatment-related. One patient with a history of environmental allergies experienced a mild allergic reaction after 3 days of treatment with lansoprazole 15 mg. Among those treated with lansoprazole 30 mg, 4 patients each reported one occurrence of pain (toothache), diarrhea, dizziness, and rash.

CONCLUSION

The pharmacokinetic parameters of lansoprazole observed in this study of adolescents are similar to those observed in studies of healthy adults. Lansoprazole 15 mg or 30 mg once daily for 5 days produces significant increases in intragastric pH, effectively relieves symptoms of reflux disease, and is well tolerated in adolescents with GERD.

Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children

OBJECTIVES

To assess the efficacy of lansoprazole for the relief of symptoms due to gastroesophageal reflux disease (GERD) in children 1 to 11 years of age. In addition, the efficacy in healing of erosive esophagitis (EE) was determined in those children with EE who were enrolled in the study.

METHODS

In this phase I/II, open-label, multicenter (11 sites) U.S. study, children with symptomatic GERD, EE by endoscopy, and/or intraesophageal pH < 4 for greater than 4.2% of the time based on 24-hour pH testing were assigned, on the basis of body weight, to lansoprazole 15 mg (< or = 30 kg) or 30 mg (> 30 kg) once daily for 8 to 12 weeks. At the discretion of the investigator, the dosage of lansoprazole was increased up to 60 mg daily in children who continued to be symptomatic after 2 weeks of treatment. Symptom response was assessed by investigator interview and daily diary. Esophagitis healing was evaluated by repeat endoscopy after 8 and, if applicable, 12 weeks of treatment.

RESULTS

Sixty-six children were enrolled. At week 8, 78% (21/27) of the children with EE at baseline had healed; the remaining six children were healed by week 12 (100%, 6/6). By investigator interview, 70% of children experienced resolution or improvement in their overall symptoms of GERD by their final visit. Statistically significant reductions from baseline in the severity of each symptom were reported with the exceptions of wheezing, hematemesis, and melena. Based on daily diary data, improvement in overall GERD symptoms was reported in 76% (47/62) of all children. With few exceptions, significant (P < 0.05) reductions from baseline occurred during each of the 2-week treatment intervals of the study period in the percentage of days and the average daily severity of GERD symptoms, the percentage of days antacid was used, and the average number of antacid tablets used per day.

CONCLUSION

In children 1 to 11 years of age, lansoprazole is efficacious in healing EE and in relieving GERD-related symptoms.

Creatine supplementation and health variables: a retrospective study

PURPOSE

Long-term safety of creatine supplementation has been questioned. This retrospective study was performed to examine markers related to health, the incidence of reported side effects and the perceived training benefits in athletes supplementing with creatine monohydrate.

METHODS

Twenty-six athletes (18 M and 8 F, 24.7 +/- 9.2 y; 82.4 +/- 20.0 kg; 176.5 +/- 8.8 cm) from various sports were used as subjects. Blood was collected between 7:00 and 8:30 a.m. after a 12-h fast. Standard clinical examination was performed for CBC and 27 blood chemistries. Testosterone, cortisol, and growth hormone were analyzed using an ELISA. Subjects answered a questionnaire on dietary habits, creatine supplementation, medical history, training history, and perceived effects of supplementation. Body mass was measured using a medical scale, body composition was estimated using skinfolds, and resting heart rate and blood pressure were recorded. Subjects were grouped by supplementation length or no use: Gp1 (control) = no use (N = 7; 3 F, 4 M); Gp2 = 0.8-1.0 yr (N = 9; 2 F, 7 M); and Gp3 = 1(+) (N = 10; 3 F, 7 M).

RESULTS

Creatine supplementation ranged from 0.8--4 yr. Mean loading dose for Gp2 and Gp3 was 13.7 +/- 10.0 and the maintenance dose was 9.7 +/- 5.7 g.d(-)1. Group differences were analyzed using one-way ANOVA.

CONCLUSIONS

Expected gender differences were observed. Of the comparisons made among supplementation groups, only two differences for creatinine and total protein (P < 0.05) were noted. All group means fell within normal clinical ranges. There were no differences in the reported incidence of muscle injury, cramps, or other side effects. These data suggest that long-term creatine supplementation does not result in adverse health effects.

Fetal biometry: a comparison of family physicians and radiologists

BACKGROUND AND OBJECTIVES

While performance and reading of obstetric sonograms is a skill widely taught in family practice residency programs, no prior studies have compared ultrasound performance and interpretation in residency programs with that of hospital radiologists. This study compares results of fetal biometry for gestational age determination performed sequentially by faculty-supervised residents and radiologists.

METHODS

This retrospective chart review selected cases from among all gravidas who had ultrasound performed in a family practice residency clinic between January 1992 and April 1999. Biometry was performed by residents under the supervision of faculty preceptors who had ultrasound training and experience. A patient was included if (1) results of both a family practice ultrasound and a radiologist-read hospital ultrasound were present in the chart, (2) both studies were done before 36 weeks gestation, and (3) the family practice examination preceded the hospital study. The difference in expected date of confinement between resident and radiologist ultrasound was calculated, and this difference was evaluated for statistical significance by a paired sample t test.

RESULTS

Ninety-two ultrasound pairs were assessed, a sample size that provided .90 power to detect a gestational age estimate difference of 3 days between family practice and radiologist interpretations. The normally distributed observed mean difference in gestational age estimates was only 1.5 days.

CONCLUSIONS

This study found no difference in gestational age assessment performed by closely supervised family practice residents in comparison to radiologists.

A confidential enquiry into methadone-related deaths

AIM

To assess the acceptability and usefulness of the "confidential enquiry" process in examining methadone-related deaths.

DESIGN

An audit of patient care.

SETTING

Glasgow, Scotland, UK (population 915,000) Participants. All doctors who, in the final 14 days of the patient's life, had attended a patient who suffered a methadone-related death.

MEASUREMENTS

The medical care of each case was assessed by peer review and the results of these assessments returned to the responsible clinician(s).

FINDINGS

(1) The audit cycle was completed in 32 of the 34 reported cases (94%). (2) Twenty-eight of 33 doctors (85%) found the audit to be helpful. (3) As a result of the enquiry, the majority of doctors whose patient management had attracted criticism intended to amend their practice. (4) Shortcomings in clinical care were identified in 18 cases (56%) and problems in the organization of services in 22 (69%).

CONCLUSIONS

(1) The model of audit piloted here was found to be highly acceptable to participants. (2) The episodes of substandard care that were uncovered provided useful opportunities to improve the future management of patients who were being prescribed methadone.

Attenuation of IL-5-mediated signal transduction, eosinophil survival, and inflammatory mediator release by a soluble human IL-5 receptor

A soluble form of the human IL-5R alpha-chain (IL-5Ra) that contains the extracellular IL-5 binding domain has been evaluated for its effect on IL-5 binding to and activation of human eosinophils and basophils. The truncated receptor was expressed in Escherichia coli and recovered in biologically active form following renaturation and anion exchange chromatography. The soluble receptor formed a 1/1 complex with IL-5 in solution and bound IL-5 with affinity comparable to that of cell-associated IL-5Ra. Soluble IL-5Ra also competed with IL-5 for binding to the native alpha beta IL-5R on human cells and inhibited IL-5-mediated receptor activation and inflammatory mediator production. In this regard, the soluble receptor prevented IL-5-induced tyrosine phosphorylation of JAK2 kinase and IL-5R beta-chain and inhibited IL-5 priming of leukotriene C4 release by human basophils. However, the E. coli-derived receptor failed to inhibit IL-5 in longer term assays, including eosinophil survival and TF-1 cell proliferation, possibly due to its propensity to aggregate in a time- and temperature-dependent manner. In contrast, we observed that a soluble IL-5Ra derived from baculovirus-infected cells was less prone to aggregate and effectively antagonized IL-5-induced cell proliferation and survival. These findings indicate that the extracellular portion of the human IL-5Ra chain can prevent association of IL-5 with cell surface receptors and can attenuate signal transduction, mediator release, and survival of inflammatory cells. As such, soluble IL-5R may be useful in treating diseases such as human asthma, in which pulmonary injury is associated with the activity of IL-5R-bearing cells.

Attenuation of IL-5-mediated signal transduction, eosinophil survival, and inflammatory mediator release by a soluble human IL-5 receptor

A soluble form of the human IL-5R alpha-chain (IL-5Ra) that contains the extracellular IL-5 binding domain has been evaluated for its effect on IL-5 binding to and activation of human eosinophils and basophils. The truncated receptor was expressed in Escherichia coli and recovered in biologically active form following renaturation and anion exchange chromatography. The soluble receptor formed a 1/1 complex with IL-5 in solution and bound IL-5 with affinity comparable to that of cell-associated IL-5Ra. Soluble IL-5Ra also competed with IL-5 for binding to the native alpha beta IL-5R on human cells and inhibited IL-5-mediated receptor activation and inflammatory mediator production. In this regard, the soluble receptor prevented IL-5-induced tyrosine phosphorylation of JAK2 kinase and IL-5R beta-chain and inhibited IL-5 priming of leukotriene C4 release by human basophils. However, the E. coli-derived receptor failed to inhibit IL-5 in longer term assays, including eosinophil survival and TF-1 cell proliferation, possibly due to its propensity to aggregate in a time- and temperature-dependent manner. In contrast, we observed that a soluble IL-5Ra derived from baculovirus-infected cells was less prone to aggregate and effectively antagonized IL-5-induced cell proliferation and survival. These findings indicate that the extracellular portion of the human IL-5Ra chain can prevent association of IL-5 with cell surface receptors and can attenuate signal transduction, mediator release, and survival of inflammatory cells. As such, soluble IL-5R may be useful in treating diseases such as human asthma, in which pulmonary injury is associated with the activity of IL-5R-bearing cells.

Elemental analysis of renal slices by proton-induced X-ray emission

We optimized proton-induced X-ray emission (PIXE) for tissue analysis in a toxicity-disposition study. We used cultured rabbit renal slices as the biological system to demonstrate the use of PIXE analysis. The renal slices were exposed to HgCl2, CdCl2, K2Cr2O7, or NaAsO2 alone or in a mixture. The PIXE analysis provides information on concentrations of elements above atomic number 11, and it is the only analytical technique that can determine 20-30 elements nondestructively in a single, small sample (approximately 5 mg) with detection limits of 1-5 ppm (dry weight). The renal slices are thin targets that yield X-ray emission spectra with low backgrounds and high elemental sensitivities. The nondestructive nature of PIXE and the ability to simultaneously measure uptake of multiple metals and endogenous elements are unique to this methodology.

Can the heart be chronically paced with electrodes on the pericardial surface?

During implantable defibrillator (ICD) operations, we measured acute and chronic transpericardial bipolar pacing thresholds through standard myocardial surface electrodes sewn on the pericardium for chronic ICD QRS rate-sensing use. We compared observations in 24 patients on day 0 with chronic measurements in seven patients at 27.4 +/- 12.1 (median 31.7) months. The leads were used only for QRS rate-sensing, not for pacing, during the time between acute and chronic measurements. Acute transpericardial pacing threshold at 0.5-msec stimulus duration on day 0 was 4.5 +/- 2.19 V (standard deviation), median 3.5 V, and at median time 964 days postimplantation was 3.8 +/- 2.07 V, median 3.5 V. Mean acute pacing current threshold was 3.7 +/- 1.90 mA, n = 23, and chronic was 2.7 +/- 1.79 mA, n = 6. Acute bipolar impedance was 1,209 +/- 383 ohms, median 1,138 ohms, and chronic was 1,550 +/- 358 ohms, median 1,410 ohms, n = 7. Acute bipolar QRS amplitude was 12.3 +/- 5.93 mV, median 12.1 mV, n = 24, and chronic was 13.5 +/- 8.5 mV, median 17.2 mV, n = 7. None of the changes between the acute and chronic states was statistically significant, with the exception of bipolar impedance (P = 0.054). We concluded that: (1) transpericardial pacing threshold did not increase with time; (2) initial and chronic pacing impedances were high and current low; (3) QRS amplitudes were highly satisfactory for defibrillator rate-sensing; and (4) this approach to ICD implantation left the surgically virgin heart unscarred to make future transplantation easier, and enhanced safety when previous cardiac operations had been done.

Hepatoid adenocarcinoma of the papilla of Vater

An adenocarcinoma of the papilla of Vater showing hepatoid differentiation similar to that described for hepatoid adenocarcinoma of the stomach is reported. The tumor was a poorly differentiated adenocarcinoma with clear cells containing occasional hyaline droplets and exhibiting bile secretion. Alpha-fetoprotein (AFP), alpha 1-antitrypsin (alpha 1-AT) and carcino-embryonic antigen (CEA) were demonstrated by immunoperoxidase staining. This appears to be the first report of a hepatoid adenocarcinoma at this location.

Lead effects on postural balance of children

The postural sway responses of 63 children with a mean age of 5.74 years were quantified with a Force Platform technique. The average maximum (max) blood lead (PbB) of these children during the first 5 years of life was 20.7 micrograms/dL (range 9.2 to 32.5). The backward stepwise regression analysis for sway area response during the eyes-closed, no-foam test with all the covariates and confounders and the PbB parameters showed a significant relationship with peak or max PbB during the second year of life. These results are consistent with our previous study with a smaller group of children. The data have been analyzed to provide some insight into the role of various afferent for the maintenance of postural balance. The results suggests a hypothesis that if the max PbB had caused some level of impairment in the functional capacities or interconnectivity of the vestibular and/or proprioception systems at 2 years of age, then it is reasonable to assume that the redundancy in the postural afferent systems would naturally adapt to rely more on the remaining intact afferent system (in this case, vision).

Role of glycine in the N-methyl-D-aspartate-mediated neuronal cytotoxicity

Current evidence indicates that glutamate acting via the N-methyl-D-aspartate (NMDA) receptor/ion channel complex plays a major role in the neuronal degeneration associated with a variety of neurological disorders. In this report the role of glycine in NMDA neurotoxicity was examined. We demonstrate that NMDA-mediated neurotoxicity is markedly potentiated by glycine and other amino acids, e.g., D-serine. Putative glycine antagonists HA-966 and 7-chlorokynurenic acid were highly effective in preventing NMDA neurotoxicity, even in the absence of added glycine. The neuroprotective action of HA-966 and 7-chlorokynurenic acid, but not that of NMDA antagonists 3-(2-carboxypiperazine-4-yl)propylphosphonate and MK-801, could be reversed by glycine. These results indicate that glycine, operating through a strychinine-insensitive glycine site, plays a central permissive role in NMDA-mediated neurotoxicity.

An endostomal tracheostomy tube for leakproof retention of the Blom-Singer stomal valve

Patients in whom fistula speech has developed after laryngectomy usually have to occlude their stoma with a finger to talk. This prevents the air that is needed to activate the fistula from being exhaled through the stoma. In order to free the hand, Blom and Singer devised a diaphragm-valved stomal device known as the tracheostoma valve. This device snaps into a flexible retention housing that must be carefully cemented to the skin. Some patients who have undergone near-total laryngectomy (and others with tracheo-esophageal voice prostheses) are unable to use their devices because the moisture and pressure around their stomas break the seal. Since air that is used to produce voice with the valve tends to lift the housing away from the stoma, a better housing design would assure that this motion would improve the seal.

Isolation of serine:glyoxylate aminotransferase from cucumber cotyledons

Serine:glyoxylate aminotransferase, a marker enzyme for leaf peroxisomes, has been purified to homogeneity from cucumber cotyledons (Cucumis sativus cv Improved Long Green). The isolation procedure involved precipitation with polyethyleneimine, a two-step ammonium sulfate fractionation (35 to 45%), gel filtration on Ultrogel AcA 34, and ion exchange chromatography on diethylaminoethyl-cellulose, first in the presence of pyridoxal-5-phosphate, and then in its absence. The enzyme was purified approximately 690-fold to a final specific activity of 34.4 units per milligram. Electrophoresis of the purified enzyme on sodium dodecyl sulfate-polyacrylamide gels revealed two polypeptide bands with apparent molecular weights of approximately 47,000 and 45,000. Both polypeptides coeluted with enzyme activity under all chromatographic conditions investigated, both were localized to the peroxisome, and both accumulated in cotyledons as enzyme activity increased during development. The two polypeptides appear not to be structurally related, since they showed little immunological cross-reactivity and gave rise to different peptide fragments when subjected to partial proteolytic digestion. Antiserum raised against either the denatured enzyme or the 45,000-dalton polypeptide did not react with any other polypeptides present in a crude cotyledonary homogenate. The purified enzyme also had alanine:glyoxylate aminotransferase activity, but was about twice as active with serine as the amino donor.

Absence of mucosal atrophy in human small intestine after prolonged isolation

Light and electron microscopic evaluation of segments of human jejunum (bypassed for 3 1/3 years in treatment of morbid obesity) and ileum (bypassed for 6 years as a Thirty-Vella fistula in treatment of postsurgical fistula) showed no obvious evidence of widespread mucosal atrophy. The findings contrast with those reported in experimental animals and in most human patients with ileal urinary conduits, where atrophy of the isolated segment is the rule. Perhaps nonluminal factors in the human subject are sufficient to maintain small intestinal mucosa for long periods in the absence of intestinal chyme.