Advice and advocacy save lives

Tobacco use remains the leading cause of preventable premature death in the United States and, increasingly, around the world. This paper describes the critical role physicians can play in decreasing tobacco use by providing smoking cessation advice and engaging in antismoking advocacy. By helping patients who smoke to quit and working to diminish the economic and political power of the tobacco industry, physicians and other health professionals can help "make smoking history."     

Hypertension and cerebrovascular disease

Cerebrovascular disease (CVD) is the third leading cause of death in United States and hypertension is a leading cause of both stroke and heart disease. It may cause headache, acute hypertensive encephalopathy, dementia and various types of strokes e.g., thrombotic, haemorrhagic, lacunar infarcts and transient ischaemic attacks. It remains the singlemost important treatable risk factor for stroke in all age groups and modern antihypertensive therapy has its documented prevention of stroke. Hypertension in acute phase of ischaemic stroke should not be treated. Hypertension in acute stroke should be treated. In advanced centres with specialised stroke units, the favoured drugs are short acting vasodilators e.g., sodium nitroprusside and labetalol. Nifedipine is the most popular drug followed by captopril, both sublingually and orally.     

Proportionate mortality trends: 1950 through 1986

Mortality trends in the United States from 1950 through 1986 were analyzed for the conditions that are or have recently been among the six leading causes of death. The age-adjusted mortality rate for all causes has decreased from 841.5 to 541.7 per 100,000 population. Cause-specific, age-adjusted mortality rates have declined from 1950 through 1986 for cerebrovascular disease, injuries, perinatal conditions, heart disease, and influenza and pneumonia. Time trends in the proportion of persons dying of each of these diseases, however, have varied; the proportion dying of cerebrovascular disease, injuries, and perinatal conditions has decreased, and the proportion of persons dying of heart disease and influenza and pneumonia has remained fairly stable from 1950 through 1986. During this same time, age-adjusted death rates have increased for chronic obstructive pulmonary disease and have remained fairly stable for malignant neoplasms, while the proportions of persons dying of chronic obstructive pulmonary disease and malignant neoplasms have increased dramatically. For people aged 35 to 64 years, malignant neoplasms have now overtaken heart disease as the leading cause of death. For those aged 65 years and older, heart disease remains the leading cause of death, accounting for almost 50% of all deaths in persons 85 years and older.     

Primary care management of childhood asthma

Asthma is the most common serious chronic disease of childhood and the eigthth leading cause of death in children 5-14 years of age in the United States. In Arkansas, asthma deaths among all ages average more than one per week, claiming 5-10 children in our state each year. However, childhood asthma continues to be under treated. Significant airway inflammation is present in early childhood. Asthma morbidity and mortality can be improved with early diagnosis, appropriate assessment of severity for which spirometry is required, the utilization of NIH preferred asthma controllers, and with scheduled follow-up visits to evaluate asthma control.     

吸烟对射血分数保留的心力衰竭患者不良事件的影响研究

背景　吸烟是发生射血分数保留的心力衰竭（HFpEF）的一个重要危险因素,既往研究证实吸烟是HFpEF患者死亡的一个重要预测因素。然而,在HFpEF患者中,吸烟与心力衰竭不良事件之间的关系尚未得到检验。目的　探讨吸烟与HFpEF患者心力衰竭不良事件之间的关系。方法　选取2013-2018年中南大学湘雅医学院附属海口医院心血管内科、全科医学科诊断的HFpEF患者为研究对象,收集其基线资料、既往病史、药物治疗数据等信息。根据吸烟状况分为目前吸烟、既往吸烟和从未吸烟三组,并比较三组之间的差异。采用Kaplan-Meier检验分析需要住院治疗的心力衰竭患者未校准的累积发病率、生存概率,并使用Log-rank检验比较差异,采用多因素Cox比例风险回归分析不同吸烟状况患者发生需要住院治疗的心力衰竭、死亡和心源性死亡风险。结果　最终入组1 717例HFpEF患者,年龄58~87岁,平均年龄（72.2±10.3）岁,目前吸烟116例（6.7%）、既往吸烟872例（50.8%）、从未吸烟729例（42.5%）。中位随访时间为2.9年,387例（22.5%）患者出现需要住院治疗的心力衰竭,374例（21.8%）死亡,218例（12.7%）心源性死亡。不同吸烟状况HFpEF患者需要住院治疗的心力衰竭未校准的累积发病率、生存概率比较,差异均有统计学意义（Log-rank P=0.003、0.044）。多因素Cox比例风险回归分析结果显示,目前吸烟是HFpEF患者发生需要住院治疗的心力衰竭〔HR=1.680,95%CI（1.083,2.606）〕、死亡〔HR=1.820,95%CI（1.195,2.773）〕、心源性死亡〔HR=1.850,95%CI（1.092,3.133）〕的影响因素（P<0.005）。结论　目前吸烟与HFpEF不良临床结局的风险增加有关,尤其是需要住院治疗的心力衰竭。戒烟策略可能有助于降低HFpEF患者心血管不良事件的风险。     

Corticosteroid resistance in chronic obstructive pulmonary disease: new uses of theophylline

Chronic obstructive pulmonary disease (COPD) is a major global health problem with a rising morbidity and mortality,which is expected to account for about 27％ of tobacco related deaths and is anticipated to move from the fifth to the fourth leading cause of death worldwide from 2002 to 2030.1 COPD is characterized by the abnormal and chronic inflammation induced by cigarette smoking and other inflammatory insults in both small airway and lung parenchyma.2,3 Glucocorticosteroids (also called glucocorticoids,corticosteroids or steroids) are the most effective anti-inflammatory drugs available for the treatment of many chronic inflammatory and immune diseases.4 However,corticosteroids have limited benefit in treating stable COPD5 defined as (relative) steroid insensitivity or resistance6 and may be characteristic of all phenotypes of COPD.Although anti-inflammatory treatments are expected to effectively treat inflammation of COPD,almost all anti-inflammatory approaches risk increasing the extent of infection by blunting host defence mechanisms.Their effectiveness in humans has been limited by various side effects.5 Therefore,it is important to develop a treatment to enhance corticosteroid anti-inflammatory action in COPD.     

风湿免疫病患者并发心血管疾病的研究进展

风湿免疫病是一组常见的慢性疾病，主要影响关节、肌腱、韧带、骨骼和肌肉组织，这类疾病可导致身体的残疾。尽管由于早期的诊断，积极有效的治疗，在过去的几十年里，风湿免疫病患者的死亡率明显下降，然而，和正常人群相比，风湿免疫病患者的死亡率仍然很高。流行病学证据显示较高的死亡率归因于风湿免疫病患者较高的并发症，尤其是心血管并发症，如缺血性心脏疾病、心瓣膜疾病、心肌病、心包疾病和心脏传导系统的异常。尽管风湿免疫病患者伴发心血管疾病的机理尚不完全清楚，但是传统心血管病的风险因子如吸烟、缺乏锻炼、高血压、高血脂、高血糖，风湿免疫病患者体内持续的慢性炎症和药物治疗带来的副作用如糖皮质激素的长期应用等可能是风湿免疫病患者伴发心血管疾病的主要原因。风湿免疫病可增加患心血管疾病的风险，而心血管疾病又是风湿病患者死亡的首要原因。因此有效的预防和治疗心血管并发症非常重要，了解风湿免疫病患者的心血管疾病的伴发情况，可以更好的帮助患者预防这些并发症，延长寿命，提高生活质量。本文综述了近年来风湿免疫病患者伴发心血管疾病的临床常见情况及这些伴发疾病的发病机理和预防治疗的研究进展。      

Smoking vs other risk factors as the cause of smoking-attributable deaths: confounding in the courtroom

CONTEXT: The surgeon general estimates that more than 400,000 deaths are attributable to smoking annually in the United States. The tobacco industry has criticized the surgeon general's estimates because they do not control for the lower educational and socioeconomic status of modern-day smokers. OBJECTIVE: To determine whether controlling for education, occupation, race, alcohol consumption, and various dietary factors, in addition to age and sex, substantially alters the relative and attributable risk estimates associated with tobacco smoking. DESIGN, SETTING, AND PARTICIPANTS: Nationwide American Cancer Society prospective cohort study of 974, 150 US adults aged 30 years or older, enrolled in 1982 and followed up through 1988. (The same study is used for the surgeon general and Centers for Disease Control and Prevention [CDC] estimates of smoking-attributable deaths in the United States.) MAIN OUTCOME MEASURES: Death from each of the chronic diseases considered in the CDC's estimate of smoking-attributable mortality (cancers of the lung, oropharynx, larynx, esophagus, pancreas, kidney, bladder, and cervix; ischemic heart disease, arterial disease, and other heart conditions; stroke; chronic obstructive pulmonary disease; and other respiratory conditions). Estimates adjusted for multiple covariates were compared with those adjusted for age only among current and former vs never smokers. RESULTS: Adjusting for multiple covariates slightly decreased the relative and attributable risk estimates for current smoking in both men and women, but slightly increased the estimates for former smoking in women. Multivariate adjustment decreased the overall estimate of deaths attributable to smoking in the United States by approximately 1%, from 401,109 to 396,741 per year. CONCLUSIONS: Our study suggests that federal estimates of deaths caused by smoking are not substantially altered by adjustment for behavioral and demographic factors associated with smoking beyond the current adjustment for age and sex. JAMA. 2000;284:706-712     

Steroid allergy? A case report and review of the literature

Does "steroid allergy" truly exist? If in fact it does, what would be the potential impact on our patients? Steroids are used extensively in the treatment of asthma, chronic obstructive pulmonary disease (COPD) and allergy-related conditions. COPD is the 5th leading cause of death in the United States. Asthma affects about 5% of adults and is the most common chronic illness of children, prompting about 1.5 million patients to seek care in the Emergency Department (ED) annually. Steroids themselves, however, have actually been shown to induce hypersensitivity reactions. This is a case report on a steroid allergy and a review of the literature. Several cases worldwide were reviewed demonstrating steroid allergies of various types. The literature shows a small population of patients who may be susceptible to an allergic reaction to corticosteroids ranging from a simple skin reaction to anaphylactic shock. Steroid allergy must be considered more frequently.     

吸烟与慢性阻塞性肺疾病

慢性阻塞性肺疾病(COPD)发病率高,发病机制不明确,是多因素引起的疾病,吸烟是最主要的环境因素。在烟雾刺激下,以中性粒细胞为主要特征的慢性炎性细胞激活并分泌大量的蛋白酶、活性氧类和细胞因子,引起肺组织损伤,黏液分泌增多,并导致氧化/抗氧化、蛋白酶/抗蛋白酶失衡,最终导致气流受限和肺气肿。戒烟是预防COPD的重要措施,在COPD的任何阶段都能显著改善患者的生活质量,对减轻COPD患者肺组织的炎性反应有一定作用。     

Smoking and pregnancy.

Smoking is associated with decreased fertility in both males and females, an increased abortion rate, lowered birth weight, an increased still birth rate and probably an increased neonatal death rate. There is also a reduced incidence of maternal hypertension (although the babies are at even greater risk), an increased incidence of ante-partum haemorrhage, impaired brain development and possible teratogenic effects. These effects can be reversed if the mother gives up smoking in pregnancy.     

Prospects for research in diabetes mellitus

Diabetes mellitus is the sixth leading cause of death in the United States, and morbidities resulting from diabetes-related complications such as retinopathy, kidney disease, and limb amputation cause a huge burden to the national health care system. Identification of the genetic components of type 1 and type 2 diabetes is the most important area of research because elucidation of the diabetes genes will influence all efforts toward a mechanistic understanding of the disease, its complications, and its treatment, cure, and prevention. Also, the link between obesity and type 2 diabetes mandates a redoubled effort to understand the genetic and behavioral contributions to obesity.     

Diarrheal deaths in the United States, 1979 through 1987. A special problem for the elderly

OBJECTIVE.--Diarrhea is an important cause of death among young children in both developing and developed countries, but little is known about diarrheal death among adults. In this study, we examined trends in diarrheal deaths among all age groups in the United States. DESIGN/SETTING/PARTICIPANTS.--We reviewed national mortality data complied by the National Center for Health Statistics, Hyattsville, Md, which consists of information from all death certificates filed in the United States for the period 1979 through 1987. A death for which diarrhea was listed as an immediate or underlying cause was considered a "diarrheal death" and included in the analysis. RESULTS.--We found that 28,538 persons died of diarrhea cited as either an immediate or the underlying cause of death during the 9-year period. A majority of diarrheal deaths occurred among the elderly (older than 74 years of age, 51%), followed by adults 55 to 74 years of age (27%), and young children (younger than 5 years of age, 11%). For the elderly, adjusted risk factors for dying of diarrhea included being white, female, and residing in a long-term care facility. Only the elderly and young children had clear, distinct winter peaks of diarrheal deaths, suggesting that the diarrhea may, in part, be infectious in origin. CONCLUSION.--For the elderly, more directed studies of those at risk, such as nursing home residents, are needed to determine if oral rehydration therapy, vaccines, or other preventive measures might benefit this population.     

吸烟与牙周病的关系探讨

吸烟是引发牙周病的重要危险因子，可对机体内多个系统造成影响，该文就吸烟对牙周病发生和预后机制，对免疫系统、成纤维细胞、牙周炎下微生物的影响进行综述。     

Effect of smoking cessation on airway inflammation of rats with chronic bronchitis

Background Smoking is the major cause of airway inflammation in chronic obstructive pulmonary disease （COPD）, and smoking cessation is regarded as one of the important strategies for prevention and treatment of the inflammation. The inflammation of the chronic airway may be present and deteriorated even if the COPD patients stop smoking. Whether and how early smoking cessation affects the progress of inflammation is still obscure. This study was conducted to find the appropriate time for smoking cessation to terminate the airway inflammation in rats with smoke-induced chronic bronchitis. Methods A rat model of COPD was established by passively inhaling smoke mixture. Fifty-four young male Sprague-Dawley rats were randomly divided into 9 groups with different periods of smoke exposure and different time points of cessation. The inflammation markers to be detected included inflammatory cells in the bronchoalveolar lavage fluid （BALF）, the myeloperoxidose （MPO） activity, the morphologic changes and the expression of ICAM-1 on the airway epithelium. Results When smoking was terminated at early stage, the inflammatory markers and related indexes were different from those of the typical chronic bronchitis group （group M7） （P〈0.01）. The pathologic score of group SC7 （2 weeks of smoking cessation after occurrence of typical chronic bronchitis ） was not different from that of group M7, and the level of ICAM-1 was still up-regulated （compared to group M7, P〉0.05）. Meanwhile, most of inflammatory cells in BALF were neutrophils compared to other groups （P〈0.01）.When smoking was terminated, the MPO activity was significantly lower than that of group M7 （P〈0.01）. Conclusions Smoking cessation at early stage can effectively inhibit the inflammatory reaction of COPD. Once chronic bronchitis occurs, little could be improved by smoking cessation.     

Pulmonary disease: pneumonia, chronic obstructive pulmonary disease, asthma, and thromboembolic disease

Although many medical problems are generally managed in concert with a general medical physician, it is important for the podiatric physician to be familiar with some of the major diseases of the lung. Pneumonia, an infectious process within the lung, is the sixth-leading overall cause of death. Antibiotic treatment, oxygen administration, and supportive care are the mainstays of its therapy. Chronic obstructive pulmonary disease presents as a spectrum from chronic bronchitis, with a greater inflammatory component, to emphysema, with a more significant destructive component. Asthma, often a more episodic chronic obstructive disease, is characterized by inflammation of the airways leading to their narrowing. The work of breathing is often increased in these diseases, and treatment is with combination therapies with a focus on smoking cessation. Thromboembolic disease, the occlusion of blood vessels with consequent interruption of blood flow, may occur in a patient with risk factors, especially after surgery. Treatment is with anticoagulation agents or in some cases with thrombolysis. Prophylaxis is key.     

Comprehensive therapy of pancreatic cancer by integrative traditional and western medicine

In recent 20 years, there has been an increasing trend in the incidence of pancreatic cancer both at home and abroad. An estimated 31 860 new cases and 31 270 deaths are expected to occur in the United States in 2004 due to this disease, the 4th and 5th leading cause of cancer death for men and women respectively(1).     

脑卒中的社区防治现状

脑卒中（stroke）是一种遍及世界范围内的慢性非传染性疾病。目前脑卒中依然是世界范围内人口死亡的第3位病因和成人残疾的首要原因。社区预防策略的实施,能够有效降低脑卒中的发病率和复发风险,通过社区干预能提高易患人群脑卒中危险因素的治疗率和控制率,改善脑卒中患者的预后。     

Cardiomyopathy associated with the smoking of crystal methamphetamine

The smoking of crystal methamphetamine, or "ice," is a growing drug abuse problem in the United States. The toxic effects of methamphetamine smoking have not been well described. We describe two patients with cardiovascular toxic effects associated with the smoking of crystal methamphetamine. In our first patient, the use of smokeable methamphetamine was associated with the subsequent development of pulmonary edema and a dilated cardiomyopathy. In our second patient, the smoking of crystal methamphetamine likely produced diffuse vasospasm that resulted in acute myocardial infarction, cardiogenic shock, and death. The recognition of potentially lethal cardiac complications associated with the smoking of crystal methamphetamine is of extreme significance and should be emphasized to potential abusers of this drug.