Preoperative tendon retraction,not smoking,is a risk factor for failure with continuity after rotator cuff repair

BackgroundSmoking is a poor prognostic factor for healing after rotator cuff repair and is associated with inferior results. We hypothesized that smokers would have higher recurrent tear rates and more postoperative myotendinous junction (MTJ) retraction in healed repairs than nonsmokers three months postoperatively.MethodsRotator cuff repairs (RCRs) were retrospectively reviewed over a 2-year period. Patients underwent magnetic resonance imaging (MRI) within 6 months prior to surgery and again at 3 months postoperatively. Seventy-nine patients were included and stratified by smokers versus nonsmokers. Baseline patient demographics, tear characteristics, and surgical factors were collected. Preoperative and postoperative MRIs were assessed to quantify the MTJ position and to establish the recurrent tear rate.ResultsFor the total cohort (nonsmokers, n = 56; smokers, n = 23), significant differences in age, race, and traumatic onset of injury existed between groups. There were no significant differences in recurrent tear between smokers (26%) and nonsmokers (27%), but nonsmokers were more satisfied. For patients with healed RCRs (nonsmokers, n = 41; smokers, n = 17), there were significant differences in race. On univariate analysis, nonsmokers had a significantly more lateral MTJ postoperatively (P = 0.05). On multivariable regression analysis, medialized postoperative MTJ position in healed cuffs was driven only by greater preoperative rotator cuff retraction preoperatively. There were no significant differences in MTJ position based on smoking status for patients with healed RCRs.ConclusionSmoking does not appear to be an independent risk factor for postoperative MTJ retraction in healed RCRs, also known as failure in continuity. Preoperative tear size and retraction play the biggest roles in predicting postoperative MTJ position, regardless of smoking status. There are no significant differences in patient-reported outcomes for patients with healed RCRs, but nonsmokers had more satisfaction following RCR in the total cohort.Level of EvidenceLevel III; Retrospective cohort study; Diagnostic study     

Smoking a virtual cigarette increases craving among smokers

Previous studies have shown the efficacy of virtual reality (VR) environments that reproduce smoking-related stimuli for increasing self-reported craving and psychophysiological reactivity in smokers. However, no study to date has attempted to simulate smoking behavior itself by means of VR technology. The aim of this study was to assess the effect of smoking a virtual cigarette on self-reported craving levels and heart rate (HR) in a sample of smokers. Participants were 45 smokers randomly assigned to three VR conditions built into a virtual pub: smoking a virtual cigarette, throwing virtual darts at a virtual dartboard or just being in the virtual pub. Results showed that smoking a virtual cigarette significantly increased self-reported craving and HR when compared to the other two conditions. These results reveal that simulation of smoking behavior in a VR environment functions as an efficacious proximal cue that can be used for triggering craving under the cue-exposure paradigm.     

Adolescent Internet use and its relationship to cigarette smoking and alcohol use: A prospective cohort study

The present study aims to investigate the longitudinal impact of situational Internet use on future cigarette smoking and alcohol use among male and female adolescents. A Northern Taiwanese cohort sample of adolescents with no prior use of cigarettes (n = 1445) or alcohol (n = 1468) was surveyed at age 16 and again 4 years later. Information regarding where, why, and length of time spent using the Internet was gathered from the 16-year-old participants. Outcome information regarding cigarette/alcohol use was gathered via a follow-up questionnaire at age 20. Multivariate regressions were used to incorporate peer, individual and family characteristics as measured at age 16 and create models of future cigarette and alcohol use at age 20. The analyses demonstrated that adolescent Internet use, particularly where such use took place, has a significant impact on future cigarette smoking and alcohol use, adjusted for conventional factors, and its relationship differs significantly by gender. Female adolescents with Internet café use appear to be especially likely to develop these two risky behaviors. The why of Internet use is also a predictor of future cigarette smoking. Finally, time spent using the Internet is significantly related to alcohol use; greater use of the Internet is associated with higher levels of drinking. The results revealed that different risky behaviors are differentially influenced by separate components of adolescent Internet use. These findings suggest that programs aimed at promoting adolescent health could potentially benefit Taiwanese adolescents by including components related to situational Internet use and taking gender into consideration.     

Cadmium,smoking, and reduced levels of exhaled nitric oxide among US adults

Exposure to cadmium is known to be associated with reducing nitric oxide (NO) production in experimental conditions, but few studies have examined the association between environmental cadmium exposures and exhaled NO in human. We examined the association between blood cadmium levels and exhaled NO levels in a representative sample of US adults. This investigation was a cross-sectional study of 7813 adults (≥20 years) who participated in the 2007–2008 and 2009–2010 National Health and Nutrition Examination Survey and had their exhaled NO and blood cadmium measurements recorded. The geometric means of the exhaled NO and blood cadmium levels were 13.3 ppb (95% CI: 12.7, 13.9) and 0.51 μg/dL (95% CI: 0.48, 0.54), respectively. Higher blood cadmium levels were associated with decreased exhaled NO levels after adjusting for potential confounding variables. Additionally, a two-fold increase in the blood cadmium levels was associated with a 5% decrease in the exhaled NO levels. The results were significant regardless of the subjects’ smoking status or serum cotinine levels, although the percent changes in the exhaled NO levels differed depending on the extent of smoking.Our findings suggest that blood cadmium levels may be associated with reduced levels of exhaled NO in a general sample of US adults. Moreover, cadmium may partially mediate the effect of smoking on exhaled NO production.     

Association of deferring a quit attempt with smoking cessation success: A secondary analysis

Several smoking cessation treatments ask smokers to wait to quit to obtain treatment. We report a secondary analysis of whether a later quit attempt is associated with less success. In a placebo-controlled trial of varenicline that allowed smokers to set their quit date within 5 weeks after starting medication, 24% had their first quit attempt during week 1, and 27%, 19%, 18% and 12% in subsequent weeks. Continuous abstinence between 9 and 24 weeks declined over time; that is, from 36% to 37%, 35%, 29%, and 18% across the 5 weeks (p < 0.001). The only statistically significant difference was between the last week and prior weeks. Whether a later quit attempt actually causes less success or is a marker for other variables (e.g., low motivation) is unclear.