Successful treatment with 308‐nm monochromatic excimer light and subsequent tacrolimus 0.03% ointment in refractory plasma cell cheilitis

Plasma cell cheilitis is a chronic inflammatory disease that presents with erythema, erosions, ulcers and occasional nodules within the mucosa, including the lips. It is histopathologically characterized by dense plasma cell infiltration in the lamina propria of the mucous membranes. Several treatments for plasma cell cheilitis have been reported, including topical steroids, topical antibiotics or topical tacrolimus. However, 308‐nm monochromatic excimer light (MEL) has never been reported as a treatment option, while it was reported to be very effective in treating erosive oral lichen planus. We report a 62‐year‐old man who had chronic plasma cell cheilitis on the lower lip, which was refractory to topical and systemic corticosteroid. The lesion and severe pain were significantly improved by the treatment with nine sessions of 308‐nm MEL twice per week with a total dose of 1120 mJ/cm². However, the lesion gradually worsened after treatment frequency was reduced to once per month. Subsequent tacrolimus 0.03% ointment cleared the lesion completely in a month and no recurrence was observed a year later. Refractory plasma cell cheilitis and concomitant severe pain quickly responded to 308‐nm MEL when administrated twice per week. Because the long interval between each MEL treatment seemed ineffective to improve the lesion, appropriate frequency and adequate total dose of MEL treatment may be necessary for a successful treatment.     

年轻吸烟者对错误反应影响的事件相关电位研究

目的:通过事件相关电位技术和Eriksen Flanker任务的结合,探讨青少年吸烟者的认知控制能力是否存在异常。方法:采用被试者包括吸烟者19名(n=19),以及年龄、性别、受教育年限等与之相匹配的健康非吸烟者19名(n=19),比较两组的错误相关成分错误正波及其行为学任务表现。结果:与健康非吸烟者相比,吸烟组的错误数明显增加(F=5.133,P=0.030)。同时,青少年吸烟者的错误正波Pe的波幅有明显降低(P<0.001)。结论:青少年吸烟者存在错误处理缺陷,错误处理能力的降低可能与吸烟有关。     

A single pulmonary rheumatoid nodule masquerading as malignancy

We present a 54-year-old man, a heavy smoker, with clinical and laboratory evidence of familial hypercholesterolemia and an asymptomatic solitary pulmonary nodule (SPN) increasing in size on follow-up chest X–ray. Laboratory work-up revealed high titers of rheumatoid factor and the presence of acute phase reactants. Because of the patients age and history of smoking, open lung biopsy was performed to rule out malignancy. The biopsy showed histological features compatible with a rheumatoid nodule. Identical features were noted in the histological examination of the subcutaneous nodule. Usually, rheumatoid nodules occur in patients with active, long-standing rheumatoid arthritis (RA) with other extra-articular manifestations. The presence of a single pulmonary rheumatoid nodule as the first manifestation of RA is extremely rare. Histologic proof is often required since pulmonary carcinoma can present an identical clinical and radiological pattern. The diagnostic work-up and the differential diagnosis of an SPN, particularly in a heavy smoker, is a common clinical request and remains a diagnostic challenge.     

Do components of current ‘hardcore smoker’ definitions predict quitting behaviour?

Aims It has been hypothesized that the smoking population is represented by an increasingly ‘hardcore’ group of smokers who are resistant to quitting. Many definitions of ‘hardcore smokers’ have been used, but their predictive validity is unknown. To evaluate whether ‘hardcore smoker’ definition components predict quitting behaviours and which combinations of ‘hardcore’ components are most predictive. Design, setting and participants Longitudinal, random telephone survey of a representative sample of adult smokers in Ontario, Canada (n = 4130, recruited 2005–08 and followed for 1 year). Measurements Multiple logistic regression models were compared to evaluate the predictive ability of ‘hardcore’ components (high daily cigarette consumption, high nicotine dependence, being a daily smoker, history of long‐term smoking, no quit intention and no life‐time quit attempt) on three outcomes [continued smoking, not attempting to quit and having unsuccessful quit attempt(s)]. Findings All ‘hardcore’ components predicted having no quit attempt and continued smoking during follow‐up (P < 0.05), except for history of long‐term smoking and no life‐time quit attempt (for continued smoking). Among respondents who made 1 + quit attempts during follow‐up, only high nicotine dependence, high daily cigarette consumption and being a daily smoker were predictive of quitting failure (P < 0.01). The best combination of components depended on the outcome. Conclusions Measures of ‘hardcore’ include a mixture of motivational, dependence and behavioural variables. As found previously, motivational and behavioural measures, such as intention to quit, predict failure to make quit attempts. However, dependence components best predicted continued smoking and thus would be best for further exploring the hardening hypothesis.     

Results of 10-year mobile low-dose computed tomography screenings for lung cancer in Shimane,Japan

BackgroundSome randomized controlled trials have evaluated the effects of low-dose computed tomography (CT) screening on lung cancer mortality in heavy smokers. Based on the results of those trials, our CT screening program recommended screening for people aged ≥40 years with a history of smoking. This retrospective study aimed to verify the validity of our CT screening program and elucidate the current state of CT screening program.MethodsWe retrospectively examined lung cancer detection in 25,189 participants who underwent chest CT screening by a mobile low-dose CT screening unit in the 10-year period from April 2009 to March 2019. Participants were recruited at Japan Agricultural Cooperatives (JA) Shimane Kouseiren. Participants requested CT screening for lung cancer. CT images were read by two pulmonologists.ResultsLung cancer was identified in 82 of the 25,189 participants over 10 years, an overall lung cancer detection rate (percentage of lung cancers detected among all participants) of 0.33%. Lung cancer among never smokers accounted for 54.9% of the detected cases. The lung cancer detection rate was similar for smokers versus never smokers. The stage IA detection rate (percentage of stage IA lung cancers among all lung cancers detected) was 62%, while the stage Ⅳ detection rate was 10%.ConclusionsChest CT detected lung cancer in never smokers as well as current or former smokers. Our CT screening program was not effective for never smokers; thus, further study of the effectiveness of CT screening in never smokers is needed.     

基于独立成分分析的青年吸烟者大脑静息态执行网络功能连接变化研究

采用独立成分分析方法探索40名青年吸烟者和40名年龄与性别相匹配的非吸烟者的静息态功能磁共振数据,并结合“双重回归”方法探索吸烟者执行网络功能连接变化,同时将有变化的脑区与吸烟统计学数据进行Pearson’s双变量相关分析,例如年龄、包年、FTND、烟龄等。通过研究发现,青年吸烟者的大脑右中央执行网络的功能连接性增强,相关分析表明执行网络包含的背外侧前额叶皮质与烟龄呈显著性负相关（r=-0.339, P=0.032）。此项研究结果表明,吸烟对右侧中央执行网络的功能连接有一定的影响,研究结果可能为青年吸烟成瘾者的神经机制的特征提供额外的新见解。     

Tobacco chippers show robust increases in smoking urge after alcohol consumption

Objective and rationale Heavy social drinkers often engage in occasional cigarette smoking, especially in the context of consuming large quantities of alcohol. The current study assessed alcohol’s effects on smoking urge as a function of alcohol dose and time course in tobacco chippers with heavy social drinking patterns. Method The study assessed 39 chippers who underwent three separate evening sessions. Each subject received a placebo (1% volume alcohol as a taste mask), a low alcohol dose (two to three drinks equivalent), and a high alcohol dose (four to five drinks equivalent) in random order. No smoking was permitted during the sessions and the participants were abstinent from smoking for at least 3 h before arrival. Throughout the session, cigarette craving was assessed by the Brief Questionnaire of Smoking Urges and alcohol response was assessed by the Biphasic Alcohol Effects Scale (BAES). Results The results showed that alcohol significantly increased cigarette craving in a dose-dependent manner (p<0.001). At the high alcohol dose, craving was heightened during the rising portion of the blood alcohol curve (BAC). There was a strong relationship between BAC and craving for positive reinforcement and this relationship was partially mediated by BAES stimulation, but not sedation. Conclusions The findings show that alcohol directly increases smoking urge in chipper smokers. Tobacco chippers may crave cigarettes more during heavier than during lighter drinking bouts, and this effect appears to be driven by heightened stimulation levels rather than as a means to offset alcohol’s sedative effects.     

主动和被动吸烟者尿尼古丁代谢产物排泄时间和总量的比较研究

本研究选择主动吸烟者4人,被动吸烟者6人,通过人体暴露试验,采用DETB萃取法测定其尿中的尼古丁代谢产物。结果表明,对于一次性剂量暴露试验,应以总排泄量作为比较依据;主动吸烟者尿尼古丁代谢产物的排泄完全时间小于36小时,被动吸烟者约为24小时;主、被动吸烟者的代谢半衰期均约为12小时;在本研究条件下,主、被动吸烟者排泄总量比为5:1。     

Determinants of accident proneness: a case-control study in railway workers

BACKGROUND: Accident proneness or workers who have more frequent occupational injuries is common but the role of occupational and individual factors has rarely been studied. AIM: To assess the relationships of certain occupational and individual characteristics with frequency of occupational injuries. METHOD: This case-control study included 1305 male workers with occupational injuries during 1999-2000 and 1305 controls from a railway company. A standardized questionnaire was completed by the occupational physician in the presence of the subject. The data were analysed using logistic regression. RESULTS: Having more than one injury was associated with short service in the present job, younger age, sleep disorders, smoking, requesting a job change, physical disability and lack of physical activity. Safety training was negatively related to injury frequency. Short service in the present job was the only significant factor for single injuries. CONCLUSION: This study identified a number of work and individual factors that predicted occupational injury frequency and may be useful in designing preventative measures. Occupational physicians could assist workers to be more aware of the risks and to find remedial measures.