Targeting OGG1 and PARG radiosensitises head and neck cancer cells to high-LET protons through complex DNA damage persistence

Complex DNA damage (CDD), containing two or more DNA lesions within one or two DNA helical turns, is a signature of ionising radiation (IR) and contributes significantly to the therapeutic effect through cell killing. The levels and complexity of CDD increases with linear energy transfer (LET), however, the specific cellular response to this type of DNA damage and the critical proteins essential for repair of CDD is currently unclear. We performed an siRNA screen of ~240 DNA damage response proteins to identify those specifically involved in controlling cell survival in response to high-LET protons at the Bragg peak, compared to low-LET entrance dose protons which differ in the amount of CDD produced. From this, we subsequently validated that depletion of 8-oxoguanine DNA glycosylase (OGG1) and poly(ADP-ribose) glycohydrolase (PARG) in HeLa and head and neck cancer cells leads to significantly increased cellular radiosensitivity specifically following high-LET protons, whilst no effect was observed after low-LET protons and X-rays. We subsequently confirmed that OGG1 and PARG are both required for efficient CDD repair post-irradiation with high-LET protons. Importantly, these results were also recapitulated using specific inhibitors for OGG1 (TH5487) and PARG (PDD00017273). Our results suggest OGG1 and PARG play a fundamental role in the cellular response to CDD and indicate that targeting these enzymes could represent a promising therapeutic strategy for the treatment of head and neck cancers following high-LET radiation.

TRIM26 Maintains Cell Survival in Response to Oxidative Stress through Regulating DNA Glycosylase Stability

Oxidative DNA base lesions in DNA are repaired through the base excision repair (BER) pathway, which consequently plays a vital role in the maintenance of genome integrity and in suppressing mutagenesis. 8-oxoguanine DNA glycosylase (OGG1), endonuclease III-like protein 1 (NTH1), and the endonuclease VIII-like proteins 1-3 (NEIL1-3) are the key enzymes that initiate repair through the excision of the oxidized base. We have previously identified that the E3 ubiquitin ligase tripartite motif 26 (TRIM26) controls the cellular response to oxidative stress through regulating both NEIL1 and NTH1, although its potential, broader role in BER is unclear. We now show that TRIM26 is a central player in determining the response to different forms of oxidative stress. Using siRNA-mediated knockdowns, we demonstrate that the resistance of cells to X-ray radiation and hydrogen peroxide generated as a consequence of trim26 depletion can be reversed through suppression of selective DNA glycosylases. In particular, a knockdown of neil1 or ogg1 can enhance sensitivity and DNA repair rates in response to X-rays, whereas a knockdown of neil1 or neil3 can produce the same effect in response to hydrogen peroxide. Our study, therefore, highlights the importance of TRIM26 in balancing cellular DNA glycosylase levels required for an efficient BER response.

Effectiveness of PARP inhibition in enhancing the radiosensitivity of 3D spheroids of head and neck squamous cell carcinoma

A critical risk factor for head and neck squamous cell carcinoma (HNSCC), particularly of the oropharynx, and the response to radiotherapy is human papillomavirus (HPV) type-16/18 infection. Specifically, HPV-positive HNSCC display increased radiosensitivity and improved outcomes, which has been linked with defective signalling and repair of DNA double-strand breaks (DSBs). This differential response to radiotherapy has been recapitulated in vitro using cell lines, although studies utilising appropriate 3D models that are more reflective of the original tumour are scarce. Furthermore, strategies to enhance the sensitivity of relatively radioresistant HPV-negative HNSCC to radiotherapy are still required. We have analysed the comparative response of in vitro 3D spheroid models of oropharyngeal squamous cell carcinoma to x-ray (photon) irradiation and provide further evidence that HPV-positive cells, in this case now grown as spheroids, show greater inherent radiosensitivity compared to HPV-negative spheroids due to defective DSB repair. We subsequently analysed these and an expanded number of spheroid models, with a particular focus on relatively radioresistant HPV-negative HNSCC, for impact of poly(ADP-ribose) polymerase (PARP) inhibitors (olaparib and talazoparib) in significantly inhibiting spheroid growth in response to photons but also proton beam therapy. We demonstrate that in general, PARP inhibition can further radiosensitise particularly HPV-negative HNSCC spheroids to photons and protons leading to significant growth suppression. The degree of enhanced radiosensitivity was observed to be dependent on the model and on the tumour site (oropharynx, larynx, salivary gland, or hypopharynx) from which the cells were derived. We also provide evidence suggesting that PARP inhibitor effectiveness relates to homologous recombination repair proficiency. Interestingly though, we observed significantly enhanced effectiveness of talazoparib versus olaparib specifically in response to proton irradiation. Nevertheless, our data generally support that PARP inhibition in combination with radiotherapy (photons and protons) should be considered further as an effective treatment for HNSCC, particularly for relatively radioresistant HPV-negative tumours.

USP9X Is Required to Maintain Cell Survival in Response to High-LET Radiation

Ionizing radiation (IR) principally acts through induction of DNA damage that promotes cell death, although the biological effects of IR are more broad ranging. In fact, the impact of IR of higher-linear energy transfer (LET) on cell biology is generally not well understood. Critically, therefore, the cellular enzymes and mechanisms responsible for enhancing cell survival following high-LET IR are unclear. To this effect, we have recently performed siRNA screening to identify deubiquitylating enzymes that control cell survival specifically in response to high-LET α-particles and protons, in comparison to low-LET X-rays and protons. From this screening, we have now thoroughly validated that depletion of the ubiquitin-specific protease 9X (USP9X) in HeLa and oropharyngeal squamous cell carcinoma (UMSCC74A) cells using small interfering RNA (siRNA), leads to significantly decreased survival of cells after high-LET radiation. We consequently investigated the mechanism through which this occurs, and demonstrate that an absence of USP9X has no impact on DNA damage repair post-irradiation nor on apoptosis, autophagy, or senescence. We discovered that USP9X is required to stabilize key proteins (CEP55 and CEP131) involved in centrosome and cilia formation and plays an important role in controlling pericentrin-rich foci, particularly in response to high-LET protons. This was also confirmed directly by demonstrating that depletion of CEP55/CEP131 led to both enhanced radiosensitivity of cells to high-LET protons and amplification of pericentrin-rich foci. Our evidence supports the importance of USP9X in maintaining centrosome function and biogenesis and which is crucial particularly in the cellular response to high-LET radiation.

The E3 Ubiquitin Ligase NEDD4L Targets OGG1 for Ubiquitylation and Modulates the Cellular DNA Damage Response

8-Oxoguanine DNA glycosylase (OGG1) is the major cellular enzyme required for the excision of 8-oxoguanine DNA base lesions in DNA through the base excision repair (BER) pathway, and therefore plays a major role in suppressing mutagenesis and in controlling genome stability. However, the mechanism of regulation of cellular OGG1 protein, particularly in response to oxidative stress, is unclear. We have purified the major E3 ubiquitin ligase responsible for OGG1 ubiquitylation from human cell extracts, and identify this as E3 ubiquitin-protein ligase NEDD4-like (NEDD4L). We demonstrate that recombinant NEDD4L stimulates ubiquitylation of OGG1 in vitro, particularly on lysine 341, and that NEDD4L and OGG1 interact in U2OS cells. Depletion of NEDD4L in U2OS cells has no impact on the stability and steady-state protein levels of OGG1, however, OGG1 stability is enhanced in response to oxidative stress induced by ionizing radiation. Furthermore, ubiquitylation of OGG1 by NEDD4L in vitro inhibits its DNA glycosylase/lyase activity. As a consequence of prolonged OGG1 stability and increased excision activity in the absence of NEDD4L, cells display increased DNA repair capacity but conversely that this decreases cell survival post-irradiation. This effect can be reproduced following OGG1 overexpression, suggesting that dysregulation of OGG1 increases the formation of lethal intermediate DNA lesions. Our study therefore highlights the importance of balancing OGG1 protein levels and BER capacity in maintaining genome stability.

CT characteristics of primary splenic torsion in eight dogs

Splenic torsion is a rare potentially life-threatening condition characterized by rotation of the spleen around the gastrosplenic and phrenosplenic ligaments leading to occlusion of venous drainage and arterial supply. This retrospective study describes the CT characteristics for dogs with surgically confirmed splenic torsion from 2013 to 2018 using the submissions to a large multinational teleradiology database. Eight dogs had the splenic torsion confirmed with surgery. Seven of eight cases had histology confirming congestion, hemorrhage, and necrosis, and one had concurrent myelolipoma infiltration. The CT characteristics included an enlarged (8/8), rounded (7/8), folded C-shaped spleen (8/8) with a difference of median parenchymal attenuation between pre- and postcontrast of +1.15 HU (Hounsfield units). Other common features included a mainly homogeneous parenchyma on pre- and post-contrast images (6/8), lack of subjective and objective vascular and parenchymal contrast enhancement (6/8) and free peritoneal fluid (6/8). A "whirl sign" was seen in the majority of cases (7/8) alongside a strongly hyperattenuating center (95-416 HU) on the precontrast images (5/7), which has not been previously described in the veterinary literature. Gastric position was normal in all cases. More variable CT characteristics of the confirmed torsions were attributable to suspected partial torsion and myelolipomatous infiltration. Overall, primary splenic torsion confirmed with surgery showed consistent characteristics on CT.

Multimodality characteristics of multifocal choroid plexus carcinoma with bilateral calvarial defects in a dog

An 8-year-old male intact miniature poodle presented for blindness, obtundation, tetraparesis, and vestibular signs. Magnetic resonance imaging, radiography, and ultrasound revealed a left piriform lobe lesion, right cerebellar and left brainstem lesions, and hydrocephalus and bilateral calvarial defects. Histopathology confirmed a choroid plexus carcinoma with meningeal and intraventricular metastases. The calvarial defect did not show evidence of necrosis, osteoclastic resorption, inflammation or neoplastic infiltration, reflecting a quiescent calvarial atrophy or dysplasia. These novel findings supported inclusion of bone atrophy secondary to chronic increased intracranial pressure as a differential diagnosis for large calvarial defects in dogs with choroid plexus carcinoma.

Effect of Physiological Concentrations of Vasopressin on Components of the Fibrinolytic System

High physiological concentrations of plasma vasopressin (aVP) when achieved by infusion cause an increase in plasma factor VIII coagulant activity and shortening of the euglobulin clot lysis time (ECLT). To investigate the effects of aVP on components of the fibrinolytic pathway and on thrombin generation, t healthy volunteers were infused with saline for 30 min followed by aVP for L hour and blood samples taken every 30 min for measurement of aVR ECtf tissue-type plasminogen activator (t-PA), t-PA inhibition (tPA-I), plasminogen activator inhibitor L (PAI-1 Ag), activated partial thromboplastin time (APTT), fibrinopeptide A (FPA), fibrinopeptide B 15-42 (FPBß 15-42) and crosslinked fibrin breakdown products (XL-FDP). Plasma aVP rose to a median of 75 pg/ml after 90 min and fell to 13.8 pdml 30 min later. The APTT fell from 43.5 to 35 sec (p <0.01) but there was no change in plasma FPA or in XL-FDP. Plasminogen activator activity (106/ECLT2) increased from 25 to 736 units (p <0.01) and t-PA from 200 to 1012 mlU/ml (p <0.01). tPA-I fell from 8.0 to 2.7 IU/ml at 90 min (p <0.05) but PAI-1 Ag remained unchanged. Plasma FPBß 15-42 was 2.4 and 1.2 pmol/ml before infusion with aVP and showed a small rise to 3.5 pmol/ml after 60 min (p <0.05). The results show the effects of aVP on fibrinolysis are mediated by an increase in t-PA. In the absence of thrombin generation the rise in t-PA was not accompanied by changes in XL-FDP.

Complications following laryngeal sacculectomy in brachycephalic dogs

OBJECTIVES

To evaluate the effect of sacculectomy on the immediate postoperative complication rate in dogs affected with brachycephalic obstructive airway syndrome.

MATERIALS AND METHODS

Retrospective review of clinical records of brachycephalic dogs with everted saccules that underwent surgery for brachycephalic obstructive airway syndrome between 2009 and 2014. Dogs were grouped as those having nares resection and staphylectomy only and those having nares resection, staphylectomy and laryngeal sacculectomy. Complications were scored as mild, moderate or severe.

RESULTS

In total, 37 dogs were included in the sacculectomy group and 44 in the comparator group. Dogs that had undergone sacculectomy were more likely to develop postoperative complications, with 18 of 37 developing complications, nine of which were moderate to severe. In the group without sacculectomy, nine of 44 dogs developed complications, of which one was severe. Different breed distribution between groups might also impact this outcome.

CLINICAL SIGNIFICANCE

The results suggest that sacculectomy might increase morbidity following brachycephalic airway surgery, but repeat studies are required to confirm this result. Further information is also required to determine whether the short-term risks of sacculectomy are outweighed by superior long-term functional outcome.

Amorphous Silicon Image Sensor Arrays

We have developed a technology for 2D matrix-addressed image sensors using amorphous silicon photodiodes and thin film transistors. We have built a small prototype, having 192×192 pixels with a 20μm pixel pitch, and assessed its performance. The nip photodiodes can have dark current densities of less than 1011 A.cm-2 (up to 5V reverse bias) and peak quantum efficiencies of 88% (at 580nm). We operated the sensor in real time mode at high speed (50 Hz frame rate and 64μS line time). The image sensor has a low noise performance giving a dynamic range in excess of 104. The maximum crosstalk is about 2%, which allows at least 50 grey levels. The bottom contact of the photodiode acts as a light shield from light through the substrate, which enables the sensor to be operated as an intimate contact image sensor to image a document placed directly on top of the array. In this mode, the CTF was 75% at 2 lp.mm1. Good quality images are demonstrated in both front projection and intimate contact imaging modes.

Amorphous Silicon Photodiode-Thin Film Transistor Image Sensor with Diode on Top Structure

We have developed a new amorphous silicon image sensor technology using a matrix array of amorphous silicon thin film transistors and photodiodes, where the amorphous silicon nip photodiode is fabricated on top of a thick insulating layer, on top of the thin film transistor array. We call this ‘diode on top’ technology or DOTTY. The active diode area can be as high as 93%, compared to 50% for our conventional photodiode-TFT technology. This leads to a higher signal to noise performance, which is important for medical X-ray applications.

A Fully Self-Aligned Amorphous Silicon Tft Technology for Large Area Image Sensors and Active-Matrix Displays

We have developed a fully self-aligned amorphous silicon TFT technology, which is suitable for large area image sensors and active matrix displays. Self-alignment is achieved by defining the top nitride by back exposure and then forming source and drain contacts by ionimplantation and silicidation. We incorporate a low resistance gate metallisation process, by using Al metal, capped by Cr. We have compared the process of forming the silicide after the ion-implantation step, with a new process of forming the silicide first and then implanting through the formed silicide. We find a significant advantage to the latter method, where we can achieve a higher doping level and reduced contact resistance. We have therefore optimised our process based on this method. Transistor characteristics as a function of channel length for both methods show the improved contact resistance, obtained with the latter method. We obtain field effect mobilities of 0.7cm2V−1s−1, measured in the saturated region, for a channel length of 8μm.

A within-subject comparison of withdrawal symptoms during abstinence from cannabis, tobacco, and both substances

A cannabis withdrawal syndrome has been characterized, but its clinical significance remains uncertain. One method of assessing the significance of cannabis withdrawal is to compare it directly to an established withdrawal syndrome. The present study was a within-subject comparison of cannabis, tobacco, and combined cannabis and tobacco withdrawal among users of both substances. Participants (N=12) completed three 5-day periods of abstinence in a randomized order, separated by 9-day periods of usual substance use. Overall withdrawal severity associated with cannabis alone and tobacco alone was of a similar magnitude. Withdrawal during simultaneous cessation of both substances was more severe than for each substance alone, but these differences were of short duration and substantial individual differences were noted. These results are consistent with other evidence suggesting cannabis withdrawal is clinically important and warrants detailed description in the DSM-V and ICD-11. Additional research is needed to replicate these findings and to further investigate the effects of abstaining from multiple drugs simultaneously.

Antidepressants for smoking cessation

BACKGROUND

There are at least two theoretical reasons to believe antidepressants might help in smoking cessation. Nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode and antidepressants may relieve these. Nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. Alternatively, some antidepressants may have a specific effect on neural pathways underlying nicotine addiction, (e.g. blocking nicotine receptors) independent of their antidepressant effects.

OBJECTIVES

The aim of this review is to assess the effect of antidepressant medications in aiding long-term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; moclobemide; nortriptyline; paroxetine; sertraline, tryptophan and venlafaxine.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in MEDLINE, EMBASE, SciSearch and PsycINFO, and other reviews and meeting abstracts, in September 2006.

SELECTION CRITERIA

We considered randomized trials comparing antidepressant medications to placebo or an alternative pharmacotherapy for smoking cessation. We also included trials comparing different doses, using pharmacotherapy to prevent relapse or re-initiate smoking cessation or to help smokers reduce cigarette consumption. We excluded trials with less than six months follow up.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of study population, the nature of the pharmacotherapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months follow up in patients smoking at baseline, expressed as an odds ratio (OR). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model.

MAIN RESULTS

Seventeen new trials were identified since the last update in 2004 bringing the total number of included trials to 53. There were 40 trials of bupropion and eight trials of nortriptyline. When used as the sole pharmacotherapy, bupropion (31 trials, odds ratio [OR] 1.94, 95% confidence interval [CI] 1.72 to 2.19) and nortriptyline (four trials, OR 2.34, 95% CI 1.61 to 3.41) both doubled the odds of cessation. There is insufficient evidence that adding bupropion or nortriptyline to nicotine replacement therapy provides an additional long-term benefit. Three trials of extended therapy with bupropion to prevent relapse after initial cessation did not find evidence of a significant long-term benefit. From the available data bupropion and nortriptyline appear to be equally effective and of similar efficacy to nicotine replacement therapy. Pooling three trials comparing bupropion to varenicline showed a lower odds of quitting with bupropion (OR 0.60, 95% CI 0.46 to 0.78). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Concerns that bupropion may increase suicide risk are currently unproven. Nortriptyline has the potential for serious side-effects, but none have been seen in the few small trials for smoking cessation. There were six trials of selective serotonin reuptake inhibitors; four of fluoxetine, one of sertraline and one of paroxetine. None of these detected significant long-term effects, and there was no evidence of a significant benefit when results were pooled. There was one trial of the monoamine oxidase inhibitor moclobemide, and one of the atypical antidepressant venlafaxine. Neither of these detected a significant long-term benefit.

AUTHORS' CONCLUSIONS

The antidepressants bupropion and nortriptyline aid long-term smoking cessation but selective serotonin reuptake inhibitors (e.g. fluoxetine) do not. Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement. Adverse events with both medications are rarely serious or lead to stopping medication.

Antidepressants for smoking cessation

BACKGROUND

There are at least two theoretical reasons to believe antidepressants might help in smoking cessation. Nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode and antidepressants may relieve these. Nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. Alternatively, some antidepressants may have a specific effect on neural pathways underlying nicotine addiction, (e.g. blocking nicotine receptors) independent of their antidepressant effects.

OBJECTIVES

The aim of this review is to assess the effect of antidepressant medications in aiding long-term smoking cessation. The medications include bupropion; doxepin; fluoxetine; imipramine; moclobemide; nortriptyline; paroxetine; sertraline, tryptophan and venlafaxine.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in MEDLINE, EMBASE, SciSearch and PsycINFO, and other reviews and meeting abstracts, in September 2006.

SELECTION CRITERIA

We considered randomized trials comparing antidepressant medications to placebo or an alternative pharmacotherapy for smoking cessation. We also included trials comparing different doses, using pharmacotherapy to prevent relapse or re-initiate smoking cessation or to help smokers reduce cigarette consumption. We excluded trials with less than six months follow up.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of study population, the nature of the pharmacotherapy, the outcome measures, method of randomization, and completeness of follow up. The main outcome measure was abstinence from smoking after at least six months follow up in patients smoking at baseline, expressed as an odds ratio (OR). We used the most rigorous definition of abstinence available in each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed-effect model.

MAIN RESULTS

Seventeen new trials were identified since the last update in 2004 bringing the total number of included trials to 53. There were 40 trials of bupropion and eight trials of nortriptyline. When used as the sole pharmacotherapy, bupropion (31 trials, odds ratio [OR] 1.94, 95% confidence interval [CI] 1.72 to 2.19) and nortriptyline (four trials, OR 2.34, 95% CI 1.61 to 3.41) both doubled the odds of cessation. There is insufficient evidence that adding bupropion or nortriptyline to nicotine replacement therapy provides an additional long-term benefit. Three trials of extended therapy with bupropion to prevent relapse after initial cessation did not find evidence of a significant long-term benefit. From the available data bupropion and nortriptyline appear to be equally effective and of similar efficacy to nicotine replacement therapy. Pooling three trials comparing bupropion to varenicline showed a lower odds of quitting with bupropion (OR 0.60, 95% CI 0.46 to 0.78). There is a risk of about 1 in 1000 of seizures associated with bupropion use. Concerns that bupropion may increase suicide risk are currently unproven. Nortriptyline has the potential for serious side-effects, but none have been seen in the few small trials for smoking cessation. There were six trials of selective serotonin reuptake inhibitors; four of fluoxetine, one of sertraline and one of paroxetine. None of these detected significant long-term effects, and there was no evidence of a significant benefit when results were pooled. There was one trial of the monoamine oxidase inhibitor moclobemide, and one of the atypical antidepressant venlafaxine. Neither of these detected a significant long-term benefit.

AUTHORS' CONCLUSIONS

The antidepressants bupropion and nortriptyline aid long-term smoking cessation but selective serotonin reuptake inhibitors (e.g. fluoxetine) do not. Evidence suggests that the mode of action of bupropion and nortriptyline is independent of their antidepressant effect and that they are of similar efficacy to nicotine replacement. Adverse events with both medications are rarely serious or lead to stopping medication.

A prospective study of off-label use of, abuse of, and dependence on nicotine inhaler

OBJECTIVE

To determine the incidence of off-label use of, abuse of, and dependence on prescription nicotine inhaler.

DESIGN

Prospective telephone and internet interviews for six months.

PARTICIPANTS

535 new inhaler users.

MAIN OUTCOME

Structured interview about off-label use (that is, use of inhaler for non-cessation reasons or concurrent use of inhaler and cigarettes) and Diagnostic and statistical manual, fourth edition (DSM-IV) and International classification of diseases, 10th edition (ICD-10) criteria for abuse and dependence

RESULTS

Although many used inhaler and cigarettes concurrently at some time (43-55%), few used inhaler for non-cessation reasons (4-9%) and few persisted in off label use (8-16%; 95% confidence interval (CI) 5% to 19%). No participant met ICD-10 criteria for harmful use/abuse (95% CI 0% to 3.3%). Eight subjects (1.4%) appeared to meet DSM-IV or ICD-10 criteria for dependence on inhaler, but none were found dependent in a clinical expert interview (95% CI 0% to 3.3%).

CONCLUSIONS

Although transient concurrent use of inhaler and cigarettes often occurs, use for non-cessation reasons, abuse and dependence are rare.

Persistent use of nicotine replacement therapy: an analysis of actual purchase patterns in a population based sample

BACKGROUND

In 1996, the US Food and Drug Administration (FDA) approved switching nicotine gum and patch from prescription to over-the-counter (OTC) status. Some expressed concerns that broader availability and lack of physician control might increase persistent use of nicotine replacement therapy (NRT)-that is, use beyond the period specified by the FDA approved label.

OBJECTIVE

To estimate the incidence of persistent use of OTC nicotine gum and patch for periods of > 3 months, > or = 6 months, > or = 12 months, and > or 24 months.

DESIGN

Analysis of NRT purchase patterns in data from a population based panel of US households that electronically scanned all household purchases between January 1997 and March 2000.

SUBJECTS

In a national panel of 40,000 US households, 2690 recorded NRT purchases.

RESULTS

Among 805 households that purchased nicotine gum, 2.3% of new purchase incidents led to continuous monthly purchase of gum for > or = 6 months. For nicotine patches (2050 households) the percentage was 0.9%. For both gum and patch, the incidence of persistent purchase dropped below 0.4% by 24 months. Allowing one month gaps within a "continuous" purchase run resulted in increased estimates (for gum: 6.7% for > or = 6 months and 1.0% for > or = 24 months; for patch: 1.7% for > or = 6 months and 0.05% for > or = 24 months).

CONCLUSION

Persistent use of nicotine gum and patch is very rare and has not increased with the transition to OTC use, despite removal of physician oversight.

A meta-analysis of the efficacy of over-the-counter nicotine replacement

OBJECTIVE

To determine whether over-the-counter (OTC) nicotine replacement therapy (NRT) is pharmacologically efficacious, whether it produces abstinence rates similar to those in prescription settings, and to estimate the long term (that is, greater than six month) abstinence rate with OTC NRT.

METHOD

Systematic literature review.

DATA SOURCES

Medline, Psych Abstracts, bibliographies, requests of scientists.

STUDY SELECTION

Studies comparing OTC NRT versus OTC placebo or studies comparing OTC NRT versus prescription NRT that reported abstinence rates and for which a full study report was available.

DATA EXTRACTION

Two of the authors independently reviewed studies and compared results.

DATA SYNTHESIS

Meta-analysis was performed by first testing for homogeneity across studies, then combining odds ratios (ORs) weighting by inverse variance and proportions weighting by study sample size.

RESULTS

One OTC NRT versus OTC placebo nicotine gum study was excluded due to small sample size and different setting. The four remaining studies were randomised trials of nicotine versus placebo patch with ORs of 2.1-3.2. These outcomes were homogenous and when combined resulted in an OR favouring NRT of 2.5 (95% confidence interval (CI) 1.8 to 3.6). Among the two randomised and two non-randomised trials of OTC NRT versus prescription NRT, one small study had an OR of 0.3, two others had ORs of 1.0 and 1.4, and a fourth study had an OR of 3.6. These results were not homogenous; however, when combined via a random effects model the estimated OR was not less than 1.0--that is, OR 1.4 (95% CI 0.6 to 3.3). The long term (that is, greater than six months) quit rates for OTC NRT was 1% and 6% in two studies and 8-11% in five other studies. These results were not homogenous; however, when combined the estimated OR was 7% (95% CI 4% to 11%).

CONCLUSIONS

OTC NRT is pharmacologically efficacious and produces modest quit rates similar to that seen in real world prescription practice.

Antidepressants for smoking cessation

BACKGROUND

There at least two reasons to believe antidepressants might help in smoking cessation. Depression may be a symptom of nicotine withdrawal, and smoking cessation sometimes precipitates depression. In some individuals, nicotine may have antidepressant effects that maintain smoking. Antidepressants may substitute for this effect.

OBJECTIVES

The aim of this review is to assess the effect of antidepressant medications in aiding long-term smoking cessation. The drugs include bupropion; doxepin; fluoxetine; imipramine; moclobemide; nortriptyline; paroxetine; selegiline; sertraline, tryptophan and venlafaxine.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register which includes trials indexed in MEDLINE, EMBASE, SciSearch and PsycINFO, and other reviews and meeting abstracts, in December 2002.

SELECTION CRITERIA

We considered randomized trials comparing antidepressant drugs to placebo or an alternative therapeutic control for smoking cessation. For the meta-analysis, we excluded trials with less than six months follow-up.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of study population, the nature of the drug therapy, the outcome measures, method of randomization, and completeness of follow-up. The main outcome measure was abstinence from smoking after at least six months follow-up in patients smoking at baseline, expressed as an odds ratio (OR). We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Where appropriate, we performed meta-analysis using a fixed effects model.

MAIN RESULTS

There was one trial each of moclobemide, sertraline and venlafaxine, two of fluoxetine, five of nortriptyline, and twenty trials of bupropion. In the bupropion trials, 18 had a placebo arm, two of which tested long-term use to prevent relapse. Nine of the bupropion trials have been published in full. Nortriptyline (five trials, OR 2.80, 95% CI 1.81 - 4.32) and bupropion (16 trials, OR 1.97, 95% CI 1.67 - 2.34) both increased the odds of cessation. In one trial the combination of bupropion and nicotine patch produced slightly higher quit rates than patch alone, but this was not replicated in a second study. Two trials of extended therapy with bupropion to prevent relapse after initial cessation have failed to detect a long-term benefit.

REVIEWER'S CONCLUSIONS

The antidepressants bupropion and nortriptyline can aid smoking cessation but selective serotonin reuptake inhibitors (e.g. fluoxetine) do not.

Comorbidity and smoking

Several behavioral/psychological/psychiatric traits/disorders have been associated with increased initiation of smoking, nicotine dependence, and decreased cessation. Although much research has focused on psychiatric disorders, subclinical syndromes (e.g., minor depression and heavy drinking) probably influence smoking initiation and cessation more because they are so much more prevalent. In prospective studies, comorbidity predicts smoking and smoking predicts comorbidity. Preliminary evidence suggests several plausible mechanisms by which this two-way linkage could occur. In addition, other variables (e.g., genetics) could account for the comorbidity/smoking association. What we need to know: how strong and consistent are comorbidity/smoking associations? Is the association of smoking and comorbidity increasing over time? Are the hypothesized mechanisms for the association valid? Can treating comorbidity improve smoking cessation outcomes? Would applying the concept of comorbidity to psychosocial conditions (e.g., poverty) be helpful?

A comparison of recovering alcoholic and non-alcoholic smokers

Whether smokers with a positive past history (PH) of alcohol dependence need more intensive or different treatment than smokers with no such history (NH) is unclear. We surveyed 31 PH smokers and 31 age and sex-matched NH smokers to examine differences in motivations for and barriers to stopping smoking. The final regression model found that PH and NH smokers did not differ in social support, social pressure, readiness to quit or physical consequences of smoking; however, PH smokers were more dependent on nicotine and had more internal (affective) barriers to cessation than NH smokers. Although our results require replication due to our small sample size, they do suggest that PH smokers would especially benefit from medications for nicotine dependence and medications or psychosocial treatments for depression.

Marijuana abstinence effects in marijuana smokers maintained in their home environment

BACKGROUND

Although withdrawal symptoms are commonly reported by persons seeking treatment for marijuana dependence, the validity and clinical significance of a marijuana withdrawal syndrome has not been established. This controlled outpatient study examined the reliability and specificity of the abstinence effects that occur when daily marijuana users abruptly stop smoking marijuana.

METHODS

Twelve daily marijuana smokers were assessed on 16 consecutive days during which they smoked marijuana as usual (days 1-5), abstained from smoking marijuana (days 6-8), returned to smoking marijuana (days 9-13), and again abstained from smoking marijuana (days 14-16).

RESULTS

An overall measure of withdrawal discomfort increased significantly during the abstinence phases and returned to baseline when marijuana smoking resumed. Craving for marijuana, decreased appetite, sleep difficulty, and weight loss reliably changed across the smoking and abstinence phases. Aggression, anger, irritability, restlessness, and strange dreams increased significantly during one abstinence phase, but not the other. Collateral observers confirmed participant reports of these symptoms.

CONCLUSIONS

This study validated several specific effects of marijuana abstinence in heavy marijuana users, and showed they were reliable and clinically significant. These withdrawal effects appear similar in type and magnitude to those observed in studies of nicotine withdrawal.

Echography of retinoblastoma: histopathologic correlation and serial evaluation after globe-conserving radiotherapy or chemotherapy

PURPOSE

To assess the sensitivity of echography in detecting retinoblastoma, compare tumor features observed by echography with histopathology data, and assess the usefulness of echography in serially following retinoblastoma tumors after globe-conserving treatments.

METHODS

The medical and echography records of all patients treated for retinoblastoma at the Bascom Palmer Eye Institute between 1991 and 1997 were reviewed. All eyes underwent pretreatment echographic evaluation, and eyes treated with external beam radiotherapy, brachytherapy, or chemotherapy underwent serial follow-up echography.

RESULTS

Sixty-nine eyes of 48 patients were identified. Echography demonstrated evidence of retinoblastoma in 69 of 69 (100%) eyes and calcification in 63 (91.3%) eyes. Histopathology was superior to echography in detecting optic nerve invasion, extraocular extension, and presence of calcification.

CONCLUSION

Echography is a useful adjunct to indirect ophthalmoscopy in establishing the diagnosis of retinoblastoma. While not as specific as histopathology, echographic evaluation before and after treatment of retinoblastoma permits monitoring of treatment response and may aid in detecting recurrent tumor growth or failure to respond to treatment.

How helpful are drug abuse helplines?

Raters called a convenience sample of 30 helplines and claimed to be alcohol, cocaine, heroin, marijuana or tobacco dependent persons seeking treatment. Responses were categorized as helpful, neutral or unhelpful. The median Kappa for agreement between pairs of raters rating a single call was 0.91. Between 36 and 78% of the helplines gave inconsistent responses to two calls giving the same scenario. Across the 346 calls, 43, 40 and 40% of responses to alcohol, cocaine and heroin scenarios were helpful and 28 and 25% of responses to tobacco and marijuana calls were helpful. These preliminary results indicate that much of the time responses to calls to national helplines are not consistent and not helpful.

Echographic evaluation of a patient with diabetes and dense vitreous hemorrhage: an avulsed retinal vessel may mimic a tractional retinal detachment

PURPOSE

To report that an avulsed retinal vessel may appear as a tractional retinal detachment on echographic evaluation.

METHODS

Case report.

RESULTS

A 57-year-old diabetic woman presented with a nonclearing vitreous hemorrhage of 2 months duration in the left eye. Echography was consistent with a localized tractional retinal detachment on longitudinal sections; transverse sections demonstrated a pinpoint opacity in the vitreous cavity. Intraoperatively, an avulsed retinal vessel was noted in the area of echographic abnormality.

CONCLUSION

An avulsed retinal vessel may mimic tractional retinal detachment on echography. Although trained ophthalmic echographers routinely perform both longitudinal and transverse sections during an echographic evaluation, less skilled observers must be aware of the importance of performing both longitudinal and transverse sections for accurate echographic diagnosis.

Why does smoking so often produce dependence? A somewhat different view

The usual explanation for why smoking produces dependence focuses on the effects of nicotine on dopamine and other neurobiological explanations. This review offers four somewhat different explanations: (1) nicotine can offer several psychopharmacological benefits at the age when such benefits are especially needed; (2) cigarettes provide for a rapid, frequent, reliable and easy-to-obtain reward; (3) nicotine is not intoxicating, allowing chronic intake; and (4) the long duration of the nicotine withdrawal syndrome effectively undermines cessation. This article reviews the evidence for the above views and the tobacco control activities these views suggest.

Smoking in correctional facilities: a survey of employees

OBJECTIVE

To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees.

DESIGN

Mailed survey to Vermont state correctional employees.

MAIN OUTCOME MEASURES

Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour.

PARTICIPANTS

321 of 640 (50%) state correctional employees responded.

RESULTS

Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers.

CONCLUSIONS

Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition.

Is dependence on one drug associated with dependence on other drugs? The cases of alcohol, caffeine and nicotine

Several studies have correlated the use of one drug with that of another drug; however, whether dependence on one drug is associated with dependence on another drug, independent of any use/use association, is unclear. We asked 196 randomly-selected subjects the DSM-IV criteria for dependence as applied to alcohol, caffeine, and nicotine. Among ever users, the severity of alcohol vs nicotine dependence and alcohol vs caffeine dependence was related, but this relationship was weak (r = .22 & .31). Nicotine and caffeine dependence were not correlated. These results fail to confirm theories of commonality that hypothesize dependence on one drug predisposes to dependence on another drug.

Two behavioral treatments for smoking reduction: a pilot study

This study compared two behavioral treatments on their efficacy and acceptability in reducing smoking, using a crossover design with interposed return to baseline, 2 weeks/condition. 20 US cigarette smokers reporting an interest in reducing, but not quitting, their smoking either increased the inter-cigarette interval or selected easy cigarettes to eliminate, with a goal of 50% reduction. Nicotine gum accompanied both treatments. Measurements taken were self-reported cigarettes per day, carbon monoxide, cotinine, and thiocyanate; self-rated acceptability of the treatments; adverse events. Both treatments decreased self-reported cigarettes per day (-45% and -38%) and carbon monoxide (-20% and -19%), but not cotinine or thiocyanate. Increasing the inter-cigarette interval produced slightly more reduction in cigarettes per day than cigarette selection, but no other differences were found. Both treatments were acceptable and safe. Although our sample size was small and the duration of reduction documented short, both treatments appear to be acceptable and efficacious behavioral treatments for reduction.

The continuous rhythmic mid-temporal discharge

This case report is of a 15-year-old male who was sent for an EEG because of possible staring spells and a learning disability. At times written examinations in school were successfully completed and at other times the patient would write only his name. In two EEGs 1 month apart during hyperventilation, Rhythmic Mid-Temporal Discharges (RMTD) were activated and appeared continuously for 84 minutes and in the second instance for 140 minutes. No maneuvers could modify the pattern and no clinical changes were reported by the patient. Discussion includes another similar case recently published and the need to test such patients in some way to see the subtle clinical changes that likely do occur. One compromise for the name of this pattern might be Rhythmic Mid-Temporal Epileptiform Activity (RMTEA), avoiding the term discharge, which implies a seizure state that has not yet been established.

Nicotine is more reinforcing in smokers with a past history of alcoholism than in smokers without this history

BACKGROUND

Whether smokers with a past history (PH) but not current history of alcohol dependence are more nicotine dependent than smokers with no such history (NH) is unclear. The present study was an experimental test of this hypothesis.

METHOD

Twenty PH and 10 NH smokers abstained from smoking for 16 hr on each of 4 days. On each of 3 days, participants received three doses per day of 0, 2, or 4 mg nicotine gum in a within-subjects, randomized, double-blind, crossover design. To examine subjective effects, participants completed the Profile of Mood States, Addiction Research Inventory, and other ratings before and after each dose. To examine nicotine reinforcement, participants reported preference among the gums, reported on money versus gum choices, and, on the 4th day, underwent a double-blind self-administration test.

RESULTS

Across the 21 subjective measures, with one exception, PH and NH smokers did not differ in subjective response to nicotine. However, across all three reinforcement measures, nicotine was a more potent reinforcer in PH than NH smokers.

CONCLUSIONS

These results provide a behavioral mechanism to explain prior findings that PH smokers are more nicotine dependent than NH smokers.

Randomised trial investigating effect of a novel nicotine delivery device (Eclipse) and a nicotine oral inhaler on smoking behaviour, nicotine and carbon monoxide exposure, and motivation to quit

OBJECTIVE

To monitor the effect of a novel nicotine delivery device that may produce fewer carcinogens (Eclipse) on cigarette smoking, carbon monoxide and nicotine concentrations, and motivation to give up smoking. The smoker's own brand of cigarette and a nicotine replacement product (Nicotrol inhaler) were used as comparisons.

DESIGN

After baseline data were recorded, smokers were randomised to either Eclipse or inhaler for two weeks and then switched to the other product for another two weeks. Thereafter a second baseline was obtained.

SETTING AND PARTICIPANTS

Fifty smokers were included and data are reported for the 40 with complete data sets. The smokers were not trying to quit but were interested in trying a new product to reduce their risk. They visited a smoking clinic 10 times during the six week period of the trial.

INTERVENTION

No counselling to aid reduction by Eclipse or inhaler was given.

MAIN OUTCOME MEASURES

At each visit smoking status and carbon monoxide concentrations were recorded. In half of the visits withdrawal symptoms, attitudes towards smoking, heart rate, and blood nicotine concentrations were also recorded.

RESULTS

Eclipse use decreased the number of cigarettes smoked per day (cpd) from 19.1 cpd at baseline to 2.1 cpd (p < 0.001), but increased carbon monoxide concentrations in parts per million (ppm) from 21.0 ppm to 33.0 ppm (p < 0.001). A similar decrease in cigarettes smoked per day was seen with the Nicotrol inhaler, from 19.1 cpd to 4.8 cpd (p < 0.001), but carbon monoxide decreased from 21.0 ppm to 12.7 ppm (p < 0.001). The blood nicotine concentration remained fairly stable with Eclipse, increasing slightly from 16.8 ng/ml to 18.0 ng/ml, while for the inhaler a significant drop was noted, from 16.8 ng/ml to 12. 2 ng/ml (p < 0.002). Craving and withdrawal did not increase with Eclipse. Few significant adverse events occurred with Eclipse.

CONCLUSIONS

Eclipse can dramatically decrease cigarette consumption without causing withdrawal symptoms or decreases in nicotine concentrations or motivation to quit altogether. Unlike the inhaler, Eclipse produces an increase in carbon monoxide concentration. Thus Eclipse may not be a safer cigarette.

Echographic features of medulloepithelioma

PURPOSE

To evaluate the echographic features of medulloepithelioma that may assist in establishing the diagnosis.

METHODS

Retrospective review identified four eyes with medulloepithelioma studied with echography. Clinical records, echographic findings, histopathologic tumor features, and the clinical course were reviewed.

RESULTS

The initial preoperative diagnosis of medulloepithelioma was uncertain, based on clinical findings alone in three cases but was accurate when echographic findings were combined with clinical findings in all four cases. Cysts posterior to the iris were detected on clinical examination in only two cases, but were revealed on echography in all four cases. Additional echographic findings included irregular high internal reflectivity (n = 4), irregular tumor surface (n = 3), molding around intraocular structures (n = 3), and internal vascularity (n = 2).

CONCLUSIONS

The diagnosis of medulloepithelioma is not always apparent on clinical examination alone. Echographic findings of a highly reflective, irregularly structured tumor with associated cystic changes involving the ciliary body region may help establish a presumed diagnosis of medulloepithelioma.

Do former smokers respond to nicotine differently from never smokers? A pilot study

Nine former, 11 never, and 10 current smokers abstained from smoking for 16 h on each of 4 days. On each of 3 days, participants received three doses per day of 0-, 2-, or 4-mg nicotine gum in a randomized, double-blind, crossover design. To examine subjective effects, participants completed the POMS, ARCI, and other ratings before and after each dose. To examine nicotine reinforcement, participants reported preferences among the gums, reported gum vs. money choices plus, on a fourth day, underwent a double-blind self-administration test. Former and never smokers did not differ on any of the subjective or reinforcement outcomes. Current smokers did prefer and self-administer more nicotine than former and never smokers. These results contradict our prior finding that former and never smokers differ in their response to nicotine. We consider the present study a more valid test than our prior study for reasons outlined in the discussion. Our results fail to confirm theories that those destined to be smokers are more or less sensitive to nicotine and that nicotine use causes irreversible brain changes that increase nicotine reinforcement.

EEG in the elderly: seizures vs. syncope

The EEGs of elderly patients with a definite seizure disorder (161 patients; 302 EEGs) were compared to patients with "syncope" (122 patients; 133 EEGs), especially to determine if the latter patients were sufficiently similar to the seizure patients that the syncope could be viewed as a seizure phenomenon. The two groups were similar only by the predominance of females in both groups (61-62%) and otherwise were very different. The seizure group had a higher incidence of (1) etiology (83 vs. 39%), (2) epileptiform discharges (93 vs. 49%), with a different location, more often parasagittal, and different number often with active or very active foci, (3) frontal slow waves, (4) more severe slow wave abnormalities, (5) slower background frequencies, that were less well organized and developed and (6) abnormal records. The conclusion is that the syncope patients as a group are usually not simply seizure patients. Regardless of etiology, the patients with "syncope" (33% with cerebrovascular and 21% cardiac etiologies) showed nearly a 50% incidence of epileptiform discharges, demonstrating a complex interrelationship between cardiac and cerebral mechanisms, which are discussed. The conclusion is that epileptiform activity in elderly patients with syncope is likely to be mildly epileptogenic, and may require additional cardiovascular mechanisms to generate an attack of unconsciousness.

Treatment resistant smokers: a pilot study of nicotine nasal spray and inhaler

A growing proportion of smokers are those who have failed prior treatments for cessation. We tested the efficacy of nicotine nasal spray and nicotine inhaler in two uncontrolled, open-label studies of 19 and 20 smokers who had previously failed nicotine patch therapy. As in the three prior studies of treatment failures, 6 month abstinence rates were extremely low both with the nasal spray (0%) and the inhaler (5%). We discuss possible treatments for and methodological issues in researching treatment-resistant smokers.

A critical view of past NIH research funding on tobacco and nicotine

We describe past NIH funding for tobacco/nicotine-related research, using data from the CRISP computerized database of NIH grants awarded in 1975, 1980, 1985, 1990, and 1995 (last year available). Two independent raters identified extramural grants whose investigators listed a nicotine/tobacco-related keyword as a primary descriptor for 1975, 1980, 1985, 1990, and 1995. From 1975 to 1985 extramural funding for nicotine/tobacco research (corrected for inflation) increased almost fourfold. From 1985 to 1995, funding increased minimally (< 20%). In 1995, NIH expended $92.1 million on research whose primary interest was nicotine or tobacco. This represented 1.1% of the overall NIH extramural budget. Over time, when contract funding increased, investigator-initiated R01 funding decreased. Nicotine/tobacco research was spread across 18 institutes. Although tobacco use accounts for 20% of all US mortality, historically only 1% of the NIH's budget has focused on nicotine or tobacco. Among nicotine/tobacco grants funded, investigator-initiated research appears to have been limited due to large contracts for clinical trials. Nicotine/tobacco research has no home institute. Funding for nicotine/tobacco research needs to be increased and better coordinated.

New treatments for smoking cessation

Helping cigarette smokers to permanently stop smoking is one of the most effective ways to prevent cancer. A physician's instruction to a patient to stop smoking and to offer assistance in this endeavor is an important motivator. Current guidelines state that clinicians should encourage all smokers who want to quit to use medications and should offer psychosocial therapies, as well. It has been shown that even brief clinician advice about smoking cessation increases quit rates. Five medications--bupropion, nicotine gum, nicotine inhaler, nicotine nasal spray, and nicotine patch--and one proven psychosocial therapy (behavior therapy) appear equally effective and safe; i.e., they all double quit rates and are associated with a less than 5% dropout rate due to adverse events. In 1998, approximately one third of those who attempted to quit smoking used a medication. Attending group behavior therapy to supplement medications increases quit rates but is not essential for medications to work. As there are no proven treatment-matching protocols, patients should choose the treatment(s) they believe will be most effective for them. In the future, people who continue to smoke will be individuals with severe nicotine dependence or psychiatric symptoms; thus, clinicians will increasingly be called on to provide pharmacotherapy for smoking cessation.

The Mozart effect: distinctive aspects of the music--a clue to brain coding?

The goal of this study was to determine distinctive aspects of Mozart music that may explain the "Mozart Effect," specifically, the decrease in seizure activity. As many as 81 musical selections of Mozart, but also 67 of J.C. Bach, 67 of J.S. Bach, 39 of Chopin and 148 from 55 other composers were computer analyzed to quantify the music in search of any distinctive aspect and later to determine the degree to which a dominant periodicity could be found. Long-term periodicity (especially 10-60 sec, mean and median of 30 sec), was found often in Mozart music but also that of the two Bachs, significantly more often than the other composers and was especially absent in the control music that had no effect on epileptic activity in previous studies. Short-term periodicities were not significantly different between Mozart and the Bachs vs. the other composers. The conclusion is that one distinctive aspect of Mozart music is long-term periodicity that may well resonate within the cerebral cortex and also may be related to coding within the brain.

Lobeline for smoking cessation

BACKGROUND

Lobeline is a partial nicotine agonist, which has been used in a variety of commercially available preparations to help stop smoking.

OBJECTIVES

The objective of this review was to assess the effects of lobeline on long term smoking cessation.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group trials register.

SELECTION CRITERIA

Randomized trials comparing lobeline to placebo or an alternative therapeutic control, which reported smoking cessation with at least six months follow-up.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate on the type of subjects, the dose and form of lobeline, the outcome measures, method of randomisation, and completeness of follow-up.

MAIN RESULTS

We identified no trials meeting the full inclusion criteria including long term follow-up.

REVIEWER'S CONCLUSIONS

There is no evidence available from long term trials that lobeline can aid smoking cessation.

Reduced smoking: an introduction and review of the evidence

The major questions about reductions in the number of cigarettes-day as a treatment goal are (1) how many smokers can reduce and maintain such reduction, (2) how much compensation will occur, (3) will reduced smoking significantly decrease the risk of smoking and (4) will reduction promote or undermine cessation. Naturalistic studies of smokers who are not trying to stop smoking indicate that a substantial minority of smokers spontaneously reduce their number of cigarettes-day and can maintain significant reductions (-7% to -43%) over long periods of time. Six experimental trials of smokers not interested in quitting were able to induce large reductions in cigarettes-day (-15% to -63%) using behavioral therapy and or nicotine replacement. Reductions in toxin exposure (carbon monoxide) were not as large but still substantial (-21% to -35%). The three studies with long-term follow-ups found little loss of effects over 6-30 months. Although face-valid, there is no direct test of whether reduced smoking will decrease smoking risks and such a study would need to be very large and last for a long time. None of the above-cited studies indicate that reduction undermines the probability of future cessation attempts and several found reduction promotes future cessation.

B-scan ultrasonographic findings in the stages of idiopathic macular hole

PURPOSE

To prospectively evaluate the relationship between the posterior hyaloid membrane (PHM) and the retina in eyes with idiopathic macular hole.

METHODS

Ninety-four eyes of 94 consecutive patients with macular hole underwent complete ophthalmologic examination, contact lens biomicroscopy, and B-scan ultrasonography and/or vitreoretinal surgery.

RESULTS

In 93 of 94 patients (99%), the relationship between the PHM and posterior retina could be visualized during echographic examinations or at surgery. Among these 93 patients, the PHM was detectable biomicroscopically in 36 (39%). Persistent PHM attachment to the foveola with partial separation of the PHM from the perifoveal retina was evident with ultrasonography in 5 of 6 patients (83%) with stage 1 hole and in 12 of 18 patients (67%) with stage 2 hole. When axial views were included, separation of the PHM from the perifoveal retina was evident in 13 of 13 patients (100%) with stage 1 and stage 2 hole. Separation of the PHM from the fovea and perifoveal retina with attachment to the peripapillary retina was evident with ultrasonography in 65 of 65 patients (100%) with stage 3 macular hole and pseudo-operculum and was evident biomicroscopically in 22 of the 65 patients (34%) in this group.

CONCLUSIONS

These findings suggest that high-resolution axial and paraxial ultrasonographic examination directly on the surface of the eye is more sensitive in detecting separation of the PHM from the retina than biomicroscopy in idiopathic macular holes. The perifoveal detachment of the PHM may be involved in the pathogenesis of macular holes.