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There were 87 smokers with schizophrenia or bipolar disease who received 12 weeks of varenicline and achieved 2 weeks or more of continuous abstinence by week 12 who were randomly assigned to receive cognitive behavioral therapy and varenicline or placebo. The authors concluded that among smokers with serious mental illness who attained initial abstinence with standard treatment, Interventions for Smoking Cessation and Treatments for Nicotine Dependence 539 A Report of the Surgeon General maintenance pharmacotherapy with varenicline and cognitive behavioral therapy improved prolonged tobacco abstinence rates compared with cognitive behavioral therapy alone after 1 year of treatment and at 6 months after treatment discontinuation (Evins et al. Approaches to smoking cessation with demonstrated efficacy among smokers with mental illness or addictive disorders include motivational and stage-based treatments and behavioral therapy that is offered outside of or integrated within mental health or addictions treatment, delivered in person or via a quitline, and combined with cessation pharmacotherapy (Hall and Prochaska 2009). More generally, the convenience and accessibility of quitlines make them an important option for clinician referrals among this population. Supplementary cessation services and treatments that can complement clinician and quitline interventions, such as in-person counseling and cessation medication, may further increase quit rates. A randomized trial of 577 mental health patients in the Veterans Health Administration found that a specialized quitline for smokers referred by a mental health provider outperformed standard state quitlines, with significantly greater 30-day abstinence at 6 months (26% vs. The interventions largely followed a behavioral therapy approach, offering group or individual counseling sessions. For example, the treatments encouraged participants to monitor their mood with a daily rating scale and to learn and apply skills to decrease negative moods and increase pleasant ones-such as by recognizing maladaptive thoughts, disputing negative thinking, engaging in pleasant activities, increasing positive social contacts, and setting realistic goals (Hall et al. Researchers have also tested the use of medications for mood management when quitting smoking. In one systematic review, use of bupropion and nortriptyline, which are both antidepressants, resulted in a statistically significant increase in tobacco abstinence, irrespective of depression history, but selective serotonin reuptake inhibitors. Instead, evidence suggests that varenicline may aid in quitting smoking while also reducing drinking in men who drink excessively. These findings are important in light of the high rate of comorbid smoking and heavy drinking, but more research is needed. In conclusion, individuals with behavioral health conditions smoke at a significantly higher rate than the general population and generally have a more difficult time quitting, despite being equally interested in quitting. However, evidence increasingly suggests that quitting smoking does not jeopardize the success of treatment for mental health conditions or substance abuse and may actually enhance recovery outcomes (McKelvey et al. Additional research is needed on which tailored tobacco cessation interventions are most effective in helping persons with behavioral health conditions quit smoking. Other data suggest that initiating tobacco use at 13 years of age or younger is associated with continuous daily and nondaily use during adolescence and with the development of nicotine dependence, compared with initiating tobacco use at 14 years of age and older (Sharapova et al. Once adolescents progress to established smoking, few of them attempt to quit, few quit successfully when trying on their own (7%), very few seek help quitting, and success rates are low-even among those who obtain help (12%) (Sussman et al. Estimates suggest that quitting smoking before 35 years of age prevents much of the harm from smoking (Doll et al. Because most smokers start young and because quitting is difficult once smoking becomes established, efforts to prevent adolescents from 540 Chapter 6 Smoking Cessation ever starting to smoke and to help adolescents who start smoking to quit as soon as possible are critical. The evidence for the effectiveness of cessation interventions targeting youth is mixed. The review included studies of smokeless tobacco cessation interventions and very brief advice, as well as limited print-based interventions. Only 3 of the 28 trials tested pharmacologic approaches, and those trials reported limited efficacy. However, cessation medications can be prescribed for and used by youth under the supervision of a physician. The Clinical Practice Guideline found insufficient evidence for the effectiveness of cessation medications in adolescents (Fiore et al. More explicit evidence-based recommendations are needed to guide clinicians and parents in weighing the potential benefits and risks of specific smoking cessation medications in adolescent patients (Federal Register 2018). Of the four studies reviewed, the intervention with the strongest effect (a 24% reduction in smoking) was based on the Stages of Change Model and was personalized, computer assisted, and motivationally tailored (Hollis et al. Adolescents were recruited in a clinic setting, and the intervention lasted 12 months. The intervention focused solely on tobacco use (rather than addressing tobacco use in conjunction with additional risk behaviors) and included educational components (Hollis et al. Further research is needed to identify and replicate best practices for tobacco cessation interventions with adolescent smokers. However, recruitment is a major challenge to research on cessation among youth, in part because of parental consent and youth emancipation laws that are in place in most states.

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Ruggenenti P, Perna A, Zoccali C, Gherardi G, Benini R, Testa A, Remuzzi G: Chronic proteinuric nephropathies. Hannedouche T, Chauveau P, Kalou F, Albouze G, Lacour B, Jungers P: Factors affecting progression in advanced chronic renal failure. Nakano S, Ogihara M, Tamura C, Kitazawa M, Nishizawa M, Kigoshi T, Uchida K: Reversed circadian blood pressure rhythm independently predicts endstage renal failure in non-insulin-dependent diabetes mellitus subjects. Kidney Int 27:S96-S102, 1989 (suppl 27) Locatelli F, Alberti D, Graziani G, Buccianti G, Redaelli B, Giangrande A: Prospective, randomised, multicentre trial of effect of protein restriction on progression of chronic renal insufficiency. Diabetes Care 24:S33-S43, 2001 (suppl 1) Diabetic Nephropathy, Position Statement. Randomised trial of old and new antihypertensive drugs in elderly patients: Cardiovascular Mortality and Mrobidity in the Swedish Trial in Old Patients with Hypertension-2 Study. Ruggenenti P, Remuzzi G: Angiotensin-converting enzyme inhibitor therapy for nondiabetic progressive renal diseas. Yusuf S, Sleigh P, Pogue J, Bosch J, Davies R, Dagenais G: Effects of an angiotensin-convertingenzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis: A randomized controlled trial. J Am Soc Nephrol 10:131A, 1999 (abstr) Buemi M, Allegra A, Corica F, Aloisi C, Giacobbe M, Pettinato G: Effect of fluvastatin on proteinuria in patients with immunoglobulin A nephropathy. J Cardiovasc Pharmacol 32:S9-S17, 1998 (suppl 2) McKenna K, Thompson C: Microalbuminuria: A marker to increased renal and cardiovascular risk in diabetes mellitus. National High Blood Pressure Education Program Working Group Report on Hypertension in Diabetes. Consensus development conference on the diagnosis of coronary heart disease in people with diabetes. American Optometric Association Consensus Panel on Diabetes: Care of the Patient With Diabetes Mellitus (ed 2). Proceedings of a consensus development conference on standardized measures in diabetic neuropathy. Morbidity and Mortality: 1998 Chartbook on Cardiovascular, Lung, and Blood Diseases. Schillaci G, Reboldi G, Verdecchia P: High-normal serum creatinine concentration is a predictor of cardiovascular risk in essential hypertension. Ljungman S, Wikstrand J, Hartford M, Berglund G: Urinary albumin excretion-A predictor of risk of cardiovascular disease. A prospective 10-year follow-up of middle-aged nondiabetic normal and hypertensive men.

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As the concentration of unbound nicotine in blood is reduced by metabolism, bound nicotine dissociates from the antibody to re-establish equilibrium and is, in turn, metabolized. In this manner, nicotine can be eliminated even in the presence of antibody, albeit more slowly than otherwise. For example, in rats, immunization doubled the elimination half-life of nicotine from 1 hour in controls to 2 hours in rats vaccinated against nicotine (Keyler et al. This process frees the antibody of its bound nicotine so that it is once again available to bind newly delivered nicotine. Extrapolating these findings to humans, it appears that nicotine vaccines will be most useful for preventing relapse, which is often triggered by taking just a few puffs or smoking just a few cigarettes, and may be less effective for encouraging smoking cessation among regular smokers who are not motivated to quit. Clinical Trials of Nicotine Vaccines Several nicotine vaccines have progressed through Phase 2 or 3 clinical trials. All of these studies provide preliminary evidence of safety, but levels of antibody in the blood have been substantially lower than those achieved in rats or mice. Part of this difference comes from the ability to administer higher doses of immunogens and stronger adjuvants in animals than would be tolerated in humans without producing side effects. Not surprising, therefore, is that the overall efficacy of vaccines for enhancing smoking cessation has not been demonstrated. In several studies, however, participants with the highest levels of serum antibody also had higher rates of smoking cessation compared with those who received a placebo vaccine (Cornuz et al. This key observation suggests that the vaccine strategy has merit and has the potential to be effective. Examining Data from Animals to Confirm Vaccine Activity In rats and mice, nicotine vaccination reduces by up to 80% the delivery of single doses of clinically relevant nicotine (equivalent to one or two cigarettes) to the brain (Cerny et al. Vaccine efficacy is lower with chronic doses of nicotine that approximate regular smoking, but the entry of nicotine into the brain is still slowed (Hieda et al. In rats, which are thought to provide the best animal models for smoking behavior in humans, vaccination markedly reduces addiction-relevant behaviors, such as nicotine self-administration (Lindblom et al. Animal studies consistently show that vaccine efficacy is greatest when the level of nicotinespecific antibodies in the blood is high, maximizing the nicotine-binding capacity provided in relation to the amount of nicotine present (Maurer et al. Passive Immunization with Monoclonal Antibodies or Gene Transfer the amount of antibody produced by vaccination is limited by the capacity of the immune system. Thus, it could be possible to produce nicotine-specific monoclonal antibodies in bacterial cultures or other in vitro systems and bypass the need for vaccination by administering the preformed antibodies directly (passive immunization). In animals, this approach mimics vaccination, but greater efficacy is possible because very large doses of antibody can be safely administered (Carrera et al. The main limitations to this approach in humans are its high cost and the likely need to administer the antibodies intravenously (Skolnick 2015). In rodents, extremely high levels of antibody have been achieved using this strategy for periods of up to several months (Hicks et al. This approach holds promise for human therapies if measures to ensure its safety can be established. Combining Vaccines with Medications Nicotine vaccines can be designed to display different surfaces of the nicotine molecule to the immune system. Because the immune system sees each surface as a distinct stimulus, two or three suitably designed nicotine vaccines can be co-administered to get an additive antibody response (Keyler et al. Nicotine vaccines also can be combined with smallmolecule medications because those drugs act by separate mechanisms. For example, nicotine-specific antibodies can be combined with mecamylamine, a nicotine antagonist that blocks the action of nicotine on its receptors in the brain and has been used experimentally to promote smoking cessation. This combination is more effective in rats than either of these treatments alone for blocking nicotine discrimination, a measure of whether the animal recognizes that it has received nicotine (LeSage et al.

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Effectiveness of the electronic cigarette: An eight-week Flemish study with six-month follow-up on smoking reduction, craving and experienced benefits and complaints. Using the electronic health record to connect primary care patients to evidence-based telephonic tobacco quitline services: a closed-loop demonstration project. A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers. Contingency management for tobacco smoking during opioid 1For addiction treatment: a randomised pilot study. E-cigarette use in the past and quitting behavior in the future: a population-based study. Effect of nicotine replacement therapy on agitation in smokers with schizophrenia: a doubleblind, randomized, placebo-controlled study. The association between e-cigarette use and myocardial infarction is what one would expect based on the biological and clinical evidence. Statement on the effects of tobacco use on surgical complications and the utility of smoking cessation counseling, August 1, 2014; < Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. A survey of tobacco-related knowledge, attitudes and behaviours of primary care providers in Mississippi. Effects of 21 days of varenicline versus placebo on smoking behaviors and urges among non-treatment seeking smokers. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Smoking quit rates among patients receiving pharmacist-provided pharmacotherapy and telephonic smoking cessation counseling. Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence. Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. Bauld L, Graham H, Sinclair L, Flemming K, Naughton F, Ford A, McKell J, McCaughan D, Hopewell S, Angus K, et al. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. Smoking behavior and exposure to tobacco toxicants during 6 months of smoking progressively reduced nicotine content cigarettes. Effect of reducing the nicotine content of cigarettes on cigarette smoking behavior 550 Chapter 6 Smoking Cessation and tobacco smoke toxicant exposure: 2-year follow up. Cardiovascular safety of varenicline, bupropion, and nicotine patch in smokers: a randomized clinical trial. Smoking cessation programs for lesbian, gay, bisexual, transgender, and intersex people: a content-based systematic review. A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: association with smoking cessation and motivation to quit. Bock B, Graham A, Sciamanna C, Krishnamoorthy J, Whiteley J, Carmona-Barros R, Niaura R, Abrams D. Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes. Systematic biases in cross-sectional community studies may underestimate the effectiveness of stop-smoking medications. Understanding inequalities of maternal smoking-bridging the gap with adapted intervention strategies.

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Acute Hemolytic Anemia, Methemoglobinemia, and Heinz Body Formation Associated with Ingestion of Red Maple leaves by Horses. History: the horse had a history of an approximately 1 cm mass within the lower left cheek that was excised 3 months prior to presentation and diagnosed as a trichoblastoma. On palpation, a 5 x 3 x 2 cm, bilobed, firm mass was present within the left cheek at the level of the first three mandibular cheek teeth (307 to 309). The mass elevated both the intact overlying skin and underlying intact oral mucosa. Some pain appeared to be associated with the mass, and the horse was intermittently depressed. An initial incisional biopsy was followed by complete surgical excision 12 days after presentation. Within the subcutis and muscle on cut section, there was a multilobulated, pink, fleshy mass extending to the surgical margins. Histopathologic Description: Mass, left cheek: Examined is an unencapsulated, poorly demarcated, multilobulated, densely cellular mass composed of lobules and tracts of neoplastic cells that infiltrate adjacent skeletal muscle and connective tissue and extend to the tissue margins. The cells within the bulk of the mass are arranged in sheets, cords, and packets within a moderately abundant fine fibrovascular stroma. Cells in these areas are polygonal with distinct cell borders, small amounts of wispy eosinophilic to clear cytoplasm, and large round central nuclei with finely stippled chromatin. In scattered areas (not present on every slide), the cells are pleomorphic, very large, lack distinct cell borders, and are often multinuceated and have bizarre nuclei and prominent 1-1. A monomorphic population of polygonal cells are arranged in nests and packets on a fine fibrovascular stroma. There are 0-3 mitoses per 10 high power fields (8 per 50 high power fields) in all regions. Along the thick fibrous septae, neoplastic cells abut and bulge into large irregular, occasionally bloodfilled, endothelial-lined clefts. Clusters of neoplastic cells are occasionally present within these vascular lumina. Neoplastic cells exhibited strong cytoplasmic immunoreactivity for smooth muscle actin and vimentin and variable to strong cytoplasmic immunoreactivity for desmin. A well-defined basal lamina surrounding the individual tumor cells was demonstrated by positive immunoreactivity for laminin outlining the cytoplasmic border of each cell. Within the walls of the anastomosing canals are epithelioid cells with ultrastructural and immunocytologic features similar to smooth muscle cells, called glomus cells, which are thought to be the cell of origin for glomus tumors. Other reported sites of glomus tumors in humans include dermis, subcutis and soft tissues in other locations, as well as bone, nerve, stomach, colon, nasal cavity, and trachea. The distribution of normal glomus bodies in horses has not been well characterized, although they occur frequently in the skin of the mammary gland. Photograph courtesy of Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Some degree of "soreness" was thought to be associated with this tumor, which was immediately adjacent to the facial nerve grossly and included several nerve fibers histologically. Primary differential diagnoses for this tumor included trichoblastoma (the initial diagnosis), other epithelial neoplasms, or a neuroendocrine tumor, all of which were ruled out with additional immunohistochemical stains. The cells were variably positive for desmin, which has occasionally been reported in human and canine glomus tumors. The tumor in this horse was considered to be malignant based on recurrence and rapid growth, invasiveness of deep tissues, large size, and areas of marked cellular atypia. Although clusters of neoplastic cells appeared to be present within vascular channels, true intravascular invasion was difficult to assess because of the close association of the tumor with blood vessels. The horse was treated with intralesional injections of cisplatin every 2-4 weeks post-surgery, with a total of 4 treatments planned. However, the mass recurred prior to the final injection, and the horse was euthanized (necropsy not performed at our institution). Left cheek, fibrovascular tissue: Conference Comment: Despite the history of recurrence and rapid growth, conference participants felt the tumor was a benign entity based on the section presented in conference, and a discussion on the features of malignancy ensued. Cytomorphologic features mentioned by the contributor such as areas of cellular atypia, atypical mitoses, and local invasiveness were not seen by conference participants, who felt the tumor showed no overt signs of malignancy. Photograph courtesy of Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis.

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Advances in burn care, specifically early excision and grafting of the burn wound, use of topical antimicrobial agents, and institution of early enteral feeding, have led to decreased infectious complications. There is no consensus on the most effective infection control practices to prevent transmission of infections to and from patients with serious burns. There also is controversy regarding the need for and type of barrier precautions for routine care of burn patients. One retrospective study demonstrated efficacy and cost effectiveness of a simplified barrier isolation protocol for wound colonization, emphasizing handwashing and use of gloves, caps, masks and plastic impermeable aprons (rather than isolation gowns) for direct patient contact365. However, there have been no studies that define the most effective combination of infection control precautions for use in burn settings. Additionally, there is a high prevalence of communityacquired infections among hospitalized infants and young children who have not yet become immune either by vaccination or by natural infection. The result is more patients and their sibling visitors with transmissible infections present in pediatric healthcare settings, especially during seasonal epidemics. Close physical contact between healthcare personnel and infants and young children Last update: July 2019 Page 34 of 206 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007) (eg. Practices and behaviors such as congregation of children in play areas where toys and bodily secretions are easily shared and family members roomingin with pediatric patients can further increase the risk of transmission. Pathogenic bacteria have been recovered from toys used by hospitalized patients379; contaminated bath toys were implicated in an outbreak of multidrug-resistant P. In addition, several patient factors increase the likelihood that infection will result from exposure to pathogens in healthcare settings. Children who attend child care centers383, 384 and pediatric rehabilitation units385 may increase the overall burden of antimicrobial resistance (eg. In addition, healthcare may be provided in nonhealthcare settings such as workplaces with occupational health clinics, adult day care centers, assisted living facilities, homeless shelters, jails and prisons, school clinics and infirmaries. Each of these settings has unique circumstances and population risks to consider when designing and implementing an infection control program. Several of the most common settings and their particular challenges are discussed below. While this Guideline does not address each setting, the principles and strategies provided may be adapted and applied as appropriate. Nursing homes for the elderly predominate numerically and frequently represent long-term care as a group of facilities. An atmosphere of community is fostered and residents share common eating and living areas, and participate in various facility-sponsored activities403, 404. Since able residents interact freely with each other, controlling transmission of infection in this setting is challenging405. Residents who are colonized or infected with certain microorganisms are, in some cases, restricted to their room. Age-related declines in immunity may affect responses to immunizations for influenza and other infectious agents, and increase susceptibility to tuberculosis. Immobility, incontinence, dysphagia, underlying chronic diseases, poor functional status, and age-related skin changes increase susceptibility to urinary, respiratory and cutaneous and soft tissue infections, while malnutrition can impair wound healing419-423. In the past decade, healthcare delivery in the United States has shifted from the acute, inpatient hospital to a variety of ambulatory and communitybased settings, including the home. Ambulatory care is provided in hospital-based outpatient clinics, nonhospital-based clinics and physician offices, public health clinics, free-standing dialysis centers, ambulatory surgical centers, urgent care centers, and many others. In 2000, there were 83 million visits to hospital outpatient clinics and more than 823 million visits to physician offices442; ambulatory care now accounts for most patient encounters with the health care system443. In these settings, adapting transmission prevention guidelines is challenging because patients remain in common areas for prolonged periods waiting to be seen by a healthcare provider or awaiting admission to the hospital, examination or treatment rooms are turned around quickly with limited cleaning, and infectious patients may not be recognized immediately. Furthermore, immunocompromised patients often receive chemotherapy in infusion rooms where they stay for extended periods of time along with other types of patients. Transmission of infections in outpatient settings has been reviewed in three publications446-448. Goodman and Solomon summarized 53 clusters of infections associated with the outpatient setting from 1961-1990 446. Overall, 29 clusters were associated with common source transmission from contaminated solutions or equipment, 14 with person-to-person transmission from or involving healthcare personnel and ten associated with airborne or droplet transmission among patients and healthcare workers. These outbreaks often are related to common source exposures, usually a contaminated medical device, multi-dose vial, or intravenous solution82, 449-453. In all cases, transmission has been attributed to failure to adhere to fundamental infection control principles, including safe injection practices and aseptic technique.

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Epidemiology and histology of oral leukoplakia and leukoedema among Papuans and New Guineans. Betel quid not containing tobacco and oral cancer: a report on a case-control study in Papua New Guinea and a meta-analysis of current evidence. Mangilao, Guam: University of Guam Cancer Research Center and Department of Public Health and Social Services; 2009. The effect of maternal betel quid exposure during pregnancy on adverse birth outcomes among aborigines in Taiwan. Betel nut chewing and incidence of newly diagnosed type 2 diabetes mellitus in Taiwan. New Caledonia: Secretary of the Pacific Community; 2010 Mar 11 [cited 2011 Jul 25]. Canberra, Australia: Australian Competition and Consumer Commission; 2013 [cited 2012 Jan 27]. Majuro, Marshall Islands: Micronitor News and Printing Company; 2011 Mar 4 (updated 2012 Jan 27] [cited 2012 Jan 27). Smokeless Tobacco and Public Health: A Global Perspective Chapter Contents Report Highlights. In countries with the highest prevalence, most current users report daily use of smokeless tobacco. Smokeless tobacco use poses an extremely complex public health challenge, as product characteristics, patterns of use, health effects, marketing and production practices, and public health and policy responses vary widely between countries and regions. Prevalence and Patterns of Smokeless Tobacco Use Smokeless tobacco has a disproportionate impact in some countries and subpopulations. Adult prevalence is high-10% or greater-in 11 countries (Bangladesh, Bhutan, India, Micronesia, Myanmar, Nepal, Norway, Sri Lanka, Sweden, Yemen, and Uzbekistan). The figures presented in this report represent only those countries for which data are available; data are lacking for some countries in each region. Eight countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Mauritania, Myanmar, and South Africa) reported prevalence of greater than 10% among adult women. For example, the use of gutka or betel quid with tobacco has been found to be very common among first-generation immigrants from Bangladesh and India living in New York and London. Additionally, because smokeless tobacco use is a limited or relatively recent practice in many countries, particularly in higher income countries, research and data collection have lagged. However, estimates of attributable risk for countries where adequate data are available show wide variation in the attributable disease burden. Diversity of Smokeless Tobacco Products the term "smokeless tobacco" covers a large and extremely diverse group of products. Though this categorization may have some utility, the product-associated risks may vary greatly even within these categories. Smokeless tobacco products also vary greatly in their chemical composition, with some products containing extremely high levels of carcinogens, nicotine, and free nicotine (the most rapidly absorbed form). Despite the enormous product diversity, some important common cross-product observations can be made. Global Smokeless Tobacco Use: Future Research Needs and Policy Recommendations Smokeless Tobacco Products levels. Gutka, a dried, prepackaged version of the fresh betel quid traditionally mixed to order by a vendor or user, has become increasingly popular in India and is now a large-scale industry. At the same time, in high-income countries such as the United States, tobacco product manufacturers have packaged moist snuff in pouches that do not require spitting, marketing them to smokers as a discreet and convenient alternative for settings where they cannot smoke. Marketing Strategies and Production Practices: the Evolving Market Tobacco industry marketing strategies also show some common trends. Across high-, middle-, and lowincome countries, tobacco product manufacturers utilize colorful packaging, suggestive names and slogans, cross-branding with non-tobacco products, price discounts, health or medicinal associations, and lifestyle marketing appeals to sell their products. Smokeless Tobacco Company aggressively promoted low-nicotine products starting in the mid-1970s to young people in an attempt to graduate these new users to products containing higher amounts of nicotine as they become more nicotine dependent. Use of small single-use packaging makes products inexpensive and more easily available to youth and may dilute the impact of tobacco taxes. In addition, large-scale marketing campaigns are generally absent for traditional cottage industry products, but large multinational companies have entered markets in some low- and middle-income countries and have begun to produce some traditionally cottage industry products on a larger, commercial scale.

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A case of hepatic anisakiasis with a literal survey for extra-gastrointestinal anisakiasis. Seafood-transmitted zoonoses in the United States: the fishes, the dishes, and the worms. Anisakis simplex induces not only anisakiasis: report on 28 cases of allergy caused by this nematode. A case of abdominal syndrome caused by the presence of a large number of Anisakis larvae. Anisakiasis of the colon: report of two cases with emphasis on the diagnosis and therapeutic value of colonoscopy. K Sakai, A Ohtani, H Muta, K Tominaga, Y Chijiiwa, K Hiroshige, H Fujishima, A Ohkubo, T Misawa, H Nawata. Anisakiasis: preparation of a stable antigen for indirect fluorescent antibody test. Immunoblot analysis of serum IgG, IgA and IgE responses against larval excretory-secretory antigens of Anisakis simplex in patients with gastric anisakiasis. Immunodiagnosis of human anisakiasis by use of larval excretory-secretory antigen. Detection of anti-Anisakis antibody of IgE type in sera of patients with intestinal anisakiasis. The secreted and somatic antigens of the third stage larva of Anisakis simplex, and antigenic relationship with Ascaris suum, Ascaris lumbicoides, and Toxocara canis. Antigenic crossreactivity in mice between third-stage larvae of Anisakis simplex and other nematodes. IgG subclass deficiencies and recurrent pyogenic infections, unresponsiveness against bacterial polysaccharide antigens. A Lindovist, Z Izezawa, A Tanaka, L Yman Seafood specific IgE in atopic dermatitis. Establishment of monoclonal antibodies that discriminate the antigen distribution specifically found in Anisakis larvae type I. A serodiagnostic assay by microenzymelinked immunosorbent assay for human anisakiasis using a monoclonal antibody specific for Anisakis larvae antigen. Human immunoglobulin isotype profiles produced in response to antigens recognized by monoclonal antibodies specific to Anisakis simplex. Usefulness of currently available methods for the diagnosis of Anisakis simplex allergy. Cross-reactivity between the major allergen from olive pollen and unrelated glycoproteins: evidence of an epitope in the glycan moiety of the allergen. Poor biologic activity of cross-reactive IgE directed to carbohydrate determinants of glycoproteins. Specific IgE to crossreactive carbohydrate determinants strongly affect the in vitro diagnosis of allergic diseases. Identification of a cross-reactive allergen (presumably tropomysin) in shrimp, mite and insects. Cross-rectivity between IgE-binding proteins from Anisakis, German cockroach, and chironomids. Free and bound biotin molecules in helminths: a source of artifacts for avidin biotin based immunoassays. Analysis of the antigenicity in mice of biotinyl-enzymes from Anisakis simplex and other nematodes. Comparative studies on biotin-coupled components in adult worms of Paragonimus species. Prevalence of larval Anisakis simplex in pen-reared and wild-caught salmon (Salmonidae) from Puget Sound, Washington. Clinical, epidemiological and morphological studies on 150 cases of acute gastric anisakiasis in Fukuoka Prefecture. The source, release and specificity of proteolytic enzyme activity produced by Anisakis simplex larvae (Nematoda: Ascaridida) in vitro.


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