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The perioperative management of patients who are smokers presents anesthesiologists with various challenges related to respiratory, circulatory, and other clinical problems. Regarding 30-day postoperative outcomes, smokers have higher risks of mortality and complications than non-smokers, including death, pneumonia, unplanned tracheal intubation, mechanical ventilation, cardiac arrest, myocardial infarction, and stroke. Given the benefits of smoking cessation and the adverse effects of smoking on perioperative patient management, patients should quit smoking long before surgery. However, anesthesiologists cannot address these issues alone. The Japanese Society of Anesthesiologists established guidelines in 2015 (published in a medical journal in 2017) to enlighten surgical staff members and patients regarding perioperative tobacco cessation. The primary objective of perioperative smoking cessation is to reduce the risks of adverse cardiovascular and respiratory events, wound infection, and other perioperative complications. Perioperative preparations constitute a powerful teachable moment, a 'golden opportunity' for smoking cessation to achieve improved primary disease outcomes and prevent the occurrence of tobacco-related conditions. This review updates the aforementioned guidelines as a practical guide to cover the nuts and bolts of perioperative smoking cessation. Its goal is to assist surgeons, anesthesiologists, and other medical professionals and to increase patients' awareness of smoking risks before elective surgery., Author(s): Hiroki Iida [sup.1] [sup.2] [sup.10], Tetsuya Kai [sup.1] [sup.3], Michioki Kuri [sup.1] [sup.4], Kumiko Tanabe [sup.1] [sup.2], Masashi Nakagawa [sup.1] [sup.5], Chizuru Yamashita [sup.1] [sup.6], Hiroshi Yonekura [sup.1] [sup.7], [...]

Investigating the mechanisms of behavior change interventions provides a more fulsome understanding of how and why interventions work (or don't work). We assessed mechanisms of two interventions (mailouts alone, and mailouts plus telephone support, informed by the Health Action Process Approach (HAPA) and Habit Theory), designed to increase medication adherence after myocardial infarction. We conducted a process evaluation alongside a pragmatic trial. Medication adherence was assessed via self-report at 12-months in the trial, and participants in all trial groups were invited to contemporaneously complete an additional questionnaire assessing targeted mechanisms (HAPA constructs and automaticity). We used multiple regression-based mediation models to investigate indirect effects. Of 589 respondents, 497 were analyzed (92 excluded due to missing data). Mailouts plus telephone support had statistically significant but small effects on intention, social support, action planning, coping planning, and automaticity. There were no indirect effects of interventions on medication adherence via these constructs. Therefore, while this intervention led to changes in proposed mechanisms, these changes were not great enough to lead to behavior change. Refinements (and subsequent evaluation) of the interventions are warranted, and our findings indicate that this could involve offering more intensive support to form plans and identify cues for taking medications, in addition to providing physical supports to encourage self-monitoring, feedback, and habit formation. Trial registration: ClinicalTrials.gov: NCT02382731., Author(s): Nicola McCleary [sup.1] [sup.2] , Noah M. Ivers [sup.3] [sup.4] [sup.5] [sup.6] [sup.7] [sup.8] , J-D Schwalm [sup.9] [sup.10] , Holly O. Witteman [sup.1] [sup.11] , Monica Taljaard [sup.1] [...]

Our current investigation comprises the synthesis and pharmacological impact of bromelain copper nanoparticles (BrCuNP) against diabetes mellitus (DM) and associated ischemia/reperfusion (I/R)--induced myocardial infarction. Bromelain is a proteolytic enzyme obtained from Ananas comosus L. Merr., which has blood platelet aggregation inhibiting and arterial thrombolytic potential. Moreover, copper is well-known to facilitate glucose metabolism and strengthen cardiac muscle and antioxidant activity; although, chronic or long-term exposure to high doses of copper may lead to copperiedus. To restrict these potential hazards, we synthesized herbal nano-formulation which convincingly indicated the improved primordial therapeutic potential of copper by reformulating the treatment carrier with bromelain, resulting in facile synthesis of BrCuNP. DM was induced by administration of double cycle repetitive dose of low dose streptozotocin (20 mg/kg, i.p.) in highfat diet- fed animals. DM and associated myocardial I/R injury were estimated by increased serum levels of total cholesterol, low-density lipoprotein, very low-density lipoprotein, lactate dehydrogenase, creatine kinase myocardial band, cardiac troponin, thiobarbituric acid reactive substances, tumor necrosis factor [alpha], interleukin 6, and reduced serum level of high- density lipoprotein and nitrite/nitrate concentration. However, treatment with BrCuNP ameliorates various serum biomarkers by approving cardioprotective potential against DM- and I/R-associated injury. Furthermore, upturn of histopathological changes were observed in cardiac tissue of BrCuNP-treated rats in comparison to disease models. Key words: diabetes mellitus, high-fat-diet, bromelain, copper, nanoparticles, myocardial infarction. La presente etude porte sur l'incidence de la synthese et de la pharmacologie des nanoparticules de bromelaine de cuivre (NPBrCu) contre le diabete sucre (DS) et l'infarctus du myocarde provoque par l'ischemie-reperfusion (I/R) qui lui est associe. La bromelaine et une enzyme proteolytique tiree de l'ananas cosmosus potentiellement dotee de proprietes inhibitrices de l'agregation plaquettaire dans le sang et thrombolytiques dans les arteres. En outre, le potentiel du cuivre a faciliter le metabolisme du glucose, a renforcer le muscle cardiaque, avec une action antioxydante est bien connu. En revanche, l'exposition au cuivre a long terme peut mener au copperiedus. Pour limiter ce danger, nous avons amplifie la synthese de la nano preparation a base de plantes, ce qui a permis d'ameliorer de maniere convaincante le potentiel therapeutique principal du cuivre en modifiant la presentation de son porteur avec de la bromelaine, ce qui facilite la synthese de NPBrCu. Nous avons provoque le DS en administrant de faibles doses de streptozotocine (20 mg/kg, par voie i.p) en cycles dedoubles a repetition chez des animaux auxquels etait administre un regime alimentaire a haute teneur en matieres grasses. Nous avons evalue le DS et les lesions d'I/R myocardiques associees par l'augmentation des concentrations seriques de cholesterol total, de LDL, de VLDL, de deshydrogenase lactique, de creatine kinase MB, de cTnI, de TBARS, de TNF-[alpha] et d'IL-6, ainsi que par la diminution des concentrations seriques de HDL et de nitrites/nitrates. Cependant, l'administration de NPBrCu a permis d'obtenir des ameliorations en matiere de divers biomarqueurs seriques, temoignant d'un potentiel cardioprotecteur contre le DS et les lesions d'I/R associees. En outre, nous avons observe une inversion des modifications histopathologiques dans le tissu cardiaque des rats auxquels etaient administrees les NPBrCu par rapport a des modeles pathologiques. [Traduit par la Redaction] Mots-cles: diabete sucre, regime alimentaire a haute teneur en matieres grasses, bromelaine, cuivre, nanoparticules, infarctus du myocarde., 1. Introduction Diabetes mellitus (DM) is a metabolic disorder characterized by perpetual hyperglycemia. The global mortality rate of diabetes and associated vascular complications are relatively higher than other morbidity (as [...]