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[61] Chronic nicotinic acetylcholine receptor activation from repeated nicotine exposure can induce strong effects on the brain, including changes in the brain's physiology, that result from the stimulation of regions of the brain associated with reward, pleasure, and anxiety

38 There is a paucity of evidence regarding smokeless tobacco use and cessation prior to orthopaedic surgery, however the results of this study indicate cessation of smokeless tobacco use may be beneficial in decreasing rates of tibia fracture nonunion and infection