Cannabis in cancer care Abrams, DI; Guzman, M
Clinical pharmacology and therapeutics,
06/2015, Letnik:
97, Številka:
6
Journal Article
Recenzirano
Cannabis has been used in medicine for thousands of years prior to achieving its current illicit substance status. Cannabinoids, the active components of Cannabis sativa, mimic the effects of the ...endogenous cannabinoids (endocannabinoids), activating specific cannabinoid receptors, particularly CB1 found predominantly in the central nervous system and CB2 found predominantly in cells involved with immune function. Delta‐9‐tetrahydrocannabinol, the main bioactive cannabinoid in the plant, has been available as a prescription medication approved for treatment of cancer chemotherapy‐induced nausea and vomiting and anorexia associated with the AIDS wasting syndrome. Cannabinoids may be of benefit in the treatment of cancer‐related pain, possibly synergistic with opioid analgesics. Cannabinoids have been shown to be of benefit in the treatment of HIV‐related peripheral neuropathy, suggesting that they may be worthy of study in patients with other neuropathic symptoms. Cannabinoids have a favorable drug safety profile, but their medical use is predominantly limited by their psychoactive effects and their limited bioavailability.
Many ecological phenomena combine to direct vegetation trends over time, with climate and disturbance playing prominent roles. To help decipher their relative importance during Euro‐American times, ...we employed a unique approach whereby tree species/genera were partitioned into temperature, shade tolerance, and pyrogenicity classes and applied to comparative tree‐census data. Our megadata analysis of 190 datasets determined the relative impacts of climate vs. altered disturbance regimes for various biomes across the eastern United States. As the Euro‐American period (ca. 1500 to today) spans two major climatic periods, from Little Ice Age to the Anthropocene, vegetation changes consistent with warming were expected. In most cases, however, European disturbance overrode regional climate, but in a manner that varied across the Tension Zone Line. To the north, intensive and expansive early European disturbance resulted in the ubiquitous loss of conifers and large increases of Acer, Populus, and Quercus in northern hardwoods, whereas to the south, these disturbances perpetuated the dominance of Quercus in central hardwoods. Acer increases and associated mesophication in Quercus‐Pinus systems were delayed until mid 20th century fire suppression. This led to significant warm to cool shifts in temperature class where cool‐adapted Acer saccharum increased and temperature neutral changes where warm‐adapted Acer rubrum increased. In both cases, these shifts were attributed to fire suppression rather than climate change. Because mesophication is ongoing, eastern US forests formed during the catastrophic disturbance era followed by fire suppression will remain in climate disequilibrium into the foreseeable future. Overall, the results of our study suggest that altered disturbance regimes rather than climate had the greatest influence on vegetation composition and dynamics in the eastern United States over multiple centuries. Land‐use change often trumped or negated the impacts of warming climate, and needs greater recognition in climate change discussions, scenarios, and model interpretations.
Purpose To determine the prevalence of complications and reoperations during and after hip arthroscopy. Methods A systematic review of multiple medical databases was performed using the Preferred ...Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All clinical outcome studies that reported the presence or absence of complications and/or reoperations were eligible for inclusion. Length of follow-up was not an exclusion criterion. Complication and reoperation rates were extracted from each study. Duplicate patient populations within separate distinct publications were analyzed and reported only once. Results Ninety-two studies (6,134 participants) were included. Most were Level IV evidence studies (88%) with short-term follow-up (mean 2.0 years). Labral tears and femoroacetabular impingement (FAI) were the 2 most common diagnoses treated, and labral treatment and acetabuloplasty/femoral osteochondroplasty were the 2 most common surgical techniques reported. Overall, major and minor complication rates were 0.58% and 7.5%, respectively. Iatrogenic chondrolabral injury and temporary neuropraxia were the 2 most common minor complications. The overall reoperation rate was 6.3%, occurring at a mean of 16 months. Total hip arthroplasty (THA) was the most common reoperation. The conversion rate to THA was 2.9%. Conclusions The rate of major complications was 0.58% after hip arthroscopy. The reoperation rate was 6.3%, and the most common reason for reoperation was conversion to THA. Minor complications and the reoperation rate are directly related to the learning curve of hip arthroscopy. As surgical indications evolve, patient selection should limit the number of cases that would have been converted to THA. Similarly, the number of minor complications is directly related to technical aspects of the procedure and therefore will decrease with surgeon experience and improvement in instrumentation. Level of Evidence Level IV, a systematic review of Level I to IV studies.
A diverse array of fire-adapted plant communities once covered the eastern United States. European settlement greatly altered fire regimes, often increasing fire occurrence (e.g., in northern ...hardwoods) or substantially decreasing it (e.g., in tallgrass prairies). Notwithstanding these changes, fire suppression policies, beginning around the 1920s, greatly reduced fire throughout the East, with profound ecological consequences. Fire-maintained open lands converted to closed-canopy forests. As a result of shading, shade-tolerant, fire-sensitive plants began to replace heliophytic (sun-loving), fire-tolerant plants. A positive feedback cycle—which we term “mesophication”—ensued, whereby microenvironmental conditions (cool, damp, and shaded conditions; less flammable fuel beds) continually improve for shade-tolerant mesophytic species and deteriorate for shade-intolerant, fire-adapted species. Plant communities are undergoing rapid compositional and structural changes, some with no ecological antecedent. Stand-level species richness is declining, and will decline further, as numerous fire-adapted plants are replaced by a limited set of shade-tolerant, fire-sensitive species. As this process continues, the effort and cost required to restore fire-adapted ecosystems escalate rapidly.
Cannabinoids and opioids share several pharmacologic properties and may act synergistically. The potential pharmacokinetics and the safety of the combination in humans are unknown. We therefore ...undertook a study to answer these questions. Twenty–one individuals with chronic pain, on a regimen of twice–daily doses of sustained–release morphine or oxycodone were enrolled in the study and admitted for a 5–day inpatient stay. Participants were asked to inhale vaporized cannabis in the evening of day 1, three times a day on days 2–4, and in the morning of day 5. Blood sampling was performed at 12–h intervals on days 1 and 5. The extent of chronic pain was also assessed daily. Pharmacokinetic investigations revealed no significant change in the area under the plasma concentration–time curves for either morphine or oxycodone after exposure to cannabis. Pain was significantly decreased (average 27%, 95% confidence interval (CI) 9, 46) after the addition of vaporized cannabis. We therefore concluded that vaporized cannabis augments the analgesic effects of opioids without significantly altering plasma opioid levels. The combination may allow for opioid treatment at lower doses with fewer side effects.
Clinical Pharmacology & Therapeutics (2011); 90 6, 844–851. doi:10.1038/clpt.2011.188
Cannabis species have been used as medicine for thousands of years; only since the 1940s has the plant not been widely available for medical use. However, an increasing number of jurisdictions are ...making it possible for patients to obtain the botanical for medicinal use. For the cancer patient, cannabis has a number of potential benefits, especially in the management of symptoms. Cannabis is useful in combatting anorexia, chemotherapy-induced nausea and vomiting, pain, insomnia, and depression. Cannabis might be less potent than other available antiemetics, but for some patients, it is the only agent that works, and it is the only antiemetic that also increases appetite. Inhaled cannabis is more effective than placebo in ameliorating peripheral neuropathy in a number of conditions, and it could prove useful in chemotherapy-induced neuropathy. A pharmacokinetic interaction study of vaporized cannabis in patients with chronic pain on stable doses of sustained-release opioids demonstrated no clinically significant change in plasma opiates, while suggesting the possibility of synergistic analgesia. Aside from symptom management, an increasing body of in vitro and animal-model studies supports a possible direct anticancer effect of cannabinoids by way of a number of different mechanisms involving apoptosis, angiogenesis, and inhibition of metastasis. Despite an absence of clinical trials, abundant anecdotal reports that describe patients having remarkable responses to cannabis as an anticancer agent, especially when taken as a high-potency orally ingested concentrate, are circulating. Human studies should be conducted to address critical questions related to the foregoing effects.
Purpose The purpose of this study was to quantify the current trends in knee cartilage surgical techniques performed in the United States from 2004 through 2011 using a large private-payer database. ...A secondary objective was to identify salient demographic factors associated with these procedures. Methods We performed a retrospective database review using a large private-payer medical record database within the PearlDiver database. The PearlDiver database is a publicly available, Health Insurance Portability and Accountability Act–compliant national database compiled from a collection of private insurer records. A search was performed for surgical techniques in cartilage palliation (chondroplasty), repair (microfracture/drilling), and restoration (arthroscopic osteochondral autograft, arthroscopic osteochondral allograft, autologous chondrocyte implantation, open osteochondral allograft, and open osteochondral autograft). The incidence, growth, and demographic factors associated with the surgical procedures were assessed. Results From 2004 through 2011, 198,876,000 patients were analyzed. A surgical procedure addressing a cartilage defect was performed in 1,959,007 patients, for a mean annual incidence of 90 surgeries per 10,000 patients. Across all cartilage procedures, there was a 5.0% annual incidence growth (palliative, 3.7%; repair, 0%; and restorative, 3.1%) ( P = .027). Palliative techniques (chondroplasty) were more common (>2:1 ratio for repair marrow-stimulation techniques and 50:1 ratio for restoration autologous chondrocyte implantation and osteochondral autograft and allograft). Palliative surgical approaches were the most common technique, regardless of age, sex, or region. Conclusions Articular cartilage surgical procedures in the knee are common in the United States, with an annual incidence growth of 5%. Surgical techniques aimed at palliation are more common than cartilage repair and restoration techniques regardless of age, sex, or region. Level of Evidence Level IV, retrospective database analysis.
Tennis is a popular sport with tens of millions of players participating worldwide. This popularity was one factor leading to the reappearance of tennis as a medal sport at the 1988 Summer Olympics ...in Seoul, South Korea. The volume of play, combined with the physical demands of the sports, can lead to injuries of the musculoskeletal system. Overall, injury incidence and prevalence in tennis has been reported in a number of investigations. The sport creates specific demands on the musculoskeletal system, with acute injuries, such as ankle sprains, being more frequent in the lower extremity while chronic overuse injuries, such as lateral epicondylitis, are more common in the upper extremity in the recreational player and shoulder pain more common in the high-level player. This review discusses the epidemiology of injuries frequently experienced in tennis players and examines some of these injuries' correlation with the development of osteoarthritis. In addition, player-specific factors, such as age, sex, volume of play, skill level, racquet properties and grip positions as well as the effect of playing surface on the incidence and prevalence of injury is reported. Finally, recommendations on standardisation of future epidemiological studies on tennis injuries are made in order to be able to more easily compare results of future investigations.
Purpose To determine the effect of different types of capsulotomies on hip rotational biomechanical characteristics. Methods Seven fresh-frozen cadaveric hip specimens were thawed and dissected, ...leaving the hip capsule and labrum intact. The femur was transected and potted, and each specimen was placed in a custom loading apparatus that allowed for adjustment of flexion, extension, and axial rotation of the femur. Six reflective infrared markers were attached to the specimens to track the motion of the femoral head with respect to the acetabulum in real time, and external rotation was produced by applying a torque of 10 Nm to the hip specimens. Data analysis was performed using the 3-dimensional position of the markers in space. The specimens were tested in neutral flexion and 40° of flexion in the following capsular states: intact, interportal capsulotomy, T-capsulotomy, repaired capsulotomy, and capsulectomy. Paired t tests and analysis of variance were used with an α value of .05 set as significant. Results With the hip in neutral flexion, there was increased external rotation with a T-capsulotomy (91.1° ± 20.3°, P = .029) and capsulectomy (91.9° ± 19.6°, P = .015) compared with the intact hip (83.2° ± 20.5°). After complete repair of the T-capsulotomy (87.4° ± 20.6°), there was no significant difference in external rotation compared with the intact hip. No significant differences were seen between groups at 40° of hip flexion. Conclusions A T-capsulotomy showed significantly increased external rotation versus the intact and interportal capsulotomy states. The repaired T-capsulotomy restored the rotational profile back to the native state. Clinical Relevance Many methods of capsular treatment during hip arthroscopy exist. Capsulotomy and capsulectomy do not restore the external rotation restraint of the hip back to its native state.
Purpose The purposes of this study were (1) to analyze long-term outcomes in patients who have undergone open or arthroscopic Bankart repair and (2) to evaluate study methodologic quality through ...validated tools. Methods We performed a systematic review of Level I to IV Evidence using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical outcome studies after open or arthroscopic Bankart repair with a minimum of 5 years' follow-up were analyzed. Clinical and radiographic outcomes were extracted and reported. Study methodologic quality was evaluated with Modified Coleman Methodology Scores and Quality Appraisal Tool scores. Results We analyzed 26 studies (1,781 patients). All but 2 studies were Level III or IV Evidence with low Modified Coleman Methodology Scores and Quality Appraisal Tool scores. Patients analyzed were young (mean age, 28 years) male patients (81%) with unilateral dominant shoulder (61%), post-traumatic recurrent (mean of 11 dislocations before surgery) anterior shoulder instability without significant glenoid bone loss. The mean length of clinical follow-up was 11 years. There was no significant difference in recurrence of instability with arthroscopic (11%) versus open (8%) techniques ( P = .06). There was no significant difference in instability recurrence with arthroscopic suture anchor versus open Bankart repair (8.5% v 8%, P = .82). There was a significant difference in rate of return to sport between open (89%) and arthroscopic (74%) techniques ( P < .01), whereas no significant difference was observed between arthroscopic suture anchor (87%) and open repair (89%) ( P = .43). There was no significant difference in the rate of postoperative osteoarthritis between arthroscopic suture anchor and open Bankart repair (26% and 33%, respectively; P = .059). There was no significant difference in Rowe or Constant scores between groups ( P > .05). Conclusions Surgical treatment of anterior shoulder instability using arthroscopic suture anchor and open Bankart techniques yields similar long-term clinical outcomes, with no significant difference in the rate of recurrent instability, clinical outcome scores, or rate of return to sport. No significant difference was shown in the incidence of postoperative osteoarthritis with open versus arthroscopic suture anchor repair. Study methodologic quality was poor, with most studies having Level III or IV Evidence. Level of Evidence Level IV, systematic review of studies with Level I through IV Evidence.
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