Background and Purpose-Our objective was to evaluate the relationship between cannabis use and ischemic stroke in a young adult population. Methods-Forty-eight consecutive young patients admitted for acute ischemic stroke participated in the study. First-line screening was performed, including blood tests, cardiovascular investigations, and urine analysis for cannabinoids. If no etiology was found, 3D rotational angiography and cerebrospinal fluid analysis were performed. A control was planned through neurovascular imaging within 3 to 6 months. Results-In this series, there was multifocal intracranial stenosis associated with cannabis use in 21% (nϭ10). Conclusions-Multifocal MethodsFrom October 2005 to September 2007, 48 consecutive patients younger than 45 years of age who were admitted to our stroke unit for IS were included in this study. Patients were informed that they were included in a prospective study and agreed to participate. Standard T1, T2, FLAIR sequences, diffusion weighted-imaging magnetic resonance imaging scans were acquired for all patients. Vascular imaging comprised 3D-time of flight magnetic resonance angiography (nϭ43) or cerebral computed tomography angiography (nϭ5). Cardiac explorations included electrocardiogram (nϭ48), transthoracic echocardiography (nϭ48), and transoesophageal echocardiography (nϭ29). Exhaustive laboratory analyses were performed for all patients. If first-line investigations were inconclusive, 3D rotational angiography (nϭ30) and cerebrospinal fluid analysis (nϭ29) were performed. A questionnaire was used to determine cardiovascular risk factors, history of medication, and illicit drug or alcohol use. Urines were systematically screened for cannabinoids, cocaine, amphetamine, and methylenedioxymethamphetamine. Follow-up clinical visits (nϭ44) and control of vascular imaging (nϭ20) were planned within 3 to 6 months after discharge from hospital.One study neurologist and 1 study radiologist separately reviewed all 3D-time of flight or computed tomography angiography images. A single operator performed all 3D rotational angiography, and 2 study radiologists, who were unaware of magnetic resonance angiography results, reviewed the 3D rotational angiography images. Involvement of single or several vessel segments were respectively classified as monoarterial stenosis or as multifocal intracranial stenosis (MIS). Statistical AnalysisData are summarized using descriptive statistics. Because of sparseness of data, computations of odds ratio and 95% CI, as well as multivariate logistic regression, were obtained using exact methods (StatXact and LogXact). The logistic regression was designed using the group of MIS as the dependent variable and the other variables as potential predictors. A probability value Յ5% was considered statistically significant. ResultsTable displays the relationship between stroke etiology, classical risk factors, and cannabis use in the 48 patients. There were no patients undergoing serotonergic medical treatment, and there were no amphetamine, meth...
To evaluate the impact of stress on children's well‐being, it is important to have valid and reliable stress assessment methods. Nevertheless, selection of an appropriate method for a particular research question may not be straightforward, as there is currently no consensus on a reference method to measure stress in children. This article examined to what extent childhood stress can be estimated accurately by stressor questionnaires (i.e., Coddington Life Events Scale) and biological markers (serum, salivary, and hair cortisol) using the Triads (a triangulation) method in 272 elementary school girls. Salivary cortisol was shown to most accurately indicate true childhood stress for short periods in the past (i.e., last 3 months), whereas hair cortisol may be preferred above salivary measurements for periods more distant and thus for chronic stress assessment. However, applicability should be confirmed in larger and more heterogeneous populations.
While cannabis is perceived as a relatively safe drug by the public, accumulating clinical data suggest detrimental cardiovascular effects of cannabinoids. Cannabis has been legalized in several countries and jurisdictions recently. Experimental studies specifically targeting cannabinoids' effects on the cerebral vasculature are rare. There is evidence for transient vasoconstrictive effects of cannabinoids in the peripheral and cerebral vasculature in a complex interplay of vasodilation and vasoconstriction. Vasoreactivity to cannabinoids is dependent on the specific molecules, their metabolites and dose, baseline vascular tone, and vessel characteristics as well as experimental conditions and animal species. We systematically review the currently available literature of experimental results in in vivo and in vitro animal studies, examining cannabinoids' effects on circulation and reactive vasodilation or vasoconstriction, with a particular focus on the cerebral vascular bed.
Betel nut is the fruit of Areca palm, growing in Papua New Guinea. Mixed with limestone and stick mustard, arecoline and guvacoline, which are present in betel nut, are hydrolyzed into arecaidine and guvacine, respectively. As part of the study on dietary habits of Papuans residents, our laboratory was asked to analyze the four alkaloids in hair to document long-term exposure. Hair samples were collected from 19 adult subjects (males = 11; females = 8), by some of the authors, and were sent to the laboratory for analysis. The four alkaloids have very similar chemical structures. In order to accurately identify the drugs, two methods were developed. First, the compounds were identified using an ultra-high-performance liquid chromatography system coupled to time-of-flight mass spectrometry. Then, they were quantified by an ultra-high-performance liquid chromatography system coupled to tandem mass spectrometry. After decontamination with dichloromethane, hair samples were cut into very small segments and 20 mg were incubated in methanol for 2 h 30 min in an ultrasound bath. After cooling, the methanol was evaporated to dryness in presence of 20-μL octanol to prevent volatilization. Nicotine-d4 was used as an internal standard. Linearity was observed for concentrations ranging from the limit of quantification to 20 ng/mg for arecoline, arecaidine, guvacine and guvacoline. Measured concentrations were in the range 60 pg/mg to 18 ng/mg for arecoline (n = 19), 14 pg/mg to 2.5 ng/mg for guvacoline (n = 11), 63 pg/mg to 3.8 ng/mg for arecaidine (n = 11) and 100 pg/mg to 3.2 ng/mg for guvacine (n = 6). There was no correlation between concentrations of arecoline and arecaidine (ratio from 0.01 to 0.18) and guvacoline and guvacine (ratio from 0.06 to 3.50). However, the identification of these substances in hair is a good marker of consumption of betel nut and allows us to document a local practice that remains difficult to evaluate just by questioning.
The manuscript presents the International Guidelines developed by the Working Group on Personal Injury and Damage under the patronage of the International Academy of Legal Medicine (IALM) regarding the Methods of Ascertainment of any suspected Whiplash-Associated Disorders (WAD).The document includes a detailed description of the logical and methodological steps of the ascertainment process as well as a synoptic diagram in the form of Flow Chart.
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