Cannabis for medical use versus opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised clinical trials.

OBJECTIVE: The objective of this study is to evaluate the comparative benefits and harms of opioids and cannabis for medical use for chronic non-cancer pain. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: EMBASE, MEDLINE, CINAHL, AMED, PsycINFO, PubMed, Web of Science, Cannabis-Med, Epistemonikos and the Cochrane Library (CENTRAL) from inception to March 2021. STUDY SELECTION: Randomised trials comparing any type of cannabis for medical use or opioids, against each other or placebo, with patient follow-up ≥4 weeks. DATA EXTRACTION AND SYNTHESIS: Paired reviewers independently extracted data. We used Bayesian random-effects network meta-analyses to summarise the evidence and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to evaluate the certainty of evidence and communicate our findings. RESULTS: Ninety trials involving 22 028 patients were eligible for review, among which the length of follow-up ranged from 28 to 180 days. Moderate certainty evidence showed that opioids provide small improvements in pain, physical functioning and sleep quality versus placebo; low to moderate certainty evidence supported similar effects for cannabis versus placebo. Neither was more effective than placebo for role, social or emotional functioning (all high to moderate certainty evidence). Moderate certainty evidence showed there is probably little to no difference between cannabis for medical use and opioids for physical functioning (weighted mean difference (WMD) 0.47 on the 100-point 36-item Short Form Survey physical component summary score, 95% credible interval (CrI) -1.97 to 2.99), and cannabis resulted in fewer discontinuations due to adverse events versus opioids (OR 0.55, 95% CrI 0.36 to 0.83). Low certainty evidence suggested little to no difference between cannabis and opioids for pain relief (WMD 0.23 cm on a 10 cm Visual Analogue Scale (VAS), 95% CrI -0.06 to 0.53) or sleep quality (WMD 0.49 mm on a 100 mm VAS, 95% CrI -4.72 to 5.59). CONCLUSIONS: Cannabis for medical use may be similarly effective and result in fewer discontinuations than opioids for chronic non-cancer pain. PROSPERO REGISTRATION NUMBER: CRD42020185184.

System design for inferring colony-level pollination activity through miniature bee-mounted sensors.

In digital agriculture, large-scale data acquisition and analysis can improve farm management by allowing growers to constantly monitor the state of a field. Deploying large autonomous robot teams to navigate and monitor cluttered environments, however, is difficult and costly. Here, we present methods that would allow us to leverage managed colonies of honey bees equipped with miniature flight recorders to monitor orchard pollination activity. Tracking honey bee flights can inform estimates of crop pollination, allowing growers to improve yield and resource allocation. Honey bees are adept at maneuvering complex environments and collectively pool information about nectar and pollen sources through thousands of daily flights. Additionally, colonies are present in orchards before and during bloom for many crops, as growers often rent hives to ensure successful pollination. We characterize existing Angle-Sensitive Pixels (ASPs) for use in flight recorders and calculate memory and resolution trade-offs. We further integrate ASP data into a colony foraging simulator and show how large numbers of flights refine system accuracy, using methods from robotic mapping literature. Our results indicate promising potential for such agricultural monitoring, where we leverage the superiority of social insects to sense the physical world, while providing data acquisition on par with explicitly engineered systems.

Cross-sectional evaluation of the Bronchitis Severity Score in Egyptian children: A move to reduce antibiotics.

BACKGROUND: Despite evidence of limited benefit of antibiotics in acute bronchitis, most paediatric patients are prescribed them. OBJECTIVES: To assess the validity of the Bronchitis Severity Score (BSS) in assessing the clinical response to treatment of acute bronchitis, and determine whether clinical data and basic laboratory measurements can be used to guide antibiotic prescription. METHODS: We enrolled 200 patients (age range 6 months - 12 years) with clinically diagnosed acute bronchitis. They were divided into three groups according to age. All patients were evaluated three times during the bronchitis episode (days 0, 5 and 7). The primary outcome measurement was the change in the BSS from day 0 to day 7. RESULTS: On the initial visit, the mean (standard deviation (SD)) BSS was 8.36 (2.6), indicating moderate severity of bronchitis. The mean BSS decreased to 4.03 (2.3) on day 5 and to 2.36 (1.45) on day 7. Initial blood tests showed anaemia (80%), leucocytosis (6%), bandaemia (3%) and lymphocytosis (52%). Only four patients were positive for C-reactive protein, while the erythrocyte sedimentation rate was elevated in 98% of cases. There were significant correlations between bandaemia, fever grade (p<0.001) and white blood cell count with clinical variables such as the presence of secretions on chest auscultation (p<0.05) and toxic facies on general examination (p<0.05). CONCLUSIONS: Acute bronchitis in children is a self-limiting disease that does not require routine administration of antibiotics. The BSS is a simple and practical clinical scoring system that is useful in evaluating disease severity and monitoring disease resolution in acute bronchitis.

Effect of honey on the reproductive system of male rat offspring exposed to prenatal restraint stress.

Exposure to prenatal stress is associated with impaired reproductive function in male rat offspring. Honey is traditionally used by the Malays for enhancement of fertility. The aim of this study was to determine the effect of honey on reproductive system of male rat offspring exposed to prenatal restraint stress. Dams were divided into four groups (n = 10/group): control, honey, stress and honey + stress groups. Dams from honey and honey + stress groups received oral honey (1.2 g kg(-1) body weight) daily from day 1 of pregnancy, meanwhile dams from stress and honey + stress groups were subjected to restraint stress (three times per day) from day 11 of pregnancy until delivery. At 10 weeks old, each male rat offspring was mated with a regular oestrus cycle female. Male sexual behaviour and reproductive performance were evaluated. Then, male rats were euthanised for assessment on reproductive parameters. Honey supplementation during prenatal restraint stress significantly increased testis and epididymis weights as well as improved the percentages of abnormal spermatozoa and sperm motility in male rat offspring. In conclusion, this study might suggest that supplementation of honey during pregnancy seems to reduce the adverse effects of restraint stress on reproductive organs weight and sperm parameters in male rat offspring.

Distribution of Molar Incisor Hypomineralization in Malaysian Children Attending University Dental Clinic.

OBJECTIVES: Molar-Incisor Hypomineralization (MIH) is a condition of hypomineralized enamel of systemic origin affecting first permanent molars and frequently permanent incisors. It is considered a global problem and data from South-East Asian countries, including Malaysia are lacking. Hence the aim of this study were to investigate the distribution and severity of MIH in a group of children aged 7-12 year olds attending pediatric dental clinic at Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Malaysia. STUDY DESIGN: Hundred and fifty four children age 7-12 year-old with mean age of 9.14 ±1.682 had their first permanent molars and permanent incisors were examined at Faculty of Dentistry, UiTM using European Academy of Paediatric Dentistry 2003 (EAPD) criteria for diagnosis of MIH. Children at least one first permanent molar affected were considered as having MIH. Data were recorded and statistically analysed using descriptive analysis and Chi square test. RESULTS: Twenty six of the total examined children (n=154) had MIH (16.9%). There was no statistical difference between males and females in the prevalence of MIH. However, a statistical significant difference was found by age groups. The first permanent molars were more frequently affected (58%) as compared to permanent incisors. Mandibular molars were to have the highest rate of MIH (15.5%). The right and left sides were equally affected. Mild defects were the most frequent lesion type (96.6%). CONCLUSIONS: This study revealed that MIH is a common condition (16.9%). Molars were more frequently affected than incisors with mild defects were the most common lesion status. Further studies on this defect amongst Malaysian children are worthwhile.

Modulation of ethanol toxicity by Asian ginseng (Panax ginseng) in Japanese ricefish (Oryzias latipes) embryogenesis.

Alcohol consumption by women during pregnancy often induces fetal alcohol spectrum disorder (FASD) in children who have serious central nervous system (CNS), cardiovascular, and craniofacial defects. Prevention of FASD, other than women abstaining from alcohol drinking during pregnancy, is not known. A limitation of the use of synthetic anti-alcoholic drugs during pregnancy led us to investigate herbal products. In particular, many plants including Asian ginseng (Panax ginseng) have therapeutic potential for the treatment of alcoholism. We used Japanese ricefish (medaka) (Oryzias latipes), an animal model of FASD, for identifying herbal medicines that can attenuate ethanol toxicity. Fertilized eggs in standard laboratory conditions were exposed to ginseng (PG) root extract (0-2 mg/mL) either 0-2 (group A) or 1-3 (group B) day post fertilization (dpf) followed by maintenance in a clean hatching solution. The calculated IC50 as determined 10 dpf in A and B groups were 355.3±1.12 and 679.7±1.6 µg/mL, respectively. Simultaneous exposure of embryos in sub-lethal concentrations of PG (50-200 µg/mL) and ethanol (300 mM) for 48 h disrupted vessel circulation and enhanced mortality. However, PG (100 µg/mL) may partially protect trabecular cartilage (TC) deformities in the neurocranium in B group embryos induced by ethanol (300 mM). To understand the mechanism, embryonic ethanol concentration was measured at 2 dpf and adh5, adh8, aldh2, aldh9a, catalase, GST, and GR mRNAs were analyzed at 6 dpf. It was observed that although ethanol is able to reduce adh8 and GST mRNA contents, the simultaneous addition of PG was unable to alter ethanol level as well as mRNA contents in these embryos. Therefore, antagonistic effects of PG on ethanol toxicity are mediated by a mechanism which is different from those regulating ethanol metabolism and oxidative stress.

Sorption of Pb(ll) by poly(hydroxamic acid) grafted oil palm empty fruit bunch.

This paper describes the sorption of Pb(ll) from aqueous solution. Oil palm empty fruit bunch (OPEFB) fiber was first grafted with poly(methylacrylate) and then treated with hydroxylammonium chloride in alkaline medium to produce hydroxamic acid (PHA) grafted OPEFB. Sorption of Pb(ll) by PHA-OPEFB was maximum at pH 5. The sorption followed the Langmuir model with maximum capacityof 125.0 mg g-1 at 25 degrees C. The sorption process was exothermic, as shown by the negative value of enthalpy change, Delta H0. The free energy change (DeltaG0) for the sorption was negative, showing that the sorption process was spontaneous. A kinetic study showed that the Pb(ll) sorption followed a second order kinetic model.

Changes in cellular immunity during chemotherapy for primary breast cancer with anthracycline regimens.

Anthracyclines are the most widely used anticancer agents for breast cancer, of which doxorubicin and epirubicin have been reported to have equal efficacy. Unfortunately, the integrity of the immune system of breast cancer patients is severely affected by chemotherapy. This study compared the effect of combination chemotherapy with epirubicin (5-fluorouracil, epirubicin, cyclophosphamide (FEC)) and doxorubicin (5-fluorouracil, doxorubicin, cyclophosphamide (FDC)) regimens on subsets of the immune cells of patients with primary malignant breast tumors. Our aim was to determine the best regimen that produces the least degree of myelosuppression. Blood from 80 breast cancer patients undergoing chemotherapy (40 FEC and 40 FDC) was taken before chemotherapy and after every cycle (3 weeks) for 6 cycles. Blood was also taken from 40 normal healthy donors who served as normal control. Subsets of lymphocytes T-helper cells (CD3(+)CD4(+)), T-cytotoxic cells (CD3(+) CD8(+)), B-cells (CD19(+) CD20(+)) and NK cells (CD16(+)/CD56(+)CD3(-)) were analyzed by flow cytometry (FacsCalibur, BD) using monoclonal antibodies (Multitest, BD). All patients in the FEC and FDC groups suffered from myelosuppressive side effects. Both regimens led to an increase in the counts of monocytes but decreased polymorphonuclear cells (PMNs) and lymphocytes. Percentages of T-cytotoxic cells and NK cells were increased, but the percentage of B-cells was dramatically decreased. The phagocytic and intracellular killing ability of PMNs were also suppressed (p<0.01). No significant difference was found between the epirubicin-based regimen and doxorubicin-based regimen with regard to numbers of immune cells, percentages of lymphocytes subsets, Th/CTL ratio, engulfment and killing abilities of PMNs. In conclusion, we found that the epirubicin-based regimen is not superior to the doxorubicin-based regimen with respect to their toxicity of the immune cells, Th/CTL ratio and PMN count and functions. Moreover, both FEC and FDC regimens appear to conserve the cell-mediated immunity response needed for fighting against cancer cells.

Removal of Cu and Pb by tartaric acid modified rice husk from aqueous solutions.

A study on the modification of rice husk by various carboxylic acids showed that tartaric acid modified rice husk (TARH) had the highest binding capacities for Cu and Pb. The carboxyl groups on the surface of the modified rice husk were primarily responsible for the sorption of metal ions. A series of batch experiments using TARH as the sorbent for the removal of Cu and Pb showed that the sorption process was pH dependent, rapid and exothermic. The sorption process conformed to the Langmuir isotherm with maximum sorption capacities of 29 and 108 mg/g at 27 +/- 2 degrees C for Cu and Pb, respectively. The uptake increased with agitation rate. Decrease in sorbent particle size led to an increase in the sorption of metal ions and this could be explained by an increase in surface area and hence binding sites. Metal uptake was reduced in the presence of competitive cations and chelators. The affinity of TARH for Pb is greater than Cu.

Genetic diversity of Eurycoma longifolia inferred from single nucleotide polymorphisms.

Eurycoma longifolia Jack. is a treelet that grows in the forests of Southeast Asia and is widely used throughout the region because of its reported medicinal properties. Widespread harvesting of wild-grown trees has led to rapid thinning of natural populations, causing a potential decrease in genetic diversity among E. longifolia. Suitable genetic markers would be very useful for propagation and breeding programs to support conservation of this species, although no such markers currently exist. To meet this need, we have applied a genome complexity reduction strategy to identify a series of single nucleotide polymorphisms (SNPs) within the genomes of several E. longifolia accessions. We have found that the occurrence of these SNPs reflects the geographic origins of individual plants and can distinguish different natural populations. This work demonstrates the rapid development of molecular genetic markers in species for which little or no genomic sequence information is available. The SNP markers that we have developed in this study will also be useful for identifying genetic fingerprints that correlate with other properties of E. longifolia, such as high regenerability or the appearance of bioactive metabolites.

Removal of fluoride ion from aqueous solution by a cerium-poly(hydroxamic acid) resin complex.

A cerium-loaded poly(hydroxamic acid) chelating ion exchanger was used for fluoride ion removal from aqueous solution. The resin was effective in decreasing the fluoride concentration from 5 mM down to 0.001 mM in acidic pH between 3 and 6. The sorption followed a Langmuir model with a maximum capacity of 0.5 mmol/g. The removal is accomplished by an anion exchange mechanism. The rate constant for the sorption was found to be 9.6 x 10(-2) min-1. A column test shows that the fluoride ion was retained on the column until breakthrough point and the fluoride sorbed in the column can be eluted with 0.1 M NaOH. The column can be reused after being condition with hydrochloric acid at pH 4. The resin was tested and found to be effective for removal of fluoride from actual industrial wastewater.

The effect of zinc supplementation on antioxidant and lipid peroxidation status during Brachiaria decumbens intoxication in sheep.

An attempt was made to clarify the association between zinc (Zn) and antioxidants due to Zn supplementation on lipid peroxidation occurring during Brachiaria decumbens intoxication. The concentration of Zn, copper, malondialdehyde (MDA), superoxide dismutase (SOD), and gluthathione peroxidase (GSH-Px) were determined in tissues. There was a gradual increment in the concentration of Zn and MDA in serum and hepatocytic SOD in groups given Zn + B decumbens. A decline in erythrocytic GSH-Px and SOD, and lower concentration of reduced glutathione in hepatocyte cytosols were also detected in these sheep. It is highly suggestive that Zn supplementation may depress antioxidant status and enhance lipid peroxidation during B decumbens intoxication.

Bitemarks in chocolate: a case report.

Police investigating a theft from a chocolate factory recovered three pieces of chocolate with irregular fractured surfaces displaying a pattern of marks made by human teeth. A highly accuracy dental impression material was used to prepare casts of these marks which were examined and photomicrographed, confirming that they had in fact been produced by human teeth. Casts and photomicrographs of the suspect's teeth were made in order to record the fine details of the casts of the dentition. Unique characteristics evident on these casts included a small notch on the incisal edge of the upper right lateral incisor, wear facets on the incisal edges of the upper central incisors and on the lower right lateral incisor and a space of approximately 1.5 mm between the upper left central incisor and lateral incisor which was rotated about 20 degrees distally. Both direct and photomicrographic comparisons between the casts of the chocolates and of the suspect's dentition revealed correspondence between their unique characteristics.

Sorption of arsenate and arsenite anions by iron(III)-poly(hydroxamic acid) complex.

Iron(III)-poly(hydroxamic acid) resin complex has been studied for its sorption abilities with respect to arsenate and arsenite anions from an aqueous solution. The complex was found effective in removing the arsenate anion in the pH range of 2.0 to 5.5. The maximum sorption capacity was found to be 1.15 mmol/g. The sorption selectivity showed that arsenate sorption was not affected by chloride, nitrate and sulphate. The resin was tested and found effective for removal of arsenic ions from industrial wastewater samples.

Evaluation of a bitemark using clear acrylic replicas of the suspect's dentition--a case report.

An assault occurred during which a bite was inflicted on the left ear of the victim, producing a laceration and severing a portion of tissue from the ear. During the course of their investigation police recovered a lacerated fragment of tissue thought to be of a person's left ear. Impressions of a suspect's dentition were made and cast in dental stone. Positive replicas of the occlusal surfaces of the suspect's dentition were subsequently made using acrylic resin. The ear fragment displayed a lacerated border and a surface which exhibited indentations. When compared with the details of the suspect's lower anterior teeth, correspondence was visible between the shape of the indentations and characteristics of the suspect's dentition. The use of transparent acrylic replicas of the suspect's dentition facilitated the interpretation and comparison between the marks retained in the ear fragment and the features of the suspect's dentition.

Ondansetron against metoclopramide/dexamethasone--a comparative study.

This trial was carried out in Hospital Kuala Lumpur. Fifty-two patients who were scheduled to receive their first or subsequent courses of cancer chemotherapy with single dose cisplatinum containing chemotherapy regimens were evaluated. Thirty-four patients were given ondansetron in one group while 18 in the other group received metoclopramide with dexamethasone. The response to treatment was categorised as complete (0 emetic episode), major (1 or 2 emetic episodes), minor (3 to 5 emetic episodes) or failure (> 5 emetic episodes or rescue medication). Among the 52 patients, a complete or major control (0 to 2 emetic episodes) was achieved in 23/34 patients (68%) from the ondansetron group and in 3/18 patients (17%) from the metoclopramide with dexamethasone group (p < 0.002) on day 1. Similarly, the control of nausea was greater in the ondansetron group compared with the metoclopramide with dexamethasone group (p < 0.0009) on day 1. Two patients were excluded (dropped out) after day one from each of the two study groups due to excessive vomiting subsequent to cisplatinum therapy. From days 2 to 6, there was a trend in favour of ondansetron. Both treatments were well tolerated. The results of this trial show that in the prophylaxis of nausea and vomiting induced by cisplatinum containing chemotherapy, the efficacy of ondansetron is superior to that of a standard anti-emetic combination, metoclopramide with dexamethasone.

Synthesis and properties of poly(hydroxamic acid) from crosslinked poly(methacrylate).

Poly(hydroxamic acid) chelating ion-exchange resin was prepared from crosslinked poly(methacrylate) beads. The starting polymer was prepared by a suspension polymerization of methacrylate and divinyl benzene. Conversion of the ester groups into the hydroxamic acid was carried out by treatment with hydroxylamine in an alkaline solution. Hydroxamic acid capacity of the product was 2.71 mmol/g. The resin exhibited high affinity towards Fe(III) and Pb ions and its capacities for Fe(III), Pb, Cu, Ni and Co ions were pH dependent. The ability of the resin to carry out the separation of Fe(III)CuCo/Ni and PbNi ions is also reported.