B Acad Nat Med Paris
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Brain development is a complex phenomenon, stretching from fetal life to adolescence, during which brain maturation proceeds through a series of ordered events including critical periods of plasticity. The brain is particularly sensitive to the environment during these changes. The endocannabinoid system participates directly and indirectly in these plasticity and maturation processes. ⋯ Therefore, exposure to cannabis in utero, in perinatal phase, as well as during the adolescence disrupts the brain maturation and can cause disturbances on the cognitive, psychotic and addictive levels that persist far beyond the period of exposure. Several factors modulate the risk of such complications, but studies performed in animal models as well as in human cohorts have shown that exposure during both the critical perinatal and adolescence phases is a risk factor per se. Current knowledge encourages the dissemination of objective information to young people, to prevent and limit early exposure and its consequences.
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Dementias, and Alzheimer's disease (AD) in particular, will increasingly become a public health issue. However, three major data may change the severity of these pathologies: in young adults, simple measures of healthy lifestyle (control of vascular risk factors, physical activity and cognitive stimulation), have an impact on a future cognitive decline; the same lifestyle interventions may delay the start of the disease for elderly people potentially at-risk; finally, and for the first time, a monoclonal antibody directed against amyloid lesions has just shown a significant effect on the progression of AD in patients at an early stage of the disease. According to these results, we will have to reconsider the strategy for managing minor or severe cognitive disorders and particularly AD. ⋯ The solution is to act earlier, even preventively. It is necessary to improve a care offer adapted to this new situation in order to impact on the disease as soon as possible, even before the onset of symptoms, based on: 1) predictive algorithms aimed at establishing whose cognitively unimpaired individuals may further develop the disease; these algorithms will be based on demographic, family, cognitive, genomic and biological data, such as in the "Santé Cerveau" project developed in partnership with the Health Regional Agency (ARS) and the general practitioners; 2)and on some expert centers which must become "dementia prevention clinics" to test prevention measures, initiate and validate multi-domain therapeutic education programs; to disclose about the risk in response to the request of worried patients; and to propose early pharmacological treatments if these individuals are on the way to declare AD in the coming months, taking into account competition between risks. This will allow to prepare to make use of new pharmacological treatments that might be discovered.
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B Acad Nat Med Paris · Jun 2020
Review[Abnormal consequences of non-faulty medical accidents: Jurisprudence of the Conseil d'État].
Compensation for no-fault medical accidents to professionals or establishments is provided for by article L. 1142-1 of the public health code, created by the law of March 4, 2002 relating to the rights of patients and the quality of the health system. It indicates the conditions of accountability, clinical criteria and severity. Among the clinical criteria "a medical accident (…) gives the right to compensation for damages (…) in the name of national solidarity, when (…) they have had abnormal consequences for the patient in view of his condition as well as the foreseeable evolution of it (…)". ⋯ According to the jurisprudence of the Conseil d'État of December 12, 2014 the condition of abnormality is always "satisfied when the medical act entailed consequences significantly more serious than those to which the patient was exposed in a sufficiently probable way in the absence of treatment". And if this is not the case, "they cannot be regarded as abnormal unless, under the conditions in which the act was performed, the occurrence of damage presented a low probability; that thus, they cannot be regarded as abnormal with regard to the state of the patient when the gravity of this state led to practicing an act involving high risks whose realization is at the origin of the damage". The Conseil d'État specified in 2019 that a probability of occurrence of 3% was a low probability.
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B Acad Nat Med Paris · Jun 2020
Review[Recreational use of cannabis: from effects to harm Epidemiological data].
As the medical use of so-called "therapeutic cannabis" is in the process of being approved in France, the opening to its recreational use is the next logical step, as it has been always the chronology followed in all countries. Indeed, those who have legalized the drug have previously approved its therapeutic use. This "justifying a project phase" stage seems unavoidable. ⋯ Estimated at 12.7% in 1992, it reached 44.8% in 2017. Moreover, 25% of users in the year aged from 18 to 64 years old were at high risk of problematic use or dependence in 2017. This figure is worrying because it is constantly increasing; it affects 3% of 18-64-year-old, just over a million people.
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B Acad Nat Med Paris · Jun 2020
Review[Testing for cannabis and synthetic cannabinoids in human specimens].
Among the 60 or so various cannabinoids which are present in cannabis sativa indica, terpenophenols are mainly found, including delta-9-trans tetrahydrocannabinol (Δ9-THC) which is the major psychoactive ingredient. Over the last decade, due to the emergence of e-commerce and the continuous investigations by pharmaceutical groups to identify new active molecules, synthetic cannabinoids have been proposed. These compounds, under the generic name "spices" have chemical structures very different from that of Δ9-THC, but share the same CB1 and CB2 receptors. ⋯ All these drugs are controlled. This means that they have to be tested in human biological specimens to document abuse. The aim of this mini-review is to present what has been described in the scientific literature according to the available specimens (blood, urine, saliva, sweat, hair and exhaled breath), focussing on the current advantages and limitations of each test.