Thursday, November 28, 2013

Expression of Bmi1, FoxF1, Nanog, and γ-catenin in relation to hedgehog signaling pathway in human non-small-cell lung cancer

 2013 Oct;191(5):511-21. doi: 10.1007/s00408-013-9490-4. Epub 2013 Jul 18.

Expression of Bmi1, FoxF1, Nanog, and γ-catenin in relation to hedgehog signaling pathway in human non-small-cell lung cancer.


Department of Anatomy, School of Medicine, University of Patras, 26500, Rio Patras, Greece,



Hedgehog signaling is known to be involved in both lung organogenesis and lung carcinogenesis. The aim of this study was to examine potential downstream targets of the hedgehog signaling pathway in non-small-cell lung cancer.


Protein expression of Bmi1, FoxF1, Nanog, and γ-catenin was examined by immunohistochemistry in 80 non-small-cell lung cancer samples. Correlations with the previously immunohistochemically recovered results for sonic hedgehog, Ptch1, Smo, Gli1, and Gli2 in the same cohort of tumors as well as the clinicopathological characteristics of the tumors were also evaluated.


Bmi1 was expressed in 78/80 (97.5 %) cases of non-small-cell lung cancer and correlated with male gender and expression of Gli1. Positive expression of FoxF1 was found in 62/80 (77.5 %) cases. Expression of FoxF1 correlated with lymph node metastases, Bmi1, and hedgehogpathway activation. Overexpression of Nanog was also noted in 74/80 (92.5 %) tumors and correlated with Bmi1. Cytoplasmic accumulation of γ-catenin was observed in 85 % (68/80) of the tumors and correlated with the expression of Bmi1, FoxF1, and Nanog.


Several developmental pathways seem to be implicated in non-small-cell lung cancer. It is also suggested that Bmi1 and FoxF1 may cooperate with hedgehog signaling in non-small-cell lung carcinogenesis.

Face transplantation: From "outlandish and morally objectionable" to "feasible and necessary"

 2013 Dec;132(6):1558-68. doi: 10.1097/PRS.0b013e3182a97e2b.

Evolution of ethical debate on face transplantation.


Boston, Mass. From Brigham and Women's Hospital, Harvard Medical School.



Face transplantation can provide improved quality of life to severely disfigured individuals. The unique challenges of face transplantation prompted much ethical discussion even before the first clinical case. Many deemed it unethical, because of issues ranging from the need for potentially harmful immunosuppression to the potential transfer of identity. Over time, the ethical debate surrounding face transplantation has evolved.


In August of 2012, the authors performed a review of the scientific literature on the ethics of face transplantation, focusing on the evolution of the discussion from before to after the first clinical case in 2005. The authors conducted a primary search (73 peer-reviewed publications) in PubMed using combinations of the terms "ethics" and "face transplantation" and "opinions," and a secondary search (37 peer-reviewed publications) retrieving publications cited in some of the primary search findings. In total, the authors reviewed 110 articles.


A series of 15 issues were addressed repeatedly throughout the reviewed articles. The authors observed an evolution of the general opinion regarding face transplantation: initially seen almost unanimously as an outlandish and morally objectionable procedure, it began to be accepted as a feasible and necessary treatment option for the most significant facial defects.


With growing clinical experience globally, new ethical questions have arisen that must be addressed to move the field of face transplantation forward in an ethically sound manner.

CT screening for lung cancer: countdown to implementation

 2013 Dec;14(13):e591-600. doi: 10.1016/S1470-2045(13)70293-6.

CT screening for lung cancer: countdown to implementation.


Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, Liverpool, UK. Electronic address:


Implementation of lung cancer CT screening is currently the subject of a major policy decision within the USA. Findings of the US National Lung Screening Trial showed a 20% reduction in lung cancer mortality and a 6·7% decrease in all-cause mortality; subsequently, five US professional and clinical organisations and the US Preventive Services Task Force recommended that screening should be implemented. Should national health services in Europe follow suit? The European community awaits mortality and cost-effectiveness data from the NELSON trial in 2015-16 and pooled findings of European trials. In the intervening years, a recommendation is proposed that a demonstration trial is done in the UK. In this Review, we summarise the existing evidence and identify questions that remain to be answered before the implementation of international lung cancer screening programmes.

"Health regulation is an area of English public policy that involves a plethora of different bodies operating independently of one another with the purported aim of monitoring standards, ensuring minimum standards are met and providing assurance for the public and government."

 2013 Nov 27. doi: 10.1002/hpm.2231. [Epub ahead of print]

NHS arm's length bodies and regulatory networks in England: quantitative analysis.


Keele University, Staffordshire, UK.


Health regulation is an area of English public policy that involves a plethora of different bodies operating independently of one another with the purported aim of monitoring standards, ensuring minimum standards are met and providing assurance for the public and government. The purpose of this research is to ascertain as well as possible whether regulation generally is having a positive effect on service provision as well as what the relationship between the data collected by these bodies is. The rationale for testing whether the effect of regulation is positive is obvious; it costs money, time and effort, so does it work? The rationale for testing the relationships is that providers who score well on quality measures should also be experiencing fewer deaths compared with what would be expected. They should also be the providers who are performing well in terms of finances and governance. If there is no relationship between these data sets, then surely something is going wrong; that is, does the various regulatory monitoring and scrutiny actually measure what it sets out to measure? 

clinical commissioners

 2013 Nov 26:1-12. [Epub ahead of print]

Palliative and end of life care for people with dementia: lessons for clinical commissioners.


1 Department of Primary Care and Population Health, University College London, Royal Free Campus, London, UK.


Aim To synthesize information about management of end of life care in people with dementia using review papers.


There are increasing numbers of people being diagnosed with dementia worldwide, and the needs of people with dementia and their carers at the end of life may be different from those with other chronic diseases. By highlighting the challenges of palliative care in persons with dementia and the ways they are best managed, practitioners in primary care may be able to improve services for this group of people at the end of life.


A search of electronic databases of English language papers published in peer-reviewed journals, 2000-2011 inclusive was undertaken using broad terms related to palliative care and dementia. 6167 papers were identified. Titles and abstracts were read. Papers were included if they were literature reviews of palliative or end of life care for people with dementia/Parkinson's disease/Lewy body dementia/cognitive impairment/Alzheimer's disease or any other cognitive impairment, in any setting (hospital, care home, community) and covering people of all ages. Papers were excluded if they covered palliative care focusing on other conditions, or were about an aspect of dementia care and treatment not related to palliative care. Findings Our critical synthesis generated five main themes from this review of the reviews: (1) carers' (family caregivers') experiences; (2) person-centred care; (3) practice (including advance care planning, pain and comfort, nutrition, medical complications and minimizing the distress of behavioural symptoms); (4) system factors, including ethical dilemmas, decision making, information, and training; and (5) research priorities. There appears to be good evidence on the care and management of patients with dementia at the end of life which can be used to influence policy development and emerging specificity about research priorities in palliative care practice for people with dementia.

Cancer seems tougher for everybody on holidays. Jackie Fox's Excellent The 10 Commandments of Breast (or any) Cancer

Jackie Fox's The 10 Commandments of Breast Cancer

Digital Pathology and Federalism

 2013 Jun 5. [Epub ahead of print]

Digital Pathology and Federalism.

One legal issue, however, stands above all others surrounding digital pathology and telemedicine. The issue of physician licensure is daunting and requires substantial consideration.28–37 In fact, the issue of physician licensure is
so significant that it credibly threatens to derail the promise of digital pathology altogether. And its potential solutions
implicate no less than the nation’s principle of federalism. And they implicate it deeply.

Telemedicine’s physician licensure problem, simply put, is that ‘‘[t]elemedical practice is not limited by geographic
boundaries and easily crosses state lines, but physician licensure does not.’’26 And ‘‘[p]rofessional licensure has
traditionally been a matter left to the regulation of the states.’’29

Texas Ethics Commission Chief Joins CPRIT

Ethics Commission Chief Leaves for CPRIT

David Reisman, the executive director of the Texas Ethics Commission, will become the chief compliance officer of the embattled Cancer Prevention and Research Institute of Texas, officials confirmed on Monday. 
“The chief compliance officer plays a critical role in CPRIT’s operations – finding a qualified, dedicated individual to fill the position was key, and we’re pleased to have Mr. Reisman join the agency,” said Wayne Roberts, CPRIT's CEO. “His unique experience and skills will serve CPRIT well as we continue to strengthen processes and increase accountability.”

Zombie allusions: They just keep on coming-thankful this Thanksgiving

Zombie apps, car door handles, and... what CNET's crew is thankful for

Why is CNET's Roger Cheng so grateful for Samsung's Galaxy Gear if he doesn't think the product's all that great (yet)? Find out as members of the CNET team share which technology they're thankful for.

"The entire CNET en Español team feels grateful for Skype, which keeps the very international crew in close touch with family in Mexico, El Salvador, Spain, and the Dominican Republic. CNET Copy Editor Kelsey Adams greatly appreciates the zombie app that keeps her company on runs.
Most of the stories are lighthearted. Then there's Associate Editor Xiomara Blanco, who shares a touching story of the birthday gadget gift she got for her mom, who's battling breast cancer. All the choices point in their own way, big and small, to the impact technology has on our lives in the early 21st century."

From Liz Wager and colleagues: Inpatient Preanalytic Process Improvements

Elizabeth A. Wagar MDRon Phipps MBA, BSRobert Del Guidice MBALavinia P. Middleton MDJohn Bingham MHACherylPrejean BAMartha Johnson-Hamilton BSPheba Philip BSNgoc Han Le BSWaheed Muses BS
From the Departments of Laboratory Medicine (Dr Wagar, Messrs Del Guidice and Muses, and Ms Prejean), Pathology and Laboratory Medicine Quality Improvement (Mr Phipps and Ms Han Le and Ms Johnson-Hamilton), Pathology (Dr Middleton), Performance Improvement (Mr Bingham), and Quality Measurement and Engineering (Ms Philip), University of Texas MD Anderson Cancer Center, Houston. Mr Muses is now with the National Guard Health Affairs, Imam Abdulrahman Bin Feisal Hospital, Dammam, Kingdom of Saudi Arabia.
Context.—Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services.
Objectives.—To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders.
Design.—The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement.
Results.—After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%.
Conclusions.—Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

From Stan Robboy and colleagues: Pathologist Workforce in the United States: I. Development of a Predictive Model to Examine Factors Influencing Supply

Stanley J. Robboy MDSally Weintraub MBAAndrew E. Horvath MDBradden W. Jensen MDC. Bruce Alexander MD;Edward P. Fody MDJames M. Crawford MD, PhDJimmy R. Clark MDJulie Cantor-Weinberg MPPMegha G. Joshi MD;Michael B. Cohen MDMichael B. Prystowsky MD, PhDSarah M. Bean MDSaurabh Gupta BPharmSuzanne Z. Powell MD;V. O. SpeightsJr DODavid J. Gross PhDW. Stephen Black-Schaffer MD; and additional members of the Workforce Project Work Group
From the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Drs Robboy and Bean); College of American Pathologists, Waukegan, Illinois (Mses Weintraub and Cantor-Weinberg, and Dr Gross); the Department of Pathology, University of New Mexico, Albuquerque, New Mexico (Dr Horvath); the Department of Pathology, Southwest Washington Medical Center, Vancouver, Washington (Dr Jensen); the Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama (Dr Alexander); the Department of Pathology, Holland Hospital, Holland, Michigan (Dr Fody); the Department of Pathology, North Shore-Long Island Jewish Health System, Manhasset, New York (Dr Crawford); ACL Labs, West Allis, Wisconsin (Dr Clark); the Department of Pathology, Lawrence General Hospital, Winchester, Massachusetts (Dr Joshi); the Department of Pathology, University of Utah, Salt Lake City (Dr Cohen); the Department of Pathology, Albert Einstein College of Medicine, Bronx, New York (Dr Prystowsky); Grail Research, Mumbai, India (Mr Gupta); the Department of Pathology, The Methodist Hospital, Houston, Texas (Dr Powell); the Department of Pathology, Scott and White Memorial Hospital, Temple, Texas (Dr Speights); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Black-Schaffer).
Context.—Results of prior pathology workforce surveys have varied between a state of equilibrium and predictions of shortage.
Objective.—To assess the current and future supply of pathologists, and apply a dynamic modeling tool for assessing the effects of changing market forces and emerging technologies on the supply of pathologists' services through 2030.
Design.—Data came from various sources, including the literature, College of American Pathologists' internal data, and primary research through custom-developed surveys for the membership and for pathology practice managers
Results.—Through 2010, there were approximately 18 000 actively practicing pathologists in the United States (5.7 per 100 000 population), approximately 93% of whom were board certified. Our model projects that the absolute and per capita numbers of practicing pathologists will decrease to approximately 14 000 full-time equivalent (FTE) pathologists or 3.7 per 100 000 in the coming 2 decades. This projection reflects that beginning in 2015, the numbers of pathologists retiring will increase precipitously, and is anticipated to peak by 2021. Including all types of separation, the net pathologist strength will begin falling by year 2015. Unless workforce entry or exit rates change, this trend will continue at least through 2030. These changes reflect the closure of many training programs 2 to 4 decades ago and the substantially decreased number of graduating residents.
Conclusions.—This comprehensive analysis predicts that pathologist numbers will decline steadily beginning in 2015. Anticipated population growth in general and increases in disease incidence owing to the aging population, to be presented in a companion article on demand, will lead to a net deficit in excess of more than 5700 FTE pathologists. To reach the projected need in pathologist numbers of nearly 20 000 FTE by 2030 will require an increase from today of approximately 8.1% more residency positions. We believe a pathologist shortage will negatively impact both patient access to laboratory services and health care providers' abilities to deliver more effective health care to their patient populations.

“All these London fogs,” he remarked. “They're killers. Bodies just pile up here.”

Simon Winchester

My First Mistake

He seemed surprised. Pleased, too, for it turned out no one else had applied for his job. “Necrophobia,” he whispered darkly. “A puzzling failing,” I explained to him my sanguine notion of man's comparability to a big rabbit; he laughed, and wondered aloud why more people didn't think that way. An interview followed: Utton turned out to be tall and solid man with a clubfoot and a ready laugh. I told him that I was rather more interested in the money than the biology; he responded that in addition to wages, he paid a per-body bonus of four shillings, and that a quick worker could soon be in pretty decent funds. “All these London fogs,” he remarked. “They're killers. Bodies just pile up here.”

From Andy Renshaw and Edwin Gould: Reducing False-Negative and False-Positive Diagnoses in Anatomic Pathology Consultation Material

Andrew A. Renshaw MDEdwin W. Gould MD
From the Department of Pathology, Baptist Hospital of Miami, Miami, Florida.
Context.—Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented.
Objective.—To identify features associated with false-negative and false-positive diagnoses in anatomic pathology.
Design.—We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified.
Results.—Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P < .001); no significant difference in sites were identified for false-positive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P = .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges.
Conclusion.—Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.

Excellent by Maureen Zakowski: Lung Cancer in the Era of Targeted Therapy: A Cytologist's Perspective

Maureen F. Zakowski MD
From the Pathology Fellowship Program, Memorial Sloan Kettering, New York, New York.
Context.—The diagnosis and treatment of non–small cell lung cancer have changed dramatically in the past few years. The discovery of activating mutations in the tyrosine kinase domain of the epidermal growth factor receptor and the use of drugs that successfully target those mutations are among the key advances that have led to a shift in the practice of oncology and pathology, with perhaps the greatest effect on the field of cytology.
Objectives.—To present the perspective of a practicing thoracic pathologist and cytopathologist on the developments that have changed practice and to place those changes in a broader context.
Data Sources.—Literature review, studies undertaken or participated in by the author, and personal experience.
Conclusions.—Cytologists are in an ideal position to influence appropriate testing and treatment in the era of targeted therapy. Lung pathology has led the way in the era of targeted therapy, in no small part due to cytology.

From Hacettepe U-Ankara: Charcot foot in diabetes and an update on imaging

 2013 Nov 20;4. doi: 10.3402/dfa.v4i0.21884.

Charcot foot in diabetes and an update on imaging.


Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.


Charcot neuroarthropathy (CN) is a serious complication of diabetes mellitus that can cause major morbidity including limb amputation. Since it was first described in 1883, and attributed to diabetes mellitus in 1936, the diagnosis of CN has been very challenging even for the experienced practitioners. Imaging plays a central role in the early and accurate diagnosis of CN, and in distinction of CN from osteomyelitis. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, and positron emission tomography are the imaging techniques currently in use for the evaluation of CN but modalities other than magnetic resonance imaging appeared to be complementary. This study focuses on imaging findings of acute and chronic neuropathic osteoarthropathy in diabetes and discrimination of infected vs. non-infected neuropathic osteoarthropathy.

Respect: Response to shame in health care

 1991 Jun;30(2):139-48. doi: 10.1007/BF00988703.

Respect: Response to shame in health care.


Department of Religion and Health at Rush-Presbyterian-St. Luke's Medical Center in Chicago, Illinois.


Shame is a not uncommon experience of patients in health care settings. Religious assessments often confuse shame with guilt, and therefore respond in ways that may not be appropriate. Illustrated by a case study, this article distinguishes shame from guilt and examines systemic considerations. Then shame is explored in relation to traditional, negotiating, and individualistic belief paradigms, looking at epistemology, causality, response to shame, healing models, and tasks. It concludes with a discussion of the idea of "respect" as foundational for responding to people experiencing shame in health care.

Wednesday, November 27, 2013

Rob Witwer: Recall Effort Claims Another Colorado Legislator

Recall Effort Claims Another Colorado Legislator

"Oddly, this particular recall effort leaves Colorado Democrats stronger than they were before. Hudak was not only controversial, she was term limited. By stepping down, she allows her party to appoint a more mainstream candidate with the ability to run as an incumbent in the next general election. And most important, Hudak’s resignation ensures that Democrats will maintain their one-seat margin in the state senate in the upcoming legislative session."

From Mike Fishbein and colleagues: A novel molecular pathway for Snail-dependent, SPARC-mediated invasion in non-small cell lung cancer pathogenesis

 2013 Nov 19. [Epub ahead of print]

A novel molecular pathway for Snail-dependent, SPARC-mediated invasion in non-small cell lung cancer pathogenesis.


1Pathology and Laboratory Medicine, University of California, Los Angeles; Jonsson Comprehensive Cancer Center.


Definition of the molecular pathogenesis of lung cancer allows investigators an enhanced understanding of the natural history of the disease, thus fostering development of new prevention strategies. In addition to regulating epithelial-to-mesenchymal transition (EMT), the transcription factor Snailexerts global effects on gene expression. Our recent studies reveal that Snail is upregulated in non-small cell lung cancer (NSCLC), is associated with poor prognosis, and promotes tumor progression in vivo. Herein, we demonstrate that overexpression of Snail leads to upregulation of Secreted Protein, Acidic and Rich in Cysteine (SPARC) in models of premalignancy and established disease, as well as in lung carcinoma tissues in situ.Snail overexpression leads to increased SPARC-dependent invasion in vitro, indicating that SPARC may play a role in lung cancer progression. Bioinformatic analysis implicates TGF-β, ERK1/2, and miR-29b as potential intermediaries in Snail-mediated upregulation of SPARC. Both the TGF-β1 ligand and TGF-βR2 are upregulated following Snail overexpression. Treatment of human bronchial epithelial cell (HBEC) lines with TGF-β1 and inhibition of TGF-β1 mRNA expression modulated SPARC expression. Inhibition of MEK phosphorylation downregulated SPARC. MiR-29b is downregulated in Snail overexpressing cell lines, while overexpression of miR-29b inhibited SPARC expression. In addition, miR-29b was upregulated following ERK inhibition, suggesting a Snail-dependent pathway by which Snail activation of TGF-β and ERK signaling results in downregulation of miR-29b and subsequent upregulation of SPARC. Our discovery of pathways responsible for Snail-induced SPARC expression contributes to the definition of NSCLC pathogenesis.

Zombie allusions: They just keep on coming-"describing the symptoms: paranoia, fear, hallucinations, restlessness, the inability to sleep, hyperthermia, fluctuations in mood and horrible attention span."

Bath Salts Make You More Like A Zombie Than You Think (VIDEO)

The Huffington Post  |  By  

"The side effects of bath salts are zombie-like because when you have increased dopamine levels mixed with lack of sleep and all of the other crazy side effects, your central nervous system doesn't work properly -- you don't feel pain," she told HuffPost Weird News via email. "[Bath salts users] aren't really there, they are just a body walking around."
Of course, bath salts aren't actually known to induce a deathly need for human meat, but they do have some zombie-like effects, Gordner says. The video cites Forbes, and Huffington Post when describing the symptoms: paranoia, fear, hallucinations, restlessness, the inability to sleep, hyperthermia, fluctuations in mood and horrible attention span.
"Bath salt hallucinations are not bright and colorful like many drug-induced hallucinations are portrayed in the media," the narrator says. "Rather these hallucinations are typically dark and threatening because the bath salts are causing your body to react as if it's in danger."

"Bath salts" intoxication: a new recreational drug that presents with a familiar toxidrome


"Bath salts" intoxication: a new recreational drug that presents with a familiar toxidrome.


It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. "Bath salts," which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers.

New designer drugs (synthetic cannabinoids and synthetic cathinones): review of literature

 2013 Aug 29. [Epub ahead of print]

New designer drugs (synthetic cannabinoids and synthetic cathinones): review of literature.


University Hospital of Lille Department of Psychiatry and Addiction Medicine CHU Lille F-59037 Lille Cedex France.


New designer drugs (synthetic cannabinoids and synthetic cathinones) are new "legal highs" that are sold online for recreational public or private use. Synthetic cannabinoids are psychoactive herbal and chemical products that mimic the effects of cannabis when used. These drugs are available on the Internet or in head shops as incense or air fresheners to circumvent the law. Cathinone is a naturally occurring beta-ketone amphetamine analog found in the leaves of the Catha edulis plant. Synthetic cathinones are phenylalkylamine derivatives that may possess amphetamine-like properties. These drugs are sold online as bath salts. Designer drugs are often labeled as "not for human consumption" to circumvent drug abuse legislation. The absence of legal risks, the ease of obtaining these drugs, the moderate cost, and the availability via the Internet are the main features that attract users, but the number of intoxicated people presenting with emergencies is increasing. There is evidence that negative health and social consequences may affect recreational and chronic users. The addictive potential of designer drugs is not negligible.

Emergence and properties of spice and bath salts: A medicinal chemistry perspective

 2013 Oct 7. pii: S0024-3205(13)00579-1. doi: 10.1016/j.lfs.2013.09.026. [Epub ahead of print]

Emergence and properties of spice and bath salts: A medicinal chemistry perspective.


Center for Organic and Medicinal Chemistry, Research Triangle Institute, Research Triangle Park, NC, USA. Electronic address:


Over the past five years the number of internet sites advertising "legal highs" has literally exploded, as have user reports of experiences (both pleasurable and frightening) with these substances and the number of emergency room visits by users. Although the majority of these "legal highs" have been described as bath salts and herbal extracts, most contain neither plant derived compounds nor components of personal hygiene products. So-called "bath salts" largely contain synthetic analogs of the natural compound Khat; spice-related materials, claimed to be "legal marijuana," are mostly synthetic analogs of cannabinoid receptor ligands that were developed as research tools. This review describes the emergence and properties of these two groups of "legal highs" from a medicinal chemist's perspective.