Impact of hyperparathyroidism on allograft histology and function after kidney transplantation: Rethinking its causal role in graft dysfunction.

INTRODUCTION: The causal relationship between hyperparathyroidism and kidney graft dysfunction remains inconclusive. Applying Bradford-Hill's temporality and consistency causation principles, we assessed the effect of parathyroid hormone (iPTH) on graft histology and eGFR trajectory on kidney transplant recipients (KTRs) with normal time-zero graft biopsies. METHODS: Retrospective cohort study evaluating the effect of hyperparathyroidism on interstitial fibrosis and tubular atrophy (IF/TA) development in 1232 graft biopsies. Pre-transplant hyperparathyroidism was categorized by KDIGO or KDOQI criteria, and post-transplant hyperparathyroidism by iPTH >1× and >2× the URL 1 year after transplantation. RESULTS: We included 325 KTRs (56% female, age 38 ± 13 years, follow-up 4.2 years [IQR: 2.7-5.8]). Based on pre-transplant iPTH levels, 26% and 66% exceeded the KDIGO and KDOQI targets, respectively. There were no significant differences in the development of >25% IF/TA between KTRs with pre-transplant iPTH levels above and within target range according to KDIGO (53% vs. 62%, P = .16, HR.94 [95% CI:.67-1.32]) and KDOQI (60% vs. 60%, P = 1.0, HR 1.19 [95% CI:.88-1.60]) criteria. Similarly, there were no differences when using 1 year post-transplant iPTH cut-offs > 88 pg/mL (58% vs. 64%, P = .33) and > 176 pg/mL (55% vs. 62%, P = .19). After adjusting for confounders, no significant differences were observed in eGFR trajectories among the iPTH strata. CONCLUSION: In young KTRs who received a healthy graft, no association was found between increased pre- and post-transplant iPTH levels and graft dysfunction, as assessed histologically and through eGFR trajectory. The concept of hyperparathyroidism as a risk factor for graft dysfunction in recipients at low risk requires reevaluation.

Severe COVID-19 Patients Show an Increase in Soluble TNFR1 and ADAM17, with a Relationship to Mortality.

Overproduction of inflammatory cytokines is a keystone event in COVID-19 pathogenesis; TNF and its receptors (TNFR1 and TNFR2) are critical pro-inflammatory molecules. ADAM17 releases the soluble (sol) forms of TNF, TNFR1, and TNFR2. This study evaluated TNF, TNFRs, and ADAM17 at the protein, transcriptional, and gene levels in COVID-19 patients with different levels of disease severity. In total, 102 patients were divided into mild, moderate, and severe condition groups. A group of healthy donors (HD; n = 25) was included. Our data showed that solTNFR1 and solTNFR2 were elevated among the COVID-19 patients (p < 0.0001), without increasing the transcriptional level. Only solTNFR1 was higher in the severe group as compared to the mildly ill (p < 0.01), and the level was higher in COVID-19 patients who died than those that survived (p < 0.0001). The solTNFR1 level had a discrete negative correlation with C-reactive protein (p = 0.006, Rho = -0.33). The solADAM17 level was higher in severe as compared to mild disease conditions (p < 0.01), as well as in COVID-19 patients who died as compared to those that survived (p < 0.001). Additionally, a potential association between polymorphism TNFRSF1A:rs767455 and a severe degree of disease was suggested. These data suggest that solTNFR1 and solADAM17 are increased in severe conditions. solTNFR1 should be considered a potential target in the development of new therapeutic options.

Potential role of angiotensin-(1-7) in the improvement of vascular insulin sensitivity after a bout of exercise.

NEW FINDINGS: What is the central question of this study? What is the mechanism by which a bout of exercise increases subsequent insulin-stimulated vasodilatation? What is the main finding and its importance? Angiotensin-(1-7) through the Mas receptor participates in enhanced insulin-induced vasorelaxation after a bout of exercise in healthy rats. This new potential role of angiotensin-(1-7) could help in understanding how physical activity improves vascular insulin sensitivity in normal and insulin-resistant states. ABSTRACT: Exercise increases insulin-stimulated vasodilatation, but the mechanisms involved are unclear. This study was performed to investigate the possible involvement of angiotensin-(1-7) (Ang-(1-7)), a vasoactive peptide of the renin-angiotensin system (RAS), in enhanced vascular insulin sensitivity after a bout of exercise. Male Wistar rats were subjected to swimming for 2.5 h. After exercise, carbachol- or insulin-induced relaxation in aorta was assessed. Prior exercise improved insulin-stimulated vasorelaxation; however, this insulin-sensitizing effect was prevented by the selective Mas receptor (MasR; an Ang-(1-7) receptor) antagonist A779. Carbachol-mediated vascular relaxation was not modified by exercise. These results suggest that Ang-(1-7) acting through MasR participates in the enhancement of vascular insulin sensitivity after an exercise session. This new potential role of Ang-(1-7) could help in understanding how exercise improves vascular insulin sensitivity in normal and insulin-resistant states.

Incidence of complications in the management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high- versus low-tone patients.

PURPOSE: The purpose of this study is to evaluate whether patients with high-tone neuromuscular early-onset scoliosis have different surgical outcome and complication rate, when compared to patients with low-tone neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system. METHODS: This is a retrospective cohort study of 67 neuromuscular early-onset scoliosis patients, collected from a multicenter database, treated with a rib-to-pelvis rib-based dual growing system. All patients were divided into two groups: high tone and low tone. Pre-, intra- and postoperative data were compared between both groups. Complications were reported by a standardized system. RESULTS: Twenty-six high-tone and 41 low-tone patients were found homogeneous regarding gender, age at surgery, weight, height, estimated blood loss and surgery time. High-tone group (19/26 = 73.1%) experiences more postoperative complications than low-tone group (22/41 = 53.7%). Most common complications were infection, device migration, death and hardware failure. Permanent abandonment of rib-based growing technique and device removal was required in 21% of high-tone patients (P < 0.001). None of the low-tone patients required abandonment. CONCLUSION: High-tone patients had more complications than those with low tone in management of neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system. A different surgical approach may be required to treat the high-tone neuromuscular early-onset scoliosis.

A Comparative Analysis of the Injury Patterns and In-Hospital Mortality Rates of Belted and Unbelted Motor-Vehicle Occupants - Puerto Rico, January 2000 to December 2014.

OBJECTIVE: Motor vehicle collisions (MVCs) constitute a leading source of morbidity and mortality worldwide. Seatbelt use has been associated with reduced mortality in MVCs. In Puerto Rico, the impact of seatbelt use on MVC deaths has not been evaluated, although they represent a major public health threat. Therefore, this study aimed to assess the association between seatbelt use and in-hospital mortality at Puerto Rico Trauma Hospital (PRTH). MATERIALS AND METHODS: A retrospective cohort study of 2,685 MVC patients aged 1 to 96 years was conducted using the Trauma Registry at PRTH, with data collected from 2000 through 2014. The patient data included sociodemographic and clinical variables and outcomes. Logistic regression analyses were used to evaluate the mortality risk of patients of severe MVC-related trauma who had been wearing seatbelts and compare it to the risk sustained by their unbelted counterparts. RESULTS: Seatbelt use was more common in females than it was in males (71% vs.62%; p < 0.001) and more prevalent in older as opposed to younger patients (p < 0.001). Belted severe trauma victims suffered less frequently from head injuries than did their unbelted counterparts (p < 0.001). The proportions of patients with Glasgow coma scale (GCS) scores of 8 or lower (17% vs. 6%; p < 0.001) and Injury Severity Scores (ISSs) of 25 or higher (24% vs. 15%; p < 0.001) were greater for the unbelted group. Belted severe trauma victims had a 30% lower in-hospital mortality risk compared to their unbelted peers (ORunadj = 0.70; 95% CI: 0.52-0.92). After adjusting for confounders, this difference in risk was eliminated (ORadj = 1.04; 95% CI: 0.72-1.52). CONCLUSION: Our findings demonstrate that seatbelt use is associated with fewer head injuries, lower ISSs, and higher GCS scores. This suggests that using seatbelts mitigates trauma severity, thereby reducing the likelihood of in-hospital mortality for those MVC victims who were wearing seatbelts at the time of their accident.

Ocular Symptoms and Signs of Chikungunya Fever in Puerto Rico.

OBJECTIVE: To determine what ocular symptoms and signs are most common and if there are any associations with comorbid conditions in patients with Chikungunya fever. METHODS: A retrospective data review and analysis of the ocular symptomatology of 139 patients with Chikungunya fever who visited a local emergency room from August through September 2014. Frequencies were calculated, and Pearson's chisquare test employed. All the patients were confirmed as having Chikungunya with IgM (ELISA) before admittance into the study. RESULTS: Of the 139 patients, 42 (30.2%) had red eyes, 27 (19.4%) had conjunctivitis, and 13 (9.4%) had symptoms related to anterior uveitis, such as unilateral red eye, ciliary flush, or irregular pupil(s). Patients with a history of diabetes, hypertension, or cancer were more likely to have both red eyes (p = 0.033) and the symptomatology of anterior uveitis (p = 0.006), while patients with nausea or vomiting were more likely to have red eyes only (p = 0.001). CONCLUSIONS AND RELEVANCE: Red eyes, conjunctivitis, and anterior uveitis occur frequently in patients with Chikungunya fever. Systemic diseases, such as diabetes, hypertension, and cancer, may increase the risk of such ocular manifestations. Routine ophthalmic evaluation is warranted in patients with these medical conditions. The relevance of this study lies in the fact that this disease remains an important public health issue, since such ocular sequelae as may be present can range from mild to severe, either as an acute or a delayed manifestation.

Traumatic Vascular Injury and its Management with Temporary Intravascular Shunts: A Puerto Rico Trauma Hospital's Experience.

OBJECTIVE: Temporary intravascular shunts (TIVSs) are commonly used as a damagecontrol procedure in trauma settings. Currently, there is scarce literature in the civilian field, and what there is is limited to large trauma centers with multiple resources. Therefore, we aimed to describe TIVS usage, and the outcomes of that usage, at Puerto Rico Trauma Hospital. MATERIALS AND METHODS: This is a case series conducted from 2009 to 2013 with 32 patients who suffered vascular trauma, of which 13 needed TIVSs. Data related to age, trauma mechanism, injured vessel, type of shunt, Glasgow Coma Scale, vital signs, and mortality were collected. The analysis was carried out using descriptive statistics. This protocol was approved by the IRB of the Medical Sciences Campus. RESULTS: The most frequent mechanism of injury was a gunshot (11/13; 84.6%). The most commonly injured vessel was the superficial femoral artery. Indwelling time ranged from 6 to 96 hours. Only 2 of the 13 (15.4%) patients with shunts reported thrombosis. Furthermore, we performed 4 (30.7% of the patients) prophylactic fasciotomies and 4 (30.7% of the patients) amputations; 4 of the 13 (30.7%) patients died from unrelated causes. CONCLUSION: Our results are consistent with those in the literature, which supports our contention that a TIVS can be an effective component of damage-control vascular surgery and can, in both military and civilian settings, aid in extremity amputation prevention. Furthermore, it has been established that a TIVS can be fashioned from any available hollow tube. However, further research is needed to evaluate the safety of an improvised catheter of this nature.

Considerations for the use of a loading dose of diazepam for the treatment of benzodiazepine dependence. / Consideraciones respecto al uso de dosis de carga de diazepam para el tratamiento de la dependencia a benzodiacepinas.

Letter to the editor.

Carta al director.

Trauma Epidemiology of Women in Puerto Rico, 2002-2011.

OBJECTIVE: Recent literature has suggested that trauma is heterogenic and that physiological response to it differs between sexes. The study represented in this manuscript aimed to describe gender differences in the mortality rates of trauma patients at the Puerto Rico Trauma Hospital (PRTH). MATERIALS AND METHODS: This was a cross-sectional study performed at PRTH. A total of 14,874 injured patients admitted to the hospital from 2002 to 2011 were included in the sample and divided into 2 groups, based on sex. Pearson's chi-square test was employed for categorical variables and the Mann-Whitney U test for continuous ones. A logistic regression model was undertaken to estimate the association between gender and study outcomes, after adjusting for confounders. A p-value lower than 0.05 was an indication of statistical significance. IRB approval was received. RESULTS: The most common injury areas for women were the chest (32.50%), followed by the extremities (25.83%) and the head/neck (21.51%). Road traffic collisions (RTCs) (45.08%), falls (19.62%), and pedestrian accidents (16.08%) were the most common injury mechanisms for women. The highest frequency of RTC injuries (57.52%) among females occurred in patients who were from 18 to 39 years old. Females 65 years old and older exhibited the highest frequency of falls (39.78%) and pedestrian injuries (25.14%). Males 17 years and under were more likely to have an Injury Severity Score (ISS) of 15 or greater (AOR = 1.56; 95% CI: 1.19-2.03) than were their female counterparts; and, overall, males were more likely to have a Glasgow coma score (GCS) under 9 (AOR = 1.30; 95% CI: 1.11-1.53) than females were. Despite these results, there were no differences between gender mortality rates (AOR = 1.04; 95% CI: 0.86-1.25). CONCLUSION: Our results suggest that there is no sex dimorphism conferring protection on females. Future studies should be conducted to assess this issue.

[Localization and size of colon adenomas as factors related to high gradedysplasia]. / Localización y tamaño de los adenomas del colon como factoresasociados a displasia de alto grado.

OBJECTIVE: To determine whether localization and size are related to the presence of high-grade dysplasia of colon adenomas in patients of a Peruvian hospital. MATERIALS AND METHODS: This is a descriptive transversal study. We checked colonoscopyreports of 2014-2015 years of Hospital Daniel Alcides Carrion, we included the polyps found in patients older than 18 years old, and excluded reports from patients with colorectal cancer, an antecedent of oncological surgery, inflammatory bowel disease and polyposis (6 or more). We used data based on localization (proximal and distal colon, based on the splenic angle), size (less than 10 mm and 10 mm or more), shape (pediculate and sessile) and grade of dysplasia (low and high-grade). We calculated the strength of association by OR, and we determined whether there was association by Chi-square test with a significance value less than 0.05. RESULTS: We reviewed a total of 1710 of colonoscopy reports, 378 patients had polyps, so the adenoma detection rate was 22.1%. There were 458 polyps, from which 254 were adenomas. From these adenomas, we found an association between distal colon localization and high-grade dysplasia (OR 2.68 IC 1.12-6.42, p < 0.05); likewise, there was an association between the size of the adenomas and high-grade dysplasia (OR 7.75 IC 3.05-19.69, p<0.05). We did not find any association between the shape and grade of dysplasia. CONCLUSION: This study concludes that there is an association between the size of 10 mm or more and localization in the distal colon with high-grade dysplasia of adenomas.

Engineering and expression of a RhoA peptide against respiratory syncytial virus infection in plants.

MAIN CONCLUSION : A RhoA-derived peptide fused to carrier molecules from plants showed enhanced biological activity of in vitro assays against respiratory syncytial virus compared to the RhoA peptide alone or the synthetic RhoA peptide. A RhoA-derived peptide has been reported for over a decade as a potential inhibitor of respiratory syncytial virus (RSV) infection both in vitro and in vivo and is anticipated to be a promising alternative to monoclonal antibody-based therapy against RSV infection. However, there are several challenges to furthering development of this antiviral peptide, including improvement in the peptide's bioavailability, development of an efficient delivery system and identification of a cost-effective production platform. In this study, we have engineered a RhoA peptide as a genetic fusion to two carrier molecules, either lichenase (LicKM) or the coat protein (CP) of Alfalfa mosaic virus. These constructs were introduced into Nicotiana benthamiana plants using a tobacco mosaic virus-based expression vector and targets purified. The results demonstrated that the RhoA peptide fusion proteins were efficiently expressed in N. benthamiana plants, and that two of the resulting fusion proteins, RhoA-LicKM and RhoA2-FL-d25CP, inhibited RSV growth in vitro by 50 and 80 %, respectively. These data indicate the feasibility of transient expression of this biologically active antiviral RhoA peptide in plants and the advantage of using a carrier molecule to enhance target expression and efficacy.

[Celiac disease and negative serology villous atrophy: histological comparison and immunohistochemical study of CD3, CD4, CD8 and CD56 lymphocytes]. / Enfermedad celíaca vs. atrofia villositaria serológicamente negativa: similitudes y diferencias histológicas y en el perfil inmunohistoquímico de linfocitos CD3, CD4, CD8 y CD56.

UNLABELLED: There is a group of enteropathies recently known as seronegative villous atrophy (SNVA), which can simulate celiac disease. OBJECTIVE: The aim of this study was to describe histological and immunohistochemical differences between a group of Celiac disease and SNVA patients. MATERIAL AND METHODS: Microscopy reexamination and Immunohistochemistry study were performed for a group of 15 celiac patients and 19 SNVA patients. Histological features as severe atrophy, crypt hyperplasia, plasma cells number, eosinophils number, neutrophils presence were studied; CD4, CD8, CD3, and CD56 markers were studied through immunohistochemistry. RESULTS: There was a significant difference between the frequency of observation of crypt hyperplasia (p=0.0348) and plasma cells (p=0.0348) in celiac disease patients than SNVA patients. In celiac disease was bigger. The number and distribution of CD 8, CD4 and CD56 lymphocytes was similar in both groups. The percentage of CD3 positive intraepithelial lymphocytes (p=0.0144) was higher in SNVA. CONCLUSION: Histological and immunohistochemical evaluation shows more similarities than differences. The differences found in this study suggest more humoral immune response in celiac disease than in SNVA.

Interferon-based therapy delays but metabolic comorbidity accelerates progression of chronic hepatitis C.

BACKGROUND: We compared mortality and complications of chronic hepatitis C between treated and untreated Mexican patients after long-term follow-up. We used a time-to-event analysis and identified the prognostic factors. MATERIAL AND METHODS: Seventy-four patients with chronic hepatitis C were studied. They were ≥ 18 years of age and had a molecular diagnosis of chronic hepatitis C and ≥ 6 months of follow-up. Patients with neoplasia or those infected with human immunodeficiency virus or hepatitis B Virus were excluded. Kaplan-Meier analysis, log-rank test, annualized incidence per 100 person-years, and stepwise discriminant analysis were used to analyse mortality and complications. RESULTS: The end-point of annualized incidence was lowest in sustained virological responders, intermediate in non-responders, and highest in untreated patients. The absence of treatment impacted adversely on cirrhosis development and the occurrence of portal hypertension and hepatic decompensation/hepatocellular carcinoma (logrank, p < 0.05). Diabetes impacted adversely on liver-related death/liver transplantation among untreated patients. Stepwise discriminant analysis showed that diabetes, high blood pressure, and no retreatment predicted cirrhosis development (eigenvalue ≥ 0.8; p < 0.05). A MELD score ≥ 18 and age ≥ 50 years predicted hepatic decompensation/hepatocellular carcinoma (eigenvalue < 0.8; p < 0.05). APRI ≥ 1.5 predicted mortality/liver transplantation and liver-related death/liver transplantation (eigenvalue < 0.8; p < 0.05). CONCLUSIONS: This is the first long-term study of chronic hepatitis C among Mexican patients. Treated patients showed less progression of liver disease. Treated patients showed less progression of liver disease; and older patients, those with metabolic comorbidities, with MELD score ≥ 18 and APRI ≥ 1.5 exhibited adverse effects.

A glass polyalkenoate cement carrier for bone morphogenetic proteins.

This work considers a glass polyalkenoate cement (GPC)-based carrier for the effective delivery of bone morphogenetic proteins (BMPs) at an implantation site. A 0.12 CaO-0.04 SrO-0.36 ZnO-0.48 SiO2 based glass and poly(acrylic acid) (PAA, Mw 213,000) were employed for the fabrication of the GPC. The media used for the water source in the GPC reaction was altered to produce a series of GPCs. The GPC liquid media was either 100 % distilled water with additions of albumin at 0, 2, 5 and 8 wt% of the glass content, 100 % formulation buffer (IFB), and 100 % BMP (150 µg rhBMP-2/ml IFB). Rheological properties, compressive strength, ion release profiles and BMP release were evaluated. Working times (Tw) of the formulated GPCs significantly increased with the addition of 2 % albumin and remained constant with further increases in albumin content or IFB solutions. Setting time (Ts) experienced an increase with 2 and 5 % albumin content, but a decrease with 8 % albumin. Changing the liquid source to IFB containing 5 % albumin had no significant effect on Ts compared to the 8 % albumin-containing BT101. Replacing the albumin with IFB/BMP-2 did not significantly affect Tw. However, Ts increased for the BT101_BMP-2 containing GPCs, compared to all other samples. The compressive strength evaluated 1 day post cement mixing was not affected significantly by the incorporation of BMPs, but the ion release did increase from the cements, particularly for Zn and Sr. The GPCs released BMP after the first day, which decreased in content during the following 6 days. This study has proven that BMPs can be immobilized into GPCs and may result in novel materials for clinical applications.

An unusual case of a borderline Brenner tumor associated with bilateral serous cystadenoma and endometrial carcinoma.

Brenner tumor accounts for 1.5 to 2.5% of ovarian tumors. Nearly all are benign and 1% malignant. Less than twenty-five cases of borderline Brenner tumor have been reported worldwide. Our case is the first one related to a bilateral ovarian serous cystadenofibroma and endometrioid adenocarcinoma. This unusual case increases the limited data for borderline Brenner tumors.

Integrative Taxonomy Reveals Hidden Diversity in the Aloina catillum Complex (Pottiaceae, Bryophyta).

Aloina catillum is a variable moss typical of xerophytic environments in the Neotropics, characterized against other closely allied Aloina species with well-differentiated leaf border by its setae twisted to the left throughout. In order to clarify its variability and its relationships with the allied species with differentiated leaf border A. brevirostris, A. obliquifolia, and A. rigida, we performed an integrative study including sequence data from four markers (nuclear ITS, plastid atpB-rbcL, trnG, trnL-F), morphometry, and species assembling by automatic partitioning (ASAP) algorithm. Our data suggest that A. catillum consists of at least three species: A. calceolifolia (an earlier name for A. catillum), and two species described here as a new, A. bracteata sp. nov. and A. limbata sp. nov. This latter species includes the specimens previously identified as A. obliquifolia from South America. Additionally, some morphological and molecular variability was also detected in A. limbata, but was not consistent enough to be recognized taxonomically. The study supports the presence of A. brevirostris in the Neotropics and A. rigida is tentatively excluded from South America. Full descriptions of the A. catillum s.l. species and a diagnostic key to this complex in South America are provided.

Laparoscopic Removal of a Non-Adjustable Gastric Band and Conversion to a Gastric Sleeve: A Case Report.

Obesity has long been recognized as a global epidemic. One of the most effective treatments is bariatric surgery. Since the first modern procedure was reported, it has evolved over time, and multiple techniques have emerged. More than 20 years ago, one of the most widely used techniques was the non-adjustable gastric band (NAGB), which showed very promising short-term results. However, over time, it became apparent that it was not as effective in the long term. Associated gastrointestinal symptoms, such as reflux and constant vomiting, along with considerable weight regain, caused this technique to fall out of favor and be replaced by other procedures like the gastric sleeve (GS). Although the technique has fallen into disuse and is no longer recommended in the literature, there are still patients with associated complications. Few recent cases associated with these complications have been reported. Most undergo band removal, and whether to perform another procedure remains with limited evidence. We present the case of a patient who underwent an NAGB procedure 10 years ago and later experienced symptoms (reflux) and weight regain. She successfully underwent band removal and conversion to a GS at our institute in Mexico.

Concurrent substance use among cancer patients with and without a history of cannabis use since cancer diagnosis at an NCI-Designated Cancer Center in Florida.

BACKGROUND: Although substance use may have adverse impacts on cancer outcomes, little is known regarding patterns of concurrent substance use with cannabis among cancer patients. Our objective was to examine predictors of concurrent substance use with cannabis among cancer patients since their cancer diagnosis and explore perceptions of cannabis among these patients. METHODS: Patients treated at a National Cancer Institute-designated comprehensive cancer center were invited to participate in an electronic survey regarding medical cannabis from August to November 2021. Survey data were linked to internal data resources including electronic health records and patient intake forms to obtain history of substance use (defined as within at least 3 months of cancer diagnosis) of cigarettes, injection drugs, high levels of alcohol, or clinically unsupervised prescription drugs (total n = 1094). Concurrent substance users were defined as those with any reported substance use and cannabis use at the time of cancer diagnosis. We used descriptive statistics (χ2 or exact tests) to compare groups and estimated adjusted odds ratios (AORs) with 95% confidence intervals (CIs) to identify predictors of substance use among users and nonusers of cannabis. RESULTS: Approximately 45% (n = 489) of the sample reported cannabis use since their cancer diagnosis. Of patients who reported using cannabis, 20% self-reported concurrent polysubstance use, while 8% of cannabis nonusers reported substance use (P < .001). Among patients who use cannabis, those who reported 2 or more self-reported treatment-related symptoms (eg, pain, fatigue) were more likely to have self-reported concurrent substance use (AOR = 3.15, 95% CI = 1.07 to 9.27) compared with those without any symptoms. Among nonusers, those with lower educational background were more likely to have a history of concurrent substance use (AOR = 3.74, 95% CI = 1.57 to 8.92). Patients who use cannabis with concurrent substance use were more likely to report improved sleep (P = .04), increased appetite (P = .03), and treatment of additional medical conditions (P = .04) as perceived benefits of cannabis use. CONCLUSIONS: High symptom burden may be associated with concurrent substance use with cannabis among cancer patients.