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Marijuana a term used to refer to plants in the cannabis genus, primarily the species of sativa , indica , and ruderalis is an herb from Traditional Chinese Medicine that also has a history of usage for various non-nutritional and non-medical purposes, such as fiber and textile manufacturing.
Its history extends beyond mainland Asia, as it has been detected alongside Egyptian mummies as hashish. The plant is called many names with the most common being marijuana referring to the plant itself , bhang referring to a drink produced in some Asian countries from the leaves and flowers  and hashish referring to a resinous solution.
All parts of the plant tend to be used, usually the leaves and flower buds. Cannabis sativa of the family Cannabaceae is a somewhat broad plant species, and previous species in the Cannabis genus Cannabis indica , which is usually the source of hemp, as well as Cannabis ruderalis are now considered varieties of Cannabis sativa. In general, the Cannabis sativa plant contains a wide variety of bioactives but those of interest are the cannabinoids.
Cannabinoids, in the context of Cannabis sativa , refer to molecules with a C 21 terpenophenolic skeleton  of which over 86 unique molecules have currently been isolated. Cannabi no diol CBND type: Volatile oils airborne constituents usually implicated in aromatherapy usually contianing a high concentration of myrcene Various phenanthrenes including 4,5-dihydroxy-2,3,6-trimethoxy-9,dihydrophenanthrene , 4-hydroxy-2,3,6,7-tetramethoxy-9,dihydrophenanthrene , and 4,7-dimethoxy-1,2,5-trihydroxyphenanthrene .
Passive inhalation refers to second-hand inhalation of smoke from marijuana, and is of concern since many athletes who are prohibited from using marijuana may associate with marijuana users, making exposure to 'side-stream' smoke a concern for positive urine tests. Tetrahydrocannabinol THC appears to be absorbed through the skin when in an appropriate medium as it is fat soluble , with some studies noting success in transdermal THC absorption in vitro with solutions containing ethanol    or propylene glycol.
Despite species-dependent differences in absorption, THC has been noted to be topically absorbed in vivo in the mouse  and guinea pig,  with the latter showing a 84 minute lag time to reach a plasma concentration of 4. When marijuana is smoked toking , a maximum plasma value of cannabinoids is achieved and the onset of psychotropic effects occurs within a few minutes.
Psychotropic effects are maximal minutes after initial ingestion and taper off hours after exposure. After oral ingestion via brownies peak serum levels are achieved at a variable minutes after ingestion, due to varying digestive potencies inter-person. Tissue distribution of THC is assumed to be due to the molecule's physicochemical properties, as no THC-specific transporters or barriers that affect tissue concentration are known to exist.
THC rapidly enters highly vascularized good blood supply tissues and organs such as muscle, spleen, heart, lungs, liver, and kidneys. THC can easily cross the placental barrier, and can appear in a child's blood if a mother ingests marijuana.
This is seen across all species to varying degrees. THC may also accumulate in the testicles, where it may influence reproductive function. Although metabolism exists in the lungs and heart tissue, tetrahydrocannabinoids are metabolized primarily in the liver through the cytochrome P CYP enzyme system, via hydroxylation and oxidation reactions.
Excretion of THC compounds in the urine and feces begins after a pseudoequilibrium is met between tissues and plasma. The time of equilibrium changes based on dosage, with low dosage 16mg THC tokes taking hours, and high dosage 34mg tokes taking hours.
Half lives in the hour range are typically reported for the THC molecule itself. Complications arise in measuring the half-life of DeltaTHC due to interpersonal and interspecies differences, with some complications in distinguishing THC from its metabolites in vivo. Chronic users tend to take much longer to fully metabolize all THC from the body; in some cases under urine analysis metabolites can be traced in the urine up to days after administration.
Smoking marijuana or tobacco can lead to increases in CYP1A2 activity, although cessation is known to return levels to normal. At times, it has been noted that the reduced liver enzyme activity from stopping marijuana smoking resulted in an overdose of some antipsychotics clozapine and olanzapine due to reduced metabolism. Notably no cannabinoids have been noted to have metabolism-dependent inhibition.
In contrast to the above information assessing acute enzyme interactions, induction of CYP3A isoforms has been noted with repeated exposure of cells to inactivating cannabinoids usually cannabidiol  although the increase in CYP3A4 mRNA and protein content was met with no significant change in catalytic activity in vitro. Other human evidence is limited to a suspected acute inhibition of CYP3A4 due to a case study where the combination of Viagra and marijuana resulted in a myocardial infarction  and a study in people with HIV on antiretroviral therapy where two weeks supplementation of dronabinol 2.
The main site of activity for the cannabinoid constituents of marijana are the cannabinoid receptors, named cannabinoid receptor 1 CB1 and cannabinoid receptor 2 CB2 , with the former being the found mostly in the brain where it modulates psychoactive effects whereas the latter is found mostly immune tissue where it modulates inflammation and immune response. CB1 receptors are prominent in neural tissue but are also found in pituitary and peripheral tissue such as the thyroid, adrenals, gastrointestinal tract, and reproductive organs.
CB1 exerts its effects through coupling with G proteins. There are some actions of cannabinoids which still occur when CB1 or CB2 or blocked or deleted entirely in knockout mouse strains, yet are sensitive to pertussis toxin that inhibits any G-protein coupled receptor's actions, suggesting that cannabinoids act directly on receptors that are not one of the two aforementioned cannabinoid receptors.
The effects of CB1 receptor activation on ion channels, and ultimately the electrical conduction and action potential in neurons are mediated primarily through CB1's effects on PKA and G proteins. A family of ion channels called the transient receptor potential TRP channels depolarize the cell membrane upon activation, and play a wide role in sensory perception, including pain.
In vitro evidence suggests that several cannabinoids from marijuana, including cannabidiol and cannabinol a degradation product of THC are able to desensitize TRPV1 and TRPA1, which could possibly lead to analgesia. Activation of both CB1 and A1 result in less-than-additive G protein activation,  while stimulation of the A1 pathway with Caffeine reduces the activation of G proteins through CB1. While both cannabinoid CB1 receptors and adenosine A1 receptors clearly share common second messengers in their respective signaling cascades, the exact nature of their crosstalk is complex, and not completely understood.
During tolerance to cannabinoids, A1 mediated G protein activation is not affected,  while CB1-dependent activation is suppressed.
Conversely, tolerance to Caffeine which increases A1 receptor density in neurons  decreases CB1 receptor density. Agmatine is a neurotransmitter derived from L-Arginine  that appears to interact with cannabinoid signalling, in particular the CB1 receptor   and imidazoline receptors  which agmatine can act upon and may act as a co-transmitter released alongside glutamate. The analgesic properties of agmatine appear to partially depend on imidazoline receptors, as the ability of mice to tolerate pain caused by heat decreases when given both imidazoline and CB1 receptor blockers.
The ability of cannabidiol to block agonists seems to occur at around a Subchronic exposure to marijuana is known to downregulate the CB1 receptor in humans  and a downregulation has been noted as acutely as after three days of exposure in rats.
Dopamine D2 receptors in the prefrontal cortex has the potential to couple with 5-HT 2A receptors, forming heteromers and thereby enhancing the actions of 5-HT 2A  . This heteromer formation is enhanced after cannabinoid treatment in rats in vivo following a week of treatment; increased membrane localization of individual 5-HT 2A , D 2 S, and D 2 L receptors also occurs, and together these effects may be involved in the mechanism by which marijuana induces mood and cognitive dysfunction in susceptible individuals.
The increase in 5-HT 2A expression upon subchronic cannabinoid exposure appears to be due to CB2 activation  which has been noted elsewhere  while the suppression of D2 mRNA is due to CB1 activation;  this suppression of D2 mRNA has been found in utero with mothers who use marijuana. Low D2 receptor content and the resulting lower dopamine release from drugs is implicated in various drug dependency situations including alcohol ,  amphetamines,  and cocaine.
The CB1 receptor is expressed on GABAergic interneurons in the hippocampus and cerebellum, usually to a larger relative degree than glutaminergic neurons. The effects of marijuana usage on glutamate, a major excitatory neurotransmitter, appear to partially underlie its impairment of working memory. The downregulation is dose- and time-dependent, and is mediated through the upregulation of COX2. Besides effects on astrocytes, activation of CB1 can also affect neurons directly; in both the ventral tegmental area VTA  and in hippocampal slices  activation of CB1 receptors presynaptically appears to attenuate glutamate release from neurons.
This reduction in NMDA signalling due to an association with CB1 is also thought to underlie some of the neuroprotective aspects of marijuana, since mice lacking HINT1 do not experience protection by CB1 agonists from glutamate-induced neurotoxicity,  which is known to be mediated by uncontrolled NMDA signalling.
In heavy smokers, administration of naltrexone opioid antagonist alongside marijuana inhalation appeared to increase the percieved high and was also noted to cause impairment to psychomotor function in a study which marijuana alone was insufficient to do so. Subchronic, but not acute, exposure to CB2 agonists has been noted to cause anxiety in rodents. Subchronic 12 day administration of the synthetic cannabinoid HU has been noted to suppress the activity of the 5-HT 1A receptor subset while upregulating the aforementioned 5-HT 2A receptor and inceasing the actions of its agonists.
Glial cells are macrophage-like brain cells that support neuronal function and highly involved in neurodegenerative disorders when overactivated. The decrease in middle cerebral blood velocity is seen with mild and major instances of orthostatic hypotension associated with marijuana after 10 minutes   and not related to plasma THC content.
When looking at the hemispheres of the brain there appears to be an increase in cerebral blood flow relative to placebo inhalation between minutes no longer present at the two hour mark in both hemispheres and globally, which is dose-dependent.
Preclinical studies have noted that the CB1 receptor is expressed in brain regions important for sensing and responding to pain nociception ,    suggesting that the cannabinoids may play an important role in nociceptive transmission.
The effect of CB1 activation on pain dissociation can occur in those who have never used marijuana before  and has a rapid onset, occurring within 45 minutes of inhalation. Marijuana is well known to increase hunger, a major cause of the 'munchies' in recreational users.
The appetite-increasing effects of marijuana have also found medicinal use however, to bolster appetite in patients with HIV, cancer, or other diseases associated with muscle-wasting cachexia. Ghrelin ultimately increases food intake via signaling in the hypothalamus, in part via increased hypothalamic AMPK activity, a central control point for nutrient sensing.
Interestingly, the requirement of CB1 activation for ghrelin appetite-inducing effects may occur in the periphery rather than the central nervous system, as CB1 receptor antagonists that cannot reach the brain are still highly effective in blocking the appetite-increasing effects of centrally administered ghrelin.
In addition to increasing ghrelin levels,  inhalation of cannabis in HIV patients blinded has been noted to reduce levels of the appetite suppressing peptide PYY. In heavy marijuana users average six sessions weekly with 5. Chronic marijuana usage has been associated with a reduction in motivation ie. A randomized trial in heavy marijuana users consumption of at least 4 times per week for at least 2 years found that acute marijuana use with medium-dose THC 5.
A systematic review of the effects of cannabinoids including marijuana use was recently completed, and overall found mixed results and general study quality to be poor, with most studies done in the short-term, with a high risk of bias, and done mainly on small and limited populations in North America only. Endocannabinoids are thought to have a protective effect in epilepsy, since they are released from neurons when a seizure occurs  and control seizure frequency and duration via activating CB1 receptors.
The anti-epileptic activity of CB1 receptor activation  is thought to occur via formation of a heterodimer between CB1 and the NMDA receptor, which functions to suppress glutamate signaling. Excessive glutamate signaling promotes seizures by activating NMDA, which then increases calcium influx and the production of intracellular Nitric Oxide via increased nNOS activity which becomes oxidized to form peroxynitrate. Subsequent peroxynitrate-induced Zinc release in neurons then increases excitatory signaling from glutamate leading to dysregulated neuronal firing.
Cannabidiol CBD is a nonpsychoactive bioactive in marijuana which is primarily looked into for epilepsy. Rather than acting upon the CB1 receptor it is thought to act on the TRPV1 calcium channel, seen in vitro to activate and rapidly desensitize this channel  ultimately resulting in less potential for hyperexcitation.
While only five studies were available for establishing a temporal relationship between marijuana use and anxiety by measuring the same individuals at two time points it does seem that people who used marijuana early on had an increased risk of developing anxiety later in life compared to users who did not use marijuana OR of 1. In heavy adolescent and adult marijuana users approximately daily usage there does not appear to be any increased risk for depression in later in life when compared to non-smokers.
A mildly increased risk for diagnosis of combined depression and anxiety in subjects who chronically use marijuana was noted in another meta-analysis OR of 1. The effects of marijuana memory and learning can be divided up into short, medium, and long-term effects.
In the short term within hours of smoking , marijuana has consistently been shown to impact working and short-term memory. Another meta-analytic study of the non-acute effects of marijuana found small but significant effects on learning and forgretting, but noted a few caveats: CB1 receptor agonists have been shown to suppress NMDA glutamate receptor-mediated calcium influx,  resulting in less CREB phosphorylation and decreased synaptic plasticity that may ultimately impair memory formation.
Inhalation of marijuana smoke is known to increase heart rate at rest. Increases in heart rate upon smoking marijuana can occur even in heavy users  and have been suggested to correlate with the percieved high.
Marijuana-induced increases in heart rate can be attenuated with beta-blockers   or atropine  , the combination of which nearly abolish any changes in heart rate  or other cardiac measures. The cannabinoid receptor CB1 has been detected in endothelial cells from the human aorta  where its activation leads to increased free radical production and Mitogen-Activated Protein Kinase MAPK activation which leads to cell death.
Atherosclerosis is a disease that is driven by chronic inflammation, where fatty deposits and immune cells enter the walls of blood vessels causing progressive narrowing and restriction of blood flow. It has been noted that cannabinoids have both immunosuppressive and anti-inflammatory properties,    suggesting they may have potential as therapeutics for atherosclerosis. Consistent with this idea, human foam cells, which are damaged macrophages that develop after engulfing oxidized lipids,  have been found to have greater amounts of CB2 than the macrophages from which they are derived.
Activation of the CB2 receptor appears to work via reducing the amount of oxidized LDL cholesterol oLDL that is accumulated by macrophages, secondary to downregulating the binding protein CD36 aka. There may be an efflux of cholesterol out of already-formed foam cells secondary to CB2 activation, since it has been noted that CB2 activation has caused an increase in ATP-Binding Cassette sub-family G member 1 ABCG1 protein levels,  which is responsible for transporting excess cholesterol out of cells.
In contrast to CB2, activation of the cannabinoid signaling system through the CB1 receptor is proatherogenic   although some compounds that inhibit CB1 also have confounding actions which may also be beneficial direct acyl CoA: CB1 receptor activation has been shown to promote cholesterol accumulation in macrophages, leading to foam cell formation. Although macrophages are traditionally considered as the source of foam cell formation, resident vascular smooth muscle cells are also capable of developing into foam cells.
Increased blood pressure may be partly driven by the action of THC on CB1 receptors in the brain, which is known to increase heart rate and produce acute increases in blood pressure. Abrupt cessation of marijuauna usage usage at least 25 times monthly for minimum of one year was associated with an increase in systolic 7. In vitro evidence suggests that some components of marijuana may inhibit platelet aggregation by blocking ADP-induced platelet aggregation.
Serotonin is taken up and stored by platelets; when these platelets are activated, serotonin is released, which functions both as a vasoconstrictor as well as an activator of additional platelets. An in vitro study found that the inhibition of serotonin release by cannabinoids was not correlated to their ability to inhibit platelet aggregation. Although present in rats, the effects of marijuana on triglycerides do not appear to occur in humans.
A large longitudinal study examining marijuana usage found a correlation between marijuana use and elevated triglyceride levels in young users, although this correlation disappeared when concurrent alcohol use was taken into account. Observational studies have failed to note changes in total cholesterol levels among marijuana users,  and either a decrease,  increase,  or no change   in HDL-C. No interventional research concerning the effects of active components of marijuana on cholesterol has been performed to date.
When total cholesterol and LDL-C are investigated, similar mixed results are noted, with one study reporting a possible decrease  and another reporting no significant changes. Although not currently well understood, the mechanisms responsible for marijuana-induced reduction in fasting insulin may occur via attenuation CB1 receptor signaling that could increase adiponectin levels,  resulting in increased insulin sensitivity  and therefore reduced production of insulin.
Moreover, in addition to containing the cannabinoid receptor agonist THC, marijuana also contains cannabidiol, which is a cannabinoid receptor antagonist. Thus, it is plausible that known or yet-to be identified components of marijuana may reduce fasting insulin concentrations via an adiponectin-mediated mechanism that is driven by decreased signaling through the CB1 receptor. Insulin sensitivity as calculated by the Homeostasis Model Assessment of Insulin Resistance HOMA-IR was observed to be higher in current users of marijuana used at least once in the past 30 days when compared to controls who never used marijuana.
No dose-dependency between marijuana use and insulin sensitivity was noted, however. However, the study of chronic users did reveal an increase in adipocyte insulin resistance despite no change in the other measures of insulin sensitivity.
There are no clinical studies on the effects of marijuana on glycogen. However, some data from animal models and in vitro experiments do exist. In animal models, acute administration of cannabis extract to rats decreases glycogen stores in the liver,  while repeated exposure to cannabis extract decreases uterine glycogen stores in rats.
Indirect in vitro evidence using human tissue suggests that the cannabinoid system may affect glycogen levels. AMP-activated protein kinase AMPK functions as a cellular energy sensor, inhibits glycogen synthesis in muscle cells, and is involved in a number among other metabolic processes associated with energy homeostasis. However cellular and molecular control of energy homeostasis is quite complex, requiring a number of other receptors and signaling pathways that also play a role and complicate the picture.
A collection of case studies has suggested that marijuana usage may 'mask' ketoacidosis, with less than expected increases in blood acidity relative to ketone concentration and symptoms. This ketonuria was remedied with intravenous insulin.
In a cross-sectional analysis of NHANES data, it appears that current or past marijuana users were at a lower risk of having type II diabetes when compared to those who never used marijuana overall OR 0. In this study past users, OR 0. Both marijuana  and the endogenous cannabinoid anandamide   have orexigenic appetite increasing effects. It was noted in one study that the appetite-increasing effects of ghrelin, an orexigenic peptide, were blocked by the cannabinoid receptor antagonist rimonabant,  suggesting the some of the appetite increasing effects of marijuana occur via increased ghrelin levels.
Moreover, rimonabant also reduced ghrelin secretion, leading to reduced food intake in food deprived rats. The hypothalamus is highly enriched in CB1 receptors,   and it has been demonstrated in rodents that rimonabant blocks the appetite-stimulating effects of ghrelin when infused directly into this region of the brain.
Marijuana also has been shown to directly increase ghrelin levels in humans. In a prospective subgroup analysis of a trial investigating the effect of smoked cannabis on neuropathic pain in HIV-positive men,  inhalation of marijuana was noted to increase circulating ghrelin by Inhalation of marijuana over a week has also been noted to increase circulating levels of leptin to a large degree in one preliminary trial in an HIV-infected population It is not clear whether the counterintuitive marijuana-induced increase in leptin levels may be population-specific, or even of functional significance.
Given the effects of marijuana on ghrelin, it is possible that leptin levels may increase as part of a negative feedback mechanism. Because calorie intake was not monitored in the HIV study,  it also cannot be ruled out that the increase in leptin levels may have occurred via increased food intake, a known stimulus for leptin production.
It has been noted that cannabinoids, similar to the peptide ghrelin,   can directly suppress lipolysis in adipocytes via CB1 activation resulting in an increase in lipid accumulation.
This causes a shift in energy utilization away from fatty acids and towards glucose. Glucose uptake into adipocytes also appears to be enhanced subsequent to CB1 activation,  despite decreased AMPK activity. Other studies assessing the anti-lipolytic effects of cannabinoids have found a suppression of peripheral AMPK mostly in visceral fat tissue  as well as carnitine palmitoyltransferase 1 CPT1   in adipose and hepatic tissue despite both being elevated in neuronal tissues.
The endocannabinoid system appears to have a location-specific influence, and during the state of obesity subcutaneous body fat exhibits a relative decrease in endocannabinoid anandamide and 2-AG concentrations    whereas visceral body fat exhibits an increase. Few studies have looked at cannabis effect on the weight of healthy subjects, and the results are conflicting.
Cross-sectional observational studies are lower-quality studies that collect data at a single point in time. One such study associated cannabis with greater fat mass,  but the others associated it with a smaller waist,  lower BMI,   and lower prevalence of obesity.
Keep in mind, however, that those studies all relied on self-reported use, and that such reports are always, to some extent, unreliable. Studies that used more reliable methods paint a different picture. Three clinical trials whose participants were largely confined to a controlled hospital environment where food intake is controlled and accounted for saw increases in body weight.
Researchers have used endocannabinoid antagonists compounds that block CB1 to treat obesity caused by compulsive binging or irresistible cravings for sweets and snacks. Rats given the anti-obesity drug rimonabant, an endocannabinoid antagonist, lost weight and experienced a reduction in their blood levels of insulin.
Yet in spite of these successes, rimonabant failed to earn approval from the U. Food and Drug Administration FDA and was withdrawn from the European market,  due to side effects that include nausea, dizziness, severe depression, and suicidal thoughts. Since CB1s are found throughout the body, it is difficult to pinpoint the causes and mechanisms of these side effects. Still, in the future, safer endocannabinoid antagonists may play a role in treating obesity by blocking CB1 in order to increase adiponectin production and reduce appetite.
While many people wish they could lose weight, people with HIV-associated wasting syndrome, cancer-associated cachexia, or anorexia nervosa, notably, are often underweight. Two synthetic THC-based drugs have been developed to address the issue: This unintentional, steady weight loss associated with HIV can lead to poor health outcomes. Oral cannabinoids dronabinol may help increase weight but the results are not entirely conclusive. The loss of skeletal muscle associated with cancer is called cancer-associated cachexia, or simply cancer wasting.
People in the intervention groups gained, on average, 0. This increase is small, but it may still benefit this population. The inhibitory effect of marijuana on motor control may be attenuated in heavy users near daily , as a dose of mg marijuana 3. Acute inhalation of marijuana 1. Inhalation of marijuana tokes of 1. Interleukin 6 IL-6 is an inflammatory and immunostimulatory cytokine produced by the immune system which normally increases with age.
Usage of bhang in youth around 1. Activation of this receptor in B cells increases differentiation,  migration,  and activation  with at least one study also implicating this receptor in antibody class switching since incubation of B cells with cannabinoid agonists can increase immunoglobulin E IgE at the cost of IgM secretion in a manner blocked by CB2 antagonists. When investigating chronic marijuana smokers, baseline B cell count appeared to be lower than nonsmoking controls  lower baseline B cell count has also been noted in chronic bhang users relative to nonusers  but this was normalized over the course of 64 days with marijuana usage in hospitalized settings.
Many case studies have reported that heavy marijuana usage often precedes the development of gynecomastia breast tissue growth in males suggesting that marijuana may have intrinsic estrogenic properties that may disrupt normal hormonal balance in males. A more recent study using in vitro as well as in vivo methods found that marijuana smoke condensate has an estrogenic effect that can be traced to phenolic compounds generated upon the combustion of plant materials.
Thus, marijuana smoke may have intrinsic estrogenic properties that occur via estrogenic polyphenols, rather than cannabinoids as previously assumed.
It has also been noted that Apigenin in Cannabis sativa is an estrogen antagonist at ,nM  while both formononetin  and 4,4,dihydroxymethoxybibenzyl from Cannabis sativa  are agonists.
Another study also found that while cannabinoids do not prevent gonadotropins from binding to receptors, they still lower testosterone by inhibiting cholesterol esterase, an enzyme needed for testosterone synthesis. In humans, infusion of 10mg THC over 50 minutes as 0.
Whereas the control group fluctuated at around 5. Two studies found that chronic users of marijuana did not display significantly different baseline levels of testosterone either gender, tested under non-smoking conditions up to daily smoking sessions, or 7 joints weekly.
It has been noted  that all human studies showing decreases are still within the normal biological range, suggesting that marijuana use is unlikely to influence behavior secondary to testosterone. Another possible mechnanism by which testosterone is depressed is through reducing hypothalamic and pituitary output of gonadotropin hormones, as administration of hCG Human chorionic gonadotropin in one study that noted marijuana-induced testosterone suppression also noted that the admistrration of hCG reversed it.
Marijuana use may suppress testosterone levels for up to 48 hours, as based on a mathematical simulation. Acute smoking of two 2. Marijuana smoking causes an acute reduction Luteinizing Hormone LH levels in males. Chronic usage of marijuana, when tested under non-smoking conditions, is not associated with significant changes in follicle-stimulating hormone levels in men or women. One study found that inhalation of marijuana smoke from cigarettes containing 2.
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