An Intense and Short-Lasting Burst of Neutrophil Activation Differentiates Early Acute Myocardial Infarction from Systemic Inflammatory Syndromes

BACKGROUND: Neutrophils are involved in thrombus formation. We investigated whether specific features of neutrophil activation characterize patients with acute coronary syndromes (ACS) compared to stable angina and to systemic inflammatory diseases. METHODS AND FINDINGS: The myeloperoxidase (MPO) content of circulating neutrophils was determined by flow cytometry in 330 subjects: 69 consecutive patients with acute coronary syndromes (ACS), 69 with chronic stable angina (CSA), 50 with inflammation due to either non-infectious (acute bone fracture), infectious (sepsis) or autoimmune diseases (small and large vessel systemic vasculitis, rheumatoid arthritis). Four patients have also been studied before and after sterile acute injury of the myocardium (septal alcoholization). One hundred thirty-eight healthy donors were studied in parallel. Neutrophils with normal MPO content were 96% in controls, >92% in patients undergoing septal alcoholization, 91% in CSA patients, but only 35 and 30% in unstable angina and AMI (STEMI and NSTEMI) patients, compared to 80%, 75% and 2% of patients with giant cell arteritis, acute bone fracture and severe sepsis. In addition, in 32/33 STEMI and 9/21 NSTEMI patients respectively, 20% and 12% of neutrophils had complete MPO depletion during the first 4 hours after the onset of symptoms, a feature not observed in any other group of patients. MPO depletion was associated with platelet activation, indicated by P-selectin expression, activation and transactivation of leukocyte β2-integrins and formation of platelet neutrophil and -monocyte aggregates. The injection of activated platelets in mice produced transient, P-selectin dependent, complete MPO depletion in about 50% of neutrophils. CONCLUSIONS: ACS are characterized by intense neutrophil activation, like other systemic inflammatory syndromes. In the very early phase of acute myocardial infarction only a subpopulation of neutrophils is massively activated, possibly via platelet-P selectin interactions. This paroxysmal activation could contribute to occlusive thrombosis

Beyond an OSN Post: Looking at Emotional Valence and Request of Support/Information

Rheumatoid arthritis is a chronic autoimmune disease that does not have a cure. Therefore, it is important for patients to receive support, which would allow them to ask questions and express their feelings. This study examined online social networks for patients with rheumatoid arthritis to better understand the emotional valence of their initial posts and whether there was an association between posts with negative emotional valence and requesting support/information. We hypothesized that the majority (more than 50%) of the emotional valence of initial posts would be negative, and that there would be an association between negative emotional valence and support/information. Nine hundred eighty-six initial posts from a rheumatoid arthritis online social network via Reddit were coded as either positive, negative, neutral, or mixed. In addition, the initial posts were coded as either requesting support/information, offering support/information, neither requesting nor offering support/information, or both requesting and offering support/information. Negative was the most common emotional valence in the initial posts followed by mixed, neutral, and positive. There was also an association between initial posts that had a negative emotional valence and requested support/information, and initial posts that had a negative emotional valence but did not request support/information. As a result, the implications of this study indicate the need for additional information and support to be provided to patients with rheumatoid arthritis, so they can have a better experience and an easier way to cope with their illness

Chronic pain patients\u27 perspectives of medical cannabis.

Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. In response to How effective is medical cannabis in treating your symptoms or conditions?, with options of 0% no relief to 100% complete relief, the average was 74.6% ± 0.6. The average amount spent on MC each year was $3064.47 ± 117.60, median =$2320.23, range = $52.14 to$52,140.00. Open-ended responses were coded into themes and subthemes. Analysis of answers to What is it that you like most about MC? (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, Changes perception and experience of my chronic pain. ), the product (14.2%, eg, Knowing exactly what strain you are getting ), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to What is it that you like least about MC? identified 12 themes, including money (28.4%, eg, The cost is expensive for someone on a fixed income ), effects (21.7%, eg, The effects on my lungs ), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC

Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep.

A prior epidemiological study identified a reduction in opioid overdose deaths in US states that legalized medical cannabis (MC). One theory to explain this phenomenon is a potential substitution effect of MC for opioids. This study evaluated whether this substitution effect of MC for opioids also applies to other psychoactive medications. New England dispensary members ( n = 1,513) completed an online survey about their medical history and MC experiences. Among respondents that regularly used opioids, over three-quarters (76.7%) indicated that they reduced their use since they started MC. This was significantly ( p \u3c 0.0001) greater than the patients that reduced their use of antidepressants (37.6%) or alcohol (42.0%). Approximately two-thirds of patients decreased their use of anti-anxiety (71.8%), migraine (66.7%), and sleep (65.2%) medications following MC which significantly ( p \u3c 0.0001) exceeded the reduction in antidepressants or alcohol use. The patient\u27s spouse, family, and other friends were more likely to know about their MC use than was their primary care provider. In conclusion, a majority of patients reported using less opioids as well as fewer medications to treat anxiety, migraines, and sleep after initiating MC. A smaller portion used less antidepressants or alcohol. Additional research is needed to corroborate these self-reported, retrospective, cross-sectional findings using other data sources