Evaluation of variable new antigen receptors (vNARs) as a novel cathepsin S (CTSS) targeting strategy

Aberrant activity of the cysteine protease Cathepsin S (CTSS) has been implicated across a wide range of pathologies. Notably in cancer, CTSS has been shown to promote tumour progression, primarily through facilitating invasion and migration of tumour cells and augmenting angiogenesis. Whilst an attractive therapeutic target, more efficacious CTSS inhibitors are required. Here, we investigated the potential application of Variable New Antigen Receptors (vNARs) as a novel inhibitory strategy. A panel of potential vNAR binders were identified following a phage display panning process against human recombinant proCTSS. These were subsequently expressed, purified and binding affinity confirmed by ELISA and SPR based approaches. Selected lead clones were taken forward and were shown to inhibit CTSS activity in recombinant enzyme activity assays. Further assessment demonstrated that our lead clones functioned by a novel inhibitory mechanism, by preventing the activation of proCTSS to the mature enzyme. Moreover, using an intrabody approach, we exhibited the ability to express these clones intracellularly and inhibit CTSS activity whilst lead clones were also noted to impede cell invasion in a tumour cell invasion assay. Collectively, these findings illustrate a novel mechanistic approach for inhibiting CTSS activity, with anti-CTSS vNAR clones possessing therapeutic potential in combating deleterious CTSS activity. Furthermore, this study exemplifies the potential of vNARs in targeting intracellular proteins, opening a range of previously "undruggable" targets for biologic-based therapy.

Temporal transcriptome and metabolite analyses provide insights into the biochemical and physiological processes underlying endodormancy release in pistachio (Pistacia vera L.) flower buds

Pistachio (Pistacia vera L.), an economically and nutritionally important tree crop, relies on winter chill for bud endodormancy break and subsequent blooming and nut production. However, insufficient winter chill poses an increasing challenge in pistachio growing regions. To gain a better understanding of the physiological and biochemical responses of endodormant pistachio buds to chilling accumulation, we investigated the global gene expression changes in flower buds of pistachio cv. Kerman that were cultivated at three different orchard locations and exposed to increasing durations of winter chill. The expression of genes encoding β-1,3-glucanase and β-amylase, enzymes responsible for breaking down callose (β-1,3-glucan) and starch (α-1,4-glucan), respectively, increased during the endodormancy break of pistachio buds. This result suggested that the breakdown of callose obstructing stomata as well as the release of glucose from starch enables symplasmic trafficking and provides energy for bud endodormancy break and growth. Interestingly, as chilling accumulation increased, there was a decrease in the expression of nine-cis-epoxycarotenoid dioxygenase (NCED), encoding an enzyme that uses carotenoids as substrates and catalyzes the rate-limiting step in abscisic acid (ABA) biosynthesis. The decrease in NCED expression suggests ABA biosynthesis is suppressed, thus reducing inhibition of endodormancy break. The higher levels of carotenoid precursors and a decrease in ABA content in buds undergoing endodormancy break supports this suggestion. Collectively, the temporal transcriptome and biochemical analyses revealed that the degradation of structural (callose) and non-structural (starch) carbohydrates, along with the attenuation of ABA biosynthesis, are critical processes driving endodormancy break in pistachio buds.

Interactive effect of branch source-sink ratio and leaf aging on photosynthesis in pistachio

Tree source-sink ratio has a predominant and complex impact on tree performance and can affect multiple physiological processes including vegetative and reproductive growth, water and nutrient use, photosynthesis, and productivity. In this study, we manipulated the branch level source-sink ratio by reduction of photosynthetic activity (partial branch defoliation) or thinning branch fruit load early in the growing season (after fruit set) in pistachio (Pistacia vera) trees. We then characterized the leaf photosynthetic light response curves through leaf aging. In addition, we determined changes in leaf non-structural carbohydrates (NSC) and nitrogen (N) concentrations. In leaves with high source-sink ratios, there was a gradual decrease in maximum net photosynthetic rate (ANmax) over the growing season, while in branches with low source-sink ratios, there was a sharp decline in ANmax in the first two weeks of August. Branches with high-sink showed an up-regulation (increase) in photosynthesis toward the end of July (at 1,500 growing degree days) during the period of rapid kernel growth rate and increased sink strength, with ANmax being about 7 μmol m-1 s-1 higher than in branches with low-sink. In August, low source-sink ratios precipitated leaf senescence, resulting in a drastic ANmax decline, from 25 to 8 μmol m-1 s-1 (70% drop in two weeks). This reduction was associated with the accumulation of NSC in the leaves from 20 to 30 mg g-1. The mechanisms of ANmax reduction differ between the two treatments. Lower photosynthetic rates of 8-10 μmol m-1 s-1 late in the season were associated with lower N levels in high-sink branches, suggesting N remobilization to the kernels. Lower photosynthesis late in the season was associated with lower respiration rates in low-source branches, indicating prioritization of assimilates to storage. These results can facilitate the adaptation of management practices to tree crop load changes in alternate bearing species.

Control of fruit softening and Ascorbic acid accumulation by manipulation of SlIMP3 in tomato

Postharvest deterioration is among the major challenges for the fruit industry. Regulation of the fruit softening rate is an effective strategy for extending shelf-life and reducing the economic losses due postharvest deterioration. The tomato myoinositol monophosphatase 3 gene SlIMP3, which showed highest expression level in fruit, was expressed and purified. SlIMP3 demonstrated high affinity with the L-Gal 1-P and D-Ins 3-P, and acted as a bifunctional enzyme in the biosynthesis of AsA and myoinositol. Overexpression of SlIMP3 not only improved AsA and myoinositol content, but also increased cell wall thickness, improved fruit firmness, delayed fruit softening, decreased water loss, and extended shelf-life. Overexpression of SlIMP3 also increased uronic acid, rhamnose, xylose, mannose, and galactose content in cell wall of fruit. Treating fruit with myoinositol obtained similar fruit phenotypes of SlIMP3-overexpressed fruit, with increased cell wall thickness and delayed fruit softening. Meanwhile, overexpression of SlIMP3 conferred tomato fruit tolerance to Botrytis cinerea. The function of SlIMP3 in cell wall biogenesis and fruit softening were also verified using another tomato species, Ailsa Craig (AC). Overexpression of SlDHAR in fruit increased AsA content, but did not affect the cell wall thickness or fruit firmness and softening. The results support a critical role for SlIMP3 in AsA biosynthesis and cell wall biogenesis, and provide a new method of delaying tomato fruit softening, and insight into the link between AsA and cell wall metabolism.

Advances in Rootstock Breeding of Nut Trees: Objectives and Strategies

The production and consumption of nuts are increasing in the world due to strong economic returns and the nutritional value of their products. With the increasing role and importance given to nuts (i.e., walnuts, hazelnut, pistachio, pecan, almond) in a balanced and healthy diet and their benefits to human health, breeding of the nuts species has also been stepped up. Most recent fruit breeding programs have focused on scion genetic improvement. However, the use of locally adapted grafted rootstocks also enhanced the productivity and quality of tree fruit crops. Grafting is an ancient horticultural practice used in nut crops to manipulate scion phenotype and productivity and overcome biotic and abiotic stresses. There are complex rootstock breeding objectives and physiological and molecular aspects of rootstock-scion interactions in nut crops. In this review, we provide an overview of these, considering the mechanisms involved in nutrient and water uptake, regulation of phytohormones, and rootstock influences on the scion molecular processes, including long-distance gene silencing and trans-grafting. Understanding the mechanisms resulting from rootstock × scion × environmental interactions will contribute to developing new rootstocks with resilience in the face of climate change, but also of the multitude of diseases and pests.

T-cell pseudolymphoma secondary to ixazomib for multiple myeloma

We present a case of a 54‐year‐old male with multiple myeloma (MM) who presented with widespread pruritic erythematous lesions following ixazomib treatment. This occurred after his third cycle of treatment with ixazomib, thalidomide and dexamethasone and was controlled by potent steroids and temporary cessation of ixazomib. The strong correlation between the timeline of the rash, ixazomib treatment and subsequent cessation led to a diagnosis of a drug‐induced rash. Skin biopsy histology, immunochemistry and the absence of monoclonal T‐cell receptor gene rearrangement further confirmed the diagnosis of a T‐cell pseudolymphoma secondary to ixazomib. Ixazomib is an oral proteasome inhibitor used in the treatment of MM. Other proteasome inhibitors have been reported to trigger cutaneous adverse effects. However, to our knowledge, this is the first report of pseudolymphoma following proteasome inhibitor use. Dermatologists should be aware of this potential effect and the possible management pathways such as cessation and dose reduction.

786 Retrospective analysis of paediatric ENT surgery outcomes during the COVID pandemic

Introduction

Studies show high morbidity/mortality for adults with peri-operative SARS-CoV-2 infection, leading to recommendations curtailing elective operations during the height of the pandemic. Our understanding of the risks associated with paediatric surgery is more limited, with preliminary data suggesting lower morbidity/mortality than in adults. A < 1% incidence of COVID-19 in paediatric patients undergoing preoperative universal screening is reported, and even in those testing positive, morbidity and mortality seem to be low. As waiting lists swell and the detriment associated with delaying surgery mounts, it is imperative to accurately quantify the risks of surgery in the paediatric population.

Method

Retrospective review of all paediatric ENT operations performed at the Evelina Children’s Hospital at the height of lockdown, from March to May 2020.

Results

61 procedures were performed on 56 patients. 50% had a pre-operative SARS-CoV-2 nasopharyngeal swabs. All cases involved a change in anesthetic practice; 2 cases involved a change in surgical practice. We noted 2 medical complications and 1 surgical complication. All patients are currently extant. No staff or patients subsequently developed COVID.

Conclusions

Our perioperative infection rates and mortality/morbidity figures concord with figures published elsewhere in literature. We are cautiously optimistic regarding risks associated with paediatric ENT surgery.

Root vacuolar sequestration and suberization are prominent responses of Pistacia spp. rootstocks during salinity stress

Understanding the mechanisms of stress tolerance in diverse species is needed to enhance crop performance under conditions such as high salinity. Plant roots, in particular in grafted agricultural crops, can function as a boundary against external stresses in order to maintain plant fitness. However, limited information exists for salinity stress responses of woody species and their rootstocks. Pistachio (Pistacia spp.) is a tree nut crop with relatively high salinity tolerance as well as high genetic heterogeneity. In this study, we used a microscopy-based approach to investigate the cellular and structural responses to salinity stress in the roots of two pistachio rootstocks, Pistacia integerrima (PGI) and a hybrid, P. atlantica x P. integerrima (UCB1). We analyzed root sections via fluorescence microscopy across a developmental gradient, defined by xylem development, for sodium localization and for cellular barrier differentiation via suberin deposition. Our cumulative data suggest that the salinity response in pistachio rootstock species is associated with both vacuolar sodium ion (Na+) sequestration in the root cortex and increased suberin deposition at apoplastic barriers. Furthermore, both vacuolar sequestration and suberin deposition correlate with the root developmental gradient. We observed a higher rate of Na+ vacuolar sequestration and reduced salt-induced leaf damage in UCB1 when compared to P. integerrima. In addition, UCB1 displayed higher basal levels of suberization, in both the exodermis and endodermis, compared to P. integerrima. This difference was enhanced after salinity stress. These cellular characteristics are phenotypes that can be taken into account during screening for sodium-mediated salinity tolerance in woody plant species.

Extensive mucocutaneous, oesophageal and otic lichen planus secondary to nivolumab therapy

We report a 73-year-old female with metastatic renal cell carcinoma who developed a widespread lichenoid reaction following nivolumab treatment. The timeline of the reaction strongly correlated with the nivolumab treatment and subsequent cessation. Our patient had cutaneous, mucosal, otic, ophthalmic and oesophageal involvement, demonstrating the potentially extensive nature of lichenoid reactions to anti-programmed cell death receptor-1 (anti-PD1) therapies. Although lichenoid reactions to anti-PD1 therapies are now well recognized, there have been no previous reports of otic or oesophageal involvement in the literature. Although cutaneous lichenoid reactions do not tend to be severe or treatment limiting, more widespread systemic lichenoid reactions are challenging to manage, particularly in the context of malignancy. This very unusual case highlights the importance of considering involvement beyond the skin in all lichenoid skin reactions.

Evaluation of gastric motility in nine dogs before and after prophylactic laparoscopic gastropexy: a pilot study

BACKGROUND

The purpose of this study was to evaluate the effect of a prophylactic laparoscopic gastropexy on gastric motility in healthy large-breed dogs.

METHODS

This was a prospective pilot study with nine healthy client-owned dogs. Each dog was its own control. Gastric motility was evaluated before and after laparoscopic gastropexy. Dogs were fed a standard diet three weeks before and after surgery. Gastric motility was measured before and 3 weeks after surgery. A wireless motility capsule (WMC) was used to measure gastric pH, intragastric pressure, temperature, frequency of contractions, motility index (MI) and transit time. Non-parametric statistical analysis was used to compare the paired data. Clients were contacted for follow-up information 2 years postoperatively.

RESULTS

Median frequency of gastric contractions was 1.3 (range, 0.6-1.9 contractions/min) before gastropexy and 1.0 (range, 0.3-2.6 contractions/min) after gastropexy (P = 0.820). Median MI was 49.2 (range, 23.7-96.6) before gastropexy and 28.1 (range, 12.2-148.9) after gastropexy (P = 0.652). Median gastric emptying time was 1140 (range, 486-1230 min) before gastropexy and 1110 (range, 306-2610 min) after gastropexy (P = 0.570). During the hour before the WMC passed through the pylorus, median MI was 72.2 (range, 48.2-549.3) before gastropexy and 52.9 (range, 15.20-322.8) after gastropexy (P = 0.734), and frequency of contractions was 1.1 (range, 0.9-4.1 contractions/min) before gastropexy and 1.2 (range, 0.5-3.0 contractions/min) after gastropexy (P = 0.652).

CONCLUSION

Motility in the stomach did not change in healthy dogs after prophylactic laparoscopic gastropexy. We conclude that preventive laparoscopic gastropexy does not induce gastroparesis.

Effects of Passive- and Active-Modified Atmosphere Packaging on Physio-Chemical and Quality Attributes of Fresh In-Hull Pistachios (Pistacia vera L. cv. Badami)

The effects of passive- and active-modified atmosphere packaging (passive- and active-MAP) were investigated on the physio-chemical and quality attributes of fresh in-hull pistachios stored at 4 ± 1 °C and 90 ± 5% R.H. Fresh pistachios were packaged under each of the following gas combinations: active-MAP1 (AMA1) (5% O₂ + 5% CO₂), AMA2 (5% O₂ + 25% CO₂), AMA3 (5% O₂ + 45% CO₂), AMA4 (2.5% O₂ + 5% CO₂), AMA5 (2.5% O₂ + 25% CO₂), and AMA6 (2.5% O₂ + 45% CO₂), all balanced with N₂, as well as passive-MAP (PMA) with ambient air (21% O₂ + 0.03% CO₂ + 78% N₂). Changes in quality parameters were evaluated after 0, 15, 30 and 45 days of storage. Results demonstrated that AMA6 and PMA had significantly lower (7.96 Log CFU g^-1) and higher (9.81 Log CFU g^-1) aerobic mesophilic bacteria counts than the other treatments. However, the AMA6 treatment decreased, kernel chlorophyll and carotenoid content, hull antioxidant capacity, and anthocyanin content. The PMA treatment produced a significant weight loss, 0.18%, relative to the other treatments. The active-MAP treatments were more effective than the passive-MAP in decreasing weight loss, microbial counts, kernel total chlorophyll (Kernel TCL), and kernel carotenoid content (Kernel CAC). The postharvest quality of fresh in-hull pistachios was maintained best by the AMA3 (5% O₂ + 45% CO₂ + 50% N₂) treatment.

Sodium interception by xylem parenchyma and chloride recirculation in phloem may augment exclusion in the salt tolerant Pistacia genus: context for salinity studies on tree crops

Working in tandem with root exclusion, stems may provide salt-tolerant woody perennials with some additional capacity to restrict sodium (Na) and chloride (Cl) accumulation in leaves. The Pistacia genus, falling at the nexus of salt tolerance and human intervention, provided an ideal set of organisms for studying the influences of both variable root exclusion and potentially variable discontinuities at the bud union on stem processes. In three experiments covering a wide range of salt concentrations (0 to 150 mM NaCl) and tree ages (1, 2 and 10 years) as well as nine rootstock-scion combinations we show that proportional exclusion of both Na and Cl reached up to ~85% efficacy, but efficacy varied by both rootstock and budding treatment. Effective Na exclusion was augmented by significant retrieval of Na from the xylem sap, as evidenced by declines in the Na concentrations of both sap and wood tissue along the transpiration stream. However, while we observed little to no differences between the concentrations of the two ions in leaves, analogous declines in sap concentrations of Cl were not observed. We conclude that some parallel but separate mechanism must be acting on Cl to provide leaf protection from toxicity specific to this ion and suggest that this mechanism is recirculation of Cl in the phloem. The presented findings underline the importance of holistic assessments of salt tolerance in woody perennials. In particular, greater emphasis might be placed on the dynamics of salt sequestration in the significant storage volumes offered by the stems of woody perennials and on the potential for phloem discontinuity introduced with a bud/graft union.

Extending storage potential of de-hulled fresh pistachios in passive-modified atmosphere

BACKGROUND

The effects of passive modified-atmosphere packaging (passive-MAP) on the postharvest quality of de-hulled fresh pistachios (Pistacia vera L. cv. Kerman) stored at cold temperature (0 ± 0.5 °C) and 90 ± 1% relative humidity was investigated with fruits under ambient air condition as the control treatment. The fruit quality parameters measured included kernel firmness, color values (L^* , a^* , b^* , h°, and C^* ), weight loss, fungal decay and marketability, ethylene production, respiration rate, and sensory characteristics at 0, 30, 60, and 105 days of storage. The carbon dioxide (CO₂ ) and oxygen (O₂ ) concentrations in the package headspace were monitored during storage.

RESULTS

A modified atmosphere of 0.95-3.35% O₂ and 23.17-29.82% CO₂ was achieved in the passive-MAP treatment. Fruit respiration rates increased significantly relative to controls throughout storage (P ≤ 0.01). However, storage had no significant effect on ethylene production rates. Additionally, passive-MAP-stored fruits maintained firmness, shell lightness, kernel color, and sensory quality with minimum weight loss and fungal decay, compared with the control.

CONCLUSION

These results demonstrate storage life of fresh pistachios in passive-MAP can be extended up to 105 days, compared with 30 days in ambient conditions. © 2019 Society of Chemical Industry.

Mechanisms underlying vulnerabilities after repeat mild traumatic brain injuries

Traumatic brain injury (TBI) has drawn national attention for its high incidence and mechanistic complexity. The majority of TBI cases are "mild" in nature including concussions and mild TBI (mTBI). Concussions are a distinct form of mTBI where diagnosis is difficult, quantification of the incidence is challenging and there is greater risk for subsequent injuries. While concussions occur in the general population, it has become a hallmark injury consistently observed among adolescent and young adult athletes and the risks for repeat TBI (rTBI) is significant. Clinical and experimental evidence shows that the magnitude and duration of deficits is dependent on the number and the interval between injuries. Several studies suggest that metabolic vulnerabilities after injury may contribute to the window for cerebral vulnerability from rTBI. In addition to metabolism, this review addresses how age, sex and hormones also play an important role in the response to repeat concussions. Understanding how these factors collectively contribute to concussion and rTBI recovery is critically important in establishing age/sex appropriate return to play guidelines, injury prevention, therapeutic interventions and mitigation of long-term consequences of rTBI.

Nurse provision of support to help inpatients quit smoking

Issue addressed Identification of the factors that facilitate nurses to provide smoking cessation advice to hospitalised patients. Method Six semistructured focus groups with 26 nurses were conducted in June 2015. Participants completed a structured survey to collect patient demographic data and assess attitudes towards their role in addressing smoking cessation among inpatients. Results Important themes that emerged from the qualitative data were: nurses' negative perceptions of smokers, nurses' confidence in their knowledge of smoking cessation care and nurses' uncertainty around whose role it is to provide smoking cessation care. Conclusion Nurses require training in order to confidently and competently address smoking among inpatients as part of routine care. Formal ways to document the smoking status of inpatients and the offer of smoking cessation support from a nurse to an inpatient would enhance the communication between nurses around which inpatients had been asked about their smoking status and which had not. For patients who are resistant to conventional cessation strategies, innovative ways are needed to reduce the harm caused to them by tobacco use. So what? Nurses need to be provided with education and training around smoking cessation to increase their confidence and skills to provide smoking cessation care to inpatients.

Ecthyma gangrenosum without bacteraemia: evidence in favour of a broader definition

Ecthyma gangrenosum (EG) is often defined as a cutaneous manifestation of Pseudomonas aeruginosa septicaemia, typically secondary to neutropenia. There is increasing recognition that a broader definition is warranted, as numerous causative organisms and predisposing conditions have been reported. We describe two cases of EG that occurred without bacteraemia. In this atypical subset of cases, the skin is thought to represent the primary inoculation site from which haematogenous spread can occur. The first case occurred in the context of human immunodeficiency virus (HIV) infection, a rarely reported association. The evidence base guiding clinicians on management of EG is very limited, particularly in relation to patients with HIV, in whom recurrence risk may be higher than normal. Recurrent EG is described in our second case, in an individual with Good syndrome, a rare association of thymoma and immunodeficiency.

The effects of training on the ability of adults with an intellectual disability to give informed consent to medication

BACKGROUND

This study had two aims: to investigate the capacity of individuals with intellectual disabilities (ID) to make decisions about their medications, and to evaluate whether the provision of training (information) sessions on medications would increase their capacity.

METHOD

Twenty-eight adults (18 male and 10 female), with a mild to moderate ID were included in this study and they were taking either Epilim, Metformin or Haloperidol medications. The participants were split into groups that comprised of participants taking the same medications. Each of the groups received three training sessions on their own medications. Capacity to consent was measured by the Adapted - Assessment of Capacity Questionnaire (A-ACQ), which was specially adapted for each medication type from the original measure (ACQ). Receptive language ability was measured by the British Picture Vocabulary Scale-II (BPVS-II).

RESULTS

A two-factor mixed anova analysis indicated that the provision of training had improved the capacity of the participants to give informed consent to taking their medications. Analysis using Pearson's correlations indicated that increased levels of receptive language ability correlated with greater ability to give informed consent to taking medication.

CONCLUSIONS

The provision of information that is formatted in a way that individuals with ID can understand may be a useful way to increase knowledge on medications. Further research that investigates the provision of information with larger samples is warranted.

Training distress and performance readiness: laboratory and field validation of a brief self-report measure

Three studies were conducted to validate the Training Distress Scale (TDS), a 19-item measure of training-related distress and performance readiness. Study 1 was a randomized, controlled laboratory experiment in which a treatment group undertook daily interval training until a 25% decrement occurred in time-to-fatigue performance. Comparisons with a control group showed that TDS scores increased over time within the treatment group but not in the control group. Study 2 was a randomized, controlled field investigation in which performance capabilities and TDS responses were compared across a high-intensity interval training group and a control group that continued normal training. Running performance decreased significantly in the training group but not in the control group, and scores on the TDS mirrored those changes in performance capabilities. Study 3 examined the relationship between TDS scores obtained over a 2-week period before major swimming competitions and subsequent performance in those competitions. Significantly, better performance was observed for swimmers with low TDS scores compared with those with moderate or high TDS scores. These findings provide both laboratory and field evidence for the validity of the TDS as a measure of short-term training distress and performance readiness.

Randomized trial comparing 600- with 300-mg loading dose of clopidogrel in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention: results of the Platelet Responsiveness to Aspirin and Clopidogrel and Troponin Increment after Coronary intervention in Acute coronary Lesions (PRACTICAL) Trial

BACKGROUND

There is uncertainty about the benefit of a higher loading dose (LD) of clopidogrel in patients with non-ST elevation acute coronary syndrome (NSTEACS) undergoing early percutaneous coronary intervention (PCI).

METHODS

We compared the effects of a 600- versus a 300-mg LD of clopidogrel on inhibition of platelet aggregation, myonecrosis, and clinical outcomes in patients with NSTEACS undergoing an early invasive management strategy. Patients with NSTEACS (n = 256, mean age 63 years, 81.6% elevated troponin) without thienopyridine for at least 7 days were randomized to receive 600- or 300-mg LD of clopidogrel. Percutaneous coronary intervention was performed in 140 patients, with glycoprotein IIb/IIIa inhibitor use in 68.6%. Adenosine diphosphate (ADP)-induced platelet aggregation was measured by optical platelet aggregometry immediately before coronary angiography.

RESULTS

Post-PCI myonecrosis was defined as a next-day troponin I greater than 5 times the upper limit of reference range and greater than baseline levels. Clopidogrel 600-mg LD compared with 300-mg LD was associated with significantly reduced ADP-induced platelet aggregation (49.7% vs 55.7% with ADP 20 micromol/L) but did not reduce post-PCI myonecrosis or adverse clinical outcomes to 6 months. There was no association between preprocedural platelet aggregation and outcome.

CONCLUSIONS

These data confirm a modest incremental antiplatelet effect of a 600-mg clopidogrel LD compared with 300-mg LD but provide no support for a clinical benefit in patients with NSTEACS managed with an early invasive strategy including a high rate (69%) of glycoprotein IIb/IIIa inhibitor use during PCI.

Genetic evidence for a family-based Scandinavian settlement of Shetland and Orkney during the Viking periods

The Viking age witnessed the expansion of Scandinavian invaders across much of northwestern Europe. While Scandinavian settlements had an enduring cultural impact on North Atlantic populations, the nature and extent of their genetic legacy in places such as Shetland and Orkney is not clear. In order to explore this question further, we have made an extensive survey of both Y-chromosomal and mitochondrial DNA (mtDNA) variation in the North Atlantic region. Our findings indicate an overall Scandinavian ancestry of approximately 44% for Shetland and approximately 30% for Orkney, with approximately equal contributions from Scandinavian male and female subjects in both cases. This contrasts with the situation for the Western Isles, where the overall Scandinavian ancestry is less ( approximately 15%) and where there is a disproportionately high contribution from Scandinavian males. In line with previous studies, we find that Iceland exhibits both the greatest overall amount of Scandinavian ancestry (55%) and the greatest discrepancy between Scandinavian male and female components. Our results suggest that while areas close to Scandinavia, such as Orkney and Shetland, may have been settled primarily by Scandinavian family groups, lone Scandinavian males, who later established families with female subjects from the British Isles, may have been prominent in areas more distant from their homeland.