Optimization of the Tet-On system for regulated gene expression through viral evolution

The ability to control (trans)gene expression is important both for basic biological research and applications such as gene therapy. In vivo use of the inducible tetracycline (Tc)-regulated gene expression system (Tet-On system) is limited by its low sensitivity for the effector doxycycline (dox). We used viral evolution to optimize this Escherichia coli-derived regulatory system for its function in mammalian cells. The components of the Tet-On system (the transcriptional activator rtTA and its tetO DNA binding site) were incorporated into the human immunodeficiency virus (HIV)-1 genome to control viral replication. Prolonged culturing of this HIV-rtTA virus resulted in virus variants that acquired mutations in the rtTA gene. Some of these mutations enhance the transcriptional activity and dox-sensitivity of the rtTA protein. This improvement was observed with different tetO-containing promoters and was independent of the episomal or chromosomal status of the target gene. Combination of these beneficial mutations resulted in greatly improved rtTA variants that are seven-fold more active and 100-fold more dox-sensitive than the original Tet-On system. Furthermore, some of the new Tet-On systems are responsive to Tc and minocycline. Importantly, these rtTA variants show no activity in the absence of dox. The optimized rtTA variants are particularly useful for in vivo applications that require a more sensitive or more active Tet-On system.

Test-retest reliability of fMRI activation during prosaccades and antisaccades

Various studies have investigated reproducibility of fMRI results. Whereas group results can be highly reproducible, individual activity maps tend to vary across sessions. Individual reliability is of importance for the application of fMRI in endophenotype research, where brain activity is linked to genetic polymorphisms. In this study, the test-retest reliability of activation maps during the antisaccade paradigm was assessed for individual and group results. Functional MRI images were acquired during two sessions of prosaccades and antisaccades in twelve healthy subjects using an event-related fMRI design. Reliability was assessed for both individual and group-wise results. In addition, the reliability of differences between subjects was established in predefined regions of interest. The reliability of group activation maps was high for prosaccades and antisaccades, but only moderate for antisaccades vs. prosaccades, probably as a result of low statistical power of individual results. Reproducibility of individual subject maps was highly variable, indicating that reliable results can be obtained in some but not all subjects. Reliability of individual activity maps was largely explained by individual differences in the global temporal signal to noise ratio (SNR). As the global SNR was stable over sessions, it explained a large portion of the differences between subjects in regional brain activation. A low SNR in some subjects may be dealt with either by improving the statistical sensitivity of the fMRI procedure or by subject exclusion. Differences in the global SNR between subjects should be addressed before using regional brain activation as phenotype in genetic studies.

In vitro evolution of a highly replicating, doxycycline-dependent HIV for applications in vaccine studies

A major concern associated with the use of vaccines based on live-attenuated viruses is the possible and well documented reversion to pathogenic phenotypes. In the case of HIV, genomic deletions or mutations introduced to attenuate viral pathogenicity can be repaired by selection of compensating mutations. These events lead to increased virus replication rates and, eventually, disease progression. Because replication competence and degree of protection appear to be directly correlated, further attenuation of a vaccine virus may compromise the ability to elicit a protective immune response. Here, we describe an approach toward a safe attenuated HIV vaccine. The system is not based on permanent reduction of infectivity by alteration of important viral genomic sequences, but on strict control of replication through the insertion of the tetracycline (Tet) system in the HIV genome. Furthermore, extensive in vitro evolution was applied to the prototype Tet-controlled HIV to select for variants with optimized rather than diminished replication capacity. The final product of evolution has properties uniquely suited for use as a vaccine strain. The evolved virus is highly infectious, as opposed to a canonically attenuated virus. It replicates efficiently in T cell lines and in activated and unstimulated peripheral blood mononuclear cells. Most importantly, replication is strictly dependent on the nontoxic Tetanalogue doxycycline and can be turned on and off. These results suggest that this in vitro evolved, doxycycline-dependent HIV might represent a useful tool toward the development of a safer, live-attenuated HIV vaccine.

Regulation of thylakoid protein phosphorylation at the substrate level: reversible light-induced conformational changes expose the phosphorylation site of the light-harvesting complex II

Light-dependent activation of thylakoid protein phosphorylation regulates the energy distribution between photosystems I and II of oxygen-evolving photosynthetic eukaryotes as well as the turnover of photosystem II proteins. So far the only known effect of light on the phosphorylation process is the redox-dependent regulation of the membrane-bound protein kinase(s) activity via plastoquinol bound to the cytochrome bf complex and the redox state of thylakoid dithiols. By using a partially purified thylakoid protein kinase and isolated native chlorophyll (chl) a/b light-harvesting complex II (LHCII), as well as recombinant LHCII, we find that illumination of the chl-protein substrate exposes the phosphorylation site to the kinase. Light does not activate the phosphorylation of the LHCII apoprotein nor the recombinant pigment-reconstituted complex lacking the N-terminal domain that contains the phosphothreonine site. The suggested light-induced conformational change exposing the N-terminal domain of LHCII to the kinase is evidenced also by an increase in its accessibility to tryptic cleavage after light exposure. Light activates preferentially the trimeric form of LHCII, and the process is paralleled by chl fluorescence quenching. Both phenomena are slowly reversible in darkness. Light-induced exposure of the LHCII N-terminal domain to the endogenous protein kinase(s) and tryptic cleavage occurs also in thylakoid membranes. These results demonstrate that light may regulate thylakoid protein phosphorylation not only via the signal transduction chain connecting redox reactions to the protein kinase activation, but also by affecting the conformation of the chl-protein substrate.

Effects of aging on BOLD fMRI during prosaccades and antisaccades

Age affects the ability to inhibit saccadic eye movements. According to current theories, this may be associated with age-induced neurophysiological changes in the brain and with compensatory activation in frontal brain areas. In the present study, the effects of aging are assessed on brain systems that subserve generation and inhibition of saccadic eye movements. For this purpose, an event-related functional magnetic resonance imaging design was used in adults covering three age ranges (18-30, 30-55, and 55-72 years). Group differences were controlled for task performance. Activity associated with saccadic inhibition was represented by the contrast between prosaccade and antisaccade activation. The tasks activated well-documented networks of regions known to be involved in generation and inhibition of saccadic eye movements. There was an age-related shift in activity from posterior to frontal brain regions after young adulthood. In addition, old adults demonstrated an overall reduction in the blood oxygenation level dependent (BOLD) signal in the visual and oculomotor system. Age, however, did not affect saccade inhibition activity. Mid and old adults appear to increase frontal activation to maintain performance even during simple prosaccades. The global reduction of the BOLD response in old adults could reflect a reduction in neural activity, as well as changes in the neuronal-vascular coupling. Future research should address the impact of altered vascular dynamics on neural activation and the BOLD signal.

Review of functional MRI in HIV: effects of aging and medication

HIV-associated neurocognitive disorder (HAND) is a frequently occurring comorbidity of HIV infection. Evidence suggests this condition starts subclinical before a progression to a symptomatic stage. Blood oxygenated level dependent (BOLD) fMRI has shown to be a sensitive tool to detect abnormal brain function in an early stage and might therefore be useful to evaluate the effect of HIV infection on brain function. An extensive literature search was performed in June 2015. Eligibility criteria for included studies were as follows: (1) conducting with HIV-positive patients, (2) using BOLD fMRI, and (3) including a HIV-negative control group. A total of 19 studies were included in the review including 931 participants. Differences in activation between HIV-positive and -negative participants were found when testing multiple domains, i.e., attention, (working) memory, and especially executive functioning. Overall, HIV-positive patients showed hyperactivation in task-related brain regions despite equal performances as controls. Task performance was degraded only for the most complex tasks. A few studies investigated the effect of aging on fMRI, and most of them found no interaction with HIV infection. Only three studies evaluated the effect of combination antiretroviral therapy (cART) on functional data suggesting an increase in activation with the use of cART. fMRI is a sensitive instrument to detect subtle cognitive changes in HIV patients. Open questions remain regarding the effects of cART on fMRI and the effects of aging on fMRI.

Diagnosis, treatment and operative complications of carotid body tumours

A series of 42 patients who were treated in the Surgical Clinic of the University of Leyden on suspicion of a carotid body tumour between 1958 and 1979 is reported. Thirty-four patients in this series were operated upon in the University Hospital Leyden. Only 6 per cent of the tumours were malignant according to the criteria of nuclear polymorphia and metastases. Local infiltration, either histological or clinical, has no correlation with later outcome. In 11 per cent of the patients, vascular complications occurred. The necessity of operative damage to the surrounding cranial nerves increased with the size of the tumour. In one case the cranial nerve lesion was accidental. No per- or postoperative mortality was seen in this series.

Autologous dendritic cells pulsed with allogeneic tumour cell lysate induce tumour-reactive T-cell responses in patients with pancreatic cancer: A phase I study

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is notorious for its poor prognosis even after curative resection. Responses to immunotherapy are rare and related to inadequate T-cell priming. We previously demonstrated the potency of allogeneic lysate-dendritic cell (DC) vaccination in a preclinical model. Here we translate this concept to patients.

METHODS

In this phase I study, patients with resected PDAC were included when they demonstrated no radiologic signs of recurrence after standard-of-care treatment. Allogeneic tumour lysate-loaded autologous monocyte-derived DCs were injected at weeks 0, 2, 4 and at months 3 and 6. Objectives are feasibility, safety and immunogenicity of allogeneic tumour-DCs. The presence of tumour antigens shared between the vaccine and patient tumours was investigated. Immunological analyses were performed on peripheral blood, skin and tumour.

RESULTS

Ten patients were included. DC production and administration were successful. All patients experienced a grade 1 injection-site and infusion-related reaction. Two patients experienced a grade 2 fever and 1 patient experienced a grade 3 dyspnoea. No vaccine-related serious adverse events were observed. Shared tumour antigens were found between the vaccine and patient tumours. All evaluated patients displayed a vaccine-induced response indicated by increased frequencies of Ki67+ and activated PD-1+ circulating T-cells. In addition, treatment-induced T-cell reactivity to autologous tumour of study patients was detected. Seven out of ten patients have not experienced disease recurrence or progression at a median follow-up of 25 months (15-32 months).

CONCLUSION

Allogeneic tumour lysate-DC treatment is feasible, safe and induces immune reactivity to PDAC expressed antigens.

fMRI-guided TMS on cortical eye fields: the frontal but not intraparietal eye fields regulate the coupling between visuospatial attention and eye movements

It is well known that parts of a visual scene are prioritized for visual processing, depending on the current situation. How the CNS moves this focus of attention across the visual image is largely unknown, although there is substantial evidence that preparation of an action is a key factor. Our results support the view that direct corticocortical feedback connections from frontal oculomotor areas to the visual cortex are responsible for the coupling between eye movements and shifts of visuospatial attention. Functional magnetic resonance imaging (fMRI)-guided transcranial magnetic stimulation (TMS) was applied to the frontal eye fields (FEFs) and intraparietal sulcus (IPS). A single pulse was delivered 60, 30, or 0 ms before a discrimination target was presented at, or next to, the target of a saccade in preparation. Results showed that the known enhancement of discrimination performance specific to locations to which eye movements are being prepared was enhanced by early TMS on the FEF contralateral to eye movement direction, whereas TMS on the IPS resulted in a general performance increase. The current findings indicate that the FEF affects selective visual processing within the visual cortex itself through direct feedback projections.

Neural correlates of trauma-unrelated emotional processing in war veterans with PTSD

BACKGROUND

Post-traumatic stress disorder (PTSD) is thought to be characterized by general heightened amygdala activation. However, this hypothesis is mainly based on specific studies presenting fear or trauma-related stimuli, hence, a thorough investigation of trauma-unrelated emotional processing in PTSD is needed.

METHODS

In this study, 31 male medication-naive veterans with PTSD, 28 male control veterans (combat controls; CC) and 25 non-military men (healthy controls; HC) were included. Participants underwent functional MRI while trauma-unrelated neutral, negative and positive emotional pictures were presented. In addition to the group analyses, PTSD patients with and without major depressive disorder (MDD) were compared.

RESULTS

All groups showed an increased amygdala response to negative and positive contrasts, but amygdala activation did not differ between groups. However, a heightened dorsal anterior cingulate cortex (dACC) response for negative contrasts was observed in PTSD patients compared to HC. The medial superior frontal gyrus was deactivated in the negative contrast in HC, but not in veterans. PTSD+MDD patients showed decreased subgenual ACC (sgACC) activation to all pictures compared to PTSD-MDD.

CONCLUSION

Our findings do not support the hypothesis that increased amygdala activation in PTSD generalizes to trauma-unrelated emotional processing. Instead, the increased dACC response found in PTSD patients implicates an attentional bias that extends to trauma-unrelated negative stimuli. Only HC showed decreased medial superior frontal gyrus activation. Finally, decreased sgACC activation was related to MDD status within the PTSD group.

At-risk individuals display altered brain activity following stress

Stress is a major risk factor for almost all psychiatric disorders, however, the underlying neurobiological mechanisms remain largely elusive. In healthy individuals, a successful stress response involves an adequate neuronal adaptation to a changing environment. This adaptive response may be dysfunctional in vulnerable individuals, potentially contributing to the development of psychopathology. In the current study, we investigated brain responses to emotional stimuli following stress in healthy controls and at-risk individuals. An fMRI study was conducted in healthy male controls (N = 39) and unaffected healthy male siblings of schizophrenia patients (N = 39) who are at increased risk for the development of a broad range of psychiatric disorders. Brain responses to pictures from the International Affective Picture System (IAPS) were measured 33 min after exposure to stress induced by the validated trier social stress test (TSST) or a control condition. Stress-induced levels of cortisol, alpha-amylase, and subjective stress were comparable in both groups. Yet, stress differentially affected brain responses of schizophrenia siblings versus controls. Specifically, control subjects, but not schizophrenia siblings, showed reduced brain activity in key nodes of the default mode network (PCC/precuneus and mPFC) and salience network (anterior insula) as well as the STG, MTG, MCC, vlPFC, precentral gyrus, and cerebellar vermis in response to all pictures following stress. These results indicate that even in the absence of a psychiatric disorder, at-risk individuals display abnormal functional activation following stress, which in turn may increase their vulnerability and risk for adverse outcomes.

Ventral striatum is related to within-subject learning performance

Learning from feedback involves a network of various cortical and subcortical regions. Although activation in this network has been shown to be especially strong in successful learners, it is currently unclear which of these regions are related to within-subject variation in learning performance. To this aim, 21 subjects performed a probabilistic feedback-learning task consisting of multiple independent Learning blocks and non-learning Control blocks, while functional magnetic resonance imaging data were acquired. In agreement with previous studies, activation in anterior, lateral and medial left prefrontal cortex, insula and superior and inferior parietal cortical regions were found when contrasting Learning and Control blocks. Furthermore, activation in the supplementary motor area, anterior cingulate cortex and bilateral striatum was associated specifically with the learning phase and not the application phase during Learning blocks. Finally, activation only in the ventral striatum was associated with within-subject learning performance across the Learning blocks. Taken together, these latter two results are argued to provide the answer to the main research question: ventral striatum activation is associated with within-subject variations in learning performance. The ventral striatum appears to play a vital role in learning by adjusting behavior based on feedback.

Radiation-induced head and neck tumours: is the skin as sensitive as the thyroid gland?

Six hundred and five persons, randomly selected from a cohort of 2400 patients who had been irradiated 16-46 yr previously for benign diseases in the head and neck region, were traced, recalled and examined for radiation-associated tumours. Three hundred and sixty-seven patients were alive, 179 had died and 66 had emigrated. Two hundred and fifty-seven patients were clinically examined, 87 refused or were not able to participate and 16 could not be contacted. Eighteen of the clinically examined patients had been or were being treated for 20 skin carcinomas with a mean latency of 37 yr. In this group only 7 carcinomas of the thyroid gland were observed, with a mean latency of 38 yr. Eleven carcinomas of the skin and 3 of the thyroid gland were reported in the group which was examined by means of questionnaires. The observed number of carcinomas of the skin is higher than expected according to the dose-effect relationship of UNSCEAR, whereas the number of carcinomas of the thyroid gland is lower. It is concluded that there might be less difference in susceptibility for the induction of tumours by ionizing radiation between the skin and the thyroid gland than is commonly assumed.

Is risperidone effective in reducing challenging behaviours in individuals with intellectual disabilities after 1 year or longer use? A placebo-controlled, randomised, double-blind discontinuation study

BACKGROUND

Many people with intellectual disabilities use risperidone long term for the management of challenging behaviours, despite its limited proof of effectiveness and its clear association with adverse events. Therefore, this study aimed to investigate the effectiveness of ongoing treatment with risperidone in reducing challenging behaviours versus controlled discontinuation on behaviour and health parameters.

METHOD

This was a placebo-controlled, double-blind, randomised discontinuation trial of risperidone. In the discontinuation group, risperidone was gradually replaced by a placebo over 14 weeks, while the control group maintained their existing dosage. Eight weeks after discontinuation, behaviour (as measured by the 'Aberrant Behavior Checklist') and health parameters (dyskinesia, akathisia, parkinsonism, weight, waist circumference, sedation and laboratory outcomes) were compared in both groups.

RESULTS

A total of 25 participants were included in the trial, of which 11 were randomised into the discontinuation group and 14 were randomised into the continued treatment group. In the discontinuation group, 82% completely withdrew from risperidone. There was no significant change in irritability, compared with the continuation group, although there was a Group*Time effects on stereotypical behaviour in favour of the continuation group. Significant Group*Time effects were also found for weight, waist, body mass index, prolactin levels and testosterone levels, with beneficial effects for the discontinuation group.

CONCLUSION

Discontinuation of long-term risperidone for reducing challenging behaviours is possible, without an increase in irritability. Discontinuation of risperidone may have beneficial effects on weight, waist circumference, prolactin levels and testosterone levels. The study suffered from difficulties in achieving the required sample size, which affected study power and generalizability.

Impact of percutaneous coronary intervention timing on 5-year outcome in patients with non-ST-segment elevation acute coronary syndromes. The 'wait a day' approach might be safer

Background

The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best treatment strategy for patients presenting with NSTE-ACS, long-term outcomes are essential.

Methods

Five-year follow-up data from 133 of the 142 patients could be retrieved (94 %). The primary endpoint was a composite of death and spontaneous myocardial infarction (MI). Spontaneous MI was defined as MI occurring more than 30 days after randomisation. Secondary endpoints were the individual outcomes of death, spontaneous MI or re-PCI.

Results

No significant difference with respect to the primary endpoint was observed (17.8 vs. 10.1 %; HR 1.55, 95 % CI: 0.73–4.22, p = 0.21). There was no significant difference in mortality rate. However, spontaneous MI was significantly more common in the group receiving immediate PCI (11.0 vs. 1.4 %; HR 4.46, 95 % CI: 1.21–16.50, p = 0.02). We did not find a significant difference between the groups with respect to re-PCI rate.

Conclusion

There was no difference in the composite of death and spontaneous MI. The trial suggests an increased long-term risk of spontaneous MI for patients treated with immediate PCI.

Negative priming in schizophrenia revisited

Reduced spatial negative priming (SNP) in schizophrenia is commonly attributed to the inability to filter out irrelevant information. However, some investigators have suggested that reduced SNP in patients is caused by either perceptual mismatching or salience of the distracter. The goal of the present study was to determine the influence of these perceptual processes. In this preliminary report, we present data of 15 schizophrenia patients on atypical medication and 15 matched healthy controls. Compared to controls, patients showed a reduced SNP effect, even when controlled for perceptual mismatching. This reduced effect was not affected by distracter salience.

Radiographic findings in the teeth and jaws of 14- to 17-year-old Estonian schoolchildren in Tartu and Tallinn

Panoramic radiographs were taken of 392 Estonian schoolchildren (33% boys and 67% girls) aged 14-17 years, 197 in Tartu and 195 in Tallinn. The mean number of permanent teeth was 31.5. In 14% of the children one to four teeth (excluding wisdom teeth) were missing. The frequencies of missing wisdom teeth and supernumerary teeth agreed with those in the literature, being 17% and 3%, respectively. The mean number of radiographically detected carious teeth was 1.9 in Tartu and 3.3 in Tallinn. Secondary caries was common, being found radiographically in half of the schoolchildren. Endodontic treatment had been given to 13% of the subjects in Tartu and to 46% in Tallinn, the success rates being 47% and 44%, respectively. The percentage of radiographic signs in the mandibular condyles of girls (5%) was greater than that of the boys (1%). Changes in the maxillary sinuses were found in 16% of the children. Eight odontogenic cysts, one cyst of the incisal canal, and one solitary bone cyst were found. Tumors included two odontomas, two cemento-ossifying lesions, and one osteoma in the maxillary sinus. The health status of the jaws of the Estonian schoolchildren was considered to be fairly good.

Obstacles in large-scale epidemiological assessment of sensory impairments in a Dutch population with intellectual disabilities

BACKGROUND

A population-based epidemiological study on visual and hearing impairment was planned in a random sample of 2100 clients, drawn from a base population of 9012 users of Dutch residential and day-care intellectual disability (ID) services with the whole range of IDs. Stratification was applied for age 50 years and over and Down syndrome. Visual and hearing functions were assessed according to a standardized protocol, in cooperation with regular ophthalmologists and regional audiological centres. Anticipated obstacles in sample collection, random inclusion, informed consent, expertise of investigators, time and costs were eliminated by a careful preparation. However, inclusion and participation were incomplete.

METHOD

In a descriptive retrospective design, we collected data from our study files on inclusion and participation as well as reasons for non-participation, to identify unanticipated obstacles for this kind of research.

RESULTS

Consent was obtained for 1660 clients, and 1598 clients participated in the data collection (76% of intended sample of 2100). Inclusion and participation rates were especially lower in community-based care organizations, resulting in unintentional skewing of the sample towards more severe levels of ID. Complete and reliable data to diagnose visual impairment were obtained for 1358/1598 (85%) and to diagnose hearing impairment for 1237/1598 participants (77%). Unanticipated obstacles had to do with the quality of coordination within care organizations, with characteristics of screening methods, and with collaboration with the regular health care system. Assessments of visual function were more easy to organize than were those of hearing. Based on our current experience, practical recommendations are given for future multicentre research, especially in community-based settings.

Recognition memory for words and faces in the very old

The assessment of very elderly people is hindered by a scarcity of normative and reliability data for non-verbal memory tests. We tested the suitability of Warrington's Recognition Memory Test (RMT) for use with the elderly. The RMT consists of verbal (Recognition Memory for Words, RMW) and non-verbal (Recognition Memory for Faces, RMF) subtests. The facial recognition test was used in the standard format and a Dutch-language version of the word recognition test was developed using low frequency (10 or less/million) monosyllabic words. Eighty-nine subjects, varying in age from 69 to 93, were tested with the RMF. Means and SD are provided for three age groups (69-79, 80-84 and 85-93). Forty-five consecutive subjects were tested both with the RMW and the RMF. Recognition memory for words was better than recognition memory for faces in this sample. Moderate correlations (0.30-0.48) were found between RMT and WAIS Vocabulary and Raven's Coloured Progressive Matrices scores. Warrington's RMT was well tolerated, even by very elderly adults. The standardization data for the elderly over 70 add to the usefulness of this test of verbal and non-verbal episodic memory.

Regulation of Photosystem II core protein phosphorylation at the substrate level: Light induces exposure of the CP43 chlorophyll a protein complex to thylakoid protein kinase(s)

Light induces conformational changes in the CP43 chl-a-protein antenna complex in isolated PS II core-complexes exposing phosphorylation site(s) to PS II core-associated protein kinase(s), to added solubilized thylakoid protein kinase(s), as well as to tryptic cleavage. The substrate-activation effect is demonstrated by exposure of the PS II cores to light during the kinase assay as well as by preillumination of the PS II cores in which the endogenous kinase(s) has been inactivated by treatment with N-ethylmaleimid. In the latter case, phosphorylation was performed in darkness following addition of the solubilized protein kinase(s). The solubilized protein kinase(s) does not require light activation. The apparent molecular masses of the main protein kinase(s) associated with the PS II cores (about 31-35 kDa and 45 kDa) differ from that of the major protein kinase present in solubilized preparations obtained from spinach thylakoids (64 kDa). The light-induced exposure of CP43 increases with the light intensity in the range of 20-100 mumol photons m(-2) s(-1) as demonstrated by preillumination of N-ethylmaleimid treated cores followed by addition of the solubilized protein kinase(s) and performing the phosphorylation assay in darkness.

2020 ESC Guidelines on acute coronary syndrome without ST-segment elevation : Recommendations and critical appraisal from the Dutch ACS and Interventional Cardiology working groups

Recently, the European Society of Cardiology (ESC) has updated its guidelines for the management of patients with acute coronary syndrome (ACS) without ST-segment elevation. The current consensus document of the Dutch ACS working group and the Working Group of Interventional Cardiology of the Netherlands Society of Cardiology aims to put the 2020 ESC Guidelines into the Dutch perspective and to provide practical recommendations for Dutch cardiologists, focusing on antiplatelet therapy, risk assessment and criteria for invasive strategy.

Dorsal attention network centrality increases during recovery from acute stress exposure

Stress is a major risk factor for the development of almost all psychiatric disorders. In addition to the acute stress response, an efficient recovery in the aftermath of stress is important for optimal resilience. Increased stress vulnerability across psychiatric disorders may therefore be related to altered trajectories during the recovery phase following stress. Such recovery trajectories can be quantified by changes in functional brain networks. This study therefore evaluated longitudinal functional network changes related to stress in healthy individuals (N = 80), individuals at risk for psychiatric disorders (healthy siblings of schizophrenia patients) (N = 39), and euthymic bipolar I disorder (BD) patients (N = 36). Network changes were evaluated before and at 20 and 90 min after onset of an experimental acute stress task (Trier Social Stress Test) or a control condition. Whole-brain functional networks were analyzed using eigenvector centrality as a proxy for network importance, centrality change over time was related to the acute stress response and recovery for each group. In healthy individuals, centrality of the dorsal attention network (DAN; p = 0.007) changed over time in relation to stress. More specifically, DAN centrality increased during the recovery phase after acute stress exposure (p = 0.020), while no DAN centrality change was observed during the initial stress response (p = 0.626). Such increasing DAN centrality during stress recovery was also found in healthy siblings (p = 0.016), but not in BD patients (p = 0.554). This study highlights that temporally complex and precise changes in network configuration are vital to understand the response to and recovery from stress.

Dental health in 14- to 17-year-old Estonian schoolchildren in Tartu and Tallinn

The dental health of 392 Estonian schoolchildren aged 14-17 years (197 in Tartu and 195 in Tallinn) was studied. In Tartu only 1 child had lost teeth because of caries, as against 30 in Tallinn. Clinically caries-free dentitions were found in 15% of the children in Tartu and in 3% in Tallinn. The mean DMFT value was 3.7 in Tartu and 7.0 in Tallinn, being higher among girls in both cities. The mean DT value was 1.0 in Tartu and 2.6 in Tallinn. All subjects examined had a gingival bleeding index (GBI) higher than zero. The mean GBI was 20% in Tartu and 18% in Tallinn.

Five-year results of the complete versus culprit vessel percutaneous coronary intervention in multivessel disease using drug-eluting stents II (CORRECT II) study: a prospective, randomised controlled trial

OBJECTIVES/BACKGROUND

In patients with multivessel coronary artery disease (MVD) the decision whether to treat a single culprit vessel or to perform multivessel revascularisation may be challenging. The purpose of this study was to evaluate the long-term outcome of multivessel percutaneous coronary intervention (MV-PCI) versus culprit vessel only (CV-PCI) in patients with stable coronary artery disease or non-ST elevation acute coronary syndrome.

METHODS

In this dual-centre, prospective, randomised study a total 215 patients with MVD were randomly assigned to MV-PCI or CV-PCI. The primary endpoint was the occurrence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), and repeat revascularisation. Secondary endpoints were the combined endpoint of death or MI, the individual components of the primary endpoint, and the occurrence of stent thrombosis. Patients were followed up to 5 years after enrolment.

RESULTS

The occurrence of the primary endpoint was similar at 28% versus 31% in the MV-PCI and CV-PCI group, respectively (hazard ratio [HR] 0.87, 95% confidence interval [CI]: 0.53-1.44, p = 0.59). The rate of repeat revascularisation was 15% versus 24% (HR 0.59, 95% CI 0.32 to 1.11, p = 0.11), whereas definite or probable stent thrombosis occurred in 2% versus 0% (p = 0.44).

CONCLUSIONS

In this randomised study comparing the strategies for MV-PCI and CV-PCI in patients with MVD, no difference was found in the occurrence of MACE after 5 years. We observed a numerically higher rate of death or MI and a lower rate of repeat revascularisation after MV-PCI, although these findings were not statistically significant.