[Modern treatment in acute coronary syndrome]

The "acute coronary syndrome" (ACS) is a life threatening condition. In patients with ST-segment elevation myocardial infarction (STEMI) an immediate reperfusion therapy is indicated. Primary percutaneous coronary intervention (PCI) is the gold standard. In ACS without ST-segment elevation (NSTE-ACS) coronary angiography should be performed within 72 hours in patients with risk factors. Depending on the coronary anatomy treatment options are PCI, aorto-coronary bypass surgery or sole medical therapy. The antiplatelet therapy has a key role in ACS. In addition to acetylsalicylic acid (ASA) another platelet aggregation inhibitor should be given for 12 months. For the majority of patients ticagrelor and prasugrel are the agents of first choice, because both act faster and stronger than clopidogrel. In patients at high risk of bleeding clopidogrel remains the preferable antiplatelet agent. In addition to antiplatelet treatment anticoagulant therapy is necessary in ACS-patients.

Additional coronary sinus defibrillation lead with a right pectoral ICD and high DFT : a case report

We report the case of a 63-year-old man with ischemic cardiomyopathy having an implantable cardioverter defibrillator (ICD) implanted for repeated ventricular tachycardia (VT). After several revisions of the ICD lead, a thrombosis of the left venous system was diagnosed. A right pectoral ICD device was implanted, and a sufficient defibrillation threshold (DFT) could not be achieved during the operation. Thus, a further defibrillation lead was implanted into the coronary sinus, which successfully terminated ventricular fibrillation.

Affective cognition and its disruption in mood disorders

In this review, we consider affective cognition, responses to emotional stimuli occurring in the context of cognitive evaluation. In particular, we discuss emotion categorization, biasing of memory and attention, as well as social/moral emotion. We discuss limited neuropsychological evidence suggesting that affective cognition depends critically on the amygdala, ventromedial frontal cortex, and the connections between them. We then consider neuroimaging studies of affective cognition in healthy volunteers, which have led to the development of more sophisticated neural models of these processes. Disturbances of affective cognition are a core and specific feature of mood disorders, and we discuss the evidence supporting this claim, both from behavioral and neuroimaging perspectives. Serotonin is considered to be a key neurotransmitter involved in depression, and there is a considerable body of research exploring whether serotonin may mediate disturbances of affective cognition. The final section presents an overview of this literature and considers implications for understanding the pathophysiology of mood disorder as well as developing and evaluating new treatment strategies.

Impairment of prosocial sentiments is associated with frontopolar and septal damage in frontotemporal dementia

Poets and philosophers have long acknowledged moral sentiments as key motivators of human social behavior. Prosocial sentiments, which include guilt, pity and embarrassment, enable us to care about others and to be concerned about our mistakes. Functional imaging studies have implicated frontopolar, ventromedial frontal and basal forebrain regions in the experience of prosocial sentiments. Patients with lesions of the frontopolar and ventromedial frontal areas were observed to behave inappropriately and less prosocially, which could be attributed to a generalized emotional blunting. Direct experimental evidence for brain regions distinctively associated with moral sentiment impairments is lacking, however. We investigated this issue in patients with the behavioral variant of frontotemporal dementia, a disorder in which early and selective impairments of social conduct are consistently observed. Using a novel moral sentiment task, we show that the degree of impairment of prosocial sentiments is associated with the degree of damage to frontopolar cortex and septal area, as assessed with 18-Fluoro-Deoxy-Glucose-Positron Emission Tomography, an established measure of neurodegenerative damage. This effect was dissociable from impairment of other-critical feelings (anger and disgust), which was in turn associated with dorsomedial prefrontal and amygdala dysfunction. Our findings suggest a critical role of the frontopolar cortex and septal region in enabling prosocial sentiments, a fundamental component of moral conscience.

[In-stent-stenosis of a bare-metal stent 11 years after its implantation]

HISTORY AND ADMISSION FINDINGS

A 52-year-old man was admitted to our hospital with unstable angina pectoris. A balloon angioplasty of his left anterior descending artery had been performed 12 years ago and two bare-metal stents had been implanted two months later for an early restenosis.

DIAGNOSTIC PROCEDURES

Bicycle ergometry was stopped because the patient experienced angina pectoris and the electrocardiogram showed ST-segment depression in leads V4-V6.

TREATMENT AND OUTCOME

A coronary angiography was performed and a single-vessel disease with a significant in-stent stenosis of the proximal left anterior descending artery was diagnosed. Another successful percutaneous coronary intervention was performed with implantation of a drug-eluting stent. The further hospital course was uneventful.

CONCLUSION

Even after more than 11 years an in-stent stenosis of a bare-metal stent can occur without progression of coronary artery disease in the other coronary arteries.

In a study for acne vulgaris, sequence-based HLA typing showed a novel DPB1 allele, DPB1*2402

In this paper, we characterize the novel human leucocyte antigen (HLA)-DPB1*2402 allele that we found in a patient suffering from acne vulgaris. In comparison to the closest related allele DPB1*0401, HLA-DPB1*2402 has a single nucleotide exchange at position 115 (202), T replaces G. In consequence, codon 39 (68) TAC encodes for tyrosine in the novel allele instead of aspartic acid 39 (68) GAC in DPB1*0401.

Glycoprotein IIb/IIIa antagonists: new developments

The role of GP IIb/IIIa antagonists has been focused on patients with acute coronary syndromes undergoing PCI. In the ISAR-REACT 2 study abciximab given in patients with NSTE-ACS undergoing PCI already treated with 600 mg clopidogrel improved 30-day death and reinfarction rate in troponin positive patients. In the large EARLY-ACS trial upstream therapy with eptifibatide in high risk with NSTE-ACS did not improve ischaemic complications but was associated with an increase in bleeding complications. Therefore GP IIb/IIIa antagonists should be given after the initial angiography and the decision the perform PCI in troponin positive patients with NSTE-ACS. In patients with STEMI undergoing primary PCI the prehospital administration of tirofiban was associated with an improved myocardial reperfusion. In contrast in the BRAVE 3 trial abciximab in patients with pretreatment with 600 mg clopidogrel did not reduce infarct size or improve clinical outcome. Comparative trials evaluating the effectiveness of abciximab and the small molecules tirofiban and eptifibatide did not show any differences between the three GP IIb/IIIa antagonists.

The role of neuroimaging in translational cognitive neuroscience

Despite the current enthusiasm for neuroimaging as a key method in translational neuroscience, there is a lack of debate about the nosological framework within which neuroimaging measures should be related to diagnostic categories. Here, the aim was to stimulate a debate about the role of cognitive neuroscience and neuroimaging in mediating between molecular/genetic, clinical diagnostic, and symptom-based descriptions of neuropsychiatric disorders. The diagnostic role of neuroimaging in translational neuroscience is stressed, namely, to be combined with cognitive measures to define cognitive-anatomical syndromes as an intermediate diagnostic category that mediates between clinical diagnoses and psychoreactive as well as neurobiological etiologic factors. This multilevel approach will be illustrated by reviewing recent insights into the cognitive-anatomical basis of inappropriate social behavior and social knowledge in frontotemporal dementia and by discussing its implications for the study of neuropsychiatric disorders such as major depressive disorder in which neuroanatomical abnormalities are more subtle.

Protein scaffold and expression level determine antiviral activity of membrane-anchored antiviral peptides

Cell membrane-anchored (ma) antiviral peptides derived from the C-terminal heptad repeat of the HIV-1 transmembrane glycoprotein gp41 (C-peptides) and expressed from retroviral vectors were shown to efficiently inhibit HIV-1 entry into target cells. Here, we analyzed the influence of the vector backbone, the scaffold modules that anchor the peptide to the membrane and the length of the C-peptide on expression level and antiviral activity. In general, antiviral activity was determined primarily by the density of the C-peptide on the cell surface. By influencing expression levels, the scaffold elements indirectly also determined antiviral activity. Additional direct effects of the scaffold on antiviral activity were minor. At comparable expression levels, the elongated C-peptide (maC46) was found to be more potent than the shorter maC36. On the basis of these findings, a dose-response assay was established that quantifies antiviral activity relative to the expression level of the antiviral gene product. Taken together, these data demonstrate the importance of analyzing the efficacy of therapeutic genes relative to the dose of the gene product.

Joint independent component analysis of structural and functional images reveals complex patterns of functional reorganisation in stroke aphasia

Previous functional activation studies in patients with aphasia have mostly relied on standard group comparisons of aphasic patients with healthy controls, which are biased towards regions showing the most consistent effects and disregard variability within groups. Groups of aphasic patients, however, show considerable variability with respect to lesion localisation and extent. Here, we use a novel method, joint independent component analysis (jICA), which allowed us to investigate abnormal patterns of functional activation with O(15)-PET during lexical decision in aphasic patients after middle cerebral artery stroke and to directly relate them to lesion information from structural MRI. Our results demonstrate that with jICA we could detect a network of compensatory increases in activity within bilateral anterior inferior temporal areas (BA20), which was not revealed by standard group comparisons. In addition, both types of analyses, jICA and group comparison, showed increased activity in the right posterior superior temporal gyrus in aphasic patients. Further, whereas standard analyses revealed no decreases in activation, jICA identified that left perisylvian lesions were associated with decreased activation of left posterior inferior frontal cortex, damaged in most patients, and extralesional remote decreases of activity within polar parts of the inferior temporal gyrus (BA38/20) and the occipital cortex (BA19). Taken together, our results demonstrate that jICA may be superior in revealing complex patterns of functional reorganisation in aphasia.