Cholesterol crystals at the culprit lesion in patients with acute coronary syndrome are associated with worse cardiovascular outcomes at two years follow up - results from the translational OPTICO-ACS study program

BACKGROUND

Cholesterol crystals (CCs) represent a feature of advanced atherosclerotic plaque and may be assessed by optical coherence tomography (OCT). Their impact on cardiovascular outcomes in patients presenting with acute coronary syndromes (ACS) is yet unknown.

METHODS

The culprit lesion (CL) of 346 ACS-patients undergoing preintervention OCT imaging were screened for the presence of CCs and divided into two groups accordingly. The primary end-point was the rate of major adverse cardiac events plus (MACE+) consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to unstable or progressive angina at two years.

RESULTS

Among 346 patients, 57.2% presented with CCs at the CL. Patients with CCs exhibited a higher prevalence of ruptured fibrous caps (RFC-ACS) (79.8% vs. 56.8%; p < 0.001) and other high-risk features such as thin cap fibroatheroma (80.8% vs. 64.9%; p = 0.001), presence of macrophages (99.0% vs. 85.1%; p < 0.001) as well as a greater maximum lipid arc (294.0° vs. 259.3°; p < 0.001) at the CL as compared to patients without CCs. MACE+ at two years follow-up occurred more often in CC-patients (29.2% vs. 16.1%; p = 0.006) as compared to patients without CCs at the culprit site. Multivariable cox regression analysis identified CCs as independent predictor of MACE+ (HR 1.705; 1.025-2.838 CI, p = 0.040).

CONCLUSIONS

CCs were associated with conventional high-risk plaque features and associated with increased MACE+-rates at two years follow up. The identification of CCs might be useful as prognostic marker in patients with ACS and assist "precision prevention" in the future.

Contribution to the knowledge of the Ichneumoninae (Hymenoptera, Ichneumonidae) from Maritime Southeast Asia

In this study, new distributional records are given for 98 species and subspecies of Darwin wasps of the subfamily Ichneumoninae (Hymenoptera, Ichneumonidae) from Maritime Southeast Asia, namely from Indonesia and Malaysia: Sabah. Four genera, 31 species and three subspecies are described as new. The new genera are: Atanyjoppoides n. gen., Moluccarches n. gen., Orientodromus n. gen. and Platylaboides n. gen. The new species are: Achaius sabahensis n. sp., Allonotus rufiventris n. sp., Amblyjoppa nigra n. sp., Amblyjoppa striata n. sp., Atanyjoppoides mandibulator n. sp., Benyllus mesonotator n. sp., Benyllus rufostriatus n. sp., Benyllus sundaensis n. sp., Celebarches albifrons n. sp., Celebarches nigritor n. sp., Celebarches sabahensis n. sp., Celebarches tricolor n. sp., Coelichneumon (Exephanides) nigropropodealis n. sp., Compsophorus (Xenojoppa) quadrimaculatus n. sp., Deniya scutellaris n. sp., Eccoptosage nigrifemur n. sp., Eccoptosage sabahensis n. sp., Heresiarches simile n. sp., Lareiga nigrita n. sp., Lissosculpta albifrons n. sp., Lissosculpta malucuensis n. sp., Lissosculpta seramensis n. sp., Losgna baliensis n. sp., Losgna rufobasalis n. sp., Moluccarches albimaculatus n. sp., Orientodromus thyridialis n. sp., Platylaboides javanicus n. sp., Pseudoplatylabus rufoniger n. sp., Setanta albimaculata n. sp., Stirexephanes albicoxis n. sp., and Stirexephanes rufopetiolaris n. sp. The new subspecies are: Allonotus rufus sumatrensis n. ssp., Amblyjoppa rufobalteata sumatera n. ssp., and Anisobas vietnamensis sabahensis n. ssp. Vulgichneumon stegemanni (Heinrich, 1934) is transferred to the genus Virgichneumon Heinrich, 1977, n. stat.. For the following species the hitherto unknown are described: Barichneumonites properans (Tosquinet, 1903), Celebarches unicus Heinrich, 1934, Celebichneumon egregius Heinrich, 1934, Coelichneumon (Coelichneumon) lineiscutis Heinrich, 1966, Eccoptosage quadridentata (Cameron, 1905), Menkokia major (Heinrich, 1934), Nesostenodontus formosanus Cushman, 1937, Stenichneumonopsis albifasciatus Heinrich, 1934, Stirexephanes impictus Heinrich, 1934, Ulesta plagiata Heinrich, 1934, and Virgichneumon stegemanni (Heinrich, 1934). All new species are described in detail and illustrated. For the known species of Celebarches Heinrich, a determination key is provided.

Coexistence of calcified- and lipid-containing plaque components and their association with incidental rupture points in acute coronary syndrome-causing culprit lesions: results from the prospective OPTICO-ACS study

AIMS

Rupture of the fibrous cap (RFC) represents the main pathophysiological mechanism causing acute coronary syndromes (ACS). Destabilization due to plaque biomechanics is considered to be importantly involved, exact mechanisms triggering plaque ruptures are, however, unknown. This study aims at characterizing the relation between plaque components and rupture points at ACS-causing culprit lesions in a large cohort of ACS-patients assessed by high-resolution intracoronary imaging.

METHODS AND RESULTS

Within the prospective, multicentric OPTICO-ACS study program, the ACS-causing culprit plaques of 282 consecutive patients were investigated following a standardized optical coherence tomography (OCT) imaging protocol. Each pullback was assessed on a frame-by-frame basis for the presence of lipid components (LC), calcium components (CC), and coexistence of both LC and CC (LCC) by two independent OCT-core labs. Of the 282 ACS-patients, 204 patients (72.3%) presented with ACS caused by culprit lesions with rupture of the fibrous cap (RFC-ACS) and 27.7% patients had ACS caused by culprit lesions with intact fibrous cap (IFC-ACS). When comparing RFC-ACS to IFC-ACS, a preferential occurrence of all three plaque components (LC, CC, and LCC) in RFC-ACS became apparent (P < 0.001). Within ruptured culprit lesions, the zone straight at the rupture point [extended rupture zone (RZ)] was characterized by similar (24.7% vs. 24.0%; P = ns) calcium content when compared with the proximal and distal border of the culprit lesion [border zone (BZ)]. The RZ displayed a significantly higher amount of both, LC (100% vs. 69.8%; P < 0.001) and LCC (22.7% vs. 6.8%; P < 0.001), when compared with the BZ. The relative component increase towards the RZ was particularly evident for LCC (+233.8%), while LC showed only a modest increase (+43.3%).

CONCLUSIONS

Calcified- and lipid-containing components characterize ruptured fibrous cap ACS-causing culprit lesions. Their coexistence is accelerated directly at the ruptured point, suggesting a pathophysiological contribution in the development of RFC-ACS.

Prognostic implications of cholesterol chrystals at ACS causing culprit lesions, insights from the translational OPTICO-ACS study program

Aims

Cholesterol chrystals (CC) represent a feature of advanced plaque remodeling. Optical coherence tomography (OCT) allows for detailed morphological assessment of the culprit lesion, including the presence of CCs, in vivo. Since CCs have been identified as prognostically relevant plaque feature in coronary artery disease (CAD), the present analysis aims to further characterize their impact on adverse cardiovascular outcome in a large cohort of patients, presenting with acute coronary syndrome (ACS).

Methods

Within the translational OPTICO-ACS study program, 371 consecutive ACS-patients were included into the final analysis. OCT-characteristics, including the presence of CCs, were assessed by a standardized CoreLab analysis following universal consensus standards for OCT-derived plaque features. All patients were followed up for 12 months after the index event and major adverse cardiac events (MACE) consisting of death, myocardial infarction, target vessel revascularization plus re-hospitalization due to unstable or progressive angina pectoris were documented.

Results

215 patients (58.1%) presented with cholesterol chrystals (CCs) at the culprit lesion. Plaque rupture (RFC-ACS) represented the primary ACS-causing pathophysiology (75.3%) in those patients. Further, the presence of CCs was associated with other high-risk features within the culprit lesion, i.e. the presence of thin cap fibroatheroma (77.7% vs. 63.2%; p&lt;0.05), plaque calcification (80.5% vs. 67.1; p&lt;0.01) and microchannels (80.1% vs. 70.1; p&lt;0.05) as well as an increased area stenosis (0.77 vs. 0.73 mm2; p&lt;0.01) and a greater maximum lipid arc (282.8 vs. 242.6°; p&lt;0.01) as compared to culprit lesions free of CCs. Of note, there was a strong association among the occurrence of macrophages within the plaque and cholesterol crystals. Finally, and most importantly MACE during 12 months follow-up, consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to progressive or unstable angina pectoris, occurred with nearly twice the frequency in CC-patients (20.3% vs. 10.6%; p&lt;0.01) as compared to patients without CCs at the culprit site.

Conclusion

The present analysis introduces cholesterol chrystals as a novel prognostically relevant high-risk plaque feature allowing individual risk stratification for patients after ACS.

Funding Acknowledgement

Type of funding sources: None.

First record of the subfamily Oxytorinae (Insecta, Hymenoptera, Ichneumonidae) from the Oriental Region, with descriptions of two new species from Vietnam

Background

The Oxytorinae is a small subfamily of the family Ichneumonidae (Insecta, Hymenoptera) with the single genus Oxytorus Förster and 23 described species. Species were previously known to occur in the Palaearctic, Nearctic and Neotropical Regions.

New information

The ichneumonid subfamily Oxytorinae is recorded for the first time from the Oriental Region. Two species, one from northern and one from central Vietnam, are described as new: Oxytoruscarinatus Riedel, sp. n. and O.rufopropodealis Riedel, sp. n.

Contribution to the Ophioninae (Hymenoptera: Ichneumonidae) of Iran with the description of 16 new species and an illustrated key to the Eremotylus of the Western Palaearctic

In this study, material of Iranian Ophioninae was examined. In total, 63 species are recognized as occurring in Iran. Sixteen species are described as new to science: Enicospilus amerii Johansson sp. nov., E. apocalypticus Johansson sp. nov., E. haladai Johansson sp. nov., Enicospilus peri sp. nov., Ophion al Johansson sp. nov., Ophion angustigena Johansson sp. nov., Ophion breviflagellator Johansson sp. nov., Ophion golestanicus Johansson sp. nov., Ophion klimenkoi Johansson sp. nov., Ophion persicus Johansson sp. nov., Ophion schmidti Johansson sp. nov., Ophion sinuosus Johansson sp. nov., Ophion sistanicus Johansson sp. nov., Ophion transcarinatus Johansson sp. nov., Ophion vasi Johansson sp. nov. and Ophion xrafstra Johansson sp. nov. Sixteen species: Enicospilus combustus (Gravenhorst, 1829); E. intermedius (Johansson, 2018); E. undulatus (Gravenhorst, 1829); Ophion angularis Johansson Cederberg, 2019; Ophion bipictor Aubert, 1980; Ophion crassicornis Brock, 1982; Ophion confusus Johansson, 2019; Ophion ellenae Johansson, 2019; Ophion eremita Kokujev, 1906; Ophion kallanderi Johansson, 2019; Ophion rostralis Meyer, 1935; Ophion rufoniger Kohl, 1905; Ophion semipullatus Kokujev, 1909; Ophion tenuicornis Johansson, 2019; Hellwigiella dichromoptera (Costa, 1886) and Eremotylus curvinervis (Kriechbaumer, 1878) are new records for the fauna of Iran. Enicospilus flavocephalus (Kirby, 1900), Enicospilus monostigma (Vollenhoven, 1879) and Eremotylus sibiricus Szpligeti, 1905 are excluded from the Iranian checklist due to previous misidentifications. Enicospilus tarsalis Hedwig, 1957 syn. nov. is excluded from synonymy with E. ahngeri and instead introduced as a junior synonym of E. cruciator Viktorov, 1957. Enicospilus affinis Hedwig, 1957 stat. rev. is excluded from synonymy with E. ocellatus Shestakov, 1926 and reinstated as a valid species. Enicospilus splendidus Rousse, Soliman Gadallah, 2017 syn. nov. is a junior synonym of Enicospilus stenopsis Kohl, 1905. Enicospilus grandiflavus Townes Townes, 1973 (= E. grandis Morley) syn. nov. is synonymized with Enicospilus unicallosus (Vollenhoven, 1878). Enicospilus contributus Shestakov, 1926 is confirmed as a junior synonym of E. merdarius (Gravenhorst, 1829). Ophion fossulatus Hedwig, 1957 stat. rev. is excluded from synonymy with Ophion mocsaryi Brauns, 1899 and reinstated as a valid species close to Ophion parvulus Kriechbaumer. Ophion mocsaryi var. decedens Hedwig, 1961 syn. nov. is a synonym of Ophion bipictor Aubert, 1980. Ophion obscuratus var. heratensis Hedwig, 1961 syn. nov. is treated as a synonym of Ophion turcomanicus Szpligeti, 1905. Ophion pravinervis Kokujev, 1906, previously only known from the lost type collected in Georgia, is redescribed. Despite the relatively high number of new species here presented, the Iranian fauna most likely still harbours additional species awaiting discovery.

Checklist of the Ichneumonidae of Germany (Insecta, Hymenoptera)

Background

A revised checklist of the Ichneumonidae of Germany is provided. The list represents an updated version of an earlier checklist published in 2001. The present list includes several records of species that are new for the German fauna and species that were discovered since the last checklist was published. The present checklist was compiled as part of the DNA barcoding projects at the Zoologische Staatssammlung München.

New information

The checklist includes 3,644 species of Ichneumonidae from Germany, with 48 species recorded for the first time. Compared to the checklist published 20 years ago, the number of ichneumonid species recorded from Germany has increased by 312 species.

Differential immunological signature at the culprit site distinguishes acute coronary syndrome with intact from acute coronary syndrome with ruptured fibrous cap: results from the prospective translational OPTICO-ACS study

AIMS

Acute coronary syndromes with intact fibrous cap (IFC-ACS), i.e. caused by coronary plaque erosion, account for approximately one-third of ACS. However, the underlying pathophysiological mechanisms as compared with ACS caused by plaque rupture (RFC-ACS) remain largely undefined. The prospective translational OPTICO-ACS study programme investigates for the first time the microenvironment of ACS-causing culprit lesions (CL) with intact fibrous cap by molecular high-resolution intracoronary imaging and simultaneous local immunological phenotyping.

METHODS AND RESULTS

The CL of 170 consecutive ACS patients were investigated by optical coherence tomography (OCT) and simultaneous immunophenotyping by flow cytometric analysis as well as by effector molecule concentration measurements across the culprit lesion gradient (ratio local/systemic levels). Within the study cohort, IFC caused 24.6% of ACS while RFC-ACS caused 75.4% as determined and validated by two independent OCT core laboratories. The IFC-CL were characterized by lower lipid content, less calcification, a thicker overlying fibrous cap, and largely localized near a coronary bifurcation as compared with RFC-CL. The microenvironment of IFC-ACS lesions demonstrated selective enrichment in both CD4+ and CD8+ T-lymphocytes (+8.1% and +11.2%, respectively, both P < 0.05) as compared with RFC-ACS lesions. T-cell-associated extracellular circulating microvesicles (MV) were more pronounced in IFC-ACS lesions and a significantly higher amount of CD8+ T-lymphocytes was detectable in thrombi aspirated from IFC-culprit sites. Furthermore, IFC-ACS lesions showed increased levels of the T-cell effector molecules granzyme A (+22.4%), perforin (+58.8%), and granulysin (+75.4%) as compared with RFC plaques (P < 0.005). Endothelial cells subjected to culture in disturbed laminar flow conditions, i.e. to simulate coronary flow near a bifurcation, demonstrated an enhanced adhesion of CD8+T cells. Finally, both CD8+T cells and their cytotoxic effector molecules caused endothelial cell death, a key potential pathophysiological mechanism in IFC-ACS.

CONCLUSIONS

The OPTICO-ACS study emphasizes a novel mechanism in the pathogenesis of IFC-ACS, favouring participation of the adaptive immune system, particularly CD4+ and CD8+ T-cells and their effector molecules. The different immune signatures identified in this study advance the understanding of coronary plaque progression and may provide a basis for future development of personalized therapeutic approaches to ACS with IFC.

TRIAL REGISTRATION

The study was registered at clinicalTrials.gov (NCT03129503).

The genus Coelichneumon Thomson in Japan (Hymenoptera, Ichneumonidae, Ichneumoninae)

In this taxonomic study, 29 species of the genus Coelichneumon Thomson, 1893 found in Japan are described in detail. For some species, other East Palaearctic material is also mentioned.                Five of the species are new to science: Coelichneumon caerulogaster nov. sp. (from Hokkaido and Honshu), C. carinator nov. sp. (from Honshu; also Russia and Korea), C. cyanator nov. sp. (from Honshu), C. terebrator nov. sp. (from Honshu) and C. uchidai nov. sp. (from Honshu). Four species are newly reported from Japan: C. clypeatus (Uchida, 1955), C. decemguttatus Uchida, 1932, C. maritimensis Heinrich, 1980 and C. nobilis (Wesmael, 1857). C. femoralis Uchida, 1927 is newly recorded from Far East Russia and C. rufibasalis (Uchida, 1927) from China and Mongolia.                C. birmanicus Heinrich, 1966 is newly synonymized under Ichneumon bivittatus Matsumura, 1912. C. coxalis Uchida, 1926 is newly synonymized under Ichneumon sinister Wesmael, 1848, and Ichneumon flavitarsis Smith, 1874 is newly synonymized under Ichneumon deliratorius Linnaeus, 1758. The female of C. rufibasalis (Uchida, 1927) and the male of C. maritimensis Heinrich, 1980 are described for the first time. For C. flavitarsis sensu Lee et al. non Smith, a new name, C. flavitarsator, is established and a lectotype designated.                The genus Aglaojoppa Cameron, 1901 is newly synonymized under Coelichneumon. Hence, A. centummaculata (Christ, 1791) is transferred to Coelichneumon (rev. stat.). The specific names of A. rufofemoratus Cameron, 1903 and A. victoriae Heinrich, 1968 are preoccupied in Coelichneumon and two replacement names are proposed, Coelichneumon cameroni nom. nov. for the former and C. paravictoriae nom. nov. for the latter species.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Impact of real-time angiographic co-registered optical coherence tomography on percutaneous coronary intervention: the OPTICO-integration II trial

Aims

Longitudinal geographic mismatch (LGM) as well as edge dissections are associated with an increased risk of adverse events after percutaneous coronary intervention (PCI). Recently, a novel system of real-time optical coherence tomography (OCT) with angiographic co-registration (ACR) became available and allows matched integration of cross-sectional OCT images to angiography. The OPTICO-integration II trial sought to assess the impact of ACR for PCI planning on the risk of LGM and edge dissections.

Methods

A total of 84 patients were prospectively randomized to ACR-guided PCI, OCT-guided PCI (without co-registration), and angiography-guided PCI. Primary endpoint was a composite of major edge dissection and/or LGM as assessed by post-PCI OCT.

Results

The primary endpoint was significantly reduced in ACR-guided PCI (4.2%) as compared to OCT-guided PCI (19.1%; p = 0.03) and angiography-guided PCI (25.5%; p < 0.01). Rates of LGM were 4.2%, 17.0%, and 22.9% in the ACR-guided PCI, in the OCT-guided PCI, and the angiography-guided PCI groups, respectively (ACR vs. OCT p = 0.04; ACR vs. angiography p = 0.04). The number of major edge dissections was low and without significant differences among the study groups (0% vs. 2.1% vs. 4.3%).

Conclusion

This study for the first time demonstrates superiority of ACR-guided PCI over OCT- and angiography-guided PCI in reducing the composite endpoint of major edge dissection and LGM, which was meanly driven by a reduction of LGM.

Graphical abstract

A pilot study of the Carpathian ichneumonine parasitoids (Hymenopera, Ichneumonidae: Ichneumoninae) reveals eighty-eight new records for Ukraine

Data on the subfamily Ichneumoninae Latreille, 1802 (Hymenopera: Ichneumonidae) from the Ukrainian Carpathians is summarized, with 196 species from eight tribes, of which 88 species are recorded from Ukraine for the first time. The new Ukrainian records belong to four tribes, Heresiarchini Ashmead, 1900, Ichneumonini Latreille, 1802, Phaeogenini Förster, 1869, and Platylabini Berthoumieu, 1904. Phaeogenini is the most poorly studied with 75% of species recorded for the country for the first time. High-altitude zone distribution is discussed: oak forest zone is the most species-rich (125 species), while the subalpine zone is the most poorly studied (57% of species found only in this zone are new records for Ukraine). The flying adults of Ichneumoninae were found from April until October, with a maximum number of species and genera collected in July, and with most specimens collected in May. Stenobarichneumon ridibitor Aubert, 1994 is transferred to the genus Baranisobas Heinrich, 1972 (comb. nov.).

A pilot study of the safety and efficacy of amisulpride and risperidone in elderly psychotic patients

Objective

The primary objective of this randomised, active–controlled, parallel group, double-blind study was to evaluate the tolerability of treatment with either amisulpride or risperidone in elderly patients with schizophrenia aged over 65 years; evaluation of efficacy was a secondary objective.

Methods

The study included patients of either sex aged 65 years or older fulfilling DSM IV-diagnostic criteria for psychotic disorders and who presented psychotic symptoms severe enough to require antipsychotic medication. Subjects were randomly allocated to a flexible dose of either amisulpride (100–400 mg/day) or risperidone (1–4 mg/day) for six weeks following a three- to six-day placebo wash-out period. Safety assessment involved adverse event reporting, physical examination, blood pressure, heart rate and ECG monitoring, and laboratory tests. Extrapyramidal symptoms were evaluated with the Simpson–Angus Scale, Barnes Akathisia Scale and the AIMS. Efficacy parameters were changes in score on the PANSS, BPRS, CDS and MMSE scores.

Results

Thirty-eight patients were randomised, 25 to amisulpride and 13 to risperidone. A total of 26 adverse events were experienced by 10 patients in the amisulpride group and five patients in the risperidone group. One patient in each group discontinued the study due to the emergence of a movement disorder. Changes in scores on the three measures of extrapyramidal symptoms were similar in the two groups. The PANSS total score decreased by 27.8% in the amisulpride group and by 29% in the risperidone group between inclusion and study end.

Conclusion

Amisulpride and risperidone are generally well tolerated in elderly patients with schizophrenia. Both drugs appeared to be efficacious in this study population, with no differences in efficacy being observed. However, the sample size was too low to reveal potential inter-group differences. Both these atypical antipsychotics thus appear to be suitable for the treatment of schizophrenia in the elderly.

What are depressive symptoms in acutely ill patients with schizophrenia spectrum disorder?

Background:

Aim was to examine depressive symptoms in acutely ill schizophrenia patients on a single symptom basis and to evaluate their relationship with positive, negative and general psychopathological symptoms.

Methods:

Two hundred and seventy-eight patients suffering from a schizophrenia spectrum disorder were analysed within a naturalistic study by the German Research Network on Schizophrenia. Using the Calgary Depression Scale for Schizophrenia (CDSS) depressive symptoms were examined and the Positive and Negative Syndrome Scale (PANSS) was applied to assess positive, negative and general symptoms. Correlation and factor analyses were calculated to detect the underlying structure and relationship of the patient’s symptoms.

Results:

The most prevalent depressive symptoms identified were depressed mood (80%), observed depression (62%) and hopelessness (54%). Thirty-nine percent of the patients suffered from depressive symptoms when applying the recommended cut-off of a CDSS total score of > 6 points at admission. Negligible correlations were found between depressive and positive symptoms as well as most PANSS negative and global symptoms despite items on depression, guilt and social withdrawal. The factor analysis revealed that the factor loading with the PANSS negative items accounted for most of the data variance followed by a factor with positive symptoms and three depression-associated factors.

Limitations:

The naturalistic study design does not allow a sufficient control of study results for the effect of different pharmacological treatments possibly influencing the appearance of depressive symptoms.

Conclusion:

Results suggest that depressive symptoms measured with the CDSS are a discrete symptom domain with only partial overlap with positive or negative symptoms.

The validity of self-rated psychotic symptoms in depressed inpatients

Background

Self-ratings of psychotic experiences might be biased by depressive symptoms.

Method

Data from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.

Results

At discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, P<0.001) and with the BDI total score (0.64, P<0.001). Moderate correlations were found for the MADRS (0.34, P<0.001), HAMD (0.37, P<0.001) and AMDP depression score (0.33, P<0.001). Only a weak correlation was found between the SCL-90 psychosis score and the AMDP paranoid-hallucinatory syndrome score (0.15, P<0.001). Linear regression showed that change in self-rated psychotic symptoms over the treatment course was best explained by a change in the SCL-90 depression score (P<0.001). The change in clinician-rated AMDP paranoid-hallucinatory score had lesser influence (P = 0.02).

Conclusions

In depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.

Heart Rate Variability and Omega-3 Index in Euthymic Patients with Bipolar Disorders

Background:

Affective disorders are associated with an increased risk of cardiovascular disease, which, at least partly, appears to be independent of psychopharmacological treatments used to manage these disorders. Reduced heart rate variability (SDNN) and a low Omega-3 Index have been shown to be associated with increased risk for death after myocardial infarction. Therefore, we set out to investigate heart rate variability and the Omega-3 Index in euthymic patients with bipolar disorders.

Methods:

We assessed heart rate variability (SDNN) and the Omega-3 Index in 90 euthymic, mostly medicated patients with bipolar disorders (Bipolar-I, Bipolar-II) on stable psychotropic medication, free of significant medical comorbidity and in 62 healthy controls. Heart rate variability was measured from electrocardiography under a standardized 30 minutes resting state condition. Age, sex, BMI, smoking, alcohol consumption and caffeine consumption as potential confounders were also assessed.

Results:

Heart rate variability (SDNN) was significantly lower in patients with bipolar disorders compared to healthy controls (35.4 msec versus 60.7 msec; P < 0.0001), whereas the Omega-3 Index did not differ significantly between the groups (5.2% versus 5.3%). In a linear regression model, only group membership (patients with bipolar disorders versus healthy controls) and age significantly predicted heart rate variability (SDNN).

Conclusion:

Heart rate variability (SDNN) may provide a useful tool to study the impact of interventions aimed at reducing the increased risk of cardiovascular disease in euthymic patients with bipolar disorders. The difference in SDNN between cases and controls cannot be explained by a difference in the Omega-3 Index.

Completing Linnaeus's inventory of the Swedish insect fauna: Only 5,000 species left?

Despite more than 250 years of taxonomic research, we still have only a vague idea about the true size and composition of the faunas and floras of the planet. Many biodiversity inventories provide limited insight because they focus on a small taxonomic subsample or a tiny geographic area. Here, we report on the size and composition of the Swedish insect fauna, thought to represent roughly half of the diversity of multicellular life in one of the largest European countries. Our results are based on more than a decade of data from the Swedish Taxonomy Initiative and its massive inventory of the country's insect fauna, the Swedish Malaise Trap Project The fauna is considered one of the best known in the world, but the initiative has nevertheless revealed a surprising amount of hidden diversity: more than 3,000 new species (301 new to science) have been documented so far. Here, we use three independent methods to analyze the true size and composition of the fauna at the family or subfamily level: (1) assessments by experts who have been working on the most poorly known groups in the fauna; (2) estimates based on the proportion of new species discovered in the Malaise trap inventory; and (3) extrapolations based on species abundance and incidence data from the inventory. For the last method, we develop a new estimator, the combined non-parametric estimator, which we show is less sensitive to poor coverage of the species pool than other popular estimators. The three methods converge on similar estimates of the size and composition of the fauna, suggesting that it comprises around 33,000 species. Of those, 8,600 (26%) were unknown at the start of the inventory and 5,000 (15%) still await discovery. We analyze the taxonomic and ecological composition of the estimated fauna, and show that most of the new species belong to Hymenoptera and Diptera groups that are decomposers or parasitoids. Thus, current knowledge of the Swedish insect fauna is strongly biased taxonomically and ecologically, and we show that similar but even stronger biases have distorted our understanding of the fauna in the past. We analyze latitudinal gradients in the size and composition of known European insect faunas and show that several of the patterns contradict the Swedish data, presumably due to similar knowledge biases. Addressing these biases is critical in understanding insect biomes and the ecosystem services they provide. Our results emphasize the need to broaden the taxonomic scope of current insect monitoring efforts, a task that is all the more urgent as recent studies indicate a possible worldwide decline in insect faunas.

P6394Neutrophil activation patterns in acute coronary syndrome with intact fibrous cap - results from the OPTICO-ACS study

Background

In up to one third of all cases, acute coronary syndrome occurs without signs of plaque rupture. Instead endothelial cell erosion is considered to be the hallmark of acute coronary syndrome with intact fibrous cap (IFC-ACS), with matrix metalloproteinase 9 (MMP9) directly linked to this pathology. The main source of MMP9 immediately after ACS are the neutrophil granulocytes. Therefore, their molecular activation patterns and subsequent MMP9 production are the objectives of the ongoing, translational OPTICO-ACS-Study, aiming to compare the mechanisms and prognosis of IFC-ACS and ACS with ruptured fibrous cap (RFC-ACS).

Methods

Local and systemic blood samples were simultaneously obtained from the site of the ACS-causing culprit lesion (LOC) using an aspiration catheter and from the systemic circulation (SYS). Using optical coherence tomography (OCT) the ACS-causing culprit lesion was characterized and two patient groups, patients with ACS caused by intact (IFC-ACS) and by ruptured fibrous cap (RFC-ACS) were compared. Each group consists of twenty patients (n=20) matched by age, gender and diabetes. Neutrophil counts and expression of activation markers were immediately quantified by whole-blood flow cytometry. Release of active MMP9 into the plasma was assessed by fluorescence-based zymography. Activation profiles of freshly isolated neutrophils, including MMP9 activity and effect on endothelial cell death, in response to toll-like receptor 2 (TLR2) stimulation was studied.

Results

Local neutrophils of patients with IFC-ACS show significantly higher expression of TLR2 in comparison to RFC-ACS neutrophils (LOC: 1866±382.1 vs. 1498±426.9; IFC-ACS vs. RFC-ACS, p=0.03). MMP9 activity is significant higher (p=0.01) in plasma obtained from the culprit site of IFC-ACS (74.1 U/ml±4.1) compared to those of RFC-ACS patients (70.0 U/ml±5.1) indicating secretion and activation of the enzyme during IFC-ACS. Importantly, in patients with IFC-ACS, TLR2-stimulation using Pam3CSK4 triggers higher activity rates of MMP9 only in neutrophils isolated directly from the culprit site (LOC), but not systemically (+27%±17.2% IFC-LOC vs. IFC-SYS; p=0.003). This effect was not observed in RFC-derived neutrophils. Inhibiting TLR2 by a monoclonal antibody, strongly reduced secretion of activated MMP9 only in the local neutrophils from IFC-ACS-patients (−54.6%±6.5% in IFC-LOC-anti-TLR2 vs. IFC-LOC-vehicle; p=0.008), but not from systemic IFC-neutrophils, nor from RFC-neutrophils. Furthermore, LOC IFC-ACS neutrophils aggravate endothelial cell death upon TLR2-activation in comparison to LOC RFC-ACS neutrophils (58.4±4.96% vs. 20±1.89%, IFC-ACS vs. RFC-ACS; p=0.0023).

Conclusion

We newly describe differential kinetics of MMP9 release by neutrophils in ACS patients with IFC versus RFC. Our data support a role of a TLR-2 activated and neutrophil-MMP9-mediated mechanism leading to endothelial cell erosion in patients with IFC-ACS.

Acknowledgement/Funding

DZHK (German Centre for Cardiovascular Research); BIH (Berlin Institute of Health)

Performance of One- Compared With Two-Catheter Concepts in Transradial Coronary Angiography (from the Randomized Use of Different Diagnostic Catheters-Radial-Trial)

The Use of Different Diagnostic Catheters-Radial-Trial sought to compare the safety and efficacy of one-catheter concepts (OCC) using Tiger II or BLK catheters with two-catheter concepts (TCC) using standard Judkins catheters for transradial coronary angiography. A total of 300 patients planed for coronary angiography were enrolled into this single-center, single-blinded trial. Patients were randomized in a 2:1 ratio to either OCC by Tiger II (n = 100) and BLK (n = 100) or TCC by Judkins (n = 100) catheters. Primary end point was time required to perform a complete coronary angiography. Coronary angiography duration was 603 ± 29 seconds and 552 ± 26 sec in the OCC and the TCC groups (p = 0.052). Fluoroscopy time was longer in the OCC (408 ± 28 sec) as compared with the TCC group (258 ± 28 sec, p = 0.009) and the amount of contrast volume used significantly higher (98 ± 5 ml vs 67 ± 4 ml, p < 0.001). Crossover rates were increased in the OCC as compared with the TCC group (37% vs 4%, p < 0.001). These effects were observed irrespective of OCC catheter type. In conclusion, this study demonstrates that OCC do not reduce angiography time, but are associated with an increased amount of contrast volume and longer fluoroscopy time as compared with TCC.

Medikamentöse Akutbehandlung schizophrener Ersterkrankungen

Atypische Neuroleptika werden heute für die Behandlung von Patienten mit schizophrenen Erkrankungen als Therapie der ersten Wahl empfohlen, da sie gegenüber den typischen Neuroleptika deutliche Vorteile hinsichtlich des Wirkungsspektrums und des Nebenwirkungsprofils aufweisen. Dies trifft insbesondere für ersterkrankte Patienten zu, da für diese Patientengruppe im Vergleich zu Mehrfacherkrankten ein höheres Risiko für extrapyramidal-motorische Nebenwirkungen beschrieben wurde. Ob die Vorteile der atypischen Neuroleptika aber auch nachweisbar sind, wenn typische Neuroleptika in niedrigen Dosierungen eingesetzt werden, ist bisher empirisch unzureichend geprüft. Vor diesem Hintergrund wurden im Rahmen einer multizentrischen, doppelblinden, randomisierten klinischen Studie des Kompetenznetz Schizophrenie die Effekte von Risperidon und Haloperidol im Niedrigdosisbereich (Tagesdosen von 2 mg bis maximal 8 mg für beide Medikamente) in der Akutbehandlung ersterkrankter Patienten verglichen.

Gas hydrate dissociation off Svalbard induced by isostatic rebound rather than global warming

Methane seepage from the upper continental slopes of Western Svalbard has previously been attributed to gas hydrate dissociation induced by anthropogenic warming of ambient bottom waters. Here we show that sediment cores drilled off Prins Karls Foreland contain freshwater from dissociating hydrates. However, our modeling indicates that the observed pore water freshening began around 8 ka BP when the rate of isostatic uplift outpaced eustatic sea-level rise. The resultant local shallowing and lowering of hydrostatic pressure forced gas hydrate dissociation and dissolved chloride depletions consistent with our geochemical analysis. Hence, we propose that hydrate dissociation was triggered by postglacial isostatic rebound rather than anthropogenic warming. Furthermore, we show that methane fluxes from dissociating hydrates were considerably smaller than present methane seepage rates implying that gas hydrates were not a major source of methane to the oceans, but rather acted as a dynamic seal, regulating methane release from deep geological reservoirs.

Methane seepage from continental slopes has been attributed to gas hydrate dissociation induced by anthropogenic bottom water warming. Here, the authors show that hydrates dissociated before the Anthropocene when the isostatic rebound induced by deglaciation of the Arctic ice sheet outpaced eustatic sea-level rise.

InGaN/GaN nanowires as a new platform for photoelectrochemical sensors - detection of NADH

InGaN/GaN nanowire heterostructures are presented as nanophotonic probes for the light-triggered photoelectrochemical detection of NADH. We demonstrate that photogenerated electron-hole pairs give rise to a stable anodic photocurrent whose potential- and pH-dependences exhibit broad applicability. In addition, the simultaneous measurement of the photoluminescence provides an additional tool for the analysis and evaluation of light-triggered reaction processes at the nanostructured interface. InGaN/GaN nanowire ensembles can be excited over a wide wavelength range, which avoids interferences of the photoelectrochemical response by absorption properties of the compounds to be analyzed by adjusting the excitation wavelength. The photocurrent of the nanostructures shows an NADH-dependent magnitude. The anodic current increases with rising analyte concentration in a range from 5µM to 10mM, at a comparatively low potential of 0mV vs. Ag/AgCl. Here, the InGaN/GaN nanowires reach high sensitivities of up to 91µAmM^-1cm^-2 (in the linear range) and provide a good reusability for repetitive NADH detection. These results demonstrate the potential of InGaN/GaN nanowire heterostructures for the defined conversion of this analyte paving the way for the realization of light-switchable sensors for the analyte or biosensors by combination with NADH producing enzymes.

Connecting quantum dots with enzymes: mediator-based approaches for the light-directed read-out of glucose and fructose oxidation

The combination of the biocatalytic features of enzymes with the unique physical properties of nanoparticles in a biohybrid system provides a promising approach for the development of advanced bioelectrocatalytic devices. This study describes the construction of photoelectrochemical signal chains based on CdSe/ZnS quantum dot (QD) modified gold electrodes as light switchable elements, and low molecular weight redox molecules for the combination with different biocatalysts. Photoelectrochemical and photoluminescence experiments verify that electron transfer can be achieved between the redox molecules hexacyanoferrate and ferrocene, and the QDs under illumination. Since for both redox mediators a concentration dependent photocurrent change has been found, light switchable enzymatic signal chains are built up with fructose dehydrogenase (FDH) and pyrroloquinoline quinone-dependent glucose dehydrogenase ((PQQ)GDH) for the detection of sugars. After immobilization of the enzymes at the QD electrode the biocatalytic oxidation of the substrates can be followed by conversion of the redox mediator in solution and subsequent detection at the QD electrode. Furthermore, (PQQ)GDH has been assembled together with ferrocenecarboxylic acid on top of the QD electrode for the construction of a funtional biohybrid architecture, showing that electron transfer can be realized from the enzyme over the redox mediator to the QDs and subsequently to the electrode in a completely immobilized fashion. The results obtained here do not only provide the basis for light-switchable biosensing and bioelectrocatalytic applications, but may also open the way for self-driven point-of-care systems by combination with solar cell approaches (power generation at the QD electrode by enzymatic substrate consumption).

EGFRvIII does not affect radiosensitivity with or without gefitinib treatment in glioblastoma cells

BACKGROUND

Glioblastomas (GBM) are often characterized by an elevated expression of the epidermal growth factor receptor variant III (EGFRvIII). We used GBM cell lines with native EGFRvIII expression to determine whether this EGFR variant affects radiosensitivity with or without EGFR targeting.

METHODS

Experiments were performed with GBM cell lines lacking (LN229, U87MG, U251, CAS-1) or endogenously expressing EGFRvIII (BS153, DKMG). The two latter cell lines were also used to establish sublines with a low (-) or a high proportion (+) of cells expressing EGFRvIII. EGFR signaling and the cell cycle were analyzed using Western blot and flow cytometry; cell survival was assessed by colony forming assay and double-strand break repair capacity by immunofluorescence.

RESULTS

DKMG and BS153 parental cells with heterogeneous EGFRvIII expression were clearly more radiosensitive compared to other GBM cell lines without EGFRvIII expression. However, no significant difference was observed in cell proliferation, clonogenicity or radiosensitivity between the EGFRvIII- and + sublines derived from DKMG and BS153 parental cells. Expression of EGFRvIII was associated with decreased DSB repair capacity for BS153 but not for DKMG cells. The effects of EGFR targeting by gefitinib alone or in combination with irradiation were also found not to depend on EGFRvIII expression. Gefitinib was only observed to influence the proliferation of EGFRvIII- BS153 cells.

CONCLUSION

The data indicate that EGFRvIII does not alter radiosensitivity with or without anti-EGFR treatment.

Representation of the characteristic function of a stochastic integral

Let X(t) be a continuous, homogeneous stochastic process with independent increments characterized by a, σ, M, N in the Lévy representation formula. In this note we obtain the Lévy canonical representation of the characteristic function of a stochastic integral (in the sense of convergence in probability) of the form (where υ(t) is a non-decreasing, non-negative and left-continuous function) in terms of υ(t), a, σ, M, N.

Characterization of stable processes by identically distributed stochastic integrals

Let X(t) be a homogeneous and continuous stochastic process with independent increments. The subject of this paper is to characterize the stable process by two identically distributed stochastic integrals formed by means of X(t) (in the sense of convergence in probability). The proof of the main results is based on a modern extension of the Phragmén-Lindelöf theory.

Evaluation of the 'Jumping to conclusions' bias in different subgroups of the at-risk mental state: from cognitive basic symptoms to UHR criteria

BACKGROUND

Patients with psychosis display the so-called 'Jumping to Conclusions' bias (JTC) - a tendency for hasty decision-making in probabilistic reasoning tasks. So far, only a few studies have evaluated the JTC bias in 'at-risk mental state' (ARMS) patients, specifically in ARMS samples fulfilling 'ultra-high risk' (UHR) criteria, thus not allowing for comparisons between different ARMS subgroups.

METHOD

In the framework of the PREVENT (secondary prevention of schizophrenia) study, a JTC task was applied to 188 patients either fulfilling UHR criteria or presenting with cognitive basic symptoms (BS). Similar data were available for 30 healthy control participants matched for age, gender, education and premorbid verbal intelligence. ARMS patients were identified by the Structured Interview for Prodromal Symptoms (SIPS) and the Schizophrenia Proneness Instrument - Adult Version (SPI-A).

RESULTS

The mean number of draws to decision (DTD) significantly differed between ARM -subgroups: UHR patients made significantly less draws to make a decision than ARMS patients with only cognitive BS. Furthermore, UHR patients tended to fulfil behavioural criteria for JTC more often than BS patients. In a secondary analysis, ARMS patients were much hastier in their decision-making than controls. In patients, DTD was moderately associated with positive and negative symptoms as well as disorganization and excitement.

CONCLUSIONS

Our data indicate an enhanced JTC bias in the UHR group compared to ARMS patients with only cognitive BS. This underscores the importance of reasoning deficits within cognitive theories of the developing psychosis. Interactions with the liability to psychotic transitions and therapeutic interventions should be unravelled in longitudinal studies.

[Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)]

The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.

New records of Ichneumonidae (Hymenoptera) for the Italian fauna

New distributional records on 55 ichneumonids (Hymenoptera, Ichneumonidae) from Italy are provided. Of these, 47 species are new for Italy, including representatives of the subfamily Diacritinae and of the tribes Zimmeriini (Ichneumoninae) and Pseudorhyssini (Poemeniinae); six species are new for Sardinia, one for Sicily and one for the Italian mainland. The hitherto unknown female of Baranisobashibericus Heinrich, 1972 (Ichneumoninae) is described.

Obsessive-compulsive symptoms in at-risk mental states for psychosis: associations with clinical impairment and cognitive function

OBJECTIVE

Obsessive-compulsive symptoms (OCS) constitute a major comorbidity in schizophrenia. Prevalence estimations of OCS for patients with at-risk mental states (ARMS) for psychosis vary largely. It is unclear how ARMS patients with or without comorbid OCS differ regarding general psychosocial functioning, psychotic and affective symptoms and neurocognitive abilities.

METHOD

At-risk mental states patients (n = 233) from the interventional trial PREVENT (Secondary Prevention of Schizophrenia) were stratified according to the presence or absence of comorbid OCS and compared on several clinical variables.

RESULTS

Patients, who fulfilled the criteria for obsessive-compulsive disorder (OCD) or presented with subclinical OCS (ARMSposOCS sample), did not significantly differ from patients without OCS (ARMSnegOCS) with regard to gender, age, premorbid verbal intelligence and levels of education. Furthermore, similar severity of depressive syndromes, basic cognitive, attenuated psychotic and brief limited intermittent psychotic symptoms were found. However, ARMSposOCS patients showed more impairment of psychosocial functioning and higher general psychopathology. In contrast, they scored higher in cognitive tasks measuring working memory and immediate verbal memory.

CONCLUSION

Findings extend upon previous results due to the multidimensional assessment. Subsequent longitudinal studies might elucidate how comorbid OCS influence differential treatment response, especially to cognitive behavioural interventions and the transition rates to psychosis.