The State of Percutaneous Intervention in Stable Coronary Artery Disease.

PURPOSE OF REVIEW: This review examines trials of percutaneous coronary intervention (PCI) compared with optimal medical therapy (OMT) in order to inform clinical decision-making regarding the role of PCI in stable ischemic heart disease (SIHD). RECENT FINDINGS: Several large, randomized, controlled trials published in recent years suggest that OMT should be the initial treatment strategy for symptomatic SIHD, but there is a role for PCI in patients who continue to be symptomatic despite OMT. Additionally, using fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) techniques may help to identify physiologically significant lesions and may be useful in maximizing the benefit from PCI in SIHD. Recent trials demonstrate PCI for the treatment of symptomatic SIHD does not reduce mortality compared with OMT but effectively relieves anginal symptoms. However, OMT continues to be the first-line therapy for SIHD but is significantly underutilized.

Imaging Considerations and Clinical Implications of Mitral Annular Disjunction.

Mitral annular disjunction is increasingly recognized as an important anatomic feature of mitral valve disease. The presence of mitral annular disjunction, defined as separation between the left atrial wall at the point of mitral valve insertion and the left ventricular free wall, has been associated with increased degeneration of the mitral valve and increased incidence of sudden cardiac death. The clinical importance of this entity necessitates standard reporting on cardiovascular imaging reports if patients are to receive adequate risk stratification and management. We provide a narrative review of the literature pertaining to mitral annular disjunction, its clinical implications, and areas needing further research.

Individual differences in cocaine conditioned taste aversion are developmentally stable and independent of locomotor effects of cocaine.

Drugs of abuse induce complex motivational states in their users which have been shown to vary developmentally. In addition to developmental variation, interindividual variation in the rewarding and aversive effects of drugs of abuse is an important consideration. A rat model was used to assess whether the conditioned rewarding/aversive effects of cocaine were maintained as individuals matured from adolescence into adulthood. We tested rats in the cocaine conditioned taste aversion task as adolescents and again in adulthood. We observed a wide range of approach/avoidance behaviors in this task, and also observed that the relative interindividual differences in approach/avoidance are remarkably stable across the two developmental stages. Furthermore, we observed that these interindividual differences are not attributable to individual differences in cocaine-induced locomotor effects or individual differences in blood or brain cocaine levels. Taken together, these findings indicate that sensitivity to cocaine's motivational effects is stable across development and part of a unique neurological process.

CXCR2-positive neutrophils are essential for cuprizone-induced demyelination: relevance to multiple sclerosis.

Multiple sclerosis is an inflammatory demyelinating disorder of the CNS. Recent studies have suggested diverse mechanisms as underlying demyelination, including a subset of lesions induced by an interaction between metabolic insult to oligodendrocytes and inflammatory mediators. For mice of susceptible strains, cuprizone feeding results in oligodendrocyte cell loss and demyelination of the corpus callosum. Remyelination ensues and has been extensively studied. Cuprizone-induced demyelination remains incompletely characterized. We found that mice lacking the type 2 CXC chemokine receptor (CXCR2) were relatively resistant to cuprizone-induced demyelination and that circulating CXCR2-positive neutrophils were important for cuprizone-induced demyelination. Our findings support a two-hit process of cuprizone-induced demyelination, supporting the idea that multiple sclerosis pathogenesis features extensive oligodendrocyte cell loss. These data suggest that cuprizone-induced demyelination is useful for modeling certain aspects of multiple sclerosis pathogenesis.