Wie entsteht Bedeutung in der präverbalen Entwicklungsphase des Kleinkindes? Analyse kognitions- und neurowissenschaftlicher Erkenntnisse zur Bildung einer Theorie der Bedeutungsentwicklung

Die Arbeit stellt heraus, dass Bedeutung der „biologische“ Wert (Damasio 2011) allen Lebens ist. Ohne Interpretation der umgebenden Umwelt ist kein Lebewesen lebensfähig. In der präverbalen Entwicklung des Kindes schlägt das „emotionale Signalisieren“ (Greenspan/Shanker 2007) die Brücke zum „kulturellen Wert“, ohne den keine Entwicklung stattfinden würde. Bedeutung entsteht demnach nur in der sozialen Bezogenheit, in der dem Kind die emotionale Kontextgebundenheit Handlungsbedeutungen eröffnet und differenziert. Bedeutungen verändern sich im Handeln zu immer differenzierteren Strukturen, anhand derer sich der Entwicklungsprozess als ein Evolutionsprozess soziokultureller Menschwerdung von einfachen zu komplexeren Formen entfaltet. Aus diesem Grund ist es wichtig, gerade in der frühen Kindheit die Entstehung von Bedeutung nicht von der sprachlichen Entwicklung abzuleiten, sondern die kontextbezogenen Handlungsprozesse von Beginn an zu untersuchen. Die Bearbeitung der Fragestellung trägt dazu bei, kindliche Selbstbildung, besonders in den ersten Jahren, differenzierter zu beschreiben, um zu verstehen, warum Kinder das eine oder andere tun, für jenes Begeisterung zeigen und anderes dafür lassen. Die Arbeit eröffnet einen Blick für eine Handlungslogik bei Kindern, anhand derer die Ausrichtung der pädagogischen Arbeit reflektiert und fundiert werden kann

Final results of the randomised evaluation of short-term dual antiplatelet therapy in patients with acute coronary syndrome treated with a new-generation stent (REDUCE trial)

Aims: The optimal duration of DAPT in ACS patients treated with DES is still unclear. Therefore, the aim of the current study was to investigate a short versus a standard 12-month DAPT regimen in ACS patients undergoing new-generation DES implantation.Methods and results: REDUCE was a prospective, open-label, multicentre, investigator-initiated study that randomised 1,496 ACS patients after treatment with the COMBO stent to either three (n=751) or 12 months (n=745) of DAPT. The primary study endpoint was a composite of all-cause mortality, myocardial infarction, stent thrombosis, stroke, target vessel revascularisation and bleeding at 12 months. No difference was observed in the demographic and clinical characteristics between the two groups, except for gender (p=0.01). At one-year follow-up, non-inferiority of three-versus 12-month DAPT in the primary endpoint was met (8.2% vs 8.4%, p(non-inferiority)<0.001). The similar outcome between the two groups was confirmed at two-year follow-up (11.6% vs 12.1%, p=0.76), with no significant difference in overall mortality (3.1% vs 2.2%, p=0.27), cardiac mortality (1.8% vs 1.1%, p=0.28), stent thrombosis (1.6% vs 0.8%, p=0.16) and major bleeding (3.3% vs 4.0%, p=0.46).Conclusions: The results show that, among ACS patients treated with the COMBO stent, three months is non-inferior to 12 months of DAPT. However, given the numerically higher rates of mortality and ST in the three-month DAPT group, one-year DAPT should still be recommended in ACS until more information becomes available. A three-month DAPT strategy should be considered only if clinically mandated

Impact of age on the comparison between short-term vs 12-month dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent : 2-Year follow-up results of the REDUCE trial

Background and aims: The impact of advanced age on the optimal duration of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary revascularization (PCI) is still greatly debated. Therefore, the aim of the present sub-analysis of the REDUCE trial was to assess the impact of age on the comparison between a short 3 months vs standard 12 months DAPT in ACS patients treated with the COMBO Dual Stent Therapy. Methods: The REDUCE trial is a prospective, multicenter, investigator-initiated study that randomized ACS patients undergoing PCI with the COMBO drug eluting stent to either 3 or 12 months of DAPT. The study population was divided according to age

Haploinsufficiency of MeCP2-interacting transcriptional co-repressor SIN3A causes mild intellectual disability by affecting the development of cortical integrity

Numerous genes are associated with neurodevelopmental disorders such as intellectual disability and autism spectrum disorder (ASD), but their dysfunction is often poorly characterized. Here we identified dominant mutations in the gene encoding the transcriptional repressor and MeCP2 interactor switch-insensitive 3 family member A (SIN3A; chromosome 15q24.2) in individuals who, in addition to mild intellectual disability and ASD, share striking features, including facial dysmorphisms, microcephaly and short stature. This phenotype is highly related to that of individuals with atypical 15q24 microdeletions, linking SIN3A to this microdeletion syndrome. Brain magnetic resonance imaging showed subtle abnormalities, including corpus callosum hypoplasia and ventriculomegaly. Intriguingly, in vivo functional knockdown of Sin3a led to reduced cortical neurogenesis, altered neuronal identity and aberrant corticocortical projections in the developing mouse brain. Together, our data establish that haploinsufficiency of SIN3A is associated with mild syndromic intellectual disability and that SIN3A can be considered to be a key transcriptional regulator of cortical brain development