Complex high-risk indicated percutaneous coronary interventions (CHIP-PCI) in elderly patients

Introduction

Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is a poorly defined concept. A recent large-scale study identified various patient- and procedure-related factors that were associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE), which were used to construct a CHIP-score [1].

Purpose

To investigate the predictive value of patient- and procedure related risk factors, based on the CHIP-score, in a large cohort of elderly patients.

Methods

This is a retrospective multicenter study of 20 centers, including patients of ≥75 years of age, that underwent PCI in the period of 2012–2019. The primary endpoint of MACCE was defined as cardiovascular death, myocardial infarction, revascularization or stroke. The follow-up time was 1 year. We created univariate and multivariate Cox regression models in order to investigate the predictive value of the CHIP-score variables (other than age, Table 2).

Results

A total of 2724 patients with a mean age of 81 (± 4.3) years were included in the study. Baseline characteristics are depicted in Table 1. The mean CHIP score was 1.74 (± 1.2) and 2262 (83%) had at least one CHIP criteria. At 1-year follow-up, 267 (9.8%) met the primary endpoint. Out of 11 investigated CHIP-score variables, only 5 were independent predictors of 1-year MACCE in adjusted regression models: Prior myocardial infarction (HR 1.56 (95% CI: 1.10–1.90), p=0.009), left ventricular ejection fraction <30% (HR: 2.02 (95% CI: 1.34–3.0, p<0.001), chronic kidney disease (HR 1.55 (95% CI: 1.21–2.02, p<0.001), left main coronary PCI (HR: 2.35 (95% CI: 1.29–4.89, p<0.001) and non-radial access (HR: 1.57 (95% CI: 1.19–1.85, p=0.002). See Table 2 for details. Overall MACCE was 4.5% when CHIP was 0, as compared to 10.7% with any CHIP factor present (p<0.001) (Figure 1). A CHIP of 4+ or higher was present in 246 (9%) patients and was associated with a three-fold increase in 1-year MACCE (HR: 2.9 (95% CI: 2.1–3.9), p<0.001).

Conclusions

The CHIP-score retains significant prognostic value in the elderly population. The implication of a CHIP-score might be a future tool for risk stratification in clinical practice, not only for in-hospital MACCE but also on long-term follow-up. In the special population of elderly patients, 3 patient related and 2 procedure related factors showed to be especially helpful for risk assessment.

Funding Acknowledgement

Type of funding sources: None.

Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry

Background

The strategy of antithrombotic therapy in patients with atrial fibrillation (AF) after revascularization with drug-eluting stents continues to be debated. The evidence in elderly population in this scenario is particularly scarce.

Purpose

We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with AF after revascularization with drug-eluting stents.

Methods

Retrospective registry in 20 centers including consecutive patients over 75 years with AF treated with drug-eluting stents. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.

Results

Out of 41,000 patients undergoing PCI 1,249 patients (81.1±4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p=0.04) but less MACCE (8.7% vs. 13.6%, p=0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p=0.03) and similar MACCE (9.8% vs. 9.4%, p=0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.

Conclusions

Despite advanced age TAT prevails, but prolonged durations or use of VKA are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bristol-Myers-Squibb/Pfizer

Optical coherence tomography, intravascular ultrasound or angiography guidance for distal left main coronary stenting. The ROCK cohort II study

OBJECTIVES

to test the safety and efficacy of intravascular imaging and specifically optical coherence tomography (OCT) as a diagnostic tool for left main angioplasty and analyze the mid-term outcome accordingly.

BACKGROUND

Clinical data and international guidelines recommend the use of intravascular imaging ultrasound (IVUS) to guide left main (LM) angioplasty. Despite early experience using OCT in this setting is encouraging, the evidence supporting its use is still limited.

METHODS

ROCK II is a multicenter, investigator-driven, retrospective European study to compare the performance of IVUS and OCT versus angiography in patients undergoing distal-LM stenting. The primary study endpoint was target-lesion failure (TLF) including cardiac death, target-vessel myocardial infarction and target-lesion revascularization. We designed this study hypothesizing the superiority of intravascular imaging over angiographic guidance alone, and the non-inferiority of OCT versus IVUS.

RESULTS

A total of 730 patients, 377 with intravascular-imaging guidance (162 OCT, 215 IVUS) and 353 with angiographic guidance, were analyzed. The one-year rate of TLF was 21.2% with angiography and 12.7% with intravascular-imaging (p = 0.039), with no difference between OCT and IVUS (p = 0.26). Intravascular-imaging was predictor of freedom from TLF (HR 0.46; 95% CI 0.23-0.93: p = 0.03). Propensity-score matching identified three groups of 100 patients each with no significant differences in baseline characteristics. The one-year rate of TLF was 16% in the angiographic, 7% in the OCT and 6% in the IVUS group, respectively (p = 0.03 for IVUS or OCT vs. angiography). No between-group significant differences in the rate of individual components of TLF were found.

CONCLUSIONS

Intravascular imaging was superior to angiography for distal LM stenting, with no difference between OCT and IVUS.

Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry

BACKGROUND

We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with atrial fibrillation (AF) after revascularization with drug-eluting stents (DES).

METHODS

Retrospective registry in 20 centers including patients over 75 years with AF treated with DES. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.

RESULTS

A total of 1249 patients (81.1 ± 4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p = 0.04) but less MACCE (8.7% vs. 13.6%, p = 0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p = 0.03) and similar MACCE (9.8% vs. 9.4%, p = 0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.

CONCLUSIONS

Despite advanced age TAT prevails, but duration over 1 month or the use of other agent than Apixaban are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

The Pt-Cr everolimus-eluting stent with bioabsorbable polymer in the treatment of patients with acute coronary syndromes. Results from the SYNERGY ACS registry

OBJECTIVES

We investigated the safety and efficacy of the bioabsorbable polymer-coated, everolimus-eluting coronary stent (SYNERGY) stent in a real-world study population with acute coronary syndromes (ACS).

BACKGROUND

A number of clinical trials support the overall efficacy and safety of the SYNERGY stent. However, a recent trial (TIDES-ACS) in the context of ACS reported worrying figures of infarction and definite/probable stent thrombosis in the SYNERGY control arm.

METHODS

This is a multicenter registry (10 centers) including consecutive patients with ACS (unstable angina, non-ST elevated myocardial infarction, ST elevated myocardial infarction) who underwent percutaneous revascularization with the implantation of SYNERGY stent. The primary endpoint was the composite of cardiac death, myocardial infarction and target lesion revascularization at 12 months.

RESULTS

A total of 1008 patients were included with age 65.4 ± 14.8 years, 23.8% females and a 24.5% diabetics. Regarding presentation, a 15.2% with unstable angina, 43% with non-ST elevated myocardial infarction and 41.8% with ST elevated myocardial infarction. Primary outcome was met in 3% (7% in SYNERGY TIDES-ACS arm, P superiority <0.01 and 6.3% in OPTIMAX TIDES-ACS arm, P superiority <0.01). Cardiac death was 1.3% (1.6%, p = 0.8 and 0.5%, P superiority =0.1 respectively). Myocardial infarction was 1.6% (4.6%, p < 0.01 and 1.8%, P superiority = 0.9 respectively). Target lesion revascularization was 1% (3.4%, p < 0.01 and 5.4%, P superiority <0.01 respectively). Definite or probable thrombosis was 0.9% (2.8%, p ≤ 0.01 and 1.1%, P superiority = 0.8 respectively).

CONCLUSIONS

The results of this registry show a very good safety and efficacy profile at 12 months for the SYNERGY stent in patients with ACS.

SUMMARY

A recent trial (TIDES-ACS) in the context of acute coronary syndromes (ACS) reported worrying figures of infarction and definite/probable stent thrombosis in the SYNERGY stent control arm. We investigated the safety of SYNERGY stent in a real-world study population with ACS applying the same inclusion/exclusion criteria as used in the TIDES-ACS trial. Primary endpoint was the composite of cardiac death, myocardial infarction and TLR at 12 months. A total of 1008 patients have been included. Primary outcome was met in 3% (7% in SYNERGY TIDES-ACS arm, P superiority <0.01 and 6.3% in OPTIMAX TIDES-ACS arm, P superiority <0.01).

Multivessel disease in patients over 75years old with ST elevated myocardial infarction. Current management strategies and related clinical outcomes in the ESTROFA MI+75 nation-wide registry

BACKGROUND

In elderly patients with ST elevated myocardial infarction (STEMI) and multivessel disease (MVD the outcomes related with different revascularization strategies are not well known.

METHODS

Subgroup-analysis of a nation-wide registry of primary angioplasty in the elderly (ESTROFA MI+75) with 3576 patients over 75years old from 31 centers. Patients with MVD were analyzed to describe treatment approaches and 2years outcomes.

RESULTS

Of 1830 (51%) with MVD, 847 (46%) underwent multivessel revascularization either in acute (51%), staged (44%) or both procedures (5%). Patients with previous myocardial infarction and those receiving drug-eluting stents or IIb-IIIa inhibitors were more prone to be revascularized, whereas older patients, females and those with Killip III-IV, renal failure and higher ejection fraction were less likely. Survival free of cardiac death and infarction at 2years was better for those undergoing multivessel PCI (85.8% vs. 80.4%, p<0.0008), regardless of Killip class. Multivessel PCI was protective of cardiac death and infarction (HR 0.60, 95% CI 0.40-0.89; p=0.011). Complete revascularization made no difference in outcomes among those patients undergoing multivessel PCI. The best prognosis corresponded to those undergoing multivessel PCI in staged procedures (p<0.001). A propensity score matching analysis (514 patients in each group) yielded similar results.

CONCLUSIONS

In elderly patients with STEMI and MVD, multivessel PCI was related with better outcomes especially after staged procedures. Among those undergoing multivessel PCI, anatomically defined completeness of revascularization had not prognostic influence.

SUMMARY

We sought to investigate the revascularization strategies applied and their prognostic implications in patients aged over 75years with ST elevated myocardial infarction showing multivessel disease. Of 1830 patients, 847 (46%) underwent multivessel PCI either in acute (51%), staged (44%) or both procedures (5%). Multivessel PCI was independent predictor of cardiac death and infarction with the best prognosis corresponding to those undergoing staged procedures.

Characterization of recent H5 subtype avian influenza viruses from US poultry

In the US, the isolation of H5 subtype avian influenza (AI) viruses has been uncommon in commercial chickens and turkeys, although sporadic isolations have been made from the live bird markets or its supply chain since 1986. In 2002, two different outbreaks of H5 AI occurred in commercial chicken or turkey operations. The first occurred in Texas and was identified as a H5N3 subtype AI virus. The second outbreak was caused by a H5N2 virus isolated from a turkey farm in California. In this study we analyzed recent H5 subtype AI viruses from different avian species and different sources in the US. Most recent H5 subtype isolates shared a high sequence identity and phylogenetically assorted into a separate clade from the Pennsylvania/83 lineage isolates. However, no established lineage was found within this clade and the recent H5 subtype isolates seemed to be the result of separate introductions from the wild bird reservoir. The Texas H5N3 isolate shared the lowest homology with the other recent isolates in the haemagglutinin gene and had a unique haemagglutinin cleavage site sequence of REKR/G (other recent isolates have the typical avirulent motif, RETR/G). Furthermore, this isolate had a 28 amino acid deletion in the stalk region of the neuraminidase protein, a common characteristic of chicken adapted influenza viruses, and may indicate that this virus had actually been circulating in poultry for an extended period of time before it was isolated. In agreement with genetic evidence, the Texas H5N3 isolate replicated better than other H5 isolates in experimentally infected chickens. The outbreak in Texas with a more chicken-adapted H5N3 virus underscores the importance of ongoing surveillance and control efforts regarding the H5 subtype AI virus in the US.

Restricted diet modifies carbohydrate metabolism in immature rats

The aim of the present work was to study the effect of a restricted diet on carbohydrate metabolism in submandibular glands of female prepuber rats and the influence of arachidonic acid derivatives. Rats of 21 days of age were divided into three groups. Group I: normally fed rats. Group II: restricted diet (50% of the normal food intake). Group III: normally restricted diet with re-feeding. The baseline concentration of tissue glycogen was significantly higher in Group II than in I or III and after 60 min of incubation in a glucose free medium all groups showed a glycogen drop. In addition, the glucose metabolism was increased in Group II. Cycloxigenase inhibitors failed to alter (14)CO(2) levels in Groups I and III. In Group II, indomethacin and acetylsalicylic acid inhibited glucose metabolism, which was reverted by PGE(2) addition. The exogenous arachidonic acid metabolism and different eicosanoids showed that restricted diet significantly increased the production of PGE(2) but diminished PGF(2)(alpha) production. Our results suggest that a restricted diet would lead to a new dynamic equilibrium of glucose homeostasis. Prostaglandins E(2) and F(2)(alpha) would participate by adapting the source of energy to tissue demands while maintaining the metabolic features that characterize puberty.

Phylogenetic analyses indicate little variation among reticuloendotheliosis viruses infecting avian species, including the endangered Attwater's prairie chicken

Reticuloendotheliosis virus infection, which typically causes systemic lymphomas and high mortality in the endangered Attwater's prairie chicken, has been described as a major obstacle in repopulation efforts of captive breeding facilities in Texas. Although antigenic relationships among reticuloendotheliosis virus (REV) strains have been previously determined, phylogenetic relationships have not been reported. The pol and env of REV proviral DNA from prairie chickens (PC-R92 and PC-2404), from poxvirus lesions in domestic chickens, the prototype poultry derived REV-A and chick syncytial virus (CSV), and duck derived spleen necrosis virus (SNV) were PCR amplified and sequenced. The 5032bp, that included the pol and most of env genes, of the PC-R92 and REV-A were 98% identical, and nucleotide sequence identities of smaller regions within the pol and env from REV strains examined ranged from 95 to 99% and 93 to 99%, respectively. The putative amino acid sequences were 97-99% identical in the polymerase and 90-98% in the envelope. Phylogenetic analyses of the nucleotide and amino acid sequences indicated the closest relationship among the recent fowl pox-associated chicken isolates, the prairie chicken isolates and the prototype CSV while only the SNV appeared to be distinctly divergent. While the origin of the naturally occurring viruses is not known, the avian poxvirus may be a critical component of transmission of these ubiquitous oncogenic viruses.

H5N2 avian influenza outbreak in Texas in 2004: the first highly pathogenic strain in the United States in 20 years?

In early 2004, an H5N2 avian influenza virus (AIV) that met the molecular criteria for classification as a highly pathogenic AIV was isolated from chickens in the state of Texas in the United States. However, clinical manifestations in the affected flock were consistent with avian influenza caused by a low-pathogenicity AIV and the representative virus (A/chicken/Texas/298313/04 [TX/04]) was not virulent for experimentally inoculated chickens. The hemagglutinin (HA) gene of the TX/04 isolate was similar in sequence to A/chicken/Texas/167280-4/02 (TX/02), a low-pathogenicity AIV isolate recovered from chickens in Texas in 2002. However, the TX/04 isolate had one additional basic amino acid at the HA cleavage site, which could be attributed to a single point mutation. The TX/04 isolate was similar in sequence to TX/02 isolate in several internal genes (NP, M, and NS), but some genes (PA, PB1, and PB2) had sequence of a clearly different origin. The TX/04 isolate also had a stalk deletion in the NA gene, characteristic of a chicken-adapted AIV. By analyzing viruses constructed by in vitro mutagenesis followed by reverse genetics, we found that the pathogenicity of the TX/04 virus could be increased in vitro and in vivo by the insertion of an additional basic amino acid at the HA cleavage site and not by the loss of a glycosylation site near the cleavage site. Our study provides the genetic and biologic characteristics of the TX/04 isolate, which highlight the complexity of the polygenic nature of the virulence of influenza viruses.

Influence of interleukin-1alpha and COX-2 over the metabolism of arachidonic acid and glucose in isolated uterus of restricted diet rats

Isolated uteri from rats fed with a normal diet convert [14C]arachidonate into eicosanoids: PGE(2), PGF(2alpha), TXB(2) and 6-keto-F(1alpha). Restricted diet (50% of the normal diet, during 25 days) diminishes the levels of PGE(2), PGF(2alpha) and TXB(2). The addition of Interleukin-1alpha to the Krebs-Ringer bicarbonate medium increases sharply the production of eicosanoids. Inhibitors of nitric oxide synthase, Nomega-nitro-L-arginine methyl ester or aminoguanidine, do not prevent eicosanoids increase. Conversely, NS-398 (a selective inhibitor of COX-2) blocks the increase of eicosanoids while PGE(2) blocks eicosanoids production mediated by IL-1alpha. Other experiments with uteri of underfed rats confirm that interleukin-1alpha produces an increase in the glucose metabolism. The addition of Nomega-nitro-L-arginine methyl ester, aminoguadinine or NS-398 blocked such stimulation. It is concluded that Interleukin-1alpha produces an increase of glucose metabolism in uteri isolated from underfed rats by two different mechanisms, both involving COX-2: (1) nitric oxide independent and (2) nitric oxide dependent.

Effect of interleukin 1alpha and interleukin 2 over glucose metabolism in isolated uterus of restricted diet rats. Influence of NO and COX-2

A 25-day dietary restriction (50% of the normal diet) produce a fall in the production of 14CO2 from 14C-glucose in rats isolated uteri. The addition of 10 or 20 ngml(-1) interleukin 1alpha (IL-1alpha) or interleukin 2(IL-2) to the Krebs-Ringer bicarbonate solution medium stimulates glucose metabolism in uteri from underfed rats. Such concentrations are not effective in control rats. The addition of Nomega-nitro-L arginine methyl ester--an inhibitor of both the constitutive and inducible forms of nitric oxide synthase (NOS)--and of aminoguadinine--a preferential inhibitor of the inducible form of NOS--block such stimulation. In other experiments, the addition to the medium of arginine-a substrate for the formation of nitric oxide-increases interleukin stimulation of glucose metabolism, which is blocked by NOS inhibitor. At the same time, NS-398--a selective inhibitor of inducible cyclooxygenase (COX)--eliminates the interleukin metabolism stimulation. We conclude that IL-1alpha and IL-2 produce an increase of glucose metabolism in uteri isolated from underfed rats. Nitric oxide produced by the inducible form of NOS mediates the interleukins-induced glucose metabolism stimulation with the participation of inducible COX.

Staphylococcus aureus pneumonia in turkey poults with gross lesions resembling aspergillosis

The present report describes a case of Staphylococcus (Staph.) aureus pneumonia in turkey poults. Initially, 3-day-old poults with a history of increased mortality were submitted for necropsy. The poults had severe bilateral consolidation of the lungs with miliary caseous nodules. The gross lesions in the lungs were highly suggestive of aspergillosis. The next day, postmortem examinations were performed on 60 dead poults at the farm, and all 60 had similar lung lesions. Histopathologic examination of affected lungs revealed severe subacute multifocal bronchopneumonia with intralesional bacteria. Tissue Gram stain of lung sections demonstrated gram-positive bacterial cocci. Gomori methenamine silver stain of the lungs failed to demonstrate fungal agents. The histologic distribution of the lesions suggested an aerogenous route of infection. Staphylococcus aureus was isolated in pure culture from affected lungs. Hatchery contamination was suspected because of the severity and early onset of the lesions. Bacterial monitoring at the hatchery demonstrated marked Staph. aureus contamination in two setters, a hatcher's air duct, and the poult room. Improved hatchery cleaning and disinfection prevented a reoccurrence of the problem.

Opioid effects on glucose and eicosanoid metabolism in isolated uterus of ovariectomized and non-ovariectomized restricted diet rats

The effect of a 25-day restricted diet (50% of the normal food intake) on uterine glucose metabolism of ovariectomized (25 days) and non-ovariectomized rats, was studied. Underfeeding reduces (14)CO(2) production from U(14)C-glucose in intact animal. However, in spayed rats, results are the opposite. In intact rats receiving a low food intake, the effect of the addition to the KRB medium of various agonist opioids, was studied. Dinorphin A did not bring about any change. On the other hand, beta endorphin increased glucose metabolism. Also, the addition of Dago and Dadle increased (14)CO(2) production, while their corresponding specific blockers, beta-FNA and Naltrindole, reversed it. Ovariectomized rats subjected to food restriction are not affected by opioid agonists. In vitro morphine, like endogenous opioids, increased (14)CO(2) in intact restricted diet rats. Arachidonic acid metabolism in these rats show that underfeeding brings about a decrease in PGF(2 alpha) and PGE(2), but the addition of morphine does not alter this situation, for which eicosanoids metabolites are not related to the effect of morphine. The morphine effect was not altered by naloxone. The subcutaneous injection of morphine increased glucose metabolism in intact underfed animals, while naloxone reduced (14)CO(2) in spayed rats subjected to underfeeding. It can be concluded that uteri from ovariectomized rats receiving a restricted diet are influenced by a mechanism of upregulation related to endogenous opioids. These likely originate in other tissues, and so prevent us from seeing the morphine effect.

Influence of insulin on the metabolism of glucose in uteri isolated from ovariectomized and non ovariectomized underfed rats

The effects of insulin on the metabolism of U14C-glucose in uteri isolated from ovariectomized and non-ovariectomized rats receiving a restricted diet (50% of the normal food intake) for 25 days, were studied. As a result of food restriction, the production of 14CO2 diminishes in intact rats, while results are reversed in ovariectomized ones. Various concentrations of insulin were added to the medium, but only 0.50 IU. ml(-1)was effective in increasing glucose metabolism in intact rats receiving a restricted diet; neither underfed castrated animals nor control ones receiving a normal diet, reacted to this concentration. The increase of 14CO2 produced by insulin is not affected by acetyl salicylic acid. Insulin does not alter the effect of underfeeding over arachidonic acid metabolism. On the contrary, the increase in glucose metabolism was blocked by N(G)methyl-L-arginine or by hemoglobin, increased with the addition of L arginine and is not affected by acetyl salicylic acid. Hemoglobin and L-arginine show no effects without insulin. We can conclude that the stimulating effect of insulin on glucose metabolism in uteri isolated from intact rats subjected to dietary restriction, is nitric oxide dependent.

Effects of morphine and naloxone on glucose metabolism in uterine strips from ovariectomized and non-ovariectomized restricted diet rats

The effect of underfeeding over glucose metabolism in uteri isolated from ovariectomized and non-ovariectomized rats subjected to a restricted diet for 25 days (50% of the normal food intake), was studied. Underfeeding decreases (14)CO(2) formation from U(14) C-glucose in intact animal uteri. While in ovariectomized rats (25 days), the effect is the opposite. The addition of morphine 10(-6) M to the medium does not affect rats fed ad libitum. However, (14)CO(2) levels increase significantly in intact animals receiving a restricted diet. In ovariectomized rats morphine does not show any activity, regardless of the type of diet rats were subjected to. None of the rat groups seems to be sensitive to naloxone 10(-6) M. The s.c. injection of morphine (4 mg.kg (-1)) increases glucose metabolism only in intact rats provided with a restricted diet, while naloxone (2.5 mg.kg (-1) ) produces a decrease of ( 14)CO(2) in ovariectomized underfed animals. To conclude, morphine either 'in vivo' or 'in vitro' is active only in uteri from intact rats subjected to underfeeding. Naloxone produces a decrease in (14)CO(2) production, particularly when it is s.c. injected to ovariectomized rats undergoing a dietary restriction. Since the uterus does not react to naloxone, the effect of the opiod blocker may be the result of endogenous opioids originated in other tissues.

Effects of inhibitors of nitric oxide synthase on isolated uteri of fasting rats

The effects of inhibitors of nitric oxide synthase on the glucose metabolism of uteri isolated from 4-day underfed rats were studied. In control rats receiving normal feeding, the addition of indomethacin (5 x 10(-6) M); acetyl salicylic acid (10(-4) M); 400 microM of N(G)methyl-L-arginine, (L-NMMA) or 400 microM of sodium nitroprusside (SNP), does not modify the production of 14CO2 from U14C-glucose. On the contrary, in fasted rat uteri, indomethacin increases glucose oxidation significantly, while acetyl salicylic acid does not alter it. Also, the addition of L-NMMA has no effect. In another group of experiments, in the preparations containing indomethacin of uteri isolated from underfed rats, the addition of L-NMMA significantly changes the effect of indomethacin. Another inhibitor of nitric oxide synthase, N(omega)nitro-L-arginine methyl ester (L-NAME), or hemoglobin (2 microg ml(-1)) a nitric oxide scavenger have the same effects while N(omega)nitro arginine-D-methyl ester (D-NAME) does not. However (SNP), a nitric oxide donor, does not alter the production of 14CO2 in uteri isolated from fasted rats. These results show that in underfed rats, indomethacin increases glucose oxidation independently from its inhibiting effect on cyclooxygenase. Specific inhibitors of nitric oxide synthase can reverse this effect.

Effects of 17 beta estradiol on the metabolism of labelled arachidonic acid in uteri isolated from intact and ovariectomized rats. Influence of a restricted diet

The effects of restricted diet (50% of the normal intake during 25 days) on the metabolism of 14U arachidonic acid, were explored in uterine horn strips isolated from intact and ovariectomized rats, treated by 17 beta-estradiol or controls. The metabolism of arachidonic acid into different eicosanoids, PGE2, PGF2alpha, 6-keto PGF1alpha and TXB2, showed that the restricted diet diminished PGE2 and PGF2alpha, in intact rats, significantly. In contrast, this kind of feeding did not produce any change in castrated rats. Tissue preparations from previously estrogenized intact and castrated normal-fed rats showed that the production of different metabolites decreased. A similar result was obtained in intact rats subjected to a restricted diet. Nevertheless, in castrated underfed rats, estrogens did not produce any effect on the various eicosanoids analysed. These results showed that in isolated uteri, the effects of 17 beta-estradiol, on metabolite production from labelled arachidonic acid, are different from controls in ovariectomized diet-restricted rats.

Effect of fasting on the contractile activity and metabolism of labelled glucose and arachidonic acid in uteri isolated from intact and ovariectomized rat

The effects of fasting for 4 days on the isometric developed tension (IDT) and on the metabolism of labelled glucose and arachidonic acid in uteri from intact and spayed (25 days) rats, were explored. Starvation produces a fall in the contractile activity of intact rats, while in ovariectomized ones, no differences can be seen with respect to their controls. Fasting produces a fall in the glucose metabolism of both intact and ovariectomized rats, being more noticeable in the former group. Indomethacin (5 x 10(-6) M) increases the metabolism of labelled glucose in all experimental groups, significantly. The metabolism of exogenous arachidonic acid into different eicosanoids, PGE2, PGF2 alpha, 6-keto-F1 alpha and TXB2, shows that total food deprivation diminishes significantly the production of PGE2 in intact rats. In contrast, in ovariectomized starved rats, PGE2 increases markedly. The rest of the metabolites studied are not influenced by fasting. These results show that the effects of fasting on the contractile activity and on the release of some metabolites from arachidonic acid by the uteri isolated from intact rats are not seen in ovariectomized animals.

Influence of underfeeding on the spontaneous contraction and on metabolism of labelled arachidonic acid in uteri isolated from intact and ovariectomized rats

The effects of restricted diet (50% of the normal intake during 25 days) on the isometric developed tension (IDT), and on the metabolism of labelled arachidonic acid in uteri from intact and spayed (25 days) rats, were studied. Underfeeding produced a fall in the contractile activity of intact rats, while in ovariectomized rats contractile activity increased. Indomethacin reduced uterine contractile activity in all the cases under study. The metabolism of arachidonic acid into different eicosanoids, PGE2, PGF2 alpha, 6-keto-F1 alpha, and TXB2, showed that the restricted diet diminished PGE2 and PGF2 alpha levels in intact rats significantly. The reduction in uterine contractile activity and reduced levels of the arachidonic acid metabolites, PGE2 and PGF2 alpha, were not seen in ovariectomized animals.

Effects of ovarian steroids on glucose metabolism in uterus horns isolated from underfed rats. Influence of castration

The effect of a restricted diet (50% of the normal intake) during 25 days, on the glucose metabolism was explored in uterus horn strips isolated from intact and ovariectomized rats. In intact underfed rats, the formation of 14CO2 from U14C-glucose was significantly lower than in their controls. In castrated rats, the formation of 14CO2 increased after underfeeding. The return to ad libitum feeding increased glucose metabolism in both groups. Total food deprivation for 4 days diminished 14CO2 formation both in non-ovariectomized rats and in ovariectomized ones as measured at the end of this fasting period. This diminution was greater in intact rats. The increase of glucose metabolism provoked by the administration of s.c. estradiol, progesterone or their combination was more important in underfed intact animals. In intact rats, blood levels of endogenous estradiol and progesterone decreased as a result of underfeeding. In spayed ones, their low concentration increased in relation to their controls.

Ascaridia dissimilis larval migration associated with enteritis and low market weights in meat turkeys

A meat turkey ranch had a history of producing flocks with low market weights. Live bird samples and environmental samples from the ranch were collected over a period of eight months and analyzed at the California Veterinary Diagnostic Laboratory System-Turlock Branch. The disease condition consistently present was enteritis associated with Ascaridia dissimilis infection in birds from growout houses. After aggressive control measures for A. dissimilis were implemented, subsequent flocks reached expected market weights.

Different effect of a restricted diet on isolated uteri of ovariectomized and non-ovariectomized rats. Influence of indomethacin and prostaglandins

The effect of restricted diet (50% of the normal intake during 25 days) on the metabolism of labelled glucose, in uteri isolated from ovariectomized (25 days) and non-ovariectomized rats, was explored. In intact rats subjected to dietary restriction, the formation of 14CO2 from U 14C-glucose is significantly lower than in controls. Indomethacin increases glucose metabolism, being even higher in underfed rats' uteri. This effect is not altered by the addition of prostaglandins E1, E2 or F2 alpha to the medium. In castrated rats, the formation of 14CO2 increases due to underfeeding and this result is not altered by indomethacin. Glycogen and triglyceride values in the isolated uterus were measured immediately after killing (O time) and after 60 min of incubation in a glucose-free KRB medium. The post-incubation levels of glycogen from intact normal fed animals diminished in comparison to initial values, and this result was not altered by the addition of indomethacin. In rats subjected to dietary restriction, glycogen did not decline further after incubation, and the addition of indomethacin led to a significant fall. In spayed rats, glycogen diminished after 60 min both in normal fed rats and in underfed ones, and they were not affected by the indomethacin. In intact underfed rats, uterine triglycerides fall after 60 min. Indomethacin changes this situation, which is again evoked by the addition of PGF2 alpha. In ovariectomized rats, uterine triglycerides are neither altered by a restricted diet nor affected by indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of a restricted diet on in vitro spontaneous activity and glucose metabolism in isolated rat uterus. Influence of castration

The effects of a restricted-diet (50% of the normal intake during 25 d) on the isometric developed tension (IDT), the metabolism of labelled glucose, and the levels of glycogen, of uteri isolated from ovariectomized (25 d) and non-ovariectomized rats were explored. The restriction of food intake produced a fall in the contractile activity of normal, non-ovariectomized, rats in permanent diestrous compared to normally fed rats in diestrous. On the contrary, in castrated rats, the IDT of isolated uterus from underfed rats, was significantly higher than its normal-fed controls. In normal rats the formation of 14CO2 from U 14C-glucose was significantly lower in uterine preparations from restricted-diet animals than the control one. On the other hand, in castrated rats, the formation of 14CO2 increased as a result of underfeeding. The post-incubation levels of glycogen in uteri from normal-fed animals diminished significantly in comparison to 0 time values. In uteri from rats subjected to a dietary restriction, the initial glycogen values were lower than in normal-fed controls, but they did not decline further after incubation in KRB medium. On the contrary, even when the levels of glycogen were significantly lower at 0 time than in diestrous animals, they diminished in ovariectomized rats after incubation, no matter the diet. The above results indicate that the effects of restricted-diet on contractile activity, levels of glycogen and glucose metabolism were not observed in ovariectomized rats. Further researches are needed to clarify that point.

An outbreak of infectious laryngotracheitis in California broilers

Infectious laryngotracheitis (ILT) was diagnosed as the cause of an outbreak of respiratory disease in broiler chickens in California. The classical form of ILT is characterized by dyspnea, gasping, coughing, and expectoration of bloody exudate. Most of the broilers submitted to the diagnostic laboratory showed a non-classical presentation of ILT, in which mucoid tracheitis and conjunctivitis were the most consistent lesions. Historically, most of the ILT cases diagnosed in our laboratory have consisted of layers with classical signs and lesions. It is not known whether this non classical presentation of ILT in broilers is due to differences in the way broilers respond to ILT infection or to the nature of the ILT virus isolate.

Spontaneous activity in vitro of the uterine horns of unilaterally pregnant rats. Relations with glycogen and triglycerides levels

Effects of the placental implantation on the in vitro spontaneous contractile activity of uterine strips incubated in a glucose-free KRB medium, and its relationship with the glycogen and triglycerides tissue levels, have been analysed using unilaterally pregnant rats. The spontaneous activity increased with pregnancy duration, both in the implantation zone (Impl) and the interembryonic segment (Inter) of the pregnant horn. It increased in the contralateral sterile horn (SH) also. Activity was significantly greater in SH and Inter than in Impl, at the same stage of pregnancy. Uterine glycogen, but not triglycerides, appeared to be the substrate used to sustain contractile activity, as its concentration was greater in Impl, the relatively quiescent zone.

Effect of partial starvation on in vitro spontaneous activity and glycogen levels of uterine smooth muscle from pregnant and non pregnant rats

Effects of a restricted-diet (50% of the normal feeding) given during 14 days, on the isometric developed tension (IDT) of uterine horns isolated from pregnant and non pregnant (diestrous) rats, incubated in a KRB-medium without glucose, were explored. In 14 days-pregnant rats, dietary restriction did not alter the contractile activity with respect to normal-fed controls. Besides, levels of uterine glycogen, immediately after killing the animals or after 60 min incubation, remained unaltered. In advanced pregnancy partial starvation led to decay of spontaneous contractile activity after 60 min incubation. However, the considerable increment in the levels of tissue glycogen at 0 time was not modified, nor its decrease at the end of the in vivo experimental period. In non-pregnant rats, a reduced feeding did not alter the development of contractile tension, but exerted a pronounced effect on the glycogen levels: these were significantly lower than controls at 0 time but suffered no changes after 60 min on in vitro activity. Indomethacin appeared to have no effect on the spontaneous contractile activity of 14 days-pregnant rats. It significantly depressed contractility in 21 days-pregnant rats. Indomethacin did not modify the levels of glycogen in any of the experimental groups.

Effect of dietary restriction on triglyceride levels in the uterus isolated from pregnant rats. Influences of prostaglandins and indomethacin

Triglyceride (TGs) concentrations in uterine strips isolated from 14 or from 21 days-pregnant rats, either normal-fed or following a restricted-diet rats (50% food intake for 14 days), were measured. Determinations were made immediately after killing (0 min time or post-isolation) as well as after a period of incubation in glucose-free medium (60 min time or post-incubation). The post-isolation levels of TGs (0 min) in the uterus from normal-fed animals at 14 or at 21 days of pregnancy, were significantly higher in implantation sites than in the interembryonic segments. These values of TGs (0 time) did not change, in comparison to post-incubation concentrations (60 min), either without additions or in the presence of indomethacin (5 X 10(-6) M) or of prostaglandins (PGs) E1, E2 or F2 alpha (10(-7) M). At 0 time, uterine TGs of rats subjected to dietary restriction, increased as pregnancy progressed, more than in normal-fed controls. The post-incubation (60 min) pattern was different depending on the days of pregnancy; i.e. at 14 days, incubation in Krebs-Ringer Bicarbonate-medium (KRB) led to a significant fall unaffected by the addition of propranolol (10(-6) M). However, in the presence of indomethacin, TGs values had a level similar to the initial one (0 time). Furthermore, exogenous PGE1 or PGE2 failed to alter the effect of indomethacin, as PGF2 alpha did.(ABSTRACT TRUNCATED AT 250 WORDS)

Different effects of prostaglandins E2 and F2 alpha on triglyceride levels in uterine smooth muscle from diabetic diestrous rats

Triglyceride (TG) concentrations in uterine strips isolated from diestrous normal rats, from diestrous streptozotocin (single iv. injection of 65 mg X Kg body weight-1)-diabetic rats and from diestrous diabetic animals, treated in vivo with insulin (protamine zinc insulin 4U X day-1, 6 days, sc.), were measured. Determinations were made immediately following killing (0 min, or postisolation) as well as after an incubation period in glucose-free medium (60 min, or postincubation), with or without additions. The basal or postisolation levels of TGs (0 min) in the uterus from control normal rats (TGs: 17.0 +/- 0.5 mumol X g-1, d.w.; blood glucose: 100.4 +/- 4.8 mg X dl-1) were lower (P less than 0.001) than in streptozotocin-diabetics (TGs: 28.5 +/- 0.6 mumol X g-1, d.w.; blood glucose: 302.0 +/- 10.1 mg X dl-1) and the treatment with insulin (blood glucose: 165.0 +/- 14.7 mg X dl-1), restored TGs towards normal (19.3 +/- 1.3 mumol X g-1, d.w.). The postisolation levels of TGs (0 min) in the uterus from normal controls did not differ in comparison with postincubation values (60 min), either without additions or in presence of indomethacin (5 X 10(-6)M) or of prostaglandins (PGs) E2 or F2 alpha, at 10(-9)M. On the contrary, in uteri from diabetic animals, the higher initial TG levels diminished spontaneously in comparison to controls (P less than 0.001) following 60 min of incubation without additions; this decrement being antagonized by indomethacin or by propranolol (10(-6)M). Moreover, exogenous PGE2 failed to alter the effect of indomethacin, whereas PGF2 alpha evoked its abolition. In addition, propranolol, which effectively blocked the spontaneous decrement of TGs as did indomethacin, prevented also the influence of PGF2 alpha on the action of the cyclo-oxygenase inhibitor. In the case of uteri from diabetic rats treated in vivo with insulin, TG levels remained unaltered at the end of an incubating period of 60 min without additions and so they did following the administration of indomethacin or PGF2 alpha. The results document that the regulation of TGs in the diestrous rat uteri, suspended in glucose-free solution, is affected differently by PGE2 and F2 alpha, depending on the existence or not of an untreated diabetic condition. They also suggest that the action of PGF2 alpha may involve the activation of tissue beta-adrenoreceptors.

Prostaglandin E2 and prostaglandin F2 regulation of triglyceride levels in uterine smooth muscle from restricted-diet estrous and diestrous rats

Triglyceride concentrations in uterine strips isolated from estrous and diestrous normal-fed or restricted-diet (50% food intake for 15 days) rats, were measured. Determinations were made immediately following killing (0 min, or postisolation) as well as after a period in glucose-free medium, (60 min or post-incubation) with or without additions. The postisolation levels of triglycerides (0 min) in the uterus from normal-fed estrous animals were lower than in diestrus but in each group did not differ in comparison with postincubation values (60 min), either without additions or in the presence of indomethacin (10-6M). Initial (0 min) tissue triglycerides of estrous and diestrous partially-starved rats were significantly higher than in their respective fed controls and exhibited different modifications depending on the stage of the sex cycle. In estrus, levels remained unaltered at the end of an incubating period without additions and declined in the presence of indomethacin. This influence of indomethacin was not modified by added PGF2 (10(-9)M) but was effectively abolished by PGE2 (10(-9)M). On the contrary, in diestrus, initial triglyceride levels diminished spontaneously following 60 min without additions, this being antagonized by indomethacin or propranolol (10(-6)M). Furthermore, exogenous PGE2 failed to alter the effect of indomethacin whereas PGF2 evoked its abolition. Propranolol, which effectively blocked the spontaneous decrement of triglycerides as did indomethacin, prevented also the influence of PGF2 on the action of indomethacin. The foregoing results are compatible with the notion that the regulation of triglycerides in rat uteri suspended in the absence of exogenous substrate, is affected differently by prostaglandin E2 and F2 alpha depending on the state of the sex cycle. They also suggest that the phenomenon may involve the activation of the beta adrenoreceptors.

Partial starvation, and "in vitro" contractions of rat uterine smooth muscle. Levels of glycogen and triglycerides

The effects of a restricted-diet (50% of the normal intake during 25 days) on the isometric developed tension (IDT) of uterine horns isolated from diestrous non-cycling rats, were explored. After 60 minutes following isolation and mounting the IDT of controls suspended in glucose containing solution was higher than in preparations from underfed animals but this was no the case in the absence of glucose. Glycogen levels of controls at 60 minutes were smaller in substrate-free than in the presence of glucose whereas no change was detected in horns from restricted-diet rats. Preparations from underfed animals had a significantly augmented basal concentration of triglycerides which diminished at 60 minutes following the removal of glucose from the suspending solution. This effect was abolished by the addition of 3-O-methyl glucose and by blockers of beta-adrenoreceptors such as propranolol or MJ-1999. A similar situation occurs when the animals were injected prior killing with 6-hydroxydopamine.