How Can We Identify Extraprostatic Extension (EPE) Before Surgery? The Use of a Preoperative Prostate MRI EPE Scoring System to Assess Postprostatectomy Locally Advanced Prostate Cancer

Background: Distinguishing between organ-confined disease and extraprostatic extension (EPE) is crucial for the treatment of patients with prostate cancer. EPE is associated with an increased risk of biochemical recurrence, positive surgical margins, and metastatic disease. An MRI-based EPE scoring system was developed by Mehralivand in 2019; however, it has not been adopted in the Urology community. The purpose of this study is to evaluate the association of MRI-based EPE scoring with the pathologic EPE (pEPE) after radical prostatectomy. Methods: We conducted a retrospective review on a prospectively collected database of male patients who underwent a prostate MRI with EPE scoring by a trained genitourinary radiologist and subsequent robotic radical prostatectomy at our institution from September 2020 to December 2022. The associations between MRI EPE (mEPE) score and the presence of EPE on surgical pathology (pEPE) were examined using multivariable logistic regression. Results: A total of 194 patients met inclusion criteria with a median age of 63 years and prostate specific antigen (PSA) 7 ng/mL. Among those with mEPE score 3, 96% had pEPE. Those patients with an mEPE score ≥2 had an increased risk of pEPE compared with those with mEPE score 0 (odds ratio 3.79; 95% confidence interval 1.28-11.3) Furthermore, those with an mEPE score 3 were significantly more likely to have pEPE compared with those with mEPE score 0, 1 and 2 independently. Conclusion: MRI EPE is a straightforward tool that strongly correlates with the presence of pEPE. If validated prospectively, this scoring system could assist in counseling patients regarding nerve-sparing approach.

The Association of a Peritoneal Interposition Flap With Lymphocele Formation After Pelvic Lymph Node Dissection During Robotic-assisted Laparoscopic Radical Prostatectomy: A Systematic Review and Meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate the association of a peritoneal interposition flap (PIF) with lymphocele formation following robotic-assisted laparoscopic radical prostatectomy (RALP) with pelvic lymph node dissection.

METHODS

We conducted a systematic search of MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials through August 30, 2023, to identify randomized and nonrandomized studies comparing RALP with pelvic lymph node dissection with and without PIF. A random effects meta-analysis was then performed to evaluate the associations of PIF with 90-day postoperative outcomes.

RESULTS

Five randomized controlled trials (RCTs) and four observational studies, including a total of 2941 patients, were included. The use of PIF was associated with a reduced risk of 90-day symptomatic lymphocele formation after RALP when examining only RCTs (pooled odds ratios [OR] 0.44, 95% CI 0.28-0.69; I2 =3%) and both RCTs and observational studies (OR 0.35, 95% CI 0.22-0.56; I2 =17%). Similarly, use of PIF was associated with a reduced risk of 90-day any lymphocele formation (OR 0.40, 95% CI 0.28-0.56, I2 =39%). There were no statistically significant differences in postoperative complications between the two groups (OR 0.89; 95% CI 0.69-1.14; I2 =20%).

CONCLUSION

Use of the PIF is associated with an approximately 50% reduced risk of symptomatic and any lymphocele formation within 90-days of surgery, and it is not associated with an increase in postoperative complications.

Disparities in the prevalence and management of high-risk non-muscle invasive bladder cancer

OBJECTIVE

To evaluate the associations of socioeconomic characteristics with the management of non-muscle invasive bladder cancer (NMIBC).

METHODS

We identified adult patients aged 18 to 89 years with Ta, T1, or Tis NMIBC in the NCDB. We then examined the associations of patient and socioeconomic characteristics with the guidelines-based management of high-risk NMIBC using multivariable logistic regression.

RESULTS

163,949 patients were included in the study cohort, including 64% with Ta, 32% with T1, and 4% with Tis disease. Among those diagnosed with bladder cancer, male (OR 1.24, 95%CI 1.21-1.27), uninsured (OR 1.10, 95%CI 1.01-1.19 vs. private), and non-White (OR 1.34, 95%CI 1.28-1.41 for Black; OR 1.10; 95%CI 1.03-1.18 for Other vs. White) patients were more likely to be diagnosed with high-risk disease, as well as patients from lower education level areas. Among those with high-risk NMIBC, patients who were older, non-White, Hispanic, uninsured or insured with Medicaid were less likely to receive guideline recommended intravesical BCG, while those residing in rural and higher education level areas were more likely to receive BCG. When examining non-guidelines based use of radiotherapy for HGT1 disease, older age (OR 1.06; 95% CI 1.04-1.07) and VA/Military insurance (OR 2.73; 95%CI 1.07, 6.98 vs. private) were associated with radiotherapy use.

CONCLUSION

There are strong disparities in the prevalence and management of high-risk NMIBC. These observations highlight important targets for future strategies to reduce such healthcare disparities and provide more equitable bladder cancer treatment to patients.

AB1207 RISK FACTORS FOR HIGHER RELAPSE RATE AND/OR PROLONGED GLUCOCORTICOID THERAPY IN POLYMYALGIA RHEUMATICA: MULTICENTRE STUDY IN 185 PATIENTS

Background

Glucocorticoids (GC) are the therapeutic mainstay in polymyalgia rheumatica (PMR). However, their adverse effects are of particular concern in elderly patients. Relapses and long-term GC dependency are common.

Objectives

Assess the risk factors for higher relapse rate and/or prolonged glucocorticoid therapy in 185 PMR patients from Argentina.

Methods

A multicenter observational study of PMR patients diagnosed according to the Chuang criteria seen at the outpatient clinics at 12 public or private rheumatology units from Argentina between 2006 and 2021 was performed. Patients were followed until permanent remission, lost to follow up, or a maximum of 2 years after diagnosis. Relapse was defined as an exacerbation of PMR symptoms requiring an adjustment of GC dose (≥ 4 mg) occurring at least 1 month after diagnosis. Time to relapse was modeled using the Kaplan-Meier method. Cox regression models were used to evaluate predictors of time to first and subsequent relapses.

Results

A total of 185 patients were included (69.1% female) with a median age of 71 years (IQR 65-78 years). The median follow-up time was 17.1 months (IQR 6.8-34.7) and the incidence of relapses was 1.2 per 100 persons/month. The median time to relapse was 70.5 months (25th percentile = 14 months). Pain and/or stiffness in shoulder girdle and pelvic girdle together more common (p = 0.02) in the clinical presentation of patients who relapsed. In univariate analysis, PMR patients with a previous history of dyslipidemia had a lower risk of relapse (HR = 0.55, 95% CI = 0.33-0.94, p = 0.03). Laboratory at time of diagnosis showed that an ESR > 50 mm was found as a risk factor for relapse (HR = 2.50, 95% CI = 1.23-5.10, p = 0.011). Regarding therapy, meprednisone (HR = 2.38, 95% CI = 1.31-4.31, p = 0.004) and high dose GC (HR = 2.35, 95% CI = 1.42-3.87, p = 0.001) had higher risk of relapse. In multivariate analysis, only meprednisone (HR = 2.59, 95% CI = 1.28-5.23, p = 0.008) and high dose of GC (HR = 2.41, 95% CI = 1.19-4.89, p = 0.014) remained the only risk factors for relapse.

Conclusion

A lower relapse rate than that reported in the literature was observed. Meprednisone and high dose of GC are significant predictors of future relapses. Our results suggest that efforts should be made to minimize initial GC dose and avoid the use of meprednisone as GC of first choice in order to prevent disease relapses.

Disclosure of Interests

None declared

Can peak left ventricular activation time measured in aVL identify left bundle capture during left bundle branch area pacing?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Two main types of capture are observed during left bundle branch area pacing (LBBAP): LBB pacing (selective-LBBP or non-selective LBBP) and LV septal (LVS) capture. Several criteria are used to distinguish between both types.

Methods

Prospective study of patients who received LBBAP device for bradycardia or heart failure indications (bailed-out strategy).

LBBP was defined if monopolar paced QRS had a right bundle branch conduction delay pattern, at least one of the following criteria:

(a) Demonstration of LB potential with LB-local ventricular electrogram interval of 10–35 ms.

(b) Demonstration of transition in QRS morphology from non-selective to selective LB capture or non-selective to LVS capture (sudden decrease in LVAT of 10 ms) with decrementing output.

(c) Peak LV activation time time as measured in leads V5–V6 <80 ms.

Patients not fulfilling criteria for LBBP were catalogued as LVS pacing.

We analyzed the role that peak LVAT in the lead aVL (measured from the onset of the pacing spike to the peak of the R wave) had to discriminate between LBBP and LVS pacing and its correlation with LVAT measured in V5-V6.

Results

154 consecutive LBBAP procedures were included. Success was achieved in 150 patients (97,4%). Mean age at implant was 79.4±9.3 years, native QRS duration was 118.7±29.4 ms, and LVEF was ≤ 40% in 16 (10,5%). A narrow (< 120 ms) QRS complex was present in 82 patients (53,2%) and LBBB was present in 21 patients. Indications for pacing were second- or third-degree AV block (n=57), slow AF (n=22), bifascicular or trifascicular block (n=12), sinus node disease (n=56) and need for resynchronization therapy (n=6). A Medtronic 3830-69 lead was implanted using a C-315-His sheath in all procedures. We did not perform His mapping to select the target delivery zone.

LBBP was achieved in 117 patients (NSLBBP in 67 and SLBBP in 50) while LVS was achieved in the remaining 30 patients. Paced QRS duration after LBBAP was 115.3±14.7 ms, with a mean LVAT (measured at V5/V6) of 79.8±11.3 ms and mean LVAT in aVL of 83.6±14.6 ms. Left bundle potential was seen in 64 patients (44.4% of total population. LVAT in both V5/V6 and aVL was longer in LBBP patients compared to LVS patients (table 1).

Accuracy of LVAT measured in aVL for the differential diagnosis of LBBP and LVS capture was good (AUC 84,6%). The diagnostically optimal value for discrimination among the two types of capture was 84 ms (sensitivity and specificity of 65.5% and 93.3%, respectively) (Panel A, figure 1).

Moreover, ROC curve for discrimination between patients with LVAT in V5/V6<80 ms and >80 ms was also good (AUC 87.8%). A cut-off point for LVAT in aVL < 84 ms was also the diagnostically optimal value with a sensitivity and specificity of 80.2% and 80%, respectively). (Panel B, figure 1)

Conclusions

Peak LVAT measured in aVL lead might be a useful tool during LBBAP for differentiation between LBB capture and LVS capture.

Linkage mapping, comparative genome analysis, and QTL detection for growth in a non-model teleost, the meagre Argyrosomus regius, using ddRAD sequencing

Meagre (Argyrosomus regius), is a benthopelagic species rapidly emerging in aquaculture, due to its low food to biomass conversion rate, good fillet yield and ease of production. Tracing a species genomic background along with describing the genetic basis of important traits can greatly influence both conservation strategies and production perspectives. In this study, we employed ddRAD sequencing of 266 fish from six F1 meagre families, to construct a high-density genetic map comprising 4529 polymorphic SNP markers. The QTL mapping analysis provided a genomic appreciation for the weight trait identifying a statistically significant QTL on linkage group 15 (LG15). The comparative genomics analysis with six teleost species revealed an evolutionarily conserved karyotype structure. The synteny observed, verified the already well-known fusion events of the three-spine stickleback genome, reinforced the evidence of reduced evolutionary distance of Sciaenids with the Sparidae family, reflected the evolutionary proximity with Dicentrarchus labrax, traced several putative chromosomal rearrangements and a prominent putative fusion event in meagre’s LG17. This study presents novel elements concerning the genome evolutionary history of a non-model teleost species recently adopted in aquaculture, starts to unravel the genetic basis of the species growth-related traits, and provides a high-density genetic map as a tool that can help to further establish meagre as a valuable resource for research and production.

Validation of leadless atrioventricular synchronous pacing with Holter-ECG: a pilot study

Background

The novel MICRA AV leadless pacemaker can provide atrioventricular (AV) synchronous pacing using an accelerometer-based atrial sensing algorithm.

Purpose

To describe the performance of MICRA AV pacemaker in a real-life setting and to determine the agreement between AV synchrony determined by the device counters and AV synchrony obtained by a 24 h ECG Holter test.

Methods

This pilot study included the first ten patients implanted with a MICRA AV leadless pacemaker at our institution. All implants were performed according to standard protocols and under deep sedation. A close follow-up was performed, and atrial sensing parameters were adjusted following AV synchrony given by the device counters. Patients underwent a 24 h ECG Holter test once AV synchrony remained stable for at least two months. The ECG Holter signal was analyzed in a blinded manner by an automatic delineation system based on the wavelet transform (Figure). This algorithm has a sensivity of 98.9% and a positive predictive value of 91.9% to detect p waves. Cardiac cycles were defined as synchronous if a QRS complex followed the P-wave by ≤300 ms, according to MARVEL 2 study criterion. AV synchrony obtained from the 24 h Holter test was compared with AV synchrony extracted from the device counters (AM-VP + AM-VS) during the same 24 h.

Results

From June to November 2020, 10 patients (7 males, mean age 83.5±5.4) were implanted with a MICRA AV leadless pacemaker (5 patients due to complete AV block and 5 patients due to second degree AV block). All devices were implanted after 1 deployment and no major complications appeared. Data related to implant parameters are displayed in Table 1. Device reprogramming was needed in all patients during follow-up. The 24 h ECG Holter monitoring was performed 141.4±45 days after the implant (mean time). Device settings and programming at Holter date is displayed in Table 1. Total ECG recorded time was 210.6 h and 915,488 cardiac cycles were analyzed. The mean percentage of synchronous cardiac cycles was 88.6±8.5% of total cycles while the mean AV synchrony determined by the device counters (AM-VP + AM-VS) during those 24 h was 89.8±5.5%. A good patient to patient correlation between these two measures was found (coefficient of intraclass correlation = 0.72).

Conclusions

We obtained high rates of AV synchrony with MICRA AV leadless pacemaker, in our short-term follow-up pilot study. Manual adjustment of the atrial sensing parameters, guided by the device counters, seems to be useful to obtain an optimal performance.

Funding Acknowledgement

Type of funding sources: None.

Single- vs dual-chamber ICDs to prevent from inappropriate shocks: the debate is still alive

Background

The efficacy of dual-chamber implantable cardioverter defibrillators (ICDs) in preventing from inappropriate shocks (IS) is still a matter of debate.

Purpose

To compare the risk of IS among single- and dual-chamber ICDs in a cohort of heart failure (HF) patients carrying a prophylactic device. We aimed to focus on the relationship between programming and discriminators, and the risk of IS in a large cohort.

Methods

All HF patients with left ventricle ejection fraction <35% undergoing a prophylactic ICD-only implant were collected from the multicentre, prospective and nationwide UMBRELLA study. ICD programming was performed according to regular clinical practice at each site and. ICD setting and arrhythmic events occurring during the study period were automatically stored through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms coming from the arrhythmic events.

Results

From 2006 to 2015, 782 patients implanted with an ICD were analysed (537 patients (68.7%) with single-chamber ICDs and 245 patients (31.3%) with dual-chamber ICDs). During a mean follow-up of 4.35±2 years, 109 IS were delivered in 49 patients. IS occurred in 7.8% (n=42) of patients carrying single-chamber ICDs and in 2.9% (n=7) of dual-chamber carriers (p=0.001). A propensity score matched analysis was performed. The matched cohort was composed by 110 well-balanced (regarding baseline characteristics and programming) patients. In the weighted sample, dual-chamber ICDs were related to lower rates of IS (Figure 1) as compared to single-chamber devices (0.9% vs. 11.8%, p≤0.001).

Among programming the following ICD settings correlated to lower risk of IS: ≥30 of 40 intervals detection within ventricular fibrillation (VF) zone (HR=0.47; p=0.018), a programmed ATP-capable zone enabled through VF zone (HR=0.54; p=0.038), morphology discriminator (Wavelet®) (HR=0.42; p=0.032), and the specific dual-chamber discriminator (PR Logic®) (HR=0.28; p=0.004). After multivariable Cox regression analysis including clinical variables and device settings, PR Logic® discriminator was the only programming parameter independently related to a lower risk of IS (HR=0.18, CI 0.06–0.48, p=0.001).

Conclusions

In our nationwide cohort of primary prevention ICD-only patients, dual-chamber devices were associated with a lower risk of IS. ICDs equipped with PR Logic® discriminator might be useful to prevent from IS.

Funding Acknowledgement

Type of funding sources: None. Programming in the matched populationFigure 1

AB0342 OBSTETRIC AND THROMBOTIC ANTIPHOSPHOLIPID SYNDROME: ARE THEY DIFFERENT ENTITIES?

Background:

Several studies showed two main clinical phenotypes of antiphospholipid syndrome (APS): thrombotic (TAPS) and obstetric APS (OAPS). Although they have the same autoantibody profile, one of them developed thrombosis and other one obstetric morbidity.

Objectives:

To study clinical, demographic and antibody profile in patients with TAPS and OAPS.

Methods:

we retrospectively evaluated TAPS and OAPS patients who were included in Argentine Antiphospholipid antibodies registry. We studied clinical, demographic and antibody profile in both groups.

Results:

238 patients were included in the registry. 201 (84.81%) of them were female. 122 (60.69 %) of them fullfilled APS Sydney classification criteria, 47 (38.52%) TAPS and 52 (42.62%) OAPS. 23 (18.85%) patients had both thrombotic and obstetric events so they were excluded in this analysis.

Arterial Hypertension (HBP) and Hyperlipidemia were more frequent in TAPS versus OAPS. Older age was found in TAPS as well as in association with Systemic lupus erythematosus (SLE). There was no difference in antibody profile between the 2 groups, and the Global Antiphospholipid Syndrome Score (aGAPSS) was higher in TAPS than OAPS.

18 (38.3%) of TAPS patients had at least 1 pregnancy. Mean number of pregnancies of TAPS was 2.5 (1.10) and 3.84 (1.86) in OAPS. Thrombotic events were not found in TAPS during pregnancy and puerperium. HBP and gestational diabetes (GD) and other pregnancy related comorbidities were found in TAPS.

OAPS (n=52)TAPS (n=47)POAPS(n=52)TAPS(n=18)SLE, n (%)11 (21.2)28 (59.6)0.0002N% (DE)N % (DE)aGAPSS, mean (RIQ)4 (5)8 (5)<0.0001Abortions (<10 weeks)3338.4 (36.2)826.5 (35.3)Age, mean (DE)39.3 (6.24)43.1 (13.5)<0.0001Live Birth3633.5 (28.1)1672.2 (34.7)HBP, n (%)5 (9.6)15 (31.9)0.0121 >37 weeks2116.4 (2.38)1661.1 (31.7)Hyperlipidemia, n (%)4 (7.7)12(25.5)0.0267Prematurity <37 >34 weeks118.76 (1.97)0-GD, n (%)3(5.8)2(4.3)0.9999Prematurity <34 weeks96.37 (1.49)11.39 (5.89)Obesity, n (%)8 (15.4)4 (8.5)0.2912Pre eclampsia >34-<37 weeks10.490 (0.0350)24.63 (0.138)Smoking, n (%)11 (21.1)13 (27.6)0.4019Placental Hematoma31.86 (8.18)12.78 (11.8)Sedentary lifestyle, n (%)16 (30.8)17 (36.2)0.8486Abruptio Placentae21.96 (9.80)24.17 (12.9)Triple Positivity59.648.50.8323 Normal delivery2017.8 (27.9)1447.7 (33.9)Double Positivity11.936.4Cesarean section2217.2 (21.6)211.1 (32.3)Simple Positivity2938.51940.4Urgent Cesarean section139.80 (20.3)412.5 (24.6)GD21.37 (7.49)12.78 (11.8)HBP63.46 (10.3)310.2 (26.3)

Conclusion:

Antibody profile was similar in TAPS and OAPS. However, clinical manifestations and cardiovascular risk were different. These results should be evaluated in prospective studies.

Disclosure of Interests:

None declared

POS0667 TOFACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REAL-WORLD SETTINGS: A NATIONAL MULTICENTER STUDY OF 167 PATIENTS FROM ARGENTINA

Background:

Tofacitinib (TOF), an oral JAK inhibitor, is approved for the treatment of rheumatoid arthritis (RA) either as monotherapy or in combination with background methotrexate (MTX). Despite the current evidence of efficacy from randomized controlled trials and open-label long-term extension studies, evidence of effectiveness and safety in real-world settings is limited, not only in Argentina but also in Latin America.

Objectives:

To describe effectiveness, safety and persistence of TOF therapy in RA patients from public and private medical centers from Argentina. In addition, establish prognostic factors for clinical remission at 3 months and TOF monotherapy at 12 months.

Methods:

A retrospective, observational and multicentre study was performed from an analysis of medical records of 10 medical centers. RA patients (ACR/EULAR, 2010) and age ≥ 18 years who had received or are under treatment with TOF until June 2020 were included. The data collection was done on a standard database that included baseline data and at 3, 6 and 12 months. Clinical remission was defined as DAS28-ESR < 2,6. Adverse events, treatment duration, TOF treatment persistence at last visit and discontinuation cause were assessed. Comparison to baseline values was performed using Wilcoxon sign for numerical variables and McNemar´s test for categorical variables. Treatment persistence was analyzed using Kaplan Meier´s technique. Multivariate analysis was performed using R software and its library packages (Lme4, Tidyverse and ggpubr). A p value < 0.05 was considered significant.

Results:

A total of 167 patients were included (78.4% were female). At baseline, the median age was 53 years (IQR 43-63 years), median disease duration was 4 years (IQR 2-13 years). RF was positive in 85.6% of patients, ACPA in 80.8% and structural radiological damage was present in 71.8%. Previous use of MTX was 97%, leflunomide 74.8% and biologic therapy 42.5% (28.74% 1 biologic, 11.98% 2 biologics and 1.8% ≥ 3 biologics). TOF dose: 48% 11 mg/day and 52% 5 mg BID. A statistically significant difference was observed not only in disease activity (p<0.0001) but also in the requirement of MTX and PDN (p<0.0001) in the 12 months evaluated. Remission significantly increased from baseline to month 3 and to a much lesser extent to month 6 (p < 0.001). The mean duration of treatment with TOF was 20.10 ± 15.25 months. Treatment persistence was 93.84% at 3 months and 91.24% at 6 months. In those patient who achieved REM at month 3, a statistically significant differences in duration of RA (p 0.0002), structural radiological damage (p 0.011), basal disease activity (p 0.018) and prior treatment with biological therapy (p 0.017) was found when compared with patients who remained active. Furthermore, in univariate logistic regression analysis, 5 years or more of disease duration was associated with a 3 times higher risk of not achieving clinical remission at 3 months (odds ratio = 0.35, 95% CI = 0.15-0.83). In the multivariate logistic regression analysis, previous biological therapy was the only predictor associated with a decrease in the probability of clinical remission (p < 0.008). Adverse events were registered in 26 patients (herpes zoster, n = 9).

Conclusion:

The effectiveness of TOF was observed not only in the clinical response achieved but also in the dose titration or withdrawal of MTX and PDN. The safety profile did not show any difference from long-term extension studies. At 12 months, 86.81% of the patients persisted with TOF therapy. We found prognostic factors associated with clinical remission at 3 months but those associated with monotherapy at 12 months could not be defined due to small number of patients analyzed that could have generated lack of statistical power, although more studies are required to confirm these assumptions.

Disclosure of Interests:

Maria Del Rosario Maliandi: None declared, Yanina Silvia Malvano: None declared, Alejandra Cusa: None declared, María Julieta Gamba: None declared, Ramiro Gomez Speakers bureau: Abbvie, Novartis, Julio Got: None declared, Oscar Gut: None declared, Ursula Vanesa Paris: None declared, Maria Andrea Spinetto: None declared, Carolina Mariach: None declared, Alejandra Ines Abalo: None declared, Adrián Estevez Speakers bureau: Bristol-Meyer-Squibb, Jose Luis Velazco Zamora: None declared, Juan Pablo Vinicki: None declared

Impact of an adaptive CRT optimization algorithm on the risk of life-threatening ventricular arrythmias of heart failure patients

Introduction

Adaptive cardiac resynchronization therapy (aCRT) algorithm provides ambulatory CRT optimization and synchronized left-ventricular pacing instead of conventional biventricular pacing.

Purpose

To analyze the impact of aCRT on the risk of life-threatening ventricular arrythmia (VA) in patients with concomitant defibrillator therapy.

Methods

Symptomatic HF patients, in sinus rhythm, with LVEF ≤35% and QRS complex ≥130 ms undergoing first CRT-defibrillator (CRT-D) implant were collected from the multicentre, prospective and nationwide UMBRELLA study (2012–2017). All device information was automatically stored and collected through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms. The endpoint was first appropriate therapy (AT) delivered within ventricular fibrillation zone at 12-months follow-up.

Results

206 patients were collected (66.1±8.7 years; 73.3% male). Fifty nine patients composed the aCRT group and 147 composed the non-aCRT group. At implant, LBBB was present in 93% of patients, functional class III or IV in 69.9%, non-ischemic HF in 63.1% of patients and mean LVEF was 26.5±5.6%. Optimal medical treatment was achieved in a majority (B-blockers in 92%; RAASi in 89% and MRA in 72.2%).

The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). At 1-year of follow-up, 16 patients were delivered an AT (event rate: 7.8%). Most of these episodes (n=14) were due to sustained monomorphic ventricular tachycardia while the rest were caused by sustained polymorphic ventricular tachycardia/VF. A lower incidence of AT was observed in aCRT patients (3.4%) compared to non-aCRT patients (9.5%) but with no statistical differences (OR=0.33, CI 0.07–1.51, p=0.155).

Conclusions

In patients undergoing CRT provided by aCRT algorithm the risk of malign VA after 1-year of follow-up was low. Randomized studies are needed to clarify the impact of this dynamic algorithm on the arrhythmic risk of HF patients.

Funding Acknowledgement

Type of funding source: None

Gambling motives: Association with addictive disorders and negative and positive mood in youth

Gambling disorder and other comorbid addictive disorders may have similar underlying affective and motivational patterns. This study aims at examining the association between gambling disorder, comorbid addictive disorders (i.e., alcohol, drugs, spending, and videogames), positive and affective mood, and gambling motives in a community sample. A sample of 1099 adolescents and young adults was recruited from educational centres, from which 569 (51.7%) scored as non-problem gamblers, 42 (3.8%) as at-risk gamblers, and 53 (4.8%) as problem gamblers. Results suggest that enhancement, social, and coping motives are greater among problem gamblers and at-risk gamblers as compared to non-problem gamblers. Problem gamblers scored higher in gambling and comorbid disorders than at-risk gamblers, and also higher in gambling motives and negative mood when compared to non-problem gamblers. Likewise, gambling severity was significantly associated to gambling motives, negative mood, and other addictive disorders. Finally, enhancement motives were predictive of gambling, alcohol, drugs, and spending while controlling for the effect of age, sex, and positive and negative mood. These results shed light into the nature of the relationship between gambling and other comorbid addictions and can be used to tailor prevention and treatment strategies.

Do we need cardiopulmonary exercise to determine the optimal time for intervention in valvular heart disease?

Introduction

Cardiopulmonary exercise testing (CPET) is underused in many clinical conditions other than HF. In valvular heart disease (VHD), CEPT can aid in choosing the right timing for surgery. The goals of this study were to compare the assessment of functional capacity (FC) by CEPT and NYHA scale, and to analyze the relationship between ventilatory efficiency (VE) parameters and time to surgery.

Methods

197 CPET were performed in 163 patients with moderate or severe VHD (51% female). Real METS (RM) were calculated as indexed peak VO2/3.5 (1 MET = 3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the exercise duration. An agreement analysis between RM, EM and NYHA was performed. The association among VE/VCO2 slope, pet CO2 at anaerobic threshold (AT), OUES and time to surgical indication was also studied using Cox logistic regression analysis.

Results

See Table. The RM and EM were 4,7±1,7and 6,2±2,9, respectively (p&lt;0.01), and the correlation was low (ICC=0,7, p&lt;0.001). The agreement between NYHA class and % of peak predicted V02 was very low (kappa index = 0.1, p&lt;0.001). VE parameters were predictive of an earlier surgical indication: petCO2 AT (p=0.02), VE/VCO2 slope (p=0.069), OUES (p=0.014).

Conclusions

In asymptomatic VHD patients, the surgical indication should not rely solely in their FC assessed by either NYHA scale or EM derived by duration of exercise. In our series, these parameters clearly overestimated the FC of the population. Also, the ventilatory inefficiency may be a surrogate marker of advanced disease and lead to a closer surveillance for an earlier intervention.

Real and estimated METS by type of VHD

Funding Acknowledgement

Type of funding source: None

P5425Prognostic value of NYHA functional class in heart failure patients undergoing primary prevention implantable cardioverter defibrillator therapy

Background

NYHA functional class (FC) is used for selection of heart failure (HF) patients who are candidates to primary prevention (PP) implantable cardioverter defibrillator (ICD) therapy. However, FC is subjectively estimated and concerns about its real prognostic value are still present in this setting.

Purpose

To compare whether mortality and arrhythmic risk are different, in a cohort of HF patients undergoing PP ICD-only implant, according to their FC.

Methods

All HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD-only implant were collected from the UMBRELLA nationwide registry (2006–2015). The sample was divided into three groups: no symptoms (NYHA I), mildly symptomatic patients (NYHA II) and severely symptomatic (NYHA III) patients. Outcomes were studied as follow: all-cause death, cardiovascular mortality and arrhythmia free survival (surrogate marker of sudden cardiac death) defined as survival free of first appropriate ICD therapy delivered in ventricular fibrillation (VF) window. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.

Results

Six hundred and twenty one patients were identified (61.1±11.4 years, 87.3% male). Distribution of study groups was as follow: 101 patients in NYHA I; 411 in NYHA II; and 109 in NYHA III. More symptomatic patients were older and had higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD). Higher rates of optimal medical treatment were present among study groups (beta-blockers: 92.1%; ACEI or ARB: 86.8%; aldosterone antagonists: 60.2%). After a median follow-up of 4.2 years (IQR, 2.7–5.7 years) 126 patients died (event rate: 20.3%). All-cause mortality was higher in patients with worse FC (13.9% vs. 18.3% vs. 32.9% for NYHA I, II and III respectively; p<0.001, log-rank test). Seventy-eight out of 126 deaths were related to cardiovascular causes (overall event rate: 12.6%). Cardiovascular mortality risk was also higher in more symptomatic patients (6.9% vs. 11% vs. 23.9% for NYHA I, II and III respectively; p<0.001, log-rank test). One hundred and seventeen patients received afirst appropriate ICD therapy (19.4%). Arrhythmia free survival was not different among study groups (20.8% vs. 18.7% vs. 20.8% for NYHA I, II and III, respectively; p=0.495, log-rank test). Cumulative incidence curves for the three outcomes are shown in Figure 1. After multivariate analysis, worse NYHA class independently predicted cardiovascular mortality but not all-cause death. Moreover, diabetes, AF and CKD strongly predicted both all-cause and cardiovascular mortality.

Figure 1

Conclusions

In HF patients, prophylactic ICD seems to be useful in preventing death due to life threatening arrhythmias, regardless of the baseline FC. Nevertheless, the combination of NYHA class with other comorbidities may be useful to select those ICD candidates who obtain less survival benefit.

P2750Why should cardiopulmonary exercise testing be routinely used for assessing patients with valvular heart disease?

Introduction

The role of cardiopulmonary exercise testing (CPET) is unquestionable to assess prognosis in heart failure. In patients with valvular heart disease (VHD), the functional capacity (FC) is crucial to aid in the right timing of surgery. The aim of this study was to compare the assessment of the FC by CPET and NYHA and the correlation between ventilatory efficiency parameters and resting systolic pulmonary artery pressure (SPAP).

Methods

We studied 100 VHD patients (57% female) who underwent a CPET. We calculated the real METS (RM) as indexed peak VO2/3.5 (1 MET=3.5 ml O2/kg/min) and compared to estimated METS (EM) derived by the time of exercise. An agreement analysis between RM, EM and NYHA was calculated. The correlation among VE/Vslope CO2, EqCO2at anaerobic threshold (AT), PETCO2, partial pressure end-tidal CO2 at AT and SPAP was analyzed.

Results

The results are shown in Table and Figure. The RM and the EM were 4.7±1.7 and 5.5±3, respectively (p<0.01) with a low agreement (ICC=0.6, p<0.01). The agreement between NYHA and the classification obtained from peak % of predicted peak VO2 was very low (weighted kappa =0.06, p=0.28). In patients with severe mitral VHD, the ventilatory efficiency parameters were correlated with SPAP (PETCO2 (AT), r=−0.7, p=0.002; EqCO2 (AT), r=0.5, p=0.04:VE/Vslope CO2, r=0.3, p 0.2), whereas in those with severe aortic VHD, these correlations were much lower (PETCO2 (AT), r=−0.3, p=0.13; EqCO2 (AT), r=0.2, p=0.15; VE/Vslope CO2, r=0.18, p 0.31).

Total (n=100) Mitral regurgitation (n=35) Aortic regurgitation (n=23) Age 65 (29–86) 66 (30–84) 65 (11–87) LVEF (%) 62±6 63±6 61±7 SPAP (mmHg) 40±11 39±11 36±8 NYHA I (60%), II (33%), III (7%) I (63%), II (29%), III (9%) I (63%), II (33%), III (4%) Indexed peak VO2 (ml/min/kg) 16±6 17±6 19±8 Peak % predicted VO2 73±18 74±17 79±18 Predicted VO2 AT (%) 58±19 54±19 61±22 Eq CO2 AT 33±6 32±7 32±5 VE/VSlope CO2 33±6 32±7 33±8 PetCO2 AT 34±4 36±4 36±5

Type and degree of VHD

Conclusions

NYHA scale and estimation of METS derived from the time of exercise clearly overestimated the FC of our population. In our series, the ventilatory inefficiency in patients with mitral VHD could be a surrogate marker of advanced disease and could lead to an earlier intervention.

Diplectanum sciaenae (Van Beneden & Hesse, 1863) (Monogenea) infecting meagre, Argyrosomus regius (Asso, 1801) broodstock in Catalonia, Spain. A case report

Recurrent infection of captive meagre, Argyrosomus regius, by a monogenean parasite has been observed in the broodstock facilities of Institut de Recerca i Tecnologia Agroalimentàries (IRTA) in Catalonia, Spain, between 2008 and 2015. Following handling procedures related with hormonal treatment for spawning induction, one fish died. Post-mortem examination and detailed microscopical examination using light microscopy, SEM, and histology revealed intense infection by Diplectanum sciaenae (Monogenea, Diplectanidae) which caused noteworthy gill pathology. In the present study, we provide detailed description of the parasite and the pathology caused to its host. This is the first report associating this parasite with disease and mortality in farmed meagre.

Biosynthesis and catabolism of prostaglandin F2alpha (PGF2alpha) are controlled by progesterone in the rat uterus during pregnancy

Myometrial quiescence is a key factor in all species to accomplish a successful gestation. PGs play a crucial role in mediating parturition events, and their synthesis and metabolism are regulated by cyclooxygenases (COXs) and NAD(+)-dependent 15-hydroxy-PG dehydrogenase (PGDH), respectively. Progesterone (P(4)) is the hormone responsible for maintaining uterine smooth muscle quiescence during pregnancy. In this work, we have studied the effect of P(4) on the activity of COXs and PGDH, the uterine enzymes involved in the biosynthesis and metabolism of prostanoids in the rat. We found that during pregnancy PGF(2alpha) production and also protein levels of COX-1 and COX-2 were decreased. The exogenous administration of P(4) significantly inhibited the uterine production of PGF(2alpha) and also the protein level of COX-2. PGF(2alpha), metabolism was assessed by PGDH activity, which resulted high during pregnancy and increased as a result of P(4) administration. These results indicate that PGs levels were negatively modulated by P(4), which could be exerting its effect by increasing PGs metabolism through stimulation on PGDH activity and an inhibition on COX and that is a major mechanism for maintain uterine quiescence in pregnancy.

Relationship between endothelin 1 and nitric oxide system in the corpus luteum regression

The present study was designed to investigate the relationship between the nitric oxide (NO) system and endothelin 1 (ET-1) in the mechanism of corpus luteum (CL) development and consequently regression in rats. We first evaluated basal ET-1 levels in ovarian tissue from rats with different stages of CL development. An increased ovarian ET-1 content was found during CL regression. In a dose-department response, ET-1 decreased progesterone (P4) and increased prostaglandin (PG) PGF2alpha production. By means of a competitive nitric oxide synthase (NOS) inhibitor: L-nitro arginine methyl ester (L-NAME) and a slow NO releasing: diethyl-aminetriamine (DETA-NONOate), we demonstrated that NO system could be the intermediary in the ET-1 diminishing P4 production. The Western blot analysis revealed an increase on iNOS while eNOS protein expression was diminished. We also found a diminution of total NOS activity after ET-1 treatment. These data suggest the existence of a functional relationship between ET-1 and NOS isoforms leading the regulation of CL functionally.

Sequence of interleukin 1beta actions on corpus luteum regression: relationship with inducible cyclooxygenase and nitric oxide synthase expression

Corpus luteum regression has been described in terms of: (i) functional luteolysis - a reversible decline in serum progesterone concentration; and (ii) structural luteolysis - irreversible morphological changes and tissue remodelling events within the cellular membrane. In rats, PGF(2alpha) and interleukin 1beta (IL-1beta) are involved in structural luteolysis, PGF(2alpha) by increasing ovarian lipid peroxidation, and IL-1beta by reducing progesterone and increasing PGF(2alpha) concentrations. The aim of the present report was to determine whether by an early action IL-1beta is able to regulate functional luteolysis. Thus, ovarian explants from rats at the mid-stage of corpus luteum development were incubated during short periods with either 15 or 25 ng IL-1beta ml(-1). At 15 ng ml(-1), IL-1beta inhibited progesterone after 4 and 8 h of culture without affecting PGF(2alpha) production, and a longer incubation (21 h) was needed to increase PGF(2alpha) production. In contrast, IL-1beta enhanced PGF(2alpha) concentrations at 8 h only at the higher dose (25 ng ml(-1)). The observed reduction in progesterone synthesis at the lower dose of IL-1beta before the increase in PGF(2alpha) concentrations led to the hypothesis that IL-1beta regulates functional luteolysis (progesterone diminution) before it affects structural luteolysis (PGF(2alpha) increase). The fact that the early IL-1beta action was described at 4 h but no effects on inducible nitric oxide synthase and inducible cyclooxygenase expression were found before this time led to the suggestion that these inductions were not necessary for the early IL-1beta action described.

Interleukin-1beta in the functional and structural luteolysis. Relationship with the nitric oxide system

The aim of the present report was to investigate the in vitro effect of interleukin-1beta(IL-1beta) on corpus luteum (CL) function and some aspects of this mechanism involved. Ovarian rat dispersates from mid-luteal phase were exposed to different doses of IL-1beta (1, 10, 20 ng/ml). Meanwhile 1, 10 and 20 ng/ml of IL-1beta decreased progesterone (P4) production, only the highest doses of IL-1beta increased prostaglandin F2alpha (PGF2alpha) levels. To investigate the possible relationship between PGs production and P4 synthesis, we incubated together IL-1beta (20 ng/ml) and indomethacin (0.1 mM) a potent inhibitor of cyclooxygenase pathway. We found that P4 inhibition induced by IL-1beta was completely prevented by addition of indomethacin. On the other hand, when ovarian rat tissue were exposed at 20 ng/ml of IL-1beta (doses that affected both PGF2alpha and P4 production) the nitric oxide synthase (NOS) activity was augmented. Moreover, IL-1beta effects on PGF2alpha and P4 levels were impaired when a NOS inhibitor N(W)-nitro- L -arginine methyl ester (L-NAME, 600 microM) was added to the incubation media. These data demonstrate that: (i) at the tested doses (1-20 ng/ml), IL-1beta is involved in CL function through the diminution of P4 production of whole ovarian dispersate culture; (ii) at the highest doses assayed (20 ng/ml) IL-1beta increased PGF2alpha production; (iii) at these doses, IL-1beta decreased P4 production by means of a cyclooxygenase pathway and (iv) the NO system would be a key intermediary second messenger in the IL-1beta actions.

Nitric oxide synthase activity in the splanchnic vasculature of patients with cirrhosis: relationship with hemodynamic disturbances

BACKGROUND/AIMS

It has been demonstrated that an overproduction of nitric oxide plays an important role in the pathogenesis of the hyperdynamic circulation exhibited by cirrhotic patients. Nevertheless, evidence is supported by studies performed in experimental models or by indirect measurements in humans. The purpose of this study has been to evaluate nitric oxide production in splanchnic vasculature of patients with cirrhosis and to investigate its possible relationship with systemic and splanchnic hemodynamics.

METHODS

Nitric oxide synthase (NOS) activity was measured in hepatic artery and portal vein tissues of nine cirrhotic patients. Samples were obtained during liver transplantation. Control samples were obtained simultaneously from the corresponding tissues of the liver donors. Hemodynamic parameters were determined with Doppler ultrasonography.

RESULTS

NOS activity was significantly higher in hepatic artery of cirrhotic patients than in controls (8.17 +/- 1.30 vs 4.57 +/- 0.61 pmoles/g of tissue/min, P < 0.05). Patients with ascites showed a higher hepatic artery NOS activity than patients without ascites. Highly significant correlation was observed between cardiac output and hepatic artery NOS activity as well as between portal blood flow and hepatic artery NOS activity.

CONCLUSIONS

The present study demonstrates an enhanced production of nitric oxide in the splanchnic vasculature of patients with cirrhosis.

Regulation of lipid peroxidation by nitric oxide and PGF2alpha during luteal regression in rats

Corpus luteum regression is related to an increased generation of reactive oxygen species. Although several studies indicate that PGF(2alpha) is involved in regression of the corpus luteum in mammalian species through an increase in reactive oxygen species, the exact mechanism remains unknown. In the present study, the relationship between nitric oxide and PGF(2alpha) in regulation of lipid peroxidation was studied. Ovarian tissue from pseudopregnant rats at mid- (day 5) or late phase or at the time of regression (day 9 of pseudopregnancy) of corpus luteum development was used. Thiobarbituric acid reactants, used as a lipid peroxidation index, were higher on day 9 of pseudopregnancy than on day 5. In contrast, glutathione content (an antioxidant metabolite) was lower on day 9 than on day 5 of pseudopregnancy. These results indicate that there was an enhanced oxidative status in ovarian tissue during luteolysis. Administration of N(omega)-nitro-L-arginine methyl ester (L-NAME: 600 micromol l(-1)), a competitive nitric oxide synthase (NOS) inhibitor, led to a decrease in basal thiobarbituric acid reactant content in ovarian tissue from rats on day 9 of pseudopregnancy only, indicating that during regression of the corpus luteum, NO could act as intermediary in ovarian lipid peroxidation. Administration of a luteolytic dose (3 microg kg(-1) body weight i.p.) of a synthetic PGF(2alpha) increased thiobarbituric acid reactant content in ovaries from rats on day 9 of pseudopregnancy. As this effect was reversed partially by L-NAME, it is proposed that during regression of corpora lutea, PGF(2alpha) and NO are involved in regulation of lipid peroxidation. As this effect was only reversed partially, it is possible that there is another mechanism involving PGF(2alpha) (but not the NO-NOS pathway) in regulation of ovarian lipid peroxidation. Furthermore, the administration of PGF(2alpha) enhanced ovarian NOS activity, whereas cyclooxygenase inhibition (by indomethacin treatment in vivo) reduced it. As western blotting of ovarian homogenates obtained from PGF(2alpha)-injected rats increased inducible NOS (iNOS) content, it is concluded that PGF(2alpha) enhances both activity and synthesis of NO in rat ovarian tissues during luteolysis. Taken together, these results indicate that in ovaries with regressing corpora lutea, both NO and PGF(2alpha) are involved in part in regulation of lipid peroxidation.

Dual effects of nitric oxide in functional and regressing rat corpus luteum

The present study investigated the effect of nitric oxide (NO) on the lifespan of the corpus luteum (CL). Using a competitive nitric oxide synthase (NOS) inhibitor, L-nitro arginine methyl ester (L-NAME, 600 micromol/l), and a long-life NO donor, diethyl-aminetriamine (DETA-NONOate, 10(-8), 10(-6) or 10(-4) mol/l), we found that in ovaries from rats at the mid stage of CL development, endogenous NO increased both glutathione (GSH) and progesterone production. However, during prostaglandin F(2 alpha) (PGF(2 alpha))-induced luteolysis NO acted as an intermediary molecule in the inhibitory effect of PGF(2 alpha), on GSH content. This was supported by the fact that in-vivo PGF(2 alpha) treatment enhanced nitric oxide synthase (NOS) activity. These results indicate that the NO could act with a dual action (protective or pro-oxidant) in CL development.

Hypercapnia induces injury to alveolar epithelial cells via a nitric oxide-dependent pathway

Ventilator strategies allowing for increases in carbon dioxide (CO(2)) tensions (hypercapnia) are being emphasized to ameliorate the consequences of inflammatory-mediated lung injury. Inflammatory responses lead to the generation of reactive species including superoxide (O(2)(-)), nitric oxide (.NO), and their product peroxynitrite (ONOO(-)). The reaction of CO(2) and ONOO(-) can yield the nitrosoperoxocarbonate adduct ONOOCO(2)(-), a more potent nitrating species than ONOO(-). Based on these premises, monolayers of fetal rat alveolar epithelial cells were utilized to investigate whether hypercapnia would modify pathways of.NO production and reactivity that impact pulmonary metabolism and function. Stimulated cells exposed to 15% CO(2) (hypercapnia) revealed a significant increase in.NO production and nitric oxide synthase (NOS) activity. Cell 3-nitrotyrosine content as measured by both HPLC and immunofluorescence staining also increased when exposed to these same conditions. Hypercapnia significantly enhanced cell injury as evidenced by impairment of monolayer barrier function and increased induction of apoptosis. These results were attenuated by the NOS inhibitor N-monomethyl-L-arginine. Our studies reveal that hypercapnia modifies.NO-dependent pathways to amplify cell injury. These results affirm the underlying role of.NO in tissue inflammatory reactions and reveal the impact of hypercapnia on inflammatory reactions and its potential detrimental influences.

Working memory capacity and time course of predictive inferences

A naming task assessed activation of inference concepts during reading. A predicting, or a control, context sentence was followed by a target word to be named, which represented the predicted event or an inconsistent event. The interval between the end of the context and the onset of the target word varied between 50 and 1050 msec. Individual differences in working memory capacity were assessed by the reading span task. As reflected by facilitation in naming latencies in the predicting condition, relative to the control condition, (a) inferences were not made within the first 50 msec after the context, regardless of reading span; (b) only the high-span participants drew inferences within a 550-msec interval; and, (c) both the high- and the low-span participants generated them within a 1050-msec interval. These results indicate that high working memory capacity accelerates the time course of predictive inferences, although they do not become automatic. We propose that this effect occurs because these inferences involve time-consuming elaborations that place demands on the effortful and limited resources of working memory. Deficiencies in word knowledge, speed of lexical access, or comprehension of explicit information do not account for low-span readers' difficulties in generating predictive inferences.

The involvement of nitric oxide in corpus luteum regression in the rat: feedback mechanism between prostaglandin F(2alpha) and nitric oxide

In the corpus luteum (CL), prostaglandin F(2alpha) (PGF(2alpha)) is a physiological agent with luteolytic actions. Nitric oxide (NO) is a messenger molecule capable of modulating diverse pathophysiological processes. The aim of the present study was to investigate the role of ovarian NO in PGE (a luteotrophic prostanoid) and PGF(2alpha) (a luteolytic prostanoid) production and in progesterone synthesis during CL regression in the rat. To obtain a longer functional CL, we used a pseudopregnant (PSP) rat model. By means of intrabursa ovarian sac treatment of two competitive nitric oxide synthase (NOS) inhibitors, N(G)-monomethyl-L-arginine (L-NMMA, 1 mg/kg) and N(W)-nitro-L-arginine methyl ester (L-NAME; 3 mg/kg), and sodium nitroprusside (SNP, 0.05 mg/kg) as a NO generator, we found that NO, produced by the ovarian tissue during the last 2 days of CL development (days 8 and 9), increased PGF(2alpha) production in the ovary and diminished serum progesterone concentrations leading to CL involution. We also proposed a positive feedback mechanism between PGF(2alpha) and NO, to ensure luteal regression. Thus, we injected intraperitoneally a luteolytic dose (3 microg/kg) of a synthetic PGF(2alpha) during the mid and late phase of CL development. Ovarian NOS activity was evaluated. The results confirmed our hypothesis; we did not see any effect in the mid-stage of CL development, but increased ovarian NOS activity was found in PGF(2alpha)-injected late pseudopregnant rats.

On-line predictive inferences in reading: processing time during versus after the priming context

Prior research suggests that predictive inferences take time to construct on-line. The present study examines the relative contribution of time available during and after reading an inducing context. In six experiments, we manipulated the presentation rate of the context and the delay between the onset of the last word in the context and a target word. A predicting, or a control, sentence context was followed by a target word, which represented the predicted event or an unlikely event. The results indicated that increasing the time available during reading of the context improved comprehension of explicit information, but it did not affect construction of inferences. In contrast, increasing the delay at the end of the context did not affect explicit comprehension, but it enhanced the probability of inferences, as revealed by shorter latencies in naming the predictable target word after the inducing context, relative to the control context. These findings show that readers defer making predictive inferences until 1 sec after the sentence context has been read, regardless of the time available when they are processing the context.

Binding of xanthine oxidase to vascular endothelium. Kinetic characterization and oxidative impairment of nitric oxide-dependent signaling

Concentrations of up to 1.5 milliunits/ml xanthine oxidase (XO) (1.1 micrograms/ml) are found circulating in plasma during diverse inflammatory events. The saturable, high affinity binding of extracellular XO to vascular endothelium and the effects of cell binding on both XO catalytic activity and differentiated vascular cell function are reported herein. Xanthine oxidase purified from bovine cream bound specifically and with high affinity (Kd = 6 nM) at 4 degreesC to bovine aortic endothelial cells, increasing cell XO specific activity up to 10-fold. Xanthine oxidase-cell binding was not inhibited by serum or albumin and was partially inhibited by the addition of heparin. Pretreatment of endothelial cells with chondroitinase, but not heparinase or heparitinase, diminished endothelial binding by approximately 50%, suggesting association with chondroitin sulfate proteoglycans. Analysis of rates of superoxide production by soluble and cell-bound XO revealed that endothelial binding did not alter the percentage of univalent reduction of oxygen to superoxide. Comparison of the extent of CuZn-SOD inhibition of native and succinoylated cytochrome c reduction by cell-bound XO indicated that XO-dependent superoxide production was occurring in a cell compartment inaccessible to CuZn-SOD. This was further supported by the observation of a shift of exogenously added XO from extracellular binding sites to intracellular compartments, as indicated by both protease-reversible cell binding and immunocytochemical localization studies. Endothelium-bound XO also inhibited nitric oxide-dependent cGMP production by smooth muscle cell co-cultures in an SOD-resistant manner. This data supports the concept that circulating XO can bind to vascular cells, impairing cell function via oxidative mechanisms, and explains how vascular XO activity diminishes vasodilatory responses to acetylcholine in hypercholesterolemic rabbits and atherosclerotic humans. The ubiquity of cell-XO binding and endocytosis as a fundamental mechanism of oxidative tissue injury is also affirmed by the significant extent of XO binding to human vascular endothelial cells, rat lung type 2 alveolar epthelial cells, and fibroblasts.

Riluzole promotes survival of rat motoneurons in vitro by stimulating trophic activity produced by spinal astrocyte monolayers

In the present study we have assessed whether riluzole stimulates the production of trophic activities for motoneurons by spinal astrocyte cultures. Astrocyte monolayers prepared from new-born rats were exposed to vehicle or riluzole (1-10 microM) for 30-36 h, then washed and further incubated without riluzole for 24 h in L15 medium to obtain the astrocyte conditioned media (ACM). Motoneuron-enriched cultures were used to test the ability of the ACM to support motoneuron viability. Astrocyte monolayers exposed to 1 microM riluzole did not show changes in morphology or in DNA or protein synthesis. However, the conditioned medium obtained from astrocyte monolayers after this treatment increased motoneuron survival compared to that from vehicle-treated cultures. A similar effect was found when astrocytes were exposed to a higher riluzole concentration (10 microM) but with greater dilutions of the conditioned medium. This trophic activity was abolished by boiling or after treatment with trypsin. These findings strongly suggest the existence of a new trophic mechanism, through which riluzole may exert motoneuron protection.

Ventricular mass in hypertensive and normotensive obese subjects

Two-dimensional echocardiography was performed in 29 normotensive obese subjects and 21 hypertensive obese subjects representative of the Chilean population. The left ventricular mass (LVM) did not correlate with height or body surface area (BSA) in these patients, but positively correlated with body mass index (BMI), tricipital skinfold thickness and blood pressure (BP). The LVM/BSA ratio was significantly higher in the hypertensive subjects and was correlated with BP only. Left ventricular hypertrophy (LVM/BSA > 120 or 150 g/m2 in women or men, respectively) was found in 28% of normotensive and 58% of hypertensive subjects (P = 0.036). No statistical differences were found in relative wall thickness (RWT) between both groups. Posterior wall thickness was independently associated with BP while interventricular septum thickness was positively associated with the waist/hip ratio. Systolic function, evaluated through fractional shortening and end systolic diameters, was negatively and independently associated with body fat area. Left ventricular hypertrophy is a prevalent condition in these obese subjects. Hypertension seems to exert an additive effect, mainly increasing posterior wall thickness. Fat accumulation was negatively related to systolic function in this sample, irrespective of blood pressure.