Sharing primary percutaneous coronary intervention care: first experiences with South Limburg ST-elevation myocardial infarction network.

BACKGROUND: In the region of South Limburg, the Netherlands, a shared ST-elevation myocardial infarction (STEMI) networking system (SLIM network) was implemented. During out-of-office hours, two percutaneous coronary intervention (PCI) centres-Maastricht University Medical Centre and Zuyderland Medical Centre-are supported by the same interventional cardiologist. The aim of this study was to analyse performance indicators within this network and to compare them with contemporary European Society of Cardiology guidelines. METHODS: Key time indicators for an all-comer STEMI population were registered by the emergency medical service and the PCI centres. The time measurements showed a non-Gaussian distribution; they are presented as median with 25th and 75th percentiles. RESULTS: Between 1 February 2018 and 31 March 2019, a total of 570 STEMI patients were admitted to the participating centres. The total system delay (from emergency call to needle time) was 65 min (53-77), with a prehospital system delay of 40 min (34-47) and a door-to-needle time of 22 min (15-34). Compared with in-office hours, out-of-office hours significantly lengthened system delays (55 (47-66) vs 70 min (62-81), p < 0.001), emergency medical service transport times (29 (24-34) vs 35 min (29-40), p < 0.001) and door-to-needle times (17 (14-26) vs 26 min (18-37), p < 0.001). CONCLUSIONS: With its effective patient pathway management, the SLIM network was able to meet the quality criteria set by contemporary European revascularisation guidelines.

ESBL carriage in pig slaughterhouse workers is associated with occupational exposure.

We investigated the prevalence of extended-spectrum ß-lactamase (ESBL) carriage in slaughterhouse workers and the association with occupational exposure to slaughter animals and products. Stool samples from 334 employees in a Dutch pig slaughterhouse were obtained. Presence of ESBL was determined by selective plating, microarray analysis, and gene sequencing. Questionnaires were used to collect personal and occupational information. The overall prevalence of ESBL carriage was 4·8% (16/334). All ESBL-producing isolates were Escherichia coli. The ESBL genes detected were bla CTX-M-1 (n = 8), bla CTX-M-15 (n = 3), bla CTX-M-27 (n = 2), bla CTX-M-24 (n = 1), bla CTX-M-55 (n = 1), and bla SHV-12 (n = 1). A higher prevalence of ESBL was seen in workers in jobs with as tasks 'removal of lungs, heart, liver, tongue' (33%), and 'removal of head and spinal cord' (25%). For further analysis, participants were divided in two groups based on potential exposure to ESBL as related to their job title. One group with an assumed higher exposure to ESBL (e.g. stable work, stabbing, dehairing, removal of organs) and another group with an assumed lower exposure to ESBL (e.g. refrigeration, packaging and expedition). In the 'higher exposure' group, ten out of 95 (10·5%) were carrying ESBL vs. six out of 233 (2·6%) in the 'lower exposure' group. Human ESBL carriage was significantly associated with job exposure in the slaughterhouse (OR 4·5, CI 1·6-12·6). Results suggest that ESBL carriage in slaughterhouse workers overall is comparable with the Dutch population. Within the slaughterhouse population a difference in carriage exists depending on their position along the slaughter line and tasks involved.

Carriage of extended-spectrum ß-lactamases in pig farmers is associated with occurrence in pigs.

Livestock may serve as a reservoir for extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE). The objectives of this study were to determine the prevalence of carriage with ESBL-PE in pig farmers, family members and employees, and its association with carriage in pigs. Rectal swabs were taken from 2388 pigs (398 pooled samples) on 40 pig farms and faecal samples were obtained from 142 humans living or working on 34 of these farms. Presence of ESBL-PE was determined by selective plating (agar). ESBL genes were analysed by PCR or microarray analysis, and gene sequencing. Genotypes and plasmids were determined by multilocus sequence typing and PCR-based replicon typing for selected isolates. ESBL genes were detected in Escherichia coli from eight humans (6%) (blaCTX-M-1, n = 6; blaTEM-52, n = 1 and blaCTX-M-14, n = 1) on six farms. In 157 pig isolates (107 pooled samples) on 18 farms (45%) ESBL genes were detected (blaCTX-M-1, n = 12; blaTEM-52, n = 6; and blaCTX-M-14, n = 3). Human and pig isolates within the same farm harboured similar ESBL gene types and had identical sequence and plasmid types on two farms (e.g. E. coli ST-453, blaCTX-M-1, IncI1), suggesting clonal transmission. For the remaining farms, sequence types, but not plasmid types, differed. Human ESBL carriage was associated with average number of hours working on the farm per week (OR = 1.04, 95% CI 1.02-1.06) and presence of ESBLs in pigs (OR = 12.5, 95% CI 1.4-111.7). Daily exposure to pigs carrying ESBL-PE is associated with ESBL carriage in humans.

Relationship between udder health and hygiene on farms with an automatic milking system.

Poor hygiene is an important risk factor for reduced udder health. Because the teat cleaning process is done automatically on farms with an automatic milking system (AMS), hygiene management might differ. The aim of this study was to determine the relationship between hygiene and udder health on farms with an AMS at the farm level as well as at the cow level. Information on hygiene and udder health was collected on 151 Dutch dairy farms with an AMS. Teams of 2 veterinary students collected data with the use of a partially open-ended questionnaire and scoring protocols for hygiene of the cows, cleanliness of the AMS, and functioning of the AMS. Milk production records from the Dutch dairy herd information association were also collected. Stepwise general linear models were used to analyze the relation between hygiene and udder health at farm level. Dependent variables were average herd somatic cell count (SCC), the average percentage of new cows with a high SCC, and the incidence rate of clinical mastitis, all in the year preceding the farm visit. The annual average herd SCC was positively related to the proportion of cows with dirty teats before milking and the proportion of cows with dirty thighs. The annual average percentage of new cows with a high SCC was positively related to the proportion of cows with dirty teats before milking and the proportion of milkings where teats were not covered with teat disinfecting spray by the AMS. The annual incidence rate of clinical mastitis was positively related to the frequency of replacing the milking filters. At the cow level, hygiene scores of the udder, thighs, and legs (range 1 to 4, where 1 is clean and 4 is very dirty) were related with cow SCC from the milk production test day closest to the farm visit using a general linear mixed model. The relationship between cow SCC and the hygiene score of the udder was positive.

[Investigation on the blood pressure-independent nephroprotective effect of nilvadipine in type 2 diabetics]. / Untersuchungder blutdruckunabhängigen nephroprotektiven Wirkungvon Nilvadipin bei Typ-2-Diabetikern.

BACKGROUND: The nephroprotective effect of ACE inhibitors and AT1 blockers has been demonstrated in manystudies. In particular, the effect produced by AT1 blockers has been described as being blood pressure-independent. The nephroprotective effect has been inconsistently observed in calcium antagonists; at the same time, it is always pointed out that calcium antagonists improve albumin excretion through a blood pressure-lowering mechanism. GOAL AND METHODS: Up to now there was not enough data available on the nephroprotective effect of nilvadipine. The goal of this study was to study the blood pressure-independent effect of the calcium antagonist nilvadipine on glomerular and renal tubular insufficiency during a 48-week treatment in hypertensive type 2 diabetics. Tubular or glomerular insufficiency was characterized on the basis of tubular and glomerular proteinuria and classified accordingto severity. RESULTS: Four of 24 patients showed an improvement in glomerular insufficiency after the 48-week treatment with a once-a-day dose of 16 mg nilvadipine. In 18 of the 24 patients, a progression in the disease was prevented. Renal tubular insufficiency was improved in 15 of 24 patients and progression in 20 of 24 patients was prevented. This nephroprotective effect on impaired tubular reabsorption, which has been ascribed to early damage in diabetic patients or as a possible prodromal stage of glomerular nephropathy in recent work, has not been observed in any other medicine.

[Rapidity of pain relief, medication requirement and patient satisfaction with reflux treatment in the physician's office]. / Refluxtherapie in der allgemein medizinischen Praxis. Schnelligkeit der Schmerzbefreiung, Medikamentenbedarf und Patientenzufriedenheit.

Treatment of gastroesophageal reflux disease (GERD) with proton pump inhibitors was investigated in three controlled prospective, randomized open studies. Lansoprazole, omeprazole MUPS and esomeprazole were compared under doctor's office conditions. The outcomes of interest were the rapidity of pain relief achieved with a single dose, effectiveness and patient satisfaction with on demand therapy. In the first study, 180 patients with chronic and prolonged episodes of reflux were investigated. Time to pain relief following a single dose was 1.1 +/- 0.8 hours with 30 mg lansoprazole, 3.0 +/- 2.5 hours with 20 mgomeprazole MUPS and 2.1 +/- 1.2 hours with 40 mg esomeprazole. Studies 2 and 3 were designed as cross-over studies intended to investigate drug consumption. In study 2, the amount of lansoprazole consumed was approximately 50% less than that of omeprazole, and this translated to 81% patient satisfaction with lansoprazole compared with only 9.5% for omeprazole. In study 3 comparing lansoprazole and esomeprazole, consumption of the former was 85% that of the latter. 58% of the patients opted to continuetreatment with lansoprazole, compared with only 25% in the case of esomeprazole. The appreciably greater patient satisfaction with lansoprazole was due tothe faster pain relief achieved with this drug.

Cellular immunomodulation and safety of standardized aqueous mistletoe extract PS76A2 in tumor patients treated for 48 weeks.

Non-selected tumor patients (n=12) with various solid carcinomas were treated continuously twice weekly over 48 weeks with the aqueous mistletoe extract PS76A2, standardized to active mistletoe lectin. The preparation was applied subcutaneously at a concentration of 15 ng mistletoe lectin per 0.5 ml. Cellular immune response and safety were determined at various times during and after the therapy. In the course of treatment, virtually all the investigated immunoparameters were raised compared to the baseline values at the start of treatment. The statistically significant rises in the cell count of total lymphocytes, monocytes and natural killer (NK) cells was noteworthy. The differences in comparison with the baseline values at the various measuring times during treatment were up to 35%. In the first weeks of treatment at least, the raised cell count of NK cells correlated with the significantly increased cytotoxic activity versus tumor cells ex vivo. The NK factor (product of NK cells and ex vivo activity) was determined to assess the total NK activity more accurately, which rose up to 50% compared to the baseline value. Other lymphatic subpopulations, for instance CD3+, CD8+, CD3+CD4+ and CD3+CD8+ cells, also revealed distinct rises in cell count in the course of treatment. Within 6 weeks after completion of treatment, the overall values dropped again; but for a series of immunoparameters--in particular for the NK cells--they were still raised in comparison to the baseline values. The extensive laboratory diagnostics (haematology, clinical chemistry) showed that treatment with the standardized mistletoe extract PS76A2 was well tolerated by all patients. In single cases, local reactions at the injection sites were of a minor nature and reversible within two days. Summarizing, it can be stated that the standardized mistletoe extract PS76A2 significantly improved the immune status of tumor patients and was administered safely over a long period.

[Short-term (6 days) eradication of Helicobacter pylori infection in the practice of a health insurance physician]. / Kurzzeit-Eradikation der Helicobacter-pylori-Infektion über 6 Tage in der Kassenarztpraxis.

OBJECTIVE: To obtain epidemiological data concerning Helicobacter pylori (H.p.) infections and peptic ulcer in patients with upper abdominal pain in a routine non-hospital based health-insurance practice, as well as to test the efficacy of H.p. eradication, especially with a new shortterm treatment scheme in this setting. PATIENTS AND METHODS: H.p. status and possible peptic ulceration (urease test, biopsies of gastric antrum and body) were determined in 1242 consecutive patients with upper abdominal pain examined gastroscopically. Patients who were H.p. positive and had a peptic ulcer or recurrent gastritis with erosions were given dual or triple medication (lansoprazole or pantoprazole with one or two antibiotics: amoxycillin, clarithromycin, azithromycin, tinidazole), under conditions of controlled compliance. RESULTS: The H.p. infection rate was 45.9% for the whole group (mean age: 49.9 years). An acute ulceration was found in 10.4% of the whole group, i.e. 20.1% of the 129 H.p. positive patients. 194 patients were given an eradication treatment. In 62 of them, put on a new 6-day eradication regimen (azithromycin, 1 x 500 mg daily; tinidazole, 1 x 2000 mg/d; and pantoprazole, 2 x 40 mg/d), an eradication rate of 93% (under protocol) or 92% (intention to treat) was achieved. INTERPRETATION: In routine non-hospital practice a 6-day modified triple-medication treatment with azithromycin, tinidazole and pantoprazole proved efficacious in eradicating H.p. infection. It not only caused few side effects and was cheap, but also achieved high patient compliance.

Preparation and characterization of two phosphopeptide fractions from calf thymus nuclei; similarity to corresponding fractions in the DNA prepared from the nuclei.

In this study two phosphopeptide (PP) fractions from purified, calf thymus nuclei, prepared under protective conditions were characterized. The nuclei were lysed and dialyzed, and the material in the dialysates was fractionated by anion exchange column chromatography. This revealed the presence of two main phosphopeptide (PP) fractions, numbers 1 and 5. Amino acid analysis of the fraction 1, occurring in the greatest amount, showed that, after deionization, it contained the metal ion complexes of phosphoserine, aspartic and glutamic acids in large amounts, and nine other amino acids. In the same way the two main PP fractions, P1 and P5, were obtained during the dialysis of the EDTA-reacted, highly purified DNA (N-DNA) prepared from calf thymus nuclei. Fraction 1 from nuclei had practically the same amino acid composition as fraction P1 from EDTA-reacted N-DNA. In both cases, the second main fraction obtained (fraction 5) had nearly the same amino acid composition as fraction 1, but the total Pser molar ratio, was about twice as high as for fraction 1. In contrast to the low molecular weights of 900-1400 daltons observed for PPs isolated directly from the dialysates in water without exposure to HCOOH, the high molecular weight of 10,260 daltons was obtained for the PP fraction 1, after exposure to HCOOH used in the gradient for the column chromatography.

Functional aspect of a phosphopeptide derived from calf thymus nuclei and DNA.

Phosphopeptides (PPs) isolated from highly purified calf thymus DNA (N-DNA) and extracted from calf thymus nuclei were fractionated, and the effect of one PP fraction on DNA replication has been examined. In the absence of inhibitors, the increasing PP concentration caused a linear decrease of 3H-thymidine uptake in L5178Y cells. If PP fraction was mildly hydrolysed with 1NHCl, the decrease in uptake was much steeper. The studies in which the inhibitors were used revealed that by the addition of the unhydrolysed PP fraction the inhibition of 3H-thymidine uptake by alpha-amanitin could be completely overcome, and that the inhibition by puromycin was reduced to 65-77% of the control. With puromycin, there was a gradual decrease of 3H-thymidine uptake with PP concentration above 3 mg/ml. The PPs gave an increase in incorporation of 3H-thymidine even after removal of alpha-amanitin and puromycin; thus, it is suggested that there is no direct interaction of either inhibitor with PP in the cell. Data on the utilization of 3H-cytidine for the synthesise of new DNA suggest that PP fraction might cause an acceleration of DNA replication.