Off-site primary percutaneous coronary intervention in a new centre is safe: comparing clinical outcomes with a hospital with surgical backup.

OBJECTIVES: To evaluate the procedural and clinical outcomes of a new primary percutaneous coronary intervention (PPCI) centre without surgical back-up (off-site PCI) and to investigate whether these results are comparable with a high volume on-site PCI centre in the Netherlands. BACKGROUND: Controversy remains about the safety and efficacy of PPCI in off-site PCI centres. METHODS: We retrospectively analysed clinical and procedural data as well as 6­month follow-up of 226 patients diagnosed with ST-elevated myocardial infarction (STEMI) who underwent PPCI at VieCuri Medical Centre Venlo and 115 STEMI patients who underwent PPCI at Catharina Hospital Eindhoven. RESULTS: PPCI patients in VieCuri Medical Centre had similar procedural and clinical outcomes to those in Catharina Hospital. Overall there were no significant differences. The occurrence of procedural complications was low in both groups (8.4 % VieCuri vs. 12.3 % Catharina Hospital). In the VieCuri group there was one procedural-related death. No patients in either group needed emergency surgery. At 30 days, 17 (7.9 %) patients in the VieCuri group and 9 (8.1 %) in the Catharina Hospital group had a major adverse cardiac event. CONCLUSION: Performing PPCI in an off-site PCI centre is safe and effective. The study results show that the procedural and clinical outcomes of an off-site PPCI centre are comparable with an on-site high-volume PPCI centre.

Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction.

Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement. Patients with chest pain most often contact the general practitioner (GP) instead of the recommended EMT, increasing delays as well. To decrease the delays by referring all patients promptly and without restriction to the emergency department (ED) is not feasible. Up to 80% of the patients with chest pain do not have a cardiac diagnosis and thus referral of all these patients would result in overcrowding of the ED. Triage is therefore crucial. Triage of patients with chest pain is therefore imperative and there is a great need of (validated) triage tools.

The first year of the Venlo percutaneous coronary intervention program: procedural and 6-month clinical outcomes.

OBJECTIVES: Analysis of the first results of off-site percutaneous coronary interventions (PCI) and fractional flow reserve (FFR) measurements at VieCuri Medical Centre for Northern Limburg in Venlo. BACKGROUND: Off-site PCI is accepted in the European and American Cardiac Guidelines as the need for PCI increases and it has been proven to be a safe treatment option for acute coronary syndrome. METHODS: Retrospective cohort study reporting characteristics, PCI and FFR specifications, complications and 6-month follow-up for all consecutive patients from the beginning of off-site PCI in Venlo until July 2012. If possible, the data were compared with those of Medical Centre Alkmaar, the first off-site PCI centre in the Netherlands. RESULTS: Of the 333 patients, 19 (5.7 %) had a procedural complication. At 6 months, a major adverse cardiovascular event (MACE) occurred in 43 (13.1 %) patients. There were no deaths or emergency surgery related to the PCI or FFR procedures. There was no significant difference in occurrence of a MACE or adverse cerebral event between the Alkmaar and Venlo population in the 30-day follow-up. CONCLUSION: This study demonstrates off-site PCI at VieCuri Venlo to have a high success rate. Furthermore, there was a low complication rate, low MACE and no procedure-related mortality.

Effects of rapeseed meal-glucosinolates on thyroid metabolism and feed utilization in rainbow trout.

Two rapeseed meals (RM1 and RM2), containing glucosinolates at a concentration of 26 and 40 micromol/g, respectively, were incorporated at increasing levels (10, 20, and 30% for RM1 and 30 and 50% for RM2) in diets of juvenile rainbow trout. Disturbances in the thyroid axis appeared after 14 days of feeding (with a dietary incorporation level of 10%). The dietary supplementation with T(3) or iodine induced an increase in plasma T(3) levels, compared to that in fish fed the RM diets, and reduced the deleterious effect of RM on growth. When trout were reared in seawater, there was also a slight increase in thyroid hormone levels. TSH treatment had no effect on the thyroid hormone plasma levels. The incorporation of 30% of RM1, which induced a lower dietary content of toxic compounds than RM2, led to a rapid decrease of plasma T(4) and T(3) levels, but growth was affected only after 6 months of feeding. During these studies, the deiodinase activities responded in a complex manner to restore plasma and tissue levels of T(3).

Dietary low-glucosinolate rapeseed meal affects thyroid status and nutrient utilization in rainbow trout (Oncorhynchus mykiss).

Two rapeseed (Brassica napus) meals, RM1 and RM2, with two levels of glucosinolates (GLS; 5 and 41 mumol/g DM respectively) were incorporated at the levels of 300 and 500 g/kg of the diets of juvenile rainbow trout (Oncorhynchus mykiss) in replacement of fish meal, and compared with a fish-meal-based diet. A decrease in the digestibility of the DM, protein, gross energy and P was observed with high-rapeseed meal (RM) incorporation. In trout fed on RM-based diets, growth performance was reduced even after only 3 weeks of feeding. Feed efficiency was adversely affected by RM and GLS intake. Protein and energy retention coefficients were significantly lower in fish fed on the diet containing the higher level of GLS. P retention was significantly lower with all the RM-based diets than with the fish-meal diet. Irrespective of the degree of growth inhibition, fish fed on RM-based diets exhibited similar typical features of hypothyroid condition due to GLS intake, expressed by lower plasma levels of triiodothyronine and especially thyroxine and a hyperactivity of the thyroid follicles. This hypothyroidal condition led to a strong adjustment of the deiodinase activities in the liver, the kidney and the brain. A significant increase of the outer ring deiodinase activities (deiodinases type I and II respectively) and a decrease of the inner ring deiodinase activity (deiodinase type III) were observed. It is concluded that the observed growth depression could be attributed to the concomitant presence of GLS, depressing the thyroid function, and of other antinutritional factors affecting digestibility and the metabolic utilization of dietary nutrients and energy.

Inhibition and activation of the thyroidal axis by the adrenal axis in vertebrates.

Hormones of the adrenal or interrenal axis and stress situations which induce elevated glucocorticoid plasma levels (e.g. handling and starvation), inhibit thyroid function in growing and adult vertebrates. However, data indicate that during foetal and embryonic development (mammals and birds) or during larval growth and metamorphosis (fish and amphibians), the adrenal axis may stimulate thyroid function. Recent findings have provided some information concerning this stimulatory interference of the adrenal axis. In amphibians corticotropin releasing hormone and not thyrotropin releasing hormone is thyrotropic during metamorphosis, thus providing the substrate T4 necessary for T3 production. Other data indicate that the increase in plasma T3 at metamorphic climax may be the result of an inhibition of the T3 degrading activity, rather than stimulation of the T4 into T3 converting activity, and that glucocorticoids may be responsible for this. Also, in the chick embryo glucocorticoids effectively increase plasma T3 concentration by reducing the hepatic T3 degrading activity, whereas corticotropin releasing hormone also induces an elevation in the thyrotropin plasma levels and hence raises T4 concentrations which may function as a substrate for T3 production.

Feeding behaviour and food utilisation in tilapia, Oreochromis niloticus: effect of sex ratio and relationship with the endocrine status.

The feeding behaviour of male monosex, female monosex, and mixed groups of Oreochromis niloticus was studied under conditions of self-feeding. Feeding activity was observed almost exclusively during the light period. The food intake pattern was similar whatever the sex ratio, and voluntary food intake (VFI) appeared lower in the male monosex groups than in the others. Male monosex groups displayed higher specific growth rates (SGR) and a lower food conversion ratio than female monosex and mixed groups. The SGR of males was higher in the monosex than in the mixed groups, whereas females of mixed and monosex groups displayed no significant difference in SGR. The efficiency of food utilisation was also analysed: nutrient retention ratios were higher in male monosex than in female monosex and mixed groups. Males displayed a distinctly higher metabolic capacity. Differences in sex-related hormones (11 ketotestosterone = 11-KT, 17beta-Oestradiol = 17beta-E2) and a metabolic hormone (triiodothyronine = T3) were observed between males and females. The hypothesis of an involvement of these hormones in the higher metabolic capacity of males is discussed. The observed differences in feeding behaviour between the different groups also suggest an effect of social interactions on the efficiency of food conversion and thus on the differential growth of males and females.

Characterization of iodothyronine outer ring and inner ring deiodinase activities in the blue tilapia, Oreochromis aureus.

The presence of iodothyronine deiodinases was investigated in the different tissues of blue tilapia (Oreochromis aureus), and their biochemical properties were compared with those of mammalian deiodinases. High-Km rT3 outer ring deiodination (ORD) was observed in tilapia kidney, low-Km T4 ORD in liver, and low-Km T3 inner ring deiodination (IRD) in brain and gill. The rT3 ORD activity in tilapia kidney has a very similar substrate specificity as rat liver type I iodothyronine deiodinase but is much less sensitive to inhibition by propylthiouracil, iodoacetic acid, and aurothioglucose. Tilapia liver T4 ORD activity and tilapia brain and gill T3 IRD activities show very similar substrate specificities as well as similar inhibitor sensitivities as rat type II and type III iodothyronine deiodinase, respectively. The optimal pH of the tilapian enzymes is 6-7, and the optimal incubation temperature is approximately 37 C. All tilapia deiodinases are stimulated by dithiothreitol, but the optimal DTT concentrations are generally lower than those required by the corresponding rat enzymes. The apparent Km values of the various tilapia deiodinases for their preferred substrate are in the same range as for the corresponding rat enzymes. Based on these findings, we conclude that fish deiodinases are more similar to mammalian deiodinases than generally accepted.

Consequences of food restriction on short-term growth variation and on plasma circulating hormones in Oreochromis niloticus in relation to sex.

In tilapia, there is a sex-related growth difference between males and females. This study tried to detect any correlation between the somatic growth and the plasma endocrine status. For this, individually marked (Floytags) male and female tilapia (BW 82 +/- 10 g) were either starved or fed on different daily food rations (1, 2, or 3% of the biomass) during 15 days. We have found that specific growth rates (SGR) were positively and significantly related to feeding levels. Growth hormone (GH) plasma levels tended to increase with the decrease in food levels, and thus with the decrease in growth rate. No significant correlation was found between GH levels and SGR. Triiodothyronine (T3) levels in well-fed fish were higher than those in restricted fish (0 and 1%), but no differences in thyroxine (T4) levels were observed. No significant relationship was found between plasma levels of steroid hormones and feeding ration, even though 11-ketotestosterone (11-KT) levels tended to increase with the ration in fed males. SGR were not significantly different between males and females at the same feeding level, but taken as a whole, they were significantly different in favor of males (P < 0.05). There was no important difference in GH levels between the two sexes. Steroid hormones were, in general, higher in males for 11-KT and in females for 17 beta-estradiol (17 beta-E2). Males and females exhibited significant differences in T3 levels (respectively 4.25 +/- 0.18 and 2.71 +/- 0.09 pmol/ml), whatever the food ration, but no significant differences in T4 levels were observed except in the high-ration group. The correlation between T3 levels and SGR was low but stronger in males (r2 = 0.21; n = 90) than in females (r2 = 0.10; n = 105). The slope of the log-log regression of T3 levels with body weight was much lower in females (b = 0.87) than in males (b = 1.31). This relationship suggests the involvement of T3 in tilapia growth and probably in the differential growth between males and females. In both males and females, a significant but low correlation was observed between T3 and 11-KT levels (respectively r2 = 0.12; n = 82 and r2 = 0.08; n = 89), while no correlation was found between the levels of T3 and 17 beta-E2. T3 plasma levels were found to be the most different parameter between males and females. This hormone seemed to be involved in the control of somatic growth, and could explain the differential growth rate between males and females.

Renal carcinoma in a horse.

A poorly performing nine-year-old thoroughbred mare was presented because of chronic weight loss. On rectal examination an abdominal mass was palpated and, on percussion of the right flank from the 11th to 13th intercostal space, a large area of dullness was delineated. Biopsies taken from the liver region and through the rectum revealed a malignant metastasising tumour of the urinary system. After euthanasia, the post mortem findings confirmed the presence of a papillary renal carcinoma with multiple metastases into the omentum and peritoneum.