Arachidonic acid metabolism by bovine placental tissue during the last month of pregnancy

Conversion of tritiated arachidonic acid (AA) into metabolites of the cyclo- and lipoxygenase pathways by bovine fetal placental tissue (200 mg) and fetal plus maternal placental tissue (400 mg) of Days 255, 265, 275 of gestation and at parturition (n = 5) during a 30 min incubation was measured using reverse-phase high pressure liquid chromatography. Fetal placental tissue produced 13,14-dihydro-15-keto-prostaglandin E2 (PGEM) as the major metabolite, the synthesis of which increased from Day 265 to Day 275 and parturition by 150% and 475%, respectively. In tissues collected at parturition, PGE2 synthesis was also detected. On Day 275 and at parturition fetal placental tissue synthesized the metabolite 12-hydroxyheptadecatrienoic acid (HHT), and throughout the experimental period the lipoxygenase product 15-HETE was detected with synthesis rates increasing over time of gestation. In addition, an unidentified metabolite was regularly found in the radiochromatograms which eluted at 1 h and 1 min (U101), between HHT and 15-HETE. The synthesis of this metabolite decreased as pregnancy progressed. Furthermore, various other polar and nonpolar metabolites pooled under the heading UNID were eluted, the production of which increased over time of gestation. The presence of maternal placental tissue did not influence the synthesis of PGEM, 15-HETE and U101, but the production of HHT was decreased when maternal tissue was present. Also, as pregnancy progressed, maternal placental tissue seemed to contribute to the pool of unidentified metabolites. In conclusion, fetal placental tissue seems to be the major source of the AA metabolites when compared with maternal placental tissue, and AA metabolism by bovine placental tissue is markedly increased throughout the last month of pregnancy, suggesting a role for AA metabolites in mechanisms controlling parturition.     

Treatment patterns of non-ST-elevation acute coronary syndrome patients presenting at non-PCI centres in the Netherlands and possible logistical consequences of adopting same-day transfer to PCI centres: a registry-based evaluation

Netherlands Heart Journal - European Society of Cardiology (ESC) guidelines recommend same-day transfer to a percutaneous coronary intervention (PCI) centre for angiography in high-risk...     

Influence of luteinizing hormone and prostaglandin F(2alpha) on progesterone secretion in superfused minced bovine luteal tissue in the early stage of the estrous cycle

Minced luteal tissue of bovine corpora lutea from Day 4, 5, and 6 of the estrous cycle (n = 4 corpora lutea each) was superfused for 9 h, and the progesterone secretion under the influence of 100 ng luteinizing hormone (LH)/ml and/or 1,000 ng prostaglandin F(2alpha) (PGF(2alpha))/ml was determined. In vivo, this period of the estrous cycle is characterized by a transition from PGF(2alpha) refractoriness to PGF(2alpha) sensitivity. The investigations were carried out in order to examine whether this transition is reflected by a change in the hormone secretion pattern in vitro. The basal secretion was higher on Day 6 than on Day 4 and 5 (P < 0.01). PGF(2alpha) slightly increased the progesterone secretion, but there was no statistically significant difference (P > 0.05). LH, however, stimulated the progesterone secretion by about 30% in luteal tissue collected from Day 4 and 5 (P < 0.01). In luteal tissue collected from Day 6, the LH-induced increase in hormone secretion was not statistically significant due to two corpora lutea that showed no response at all to LH. The progesterone secretion of the two other corpora lutea, however, was increased by 30% (P < 0.01). When PGF(2alpha) and LH were simultaneously added, the LH-induced progesterone secretion was not inhibited; PGF(2alpha) even seemed to intensify the action of LH. The difference between the hormone secretion under the influence of LH alone and that under the influence of a combination of LH and PGF(2alpha), however, was not statistically significant. It is concluded that in cattle the end of the refractoriness to PGF(2alpha) in vivo is not reflected by a corresponding change of the hormone secretion pattern in vitro.     

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates¹. The incidence of AL varies between 2.5 and 20% ^2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined^{6, 7}.The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis⁸. Furthermore, some anastomoses may be insufficient from the start due to technical failure.Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.     

Practice of ST-segment elevation myocardial infarction care in the Netherlands during four snapshot weeks with the National Cardiovascular Database Registry for Acute Coronary Syndrome

Background

Clinical registries provide information on the process of care and patient outcomes, with the potential to improve the quality of patient care. A large Dutch national acute coronary syndrome (ACS) registry is currently lacking. Recently, we initiated the National Cardiovascular Database Registry (NCDR) for ACS in the Netherlands. The purpose of this study was to assess the NCDR ACS registry on feasibility and data completeness during a pilot phase of four snapshot weeks.

Methods

Between 2013 and 2015, we invited all hospitals in the Netherlands to record a predefined dataset for every patient that was admitted to their hospital with ST-segment elevation myocardial infarction (STEMI). Data were entered in an online case report form. All patient-specific data were encrypted to ensure privacy.

Results

A total of 392 patients were registered in 35 centres. The mean age of the patients was 64 years (SD 13); 8% of patients presented with signs of cardiogenic shock and 11% with an out-of-hospital cardiac arrest. The median time from first medical contact to percutaneous coronary intervention (PCI) was 75 min (IQR 51–108) and this was significantly longer for patients who presented at a non-PCI centre or to a primary care physician. In-hospital and 30-day mortality rates were 5.2% and 7.8%, respectively. The amount of completeness varied, with improved completeness over time.

Conclusion

This report shows that a Dutch ACS registry is feasible with respect to STEMI patients. Data completeness, however, was suboptimal. Improved data completeness is warranted for the future.

     

Steroid synthesis by the fetal part of the bovine placenta of late pregnancy in vitro: Effect of a low dose of dexamethasone in vivo

Pregnant cows were treated with 5 mg dexamethasone (DEX) (n = 5) or 0.9% saline (n = 3) on Day 255 of gestation. Placentomes were removed on Day 250, Day 260 by laparotomy, and immediately after parturition. Fetal placental tissue (500 mg) was homogenized and frozen for the determination of initial tissue content of progesterone (P(4)) and estrone (E(1)) by radioimmunoassay (RIA). Tissue samples (500 mg) were incubated for 1, 5, or 9 h in the presence of 0, 10, or 100 ng/ml androstenedione (A) or pregnenolone (P(5)). After incubation, tissue was homogenized in the incubation medium (HOM) and P(4) and E(1) content assessed by RIA. Finally, tissue was incubated in medium containing (3)H-A or (3)H-P(5) with or without cortisol (70 ng/ml) to measure conversion of precursors into estrogens (E). Overall initial tissue concentration of P(4) decreased as pregnancy progressed (P < 0.05). An interaction between DEX treatment and stage of gestation (P < 0.05) indicated that P(4) decreased only in tissue from DEX-treated cows, whereas P(4) in tissue from control cows remained constant. Tissue concentrations of E(1) increased from Day 250 to parturition (P < 0.05) and were not influenced by in vivo DEX treatment. Progesterone concentration in HOM increased during incubation indicating P(4) synthesis (P < 0.001). Addition of 100 ng/ml P(5) stimulated P(4) production (P < 0.05). There was a larger increase in P(4) in HOM from DEX-treated cows than in HOM from control cows (P < 0.05). Concentration of E(1) decreased during incubation (P < 0.0001) and was not influenced by the addition of A or P(5). Estrogen synthesis was indicated by the conversion of A or P(5) into E (pmol/g/h). The conversion of precursors (A or P(5)) into E increased during gestation and was not influenced by in vivo DEX treatment. Cortisol application in vitro did not affect E synthesis. It is concluded that treatment with 5 mg DEX in vivo on Day 255 of pregnancy does not seem to influence placental E synthesis in vitro. However, the decrease in initial P(4) tissue concentration and the increase in P(4) synthesis by fetal placental tissue from DEX-treated cows in vitro suggest that DEX treatment in vivo stimulates P(4) synthesis with increased metabolism of P(4) into other metabolites.     

Coronary artery dissection following blunt chest trauma: a case report

Coronary artery dissection following blunt chest trauma is rare. We report the case of a 43-year-old woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery. Ten days earlier, she had sustained a minimal chest trauma. The literature is reviewed and management is discussed.