Acid-base Parameters Research Articles

Relationship between Apgar score and umbilical cord blood acid-base balance in full-term and late preterm newborns born in medium and severe conditions.

Application of Apgar scores (AS) and umbilical cord blood acid-base analysis is a base for the prediction of future neurological development in children. In clinical practice we often observe huge discrepancy between clinical and biochemical status of newborn. Because many obstetricians consider both assessments as substitute and measure of their proceeding's outcome, we decided to scientifically measure actual correlation between them among newborns born with Apgar less than 8 points. This was an observational retrospective study. The study included 141 newborns born in general medium and severe condition (Apgar < 8 points in first minute of life). Acid-base analysis of umbilical cord vein blood immediately after birth was performed. We correlated gasometer parameters with Apgar scores of newborns. The clinical condition of a newborn at 1, 5, and 10 minutes after birth correlates positively and significantly with pH values (0.25; 0.24; and 0.26; respectively) and bicarbonate levels (0.21; 0.27; 0.28; respectively) in the umbilical cord vein, however correlation was low. Subsequently we qualified newborns to four groups depending on the degree of invasiveness of respiratory support after delivery, and the groups were compared in terms of parameters of acid-based balance. No significant differences were observed between groups in terms of acid-base balance parameters. There is low, but significant correlation between clinical condition of a newborn after birth with most of acid-base parameters from umbilical vein blood. The assessment of the newborn's condition after birth using the Apgar score, (but not acid-base parameters) determines the degree of invasiveness of respiratory support activities for newborns after birth.

Неінвазивна вентиляція легень у онкохворих після операцій на органах грудної клітки

У статті вірогідно доведена клінічна ефективність набувшої останнім часом широкої популярності серед спеціалістів у галузі інтенсивної терапії методики респіраторної терапії — неінвазивної вентиляції легень. Специфікою групи спостереження була онкопатологія органів грудної клітки у хворих у стані після оперативного лікування, оперованих в умовах тотальної внутрішньовенної анестезії із застосуванням штучної вентиляції легень. З метою визначення ефективності досліджуваного способу респіраторної терапії в наведеній групі хворих нами були застосовані методи визначення комфорту хворого з використанням візуально-аналогової шкали. Неінвазивна вентиляція довела свою ефективність як спосіб інтенсивної терапії та метод профілактики респіраторних розладів: у хворих, при веденні яких у постопераційному періоді застосовувалася методика неінвазивної вентиляції легень, було відзначено вірогідне покращання показників кислотно-лужного, газового складу крові та гемодинамічних показників. Під час спостережень були виділені такі показання до застосування методики, що розглядалася, у тактиці інтенсивної терапії хворих, прооперованих із приводу онкологічних утворень грудної порожнини: дихальна недостатність 1–2-го ст. у хворих із збереженою свідомістю, ателектази легеневої тканини, ризик розвинення вентиляторасоційованих пневмоній з урахуванням метаболічних та гемодинамічних порушень, особливо в ранньому післяопераційному періоді. У статті розглянуто й обґрунтовано рекомендації до проведення респіраторної терапії із застосуванням неінвазивної вентиляції легень, параметри режимів та строки вентиляції легень. Розглянута тактика респіраторного післяопераційного ведення онкохворих у стані після оперативних втручань значно скорочує строки перебування пацієнтів в умовах відділень інтенсивної терапії, а отже, зменшує вартість лікування, справляє позитивний психоемоційний ефект, що є дуже важливим у групі ракової патології.

Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap.

Metabolic acidosis is one of the most common complications of chronic kidney disease (CKD). It is associated with the progression of CKD, and many other functional impairments. Until recently, only serum bicarbonate levels have been used to evaluate acid-base changes in patients with reduced kidney function. However, recent emerging evidence suggests that nephrologists should reevaluate the clinical approach for diagnosing metabolic acidosis in patients with CKD based on two perspectives; pH and anion gap. Biochemistry and physiology textbooks clearly indicate that blood pH is the most important acid-base parameter for cellular function. Therefore, it is important to determine if the prognostic impact of hypobicarbonatemia varies according to pH level. A recent cohort study of CKD patients showed that venous pH modified the association between a low bicarbonate level and the progression of CKD. Furthermore, acidosis with a high anion gap has recently been recognized as an important prognostic factor, because veverimer, a nonabsorbable hydrochloride-binding polymer, has been shown to improve kidney function and decrease the anion gap. Acidosis with high anion gap frequently develops in later stages of CKD. Therefore, the anion gap is a time-varying factor and renal function (estimated glomerular filtration rate) is a time-dependent confounder for the anion gap and renal outcomes. Recent analyses using marginal structural models showed that acidosis with a high anion gap was associated with a high risk of CKD. Based on these observations, reconsideration of the clinical approach to diagnosing and treating metabolic acidosis in CKD may be warranted.

Comparison of blood electrolyte and biochemical parameters between single infections of rotavirus and Cryptosporidium parvum in diarrheic Hanwoo calves.

Neonatal calf diarrhea is a major problem in the cattle industry worldwide. Rotavirus and Cryptosporidium parvum are the primary causative agents, especially during the first three weeks of the calf's life. This study investigated the differences in acid-base, electrolytes, and biochemical parameters of diarrheic calves with infection of either rotavirus or C. parvum. A total of 61 Korean native calves (≤ 20 days old) were divided into two groups based on rotavirus or C. parvum infections: rotavirus infection (n = 44) and C. parvum infection (n = 17). The calves with at a specific blood pH range (pH 6.92-7.25) were chosen for comparison. The acid-base, electrolyte, chemistry, and serum proteins were analyzed, Further, fecal examinations were performed. Compared to C. parvum-infected calves, the rotavirus-infected calves showed lower levels of total carbon dioxide, bicarbonate (HCO3-), anion gap, total protein, and albumin/globulin ratio, and significantly lower levels of potassium, globulin, and α2-globulin (p < 0.05). The C. parvum-infected calves (r = 0.749) had stronger correlations between pH and HCO3- than the rotavirus-infected calves (r = 0.598). Compared to rotavirus-infected calves, strong correlations between globulin and α2-globulin, α2-globulin and haptoglobin were identified in C. parvum-infected calves. This study is the first to investigate acid-base, electrolyte, and biochemical parameters in calves in response to infections of rotavirus and C. parvum. Although rotavirus and C. parvum cause malabsorptive and secretory diarrhea in similar-aged calves, blood parameters were different. This would help establish the diagnostic and treatment strategies.

Does blood sampling from caudal vessels in fish produce parameter values different from those obtained by heart puncture?

Analyses of blood samples in ichthyology are of importance for assessment of fish health as well as fish responses to environmental stressors. The measurement results may be affected by multiple factors. This study aimed at assessment of the influence of the blood collection site by comparing dual values of indices measured in samples obtained both from the heart and puncturing caudal vessels in the same fish specimens. Our results revealed that the sampling site did not significantly influence measured variables including haematological indices, the plasma biochemistry profile, acid-base balance parameters and the phagocytic activity. To conclude, for the rainbow trout (Oncorhynchus mykiss) both sampling methods are interchangeable with regard to the above-mentioned indices.

Oxidative stress and biochemical indicators in blood of patients addicted to alcohol treated for acute ethylene glycol poisoning

Ethylene glycol (EG), in addition to its neurotoxic and nephrotoxic effects, evokes oxidative stress. The aim of this study was to assess the influence of the ethylene glycol on the biochemical indicators and oxidoreductive balance of patients treated for acute poisoning. The total study group consisted of 56 persons including 26 alcoholics who took EG as a substitute for ethyl alcohol in the course of alcohol dependence syndrome and 30 controls. Severity of poisoning, results of acid-base parameters, biochemical, and toxicological tests as well as biomarkers of the oxidative stress in blood were analyzed during the patients' hospitalization. The key issue was to assess the oxidative stress and biochemical disturbances caused by EG and the type of treatment applied in the course of poisoning. Significant changes in some parameters were found both at time of diagnosis and after treatment initiation (ethanol as an antidote and hemodialysis). The most important differences included the activity of hepatic parameters (aspartate aminotransferase, AST) and oxidative stress markers like catalase (CAT); correlation of the lipid peroxidation products level (TBARS) with urea concentration has been shown. On the last day of the hospitalization, in some cases, the mutual correlation between the evaluated markers were observed, for example, between alanine transaminase (ALT) and glutathione reductase (GR), and urea concentration and glutathione level (GSH/GSSG). The concentration of ions (H+) had a major impact on the oxidoreductive balance, correlating with the elevated GR and GSH/GSSG levels.

HYPOXIC BRAIN DAMAGEIN PREMATURE INFANTS (MORPHOLOGICAL STUDY)

The aim of the study was to investigate the morphological signs of hypoxic damage to the central nervous system (CNS) in premature infants. Material and methods: The autopsy reports of 20 premature infants were analyzed. The mean gestational age was 25.9±3.7 weeks, median birth weight was 650 [535;940] grams, and height was 32.6±5.4 cm. We analyzed clinical assessment of the infant's condition at birth, the course of the neonatal period, blood gases and acid-base status, the mode and parameters of mechanical lung ventilation, as well as the oxygenation index (OI) and oxygen saturation index (OSI). Macroscopic and histological signs of damage to various brain structures were studied during pathological anatomical examination. Cortex, parietal subcortex, hippocampus, striatum, cerebellum, foci of hemorrhage were examined. Results: The main causes of mortality in premature infants were severe asphyxia and its sequelae such as combined ischemic and hemorrhagic brain and spinal cord damage (45%). Severe hypoxia was confirmed by laboratory investigations. Critical lactate and acid-base blood values corresponding to decompensated lactate acidosis were registered in newborns including hyperlactatemia up to 9±3.6 mmol/l, pH 7.01±0.21, BE (-12.3) [-30; -7.9] mmol/l. The OI and OSI, indicating severity of hypoxia, were significantly elevated with their medians being 13.7[9.6;19.8] and 31.8[9.6;16.2], respectively. All infants had central nervous system lesions of varying severity with the underlying morphological immaturity. Pericellular and perivascular cerebral edema, unilateral or bilateral subcortical and subependymal hemorrhages, intraventricular hemorrhages of various degrees, up to tamponade and blood leakage into the cisterna magna, and cerebral leukomalacia were the most frequent findings. In all patients, altered neuronal shape and size as well as hyperchromic nuclei were revealed in the subcortical zone. Changes in all cell structures (cytoplasm, nuclei, and nucleoli), as well as satellitosis and neuronophagy, were characteristic. Conclusion: Polymorphic morphological changes were observed in the brain structures of premature infants who died as a result of perinatal hypoxia. Along with signs of morphological immaturity, irreversible changes in cortical and subcortical neurons were found. The magnitude of changes is associated with the severity of perinatal hypoxia and decompensated lactate acidosis.

104&#x2003;Metabolic, electrolyte and acid-base parameters in blood and fluids of the reproductive tracts during in vivo maturation of bovine oocytes.

Reproduction, Fertility and Development is an international journal publishing original research , review and comment in the fields of reproduction and developmental biology in humans, domestic animals and wildlife

Association of acidosis with coagulopathy and transfusion requirements in liver transplantation.

The relationship between acidosis and coagulopathy has long been described in vitro and in trauma patients, but not yet in orthotopic liver transplantation (OLT). The association of metabolic acidosis with coagulopathy and with transfusion requirements was evaluated in patients submitted to OLT. Changes in acid-base and coagulation parameters were analyzed by repeated measures. Regression analyses [adjusted for sex, age, model for end stage liver disease (MELD) score, and baseline values of hemoglobin, fibrinogen, international normalized ratio, platelets] determined the association of acid-base parameters with coagulation markers and transfusion requirement. We included 95 patients, 66% were male, 49.5% of the patients had hepatocellular carcinoma and the mean MELD score was 20.4 (SD 8.9). The values of all the coagulation and acid-base parameters significantly changed during OLT, particularly in the reperfusion phase. After adjustments for baseline parameters, the decrease in pH and base excess (BE) values were associated with a decrease in fibrinogen levels (mean decrease of fibrinogen level = 14.88mg/dL per 0.1 unit reduction of pH values and 3.6mg/dL per 1 mmol/L reduction of BE levels) and an increase in red blood cells transfusion (2.16 units of RBC per 0.1 unit reduction of pH and 0.38 units of RBC per 1 mmol/L reduction of BE levels). Among multiple factors potentially associated with adverse outcomes, decreasing pH levels were independently associated with the length of hospitalization but not with in-hospital mortality. Metabolic acidosis is independently associated with decreased fibrinogen levels and increased intraoperative transfusion requirement during OLT. Awareness of that association may improve treatment strategies to reduce intraoperative bleeding risk in OLT.

Effects of the Administration of Different Buffered Balanced Crystalloid Solutions on Acid–Base and Electrolyte Status in Dogs with Gastric Dilation–Volvulus Syndrome: A Randomized Clinical Trial

ObjectiveTo investigate the effect of three different buffered balanced crystalloid solutions on acid–base status and electrolyte concentrations in dogs with gastric dilation–volvulus (GDV) syndrome. MethodsThe study design was a prospective, randomized clinical trial of 40 dogs. The dogs were randomly assigned to one of three groups according to the fluid used: Hartmann's solution (H), Plasmalyte (PL), and Ringerfundin (RF). Hemoglobin, albumin, lactate, electrolyte, and acid–base parameters were determined before fluid administration (T0) and at the end of surgery (T1). Results were assessed by one-way ANOVA, Fisher's exact test, the Wilcoxon signed-rank test, the Kruskal–Wallis test, and a linear mixed-effect regression model. A significance level of 0.05 was used in all analyses. ResultsBicarbonate and base excess (BE) levels increased and chloride concentration decreased in the PL group; in contrast, strong ion difference apparent (SIDapp) decreased and chloride concentration increased in the RF group. The mixed-effect model confirmed a significant interaction between the type of solution and time on the changes in bicarbonate, BE, anion gap (AG), SIDapp, and chloride levels. Clinical significanceSignificantly different effects in acid–base parameters were observed in dogs after intravenous administration of H, PL, and RF. However, clinical significance of these changes is lacking, requiring further investigation in a larger randomized controlled clinical trial.

Mathematically arterialised venous blood is a stable representation of patient acid-base status at steady state following acute transient changes in ventilation.

Hyper- or hypoventilation are commonly occurring stress responses to arterial puncture around the time of blood sampling and have been shown to rapidly alter arterial blood acid–base parameters. This study aimed to evaluate a physiology-based mathematical method to transform peripheral venous blood acid–base values into mathematically arterialised equivalents following acute, transient changes in ventilation. Data from thirty patients scheduled for elective surgery were analysed using the physiology-based method. These data described ventilator changes simulating ‘hyper-’ or ‘hypoventilation’ at arterial puncture and included acid–base status from simultaneously drawn blood samples from arterial and peripheral venous catheters at baseline and following ventilatory change. Venous blood was used to calculate mathematically arterialised equivalents using the physiology-based method; baseline values were analysed using Bland–Altman plots. When compared to baseline, measured arterial and calculated arterialised values at each time point within limits of pH: ± 0.03 and PCO2: ± 0.5 kPa, were considered ‘not different from baseline’. Percentage of values considered not different from baseline were calculated at each sampling timepoint following hyper- and hypoventilation. For the physiological method, bias and limits of agreement for pH and PCO2 were -0.001 (-0.022 to 0.020) and -0.02 (-0.37 to 0.33) kPa at baseline, respectively. 60 s following a change in ventilation, 100% of the mathematically arterialised values of pH and PCO2 were not different from baseline, compared to less than 40% of the measured arterial values at the same timepoint. In clinical situations where transient breath-holding or hyperventilation may compromise the accuracy of arterial blood samples, arterialised venous blood is a stable representative of steady state arterial blood.

Biochemical and cardiovascular predictors of PIMS risk in children after COVID-19 recovery =- the results of the LATE COVID Kids study

Abstract Background Unfortunately, the number of children with the pediatric inflammatory multisystem syndrome (PIMS) associated with previous coronavirus disease has been increasing significantly. Purpose The aim of the present study was to characterize biochemical and cardiovascular predictors of PIMS risk in children recovered from COVID-19 based on the data from the LATE-COVID-Kids study (NCT04799444). Methods 131 consecutive COVID-19 convalescents (mean age: 8.89±4.91; 67 boys and 64 girls) hospitalized for the clinical evaluation after the acute phase of the COVID-19 were classified into two groups related to symptoms: 29 children finally diagnosed with PIMS and 102 children with no-PIMS. All patients had confirmed coronavirus infection based on the positive results of nucleic acid test (RT-PCR - reverse transcriptase-polymerase chain), and they were serologically tested for antibodies against SARS-CoV-2. They had detailed laboratory testing, electrocardiography, and echocardiography. Results The time from COVID-19 recovery was from 1 to 10 months (median 4.0 [3.00–5.00] months). Children with PIMS were significantly younger in comparison to those without (6.60±4.50 vs 9.50±4.80 years, respectively; p=0,005). In comparison to non-PIMS group, children with PIMS had higher level of antithrombin III (111±7.23 vs. 104±10.9; p=0.0015), CK-MB (29.0 [18.5–36.0] vs. 21.0 [15.0–30.7]; p=0.03) and heart rate [HR]/min (100 [89.0–112] vs. 90.0 [79.0–100]; p=0.006) but lower PQ interval (120 [110–120] vs. 130 [120–140]; p=0.023) on admission to hospital. Moreover, the immunological parameters: IgA and neutrophils were lower in children with PIMS vs. no-PIMS (0.69 [0.47–0.85] vs. 1.19 [0.71–1.50]; p=0.0001 and 37.4%±13.3 vs. 43.0±11.6; p=0.0045, respectively), but lymphocytes were significantly higher (50.6±13.6 vs. 43.7±10.9; p=0.002). Some acid-base balance parameters were higher in children following PIMS vs. no-PIMS children group: pCO2 (41.30±5.70 vs. 45.0±7.00; p=0.019), pO2 (50.1 [38.4–59.7] vs. 37.8 [27.9–49.9]; p=0.007), and O2Sat (84.2 [69.3–90.6] vs. 64.2 [44.3–82.6]; p=0.004); however, concentration of HCO3- (23.6 [22.2–24.4] vs. 24.3 [22.8–26.2]; p=0.023) was lower in group of PIMS children. Conclusions Based on our best knowledge, it is the first data on the possible predictors of PIMS risk in children recovered from COVID-19. We showed that children with PIMS have significantly higher levels of antithrombin III, CK-MB, HR, as well as lymphocytes, pCO2, pO2 and O2Sat on admission to hospital and lower levels of PQ interval, IgA, neutrophils and concentration of HCO3. We continue our research to confirm these results and to create the PIMS SCORE algorithm to allow prediction of children with the risk of PIMS occurrence after COVID-19 recovery. Funding Acknowledgement Type of funding sources: None.

Prognosis of Hypothermic Patients Undergoing ECLS Rewarming-Do Alterations in Biochemical Parameters Matter?

Background: While ECLS is a highly invasive procedure, the identification of patients with a potentially good prognosis is of high importance. The aim of this study was to analyse changes in the acid-base balance parameters and lactate kinetics during the early stages of ECLS rewarming to determine predictors of clinical outcome. Methods: This single-centre retrospective study was conducted at the Severe Hypothermia Treatment Centre at John Paul II Hospital in Krakow, Poland. Patients ≥18 years old who had a core temperature (Tc) < 30 °C and were rewarmed with ECLS between December 2013 and August 2018 were included. Acid-base balance parameters were measured at ECLS implantation, at Tc 30 °C, and at 2 and 4 h after Tc 30 °C. The alteration in blood lactate kinetics was calculated as the percent change in serum lactate concentration relative to the baseline. Results: We included 50 patients, of which 36 (72%) were in cardiac arrest. The mean age was 56 ± 15 years old, and the mean Tc was 24.5 ± 12.6 °C. Twenty-one patients (42%) died. Lactate concentrations in the survivors group were significantly lower than in the non-survivors at all time points. In the survivors group, the mean lactate concentration decreased −2.42 ± 4.49 mmol/L from time of ECLS implantation until 4 h after reaching Tc 30 °C, while in the non-survivors’ group (p = 0.024), it increased 1.44 ± 6.41 mmol/L. Conclusions: Our results indicate that high lactate concentration is associated with a poor prognosis for hypothermic patients undergoing ECLS rewarming. A decreased value of lactate kinetics at 4 h after reaching 30 °C is also associated with a poor prognosis.

Treatment of Metabolic Alkalosis with Rice Broth

The available treatments of metabolic alkalosis should be given in the hospital and may be associated with serious adverse events. We aimed to use rice broth for treatment of metabolic alkalosis. Patients with metabolic alkalosis were received oral rice broth solution; serum electrolytes and acid-base parameters were measured before and after the treatment. The majority of patients were older and in the ICU. After treatment with rice broth solution, there was statistical significant decreased in blood PH and serum [HCO3-] from a mean of 7.45 ± 0.03 to 7.4 ± 0.009 and 34.5 ± 4.4 to 24.9 ± 1.1 mmol/l respectively and statistical significant increase in serum [Na+], serum [Cl-], serum [K+], serum [Ca+2], serum [PO4-2] and serum [Mg+2] from a mean of 132.5 ± 3.7 to 136.5 ± 1.9 mmol/l, 93.2 ± 5.4 to 101.9 ± 2.7 mmol/l, 3.1 ± 0.3 to 3.6 ± 0.2 mmol/l, 0.99 ± 0.1 to 1 ± 0.1mmol/l, 3.4 ± 0.5 to 3.6 ± 0.4 mg/dl and 1.88 ± 0.2 to 2.28 ± 0.17 mg/dl respectively. Rice broth is an effective oral treatment of metabolic alkalosis.

Reliability of monitoring acid-base and electrolyte parameters through circuit lines during regional citrate anticoagulation-continuous renal replacement therapy.

BackgroundThe current practice involves blood sampling from the circuit line to measure acid‐base and electrolyte parameters during continuous renal replacement therapy (CRRT). However, there is limited evidence supporting its reliability due to the effects of anticoagulant mechanism and access recirculation associated with regional citrate anticoagulation (RCA).AimTo evaluate the reliability of monitoring acid‐base and electrolyte parameters through circuit lines in regular and reversed connections during RCA‐CRRT.Study designIn this prospective cohort study, we included critically ill patients receiving RCA‐CRRT via a double‐lumen catheter. During the second hour after CRRT initiation, we collected blood samples to monitor acid‐base and electrolyte parameters and their levels were compared between samples from the circuit lines (at 0, 3, and 5 minutes) and those from the central venous catheter (CVC) line (at 0 minute). During this time, CRRT switched to the replacement state as controls.ResultsWe observed 128 CRRT circuits in 60 adult patients receiving RCA‐CRRT. Ninety‐eight (76.6%) circuits had regular connections, while 30 (23.4%) had reversed connections. Among regular connections, no differences were observed in any acid‐base or electrolyte parameters between samples from the CVC line and those from the circuit line at all time points (P > .05). Among reversed connections, ionized calcium levels were dramatically decreased at all three time points in samples from the circuit line compared with those from the CVC line (0.65 ± 0.12, 0.72 ± 0.11, and 0.78 ± 0.99 vs 0.98 ± 0.07 mmol/L, P < .001), with comparable levels of other acid‐base or electrolyte parameters between the sampling patterns (P > .05).ConclusionsAcid‐base and electrolyte parameters could be reliably monitored through the circuit line during RCA‐CRRT in regular connections. However, in reversed connections, pre‐filter ionized calcium concentrations determined through the circuit line were lower than those determined through the CVC line.Relevance to clinical practiceWe suggest sampling from arterial or CVC lines rather than from the circuit line in a reversed connection during RCA‐CRRT.

Genetic and physiological traits conferring tolerance to ocean acidification in mesophotic corals.

The integrity of coral reefs worldwide is jeopardized by ocean acidification (OA). Most studies conducted so far have focused on the vulnerability to OA of corals inhabiting shallow reefs while nothing is currently known about the response of mesophotic scleractinian corals. In this study, we assessed the susceptibility to OA of corals, together with their algal partners, inhabiting a wide depth range. We exposed fragments of the depth generalist coral Stylophora pistillata collected from either 5 or 45m to simulated future OA conditions, and assessed key molecular, physiological and photosynthetic processes influenced by the lowered pH. Our comparative analysis reveals that mesophotic and shallow S. pistillata corals are genetically distinct and possess different symbiont types. Under the exposure to acidification conditions, we observed a 50% drop of metabolic rate in shallow corals, whereas mesophotic corals were able to maintain unaltered metabolic rates. Overall, our gene expression and physiological analyses show that mesophotic corals possess a greater capacity to cope with the effects of OA compared to their shallow counterparts. Such capability stems from physiological characteristics (i.e., biomass and lipids energetics), a greater capacity to regulate cellular acid-base parameters, and a higher baseline expression of cell adhesion and extracellular matrix genes. Moreover, our gene expression analysis suggests that the enhanced symbiont photochemical efficiency under high pCO2 levels could prevent acidosis of the host cells and it could support a greater translocation of photosynthates, increasing the energy pool available to the host. With this work, we provide new insights on the response to OA of corals living at mesophotic depths. Our investigation discloses key genetic and physiological traits underlying the potential for corals to cope with future OA conditions.

Selenoyl-trifluoroacetone: Synthesis, properties, and complexation ability towards trivalent rare-earth ions

The selenium-containing analog of thenoyl-trifluoroacetone has been synthesized and first characterized by UV–visible and NMR-spectroscopies. Synthesis of selenoyltrifluoroacetone was performed by a two-step procedure: acetylation of selenophene and interaction of 2-acetylselenophene with ethyl-trifluoroacetate. The structure of the obtained product has been confirmed using NMR, EI-MS, and elemental analysis. Spectral, acid-base, complexing, and keto-enol parameters were studied under various conditions. Received values of dissociation and protonation constants characterize selenoyltrifluroracetone as a stronger acid and stronger base than acetylacetone. The aqueous chelation with sixteen rare-earth metals has been studied in acetate and glycine buffer media at I = 0.5 M (NaCl). Values of logK non-monotonically increase from La(III) to Lu(III) and lay within the range of 4.5–11.5 logarithmic units. Most of the determined formation constants were higher than analogous values for thenoyl- and furoyl-trifluoroacetone rare-earth metal complexes. Thermodynamic and spectral parameters were simulated using both DFT and TD-DFT approaches.

Carbonic anhydrase inhibitors suppress seizures in a rat model of birth asphyxia.

Seizures are common in neonates recovering from birth asphyxia but there is general consensus that current pharmacotherapy is suboptimal and that novel antiseizure drugs are needed. We recently showed in a rat model of birth asphyxia that seizures are triggered by the post-asphyxia recovery of brain pH. Here our aim was to investigate whether carbonic anhydrase inhibitors (CAIs), which induce systemic acidosis, block the post-asphyxia seizures. The CAIs acetazolamide (AZA), benzolamide (BZA), and ethoxzolamide (EZA) were administered intraperitoneally or intravenously to 11-day-old rats exposed to intermittent asphyxia (30min; three 7+3 min cycles of 9% and 5% O2 at 20% CO2 ). Electrode measurements of intracortical pH, Po2 , and local field potentials (LFPs) were made under urethane anesthesia. Convulsive seizures and blood acid-base parameters were examined in freely behaving animals. The three CAIs decreased brain pH by 0.14-0.17 pH units and suppressed electrographic post-asphyxia seizures. AZA, BZA, and EZA differ greatly in their lipid solubility (EZA > AZA > BZA) and pharmacokinetics. However, there were only minor differences in the delay (range 0.8-3.7min) from intraperitoneal application to their action on brain pH. The CAIs induced a modest post-asphyxia elevation of brain Po2 that had no effect on LFP activity. AZA was tested in freely behaving rats, in which it induced a respiratory acidosis and decreased the incidence of convulsive seizures from 9 of 20 to 2 of 17 animals. AZA, BZA, and EZA effectively block post-asphyxia seizures. Despite the differences in their pharmacokinetics, they had similar effects on brain pH, which indicates that their antiseizure mode of action was based on respiratory (hypercapnic) acidosis resulting from inhibition of blood-borne and extracellular vascular carbonic anhydrases. AZA has been used for several indications in neonates, suggesting that it can be safely repurposed for the treatment of neonatal seizures as an add-on to the current treatment regimen.

Effect of Acid-Base Disorders on Mortality and Level of consciousness for Patients Admitted to ICU: A Prospective Observational Study

Abstract Background: Acid-base disorders are very common in critically ill as well as contribute significantly to morbidity and mortality. Aim: To evaluate the effect of acid-base disorders on mortality and level of consciousness for patients admitted to ICU. Design: descriptive exploratory research design was utilized to conduct this study .Setting: This study was carried out in anesthesia intensive care units at Assiut university hospital. Sample: One hundred sixty adult male and female patients. Tools: Two tools were used in this study, the Critically Ill Patients Characteristics tool, and Acid-base parameters assessment tool. Result: more than one third of the patients (36.3%) had respiratory alkalosis and was the most common acid-base disorder observed on admission . Metabolic acidosis and respiratory acidosis was associated with higher mortality (36.4%), and (22.75). Length of ICU stay was significantly higher in non-survivors (10.23±6.91 versus 7.60±4.69, p= 0.007). Mortality was significantly higher in the GCS < 9 group with metabolic acidosis (37.5 % versus 33.3 %, p=0.033). Conclusion: Respiratory alkalosis was a common acidbase disorder. Acidemia whether due to metabolic or respiratory acidosis is associated with increased mortality in ICU patients. Low GCS low is associated with increased mortality especially in the patients with metabolic acidosis. Recommendation: Closely monitoring and early managment is important to correct acid-base imbalance to avoid poor patient outcomes.

Development of a visual analytics tool for polytrauma patients: Proof of concept for a new assessment tool using a multiple layer sankey diagram in a single-center database

Abstract Objective Early physiological assessment of multiply injured patients is crucial for decision-making and has relied on personal experience of trauma experts. We have developed a new visual analytics tool (Sankey diagram, Watson Trauma Health care tool) that includes known prognostic parameters for polytrauma patients to help guide assessment and treatment decisions for physicians involved in trauma care. Methods A prospectively collected trauma database of a single level I trauma center (3655 patients) was used. Inclusion criteria: age &amp;gt; 16 years, an Injury Severity Score (ISS) &amp;gt; 16, and presence of a complete data set in the database. Data collected included admission values of patient age, injury scoring, shock classification, temperature, acid-base and hemostasis parameters. All of these parameters were collected daily as longitudinal parameters. Endpoints of the clinical course we considered were sepsis, SIRS and early in-hospital mortality (&amp;lt;72 hours). A proof of concept of the visualization was developed over a 2-year period in a cooperation between physicians and engineers. Statistically, the most predictive parameters were selected by binary logistic regression and ROC analysis. Results A dynamic interactive multi-layer Sankey diagram, based on cohort similarities, was developed in a collaboration between a level I trauma center and IBM, from August 2017 until January 2018. It is a modular tool and allows any user to add a new patient, or work with an existing case. The visualisation used the Data-Driven Documents (D3) interactive visualisation library to create a responsive graphic. Conclusion This application summarizes the experience of 3655 polytrauma patients and might serve as a guide for clinical decisions and educative purposes, as well as new scientific questions for the polytrauma patient.