Changes In Lactate Research Articles

Negative alactic base excess is reversed by hemoperfusion in septic patients

Introduction: Gattinoni et al. have recently introduced a new parameter: the “alactic base excess” (ABE). ABE is equivalent to the number of strong acids, other than lactate, which are present in the plasma in abnormal concentrations, negative ABE being associated with higher mortality in sepsis. Hemoperfusion (HPF) is an extracorporeal procedure that involves the passage of blood through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Then, it was decided to explore the influence of HPF on negative ABE value in sepsis. Materials and methods: Basal values of ABE, standard base excess (SBE), and lactate (mean, standard deviation [SD]) were obtained. The difference between these parameter values before and after four sessions of HPF (HA330) (delta value) was evaluated. Student’s t-test and Wilcoxon test were applied. Results: From 32 patients (age: 57±13) suffering from respiratory insufficiency secondary to COVID-19 who were treated with HPF in the critical care unit of Clinica de la Mujer, Bogotá (Colombia), 6 patients presented with metabolic acidosis with negative ABE value (‒2.7±1) with negative SBE (‒4.7±1) and high lactate serum value (2±0.7 mmol/L). Delta ABE, SBE, and lactate were: 7.7 (p = 0.005), 6.1 (p = 0.003), and 1.6 (p = NS), respectively. Thus, negative ABE was significantly reversed by HPF, since SBE value turned positive without significant change in lactate. Conclusion: Negative alactic parameter was significantly reversed by HPF in septic patients. It is necessary to carry out evaluations in larger groups to estimate their impact on clinical outcomes.

493: MULTIMODAL NEUROMONITORING: CEREBRAL MICRODIALYSIS IN A CASE OF INTRACEREBRAL HEMORRHAGE

Introduction: Cerebral Microdialysis (CMD) is a FDA approved multimodal invasive monitor technique that provides measurements of local brain metabolism via continuous sampling of interstitial brain fluid at bedside. Past applications in TBI and SAH show that acute brain injury (ABI) can lead to metabolic crisis reflected by changes in cerebral glucose, pyruvate and lactate. Limited literature exists on CMD in spontaneous intracerebral hemorrhage (ICH). Description: A 45 year old woman presented with a GCS of 8T and a 89 cc left frontal ICH with ventricular involvement and 9 mm of midline shift. She underwent craniotomy and minimally invasive perifascicular surgery with BrainPath (NICO, IN) for evacuation. Intraoperatively, Quad Lumen Bolt (Hemedex, MA) with CMD (M-Dialysis, MA), PbtO2 (Licox, Integra, NJ) and ICP (Camino, Natus, CA) monitors were placed in the peri-hematoma region. Post operatively, mean ICP was normal (13.2 +/- 4.7 mm Hg) though mean brain tissue oxygen (5.4 +/- 4 mmHg) and glucose (13.9 +/- 4.9 mg/dl) were low and lactate/pyruvate ratio (65.8 +/- 16 mmol/L) was high. Due to concern for metabolic crisis, poor exam and hydrocephalous on head CT, the patient underwent external ventricular drainage (EVD). Post EVD, mean ICP (8.8 +/- 2.7 mmHG) and L/P ratio (31.4 +/- 9 mmol/L) decreased, and PbtO2 (23.8 +/- 11 mmHg) and glucose (26.2 +/- 6.1 mg/dl) increased. All pre and post EVD changes were statistically significant on student-test (P<.05). Monitors were removed without complication. The patient was discharged to nursing facility with a modified rankin scale of 4. Discussion: Here we demonstrate the safe implementation of CMD in ICH and the use of CMD in tandem with PbtO2/ICP to guide treatment in ICH. Despite a normal ICP, numerous cerebral metabolic derangements existed and improved after CSF diversion. A normal ICP may not reflect underlying metabolic-substrate demands of the brain during acute brain injury. CMD and PbtO2 monitoring augment traditional ICP monitoring in brain injury. Further prospective studies will need to be performed to understand the interplay between ICP, cerebral metabolic and PbtO2 in ABI.

The effect of positive pressure ventilation on serum ischemia-modified albumin levels in obese patients with obstructive sleep apnea syndrome.

Respiratory abnormalities in obstructive sleep apnea syndrome (OSAS) are corrected with positive pressure ventilation treatments. We investigated the effect of positive airway pressure (PAP) treatment on the serum level of ischemia-modified albumin (IMA), an oxidative stress product, in OSAS patients with higher body mass index (BMI) and indication for PAP treatment. Seven consecutive female and 23 male patients with a BMI of ≥30 kg/m2 who were diagnosed as having OSAS according to ICSD3 criteria and were planned for PAP, were included. The Epworth Sleepiness Scale and STOP-Bang Questionnaire were performed. Morning arterial blood gas, hemogram, biochemistry, insulin, and IMA were measured after polysomnography and after three months of PAP. There were no significant changes in lactate, CRP, and serum electrolyte levels measured before and after PAP, except for potassium. When 30 patients were compared in terms of serum IMA levels at baseline and after treatment, the mean baseline value was 0.56 absorbance units (ABSU), and the 3rd-month follow-up IMA value was 0.53 ABSU (p= 0.537). The mean serum fasting insulin level was 15.85 µIU/mL and 11.6 (p= 0.002) and the mean HOMA index was 4.4 and 3.0 (p= 0.001), respectively. Serum IMA levels seem not to be an appropriate marker for the evaluation of PAP treatment in OSAS patients with higher BMI. PAP is associated with a decrease in the fasting insulin level, HOMA index, and hematocrit, but not with serum electrolytes except potassium.

Neurotrophic and growth factor response to acute exercise across the lifespan

AbstractBackgroundThere is evidence that aerobic exercise is beneficial to the brain and may reduce risk for cognitive decline and dementia. However, clinical trials have shown the benefits of exercise programs vary amongst individuals. This variability may occur in part due to differences in the physiological biomarker response to acute exercise. Characteristics such as age, sex, and apolipoprotein E4 (APOE4) genotype may affect these responses, but differences in blood processing protocols may introduce additional variability into the measures.MethodWe characterized the blood biomarker response to acute exercise in 80 individuals, including older adults (n=62, mean age 73y) and 18 young controls (n=18, mean age 37). Participants engaged in an acute, 15 minute bout of moderate intensity exercise (45‐55% HRR) following a 5 minute warm‐up. Blood was collected immediately prior to exercise, immediately post exercise, and 40 minutes post exercise. After collection, each timepoint sample was immediately processed for plasma and platelet poor plasma and frozen; this was done to limit release of growth factors from activated platelets post‐blood draw. Time course responses of brain derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), insulin like growth factor 1 (IGF1) were measured using ELISA in platelet poor plasma. Lactate was measured in plasma (YSI 2500).ResultLinear mixed modeling performed with age, sex, and APOE4 genotype as covariates revealed a significant change in BDNF (p&lt;0.001) and lactate (p&lt;0.001) over time, with the highest levels of lactate observed immediately post‐exercise, while BDNF was elevated at 40 minutes post‐exercise in both young and older adults. There was no significant change with either VEGF or IGF1 over time in response to exercise, although older adults had significantly higher VEGF (p=0.01) and lower IGF1 (p&lt;0.001) compared to young controls across all timepoints.ConclusionWe report here that analysis of the acute exercise response reveals a significant increase in circulating BDNF and lactate, but not VEGF or IGF1, following aerobic exercise in both young controls and older adults. Further investigation into the mechanisms that contribute to these changes and the relevance to additional fluid and imaging brain health biomarkers in this cohort is ongoing.

Acute Effects of Heavy Strength Training on Mechanical, Hemodynamic, Metabolic, and Psychophysiological Parameters in Young Adult Males.

This study analyzed the acute effects of heavy strength training on mechanical, hemodynamic, metabolic, and psychophysiological responses in adult males. Thirteen recreational level males (23.3 ± 1.5 years) randomly performed two heavy strength training sessions (3 sets of 8 repetitions at 80% of one repetition maximum [1RM]) using the bench press (HST-BP) or full squat (HST-FS)). The repetition velocity was recorded in both sessions. Moreover, before and after the sessions, the velocity attained against the ~1.00 m·s−1 load (V1Load) in the HST-BP, countermovement jump (CMJ) height in the HST-FS, blood pressure, heart rate, blood lactate, and psychophysiological responses (OMNI Perceived Exertion Scale for Resistance Exercise) were measured. There were differences between exercises in the number of repetitions performed in the first and third sets (both <8 repetitions). The velocity loss was higher in the HST-BP than in the HST-FS (50.8 ± 10.0% vs. 30.7 ± 9.5%; p < 0.001). However, the mechanical fatigue (V1Load vs. CMJ height) and the psychophysiological response did not differ between sessions (p > 0.05). The HST-FS caused higher blood pressure and heart rate responses than the HST-BP (p < 0.001 and p = 0.02, respectively) and greater blood lactate changes from pre-training to post-set 1 (p < 0.05). These results showed that the number of maximal repetitions performed in both sessions was lower than the target number and decreased across sets. Moreover, the HST-BP caused a higher velocity loss than the HST-FS. Finally, the HST-FS elicited higher hemodynamic and metabolic demand than the HST-BP.

Phenotypic Variations Related to Hypoxic Responses Among Andean Highlanders Living at Different Altitudes (400m, 4000m, 5000m)

Introduction Adaptation to high altitude poses selective evolutionary changes involving multiple and challenging adaptive responses, and one of them deals with the low pressure of oxygen. Native Bolivian Andeans have lived at an average of 3000-5000 m for about 14,000 years, and have developed different erythroid phenotypes compared to other populations living at high altitude (PMID 30781443; PMID 25342802). Although Andeans have developed genetic adaptations related to erythropoiesis regulation (Blood, ASH 2316, 2018) they still undergone with polycythemic states, and those of clinical relevance are often Chronic Mountain Sickness erythrocytosis (CMS-E), secondary erythrocytosis (SE) and polycythemia vera (PV) (Rev Hematol Mex. 2016 Jan;17(1):8-20). Either adaptation or erythrocytosis condition entails important changes in hemoglobin, SpO2, P50 and lactate, so evaluating significant changes among Andeans living at different altitudes as well as the modifications between erythrocytosis patients and healthy highlanders became of interest. Material and method We collected venous blood samples from Bolivian native Andeans born at 4000 m (n=124) but living at 3 different altitudes (400 m, 4000 m, 5000 m), aside from Europeans (n=11) residing at 4000 m. Complete blood count, venous blood gas, and oxygen saturation studies were performed. P50 was measured by using a formula described by Lichtman. Likewise, a differential diagnosis regarding healthy inhabitants and polycythemia patients was performed. Results In healthy Andean inhabitants in different altitudes, the Hb levels increased at increasing altitude (p:0.001), meanwhile SpO2 (p:0.001) and P50 (p:0.001) decreased. No lactate variations among them were observed (Table 1). European subjects at 4000 m in relation to Andean inhabitants at the same altitude displayed higher Hb levels (p: 0.01), without variations in SpO2 and P50, but a significant increased lactate (p: 0.001) (Table 1). When comparing healthy subjects and patients with erythrocytosis (CMS-E, SE, PV) at 4000 m, the latter displayed higher Hb levels (p:0.001), decreased SpO2 (p:0.001), no variations in P50, and increased lactate in CMS-E and SE patients (p:0.01) (Table 2). Similarly, patients with erythrocytosis (CMS-E, SE) at 5000 m, related to healthy subjects at the same altitude, reflected increased Hb (p:0.001), decreased SpO2 (p:0.01), P50 without variations, and increased lactate (p:0.01) (Table 2). Conclusions Native Andeans from Bolivia born at 4000 m but living at different altitudes have variations regarding hematological phenotypes, decreased P50 shifts the hemoglobin dissociation curve to left. Patients with erythrocytosis have distinct phenotypes in relation to healthy subjects characterized by decreased saturation and increased lactate. Higher Hb levels and increased lactate in Europeans living at 4000 m probably due to the different residing time at high altitude, since native Andean inhabited high-altitude regions for many years. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Integrated biomarker response index as an ally in the observation of metabolic biomarkers in muscle of Astyanax lacustris exposed to thermal variation

Temperature is an important factor that conditions the physiological responses of fish, generating a stressful condition when in non-ideal parameters. Thus, the objective was to evaluate metabolic aspects in the muscle of fish Astyanax lacustris submitted to thermal shock. The specimens were subjected to 2, 6, 12, 24, 48, and 96 h of exposure to 15 °C and 31 1 °C, with their respective controls 23 °C. At 15 °C there was a reduction in glycogenolysis in the initial periods indicated by changes in glycogen phosphorylase (GP), pyruvate and lactate. Subsequently, there was an increase in GP activity, pyruvate levels and hexokinase activity in the next time periods, suggesting an increase in energy demand. At 31 °C there was observed low need for the protein metabolism, indicated by reduction in the activity of aspartate aminotransferase and alanine aminotransferase. At 15 °C, initial periods show an increase in glutathione reductase activity and an increase in carbonylated protein levels, indicating induction of oxidative stress for muscle. At 31 °C, there was a punctual increase in reduced glutathione levels at 24 h. In addition, the integrated biomarker response index proved to be a good ally in the evaluation of a set of biomarkers, corroborating the results observed by the biomarkers individually. Thus, it is possible to conclude that the acute thermal shock affects the metabolism of A. lacustris muscle, which undergoes rearrangements to deal with temperature, where 15 °C is more stressful than 31 °C.

Suppression of milk-derived miR-148a caused by stress plays a role in the decrease in intestinal ZO-1 expression in infants

Milk-derived miR-148a-3p (miR-148a), which is abundant in breast milk, has been shown to be associated with the development of infants' intestines. Although it is well known that stress during lactation changes milk constituents in terms of lipid and protein, no studies have examined the influence of stress on miR-148a expression in breast milk. The objective of this study is to investigate the relationship between stress and miR-148a expression in milk, and to evaluate whether the changes in milk-derived miR-148a expression-caused by the mother's exposure to stress-influence intestinal ZO-1 expression in infants. The participants of this study were healthy Japanese women who were nursing. Psychological stress evaluation of the subjects was conducted using a short form of the Profile of Mood State Second Edition-Adult (POMS-2). Additionally, miR-148a expressions in restraint stressed nursing mice were investigated using quantitative real-time PCR. The levels of a tight junction protein zonula occludens-1 (ZO-1) and DNA methyltransferase 1 (DNMT1), which is a direct target of miR-148a, in ileum in neonatal mice breastfed by stressed nursing mice were investigated using Western blot. Furthermore, to investigate the influence of miR-148a on ZO-1 expression within the intestine, the levels of ZO-1 and DNMT1 in human intestinal epithelial Caco-2cells with lentivirus-mediated miR-148a overexpression were evaluated. A significantly negative correlation was observed between relative miR-148a expression in breast milk and the total mood disturbance T-score. Each T-score on negative mood subscales of anger-hostility, confusion-bewilderment, depression-dejection, fatigue-inertia, and tension-anxiety was significantly negatively correlated with relative miR-148a expression in breast milk: a positive mood subscale vigor-activity T-score was significantly positively correlated with relative miR-148a expression in breast milk. A positive mood friendliness T-score, estimated separately from other scores, was significantly positively correlated with relative miR-148a expression in breast milk. Additionally, the relative expression of miR-148a in the milk obtained from stressed mice was significantly lower than that of control mice. The relative level of ZO-1 in ileum of neonatal mice nursed by stressed mice was significantly lower than that of neonatal mice nursed by control mice. Additionally, the relative level of DNMT1 in ileum of neonatal mice nursed by stressed mice was significantly higher than that of neonatal mice nursed by control mice. Furthermore, the relative level of ZO-1 in miR-148a-overexpressed Caco-2cells was significantly higher than that in control cells. The relative level of DNMT1 in miR-148a-overexpressed Caco-2cells was significantly lower than that in control cells. Mothers' exposure to stress during lactation may cause miR-148a expression in breast milk. Additionally, stressed-induced suppression of miR-148a expression in breast milk may cause a decrease in intestinal ZO-1 level via the increase in DNMT1 in infants' intestines. These observations are beneficial information for breastfeeding mothers and their families and perinatal medical professionals. Our findings encourage monitoring maternal psychological stress during lactation to promote breastfeeding and adequate infant nutrition.

Smart Bandage to Monitor Combat Wounds and Control Bacterial Infections During Military Operations

In the United States Army, nearly 50% of soldiers experience 1 or more injuries a year during deployment and mission operations. The most common injuries during these operations can be classified between saturable wounds, such as lacerations and punctures, and non-saturable wounds, such as blast wounds, gunshot wounds, head injuries, bone fractures, burns, and ulcers. In all cases, the leading post-wound treatment are complications associated with wound infections; with sepsis being the leading cause of death in after wound care. Gram-positive, gram-negative, and fungal infections are the most prevalent types of infections seen in the U.S. Army, with Staphylococcus aureus (s. aureus) being the most common infection recorded in about 20% of soldiers. Present techniques are limited to using pressure pads and antibacterial gels for preventing infections. These approaches cannot be integrated into a wearable construct and do not offer a reliable method of management. Therefore, monitoring and treating infection in combat wounds is a major healthcare challenge in wound care management for army application.Our work focuses on developing a wearable smart bandage that can detect a change in pH and lactate using an electrochemical sensing approach that responds as a function of bacterial infection and can monitor in real-time using data generated by sensors. Further, the pH sensing causes a triggered release of drug molecules that control bacterial infection in the wound bed. The electrochemical pH sensors were fabricated by printing commercial flexible inks onto a stretchable thermoplastic polyurethane (TPU, TE-11C DuPontTM) film, and subsequently heat laminating over a cotton gauze (thickness: 100 μm). A conventional three-electrode cell assembly consisting of SPCE, Ag/AgCl as a reference electrode, and a Pt wire as a counter electrode was used for the experiments. CV was performed to assess the performance of the electrodeposited polyaniline. The measurements were performed at a scan rate of 0.02 V s-1 in a potential window of 1 V and -0.2 V. Sensor stability was characterized under room temperature and physiological conditions (RT) over 3 days. In case of the triggered drug release, we synthesized chitosan-pH responsive polymer using an ionic gelation process and drug ampicillin and kanamycin were encapsulated with a 64% efficiency. The polymer released drug above pH 6.5 which correlated to 105 bacterial CFU/ml, thus was incorporated in the bandage matrix and served as a controlled release when infection occurs. It was observed that pH tends to rise as infection progress therefore ideal for drug release in an alkaline environment.Finally, the sensor was able to detect bacterial cells ranging from 102-105 cells and the drug release showed an 82% reduction in cell number. The work carried out highlights an integrated sensor to sense bacterial infections and simultaneously trigger drug release. In light of current findings, this study allowed us to understand the dynamic interaction occurring between the sensor surface and wound bed and the sensor data showed a direct correlation to bacterial infection. The sensor can be integrated into a multiplex wearable device detecting different biomarkers to simultaneously monitor and manage infection in combat as well as chronic wounds.

Dual-Color Fluorescent Hydrogel Microspheres Combined with Smartphones for Visual Detection of Lactate.

Since it is difficult for human eyes to distinguish between two identical colors with only <15% variation in brightness, mono-color fluorescent hydrogel microspheres have some limitations in the detection of lactate. Herein, we prepared novel dual-color fluorescent hydrogel microspheres, which can achieve hue transformation. Microspheres were prepared by introducing a fluorescent nanoparticle as the reference signal while CdTe QDs were used as the response signal. We used smartphones with image processing software to collect and analyze data. In this way, the signal of lactate was converted to RGB (red, green, and blue) values, which can be quantitatively read. Within 10 to 1500 μM, the R/G values of the microspheres had a linear relationship with the logarithm of the lactate concentration. Moreover, color cards for lactate detection were prepared, from which the color change and concentration of lactate could be easily read by the naked eye. It is worth mentioning that this method was successfully applied to screen patients with hyperlactatemia.

Fibroadenoma in axillary accessory breast tissue: a case report

BackgroundAccessory breast(s) is defined as the presence of more than two breasts with or without a nipple and areola in human beings. It may occur anywhere along the primitive embryonic milk lines, which extend from the axilla to the groin. Accessory breast tissue can potentially undergo the same physiological and pathological processes as the normally located breast, including lactational change, fibroadenoma, and carcinoma. Although common in the normally located breast tissue, the incidence of fibroadenoma in accessory breast tissue is rare. Furthermore, if the swelling occurs in the axilla or groin, it may present a diagnostic challenge by clinically mimicking a lymphoma or other causes of lymphadenopathy. Owing to its rarity and its tendency to pose a clinical diagnostic challenge, we decided to report a case of fibroadenoma in axillary accessory breast.Case presentationA 28-year-old Ethiopian female patient came to University of Gondar comprehensive specialized hospital with a complaint of left axillary swelling of 3 years duration. There was no history of cough, fever, weight loss, or night sweating. On physical examination, there was an approximately 5 × 4 cm, firm, well-defined, mobile, nontender solitary mass in the left axilla that was completely separated from the left breast. Fine-needle aspiration cytology suggested a diagnosis of fibroadenoma in axillary accessory breast tissue. The mass was completely excised, and histopathologic examination confirmed the diagnosis. Her recovery was uneventful. She was informed about the diagnosis, reassured, and discharged from care.ConclusionIn the clinical evaluation of a patient with axillary swelling, accessory breast tissue disorders such as fibroadenoma must be considered as a differential diagnosis for early diagnostic workup and management. Moreover, this case underscores the fact that, similar to normal breast tissue, accessory breast tissue is also susceptible to the same pathologic disease processes including neoplasms such as fibroadenoma.

Acute effects of two different work-to-rest ratio of high-intensity interval training on brain-derived neurotrophic factor in untrained young men.

Background: Aerobic exercise could produce a positive effect on the brain by releasing brain-derived neurotrophic factor (BDNF). In untrained healthy humans there seems to be a linear correlation between exercise duration and the positive effect of acute aerobic exercise on brain-derived neurotrophic factor levels. Therefore, we performed two different duration of high-intensity interval training protocols (HIIT), both known to improve cardiovascular fitness, to determine whether then have a similar efficacy in affecting brain-derived neurotrophic factor levels. Methods: 12 untrained young males (aged 23.7 ± 1.8 years), participated in a randomized controlled cross-over trial. They underwent two different work-to-rest ratio high-intensity interval training protocols: high-intensity interval training 1 (30 min, 15 intervals of 1 min efforts at 85%–90% VO2max with 1 min of active recovery at 50%–60% VO2max) and HIIT2 (30 min, 10 intervals of 2 min efforts at 85%–90% VO2max with 1 min of active recovery at 50%–60% VO2max). Serum cortisol, brain-derived neurotrophic factor were collected at baseline, immediately following intervention, and 30 min into recovery for measurements using a Sandwich ELISA method, blood lactate was measured by using a portable lactate analyzer. Results: Our results showed that the similar serum brain-derived neurotrophic factor change in both high-intensity interval training protocols, with maximal serum brain-derived neurotrophic factor levels being reached toward the end of intervention. There was no significant change in serum brain-derived neurotrophic factor from baseline after 30 min recovery. We then showed that both high-intensity interval training protocols significantly increase blood lactate and serum cortisol compared with baseline value (high-intensity interval training p < 0.01; high-intensity interval training 2 p < 0.01), with high-intensity interval training 2 reaching higher blood lactate levels than high-intensity interval training 1 (p = 0.027), but no difference was observed in serum cortisol between both protocols. Moreover, changes in serum brain-derived neurotrophic factor did corelate with change in blood lactate (high-intensity interval training 1 r = 0.577, p < 0.05; high-intensity interval training 2 r = 0.635, p < 0.05), but did not correlate with the change in serum cortisol. Conclusions: brain-derived neurotrophic factor levels in untrained young men are significantly increased in response to different work-to-rest ratio of high-intensity interval training protocols, and the magnitude of increase is exercise duration independent. Moreover, the higher blood lactate did not raise circulating brain-derived neurotrophic factor. Therefore, given that prolonged exercise causes higher levels of cortisol. We suggest that the 1:1work-to-rest ratio of high-intensity interval training protocol might represent a preferred intervention for promoting brain health.

Impact Of Traditional Blood Flow Restriction Versus Band Tissue Flossing On Metabolism And Performance

Blood flow restriction during resistance exercise (BFR + RE) increases metabolic stress and muscle fiber recruitment, elevating fatigue even at low resistance loads. Band tissue flossing (BTF) is a method for BFR in which an elastic band wraps around the limb. PURPOSE: The purpose of this study was to compare the effects of BTF to BFR during RE on changes in glucose, lactate, and total work performed. METHODS: Fifteen apparently healthy subjects (25 ± 1.2 yrs) visited the lab for three sessions separated by at least 72 hours. Each session involved 3 sets of 20 max-effort seated leg extensions and flexions on an isokinetic dynamometer with one of three randomized conditions: control (CON), BFR, or BTF. During BFR and BTF sessions, occlusion was applied immediately before exercise and removed immediately after collecting post- blood. Glucose and lactate measurements were collected pre- and immediately post-exercise. Total work performed was recorded during each extension and analyzed for between-condition differences. RESULTS: Only CON and BTF conditions resulted in significantly lower glucose immediately post-exercise compared to pre- (mean change: CON = -11.0 ± 13.5 and BTF = -10.31 ± 10.9 mg/dL). However, no significant differences in mean change in glucose were found between any conditions. In all conditions, blood lactate post-exercise was significantly greater than pre- (mean change: CON = 3.5 ± 0.6, BFR = 3.4 ± 0.5, BTF = 3.4 ± 0.6 mmol/L), again with no between-condition differences in mean change. Total work performed during set 1 was not significantly different between conditions. During set 2, significantly less work was performed in BFR (p = 0.046; 1024.9 ± 96.9 ft-lbs) and BTF (p = 0.004; 865.1 ± 118.2 ft-lbs) when compared to CON (1182.0 ± 115.6 ft-lbs). During set 3, significantly less work was again performed in the BTF condition (p < 0.001; 663.1 ± 333.7 ft-lbs) when compared to CON (1050.7 ± 325.8 ft-lbs). CONCLUSIONS: Application of an occluding device, whether BFR or BTF, results in significantly less work done than without occlusion. Despite the decrease in work, BFR and BTF + RE result in similar increases in lactate and uptake of glucose than CON. This suggests both BTF and BFR are effective for achieving significant metabolite production during RE via lesser amounts of work.

Neonatal breast-suckling skills in the context of lactation and peripartum hormonal changes and additional factors—a pilot study

BackgroundChildbirth and lactation are intricate processes, involving several hormones, the most important of which are prolactin (a protein hormone) and cortisol (one of the glucocorticoids). The early postpartum period is crucial for both mother and newborn and has an impact on the lactation and breastfeeding process.MethodsThe study included 78 patients who were admitted to the Gynecology-Obstetrics Clinical Hospital in Poznań for labor induction and/or in the active phase of the first labor stage. The levels of cortisol and prolactin in serum were assessed in these women during admission in labor, during the third labor stage, and on the second day postpartum. The levels of cortisol and prolactin in the umbilical cord serum were assessed immediately after cord clamping. The “Protocol for the assessment of breast-suckling skills” was used to assess the neonatal breast-suckling skills on the second day postpartum. Some additional parameters were evaluated in mothers via a telephone interview at three and six months postpartum. The study was conducted from January to August 2020, however the study was suspended during April–July 2020 due to the SARS-CoV-2 pandemic, which led to restrictions in the hospital limiting access to the hospital wards unless necessary.ResultsEarly breastfeeding with skin-to-skin contact was associated with low levels of hormones, cortisol levels were lower in serum (p = 0.0108) and umbilical vein (p = 0.0273) in mothers who breastfed immediately after childbirth. At three months postpartum, 88% of the mothers who did not offer a pacifier to the child during the first few days of life breastfed the child naturally (p = 0.037), and at six months, 96% of those who did not offer a pacifier continued to breastfeed (p = 0.0008). Multiple, statistically significant correlations were observed between the variables assessed according to the “Protocol for the assessment of breast-suckling skills” and breastfeeding after three months.ConclusionsBreastfeeding immediately after childbirth, appropriate assessment of the breast-suckling skills of newborns, avoiding pacifiers and infant formula feeding, and offering support to new mothers in the early days after childbirth seem to be important factors for sustaining breastfeeding after three and six months of childbirth.

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal).

Hyperlactatemia, a problem reported in up to 30% of cardiac surgery patients, results from excessive production of or decreased clearance of lactate. It is typically a symptom of tissue hypoperfusion and may be associated with the prevalence of postoperative acute mesenteric ischemia and renal failure, or prolonged intensive care unit (ICU) and hospital stay, and increased 30-day mortality. Eighty cardiac surgery patients using cardiopulmonary bypass (CPB) were randomly assigned into either a placebo (n = 39) or norepinephrine 0.05-0.2 µg/kg/min (n = 41) as well as norepinephrine boluses during CPB to maintain mean arterial blood pressure (MAP) at 65 to 80 mm Hg. Patient assignments were done after receiving ethical approval to proceed. The primary result was the perioperative changes in lactic acid level. Secondary findings were also recorded, including hemodynamic variables, the incidence of vasoplegia, intraoperative hypotension, myocardial ischemia, the need for vasopressor support, postoperative complications, and mortality. The peak levels and perioperative changes in blood lactate during the first 24 postoperative hours, the number of patients who experienced early hyperlactatemia on admission to the ICU (Placebo: 46.2%, Norepinephrine: 51.2%, p = .650), vasoplegia, hemodynamic changes, incidences of intraoperative hypotension, myocardial ischemia, postoperative complications, and mortality rates were similar in the two groups. Patients in the norepinephrine group received lower intraoperative rescue norepinephrine boluses to maintain the target MAP (p = .039) and had higher MAP values during the CPB and intraoperative blood loss [mean difference [95% confidence interval]; 177 [20.9-334.3] ml, p = .027]. norepinephrine and placebo infusions during the CPB with the maintenance of MAP from 65 to 80 mmHg had comparative effects on the changes in blood lactate and incidence of vasoplegia after cardiac surgery. Norepinephrine infusion maintained higher MAP values during the CPB.

The Association Between Serum Lactate Concentration, Base Deficit, and Mortality in Polytrauma Patients as a Prognostic Factor: An Observational Study.

IntroductionIn polytrauma patients, it is crucial to identify the severity of the injuries to ensure patient safety and survival. Polytrauma leads to hypotension and hypoperfusion, which results in an anaerobic metabolism with acidosis and a decrease in base excess. Thus, blood lactate levels above a certain threshold indicate the existence of global tissue hypoxia, which is a precursor to shock and multiple organ dysfunction syndrome (MODS). The serum lactate and base deficit (BD) levels are used in polytrauma patients as measures of damage severity and resuscitation endpoints and as a way to evaluate therapy efficacy and to predict outcomes. Thus, arterial blood gas analysis is of great value in assessing the status and prognosis of patients with polytrauma. There are few comparative studies on the predictive values of these markers in trauma patients. To determine which measure can more accurately predict the prognosis of polytrauma patients, the present study investigated the predictive values of mortality of these indicators for mortality within 48 hours of admission to the emergency room (ER) in patients with polytrauma.MethodsThis prospective study was designed for a single tertiary care center in northern India. We included 90 patients with polytrauma who were between the ages of 18 and 70 years, with the exception of pregnant women, who presented to the ER within six hours of injury with an injury severity score (ISS) >16, serum lactate level >2.0 mmol/L, and BD -4.0 mEq/L at the time of admission. If the patient's ISS was >16 at the time of ER presentation, arterial blood samples were drawn to determine the serum lactate and BD level at the time of admission and at 12, 24, and 48 hours intervals after ER admission. The primary outcome was the change in serum lactate and BD level in polytrauma. The secondary outcomes were an association of serum lactate and BD with mortality and the correlation between serum lactate with the BD and ISS with mortality of polytrauma patients. The timing of all outcome assessments was at 48 hours after each patient's ER admission.ResultsLactate clearance from 0-12 hours (t = 2.28, p <0.05), 0-24 hours (t = 6.01, p <0.001), and 0-48 hours (t = 7.98, p <0.001) and a correction in BD from 0-24 (t = 2.68, p <0.01 ) and 0-48 hours (t = 5.46, p <0.001) were significantly higher in nonsurvivors as compared with survivors. In survivors and nonsurvivors, mean serum lactate levels (2.46 ± 1.46 versus 4.15 ± 2.99, t = 3.31, p <0.001, 95%Cl) and mean BD (-3.17 ± 2.58 versus -6.5 ± 4.91, t = 3.86, p <0.001, 95%CI) had a statistically significant difference. The serum lactate and BD levels at time of ER admission (r L0, BD0 = -0.765, p <0.01) and 48 hours after ER admission (r L48, BD 48 = -0.652, p <0.001) were highly negatively correlated.ConclusionIn polytrauma patients, serum lactate and BD are simple, quick, and independent biochemical predictors of 48-hour mortality, and this single arterial blood test would thereby improve decision-making for resuscitation effectiveness. Prolonged lactate and BD normalization time were associated with higher mortality. Serum lactate and BD are negatively correlated. A higher ISS at admission was associated with a higher incidence of mortality in polytrauma patients.

Breast Implant Capsule-Associated Squamous Cell Carcinoma during Pregnancy: A Mimicker of Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Breast Implant Capsule-Associated Squamous Cell Carcinoma during Pregnancy: A Mimicker of Breast Implant-Associated Anaplastic Large-Cell Lymphoma.

Abstract P2019: Do Changes In Metabolism Or Lactation Mediate The Reversal Of Pregnancy-induced Cardiac Growth?

During pregnancy, the maternal heart undergoes physiologic growth, which reverses following parturition and is associated with the restoration of hemodynamic parameters. However, the molecular processes underlying the reversal of pregnancy-induced cardiac growth and the time frame in which these changes occur remain unclear. Because changes in cardiac metabolism have been shown to influence the remodeling in the maternal heart, changes in metabolism may also contribute to the reversal of pregnancy-induced remodeling. Therefore, the goal of this study was to examine the underlying processes that contribute to the structural and functional changes occurring in the maternal heart following parturition. Timed pregnancy studies in 12-week-old female FVB/NJ mice showed that heart weight to tibia length (HW:TL) and cardiomyocyte size were highest in lactating 1-week post-birth (PB) mice versus mid-pregnant (8 d), late-pregnant (LP; 16 d), and non-pregnant (NP) mice. Interestingly, we also found that HW:TL was significantly reduced in non-lactating 1-week post-birth mice (PBNL) compared with LP mice. To determine the time-course of the reversal of pregnancy-induced remodeling and to examine the impact of lactation, we examined HW:TL in PB and PBNL mice 1, 3, and 6 weeks following parturition. We find that HW:TL is significantly higher in lactating PB mice versus non-lactating PBNL mice at 1 (8.71 ± 0.05 v 7.09 ± 0.26 mg/mm) and 3 weeks following parturition (8.90 ± 0.40 v 6.92 ± 0.56 mg/mm); however, 6 weeks after parturition, HW:TL was comparable between PB (7.35 ± 0.29 mg/mm) and PBNL groups (7.05 ± 0.18 mg/mm). Nevertheless, HW:TL remained elevated for 6 weeks after parturition in PB and PBNL mice compared with NP mice. RNA-Seq showed reductions in metabolic transcripts in PB hearts, including Pdk4 . Immunoblot analysis of key metabolic proteins showed that Pdk4 was reduced in hearts from 1 and 3 PB versus 1 and 3 weeks PBNL and NP. Together, these findings suggest that lactation influences the reversal of pregnancy-induced cardiac growth, which may be due in part to changes in cardiac metabolism.

COMBINAÇÃO DE DIFERENTES MÉTODOS DE TREINO CONCORRENTES EM IDOSOS COM SÍNDROME METABÓLICA

ABSTRACT Introduction: There are no studies comparing the effects of different concurrent training routines [i.e., a resistance training plus high-intensity interval training (RT+HIIT) program compared to an RT plus moderate-intensity continuous training (RT+MICT) program] on cardiorespiratory fitness (CRF) and physical performance in older adults with metabolic syndrome (MetS). Objective: This study aimed to compare the effects of two concurrent training routines, RT+HIIT versus RT+MICT, on CRF and physical fitness in adults and older adults with MetS. Methods: Thirty-nine participants (67.0±6.7 years of age) were randomly assigned into three groups: RT+ MICT, RT+ HIIT and the control group (CON, no exercise). The 12-week physical training program consisted of 3 sessions/week (~50 minutes/session). The aerobic training component was customized for iso-caloric energy expenditure (P≥0.217) and iso-load distribution (TRIMP, P≥0.893), however the MICT component had a longer aerobic training time (P≤0.01). We evaluated pre- and post-evaluation CRF (VO2peak), physical capacity [power of lower limbs (PLL), running velocity, and running time to exhaustion], plasma lactate, rate of perceived exertion (RPE), resting heart rate (HRrest), and peak heart rate (HRpeak). Results: At the end of the intervention, a significant increase in the VO2peak was observed only in the RT+HIIT group (P=0.01), but compared to the CON group both RT+HIIT and RT+MICT groups had significant improvement in the VO2peak (P≤0.02). Only the RT+HIIT group had lower HRrest as compared to the baseline and the CON group. Also, both RT+HIIT and RT+MICT groups, but not CON, significantly improved running speed, time to exhaustion, and PLL (P&lt;0.05). There were no significant changes in HRpeak, RPE, and lactate for any of the groups. Conclusion: Our results suggest that 12 weeks of RT+MICT or RT+HIIT improve lower-limb physical performance. Also, our results suggest that RT+HIIT provides additional CRF benefits in older adults with MetS. Level of evidence II; Randomized Experimental Study.

Insight into molecular interactions and structural changes of ethyl lactate and (tri/tetra)-ethylene glycol binary mixture: A thermophysical and spectral depiction

The current work deals with the analysis of the molecular interactions amongst the binary systems formed by significant solvents with environment friendly characteristics. The density (ρ) and refractive index (nD) of pure liquids and mixtures containing L-Ethyl Lactate (EL) + Tri-Ethylene Glycol (TrEG) or Tetra-Ethylene Glycol (TeEG) over the entire composition have been measured at four equidistant temperatures from T/(K) = 298.15 to 313.15 and pressure p/(MPa) = 0.1. Based on the experimental data, calculation of derived properties (excess molar volumes (VmE), partial molar volumes (V¯m), excess partial molar volumes (V¯mE), deviations in refractive index (ΔϕnD) and deviations in molar refraction (ΔϕRM)) was done. The consequent properties were fitted to the Redlich-Kister polynomial equation to recognize the interaction coefficients and standard deviations. The obtained outcomes were examined theoretically through Prigogine-Flory-Patterson (PFP) theory and Graph theory to elucidate the non-ideal behaviour of investigated mixtures. The theoretical interpretations were found to be in harmony with experimental observations. Spectroscopic data from UltraViolet (UV) and Fourier Transform InfraRed (FT-IR) analysis ascertains the dominance of solute-solvent interactions in mixed state hereby supporting the experimental and theoretical analysis.