High Lactate Research Articles

The impact of MYD88 and PIM1 in mature large B-cell non-Hodgkin lymphomas: Defining element of their evolution and prognosis.

Sequence studies of the entire exome and transcriptome of lymphoma tissues have identified MYD88 and PIM1 as involved in the development and oncogenic signaling. We aimed to determine the frequency of MYD88 and PIM1 mutations, as well as their expressions in conjunction with the clinicopathological parameters identified in mature large B-cell non-Hodgkin lymphomas. The ten-year retrospective study included 50 cases of mature large B-cell lymphoma, diagnosed at the Pathology Department of the Emergency County Hospital of Constanţa and Săcele County Hospital of Brasov. They were statistically analyzed by demographic, clinicopathological, and morphogenetic characteristics. We used a real-time polymerase chain reaction technique to identify PIM1 and MYD88 mutations as well as an immunohistochemical technique to evaluate the expressions of the 2 genes. Patients with lymphoma in the small bowel, spleen, brain, and testis had a low-performance status Eastern Cooperative Oncology Group (P = .001). The Eastern Cooperative Oncology Group performance status represented an independent risk factor predicting mortality (HR = 9.372, P < .001). An increased lactate dehydrogenase value was associated with a low survival (P = .002). The international prognostic index score represents a negative risk factor in terms of patient survival (HR = 4.654, P < .001). In cases of diffuse large B-cell lymphoma (DLBCL), immunopositivity of MYD88 is associated with non-germinal center B-cell origin (P < .001). The multivariate analysis observed the association between high lactate dehydrogenase value and the immunohistochemical expression of PIM1 or with the mutant status of the PIM1 gene representing negative prognostic factors (HR = 2.066, P = .042, respectively HR = 3.100, P = .004). In conclusion, our preliminary data suggest that the oncogenic mutations of PIM1 and MYD88 in our DLBCL cohort may improve the diagnosis and prognosis of DLBCL patients in an advanced stage.

Assessing pattern of the Pediatric Multisystem Inflammatory Syndrome (PMIS) in children during the COVID-19 pandemic: experience from the emergency department of tertiary care center of a low-middle-income country

BackgroundPediatric Multisystem Inflammatory Syndrome (PMIS) is a hyperinflammatory condition affecting multiple organs in children, often resembling incomplete Kawasaki Disease during later phases of COVID-19 infection. Data on PMIS in low-middle-income countries, particularly in emergency department settings, is limited.ObjectivesThis prospective observational study at Aga Khan University Hospital, Karachi, aimed to determine the frequency, clinical presentation patterns, and laboratory parameters of children with PMIS visiting the emergency department during the COVID-19 pandemic. Secondary objectives included assessing factors associated with in-hospital mortality.MethodsFrom March 2020 to September 2021, patients meeting World Health Organization PMIS criteria were enrolled. COVID-19 testing included PCR and antibody testing. Data was collected through a questionnaire and analyzed statistically.ResultsAmong 56 PMIS patients (85.7% male, mean age 7.67 ± 4.8 years), respiratory symptoms (70%), neurological symptoms (57%), and gastrointestinal symptoms (54%) were common presentations. Signs included delayed capillary refill time (93%), low-volume pulses (89%), and hypotension (68%). COVID-19 antibodies were positive in the majority (78.6%) while PCR was positive in 18%. Risk factors for mortality included prolonged emergency department stay, and high Ferritin and Lactate Dehydrogenase levels.ConclusionPMIS affects children of all ages. Respiratory and gastrointestinal symptoms are the most frequent presentations. Elevated inflammatory markers, including LDH, Ferritin, D-dimer, and Pro-BNP, correlate with higher mortality risk.

Abstract A039: Metabolic evolution in breast cancer predicts organ-specific metastasis

Abstract The metastatic cascade is a critical component of cancer evolution. Understanding the rewired metabolism in organ-specific metastasis in breast cancer could help identify strategies to improve the treatment and prevention of metastatic disease. Here, we used a systems biology approach to assess the evolution of metabolic fluxes from parental breast cancer cells to their brain- and lung-homing metastatic derivatives. We found that divergent lineages had distinct, heritable metabolic fluxes. Lung-homing cells maintained adaptations for high glycolytic flux despite low levels of glycolytic intermediates, constitutively activating a pathway sink into lactate. This exacerbated Warburg effect –– stronger than the Warburg effect in the primary tumor –– was associated with a high ratio of lactate dehydrogenase (LDH) to pyruvate dehydrogenase (PDH) expression, a signature which correlated with lung metastasis in patients with breast cancer. While feature classification models trained on clinical characteristics alone were unable to predict tropism, the LDH/PDH ratio was a significant predictor of a patient's future metastasis to the lung but not to other organs, independent of other transcriptomic signatures. Lung- and brain-homing lineages had differential selection patterns in acidic metabolic microenvironments. High lactate efflux was also a trait in lung-homing metastatic pancreatic cancer cells, suggesting that lactate production may be a convergent phenotype in lung metastasis. Together, these analyses highlight the essential role that metabolic evolution plays in organ-specific cancer metastasis and identify a putative biomarker for predicting lung metastasis in breast cancer patients. Citation Format: Deepti Mathur, Chen Liao, Wendy Lin, Alessandro La Ferlita, Salvatore Alaimo, Samuel Taylor, Yi Zhong, Christine Iacobuzio-Donahue, Alfredo Ferro, Joao Xavier. Metabolic evolution in breast cancer predicts organ-specific metastasis [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr A039.

High Intraoperative Serum Lactate Level is Associated with Acute Kidney Injury after Brain Tumor Resection.

Postoperative acute kidney injury (AKI) is associated with poor clinical outcomes. Identification of risk factors for postoperative AKI is clinically important. Serum lactate can increase in situations of inadequate oxygen delivery and is widely used to assess a patient's clinical course. We investigated the association between intraoperative serum lactate levels and AKI after brain tumor resection. Demographics, medical and surgical history, tumor characteristics, surgery, anesthesia, preoperative and intraoperative blood test results, and postoperative clinical outcomes were retrospectively collected from 4131 patients who had undergone brain tumor resection. Patients were divided into high (n=1078) and low (n=3053) lactate groups based on an intraoperative maximum serum lactate level of 3.35mmol/L. After propensity score matching, 1005 patients were included per group. AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria, based on serum creatinine levels within 7 days after surgery. Postoperative AKI was observed in 53 (1.3%) patients and was more frequent in those with high lactate both before (3.2% [n=35] vs. 0.6% [n=18]; P < 0.001) and after (3.3% [n=33] vs. 0.6% [n=6]; P < 0.001) propensity score matching. Intraoperative predictors of postoperative AKI were maximum serum lactate levels > 3.35mmol/L (odds ratio [95% confidence interval], 3.57 [1.45-8.74], P = 0.005), minimum blood pH (odds ratio per 1 unit, 0.01 [0.00-0.24], P = 0.004), minimum hematocrit (odds ratio per 1%, 0.91 [0.84-1.00], P = 0.037), and mean serum glucose levels > 200mg/dL (odds ratio, 6.22 [1.75-22.16], P = 0.005). High intraoperative serum lactate levels were associated with AKI after brain tumor resection.

Impact of early postoperative haemodynamic and laboratory parameters on outcome after the Fontan procedure.

To identify early postoperative haemodynamic and laboratory parameters predicting outcomes following total cavopulmonary connection. Patients who underwent total cavopulmonary connection between 2012 and 2021 were evaluated. Serial values of mean pulmonary artery pressure, mean arterial pressure, peripheral oxygen saturation, and lactate levels were collected. The influence of these variables on morbidities was analyzed. Cut-off values were calculated using the receiver operating characteristic analysis. A total of 249 patients were included. All patients had previous bidirectional cavopulmonary shunt. Median age and weight at total cavopulmonary connection were 2.2 (1.8-2.7) years and 11.7 (10.7-13.4) kg, respectively. All patients were extubated in the ICU at a median of 3 (2-5) hours after ICU admission. Postoperative pulmonary artery pressure, around 12 hours after extubation, was significantly associated with chest tube drainage (p = 0.048), chylothorax (p = 0.021), ascites (p = 0.016), and adverse events (p = 0.028). Receiver operating characteristic analysis revealed a cut-off value of 13-15 mmHg for chest tube drainage and chylothorax and 17 mmHg for ascites and adverse events. Mean arterial pressure 1 hour after extubation was associated with prolonged chest tube drainage (p = 0.015) and adverse events (p = 0.008). Peripheral oxygen saturation 6 hours after extubation (p = 0.003) was associated with chest tube duration and peripheral oxygen saturation 1 hour after extubation (p < 0.001) was associated with ascites. Lactate levels on 2nd postoperative day (p = 0.022) were associated with ascites and lactate levels on 1st postoperative day (p = 0.009) were associated with adverse events. Higher pulmonary artery pressure, lower mean arterial pressure, lower peripheral oxygen saturation, and higher lactate in early postoperative period, around 12 hours after extubation, predicted in-hospital and post-discharge adverse events following total cavopulmonary connection.

A Predictive Nomogram for Intensive Care-Acquired Weakness after Cardiopulmonary Bypass.

Intensive care unit-acquired weakness (ICUAW) affects patient prognosis after cardiopulmonary bypass (CPB) surgery, but its risk factors remain unclear. We investigated these risk factors and developed a nomogram for predicting ICUAW after CPB. Baseline characteristics, preoperative laboratory data, and intra- and postoperative variables of 473 patients after CPB were determined in this prospective cohort study. Lower limb muscles on bedside ultrasound images were compared 1 day before and 7 days after CPB. Risk factors were assessed using logistic regression models. Approximately 50.95% of the patients developed ICUAW after CPB. The body mass index (BMI), New York Heart Association (NYHA) class, lactate, albumin, aortic clamping time, operation time, and acute physiological and chronic health evaluation II were determined as independent risk factors. The average absolute error of coincidence was 0.019; the area under the curve, sensitivity, and specificity were 0.811, 0.727, and 0.733, respectively, for the predictive nomogram. A high BMI, poor NYHA class, preoperative high serum lactate, low serum albumin, long surgical duration, aortic clamping, and high acute physiological and chronic health evaluation II score are risk factors for ICUAW after CPB. This robust and easy-to-use nomogram was developed for clinical decision-making.

Real-World Outcomes of Inoperable and Metastatic Cutaneous Head and Neck Melanoma Patients.

This study aims to describe the overall survival (OS) and to identify associated prognostic factors in patients with inoperable and metastatic cutaneous melanoma of the head and neck (H&N) region, undergoing modern systemic treatments. This is a retrospective single institutional study. Data on all consecutive H&N melanoma patients treated with systemic oncologic treatments between 2015 and 2022 were collected from electronic medical files. Kaplan-Meier curves were used to describe survival and Cox regression analysis was used to identify patient and tumor factors associated with prognosis. A total of 144 patients were included. Median OS was 45 months (95% confidence interval [CI] 28-65 m). On univariable analysis for OS, the primary disease site, specifically the nape and neck (hazard ratio [HR] 3.3, 95% CI 1.4-7.7, p = 0.007), high Eastern Cooperative Oncology Group Performance Status ([ECOG-PS], HR 2.5, 95% CI = 1.9-3.3, p < 0.001), high lactate dehydrogenase (LDH) levels (HR 2.8, 95% CI = 1.7-4.6, p < 0.001), and treatment with targeted therapy (TT) as compared with immunotherapy (HR 2.6, 95% CI = 1.06-6.3, p = 0.03) were all associated with shorter OS. High-grade adverse events (AEs) were associated with a longer OS (HR 0.41, 95% CI = 0.25-0.68, p = 0.001). On multivariable analysis for OS, the ECOG-PS, LDH levels, site of disease, and the development of moderate-severe AEs remained significant. In the era of modern oncologic treatments, the prognosis of inoperable and metastatic cutaneous H&N melanoma aligns with other cutaneous melanomas. Primary tumor site of the nape and neck region emerges as a significant prognostic factor. 3 Laryngoscope, 134:2762-2770, 2024.

Relating capture and physiological conditions to viability and survival of Pacific halibut discarded from commercial longline gear

Mortality of fish discarded from commercial fisheries is often estimated by using viability keys to parse fish into different categories with unique estimated survival outcomes. In this study we examined the relationships of environmental and physiological parameters and viability classifications of Pacific halibut (Hippoglossus stenolepis) released from commercial longline gear using three distinct hook-release methods. Our results indicate that the hook release method used strongly influenced viability, with careful shake and gangion cut resulting in minimal injuries leading to discarded fish characterized as having excellent viability. In contrast hook stripping resulted in most released fish having moderate or poor viability. Physiological parameters (lactate, hematocrit) were strong indicators of Pacific halibut assigned to the dead viability category. In addition to being captured at greater depth and lower sea bottom temperature, dead categorized fish were associated with high plasma lactate levels and lower hematocrit, attributed to sand flea intrusion. Reducing the use of hook strippers and limiting soak times in areas of known sand flea activity are likely to improve viability outcomes of Pacific halibut released from commercial longline gear. Discard survival and understanding of the factors affecting it remain critical to successful long-term management of Pacific halibut, as sustainable fishing levels are adjusted yearly for estimated mortality consistent with recent fishing discards.

High serum lactate dehydrogenase to albumin ratio is associated with increased risk of poor prognosis after ischemic stroke

BackgroundLactate dehydrogenase to albumin ratio (LAR) is a comprehensive biomarker for anaerobiosis, inflammation, and nutritional status, but its prognostic value for ischemic stroke has rarely been reported. We aimed to prospectively investigate whether serum LAR is associated with the prognosis of ischemic stroke patients in a large-scale cohort study. Materials and MethodsSerum LAR levels were measured among 6634 patients with ischemic stroke admitted at Minhang hospital from January 2018 to December 2022. The primary outcome was the composite of major disability and death (modified Rankin Scale score [mRS] ≥ 3) at 3-month follow up. Secondary outcomes included death and the ordered 7-level category score of mRS. Multivariate logistic regression and restricted cubic splines were adopted to evaluate the associations between serum LAR levels and adverse clinical outcomes of ischemic stroke. ResultsDuring 3 months of follow-up period, a total of 2125 patients experienced primary outcome. After multivariate adjustment, the highest quartile of serum LAR was associated with an increased risk of primary outcome (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.27–1.83; P for trend < 0.001). Each standard deviation higher log-transformed serum LAR resulted in a 20% (95% CI, 12%−28%) increased risk of primary outcome. Furthermore, multivariable-adjusted restricted cubic spline analyses showed a linear association between the serum LAR level with primary outcome (P for linearity < 0.001). Finally, the addition of serum LAR to conventional risk factors significantly improved risk predictive abilities for the primary outcome (net reclassification improvement [NRI]: 18.35%, P < 0.001; integrated discrimination improvement [IDI]: 0.35%, P < 0.001) at 3-month follow up in patients with ischemic stroke. ConclusionHigh serum LAR level was independently associated with an increased risk of adverse clinical outcomes among patients with ischemic stroke, indicating that serum LAR may be a valuable prognostic biomarker for ischemic stroke.

The prognostic importance of the pan-immune-inflammation value in patients with septic shock

IntroductionThe purpose of this study was to determine whether the pan-immune-inflammation value (PIV), a novel biomarker combining neutrophil platelet, monocyte, and lymphocyte counts, some of the most widespread indicators of systemic inflammation, can predict mortality and prognosis in patients admitted to the intensive care unit (ICU) with septic shock.MethodThis prospective study was performed with 82 patients aged 18 or over admitted to a tertiary ICU with diagnoses of septic shock. Patients with hematological disease and neutropenia were excluded. PIV was calculated with the formula [neutrophil count (103/μL) × platelet count (103/μL) × monocyte count (103/μL)]/lymphocyte count (103/μL).ResultsMedian age, presence of hypertension, Acute Physiology and Chronic Health Evaluation II (APACHE II) levels, and neutrophil, monocyte, and platelet counts were lower in the low-PIV group than in the high-PIV group (p < 0.05). The highest area under ROC curve (AUC) was determined for Sequential Organ Failure Assessment (SOFA) (0.94 (0.89 – 0.99)), followed by Glasgow Coma Scale (GCS) (0.81 (0.70 – 0.91)), APACHE II (0.80 (0.69 – 0.91)) and lactate (0.77 (0.67 – 0.88)). Median survival was longer in the low-PIV group than in the high-PIV group (28 (15.25 – 40.76) vs 16 (9.46 – 22.55) days, respectively, p < 0.05). The univariate Cox proportional hazards (CPH) model showed that high PIV (HR = 2.13 (1.03—4.38)), low GCS (HR = 3.31 (1.34 – 8.15)), high SOFA (HR = 9.41 (2.86 – 30.95)), high APACHE II (HR = 3.08 (1.47 – 6.45)), high lactate (HR = 6.56 (2.73 – 15.75)), and high procalcitonin (PCT) (HR = 2.73 (1.11 – 6.69)) values were associated with a decreased survival time among ICU patients (p < 0.05). The multivariate CPH model showed the age-adjusted risk estimates for these six laboratory parameters. High lactate (HR = 7.97 (2.19 – 29.08)) and high SOFA scores (HR = 4.85 (1.22 – 19.32)) were significantly associated with shorter survival in ICU patients (p < 0.05).ConclusionThe findings of this research suggest that PIV could predict the longer survival in patients with septic shock. Despite PIV score’s capability to show inflammation, it is not significantly associated with mortality in the multivariate analysis.

Understanding The Influence of Tumour Microenvironment Variability On Therapeutic Effectiveness

Cancer immunotherapy has proven effective in treating malignant diseases, but only a small percentage of patients experience completeand durable responses to current treatments. This highlights the need for more effective immunotherapies, combination treatments, andpredictive biomarkers. The molecular properties of a tumor, intratumor heterogeneity, and the tumor immune microenvironment are key targetsfor precision cancer medicine. Humanized mice that support the engraftment of patient-derived tumors and recapitulate the human tumorimmune microenvironment of patients represent a promising preclinical model for addressing fundamental questions in precision immuno-oncology and cancer immunotherapy. The microenvironmental physiology of tumors is unique from normal tissues, characterized by oxygendepletion, glucose and energy deprivation, high lactate levels, and extracellular acidosis. Hypoxia and other hostile microenvironmental parameterscan confer resistance to irradiation, leading to treatment failure. Pretreatment assessment of critical microenvironmental parameters is neededto select patients who could benefit from special treatment approaches, such as hypoxia-targeting therapy. Acquired resistance to varioustherapeutic interventions is a hallmark of cancer, and the tumor microenvironment (TME) plays a crucial role in cancer progression, particularlytherapeutic resistance. Targeting the TME as an essential strategy to overcome cancer resistance and improve therapeutic outcomes throughprecise intervention is highly desired. Cell stem cells (CSCs) play a pivotal role in tumorigenesis, tumor progression, and metastasis. Theinflammatory microenvironment is an essential component of the tumor microenvironment, and understanding the key factors that exertimportant actions in the tumor process would be important to improve clinical outcomes.

Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery.

To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91-10.97) and duration of ruptured fetal membranes (ORs 1.36-2.46), higher gestational age at birth (ORs 1.41-1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries.

Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial

BackgroundThe appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels.MethodsWe performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups.ResultsOf the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury.ConclusionsOur results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.

Predicting Sepsis‐Related Mortality: Pitt Bacteremia Score is Superior to the Charlson Comorbidity Index

Aim: To assess the role of Pitt bacteremia score (PBS) and Charlson Comorbidity Index (CCI) in predicting mortality among patients with intensive care unit (ICU)–acquired Gram‐negative bacterial sepsis and to investigate other factors associated with mortality.Methods: This retrospective study was carried out between January 2018 and January 2023. Patients diagnosed with ICU‐acquired sepsis caused by Gram‐negative bacteria were included in the study. Demographics, laboratory data, blood culture results, management, length of ICU stay, mortality, and other clinical data were recorded. PBS and CCI score were calculated based on data collected at time of blood withdrawal. The primary endpoint was mortality in ICU.Results: Among the 425 patients included in the study, mortality was observed in 268 (63%). Age and sex were distributed similarly in the mortality and survival groups. CCI score with a cutoff value of &gt; 5.5 (AUC = 0.611) and PBS with a cutoff value of &gt; 2.5 (AUC = 0.904) were able to significantly predict mortality. Multivariable logistic regression revealed that mortality was independently associated with having any comorbidity, congestive heart failure, low platelet count, high lactate, high (&gt; 2.5) PBS, and carbapenem resistance (p = 0.001).Conclusion: PBS was more successful than CCI in predicting mortality in patients with ICU‐acquired sepsis caused by Gram‐negative bacteria. In addition to higher PBS, having any comorbidity (and additionally, congestive heart failure), lower platelet, higher lactate, and carbapenem resistance were risk factors for mortality.

Hypocapnia in women with fibromyalgia.

The purpose of this study was to investigate whether people with fibromyalgia (FM) have dysfunctional breathing by examining acid-base balance and comparing it with healthy controls. Thirty-six women diagnosed with FM and 36 healthy controls matched for age and gender participated in this cross-sectional study. To evaluate acid-base balance, arterial blood was sampled from the radial artery. Carbon dioxide, oxygen, bicarbonate, base excess, pH and lactate were analysed for between-group differences. Blood gas analyses were performed stepwise on each individual to detect acid-base disturbance, which was categorized as primary respiratory and possible compensation indicating chronicity. A three-step approach was employed to evaluate pH, carbon dioxide and bicarbonate in this order. Women with FM had significantly lower carbon dioxide pressure (p = 0.013) and higher lactate (p = 0.038) compared to healthy controls at the group level. There were no significant differences in oxygen pressure, bicarbonate, pH and base excess. Employing a three-step acid-base analysis, 11 individuals in the FM group had a possible renally compensated mild chronic hyperventilation, compared to only 4 among the healthy controls (p = 0.042). In this study, we could identify a subgroup of individuals with FM who may be characterized as mild chronic hyperventilators. The results might point to a plausible dysfunctional breathing in some women with FM.

Prognostic Relevance of Immunophenotyping in Adult Patients with Acute Leukemia in Turkey: A Single-Center Experience.

In acute leukemia, many associations have been identified between prognosis and some factors, such as individual antigen expression, cytogenetics, gender, age, high leukocyte level (WBC), platelet count (PLT), and lactate dehydrogenase (LDH), but few are consistent. In this study, we aimed to investigate the cell surface markers and other clinical pathological features for prognosis determination in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) patients in our population. This cross-sectional study was performed from January 2017 to December 2023 in İstanbul Training and Research Hospital and included 113 patients (86 AML and 27 ALL) newly diagnosed with AML (non-APL) and ALL. The following tests were fulfilled for the included patients: complete blood count (CBC), LDH, and flow cytometric analysis using a blood sample or bone marrow aspirate. The effects of surface markers, gender, age, WBC, PLT, and LDH on 24-month survival were evaluated retrospectively. Among the investigated parameters, lack of CD13 expression and positive CD10, cTdT expressions were associated with poor prognosis in AML patients (p = 0.01, p = 0.04, and p = 0.04, respectively). We have found no association between the surface markers and other parameters with prognosis in ALL patients. Age > 65 years was associated with poor prognosis in both AML and ALL patients (p < 0.001). CD10, cTdT positivity, and CD13 negativity may predict poor prognosis for AML and can be considered as prognostic biomarkers for AML patients.

Solução intravenosa poliiônica com concentração elevada de lactato (84 mEq/L) é eficaz para o tratamento de bezerros com diarreia

ABSTRACT This study aimed to evaluate the effectiveness of an electrolyte solution with a high lactate concentration (84mEq/L; L84) in correcting imbalances in diarrheal calves. Another solution with similar electrolyte composition, containing 84mEq/L of bicarbonate (B84) was used for comparison. Diarrhea was induced in neonatal calves by rotavirus infection, sucrose ingestion and furosemide administration. When a moderate degree of metabolic acidosis was reached, the calves were treated with intravenous infusion of L84 (n=10) or B84 (n=10) solutions. Venous blood and urine samples were collected before starting the infusion (0 h), in the middle (2.5 h), at the end (5.0 h) and 2.5 hours later. Total plasma protein concentration, blood and urine pH, blood pCO2, HCO3 -, and BE, plasma and urine concentration of L-lactate, and serum and urine concentrations of Na+, K+, and Cl- were measured. Strong ion difference, total concentration of non-volatile weak acids, anion gap, strong ion gap, percentage change in plasma volume, and urinary fractional clearances of Na+, K+, Cl-, and L-lactate were calculated. The calves demonstrated moderate dehydration, hypernatremia, hyperchloremia, metabolic acidosis, and unmeasured anion accumulation. These changes were completely corrected with the L84 solution, and the effects did not differ from those observed with B84 solution. The calves recovered without further therapeutic procedures, demonstrating that the L84 solution was effective for treating diarrheal calves.

Bifunctional Au-Sn-SiO2 catalysts promote the direct upgrading of glycerol to methyl lactate.

Valuable alkyl lactates can be obtained from (waste) glycerol, through a two-step process that entails (i) the oxidation of glycerol to dihydroxyacetone (DHA) catalyzed by support Au nanoparticles and (ii) a rearrangement of DHA with an alcohol effectively catalyzed by Sn-based heterogeneous catalysts. To solve selectivity and processing issues we propose to run the process as a cascade reaction, in one step, and with a single bifunctional catalyst. Tackling the challenge associated with the preparation of such bifunctional catalysts, here, an aerosol-assisted sol-gel route is exploited. The catalysts feature small Au nanoparticles (3-4 nm) embedded at the surface of mesoporous Sn-doped silica microspheres. The preparation successfully leads to insert both active sites in their most active forms, and in close proximity. With the bifunctional catalysts, the yield for the final product of the cascade reaction (methyl lactate) is higher than the DHA yield when only the first reaction is carried out. This highlights a beneficial substrate channeling effect which alleviates side reactions. Interestingly, the bifunctional catalysts also markedly outcompeted mechanical mixtures of the corresponding monofunctional Au- and Sn-based catalysts. Thus, the spatial proximity between the two active sites in bifunctional catalysts is identified as a key to stir the cascade reaction towards high lactate yield.

PREDICTIVE VALUE OF UMBILICAL ARTERIAL BLOOD LACTATE IN NEONATES WITH MECONIUM-STAINED LIQUOR

This research aims to determine the clinical and maternal variables contributing to increased lactate levels and determine the prognostic usefulness of umbilical cord blood lactate levels in neonates through meconium-stained liquor. The study was conducted between 01 June 2022 and 31 May 2023 at the Department of Neonatology, CMH Rawalpindi. This study included 100 newborns with meconium aspiration syndrome (MAS) in a thin cross-sectional design. Newborn babies received treatment at CMH Hospital throughout the approved period, and observations of umbilical cord blood have been obtained for lactate measurement and arterial blood gas analysis. Furthermore, information on post-delivery problems and neonatal features was retrieved using hospital records. The research included comprehensive statistical analyses, encompassing both Bivariate and multivariate evaluations, to pinpoint the variables linked to increased lactate levels and their potential predictive significance for unfavorable neonatal outcomes. This study included 720 unpaired samples of cord blood from the umbilical artery. The lactate result had an interquartile range of 4.0–6.2 mmol/L and a mean of 5.49 mmol/L (± SD 2.44 mmol/L). After birth, resuscitation was required for a considerably more significant number of neonates with increased lactate levels (25.1%) than for those who had lesser lactate levels (1.3%). At five minutes, Apgar scores of less than seven also showed a significant correlation between high lactate levels and a greater incidence of asphyxia (19.8%). Meconium-stained liquor (aOR=5.85), primigravidity (aOR=2.78), male sex (aOR=1.71), and oxytocic administration (OR=1.97) were factors linked to elevated lactate levels. The results highlight the prognostic significance of umbilical cord blood lactate levels in newborn outcomes, particularly while considering the necessity for resuscitation, asphyxia, and diagnosis such as hypoxic encephalopathy. Elevated lactate levels are more likely in cases where maternal and clinical variables are present, such as primigravidity and liquor stained with meconium. This study underscores the feasibility of including lactate measures from umbilical cord blood into standard evaluations of neonates, providing a valuable instrument for prompt identification and remediation. Prospective investigations and multi-center trials are necessary to confirm these results and investigate the long-term effects of increased lactate levels on newborn health.

Risk factors of Fournier’s gangrene associated with mortality in Sunpasittiprasong Hospital

Objective: To determine the mortality rate in patients with Fournier’s gangrene (FG) in Sunpasittiprasong Hospital and to identify potential risk factors associated with mortality among patients of FG. Materials and Methods: This retrospective cohort study investigated patients diagnosed with FG in Sunpasittiprasong Hospital from 2016 to 2021. Data related to clinical presentation, demographics, comorbidities, etiology, laboratory investigation, and therapeutic intervention of the patients were recorded. Prognostic severity indexes were calculated. All factors were statistically analyzed using univariate and then multivariate analysis. Results: Of 62 patients, the mortality rate was 29% (18 of 62). The significant risk factors for death included patients with kidney disease, septic shock, respiratory failure, acute kidney injury, low mean arterial blood pressure (MAP), admission to ICU and prolonged ventilator used. Risk factors from the laboratory data included abnormal coagulogram, high serum creatinine, lactate, and low bicarbonate. Some prognostic scoring systems were able to predict prognosis and mortality. Multivariate analysis revealed that patients with kidney disease (p = 0.007) or respiratory failure at presentation (p = 0.020) were significantly associated with mortality. Conclusions: The significant risk factors associated with mortality among patients with FG were kidney disease or respiratory failure. Some prognostic scoring systems may be applied to Thai patients with FG to predict prognosis.