Peripheral Perfusion vs Standard Management in Sepsis/Septic Shock: A Prospective Randomized ED Study.

Background: Serum lactate is a key biomarker of tissue hypoperfusion and metabolic stress in sepsis. Although lactate clearance is widely recognized, many intensive care units record only a peak lactate within 24 h (pLac-24h). The prognostic value of pLac-24h among patients receiving blood purification therapy remains unclear in Asian intensive care settings. Methods: We retrospectively analyzed the 2018–2020 ICU dataset from MacKay Memorial Hospital, Taiwan. Among 16,693 adult ICU admissions, 2506 patients received continuous renal replacement therapy (CRRT) as blood purification for severe sepsis or septic shock. Of these, 1264 (50.4%) had available pLac-24h data, and 27 (1.1%) also required extracorporeal membrane oxygenation (ECMO). The primary outcome was 28-day all-cause mortality. Multivariate logistic regression adjusted for age, sex, APACHE II score, infection source, and CRRT/ECMO use. Discrimination was evaluated by receiver operating characteristic (ROC) curves and decision-curve analysis. This analysis was conducted as a predefined sub-analysis of an institutional ICU database. Results: The mean age of the cohort was 65.7 ± 13.4 years, and 64.8% were male. Median pLac-24h was 5.1 mmol/L (IQR 3.2–8.6). The overall 28-day mortality among CRRT patients was 47.3%. Mortality rose progressively across pLac-24h quartiles (Q1–Q4: 28.9%, 39.4%, 54.7%, and 68.1%; p < 0.001). Each 1 mmol/L increase in pLac-24h independently predicted higher mortality (adjusted OR 1.18, 95% CI 1.10–1.26, p < 0.001). The area under the ROC curve for pLac-24h predicting 28-day mortality was 0.78 (95% CI 0.74–0.82), outperforming the APACHE II score (AUC 0.69, p = 0.02). Conclusions: In critically ill patients with septic shock undergoing CRRT, peak lactate within 24 h was a strong, independent predictor of 28-day mortality. pLac-24h offers a pragmatic, readily available prognostic indicator when serial lactate measurements are unavailable, supporting its integration into bedside risk assessment in real-world Asian ICU practice.

The University of Wisconsin (UW) solution is widely used for cardiac allograft preservation. In early 2021, our center transitioned to Del Nido (DN) cardioplegia for all donors. This study evaluated whether this shift affected post-transplant outcomes. Adult, single-organ, donation after brain death heart transplants from January 2020 to December 2023 were included; congenital cases and non-ice storage techniques were excluded. Recipients were grouped by preservation solution. Interrupted time series (ITS) regression accounted for temporal bias and baseline differences, while exponential decay analysis evaluated lactate clearance. Of 203 transplants, 71 used UW and 132 used DN. Baseline characteristics were similar aside from longer ischemic times in the DN group. Unadjusted outcomes showed no significant differences in severe primary graft dysfunction (PGD), early mortality, cardiac index, or 24 hour vasoactive inotrope score (VIS). Intensive care unit and hospital stays were longer in the DN group. Lactate clearance was faster with DN (half-life 11.3 vs. 18.6 hours; p = 0.07). Interrupted time series regression showed no significant impact of DN on PGD, mortality, or morbidity scores, though VIS modestly increased (p = 0.048), and peak lactate levels decreased (p = 0.004). Del Nido provides comparable preservation to UW, supporting its use based on logistics and availability.

Objective: To evaluate the association between initial blood lactate levels, blood lactate clearance (BLC) at 6 hours, and in-hospital mortality among patients with severe trauma. Material and Methods: This prospective observational study included 100 adult patients with severe trauma (Revised Trauma Score <6) admitted to a Level-I Trauma Center. Initial and 6-hour venous lactate levels were measured, and BLC was calculated. The endpoint was in-hospital mortality. Logistic regression was used to assess associations with in-hospital mortality and BLC.Results: The in-hospital mortality rate was 27%. Non-survivors had significantly higher initial lactate levels than survivors (14.2±6.4 vs. 5.7±2.2 mmol/L; p-value<0.01). In multivariate analysis, only initial lactate remained independently associated with mortality (adjusted OR 3.98; 95% CI: 1.30–9.71; p-value<0.001). Patients with low BLC (<10%) had significantly higher mortality than those with high BLC (40.0% vs. 7.9%; p-value=0.030), although no clinical variable independently predicted BLC.Conclusion: Initial blood lactate is a strong independent predictor of mortality in severe trauma. While BLC ≥10% is associated with improved survival, its determinants remain multifactorial. Serial lactate monitoring should be considered an integral part of early trauma care, especially in resource-limited settings.

Background: Tight blood pressure control is a cornerstone of postoperative cardiac surgery patients. In addition, plasma lactate levels are frequently monitored in this setting as it is a marker for malperfusion, with early elevated levels being associated with increased morbidity and mortality. Elevations from malperfusion may be due to decreased cardiac output, hypovolemia, or persistent post-bypass vasoplegic response. Here, we investigate whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery. Methods: This is a retrospective cohort observational study of patients who have undergone coronary artery bypass graft (CABG) and valve replacement or repair surgeries at NYU Langone Long Island Hospital over a 6-month period. Postoperative blood pressures and lactate levels were examined over the first 16 h of care. Primary outcome: The relationship between blood pressure parameters and lactate clearance. Secondary outcomes: ICU length of stay, hospital length of stay, and mortality. Results: A total of 81 patients met inclusion criteria. The average pre-operative mean arterial blood pressure (MAP) was 95.4 mmHg and the average MAP in the first 6 h post-operatively was 78.4 mmHg. The average change in MAP from baseline was a decrease of 16.7%. The average cleared lactate fraction by 16 h postoperatively was 85.9%. Lactate clearance was associated in a statistically significant way only with the need for inotropic support on postoperative day 1, p = 0.03. There was a slight trend toward a delay in lactate clearance in those with lower early systolic blood pressures, p = 0.14. Conclusions: Lactate clearance appears to occur largely independently of postoperative blood pressures in the first 16 h after surgery but may be delayed in those requiring inotropic support through the morning or postoperative day one.

Normothermic machine perfusion has emerged as a valuable technique for organ preservation, enabling liver viability assessment and reducing the discard rates of marginal grafts. However, the standard protocol involves two cooling/rewarming phases, which can result in a double ischemia/reperfusion injury that increases the risk of graft dysfunction. We describe a novel surgical technique, named quasi ischemia-free liver procurement, which circumvents cold ischemia during liver procurement, thereby minimizing ischemia-reperfusion injury. In this study, we applied quasi-ischemia-free liver procurement to an orphan liver graft from a 43-year-old deceased brain donor. The liver was subsequently transplanted into a 66-year-old male recipient with alcoholic liver cirrhosis and hepatocellular carcinoma. The technique was successful, with ex-situ normothermic perfusion beginning within 3 min of graft disconnection without graft cooling and lasting for nearly 4 h. The graft exhibited excellent viability, evidenced by immediate lactate clearance, stable transaminase levels, and good bile production during machine perfusion. The recipient experienced an uneventful postoperative course with immediate graft function and was discharged on postoperative day 8. Quasi ischemia-free liver procurement represents a simpler alternative to ischemia-free liver transplantation, potentially simplifying the implantation phase. This technique holds promise for improving outcomes in liver transplantation, particularly in cases involving marginal grafts.

Machine perfusion has revolutionized organ preservation by enabling enhanced graft viability, real-time functional assessment, and targeted therapeutic interventions. However, isolated organ perfusion models may fail to replicate the physiological interplay between abdominal organs. Ex situ multivisceral perfusion offers a promising alternative by maintaining critical inter-organ relationships, potentially improving the viability of low-flow organs, better mimicking insitu physiology, and extending preservation times. This approach may be especially beneficial for multivisceral transplant recipients, who often present with complex clinical needs and limited options. A central challenge in developing multivisceral perfusion strategies is defining and measuring perfusion success. Key indicators include macroscopic graft appearance, hemodynamic and biochemical parameters during perfusion, and post-perfusion histological evaluation. Over the course of perfusion, characteristic changes such as bowel distension and loss of peristalsis may occur, especially during prolonged cases. Successful perfusion is marked by homogeneous graft perfusion, stable arterial flows at physiological pressures, minimal edema, effective lactate clearance, preserved perfusate pH, and sustained bile and urine production without excessive fluid losses. Here, we present a comprehensive, stepwise protocol for normothermic machine perfusion of porcine abdominal multivisceral grafts, designed to support preclinical development and translational efforts aimed at improving organ preservation and expanding the potential of multivisceral transplantation.

Background: Hyperlactatemia has been associated with poor outcomes in various clinical settings including liver transplantation (LT). However, the impact of intraoperative lactate levels and lactate clearance on long-term mortality in LT recipients remains unclear.Methods: We retrospectively reviewed data from 1,067 patients who underwent LT. All lactate data measured intraoperatively were used to calculate the time-weighted average lactate (TWAL) method. Lactate clearance was calculated as the difference between lactate levels immediately after reperfusion and at the end of surgery. Multivariable analyses were performed to identify independent predictors of mortality after LT.Results: Higher lactate group showed significantly worse survival at 30-days, 1-year, and 3-years (P = 0.01, P < 0.001, and P < 0.001, respectively), and lactate clearance was significantly lower in non-survivors (P = 0.003, P = 0.003, and P = 0.002, respectively). Multivariable analyses revealed that the TWAL was independently associated with each mortality timepoint (hazard ratio [HR], 1.41, 95% confidence interval [CI], 1.19–1.67; P < 0.001, HR, 1.29, 95% CI, 1.17–1.42; P < 0.001, HR, 1.20, 95% CI, 1.10–1.30; and P < 0.001, respectively). Furthermore, lactate clearance was also an independent predictor for each mortality timepoint (HR, 0.69, 95% CI, 0.60–0.80; P < 0.001, HR, 0.80, 95% CI, 0.73–0.88; P < 0.001, and HR, 0.83, 95% CI, 0.77–0.90; P < 0.001, respectively).Conclusions: Both intraoperative lactate level and lactate clearance was independently associated with mortality after LT. Intraoperative lactate monitoring may help predict both short- and long-term mortality in LT recipients.

Although lactate clearance provides important information regarding hepatocellular function during normothermic machine perfusion (NMP), the information inferred is adequate to exclude nonfunctioning grafts but is limited in evaluating comprehensive hepatocyte function. Liver maximum capacity (LiMAx), using C13-methacetin, has been adopted to assist in the functional assessment of the liver before major oncological resection. We evaluated the combined use of lactate clearance and LiMAx measurement to monitor liver function during extended-duration NMP. Seven discarded donor livers underwent extended NMP for 87-184 h using a blood-based perfusate and a modified Liver Assist device incorporating hemofiltration. Hepatocellular function was assessed every 6 h using LiMAx: a fixed bolus of C13-methacetin was administered and the delta over baseline was measured. Lactate clearance capacity was tested every 24 h by administering 50% sodium lactate to achieve perfusate concentrations of 10-15 mmol/L. Initial lactate clearance to <2.5 mmol/L was achieved within 1.75-7.75 h post-NMP initiation. The median LiMAx value was 829 (range, 325-3130) µg/kg/h. Livers with efficient lactate clearance (<4 h) displayed stable LiMAx profiles with consistently low, flat delta over baseline curves, maintaining similar amplitude for 80 h of perfusion, indicative of preserved hepatocyte function. Conversely, livers with progressive reductions in LiMAx amplitude and curve flattening were associated with deteriorating function and eventual graft failure. LiMAx enables real-time, longitudinal monitoring of hepatocyte metabolic activity during extended NMP. When combined with lactate clearance, it could offer a more comprehensive assessment of graft viability. Incorporating LiMAx into viability criteria could refine current decision-making frameworks for liver transplantation, particularly in marginal grafts.

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for selected peritoneal surface malignancies. However, postoperative hemodynamic fluctuations, fluid shifts, and nephrotoxic chemotherapeutic agents may increase the risk of acute kidney injury (AKI). Early postoperative lactate levels and lactate clearance are markers of tissue perfusion and metabolic recovery, but their prognostic role after HIPEC remains unclear. To evaluate the association between early postoperative lactate dynamics (0-h and 12-h lactate levels and lactate clearance) and AKI, defined by KDIGO criteria, in patients undergoing HIPEC. Secondary aims were to assess the relationship of lactate dynamics with ICU length of stay and mortality. This retrospective, single- center cohort included 98 patients who underwent CRS-HIPEC between 2019 and 2024. Demographic, perioperative, and postoperative data were collected. Lactate clearance was calculated from 0-h and 12-h lactate values. AKI was defined according to KDIGO criteria. Statistical comparisons and ROC curve analysis were performed, with p < 0.05 considered significant. AKI occurred in 32.7% of patients. Intraoperative inotrope use was significantly associated with AKI. Patients with AKI had longer ICU length of stay and higher mortality. The 12-h lactate level was significantly higher in the AKI group and showed limited but significant predictive value for AKI (AUC = 0.623). A threshold above 1.9mmol/L indicated higher risk. Elevated 12-h lactate and negative lactate clearance were also strong predictors of mortality. Postoperative 12-h lactate was associated with AKI and strongly predicted mortality, whereas lactate clearance was not predictive of AKI. Elevated postoperative 12-h lactate and negative clearance may serve as simple and early biomarkers for risk stratification following HIPEC.

Duck-egg white hydrolysate supplementation enhances muscle endurance and fatigue resistance during high-intensity exercise

Background.Several viability tests, including lactate clearance and bile production, are used to evaluate livers during normothermic machine perfusion (NMP). However, specific cutoff values and therapeutic consequences vary significantly. The noninvasive 13C-methacetin liver function breath test (LiMAx) was developed to measure the actual liver function capacity. This might also provide useful insights into graft function during NMP.Methods.Therefore, we used an established porcine model of prolonged static cold storage (pSCS) and subsequent NMP for additional functional monitoring with the LiMAx test. Livers obtained from 9 pigs underwent NMP for 6 h directly after procurement (control group) or after 20 h of SCS (pSCS). After 6 h of NMP, the LiMAx test was performed using a liver weight-adjusted dose of 13C-methacetin.Results.After pSCS, transaminase and cholestasis parameters were found to be elevated in the perfusate and reduced lactate clearance was measured. Bile analyses further revealed reduced bile production and elevated glucose concentrations. In line with these results, the LiMAx test also showed significantly reduced values compared with the control group, with a mean value of 57.0 µg/kg/h compared with 182.0 µg/kg/h in the control group (P = 0.032).Conclusions.Therefore, we suggest the LiMAx test as a novel diagnostic tool for evaluating donor organs during NMP.

Background: Critically ill patients frequently exhibit disturbances in circulatory regulation that impair tissue perfusion and contribute to organ dysfunction and mortality. Alterations in peripheral vascular tone are central to these hemodynamic abnormalities. Among this population, septic shock is one of the most common and severe conditions. The Radial Artery Resistance Index (RARI), measured by bedside Doppler ultrasonography, has emerged as a noninvasive and dynamic marker of peripheral vascular resistance that may help detect perfusion abnormalities early and complement conventional monitoring in the intensive care setting. Objective: To evaluate the utility of the Radial Artery Resistance Index (RARI), measured by point-of-care Doppler ultrasonography (POCUS), in predicting tissue perfusion in patients with septic shock. Methods: This prospective observational study was conducted in the Intensive Care Unit of the University Hospital of Brasília from June 2022 to March 2024. A total of 143 adult patients were included: 112 with a confirmed diagnosis of septic shock and 31 hemodynamically stable postoperative patients without clinical or laboratory evidence of infection, who served as controls. The following variables were assessed simultaneously: Radial Artery Resistance Index (RARI), capillary refill time (CRT), peripheral perfusion index (PPI), serum lactate concentration, standard hemodynamic parameters, and the Sequential Organ Failure Assessment (SOFA) score at ICU admission and 48 hours later. Results: Patients with septic shock had higher serum lactate levels and SOFA scores than controls. RARI correlated with lactate (r = 0.71, p &lt; 0.0001), CRT (r = 0.67, p &lt; 0.0001), and PPI (r = –0.46, p &lt; 0.0001). ROC analysis for lactate clearance showed an AUC of 0.95 (95% CI: 0.89–1.00) for RARI (cutoff 0.99; sensitivity 0.94, 95% CI: 0.80–0.99; specificity 0.97, 95% CI: 0.91–1.00) and 0.77 (95% CI: 0.68–0.86) for CRT (cutoff 4 s; sensitivity 0.73, 95% CI: 0.54–0.87; specificity 0.72, 95% CI: 0.60–0.81), with higher accuracy for RARI (p &lt; 0.0001). Conclusion: The Radial Artery Resistance Index (RARI) was associated with clinical and laboratory markers of hypoperfusion in patients with septic shock. RARI showed stronger correlation with lactate, capillary refill time (CRT), and peripheral perfusion index (PPI), and demonstrated higher diagnostic accuracy than CRT for predicting lactate clearance. These findings support the use of bedside Doppler ultrasonography as a noninvasive method for assessing peripheral perfusion in critically ill patients.

Early fluid resuscitation reduces mortality in patients with sepsis or septic shock, but excessive fluid administration may prolong hospitalization and increase complications. Several non-invasive strategies have been proposed to guide fluid resuscitation, yet their comparative efficacy remains uncertain. We systematically searched PubMed and EMBASE through June 2025 to identify randomized controlled trials evaluating non-invasive strategies to guide fluid resuscitation in adult patients with sepsis or septic shock. Pairwise and network meta-analyses were conducted to assess short-term mortality. Length of stay (LOS) in intensive care unit (ICU) was also analyzed. 20 RCTs (2.435 patients) were included. In pairwise meta-analyses, lactate clearance-guided resuscitation was associated with reduced short-term mortality compared to ScvO₂ (RR 0.81, 95% CI 0.65-1.00; I2 = 0%). No significant difference in mortality was observed between capillary refill time versus lactate clearance (RR 0.82; 95% CI 0.65-1.04; I2 = 0%), passive leg-raising plus stroke volume versus usual care (RR 0.91, 95% CI 0.67-1.23; I2 = 14%), echocardiography versus usual care (RR 0.72, 95% CI 0.32-1.61; I2 = 70%), and inferior vena cava collapsibility versus usual care (RR 0.75, 95% CI 0.52-1.09; I2 = 19%). In network meta-analysis, none of the assessed strategies to guide fluid resuscitation reduced mortality compared to usual care. Heterogeneity was moderate. Non-invasive dynamic parameters-lactate clearance, along with capillary refill time and inferior vena cava collapsibility assessment-are promising, bedside-available tools for guiding fluid resuscitation in patients with sepsis or septic shock. Their broader use in clinical practice may be warranted, pending confirmation from high-quality studies.

There is a lack of research conducted to examine the over-time changes in aerobic and anaerobic fitness in table tennis (TT) players with various athletic levels. In order to fill the gap in knowledge, this study was to assess physiological responses to the graded exercise test in Level-1 collegiate, Level-2 collegiate, and U16-U18 TT players and to track their performance for one year. Forty-eight well-trained TT players participated in this study. The competitive TT-specific aerobic test (CTTSAT) was conducted to assess their fitness, and data were collected to represent their aerobic fitness (i.e., total testing time and heart rate recovery) and anaerobic fitness (i.e., blood lactate clearance). Mixed-effects models were conducted to examine the main effects of time and group and the time-by-group interaction on all indicators while controlling for sex. There was a significant main effect of time on the total testing time (estimate = 243.04, SE = 57.30, p &lt; 0.001), indicating that TT players improved their performance on the CTTSAT test over time. Neither the main effect of group nor the interaction of time by group was found on all outcomes. Despite similar physiological responses to the CTTSAT, well-trained TT players with various athletic levels could continuously improve aerobic fitness. Nevertheless, our findings imply a potential time-tactic or time-technique trade-off which needs to be further tested.

Background.Normothermic regional perfusion (NRP) is an organ procurement technique developed for donation after circulatory death (DCD). NRP is associated with better liver transplant outcomes and allows increased risk thresholds for medically complex DCD donors. DCD donors on extracorporeal membrane oxygenation (ECMO) are a category of medically complex donors lacking significant reported experience.Objectives.This brief report describes the utilization of liver grafts from ECMO-DCD donors using an NRP procurement technique.Methods.Retrospective analysis of donor and recipient outcomes in 3 cases following abdominal DCD-NRP with ECMO cannula exchange to an NRP circuit. Existing cannulas and tubing can be used for NRP inflow, outflow, or both depending on the configuration.Results.All donors were older than the age of 50 y and had a functional warm ischemia time of <30 min. NRP duration ranged from 66 to 134 min. All 3 donors demonstrated lactate clearance while on NRP. Recipient age ranged from 52 to 68 and model for end-stage liver disease scores were 22, 26, and 7. All had a 1-d intensive care unit stay and 5- to 7-d total hospital length of stay. One of the 3 recipients had a biliary anastomotic stricture.Conclusions.This report demonstrates the technical and clinical feasibility of liver transplantation from ECMO-DCD-NRP donors. Preoperative planning for the utilization of existing cannulas, the addition of needed inflow or outflow, and circuit exchange logistics is essential for a smooth transition to NRP in these cases.

BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving mechanical support in patients with cardiogenic shock. There are great variations in the reported rates of neurological complications and associated mortality. Our aim was to analyze our cohort of adult patients supported with VA-ECMO to identify the incidence, outcomes, and predictors of acute ischemic and hemorrhagic strokes.MethodsA total of 195 patients between January 2016 and January 2023 were reviewed, 22 (11.3%) ECPR patients were excluded, and 173 (88.7%) patients were analyzed. We divided the patients into stroke and nonstroke groups according to the presence of radiologically confirmed acute ischemic and hemorrhagic strokes.ResultsThirty-five (20.2%) patients had acute cerebrovascular strokes. 13 (7.5%) patients had intracranial hemorrhage (ICH) while 22 (12.7%) patients had ischemic stroke. The median age was 48 years (IQR: 31, 56), 98 (56.6%) patients were males, and 152 (87.9%) patients had cardiac surgeries. The patients who developed cerebrovascular stroke had higher blood lactate at ECMO initiation (8.9 [5.5, 11.2] versus 5.7 [4.6, 11.9] mmol/L, p = 0.02) and 12 h later (8.7 [4.7, 14.5] versus 5.8 [4.6, 15] mmol/L, p = 0.024) with lesser lactate clearance (LC) at 12 h (6.35 [−51.5, 40.6] versus 14.65% [−43.55, 38.3], p < 001) compared to the patients in the nonstroke group. The stroke group had longer ICU stay (21 vs. 15.5 days, p = 0.03), higher frequency of new hemodialysis (62.9% vs. 46.4%, p = 0.026), and on-ECMO mortality (54.3% vs. 44.9%, p = 0.041) compared with the nonstroke group. The ICH was associated with higher hospital mortality (p = 0.021) compared to the ischemic stroke. Logistic multivariate regression revealed that the initial lactate level (OR: 1.6, 95% CI: 1.2–8.92, p = 0.031), cardiopulmonary bypass time (OR:1.8, 95% CI: 1.32–6.42, p = 0.02), and LC at 12 h (OR: 2.4, 95% CI: 1.91–17.4, p = 0.042) were associated with ischemic stroke. Thrombocytopenia (OR: 3.22, 95% CI: 1.82–7.83, p = 0.001) and low body mass index (OR: 2.1, 95% CI: 1.31–4.6, p = 0.02) were associated with ICH.ConclusionsIschemic and hemorrhagic strokes are frequent with VA-ECMO support and associated with worse outcomes, especially the hemorrhagic type. Awareness of the incidence and the factors associated with strokes is crucial in early identification and management.

BackgroundExercise-induced muscle fatigue is a major challenge for athletes. Our previous study indicated that Levilactobacillus brevis GKEX improved endurance and reduced fatigue in mice. This study aimed to further evaluate the effects of different preparations of L. brevis GKEX on exercise performance and fatigue resistance.MethodsEight-week-old male ICR mice were divided into six groups (n = 8): vehicle, BCAA, low-dose GKEX (0.0615 mg/day), high-dose GKEX (0.615 mg/day), heat-killed GKEX (0.615 mg/day), and freeze-killed GKEX (0.615 mg/day). Treatments lasted for four consecutive weeks. Exercise performance, fatigue-related biochemical markers, and gut microbiota composition were assessed.ResultsCompared with BCAA, L. brevis GKEX significantly improved aerobic performance, including forelimb grip strength and running-exhaustion time. It enhanced lactate clearance and glycogen storage in the liver and muscles while reducing lactate production and blood urea nitrogen levels after exercise. L. brevis GKEX supplementation also increased key short-chain fatty-acid–producing bacteria in the intestines.ConclusionOral administration of different doses of live and dead L. brevis GKEX promoted exercise performance and ameliorated fatigue, especially live GKEX. These findings suggest that L. brevis GKEX may serve as an ergogenic aid for athletes and support broader applications across various product forms.

Normothermic machine perfusion (NMP) enables real-time liver viability assessment and therapeutic intervention during preservation. Rapamycin, an mTORC1 inhibitor known to induce autophagy and promote cellular resilience, represents a promising candidate for mitigating ischemic injury during NMP. We developed a rat model of warm ischemia followed by NMP to evaluate whether rapamycin improves liver graft quality. Livers were subjected to 90 minutes of warm ischemia and then perfused for three hours with or without 50nM rapamycin. While no significant differences were observed in perfusate oxygen consumption, lactate clearance, or transaminase release, histological analysis revealed that rapamycin-treated livers had improved cellular architecture and reduced necrosis compared to untreated controls. These findings suggest that rapamycin may confer structural protection independent of immediate metabolic changes. This model provides a platform to further study targeted therapies during NMP and supports the potential role of mTORC1 modulation in enhancing liver graft preservation.

Reflective biomarker or independent risk predictor? Assessing lactate clearance in post-operative cardiac surgery outcomes