Lactate Levels Research Articles

ACEF score and lactate: lifeline predictors in endocarditis valve procedures: insights from a single-center study.

This study aimed to assess the prognostic value of routinely collected laboratory parameters, specifically lactate, troponin-T, and CK-MB, in predicting mortality in patients with surgically treated endocarditis. Additionally, the study evaluated the effectiveness of two mortality scores, EuroSCORE II and ACEF II Score, in this clinical context. We retrospectively analyzed data from 130 patients diagnosed with endocarditis who underwent surgery at a single tertiary center over nine years. The study utilized preoperative mortality scores and laboratory parameters collected within the first 24h post-surgery. Statistical analyses included AUROC curves, Kaplan-Meier survival analyses, and correlation analyses to determine predictive values and associations with patient outcomes. Among the 130 patients, 28 (21.5%) died within one year post-surgery. Elevated postoperative lactate levels were significantly associated with increased short- and long-term mortality, with AUROC values indicating strong predictive capability. The ACEF II Score also demonstrated significant predictive value for mortality at various time points, outperforming EuroSCORE II. Higher lactate levels and ACEF II Scores correlated with increased hazard ratios for mortality. Kaplan-Meier analyses revealed significant survival differences based on lactate and ACEF II Score thresholds. Postoperative lactate levels and the ACEF II Score are robust predictors of mortality in patients undergoing cardiac surgery for endocarditis. Integrating these parameters into clinical practice can enhance risk stratification and guide therapeutic decisions, improving patient outcomes through personalized care. Further studies are needed to validate these findings across diverse populations and explore additional biomarkers for refined predictive accuracy.

An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk

AbstractA 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.

Paediatric acute liver failure: early outcome and evaluation of transplantation criteria in a Belgian transplantation centre

BackgroundOne of the challenges when caring for children admitted for acute liver failure (ALF) is to quickly identify those who will improve spontaneously and those for whom liver transplantation (LT) is the only therapeutic option.MethodsRetrospective study to review our experience, identify mortality risk factors and update our LT criteria in case of paediatric ALF.Results111 children were admitted between March 1989 and May 2021 (mean age 59.1 months). 28 children never met our LT criteria; 17 had contraindication to LT; 66 were registered on the LT waitlist. 14 of these 66 were subsequently withdrawn because of spontaneous liver function recovery; 11 died before having received a liver; 41 were transplanted. Hospital survival rate was 63% for the whole series, 98% for the children without LT criteria and 71% for the transplanted children. Univariate analysis identified cardiovascular and respiratory failures on admission, and grade 4–5 hepatic encephalopathy (HE) during stay significantly associated with death. Non-survivors also had, on admission and during their stay, significantly higher levels of lactate, ammonia and bilirubin and, during their stay, significantly more frequent prothrombin time ≤ 25% or international normalized ratio ≥ 4.0 than the survivors. Multivariate analysis identified grade 4–5 HE, lactate level on admission and ammonia peak level as significant mortality risk factors.ConclusionOur criteria identified almost all children who had the capacity to spontaneously recover their liver function and suggest that updated criteria should combine biological tests and signs of multiple organ failure.

Influenza A virus-induced glycolysis facilitates virus replication by activating ROS/HIF-1α pathway.

As a highly contagious acute respiratory disease, influenza A virus (A/WSN/1933) poses a huge threat to human health and public health. influenza A virus proliferation relies on glucose metabolism in host cells, yet the effects of influenza A virus on glucose metabolism and the underlying molecular mechanisms remain unclear. Here, we created models of WSN virus-infected mice and A549 cells, along with analyzing metabolomics and transcriptomics data, to investigate how WSN virus infection affects host cell glucose metabolism and specific mechanisms. Analysis of metabolites and gene expression showed that WSN virus infection triggers glycolysis in A549 cells, with notable upregulation of hexokinase 2 (HK2), lactate dehydrogenase A (LDHA), hypoxia-inducible factor-1 alpha (HIF-1α), and elevated lactate levels. Additionally, it leads to mitochondrial impairment and heightened reactive oxygen species (ROS) generation. Elevated levels of glucose may enhance the replication of WSN virus, whereas inhibitors of glycolysis can reduce it. Enhancement of HIF-1α activation facilitated replication of WSN virus through stimulation of lactate synthesis, with the primary influence of glycolysis on WSN virus replication being mediated by ROS/HIF-1α signaling. Mice given HIF-1α inhibitor PTX-478 or glycolysis inhibitor 2-Deoxyglucose (2-DG) exhibited reduced lactate levels and decreased WSN virus replication, along with mitigated weight loss and lung damage. In summary, WSN virus-induced glycolysis has been demonstrated to enhance virus replication through the activation of the ROS/HIF-1α pathway, suggesting potential new targets for combating the virus.

Application of Sini Decoction at acupoint on gastrointestinal dysfunction in patients with sepsis: A clinical study.

The occurrence of gastrointestinal dysfunction is widely recognized as a prevalent complication in patients with sepsis. To investigate clinical effect of Sini Decoction at acupoint on gastrointestinal dysfunction in sepsis patients. Seventy-five patients with gastrointestinal dysfunction caused by sepsis were randomly divided into 2 groups. Treatment group received routine Western medicine treatment combined with Sini Decoction at acupoint, while control group treated with talcum powder at acupoint. Treatments in both groups lasted 7 days. Changes in the acute physiology and chronic health evaluation II score, sequential organ failure assessment score, mechanical ventilation duration, the length of Intensive Care Unit (ICU) stay, enteral nutrition tolerance scores, abdominal circumference, gastric residual volume, bowel sounds, and serum index were observed. After treatment, the enteral nutrition tolerance score, abdominal circumference, gastric residual volume, and levels of lactate and interleukin-6 were significantly lower in the treatment group compared to the control group. Bowel sounds were more active and motilin levels were higher in the treatment group. Additionally, the length of ICU stay was significantly shorter in the treatment group than in the control group. Our findings demonstrated that the application of Sini Decoction at acupoints in sepsis patients with gastrointestinal dysfunction can effectively enhance gastrointestinal function, leading to a reduction in ICU stay duration and an improvement in patients' prognosis.

Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study

BackgroundSeptic shock and hypovolemic shock are life-threatening illnesses that necessitate immediate recognition and intervention, as they can result in deadly consequences. While the underlying processes may vary, both entities can exhibit hypotension and organ dysfunction. No studies have been conducted on bedside testing to differentiate between these illnesses. Lactate measurement has been established as a viable option for early detection of septic shock. However, its role in diagnosing hypovolemic shock has yet to be evaluated. The aim of the study was to investigate alterations in lactate levels among diarrheal patients with septic shock and hypovolemic shock following the administration of first fluid resuscitation. MethodsWe conducted a prospective observational study in critically ill diarrheal adults aged ≥18 years in the emergency ward in Dhaka Hospital of icddr,b from 21st October 2021 to 31st May 2023 (total 19 months). The enrollment process was operational between 8:30 AM and 5:00 PM. Diarrheal adults with a diagnosis of sepsis with shock featured with poor peripheral perfusion (characterized by cold periphery and weak or absent pulse and capillary refill time >3 sec) or hypotension (characterized by mean arterial pressure <65 mm-Hg) were enrolled as cases and consecutive diarrheal patients without any obvious features of sepsis with hypovolemic shock (due to severe dehydration) comprised the comparison group.POC lactate test was done at hours 0, 1st and 6th by StatStrip Lactate meters (Nova Biomedical, US) to all enrolled patients. For comparison of POC lactate levels, we used paired t-test for comparing the lactate samples drawn at hour 0, hour 1 and 6 with the septic shock and hypovolemic shock group. Odds ratio (OR) and their 95% confidence intervals (CIs) were used to demonstrate the strength of association. The study was registered at Clinicaltrials.gov (NCT05108467) and received institutional ethical approval (PR-21097). FindingsOf 435 patients, 135 had septic shock and 141 had hypovolemic shock, rest 41 patient responded with fluid bolus. 25% (34/135) of the people in the septic shock group died whereas there is no mortality in the hypovolemic shock group. The number of patients visiting from outside Dhaka city had more septic shock than from inside were higher in comparison with (55% vs. 28%; p <0.001). Statistically significant difference was observed between septic shock and hypovolemic shock group for a median POC lactate in 0, 1st and 6th hours with an OR of 1.07 (95% CI: 0.99, 1.17; p=0.039); 1.48, (95% CI: 1.28, 1.70; p<0.001) and 2.36 (95% CI: 1.85, 3.00; p<0.001), respectively. The gradient of 1st to 2nd sample between septic shock and hypovolemic shock was found to be significantly different (OR:0.74, 95% CI: 0.64, 0.85; p<0.001). InterpretationPOC lactate test can detect septic shock by differentiating hypovolemic shock in diarrheal patients. By providing quick, reliable and accurate result this test can help clinicians quickly diagnose and treat time-sensitive condition, like septic shock. FundingThe study was funded by Global Affairs of Canada (GR-01726). The donors had no role in the design, implementation, analysis, data interpretation or writing manuscript, or decision to publish. The corresponding author had access to all data and takes responsibility for the final approval and submission of the manuscript.

Glycolytic activity following anti-CD19 CAR-T cell infusion in non-Hodgkin lymphoma.

Energy metabolism of chimeric antigen receptor-T cells (CAR-T) activation in humans remains unexplored. As a glycolytic activity surrogate, we investigated the dynamics of peripheral blood (PB) lactate in the first weeks post-CAR-T infusion. In 17 patients treated with CD28 harbording anti-CD19 CAR-T for relapsed/refractory non-Hodgkin lymphomas, PB lactate levels increased following CAR-T infusion. Elevated lactate levels correlated with longer CAR-T persistence and higher CD8+/CD4+ ratio. Peripheral blood lactate kinetics may reflect immune cells activation and be useful for bedside monitoring.

Assessment of clinical and laboratory parameters of oral сavity in patients with orthodontic systems

equipment (braces) on the biochemical parameters of oral fluid. Materials and methods. The study involved patients aged 18 to 22 years who are undergoing orthodontic treatment with a bracket system. Thegroup of examined persons was 25 people. The control group included 15 practically healthy people without braces. All patients underwent dental status assessment (Green – Vermillion hygiene index – simplified IG-Y; PMA inflammation index), laboratory examination of oral fluid before and after controlled oral hygiene. The biochemical analysis included determination of the acid-base balance in the oral fluid using a pH meter, assessment of free radical oxidation by chemiluminogram parameters by biochemiluminescence and by levels of molecular products of lipid peroxidation (diene and triene conjugates, Schiff bases), activity of the enzyme alkaline phosphatase, concentrations of total protein and lactate. Results and discussions. In patients undergoing orthodontic treatment with a bracket system, an insufficient level of oral hygiene and inflammatory manifestations in the gums of moderate severity were revealed. The level of the acid-base balance of the oral fluid before controlled hygiene was equal to 6.8±0.19, that is, below the range of normal pH values in the oral cavity. After hygiene, the pH of the oral fluid returned to the norm of 7.1±0.2. In patients with braces, activation of free radical oxidation and an increase in lipoperoxidation parameters – triene conjugates and Schiff bases, increased activity of alkaline phosphatase, total protein and lactate levels took place.Cоnclusion. After hygienic treatment of the oral cavity, the biochemical parameters did not differ statistically significantly from the control data.

Patients with crush syndrome and kidney disease: lessons learned from the earthquake in Kahramanmaraş, Türkiye

This study investigated in-hospital outcomes and related factors in patients diagnosed with postearthquake crush syndrome after the earthquakes in Kahramanmaraş, Türkiye. One thousand twenty-four adult patients diagnosed with crush syndrome were analyzed. Data on demographic characteristics, clinical presentation, laboratory values, treatments, and outcomes were collected. A total of 9.8% of patients died during their hospital stay. Nonsurvivors were generally older, more likely to have preexisting chronic kidney disease, and faced more severe injuries and complications, including hypotension-shock, arrhythmias, elevated markers of renal dysfunction, and higher rates of acute kidney injury (AKI) and compartment syndrome. In addition, intensive care unit needs were higher. Multivariate analysis confirmed that age, injury severity, shock, high potassium, uric acid, and lactate levels on admission, development of AKI, compartment syndrome, and intensive care unit admission were significant predictors of mortality. Better disaster preparedness and improved health care infrastructure could be potential explanations for improved in-hospital mortality in the current era, as compared to previous earthquakes.

Biochemical analysis of soft tissue infectious fluids and its diagnostic value in necrotizing soft tissue infections: a 5-year cohort study

BackgroundNecrotizing soft tissue infections (NSTI) are rapidly progressing and life-threatening conditions that require prompt diagnosis. However, differentiating NSTI from other non-necrotizing skin and soft tissue infections (SSTIs) remains challenging. We aimed to evaluate the diagnostic value of the biochemical analysis of soft tissue infectious fluid in distinguishing NSTIs from non-necrotizing SSTIs.MethodsThis cohort study prospectively enrolled adult patients between May 2023 and April 2024, and retrospectively included patients from April 2019 to April 2023. Patients with a clinical suspicion of NSTI in the limbs who underwent successful ultrasound-guided aspiration to obtain soft tissue infectious fluid for biochemical analysis were evaluated and classified into the NSTI and non-necrotizing SSTI groups based on their final discharge diagnosis. Common extravascular body fluid (EBF) criteria were applied.ResultsOf the 72 patients who met the inclusion criteria, 10 patients with abscesses identified via ultrasound-guided aspiration were excluded. Based on discharge diagnoses, 39 and 23 patients were classified into the NSTI and non-necrotizing SSTI groups, respectively. Biochemical analysis revealed significantly higher albumin, lactate, lactate dehydrogenase (LDH), and total protein levels in the NSTI group than in the non-necrotizing SSTI group, and the NSTI group had significantly lower glucose levels and pH in soft tissue fluids.In the biochemical analysis, LDH demonstrated outstanding discrimination (area under the curve (AUC) = 0.955; p < 0.001) among the biochemical markers. Albumin (AUC = 0.884; p < 0.001), lactate (AUC = 0.891; p < 0.001), and total protein (AUC = 0.883; p < 0.001) levels also showed excellent discrimination. Glucose level (AUC = 0.774; p < 0.001) and pH (AUC = 0.780; p < 0.001) showed acceptable discrimination. When the EBF criteria were evaluated, the total scores of Light’s criteria (AUC = 0.925; p < 0.001), fluid-to-serum LDH ratio (AUC = 0.929; p < 0.001), and fluid-to-serum total protein ratio (AUC = 0.927; p < 0.001) demonstrated outstanding discrimination.ConclusionBiochemical analysis and EBF criteria demonstrated diagnostic performances ranging from acceptable to outstanding for NSTI when analyzing soft tissue infectious fluid. These findings provide valuable diagnostic insights into the recognition of NSTI. Further research is required to validate these findings.

Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition

Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition

PREBIOTIC EFFICACY OF DEFATTED FENUGREEK SEED FLAKES (FENUFLAKESTM): A SHORT-TERM COLONIC SIMULATION STUDY

Objective: To investigate the prebiotic effects of defatted fenugreek seed flakes (Fenuflakes™) using a 48-hour colonic simulation model. Methods: Fecal samples from three healthy adult human donors were exposed to treatment conditions of blank (medium control), Fenuflakes, or inulin (fiber control). The effects on microbial fermentation (pH and gas production), metabolite production [Short Chain Fatty Acid (SCFAs), Branched-Chain Fatty Acid (BCFA), ammonium and lactate production], and microbial community composition were evaluated at 0, 6, 24, and 48 h. Results: In comparison to inulin, Fenuflakes demonstrated a significant reduction in gas production. Both inulin and Fenuflakes significantly increased beneficial SCFAs, but no significant change was observed in BCFA. Ammonium production increased upon Fenuflakes treatment due to a residual protein fraction reaching the colon, in contrast to inulin, which is in a protein-depleted state. The lactate levels significantly increased for Fenuflakes and inulin. The presence of Fenuflakes and inulin resulted in favorable fermentation by the colonic gut microbiota, indicating an increase in species enrichment and alpha diversity in the microbial community composition. Conclusion: Fenuflakes exhibit prebiotic potential by increasing SCFA and promoting the enrichment of several beneficial colonic bacteria while maintaining normal colonic pH and producing less gas than inulin.

Personalized management of hepatic glycogen storage disorders: The role of continuous glucose monitoring.

Glycogen storage disorders (GSD), inherent disorders of carbohydrate metabolism, feature hypoglycemia as a hallmark. Normoglycemia and glucose monitoring are pivotal in disease management. Conventional glucometer-based monitoring may overlook hypoglycemic trends. This study assesses glycemic control in Asian Indian GSD children using continuous glucose monitoring (CGM) and its role in facilitating dietary adjustments. A pre-post study enrolled molecularly confirmed GSDI, GSDIII, GSDVI, and GSDIX patients for baseline dietary compliance and CGM-based glycemic status evaluation. Hypoglycemic patients were stratified into diet-compliant and diet-noncompliant groups. Noncompliant patients received dietary reinforcement; compliant individuals underwent dietary adjustments. Repeat CGM (rCGM) was performed 6 weeks to 6 months postadjustments. Clinical and metabolic parameters were re-evaluated at 6 months. Of the 20 patients assessed at baseline, 11 were diet compliant. Six among these exhibited hypoglycemia, prompting diet adjustments. Among nine noncompliant patients, eight experienced hypoglycemia and received diet reinforcement. rCGM in 10 patients (five GSDI, three GSDIII, and two GSDIXc) showed a significant reduction in hypoglycemia duration in all. An improvement in height and body mass index was observed in all GSDI and GSDIII patients. Triglyceride levels, raised at baseline in two GSDI and one GSDIII, showed a substantial decline in one GSDI patient. Hepatic transaminase levels decreased in both GSDIXc patients. Plasma lactate levels decreased in all GSDI patients. CGM is an efficacious adjunct in the personalized management of hepatic GSD patients, in the Asian Indian population. The study also underscores the need for long-term follow-up to determine the role of glycemic management in growth, general well-being, and metabolic control in the GSD subtypes.

Methods to characterize lactate turnover in aging and Alzheimer's disease; The LEAN study

BackgroundThere is evidence that chronic exercise can benefit the brain, but the effects vary markedly between studies. One potential mechanism for exercise-related benefit is the increase in systemic lactate concentration that is well-characterized to occur during exercise. Lactate is known to cross the blood brain barrier and can be used readily as a fuel for neurons. This may be particularly important in Alzheimer's Disease, which is characterized by cerebral hypometabolism. However, little is known about how whole-body lactate metabolism differs between older adults and individuals with cognitive impairment. This information is critical when considering potential differences in responses to exercise in various cognitive diagnosis groups. MethodsHere we describe the use of a “lactate clamp” procedure to adjust blood lactate levels to approximate those achieved during exercise, but while at rest. This trial will compare lactate oxidation between cognitively healthy older adults and cognitively impaired participants. We will further evaluate the effect of acute lactate infusion on cognitive performance. DiscussionThe findings of the study described here, the Lactate for Energy and Neurocognition trial (clinicaltrials.gov # NCT05207397) will add to our understanding of systemic lactate mechanics in cognitively healthy older adults and individuals with Alzheimer's Disease. These findings will be applicable to ongoing exercise trials and to future studies aimed at modulating systemic bioenergetic function in aging and Alzheimer's Disease.

Effects of small-sided games on some recovery markers in football

Background and Study Aim. Small-sided games (SSGs) are widely used in football training to replicate match conditions while controlling the physical load on players. Variations in the number of players during these games can significantly influence key recovery markers. This study aims to investigate the effects of variations in player numbers on maximal heart rate, blood lactate levels, and perceived exertion in small-sided games acutely applied in football. Material and Methods. The study involved 28 male football players who were also university students (mean age 24.89±4.59 years, mean height 179±0.04 cm, mean body weight 73.21±4.34 kg). The participants were divided into three groups based on the number of players (2 vs. 2, 4 vs. 4, and 8 vs. 8). Heart rate and lactate levels were measured at three time points: before training, immediately after training, and 30 minutes post-training. Results. The study revealed that post-training maximal heart rates (MHR) and lactate levels were significantly higher across all groups compared to pre-training levels, while measurements taken 30 minutes post-training were significantly lower than post-training levels (P&lt;0.05). No significant differences were found between pre-training and 30-minute post-training MHR values across the three groups (P&gt;0.05). Post-training MHR values were similar between the 2 vs. 2 and 4 vs. 4 groups (P&gt;0.05), whereas the 8 vs. 8 group showed significantly higher values (P&lt;0.05). Post-training and 30-minute post-training lactate levels were similar between the 4 vs. 4 and 8 vs. 8 groups (P&gt;0.05), but the 2 vs. 2 group had significantly lower levels (P&lt;0.05). Perceived exertion levels post-training were similar between the 2 vs. 2 and 4 vs. 4 groups (P&gt;0.05), while the 8 vs. 8 group reported significantly higher perceived exertion levels (P&lt;0.05). Conclusions. Small-sided games with varying numbers of players are an effective method for modulating physical load during football training. These findings underscore the importance of considering game format in designing training sessions to optimize player performance and recovery.

PKM2-Driven Lactate Overproduction Triggers Endothelial-To-Mesenchymal Transition in Ischemic Flap via Mediating TWIST1 Lactylation.

The accumulation of lactate is a rising risk factor for patients after flap transplantation. Endothelial-to-mesenchymal transition (EndoMT) plays a critical role in skin fibrosis. Nevertheless, whether lactate overproduction directly contributes to flap necrosis and its mechanism remain unknown. The current study reveals that skin flap mice exhibit enhanced PKM2 and fibrotic response. Endothelial-specific deletion of PKM2 attenuates flap necrosis and ameliorates flap fibrosis in mice. Administration of lactate or overexpressing PKM2 promotes dysfunction of endothelial cells and stimulates mesenchymal-like phenotype following hypoxia. Mechanistically, glycolytic-lactate induces a correlation between Twist1 and p300/CBP, leading to lactylation of Twist1 lysine 150 (K150la). The increase in K150la promotes Twist1 phosphorylation and nuclear translocation and further regulates the transcription of TGFB1, hence inducing fibrosis phenotype. Genetically deletion of endothelial-specific PKM2 in mice diminishes lactate accumulation and Twist1 lactylation, then attenuates EndoMT-associated fibrosis following flap ischemia. The serum lactate levels of flap transplantation patients are elevated and exhibit predictive value for prognosis. This findings suggested a novel role of PKM2-derived lactate in mediating Twist1 lactylation and exacerbates flap fibrosis and ischemia. Inhibition of glycolytic-lactate and Twist1 lactylation reduces flap necrosis and fibrotic response might become a potential therapeutic strategy for flap ischemia.

Exploring mitochondrial blood-based and genetic markers in older adults with mild cognitive impairment and remitted major depressive disorder

Mild cognitive impairment (MCI) is a prodromal stage in aging to possible progression to Alzheimer’s disease and related dementia (ADRD), where co-occurrence of major depressive disorder (MDD) accelerates the progression. Metabolic and mitochondrial abnormalities in ADRD and other neurodegenerative disorders have been widely suggested, while possible mitochondrial dysfunction has been associated with etiopathology of both MCI and MDD. Hence, investigation of mitochondrial markers in MCI, MDD, and presence of both conditions is warranted. In total, 332 older adult participants were included: 168 with MCI, 108 with MCI plus remitted MDD (rMDD), and 56 with rMDD but without MCI. We measured plasma circulating mitochondrial DNA (ccf-mtDNA), lactate, and extracted nuclear mitochondrial encoded (NMt) single-nucleotide variants (SNVs) (n = 312). Non-parametric statistical tests on ccf-mtDNA and lactate levels were performed on the diagnosis, clinical and cardiometabolic variables. Binary sequence kernel association test (SKAT-O) and burden test were performed on NMt-SNV, adjusted for age, race, gender, type II diabetes, and APOE genotype. Lower level of lactate was observed in MCI (KW χ2 = 14.8, P = 0.0024), more specifically, significant differences of lower plasma lactate between MCI only and rMDD, but not between MCI+rMDD and MCI were found, suggesting potential roles in MCI driving lactate lower levels. While higher levels of ccf-mtDNA were observed in APOE-ε4 carrier (χ2 = 5.04, P = 0.05). This relationship was present only in MCI (P = 0.043) and MCI+rMDD groups (P = 0.023). No significant nuclear-encoded mitochondrial gene associations were observed with MCI or MDD. The results suggest decreased level of plasma lactate in individuals with MCI and MCI+rMDD, with inverse correlation with ccf-mtDNA, in addition to effect of APOE-ε4 in further increasing ccf-mtDNA specifically in participants with cognitive impairment. These findings contribute to a deeper understanding of the mitochondrial markers in MCI and MDD, warranting further research to explore the precise roles of mitochondrial abnormalities in the development and progression of MCI.

Influence of Right and Left Bundle Branch Block in Patients With Cardiogenic Shock and Cardiac Arrest.

The study investigates the prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in patients with cardiogenic shock (CS) compared with no bundle branch block (BBB). In patients with heart failure, existence of RBBB and LBBB has influence on prognosis. Prospective registry-study. ICU of a tertiary academic hospital in Germany. Adult patients with CS. None. Consecutive patients with CS were included. The prognostic impact of RBBB and LBBB on 30-day all-cause mortality was tested within the entire cohort and in the subgroup of CS patients with cardiac arrest at admission. The final study cohort comprised 248 patients. Patients with RBBB showed the highest 30-day all-cause mortality followed by LBBB and no BBB (72.5% vs. 52.9% vs. 50.0%; log-rank p = 0.015). These findings were consistent even after solely including CS patients with cardiac arrest (90.0% vs. 73.3% vs. 62.2%; log-rank p = 0.008). After adjustment for lactate, norepinephrine, troponin I, Acute Physiology Score, Society of Cardiovascular Angiography & Interventions shock stage, and heart rate in a multivariable Cox regression analysis, RBBB still revealed a negative impact on 30-day all-cause mortality (hazard ratio [HR], 1.807; 95% CI, 1.107-2.947; p = 0.018), whereas LBBB was not associated with 30-day all-cause mortality. In this multivariable Cox regression model lactate (HR, 1.065; 95% CI, 1.018-1.115; p = 0.006), troponin I (HR, 1.003; 95% CI, 1.001-1.005; p = 0.001), and Acute Physiology Score (HR, 1.033; 95% CI, 1.001-1.066; p = 0.041) were as well associated with 30-day all-cause mortality. Finally, no association of RBBB was found with the incidence of liver or severe renal failure. Besides the Acute Physiology Score, lactate, and troponin levels, RBBB was associated with an increased 30-day all-cause mortality in consecutive CS patients with and without cardiac arrest, whereas LBBB showed no prognostic impact.

Assessment of hemodynamic parameters and caudal vena cava-to-aorta ratio pre- and post-pericardiocentesis in dogs with cardiac tamponade.

To evaluate haemodynamic parameters and ultrasonographic measurements of the caudal vena-cava-to-aorta ratio at the splenorenal view in canine cardiac tamponade before and 30 minutes after pericardiocentesis. Dogs presenting with cardiac tamponade at two veterinary hospitals were included. Triage examination, noninvasive systolic arterial blood pressure, shock index, venous lactatemia and POCUS results were recorded at admission and 30 minutes after pericardiocentesis. This prospective observational study included 22 dogs, and all had an increased caudal vena-cava-to-aorta ratio. After pericardiocentesis, there were significant changes in vital signs, including a decrease in the median heart rate by 42.1%, a decrease in the median respiratory rate by 40.1%, and an increase in the median rectal temperature from 37.8°C (range: 35.6 to 39.2) to 38.1°C ( 36.1 to 38.7). In regards of hemodynamic parameters, the median systolic arterial pressure increased significantly by 23.2%, the shock index decreased significantly by 52.8%, the median lactate level decreased significantly from 6.1 mmol/L (1.4 to 14.7) to 3.6 mmol/L (1.1 to 13.6), and the median caudal vena-cava-to-aorta ratio decreased significantly by 37.5%, from 1.76 (1.35 to 2.13) to 1.12 (0.91 to 1.51). This study demonstrated an increased caudal vena-cava-to-aorta ratio in dogs with cardiac tamponade and a rapid haemodynamic improvement in dogs with cardiac tamponade within 30 minutes of the pericardiocentesis, resulting in excellent short-term prognosis.

Deciphering postoperative hemodynamics in pediatric intensive care: insights from patient-specific computational fluid dynamics models for congenital heart disease

Abstract Purpose Precise hemodynamic control is imperative for optimizing outcomes in children undergoing cardiac surgery, particularly in the pediatric intensive care unit (PICU). Computational fluid dynamic (CFD) models tailored to individual pediatric patients following definitive repairs for congenital heart disease hold the potential to discern and analyze the intricacies of their hemodynamic systems. This study aims to explore the applicability of patient-specific CFD models in determining optimal treatment strategies to enhance patient hemodynamics. Methods Ten postoperative pediatric patients (6 females and 4 males, median age 4.5±3.6 months, median height 62.5±5.3 cm, and median weight 6.2±1.3 kg) diagnosed with ventricular septal defect (VSD, n=5), atrial septal defect (ASD, n=2), and atrioventricular septal defect (AVSD, n=3) were enrolled. Continuous radial arterial waveforms and sporadic arterial blood draws, including lactate levels, were recorded in the PICU postoperatively. Fluid dynamics equations were employed to model major and peripheral blood vessels, utilizing a 0–1-dimensional hemodynamic model validated in previous studies and refined for this investigation. Sensitivity analysis based on correlation coefficients identified significant parameters, adjusted for replicating pressure waveforms. Comparison and re-approximation was made with actual radial artery pressure waveforms from 78 arterial waveforms and blood draws. Updated parameters were then correlated with postoperative time and lactate levels in the ICU. Results Replicated waveforms demonstrated high agreement with original arterial waveforms, with mean, maximal, and minimal blood pressure percentages of 96.7±1.8%, 96.7±2.4%, and 95.8±2.4%, respectively. Notably, systemic vascular resistance and compliance exhibited a substantial relationship with time elapsed after admission to the PICU, with correlation coefficients (R) of 0.26 and 0.43, respectively. Lactate levels demonstrated a decrease with reduced peripheral vascular resistance and an increase in vascular compliance, with R of 0.23 and 0.32, respectively, aligning with expected clinical improvement and stability. Conclusion This study successfully attained precise replication of radial artery blood pressures and intricate pressure waveforms using patient-specific CFD models in pediatric patients following congenital heart disease repairs. The insights gained shed light on the pivotal hemodynamic parameters that impact both stability and instability. This research sets the stage for theoretically informed treatments by amalgamating real-time biological information with patient-specific CFD models.Re-approximation of arterial waveformCorrelation of hemodynamic parameters