Letteratura scientifica selezionata sul tema "L-lactate levels"

Background: In septic shock patients with cirrhosis, impaired liver function might decrease lactate elimination and produce a higher lactate level. This study investigated differences in initial lactate, lactate clearance, and lactate utility between cirrhotic and non-cirrhotic septic shock patients.Methods: This is a retrospective cohort study conducted at a referral, university-affiliated medical center. We enrolled adults admitted during 2012–2018 who satisfied the septic shock diagnostic criteria of the Surviving Sepsis Campaign: 2012. Patients previously diagnosed with cirrhosis by an imaging modality were classified into the cirrhosis group. The initial lactate levels and levels 6 hours after resuscitation were measured and used to calculate lactate clearance. We compared initial lactate, lactate at 6 hours, and lactate clearance between the cirrhosis and non-cirrhosis groups. The primary outcome was in-hospital mortality.Results: Overall 777 patients were enrolled, of whom 91 had previously been diagnosed with cirrhosis. Initial lactate and lactate at 6 hours were both significantly higher in cirrhosis patients, but there was no difference between the groups in lactate clearance. A receiver operating characteristic curve analysis for predictors of in-hospital mortality revealed cut-off values for initial lactate, lactate at 6 hours, and lactate clearance of >4 mmol/L, >2 mmol/L, and <10%, respectively, among non-cirrhosis patients. Among patients with cirrhosis, the cut-off values predicting in-hospital mortality were >5 mmol/L, >5 mmol/L, and <20%, respectively. Neither lactate level nor lactate clearance was an independent risk factor for in-hospital mortality among cirrhotic and non-cirrhotic septic shock patients.Conclusions: The initial lactate level and lactate at 6 hours were significantly higher in cirrhosis patients than in non-cirrhosis patients.

Background: The outcome after weaning from postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO) is poor. In this study, we investigated the prognostic impact of arterial lactate levels at the time of weaning from postcardiotomy VA. Methods: This analysis included 338 patients from the multicenter PC-ECMO registry with available data on arterial lactate levels at weaning from VA-ECMO. Results: Arterial lactate levels at weaning from VA-ECMO (adjusted OR 1.426, 95%CI 1.157–1.758) was an independent predictor of hospital mortality, and its best cutoff values was 1.6 mmol/L (<1.6 mmol/L, 26.2% vs. ≥ 1.6 mmol/L, 45.0%; adjusted OR 2.489, 95%CI 1.374–4.505). When 261 patients with arterial lactate at VA-ECMO weaning ≤2.0 mmol/L were analyzed, a cutoff of arterial lactate of 1.4 mmol/L for prediction of hospital mortality was identified (<1.4 mmol/L, 24.2% vs. ≥1.4 mmol/L, 38.5%, p = 0.014). Among 87 propensity score-matched pairs, hospital mortality was significantly higher in patients with arterial lactate ≥1.4 mmol/L (39.1% vs. 23.0%, p = 0.029) compared to those with lower arterial lactate. Conclusions: Increased arterial lactate levels at the time of weaning from postcardiotomy VA-ECMO increases significantly the risk of hospital mortality. Arterial lactate may be useful in guiding optimal timing of VA-ECMO weaning.

Background. Plasma and urinary levels of D-lactate have been linked to the presence of diabetes. Previously developed techniques have shown several limitations to further evaluate D-lactate as a biomarker for this condition.Methods. D- and L-lactate were quantified using ultraperformance liquid chromatography tandem mass spectrometry with labelled internal standard. Samples were derivatized with diacetyl-L-tartaric anhydride and separated on a C18-reversed phase column. D- and L-lactate were analysed in plasma and urine of controls, patients with inflammatory bowel disease (IBD), and patients with type 2 diabetes (T2DM).Results. Quantitative analysis of D- and L-lactate was achieved successfully. Calibration curves were linear (r2>0.99) over the physiological and pathophysiological ranges. Recoveries for urine and plasma were between 96% and 113%. Inter- and intra-assay variations were between 2% and 9%. The limits of detection of D-lactate and L-lactate in plasma were 0.7 μmol/L and 0.2 μmol/L, respectively. The limits of detection of D-lactate and L-lactate in urine were 8.1 nmol/mmol creatinine and 4.4 nmol/mmol creatinine, respectively. Plasma and urinary levels of D- and L-lactate were increased in patients with IBD and T2DM as compared with controls.Conclusion. The presented method proved to be suitable for the quantification of D- and L-lactate and opens the possibility to explore the use of D-lactate as a biomarker.

ABSTRACT Gene expression changes of glutamate-producing Corynebacterium glutamicum were identified in transcriptome comparisons by DNA microarray analysis. During glutamate production induced by a temperature shift, C. glutamicum strain 2262 showed significantly higher mRNA levels of the NCgl2816 and NCgl2817 genes than its non-glutamate-producing derivative 2262NP. Reverse transcription-PCR analysis showed that the two genes together constitute an operon. NCgl2816 putatively codes for a lactate permease, while NCgl2817 was demonstrated to encode quinone-dependent l-lactate dehydrogenase, which was named LldD. C. glutamicum LldD displayed Michaelis-Menten kinetics for the substrate l-lactate with a Km of about 0.51 mM. The specific activity of LldD was about 10-fold higher during growth on l-lactate or on an l-lactate-glucose mixture than during growth on glucose, d-lactate, or pyruvate, while the specific activity of quinone-dependent d-lactate dehydrogenase differed little with the carbon source. RNA levels of NCgl2816 and lldD were about 18-fold higher during growth on l-lactate than on pyruvate. Disruption of the NCgl2816-lldD operon resulted in loss of the ability to utilize l-lactate as the sole carbon source. Expression of lldD restored l-lactate utilization, indicating that the function of the permease gene NCgl2816 is dispensable, while LldD is essential, for growth of C. glutamicum on l-lactate.

AbstractObjectiveTo compare the accuracy of cord blood lactate measurement using gas analyzer and portable devices in order to assess possibility of implementation of these devices in clinical practice.MethodsWe performed a prospective observational study using 30 umbilical cord samples which were obtained immediately after birth. Portable electrochemical devices Lactate Scout (SensLab GmbH, Leipzig, Germany) and StatStrip Lactate (NOVA Biomedical, Waltham, MA, USA) were used to determine lactate level. A gas analyzer ABL800 FLEX (Radiometer Medical ApS, Brønshøj-Husum, Denmark) was used as a reference. Base excess (BE), pH, partial oxygen (pO2) and carbon dioxide (pCO2) pressure, hemoglobin (ctHb) and bilirubin (ctBl) levels were measured.ResultsThe mean umbilical cord blood lactate level determined by the gas analyzer was 5.85 ± 2.66 mmol/L (ranging from 1.4 mmol/L to 13.4 mmol/L). Lactate level estimated by Lactate Scout was 5.66 ± 2.65 mmol/L and did not significantly differ from the reference method level (P = 0.2547). The mean lactate level determined by StatStrip Lactate was significantly lower than by the gas analyzer – 4.81 ± 2.38 mmol/L (P < 0.0001). Umbilical cord blood pH, BE, pO2 and pCO2, ctHb and ctBl levels did not affect the accuracy of the lactate measurement in absolute units (mmol/L).ConclusionUmbilical cord blood lactate level measured by StatStrip Lactate was lower than estimated by the ABL800 FLEX gas analyzer. This shows the necessity to develop decision-making reference points separately for each device. Umbilical cord blood pH, BE, pO2 and pCO2, ctHb and ctBl levels did not affect the accuracy of measurements by electrochemical portable devices.

The pattern of lactate increase and its relation to pyruvate and lactate-to-pyruvate (L/P) ratio were studied during exercise and early recovery in 10 normal subjects for incremental exercise on a cycle ergometer. Gas exchange was measured breath by breath. Lactate and pyruvate were measured by enzymatic techniques. Lactate and log lactate changed only slightly at low levels of O2 uptake (VO2) but both began to abruptly increase at approximately 40–55% of the maximal VO2. However, the point of abrupt increase in pyruvate occurred at higher work rates and the rate of increase was not as great as that for lactate. Thus L/P ratio increased at the same VO2 as the log lactate increase. Following the exercise, pyruvate continued to increase steeply for at least the first 5 recovery min, whereas at 2 min lactate increased only slightly or decreased. Thus arterial L/P ratio reversed its direction of change and decreased toward the resting value by 2 min of recovery. Lactate, as well as L/P ratios, decreased in all subjects by 5 min. This study demonstrates that lactate and pyruvate concentrations increase slightly at low levels of exercise without a change in L/P ratio until a threshold work rate at which lactate abruptly increases without pyruvate. The resulting increase in L/P ratio is progressive as work rate is incremented and abruptly reverses when exercise stops.

ABSTRACT Corynebacterium glutamicum can grow on l-lactate as a sole carbon and energy source. The NCgl2816-lldD operon encoding a putative transporter (NCgl2816) and a quinone-dependent l-lactate dehydrogenase (LldD) is required for l-lactate utilization. DNA affinity chromatography revealed that the FadR-type regulator LldR (encoded by NCgl2814) binds to the upstream region of NCgl2816-lldD. Overexpression of lldR resulted in strongly reduced NCgl2816-lldD mRNA levels and strongly reduced LldD activity, and as a consequence, a severe growth defect was observed in cells grown on l-lactate as the sole carbon and energy source, but not in cells grown on glucose, ribose, or acetate. Deletion of lldR had no effect on growth on these carbon sources but resulted in high NCgl2816-lldD mRNA levels and high LldD activity in the presence and absence of l-lactate. Purified His-tagged LldR bound to a 54-bp fragment of the NCgl2816-lldD promoter, which overlaps with the transcriptional start site determined by random amplification of cDNA ends-PCR and contains a putative operator motif typical of FadR-type regulators, which is −1TNGTNNNACNA10. Mutational analysis revealed that this motif with hyphenated dyad symmetry is essential for binding of LldD to the NCgl2816-lldD promoter. l-Lactate, but not d-lactate, interfered with binding of LldRHis to the NCgl2816-lldD promoter. Thus, during growth on media lacking l-lactate, LldR represses expression of NCgl2816-lldD. In the presence of l-lactate in the growth medium or under conditions leading to intracellular l-lactate accumulation, the l-lactate utilization operon is induced.

Objective. Evaluate the change of lactate levels and its prognostic role in the postoperative period of patients undergoing pulmonary thromboendarterectomy. Methods. Retrospective study between 2001 and 2019. Patients older than 18 years and who underwent pulmonary thromboendarterectomy were included. The U Mann Whitney test was performed to evaluate the change between lactate levels, and Cox regression analysis to evaluate the relationship with mortality. Areas under the curve were constructed for lactate levels. Results. Seventy-three patients were operated on during the study period. Median age was 51 years, 55% female. The median lactate on days 1 was 4.65 mml/L and on day 2 it was 1.62 mml/L with a change of 2.87 mml/L. No differences were found between the levels measured on day 1 and 2 between the people who died and those who did not on day 30. In the multivariate regression of COX, no relationship with mortality was found. The area under the curve shows regular performance on both day 1 and day 2 in predicting mortality outcomes. Conclusions. The behavior of the lactate in patients undergoing pulmonary thromboendarterectomy shows a rapid change during the first hours after the procedure. No role was found as a predictor of mortality neither in-hospital nor in follow-up.

We have studied the role of substrate availability on net L-lactate uptake by liver of anaesthetized fed and 24 h-fasted rats. L-Lactate was infused through a mesenteric vein at infusion rates equivalent to 0, 0.125, 0.25 and 0.5 times the basal turnover rate (Rt). By these means we were able to increase L-lactate portal concentrations up to 5.5 mM, without significant changes in portal pH. In the basal state (0 Rt), a net L-lactate uptake by liver was found in 24 h-fasted animals. No net balance was observed in fed rats. Infusion of L-lactate in fed animals failed to induce a net hepatic uptake, except when L-lactate levels in portal vein were raised above 5 mM. In fasted animals, net L-lactate uptake by liver increased linearly (r = 0.99) as a function of L-lactate concentration in the portal vein, even beyond the saturation of its specific carrier. It is concluded that, first, the L-lactate carrier does not limit net L-lactate uptake, and second, that substrate availability is an important factor modulating net L-lactate uptake by liver.

This thesis reports on investigations into the influence of diet and a bentonite feed additive on blood parameters in the horse, and the effect of a bentonite feed additive on the process of digestion in the dog. In addition, the methodology of scientific research is examined, and reflections of learning experiences arising from contact with the Hawkesbury approach described. A high-concentrate low-roughage diet, consisting by weight of 70% oats and 30% lucerne chaff, when fed to horses was shown to influence blood red cell levels and blood L-lactate levels compared to three diets of equivalent energy content but reduced proportion of concentrate. Other blood parameters measured included pack cell volume, total plasma protein, total and differential white blood cell count. These demonstrated no significant alteration with diet. The inclusion of bentonite feed additive in a kibble and mince diet fed to dogs was demonstrated to improve the digestion of dry matter and organic matter components of the diet compared to the unmedicated control diet. Inclusion of bentonite food additive in the diet was also associated with an improvement in degree of stool formation and reduction in faecal odour. Part B of the thesis documents the learning experience developed from involvement in the Masters program and reflection on the research studies undertaken. A model for improved reductionist research is described.
Master of Science (Hons) (Systems Agriculture)

This thesis reports on investigations into the influence of diet and a bentonite feed additive on blood parameters in the horse, and the effect of a bentonite feed additive on the process of digestion in the dog. In addition, the methodology of scientific research is examined, and reflections of learning experiences arising from contact with the Hawkesbury approach described. A high-concentrate low-roughage diet, consisting by weight of 70% oats and 30% lucerne chaff, when fed to horses was shown to influence blood red cell levels and blood L-lactate levels compared to three diets of equivalent energy content but reduced proportion of concentrate. Other blood parameters measured included pack cell volume, total plasma protein, total and differential white blood cell count. These demonstrated no significant alteration with diet. The inclusion of bentonite feed additive in a kibble and mince diet fed to dogs was demonstrated to improve the digestion of dry matter and organic matter components of the diet compared to the unmedicated control diet. Inclusion of bentonite food additive in the diet was also associated with an improvement in degree of stool formation and reduction in faecal odour. Part B of the thesis documents the learning experience developed from involvement in the Masters program and reflection on the research studies undertaken. A model for improved reductionist research is described.

Kardijalni biomarkeri u predviđanju operativnog rizika kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore Evaluacija rezultata u kardiohirurgiji podrazumeva praćenje ishoda operativnog lečenja u određenom vremenskom periodu. Najčešće je to interval od 30 dana od datuma intervencije. Najčešći kriterijumi za praćenje su stopa mortaliteta i morbiditeta, dužina boravka u jedinici intenzivnog lečenja, ukupna dužina hospitalizacije i troškovi lečenja. Stratifikacija rizika podrazumeva da se bolesnici mogu podeliti u grupe u zavisnosti od broja i važnosti preoperativno utvrđenih faktora rizika, odnosno da se pre operacije može predvideti ishod hirurške intervencije kod svakog od njih pojedinačno. U Evropi je, u periodu između 1995. i 1999. godine, na osnovu multicentrične studije u 8 evropskih zemalja i 128 kardiohirurških centara u kojima je operisano 19.030 odraslih bolesnika, kreiran EvroSKOR - EuroSCORE (European System for Cardiac Operative Risk Evaluation) model za stratifikaciju rizika u kardiohirurgiji. Međutim, neminovne promene i napredak u operativnom lečenju doveli su do toga da je neophodno ažurirati postojeći sistem stratifikacije. Tako je 2012. godine u rutinsku upotrebu uveden novi sistem Euroscore II. Na Klinici za kardiohirurgiju Instituta za kardiovaskularne bolesti Vojvodine (IKVBV), EuroSCORE model uveden je u rutinsku upotrebu od početka 2001. godine. Analizom rezultata, posle dvogodišnje primene, pokazalo se da je model bio precizan, odnosno da nije postojala značajna razlika između očekivanog (3,7%) i stvarnog mortaliteta (3,47%). U poslednjih nekoliko godina, kod bolesnika kojima sledi kardiohirurška intervencija, u smislu razmatranja njihove prediktivne vrednosti, sve više pažnje se poklanja kardijalnim biomarkerima. Najznačajniji biomarkeri u kardiovaskularnoj medicini su: Troponin, Kreatin kinaza MB izoenzim (CKMB), N-terminalni pro B-tip natriuretski peptid (NT-proBNP), C-reaktivni protein (CRP), Laktat dehidrogenaza (LDH), Mokraćna kiselina (Acidum uricum). Ciljevi ovog rada su bili da se kreira model za predviđanje preoperativnog rizika kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore na osnovu preoperativnih vrednosti određenih biomarkera i da se kreira novi model sa kombinacijom prethodnog modela i već postojećeg modela EuroSCORE II. Ispitana su 704 bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcione frakcije manje ili jednake 50%. Bolesnici su operisani na Institutu za kardiovaskularne bolesti Vojvodine, od 20. januara 2014. do 20. aprila 2016. Kod bolesnika su urađene tri vrste operacija: revaskularizacija miokarda-koronarna hirurgija, hirurgija stečenih srčanih mana - valvularna hirurgija i kombinovane operacije. Od biohemijskih analiza, 24 sata pre operacije, urađene su sledeće analize: troponin I, kreatin kinaza, kreatin kinaza MB izoenzim, masena kreatin kinaza, laktat dehidrogenaza, C-reaktivni protein, NT-proBNP i mokraćna kiselina. Praćen je postoperativni mortalitet, postoperativni infarkt miokarda i postoperativni cerebrovaskularni incident i njihova povezanost sa preoperativnim vrednostima nabrojanih biomarkera. U studiju su bili uključeni svi bolesnici sa stečenim bolestima srca, stariji od 18 godina, kod kojih je ejekciona frakcija leve komore bila manja ili jednaka 50% i kod kojih su izvršene sledeće vrste operacija: revaskularizacija miokarda - koronarna hirurgija, hirurgija stečenih srčanih mana - valvularna hirurgija i kombinovane operacije - koronarna i valvularna hirurgija. Rezultati su pokazali da je postoperativni mortalitet bio 3,13%, da je postoperativni infarkt miokarda imalo 7,95% a postoperativni cerebrovaskularni incident 9,23% od ukupnog broja ispitanika. 1. Povezanost vrednosti biomarkera sa postoperativnim infarktom miokarda kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore: povišene preoperativne vrednosti troponina I su bile povezane sa postoperativnim infarktom miokarda. Povezanost preoperativnih vrednosti biomarkera sa postoperativnim cerebrovaskularnim incidentom kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore: povišene preoperativne vrednosti troponina I i CRP-a su bile povezane sa postoperativnim cerebrovaskularnim incidentom. 2. Analiziran je uticaj preoperativnog nivoa svih biomarkera, pojedinačno, na značajne neželjene kardijalne i cerebrovaskularne događaje - Major Adverse Cardiac and Cerebrovascular Events (MACCE) kao ishod posle operacije na srcu, kod bolesnika sa oslabljenom ejekcionom frakcijom leve komore. Dobijeni su sledeći rezultati: Preoperativna vrednost nivoa troponina I veća od 0,01μg/L i MACCE bili su povezani. Povećane preoperativne vrednosti nivoa C-reaktivnog proteina (CRP) i postoperativni MACCE bili su povezani. Povećane preoperativne vrednosti nivoa laktat dehidrogenaze (LDH) i MACCE bili su povezani. Zaključci ove teze su: 1. Nezavisni prediktor postoperativnog infarkta miokarda i značajnih neželjenih kardijalnih i cerebrovaskularnih događaja, kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, jeste povišena preoperativna vrednost troponina I. 2.Vrednost preoperativnog troponina I je slab marker za predviđanje postoperativnog infarkta miokarda i značajnih neželjenih kardijalnih i cerebrovaskularnih događaja, kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 3. Na pojavu postoperativnog cerebrovaskularnog incidenta, kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, ne utiče nijedna od ispitivanih varijabli. 4. Nezavisni prediktori postoperativnog mortaliteta kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%, na osnovu kojih je moguće kreirati prediktivni Model su godine starosti i povišene preoperativne vrednosti NT-proBNP. 5. Kreirani Model je dobar marker za predikciju ishoda posle operacije na srcu, kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 6. Povišena preoperativna vrednost NT- proBNP može da bude dobar marker u predikciji smrtnog ishoda posle operacije na srcu kod bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 7. Model EuroSCORE II se pokazao kao slabiji marker za predikciju ishoda posle operacije na srcu kod kardiohirurških bolesnika sa oslabljenom sistolnom funkcijom leve komore, ejekcionom frakcijom manjom ili jednakom 50%. 8. Testiranjem kreiranog modela, podelom na manje rizične i više rizične bolesnike, u odnosu na visinu ejekcione frakcije leve komore, pokazalo se da je model dobar marker za predviđanje smrtnog ishoda posle operacije na srcu, u obe grupe.
Cardiac surgery operative risk assessment in patients with imapired systolic left ventricular function using cardial biomarkers Evaluation of results in cardiac surgery involves monitoring the outcomes of operative treatment in a given time period. Typically, this interval includes 30 days from the date of operation. The most common criteria used for monitoring are the rate of mortality and morbidity, length of stay in the intensive care unit, the total length of hospitalization and medical costs. Risk stratification means that patients can be divided into groups depending on the number and importance of preoperatively identified risk factors, and that the outcome of surgery for each of the patients can be predicted preoperatively. In Europe, in the period of 1995-1999 on the basis of a multi-center study in 8 European countries and 128 cardiac centers in which 19,030 adult patients were operated on, EuroSCORE (European System for Cardiac Operative Risk Evaluation) model for risk stratification in cardiac surgery was developed. However, the inevitable changes and progress in the surgical treatment rendered the EuroSCORE model obsolete warranting updated system. It was in 2012 when a new system EuroSCORE II was introduced into practice At the Clinic for Cardiac Surgery of the Institute of Cardiovascular Diseases, EuroSCORE model was introduced in routine clinical use since the beginning of 2001. By analyzing the results, two years after application, it was shown that the model was accurate, and that there was no significant difference between the expected (3.7%) and the actual mortality (3.47%) In recent years, in patients who are candidates for cardiac surgery, more attention is paid to cardiac biomarkers in terms of evaluating their predictive power. The most significant biomarkers in cardiovascular medicine are: Troponin, creatine kinase MB isoenzyme (CKMB), N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), Lactate dehydrogenase (LDH), and uric acid (Uric uricum). The objectives of this study were to create a model to predict preoperative risk for cardiac surgery patients with impaired systolic left ventricular function on the basis of preoperative levels of certain biomarkers and to create a new model with a combination of the previous model and already existing EuroSCORE II model. The study included 704 patients with impaired systolic left ventricular function, ejection fraction less than or equal to 50%. All patients underwent cardiac surgery at the Institute of Cardiovascular Diseases, from January 20th 2014 until 20th April 2016. Patients were submitted to three types of operations: revascularization - coronary surgery, surgery of acquired heart defects - valvular surgery and combined operations. Following biochemical analyses were performed 24 hours prior to surgery: troponin I, creatine kinase, creatine kinase MB isoenzyme, mass creatine kinase, lactate dehydrogenase, C-reactive protein, NT-proBNP and uric acid. Postoperative mortality, postoperative onset of myocardial infarction and occurence of cerebrovascular accident and their correlation with preoperative values of listed biomarkers were registered. The study included all patients with acquired heart disease, older than 18 years, with the left ventricular ejection fraction less than or equal to 50% who were submitted to the following types of operations: revascularization - coronary surgery, surgery of acquired heart diseases - valvular surgery and combined operations - coronary and valvular surgery. The results showed that the postoperative mortality was 3.13%, new onset of postoperative myocardial infarction was detected in 7.95% of the patients and postoperative cerebrovascular accident developed in 9.23% of patients. Correlation of preoperative biomarkers values with postoperative myocardial infarction in patients with impaired left ventricular ejection fraction - elevated preoperative troponin I were associated with postoperative myocardial infarction. Correlation of preoperative biomarkers values with postoperative cerebrovascular incident occurence in patients with impaired left ventricular ejection fraction - elevated preoperative troponin I and CRP were associated with postoperative cerebrovascular incident. The influence of preoperative levels of all biomarkers, separetly, on the rate of significant adverse cardiac and cerebrovascular events - Major Adverse Cardiac and Cerebrovascular Events (MACCE) as the heart surgery outcome, in patients with impaired left ventricular ejection fraction. The following results were obtained: Increased preoperative levels of C-reactive protein (CRP) and postoperative MACCE were related. Increased preoperative levels of lactate dehydrogenase (LDH) and MACCE were related. The conclusions of this thesis are: 1. Independent predictor of postoperative myocardial infarction onset and significant adverse cardiac and cerebrovascular events in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%) is elevated preoperative value of troponin I. 2. Preoperative Troponin I value was poor marker for predicting postoperative myocardial infarction and significant adverse cardiac and cerebrovascular events in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 3. None of the studied variables showed influence on the postoperative cerebrovascular accident occurence, in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 4. Independent predictors of postoperative mortality in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%), that could be used to create a predictive model are: age and elevated preoperative value of NT-proBNP. 5. Developed model showed satisfactory results for predicting outcome after heart surgery in cardiac surgery patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 6. Elevated preoperative value of NT-proBNP may be a good marker for mortality prediction after the cardiac surgery in patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 7. EuroSCORE II model showed poor performance when predicting outcomes after cardiac surgery in patients with impaired systolic left ventricular function (ejection fraction less than or equal to 50%). 8. Validation of the newly-created model, considering low and medium risk patients, based on the value of left ventricular ejection fraction, showed that the model is a good marker for the mortality prediction in both groups.

Septic shock with AKI is associated with a high mortality. We evaluated whether continuous renal replacement therapy (CRRT) using a membrane (oXiris) with adsorbing properties could improve cardio-renal response and modulate endotoxin and cytokine levels. 105 patients requiring CRRT for septic shock-AKI received CRRT with an oXiris filter. The main cardio-renal parameters, SOFA total score, SOFA organ score, endotoxin and cytokine levels were measured at baseline (T0) and 72 h after the start of CRRT (T1). Norepinephrine infusion rate, blood lactate levels, and thromboelastographic parameters were monitored. At T1, the renal function improved (p < 0.01) urinary output increased ( p < 0,.01 ) with the cardiac response and the decrease of norepinephrine infusion. SOFA total decreased to 8.4 ± 3 from 12 ± 2 (p < 0.001). Endotoxin decreased also at T 1 ( p < 0.01) with a reduction of Il 6 and procalcitonin. Lactate level ranged from 3.37 ± 3.2mto 1.67 ± 1.8 mmol/l (p < 0.01). CRRT with the oxiris filter improves the cardio renal response response in septic patients with AKI. This is associated with a modulation of endo-toxemia, of cytokines and the stability of the coagulation parameters.

Sepsis is defined as life- threatening organ dysfunction caused by a detrimental host response to infection. Septic shock is a subset of sepsis in which underlying circulatory and cellular abnormalities are profound enough to substantially increase mortality. Septic shock is characterized by: ● The need for vasopressors to maintain mean arterial pressure (MAP) > 65mmHg despite adequate volume resuscitation. ● A serum lactate > 2mmol/L In lay terms, it is hypoperfusion with evidence of metabolic derangement. The mortality for both criteria is ~40%, compared to 20–30% for a single item. Please also refer to: https:// www.nice.org.uk/ guidance/indevelopment/gid-cgwave0686 The old definitions of sepsis described a heterogeneous group of patients and did not discriminate between infectious and non- infectious causes such as pancreatitis and trauma. The new definitions also allow easier recognition, based on a combination of symptoms and signs. Key parameters include: decreased level of consciousness, rigors, severe myalgia, high or low temperature, pulse > 130/min, systolic blood pressure < 90mmHg, respiratory rate (RR) > 25/ min, creatinine > 170μmol/ L, platelets < 100 x 109/l and bilirubin > 33μmol/ L. The Clinical Quality Commission recommend that NHS trusts use the national early warning score (NEWS), and a score > 5 is an indication to consider moving a patient to critical care. SIRS is defined as any of the two following criteria: acutely altered mental state, temperature < 36°C or > 38°C, pulse > 90/ min, RR > 20/ min, WCC > 12 or < 4 x 109/L and hyperglycaemia in the absence of diabetes mellitus. In the former definitions (1991 and 2001), sepsis was defined as infection plus SIRS. SIRS, however, was not good at separating infected patients who died from those who recovered from infection. SIRS was often an appropriate reaction to infection and many hospitalized patients meet the SIRS criteria. Also, as many as one in eight patients admitted to critical care units with infection and new organ failure did not have two SIRS criteria required to fulfil the sepsis definition. SIRS is no longer part of the new definitions.

Occupational compression sleeves are commonly used to relieve pain in the upper and lower extremities. Anecdotal data agree on the benefits of using compression sleeves while performing physical work. The purpose of this study was to assess the effects of wearing compression sleeves on the upper limbs on blood lactate concentration while completing a physically demanding activity. This study included six college-age participants from the University of Texas at El Paso. Anthropometric measurements were taken before the beginning of the study. Afterward, each participant’s basal capillary blood lactate level was established by averaging lactate concentration from three consecutive days. Capillary blood samples were taken from the participant’s earlobe, and lactate concentration (mmol/L) was assessed using the Lactate Plus Lactate Analyzer (Nova Biomedical). After obtaining all the baseline measurements, each participant completed six simulated work sessions, one with sleeves and another without sleeves, at an intensity of 25 Watts, 50 Watts, and 75 Watts a cadence of 60 RPM, and 10 minutes of duration. All participants rested for at least 72 hours between sessions to prevent muscular fatigue effects of lactate concentrations. The use of compression sleeves showed an average reduction of lactate concentration of 0.2 mmol/L. This study shows the potential benefits of wearing compression sleeves while performing activities involving the upper limbs by helping prevent lactate accumulation, a common indicator of muscular effort.

Introdução: As cardiopatias são as maiores causas de morte materna indireta no ciclo gravídico- puerperal, com incidência de 4,2% das gestações em todo país. Entre as cardiomiopatias, a estenose da valva mitral (EM) destaca-se pela maior incidência e está relacionada com febre reumática nos países subdesenvolvidos. Relato de caso: Paciente do sexo feminino, 41 anos (G4 P0 A2 C2), branca, obesa, puérpera há três dias, procura atendimento em razão de desconforto respiratório. A paciente foi acompanhada no pré-natal de alto risco por conta de hipertensão arterial crônica e por possuir histórico de acidente vascular encefálico isquêmico um ano antes. Da nona semana de gestação em diante, iniciou Metildopa 500 mg duas vezes ao dia, manutenção do AAS 100 mg uma vez ao dia e suspensão das outras medicações. A cesárea de emergência foi realizada com idade gestacional de 35 semanas, em razão da evolução de um quadro de pré-eclâmpsia sobreposta, sem intercorrências, e o recém-nascido nasceu vigoroso e sem complicações. Na admissão, a paciente encontrava-se dispneica e cianótica. Ao exame físico: saturação de 79%, pressão sistólica de 200 mmHg, pressão diastólica de 120 mmHg e ausculta pulmonar que evidenciava roncos com estertores em terço médio bilateral. A paciente evoluiu com quadro de parada cardiorrespiratória, com reversão após 10 minutos de massagem, desfibrilação e adrenalina endovenosa. Foi realizada a intubação orotraqueal. Tomografia computadorizada de tórax: consolidações extensas. Exames laboratoriais: leucócitos 26.640, proteína C reativa 118,9 mg/L e lactato 2,7 mmol/L. A paciente foi encaminhada e isolada na unidade de tratamento intensivo (UTI) em consequência da evolução para um quadro de síndrome do desconforto respiratório agudo grave e suspeita de COVID-19. Foi iniciada a antibioticoterapia empírica para infecção de foco pulmonar com Amoxicilina-Clavulanato, Azitromicina e Oseltamivir. Com a suspeita de quadro hipervolêmico pudesse ser por causa cardíaca, solicitou-se ecocardiograma transtorácico, que apresentou alterações sugestivas de EM reumática, com volume do átrio esquerdo de 53,4 ­ml/­m2, gradiente médio átrio esquerdo/ventrículo esquerdo de 19,0 mmHg, área valvar mitral estimada pela planimetria de 0,97 cm2 e pressão arterial pulmonar estimada em 65 mmHg. Caracterizou-se assim uma cardiomiopatia reumática com envolvimento mitroaórtico, sobrecarga de átrio esquerdo, esclerose valvar aórtica com regurgitação leve, dupla disfunção mitral com estenose severa e regurgitação tricúspide com moderada hipertensão pulmonar. Retirou-se a paciente do isolamento por reação em cadeia da polimerase (PCR)/SARS-CoV-2 negativo. Após oito dias de internação na UTI, a paciente recebe alta e aguarda cirurgia para troca de valva mitral. Conclusão: A descompensação de EM reumática pode ocorrer pelas modificações fisiológicas da gestação, como aumento do débito cardíaco e diminuição da resistência vascular periférica. O diagnóstico precoce e o adequado manejo são importantes para o desfecho clínico favorável.