Marcadores hematológicos y bioquímicos para el diagnóstico precoz de bacteriemiascausadas por Enterobacteriaceae resistentes a los carbapenémicos / Haematological and biochemical markers for the early diagnosis of bacteremias caused bycarbapenem-resistant Enterobacteriaceae

INTRODUCCIÓN. Las bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos se asocian con altas tasas de mortalidad a diferencia de las bacteriemias causadas por Enterobacteriaceae sensibles a carbapenémicos. Los hallazgos clínicos y de laboratorio son importantes para determinar los esquemas terapéuticos y su pronóstico; su diagnóstico precoz resulta esencial para un manejo adecuado. OBJETIVO. Relacionar valores de marcadores sanguíneos y bioquímicos en bacteriemias causadas por Enterobacteriaceae resistentes a carbapenémicos. MATERIALES Y MÉTODOS. Estudio analítico transversal. Población de 427 y muestra de 224 datos de hemocultivos positivos para Enterobacteriaceae de pacientes atendidos en el Hospital de Especialidades Carlos Andrade Marín en el periodo mayo 2016 a julio 2018. Criterios de inclusión: i) al menos un hemocultivo positivo; ii) recuperación del aislado de CRE o CSE y iii) recolección simultanea de muestras de sangre y pruebas de laboratorio. Criterios de exclusión: i) bacteriemias polimicrobianas; ii) valores fuera de rango y iii) reportes sin valores numéricos. El análisis de datos se realizó mediante el programa estadístico International Business Machines Statistical Package for the Social Sciences versión 24.0. RESULTADOS. Se demostró que el recuento de leucocitos [OR 1,21 (95% IC: 1,03-1,43)], el recuento de plaquetas [OR 1,65 (95% IC: 1,37-1,98)] y el tiempo parcial de tromboplastina [OR 1,29 (95% IC: 1,04-1,60)] fueron buenas variables predictoras independientes, mediante análisis de regresión logística multivariante. CONCLUSIÓN. La trombocitopenia y el tiempo parcial de tromboplastina prolongado se asociaron con bacteremia causada por Enterobacteriaceae resistentes a carbapenémicos.

INTRODUCTION. Bacteremias caused by carbapenem-resistant Enterobacteriaceae are associated with high mortality rates in contrast to bacteremias caused by carbapenem-sensitive Enterobacteriaceae. Clinical and laboratory findings are important in determining therapeutic regimens and prognosis; early diagnosis is essential for appropriate management. OBJECTIVE. To relate blood and biochemical marker values in bacteremia caused by carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 427 and sample of 224 blood culture data positive for Enterobacteriaceae from patients attended at the Carlos Andrade Marín Specialties Hospital in the period May 2016 to July 2018. Inclusion criteria: i) at least one positive blood culture; ii) recovery of CRE or CSE isolate and iii) simultaneous collection of blood samples and laboratory tests. Exclusion criteria: i) polymicrobial bacteremia; ii) out-of-range values and iii) reports without numerical values. Data analysis was performed using the statistical program International Business Machines Statistical Package for the Social Sciences version 24.0. RESULTS. Leukocyte count [OR 1.21 (95% CI: 1.03-1.43)], platelet count [OR 1.65 (95% CI: 1.37- 1.98)] and partial thromboplastin time [OR 1.29 (95% CI: 1.04-1.60)] were shown to be good independent predictor variables, by multivariate logistic regression analysis. CONCLUSION. Thrombocytopenia and prolonged partial thromboplastin time were associated with bacteremia caused by carbapenem-resistant Enterobacteriaceae.

Aerobic and anaerobic exercise ability of athletes combined with balanced nutrition / Capacidade de exercício aeróbico e anaeróbio de atletas combinada com nutrição equilibrada / Efectos combinados de una nutrición equilibrada en la capacidad de los atletas para realizar actividades aeróbicas

ABSTRACT Balanced nutrition is very important for athletes' health and competition performance, and balanced nutrition has become a hot topic in the sports industry. In this study, 30s anaerobic work test and maximal oxygen uptake test were used to test anaerobic exercise ability and aerobic exercise ability, respectively. Four groups were set up in the two test methods, and the corresponding functional test indexes, heart rate recovery index and blood lactic acid recovery value were determined. The anaerobic capacity test showed that the maximum power of male athletes in the experimental group had significant statistical difference before and after dietary balance management, and the fatigue index of female athletes in the experimental group had a significant downward trend. Five minutes and nine minutes after exercise, the blood lactic acid value of males in the experimental group was lower than before balanced nutrition. The aerobic capacity test showed that the exhaustion time of male athletes in the experimental group was significantly different before and after balanced nutrition. After the balanced nutrition, the blood lactic acid value of male athletes in the experimental group was lower than before the management immediately and nine minutes after exercise, and the heart rate value of the male athletes in the experimental group was far lower than before the management.

RESUMO Uma alimentação balanceada é muito importante para a saúde e o desempenho dos atletas em competições, tendo se tornado um tema bastante debatido no setor esportivo. Neste estudo, foram utilizados testes anaeróbios de 30 segundos e o teste captação máxima de oxigênio para testar a capacidade de exercício anaeróbio e a capacidade de exercício aeróbio, respectivamente. Foram criados quatro grupos nos dois métodos de teste, e foram determinados os índices de teste funcional, o índice de recuperação da frequência cardíaca e o valor de recuperação do ácido láctico no sangue. O teste de capacidade anaeróbia mostrou que a potência máxima dos atletas masculinos do grupo experimental apresentava diferença estatística significativa antes e depois da administração de alimentação balanceada, e o índice de fadiga dos atletas do grupo experimental apresentava uma tendência descendente significativa Cinco minutos e nove minutos após o exercício, o valor do ácido láctico no sangue dos homens do grupo experimental mostrou-se inferior ao valor anterior à alimentação balanceada. O teste de capacidade aeróbica mostrou que o tempo de esgotamento dos atletas masculinos no grupo experimental mostrou-se significativamente diferente antes e depois da administração de alimentação balanceada. Após a administração de alimentação balanceada, o valor do ácido láctico no sangue dos atletas masculinos no grupo experimental foi menor do que aquele antes da administração de alimentação balanceada imediatamente e nove minutos após o exercício, e o valor da frequência cardíaca dos atletas masculinos no grupo experimental foi muito menor do que o valor anterior à administração de alimentação balanceada.

RESUMEN Una alimentación balanceada es muy importante para la salud y el desempeño de los atletas en competencias, habiéndose vuelto un tema bastante debatido en el sector deportivo. En este estudio, fueron utilizados tests anaeróbicos de 30 segundos y el test de captación máxima de oxígeno para verificar la capacidad de ejercicio anaeróbico y la capacidad de ejercicio aeróbico, respectivamente. Fueron creados cuatro grupos en los dos métodos de test, y fueron determinados los índices de test funcional, el índice de recuperación de la frecuencia cardíaca y el valor de recuperación del ácido láctico en la sangre. El test de capacidad anaeróbica mostró que la potencia máxima de los atletas masculinos del grupo experimental presentaba diferencia estadística significativa antes y después de la administración de alimentación balanceada, y el índice de fatiga de los atletas del grupo experimental presentaba una tendencia descendente significativa Cinco minutos y nueve minutos después del ejercicio, el valor del ácido láctico en la sangre de los hombres del grupo experimental se mostró inferior al valor anterior a la alimentación balanceada. El test de capacidad aeróbica mostró que el tiempo de agotamiento de los atletas masculinos en el grupo experimental se mostró significativamente diferente antes y después de la administración de alimentación balanceada. Después de la administración de alimentación balanceada, el valor del ácido láctico en la sangre de los atletas masculinos en el grupo experimental fue menor que aquel antes de la administración de alimentación balanceada inmediatamente y nueve minutos después del ejercicio, y el valor de la frecuencia cardíaca de los atletas masculinos en el grupo experimental fue mucho menor que el valor anterior a la administración de alimentación balanceada.

Effects of blood flow restriction in large and small muscle groups / Efeitos da restrição do fluxo sanguíneo em grupamentos musculares grandes e pequenos / Efectos de la restricción del flujo sanguíneo en grupos musculares grandes y pequeños

ABSTRACT Introduction It is known that strength training brings improvements in health and sports performance by causing muscle hypertrophy and increased strength, as well as modifying some hemodynamic and physiological factors. Several strength training methodologies have been developed, one of which is vascular occlusion. There are few studies with large muscle groups due to poor adherence to the training style and the fact that vascular occlusion of large muscle groups is more difficult. Objective To verify and compare the hemodynamic effects of exercise with and without vascular occlusion in different muscle groups. Methods Quantitative crossover study, with cross-sectional and field procedures. The sample consisted of 10 physically active healthy male and female subjects between 18 and 30 years of age. With the cross-over design, all the volunteers participated in 3 groups: intervention with vascular occlusion, intervention without vascular occlusion and the control group. Results Overall, lactate and cholesterol remained elevated after 15 minutes of recovery and blood glucose and blood pressure did not vary among the groups. Conclusion Vascular occlusion training is an effective method for manipulating hemodynamic variables. Evidence level II; Clinical study.

RESUMO Introdução Sabe-se que o treino de força traz melhorias para a saúde e o desempenho esportivo, por ocasionar hipertrofia muscular e aumento de força, além de modificar alguns fatores hemodinâmicos e fisiológicos. Foram desenvolvidos vários métodos de treinamento de força, entre eles, a oclusão vascular. Porém, existem poucos estudos com grandes grupamentos musculares, devido à pouca adesão ao estilo de treino e ao fato de a oclusão vascular de grandes grupos musculares ser mais difícil. Objetivo Verificar e comparar os efeitos hemodinâmicos do exercício com e sem oclusão vascular em diferentes grupamentos musculares. Métodos Estudo quantitativo, cruzado, com procedimentos transversais e de campo. A amostra foi composta por 10 indivíduos saudáveis e fisicamente ativos do sexo masculino e feminino, na faixa etária de 18 a 30 anos. Com o desenho cruzado, todos os voluntários participaram de 3 grupos: intervenção com oclusão vascular, intervenção sem oclusão vascular e grupo controle. Resultados De forma geral, entre grupos, o lactato e o colesterol se mantiveram elevados depois de 15 minutos de recuperação, a glicemia e as pressões arteriais não variaram. Conclusão O treinamento com oclusão vascular é um método eficaz para manipular as variáveis hemodinâmicas. Nível de evidência II; Estudo clínico.

RESUMEN Introducción Se sabe que el entrenamiento de fuerza trae mejoras para la salud y el desempeño deportivo, por causar hipertrofia muscular y aumento de fuerza, además de modificar algunos factores hemodinámicos y fisiológicos. Fueron desarrollados varios métodos de entrenamiento de fuerza, entre ellos, la oclusión vascular. Sin embargo, existen pocos estudios con grandes grupos musculares, debido a la poca adhesión al estilo de entrenamiento y al hecho de que la oclusión vascular de grandes grupos musculares grandes es más difícil. Objetivo Verificar y comparar los efectos hemodinámicos del ejercicio con y sin oclusión vascular en diferentes grupos musculares. Métodos Estudio cuantitativo, cruzado, con procedimientos transversales y de campo. La muestra fue compuesta por 10 individuos saludables y físicamente activos del sexo masculino y femenino, en el grupo de edad de 18 a 30 años. Con el diseño cruzado, todos los voluntarios participaron en 3 grupos: intervención con oclusión vascular, intervención sin oclusión vascular y grupo control. Resultados De forma general, entre los grupos, el lactato y el colesterol se mantuvieron elevados después de 15 minutos de recuperación, la glucemia y las presiones arteriales no variaron. Conclusión El entrenamiento de oclusión vascular es un método eficaz para manipular las variables hemodinámicas. Nivel de evidencia II; Estudio clínico.

Lactate: a biological marker of physical activity in colombian weightlifting athletes / Lactato: um marcador biológico da atividade física em atletas colombianos de halterofilismo / Lactato: un marcador biológico de la actividad física en atletas colombianos de halterofilia

ABSTRACT Introduction Blood biomarkers are measurable metabolic products that allow objective monitoring of the training process, and their analysis provides an opportunity to improve athletic performance. Objective To evaluate blood lactate concentrations in a group of the Valle League weightlifting athletes as a tool to determine the effects of training and its direct relationship to performance during competition. Methods This is an observational cross-sectional study. Lactate levels of 32 weightlifting athletes belonging to the Valle Weightlifting League were evaluated. Blood samples were taken from the ear lobe to quantify the lactate concentration, using a Scout Lactate analyzer. Samples were taken before and after a high intensity training section consisting of four maximum repetition (MR) sports gestures, in which 5 series and 15 repetitions were performed for each sports gesture, with a rest period of 40 seconds between each exercise. The software program SPSS, version 25, was used to determine the lactate concentrations. Results An average lactate concentration 22.46 mg/dL was obtained for the athletes at rest, and an average of 98.30 mg/dL in the final lactate concentration, after high intensity exercise. Significant differences were found between the initial and final lactate concentrations. Conclusion Lactate concentration increases with physical activity; it varies from one individual to another; and it can be used as a biomarker of intensity of physical activity in the field of sports. Level of evidence; II type of study: Prognostic Studies Investigating the Effect of a Patient Characteristic on a disease outcome.

RESUMO Introdução Os biomarcadores sanguíneos são produtos metabólicos mensuráveis que permitem a monitorização objetiva do processo de treino, e sua análise é uma oportunidade para melhorar o desempenho atlético. Objetivos Avaliar as concentrações de lactato no sangue de um grupo de atletas de halterofilismo da Liga Valle como ferramenta para determinar os efeitos do treino e sua relação direta com o desempenho durante a competição. Métodos Este é um estudo transversal e observacional. Foram avaliados os níveis de lactato em 32 atletas da Liga de Halterofilismo Valle. A amostra de sangue foi retirada do lóbulo da orelha com o intuito de quantificar a concentração de lactato com o analisador Scout Lactate. As amostras foram colhidas antes e depois de uma seção de treino de alta intensidade, que consistiu em quatro gestos esportivos de repetição máxima (RM), nos quais foram realizadas 5 séries e 15 repetições para cada gesto esportivo, com um período de repouso de 40 segundos entre cada exercício. O software SPSS, versão 25 foi usado para determinar as concentrações de lactato. Resultados A concentração média de lactato nos atletas em repouso foi 22,46 mg/dl e a concentração média final foi de 98,30 mg/dl depois de exercício de alta intensidade. Foram encontradas diferenças significativas ao comparar a concentração inicial com a concentração final de lactato. Conclusões A concentração de lactato aumenta com a realização da atividade física, é variável de um indivíduo para outro e pode ser usada como biomarcador de intensidade da atividade física na área dos esportes. Nível de Evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença.

RESUMEN Introducción Los biomarcadores sanguíneos son productos metabólicos mensurables que permiten la monitorización objetiva del proceso de entrenamiento, y su análisis es una oportunidad para mejorar el desempeño atlético. Objetivos Evaluar las concentraciones de lactato en la sangre de un grupo de atletas de halterofilia de la Liga Valle como herramienta para determinar los efectos del entrenamiento y su relación directa con el desempeño durante la competición. Métodos Este es un estudio transversal y observacional. Fueron evaluados los niveles de lactato en 32 atletas de la Liga de Halterofilia Valle. La muestra de sangre fue retirada del lóbulo de la oreja con el objetivo de cuantificar la concentración de lactato con el analizador Scout Lactate. Las muestras fueron tomadas antes y después de una sección de entrenamiento de alta intensidad, que consistió en cuatro gestos deportivos de repetición máxima (RM), en los que se realizaron 5 series y 15 repeticiones para cada gesto deportivo, con un período de descanso de 40 segundos entre cada ejercicio. El software SPSS versión 25 fue usado para determinar las concentraciones de lactato. Resultados La concentración promedio de lactato en los atletas en reposo fue 22,46 mg/dl y la concentración promedio final fue de 98,30 mg/dl después del ejercicio de alta intensidad. Fueron encontradas diferencias significativas al comparar la concentración inicial con la concentración final de lactato. Conclusiones La concentración de lactato aumenta con la realización de actividad física, es variable de un individuo para otro, y puede ser usada como biomarcador de intensidad de la actividad física en el área de los deportes. Nivel de evidencia II; Estudios pronósticos - Investigación del efecto de característica de un paciente sobre el resultado de la enfermedad

Frequência cardíaca, lactacidemia e gasto energético de equinos da raça Crioula em provas credenciadoras ao Freio de Ouro / [Heart rate, lactate concentration and energy expenditure of Creole breed horses during qualifying tests at Freio de Ouro]

Avaliações com o intuito de mensurar marcadores de eficiência na performance esportiva do cavalo Crioulo são escassas e de fundamental importância no que tange às possíveis especificidades da raça. O objetivo do presente trabalho foi avaliar e determinar os padrões de frequência cardíaca, velocidade, concentração de lactato e gasto energético de equinos da raça Crioula durante provas credenciadoras ao Freio de Ouro. Tais variáveis foram avaliadas durante a realização das etapas funcionais da competição. Observaram-se flutuações superiores da variável frequência cardíaca (FC) durante a realização das etapas de Andadura, Figura, Volta sobre Patas e Esbarradas (And/fig/VSP) (203bpm) e menores valores na etapa Paleteada II (185bpm) (P<0,05). Em relação à velocidade, o maior valor atingido foi registrado na etapa de Paleteada II (39,7km/h). A concentração de lactato sanguíneo aferida se mostrou elevada em todas as fases da competição, sendo o maior valor observado na etapa de Paleteada II (14,5mmol/L) (P<0,05) e o menor durante a etapa de Mangueira I (9,3mmol/L). Superior gasto energético foi atribuído à etapa de And/Fig/VSP (853,28kcal/kgPV/min). Portanto, todas as etapas funcionais podem ser classificadas como anaeróbias, por apresentarem concentrações de lactato sanguíneo acima de 4mmol/L, e demandam alto gasto energético pelos competidores.(AU)

Evaluations of athletic performance markers of Crioulo breed horses are scarce yet fundamentally important regarding possible unique characteristics of this breed. This study aimed to evaluate and determine heart rate, speed, blood lactate and energy expenditure patterns of Crioulo breed horses during qualifying tests in the functional phases of the "Freio de Ouro" championship. Higher values of heart rate during the phases "andadura, figura, voltas sobre patas, esbarradas" (And/Fig/VSP) (203bpm) and lower values at "Paleteada II" (185bpm) (P<0.05) were noticed. Regarding speed variable, the maximum value was registered at "Paleteada II" (39.7km/h). During all the phases, blood lactate concentration was high, with the highest value found at "Paleteada II" (14.5mm/L) and the lowest during "Mangueira I" (9.3mm/L) (P<0.05). Superior energy expenditure was noticed in the "And/Fig/VSP" phase (853.28Kcal/kgPV/min). Thus, all functional phases can be classified as anaerobic, as blood lactate concentrations remained above 4mmol/L, with high energy demand of the horses.(AU)

Acute effect of sodium bicarbonate supplementation on the performance during CrossFit® training

Abstract Aim: To verify the acute effect of sodium bicarbonate (NaHCO3) supplementation on performance during CrossFit® workout. Methods: Nine experienced males (30.8 ± 3.5 years; 84.4 ± 9.5 kg; 177.5 ± 4.03 cm; 2.2 ± 1.0 years) in CrossFit® participated in this study. They were allocated to two conditions: a) supplementation with 0.3 g.kg-1 of body weight of NaHCO3 and b) supplementation with 0.045 g.kg-1 of body weight of sodium chloride (NaCl). Blood lactate was analyzed at two different moments: before (lac-pre) and after the training protocol (lac-post). The heart rate (HR) and the rating of perceived exertion (RPE) were also collected every two minutes during the execution of the training protocol, and the RPE was also collected after it was finished. At the end of the training protocol, a questionnaire to measure gastrointestinal side effects (GSE) was answered by the participants. Repetitions performed in the training protocol was computed to evaluate the performance during the workout. Results: The results showed that there were no differences found when comparing the conditions for all parameters. HR and RPE were different in the first few minutes (< 4-6 minutes) when compared to the final minutes (> 14 minutes) of the workout. The area under the curve of HR and RPE was significantly lower in the NaHCO3 condition. Conclusion: Acute NaHCO3 supplementation did not improve performance during workout 'Cindy' in experienced men. Supplementation also did not alter hemodynamic and perceptual parameters, nor did it cause any GSE. However, responses as a function of time were reduced with NaHCO3 supplementation.

Ingestion of a moderate dose of alcohol enhances physical exercise-induced changes in blood lactate concentration

The consumption of alcoholic beverages influences carbohydrate and lipid metabolism, although it is not yet clear whether metabolism during physical exercise at different intensities is also affected. This was the objective of the present study. Eight young and healthy volunteers performed a treadmill test to identify the running speed corresponding to a lactate concentration of 4 mM (S4mM). At least 48 h later, they were subjected to two experimental trials (non-alcohol or alcohol) in which they performed two 1-km running sessions at the following intensities: 1) S4mM; 2) 15% above S4mM. In both trials, blood lactate, triglycerides, and glucose concentrations were measured before and after exercise. The acute alcohol intake increased triglycerides, but not lactate concentration under resting conditions. Interestingly, alcohol intake enhanced the exercise-induced increase in lactate concentration at the two intensities: S4mM (non-alcohol: 4.2±0.3 mM vs alcohol: 4.8±0.9 mM; P=0.003) and 15% above S4mM trial (P=0.004). When volunteers ingested alcohol, triglycerides concentration remained increased after treadmill running (e.g., at S4mM - at rest; non-alcohol: 0.2±0.5 mM vs alcohol: 1.3±1.3 mM; P=0.048). In contrast, glucose concentration was not modified by either alcohol intake, exercise, or their combination. We concluded that an acute alcohol intake changed lactate and lipid metabolism without affecting blood glucose concentration. In addition, the increase in lactate concentration caused by alcohol was specifically observed when individuals exercised, whereas augmented triglycerides concentration was already observed before exercise and was sustained thereafter.

Utilidade clínica dos escores de risco no sangramento varicoso / Clinical utility of risk scores in variceal bleeding

ABSTRACT BACKGROUND: Variceal bleeding remains important cause of upper gastrointestinal bleed. Various risk scores are used in risk stratification for non-variceal bleed. Their utility in variceal bleeding patients is not clear. This study aims to compare probability of these scores in predicting various outcomes in same population. OBJECTIVE: This study aims to compare probability of these scores in predicting various outcomes in same population. To study characteristics and validate AIMS65, Rockall, Glasgow Blatchford score(GBS), Progetto Nazionale Emorragia Digestiva (PNED) score in variceal Upper Gastrointestinal Bleed (UGIB) patients for predicting various outcomes in our population. METHODS: Three hundred subjects with UGIB were screened prospectively. Of these 141 patients with variceal bleeding were assessed with clinical, blood investigations and endoscopy and risk scores were calculated and compared to non-variceal cases. All cases were followed up for 30 days for mortality, rebleeding, requirement of blood transfusion and need of radiological or surgical intervention. RESULTS: Variceal bleeding (141) was more common than non variceal (134) and 25 had negative endoscopy. In variceal group, cirrhosis (85%) was most common etiology. Distribution of age and sex were similar in both groups. Presence of coffee coloured vomitus (P=0.002), painless bleed (P=0.001), edema (P=0.001), ascites (P=0.001), hemoglobin <7.5 gms (P<0.001), pH<7.35 (P<0.001), serum bicarbonate level <17.6 mmol/L (P<0.001), serum albumin<2.75 gms% (P<0.001), platelet count <1.2 lacs/µL (P<0.001), high INR 1.35 (P<0.001), BUN >25mmol/L (P<0.001), and ASA status (P<0.001), high lactate >2.85 mmol/L (P=0.001) were significant. However, no factor was found significant on multivariate analysis. Rockall was found to be significant in predicting mortality and rebleed. AIMS65 was also significant in predicting mortality. GBS was significant in predicting blood transfusion and need of intervention. PNED score was significant in all events except mortality. CONCLUSION: All four scores had lower predictive potential in predicting events in variceal bleed. However, AIMS65 & Rockall score were significant in predicting mortality, while GBS in predicting need of transfusion and intervention. PNED score was significant in all events except mortality.

RESUMO CONTEXTO: O sangramento varicoso permanece como importante causa de sangramento gastrointestinal superior. Vários escores são utilizados na estratificação do risco para sangramento não varicoso. Sua utilidade em pacientes de sangramento varicoso não é clara. OBJETIVO: Este estudo tem como objetivo comparar a probabilidade desses escores em prever vários desfechos na mesma população. Estudar característica e validar o AIMS65, o Rockall, a Pontuação de Glasgow Blatchford (GBS), o escore Progetto Nazionale Emorragia Digestiva (PNED), na pontuação em hemorragia gastrointestinal varicosa superior (UGIB) em pacientes para prever vários resultados em nossa população. MÉTODOS: Um total de 300 indivíduos com UGIB foram rastreados prospectivamente. Destes, 141 pacientes com sangramento varicoso foram submetidos à avaliação clínica, hematológica e endoscopia tendo seus escores de risco calculados e comparados aos casos não-varicosos. Todos os casos foram acompanhados por 30 dias para mortalidade, necessidade de transfusão sanguínea por ressangramento ou de necessidade de intervenção radiológica ou cirúrgica. RESULTADOS: O sangramento varicoso (141) foi mais comum do que não varicoso (134) e em 25 teve endoscopia negativa. No grupo varicoso, a cirrose foi a etiologia mais comum (85%). A distribuição da idade e do sexo foi semelhante em ambos os grupos. Presença de vômito colorido em borra de café (P=0,002), sangramento indolor (P=0,001), edema (P=0,001), ascite (P=0,001), hemoglobina <7,5 GMS (P<0,001), pH <7,35 (P<0,001), nível de bicarbonato sérico <17,6 mmol/L (P<0,001), albumina sérica <2,75 GMS% (P<0,001), contagem plaquetária <1,2 Lacs/μL (P<0,001), INR elevada 1,35 (P<0,001), Bun >25 mmol/L (P<0,001) e estado ASA (P<0,001), lactato elevado >2,85 mmol/L (P=0,001) foram significativos. Entretanto, nenhum fator foi encontrado como significativo na análise multivariada. Rockall foi significativo em prever a mortalidade e ressangrar. O AIMS65 também foi significante na predição da mortalidade. O GBS foi significativo na predição de transfusão sanguínea e necessidade de intervenção. O escore de PNED foi significante em todos os eventos, exceto mortalidade. CONCLUSÃO: Todos os quatro escores apresentaram menor potencial preditivo na predição de eventos em sangramento varicoso. Entretanto, o AIMS65 e o escore de Rockall foram significantes na predição da mortalidade, enquanto o GBS na predição da necessidade de transfusão e intervenção. O escore de PNED foi significante em todos os eventos, exceto mortalidade.

Could cerebrospinal fluid biomarkers offer better predictive value for spinal cord ischaemia than current neuromonitoring techniques during thoracoabdominal aortic aneurysm repair - a systematic review

Abstract Objective: Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker.

The expression of and preoperative correlation between heat-shock protein 70, euroscore, and lactate in patients undergoing cabg with cardiopulmonary bypass

Abstract Objetive: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) improved symptoms and increased survival and quality of life in patients with coronary artery disease. However, it should be the main cause of a complex organic systemic inflammatory response that greatly contributes to several postoperative adverse effects. Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined. Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB. Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery.

Sepsis: evolving concepts and challenges

Sepsis remains a major cause of morbidity and mortality worldwide, with increased burden in low- and middle-resource settings. The role of the inflammatory response in the pathogenesis of the syndrome has supported the modern concept of sepsis. Nevertheless, a definition of sepsis and the criteria for its recognition is a continuous process, which reflects the growing knowledge of its mechanisms and the success and failure of diagnostic and therapeutic interventions. Here we review the evolving concepts of sepsis, from the "systemic inflammatory response syndrome triggered by infection" (Sepsis-1) to "a severe, potentially fatal, organic dysfunction caused by an inadequate or dysregulated host response to infection" (Sepsis-3). We focused in the pathophysiology behind the concept and the criteria for recognition and diagnosis of sepsis. A major challenge in evaluating the host response in sepsis is to characterize what is protective and what is harmful, and we discuss that, at least in part, the apparent dysregulated host response may be an effort to adapt to a hostile environment. The new criteria for recognition and diagnosis of sepsis were derived from robust databases, restricted, however, to developed countries. Since then, the criteria have been supported in different clinical settings and in different economic and epidemiological contexts, but still raise discussion regarding their use for the identification versus the prognostication of the septic patient. Clinicians should not be restricted to definition criteria when evaluating patients with infection and should wisely use the broad array of information obtained by rigorous clinical observation.

Differences between genders in anaerobic capacity during a supramaximal effort

Aim: The present study aimed to verify if there is a difference between genders in anaerobic capacity estimated by energetic equivalents of glycolytic and phosphagen pathways (AC[La-]+EPOCfast). Methods: In this way, 8 men and 8 women (physical education students) were subjected to the following sequence of tests: session 1) graded exercise test to measure the maximal oxygen consumption (VÖ½ O2max) and intensity associated with VÖ½ O2max (iVÖ½ O2max); sessions 2 to 3) familiarization with supramaximal effort at 115% of iVÖ½ O2max; session 4) supramaximal effort at 115% of iVÖ½ O2max to measure AC[La-]+EPOCfast. Results: The AC[La-]+EPOCfast was lower in women compared to men when expressed in absolute and relative values (-38.11%; p=0.01 and -25.71%; p=0.03, respectively). A non-significant difference was observed in performance in the supramaximal effort (-12.08%; p=0.15), besides which, a likely negative inference was observed when comparing women to men. In addition, energetic equivalents of the glycolytic pathway (e[La- ]) were also lower in women when expressed in relative and absolute values (-47.01%; p=0.001 and -36.71%; p=0.001, respectively), however no statistical difference was found for energetic equivalents of the phosphagen pathway (ePCr) (p>0.05). Conclusion: The AC[La-]+EPOCfast is lower in women compared to men, mainly due to differences in the glycolytic pathway.(AU)

Plano de análise estatística para o estudo do tratamento precoce baseado em metas com utilização de uma visão fisiológica holística - estudo ANDROMEDA-SHOCK: um estudo randomizado e controlado / Statistical analysis plan for early goal-directed therapy using a physiological holistic view - the ANDROMEDA-SHOCK: a randomized controlled trial

RESUMO Fundamentação: O estudo ANDROMEDA-SHOCK é um estudo internacional, multicêntrico, randomizado e controlado comparando ressuscitação guiada pela perfusão periférica com ressuscitação guiada pelo lactato em pacientes com choque séptico, com a finalidade de testar a hipótese de que a ressuscitação guiada pela perfusão periférica associa-se a menor morbidade e mortalidade. Objetivo: Relatar o plano de análise estatística para o estudo ANDROMEDA-SHOCK. Métodos: Descrevemos o delineamento do estudo, os objetivos primário e secundários, pacientes, métodos de randomização, intervenções, desfechos e tamanho da amostra. Descrevemos nossos planos de análise estatística para os desfechos primários, secundários e terciários. Também descrevemos as análises de subgrupos e sensibilidade. Finalmente, fornecemos detalhes para a apresentação dos resultados, inclusive modelos de tabelas para apresentar as características basais, a evolução das variáveis de hemodinâmica e perfusão, e os efeitos dos tratamentos nos desfechos. Conclusão: Segundo as melhores práticas de pesquisa, relatamos nosso plano de análise estatística e plano de gestão de dados antes do fechamento da base de dados e do início da análise dos dados. Nossa expectativa é que este procedimento previna a ocorrência de vieses na análise e incremente a utilidade dos resultados relatados.

ABSTRACT Background: ANDROMEDA-SHOCK is an international, multicenter, randomized controlled trial comparing peripheral perfusion-targeted resuscitation to lactate-targeted resuscitation in patients with septic shock in order to test the hypothesis that resuscitation targeting peripheral perfusion will be associated with lower morbidity and mortality. Objective: To report the statistical analysis plan for the ANDROMEDA-SHOCK trial. Methods: We describe the trial design, primary and secondary objectives, patients, methods of randomization, interventions, outcomes, and sample size. We describe our planned statistical analysis for the primary, secondary and tertiary outcomes. We also describe the subgroup and sensitivity analyses. Finally, we provide details for presenting our results, including mock tables showing baseline characteristics, the evolution of hemodynamic and perfusion variables, and the effects of treatments on outcomes. Conclusion: According to the best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and initiating the analyses. We anticipate that this procedure will prevent analysis bias and enhance the utility of the reported results.

Extended-time of noninvasive positive pressure ventilation improves tissue perfusion after coronary artery bypass surgery: a randomized clinical trial

Abstract Objective: To compare the effects of extended- versus short-time noninvasive positive pressure ventilation on pulmonary function, tissue perfusion, and clinical outcomes in the early postoperative period following coronary artery bypass surgery in patients with preserved left ventricular function. Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded. Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05). Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function. Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br

Impact of a High-Intensity Training on Ventricular Function in Rats After Acute Myocardial Infarction / Repercussão do Treinamento de Alta Intensidade sobre a Função Ventricular de Ratos após Infarto Agudo do Miocárdio

Abstract Background: Physical exercise should be part of the treatment of post-acute myocardial infarction (AMI) patients. Objective: To evaluate the effects of two training prescription models (continuous x interval) and its impact on ventricular function in rats after AMI with normal ventricular function. Methods: Forty Wistar rats were evaluated by echocardiography 21 days after the AMI. Those with LVEF = 50% (n = 29) were included in the study and randomized to control group (CG n = 10), continuous training group (CTG n = 9) or interval training group (ITG, n = 10). Then, a swimming test with control of lactate production was performed. Based on its result, the lactate threshold (LT) was established to define the training intensities. After six weeks, the animals were reassessed by echocardiography and lactate production. Outcome measures were end-diastolic diameter (EDD), end-systolic diameter (ESD), left ventricular ejection fraction (LVEF, %) lactate at rest, lactate without overload, and lactate with 12g and 13.5g of additional load. Group comparisons of quantitative variables of the study were performed by one-factor analysis of variance (ANOVA). The Newman-Keuls test was used for multiple comparisons of the groups. Within-group comparisons of dependent variables between the two training protocols were performed by Student's t-test. Normality of the variables was tested by the Shapiro-Wilks test. Values of p < 0.05 indicated statistical significance. Results: EDD, ESD, and LVEF before and after the training period were similar in within-group comparisons. However, EDD was significantly different (p=0.008) in the CG. Significant differences were found for L12g (p=0.002) and L13.5g (p = 0.032) in the ITG, and for L12g (p = 0.014) in the CG. No differences were found in the echocardiographic parameters between the groups. Significant differences were found in lactate without overload (p = 0.016) and L12 (p = 0.031) in the second assessment compared with the first, and between the groups - ITG vs. CG (p = 0.019) and CTG vs. CG (p = 0.035). Conclusion: Both methods produced a training effect without altering ventricular function.

Resumo Fundamento: O exercício físico deve fazer parte do tratamento de pacientes pós-infarto agudo do miocárdio (IAM). Objetivo: Avaliar os efeitos de treinamento produzidos por dois modelos distintos (contínuo x intervalado) e sua repercussão sobre a função ventricular de ratos pós-IAM com função ventricular normal. Métodos: Quarenta ratos Wistar pós-IAM foram avaliados ecocardiograficamente 21 dias após o evento. Aqueles com FEVE = 50% (n = 29) foram incluídos e randomizados: controle (GC n = 10), treinamento contínuo (GTC n = 9) e treinamento intervalado (GTI n = 10). Após, foi realizado um teste de natação com controle de lactato. A partir do resultado foi definido o limiar de lactato (LL) para determinar as intensidades do treinamento. Após seis semanas, foram reavaliados com ecocardiografia e controle de lactato. Como desfecho, foram avaliados: diâmetros diastólico e sistólico final (DDF, DSF, mL), fração de ejeção do ventrículo esquerdo (FEVE, %), lactato de repouso, livre de carga (LC), lactato com 12 g e 13,5 g de carga adicional. Para a comparação dos grupos em relação às variáveis quantitativas do estudo, foi considerado o modelo de análise da variância com um fator (ANOVA). Nas comparações múltiplas dos grupos foi usado o teste de Newman-Keuls. Na comparação entre as duas avaliações, dentro de cada grupo, foi usado o teste t de Student para amostras dependentes. A condição de normalidade das variáveis foi avaliada pelo teste de Shapiro-Wilks. Valores de p < 0,05 indicaram significância estatística. Resultados: Com relação à análise intragrupos, entre o período pré- e pós-treinamento foi identificado semelhança para DDF, DSF, FEVE, porém o GC apresentou diferença significativa para a variável DDF (p = 0,008). Houve diferença do GTI para L12g (p = 0,002) e L13,5g (p = 0,032) e para o GTC na variável L12g (p = 0,014). Não houve diferença para as variáveis ecocardiográficas entre os grupos. Houve diferença nas variáveis LC e L12g na segunda avaliação (p = 0,016 e p = 0,031, respectivamente) e entre os grupos: GTI vs. GC (p = 0,019) e GTC vs. GC (p = 0,035). Conclusão: Os dois métodos produziram efeito de treinamento sem alterar a função ventricular.

Influence of hand paddles and fins on blood lactate, heart rate and perceived exertion behavior / Influência do uso de palmares e nadadeiras no comportamento do lactato sanguíneo, da frequência cardíaca e do esforço percebido

Abstract - One of the great challenges for swim coaches is proper control of the training intensity. This issue is more complex when using equipment such as paddles and fins. Among intensity control parameters, blood lactate concentration is the standard for monitoring metabolic responses, and heart rate and perceived effort are practical and inexpensive methods. The aim of this study was to compare blood lactate concentration ([LA]), heart rate (HR) and rate of perceived exertion (RPE) in swimming training series without equipment and with paddles and fins. We evaluated 11 swimmers on three different days during sessions in a series of 12 repetitions of 50 m in front crawl. The first session was performed without equipment, maintaining perception exertion at 15 (15 points) of the 6-20 point Borg scale. In the second and third sessions, athletes should swim in the series with: (i) paddles and (ii) fins, at the same swimming speed of the series without equipment, in random order. [LA], HR and RPE at rest (after warm-up and before swimming series) and after the sixth and 12th repetitions were measured and compared. The mean speed for all series was 1.30 ± 0.13 m.s-1; fins and paddles presented lower final [LA] (respectively, 5.9 ± 0.3 and 8.1 ± 0.4 mmol.l-1) and HR values (respectively, 161.1 ± 15, 5 161.1 and 170.3 ± 13.3 170.3 bpm) in comparison to series without equipment (respectively, 10.8 ± 0.7 mmol.l-1 and 178.2 ± 4.3 bpm). Fins had lower final RPE values (12.5 ± 0.6 points) in relation to series without equipment (15.8 ± 0.2 points) and similar values in relation to swimming with paddles. Swimming series with equipment produced lower physiological demands in relation to swimming without equipment if performed at the same swimming speed as swimming without equipment.

Resumo Um dos grandes desafios para treinadores de natação é o adequado controle da intensidade de treino. Essa questão é mais complexa quando utilizados equipamentos como palmares e nadadeiras. Dentre os parâmetros de controle de intensidade, a concentração sanguínea de lactato [LA] é padrão para acompanhamento de respostas metabólicas, e a frequência cardíaca (FC) e o esforço percebido (EP) são métodos práticos e baratos. Esse estudo teve como objetivo comparar a concentração sanguínea de lactato, a frequência cardíaca e o esforço percebido em série de treinamento de natação sem equipamentos, com palmares ou com nadadeiras. Foram avaliados 11 nadadores em três diferentes dias durante série de 12 repetições de 50 m nado crawl. A primeira foi realizada sem equipamentos mantendo a percepção relativa ao escore 15 da escala de 6 a 20 pontos de Borg. A segunda e terceira séries os atletas realizavam (i) utilizando palmares e (ii) utilizando nadadeiras, na mesma velocidade de nado da série sem equipamentos, em ordem aleatória. Foram mensuradas e comparadas [LA], FC e EP nos momentos repouso (pós-aquecimento e antes da série), após a sexta e a 12ª repetições. A velocidade média para todas as séries foi de 1,30 ± 0,13 m.s-1; nadadeiras e palmares apresentaram menores valores finais de [LA] (respectivamente, 5,9 ± 0,3 e 8,1 ± 0,4 mmol.l-1) e de FC (respectivamente, 161,1 ± 15,5 e 170,3 ± 13,3 bpm) em relação ao nado sem equipamentos (respectivamente, 10,8 ± 0,7 mmol.l-1 e 178,2 ± 4,3 bpm). O nado com nadadeiras apresentou menores valores finais de EP (12,5 ± 0,6 pontos) em relação ao nado sem equipamentos (15,8 ± 0,2 pontos) e similares valores em relação ao nado com palmares. Séries de natação com equipamentos produzem menores demandas fisiológicas em relação ao nado sem equipamentos se realizadas na mesma velocidade de nado que o nado sem equipamentos.

Performance during a strenuous swimming session is associated with high blood lactate: pyruvate ratio and hypoglycemia in fasted rats

The aim of this study was to investigate the effect of lactatemia elevation and glycemia reduction on strenuous swimming performance in fasted rats. Three rats were placed in a swimming tank at the same time. The first rat was removed immediately (control group) and the remaining ones were submitted to a strenuous swimming session. After the second rat was exhausted (Exh group), the third one was immediately removed from the water (Exe group). According to the period of time required for exhaustion, the rats were divided into four groups: low performance (3-7 min), low-intermediary performance (8-12 min), high-intermediary performance (13-17 min), and high performance (18-22 min). All rats were removed from the swimming tanks and immediately killed by decapitation for blood collection or anesthetized for liver perfusion experiments. Blood glucose, lactate, and pyruvate concentrations, blood lactate/pyruvate ratio, and liver lactate uptake and its conversion to glucose were evaluated. Exhaustion in low and low-intermediary performance were better associated with higher lactate/pyruvate ratio. On the other hand, exhaustion in high-intermediary and high performance was better associated with hypoglycemia. Lactate uptake and glucose production from lactate in livers from the Exe and Exh groups were maintained. We concluded that there is a time sequence in the participation of lactate/pyruvate ratio and hypoglycemia in performance during an acute strenuous swimming section in fasted rats. The liver had an important participation in preventing hyperlactatemia and hypoglycemia during swimming through lactate uptake and its conversion to glucose.

Description of training loads using whole-body exercise during high-intensity interval training

OBJECTIVES: To describe external training load and internal training load through sets of a single session of high-intensity interval training (HIIT) body work. METHODS: Twenty male individuals (24±3 years) performed a HIIT body work protocol consisting of a single bout of exercise with 1:1 stimuli. The exercises used were 30 min in duration with "all-out" intensity. The exercises included jumping jacks, mountain climbers, burpees and squat jumps, totaling 20 min of exercise. During exercise, total movement capacity, blood lactate measurement, ratings of perceived exertion and recovery, training load and intensity were monitored. RESULTS: The single bout examined showed a total of 382±89 movements. Differences (p<0.01) in the total amount of movement for each exercise were noted, reflecting the difficulty of maintaining exercise over time. Increases in lactate concentrations (before: 0.98±0.16, after: 14.10±1.66; mmol/L) were found postexercise. Significant differences (p<0.01) were found after the fifth set, and the values for movement capacity remained higher than the values of the first set, demonstrating high load in a single session. No differences in ratings of perceived exertion (RPE) during the sets were found. However, the ratings of perceived recuperation from the second set were significantly (p<0.01) lower than those from the first set. CONCLUSIONS: The exercise protocol used in this study was of high intensity and produced large values for stress during performance, with increases recorded for the internal load indicators.

A fatal and metabolic experimental hemorrhagic shock in immature swine

Abstract Purpose: To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock. Methods: Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes. Hemodynamic and metabolic data were recorded at Baseline, at 30, 60 and 120 minutes after Baseline. The animals were intubated in spontaneous breathing (FIO2=0.21) with halothane. Results: Group I all survived. In Group II all died; no mortality occurred before a BL<10mM/L. Beyond the end-point all animals exhibited severe acidemia, hyperventilation and clinical signs of shock. Without treatment all animals died within 70.43±24.51 min of hypotension shortly after reaching an average level of BL 17.01±3.20mM/L. Conclusions: Swine's breathing room air spontaneously in hemorrhagic shock not treated a blood lactate over 10mM/L results fatal. The predictable outcome of this shock model is expected to produce consistent information based on possible different metabolic and hemodynamic patterns as far as the type of fluid and the timing of resuscitation in near fatal hemorrhagic shock.

Evaluation of anaerobic threshold in non-pregnant and pregnant rats

ABSTRACT Several studies present different methodologies and results about intensity exercise, and many of them are performed in male rats. However, the impact of different type, intensity, frequency and duration of exercise on female rats needs more investigation. From the analysis of blood lactate concentration during lactate minimum test (LacMin) in the swimming exercise, the anaerobic threshold (AT) was identified, which parameter is defined as the transition point between aerobic and anaerobic metabolism. LacMin test is considered a good indicator of aerobic conditioning and has been used in prescription of training in different exercise modalities. However, there is no evidence of LacMin test in female rats. The objective was to determine AT in non-pregnant and pregnant Wistar rats. The LacMin test was performed and AT defined for mild exercise intensity was from a load equivalent to 1% of body weight (bw), moderate exercise as carrying 4% bw and severe intensity as carrying 7% bw. In pregnant rats, the AT was reached at a lower loading from 5.0% to 5.5% bw, while in non-pregnant the load was from 5.5% to 6.0% bw. Thus, this study was effective to identify exercise intensities in pregnant and non-pregnant rats using anaerobic threshold by LacMin test.