Persistently elevated early warning scores and lactate identifies patients at high risk of mortality in suspected sepsis.

OBJECTIVE: In the UK, the National Early Warning Score (NEWS) is recommended as part of screening for suspicion of sepsis. Is a change in NEWS a better predictor of mortality than an isolated score when screening for suspicion of sepsis?. METHODS: A prospectively gathered cohort of 1233 adults brought in by ambulance to two UK nonspecialist hospitals, with suspicion of sepsis at emergency department (ED) triage (2015-2017) was analysed. Associations with 30-day mortality and ICU admission rate were compared between groups with an isolated NEWS ≥5 points prehospital and those with persistently elevated NEWS prehospital, in ED and at ward admission. The effect of adding the ED (venous or arterial) lactate was also assessed. RESULTS: Mortality increased if the NEWS persisted ≥5 at ED arrival 22.1% vs. 10.2% [odds ratio (OR) 2.5 (1.6-4.0); P < 0.001]. Adding an ED lactate ≥2 mmol/L was associated with an increase in mortality greater than for NEWS alone [32.2% vs. 13.3%, OR 3.1 (2.2-4.1); P < 0.001], and increased ICU admission [13.9% vs. 3.7%, OR 3.1 (2.2-4.3); P < 0.001]. If NEWS remained ≥5 at ward admission (predominantly within 4 h of ED arrival), mortality was 32.1% vs. 14.3%, [OR 2.8 (2.1-3.9); P < 0.001] and still higher if accompanied by an elevated ED lactate [42.1% vs. 16.4%, OR 3.7 (2.6-5.3); P < 0.001]. CONCLUSION: Persistently elevated NEWS, from prehospital through the ED to the time of ward admission, combined with an elevated ED lactate identifies patients with suspicion of sepsis at highest risk of in-hospital mortality.

Depuración de lactato a gran altitud / Lactate clearance at high altitude

OBJETIVO: el estudio pretende caracterizar la depuración de lactato (DL) en pacientes críticamente enfermos, a gran altitud. DISEÑO: estudio prospectivo de cohorte. ÁMBITO: unidad de Cuidados Intensivos de Adultos del Hospital del Norte de la ciudad de El Alto, La Paz (Bolivia), a 4 150 metros sobre el nivel del mar, periodo 25 de abril 2016-01 de junio 2018. PACIENTES: todos los pacientes ingresados a la Unidad de Cuidados Intensivos de Adultos, nativos de gran altitud, así como residentes de la misma por lo menos los últimos 6 meses. RESULTADOS: se incluyeron 250 pacientes, con sobrevida de 68%, promedio de edad 50 años; en el grupo de 170 supervivientes, poco más de la cuarta parte del lactato de ingreso fue depurado (26%), a comparación del grupo de 80 fallecidos, en el cual incluso el valor de lactato se vio incrementado alrededor de la quinta parte del lactato de ingreso (21%), ambos con p ≤ 0.05 mediante el test de ANOVA. En pacientes críticamente enfermos a gran altitud, el riesgo relativo entre depuración de lactato ≥ 26% y sobrevida es de 2.7 con sensibilidad 0.72 y especificidad de 1. DISCUSIÓN Y CONCLUSIONES: la depuración de lactato en individuos críticamente enfermos nativos de gran altitud, se asocia a mayor sobrevida y debería ser considerado como un objetivo durante la reanimación en pacientes críticos, de forma similar a estudios realizados en otras latitudes

OBJECTIVE: to characterize the lactate clearance on critically ill patients, at high altitude. DESIGN: prospective cohort study. FIELD: critical Care Unit of "Hospital del Norte" in El Alto, La Paz (Bolivia), during the period April 25, 2016 ­ June 01, 2018. PARTICIPANTS: critically ill patients residents of high altitude at least the last 6 months, admitted to the Adult Critical Care Unit. RESULTS: 250 patients were included, with survival of 68%, age average of 50 years; in the 170 survivors, lactate clearance average was 26%, in contrast with 80 deceased patients who presented an increased lactate level of 25%, p ≤ 0.05, both of them through ANOVA test. In high landers critically ill patients, relative risk of lactate clearance ≥ 26% and survival was 2.7 with sensitivity 0.72 and specificity 1. DISCUSSION AND CONCLUSIONS: lactate clearance in critically ill high landers dwellers, is associated with survival and it should be considered also as a reanimation objective, comparable to other studies developed in different latitudes

Lactate as a hemodynamic marker in the critically ill.

PURPOSE OF REVIEW: An early quantitative resuscitation strategy improves outcome in critically ill patients. The hemodynamic endpoints of such a strategy have been a topic of debate in the literature. This review focuses on the use of lactate as a marker for risk stratification, lactate clearance as a hemodynamic endpoint, and its use compared to mixed venous oxygenation as a resuscitation goal. RECENT FINDINGS: Lactate clearance is associated with improved outcome across several cohorts of critically ill patients. Lactate levels and central venous oxygen saturations are frequently discordant. Targeting lactate clearance as part of a quantitative resuscitation strategy may be as effective as targeting central venous oxygen saturation. SUMMARY: Resuscitation of the critically ill patient should be aimed at the reversal of tissue hypoxia. The use of lactate as a hemodynamic marker and resuscitation endpoint makes physiologic sense, and is supported by the recent data. The use of lactate clearance versus other traditional endpoints of resuscitation, such as mixed venous oxygen saturation, should be based on the clinical characteristics and response of the individual patient.

Producción de ácido láctico por una mezcla de Lactococcus lactis y Streptococcus salivarius en fermentaciones en discontinuo / Lactic acid production from a mixture of cultures of Lactococcus lactis and Streptococcus salivarius using batch fermentation

Se estudió la producción de ácido láctico (AL), la conversión de sustrato (CG), y el rendimiento (Y p/s) de Lactococcus lactis, Streptococcus salivarius y una mezcla 1:1 de ambas cepas en sustrato glucosado. Lactococcus lactis se seleccionó de 20 cepas homofermentativas aisladas de cultivos de caña de azúcar variedad CC85-92 y Streptococcus salivarius se aisló de un fermento láctico comercial. En fermentaciones llevadas a cabo con lamezcla microbiana, a 32 °C con 60 gL-1 de glucosa y pH 6,0 se obtuvo un máximo de 47,63 gL-1 de ácido láctico, conversión de glucosa de 95,4% y rendimiento en producto de 0,83 gg-1.

Production of lactic acid (LA), yield (Y p/s) and substrate conversion (SC) from Lactococcus lactis, Streptococcus salivarius and their mixtures were tested. Lactococcus lactis was selected from 20 homofermentative strains isolated from a sugar cane crop (variety CC85-92) and Streptococcus salivarius was isolated from a commercial lactic ferment. Batch fermentation experiments at 32 C with a glucose concentration of 60 gL-1 and a pH of 6,0 were carried out. A maximum of 47,63 gL-1 of lactic acid concentration, 95,4% of substrate conversion and 83 gg-1were obtained from the mixture of strains after a fermentation of 48 h.

Dental devices; reclassification of tricalcium phosphate granules and classification of other bone grafting material for dental bone repair. Final rule.

The Food and Drug Administration (FDA) is reclassifying tricalcium phosphate (TCP) granules for dental bone repair from class III to class II (special controls), classifying into class II (special controls) other bone grafting material for dental indications, and revising the classification name and identification of the device type. Bone grafting materials that contain a drug that is a therapeutic biologic will remain in class III and continue to require a premarket approval application. The classification identification includes materials such as hydroxyapatite, tricalcium phosphate, polylactic and polyglycolic acids, or collagen. This action is being taken to establish sufficient regulatory controls that will provide reasonable assurance of the safety and effectiveness of these devices. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of the guidance document that will serve as the special control for the class II devices.

Poly(lactide-co-glycolide) microparticles as systems for controlled release of proteins -- preparation and characterization.

Poly(DL-lactide-co-glycolide) (PDLLGA) and poly(L-lactide-co-glycolide) (PLLGA) copolymers were prepared by bulk ring opening polymerization of lactide and glycolide and characterized by GPC, FTIR, 1H NMR and DSC. Copolymers with different molar masses at a constant lactide/glycolide ratio were used for preparation of bovine serum albumin (BSA)-loaded microparticles by the double emulsion w/o/w method. The influence of the copolymer molar mass and composition on the microparticle morphology, size, yield, degradation rate, BSA-loading efficiency and BSA release profile were studied. For microparticles prepared from PDLLGA copolymers, a biphasic profile for BSA release was found and for those made from PLLGA copolymers the release profile was typically triphasic; both of them were characterized by high initial burst release. Possible reasons for such behavior are discussed.

A new delivery system for antisense therapy: PLGA microspheres encapsulating oligonucleotide/polyethyleneimine solid complexes.

Microspheres for the controlled release of an antisense oligonucleotide against the Transforming growth factor beta(1) were designed. Free oligonucleotide or its solid complexes with polyethylenimine (PEI) at different nitrogen/phosphate (N/P) ratios, were encapsulated within poly(lactide-co-glycolide) (PLGA) microspheres prepared by the multiple emulsion-solvent evaporation technique. The encapsulation of the oligonucleotide in form of solid complexes, the N/P ratio, as well as the PLGA type affected microspheres characteristics in term of loading, morphology, oligonucleotide distribution inside matrix and in vitro release profile. The designed microspheres allow the encapsulation and slow release of oligonucleotide/PEI solid complexes that should be effectively internalized inside cells.

Differentiation of Lactobacillus helveticus, Lactobacillus delbrueckii subsp bulgaricus, subsp lactis and subsp delbrueckii using physiological and genetic tools and reclassification of some strains from the ATCC collection.

Several physiological tests of glucose metabolism and genetic tools including species specific probes and 16S rDNA sequences were used to identify strains of L. helveticus and the group of L. delbrueckii with its three subspecies lactis, bulgaricus, and delbrueckii. These species are important for the milk industry as fermenting lactic acid bacteria. The identification procedure was applied to the different strains of these species available from the ATCC collection and allowed to reclassify part of them.

Reprodutibilidade do limiar anaerobico individual (iat) e lactato minimo (lm) determinados em teste de pista / Reliability of the individual anaerobic threshold(iat)and lactate minimum (lm)determined in track test

O objetivo deste estudo foi investigar a reprodutividade dos protocolos de determinacao do IAT(Individual Anaerobic Threshold) eLM(Lactate Minimum) para a identificacao da maxima fase estavel de lactato(MSSLac) em testes de pista.Participaram do estudo 10 individuos do sexo masculino,sendo 6 corredores de endurance e 4 individuos ativos(30,0+6,0 anos;70,5+8,3kg;177,0+6,7cm).Os individuos realizaram teste(T1) e reteste(T2)dos seguintes protocolos:IAT- 8 vezes 800m progressivos em intensidades de 84,87,89,91,93,95,97 e 103 por cento da Vm3km.Durante o primeiro min de recuparacao entre cada serie de 800m,e aos 3,5,7,9,e,11 minutos de recupercao apos a ultima serie de 800m,25pl de sangue arterial foram coletados para dosagem de intensidades de 85,87,89,94 e 97 por cento da Vm3km.Aos 7 minutos de recuperacao apos 1 vezes500 na maxima e durante o primeiro minuto de recuperacao entre cada serie de 800m,25pl de sangue arterial foram coletados para posterior dosagem de lactato.Nao houve diferenca significante entre a velocidade(m/min)do IAT no T1(247,7+33,3)e T2(246,4+35,3) (r=0,099;pmenor0,001)A frequencia cardiaca(bpm)no IAT no T1(172,6+12,0) e no T2(171,3+5,5)nao foi diferente,porem nao apresentou correlacao significante(r=0,72).Nao foi verificada diferenca significante entre a velocidade (m/min)do LM no T1(273,6+25,5) e no T2(273,6+26,1)(r=0,09;pmenor0,001).Os valores de FC noLM ni T1(170,5+8,6) e no T2(169+8,1)nao foram diferentes,porem,tambem nao apresentaram correlacao significante(r=0,68).Pode-se concluir que os protocolos LM e IAT de determinacao da intensidade correspondente a MSSLac(m.min)adaptados para este teste em pista,foram altamente reprodutiveis.O mesmo nao se pode dizer sobre a frequencia cardiaca,que obteve uma baiza reprodutividade nos dois protocolos estudados