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BackgroundThe use of sodium bicarbonate to treat metabolic acidosis is intuitive, yet data suggest that not all patients benefit from this therapy.ObjectiveIn this narrative review, we describe the physiology behind commonly encountered nontoxicologic causes of metabolic acidosis, highlight potential harm from the indiscriminate administration of sodium bicarbonate in certain scenarios, and provide evidence-based recommendations to assist emergency physicians in the rational use of sodium bicarbonate.DiscussionSodium bicarbonate can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion. Lactic acidosis and cardiac arrest are two common scenarios where there is limited benefit to routine use of sodium bicarbonate, although certain circumstances, such as patients with concomitant acute kidney injury and lactic acidosis may benefit from sodium bicarbonate. Patients with cardiac arrest secondary to sodium channel blockade or hyperkalemia also benefit from sodium bicarbonate therapy. Recent data suggest that the use of sodium bicarbonate in diabetic ketoacidosis does not confer improved patient outcomes and may cause harm in pediatric patients. Available evidence suggests that alkalinization of urine in rhabdomyolysis does not improve patient-centered outcomes. Finally, patients with a nongap acidosis benefit from sodium bicarbonate supplementation.ConclusionsEmpiric use of sodium bicarbonate in patients with nontoxicologic causes of metabolic acidosis is not warranted and likely does not improve patient-centered outcomes, except in select scenarios. Emergency physicians should reserve use of this medication to conditions with clear benefit to patients.

Introduction. Products of enzymatic hydrolysis of corn starch are promising multifunctional ingredients in yogurt, but their use requires studying their influence on the vitality and activity of lactic acid bacteria, as well on some physico-chemical characteristics of the product. Materials and methods. Yoghurt with a fat content of 1% with maltodextrin, glucose, and glucose-fructose syrup in an amount of 9% in terms of dry matter were studied. The number of lactic acid bacteria cells was determined by plating on MRS solid nutrient medium, water activity was measured using a HygroLab 2 device, syneresis of clots was estimated by centrifugation, and active acidity - by the potentiometric method. Results and discussion. The influence of starch product with different dextrose equivalents addition on the viability and activity of lactic acid bacteria Streptococcus thermophilus and Lactobacillus delbrueckii ssp. bulgaricus during fermentation and storage of yogurt has been studied. An increase of dextrose equivalent and monosaccharides content in starch products reduce the fermentation time of milk due to the increase of lactic acid bacteria activity. A slight decrease in water activity in the presence of glucose-fructose syrup in yogurt in an amount of 9% had virtually no effect on the milk fermentation process. The number of lactic acid bacteria increased during the first seven days of yogurt storage added with glucose-fructose syrup. On the 14th day of storage, the concentration of cells of S. thermophilus and L. delbrueckii ssp. bulgaricus became almost the same in all yogurts due to almost complete consumption of carbon sources. When the storage of yogurt was extended to 28 days, the most stable content of lactic acid bacteria was found in yogurt added with maltodextrin due to its prebiotic properties. The increases of active acidity and syneresis in all yogurts were greatest in the first 8-14 days. Presence of dextrins in yogurt stabilizes its physical and chemical properties during storage. Conclusions. Adding starch-containing products to yogurt allows to activate the activity of lactic acid bacteria and improve their survival during yogurt storage. [ABSTRACT FROM AUTHOR]

Background. The relationship between hyperlactatemia and prognosis after cardiopul-monary bypass (CPB) is controversial, and some studies ignore the presence of lactic acidosis in patients with severe hyperlactacemia. This study explored the association between lactic acidosis (LA) and the occurrence of multiple organ dysfunction syndrome (MODS) after cardiopulmonary bypass. Methods. This study was a post hoc analysis of patients who underwent cardiac surgery between February 2017 and August 2018 and participated in a prospective study at Taizhou Hospital. The data were collected at: ICU admission (H0), and 4, 8, 12, 24, and 48 h after admission. Blood lactate levels gradually increased after CPB, peaking at H8 and then gradually decreasing. The patients were grouped as LA, hyperlactatemia (HL), and normal control (NC) based on blood test results 8 h after ICU admission. Basic preoperative, perioperative, and postoperative conditions were compared between the three groups, as well as postoperative perfusion and oxygen metabolism indexes. Results. There were 22 (19%), 73 (64%), and 19 (17%) patients in the LA, HL, and NC groups, respectively. APACHE II (24h) and SOFA (24h) scores were the highest in the LA group (P <0.05). ICU stay duration was the longest for the LA group (48.5 (42.5, 50) h), compared with the HL (27 (22, 48) h) and NC (27 (25, 46) h) groups (P =0.012). The LA group had the highest incidence of MODS (36%), compared with the HL (14%) and NC (5%) groups (P D0:015). In the LA group, the oxygen extraction ratio (O2ER) was lower (21.5 (17.05, 32.8)%) than in the HL (31.3 (24.8, 37.6)%) and the NC group (31.3 (29.0, 35.4) %) (P =0.018). In the univariable analyses, patient age (OR = 1.054, 95% CI [1.003-1.109], P =0.038), the LA group (vs. the NC group, (OR = 10.286, 95% CI [1.148-92.185], P =0.037), and ΔPCO2 at H8 (OR = 1.197, 95% CI [1.022-1.401], P =0.025) were risk factor of MODS after CPB. Conclusions. We speculated that there was correlation between lactic acidosis and MODS after CPB. In addition, LA should be monitored intensively after CPB. [ABSTRACT FROM AUTHOR]

The safety and efficacy of anti-diabetic drugs are critical for maximizing the beneficial impacts of well-controlled blood glucose on the prognosis of individuals with COVID-19 and pre-existing type 2 diabetes (T2D). Metformin is the most commonly prescribed first-line medication for T2D, but its impact on the outcomes of individuals with COVID-19 and T2D remains to be clarified. Our current retrospective study in a cohort of 1,213 hospitalized individuals with COVID-19 and pre-existing T2D indicated that metformin use was significantly associated with a higher incidence of acidosis, particularly in cases with severe COVID-19, but not with 28-day COVID-19-related mortality. Furthermore, metformin use was significantly associated with reduced heart failure and inflammation. Our findings provide clinical evidence in support of continuing metformin treatment in individuals with COVID-19 and pre-existing T2D, but acidosis and kidney function should be carefully monitored in individuals with severe COVID-19.

Fermentative microbial communities have the potential to serve as biocatalysts for the conversion of low-value dairy coproducts into renewable chemicals, contributing to a more sustainable global economy. To develop predictive tools for the design and operation of industrially relevant strategies that utilize fermentative microbial communities, there is a need to determine the genomic features of community members that are characteristic to the accumulation of different products. To address this knowledge gap, we performed a 282-day bioreactor experiment with a microbial community that was fed ultra-filtered milk permeate, a low-value coproduct from the dairy industry. The bioreactor was inoculated with a microbial community from an acid-phase digester. A metagenomic analysis was used to assess microbial community dynamics, construct metagenome-assembled genomes (MAGs), and evaluate the potential for lactose utilization and fermentation product synthesis of community members represented by the assembled MAGs. This analysis led us to propose that, in this reactor, members of the Actinobacteriota phylum are important in the degradation of lactose, via the Leloir pathway and the bifid shunt, and the production of acetic, lactic, and succinic acids. In addition, members of the Firmicutes phylum contribute to the chain-elongation-mediated production of butyric, hexanoic, and octanoic acids, with different microbes using either lactose, ethanol, or lactic acid as the growth substrate. We conclude that genes encoding carbohydrate utilization pathways, and genes encoding lactic acid transport into the cell, electron confurcating lactate dehydrogenase, and its associated electron transfer flavoproteins, are genomic features whose presence in Firmicutes needs to be established to infer the growth substrate used for chain elongation.

A Total of six groups of fresh broiler carcasses randomly collected from different poultry shops at Alexandria province. After examination of an untreated samples, the samples were classified into six groups, each group was represented by their muscle samples which were dipped in acid solutions as follows; the 1st group was dipped in 1% lactic acid solution v/v for five min., the 2nd group was dipped in 2% lactic acid solution v/v for five min., the 3rd group was dipped in 1% acetic acid solution v/v for five min., the 4th group was dipped in 2% acetic acid solution v/v for five min., the 5th group was dipped in 1% mixture of lactic and acetic acids v/v for five min. and the 6th group was dipped in 2% mixture of lactic and acetic acids v/v for five min. Determination of spoilage markers including determination of pH and total volatile nitrogen (TVN) was performed beside determination of aerobic plate count (APC), psychrophilic bacteria count and Enterobacteriaceae count. The inhibitory effect of lactic acid and acetic acid on microbial population has long been used to preserve food from spoilage, while much of the effect can be accounted for pH and temperature of storage. Immersion of the examined samples with 1, 2 % (lactic, acetic acids). chilled for 1, 2, 4, 6, 8, 10 and 12 days resulted in population reductions of aerobic bacteria, psychrophilic and Enterobacteriaceae. Effect of organic acids as lactic acid, acetic acid and mixture of lactic and acetic acids are mainly affecting growth of microorganisms mainly by lowering of pH and increase acidity of media. The acids have effect until 10 days of storage at chilling condition in case of 1% concentration, but its effect reach to 12 days in case of 2% concentration. [ABSTRACT FROM AUTHOR]

Copyright of Medicina (Buenos Aires) is the property of Medicina (Buenos Aires) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Case report: A 64‐year‐old man was hospitalized in the intensive care unit with pneumonia, lactic acidosis, and hypoglycemia. Investigations revealed a kappa light chain multiple myeloma. The patient underwent chemotherapy by bortezomib, lenalidomide, and dexamethasone. Serum lactate level and glycemia normalized. Evaluation at day 28 showed a disease progression. Lenalidomide was switched for daratumumab, bortezomib, and dexamethasone. In front of the inefficiency of the chemotherapy, the patient underwent third‐line chemotherapy by melphalan. There was a correlation between the evolution of the myeloma, serum lactate level, and hypoglycemia, with a normalization after chemotherapy, and a rise at myeloma's relapse. Daratumumab was continued as a maintenance treatment. The patient died 4 months and 10 days after his first hospital admission. Discussion: Our case is consistent with a type B tumor‐associated aerobic glycolytic lactic acidosis, called the Warburg effect. It is well described in association with other hematologic malignancies, but rarely in association with myeloma. All reported cases of myeloma with type B lactic acidosis died within 1 year. Conclusion: When associated with multiple myeloma, tumor‐associated aerobic glycolytic lactic acidosis is correlated with the disease progression and has a very high mortality rate. Significance Statement : Aerobic glycolytic lactic acidosis also known as the Warburg effect can be encountered in multiple myeloma, resulting of a metabolic shift to increased glycolysis operating in malignant cells. Together with hypoglycemia, it is well correlated with the disease progression and has a very poor outcome.

Debate exists regarding the safety of metformin and the risk of metformin-associated lactic acidosis, particularly in the setting of kidney dysfunction. Data from two studies examining the interplay between metformin, acute kidney injury, and complications including lactic acidosis suggest that metformin should be used conservatively in patients with kidney dysfunction.

Like other biguanide agents, metformin is an anti-hyperglycemic agent with lower tendency towards hypoglycemia compared to other anti-diabetic drugs. Given its favorable effects on serum lipids, obese body habitus, cardiovascular disease, and mortality, metformin is recommended as the first-line pharmacologic agent for type 2 diabetes in the absence of contraindications. However, as metformin accumulation may lead to type B non-hypoxemic lactic acidosis, especially in the setting of kidney injury, chronic kidney disease, and overdose, regulatory agencies such as the United States Food and Drug Administration (FDA) have maintained certain restrictions regarding its use in kidney dysfunction. Case series have demonstrated a high fatality rate with metformin-associated lactic acidosis (MALA), and the real-life incidence of MALA may be underestimated by observational studies and clinical trials that have excluded patients with moderate-to-advanced kidney dysfunction. A recent study of advanced diabetic kidney disease patients in Taiwan in Lancet Endocrinology and Diabetes has provided unique insight into the potential consequences of unrestricted metformin use, including a 35% higher adjusted mortality risk that was dose-dependent. This timely study, as well as historical data documenting the toxicities of other biguanides, phenformin and buformin, suggest that the recent relaxation of FDA recommendations to expand metformin use in patients with kidney dysfunction (i.e., those with estimated glomerular filtration rates ≥30 instead of our recommended ≥45 ml/min/1.73 m2) may be too liberal. In this article, we will review the history of metformin use; its pharmacology, mechanism of action, and potential toxicities; and policy-level changes in its use over time.

PurposeCurrent knowledge about pulmonary/systemic hemodynamics and gas exchange during neonatal resuscitation in a model of transitioning fetal circulation with fetal shunts and fluid-filled alveoli is limited. Using a fetal lamb asphyxia model, we sought to determine whether hemodynamic or gas-exchange parameters predicted successful return of spontaneous circulation (ROSC).MethodsThe umbilical cord was occluded in 22 lambs to induce asphyxial cardiac arrest. Following five minutes of asystole, resuscitation as per AHA-Neonatal Resuscitation Program guidelines was initiated. Hemodynamic parameters and serial arterial blood gases were assessed during resuscitation.ResultsROSC occurred in 18 lambs (82%) at a median (IQR) time of 120 (105-180) seconds. There were no differences in hemodynamic parameters at baseline and at any given time point during resuscitation between the lambs that achieved ROSC and those that did not. Blood gases at arrest prior to resuscitation were comparable between groups. However, lambs that achieved ROSC had lower PaO2, higher PaCO2, and lower lactate during resuscitation. Increase in diastolic blood pressures induced by epinephrine in lambs that achieved ROSC (11 ±4 mmHg) did not differ from those that were not resuscitated (10 ±6 mmHg). Low diastolic blood pressures were adequate to achieve ROSC.ConclusionsHemodynamic parameters in a neonatal lamb asphyxia model with transitioning circulation did not predict success of ROSC. Lactic acidosis, higher PaO2 and lower PaCO2 observed in the lambs that did not achieve ROSC may represent a state of inadequate tissue perfusion and/or mitochondrial dysfunction.

Metformin is and has been considered as first-line therapy for type 2 diabetes for over a quarter of a century. Like other biguanides, metformin can cause a lactic acidosis that is exceptionally rare but fatal. The likelihood of metformin-associated lactic acidosis is substantially higher in patients with kidney impairment and also among those with seemingly normal kidney function who are at risk of acute kidney injury (AKI). Hence, regulatory agencies in many industrialized nations have maintained strict renal restrictions surrounding metformin. However, there have been millions of people exposed to metformin for many years, many of them with serum creatinine values at or close to 1.5 mg/dL with estimated glomerular filtration rates (eGFRs) much below 60 mL/min/1.73 m(2) who have not developed lactic acidosis. Thus, there clearly remains controversy in this area, and there has been heightened pressure to remove the renal restrictions of metformin. To provide a discussion on the pros and cons of relaxing the renal restrictions for metformin use, we provide a Point-Counterpoint. In the point narrative below, Drs. Kalantar-Zadeh and Kovesdy provide their argument that although there is little evidence of the potential benefits of metformin in kidney disease, just considering the sheer numbers of metformin users and the high fatality rate of its associated lactic acidosis, the most appropriate practice is to avoid metformin use in people with eGFR 30 mL/min/1.73 m(2)-William T. CefaluEditor in Chief, Diabetes Care.

Background: Metformin-associated lactic acidosis (MALA) is a relatively rare adverse effect of metformin therapy. It usually occurs in patients with metformin overdose or in those with underlying acute and/or chronic conditions resulting in impaired lactate metabolism. Among these, patients with acute kidney injury, heart failure, sepsis, and cirrhosis are the most vulnerable to MALA, even in the setting of appropriate therapy. The most common symptoms of MALA include nausea, vomiting, diarrhea, encephalopathy, hypothermia, respiratory failure, and hypotension. Blindness is a dramatic symptom that has been rarely reported with MALA. Case Report: We report a case of 78-year-old woman with history of type 2 diabetes mellitus with nephropathy for which she was treated with metformin and insulin. She developed nausea, non-bloody emesis, and watery diarrhea, which led to dehydration, anion gap metabolic acidosis due to hyperlactatemia, and acute kidney injury (AKI). She was hospitalized for i.v. hydration and further management when she suddenly developed blindness. The diagnostic work-up ruled out central causes and her symptoms resolved briefly after continuous renal replacement therapy (CRRT) was initiated, confirming the diagnosis of MALA. Conclusions: By reporting this case, we wish to increase awareness about MALA symptoms, its diagnosis, and the importance of early recognition and initiation of treatment among clinicians involved in the care of patients with chronic kidney disease (CKD) who take metformin for diabetes mellitus. Although rare, this metformin adverse effect can present dramatically and can be distressing for both patient and treating team. [ABSTRACT FROM AUTHOR]

Aim/Purpose A literature review is often criticized for the absence of coherent construction, synthesis of topics, and well-reasoned analysis. A framework is needed for novice researchers to organize and present information obtained from the literature review. Background Information and communication technologies advancement have yielded overwhelming information. The massive availability of information poses several challenges, including storage, processing, meaningful organization, and presentation for future consumption. Information System Researchers have developed frameworks, guidelines, and tools for gathering, filtering, processing, storing, and organizing information. Interestingly, information system researchers have vast information that needs meaningful organization and presentation to the research fraternity while conducting a literature review on a research topic. Methodology This paper describes a framework called LACTiC (Location, Author, Continuum, Time, and Category) that we adapted from another framework called LATCH (Location, Alphabetical, Time, Category, and Hierarchy). LATCH was used to organize and present information on e-commerce websites for seamless navigation. We evaluated the LACTiC framework. Contribution Information System Researchers can use the LACTiC framework to organize information obtained from literature review. Findings The evaluation reveals that most researchers from information systems organize information obtained from the literature review category-wise, followed by continuum, author, time, and location. Recommendations for Researchers Overall, the framework works well and can be helpful for researchers for an initial idea for organizing information obtained from the literature review. Future Research To conceptualize the framework, the study was carried out using Information Systems related literature. To generalize the proposed framework, we may suggest that the study can be extended to other areas of business management, such as marketing, finance, operation, decision sciences, accounting, and economics. [ABSTRACT FROM AUTHOR]

Lactic acidosis results from the accumulation of lactate and protons in the body fluids and is often associated with poor clinical outcomes. The effect of lactic acidosis is governed by its severity and the clinical context. Mortality is increased by a factor of nearly three when lactic acidosis accompanies low-flow states or sepsis,1 and the higher the lactate level, the worse the outcome.2 Although hyperlactatemia is often attributed to tissue hypoxia, it can result from other mechanisms. Control of the triggering conditions is the only effective means of treatment. However, advances in understanding its pathophysiological features and the factors causing cellular dysfunction in the condition could lead to new therapies. This overview of lactic acidosis emphasizes its pathophysiological aspects, as well as diagnosis and management. We confine our discussion to disorders associated with accumulation of the l optical isomer of lactate, which represent the vast majority of cases of lactic acidosis encountered clinically.

Lactic acidosis results from the accumulation of lactate and protons in the body fluids and is often associated with poor clinical outcomes. The effect of lactic acidosis is governed by its severity and the clinical context. Mortality is increased by a factor of nearly three when lactic acidosis accompanies low-flow states or sepsis,1 and the higher the lactate level, the worse the outcome.2 Although hyperlactatemia is often attributed to tissue hypoxia, it can result from other mechanisms. Control of the triggering conditions is the only effective means of treatment. However, advances in understanding its pathophysiological features and the factors causing cellular dysfunction in the condition could lead to new therapies. This overview of lactic acidosis emphasizes its pathophysiological aspects, as well as diagnosis and management. We confine our discussion to disorders associated with accumulation of the l optical isomer of lactate, which represent the vast majority of cases of lactic acidosis encountered clinically.

Metformin is a widely used biguanide for the treatment of type 2 diabetes mellitus. Metformin-induced lactic acidosis (MALA) is a rare but potentially fatal entity in the pediatric age group, seen mainly in suicide attempts in adolescents. MALA has not yet been reported in younger patients or pediatric patients taking regular therapeutic doses. Here, we report a three-year-old female receiving therapeutic metformin who developed MALA. MALA should be suspected in patients with unexplained lactic acidosis and on regular metformin, especially in the setting of renal impairment or hypoxic events.

Metformin is recommended as a first-line treatment for patients with diabetes mellitus type 2; it has a cardiovascular protective effect, and low risk of hypoglycemia. However, a severe but infrequent complication of its use is lactic acidosis, which has high morbidity and mortality rates. The estimated incidence of metformin lactic acidosis is 7,4 cases per 100.000 patients per year. Main risk factors are acute or chronic renal disease, congestive heart failure, hepatic failure, and concomitant use of drugs that affect metformin clearance or energy metabolism. Treatment includes hydration with crystalloids, support measures, and intravenous bicarbonate. Renal replacement therapy has been successful for treating metformin-associated lactic acidosis, but there are still no clear indications for it, because metformin is a partially dialyzable molecule and prolonged hemodialysis is required to reduce its levels sufficiently. Despite current treatment, mortality remains high. Early diagnosis and prompt multidisciplinary support are essential to improve outcome in these patients.

Background Metformin associated lactic acidosis (MALA) is a serious adverse event with a high mortality rate of 30–50%. Early recognition of MALA and timely starting treatment may reduce its morbidity and mortality. Objective The aim of this study was to explore clinical parameters to identify patients with MALA in patients with suspected sepsis induced lactic acidosis in the emergency department ED. Setting A retrospective single centre study was conducted at the Deventer Teaching Hospital in the Netherlands. Method Patients with lactate concentration > 4.0 mmol/l admitted at the ED between 2010 and 2017 with suspected sepsis or confirmed MALA and referred to the Intensive Care Unit were included. Baseline characteristics (pH, lactate, creatinine and CRP) of MALA patients were compared with patients with suspected sepsis induced lactic acidosis. Creatinine and lactate concentration were selected as potential relevant parameters. Main outcome measure Sensitivity and specificity of the highest tertiles of the creatinine and the lactate concentrations separately, in combination, and both combined with metformin use, were calculated. Results Thirteen MALA and 90 suspected sepsis induced lactic acidosis patients were included. Lactate (14.7 vs 5.9 mmol/l, p < 0.01) and creatinine concentration (642 vs 174 μmol/l, p < 0.01) were significantly higher in the MALA group and arterial pH (7.04 vs 7.38, p < 0.01) and CRP (90 vs 185 mg/l, p < 0.01) were significantly lower. The combined parameters lactate ≥ 8.4 mmol/l, creatinine ≥ 256 μmol/l had a sensitivity of 85% and a specificity of 95% for identifying MALA in suspected sepsis induced lactic acidosis patients in the ED. When combined with metformin use the specificity increased to 99%. Conclusion When managing lactic acidosis in the ED the diagnosis MALA should be considered in patients with a creatinine concentration ≥ 256 μmol/l and lactate concentration ≥ 8.4 mmol/l. [ABSTRACT FROM AUTHOR]

Basal ganglia, which are one of the most active and permeable regions of the brain, can be reversibly or irreversibly damaged due to metabolic diseases, carbon monoxide intoxication, hypoxia, infectious and vasculitic causes. This may lead to various manifestations, especially movement disorders, but also epilepsy, encephalopathy and gait abnormalities. We present a 64-year-old female patient who had involuntary movements of the limbs. Her diffusion brain magnetic resonance imaging (MRI) showed bilateral basal ganglia hyperintense lesions in T2 weighted flair sequences. The involvement of the basal ganglia is explained by lactic acidosis, caused by metformin usage despite chronic renal failure. In this study, we present a case of generalized choreatethosis and involvement of basal ganglia due to lactic acidosis in end stage renal failure. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to prepare exercises using the black bean and in the form of doses based on studied scientific basis. The sample of the research was for Karbala players in 800 m activity for the youth group of 7 players. The experimental method was used for one group by tribal and remote testing. The black bean was given in capsules the results of the study showed that there was a significant effect of the black pill dose and the sports training, which was demonstrated by the emergence of significant differences in the post-test in running 800 meters for the benefit of Dimensional test. [ABSTRACT FROM AUTHOR]

Introduction: Acute mesenteric ischemia (AMI) in cardiac surgery is a rare condition, associated with low incidence (0.2-0.4%) and very high mortality (up to 95%). Advanced age and coexisting morbidity, such as acute myocardial infarction or atrial fibrillation are the known risk factors. Case report: We are presenting 76 years old patient with aortic valve replacement and double coronary artery bypass grafting followed by hemodynamic instability and lactic acidosis on the first postoperative day. Diagnosis of AMI was made by exclusion. We discuss diagnostic and therapeutic approach applied regarding existing data from the literature. Conclusion: Diagnosis of AMI after cardiac surgery demands high level of suspicion. Early diagnosis is of vital importance. Systematical approach and early surgical exploration affects the overall outcome.

Elevated lactate levels are associated with acute illnesses, and the mortality is high. Here, we report a case of lactate-containing peritoneal dialysis (PD) solution inducing lactic acidosis corrected by changing to hemodialysis (HD). This 70-year-old female patient was treated with PD 8 months previously for end-stage renal disease caused by diabetes mellitus. She was admitted complaining of general weakness. Initial lactate level was 22.1 mg/dL and increased to 62.4 mg/dL showing high anion gap metabolic acidosis and compensatory hyperventilation. There are no definite causes of lactic acidosis besides the use of PD solutions containing a lactate component. The patient's lactate level was decreased after temporarily changing the dialysis modality to HD. Her lactate level was increased again after restarting PD, and decreased to normal after restarting HD. We report this case because physicians should consider lactate-containing PD solution as a possible cause of lactic acidosis.

In this work, a new paired electrolysis procedure is successfully introduced. This is a combination of two different processes: electrochemical water softening (EWS) and electrochemical production of weak acid solutions (EPWA). This paired electrolysis method is tested for hardness removal in a simulated solution of concentrates, such as that produced by the electrodialysis of brackish water. The use of a divided electrochemical cell makes it possible to achieve removal efficiencies higher than 90% in optimum conditions. The good performance and stability of the cathode are also demonstrated by long-term experiments. Simultaneously, weak acids are obtained by protonation of their conjugate bases in the anodic compartment. Lactic acid is obtained from lactate with a purity of no less than 80% in this work without significant loss of efficiency in hardness removal. The main interest lies in the commercial value of weak acids such as lactic acid, citric acid or gluconic acid, among others. The methodology makes it possible to benefit from both cathodic and anodic processes, which may contribute to decreasing the final EWS treatment costs for a cost-effective desalination application. Unlabelled Image • Electrochemical water softening and production of weak acid solutions as coupled processes • A new approach based on obtaining suitably pure weak acids solutions is tested. • Lactic acid solutions with purity around 80% are obtained without efficiency loss. • Lactic acid is used due to its commercial value and possibility of valorisation. • Long-term experiments evaluate the system behaviour with time. [ABSTRACT FROM AUTHOR]

Antecedentes: la conservación de pastos en ensilajes es una estrategia a la escasez de forrajes en épocas de sequía‚ sin embargo‚ por proliferación de bacterias patógenas derivadas de los indebidos procesos de fermentación‚ se generan pérdidas del material vegetal‚ por ello‚ la adición de microorganismos eficientes aseguran la conservación de los ensilajes al producir ácidos grasos volátiles que inhiben la proliferación bacteriana indeseada. Objetivo: determinar los niveles de ácidos grasos volátiles presentes en el ensilaje de pasto de corte (Pennisetum purpureum Schum) variedad Taiwán rojo con adición de microorganismos eficientes. Métodos: para activar los microorganismos eficientes (EM®) ‚ se mezclaron en un recipiente 5 % de los (EM®)‚ 5 % de melaza y 90 % de agua‚ dejándolos fermentar por 10 días. Para la elaboración de los microsilos‚ se utilizó el pasto variedad Taiwán rojo recolectado a los 45‚ 60‚ 75 y 90 días después de la cosecha (tratamientos)‚ picándolo a un tamaño de 2‚5 cm y empacando porciones del material en bolsas de polietileno negro hasta completar 1 kg e inoculando 2 ml de EM®. Para cada tratamiento se elaboraron 2 repeticiones con EM® y una repetición sin EM®‚ para un total de 12 microsilos‚ dejándolos fermentar y tomando muestras a los 0‚7‚ 14‚ 21 y 30 días de fermentación para cada tratamiento‚ evaluando: pH‚ ácido láctico‚ acido butírico y acido propiónico. El diseño experimental correspondió a un estudio de parcelas divididas en el tiempo. Resultados: se encontraron diferencias significativas entre la inclusión de los EM® y el control. Los valores de pH para los días 7‚ 14‚ 21 y 30 mostraron un efecto de estabilización a medida que aumentó el periodo de fermentación‚ el ácido láctico tuvo la mayor concentración a los 30 días‚ el ácido acético y propiónico se estabilizaron a los 14 días‚ y el ácido butírico fue mayor a los 21 días. Conclusiones: la inclusión de EM® ayudo a conservar mejor los ensilajes‚ ya que los niveles de pH alcanzados y las diferencias significativas en los niveles de ácidos grasos volátiles alcanzados‚ evitan la proliferación de bacterias patógenas y a su vez mejoran la calidad nutricional de los ensilajes. [ABSTRACT FROM AUTHOR]

In this study, the effects of inoculation of two lactic acid bacteria including Pediococcus pentosaceu and Lactobacillus plantarum were evaluated on the fermented fish sausages produced from Common carp, as a model, at incubation temperature of 35˚C. Common carp fermented sausages were prepared from minced fish, salt (3%), glucose (3%) and the combination of two starter cultures of bacteria (6 log CFU/g) and fermentation occurred during the 48 h incubation. Soluble peptides, pH, phsycrophilic and lactic acid bacterial counts, proximate composition (protein, lipid, moisture and ash), texture profile analysis and color of fermented sausages were measured and compared to the non-inoculated sausages (the control group) at 0, 24 and 48 h after incubation. According to the results, lactic acid bacteria showed rapid growth after 48 h fermentation which led to the significant decrease in pH from initial values of around 6.9 to 4.4 (P

Introduction. The purpose of research - to establish optimal cultivation conditions to determine of the efficacy of development lactic acid bacteria isolated from goat milk. Materials and methods. Strains cultivation were performed in sterilized goat milk medium at the 30±2 °C. Parameters determination have been established for the periodic cultivation in bioreactor Sartorius Biostat® A plus. Count enumeration of lactic acid bacteria cells was performed using the spread count method. Results and discussion. The slow pH decrease was observed at all selected strains during cultivation time. Lactic acid has been accumulated proportional what shows the intense development of the lactic acid bacteria up to 14 cultivation hours. The active development is characterized through moderate acidity of fermented milk. Data of strains development dynamics and the biomass accumulation in the medium goat milk-based proved the obtaining to maximum count of lactic acid bacteria cells lg CFU/g. At the same time the regression analysis of the pH value dinamics and viable cells count were performed for exactly describes results of the experiments. The strains CNMN-LB-73, CNMN-LB-74, CNMN-LB-77 and CNMN-LB-78 has the accurate regression line at pH dinamic and strains CNMN-LB-73, CNMN-LB-74, CNMN-LB-75, CNMN-LB-76 and CNMN-LB-78 at the dynamic of cells development. Strains development stages have observed since 10 hours of cultivation. The decline phase started after 12 hours for CNMN-LB-76, CNMN-LB-77, CNMN-LB-79 strains and after 14 hours for CNMN-LB-73, CNMN-LB-74, CNMN-LB-75, CNMN-LB-78, indicating that they are more resistant to acid conditions that isolated strains reported by other authors, cell multiplication was observed until the pH 4.7. Conclusions. In conditions of periodic cultivation biotechnological parameters for cultivation of lactic acid bacteria from goat milk were determinated. Obtained data demonstrated important biotechnological properties of isolated strains. [ABSTRACT FROM AUTHOR]

This research aimed to increase the resistant starch (RS) content of taro flour by using Lactic Acid Bacteria (LAB) fermentation and autoclaving-cooling method. Taro chips were fermented by mixed culture of Lactobacillus plantarum D-240 and Leuconostoc mesenteroides SU-LS 67 (1:1) at 370C for 18 hr. Fermented taro chips were further autoclaved (1210C, 15 mins) and cooled (40C, 24 hr). The autoclaving-cooling cycle were performed for one and two cycles. Taro chips were then dried (700C, 16hr), milled and sieved (80 mesh) to obtain the modified taro flour. Prebiotic properties of modified taro flour were evaluated and expressed as prebiotic effect, index and activity. The results showed that fermentation followed by one cycle autoclaving-cooling increased the RS content by 2.8 fold (from 4.13% to 11.45%) compared with control without fermentation. Fermentation of taro chips could be able to reduce the number of autoclaving-cooling cycle to only one cycle. The modified taro flour demonstrated prebiotic effect, index and activity better than control. [ABSTRACT FROM AUTHOR]

Hypermetabolic and catabolic states in large TBSA burns lead to higher basal body temperature and tachycardia. These metabolic changes complicate the diagnosis of bacteremia and sepsis. Current indications for obtaining blood cultures (BCs) in this population are poorly described and nonstandardized. Fever, leukocytosis, and lactic acidosis are common during sepsis. This study aims to identify limits of these parameters with the highest rates of bacteremia. A retrospective review was performed for burn patients with > 20% TBSA between January 2009 and June 2011. BCs were collected with corresponding body temperature, white blood cell (WBC) count, and serum lactate levels. Positive culture rates were analyzed with univariate and multivariate analysis. Seventy-one patients met inclusion criteria and 360 BCs were included in data analysis. Cultures taken with temperature > 38.9°C were significantly more positive (P = .01) than temperatures between 38 and 38.9°C. There were significantly more positive cultures when the WBC count was < 4.5 compared with those ≥ 4.5 × 103/µl (P = .04). Lactate was an independent predictor of bacteremia (OR, 1.81; 95% CI, 1.21-12.71). Cultures were significantly more positive when the lactate level was ≥ 2.5 compared with < 2.5 mg/dL (P = .02). A temperature ≥ 38.5°C and a lactate ≥ 2.5 mg/dL corresponded to a 28.6% positive culture rate compared with 4.8% for all other scenarios (P = .001). This study demonstrates that body temperature > 38.9°C, WBC < 4.5 × 103/µl, and serum lactate ≥ 2.5 mg/dL have the highest rate for positive BCs in severe burn patients. A combination of leukopenia and pyrexia as well as lactic acidosis and pyrexia represent even higher specificity for positive BC in these patients. [ABSTRACT FROM AUTHOR]

Determination of p K a values, especially for OH groups of α-hydroxycarboxylic acids, is challenging and rarely reported. Here, successive p K a values for COOH, and more importantly for OH groups of the nine biologically important α-hydroxycarboxylic acids (glycolic, lactic, methyl lactic, α-hydroxybutyric, mandelic, atrolactic, benzilic, malic, and citramalic) were calculated computationally. We benchmarked the accuracy for predicting p K a values by HF, MP2, B3LYP, B97D, B2PLYP, M06-2X, G3 and CBS-QB3 levels of theory combined with CPCM and SMD solvation models applied to lactic acid whose experimental p K a values are reported in the literature. Also, we considered six thermodynamic cycles in combination with a number of DFT methods and some cavity sets, such as, UAKS, Pauling and Bondi to obtain the reasonable results. Finally, we employed two best methods to predict the p K a values of the remaining eight α-hydroxycarboxylic acids. Estimated p K a values of OH groups are reported for these α–hydroxycarboxylic acids that were not yet determined experimentally. [ABSTRACT FROM AUTHOR]

Lactic acidosis is defined as the presence of pH < 7.35, blood lactate> 2.0 mmol/L and PaCO2 < 42 mmHg. However, the definition of severe lactic acidosis is controversial. The primary cause of severe lactic acidosis is shock. Although rare, metformin-related lactic acidosis is associated with a mortality as high as 50%. The treatment for metabolic acidosis, including lactic acidosis, may be specific or general, using sodium bicarbonate, trihydroxyaminomethane, carbicarb or continuous haemodiafiltration. The successful treatment of lactic acidosis depends on the control of the aetiological source. Intermittent or continuous renal replacement therapy is perfectly justified, shock being the argument for deciding which modality to use. We report a case of a male patient presenting with metformin poisoning as a result of attempted suicide, who developed lactic acidosis and multiple organ failure. The critical success factor was treatment with continuous haemodiafiltration. [ABSTRACT FROM AUTHOR]

Background: The pursuit for clarity in diagnostic and treatment pathways for the complex, chronic condition of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) continues. This systematic review raises a novel question to explore possible overlapping aetiology in two distinct conditions. Similar neurocognitive symptoms and evidence of D-lactate producing bacteria in ME/CFS raise questions about shared mechanisms with the acute condition of D-lactic acidosis (D-la).Methods: D-la case reports published between 1965 and March 2016 were reviewed for episodes describing both neurological symptoms and high D-lactate levels. Fifty-nine D-la episodes were included in the qualitative synthesis comparing D-la symptoms with ME/CFS diagnostic criteria. A narrative review of D-la mechanisms and relevance for ME/CFS was provided.Results: The majority of neurological disturbances reported in D-la episodes overlapped with ME/CFS symptoms. Of these, the most frequently reported D-la symptoms were motor disturbances that appear more prominent during severe presentations of ME/CFS. Both patient groups shared a history of gastrointestinal abnormalities and evidence of bacterial dysbiosis, although only preliminary evidence supported the role of lactate-producing bacteria in ME/CFS.Limitations: Interpretation of results are constrained by both the breadth of symptoms included in ME/CFS diagnostic criteria and the conservative methodology used for D-la symptom classification. Several pathophysiological mechanisms in ME/CFS were not examined.Conclusions: Shared symptomatology and underlying microbiota-gut-brain interactions raise the possibility of a continuum of acute (D-la) versus chronic (ME/CFS) presentations related to D-lactate absorption. Measurement of D-lactate in ME/CFS is needed to effectively evaluate whether subclinical D-lactate levels affect neurological symptoms in this clinical population. [ABSTRACT FROM AUTHOR]

This study was aimed at investigating the effect of including a mixture of natural organic acids (citric, ascorbic and lactic) in the icing medium employed during the chilled storage of horse mackerel (Trachurus trachurus). To this end, two aqueous solutions including 0.005% and 0.020% (w/v) of each acid (P-1 and P-2 conditions, respectively) were employed as icing systems. The effects on lipid damage development in fish muscle were monitored for up to a 13- day storage period; complementary chemical quality and sensory acceptance analyses were carried out. According to peroxide and thiobarbituric acid reactive substance assessment, a slight inhibitory effect was concluded as a result of the acid mixture present in the chilling medium. At the same time, P-2-treated fish showed a longer shelf life than their counterparts belonging to P-1 and control conditions. No effect of the acid presence in the icing system could be outlined on the nucleotide degradation or the free fatty acid formation.

Although bilateral basal ganglia lesions are common in hypoxic encephalopathy and methanol intoxication, they are a rare finding in end-stage chronic renal failure. The pathophysiology of both bilateral and selective involvement of the basal ganglia is unclear, but severe metabolic acidosis is one of the affected processes. In this report bilateral basal ganglia lesions and accompanying signs, which ensued after the use of metformin in a patient with chronic renal failure, are discussed