Search

Abstract Background Wound healing complications are a major challenge following the extended lateral approach in calcaneal fractures. Soft-tissue microcirculation plays an important role via the delivery of oxygen, nutrients, and the regulation of a local milieu. The aim of this clinical study was to examine the effect of intraoperative pneumatic tourniquet application on skin and subcutaneous microcirculation, and its impact on wound healing progression. Methods Patients with calcaneal fractures were randomly assigned to two groups defined by a surgery conducted either with use or without use of a tourniquet. Blood flow (BF [AU]), tissue oxygen saturation (SO 2 [%]) and the relative amount of haemoglobin (rHb[AU]) were intraoperatively measured at two depths (2 and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C ® , LEA Medizintechnik, Giessen, Germany). Time points were before and after inflation of the pneumatic tourniquet and also at the end of surgery before deflation. A linear mixed model (LMM) was fitted for statistical analysis. Results Thirty-four patients (3 women and 31 men) with 37 calcaneal fractures were included. In 22 of them, the surgery was conducted with a tourniquet and in the other 15 without its use. A significant decrease of microcirculation, characterized by decreases in blood flow (p = 0.011) and tissue oxygenation (p = 0.023) was measured in 8 mm depth after inflating the tourniquet. However, these changes did not influence the time of postoperative wound healing. Conclusion The use of a pneumatic tourniquet reduces deep microcirculation without affecting postoperative wound healing. Trial registration The study was registered in www.ClinicalTrials.gov (NCT01264146).

This study investigated the physiological responses and effects of exercise training under hypoxic conditions at the skeletal muscle level induced by reducing muscle temperature in cold water environment. Participants were divided into two intervention groups, cooling and control conditions, according to the water temperature of 15°C and 33°C where the training were conducted in. Eight participants in each group performed submaximal cycling exercise in the water for 30 minutes at the lactate threshold (LT) intensity, three times a week for four weeks (12 sessions). LT intensity was assessed at pre- and post-intervention in a 33°C water temperature environment. A progressive load cycling test was performed on land to assess maximal oxygen uptake (V̇O2max) and Wingate test was conducted to measure anaerobic power. In the cooling group, working muscle deoxygenation increased during submaximal and maximal exercise, suggesting an improvement in the muscle oxygen extraction capacity. However, no effects on aerobic capacity such as V̇O2max or LT intensity were observed. The improvement in mean power and time to peak during the Wingate test in the cooling group indicated that LT intensity exercise training in a cold water environment would increase anaerobic power. [ABSTRACT FROM AUTHOR]

Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among pa- tients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desat- uration have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR-γ) downregulation. In human adipose tissue, PPAR-γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR-γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index. [ABSTRACT FROM AUTHOR]

The transfer of calcium ions through the cell membrane of a cardiomyocyte is associated with overcoming a high energy barrier and can be impaired by vibration. Since drugs of the calcium channel blocker group are able to reduce damage to mitochondria and cell membranes, the effect of the calcium channel blocker nifedipine (adalat) at a dose of 7.5 mg/kg on the energy metabolism of cardiomyocytes in a vibration-mediated (56 sessions of vibration with a frequency of 44 Hz and an amplitude of 0.5 mm) model of cellular hypoxia was evaluated. The functional states of mitochondria in the composition of 30% homogenate of the myocardial tissue of the left ventricle of the rabbit heart were studied using the polarographic method with a closed galvanic oxygen sensor in a thermostatically controlled 1 mL cuvette with a protein content of 2.4 ± 0.5 mg, measured by a modified microbiuretic assay. In animals subjected to vibration in the presence of calcium channel blockers, the rate of endogenous respiration (Ve) remained at the level of intact animals and was 16.4 ± 4.1 [ng-atom O] min–1 mg–1 protein; sensitivity to amytal increased by 39% and sensitivity to malonate decreased by 40% compared with the indicators in animals subjected to vibration without pharmacological protection. The indicators of the ratio of the activity of mitochondrial enzyme complexes I and II and the processes of regulation in different metabolic states of mitochondria confirmed the restoration of the activity of mitochondrial enzyme complex I suppressed by vibration and the regulatory restriction of mitochondrial enzyme complex II. The revealed energy-protective effect of calcium channel blockers increased the vibration resistance of the tissue, preventing the development of necrotic changes in it. [ABSTRACT FROM AUTHOR]

Anemia is a pathological condition in which the hemoglobin and red blood cell mass decrease; it is mainly defined by the concentration of hemoglobin in the blood. The World Health Organization guidelines establish specific values to define anemia in different population groups. Early detection of anemia can also be a valuable indicator of underlying medical conditions. Clinical studies have explored the relationship between perioperative anemia and morbidity, highlighting the need for more judicious therapeutic strategies, such as the use of Patient Blood Management, which aims to prevent and treat anemia in a personalized and effective way. Patient Blood Management emerges as a promising approach to dealing with anemia, recognizing that its correction through transfusion always carries risks and that personalized prevention and treatment can offer better outcomes for patients.

Patients with obstructive sleep apnea (OSA) experience insulin resistance and its clinical consequences, including hypertriglyceridemia, reduced high density lipoprotein-associated cholesterol (HDL-c), visceral adiposity, hepatic steatosis, increased epicardial fat thickness, essential hypertension, glucose intolerance, increased risk for type 2 diabetes, chronic kidney disease, subclinical vascular damage, and increased risk for cardiovascular events. Obesity is a major contributor to OSA. The prevalence of OSA is almost universal among patients with severe obesity undergoing bariatric surgery. However, insulin resistance and its clinical complications occur in OSA patients irrespective of general obesity (body mass index). In OSA patients, apnea episodes during sleep induce oxyhemoglobin desaturation and tissue hypoxia. Insulin resistance is an adaptive response to tissue hypoxia and develops in conditions with limited tissue oxygen supply, including healthy subjects exposed to hypobaric hypoxia (high altitude) and OSA patients. Indicators of oxyhemoglobin desaturation have been robustly and independently linked to insulin resistance and its clinical manifestations in patients with OSA. Insulin resistance mediates the elevated rate of type 2 diabetes, chronic kidney disease, and cardiovascular disease unexplained with traditional cardiovascular risk factors present in OSA patients. Pathophysiological processes underlying hypoxia-induced insulin resistance involve hypoxia inducible factor-1 upregulation and peroxisome proliferator-activated receptor-gamma (PPAR-γ) downregulation. In human adipose tissue, PPAR-γ activity promotes glucose transport into adipocytes, lipid droplet biogenesis, and whole-body insulin sensitivity. Silencing of PPAR-γ in the adipose tissue reduces glucose uptake and fat accumulation into adipocytes and promotes insulin resistance. In conclusion, tissue hypoxia drives insulin resistance and its clinical consequences in patients with OSA, regardless of body mass index.

Abstract Background Veno-arterial carbon dioxide tension difference (ΔPCO2) and mixed venous oxygen saturation (SvO2) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO2 (ΔPCO2 fem) and SvO2 (SvO2 fem) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO2 fem, SvO2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBCH6) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBCH6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO2 fem was 9.1 ± 6.0 mmHg, SvO2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P

Arterial hypocapnia (AH), induced by voluntary or forced hyperventilation of the lungs, is accompanied by a decrease in cerebral blood flow (due to an increase in the arteriole tone) and an increase in the affinity of hemoglobin for oxygen. As a result, an oxygen supply to cortical tissue decreases and zones with a critically low oxygen tension (pO2) are formed in brain tissue. The distribution of pO2 in cerebral cortex during AH has not been studied enough. The aim of the work was to evaluate the effectiveness of oxygen supply to brain tissue at the level of arterial and venous microvessels at AH. To do this, the following tasks were set: (1) to study the distribution of the pO2 on the arterial and venous microvessels of the rat cerebral cortex; (2) to analyze tissue pO2 profiles near the walls of these microvessels. On anesthetized Wistar rats under conditions of forced hyperventilation (PaCO2 = 17.1 ± 0.7 mm Hg), the distribution of oxygen tension on the wall of pial and radial arterioles with a lumen diameter of 7–70 µm and on the wall of pial and ascending venules with a lumen diameter of 7–300 µm was studied. In tissue, near the wall of cortical arterioles and venules with a lumen diameter of 10–20 µm, tissue pO2 profiles were measured. Measurements of pO2 during spontaneous breathing of the animal with air served as a control. All pO2 measurements were made using platinum polarographic microelectrodes with a tip diameter of 3–5 µm. Visualization of the electrode tip and microvessels was carried out using a LUMAM-K1 microscope with epiobjectives of the contact type. This work presents for the first-time direct measurements of pO2 on the walls of arterioles and venules of the rat cerebral cortex and in tissues at different distances from the walls of these microvessels at AH. It has been shown that AH results in significant decrease in the oxygen supply to cerebral cortex, that is manifested by a significant drop of the pO2's on venous microvessels and in tissue in the immediate vicinity of the studied microvessels. It has been shown, that the role of arterioles as a direct source of oxygen to brain tissue, is significantly reduced during arterial hypocapnia. Forced hyperventilation results in significant deterioration of oxygen supply to cerebral cortex, despite elevated pO2 values in the systemic arterial blood and in blood of systemic cerebral veins (sagittal sinus). [ABSTRACT FROM AUTHOR]

Background: Dysregulation of the hypoxia‐aerobic system has been postulated in various malignancies. Nonetheless, the contribution of hypoxia to oral carcinogenesis is yet to be elucidated. Understanding this mechanism is important for improving diagnostic tools and targeted therapies. This study aimed to assess the dysregulation of hypoxia‐related factors during different stages of oral squamous cell carcinoma (OSCC) development. Methods: Ninety‐two patients diagnosed clinically with oral leukoplakia or OSCC were included and classified according to their histopathological diagnoses. A panel of seven hypoxia‐related antibodies were used for immunohistochemical staining of each case. Automated quantification of immunostaining was used for objective reporting. Microvessel density was also assessed. Results: Significant associations were reported for non‐dysplastic epithelial changes and malignancy for Glut1, HIF‐1α, vascular endothelial growth factor, and signal transducer and activator of transcription 3(p < 0.005). Similarly, microvessel density significantly increased with the severity of epithelial disorders. A multiple regression model including the H‐score of HIF‐1α and microvessel density could statistically significantly predict the grade of epithelial disorder (p < 0.005). The associated diagnostic accuracy of this approach was 88%. Conclusions: Hypoxia‐associated events are observed during early epithelial dysplastic changes and have a potential role in oral carcinogenesis. The level of hypoxia may assist in stratifying the severity of epithelial changes among patients with oral leukoplakia. [ABSTRACT FROM AUTHOR]

Background: Veno-arterial carbon dioxide tension difference (ΔPCO2) and mixed venous oxygen saturation (SvO2) have been shown to be markers of the adequacy between cardiac output and metabolic needs in critical care patients. However, they have hardly been assessed in trauma patients. We hypothesized that femoral ΔPCO2 (ΔPCO2 fem) and SvO2 (SvO2 fem) could predict the need for red blood cell (RBC) transfusion following severe trauma. Methods: We conducted a prospective and observational study in a French level I trauma center. Patients admitted to the trauma room following severe trauma with an Injury Severity Score (ISS) > 15, who had arterial and venous femoral catheters inserted were included. ΔPCO2 fem, SvO2 fem and arterial blood lactate were measured over the first 24 h of admission. Their abilities to predict the transfusion of at least one pack of RBC (pRBCH6) or hemostatic procedure during the first six hours of admission were assessed using receiver operating characteristics curve. Results: 59 trauma patients were included in the study. Median ISS was 26 (22–32). 28 patients (47%) received at least one pRBCH6 and 21 patients (35,6%) had a hemostatic procedure performed during the first six hours of admission. At admission, ΔPCO2 fem was 9.1 ± 6.0 mmHg, SvO2 fem 61.5 ± 21.6% and blood lactate was 2.7 ± 1.9 mmol/l. ΔPCO2 fem was significantly higher (11.6 ± 7.1 mmHg vs. 6.8 ± 3.7 mmHg, P = 0.003) and SvO2 fem was significantly lower (50 ± 23 mmHg vs. 71.8 ± 14.1 mmHg, P < 0.001) in patients who were transfused than in those who were not transfused. Best thresholds to predict pRBCH6 were 8.1 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Best thresholds to predict the need for a hemostatic procedure were 5.9 mmHg for ΔPCO2 fem and 63% for SvO2 fem. Blood lactate was not predictive of pRBCH6 or the need for a hemostatic procedure. Conclusion: In severe trauma patients, ΔPCO2 fem and SvO2 fem at admission were predictive for the need of RBC transfusion and hemostatic procedures during the first six hours of management while admission lactate was not. ΔPCO2 fem and SvO2 fem appear thus to be more sensitive to blood loss than blood lactate in trauma patients, which might be of importance to early assess the adequation of tissue blood flow with metabolic needs. [ABSTRACT FROM AUTHOR]

Abstract Background High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (PvaCO2/CavO2) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO2). This study investigated whether PvaCO2/CavO2 was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia. Methods This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels

Abstract Background Although blood transfusions can be lifesaving in severe hemorrhage, they can also have potential complications. As anemia has also been associated with poor outcomes in critically ill patients, determining an optimal transfusion trigger is a real challenge for clinicians. This is even more important in patients with acute brain injury who were not specifically evaluated in previous large randomized clinical trials. Neurological patients may be particularly sensitive to anemic brain hypoxia because of the exhausted cerebrovascular reserve, which adjusts cerebral blood flow to tissue oxygen demand. Methods We described herein the methodology of a prospective, multicenter, randomized, pragmatic trial comparing two different strategies for red blood cell transfusion in patients with acute brain injury: a “liberal” strategy in which the aim is to maintain hemoglobin (Hb) concentrations greater than 9 g/dL and a “restrictive” approach in which the aim is to maintain Hb concentrations greater than 7 g/dL. The target population is patients suffering from traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH). The primary outcome is the unfavorable neurological outcome, evaluated using the extended Glasgow Outcome Scale (eGOS) of 1–5 at 180 days after the initial injury. Secondary outcomes include, among others, 28-day survival, intensive care unit (ICU) and hospital lengths of stay, the occurrence of extra-cerebral organ dysfunction/failure, and the development of any infection or thromboembolic events. The estimated sample size is 794 patients to demonstrate a reduction in the primary outcome from 50 to 39% between groups (397 patients in each arm). The study was initiated in 2016 in several ICUs and will be completed in December 2022. Discussion This trial will assess the impact of a liberal versus conservative strategy of blood transfusion in a large cohort of critically ill patients with a primary acute brain injury. The results of this trial will help to improve blood product and transfusion use in this specific patient population and will provide additional data in some subgroups of patients at high risk of brain ischemia, such as those with intracranial hypertension or cerebral vasospasm. Trial registration ClinicalTrials.gov NCT02968654.

Abstract Background During surgery, any mismatch between oxygen delivery (DO2) and consumption (VO2) can promote the development of postoperative complications. The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production (VCO2) to VO2, may be a useful noninvasive tool for detecting inadequate DO2. The primary objective of this study was to test the hypothesis that RER measured during liver transplantation may predict postoperative morbidity. Secondary objectives were to assess the ability of other variables used to assess the DO2/VO2 relationship, including arterial lactate, mixed venous oxygen saturation, and veno-arterial difference in the partial pressure of carbon dioxide (VAPCO2gap), to predict postoperative complications. Methods This retrospective study included consecutive adult patients who underwent liver transplantation for end stage liver disease from June 27th, 2020, to September 5th, 2021. Patients with acute liver failure were excluded. All patients were routinely equipped with a pulmonary artery catheter. The primary analysis was a receiver operating characteristic (ROC) curve constructed to investigate the discriminative ability of the mean RER measured during surgery to predict postoperative complications. RER was calculated at five standardized time points during the surgery, at the same time as measurement of blood lactate levels and arterial and mixed venous blood gases, which were compared as a secondary analysis. Results Of the 115 patients included, 57 developed at least one postoperative complication. The mean RER (median [25–75] percentiles) during surgery was significantly higher in patients with complications than in those without (1.04[0.96–1.12] vs 0.88[0.84–0.94]; p

The purpose of this study is to substantiate the choice and evaluate the effectiveness of therapeutic tactics aimed at suppressing collagen formation and improving metabolic processes in the kidney parenchyma in young children with pyelonephritis against the background of vesicoureteral reflux associated with undifferentiated tissue dysfunction. 67 children from 2 weeks to 3 years old with pyelonephritis and vesicoureteral reflux were examined. All children during the period of remission of the inflammatory process were examined for the content of oxyproline in the urine. Urine crystallinity and urinary excretion were determined, and markers of the morphofunctional state of the cytomembranes of the renal epithelium were determined: calcification test—the presence of polar lipids in the urine and test for the presence of lipid peroxidation products in the urine. Children with high urinary hydroxyproline excretion prior to protocol treatment of pyelonephritis during the remission of the inflammatory process at the stage of maintenance therapy were recommended to receive metabolic preparations that can inhibit collagen formation and improve parenchyma metabolic processes during the month—vitamin E 10% and l-carnitine in age-related doses. After 6 months, a study was made on the functional state of the renal parenchyma in the dynamics of treatment. After metabolic antihypoxic and membrane-protective therapy, there was a significant positive dynamic of all markers of tissue hypoxia and membrane destruction in the kidney parenchyma, which confirms the inhibition of collagen formation processes and a decrease in tissue hypoxia with vitamin E and l-carnitine in age-related doses. [ABSTRACT FROM AUTHOR]

Abstract Background The prognostic value of mixed venous oxygen tension (PvO2) at pulmonary hypertension diagnosis treated with selective pulmonary vasodilators remains unclear. This study sought to investigate the association of PvO2 with long-term prognosis in pulmonary arterial hypertension (PAH) and medically treated chronic thromboembolic pulmonary hypertension (CTEPH) and to identify the distinct mechanisms influencing tissue hypoxia in patients with CTEPH or PAH. Methods We retrospectively analyzed data from 138 (age: 50.2 ± 16.6 years, 81.9% women) and 268 (age: 57.4 ± 13.1 years, 72.8% women) patients with PAH and CTEPH, respectively, diagnosed at our institution from 1983 to 2018. We analyzed the survival rates of patients with/without tissue hypoxia (PvO2

Abstract Background A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a non-invasive tool to rapidly detect inadequate DO2 is of great clinical relevance. The respiratory exchange ratio (RER) can be easily measured in all intubated patients and has been shown to predict postoperative complications. We therefore aimed to assess the discriminative ability of the RER to detect an inadequate DO2 as reflected by hyperlactatemia in patients having intermediate-to-high risk abdominal surgery. Methods This historical cohort study included all consecutive patients who underwent intermediate-to-high risk surgery from January 1st, 2014, to April 30th, 2019 except those who did not have RER and/or arterial lactate measured. Blood lactate levels were measured routinely at the beginning and end of surgery and RER was calculated at the same moment as the blood gas sampling. The present study tested the hypothesis that RER measured at the end of surgery could detect hyperlactatemia at that time. A receiver operating characteristic (ROC) curve was constructed to assess if RER calculated at the end of the surgery could detect hyperlactatemia. The chosen RER threshold corresponded to the highest value of the sum of the specificity and the sensitivity (Youden Index). Results Among the 996 patients available in our study cohort, 941 were included and analyzed. The area under the ROC curve was 0.73 (95% CI: 0.70 to 0.76; p 1.5 mmol/L with a sensitivity of 87.5% and a specificity of 49.5%. Conclusion In mechanically ventilated patients undergoing intermediate to high-risk abdominal surgery, the RER had moderate discriminative abilities to detect hyperlactatemia. Increased values should prompt clinicians to investigate for the presence of hyperlactatemia and treat any potential causes of DO2/VO2 mismatch as suggested by the subsequent presence of hyperlactatemia.

Background: High ratio of the carbon dioxide veno-arterial difference to the oxygen arterial-venous difference (PvaCO2/CavO2) is associated with fluid bolus (FB) induced increase in oxygen consumption (VO2). This study investigated whether PvaCO2/CavO2 was associated with decreases in blood-lactate levels FB in critically ill patients with hyperlactatemia. Methods: This prospective observational study examined adult patients in the intensive care unit (ICU) with lactate levels > 1.5 mmol/L who received FBs. Blood-lactate levels were measured before and after FB under unchanged metabolic, respiratory, and hemodynamic conditions. The primary outcome was blood-lactate levels after FB. Significant decreases in blood-lactate levels were considered as blood-lactate levels < 1.5 mmol/L or a decrease of more than 10% compared to baseline. Results: The study enrolled 40 critically ill patients, and their median concentration of blood lactate was 2.6 [IQR:1.9 − 3.8] mmol/L. There were 27 (68%) patients with PvaCO2/CavO2 ≥ 1.4 mmHg/ml, and 10 of them had an increase in oxygen consumption (dVO2) ≥ 15% after FB, while 13 (32%) patients had PvaCO2/CavO2 < 1.4 mmHg/ml before FB, and none of them had dVO2 ≥ 15% after FB. FB increased the cardiac index in patients with high and low preinfusion PvaCO2/CavO2 (13.4% [IQR: 8.3 − 20.2] vs. 8.8% [IQR: 2.9 − 17.4], p = 0.34). Baseline PvaCO2/CavO2 was not found to be associated with a decrease in blood lactate after FB (OR: 0.88 [95% CI: 0.39 − 1.98], p = 0.76). A positive correlation was observed between changes in blood lactate and baseline PvaCO2/CavO2 (r = 0.35, p = 0.02). Conclusions: In critically ill patients with hyperlactatemia, PvaCO2/CavO2 before FB cannot be used to predict decreases in blood-lactate levels after FB. Increased PvaCO2/CavO2 is associated with less decrease in blood-lactate levels. [ABSTRACT FROM AUTHOR]

Background: Although blood transfusions can be lifesaving in severe hemorrhage, they can also have potential complications. As anemia has also been associated with poor outcomes in critically ill patients, determining an optimal transfusion trigger is a real challenge for clinicians. This is even more important in patients with acute brain injury who were not specifically evaluated in previous large randomized clinical trials. Neurological patients may be particularly sensitive to anemic brain hypoxia because of the exhausted cerebrovascular reserve, which adjusts cerebral blood flow to tissue oxygen demand. Methods: We described herein the methodology of a prospective, multicenter, randomized, pragmatic trial comparing two different strategies for red blood cell transfusion in patients with acute brain injury: a "liberal" strategy in which the aim is to maintain hemoglobin (Hb) concentrations greater than 9 g/dL and a "restrictive" approach in which the aim is to maintain Hb concentrations greater than 7 g/dL. The target population is patients suffering from traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH). The primary outcome is the unfavorable neurological outcome, evaluated using the extended Glasgow Outcome Scale (eGOS) of 1–5 at 180 days after the initial injury. Secondary outcomes include, among others, 28-day survival, intensive care unit (ICU) and hospital lengths of stay, the occurrence of extra-cerebral organ dysfunction/failure, and the development of any infection or thromboembolic events. The estimated sample size is 794 patients to demonstrate a reduction in the primary outcome from 50 to 39% between groups (397 patients in each arm). The study was initiated in 2016 in several ICUs and will be completed in December 2022. Discussion: This trial will assess the impact of a liberal versus conservative strategy of blood transfusion in a large cohort of critically ill patients with a primary acute brain injury. The results of this trial will help to improve blood product and transfusion use in this specific patient population and will provide additional data in some subgroups of patients at high risk of brain ischemia, such as those with intracranial hypertension or cerebral vasospasm. Trial registration: ClinicalTrials.gov NCT02968654. [ABSTRACT FROM AUTHOR]

The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients. [ABSTRACT FROM AUTHOR]

Background: During surgery, any mismatch between oxygen delivery (DO2) and consumption (VO2) can promote the development of postoperative complications. The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production (VCO2) to VO2, may be a useful noninvasive tool for detecting inadequate DO2. The primary objective of this study was to test the hypothesis that RER measured during liver transplantation may predict postoperative morbidity. Secondary objectives were to assess the ability of other variables used to assess the DO2/VO2 relationship, including arterial lactate, mixed venous oxygen saturation, and veno-arterial difference in the partial pressure of carbon dioxide (VAPCO2gap), to predict postoperative complications. Methods: This retrospective study included consecutive adult patients who underwent liver transplantation for end stage liver disease from June 27th, 2020, to September 5th, 2021. Patients with acute liver failure were excluded. All patients were routinely equipped with a pulmonary artery catheter. The primary analysis was a receiver operating characteristic (ROC) curve constructed to investigate the discriminative ability of the mean RER measured during surgery to predict postoperative complications. RER was calculated at five standardized time points during the surgery, at the same time as measurement of blood lactate levels and arterial and mixed venous blood gases, which were compared as a secondary analysis. Results: Of the 115 patients included, 57 developed at least one postoperative complication. The mean RER (median [25–75] percentiles) during surgery was significantly higher in patients with complications than in those without (1.04[0.96–1.12] vs 0.88[0.84–0.94]; p < 0.001). The area under the ROC curve was 0.87 (95%CI: 0.80–0.93; p < 0.001) with a RER value (Youden index) of 0.92 giving a sensitivity of 91% and a specificity of 74% for predicting the occurrence of postoperative complications. The RER outperformed all other measured variables assessing the DO2/VO2 relationship (arterial lactate, SvO2, and VAPCO2gap) in predicting postoperative complications. Conclusion: During liver transplantation, the RER can reliably predict postoperative complications. Implementing this measure intraoperatively may provide a warning for physicians of impending complications and justify more aggressive optimization of oxygen delivery. Further studies are required to determine whether correcting the RER is feasible and could reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

Anna Wo&zacute;niak,1 Irena Smó&lstrok;ka,2 Aleksandra Dusi&nacute;ska,3 Weronika Misi&aogon;g,3 Mariusz Chabowski4,5 1Department of Anaesthesiology and Intensive Care, 4th Military Teaching Hospital, Wroclaw, Poland; 2Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland; 3Student Research Group No. 180, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland; 4Department of Nursing and Obstetrics, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland; 5Department of Surgery, 4th Military Teaching Hospital, Wroclaw, PolandCorrespondence: Mariusz Chabowski, Tel +48 261 660 247, Fax +48 261 660 245, Email mariusz.chabowski@gmail.comIntroduction: Pressure ulcers are an important indicator of hospital care quality and a costly complication of intensive care. The incidence of PU is influenced by individual patient factors and the type of treatment used. Patients after surgery have been shown to have reduced albumin levels and elevated blood lactate levels. Increased lactate levels are associated with tissue hypoxia, increased morbidity and mortality.Aim: The aim of the study was to establish the relationship between the incidence of pressure ulcers and blood lactate levels in intensive care unit patients.Material and Methods: Our retrospective and non-randomized study was conducted among 125 patients treated at the Department of Anesthesiology of the 4th Military Teaching Hospital in Wroclaw between 2019 and 2020. The inclusion criteria were as follows: the use of intubation, analgosedation and vasopressors during intensive care treatment. The patients were divided into three main groups, which were each divided into two subgroups differing in blood lactate levels. We analyzed the patients’ lactate levels, as measured by arterial blood gas analysis, and monitored their pressure ulcers using their medical records: the pressure ulcer monitoring chart, the Waterlow pressure ulcer risk assessment chart, history of present illness and medical history.Results: Lactate levels in the patients studied ranged between 0.2 and 30.0 mmol/l. The incidence of pressure ulcers in ICU patients is 8.8%.Conclusion: The incidence of pressure ulcers in ICU patients is not different from the incidence rates reported in the literature. The study did not show a correlation between the patients’ arterial blood lactate levels and the incidence of pressure ulcers. Considering the low expected values due to the small number of patients in each subgroup, the findings should be treated with caution. Given the importance of pressure ulcers, a larger population study covering a longer period of time seems warranted.Keywords: pressure ulcers, lactate levels, intensive care unit, tissue hypoxia

Abstract The main objective of the study conducted here was to estimate the concentration of 2,3‐Bisphosphoglycerate (2,3‐BPG), 1,3‐Bisphosphoglycerate (1,3‐BPG), bisphospho‐glycerate mutase (BPGM) and 3‐phosphoglycerate (3PG) in cattle clinically diagnosed with acute ruminal acidosis. A secondary objective was to examine the physical and chemical characteristics of the ruminal fluid in affected cattle. A total of 20 cattle clinically diagnosed with acute ruminal acidosis and eight clinically normal cattle were included in this study. The results showed that decrease of ruminal pH changed the ruminal fluid colour, odour and consistency, as well as decreased the sedimentation time, increased the methylene blue reduction time, and decreased ruminal microflora motility. The study indicated that the concentration of 2,3‐BPG, BPGM and BPGP decreased with the decrease of ruminal pH, while 3‐PG concentration was not affected with the decrease of ruminal pH. In conclusion, 2,3‐BPG could play a role in the pathogenesis of ruminal acidosis, and thus, the intravenous administration of sodium bicarbonate is important, particularly in severe cases, to correct any systemic acidosis that can decrease 2,3‐BPG concentration and results in tissue hypoxia.

Background: The prognostic value of mixed venous oxygen tension (PvO2) at pulmonary hypertension diagnosis treated with selective pulmonary vasodilators remains unclear. This study sought to investigate the association of PvO2 with long-term prognosis in pulmonary arterial hypertension (PAH) and medically treated chronic thromboembolic pulmonary hypertension (CTEPH) and to identify the distinct mechanisms influencing tissue hypoxia in patients with CTEPH or PAH.Methods: We retrospectively analyzed data from 138 (age: 50.2 ± 16.6 years, 81.9% women) and 268 (age: 57.4 ± 13.1 years, 72.8% women) patients with PAH and CTEPH, respectively, diagnosed at our institution from 1983 to 2018. We analyzed the survival rates of patients with/without tissue hypoxia (PvO2 < 35 mmHg) and identified their prognostic factors based on the pulmonary hypertension risk stratification guidelines.Results: Survival was significantly poorer in patients with tissue hypoxia than in those without it for PAH (P = 0.001) and CTEPH (P = 0.017) treated with selective pulmonary vasodilators. In patients with PAH, PvO2 more strongly correlated with prognosis than other hemodynamic prognostic factors regardless of selective pulmonary vasodilators usage. PvO2 was the only significant prognostic factor in patients with CTEPH treated with pulmonary hypertension medication. Patients with CTEPH experiencing tissue hypoxia exhibited significantly poorer survival than those in the intervention group (P < 0.001). PvO2 more strongly correlated with the cardiac index (CI) than the alveolar-arterial oxygen gradient (A-aDO2) in PAH; whereas in CTEPH, PvO2 was more strongly correlated with A-aDO2 than with CI.Conclusions: PvO2 may represent a crucial prognostic factor for pulmonary hypertension. The prognostic impact of tissue hypoxia affects different aspects of PAH and CTEPH, thereby reflecting their distinct pathogenesis. [ABSTRACT FROM AUTHOR]

Background: A mismatch between oxygen delivery (DO2) and consumption (VO2) is associated with increased perioperative morbidity and mortality. Hyperlactatemia is often used as an early screening tool, but this non-continuous measurement requires intermittent arterial line sampling. Having a non-invasive tool to rapidly detect inadequate DO2 is of great clinical relevance. The respiratory exchange ratio (RER) can be easily measured in all intubated patients and has been shown to predict postoperative complications. We therefore aimed to assess the discriminative ability of the RER to detect an inadequate DO2 as reflected by hyperlactatemia in patients having intermediate-to-high risk abdominal surgery. Methods: This historical cohort study included all consecutive patients who underwent intermediate-to-high risk surgery from January 1st, 2014, to April 30th, 2019 except those who did not have RER and/or arterial lactate measured. Blood lactate levels were measured routinely at the beginning and end of surgery and RER was calculated at the same moment as the blood gas sampling. The present study tested the hypothesis that RER measured at the end of surgery could detect hyperlactatemia at that time. A receiver operating characteristic (ROC) curve was constructed to assess if RER calculated at the end of the surgery could detect hyperlactatemia. The chosen RER threshold corresponded to the highest value of the sum of the specificity and the sensitivity (Youden Index). Results: Among the 996 patients available in our study cohort, 941 were included and analyzed. The area under the ROC curve was 0.73 (95% CI: 0.70 to 0.76; p < 0.001), with a RER threshold of 0.75, allowing to discriminate a lactate > 1.5 mmol/L with a sensitivity of 87.5% and a specificity of 49.5%. Conclusion: In mechanically ventilated patients undergoing intermediate to high-risk abdominal surgery, the RER had moderate discriminative abilities to detect hyperlactatemia. Increased values should prompt clinicians to investigate for the presence of hyperlactatemia and treat any potential causes of DO2/VO2 mismatch as suggested by the subsequent presence of hyperlactatemia. [ABSTRACT FROM AUTHOR]

The present study aimed to assess the effect of tissue hypoxia induced by sodium cyanide (NaCN) on male mice fertility and the protective role of ethyl pyruvate (EP). A number of 30 adult mice were assigned to three groups: 1) a control group, 2) a treatment group treated with 2 mg/kg of NaCN, and 3) a treatment group treated with 2 mg/kg of NaCN, along with 40 mg/kg EP (NaCN+EP). After 35 days, animals were anesthetized and serum, sperm, and tissue samples were taken. The results demonstrated a significant decrease in sperm quality, reproduction potency, and anti-oxidant potential, as well as an increase in lipid peroxidation in the NaCN group (p

The aim of the study was to examine the clinical phenotypes of hypoxia in patients with COVID-19 in relation to the severity of acute respiratory failure (ARF).Material and methods. Sixty patients with severe COVID-19 and manifestations of acute respiratory failure admitted to the infectious disease hospitals of Nizhny Novgorod were enrolled in the study.The study included patients with transcutaneous saturation (SpO2) below 93% on spontaneous breathing, who required correction of respiratory alterations according to the Interim Clinical Guidelines for the Treatment of Patients with COVID-19. All patients were divided into 2 groups of 30 patients each according to the nature of respiratory impairment. Group 1 included patients without breathing difficulties who had respiratory rate up to 25 per minute. Group 2 patients had breathing difficulties and respiratory rate over 25 per minute.In addition to SpO2, severity of respiratory difficulties, respiratory rate (RR), forced breathing (FB), heart rate (HR), acid-base balance (ABB) and arterial and venous blood gases, capillary refill time, blood lactate level were assessed. The severity of lung involvement was determined using chest computed tomography, and severity of disease was assessed using the NEWS score. Respiratory treatment required for ARF correction and the outcome of hospitalization were also considered.Results. In group 1, the mean age was 66 (56; 67) years and the disease severity was 8 (7; 10) points. Group 1 patients had minor tachycardia and tachypnoea, there were no lactate elevation or prolonged capillary refill time. Mean SpO2 was as low as 86 (83; 89)%. Venous blood pH and pCO2 values were within normal reference intervals, mean BE was 6 (4; 9) mmol/l, pO2 was 42 (41; 44) mm Hg, and SO2 was 67 (65; 70)%. Mean arterial blood pO2 was 73 (69; 75) mm Hg, SO2 was 86 (83; 90)%, and O2 was 37 (35; 39) mm Hg. Oxygen therapy with the flow rate of 5-15 l/min in prone position helped correct ARF. All patients of this group were discharged from hospital.In group 2, the mean age was 76 (70;79) years and the disease severity was 14 (12; 18) points. Anxiety was observed in 15 patients, prolonged capillary refill time was seen in 13 patients, and increased lactate level in 18 patients. Mean RR was 34 (30; 37) per minute, HR was 110 (103; 121) per minute, and SpO2 was 76 (69; 83)%. Mean venous blood pH was 7.21 (7.18; 7.27), pCO2 was 69 (61; 77) mm Hg, BE was -5 (-7; 2) mmol/l, pO2 was 25 (22; 28) mm Hg, SO2 was 47 (43; 55)%. Mean arterial blood pO2 was 57 (50; 65) mm Hg, SO2 was 74 (69; 80)%, and pCO2 was 67 (58; 74) mm Hg. In the group 2 patients, the standard oxygen therapy in prone position failed to correct ARF, and high flow oxygen therapy, noninvasive CPAP with FiO2 of 50-90% or noninvasive CPAP+PS were administered. Fourteen patients were started on invasive lung ventilation. There were 10 fatal outcomes (33%) in this group.Conclusion. Two clinical phenotypes of hypoxia in patients with COVID-19 can be distinguished. The first pattern is characterized by reduced SpO2 (80-93%), no tachypnoea (RR >25 per minute) and moderate arterial hypoxemia without tissue hypoxia and acidosis («silent hypoxia»). It is typical for younger patients and associates with less lung damage and disease severity than in patients with severe ARF. Hypoxemia can be corrected by prone position and oxygen therapy and does not require switching to mechanical ventilation. The second pattern of hypoxia is characterized by significant arterial hypoxemia and hypercapnia with tissue hypoxia and acidosis. Its correction requires the use of noninvasive or invasive mechanical ventilation.

Aim: The aim of the present study was to comparison of blood gases, hematological and monitorization parameters in hypotensive and non-hypotensive calves with sepsis and also, determine the probably prognostic variables to prediction mortality. Materials and Methods: Twenty-two calves were met the criteria of sepsis were enrolled in the study. Hypotension was defined as presence of systolic blood pressure (SBP) Results: During study 7 (58%) hypotensive and 4 (40%) non-hypotensive calves died. Clinical findings showed that hypotensive calves had a lower body temperature, SBP and MAP than hypotensive calves. Glucose levels were significantly lower, and RBC and HCT levels were higher in hypotensive calves than non-hypotension calves. Venous pO2 and SO2 were lower and lactate was higher in non-survivor calves than survivor calves. The findings of receiver operating characteristic curve (ROC) showed the area under the curve (AUC) of 0.991 (p=0.000, 95% CI=0.962-1.000), sensitivity of 100% and a specificity of 99% for prediction of mortality at optimum cut off point of 6.7 mmol/L propound the lactate as best prognostic indicator. Conclusion: Mortality rate in hypotensive calves is higher than nonhypotensive calves. Our findings indicated that tissue hypoxia is the strongest determinant of mortality in septic calves. Blood lactate levels with sensitivity of 100% and specificity of %99 at cut-off point of 6.7 mmol/L is the best prognostic indicator to differentiate between survivor and non-survivor calves with sepsis.

Infection of humans with SARS‐CoV‐2 virus causes a disease known colloquially as "COVID‐19" with symptoms ranging from asymptomatic to severe pneumonia. Initial pathology is due to the virus binding to the ACE‐2 protein on endothelial cells lining blood vessels and entering these cells in order to replicate. Viral replication causes oxidative stress due to elevated levels of reactive oxygen species. Many (~60%) of the infected people appear to have eliminated the virus from their body after 28 days and resume normal activity. However, a significant proportion (~40%) experience a variety of symptoms (loss of smell and/or taste, fatigue, cough, aching pain, "brain fog," insomnia, shortness of breath, and tachycardia) after 12 weeks and are diagnosed with a syndrome named "LONG COVID." Longitudinal clinical studies in a group of subjects who were infected with SARS‐CoV‐2 have been compared to a non‐infected matched group of subjects. A cohort of infected subjects can be identified by a battery of cytokine markers to have persistent, low level grade of inflammation and often self‐report two or more troubling symptoms. There is no drug that will relieve their symptoms effectively. It is hypothesized that drugs that activate the intracellular transcription factor, nuclear factor erythroid‐derived 2‐like 2 (NRF2) may increase the expression of enzymes to synthesize the intracellular antioxidant, glutathione that will quench free radicals causing oxidative stress. The hormone melatonin has been identified as an activator of NRF2 and a relatively safe chemical for most people to ingest chronically. Thus, it is an option for consideration of re‐purposing studies in "LONG COVID" subjects experiencing insomnia, depression, fatigue, and "brain fog" but not tachycardia. Appropriately designed clinical trials are required to evaluate melatonin. [ABSTRACT FROM AUTHOR]

Introduction: The appropriate management of shock in paediatrics includes early recognition of tissue hypoxia and its timely intervention thus preventing shift to anaerobic metabolism, metabolic acidosis and cell death. Aim: To determine the effectiveness of blood lactate levels as a prognostic indicator of mortality in children with shock admitted to Paediatric Intensive Care Unit (PICU) and to To correlate between blood lactate levels and Paediatric Risk of Mortality III (PRISM III) scores. Materials and Methods: This was a prospective observational cross-sectional study conducted between January 2018 to May 2019 in the PICU of a tertiary care centre in rural India. A total of 144 children presenting with shock to PICU were included in the study. The serum lactate values were assessed at 0, 12 and 24 hours of admission. The various parameters of PRISM III scores was documented for each child at 0, 12 and 24 hours of admission and score was calculated. Lactate levels and PRISM III score were analysed using the Receiver Operating Characteristic (ROC) curve and optimal cut-off points were chosen for the calculation of sensitivity, specificity, positive and negative predictive values. An area under the ROC curve above 0.8 indicated fairly good prediction. Results: The most common aetiologies for shock in the present study included severe sepsis (42.3%), acute gastroenteritis (21.5%) and dengue fever (21.5%). Persistent hyperlactatemia was observed in non survivors and serum lactate values persistently greater than 4 mmol/L within the first 24 hours of admission were associated with greater risk of mortality. The area under the ROC curve for the serum lactate levels (0.958) suggested that it was a strong predictor of mortality in study subjects when compared to PRISM III score which had area under the ROC curve 0.866. Conclusion: Serum lactate values are an early useful predictor of mortality in children with shock and it is more feasible indicator when compared to PRISM III scores. [ABSTRACT FROM AUTHOR]

The SARS COVID-19 virus has arisen as a major hazard to mankind, posing harm to the whole world population. During the second COVID wave, mucormycosis has emerged as one of the deadliest and most devastating illnesses. Mucormycosis is strongly associated with diabetes, prolonged use of steroids, prolonged hospitalisation and immunocompromised states. Children have also been affected by this badly. Hyperbaric oxygen therapy is a non-invasive, cost-effective and painless therapy where 100% oxygen is given to patients under high atmospheric pressure in small tents or chambers. It helps in tissue regeneration and angiogenesis. Hyperbaric oxygen has proved to be effective in the treatment of oculo-rhino-cerebral mucormycosis. Various studies have proved its role in the management of mucormycosis and acute respiratory distress syndrome associated with COVID-19 infection. The advantages of hyperbaric oxygen are same in children as in adults with minimum side effects. Hyperbaric oxygen therapy can be one of the good adjunctive therapies in the management of mucormycosis. It is found to be safe in the treatment of COVID-19 infection, but data is still limited on its use and further studies are needed. This article is all about its use, its efficacy, and future perspectives in the management of mucormycosis and COVID-19 in view of the arrival of the third COVID wave in developing countries like India. [ABSTRACT FROM AUTHOR]

The history of the discovery of radioprotectors from the group of aminothiols and biogenic amines and of the formation of an idea about the mechanism of their action is presented. An analysis of the achievements of domestic scientists, radiation pharmacologists, and chemists is conducted. The role of the Institute of Aviation and Space Medicine, the Institute of Biophysics of the Ministry of Health, and Mendeleev Moscow Institute of Chemical Technology in the synthesis and development of an emergency radioprotector, B‑190 (indralin), is noted. The mechanism of pharmacological, radioprotective, and radiomitigative effect of indralin and its advantages over known radioprotectors are presented. The critical role of tissue hypoxia due to increased oxygen consumption against circulatory hypoxia under the action of α1-adrenomimetic radioprotector indralin in the implementation of its radioprotective properties in large animals (dogs and monkeys) is discussed. Radiomitigative effect of indralin occurs mainly through 5-H2 cherotonin receptors. [ABSTRACT FROM AUTHOR]

In the treatment of breast cancer, the neoadjuvant chemotherapy is vitally important and the evaluation of its effectiveness is crucial for determining the further therapy treatment, as well as the prognosis of the disease. This review provides current data of the physical, instrumental, morphological, molecular biology and genetics analysis used for the estimation of the neoadjuvant treatment effectiveness. Thus, review discusses the data concerning association of the disease peculiarities with the efficient therapeutic response to neoadjuvant chemotherapy including characteristics of patients (age, status of regional lymph nodes, presence of the lymphovascular invasion) and tumors (size, histological type, degree of differentiation, severity of the lymphoid tumor infiltration, molecular biological and genetic peculiarities). Particular attention is paid to such a promising predictive marker of the breast cancer response to chemotherapy as the level of tissue hypoxia. This section discusses the currently known mechanisms that might enable the effect of tissue hypoxia on the sensitivity of the tumor to drug treatment. The prospects for the use of a comprehensive analysis of predictive markers of the effectiveness of chemotherapeutic treatment are discussed.

Introduction: The appropriate management of shock in paediatrics includes early recognition of tissue hypoxia and its timely intervention thus preventing shift to anaerobic metabolism, metabolic acidosis and cell death. Aim: To determine the effectiveness of blood lactate levels as a prognostic indicator of mortality in children with shock admitted to Paediatric Intensive Care Unit (PICU) and to correlate between blood lactate levels and Paediatric Risk of Mortality III (PRISM III) scores. Materials and Methods: This was a prospective observational cross-sectional study conducted between January 2018 to May 2019 in the PICU of a tertiary care centre in rural India. A total of 144 children presenting with shock to PICU were included in the study. The serum lactate values were assessed at 0, 12 and 24 hours of admission. The various parameters of PRISM III scores was documented for each child at 0, 12 and 24 hours of admission and score was calculated. Lactate levels and PRISM III score were analysed using the Receiver Operating Characteristic (ROC) curve and optimal cut-off points were chosen for the calculation of sensitivity, specificity, positive and negative predictive values. An area under the ROC curve above 0.8 indicated fairly good prediction. Results: The most common aetiologies for shock in the present study included severe sepsis (42.3%), acute gastroenteritis (21.5%) and dengue fever (21.5%). Persistent hyperlactatemia was observed in non survivors and serum lactate values persistently greater than 4 mmol/L within the first 24 hours of admission were associated with greater risk of mortality. The area under the ROC curve for the serum lactate levels (0.958) suggested that, it was a strong predictor of mortality in study subjects when compared to PRISM III score which had area under the ROC curve 0.866. Conclusion: Serum lactate values are an early useful predictor of mortality in children with shock and it is more feasible indicator when compared to PRISM III scores.

The aim of review is to discuss the results of studies on diagnosis of tissue hypoxia by laser-induced spectroscopy, as well as to identify promising trends and prospects of this technique for its further application in experimental and clinical medicine.The review presents the findings of studies of the fluorescence intensity of endogenous fluorophore molecules (reduced nicotinamide adenine dinucleotide, oxidized flavin adenine dinucleotide) as markers of ischemic injury of internal organs (brain, heart, liver, kidneys, etc.). The principles of fluorescence laser-induced spectroscopy in vivo are discussed. The historical aspects of the subject are also covered. The results of the use of the technique in experimental and clinical studies of tissue hypoxia and ischemia are shown. Difficulties in interpreting the intensity values of autofluorescent signal of the studied molecules are revealed. It was noted that the tissue autofluorescence in a long-term anoxia remains unknown, and there are no structured ideas about the impact of exogenous and endogenous factors on autofluorescence intensity.In conclusion, the use of laser-induced fluorescence spectroscopy to diagnose tissue ischemia is a promising area of experimental and clinical medicine, which still has various unresolved issues, despite a large number of studies in this domain.

Objective: The response of different critical acute and hard-to-heal wounds to an innovative wound care modality—direct application of cold atmospheric plasma (CAP)—was investigated in this clinical case series. Method: Over an observation period of two years, acute wounds with at least one risk factor for chronification, as well as hard-to-heal wounds were treated for 180 seconds three times per week with CAP. CAP treatment was additional to standard wound care. Photographs were taken for wound documentation. The wound sizes before the first CAP treatment, after four weeks, after 12 weeks and at wound closure/end of observation time were determined using image processing software, and analysed longitudinally for the development of wound size. Results: A total of 27 wounds (19 hard-to-heal and eight acute wounds) with a mean wound area of 15cm2 and a mean wound age of 49 months were treated with CAP and analysed. All (100%) of the acute wounds and 68% of the hard-to-heal wounds healed after an average treatment duration of 14.2 weeks. At the end of the observation period, 21% of hard-to-heal wounds were not yet closed but were reduced in size by >80%. In 11% of the hard-to-heal wounds (n=2) therapy failed. Conclusion: The results suggested a beneficial effect of additional CAP therapy on wound healing. Declaration of interest: This work was carried out within the research projects 'Plasma for Life' (funding reference no. 13FH6I04IA) with financial support from the German Federal Ministry of Education and Research (BMBF). In the past seven years AFS has provided consulting services to Evonik and has received institutional support by Heraeus, Johnson & Johnson and Evonik. There are no royalties to disclose. The Department for Trauma Surgery, Orthopaedics and Plastic Surgery received charitable donations by CINOGY GmbH. CINOGY GmbH released the di_CAP devices and electrodes for the study. WV and AH were involved in the development of the used di_CAP device (Plasmaderm, CINOGY GmbH). WV is shareholder of the outsourced start-up company CINOGY GmbH. [ABSTRACT FROM AUTHOR]

Shock is the clinical syndrome that arises from inadequate cellular oxygen metabolism which can occur when there is either insufficient oxygen delivery or impaired oxygen utilization. As a clinical syndrome, shock is associated with significant morbidity and mortality particularly if there is a delay in recognition or initiation of treatment. There are multiple mechanisms that can result in a shocked state; often clinical examination is insufficient to differentiate between such mechanisms. Clinicians must instead rely on haemodynamic monitoring devices for both diagnosis and the targeting of therapies. In this article we review the basic principles of haemodynamics, the different aetiologies of shock and explore the various haemodynamic monitoring devices available to clinicians. [ABSTRACT FROM AUTHOR]

Indoxacarb is an oxadiazine insecticide, which is a sodium channel blocker in the nervous system of insects and causes mild tremors, cessation of feeding, and death in few hours. Here we describe a case of novaluron and indoxacarb poisoning in a suicide attempt. The patient presented with cyanosis with saturation - paO2 gapindicating methemoglobinemia and was treated with methylene blue and other supportive measures. [ABSTRACT FROM AUTHOR]

The main objective of the study conducted here was to estimate the concentration of 2,3‐Bisphosphoglycerate (2,3‐BPG), 1,3‐Bisphosphoglycerate (1,3‐BPG), bisphospho‐glycerate mutase (BPGM) and 3‐phosphoglycerate (3PG) in cattle clinically diagnosed with acute ruminal acidosis. A secondary objective was to examine the physical and chemical characteristics of the ruminal fluid in affected cattle. A total of 20 cattle clinically diagnosed with acute ruminal acidosis and eight clinically normal cattle were included in this study. The results showed that decrease of ruminal pH changed the ruminal fluid colour, odour and consistency, as well as decreased the sedimentation time, increased the methylene blue reduction time, and decreased ruminal microflora motility. The study indicated that the concentration of 2,3‐BPG, BPGM and BPGP decreased with the decrease of ruminal pH, while 3‐PG concentration was not affected with the decrease of ruminal pH. In conclusion, 2,3‐BPG could play a role in the pathogenesis of ruminal acidosis, and thus, the intravenous administration of sodium bicarbonate is important, particularly in severe cases, to correct any systemic acidosis that can decrease 2,3‐BPG concentration and results in tissue hypoxia. [ABSTRACT FROM AUTHOR]

Previous studies reported that cigarette smoking during radiation therapy was associated with unfavorable outcomes in various cancers using medical interviewing or monitoring of cotinine. Here, we evaluated the effect of smoking cessation on definitive radiation therapy for early stage glottic carcinoma by monitoring expiratory carbon monoxide (CO). We enrolled 103 patients with early glottic carcinoma (T1N0/T2N0 = 79/24) who underwent conventional radiotherapy between 2005 and 2016. The median age was 70 years. Pathologically, all patients had squamous cell carcinoma. Since 2009, we confirmed smoking cessation before radiation therapy by medical interviews. Since 2014, we measured expiratory CO to strictly monitor smoking cessation. The patients were divided according to diagnosis years: 'no cessation' (2005–2008), 'incomplete cessation' (2009–2013), and 'complete cessation' (2014–2016). We retrospectively analyzed the local recurrence rate and disease-free survival (DFS). The median follow-up period was 60.1 months (range, 1.9–110.0 months). The 2-year local recurrence rate in the 'complete cessation' group was 5.3% and tended to be lower than that in the 'incomplete cessation' group (13.7%) and 'no cessation' group (21.2%). Multivariate analysis revealed that 'no cessation' was a risk factor for DFS (hazard ratio [HR] = 4.25) and local recurrence rate (HR = 16.5, p <.05) compared to 'complete cessation.' We confirmed that the 'complete cessation' group had better prognosis than the 'no cessation' group by monitoring expiratory CO during radiation therapy for early stage glottic carcinoma. Moreover, monitoring expiratory CO was easier and more suitable than conventional methods for evaluating smoking cessation because it provided real-time measurements. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Razi Institute is the property of Institut Razi 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.)

Copyright of Eurasian Journal of Veterinary Sciences is the property of Eurasian Journal of Veterinary Sciences 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.)