Significado biológico y utilidad clínica del lactato en la sepsis / Biological significance and clinical utility of lactate in sepsis

La sepsis es un problema global de salud y la progresión hacia el shock séptico se asocia con un incremento marcado de la morbimortalidad. En este escenario, el aumento del lactato plasmático demostró ser un indicador de gravedad y un predictor de mortalidad, y suele interpretarse casi exclusivamente como marcador de baja perfusión tisular. Sin embargo, últimamente se produjo un cambio de paradigma en la exégesis del metabolismo y propiedades biológicas del lactato. En efecto, la adaptación metabólica al estrés, aun con adecuado aporte de oxígeno, puede justificar la elevación del lactato circulante. Asimismo, otras consecuencias fisiopatológicas de la sepsis, como la disfunción mitocondrial, se asocian con el desarrollo de hiperlactatemia sin que necesariamente se acompañen de baja perfusión tisular. Interpretar el origen y la función del lactato puede resultar de suma utilidad clínica en la sepsis, especialmente cuando sus niveles circulantes fundamentan las medidas de reanimación.

Sepsis is a global health problem; progression to septic shock is associated with a marked increase in morbidity and mortality. In this setting, increased plasma lactate levels demonstrated to be an indicator of severity and a predictor of mortality, and are usually interpreted almost exclusively as a marker of low tissue perfusion. However, a recent paradigm shift has occurred in the exegesis of lactate metabolism and its biological properties. Indeed, metabolic adaptation to stress, even with an adequate oxygen supply, may account for high circulating lactate levels. Likewise, other pathophysiological consequences of sepsis, such as mitochondrial dysfunction, are associated with the development of hyperlactatemia, which is not necessarily accompanied by low tissue perfusion. Interpreting the origin and function of lactate may be of great clinical utility in sepsis, especially when circulating lactate levels are the basis for resuscitative measures.

Short-chain fatty acids production by Bifidobacterium species in the presence of salep

BACKGROUND: Salep is obtained by grinding dried orchid tubers and used as a valuable ingredient in the food industry. Because of the glucomannan content of salep, it is thought to have prebiotic potential. However, there is little information in studies concerning the fermentation characteristics and potential prebiotic properties of salep. The objective of this study was to investigate the effect of salep on bifidobacterial growth by measuring the highest optical density (OD), calculating the specific growth rates, and determining the production of lactic acid and short-chain fatty acids (acetic, propionic, and butyric acid) as a result of bacterial fermentation. RESULT: The OD and pH values obtained in this study showed that salep was utilized as a source of assimilable carbon and energy by the Bifidobacterium species (BS). All Bifidobacterium strains produced lactic, acetic, propionic, and butyric acid, indicating that salep is readily fermented by these bacteria. Salep at 1% (w/v) showed a similar effect on bifidobacterial growth as that promoted by 1% (w/v) glucose used as a traditional carbon source. CONCLUSIONS: Bifidobacterium species can develop in media containing salep as well as in glucose and exhibit the potential to be used as new sources of prebiotics.

Sobrecarga de fluidos em pacientes com choque séptico e depuração de lactato como alvo terapêutico: um estudo de coorte retrospectiva / Fluid overload in patients with septic shock and lactate clearance as a therapeutic goal: a retrospective cohort study

RESUMO Objetivo: Avaliar se a sobrecarga de fluidos na terapia hídrica é fator prognóstico para pacientes com choque séptico quando ajustada para os alvos de depuração de lactato. Métodos: Este estudo envolveu uma coorte retrospectiva e foi conduzido em um hospital de cuidados nível IV localizado em Bogotá, na Colômbia. Foi organizada uma coorte de pacientes com choque séptico, e suas características e balanço hídrico foram documentados. Os pacientes foram estratificados por níveis de exposição segundo a magnitude da sobrecarga de fluidos por peso corporal após 24 horas de terapia. A mortalidade foi determinada aos 30 dias, e foi desenvolvido um modelo de regressão logística incondicional com ajuste para fatores de confusão. A significância estatística foi estabelecida com nível de p ≤ 0,05. Resultados: Foram 213 pacientes com choque séptico e, após o tratamento, 60,8% deles tiveram depuração de lactato acima de 50%. Dentre os pacientes 97 (46%) desenvolveram sobrecarga de fluidos ≥ 5%, e apenas 30 (13%) desenvolveram sobrecarga ≥ 10%. Pacientes com sobrecarga de fluidos ≥ 5% receberam, em média, 6.227mL de soluções cristaloides (DP ± 5.838mL) em 24 horas, enquanto os não expostos receberam 3.978mL (DP ± 3.728mL), com p = 0.000. Os pacientes que desenvolveram sobrecarga de fluidos foram mais frequentemente tratados com ventilação mecânica (70,7% versus 50,8%; p = 0,003), albumina (74,7% versus 55,2%; p = 0,003) e corticosteroides (53,5% versus 35,0%; p = 0,006) do que os que não desenvolveram sobrecarga de fluidos. Em análise multivariada, o balanço acumulado de fluidos não se associou com mortalidade (RC 1,03; IC95% 0,89 - 1,20). Conclusão: Após ajuste para severidade da condição e depuração adequada de lactato, a ocorrência de balanço hídrico positivo não se associou com aumento da mortalidade nessa coorte latino-americana de pacientes sépticos.

ABSTRACT Objective: To assess whether fluid overload in fluid therapy is a prognostic factor for patients with septic shock when adjusted for lactate clearance goals. Methods: This was a retrospective cohort study conducted at a level IV care hospital in Bogotá, Colombia. A cohort of patients with septic shock was assembled. Their characteristics and fluid balance were documented. The patients were stratified by exposure levels according to the magnitude of fluid overload by body weight after 24 hours of therapy. Mortality was determined at 30 days, and an unconditional logistic regression model was created, adjusting for confounders. The statistical significance was established at p ≤ 0.05. Results: There were 213 patients with septic shock, and 60.8% had a lactate clearance ≥ 50% after treatment. Ninety-seven (46%) patients developed fluid overload ≥ 5%, and only 30 (13%) developed overload ≥ 10%. Patients exhibiting fluid overload ≥ 5% received an average of 6227mL of crystalloids (SD ± 5838mL) in 24 hours, compared to 3978mL (SD ± 3728mL) among unexposed patients (p = 0.000). The patients who developed fluid overload were treated with mechanical ventilation (70.7% versus 50.8%) (p = 0.003), albumin (74.7% versus 55.2%) (p = 0.003) and corticosteroids (53.5% versus 35.0%) (p = 0.006) more frequently than those who did not develop fluid overload. In the multivariable analysis, cumulative fluid balance was not associated with mortality (OR 1.03; 95%CI 0.89 - 1.20). Conclusions: Adjusting for the severity of the condition and adequate lactate clearance, cumulative fluid balance was not associated with increased mortality in this Latin American cohort of septic patients.

Comparison of Lactic Acid Production by L. casei in Batch, Fed-batch and Continuous Cultivation, Testing the use of Feather Hydrolysate as a Complex Nitrogen Source

Abstract A comprehensive comparison of the main fermentation parameters, productivity, yield and final L-lactic acid concentration, obtained through batch, fed-batch and continuous cultivations using Lactobacillus casei CCDM 198 and a model cultivation medium was carried out. Using this data, a pulse-feed fed-batch process was established for testing chicken feather hydrolysate as a replacement for all complex nitrogen sources (yeast and beef extracts and peptone) in the medium. As comparably high values of productivity (about 4.0 g/L/h) and yield (about 98 %) were reached under all cultivation conditions, the maximum final L-lactic acid concentration (116.5 g/L), as achieved through pulse-feed fed-batch fermentation, was chosen as the most important criterion for process selection. Fed-batch cultivation with chicken feather hydrolysate as both a complex nitrogen source and a neutralizing agent for maintaining constant culture pH yielded half the concentration of L-lactic acid compared to the model medium. We demonstrate here that chicken feather hydrolysate has potential for use in the production of L-lactic acid but its utilization requires further optimization

Effect of hydroalcoholic extract of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on the viability and activity of microcosm biofilm and on enamel demineralization

Abstract Objectives: The aim of this study was to assess the effect of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves hydroalcoholic extracts on viability and metabolism of a microcosm biofilm and on enamel demineralization prevention. Methodology: Microcosm biofilm was produced on bovine enamel using inoculum from pooled human saliva mixed with McBain saliva, under 0.2% sucrose exposure, for 14 days. The biofilm was daily-treated with the extracts for 1 min. At the end, it was analyzed with respect to viability by fluorescence, CFU counting and extracellular polysaccharides (phenol-sulphuric acid colorimetric assay) and lactic acid (enzymatic assay) production. The demineralization was measured by TMR. The data were compared using ANOVA or Kruskal-Wallis (p<0.05). Results: M. urundeuva All. at 100, 10 and 0.1 μg/mL and Q. grandiflora Mart. at 100 and 0.1 μg/mL reduced biofilm viability similarly to positive control (chlorhexidine) and significantly more than the negative-vehicle control (35% ethanol). M. urundeuva at 1000, 100 and 0.1 μg/mL were able to reduce both lactobacilli and mutans streptococci CFU counting, while Q. grandiflora (1000 and 1.0 μg/mL) significantly reduced mutans streptococci CFU counting. On the other hand, the natural extracts were unable to significantly reduce extracellular polysaccharides and lactic acid productions neither the development of enamel carious lesions. Conclusions: The extracts showed antimicrobial properties on microcosm biofilm, however, they had no effect on biofilm metabolism and caries protection.

Effects of hypertonic saline vs normal saline on lactate clearance after cardiovascular surgery / Efectos del salino hipertónico versus el salino normal en la depuración de lactato después de cirugía cardiovascular

Abstract Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Introducción: El cuidado postoperatorio de pacientes sometidos a cirugía cardíaca requiere frecuentemente una reanimación completa con líquidos intravenosos, pero las soluciones cristaloides pueden incrementar el edema intersticial y la sobrecarga de líquidos incrementa la mortalidad. Objetivo: Comparar el efecto del salino hipertónico (SH) al 7.5% con respecto al salino normal (SN) del 0.9% en la depuración de lactato y la respuesta hemodinámica durante el primer día postoperatorio de pacientes con cirugía cardiovascular con circulación extracorpórea. Métodos: Pacientes mayores de 18 años con cirugía de arterias coronarias o de enfermedad valvular cardíaca fueron aleatorizados a recibir 4 ml/kg de SH o SN intravenosos en los primeros 30min de admisión a UCI. Se midieron los valores de lactato, estado ácido-base, frecuencia cardíaca, presión venosa central y presión en cuña pulmonar a las horas 0, 6, 12 y 24 después del ingreso a UCI. Se hizo un análisis con el principio de intención de tratar para un modelo de datos longitudinales. Resultados: Se evaluaron 494 pacientes y se aleatorizaron 102 a los grupos de SH (n = 51) o SN (n = 51). El promedio de edad fue 59 ± 14 años y el 59.8% fueron hombres. No se observó ninguna diferencia estadísticamente significativa entre los 2 grupos en la depuración de lactato o en cualquiera de los desenlaces secundarios. Conclusiones: Nuestro estudio no mostró mejor depuración de lactato con el uso de una dosis de SH ni mayor frecuencia de efectos adversos en ese grupo. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Lactate-upregulation of lactate oxidation complex-related genes is blunted in left ventricle of myocardial infarcted rats

Lactate modulates the expression of lactate oxidation complex (LOC)-related genes and cardiac blood flow under physiological conditions, but its modulatory role remains to be elucidated regarding pathological cardiac stress. The present study evaluated the effect of lactate on LOC-related genes expression and hemodynamics of hearts submitted to myocardial infarction (MI). Four weeks after MI or sham operation, isolated hearts of male Wistar rats were perfused for 60 min with Na+-lactate (20 mM). As expected, MI reduced cardiac contractility and relaxation with no changes in perfusion. The impaired cardiac hemodynamics were associated with increased reactive oxygen species (ROS) levels (Sham: 19.3±0.5 vs MI: 23.8±0.3 µM), NADPH oxidase (NOX) activity (Sham: 42.2±1.3 vs MI: 60.5±1.5 nmol·h−1·mg−1) and monocarboxylate transporter 1 (mct1) mRNA levels (Sham: 1.0±0.06 vs MI: 1.7±0.2 a.u.), but no changes in superoxide dismutase (SOD), catalase, NADH oxidase (NADox), and xanthine oxidase activities. Lactate perfusion in MI hearts had no additional effect on ROS levels, NADox, and NOX activity, however, it partially reduced mct1 mRNA expression (MI-Lactate 1.3±0.08 a.u.). Interestingly, lactate significantly decreased SOD (MI-Lactate: 54.5±4.2 µmol·mg−1·min−1) and catalase (MI: 1.1±0.1 nmol·mg−1·min−1) activities in MI. Collectively, our data suggest that under pathological stress, lactate lacks its ability to modulate the expression of cardiac LOC-related genes and the perfused pressure in hearts submitted to chronic MI. Together, these data contribute to elucidate the mechanisms involved in the pathogenesis of heart failure induced by MI.

Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.

Bioconversion of waste cooking oil glycerol from cabbage extract to lactic acid by Rhizopus microsporus

Abstract Glycerol from spent oil was processed by transesterification for biodiesel production. Although glycerol contains many types of impurities, it can be used as a C-source for lactic acid production by fungi, such as Rhizopus microsporus. In this study, we found that wild type R. microsporus (LTH23) produced more lactic acid than the mutant strains on cabbage glycerol media (CG media). More lactic acid was produced on CG media than on cabbage extract media (C media) by about two-fold in batch fermentation conditions. In addition, we found that lactic acid production in a fed-batch process was also slightly higher than in a batch process. To study the combined effects of pH, urea, and glycerol waste concentration on lactic acid production, a response surface methodology was used. The optimum pH, urea, and glycerol waste concentrations were pH 6.5, 3.75 g/L, and 17 g/L, respectively. The maximum lactic acid production predicted by this equation model was 4.03 g/L.

Evaluation of anaerobic threshold in non-pregnant and pregnant rats

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

Whole genome sequence of lactic acid bacterium Pediococcus acidilactici strain S1

Abstract Pediococcus acidilactici strain S1, a lactic acid-fermenting bacterium, was isolated from makgeolli-a Korean traditional fermented alcoholic beverage. Here we report the 1,980,172 bp (G + C content, 42%) genome sequence of Pediococcus acidilactici strain S1 with 1,525 protein-coding sequences (CDS), of which 47% could be assigned to recognized functional genes. The genome sequence of the strain S1 might provide insights into the genetic basis of the lactic acid bacterium with alcohol-tolerant.

Growth kinetic models of five species of Lactobacilli and lactose consumption in batch submerged culture

Abstract Kinetic behaviors of five Lactobacillus strains were investigated with Contois and Exponential models. Awareness of kinetic behavior of microorganisms is essential for their industrial process design and scale up. The consistency of experimental data was evaluated using Excel software. L. bulgaricus was introduced as the most efficient strain with the highest biomass and lactic acid yield of 0.119 and 0.602 g g-1 consumed lactose, respectively. The biomass and carbohydrate yield of L. fermentum and L. lactis were slightly less and close to L. bulgaricus. Biomass and lactic acid production yield of 0.117 and 0.358 for L. fermentum and 0.114 and 0.437 g g-1 for L.actobacillus lactis were obtained. L. casei and L. delbrueckii had the less biomass yield, nearly 11.8 and 22.7% less than L. bulgaricus, respectively. L. bulgaricus (R 2 = 0.9500 and 0.9156) and L. casei (R 2 = 0.9552 and 0.8401) showed acceptable consistency with both models. The investigation revealed that the above mentioned models are not suitable to describe the kinetic behavior of L. fermentum (R 2 = 0.9367 and 0.6991), L. delbrueckii (R 2 = 0.9493 and 0.7724) and L. lactis (R 2 = 0.8730 and 0.6451). Contois rate equation is a suitable model to describe the kinetic of Lactobacilli. Specific cell growth rate for L. bulgaricus, L. casei, L. fermentum, L. delbrueckii and L. lactis with Contois model in order 3.2, 3.9, 67.6, 10.4 and 9.8-fold of Exponential model.

Enzymatic saccharification and fermentation of cellulosic date palm wastes to glucose and lactic acid

Abstract The bioconversion of cellulosic wastes into high-value bio-products by saccharification and fermentation processes is an important step that can reduce the environmental pollution caused by agricultural wastes. In this study, enzymatic saccharification of treated and untreated date palm cellulosic wastes by the cellulases from Geobacillus stearothermophilus was optimized. The alkaline pre-treatment of the date palm wastes was found to be effective in increasing the saccharification percentage. The maximum rate of saccharification was found at a substrate concentration of 4% and enzyme concentration of 30 FPU/g of substrate. The optimum pH and temperature for the bioconversions were 5.0 and 50 °C, respectively, after 24 h of incubation, with a yield of 31.56 mg/mL of glucose at a saccharification degree of 71.03%. The saccharification was increased to 94.88% by removal of the hydrolysate after 24 h by using a two-step hydrolysis. Significant lactic acid production (27.8 mg/mL) was obtained by separate saccharification and fermentation after 72 h of incubation. The results indicate that production of fermentable sugar and lactic acid is feasible and may reduce environmental pollution by using date palm wastes as a cheap substrate.

Efeito do eugenol como agente mitigador do estresse no transporte de juvenis de tilápia do Nilo / Eugenol effect as a mitigate agent of stress in transport of Nile tilapia juveniles

O Brasil se destaca no cenário americano como um dos países com maior potencial para a piscicultura, principalmente a dulcícola. A tilápia do Nilo (Oreochromis niloticus) se destaca sendo a espécie mais cultivada em nosso país. Metodologias para diminuir a interferência de agentes estressores nas funções vitais e fisiológicas dos peixes são importantes durante o manejo. O presente trabalho teve como objetivo avaliar o efeito do eugenol nas respostas metabólicas e iônicas de juvenis de tilápia do Nilo, submetidos ao transporte em sacos plásticos, em diferentes densidades, a fim de verificar a eficiência do produto como agente mitigador do estresse. O eugenol foi utilizado na concentração de 15mg/L em água. As densidades avaliadas foram 4, 7 e 10 peixes L-1, equivalente a 140, 245 e 350g L-1. Após quatro horas de transporte foram avaliados os parâmetros metabólicos (glicose e lactato) e iônicos (cloreto, magnésio e cálcio), bem como a qualidade da água nos sacos plásticos. Em relação aos dois parâmetros metabólicos, o uso do eugenol com o intuito de diminuir as respostas do estresse não foi satisfatório. Houve elevação no nível de glicose nas densidades 140 e 350g L-1 imediatamente ao término do transporte, e o teor de lactato dos peixes na densidade 245g L-1 aumentou 24 horas depois, indicando que os animais não conseguiram manter a homeostase inicial. Dentre as concentrações de íons avaliados, o magnésio foi o que sofreu maior variação. Podemos concluir que a adição de 15mg L-1 de eugenol na água durante o transporte de juvenis de tilápia do Nilo nas densidades de 140, 245 e 350g L-1 não foi capaz de minimizar as respostas ao estresse...

Brazil stands out in the American scene as one of the countries with the greatest potential for fish farming mainly in fresh water. Nile tilapia (Oreochromis niloticus) stands out being the most cultivated fish species in our country. Methodologies to reduce the interference of stressors agents in vital and physiological functions of fishes are important during handling. This study aimed to evaluate the effect of eugenol in the metabolic and ionic responses of juvenile Nile tilapia, submitted to transport in plastic bags, at different densities in order to verify the efficiency of the product as an mitigate agent of stress. Eugenol was used at a concentration of 15mg L-1 in water. The evaluated densities were 4, 7 and 10 fish L-1, which were equivalent to 140, 245 and 350g L-1. After four hours of transport the metabolic (glucose and lactate) and ions parameters (chloride, magnesium and calcium) were evaluated, as well as the water quality in the plastic bags. For the two metabolic parameters, the use of the eugenol in order to reduce the stress response was not satisfactory. There was an increase in blood glucose level at the densities of 140 and 350g L-1 immediately after termination of the transport, and the level of fish lactate content at the density of 245g L-1 had increased after 24 hours indicating that the animals could not maintain the initial homeostasis. Among the concentrations of the evaluated ions magnesium suffered the greater variation. We can conclude that the addition of 15 mg L-1 of eugenol in the water during the transport of juvenile Nile tilapia at densities of 140, 245 and 350g L-1 was not able to minimize stress responses...

Current concepts on hemodynamic support and therapy in septic shock / Conceitos atuais sobre suporte hemodinâmico e terapia em choque séptico

ABSTRACTSevere sepsis and septic shock represent a major healthcare challenge. Much of the improvement in mortality associated with septic shock is related to early recognition combined with timely fluid resuscitation and adequate antibiotics administration. The main goals of septic shock resuscitation include intravascular replenishment, maintenance of adequate perfusion pressure and oxygen delivery to tissues. To achieve those goals, fluid responsiveness evaluation and complementary interventions - i.e. vasopressors, inotropes and blood transfusion - may be necessary. This article is a literature review of the available evidence on the initial hemodynamic support of the septic shock patients presenting to the emergency room or to the intensive care unit and the main interventions available to reach those targets, focusing on fluid and vasopressor therapy, blood transfusion and inotrope administration.

RESUMOA sepse grave e o choque séptico são um grande desafio para a assistência médica. Grande parte da melhoria na taxa de mortalidade associada ao choque séptico está relacionada ao reconhecimento precoce em combinação com a reposição volêmica oportuna e a administração adequada de antibióticos. Os principais objetivos da reanimação do choque séptico incluem reposição intravascular, manutenção adequada da pressão de perfusão e fornecimento de oxigênio para os tecidos. Para atingir esses objetivos, a avaliação da responsividade do volume e das intervenções complementares (vasopressores, inotrópicos e transfusão de sangue) pode ser necessária. Este artigo é uma revisão da literatura para identificar as evidências disponíveis do suporte hemodinâmico inicial aos pacientes com choque séptico admitidos em sala de emergência ou unidade de terapia intensiva e as principais intervenções disponíveis para atingir essas metas, com foco em terapia com reposição de líquidos e vasopressores, transfusão de sangue e administração de inotrópicos.

The use of date waste for lactic acid production by a fed-batch culture using Lactobacillus casei subsp. rhamnosus

The production of lactic acid from date juice by Lactobacillus caseisubsp. rhamnosus in batch and fed-batch cultures has been investigated. The fed-batch culture system gave better results for lactic acid production and volumetric productivity. The aim of this work is to determine the effects of the feeding rate and the concentration of the feeding medium containing date juice glucose on the cell growth, the consumption of glucose and the lactic acid production by Lactobacillus casei subsp. rhamnosus in fed-batch cultures. For this study, two concentrations of the feeding medium (62 and 100 g/L of date juice glucose) were tested at different feeding rates (18, 22, 33, 75 and 150 mL/h). The highest volumetric productivity (1.3 g/L.h) and lactic acid yield (1.7 g/g) were obtained at a feeding rate of 33 mL/h and a date juice glucose concentration of 62 g/L in the feeding medium. As a result, most of the date juice glucose was completely utilised (residual glucose 1 g/L), and a maximum lactic acid production level (89.2 g/L) was obtained.

How to choose the therapeutic goals to improve tissue perfusion in septic shock / Como escolher os alvos terapêuticos para melhorar a perfusão tecidual no choque séptico

The early recognition and treatment of severe sepsis and septic shock is the key to a successful outcome. The longer the delay in starting treatment, the worse the prognosis due to persistent tissue hypoperfusion and consequent development and worsening of organ dysfunction. One of the main mechanisms responsible for the development of cellular dysfunction is tissue hypoxia. The adjustments necessary for adequate tissue blood flow and therefore of oxygen supply to metabolic demand according to the assessment of the cardiac index and oxygen extraction rate should be performed during resuscitation period, especially in high complexity patients. New technologies, easily handled at the bedside, and new studies that directly assess the impact of macro-hemodynamic parameter optimization on microcirculation and in the clinical outcome of septic patients, are needed.

O reconhecimento e o tratamento precoce da sepse grave e do choque séptico é a chave para o sucesso terapêutico. Quanto maior o atraso no início do tratamento, pior é o prognóstico, em decorrência da hipoperfusão tecidual persistente, e do consequente desenvolvimento e agravamento das disfunções orgânicas. Um dos principais mecanismos responsáveis pelo desenvolvimento da disfunção celular é a hipóxia. A adequação do fluxo sanguíneo tecidual e, consequentemente, da oferta de oxigênio à demanda metabólica, de acordo com a avaliação do índice cardíaco e da taxa de extração de oxigênio, deve ser realizada durante a ressuscitação, principalmente nos pacientes de alta complexidade. Novas tecnologias, de fácil manuseio à beira do leito, e novos estudos, que avaliem diretamente o impacto da otimização dos parâmetros macro-hemodinâmicos na microcirculação e no desfecho clínico dos pacientes sépticos, são necessários.

Reducing lactate secretion by ldhA Deletion in L-glutamate- producing strain Corynebacterium glutamicum GDK-9

L-lactate is one of main byproducts excreted in to the fermentation medium. To improve L-glutamate production and reduce L-lactate accumulation, L-lactate dehydrogenase-encoding gene ldhA was knocked out from L-glutamate producing strain Corynebacterium glutamicum GDK-9, designated GDK-9ΔldhA. GDK-9ΔldhA produced approximately 10.1% more L-glutamate than the GDK-9, and yielded lower levels of such by-products as α-ketoglutarate, L-lactate and L-alanine. Since dissolved oxygen (DO) is one of main factors affecting L-lactate formation during L-glutamate fermentation, we investigated the effect of ldhA deletion from GDK-9 under different DO conditions. Under both oxygen-deficient and high oxygen conditions, L-glutamate production by GDK-9ΔldhA was not higher than that of the GDK-9. However, under micro-aerobic conditions, GDK-9ΔldhA exhibited 11.61% higher L-glutamate and 58.50% lower L-alanine production than GDK-9. Taken together, it is demonstrated that deletion of ldhA can enhance L-glutamate production and lower the unwanted by-products concentration, especially under micro-aerobic conditions.

Effects of sciatic nerve transection on glucose uptake in the presence and absence of lactate in the frog dorsal root ganglia and spinal cord / Efeito da secção do nervo isquiático sobre a captação de glicose na presença e ausência de lactato em gânglio da raiz dorsal e medula espinhal de rãs

Frogs have been used as an alternative model to study pain mechanisms because the simplicity of their nervous tissue and the phylogenetic aspect of this question. One of these models is the sciatic nerve transection (SNT), which mimics the clinical symptoms of “phantom limb”, a condition that arises in humans after amputation or transverse spinal lesions. In mammals, the SNT increases glucose metabolism in the central nervous system, and the lactate generated appears to serve as an energy source for nerve cells. An answerable question is whether there is elevated glucose uptake in the dorsal root ganglia (DRG) after peripheral axotomy. As glucose is the major energy substrate for frog nervous tissue, and these animals accumulate lactic acid under some conditions, bullfrogs Lithobates catesbeianus were used to demonstrate the effect of SNT on DRG and spinal cord 1-[14C] 2-deoxy-D-glucose (14C-2-DG) uptake in the presence and absence of lactate. We also investigated the effect of this condition on the formation of 14CO2 from 14C-glucose and 14C-L-lactate, and plasmatic glucose and lactate levels. The 3-O-[14C] methyl-D-glucose (14C-3-OMG) uptake was used to demonstrate the steady-state tissue/medium glucose distribution ratio under these conditions. Three days after SNT, 14C-2-DG uptake increased, but 14C-3-OMG uptake remained steady. The increase in 14C-2-DG uptake was lower when lactate was added to the incubation medium. No change was found in glucose and lactate oxidation after SNT, but lactate and glucose levels in the blood were reduced. Thus, our results showed that SNT increased the glucose metabolism in the frog DRG and spinal cord. The effect of lactate on this uptake suggests that glucose is used in glycolytic pathways after SNT.

As rãs são usadas como modelos experimentais alternativos no estudo da nocicepção, tanto pela simplicidade do seu tecido nervoso como por permitirem uma abordagem filogenética sobre o tema. Um desses modelos é a secção do nervo isquiático (SNI), o qual simula os sintomas clínicos do “membro fantasma”, uma condição que ocorre nos humanos após amputação ou secção completa da medula espinal. Em mamíferos, a SNI aumenta o metabolismo da glicose no sistema nervoso central, e o lactato é uma fonte energética para as células nervosas. Porém é desconhecido se essa é a situação em gânglio da raiz dorsal (GRD). Como a glicose é o principal substrato energético para o tecido nervoso de rãs, e a concentração plasmática de lactato está aumentada nesses animais em distintas situações, a rã-touro Lithobates catesbeianus foi usada para demonstrar os efeitos da SNI sobre a captação de 1-[14C] 2-deoxi-D-glicose (14C-2-DG), na presença e ausência de lactato, em GRD e medula espinal. Foram demonstrados ainda os efeitos dessa condição experimental sobre a formação de 14CO2 a partir de 14C-glicose e 14C-L-lactato, e a concentração plasmática de glicose e lactato. A captação de 3-O-[14C] metil-D-glicose (14C-3-OMG) foi usada para demonstrar a relação tecido/meio estável da glicose nessas condições. A captação de 14C-2-DG aumentou três dias após a SNI, sem qualquer alteração na captação de 14C-3-OMG. O aumento foi reduzido quando o lactato foi acrescentado ao meio de incubação. A taxa de oxidação da glicose e do lactato não modificou após SNI, mas houve redução na concentração plasmática de glicose e lactato. Assim, a SNI aumenta o metabolismo da glicose no GRD e medula espinal de rãs. Os efeitos do lactato sobre essa captação sugerem o uso da glicose na via glicolítica após a SNI.