Accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying acidemia at birth by umbilical cord blood gasometry in high-risk pregnancies. METHODS: This was a retrospective cohort study of singleton high-risk parturients using intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by the analysis of umbilical cord arterial blood pH (<7.1). Associations between variables were determined using the chi-square test and Kruskal-Wallis tests. RESULTS: We included 105 cases of cardiotocography category I, 20 cases of cardiotocography category II, and 10 cases of cardiotocography category III. cardiotocography category III had a higher prevalence of cesarean sections compared to cardiotocography category I (90.0 vs. 42.9%, p<0.006). Venous pH was higher in patients with cardiotocography category I compared to cardiotocography category III (7.32 vs. 7.23, p=0.036). Prevalence of neonatal intensive care unit (NICU) admission was lower in neonates of patients with cardiotocography category I compared to cardiotocography category III (3.8 vs. 30.0%, p=0.014). Prevalence of composite adverse outcomes was lower in neonates of patients with cardiotocography category I compared to cardiotocography category II (9.5 vs. 30.0%, p=0.022) and cardiotocography category III (9.5 vs. 60.0%, p=0.0004). cardiotocography categories II and III had low sensitivity (0.05 and 0.00, respectively) and high negative predictive value (NPV) (0.84 and 0.91, respectively) for identifying fetal acidemia at birth. The three categories of intrapartum cardiotocography showed high specificities (96.0, 99.0, and 99.0%, respectively). CONCLUSION: All three categories of intrapartum cardiotocography showed low sensitivity and high specificity for identifying acidemia at birth.

Accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies

SUMMARY OBJECTIVE: The aim of this study was to evaluate the accuracy of intrapartum cardiotocography in identifying fetal acidemia by umbilical cord blood analysis in low-risk pregnancies. METHODS: This is a retrospective cohort study of low-risk singleton pregnancies in labor after performing intrapartum cardiotocography categories I, II, and III. The presence of fetal acidemia at birth was identified by analyzing the pH of umbilical cord arterial blood (pH<7.1). RESULTS: No significant effect of the cardiotocography category on the arterial (p=0.543) and venous (p=0.770) pH of umbilical cord blood was observed. No significant association was observed between the cardiotocography category and the presence of fetal acidemia (p=0.706), 1-min Apgar score <7 (p=0.260), hospitalization in the neonatal intensive care unit (p=0.605), newborn death within the first 48 h, need for neonatal resuscitation (p=0.637), and adverse perinatal outcomes (p=0.373). Sensitivities of 62, 31, and 6.0%; positive predictive values of 11.0, 16.0, and 10.0%; and negative predictive values of 85, 89.0, and 87.0% were observed for cardiotocography categories I, II, and III, respectively. CONCLUSION: The three categories of intrapartum cardiotocography presented low sensitivities and high negative predictive values to identify fetal acidemia at birth in low-risk pregnancies.

Perioperative central venous oxygen saturation and its correlation with mortality during cardiac surgery: an observational prospective study / Correlação entre saturação venosa central de oxigênio perioperatória e mortalidade em cirurgia cardíaca: estudo prospectivo observacional

Abstract Background: Cardiac surgery can produce persistent deficit in the ratio of Oxygen Delivery (DO2) to Oxygen Consumption (VO2). Central venous oxygen Saturation (ScvO2) is an accessible and indirect measure of DO2/VO2 ratio. Objective: To monitor perioperative ScvO2 and assess its correlation with mortality during cardiac surgery. Methods: This prospective observational study evaluated 273 patients undergoing cardiac surgery. Blood gas samples were collected to measure ScvO2 at three time points: T0 (after anesthetic induction), T1 (end of surgery), and T2 (24 hours after surgery). The patients were divided into two groups (survivors and nonsurvivors). The following outcomes were analyzed: intrahospital mortality, length of Intensive Care Unit (ICU) and hospital stay (LOS), and variation in ScvO2. Results: Of the 273 patients, 251 (92%) survived and 22 (8%) did not. There was a significant perioperative reduction of ScvO2 in both survivors (T0 = 78% ± 8.1%, T1 = 75.4% ± 7.5%, and T2 = 68.5% ± 9%; p< 0.001) and nonsurvivors (T0 = 74.4% ± 8.7%, T1 = 75.4% ± 7.7%, and T2 = 66.7% ± 13.1%; p < 0.001). At T0, the percentage of patients with ScvO2< 70% was greater in the nonsurvivor group (31.8% vs. 13.1%; p= 0.046) and the multiple logistic regression showed that ScvO2 is an independent risk factor associated with death, OR = 2.94 (95% CI 1.10−7.89) (p= 0.032). The length of ICU and LOS were 3.6 ± 3.1 and 7.4 ± 6.0 days respectively and was not significantly associated with ScvO2. Conclusions: Early intraoperative ScvO2 < 70% indicated a higher risk of death. A perioperative reduction of ScvO2 was observed in patients undergoing cardiac surgery, with high intraoperative and lower postoperative levels.

Resumo Justificativa: A cirurgia cardíaca pode produzir déficit persistente na razão entre oferta de oxigênio (DO2) e consumo de oxigênio (VO2). A Saturação venosa central de Oxigênio (SvcO2) é uma medida acessível e indireta da razão DO2/VO2. Objetivo: Monitorar a SvcO2 perioperatória e avaliar sua correlação com a mortalidade em cirurgia cardíaca. Método: Este estudo observacional prospectivo avaliou 273 pacientes submetidos a cirurgia cardíaca. Coletamos amostras de sangue para medir a SvcO2 em três momentos: T0 (após indução anestésica), T1 (final da cirurgia) e T2 (24 horas após a cirurgia). Os pacientes foram divididos em dois grupos (sobreviventes e não sobreviventes). Os seguintes desfechos foram analisados: mortalidade intra-hospitalar, tempo de permanência na Unidade de Terapia Intensiva (UTI) e de internação hospitalar, e variação na SvcO2. Resultados: Dos 273 pacientes, 251 (92%) sobreviveram e 22 (8%) não. Houve queda significante da SvcO2 perioperatória nos sobreviventes (T0 = 78% ± 8,1%, T1 = 75,4% ± 7,5% e T2 = 68,5% ± 9%; p< 0,001) e nos não sobreviventes (T0 = 74,4% ± 8,7%, T1 = 75,4% ± 7,7% e T2 = 66,7% ± 13,1%; p< 0,001). No T0, a porcentagem de pacientes com SvcO2< 70% foi maior no grupo não sobrevivente (31,8% vs. 13,1%; p = 0,046) e a regressão logística múltipla mostrou que a SvcO2 é um fator de risco independente associado ao óbito, OR = 2,94 (95% IC 1,10 − 7,89) (p = 0,032). O tempo de permanência na UTI e de hospitalização foi de 3,6 ± 3,1 e 7,4 ± 6,0 dias, respectivamente, e não foi significantemente associado à SvcO2. Conclusões: Valores precoces de SvcO2 intraoperatória < 70% indicaram maior risco de óbito em pacientes submetidos à cirurgia cardíaca. Observamos redução perioperatória da SvcO2, com altos níveis no intraoperatório e mais baixos no pós-operatório.

Effect and mechanism of Huanglianjiedu decoction on high fat-induced atherosclerosisrats and metabolomics study by ultra-performance liquid chromatography-mass spectrometry / 中国药理学与毒理学杂志

OBJECTIVE To explore the biomarkers and molecular mechanism of Huanglianjiedu decoction (HJD) on high fat diet-induced experimental atherosclerosis in rats. METHODS SD male rats were randomly dividedinto five groups(n=8):normal control group,model group,and three dosage groups (1.5, 3 and 6 g crude drug per kilogram of body weight). Atherosclerosis was induced by the combination of regular intraperitoneal injection of vitamin D3and high fat diet for 8 weeks. HJD was administered by oral gavage from the third week once per day and until the end of the study.After the final administration, the blood samples were collected for biochemical analyses [total cholesterol (TC), triglycerides (TG), highdensity lipoprotein (HDL-C), low-density cholesterol (LDL-C)] and blood gas analyses(PaO2, PaCO2, pH, ctHb, etc); the abdominal aorta sections were stained with hematoxylin and eosin for histopathology; the liver homogenate were determined for MDA, SOD, OX-LDL, MCP-1 and VCAM-1.The plasma samples were detected using ultraper formance liquid chromatography coupled with quadrupole-time-of-flight tandem mass spectrometry(UPLC-Q-TOF-MS).The data of endogenous compounds were preliminarily preprocessed by software Progenesis QI and then analyzed by multivari-ate statistical analysis software EZinfo 2.0 to screen the distinguished biomarkers and the metabolic pathways were analyzed through website http://www.metaboanalyst.ca/. RESULTS Compared with the normal control group,the content of TC,TG,LDL-C,PaCO2,MDA,Ox-LDL,MCP-1 and VCAM-1were significantly increased and HDL-C, PaO2, ctHb and SOD decreased in the atherosclerosis rats. HJD could significantly attenuated the high fat-induced atherosclerosis pathological injury and the above-mentioned indexes (P<0.05). The five groups could be clearly distinguished using the metabolomics method.The administration groups profile exhibited an apparent returning trend from that of the model group and that of the normal control group.Twenty-one endogenous metabolites has been significantly changed in atherosclerosis rats.HJD could remarkably up-regulate 5-L-glutamyl-taurine,L-beta-aspartyl-L-glutamic acid, histidinyl-hydroxyproline, tryptophyl-alanine, 4′-O-methyl-(-)-epicatechin, and down-regulate protoporphyrin IX,azelaic acid,lacto-N-triaose,cinnamoylglycine and 9′-carboxy-alpha-tocotri-enol. CONCLUSION The beneficial effect of HJD in high fat-induced atherosclerosis rats may be due to anti-oxidant and anti-inflammatory. And it is suggested that HJD may affect the model rats through tryptophan metabolism, taurine and hypotaurine metabolism, histidine metabolism, lysine degradation and porphyrin and chlorophyll metabolism pathway.

Hemogasometria de eqüinos submetidos à obstrução experimental do duodeno, íleo e cólon maior / Blood gas analysis of horses submitted to experimental obstruction of duodenum, ileum and large colon

Visando estudar os parâmetros do equilíbrio ácido-base de eqüinos submetidos a um modelo experimental de obstrução intestinal, 24 animais foram distribuídos em quatro grupos, controle instrumentado (GI), obstrução do duodeno (GII), íleo (GIII) e cólon maior (GIV). As amostras de sangue venoso foram coletadas antes das cirurgias (T0), durante as obstruções (T30ob-T180ob) e após as desobstruções (T60des-T180des). Os eqüinos do GIV, no T30ob, e os eqüinos do GII, nos T60ob, T90ob e T120ob, apresentaram aumento do pH(v), da cHCO-3(vP) e da cBase(v) que, acrescidos do aumento da pCO2(v) e da ctCO2(v), caracterizou a alcalose metabólica com compensação respiratória. Nos T90ob e T120ob, nos animais do GII, e no T180ob, nos animais do GIII, a pO2(v) e a sO2(v) tiveram comportamento semelhante. Os valores baixos apresentados pelos animais do GII foram associados à hipercapnia ou à hipoventilação, desencadeadas para a correção da alcalose metabólica. Entretanto, a hipoxemia apresentada pelos animais do GIII foi associada à hipovolemia presente neste período. As alterações ácido-base observadas constituem-se de alterações leves e temporárias, as quais não são capazes de predizer o diagnóstico das obstruções intestinais específicas em eqüinos com cólica. Entretanto, por relacionarem-se diretamente com a precocidade do distúrbio gastrintestinal, elas auxiliam o pesquisador no prognóstico.

This study aimed to evaluate parameters of acid-base balance in horses submitted to an experimental model of intestinal obstruction. Twenty-four animals were divided in four groups: instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII) and large colon obstruction (GIV). Venous blood samples were collected before surgery (T0), during the obstruction (T30ob-T180ob) and after unblocking procedures (T60des-T180des). Animals from GIV, at T30ob and animals from GII, at T60ob, T90ob and T120ob, presented higher values for pH(v), cHCO-3(vP) and cBase(v) which, added to the increase of pCO2(v) and ctCO2(v), characterized the metabolic alkalosis with respiratory compensation. At T90ob and T120ob, in GII animals, and at T180ob, in GIII animals the pO2(v) and sO2(v) had similar response. Low values presented by GII animals were associated to hypercapnia or hypoventilation triggered for metabolic alkalosis correction. However, a hypoxemia presented by GIII animals was associated to hypovolemia at that period. There were light and temporary acid-base alterations that are not capable to predict specific intestinal obstruction diagnosis in equines with colic. However they help in prognosis since both have a direct relation with the precociousness of gastrointestinal disturbance.