Serum lactic acid level predicts poor myocardial perfusion and in-hospital outcomes in patients undergoing primary percutaneous coronary intervention

Background Elevated serum lactic acid level is associated with poor outcomes in patients with critical diseases like shock. However, the clinical implication of this biomarker in patients with acute myocardial infarction remains unclear. Purpose We aimed to explore the predictive power of serum lactic acid level on admission for in-hospital outcomes in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (pPCI). Methods Consecutive patients undergoing pPCI with available data on serum lactid acid level were evaluated for eligbility in this retrospective cohort study. The primary outcome was all-cause death during hospitalization. Enzymatic infarct size and major adverse cardiovascular events (MACE, defined as a combination of all-cause death, recurrent myocardial infarction, and unplanned repeated revascularization) were considered secondary outcomes. Independent preditors of in-hospital death were determined by multiple logisic regression analysis. Odds ratio (OR) with 95% confidence interval (CI) was used to demonstrate the association. The predictive power of serum latictic acid level for in-hospital death was evaluated through receiver operator characteristic curve, which generated C-statictic. A combination model was further constructed by adding serum latictic acid level to the Global Registry of Acute Coronary Events (GRACE) risk score (LA-GRACE risk score). The linear dependence between serum lactic acids level and othe clinical variables was analysed using Spearman rank correlation. Results Of the 302 patients enrolled in the current analysis, 15 (5.0%) died during hospitalization. Serum lactic acid level (OR=1.657, 95% CI: 1.115 to 2.463, p=0.012)and left ventricular ejection fraction (OR=0.858, 95% CI: 0.767 to 0.959, p=0.007) were the only two independent predictors of in-hospital death. The C-statistic of serum lactic acid level for predicting in-hospital death was 0.886 (95% CI: 0.793 to 0.979). The LA-GRACE risk score improved the C-statistic of the GRACE score from 0.898 to 0.911 (p=0.294), with continuous net reclassification improvement of 0.567 (p=0.023) and integrated discrimination improvement of 0.206 (p=0.003). High serum lactic acid level was also asscoiated with larger enzymatic infarct size (p=0.002) and MACE (p=0.004). Further, it significantly correlated with white blood cell counts (r=0.264, p<0.001), serum creatinine level (r=0.189, p=0.001), and systolic blood pressure (r=−0.122, p=0.034). Conclusion Serum lactic acid level on admission is asscoiated with poor myocardial perfusion and in-hospital outcomes in patients with acute myocardial infarction undergoing pPCI. It may contribute to better risk stratification in these populations. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported by the National Program on Key Basic Research Project of China (Grant No: 2019YFC0840601 and 2014CBA02003), National Natural Science Foundation of China (Grant No: 81870267, 81970295, 81521001, 81670318 and 81570314), Grant of Shanghai Shenkang on Key Clinical Research Project (Grant No: SHDC2020CR2015A and SHDC12019104), Grant of Shanghai Science and Technology Committee (Grant No: 19MC1910300, 18411950200 and 20JC1410800), Key Medical and Health Projects of Xiamen Province (No: 3502Z20204004), Grant of Shanghai Municipal Commission of Health and Family Planning (Grant No: 2017YQ057), Grant of Zhongshan Hospital Affiliated to Fudan University (Grant No: 2018ZSLC01), VG Funding of Clinical Trials (2017-CCA-VG-036) and Merck Funding (Xinxin-merck-fund-051). ROC of lactic acid and GRACE score

Construction and Evaluation of a Rat Model of Postpartum Fatigue

<b><i>Objectives:</i></b> The aim of the study was to construct and evaluate a rat model of postpartum fatigue. <b><i>Design:</i></b> This is an article about animal model building. <b><i>Methods:</i></b> Sprague-Dawley rats on the 1st day after delivery were randomized into control group and fatigue group. The deep sleep of rats was interfered with by forcing them to stand in water, to make the rats experience mental and physical fatigue. To maintain galactosis and lactation, rats and pups were caged for 90 min after every 3 h of separation. The control group was separated routinely without any stimulus. The model was evaluated from mental and physical fatigue on the 8th day and 15th day. The mental fatigue was evaluated by a water maze test and the rat’s 5-hydroxytryptamine (5-HT) level in hippocampus, while the physical fatigue was evaluated using lactic acid level in serum and duration of weight-loaded forced swimming. <b><i>Results:</i></b> Among the 7-day and 14-day modeling groups, compared with the control group, the success rate of water maze landing was significantly decreased, the time for water maze landing was significantly prolonged and 5-HT level in hippocampus significantly decreased in the fatigue group. With respect to physical fatigue, among the 7-day and 14-day modeling groups, the lactic acid level in serum in the fatigue group was significantly increased, and the duration of exhaustive swimming of rats was significantly shortened. <b><i>Limitations:</i></b> A small sample size was the main limitation of this study. <b><i>Conclusions:</i></b> We have successfully constructed a rat model of postpartum fatigue by forcing postpartum rats to stand in water, which was similar to a level of stress that contributes to the development of postpartum fatigue. Our model opens the door for future studies evaluating the effectiveness of pharmacological and behavioral therapies.

Mechanism of Circular RNA RAD23B for Regulating Glycolysis and Proliferation of Ovarian Cancer Cells by Targeting MicroRNA-519b-3p

We investigated whether circRAD23B regulates glycolysis and proliferation of ovarian cancer cells by targeting miRNA-519b-3p. circRAD23B expression in ovarian cancer tissues was significantly higher than that in paracancerous tissues, and miRNA-519b-3p expression in ovarian cance tissues was significantly lower than that in paracancerous tissues (P < 0.05). Transfection sicircRAD23B or miRNA-519b-3p mimics can greatly attenuate cell viability, glucose consumption, lactic acid level, and CyclinD1 protein level (P < 0.05), and increase p21 protein level (P < 0.05). Double luciferase reporter experiment confirmed that circRAD23B could function as a miRNA-519b-3p sponge molecule. Co-transfection of si-circRAD23B and anti-miRNA-519b-3p could greatly decrease cell viability, glucose consumption, lactic acid level, and CyclinD1 protein level (P < 0.05), and increase p21 protein level by comparison with si-circRAD23B+anti-miRNA-NC group (P < 0.05). Inhibiting circRAD23B expression can, in turn, inhibit glycolysis and the proliferation of ovarian cancer cells by up-regulating miRNA-519b-3p expression.

A Clinical Triad with Fatal Implications: Recrudescent Diffuse Large B-cell Non-Hodgkin Lymphoma Presenting in the Leukemic Phase with an Elevated Serum Lactic Acid Level and Dysregulation of the TP53 Tumor Suppressor Gene – A Case Report and Literature Review

Despite representing 30% to 40% of newly diagnosed cases of adult non-Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL) rarely presents (1) in the leukemic phase (2) with dysregulation of the TP53 tumor suppressor gene and (3) an elevated serum lactic acid level. In this case report and literature review, we highlight this unfortunate triad of poor prognostic features associated with an aggressive and fatal clinical course in a 53-year-old man with recrudescent DLBCL. A leukemic presentation of de novo or relapsed DLBCL is rare and may be related to differential expressions of adhesion molecules on cell surfaces. In addition, TP53 gene mutations are present in approximately 20% to 25% of DLBCL cases and foreshadow worse clinical outcomes. Finally, an elevated serum lactic acid level in DLBCL that is not clearly associated with sepsis syndrome is a poor prognostic factor for survival and manifests as type B lactic acidosis through the Warburg effect.

Evaluation of various barley processing methods on rumen microbial population, histomorphometry, and fermentation characteristics in fattening lamb

Barley deserves a top place in the farm for feeding livestock. It is irreplaceable by any other grain in sheep diets for producing capacious rumen microbial yields. The present study was conducted to investigatethe effect of different methods of barley processing on a number of microbes, fermentation parameters, and the rumen tissue characteristics of fattening lambs. For this purpose, 20 fattening male lambs with a mean weight of 25 ± 1.1 kg were tested for 80 daysbasedon a completely randomized design with four treatments (GRB: ground barley, SRB: steam-rolled barley, GEB: germinated barley, SOB: soaked barley) and five replicates. Three lambs from each treatment were slaughtered and sampling was done on the rumen liquid and tissue to determine their pH and volatile fatty acid (VFA), amylolytic bacteria, proteolytic, cellulolytic, heterophilic, and protozoa contents. The findings showed that the number of cellulolytic bacteria in ground barley treatment was lower than that of soaked barley treatment. In addition, there existed fewer heterophilic bacteria in germinated barley groups compared with other treatments. The lactic acid level in the GRB was increased compared to that in SRB and GEB treatments (P < 0.05). The GRB further reduced the thickness of the rumen wall in comparison with SRB. In general, replacing GRB with SOB improved certain thickness of the epithelial tissue and cellulolytic bacteria of the rumen.

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 hours of reduction or when surgical reduction was required due to air enema failure. Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥1.5, ≥2.0, ≥2.5, and ≥3.0 mmol/L, the positive predictive values for poor outcomes were 30.0%, 34.6%, 50.0%, and 88.9%, respectively. Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.