血乳酸浓度和D－二聚体联合测定对急诊创伤性休克患者预后评估研究

目的：探讨血乳酸浓度和D－二聚体联合测定对急诊创伤性休克患者预后评估的价值。方法回顾性分析98例急诊创伤性休克患者的临床资料,其中77例经ICU治疗后存活并转出（存活组）,21例患者经ICU急救后死亡（死亡组）。观察两组患者血乳酸浓度和D－二聚体水平。结果存活组入院时、6 h、12 h、24 h血乳酸水平、D－二聚体水平、急性心理学与慢性健康状况Ⅱ（ APACHEⅡ）评分均低于死亡组（ P＜0.05）。结论联合测定血乳酸浓度、D－二聚体及APACHEⅡ评分,能准确评价病情及预后,为临床救治急性创伤性休克患者提供参考。     

Glucose metabolism transporters and epilepsy: Only GLUT1 has an established role

The availability of glucose, and its glycolytic product lactate, for cerebral energy metabolism is regulated by specific brain transporters. Inadequate energy delivery leads to neurologic impairment. Haploinsufficiency of the glucose transporter GLUT1 causes a characteristic early onset encephalopathy, and has recently emerged as an important cause of a variety of childhood or later‐onset generalized epilepsies and paroxysmal exercise‐induced dyskinesia. We explored whether mutations in the genes encoding the other major glucose (GLUT3) or lactate (MCT1/2/3/4) transporters involved in cerebral energy metabolism also cause generalized epilepsies. A cohort of 119 cases with myoclonic astatic epilepsy or early onset absence epilepsy was screened for nucleotide variants in these five candidate genes. No epilepsy‐causing mutations were identified, indicating that of the major energetic fuel transporters in the brain, only GLUT1 is clearly associated with generalized epilepsy.     

Temporal relationship of serum markers and tissue damage during acute intestinal ischemia/reperfusion

OBJECTIVE:

It is essential to identify a serological marker of injury in order to study the pathophysiology of intestinal ischemia reperfusion. In this work, we studied the evolution of several serological markers after intestinal ischemia reperfusion injury in rats. The markers of non-specific cell damage were aspartate aminotransferase, alanine aminotransaminase, and lactic dehydrogenase, the markers of inflammation were tumor necrosis factor alpha, interleukin-6, and interleukin-1 beta, and the markers of intestinal mucosal damage were intestinal fatty acid binding protein and D-lactate. We used Chiús classification to grade the histopathological damage.

METHODS:

We studied 35 Wistar rats divided into groups according to reperfusion time. The superior mesenteric artery was clamped for 30 minutes, and blood and biopsies were collected at 1, 3, 6, 12, 24, and 48 hours after reperfusion. We plotted the mean ± standard deviation and compared the baseline and maximum values for each marker using Student''s t-test.

RESULTS:

The maximum values of interleukin-1 beta and lactic dehydrogenase were present before the maximal histopathological damage. The maximum tumor necrosis factor alpha and D-lactate expressions coincided with histopathological damage. Alanine aminotransaminase and aspartate aminotransferase had a maximum expression level that increased following the histopathological damage. The maximum expressions of interluken-6 and intestinal fatty acid binding protein were not significantly different from the Sham treated group.

CONCLUSION:

For the evaluation of injury secondary to acute intestinal ischemia reperfusion with a 30 minute ischemia period, we recommend performing histopathological grading, quantification of D-lactate, which is synthesized by intestinal bacteria and is considered an indicator of mucosal injury, and quantification of tumor necrosis factor alpha as indicators of acute inflammation three hours after reperfusion.     

乳酸穿梭在心肌缺血/再灌注损伤中保护作用研究进展

背景 在传统观念上,乳酸是葡萄糖无氧代谢的废弃物,然而最近研究表明乳酸可作为能源物质,在体内能量代谢中有重要意义.在组织和细胞间存在大量乳酸穿梭现象,此种现象为机体代谢提供了保障. 目的 结合国内外相关研究,就乳酸穿梭机制在心肌保护中的作用进行阐述. 内容 乳酸是葡萄糖酵解的产物.乳酸穿梭是指机体不同组织和细胞间存在乳酸互相穿梭供能的现象.细胞间的乳酸转运主要由单羧酸转运蛋白(monocarboxylate transporter,MCT)、黏附分子(CD147)、乳酸脱氢酶组成.在心肌缺血/再灌注损伤(ischemia/reperfusion injury,I/RI)中乳酸穿梭主要是通过优化能量代谢及对Ca2+浓度的影响来发挥对心肌的保护作用. 趋向 目前研究发现乳酸在能量代谢中有重要意义,乳酸穿梭是机体I/RI时重要的能量代谢调节途径.但关于乳酸穿梭具体的调控机制研究尚少.     

依沙吖啶联合米非司酮和米索前列醇治疗中期妊娠引产的疗效观察

目的探讨乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产的临床疗效。方法选取2013年9月—2017年3月安阳市人民医院妇产科收治的中期妊娠引产患者132例为研究对象,将所有患者分为依沙吖啶组(A组,44例)、米非司酮联合米索前列醇组(B组,41例)和依沙吖啶联合米非司酮和米索前列醇组(C组,47例)。A组腹部注射位点采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg。B组口服米非司酮片,50 mg/次,2次/d,连续3 d,第4天阴道后穹窿放置米索前列醇片0.4 mg。C组口服米非司酮片100 mg/次,1 h后采用腰穿针行羊膜腔穿刺,注入乳酸依沙吖啶注射液100 mg,12 h后阴道后穹窿放置米索前列醇片0.4 mg。观察各组患者的引产效果,比较术中及术后情况。结果3组引产成功率比较差异无统计学意义。A、B、C组清宫率分别为36.36%、29.27%、12.77%,C组清宫率明显低于A、B组,3组比较差异具有统计学意义(P0.05)。C组用药至宫缩时间、引产时间、产后2 h出血量、产后出血天数、胎盘残留率显著低于A、B组,3组比较差异具有统计学意义(P0.05)。C组1级疼痛程度明显高于A、B组,3、4级疼痛程度明显低于A、B组,3组比较差异具有统计学意义(P0.05)。3组患者复潮时间、经期持续时间相当,没有统计学差异。结论乳酸依沙吖啶注射液联合米非司酮片和米索前列醇片治疗中期妊娠引产具有较好的临床效果,可降低清宫率和胎盘残留率,缩短用药至宫缩时间、引产时间,减少出现量和出血天数,具有一定临床推广应用价值。     

LD1的快速测定法及其在急性心梗塞早期诊断中的价值

在全自动生化分析仪上建立了过氯酸钠抑制乳法乳酸脱氢酶同工酶１（ＬＤ１）双试剂测定法，具有简便、快速、可靠、精确等优点，适于常规和急诊使用。罗克（ＲＯＣ０曲线分析表明ＬＤ１用于急性心肌梗塞（ＡＭＩ）的诊断效能高于ＬＤ％，入院２４ｈ内动态监测ＬＤ１的升高趋势有助于ＡＭＩ的早期诊断。     

Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis

ObjectiveTo evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis.MethodsIn this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed.ResultsA total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772–0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34–0.7], Sp 98.1% [0.95–0.99], LR+ 27.0[9.50–76.00]).ConclusionThe diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.     

Is elevated plasma lactate a useful marker in the evaluation of pure carbon monoxide poisoning?

Objective To examine whether CO poisoning induces a significant increase in plasma lactate concentration.Design and setting Prospective observational clinical study in the emergency department and intensive care unit in a university-affiliated teaching hospital.Patients 146 pure CO poisonings resulting from dysfunction of gas cookers or water heaters.Measurements and results Patients were classified into four neurological impairment groups: 37% were severely, 8% moderately, and 45% mildly intoxicated, while 1% were asymptomatic. We found only very mild increases in plasma lactate concentration (median 2.30 mmol/l) which, however, was significantly correlated with the severity of neurological impairment and blood CO concentration (1.41 mmol/l, Spearman's test r=0.3).Conclusions Plasma lactate is mildly elevated in pure CO-exposed patients. This mild increase and the extensive overlap between the groups of neurological impairment severity do not suggest the usefulness of systematic plasma lactate measurement in pure CO poisoning.     

Current understandings and perspectives on non-cancer health effects of benzene: A global concern

Objective

Benzene, as a volatile organic compound, is known as one of the main air pollutants in the environment. The aim of this review is to summarize all available evidences on non-cancerous health effects of benzene providing an overview of possible association of exposure to benzene with human chronic diseases, specially, in those regions of the world where benzene concentration is being poorly monitored.

Methodology

A bibliographic search of scientific databases including PubMed, Google Scholar, and Scirus was conducted with key words of “benzene toxic health effects”, “environmental volatile organic compounds”, “diabetes mellitus and environmental pollutants”, “breast cancer and environmental pollution”, “prevalence of lung cancer”, and “diabetes prevalence”. More than 300 peer reviewed papers were examined. Experimental and epidemiologic studies reporting health effects of benzene and volatile organic compounds were included in the study.

Results

Epidemiologic and experimental studies suggest that benzene exposure can lead to numerous non-cancerous health effects associated with functional aberration of vital systems in the body like reproductive, immune, nervous, endocrine, cardiovascular, and respiratory.

Conclusion

Chronic diseases have become a health burden of global dimension with special emphasis in regions with poor monitoring over contents of benzene in petrochemicals. Benzene is a well known carcinogen of blood and its components, but the concern of benzene exposure is more than carcinogenicity of blood components and should be evaluated in both epidemiologic and experimental studies. Aspect of interactions and mechanism of toxicity in relation to human general health problems especially endocrine disturbances with particular reference to diabetes, breast and lung cancers should be followed up.