Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review

<p>Abstract</p> <p>Background</p> <p>Using blood lactate monitoring for risk assessment in the critically ill patient remains controversial. Some of the discrepancy is due to uncertainty regarding the appropriate reference interval, and whether to perform a single lactate measurement as a screening method at admission to the hospital, or serial lactate measurements. Furthermore there is no consensus whether the sample should be drawn from arterial, peripheral venous, or capillary blood. The aim of this review was:</p> <p>1) To examine whether blood lactate levels are predictive for in-hospital mortality in patients in the acute setting, i.e. patients assessed pre-hospitally, in the trauma centre, emergency department, or intensive care unit.</p> <p>2) To examine the agreement between arterial, peripheral venous, and capillary blood lactate levels in patients in the acute setting.</p> <p>Methods</p> <p>We performed a systematic search using PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL up to April 2011. 66 articles were considered potentially relevant and evaluated in full text, of these ultimately 33 articles were selected.</p> <p>Results and Conclusion</p> <p>The literature reviewed supported blood lactate monitoring as being useful for risk assessment in patients admitted acutely to hospital, and especially the trend, achieved by serial lactate sampling, is valuable in predicting in-hospital mortality. All patients with a lactate at admission above 2.5 mM should be closely monitored for signs of deterioration, but patients with even lower lactate levels should be considered for serial lactate monitoring. The correlation between lactate levels in arterial and venous blood was found to be acceptable, and venous sampling should therefore be encouraged, as the risk and inconvenience for this procedure is minimal for the patient. The relevance of lactate guided therapy has to be supported by more studies.</p

Biomonitoring der weiträumigen Verdriftung von Pestiziden mittels Baumrinde, Vegetation und Passivsammler

Anlass für ein Biomonitoring zur weiträumigen Verfrachtung von Pestiziden über die Luft war die wiederholte und erhebliche Kontamination von Bio-Körnerfenchel mit zugelassenen, häufig applizierten Pflanzenschutzmitteln, die kilometerweit von den Fenchelflächen angewendet wurden. Zudem wurde für Glyphosat eine breite Belastung der Bevölkerung gemessen: 99,6% von über 2000 Probanden der bundesweiten Studie „Urinale 2015“. Das Luftgüte-Rindenmonitoring mit Analysen von über 500 Pestiziden wurde von 2014 bis 2017 an 24 Standorten in Brandenburg und Bayern durchgeführt. Weitere Vegetationsproben wie Körnerfenchel und Grünkohl wurden an 11 Standorten und technische Passivsammler (PUF-SIP) an 2 Standorten zur Kalibrierung analysiert. Insgesamt wurden 55 Pestiziden gefunden, im Durchschnitt 27 (4 - 36) pro Standort. Insbesondere zeigten 15 Pestizide eine über einzelne Standorte hinausgehende, weiträumige Verbreitung auf. Diese Drift verursacht eine ubiquitäre Kontamination bishin zu weit entfernt liegenden Naturschutzgebieten. So wurde Pendimethalin an 22 von 24 Standorten (93%), Prosulfocarb bei 75% und sogar Glyphosat bei 33% aller Standorte gemessen. Für derartige hochproblematischen Pestizide sind angemessene Änderungen im Zulassungsverfahren erforderlich, um  Umweltbelastungen wirksam zu reduzieren und die Koexistenz alternativer Anbaumethoden, wie zum Beispiel des ökologischen Landbaus, zu gewährleisten

Serum neurofilament light chains in progressive multiple sclerosis patients treated with repeated cycles of high-dose intravenous steroids

Background and objectives: In progressive multiple sclerosis (MS) patients, CNS inflammation trapped behind a closed blood brain barrier drives continuous neuroaxonal degeneration, thus leading to deterioration of neurological function. Therapeutics in progressive MS are limited. High-dose intravenous glucocorticosteroids (HDCS) can cross the blood-brain barrier and may reduce inflammation within the CNS. However, the treatment efficacy of HDCS in progressive MS remains controversial. Serum neurofilament light chains (sNfL) are an established biomarker of neuroaxonal degeneration and are used to monitor treatment responses. We aimed to investigate whether repeated cycles of intravenous HDCS reduce the level of sNfL in progressive MS patients. Methods: We performed a monocentric observational study of 25 patients recruited during ongoing clinical routine care who were treated with repeated cycles of intravenous HDCS as long-term therapy for their progressive MS. sNfL were measured in 103 repeated blood samples (median time interval from baseline 28 weeks, range 2-55 weeks) with the Single Molecular Array (SiMoA) technology. The Expanded Disability Status Score (EDSS) was documented at baseline and follow-up. Results: The median age of patients was 55 years (range 46-77 years) with a median disease duration of 26 years (range 11-42 years). sNfL baseline levels at study inclusion were significantly higher in progressive MS patients compared to age-matched healthy controls (median 16.7 pg/ml vs 11.5 pg/ml, p=0.002). sNfL levels showed a positive correlation with patient age (r=0.2, p=0.003). The majority of patients (72%, 16/23) showed reduced sNfL levels ≥20 weeks after HDCS compared to baseline (median 13.3 pg/ml, p=0.03). sNfL levels correlated negatively with the time interval from baseline HDCS therapy (r=-0.2, p=0.03). This association was also evident after correction for treatment with disease-modifying drugs (adjusted R2=0.10, p=0.001). The EDSS remained stable (median 6.5) within a median treatment duration of 26 weeks (range 13-51 weeks). Conclusion: Although larger studies are needed to confirm our findings, we were able to demonstrate that HDCS treatment reduces sNfL levels and therefore may slow down neuroaxonal damage in a subgroup of patients with progressive MS. Moreover, a stable EDSS was observed during therapy. Findings suggest that HDCS may be beneficial for the treatment of progressive MS

Exploring the flexibility of everyday practices for shifting energy consumption through clockcast

Encouraging sustainable living by raising awareness of resource consumption has long been a topic within HCI. However, getting people to change behavior when it comes to energy consumption is difficult. This is one of the major challenges ahead for future energy systems, in particular if resources are renewable and plentiful. We developed the ClockCast prototypes (web and clock forecast) to explore demand response and the flexibility potential of everyday practices. We wanted to reframe the conversation on demand response: from highlighting when not to use energy to highlighting when to use it. The ClockCast prototypes display the best times to use electricity, and they were complemented by proactive and positive suggestions. We conducted a pilot study with five different households to uncover the socio-technical challenges around shifting consumption and the participants' experiences with the prototypes. While the participants increased their awareness of the environmental implications of their actions, shifted some electricity use, and found the forecasts useful, some participants also reported newfound guilt when they did not follow the forecasts