The Role of Lactate Clearance in Severe Septic Patients Survival

Introduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown. Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression test. Results. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder. Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder

A heuristic approach on a multi-objective vehicle routing problem with pick-up and delivery service

Vehicle Routing Problem has captured the interest mar researchers through the years. Studies with different types of VRP were developed such as VRP with time window, VRP with capacitated vehicle, VRP with pick-up and delivery service and the likes. These studies in the past would cater to different kinds of systems. In order to consider all parameters in a unique system, and to meet objectives in a VRP, this study was made. The Model development was first used in order to assess and determine the variables. From these variables, equations were made in order to clarify and express the constraints of the system. A discussion of the limitations of the system is later then used in the development of the heuristic. The development of heuristic is subjected of 3 phases. The first phase considers the maximization of its service level. Given the service level, the lowest transaction time of which generates an algorithm that which node to serve first. The 2nd phase generally proceeds to minimizing the cost of the route. Looking for the least cost that would able to serve the demand of which the route taken on phase 1 was done. Service level is still a main aspect, so the decision of getting the least cost should also accept the service level gotten from phase 1. The last phase would be the use of the sub-con. The travel cost of the sub-con is computed in a way that which route it takes. This will then be weighed with the penalty cost that was incurred in the 1st phase. A computer program was done given the data and a validation was prepared in order to see how close the optimality of the heuristic. The heuristic was able to get the most optimal solution for the given data. Sensitivity analysis was also done and the factors including the relationship of sub-con and owned vehicles, time window, and demand are known to be significant in affecting the response on the service level and operation cost

Multiparametric High‐Content Assays to Measure Cell Health and Oxidative Damage as a Model for Drug‐Induced Liver Injury

Drug-induced liver injury is an important cause of non-approval in drug development and the withdrawal of already approved drugs from the market. Screening human hepatic cell lines for toxicity has been used extensively to predict drug-induced liver injury in preclinical drug development. Assessing hepatic-cell health with more diverse markers will increase the value of in vitro assays and help predict the mechanism of toxicity. We describe three live cell-based assays using HepG2 cells to measure cell health parameters indicative of hepatotoxicity. The first assay measures cellular ATP levels using luciferase. The second and third assays are multiparametric high-content screens covering a panel of cell health markers including cell count, mitochondrial membrane potential and structure, nuclear morphology, vacuolar density, and reactive oxygen species and glutathione levels