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Paulus J, Croisier JL, Kaux JF, Bury T. Eccentric versus Concentric - Which Is the Most Stressful Cardiovascularly and Metabolically? Curr Sports Med Rep 2020; 18:477-489. [PMID: 31834180 DOI: 10.1249/jsr.0000000000000666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to compare the fatigability resistance profile and the physiological responses of strenuous concentric (CON) versus eccentric (ECC) isokinetic exercises. At two different sessions, 12 healthy sedentary male subjects (24.3 ± 2.5 years) performed strenuous CON and ECC isokinetic exercises. The protocol consisted of three sets of 12 maximal repetitions, separated by 30-s intervals, at a velocity of 60°·s for both flexor and extensor knee muscles of the dominant leg. Metabolic (ventilation, oxygen uptake, blood lactate concentration) and cardiovascular (HR, mean arterial blood pressure) parameters were registered before, throughout, and after the isokinetic session. The isokinetic data analysis revealed a more pronounced fatigue in the hamstrings than in the quadriceps in the ECC mode (fatigue index, ratio between the third and the first sets, of 94.8% ± 11.8% vs 86.4% ± 10.8%; P < 0.05). All physiological responses studied increased gradually during the isokinetic evaluation, both in CON and ECC modes. For total work normalized by physiological responses, cardiovascular and metabolic variables were lower in the CON than in the ECC mode, a sign of a weaker efficiency in CON mode (ratio between performance and physiological cost). In conclusion, the study shows a specific fatigability resistance profile consisting of an early decrease of ECC hamstring performance compared with the quadriceps profile. In addition, we confirm that physiological consequences are important during strenuous isokinetic exercises but ECC exercise produces less stress on the cardiovascular and the metabolic systems than does CON exercise.
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Affiliation(s)
- Julien Paulus
- Department of Motricity Sciences and Physical Therapy and Rehabilitation, University of Liege, Liège, BELGIUM.,Laboratory of Human Motion Analysis, University of Liege, Liège, BELGIUMPhysical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
| | - Jean-Louis Croisier
- Department of Motricity Sciences and Physical Therapy and Rehabilitation, University of Liege, Liège, BELGIUM.,Laboratory of Human Motion Analysis, University of Liege, Liège, BELGIUMPhysical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM.,Physical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
| | - Jean-François Kaux
- Department of Motricity Sciences and Physical Therapy and Rehabilitation, University of Liege, Liège, BELGIUM.,Laboratory of Human Motion Analysis, University of Liege, Liège, BELGIUMPhysical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM.,Physical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
| | - Thierry Bury
- Department of Motricity Sciences and Physical Therapy and Rehabilitation, University of Liege, Liège, BELGIUM.,Physical Medicine and Sports Traumatology Department, SportS, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborating Center of Sports Medicine, University and University Hospital of Liège, Liège, BELGIUM
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Cole GC, Tordiffe ASW, Steenkamp G. Assessment of a portable lactate meter for field use in the white rhinoceros (<i>Ceratotherium simum</i>). ACTA ACUST UNITED AC 2017; 84:e1-e10. [PMID: 29227129 PMCID: PMC8552300 DOI: 10.4102/ojvr.v84i1.1399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 11/13/2022]
Abstract
Blood lactate is a predictor of mortality in critically ill humans and animals. Handheld lactate meters have the potential to be used in the field to evaluate the condition of severely injured rhinoceroses but have not been compared with laboratory-based methods. Agreement between a handheld lactate meter and a laboratory method was assessed, as was the stability of rhino blood lactate in the anticoagulant sodium fluoride/potassium oxalate (fluoride/oxalate). Blood samples were obtained from 53 white rhinos that had been immobilised for management reasons. Lactate was measured by means of a handheld meter using whole blood in heparin (WBHEP), whole blood in fluoride/oxalate (WBFO) and fluoride/oxalate plasma (PFO). Results were recorded in both blood (BL) and plasma (PL) modes and compared to an established laboratory method for measuring plasma lactate. To assess the stability of lactate over time, blood lactate in fluoride/oxalate was measured on the handheld meter at intervals for up to 91 h. Agreement was best using WBFO in PL mode, with small bias (−0.16), tight 95% limits of agreement (LOA) (−1.46, 1.14) and a Pc (95% CI) of 0.97 (0.92, 0.99). The agreement was improved for all sample types when using the PL mode compared to the blood lactate (BL) mode. Blood lactate was stable in fluoride/oxalate for 91 h, with a mean change from baseline of 0.15 (−0.178, 0.478) mmol/L (mean, 95% CI). The handheld meter was found to be suitable for field use in white rhinos but provided more reliable results with the device in PL mode. Furthermore, rhino blood lactate was found to be stable in fluoride/oxalate for as long as 3 days.
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Affiliation(s)
- Georgina C Cole
- Department of Companion Animal Clinical Studies, University of Pretoria.
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Wang M, Chua SC, Bouhadir L, Treadwell EL, Gibbs E, McGee TM. Point-of-care measurement of fetal blood lactate - Time to trust a new device. Aust N Z J Obstet Gynaecol 2017; 58:72-78. [DOI: 10.1111/ajo.12671] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mandy Wang
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Seng C. Chua
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Lilain Bouhadir
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Erin L. Treadwell
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
| | - Emma Gibbs
- NHMRC Clinical Trials Centre; University of Sydney; Sydney New South Wales Australia
| | - Therese M. McGee
- Department of Obstetrics and Gynaecology; Westmead Hospital; Sydney New South Wales Australia
- Sydney Medical School Westmead; University of Sydney; Sydney New South Wales Australia
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Allanson ER, Waqar T, White C, Tunçalp Ö, Dickinson JE. Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review. BJOG 2017; 124:584-594. [PMID: 27704703 DOI: 10.1111/1471-0528.14306] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns. OBJECTIVE To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome. SEARCH STRATEGY Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed. SELECTION CRITERIA Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome. DATA COLLECTION AND ANALYSIS Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Meta-analysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model. MAIN RESULTS Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) -0.650; 95% CI -0.663 to -0.637, P < 0.001], base excess (ES -0.710; 95% CI -0.721 to -0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%). AUTHORS' CONCLUSION Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome. TWEETABLE ABSTRACT Umbilical cord lactate: a clinically applicable, inexpensive, effective way to measure intrapartum acidosis.
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Affiliation(s)
- E R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - T Waqar
- CMH Medical College, CMH Lahore, Lahore, Pakistan
| | - Crh White
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Ö Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - J E Dickinson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
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Allanson ER, Grobicki K, Pattinson RC, Dickinson JE. Attitudes towards the implementation of universal umbilical artery lactate analysis in a South African district hospital. BMC Pregnancy Childbirth 2016; 16:166. [PMID: 27430973 PMCID: PMC4950755 DOI: 10.1186/s12884-016-0968-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 05/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background Of the 5.54 million stillbirths and neonatal deaths occurring globally each year, a significant amount of these occur in the setting of inadequate intrapartum care. The introduction of universal umbilical artery lactate (UA) measurements in this setting may improve outcomes by providing an objective measurement of quality of care and stimulating case reflection, audit, and practice change. It is important that consideration is given to the barriers and facilitators to implementing this tool outside of a research setting. Methods During the period 16/11/2014 -13/01/2015, we conducted a training course in cardiotocograph (CTG) interpretation, fetal physiology, and the sampling and analysing of UA lactate, with a pre and post questionnaire aimed at assessing the barriers and facilitators to the introduction of universal UA lactate in a district hospital in the Eastern Cape, South Africa. Results Thirty-five pre-training questionnaires available (overall response rate 95 %) and 22 post training questionnaires (response rate 63 %) were available for analysis. Prior to training, the majority gave positive responses (strongly agree or agree) that measuring UA lactate assists neonatal care, is protective for staff medicolegally, and improves opportunities for audit and teaching of maternity practice (n = 33, 30, 32; 94.4 %, 85.7 %, 91.4 % respectively). Respondents remained positive about the benefits post training. An increased workload on medical or midwifery staff was less likely to be seen as barrier following training (71 vs. 38.9 % positive response, p = 0.038). A higher rate of respondents felt that expense and lack of equipment were likely to be barriers after completing training, although this wasn’t significant. There was a trend towards lack of time and expertise being less likely to be seen as barriers post training. Conclusion The majority of participants providing intrapartum care in this setting are positive about the role of universal UA lactate analysis and the potential benefits it provides. Training aids in overcoming some of the perceived barriers to implementation of universal UA lactate analysis.
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Affiliation(s)
- Emma R Allanson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia. .,SAMRC Maternal and Infant Health Care Strategies unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa.
| | | | - Robert C Pattinson
- SAMRC Maternal and Infant Health Care Strategies unit, Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Jan E Dickinson
- School of Women's and Infants' Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia
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White CRH, Doherty DA, Cannon JW, Kohan R, Newnham JP, Pennell CE. Cost effectiveness of universal umbilical cord blood gas and lactate analysis in a tertiary level maternity unit. J Perinat Med 2016; 44:573-84. [PMID: 26966927 DOI: 10.1515/jpm-2015-0398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/08/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is an increasing body of literature supporting universal umbilical cord blood gas analysis (UCBGA) into all maternity units. A significant impediment to UCBGA's introduction is the perceived expense of the introduction and associated ongoing costs. Consequently, this study set out to conduct the first cost-effectiveness analysis of introducing universal UCBGA. METHODS Analysis was based on 42,100 consecutive deliveries ≥23 weeks of gestation at a single tertiary obstetric unit. Within 4 years of UCBGA's introduction there was a 45% reduction in term special care nursery (SCN) admissions >2499 g. Incurred costs included initial and ongoing costs associated with universal UCBGA. Averted costs were based on local diagnosis-related grouping costs for reduction in term SCN admissions. Incremental cost-effectiveness ratio (ICER) and sensitivity analysis results were reported. RESULTS Under the base-case scenario, the adoption of universal UCBGA was less costly and more effective than selective UCBGA over 4 years and resulted in saving of AU$641,532 while adverting 376 SCN admissions. Sensitivity analysis showed that UCBGA was cost-effective in 51.8%, 83.3%, 99.6% and 100% of simulations in years 1, 2, 3 and 4. These conclusions were not sensitive to wide, clinically possible variations in parameter values for neonatal intensive care unit and SCN admissions, magnitude of averted SCN admissions, cumulative delivery numbers, and SCN admission costs. CONCLUSIONS Universal UCBGA is associated with significant initial and ongoing costs; however, potential averted costs (due to reduced SCN admissions) exceed incurred costs in most scenarios.
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White CR, Doherty DA, Newnham JP, Pennell CE. The impact of introducing universal umbilical cord blood gas analysis and lactate measurement at delivery. Aust N Z J Obstet Gynaecol 2013; 54:71-8. [DOI: 10.1111/ajo.12132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Christopher R.H. White
- School of Women's and Infants’ Health; The University of Western Australia; Perth Western Australia Australia
| | - Dorota A. Doherty
- School of Women's and Infants’ Health; The University of Western Australia; Perth Western Australia Australia
- Women and Infants Research Foundation; Perth Western Australia Australia
| | - John P. Newnham
- School of Women's and Infants’ Health; The University of Western Australia; Perth Western Australia Australia
- Women and Infants Research Foundation; Perth Western Australia Australia
| | - Craig E. Pennell
- School of Women's and Infants’ Health; The University of Western Australia; Perth Western Australia Australia
- Women and Infants Research Foundation; Perth Western Australia Australia
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Su TY, Reece M, Chua SC. Lactate study using umbilical cord blood: agreement between Lactate Pro hand-held devices with blood gas analyser and evaluation of lactate stability over time. Aust N Z J Obstet Gynaecol 2013; 53:375-80. [PMID: 23550587 DOI: 10.1111/ajo.12081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 02/16/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lactate measurements have become increasingly preferred over pH analysis in the evaluation of fetal acidaemia in labour. In a busy labour ward, often the umbilical cord may be sampled late and as a result yield unreliable lactate values. AIM To investigate the agreement of hand-held device Lactate Pro with a reference method blood gas analyser and evaluate the stability of umbilical cord lactate values over time. METHODS Prospective study carried out at elective caesarean section. Sixteen umbilical cords were double clamped immediately after delivery with paired arterial and venous blood samples collected by an independent researcher, at varying time intervals, and processed by two Lactate Pro devices and a reference method blood gas analyser. RESULTS A significant difference of -0.41 to 0.10 mmol/L was found when different groups of Lactate Pro devices were compared with blood gas analyser at lactate values up to 5.70 mmol/L, with average lactate value of 2.45 mmol/L. Over time, there is progressive rise in lactate samples obtained from the umbilical cord. CONCLUSION Lactate Pro devices have a significant difference, but when used in clinical practice on cord blood after delivery, this is unlikely to be meaningful. In intrapartum fetal surveillance, a systematic overestimation might lead to unnecessary intervention. It is possible to retrospectively predict the likely level of lactate at birth in delayed cord samples.
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Affiliation(s)
- Tina Y Su
- Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia.
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White CRH, Kohan R, Doherty DA, Newnham JP, Pennell CE. Attitudes and barriers to the introduction of umbilical cord blood gas and lactate analysis at birth. Aust N Z J Obstet Gynaecol 2013; 53:271-6. [PMID: 23452231 DOI: 10.1111/ajo.12058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 01/02/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite a growing body of evidence demonstrating the value of universal umbilical cord blood gas analysis (UCBGA), there remains reluctance in some maternity units to adopt universal testing. AIMS Identify perceived barriers and benefits of universal UCBGA. METHODS Medical and midwifery staff involved in intrapartum care at four level two maternity units (one metropolitan and three regional) completed questionnaires evaluating attitudes to UCBGA. Questionnaires included 13 statements with responses ranging from strongly agree to strongly disagree and background demographic data. RESULTS Most respondents considered UCBGA beneficial to perinatal care (n = 72; 67.3%), with only nine individuals (8.4%) believing UCBGA had no place in perinatal care. The majority of respondents considered benefits of UCBGA to include being an effective and objective marker of neonatal status (n = 64; 59.8%), as well as playing a role in medicolegal issues (n = 74; 69.2%) and audit and teaching (n = 64; 59.8%). Respondents considered that barriers to universal UCBGA introduction included insufficient time following delivery, increased workload and encroachment of technology into birth. CONCLUSIONS The majority of respondents indicated support for UCBGA. Information derived from this study may be useful in identifying and resolving concerns prior to the introduction of UCBGA. Further, it could be useful in the preparation of education and implementation packages necessary for introduction of UCBGA.
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Affiliation(s)
- Christopher R H White
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.
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White CRH, Doherty DA, Henderson JJ, Kohan R, Newnham JP, Pennell CE. Accurate prediction of hypoxic-ischaemic encephalopathy at delivery: a cohort study. J Matern Fetal Neonatal Med 2012; 25:1653-9. [DOI: 10.3109/14767058.2011.653421] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Heinis AMF, Dinnissen J, Spaanderman MEA, Lotgering FK, Gunnewiek JMTK. Comparison of two point-of-care testing (POCT) devices for fetal lactate during labor. Clin Chem Lab Med 2011; 50:89-93. [PMID: 21955187 DOI: 10.1515/cclm.2011.734] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/09/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND Point-of-care testing (POCT) of fetal scalp blood lactate is used as an alternative for pH analysis. Lactate measurements have not been standardized and values vary with each device used. The aim of this study was to evaluate the performance of two POCT lactate meters for intrapartum use. METHODS Analytical performance of StatStrip Lactate (Nova Biomedical) and Lactate Pro (Arkray) was evaluated using CLSI EP10. Both POCT meters were compared with our lactate reference method (RapidLab 860; Siemens Healthcare Diagnostics) using fetal scalp and neonatal cord blood. Deming regression analysis was performed. RESULTS StatStrip Lactate coefficients of variation (CVs) were 5.1%, 5.0% and 2.6% at 0.9, 7.5 and 14.1 mmol/L lactate, respectively. CVs for Lactate Pro were 10.7%, 5.2% and 5.7% at 1.7, 4.1 and 6.4 mmol/L lactate, respectively. Consecutive lactate measurements in 37 fetal scalp and 122 cord blood samples revealed different test characteristics for the two POCT devices. In fetal scalp blood: StatStrip Lactate=1.13*RapidLab-0.39 (R(2)=0.907) and Lactate Pro=0.95*RapidLab-0.03 (R(2)=0.823). In cord artery blood: StatStrip Lactate=1.08*RapidLab-0.09 (R(2)=0.810) and Lactate Pro=0.72*RapidLab+0.59 (R(2)=0.807). CONCLUSIONS Overall performance of both Lactate Pro and StatStrip Lactate was good, with StatStrip Lactate having smallest CVs and closest correlation to our reference method. Both StatStrip Lactate and Lactate Pro can be used as a lactate POCT device for obstetric use.
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Affiliation(s)
- Ayesha M F Heinis
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Center, The Netherlands
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White CR, Mok T, Doherty DA, Henderson JJ, Newnham JP, Pennell CE. The effect of time, temperature and storage device on umbilical cord blood gas and lactate measurement: a randomized controlled trial. J Matern Fetal Neonatal Med 2011; 25:587-94. [DOI: 10.3109/14767058.2011.596959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kay HH, Zhu S, Tsoi S. Hypoxia and Lactate Production in Trophoblast Cells. Placenta 2007; 28:854-60. [PMID: 17275903 DOI: 10.1016/j.placenta.2006.11.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 11/14/2006] [Accepted: 11/15/2006] [Indexed: 12/20/2022]
Abstract
The etiology of preeclampsia is unknown but is thought to be related to hypoxia in the placenta. We previously reported that the enzyme lactate dehydrogenase (LDH) has increased activity and gene expression in placentas from preeclamptic pregnancies [Tsoi SCM, Zheng J, Xu F, Kay HH. Differential expression of lactate dehydrogenase isozymes (LDH) in human placenta with high expression of LDH-A(4) isozyme in the endothelial cells of pre-eclampsia villi. Placenta 2001;22:317-22]. LDH is responsible for pyruvate conversion to lactate through glycolysis. In this study, we further investigated the role of hypoxia in primary trophoblast cells and a cultured cell line, JEG3 cells, to obtain a better understanding of how it affects the activities of lactate dehydrogenase, lactate production and regulatory genes, as a possible model for preeclampsia. Primary trophoblast cells and JEG3 cells were cultured under 1% oxygen. At 6, 12 and 24h, cells were analyzed for LDHA and LDHB isozyme activities, mRNA and protein expression compared to standard culture conditions. Lactate was measured from cell medium. The hypoxia inducible transcription factor (HIF-1alpha) protein expression was confirmed by western blot. Two lactate transporters (MCT1 and MCT4) mRNA and protein expression were also studied under hypoxia. Finally, lactate was measured in plasma obtained from patients with severe preeclampsia. Under hypoxic conditions, LDHA mRNA is increased in primary trophoblast cells and JEG3 cells. The HIF-1alpha protein expression is higher in hypoxia-treated JEG3 cells than control. LDHA isozyme activity and its protein expression are increased most significantly at 24h of culture under hypoxia. However, LDHB protein is unchanged while its mRNA is decreased. Lactate secretion from JEG3 cells under hypoxia is increased, as is the lactate levels in the plasma from preeclampsia patients. Of the two lactate transporters studied, MCT4 mRNA and protein level are increased under hypoxia. Our findings support the role of hypoxia in inducing HIF-1alpha activity in trophoblasts and increasing LDH transcription as well as its activity. Higher levels of lactate are produced and secreted which may contribute to the higher lactate levels in plasma of preeclamptic patients. These mechanisms may be important in the pathophysiology of preeclampsia.
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Affiliation(s)
- H H Kay
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA.
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Allen RM, Bowling FG, Oats JJN. Determining the fetal scalp lactate level that indicates the need for intervention in labour. Aust N Z J Obstet Gynaecol 2004; 44:549-52. [PMID: 15598295 DOI: 10.1111/j.1479-828x.2004.00306.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fetal scalp lactate testing has been shown to be as useful as pH with added benefits. One remaining question is 'What level of lactate should trigger intervention in the first stage of labour?' AIMS This study aimed to establish the lactate level in the first stage of labour that indicates the need for intervention to ensure satisfactory outcomes for both babies and mothers. METHODS A prospective study at Mater Mothers' Hospital, Brisbane, Australia, a tertiary referral centre. One hundred and forty women in labour, with non-reassuring fetal heart rate traces, were tested using fetal blood scalp sampling of 5 microL of capillary blood tested on an Accusport (Boeringer, Mannheim, East Sussex, UK) lactate meter. Decision to intervene in labour was based on clinical assessment plus a predetermined cut off. Main outcome measures were APGAR scores, cord arterial pH, meconium stained liquor and Intensive Care Nursery admission. RESULTS Two-graph receiver operating characteristic (TG-ROC) analysis showed optimal specificity, and sensitivity for predicting adverse neonatal outcomes was a scalp lactate level above 4.2 mmol/L. CONCLUSIONS Fetal blood sampling remains the standard for further investigating-non-reassuring cardiotocograph (CTG) traces. Even so, it is a poor predictor of fetal outcomes. Scalp lactate has been shown to be at least as good a predictor as scalp pH, with the advantages of being easier, cheaper and with a lower rate of technical failure. Our study found that a cut off fetal scalp lactate level of 4.2 mmol/L, in combination with an assessment of the entire clinical picture, is a useful tool in identifying those women who need intervention.
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Affiliation(s)
- Rod M Allen
- Mater Hospital, South Brisbane, Queensland, Australia.
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Divi RL, Walker VE, Wade NA, Nagashima K, Seilkop SK, Adams ME, Nesel CJ, O'Neill JP, Abrams EJ, Poirier MC. Mitochondrial damage and DNA depletion in cord blood and umbilical cord from infants exposed in utero to Combivir. AIDS 2004; 18:1013-21. [PMID: 15096804 DOI: 10.1097/00002030-200404300-00009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although most uninfected infants born to women infected with HIV-1 show no clinical evidence of mitochondrial compromise, mitochondrial dysfunction has been reported in children born to women receiving zidovudine and/or lamivudine during pregnancy. In this pilot study we examined mitochondrial integrity in HIV-1-uninfected infants born to HIV-1-infected women receiving Combivir during pregnancy. DESIGN : Samples of umbilical cord and cord blood were obtained from HIV-1-uninfected infants born to either HIV-1-infected women receiving Combivir therapy during pregnancy (n = 10) or HIV-1-uninfected women (n = 9). METHODS Mitochondrial morphological integrity was examined in umbilical cords (n = 16) by electron microscopy and mtDNA quantity was determined in DNA from cord blood (n = 18) and umbilical cord (n = 18) by PCR-chemiluminescence immunoassay detection. RESULTS In umbilical cords from six of nine infants born to HIV-1-infected mothers taking Combivir moderate to severe mitochondrial morphological damage was observed (P = 0.011), while none of seven unexposed infants showed similar damage. Compared to unexposed infants, statistically significant mtDNA depletion was observed in umbilical cord (P = 0.006) and cord blood (P = 0.003) from drug-exposed infants. CONCLUSIONS A cohort of HIV-1-uninfected Combivir-exposed infants with no clinical symptoms showed morphological and molecular evidence of mitochondrial damage.
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Affiliation(s)
- Rao L Divi
- CDI Section, National Cancer Institute, NIH, Bethesda, Maryland 20892, USA
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Abstract
Lactate has been measured to evaluate fetal metabolic acidosis for some decades. However, not until the past few years have reliable lactate meters become available for bedside obstetric practice. The new technology, which requires only 5 microl blood, has reduced the sampling failure rate of fetal scalp blood to almost nil. A growing body of evidence has also shown lactate to be good at predicting neonatal outcome.
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Affiliation(s)
- L Nordström
- Department of Obstetrics and Gynaecology, Karolinska Institute, Söder Hospital, Stockholm, Sweden.
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