Misconception of Glycemic Control Algorithms (B. Wayne Bequette, 03 January 2012)
Hoekstra and coworkers [1] review the technologies available for computerized glucose regulation in the intensive care unit, but misrepresent the differences between two control algorithms, Proportional-Integral-Derivative (PID) and Model Predictive Control (MPC). The differences between PID and MPC are illustrated by an example of an automobile on a roadway. They claim that the driver using MPC determines his/her driving strategy before departing, and maintains that trajectory throughout the trip. They also claim that the driver using PID makes frequent control action changes based on the difference between the ¿ideal¿ and actual trajectory. The MPC scenario shown is largely incorrect. MPC looks into the future (down the roadway) and determines the best sequence of control actions (driving...
read full comment
I believe the last sentence of the abstract is still incorrect, despite an apparent previous correction. It should read that SIMV is the "least" effective method of weaning.
read full comment
Response of the authors (Laurent PAPAZIAN, 08 November 2011)
Dr. Yegneswaran and Dr. Murugan did an interesting analysis of the ACURASYS trial. Some comments should however be made in order to clarify certain...
read full comment
Ambiguous primary endpoint and late trial registration (Jim Thornton, 08 November 2011)
In addition to the potential bias, identified by the authors, arising from an open study and a subjective endpoint, I have two other worries....
read full comment
What were the hemoglobin levels? (David Whitlock, 08 November 2011)
This is very interesting. I appreciate that the conventional wisdom is that O2 levels are all important, but what is also important is the balance of O2 vs NO. It is NO that tonally inhibits mitochondrial reduction of O2 to water by blocking cytochrome c oxidase from binding O2. It is not O2 consumption that is necessary for cells to survive, it is sufficient ATP levels. In sepsis, ATP levels are actually higher than during non-sepsis (for those who survive).[1]...
read full comment
Diagnostic tools in kidney damage (Heikki Savolainen, 21 July 2011)
Dear Editor,
The elegant study by Prowle et al (1) shows that diminished diuresis is a good prognostic predictor. The kidney concentration capacity has been used as one of the earliest functional tests (2).
Renal (3) and extrarenal causes can cause oliguria and to understand them, determination of ion fluxes, erytrocytes and protein in the urine may be helpful (2). Altered excretion of proteoglycans in the urine are associated with frank proteinuria (4) and they may also be associated with a generalized capillary leak syndrome.
1 Prowle JR, et al. Oliguria as a predictive biomarker of acute kidney injury in critically ill patients. Crit Care 2011, 15: R17
2 Savolainen H. New uses for old urine tests. Brit J Ind Med 1989, 46: 361 ...
read full comment
Neurotoxicity of ketones (Heikki Savolainen, 25 May 2011)
Dear Editor,
The ideas raised in the review (1) are excellent. It is now clear that L-lactate, for example, has also important regulatory roles in addition to its fuel characteristics (2).
However, many diketones, e.g. methylglyoxal (3)and diketohexane (4), toxic. The former is a metabolite of glucose and the second is derived from n-hexane, an industrial solvent. The compounds can form so-called Schiff bases with the free amino groups in the polypeptides rendering them nonfunctional or directly harmful.
Lastly, the end metabolite of methylglyoxal is D-lactate which cannot be metabolized as well as the physiological L form. However, it is taken up by the same monocarboxylate transporters as L-lactate thus accumulating in the cells. While using the...
read full comment
RESPONSE TO THE LETTER (FRANCO TURANI, 24 May 2011)
Dear Nicola Stigliano , Thank you very much for your attention in our study and your consideration. Control of coagulation, in effect, is an important issue during CPFA. CPFA, as you know, requires a plasma filter, an additional Ultrafiltration filter and the cartridge for plasma adsorption, plus the extracorporeal circuit. So it’s possible, that coagulation may occur despite heparin infusion. Moreover thrombocitopenia, commonly observed during sepsis, may induce to decrease the infusion of heparin. What we observed in our study was a non significant different platelets count compared with standard CRTT treatment, More in detail, the platelets count decreased from 161.467 (basal time) to 116.464 (t1) and to 102.538 (t2). Only one Patient ( with...
read full comment
Real-time ultrasound guidance for percutaneous tracheostomy (Venkatakrishna Rajajee, 14 April 2011)
We would like to thank Drs. Tremblay and Scales for their thoughtful commentary on our feasibility study of real-time ultrasound guidance for percutaneous tracheostomy (PT). We agree wholeheartedly with their assessment that further study is required to clarify the benefits of this procedure. We would, however, like to address two specific issues that were raised in the commentary-
1. While actual indentation of the anterior tracheal wall was visible only in 4/13 cases in our series, the needle path was traceable up to the anterior tracheal wall in all 13 patients. The lack of indentation, in our opinion, does not reflect an inability to track to the point of penetration; rather, as is frequently seen during direct bronchoscopic visualization of tracheal puncture, the needle is...
read full comment
cpfa and serious thrombocitopenia... (nicola stigliano, 04 April 2011)
this work is very interesting.I would know what is the clinical strategy used by authors when their patients had a serious thrombocitopenia and is important to use CPFA.
Immunologic properties of heparin congeners (Heikki Savolainen, 25 March 2011)
Dear Editor,
The excellent review summarizes the salient points of heparin-induced thrombocytopenia (1). The immnunological features seem to include the circumstance that heparan sulfate (2) ,and thus heparin, may act as "docking" substrate for properdin, an alternate complement component.
The skin keratinocyte CD-44, i.e. epican, is also a heparan sulfate proteoglycan so that skin lesions associated with heparan could be caused by an analogous mechanism.
1 Sakr Y. Heparin-induced thrombocytopenia in the ICU: an overview. Critical Care 2011; 15: 211
2 Zaferani A, et al. Identification of tubular heparan sulfate as a docking platform for the alternative complement component properdin in proteinuric renal disease. J biol Chem 2011; 286: 5423...
read full comment
A single center retrospective study is a poor match for a multicenter prospective randomized controlled trial (Nathaniel Usoro, 24 February 2011)
A single center retrospective cohort study cannot rationally be used to overturn the findings and conclusions of a multicenter prospective randomised controlled trial supported by several other studies (Marik & Corwin, 2008). Using such a study to support blood transfusion, a war-time practice that crept into civilian medicine 'through the back door' so to speak, and that is obviously on the way out courtesy of Evidence Based Medicine, is like using retrospective data to prove that analogue technology is superior to digital. New TRICCs or no, blood transfusion remains a hazardous treatment of unproven efficacy and proven adverse outcome (Rawn, 2008). It may yet turn out to be the biggest scandal in modern medical practice.
read full comment
Family involvent in EOL (George Mixides, 13 January 2011)
From the data reported in table 7 of the paper by Kranidiotis et al, one concludes that family involvement in EOL in the included ICUs is a rare occurrence. As one of the Intensivists of one of these ICUs, I submit that this is not an accurate account. In our unit it is never an option to withdraw, withhold or not escalate therapy without the family being involved in the decision. What is not uncommon is withholding CPR in dying patients without specifically asking the family, because we think that this will not be comprehended by most families and because we consider it unethical to perform CPR on a patient that will surely die (e.g. refractory septic or cardiogenic shock or refractory ARDS). Since data from individual ICUs are not shown, I cannot explain this discrepancy....
read full comment
Appropriateness of Cox models for Assessing Predictors (Eduard Vasilevskis, 04 November 2010)
Our previous letter to the editor(1) created some unanticipated errors in communication that prompted us to write this second letter with the hope of leaving the readership with factual knowledge of this confusing topic regarding the best methods by which to assess predictor relationships from cohort studies. Specifically, we want to address the statement by van den Boogaard and colleagues that Cox regression methods are not valid for assessing delirium as a predictor of mortality.(1) The authors support this opinion by inappropriately citing work by Steyerberg(2) and Cook.(3) We could not find any statement in these references that claimed that Cox models are inappropriate for assessing predictors. In fact, Steyerberg stated that Cox models are more than appropriate for modeling...
read full comment
Haemodynamic improvement : does fluid balance matter ? (Didier Journois, 01 October 2010)
Unfortunately the hydric and electrolytic status of the patients is not reported. One must agree that both macro and micro haemodynamic status are likely to be influenced by this balance. If patients were at Na = 130 mmol/L, exchanging this plasma water with a solution at Na = 140 mmol/L is to be considered as an important fluid loading ! read full comment
Mechanism of hydrogen sulfide effects (Heikki Savolainen, 21 September 2010)
Dear Editor,
Hydrogen sulfide is a notorious inhibitor of the cytochrome oxidase activity at the end of the mitochondrial respiratory chain (1). This explains the lethality of the gas exposure accidents and decreased consumption of oxygen in the brain (1).
The elegant work by Ganster et al. (2) shows beneficial effects in the vascular system by a much lower dose. One might ask whether the mechanisms of these are other than the inhibition of oxygen metabolism. Hydrosulfide salts are also very alkaline and it may be asked whether this plays a role in a direct infusion as well.
1 Rafalowska U, Zitting A, Savolainen H. Metabolic changes in rat brain synaptosomes after exposure to sulfide in vivo. Toxicol Lett 1986; 34: 193-200
Dependence of endothelial function and blood flow on insulin and glucose levels (IVAN ZURAN, 21 September 2010)
Dependence of endothelial function and blood flow on insulin and glucose levels Pavel Poredoš1 and Ivan Žuran2 1Clinical Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška c. 2,1000 Ljubljana, Slovenia 2 Department of Angiology, Endocrinology and Rheumatology, General Hospital Celje, Oblakova ul.5, 3000 Celje, Slovenia
Commentary
In the commentary published in Critical Care, 2010, 14: 122 related to the article by Žuran and collaborators [1], Van den Berghe highlighted the involvement of insulin and glucose levels in the regulation of blood flow, and the clinical relevance of changes in forearm blood flow in critically ill patients [2]. In the study conducted by Žuran and co-workers it was...
read full comment
Methodological issues in measuring circulating endothelial cells to detect endothelial dysfunction (Bart Ramakers, 18 June 2010)
To the editor: Referring to the article of Fink et al. [1] we consider it important to discuss a major drawback using circulating endothelial cells (CECs) as a marker of endothelial dysfunction. There is a wide variety in techniques to measure CECs and endothelial progenitor cells (EPCs). Only in the field of oncology there seems to be consensus that CECs and EPCs can properly be distinguished from other cells using: CD31, CD34, CD45, CD133, CD146 and VEGF. Fink et al. used CD146 and CD45 to detect CECs after ferromagnetic separation. Since, e.g., smooth muscle cells, parenchyma cells and hematopoietic stem cells express the same markers this method is rather nonspecific. In healthy subjects, CECs do not exceed 0.7±0.3 cells/ml, while during septic shock, also associated with...
read full comment
I am sorry to report that, in reading over the published manuscript, I found the following error which I wish to point out – it does not significantly alter the meaning of the paper
Page 6, Results, Longitudinal changes in RH-PAT and L-arginine. “Mean plasma L-arginine concentrations increased from baseline to day 2 to 4 (95% CI: 38.2 to 49.9 µmol/L)” – should say: . . . (Mean [95% CI]: 38.2 µmol/L [33.7-42.6] to 49.9 [39.2-60.6], p=0.01).
Complexities of glycemic control (Heikki Savolainen, 16 June 2010)
Dear Editor,
The erudite review presents comprehensively the complexity of the management of hyperglycemia in a critical illness (1).
Treatment with insulin or with an other hypoglycemia-inducing agent causes the circulating glucose to enter in the responsive cells to be metabolised in them. Some of the downward metabolites, methylglyoxal and D-lactic acid (2), may hamper the cell functions.
Increased intracellular glucose concentrations may also initiate "Warburg effect"-like metabolic changes (3) if the oxygen delivery to the cells is simultaneously compromised. They include e.g. the activation of signal transduction pathways (3).
Thus, the correct treatment of hyperglycemia remains an unsettled issue until a firmer idea of the metabolic...
read full comment
Vitamin D can reduce the risk of pneumonia following influenza infection (William B. Grant, 16 June 2010)
A recent paper stated “Influenza may be complicated by bacterial pneumonia. .. At present, antibiotic treatment appears to be the only therapeutic option for postinfluenza pneumonia.” [1] However, this paper overlooks recent evidence that vitamin D can reduce the risk of both type A influenza and pneumonia. A randomized controlled trial involving school children in Japan found a 64% reduced risk of type A influenza for those taking 1200 IU/day of vitamin D versus 200 IU/day [2]. An ecological study based on case-fatality rates of those infected by influenza in 12 U.S. communities during the 1918-19 pandemic influenza found indices of solar ultraviolet B (UVB) doses explained 50% of the variance [3]. A study in Turkey found childhood pneumonia was frequently associated with...
read full comment
RSS
Latest comments
Importance of Metabolic Acidemia (Viktor Rosival, 03 January 2012)
In the recent study of Jung et al [l] there are some discrepancies with the... read full comment
Comment on: Jung et al. Critical Care, 15:R238
Misconception of Glycemic Control Algorithms (B. Wayne Bequette, 03 January 2012)
Hoekstra and coworkers [1] review the technologies available for computerized glucose regulation in the intensive care unit, but misrepresent the differences between two control algorithms, Proportional-Integral-Derivative (PID) and Model Predictive Control (MPC). The differences between PID and MPC are illustrated by an example of an automobile on a roadway. They claim that the driver using MPC determines his/her driving strategy before departing, and maintains that trajectory throughout the trip. They also claim that the driver using PID makes frequent control action changes based on the difference between the ¿ideal¿ and actual trajectory. The MPC scenario shown is largely incorrect. MPC looks into the future (down the roadway) and determines the best sequence of control actions (driving... read full comment
Comment on: Hoekstra et al. Critical Care, 13:223
typo (Jon Borger, 03 January 2012)
I believe the last sentence of the abstract is still incorrect, despite an apparent previous correction. It should read that SIMV is the "least" effective method of weaning. read full comment
Comment on: Alía et al. Critical Care, 4:72
Response of the authors (Laurent PAPAZIAN, 08 November 2011)
Dr. Yegneswaran and Dr. Murugan did an interesting analysis of the ACURASYS trial. Some comments should however be made in order to clarify certain... read full comment
Comment on: Yegneswaran et al. Critical Care, 15:311
Ambiguous primary endpoint and late trial registration (Jim Thornton, 08 November 2011)
In addition to the potential bias, identified by the authors, arising from an open study and a subjective endpoint, I have two other worries.... read full comment
Comment on: Ducloy-Bouthors et al. Critical Care, 15:R117
What were the hemoglobin levels? (David Whitlock, 08 November 2011)
This is very interesting. I appreciate that the conventional wisdom is that O2 levels are all important, but what is also important is the balance of O2 vs NO. It is NO that tonally inhibits mitochondrial reduction of O2 to water by blocking cytochrome c oxidase from binding O2. It is not O2 consumption that is necessary for cells to survive, it is sufficient ATP levels. In sepsis, ATP levels are actually higher than during non-sepsis (for those who survive).[1]... read full comment
Comment on: Velissaris et al. Critical Care, 15:R177
Info (Mark Jason, 08 November 2011)
Thank you for sharing such useful information. It contains that basic info which everyone should know. read full comment
Comment on: Brindley Critical Care, 14:217
Request for Clarification of Randomization Method (James Munis, 16 August 2011)
Dear Editor... read full comment
Comment on: Benes et al. Critical Care, 14:R118
Diagnostic tools in kidney damage (Heikki Savolainen, 21 July 2011)
Dear Editor,
The elegant study by Prowle et al (1) shows that diminished diuresis is a good prognostic predictor. The kidney concentration capacity has been used as one of the earliest functional tests (2).
Renal (3) and extrarenal causes can cause oliguria and to understand them, determination of ion fluxes, erytrocytes and protein in the urine may be helpful (2). Altered excretion of proteoglycans in the urine are associated with frank proteinuria (4) and they may also be associated with a generalized capillary leak syndrome.
1 Prowle JR, et al. Oliguria as a predictive biomarker of acute kidney injury in critically ill patients. Crit Care 2011, 15: R17
2 Savolainen H. New uses for old urine tests. Brit J Ind Med 1989, 46: 361
... read full comment
Comment on: Prowle et al. Critical Care, 15:R172
RRT modalities (Jean-Michel Lannoy, 07 June 2011)
Considering RRT modalities and own impact, it should be describe RRT technics (HD, CVVH, CVVHD, CVVHDF)performed for this study read full comment
Comment on: Chou et al. Critical Care, 15:R134
Neurotoxicity of ketones (Heikki Savolainen, 25 May 2011)
Dear Editor,
The ideas raised in the review (1) are excellent. It is now clear that L-lactate, for example, has also important regulatory roles in addition to its fuel characteristics (2).
However, many diketones, e.g. methylglyoxal (3)and diketohexane (4), toxic. The former is a metabolite of glucose and the second is derived from n-hexane, an industrial solvent. The compounds can form so-called Schiff bases with the free amino groups in the polypeptides rendering them nonfunctional or directly harmful.
Lastly, the end metabolite of methylglyoxal is D-lactate which cannot be metabolized as well as the physiological L form. However, it is taken up by the same monocarboxylate transporters as L-lactate thus accumulating in the cells. While using the... read full comment
Comment on: White et al. Critical Care, 15:219
RESPONSE TO THE LETTER (FRANCO TURANI, 24 May 2011)
Dear Nicola Stigliano ,
Thank you very much for your attention in our study and your consideration.
Control of coagulation, in effect, is an important issue during CPFA.
CPFA, as you know, requires a plasma filter, an additional Ultrafiltration filter and the cartridge for plasma adsorption, plus the extracorporeal circuit. So it’s possible, that coagulation may occur despite heparin infusion.
Moreover thrombocitopenia, commonly observed during sepsis, may induce to decrease the infusion of heparin.
What we observed in our study was a non significant different platelets count compared with standard CRTT treatment, More in detail, the platelets count decreased from 161.467 (basal time) to 116.464 (t1) and to 102.538 (t2). Only one Patient ( with... read full comment
Comment on: Turani et al. Critical Care, 15:P117
Real-time ultrasound guidance for percutaneous tracheostomy (Venkatakrishna Rajajee, 14 April 2011)
We would like to thank Drs. Tremblay and Scales for their thoughtful commentary on our feasibility study of real-time ultrasound guidance for percutaneous tracheostomy (PT). We agree wholeheartedly with their assessment that further study is required to clarify the benefits of this procedure. We would, however, like to address two specific issues that were raised in the commentary-
1. While actual indentation of the anterior tracheal wall was visible only in 4/13 cases in our series, the needle path was traceable up to the anterior tracheal wall in all 13 patients. The lack of indentation, in our opinion, does not reflect an inability to track to the point of penetration; rather, as is frequently seen during direct bronchoscopic visualization of tracheal puncture, the needle is... read full comment
Comment on: Tremblay et al. Critical Care, 15:147
cpfa and serious thrombocitopenia... (nicola stigliano, 04 April 2011)
this work is very interesting.I would know what is the clinical strategy used by authors when their patients had
a serious thrombocitopenia and is important to use CPFA.
Thank you for attention read full comment
Comment on: Turani et al. Critical Care, 15:P117
Immunologic properties of heparin congeners (Heikki Savolainen, 25 March 2011)
Dear Editor,
The excellent review summarizes the salient points of heparin-induced thrombocytopenia (1). The immnunological features seem to include the circumstance that heparan sulfate (2) ,and thus heparin, may act as "docking" substrate for properdin, an alternate complement component.
The skin keratinocyte CD-44, i.e. epican, is also a heparan sulfate proteoglycan so that skin lesions associated with heparan could be caused by an analogous mechanism.
1 Sakr Y. Heparin-induced thrombocytopenia in the ICU: an overview. Critical Care 2011; 15: 211
2 Zaferani A, et al. Identification of tubular heparan sulfate as a docking platform for the alternative complement component properdin in proteinuric renal disease. J biol Chem 2011; 286: 5423... read full comment
Comment on: Sakr Critical Care, 15:211
A single center retrospective study is a poor match for a multicenter prospective randomized controlled trial (Nathaniel Usoro, 24 February 2011)
A single center retrospective cohort study cannot rationally be used to overturn the findings and conclusions of a multicenter prospective randomised controlled trial supported by several other studies (Marik & Corwin, 2008). Using such a study to support blood transfusion, a war-time practice that crept into civilian medicine 'through the back door' so to speak, and that is obviously on the way out courtesy of Evidence Based Medicine, is like using retrospective data to prove that analogue technology is superior to digital. New TRICCs or no, blood transfusion remains a hazardous treatment of unproven efficacy and proven adverse outcome (Rawn, 2008). It may yet turn out to be the biggest scandal in modern medical practice. read full comment
Comment on: Walsh Critical Care, 14:170
Family involvent in EOL (George Mixides, 13 January 2011)
From the data reported in table 7 of the paper by Kranidiotis et al, one concludes that family involvement in EOL in the included ICUs is a rare occurrence.
As one of the Intensivists of one of these ICUs, I submit that this is not an accurate account. In our unit it is never an option to withdraw, withhold or not escalate therapy without the family being involved in the decision. What is not uncommon is withholding CPR in dying patients without specifically asking the family, because we think that this will not be comprehended by most families and because we consider it unethical to perform CPR on a patient that will surely die (e.g. refractory septic or cardiogenic shock or refractory ARDS).
Since data from individual ICUs are not shown, I cannot explain this discrepancy.... read full comment
Comment on: Kranidiotis et al. Critical Care, 14:R228
Appropriateness of Cox models for Assessing Predictors (Eduard Vasilevskis, 04 November 2010)
Our previous letter to the editor(1) created some unanticipated errors in communication that prompted us to write this second letter with the hope of leaving the readership with factual knowledge of this confusing topic regarding the best methods by which to assess predictor relationships from cohort studies. Specifically, we want to address the statement by van den Boogaard and colleagues that Cox regression methods are not valid for assessing delirium as a predictor of mortality.(1) The authors support this opinion by inappropriately citing work by Steyerberg(2) and Cook.(3) We could not find any statement in these references that claimed that Cox models are inappropriate for assessing predictors. In fact, Steyerberg stated that Cox models are more than appropriate for modeling... read full comment
Comment on: Vasilevskis et al. Critical Care, 14:449
Haemodynamic improvement : does fluid balance matter ? (Didier Journois, 01 October 2010)
Unfortunately the hydric and electrolytic status of the patients is not reported. One must agree that both macro and micro haemodynamic status are likely to be influenced by this balance. If patients were at Na = 130 mmol/L, exchanging this plasma water with a solution at Na = 140 mmol/L is to be considered as an important fluid loading !
read full comment
Comment on: Ruiz et al. Critical Care, 14:R170
Mechanism of hydrogen sulfide effects (Heikki Savolainen, 21 September 2010)
Dear Editor,
Hydrogen sulfide is a notorious inhibitor of the cytochrome oxidase activity at the end of the mitochondrial respiratory chain (1). This explains the lethality of the gas exposure accidents and decreased consumption of oxygen in the brain (1).
The elegant work by Ganster et al. (2) shows beneficial effects in the vascular system by a much lower dose. One might ask whether the mechanisms of these are other than the inhibition of oxygen metabolism. Hydrosulfide salts are also very alkaline and it may be asked whether this plays a role in a direct infusion as well.
1 Rafalowska U, Zitting A, Savolainen H. Metabolic changes in rat brain synaptosomes after exposure to sulfide in vivo. Toxicol Lett 1986; 34: 193-200
2 Ganster F... read full comment
Comment on: Ganster et al. Critical Care, 14:R165
Dependence of endothelial function and blood flow on insulin and glucose levels (IVAN ZURAN, 21 September 2010)
Dependence of endothelial function and blood flow on insulin and glucose levels
Pavel Poredoš1 and Ivan Žuran2
1Clinical Department of Vascular Diseases, University Medical Centre Ljubljana, Zaloška c. 2,1000 Ljubljana, Slovenia
2 Department of Angiology, Endocrinology and Rheumatology, General Hospital Celje, Oblakova ul.5, 3000 Celje, Slovenia
Commentary
In the commentary published in Critical Care, 2010, 14: 122 related to the article by Žuran and collaborators [1], Van den Berghe highlighted the involvement of insulin and glucose levels in the regulation of blood flow, and the clinical relevance of changes in forearm blood flow in critically ill patients [2]. In the study conducted by Žuran and co-workers it was... read full comment
Comment on: Žuran et al. Critical Care, 13:R198
Methodological issues in measuring circulating endothelial cells to detect endothelial dysfunction (Bart Ramakers, 18 June 2010)
To the editor: Referring to the article of Fink et al. [1] we consider it important to discuss a major drawback using circulating endothelial cells (CECs) as a marker of endothelial dysfunction. There is a wide variety in techniques to measure CECs and endothelial progenitor cells (EPCs). Only in the field of oncology there seems to be consensus that CECs and EPCs can properly be distinguished from other cells using: CD31, CD34, CD45, CD133, CD146 and VEGF. Fink et al. used CD146 and CD45 to detect CECs after ferromagnetic separation. Since, e.g., smooth muscle cells, parenchyma cells and hematopoietic stem cells express the same markers this method is rather nonspecific.
In healthy subjects, CECs do not exceed 0.7±0.3 cells/ml, while during septic shock, also associated with... read full comment
Comment on: Fink et al. Critical Care, 14:R104
Erratum (Joshua Davis, 17 June 2010)
I am sorry to report that, in reading over the published manuscript, I found the following error which I wish to point out – it does not significantly alter the meaning of the paper
Page 6, Results, Longitudinal changes in RH-PAT and L-arginine.
“Mean plasma L-arginine concentrations increased from baseline to day 2 to 4 (95% CI: 38.2 to 49.9 µmol/L)” – should say: . . . (Mean [95% CI]: 38.2 µmol/L [33.7-42.6] to 49.9 [39.2-60.6], p=0.01).
Dr Joshua Davis
read full comment
Comment on: Davis et al. Critical Care, 13:R155
Complexities of glycemic control (Heikki Savolainen, 16 June 2010)
Dear Editor,
The erudite review presents comprehensively the complexity of the management of hyperglycemia in a critical illness (1).
Treatment with insulin or with an other hypoglycemia-inducing agent causes the circulating glucose to enter in the responsive cells to be metabolised in them. Some of the downward metabolites, methylglyoxal and D-lactic acid (2), may hamper the cell functions.
Increased intracellular glucose concentrations may also initiate "Warburg effect"-like metabolic changes (3) if the oxygen delivery to the cells is simultaneously compromised. They include e.g. the activation of signal transduction pathways (3).
Thus, the correct treatment of hyperglycemia remains an unsettled issue until a firmer idea of the metabolic... read full comment
Comment on: Schultz et al. Critical Care, 14:223
Vitamin D can reduce the risk of pneumonia following influenza infection (William B. Grant, 16 June 2010)
A recent paper stated “Influenza may be complicated by bacterial pneumonia. .. At present, antibiotic treatment appears to be the only therapeutic option for postinfluenza pneumonia.” [1] However, this paper overlooks recent evidence that vitamin D can reduce the risk of both type A influenza and pneumonia. A randomized controlled trial involving school children in Japan found a 64% reduced risk of type A influenza for those taking 1200 IU/day of vitamin D versus 200 IU/day [2]. An ecological study based on case-fatality rates of those infected by influenza in 12 U.S. communities during the 1918-19 pandemic influenza found indices of solar ultraviolet B (UVB) doses explained 50% of the variance [3]. A study in Turkey found childhood pneumonia was frequently associated with... read full comment
Comment on: van der Sluijs et al. Critical Care, 14:219