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Xu J, Yang B, Kong J, Zhang Y, Fang X. Real-Time Monitoring and Early Warning of a Cytokine Storm In Vivo Using a Wearable Noninvasive Skin Microneedle Patch. Adv Healthc Mater 2023; 12:e2203133. [PMID: 36857411 DOI: 10.1002/adhm.202203133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Indexed: 03/02/2023]
Abstract
A cytokine storm may be the last attack of various diseases, such as sepsis, cancer, and coronavirus disease 2019, that can be life threatening. Real-time monitoring of cytokines in vivo is helpful for assessing the immune status of patients and providing an early warning of a cytokine storm. In this study, a functional carbon nanotube biointerface-based wearable microneedle patches for real-time monitoring of a cytokine storm in vivo via electrochemical analysis are reported. This wearable system has sensitivity with a detection limit of 0.54 pg mL-1 , high specificity, and 5 days of stability with a coefficient of variation of 4.0%. The system also has a quick response of several hours (1-4 h) to increasing cytokines. This wearable microneedle patch may offer a promising route for real-time biomolecule wearables construction. The patch is also the first reported integrated capture and monitoring system that is capable of real-time measurement of protein markers in interstitial fluid.
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Affiliation(s)
- Jingxian Xu
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P. R. China
| | - Bin Yang
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, P. R. China
| | - Jilie Kong
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, P. R. China
| | - Yongjun Zhang
- Department of Neonatology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P. R. China
| | - Xueen Fang
- Department of Chemistry and Institutes of Biomedical Sciences, Fudan University, Shanghai, 200433, P. R. China
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2
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Himawan A, Vora LK, Permana AD, Sudir S, Nurdin AR, Nislawati R, Hasyim R, Scott CJ, Donnelly RF. Where Microneedle Meets Biomarkers: Futuristic Application for Diagnosing and Monitoring Localized External Organ Diseases. Adv Healthc Mater 2023; 12:e2202066. [PMID: 36414019 DOI: 10.1002/adhm.202202066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/03/2022] [Indexed: 11/24/2022]
Abstract
Extracellular tissue fluids are interesting biomatrices that have recently attracted scientists' interest. Many significant biomarkers for localized external organ diseases have been isolated from this biofluid. In the diagnostic and disease monitoring context, measuring biochemical entities from the fluids surrounding the diseased tissues may give more important clinical value than measuring them at a systemic level. Despite all these facts, pushing tissue fluid-based diagnosis and monitoring forward to clinical settings faces one major problem: its accessibility. Most extracellular tissue fluid, such as interstitial fluid (ISF), is abundant but hard to collect, and the currently available technologies are invasive and expensive. This is where novel microneedle technology can help tackle this significant obstacle. The ability of microneedle technology to minimally invasively access tissue fluid-containing biomarkers will enable ISF and other tissue fluid utilization in the clinical diagnosis and monitoring of localized diseases. This review attempts to present the current pursuit of the application of microneedle systems as a diagnostic and monitoring platform, along with the recent progress of biomarker detection in diagnosing and monitoring localized external organ diseases. Then, the potential use of various microneedles in future clinical diagnostics and monitoring of localized diseases is discussed by presenting the currently studied cases.
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Affiliation(s)
- Achmad Himawan
- School of Pharmacy, Queen's University Belfast, Belfast, BT97BL, UK.,Department of Pharmaceutical Science and Technology, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | | | - Andi Dian Permana
- Department of Pharmaceutical Science and Technology, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Sumarheni Sudir
- Department of Pharmacy, Faculty of Pharmacy, Hasanuddin University, Makassar, 90245, Indonesia
| | - Airin R Nurdin
- Department of Dermatology and Venereology, Faculty of Medicine, Hasanuddin University, Makassar, 90245, Indonesia.,Hasanuddin University Hospital, Hasanuddin University, Makassar, 90245, Indonesia
| | - Ririn Nislawati
- Hasanuddin University Hospital, Hasanuddin University, Makassar, 90245, Indonesia.,Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Makassar, 90245, Indonesia
| | - Rafikah Hasyim
- Department of Oral Biology, Faculty of Dentistry, Hasanuddin University, Makassar, 90245, Indonesia
| | - Christopher J Scott
- Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, Belfast, BT97BL, UK
| | - Ryan F Donnelly
- School of Pharmacy, Queen's University Belfast, Belfast, BT97BL, UK
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3
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Tang AL, Peng Y, Shen MJ, Liu XY, Li S, Xiong MC, Gao N, Hu TP, Zhang GQ. Prognostic role of elevated VEGF in sepsis: A systematic review and meta-analysis. Front Physiol 2022; 13:941257. [PMID: 35936894 PMCID: PMC9355294 DOI: 10.3389/fphys.2022.941257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The incidence and mortality of sepsis are increasing year by year, and there is still a lack of specific biomarkers to predict its prognosis. Prognostic value of vascular endothelial growth factor (VEGF) in predicting the severity and mortality of sepsis has been gradually discovered. Methods: Literature was searched through Embase, PubMed, Web of Science, China National Knowledge Infrastructure(CNKI) and Cochrane Library databases in March 2022. Observational studies, evaluating the impact of VEGF in sepsis outcomes (mortality and severity) are included in this meta-analysis. Risk of bias was assessed with the Newcastle-Ottawa Scale (NOS). Sensitivity and publication bias analyses were also assessed. Meta-regression analysis were performed to identify the potential sources of heterogeneity. Result: A total of 1,574 articles were retrieved from the systematic literature search. We included 20 studies for qualitative and quantitative analysis. Deceased and critically ill patients had higher baseline VEGF levels than survivors and non-severe patients. The pooled sensitivity and specificity for VEGF predicts sepsis mortality were 0.79and 0.76, respectively. the area under the SROC curve was 0.83. Conclusion: High VEGF are associated with poor clinical outcomes for patients diagnosed with sepsis. This study was recorded on PROSPERO, under the registration ID: CRD42022323079.
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Affiliation(s)
- A-ling Tang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Yu Peng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Mei-jia Shen
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Xiao-yu Liu
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Shan Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Meng-chen Xiong
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - Nan Gao
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Tian-peng Hu
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Guo-qiang Zhang
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
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4
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Zhang T, Lu B, Yang B, Zhang D, Shi X, Shen C, Cui H, Yuan X, Zhao D, Yang J, Hao Y, Chen X, Liu X, Zhang K, Zheng H. Component Identification and Analysis of Vesicular Fluid From Swine Infected by Foot-and-Mouth Disease Virus. Front Vet Sci 2022; 9:860978. [PMID: 35372527 PMCID: PMC8968935 DOI: 10.3389/fvets.2022.860978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Foot-and-mouth disease (FMD) is induced by FMD virus (FMDV) and characterized by fever and vesicular (blister-like) lesions. However, the exact composition of the vesicular fluid in pigs infected with FMDV remains unclear. To identify and analyze the components of the vesicular fluid in FMDV-infected domestic pigs, the fluid was collected and subjected to mass spectrometry. Further analyses were conducted using Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genome (KEGG), and protein–protein interaction (PPI). Quantitative ELISA kit for TNF-α, and IFN-α, IFN-β, IL-6, IL-10, IL-1β, and IFN-γ were used to verify the mass spectrometry results. Results showed that 937 proteins were identified in the vesicular fluid from swine after FMDV infection, and bioinformatics analysis indicated that these proteins are related to the innate immune and inflammation pathways. The levels of cytokines involved in the disease-related pathways, tumor necrosis factors, and IL-6 in the fluid samples were significantly increased. This study identified and analyzed the composition of vesicular fluid in pigs after FMD infection for the first time and provided interesting information that help understand the infection and pathogenesis mechanism of FMD. These information will eventually contribute to the prevention and control of FMD.
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Jaurila H, Koskela M, Koivukangas V, Gäddnäs F, Salo T, Ala-Kokko TI. Growth factor expression is enhanced and extracellular matrix proteins are depressed in healing skin wounds in septic patients compared with healthy controls. APMIS 2021; 130:155-168. [PMID: 34939229 PMCID: PMC9305760 DOI: 10.1111/apm.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/28/2022]
Abstract
Sepsis manifests as a dysregulated immune response to infection, damaging organs. Skin has a critical role in protecting the body. In sepsis, skin wound healing is impaired. The mechanisms behind it have been poorly studied. In this study, suction blister wounds were induced on intact abdominal skin in 15 septic patients. A single blister wound was biopsied from each patient and from 10 healthy controls. Immunohistochemical staining of growth factors and extracellular matrix (ECM) proteins was performed. Significance (p < 0.05) of the differences was calculated. The following growth factors were overexpressed in the skin of septic patients compared with healthy controls: epithelial growth factor (intact epithelium p = 0.007, migrating epithelium p = 0.038), vascular epithelial growth factor (intact epithelium p < 0.001, migrating epithelium p = 0.011) and transforming growth factor beta (migrating epithelium p = 0.002). The expression of syndecan‐1 was upregulated in the skin of septic patients compared with healthy controls (intact epithelium p = 0.048, migrating epithelium p = 0.028). The following ECM proteins had lower expression in the epithelium in septic patients than in healthy controls: tenascin‐C (migrating epithelium p = 0.03) and laminin‐332 (intact epithelium p = 0.036). In sepsis, growth factor and syndecan expression was enhanced, while ECM and basement membrane proteins were mostly depressed.
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Affiliation(s)
- Henna Jaurila
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, Finland
| | - Marjo Koskela
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Vesa Koivukangas
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Fiia Gäddnäs
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, Medical Research Center Oulu, University of Oulu, Finland.,Research Group of Oral Health Sciences, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Finland
| | - Tero I Ala-Kokko
- ¹Research Group of Surgery, Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland, Medical Research Center Oulu, University of Oulu, Finland
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Sjöbom U, Christenson K, Hellström A, Nilsson AK. Inflammatory Markers in Suction Blister Fluid: A Comparative Study Between Interstitial Fluid and Plasma. Front Immunol 2020; 11:597632. [PMID: 33224151 PMCID: PMC7670055 DOI: 10.3389/fimmu.2020.597632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Biomarker analysis allows for the detection and prediction of disease as well as health monitoring. The use of interstitial fluid (ISF) as a matrix for biomarkers has recently gained interest. This study aimed to compare levels of inflammatory markers in ISF from suction blister fluid (SBF) and plasma. Methods Plasma and SBF were collected from 18 healthy individuals. Samples were analyzed for 92 inflammation-related protein biomarkers by Proximity Extension Assay (PEA). Protein profiles in the two matrices were compared using traditional and multivariate statistics. Results Out of 92 targeted proteins, 70 were successfully quantified in both plasma and SBF. Overall, plasma and SBF displayed distinct protein profiles with up to 40-fold difference in abundance of specific proteins. The levels of 25 proteins were significantly correlated between plasma and SBF and several of these were recognized as potential markers to monitor health using ISF. Conclusions Skin ISF and plasma have unique protein profiles but many inflammatory markers are proportionally related between the matrices at the individual level. ISF is a promising biofluid for the monitoring of biomarkers in clinical studies and routine analyses.
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Affiliation(s)
- Ulrika Sjöbom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Christenson
- Department of Oral Microbiology and Immunology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders K Nilsson
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Khan MA, Mujahid M, Loo SCJ, Chamundeswari VN. Nanophotonics based label free detection mechanism for real-time monitoring of interleukin-6. NANOSCALE 2020; 12:9194-9207. [PMID: 32301466 DOI: 10.1039/d0nr01151g] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Magneto-photonic crystals/MPCs are promising candidates for devising high-fidelity embedded biosensor systems which offer facile & real time detection of diagnostic proteins. Despite extensive use of magnetic nanomaterials for theranostic applications, the idea of exploiting its photonic response when assembled as a colloid inside a matrix remains unexplored. Herein, we report a novel label free method for quantitative detection of interleukin 6 which is a widely used prognostic marker for multiple pathological conditions. Cobalt ferrite/CoF and magnetite nanoparticles with Ms of 74.8 and 77 emu g-1 were assembled inside a hydrogel matrix with the application of an external magnetic field. Through the use of click chemistry, detecting antibodies were immobilized on their surface. The interaction of interleukin 6 with the antibodies produces a blue-shift in resonant wavelength and the reflectance intensity increases up to 50% and 44% when tested with CoF & magnetite based MPC respectively at a concentration of 50 pg ml-1. The dynamic range of the sensor lies within the prognostic values of IL-6, and the integrated sensing mechanism proposed in this study provides an ideal platform for real-time management of sepsis in patients with higher degree burns.
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Affiliation(s)
- Munezza A Khan
- School of Materials Science & Engineering, Nanyang Technological University, Nanyang Avenue, Nanyanf Avenue, 639798, Singapore.
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8
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Tian R, Wang X, Pan T, Li R, Wang J, Liu Z, Chen E, Mao E, Tan R, Chen Y, Liu J, Qu H. Plasma PTX3, MCP1 and Ang2 are early biomarkers to evaluate the severity of sepsis and septic shock. Scand J Immunol 2019; 90:e12823. [PMID: 31489646 PMCID: PMC6900011 DOI: 10.1111/sji.12823] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
Sepsis is associated with significant mortality. Early diagnosis and prognosis of patients with sepsis is still a difficult clinical challenge. In this study, the ability of plasma PTX3 (pentraxin 3), MCP1 (monocyte chemoattractant protein 1) and Ang (angiopoietin)1/2 was investigated to evaluate the severity of sepsis. Blood samples were obtained from 43 patients with sepsis. A total of 33 post‐surgery patients with infections and 25 healthy individuals served as controls. The results showed that plasma PTX3, MCP1 and Ang2 significantly increased in patients on the first day of septic shock onset, while sepsis patients had significantly higher Ang2 level, compared with controls. Furthermore, PTX3, MCP1 and Ang2 had high AUROC values in patients with septic shock on the first day of sepsis onset. The findings suggest that PTX3, MCP1 and Ang2 maybe early predictors to evaluate the severity of sepsis and septic shock with the latest Sepsis 3.0 definitions.
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Affiliation(s)
- Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ranran Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiahui Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaojun Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Holm LL, Vukmanovic-Stejic M, Blauenfeldt T, Benfield T, Andersen P, Akbar AN, Ruhwald M. A Suction Blister Protocol to Study Human T-cell Recall Responses In Vivo. J Vis Exp 2018. [PMID: 30148487 PMCID: PMC6126709 DOI: 10.3791/57554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cutaneous antigen-recall models allow for studies of human memory responses in vivo. When combined with skin suction blister (SB) induction, this model offers accessibility to rare populations of antigen-specific T-cells representative of the cellular memory response as well as the cytokine microenvironment in situ. This report describes the practical procedure of a cutaneous recall, an SB induction, and a harvest of antigen-specific T-cells. To exemplify the method, the tuberculin skin test is used for antigenic recall in individuals who, prior to this study, underwent a Bacillus Calmette-Guérin vaccination against an infection with Mycobacterium tuberculosis. Finally, examples of multiplex and flow cytometric analyses of SB specimens are provided, illustrating high fractions of antigen-specific polyfunctional CD4+ T-cells available by this sampling method compared with cells isolated from the blood. The method described here is safe and minimally invasive, provides a unique opportunity to study both innate and adaptive immune responses in vivo, and may be beneficial to a broad community of researchers working with cell-mediated immunity and human memory responses, in the context of vaccine development.
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Affiliation(s)
- Line L Holm
- Department of Infectious Disease Immunology, Center for Vaccine Research, Statens Serum Institut; Department of Infectious Diseases, Hvidovre Hospital; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen;
| | | | - Thomas Blauenfeldt
- Department of Infectious Disease Immunology, Center for Vaccine Research, Statens Serum Institut
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
| | - Peter Andersen
- Department of Infectious Disease Immunology, Center for Vaccine Research, Statens Serum Institut
| | - Arne N Akbar
- Division of Infection and Immunity, University College London
| | - Morten Ruhwald
- Department of Infectious Disease Immunology, Center for Vaccine Research, Statens Serum Institut
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Pischke SE, Haugaa H, Haney M. A neglected organ in multiple organ failure - 'skin in the game'? Acta Anaesthesiol Scand 2017; 61:5-7. [PMID: 27918100 DOI: 10.1111/aas.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S. E. Pischke
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Department of Immunology and K.G. Jebsen IRC; University of Oslo; Oslo Norway
| | - H. Haugaa
- Department of Anaesthesiology; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
| | - M. Haney
- Anesthesiology and Intensive Care Medicine; Umeå University and the University Hospital of Umeå; Umeå Sweden
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