Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:26 November 2012
Reviewer: Faouzi Saliba
Reviewer's report:
This is an experimental study performed in a model of Acute liver failure in pigs.
The authors compared an investigational albumin dialysis system (Hepawash®)
in 6 pigs compared to 4 controls and 2 other pigs treated with the MARS®
system.
Major Compulsory Revisions
1. There is major confusion in the introduction mixing acute liver failure and acute
on chronic liver failure. These are two different entities. The work in this paper
focused on an acute liver failure pig model. Therefore, the authors should rewrite
all introduction focusing only on ALF populations.
2. The authors took a reference N°1 from the Cochrane database (2004) by Liu
JP et al. This could be repkaced by a more recent one published in British
Journal of Surgery (2011)
3. In introduction. The RELIEF and HELIOS study has no place in this
intrioduction as these were not ALF patients. Other types of liver support systems
have also been evaluated with similar results (13-17). Please keep references on
ALF.
4. The number of animals treated is confusing. In methods it is stated control
group (n=5) and one animal was excluded and the figures illustrates n=5.
Otherwise the sentence needs to be reformulated.
5. Discrepancy between randomization Hepawash (n=6) and MARS (n=2) !!
6a. The timing is confusing throughout the manuscript. In figure 2, should appear
T4, T8 and T12.
6b. As it took a mean of 3 1/4 hours to reach a CPP of 45 mmHg (2-5h). Did all
animal received an 8 hour treatment ?
6c. Do that mean that all animals were sacrified or died at end of treatment ?
7. In results A survival curve could be more accurate till 13 hours when animal
were sacrified.
8. The cerebral perfusion pressure in liver failure sentence could be better within
the Cerebral parameters.
9. In Discussion. the authors should compare their animal model of ALF to
existing models
10. The data on the 2 animals treated with MARS and ICP has not been
previously observed in other reports. Did these 2 animals had the same model of
surgery, drugs during treatment and at end of treatment ? Was there any volume
or albumin reconstitition at end of therapy ?
Minor Essential Revisions
11. Some differences are found between tables and the Results in the
manuscript ie. in hemaodynamics. All values in tables should be expressed with
mean and SD.
12. Do figure the numer of animal per group and at each remaining time in both
table 1 and 2
13. Number of figures to be reduced.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I have received speaker's fees from Gambro
Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:26 November 2012
Reviewer: Faouzi Saliba
Reviewer's report:
This is an experimental study performed in a model of Acute liver failure in pigs.
The authors compared an investigational albumin dialysis system (Hepawash®)
in 6 pigs compared to 4 controls and 2 other pigs treated with the MARS®
system.
Major Compulsory Revisions
1. There is major confusion in the introduction mixing acute liver failure and acute
on chronic liver failure. These are two different entities. The work in this paper
focused on an acute liver failure pig model. Therefore, the authors should rewrite
all introduction focusing only on ALF populations.
2. The authors took a reference N°1 from the Cochrane database (2004) by Liu
JP et al. This could be repkaced by a more recent one published in British
Journal of Surgery (2011)
3. In introduction. The RELIEF and HELIOS study has no place in this
intrioduction as these were not ALF patients. Other types of liver support systems
have also been evaluated with similar results (13-17). Please keep references on
ALF.
4. The number of animals treated is confusing. In methods it is stated control
group (n=5) and one animal was excluded and the figures illustrates n=5.
Otherwise the sentence needs to be reformulated.
5. Discrepancy between randomization Hepawash (n=6) and MARS (n=2) !!
6a. The timing is confusing throughout the manuscript. In figure 2, should appear
T4, T8 and T12.
6b. As it took a mean of 3 1/4 hours to reach a CPP of 45 mmHg (2-5h). Did all
animal received an 8 hour treatment ?
6c. Do that mean that all animals were sacrified or died at end of treatment ?
7. In results A survival curve could be more accurate till 13 hours when animal
were sacrified.
8. The cerebral perfusion pressure in liver failure sentence could be better within
the Cerebral parameters.
9. In Discussion. the authors should compare their animal model of ALF to
existing models
10. The data on the 2 animals treated with MARS and ICP has not been
previously observed in other reports. Did these 2 animals had the same model of
surgery, drugs during treatment and at end of treatment ? Was there any volume
or albumin reconstitition at end of therapy ?
Minor Essential Revisions
11. Some differences are found between tables and the Results in the
manuscript ie. in hemaodynamics. All values in tables should be expressed with
mean and SD.
12. Do figure the numer of animal per group and at each remaining time in both
table 1 and 2
13. Number of figures to be reduced.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I have received speaker's fees from Gambro
Please review this paper.
user
Reviewer's report
Title:Evaluation the Hepa Wash(R) treatment in pigs with acute liver failure
Version: 1Date:26 November 2012
Reviewer: Faouzi Saliba
Reviewer's report:
This is an experimental study performed in a model of Acute liver failure in pigs.
The authors compared an investigational albumin dialysis system (Hepawash®)
in 6 pigs compared to 4 controls and 2 other pigs treated with the MARS®
system.
Major Compulsory Revisions
1. There is major confusion in the introduction mixing acute liver failure and acute
on chronic liver failure. These are two different entities. The work in this paper
focused on an acute liver failure pig model. Therefore, the authors should rewrite
all introduction focusing only on ALF populations.
2. The authors took a reference N°1 from the Cochrane database (2004) by Liu
JP et al. This could be repkaced by a more recent one published in British
Journal of Surgery (2011)
3. In introduction. The RELIEF and HELIOS study has no place in this
intrioduction as these were not ALF patients. Other types of liver support systems
have also been evaluated with similar results (13-17). Please keep references on
ALF.
4. The number of animals treated is confusing. In methods it is stated control
group (n=5) and one animal was excluded and the figures illustrates n=5.
Otherwise the sentence needs to be reformulated.
5. Discrepancy between randomization Hepawash (n=6) and MARS (n=2) !!
6a. The timing is confusing throughout the manuscript. In figure 2, should appear
T4, T8 and T12.
6b. As it took a mean of 3 1/4 hours to reach a CPP of 45 mmHg (2-5h). Did all
animal received an 8 hour treatment ?
6c. Do that mean that all animals were sacrified or died at end of treatment ?
7. In results A survival curve could be more accurate till 13 hours when animal
were sacrified.
8. The cerebral perfusion pressure in liver failure sentence could be better within
the Cerebral parameters.
9. In Discussion. the authors should compare their animal model of ALF to
existing models
10. The data on the 2 animals treated with MARS and ICP has not been
previously observed in other reports. Did these 2 animals had the same model of
surgery, drugs during treatment and at end of treatment ? Was there any volume
or albumin reconstitition at end of therapy ?
Minor Essential Revisions
11. Some differences are found between tables and the Results in the
manuscript ie. in hemaodynamics. All values in tables should be expressed with
mean and SD.
12. Do figure the numer of animal per group and at each remaining time in both
table 1 and 2
13. Number of figures to be reduced.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I have received speaker's fees from Gambro
assistant