Errata for Mushtaq et al. BMC Pediatrics 2011, 11:114 (Muhammad Umair Mushtaq, 07 March 2012)
Since the publication of our article, we have noted a typographical error in the final published version, for which the corresponding author accepts full responsibility. Page reference is to the final PDF version.
Page 3, Results (sentence 10, lines 16-17): "Mean (SD) BMI was 20.7 (5.02) kg/m2..." should read "Mean (SD) BMI was 16.0 (3.0) kg/m2...¿
dominant effect of protein (Peter Woolf, 17 March 2011)
I'm curious about the protein composition of the two diets. As you show in Table 1, the beef diet adds 13 or 19.5 g of protein for the 6-12 and 13-18 month range, while the cereal diet adds only 3.07 or 4.60 for each group.
RDA values for protein for infants up to 12 months are 13-14 g/day while for 1-3 years old is 16 g/day. In this case, the beef is providing 100% or more of the infant's RDA of protein, while the cereal is providing only ~20%.
The role of dietary protein on linear growth is well established when protein is limiting--which is likely to be the case here.
It would be interesting if in the study you also measured/estimated the protein intake per infant in both groups in each location. This would help to tease out the role of...
read full comment
Interesting paper (Jonas Ludvigsson, 14 January 2011)
I often work in the pediatric emergency unit and this is something I have been thinking about. Interesting to find that a visit to the emergency department was not associated with an increased risk of infection in children. Jonas F Ludvigsson, Sweden
read full comment
ignoring 100ys of independent research (Lucija Tomljenovic, 23 September 2010)
The regulatory authorities have been successful in their strategy of ignoring independent research, ever since 1911.
“These studies have convinced me that the use in food of aluminium or any other aluminium compound is a dangerous practice. That the aluminium ion is very toxic is well known. That aluminized food yields soluble aluminium compounds to gastric juice (and stomach contents) has been demonstrated. That such soluble aluminium is in part absorbed and carried to all parts of the body by the blood can no longer be doubted. That the organism can "tolerate" such treatment without suffering harmful consequences has not been shown. It is believed that the facts in this paper will give emphasis to my conviction that aluminium should be excluded from food” WJ Gies...
read full comment
I think the concern of Chris and his collegues is reasonable, the problem raised by them is common over the world. I hope it can be taken into consideration, emphosized and resolved by authorities and producers.
read full comment
Complacency and Regulation of Aluminium in Food (Chris Exley, 15 September 2010)
In spite of the clear results and recommendations of our study the Food Standards Agency (FSA) in the UK has not made any official comment regarding our findings. The Food Safety Act of 2007 (updated in 2008) specifically states under article 5 that infant formulas should not contain anything which might 'endanger the health of infants and young children'. The Chief Scientist at the FSA, Andrew Wadge, responding to my enquiry on his blog has said that the aluminium content of most infant formulas are within the tolerable weekly limit (TWI) of 1 mg/kg body weight, set by the Joint FAO/WHO Expert Committee on Food Additives,20-29 June 2006, Rome. He concedes that there are no regulatory requirements for aluminium in food. He does not mention that the TWI set by the aforementioned committee is...
read full comment
Spectrographic murmur analysis (Vladimir Kudriavtsev, 17 August 2010)
Reader may want to review another publication from BMC on the same subject http://www.biomedical-engineering-online.com/content/6/1/16 BioMedical Engineering OnLine 2007, 6:16 "Heart energy signature spectrogram for cardiovascular diagnosis" Article specifically addresses issue of the accuracy of the method utilized in the present paper.
read full comment
A Disapponting Study (Beverley Chalmers, 17 June 2010)
This comment jointly authored by Beverley Chalmers (DSc(Med); PhD)and Janusz Kaczorowski, (PhD).
It is gratifying to see a publication emerging utilizing the data collected by the Maternity Experiences Survey. This major research program was conducted by the Maternity Experiences Study Group of the Canadian Perinatal Surveillance System of the Public Health Agency of Canada in collaboration with Statistics Canada.
It is disappointing, however, to note the errors and omissions that this particular manuscript includes. The issue of predicting exclusive breastfeeding at 6 months after birth is an extremely important one for both mothers and babies globally and in Canada. For this reason, some clarification of this BMC Pediatrics report is needed. These include: ...
read full comment
Response to: Hausdorff WP, Hoet B, Schuerman L: Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A? BMC Pediatr 2010, 10:4. (Peter Paradiso, 21 April 2010)
Dear Sir or Madam:
The article by Hausdorff et al. [1] is a compilation of available published data on cross-protection for serotype 19A afforded by serotype 19F in pneumococcal conjugate vaccine formulations. As pointed out by the authors, when 7-valent pneumococcal conjugate vaccine (PCV7; Prevenar; Pfizer Inc) was developed, it was hoped that the protective anticapsular antibody induced by the 19F and 6B conjugates would provide cross-protection for serotype 19A and 6A disease, respectively. While some cross-protection has been observed against serotype 6A disease, from a practical perspective, regardless of the “suggestions” from the literature, there has been no impact on 19A disease in countries where PCV7 has been used [2-7]. As pointed out by the...
read full comment
ppO2 seems to be the key factor (Herb Martin, 13 April 2010)
Presuming for the sake of discussion that treatment is effective.
As the grandparent of an autistic child and a former commercial diver I have great personal interest in this subject, and knowledge of diving gases and physiological effects.
After a serious Internet search, I can find no evidence, nor any serious claim, of any proposed mechanism for these effects EXCEPT for the increased partial pressure of O2 (ppO2).
Given that an oxygen concentrator can produce 95% O2 (perhaps as low as 80% actually delivered) and that the treatment dives of this study are only to 1.3 ATA -- or in home devices up to 1.6 ATA -- then we need to seriously consider the idea of treatment with O2 at standard pressure.
The Authors Respond: Results of the Study are Positive (Daniel Rossignol, 26 October 2009)
We again thank Drs. Mintz, Mink, and Wiznitzer for their comments on our article reporting our double-blind controlled study demonstrating the effectiveness of hyperbaric treatment in children with autism. We address their additional concerns as follows: 1. Since the CGI-I is a scale of improvement, the only scores obtained for the physician CGI-I scale were generated at the end of the study. To obtain these scores, the physician rated the child’s performance at the end of the study compared to the physician’s baseline exam of the child. This evaluation generated a score for the change in overall functioning compared to baseline for each child. The statistical analysis then compared the scores in the treatment group to the scores in the control group, and therefore...
read full comment
Response to the Authors’ Response: Results of the study are NOT positive as claimed (Mark Mintz, 12 August 2009)
We thank Drs. Rossingol et al. for responding to our posted comment about our concerns with their study’s methodologies, results and conclusions. The authors’ response has not changed our analyses and opinions, and in particular has not changed our conclusion: it is our opinion that the paper does not support the use of hyperbaric oxygen therapy (HBOT) for children with autism. In particular, we invite the authors to explain or comment on the following:
1. In the authors’ response, they have not clarified how a physician-completed Clinical Global Impression-Improvement scale (CGI-I) can be used at baseline and then again after 40 treatment sessions. [In the Methods section, it states that physicians completed the CGI-I after 40 treatment sessions, but in the...
read full comment
Cost-effective Oxygen Delivery (James (Undisclosed), 24 June 2009)
Dr. Rossignol writes:
"We are confused as to why the commentators state, without support, that the treatment we have evaluated would demonstrate “harm” to the patient, as we are not aware of any evidence of harm that has come to a child using hyperbaric treatment within the parameters used in this study."
This confusion is understandable, but unfounded. A quick review of the commentators' actual words and context reveals that no such statement, that the treatment evaluated by Rossignol et al. would demonstrate harm, was made.
Dr. Rossignol also notes:
"In conclusion, we maintain our position that hyperbaric treatment using the parameters in this study is a cost-effective and promising medical adjunctive intervention to...
read full comment
The Authors Respond: Results of the Study are Positive (Daniel Rossignol, 09 June 2009)
We thank Drs. Mintz, Mink, and Wiznitzer for their comments on our article reporting our double-blind controlled study demonstrating the effectiveness of hyperbaric treatment in children with autism. We must point out fundamental errors in their review of our study, its methodology, and its data analyses, however, and clarify any misinterpretations of our findings.
1. With regard to the blinding procedure, only after all study data had been collected, taken to a central location, and analyzed were the control group patients unblinded and offered 40 hyperbaric treatments. These subsequent additional treatments were provided to the controls at a location remote from all study sites. Thus, the integrity of the double-blind procedure was kept completely intact...
read full comment
Results of the Study are NOT Positive as Claimed (Mark Mintz, 07 May 2009)
Dear Editor/Authors:
We read with interest the recently published article by Rossignol et. al.(1) concerning the use of hyperbaric oxygen treatment (HBOT) in children with Pervasive Developmental Disorder-Autistic Disorder. As the authors have rightly pointed out, there is a need for more evidenced-based treatments for this distressing disorder, and they should be commended for undertaking a controlled clinical trial. But we are concerned that the evidence as presented by these authors does not provide support for the use of HBOT in this population despite the authors’ conclusions and claims to the contrary. In particular, we believe there are significant methodological and statistical flaws in the design, implementation and interpretation of the results of this clinical...
read full comment
In my first comment, I mistakenly asked if the treatment pressure for the CONTROL group was 1.3 atmospheres absolute or 1.3 atmospheres gauge. My question was about the TREATMENT group. I regret any misunderstanding that may have arisen as a result.
read full comment
Gas Laws Not Mysterious - They Apply Here (James (Undisclosed), 16 April 2009)
Comments by Mr. Stoller indicate that oxygen dosing is more modulated by pressure than absolute concentration. While that may be especially true when concentrations of O2 (FIO2) approach 100%, the statement does not apply with respect to this study. In fact, inflatable chambers have built-in pressure relief valves that, unless modified (illegally), limit the total pressure at about 4psi above ambient atmospheric pressure. Without the ability to add additional pressure above this very low maximum, the ability to "modulate" pressure, except towards even less pressure (and lower oxygen dose), does not even exist. Citation of Weaver et al. fails to add relevance with respect to this study (or autism) - The Weaver et al. treatment group seems to have received real hyperbaric oxygen therapy...
read full comment
hyperbaric vs. normobaric oxygen (response) (Eric Hexdall, 16 April 2009)
Dr. Stoller's prolific writing and his efforts toward educating the public on hyperbaric medicine are respectfully acknowledged. I would disagree with his implication that the mechanism of action of hyperbaric oxygen is poorly understood in the hyperbaric community. Granted, some of the biomechanics of oxygen at the cellular and subcellular level remain unclear. However, Dalton's Law, Henry's Law and the alveolar gas equation are familiar to most of us, and they all support the contention that 0.31 ATA of oxygen is 0.31 ATA of oxygen no matter what the delivery method. Perhaps there is an as-yet-unknown synergistic effect of slight increases of ambient pressure on "normobaric" oxygen pressures, i.e. partial pressures of O2 that are less than or equal to 1.0 ATA (as this study suggests)....
read full comment
Not just Oxygen? (Edward Fogarty, M.D., 06 April 2009)
Hopefully this study will be repeated in a multi-center trial in academic medical centers as it does seem promising, with some added neurofunctional imaging such as SPECT, PET or fMRI with MRS. The difficulties of shamming or placebo grouping this intervention seems to have plagued the idea since its first inceptions for medical therapy. I simply wonder on the basis of having read the following article whether too much focus has been placed on oxygen as the sole therapeutic effector in this treatment modality?
Stem cell mobilization by hyperbaric oxygen. Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG. Am J Physiol Heart Circ Physiol. 2006 Apr;290(4):H1378-86. Epub 2005 Nov 18. PMID: 16299259 [PubMed - indexed for MEDLINE]
Normobaric oxygen vs Hyperbaric Oxygen (Kenneth Stoller, 06 April 2009)
Oxygen dosing (which is modulated by pressure far more than absolute concentration)is what provides the signaling at a cellular level, including the subcellular level in the mitochondria, to facilitate the changes observed using a hyperbaric environment.
No where was this made more clear than in a 163 patient prospective study of carbon monoxide poisoning patients who were given different doses of supplemental normobaric oxygen. Six week post-treatment cognitive sequelae were unchanged - contrast that to the results when hyperbaric oxygen is used. (Weaver et al in reply to Scheinkestal et al: The role of hyperbaric oxygen in carbon monoxide poisoning. Emerg Med Australa 2004;16;394-399).
The gas laws and hyperbaric medicine are not taught in medical school, so it is...
read full comment
Two Small Points (James (Undisclosed), 01 April 2009)
This article is quite interesting. While on the surface it seems to lend some scientfic validation for a possible treatment of autism, it may raise questions - about validity of the results based on the methodology employed, and possible clinical and economic implications of the therapy described.
Firstly, the stated treatment pressure (1.3ATM) would seem highly unlikely to be uniformly achievable across all study locations with the equipment that appears to have been used.
As described in the section titled, "Interventions":
"These procedures included covering control switches, inflating and deflating the chambers to simulate pressure changes, and masking the sounds from the chambers."
The use of "inflatable" monoplace chambers, sometimes known...
read full comment
Hyperbaric Oxygen (William Anderson, 01 April 2009)
24% Oxygen at 1.3 atmospheres is equivalent to 31.2% at 1 atmosphere. This is not by any normal usage hyperbaric oxygen. The same Oxygen levels could have been achieved at less distress to the children and less cost with a simple face mask or even in a small room. If the pressure as opposed to the oxygen is the dimension of interest then 1.3 atmospheres at 21% could have been compared with 27.3% at ambient pressure. Autism is a terrible affliction and we owe the sufferers our best efforts.
read full comment
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Latest comments
Tocilizumab in JIA (Isidro Villanueva, 31 May 2012)
April 27... read full comment
Comment on: Kemper et al. BMC Pediatrics, 12:29
Errata for Mushtaq et al. BMC Pediatrics 2011, 11:114 (Muhammad Umair Mushtaq, 07 March 2012)
Since the publication of our article, we have noted a typographical error in the final published version, for which the corresponding author accepts full responsibility. Page reference is to the final PDF version.
Page 3, Results (sentence 10, lines 16-17): "Mean (SD) BMI was 20.7 (5.02) kg/m2..." should read "Mean (SD) BMI was 16.0 (3.0) kg/m2...¿
M.U. Mushtaq, et al. read full comment
Comment on: Mushtaq et al. BMC Pediatrics, 11:114
Error in rates of SGA in Table 1 (Tanis Fenton, 10 October 2011)
The correct numbers and rates of SGA (small size for gestational age) are:
Gest age # %
23-27 2 3.9%
28-31 3 2.3%
32-34 7 3.5%
35-36 15 12.3%
Preterm 27 5.3%
Term 0 0%
read full comment
Comment on: Fenton et al. BMC Pediatrics, 11:76
dominant effect of protein (Peter Woolf, 17 March 2011)
I'm curious about the protein composition of the two diets. As you show in Table 1, the beef diet adds 13 or 19.5 g of protein for the 6-12 and 13-18 month range, while the cereal diet adds only 3.07 or 4.60 for each group.
RDA values for protein for infants up to 12 months are 13-14 g/day while for 1-3 years old is 16 g/day. In this case, the beef is providing 100% or more of the infant's RDA of protein, while the cereal is providing only ~20%.
The role of dietary protein on linear growth is well established when protein is limiting--which is likely to be the case here.
It would be interesting if in the study you also measured/estimated the protein intake per infant in both groups in each location. This would help to tease out the role of... read full comment
Comment on: Krebs et al. BMC Pediatrics, 11:4
New email (Anand Reddi, 11 March 2011)
Anand Reddi's email address is anand(dot)reddi AT gmail(dot)com or anand(dot)reddi AT ucdenver(dot)edu read full comment
Comment on: Reddi et al. BMC Pediatrics, 7:13
Interesting paper (Jonas Ludvigsson, 14 January 2011)
I often work in the pediatric emergency unit and this is something I have been thinking about. Interesting to find that a visit to the emergency department was not associated with an increased risk of infection in children.
Jonas F Ludvigsson, Sweden read full comment
Comment on: Quach et al. BMC Pediatrics, 11:2
ignoring 100ys of independent research (Lucija Tomljenovic, 23 September 2010)
The regulatory authorities have been successful in their strategy of ignoring independent research, ever since 1911.
“These studies have convinced me that the use in food of aluminium or any other aluminium compound is a dangerous practice. That the aluminium ion is very toxic is well known. That aluminized food yields soluble aluminium compounds to gastric juice (and stomach contents) has been demonstrated. That such soluble aluminium is in part absorbed and carried to all parts of the body by the blood can no longer be doubted. That the organism can "tolerate" such treatment without suffering harmful consequences has not been shown. It is believed that the facts in this paper will give emphasis to my conviction that aluminium should be excluded from food” WJ Gies... read full comment
Comment on: Burrell et al. BMC Pediatrics, 10:63
Chris is right (Qiao Niu, 16 September 2010)
I think the concern of Chris and his collegues is reasonable, the problem raised by them is common over the world. I hope it can be taken into consideration, emphosized and resolved by authorities and producers. read full comment
Comment on: Burrell et al. BMC Pediatrics, 10:63
Complacency and Regulation of Aluminium in Food (Chris Exley, 15 September 2010)
In spite of the clear results and recommendations of our study the Food Standards Agency (FSA) in the UK has not made any official comment regarding our findings. The Food Safety Act of 2007 (updated in 2008) specifically states under article 5 that infant formulas should not contain anything which might 'endanger the health of infants and young children'. The Chief Scientist at the FSA, Andrew Wadge, responding to my enquiry on his blog has said that the aluminium content of most infant formulas are within the tolerable weekly limit (TWI) of 1 mg/kg body weight, set by the Joint FAO/WHO Expert Committee on Food Additives,20-29 June 2006, Rome. He concedes that there are no regulatory requirements for aluminium in food. He does not mention that the TWI set by the aforementioned committee is... read full comment
Comment on: Burrell et al. BMC Pediatrics, 10:63
Spectrographic murmur analysis (Vladimir Kudriavtsev, 17 August 2010)
Reader may want to review another publication from BMC on the same subject
http://www.biomedical-engineering-online.com/content/6/1/16
BioMedical Engineering OnLine 2007, 6:16
"Heart energy signature spectrogram for cardiovascular diagnosis"
Article specifically addresses issue of the accuracy of the method utilized in the present paper. read full comment
Comment on: Noponen et al. BMC Pediatrics, 7:23
A Disapponting Study (Beverley Chalmers, 17 June 2010)
This comment jointly authored by Beverley Chalmers (DSc(Med); PhD)and Janusz Kaczorowski, (PhD).
It is gratifying to see a publication emerging utilizing the data collected by the Maternity Experiences Survey. This major research program was conducted by the Maternity Experiences Study Group of the Canadian Perinatal Surveillance System of the Public Health Agency of Canada in collaboration with Statistics Canada.
It is disappointing, however, to note the errors and omissions that this particular manuscript includes. The issue of predicting exclusive breastfeeding at 6 months after birth is an extremely important one for both mothers and babies globally and in Canada. For this reason, some clarification of this BMC Pediatrics report is needed. These include:
... read full comment
Comment on: Al-Sahab et al. BMC Pediatrics, 10:20
Response to: Hausdorff WP, Hoet B, Schuerman L: Do pneumococcal conjugate vaccines provide any cross-protection against serotype 19A? BMC Pediatr 2010, 10:4. (Peter Paradiso, 21 April 2010)
Dear Sir or Madam:
The article by Hausdorff et al. [1] is a compilation of available published data on cross-protection for serotype 19A afforded by serotype 19F in pneumococcal conjugate vaccine formulations. As pointed out by the authors, when 7-valent pneumococcal conjugate vaccine (PCV7; Prevenar; Pfizer Inc) was developed, it was hoped that the protective anticapsular antibody induced by the 19F and 6B conjugates would provide cross-protection for serotype 19A and 6A disease, respectively. While some cross-protection has been observed against serotype 6A disease, from a practical perspective, regardless of the “suggestions” from the literature, there has been no impact on 19A disease in countries where PCV7 has been used [2-7]. As pointed out by the... read full comment
Comment on: Hausdorff et al. BMC Pediatrics, 10:4
ppO2 seems to be the key factor (Herb Martin, 13 April 2010)
Presuming for the sake of discussion that treatment is effective.
As the grandparent of an autistic child and a former commercial diver I have great personal interest in this subject, and knowledge of diving gases and physiological effects.
After a serious Internet search, I can find no evidence, nor any serious claim, of any proposed mechanism for these effects EXCEPT for the increased partial pressure of O2 (ppO2).
Given that an oxygen concentrator can produce 95% O2 (perhaps as low as 80% actually delivered) and that the treatment dives of this study are only to 1.3 ATA -- or in home devices up to 1.6 ATA -- then we need to seriously consider the idea of treatment with O2 at standard pressure.
1.3 - 1.6 with only slightly increased O2... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
The Authors Respond: Results of the Study are Positive (Daniel Rossignol, 26 October 2009)
We again thank Drs. Mintz, Mink, and Wiznitzer for their comments on our article reporting our double-blind controlled study demonstrating the effectiveness of hyperbaric treatment in children with autism. We address their additional concerns as follows:
1. Since the CGI-I is a scale of improvement, the only scores obtained for the physician CGI-I scale were generated at the end of the study. To obtain these scores, the physician rated the child’s performance at the end of the study compared to the physician’s baseline exam of the child. This evaluation generated a score for the change in overall functioning compared to baseline for each child. The statistical analysis then compared the scores in the treatment group to the scores in the control group, and therefore... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Response to the Authors’ Response: Results of the study are NOT positive as claimed (Mark Mintz, 12 August 2009)
We thank Drs. Rossingol et al. for responding to our posted comment about our concerns with their study’s methodologies, results and conclusions. The authors’ response has not changed our analyses and opinions, and in particular has not changed our conclusion: it is our opinion that the paper does not support the use of hyperbaric oxygen therapy (HBOT) for children with autism. In particular, we invite the authors to explain or comment on the following:
1. In the authors’ response, they have not clarified how a physician-completed Clinical Global Impression-Improvement scale (CGI-I) can be used at baseline and then again after 40 treatment sessions. [In the Methods section, it states that physicians completed the CGI-I after 40 treatment sessions, but in the... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Cost-effective Oxygen Delivery (James (Undisclosed), 24 June 2009)
Dr. Rossignol writes:
"We are confused as to why the commentators state, without support, that the treatment we have evaluated would demonstrate “harm” to the patient, as we are not aware of any evidence of harm that has come to a child using hyperbaric treatment within the parameters used in this study."
This confusion is understandable, but unfounded. A quick review of the commentators' actual words and context reveals that no such statement, that the treatment evaluated by Rossignol et al. would demonstrate harm, was made.
Dr. Rossignol also notes:
"In conclusion, we maintain our position that hyperbaric treatment using the parameters in this study is a cost-effective and promising medical adjunctive intervention to... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
The Authors Respond: Results of the Study are Positive (Daniel Rossignol, 09 June 2009)
We thank Drs. Mintz, Mink, and Wiznitzer for their comments on our article reporting our double-blind controlled study demonstrating the effectiveness of hyperbaric treatment in children with autism. We must point out fundamental errors in their review of our study, its methodology, and its data analyses, however, and clarify any misinterpretations of our findings.
1. With regard to the blinding procedure, only after all study data had been collected, taken to a central location, and analyzed were the control group patients unblinded and offered 40 hyperbaric treatments. These subsequent additional treatments were provided to the controls at a location remote from all study sites. Thus, the integrity of the double-blind procedure was kept completely intact... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Results of the Study are NOT Positive as Claimed (Mark Mintz, 07 May 2009)
Dear Editor/Authors:
We read with interest the recently published article by Rossignol et. al.(1) concerning the use of hyperbaric oxygen treatment (HBOT) in children with Pervasive Developmental Disorder-Autistic Disorder. As the authors have rightly pointed out, there is a need for more evidenced-based treatments for this distressing disorder, and they should be commended for undertaking a controlled clinical trial. But we are concerned that the evidence as presented by these authors does not provide support for the use of HBOT in this population despite the authors’ conclusions and claims to the contrary. In particular, we believe there are significant methodological and statistical flaws in the design, implementation and interpretation of the results of this clinical... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
correction (Eric Hexdall, 17 April 2009)
In my first comment, I mistakenly asked if the treatment pressure for the CONTROL group was 1.3 atmospheres absolute or 1.3 atmospheres gauge. My question was about the TREATMENT group. I regret any misunderstanding that may have arisen as a result. read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Gas Laws Not Mysterious - They Apply Here (James (Undisclosed), 16 April 2009)
Comments by Mr. Stoller indicate that oxygen dosing is more modulated by pressure than absolute concentration. While that may be especially true when concentrations of O2 (FIO2) approach 100%, the statement does not apply with respect to this study. In fact, inflatable chambers have built-in pressure relief valves that, unless modified (illegally), limit the total pressure at about 4psi above ambient atmospheric pressure. Without the ability to add additional pressure above this very low maximum, the ability to "modulate" pressure, except towards even less pressure (and lower oxygen dose), does not even exist. Citation of Weaver et al. fails to add relevance with respect to this study (or autism) - The Weaver et al. treatment group seems to have received real hyperbaric oxygen therapy... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
hyperbaric vs. normobaric oxygen (response) (Eric Hexdall, 16 April 2009)
Dr. Stoller's prolific writing and his efforts toward educating the public on hyperbaric medicine are respectfully acknowledged. I would disagree with his implication that the mechanism of action of hyperbaric oxygen is poorly understood in the hyperbaric community. Granted, some of the biomechanics of oxygen at the cellular and subcellular level remain unclear. However, Dalton's Law, Henry's Law and the alveolar gas equation are familiar to most of us, and they all support the contention that 0.31 ATA of oxygen is 0.31 ATA of oxygen no matter what the delivery method. Perhaps there is an as-yet-unknown synergistic effect of slight increases of ambient pressure on "normobaric" oxygen pressures, i.e. partial pressures of O2 that are less than or equal to 1.0 ATA (as this study suggests).... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Not just Oxygen? (Edward Fogarty, M.D., 06 April 2009)
Hopefully this study will be repeated in a multi-center trial in academic medical centers as it does seem promising, with some added neurofunctional imaging such as SPECT, PET or fMRI with MRS. The difficulties of shamming or placebo grouping this intervention seems to have plagued the idea since its first inceptions for medical therapy. I simply wonder on the basis of having read the following article whether too much focus has been placed on oxygen as the sole therapeutic effector in this treatment modality?
Stem cell mobilization by hyperbaric oxygen.
Thom SR, Bhopale VM, Velazquez OC, Goldstein LJ, Thom LH, Buerk DG.
Am J Physiol Heart Circ Physiol. 2006 Apr;290(4):H1378-86. Epub 2005 Nov 18.
PMID: 16299259 [PubMed - indexed for MEDLINE]
read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Normobaric oxygen vs Hyperbaric Oxygen (Kenneth Stoller, 06 April 2009)
Oxygen dosing (which is modulated by pressure far more than absolute concentration)is what provides the signaling at a cellular level, including the subcellular level in the mitochondria, to facilitate the changes observed using a hyperbaric environment.
No where was this made more clear than in a 163 patient prospective study of carbon monoxide poisoning patients who were given different doses of supplemental normobaric oxygen. Six week post-treatment cognitive sequelae were unchanged - contrast that to the results when hyperbaric oxygen is used. (Weaver et al in reply to Scheinkestal et al: The role of hyperbaric oxygen in carbon monoxide poisoning. Emerg Med Australa 2004;16;394-399).
The gas laws and hyperbaric medicine are not taught in medical school, so it is... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Two Small Points (James (Undisclosed), 01 April 2009)
This article is quite interesting. While on the surface it seems to lend some scientfic validation for a possible treatment of autism, it may raise questions - about validity of the results based on the methodology employed, and possible clinical and economic implications of the therapy described.
Firstly, the stated treatment pressure (1.3ATM) would seem highly unlikely to be uniformly achievable across all study locations with the equipment that appears to have been used.
As described in the section titled, "Interventions":
"These procedures included covering control switches, inflating and deflating the chambers to simulate pressure changes, and masking the sounds from the chambers."
The use of "inflatable" monoplace chambers, sometimes known... read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21
Hyperbaric Oxygen (William Anderson, 01 April 2009)
24% Oxygen at 1.3 atmospheres is equivalent to 31.2% at 1 atmosphere. This is not by any normal usage hyperbaric oxygen. The same Oxygen levels could have been achieved at less distress to the children and less cost with a simple face mask or even in a small room. If the pressure as opposed to the oxygen is the dimension of interest then 1.3 atmospheres at 21% could have been compared with 27.3% at ambient pressure. Autism is a terrible affliction and we owe the sufferers our best efforts. read full comment
Comment on: Rossignol et al. BMC Pediatrics, 9:21