John Prowle

A brief history of the discovery of the immunoglobulins and the origin of the modern immunoglobulin nomenclature

onlinelibrary.wiley.com/doi/epdf/10....

After 14 days in ICU eGFR or eCrCl will over estimate true GFR more than TWO-fold yet they are still often quoted as guides to drug dosing!

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Please consider joining this exciting and cutting edge course in intensive care nephrology in person at ESICM Lives 2025 with a superb international faculty.

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Intensive Care Nephrology: building future progress on a legacy of success - ESICM Save the date - Explore how decades of research and clinical innovation in Intensive Care Nephrology are shaping the future of kidney care for critically ill patients. This session will highlight pion...

Please join our ESICM AKI section webinar tomorrow

Intensive Care Nephrology: building future progress on a legacy of success

11 SEPTEMBER 2025. 16:00 - 17:00 CEST and available online on the ESICM website

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European Society of Intensive Care Medicine - ESICM

As intravenous fluids are rapidly lost to the interstitial space any affect on cardiac output and GFR will be very transient…

However creatinine concentration decrease reduces its excretion for any fixed GFR causing loss of steady state and rapid accumulation of creatinine in the expanded volume until concentration is normalized and steady state is regained. This can be easily modeled and takes a few hours at most.

A great honour to contribute to this article celebrating the inspirational scientific contributions of Rinaldo Bellomo. rdcu.be/epoBg

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Obituary: Rinaldo Bellomo - ESICM In Memory of Professor Rinaldo Bellomo

It’s a time of great personal sadness for me personally and across the intensive care community. Remembering the great and ongoing legacy of Rinaldo Bellomo as well as his great friendship and mentorship. www.esicm.org/obituary-rin...

Also our good friend the Canadian Intensivist!!

Hyponatremia in the Dialysis Population Sodium derangements are among the most frequently encountered electrolyte disorders in patients with end-stage renal disease. As dialysis patients are predisposed to hyponatremia via multiple pathways...

I’m no expert in this area but this is a good start I think: www.kireports.org/article/S246...

What about hyponatraemia in chronic dialysis patients? - common and impactful - mostly but not exclusively due to fluid overload??

Incredibly valuable approach. I’m interested in ordinal longitudinal outcomes based on an organ failure score - ie where there might be more than one way to achieve the same level. Can this approach be applied to this type of ordinal outcome variable?

Acute Kidney Injury and Risk of Death After Elective... : Anesthesia & Analgesia ndergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logis...

My approach was by no means perfect but see journals.lww.com/anesthesia-a...

So what you need to model is an interaction term between age and eGFR with eGFR fitted to a spline (ie rcs). If you use creatinine then you would do the same but an interaction with sex would also be needed!

That is an eGFR of 100 at age 20y equates lowest risk but at 75y this would equate to sarcopenia and the nadir of risk might be eGFR 70.

A good question John and one I’ve looked at previously. eGFR (and creatinine) has a u-shaped relationship with risk of death - the minima of this risk profile varies with age.

YouTube video by ESICM World Kidney Day 2025

World Kidney Day 2025 & Intensive Care Nephrology: Listen to our discussion and reflections from the European Society of Intensive Care Medicine Acute Kidney Injury Section. youtu.be/trX8Zpq_l60

In another thought differentiating urinoma as a cause of a post-transplant collection in the context of severe DGF (ATN) can’t be reliably made based on fluid biochemistry as composition of urine CAN be similar to plasma

In these circumstances GFR 5 can still give >200ml/h urine. I’ve always felt the TGF response in AKI may be adaptive to prevent massive diuresis in context of tubular injury…

Fun fact- the clock time in the UK the at start of posix time was at 01:00 1/1/1970 due to a short lived experiment with British Standard Time (GMT+1 year round) that was in place in 1970. This genuinely caused an off by one hour issue in some of my code once that was difficult to debug!

Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery | NEJM Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, ...

Effectively practice has changed ahead of evidence. Also note highly restrictive strategies might also be harmful in some contexts ie surgery see RELIEF. www.nejm.org/doi/full/10....

Restriction of Intravenous Fluid in ICU Patients with Septic Shock | NEJM Intravenous fluids are recommended for the treatment of patients who are in septic shock, but higher fluid volumes have been associated with harm in patients who are in the intensive care unit (ICU...

CLOVERS as above and CLASSIC www.nejm.org/doi/full/10....
Both studies are ‘neutral’ but essentially define the bottom of the j-shape risk distribution - Note the fluid administration in the ‘liberal’ arms is a lot less liberal than fluid use seen in the past ie PROCESS study 2014.

I just completed all 25 days of Advent of Code 2024! #AdventOfCode adventofcode.com

I think I had only 2 and they were only 89 apart

AOC2024/Day 13 at main · jprowle/AOC2024 Soultions to Advent of Code 2024 in R. Contribute to jprowle/AOC2024 development by creating an account on GitHub.

'Solve' in the base package does part 1 nicely. For part 2 I seemed to need more the 64 bits to avoid floating point errors and this required hand-coding the solution to the system of equation to allow use of Rmpfr github.com/jprowle/AOC2...

library(igraph) d24.12<-aoc_get_response(12, session_cookie ) %>% content(encoding = 'UTF-8') %>%read_lines() %>% str_split("",simplify=T) x <- which(nchar(d24.12)==1,arr.ind = T) #just all the coordinates y <- seq(d24.12) #and all the indices mp12 <- NULL for(i in seq(y)){ v <- y[rowSums(cbind(abs(x[,1]-x[i,1]),abs(x[,2]-x[i,2])))==1 & (d24.12[i]==d24.12)] if(length(v>0)){mp12 <- rbind(mp12,matrix(c(rep(i,length(v)),v),ncol=2))} } mp12.1 <- as.vector(t(mp12)) G12 <- make_graph(mp12.1,directed=F) d12 <- components(G12) tot1=NULL for(j in 1:d12$no){ tot <- 0 for(i in seq(d12$csize[j])){ tot <- tot+sum(mp12[,1]==y[d12$membership==j][i])} tot1 <- c(tot1,(4*d12$csize[j]-tot)*d12$csize[j]) } sum(tot1) tot1 <- 0 u <- matrix(c(0,1,1,0,1,1),ncol=2,byrow=T) u1 <- matrix(c(0,-1,1,0,1,-1),ncol=2,byrow=T) u2 <- matrix(c(0,-1,-1,0,-1,-1),ncol=2,byrow=T) u3 <- matrix(c(0,1,-1,0,-1,1),ncol=2,byrow=T) for(j in 1:d12$no){ X <- x[d12$membership==j,] %>% matrix(ncol=2) XX <- apply(X,1,paste,collapse=",") tot <- 0 for(i in 1:(nrow(X))){ v <- sweep(u,2,X[i,],"+") %>% apply(1,paste,collapse=",")%in%XX if(identical(v,c(F,F,F))|identical(v,c(T,T,F))|identical(v,c(F,F,T))){tot <- tot+1} v <- sweep(u1,2,X[i,],"+") %>% apply(1,paste,collapse=",")%in%XX if(identical(v,c(F,F,F))|identical(v,c(T,T,F))|identical(v,c(F,F,T))){tot <- tot+1} v <- sweep(u2,2,X[i,],"+") %>% apply(1,paste,collapse=",")%in%XX if(identical(v,c(F,F,F))|identical(v,c(T,T,F))|identical(v,c(F,F,T))){tot <- tot+1} v <- sweep(u3,2,X[i,],"+") %>% apply(1,paste,collapse=",")%in%XX if(identical(v,c(F,F,F))|identical(v,c(T,T,F))|identical(v,c(F,F,T))){tot <- tot+1} } tot1 <- tot1+d12$csize[j]*tot } tot1

Just fits in! - igraph components() to define regions. 'Corner' definition in part 2 was the hardest bit...

🪄 str_extract_all("\\d+",simplify=T)