Background: We have demonstrated that extracellular branched-chain amino acids (BCAAs), especially valine, regulate the maturation and function of monocyte-derived dendritic cells (J Immunol. 179: 2007) . However, it is not clear whether an imbalance in plasma amino acids of advaced cirrhotic patients influence the function of dendritic cells (DCs). Methods: We used human PBMCs and CD1c+DCs in this study. We made two mediums: a serum free culture medium consistent with the average concentration of the plasma amino acids from a healthy volunteer (n=100) was defined as the healthy control medium (HCM); whereas that from advanced cirrhotic patients (n=50) was defined as the advanced cirrhotic  Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient This is part II of two series review of reading chest radiographs in the critically ill. Conventional chest radiography remains the cornerstone of day to day management of the critically ill occasionally supplemented by computed tomography or ultrasound for specific indications. In this second review we discuss radiographic findings of cardiopulmonary disorders common in the intensive care patient and suggest guidelines for interpretation based not only on imaging but also on the pathophysiology and clinical grounds.  Cytomegalovirus infection in critically ill patients: a systematic review INTRODUCTION: The precise role of cytomegalovirus (CMV) infection in contributing to outcomes in critically ill immunocompetent patients has not been fully defined. METHODS: Studies in which critically ill immunocompetent adults were monitored for CMV infection in the intensive care unit (ICU) were reviewed. RESULTS: CMV infection occurs in 0 to 36% of critically ill patients, mostly between 4 and 12 days after ICU admission. Potential risk factors for CMV infection include sepsis, requirement of mechanical ventilation, and transfusions. Prolonged mechanical ventilation (21 to 39 days vs. 13 to 24 days) and duration of ICU stay (33 to 69 days vs. 22 to 48 days) correlated significantly with a higher risk of CMV infection. Mortality rates in patients with CMV infection were higher in some but not all studies. Whether CMV produces febrile syndrome or end-organ disease directly in these patients is not known. CONCLUSIONS: CMV infection frequently occurs in critically ill immunocompetent patients and may be associated with poor outcomes. Further studies are warranted to identify subsets of patients who are likely to develop CMV infection and to determine the impact of antiviral agents on clinically meaningful outcomes in these patients. Cytomegalovirus (CMV) is a major  herpes virus and a significant human pathogen. Infection is common with seroprevalence rates increasing steadily from 65% among 40 to 49 year olds to 91% in those aged 80 years or over [1] . After primary infection, CMV, like other  herpes viruses, establishes lifelong latency. In immunocompetent individuals, asymptomatic viral shedding may be detectable in saliva or urine; however, cell-mediated host immune responses prevent the development of overt CMV disease.