Combined Hemoperfusion and Continuous Veno-Venous Hemofiltration for Carbamazepine Intoxication

<b><i>Introduction:</i></b> Carbamazepine (CBZ) is a widely used anticonvulsant with a low molecular weight that allows for extracorporeal removal of free drug by both dialytic and hemoperfusion techniques, particularly in a massive overdose where serum protein binding is saturated. This report presents a case of CBZ intoxication where we were able to compare the mass removal of CBZ using hemoperfusion, with the mass removal of CBZ achieved with continuous renal replacement therapy (CRRT) during combined treatment. <b><i>Methods:</i></b> The Jafron HA230 resin hemoperfusion cartridge was applied in series with the continuous veno-venous hemofiltration (CVVH) circuit. Baseline and ongoing serum drug levels along with further samples from pre- and post-hemoperfusion cartridges and from CVVH effluent were collected. <b><i>Results:</i></b> Combined CVVH and resin hemoperfusion therapy in series was associated with a 50% reduction in the CBZ level from 16 mg/L to 8 mg/L over 3 h, far more rapid than that observed with CVVH alone or in the absence of extracorporeal drug clearance in the preceding hours. The combination therapy removed close to 35 mg/h of CBZ. <b><i>Conclusion:</i></b> The combination of CRRT and hemoperfusion can be easily deployed, appears safe, and is able to combine the CBZ mass removal achieved with each technique, thus to maximize CBZ extraction.

A Personal and Practical Answer from A Clinical Perspective

Restoring sodium and fluid homeostasis in hemodialysis (HD) patients is a crucial aim to reduce cardiovascular burden and improve global outcome. This crucial target is achieved at maximum in one quarter of HD patients according to a recent study. Sodium and fluid balance relies on a multitarget approach involving dietary salt restriction, dialysis salt mass removal and eventually residual kidney function. Salt mass removal in hemodialysis relies on ultrafiltration (convective sodium), the dialysate–plasma sodium gradient (diffusive sodium) and total treatment time. Manual dialysate sodium prescription has three major aims: dialysate–plasma sodium gradient; sodium mass removal target; hemodialysis tolerance and patient risks. In the future, automated dialysate sodium adjustment by HD machine will facilitate this aim.

FLOW OF WORKING MEDIA THROUGH THE CHANNELS IN THE BODY OF THE ELECTRODE-TOOL

Рассмотрен механизм течения жидких и газожидкостных рабочих сред через профильный инструмент для комбинированных методов обработки. Приведены типовые детали, для которых применимы электроды-инструменты с регулируемой подачей рабочей среды в зону обработки, обеспечивающей массовынос продуктов обработки из межэлектродного зазора. За счет применения аддитивных технологий решена проблема изготовления инструмента с внутренними каналами расчетного переменного сечения, обеспечивающими стабильную подачу жидкой (газожидкостной) среды и массовынос продуктов обработки. Предложены новые (на уровне изобретений) способ и электрод-инструмент с управляемой подачей по внутренним каналам рабочей среды, параметры которой рассчитаны с учетом специфики чистовой электроабразивной обработки по схеме копирования профиля детали. Расчетные зависимости для описания механизма течения рабочих сред и методы их использования позволили проектировать электроды-инструменты с профильными каналами, обеспечивающими применение технологических режимов для чистовой обработки инструментом с регулируемой подачей сред и выполнением критерия массовыноса продуктов обработки. Приведенные результаты расчета параметров течения рабочих сред через каналы в инструменте позволили расширить область эффективного использования аддитивных технологий и создать новые (на уровне изобретений) инструменты для электроабразивной обработки по методу копирования и высокопроизводительного одновременного профилирования нескольких поверхностей. Доказана возможность использования энергетической модели для расчета потенциальной составляющей энергии от реализации мощности, затрачиваемой на подкачку рабочей среды, и кинетической энергии от вращения инструмента для получения в зоне обработки требуемой скорости течения жидких (газожидкостных) сред We considered the mechanism of flow of liquid and gas-liquid working media through a profile tool for combined processing methods. We present typical parts for which electrodes-tools are applicable with an adjustable supply of the working medium to the processing zone, which ensures the mass removal of processing products from the interelectrode gap. Through the use of additive technologies, we solved the problem of making a tool with internal channels of a calculated variable cross-section, providing a stable supply of a liquid (gas-liquid) medium and mass removal of processing products. We propose a new (at the level of inventions) method and electrode-tool with a controlled feed through the internal channels of the working medium, the parameters of which are calculated taking into account the specifics of finishing electro-abrasive machining according to the pattern of copying the profile of the part. Calculated dependencies for describing the mechanism of flow of working media and methods of their use made it possible to design electrodes-tools with profile channels that ensure the use of technological modes for finishing with a tool with controlled supply of media and fulfillment of the criterion of mass removal of processing products. The presented results of calculating the parameters of the flow of working media through channels in the tool made it possible to expand the area of effective use of additive technologies and create new (at the level of inventions) tools for electro-abrasive processing using the copying method and high-performance simultaneous profiling of several surfaces. The possibility of using the energy model for calculating the potential component of energy from the implementation of the power spent on pumping the working medium and the kinetic energy from the rotation of the tool has been proved to obtain the required flow rate of liquid (gas-liquid) media in the processing zone

The alt-right digital migration: A heterogeneous engineering approach to social media platform branding

In recent years, social media platforms such as Twitter have removed users that espouse alt-right narratives of White nationalism and xenophobia from their platforms. This mass removal has caused alt-right users to migrate in droves to alternative social media sites, such as Gab. This migration reflects the “platform branding” of these social media platforms which dictates users’ choices of where to migrate based on the affordances and culture of a given site. Using heterogeneous engineering, this article analyzes the contextual history, language, and technological affordances of Twitter, Reddit, and Gab. The article finds that Twitter’s focus on politics and civil conversation is unhospitable to alt-right content. Reddit’s somewhat neutral positioning and decentralized moderation system make alt-right content possible but unpopular. Finally, Gab provides a haven to alt-right beliefs, constructing its platform around “free speech” and alt-right extremism. Platforms embody holistic brand images through contextual, linguistic, and technological features.

Wastewater Treatment and Wood Production of Willow System in Cold Climate

This article studied how wastewater treatment performance of a short rotation forestry system was influenced by the seasonal operational changes under the extreme Mongolian winter conditions. For this reason, two beds planted with Willow (Salix spec.) and Poplar (Populus spec.) trees were operated over a period of two years under two different seasonal conditions: (A) “external winter storage” and (B) “internal winter storage” of pretreated wastewater. For operational condition A, the tree-bed was loaded with wastewater for only 4 summer months. For this operational condition it was considered that the treatment bed was fed with primary treated wastewater, which was stored in a sealed pond during the remaining 8 months. The other Bed B was irrigated throughout the year (12 months) with the same daily loading rate. In winter, the wastewater accumulated as ice in the tree-bed. Bed A, with external winter storage, showed mass removal percentage up to 95%, while the bed with internal winter storage showed mass removal rates up to 86% for pollutants such as COD, BOD5, TN, and TP. A high yield of biomass was recorded for both beds with slight differences. Based on the results, a design recommendation was developed for full-scale systems of short rotation coppice irrigated with wastewater under various operational conditions, which show these systems to be a viable method for treating wastewater and producing biomass for energy production in Mongolia.

Research on Electrochemical Machining of Deep Small Holes with Positive and Negative Pulse Power

Background: High-temperature alloy such as nickel-based alloy has become the main material for core components such as aero engines due to their high strength and good toughness. Therefore, it is of great significance to study how to improve the machining accuracy and stability of electrochemical machining (ECM) of deep small holes on the nickel-based alloy. The instantaneous high-density current during the pulse width of pulse ECM is beneficial to the dissolution of metal workpieces. Many experts and scholars have studied the pulse ECM of deep small holes. Objective: The purpose of this article is to propose and design a Positive And Negative Pulse (PANP) power supply to study the accuracy and stability of ECM of deep small holes on nickel-based alloys. Methods: First of all, an H-bridge composed of four MOSFET switches is designed to achieve PANP output in the main circuit of the power supply. Then, this paper studies the influence of the ratio of positive and negative pulses on short circuits, the influence of the ratio of positive and negative pulses on the mass removal rate, and the influence of the electrolyte concentration and pulse width on the mass removal rate. Finally, according to the obtained optimal parameters, the influence of electrolyte pressure on the average radial overcut of hole depth is analyzed. Results: The experimental results showed that the short-circuit frequency is reduced by more than 50% compared with non-negative pulse power supply; the ratio of positive and negative pulses, pulse width and electrolyte concentration and pressure were optimized by experiments to improve the mass removal rate of the workpiece and the average radial overcut of hole depth. Conclusion: The designed PANP power supply can improve the machining accuracy and stability of ECM of deep small holes on nickel-based alloys.

MO703URINE VOLUME AS A MARKER OF RESIDUAL KIDNEY FUNCTION IN PERITONEAL DIALYSIS PATIENTS: QUANTITATIVE ASSESSMENT

Background and Aims In dialysis patients, urine volume is an easy-to-obtain marker of residual kidney function but information is lacking of its potential value as an estimate of the renal contribution to total clearance of small solutes. We explored whether correlations of urine volume with different estimations of the residual renal function for urea, creatinine, and phosphorus, could be used to assess renal solute clearances and renal mass removal for investigated solutes. Method In an observational study of 94 non-anuric (urine output ≥ 100 mL per 24 hours) patients (54% men, median age 59 [45 - 68] year, BMI 25.8 [21.4 - 27.7] kg/m2) undergoing automated (n = 59) or continuous ambulatory (n = 35) peritoneal dialysis (PD), we evaluated renal, peritoneal and total (renal plus peritoneal) solute removal (g/week) and clearance (L/week) in relation to urine volume (L/day). Urine volume, renal clearances, ratio of urine solute to serum solute concentration, removed mass of each solute and the ratio of mass removed by urine (renal clearance) over total mass removed by urine and dialysate (total clearance) for urea, creatinine and phosphorus were estimated from 24 h collections of urine and dialysate and determination of solute concentrations in serum, urine and dialysate. Statistical dependence between variables was tested using Spearman’s correlation coefficient (rho). Data are expressed as median with interquartile range. Results Median 24-hour urine output was 560 [323 – 938] mL. Renal mass removal for urea, creatinine and phosphorus was 10.1 [4.5 – 17.1], 3.5 [1.8 – 5.6] and 1.0 [0.4 – 1.7] g/week, respectively. The average contribution of residual renal removal to the total mass removed was 28% [17% - 41%] for urea, 56% [30% - 72%] for creatinine and 44% [24% - 58%] for phosphorus. Serum creatinine correlated weakly and negatively with urine volume (rho = -0.26, p &lt; 0.05), but no such relationship was observed for urea and phosphorus. Only urine concentration of creatinine correlated weakly with urine volume with rho = -0.28 and p &lt; 0.01. Urine concentration over plasma concentration did not correlate with urine volume for any solute. Renal urea clearance (20.1 [11.4 - 35.7] L/week) correlated positively with creatinine renal clearance (43.0 [18.9 - 75.1] L/week), (rho = 0.92), and with phosphorus renal clearance (17.3 [7.6 - 32.9] L/week), (rho = 0.89, p &lt; 0.001; Fig. 1A), while renal creatinine clearance correlated positively with phosphorus renal clearance (rho = 0.86, p&lt;0.001). Urine volume correlated positively with urea, creatinine and phosphorus clearances at rho 0.78, 0.63 and 0.73, respectively (all p&lt; 0.001), and with renal removal of mass of urea, creatinine, and phosphorus with rho= 0.83, 0.68 and 0.74 (Fig. 1B), respectively; all p&lt;0.001. Conclusion In PD patients, solute renal clearances and renal mass removal for urea, creatinine and phosphorus may be predicted from urine volume. Among renal clearances for urea, creatinine, and phosphorus two of them may be assessed based on measurements of the third one.