Opinion on the (Hemo)dialysate Sodium Prescription: Dialysate Sodium Prescription Should Not Be Considered in Isolation

With advances in hemodialysis technology and the desire to achieve cardiovascular stability during dialysis, prescribed dialysate sodium concentration has gradually increased over the years. Short-term trials suggest low dialysate sodium (<138 mEq/L) is beneficial in reducing interdialytic weight gain, pre- and post-dialysis BP, and predialysis serum sodium; but it increases intradialytic hypotensive episodes. We believe dialysate sodium prescription cannot be considered in isolation. Our approach is to use patient symptoms, meticulous fluid volume management and low temperature dialysate in conjunction with neutral dialysate sodium in managing our dialysis patients. Long-term trials are needed to inform optimum dialysate sodium prescription.

DSO Strategies Proposal for the LV Grid of the Future

A significant challenge for the DSO (Distribution System Operator) will be to choose the optimum strategy for flexibility service in the LV area with high RES (renewable energy sources) penetration. To this end, a representative LV grid operated in Poland was selected for analysis. Three research scenarios with RES generation were presented in the range of 1–8 kW for the power factor from 0.9 to 1. The grid PV capacity was determined for four load profiles. Based on this factor, optimum RES volume management service types were determined. Under the flexibility service, the proposed power conversion services and active RES operations for DOS were proposed. The research was conducted using the Matlab and PowerWorld Simulator environment. Optimum active power values were obtained for the RES generation function for single and dual operation systems of the power conversion system. In future, the knowledge in the field of grid capacity will enable the DSO to increase the operating efficiency of the LV grid. It will enable the optimum use of the RES generation maximisation function and proper strategy selection. It will improve the energy efficiency of the power input through the MV/LV node.

Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature

Introduction: Despite extensive evidence that shows clinical of superiority of MiECC, worldwide penetration remains low due to concerns regarding air handling and volume management in the context of a closed system. The purpose of this study is to thoroughly investigate perfusion safety and technical feasibility of performing all cardiac surgical procedures with modular (hybrid) MiECC, as experienced from the perfusionist’s perspective. Methods: We retrospectively reviewed perfusion charts of consecutive adult patients undergoing all types of elective, urgent, and emergency cardiac surgery under modular MiECC. The primary outcome measure was perfusion safety and technical feasibility, as evidenced in the need for conversion from a closed to an open circuit. A systematic review of the literature was conducted aiming to ultimately clarify whether there are any safety issues regarding MiECC technology. Results: We challenged modular MiECC use in a series of 403 consecutive patients of whom a significant proportion (111/403; 28%) underwent complex surgery including reoperations (4%), emergency repair of acute type A aortic dissection and composite aortic surgery (1.7%). Technical success rate was 100%. Conversion to an open circuit was required in 18/396 patients (4.5%), excluding procedures performed under circulatory arrest. Open configuration accounted for 40% ± 21% of total procedural perfusion time and was related to significant hemodilution and increase in peak lactate levels. Systematic review revealed that safety of the procedure challenged originated from a single report, while no clinical adverse event related to MiECC was identified. Conclusions: Use of modular MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. It represents a type III active closed system, while its stand-by component is reserved for a small (<5%) proportion of procedures and for a partial procedural time. Thus, it eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.

Treatment of COVID-19 Complications at Home Conditions

This paper reports the clinical characteristics, diagnosis, and treatment of myself after being infected with Covid-19. After comprehensive treatment including nasal cannula oxygen therapy, antiviral and anti-infection therapies, liquid volume management, glucocorticoids, analgesia and sedation, blood tests control, anticoagulation, and thrombus prevention, and electrolyte balance maintenance, after 24 days finally my health situation was good. The purpose of this case report is to provide a reference for the clinical diagnosis and treatment of myself, in-home condition in this critical situation.