Considerations for Peripheral Blood Stem Cell Apheresis in a Low Body Weight Infant.

INTRODUCTION: Peripheral blood stem cell (PBSC) apheresis in infants (<10 kg body weight) requires specific precautions to prevent periprocedural complications. CASE REPORT: A 9 month old child was diagnosed with high-risk neuroblastoma and planned for autologous stem cell transplantation after induction chemotherapy. We illustrate the precautions and technical details observed while performing PBSC collection in this patient. DISCUSSION: Use of continuous flow devices, priming of apheresis circuits, appropriate flow rates and continuous monitoring can help to mitigate several procedure related complications. CONCLUSIONS: PBSC apheresis in infants (<10 Kg) is safe and feasible with appropriate precautions detailed above.

Comparatively Evaluating Medication Preparation Sequences for Treatment of Hyperkalemia in Pediatric Cardiac Arrest: A Prospective, Randomized, Simulation-Based Study.

OBJECTIVES: To determine whether time to prepare IV medications for hyperkalemia varied by 1) drug, 2) patient weight, 3) calcium salt, and 4) whether these data support the Advanced Cardiac Life Support recommended sequence. DESIGN: Prospective randomized simulation-based study. SETTING: Single pediatric tertiary medical referral center. SUBJECTS: Pediatric nurses and adult or pediatric pharmacists. INTERVENTIONS: Subjects were randomized to prepare medication doses for one of four medication sequences and stratified by one of three weight categories representative of a neonate/infant, child, or adult-sized adolescent: 4, 20, and 50 kg. Using provided supplies and dosing references, subjects prepared doses of calcium chloride, calcium gluconate, sodium bicarbonate, and regular insulin with dextrose. Because insulin and dextrose are traditionally prepared and delivered together, they were analyzed as one drug. Subjects preparing medications were video-recorded for the purpose of extracting timing data. MEASUREMENTS AND MAIN RESULTS: A total of 12 nurses and 12 pharmacists were enrolled. The median (interquartile range) total preparation time for the three drugs was 9.5 minutes (6.4-13.7 min). Drugs were prepared significantly faster for larger children (50 kg, 6.8 min [5.6-9.1 min] vs 20 kg, 9.5 min [8.6-13.0 min] vs 4 kg, 16.3 min [12.7-18.9 min]; p = 0.001). Insulin with dextrose took significantly longer to prepare than the other medications, and there was no difference between the calcium salts: (sodium bicarbonate, 1.9 [0.8-2.6] vs calcium chloride, 2.1 [1.2-3.1] vs calcium gluconate, 2.4 [2.1-3.0] vs insulin with dextrose, 5.1 min [3.7-7.7 min], respectively; p < 0.001). Forty-two percent of subjects (10/24) made at least one dosing error. CONCLUSIONS: Medication preparation for hyperkalemia takes significantly longer for smaller children and preparation of insulin with dextrose takes the longest. This study supports Pediatric Advanced Life Support guidelines to treat hyperkalemia during pediatric cardiac arrest similar to those recommended per Advanced Cardiac Life Support (i.e., first, calcium; second, sodium bicarbonate; and third, insulin with dextrose).

Emergence of MXene and MXene-Polymer Hybrid Membranes as Future- Environmental Remediation Strategies.

The continuous deterioration of the environment due to extensive industrialization and urbanization has raised the requirement to devise high-performance environmental remediation technologies. Membrane technologies, primarily based on conventional polymers, are the most commercialized air, water, solid, and radiation-based environmental remediation strategies. Low stability at high temperatures, swelling in organic contaminants, and poor selectivity are the fundamental issues associated with polymeric membranes restricting their scalable viability. Polymer-metal-carbides and nitrides (MXenes) hybrid membranes possess remarkable physicochemical attributes, including strong mechanical endurance, high mechanical flexibility, superior adsorptive behavior, and selective permeability, due to multi-interactions between polymers and MXene's surface functionalities. This review articulates the state-of-the-art MXene-polymer hybrid membranes, emphasizing its fabrication routes, enhanced physicochemical properties, and improved adsorptive behavior. It comprehensively summarizes the utilization of MXene-polymer hybrid membranes for environmental remediation applications, including water purification, desalination, ion-separation, gas separation and detection, containment adsorption, and electromagnetic and nuclear radiation shielding. Furthermore, the review highlights the associated bottlenecks of MXene-Polymer hybrid-membranes and its possible alternate solutions to meet industrial requirements. Discussed are opportunities and prospects related to MXene-polymer membrane to devise intelligent and next-generation environmental remediation strategies with the integration of modern age technologies of internet-of-things, artificial intelligence, machine-learning, 5G-communication and cloud-computing are elucidated.