The EXTRIP (EXtracorporeal TReatments In Poisoning) workgroup: Guideline methodology

Extracorporeal treatments (ECTRs), such as hemodialysis and hemoperfusion, are used in poisoning despite a lack of controlled human trials demonstrating efficacy. To provide uniform recommendations, the EXTRIP group was formed as an international collaboration among recognized experts from nephrology, clinical toxicology, critical care, or pharmacology and supported by over 30 professional societies. For every poison, the clinical benefit of ECTR is weighed against associated complications, alternative therapies, and costs. Rigorous methodology, using the AGREE instrument, was developed and ratified. Methods rely on evidence appraisal and, in the absence of robust studies, on a thorough and transparent process of consensus statements. Twenty-four poisons were chosen according to their frequency, available evidence, and relevance. A systematic literature search was performed in order to retrieve all original publications regardless of language. Data were extracted on a standardized instrument. Quality of the evidence was assessed by GRADE as: High = A, Moderate = B, Low = C, Very Low = D. For every poison, dialyzability was assessed and clinical effect of ECTR summarized. All pertinent documents were submitted to the workgroup with a list of statements for vote (general statement, indications, timing, ECTR choice). A modified Delphi method with two voting rounds was used, between which deliberation was required. Each statement was voted on a Likert scale (1-9) to establish the strength of recommendation. This approach will permit the production of the first important practice guidelines on this topic.

The influence of the Pt crystalline surface orientation on the glycerol electro-oxidation in acidic media

We investigated the electrochemical oxidation of glycerol on low-index Pt single crystals in acidic media (H2SO4 and HClO4) by cyclic voltammetry and Fourier Transform Infrared (FTIR) spectroscopy and we verified that this is a surface sensitive reaction. Pt(100) and Pt(110) surface structures favor the breaking of the C-C-C bond at low potentials (say 0.05 V), as seen by the formation of CO, one of the adsorbed residues of the glycerol dissociation, which poisons these surfaces even at high potentials. Pt(111) surface structure does not favor the C-C-C bond breaking at potentials as low as 0.05 V. However, Pt(111) is less poisoned by residues of glycerol dissociation and, for this reason, it is more active for glycerol oxidation than Pt(100) and Pt(110) at low potentials. Carbonyl containing compounds and CO2 were detected as reaction products of the glycerol oxidation on all investigated single-crystal Pt surfaces. The ratio between CO2 and carbonyl containing compounds is clearly much higher for Pt(100) and Pt(110) than for Pt(111). (C) 2012 Elsevier Ltd. All rights reserved.