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Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery
Patients undergoing major abdominal surgery received restrictive or liberal intravenous fluids during surgery and up to 24 hours thereafter. The restrictive regimen did not improve disability-free survival and resulted in increased acute kidney injury.
Journal Article
Advanced numerical methods with Matlab 2 : resolution of nonlinear, differential and partial differential equations
The purpose of this book is to introduce and study numerical methods basic and advanced ones for scientific computing. This last refers to the implementation of appropriate approaches to the treatment of a scientific problem arising from physics (meteorology, pollution, etc.) or of engineering (mechanics of structures, mechanics of fluids, treatment signal, etc.). Each chapter of this book recalls the essence of the different methods resolution and presents several applications in the field of engineering as well as programs developed under Matlab software.
Book
Asymptotic Spreading for General Heterogeneous Fisher-KPP Type Equations
In this monograph, we review the theory and establish new and general results regarding spreading properties for heterogeneous
reaction-diffusion equations:
The characterizations of these sets involve two new notions of generalized principal eigenvalues
for linear parabolic operators in unbounded domains. In particular, it allows us to show that
eBook
Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis
Saline (0.9% sodium chloride), the fluid most commonly used to treat diabetic ketoacidosis (DKA), can cause hyperchloremic metabolic acidosis. Balanced crystalloids, an alternative class of fluids for volume expansion, do not cause acidosis and, therefore, may lead to faster resolution of DKA than saline.
To compare the clinical effects of balanced crystalloids with the clinical effects of saline for the acute treatment of adults with DKA.
This study was a subgroup analysis of adults with DKA in 2 previously reported companion trials-Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) and the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). These trials, conducted between January 2016 and March 2017 in an academic medical center in the US, were pragmatic, multiple-crossover, cluster, randomized clinical trials comparing balanced crystalloids vs saline in emergency department (ED) and intensive care unit (ICU) patients. This study included adults who presented to the ED with DKA, defined as a clinical diagnosis of DKA, plasma glucose greater than 250 mg/dL, plasma bicarbonate less than or equal to 18 mmol/L, and anion gap greater than 10 mmol/L. Data analysis was performed from January to April 2020.
Balanced crystalloids (clinician's choice of Ringer lactate solution or Plasma-Lyte A solution) vs saline for fluid administration in the ED and ICU according to the same cluster-randomized multiple-crossover schedule.
The primary outcome was time between ED presentation and DKA resolution, as defined by American Diabetes Association criteria. The secondary outcome was time between initiation and discontinuation of continuous insulin infusion.
Among 172 adults included in this secondary analysis of cluster trials, 94 were assigned to balanced crystalloids and 78 to saline. The median (interquartile range [IQR]) age was 29 (24-45) years, and 90 (52.3%) were women. The median (IQR) volume of isotonic fluid administered in the ED and ICU was 4478 (3000-6372) mL. Cumulative incidence analysis revealed shorter time to DKA resolution in the balanced crystalloids group (median time to resolution: 13.0 hours; IQR: 9.5-18.8 hours) than the saline group (median: 16.9 hours; IQR: 11.9-34.5 hours) (adjusted hazard ratio [aHR] = 1.68; 95% CI, 1.18-2.38; P = .004). Cumulative incidence analysis also revealed shorter time to insulin infusion discontinuation in the balanced crystalloids group (median: 9.8 hours; IQR: 5.1-17.0 hours) than the saline group (median: 13.4 hours; IQR: 11.0-17.9 hours) (aHR = 1.45; 95% CI, 1.03-2.03; P = .03).
In this secondary analysis of 2 cluster randomized clinical trials, compared with saline, treatment with balanced crystalloids resulted in more rapid resolution of DKA, suggesting that balanced crystalloids may be preferred over saline for acute management of adults with DKA.
ClinicalTrials.gov Identifiers: NCT02614040; NCT02444988.
Journal Article
Separation of variables for partial differential equations : an eigenfunction approach
\"Written at the advanced undergraduate level, the book will serve equally well as a text for students and as a reference for instructors and users of separation of variables. It requires a background in engineering mathematics, but no prior exposure to separation of variables. The abundant worked examples provide guidance for deciding whether and how to apply the method to any given problem, help in interpreting computed solutions, and give insight into cases in which formal answers may be useless\"--Jacket.
Book
Preventive Inhalation of Hypertonic Saline in Infants with Cystic Fibrosis (PRESIS). A Randomized, Double-Blind, Controlled Study
Abstract
Rationale
Cystic fibrosis (CF) lung disease starts in early infancy, suggesting that preventive treatment may be most beneficial. Lung clearance index (LCI) and chest magnetic resonance imaging (MRI) have emerged as promising endpoints of early CF lung disease; however, randomized controlled trials testing the safety and efficacy of preventive therapies in infants with CF are lacking.
Objectives
To determine the feasibility, safety, and efficacy of preventive inhalation with hypertonic saline (HS) compared with isotonic saline (IS) in infants with CF, including LCI and MRI as outcome measures.
Methods
In this randomized, double-blind, controlled trial, 42 infants with CF less than 4 months of age were randomized across five sites to twice-daily inhalation of 6% HS (n = 21) or 0.9% IS (n = 21) for 52 weeks.
Measurements and Main Results
Inhalation of HS and IS was generally well tolerated by infants with CF, and the number of adverse events did not differ between groups (P = 0.49). The change in LCI from baseline to Week 52 was larger in infants with CF treated with HS (−0.6) than in those treated with IS (−0.1; P < 0.05). In addition, weight gain was improved in infants with CF treated with HS (P < 0.05), whereas pulmonary exacerbations and chest MRI scores did not differ in the HS group versus the IS group.
Conclusions
Preventive inhalation with HS initiated in the first months of life was safe and well tolerated and resulted in improvements in LCI and weight gain in infants with CF. Our results support the feasibility of LCI as an endpoint in randomized controlled trials in infants with CF.
Clinical trial registered with www.clinicaltrials.gov (NCT01619657).
Journal Article
Propagating Terraces and the Dynamics of Front-Like Solutions of Reaction-Diffusion Equations on ℝ
We consider semilinear parabolic equations of the form
eBook