Perioperative use of crystalloids in patients undergoing open radical cystectomy: balanced Ringer's maleate versus a glucose 5%/potassium-based balanced solution: study protocol for a randomized controlled trial

BACKGROUND The optimal crystalloid solution to use perioperatively in patients undergoing open radical cystectomy remains unclear. Many of the fluids used for intravenous hydration contain supraphysiologic concentrations of chloride, which can induce hyperchloremia and metabolic acidosis, resulting in renal vasoconstriction and decreased renal function. In addition, patients receiving less fluid and less sodium show faster recovery of gastrointestinal (GI) function after colonic surgery. METHODS AND DESIGN This is an investigator-initiated, single-center, randomized, controlled, parallel group trial with assessor-blinded outcome assessment, in the Department of Urology, University Hospital Bern, Switzerland. The study will involve 44 patients with bladder cancer scheduled for radical cystectomy and urinary diversion. The primary outcome is the duration between the end of surgery and the return of the GI function (first defecation). Secondary outcomes are fluid balance (body weight difference postoperatively versus preoperatively) and the incidence of kidney function disorders according to the Risk-Injury-Failure-Loss-End Stage Renal Disease (RIFLE classification). An equal number of patients are allocated to receive Ringerfundin® solution or a glucose/potassium-based balanced crystalloid solution as baseline infusion during the entire time that intravenous administration of fluid is necessary during the perioperative period. The randomized crystalloid solution is infused at a rate of 1 ml/kg/h until the bladder has been removed, followed by 3 ml/kg/h until the end of surgery. Postoperative hydration is identical in both groups and consists of 1,500 ml of the randomized crystalloid solution per 24 hours. Postoperative patient care is identical in both groups; patients are allowed to drink clear fluids immediately after surgery, and liquid diet is started on postoperative day 1, as well as active mobilization and the use of chewing gum. Body weight is measured daily in the morning. Time of first flatus and first defecation are recorded. DISCUSSION This trial assesses the benefits and harms of two different balanced crystalloid solutions for perioperative fluid management in patients undergoing open radical cystectomy with urinary diversion, with regard to return of GI function and effects on postoperative renal function. TRIAL REGISTRATION Current Controlled Trials ISRCTN32976792 (registered on November 21 2013).

Development of a balanced experimental–computational approach to understanding the mechanics of proximal femur fractures

The majority of people who sustain hip fractures after a fall to the side would not have been identified using current screening techniques such as areal bone mineral density. Identifying them, however, is essential so that appropriate pharmacological or lifestyle interventions can be implemented. A protocol, demonstrated on a single specimen, is introduced, comprising the following components; in vitro biofidelic drop tower testing of a proximal femur; high-speed image analysis through digital image correlation; detailed accounting of the energy present during the drop tower test; organ level finite element simulations of the drop tower test; micro level finite element simulations of critical volumes of interest in the trabecular bone. Fracture in the femoral specimen initiated in the superior part of the neck. Measured fracture load was 3760 N, compared to 4871 N predicted based on the finite element analysis. Digital image correlation showed compressive surface strains as high as 7.1% prior to fracture. Voxel level results were consistent with high-speed video data and helped identify hidden local structural weaknesses. We found using a drop tower test protocol that a femoral neck fracture can be created with a fall velocity and energy representative of a sideways fall from standing. Additionally, we found that the nested explicit finite element method used allowed us to identify local structural weaknesses associated with femur fracture initiation.

Balanced bilinguals favor lexical processing in their opaque language and conversion system in their shallow language

Referred to as orthographic depth, the degree of consistency of grapheme/phoneme correspondences varies across languages from high in shallow orthographies to low in deep orthographies. The present study investigates the impact of orthographic depth on reading route by analyzing evoked potentials to words in a deep (French) and shallow (German) language presented to highly proficient bilinguals. ERP analyses to German and French words revealed significant topographic modulations 240-280ms post-stimulus onset, indicative of distinct brain networks engaged in reading over this time window. Source estimations revealed that these effects stemmed from modulations of left insular, inferior frontal and dorsolateral regions (German>French) previously associated to phonological processing. Our results show that reading in a shallow language was associated to a stronger engagement of phonological pathways than reading in a deep language. Thus, the lexical pathways favored in word reading are reinforced by phonological networks more strongly in the shallow than deep orthography.

The great fluid debate: saline or so-called "balanced" salt solutions?

BACKGROUND Intravenous fluids are commonly prescribed in childhood. 0.9 % saline is the most-used fluid in pediatrics as resuscitation or maintenance solution. Experimental studies and observations in adults suggest that 0.9 % saline is a poor candidate for fluid resuscitation. Although anesthesiologists, intensive care specialists, perioperative physicians and nephrologists have been the most active in this debate, this issue deserves some physiopathological considerations also among pediatricians. RESULTS As compared with so-called "balanced" salt crystalloids such as lactated Ringer, administration of large volumes of 0.9 % saline has been associated with following deleterious effects: tendency to hyperchloremic metabolic acidosis (called dilution acidosis); acute kidney injury with reduced urine output and salt retention; damaged vascular permeability and stiffness, increase in proinflammatory mediators; detrimental effect on coagulation with tendency to blood loss; detrimental gastrointestinal perfusion and function; possible uneasiness at the bedside resulting in unnecessary administration of more fluids. Nevertheless, there is no firm evidence that these adverse effects are clinically relevant. CONCLUSIONS Intravenous fluid therapy is a medicine like insulin, chemotherapy or antibiotics. Prescribing fluids should fit the child's history and condition, consider the right dose at the right rate as well as the electrolyte levels and other laboratory variables. It is unlikely that a single type of fluid will be suitable for all pediatric patients. "Balanced" salt crystalloids, although more expensive, should be preferred for volume resuscitation, maintenance and perioperatively. Lactated Ringer appears unsuitable for patients at risk for brain edema and for those with overt or latent chloride-deficiency. Finally, in pediatrics there is a need for new fluids to be developed on the basis of a better understanding of the physiology and to be tested in well-designed trials.

Prag und seine Umgebungen : Mit einem Anhange, einem Plane der Stadt, und vier Ansichten, dann einer Postkarte und einem Briefposten-Tableau durch Böhmen

von C. E. Rainold

Esquisse d'un tableau historique des progrès de l'ésprit humain : ouvrage posthume

de Condorcet

The Need for Balanced Methods of Measuring Performance

Michelle Rhee weighs in on measuring success in pubic education.

Two-polar growth strategy in Myanmar : seeking "high" and "balanced" development

The Thein Sein government of Myanmar seeks higher and balanced economic growth. This is a challenge for the government since some economic literature identifies a trade-off between higher economic growth and better regional equality, especially for countries in the early stages of development. In this paper, we propose a two-polar growth strategy as one that includes both "high" and "balanced" growth. The first growth pole is Yangon, and the second is Mandalay. Nay Pyi Taw, the national capital, will develop as an administrative centre, not as an economic or commercial one. We also propose border development with enhanced connectivity with richer neighboring countries as a complementary strategy to the two growth poles. Effects of the two-polar growth strategy with border development are tested using a Geographical Simulation Model (GSM).

Cloud Computing Service for Managing Large Medical Image Data-Sets Using Balanced Collaborative Agents

Managing large medical image collections is an increasingly demanding important issue in many hospitals and other medical settings. A huge amount of this information is daily generated, which requires robust and agile systems. In this paper we present a distributed multi-agent system capable of managing very large medical image datasets. In this approach, agents extract low-level information from images and store them in a data structure implemented in a relational database. The data structure can also store semantic information related to images and particular regions. A distinctive aspect of our work is that a single image can be divided so that the resultant sub-images can be stored and managed separately by different agents to improve performance in data accessing and processing. The system also offers the possibility of applying some region-based operations and filters on images, facilitating image classification. These operations can be performed directly on data structures in the database.

E.1027. Maison en bord de mer: Theoretical Restoration

E.1027, Maison en bord de mer is a small villa in Roquebrune Cap-Martin, built by architects Eileen Gray and Jean Badovici between 1926 and 1929. It was hailed as a landmark of modern architecture, and then forgotten. Over the years many transformations have been carried out, and these changes have altered the spatial qualities of the original project. Time and neglect have taken their toll, and until 2008 the villa was abandoned, a shadow of its former self. In order to state an appropriate restoration, a description of the house and its historic evolution has been made, comparing plans of its different transformations. After compiling the most common pathologies and restoration procedures in buildings of the Modern Movement in general, the particular pathologies of E.1027 are presented, concluding with a restoration proposal for E.1027 that considers aesthetical as well as technical aspects. This study involves an attempt to establish guidelines for the theoretical and technical aspects for restoration of architecture of the Modern Movement, using the Maison en bord de mer as an example.

A Balanced Memory-Based Collaborative Filtering Similarity Measure.

Collaborative filtering recommender systems contribute to alleviating the problem of information overload that exists on the Internet as a result of the mass use of Web 2.0 applications. The use of an adequate similarity measure becomes a determining factor in the quality of the prediction and recommendation results of the recommender system, as well as in its performance. In this paper, we present a memory-based collaborative filtering similarity measure that provides extremely high-quality and balanced results; these results are complemented with a low processing time (high performance), similar to the one required to execute traditional similarity metrics. The experiments have been carried out on the MovieLens and Netflix databases, using a representative set of information retrieval quality measures.

New PV self-orientating roof based on a balanced movement

New PV self-orientating roof based on a balanced movement

Sophisticated security verification on routing repaired balanced cell-based dual-rail logic against side channel analysis

Conventional dual-rail precharge logic suffers from difficult implementations of dual-rail structure for obtaining strict compensation between the counterpart rails. As a light-weight and high-speed dual-rail style, balanced cell-based dual-rail logic (BCDL) uses synchronised compound gates with global precharge signal to provide high resistance against differential power or electromagnetic analyses. BCDL can be realised from generic field programmable gate array (FPGA) design flows with constraints. However, routings still exist as concerns because of the deficient flexibility on routing control, which unfavourably results in bias between complementary nets in security-sensitive parts. In this article, based on a routing repair technique, novel verifications towards routing effect are presented. An 8 bit simplified advanced encryption processing (AES)-co-processor is executed that is constructed on block random access memory (RAM)-based BCDL in Xilinx Virtex-5 FPGAs. Since imbalanced routing are major defects in BCDL, the authors can rule out other influences and fairly quantify the security variants. A series of asymptotic correlation electromagnetic (EM) analyses are launched towards a group of circuits with consecutive routing schemes to be able to verify routing impact on side channel analyses. After repairing the non-identical routings, Mutual information analyses are executed to further validate the concrete security increase obtained from identical routing pairs in BCDL.