Background
This is the fourth updated Enhanced Recovery After Surgery (ERAS
®
) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded ...recommendations for each ERAS item within the ERAS
®
protocol.
Methods
A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.
Results
All recommendations on ERAS
®
protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly.
Conclusions
The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS
®
Society in this comprehensive consensus review.
Charge-transfer (CT) states, bound combinations of an electron and a hole on separate molecules, play a crucial role in organic optoelectronic devices. We report direct nanoscale imaging of the ...transport of long-lived CT states in molecular organic donor-acceptor blends, which demonstrates that the bound electron-hole pairs that form the CT states move geminately over distances of 5-10 nm, driven by energetic disorder and diffusion to lower energy sites. Magnetic field dependence reveals a fluctuating exchange splitting, indicative of a variation in electron-hole spacing during diffusion. The results suggest that the electron-hole pair of the CT state undergoes a stretching transport mechanism analogous to an 'inchworm' motion, in contrast to conventional transport of Frenkel excitons. Given the short exciton lifetimes characteristic of bulk heterojunction organic solar cells, this work confirms the potential importance of CT state transport, suggesting that CT states are likely to diffuse farther than Frenkel excitons in many donor-acceptor blends.
Recent proposals of topological flat band models have provided a new route to realize the fractional quantum Hall effect without Landau levels. We study hard-core bosons with short-range interactions ...in two representative topological flat band models, one of which is the well-known Haldane model (but with different parameters). We demonstrate that fractional quantum Hall states emerge with signatures of an even number of quasidegenerate ground states on a torus and a robust spectrum gap separating these states from the higher energy spectrum. We also establish quantum phase diagrams for the filling factor 1/2 and illustrate quantum phase transitions to other competing symmetry-breaking phases.
Current staging methods for pancreatic cancer (PC) are inadequate, and biomarkers to aid clinical decision making are lacking. Despite the availability of the serum marker carbohydrate antigen 19.9 ...(CA19.9) for over two decades, its precise role in the management of PC is yet to be defined, and as a consequence, it is not widely used.
We assessed the relationship between perioperative serum CA19.9 levels, survival and adjuvant chemotherapeutic responsiveness in a cohort of 260 patients who underwent operative resection for PC.
By specifically assessing the subgroup of patients with detectable CA19.9, we identified potential utility at key clinical decision points. Low postoperative CA19.9 at 3 months (median survival 25.6 vs 14.8 months, P = 0.0052) and before adjuvant chemotherapy were independent prognostic factors. Patients with postoperative CA 19.9 levels >90 U/ml did not benefit from adjuvant chemotherapy (P = 0.7194) compared with those with a CA19.9 of ≤90 U/ml (median 26.0 vs 16.7 months, P = 0.0108). Normalization of CA19.9 within 6 months of resection was also an independent favorable prognostic factor (median 29.9 vs 14.8 months, P = 0.0004) and normal perioperative CA19.9 levels identified a good prognostic group, which was associated with a 5-year survival of 42%.
Perioperative serum CA19.9 measurements are informative in patients with detectable CA19.9 (defined by serum levels of >5 U/ml) and have potential clinical utility in predicting outcome and response to adjuvant chemotherapy. Future clinical trials should prioritize incorporation of CA19.9 measurement at key decision points to prospectively validate these findings and facilitate implementation.
Background
Hypercalcemia is commonly observed in cats with azotemic chronic kidney disease (CKD). Dietary phosphate restriction is considered standard of care but may contribute to the development of ...hypercalcemia. The optimal dietary management strategy for these cats is unclear.
Objectives
To describe the effect of feeding a moderately phosphate‐restricted diet (MP; 1.5 g/Mcal phosphorus; Ca : P ratio, 1.3) to cats with concurrent azotemic CKD and ionized hypercalcemia.
Animals
Client‐owned cats with ionized hypercalcemia (ionized calcium iCa concentration >1.4 mmol/L) at diagnosis of CKD (n = 11; baseline hypercalcemics) or after CKD diagnosis while eating a phosphate‐restricted clinical renal diet (0.8 g/Mcal phosphorus; Ca : P ratio, 1.9; n = 10; RD hypercalcemics).
Methods
Changes in variables over time, after starting MP at visit 1, were assessed using linear mixed model analysis within each group of cats. Data are reporte as median 25th, 75th percentiles.
Results
At visit 1, iCa was 1.47 1.42, 1.55 mmol/L for baseline hypercalcemics and 1.53 1.5, 1.67 mmol/L for RD hypercalcemics. Blood iCa decreased (P < .001) when RD hypercalcemics were fed MP, with iCa <1.4 mmol/L in 8/10 cats after 2.2 1.8, 3.7 months. Plasma phosphate concentrations did not change. In contrast, the baseline hypercalcemic group overall showed no change in iCa but a decrease in plasma phosphate concentration during 8.8 5.5, 10.6 months on the MP diet, although 4/11 individual cats achieved iCa <1.4 mmol/L by 3.4 1.0, 6.2 months.
Conclusions and Clinical Importance
Attenuation of dietary phosphate restriction could result in normalization of iCa in cats that develop hypercalcemia while eating a clinical renal diet.
This paper investigates the adaptive finite-time tracking control problem for a class of switched nonlinear systems with unmodeled dynamics. In practical applications, switched systems usually ...possess unfavourable factors, such as unmeasured states and unmodeled dynamics both of which are taken into account in this paper. A dynamic signal defined with a special property is introduced in this paper to improve control performance while garanteeing stability of the controlled system. By designing an observer, a finite-time adaptive output-feedback tracking controller is constructed via the backstepping technique. Then, the finite-time stability problem of the considered systems is studied. It is shown that all the signals in the closed-loop system are semi-globally uniformly finite-time bounded (SGFUB), and the observer errors and tracking errors can be regulated to a small neighborhood of the origin by choosing appropriate parameters. It is noted that, the design process is less complex than some existing results on tackling control problems of nonlinear systems with unmodeled dynamics. In the example, the simulation result testifies the effectiveness of the proposed method.
Van Allen radiation belts consist of relativistic electrons trapped by Earth's magnetic field. Trapped electrons often drift azimuthally around Earth and display a butterfly pitch angle distribution ...of a minimum at 90° further out than geostationary orbit. This is usually attributed to drift shell splitting resulting from day-night asymmetry in Earth's magnetic field. However, direct observation of a butterfly distribution well inside of geostationary orbit and the origin of this phenomenon have not been provided so far. Here we report high-resolution observation that a unusual butterfly pitch angle distribution of relativistic electrons occurred within 5 Earth radii during the 28 June 2013 geomagnetic storm. Simulation results show that combined acceleration by chorus and magnetosonic waves can successfully explain the electron flux evolution both in the energy and butterfly pitch angle distribution. The current provides a great support for the mechanism of wave-driven butterfly distribution of relativistic electrons.
Inspired by the recent theoretical discovery of robust fractional topological phases without a magnetic field, we search for the non-abelian quantum Hall effect in lattice models with topological ...flat bands. Through extensive numerical studies on the Haldane model with three-body hard-core bosons loaded into a topological flat band, we find convincing numerical evidence of a stable ν=1 bosonic non-abelian quantum Hall effect, with the characteristic threefold quasidegeneracy of ground states on a torus, a quantized Chern number, and a robust spectrum gap. Moreover, the spectrum for two-quasihole states also shows a finite energy gap, with the number of states in the lower-energy sector satisfying the same counting rule as the Moore-Read pfaffian state.
The recent launching of Van Allen probes provides an unprecedent opportunity to investigate variations of the radiation belt relativistic electrons. During the 17–19 March 2013 storm, the Van Allen ...probes simultaneously detected strong chorus waves and substantial increases in fluxes of relativistic (2 − 4.5 MeV) electrons around L = 4.5. Chorus waves occurred within the lower band 0.1–0.5fce (the electron equatorial gyrofrequency), with a peak spectral density ∼10−4 nT2/Hz. Correspondingly, relativistic electron fluxes increased by a factor of 102–103 during the recovery phase compared to the main phase levels. By means of a Gaussian fit to the observed chorus spectra, the drift and bounce‐averaged diffusion coefficients are calculated and then used to solve a 2‐D Fokker‐Planck diffusion equation. Numerical simulations demonstrate that the lower‐band chorus waves indeed produce such huge enhancements in relativistic electron fluxes within 15 h, fitting well with the observation.
Key Points
Initial RBSP correlated data of chorus waves and relativistic electron fluxes
A realistic simulation to examine effect of chorus on relativistic electron flux
Chorus yields huge increases in electron flux rapidly, consistent with data
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