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.
Interferometric gravitational-wave detectors are complex instruments comprised of a Michelson interferometer enhanced by multiple coupled cavities. Active feedback control is required to operate ...these instruments and keep the cavities locked on resonance. The optical response is highly nonlinear until a good operating point is reached. The linear operating range is between and 1% of a fringe for each degree of freedom. The resonance lock has to be achieved in all five degrees of freedom simultaneously, making the acquisition difficult. Furthermore, the cavity linewidth seen by the laser is only Hz, which is four orders of magnitude smaller than the linewidth of the free running laser. The arm length stabilization system is a new technique used for arm cavity locking in Advanced LIGO. Together with a modulation technique utilizing third harmonics to lock the central Michelson interferometer, the Advanced LIGO detector has been successfully locked and brought to an operating point where detecting gravitational-waves becomes feasible.
We present a catalog of sources detected above 10 GeV by the Fermi Large Area Telescope (LAT) in the first 7 years of data using the Pass 8 event-level analysis. This is the Third Catalog of Hard ...Fermi-LAT Sources (3FHL), containing 1556 objects characterized in the 10 GeV-2 TeV energy range. The sensitivity and angular resolution are improved by factors of 3 and 2 relative to the previous LAT catalog at the same energies (1FHL). The vast majority of detected sources (79%) are associated with extragalactic counterparts at other wavelengths, including 16 sources located at very high redshift (z > 2). Of the sources, 8% have Galactic counterparts and 13% are unassociated (or associated with a source of unknown nature). The high-latitude sky and the Galactic plane are observed with a flux sensitivity of 4.4 to 9.5 × 10−11 ph cm−2 s−1, respectively (this is approximately 0.5% and 1% of the Crab Nebula flux above 10 GeV). The catalog includes 214 new γ-ray sources. The substantial increase in the number of photons (more than 4 times relative to 1FHL and 10 times to 2FHL) also allows us to measure significant spectral curvature for 32 sources and find flux variability for 163 of them. Furthermore, we estimate that for the same flux limit of 10−12 erg cm−2 s−1, the energy range above 10 GeV has twice as many sources as the range above 50 GeV, highlighting the importance, for future Cherenkov telescopes, of lowering the energy threshold as much as possible.
The embryonic avian heart is an important model for studying cardiac developmental biology. The mechanisms that govern the development of a four-chambered heart from a peristaltic heart tube are ...largely unknown due in part to a lack of adequate imaging technology. Due to the small size and rapid motion of the living embryonic avian heart, an imaging system with high spatial and temporal resolution is required to study these models. Here, an optical coherence tomography (OCT) system using a buffered Fourier Domain Mode Locked (FDML) laser is applied for ultrahigh-speed non-invasive imaging of embryonic quail hearts at 100,000 axial scans per second. The high scan rate enables the acquisition of high temporal resolution 2D datasets (195 frames per second or 5.12 ms between frames) and 3D datasets (10 volumes per second). Spatio-temporal details of cardiac motion not resolvable using previous OCT technology are analyzed. Visualization and measurement techniques are developed to non-invasively observe and quantify cardiac motion throughout the brief period of systole (less than 50 msec) and diastole. This marks the first time that the preseptated embryonic avian heart has been imaged in 4D without the aid of gating and the first time it has been viewed in cross section during looping with extremely high temporal resolution, enabling the observation of morphological dynamics of the beating heart during systole.
Black holes with masses below approximately 1015 g are expected to emit gamma-rays with energies above a few tens of MeV, which can be detected by the Fermi Large Area Telescope (LAT). Although black ...holes with these masses cannot be formed as a result of stellar evolution, they may have formed in the early universe and are therefore called primordial black holes (PBHs). Previous searches for PBHs have focused on either short-timescale bursts or the contribution of PBHs to the isotropic gamma-ray emission. We show that, in cases of individual PBHs, the Fermi-LAT is most sensitive to PBHs with temperatures above approximately 16 GeV and masses 6 × 1011 g, which it can detect out to a distance of about 0.03 pc. These PBHs have a remaining lifetime of months to years at the start of the Fermi mission. They would appear as potentially moving point sources with gamma-ray emission that become spectrally harder and brighter with time until the PBH completely evaporates. In this paper, we develop a new algorithm to detect the proper motion of gamma-ray point sources, and apply it to 318 unassociated point sources at a high galactic latitude in the third Fermi-LAT source catalog. None of the unassociated point sources with spectra consistent with PBH evaporation show significant proper motion. Using the nondetection of PBH candidates, we derive a 99% confidence limit on the PBH evaporation rate in the vicinity of Earth, ˙ PBH < 7.2 × 10 3 pc − 3 yr − 1 . This limit is similar to the limits obtained with ground-based gamma-ray observatories.
Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number ...of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management.
A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management.
Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p < 0.0001).
Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119-25.
Analysis is presented for 15 months of data taken with the Large Area Telescope (LAT) on the Fermi Gamma-ray Space Telescope for 11 non-blazar active galactic nuclei (AGNs), including seven FRI radio ...galaxies and four FRII radio sources consisting of two FRII radio galaxies and two steep spectrum radio quasars. The broad line FRI radio galaxy 3C 120 is reported here as a gamma-ray source for the first time. The analysis is based on directional associations of LAT sources with radio sources in the 3CR, 3CRR, and MS4 (collectively referred to as 3C-MS) catalogs. Seven of the eleven LAT sources associated with 3C-MS radio sources have spectral indices larger than 2.3 and, except for the FRI radio galaxy NGC 1275 that shows possible spectral curvature, are well described by a power law. No evidence for time variability is found for any sources other than NGC 1275. The gamma-ray luminosities of FRI radio galaxies are significantly smaller than those of the BL Lac objects detected by the LAT, whereas the gamma-ray luminosities of the FRII sources are quite similar to those of FSRQs, which could reflect different beaming factors for the gamma-ray emission. A core dominance (CD) study of the 3CRR sample indicates that sources closer to the jet axis are preferentially detected with the Fermi LAT, insofar as the gamma-ray-detected misaligned AGNs have larger CD at a given average radio flux. The results are discussed in view of the AGN unification scenario.
Analyses of form-function relationships during heart looping are directly related to technological advances. Recent advances in four-dimensional optical coherence tomography (OCT) permit observations ...of cardiac dynamics at high-speed acquisition rates and high resolution. Real-time observation of the avian stage 13 looping heart reveals that interactions between the endocardial and myocardial compartments are more complex than previously depicted. Here we applied four-dimensional OCT to elucidate the relationships of the endocardium, myocardium, and cardiac jelly compartments in a single cardiac cycle during looping. Six cardiac levels along the longitudinal heart tube were each analyzed at 15 time points from diastole to systole. Using image analyses, the organization of mechanotransducing molecules, fibronectin, tenascin C, α-tubulin, and nonmuscle myosin II was correlated with specific cardiac regions defined by OCT data. Optical coherence microscopy helped to visualize details of cardiac architectural development in the embryonic mouse heart. Throughout the cardiac cycle, the endocardium was consistently oriented between the midline of the ventral floor of the foregut and the outer curvature of the myocardial wall, with multiple endocardial folds allowing high-volume capacities during filling. The cardiac area fractional shortening is much higher than previously published. The in vivo profile captured by OCT revealed an interaction of the looping heart with the extra-embryonic splanchnopleural membrane providing outside-in information. In summary, the combined dynamic and imaging data show the developing structural capacity to accommodate increasing flow and the mechanotransducing networks that organize to effectively facilitate formation of the trabeculated four-chambered heart.
Purpose: Flavopiridol is a potent cyclin-dependent kinase inhibitor with preclinical activity against non-small cell lung cancer (NSCLC),
inhibiting tumor growth in vitro and in vivo by cytostatic ...and cytotoxic mechanisms. A Phase II trial was conducted to determine the activity and toxicity of flavopiridol
in untreated patients with metastatic NSCLC.
Experimental Design: A total of 20 patients were treated with a 72-h continuous infusion of flavopiridol every 14 days at a dose of 50 mg/m 2 /day and a concentration of 0.1–0.2 mg/ml. Dose escalation to 60 mg/m 2 /day was permitted if no significant toxicity occurred. Response was initially assessed after every two infusions; patients
treated longer than 8 weeks were then assessed after every four infusions. Plasma levels of flavopiridol were measured daily
during the first two infusions to determine steady-state concentrations.
Results: This study was designed to evaluate a total of 45 patients in two stages. However, because no objective responses were seen
in the first 20 patients, the early-stopping rule was invoked, and patient accrual was halted. In four patients who received
eight infusions, progression was documented at 15, 20, 40, and 65 weeks, respectively. The most common toxicities included
grade 1 or 2 diarrhea in 11 patients, asthenia in 10 patients, and venous thromboses in 7 patients. The mean ± SD steady-state
concentration of drug during the first infusion was 200 ± 89.9 n m , sufficient for cytostatic effects in in vitro models.
Conclusions: At the current doses and schedule, flavopiridol does not have cytotoxic activity in NSCLC, although protracted periods of
disease stability were observed with an acceptable degree of toxicity.
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