Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

Enhanced recovery after surgery(ERAS)programs have been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAS programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAS programs are:ERAS decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.So,ERAS could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAS focusing on its oncological implications and future investigations projects.

Ground threat prediction-based path planning of unmanned autonomous helicopter using hybrid enhanced artificial bee colony algorithm

Unmanned autonomous helicopter(UAH)path planning problem is an important component of the UAH mission planning system.Aiming to reduce the influence of non-complete ground threat information on UAH path planning,a ground threat prediction-based path planning method is proposed based on artificial bee colony(ABC)algorithm by collaborative thinking strategy.Firstly,a dynamic threat distribution probability model is developed based on the characteristics of typical ground threats.The dynamic no-fly zone of the UAH is simulated and established by calculating the distribution probability of ground threats in real time.Then,a dynamic path planning method for UAH is designed in complex environment based on the real-time prediction of ground threats.By adding the collision warning mechanism to the path planning model,the flight path could be dynamically adjusted according to changing no-fly zones.Furthermore,a hybrid enhanced ABC algorithm is proposed based on collaborative thinking strategy.The proposed algorithm applies the leader-member thinking mechanism to guide the direction of population evolution,and reduces the negative impact of local optimal solutions caused by collaborative learning update strategy,which makes the optimization performance of ABC algorithm more controllable and efficient.Finally,simulation results verify the feasibility and effectiveness of the proposed ground threat prediction path planning method.

CO_(2)flooding in shale oil reservoir with radial borehole fracturing for CO_(2)storage and enhanced oil recovery

This study introduces a novel method integrating CO_(2)flooding with radial borehole fracturing for enhanced oil recovery and CO_(2)underground storage,a solution to the limited vertical stimulation reservoir volume in horizontal well fracturing.A numerical model is established to investigate the production rate,reservoir pressure field,and CO_(2)saturation distribution corresponding to changing time of CO_(2)flooding with radial borehole fracturing.A sensitivity analysis on the influence of CO_(2)injection location,layer spacing,pressure difference,borehole number,and hydraulic fractures on oil production and CO_(2)storage is conducted.The CO_(2)flooding process is divided into four stages.Reductions in layer spacing will significantly improve oil production rate and gas storage capacity.However,serious gas channeling can occur when the spacing is lower than 20 m.Increasing the pressure difference between the producer and injector,the borehole number,the hydraulic fracture height,and the fracture width can also increase the oil production rate and gas storage rate.Sensitivity analysis shows that layer spacing and fracture height greatly influence gas storage and oil production.Research outcomes are expected to provide a theoretical basis for the efficient development of shale oil reservoirs in the vertical direction.

Synergistic anionic/zwitterionic mixed surfactant system with high emulsification efficiency for enhanced oil recovery in low permeability reservoirs

Emulsification is one of the important mechanisms of surfactant flooding. To improve oil recovery for low permeability reservoirs, a highly efficient emulsification oil flooding system consisting of anionic surfactant sodium alkyl glucosyl hydroxypropyl sulfonate(APGSHS) and zwitterionic surfactant octadecyl betaine(BS-18) is proposed. The performance of APGSHS/BS-18 mixed surfactant system was evaluated in terms of interfacial tension, emulsification capability, emulsion size and distribution, wettability alteration, temperature-resistance and salt-resistance. The emulsification speed was used to evaluate the emulsification ability of surfactant systems, and the results show that mixed surfactant systems can completely emulsify the crude oil into emulsions droplets even under low energy conditions. Meanwhile,the system exhibits good temperature and salt resistance. Finally, the best oil recovery of 25.45% is achieved for low permeability core by the mixed surfactant system with a total concentration of 0.3 wt%while the molar ratio of APGSHS:BS-18 is 4:6. The current study indicates that the anionic/zwitterionic mixed surfactant system can improve the oil flooding efficiency and is potential candidate for application in low permeability reservoirs.

Enhanced structural damage behavior of liquid-filled tank by reactive material projectile impact

A series of ballistic experiments were performed to investigate the damage behavior of high velocity reactive material projectiles(RMPs) impacting liquid-filled tanks,and the corresponding hydrodynamic ram(HRAM) was studied in detail.PTFE/Al/W RMPs with steel-like and aluminum-like densities were prepared by a pressing/sintering process.The projectiles impacted a liquid-filled steel tank with front aluminum panel at approximately 1250 m/s.The corresponding cavity evolution characteristics and HRAM pressure were recorded by high-speed camera and pressure acquisition system,and further compared to those of steel and aluminum projectiles.Significantly different from the conical cavity formed by the inert metal projectile,the cavity formed by the RMP appeared as an ellipsoid with a conical front.The RMPs were demonstrated to enhance the radial growth velocity of cavity,the global HRAM pressure amplitude and the front panel damage,indicating the enhanced HRAM and structural damage behavior.Furthermore,combining the impact-induced fragmentation and deflagration characteristics,the cavity evolution of RMPs under the combined effect of kinetic energy impact and chemical energy release was analyzed.The mechanism of enhanced HRAM pressure induced by the RMPs was further revealed based on the theoretical model of the initial impact wave and the impulse analysis.Finally,the linear correlation between the deformation-thickness ratio and the non-dimensional impulse for the front panel was obtained and analyzed.It was determined that the enhanced near-field impulse induced by the RMPs was the dominant reason for the enhanced structural damage behavior.

Effects of fracture evolution and non-Darcy flow on the thermal performance of enhanced geothermal system in 3D complex fractured rock

In fractured geothermal reservoirs,the fracture networks and internal fluid flow behaviors can significantly impact the thermal performance.In this study,we proposed a non-Darcy rough discrete fracture network(NR-DFN)model that can simultaneously consider the fracture evolution and non-Darcy flow dynamics in studying the thermo-hydro-mechanical(THM)coupling processes for heat extraction in geothermal reservoir.We further employed the model on the Habanero enhanced geothermal systems(EGS)project located in Australia.First,our findings illustrate a clear spatial-temporal variation in the thermal stress and pressure perturbations,as well as uneven spatial distribution of shear failure in 3D fracture networks.Activated shear failure is mainly concentrated in the first fracture cluster.Secondly,channeling flow have also been observed in DFNs during heat extraction and are further intensified by the expansion of fractures driven by thermal stresses.Moreover,the combined effect of non-Darcy flow and fracture evolution triggers a rapid decline in the resulting heat rate and temperature.The NR-DFN model framework and the Habanero EGS's results illustrate the importance of both fracture evolution and non-Darcy flow on the efficiency of EGS production and have the potential to promote the development of more sustainable and efficient EGS operations for stakeholders.

Model Parameters Identification and Backstepping Control of Lower Limb Exoskeleton Based on Enhanced Whale Algorithm

Exoskeletons generally require accurate dynamic models to design the model-based controller conveniently under the human-robot interaction condition.However,due to unknown model parameters such as the mass,moment of inertia and mechanical size,the dynamic model of exoskeletons is difficult to construct.Hence,an enhanced whale optimization algorithm(EWOA)is proposed to identify the exoskeleton model parameters.Meanwhile,the periodic excitation trajectories are designed by finite Fourier series to input the desired position demand of exoskeletons with mechanical physical constraints.Then a backstepping controller based on the identified model is adopted to improve the human-robot wearable comfortable performance under cooperative motion.Finally,the proposed Model parameters identification and control are verified by a two-DOF exoskeletons platform.The knee joint motion achieves a steady-state response after 0.5 s.Meanwhile,the position error of hip joint response is less than 0.03 rad after 0.9 s.In addition,the steady-state human-robot interaction torque of the two joints is constrained within 15 N·m.This research proposes a whale optimization algorithm to optimize the excitation trajectory and identify model parameters.Furthermore,an enhanced mutation strategy is adopted to avoid whale evolution’s unsatisfactory local optimal value.

Modified electronic structure and enhanced hydroxyl adsorption make quaternary Pt-based nanosheets efficient anode electrocatalysts for formic acid-/alcohol-air fuel cells

Surface/interface engineering of a multimetallic nanostructure with diverse electrocatalytic properties for direct liquid fuel cells is desirable yet challenging.Herein,using visible light,a class of quaternary Pt_(1)Ag_(0.1)Bi_(0.16)Te_(0.29)ultrathin nanosheets is fabricated and used as high-performance anode electrocatalysts for formic acid-/alcohol-air fuel cells.The modified electronic structure of Pt,enhanced hydroxyl adsorption,and abundant exterior defects afford Pt_(1)Ag_(0.1)Bi_(0.16)Te_(0.29)/C high intrinsic anodic electrocatalytic activity to boost the power densities of direct formic acid-/methanol-/ethanol-/ethylene glycol-/glycerol-air fuel cells,and the corresponding peak power density of Pt_(1)Ag_(0.1)Bi_(0.16)Te_(0.29)/C is respectively 129.7,142.3,105.4,124.3,and 128.0 mW cm^(-2),considerably outperforming Pt/C.Operando in situ Fourier transform infrared reflection spectroscopy reveals that formic acid oxidation on Pt_(1)Ag_(0.1)Bi_(0.16)Te_(0.29)/C occurs via a CO_(2)-free direct pathway.Density functional theory calculations show that the presence of Ag,Bi,and Te in Pt_(1)Ag_(0.1)Bi_(0.16)Te_(0.29)suppresses CO^(*)formation while optimizing dehydrogenation steps and synergistic effect and modified Pt effectively enhance H_(2)O dissociation to improve electrocatalytic performance.This synthesis strategy can be extended to 43 other types of ultrathin multimetallic nanosheets(from ternary to octonary nanosheets),and efficiently capture precious metals(i.e.,Pd,Pt,Rh,Ru,Au,and Ag)from different water sources.

Enhanced Temporal Correlation for Universal Lesion Detection

Universal lesion detection(ULD)methods for computed tomography(CT)images play a vital role in the modern clinical medicine and intelligent automation.It is well known that single 2D CT slices lack spatial-temporal characteristics and contextual information compared to 3D CT blocks.However,3D CT blocks necessitate significantly higher hardware resources during the learning phase.Therefore,efficiently exploiting temporal correlation and spatial-temporal features of 2D CT slices is crucial for ULD tasks.In this paper,we propose a ULD network with the enhanced temporal correlation for this purpose,named TCE-Net.The designed TCE module is applied to enrich the discriminate feature representation of multiple sequential CT slices.Besides,we employ multi-scale feature maps to facilitate the localization and detection of lesions in various sizes.Extensive experiments are conducted on the DeepLesion benchmark demonstrate that thismethod achieves 66.84%and 78.18%for FS@0.5 and FS@1.0,respectively,outperforming compared state-of-the-art methods.

Prediction of high-embankment settlement combining joint denoising technique and enhanced GWO-v-SVR method

Reliable long-term settlement prediction of a high embankment relates to mountain infrastructure safety.This study developed a novel hybrid model(NHM)that combines a joint denoising technique with an enhanced gray wolf optimizer(EGWO)-n-support vector regression(n-SVR)method.High-embankment field measurements were preprocessed using the joint denoising technique,which in-cludes complete ensemble empirical mode decomposition,singular value decomposition,and wavelet packet transform.Furthermore,high-embankment settlements were predicted using the EGWO-n-SVR method.In this method,the standard gray wolf optimizer(GWO)was improved to obtain the EGWO to better tune the n-SVR model hyperparameters.The proposed NHM was then tested in two case studies.Finally,the influences of the data division ratio and kernel function on the EGWO-n-SVR forecasting performance and prediction efficiency were investigated.The results indicate that the NHM suppresses noise and restores details in high-embankment field measurements.Simultaneously,the NHM out-performs other alternative prediction methods in prediction accuracy and robustness.This demonstrates that the proposed NHM is effective in predicting high-embankment settlements with noisy field mea-surements.Moreover,the appropriate data division ratio and kernel function for EGWO-n-SVR are 7:3 and radial basis function,respectively.

Carbon enhanced nucleophilicity of Na_(3)V_(2)(PO_(4))_(3):A general approach for dendrite-free zinc metal anodes

Zincophilic property and high electrical conductivity are both very important parameters to design novel Zn anode for aqueous Zn-ion batteries(AZIBs).However,single material is difficult to exhibit zincophilic property and high electrical conductivity at the same time.Herein,originating from theoretical calculation,a zincophilic particle regulation strategy is proposed to address these limitations and carbon coated Na_(3)V_(2)(PO_(4))_(3)is taken as an example to be a protective layer on zinc metal(NVPC@Zn).Na_(3)V_(2)(PO_(4))_(3)(NVP)is a common cathode material for Zn-ion batteries,which is zincophilic.Carbon materials not only offer an electron pathway to help Zn deposition onto NVPC surface,but also enhance the zinc nucleophilicity of Na_(3)V_(2)(PO_(4))_(3).Hence,this hybrid coating layer can tune zinc deposition and resist side reactions such as hydrogen generation and Zn metal corrosion.Experimentally,a symmetrical battery with NVPC@Zn electrode displays highly reversible plating/stripping behavior with a long cycle lifespan over 1800 h at2 mA cm^(-2),much better than carbon and Na_(3)V_(2)(PO_(4))_(3)solely modified Zn electrodes.When the Na_(3)V_(2)(PO_(4))_(3)is replaced with zincophobic Al2O3or zincophilic V2O3,the stability of the modified zinc anodes is also prolonged.This strategy expands the option of zincophilic materials and provides a general and effective way to stabilize the Zn electrode.

Tailoring MXene Thickness and Functionalization for Enhanced Room‑Temperature Trace NO_(2) Sensing

In this study,precise control over the thickness and termination of Ti3C2TX MXene flakes is achieved to enhance their electrical properties,environmental stability,and gas-sensing performance.Utilizing a hybrid method involving high-pressure processing,stirring,and immiscible solutions,sub-100 nm MXene flake thickness is achieved within the MXene film on the Si-wafer.Functionalization control is achieved by defunctionalizing MXene at 650℃ under vacuum and H2 gas in a CVD furnace,followed by refunctionalization with iodine and bromine vaporization from a bubbler attached to the CVD.Notably,the introduction of iodine,which has a larger atomic size,lower electronegativity,reduce shielding effect,and lower hydrophilicity(contact angle:99°),profoundly affecting MXene.It improves the surface area(36.2 cm^(2) g^(-1)),oxidation stability in aqueous/ambient environments(21 days/80 days),and film conductivity(749 S m^(-1)).Additionally,it significantly enhances the gas-sensing performance,including the sensitivity(0.1119Ωppm^(-1)),response(0.2% and 23%to 50 ppb and 200 ppm NO_(2)),and response/recovery times(90/100 s).The reduced shielding effect of the–I-terminals and the metallic characteristics of MXene enhance the selectivity of I-MXene toward NO2.This approach paves the way for the development of stable and high-performance gas-sensing two-dimensional materials with promising prospects for future studies.

Acidic/hypoxia dual-alleviated nanoregulators for enhanced treatment of tumor chemo-immunotherapy

Chemotherapy plays a crucial role in triple-negative breast cancer (TNBC) treatment as it not only directly kills cancer cells but also induces immunogenic cell death. However, the chemotherapeutic efficacy was strongly restricted by the acidic and hypoxic tumor environment. Herein, we have successfully formulated PLGA-based nanoparticles concurrently loaded with doxorubicin (DOX), hemoglobin (Hb) and CaCO3 by a CaCO3-assisted emulsion method, aiming at the effective treatment of TNBC. We found that the obtained nanomedicine (DHCaNPs) exhibited effective drug encapsulation and pH-responsive drug release behavior. Moreover, DHCaNPs demonstrated robust capabilities in neutralizing protons and oxygen transport. Consequently, DHCaNPs could not only serve as oxygen nanoshuttles to attenuate tumor hypoxia but also neutralize the acidic tumor microenvironment (TME) by depleting lactic acid, thereby effectively overcoming the resistance to chemotherapy. Furthermore, DHCaNPs demonstrated a notable ability to enhance antitumor immune responses by increasing the frequency of tumor-infiltrating effector lymphocytes and reducing the frequency of various immune-suppressive cells, therefore exhibiting a superior efficacy in suppressing tumor growth and metastasis when combined with anti-PD-L1 (αPD-L1) immunotherapy. In summary, this study highlights that DHCaNPs could effectively attenuate the acidic and hypoxic TME, offering a promising strategy to figure out an enhanced chemo-immunotherapy to benefit TNBC patients.

Enhanced resonance frequency in Co2FeAl thin film with different thicknesses grown on flexible graphene substrate

The flexible materials exhibit more favorable properties than most rigid substrates in flexibility,weight saving,mechanical reliability,and excellent environmental toughness.Particularly,flexible graphene film with unique mechanical properties was extensively explored in high frequency devices.Herein,we report the characteristics of structure and magnetic properties at high frequency of Co2FeAl thin film with different thicknesses grown on flexible graphene substrate at room temperature.The exciting finding for the columnar structure of Co2FeAl thin film lays the foundation for excellent high frequency property of Co2FeAl/flexible graphene structure.In-plane magnetic anisotropy field varying with increasing thickness of Co2FeAl thin film can be obtained by measurement of ferromagnetic resonance,which can be ascribed to the enhancement of crystallinity and the increase of grain size.Meanwhile,the resonance frequency which can be achieved by the measurement of vector network analyzer with the microstrip method increases with increasing thickness of Co2FeAl thin film.Moreover,in our case with graphene film,the resonance magnetic field is quite stable though folded for twenty cycles,which demonstrates that good flexibility of graphene film and the stability of high frequency magnetic property of Co2FeAl thin film grown on flexible graphene substrate.These results are promising for the design of microwave devices and wireless communication equipment.

Multi-Stream Temporally Enhanced Network for Video Salient Object Detection

Video salient object detection(VSOD)aims at locating the most attractive objects in a video by exploring the spatial and temporal features.VSOD poses a challenging task in computer vision,as it involves processing complex spatial data that is also influenced by temporal dynamics.Despite the progress made in existing VSOD models,they still struggle in scenes of great background diversity within and between frames.Additionally,they encounter difficulties related to accumulated noise and high time consumption during the extraction of temporal features over a long-term duration.We propose a multi-stream temporal enhanced network(MSTENet)to address these problems.It investigates saliency cues collaboration in the spatial domain with a multi-stream structure to deal with the great background diversity challenge.A straightforward,yet efficient approach for temporal feature extraction is developed to avoid the accumulative noises and reduce time consumption.The distinction between MSTENet and other VSOD methods stems from its incorporation of both foreground supervision and background supervision,facilitating enhanced extraction of collaborative saliency cues.Another notable differentiation is the innovative integration of spatial and temporal features,wherein the temporal module is integrated into the multi-stream structure,enabling comprehensive spatial-temporal interactions within an end-to-end framework.Extensive experimental results demonstrate that the proposed method achieves state-of-the-art performance on five benchmark datasets while maintaining a real-time speed of 27 fps(Titan XP).Our code and models are available at https://github.com/RuJiaLe/MSTENet.

Superwetting Ag/α-Fe_(2)O_(3) anchored mesh with enhanced photocatalytic and antibacterial activities for efficient water purification

Superwetting materials have drawn unprecedented attention in the treatment of oily wastewater due to their preferable anti-fouling property and selective oil/water separation.However,it is still a challenge to fabricate multifunctional and environmentally friendly materials,which can be stably applied to purify the actual complicated wastewater.Here,a Ag/Ag/α-Fe_(2)O_(3) heterostructure anchored copper mesh was intentionally synthesized using a facile two-step hydrothermal method.The resultant mesh with superhydrophilicity and underwater superoleophobicity was capable of separating various oil/water mixtures with superior separation efficiency and high permeationflux driven by gravity.Benefiting from the joint effects of the smaller band gap of Ag/α-Fe_(2)O_(3) heterojunction,inherent antibacterial capacity of Ag/α-Fe_(2)O_(3) and Ag nanoparticles,favorable conductive substrate,as well as the hierarchical structure with superwettability,such mesh presented remarkably enhanced degradation capability toward organic dyes under visible light irradiation and antibacterial activity against both Escherichia coli(E.coli)and Staphylococcus aureus(S.aureus)compared with the pure Ag/α-Fe_(2)O_(3) coated mesh.Impressively,the mesh exhibited bifunctional water purification performance,in which organic dyes were eliminated simultaneously from water during oil/water separation in onefiltration process.More importantly,this mesh behaved exceptional chemical resistance,mechanical stability and long-term reusability.Therefore,this material with multifunctional integration may hold promising potential for steady water purification in practice.

Experimental investigation on using CO_(2)/H_(2)O emulsion with high water cut in enhanced oil recovery

CO_(2) emulsions used for EOR have received a lot of interest because of its good performance on CO_(2)mobility reduction.However,most of them have been focusing on the high quality CO_(2) emulsion(high CO_(2) fraction),while CO_(2) emulsion with high water cut has been rarely researched.In this paper,we carried out a comprehensive experimental study of using high water cut CO_(2)/H_(2)O emulsion for enhancing oil recovery.Firstly,a nonionic surfactant,alkyl glycosides(APG),was selected to stabilize CO_(2)/H_(2)O emulsion,and the corresponding morphology and stability were evaluated with a transparent PVT cell.Subsequently,plugging capacity and apparent viscosity of CO_(2)/H_(2)O emulsion were measured systematically by a sand pack displacement apparatus connected with a 1.95-m long capillary tube.Furthermore,a high water cut(40 vol%) CO_(2)/H_(2)O emulsion was selected for flooding experiments in a long sand pack and a core sample,and the oil recovery,the rate of oil recovery,and the pressure gradients were analyzed.The results indicated that APG had a good performance on emulsifying and stabilizing CO_(2) emulsion.An inversion from H_(2)O/CO_(2) emulsion to CO_(2)/H_(2)O emulsion with the increase in water cut was confirmed.CO_(2)/H_(2)O emulsions with lower water cuts presented higher apparent viscosity,while the optimal plugging capacity of CO_(2)/H_(2)O emulsion occurred at a certain water cut.Eventually,the displacement using CO_(2)/H_(2)O emulsion provided 18.98% and 13.36% additional oil recovery than that using pure CO_(2) in long sand pack and core tests,respectively.This work may provide guidelines for EOR using CO_(2) emulsions with high water cut.

Enhanced Wolf Pack Algorithm (EWPA) and Dense-kUNet Segmentation for Arterial Calcifications in Mammograms

Breast Arterial Calcification(BAC)is a mammographic decision dissimilar to cancer and commonly observed in elderly women.Thus identifying BAC could provide an expense,and be inaccurate.Recently Deep Learning(DL)methods have been introduced for automatic BAC detection and quantification with increased accuracy.Previously,classification with deep learning had reached higher efficiency,but designing the structure of DL proved to be an extremely challenging task due to overfitting models.It also is not able to capture the patterns and irregularities presented in the images.To solve the overfitting problem,an optimal feature set has been formed by Enhanced Wolf Pack Algorithm(EWPA),and their irregularities are identified by Dense-kUNet segmentation.In this paper,Dense-kUNet for segmentation and optimal feature has been introduced for classification(severe,mild,light)that integrates DenseUNet and kU-Net.Longer bound links exist among adjacent modules,allowing relatively rough data to be sent to the following component and assisting the system in finding higher qualities.The major contribution of the work is to design the best features selected by Enhanced Wolf Pack Algorithm(EWPA),and Modified Support Vector Machine(MSVM)based learning for classification.k-Dense-UNet is introduced which combines the procedure of Dense-UNet and kU-Net for image segmentation.Longer bound associations occur among nearby sections,allowing relatively granular data to be sent to the next subsystem and benefiting the system in recognizing smaller characteristics.The proposed techniques and the performance are tested using several types of analysis techniques 826 filled digitized mammography.The proposed method achieved the highest precision,recall,F-measure,and accuracy of 84.4333%,84.5333%,84.4833%,and 86.8667%when compared to other methods on the Digital Database for Screening Mammography(DDSM).

Enhanced recovery after surgery:Progress in adapted pathways for implementation in standard and emerging surgical settings

The concept of enhanced recovery after surgery(ERAS)has been practiced for decades and has been implemented in numerous surgical specialties.ERAS is a global surgical quality improvement initiative,and it is an element in the field of perioperative care.ERAS had shown significant clinical outcomes,patientreported satisfaction,and improvements in medical service cost.ERAS has been developed for specific surgical procedures,but with the fast progress of newly introduced surgical procedures,the original ERAS have been developed and modified.Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status,including but not limited to pediatric surgery,laparoscopic and robotic assisted surgery,bariatric surgery,thoracic surgery,and renal transplantation.The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative,operative,and post-operative pathways.ERAS costs are higher than traditional care,but the patient’s clinical outcome and satisfaction are higher.ERAS is in progress in the fields of anesthetic tasks,pediatric surgery,and organ transplantation.Although ERAS has shown significant clinical outcomes,there are needs to modify the protocol for specific cases,hospital facilities,resources,and nurses training on elements of ERAS.Several challenges and limitations exist in the implementation of ERAS that deserve consideration,it includes:Frailty,maximizing nutrition,prehabilitation,treating preoperative anemia,and enhancing ERAS adoption globally are all included.

Pre-operative enhanced magnetic resonance imaging combined with clinical features predict early recurrence of hepatocellular carcinoma after radical resection

BACKGROUND Indentifying predictive factors for postoperative recurrence of hepatocellular carcinoma(HCC)has great significance for patient prognosis.AIM To explore the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)combined with clinical features in predicting early recurrence of HCC after resection.METHODS A total of 161 patients with pathologically confirmed HCC were enrolled.The patients were divided into early recurrence and non-early recurrence group based on the follow-up results.The clinical,laboratory,pathological results and Gd-EOB-DTPA enhanced MRI imaging features were analyzed.RESULTS Of 161 patients,73 had early recurrence and 88 were had non-early recurrence.Univariate analysis showed that patient age,gender,serum alpha-fetoprotein level,the Barcelona Clinic Liver Cancer stage,China liver cancer(CNLC)stage,microvascular invasion(MVI),pathological satellite focus,tumor size,tumor number,tumor boundary,tumor capsule,intratumoral necrosis,portal vein tumor thrombus,large vessel invasion,nonperipheral washout,peritumoral enhancement,hepatobiliary phase(HBP)/tumor signal intensity(SI)/peritumoral SI,HBP peritumoral low signal and peritumoral delay enhancement were significantly associated with early recurrence of HCC after operation.Multivariate logistic regression analysis showed that patient age,MVI,CNLC stage,tumor boundary and large vessel invasion were independent predictive factors.External data validation indicated that the area under the curve of the combined predictors was 0.861,suggesting that multivariate logistic regression was a reasonable predictive model for early recurrence of HCC.CONCLUSION Gd-EOB-DTPA enhanced MRI combined with clinical features would help predicting the early recurrence of HCC after operation.