Supersolid Properties of a Bose-Einstein Condensate in a Ring Resonator.

We investigate the dynamics of a Bose-Einstein condensate interacting with two noninterfering and counterpropagating modes of a ring resonator. Superfluid, supersolid, and dynamic phases are identified experimentally and theoretically. The supersolid phase is obtained for sufficiently equal pump strengths for the two modes. In this regime we observe the emergence of a steady state with crystalline order, which spontaneously breaks the continuous translational symmetry of the system. The supersolidity of this state is demonstrated by the conservation of global phase coherence at the superfluid to supersolid phase transition. Above a critical pump asymmetry the system evolves into a dynamic runaway instability commonly known as collective atomic recoil lasing. We present a phase diagram and characterize the individual phases by comparing theoretical predictions with experimental observations.

Correction to: Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis.

In the list of participating investigators that appears in Acknowledgements, one of the investigators names appears incorrectly.

Incidence and Risk Factors for Severity of Postoperative Ileus After Colorectal Surgery: A Prospective Registry Data Analysis.

BACKGROUND: Defining severe postoperative ileus in terms of consequences could help physicians standardize the management of this condition. The recently described classification based on consequences requires further investigation. The aim of this study was to obtain a snapshot of postoperative ileus in patients undergoing colorectal surgery within enhanced recovery programs and to identify factors associated with non-severe and severe postoperative ileus. METHODS: This prospective registry data analysis was conducted in 40 centers in five different countries. A total of 786 patients scheduled for colorectal surgery within enhanced recovery programs were included. The primary endpoint was the incidence rate of postoperative ileus as defined by Vather et al. RESULTS: A total of 121 patients experienced postoperative ileus (15.4%). Non-severe POI occurred in 48 patients (6.1%), and severe postoperative ileus occurred in 73 patients (9.3%). In multivariate analysis, the male gender and intra-abdominal complications were associated with severe postoperative ileus: odd ratio (OR) = 2.03 [95% confidence interval (CI) 1.14-3.59], p = 0.01 and OR = 3.60 [95% CI 1.75-7.40], p < 0.0001, respectively. Conversely, open laparotomy and urinary retention were associated with non-severe POI: OR = 3.03 [95% CI 1.37-6.72], p = 0.006 and OR = 2.70 [95% CI 0.89-8.23], p = 0.08, respectively. CONCLUSIONS: Postoperative ileus occurred in 15% of patients after colorectal surgery within enhanced recovery programs. For 60% of patients, this was considered severe. The physiopathology of these two entities could be different, severe POI being linked to intraabdominal complication, while non-severe POI being linked with risk factors for "primary" POI. The physician should pay attention to male patients having POI after colorectal surgery and look for features evocating intraabdominal complications.

Are enhanced recovery programs in colorectal surgery feasible and useful in the elderly? A systematic review of the literature.

INTRODUCTION: Enhanced recovery programs (ERP) are no longer questionable in the management of patients undergoing surgery. However, there is some doubt as to their feasibility and efficacy in the elderly. Our goal was to systematically review the evidence-based literature concerning the feasibility of ERP in elderly patients undergoing colorectal surgery. MATERIAL AND METHODS: The PubMed and Cochrane Database for systematic reviews as well as the "grey" literature between 2000 and 2015 were sought. Articles were selected if they compared ERP in elderly patients to ERP in young patients (feasibility) or compared ERP to traditional post-operative management in the elderly (efficacy). RESULTS: Sixteen articles were identified according to the inclusion criteria. All showed that an ERP was feasible in the elderly although post-operative morbidity was higher compared to younger patients. Compared to traditional management, ERP was effective since it decreased (as in the young) the overall rate of complications and thus the duration of hospital stay. There were not enough data on the degree of implementation of ERP and the medico-economic aspects to come to any formal conclusions. CONCLUSION: This comprehensive systematic review of the literature showed that ERP was feasible and effective in the elderly undergoing colorectal surgery. Protocols should be adapted to the particular aspects of this population. Future research should target pre-operative evaluation and the place of pre-habilitation in geriatric ERP.

Notable features in composite tissue allografts: value of high-resolution ultrasonography as a first-line imaging modality.

PURPOSE: Hand transplantation is challenging, especially with respect to postoperative care. Serious complications including rejection of the transplant are possible. To date, imaging has relied mainly on plain radiography, CT and MRI. High-resolution ultrasound (HRUS) has the potential to be a quick, cost-effective and dynamic alternative at least for the initial assessment of most of these complications. We report on our experience with HRUS in three patients after bilateral hand/forearm transplantation. MATERIALS AND METHODS: Three male patients with bilateral hand/forearm transplantation after traumatic amputation underwent periodic HRUS and color Doppler assessment. These exams focused especially on the detection of changes at the coaptation sites (nerve/muscle/tendon coaptation) and expected changes in vessels and healing bones in the compound allograft. The HRUS data were compared to available data of other radiological imaging modalities. RESULTS: Relevant post-transplant changes such as neuromas, arteriovenous fistulas, heterotopic ossifications and scars were specified by HRUS. In addition information on muscle and tendon function was gained by dynamic ultrasound. In most cases no relevant information gain by other modalities was stated. CONCLUSION: Based on our experience, we recommend sonography as a first-line modality for the follow-up of patients who underwent composite tissue allografting. HRUS allows the reliable and timely diagnosis of relevant complications and the monitoring of postoperative changes and sets the course for therapy or further more invasive imaging.

Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy.

BACKGROUND: Conventional laparoscopy with three or more ports remains the 'gold standard' for cholecystectomy, but a laparoendoscopic single-site (LESS) approach is emerging, designed to decrease parietal trauma and improve cosmesis. This study compared conventional laparoscopic (CL) with LESS cholecystectomy, with short-term clinical results as the main outcomes. METHODS: A randomized trial of CL and LESS cholecystectomies involving 150 patients was undertaken. Follow-up was for 1 month after surgery. The primary endpoint was body image results evaluated by means of validated scales. Secondary endpoints were: postoperative pain measured on a visual analogue scale, analgesia requirement, morbidity, quality of life (QoL) measured with Short Form 12, duration of operation, hospital stay, time to return to work and cost analysis. RESULTS: Operating times and complications were similar in the two groups. Two LESS procedures (3 per cent) were converted to two-port laparoscopy owing to difficulties with exposure, and one CL operation was achieved through a single port because extensive fibrous peritoneal adhesions prevented placement of other ports. There were three and four port-site seroma/haematomas in the LESS and CL groups respectively. Better pain profiles and lower analgesia requirements were recorded in the LESS group (P < 0·001). QoL, body image and scar scale results were also better (P < 0·001). Operative costs were higher for LESS procedures (P < 0·001), although median time to return to work was shorter (P = 0·003). CONCLUSION: LESS is an alternative to CL cholecystectomy associated with better cosmesis, body image, QoL and an improved postoperative pain profile.

Unusual functional compression of the deep branch of the radial nerve by a vascular branch (leash of Henry): ultrasonographic appearance.

PURPOSE: Radial nerve compression caused by crossing branches of the recurrent radial artery - so called hypertrophic "leash(es) of Henry" (LoH) - is rare. Nevertheless it is important to diagnose the type of compression neuropathy in the forearm. MATERIALS AND METHODS: We report 2 subjects with unclear neuropathy of the deep branch of the radial nerve (DBRN) who showed compression by an LoH on high resolution ultrasound (HRUS) assessment. The shape and echotexture of the radial nerve were assessed with respect to the typical outer and inner texture of peripheral nerves in HRUS. Using color and/or power Doppler, an exact analysis of the surrounding soft tissues follows to search for possible atypical vessels compressing the nerve. RESULTS: In both patients a hypertrophic leash of Henry was identified with color/power Doppler ultrasound and the direct vascular compression of the DBRN was readily demonstrated. The involved nerve segment was enlarged with a mean transverse diameter of 2.7 mm and 1.9 mm, with a hypoechoic change and partial masking of the inner fascicular texture of the nerve at the level of the LoH. CONCLUSION: In summary, both presented patients showed a unique topographic concordance of a textural change of the deep radial nerve (i. e., swelling and inner hypoechoic fascicular change) and the causative hypertrophic crossing artery. The use of power Doppler ultrasound in addition to caliber and texture changes shown on grayscale ultrasound and the functional visualization of pulsating vessels should be included in every sonographic examination of patients with chronic forearm pain symptoms.

[Patient's point of view on surgical innovations: for less traumatic surgery and enhanced recovery]. / Innovations chirurgicales et point de vue du patient: vers une chirurgie moins traumatisante et une réhabilitation accélérée.

Surgical innovations (associating LESS, NOTES, robotics, images software and Fast-track surgery) will allow a less and less invasive surgery. While these advances could be view as surgical or industrial marketing, or compared to the laparoscopic revolution, they simply answer patients' demand in a society changing its standard regarding: medical care, body image, recovery and rehabilitation. We will in this paper, according to results of a Google Survey analyzing population expectations of surgery, evaluate the interest of these surgical innovations. While, these innovations at least in part answers patients expectation, their therapeutic validity will have to be proved. It is our job, to foresee the future of surgery in accordance with health care system needs and patients expectation for adequate implementation of these innovations.

[Really so far from fast-track colorectal surgery in senior patients?]. / Vraiment si loin d'une approche fast-track chez les seniors après chirurgie colorectale?

Senior population (> or = 70 y) represents approximately 17% of Western population and account for 2/3 of all solids cancers of which > 50% are colorectal. Their treatment would request major abdominal surgery, often not offered because of senior age or fear of prohibitive morbidity. Fast-track programs reduce postoperative morbidity and hospital stay after elective colorectal surgery. According to few studies, this approach seems to be safe and feasible in senior patients. In our institution, mortality/morbidity rates were 0% and 37% after elective colorectal surgery in senior patients with standard care, with a median hospital stay of 13 days. Elective colorectal surgery should be offered to senior patients. However the relative high morbidity rate with standard care prompts us to initiate a specifically designed fast-track protocol in senior patients.

Unloading of baroreceptors by carotid occlusion does not increase heart rate in fetal sheep.

UNLABELLED: Unloading of baroreceptors by carotid occlusion does not increase heart rate in fetal sheep; OBJECTIVES: To test the hypothesis that in fetal sheep reduction of carotid sinus pressure by carotid occlusion increases heart rate. STUDY DESIGN: Fetal sheep (gestational age 121-132 days) were chronically instrumented with bilateral carotid occluders, catheters and electrodes (ECG) to measure systemic arterial and carotid sinus (CSP) blood pressures, and fetal heart rate. RESULTS: Bilateral carotid occlusion (BCO) increased mean arterial blood pressure from 46+/-7 mmHg to 53+/-8 mmHg (mean+/-S.D.) while CSP decreased from 44+/-7 mmHg to 17+/-7 mmHg. Fetal heart rate fell during occlusion significantly from 186+/-34 bpm to 159+/-26 bpm (n=20 animals). Infusion of phenylephrine (8.5-20 microg min(-1)kg(-1)) or methoxamine (60-200 microg min(-1)kg(-1)) increased mean blood pressure from 44+/-6 to 61+/-9 mmHg, and fetal heart rate decreased from 186+/-30 to 132+/-31 bpm (n=12). BCO increased systemic arterial pressure further to 70+/-11 mmHg whereas carotid sinus pressure was reduced to 31+/-13 mmHg. However, average heart rate did not increase significantly (136+/-28 bpm). CONCLUSION: We conclude that in contrast to adult animals, in fetal sheep carotid occlusion with subsequent unloading of baroreceptors does not increase heart rate even when the baroreflex had been activated by arterial hypertension. It seems likely that stimulation of carotid chemoreceptors prevents the expected baroreceptor mediated heart-rate response.

[Epidural hematoma with secondary middle ear involvement. A rare differential diagnosis of otogenic brain abscess]. / Das epidurale Hämatom mit sekundärer Mittelohrbeteiligung. Eine seltene Differentialdiagnose des otogenen Hirnabszesses.

Processes in the middle ear can occasionally lead to clinical disorders extending beyond the anatomic boundaries of the area of the mastoid process. In contrast to this, pathological processes of the areas adjoining the middle ear might also lead to secondary involvement of the tympanic area. The report describes an initially asymptomatic epidural hematoma, which secondarily led to involvement of the middle ear. In general, such cases affecting the middle ear will produce symptoms usually interpreted as primary middle ear pathology. This association shows which disorders must be considered, the differential diagnosis and methods of therapy.

A history of treatment for chemically dependent women.

AIDS: Traditional alcohol and drug abuse services can be traced back to the founding of Alcoholics Anonymous and the Synanon Foundation. These organizations incorporate peer counseling, self-help, and therapeutic community approaches. Feminists claim that these and other conventional recovery programs were designed for and by men, and therefore do not address the specific needs of drug-dependent women, especially those who are HIV-positive. The initial involvement of the U.S. Government in the development and delivery of treatment services greatly improved opportunity and potential outcome for women. However, the 1980's marked an increased prevalence of drug-affected newborns, leading to the criminalization of drug use during pregnancy. Public funding continues to focus on pregnant and parenting women. This climate, economic trends, and a shift toward outpatient services, severely impact the quality and availability of services for women who are not pregnant and/or do not have custody of minor children. Women's advocates are calling for a long-term continuum of care that habilitates, rather than rehabilitates, women, and that recognizes the impact that HIV disease has on this segment of the population.^ieng