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We investigate the functionality of NbOx-based selector devices on a flexible substrate. It was observed that the failure mechanism of cyclic tensile strain is from the disruption of atom arrangements, which essentially led to the crack formation of the film. When under cyclic compressive strain, buckling delamination of the film occurs as the compressed films have debonded from their neighboring layers. By implementing an annealing process after the strain-induced degradation, recovery of the device is observed with reduced threshold and hold voltages. The physical mechanism of the device is investigated through Poole–Frenkel mechanism fitting, which provides insights into the switching behavior after mechanical strain and annealing process. The result demonstrates the potential of the NbOx device in flexible electronics applications with a high endurance of up to 105 cycles of cyclic bending strain and the recovery of the device after degradation. [ABSTRACT FROM AUTHOR]

Background: Adding intraperitoneal paclitaxel (IP-PTX) to paclitaxel/5-fluoropyrimidine has shown promising results in patients with gastric cancer peritoneal metastases (GCPM) but has not been studied with standard-of-care platinum/fluoropyrimidine combinations. Our goal to was evaluate IP-PTX with capecitabine/oxaliplatin (XELOX) in GCPM. Methods: Forty-four patients with GCPM received IP PTX (40 mg/m2, Days 1, 8), oral capecitabine (1000 mg/m2 twice daily, Days 1–14) and intravenous oxaliplatin (100 mg/m2, Day 1) in 21-day cycles. Patients with synchronous GCPM underwent conversion surgery if they had good response after chemotherapy, conversion to negative cytology, no extraperitoneal metastasis, and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were compared against a matched cohort of 39 GCPM patients who received systemic chemotherapy (SC) comprising platinum/fluoropyrimidine. Results: The median OS for the IP and SC groups was 14.6 and 10.6 months (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.26–0.74; p = 0.002). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI 0.25–0.66; p < 0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p = 0.021) and had better performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p = 0.007) compared with the IP cohort. In IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95% CI 13.1–35.3) months and 1-year OS of 84.6%. Conclusions: IP PTX with XELOX is a promising treatment option for GCPM patients. In patients with good response, conversion surgery was feasible with favourable outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Enhanced recovery after surgery (ERAS) programs for patients undergoing colorectal surgery has yielded promising results. However, there remains controversy regarding the application of ERAS protocols in an elderly population. The aim of this review is to compare the clinical outcomes between ERAS versus conventional peri-operative care (Non-ERAS) for colorectal surgery in patients aged ≥ 65 years old.Methods: The PRISMA guidelines were adhered to. A comprehensive search was performed using Medline, Embase and the Cochrane Library electronic databases and relevant articles were identified. Indications for the colorectal resections included both benign and malignant diseases, while emergency surgeries were excluded. Primary outcomes include post-operative morbidity, length of stay and re-admission rates. Data analysis was performed using Revman 5.3.Results: A total of six studies were included, which involved a total of 1174 patients. ERAS was associated with a lower incidence of post-operative morbidity compared to Non-ERAS (OR 0.38, 95% CI 0.25-0.59), p < 0.001). Similarly, ERAS was also associated with a significantly shorter hospital length of stay (MD - 2.49, 95% CI - 4.11 to 0.88, p = 0.002). Return of bowel function as measured by time to flatus was significantly faster in the ERAS group (MD - 20.01 95% CI - 36.23 to 3.79, p = 0.02), but post-operative ileus rates (OR 0.86, 95% CI 0.50-1.47, p = 0.58) were comparable. Re-admission, re-operation and post-operative mortality rates were also similar between both groups.Conclusion: The application of ERAS protocols in an elderly population provides the advantages of lower post-operative morbidity and shorter hospital length of stay. Future studies should aim to evaluate factors that can improve ERAS compliance rates in this group of patients. [ABSTRACT FROM AUTHOR]

Background: Current enhanced recovery after surgery (ERAS) protocols are designed for all patients without tailored programmes for at-risk groups. A risk score to determine elective colorectal cancer patients at risk for prolonged length of stay (LOS) would help to identify this group for preoperative intervention. Methods: Multivariate analysis of demographic and preoperative variables was performed to identify independent risk factors for prolonged LOS, defined as 7 days or more. A stepwise variable selection approach using logistic regression was then used to build a risk prediction model. Results: Among 172 patients in our population, 41.9% of patients had prolonged LOS. Five variables were included in our risk prediction model. These were age ≥ 65 years (OR 13.9 5.09–38.0; p < 0.0001), neoadjuvant therapy (OR 7.60 2.51–23.0; p < 0.0001), open approach (OR 3.96 1.68–15.9); p = 0.008), history of smoking (OR 5.18 1.68–15.9; p = 0.004) and white blood cell (WBC) count (OR 0.83/unit 0.69–0.99; p = 0.040). These variables were combined to produce a score, for which the area under the receiving operator curve was 0.82 (95% CI 0.76–0.88), and Hosmer-Lemeshow test showed a χ2 statistic of 9.14 and p = 0.519. Using 0.9 as a cut-off, the score has sensitivity of 81.9% and specificity of 65.0%. Conclusion: A simple, clinical score can be used to predict for prolonged LOS based on preoperative variables, allowing for intervention before surgery. Article summary: Age, neoadjuvant therapy, smoking status, open approach and WBC count are independent risk factors for prolonged length of stay following elective colorectal cancer surgery. A risk score comprising the above independent variables was developed with area under the receiving operator curve of 0.82 (95% CI 0.76–0.88), and a Hosmer-Lemeshow test showing a χ2 statistic of 9.14 and p = 0.519. [ABSTRACT FROM AUTHOR]

Introduction: Elderly patients with colorectal cancer are high-risk surgical candidates. ERAS protocols have been developed to mitigate against these risks. We performed this study to quantify the risks which elderly patients face and then to determine independent risk factors for short-term ERAS-specific outcomes. Methods: An analysis of a prospectively collected audit database of all patients who underwent elective colorectal cancer resection within an ERAS framework from January 2018 to December 2018 was performed. Elderly was defined in our study as age ≥ 65 years. Results: There were 172 elective colorectal cancer resections performed. Ninety-seven (56.4%) were elderly. Elderly patients were at increased risk of developing post-operative complications (33.0% vs 16.0%, p = 0.011), longer time to diet (3.4 vs 2.2 days, p = 0.001), and longer hospital stay (10.9 vs 6.7 days, p = 0.007). Independent risk factors were determined for the abovementioned three outcomes. Elderly status was the only risk factor for increased complications (OR 2.61 95% CI (1.05–6.51), p = 0.040). For delayed time to soft diet, male gender (OR 6.67(1.92–20.0), p = 0.002), open approach (OR 9.06(2.26–36.30), p = 0.002), and increased operative time (OR 1.01(1.00–1.01) p = 0.014) were risk factors. Finally, elderly age (OR 5.53(1.82–16.84), p = 0.003), leucocyte count (OR 1.39(0.76–2.57), p = 0.038), open approach (OR 5.26(1.41–19.62), p = 0.013), operative time (OR 1.01(1.00–1.01), p = 0.021), and Clavien-Dindo classification (OR 7.97(1.27–49.88), p = 0.027) were risk factors for prolonged length of stay. Conclusion: Elderly patients are intrinsically at risk for increased complications, longer time to soft diet and longer hospital stay. ERAS protocols may need to be specifically tailored for elderly patients. [ABSTRACT FROM AUTHOR]