Assessing the Value of Prehabilitation in Patients Undergoing Colorectal Surgery According to the Enhanced Recovery After Surgery (ERAS) Pathway for the Improvement of Postoperative Outcomes: Protocol for a Randomized Controlled Trial

A key element in the postoperative phase of the standardized Enhanced Recovery After Surgery (ERAS) treatment pathways is mobilization. Currently, there are no recommendations in the ERAS guidelines for preoperative physical activity. Patients undergoing major surgery are prone to functional decline due to the impairment of muscle, cardiorespiratory, and neurological function as a response to surgical stress. It has been shown that preoperative physical training reduces postoperative complications. To date, there are limited studies that investigate preoperative physical training combined with ERAS

Ba–Al-decorated iron ore as bifunctional oxygen carrier and HCl sorbent for chemical looping combustion of syngas

The simultaneous high-temperature HCl removal and chemical looping combustion (CLC) of syngas over barium-decorated oxygen carriers (OCs) was investigated. An iron ore was coated with a layer of sorbent (5 wt%) containing Ba and Al compounds (molar ratios Al:Ba = 0.5, 2.0, 4.5, 8.0, 12) and used for model syngas combustion at 800 °C. It was found that the synthesized materials can effectively remove HCl from the syngas. The HCl removal capacity increased with the Ba loading, and the HCl breakthrough capacity can reach 0.0345 mmol/g for the OC with Al:Ba = 0.5, resulting in the formation of BaCl₂. The conversion of Ba species into BaCl₂ was 17.3%. Besides the HCl sorption, the coating with Ba and Al compounds enhanced the activity of lattice oxygen and improved the reducibility of OCs during CLC due to the Ba–Fe composite formed on the OCs surface. Compared to the iron ore, the combustion efficiencies of the coated OC with Al:Ba = 4.5 for CO and H₂ increased from 62.2% and 87.2% to 99.6% and 95.9%, respectively. Through fluidized bed experiments and thermodynamic calculations, the feasibility of sorbent regeneration was demonstrated by treating OCs with a mixture of CO₂ and H₂O at 800–1000 °C. The HCl desorption rate increased with temperature and nearly complete sorbent regeneration (99.6%) could be achieved at 1000 °C. These findings demonstrate that Ba–Al-decorated iron ore can be used as bifunctional material in CLC process since it enables simultaneous high-temperature HCl removal and syngas combustion.Economic Development Board (EDB)Ministry of the Environment and Water ResourcesNanyang Technological UniversityNational Environmental Agency (NEA)This work is supported by the National Environment Agency, Ministry of the Environment and Water Resources, Singapore, under the Waste-to-Energy Competitive Research Programme (WTE CRP 1701 105). The authors also acknowledge the management of Nanyang Environment and Water Research Institute and Economic Development Board, Singapore for the support

Ba–Al-decorated iron ore as bifunctional oxygen carrier and HCl sorbent for chemical looping combustion of syngas

Summarization: The simultaneous high-temperature HCl removal and chemical looping combustion (CLC) of syngas over barium-decorated oxygen carriers (OCs) was investigated. An iron ore was coated with a layer of sorbent (5 wt%) containing Ba and Al compounds (molar ratios Al:Ba = 0.5, 2.0, 4.5, 8.0, 12) and used for model syngas combustion at 800 °C. It was found that the synthesized materials can effectively remove HCl from the syngas. The HCl removal capacity increased with the Ba loading, and the HCl breakthrough capacity can reach 0.0345 mmol/g for the OC with Al:Ba = 0.5, resulting in the formation of BaCl2. The conversion of Ba species into BaCl2 was 17.3%. Besides the HCl sorption, the coating with Ba and Al compounds enhanced the activity of lattice oxygen and improved the reducibility of OCs during CLC due to the Ba–Fe composite formed on the OCs surface. Compared to the iron ore, the combustion efficiencies of the coated OC with Al:Ba = 4.5 for CO and H2 increased from 62.2% and 87.2% to 99.6% and 95.9%, respectively. Through fluidized bed experiments and thermodynamic calculations, the feasibility of sorbent regeneration was demonstrated by treating OCs with a mixture of CO2 and H2O at 800–1000 °C. The HCl desorption rate increased with temperature and nearly complete sorbent regeneration (99.6%) could be achieved at 1000 °C. These findings demonstrate that Ba–Al-decorated iron ore can be used as bifunctional material in CLC process since it enables simultaneous high-temperature HCl removal and syngas combustion.Παρουσιάστηκε στο: Combustion and Flam

Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity : results of a single-center, blinded, randomized controlled trial

Background: Currently, there are solely weak recommendations in the enhanced recovery after surgery (ERAS) protocol regarding the role of preoperative physical activity and prehabilitation in patients undergoing colorectal surgery. Studies in heterogenous groups showed contradictory results regarding the impact of prehabilitation on the reduction of postoperative complications. The aim of this study was to assess the impact of prehabilitation on postoperative complications in patients undergoing colorectal surgery within an ERAS protocol. Methods. Between July 2016 and June 2019, a single-center, blinded, randomized controlled trial designed to test whether physiotherapeutic prehabilitation vs. normal physical activities prior to colorectal surgery may decrease morbidity within a stringent ERAS protocol was carried out. The primary endpoint was postoperative complications assessed by Comprehensive Complications Index (CCI®). Primary and secondary endpoints for both groups were analyzed and compared. Results: A total of 107 patients (54 in the prehabilitation enhanced recovery after colorectal surgery [pERACS] group and 53 in the control group) were included in the study and randomized. Dropout rate was 4.5% (n = 5). Baseline characteristics were comparable between the pERACS and control groups. The percentage of colorectal adenocarcinoma was low in both groups (pERACS 32% vs. control 23%, p = 0.384). Almost all patients underwent minimally invasive surgery in both groups (96% vs. 98%, p = 1.000). There was no between-group difference in the primary outcome, as the mean CCI at 30-day postoperative in the pERACS group was 18 (SD 0–43) compared to 15 (SD 0–49) in the control group (p = 0.059). Secondary outcome as complications assessed according to Clavien-Dindo, length of hospital stay, reoperation rate, and mortality showed no difference between both groups. Conclusions: Routine physiotherapeutic prehabilitation has no additional benefit for patients undergoing colorectal surgery within an ERAS protocol. Trial registration: ClinicalTrial.gov: ID: NCT02746731; Institution Ethical Board Approval: KEK-ZH Nr. 2016–00,229