SEVTAR-A multicenter randomized controlled trial to investigate the impact of prophylactic endoluminal placed vacuum sponge for prevention of anastomotic leakage after low rectal resections

Background

Low anterior resection for rectal cancer is commonly associated with a diverting stoma. In general, the stoma is closed 3 months after the initial operation. The diverting stoma reduces the rate of anastomotic leakage as well as the severeness of a potential leakage itself. Nevertheless, anastomotic leakage is still a life-threatening complication and might reduce the quality of life in the short and long term. In case of leakage, the construction can be converted into a Hartmann situation or it could be treated by endoscopic vacuum therapy or by leaving the drains. In recent years, endoscopic vacuum therapy has become the treatment of choice in many institutions. In this study, the hypothesis is to be evaluated, if a prophylactic endoscopic vacuum therapy reduces the rate of anastomotic leakage after rectal resections.

Methods

A multicenter parallel group randomized controlled trial is planned in as many as possible centers in Europe. The study aims to recruit 362 analyzable patients with a resection of the rectum combined with a diverting ileostoma. The anastomosis has to be between 2 and 8 cm off the anal verge. Half of these patients receive a sponge for 5 days, and the control group is treated as usual in the participating hospitals. There will be a check for anastomotic leakage after 30 days. Primary end point is the rate of anastomotic leakages. The study will have 60% power to detect a difference of 10%, at a one-sided alpha significance level of 5%, assuming an anastomosis leakage rate of 10%-15%.

Discussion

If the hypothesis proves to be true, anastomosis leakage could be reduced significantly by placing a vacuum sponge over the anastomosis for 5 days.

Trial registration

The trial is registered at DRKS: DRKS00023436. It has been accredited by Onkocert of the German Society of Cancer: ST-D483. The leading Ethics Committee is the Ethics Committee of Rostock University with the registration ID A 2019-0203.

Neutrale Ultrastrahlung von der Sonne

Es wird gezeigt, daß bei der Beschleunigung geladener Teilchen in den äußeren Teilen der Sonnenatmosphäre durch Kerntreffer von auf die Sonne zurückfliegenden Partikeln Neutronen erzeugt werden können. Obwohl die Ausbeute (Zahl der die Sonne verlassenden Neutronen / Zahl der beschleunigten geladenen Teilchen) von der Ordnung 10-2 sein mag, kann der Effekt merklich sein, da auch geladene Teilchen einer Energie unterhalb der Abschneideenergie des Erdmagnetfeldes zur Neutronenproduktion beitragen.

[Pelvic reconstruction after tubular rectumresection (extended abdominoperineal resection combined with extended transpelvic myocutaneous M. rectus abdominis flap (extended VRAM) in low rectum cancer - case series)]

In advanced lower rectal cancer tubular abdomino-perineal resection (APR) in combination with simultaneous extended distally pedicled vertical rectus abdominis muscle flap (VRAM) facilitates a more radical tumor resection. Additionally a prolapse of small intestine into the pelvis can be blocked and a perineal defect coverage can be achieved. 4 patients have been treated with an interdisciplinary one stage combined tubular APR and extended VRAM. In all cases a R0 resection and a complete defect closure could be achieved.The extended VRAM is an appropriate technique to close the pelvic defect because it originates from a non irradiated area, has a monitor island, and the donor site does not handicap the patient as much as local flaps. This interdisciplinary approach facilitates a more radical tumor resection and thus reduces the risk of recurrence.

Aphelion clustering of "new" comets: Star tracks through Oort's cloud

An explanation is proposed for the observed and often discussed clustering of long-period comet aphelia on the sky. Poisson and several multinomial distributions are applied to the most conspicuous cluster, considering only the 80 "new" and 59 "intermediate" comets with the best-determined orbits. The observed number of aphelion points in adjacent areas in two tests with 24 and 36 equal sky areas, respectively, shows a large deviation from a random distribution. The expected probability frequency for this to happen by chance is <0.1% for the "new" comets alone; it is further reduced when "new" and "intermediate" comets are combined. When these comets are analyzed separately from others, it is found that the clustering is the result of perturbations of their original orbits by the passage of a star, or a stellar system, through Oort's cloud a few million years ago. Because the statistical effect on the change of a comet's angular momentum about the sun is proportional to the square of the ratio of the mass to the velocity of a star relative to the sun, it is a priori probable that passages by a few stars should produce clustering of the aphelia, as is discussed in detail.

Validation of the Multiple Sclerosis International Quality of Life questionnaire

This study aims to validate the Multiple Sclerosis (MS) International Quality of Life (MusiQoL) questionnaire, a multi-dimensional, self-administered questionnaire, available in 14 languages, as a disease-specific quality of life scale that can be applied internationally. A total of 1992 patients with different types and severities of MS from 15 countries were recruited. At baseline and day 21 ± 7, each patient completed the MusiQoL, a symptom checklist and the short-form (SF)-36 QoL questionnaire. Neurologists also collected socio-demographic, MS history and outcome data. The database was randomly divided into two subgroups and analysed according to different patient characteristics. For each model, psychometric properties were tested and the number of items was reduced by various statistical methods. Construct validity, internal consistency, reproducibility and external consistency were also tested. Nine dimensions, explaining 71% of the total variance, were isolated. Internal consistency and reproducibility were satisfactory for all the dimensions. External validity testing revealed that dimension scores correlated significantly with all SF-36 scores, but showed discriminant validity by gender, socio-economic and health status. Significant correlations were found between activity in daily life scores and clinical indices. These results demonstrate the validity and reliability of the MusiQoL as an international scale to evaluate QoL in patients with MS. Multiple Sclerosis 2008; 14: 219—230. http://msj.sagepub.com

[Resection of tumor stenoses and stent implantations in advanced neoplasms of the esophagus, stomach and duodenum]

Up to now many people demand treatment only with symptoms of a progressed cancer disease. As curative therapy is often not possible any more, endoscopy offers valuable palliative treatment options. Tumor destructive methods are mainly used for soft exophytic neoplastic tissue, whereas stent implantation is the therapy of choice in all other cases, especially if severe obstruction is present. The advantage of this method is the immediate and long lasting effect. Because of the different stent types and indications there is no optimal universal stent, so that we have to choose the individual best endoprosthesis.

Neoglycoprotein-binding sites (endogenous lectins) in the Fallopian tube, uterus and blastocyst of the rabbit during the preimplantation phase and implantation

Regulation of the initial phase of embryo implantation may involve the recognition interplay of glycoconjugates and respective receptors such as endogenous lectins on both cellular surfaces. Whereas changes in glycoconjugate composition have been detected in preparation for embryo implantation and described in detail, knowledge on endogenous lectins has remained scant. Affinity probes (carrier-immobilized carbohydrate structures as ligand part on a histochemically inert backbone) are used in the present investigation in order to gain further insights in this area. Cryostat sections of rabbit Fallopian tubes and uteri in nonpregnant and early pregnant [tubes: 3 days post coitum (d p.c.); uteri: 3, 5, 7 and 9 d p.c.] states were studied for binding patterns of a series of biotinylated (neo)glycoproteins. A high density of binding sites was detected with beta-galactosides (with decreasing intensity: beta-D-galactose-BSA, asialofetuin with its triantennary glycan chains, lactose-BSA). Considerably less binding (but with the same pattern) was obtained with beta-N-acetyl-D-glucosaminide-BSA and is interpreted to originate from a cross-reactivity of such sites which may bind physiologically to Gal-beta1,3/4-GlcNAc sequences. In contrast, no evidence for the presence of binding molecules with specificities for a-D-mannose-BSA, maltose-BSA, N-acetyl-galactosaminide-BSA and N-acetyl-D-neuraminic acid-BSA was obtained in these tissues under the same conditions. The epithelium of the Fallopian tube showed a high density of beta-galactoside-binding sites at the apical cell poles (including the cytoplasm and membrane region) already in the nonpregnant state. At 3 d p.c., a strong reaction in all epithelial cells of the isthmus and a marked decrease in the ampulla were noted. The putative lectin(s) appear(s) to be synthesized and secreted by the tubal epithelium. A physiological role in forming the mucoprotein layer of the blastocyst coverings by precipitating the appropriate mucin-type molecules can be considered. Within the endometrium, the beta-galactoside-binding molecules were almost exclusively localized at the apical cell pole of epithelial cells, whereas there was hardly any binding in the epithelial cytoplasm or in the endometrial stroma. The reaction was very weak in the non-pregnant state but increased considerably until 5 d p.c., starting in the luminal-most parts of the epithelium. While the reaction was rather homogeneous at the surface of the luminal epithelium at 5 d p.c., the degree of heterogeneity increased stepwise from 7 to 9 d p.c. In the implantation chamber, the density of these beta-galactoside-specific 'receptors' was further enhanced in particular at the epithelial surface of the placental folds. In contrast, the reaction was less intense at the antimesometrial uterine epithelium and in interblastocyst segments of the uterus, and it remained weak in the middle and deep crypts. The trophoblast showed a high density of galactoside-binding sites at its surface, and less in the cytoplasm. Neoglycoprotein binding to the blastocyst coverings observed at 7 d p.c. was strong in particular at the outer and inner surfaces. Physical factors (e.g. differential texture at surfaces) are discussed to influence the staining patterns of these extracellular coverings. Nevertheless, the observations made on the tubal and the uterine mucosa suggest that the putative lectin(s) detected here is (are) secreted by these epithelia and could be involved in the structural organization of the various layers of the blastocyst coverings with their remarkable content of oligosaccharide chains. This effect on topological aspects of the zona pellucida equivalents may be important for the interplay between trophoblast and uterine epithelium and the cascade leading to implantation initiation.