Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes

Background: In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Methods: Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. Results: More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 us HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Conclusion: Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes. Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators

Assuring the integrity of offshore carbon dioxide storage

Carbon capture and storage is a key mitigation strategy proposed for keeping the global temperature rise below 1.5 °C. Offshore storage can provide up to 13% of the global CO2 reduction required to achieve the Intergovernmental Panel on Climate Change goals. The public must be assured that potential leakages from storage reservoirs can be detected and that therefore the CO2 is safely contained. We conducted a controlled release of 675 kg CO2 within sediments at 120 m water depth, to simulate a leak and test novel detection, quantification and attribution approaches. We show that even at a very low release rate (6 kg day−1), CO2 can be detected within sediments and in the water column. Alongside detection we show the fluxes of both dissolved and gaseous CO2 can be quantified. The CO2 source was verified using natural and added tracers. The experiment demonstrates that existing technologies and techniques can detect, attribute and quantify any escape of CO2 from sub-seabed reservoirs as required for public assurance, regulatory oversight and emissions trading schemes

The police, the public, and the pursuit of trust. A cross-national, dynamic study of trust in the police and police trustbuilding

Contains fulltext : 190612.pdf (publisher's version ) (Open Access)Radboud University, 16 mei 2018Promotores : Terpstra, J.B., Scheepers, E.J.J.379 p

Een vertrouwenscrisis? Ontwikkelingen in het vertrouwen van burgers in de politie in Nederland en Europa

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Politie heeft diversiteit hard nodig

Item does not contain fulltext13 oktober 201