Usefulness of CT scan as part of an institutional protocol for proactive leakage management after low anterior resection for rectal cancer

Purpose: Highly selective fecal diversion after low anterior resection (LAR) for rectal cancer requires a strict postoperative protocol for early detection of anastomotic leakage (AL). The purpose of this study was to evaluate C-reactive protein (CRP)–based CT imaging in diagnosis and subsequent management of AL. Methods: All patients that underwent a CT scan for suspicion of AL after transanal total mesorectal excision for rectal cancer in a university center (2015–2020) were included. Outcome parameters were diagnostic yield of CT and timing of CT and subsequent intervention. Results: Forty-four out of 125 patients underwent CT (35%) with an overall median interval of 5 h (IQR 3–6) from CRP measurement. The anastomosis was diverted in 7/44 (16%). CT was conclusive or highly suspicious for AL in 23, with confirmed AL in all those patients (yield 52%), and was false-negative in one patient (sensitivity 96%). CT initiated subsequent intervention after median 6 h (IQR 3–25). There was no or minor suspicion of AL on imaging in all 20 patients without definitive diagnosis of AL. After CT imaging on day 2, AL was confirmed in 0/1, and these proportions were 6/6 for day 3, 7/10 for day 4, 2/4 for day 5, and 9/23 beyond day 5. Conclusion: In the setting of an institutional policy of highly selective fecal diversion and pro-active leakage management, the yield of selective CT imaging using predefined CRP cut-off values was 52% with a sensitivity of 96%, enabling timely and tailored intervention after a median of 6 h from imaging.</p

EVA London 2021: Keynote summaries

This paper records summaries of invited keynote talks and backgrounds of the keynote speakers at the EVA London 2021 Conference (Weinel et al. 2021). EVA London takes place annually, originally starting in 1990 (Bowen 2020; Hemsley 2013). As for the previous year, due to the Covid-19 pandemic, EVA London 2021 is a completely online conference. The conference is broadly based on digital culture (Giannini&Bowen2019b; Bowen & Giannini 2021) with a special emphasis on digital art (Bowen 2013).The conference also includes a symposium panel with three invited panellists presenting position statements (Bowen et al. 2021)

Bioavailability and biodistribution of differently charged polystyrene nanoparticles upon oral exposure in rats

The likelihood of oral exposure to nanoparticles (NPs) is increasing, and it is necessary to evaluate the oral bioavailability of NPs. In vitro approaches could help reducing animal studies, but validation against in vivo studies is essential. Previously, we assessed the translocation of 50 nm polystyrene NPs of different charges (neutral, positive and negative) using a Caco-2/HT29-MTX in vitro intestinal translocation model. The NPs translocated in a surface charge-dependent manner. The present study aimed to validate this in vitro intestinal model by an in vivo study. For this, rats were orally exposed to a single dose of these polystyrene NPs and the uptake in organs was determined. A negatively charged NP was taken up more than other NPs, with the highest amounts in kidney (37.4 µg/g tissue), heart (52.8 µg/g tissue), stomach wall (98.3 µg/g tissue) and small intestinal wall (94.4 µg/g tissue). This partly confirms our in vitro findings, where the same NPs translocated to the highest extent. The estimated bioavailability of different types of NPs ranged from 0.2 to 1.7 % in vivo, which was much lower than in vitro (1.6–12.3 %). Therefore, the integrated in vitro model cannot be used for a direct prediction of the bioavailability of orally administered NPs. However, the model can be used for prioritizing NPs before further in vivo testing for risk assessment. © 2015, The Author(s)

The global financial crisis and its aftermath: Economic and political recalibration in the non-sovereign Caribbean

© 2017, © 2017 CALACS. The small non-sovereign island jurisdictions (SNIJs) of the Caribbean have a privileged position in the global political economy, with significant political and economic autonomy on the one hand, and useful protections and support structures provided by their metropolitan powers on the other. However, the global financial and economic crisis of 2007–2008 highlighted starkly some of the fragilities of this privileged status; in particular their economic vulnerability and the unequal and often fractious relationship with their metropolitan powers. This article considers the British, Dutch, French, and US jurisdictions and the short- and longer-term impacts of the crisis. The article’s key concern is to assess the extent to which the instability in the global economy over the last decade has affected both the economic and political dynamic of these jurisdictions, and to what extent their unique position in the global political economy has been compromised