Suture reinforcement using a modified cyanoacrylate glue to prevent anastomotic leak in colorectal surgery: a prospective multicentre randomized trial : The Rectal Anastomotic seaL (ReAL) trial.

BACKGROUND: Anastomotic leakage (AL) is the most frequent life-threating complication following colorectal surgery. Several attempts have been made to prevent AL. This prospective, randomized, multicentre trial aimed to evaluate the safety and efficacy of nebulised modified cyanoacrylate in preventing AL after rectal surgery. METHODS: Patients submitted to colorectal surgery for carcinoma of the high-medium rectum across five high-volume centres between June 2021 and January 2023 entered the study and were randomized into group A (anastomotic reinforcement with cyanoacrylate) and group B (no reinforcement) and followed up for 30 days. Anastomotic reinforcement was performed via nebulisation of 1 mL of a modified cyanoacrylate glue. Preoperative features and intraoperative and postoperative results were recorded and compared. The study was registered at ClinicalTrials.gov (ID number NCT03941938). RESULTS: Out of 152 patients, 133 (control group, n = 72; cyanoacrylate group, n = 61) completed the follow-up. ALs were detected in nine patients (12.5%) in the control group (four grade B and five grade C) and in four patients (6.6%), in the cyanoacrylate group (three grade B and one grade C); however, despite this trend, the differences were not statistically significant (p = 0.36). However, Clavien-Dindo complications grade > 2 were significantly higher in the control group (12.5% vs. 3.3%, p = 0.04). No adverse effects related to the glue application were reported. CONCLUSION: The role of modified cyanoacrylate application in AL prevention remains unclear. However its use to seal colorectal anastomoses is safe and could help to reduce severe postoperative complications.

Ultra-efficient, widely tunable gold nanoparticle-based fiducial markers for X-ray imaging.

We show the development of a new class of highly efficient, biocompatible fiducial markers for X-ray imaging and radiosurgery, based on polymer shells encapsulating engineered gold nanoparticle (AuNP) suspensions. Our smart fabrication strategy enables wide tunability of the fiducial size, shape, and X-ray attenuation performance, up to record values >20 000 Hounsfield units (HU), i.e. comparable to or even higher than bulk gold. We show that the NP fiducials allow for superior imaging both in vitro and in vivo (yet requiring 2 orders of magnitude less material), with strong stability over time and the absence of classical "streak artifacts" of standard bulk fiducials. NP fiducials were probed in vivo, showing exceptional contrast efficiency, even after 2 weeks post-implant in mice.

Correction: Ultra-efficient, widely tunable gold nanoparticles-based fiducial markers for X-ray imaging.

Correction for 'Ultra-efficient, widely tunable gold nanoparticles-based fiducial markers for X-ray imaging' by Gabriele Maiorano, et al., Nanoscale, 2016, DOI: 10.1039/c6nr07021c.

[A new reconstructive model after total proctectomy]. / Un nuovo modello ricostruttivo dopo proctectomia totale.

The Authors describe a new reconstructive model after total proctectomy: the S-E colo-anal anastomosis (S-E CAA). The technical requisites of this variant are discussed and compared with more traditional reconstruction models. At a first evaluation of the results, the S-E CAA seems to be able to sensibly ameliorate the course and the outcome of the anastomosis and to hasten the recovery of the normal sphincteric function.