Comparison of The Functional and Oncological Outcomes of the Sub-trigonal Versus Conventional Robotic Radical Prostatectomy for Prostate Cancer

6.1. Background The subtrigonal approach for robotic assisted radical prostatectomy was first described in 2010 as the most anatomically preserving technique, in which the prostate can be completely removed through the Douglas pouch. This technique was introduced in the Urology Department of Tuebingen University Hospital in June 2013 after many years of performing the conventional transperitoneal robotic prostatectomy, however few data is available regarding its outcome. 6.2. Objectives The aim of this study is to compare the functional and oncological outcomes of subtrigonal approach versus the conventional approach for robotic radical prostatctomy 6.3. Methods Consecutive groups of patients who underwent TPRP (n=126) from 01/2012 to 05/2013, and those who switched and underwent STRP (n=62) from 01/2014 to 01/2015 were compared;. Functional outcomes were evaluated using ICIQ and IIEF of both groups by questionnaire and telephone protocols. Oncological outcomes were assessed regarding positive surgical margins and biochemical recurrence free survival (PSA ≥ 0.02 ng/ml) using the Kaplan Meier curve. Postoperative complications were classified using the Clavien-Dindo system. Statistical analysis was performed using the jmp v.12 software®. Mann-Whitney-U and Pearson x2 tests were employed to compare the continuous and categorical variables, respectively. The Kaplan Meier curve was applied to present the survival data 6.4. Results The median age and follow-up time in the TPRP and STRP groups were 64 and 62.5 years and 34 and nine months, respectively. Within 7 days of catheter removal, 37/93 patients (40%) in group A were continent compared to 23/53 (43%) in group B (p-value = 0.67). At 3, 6 and 12-month intervals, the continence recovery rates were 71%, 73% and 87% in group A versus 76%, 89% and 96% in group B. The p-values were 0.55, 0.02 and 0.054, respectively. 15 and 7 patients in group A and B, respectively, underwent bilateral nerve sparing surgery (NS). In group A, 2/15 (13%) could achieve enough erection for penetration versus 3/7 (43%) in group B; (p-value = 0.13). The overall positive surgical margin (PSM) rate was 16% in group A versus 8% in group B (p-value = 0.11). According to the pathological stage, PSM rates in pT2, pT3a and pT3b were 7.2%, 53% and 55.6% in group A compared to 2.2%, 11% and 60% in group B, respectively (p-values = 0.19, 0.03 and 0.87). PSM in pT3a was significantly lower in group B. When comparing the PSM rate at the prostatic apex, it was 9.8% in group A versus 1.6% in group B; with a significant difference (p-value = 0.02). The BCR 1y-free survival was 91% in group A versus 94% in group B (Log-rank p-value = 0.57). 6.5. Conclusion The anatomical preservative sub-trigonal approach for RARP increases the post-operative continence recoverability. Our results approved the oncological safety of this technique even in locally advanced cases. Sub-trigonal approach displayed reduction of PSM especially at the apex and in tumors with extra- capsular extension. Prospective randomized studies including bigger cohorts of patients with longer follow up are mandatory to confirm these results

The Impact of Entrepreneurship Education on the Construction of Entrepreneurial Self-identity of University Students in Egypt

Due to the rise in the number of entrepreneurship education programs that are believed to have an impact beyond creating entrepreneurial knowledge and the multiple attempts to understand the entrepreneurial identity and how it is constructed, the current research aims at investigating the relationship between entrepreneurship education and entrepreneurial self-identity construction for university level-students, hence utilized two measures, the first one asked students whether they define him or herself in an entrepreneurial role or not (Hoang and Gimeno, 2015) and the second one was concerned about the social identity and measured it using the “Identity-scale” developed by Sieger et al. (2016).A self-administered questionnaire was distributed to a sample of 550 students, whereas 280 received formal entrepreneurship education and 270 did not. Results showed that entrepreneurship education had a direct impact on the construction of entrepreneurial identities of university students. However, the impact was of a very low level not exceeding 3.1%, implying the existence of other non-entrepreneurship education-related factors that might contribute to entrepreneurial identity construction to a higher extent

Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer

Objectives: To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). Material and methods: A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55). Results: Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. Conclusions: In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer

The current status of checkpoint inhibitors in metastatic bladder cancer

For many decades, no significant improvements could be achieved to prolong the survival in metastatic bladder cancer. Recently, systemic immunotherapy with checkpoint inhibitors (anti-PD-L1/anti-CTLA-4) has been introduced as a novel treatment modality for patients with metastatic bladder cancer. We conducted a systematic review according to the PRISMA statement for data published on the clinical efficacy of checkpoint inhibitors in metastatic bladder cancer. Clinical efficacy of anti PD-L1 therapy was investigated in prospective trials in a total of 155 patients. Patients with positive expression for PD-L1 tended towards better overall response rates (ORR) compared to those with negative expression (34/76 vs 10/73, 45 vs 14 %; p = 0.21). Among patients with PD-L1 positive tumors, those with non-visceral metastases exhibited significantly higher ORR compared to those with visceral metastases (82 vs 28 %; p = 0.001). For anti-CTLA4 therapy, there were no data retrievable on clinical efficacy. Although data on clinical efficacy of checkpoint inhibitors in metastatic bladder cancer are currently limited, the efficacy of these drugs might depend mainly on the metastatic volume and immune system integrity. Patients with PD-L1 positive tumors and non-visceral metastases seem to derive the highest benefit from therapy

Business Entities’ Liability for ‘Associated Persons’ Corruption in Malaysia: Key reflections

Section 17A of the Malaysian Anti-Corruption Commission Act 2009 imposes liability on business entities and their management if persons associated with them offer a bribe for their benefit. It provides a new regulatory capture to the meaning ‘Associated Persons’ and corporate liability. This doctrinal research highlights the associated persons' legal framework that business entities should take cognisance of and incorporate in business operations. A comparative approach is undertaken to investigate how other jurisdictions deal with the issue. The study’s findings are significant to Malaysia’s business entities in curbing the associated persons’ corruption acts. Keywords: corporate liability; associated person; corporate corruption; risk assessment  eISSN: 2398-4287© 2021. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v6i18.309

Algorithm for optimal urethral coverage in hypospadias and fistula repair: a systematic review

Context: Although urethral covering during hypospadias repair minimizes the incidence of fistula, wide variation in results among surgeons has been reported. Objective: To investigate what type of flap used during Snodgrass or fistula repair reduces the incidence of fistula occurrence. Evidence acquisition: We systematically reviewed published results for urethral covering during Snodgrass and fistula repair procedures. An initial online search detected 1740 reports. After exclusion of ineligible studies at two stages, we included all patients with clear data on the covering technique used (dartos fascia [DF] vs tunica vaginalis flap [TVF]) and the incidence of postoperative fistula. Evidence synthesis; A total of 51 reports were identified involving 4550 patients, including 33 series on DF use, 11 series on TVF use, and seven retrospective comparative studies. For distal hypospadias, double-layer DF had the lowest rate of fistula incidence when compared to single-layer DF (5/855 [0.6%] vs 156/3077 [5.1%]; p = 0.004) and TVF (5/244, 2.0%), while the incidence was highest for single-layer DF among proximal hypospadias cases (9/102, 8.8%). Among repeat cases, fistula incidence was significantly lower for TVF (3/47, 6.4%) than for DF (26/140, 18.6%; p = 0.020). Among patients with fistula after primary repair, the incidence of recurrence was 12.2% (11/90) after DF and 5.1% (5/97) after TVF (p = 0.39). The absence of a minimum follow-up time and the lack of information regarding skin complications and rates of urethral stricture are limitations of this study. Conclusion: A double DF during tubularized incised plate urethroplasty should be considered for all patients with distal hypospadias. In proximal, repeat, and fistula repair cases, TVF should be the first choice. On the basis of these findings, we propose an evidence-based algorithm for surgeons who are still in their learning phase or want to improve their results. Patient summary: We systematically reviewed the impact of urethral covering in reducing fistula formation after hypospadias repair. We propose an algorithm that might help to maximize success rates for tubularized incised plate urethroplasty

Impact of Nutritional Educational Program on the Nutritional Habits and Status among Older Adults at Qena City, Egypt

Background: The age-related changes of the gastrointestinal tract, availability of the food and the functional ability affect the nutritional intake among elderly people. Most of the diseases originate from malnutrition especially among the vulnerable group as older adults. Therefore, the aim of this study is to improve older adults' nutritional habits. The study followed a quesi experimental research design and was carried out in the Elderly Club at Qena City. Sample; One hundred and six older adults who fulfilled the inclusion criteria participated in this study and assigned randomly into fifty-three intervention group and fifty-three control group. Two tools were used to collect the data; Tool I Structured Interview Form and tool II Mini-Nutritional Assessment Scale. The results of this study revealed that there are no statistically significant differences of frequency of usual food consumed per week between pre-test and Posttest among the intervention or control group (P > 0.05). There are significance differences between pre-test and Posttest of food preparation method and the substances used in cooking among only the intervention group. It was concluded from the current study that the intervention improved the nutritional habits. Based on the study results, it will be useful implement the nutritional educational program at all older organizations which provide services to older adults such as elderly homes, elderly clubs, and hospitals in Egypt

TRA-954: SOLUTION MODEL FOR URBAN TRAFFIC CONGESTION: EGYPTIAN CASE STUDY

Traffic congestion is a major problem in many cities around the world resulting in massive delays, increased fuel wastage, environmental impact and other negative consequences affecting the daily life of each individual. From a transportation engineering point of view, making the correct decision to eliminate such congestion problems can be very difficult for decision-makers who carry the burden of analyzing large quantities of data which could be vague and conflicting in nature. Therefore, an effective and consistent system is required to simplify the decision-making process of the traffic congestion control. Traffic simulation could be that tool. The seriousness of traffic congestion in Egypt is the main motive for the study presented herein. The study aims at developing a model that sets guidelines on how to approach an urban congested traffic area, be able to tackle the problem and choose the effective engineering solution in terms of either geometry and/or structure. Sectors of El Nasr Road, Cairo with a total length of 2.4 km is chosen as a typical example of an urban area with traffic congestion hotspots. It serves as an excellent location to implement the traffic solution model on. The model is developed and implemented as follows: collection of traffic data, diagnosis of the congestion problems in terms of social, commercial, cultural, and behavioral aspects. The analysis of the data finger points out the flag areas by conducting total and peak traffic volume counts, simulation of the existing traffic conditions to get the delayed travel times of vehicles in that area. The analysis of the output would finally help decide whether such problem would be solved by geometric adjustments of the surface or the problem requires a multi-layered intersection

Age, Comorbidities, and Mortality Correlation in COVID-19 Patients: A Review

Background: The risk of death due to COVID-19 among hospitalized patients is known to be higher in older adults and those with underlying health conditions. Understanding the percentage of patients who are at increased risk of death due COVID-19 and how this varies between age groups will inform the healthcare community how to evaluate the risk of COVID-19, and better design healthcare and economic policies. Methods: We conducted a literature search for studies published between December 2019 until May 16, 2020 in PubMed, Embase, and Cochrane (CENTRAL). Descriptive statistics were performed. Results: We reviewed 14 studies of which 13 were retrospective and one was prospective. Eleven studies were conducted in Wuhan, China. A grand total of 11,938 COVID-19 confirmed patients were reviewed. Among these patients, 7637 (64%) were males. Our review reported hypertension (41%), diabetes (21%), cardiac diseases (14%), COPD (8%), chronic kidney disease (4%) and cerebrovascular disease (10%) as the most common underlying diseases among patients who died during hospitalization due to COVID-19. The total number of patients died in the hospital was 1744 (15%). Among patients who died in the hospital, 1% patients were 30-39 years, 16% patients were 40-59 years and 83% patients were more than 60 years of age. Conclusions: Older patients with underlying diseases appear to be at higher risk of mortality from COVID-19. Comorbidities are significant predictors of mortality in COVID-19 patients. There is an urgent need to know the epidemiology of the novel virus and characterize its potential impact

Diagnostic ureteroscopy in CT urography-diagnosed upper tract urothelial carcinoma: delay in definitive treatment and increased intravesical recurrence

Purpose To investigate the effect of diagnostic ureteroscopy (URS) on the delay to surgical treatment of upper tract urothelial carcinoma (UTUC) detected by imaging and the risk of intravesical recurrence. Materials and methods We undertook a retrospective case-note analysis of all patients who underwent radical nephroureterectomy (NUU) from November 2012 to July 2019. We identified those who underwent diagnostic ureteroscopy prior to NUU as Group 1 and those who did not undergo diagnostic URS as Group 2. Perioperative and pathological parameters were compared between both groups. Kaplan-Meier and Log-Rank analyses were used to compare delay to NUU and the intravesical recurrence (IVR) free survival. Cox regression models were employed to analyze the risk factors of intravesical recurrence. Results Out of 69 patients with a mean age of 71.3 years and a mean follow-up of 48.5 months, 49 (71%) underwent URS while 20 (29%) did not. The mean time between the computerized tomography urography (CTU) and surgery was 86 days with URS and 59 days in the control groups(p=0.007). Intravesical recurrence in year one postoperatively was 28.2 % in the URS group vs 5.9% in the control group (p=0.04). The Kaplan-Meier curve showed improved, yet insignificant, IVR-free survival for the control group (Log-Rank p-value=0.21). In multivariate Cox regression analysis, concomitant bladder carcinoma was an independent risk factor for IVR (HR, 15.01; 95%CI, 3.311 - 68.07; p=0.0004). Intravesical mitomycin-c was a protective factor (HR 0.154; 95%CI 0.025 - 0.922; p=0.040). Conclusion In our retrospective single-unit study, diagnostic ureteroscopy for CTU-detected upper tract urothelial carcinoma delayed definitive surgical treatment. Furthermore, it was associated with a significantly increased risk of early intravesical recurrence. URS can provide useful information and reassurance prior to major surgery but must be used with caution in light of these findings