Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments.

BackgroundIrreversible Electroporation (IRE) is a novel image-guided tissue ablation technology that induces cell death via very short but strong pulsed electric fields. IRE has been shown to have preserving properties towards vessels and nerves and the extracellular matrix. This makes IRE an ideal candidate to treat prostate cancer (PCa) where other treatment modalities frequently unselectively destroy surrounding structures inducing severe side effects like incontinence or impotence. We report the retrospective assessment of 471 IRE treatments in 429 patients of all grades and stages of PCa with 6-year maximum follow-up time.Material and findingsThe patient cohort consisted of low (25), intermediate (88) and high-risk cancers (312). All had multi-parametric magnetic resonance imaging, and 199 men had additional 3D-mapping biopsy for diagnostic work-up prior to IRE. Patients were treated either focally (123), sub-whole-gland (154), whole-gland (134) or for recurrent disease (63) after previous radical prostatectomy, radiation therapy, etc. Adverse effects were mild (19.7%), moderate (3.7%) and severe (1.4%), never life-threatening. Urinary continence was preserved in all cases. IRE-induced erectile dysfunction persisted in 3% of the evaluated cases 12 months post treatment. Mean transient IIEF-5-Score reduction was 33% within 12-month post IRE follow-up and 15% after 12 months. Recurrences within the follow-up period occurred in 10% of the treated men, 23 in or adjacent to the treatment field and 18 outside the treatment field (residuals). Including residuals for worst case analysis, Kaplan Maier estimation on recurrence rate at 5 years resulted in 5.6% (CI95: 1.8-16.93) for Gleason 6, 14.6% (CI95: 8.8-23.7) for Gleason 7 and 39.5% (CI95: 23.5-61.4) for Gleason 8-10.ConclusionThe results indicate comparable efficacy of IRE to standard radical prostatectomy in terms of 5-year recurrence rates and better preservation of urogenital function, proving the safety and suitability of IRE for PCa treatment. The data also shows that IRE, besides focal therapy of early PCa, can also be used for whole-gland ablations, in patients with recurrent PCa, and as a problem-solver for local tumor control in T4-cancers not amenable to surgery and radiation therapy anymore

Saudi international students’ perceptions of their transition to the UK and the impact of social media

In their transition to a new country, international students often feel lost, anxious or stressed. Saudi students in the UK in particular may face further challenges due to the cultural, social and religious differences that they experience. There is a lot of evidence that social media play a crucial role in this experience. By interviewing 12 Saudi students from different cities in the UK, the aim of this study is to investigate how they perceive their transition to the UK and how social media is involved. The analysis indicates that Saudi students’ perceptions of transition tend to fall in to one of two markedly different camps. Some students see transition as an opportunity to detach themselves from their home country and to engage with the new society. Those students turn to social media as a tool allowing them to build bridges with the new society. Other students feel less enthusiastic to make a full engagement with the UK society. Those students find social media as a good tool to maintain connections and links with family and friends in their home country

New Ways of Thinking about the Influence of Cultural Identity, Place and Spirituality on Child Development within Child Placement Practice

The policy and practice of family placement within the UK can be understood as the archetypal separation of a person from their physical environment, yet the inter section of ‘person with place’ – both past and present – has been argued to be crucial for identity formation. Indeed, intersectional analysts have called for alternative frame -works which challenge western models centering on the individual person disconnected from his or her community. An emerging body of work has drawn on Maori social work literature to explore the intersection of ‘person (identity) with place’ through an application to the concept of spirituality within western social work practice models. According to this perspective, people can have deep spiritual connections with the physical environment in which they live, creating a sense of belonging and attachment to that place. Victoria Sharley considers this Maori spiritual analysis in the context of family placement practice in the UK. In so doing, she offers a new way of thinking about the inter-relationship of cultural identity, place and spirituality as it affects the development of children separated from their birth families.<br/