Search

We present a compartmental extended SEIQRD metapopulation model for SARS-CoV-2 spread in Belgium. We demonstrate the robustness of the calibration procedure by calibrating the model using incrementally larger datasets and dissect the model results by computing the effective reproduction number at home, in workplaces, in schools, and during leisure activities. We find that schools and home contacts are important transmission pathways for SARS-CoV-2 under lockdown measures. School reopening has the potential to increase the effective reproduction number from R e =0.66±0.04 (95 % CI) to R e =1.09±0.05 (95 % CI) under lockdown measures. The model accounts for the main characteristics of SARS-CoV-2 transmission and COVID-19 disease and features a detailed representation of hospitals with parameters derived from a dataset consisting of 22 136 hospitalized patients. Social contact during the pandemic is modeled by scaling pre-pandemic contact matrices with Google Community Mobility data and with effectivity-of-contact parameters inferred from hospitalization data. The calibrated social contact model with its publically available mobility data, although coarse-grained, is a cheap and readily available alternative to social-epidemiological contact studies under lockdown measures, which were not available at the start of the pandemic., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests.

Background: Whether extragonadal germ cell tumors develop primarily in the retroperitoneum or whether they are essentially metastases of a primary testicular tumor has long been debated and remains controversial., Patients and Methods: Three patients presenting with apparent primary extragonadal retroperitoneal germ cell tumors are reported. Ipsilateral testicular evaluation was extended with palpation, ultrasonography and finally histological examination., Results: The retroperitoneal extragonadal tumors were found during abdominal MSCT. It was a fortuitous finding in the two first patients.The third patient presented with abdominal pain attributed to necrosis of the large mass which was subsequently firstly drained through endoscopic ultrasound-guided transduodenal puncture. The seminomatous nature of the retroperitoneal tumors was obtained through transduodenal echoendoscopic-guided cytopuncture in the first case, celioscopic resection in the second case and delayed percutaneous CT guided biopsy in the third symptomatic case. The first two patients had a history of cryptorchidism with substantial clinical testicular atrophy; ultrasonography showed microlithiasis and a small intratesticular tumor in the first patient and an hypoechoic but rather homogeneous atrophic testis in the other; orchiectomy confirmed small seminomatous intratesticular tumors in the two cases. The third patient had an atypical hypoechoic area on testicular ultrasound and histopatholgy revealed a burn-out primary tumor., Conclusions: So-called primary extragonadal retroperitoneal germ cell tumors are extremely rare and should first be considered as metastases of a viable or burned-out testicular cancer until proven otherwise. All ipsilateral testicular abnormalities revealed by the patient's history, clinical examination and mostly by testicular ultrasound must be treated adequately with orchiectomy because they may act as a sanctuary for later tumor growth.

Objectives: To evaluate the technical and oncologic feasibility of laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma., Methods: A retrospective survey of 100 patients, treated with laparoscopic nephroureterectomy in 10 Belgian centres, was performed. Most procedures were performed transperitoneally. The distal ureter was managed by open surgery in 55 patients and laparoscopically in 45 patients. The mean follow-up was 20 mo., Results: Mean operation time was 192 min and mean blood loss 234 ml. The conversion rate was 7%. Important postoperative complications were seen in 9%. Pathologic staging was pTa in 31 patients, pT1 in 23, pT2 in 12, pT3 in 33, and pT4 in 1, concomittant pTis in 3. Pathologic grade was G1 in 24 patients, G2 in 28, and G3 in 48. Negative surgical margins were obtained in all but one patient. Twenty-five patients developed progressive disease (24%) at a mean postoperative time of 9 mo (local recurrence in 8%, metastases in 11%, both in 5%). Progression was 0% for pTa, 17% for pT1, 17% for pT2, 51% for pT3, and 100% for pT4. Cancer-specific survival was 100% for pTa, 86% for pT1, 100% for pT2, 77% for pT3, and 0% for pT4., Conclusion: Laparoscopic nephroureterectomy appears to be a technically and oncologically feasible operation. To prevent tumour seeding, one should avoid opening the urinary tract and should extract the specimen with an intact organ bag. The high local recurrence rate in this study probably reflects the high percentage of high-grade and high-stage tumours in this study.

Purpose: We analyzed the potential influence of adjuvant radiotherapy on urinary continence after radical prostatectomy., Materials and Methods: A total of 100 patients with N0M0 prostate cancer randomized in a prospective study on postoperative radiotherapy for locally advanced disease (positive surgical margin, capsular perforation and/or seminal vesicle infiltration) were studied. Objective pad weighing tests corroborated by direct personal interviews were used to evaluate urinary continence at regular postoperative intervals., Results: Of the patients 48 received 60 Gy. external radiotherapy with 18 MV photon beams between 12 and 16 weeks postoperatively, and 52 were followed expectantly. Risk factors were similar in both groups. With a mean followup of 24 months, no difference in complete urinary continence was observed. Of the irradiated group 77% and of the surveillance group 83% were totally dry. The fate of the bladder neck had no significant influence on final continence status, although there was a trend for faster recovery when the bladder neck was preserved., Conclusions: In this prospective randomized study 60 Gy. external radiation therapy administered between 3 and 4 months after radical prostatectomy for pathologically locally advanced prostate cancer had no significant influence on urinary continence.