Research Trends and Challenges in Medical Science Vol. 9

ADHD (Attention-Deficit Hyperactivity Disorder) is a neurodevelopmental disorder, characterized by inattentive, impulsive or hyperactive behaviors that are manifested in a disproportional manner, considering the age and level of development of the individual. Resilience (RS) is a construct understood as being a dynamic process of positive adaptation within the context of great adversity. Studies about RS in ADHD may provide new therapeutic strategies. The aim of this study was to conduct an integrative review of the literature with the purpose of seeking to understand the aspects of RS and ADHD that have been studied over the last few years, as well as which advancements and new approaches have been made with regard to management of the disability. An integrative review of the literature was made in the databases of PubMed, SciELO, Lilacs and PsycINFO with the descriptors “TDAH e RESILIÊNCIA” and “ADHD AND RESILIENCE”. The articles included were those published in scientific journals over the last 20 years, written in the Portuguese, English or Spanish language, and within the age-range of the sample of up to 18 years. The review studies were excluded. In total 119 articles were identified, and after triage, 57 eligible articles remained. After application of the inclusion and exclusion criteria, the abstracts of the studies identified and removal of the duplicated studies, 09 studies were included and revised, of which 08 had a quantitative and 01 a qualitative approach. The articles pointed out strong relations between ADHD and low levels of RS, with increase in negative outcomes in adolescence, such as academic failure, lower self-esteem and development of anxiety and depression disorders. In a similar manner family members of individuals with ADHD also have more propensity to developing anxiety and depression disorders, which may be explained by the fact they share endophenotypes and by their exposure to similar factors that induce RS, such as family conflicts and adversities.

Objective: Initial assessment of the potential of using the Gas Discharge Visualization (GDV) technique to identify patients with colon neoplasia.

Materials and Methods: The group of medical doctors used the Gas Discharge Visualization (GDV) camera to assess subjects with different epithelial lesions. A colonoscopy was performed on each of the 132 subjects, followed by a GDV scan. An endoscopic examination identified colon epithelial lesions 77 patients. The control group consisted of remaining 55 people without lesions. The age of the subjects ranged from 17 to 85 years (mean 64.6 ± 1.2). The study analyzed GDV images of each subject's finger and separate sectors corresponding to the organs in question.

Results: There were a significant number of differences between the control group and the group of patients with colon tumors. We examined the dynamics of the parameters as the level of tumor dysplasia (neoplasia) varied. The values of the following parameters: normalized luminescence area, internal noise, contour radius, and average luminescence intensity - decrease in the control group as compared to patients with cancerous polyps. The values of the following parameters: radius of the inscribed circle, contour line length, area of luminescence, contour line fractality, contour line entropy, form coefficients – increased by comparison.

Conclusion: This pilot study demonstrated a statistical difference between the GDV parameters of patients with colon tumors and the control group.

Aims: The aim of this study was to examine the prevalence of depressive symptoms and their related factors in Japan. Depressive disorder is one of the most common mental disorders and is a major public health problem in Japan. The results were analyzed to identify the relationship between high scores on the CES-D, socio-demographic status, and employment-related variables.

Methods: Employees in Akita prefecture completed the Center for Epidemiologic Studies Depression Scale (CES-D) during a survey period between November and December 2010. The cutoff point for the CES-D scores was 16 or above (high scorers).

Results: Data from 1,476 employees indicated that 44.2% had high scores on the CES-D. Socio-demographic and occupation-related factors associated with a high risk of depression were being female, young age, fewer hours of sleep on weekdays, and working over 8 hours per day, whereas drinking alcohol one to two days per week, albeit only in men, was significantly associated with a low risk of depression. The present results were consistent with the results of a previous survey completed in 2007; however, the present results regarding job categories and smoking behavior were not significantly associated with depression, and thus were inconsistent with the 2007 survey data.

Conclusions: The data presented in this paper will help identify employees at high risk of depressive disorders as well as detect the contributing socio-demographic and work-related factors. These results can be useful as benchmark values for the CES-D and might help predict depressive disorders.

Background: Lymphoma of the urinary bladder is a very rare lesion in view of this its manifestation, diagnosis, and treatment may not be known by some practitioners.

Aims: To review and update the literature on lymphoma of the urinary bladder

Methods: Internet data search bases including: Pub Med, Google, Google Scholar, Yahoo, and Bing were used to identify documented literature from case reports and cases series and studies on lymphoma of the urinary bladder in order to define the lesion and to document its presentation, diagnosis and treatment.

Results / Literature Review: Lymphoma of the urinary bladder can be either (a) primary lymphoma of the urinary bladder which is a rare lymphoma originating in the urinary bladder with no known lymphoma elsewhere or (b) secondary lymphoma of the urinary bladder which is much more common and secondary lymphoma is associated with a primary lymphoma that has originated in an extra vesical site.

Lymphomas of the urinary bladder do have a female predominance, and majority of cases of lymphoma of the urinary bladder do occur in middle age women.  Secondary involvement of the urinary bladder does occur in 10% to 25% of leukemias / lymphomas and they tend to occur in advanced stage systemic lymphoma. Less than 100 cases of lymphoma of the urinary bladder have been reported so far. MALT lymphoma is the most common sub-type of lymphoma in the urinary bladder and this typically tends to affect adults who are more than 60 years old and 75% are female.  It has been reported that diffuse large B cell lymphoma is also common, and they may arise from transformation of MALT.

Lymphoma of the urinary bladder manifests with visible haematuria, dysuria, urinary frequency, nocturia, and abdominal pain or back pain.

The radiology imaging investigations of lymphoma of the urinary bladder tend to reveal sub-mucosal masses.

Macroscopic examination of lymphomas of the urinary bladder show discrete tumours which are large and centred in the dome or lateral walls of the urinary bladder.

Positive staining of lymphomas of the urinary bladder varies by the sub-type of lymphoma; B-cell lymphomas are CD20 positive.

MALT lymphoma tends to be positively stained for CD20, CD19, and they tend to be negatively stained for CD5, CD10, CD11c but they also tend to be positively stained for FMC7.

Lymphomas of the urinary bladder tend to stain negatively with Pan-keratin, vimentin, CK20 and CK7.

MALT lymphoma exhibit t (11; 18) (q21: 21). 

Radiotherapy is the treatment for the MALT type of lymphoma of the urinary bladder and usually there is no recurrence of tumour following such treatment

Conclusions: Lymphoma of the urinary bladder could be either primary or secondary lymphoma.

Diagnosis of lymphoma of the urinary bladder is based upon the characteristic morphology of the bladder lesion which has been resected or biopsied and this must be supported by immunohistochemical analysis.

Lymphoma of the urinary bladder is a rare lesion.

Radiotherapy is a useful treatment for lymphoma of the urinary bladder.

Primary leiomyosarcoma of the prostate (PLSOP) is rare, with less than 200 cases reported so far. PLSOPs present with lower urinary tract symptoms, haematuria, and perineal pain; may or may not be associated with a history of previous treatment for adenocarcinoma of prostate by means of radiotherapy and or hormonal treatment; may afflict children and adult male. Examination may reveal benign enlarged prostate and hard enlarged mass. PLSOPs may be diagnosed by histological examination findings of spindle-shaped carcinoma cells in prostate specimens. Immunohistochemical staining tends to be positive for vimentin, CD44, smooth muscle actin, and calponin, focally positive for desmin, and at times positive for keratin. They stain negatively for PSA, S-100, CD34, CD117, and cytokeratin. Cytogenetic study on primary leiomyosarcoma of the prostate gland may show clonal chromosomal rearrangement involving Chromosomes 2, 3, 9, 11, and 19. On the whole the prognosis is poor. Surgery with or without chemotherapy would appear to be the mainstay of treatment for PLSOPs that are operable, but generally there is no consensus opinion on the best therapeutic approach. Most cases of PLSOPs are diagnosed in an advanced stage of the disease. A global multi-centre trial is required to find therapies that would improve the prognosis. New treatment options need to be explored including: Cryotherapy plus multi-modality adjuvant therapy, radiofrequency ablation of the tumour plus multi-modality adjuvant therapy, selective prostatic artery angiography and super-selective embolization of the arterial branch supplying the tumour plus multi-modality adjuvant therapy, immunotherapy plus multi-modality adjuvant therapy.

Background: Microcystic variant of urothelial carcinoma is one of the new variants of urothelial carcinoma that was added to the WHO classification in 2004.

Aims: To review the literature on microcystic variant of urothelial carcinoma.

Materials and Methods: Various internet search engines were used to document the presentation, diagnosis, management and outcomes of microcystic variant of urothelial carcinoma.

Results: (Summary of the Review and Update of the Literature): Microcystic urothelial carcinoma is a rare variant of urothelial carcinoma which was added to the WHO classification in 2004.

Microscopic examination of microcystic variant of urothelial carcinoma tends to reveal the ensuing characteristic features:

• Conspicuous intracellular and intercellular lumina / microcysts encompassed by malignant urothelial or squamous cells.
• The lumina tend to be empty but they may contain granular eosinophilic debris, mucin, or necrotic cells.
• The cysts tend to be variable in size and they are either round or oval, up to 2mm; they are lined by urothelium which are either flattened cells or low columnar cells however, they do not contain colonic epithelium or goblet cells.
• The cysts tend to be infiltrative and they may invade the muscularis propria.
•  Their microscopic pattern mimics cystitis cystica and cystitis glandularis which should be considered as differential diagnoses.
• Elongated and irregular branching spaces are usually seen.
• Occasionally they may exhibit neuroendocrine differentiation.   

Out of about 17 cases of microcystic variant of urothelial carcinoma that had earlier on been reported, only 2 patients had survived. Three more patients were reported from 2017 to 2020 and two of them had survived for 2 years in one case, six months in another case, but definite confirmation of the outcome of the third person as to how long he survived was not available to the author.

Because of the rarity of microcystic variant of urothelial carcinoma its biological behaviour is not well known but there is some evidence to suggest that this tumour tends to be of high-grade and high-stage.  There is also no consensus opinion on the best option of treatment of the tumour.

Conclusions: Microcystic variant of urothelial carcinoma is a rare tumour and to the knowledge of the author less than 25 cases have been reported in the literature.

In view of the limited number of reported cases of microcystic variant of urothelial carcinoma in the literature, it would prove difficult at the moment to be dogmatic regarding its prognosis.

However, it would appear from the few reported cases of microcystic urothelial carcinoma that on the whole this tumour is a highly aggressive tumour.

Urologists, pathologists and oncologists throughout the world should be encouraged to report new cases of microcystic urothelial carcinoma in order to document the biological behaviour such a rare tumour.

Background: Nested Variant of urothelial Carcinoma was added to the World Health Organization’s classification in 2004 as a new variant.

Aims: To review the literature on nested variant of urothelial carcinoma.

Results: About 200 cases of Nested variant of urothelial carcinoma have been reported so far and the tumour has the ensuing morphological features: Large numbers of small confluent irregular nests of bland-appearing, closely packed, haphazardly arranged, poorly defined urothelial cells which infiltrate the lamina propria and the muscularis propria.

The tumour which has a bland histomorphology appearance, is reported to have an aggressive biological behaviour.

Because of the tumour’s bland appearance, it has been at times mis-diagnosed as a benign lesion which had led to a significant delay in the establishment of the correct diagnosis and contributing to the advanced stage of the disease.

Immunohistochemically, the tumour shares some characteristic features with high-risk conventional urothelial carcinomas such as, high proliferation index, and loss of p27 expression. However, p53, bcl-2, or EGF-r immunoreactivity is not frequently seen.

The tumour must be differentiated from a number of proliferative lesions of the urothelium

Conclusions: Correct and early diagnosis of this tumour is essential in order to provide early curative treatment in order to avoid diagnosis at an advanced stage. A multi-centre trial is required to identify treatment options that would improve the outcome of this tumour.