The cross-cultural expression of internet gaming distress in North America, Europe, and China.

We compare the forms online gaming-related distress takes cross-culturally, and examine how much such distress resembles the World Health Organization's (WHO) "Gaming disorder," understood to be an "addiction." Our preliminary exploratory factor analysis (EFA) in North America (n = 2025), Europe (n = 1198), and China (n = 841) revealed a constant four-factor structure across the three regions, with classic "addiction" symptoms always clustering together on the first and most important factor, though with some variability in regional factors' exact item composition. In the present study, we use second-order confirmatory factor analysis (CFA) to further examine this factor structure and the cultural similarities and differences. Specifically, we focus on confirming the regional structure and composition of an ethnographically developed 21-item gaming distress scale, which contains a wider symptoms pool than typical gaming disorder scales, and thus allows us to better separate generalized gaming distress's "addictive" from other culturally-influenced "problem" experiences and behaviors in each regional case. We use propensity score matching to separate the impact on gaming-related distress of regional culture from demographic variables (North America/Europe: n = 1043 pairs; North America/China: n = 535 pairs). Although our results support current WHO formulations of gaming-related distress as an addictive disorder, we show how cultural forces can shape how "addictive" and "problem" gaming are experienced and thus psychiatrically presented in different parts of the world. In particular, generalized gaming distress's addictive and problematic dimensions seem to be shaped by culture-specific expressions of achievement motivations, social connection and disconnection, and unique psychosomatic experiences.

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China.

We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.

Prostate-derived Ets transcription factor (PDEF) is a potential prognostic marker in patients with prostate cancer.

BACKGROUND: Reduced expression of prostate-derived Ets transcription factor (PDEF) leads to morphologic change as well as increased migration and invasiveness of prostate cancer cells. However, the clinical relevance of PDEF expression and its relationship to anti-apoptotic protein survivin is yet to be determined. METHODS: Tissue microarrays of 73 prostate carcinomas and their adjacent benign prostate tissue, as well as 50 benign prostates were evaluated for PDEF expression by immunohistochemistry. Results were confirmed in available tumor tissues using Western blot and RT-PCR. Expression of survivin in prostate carcinoma and benign tissues were determined using Western blot. Results and correlation with clinical data were statistically analyzed. RESULTS: Patients' specimens with low Gleason scores (GS < 5) expressed higher levels of PDEF protein and lower levels of survivin protein when compared with moderate-to-high GS tumors (GS > 6). Patients with PDEF-positive tumor survived significantly longer (P < 0.0001) than patients with PDEF-negative tumor, and the 8-year survival rate was 94% and 40%, respectively. PDEF expression was detected at the highest levels in benign tissues and was down-regulated or lost in 30 recently diagnosed prostate carcinomas. Re-expression of PDEF in prostate cancer cells inhibited survivin expression. Treatment of prostate cancer cells with methylseleninic acid resulted in restoration of PDEF expression, down-regulation of survivin, and inhibition of tumor cell growth when compared with untreated controls (P < 0.05). CONCLUSIONS: These studies demonstrated an inverse correlation between PDEF and survivin expression, and that up-regulation of PDEF was associated with a favorable prognosis in patients with clinically localized prostate cancer.

Prospective clinical trial of preoperative sunitinib in patients with renal cell carcinoma.

PURPOSE: Sunitinib is an approved treatment for metastatic renal cell carcinoma. We performed a prospective clinical trial to evaluate the safety and clinical response to sunitinib administered before nephrectomy in patients with localized or metastatic clear cell renal cell carcinoma. MATERIALS AND METHODS: Patients with biopsy proven clear cell renal cell carcinoma were enrolled in the study and treated with 37.5 mg sunitinib malate daily for 3 months before nephrectomy. The primary end point was safety. RESULTS: In an 18-month period 20 patients were enrolled. The most common toxicities were gastrointestinal symptoms and hematological effects. Grade 3 toxicity developed in 6 patients (30%). No surgical complications were attributable to sunitinib treatment. Of the 20 patients 17 (85%) experienced reduced tumor diameter (mean change -11.8%, range -27% to 11%) and cross-sectional area (mean change -27.9%, range -43% to 23%). Enhancement on contrast enhanced computerized tomography decreased in 15 patients (mean HU change -22%, range -74% to 29%). After tumor reduction 8 patients with cT1b disease underwent laparoscopic partial nephrectomy. Surgical parameters, such as blood loss, transfusion rate, operative time and complications, were similar to those in patients who underwent surgery during the study period and were not enrolled in the trial. CONCLUSIONS: Preoperative treatment with sunitinib is safe. Sunitinib decreased the size of primary renal cell carcinoma in 17 of 20 patients. Future trials can be considered to evaluate neoadjuvant sunitinib to maximize nephron sparing and decrease the recurrence of high risk, localized renal cell carcinoma.

Osteoclastlike giant cell tumor of the salivary gland.

Giant cell tumor of the salivary gland is extremely rare, with only 15 cases published in the English literature. The tumor characteristically contains a mixture of multinucleated giant cells, resembling osteoclasts of bone, and neoplastic mononuclear cells. In about half of the reported cases, there is an associated carcinomatous component. We are reporting an additional case of giant cell tumor of the parotid gland that was initially misinterpreted as an extraosseous osteosarcoma in the biopsy specimen. The histologic and immunohistochemical findings as well as a review of the literature with discussion of the histogenesis of this unusual neoplasm are presented.

Apoptosis-related (survivin, Bcl-2), tumor suppressor gene (p53), proliferation (Ki-67), and non-receptor tyrosine kinase (Src) markers expression and correlation with clinicopathologic variables in 60 thymic neoplasms.

BACKGROUND: Our objective was to investigate the expression of survivin, Bcl-2, p53, Ki-67, and Src in thymic neoplasms and analyze their interrelationship with clinicopathologic variables. METHODS: A series of 60 thymic neoplasms was reviewed and classified according to the World Health Organization (WHO) scheme. Key clinical information, including Masaoka stage, recurrence-free survival (RFS), and overall survival (OS) was obtained. The percentage and staining intensity of listed markers were recorded. The correlation of markers and clinicopathologic variables was statistically analyzed using the Fisher exact test and log-rank test. RESULTS: There were 7 type A, 15 type AB, 8 type B1, 5 type B2, 17 type B3 thymomas, and 8 thymic carcinomas. Seven patients (11.7%) died of the disease. Tumors recurred in eight patients (13.3%). Although p53 expression alone was found to be correlated with RFS with borderline significance (p = 0.056), patients with Src-positive and p53-positive coexpression had a shorter OS time than the other groups (p < 0.008). Cytoplasmic expression of survivin was present in 5 of 60 thymic neoplasms (8.3%), 4 of which were thymic carcinomas that all recurred. CONCLUSIONS: Regardless of WHO type and/or tumor stage, although p53 expression may predict recurrence in thymomas, p53 and Src coexpression can predict shorter OS, and cytoplasmic localization of survivin may predict recurrence in thymic carcinoma. These findings make thymic tumors a prime target for newly developed anti-Src and anti-survivin therapies.

Apical margins after robot-assisted radical prostatectomy: does technique matter?

BACKGROUND AND PURPOSE: The apex is the most common site of an involved surgical margin after robot-assisted radical prostatectomy. We assessed the impact of two surgical techniques for dorsal vein control on surgical margins rates. PATIENTS AND METHODS: From August 2005 to January 2008, 480 patients underwent robot-assisted radical prostatectomy at Roswell Park Cancer Institute. The Roswell Park Cancer Institute Quality Assurance robotic prostatectomy database was reviewed to identify all patients with prostate cancer at the apex on final pathologic evaluation. The rate of positive apical margins was compared between two surgical techniques. Group 1 consisted of 145 patients who underwent apical dissection after cold incision of the dorsal venous complex (DVC) without previous suture ligation, and group 2 consisted of 158 patients who underwent suture ligation of the DVC before apical dissection. RESULTS: Of 480 patients, 303 (63%) patients had prostate cancer in the apex. Age, body mass index, prostate-specific antigen level, and clinical stage were similar in both groups. The overall apical positive margin rate was 5%. Group 1 patients had an apical positive margin rate of 2%, while group 2 patients had a positive margin rate of 8% (P = 0.02). Mean operative blood loss estimated by the attending anesthesiologist was 331 mL and 268 mL in group 1 and group 2, respectively (P = 0.044). One patient in group 1 needed blood transfusion. CONCLUSIONS: Cold incision of the DVC before suture ligation reduces the rate of apical margin involvement during robot-assisted radical prostatectomy.

Intraobserver and interobserver variability in distinguishing between endocervical and endometrial adenocarcinoma on problematic cases of cervical curettings.

We conducted a prospective study where 4 pathologists examined patients' problematic cases of cervical curetting for adenocarcinoma to determine whether it is of endocervical or endometrial origin based on 3 parameters: age, morphology, and immunohistochemistry (IHC) panel. Our aims were to evaluate the intraobserver and interobserver variability and to compare the results using those parameters to the final hysterectomy specimens. The value of morphology, morphology+age, and the combined parameters (morphology+age+IHC) in predicting the correct origin of the tumor was evaluated. The intraobserver agreements ranged from fair to almost perfect for each of morphology, morphology+age, and the combined parameters. The interobserver agreements were fair in the first review and ranged from slight to fair in the second review. The agreements between the diagnosis based on morphology, morphology+age, and the combined parameters compared with the final diagnosis on the hysterectomy specimen were slight (kappa=0.137), fair (kappa=0.290), and moderate (kappa=0.497), respectively. We concluded that (i) discriminating between endocervical and endometrial carcinoma is highly subject to intraobserver and interobserver variability. (ii) Surprisingly, this variability is not affected by pathologists' experience. (iii) An IHC panel adds a useful piece of information to predict the tumor origin. Lastly, even though the combination of morphology, age, and IHC is far from perfect in predicting the correct origin of the tumor, it is still the best available method.

Prostate-derived Ets transcription factor as a favorable prognostic marker in ovarian cancer patients.

We have previously shown that ovarian tumors express prostate-derived Ets transcription factor (PDEF). However, the precise role of PDEF in the prognosis of ovarian cancer is unknown. In our study, we report for the first time that expression of PDEF in tumor lesions of patients with ovarian cancer is associated with favorable prognosis. Evaluation of samples from 40 patients with ovarian cancer showed that early stage (IA) and borderline (IIB, III) ovarian tumors expressed higher levels of PDEF mRNA and protein and lower levels of survivin compared to late stage ovarian tumors (IIIC and IV, p < 0.05). Normal ovarian tissues expressed the highest levels of PDEF mRNA and protein when compared to tumor tissues (p < 0.05). A Log-Rank test showed that overall survival of patients with PDEF-positive and survivin-negative ovarian tumors was significantly longer than those with PDEF-negative and survivin-positive tumors (p < 0.01). Forced expression of PDEF in PDEF-negative ovarian tumor cells inhibited tumor cell growth, induced apoptosis, downregulated survivin expression and its promoter activity. Furthermore, treatment of ovarian cancer cells with vitamin D or a selenium compound resulted in re-expression of PDEF, downregulation of survivin, induction of apoptosis and inhibition of tumor cell growth when compared to untreated controls (p < 0.05). Together, these observations showed an inverse correlation between PDEF and survivin expression and suggested that increased PDEF expression along with reduced survivin was associated with prolonged survival of patients with ovarian cancer.

Laparoscopic lymph node dissection in clinically node-negative patients undergoing laparoscopic nephrectomy for renal carcinoma.

OBJECTIVES: Accurate staging of renal cell carcinoma (RCC) is important when risk-stratifying patients for clinical trials and identifying patients most likely to benefit from adjuvant therapy. We investigated the feasibility and potential role of laparoscopic lymph node dissection (LND) in patients undergoing radical nephrectomy with clinically node-negative RCC. METHODS: We retrospectively compared 50 consecutive patients undergoing laparoscopic nephrectomy without LND (Nx group) with 50 consecutive patients undergoing combined laparoscopic nephrectomy and retroperitoneal LND (LND group). RESULTS: The two groups had similar clinical and pathological characteristics; the only difference was a higher proportion of non-clear cell histology in the LND group. In the Nx group, no patient was identified as having node-positive RCC; 5 of 50 patients (10%) in the LND group had nodal disease (P = 0.0155). Among a subgroup of patients with clinically localized RCC, 3 of 46 (6.5%) patients had node-positive disease identified by LND. All patients with positive nodes had primary tumors that were at least 7 cm in diameter, pT3 or pT4, and high grade. With increased surgeon experience, extent of the LND was incrementally increased. The mean number of nodes recovered was 7.8; however, a mean of 12.1 nodes were recovered using an extended LND. The mean numbers of nodes recovered from the paraaortic, interaortocaval, paracaval, and retrocaval regions were 9.8, 4.2, 2.4, and 5.0, respectively. The overall risk of intraoperative and postoperative complications was similar between groups. CONCLUSIONS: Laparoscopic LND in patients undergoing nephrectomy for RCC is safe and feasible, and may improve staging accuracy.

Muscularis mucosae of the urinary bladder revisited with emphasis on its hyperplastic patterns: a study of a large series of cystectomy specimens.

Although the presence of the muscularis mucosae (MM) in the urinary bladder is well known, hyperplastic MM (HMM) has not been well established in the English literature. In this study, we analyzed the presence and distribution of the MM and HMM in 102 consecutive cystectomy specimens and 17 bladders obtained at autopsy. Hyperplastic MM, defined as MM composed of more than 3 layers of muscle fibers appearing either as fibers parallel to the surface mucosa or rounded bundles, was found in all of the cystectomy specimens. Hyperplasia was subclassified as mild (4 to 6 layers of smooth muscle) and prominent (more than 6 layers). Hyperplastic MM was found in the dome, trigone, and anterior, posterior, left lateral, and right lateral walls. The incidence was relatively similar among these locations. The 3 patterns of HMM (continuous, interrupted, scattered) were similar to those of MM. Hyperplastic MM appeared most frequently in the scattered pattern and was always adjacent to large-caliber blood vessels. The hyperplasia is usually mild and is occasionally prominent. The presence of HMM did not appear to be related to the patient's age and occurs slightly more often in bladders from cystectomy for neoplasms than bladders obtained from autopsy. Although the MM has been used along with the muscularis propria as a histological landmark for staging of bladder cancer, little is known about HMM. Pathologists should be aware of its occurrence and morphologic patterns to accurately assess the depth of invasion of bladder tumors and avoid misinterpreting HMM as the muscularis propria.

Clinical presentation of epithelioid angiomyolipoma.

OBJECTIVE: Epithelioid angiomyolipomas (AML) of the kidney are malignant tumors with aggressive clinical behavior. METHODS: We reviewed cases of epithelioid AML recently diagnosed at our institution to highlight the spectrum of clinical presentations. RESULTS: In all cases, renal lesions seen on computed tomography were suspicious for renal cell carcinoma (RCC). Histologically, these tumors can resemble RCC. The diagnosis of epithelioid AML was established by positive staining for melanoma and smooth muscle cell markers, and presence of perivascular epithelioid cells. One patient presented with a renal tumor extending into the inferior vena cava to the level of the hepatic veins. Two patients developed recurrent, metastatic disease following nephrectomy. One patient with tuberous sclerosis and multiple, bilateral AML developed an enhancing renal tumor that did not contain any fat densities. A partial nephrectomy was performed and pathology revealed epithelioid AML adjacent to conventional AML. CONCLUSIONS: These tumors are distinguished from RCC by positive immunostaining for melanoma markers and smooth muscle cell markers. They resemble conventional RCC on imaging. Epithelioid AML may be locally aggressive and metastasize.

Pax-5 immunoexpression in various types of benign and malignant tumours: a high-throughput tissue microarray analysis.

BACKGROUND: Pax-5 belongs to the Pax gene family transcription factors that play an important role in organogenesis and in B cell ontogeny. It is expressed in B cell non-Hodgkin's lymphoma (B-NHL), Hodgkin's lymphoma (HL) and neuroendocrine carcinomas. However, its expression in other tumour types is not fully explored. AIMS AND METHODS: To determine Pax-5 expression in other tumour types, immunohistochemistry was performed on 3758 benign and malignant tumours using multiple tumour microarrays, as well as on whole sections. RESULTS: Pax-5 was expressed in 108/118 (91.5%) B-NHLs, in 60/70 (85.7%) HLs and in 0/7 T cell lymphomas. In addition, Pax-5 was seen in 24/34 (70.6%) Merkel cell carcinomas, 42/53 (79.2%) small cell carcinomas, 1/164 (0.6%) breast carcinomas, 2/204 (1%) endometrial adenocarcinomas and 1/452 (0.2%) urothelial carcinoma of the bladder. CONCLUSION: Despite its expression in a small subset of malignancies of epithelial origin, Pax-5 is still a good and reliable immunomarker in diagnosing B-NHL, HL and neuroendocrine carcinomas.

[Treatment techniques of harvesting injury of donor renal blood vessels].

OBJECTIVE: To study the treatment technique for harvesting injury of donor blood vessels for the clinic application. METHODS: The data of 32 renal transplantation patients with injury of graft blood vessels were retrospectively reviewed. 60 renal transplantation patients with non-injury during the same term were selected as the control group. The treatment techniques for harvesting injury of graft blood vessels mainly includes end-to-end anastomosis of graft artery, side-to-side anastomosis of branch artery, end-to-side anastomosis of branch artery to the main renal artery, reconstruction of multiple segmental arteries by using iliac arterial grafts from cadaveric donors or recipients on the workbench, repairs of injuries for the smaller segmental/polar arteries by using inferior epigastric artery, end-to-end anastomosis of the lower thick segmental/polar arteries with the iliac internal arterial by placing kidney upside down. RESULTS: Those injured included 28 arterial and 4 venous. Average bench surgery time was 42 minutes. Mean warm ischemic time was 31 minutes. No death occurred at an average follow-up of 3.5 years (1 - 5 years). There was no statistical difference in the 1-year graft survival, postoperative 1-year acute rejection, delayed graft function (DGF) and the incidence of constriction of vascular anastomosis rate (96.9%, 12.5%, 21.9%, 3.1%, respectively) compared with non-reconstructed kidneys during the same term (98.3%, 11.7%, 18.3%, 1.7%, P > 0.05, respectively). CONCLUSION: The flexible and appropriate application of different vascular reconstruction means and satisfactory surgery techniques play an important role in assuring quality of kidney with harvesting blood vessels injury and donor kidney availability.

[Clinical investigation of renal angiomyolipoma].

OBJECTIVE: To study the diagnosis and management of renal angiomyolipoma (RAML), and to identify risk factors affecting spontaneous angiomyolipoma rupture. METHODS: The data of 68 patients with RAML from 1989 to 2002 were retrospectively reviewed. These patients were divided in two groups on the basis of tumor size, 35 patients in group A ( 4 cm). RESULTS: Seven patients were identified by image-guided percutaneous biopsy, and no major complications was noted. Sixteen patients with RAML were examined with angiography and 9 of 16 patients had got spontaneous rupture. 41.2% of patients were symptomatic, 4 cases (11.4%) in group A and 24 (72.7%) cases in group B (P < 0.01). There were significant differences in mean tumor size (11.6 cm +/- 5.1 cm vs 5.3 cm +/- 2.9 cm, P < 0.01) and mean aneurysm size (13.6 mm +/- 5.8 mm vs 2.6 mm +/- 3.0 mm, P < 0.01) between 9 cases of the ruptured tumor and 59 cases of unruptured tumor, 9 cases of the ruptured and 7 cases of unruptured tumor with angiography, respectively. Treatment consisted of conservative observation in 10 patients (no radiographic changes during the follow-up of 2 - 7 years); partial nephrectomy in 14 patients, tumor enucleation in 30 patients, total nephrectomy in 14 and posterior laparoscopic nephrectomy in 3 (no recurrence and complication correlation to operation during the follow-up of 2 - 144 months). CONCLUSIONS: It is an important role that percutaneous biopsy guided by ultrasonography or computerized tomography performs in managing suspicious and/or indeterminate RAML. A higher probability of rupture is related to tumor and/or aneurysms size. Nephron-sparing surgery is the first choice for surgical treatment of RAML.