Urothelial neoplasms of the urinary bladder occurring in young adult and pediatric patients: a comprehensive review of literature with implications for patient management

Bladder urothelial carcinoma is typically a disease of older individuals and rarely occurs below the age of 40 years. There is debate and uncertainty in the literature regarding the clinicopathologic characteristics of bladder urothelial neoplasms in younger patients compared with older patients, although no consistent age criteria have been used to define "younger" age group categories. Use of the World Health Organization 2004/International Society of Urological Pathology 1998 grading nomenclature and recent molecular studies highlight certain unique features of bladder urothelial neoplasms in young patients, particularly in patients below 20 years of age. In this meta-analysis and review, the clinical, pathologic, and molecular features and risk factors of bladder urothelial neoplasms in patients 40 years or less are presented and analyzed according to decades of presentation. Similar to older patients, bladder urothelial neoplasms in patients 40 years or younger occur more common in male patients, present mainly with gross painless hematuria, and are more commonly located at bladder trigone/ureteral orifices, but in contrast have a greater chance for unifocality. Delay in diagnosis of bladder urothelial neoplasms seems not to be uncommon in younger patients probably because of its relative rarity and the predominance of benign causes of hematuria in this age group causing hesitancy for an aggressive work-up. Most tumors in patients younger than 40 years were low grade. The incidence of low-grade tumors was the lowest in the first 2 decades of life, with incremental increase of the percentage of high-grade tumors with increasing age decades. Classification according to the World Health Organization 2004/International Society of Urological Pathology grading system identified papillary urothelial neoplasms of low malignant potential to be relatively frequent among bladder tumors of young patients particularly in the teenage years. Similar to grade, there was marked predominance of low stage tumors in the first 2 decades of life with gradual inclusion of few higher stage and metastatic tumors in the 2 older decades. Bladder urothelial neoplasms occurring in patients <20 years of age lack or have a much lower incidence of aberrations in chromosome 9, FGFR3, p53, and microsatellite instability and have fewer epigenetic alterations. Tumor recurrence and deaths were infrequent in the first 2 decades and increased gradually in each successive decade, likely influenced by the increased proportion of higher grade and higher stage tumors. Our review of the literature shows that urothelial neoplasms of the bladder occurring in young patients exhibit unique pathologic and molecular features that translate to its more indolent behavior; this distinction is most pronounced in patients <20 years. Our overall inferences have potential implications for choosing appropriate noninvasive diagnostic and surveillance modalities, whenever feasible, and for selecting suitable treatment strategies that factor in quality of life issues vital to younger patients.

The Politics of the "New North": Putting History and Geography at Stake in Arctic Futures

References to a “New North” have snowballed across popular media in the past 10 years. By invoking the phrase, scientists, policy analysts, journalists and others draw attention to the collision of global warming and global investment in the Arctic today and project a variety of futures for the region and the planet. While changes are apparent, the trope of a “New North” is not new. Discourses that appraised unfamiliar situations at the top of the world have recurred throughout the twentieth century. They have also accompanied attempts to cajole, conquer, civilize, consume, conserve and capitalize upon the far north. This article examines these politics of the “New North” by critically reading “New North” texts from the North American Arctic between 1910 and 2010. In each case, appeals to novelty drew from evaluations of the historical record and assessments of the Arctic’s shifting position in global affairs. “New North” authors pinpointed the ways science, state power, capital and technology transformed northern landscapes at different moments in time. They also licensed political and corporate influence in the region by delimiting the colonial legacies already apparent there. Given these tendencies, scholars need to approach the most recent iteration of the “New North” carefully without concealing or repeating the most troubling aspects of the Arctic’s past.

Gender Differences in Emotional Responses to Hooking Up

The present research looked to explore the relationship between the emotional responses of college students to different hooking up behaviors. Seven hundred and nine undergraduates participated in a web-based survey that included a demographic questionnaire, SDS, PANAS, AUDIT, and a measure of hooking up. This measure examined the frequency with which they participated in eight different types of hooking up varying by degree of familiarity to their hook partner and whether or not the hook up was coital or non-coital, as well as their emotional responses to the behavior and their perception of the emotional responses of their partner. Results showed that both menand women experienced more positive emotional responses to hooking up behaviors than negative emotional responses. Men experienced significantly more positive emotional responses to hook up behaviors than did women. Women experienced significantly more negative emotional responses for hook ups that were coital with strangers than did men, while men experienced more positive emotional responses for hook ups that were coital with strangers, coital with acquaintances, and coital with partners that were previous romantic partners than did women. Men also experienced more positive emotional responses for hook ups that were non-coital with strangers and non-coital withacquaintances. Men tended to rate their partner’s positive emotional responses higher than what women reported experiencing, particularly for hook ups with less familiar partners. Women’s ratings of their partner’s negative emotional responses were lower than what men actually reported experiencing. The data collected provide several opportunities for future analyses to be conducted and this research will add to the relatively small body of literature on hooking up.

Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature

Diagnosis, staging, and treatment monitoring are still suboptimal for most genitourinary tumours. Diffusion-weighted magnetic resonance imaging (DW-MRI) has already shown promise as a noninvasive imaging modality in the early detection of microstructural and functional changes in several pathologies of various organs.

Parochialism or self-consciousness? Internationality in medical history journals 1997-2006

Research councils, universities and funding agencies are increasingly asking for tools to measure the quality of research in the humanities. One of their preferred methods is a ranking of journals according to their supposed level of internationality. Our quantitative survey of seventeen major journals of medical history reveals the futility of such an approach. Most journals have a strong national character with a dominance of native language, authors and topics. The most common case is a paper written by a local author in his own language on a national subject regarding the nineteenth or twentieth century. American and British journals are taken notice of internationally but they only rarely mention articles from other history of medicine journals. Continental European journals show a more international review of literature, but are in their turn not noticed globally. Increasing specialisation and fragmentation has changed the role of general medical history journals. They run the risk of losing their function as international platforms of discourse on general and theoretical issues and major trends in historiography, to international collections of papers. Journal editors should therefore force their authors to write a more international report, and authors should be encouraged to submit papers of international interest and from a more general, transnational and methodological point of view.

Mycobacterium microti infection in the cat: a case report, literature review and recent clinical experience

OVERVIEW: Mycobacterium microti infection is infrequently described in cats in the veterinary literature. It can be one of a large number of possible differential diagnoses in a feline patient with dermal nodules and non-healing draining ulcers, and can occasionally spread to involve the lungs and/or other areas of the body. CASE SUMMARY: This report describes the clinical signs, eventual diagnosis and variable response to treatment in a cat in Switzerland with recurrent cutaneous M microti infection. Only after several diagnostic and therapeutic attempts, over more than 2 years, was the species of Mycobacterium finally identified and targeted therapy given. PRACTICAL RELEVANCE: For any cat in which there is even a low suspicion of mycobacterial infection, the authors recommend that an aggressive diagnostic approach is taken. Tissue specimens should be collected and frozen early on, and, as soon as acid-fast bacilli are detected, samples should be sent to a mycobacterial reference laboratory for definitive identification. LITERATURE REVIEW: A review of the literature relating to the aetiopathogenesis, diagnosis and management of M microti infection in cats and dogs is included. This is supplemented with clinical and therapeutic experience gained from this case and other, unpublished cases managed over the past 15 years by one of the authors (DGM).