Spatial and temporal analysis of African swine fever front-wave velocity in wild boar: implications for surveillance and control strategies.

The front-wave velocity of African swine fever (ASF) virus spread is depicted through a retrospective spatial and temporal analyses of wild boar outbreaks from Jan. 2014 to Jan. 2022 in Estonia, Latvia, Lithuania and Eastern Poland-regions responsible for more than 50% of all wild boar cases in the EU. The study uses empirical semivariograms in a universal kriging model to assess spatial autocorrelation in notification dates and identifies a discernable large-scale spatial trend. The critical parameter of ASF front-wave velocity was identified (Mean = 66.33 km/month, SD = 163.24) in the whole study area, and explored the variations across countries, wild boar habitat suitability, seasons, and the study period. Statistical differences in front-wave velocity values among countries and temporal clusters are explored, shedding light on potential factors influencing ASF transmission dynamics. The implications of these findings for surveillance and control strategies are discussed.

The role of veterinarians in zoonosis prevention: Advising families of immunocompromised children with pets.

Background: Pet ownership is widespread, offering numerous benefits to individuals and families. However, the risk of zoonotic diseases must be carefully considered, especially for immunosuppressed patients. Knowledge gaps in preventive measures for zoonoses have been identified, underscoring the vital role of veterinarians in addressing this issue. Objectives: This study aimed to assess the knowledge and recommendations of veterinarians regarding pet ownership by immunocompromised individuals. Additionally, we compared these insights with responses from European healthcare professionals specializing in pediatric transplant recipients. Methods: We conducted an observational, cross-sectional study involving small animal veterinarians in Spain. An online survey was administered to gather information on veterinarians' knowledge of zoonoses and their recommendations for immunocompromised pet owners. Results: A survey of 514 individuals was collected from experienced veterinarians mainly working in primary care clinics. Surprisingly, 63% of respondents did not routinely inquire about the presence of immunocompromised individuals among pet owners, although 54% offered specific recommendations for this group. Most respondents adhered to deworming guidelines for pets owned by immunocompromised individuals and demonstrated sound practices in Leishmania and Leptospira prevention, as well as the avoidance of raw food. However, gaps were noted concerning Bordetella bronchiseptica vaccination. Notably, veterinarians outperformed medical professionals in their knowledge of zoonotic cases and identification of zoonotic microorganisms. The presence of specific recommendations in veterinary clinics was viewed positively by nearly all respondents. Conclusions: Our findings indicate that veterinarians possess a superior understanding of zoonotic pathogens and exhibit greater proficiency in diagnosing zoonoses compared with physicians. They stay well-informed about recommendations outlined in established guidelines and are more likely to provide written recommendations in their clinics than physicians. Nevertheless, knowledge gaps among veterinarians emphasize the need for enhanced communication between medical and veterinary professionals. Reinforcing the "One Health" concept is imperative, with veterinarians playing a pivotal role in this collaborative effort.

First detection of herpesvirus and hemosporidians in the endangered Pyrenean Capercaillie (Tetrao urogallus aquitanicus).

Pathogens affect wild bird populations worldwide, contributing to their decline. Considering the scarce health data regarding the endangered Pyrenean Capercaillie (Tetrao urogallus aquitanicus), we molecularly surveyed selected pathogens (Newcastle disease virus, Avian influenza virus, Chlamydia psittaci, avian pathogenic Escherichia coli, Campylobacter jejuni, and Salmonella spp.) in 30 Pyrenean Capercaillie feces collected in the field (Catalonia, northeastern Spain). Additionally, swab and tissue samples from eight wild Pyrenean Capercaillies of Catalonia and Andorra were molecularly tested for herpesvirus and hemosporidians (Plasmodium spp., Haemoproteus spp., and Leucocytozoon spp.). All fecal samples were negative for the pathogens tested. Nevertheless, we detected a novel herpesvirus in 50% (4/8) of the Pyrenean Capercaillies, and hemosporidian DNA in 62.5% (5/8) of the tissue samples (i.e., Haemoproteus sp. [4 of 8] and/or Leucocytozoon sp. [3 of 8]). To our knowledge, this is the first detection of herpesvirus and hemosporidians infections in Pyrenean Capercaillies. The putative novel herpesvirus belongs to the genus Iltovirus. The presence of hemosporidian parasites in this mountain bird species is of concern, and could be related to the marked increase in the average temperature in the Pyrenees as a consequence of climate change. Our findings are fundamental to improve the conservation plans for the endangered Pyrenean Capercaillie population.

Salmonella assessment along the Spanish food chain: Likelihood of Salmonella occurrence in poultry and pig products is maintained across the food chain stages.

Salmonellosis is one of the most important foodborne diseases worldwide, including the European Union. Despite the One Health approach measures for risk assessment and risk management implemented by the European Union, the occurrence of disease and disease outbreaks remains high (e.g. 694 outbreaks were reported in 2020), highlighting the need of new assessment methods. Herein we applied machine learning using the random forests method to evaluate and identify key points regarding the occurrence of Salmonella sp. along the Spanish food chain during 2015-2020, using data provided by the Spanish Agency for Food Safety and Nutrition. We compared the role of the three categorical variables [product (20 categories), region (18 categories) and stage (11 categories)]. Salmonella presence was influenced by the three explanatory variables considered: first by product, followed by region and stage. The most determinant product for Salmonella probability was 'meat', while the most important stage was 'slaughterhouse'. Specifically, the highest values were found in pig and poultry meats. In these products, the Salmonella probability was high at the early and final stages of the food chain, although not at intermediate stages. The presence of Salmonella in the final stages (retail) of the food chain is of concern, as it can cause human cases of salmonellosis, including outbreaks. This study demonstrates the utility of the random forest method to identify key points and evaluate the control efforts. We recommend improving the surveillance and control measures, especially in the product and stages pointed out by our analysis, and enhancing the data collection harmonization among the different autonomous communities.

Immunomodulatory, Anti-Inflammatory, and Anti-Cancer Properties of Ginseng: A Pharmacological Update.

Ginseng, a medicinal plant of the genus Panax, boasts a rich historical record of usage that dates back to the Paleolithic period. This botanical is extensively acknowledged and consumed in Eastern countries for its therapeutic properties, and, in Western countries, it is becoming increasingly popular as a remedy for fatigue and asthenia. This review provides an update on current research pertaining to ginseng and its isolated compounds, namely, ginsenosides and polysaccharides. The primary focus is on three crucial pharmacological activities, namely, immunomodulation, anti-inflammatory, and anti-cancer effects. The review encompasses studies on both isolated compounds and various ginseng extracts obtained from the root, leaves, and berries.

Neuropharmacological Effects in Animal Models and HPLC-Phytochemical Profiling of Byrsonima crassifolia (L.) Kunth Bark Extracts.

B. crassifolia is a species that grows in various areas of Latin America. It was known to be useful for the treatment of different human ailments. The present work evaluated the neuropharmacological and analgesic effects of hydroalcoholic and dichloromethane extracts of B. crassifolia. The effect on the central nervous system (CNS) of both extracts obtained from bark, administered by the intraperitoneal route in mice, was evaluated by different tests: spontaneous motor activity, hole-board, motor coordination, pentobarbital induced hypnosis, and rectal temperature. Analgesic activity was evaluated using a hot plate test. Phytochemical analysis was performed by high-performance liquid chromatography (HPLC) using reversed-phase and gradient of elution. The hydroalcoholic extract (dose 0.5 g dry plant/kg weigh) administration caused an important reduction of the head-dipping response in the hole board test. A decrease in spontaneous motor activity test and a disturbance of motor coordination in the rotarod test was observed. The hydroalcoholic extract produced a significant prolongation of pentobarbital induced sleeping time. This extract prevented hot plate test induced nociception. The phytochemical analysis revealed the presence of catechin, epicatechin, and procyanidin B12. Therefore, this study revealed that the hydroalcoholic extract of B. crassifolia possesses analgesic and sedative CNS activity.

Balancing the Risks and Benefits of Pet Ownership in Pediatric Transplant Recipients.

In recent decades, the number of pediatric transplantations and their survival rates have increased. Psychological problems and poorer quality of life are notable among children undergoing transplantation and can have long-lasting consequences and affect immunosuppressive therapy adherence. Pet ownership and animal contact have been associated with physical, mental, and social health benefits. Despite these potential benefits, however, companion animals are known to be a source of infection, which is one of the main concerns for clinicians. Because of immunosuppression, these children are particularly vulnerable to infections. Zoonoses comprise a long list of infectious diseases and represent a major public health problem. Nevertheless, many families and most healthcare providers are unaware of these potential risks, and there is a worrisome lack of recommendations to manage the risk-benefit balance, which could pose a risk for acquiring a zoonosis. Furthermore, no data are available on the number of transplanted patients with pets, and this risk-benefit balance is difficult to adequately evaluate. In this document, we review the currently available evidence regarding the epidemiology of zoonotic infections in patients undergoing transplantation, focusing on pediatric patients from a risk-benefit perspective, to help inform decision-making for clinicians. Families and healthcare professionals should be aware of the risks, and clinicians should actively screen for pets and offer comprehensive information as part of routine clinical practice. A multidisciplinary approach will ensure proper care of patients and pets and will establish preventive measures to ensure patients are safe living with their pets.

Pets for pediatric transplant recipients: To have or not to have.

Pets have many health, emotional and social benefits for children, but the risk of zoonotic infections cannot be underestimated, especially for immunosuppressed patients. We report the recommendations given by health professionals working with pediatric transplant recipients to their families regarding pet ownership. An online survey addressing zoonosis knowledge and recommendations provided by health care practitioners regarding pets was distributed to clinicians treating pediatric transplant recipients. The European Society of Pediatric Infectious Disease (ESPID) and the European Reference Network ERN-TransplantChild, which works to improve the quality of life of transplanted children, allowed the online distribution of the survey. A total of 151 practitioners from 28 countries participated in the survey. Up to 29% of the respondents had treated at least one case of zoonosis. Overall, 58% of the respondents considered that the current available evidence regarding zoonotic risk for transplanted children of having a pet is too scarce. In addition, up to 23% of the surveyed professionals recognized to be unaware or outdated. Still, 27% of the respondents would advise against buying a pet. Practitioners already owning a pet less frequently advised patients against pet ownership, whereas non-pet-owners were more keen to advise against pet ownership (p = 0.058). 61% of the participants stated that there were no institutional recommendations regarding pets in their centers/units. However, 43% of them reported therapeutic initiatives that involved animals in their centers. Infectious disease specialists were more likely to identify zoonotic agents among a list of pathogens compared to other specialists (p < 0.05). We have observed a huge heterogeneity among the recommendations that health care providers offer to families in terms of risk related to pet ownership for transplant recipients. The lack of evidence regarding these recommendations results in practitioners' recommendations based on personal experience.

Oral saliva swab reverse transcription PCR for Covid-19 in the paediatric population.

OBJECTIVES: To evaluate the performance of oral saliva swab (OSS) reverse transcription PCR (RT-PCR) compared with RT-PCR and antigen rapid diagnostic test (Ag-RDT) on nasopharyngeal swabs (NPS) for SARS-CoV-2 in children. DESIGN: Cross-sectional multicentre diagnostic study. SETTING: Study nested in a prospective, observational cohort (EPICO-AEP) performed between February and March 2021 including 10 hospitals in Spain. PATIENTS: Children from 0 to 18 years with symptoms compatible with Covid-19 of ≤5 days of duration were included. Two NPS samples (Ag-RDT and RT-PCR) and one OSS sample for RT-PCR were collected. MAIN OUTCOME: Performance of Ag-RDT and RT-PCR on NPS and RT-PCR on OSS sample for SARS-CoV-2. RESULTS: 1174 children were included, aged 3.8 years (IQR 1.7-9.0); 73/1174 (6.2%) patients tested positive by at least one of the techniques. Sensitivity and specificity of OSS RT-PCR were 72.1% (95% CI 59.7 to 81.9) and 99.6% (95% CI 99 to 99.9), respectively, versus 61.8% (95% CI 49.1 to 73) and 99.9% (95% CI 99.4 to 100) for the Ag-RDT. Kappa index was 0.79 (95% CI 0.72 to 0.88) for OSS RT-PCR and 0.74 (95% CI 0.65 to 0.84) for Ag-RDT versus NPS RT-PCR. CONCLUSIONS: RT-PCR on the OSS sample is an accurate option for SARS-CoV-2 testing in children. A less intrusive technique for younger patients, who usually are tested frequently, might increase the number of patients tested.

African Swine Fever Survey in a European Context.

African swine fever (ASF) is currently the most threatening disease for domestic and wild pigs worldwide. Wild boar has been the main affected species in all EU countries except for Romania, where most notifications occur in domestic pigs. The spread of ASF in wild boar is challenging to control; risk factors are harder to identify and establish than in domestic pigs, which, together with an underestimation of the disease and the lack of treatment or an effective vaccine, are hindering control and eradication efforts. We distributed two online questionnaires, one for domestic pigs and one for wild boar, to experts of different background and countries in Europe, to explore risk factors in relation to ASF control connected to farming, hunting, trade, the environment, and domestic pig and wild boar populations. Overall, wild boar movements were estimated to pose the highest risk of ASF introduction and spread. The movement of pork and pork products for own consumption also ranked high. Here we explored, in addition to the assessment of risk pathways, the identification of risks of transmission at the domestic/wild boar interface, the importance of biosecurity practices and improved control efforts, and controversial opinions that require further attention.

RAS Mutational Status in Advanced Colorectal Adenocarcinoma Treated With Anti-angiogenics: Preliminary Experience With Liquid Biopsy.

AIM: To determinate molecular changes in the downstream epidermal growth factor receptor signaling pathway using serial liquid biopsies in patients with metastatic colorectal tumors (mCRC) under anti-angiogenic treatment. PATIENTS AND METHODS: Determination of RAS mutation in primary tissue samples from colorectal tumors was performed in the 23 patients included in the study at diagnosis using quantitative-polymerase chain reaction. Sequential mutations were studied in circulating tumor (ct) DNA obtained from plasma samples. RESULTS: Twenty-three patients with RAS-mutated primary tumors were included. In the first ctDNA determination, 17 of these patients were found to have wild-type RAS status. Remarkably, three out of these 17 wild-type cases changed to RAS-mutated in subsequent ctDNA assays. CONCLUSION: Serial liquid biopsies in patients with mCRC might be a useful tool for identifying changes in the RAS mutation status in patients who had undergone previous anti-angiogenic therapy. The understanding of these changes might help to better define the landscape of mCRC and be the path to future randomized studies.

Long-Range Ordering Effects in Magnetic Nanoparticles.

The challenge for synthesizing magnetic nanoparticle chains may be achieved under the application of fixation fields, which are the externally applied fields, enhancing collective magnetic features due to adequate control of dipolar interactions among magnetic nanoparticles. However, relatively little attention has been devoted to how size, concentration of magnetic nanoparticles, and intensity of an external magnetic field affect the evolution of chain structures and collective magnetic features. Here, iron oxide nanoparticles are developed by the coprecipitation method at diameters below (10 and 20 nm) and above (50 and 80 nm) their superparamagnetic limit (at about 25 nm) and then are subjected to a tunable fixation field (40-400 mT). Eventually, the fixation field dictates smaller particles to form chain structures in two steps, first forming clusters and then guiding chain formation via "cluster-cluster" interactions, whereas larger particles readily form chains via "particle-particle" interactions. In both cases, dipolar interactions between the neighboring nanoparticles augment, leading to a substantial increase in their collective magnetic features which in turn results in magnetic particle hyperthermia efficiency enhancement of up to one order of magnitude. This study provides new perspectives for magnetic nanoparticles by arranging them in chain formulations as enhanced performance magnetic actors in magnetically driven magnetic applications.

Corrigendum: Evolution of the ASF Infection Stage in Wild Boar Within the EU (2014-2018).

[This corrects the article DOI: 10.3389/fvets.2020.00155.].

Current uses and knowledge of medicinal plants in the Autonomous Community of Madrid (Spain): a descriptive cross-sectional study.

BACKGROUND: The usage of medicinal plants as a key component of complementary and alternative medicine, has acquired renewed interest in developed countries. The current situation of medicinal plants in Spain is very limited. This paper provides new insights and greater knowledge about current trends and consumption patterns of medicinal plants in the Autonomous Community of Madrid (Spain) for health benefits. METHODS: A descriptive cross-sectional study was designed for a population-based survey on medicinal plants. The data were collected (May 2018 to May 2019) using semi-structured face-to-face interviews in independent pharmacies, hospital centers and primary care health centers in the Autonomous Community of Madrid. The survey had 18 multiple choice and open-ended questions. Quantitative indices were calculated: Fidelity Level (FL), Use Value (UV) and Informants Consensus Factor (ICF). Chi-square test was used for data analysis. RESULTS: Five hundred forty-three people were interviewed. The majority of the participants (89.6%) have used medicinal plants to treat health disorders in the past 12 months, mainly for digestive problems, sleep disorders and central nervous system diseases. A total of 78 plants were recorded, being Matricaria recutita, Valeriana officinalis, Tilia spp. and Aloe vera the most used. The highest UV was found for Mentha pulegium (UV 0.130) followed by Aloe vera (UV 0.097) and Vaccinium macrocarpon. (UV 0.080). The highest FL values were for Eucalyptus spp. (FL 90.47%) for respiratory conditions and, Matricaria recutita (85.55%) and Mentha pulegium (84.09%) for digestive problems. The highest ICF corresponded to metabolism and depression (ICF = 1), pain (ICF = 0.97), insomnia (ICF = 0.96) and anxiety (ICF = 0.95). Participants mostly acquired herbal medicines from pharmacies, herbal shops and supermarkets. Some side effects (tachycardia, dizziness and gastrointestinal symptoms) and potential interactions medicinal plants-drugs (V. officinalis and benzodiazepines) were reported. CONCLUSION: Many inhabitants of the Autonomous Community of Madrid currently use herbal products to treat minor health problems. The most common consumer pattern are young women between 18 and 44 years of age with higher education. In order to confirm the pattern, further research should be focused to investigate current uses of medicinal plants in other Spanish regions.

Cross-reactivity between Parietaria judaica and Parietaria officinalis in immunotherapy extracts for the treatment of allergy to Parietaria.

Parietaria judaica and P. officinalis are the two most common subspecies of the Parietaria genus. P. judaica and P. officinalis have exhibited cross-reactivity in previous studies. P. judaica pollen is the main cause of allergy in the Mediterranean area. It has been shown that a high percentage of patients sensitized to P. judaica with allergic rhinitis (AR) have an increased risk of developing asthma. The present study aimed to confirm the cross-reactivity between P. judaica and P. officinalis and to evaluate the use of a single P. officinalis extract in patients allergic to both subspecies as a preferable option for the diagnosis and treatment of allergy in a highly pollinated area of the Spanish Mediterranean coast. The present study was a single centre, observational cross-sectional study of adult patients diagnosed with AR and/or bronchial asthma who were sensitized to Parietaria pollen. A total of 24 patients were enrolled in the study and included in the analysis. Allergovit® immunotherapy extracts were selected for the study based on the protein content (P. officinalis pollen extract). The results of an in vitro ELISA revealed that 79.1% (n=19) of the patient sera were reactive to immunotherapy extracts. ELISA inhibition assay of the IgE binding to P. officinalis demonstrated inhibition values >70% in the sera of highly reactive patients, confirming the cross-reactivity between the two Parietaria subspecies. In addition, all patients enrolled in the study exhibited double skin positivity against P. judaica and P. officinalis extracts, as assessed by the skin prick test, further supporting the in vivo reactivity between the two subspecies. The present study demonstrated that P. judaica and P. officinalis pollen extracts were highly cross-reactive, and that a unique P. officinalis pollen extract may be used for the diagnosis and immunotherapy of patients allergic to Parietaria.

The Pharmacological Activity of Camellia sinensis ( L. ) Kuntze on Metabolic and Endocrine Disorders: A Systematic Review.

Tea made from Camellia sinensis leaves is one of the most consumed beverages worldwide. This systematic review aims to update Camellia sinensis pharmacological activity on metabolic and endocrine disorders. Inclusion criteria were preclinical and clinical studies of tea extracts and isolated compounds on osteoporosis, hypertension, diabetes, metabolic syndrome, hypercholesterolemia, and obesity written in English between 2014 and 2019 and published in Pubmed, Science Direct, and Scopus. From a total of 1384 studies, 80 reports met inclusion criteria. Most papers were published in 2015 (29.3%) and 2017 (20.6%), conducted in China (28.75%), US (12.5%), and South Korea (10%) and carried out with extracts (67.5%, especially green tea) and isolated compounds (41.25%, especially epigallocatechin gallate). Most pharmacological studies were in vitro and in vivo studies focused on diabetes and obesity. Clinical trials, although they have demonstrated promising results, are very limited. Future research should be aimed at providing more clinical evidence on less studied pathologies such as osteoporosis, hypertension, and metabolic syndrome. Given the close relationship among all endocrine disorders, it would be of interest to find a standard dose of tea or their bioactive constituents that would be beneficial for all of them.

Evolution of the ASF Infection Stage in Wild Boar Within the EU (2014-2018).

African swine fever (ASF) is one of the most important emerging transboundary diseases of pigs, causing trade restrictions, and a health impact on susceptible pigs. Nine countries in the continental European Union (Estonia, Lithuania, Latvia, Poland, Czech Republic, Bulgaria, Belgium, Romania, and Hungary) have been affected by ASF from 2014 to 2018 and it keeps spreading despite the efforts to control it. For a number of years, we have witnessed high case-fatality rates in wild boar found dead particularly in new infected areas, which is typical of the peracute and acute forms of the infection at the beginning of an ASF epidemic. Experimental evidence with currently circulating strains indicates that some infected animals can remain asymptomatic and might even survive the infection. An increased presence of virus of moderate virulence can complicate ASF diagnosis as well as the mitigation and control of the disease. We analyze the ASF surveillance data in wild boar in the four EU countries where ASF has been present for longer, comparing the spatial density of antibody positive notifications with the time ASF has been present per region. Results indicate an increasing annual distribution of notifications based on antibodies over nucleic acid detection in hunted wild boar in Estonia, Latvia and Poland. Potentially, Lithuania, and Poland seem to have experienced more acute forms in 2017 and 2018 than Latvia and Estonia. Overall there was a positive statistical correlation between time with infection (TWI) and antibody positive density, with some variations in certain regions, particularly of Lithuania and Estonia. The increasing trend in potential survivors (hunted wild boar with confirmed PCR negative and antibody positive results) enhances the importance of surveillance design to sample and test shot wild boar. In conclusion, surveillance data based on ASFV detection by PCR and serology can be used to assess the status of the epidemic in wild boar.

Pharmacological Update Properties of Aloe Vera and its Major Active Constituents.

Aloe vera has been traditionally used to treat skin injuries (burns, cuts, insect bites, and eczemas) and digestive problems because its anti-inflammatory, antimicrobial, and wound healing properties. Research on this medicinal plant has been aimed at validating traditional uses and deepening the mechanism of action, identifying the compounds responsible for these activities. The most investigated active compounds are aloe-emodin, aloin, aloesin, emodin, and acemannan. Likewise, new actions have been investigated for Aloe vera and its active compounds. This review provides an overview of current pharmacological studies (in vitro, in vivo, and clinical trials), written in English during the last six years (2014-2019). In particular, new pharmacological data research has shown that most studies refer to anti-cancer action, skin and digestive protective activity, and antimicrobial properties. Most recent works are in vitro and in vivo. Clinical trials have been conducted just with Aloe vera, but not with isolated compounds; therefore, it would be interesting to study the clinical effect of relevant metabolites in different human conditions and pathologies. The promising results of these studies in basic research encourage a greater number of clinical trials to test the clinical application of Aloe vera and its main compounds, particularly on bone protection, cancer, and diabetes.

Comparative Study of Different Classification Models in Renal-Cell Carcinoma.

The aim of this study was to compare the Memorial Sloan-Kettering Cancer Center (MSKCC) and the Cleveland Clinic Foundation (CCF) models of classification of aRCC patients. In addition, the model developed from the pivotal trial of temsirolimus and those proposed by Motzer et al. in 2004, Escudier et al., Heng et al., Choueiri et al. and Bamias et al. were examined. An observational, retrospective study of patients starting first-line systemic therapy was conducted between 2008 and 2011. The variables used to evaluate the classification models were median overall survival (mOS) and median progression-free survival (mPFS). The comparison of different classification models was performed by comparing the area under the ROC (Receiver Operating Characteristic) curve (AUC) for time-dependent variables proposed by Heagerty. Eighty-eight patients were included. When the different models were compared, it was found that although based on the mOS, the Escudier model had better short-term (1-year) prognostic value, followed by the Heng model; in the long term, the models that presented a higher prognosis capacity were the Hudes and CCF models, closely followed by the Heng model. In addition, the Heng model had a slightly higher predictive ability than the other models. Based on the results, and in line with the European society for medical oncology (ESMO) guidelines, it appears that the model of Heng could be the best model to classify patients with aRCC and combines good short- and long-term prognostics while possessing better predictive ability and a more equal distribution of patients.