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BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leaks occur when there is a tear in the dura mater. Spontaneous CSF leaks are rare, and often associated with conditions like intracranial hypertension, connective tissue disorders, or congenital defects in the dura mater. CASE REPORT: The patient was a 66-year-old woman who presented to the Emergency Department with clear, positional nasal discharge from her left nostril for 1 week. She had a history of chronic headaches, which seemed to have been relieved around the time of onset of her rhinorrhea. Diagnostic imaging, including computed tomography and magnetic resonance imaging scans, confirmed the presence of a CSF leak and a left temporal meningoencephalocele. The patient subsequently underwent surgical repair of the leak and ventriculoperitoneal shunt placement, and was discharged home in stable condition. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early detection of CSF leaks require a thorough history and physical examination, and is crucial in preventing potentially life-threatening complications such as meningitis and intracranial abscesses.
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Rinorrea de Líquido Cefalorraquídeo , Hipertensión Intracraneal , Seudotumor Cerebral , Femenino , Humanos , Anciano , Seudotumor Cerebral/complicaciones , Seudotumor Cerebral/diagnóstico , Seudotumor Cerebral/cirugía , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/cirugía , Rinorrea de Líquido Cefalorraquídeo/diagnóstico , Pérdida de Líquido Cefalorraquídeo/diagnóstico , Pérdida de Líquido Cefalorraquídeo/etiología , Hipertensión Intracraneal/diagnóstico , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
Mitchell-Riley syndrome (MRS) is caused by recessive mutations in the regulatory factor X6 gene (RFX6) and is characterised by pancreatic hypoplasia and neonatal diabetes. To determine why individuals with MRS specifically lack pancreatic endocrine cells, we micro-CT imaged a 12-week-old foetus homozygous for the nonsense mutation RFX6 c.1129C>T, which revealed loss of the pancreas body and tail. From this foetus, we derived iPSCs and show that differentiation of these cells in vitro proceeds normally until generation of pancreatic endoderm, which is significantly reduced. We additionally generated an RFX6HA reporter allele by gene targeting in wild-type H9 cells to precisely define RFX6 expression and in parallel performed in situ hybridisation for RFX6 in the dorsal pancreatic bud of a Carnegie stage 14 human embryo. Both in vitro and in vivo, we find that RFX6 specifically labels a subset of PDX1-expressing pancreatic endoderm. In summary, RFX6 is essential for efficient differentiation of pancreatic endoderm, and its absence in individuals with MRS specifically impairs formation of endocrine cells of the pancreas head and tail.
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Diferenciación Celular , Diabetes Mellitus/genética , Diabetes Mellitus/patología , Endodermo/embriología , Enfermedades de la Vesícula Biliar/genética , Enfermedades de la Vesícula Biliar/patología , Células Madre Pluripotentes Inducidas/patología , Atresia Intestinal/genética , Atresia Intestinal/patología , Mutación/genética , Páncreas/embriología , Factores de Transcripción del Factor Regulador X/genética , Alelos , Secuencia de Bases , Diferenciación Celular/genética , Cromatina/metabolismo , Consanguinidad , Diabetes Mellitus/diagnóstico por imagen , Embrión de Mamíferos/metabolismo , Desarrollo Embrionario , Familia , Femenino , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Genoma Humano , Humanos , Células Madre Pluripotentes Inducidas/metabolismo , Atresia Intestinal/diagnóstico por imagen , Masculino , Linaje , Transcripción Genética , Transcriptoma/genética , Microtomografía por Rayos XRESUMEN
Refugee and immigrant populations are extremely vulnerable to the consequences of the COVID-19 pandemic. COVID-19 vaccination is a critical tool in mitigating these consequences, but these same communities often lack access to COVID-19 vaccines. We describe the efforts of a community-based primary care clinic in Clarkston, Georgia to provide access to COVID-19 vaccines in a culturally sensitive manner to address this health disparity and vaccine hesitancy.
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Vacunas contra la COVID-19/provisión & distribución , COVID-19/prevención & control , Emigrantes e Inmigrantes , Programas de Inmunización/organización & administración , Refugiados , COVID-19/etnología , Competencia Cultural , Georgia/epidemiología , Humanos , Pandemias , SARS-CoV-2 , ConfianzaRESUMEN
Improving our understanding of mammalian pancreas development is crucial for the development of more effective cellular therapies for diabetes. Most of what we know about mammalian pancreas development stems from mouse genetics. We have learnt that a unique set of transcription factors controls endocrine and exocrine cell differentiation. Transgenic mouse models have been instrumental in studying the function of these transcription factors. Mouse and human pancreas development are very similar in many respects, but the devil is in the detail. To unravel human pancreas development in greater detail, in vitro cellular models (including directed differentiation of stem cells, human beta cell lines and human pancreatic organoids) are used; however, in vivo validation of these results is still needed. The current best 'model' for studying human pancreas development are individuals with monogenic forms of diabetes. In this review, we discuss mammalian pancreas development, highlight some discrepancies between mouse and human, and discuss selected transcription factors that, when mutated, cause permanent neonatal diabetes. Graphical abstract.
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Regulación del Desarrollo de la Expresión Génica/genética , Páncreas/embriología , Factores de Transcripción/genética , Animales , Línea Celular , Diabetes Mellitus/genética , Humanos , Técnicas In Vitro , Células Secretoras de Insulina , Ratones , Organoides , Páncreas/metabolismo , Células Madre PluripotentesRESUMEN
Plasma exchange is a highly efficient technique to remove circulating autoantibodies and other humoral factors rapidly from the vascular compartment. It was the first effective acute treatment for peripheral disorders such as Guillain-Barré syndrome and myasthenia gravis before intravenous immunoglobulin became available. The recent recognition of rapidly progressive severe antibody-mediated central nervous system disorders, such as neuromyelitis optica spectrum disorders and anti-N-methyl-D-aspartate-receptor encephalitis, has renewed interest in using plasma exchange for their acute treatment also. In this review we explain the principles and technical aspects of plasma exchange, review its current indications, and discuss the implications for its provision in the UK.
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Autoanticuerpos/sangre , Enfermedades del Sistema Nervioso/sangre , Enfermedades del Sistema Nervioso/terapia , Intercambio Plasmático/métodos , Autoanticuerpos/inmunología , Humanos , Enfermedades del Sistema Nervioso/inmunología , Intercambio Plasmático/instrumentación , Intercambio Plasmático/tendenciasRESUMEN
Ixodid ticks are acknowledged as one of the most important hematophagous arthropods because of their ability in transmitting a variety of tick-borne diseases. Mathematical models have been developed, based on emerging knowledge about tick ecology, pathogen epidemiology and their interface, to understand tick population dynamics and tick-borne diseases spread patterns. However, no serious effort has been made to model and assess the impact of host immunity triggered by tick feeding on the distribution of the tick population according to tick stages and on tick population extinction and persistence. Here, we construct a novel mathematical model taking into account the effect of host immunity status on tick population dynamics, and analyze the long-term behaviours of the model solutions. Two threshold values, [Formula: see text] and [Formula: see text], are introduced to measure the reproduction ratios for the tick-host interaction in the absence and presence of host immunity. We then show that these two thresholds (sometimes under additional conditions) can be used to predict whether the tick population goes extinct ([Formula: see text]) and the tick population grows without bound ([Formula: see text]). We also prove tick permanence (persistence and boundedness of the tick population) and the existence of a tick persistence equilibrium if [Formula: see text]. As the host species adjust their immunity to tick infestation levels, they form for the tick population an environment with a carrying capacity very much like that in logistic growth. Numerical results show that the host immune reactions decrease the size of the tick population at equilibrium and apparently reduce the tick-borne infection risk.
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Vectores Arácnidos/inmunología , Interacciones Huésped-Patógeno/inmunología , Modelos Inmunológicos , Enfermedades por Picaduras de Garrapatas/inmunología , Enfermedades por Picaduras de Garrapatas/transmisión , Garrapatas/inmunología , Animales , Vectores Arácnidos/patogenicidad , Humanos , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/parasitología , Enfermedad de Lyme/transmisión , Conceptos Matemáticos , Dinámica Poblacional , Infestaciones por Garrapatas/inmunología , Infestaciones por Garrapatas/parasitología , Enfermedades por Picaduras de Garrapatas/parasitología , Garrapatas/crecimiento & desarrollo , Garrapatas/patogenicidadAsunto(s)
Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Manejo de Especímenes/métodos , Betacoronavirus , COVID-19 , Prueba de COVID-19 , Personal de Salud , Humanos , Nasofaringe/virología , Nariz/virología , Pandemias , Pacientes , SARS-CoV-2 , Sensibilidad y Especificidad , Lengua/virología , Cornetes Nasales/virologíaRESUMEN
A wealth of data and comprehensive reviews exist on pancreas development in mammals, primarily mice, and other vertebrates. By contrast, human pancreatic development has been less comprehensively reviewed. Here, we draw together those studies conducted directly in human embryonic and fetal tissue to provide an overview of what is known about human pancreatic development. We discuss the relevance of this work to manufacturing insulin-secreting ß-cells from pluripotent stem cells and to different aspects of diabetes, especially permanent neonatal diabetes, and its underlying causes.
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Diferenciación Celular/fisiología , Regulación del Desarrollo de la Expresión Génica/fisiología , Células Secretoras de Insulina/citología , Morfogénesis/fisiología , Páncreas/embriología , Páncreas/crecimiento & desarrollo , Células Madre Pluripotentes/fisiología , Regulación del Desarrollo de la Expresión Génica/genética , Humanos , Especificidad de la EspecieRESUMEN
Urinary bladder malformations associated with bladder outlet obstruction are a frequent cause of progressive renal failure in children. We here describe a muscarinic acetylcholine receptor M3 (CHRM3) (1q41-q44) homozygous frameshift mutation in familial congenital bladder malformation associated with a prune-belly-like syndrome, defining an isolated gene defect underlying this sometimes devastating disease. CHRM3 encodes the M3 muscarinic acetylcholine receptor, which we show is present in developing renal epithelia and bladder muscle. These observations may imply that M3 has a role beyond its known contribution to detrusor contractions. This Mendelian disease caused by a muscarinic acetylcholine receptor mutation strikingly phenocopies Chrm3 null mutant mice.
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Errores Innatos del Metabolismo/genética , Síndrome del Abdomen en Ciruela Pasa/genética , Receptor Muscarínico M3 , Vejiga Urinaria , Animales , Secuencia de Bases , Consanguinidad , Femenino , Mutación del Sistema de Lectura/genética , Humanos , Mutación INDEL/genética , Inmunohistoquímica , Masculino , Ratones , Ratones Noqueados , Modelos Moleculares , Síndrome del Abdomen en Ciruela Pasa/patología , Receptor Muscarínico M3/deficiencia , Receptor Muscarínico M3/genética , Homología de Secuencia de Ácido Nucleico , Factores Sexuales , Vejiga Urinaria/embriología , Vejiga Urinaria/patología , Obstrucción del Cuello de la Vejiga Urinaria/genética , Obstrucción del Cuello de la Vejiga Urinaria/patologíaRESUMEN
Islet transplantation (IT) offers the potential to restore euglycemia for patients with type 1 diabetes mellitus (T1DM). Despite improvements in islet isolation techniques and immunosuppressive regimes, outcomes remain suboptimal with UK five-year graft survivals (5YGS) of 55% and most patients still requiring exogenous insulin after multiple islet infusions. Native islets have a significant non-endocrine component with dense extra-cellular matrix (ECM), important for islet development, cell survival and function. Collagenase isolation necessarily disrupts this complex islet microenvironment, leaving islets devoid of a supporting framework and increasing vulnerability of transplanted islets. Following portal venous transplantation, a liver injury response is potentially induced, which typically results in inflammation and ECM deposition from liver specific myofibroblasts. The impact of this response may have important impact on islet survival and function. A fibroblast response and ECM deposition at the kidney capsule and eye chamber alongside other implantation sites have been shown to be beneficial for survival and function. Investigating the implantation site microenvironment and the interactions of transplanted islets with ECM proteins may reveal therapeutic interventions to improve IT and stem-cell derived beta-cell therapy.
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Diabetes Mellitus Tipo 1 , Humanos , Supervivencia Celular , Diabetes Mellitus Tipo 1/cirugía , Matriz Extracelular , Proteínas de la Matriz Extracelular , FibroblastosRESUMEN
Cell proliferation is fundamental for almost all stages of development and differentiation that require an increase in cell number. Although cell cycle phase has been associated with differentiation, the actual process of proliferation has not been considered as having a specific role. Here we exploit human embryonic stem cell-derived endodermal progenitors that we find are an in vitro model for the ventral foregut. These cells exhibit expansion-dependent increases in differentiation efficiency to pancreatic progenitors that are linked to organ-specific enhancer priming at the level of chromatin accessibility and the decommissioning of lineage-inappropriate enhancers. Our findings suggest that cell proliferation in embryonic development is about more than tissue expansion; it is required to ensure equilibration of gene regulatory networks allowing cells to become primed for future differentiation. Expansion of lineage-specific intermediates may therefore be an important step in achieving high-fidelity in vitro differentiation.
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Cromatina , Páncreas , Humanos , Linaje de la Célula/genética , Diferenciación Celular/genética , Cromatina/genética , Cromatina/metabolismo , Páncreas/metabolismo , Elementos de Facilitación Genéticos/genéticaRESUMEN
Identifying genes linked to extreme phenotypes in humans has the potential to highlight biological processes not shared with all other mammals. Here, we report the identification of homozygous loss-of-function variants in the primate-specific gene ZNF808 as a cause of pancreatic agenesis. ZNF808 is a member of the KRAB zinc finger protein family, a large and rapidly evolving group of epigenetic silencers which target transposable elements. We show that loss of ZNF808 in vitro results in aberrant activation of regulatory potential contained in the primate-specific transposable elements it represses during early pancreas development. This leads to inappropriate specification of cell fate with induction of genes associated with liver identity. Our results highlight the essential role of ZNF808 in pancreatic development in humans and the contribution of primate-specific regions of the human genome to congenital developmental disease.
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Anomalías Congénitas , Elementos Transponibles de ADN , Proteínas de Unión al ADN , Páncreas , Animales , Humanos , Diferenciación Celular , Genoma Humano , Primates/anomalías , Primates/genética , Proteínas de Unión al ADN/genética , Anomalías Congénitas/genética , Páncreas/anomalíasRESUMEN
From the beginning of the COVID-19 pandemic, researchers assessed the impact of the disease in terms of loss of life, medical load, economic damage, and other key metrics of resiliency and consequence mitigation; these studies sought to parametrize the critical components of a disease transmission model and the resulting analyses were informative but often lacked critical parameters or a discussion of parameter sensitivities. Using SARS-CoV-2 as a case study, we present a robust modeling framework that considers disease transmissibility from the source through transport and dispersion and infectivity. The framework is designed to work across a range of particle sizes and estimate the generation rate, environmental fate, deposited dose, and infection, allowing for end-to-end analysis that can be transitioned to individual and population health models. In this paper, we perform sensitivity analysis on the model framework to demonstrate how it can be used to advance and prioritize research efforts by highlighting critical parameters for further analyses.
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COVID-19 , SARS-CoV-2 , Humanos , PandemiasRESUMEN
BACKGROUND: Posterior urethral valves (PUVs) and ureteropelvic junction obstruction (UPJO) are congenital obstructive uropathies that may impair kidney development. OBJECTIVE: To identify genetic variants associated with kidney injury in patients with obstructive uropathy. DESIGN SETTING AND PARTICIPANTS: We included 487 patients born in 1981 or later who underwent pyeloplasty or valve resection before 18 yr of age in the discovery phase, 102 PUV patients in a first replication phase, and 102 in a second replication phase. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Signs of kidney injury were defined as dialysis, nephrectomy, kidney transplantation, estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, high blood pressure, antihypertensive medication use, proteinuria, and/or one kidney functioning at <45%. We used χ2 tests to calculate p values and odds ratios for >600 000 single-nucleotide polymorphisms (SNPs) in the discovery sample comparing patients with and without signs of kidney injury within 5 yr after surgery. We performed stratified analyses for PUV and UPJO and Kaplan-Meier and Cox regression analyses in the discovery and two replication samples for the associated SNPs, and RNA and protein expression analyses for the associated gene in fetal tissues. RESULTS AND LIMITATIONS: Despite the small and nonhomogeneous sample, we observed suggestive associations for six SNPs in three loci, of which rs6874819 in the CDH12 gene was the most clear (p = 7.5 × 10-7). This SNP also seemed to be associated with time to kidney injury in the PUV discovery and replication samples. RNA expression analyses showed clear CDH12 expression in fetal kidneys, which was confirmed by protein immunolocalization. CONCLUSIONS: This study identified CDH12 as a candidate gene for kidney injury in PUV. PATIENT SUMMARY: We found that variants of the CDH12 gene increase the risk of kidney injury in patients with extra flaps of tissue in the urethra (posterior urethral valves). This is the first report on this gene in this context. Our study provides interesting new information about the pathways involved and important leads for further research for this condition.
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BACKGROUND: Multidetector computed tomography is vital in preoperative sizing for transcatheter aortic valve replacement. The purpose of this study is to determine whether preoperative transcatheter aortic valve replacement multidetector computed tomography accurately predicts surgical aortic valve prosthesis size. METHODS: Between July 2012 and July 2017, 102 patients who underwent surgical aortic valve replacement had preoperative aortic valve sizing by multidetector computed tomography. The aortic annulus diameter calculated using multidetector computed tomography was compared with intraoperative valve sizing during surgical aortic valve replacement. RESULTS: Forty-one (40.2%) of the 102 patients studied had multidetector computed tomography aortic valve measurements that were accurate. Implanted valves were smaller than multidetector computed tomography calculation in 40 patients (39.2%) and were larger in 21 patients (20.6%). Multidetector computed tomography measurements remained inconsistent with intraoperative sizing regardless of aortic annulus diameter. The variance between multidetector computed tomography annulus measurements and intraoperative sizing was statistically significant. CONCLUSIONS: Preoperative aortic annulus measurements by our institutional transcatheter aortic valve replacement multidetector computed tomography protocol differed substantially from surgical implant size. There was no trend toward over nor under sizing for the entire cohort. However, patients with large measured annulus diameter were more likely to have a smaller valve implanted than predicted, and patients with small measured annulus diameter were more likely to have a larger valve implanted than predicted. These results may affect preoperative planning for patients undergoing aortic valve replacement.
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Válvula Aórtica , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Prótesis Valvulares Cardíacas , Tomografía Computarizada Multidetector/estadística & datos numéricos , Anciano , Bioprótesis , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Both polyester and foam nasal swabs were collected from convalescent COVID-19 patients at a single visit and stored in viral transport media (VTM), saline or dry. Sensitivity of each swab material and media combination were estimated, three by three tables were constructed to measure polyester and foam concordance, and cycle threshold (Ct) values were compared. 126 visits had polyester and foam swabs stored in viral transport media (VTM), 51 had swabs stored in saline, and 63 had a foam swab in VTM and a polyester swab stored in a dry tube. Polyester and foam swabs had an estimated sensitivity of 87.3% and 94.5% respectively in VTM, 87.5% and 93.8% respectively in saline, and 75.0% and 90.6% respectively for dry polyester and foam VTM. Polyester and foam Ct values were correlated, but polyester showed decreased performance for cases with a viral load near the detection threshold and higher Ct values on average.
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Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Convalecencia , Infecciones por Coronavirus/virología , Cavidad Nasal/virología , Pandemias , Neumonía Viral/virología , Poliésteres , Poliuretanos , Manejo de Especímenes/instrumentación , Adulto , Betacoronavirus/genética , COVID-19 , Prueba de COVID-19 , Infecciones por Coronavirus/diagnóstico , Medios de Cultivo , Equipos Desechables/provisión & distribución , Femenino , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , ARN Viral/análisis , Distribución Aleatoria , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , SARS-CoV-2 , Solución Salina , Sensibilidad y Especificidad , Manejo de Especímenes/métodos , Carga ViralRESUMEN
How the genome activates or silences transcriptional programmes governs organ formation. Little is known in human embryos undermining our ability to benchmark the fidelity of stem cell differentiation or cell programming, or interpret the pathogenicity of noncoding variation. Here, we study histone modifications across thirteen tissues during human organogenesis. We integrate the data with transcription to build an overview of how the human genome differentially regulates alternative organ fates including by repression. Promoters from nearly 20,000 genes partition into discrete states. Key developmental gene sets are actively repressed outside of the appropriate organ without obvious bivalency. Candidate enhancers, functional in zebrafish, allow imputation of tissue-specific and shared patterns of transcription factor binding. Overlaying more than 700 noncoding mutations from patients with developmental disorders allows correlation to unanticipated target genes. Taken together, the data provide a comprehensive genomic framework for investigating normal and abnormal human development.
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Discapacidades del Desarrollo/genética , Epigénesis Genética , Organogénesis/genética , Animales , Animales Modificados Genéticamente , Bases de Datos Genéticas , Elementos de Facilitación Genéticos , Regulación del Desarrollo de la Expresión Génica , Código de Histonas/genética , Humanos , Modelos Genéticos , Mutación , Organogénesis/fisiología , Regiones Promotoras Genéticas , Distribución Tisular , Factores de Transcripción/metabolismo , Pez Cebra/embriología , Pez Cebra/genéticaRESUMEN
Detection of pathogens in food processing facilities by routine environmental monitoring (EM) is essential to reduce the risk of foodborne illness but is complicated by the complexity of equipment and environment surfaces. To optimize design of EM programs, we developed EnABLe ("Environmental monitoring with an Agent-Based Model of Listeria"), a detailed and customizable agent-based simulation of a built environment. EnABLe is presented here in a model system, tracing Listeria spp. (LS) (an indicator for conditions that allow the presence of the foodborne pathogen Listeria monocytogenes) on equipment and environment surfaces in a cold-smoked salmon facility. EnABLe was parameterized by existing literature and expert elicitation and validated with historical data. Simulations revealed different contamination dynamics and risks among equipment surfaces in terms of the presence, level and persistence of LS. Grouping of surfaces by their LS contamination dynamics identified connectivity and sanitary design as predictors of contamination, indicating that these features should be considered in the design of EM programs to detect LS. The EnABLe modeling approach is particularly timely for the frozen food industry, seeking science-based recommendations for EM, and may also be relevant to other complex environments where pathogen contamination presents risks for direct or indirect human exposure.
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Contaminación de Alimentos/prevención & control , Manipulación de Alimentos , Microbiología de Alimentos , Listeria monocytogenes/crecimiento & desarrollo , Modelos Biológicos , HumanosRESUMEN
The observed diversity of dinosaurs reached its highest peak during the mid- and Late Cretaceous, the 50 Myr that preceded their extinction, and yet this explosion of dinosaur diversity may be explained largely by sampling bias. It has long been debated whether dinosaurs were part of the Cretaceous Terrestrial Revolution (KTR), from 125-80 Myr ago, when flowering plants, herbivorous and social insects, squamates, birds and mammals all underwent a rapid expansion. Although an apparent explosion of dinosaur diversity occurred in the mid-Cretaceous, coinciding with the emergence of new groups (e.g. neoceratopsians, ankylosaurid ankylosaurs, hadrosaurids and pachycephalosaurs), results from the first quantitative study of diversification applied to a new supertree of dinosaurs show that this apparent burst in dinosaurian diversity in the last 18 Myr of the Cretaceous is a sampling artefact. Indeed, major diversification shifts occurred largely in the first one-third of the group's history. Despite the appearance of new clades of medium to large herbivores and carnivores later in dinosaur history, these new originations do not correspond to significant diversification shifts. Instead, the overall geometry of the Cretaceous part of the dinosaur tree does not depart from the null hypothesis of an equal rates model of lineage branching. Furthermore, we conclude that dinosaurs did not experience a progressive decline at the end of the Cretaceous, nor was their evolution driven directly by the KTR.
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Dinosaurios , Ecosistema , Extinción Biológica , Modelos Genéticos , Filogenia , Animales , Historia Antigua , Especificidad de la EspecieRESUMEN
Background: Endometriosis is a multifactorial benign disorder characterized by the abnormal presence of endometrial tissue in an extraendometrial site. Although extrapelvic endometriosis is uncommon, symptomatic involvement of the kidney is exceedingly rare. This benign disease can mimic several urologic processes, but because of its scarcity in clinical practice, it is seldom considered in the differential. Case Presentation: In this report, we describe the case of a 45-year-old woman with flank pain and hematuria, who was found to have a left renal mass on cross-sectional imaging. After robotic partial nephrectomy, pathologic analysis revealed an endometrial implant within the renal parenchyma. Conclusion: This case of renal endometriosis highlights how this benign disease process can mimic several more sinister urologic processes.