Telomerase Reverse Transcriptase-Promoter Mutation in Young Patients with Bladder Tumors.

The TERT (Telomerase Reverse Transcriptase) gene promoter mutation is one of the most prevalent mutations in urothelial bladder tumors and this mutation is related to bladder tumor progression. Our purpose was to evaluate the presence of this mutation in a population of patients who were first diagnosed at age ≤ 40 years and to examine its relationship with tumor characteristics and progression. A molecular study was performed to detect the two most prevalent mutations in the TERT promoter (C228T and C250T). The study included 29 patients, with a mean follow-up of 152 months. There were no statistically significant differences in the clinical or tumor characteristics according to the presence or absence of the mutation. Although the mutation group showed poorer recurrence-free survival (RFS), there was no statistically significant difference and there was no difference in progression-free survival by group (p > 0.05). The pTERT mutations in bladder tumor cells occurred less frequently in younger patients than in older patients, a finding that could indicate different mechanisms of carcinogenesis. The trend towards lower RFS in patients with mutated pTERT needs to be confirmed by further studies, given the small number of patients included in these studies due to the low incidence of bladder tumors in this age group.

ABO Blood System and COVID-19 Susceptibility: Anti-A and Anti-B Antibodies Are the Key Points.

The implication of the ABO blood group in COVID-19 disease was formulated early, at the beginning of the COVID-19 pandemic more than 2 years ago. It has now been established that the A blood group is associated with more susceptibility and severe symptoms of COVID-19, while the O blood group shows protection against viral infection. In this review, we summarize the underlying pathophysiology of ABO blood groups and COVID-19 to explain the molecular aspects behind the protective mechanism in the O blood group. A or B antigens are not associated with a different risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than that of other antigens. In this case, the cornerstone is natural anti-A and anti-B antibodies from the ABO system. They are capable of interfering with the S protein (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2; host cell receptor), thereby conferring protection to patients with sufficient antibodies (O blood group). Indeed, the titers of natural antibodies and the IgG isotype (specific to the O blood group) may be determinants of susceptibility and severity. Moreover, older adults are associated with a higher risk of bad outcomes due to the lack of antibodies and the upregulation of ACE2 expression during senescence. A better understanding of the role of the molecular mechanism of ABO blood groups in COVID-19 facilitates better prognostic stratification of the disease. Furthermore, it could represent an opportunity for new therapeutic strategies.

[Mucinous tubular and spindle cell renal cell carcinoma: two novel cases and a literature review.] / Carcinoma mucinoso tubular y de células fusiformes renal: aportación de 2 nuevos casos y revisión de la literatura.

INTRODUCTION: Mucinous tubularand spindle cell carcinomas (MTSC) are a relativelyrare subtype of renal cell carcinoma (RCC) . Thesetumors are composed by tubular and spindle cellareas within a mucinous stroma. They are generallylow-grade nuclei tumors and limited to the kidney, sothey usually have a favorable prognosis. We report twonew cases of MTSC treated at our institution. MATERIALS AND METHODS: We reviewed therenal tumors surgery database of our hospital from2008 to 2019, selecting patients diagnosed with CMTF.We evaluated clinicopathological data and evolution ofthe patients. We also reviewed the published literatureto compare it with our findings. RESULTS: Two patients were included in the study,a 50-year-old male (case 1) and a 55-year-old female(case 2). The diagnosis was made by ultrasound asan incidental fi nding in case 1 and during the studyof fl ank pain in case 2. Treatment was surgical withpartial and radical nephrectomy respectively. After amean follow-up of 70 months, both patients are aliveand disease-free. CONCLUSION: Mucinous tubular and spindle cellcarcinomas (MTSC) is a rare renal tumor, approximatelytwo hundred cases have been published. Thereare questions yet to be answered about their diagnosisand behaviour so it is of utmost importance to reportnew cases in order to increase our knowledge and improvepatient care.

INTRODUCCIÓN: Los carcinomasmucinosos tubulares y de células fusiformes (CMTF)son un subtipo relativamente infrecuente de carcinomarenal (CCR). Están compuestos por célulastubulares y fusiformes con un estroma mucinoso.Generalmente son tumores de bajo grado y estánlimitados al riñón, por lo que habitualmente tienenbuen pronóstico. Reportamos dos nuevos casos deCMTF tratados en nuestra institución. MATERIAL Y MÉTODOS: Se realizó una revisiónde todos los tumores renales intervenidos en nuestrohospital desde el año 2008 has ta el año 2019, seleccionandolos pacientes diagnosticados de CMTF.Se evaluaron las características clinicopatológicasy la evolución de los pacientes. Así mismo, se realizóuna revisión exhaustiva de la literatura publicadapara comparar los hallazgos descritos con los denuestros casos. RESULTADOS: Dos pacientes fueron incluidos enel estudio, un varón de 50 años ( caso 1) y una mujer de55 años ( caso 2). El diagnóstico fue ecográfico, de forma incidental en el caso 1 y a partir del estudio de undolor en flanco, en el caso 2. El tratamiento fue quirúrgicomediante nefrectomía parcial y radical respectivamente.Tras un seguimiento medio de 70 meses ambospacientes están vivos y libres de enfermedad. CONCLUSIÓN: El carcinoma mucinoso tubular yde células fusiformes (CMTF) es un tumor renal infrecuente,habiéndose publicado aproximadamente doscentenares de casos. Aún hay incógnitas que resolversobre su diagnóstico y comportamiento, de ahí la importanciade reportar nuevos casos que nos permitanaumentar su conocimiento y mejorar el manejo denuestros pacientes.

Carcinoma mucinoso tubular y de células fusiformes renal: aportación de 2 nuevos casos y revisión de la literatura / Mucinous tubular and renal spindle cell carcinoma: contribution of 2 new cases and review of the literature

INTRODUCCIÓN: Los carcinomasmucinosos tubulares y de células fusiformes (CMTF)son un subtipo relativamente infrecuente de carcinoma renal (CCR). Están compuestos por célulastubulares y fusiformes con un estroma mucinoso.Generalmente son tumores de bajo grado y estánlimitados al riñón, por lo que habitualmente tienenbuen pronóstico. Reportamos dos nuevos casos deCMTF tratados en nuestra institución.MATERIAL Y MÉTODOS: Se realizó una revisiónde todos los tumores renales intervenidos en nuestro hospital desde el año 2008 hasta el año 2019, seleccionando los pacientes diagnosticados de CMTF.Se evaluaron las características clinicopatológicasy la evolución de los pacientes. Así mismo, se realizó una revisión exhaustiva de la literatura publicada para comparar los hallazgos descritos con los denuestros casos.RESULTADOS: Dos pacientes fueron incluidos enel estudio, un varón de 50 años ( caso 1) y una mujer de55 años ( caso 2). El diagnóstico fue ecográfico, de forma incidental en el caso 1 y a partir del estudio de undolor en flanco, en el caso 2. El tratamiento fue quirúrgico mediante nefrectomía parcial y radical respectivamente. Tras un seguimiento medio de 70 meses ambos pacientes están vivos y libres de enfermedad.CONCLUSIÓN: El carcinoma mucinoso tubular yde células fusiformes (CMTF) es un tumor renal infrecuente, habiéndose publicado aproximadamente doscentenares de casos. Aún hay incógnitas que resolversobre su diagnóstico y comportamiento, de ahí la importancia de reportar nuevos casos que nos permitanaumentar su conocimiento y mejorar el manejo denuestros pacientes.

INTRODUCTION: Mucinous tubularand spindle cell carcinomas (MTSC) are a relativelyrare subtype of renal cell carcinoma (RCC) . These tumors are composed by tubular and spindle cellareas within a mucinous stroma. They are generallylow-grade nuclei tumors and limited to the kidney, sothey usually have a favorable prognosis. We report twonew cases of MTSC treated at our institution.MATERIALS AND METHODS: We reviewed therenal tumors surgery database of our hospital from2008 to 2019, selecting patients diagnosed with CMTF.We evaluated clinicopathological data and evolution ofthe patients. We also reviewed the published literatureto compare it with our findings. RESULTS: Two patients were included in the study,a 50-year-old male (case 1) and a 55-year-old female (case 2). The diagnosis was made by ultrasound asan incidental fi nding in case 1 and during the studyof fl ank pain in case 2. Treatment was surgical withpartial and radical nephrectomy respectively. After amean follow-up of 70 months, both patients are aliveand disease-free.CONCLUSION: Mucinous tubular and spindle cellcarcinomas (MTSC) is a rare renal tumor, approximately two hundred cases have been published. Thereare questions yet to be answered about their diagnosisand behaviour so it is of utmost importance to reportnew cases in order to increase our knowledge and improve patient care.

Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can.

Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.

HGF, IL-1α, and IL-27 Are Robust Biomarkers in Early Severity Stratification of COVID-19 Patients.

Pneumonia is the leading cause of hospital admission and mortality in coronavirus disease 2019 (COVID-19). We aimed to identify the cytokines responsible for lung damage and mortality. We prospectively recruited 108 COVID-19 patients between March and April 2020 and divided them into four groups according to the severity of respiratory symptoms. Twenty-eight healthy volunteers were used for normalization of the results. Multiple cytokines showed statistically significant differences between mild and critical patients. High HGF levels were associated with the critical group (OR = 3.51; p < 0.001; 95%CI = 1.95-6.33). Moreover, high IL-1α (OR = 1.36; p = 0.01; 95%CI = 1.07-1.73) and low IL-27 (OR = 0.58; p < 0.005; 95%CI = 0.39-0.85) greatly increased the risk of ending up in the severe group. This model was especially sensitive in order to predict critical status (AUC = 0.794; specificity = 69.74%; sensitivity = 81.25%). Furthermore, high levels of HGF and IL-1α showed significant results in the survival analysis (p = 0.033 and p = 0.011, respectively). HGF, IL-1α, and IL 27 at hospital admission were strongly associated with severe/critical COVID-19 patients and therefore are excellent predictors of bad prognosis. HGF and IL-1α were also mortality biomarkers.

Crimean-Congo haemorrhagic fever (CCHF) virus-specific antibody detection in blood donors, Castile-León, Spain, 2017 and 2018.

BackgroundCrimean-Congo haemorrhagic fever virus (CCHFV) is considered an emerging or even a probable re-emerging pathogen in southern Europe. Presence of this virus had been reported previously in Spain in 2010.AimWe aimed to evaluate the potential circulation of CCHFV in western Spain with a serosurvey in asymptomatic adults (blood donors).MethodsDuring 2017 and 2018, we conducted a CCHFV serosurvey in randomly selected asymptomatic blood donors from western Spain. Three assays using specific IgG antibodies against CCHFV were performed: the VectoCrimea ELISA test, an in-house ELISA and indirect immunofluorescence (EuroImmun) test with glycoprotein and nucleoprotein.ResultsA total of 516 blood donors participated in this cross-sectional study. The majority of the study participants were male (68.4%), and the mean age was 46.3 years. Most of the participants came from rural areas (86.8%) and 68.6% had contact with animals and 20.9% had animal husbandry practices. One in five participants (109/516, 21.1%) were engaged in at-risk professional activities such as agriculture and shepherding, slaughtering, hunting, veterinary and healthcare work (mainly nursing staff and laboratory technicians). A total of 15.3% of the participants were bitten by ticks in the days or months before the date of sampling. We detected anti-CCHFV IgG antibodies with two diagnostic assays in three of the 516 individuals and with one diagnostic assay in six of the 516 individuals.ConclusionSeroprevalence of CCHFV was between 0.58% and 1.16% in Castile-León, Spain. This is the first study in western Spain that showed circulation of CCHFV in healthy people.

[Evolution of the clinical presentation of renal cancer. Fifteen years experience]. / Evolución de las manifestaciones clínicas del cáncer renal. Experiencia de 15 años.

OBJECTIVE: To evaluate the evolution of the clinical presentation of this malignancy over time, and its possible prognostic repercussions. METHODS: A retrospective study of 538 patients subjected to surgery due to renal cancer in our hospital during the period 1995-2011. An analysis was made of the evolution of the clinical manifestations at the time of diagnosis, stratifying the results by years during four time periods. RESULTS: At the time of diagnosis, 53,4% of the patients were asymptomatic for 1995-1999 and 72% in the period 2008-2011. Pain is the symptom that occurs most frequently (18.8%) followed by hematuria (15.4% ). The proportion of symptomatic patients increases in relation to stage and histopathological grade. CONCLUSIONS: The clinical presentation of renal cancer has evolved over the years, not in terms of symptoms, which when present are still similar, but in terms of their incidence.

Evolución de las manifestaciones clínicas del cáncer renal. Experiencia de 15 años / Evolution of the clinical presentation of renal cancer: Fifteen years experience

OBJETIVO: Análisis del cambio de presentación clínica del tumor renal con el paso del tiempo y su posible repercusión pronóstica. MÉTODOS: Estudio retrospectivo de 538 pacientes intervenidos quirúrgicamente por esta patológica en nuestro hospital entre 1995 y 2011. Analizamos la evolución de las manifestaciones clínicas al diagnóstico estratificando los resultados por años divididos en cuatro periodos. RESULTADOS: Se observa un porcentaje significativamente creciente de diagnóstico en pacientes asintomáticos con el paso del tiempo siendo del 53.4% en el periodo 1995-1999 y del 72 % en 2008-2011. El dolor es el síntoma que se presenta con mayor frecuencia (18.8%) seguido de la hematuria (15.4%). El porcentaje de pacientes sintomáticos aumenta con el estadio y el grado tumoral. CONCLUSIÓN: Las manifestaciones clínicas del tumor renal han evolucionado con el tiempo, no en cuanto a los síntomas que cuando están presentes son similares, sino en cuanto a su incidencia (AU)

OBJECTIVE: To evaluate the evolution of the clinical presentation of this malignancy over time, and its possible prognostic repercussions. METHODS: A retrospective study of 538 patients subjected to surgery due to renal cancer in our hospital during the period 1995-2011. An analysis was made of the evolution of the clinical manifestations at the time of diagnosis, stratifying the results by years during four time periods. RESULTS: At the time of diagnosis, 53,4% of the patients were asymptomatic for 1995-1999 and 72% in the period 2008-2011. Pain is the symptom that occurs most frequently (18.8%) followed by hematuria (15.4%). The proportion of symptomatic patients increases in relation to stage and histopathological grade. CONCLUSIONS: The clinical presentation of renal cancer has evolved over the years, not in terms of symptoms, which when present are still similar, but in terms of their incidence (AU)

Flexible ureterorenoscopy (URS): technique and results.

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis. We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients. The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibers RESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope. Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter. CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm.

URS Flexible. Técnica y resultados / Flexible ureterorenoscopy (URS): technique and results

OBJETIVO: Los objetivos fundamentales de éste trabajo son dos. Por una parte exponer la técnica empleada en nuestro Servicio ya que difiere en algunos aspectos importantes de las publicadas en otros centros, explicando en algunos casos pequeños detalles que pueden ayudar al mejor desarrollo de la técnica. Por otra parte, exponemos los resultados de una serie de 100 casos.MÉTODOS: Presentamos nuestra serie reciente de URS Flex para el tratamiento de la litiasis renal. Para ello hemos revisado de forma retrospectiva éste tratamiento desde Enero de 2007 hasta Marzo de 2010. El tamaño medio de la litiasis tratada es de 1.5cm (0.5-6cms) y en todos los casos utilizamos vainas protectoras del ureteroscopio. La litotricia empleada en todos los casos fue láser de holmio con fibras de 200 y 365 micrasRESULTADOS: El porcentaje de pacientes que quedaron libres de litiasis (stone free rate-SFR) tras la cirugía en el postoperatorio inmediato fue de 77/100 pacientes (77%) contabilizando como resto litiásico fragmentos visualizados mediante la fluoroscopia del quirófano y la visión directa del URS Flex. A los 3 meses de la cirugía 89/96 pacientes (92.7%) estaban libres de litiasis comprobado mediante urografía intravenosa.Respecto a las complicaciones destacar 5 pacientes con lesión ureteral durante la colocación de la vaina protectora y 9 pacientes que acudieron a urgencias en el postoperatorio por molestias secundarias al catéter doble J.CONCLUSIÓN: Como conclusión podemos defender el tratamiento de las litiasis renales mediante URS Flex hasta un tamaño máximo de 2 cm siguiendo nuestro algoritmo terapéutico(AU)

OBJECTIVES: This paper has two main objectives: First, to expose the URS technique used in our Department because there are important differences with respect to others centres published, explaining same aspect that can benefit to the better development of the technique. Second, we present the results of a series of 100 cases. Flexible ureterorenoscopy (Flex URS) has been little used to date, mainly because of the technical difficulties created by the deficient quality of the instruments used, such as ureteroscopes offering scant visibility, poor illumination, a small working channel, deficient quality of the forceps and baskets, etc. METHODS: We present our recent series of flexible URS for the treatment of renal lithiasis.We performes a retrospective analysis of this treatment corresponding to the period between January 2007 and March 2010. In this period we have treated 100 patients.The medium size of the stone treated is 1.5cm (0.5-6cm) and we used ureteroscopic protector sheath in all cases. The lithotripter system used in all cases was Ho:YAG Laser with 200 and 365 micras fibersRESULTS: The stone-free rate (SFR) in the immediate postoperative period was 77% (77/100 patients). Residual stones, defined as stone fragments visualized in the operating room via fluoroscopy and directly with the flexible ureteroscope.Three months after surgery, the SFR was 92.7% (89/96 patients) confirmed by intravenous urography. Regarding complications, we had 5 patients with ureteral lesions during protector sheath pass and 9 patients that presented at the emergency room with pain secondary to the double J catheter.CONCLUSIONS: Flexible URS for of renal lithiasis can be defended in stones measuring up to 2 cm in diameter, based on our treatment algorithm(AU)