Gender trends at the annual Spanish Urologic Association (AEU) meeting: A review of AEU programmes over a 10-year period (2012-2022)

INTRODUCTION

Gender equity in urological meetings is pivotal for fostering diversity and inclusivity in the field. This study aims to evaluate the representation of Spanish urologist and regional disparities, and to assess its alignment with the demographic composition of the urological community.

MATERIALS AND METHODS

All urology meetings organized by the AEU between January 2012 and December 2022 were reviewed, including meeting information and details of the faculty. Additionally, we analysed geographic distribution of speakers across 17 different regions. Gender demographics were obtained disaggregating data by sex and year from the Organización Médica Colegial de España (OMC) and from those urologists affiliated to the AEU.

RESULTS

Analysing 52 AEU congresses held from 2012 to 2022, encompassing 3,407 speakers, the study found that 95.25% of speakers were from Spain and 89.6% were male speakers. Over the years, there was a positive trend in female speaker representation, increasing by 1.1% annually, slightly lagging the 1.8% annual rise in the number of female urologists in Spain. In specific subfields like functional, transplantation, and oncology sessions, the study revealed a higher representation of women, indicating focused efforts in these areas. Geographically, Madrid, Catalonia and Andalusia exhibited the highest representation.

CONCLUSIONS

Although there was a positive trend towards an increased participation of female urologists in Spanish urological meetings, it fails to accurately reflect the proportional increase in the number of women entering the urology profession in recent years. This study underscores the importance of ongoing efforts to ensure diverse and balanced representation in urological forum.

Distribution, reactivity and vertical fluxes of methane in the Guadalquivir Estuary (SW Spain)

The influence of temperature, salinity, sediment-water-atmosphere exchanges and oxidation rate on the variability of methane (CH4) in the Guadalquivir Estuary has been studied. The database corresponds to 3 intensive samplings carried out in summer (2021 and 2022) and winter (2022). An increase in CH4 concentration towards the interior of the estuary has been observed, more intense during summer (19-371 nmol L-1). The influence of temperature and salinity on the variability of CH4 concentration is negligible, with contributions below 1 nmol L-1. Water-atmosphere fluxes increase inland in summer (28-574 μmol m-2 d-1), being generally higher than in winter (18-80 μmol m-2 d-1). Similarly, benthic fluxes remain relatively constant in winter (10 ± 6 μmol m-2 d-1) and increase inland in summer (7-212 μmol m-2 d-1). In the innermost station of the estuary, with salinities lower than 1, there is a significant increase in benthic fluxes, with values above 9000 μmol m-2 d-1. CH4 oxidation rates increase towards low salinities, being especially high in summer (489 nmol L-1 d-1). Based on the information obtained, CH4 variability in the Guadalquivir Estuary is mainly controlled by water-atmosphere fluxes, benthic fluxes and oxidation in the water column. The uncertainty associated with the quantification of these processes does not allow an adequate assessment of the influence of lateral inputs, although there is experimental evidence of their importance in the Guadalquivir.

Dynamics of CO2, CH4, and N2O in Ria Formosa coastal lagoon (southwestern Iberia) and export to the Gulf of Cadiz

A first characterization of greenhouse gases had been carried out to study their role and impact in a productive transitional coastal system of the southern Portugal - Ria Formosa lagoon. To this purpose, the partial pressure of CO2 (pCO2) and the concentration of dissolved CH4 and N2O have been measured. Two surveys were carried out during 2020, at low tide under typical conditions of Spring (March) and end of Summer (October). The samplings sites were distributed along the costal lagoon covering: i) inner areas with strong human impact (influence of different flows of treated wastewater discharges); and ii) main channels in connection with the main inlets to study the exchanges with the ocean. In general, the highest values of the three greenhouse gases were found at the inner studied areas, especially affected by the disposal of treated effluents from wastewater treatment plans, in October. The mean water - atmosphere fluxes of the CO2, CH4 and N2O are positive, showing that the study area acts as a source of these gases to the atmosphere. On the other hand, it was calculated a rough estimation of the three gases globally exported from Ria Formosa to the ocean, through the main six inlets to evaluate the magnitude of the supply of these gases from Ria Formosa to the adjacent ocean. The mean CO2, CH4 and N2O horizontal water fluxes exported from all the inlets of Ria Formosa to the Gulf of Cadiz for both seasons, during low water, are 8.7 ± 3.9 mmol m-2 s-1, 8.0 ± 3.5 μmol m-2 s-1 and 3.2 ± 1.5 μmol m-2 s-1, which corresponds to a mass transport through the inlets section of 0.7 ± 0.7 kg s-1, 0.2 ± 0.2 g s-1 and 0.2 ± 0.3 g s-1 respectively. From these estimates, as expected, the higher mass transport was found at the larger and deeper inlets (Faro-Olhão and Armona).

Greenhouse gas assemblages (CO2, CH4 and N2O) in the continental shelf of the Gulf of Cadiz (SW Iberian Peninsula)

This study examines the simultaneous water-atmosphere exchange of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) on the continental shelf of the Gulf of Cadiz, as well as the effect it has in terms of the radiative balance in the atmosphere, between 2014 and 2016. The experimental database consists of new measurements of the spatial and seasonal distribution of CO2 partial pressure (pCO2) and N2O concentration in 2016. pCO2 shows a wide range of variation influenced mainly by seasonal thermal variations (8.0 μatm 0C-1), as well as with the relative intensity of biological activity. There is experimental evidence of a progressive increase of pCO2 over the last 2 decades, with an estimated gradient of 4.2 ± 0.7 μatm y-1. During 2016, the Gulf of Cadiz acted as a slight source of CO2 to the atmosphere, with a mean flux of 0.4 ± 2.2 mmol m-2 d-1. The analysis of concentration variations in the water column shows that nitrification is the main N2O production process in the study area, although in the more coastal zone there are signs of inputs related to continental and sediment contributions, most probably induced by denitrification processes. In 2016, the Gulf of Cadiz acted as a weak sink of atmospheric N2O, with a mean flux of -0.1 ± 0.9 μmol m-2 d-1. From previous studies, performed with a similar methodology, an interannual database (2014-2016) of water-atmosphere fluxes of CO2, CH4 and N2O, normalized to the mean wind speed in the area, has been generated. Considering their respective Global Warming Potential (GWP) a joint greenhouse gasses (GHG) flux, expressed in CO2 equivalents of 0.6 ± 2.0 mmol m-2 d-1, has been estimated, which extended to the area of study indicates an approximate emission of 67.9 Gg CO2 y-1. However, although there is a high uncertainty associated with the spatial, temporal and interannual variations of CO2, CH4 and N2O fluxes in the Gulf of Cadiz, the exchange of greenhouse gasses could be influencing a radiative forcing increase in the atmosphere. When considering the available information on local and global estimates, the uncertainty about the effect of the joint exchange of GHGs to the atmosphere from the coastal seas increases significantly.

IgG N-glycans are associated with prevalent and incident complications of type 2 diabetes

AIMS/HYPOTHESIS

Inflammation is important in the development of type 2 diabetes complications. The N-glycosylation of IgG influences its role in inflammation. To date, the association of plasma IgG N-glycosylation with type 2 diabetes complications has not been extensively investigated. We hypothesised that N-glycosylation of IgG may be related to the development of complications of type 2 diabetes.

METHODS

In three independent type 2 diabetes cohorts, plasma IgG N-glycosylation was measured using ultra performance liquid chromatography (DiaGene n = 1815, GenodiabMar n = 640) and mass spectrometry (Hoorn Diabetes Care Study n = 1266). We investigated the associations of IgG N-glycosylation (fucosylation, galactosylation, sialylation and bisection) with incident and prevalent nephropathy, retinopathy and macrovascular disease using Cox- and logistic regression, followed by meta-analyses. The models were adjusted for age and sex and additionally for clinical risk factors.

RESULTS

IgG galactosylation was negatively associated with prevalent and incident nephropathy and macrovascular disease after adjustment for clinical risk factors. Sialylation was negatively associated with incident diabetic nephropathy after adjustment for clinical risk factors. For incident retinopathy, similar associations were found for galactosylation, adjusted for age and sex.

CONCLUSIONS

We showed that IgG N-glycosylation, particularly galactosylation and to a lesser extent sialylation, is associated with a higher prevalence and future development of macro- and microvascular complications of diabetes. These findings indicate the predictive potential of IgG N-glycosylation in diabetes complications and should be analysed further in additional large cohorts to obtain the power to solidify these conclusions.

Early Dalmatian farmers specialized in sheep husbandry

The spread of farming in the central and western Mediterranean took place rapidly, linked to the Impressa Ware. The Impressa Ware originated somewhere in the southern Adriatic and spread westwards across the Mediterranean. These early farmers had an economy based on cereal agriculture and caprine husbandry, but there is still little information on how this agropastoral system functioned. This study aims to unravel the farming practices of the early Dalmatian farmers linked to the Impressa culture by using an integrated analysis, combining archaeozoology, palaeoproteomics and stable isotopes, applied to the faunal assemblages of Tinj-Podlivade and Crno Vrilo. The results show: (1) the composition of the flocks was overwhelmingly sheep; (2) sheep exploitation at both sites was similar, focusing on milk and meat; (3) sheep reproduction was concentrated at the beginning of winter, with no reproduction in autumn as in later sites in the western Mediterranean. We conclude that a common animal economy existed at both sites, which could be related to the mobility practiced by these early farming societies throughout the Mediterranean.

Dynamic of CO2, CH4 and N2O in the Guadalquivir estuary

The concentration of dissolved CH₄ and N₂O, as well as the partial pressure of CO₂ (pCO₂) were studied in the Guadalquivir estuary. Samples were taken in March and April 2018 and 2019, under different rainy and tidal conditions. The available database for summer 2017 (Sierra et al., 2020) was included in the interpretation of the factors that determine the variability of these gases in the Guadalquivir estuary. Two different types of samplings were carried out: a longitudinal transect across the river with salinity values close to zero and another one during two consecutive tidal cycles in the mouth of the estuary. The highest concentrations were found in the upper zone of the estuary and during the low tide. This distribution was related to 4 factors: temperature, salinity, exchange with the atmosphere, and biochemical processes together with the river inputs. Temperature is one of the factors that clearly seems to determine the distribution of gases and fluxes, showing the highest values in the upper zone during the summer of 2017. Intense rains cause a dilution effect of the gas in the water column, this provoked, during the season of spring 2018, an increase in the salinity factor in the distribution of gases in the middle zone. High concentrations of the gases have been linked to production processes in the water column, as well as to benthic production and lateral inputs. While the gases concentrations at the mouth presented values close to those of the equilibrium with the atmosphere, the fluxes in the upper zone of the estuary reached average values of 89.6 mmol m^-2 d^-1, 121.7 μmol m^-2 d^-1 and 59.9 μmol m^-2 d^-1 for CO₂, CH₄ and N₂O, respectively. Generally, water-atmosphere fluxes are positive through the whole study, which means that the estuary acts as a source of these gasses to the atmosphere.

[Chronic migraine with daily headache. Literature review]

INTRODUCTION

Despite representing a significant number of cases, patients with chronic migraine and daily headache are frequently excluded from large therapeutic clinical trials. These individuals have hardly been studied and could have specific properties. Development. A third of patients with chronic migraine may suffer from headaches every day, representing up to 1.7 - 3.3% of patients in a general neurology consultation. These patients are excluded from most studies, so little information is available. They may have a longer lasting migraine and different response to treatment. Patients with chronic migraine and daily headache may have complex pathophysiological mechanisms that favor the daily manifestation of migraine. The management of these patients is a therapeutic challenge, and OnabotulinumtoxinA may be useful.

CONCLUSION

Patients with chronic migraine and daily headache may have specific clinical and therapeutic characteristics. New studies could lead to differentiate it from chronic migraine.

Essential omega-3 fatty acids tune microglial phagocytosis of synaptic elements in the mouse developing brain

Omega-3 fatty acids (n-3 PUFAs) are essential for the functional maturation of the brain. Westernization of dietary habits in both developed and developing countries is accompanied by a progressive reduction in dietary intake of n-3 PUFAs. Low maternal intake of n-3 PUFAs has been linked to neurodevelopmental diseases in Humans. However, the n-3 PUFAs deficiency-mediated mechanisms affecting the development of the central nervous system are poorly understood. Active microglial engulfment of synapses regulates brain development. Impaired synaptic pruning is associated with several neurodevelopmental disorders. Here, we identify a molecular mechanism for detrimental effects of low maternal n-3 PUFA intake on hippocampal development in mice. Our results show that maternal dietary n-3 PUFA deficiency increases microglia-mediated phagocytosis of synaptic elements in the rodent developing hippocampus, partly through the activation of 12/15-lipoxygenase (LOX)/12-HETE signaling, altering neuronal morphology and affecting cognitive performance of the offspring. These findings provide a mechanistic insight into neurodevelopmental defects caused by maternal n-3 PUFAs dietary deficiency.

COVID-19 in elderly kidney transplant recipients

The SARS-Cov-2 infection disease (COVID-19) pandemic has posed at risk the kidney transplant (KT) population, particularly the elderly recipients. From March 12 until April 4, 2020, we diagnosed COVID-19 in 16 of our 324 KT patients aged ≥65 years old (4.9%). Many of them had had contact with healthcare facilities in the month prior to infection. Median time of symptom onset to admission was 7 days. All presented with fever and all but one with pneumonia. Up to 33% showed renal graft dysfunction. At infection diagnosis, mTOR inhibitors or mycophenolate were withdrawn. Tacrolimus was withdrawn in 70%. The main treatment combination was hydroxychloroquine and azithromycin. A subset of patients was treated with anti-retroviral and tocilizumab. Short-term fatality rate was 50% at a median time since admission of 3 days. Those who died were more frequently obese, frail, and had underlying heart disease. Although a higher respiratory rate was observed at admission in nonsurvivors, symptoms at presentation were similar between both groups. Patients who died were more anemic, lymphopenic, and showed higher D-dimer, C-reactive protein, and IL-6 at their first tests. COVID-19 is frequent among the elderly KT population and associates a very early and high mortality rate.

COVID-19 in Grade 4-5 Chronic Kidney Disease Patients

Introduction

Chronic kidney disease (CKD) increases the risk of mortality during coronavirus disease 2019 (COVID-19) episodes, and some reports have underlined the high incidence and severity of this infection in dialysis patients. Information on COVID-19 in nondialysis CKD patients is not available yet.

Case Reports

Here we present 7 patients with grade 4–5 CKD who developed symptomatic COVID-19; they comprise 2.6% of our 267 advanced CKD patients. The estimated GFR was between 12 and 20 mL/min during the month prior to COVID-19. The 3 major symptoms were fever, cough, and dyspnea, and 5 patients showed bilateral pneumonia. Hydroxychloroquine, azithromycin, ceftriaxone, and steroids were the most frequently prescribed drugs. Two patients needed noninvasive mechanical ventilation. All patients showed minimal to moderate kidney function deterioration during admission, with an eGFR decline below 5 mL/min in 6 cases. No patient required acute dialysis. Six patients were discharged alive and remained dialysis free athe t the time of reporting, and one 76-year-old patient died.

Conclusions

COVID-19 affects grade 4–5 CKD patients, but prognosis may be acceptable if prompt supportive measures are applied. These findings should be confirmed in larger cohorts, and further observations will be needed to understand the full spectrum of clinical features and the optimal approach to COVID-19 in patients with advanced CKD.

SAT0210 FACTORS ASSOCIATED WITH TIME TO SEVERE LUPUS NEPHRITIS IN A COHORT OF COLOMBIAN PATIENTS

Background:

Systemic lupus erythematosus (SLE) clinical manifestations, and their severity, vary according to age, ethnicity and socioeconomic status. Both Hispanic and Afro-Americans have a higher incidence and more sever presentation when compared to Caucasian patients with SLE

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018

Methods:

Retrospective follow-up study based in clinical records. Patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. We included patients with diagnosis of lupus nephritis according to Wallace and Dubois criteria. Patients who did not have at least two follow-up measurements or had a cause of nephritis other than lupus were excluded. The main outcome was defined as time from diagnosis to sever renal involvement defined as creatinine clearance ≤50 ml/min, 24-hour proteinuria ≥3.5 grams o end stage renal disease.

We analyzed clinical and immunological characteristics. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges (IQR) for quantitative variables. Age and sex adjusted survival functions and Hazard ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models por interval-censored data. P values < 0.05 were considered statistically significant

Results:

548 patients were analyzed: 67 were left-censored as they presented renal involvement at entry, 6 were interval censored as outcome occurred between study visits, and 475 were right-censored as involvement was not registered during follow-up. 529 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.5 (IQR = 20.6). 67% were mestizo, 13% Caucasian and 0.3% Afro-Colombian. Age and sex adjusted variables associated with time to severe lupus nephritis were high blood pressure HR = 3.5 (95%CI 2.2-5.6; p-value <0.001) and Anti-RO (per unit increase) HR = 1.002 (95%CI 1.001-1.004; p-value = 0.04). Figure 1 shows age and sex adjusted survival function.

Conclusion:

In our cohort the appearance of severe lupus nephritis occurs in less than 15% of patients at 10 years. Both high blood pressure and elevated anti-Ro titers were associated with a higher rate of onset in the presentation of severe lupus nephritis, as seen in some polymorphs of anti Ro.

References:

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Lopez: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Ana Sierra: None declared, Deicy Hernandez-Parra: None declared, Ricardo Pineda.Tamayo: None declared

AB0246 FACTORS ASSOCIATED WITH THE TIME OF PRESENTATION OF CARDIOVASCULAR EVENTS IN A COHORT OF COLOMBIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus is a systemic disease characterized by a compromise of vital organs. The autoimmune activity has been linked to accelerated endothelial damage and increased cardiovascular risk and its outcomes such as heart attack, stroke, and peripheral arterial disease(1). Patients with Lupic nephritis have been characterized by requiring aggressive immunosuppressive therapies apart from prolonged and progressive use of corticosteroids, what you have shown can accelerate these outcomes(2). Other factors such as secondary arterial hypertension, dyslipidemia among others are factors to consider (3).

Objectives:

To analyze clinical and immunological characteristics associated with time to severe renal involvement in patients with Systemic Lupus Erythematous in a Colombian cohort followed for one year, between January 2015 and December 2018.

Methods:

Retrospective follow-up study based on clinical records of patients with SLE diagnosis that fulfilled either 1987 American College of Rheumatology Classification Criteria for SLE or 2011 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE. Patients with cardiovascular disease outcomes such as angina, acute myocardial infarction, stroke, transient cerebral ischemia and chronic arterial occlusive disease were included. Patients who did not have at least two follow-up measurements or had structural heart disease, valvulopathies, arrhythmias, myocarditis, pericarditis were excluded. The main outcome was defined as the time from diagnosis to cardiovascular diseases.

Clinical and immunological characteristics were analyzed. Descriptive statistical analyses of participant data during the first evaluation are reported as frequencies and percentages for categorical variables, and as medians and interquartile ranges for quantitative variables. Age and sex adjusted survival functions and Hazard Ratios (HR) with 95% confidence intervals and p-values were estimated using parametric Weibull models for interval-censored data. P values < 0.05 were considered statistically significant

Results:

547 patients were analyzed: 29 were left-censored as they presented renal involvement at entry, 22 were interval censored as outcome occurred between study visits, and 496 were right-censored as involvement was not registered during follow-up. 528 (96.5%) patients were female, median age at entry was 46 (IQR = 23) and median age to diagnosis was 29.4 (IQR = 20.9). Statistically significant age and sex adjusted variables were High Blood Pressure (HBP) HR = 2.0 (95%CI 1.1-3.6; p-value <0.018) and cumulative prednisolone dose (>10 gr vs <2 gr) HR = 2.4 (95%CI 1. 1-5.1; p-value = 0.023). Figure 1 shows the age and sex adjusted survival function for HBP

Conclusion:

HBP and cumulative steroid doses accelerate the onset of cardiovascular diseases in patients with lupus more than two times. Maintaining blood pressure in goals and performing early clearance of glucocorticoids could improve outcomes in these patients who are already considered a high cardiovascular risk

References:

[1]Hans-Joachim Anders, Ramesh Saxena, Ming-Hui Zhao. Lupus Nephritis. Nat Rev Dis Primers. 2020 Jan 23;6(1):7.

[2]Shanthini Kasturi, Lisa R Sammaritano. Corticosteroids in Lupus. Rheum Dis Clin North Am, 42 (1), 47-62, viii

[3]César Magro-Checa, Juan Salvatierra, José Luis Rosales-Alexander, et al. Cardiovascular risk in systemic lupus erythematosus: implicated factors and assessment methods. Semin Fund Esp Reumatol. 2012;13(3):95–102

Disclosure of Interests:

Sebastian Herrera Speakers bureau: academic conference, Juan camilo Diaz-Coronado: None declared, Diego Rojas-Gualdrón: None declared, Laura Betancur-Vasquez: None declared, Daniel Gonzalez-Hurtado: None declared, Juanita Gonzalez-Arango: None declared, laura Uribe-Arango: None declared, Maria Fernanda Saavedra Chacón: None declared, Jorge Lacouture-Fierro: None declared, Santiago Monsalve: None declared, Sebastian Guerra-Zarama: None declared, Juan david Serna: None declared, Julian Barbosa: None declared, Deicy Hernandez-Parra: None declared, Ana Sierra: None declared, Ricardo Pineda.Tamayo: None declared

Clinicopathological evaluation of the programmed cell death 1 (PD1)/programmed cell death-ligand 1 (PD-L1) axis in post-transplant lymphoproliferative disorders: association with Epstein-Barr virus, PD-L1 copy number alterations, and outcome

AIMS

The clinical implications of the programmed cell death 1 (PD1)/programmed cell death-ligand 1 (PD-L1) axis in patients with post-transplant lymphoproliferative disorders are largely unknown, and its association with Epstein-Barr virus (EBV) status and PD-L1 copy number alterations (CNAs) has not been thoroughly studied.

METHODS AND RESULTS

PD1/PD-L1 expression was studied in 50 adult post-transplant lymphoproliferative disorders, and the correlations with PD-L1 CNAs, EBV, clinicopathological features and outcome were evaluated. Thirty-seven (74%) cases were classified as diffuse large B-cell lymphoma (DLBCL), nine (18%) cases were classified as polymorphic, and four (8%) cases were classified as classic Hodgkin lymphoma. Thirty-four cases were EBV-positive, with 29 of 34 (85%) having latency II or III, and 15 of 34 (44%) having viral replication. PD-L1 expression in tumour cells and tumour-associated macrophages was observed in 30 (60%) and 37 (74%) cases, respectively. PD1 positivity was seen in 16 (32%) cases. PD-L1 expression was associated with EBV with latency II or III (P = 0.001) and organ rejection (P = 0.04), and, in DLBCL, with non-germinal centre type DLBCL (P < 0.001). Cases with PD-L1-positive tumour cells showed a higher number of PD-L1 CNAs than PD-L1-negative cases (P = 0.001). Patients with EBV/latency III/replication and simultaneous PD-L1 expression showed the worst overall survival (P < 0.001).

CONCLUSIONS

The PD1/PD-L1 axis is deregulated in post-transplant lymphoproliferative disorders, with frequent PD-L1 expression and PD1 negativity. PD-L1 expression is associated with EBV latency II or III and PD-L1 CNAs, and probably reflects a proinflammatory tumour microenvironment. The combined analysis of EBV status and PD-L1 expression may help to identify deeply immunosuppressed patients who can benefit from immune reconstitution approaches.

CADM1, MAL, and miR124 Promoter Methylation as Biomarkers of Transforming Cervical Intrapithelial Lesions

Background: Squamous intraepithelial lesions/cervical intraepithelial neoplasias (SIL/CIN) are high-risk human papilloma virus (hrHPV)-related lesions which are considered as high grade (HSIL/CIN2-3) or low grade (LSIL/CIN1) lesions according to their risk of progression to cervical cancer (CC). Most HSIL/CIN2-3 are considered as transforming hrHPV infections, so truly CC precursors, although some clear spontaneously. hrHPV testing has a high sensitivity for the detection of HSIL/CIN2-3 but a relatively low specificity for identifying transforming lesions. We aimed to determine whether the combination of CADM1, MAL and miR124 promoter methylation status assessed in histological samples can be used as a biomarker in the identification of transforming HSIL/CIN lesions. Design: 131 cervical biopsies, including 8 cases with no lesion and a negative hrHPV test result (control group), 19 low-grade (L)SIL/CIN1, 30 HSIL/CIN2, 60 HSIL/CIN3, and 14 CC were prospectively collected. hrHPV was detected and genotyped using the polymerase chain reaction (PCR)-based technique SPF10 HPV LIPA. A multiplex quantitative methylation-specific PCR (qMSP) was used to identify the methylation status of the CADM1, MAL, and miR124 promoter genes. Results: Significantly higher methylation levels of CADM1, MAL and miR-124 were found in HSIL/CIN2-3 and CC compared with normal and LSIL lesions. DNA methylation of at least one gene was detected in 12.5% (1/8) of normal samples, 31.5% (6/19) of LSIL/CIN1, 83.3% (25/30) of HSIL/CIN2, 81.6% (49/60) of HSIL/CIN3 and 100% (14/14) of CC (p < 0.001). The sensitivity and specificity for HSIL/CIN2-3 and CC of having at least one methylated gene were 84.6% and 74.0%, respectively. The sensitivity and specificity of the combination of at least one methylated gene and a positive hrHPV test were 80.7% and 85.1% for HSIL/CIN2-3 and CC, respectively. Conclusions: The methylation rate of CADM1, MAL and miR124 increases with the severity of the lesion. Further research is warranted to evaluate the usefulness of these biomarkers for the identification of transforming HSIL/CIN.

Elevated age-related cortical iron, ferritin and amyloid plaques in APPswe/PS1ΔE9 transgenic mouse model of Alzheimer’s disease

Iron is very important element for functioning of the brain. Its concentration changes with aging the brain or during disease. The aim of our work was the histological examination of content of ferritin and free iron (unbound) in brain cortex in association with Aβ plaques from their earliest stages of accumulation in amyloid plaque forming APP/PS1 transgenic mice. Light microscopy revealed the onset of plaques formation at 8-monthage. Detectable traces of free iron and no ferritin were found around plaques at this age, while the rate of their accumulation in and around Aβ plaques was elevated at 13 months of age. Ferritin accumulated mainly on the edge of Aβ plaques, while the smaller amount of free iron was observed in the plaque-free tissue, as well as in and around Aβ plaques. We conclude that free iron and ferritin accumulation follows the amyloid plaques formation. Quantification of cortical iron and ferritin content can be an important marker in the diagnosis of Alzheimer’s disease.

Value of HPV 16/18 Genotyping and p16/Ki-67 Dual Staining to Predict Progression to HSIL/CIN2+ in Negative Cytologies From a Colposcopy Referral Population

OBJECTIVES

To assess the prognostic value of human papillomavirus (HPV) 16/18 genotyping and p16/Ki-67 dual staining cytology in high-risk HPV (hrHPV)-positive women with no lesion or minor abnormalities.

METHODS

We evaluated progression to high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grades 2 to 3 or cervical cancer (HSIL/CIN2+), persistence/regression of hrHPV infection in women referred to colposcopy showing hrHPV infection, histology diagnosis different from HSIL/CIN2+, and negative cytology. HPV 16/18 genotyping and dual staining were performed in liquid-based cytologic specimens obtained on the first visit.

RESULTS

Progression was observed in 16 (8.0%) of 200 women. Those with HPV 16/18 infection had an increased risk of progression compared with women infected by other hrHPV types, and they also showed more persistence. However, no association was observed between progression or persistence and the result of the dual staining.

CONCLUSIONS

HPV 16/18-positive women with no lesions or minor abnormalities are at high risk of progression to HSIL/CIN2+ and hrHPV persistence.

Usefulness of the KDPI in Spain: A comparison with donor age and definition of standard/expanded criteria donor

INTRODUCTION

Kidney donor shortage requires expanding donor selection criteria, as well as use of objective tools to minimize the percentage of discarded organs. Some donor pre-transplant variables such as age, standard/expanded criteria donor (SCD/ECD) definition and calculation of the Kidney Donor Profile Index (KDPI), have demonstrated correlations with patient and graft outcomes. We aimed to establish the accuracy of the three models to determine the prognostic value of kidney transplantation (KT) major outcomes.

MATERIAL AND METHODS

We performed a retrospective study in deceased donor KTs at our institution. Unadjusted Cox and Kaplan-Meier survival, and multivariate Cox analyses were fitted to analyze the impact of donor age, SCD/ECD and KDPI on outcomes.

RESULTS

389 KTs were included. Mean donor age was 53.6±15.2 years; 163 (41.9%) came from ECD; mean KDPI was 69.4±23.4%. Median follow-up was 51.9 months. The unadjusted Cox and Kaplan-Meier showed that the three prognostic variables of interest were related to increased risk of patient death, graft failure and death-censored graft failure. However, in the multivariate analysis only KDPI was related to a higher risk of graft failure (HR 1.03 [95% CI 1.01-1.05]; p=0.014).

CONCLUSIONS

SCD/ECD classification did not provide significant prognostic information about patient and graft outcomes. KDPI was linearly related to a higher risk of graft failure, providing a better assessment. More studies are needed before using KDPI as a tool to discard or accept kidneys for transplantation.

Impact of Recurrent Acute Kidney Injury on Patient Outcomes

BACKGROUND/AIMS

Recurrent acute kidney injury (AKI) is common among patients after a first hospitalized AKI. However, little is known about the prognosis of recurrent AKI episodes in chronic kidney disease (CKD) development, cardiovascular events and mortality.

METHODS

A retrospective study included patients admitted to our Hospital from 2000 to 2010. AKI was defined according to the Acute Dialysis Quality Initiative criteria. In the follow-up period after the first AKI episode, clinical, laboratory data and the number of repeated AKI episodes, etiology and severity were recorded.

RESULTS

Among the 359 AKI survivor patients included, 250 new AKI episodes were observed in 122 patients (34%). Variables independently associated to new episodes were: type 2 DM [OR 1.2, 95%CI 1.2-3.8, p=0.001], ischemic heart disease [OR 1.9; 95%CI 1.1-3.6, p=0.012], and SCr at the first AKI event>2,6 mg/dl [OR 1.2; 95%CI 1.03-1.42, p=0.02]. Development of CKD during four years follow-up was more frequent in patients with recurrent AKI, HR [2.2 (95% CI: 1.09-4.3, p=0.003)] and 44% of recurrent AKI patients who developed CKD occurred during the first 6 months after the initial event. Cardiovascular events were more frequent among patients with recurrent AKI patients than in those with one AKI episode (47.2% vs 24%, p=0.001). Mortality at 4 years was higher in the patient subgroup with several episodes of AKI as compared with those with a single episode [HR: 4.5 (95% CI 2.7-7.5) p<0.001].

CONCLUSION

Episodes of recurrent AKI have a high potential to be associated with relevant complications such as cardiovascular events, mortality and CKD development.

Distribution of N2O in the eastern shelf of the Gulf of Cadiz (SW Iberian Peninsula)

Distribution of N₂O has been determined in eight cruises along three transects (Guadalquivir, Sancti Petri and Trafalgar) in the Gulf of Cadiz, during 2014 and 2015. The mean N₂O value for this area was 10.0±0.9nM, with large spatial and temporal variations. Stratification in the water column has been observed; the concentration of this gas increases with the depth, because of the presence of the Eastern North Atlantic Central Water (ENACW) and the Mediterranean Outflow Waters (MOW). The N₂O production measured in this study is mainly due to nitrification. N₂O yields from nitrification were estimated from the linear correlation of the excess of N₂O (ΔN₂O) with Apparent Oxygen Utilization (AOU) and nitrate (NO₃^-), with values of their slopes ranged between 0.010 and 0.021% and 0.017-0.025% respectively. There is an onshore - offshore gradient of N₂O; the highest values were found at the shallower stations, indicating coastal input and benthic remineralization. The seawater-air flux of N₂O is affected by several variables (temperature, AOU and NO₃^-), and the average flux calculated is 2.7±2.0μmolm^-2d^-1. The fluxes show a decrease with increasing distance from the coast, and with proximity to the Strait of Gibraltar. The study area behaves as a source of N₂O to the atmosphere, with a global emission of 0.18Ggyear^-1.

Spatial and seasonal variability of CH4 in the eastern Gulf of Cadiz (SW Iberian Peninsula)

Methane (CH₄) concentrations were measured along three sections of the eastern Gulf of Cadiz (designated "Guadalquivir", "Sancti Petri" and "Trafalgar") during eight cruises in 2014 and 2015. The concentration of CH₄ varied from 3.6 to 19.7nmolkg^-1 (CH₄ saturation percent of 122 and 916%), showing seasonal variation. The highest values were found in December 2014 and November 2015. In most of the sampling area the highest concentration of CH₄ was found in subsurface waters at depths close to the thermocline, and in the bottom waters near the coast. The seawater-air flux of CH₄ ranged between 0.8 and 59.7μmolm^-2d^-1, showing seasonal variation in function of the temperature of the surface water. In the "Guadalquivir" and "Sancti Petri" sections, the CH₄ fluxes increased with proximity to the coast; this may be a result of continental inputs and CH₄ emissions from sediments. The whole study area behaves as a source of CH₄ to the atmosphere with mean values of 0.5 and 0.6GgCH₄yr^-1 in 2014 and 2015, respectively.

Stem cell-like transcriptional reprogramming mediates metastatic resistance to mTOR inhibition

Inhibitors of the mechanistic target of rapamycin (mTOR) are currently used to treat advanced metastatic breast cancer. However, whether an aggressive phenotype is sustained through adaptation or resistance to mTOR inhibition remains unknown. Here, complementary studies in human tumors, cancer models and cell lines reveal transcriptional reprogramming that supports metastasis in response to mTOR inhibition. This cancer feature is driven by EVI1 and SOX9. EVI1 functionally cooperates with and positively regulates SOX9, and promotes the transcriptional upregulation of key mTOR pathway components (REHB and RAPTOR) and of lung metastasis mediators (FSCN1 and SPARC). The expression of EVI1 and SOX9 is associated with stem cell-like and metastasis signatures, and their depletion impairs the metastatic potential of breast cancer cells. These results establish the mechanistic link between resistance to mTOR inhibition and cancer metastatic potential, thus enhancing our understanding of mTOR targeting failure.

Renal graft survival according to Banff 2013 classification in indication biopsies

INTRODUCTION

The impact of acute rejection in kidney graft survival is well known, but the prognosis of other diagnoses is uncertain. We evaluated the frequency and impact on graft survival of different diagnostic categories according to the Banff 2013 classification in a cohort of renal transplant recipients.

MATERIAL AND METHODS

Retrospective study of 495 renal biopsies by indication in 322 patients from 1990-2014. Two independent observers reviewed the histological reports, reclassifying according to the Banff 2013 classification.

RESULTS

Of 495 biopsies, 28 (5.7%) were not diagnostic. Of the remaining 467, 10.3% were «normal» (category 1), 19.6% antibody-mediated changes (category 2), 5.9% «borderline» changes (category 3), 8.7% T-cell-mediated rejection (category 4), 23.4% interstitial fibrosis/tubular atrophy (IFTA) (category 5) and 26.5% with other diagnoses (category 6). As time after transplantation increases, diagnoses of categories 1, 3 and 4 decrease, while categories 5 and 2 increase. Worse graft survival with category 2 diagnosis was observed (45% at 7.5 years, HR 4.29 graft loss [95% CI, 2.39-7.73]; P≤.001, compared to category 1). Grafts with «unfavourable histology» (chronic antibody-mediated rejection, moderate-severe IFTA) presented worse survival that grafts with «favourable histology» (normal, acute tubular necrosis, mild IFTA).

CONCLUSIONS

The Banff 2013 classification facilitates a histological diagnosis in 95% of indication biopsies. While diagnostic category 6 is the most common, a change in the predominant histopathology was observed according to time elapsed since transplantation. Antibody-mediated changes are associated with worse graft survival.

Genetic relationships among American donkey populations: insights into the process of colonization

This study presents the first insights into the genetic diversity and structure of the American donkey metapopulation. The primary objectives were to detect the main structural features underlying variability among American donkey populations, identify boundaries between differentiated gene pools, and draw the main colonization pathways since the introduction of donkeys into America in the 15th century. A panel of 14 microsatellite markers was applied for genotyping 350 American donkeys from 13 countries. The genetic structure of this metapopulation was analysed using descriptive statistics and Bayesian model-based methods. These populations were then compared to a database containing information on 476 individuals from 11 European breeds to identify the most likely ancestral donor populations. Results showed the presence of two distinct genetic pools, with confluence of the two in Colombia. The southern pool showed a unique genetic signature subsequent to an older founder event, but lacked any significant influence of modern gene flow from Europe. The northern pool, conversely, may have retained more ancestral polymorphisms and/or have experienced modern gene flow from Spanish breeds. The Andalusian and, to a lesser extent, the Catalan breeds have left a more pronounced footprint in some of the American donkey populations analysed.

Longitudinal variations of brain functional connectivity: A case report study based on a mouse model of epilepsy

Brain Functional Connectivity (FC) quantifies statistical dependencies between areas of the brain. FC has been widely used to address altered function of brain circuits in control conditions compared to different pathological states, including epilepsy, a major neurological disorder. However, FC also has the as yet unexplored potential to help us understand the pathological transformation of the brain circuitry. Our hypothesis is that FC can differentiate global brain interactions across a time-scale of days. To this end, we present a case report study based on a mouse model for epilepsy and analyze longitudinal intracranial electroencephalography data of epilepsy to calculate FC changes from the initial insult (status epilepticus) and over the latent period, when epileptogenic networks emerge, and at chronic epilepsy, when unprovoked seizures occur as spontaneous events. We found that the overall network FC at low frequency bands decreased immediately after status epilepticus was provoked, and increased monotonously later on during the latent period. Overall, our results demonstrate the capacity of FC to address longitudinal variations of brain connectivity across the establishment of pathological states.

Anthropogenic effects on greenhouse gas (CH4 and N2O) emissions in the Guadalete River Estuary (SW Spain)

Coastal areas are subject to a great anthropogenic pressure because more than half of the world's population lives in its vicinity causing organic matter inputs, which intensifies greenhouse gas emissions into the atmosphere. Dissolved concentrations of CH4 and N2O have been measured seasonally during 2013 in the Guadalete River Estuary, which flows into the Cadiz Bay (southwestern Spanish coast). It has been intensely contaminated since 1970. Currently it receives wastewater effluents from cities and direct discharges from nearby agriculture crop. Eight sampling stations have been established along 18 km of the estuary. CH4 and N2O were measured using a gas chromatograph connected to an equilibration system. Additional parameters such as organic matter, dissolved oxygen, nutrients and chlorophyll were determinate as well, in order to understand the relationship between physicochemical and biological processes. Gas concentrations increased from the River mouth toward the inner part, closer to the wastewater treatment plant discharge. Values varied widely within 21.8 and 3483.4 nM for CH4 and between 9.7 and 147.6 nM for N2O. Greenhouse gas seasonal variations were large influenced by the precipitation regime, masking the temperature influence. The Guadatete Estuary acted as a greenhouse gas source along the year, with mean fluxes of 495.7 μmol m(-2)d(-1) and 92.8 μmol m(-2)d(-1) for CH4 and N2O, respectively.

Breast cancer brain metastases: a review of the literature and a current multidisciplinary management guideline

Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10–30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.

Ozone sensitivity to its precursor emissions in northeastern Mexico for a summer air pollution episode

A summer episode was modeled to address the expected response of ambient air O3 to hypothetical emission control scenarios in northeastern Mexico, and in particular in the Monterrey Metropolitan Area (MMA). This region is of interest because the MMA holds one of the worst air quality problems in the country and levels of air pollutants in the rest of northeastern Mexico are starting to be a concern. The MM5-SMOKE-CMAQ platform was used to conduct the numerical experiments. Twenty-four control scenarios were evaluated, combining the level of emission controls of O3 precursors (NO(x) and volatile organic compounds [VOCs]) from 0% to 50%. For the MMA, VOC-only controls result in the best option to reduce O3 concentrations, though the benefit is limited to the urban core. This same strategy results in negligible benefits for the rest of northeastern Mexico. NO(x) controls result in an increase in O3 concentration within the MMA of up to 20 ppbv and a decrease at downwind locations of up to 11 ppbv, with respect to the base-case scenario. Indicator ratios were also used to probe for NO(x)-sensitive and VOC-sensitive areas. Locations with an important influence of NO(x) point sources (i.e., Monclova and Nava/Acuña) are quite sensitive to changes in NO(x) emissions. Border cities in the Rio Bravo/Grande Valley tend to be marginally NO(x)-sensitive. Overall, the MMA seems to be dominated by a VOC-sensitive regime, while the rest of the region would tend to have a NO(x)-sensitive response. The results obtained serve to expand the current knowledge on the chemical regimes that dominate this region (VOC- or NO(x)-sensitive), and thus could help guide public policies related to emission regional control strategies.

Enterotoxigenic Escherichia coli CS21 pilus contributes to adhesion to intestinal cells and to pathogenesis under in vivo conditions

Colonization surface antigens (CSs) represent key virulence-associated factors of enterotoxigenic Escherichia coli (ETEC) strains. They are required for gut colonization, the first step of the diarrhoeal disease process induced by these bacteria. One of the most prevalent CSs is CS21, or longus, a type IV pili associated with bacterial self-aggregation, protection against environmental stresses, biofilm formation and adherence to epithelial cell lines. The objectives of this study were to assess the role of CS21 in adherence to primary intestinal epithelial cells and to determine if CS21 contributes to the pathogenesis of ETEC infection in vivo. We evaluated adherence of a CS21-expressing wild-type ETEC strain and an isogenic CS21-mutant strain to pig-derived intestinal cell lines. To determine the role of CS21 in pathogenesis we used the above ETEC strains in a neonatal mice challenge infection model to assess mortality. Quantitative adherence assays confirmed that ETEC adheres to primary intestinal epithelial cells lines in a CS21-dependent manner. In addition, the CS21-mediated ETEC adherence to cells was specific as purified LngA protein, the CS21 major subunit, competed for binding with the CS21-expressing ETEC while specific anti-LngA antibodies blocked adhesion to intestinal cells. Neonatal DBA/2 mice died after intra-stomach administration of CS21-expressing strains while lack of CS21 expression drastically reduced the virulence of the wild-type ETEC strain in this animal model. Collectively these results further support the role of CS21 during ETEC infection and add new evidence on its in vivo relevance in pathogenesis.