Kidney biopsy in lupus nephritis after achieving clinical renal remission: paving the way for renal outcome assessment.

The role of repeat kidney biopsy in lupus nephritis (LN) with renal remission is unclear. The aim of this study was to assess this role in a real-life scenario. This retrospective, single-centre study included 56 patients with LN diagnosed from 1998 to 2019, with an initial kidney biopsy (KB1) at the onset of LN and a second kidney biopsy (KB2) after achieving renal remission. A total of 51 (91.1%) patients were women with a median age of 29.9 years [interquartile range (IQR) 23.4-40.6] at the time of LN diagnosis. KB2s were performed after 41.1 months (IQR 30.1-52.5) of KB1. At the time of KB2, complete renal response was achieved in 51 (91.1%) patients. The median activity index decreased from a baseline value of 6.5 (IQR 2.8-11) to 0 (IQR 0-2) (P < .001). The chronicity index worsened from 1 (IQR 0-2) to 2 (IQR 1-3) (P = .01). In patients with proliferative/mixed forms at KB2, the chronicity index median value increased to 3 (IQR 1.5-4), as well as interstitial fibrosis and tubular atrophy [Formula: see text]25%, from 5.4% to 13.5%. Persistent histological active LN (activity index ≥2) was present in 11 (19.6%) KB2s. There were no differences when comparing immunological parameters between both groups (activity index ≥2 versus <2) at KB2, nor in the percentage of patients who presented renal flare. Immunosuppressive treatment was withdrawn in 35 (62.5%) patients and maintained/switched in 21 (37.5%). Afterward, new renal flare occurred in 9 patients per group (25.7% and 43%, respectively), after a median time of 39 months (IQR 6.5-55) and 7 months (IQR 6-30), respectively. There was no difference in the number of patients who developed chronic kidney disease [n = 14 (25%)] according to the treatment. In conclusion, KB2 provides valuable information to guide immunosuppressive maintenance therapy

Differentiating Acute Interstitial Nephritis From Immune Checkpoint Inhibitors From Other Causes

Immune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with neoplasms in advanced stages. On the other hand, ICIs have immune-related adverse events. These adverse events affect mostly other organs than the kidney, such as skin or gastrointestinal tract. The incidence of nephrotoxicity with monotherapy with any ICI is about 2%, which increases to 5% in combination therapy. Acute tubulointerstitial nephritis (AIN) is the most common pattern of kidney damage related to ICIs. Globally, without considering ICI nephrotoxicity, AIN is estimated to account for 15% to 20% of cases of acute kidney injury (AKI). This is crucial because patients who are treated with ICIs, may also be taking other drugs that potentially cause AIN, and therefore, knowing the particularities about ICI-related AIN could be helpful in clinical practice to better understand the phenotypic differences between the 2 types of AIN. In addition, several studies have now shown that being on proton pump inhibitors is a risk factor for AIN from ICI therapy

Development of a DIPG Orthotopic Model in Mice Using an Implantable Guide-Screw System

Objective In this work we set to develop and to validate a new in vivo frameless orthotopic Diffuse Intrinsic Pontine Glioma (DIPG) model based in the implantation of a guide-screw system. Methods It consisted of a guide-screw also called bolt, a Hamilton syringe with a 26-gauge needle and an insulin-like 15-gauge needle. The guide screw is 2.6 mm in length and harbors a 0.5 mm central hole which accepts the needle of the Hamilton syringe avoiding a theoretical displacement during insertion. The guide-screw is fixed on the mouse skull according to the coordinates: 1mm right to and 0.8 mm posterior to lambda. To reach the pons the Hamilton syringe is adjusted to a 6.5 mm depth using a cuff that serves as a stopper. This system allows delivering not only cells but also any kind of intratumoral chemotherapy, antibodies or gene/viral therapies. Results The guide-screw was successfully implanted in 10 immunodeficient mice and the animals were inoculated with DIPG human cell lines during the same anesthetic period. All the mice developed severe neurologic symptoms and had a median overall survival of 95 days ranging the time of death from 81 to 116 days. Histopathological analysis confirmed tumor into the pons in all animals confirming the validity of this model. Conclusion Here we presented a reproducible and frameless DIPG model that allows for rapid evaluation of tumorigenicity and efficacy of chemotherapeutic or gene therapy products delivered intratumorally to the pons

Diversity, distribution and conservation of the terrestrial reptiles of Oman (Sauropsida, Squamata)

All authors: Salvador Carranza , Meritxell Xipell, Pedro Tarroso, Andrew Gardner, Edwin Nicholas Arnold, Michael D. Robinson, Marc Simó-Riudalbas, Raquel Vasconcelos, Philip de Pous, Fèlix Amat, Jiří Šmíd, Roberto Sindaco, Margarita Metallinou †, Johannes Els, Juan Manuel Pleguezuelos, Luis Machado, David Donaire, Gabriel Martínez, Joan Garcia-Porta, Tomáš Mazuch, Thomas Wilms, Jürgen Gebhart, Javier Aznar, Javier Gallego, Bernd-Michael Zwanzig, Daniel Fernández-Guiberteau, Theodore Papenfuss, Saleh Al Saadi, Ali Alghafri, Sultan Khalifa, Hamed Al Farqani, Salim Bait Bilal, Iman Sulaiman Alazri, Aziza Saud Al Adhoobi, Zeyana Salim Al Omairi, Mohammed Al Shariani, Ali Al Kiyumi, Thuraya Al Sariri, Ahmed Said Al Shukaili, Suleiman Nasser Al Akhzami.In the present work, we use an exceptional database including 5,359 records of 101 species of Oman’s terrestrial reptiles together with spatial tools to infer the spatial patterns of species richness and endemicity, to infer the habitat preference of each species and to better define conservation priorities, with especial focus on the effectiveness of the protected areas in preserving this unique arid fauna. Our results indicate that the sampling effort is not only remarkable from a taxonomic point of view, with multiple observations for most species, but also for the spatial coverage achieved. The observations are distributed almost continuously across the two-dimensional climatic space of Oman defined by the mean annual temperature and the total annual precipitation and across the Principal Component Analysis (PCA) of the multivariate climatic space and are well represented within 17 out of the 20 climatic clusters grouping 10% of the explained climatic variance defined by PC1 and PC2. Species richness is highest in the Hajar and Dhofar Mountains, two of the most biodiverse areas of the Arabian Peninsula, and endemic species richness is greatest in the Jebel Akhdar, the highest part of the Hajar Mountains. Oman’s 22 protected areas cover only 3.91% of the country, including within their limits 63.37% of terrestrial reptiles and 50% of all endemics. Our analyses show that large areas of the climatic space of Oman lie outside protected areas and that seven of the 20 climatic clusters are not protected at all. The results of the gap analysis indicate that most of the species are below the conservation target of 17% or even the less restrictive 12% of their total area within a protected area in order to be considered adequately protected. Therefore, an evaluation of the coverage of the current network of protected areas and the identification of priority protected areas for reptiles using reserve design algorithms are urgently needed. Our study also shows that more than half of the species are still pending of a definitive evaluation by the International Union for Conservation of Nature (IUCN).This work was funded by grants CGL2012-36970, CGL2015-70390-P from the Ministerio de Economía y Competitividad, Spain (cofunded by FEDER) to SC, the project Field study for the conservation of reptiles in Oman, Ministry of Environment and Climate Affairs, Oman (Ref: 22412027) to SC and grant 2014-SGR-1532 from the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement de la Generalitat de Catalunya to SC. MSR is funded by a FPI grant from the Ministerio de Economía y Competitividad, Spain (BES-2013-064248); RV, PT and LM were funded by Fundação para a Ciência e Tecnologia (FCT) through post-doc grants (SFRH/BPD/79913/2011) to RV, (SFRH/BPD/93473/2013) to PT and PhD grant (SFRH/BD/89820/2012) to LM, financed by Programa Operacional Potencial Humano (POPH) – Quadro de Referência Estrategico Nacional (QREN) from the European Social Fund and Portuguese Ministerio da Educação e Ciência

Jardins per a la salut

Facultat de Farmàcia, Universitat de Barcelona. Ensenyament: Grau de Farmàcia. Assignatura: Botànica farmacèutica. Curs: 2014-2015. Coordinadors: Joan Simon, Cèsar Blanché i Maria Bosch.Els materials que aquí es presenten són el recull de les fitxes botàniques de 128 espècies presents en el Jardí Ferran Soldevila de l’Edifici Històric de la UB. Els treballs han estat realitzats manera individual per part dels estudiants dels grups M-3 i T-1 de l’assignatura Botànica Farmacèutica durant els mesos de febrer a maig del curs 2014-15 com a resultat final del Projecte d’Innovació Docent «Jardins per a la salut: aprenentatge servei a Botànica farmacèutica» (codi 2014PID-UB/054). Tots els treballs s’han dut a terme a través de la plataforma de GoogleDocs i han estat tutoritzats pels professors de l’assignatura. L’objectiu principal de l’activitat ha estat fomentar l’aprenentatge autònom i col·laboratiu en Botànica farmacèutica. També s’ha pretès motivar els estudiants a través del retorn de part del seu esforç a la societat a través d’una experiència d’Aprenentatge-Servei, deixant disponible finalment el treball dels estudiants per a poder ser consultable a través d’una Web pública amb la possibilitat de poder-ho fer in-situ en el propi jardí mitjançant codis QR amb un smartphone

Carta rebuda de Francesc de Marc Xipell. 1728

Sallen

The ‘Phosphorus Week’: involvement of Spanish nephrologists in the control of phosphorus blood levels

Background: The adequate control of phosphorus levels is a major concern for professionals involved in the care of patients with chronic kidney disease (CKD), since high phosphorus levels are directly related to an increase in mortality. Objectives: To know the perception and involvement of Spanish nephrologists on the control of phosphorus levels, the so-called 'Phosphorus Week' was organized (November 13–17, 2017). Methods: All members of the Spanish Society of Nephrology were invited to participate in an online survey, which included questions on aspects related to phosphorus control in patients with advanced CKD (aCKD) (glomerular filtration rate <30 ml/min/1, 73 m2) and in the different modalities of renal replacement therapies [peritoneal dialysis (PD), hemodialysis (HD) and renal transplantation (KT)]. Results: 72 data entries were obtained in the survey with an inclusion of 7463 patients. Of them, 35.4% were on HD, 34.8% were KT, 24.2% had aCKD and 5.5% were on PD. The serum phosphorus level target for the four groups of patients was 4.5 mg/dl, with minimal variations depending on the area of ​​the national territory. The patients with better control of phosphataemia were patients with KT (93.3% had phosphorus values ​​<4.5 mg/dl), followed by patients with aCKD (65.6% with phosphorus <4.5 mg/dl). Only 53.6% of the patients on HD and 39.4% of those on PD reached the phosphorus goal <4.5 mg/dl. The group of patients on dialysis was the one in whom phosphorus binders prescribed the most (73.5% and 75.6% in HD and PD, respectively), being less frequent in patients with patients with aCKD (39.9%) and only 4.5 % in KT. Conclusions: The objectives of the Spanish nephrologists are in line with those recommended by the national and international clinical guidelines; however, there is still a wide room for improvement to achieve these goals, especially in HD and PD patients. Resumen: Antecedentes: El adecuado control de la fosfatemia es objeto de importante preocupación por los profesionales involucrados en el cuidado de los pacientes con enfermedad renal crónica (ERC), ya que los valores elevados de fósforo se encuentran directamente relacionados con un aumento de la mortalidad. Objetivos: Con el objetivo de conocer la percepción e implicación que los nefrólogos españoles tienen de la necesidad de controlar el fósforo sérico, así como lograr una muestra lo más representativa posible de los valores séricos actuales, se organizó la denominada ‘Semana del Fósforo’ (13–17 de noviembre de 2017). Métodos: Se invitó a participar en una encuesta “on-line” a todos los socios de la Sociedad Española de Nefrología, que incluía preguntas sobre aspectos relacionados con el control del fósforo en pacientes con ERC avanzada (ERCA) (filtrado glomerular <30 ml/min/1.73 m2) y en las distintas modalidades de tratamiento renal sustitutivo [diálisis peritoneal (DP), hemodiálisis (HD) y trasplante renal (TR)]. Resultados: Se obtuvieron 72 entradas de datos con 7463 pacientes incluidos, de los cuales el 35.4% de ellos estaban en HD, el 34.8% eran TR, el 24.2% tenían ERCA y el 5.5% estaban en DP. El objetivo de fósforo sérico para los cuatro grupos de pacientes fue de 4.5 mg/dl, con mínimas variaciones en función del área del territorio nacional. Los pacientes con mejor control de la fosfatemia fueron los pacientes con TR (el 93.3% presentaban valores de fósforo <4.5 mg/dL), seguidos por los pacientes en ERCA (65.6% con fósforo <4.5 mg/dL). Sólo un 53.6% de los pacientes en HD y el 39.4% de los que estaban en DP cumplieron el objetivo de fósforo <4.5 mg/dL. El grupo de pacientes en diálisis fue en el que más se prescribían captores de fósforo (73.5% y 75.6% en los pacientes en HD y DP, respectivamente), siendo menos frecuente en los pacientes en ERCA (39.9%) y sólo un 4.5% en los TR. Conclusiones: Los resultados nos indican que los objetivos de los profesionales españoles están en consonancia con lo que recomiendan las guías clínicas nacionales e internacionales; sin embargo, aún hay un amplio margen de mejora para lograr esos objetivos, especialmente en los pacientes en HD y DP

Diversidad, distribución y conservación de los rept iles terrestres de Omán

Xipell, Meritxell et al.-- Trabajo presentado en el XIV Congreso Luso-Español de Herpetología (CLEH2016), XVIII Congreso Español de Herpetología (Challenges of Herpetology in the XXI century), celebrado en Lleida del 5 al 8 de octubre de 2016.[EN] Arid areas encompass a large portion of Earth surface and are important for understanding global biodiversity patterns. Despite arid areas are thought to have relative low species richness compared to other biomes like for instance tropical rainforests, they are often inhabited by many specialized deep lineages of arid adapted species. While much attention has been focused on arid areas from Australia and North America, other areas of North Africa and especially Arabia have been largely neglected despite an increasing number of biogeographic and phylogenetic studies. The Arabian Peninsula comprises an area of approximately 3.2 million km 2 where arid conditions prevail and deserts have a dominant presence. Its geological and climatic history is rich and complex and includes major tectonic events, the for mation of mountain and deserts. All these geological and climatic factors have conditioned the evolution of its biota. Although arid environments are often perceived as monotonous, Arabian hosts a great diversity of organism adapted to its challenging conditions, being reptil es one of the commonest inhabitants. As a result of their ectothermy, reptiles are greatly affected by the thermal landscapes of their habitat. Moreover, they are relatively easy to catch and sample for phylogenetic studies, they are widely represented in Museum collections worldwide and, for many groups, there is abundant and detailed information on their taxonomy, ecology and distribution ranges. As a result of that, they not only constitute excellent vertebrate models for evolutionary, biogeographical and ecological studies, but also are excellent surrogates for conservation planning on arid areas. For the past 10 years we have been working on the Systematics, Biodiversity, Biogeography and evolution of Arabian reptiles, with special attention to the terrestrial reptiles of Oman, a country in which we have carried out more than 16 independent field trips since 2005, allowing us to explore its geography in depth, including most of its mountain ranges and islands. The systematic knowledge of the reptile fauna of Oman, to which our group has contributed extensively, is, by far, the most comprehensive in all Arabia Peninsula. In this talk , we will use an unprecedented database of 5359 records for all 101 species of terrestrial reptiles of Oman together with spatial tools to assess the quality of our sampling, provide detailed distribut ion maps of the species, and infer the spatial patterns of species richness and endemicity. With environmental data sets we will assess the habitat preference of each species. As a poorly assessed area for conservation priorities, we will additionally provide information to inform the conservation status and conservation threats of the reptiles of Oman, with an especial interest on the effectiveness of the protected areas to preserve this unique fauna.[ES] Las zonas áridas abarcan una gran parte de la superficie de la Tierra y son claves para entender los patrones de biodiversidad a nivel mundial. A pesar de la creencia de que las zonas áridas tienen una riqueza de especies relativamente baja en comparación con otros biomas, como por ejemplo los bosques tropicales, a menudo están habitadas por una gran cantidad de linajes profundos adaptados a las condiciones áridas. Mientras que la mayor parte de la atención se ha centrado en las zonas áridas de Australia y América del Norte, el Norte de África y en especial Arabia han sido descuidadas en gran medida a pesar de un número creciente de estudios biogeográficos y filogenéticos. La Península Arábiga comprende una superficie de aproximadamente 3,2 millones de km2, donde las condiciones áridas prevalecen y los desiertos tienen una presencia dominante. Su historia geológica y climática es rica y a su vez compleja e incluye numerosos eventos tectónicos, la formación de las montañas y desiertos. Todos estos factores geológicos y climáticos han condicionado la evolución de su biota. A pesar de que los ambientes áridos a menudo se perciben como monótonos, Arabia alberga una gran diversidad de organismos adaptados a sus condiciones extremas, siendo los reptiles uno de sus habitantes más comunes. Como resultado de su ectotermia, los reptiles se ven muy afectados por los cambios climáticos. Por otra parte, son relativamente fáciles de coger y de muestrear para estudios filogenéticos, están ampliamente representados en colecciones y, para muchos grupos, existe información abundante y detallada sobre su taxonomía, ecología y distribución. Como resultado de ello, no sólo constituyen un excelente modelo para los estudios evolutivos, biogeográficos y ecológicos de vertebrados, sino que también son un modelo excelente para la planificación de la conservación en zonas áridas. Durante los últimos 10 años hemos estado trabajando en la sistemática, biodiversidad, biogeografía y evolución de los reptiles de Arabia, con especial atención a los reptiles terrestres de Omán, un país en el que hemos llevado a cabo más de 16 expediciones desde el año 2005, lo que nos ha permitido explorar su geografía en profundidad, incluyendo la mayoría de sus cadenas montañosas e islas. El conocimiento sistemático de la fauna de reptiles de Omán, al que nuestro grupo ha contribuido en gran medida, es, sin lugar a dudas, el más completo de toda Arabia. En esta charla, vamos a utilizar una base de datos sin precedentes que incluye 5359 registros de las 101 especies de reptiles terrestres de Omán. Mediante herramientas geoespaciales vamos a evaluar la calidad de nuestros muestreos, proporcionar mapas de distribución detallados de las especies, e inferir los patrones espaciales de la riqueza de especies y endemicidad. Con los conjuntos de datos ambientales vamos a evaluar la preferencia de hábitat de cada especie. Igualmente, vamos a proporcionar información adicional para informar sobre el estado de conservación y amenazas de los reptiles de Omán y vamos a evaluar la eficacia de las áreas protegidas para preservar esta fauna tan excepcional.N