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Abstract: Brain tissue is known to have elevated citrate levels, necessary to regulate ion chelation, neuron excitability, and are also necessary for the supply of necessary energy substrates to neurons. Importantly, citrate also acts as a central substrate in cancer metabolism. Recent studies have shown that extracellular citrate levels in the brain undergo significant changes during tumor development and may play a dual role in tumor progression, as well as cancer cell aggressiveness. In the present article, we review available literature describing changes of citrate levels in brain tissue, blood, and cerebrospinal fluid, as well as intracellular alterations during tumor development before and after metastatic progression. Based on the available literature and our recent findings, we hypothesize that changes in extracellular citrate levels may be related to the increased consumption of this metabolite by cancer cells. Interestingly, cancerassociated cells, including reactive astrocytes, might be a source of citrate. Extracellular citrate uptake mechanisms, as well as potential citrate synthesis and release by surrounding stroma, could provide novel targets for anti-cancer treatments of primary brain tumors and brain metastases.

Background Demographic changes are leading to an increase in geriatric urolithiasis patients aged ≥70 yr. Published data regarding their management remain sparse. In particular, for the subgroup of patients aged ≥80 yr there is a lack of evidence supporting the hypothesis that stone-removing treatment is effective, safe, and beneficial. Objective To examine the efficiency and safety of stone-removing treatment in geriatric urolithiasis patients aged ≥80 yr compared to their younger geriatric counterparts aged 70–79 yr against the background of their respective life expectancy. Design, setting, and participants Data for the study cohort were extracted from an institutional review board–approved retrospective database with 325 patients aged ≥70 yr (70–79 yr: n = 241; ≥80 yr: n = 84) consecutively admitted to hospital because of symptomatic urolithiasis from 2013 to 2018. Outcome measurements and statistical analysis Baseline characteristics, outcome and follow-up data, and survival were compared using Wilcoxon-Mann-Whitney U tests, χ2 tests, Kaplan-Meier estimation, log-rank tests, and Cox regression. Results and limitations At baseline, the incidence of infected hydronephrosis was greater among patients aged ≥80 yr (p 0.05). Survival analysis for the two groups demonstrated a 2-yr overall survival (OS) rate of 0.91 (95% confidence interval [CI] 0.75–1) for patients aged ≥80 yr and 0.97 (95% CI 0.88–1), for those aged 70–79 yr (p Conclusions Stone-removing treatment for patients aged ≥80 yr proved to be as effective and safe as for patients in their seventies. Although characterized by shorter remaining life expectancy, excellent 2-yr OS for patients aged ≥80 yr supports the hypothesis of equal benefit from stone-removing treatment when compared to septuagenarians. Patient summary There is a lack of evidence supporting the benefit of urinary stone-removing treatment for patients older than 80 yr. Our study included geriatric patients older than 70 yr with symptomatic urinary stone disease for which urinary drainage or stone removal is indicated. We compared treatment outcomes and survival between two age groups: patients aged 70–79 yr and those aged 80 yr or older. We found equivalent outcomes for the two groups and excellent 2-yr overall survival of 91% for those older than 80 yr. The study strengthens the evidence that active stone-removing therapy is safe and beneficial for these patients.

To investigate the efficacy and safety of multi-tract percutaneous nephrolithotomy (PNL) against the benchmark of the single-tract approach.A retrospective analysis of 391 consecutive PNL procedures was conducted in our tertiary referral center between April 2016 and March 2020. Clinical outcome parameters such as stone-free rate, operation time, postoperative complications according to Clavien-Dindo, length of hospital stay and time to ipsilateral recurrence resulting in active treatment were assessed.Multi-tract PNL and single-tract PNL were performed in 37 (9%) and 354 (91%) cases respectively. At baseline, compared to single-tract PNL, multi-tract PNL cases were characterized by significantly larger stone burden (2.62 vs 0.97 cmIn this retrospective single-center analysis, a multi-tract PNL has been proved to be an efficient and safe expansion of single-tract PNL for large stone burden and complex kidney stone disease. Future prospective research should focus on the procedure's potential effectiveness in reducing the number of interventions until stone-free status in patients with massive stone disease.

Die Einführung von Antikörpern gegen die immunregulatorischen Oberflächenmoleküle, programmed cell death protein 1 (PD-1) und cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), hat die Behandlung von Tumorerkrankungen revolutioniert. Diese sogenannten Immuncheckpoint-Inhibitoren verfügen über ein enormes therapeutisches Potenzial und werden zur Behandlung vieler verschiedener Tumorentitäten eingesetzt. Häufig treten bei Patienten, die mit Checkpoint-Inhibitoren behandelt werden, immunvermittelte Nebenwirkungen auf, die die klinische Anwendung limitieren. Trotz umfassender Bemühungen, die Ätiologie immunvermittelter Komplikationen zu verstehen, sind die zugrundeliegenden zellulären Mechanismen nach wie vor weitgehend ungeklärt. Unserer Arbeitsgruppe ist es gelungen, Patienten mit metastasiertem Melanom zu identifizieren, die eine erhöhtes Risiko haben, eine immunvermittelte Hepatitis zu entwickeln. Diese Gruppe von Patienten zeichnet sich durch eine erhöhte Anzahl von CD4