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ZusammenfassungDas Nierenzellkarzinom ist der zweithäufigste bzw. dritthäufigste urologische maligne Tumor der Frau bzw. des Mannes mit einem Erkrankungsgipfel in der 7. Lebensdekade. Früh erkannt ist es gut heilbar, sofern der Tumor nicht metastasiert ist. Im Gegensatz zu früher ist bei lokal begrenzten Nierenzellkarzinomen die lokale Therapie (Teil-Entfernung/topische Energieapplikation wie Radio-Frequenz-Ablation oder Kryoablation) die leitliniengerechte operative Therapie, wobei je nach Expertise des Operateurs die minimalinvasive (laparoskopisch/roboterassistiert) oder offene Operation ihre Berechtigung haben. Die verschiedenen Leitlinien setzen hier unterschiedliche Akzente. Bei der individuellen Therapieentscheidung müssen aber insbesondere Alter und Komorbiditäten in die Überlegung einbezogen werden. Dies kann dazu führen, dass auch bei lokal begrenzten Tumoren aufgrund der geringen perioperativen Morbidität eine (minimalinvasive) radikale Nephrektomie an Stelle einer Teil-Nephrektomie zu empfehlen ist oder aber eine aktive Überwachungsstrategie die richtige Behandlungsoption darstellt, ohne die Lebenserwartung des Karzinomträgers zu kompromittieren. Höhergradige Tumoren hingegen sollen – vorausgesetzt es sind keine Metastasen nachweisbar – Indikation zur Nephrektomie sein, auch wenn z. B. Tumorthromben bis in den Vorhof reichen. Mögliche Komplikationen eines operativen Eingriffs sind in aller Regel selten und gut beherrschbar.

ImportanceGrowing evidence suggests that coronavirus disease 2019 (COVID-19) is associated with neurological sequelae. However, the underlying pathophysiological mechanisms resulting in central nervous system (CNS) derogation remain unclear.ObjectiveTo identify severity-dependent immune mechanisms in the cerebrospinal fluid (CSF) and plasma of COVID-19 patients and their association with brain imaging alterations.DesignProspective cross-sectional cohort study.SettingThis study was performed from August 2020 to April 2021. Participants were enrolled in the outpatient clinics, hospital wards and intensive care units (ICU) of two clinical sites in Basel and Zurich, Switzerland.ParticipantsAge >18 years and a positive SARS-CoV-2 test result were inclusion criteria. Potentially matching individuals were identified (n=310), of which 269 declined to participate and 1 did not match inclusion criteria. Paired CSF and plasma samples, as well as brain images, were acquired. The COVID-19 cohort (n=40; mean [SD] age, 54 [20] years; 17 women (42%)) was prospectively assorted by neurological symptom severity (classes I, II and III). Age/sex-matched inflammatory (n=25) and healthy (n=25) CSF and plasma control samples were obtained. For volumetric brain analysis, a healthy age/sex-matched control cohort (n=36) was established.ExposuresLumbar puncture, blood sampling and cranial MRI and/or CT.Main outcomes and measuresProteomics, standard parameters and antibody profiling of paired CSF and plasma samples in COVID-19 patients and controls. Brain imaging and gray matter volumetric analysis in association with biomarker profiles. Follow-up after 10-months.ResultsCOVID-19 patients displayed a plasma cytokine storm but a non-inflammatory CSF profile. Class III patients displayed signs of blood-brain barrier (BBB) impairment and a polyclonal B cell response targeting self- and non-self antigens. Decreased regional brain volumes were present in COVID-19 patients and associated with specific CSF and plasma parameters.Conclusion and relevanceNeuro-COVID class III patients had a strong, peripheral immune response resulting in (1) BBB impairment (2) ingress of (auto-)antibodies, (3) microglia activation and neuronal damage signatures. Our data point towards several potentially actionable targets that may be addressed to prevent COVID-19-related neurological sequelae.Trial registrationThe trial (NCT04472013) was registered on clinicaltrials.gov.Key pointsQuestionDoes a severity-dependent pattern of immune mechanisms exist in the cerebrospinal fluid (CSF) and plasma of COVID-19 patients and are these associated with clinical and brain imaging findings?FindingsNeuro-COVID patients display a robust class III-specific peripheral immune response resulting in (1) blood-brain barrier (BBB) impairment, (2) ingress of (auto-)antibodies, (3) microglia activation and neuronal damage signatures. Integration of MRIs, brain volumetry and proteomics identified biomarkers associated with regional brain volume loss in severe Neuro-COVID.MeaningWe provide a multidimensional framework of mechanisms associated with severe Neuro-COVID and present possible targets to prevent COVID-19-related neurological sequelae.

O feijão representa 50% do volume de grãos consumidos no mundo e este é a principal fonte de proteína usada na alimentação humana em diversos países da América Latina, da África Oriental e da África do Sul. O presente estudo foi realizado com o objetivo de estimar a diversidade genética de nove acessos de feijão (oito acessos crioulos e uma cultivar comercial) por meio da caracterização morfológica e agronômica em condições de campo na região Noroeste do Rio Grande do Sul. Foram avaliados treze caracteres de plantas e sementes. Os acessos de feijão crioulo apresentaram pouca divergência significativa, exceto o acesso Vermelho que se destacou como o de maior divergência genética a partir dos caracteres avaliados. As variáveis com maior contribuição para a separação dos acessos foram peso de mil sementes, largura e comprimento das sementes e número de dias da emergência a floração. Os caracteres relacionados à morfologia das sementes apresentam maior contribuição relativa na formação dos grupos. A maturação fisiológica não é um bom indicador da distância genética entre os acessos de feijão para as condições de condução do experimento.

Renal cell carcinoma is the 2nd most frequent urological malignancy in women and the third most frequent in men, with an age peak in the seventh decade of life. If detected early in a local non-metastatic stage, options for complete recovery are excellent. While two decades ago, even locally limited cancers of the kidney were cured by radical nephrectomy, treatment today mostly consists of local treatment for locally confined cancers. Guidelines today recommend local surgical excision (open or minimally-invasive) or - in selected cases - topical energy application (radio-frequency ablation, cryoablation). The surgeon's expertise is most important in the selection of the appropriate kind of surgery and different guidelines have slightly different recommendations.Treatment decisions should be made on an individual basis in due consideration of an individual's age and co-morbidities. This may lead to the recommendation that, due to low perioperative morbidity, even localised carcinomas should be treated by (minimally-invasive) radical nephrectomy instead of nephron-sparing surgery and, in other cases, a non-interventional, active surveillance strategy may be pursued without compromising the patient's life expectancy. For higher-grade renal cell carcinomas, there is usually an indication for radical nephrectomy, as long as no metastases are detected. This also applies to carcinomas with venous thrombi extending into the atrium of the heart. Complications in the treatment of renal carcinomas are usually rare and easily treatable in most cases.Das Nierenzellkarzinom ist der zweithäufigste bzw. dritthäufigste urologische maligne Tumor der Frau bzw. des Mannes mit einem Erkrankungsgipfel in der 7. Lebensdekade. Früh erkannt ist es gut heilbar, sofern der Tumor nicht metastasiert ist. Im Gegensatz zu früher ist bei lokal begrenzten Nierenzellkarzinomen die lokale Therapie (Teil-Entfernung/topische Energieapplikation wie Radio-Frequenz-Ablation oder Kryoablation) die leitliniengerechte operative Therapie, wobei je nach Expertise des Operateurs die minimalinvasive (laparoskopisch/roboterassistiert) oder offene Operation ihre Berechtigung haben. Die verschiedenen Leitlinien setzen hier unterschiedliche Akzente. Bei der individuellen Therapieentscheidung müssen aber insbesondere Alter und Komorbiditäten in die Überlegung einbezogen werden. Dies kann dazu führen, dass auch bei lokal begrenzten Tumoren aufgrund der geringen perioperativen Morbidität eine (minimalinvasive) radikale Nephrektomie an Stelle einer Teil-Nephrektomie zu empfehlen ist oder aber eine aktive Überwachungsstrategie die richtige Behandlungsoption darstellt, ohne die Lebenserwartung des Karzinomträgers zu kompromittieren. Höhergradige Tumoren hingegen sollen – vorausgesetzt es sind keine Metastasen nachweisbar – Indikation zur Nephrektomie sein, auch wenn z. B. Tumorthromben bis in den Vorhof reichen. Mögliche Komplikationen eines operativen Eingriffs sind in aller Regel selten und gut beherrschbar.

INTRODUCTION AND OBJECTIVES:Recently our group showed that Vim3, a truncated variant of Vimentin, is overexpressed in oncocytoma and can be used as differentiating marker. Normally Vim3 is a marker...

INTRODUCTION AND OBJECTIVES:One-stage augmentation urethral reconstruction with buccal mucosa is the method of choice in recurrent urethral strictures and achieves good results up to 75-85% with lo...