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Hector Vazquez-Lorente (FPU18/03655) and Lucas Jurado-Fasoli (FPU19/01609) are under an FPU fellowship from the Spanish Ministry of Education. This study is part of a Ph.D. thesis conducted in the Biomedicine Doctoral Studies of the University of Granada, Spain. The APC was funded by San Cecilio University Hospital, FIBAO, IBS-Granada, Spain., alpha-Klotho protein is a powerful predictor of the aging process and lifespan. Although lowered circulating soluble alpha-Klotho levels have been observed in aged non-healthy individuals, no specific reference values across a wide range of ages and sex using an enzyme-linked immunosorbent assay (ELISA) are available for larger cohorts of healthy individuals. The present analytical cross-sectional study was aimed to establish the reference values of soluble alpha-Klotho serum levels in healthy adults by age and sex groups. A total of 346 (59% women) healthy individuals aged from 18 to 85 years were recruited. Subjects were divided by sex and age as: (i) young (18-34.9 years), (ii) middle-aged (35-54.9 years), and (iii) senior (55-85 years) individuals. The soluble alpha-Klotho levels were measured in serum using ELISA. Senior adults were the age-group that presented the lowest soluble alpha-Klotho serum levels (p < 0.01), with age showing a negative association with soluble alpha-Klotho serum levels (p < 0.001). No differences between sexes were observed. Therefore, soluble alpha-Klotho levels were especially decreased-regardless of sex-in our cohort of healthy individuals because of the physiological decline derived from the aging process. We recommend routine assessments of soluble alpha-Klotho levels using ELISA as a simple and cheap detectable marker of aging that improves quality of life in the elderly., Spanish Government FPU18/03655 FPU19/01609, San Cecilio University Hospital, FIBAO, IBS-Granada, Spain

This research was funded by the Institute of Health Carlos III grants (PI18-00803 and PI18-01235), co-funded by the European Regional Development Fund (FEDER). In addition, JM.V-S and C.G-F are funded by predoctoral and postdoctoral fellowships, respectively, from the Institute of Health Carlos III (CM19/00188; CD20/00022). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results., Hypophosphatasia (HPP) is a rare genetic disease characterized by a decrease in the activity of tissue non-specific alkaline phosphatase (TNSALP). TNSALP is encoded by the ALPL gene, which is abundantly expressed in the skeleton, liver, kidney, and developing teeth. HPP exhibits high clinical variability largely due to the high allelic heterogeneity of the ALPL gene. HPP is characterized by multisystemic complications, although the most common clinical manifestations are those that occur in the skeleton, muscles, and teeth. These complications are mainly due to the accumulation of inorganic pyrophosphate (PPi) and pyridoxal-5 '-phosphate (PLP). It has been observed that the prevalence of mild forms of the disease is more than 40 times the prevalence of severe forms. Patients with HPP present at least one mutation in the ALPL gene. However, it is known that there are other causes that lead to decreased alkaline phosphatase (ALP) levels without mutations in the ALPL gene. Although the phenotype can be correlated with the genotype in HPP, the prediction of the phenotype from the genotype cannot be made with complete certainty. The availability of a specific enzyme replacement therapy for HPP undoubtedly represents an advance in therapeutic strategy, especially in severe forms of the disease in pediatric patients., Instituto de Salud Carlos III PI18-00803 PI18-01235 CM19/00188 CD20/00022, European Commission

A 76-year-old man presented with a tumoral lesion in his penis that had all the light microscopic and immunohistochemical features of a squamous cell carcinoma with rhabdoid phenotype. We believe that this is the fourth reported case of squamous cell carcinoma with rhabdoid features and the first one located in the penis. Rhabdoid cells were primarily located in areas with an alveolar pattern, most of them being isolated and intermixed with necrotic cells and necrotic debris. We suggest that the rhabdoid phenotype could represent a type of degeneration, or a preliminary stage before apoptosis or cell necrosis, instead of a specific differentiation. In extrarenal tumors with rhabdoid features, stage and histologic types of tumors where rhabdoid changes occur are the most important prognostic factors. Ann Diagn Pathol 6:381-384, 2002.

Recurrent kidney stones are associated with bone mineral density loss, altered bone remodeling markers, hypercalciuria and increased in fasting calcium/creatinine ratio. The objective was to determine biochemical alterations in urine in patients with osteopenia/osteoporosis without calcium kidney stones compared with patients with calcium kidney stones. This is a cross-sectional study including 142 patients who were divided in two groups: Group 1 (patients with recurrent calcium kidney stones) and Group 2 (patients with osteopenia/osteoporosis in the lumbar spine or hip). Analyses of bone mineral density, calcium–phosphorous and bone metabolism and lithogenic risk factors in fasting urine samples and 24-h urine samples were performed. Statistical analysis was carried out with SPSS 17.0. A p ≤ 0.05 was considered statistically significant. Patients in Group 2 presented greater loss of bone mineral density and more elevated alkaline phosphatase, iPTH, phosphorous and β-crosslaps levels, as compared to patients in Group 1. However, Group 1 presented greater urine calcium, oxalate and uric acid and a higher proportion of hypocitraturia, hypercalciuria and hyperoxaluria, as compared to Group 2. Multivariate analysis revealed that advanced age and β-crosslaps levels are risk factors for bone mineral density loss, while low urinary calcium excretion was protective against bone demineralization. Patients with osteopenia/osteoporosis without lithiasis present some urinary biochemical alterations. This would explain the lack of lithogenic activity, although low calcium excretion in 24-h urine samples is a protective factor against the loss of bone mineral density.