Robot-assisted vs. open radical cystectomy: systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Several randomized controlled trials (RCTs) have been launched in the last decade to examine the surgical safety and oncological efficacy of robot-assisted (RARC) vs open radical cystectomy (ORC) for patients with bladder cancer. The aim of the study was to perform a systematic review and meta-analysis of RCTs to compare the perioperative and oncological outcomes of RARC vs ORC. METHODS: A literature search was conducted through July 2022 using PubMed/Medline, Embase, and Web of Science databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. The outcomes were intraoperative, postoperative, and oncological outcomes of RARC vs ORC. RESULTS: A total of eight RCTs comprising 1,024 patients met our inclusion criteria. RARC was associated with longer operative time (mean 92.34min, 95% CI 83.83-100.84, p<0.001) and lower blood transfusion rate (Odds ratio [OR] 0.43, 95% CI 0.30-0.61, p<0.001). No differences emerged in terms of 90-day overall (p=0.28) and major (p=0.57) complications, length of stay (p=0.18), bowel recovery (p=0.67), health-related quality of life (p=0.86), disease recurrence (p=0.77) and progression (p=0.49) between the two approaches. The main limitation is represented by the low number of patients included in half of RCTs included. CONCLUSIONS: This study supports that RARC is not inferior to ORC in terms of surgical safety and oncological outcomes. The benefit of RARC in terms of lower blood transfusion rate need to be balanced with the cost related to the procedure.

Endophytic fungi isolated from plants present in a mine tailing facility show a differential growth response to lead.

Plants growing in metal-polluted sites can be a source of micro-organisms suitable for bio-assisted phytoremediation strategies. In this work, three endophytic fungi from the roots of Poa stuckertii and Poa pratensis, two grasses that naturally colonize a Lead-Zinc tailing storage facility in Southern Chile, were isolated and identified. The leachate of the tailing sands showed a Pb content of 1·36 ± 0·71 ppm, and a pH of 7·3. By amplifying the ITS1/ITS4 region of fungal ribosomal DNA, the isolates were identified as Bjerkandera sp., Microdochium sp. and Sarocladium sp. When the growth media was supplemented with 50 ppm of Pb at pH 4·5, Microdochium sp. showed an 80% decrease in the biomass, but the biomass production of Bjerkandera sp. and Sarocladium sp. was not affected by the same treatment. The accumulation of Pb in Microdochium sp. increased as a function of the concentration of the metal in the growth media, between 48·3 and 241·3 µmol l-1 . We showed that two Poaceae plants growing on a Lead-Zinc tailing storage facility are a source of endophyte fungi and that Pb had a differential effect on the growth of the isolated fungi independent of the plant of origin.

Failure of Bacillus Calmette-Guérin therapy in non-muscle-invasive bladder cancer: Definition and treatment options.

UNLABELLED: Adjuvant intravesical bacillus Calmette- Guérin (BCG) therapy is the standard conservative adjuvant treatment and the most effective regimen for patients with high-risk non-muscle-invasive bladder cancer (NMIBC). The term "BCG failure" is generally used to refer to recurrence or progression following BCG therapy, as experienced by many patients. However, the term has been defined inconsistently, and several studies have indicated that patients with a particular pattern of BCG failure have a worse prognosis. There are many different treatment options for patients who experience BCG failure. OBJECTIVE: To summarize the different current definitions of BCG failure and the present treatment options available for patients with high-risk NMIBC who experience BCG failure. EVIDENCE SYNTHESIS: Overall, the failure rate in response to BCG is about 40-50%. Most guidelines recommend that patients failing BCG should be offered radical cystectomy (RC). The significant potential for progression specific to high-risk NMIBC leads some clinicians to argue that immediate RC should be considered the preferred first-line treatment in high-risk patients, bearing in mind that it achieves a long-term survival rate in excess of 90% with ongoing improvements in morbidity. While other salvage intravesical treatments have to be considered oncologically inferior to RC, several therapies are now available if the patient is unfit to undergo RC or if bladder preservation is the objective, and some agents have shown promise in the context of BCG failure. CONCLUSIONS: The definition, prediction, and treatment of BCG failure remain topics of debate. Patients with BCG failure need carefully selected, individualized therapy in experienced hands. Stratification of patients with BCG failure into groups can identify those with a better or worse prognosis. RC should be the selected option if a patient experiences BCG failure, but several promising intravesical salvage options are available for those cases in which the patient is unfit for surgery or bladder preservation is preferred. Currently data are still inadequate to allow formulation of definitive recommendations, and larger and higher quality studies of salvage intravesical therapies are urgently required.

[History of the split between medicine and surgery]. / Dos mil años de separación entre medicina y cirugía: bases para comprender el fenómeno.

This paper summarizes historical and philosophical aspects, from Ancient Greece to the Middle Ages, concerning the split between physicians and surgeons that began to take place in Alexandria. When exploring the changes in classical medical thought and its influence on philosophy, we conclude that this historical moment was marked by a dual distinction between an essential being and a body subjected to becoming. From a unified mind in Hippocrates, in which medicine is based in knowledge of the relations, subjected to laws, of the organism exposed to natural forces Φνσις (physis among the Jonics), a rift amongst body and soul is conceived, specifically in Platonic thought, from which the surgical intervention of the body is considered improper of the medical art.

The use of microsatellite polymorphism in genetic mapping of the ostrich (Struthio camelus).

The aim of this study was to determine microsatellite polymorphism in ostriches and using it in creation the genetic map of the ostrich. The polymorphism analysis covered 30 microsatellite markers characteristic of ostrich, for the CAU (China Agricultural University) group. The material consisted of 150 ostriches (Struthio camelus). The 30 microsatellite loci was examined and a total of 343 alleles was identified. The number of alleles at a single locus ranged from 5 at locus CAU78 to 34 at locus CAU85. The values for the observed heterozygosity H(o) ranged from 0.467 (locus CAU78) to 0.993 (locus CAU16), whereas for the expected heterozygosity H(e)--from 0.510 (locus CAU78) to 0.953 (locus CAU85). Analyzing the individual loci, the highest PIC value, more than 0.7 was observed for: loci CAU85 (0.932), CAU64 (0.861) and CAU32, 75 (0.852), respectively. It should be noted, that the microsatellite markers used in our study were very polymorphic as evidenced by the large number of detected alleles and high rates of heterozygosity, PIC and PE as well. The analysed microsatellite markers may be used in genetic linkage mapping of ostrich, the construction of a comparative genetic map with other ratites, such as emu and rhea, and population genetics studies or phylogenetic studies of these birds.

Alternaria brassicae produces a host-specific protein toxin from germinating spores on host leaves.

Spore suspensions of Alternaria brassicae, the causal agent of gray leaf spot in Brassica plants, were incubated on the leaves of cabbage (B. oleracea) and spore germination fluid (SGF) was collected after 48 h. A high molecular weight (HMW) fraction (>10 kDa) was separated from the SGF by ultrafiltration. In a detached leaf assay, the HMW fraction induced visible symptoms only on host leaves and the toxicity was lost by treatment with proteinase K or heat at 60 degrees C for 15 min, indicating the presence of host-specific protein toxin(s). A protein toxin in the HMW fraction was purified by several chromatography steps. The toxin induced water-soaked symptoms followed by chlorosis at concentrations of 0.5 to 1 microg/ml on host leaves, but not on nonhost leaves even at 50 microg/ml. The toxin also had infection-inducing activity when added to spore suspension of a nonpathogenic isolate of A. alternata, causing symptoms similar to the infection of A. brassicae only on host leaves. These results indicate that a new host-specific protein toxin named ABR-toxin is released from germinating spores of A. brassicae on host leaves. ABR-toxin migrated as a protein of 27.5 kDa by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The isoelectric point of ABR-toxin was estimated to be approximately 7.0 and 21 N-terminal amino acid residues were sequenced.

Genetic characteristics of the ostrich population using molecular methods.

A genetic analysis was performed on Polish ostriches from the 3 principal ostrich breeds: red-, blue-, and black-necks. The analysis was based on 2 molecular methods: DNA fingerprinting and microsatellites. The DNA fingerprinting patterns were obtained using the restriction enzyme HinfI and Jeffrey's 33.15 probe. The second method consisted of a PCR procedure, for which 5 VIAS-OS primers specific to the ostrich were used. The PCR products were separated on polyacrylamide gel using ALFexpress (Authomated Laser Fluorescent DNA Sequencer). The study aimed at assessing the genetic variability within and among the 3 ostrich breeds as well as evaluating the genetic distance between them, and represents the first report on the genetic characteristics of the ostrich breeds. The results obtained by both methods showed considerable compatibility, especially with regard to the relationship among the breeds analyzed. The diversity within breeds, obtained on the basis of the DNA fingerprinting analysis, proved to be low. Among the ostrich populations analyzed, the highest variability potential was observed for black-necked ostriches (the mean diversity of patterns amounted to 29.04%, whereas the mean heterozygosity was 0.30) and the lowest was observed for the red-necks. The largest genetic similarity was recorded between red- and blue-necked ostriches, but the greatest genetic distance was between the red- and black-necks. This means that the use of birds of those breeds in crosses should result in the highest heterotic effect. Both of these methods measured the genetic distance between the analyzed ostrich breeds that was expected from the geographic origin of these birds. The results obtained in the present study showed that both analytic methods used can be successfully applied when elaborating on the genetic characteristics of the ostrich.

Gene expression profiling of hereditary exencephaly in chickens.

In this preliminary study, differentially expressed genes were investigated in cranial tissues from chickens with hereditary exencephaly using cDNA microarrays containing 1,152 genes and expressed sequence tags (ESTs). Genes showing twofold or greater differences at P < 0.05 between affected and normal cranial cells were considered to be candidates for hereditary exencephaly in chicken. Eighteen ESTs (11 known genes/homologues) were upregulated and 108 ESTs (51 known genes/homologues) were downregulated. The EST AL584231 (ROS006C9), orthologous to human MTHFD1, a known candidate gene for human neural tube defects (NTDs), was expressed at the same level both in normal and affected chicken cranial tissues. ESTs AL584253 (ROS006F7, thioredoxin reductase 1) and AL585511 (ROS024H9, thioredoxin), both involved in NTD pathogenic pathways in mice, were downregulated and had mean ratios of 0.41 and 0.04 for expression in affected vs. normal cells respectively. Expression differences of these two ESTs were confirmed by quantitative real-time polymerase chain reaction. These data indicate that ESTs AL584253 and AL585511 are candidates for hereditary exencephaly in chickens.

Cytogenetic study of some tissues and age-related changes in cell proportions in a goat-sheep chimera.

Different percentages of cells with a female sheep or male goat karyotype were found in kidney (12.0% vs. 88.0%) and lung (42.6% vs. 57.4%) cell cultures from a 10-year-old chimera. Skin biopsies from patches with goat hair or sheep wool showed different, age-related goat-to-sheep fibroblast ratios. Karyotypic analysis of lymphocytes obtained from peripheral blood of the chimera at 6 and 10 yr of age showed no chimerism. Two weeks after birth, however, lymphocytes with both sheep (54,XX) and goat (60,XY) karyotypes were apparent in the blood of this chimera. Twenty percent of the blood cells examined at 2 wk had a caprine karyotype; this proportion declined with time, until it was totally eliminated at age 6.

A cytogenetic study of cows from a highly industrial or an agricultural region.

An examination was made of the frequency of chromosomal aberrations and sister-chromatid exchange in the blood lymphocytes of cows from an industrial region (aluminium smelting plant, lignite quarries, briquette factory, electric plants, mechanical plants. The control group consisted of cows from an agricultural region. In cows from the industrial region a significantly higher level of chromosomal aberrations was observed than in cows from the agricultural region (5.82 +/- 0.46 vs. 2.11 +/- 0.31 per 100 cells). In older, 7-12-year-old cows from the industrial region a slightly higher level of chromosomal aberrations was observed, and a significantly higher level of gaps than in younger cows. The frequency of SCE in the blood lymphocytes of cows from the industrial region was also higher and reached 7.47 +/- 2.33 per cell, while in cows from the agricultural region it was only 6.38 +/- 1.88, but these differences were not significant statistically. However, significant differences were observed in the number of SCE between the age groups within the industrial region P < or = 0.001) in favour of the younger animals. The results obtained indicate that the industrial pollution emitted into the environment may have a genotoxic character. Thus cytogenetic examination of cattle may be a useful test for monitoring industrial pollution.

Cytogenetic analysis of experimental interspecies goat-sheep chimera.

Chromosomal analysis was carried out on blood lymphocytes, skin fibroblasts, and germinal cells of an interspecies goat-sheep chimera. This chimera was produced by aggregation of blastomeres of goat and sheep embryos. A cell chimerism 54,XX/60,XY was found in blood lymphocytes and skin fibroblasts. At birth the percentage of lymphocytes with karyotype 54,XX (sheep) amounted to 80% and with karyotype 60,XY (goat) to 20%. With age the percentage of lymphocytes with chromosome complement 54,XX increased, so that at 18 months it was 94% sheep and 6% goat. At the same age, in skin fibroblasts the percentage of cells with goat karyotype reached 25%. Analysis of germinal cells showed in spermatogonia the presence of only karyotype 60,XY and in primary spermatocytes of 29 autosomal bivalents and the sex bivalent XY.

Industrial pollution with copper and other heavy metals in a beef cattle ranch.

Experimental evidence of air borne heavy metal pollution as the cause of a disease of unknown etiology in beef cattle was obtained. Analysis of metals in natural grasses and leaves of tree defined Cu, Zn and Pb as the major pollutants, with Cd being a minor one. Emissions from a Cu smelter were traced as the main source of metallic pollution. No evidence of metal accumulation in the soil was found, mainly because of the short duration and intermittent pattern of pollution. A progressive intake of the several heavy metals contained in dusts deposited on the grasses was considered the cause of the sickness; this was associated with the grazing of cattle on contaminated grasses. The most severe cases were found in the most polluted pastures. Excepting Cd, the concentrations of the metals in the livers and kidneys of affected cattle were high. No overlapping of the respective ranges between test and control samples from both organs was found. Mean hepatic levels of Cu (925.7 mg/kg DM), Zn (491.2 mg/kg) and Pb (26.7 mg/kg) reflected the decreasing order of the concentrations of these elements in the polluted grasses. The main clinical and pathological features of this disease were discussed in light of the organic levels of the investigated metals. Disease could not be ascribed to a pure chronic toxicosis with any one of these.

Zinc deficiency in molybdenum poisoned cattle.

Clinical signs ascribable to zinc deficiency were noted in a group of Friesian cows industrially poisoned with molybdenum. Zinc, copper, and molybdenum were determined in blood serum and black hair, and in the contaminated alfalfa pasture the group grazed on. Hematological parameters, and serum calcium and alkaline phosphatase activity, were also determined. Pooled samples of alfalfa from 2 uncontaminated pastures, and of blood, serum and black hair of clinically normal Friesian cattle grazing on these were used as controls. A mixed contamination of the polluted pasture with molybdenum and copper was found, both metals being inversely correlated with he distance to the polluting chimney. Zinc concentrations were normal and not significantly correlated with the distance to the chimney very high molybdenum was found in serum and hair of the poisoned animals; copper was normal in serum and hair. Low calcium and Alkaline phosphatase activity were found in serum, both variables being significantly correlated with serum zinc. Reduced red blood cell number, packed cell volumes and hemoglobin concentrations were also found, but no significant correlation of these parameters with any of the trace metals in serum or hair was found. Signs ascribed to zinc deficiency were consistent with the reduction of zinc in serum and hair and decreased alkaline phosphatase activity in serum. A zinc deficiency conditioned by a simultaneous increased intake of molybdenum and copper is proposed.