Glioma angiogenesis is boosted by ELK3 activating the HIF-1[Formula: see text]/VEGF-A signaling axis.

BACKGROUND: Clinical studies have shown that first-line use of anti-angiogenetic therapy can prolong progression-free survival but little progress has been made in extending the overall survival of the patients. We explored the role of ELK3 in glioma angiogenesis to improve and design more efficacious therapies. METHODS: A tissue microarray and immunohistochemistry analysis were used to determine the expression of ELK3 protein in 400 glioma patients. Cell proliferation, metastasis, cell cycle, and apoptosis were monitored in U87 and U251 cells using CCK-8, EdU, transwell assays, and flow cytometry. A tube-formation assay, a rat aorta ring sprouting assay, and a matrigel plug assay were performed to examine the antiangiogenic activity of ELK3. An ELISA, Western blot, and correlation analysis of the CGGA dataset were used to detect the association between ELK3 and VEGF-A or ELK3 and HIF-1[Formula: see text]. Besides, orthotopic transplantation in nude mice and histopathological and immunological analysis of in vitro tumors were used to explore the effect of ELK3 on tumor progression and median survival. RESULTS: ELK3 was upregulated in glioma tissues and associated with a poor prognosis. In vitro, ELK3 promoted cell proliferation and cell cycle progression, induced metastasis, and suppressed apoptosis. Then, silencing ELK3 inhibited VEGF-A expression and secretion by facilitating HIF-1[Formula: see text] degradation via ubiquitination. Finally, knockdown ELK3 inhibited tumor progression and angiogenesis in vitro and in vivo, as well as prolonged nude mice's median survival. CONCLUSIONS: Our findings first evidenced that ELK3 is crucial for glioma because it promotes angiogenesis by activating the HIF-1[Formula: see text]/VEGF-A signaling axis. Therefore, we suggest that ELK3 is a prognostic marker with a great potential for glioma angiogenesis and ELK3-targeted therapeutic strategies might hold promise in improving the efficacy of anti-angiogenic therapies.

Calibration for light field cameras based on fixed point constraint of spatial plane homography.

Light field cameras can record the spatial and angular information of light rays at the same time, which facilitate many vision tasks such as 3D reconstruction and digital refocusing. In this paper, we deduce a projection model from a 3D space point to each sub-aperture image according to the transmission of light rays in the light field camera, and the projection model of traditional cameras can be considered as a special case of it. We propose a camera calibration method using this model. Firstly, the homography from a space plane to each sub-aperture image is estimated, which implies the imaging parameters of the standard light field camera, and then the principal line on each sub-aperture image is derived from the constraint of the fixed point of the plane homography. The principal point of each sub-aperture image is robustly determined from the principal lines by using RANSAC. The other parameters can be determined from the homography constrains on them. Compared with the state of art methods, the proposed method can calibrate the light field images with a varying focal length and has higher accuracy. Moreover, it provides a unified framework for the calibration of standard light field cameras and traditional cameras. Experimental results validate the proposed method.

Cardanol-derived cationic surfactants enabling the superior antibacterial activity of single-walled carbon nanotubes.

Single-walled carbon nanotubes (SWCNTs) are potential antibacterial material, and their antibacterial activity in aqueous solutions depends on efficient surfactants to create strong interactions between well-dispersed SWCNTs and bacterial cells. Here, we designed and synthesized a new family of cationic surfactants by introducing different positively charged hydrophilic heads, i.e. -(CH2)6N+(CH3)3Br-, -(CH2)2N+(CH3)3Br- and -(CH2)2N+PyridineBr-, to cardanol obtained from cashew nut shell liquid. These surfactants can efficiently disperse SWCNTs in aqueous solutions because benzene rings and olefin chains in cardanol enable their strong π-stacking on SWCNTs. A much higher fraction of SWCNTs can be dispersed individually compared to the commonly used surfactant, dodecylbenzene-sulfonate sodium (SDBS). SWCNTs dispersed in the cardanol-derived surfactants demonstrate significantly improved antibacterial activity. At the concentration of 0.5 wt%, their minimum inhibitory concentration is 0.33 and 0.02 µg ml-1 against E. coli and S. aureus, respectively, which is only 0.8%-1.5% of that of SDBS-dispersed SWCNTs. The strong antibacterial activity can be attributed to both better dispersion of SWCNTs and positive charges introduced by hydrophilic heads, which are attracted to negatively charged bacterial cell surfaces. These cardanol-derived surfactants are promising as sustainable surfactants for enabling various SWCNT applications.

Application of the WeChat Platform to Implement Continuous Nursing for Patients After Percutaneous Coronary Intervention.

BACKGROUND Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease. However, a lack of cardiac rehabilitation and continuous nursing management leads to repeated patient hospitalizations. Long-term systematic rehabilitation and nursing management after discharge are key to ensuring quality of treatment and patient quality of life. This study aimed to explore the application of the WeChat platform in continuous nursing after PCI. MATERIAL AND METHODS This was a retrospective case-control study. The clinical data of 63 patients in our cardiac center who underwent PCI between June 2017 and January 2018 were recorded. Patients were divided into 2 groups: the continuous nursing through the WeChat platform (intervention) group and the conventional nursing (control) group. The Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Seattle Angina Questionnaire (SAQ) were used as the evaluation tools. RESULTS The SAQ scores in all 5 SAQ dimensions in the continuous nursing group were significantly higher than those of the control group at the 1-year follow-up. Scores on the SAS and SDS scales at 1-year follow-up were significantly better in the intervention group than in the control group. The SAS and SDS scores in both groups were better at the 1-year follow-up, but the difference was statistically significant in the continuous nursing group and not in the control group. CONCLUSIONS Using the WeChat platform can make continuous nursing more convenient and effective for patients after PCI. It may reduce the occurrence of complications, relieve patient depression and anxiety, and improve patient quality of life.

A near-infrared biothiol-specific fluorescent probe for cancer cell recognition.

Cancer is a global health issue and a leading cause of death. The discrimination of cancer cells from normal cells is of significant importance for the early diagnosis of cancers. As one of the useful biomarkers for developing cancer diagnosis and chemotherapy resistance systems, biothiols not only play an essential role in physiological and pathological processes but also exhibit cytoprotective effects in the susceptibility to carcinogenesis. It would be highly desirable to explore near-infrared biothiol-specific fluorescent probes for cancer diagnosis with outstanding specificity. In this study, a novel near-infrared fluorescent probe BPO-THAZ decorated with thiazole as a recognition site was presented for sensitive and selective detection of endogenous biothiols. BPO-THAZ can be used to not only evaluate the biothiol level in living HeLa cells upon treatment with H2O2 or anti-cancer drugs but also assess endogenous biothiols in stem cells. Furthermore, BPO-THAZ was successfully utilized to discriminate cancer cells from normal cells showing great promise for cancer diagnosis.

Atorvastatin Protects Against Cerebral Aneurysmal Degenerative Pathology by Promoting Endothelial Progenitor Cells (EPC) Mobilization and Attenuating Vascular Deterioration in a Rat Model.

BACKGROUND Endothelial injury is the early pathological change of cerebral aneurysm (CA) formation. In addition to its lipid-lowering activity, atorvastatin (ATR) also reportedly promotes vascular repair via mobilizing endothelial progenitor cells (EPC). Here, we investigated the influence of ATR on vascular worsening after CA induction in rats. MATERIAL AND METHODS Adult male Sprague-Dawley rats were randomly assigned to 3 groups: a control (CTR) group, a CA group, and a CA+ATR treatment group. Circulating EPC level and hematological and lipid profiles were measured 3 months after CA induction. Verhoeff-Van Gieson staining and transmission electron microscopy were performed to assess pathological changes in the artery wall. RT-PCR was also performed to evaluate the expression of inflammation-related genes in the aneurysmal wall. RESULTS ATR significantly restored the impaired level of circulating EPC without changing hematological and lipid profiles 3 months after CA induction. ATR markedly inhibited endothelial injury, media thinning, and CA enlargement, accompanied by reduced vascular inflammation. CONCLUSIONS Our preliminary results demonstrate that the mobilization of EPC and improvement of endothelial function by ATR contribute to the prevention of cerebral aneurysm. Further studies are warranted to investigate the detailed mechanism.

Growth mechanisms of Pd nanofilms electrodeposited onto Au(111): an in situ grazing incidence X-ray diffraction study.

Electrochemical deposition of ultra-thin Pd films onto Au(111) single crystals in a solution containing chloride was studied with in situ surface X-ray diffraction measurements. We report a detailed description of the growth mode, as well as film morphology and lattice parameters as a function of thickness, from 2 up to 10 monolayers (ML) as equivalent thickness. An almost ideal layer-by-layer pseudomorphic growth is observed up to two deposited ML. For higher thicknesses, it is followed by the growth of large 3D Pd bulk-like islands. They are about 20 ± 5 ML high and ∼220 Å in diameter for the Pd4ML film and occupy only about 20% of the surface. Their height increases faster than their size with the Pd deposited amount. We could clearly show that chlorides do not play any role in inhibiting the three-dimensional growth of Pd/Au(111) films. We could also unequivocally correlate the features observed by electrochemical surface characterisation in an acidic medium with the detailed structure obtained by diffraction.

In vitro simulation of in vivo pharmacokinetic model with intravenous administration via flow rate modulation.

The aim of this paper was to propose a method of flow rate modulation for simulation of in vivo pharmacokinetic (PK) model with intravenous injection based on a basic in vitro PK model. According to the rule of same relative change rate of concentration per unit time in vivo and in vitro, the equations for flow rate modulation were derived using equation method. Four examples from literature were given to show the application of flow rate modulation in the simulation of PK model of antimicrobial agents in vitro. Then an experiment was performed to confirm the feasibility of flow rate modulation method using levo-ornidazole as an example. The accuracy and precision of PK simulations were evaluated using average relative deviation (ARD), mean error and root mean squared error. In vitro model with constant flow rate could mimic one-compartment model, while the in vitro model with decreasing flow rate could simulate the linear mammillary model with multiple compartments. Zero-order model could be simulated using the in vitro model with elevating flow rate. In vitro PK model with gradually decreasing flow rate reproduced the two-compartment kinetics of levo-ornidazole quite well. The ARD was 0.925 % between in vitro PK parameters and in vivo values. Results suggest that various types of PK model could be simulated using flow rate modulation method without modifying the structure. The method provides uniform settings for the simulation of linear mammillary model and zero-order model based on in vitro one-compartment model, and brings convenience to the pharmacodynamic study.

Effect of Huqian Wan on liver-Yin and kidney-Yin deficiency patterns in patients with knee osteoarthritis.

OBJECTIVE: To observe the curative effect of Huqian Wan on liver and kidney-Yin deficiency knee osteoarthritis (KOA). METHODS: One hundred patients were randomly divided, into a treatment (50 patients) and control group (50 patients). In the treatment group, patients orally took the Chinese medicine Huqian Wan. Control group patients orally took Votalin, 75 mg, once a day, for 8 weeks. The visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Medical Outcomes Study Short Form 36-Item Health Survey (SF 36) were used to evaluate the curative effect before treatment and after 8 and 16 weeks of treatment. RESULTS: VAS and WOMAC scores significantly decreased and SF 36 scores significantly increased after treatment in both groups compared with before treatment (P < 0.05). There were significant differences in VAS, WOMAC, and SF 36 score changes between the two groups at week 16 (P < 0.05). There was a significant increase in VAS and WOMAC scores in the control groups (P < 0.05) between weeks 8 and 16, but no significant difference was found in the treatment group (P > 0.05). CONCLUSION: Huqian Wan could effectively improve the clinical symptoms and quality of life in patients with KOA. It could also have a better and longer lasting curative effect without obvious adverse events compared with Votalin.

Comparison of sludge treatment by O3 and O3/H2O2.

This work focuses on the comparison of sludge decomposition caused by ozone (O3) alone and by ozone/hydrogen peroxide (O3/H2O2). The content of carbonaceous organic materials, nitrogenous compounds and phosphoric substances in sludge supernatant were measured. The release of soluble chemical oxygen demand, total nitrogen (TN) and total phosphorus (TP) caused by O3/H2O2 treatment were more than by O3 alone. As a result, it can be concluded that the efficiency of sludge breakup in O3/H2O2 was better than that in O3 alone. However, a peak appeared in both systems for the biodegradable substances such as carbohydrate. Carbohydrate could be used as the carbon source for denitrification, and the releasing of TN and TP may become an additional burden for a subsequent biological system. So, it was of benefit for the enhancement of cryptic growth and cost reduction by raising and maintaining the content of biodegradable substance and reducing the concentrations of the nitrogenous and phosphoric substances as far as possible. Therefore, sludge treated by O3/H2O2 with lower O3 dose would be more suitable than O3 alone.

[Detection of KRAS gene mutations in colorectal carcinoma: a study of 6 364 patients].

OBJECTIVE: To investigate the mutation rate and types of KRAS gene in colorectal carcinoma of Chinese patients, and to document the regional distribution of the mutation. METHODS: A total of 6 364 colorectal carcinoma tumor specimens were obtained from 27 provinces and autonomous regions in China from 2009 to 2013. Pyrosequencing was used to detect mutations in codons 12 and 13 of KRAS gene. The mutation types of KRAS and the difference of regional distribution were statistically analyzed. RESULTS: KRAS mutation rate in Chinese colorectal carcinoma patients was 37.43 % (2 382/6 364). Ten types of single-base mutations of KRAS codons 12 and 13 were detected, including six common types: 12GGT > GAT (14.77%), 13GGC > GAC (8.19%), 12GGT > GTT (7.89%), 12GGT > TGT (2.20%), 12GGT > AGT (2.00%), and 12GGT > GCT (1.48%). Other four less occurring mutation types (<1%) included 12GGT > CGT, 13GGC > TGC, 13GGC > CGC, and 13GGC > AGC. In addition, 8 other mutation types were identified in 13 tumor samples. The rates of KRAS mutation in patients from different regions were between 35.68% and 38.04% and no significant differences were observed (P > 0.05). CONCLUSIONS: Abundant mutation types of KRAS gene exist in colorectal cancers among Chinese patients. The six common mutation types occur with a frequency of not less than 1%. There are no significant differences of KRAS mutation rate among Chinese patients from various areas. Pyrosequencing provides a rapid and accurate method of KRAS mutation detection for clinical application.

Identifying the effective combination of acupuncture and traditional Chinese medicinal herbs for postmenopausal osteoporosis therapy through studies of their molecular regulation of bone homeostasis.

Worldwide, as the population age, osteoporosis is becoming increasingly common, and osteoporotic fractures have a significant economic burden. Postmenopausal women are the most susceptible to developing osteoporosis and the most critical time to prevent it is during the perimenopausal and early menopausal years. In this regard, we hypothesize rational combination of acupuncture and Traditional Chinese Medicine (TCM) in the form of herbal extract could prevent osteoporosis in women. Estrogen deficiency during menopause causes low-level inflammation that stimulates the formation of osteoclasts, the bone-resorbing cells, and simultaneously inhibits the viability and function of osteoblasts, the bone-forming cells. The most potent inflammatory cytokine in skeletal homeostasis is the receptor activator of nuclear factor kappa B ligand (RANKL) that stimulates osteoclast function. Conversely, the canonical Wnt pathway is essential for osteoblastogenesis and bone formation, and estrogen deficiency leads to diminished functioning of this pathway. TCM and acupuncture could target the RANKL and the Wnt pathway in favorable ways to prevent the accelerated bone loss experienced during the early menopausal stage and promote the gain in bone mass in postmenopausal women. In this review, we propose a rational combination of specific TCM and acupuncture targeting those signaling molecules/pathways by the drugs that are in clinical use for the treatment of postmenopausal osteoporosis. Our rational approach revealed that Danshen (Radix Salviae Miltiorrhizae) could exert a synergistic effect with acupuncture. We then propose a translational path for developing the putative combination in women with postmenopausal osteoporosis to curtail the risk of osteoporotic fractures.

Comparison of post-resection survival between hepatocellular carcinoma patients in BCLC stage A or B who experience tumor rupture and patients in BCLC stage C who do not.

Background and aim: Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening complication, and patients who experience it are formally assigned to stage T4 in the TNM system, while many clinicians informally assign them to stage C in the more widely used Barcelona Clinic Liver Cancer (BCLC) system. The present study explored whether these re-staging practices are appropriate for HCC patients who suffer tumor rupture. Methods: We retrospectively reviewed the records of 1952 HCC patients who underwent hepatic resection at our hospital between January 2017 and June 2021. We compared recurrence-free and overall survival between 143 patients who had BCLC stage A or B disease at the time of spontaneous rupture and 449 patients who had BCLC stage C disease without rupture. Results: Overall survival rate was significantly higher among the 143 patients (1, 3, 5-year survival rate was 80.3%, 60.4%, 51.4%) with rupture than among the 449 (1, 3, 5-year survival rate was 69.5%, 41.5%, 32.4%) with BCLC stage C disease (hazard ratio 1.65, 95% confidence interval 1.29 to 2.12). The two groups had similar recurrence-free survival (hazard ratio 1.19, 95% confidence interval 0.92 to 1.53), but most patients with rupture were able to receive interventional and potentially curative treatments after recurrence, whereas most patients in BCLC stage C received interventional or supportive care. Similar results were obtained after propensity score matching. Conclusion: HCC patients who experience spontaneous rupture tumor while in BCLC stage A or B have better prognosis than patients in BCLC stage C without rupture. Our results suggest that HCC patients who suffer rupture in BCLC stage A or B should not be assigned to BCLC stage C.

Pharmacokinetics and pharmacodynamics of nemonoxacin against Streptococcus pneumoniae in an in vitro infection model.

The aim of this paper was to investigate the pharmacokinetics (PK) and pharmacodynamics (PD) of nemonoxacin, a novel nonfluorinated quinolone, against Streptococcus pneumoniae in vitro. A modified infection model was used to simulate the pharmacokinetics of nemonoxacin following scaling of single oral doses and multiple oral dosing. Four S. pneumoniae strains with different penicillin sensitivities were selected, and the drug efficacy was quantified by the change in log colony counts within 24 h. A sigmoid maximum-effect (Emax) model was used to analyze the relationship between PK/PD parameters and drug effect. Analysis indicated that the killing pattern of nemonoxacin shows a dualism which is mainly concentration dependent when the MIC is low and that the better PK/PD index should be the area under the concentration-time curve for the free, unbound fraction of the drug divided by the MIC (fAUC0-24/MIC), which means that giving the total daily amount of drug as one dose is appropriate under those conditions. When the MIC is high, the time (T) dependency is important and the valid PK/PD index should be the cumulative percentage of a 24-h period in which the drug concentration exceeds the MIC under steady-state pharmacokinetic conditions (f%T>MIC), which means that to split the maximum daily dose into several separate doses will benefit the eradication of the bacteria. To obtain a 3-log10-unit decrease, the target values of fAUC0-24/MIC and f%T>MIC are 47.05 and 53.4%, respectively.

Cytokeratin distribution and expression during the maturation of mouse germinal vesicle oocytes after vitrification.

Cytokeratin (CK) is a type of the cytoskeleton that increases cell stabilization during oocyte maturation. This study was conducted to investigate the effect of vitrification on the distribution and expression of CK during mouse oocyte maturation. Germinal vesicle (GV) oocytes were randomly allocated into three groups: (1) untreated (fresh), (2) exposed to vitrification solution (VS) without being plunged into liquid nitrogen (CPA exposure), or (3) vitrified using the open-pulled straw (OPS) method (vitrification). The oocytes were then incubated for 0 h, 6h (metaphase I (MI) stage), and 10h (metaphase II (MII) stage). The CK distribution in the oocytes at the GV, MI, and MII stages was observed by immunofluorescence, and the expression at the MII stage oocytes derived from vitrified GV oocytes was detected by Western blotting. The CK distribution in the GV oocytes (88.5%) displayed a cortical pattern in the fresh group, whereas a granular pattern was mainly found at the MI (86.7%) and MII (93.5%) stages. In the CPA exposure group, 90.3% of the GV oocytes were observed to display the cortical pattern, and 69.2% of the MI oocytes and 92.9% of the MII oocytes showed the granular pattern. In the vitrification group, most oocytes (GV, 88.9%; MI, 100%; MII, 93.3%) exhibited the cortical pattern. The CK fluorescence intensities of the MII stage oocytes in both the fresh (59.27) and CPA exposure (60.05) group were significantly higher than that of the vitrification (26.53) group (p<0.05). Western blotting showed that the CK expression in the MII oocytes derived from vitrified GV oocytes was significantly lower (p<0.05) than in the control. In conclusion, OPS vitrification affects the normal CK distribution pattern during oocyte maturation and results in decreased CK expression in MII oocytes derived from vitrified GV oocytes.

[Preliminary study of establishing clinical effect evaluation methods of Chinese medicine based on combination of disease and syndrome, systematic staging, and multi-dimension index].

The clinical effect evaluation of Chinese medicine (CM) has been the bottleneck restricting its development. Based on the current situation, in this study, we integrated and combined previous results of clinical effect evaluation of CM, and proposed the clinical effect evaluation method of CM based on combination of disease and syndrome, systematic staging, and multi-dimension index. We also made a specific exposition on the connotation, establishment methods and practice of the clinical effect evaluation methods of CM based on combination of disease and syndrome, systematic staging, and multi-dimension index.

A reactive molecular dynamics study of thermal pyrolysis behavior and mechanisms of lignin during the hydrothermal process: The function of the water molecules.

The lignin hydrothermal processing is an important option but a full understanding of the role played by the water molecules in the depolymerization of lignin is still lacking. In order to clarify the role of the water molecules in the depolymerization of lignin, the evolution of chemical bonds, microstructural changes, and possible mechanisms of product generation were compared during the pyrolysis process under vacuum and water conditions using Reactive Molecular Dynamics Simulation. Compared with vacuum conditions, the role of water changes with temperature, identifying three stages: promotion (1200-1800 K)-inhibition (2100-2400 K)-promotion (2700-3000 K). Also compared with vacuum conditions, hydrothermal processing can promote the cleavage of the ether bonds while inhibiting the destruction of carbocycles. Water molecules promote the depolymerization of lignin into more C4-molecules, thereby generating more combustible gas resources. Based on the research results, the pyrolysis conditions of lignin can be flexibly controlled to obtain solids, liquids or gases.

Metformin suppressed tendon injury-induced adhesion via hydrogel-nanoparticle sustained-release system.

Tendon adhesion is one of the sequelae of tendon injury and can lead to disability in severe cases. Metformin is a commonly used antidiabetic drug. Some studies had shown that metformin could reduce tendon adhesion as well. Considering the characteristic of low absorption rate and short half-life, we established a sustained-release system, i.e., hydrogel-nanoparticle system to deliver metformin. In vitro, metformin could effectively suppress TGF-ß1-induced cell proliferation and accelerate cell apoptosis, according to cell counting kit-8, flow cytometry, and 5-ethynyl-2'-deoxyuridine (EdU) staining studies. In vivo, hydrogel-nanoparticle/metformin system could significantly lower adhesion scores and improve the gliding function of repaired flexor tendons, as well as decrease the expression of fibrotic proteins Col1a1, Col3a1, and α-smooth muscle actin (α-SMA). Histological staining revealed that the inflammation had subsided and that the gap between the tendon and the surrounding tissue was wider in the hydrogel-nanoparticle/metformin treatment group. Finally, we speculated that effect of metformin on reducing tendon adhesion might be achieved by regulating both Smad and MAPK-TGF-ß1 signaling pathways. In conclusion, metformin delivered through hydrogel-nanoparticle sustained-release system may be a promising strategy for coping with tendon adhesion.

Why Has a Progressive Court Failed to Protect the Prison Population against COVID-19? Mass Incarceration and Brazil's Supreme Court.

Despite acknowledging the risks of the COVID-19 pandemic for the prison population, Brazil's Supreme Court declined to issue structural injunctions during the health crisis ordering lower courts to consider these risks when making incarceration-related decisions. These injunctions could have been crucial to mitigate mass incarceration and protect the prison population during the pandemic. Through an examination of the Supreme Court's rulings in structural cases and in a sample of over 4,000 habeas corpus decisions, this paper argues that granting these injunctions would have overwhelmed the court with an unmanageable influx of individual claims. Consequently, the Supreme Court acted strategically in anticipation of its limited institutional capacity to enforce compliance with structural injunctions among lower courts. This case study illustrates how practical considerations can hinder structural decisions in criminal law and highlights the limits of structural litigation and constitutional jurisdiction to address mass incarceration.

A Systematic Review and Meta-Analysis of Minimally Invasive Partial Nephrectomy Versus Focal Therapy for Small Renal Masses.

Background: Minimally invasive partial nephrectomy (MIPN) and focal therapy (FT) are popular trends for small renal masses (SRMs). However, there is currently no systematic comparison between MIPN and FT of SRMs. Therefore, we systematically study the perioperative, renal functional, and oncologic outcomes of MIPN and FT in SRMs. Methods: We have searched the Embase, Cochrane Library, and PubMed for articles between MIPN (robot-assisted partial nephrectomy and laparoscopic partial nephrectomy) and FT {radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), irreversible electroporation, non-thermal [irreversible electroporation (IRE)] ablation, and stereotactic body radiation therapy (SBRT)}. We calculated pooled mean difference (MD), odds ratios (ORs), and 95% confidence intervals (CIs) (CRD42021260787). Results: A total of 26 articles (n = 4,420) were included in the study. Compared with MIPN, the operating time (OP) of FT had significantly lower (SMD, -1.20; CI, -1.77 to -0.63; I2 = 97.6%, P < 0.0001), estimated blood loss (EBL) of FT had significantly less (SMD, -1.20; CI, -1.77 to -0.63; I2 = 97.6%, P < 0.0001), length of stay (LOS) had shorter (SMD, -0.90; CI, -1.26 to -0.53; I2 = 92.2%, P < 0.0001), and estimated glomerular filtration rate (eGFR) of FT was significantly lower decrease (SMD, -0.90; CI, -1.26 to -0.53; I2 = 92.2%, P < 0.0001). However, FT possessed lower risk in minor complications (Clavien 1-2) (OR, 0.69; CI, 0.45 to 1.07; I2 = 47%, P = 0.023) and overall complications (OR, 0.71; CI, 0.51 to 0.99; I2 = 49.2%, P = 0.008). Finally, there are no obvious difference between FT and MIPN in local recurrence, distant metastasis, and major complications (P > 0.05). Conclusion: FT has more advantages in protecting kidney function, reducing bleeding, shortening operating time, and shortening the length of stay. There is no difference in local recurrence, distant metastasis, and major complications. For the minimally invasive era, we need to weigh the advantages and disadvantages of all aspects to make comprehensive choices. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier PROSPERO (CRD42021260787).