Comparison of the perioperative outcomes of robot-assisted laparoscopic transperitoneal versus retraperitoneal partial nephrectomy for posterior-lateral renal tumors: a systematic review and meta-analysis.

The study aims to assess the available literature and compare the perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) for posterior-lateral renal tumors using transperitoneal (TP) and retroperitoneal (RP) approaches. Systematically searched the Embase, PubMed, and Cochrane Library databases for literature. Eligible studies were those that compared TP-RAPN and RP-RAPN for posterior-lateral renal tumors. The data from the included studies were analyzed and summarized using Review Manager 5.3, which involved comparing baseline patient and tumor characteristics, intraoperative and postoperative outcomes, and oncological outcomes. The analysis included five studies meeting the inclusion criteria, with a total of 1440 patients (814 undergoing RP-RAPN and 626 undergoing TP-RAPN). Both groups showed no significant differences in age, gender, BMI, R.E.N.A.L. score, and tumor size. Notably, compared to TP-RAPN, the RP-RAPN group demonstrated shorter operative time (OT) (MD: 17.25, P = 0.01), length of hospital stay (LOS) (MD: 0.37, P < 0.01), and lower estimated blood loss (EBL) (MD: 15.29, P < 0.01). However, no significant differences were found between the two groups in terms of warm ischemia time (WIT) (MD: -0.34, P = 0.69), overall complications (RR: 1.25, P = 0.09), major complications (the Clavien-Dindo classification ≥ 3) (RR: 0.97, P = 0.93), and positive surgical margin (PSM) (RR: 1.06, P = 0.87). The systematic review and meta-analysis suggests RP-RAPN may be more advantageous for posterior-lateral renal tumors in terms of OT, EBL, and LOS, but no significant differences were found in WIT, overall complications, major complications, and PSM. Both surgical approaches are safe, but a definitive advantage remains uncertain.

Comparison of perioperative outcomes of selective arterial clipping guided by near-infrared fluorescence imaging using indocyanine green versus undergoing standard robotic-assisted partial nephrectomy: a systematic review and meta-analysis.

BACKGROUND: This study employs a meta-analytic approach to investigate the impact of robotic-assisted partial nephrectomy, with and without near-infrared fluorescence imaging (NIRF-RAPN vs S-RAPN), on patients' perioperative outcomes and postoperative changes in renal function. MATERIALS AND METHODS: The authors conducted a comprehensive and rigorous systematic review and cumulative meta-analysis of primary outcomes following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines, and Risk-of-Bias Tool (RoB2). To ensure a thorough search, the authors systematically searched five major databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, from databases' inception to April 2023. RESULTS: No significant differences were found between the two groups in terms of age ( P =0.19), right side ( P =0.54), BMI ( P =0.39), complexity score ( P =0.89), tumor size ( P =0.88), operating time ( P =0.39), estimated blood loss ( P =0.47), length of stay ( P =0.87), complications ( P =0.20), transfusion ( P =0.36), and positive margins ( P =0.38). However, it is noteworthy that the NIRF-RAPN group exhibited significant reductions in warm ischemia time ( P =0.001), the percentage change in estimated glomerular filtration rate at discharge ( P =0.01) compared to the S-RAPN group. CONCLUSION: This meta-analysis provides evidence that the group undergoing NIRF-RAPN showed a statistically significant protective effect on the estimated glomerular filtration rate (eGFR).

Effect of the TERT mutation on the prognosis of patients with urothelial carcinoma: a systematic review and meta-analysis.

BACKGROUND: Telomerase reverse transcriptase (TERT) mutation represents the most prevalent genetic mutation found in urothelial carcinoma (UC) and holds potential as a prognostic indicator for tumor outcomes. However, the association between TERT mutation and prognosis in UC patients remains poorly elucidated due to conflicting findings in existing literature. Therefore, this study aimed to investigate the effect of the TERT mutation on the survival of UC patients. METHODS: We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that investigated the relationship between the TERT mutation and the prognosis of UC patients. Endpoints included the 2-year and 5-year recurrence-free survival (RFS) and overall survival (OS). The Newcastle-Ottawa Scale (NOS) tool was used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis. RESULTS: Nine studies with a total of 1,552 patients were included in the analysis. Two studies were prospective, and seven were retrospective. The TERT promoter mutation was associated with a lower 2-year OS (relative risk [RR] = 0.92, 95% confidence interval [CI] 0.86-0.98; P = 0.007) and a lower 5-year OS (RR = 0.80, 95% CI 0.68-0.94; P = 0.008) compared with the TERT wild type. However, no significantly differences were found between two groups in terms of HR for OS (hazard ratio [HR] = 1.29, 95% CI 0.80-2.08; P = 0.29). Furthermore, we investigated the differences in RFS and disease-specific survival (DSS) between the two groups. CONCLUSION: The TERT mutation increases the risk of death and decreases the survival time of UC patients. TERT may be a valuable marker with individual prognostic value.

Comparison of perioperative, oncologic, and functional outcomes between 3D and 2D laparoscopic radical prostatectomy: a systemic review and meta-analysis.

Objectives: Literature regarding experience with 3D laparoscopy about prostatectomy has remained scanty, and this could be related to the rise of robotic assisted laparoscopic surgery. This study aimed to perform a systemic review and meta-analysis to evaluate the perioperative, functional, and oncologic outcomes between 3D and 2D laparoscopic radical prostatectomy (LRP). Methods: We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared perioperative, functional, or oncologic outcomes of both 3D and 2D LRP. The Newcastle-Ottawa Scale (NOS) tool and Jadad scale were used to assess the risk of bias in the included studies. Review Manager 5.3 was used for the meta-analysis. Results: Seven studies with a total of 542 patients were included in the analysis. Among them, two were RCTs. There was no difference between groups in terms of preoperative characteristics. Anastomosis time, hospital day, and overall complication rates were similar in 3D than 2D group. However, operative time [mean difference (MD) -36.96; 95% confidence interval [CI] -59.25 to -14.67; p = 0.001], blood loss (MD -83.5; 95% CI -123.05 to -43.94; p <0.0001), and days of drainage (MD -1.48; 95% CI -2.29 to -0.67; p = 0.0003) were lower in 3D LRP. 2D and 3D LRP showed similarity in the positive surgical margin (PSM) rate and biochemical recurrence (BCR) rate at 3, 6, and 12months postoperatively. Additionally, there was no significant differences in continence and potency recovery rate between two group except higher continence rate of 3D LRP at 3 months. Conclusion: Current evidence shows that 3D LRP offers favorable outcomes compared with 2D LRP, including operative time, blood loss, days of drainage, and early continence. However, there was no conclusive evidence that 3D LRP was advantaged in terms of oncologic and functional outcomes (except for continence rate at 3 months). Systematic review registration: The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023426403).

Comparison of the efficacy and safety of robotic-assisted simple prostatectomy and laser enucleation of prostate for large benign prostatic hyperplasia.

Laser enucleation of the prostate (LEP) and robotic-assisted simple prostatectomy (RASP) are two main treatment methods for large benign prostatic hyperplasia (BPH), but the superiority between these two methods in treating large BPH is currently unclear. This study aims to conduct a meta-analysis to compare the efficacy and the safety of LEP and RASP in treating large BPH. We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared safety and efficacy outcomes of both LEP and RASP. Review Manager 5.3 was used for the meta-analysis. Six studies with a total of 1235 patients were included in the analysis. Resected adenoma weight was similar in LEP than RASP group. Operative time [mean difference (MD) - 67.96; 95% confidence interval [CI] - 131.66 to - 4.25; p = 0.04], catheterization time (MD -6.31; 95% CI - 9.44 to - 3.18; p < 0.0001), and length of stay (MD - 2.44; 95% CI - 3.55 to - 1.34; p < 0.0001) were lower in LEP. The International Prostate Symptom Score, maximum urinary flow rate, prostate-specific antigen, and post-void residual urine volume were also comparable between two groups. Furthermore, LEP demonstrated lesser hemoglobin decrease (MD - 0.50; 95% CI - 0.96 to - 0.05; p = 0.03), lower blood transfusion rate [odd ratio (OR) 0.23, 95% CI 0.08-0.66; p = 0.006], and lower rate of Clavien-Dindo Grade ≥ 3 complications (OR 0.435, 95% CI 0.189-0.998; p = 0.049). Finally, there was no significant difference in overall complications between two groups. Current evidence shows that LEP offers favorable perioperative outcomes compared with RASP. However, there was no conclusive evidence that LEP was advantaged in terms of efficacy outcomes.

Effect of Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles in Robot-Assisted Radical Prostatectomy with Pelvic Lymphadenectomy: A Meta-Analysis and Systematic Review.

Background: This systematic review and meta-analysis investigated whether peritoneal interposition flap (PIF) prevent lymphocele formation after robot-assisted radical prostatectomy with extended pelvic lymph node dissection. Materials and Methods: We performed a systematic review and cumulative meta-analysis of the primary outcomes according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Assessing the Methodological Quality of Systematic Reviews guidelines and risk-of-bias tool. Five databases, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science, were systematically searched. The time frame of the search was set from the creation of the database to February 2023. Results: Meta-analysis of symptomatic lymphoceles (sLCs) rates revealed significant difference between PIF and no PIF group (eight studies pooled; p = 0.005), The sLCs rates account for 2.6% (28/1074) and 7.1% (85/1186) in the PIF and no PIF group, respectively. The resulting odds ratio was 0.34 (95% confidence interval: 0.16-0.73), taking into account the heterogeneity of these studies (Q = 14.32, p = 0.05; I2 = 51%). Conclusion: PIF is an effective intraoperative modification on the prevention or reduction of sLC, which is worthy of further clinical promotion. Systematic Review Registration: National Institute for Health and Care Research, identifier CRD42022364461.

Comparative Transcriptome Analysis Reveals the Interaction of Sugar and Hormone Metabolism Involved in the Root Hair Morphogenesis of the Endangered Fir Abies beshanzuensis.

Abies beshanzuensis, an extremely rare and critically endangered plant with only three wild adult trees globally, is strongly mycorrhizal-dependent, leading to difficulties in protection and artificial breeding without symbiosis. Root hair morphogenesis plays an important role in the survival of mycorrhizal symbionts. Due to the lack of an effective genome and transcriptome of A. beshanzuensis, the molecular signals involved in the root hair development remain unknown, which hinders its endangered mechanism analysis and protection. Herein, transcriptomes of radicles with root hair (RH1) and without root hair (RH0) from A. beshanzuensis in vitro plantlets were primarily established. Functional annotation and differentially expressed gene (DEG) analysis showed that the two phenotypes have highly differentially expressed gene clusters. Transcriptome divergence identified hormone and sugar signaling primarily involved in root hair morphogenesis of A. beshanzuensis. Weighted correlation network analysis (WGCNA) coupled with quantitative real-time PCR (qRT-PCR) found that two hormone-sucrose-root hair modules were linked by IAA17, and SUS was positioned in the center of the regulation network, co-expressed with SRK2E in hormone transduction and key genes related to root hair morphogenesis. Our results contribute to better understanding of the molecular mechanisms of root hair development and offer new insights into deciphering the survival mechanism of A. beshanzuensis and other endangered species, utilizing root hair as a compensatory strategy instead of poor mycorrhizal growth.

Adaptive Multi-View and Temporal Fusing Transformer for 3D Human Pose Estimation.

This article proposes a unified framework dubbed Multi-view and Temporal Fusing Transformer (MTF-Transformer) to adaptively handle varying view numbers and video length without camera calibration in 3D Human Pose Estimation (HPE). It consists of Feature Extractor, Multi-view Fusing Transformer (MFT), and Temporal Fusing Transformer (TFT). Feature Extractor estimates 2D pose from each image and fuses the prediction according to the confidence. It provides pose-focused feature embedding and makes subsequent modules computationally lightweight. MFT fuses the features of a varying number of views with a novel Relative-Attention block. It adaptively measures the implicit relative relationship between each pair of views and reconstructs more informative features. TFT aggregates the features of the whole sequence and predicts 3D pose via a transformer. It adaptively deals with the video of arbitrary length and fully unitizes the temporal information. The migration of transformers enables our model to learn spatial geometry better and preserve robustness for varying application scenarios. We report quantitative and qualitative results on the Human3.6M, TotalCapture, and KTH Multiview Football II. Compared with state-of-the-art methods with camera parameters, MTF-Transformer obtains competitive results and generalizes well to dynamic capture with an arbitrary number of unseen views.

Genome-wide identification and expression analysis of JmjC domain-containing genes in grape under MTA treatment.

Histone demethylases containing the JmjC domain play an extremely important role in maintaining the homeostasis of histone methylation and are closely related to plant growth and development. Currently, the JmjC domain-containing proteins have been reported in many species; however, they have not been systematically studied in grapes. In this paper, 21 VviJMJ gene family members were identified from the whole grape genome, and the VviJMJ genes were classified into five subfamilies: KDM3, KDM4, KDM5, JMJD6, and JMJ-only based on the phylogenetic relationship and structural features of Arabidopsis and grape. After that, the conserved sites of VviJMJ genes were revealed by protein sequence analysis. In addition, chromosomal localization and gene structure analysis revealed the heterogeneous distribution of VviJMJ genes on grape chromosomes and the structural features of VviJMJ genes, respectively. Analysis of promoter cis-acting elements demonstrated numerous hormone, light, and stress response elements in the promoter region of the VviJMJ genes. Subsequently, the grape fruit was treated with MTA (an H3K4 methylation inhibitor), which significantly resulted in the early ripening of grape fruits. The qRT-PCR analysis showed that VviJMJ genes (except VviJMJ13c) had different expression patterns during grape fruit development. The expression of VviJMJ genes in the treatment group was significantly higher than that in the control group. The results indicate that VviJMJ genes are closely related to grape fruit ripening.

Novel Biosynthetic Route to the Isoquinoline Scaffold.

Isoquinoline alkaloids are a large class of natural products with a broad range of biological activities, including antimicrobial, antitumor, antileukemic and anti-inflammatory properties. Although mostly found in plants, isoquinolines can also be found in the extracts of bacterial and fungal cultures. Regardless of the origin, most of the reported biosynthetic routes for isoquinolines use tyrosine as a main biosynthetic precursor. Here, we report the identification of a new biosynthetic pathway for production of isoquinolinequinone alkaloid mansouramycin D in Streptomyces albus Del14. Using feeding, mass spectrometry, and nuclear magnetic resonance spectroscopy, we demonstrate that tryptophan serves instead of tyrosine as a main mansouramycin biosynthetic precursor. The biosynthetic genes were identified in the chromosome of the strain by using gene inactivation and heterologous expression. Insights into the biosynthesis of mansouramycins are also presented.

Multilevel Spatial-Temporal Excited Graph Network for Skeleton-based Action Recognition.

The ability to capture joint connections in complicated motion is essential for skeleton-based action recognition. However, earlier approaches may not be able to fully explore this connection in either the spatial or temporal dimension due to fixed or single-level topological structures and insufficient temporal modeling. In this paper, we propose a novel multilevel spatial-temporal excited graph network (ML-STGNet) to address the above problems. In the spatial configuration, we decouple the learning of the human skeleton into general and individual graphs by designing a multilevel graph convolution (ML-GCN) network and a spatial data-driven excitation (SDE) module, respectively. ML-GCN leverages joint-level, part-level, and body-level graphs to comprehensively model the hierarchical relations of a human body. Based on this, SDE is further introduced to handle the diverse joint relations of different samples in a data-dependent way. This decoupling approach not only increases the flexibility of the model for graph construction but also enables the generality to adapt to various data samples. In the temporal configuration, we apply the concept of temporal difference to the human skeleton and design an efficient temporal motion excitation (TME) module to highlight the motion-sensitive features. Furthermore, a simplified multiscale temporal convolution (MS-TCN) network is introduced to enrich the expression ability of temporal features. Extensive experiments on the four popular datasets NTU-RGB+D, NTU-RGB+D 120, Kinetics Skeleton 400, and Toyota Smarthome demonstrate that ML-STGNet gains considerable improvements over the existing state of the art.

Backward Attentive Fusing Network With Local Aggregation Classifier for 3D Point Cloud Semantic Segmentation.

In this paper, a Backward Attentive Fusing Network with Local Aggregation Classifier (BAF-LAC) is proposed to improve the performance of 3D point cloud semantic segmentation. It consists of a Backward Attentive Fusing Encoder-Decoder (BAF-ED) to learn semantic features and a Local Aggregation Classifier (LAC) to maintain the context-awareness of points. BAF-ED narrows the semantic gap between the encoder and the decoder via fusing multi-layer encoder features with the decoder features. High-level encoder features are transformed into an attention map to modulate low-level encoder features backward. LAC adaptively enhances the intermediate features in point-wise MLPs via aggregating the features of neighboring points into the center point. It takes the place of commonly used post-processing techniques and retains context consistency into the classifier. Equipped with these modules, BAF-LAC can extract discriminative semantic features and predict smoother results. Extensive experiments on Semantic3D, SemanticKITTI, and S3DIS demonstrate that the proposed method can achieve competitive results against the state-of-the-art methods.

Identification of a Biosynthetic Gene Cluster Responsible for the Production of a New Pyrrolopyrimidine Natural Product-Huimycin.

Pyrrolopyrimidines are an important class of natural products with a broad spectrum of biological activities, including antibacterial, antifungal, antiviral, anticancer or anti-inflammatory. Here, we present the identification of a biosynthetic gene cluster from the rare actinomycete strain Kutzneria albida DSM 43870, which leads to the production of huimycin, a new member of the pyrrolopyrimidine family of compounds. The huimycin gene cluster was successfully expressed in the heterologous host strain Streptomyces albus Del14. The compound was purified, and its structure was elucidated by means of nuclear magnetic resonance spectroscopy. The minimal huimycin gene cluster was identified through sequence analysis and a series of gene deletion experiments. A model for huimycin biosynthesis is also proposed in this paper.