uide intraoperative decision-making during myomectomy.Study objective To demonstrate the surgical steps used to perform a robotic radical parametrectomy in a woman with deep infiltrating endometriosis DESIGN Description of the procedure using video. Setting A university hospital, referral center for endometriosis and minimally invasive surgery. Intervention A 47 years old woman, BMI 31, who underwent supracervical hysterectomy for fibromatosis 5 years before. She presented for definitive surgical management of parametrial and rectal endometriosis-associated pain. Robotic assisted nerve sparing eradication of endometriosis, trachelectomy and rectal shaving was planned. On the right side retroperitoneum was opened to widely expose the ureter and right adnexectomy was carried out gently separating the ureter from the diffuse periadnexal fibrosis. Right medial pararectal space was developed and, after right partial uterolysis, a nerve-sparing resection of the posterior parametrial endometriosis was carried out. On the left side endometriotic infiltration penetrated into the lateral and the anterior (cranial portion) parametrium, wrapping the left uterine artery (LUA) and the ureter. Left paravescical and pararectal spaces were developed. LUA was clipped at its origin and the resection of the lateral and anterior parametrial nodule was completed following the shape of the nodule, dividing the lesion in two parts and following the plane of the deep uterine vein to avoid the excision of the nerve branches from the left inferior hypogastric plexus. Rectal endometriosis was removed by shaving and surgery ended with the trachelectomy and the robotic suture of the vaginal cuff. Conclusion Robotic assisted laparoscopy is a safe and effective technique for nerve-sparing resection of parametrial endometriosis.RING-in-between-RING (RBR) E3 ligases are one class of E3 ligases that is characterized by the unique RING-HECT hybrid mechanism to function with E2s to transfer ubiquitin to target proteins for degradation. Emerging evidence has demonstrated that RBR E3 ligases play an essential role in neurodegenerative diseases, infection, inflammation and cancer. Accumulated evidence has revealed that RBR E3 ligases exert their biological functions in various types of cancers by modulating the degradation of tumor promoters or suppressors. Hence, we summarize the differential functions of RBR E3 ligases in a variety of human cancers. In general, ARIH1, RNF14, RNF31, RNF144B, RNF216, and RBCK1 exhibit primarily oncogenic roles, whereas ARIH2, PARC and PARK2 mainly have tumor suppressive functions. Moreover, the underlying mechanisms by which different RBR E3 ligases are involved in tumorigenesis and progression are also described. We discuss the further investigation is required to comprehensively understand the critical role of RBR E3 ligases in carcinogenesis. We hope our review can stimulate the researchers to deeper explore the mechanism of RBR E3 ligases-mediated carcinogenesis and to develop useful inhibitors of these oncogenic E3 ligases for cancer therapy.Objectives To investigate the main characteristics and the precision of outcomes between updated and original systematic reviews (SRs). Study design and setting We searched PubMed and Embase.com on 31 March 2019, and included 30 pairs of updated and original SRs. We calculated changes in outcomes and the precision of effect size estimates in updated SRs, compared with original SRs. Review Manager 5.3 software was adopted to create forest plots showing comparable outcomes. Results The average update time was 56.0 months, and incorporating new trials (23 SRs, 76.7%) was the main reason for the update.  https://www.selleckchem.com/products/Abiraterone.html  Compared with original SRs, 24 (80.0%) updated SRs included more randomized controlled trials (RCTs) and 22 (73.3%) updated SRs involved a larger number of patients. Of the 130 comparable outcomes, only three (2.3%) outcomes were observed with a significant change in three SR updates. No new data from RCTs were added to 36 (27.7%) outcomes during the update process. Of the 94 outcomes including new evidence, 83 (88.3%) showed an improvement in precision, 5 (5.3%) showed a decrease, and 6 (6.4%) did not exhibit changes in precision. Conclusion Updating SRs could increase the precision of most comparable outcomes, although the conclusions of almost all updated SRs were similar to original SRs.Introduction Chronic breathlessness is associated with poorer quality of life. This population study aimed to define dimensions of quality of life (QoL), and duration and dominant causes of breathlessness that most diminished QoL. Methods This cross-sectional, population-based, randomised survey of adults (n=2,977) in South Australia collected data on demographics, modified Medical Research Council (mMRC) breathlessness and QoL (EQ-5D-5L; SF-12). Data weighted to the census were analysed for relationships between EQ-5D-5L and its dimensions with mMRC. Regression models controlled for age, sex, education, rurality and body mass index. Results 2,883 responses were analysed 49% were male; mean age 48 years (SD 19). As mMRC worsened, EQ-5D-5L and its dimensions worsened. More severe chronic breathlessness was iteratively associated with lower mobility, daily activities and worse pain/discomfort. For self-care and anxiety/depression, impairment was only with the most severe breathlessness. Respondents who had chronic breathlessness for two to six years had the worst quality of life scores. People who attributed their breathlessness to cardiac failure had poorer quality of life. Respondents who reported a cardiac cause for their breathlessness had worse mobility, poorer usual activities and more pain than the other causes. The regression analyses showed that worse chronic breathlessness was associated with worsening QoL in each dimension of EQ-5D-5L, with the exception of the self-care, which only worsened with the most severe breathlessness. Conclusions This is the first study to report on chronic breathlessness and impairment across dimensions of QoL and differences by its duration. Mobility, usual activity and pain drive these reductions.