First Affiliated Hospital of China Medical University

This interdisciplinary approach underscores the complexity and the necessity for a broad skill set among medical professionals involved in these procedures, ensuring that the procedure is comprehensive and precise. Discussing the necessary training protocols and the time required for surgeons to attain proficiency with HRR would be beneficial. This information could help other institutions anticipate the resources needed for successful implementation and ensure that integrating HRR does not adversely affect surgical efficiency or patient outcomes during the transition period. Thirdly, the need for an economic evaluation of HRR technology is a significant oversight. Incorporating cost-effectiveness analysis is crucial when introducing new technologies into healthcare systems. Assessing expenses such as equipment, software licenses, maintenance, and training about the potential financial benefits from improved surgical outcomes is essential. Without this assessment, health-care providers may struggle to make informed investment and resource allocation decisions, particularly in settings with limited budgets. Moreover, although the authors present promising results, the study design lacks a control group, which limits the ability to directly attribute improvements in surgical outcomes to the use of HRR. Quantitative data comparing surgical outcomes with and without HRR assistance are essential to substantiate its advantages. Conducting a comparative study, potentially utilizing propensity score matching to retrospectively compare outcomes with previous cases where HRR was not employed, would be beneficial [4]. This approach could help manage confounding variables and provide more robust evidence of HRR's efficacy. In conclusion, the integration of HRR technology in lap-aroscopic adrenalectomy for giant adrenal tumors is a promising advancement. Addressing these aspects could augment its clinical applicability and facilitate broader adoption in practice. We commend the authors for their essential work and eagerly anticipate further studies that build upon these preliminary findings. Dear Editor, The surgical management of large adrenal tumors is challenging due to the difficulty in delineating the boundaries of critical vessels and adjacent tissues [1]. Imaging modalities provide essential anatomical details for surgical planning and execution. We have taken a keen interest in the recent publication in the World Journal of Urology entitled "Hyper-realistic Rendering-Assisted Laparoscopic Adrenal-ectomy for Giant Adrenal Tumors: A Pilot Study [2]" This innovative approach shows significant promise in enhancing surgical visualization and patient outcomes. While these findings are encouraging, several limitations need to be addressed. Firstly, the study needs comprehensive details regarding the hardware and software requirements for implementing hyper-realistic rendering (HRR) technology. Previous research has highlighted that the quality of cinematic rendering (CR) images critically depends on the quality of the CT dataset and the optimization of acquisition parameters used in their generation [3]. Since HRR is similar to CR technology [2], understanding practical aspects-such as equipment specifications, processing times, and compatibility with existing surgical systems-is vital for assessing its feasibility and scalability in clinical practice. Without this information, other institutions may find adopting and integrating HRR into their surgical workflows challenging, potentially limiting its widespread clinical application. Secondly, the learning curve associated with HRR technology warrants attention. Although the study is primarily conducted by urologists, even radiologists may require specialized training in CR procedures to manipulate and adjust real-time parameters for diverse pathologies effectively [3].

The formation of functional bacterial amyloids by phenol-soluble modulins (PSMs) in Staphylococcus aureus is a critical component of biofilm-associated infections, providing robust protective barriers against antimicrobial agents and immune defenses. Clarifying the molecular mechanisms of PSM self-assembly within the biofilm matrix is essential for developing strategies to disrupt biofilm integrity and combat biofilm-related infections. In this study, we analyzed the self-assembly dynamics of PSM-β1 and PSM-β2 by examining their folding and dimerization through long-timescale atomistic discrete molecular dynamics simulations. Our findings revealed that both peptides primarily adopt helical structures as monomers but shift to β-sheets upon dimerization. Monomeric state, PSM-β1 exhibited frequent transitions between helical and β-sheet forms, while PSM-β2 largely retained a helical structure. Upon dimerization, both peptides showed pronounced β-sheet formation around conserved C-terminal residues 21–44. Residues 21–33, largely unstructured as monomers, demonstrated strong tendencies for β-sheet formation and intermolecular interactions, underscoring their central role in the self-assembly of both peptides. Additionally, the PSM-β1 N-terminus formed β-sheets only when interacting with the C-terminus, whereas the PSM-β2 N-terminus remained helical and uninvolved in β-sheet formation. These distinct aggregation behaviors likely contribute to biofilm dynamics, with C-terminal regions facilitating biofilm formation and N-terminal regions influencing stability. Targeting residues 21–33 in PSM-β1 and PSM-β2 offers a promising therapeutic approach for disrupting biofilm integrity. This study advances our understanding of PSM-β1 and PSM-β2 self-assembly and presents new targets for drug design against biofilm-associated diseases.