Intraoperative Iris Behavior during Phacoemulsification Maneuvers in Rabbits Treated with Selective α1-Blocker, 5α-Reductase Inhibitor, or Anxiolytic Medication.

This prospective, experimental study aims to evaluate the association between administration of α-blocker, 5α-reductase inhibitor, or anxiolytic medications and intraoperative floppy iris syndrome (IFIS) using a rabbit animal model. A total of 31 Metis rabbits were distributed into four groups as follows: 10 rabbits given tamsulosin, 10 rabbits given finasteride, 5 rabbits who received lorazepam, and 6 treatment-naive animals in the control group. Dosing was calculated according to body surface area ratio of man to rabbit, with a dosing duration of 43 days for all groups. Phacoemulsification maneuvers were performed by a single surgeon, who was blinded to group allocation. Any intraoperative billowing of the iris was noted and subsequently graded from 0 to 3. Higher incidences of iris billowing were found in the tamsulosin-dosed animals [OR = 8.33 (CI 95% 0.63-110.09)], (p = 0.13), the finasteride group [OR = 11.6 (CI 95% 0.92-147.6)], (p = 0.11), and the lorazepam group [OR = 7.5 (CI 95% 0.45-122.8)], (p = 0.24), as opposed to the control. Administration of α-blocker tamsulosin, 5α-reductase inhibitor finasteride, or anxiolytic medication lorazepam induces altered intraoperative iris behavior. These results correspond with previous studies and further solidify the hypothesis that systemic medication, administered both long and short-term, influences surgical parameters in cataract surgery. The present study can become the basis for further clinical or experimental research.

Microfluidic Transfection System and Temperature Strongly Influence the Efficiency of Transient Transfection.

For the process of transient transfection (TTF), DNA is often transported into the cells using polyplexes. The polyplex uptake and the subsequent transient expression of the gene of interest are of great importance for a successful transfection. In this study, we investigated a 3D-printed microfluidic system designed to facilitate direct TTF for suspension of CHO-K1 cells. The results demonstrate that this system achieves significantly better results than the manual approach. Furthermore, the effect of both post-transfection incubation time (t) and temperature (T) on polyplex uptake was explored in light of the membrane phase transitions. Attention was paid to obtaining the highest possible transfection efficiency (TFE), viability (V), and viable cell concentration (VCC). Our results show that transfection output measured as product of VCC and TFE is optimal for t = 1 h at T = 22 °C. Moreover, post-transfection incubation at T = 22 °C with short periods of increased T at T = 40 °C were observed to further increase the output. Finally, we found that around T = 19 °C, the TFE increases strongly. This is the membrane phase transition T of CHO-K1 cells, and those results therefore suggest a correlation between membrane order and permeability (and in turn, TFE).

Peritoneal Flap for Lymphocele Prophylaxis Following Robotic-assisted Radical Prostatectomy with Lymph Node Dissection: The Randomised Controlled Phase 3 PELYCAN Trial.

BACKGROUND: Symptomatic lymphoceles (SLCs) after transperitoneal robotic-assisted radical prostatectomy with pelvic lymph node dissection (PLND) are common. Evidence from randomised controlled trials (RCTs) on the impact of peritoneal flaps (PFs) on lymphocele (LC) reduction is inconclusive. OBJECTIVE: To show that addition of PFs leads to a reduction of postoperative SLCs. DESIGN, SETTING, AND PARTICIPANTS: An investigator-initiated, prospective, parallel, double-blinded, adaptive, phase 3 RCT was conducted. Recruitment took place from September 2019 until December 2021; 6-month written survey-based follow-up was recorded. Stratification was carried out according to potential LC risk factors (extended PLND, diabetes mellitus, and anticoagulation) and surgeons; 1:1 block randomisation was used. Surgeons were informed about allocation after completion of the last surgical step. INTERVENTION: To create PFs, the ventral peritoneum was incised bilaterally and fixated to the pelvic floor. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was SLCs. Secondary endpoints included asymptomatic lymphoceles (ALCs), perioperative parameters, and postoperative complications. RESULTS AND LIMITATIONS: In total, 860 men were screened and 551 randomised. Significant reductions of SLCs (from 9.1% to 3.7%, p = 0.005) and ALCs (27.2% to 10.3%, p < 0.001) over the follow-up period of 6 mo were observed in the intention-to-treat analysis. Operating time was 11 min longer (p < 0.001) in the intervention group; no significant differences in amount (80 vs 103, p = 0.879) and severity (p = 0.182) of postoperative complications (excluding LCs) were observed. The survey-based follow-up might be a limitation. CONCLUSIONS: This is the largest RCT evaluating PF creation for LC prevention and met its primary endpoint, the reduction of SLCs. The results were consistent among all subgroup analyses including ALCs. Owing to the subsequent reduction of burden for patients and the healthcare system, establishing PFs should become the new standard of care. PATIENT SUMMARY: A new technique-creation of bilateral peritoneal flaps-was added to the standard procedure of robotic-assisted prostatectomy for lymph node removal. It was safe and decreased lymphocele development, a common postoperative complication and morbidity. Hence, it should become a standard procedure.