OBJECTIVE: Ischemic complications account for significant patient morbidity following aneurysmal subarachnoid hemorrhage (aSAH). The Prevention and Treatment of Vasospasm with Clazosentan (REACT) study was designed to assess the safety and efficacy of clazosentan, an endothelin receptor antagonist, in preventing clinical deterioration due to delayed cerebral ischemia (DCI) in patients with aSAH. METHODS: REACT was a prospective, multicenter, randomized, double-blind, phase 3 study. Eligible patients had aSAH secured by surgical clipping or endovascular coiling, and had presented with thick and diffuse clot on admission CT scan. Patients were randomized (1:1 ratio) to 15 mg/hour intravenous clazosentan or placebo within 96 hours of the aSAH for up to 14 days, in addition to standard of care treatment including oral or intravenous nimodipine. The primary efficacy endpoint was the occurrence of clinical deterioration due to DCI up to 14 days after initiation of the study drug. The main secondary endpoint was the occurrence of clinically relevant cerebral infarction at day 16 after study drug initiation. Other secondary endpoints included clinical outcome assessed on the modified Rankin Scale (mRS) and the Glasgow Outcome Scale-Extended (GOSE) at week 12 post-aSAH. Imaging and clinical endpoints were centrally adjudicated. RESULTS: A total of 409 patients were randomized between February 2019 and May 2022 across 74 international sites. Three patients did not start study treatment and were not included in the analysis set. The occurrence of clinical deterioration due to DCI was 15.8% (32/202 patients) in the clazosentan group and 17.2% (35/204 patients) in the placebo group, and the difference was not statistically significant (relative risk reduction [RRR] 7.2%, 95% CI -42.6% to 39.6%, p = 0.734). A nonsignificant RRR of 34.1% (95% CI -21.3% to 64.2%, p = 0.177) was observed in clinically relevant cerebral infarcts treated with clazosentan (7.4%, 15/202) versus placebo (11.3%, 23/204). Rescue therapy was less frequently needed for patients treated with clazosentan compared to placebo (10.4%, 21/202 vs 18.1%, 37/204; RRR 42.6%, 95% CI 5.4%-65.2%). A nonsignificant relative risk increase of 25.4% (95% CI -10.7% to 76.0%, p = 0.198) was reported in the risk of poor GOSE and mRS scores with clazosentan (24.8%, 50/202) versus placebo (20.1%, 41/204) at week 12 post-aSAH. Treatment-emergent adverse events were similar to those reported previously. CONCLUSIONS: Clazosentan administered for up to 14 days at 15 mg/hour had no significant effect on the occurrence of clinical deterioration due to DCI. Clinical trial registration no.: NCT03585270 (ClinicalTrials.gov) EU clinical trial registration no.: 2018-000241-39 (clinicaltrialsregister.eu).

• MeSH
• Dioxanes * therapeutic use   adverse effects   MeSH
• Adult MeSH
• Double-Blind Method MeSH
• Vasospasm, Intracranial etiology   prevention & control   drug therapy   diagnostic imaging   MeSH
• Brain Ischemia * prevention & control   etiology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Pyridines * therapeutic use   adverse effects   administration & dosage   MeSH
• Pyrimidines * therapeutic use   adverse effects   administration & dosage   MeSH
• Aged MeSH
• Subarachnoid Hemorrhage * complications   diagnostic imaging   MeSH
• Sulfonamides * therapeutic use   adverse effects   administration & dosage   MeSH
• Tetrazoles * therapeutic use   adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial, Phase III MeSH
• Multicenter Study MeSH
• Randomized Controlled Trial MeSH

Úvod: U idiopatické retroperitoneální fibrózy dominuje zavzetí ureterů do retroperitoneální fibrotické masy (zejména ve střední části ureterů), což vede k rozvoji (dolicho-) megaureterů s následnou progredující renální insuficiencí. Levá strana bývá postižena dříve. Řešením je ovlivnění etiopatogeneze onemocnění (zejména kortikoidní léčba) a derivace horních cest močových. Je možné provést buď trvalý stenting obou ureterů se všemi svými nevýhodami, či jejich deliberaci, která se historicky prováděla otevřeně ze střední laparotomie, nověji miniinvazivně. V práci hodnotíme výsledky miniinvazivní (laparoskopické, resp. roboticky asistované) deliberace a prezentujeme video robotické varianty. Soubor: V období 2001–2024 bylo k oboustranné deliberaci indikováno devět nemocných – tři muži (33 %) a šest žen; průměrný věk 58,5 ± 6,9 (48,8–69,6) roků; body mass index (BMI) 28,9 ± 5,8 (19,5–38,1). První čtyři řešení laparoskopicky, pět poté roboticky asistovaně. U dvou (22,2 %) nemocných nebylo možno uretery z těžkých fibrotických změn uvolnit (jeden z laparoskopie ponechán na stentech, druhý řešený roboticky asistovaně, provedena otevřená nefrektomie u ledviny s 8,6 % funkce a otevřená druhostranná deliberace – ze střední laparotomie). Doba operace obou stran (bez otevřeného výkonu) byla 154,0 ± 33,5 (100–201) min. Video: Ukazuje deliberaci obou ureterů roboticky asistovaně. Je užit čtyřramenný systém da Vinci Xi, poloha na boku 70°. Začínáme postiženější levou stranou. S Veres jehlou vytvořeno kapnoperitoneum tlakem 12 mm Hg, pupkem zaveden asistentský port 11 mm, za kontroly zraku zavedeny čtyři robotické 8mm porty. Kamera 30°, ProGraspTM, bipolární grasper MarylandTM, monopolární nůžky. Otevřeno parakolicky peritoneum, nalezen ureter a deliberován od dolního pólu ledviny až pod ilické cévy. Pod deliberovaný močovod vloženo mediální peritoneum a fixováno k laterálnímu okraji stehem či Hem-o-lok® L klipy. Ponechán port v pupku, změněna poloha a identicky proveden výkon i vpravo. Dutina břišní nedrénována. Ureterální stenty odstraněny za 3–6 týdnů. Výsledky: U 8 nemocných, kde bylo možno uretery deliberovat (15 močovodů, z toho 1 otevřeně), je známo dlouhodobé sledování všech 15 močovodů, u nich není nutný další stenting ureterů, horní cesty močové jsou sonograficky bez dilatace a nedochází k rozvoji renální insuficience. Doba sledování je v průměru 63,9 ± 64,3 (1–158) měsíců. U 8 kombinováno s kortikoidní terapií, která vedla vždy k výrazné regresi fibrotických hmot. Závěr: Deliberace močovodů při morbus Ormond je proveditelná miniinvazivně (laparoskopicky či roboticky asistovaně) u 77,8 % s překvapivě dobrými dlouhodobými výsledky umožňujícími uchránit horní cesty močové a vyhnout se dlouhodobému stentingu (ve 100 %). Robotické variantě dáváme nyní jednoznačně přednost.

Introduction: In idiopathic retroperitoneal fibrosis, ureteral involvement of the retroperitoneal fibrotic mass (especially in the middle part of the ureters) dominates, leading to the development of (dolicho-) megaureters with subsequent progressive renal insufficiency. The left side tends to be affected earlier. The solution is to influence the etiopathogenesis of the disease (especially corticoid treatment) and diversion of the upper urinary tract. Either permanent stenting of both ureters with all its disadvantages or ureterolysis. Historically open via midline laparotomy, more recently minimally invasive. In this paper we evaluate the results of minimally invasive (laparoscopic or robotic assisted) ureterolysis. Abstract: Between 2001 and 2024, nine patients were indicated for bilateral ureterolysis. Three men (33%) and six women. Mean age 58.5±6.9 (48.8-69.6) years. Body mass index (BMI) 28.9±5.8 (19.5-38.1). First four laparoscopically, subsequent five robotic assisted. In two (22.2%) patients ureters could not be released from severe fibrotic changes (one laparoscopy left with stents, the other robotically assisted open nephrectomy in a kidney with 8.6% function and open secondary ureterolysis - via midline laparotomy). The bilateral operation time (without open surgery) was 154.0±33.5 (100-201) min. Video: Shows the robotic-assisted bilateral ureterolysis. The 4-arm daVinci Xi system is used, 70° lateral position. Starting with the more affected left side. With Veres needle, capnoperitonum pressure of 12 mmHg created, 11 mm assisted port inserted through umbilicus, four robotic 8mm introduced under visual control. Camera 30°, ProGraspTM, bipolar grasper MarylandTM, monopolar scissors. Paracolic peritoneum opened, ureter found and liberated from the lower pole of the kidney to below the iliac vessels. Medial peritoneum inserted under the deliberated ureter and fixed to the lateral margin with suture or Hem-o-lok® L clips. The port in the umbilicus was left, the position was changed and the procedure was performed identically on the right side. The abdominal cavity was not drained. Ureteral stents removed in 3-6 weeks. Results: In the eight patients where ureters could be liberated (15 ureters, 1 open), long-term follow-up is known for all 15 ureters, no further ureteral stenting is required, the upper urinary tract is sonographically free of dilatation and no renal insufficiency developed. The mean follow-up time is 63.9±64.3 (1-158) months. In eight cases, combined corticosteroid therapy always resulted in significant regression of fibrotic masses. Conclusion: Liberation of ureters in morbus Ormond is feasible minimally invasively (laparoscopically or robotically assisted) in 77.8% with surprisingly good long-term results allowing preservation of the upper urinary tract and avoiding long-term stenting (in 100%). The robotic option is now clearly preferred.

• MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures MeSH
• Ureteral Obstruction surgery   MeSH
• Retroperitoneal Fibrosis * complications   MeSH
• Robotic Surgical Procedures MeSH
• Urologic Surgical Procedures MeSH
• Check Tag
• Humans MeSH
• Publication type
• Video-Audio Media MeSH

Aim: To present on video our current most used technique of robot-assisted resection of renal tumour (RR). Material: We performed 274 RRs between June 2020 and November 2024. Our technique is based on a modification of conventional laparoscopic renal resection, of which we performed 599 between August 2004 and May 2020. RRs currently account for over one third of the surgical procedures for kidney cancer at our institution. Laparoscopic (rarely robotic assisted) nephrectomy is almost as frequent. Open resection accounts for about 17% and open nephrectomy for slightly less. Open resections are mainly indicated for more complex tumours, for tumors with significant \"toxic\" fat capsule, and when combined with other procedures, mostly for intestinal malignancies. RR is routinely performed by two console surgeons, occasionally by two additional ones. Operation technique: General anaesthesia. Optional urinary catheter inserted. Lateral position 60-70°. Upper limbs extended in front, close together. Operative field prepared for eventual lumbotomy. Transperitoneal approach. The capnoperitoneum is created with a Veres needle, CO2 pressure 12 mmHg. Assist port 12 mm slightly lateral to the umbilicus. Four 8-mm robotic ports are inserted pararectally under visual control. Four-arm daVinci Xi robotic system is inserted. Ports craniocaudally: 1. ProGrasp, 2. bipolar grasper (bipolar forceps Maryland or more often fenestrated) or monopolar curved scissors (Hot shears) according to the operated side and the dominant hand of the operator, 3. camera 30°, 4. the second of the mentioned instruments from port 2. The scissors are alternated with a needle driver, usually the Large SutureCut needle driver. In the Toldt line, the peritoneum is opened, the colon is retracted medially, and the Gerota fascia is opened medially from the kidney. The necessary part of the kidney is dissected from the fat capsule for good access to the tumour. The tumour is verified sonographically with a drop-in probe inserted through the assistant port. Scissors can be used to mark the line of resection on the kidney. The ureter is verified and the hilar vessels are released. The artery(s) or necessary branch is bypassed with tubing and clamped with the SCANLAN® robotic endo-bulldog. Only in central tumours is the vein also clamped. Knowledge of the topographic anatomy of the vessels from two-phase CT angiography is very helpful at this stage. The effectiveness of ischemia is verified by Doppler; exceptionally (especially in selective clamping of the artery branches) by NIR imaging with FireFly® with administration of indocyanine green - Verdye® 1.25-2.5 mg. The tumour is resected with cold scissors with a rim of healthy tissue. Suturing of the base is performed with an absorbable self-anchoring barbed suture (V-Loc® 90, size 3-0, 1/2 needle 26 mm). The edges of the kidney are mattress sutured with another suture, tightened with Absolok® AP300 absorbable clips (polydioxanone PDS, size ML) - \"sliding clips\" technique. The second layer of the parenchyma is sewn with simple continuation stitches, mostly without continuous anchoring. For more superficial tumours, a straight suture of the parenchyma is

• MeSH
• Laparoscopy MeSH
• Humans MeSH
• Kidney Neoplasms * surgery   MeSH
• Nephrectomy MeSH
• Robotic Surgical Procedures methods   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Management of recurrent mitral regurgitation (MR) or relevant iatrogenic mitral valve (MV) stenosis after mitral transcatheter edge-to-edge repair (M-TEER) emerges as an increasingly relevant clinical issue. Surgery after M-TEER is associated with higher morbidity and mortality. Electrosurgical leaflet laceration and stabilization of the implant (ELASTA-Clip) followed by transcatheter mitral valve replacement (TMVR) is an innovative, less-invasive treatment option for patients with TEER failure. OBJECTIVES: The authors sought to evaluate the early results of ELASTA-Clip followed by transapical TMVR in patients with symptomatic failed M-TEER (defined as persistent or recurrent MR, or iatrogenic MV stenosis). METHODS: Data from symptomatic patients with failed M-TEER who underwent ELASTA-Clip followed by compassionate use or commercial transapical TMVR using the Abbott Tendyne system were retrospectively collected from 8 tertiary care centers in 4 countries. Safety and efficacy of the procedure were assessed up to 1 year according to Mitral Valve Academic Research Consortium (MVARC) criteria. RESULTS: A total of 22 patients (mean age 77.8 ± 9.2 years, 40.9% [9/22] female) at high surgical risk (EuroSCORE II 8.0 ± 0.4, STS score 7.2% ± 1.1%) with symptomatic residual MR ≥3+ (n = 21) or iatrogenic MV stenosis (n = 1) after failed M-TEER were followed for a median period of 8.5 [Q1-Q3: 2.6-11.6] months. The ELASTA-Clip procedure (90.9% [20/22] transseptal, 9.1% [2/22] transapical) followed by TMVR were successful in all patients (22/22). Technical success according to MVARC was achieved in 21 patients (21/22, 95.4%) without left ventricular outflow tract obstruction or conversion to sternotomy. At 30 days, 3 patients had paravalvular leak progression, ischemic stroke occurred in 3 patients (3/20, 15.0%). Baseline MR (≥3+ in 95.5% [21/22]) was reduced to grade 1+ or less in all patients with durable results in 89.5% (17/19) (P < 0.001). NYHA functional class significantly improved to ≤II in 81.3% (13/16) at discharge (P < 0.001) and 72.2% (13/18) at last follow-up (P < 0.001). At 30 days, all patients (20/20) were alive. Three patients (3/20, 15.0%) were rehospitalized for heart failure (uncontrolled atrial fibrillation in 2 cases) and 1 of them (1/22, 4.5%) underwent a reintervention (valve retensioning). CONCLUSIONS: Transapical TMVR after ELASTA-Clip is a feasible and less invasive option for the management of failed M-TEER that can be performed with acceptable results in a carefully selected patient population. Particular attention is required to avoid paravalvular leakage and measures to minimize the risk of periprocedural cerebrovascular events need to be implemented in future larger-scale prospective studies with longer-term follow-up.

• MeSH
• Time Factors MeSH
• Heart Valve Prosthesis Implantation * instrumentation   adverse effects   MeSH
• Compassionate Use Trials MeSH
• Electrosurgery adverse effects   MeSH
• Iatrogenic Disease MeSH
• Humans MeSH
• Mitral Valve * surgery   diagnostic imaging   physiopathology   MeSH
• Mitral Valve Insufficiency * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Mitral Valve Stenosis * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Treatment Failure MeSH
• Recovery of Function MeSH
• Recurrence * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis * MeSH
• Cardiac Catheterization * instrumentation   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Single-cell RNA-seq methods can be used to delineate cell types and states at unprecedented resolution but do little to explain why certain genes are expressed. Single-cell ATAC-seq and multiome (ATAC + RNA) have emerged to give a complementary view of the cell state. It is however unclear what additional information can be extracted from ATAC-seq data besides transcription factor binding sites. Here, we show that ATAC-seq telomere-like reads counter-inituively cannot be used to infer telomere length, as they mostly originate from the subtelomere, but can be used as a biomarker for chromatin condensation. Using long-read sequencing, we further show that modern hyperactive Tn5 does not duplicate 9 bp of its target sequence, contrary to common belief. We provide a new tool, Telomemore, which can quantify nonaligning subtelomeric reads. By analyzing several public datasets and generating new multiome fibroblast and B-cell atlases, we show how this new readout can aid single-cell data interpretation. We show how drivers of condensation processes can be inferred, and how it complements common RNA-seq-based cell cycle inference, which fails for monocytes. Telomemore-based analysis of the condensation state is thus a valuable complement to the single-cell analysis toolbox.

• MeSH
• Single-Cell Analysis * methods   MeSH
• B-Lymphocytes metabolism   cytology   MeSH
• Cell Cycle * genetics   MeSH
• Chromatin Immunoprecipitation Sequencing methods   MeSH
• Chromatin * metabolism   chemistry   genetics   MeSH
• Fibroblasts metabolism   cytology   MeSH
• Humans MeSH
• RNA-Seq methods   MeSH
• Telomere * genetics   MeSH
• Binding Sites MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

The ApxIVA protein belongs to a distinct class of a "clip and link" activity of Repeat-in-ToXin (RTX) exoproteins. Along with the three other pore-forming RTX toxins (ApxI, ApxII and ApxIII), ApxIVA serves as a major virulence factor of Actinobacillus pleuropneumoniae, the causative agent of porcine pneumonia. The gene encoding ApxIVA is located on a bicistronic operon downstream of the orf1 gene and is expressed exclusively under in vivo conditions. Both ApxIVA and ORF1 are essential for full virulence of A. pleuropneumoniae, but the molecular mechanisms by which they contribute to the pathogenicity are not yet understood. Here, we provide a comprehensive structural and functional analysis of ApxIVA and ORF1 proteins. Our findings reveal that the N-terminal segment of ApxIVA shares structural similarity with colicin M (ColM)-like bacteriocins and exhibits an antimicrobial activity. The ORF1 protein resembles the colicin M immunity protein (Cmi) and, like Cmi, is exported to the periplasm through its N-terminal signal peptide. Additionally, ORF1 can protect bacterial cells from the antimicrobial activity of ApxIVA, suggesting that ORF1 and ApxIVA function as an antibacterial toxin-immunity pair. Moreover, we demonstrate that fetal bovine serum could elicit ApxIVA and ORF1 production under in vitro conditions. These findings highlight the coordinated action of various RTX determinants, where the fine-tuned spatiotemporal production of ApxIVA may enhance the fitness of A. pleuropneumoniae, facilitating its invasion to a resident microbial community on the surface of airway mucosa.

• MeSH
• Actinobacillus pleuropneumoniae * genetics   immunology   MeSH
• Anti-Bacterial Agents pharmacology   MeSH
• Bacterial Proteins * genetics   metabolism   immunology   MeSH
• Bacterial Toxins genetics   metabolism   immunology   MeSH
• Virulence Factors genetics   MeSH
• Actinobacillus Infections microbiology   veterinary   MeSH
• Colicins genetics   metabolism   MeSH
• Operon * MeSH
• Swine MeSH
• Gene Expression Regulation, Bacterial MeSH
• Virulence MeSH
• Animals MeSH
• Check Tag
• Animals MeSH
• Publication type
• Journal Article MeSH

• Publication type
• Overall MeSH

Bronchoezofageálne a bronchogastrické fistuly sú zriedkavou komplikáciou chirurgických zákrokov v hrudnej dutine, ako ezofagektómia, malígnych ochorení, dlhodobej endotracheálnej intubácie alebo infekčných ochorení. I keď nie sú časté, dosahujú vysokú morbiditu a mortalitu. Liečba týchto fistúl je náročná a často zdĺhavá s obmedzenou úspešnosťou. V rámci terapie môžeme u niektorých typov fistúl zvoliť endoskopické riešenie, ktorého úspešnosť, napriek veľkému množstvu rôznych metód, je nižšia s malým množstvom konzistentných dôkazov o účinnosti. Súčasne sa objavujú nové zariadenia a technológie s potenciálom na riešenie týchto stavov. Jednou z týchto metód je aj endobronchiálny bloker – Watanabeho spigot, ktorý sa iniciálne používal v pneumológii v terapii perzistentného pneumotoraxu, resp. pyotoraxu s bronchiálnou fistulou. V prezentovaných kazuistikách uvádzame použitie Watanabeho spigotu v kombinácii s over-the-scope klipmi v rámci terapie bronchoezofageálnych fistúl po ezofagektómii. V teoretickej časti článku uvádzame tiež prehľad endoskopických možností terapie uvedených fistúl v kontexte najnovších poznatkov a osobitne diskutujeme dostupné dáta o možnostiach využitia Watanabeho spigotov v liečbe bronchoezofageálnych fistúl.

Bronchoesophageal and bronchogastric fistulas are rare complications of thoracic surgery as esophagectomy, malignancy or prolonged endotracheal intubation. Although uncommon, their morbidity and mortality is substantial. Treatment of these fistulas is challenging and often lengthy with limited success rates. Endoscopic treatment may be the treatment of choice for some types of fistulas, but despite a variety of methods available, the success rate is relatively low with little consistent data about its effectiveness. At the same time, new technologies and devices have become available with a potential to address these complicated conditions. One of them are Watanabe spigots, initially used in pneumology for the treatment of persistent pneumothorax and pyothorax with bronchial fistula. In the presented case reports Watanabe spigots are used in combination with over-the-scope clips in two of our patients with bronchoesophageal fistulas fol lowing esophagectomy with promising results. We also present an overview of endoscopic methods of therapy in the context of and separately discuss available evidence about the possibilities of the use of Watanabeho spigots in the treatment of bronchoesophageal fistulas.

• MeSH
• Bronchial Fistula * surgery   diagnosis   MeSH
• Diagnostic Imaging MeSH
• Adult MeSH
• Endoscopes, Gastrointestinal MeSH
• Esophagectomy methods   MeSH
• Humans MeSH
• Esophageal Neoplasms surgery   drug therapy   MeSH
• Postoperative Complications etiology   therapy   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

In mammals, RNA interference (RNAi) was historically studied as a cytoplasmic event; however, in the last decade, a growing number of reports convincingly show the nuclear localization of the Argonaute (AGO) proteins. Nevertheless, the extent of nuclear RNAi and its implication in biological mechanisms remain to be elucidated. We found that reduced Lamin A levels significantly induce nuclear influx of AGO2 in SHSY5Y neuroblastoma and A375 melanoma cancer cell lines, which normally have no nuclear AGO2. Lamin A KO manifested a more pronounced effect in SHSY5Y cells compared to A375 cells, evident by changes in cell morphology, increased cell proliferation, and oncogenic miRNA expression. Moreover, AGO fPAR-CLIP in Lamin A KO SHSY5Y cells revealed significantly reduced RNAi activity. Further exploration of the nuclear AGO interactome by mass spectrometry identified FAM120A, an RNA-binding protein and known interactor of AGO2. Subsequent FAM120A fPAR-CLIP, revealed that FAM120A co-binds AGO targets and that this competition reduces the RNAi activity. Therefore, loss of Lamin A triggers nuclear AGO2 translocation, FAM120A mediated RNAi impairment, and upregulation of oncogenic miRNAs, facilitating cancer cell proliferation.

• MeSH
• Active Transport, Cell Nucleus MeSH
• Argonaute Proteins * metabolism   genetics   MeSH
• Cell Nucleus * metabolism   MeSH
• Lamin Type A * metabolism   genetics   MeSH
• Humans MeSH
• Melanoma genetics   metabolism   pathology   MeSH
• MicroRNAs * metabolism   genetics   MeSH
• Cell Line, Tumor MeSH
• Cell Proliferation * genetics   MeSH
• RNA-Binding Proteins metabolism   genetics   MeSH
• RNA Interference * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

PRCIS: Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively. OBJECTIVE: To evaluate short and medium-term postoperative results of DS with a fibrin sealant. PATIENTS AND METHODS: This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery. RESULTS: The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively ( P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery ( P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes. CONCLUSIONS: Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.

• MeSH
• Sutureless Surgical Procedures * methods   MeSH
• Glaucoma Drainage Implants MeSH
• Fibrin Tissue Adhesive * therapeutic use   MeSH
• Glaucoma, Open-Angle * surgery   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Follow-Up Studies MeSH
• Intraocular Pressure * physiology   MeSH
• Prospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sclera * surgery   MeSH
• Sclerostomy * methods   MeSH
• Tissue Adhesives * therapeutic use   MeSH
• Tonometry, Ocular MeSH
• Treatment Outcome MeSH
• Visual Acuity * physiology   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH