Almost fifteen years since its initial description, intraoperative floppy iris syndrome (IFIS) during phacoemulsification surgery remains a challenge for cataract surgeons in all its key aspects that include the stratification of the preoperative risk, preoperative prophylaxis treatment, surgery design and intraoperative management. Since its original association with tamsulosin intake, IFIS has been positively correlated with a plethora of risk factors which include: gender, age, hypertension, other a1-adrenergic receptor antagonists, finasteride, angiotensin II receptor inhibitors, benzodiazepines, antipsychotics, hypertension drugs and decreased dilated pupil diameter. The assessment and stratification of the preoperative risk is pivotal in screening patients prone to develop IFIS. For these patients, it is essential that preoperative prophylaxis, employment of necessary measures and surgical technique modifications are considered. A multidisciplinary approach of IFIS is a mandate, thus ophthalmologists, urologists and sometimes other specialties should cooperate to “educate” each other about the risks of their respective fields. They both must be aware of the joint statement on IFIS by the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery which suggests either the initiation of tamsulosin after phacoemulsification or the use of a non-selective a1-ARA for benign prostatic hyperplasia treatment. In conclusion, awareness of the risk factors associated with IFIS and their detailed preoperative documentation is crucial in addressing IFIS. The lack of such an awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

Introduction: Ischemia-reperfusion (I/R) injuries are caused by complex interrelated mechanisms and pathways. Regarding the liver, I/R injuries and their clinical manifestations are crucial for the surgical outcome. Despite its importance, there is no broadly accepted therapy either for the prevention or for the management of I/R injury. I/R injury of the liver can occur either during hepatic surgery (warm) or during the transplantation procedure (cold). MicroRNAs play a pivotal role in the mechanism of I/R injury, as they regulate the expression of the cellular participants and humoral factors associated with I/R injury. Objective: In this review, we highlight the microRNAs that are involved in the I/R injury of the liver, and the molecular pathways that they regulate. In addition, we discuss the potential role of circulating microRNAs as biomarkers and their role as pharmacological targets in the prevention, diagnosis and treatment of I/R injuries. Method: We conducted a comprehensive review of the PubMed bibliographic database regarding microRNAs and I/R injuries of the liver. Results: In diagnostics, microRNA panels could replace invasive diagnostic procedures, relieving patients of the associated complications. In therapeutics, microRNA agomirs, antagomirs and other drugs can be used to shift the balance between proapoptotic and survival pathways, to alleviate the liver damage caused by I/R. In transplantation procedures, microRNA profiling could decrease the incidence of early graft dysfunction, especially regarding marginal grafts. Conclusion: Although microRNAs seem a very promising clinical tool in the management of I/R injuries, further research is required, until microRNAs become a novel tool in the diagnosis and monitoring of an I/R injury of the liver.

For patients with end-stage kidney disease (ESKD), renal transplantation is the treatment of choice, constituting the most common solid organ transplantation. This study aims to provide a comprehensive review regarding the application of three-dimensional (3D) printing and bioprinting in renal transplantation and regenerative medicine. Specifically, we present studies where 3D-printed models were used in the training of surgeons through renal transplantation simulations, in patient education where patients acquire a higher understanding of their disease and the proposed operation, in the preoperative planning to facilitate decision-making, and in fabricating customized, tools and devices. Three-dimensional-printed models could transform how surgeons train by providing surgical rehearsal platforms across all surgical specialties, enabling training with tissue realism and anatomic precision. The use of 3D-printed models in renal transplantations has shown a positive impact on surgical outcomes, including the duration of the operation and the intraoperative blood loss. Regarding 3D bioprinting, the technique has shown promising results, especially in the field of microfluidic devices, with the development of tissue demonstrating proximal tubules, glomerulus, and tubuloinerstitium function, and in renal organoid development. Such models can be applied for renal disease modeling, drug development, and renal regenerative medicine.

: MicroRNAs constitute small non-coding RNAs that play a pivotal role in regulating the translation and degradation of mRNA and have been associated with many diseases. Artificial Intelligence (AI) is an evolving cluster of interrelated fields, with machine learning (ML) standing out as one of the most prominent AI fields, with a plethora of applications in almost every aspect of human life. ML could be defined as computer algorithms that learn from past data to predict future data. This review comprehensively reviews the current applications of microRNA-based ML models in healthcare. The majority of the identified studies investigated the role of microRNA-based ML models in the management of cancer and specifically gastric cancer (maximum diagnostic accuracy (Accmax): 94%), pancreatic cancer (Accmax: 93%), colorectal cancer (Accmax: 100%), breast cancer (Accmax: 97%), ovarian cancer, neck squamous cell carcinoma, liver cancer, lung cancer (Accmax: 100%), and melanoma. Except for cancer, microRNA-based ML models have been applied for a plethora of other diseases, including ulcerative colitis (Accmax: 92.8%), endometriosis, gestational diabetes mellitus (Accmax: 86%), hearing loss, ischemic stroke, coronary heart disease (Accmax: 96%), tuberculosis, pulmonary arterial hypertension (Accmax: 83%), dementia (Accmax: 82.9%), major cardiovascular events in end-stage renal disease patients, and alcohol dependence (Accmax: 79.1%). Our findings suggest that the development of microRNA-based ML models could be used to enhance the diagnostic accuracy of a plethora of diseases while at the same time substituting or minimizing the use of more invasive diagnostic means (such as endoscopy). Even not as fast as anticipated, AI will eventually infiltrate the entire healthcare industry. AI is the key to a clinical practice where medicine's inherent complexity is embraced. Therefore, AI will become a reality that physicians should conform with to avoid becoming obsolete.

Ischemia-reperfusion injury (IRI) is an unavoidable consequence of kidney transplantation and a major contributor to delayed graft function (DGF). DGF, traditionally defined as the need for dialysis within the first week post-transplant, is linked to inferior graft and patient outcomes, prolonged hospitalization, and higher health care costs. IRI begins with tissue hypoxia, which triggers an inflammatory response on reperfusion. The renal tubule plays a critical role in complement synthesis, with local activation driving inflammation and graft immunogenicity more than circulating liver-derived complement. The lectin pathway is a key initiator of complement activation in hypoxic renal tubules, primarily through collectin-11's interaction with glycan ligands on hypoxic cells, with further amplification through the alternative pathway. Despite promising preclinical results, systemic complement inhibitors have not significantly improved DGF in clinical studies, likely due to inefficient targeting of ischemic renal tubules. Machine perfusion offers a novel approach to delivering therapeutics directly to donor kidneys. Notably, hypothermic machine perfusion has improved DGF rates and early graft outcomes. Emerging targeted delivery systems using extracellular vesicles or nanoparticle-based carriers also promise to deliver therapeutics to the sites of injury. Organ-targeted complement inhibition through machine perfusion or other targeted delivery systems represent compelling strategies for IRI prevention. Finally, multigenic xenografts engineered to prevent complement activation have shown initial promise in overcoming the complement-mediated barriers that continue to challenge allotransplantation in humans.