Is there a role of statins in the prevention of aortic biological prostheses degeneration

It has been recently observed that statins might slow the progression of aortic stenosis or sclerosis. Preliminary reports suggested a similar positive effect in reducing the degeneration of aortic valve bioprostheses even though this hypothesis should be further proven and supported by new data. In this review the present evidences of the possible effects of statins in this field are discussed

A New Kinematic Performance Index for Surgical Robots Design

4In the last years a large number of new surgical devices has been developed so to improve the operation outcomes and reduce the patient's trauma. Nevertheless the dexterity and accuracy required in positioning the surgical devices are often unreachable if the surgeons are not assisted by a suitable system. Since a medical robot works in an operating room, close to the patient and the medical staff, it has to satisfy much stricter requirements with respect to an industrial one. From a kinematic point of view, the robot must reach any target position in the patient's body being less invasive as possible for the surgeon's workspace. In order to meet such requirements a suitable performance index to optimal kinematic design is needed. This paper proposes an optimal index which maximizes the robot workspace and minimizes the invasiveness with respect to the surgeon's workspace. The index is used to evaluate the performances of a commercial medical robot and will be very useful in the future design of a new special robot for neurosurgery.nonenoneBaldessin, L.; Gasparetto, A.; Vidoni, R.; Zanotto, V.Baldessin, L.; Gasparetto, Alessandro; Vidoni, R.; Zanotto, V

A new kinematic performance index for surgical robots design

In the last years a large number of new surgical devices has been developed so to improve the operation outcomes and reduce the patient's trauma. Nevertheless the dexterity and accuracy required in positioning the surgical devices are often unreachable if the surgeons are not assisted by a suitable system. Since a medical robot works in an operating room, close to the patient and the medical staff, it has to satisfy much stricter requirements with respect to an industrial one. From a kinematic point of view, the robot must reach any target position in the patient's body being less invasive as possible for the surgeon's workspace. In order to meet such requirements a suitable performance index to optimal kinematic design is needed. This paper proposes an optimal index which maximizes the robot workspace and minimizes the invasiveness with respect to the surgeon's workspace. The index is used to evaluate the performances of a commercial medical robot and will be very useful in the future design of a new special robot for neurosurgery

Pharmacokinetic drug interactions of the non-vitamin K antagonist oral anticoagulants (NOACs)

The use of warfarin, the most commonly prescribed oral anticoagulant, is being questioned by clinicians worldwide due to warfarin several limitations (a limited therapeutic window and significant variability in dose-response among individuals, in addition to a potential for drug-drug interactions). Therefore, the need for non-vitamin K antagonist oral anticoagulants (NOACs) with a rapid onset of antithrombotic effects and a predictable pharmacokinetic (PK) and pharmacodynamic (PD) profile led to the approval of five new drugs: the direct factor Xa (F-Xa) inhibitors rivaroxaban, apixaban, edoxaban and betrixaban (newly approved by FDA) and the direct thrombin (factor-IIa) inhibitor dabigatran etexilate. The advantages of NOACs over warfarin are a fixed-dosage, the absence of the need for drug monitoring for changes in anti-coagulation and fewer clinically significant PK and PD drug\u2013drug interactions. NOACs exposure will likely be increased by the administration of strong P-glycoprotein (P-gp) and cytochrome P450 (CYP) 3A4-inhibitors and may increase the risk of bleeds. On the contrary, P-gp inducers could significantly decrease the NOACs plasma concentration with an associated reduction in their anticoagulant effects. This manuscript gives an overview of NOACs PK profiles and their drug-drug interactions potential. This is meant to be of help to physicians in choosing the best therapeutic approach for their patients

Pharmacokinetic interactions of monoclonal antibodies

The clearance of therapeutic monoclonal antibodies (mAbs) typically does not involve CYP450-mediated metabolism or interaction with cell membrane transporters, therefore the pharmacokinetic interaction of mAbs and small molecule drugs is limited. However, a drug may affect the clearance of mAbs through the modulation of immune response (e.g., methotrexate reduces the clearance of infliximab, adalimumab, and golimumab, possibly due to methotrexate's inhibitory effect on the formation of antibodies against the mAbs). In addition, mAbs that are cytokine modulators may modify the metabolism of drugs through their effects on the regulation pathways of P450 enzymes. For example, cytokine modulators such as tocilizumab (anti-IL-6 receptor antibody) may reverse the "inhibitory" effect of IL-6 on CYP substrates, resulting in a "normalization" of CYP activities. Finally, a drug may alter the clearance of mAbs by either increasing or reducing the levels of expression of targets of mAbs on the cell surface. For instance, statins and fibrates induce PCSK9 expression and therefore increase cellular uptake and clearance of alirocumab and evolocumab, anti-PCSK9 antibodies. In the present review, we will provide an overview on the pharmacokinetics properties of mAbs as related to the most relevant examples of mAbs-small molecule drug interaction

Liver transplantation for the management of hepatoblastoma

Abstract INTRODUCTION: Hepatoblastoma (HEP) is the most frequent liver malignancy occurring in childhood. Surgical resection currently represents the gold standard for treatment. In patients with initially unresectable tumors, chemotherapy may induce remarkable reductions in size. In nonresponder patients, liver transplantation (OLTx) may offer a chance of cure. MATERIALS AND METHODS: From 1990 to 2003, a total of 400 OLTx (31 pediatric transplants) have been performed at Padua University. Seven patients (4 males and 3 females) underwent OLTx for hepatoblastoma. All patients presented with bilobar liver involvement and had received chemotherapy according to the SIOPEL-1. In all patients preoperative staging was negative for extrahepatic involvement. RESULTS: The mean age of the pts was 8.2 years (range 6.4 months to 34 years). Mean follow-up after OLTx was 41.4 months (median 36, range 3 to 108 months). Actuarial patient survival rates after OLTx for hepatoblastoma are 83.3%, 83.3%, and 56% at 1, 3, and 5 years, respectively. Five of seven subjects with HEP are alive after transplant at 3, 12, 36, 65, and 108 months. Two patients died owing to recurrent disease after 6 and 60 months, respectively, from transplantation. Another subject, primarily treated with surgical resection, shows HEP recurrence at 40 months after OLTx. The remaining 4 patients are alive and well at a mean follow-up of 28 months (median 24, range 3 to 65 months). CONCLUSIONS: Liver transplantation may represent a valid therapeutic option for patients with unresectable HEP, but it is contraindicated in cases of recurrence following previous resection surgery. Neo-adjuvant chemotherapy is of paramount importance to obtain good long-term results