Therapeutic Drug Monitoring of Micophenolate Mofetil in Cardiac Transplant Patients by Limited Sampling Strategy: An Update

In the last few years, much progress in avoiding acute and chronic rejection in transplanted patients has been made by introducing new and more effective drugs with different formulations and combinations, and fewer side effects. Standardized protocols have been proposed for different organs, but individualized therapy based on immunosuppressive therapy blood monitoring is necessary because of pharmacological interaction, new generic drug introductions, and different absorptions and biodistributions. In specific mycophenolate mofetil dosing through mycophenolic acid (MPA), therapeutic drug monitoring has demonstrated minimal risk of organ transplant rejection. Even if the MPA area under the 12 h concentration–time curve is more accurate than MPA levels, it appears to be resource consuming and clinically impractical because of the need for numerous blood samples. Limited sampling strategy (LLS) has been proposed to overcome this problem. In heart-transplanted patients, MPA LSS is useful in guiding clinical management and dosing. The purpose of this chapter is to describe the state of the art of MPA LSS employment in heart transplantation and to perform an update of the scientific literature

BIODIVERSIDAD EN VENEZUELA. ARÁCNIDOS. DESCRIPCIÓN DE UNA NUEVA ESPECIE DEL GÉNERO TITYUS KOCH, 1836 (BUTHIDAE) Y TRES DEL GENERO CHACTAS GERVAIS, 1844 (CHACTIDAE). ESCORPIONES DE LOS ALREDEDORES DEL CARACAS, DISTRITO METROPOLITANO.

Se describen cuatro especies nuevas de escorpiones TiIyus kalettaz, (Buthídae), Chactas granulosus. Chactas hatilloensis y Cha ctas turguaenszs (Chactídae) Habitan en localidades situadas alrededor de Caracas, Distrito Metropolitano, en localidades variables entre 850 y 1100 metros Presentamos dibujos con los caracteres morfológicos significativos para diagnosticar las especies, éstos fueron realizados por el autor usando una lupa estereoscópica, éste mismo equipo se usó para tomar los caracteres morfométricos Las localidades típicas están señaladas en un mapa

DESCRIPCIÓN DE SEIS NUEVAS ESPECIES DEL GÉNERO BLECHROSCELIS (ARANEAE: PHOLCIDAE)

Describimos seis nuevas especies del género Blechroscelis de la familia Pholcidae: Blechroscelis aquoso n. sp., Blechroscelis araguanus n. sp., Blechroscelis lechroscelis n. sp., Blechroscelis copeyensis n. sp., Blechroscelis cordillerano n. sp. y Blechroscelis andinensis n. sp. Presentamos dibujos con los caracteres morfológicos significativos, tablas con la morfometría y en un mapa señalamos las localidades típicas

ARÁCNIDOS DEVENEZUELA. TRES NUEVOS GÉNEROS Y CUATRO NUEVAS ESPECIES DE LA FAMILIA PHOLCIDAE (ARANEAE)

Se describen tres géneros nuevos y cuatro nuevas especies de la familia Pholcidae: Codazziella pilosa, Coroia magna, Rioparaguanus spinosus y Stenosfemuraia cuadrata; con figuras se ilustran los caracteres morfológicos importantes para identificar los géneros y las especies; se presentan tablas con los caracteres morfométricos; un mapa permite conocer la localidad típica de cada especie.   Palabras claves: Biodiversidad. Arácnidos. Araneae. Familia Pholcidae. Nuevos géneros. Nuevas especies. Venezuela.   ABSTRACT This paper characterizes three new genera and four new species of the Pholcidae family: Codazziella pilosa, Coroia magna, Rioparaguanus spinosus, and Stenosfemuraia cuadrata. Figures illustrating the morphological characters identify the genera and the species. The morphometric characters are indicated in tables. A map shows the typical habitat for each species. Key words: Biodiversity, arachnids, Araneae, Pholcidae family, new genera, new species

Cardiac Cell Senescence and Redox Signaling

Aging is characterized by a progressive loss of the ability of the organism to cope with stressors and to repair tissue damage. As a result, chronic diseases, including cardiovascular disease, increase their prevalence with aging, underlining the existence of common mechanisms that lead to frailty and age-related diseases. In this frame, the progressive decline of the homeostatic and reparative function of primitive cells has been hypothesized to play a major role in the evolution of cardiac pathology to heart failure. Although initially it was believed that reactive oxygen species (ROS) were produced in an unregulated manner as a byproduct of cellular metabolism, causing macromolecular damage and aging, accumulating evidence indicate the major role played by redox signaling in physiology. Aim of this review is to critically revise evidence linking ROS to cell senescence and aging and to provide evidence of the primary role played by redox signaling, with a particular emphasis on the multifunctional protein APE1/Ref in stem cell biology. Finally, we will discuss evidence supporting the role of redox signaling in cardiovascular cells

Use of sutureless and rapid deployment prostheses in challenging reoperations

Sutureless and rapid-deployment bioprostheses have been introduced as alternatives to traditional prosthetic valves to reduce cardiopulmonary and aortic cross-clamp times during aortic valve replacement. These devices have also been employed in extremely demanding surgical settings, as underlined in the present review. Searches on the PubMed and Medline databases aimed to identify, from the English-language literature, the reported cases where both sutureless and rapid-deployment prostheses were employed in challenging surgical situations, usually complex reoperations sometimes even performed as bailout procedures. We have identified 25 patients for whom a sutureless or rapid-deployment prosthesis was used in complex redo procedures: 17 patients with a failing stentless bioprosthesis, 6 patients with a failing homograft, and 2 patients with the failure of a valve-sparing procedure. All patients survived reoperation and were reported to be alive 3 months to 4 years postoperatively. Sutureless and rapid-deployment bioprostheses have proved effective in replacing degenerated stentless bioprostheses and homografts in challenging redo procedures. In these settings, they should be considered as a valid alternative not only to traditional prostheses but also in selected cases to transcatheter valve-in-valve solutions

An integrated approach for treatment of acute type a aortic dissection

Background and objective: We reviewed a single-institution experience to verify the impact of surgery during different time intervals on early and late results in the treatment of patients with type A acute aortic dissection (A-AAD). Materials and Methods: From 2004 to 2021, a total of 258 patients underwent repair of A-AAD; patients were equally distributed among three periods: 2004–2010 (Era 1, n = 90), 2011–2016 (Era 2, n = 87), and 2017–2021 (Era 3, n = 81). The primary end-point was to assess whether through the years changes in indications, surgical strategies and techniques and increasing experience have influenced early and late outcomes of A-AAD repair. Results: Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while one femoral artery was mainly cannulated in Era 1 (91%) (p < 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p < 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p < 0.01). A frozen elephant trunk was mainly performed in Era 3. Hospital mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Conclusions: With increasing experience and a more aggressive approach, including total arch replacement, repair of A-AAD can be performed with low operative mortality in many patients. Patient care and treatment by a specific team organization allows a faster diagnosis and referral for surgery allowing to further improve early and late outcomes