Switch From Twice-daily Tacrolimus to Once-daily, Prolonged-release Tacrolimus in Kidney Transplantation: Long-term Outcome.

BACKGROUND: One daily dose of tacrolimus (QDT) improves adherence in kidney transplant (KT) recipients. A switch from twice-daily tacrolimus (BDT) to QDT showed similar efficacy and safety. METHODS: The aim of our study was to demonstrate the long-term efficacy and safety of switching from BDT to QDT in KT recipients. Preliminary results have already been published. Forty-one patients (34 men and 7 women), mean age at KT of 43.9 ± 12.7 years, underwent a 1:1 dose switch from BDT to QDT; the mean time from KT to switch was 36.6 ± 16.1 months. In our study population, 4 patients received a living donor KT and 2 received a second allograft. RESULTS: The mean follow-up was 86.8 ± 13 months from the switch and 126.2 ± 22.3 months from KT. Graft and patient survival rates were 90.2% and 95.1%, respectively. All patients maintained stable renal function during follow-up. During the first 3 months after the switch we observed a significant decrease in tacrolimus blood level (P = .0001). No significant differences were observed regarding tacrolimus dose before and after QDT introduction (P = not significant [NS]). Fourteen patients who stopped steroids under BDT treatment and 16 patients who stopped steroids after the switch are currently steroid-free. CONCLUSION: Our study showed safety and efficacy in switching from BDT to QDT. After early (<1 year) dose adjustment, tacrolimus blood levels remained stable throughout follow-up. Moreover, QDT represented a valid alternative for patients showing steroid side effects.

Robotic-assisted laparoscopic simple prostatectomy and bladder diverticulectomy with temporary clamping of internal iliac arteries.

The minimally invasive approach for benign prostatic hyperplasia (BPH) is replacing open surgery. Laparoscopic and robotic techniques have benefits in treatment of BPH especially for large prostatic adenoma. We present a case of laparoscopic robotic-assisted simple prostatectomy with bilateral transient occlusion of internal iliac arteries. This could be an optional surgical technique when a significant blood loss is expected, for example in patients with an estimated volume of BPH larger than 100 ml or in patients who cannot suspend antiaggregant therapy. In this case we temporarily occluded the internal iliac arteries bilaterally with Bulldog clamps and the adenoma was enucleated according to Sotelo's laparoscopic robotic-assisted technique. We had optimal results in terms of intraoperative and postoperative outcomes.

Muscular activity when walking in a non-anthropomorphic wearable robot.

Wearable robots should be designed not to alter human physiological motion. Perturbations introduced by a robot can be quantified by measuring EMG activity. This paper presents tests on the LENAR, an intrinsically back-drivable non-anthropomorphic lower limb wearable robot designed to provide hip and knee flexion/extension assistance. In previous works the robot was demonstrated to exhibit low mechanical impedance and to introduce minor alterations to human kinematic patterns during walking. In this paper muscular activity is assessed, demonstrating small alterations in the EMG patterns during the interaction with the robot, in both unpowered and assistive mode.

Leucocyte activity in chronic venous insufficiency.

Before and after venous stasis and upon recovery blood samples were drawn from the saphenous vein in 10 patients with varicose veins (Group 1), in 10 with venous hypertension (Group 2) and in 10 healthy controls. The total leucocyte count, the leucocyte filterability rate (LFR), superoxide dismutase blood concentrations (SOD) and the production of superoxide anions from granulocytes were determined. After stasis, the total leucocyte count increased significantly (p < 0.01) in both groups of patients and the LFR was significantly (p < 0.01) impaired. SOD blood concentrations fell significantly (p < 0.01) and oxygen free radical production dropped significantly (p < 0.01) in both groups. Upon recovery, all parameters returned to normal in Group 1 but significant differences remained in Group 2. No significant modification was observed at any stage of the study in the control group. These results suggest that impairments in leucocyte rheology and granulocyte production of oxygen free radicals cause capillary plugging and possibly damage to microcirculatory vessel walls in venous disease.