Analisi round-trip di processi BPMN

la tesi affronta il problema della verifica di processi BPMN concentrandosi su tecniche di analisi che consentono di riportare i risultati ottenuti dal modello formale (rete di Petri) alla notazione grafica BPMN. Lo studio ha portato allo sviluppo di un plug-in di ProM che svolge l'analisi in modo automatic

Homocysteine and risk of age-related macular degeneration: a systematic review and meta-analysis

There is still no agreement on total plasma homocysteine (tHcy) role in age-related macular degeneration (AMD), the leading cause of new blindness in industrialized countries. We performed a systematic review and meta-analysis of the published data on the correlation between tHcy and AMD. MEDLINE/PubMed and ISI Web of Sciences searches were performed according to MOOSE guidelines. Case-control studies were eligible for inclusion. Participants and controls were AMD patients and subjects without AMD. The main outcome measure was wet AMD. Homocysteine level was the main exposure variable. Data were pooled using a random-effects model. Twelve case-control studies were identified: 10 assessed wet AMD, four dry AMD, one early AMD, one late AMD, and one any AMD. As for wet AMD, there was a total of 453 cases and 514 controls. Mean tHcy was on average 1.1 μmol/l (95% confidence interval [CI] = 0.96-1.25) greater in wet AMD cases, but there was evidence of extreme between-study heterogeneity (p < 0.001, I2 = 91.8%). In a model homogenous for age, including six wet AMD studies (214 cases, 274 controls), mean tHcy was on average 0.58 μmol/l (95% CI = 0.35-0.73) greater in the case group, a not statistically significant result (p = 0.144) associated with moderate heterogeneity (I2 = 39.2%). Our meta-analysis indicates that there is some weak evidence that increased tHcy might be associated with wet AMD; however, this result should be interpreted cautiously, because of a marked between-study heterogeneity and the possible effect of publication bias. Future studies, preferably of cohort design, are necessary before any firm conclusions on the putative role of increased tHcy on AMD can be drawn

Ranibizumab in retinal vein occlusion: Treatment recommendations by an expert panel

Retinal vein occlusion (RVO) is a common cause of retinal vascular disease, resulting in potentially irreversible loss of vision despite the existence of several therapeutic options. The humanised monoclonal antibody fragment ranibizumab binds to and inhibits vascular endothelial growth factor, a key driver of macular oedema in RVO. In 2010, ranibizumab was approved in the USA for the treatment of macular oedema in RVO and, in 2011, ranibizumab was approved in the European Union for the treatment of visual impairment caused by macular oedema secondary to RVO in branch and central RVO. Ranibizumab provides an additional therapeutic option for this complex disease: an option that was not fully considered during the preparation of current international guidelines. An expert panel was convened to critically evaluate the evidence for treatment with ranibizumab in patients with visual impairment caused by macular oedema secondary to RVO and to develop treatment recommendations, with the aim of assisting physicians to optimise patient treatment

Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema

Purpose: Different patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD). Methods: In this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment. Results: There were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P < 0.01 and P ≤ 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, –149 ± 127 μm vs four-month CRT reduction, –72 ± 174 μm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, –0.49 ± 1.7 mm3 vs Group 2, –1.3 ± 1.3 mm3; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed. Conclusion: DEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy

Intravitreal steroids for the treatment of retinal diseases

Diabetic macular edema (DME), pseudophakic cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO), and uveitis are ocular conditions related to severe visual impairment worldwide. Corticosteroids have been widely used in the treatment of these retinal diseases, due to their well-known antiangiogenic, antiedematous, and anti-inflammatory properties. Intravitreal steroids have emerged as novel and essential tools in the ophthalmologist’s armamentarium, allowing for maximization of drug efficacy and limited risk of systemic side effects. Recent advances in ocular drug delivery methods led to the development of intraocular implants, which help to provide prolonged treatment with controlled drug release. Moreover, they may add some potential advantages over traditional intraocular injections by delivering certain rates of drug directly to the site of action, amplifying the drug’s half-life, contributing in the minimization of peak plasma levels of the drug, and avoiding the side effects associated with repeated intravitreal injections. The purpose of this review is to provide an update on the use of intravitreal steroids as a treatment option for a variety of retinal diseases and to review the current literature considering their properties, safety, and adverse events

Intravitreal Dexamethasone in Patients with Wet Age-Related Macular Degeneration Resistant to Anti-VEGF: A Prospective Pilot Study

Purpose. To evaluate the efficacy and safety of a single intravitreal dexamethasone implant (DXI) combined with intravitreal antivascular endothelial growth factor (anti-VEGF) therapy, in patients with neovascular age-related macular degeneration (wet-AMD) resistant to conventional treatment. Methods. In this randomized, controlled pilot study, 16 eyes of 15 patients, unresponsive to anti-VEGF therapy, were enrolled and randomly assigned to two groups: DXI + anti-VEGF (treatment group: 11 eyes) and monthly anti-VEGF alone (control group: 5 eyes). Patients were treated at baseline and followed for 6 months. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters, and fluorescein angiography (FA) were evaluated. Results. Eight eyes (72.7%) in the treatment group and 2 eyes in the control group (40%) showed complete retinal fluid resorption (p=0.049). BCVA showed no significant change from baseline in both the treatment group and the control group (p=0.40 and p=0.29, respectively). Both median central foveal thickness (CFT) and median macular volume showed a greater reduction from baseline in the treatment group. Conclusion. In patients showing an incomplete response to anti-VEGF therapy, DXI combined with intravitreal anti-VEGF seems to improve retinal fluid resorption without functional advantage. This trial is registered with ACTRN12618001102268

Eye-related emergencies incidence at a tertiary referral center in Southern Italy during COVID-19 related lockdown

Background: In order to contain the community spread of coronavirus disease (COVID-19) in Italy, a stringent lockdown was imposed, which also impacted the healthcare services. The purpose of this study is to investigate the drop in the number of outpatients in the Ophthalmic Emergency Service (OES) in the Eye Clinic of University of Bari during the COVID-19 lockdown. Methods: A retrospective analysis of electronic medical records from a tertiary referral center in Southern Italy was performed. Demographics and medical characteristics of patients examined in the OES between March 10th, 2020 and May 3rd, 2020 were assessed and compared with records from the same period in 2019. We categorized the patients by sex, age group, and by the type of eye disease that was recorded as the principal diagnosis. The change (%) in the number of patients and diseases between the study periods was analyzed. Results: We observed a reduction in the number of OES visits during the lockdown (-63.4%) compared to the number of visits in 2019. The greatest changes were observed in the youngest (≤20 years; -76.6%) and the most elderly patients (≥81 years; -70.9%). The decrease in the number of patients presenting with each pathology ranged from -82% to -28.5%, depending on the pathology, and mainly involved the orbital and palpebral pathologies, anterior segment disorders, non-specific visual symptoms, and minor injuries. The diagnosis of chronic pathologies, rhegmatogenous retinal detachment, and vitreous haemorrhage increased by 134%, 100%, and 75%, respectively. Conclusions: Our results revealed the impact of the COVID-19 lockdown on OES activities in the Eye Clinic of University of Bari. A drop in number of visits across all age groups was observed. The number of patients presenting with minor and nonurgent conditions decreased, whereas the number of patients presenting with chronic diseases and urgent but deferrable conditions increased

Survey of Auchenorrhyncha in the Salento peninsula in search of putative vectors of Xylella fastidiosa subsp. pauca CoDiRO strain

Xylella fastidiosa (Xf) was identified in September 2013 in olive trees affected by the Olive quick decline syndrome (OQDS) in the Salento peninsula (southern Italy) and denoted Xf strain CoDiRO. Xf is comprised of a group of genetically diverse bacteria in the class Gammaproteobacteria that causes severe plant diseases in many crops and ornamentals. The bacterium is acquired and transmit- ted by xylem-sap feeding hemipterans such as sharpshooter leaf- hoppers (Cicadellidae, Cicadellinae), froghoppers and spittlebugs (Aphrophoridae and Cercopidae) and, possibly, cicadas (Cicadidae and Tibicinidae). Due to the rapid spread and devastation associ- ated with OQDS, a survey of candidate vectors of Xf was conducted from September 2013 in the Gallipoli area in accordance to a EFSA list (EFSA, 2013). Four candidate vector species were identified: (i) Aphrophoridae: Philaenus spumarius L. and Neophilaenus camp- estris Fallen; (ii) Cercopidae: Cercopis sanguinolenta Scopoli; (iii) Ci- cadidae: Cicada orni L. Among these, only P. spumarius, the meadow spittlebug, was experimentally proven to be a vector of X. fastidiosa strain CoDiRO. A high percentage of meadow spittlebugs collected from OQDS-affected orchards, from May to September 2014, tested positive for X. fastidiosa by PCR. Transmission to periwinkle plants was successful. Laboratory tests, so far limited to the Philaenus-ex- posed periwinkle seedlings, will be extended to the entire panel of the host plants (olives, grapes, citrus, oleander and Prunus spp.) that were exposed to infectious spittlebugs. Further ongoing experiments include Xf-free spittlebugs that were allowed to feed on infected olives and other hosts plants prior to transferring onto receptor host plants. The results so far obtained have shown that olive is a source of inoculum from which P. spumarius is able to acquire the bacte- rium and transfer it to other olives. These data strongly suggest that the main vector of Xf in the area of it occurrence is P. spumarius. Transmission tests carried out with other xylem sap feeders found in the OQDS area are also discussed

Sustained Benefits of Ranibizumab with or without Laser in Branch Retinal Vein Occlusion: 24-Month Results of the BRIGHTER Study

Purpose To evaluate the long-term (24-month) efficacy and safety of ranibizumab 0.5 mg administered pro re nata (PRN) with or without laser using an individualized visual acuity (VA) stabilization criteria in patients with visual impairment due to macular edema secondary to branch retinal vein occlusion (BRVO). Design Phase IIIb, open-label, randomized, active-controlled, 3-arm, multicenter study. Participants A total of 455 patients. Methods Patients were randomized (2:2:1) to ranibizumab 0.5 mg (n = 183), ranibizumab 0.5 mg with laser (n = 180), or laser (with optional ranibizumab 0.5 mg after month 6; n = 92). After initial 3 monthly injections, patients in the ranibizumab with or without laser arms received VA stabilization criteria-driven PRN treatment. Patients assigned to the laser arm received laser at the investigator's discretion. Main Outcome Measures Mean (and mean average) change in best-corrected visual acuity (BCVA) and central subfield thickness (CSFT) from baseline to month 24, and safety over 24 months. Results A total of 380 patients (83.5%) completed the study. Ranibizumab with or without laser led to superior BCVA outcomes versus laser (monotherapy and combined with ranibizumab from month 6; 17.3/15.5 vs. 11.6 letters; P P P = 0.4259). A greater reduction in CSFT was seen with ranibizumab with or without laser versus laser monotherapy over 24 months from baseline (ranibizumab monotherapy −224.7 μm, ranibizumab with laser −248.9 μm, laser [monotherapy and combined with ranibizumab from month 6] −197.5 μm). Presence of macular ischemia did not affect BCVA outcome or treatment frequency. There were no reports of neovascular glaucoma or iris neovascularization. No new safety signals were identified. Conclusions The BRIGHTER study results confirmed the long-term efficacy and safety profile of PRN dosing driven by individualized VA stabilization criteria using ranibizumab 0.5 mg in patients with BRVO. Addition of laser did not lead to better functional outcomes or lower treatment need. The safety results were consistent with the well-established safety profile of ranibizumab

Infectivity and Transmission of Xylella fastidiosa by Philaenus spumarius (Hemiptera: Aphrophoridae) in Apulia, Italy

Discovery of Xylella fastidiosa from olive trees with "Olive quick decline syndrome" in October 2013 on the west coast of the Salento Peninsula prompted an immediate search for insect vectors of the bacterium. The dominant xylem-fluid feeding hemipteran collected in olive orchards during a 3-mo survey was the meadow spittlebug, Philaenus spumarius (L.) (Hemiptera: Aphrophoridae). Adult P. spumarius, collected in November 2013 from ground vegetation in X. fastidiosa-infected olive orchards, were 67% (40 out of 60) positive for X. fastidiosa by polymerase chain reaction (PCR) assays. Euscelis lineolatus Brulle were also collected but tested negative for the pathogen. Transmission tests with P. spumarius collected from the Salento area were, therefore, conducted. After a 96-h inoculation access period with 8 to 10 insects per plant and a 30-d incubation period, PCR results showed P. spumarius transmitted X. fastidiosa to two of five periwinkle plants but not to the seven olive plants. Sequences of PCR products from infected periwinkle were identical with those from X. fastidiosa-infected field trees. These data showed P. spumarius as a vector of X. fastidiosa strain infecting olives trees in the Salento Peninsula, Italy