Effects of oral citicoline in perimetric glaucoma defects

Abstract: Purpose: to study the neuroprotective effect of oral citicoline (CT) in patients with primary open-angle glaucoma (POAG). Methods: this study recruits 110 patients with stage IV POAG and well-controlled intraocular pressure (IOP). Enrollees were randomly allocated in two groups: therapy group (TG) or control group (CG). Subjects in TG were treated with citicoline 500 mg / die for 4 months. The treatment period was followed by a wash-out phase of 2 months. At the end of the washout phase, subjects in TG resumed CT in the same fashion. Both groups were treated with pressurelowering medications. Each subject was evaluated with standard automated perimetry (SAP) at baseline, and then again 12, 24, and 36 months after enrollment. Results: TG showed a statistically significant improvement in MD values at 12 months (∆ = 21%) and T24 (∆ = 35%), and gradual improvements of the stage, up to the 3rd stage with localized defects after 36 months of therapy. Conversely, in CG, both the MD and PSD indices continued to deteriorate throughout the duration of the study. Conclusion: long-term daily treatment with citicoline might have a neuroprotective effect. Patients treated with oral citicoline showed an improvement in perimetric indices. Additional studies with larger samples and longer follow-ups are needed to confirm these results

Optical coherence tomography of retinal and choroidal layers in patients with familial hypercholesterolaemia treated with lipoprotein apheresis

PURPOSE: Detect and quantify morpho-functional alterations of the retina and choroid in patients affected by familial hypercholesterolemia (FH) treated with lipoprotein apheresis (LA) using optic coherence tomography (OCT) and optic coherence tomography-angriography (OCTA). DESIGN: Observational study. SUBJECTS: To be diagnosed: A group of 20 patients (40 eyes) being clinically and genetically diagnosed as FH and under treatment (FH-Group)", for at least 2 years, was compared to a control group of 20 healthy subjects (40 eyes), with a normal lipid profile and no ocular disease (CT-Group). METHODS: Participants were studied with the slit lamp, binocular indirect fundoscopy, OCT and OCTA. MAIN OUTCOME MEASURES: Best corrected visual acuity (BVCA), spherical equivalent (SE), intraocular pressure (IOP), central macular thickness (CMT), choroidal thickness (CHT), retinal nerve fiber layer in four quadrants (RNFL (Superior = Sup; Inferior = Inf; Nasal = Nas Temporal = Temp), and the mean value across the four quadrants (RNFL G), foveal avascular zone (FAZ) and vascular density (VD). RESULTS: FH subjects had smaller RNFL superiorly (108 ± 19,38 μm OD/111 ± 16,56 μm OS FH-Group vs 127 ± 7,42 μm OD/129 ± 14,64 μm OS CT-Group; P < 0,001 for both OD and OS) and inferiorly (108 ± 23,58 μm OD/115 ± 17,33 μm OS FH-Group vs 128 ± 18,15 μm OD/133 ± 17,38 μm OS CT-Group; P = 0,002 OD; P = 0,001 OS). G RNFL was consequently smaller (93 ± 12,94 μm OD/94 ± 10,49 μm OS FH-Group vs 101 ± 9,01 μm OD/101 ± 10,20 μm OS CT-Group; P = 0,03 OD; P = 0,02 OS). FH subjects had a larger FAZ (0,31 ± 0,08 mm2 OD/0,33 ± 0,10 mm2 in OS FH-Group vs 0,21 ± 0,05 mm2 OD/0,21 ± 0,07 mm2 OS CT-Group; P < 0,001 OD; P = 0,002 OS). CONCLUSIONS: Early signs of retinal vessel damage in FH patients can be detected and quantified with OCT and OCTA

Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk

Purpose: The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding. Material and methods: From 2013 to 2017, nine patients (six males, three females, aged 68.5 \ub1 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded. Results: Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11\u201349 months). Conclusions: LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding

Pigment epithelium-derived factor (PEDF) attenuated capsaicin-induced neurotrophic keratouveitis

PURPOSE. To reveal the influence of retrobulbar capsaicin treatment on rats' eyes and to test the protective effects of PEDF, a known neurotrophic and antiangiogenic substance, against neurotrophic keratouveitis. METHODS. A single retrobulbar injection of capsaicin (50 mg/kg) was performed in young rats, and the effect of subsequent retrobulbar injections of PEDF 3.2 or 6.4 mu g was recorded. Tear fluid alterations were evaluated with the Schirmer test and corneal alterations with slit lamp biomicroscopy. Histopathologic alterations were studied with light and electron microscopy. The number of leukocytes (myeloid cells) in the anterior and posterior chambers, peripheral retina, and vitreous were quantitatively evaluated. RESULTS. Reduced tear secretion was found in capsaicin-treated rats compared with the control, but this effect was significantly attenuated by PEDF. Corneal ulceration developed and was followed by scar formation and neovascularization in the capsaicin-treated, and it was also significantly attenuated by PEDF treatment. Leukocyte infiltration of the anterior and posterior chambers, as well as the peripheral retina and vitreous, was also observed in capsaicin-treated eyes and was significantly reduced by PEDF treatment. The protective effects of PEDF were dose dependent for each parameter, even if the treatment was initiated at day 14 after the challenge. CONCLUSIONS. PEDF accelerated the recovery of tear secretion and also prevented capsaicin-induced neurotrophic keratouveitis and peripheral vitreoretinal inflammation. These effects of PEDF, described herein for the first time, may have a clinical application in inflammatory and neovascular diseases of the eye. (Invest Ophthalmol Vis Sci. 2009;50:5173-5180) DOI:10.1167/iovs.08-185

Dropout and narcissism: An exploratory research about situational factors and personality variables of the psychotherapist

The premature interruption of psychotherapeutic treatments is a significant phenomenon, with rates that can be above 50%, although differences emerge among studies. In general, the variables related to the psychotherapists have a significant effect on the treatment and a greater extent than the situational variables. In this study a multi-method research has been conducted to test the situations of impasse ending in dropout and the relationship between these situations and the covert narcissistic dimension of the therapist. Each participant was administrated the Impasse Interview, asking the therapist to focus on a salient or recent dropout case, and the Hypersensitive Narcissism Scale. The linguistic analysis of the interviews carried out with T-Lab produced 4 thematic clusters. Furthermore, as for the covert narcissistic dimension, 11 therapists reported a score below the average (Group A) and 9 scoring in the average (Group B). Finally, the association between the four clusters and the two groups of therapists was investigated. The therapeutic alliance and the emotional reaction of the therapist, influenced by his narcissistic dimension, represent key variables for the outcome of the therapy

Disconnections in personal neglect

Personal neglect is a disorder in the perception and representation of the body that causes the patients to behave as if the contralesional side of their body does not exist. This clinical condition has not been adequately investigated in the past as it has been considered a symptom of unilateral spatial neglect, which has mainly been studied with reference to extrapersonal space. Only a few studies with small samples have investigated the neuroanatomical correlates of personal neglect, and these have mainly focused on discrete cortical lesions and modular accounts, as well as being based on the hypothesis that this disorder is associated with somatosensory and spatial deficits. In the present study, we tested the novel hypothesis that personal neglect may be associated not only with discrete cortical and subcortical lesions, but also with disconnections of white matter tracts. We performed an advanced lesion analyses in a large sample of 104 right hemisphere damaged patients, 72 of whom were suffering from personal neglect. Results from the analyses of the grey and white matter were controlled for co-occurrent clinical variables such as extrapersonal neglect, anosognosia for hemiplegia and motor deficits, along with other lesion-related variables such as lesion size and the interval from the lesion onset to neuroimaging recordings. Our results reveal that personal neglect is associated with lesions in a medial network which involves the temporal cortex (Heschl's gyrus), the ventro-lateral nuclei of the thalamus and the fornix. This suggests that personal neglect involves a convergence between sensorimotor processes, spatial representation and the processing of self-referred information (episodic memory)

Polycapillary optics for soft X-ray imaging and tomography

Magnetic plasmas are extended volumetric sources of X-rays, and these emissions could reveal a lot of information about the processes occurring into the plasmas. Unfortunately, the constraints posed by these toroidal devices (high neutron flux, gamma and hard-X background, extremely high radiofrequency powers, high magnetic fields, optical limitations and so on) are very severe and limit strongly the possibility to install X-ray detectors directly into or close to the machine. Soft X-ray diagnostics are meant both as tomography and imaging. We started, therefore, to investigate the feasibility of using polycapillary optics for these purposes, in collaboration between Istituto Nazionale di Fisica Nucleare (INFN)- Frascati, Ente per le Nuove tecnologie, l’Energia e l’Ambiente (ENEA)-Frascati and the Commissariat de l’Energie Atomique (CEA)-Cadarache. The first tests were performed in order to characterize the polycapillary lenses (convergence, divergence, efficiency, spectral dispersion, etc.) for distances much larger than the optical focal length of the lenses, both for the detector and for the source. A silicon-based C-MOS imager (Medipix 2) has been used as a detector and the micro focus X-ray tubes as point-like sources. Results of these preliminary tests are presented, and the imaging capabilities of a polycapillary lens as well

Effectiveness of Mp-3 Microperimetric Biofeedback Fixation Training For Low Vision Rehabilitation in Patients Treated With Corticosteroid Ivt in Retinal Vein Occlusions

Mariaelena Malvasi,1 Sabrina Compagno,1 Alessandro Segnalini,1 Vito Maurizio Malvasi,2 Fernanda Pacella,3 Paolo Turchetti,4 Elena Pacella1 1Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy; 2Department of Odontostomatological and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy; 3Department of Ophthalmology, Carlo Poma Hospital, Mantua, Italy; 4National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, ItalyCorrespondence: Elena Pacella, Department of Sense Organs, University Sapienza, Rome, Policlinico Umberto I, Viale, del Policlinico 155, Rome, 00161, Italy, Email [email protected]: The success of fixation training using microperimetric biofeedback (MP-3 MBFT) in the realm of visual rehabilitation for patients with central vision loss caused by macular pathologies is well established. This study aimed to assess the effectiveness and safety of visual rehabilitation with microperimetric biofeedback in consolidating the benefits obtained, with the goal of reducing the need for repeated intravitreal injections (IVT). Specifically, the focus is on the eyes of patients with central vision loss treated with slow-release corticosteroid IVT following retinal venous thrombosis (RVO), aiming to enhance and maintain postoperative efficacy.Methods: This retrospective review involved the examination of 44 eyes affected by macular edema due to RVO associated with central vision loss. Patients were divided into two groups, with only one undergoing ten sessions of 10-minute visual rehabilitation with a microperimeter (MP-3 MBFT) after IVT over a period of 20 weeks.Results: All the treated patients demonstrated good tolerance to the procedure, with no reported complications. A comparison of best-corrected visual acuity (BCVA), retinal sensitivity recorded with a microperimeter, and pre-IVT fixation stability revealed statistically significant improvements at the end of the first month after IVT. However, the treatment group continued to exhibit superior and more enduring results at four months post-IV.Conclusion: The synergistic use of MP-3 MBFT rehabilitation after IVT with slow-release corticosteroids has proven particularly effective in improving BCVA and long-term fixation stability. This led to a significant reduction in the number of required IVTs, with no related adverse events. The authors argue that biofeedback utilization represents a noninvasive therapeutic option devoid of contraindications and easy to implement and that it positively contributes to the overall patient experience regarding quality of life in advanced stages of macular diseases.Keywords: microperimetric biofeedback, visual rehabilitation, macular edema, intravitreal corticosteroid, retinal vein occlusio

Wnt3a neutralization enhances T-cell responses through indirect mechanisms and restrains tumor growth

The Wnt/beta-catenin pathway regulates T-cell functions, including the repression of effector functions to the advantage of memory development via Tcf1. In a companion study, we demonstrate that, in human cancers, Wnt3a/beta-catenin signaling maintains tumor-infiltrating T cells in a partially exhausted status. Here, we have investigated the effects of Wnt3a neutralization in vivo in a mouse tumor model. Abundant Wnt3a was released, mostly by stromal cells, in the tumor microenvironment. We tested whether Wnt3a neutralization in vivo could rescue the effector capacity of tumor-infiltrating T cells, by administering an antibody to Wnt3a to tumor-bearing mice. This therapy restrained tumor growth and favored the expansion of tumor antigen-specific CD8(+) effector memory T cells with increased expression of Tbet and IFN gamma and reduced expression of Tcf1. However, the effect was not attributable to the interruption of T-cell-intrinsic beta-catenin signaling, because Wnt3a/beta-catenin activation correlated with enhanced, not reduced, T-cell effector functions both ex vivo and in vitro. Adoptively transferred CD8(+) T cells, not directly exposed to the anti-Wnt3a antibody but infiltrating previously Wnt3a-neutralized tumors, also showed improved functions. The rescue of T-cell response was thus secondary to T-cell-extrinsic changes that likely involved dendritic cells. Indeed, tumor-derived Wnt3a strongly suppressed dendritic cell maturation in vitro, and anti-Wnt3a treatment rescued dendritic cell activities in vivo. Our results clarify the function of the Wnt3a/beta-catenin pathway in antitumor effector T cells and suggest that Wnt3a neutralization might be a promising immunotherapy for rescuing dendritic cell activities. (C) 2018 AACR