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1.
IEEE Trans Biomed Eng ; 71(5): 1617-1627, 2024 May.
Article in English | MEDLINE | ID: mdl-38133970

ABSTRACT

OBJECTIVE: The purpose of this study was to develop and evaluate the performance of RPC-Net (Recursive Prosthetic Control Network), a novel method using simple neural network architectures to translate electromyographic activity into hand position with high accuracy and computational efficiency. METHODS: RPC-Net uses a regression-based approach to convert forearm electromyographic signals into hand kinematics. We tested the adaptability of the algorithm to different conditions and compared its performance with that of solutions from the academic literature. RESULTS: RPC-Net demonstrated a high degree of accuracy in predicting hand position from electromyographic activity, outperforming other solutions with the same computational cost. Including previous position data consistently improved results across subjects and conditions. RPC-Net showed robustness against a reduction in the number of electromyography electrodes used and shorter input signals, indicating potential for further reduction in computational cost. CONCLUSION: The results demonstrate that RPC-Net is capable of accurately translating forearm electromyographic activity into hand position, offering a practical and adaptable tool that may be accessible in clinical settings. SIGNIFICANCE: The development of RPC-Net represents a significant advancement. In clinical settings, its application could enable prosthetic devices to be controlled in a way that feels more natural, improving the quality of life for individuals with limb loss.


Subject(s)
Algorithms , Electromyography , Hand , Machine Learning , Signal Processing, Computer-Assisted , Humans , Electromyography/methods , Hand/physiology , Male , Adult , Neural Networks, Computer , Female , Young Adult , Biomechanical Phenomena/physiology , Artificial Limbs , Forearm/physiology
2.
J Sports Med Phys Fitness ; 62(9): 1266-1271, 2022 Sep.
Article in English | MEDLINE | ID: mdl-34931787

ABSTRACT

BACKGROUND: Limited data are available on the efficacy of catheter ablation (CA) for sport-associated atrial fibrillation (AF), in particular at long term follow-up. Moreover, the impact of AF CA on Quality of Life (QoL) in this population remains unknown. We aimed to determine AF CA efficacy in athletes, to assess the impact on athletes' QoL (with SF36 score) and on training capabilities in a long-term follow-up (FU). METHODS: A total of 1215 AF patients' candidates to CA between January 2007 and December 2012, were retrospectively screened. Athletes were defined as patients performing ≥5 h/week of vigorous sports, achieving a total of ≥1500 h lifetime sport activity, for at least one year before AF first symptomatic episode. RESULTS: Out of 1215 AF patients, 133 were considered competitive athletes and underwent CA. Overall, 43% of our cohort showed typical or atypical atrial flutter, which required a more extensive ablation procedure. Before AF, athletes used to practice for a mean of 8.5±2.7 h/week, while after the first AF episode the mean practice duration decreased to 2.8±2.5 h/week. At 10-year follow-up, 83% of athletes did not present any recurrent event, and training capabilities increased up to 5.6±3.6 h/week after the procedure. Moreover, intense physical activity before AF CA was related to long-term AF recurrence rates (P=0.05). QoL scores significantly improved in each single domain (P<0.05). CONCLUSIONS: AF CA represents an effective procedure to maintain sinus rhythm in athletes, with a significant improvement in QoL.


Subject(s)
Atrial Fibrillation , Catheter Ablation , Athletes , Atrial Fibrillation/epidemiology , Atrial Fibrillation/surgery , Catheter Ablation/methods , Humans , Quality of Life , Recurrence , Retrospective Studies , Treatment Outcome
3.
Am J Cardiovasc Dis ; 11(5): 555-563, 2021.
Article in English | MEDLINE | ID: mdl-34849287

ABSTRACT

BACKGROUND: Heart diseases due to iron overload are still the main cause of mortality in patients affected by beta-thalassemia. Detection of cardiac iron overload in pre-clinical stage allows tailoring of chelation therapy and follow-up strategies. Echocardiographic longitudinal strain analysis may be a useful tool for early detection of cardiac functional impairment iron-related. METHODS: We examined 58 patients with beta-thalassemia on regular blood transfusion and iron chelation, without overt cardiac disease who had recent Biosusceptometry SQUID to quantify liver iron concentration and cardiac assessment by CMR T2*. RESULTS: Average global longitudinal strain (GLS) was able to identify abnormal (<20 ms) cardiac T2* values with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.01). Apical 4-ch GLS may help identify early longitudinal impairment associated with severe liver iron overload with 96% specificity and negative predictive value of 92% (AUC 0.84, P=0.02). Patients with severe liver iron overload had lower average Global Longitudinal Strain values compared to other patients (P-value =0.005). CONCLUSION: GLS was a sensitive marker to detect both myocardial and liver iron overload in a population that is still free from cardiac symptoms. Thus, strain echocardiography may be a useful tool for early detection of iron overload in Beta-thalassemia.

4.
G Ital Med Lav Ergon ; 43(2): 144-149, 2021 06.
Article in English | MEDLINE | ID: mdl-34370925

ABSTRACT

SUMMARY: Object. The following study was carried out in order to evaluate through guidelines the best evidence in occupational therapy for daily activities and quality of life of patients with hip prostheses. Methods. Recommendations were generated following the grading method of the National Program for Guidelines/National System Guidelines (PNLG-SNLG), a system for developing guidelines for recommendations in clinical practice. The Appraisal of Guidelines Research and Evaluation in Europe (AGREE) tool was also applied. Results. A total of seven studies were included in this research: one randomized controlled trial, two systematic reviews, two outcomes research studies, and two observational studies. We found that, for the three clinical questions we proposed, more research on the effectiveness of treatments is required. Conclusions. The evidence resulting from this study is not sufficient to determine whether the rehabilitation techniques under consideration are effective.


Subject(s)
Occupational Therapy , Europe , Humans , Outcome Assessment, Health Care , Quality of Life
5.
Int J Cardiol Heart Vasc ; 35: 100839, 2021 Aug.
Article in English | MEDLINE | ID: mdl-34307829

ABSTRACT

BACKGROUND: Subcutaneous implantable cardioverter defibrillator (S-ICD) is a well-established therapy for sudden death prevention. Considering the painful nature of the procedure anaesthesia may be required for analgo-sedation. Hypnosis is emerging as a promising therapeutic strategy for pain control. Few data are available regarding the use of hypnosis as adjunctive technique for pain control during S-ICD implantation. METHODS: Thirty consecutive patients referred to our centre for S-ICD implantation were prospectively and alternatively allocated with 1:1 ratio in two groups: A) Standard analgo-sedation approach (Hypnosis non responder patients) B) Standard analgo-sedation approach with the addition of hypnotic communication (Hypnosis responder patients). Peri-procedural pain perception and anxiety, perceived procedural length, type and dosage of administered analgesic drugs have been measured using validate scores and compared. RESULTS: Hypnotic communication was offered to 15 patients of which was successful in 11 patients (73%). There were no statistical differences between the two study groups according to baseline characteristics. Hypnosis communication resulted in significant pain perception reduction (Group A 6,9 ± 1,6 Vs Group B 1,1 ± 0,9, p value < 0,01), peri-procedural anxiety (Group A 3,5 ± 1,6 Vs Group B 1,9 ± 0,5, p value < 0,01) and reduced perceived procedural length (Group A 58,7 ± 13,4 min Vs Group B 44,7 ± 5,5 min, p value < 0,01). Fentanyl dosage was significantly lower in Group B patients. CONCLUSIONS: Our results demonstrated a significant reduction of perceived pain, anxiety, procedural time and use of analgesic drugs in hypnosis responder patients. These results reinforce the beneficial effects of the hypnotic technique in patients undergoing S-ICD implantation.

7.
Ophthalmic Surg Lasers Imaging Retina ; 50(4): e112-e117, 2019 04 01.
Article in English | MEDLINE | ID: mdl-30998254

ABSTRACT

BACKGROUND AND OBJECTIVE: Optical coherence tomography angiography (OCTA) comparison between vessel density in patients with degenerative-subtype lamellar macular hole (LMH) and healthy individuals. Unaffected fellow eyes were also included in the study. PATIENTS AND METHODS: This observational, cross-sectional study examined 32 eyes affected by unilateral degenerative-subtype LMH, as well as the 32 fellow eyes of the enrolled population. Thirty healthy eyes were used as controls. ImageJ software was used to calculate macular vessel density in the three vascular plexuses (superficial capillary plexus [SCP], deep capillary plexus [DCP], choriocapillaris [CC]) in two regions: (1) a fovea-centered 1.5-mm diameter circular area after subtracting the foveal avascular zone (FAZ) area, obtaining a "ring" in the immediate FAZ proximity (peri-FAZ); (2) the area external to (1) included in the scan. RESULTS: In the peri-FAZ, the SCP of both LMH and fellow eyes showed higher vascular density than in controls (P = .004 for LMH; P = .015 for fellow eye), whereas no difference was evident between LMH and fellow eyes (P = .190). No changes were found in the DCP or the CC. No differences in vessel density of the three plexuses in the area outside the peri-FAZ were evident in any of the three groups. The FAZ in the SCP was larger in the LMH (0.39 ± 0.16 mm2) and in the fellow eye (0.39 ± 0.21 mm2) groups compared with controls (0.27 ± 0.07 mm2; P = .021 for LMH; P = .0043 for fellow eye), whereas it was similar between LMH and fellow eyes (P = .967). CONCLUSIONS: Degenerative-subtype LMH in the immediate proximity of the FAZ has a larger FAZ and higher vascular density in the SCP compared with healthy eyes. Unaffected fellow eyes also have increased vascular density compared with controls. Microvascular changes are evident in both LMH and unaffected fellow eyes and might play a role in disease pathogenesis. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e112-e117.].


Subject(s)
Capillaries/diagnostic imaging , Fluorescein Angiography/methods , Macula Lutea/blood supply , Retinal Perforations/diagnosis , Retinal Vessels/diagnostic imaging , Tomography, Optical Coherence/methods , Visual Acuity , Cross-Sectional Studies , Female , Follow-Up Studies , Fundus Oculi , Humans , Macula Lutea/diagnostic imaging , Male , Middle Aged
8.
Ophthalmic Surg Lasers Imaging Retina ; 50(3): e81-e83, 2019 03 01.
Article in English | MEDLINE | ID: mdl-30893462

ABSTRACT

Retinal capillary hemangioma (RCH) is a benign retinal tumor defined by a vascular proliferation localized in the peripheral retina, juxtapapillary retina, or the intraneural portion of the optic nerve. In most cases, diagnosis of RCH is performed by fundus evaluation and confirmed by fluorescein fundus angiography. Nevertheless, a small RCH localized on or adjacent to the optic nerve head could be difficult to detect by fundus examination. Here, the authors report an atypical case of RCH, not ophthalmoscopically visible, but successfully detected first by optical coherence tomography (OCT) and then by OCT angiography, which confirmed its vascular nature. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e81-e83.].


Subject(s)
Diagnostic Techniques, Ophthalmological , Fluorescein Angiography/methods , Hemangioma, Capillary/diagnosis , Retinal Neoplasms/diagnosis , Tomography, Optical Coherence/methods , Adult , Female , Humans
9.
Eur Heart J Acute Cardiovasc Care ; 8(5): 412-420, 2019 Aug.
Article in English | MEDLINE | ID: mdl-29350536

ABSTRACT

BACKGROUND: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. METHODS: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. RESULTS: Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79-0.94) and 0.84 (0.74-0.9) vs 0.89 (0.78-0.94) and 0.83 (0.70-0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81-0.98) and specificity 0.90 (0.93-0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77-0.91) and specificity 0.92 (0.83-0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. CONCLUSIONS: Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.


Subject(s)
Acute Coronary Syndrome/blood , Chest Pain/blood , Coronary Vessels/diagnostic imaging , Myocardial Perfusion Imaging/methods , Tomography, X-Ray Computed/methods , Acute Coronary Syndrome/diagnostic imaging , Biomarkers/blood , Chest Pain/diagnostic imaging , Echocardiography, Stress/methods , Emergency Service, Hospital , Exercise Test/methods , Female , Glycopeptides/blood , Humans , Male , Middle Aged , Prospective Studies , Radionuclide Imaging/methods , Sensitivity and Specificity , Troponin T/blood
10.
Curr Gerontol Geriatr Res ; 2018: 8294568, 2018.
Article in English | MEDLINE | ID: mdl-30224917

ABSTRACT

OBJECTIVE: The aim of the study was to translate and culturally adapt the Physical Activity Scale for the Elderly into Italian (PASE-I) and to evaluate its psychometric properties in the Italian older adults healthy population. METHODS: For translation and cultural adaptation, the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines have been followed. Participants included healthy individuals between 55 and 75 years old. The reliability and validity were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. To evaluate internal consistency and test-retest reliability, Cronbach's α and Intraclass Correlation Coefficient (ICC) were, respectively, calculated. The Berg Balance Score (BBS) and the PASE-I were administered together, and Pearson's correlation coefficient was calculated for validity. RESULTS: All the PASE-I items were identical or similar to the original version. The scale was administered twice within a week to 94 Italian healthy older people. The mean PASE-I score in this study was 159±77.88. Cronbach's α was 0.815 (p < 0.01) and ICC was 0.977 (p < 0.01). The correlation with the BBS was 0.817 (p < 0.01). CONCLUSIONS: The PASE-I showed positive results for reliability and validity. This scale will be of great use to clinicians and researchers in evaluating and managing physical activities in the Italian older adults population.

11.
J Invasive Cardiol ; 30(8): 283-288, 2018 08.
Article in English | MEDLINE | ID: mdl-29760284

ABSTRACT

OBJECTIVE: To evaluate the outcome of patients undergoing PCI for unprotected left main coronary artery (ULMCA) disease with different drug-eluting stent (DES) types. BACKGROUND: Published literature suggests that second-generation DES options have differing vascular responses and outcomes, but there is a paucity of data in real-life patients in the LM setting. METHODS: This is a retrospective, multicenter study, including patients treated with a second-generation DES for ULMCA disease between 2007 and 2015. The primary endpoint was target-lesion revascularization (TLR). Secondary endpoints were major adverse cardiac events, myocardial infarction (MI), and stent thrombosis (ST). RESULTS: A total of 1209 patients were enrolled; 840 patients (69.5%) received an everolimus-eluting stent (EES), 133 patients (11.0%) received a zotarolimus-eluting stent (ZES), and 236 patients (19.5%) received a biodegradable polymer, biolimus-eluting stent (BP-BES). During a mean follow-up of 722 ± 640 days, TLR occurred in 47 patients (3.8%). At univariate analysis, EES patients had a lower TLR rate (3.6% vs 4.5% in ZES vs 4.2% in BP-BES), which was statistically significant at multivariate analysis (hazard ratio, 0.50; 95% confidence interval, 0.27-0.93; P=.03). No differences in major adverse cardiac events, death, MI, or ST were observed between groups. CONCLUSION: The safety profile of the stents used was comparable over the follow-up period. However, EES patients had lower restenosis rates, with a reduced need for repeat PCI.


Subject(s)
Coronary Artery Disease/surgery , Coronary Vessels/surgery , Drug-Eluting Stents , Percutaneous Coronary Intervention/methods , Aged , Coronary Angiography , Coronary Artery Disease/diagnosis , Coronary Vessels/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Prosthesis Design , Retrospective Studies , Time Factors , Treatment Outcome
13.
Ophthalmic Surg Lasers Imaging Retina ; 48(8): 648-654, 2017 08 01.
Article in English | MEDLINE | ID: mdl-28810040

ABSTRACT

BACKGROUND AND OBJECTIVE: To compare vessel density and the foveal avascular zone (FAZ) area among eyes with full-thickness macular hole (FTMH), lamellar macular hole (LMH), and macular pseudohole (MPH) using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Cross-sectional study involving 10 eyes with idiopathic FTMH, 10 eyes with LMH, 10 eyes with MPH, 17 unaffected fellow eyes, and 10 healthy controls. All patients underwent 3 mm × 3 mm OCTA centered on the macula. Vessel density and FAZ area were calculated. RESULTS: In the deep capillary plexus, FTMHs disclosed the highest vessel density (82.7% ± 16.8%), superior to LMHs (63.7% ± 5.9%; P = .0092), MPHs (37.8% ± 2.5%; P = .0011), and controls (53.0% ± 12.2%; P < .0001). In the superficial capillary plexus (SCP), MPHs had the lowest vascular density. Fellow eyes had reduced vascular density at SCP compared to control eyes. CONCLUSIONS: Microvascular changes are evident in different subtypes of macular holes. Unaffected fellow eyes exhibit early involvement of SCP. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:648-654.].


Subject(s)
Fluorescein Angiography/methods , Macula Lutea/blood supply , Retinal Perforations/diagnosis , Retinal Vessels/pathology , Tomography, Optical Coherence/methods , Visual Acuity , Aged , Cross-Sectional Studies , Female , Fundus Oculi , Humans , Male , Middle Aged , Retrospective Studies
14.
Ophthalmic Surg Lasers Imaging Retina ; 48(8): 684-685, 2017 08 01.
Article in English | MEDLINE | ID: mdl-28810047

ABSTRACT

Retinal cavernous hemangioma is a rare, benign, retinal tumor characterized by angiomatous proliferation of vessels within the inner retina or the optic disc.1 Here we report a case of retinal cavernous hemangioma on the margin of the optic disc in the right eye of a 61-year-old asymptomatic female. The lesion was studied with multimodal imaging which included structural optical coherence tomography, fluorescein angiography, blue fundus auto-fluorescence, optical coherence tomography angiography (OCTA) (DRI OCT Triton; Topcon, Tokyo, Japan) and visual field examination. Blood circulation inside retinal cavernous hemangioma lesion is typically low-stagnant.2 However, OCTA demonstrated blood flow inside the lesion, illustrating its vascular circulation.3 Visual field was within the normal limits, except from a slight enlargement of the blind spot. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:684-685.].


Subject(s)
Fluorescein Angiography/methods , Hemangioma, Cavernous/diagnosis , Retina/pathology , Retinal Neoplasms/diagnosis , Tomography, Optical Coherence/methods , Diagnosis, Differential , Female , Fundus Oculi , Humans , Middle Aged
15.
Eur J Ophthalmol ; 27(6): e175-e178, 2017 Nov 08.
Article in English | MEDLINE | ID: mdl-28708222

ABSTRACT

PURPOSE: To describe the case and the follow-up of a traumatic choroidal rupture characterized by means of multimodal imaging including color fundus photographs, infrared reflectance, blue autofluorescence, swept-source optical coherence tomography, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCT-A). METHODS: Case report. RESULTS: A 17-year-old boy was referred to our clinic complaining of reduction in visual acuity in the right eye (RE) after a blunt ocular trauma during a soccer match. Dilated fundus examination of RE showed 2 peripapillary choroidal ruptures located temporally and inferiorly to the optic disc. Among different imaging tools useful in the diagnosis and study of choroidal ruptures, particular attention must be paid to OCT-A, which showed the lesions as breaks in the choriocapillaris plexus with a hypointense appearance due to the lack of substance. Moreover, along the break it was possible to see the projection of the underlying choroidal vasculature, which appeared hyperintense. The retinal vascular plexa were spared. CONCLUSIONS: All patients presenting with blunt ocular trauma should undergo fundus examination to exclude damage to the optic nerve, retina, and choroid, and need close follow-up to avoid the development of secondary complications such as choroidal neovascularization. Optical coherence tomography angiography might add relevant information in the global evaluation and follow-up of choroidal ruptures in a noninvasive fashion, and could replace other invasive modalities such as FA or ICGA.


Subject(s)
Choroid/injuries , Eye Injuries/diagnosis , Multimodal Imaging , Rupture/diagnosis , Soccer/injuries , Wounds, Nonpenetrating/diagnosis , Adolescent , Coloring Agents/administration & dosage , Drug Combinations , Eye Injuries/drug therapy , Eye Injuries/etiology , Fluorescein Angiography/methods , Glucocorticoids/therapeutic use , Humans , Indocyanine Green/administration & dosage , Male , Mydriatics/therapeutic use , Photography , Rupture/drug therapy , Rupture/etiology , Tomography, Optical Coherence/methods , Tropicamide/therapeutic use , Visual Acuity/physiology , Wounds, Nonpenetrating/drug therapy , Wounds, Nonpenetrating/etiology
16.
Retina ; 37(7): 1314-1319, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28574419

ABSTRACT

PURPOSE: To analyze the changes in ganglion cell complex and peripapillary retinal nerve fiber layer thickness, in central macular thickness and choroidal thickness on spectral domain optical coherence tomography in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab injections. METHODS: All consecutive patients with untreated neovascular age-related macular degeneration received loading phase of three monthly intravitreal ranibizumab, followed by retreatments on a pro re nata protocol for 12 months. PRIMARY OUTCOME: changes in ganglion cell complex and retinal nerve fiber layer at the end of follow-up. Secondary outcome: changes in best-corrected visual acuity, central macular thickness, and choroidal thickness at the end of follow-up. Choroidal thickness was measured at 500 µm, 1000 µm, and 1,500 µm intervals nasally, temporally, superiorly, and inferiorly to the fovea, respectively, on horizontal and vertical line scans centered on the fovea. RESULTS: Twenty-four eyes were included. Ganglion cell complex and peripapillary retinal nerve fiber layer thickness did not show statistically significant changes through 12 months (55.6 ± 18.5 and 81.9 ± 9.9 µm at baseline, 52.7 ± 19.3 and 84.6 ± 15.5 µm at month 12, P > 0.05). Central macular thickness showed progressive decrease from baseline to month 12, with maximum reduction at month 3 (P < 0.001). Statistically significant reduction in choroidal thickness was registered in the nasal 500, 1000, and 1,500 µm from the fovea, corresponding to the papillomacular region (from 169.6 ± 45.3 to 153.9 ± 46.9, P < 0.001). CONCLUSION: Intravitreal ranibizumab injections did not affect retinal nerve fiber layer and ganglion cell complex thickness in 1-year follow-up. Choroidal thickness in papillomacular area and central macular thickness was significantly reduced at the end of treatment. Further studies, with larger sample, longer follow-up, and greater number of injections, are warranted.


Subject(s)
Fovea Centralis/drug effects , Nerve Fibers/drug effects , Ranibizumab/administration & dosage , Retinal Ganglion Cells/drug effects , Tomography, Optical Coherence/mortality , Wet Macular Degeneration/drug therapy , Aged , Angiogenesis Inhibitors/administration & dosage , Female , Fluorescein Angiography , Fovea Centralis/pathology , Fundus Oculi , Humans , Intravitreal Injections , Male , Nerve Fibers/pathology , Retinal Ganglion Cells/pathology , Treatment Outcome , Wet Macular Degeneration/diagnosis
17.
Br J Ophthalmol ; 101(4): 428-432, 2017 04.
Article in English | MEDLINE | ID: mdl-27343210

ABSTRACT

AIMS: To describe the vascular abnormalities in patients affected by retinitis pigmentosa (RP) by means of optical coherence tomography angiography (OCT-A). METHODS: Cross-sectional case series; patients with RP presenting at the Medical Retina Service of the Department of Ophthalmology, University Vita-Salute San Raffaele in Milan were recruited. Inclusion criteria were: diagnosis of RP, clear ocular media, adequate pupillary dilation, and stable fixation. Patients underwent best-corrected visual acuity (BCVA), biomicroscopy, short-wavelength fundus autofluorescence (SW-FAF), and 3×3 Swept Source OCT-A. 30 healthy subjects were chosen as controls. The main outcome was identification of abnormalities in density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), along with abnormalities of the choriocapillaris (CC). RESULTS: 16 patients (32 eyes) were recruited (6 females, 37.4%). Mean age was 53±18 years; mean BCVA was 0.5±0.3 LogMAR. Vessel density analysis disclosed a statistical significant difference in the SCP (29.5±6.8 vs 34.1±4.3; p=0.009) and in the DCP (28.7±7.5 vs 35.5±5.7; p=0.001) between the patients and the controls. No difference was found at the level of the CC (51±4.4 vs 51.3±2.2; p=0.716). RP patients showed a bigger foveal avascular zone at the DCP level compared to controls (p<0.001). CONCLUSIONS: This study showed that most of the vascular impairment in patients affected by RP localised in the DCP, with relative sparing of the SCP and CC. DCP alterations were more pronounced outside the hyper-autofluorescent ring on SW-FAF. Vascular impairment may preclude good treatment outcomes in RP patients.


Subject(s)
Fluorescein Angiography , Macula Lutea/pathology , Retinitis Pigmentosa/pathology , Tomography, Optical Coherence , Adult , Cross-Sectional Studies , Female , Fundus Oculi , Humans , Italy , Macula Lutea/diagnostic imaging , Male , Middle Aged , Retinitis Pigmentosa/diagnostic imaging , Visual Acuity , Visual Field Tests
18.
Am J Cardiovasc Drugs ; 17(1): 61-71, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27738920

ABSTRACT

OBJECTIVE: Our objective was to define the most appropriate treatment for acute coronary syndrome (ACS) in patients with malignancy. METHODS AND RESULTS: The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether ß-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23-0.61; p < 0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55-1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83-2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1-0.4; log-rank p < 0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01). CONCLUSION: In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs. (Clinical trials identifier: NCT02466854).


Subject(s)
Acute Coronary Syndrome/drug therapy , Acute Coronary Syndrome/epidemiology , Neoplasms/drug therapy , Neoplasms/epidemiology , Percutaneous Coronary Intervention/trends , Registries , Acute Coronary Syndrome/diagnosis , Adrenergic beta-Antagonists/therapeutic use , Aged , Aged, 80 and over , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cohort Studies , Female , Hemorrhage/chemically induced , Hemorrhage/epidemiology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Male , Middle Aged , Neoplasms/diagnosis , Prospective Studies , Retrospective Studies
19.
Optom Vis Sci ; 93(11): 1371-1379, 2016 11.
Article in English | MEDLINE | ID: mdl-27571223

ABSTRACT

PURPOSE: To assess agreement between one ultrasonic (US) and nine optical instruments for the measurement of central corneal thickness (CCT), and to evaluate intra- and inter-operator reproducibility. METHODS: In this observational cross-sectional study, two masked operators measured CCT thickness twice in 28 healthy eyes. We used seven spectral-domain optical coherence tomography (SD-OCT) devices, one time-domain OCT, one Scheimpflug camera, and one US-based instrument. Inter- and intra-operator reproducibility was evaluated by intraclass correlation coefficient (ICC), coefficient of variation (CV), and Bland-Altman test analysis. Instrument-to-instrument reproducibility was determined by ANOVA for repeated measurements. We also tested how the devices disagreed regarding systemic bias and random error using a structural equation model. RESULTS: Mean CCT of all instruments ranged from 536 ± 42 µm to 577 ± 40 µm. An instrument-to-instrument correlation test showed high values among the 10 investigated devices (correlation coefficient range 0.852-0.995; p values <0.0001 in all cases). The highest correlation coefficient values were registered between 3D OCT-2000 Topcon-Spectral OCT/SLO Opko (0.995) and Cirrus HD-OCT Zeiss-RS-3000 Nidek (0.995), whereas the lowest were seen between SS-1000 CASIA and Spectral OCT/SLO Opko (0.852). ICC and CV showed excellent inter- and intra-operator reproducibility for all optic-based devices, except for the US-based device. Bland-Altman analysis demonstrated low mean biases between operators. CONCLUSIONS: Despite highlighting good intra- and inter-operator reproducibility, we found that a scale bias between instruments might interfere with thorough CCT monitoring. We suggest that optimal monitoring is achieved with the same operator and the same device.


Subject(s)
Cornea/anatomy & histology , Diagnostic Techniques, Ophthalmological/instrumentation , Adult , Corneal Pachymetry/instrumentation , Cross-Sectional Studies , Female , Healthy Volunteers , Humans , Male , Middle Aged , Observer Variation , Ophthalmoscopes , Organ Size , Photography/instrumentation , Reproducibility of Results , Tomography, Optical Coherence/instrumentation
20.
Eur J Ophthalmol ; 26(6): e158-e160, 2016 Nov 04.
Article in English | MEDLINE | ID: mdl-27405286

ABSTRACT

PURPOSE: To report the case of a 61-year-old woman with pancreas divisum and an asymptomatic chorioretinal coloboma in its 2 forms: complete and partial. METHODS: Case report. RESULTS: Dilated fundus examination and photograph revealed a complete and partial coloboma in the right eye. Swept-source optical coherence tomography and swept-source optical coherence tomography angiography (SS-OCTA) were performed. Swept-source optical coherence tomography angiography disclosed the complete coloboma as a black, round, avascular area surrounded by normal vascular tissue in every plexus (i.e., superficial, deep, and choriocapillary). Although irregular and attenuated, the vascular network of the partial coloboma was appreciable in each layer, indicating some degree of vascular preservation. CONCLUSIONS: Chorioretinal coloboma has been linked to several ocular and systemic conditions. To our knowledge, no association between coloboma and pancreas divisum has been reported. In addition, chorioretinal coloboma has not been previously characterized by means of SS-OCTA.


Subject(s)
Choroid/abnormalities , Coloboma/diagnostic imaging , Pancreas/abnormalities , Retinal Pigment Epithelium/abnormalities , Cholangiopancreatography, Magnetic Resonance , Choroid/diagnostic imaging , Female , Humans , Middle Aged , Pancreas/diagnostic imaging , Pancreatitis, Chronic/diagnosis , Retinal Pigment Epithelium/diagnostic imaging , Tomography, Optical Coherence/methods , Ultrasonography
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