Natalizumab affects T-cell phenotype in multiple sclerosis: implications for JCV reactivation

The anti-CD49d monoclonal antibody natalizumab is currently an effective therapy against the relapsing-remitting form of multiple sclerosis (RRMS). Natalizumab therapeutic efficacy is limited by the reactivation of the John Cunningham polyomavirus (JCV) and development of progressive multifocal leukoencephalopathy (PML). To correlate natalizumab-induced phenotypic modifications of peripheral blood T-lymphocytes with JCV reactivation, JCV-specific antibodies (serum), JCV-DNA (blood and urine), CD49d expression and relative abundance of peripheral blood T-lymphocyte subsets were longitudinally assessed in 26 natalizumab-treated RRMS patients. Statistical analyses were performed using GraphPad Prism and R. Natalizumab treatment reduced CD49d expression on memory and effector subsets of peripheral blood T-lymphocytes. Moreover, accumulation of peripheral blood CD8+ memory and effector cells was observed after 12 and 24 months of treatment. CD4+ and CD8+ T-lymphocyte immune-activation was increased after 24 months of treatment. Higher percentages of CD8+ effectors were observed in subjects with detectable JCV-DNA. Natalizumab reduces CD49d expression on CD8+ T-lymphocyte memory and effector subsets, limiting their migration to the central nervous system and determining their accumulation in peripheral blood. Impairment of central nervous system immune surveillance and reactivation of latent JCV, can explain the increased risk of PML development in natalizumab-treated RRMS subjects

Malignant glaucoma following gonioscopy-assisted transluminal trabeculotomy: a case report

Background: To report a case of malignant glaucoma that developed after gonioscopy-assisted transluminal trabeculotomy (GATT). Case presentation: An 85-year-old male pseudophakic patient afected by pseudoexfoliative glaucoma (PEXG), unresponsive to medical glaucoma treatment, underwent uneventful GATT surgery. On the frst day after surgery, the eye showed a shallow central and peripheral anterior chamber (AC) with a raised intraocular pressure (IOP) measured at 55mmHg. Optical coherence tomography and ultrasound biomicroscopy confrmed the diagnosis of malignant glaucoma. Laser iridotomy, posterior capsulotomy and hyaloidotomy were performed, and the patient was treated with atropine sulphate 1%, maximum topical and systemic ocular hypotensive drugs with no improvement in the IOP. Subsequently, the patient underwent pars plana anterior vitrectomy, resulting in deepening of the AC with opening of the iridocorneal angle and decrease of the IOP. No further postoperative complications were recorded, and the IOP remained controlled 12months after surgery without antiglaucoma medications. Conclusions: Despite the minimally invasive profle of GATT, malignant glaucoma may develop after this procedure. Early recognition and prompt treatment are mandatory for preventing permanent visual loss

Rhegmatogenous retinal detachment: a review of current practice in diagnosis and management.

Rhegmatogenous retinal detachment (RRD) is a common condition with an increasing incidence, related to the ageing demographics of many populations and the rising global prevalence of myopia, both well known risk factors. Previously untreatable, RRD now achieves primary surgical success rates of over 80%-90% with complex cases also amenable to treatment. The optimal management for RRD attracts much debate with the main options of pneumatic retinopexy, scleral buckling and vitrectomy all having their proponents based on surgeon experience and preference, case mix and equipment availability. The aim of this review is to provide an overview for the non-retina specialist that will aid and inform their understanding and discussions with patients. We review the incidence and pathogenesis of RRD, present a systematic approach to diagnosis and treatment with special consideration to managing the fellow eye and summarise surgical success and visual recovery following different surgical options

Iridocorneal endothelial syndrome in a patient with keratoconus. A case report

Background: To describe a case of a rare association of bilateral keratoconus and unilateral essential iris atrophy and to conduct a literature review of the current strategies of treatment of the corneal disease and glaucoma in patients with Iridocorneal Endothelial Syndrome (ICE). Case presentation: We report a rare association of bilateral keratoconus and unilateral essential iris atrophy in a 38-year-old man. Diagnosis of bilateral keratoconus was confirmed by corneal topography. Slit-lamp examination showed extensive iris atrophy with corectopia and policoria in one eye. Corneal specular microscopy revealed an abnormal endothelium morphology in the same eye with extensive peripheral anterior synechiae and closure of the drainage angle at gonioscopy. Intraocular pressure was 26 mmHg, despite maximal topical therapy. Optic disc examination showed severe glaucomatous cupping. Surgery by glaucoma drainage device implantation was performed. Conclusion: Essential iris atrophy is a rare clinical variant of ICE syndrome characterized by profound anatomical alterations of the anterior segment associated with corneal edema and secondary glaucoma. In these patients, selective keratoplasties have replaced penetrating keratoplasty to treat corneal decompensation and glaucoma drainage devices are preferred to conventional trabeculectomy for the treatment of secondary glaucoma

Viscoelastics enable dissection of anterior closed funnels in proliferative vitreoretinopathy: a retrospective case series

Introduction: The present study aimed to describe a case series of patients in which a cohesive ophthalmic viscous device (OVD) was used to viscodissect and posteriorly displace the retina in cases of total retinal detachment complicated by proliferative vitreoretinopathy, operated with minimally invasive pars plana vitrectomy. Case Presentations: Three patients with a mean age of 67 years were included in the present study. One eye was aphakic, while the others were pseudophakic. OVD injection was performed through the limbus in the aphakic eye and via pars plana in the pseudophakic eyes. In all cases, the OVD injection led to a posterior displacement of the detached retina with a smooth dissection. No complications related to the surgery were observed. At the last follow-up visit, the retina was attached in all cases, with an improvement in visual acuity. Conclusion: To conclude, the injection of a cohesive OVD anterior to the detached retina allowed to posteriorize and viscodissect to some extent the retina, facilitating the implant of trocars

Endothelial keratoplasty combined with scleral fixation intraocular lens

describe, for the first time, the surgical management of two aphakic patients with corneal decompensation treated with concomitant ultrathin-Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and implantation of two different scleral-fixated (SF) intraocular lenses (IOLs), namely sutureless SF (SSF) Carlevale IOL (Soleko, Italy; Figure 1) or Morcher Type 90L IOL (Morcher GmbH, Germany; Figure 2). Both IOLs are hydrophilic acrylic. The Carlevale IOL is 13.2 mm long with a 6.5 mm optic plate, foldable and injectable through a 2.2 mm corneal tunnel. A T-shaped harpoon protrudes off the closed haptics and is designed to be externalized underneath a partial thickness scleral flap (Figure 1). The Morcher Type 90L IOL is 15 mm long with a 6.5 mm optic plate. The two C-loop haptics have an eyelet for the passage of the sutures for the scleral fixatio

The integrated action framework of Rete Natura 2000 Basilicata

Basilicata Natura 2000 network consists of 50 Sites of Community Importance (SCI) and 17 Special Protection Zones (SPZs), covering alltogether more than 17% of the regional area. This network, partially overlapping other forms of land protection, represents a valuable environmental, agricultural and cultural heritage, in which the safeguard of natural resources and landscapes has to be coupled with the needs of the local population; especially in relation to development and social welfare. The Natura 2000 project involved a panel of experts belonging to 15 different institutions, to form a steering committee with the following professional and scientific skills: vegetation, landscape, fauna, geology, agriculture, forestry, sea, architecture and planning, territorial analysis and representation. Along the 4 years project, the steering committee designed and coordinated the activities of over 150 professionals, mostly from Basilicata, who carried out field surveys and data analysis aimed at assessing the environmental conditions in the SCI and SPZs, proposing measures and plans, implementing thematic databases. SCI/SPZ management plans, by themselves, may not be sufficient to fulfill the requirements of an effective environmental policy, which has to go along with the awareness of people, citizens and local administrators about the instances of a sustainable policy. For this reason, the activities of surveying and management have been coupled with a communication project that involves all the experts and a relevant part of professionals who participated to the Natura 2000 project. The communication activity implies the use and the creation of several tools (publishing, video, websites, meetings, photo contests, social networks ...) targeted to different groups: policy makers (local, regional, national, European ), organizations, citizens, schools, farmers, small and medium enterprises (www.natura2000basilicata.it). A further goal is to feature the environmental highlights of Basilicata which are linked to a specific and often surprising integration of an ancient human presence with the natural elements, and the role performed by the traditional farming activities in the maintenance of ecosystem dynamics and services (in particular with agriculture). In fact, a good number of Natura 2000 sites can be considered High Nature Value Farmlands (HNVF, sensu E. Andersen, 2003), in which a virtuous relationship was established a long time ago between traditional practices and the environment itself. In this context, it combines the convergence between the activities carried on the Natura 2000 network and the project Agrival (http://utagri.enea.it/projects/agrival), a research project led by ENEA in Val d'Agri, in order to experimentally contribute to the methodology for the identification of the High Nature Value Farmlands and make them cohabit with the other economic activities in the local context. The process started with the project Basilicata Natura 2000 Network is therefore an interesting methodological model that, in coherence with the financial planning of the European Community for the period 2014-2020 (Brussels, 12.12.2011, COMM. 874) puts together projects on environmental issues to boost the meeting of agricultural, environmental, cultural and productive policies, fostered by the EC, and enhancing the implementation of the "Prioritized Actions Frameworks" (PAF), pointed out by the European Commission as the optimal tools for the management of Natura 2000 networks

Pneumatic retinopexy for primary rhegmatogenous retinal detachment: from a clinical trial to the real-life experience

Background: To report real-world outcomes of patients with primary Reghmatogenous Retinal Detachment (RRD) treated with Pneumatic Retinopexy (PnR) according to the indications of the Pneumatic Retinopexy versus Vitrectomy for management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) trial. Methods: Multicenter, retrospective study. Patients treated with PnR for RRD between 2021 and 2023 and a follow-up of at least 6 months were included. Single-procedure anatomical success, final anatomical success, complications, causes of failures, best corrected visual acuity (BCVA) after surgery, and the vision-related quality of life using the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were reported. Results: A total of 76 eyes of 76 patients were included. Mean age was 60 ± 8.1 years. Primary anatomic reattachment was achieved by 84.3% of patients and final anatomical reattachment after pars plana vitrectomy was obtained in 100% of patients. BCVA improved from 0.32 (20/40) to 0.04 (20/20) logMar (p < 0.001) at 6 months. The main cause of failure was related to the presence of additional (likely missed) retinal breaks (66.6% of cases). Also, primary PnR failure was more frequent in eyes of patients with older age, macular involvement, worse baseline BCVA, greater extent of the RRD, and increased duration from diagnosis to treatment. Overall, the mean NEI-VFQ 25 composite score was 93.9% ± 6.4 at 6 months. Conclusions: The criteria of the PIVOT trial can be applied to real-world scenarios in the decision-making process for the treatment of primary RRD, with excellent anatomical and functional outcomes

More than a meat- or synthetic nitrogen fertiliser-substitute:a review of legume phytochemicals as drivers of 'One Health' via their influence on the functional diversity of soil- and gut-microbes

Legumes are essential to healthy agroecosystems, with a rich phytochemical content that impacts overall human and animal well-being and environmental sustainability. While these phytochemicals can have both positive and negative effects, legumes have traditionally been bred to produce genotypes with lower levels of certain plant phytochemicals, specifically those commonly termed as 'antifeedants' including phenolic compounds, saponins, alkaloids, tannins, and raffinose family oligosaccharides (RFOs). However, when incorporated into a balanced diet, such legume phytochemicals can offer health benefits for both humans and animals. They can positively influence the human gut microbiome by promoting the growth of beneficial bacteria, contributing to gut health, and demonstrating anti-inflammatory and antioxidant properties. Beyond their nutritional value, legume phytochemicals also play a vital role in soil health. The phytochemical containing residues from their shoots and roots usually remain in-field to positively affect soil nutrient status and microbiome diversity, so enhancing soil functions and benefiting performance and yield of following crops. This review explores the role of legume phytochemicals from a 'one health' perspective, examining their on soil- and gut-microbial ecology, bridging the gap between human nutrition and agroecological science.</p

Predictive Association of Pre-Operative Defect Areas in the Outer Retinal Layers With Visual Acuity in Macular Hole Surgery

Purpose: The purpose of this study was to develop methods to model the external limiting membrane (ELM) and ellipsoid zone (EZ) within the elevated cuff surrounding a macular hole (MH) to determine if the predicted size of the defect in these layers after virtual flattening was associated with the actual postoperative defect and best corrected visual acuity (BCVA). Methods: Patients were included who had undergone successful MH surgery. The defects in the ELM and EZ after virtual flattening were modeled using in-house software. Main outcomes were postoperative defects in ELM and EZ at 2 months and BCVA at 12 months. Results: Fifty-eight patients were included. BCVA improved from 0.87 (0.31) logMAR pre-operatively to 0.26 (0.21) at 12 months (P &lt; 0.001). For both the ELM and EZ, the predicted virtually flattened pre-operative defects were associated with the actual postoperative defects at 2 months (R-2 = 0.33, P &lt; 0.01 and R-2 = 0.50, P &lt; 0.01, respectively). There was a significant association of BCVA at 12 months (adjusted R-2 = 0.85) with the pre-operative modeled area of the defect in the ELM (P &lt; 0.01) and to a lesser extent with the defect in the EZ (P &lt; 0.01) and base of the MH (P &lt; 0.01). Conclusions: Virtually flattening of the pre-operative defect in the ELM provides important predictive information of visual acuity. Incorporation of tools into commercially available optical coherence tomography (OCT) devices to facilitate such measurements would provide the clinician with important prognostic information. Translational Relevance: We have developed methodology that can potentially be used to predict the postoperative state of the outer retinal layers and the associated visual outcome in patients undergoing surgery for MH