The Italian fund for Alzheimer's and other dementias: strategies and objectives to face the dementia challenge

The Italian Fund for Alzheimer's and other dementias was approved and signed in December 2021. The Fund is financed with 15 million euros in three years. The main goal is to provide new strategies in the field of dementia with a Public Health perspective. The Fund includes eight main activities that will be monitored and supervised by the Italian National Institute of Health: 1) development of a guideline for the assessment, management and support for people with dementia and their families/carers; 2) updating of the Dementia National Plan (DNP); 3) implementation of the documents of the DNP; 4) conducting surveys dedicated to the Italian Dementia Services; 5) promotion of dementia prevention strategies; 6) training strategies for healthcare professionals, families and caregivers; 7) creation of a National Electronic Record for Dementia; 8) evaluation and monitoring of activities promoted by Regions and Autonomous Provinces in the field of dementia, together with the dementia National Permanent Table. These activities are outlined in detail in the present paper

Aplicación del bloqueo del ganglio estrellado en el tratamiento de dos pacientes con angina refractaria crónica

Objective: Evaluation and follow-up of two patients whom Stellate Ganglion Blockade (SGB) Technique was performed to treat chronic refractory angina. Clinical cases: We analyzed during a year period two patients with refractory angina despite optimal medication who underwent repeated Stellate Ganglion Block under fluoroscopic guidance by left anterior approach. We recorded the presence or absence of chest pain and the number of antiangina medications pre and post-treatment. Both patients achieve pain relief without complications. The period of complete pain relief was 2 and 3 months for each patient. SGB was repeated when angina returned. Conclusions: Temporal sympathectomy may provide a safe and effective option in patients with angina pectoris that is refractory to optimal medication and revascularization as part of holistic care. Continuous fluoroscopy monitoring may also prevent serious complications.Objetivo: Evaluación y seguimiento de dos pacientes a los que se les realizó la técnica del Bloqueo del Ganglio Estrellado (BGE) como tratamiento del angor refractario. Casos clínicos: Se controla durante un período de 12 meses la evolución de dos pacientes con angina crónica refractaria a los que se les realizó la técnica de BGE por abordaje anterior izquierdo bajo fluoroscopía. Durante el control evolutivo se registraron la aparición de episodios anginosos y su relación con la actividad diaria así como el incremento en el uso de medicación antiisquémica. En ambos casos se logró remisión de la sintomatología sin constatarse complicaciones, permaneciendo libres de síntomas entre 2 y 3 meses, reiterándose el procedimiento ante la aparición de dolor precordial al esfuerzo. Conclusión: La simpatectomía temporal aparece como una opción efectiva, bien tolerada y de bajo riesgo en pacientes ambulatorios con angina refractaria a tratamiento médico y revascularización, aplicada en el marco de un tratamiento de Cuidado Integral Cardiovascular

A silicon strip detector dose magnifying glass for IMRT dosimetry

Purpose: Intensity modulated radiation therapy (IMRT) allows the delivery of escalated radiation dose to tumor while sparing adjacent critical organs. In doing so, IMRT plans tend to incorporate steep dose gradients at interfaces between the target and the organs at risk. Current quality assurance (QA) verification tools such as 2D diode arrays, are limited by their spatial resolution and conventional films are nonreal time. In this article, the authors describe a novel silicon strip detector (CMRP DMG) of high spatial resolution (200 μm) suitable for measuring the high dose gradients in an IMRT delivery. Methods: A full characterization of the detector was performed, including dose per pulse effect, percent depth dose comparison with Farmer ion chamber measurements, stem effect, dose linearity, uniformity, energy response, angular response, and penumbra measurements. They also present the application of the CMRP DMG in the dosimetric verification of a clinical IMRT plan. Results: The detector response changed by 23% for a 390-fold change in the dose per pulse. A correction function is derived to correct for this effect. The strip detector depth dose curve agrees with the Farmer ion chamber within 0.8%. The stem effect was negligible (0.2%). The dose linearity was excellent for the dose range of 3–300 cGy. A uniformity correction method is described to correct for variations in the individual detector pixel responses. The detector showed an over-response relative to tissue dose at lower photon energies with the maximum dose response at 75 kVp nominal photon energy. Penumbra studies using a Varian Clinac 21EX at 1.5 and 10.0 cm depths were measured to be 2.77 and 3.94 mm for the secondary collimators, 3.52 and 5.60 mm for the multileaf collimator rounded leaf ends, respectively. Point doses measured with the strip detector were compared to doses measured with EBT film and doses predicted by the Philips Pinnacle treatment planning system. The differences were 1.1%±1.8% and 1.0%±1.6%, respectively. They demonstrated the high temporal resolution capability of the detector readout system, which will allow one to investigate the temporal dose pattern of IMRT and volumetric modulated arc therapy (VMAT) deliveries. Conclusions: The CMRP silicon strip detector dose magnifying glass interfaced to a TERA ASIC DAQ system has high spatial and temporal resolution. It is a novel and valuable tool for QA in IMRT dose delivery and for VMAT dose delivery