Atti del Workshop: Tecniche Speciali e Avanzate di Dosimetria e Radioprotezione

Atti del Workshop organizzato dall'Associazione Italiana di Radioprotezione (AIRP) in collaborazione con l'Università degli Studi di Palermo, dal titolo "Tecniche Speciali e Avanzate in Dosimetria e Radioprotezione" che si svolgerà venerdì 24 Giugno a Palermo presso l'Aula Magna del Dipartimento di Fisica e Chimica, Viale delle Scienze Edificio 18. L'evento rientra tra i 210 Eventi organizzati per i 210 anni dalla fondazione dell'Ateneo palermitano su iniziativa del Magnifico Rettore, Prof. Fabrizio Micari. L’evento prevede la discussione di 4 tematiche in ambito della dosimetria e della radioprotezione in campo sanitario ed ambientale (Dosimetria Clinica, Dosimetria Ambientale, Dosimetria Retrospettiva e Tecniche Dosimetriche avanzate in Radioprotezione) ciascuna delle quali ha una relazione generale ad invito e alcune brevi comunicazioni orali. Le sessioni sono moderate da Dirigenti Fisici medici di due delle più importanti Aziende Ospedaliere Siciliane, Dirigenti dell’Istituto Superiore di Sanità e l’ex Rettore dell’Ateneo e membro del CdA del CNR, il Prof. Roberto Lagalla. Interverranno il magnifico Rettore dell’Università di Palermo, l’Assessore alla Sanità della Regione Sicilia, il Direttore dell’Istituto Zooprofilattico Sperimentale di Sicilia, il Direttore Generale dell’Agenzia per la Protezione dell’Ambiente Sicilia, il Direttore del Dipartimento di Fisica e Chimica, il Direttore di ATeN Center (Advanced Technologies Network), Dirigenti Fisici dell’Istituto Superiore di Sanità e dell’Istituto Europeo Oncologico di Milano. Hanno contribuito alla parte organizzativa e scientifica Dirigenti dell’ARPA Sicilia, Dirigenti dell’ARNAS Civico di Palermo, Docenti dell’Università di Palermo e di Milano, Ricercatori del CNR e Specializzandi UniPa. Questo evento è di grande rilevanza nazionale in termini di divulgazione scientifica vista la presenza dei relatori e moderatori invitati che ne danno lustro e rilevanza. Sarà un'occasione di confronto e di analisi retrospettiva a quarant'anni della giornata di studio “Problemi e prospettive della Fisica Sanitaria nel settore medico” organizzata dalla Prof.ssa Maria Brai

BMP2/BMP4 colorectal cancer susceptibility loci in northern and southern european populations

Genome-wide association studies have successfully identified 20 colorectal cancer susceptibility loci. Amongst these, four of the signals are defined by tagging single nucleotide polymorphisms (SNPs) on regions 14q22.2 (rs4444235 and rs1957636) and 20p12.3 (rs961253 and rs4813802). These markers are located close to two of the genes involved in bone morphogenetic protein (BMP) signaling (BMP4 and BMP2, respectively). By investigating these four SNPs in an initial cohort of Spanish origin, we found substantial evidence that minor allele frequencies (MAFs) may be different in northern and southern European populations. Therefore, we genotyped three additional southern European cohorts comprising a total of 2028 cases and 4273 controls. The meta-analysis results show that only one of the association signals (rs961253) is effectively replicated in the southern European populations, despite adequate power to detect all four. The other three SNPs (rs4444235, rs1957636 and rs4813802) presented discordant results in MAFs and linkage disequilibrium patterns between northern and southern European cohorts. We hypothesize that this lack of replication could be the result of differential tagging of the functional variant in both sets of populations. Were this true, it would have complex consequences in both our ability to understand the nature of the real causative variants, as well as for further study designs

Efficacy of pulmonary rehabilitation in chronic respiratory failure (CRF) due to chronic obstructive pulmonary disease (COPD): The Maugeri Study.

14noWhile the effectiveness of pulmonary rehabilitation (PR) in chronic obstructive pulmonary disease (COPD) is well established, its effectiveness in the most severe category of COPD, i.e. patients with chronic respiratory failure (CRF), is less well known. OBJECTIVE: To verify the effects of PR in patients with CRF, and compare the level of improvement with PR in these patients to that of COPDs not affected by CRF. METHODS: A multi-centre study was carried out on COPD patients with versus without CRF. The PR program included educational support, exercise training, and nutritional and psychological counselling. Lung function, arterial gases, walk test (6MWT), dyspnoea (MRC; BDI/TDI), and quality of life (MRF(28); SGRQ) were evaluated. RESULTS: Thousand forty seven consecutive COPD inpatients (327 with CRF) were evaluated. In patients with CRF all parameters improved after PR (0.001). Mean changes: FEV(1), 112 ml; PaO(2), 3.0 mmHg; PaCO(2), 3.3 mmHg; 6MWT, 48 m; MRC, 0.85 units; MRF(28) total score, 11.5 units. These changes were similar to those observed in patients without CRF. CONCLUSIONS: This study, featuring the largest cohort so far reported in the literature, shows that PR is equally effective in the more severe COPD patients, i.e. those with CRF, and supports the prescription of PR also in these patients.nonemixedCARONE M; PATESSIO A; AMBROSINO N; BAIARDI P; BALBI B; BALZANO G; CUOMO V; DONNER CF; FRACCHIA C; NAVA S; NERI M; POZZI E; VITACCA M; SPANEVELLO A.Carone, M; Patessio, A; Ambrosino, N; Baiardi, P; Balbi, B; Balzano, G; Cuomo, V; Donner, Cf; Fracchia, C; Nava, S; Neri, M; Pozzi, E; Vitacca, M; Spanevello, Antoni

One year of surgical mask testing at the University of Bologna labs:Lessons learned from data analysis

The outbreak of SARS-CoV-2 pandemic highlighted the worldwide lack of surgical masks and personal protective equipment, which represent the main defense available against respiratory diseases as COVID-19. At the time, masks shortage was dramatic in Italy, the first European country seriously hit by the pandemic: aiming to address the emergency and to support the Italian industrial reconversion to the production of surgical masks, a multidisciplinary team of the University of Bologna organized a laboratory to test surgical masks according to European regulations. The group, driven by the expertise of chemical engineers, microbiologists, and occupational physicians, set-up the test lines to perform all the functional tests required. The laboratory started its activity on late March 2020, and as of the end of December of the same year 435 surgical mask prototypes were tested, with only 42 masks compliant to the European standard. From the analysis of the materials used, as well as of the production methods, it was found that a compliant surgical mask is most likely composed of three layers, a central meltblown filtration layer and two external spunbond comfort layers. An increase in the material thickness (grammage), or in the number of layers, does not improve the filtration efficiency, but leads to poor breathability, indicating that filtration depends not only on pure size exclusion, but other mechanisms are taking place (driven by electrostatic charge). The study critically reviewed the European standard procedures, identifying the weak aspects; among the others, the control of aerosol droplet size during the bacterial filtration test results to be crucial, since it can change the classification of a mask when its performance lies near to the limiting values of 95 or 98%

PVA-GTA Fricke gel dosimeters exposed to clinical photons beams: Nuclear Magnetic Resonance Relaxometry and Imaging

Fricke Gel (FXGs) dosimetric system is based on the radiation induced oxidation of ferrous to ferric ions. The application of Fricke gels for ionizing radiation dosimetry is continuously increasing worldwide due to their many favorable properties. However, one of their shortcomings is that ferrous and ferric ions diffuse in the gel matrix. To maintain the spatial integrity of the dose distribution, Fricke gels must be undergoing measurement within a few hours of their irradiation, so that ferric ions remain close to their point of production. Thus, the spatial integrity of the dose distribution in the Fricke gel is maintained (Schreiner, 2015). The gel matrix also contributes to the oxidation of ferrous ions during irradiation, increasing the chemical yield of ferric ions in aqueous solution and increasing the sensitivity of the dosimeter. The oxidation of ferrous ions also causes a reduction of the longitudinal nuclear magnetic relaxation time T1 which can be measured by means of Nuclear Magnetic Resonance Relaxometry (NMR) and Magnetic Resonance Imaging (MRI) (Marrale, 2014). The results here presented are related to an experimental investigation conducted on Fricke Gels characterized by gelatinous matrix of Polyvinyl alcohol (PVA) cross-linked with a Glutaraldehyde (GTA) (Marini, 2016). The main dosimetric features of the NMR signal were investigated. The gels were irradiated in the clinical dose range between 0 and 20 Gy. In order to assess the photon sensitivity we analyzed the dependence of NMR relaxation times on radiation dose with varying ferrous ammonium sulfate content inside FXGs. Furthermore, signal stability was followed for several days after irradiation. These measurements were preliminary to MRI analysis which can permit 3D dose mapping. In order to maximize the MRI response a systematic study was performed to optimize acquisition sequences and parameters. In particular, we analyzed for inversion recovery sequences the dependence of MRI signal on the repetition time TR and on the inversion time TI. The dose calibration curves are reported and discussed from the point of view of the dosimeter use in clinical radiotherapy. This work has highlighted that the optimization of additives inside gel matrix is fundamental for maximizing photon sensitivity of these detectors. We can conclude that FXG dosimeters with optimal ferrous ammonium sulfate content can be regarded as a valuable dosimetric tool to achieve fast information on spatial dose distribution

Short term effects of exercise training on exercise capacity and quality of life in patients with pulmonary arterial hypertension: protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Advances in the understanding and management of pulmonary arterial hypertension have enabled earlier diagnosis and improved prognosis. However, despite best available therapy, symptoms of exertional dyspnoea and fatigue are commonly reported and result in a reduced capacity to perform daily activities and impaired quality of life. Exercise training has demonstrated efficacy in individuals with other respiratory and cardiovascular diseases. Historically, however, exercise training has not been utilised as a form of therapy in pulmonary arterial hypertension due to the perceived risk of sudden cardiac death and the theoretical possibility that exercise would lead to worsening pulmonary vascular haemodynamics and deterioration in right heart function. Now, with the advances in pharmaceutical management, determining the safety and benefits of exercise training in this population has become more relevant. Only three studies of supervised exercise training in pulmonary arterial hypertension have been published. These studies demonstrated improvements in exercise capacity and quality of life, in the absence of adverse events or clinical deterioration. However, these studies have not utilised an outpatient-based, whole body exercise training program, the most common format for exercise programs within Australia. It is uncertain whether this form of training is beneficial and capable of producing sustained benefits in exercise capacity and quality of life in this population.</p> <p>Design/Methods</p> <p>This randomised controlled trial will determine whether a 12 week, outpatient-based, supervised, whole body exercise training program, followed by a home-based exercise program, is safe and improves exercise capacity and quality of life in individuals with pulmonary arterial hypertension. This study aims to recruit 34 subjects who will be randomly allocated to the exercise group (supervised exercise training 3 times a week for 12 weeks, followed by 3 sessions per week of home exercise for 12 weeks) or the control group (usual medical care). Subjects will be assessed at baseline, 12 weeks and 24 weeks.</p> <p>Discussion</p> <p>This study will determine whether outpatient-based, whole body exercise training is beneficial and safe in individuals with pulmonary arterial hypertension. Additionally, this study will contribute to clinical practice guidelines for this patient population.</p> <p>Trial registration</p> <p>Australia and New Zealand Clinical Trials Register (ANZCTR): <a href="http://www.anzctr.org.au/ACTRN12609000502235.aspx">ACTRN12609000502235</a></p

Stimulation of MAP kinase pathways after maternal IL-1β exposure induces fetal lung fluid absorption in guinea pigs

BACKGROUND: We tested the hypothesis that maternal interleukin-1β (IL-1β) pretreatment and induction of fetal cortisol synthesis activates MAP kinases and thereby affects lung fluid absorption in preterm guinea pigs. METHODS: IL-1β was administered subcutaneously daily to timed-pregnant guinea pigs for three days. Fetuses were obtained by abdominal hysterotomy and instilled with isosmolar 5% albumin into the lungs and lung fluid movement was measured over 1 h by mass balance. MAP kinase expression was measured by western blot. RESULTS: Lung fluid absorption was induced at 61 days (D) gestation and stimulated at 68D gestation by IL-1β. Maternal IL-1β pretreatment upregulated ERK and upstream MEK expression at both 61 and 68D gestation, albeit being much more pronounced at 61D gestation. U0126 instillation completely blocked IL-1β-induced lung fluid absorption as well as IL-1β-induced/stimulated ERK expression. Cortisol synthesis inhibition by metyrapone attenuated ERK expression and lung fluid absorption in IL-1β-pretreated fetal lungs. JNK expression after maternal IL-1β pretreatment remained unaffected at either gestation age. CONCLUSION: These data implicate the ERK MAP kinase pathway as being important for IL-1β induction/stimulation of lung fluid absorption in fetal guinea pigs

The effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: protocol for a randomised controlled trial

BACKGROUND: Non-cystic fibrosis bronchiectasis is characterised by sputum production, exercise limitation and recurrent infections. Although pulmonary rehabilitation is advocated for this patient group, its effects are unclear. The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity, cough, quality of life and the incidence of acute pulmonary exacerbations. METHODS/DESIGN: This randomised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions. Participants will be randomly allocated to the intervention group (supervised, twice weekly exercise training with regular review of airway clearance therapy) or a control group (twice weekly telephone support). Measurements will be taken at baseline, immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor. Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test. Quality of life and health status will be measured using the Chronic Respiratory Questionnaire, Leicester Cough Questionnaire, Assessment of Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary. DISCUSSION: Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population. TRIAL REGISTRATION: This study protocol is registered with ClinicalTrials.gov (NCT00885521)