Results of Gamma Knife Radiosurgery in Acromegaly

Objective. Single-session radiosurgery with Gamma Knife (GK) may be a potential adjuvant treatment in acromegaly. We analyzed the safety and efficacy of GK in patients who had previously received maximal surgical debulking at our hospital. Methods. The study was a retrospective analysis of hormonal, radiological, and ophthalmologic data collected in a predefined protocol from 1994 to 2009. The mean age at treatment was 42.3 years (range 22–67 yy). 103 acromegalic patients participated in the study. The median follow-up was 71 months (IQ range 43–107). All patients were treated with GK for residual or recurrent GH-secreting adenoma. Results. Sixty-three patients (61.2%) reached the main outcome of the study. The rate of remission was 58.3% at 5 years (95% CI 47.6–69.0%). Other 15 patients (14.6%) were in remission after GK while on treatment with somatostatin analogues. No serious side effects occurred after GK. Eight patients (7.8%) experienced a new deficit of pituitary function. New cases of hypogonadism, hypothyroidism, and hypoadrenalism occurred in 4 of 77 patients (5.2%), 3 of 95 patients (3.2%), and 6 of 100 patients at risk (6.0%), respectively. Conclusion. In a highly selected group of acromegalic patients, GK treatment had good efficacy and safety

Evaluation of a synthetic single-crystal diamond detector for relative dosimetry on the Leksell Gamma Knife Perfexion radiosurgery system

Purpose: To evaluate the new commercial PTW-60019 synthetic single-crystal microDiamond detector (PTW, Freiburg, Germany) for relative dosimetry measurements on a clinical Leksell Gamma Knife Perfexion radiosurgery system. Methods: Detector output ratios (DORs) for 4 and 8 mm beams were measured using a micro- Diamond (PTW-60019), a stereotactic unshielded diode [IBA stereotactic field detector (SFD)], a shielded diode (IBA photon field detector), and GafChromic EBT3 films. Both parallel and transversal acquisition directions were considered for PTW-60019 measurements. Measured DORs were compared to the new output factor reference values for Gamma Knife Perfexion (0.814 and 0.900 for 4 and 8 mm, respectively). Profiles in the three directions were also measured for the 4 mm beam to evaluate full width at half maximum (FWHM) and penumbra and to compare them with the corresponding Leksell GammaPlan profiles. Results: FWHM and penumbra for PTW-60019 differed from the calculated values by less than 0.2 and 0.3 mm, for the parallel and transversal acquisitions, respectively. GafChromic films showed FWHM and penumbra within 0.1 mm. The output ratio obtained with the PTW-60019 for the 4 mm field was 1.6% greater in transverse direction compared to the nominal value. Comparable differences up to 0.8% and 1.0% for, respectively, GafChromic films and SFD were found. Conclusions: The microDiamond PTW-60019 is a suitable detector for commissioning and routine use of Gamma Knife with good agreement of both DORs and profiles in the three directions

Predicting the macroseismic intensity from early radiated P wave energy for on-site earthquake early warning in Italy

Earthquake Early Warning Systems (EEWS) are potentially effective tools for risk mitigation in active seismic regions. The present study explores the possibility of predicting the macroseismic intensity within EEW timeframes using the squared velocity integral (IV2) measured on the early Pwave signals, a proxy for the P wave radiated energy of earthquakes. This study shows that IV2 correlates better than the peak displacement measured on P waves with both the peak ground velocity and the Housner Intensity, with the latter being recognized by engineers as a reliable proxy for damage assessment. Therefore, using the strong motion recordings of the Italian Accelerometric Archive, a novel relationship between the parameter IV2 and the macroseismic intensity (IM) has been derived. The validity of this relationship has been assessed using the strong motion recordings of the Istituto Nazionale di Geofisica e Vulcanologia Strong Motion Data and Osservatorio Sismico delle Strutture databases, as well as, in the case of the M-W 6, 29 May 2012 Emilia earthquake (Italy), comparing the predicted intensities with the ones observed after a macroseismic survey. Our results indicate that P wave IV2 can become a key parameter for the design of on-site EEWS, capable of proving real-time predictions of the IM at target sites

Exploring the feasibility of a nationwide earthquake early warning system in Italy

When accompanied by appropriate training and preparedness of a population, Earthquake Early Warning Systems (EEWS) are effective and viable tools for the real-time reduction of societal exposure to seismic events in metropolitan areas. The Italian Accelerometric Network, RAN, which consists of about 500 stations installed over all the active seismic zones, as well as many cities and strategic infrastructures in Italy, has the potential to serve as a nationwide early warning system. In this work, we present a feasibility study for a nationwide EEWS in Italy obtained by the integration of the RAN and the software platform PRobabilistic and Evolutionary early warning SysTem (PRESTo). The performance of the RAN-PRESTo EEWS is first assessed by testing it on real strong motion recordings of 40 of the largest earthquakes that have occurred during the last 10 years in Italy. Furthermore, we extend the analysis to regions that did not experience earthquakes by considering a nationwide grid of synthetic sources capable of generating Gutenberg-Richter sequences corresponding to the one adopted by the seismic hazard map of the Italian territory. Our results indicate that the RAN-PRESTo EEWS could theoretically provide for higher seismic hazard areas reliable alert messages within about 5 to 10s and maximum lead times of about 25s. In case of large events (M\textgreater6.5), this amount of lead time would be sufficient for taking basic protective measures (e.g., duck and cover, move away from windows or equipment) in tens to hundreds of municipalities affected by large ground shaking

In vitro fertilization (IVF) and hormone-dependent brain tumors: could the new era of IVF and social freezing change our incidentally discovered brain tumor management?

The new era of IVF and social freezing could change our ethical indication of the monitoring and treatment of brain lesions, especially those related to hormones such as meningiomas. The data regarding IVF in Italy (IARTR Italian Assisted Reproductive Technology Register) reveal a progressive increase of cycles from 52676 cycles in 2010 to 95110 in 2013. The same results have been reported in Europe (European Register EHSRE 2013) (1) and the results of the data from the last 4 years confirm this trend. This indicates that the “incidental hormone related lesions” will strongly increase over the coming years. Meningiomas represent the most common primary brain tumor (34% of CNS). Incidence in females is nearly twice of that in men (2). Recent data reported incidental meningioma findings in 2.5% of the population. Ten percent of meningiomas contain estrogen receptors. A large number of meningiomas show very slow growth (3). The literature reports several cases regarding meningiomas fast growing in hyperestrogenic and hyperprogestinic states. In recent studies, progesterone also seems to be strongly correlated to increased risks of recurrence compared to estrogen and estrogen/progesterone . Estrogen expression in meningiomas is present in a much higher proportion of cases than expression based on immunohistochemical results due to the different sensitivity of the applied technique. While the functional role of the estrogen expression is still debated the majority of meningiomas express progesterone (PR) receptors (4

Earthquake early warning feasibility in the Campania region (southern Italy) and demonstration system for public school buildings

We present the results of a feasibility study of an earthquake early warning system (EEWS) for the Campania region (southern Italy) using schools as specific targets. The study considered the seismogenic zones as sources of potential earthquakes for the area, the Italian accelerometric network as the recording network for seismic event occurrence, and the performances of the software platform PRESToPlus for data analysis and processing. We analyze the distribution of lead-times for all possible threatening seismic sources for each municipality in the region under study by extracting the lead-time value corresponding to the 5th, 10th and 25th percentiles of the distributions. We discuss the results for the 5th percentile in order to analyze the worst-case scenario: in the case of a single site, the lead-time is expected to be larger than this value in the 95 % of the cases. Since the population distribution in Campania is uneven and most of the people live nearby the coast, whilst the most destructive earthquakes occur along the Apennine chain, we can conclude that an efficient EEWS can allow most of the schools in the area to undertake some mitigating actions. The testing of the EEWS was carried out in the high school ITIS ‘E. Majorana’, located at Somma Vesuviana, about 80 km from the seismogenic Irpinia region. For this purpose, the Sentinel, an actuator made up of low-cost hardware (i.e., Arduino), was developed in close cooperation with students and teachers of the school to receive alert messages from the PRESToPlus platform and warn the school users in case of a seismic event. The EEWS and the Sentinel were successfully tested during some blind drills performed during normal school activities