Therapy of age-related exudative macular degeneration with anti-vascular endothelial growth factor drugs: An Italian real life study

Aim: To evaluate the real utilization of ranibizumab and aflibercept in the daily management of patients with neovascular age-related macular degeneration (nAMD) treated at the Eye Clinic of Campania University L.Vanvitelli. Background: Therapy with anti-vascular endothelial growth factor represents the gold standard in wet age-related macular degeneration. There are nonreal life italian studies of this therapy in the literature. Objective: To analyze in our sample the post-therapy variations of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) observed at the end of a 12-month follow-up period. Methods: This real-life study analyzes 109 patients that underwent monthly checks for the first 4 months and then every 2 months until the end of the 12-month follow-up. The sample was first analyzed in its entirety, subsequently subdivided into 3 groups based on baseline BCVA, age, and the number of intravitreal injections performed, in order to identify possible predictive elements of the anti-VEGF response. Results: On average, patients underwent 4.16 ± 1.58 intravitreal anti-VEGF injections in 1 year. At the end of the 12-month follow-up, the patients’ average BCVA increased from 33.01 letters to 33.75 letters (+0.74 ± 9,4 letters), while the average CRT decreased from 346.86 µm to 265.39 µm (-81.47 ± 121 µm). Conclusion: The study shows the efficacy of anti-VEGF therapy in the stabilization of BCVA in nAMD, confirming the differences in visual outcomes compared to clinical trials, mainly for economic-organizational reasons

The safety of pneumococcal vaccines at the time of sequential schedule: data from surveillance of adverse events following 13-valent conjugated pneumococcal and 23-valent polysaccharidic pneumococcal vaccines in newborns and the elderly, in Puglia (Italy), 2013-2020

Background: Nowadays, two types of anti-pneumococcal vaccine are available: pneumococcal 13-valent conjugate vaccine (PCV13), first licensed in the United States (US) in 2013, and pneumococcal 23-valent polysaccaridic vaccine (PPSV23), first licensed in the US in 1999. These vaccines are recommended in Italy for the immunization of newborns and of the elderly, using a combined sequential schedule for the latter. This report aims to describe the PCV13- and PPSV23-related AEFIs notified in Puglia in 2013-2020, in order to design these products' safety profile in a real-life scenario, three years after the official recommendation about the sequential schedule for people over 60 years of age. Methods: This is a retrospective observational study. Data were gathered from the list of AEFIs notified following PCV13 and PPSV23 administration in Puglia in 2013-2020. The number of administered vaccine doses was obtained from the regional immunization database. AEFIs were classified according to WHO's algorithm, and causality assessment was carried out in case of serious AEFIs. Results: From January 2013 to December 2020, 764,183 doses of PCV13 and 40,382 doses of PPSV23 were administered in Puglia. In the same period, 71 PCV13 AEFIs (Reporting Rate: 9.29 x100,000 doses) and 5 PPSV23 AEFIs (Reporting Rate: 12.4 x100,000 doses) were reported. The overall male/female ratio in AEFIs was 0.85. The majority of AEFIs occurred in subjects aged less than 2 (64/76, 84.2%), while 10 out of 76 (13.2%) occurred in patients aged 60 or older. 22 AEFIs were classified as serious and for 12 (54.5%) causality assessment showed a consistent relationship with immunization. The most commonly reported symptoms were fever (Reporting Rate: 4.72 x100,000 doses) and neurological symptoms (Reporting Rate: 3.23 x100,000 doses). Only one death was notified, classified as non-vaccine-related. Conclusions: The benefit of pneumococcal vaccination appears to be greater than the risk of AEFIs for both PCV13 and PPSV23. In fact, AEFIs occur in less than 0.1‰ of patients and the majority of AEFIs are mild and self-limiting

Real time spectrometer for thermal neutrons from radiotherapic accelerators

Radiotherapy accelerators can produce high energy photon beams for deep tumour treatments. Photons with energies greater than 8 MeV produce neutrons via photoproduction. The PHONES (PHOto NEutron Source) project is developing a neutron moderator to use the photoproduced neutrons for BNCT (Boron Neutron Capture Therapy) in hospital environments. In this framework we are developing a real time spectrometer for thermal neutrons exploiting the bunch structure of the beam. Since the beam is produced by a linear accelerator, in fact, particles are sent to the patient in bunches with a rate of 150-300 Hz depending on the beam type and energy. The neutron spectrum is usually measured with integrating detectors such as bubble dosimeters or TLDs, which integrate over a time interval and an energy one. We are developing a scintillator detector to measure the neutron spectrum in real time in the interval between bunches, that is in the thermal region. The signals from the scintillator are discriminated and sampled by a dedicated clock in a Cyclone II FPGA by Altera, thus obtaining the neutron time of flight spectrum. The exploited physical process in ordinary plastic scintillators is neutron capture by H with a subsequent γ emission. The measured TOF spectrum has been compared with a BF3 counter one. A dedicated simulation with MCNP is being developed to extract the energy spectrum from the TOF one. The paper will present the results of the prototype measurements and the status of the simulation

Neutron imaging in a hospital environment

16BNCT is a technique exploiting the capture conversion process of thermal neutrons in the reaction 10B(n,α)7Li to treat extended and radioresistant tumours. One of its main limitations is the lack of specificity of the boron compounds with respect to tumour cells, which needs to be studied with a dedicated neutron beam. This work, developed within the INFN PhoNeS project and carried out at the radiotherapy unit of the S. Anna Hospital in Como with a Varian Clinac 2100C/D, describes the possibility of neutron imaging, performed with the neutrons produced by a Linac detecting the alpha particles with a non depleted self-triggering microstrip silicon detector. Several trials have been made with solutions of 10B at different percentages, obtaining a minimum sensitivity of 1.9 nmol/cm2 . The paper describes the detector, the measurement setup and the first results with biological samples.noneS. SCAZZI ; D. BOLOGNINI; V. MASCAGNA; A. MATTERA; M. PREST; G. BARTESAGHI; V. CONTI; P. CAPPELLETTI; M. FRIGERIO; S. GELOSA; A. MONTI; A. OSTINELLI; G. GIANNINI; E. VALLAZZA; F. BASILICO; P. MAURIScazzi, S.; Bolognini, D.; Mascagna, V.; Mattera, A.; Prest, Michela; Bartesaghi, G.; Conti, V.; Cappelletti, P.; Frigerio, M.; Gelosa, S.; Monti, A.; Ostinelli, A.; Giannini, G.; Vallazza, E.; Basilico, F.; Mauri, P

A real time scintillating fiber dosimeter for gamma and neutron monitoring on radiotherapy accelerators

The quality of the radiotherapic treatment depends strongly on the capability to measure the dose released in the treated volume and the one absorbed by the surrounding volumes, which is mainly due to the scattered radiation produced by the primary beam interaction with the accelerator collimating system. Radiotherapy linear accelerators produce electron (6-20MeV) and photon (6, 18MV) irradiating fields up to 40 x 40 cm(2). Photons with energies greater than 8 MeV generate neutrons via photoproduction which are being studied for possible BNCT applications

Real time spectrometer for thermal neutrons from radiotherapic accelerators

Radiotherapy accelerators can produce high energy photon beams for deep tumour treatments. Photons with energies greater than 8 MeV produce neutrons via photoproduction. The PHONES (PHOto NEutron Source) project is developing a neutron moderator to use the photoproduced neutrons for BNCT (boron neutron capture therapy) in hospital environments. In this framework we are developing a real time spectrometer for thermal neutrons exploiting the bunch structure of the beam. Since the beam is produced by a linear accelerator, in fact, particles are sent to the patient in bunches with a rate of 150-300 Hz depending on the beam type and energy.The neutron spectrum is usually measured with integrating detectors such as bubble dosimeters or TLDs, which integrate over a time interval and an energy one. We are developing a scintillator detector to measure the neutron spectrum in real time in the interval between bunches, that is in the thermal region. The signals from the scintillator are discriminated and sampled by a dedicated clock in a Cyclone II FPGA by Altera, thus obtaining the neutron time of flight spectrum. The exploited physical process in ordinary plastic scintillators is neutron capture by H with a subsequent \u3b3 emission. The measured TOF spectrum has been compared with a BF3 counter one. A dedicated simulation with MCNP is being developed to extract the energy spectrum from the TOF one.The paper will present the results of the prototype measurements and the status of the simulation

A time-of-flight detector for thermal neutrons from radiotherapy Linacs

Boron Neutron Capture Therapy (BNCT) is a therapeutic technique exploiting the release of dose inside the tumour cell after a fission of a 10B nucleus following the capture of a thermal neutron. BNCT could be the treatment for extended tumors (liver, stomach, lung), radio-resistant ones (melanoma) or tumours surrounded by vital organs (brain). The application of BNCT requires a high thermal neutron flux (> 5 × 108 n cm- 2 s- 1) with the correct energy spectrum (neutron energy 8 MeV) photon beam. In this framework, we have developed a real-time detector to measure the thermal neutron time-of -flight to compute the flux and the energy spectrum. Given the pulsed nature of Linac beams, the detector is a single neutron counting system made of a scintillator detecting the photon emitted after the neutron capture by the hydrogen nuclei. The scintillator signal is sampled by a dedicated FPGA clock thus obtaining the exact arrival time of the neutron itself. The paper will present the detector and its electronics, the feasibility measurements with a Varian Clinac 1800/2100CD and comparison with a Monte Carlo simulation

A real time scintillating fiber dosimeter for gamma and neutron monitoring on radiotherapy accelerators

The quality of the radiotherapic treatment depends strongly on the capability to measure the dose released in the treated volume and the one absorbed by the surrounding volumes, which is mainly due to the scattered radiation produced by the primary beam interaction with the accelerator collimating system. Radiotherapy linear accelerators produce electron (6-20 MeV) and photon (6, 18 MV) irradiating fields up to 40 × 40 cm2. Photons with energies greater than 8 MeV generate neutrons via photoproduction which are being studied for possible BNCT applications. We have developed a prototype of a real time dosimeter with 1 mm diameter scintillating and clear fibers readout by multianode photomultipliers. For neutron applications, the fibers have been coupled with boron loaded scintillator. We will describe the dosimeter and the results of the tests comparing them to the ones obtained with the standard dosimeters

Neutron imaging in a hospital environment

BNCT is a technique exploiting the capture conversion process of thermal neutrons in the reaction 10B(n,α)7Li to treat extended and radioresistant tumours. One of its main limitations is the lack of specificity of the boron compounds with respect to tumour cells, which needs to be studied with a dedicated neutron beam. This work, developed within the INFN PhoNeS project and carried out at the radiotherapy unit of the S. Anna Hospital in Como with a Varian Clinac 2100C/D, describes the possibility of neutron imaging, performed with the neutrons produced by a Linac detecting the alpha particles with a non depleted self-triggering microstrip silicon detector. Several trials have been made with solutions of 10B at different percentages, obtaining a minimum sensitivity of 1.9 nmol/cm2 . The paper describes the detector, the measurement setup and the first results with biological samples

Boron imaging with a microstrip silicon detector for applications in BNCT

Boron Neutron Capture Therapy (BNCT) is a radiotherapic technique exploiting the alpha particles produced after the irradiation of the isotope 10 of boron with thermal neutrons in the capture reaction B-10(n, alpha)Li-7. it is used to treat tumours that for their features (radioresistance, extension, localization near vital organs) cannot be treated through conventional photon-beams radiotherapy. One of the main limitations of this technique is the lack of specificity (i.e. the ability of localizing in tumour cells, saving the healthy tissues) of the compounds used to carry the B-10 isotope in the organs to be treated. This work, developed in the framework of the INFN PhoNeS project, describes the possibility of boron imaging performed exploiting the neutrons photoproduced by a linac (the Clinac 2100C/D of the S. Anna Hospital Radiotherapy Unit in Como, Italy) and detecting the alpha s with a non-depleted microstrip silicon detector: the result is a 1D scan of the boron concentration. Several boron doped samples have been analysed, from solutions of H3BO3 (reaching a minimum detectable amount of 25 ng of B-10) to biological samples of urine containing BPA and BSH (the two molecules currently used for the clinical trials in BNCT) in order to build kinetic curves (showing the absolute B-10 concentration as a function of time). Further measurements are under way to test the imaging system with (10)BPA-Fructose complex perfused human lung samples. (C) 2009 Elsevier B.V. All rights reserved