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Objective: To determine the effect of dose calculation accuracy on inverse linear energy transfer (LET) optimization for intensity‐modulated proton therapy, and to determine whether adding more beams would improve the plan robustness to different dose calculation engines. Methods: Two sets of intensity‐modulated proton therapy plans using two, four, six, and nine beams were created for 10 prostate cancer patients: one set was optimized with dose constraints (DoseOpt) using the pencil beam (PB) algorithm, and the other set was optimized with additional LET constraints (LETOpt) using the Monte Carlo (MC) algorithm. Dose distributions of DoseOpt plans were then recalculated using the MC algorithm, and the LETOpt plans were recalculated using the PB algorithm. Dosimetric indices of targets and critical organs were compared between the PB and MC algorithms for both sets of plans. Results: For DoseOpt plans, dose differences between the PB and MC algorithms were minimal. However, the maximum dose differences in LETOpt plans were 11.11% and 15.85% in the dose covering 98% and 2% (D2) of the clinical target volume, respectively. Furthermore, the dose to 1 cc of the bladder differed by 11.42 Gy (relative biological effectiveness). Adding more beams reduced the discrepancy in target coverage, but the errors in D2 of the structure were increased with the number of beams. Conclusion: High modulation of LET requires high dose calculation accuracy during the optimization and final dose calculation in the inverse treatment planning for intensity‐modulated proton therapy, and adding more beams did not improve the plan robustness to different dose calculation algorithms. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the bioequivalence of China-manufactured biosimilar, HLX02, to reference China (CN)- and European Union (EU)-sourced trastuzumab.Methods: This was a two-part Phase 1 study conducted in healthy Chinese males. Part 1 evaluated the safety of different doses of HLX02 (2, 4, 6 or 8 mg/kg; intravenous infusion over 90 min, n = 3 per group). Part 2, a randomized, double-blind study, investigated the pharmacokinetics (PK), safety and immunogenicity of study drugs (HLX02 [n = 37], CN-trastuzumab [n = 35] or EU-trastuzumab [n = 37] at the dose suggested by Part 1 results). The primary PK endpoint was the area under the serum concentration-time curve from time 0 to infinity (AUCinf). Equivalence was concluded if the 90% confidence interval (CI) for the geometric least squares mean ratio (GLSMR) fell in the equivalence criteria of 0.80-1.25.Results: In Part 1, all doses of HLX02 were well tolerated and 6 mg/kg was suggested for Part 2. The GLSMRs and 90% CIs for AUCinf were: 0.950 (0.891-1.013), 0.914 (0.858-0.973) and 0.962 (0.902-1.025) for HLX02 versus CN-trastuzumab, HLX02 versus EU-trastuzumab and CN-trastuzumab versus EU-trastuzumab, respectively. Secondary endpoints comparisons also fell in the equivalence criteria. Treatment-emergent adverse events were reported in 75.7, 86.5 and 70.3% of the subjects in HLX02, CN-trastuzumab, and EU-trastuzumab groups, respectively. No serious adverse events or deaths occurred. No treatment-related anti-drug antibodies were detected.Conclusion: This study demonstrated comparable safety profiles and PK bioequivalence among HLX02, CN-trastuzumab and EU-trastuzumab in healthy Chinese male subjects.Clinical Trial Registration: ClinicalTrials.gov, NCT02581748, registered at October 19, 2015. [ABSTRACT FROM AUTHOR]

Maize is an important crop and its nitrogen use efficiency (NUE) has been an issue for plant scientists and breeders for many years. To meet the demand of genetic diversity in cultivating local elite maize cultivars, researchers need to isolate germplasms with a high NUE. In this study, 30 maize inbred lines were screened under hydroponic conditions, and three inbred lines that tolerate low nitrogen concentration were identified. A comparative analysis of genes involved in N uptake, transport, and assimilation between two lines with different tolerances revealed that the low-nitrogen-tolerant inbred line MBST exhibited higher expressions of nitrate and ammonium transporters, especially ZmNRT3.1B, than less tolerant B73. This suggests that the MBST line had a more efficient high-affinity transporter system. We also showed that lownitrogen conditions down-regulated the expressions of master genes, ZmNLPs, which were negatively correlated with the expressions of the nitrate transporters ZmNRTs. This indicates the existence of regulators that antagonize the function of ZmNLPs. Some genes related to N assimilation and carbon metabolism were also more expressed in MBST. This research shows that the low-nitrogen-tolerant line, MBST, transported nitrate and ammonium more effectively than the B73 line. The NUE was also higher in MBST than in B73. [ABSTRACT FROM AUTHOR]

Periodontitis is twice as prevalent in diabetics as in nondiabetics, and type 2 diabetes (T2D)-associated periodontitis is severe in many cases due to the altered and aberrant functions of bone cells in hyperglycemic conditions. Therefore, developing an effective method to halt the disease process, as well as restore and regenerate lost alveolar bone to reserve the natural teeth in diabetics, is critically important. In the current study, we applied a newly discovered adiponectin receptor agonist AdipoRon (APR) in experimental periodontitis in diabetic animal models and demonstrated the underlying molecular mechanisms. We found that when APR systemically quenched the blood sugar level in diet-induced obesity (DIO) diabetic mice, it reduced osteoclast numbers and alveolar bone loss significantly due to APR's inhibition on osteoclast differentiation shown in our in vitro studies. APR also decreased the production of proinflammatory molecules CC chemokine ligand 2 and interleukin 6 in diseased gingival tissues. On the other hand, APR promoted alveolar bone regeneration through enhancing osteogenic differentiation and decreasing stromal cell-derived factor 1 in the bone marrow that facilitates stem cell migration. Same results were achieved by APR treatment of periodontitis induced in adiponectin (APN) knockout mice, indicating the ability of APR to activate the endogenous APN receptors to exert osteoanabolic effects. In summary, our study supports the notion that APR could be used as an effective multipronged approach to target T2D-associated periodontitis. [ABSTRACT FROM AUTHOR]

Purpose: To develop and validate a novel delivery strategy for reducing the respiratory motion-induced dose uncertainty of spot-scanning proton therapy.Methods and Materials: The spot delivery sequence was optimized to reduce dose uncertainty. The effectiveness of the delivery sequence optimization was evaluated using measurements and patient simulation. One hundred ninety-one 2-dimensional measurements using different delivery sequences of a single-layer uniform pattern were obtained with a detector array on a 1-dimensional moving platform. Intensity modulated proton therapy plans were generated for 10 lung cancer patients, and dose uncertainties for different delivery sequences were evaluated by simulation.Results: Without delivery sequence optimization, the maximum absolute dose error can be up to 97.2% in a single measurement, whereas the optimized delivery sequence results in a maximum absolute dose error of ≤11.8%. In patient simulation, the optimized delivery sequence reduces the mean of fractional maximum absolute dose error compared with the regular delivery sequence by 3.3% to 10.6% (32.5-68.0% relative reduction) for different patients.Conclusions: Optimizing the delivery sequence can reduce dose uncertainty due to respiratory motion in spot-scanning proton therapy, assuming the 4-dimensional CT is a true representation of the patients' breathing patterns. [ABSTRACT FROM AUTHOR]

Two trials were conducted to investigate protein requirements of juvenile (3.18 g in Trial 1) and on-growing (87.1 g in Trial 2) gibel carp, Carassius auratus gibelio var. CAS III. Six isoenergetic diets containing 250-500 g kg−1 dietary protein were formulated using soy protein concentrate ( SPC) and casein as protein sources. The results showed that weight gain ( WG) increased when dietary protein increased from 250 to 400 g kg−1 and decreased at 400 to 500 g kg−1 CP in Trial 1, while WG increased when dietary protein increased from 250 to 350 g kg−1 and kept constant at 350 to 500 g kg−1 CP in Trial 2. With increasing dietary protein, feed conversion ratio ( FCR) decreased, while protein retention efficiency ( PRE) decreased in Trial 1 and was not affected in Trial 2. Apparent digestibility coefficient of protein ( ADCp) increased with increasing dietary protein in two trails. Trypsin activity increased with dietary protein in the juveniles and was not affected in on-growing fish. Hepatic alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) activities increased with dietary protein. Broken-line and quadratic regression of WG estimated that dietary protein requirements for maximum growth were about 402-427 g kg−1 for the juvenile and 337-418 g kg−1 for on-growing gibel carp. [ABSTRACT FROM AUTHOR]

Abstract: A good understanding of diurnal warming in the upper ocean is important for the validation of satellite-derived sea surface temperature (SST) against in-situ buoy data and for merging satellite SSTs taken at different times of the same day. For shallow coastal regions, better understanding of diurnal heating could also help improve monitoring and prediction of ecosystem health, such as coral reef bleaching. Compared to its open ocean counterpart which has been studied extensively and modeled with good success, coastal diurnal warming has complicating localized characteristics, including coastline geometry, bathymetry, water types, tidal and wave mixing. Our goal is to characterize coastal diurnal warming using two extensive in-situ temperature and weather datasets from the Caribbean and Great Barrier Reef (GBR), Australia. Results showed clear daily warming patterns in most stations from both datasets. For the three Caribbean stations where solar radiation is the main cause of daily warming, the mean diurnal warming amplitudes were about 0.4K at depths of 4–7m and 0.6–0.7K at shallower depths of 1–2m; the largest warming value was 2.1K. For coral top temperatures of the GBR, 20% of days had warming amplitudes >1K, with the largest >4K. The bottom warming at shallower sites has higher daily maximum temperatures and lower daily minimum temperatures than deeper sites nearby. The averaged daily warming amplitudes were shown to be closely related to daily average wind speed and maximum insolation, as found in the open ocean. Diurnal heating also depends on local features including water depth, location on different sections of the reef (reef flat vs. reef slope), the relative distance from the barrier reef chain (coast vs. lagoon stations vs. inner barrier reef sites vs. outer rim sites); and the proximity to the tidal inlets. In addition, the influence of tides on daily temperature changes and its relative importance compared to solar radiation was quantified by calculating the ratio of power spectrum densities at the principal lunar semidiurnal M2 tide versus 24-hour cycle frequency representing mainly solar radiation forcing, i.e., (PSDM2/PSD24). Despite the fact that GBR stations are generally located at regions with large tidal changes, the tidal effects were modest: 80% of stations showed value of (PSDM2/PSD24) of less than 10%. [Copyright &y& Elsevier]

BackgroundThe self-referential memory (SRM) effect refers to the phenomenon that stimuli processed with reference to the self are better remembered than those referenced to others. Studies have shown that schizophrenia patients do not have this memorial advantage for self-referenced information. The current study investigated the electrophysiological mechanism of the abolished SRM effect in schizophrenia.MethodTwenty schizophrenia patients and 22 controls were recruited to complete an SRM task. We used a high-time resolution event-related potential (ERP) technique to analyze the electrophysiological differences between patients and controls during self- and other-reflection processing.ResultsBehavior data indicated that healthy controls had a typical SRM bias that was absent in the schizophrenia patients. ERP comparison between groups showed that the schizophrenia patients presented smaller voltages in both self- and other-reflection conditions in the 160–260 ms (P2 component) and 800–1200 ms (positive slow wave) time windows over the pre/frontal cortex. Furthermore, the N2 amplitudes (270–380 ms) differed between self- and other-reflection conditions in patients but not in normal controls. More importantly, we found that the P3 amplitudes in the parietal cortex correlated significantly with the SRM bias score in the patients (r = –0.688).ConclusionsThese results provide comprehensive and direct electrophysiological evidence for self- and other-reflective dysfunction in schizophrenia patients and contribute to our understanding of the underlying neural substrates of the abolished SRM effect in schizophrenia. [ABSTRACT FROM AUTHOR]

The object of this study was to investigate the effect of two altitudes (1600 vs. 3600 m) with two nutritional levels [5.88 MJ/kg dry matter (DM) vs. 7.56 MJ/kg DM] on apparent total tract digestibility, rumen fermentation, energy metabolism, milk yield and milk composition in Chinese Holstein cows. Sixteen Chinese Holstein cows in their third lactation with close body weights, days in milk and milk yield were randomly divided into four groups, of which two were directly transferred from Lanzhou (altitude of 1600 m) to Lhasa (altitude of 3600 m). Four treatments (high plateau and high nutrition level, HA-HN; high plateau and low nutrition level, HA-LN; low plateau and high nutrition level, LA-HN; and low plateau and low nutrition level, LA-LN) were randomly arranged in a 2 × 2 factorial experimental design. Results indicated that the apparent total tract digestibility of a diet's DM, organic matter, crude protein, neutral detergent fibre and acid detergent fibre and DM intake were not affected by either altitude or nutrition level (p > 0.05). Milk protein percentage was higher for the diet with the high level of nutrition than for the diet with low nutrition level irrespective of altitude (p < 0.05). Percentages of milk fat and milk lactose were not affected by either altitude or nutrition level (p > 0.05). The metabolizable energy used for milk energy output was decreased by high altitude in comparison with that at low altitude (p < 0.05). No differences were observed in the live body weight or body condition score (BCS) of Chinese Holstein cows among all of the four treatments (p > 0.05). [ABSTRACT FROM AUTHOR]

Background: For treatment of the entire cranium using passive scattering proton therapy (PSPT) compensators are often employed in order to reduce lens and cochlear exposure. We sought to assess the advantages and consequences of utilizing compensators for the treatment of the whole brain as a component of craniospinal radiation (CSI) with PSPT. Moreover, we evaluated the potential benefits of spot scanning beam delivery in comparison to PSPT.Methods: Planning computed tomography scans for 50 consecutive CSI patients were utilized to generate passive scattering proton therapy treatment plans with and without Lucite compensators (PSW and PSWO respectively). A subset of 10 patients was randomly chosen to generate scanning beam treatment plans for comparison. All plans were generated using an Eclipse treatment planning system and were prescribed to a dose of 36 Gy(RBE), delivered in 20 fractions, to the whole brain PTV. Plans were normalized to ensure equal whole brain target coverage. Dosimetric data was compiled and statistical analyses performed using a two-tailed Student's t-test with Bonferroni corrections to account for multiple comparisons.Results: Whole brain target coverage was comparable between all methods. However, cribriform plate coverage was superior in PSWO plans in comparison to PSW (V95%; 92.9 ± 14 vs. 97.4 ± 5, p < 0.05). As predicted, PSWO plans had significantly higher lens exposure in comparison to PSW plans (max lens dose Gy(RBE): left; 24.8 ± 0.8 vs. 22.2 ± 0.7, p < 0.05, right; 25.2 ± 0.8 vs. 22.8 ± 0.7, p < 0.05). However, PSW plans demonstrated no significant cochlear sparing vs. PSWO (mean cochlea dose Gy(RBE): 36.4 ± 0.2 vs. 36.7 ± 0.1, p = NS). Moreover, dose homogeneity was inferior in PSW plans in comparison to PSWO plans as reflected by significant alterations in both whole brain and brainstem homogeneity index (HI) and inhomogeneity coefficient (IC). In comparison to both PSPT techniques, multi-field optimized intensity modulated (MFO-IMPT) spot scanning treatment plans displayed superior sparing of both lens and cochlea (max lens: 12.5 ± 0.6 and 12.9 ± 0.7 right and left respectively; mean cochlea 28.6 ± 0.5 and 27.4 ± 0.2), although heterogeneity within target volumes was comparable to PSW plans.Conclusions: For PSPT treatments, the addition of a compensator imparts little clinical advantage. In contrast, the incorporation of spot scanning technology as a component of CSI treatments, offers additional normal tissue sparing which is likely of clinical significance. [ABSTRACT FROM AUTHOR]

Purpose: Beam angle optimization (BAO) by far remains an important and challenging problem in external beam radiation therapy treatment planning. Conventional BAO algorithms discussed in previous studies all focused on photon-based therapies. Impact of BAO on proton therapy is important while proton therapy increasingly receives great interests. This study focuses on potential benefits of BAO on intensity-modulated proton therapy (IMPT) that recently began available to clinical cancer treatment. Methods: The authors have developed a novel uncertainty incorporated BAO algorithm for IMPT treatment planning in that IMPT plan quality is highly sensitive to uncertainties such as proton range and setup errors. A linear programming was used to optimize robust intensity maps to scenario-based uncertainties for an incident beam angle configuration. Unlike conventional intensity-modulated radiation therapy with photons (IMXT), the search space for IMPT treatment beam angles may be relatively small but optimizing an IMPT plan may require higher computational costs due to larger data size. Therefore, a deterministic local neighborhood search algorithm that only needs a very limited number of plan objective evaluations was used to optimize beam angles in IMPT treatment planning. Results: Three prostate cancer cases and two skull base chordoma cases were studied to demonstrate the dosimetric advantages and robustness of optimized beam angles from the proposed BAO algorithm. Two- to four-beam plans were optimized for prostate cases, and two- and three-beam plans were optimized for skull base cases. By comparing plans with conventional two parallel-opposed angles, all plans with optimized angles consistently improved sparing at organs at risks, i.e., rectum and femoral heads for prostate, brainstem for skull base, in either nominal dose distribution or uncertainty-based dose distributions. The efficiency of the BAO algorithm was demonstrated by comparing it with alternative methods including simulated annealing and genetic algorithm. The numbers of IMPT plan objective evaluations required were reduced by up to a factor of 5 while the same optimal angle plans were converged in selected comparisons. Conclusions: Uncertainty incorporated BAO may introduce pronounced improvement of IMPT plan quality including dosimetric benefits and robustness over uncertainties, based on the five clinical studies in this paper. In addition, local search algorithms may be more efficient in finding optimal beam angles than global optimization approaches for IMPT BAO. [ABSTRACT FROM AUTHOR]

We report a comparative study of the microstructure of compositionally graded (Ba1-xSrx)TiO3 (BST) films with two compositionally graded directions, up and down, with respect to the substrate, which were deposited epitaxially on (La,Sr)CoO3 (LSCO)-covered MgO(100) single-crystal substrates by pulsed laser deposition. Cross-sectional transmission electron microscopy (TEM) images and electron diffraction show that the graded films grow epitaxially with their (100) plane parallel to the (100) surface of the MgO single-crystal substrate, and with an in-plane orientation relationship of 〈001〉BST//〈001〉LSCO//〈001〉MgO. The crystalline quality and surface morphology of the graded films are closely related to the direction of the compositional gradient built into the graded films. Down-graded films (starting with a BaTiO3 layer at the film/substrate interface) have a much better crystalline quality and a smoother surface than the up-graded films (starting with a (Ba0.75Sr0.25)TiO3 layer at the film/substrate interface). Obviously, the BaTiO3 bottom layer in the down-graded film acts not only as a part of the graded film but also as an excellent seeding layer to enhance the crystallization of the subsequent film layers, resulting in a high crystalline quality of the down-graded film and an enhanced dielectric behavior. Planar (high-resolution) TEM images also demonstrate that down-graded films have a larger, and more uniform, grain size than up-graded films, and that the latter contain voids. [ABSTRACT FROM AUTHOR]

Objective: Early pregnancy losses increase with marked hyperglycemia in diabetic pregnancy. However, mean loss rates do not differ from those of nondiabetic pregnancy. This observation might be explained by increased fetal losses at the extremes of glycemia in diabetic and nondiabetic pregnancy. To test this hypothesis, we examined relationships of proximate measures of prior glycemia, glycated protein and fructosamine, to pregnancy loss.Research Design and Methods: A total of 389 diabetic and 429 nondiabetic pregnant subjects participated in the Diabetes In Early Pregnancy study. Glycated protein and fructosamine measurements were standardized as multiples of control values for each center (Z score). The logarithm of odds of pregnancy loss were plotted against Z scores and tested by logistic models.Results: Mean pregnancy loss rates were 12% in diabetic and 13% in normal pregnancies. However, over six intervals of glycated protein in diabetic pregnancy, fetal loss rates at the upper and lower extremes (24 and 33%, respectively) were approximately threefold higher than the four intervening rates (8-14%). The odds ratio of pregnancy loss for these extreme intervals to the intervening intervals is 3.0 (P = 0.01). Nondiabetic losses showed a similar pattern. In confirmation, logit pregnancy losses were increased in a J-shaped curve at the glycemic extremes in normal (P < 0.019) and diabetic (P < 0.015) pregnancy. The upper glycemic extreme in diabetic pregnancy was two- to fivefold higher than in control pregnancy.Conclusions: Pregnancy losses are increased at the extremes of glycemia in both normal and diabetic pregnancy but at higher levels in diabetic pregnancy. The data suggest defensive adaptations against hyperglycemia in diabetic pregnancy. [ABSTRACT FROM AUTHOR]

A completely non-invasive and unconstrained method is proposed to detect respiration rhythm and pulse rate during sleep. By employing wavelet transformation (WT), waveforms corresponding to the respiration rhythm and pulse rate can be extracted from a pulsatile pressure signal acquired by a pressure sensor under a pillow. The respiration rhythm was obtained by an upward zero-crossing point detection algorithm from the respiration-related waveform reconstructed from the WT 2(6) scale approximation, and the pulse rate was estimated by a peak point detection algorithm from the pulse-related waveform reconstructed from the WT 2(4) and 2(5) scale details. The finger photo-electric plethysmogram (FPP) and nasal thermistor signals were recorded simultaneously as reference signals. The reference pulse rate and respiration rhythm were detected with the peak and upward zero-crossing point detection algorithm. This method was verified using about 24 h of data collected from 13 healthy subjects. The results showed that, compared with the reference data, the average error rates were 3.03% false negative and 1.47% false positive for pulse rate detection in the extracted pulse waveform. Similarly, 4.58% false negative and 3.07% false positive were obtained for respiration rhythm detection in the extracted respiration waveform. This study suggests that the proposed method is suitable, in sleep monitoring, for the diagnosis of sleep apnoea or sudden death syndrome. [ABSTRACT FROM AUTHOR]

National-level data on the incidence of retinopathy of prematurity (ROP) in different regions of China is insufficient. This study aimed to compare ROP incidences and care practices in different regions of China and their relationship with regional gross domestic product (GDP) per capita. Retrospective cohort study. All infants born at <32 weeks gestational age (GA) and admitted to 70 neonatal intensive care units (NICUs) from January 1, 2019, to December 31, 2020, were enrolled. Hospitals were categorised into three regional groups according to geographical locations and GDP per capita from high to low: Eastern, Central, and Western China. The incidence of death or ROP, and care practices were compared among the groups. A total of 18,579 infants were enrolled. Median GA was 29.9 (interquartile range 28.4–31.0) weeks and birth weight was 1318.1 (317.2) g. The percentage of GA <28 weeks, complete administration of antenatal steroids, and weight gain velocity during NICU stay were highest in Eastern China and lowest in Western China (all P < 0.01). In Eastern, Central, and Western China, the rates of death or any stage of ROP were 33.3%, 38.5%, and 39.2%, respectively (P < 0.01). There were considerable regional disparities in ROP incidence in preterm infants with GA <32 weeks in China. The incidence of death or ROP ranged from high to low in Western, Central, and Eastern China. [ABSTRACT FROM AUTHOR]

To determine the efficacy of preoperative chemoradiotherapy as per the CROSS protocol for oesophageal/gastroesophageal junction cancer (OEGEJC), when expanded to patients outside of the inclusion/exclusion criteria defined in the original clinical trial. Data were collected retrospectively on 229 OEGEJC patients referred for curative-intent preoperative chemoradiotherapy. Outcomes including pathological complete response (pCR), overall survival (OS), cancer-specific survival and recurrence-free survival (RFS) of patients who met CROSS inclusion criteria (MIC) versus those who failed to meet criteria (FMIC) were determined. In total, 42.8% of patients MIC, whereas 57.2% FMIC; 16.6% of patients did not complete definitive surgery. The MIC cohort had higher rates of pCR, when compared with the FMIC cohort (33.3% versus 20.6%, P = 0.039). The MIC cohort had a better RFS, cancer-specific survival and OS compared with the FMIC cohort (P = 0.006, P = 0.004 and P = 0.009, respectively). Age >75 years and pretreatment weight loss >10% were not associated with a poorer RFS (P = 0.541 and 0.458, respectively). Compared with stage I–III patients, stage IVa was associated with a poorer RFS (hazard ratio (HR) = 2.158; 95% confidence interval (CI) = 1.339–3.480, P = 0.001). Tumours >8 cm in length or >5 cm in width had a trend towards worse RFS (HR = 2.060; 95% CI = 0.993–4.274, P = 0.052). Our study showed that the robust requirements of the CROSS trial may limit treatment for patients with potentially curable OEGEJC and can be adapted to include patients with a good performance status who are older than 75 years or have >10% pretreatment weight loss. However, the inclusion of patients with celiac nodal metastases or tumours >8 cm in length or >5 cm in width may be associated with poor outcomes. • CROSS protocol is a standard of care for oesophageal/gastroesophageal junction cancer. • Expanding the inclusion criteria as per the CROSS protocol maybe beneficial. • Patients with a good performance status who are older than 75 years may be included. • Patients with >10% weight loss but with a good performance status may also benefit. • GEJ cancers with celiac nodal metastases or large tumours have questionable benefit. [ABSTRACT FROM AUTHOR]

Purpose: To report the feasibility of conducting a randomized study to compare the toxicity and efficacy of stereotactic body radiation therapy (SBRT) versus stereotactic body proton therapy (SBPT) for high-risk, medically inoperable, early-stage non-small cell lung cancer (NSCLC).Patients and Methods: Patients with medically inoperable NSCLC with high-risk features (centrally located or <5 cm T3 tumor or isolated lung parenchymal recurrences) were randomly assigned to SBRT or SBPT. Radiation dose was 50 Gy(relative biological effectiveness [RBE]) in 4 12.5-Gy(RBE) fractions prescribed to the planning target volume. Stereotactic body radiation therapy was given using 3-dimensional conformal radiation therapy or intensity modulated radiation therapy, and SBPT was given using passive scattering. Consistency in patient setup was ensured with on-board cone beam computed tomography for the SBRT group and with orthogonal X rays for the SBPT group.Results: The study closed early owing to poor accrual, largely because of insurance coverage and lack of volumetric imaging in the SBPT group. Ultimately, 21 patients were enrolled, and 19 patients who received 50 Gy in 4 fractions were included for analysis (9 SBRT, 10 SBPT). At a median follow-up time of 32 months, median overall survival time was 28 months in the SBRT group and not reached in the SBPT group. Three-year overall survival was 27.8% and 90%, 3-year local control was 87.5% (8 of 9) and 90.0% (9 of 10), and 3-year regional control was 47.6% (5 of 9) and 90% (9 of 10) in the SBRT and SBPT groups, respectively. One patient in the SBPT group developed grade 3 skin fibrosis. No patients experienced grade 4/5 toxicity.Conclusion: Poor accrual, due to lack of volumetric imaging and insurance coverage for proton therapy, led to early closure of the trial and precluded accurate assessment of efficacy and toxicity. Comparable maturity of 2 radiation therapy modalities, particularly on-board imaging, and better insurance coverage for SBPT should be considered for future studies. [ABSTRACT FROM AUTHOR]

Background: Patients with mild or moderate chronic obstructive pulmonary disease (COPD) rarely receive medications, because they have few symptoms. We hypothesized that long-term use of tiotropium would improve lung function and ameliorate the decline in lung function in patients with mild or moderate COPD.Methods: In a multicenter, randomized, double-blind, placebo-controlled trial that was conducted in China, we randomly assigned 841 patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 1 (mild) or 2 (moderate) severity to receive a once-daily inhaled dose (18 μg) of tiotropium (419 patients) or matching placebo (422) for 2 years. The primary end point was the between-group difference in the change from baseline to 24 months in the forced expiratory volume in 1 second (FEV1) before bronchodilator use. Secondary end points included the between-group difference in the change from baseline to 24 months in the FEV1 after bronchodilator use and the between-group difference in the annual decline in the FEV1 before and after bronchodilator use from day 30 to month 24.Results: Of 841 patients who underwent randomization, 388 patients in the tiotropium group and 383 in the placebo group were included in the full analysis set. The FEV1 in patients who received tiotropium was higher than in those who received placebo throughout the trial (ranges of mean differences, 127 to 169 ml before bronchodilator use and 71 to 133 ml after bronchodilator use; P<0.001 for all comparisons). There was no significant amelioration of the mean (±SE) annual decline in the FEV1 before bronchodilator use: the decline was 38±6 ml per year in the tiotropium group and 53±6 ml per year in the placebo group (difference, 15 ml per year; 95% confidence interval [CI], -1 to 31; P=0.06). In contrast, the annual decline in the FEV1 after bronchodilator use was significantly less in the tiotropium group than in the placebo group (29±5 ml per year vs. 51±6 ml per year; difference, 22 ml per year [95% CI, 6 to 37]; P=0.006). The incidence of adverse events was generally similar in the two groups.Conclusions: Tiotropium resulted in a higher FEV1 than placebo at 24 months and ameliorated the annual decline in the FEV1 after bronchodilator use in patients with COPD of GOLD stage 1 or 2. (Funded by Boehringer Ingelheim and others; Tie-COPD ClinicalTrials.gov number, NCT01455129 .). [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the impact of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (IMRT) of patients with head-and-neck carcinoma. Methods and Materials: From October 2002 through April 2005, we performed FDG-PET/CT guided IMRT for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. FDG-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and IMRT plans were generated based on the fused images. Results: All 28 patients had abnormal increased uptake in FDG-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months. Conclusion: Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma. [ABSTRACT FROM AUTHOR]