1
|
Mascia A, McCauley S, Speth J, Nunez SA, Boivin G, Vilalta M, Sharma RA, Perentesis JP, Sertorio M. Impact of Multiple Beams on the FLASH Effect in Soft Tissue and Skin in Mice. Int J Radiat Oncol Biol Phys 2024; 118:253-261. [PMID: 37541394 DOI: 10.1016/j.ijrobp.2023.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/19/2023] [Accepted: 07/14/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE FLASH proton pencil beam scanning (p-PBS) showed a reduction in mouse skin toxicity and fibrosis when delivered as a single, uninterrupted, high-dose fraction. Clinical p-PBS treatment usually requires multiple beams to achieve good conformality, and these beams are separated by minutes to allow patient and equipment repositioning. We evaluate the impact of multibeam versus single-beam proton radiation on the FLASH sparing effect on skin toxicity. METHODS AND MATERIALS The right hind leg of 10-week-old female C57Bl/6j mice was irradiated using a Varian ProBeam proton beam scanning gantry system at conventional (1 Gy/s) or FLASH (100 Gy/s) average field dose rate. We scored the skin toxicity after different doses for 7 weeks. The treatment was delivered as 1, 2, or 3 equal beams with an interruption of 2 minutes. For each beam delivery, the equipment remained in the same position so that there was a full overlap of beams administered. RESULTS Single-beam delivery confirmed a benefit for p-PBS FLASH in this model at 30, 35, and 40 Gy. At 30 and 35 Gy, a single beam interruption of 2 minutes (2 × 15 Gy or 2 × 17.5 Gy) reduced the FLASH sparing effect, which remained significant (P < .001). However, 2 interruptions (3 × 10 Gy or 3 × 11.6 Gy) abrogated the normal tissue sparing effect. CONCLUSIONS Our results indicate that the FLASH sparing effect in areas of beam overlap can be compromised by interruptions in delivery time. Time gap between overlapping beams and spatial arrangement of the delivered beams are important parameters for FLASH studies. The effect of multibeam needs to be studied on different organs of interest.
Collapse
Affiliation(s)
- Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shelby McCauley
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph Speth
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stefanno Alarcon Nunez
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gael Boivin
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | - Marta Vilalta
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | - Ricky A Sharma
- Varian, a Siemens Healthineers Company, Palo Alto, California
| | | | - Mathieu Sertorio
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Radiation Oncology, University of Cincinnati Cancer Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| |
Collapse
|
2
|
Xiao Z, Zhang Y, Speth J, Lee E, Mascia A, Lamba M. Evaluation of a conventionally shielded proton treatment room for FLASH radiotherapy. Med Phys 2022; 49:6765-6773. [PMID: 36114793 PMCID: PMC10091931 DOI: 10.1002/mp.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/27/2022] [Accepted: 08/28/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE FLASH radiotherapy (FLASH-RT) is the potential for a major breakthrough in cancer care, as preclinical results have shown significantly reduced toxicities to healthy tissues while maintaining excellent tumor control. However, FLASH conditions were not considered in the current proton facilities' shielding designs. The purpose of this study is to validate the adequacy of conventionally shielded proton rooms used for FLASH-RT. METHODS Clinical FLASH irradiations typically take place in a few 100 ms, orders of magnitude shorter than the response time of the wide-energy neutron detector (WENDI-II). The nozzle beam current (representing the dose rate) dependence of the WENDI-II detector response was empirically determined to stabilize with a beam current of ≤10 nA at the measurement point with the highest dose rate. A large, predefined proton transmission FLASH plan (250 MeV, 7 × 20 cm2 , 8 Gy at isocenter) was commissioned as part of a FLASH clinical trial. For purpose of this study, that field was adjusted from 250 to 244 MeV, allowing a lower beam current of 10 nA to provide reliable detector response. Radiation surveys were performed for the proton beams with/without extra beam stopper (30 × 30 × 40-cm3 solid water slabs) at 0°, 90°, 180°, and 270° gantry angles. RESULTS Ambient doses were recorded at seven different locations. A 170-nA beam current, commonly used for clinical FLASH plans, was chosen to normalize the average ambient dose rate to FLASH conditions. Assuming 200-Gy/h workload (25 FLASH beams, 8 Gy/beam), annual occupational dose at controlled areas was calculated. For all gantry angles, ≤0.4 mSv/year is expected at treatment room door. The highest ambient dose, 2.46 mSv/year, ∼5% of the maximum annual permissible occupational dose, was identified at the isocenter of the adjacent treatment room with 90° gantry. CONCLUSION These survey results indicate that our conventionally shielded proton rotating gantry rooms result in acceptable occupational and public doses when the transmission FLASH beams delivered at four cardinal gantry angles based on 200-Gy/h workload assumption. These findings support that FLASH clinical trials in our conventionally shielded proton facilities can be safely implemented.
Collapse
Affiliation(s)
- Zhiyan Xiao
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Yongbin Zhang
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph Speth
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eunsin Lee
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Lamba
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
3
|
Daugherty E, Mascia A, Sertorio M, Zhang Y, Lee E, Xiao Z, Speth J, Woo J, McCann C, Russell K, Levine L, Sharma R, Khuntia D, Perentesis J, Breneman J. FAST-01: Results of the First-in-Human Study of Proton FLASH Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Lee E, Lourenço AM, Speth J, Lee N, Subiel A, Romano F, Thomas R, Amos RA, Zhang Y, Xiao Z, Mascia A. Ultra-high dose rate pencil beam scanning proton dosimetry using ion chambers and a calorimeter in support of first in-human flash clinical trial. Med Phys 2022; 49:6171-6182. [PMID: 35780318 PMCID: PMC9546035 DOI: 10.1002/mp.15844] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To provide ultra-high dose rate pencil beam scanning proton dosimetry comparison of clinically used plane-parallel ion chambers, PTW Advanced Markus and IBA PPC05, with a proton graphite calorimeter in support of first in-human proton FLASH clinical trial. METHODS Absolute dose measurement intercomparison of the plane-parallel plate ion chambers and the proton graphite calorimeter was performed at 5 cm water equivalent depth using rectangular 250 MeV single layer treatment plans designed for the first in-human FLASH clinical trial. The dose rate for each field was designed to remain above 60 Gy/s. The ion recombination effects of the plane-parallel plate ion chambers at various bias voltages were also investigated in the range of dose rates between 5 - 60 Gy/s. Two independent model-based extrapolation methods were used to calculate the ion recombination correction factors ks to compare with the two-voltage technique from most widely used clinical protocols. RESULTS The mean measured dose to water with the proton graphite calorimeter across all the pre-defined fields is 7.702 ± 0.037 Gy. The average ratio over the pre-defined fields of the PTW Advanced Markus chamber dose to the calorimeter reference dose is 1.002 ± 0.007 while the IBA PPC05 chamber shows ∼3% higher reading of 1.033 ± 0.007. The relative difference in the ks values determined from between the linear and quadratic extrapolation methods and the two-voltage technique for the PTW Advanced Markus chamber are not statistically significant and the trends of dose rate dependence are similar. The IBA PPC05 shows a flat response in terms of ion recombination effects based on the ks values calculated using the two-voltage technique. Differences in ks values for the PPC05 between the two-voltage technique and other model-based extrapolation methods are not statistically significant at FLASH dose rates. Some of the ks values for the PPC05 that were extrapolated from the three-voltage linear method and the semi-empirical model were reported less than unity possibly due to the charge multiplication effect, which was negligible compared to the volume recombination effect in FLASH dose rates. CONCLUSIONS The absolute dose measurements of both PTW Advanced Markus and IBA PPC05 chambers are in a good agreement with the NPL graphite calorimeter reference dose considering overall uncertainties. Both ion chambers also demonstrate good reproducibility as well as stability as refence dosimeters in ultra-high dose rate pencil beam scanning proton radiotherapy. The dose rate dependency of the ion recombination effects of both ion chambers in cyclotron generated PBS proton beams is acceptable and therefore, both chambers are suitable to use in clinical practice for the range of dose rates between 5 - 60 Gy/s. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Eunsin Lee
- Department of Radiation OncologyUniversity of CincinnatiCincinnatiOhioUSA
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Ana Mónica Lourenço
- National Physical LaboratoryMedical Science GroupTeddingtonUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Joseph Speth
- University of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Nigel Lee
- National Physical LaboratoryMedical Science GroupTeddingtonUK
| | - Anna Subiel
- National Physical LaboratoryMedical Science GroupTeddingtonUK
| | - Francesco Romano
- Istituto Nazionale di Fisica NucleareSezione di CataniaCataniaItaly
| | - Russell Thomas
- National Physical LaboratoryMedical Science GroupTeddingtonUK
- Faculty of Engineering and Physical ScienceUniversity of SurreyGuildfordSurreyUK
| | - Richard A. Amos
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonUK
| | - Yongbin Zhang
- Department of Radiation OncologyUniversity of CincinnatiCincinnatiOhioUSA
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Zhiyan Xiao
- Department of Radiation OncologyUniversity of CincinnatiCincinnatiOhioUSA
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Anthony Mascia
- Department of Radiation OncologyUniversity of CincinnatiCincinnatiOhioUSA
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| |
Collapse
|
5
|
Cunningham S, McCauley S, Vairamani K, Speth J, Girdhani S, Abel E, Sharma RA, Perentesis JP, Wells SI, Mascia A, Sertorio M. FLASH Proton Pencil Beam Scanning Irradiation Minimizes Radiation-Induced Leg Contracture and Skin Toxicity in Mice. Cancers (Basel) 2021; 13:cancers13051012. [PMID: 33804336 PMCID: PMC7957631 DOI: 10.3390/cancers13051012] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Dose and efficacy of radiation therapy are limited by the toxicity to normal tissue adjacent to the treated tumor region. Recently, ultra-high dose rate radiotherapy (FLASH radiotherapy) has shown beneficial reduction of normal tissue damage while preserving similar tumor efficacy with electron, photon and scattered proton beam irradiation in preclinical models. Proton therapy is increasingly delivered by pencil beam scanning (PBS) technology, and we therefore set out to test PBS FLASH radiotherapy on normal tissue toxicity and tumor control in vivo in mouse using a clinical proton delivery system. This validation of the FLASH normal tissue-sparing hypothesis with a clinical delivery system provides supporting data for PBS FLASH radiotherapy and its potential role in improving radiotherapy outcomes. Abstract Ultra-high dose rate radiation has been reported to produce a more favorable toxicity and tumor control profile compared to conventional dose rates that are used for patient treatment. So far, the so-called FLASH effect has been validated for electron, photon and scattered proton beam, but not yet for proton pencil beam scanning (PBS). Because PBS is the state-of-the-art delivery modality for proton therapy and constitutes a wide and growing installation base, we determined the benefit of FLASH PBS on skin and soft tissue toxicity. Using a pencil beam scanning nozzle and the plateau region of a 250 MeV proton beam, a uniform physical dose of 35 Gy (toxicity study) or 15 Gy (tumor control study) was delivered to the right hind leg of mice at various dose rates: Sham, Conventional (Conv, 1 Gy/s), Flash60 (57 Gy/s) and Flash115 (115 Gy/s). Acute radiation effects were quantified by measurements of plasma and skin levels of TGF-β1 and skin toxicity scoring. Delayed irradiation response was defined by hind leg contracture as a surrogate of irradiation-induced skin and soft tissue toxicity and by plasma levels of 13 different cytokines (CXCL1, CXCL10, Eotaxin, IL1-beta, IL-6, MCP-1, Mip1alpha, TNF-alpha, TNF-beta, VEGF, G-CSF, GM-CSF and TGF- β1). Plasma and skin levels of TGF-β1, skin toxicity and leg contracture were all significantly decreased in FLASH compared to Conv groups of mice. FLASH and Conv PBS had similar efficacy with regards to growth control of MOC1 and MOC2 head and neck cancer cells transplanted into syngeneic, immunocompetent mice. These results demonstrate consistent delivery of FLASH PBS radiation from 1 to 115 Gy/s in a clinical gantry. Radiation response following delivery of 35 Gy indicates potential benefits of FLASH versus conventional PBS that are related to skin and soft tissue toxicity.
Collapse
Affiliation(s)
- Shannon Cunningham
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
| | - Shelby McCauley
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
| | - Kanimozhi Vairamani
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
| | - Joseph Speth
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (J.S.); (A.M.)
| | - Swati Girdhani
- Varian Medical Systems, Inc., Palo Alto, CA 94304, USA; (S.G.); (E.A.); (R.A.S.)
| | - Eric Abel
- Varian Medical Systems, Inc., Palo Alto, CA 94304, USA; (S.G.); (E.A.); (R.A.S.)
| | - Ricky A. Sharma
- Varian Medical Systems, Inc., Palo Alto, CA 94304, USA; (S.G.); (E.A.); (R.A.S.)
| | - John P. Perentesis
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Susanne I. Wells
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA; (J.S.); (A.M.)
| | - Mathieu Sertorio
- Cincinnati Children’s Hospital Medical Center, Division of Oncology, Cincinnati, OH 45229, USA; (S.C.); (S.M.); (K.V.); (J.P.P.); (S.I.W.)
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Correspondence:
| |
Collapse
|
6
|
Lee E, Perry D, Speth J, Zhang Y, Xiao Z, Mascia A. Measurement-based study on characterizing symmetric and asymmetric respiratory motion interplay effect on target dose distribution in the proton pencil beam scanning. J Appl Clin Med Phys 2020; 21:59-67. [PMID: 32170992 PMCID: PMC7170285 DOI: 10.1002/acm2.12846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/17/2020] [Accepted: 02/10/2020] [Indexed: 12/25/2022] Open
Abstract
Pencil beam scanning proton therapy makes possible intensity modulation, resulting in improved target dose conformity and organ‐at‐risk (OAR) dose sparing. This benefit, however, results in increased sensitivity to certain clinical and beam delivery parameters, such as respiratory motion. These effects can cause plan degeneration, which could lead to decreased tumor dose or increased OAR dose. This study evaluated the measurements of proton pencil beam scanning delivery made with a 2D ion chamber array in solid water on a 1D motion platform, where respiratory motion was simulated using sine and cosine4 waves representing sinusoidal symmetric and realistic asymmetric breathing motions, respectively. Motion amplitudes were 0.5 cm and 1 cm corresponding to 1 cm and 2 cm of maximum respiratory excursions, respectively, with 5 sec fixed breathing cycle. The treatment plans were created to mimic spherical targets of 3 cm or 10 cm diameter located at 5 cm or 1 cm depth in solid water phantom. A reference RBE dose of 200 cGy per fraction was delivered in 1, 5, 10, and 15 fractions for each dataset. We evaluated dose conformity and uniformity at the center plane of targets by using the Conformation Number and the Homogeneity Index, respectively. Results indicated that dose conformity as well as homogeneity was more affected by motion for smaller targets. Dose conformity was better achieved for symmetric breathing patterns than asymmetric breathing patterns regardless of the number of fractions. The presence of a range shifter with shallow targets reduced the motion effect by improving dose homogeneity. While motion effects are known to be averaged out over the course of multifractional treatments, this might not be true for proton pencil beam scanning under asymmetrical breathing pattern.
Collapse
Affiliation(s)
- Eunsin Lee
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Perry
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Joseph Speth
- Department of Radiation Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Yongbin Zhang
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Zhiyan Xiao
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anthony Mascia
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
7
|
Speth C, Speth J, Harley T. Transcranial direct current stimulation and cortical indicators of relaxation. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Speth J, Frenzel C, Harley T. Transcranial direct current stimulation of areas above the motor cortex (C3) in waking resting state and REM sleep induces motor imagery. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
9
|
Abstract
Es wird ein kombiniertes Streu-Absorptionsexperiment beschrieben, wobei am 77,4 keV-Grund-zustandsübergang des Au197 der Einfluß des Lamb-Mössbauer-Faktors ƒ' auf die Resonanzstreuung untersucht wurde. In einer theoretischen Betrachtung wird der Einfluß der mittleren Gitterschwingungszeit Tm im Vergleich zur reziproken Niveaubreite 1/Γ des angeregten Niveaus, an dem gestreut wird, abgeschätzt, wobei die beiden Grenzfälle τm ≫1/Γ und τm ≪1/Γ betrachtet werden. Der erste Fall tritt z. B. bei der Rayleigh-Streuung von Röntgen-Strahlen auf und wird als schneller Prozeß bezeichnet, während man für die hier untersuchte Kernresonanzstreuung den zweiten Fall als sogenannten langsamen Prozeß erwartet. Für den schnellen Prozeß ist der Beitrag von ƒ' linear, während er für den langsamen Prozeß proportional zu ƒ'2 ist.
Benutzt man die resonant gestreute Komponente als sekundäre Quelle für ein Absorptionsexperiment, so läßt sich für einen linearen Beitrag von ƒ' eine 84,5-proz. Absorption erwarten, während man für einen quadratischen Beitrag nur 14% erhalten wird.
Unsere Messungen ergaben eine Absorption von (15,8 ± 4,2) %, was mit ausreichendem Fehlerabstand bestätigt, daß der zu erwartende langsame Streuprozeß stattfindet.
Collapse
Affiliation(s)
- J. Speth
- Physik-Department der Technischen Hochschule München
| | - F. W. Stanek
- Physik-Department der Technischen Hochschule München
| |
Collapse
|
10
|
Lyutorovich N, Tselyaev VI, Speth J, Krewald S, Grümmer F, Reinhard PG. Self-consistent calculations of the electric giant dipole resonances in light and heavy nuclei. Phys Rev Lett 2012; 109:092502. [PMID: 23002827 DOI: 10.1103/physrevlett.109.092502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Indexed: 06/01/2023]
Abstract
While bulk properties of stable nuclei are successfully reproduced by mean-field theories employing effective interactions, the dependence of the centroid energy of the electric giant dipole resonance on the nucleon number A is not. This problem is cured by considering many-particle correlations beyond mean-field theory, which we do within the quasiparticle time blocking approximation. The electric giant dipole resonances in 16O, 40Ca, and 208Pb are calculated using two new Skyrme interactions.
Collapse
Affiliation(s)
- N Lyutorovich
- VA Fock Institute of Physics, St. Petersburg State University, St. Petersburg, Russia
| | | | | | | | | | | |
Collapse
|
11
|
Bhargava A, Trivedi D, Kalva L, Tumas M, Hooks M, Speth J. Management of cancer-related vertebral compression fracture: Comparison of treatment options: A literature meta-analysis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20529] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20529 Objective: The objective of this review was to compare the efficacy and safety of treatment options for management of vertebral compression fractures (VCF) secondary to multiple myeloma and/or metastatic tumors based on a meta-analysis of the literature. Methods: A search was performed of published literature through November 2008. All articles reporting at least one clinical outcome were included. VAS pain scores and cement extravasation were the most common efficacy and safety outcomes reported in the included studies and were considered for analysis. The mean weighted difference in VAS scores or the effect size was calculated using the number of patients in each study as the weights. The paired t-test was used to assess significance of these differences. A 95% confidence interval (CI) was computed around these differences. The significance of difference (VAS and % cement extravasations) between different modes of treatment was assessed using a two sample t-test. Results: A total of 59 studies met the inclusion criteria and were included in the meta-analysis. The majority of the included studies (56 studies) were case series. No randomized controlled study was identified. The total sample size from the included study was 4,460 patients - 73% of patients had a diagnosis of tumor metastasis to the vertebral column; 18% had a diagnosis of multiple myeloma. Percutaneous vertebroplasty (VP) was described in 57.6% studies; balloon kyphoplasty (BKP) in 20.3%; conservative/combined (CC) therapy in 22%. Results are shown in the Table . Conclusions: This meta-analysis indicates that BKP is more effective than either VP or conservative therapy in relieving pain secondary to cancer-related VCF and that BKP is a safer intervention than VP based on the analysis of the rates of cement extravasation. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Bhargava
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| | - D. Trivedi
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| | - L. Kalva
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| | - M. Tumas
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| | - M. Hooks
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| | - J. Speth
- Max Healthcare, Ghaziabad, India; HCL Technologies, Noida, India; Medtronics Spinal and Biologics, Sunnyvale, CA
| |
Collapse
|
12
|
Gidal BE, Walker JK, Lott RS, Shaw R, Speth J, Marty KJ, Rutecki P. Efficacy of lamotrigine in institutionalized, developmentally disabled patients with epilepsy: a retrospective evaluation. Seizure 2000; 9:131-6. [PMID: 10845738 DOI: 10.1053/seiz.1999.0372] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The paper evaluates the efficacy of the newer anticonvulsant lamotrigine in a developmentally disabled patient population. A retrospective evaluation was done at two institutional centres to assess adjunctive lamotrigine (Lamictal) efficacy in a developmentally disabled population. Mean seizure frequency was compared between a 2-month pre-lamotrigine baseline period and a 2-month treatment period. A 3-month lamotrigine titration phase occurred between baseline and treatment periods. Seizure frequency data was obtained from standardized, daily seizure records. Adverse effect data was obtained from medical and nursing notes. An intent to treat analysis was performed. Data were analysed using Student's t-test for paired data. We evaluated 44 centre residents (25 male, 19 female, average age 33 +/- 11 years). Mean lamotrigine dose was 272 +/- 133 mg per day. A significant reduction in seizure frequency was noted. Seizure frequency (all seizures) was 10.1 +/- 11.2 during the baseline period vs. 5.8 +/- 7.9 seizures per month during the treatment period (P = 0.002). Thirty-two percent of patients (n = 14) had greater than a 75% reduction in seizure frequency. Twenty-three percent of patients (n = 10) had a 50-74% seizure reduction. Twenty-five percent of patients (n = 11) had less than a 50% reduction in seizures, while 20% (n = 9) had an increase in seizures. A significant reduction of 48% in generalized seizures (9.5 +/- 11.6 vs. 4.9 +/- 6.5 seizures per month, P = 0.013) was noted. Reductions in partial seizure frequency of 48% (7.9 +/- 10 vs. 4 +/- 6.6 seizures per month, P = 0.16) as well as in mixed-type seizures (19.9 +/- 9.3 was vs. 15 +/- 12.1 seizures per month, P = 0.11) were also seen; however, these changes did not reach significance. Overall, lamotrigine was well tolerated by the subject population. Adjunctive treatment with lamotrigine appears to be an efficacious and well-tolerated treatment for seizures in a significant percentage of developmentally disabled patients with epilepsy.
Collapse
Affiliation(s)
- B E Gidal
- University of Wisconsin, School of Pharmacy and Department of Neurology, Madison 53706, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
|
14
|
|
15
|
Janssen G, Pearce BC, Holinde K, Speth J. Structure of the scalar mesons f0(980) and a0(980). Phys Rev D Part Fields 1995; 52:2690-2700. [PMID: 10019486 DOI: 10.1103/physrevd.52.2690] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
16
|
Kamerdzhiev S, Speth J, Tertychny G. Splitting of the Isoscalar E2 Giant Resonance and Evidence of Low-Lying E0 Strength in 40Ca. Phys Rev Lett 1995; 74:3943-3946. [PMID: 10058373 DOI: 10.1103/physrevlett.74.3943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
17
|
Schütz C, Holinde K, Speth J, Pearce BC, Durso JW. Dynamical model for correlated two-pion exchange in the pion-nucleon interaction. Phys Rev C Nucl Phys 1995; 51:1374-1383. [PMID: 9970189 DOI: 10.1103/physrevc.51.1374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
18
|
|
19
|
Nikolaev NN, Szczurek A, Speth J, Wambach J, Zakharov BG, Zoller VR. Erratum: Theoretical interpretation of the NE18 experiment on nuclear transparency in A(e,e'p) scattering. Phys Rev C Nucl Phys 1995; 51:1041. [PMID: 9970150 DOI: 10.1103/physrevc.51.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
20
|
|
21
|
Nikolaev NN, Szczurek A, Speth J, Wambach J, Zakharov BG, Zoller VR. Theoretical interpretation of the NE18 experiment on nuclear transparency in A(e,e'p) scattering. Phys Rev C Nucl Phys 1994; 50:R1296-R1299. [PMID: 9969851 DOI: 10.1103/physrevc.50.r1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
22
|
Schütz C, Durso JW, Holinde K, Speth J. Role of correlated two-pion exchange in pi N scattering. Phys Rev C Nucl Phys 1994; 49:2671-2687. [PMID: 9969516 DOI: 10.1103/physrevc.49.2671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
23
|
|
24
|
Drozdz S, Nishizaki S, Speth J, Wambach J. Modeling complex nuclear spectra: Regularity versus chaos. Phys Rev C Nucl Phys 1994; 49:867-870. [PMID: 9969292 DOI: 10.1103/physrevc.49.867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
25
|
|
26
|
Hao J, Kuo TT, Reuber A, Holinde K, Speth J, Millener DJ. Hypernucleus Lambda 16O and accurate hyperon-nucleon G-matrix interactions. Phys Rev Lett 1993; 71:1498-1501. [PMID: 10054423 DOI: 10.1103/physrevlett.71.1498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
27
|
Wyborny P, Hoffmann M, Holinde K, Speth J. Role of K Delta interactions in K+N pion production. Phys Rev C Nucl Phys 1993; 48:1376-1378. [PMID: 9968967 DOI: 10.1103/physrevc.48.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
28
|
Haidenbauer J, Holinde K, Speth J. p-barp--> Xi -bar Xi reaction in the meson exchange picture. Phys Rev C Nucl Phys 1993; 47:2982-2985. [PMID: 9968776 DOI: 10.1103/physrevc.47.2982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
29
|
Haidenbauer J, Holinde K, Speth J. Antihyperon-hyperon production in the meson exchange framework. Phys Rev C Nucl Phys 1992; 46:2516-2518. [PMID: 9968382 DOI: 10.1103/physrevc.46.2516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
30
|
Haidenbauer J, Holinde K, Mull V, Speth J. Meson-exchange and quark-gluon transitions in the p-barp--> Lambda -bar Lambda process. Phys Rev C Nucl Phys 1992; 46:2158-2171. [PMID: 9968344 DOI: 10.1103/physrevc.46.2158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
31
|
Hwang WY, Speth J. Origin of the violation of the Gottfried sum rule. Phys Rev D Part Fields 1992; 46:1198-1201. [PMID: 10015037 DOI: 10.1103/physrevd.46.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
32
|
Drozdz S, Speth J. Droz-dotdz-dot and Speth reply. Phys Rev Lett 1992; 68:3109. [PMID: 10045610 DOI: 10.1103/physrevlett.68.3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
33
|
|
34
|
Haidenbauer J, Hippchen T, Holinde K, Holzenkamp B, Mull V, Speth J. Reaction p-barp--> Lambda -bar Lambda in the meson-exchange picture. Phys Rev C Nucl Phys 1992; 45:931-946. [PMID: 9967842 DOI: 10.1103/physrevc.45.931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
35
|
|
36
|
Herrmann V, Speth J, Nakayama K. Nucleon-nucleon bremsstrahlung at intermediate energies. Phys Rev C Nucl Phys 1991; 43:394-415. [PMID: 9967085 DOI: 10.1103/physrevc.43.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
37
|
Zawischa D, Macfarlane M, Speth J. Magnetic dipole strength functions in heavy deformed nuclei. Phys Rev C Nucl Phys 1990; 42:1461-1471. [PMID: 9966881 DOI: 10.1103/physrevc.42.1461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
38
|
Hippchen T, Speth J, Johnson MB. Spin-spin and tensor observables in the isovector nucleon-nucleon force. Phys Rev C Nucl Phys 1989; 40:1316-1322. [PMID: 9966106 DOI: 10.1103/physrevc.40.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
39
|
Unkelbach W, Speth J, Wambach J. Possible existence of a low-energy octupole resonance in 208Pb. Phys Rev C Nucl Phys 1989; 40:1534-1536. [PMID: 9966131 DOI: 10.1103/physrevc.40.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
40
|
Kaplan EL, Berrios X, Speth J, Siefferman T, Guzman B, Quesny F. Pharmacokinetics of benzathine penicillin G: serum levels during the 28 days after intramuscular injection of 1,200,000 units. J Pediatr 1989; 115:146-50. [PMID: 2738782 DOI: 10.1016/s0022-3476(89)80352-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Because of published data suggesting the inadequacy of once-every-4-weeks intramuscular injections of benzathine penicillin G for secondary rheumatic fever prevention, serum penicillin levels were determined at 1, 3, 10, 21, and 28 days after administration of 1,200,000 units of this repository penicillin. A total of 193 samples were studied. Mean serum penicillin levels remained greater than or equal to 0.02 micrograms/ml for 21 days, but by 28 days only 44% of the serum samples had detectable levels of penicillin and only 36% had levels greater than or equal to 0.02 micrograms/ml. Patients weighing more than 45 kg had significantly lower serum penicillin levels than did those who weighed less. There were similar correlations with body surface area and with age. These data indicate that a significant percentage of patients receiving benzathine penicillin G prophylaxis for prevention of recurrent attacks of rheumatic fever are not protected during the fourth week. More frequent administration of benzathine penicillin G should be considered in instances of high risk of recurrence of rheumatic fever.
Collapse
Affiliation(s)
- E L Kaplan
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
The pharmacokinetic properties of hPA(B), characterized by the insertion of a urokinase kringle coding region before the double kringle of tPA plus the complete tPA coding region, were investigated and compared to those of melanoma tPA (mtPA). Mean peak plasma concentrations at the end of infusion were 4.7 micrograms/ml for hPA(B) and 4.6 micrograms/ml for mtPA. The pharmacokinetics of both hPA(B) and mtPA showed a biexponential disappearance from plasma which is consistent with a two-compartment model of t 1/2 (lambda 1) = 2 minutes, t 1/2 (lambda 2) = 58 minutes for hPA(B), and t 1/2 (lambda 1) = 2.2 minutes, t 1/2 (lambda 2) = 61 minutes for mtPA. However, this very fast decaying lambda 1 phase of mtPA lasted five times longer than that of hPA(B) which resulted in very low concentrations of mtPA. Thus, hPA(B) exhibited larger AUC, slower clearance rate, and smaller volume of distribution (P less than 0.01) than those of mtPA. The fibrinolytic activity of hPA(B) in rabbit plasma as determined by zymography lasted up to 120 minutes after the end of infusion as compared to that of 2 minutes for mtPA. This indicates that mtPA, despite its t 1/2 (lambda 2) being similar to that of hPA(B), is no longer at physiologically meaningful concentrations at the start of the lambda 2 phase.
Collapse
Affiliation(s)
- K P Fu
- Biotechnology and Microbiology Division, Wyeth-Ayerst Research, Philadelphia, PA 19101
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Wambach J, Drod S, Schulte A, Speth J. 90Zr (p,n) and (n,p) distorted-wave impulse approximation cross sections in 2p2h random-phase approximation. Phys Rev C Nucl Phys 1988; 37:1322-1325. [PMID: 9954574 DOI: 10.1103/physrevc.37.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
43
|
|
44
|
|
45
|
Nakayama K, Krewald S, Speth J, Love WG. Energy and density dependence of the isovector tensor interaction. Phys Rev C Nucl Phys 1985; 31:2307-2309. [PMID: 9952794 DOI: 10.1103/physrevc.31.2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
46
|
Speth J, Cha D, Klemt V, Wambach J. Signature to detect the isovector giant quadrupole resonance. Phys Rev C Nucl Phys 1985; 31:2310-2313. [PMID: 9952795 DOI: 10.1103/physrevc.31.2310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
47
|
|
48
|
Osterfeld F, Cha D, Speth J. Microscopic analysis of complete 90Zr(p,n) spectra including the Delta isobar effect. Phys Rev C Nucl Phys 1985; 31:372-383. [PMID: 9952533 DOI: 10.1103/physrevc.31.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
49
|
|
50
|
|