[The preliminary report of a registration clinical trial of proton and heavy ion irradiation].

Objective: To verify the safety and efficacy of IONTRIS particle therapy system (IONTRIS) in clinical implementation. Methods: Between 6.2014 and 8.2014, a total of 35 patients were enrolled into this trial: 31 males and 4 females with a median age of 69 yrs (range 39-80). Ten patients had locally recurrent head and neck tumors after surgery, 4 cases with thoracic malignancies, 1 case with hepatocellular carcinoma, 1 case with retroperitoneal sarcoma, and 19 cases with non-metastatic prostate carcinomas. Phantom dose verification was mandatory for each field before the start of radiation. Results: Twenty-two patients received carbon ion and 13 had proton irradiation. With a median follow-up time of 1 year, all patients were alive. Among the 16 patients with head and neck, thoracic, and abdominal/pelvic tumors, 2, 1, 12, and 1 cases developed complete response, partial response, stable disease, or disease progression, respectively. Progression-free survival rate was 93.8% (15/16). Among the 19 patients with prostate cancer, biological-recurrence free survival was 100%. Particle therapy was well tolerated in all 35 patients. Twenty-five patients (71.4%) experienced 33 grade 1 acute adverse effects, which subsided at 1 year follow-up. Six (17.1%) patients developed grade 1 late adverse effects. No significant change in ECOG or body weight was observed. Conclusions: IONTRIS is safe and effective for clinical use. However, long term follow-up is needed to observe the late toxicity and long term result.

Explicit nonlinear finite element geometric analysis of parabolic leaf springs under various loads.

This study describes the effects of bounce, brake, and roll behavior of a bus toward its leaf spring suspension systems. Parabolic leaf springs are designed based on vertical deflection and stress; however, loads are practically derived from various modes especially under harsh road drives or emergency braking. Parabolic leaf springs must sustain these loads without failing to ensure bus and passenger safety. In this study, the explicit nonlinear dynamic finite element (FE) method is implemented because of the complexity of experimental testing A series of load cases; namely, vertical push, wind-up, and suspension roll are introduced for the simulations. The vertical stiffness of the parabolic leaf springs is related to the vehicle load-carrying capability, whereas the wind-up stiffness is associated with vehicle braking. The roll stiffness of the parabolic leaf springs is correlated with the vehicle roll stability. To obtain a better bus performance, two new parabolic leaf spring designs are proposed and simulated. The stress level during the loadings is observed and compared with its design limit. Results indicate that the newly designed high vertical stiffness parabolic spring provides the bus a greater roll stability and a lower stress value compared with the original design. Bus safety and stability is promoted, as well as the load carrying capability.

Physiologic responses to epinephrine infusion: the basis for a new stress test for coronary artery disease.

Since many patients with chest pain cannot exercise adequately, an alternative stress would be useful to evaluate coronary reserve. We studied the physiologic responses to epinephrine to assess its potential. We report on 39 patients with chest pain. Doses from 0.03 to 0.30 micrograms/kg/min were administered intravenously. Heart rate increased from 72 +/- 10 to 86 +/- 12 bpm (mean +/- SD), systolic blood pressure (BP) from 122 +/- 20 to 158 +/- 18 mm Hg (increased afterload), and rate-pressure product/100 from 88 +/- 21 to 133 +/- 18. Rate-corrected pre-ejection period decreased from 141 +/- 23 to 92 +/- 14 msec and LVET/PEP ratio from 0.41 +/- 0.1 to 0.24 +/- 0.05 (increased contractility). Increased afterload and contractility increased myocardial oxygen demand. Simultaneously diastolic time and BP decreased, reducing myocardial blood supply. The endocardial viability ratio fell from 1.27 +/- 0.3 to 0.80 +/- 0.2. These data suggest that epinephrine infusion would be a useful stress test for coronary disease and are supported by a sensitivity of 87% and specificity of 100% in 23 patients with known coronary anatomy.

Retroperitoneal lymphadenectomy for testis tumor with nerve sparing for ejaculation.

The principal morbidity of retroperitoneal lymphadenectomy is the potential loss of ejaculation and, therefore, fertility owing to damage of the retroperitoneal sympathetic nerves that form the superior hypogastric plexus. We describe the results of our retroperitoneal lymphadenectomy when individual nerves from the sympathetic ganglia are identified and preserved while still performing a thorough bilateral retroperitoneal lymphadenectomy. The nerve-sparing procedure was technically feasible in 20 of 30 consecutive patients and it was only impractical with extensive gross disease. Of the 20 patients 18 (90 per cent) ejaculate, including 8 with bulky (5 cm. or more) residual retroperitoneal disease who underwent a successful nerve-sparing operation. All 12 patients (100 per cent) with nonbulky disease ejaculate. With short followup, no retroperitoneal recurrences have been detected. This technique is an alternative to limited dissection designed to spare nerves using boundaries based on the patterns of metastatic involvement.