Radiation-induced intestinal injury denotes structural and functional impairment of the intestines resulting directly or indirectly from ionizing radiation, such as that employed in radiation therapy for malignant tumors in the abdominal or pelvic regions, within the treatment area. It is a prevalent and severe consequence of radiation therapy for abdominal and pelvic tumors, greatly affecting treatment outcomes and patients' quality of life. Western medicine primarily employs symptomatic management, including medical drug therapy, hyperbaric oxygen therapy, nutritional support therapy, endoscopic and surgical interventions, as well as stem cell transplantation. However, current therapeutic agents for RIII fall far short of achieving ideal outcomes. Previous studies indicate that blueberry anthocyanins (BA) possess not only anticancer properties but also potent anti-inflammatory, antioxidant, and anti-radiation activities. Seventy male C57BL/6J mice (6-8 weeks old) were categorized into five groups: a normal control group (Con), an irradiation-only group (IR), groups administered low-dose BA prior to and following irradiation (IR+BA-L, 100 mg/kg bw), a high-dose BA group (IR+BA-H, 200 mg/kg bw), and a group receiving the clinical radiation protection agent amphotericin (IR+WR-2721, 30 mg/kg bw). Furthermore, a group for antibiotic-induced gut microbiota depletion and a validation group for fecal microbiota transplantation (FMT) were established. A model of radiation-induced intestinal damage was created utilizing a single 14 Gy dose of abdominal X-ray irradiation. The irradiation field encompassed a 2.5 cm by 20 cm region extending from the pubic symphysis to the xiphoid process. BA was supplied through oral gavage from 14 days prior to irradiation until 3.5 days post-irradiation at a dose of 0.2 mL/day per mouse, whereas the normal control group received saline via gavage for 14 consecutive days. Tissue samples were obtained 3.5 days post-irradiation. Through the assessment of survival rates, body mass, intestinal histopathology, inflammatory cytokine concentrations (IL-1β, IL-6, TNF-α), oxidative stress indicators (SOD, MDA), and intestinal barrier proteins (occludin, claudin-1), alongside immunohistochemical analysis of the proliferative cell marker Ki67 and the Paneth cell marker lysozyme, the proliferation and differentiation of intestinal stem cells will be evaluated. Furthermore, 16S rDNA sequencing was executed on colonic contents, and non-targeted metabolomics analysis was undertaken on colonic tissue to assess alterations in gut microbiota and host metabolism. Mice treated with BA intervention exhibited significant alleviation of intestinal injury, manifested as reduced weight loss, increased survival rate, markedly elongated colon length, substantially mitigated intestinal damage, and elevated histological scores. Concurrently, BA therapy downregulated levels of pro-inflammatory cytokines IL-1β, TNF-α, and IL-6, while decreasing elevated SOD content and MDA levels. Immunohistochemical analysis revealed that BA intervention significantly increased Ki67+proliferating cells and Lysozyme+ Paneth cells in the crypt region of the colon. Western blot analysis demonstrated that BA upregulated the levels of intestinal tight junction proteins Occludin and Claudin-1. 16S rDNA sequencing revealed that BA improved gut microbiota composition by increasing the abundance of beneficial bacteria and reducing pathogenic bacteria. Metabolomic analysis revealed altered metabolic patterns in mouse colon tissue following both radiation exposure and BA intervention. BA restored levels of 53 potential biomarkers. Finally, fecal microbiota transplantation (FMT) validated BA's protective effect against RIII via the gut microbiota. The results of this study show that blueberry anthocyanin (BA) exerts significant protective effects against radiation-induced intestinal injury (RIII). It ameliorates RIII by modulating gut microbiota composition and associated metabolites. FMT experiments further validate that BA's protective action depends on gut microbiota regulation. The findings suggest that BA, as a gut microbiota-modulating agent, holds promise for preventing and treating RIII.
It is common to model ion-irradiated amorphous thin films as if they were highly viscous fluids. In such models, one is frequently concerned with the ion-enhanced fluidity, a measure of the ability of the free interface to relax surface energy. Motivated by usual fluid dynamics problems, the ion-enhanced fluidity is near universally treated as a constant throughout the amorphous layer. However, for an irradiated thin film, the fluidity is ultimately caused by radiation-induced defect kinetics within the film, leading to regions with greater or lesser fluidity, and sensitive dependence on ion energy, species, flux, irradiation angle, temperature, and other experimental parameters. Here we develop and analyze a model of radiation-induced defect kinetics coupled to the continuum equations of a viscous thin film where sputtering-induced surface destabilization is neglected. Using realistic parameter values, we show that defect kinetics can meaningfully alter theoretical predictions of surface relaxation and ion-enhanced fluidity. Implications for aligning theoretical and experimental work, especially for surface nanopatterning of silicon induced by low-energy argon irradiation, are discussed.
Xerostomia remains a common toxicity after head and neck radiation therapy that significantly impacts patients' quality of life. Although intensity modulated radiation therapy reduces the dose to the salivary glands, many patients still experience salivary gland toxicity. This study examined the association between radiation-induced volume changes in the parotid and submandibular glands, mean dose to the salivary glands, and intragland dose distribution, as well as its relationship to quality of life scores, over a median follow-up period of 47 months. Analysis of 329 patients using a linear mixed-effects model revealed distinct volume change patterns. The parotid glands initially underwent significant volume reduction but subsequently showed dose-dependent recovery, increasing in volume by an average rate of 2.4% per doubling of time. This recovery was negatively impacted by higher age and poor performance status (PS). Conversely, the submandibular glands gradually reduced in volume over time by 5.3% per doubling of time without evidence of recovery, even at low doses. Voxel-wise analysis of the parotid glands indicated that dose constraints targeting the cranial-ventral-lateral portion were critical for accurately predicting volume recovery. No regional dose effects were found for the submandibular gland. Persistent associations were found between salivary gland volumes and chronic xerostomia symptoms, including dry mouth and sticky saliva. Objective measurement of salivary gland volume can be used as an indicator of damage and recovery. The observed differential longitudinal patterns suggest that distinct dosing strategies and regenerative approaches may be necessary for the parotid and submandibular glands.
The transient evolution and established states of color domains in fiber lasers with a doublet radiation spectrum are investigated by constructing a Lyapunov functional. In the transient process, the constructed functional decreases monotonically and reaches its minimum, regardless of the initial conditions. This evolution of the constructed functional allows one to determine the direction of the transient process for the generated radiation and its steady-state structure that minimizes this functional. The analysis using variational principles is based on an approximation neglecting the chromatic dispersion and refractive-index nonlinearity of the intracavity medium. The obtained results are useful for understanding the features of the transient evolution of the laser generation and for the development of methods for controlling the generation regimes of fiber lasers.
To understand the percentage of patients who exceed a cumulative effective dose of 50 or 100 mSv within 1-5 years of first CT scan, while accounting for data censoring (i.e. considering patients who are no longer being followed in the study and whose unobserved exams may influence the estimates) - a major limitation of prior reports. Retrospective, multi-national study of 5.6 million CT exams in 2.8 million patients from 161 hospitals between 2010-2021. We quantified the percentage of exams with effective doses >50 and >100 mSv, and using survival analysis, projected the percentage of patients with cumulative effective doses above these levels at 1 and 5 years, and identified relevant drivers (e.g., patient size, exam type, country). 189,981 (3.4%) of exams were >50 mSv and 14,906 (0.3%) >100 mSv, varying by patient age, size, and exam type. Overall, 13% of average-sized adults and 5% of average-sized children were estimated to accumulate 50 mSv over 5 years (56% and 27% of large-sized adults and children, respectively), whereas 4% of average-sized adults and 1% of average-sized children were estimated to accumulate 100 mSv over 5 years (31% and 13% of large-sized adults and children, respectively). England had a 1.7- to 5-times lower than average percentage of patients exceeding these levelss. High cumulative doses were not rare, particularly high in larger patients, and repeat imaging was a strong driver of these exposures. When accounting for data censoring, a considerably larger share of patients accumulated high effective dose from CT than has been previously reported, exceeding radiation dose ranges associated with radiation-induced cancer.
Randomized trials and international guidelines endorse hypofractionated whole-breast irradiation (HF-WBI) as standard of care for early breast cancer, offering equivalent tumour control with shorter treatment times and reduced system burden. In South Africa, where access and throughput are critical, real-world uptake is particularly relevant. This review evaluates our centre's adoption of HF-WBI and adherence to guideline-based practice. We retrospectively reviewed all breast cancer patients referred for radiotherapy from 2018-2024, stratifying fractionation as conventional WBI (CF-WBI; ~50 Gy/25 fractions), hypofractionation (40.05 Gy/15 or 42.5 Gy/16), and ultra-hypofractionation (≈26 Gy/5). Among those receiving breast-conserving therapy (BCT), we assessed annual HF-WBI adoption, age distribution (<50 vs. ≥50 years), and boost use. Across yearly datasets, HF-WBI increased steadily and substantially. In 2018, HF-WBI accounted for 17/138 CF/HF cases (12.3%). Uptake rose through 2019 (21.0%), 2020 (27.1%), 2021 (43.4%), 2022 (38.6%), 2023 (54.6%), and reached 82.4% in 2024 (103 HF vs. 22 CF). Ultra-hypofractionation (≈26 Gy/5) appeared from 2022 onward at low but increasing levels (e.g., 6 cases in 2024). Boost delivery was used across schedules; HF-WBI frequently included a boost (e.g., 59 cases in 2023; 70 in 2024), indicating protocol flexibility without abandoning shorter courses. Importantly, HF-WBI was used in both younger and older patients (e.g., 2024: <50 y = 32; ≥50 y = 70 within HF cases), reflecting rising clinician confidence across age groups as guideline-concordant practice matured. Our multi-year review demonstrates a decisive transition from conventional to HF breast RT, with HF-WBI becoming the predominant regimen by 2024. Real-world implementation was feasible with sustained boost utilisation and broad age inclusivity, aligning with international guidelines while improving patient convenience and departmental efficiency. Wider adoption of HF-WBI-and selective use of ultra-hypofractionation- can expand equitable access and support service sustainability in resource-constrained health systems. 1. Adopt "HF-by-default" for eligible BCT patients, requiring a documented exception for CF-WBI. 2. Scale a FAST-Forward pathway (≈26 Gy/5) where clinically appropriate with clear selection criteria. 3. Standardise boost indications in HF schedules (e.g., 10-16 Gy in 4-8 fractions). 4. Embed age-agnostic eligibility in MDM checklists to avoid age-based bias against HF. 5. Bundle HF-WBI with DIBH planning QA for left-sided cases to maintain cardiac/lung constraints. 6. Implement a KPI dashboard tracking HF share, median treatment days, boost rate, and re-planning rate. 7. Update patient-facing education to explain HF schedules and boost delivery, improving adherence.
[This corrects the article DOI: 10.3389/fimmu.2026.1642012.].
Plasma discharge devices have recently emerged as compact and versatile tools for particle beam manipulation. Building upon the active plasma lens (APL) and its curved extension, the active plasma bending, this work introduces the concept of the plasma discharge undulator (PDU). In a PDU, a high-current discharge within a capillary generates an azimuthal magnetic field providing strong linear focusing [O(kT/m)], while a controlled and periodical spatial modulation of the discharge axis acts as a geometric driving term. The resulting beam dynamics can be modeled as a forced harmonic oscillator, yielding a well-defined oscillation at wavelength λ_{PDU}, distinct from the natural betatron wavelength λ_{β} related to APL focusing. Proper injection conditions result in the suppression of collective betatron oscillations, significantly reducing the intrinsic undulator strength spread typical of conventional plasma undulators while allowing for matched beam transport thanks to strong APL focusing. Analytical models for particle trajectories and radiation emission are developed, and the one-dimensional requirements for free-electron laser (FEL) emission are evaluated, providing scaling relations and feasibility criteria for FEL operation in the proposed scheme. Theoretical estimates are validated through multiparticle simulations of beam dynamics and radiation emission, confirming that the PDU can operate in the short-period regime (λ_{PDU} of millimeters to centimeters) with tunable undulator strength K_{PDU}, supporting narrow-band radiation emission. Numerical studies further demonstrate that the PDU is capable of sustaining seeded longitudinal microbunching analogous to that occurring in conventional magnetic undulators. The PDU thus provides a pathway toward miniaturized, tunable, fully plasma based light sources with enhanced control over focusing and spectral properties.
A complex study of Ti hybrid X-pinch (HXP) radiation, including spectroscopic studies with temporal and spatial resolutions, source size measurements, and relative intensities of the spectral lines, was carried out. The time-resolved spectra recorded by the x-ray streak camera were calibrated in intensity using the time-integrated spectra recorded on imaging plates with a linear response. A numerical modeling using the PrismSPECT program was used to estimate the parameters of Ti HXP plasma and their changes in time. The radiation source size determined by point-projection radiography was taken into account in the spectral analysis. The results show that radiation collapse is most likely the mechanism responsible for the formation of hot spots in X pinches.
Radiation-induced sarcoma (RIS) is a rare, life-threatening late complication of radiotherapy, typically diagnosed 3-5 years post-treatment. It is associated with a poor prognosis and poses diagnostic challenges due to non-specific imaging and clinical features that mimic tumor recurrence. As the long-term survival rates of patients with rectal cancer improve, recognizing late-onset treatment-related malignancies becomes increasingly paramount. The present study describes the case of a 62-year-old male patient who presented to Shaoyang Central Hospital (Shaoyang, Hunan, China) in February 2019 and underwent neoadjuvant chemoradiotherapy followed by radical resection for rectal adenocarcinoma in June 2019. After 5 years, he presented with buttock pain in December 2024. Computed tomography (CT) imaging revealed a sacrococcygeal soft tissue mass within the prior radiation field. A biopsy confirmed an undifferentiated sarcoma, histologically distinct from the primary carcinoma, fulfilling modified Cahan criteria for RIS. Despite diagnosis, the patient declined further treatment due to concerns about toxicity and exhibited disease progression. A follow-up examination in June 2025 showed that the masses had increased in number and size. The present case underscores the importance of long-term surveillance in rectal cancer survivors. A re-biopsy of suspicious masses is key to differentiate RIS from recurrence. Early recognition may improve patient outcomes, although current therapeutic options, such as standard radiotherapy and chemotherapy, remain limited. Immunotherapy and targeted therapy are considered as second-line treatment options. However, due to factors such as physical and financial conditions, this patient did not choose to continue the treatment.
Skin not only serves as a protective barrier, but also as a dynamic immunological and sensory organ responsible for complex physiological processes. Disruption through trauma, surgery, burns or chronic metabolic disease initiates a tightly regulated healing cascade involving inflammatory signaling, extracellular matrix remodeling, angiogenesis and coordinated cellular responses. While acute wounds generally progress through orderly phases of repair, chronic wounds such as diabetic foot ulcers, venous ulcers and pressure injuries become arrested in persistent inflammatory states characterized by protease imbalance, senescent cell accumulation, impaired vascularization and colonization of microbial biofilms, contributing to significant global morbidity and healthcare burden. This review integrates structural biology, immune mechanisms and molecular signaling pathways that govern wound repair, clearly delineating the differences between acute and chronic healing. Particular emphasis is placed on inflammation-driven dysregulation, extracellular matrix dynamics and defective angiogenesis that underpin chronic wound pathology. Rare and often underrepresented wound types, including radiation-induced and autoimmune-associated lesions, are also discussed to provide a broader and clinically relevant perspective. Importantly, the review highlights translational and technological advances transforming wound management, including self-healing hydrogels, nanofiber scaffolds, bioactive and stimuli-responsive dressings, biosensor-integrated platforms, cellular and molecular therapies and AI-assisted diagnostic systems. These innovations exemplify a shift from passive wound coverage toward biointeractive, precision-guided and microenvironment-responsive therapeutic strategies. By bridging immunopathology, regenerative medicine, nanobiotechnology and digital health platforms within a single cohesive narrative, this review serves as a comprehensive and integrative resource for academicians, clinicians, translational researchers and pharmaceutical innovators seeking a mechanistically grounded yet application-oriented understanding of modern wound care.
Non-melanoma skin cancer (NMSC), represents the most common malignancy in fair-skinned populations and constitutes a growing public health burden. Although surgery remains the standard of care, a significant proportion of patients are poor surgical candidates due to age, comorbidities, tumor location or personal preference, highlighting the need for effective non-surgical alternatives. To review current therapeutic strategies and the clinical, physical and radiobiological basis, indications, efficacy and safety of rhenium-188 Epidermal Radionuclide Therapy (ERT) as an emerging treatment option in NMSC. Re-188 ERT is a form of high-dose superficial brachytherapy using an unsealed beta-emitting radioisotope embedded in a synthetic resin applied directly to the skin surface. Owing to the limited penetration depth of beta radiation, high doses can be delivered selectively to superficial tumors while sparing deeper tissues. Clinical series report complete response rates ranging from 90 to 100%, with very low recurrence rates and predominantly mild, transient toxicity. Cosmetic outcomes are generally good to excellent. Emerging evidence also supports its potential role in extramammary Paget disease and refractory keloids. Re-188 ERT is a safe, effective and minimally invasive alternative for selected patients with NMSC, particularly those unsuitable for surgery or with tumours in anatomically complex areas. While it does not replace surgery as first-line treatment, its high efficacy, favourable cosmetic outcomes and single-session outpatient delivery makes it a valuable addition to the therapeutic armamentarium. Further prospective studies are warranted to optimize dosimetry, reduce toxicity and expand evidence for additional indications.
Existing studies on the effects of altitude on rice yield and quality have drawn different conclusions. However, the underlying mechanisms of how altitude-induced differences in the utilization of temperature and light resources drive the differential responses of yield and quality formation remain unclear. In particular, the synergistic effects of the ecological adaptability of rice varieties, altitude-mediated distribution of light and temperature resources, and nitrogen regulation on rice yield and grain quality have not yet been clearly elucidated. A two-year field experiment was conducted in low-altitude (520.70 m) and high-altitude (1640.56 m) rice-growing regions using two rice varieties with differential altitude responsiveness of core agronomic traits, Meixiangzhan 2 and Yunjing 39. Under a nitrogen (N) application rate of 150 kg N ha-1, three N management strategies with basal: tiller: panicle fertilizer ratios of 5:3:2 (N1), 3:3:4 (N2), and 3:1:6 (N3) were implemented, with a no-N treatment (N0) as the control. Altitude, variety, and N management significantly affected grain yield, rice quality, and the utilization of temperature and light resources. Compared with the low-altitude site, the rice growth period at high altitude was prolonged by 27.25-30.77 days, while effective panicles and seed-setting rates increased by 16.53%-27.37% and 2.71%-6.68%, respectively, contributing to a 4.10%-4.12% yield increase. Meixiangzhan 2 showed higher yields at low altitude (4.84%-8.12%) but significantly lower yields at high altitude (19.80%-25.13%) compared with Yunjing 39. High altitude improved grain quality by increasing head rice rate (5.10%-9.42%) and reducing chalkiness (2.87%-6.38%), although lower temperatures from the heading to maturity stage increased amylose content (13.71%-19.82%) and reduced taste value (2.29%-5.22%). Among the N treatments, N2 consistently improved both yield and rice quality of two varieties at different altitudes. Optimizing temperature and light resource allocation during key growth stages-particularly increasing the effective accumulated temperature over the entire rice growth period, the diurnal temperature range from heading to maturity stage, the average daily sunshine hours, and the solar radiation-is critical for achieving high yield, high quality, and efficient resource utilization across altitudes.
Macrophages, as central players in the tumor microenvironment (TME), exhibit remarkable plasticity, shifting between pro-inflammatory M1 and immunosuppressive M2 states. This polarization directly influences the response to radiotherapy in cancers. While M1 macrophages promote antitumor immunity, M2 macrophages contribute to immune evasion, metastasis, and treatment resistance. Ionizing radiation, while designed to kill tumor cells, can inadvertently alter macrophage polarization within the TME. High-dose and particle-based radiotherapies tend to favor M1 polarization, enhancing tumor control, while conventional radiotherapy often induces M2 macrophages, promoting radioresistance. These shifts in macrophage phenotype are driven by changes in metabolic signaling, hypoxia, and cytokine production within the TME, which together dictate the outcome of therapy. Emerging strategies aim to manipulate macrophage polarization to overcome radiotherapy-induced resistance, including the use of immune checkpoint inhibitors, nanoparticles, and metabolic reprogramming agents. By targeting macrophage recruitment, survival, and reprogramming, these therapies can potentially improve the efficacy of radiotherapy and reduce tumor recurrence. Understanding and leveraging macrophage plasticity holds promise for optimizing cancer treatment and enhancing patient outcomes in the era of precision oncology.
The National Quality Measures for Breast Centers (NQMBC) originated as an idea in 2003 by the National Consortium of Breast Centers (NCBC) board who felt that increased attention was warranted, initiated by the institute of medicine, to measure, evaluate and improve the quality of breast cancer care. To serve the widespread membership of NCBC, any quality assessment program would need to be web-based so that no matter where your breast center was located, your center could assess their own level of their quality care performance. The focus of quality performance was on the level of care actually delivered for each performance measure. The NQMBC is a set of quality measures including each discipline in the breast center; imaging, surgery, pathology, medical oncology, radiation oncology, genetics, navigation and the newly added inflammatory breast cancer. The NQMBC looks at real time data from participating breast centers across the country. Once a center's data on a particular is entered into the NQMBC, the website immediately provides comparisons with other centers' performance. The results show the submitted center's data and the comparison 25th, 50th and 75th percentile performance of all the other centers who have submitted data on that measure. A center can identify the level of performance on that specific measure and decide whether improvement is neded or congratulations is deserved. All data is confidential and hot shared with any other center. No patient data is used. Recently a government grant was awarded to a group headed by Aurora Inc., striving to improve the quality of care provided in China. Experts in breast cancer care were identified to aid in this effort. Many clinicians from China have been sent for two-month observerships to Montefiore-Einstein Medical Center to see how the US approaches breast cancer. To assess the quality of care provided, the NQMBC was chosen to assess the resultant quality of care it in at least three large breast centers in China. In-person exchanges occurred this last month to initiate the integration of NQMBC as a measure of their quality breast cancer care. Goals of these three facilities is to achieve the level of a quality breast center of excellence. Three main medical centers in three separate provinces, each serving a population of over 100 million, have agreed to integrate the NQMBC quality program as a measure of their breast care. This long-term pilot program has positive implications to improve the level of breast care in China, and a valuable extension of the international use of NQMBC.
Persistent muscular weakness and reduced quality of life is a common treatment related adverse effect among breast cancer survivors. The benefits of progressive resistance training (PRT) for 12 weeks and longer time using 1 repetition max (RM) are well documented. This is a retrospective analysis investigating the effects of a 6-week resistance training program performed to volitional fatigue on functional strength and quality of life (QOL) in survivors. This single-arm retrospective pilot analysis examined the effects of PRT in 20 breast cancer survivors (mean age 62.9±11.1 years). Participants completed PRT twice per week for six consecutive weeks. We evaluated changes in grip strength, skeletal muscle mass (SMM), lower body strength, and QOL. Participants completed pre and post measurements of grip strength, sit-to-stand test, SMM measured by bioelectrical impedance, and QOL measured by FACT-G scale. Women who had completed surgery, chemo, and/or radiation treatment within the two years preceding the study (2024-2025) were included in the program. Training sessions included 30- 45 minutes of PRT along with 5 to 10 minutes of warm-up and cool-down, respectively. Intensity was standardized by training to fatigue, rather than percentage of 1RM. Paired t-tests were used to assess change in SMM and grip strength. Wilcoxon signed rank test was used to analyze change in sit to stand test, and FACT-G scores. There was a significant increase in functional lower-body strength [sit to stand: +2.50 reps, 95% confidence interval (CI) (1.54, 3.46), p<0.001] and bilateral grip strength [right: +3.48 lbs., 95% CI (0.11, 6.86), p = 0.043; left: 5.35 lbs., 95% CI (2.52, 8.18), p<0.001]. Positive impact on QOL was observed [FACT-G: + 7.00 points, 95% CI (1.22, 12.78), p = 0.003]. No significant changes were seen in SMM [+0.21 lbs., 95% CI (-0.16, 0.58), p = 0.254). Strength gains were not correlated with QOL improvements. A 6-week resistance training program performed to volitional fatigue is an effective rehabilitation strategy for breast cancer patients. The intervention yielded significant improvements in functional lower-body strength, grip strength, and overall QOL. No changes in SMM occurred. Improvements in FACT G scores were independent of strength.
To explore the multidimensional challenges and unmet care needs across the radiotherapy trajectory of patients with head and neck cancer (HNC) using a patient journey map, and to identify key intervention nodes, providing a basis for improving clinical management and patients' well-being. A descriptive qualitative research design was employed, and semi-structured in-depth interviews were conducted with 18 patients with HNC receiving radiotherapy in the Department of Radiation Oncology at Tianjin Medical University Cancer Institute & Hospital in Tianjin, China, between September and December 2025. Data were analyzed using Colaizzi's seven-step method, and a patient journey map was constructed for visualization. Four themes were identified: (1) Physiological Trajectory of Suffering Accompanying Cumulative Toxicity Challenges, transitioning from latent early discomforts to severe prolonged symptom burdens; (2) Psychological Trajectory Intertwined with Cognitive Biases and Emotional Fluctuations, characterized by early expectancy violations, mid-term treatment burnout, and late-stage fear of recurrence; (3) Self-Identity Disruption and Social Withdrawal Precipitated by Altered Facial Appearance and Oral Feeding Dysfunction, highlighting how disrupted "social commensality" and body image disturbances lead to social isolation; and (4) Dynamic Evolution of Multidimensional Needs and Transitional Care Discontinuity, shifting from early information overload to a critical need for continuity of care post-discharge. The needs of patients with HNC during radiotherapy exhibit a complex, non-linear evolution. Future efforts should establish a phased, precision nursing model centered on "cognitive correction-crisis intervention-continuity empowerment." Integrating digital intervention technologies with peer support strategies may help address symptom burdens and social reintegration barriers, supporting high-quality care across the radiotherapy trajectory and improving patients' quality of life.
ObjectiveTo evaluate current pharmacotherapeutic strategies for H3 K27M-mutant diffuse midline glioma (DMG), with emphasis on the clinical evidence for dordaviprone, its place in therapy, and its implications for oncology practice.Study Selection and Data ExtractionA structured literature search was conducted using PubMed and ClinicalTrials.gov through November 1, 2025. The search terms "(ONC201 OR dordaviprone) AND ('diffuse midline glioma' OR DMG OR H3 K27 M OR H3K27-altered)" were applied using Boolean operators. Clinical trials, cohort studies, case reports, and relevant preclinical studies evaluating pharmacologic therapies in H3 K27 M DMG were included, with emphasis on clinical outcomes and safety. The review was informed by PRISMA principles and conducted as a narrative review given the limited evidence base. A full systematic review was not possible given the limited and heterogeneous evidence base.ResultsDordaviprone received accelerated FDA approval based on the results of an integrative analysis of five phase 1 and 2 trials. The primary endpoint of overall response rate (ORR) was 20%, disease control rate 40%, and median duration of response (DOR) was 11.2 months. Fatigue, headache, vomiting, and nausea are the most common adverse effects.DiscussionDordaviprone is the only FDA approved medication for H3 K27 M DMG. It demonstrates long-lasting radiographic and symptomatic improvement. It is currently approved for recurrence following prior therapy, not as a substitute for radiation or surgery. The ACTION trial may provide guidance on its broader use in newly diagnosed H3 K27 M DMG. Pharmacists play a role in optimizing treatment, monitoring safety and drug interactions, and supporting patient adherence.ConclusionDordaviprone is a novel treatment option with modest response rates and durable benefit in recurrent/progressive H3 K27 M DMG. Ongoing trials may further define its role in earlier lines of therapy.
The availability of proton beam therapy (PBT) continues to grow exponentially worldwide, driven by technological advancements to reduce the facility size and costs, towards more efficient and higher quality treatments. The characteristic physical and biological advantages of protons can provide superior clinical outcomes for patients, as modern techniques enable a highly configurable and conformal dose delivery. Although active scanning methods allow precise beam control, proton beams are highly sensitive to range and motion errors which impact treatment quality. Treatment delivery is largely determined by capabilities of the beam delivery system (BDS), where faster delivery can have many potential benefits including improved dosimetric quality, utility, cost effectiveness, patient throughput and comfort. Despite significant developments in accelerators, delivery methodologies, dose optimisation and more, the energy layer switching time (ELST) is still a persisting limitation in existing beam delivery systems. The ELST can be a major contributor to the irradiation time, leading to increased treatment times, and may require further compensation using optimisation planning approaches, motion mitigation strategies, or active beam modification. This fundamental constraint can be addressed by increasing the narrow energy acceptance range of conventional beamlines to allow a wide range of beam energies to be transported without bottleneck delays due to magnetic field adjustments, therefore minimising ELSTs and enabling ultra-fast delivery (single field within ∼10 s). We review the abundant opportunities offered by this enabling technology: shorter treatment times, reduced motion induced dose degradation, improved effectiveness of motion management techniques, possibilities for volumetric rescanning, bidirectional delivery, novel planning optimisation schemes, and emerging delivery strategies. We overview the design concepts of several large energy acceptance (LEA) proposals, technology requirements, and also discuss the remaining challenges and considerations with realising a LEA system in practice. Although there are multiple avenues requiring further development and study, a large energy acceptance BDS has the potential for significant clinical benefits: ultra-fast delivery offers both immediate improvements to current treatment delivery and enables future possibilities for PBT.
To retrospectively validate a patient-specific post-trigger delay technique for coronary CT angiography (CCTA) and compare it with the conventional fixed-delay approach using true peak arterial enhancement as the reference standard. Thirty-seven patients (mean age 63 ± 9 years; 35% male) who underwent dynamic CT perfusion imaging were retrospectively analyzed. Serial volumetric acquisitions were obtained during and after intravenous administration of 40-50 mL iodinated contrast. Time-attenuation curves from the descending aorta and major coronary arteries (LAD, LCx, RCA) were modeled using a gamma variate function to determine true time-to-peak enhancement (TTP), peak attenuation, and contrast-to-noise ratio (CNR). Coronary enhancement was simulated using (1) a fixed 5-second post-trigger delay and (2) a patient-specific delay defined as half the injection duration plus a dispersion constant. True peak enhancement was used as the reference standard. Timing accuracy and enhancement differences were evaluated using paired statistical analyses. The patient-specific delay predicted peak coronary enhancement with a mean deviation of -0.80 ± 0.85 s, maintaining enhancement and CNR within 10% of peak values. The fixed 5-second delay showed a larger deviation (-2.11 ± 0.82 s; p < 0.001) and reduced coronary enhancement (-37%) and CNR (-27%) relative to peak (p < 0.05). Improvements were consistent across all coronary arteries. Injection-duration-based patient-specific timing more accurately predicts peak coronary enhancement than a fixed-delay strategy and improves CCTA contrast enhancement and CNR without increasing radiation dose or workflow complexity.