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Upright Immobilization for Proton Therapy: A Critical Review and Single-Institution Experience.

Upright positioning coupled with gantry-less proton therapy designs may reduce facility footprint and cost while introducing specific technical requirements for reproducible positioning, immobilization, volumetric image guidance, motion management, and treatment delivery. Historically, upright radiotherapy was limited to specialized applications and institution-specific systems, while recent advances in six-degree-of-freedom positioning and upright volumetric imaging have enabled broader image-guided clinical workflows. Published clinical evidence is most mature for head-and-neck applications,

Potential Role of Proton Beam Therapy for Locally Advanced Pancreatic Cancer.

BACKGROUND/AIM: Proton beam therapy (PBT) has emerged as an alternative to conventional photon therapy for locally advanced pancreatic cancer (LAPC). This study evaluated the outcomes and adverse events of PBT combined with chemotherapy in LAPC, with outcomes of chemotherapy alone presented for reference. PATIENTS AND METHODS: This study included 58 patients diagnosed with LAPC between January 2016 and December 2022. We analyzed data from 14 patients receiving chemoradiotherapy with PBT of 67.5 Gy relative biological effectiveness in 25 fractions (PBT group). As a reference, data from 32 pati

Modeling and optimization of a multiple-ring double scattering system for proton therapy.

This study investigates proton beam scattering systems with the aim of improving beam-shaping efficiency and increasing transmission within the radiation field for low-energy beams under intensity-limited conditions. These improvements are particularly relevant for delivering radiation fields at high dose rates for ocular proton therapy (OPT) and even at ultra-high dose rates for potential FLASH radiotherapy applications. A systematic methodology was developed to design multiple-ring double-scattering systems that maximize transmission under a field-homogeneity constraint while controlling the

Hypersensitivity reactions with proton pump inhibitors: five years of clinical experience.

INTRODUCTION: Proton pump inhibitors (PPIs) are generally well tolerated and are frequently prescribed drugs because their risk of adverse effects is 1-3%. Although PPIs have a good safety profile, allergic reactions to these molecules can occur. We aimed to investigate hypersensitivity reactions in patients who underwent oral provocation tests with PPIs in our clinic. METHODS: In all, 58 subjects who applied to allergy clinic between January 2018 and December 2023 with a history of early allergic reactions with PPIs and subsequently underwent oral provocation testing to find a diagnostic or

Gastric neuroendocrine tumours after prolonged proton pump inhibitor use.

Gastric neuroendocrine tumours (gNETs) are rare gastric neoplasms. Here we report a case of a woman in her 40s with chronic gastro-oesophageal reflux disease (GERD) on proton pump inhibitors (PPIs) for 20 years who was diagnosed with gNETs on upper endoscopy. Extensive evaluations ruled out known causes of gNETs including autoimmune gastritis, gastrinoma and inherited cancer syndromes. After discontinuation of PPI and endoscopic resection of gNETs, her biomarkers including chromogranin A and gastrin completely normalised. This case highlights a rare occurrence of sporadic gNETs following prolo

Engineering Dynamic Proton "Hubs" in Hydrogen-Bonded Frameworks for Superprotonic Conductivity.

Mimicking the synergistic proton conduction in biology remains a formidable challenge for synthetic materials. Here, we report a strategic approach by engineering dynamic proton "hubs" within hydrogen-bonded organic frameworks (HOFs). These hubs are supramolecular secondary building units (SSBUs) formed by charge-assisted hydrogen bonds between ammonium and sulfonate groups, which are programmed into the frameworks to direct proton traffic. The resulting ammonium-sulfonate HOF, BPDS_NH4, exhibits a highly competitive proton conductivity of 0.21 S cm-1 (90°C, 90% RH). The exceptional performanc

ATP synthase activity boosts membrane proton acceptance and lateral diffusion.

In most organisms, ATP synthesis is powered by the proton motive force (pmf) and catalyzed by ATP synthase. While the chemiosmotic theory or … nder conditions with non-ATP- and ATP-producing enzymes. Our results show that the membrane accepts protons at its interface and that PT is enhanced only when ATP synthase is active. A comparison with soluble photoacid positioned near the membrane shows that protons consumed by ATP synthase do not equilibrate with the bulk aqueous phase. Instead, they are …

Mid-range arc therapy for efficient and RBE-robust proton treatment.

Objective.Proton arc therapy (PAT) has the potential to improve plan conformity while enhancing normal tissue sparing; however, its clinical translation faces practical barriers related to radiobiological uncertainties and delivery inefficiency. This study introduces a novel planning approach, mid-range PAT (MRPAT), designed to enhance delivery efficiency and mitigate range-related uncertainties in PAT.Approach.MRPAT employs a single mid-range energy layer per beam direction, positioning the Bragg peak near the target center (mid-range) plane to confine range uncertainty within the target whil

Harnessing Interpenetration for High Proton Conductivity in Zirconium Metal-Organic Frameworks.

While interpenetration has emerged as a powerful strategy for engineering pore geometry and introducing synergistic functionality, its specific role in enhancing proton conduction has remained unexplored. Herein, we report the rational design and synthesis of two new isomeric Zr-MOFs, denoted IAM-12 and IAM-13, constructed from pyrrolo-pyrrole-based tetratopic linkers (H4L1 and H4L2). Both MOFs possess the same 4,8-connected scu topology, along with unexpected 2-fold interpenetrated frameworks. Single-crystal X-ray diffraction analysis reveals that interpenetration arranges the terminal H2O/OH

Effects of proton therapy on the tumor immune system and clinical implications: A review.

Proton therapy, an emerging radiation therapy technique, has gained significant attention owing to its unique physical properties and biological effects. This review aims to explore the impact of proton therapy on the tumor immune system and of its combination with other therapies. This review outlines the fundamental principles and oncological applications of proton therapy, followed by an analysis of its impact on the immune system-encompassing draining lymph nodes, peripheral blood immune cells, tumor cell immune responses, and the tumor microenvironment. We further discuss current combinat

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… most from proton therapy for certain types of cancers. … Proton therapy is a form of particle therapy that uses protons instead of conventional photons. 11 The fundamental principle underlying proton therapy involves the unique physical properties of protons, particularly their ability to deliver energy to a specific depth within the tissue, known as the Bragg …

Cost-Effectiveness of Proton Therapy Compared With Photon Therapy in Breast Cancer.

IMPORTANCE: Proton therapy reduces radiation exposure to the heart, lungs, and contralateral breast compared with conventional photon-based breast radiotherapy. However, its clinical benefit-particularly relative to photon deep inspiration breath-hold (DIBH)-remains uncertain, and its high cost raises questions about cost-effectiveness. OBJECTIVE: To evaluate the cost-effectiveness of proton therapy compared with photon-based radiotherapy, including DIBH and free breathing (FB), among patients with breast cancer in Belgium. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation using st

Disequilibrium between chloroplast proton motive force and ATP levels in Arabidopsis.

Current dogma holds that CO2 fixation by photosynthesis requires additional ATP production via cyclic electron transfer, mediated by two distinct pathways involving the NADH dehydrogenase-like complex (NDH) and proton gradient regulation 5 protein (PGR5), to augment the ATP relative to NADPH produced by linear electron transfer. Here we use the MgATP2- fluorescent biosensor ATeam1.03-nD/nA and find that, while proton motive force in the Arabidopsis pgr5CAS and pgr5 ndho mutants is only 50-75% that of the wild type, chloroplast MgATP2- levels are unchanged. These data demonstrate that disequili

Multimodal Characterization of Radiation-Induced Optic Neuropathy after Proton Radiotherapy.

PURPOSE: To evaluate the performance of multimodal ophthalmologic assessment compared with current visual acuity (VA)-based on Common Terminology Criteria for Adverse Events classification evaluation of radiation-induced optic neuropathy (RION) severity grade and to describe the relative prominence of functional, electrophysiological, and structural changes across postradiotherapy time windows. DESIGN: Prospective cohort study. SUBJECTS: Patients treated with proton radiotherapy for brain, skull base, or head-and-neck tumors between 2018 and 2023 who underwent standardized baseline and longi

Deceleration of Proton Exchange between Monosaccharides and Water by Metallocryptand and Related Compounds.

We report an unexpected yet powerful ability of a tris(salen) nickel(II) metallocryptand LNi3 to dramatically decelerate proton exchange between monosaccharides and water. In the presence of only 0.025 equiv of LNi3, the exchange rates of glucose hydroxy protons with water decreased by up to 74-fold. Similar deceleration effects were also observed for mannose, fructose, galactose, and methanol. Comparative studies using a mononuclear analogue (LmNi) and a metal-free analogue (H6L) suggest that the salen framework itself reorganizes the local hydrogen-bonding network. These findings identify sa…

Impact of proton pump inhibitors on infectious and wound outcomes in burn patients.

INTRODUCTION: Proton pump inhibitors (PPIs) are commonly used for stress ulcer prophylaxis in critically ill patients, but they have adverse effects such as heightened infection risk. We evaluated the complex risk-benefit profile and impact of PPI use on long-term clinical and wound healing outcomes in burn patients. METHODS: A retrospective analysis was conducted by using data extracted from the TriNetX database between 2015 and 2025. Adult patients receiving PPIs within one month of burn injury were identified (n= 52,100) and 1:1 propensity score matched to a control group of patients not r

Gastric Proton Pumpopathy Associated with Protein Sorting Machinery: A Narrative Review.

BACKGROUND: Gastric acid secretion by parietal cells depends on the trafficking and exocytosis of H⁺/K⁺-ATPase-rich tubulovesicles (TVs) to the apical membrane in response to histamine stimulation via cyclic AMP elevation. However, the role of parietal cell's protein sorting machinery [eg, coat protein (COP) II/COP I vesicle proteins, soluble NSF attachment protein receptors (SNAREs), Rab GTPases, clathrin-adaptor proteins, etc.] in the dysregulation of gastric acid homeostasis remains poorly understood. This review synthesizes available evidence on the role of protein sorting machinery in gas

Musculoskeletal and Marrow Sparing With Proton FLASH Radiation Therapy in Juvenile Mice.

PURPOSE: Radiation‑induced musculoskeletal toxicities are one of the major limitations in pediatric patients whose skeletons are still devel … . METHODS AND MATERIALS: Juvenile C57BL/6 mice (3 to 4 weeks old) were randomized to receive 11 Gy protons with FLASH (≈200 Gy/s), conventional dose-rate irradiation (CONV, 0.2 Gy/s average), or sham treatment (SHAM) to the left hind leg using a synchrotron-based proton beamline. Mice were followed for 10 weeks posttreatment. Bone toxicity was assessed w …

Validation of Cardiorespiratory-Gated Proton Beam Delivery for Stereotactic Arrhythmia Radioablation.

AIMS: Stereotactic arrhythmia radioablation (STAR) is a promising noninvasive therapy for refractory ventricular tachycardia. Using scanned proton beams for STAR enables precisely focused, high doses of ionizing radiation. Effective mitigation of target motion is critical for safety but remains challenging due to the complex interplay between beam scanning and cardiorespiratory motion. We evaluated the safety and feasibility of accurately delivering gated scanned proton beams to a ventricular myocardial target and compared lesion outcomes of respiratory (single)- and cardiorespiratory (dual)-g

Surface Proton Reservoirs Constrain Alkalinity Export from Enhanced Weathering.

The addition of silicate and carbonate materials to soils (enhanced weathering) is a proposed carbon dioxide removal (CDR) strategy with potential agronomic co-benefits, especially for soil pH management. However, alkalinity from mineral dissolution interacts with the surface proton reservoir (SPR), consuming alkalinity prior to export and complicating quantification. Because durable CDR requires transmission of alkalinity to marine storage, soil export constitutes a mechanistically definable upper bound on EW performance. Here, we develop a framework that partitions operational cation exchang