3.4. Drug Delivery Dosage

Forms and FUS Future Perspective During the last few years there has been an expansion in research in MRgFUS drug delivery. The main dosage forms tested in MRgFUS drug delivery strategy are the thermosensitive liposomes and the lipid based microbubbles that can be conjugated with drugs or other liposomes on their surface [78, 81]. There is limited research in the area of using other responsive materials or nanocarriers. Rapoport discussed recently the potential of using micelles and FUS [82] for enhanced tissue permeation. Micelles are nanosized Inhibitors,research,lifescience,medical carriers able to carry hydrophobic drugs; their combination with FUS could substantially enhance their delivery in tissues. Kostarelos and colleagues suggested Inhibitors,research,lifescience,medical the incorporation of thermosensitive peptides onto liposome bilayers to enhance thermoresponsiveness [83], and the group of Lammers designed polymer-based microbubbles for ultrasound drug release [84]. It is clear that already established delivery systems such as different structurally nanocarriers have not been investigated in combination with image guided FUS. It would be interesting to see the effect of FUS on the enhanced permeability of micelles,

polymers (dendrimers cyclodextrins), or metal nanoparticles (gold-iron) to tissues. Thermosensitive materials have been hardly explored in this field. Polymers or proteins Inhibitors,research,lifescience,medical that respond to small change of temperature could form suitable image guided FUS triggered platforms. The effects of FUS in biological tissues with or without carriers will require a more thorough investigation to understand the Inhibitors,research,lifescience,medical short- and long-term effects of ultrasound in the body and the complex environments such as tumours, blood AZD4547 research buy vessels, and bone. The mechanism of FUS induced hyperthermia and/or the FUS tissue permeability increase is not well understood at cellular and molecular levels. There is

limited knowledge Inhibitors,research,lifescience,medical on the effects of FUS on genomic DNA and if certain proteins are overexpressed after FUS treatment. In addition to the above, the frequency of FUS drug delivery treatments (or dosing) and the long-term effects in the body will have to be investigated in preclinical studies in order to design a FUS drug treatment regime. An imaging modality will have to be used for accurate image guided FUS therapy. In the case of MRI clinically approved contrast these enhancing agents will have to be added to the delivery system to monitor carriers’ distribution in the treatment area as well as efficient and rapid release. Considering the approval in clinical applications, such treatments will require the control of several factors such as drug and drug carrier, MRI contrast enhancing agents, and MRgFUS parameters, and this could mean several regulatory hurdles. However, the fact that most of the components (FUS, liposomes) have been tested in clinical trials is encouraging for such approach to move forward.

Based on findings that clear, directive leadership can enhance performance in cardiac resuscitation [5,8], we further (5) investigated if stress was associated with fewer leadership statements. Methods Participants and simulator This study was conducted at the Simulator Center of the University Hospital in Basel, Switzerland, between December, 2007 and May, 2008. Workshops were offered to 4th year medical students and presented as a learning experience in a patient simulator. Prior to this simulation, no CPR training had been offered to the students within their

medical curriculum. No information about the content of the scenarios and about our specific hypotheses Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical was provided to students before the study (blinding). The study was done in compliance with the Helsinki Declaration, approved by the local ethical committee (Ethikkommission beider Basel, EKBB, http://www.ekbb.ch/), and written informed consent was obtained from all participants. For this study, we used a high fidelity manikin with the possibility of remote control of vital signs (Human Patient Simulator, METI) [36,37]. This full body simulator is a computer-based manikin with human physiology emulation capability that

also can interact very realistically, e.g. by talking. Study design and intervention This is a prospective randomized controlled study. Prior to the test-scenario, Inhibitors,research,lifescience,medical all students were made familiar with the simulator in a baseline training session followed by a general video-assisted debriefing focusing on ACLS algorithms (Figure 1). Students were then randomly allocated to two different Inhibitors,research,lifescience,medical randomization arms using computer generated randomization lists. Students in the control group did not receive any further instructions. Students in the intervention group received a 10 minute instruction to cope Inhibitors,research,lifescience,medical with stress. They were informed that an emergency situation is a stressful experience for health care workers and that perceived

stress may interfere with their decision-making abilities and performance. Particularly, feeling overwhelmed by stress may cause cognitive impairment potentially leading to loss of concept how to deal of with an emergency situation, which in turn further increases stress (vicious cycle). However, it is possible to overcome this situation by focusing on the basic conditions of the situation and the immediate actions that are ABT-869 order needed. They were instructed that they should ask two task-focusing questions aloud (“what is the patient’s condition?”, “what immediate action is needed?”) to overcome the negative consequences of feeling overwhelmed by stress. Figure 1 Flow chart of randomisation groups. N denotes number of participants. Test-scenario The test-scenario was a simulated witnessed cardiac arrest. Students performed the test-scenario alone.

OCD and infections: the example of PANDAS syndrome A potential environmental

contributor to the development of OCD, particularly in childhood, is a suspected relationship between group A streptococcal infections and onset of OCD and/or tics/Tourette syndrome, akin to the development of Sydenham’s chorea reported previously following streptococcal infection.82-84 In fact, an increased prevalence of obsessive-compulsive symptoms85-87 and OCD88 has also been noted in patients with rheumatic fever (RF) with or without Sydenham’s chorea. Inhibitors,research,lifescience,medical Initially, these findings were reported in children during an active phase of rheumatic fever.88 Subsequent studies revealed the presence of OCSDs in adults with a previous history of rheumatic fever (not active), suggesting that the streptococcal infection may trigger OCD, which may persist throughout life regardless of the activity of the rheumatic fever.85,86 Recent family studies

have reported that OCSDs Inhibitors,research,lifescience,medical and OCRDs (such as tic disorders, body Inhibitors,research,lifescience,medical dysmorphic disorder, trichotillomania, grooming behaviors, and others) aggregate more frequently in first-degree relatives of rheumatic fever see more probands when compared with controls.89,90 Moreover, two polymorphisms of the promoter region of the tumor necrosis factor-alpha (TNF-α) gene have been associated with both OCD and rheumatic fever, which is an interesting finding since the TNF-α gene is a proinflammatory cytokine involved in rheumatic fever and several other autoimmune diseases,91,92 suggesting that both obsessive-compulsive

related disorders and rheumatic Inhibitors,research,lifescience,medical fever share a common genetic Inhibitors,research,lifescience,medical vulnerability. Thus, PANDAS OCD could be a mild expression of rheumatic fever whose incidence is higher in developing countries, while the full development of rheumatic feverrelated disorders may be attenuated by the appropriated antibiotic prophylaxis in developed countries. Consistent with this hypothesis, there was a higher family history of rheumatic fever in PANDAS OCD patients. Thus, abnormal immune response to this streptococcal infection, with abnormal antibody production and leading to basal ganglia damage has been focused upon as a likely mechanism for both rheumatic fever and PANDAS OCD.52,93,94 This proposed mechanism is supported by behavioral changes and brain lesion development in mice following immunization with streptococcal antigens,95 with resemblances to similar studies investigating immune mechanisms in Sydenham’s chorea.83 Abnormal brain autoantibody production may itself be mediated by specific genetic factors, posing a possible gene X environment (G x E) pathogenesis for a PANDAS subgroup.

There are studies [12,15] suggesting that neither waiting times nor delays are directly correlated with resources or demand, but rather with how smoothly the processes of working are in an ED. Additional studies are needed to characterize the patients who visit tertiary care EDs without a pre-check by the primary health care in order to improve patient flow in an ED of the kind

described in this study. The number of visits to primary care doctors during office hours was unchanged during 2003-2005 in both Vantaa and Espoo (Figure ​(Figure2).2). Thus, the decrease in the patient visits to the Inhibitors,research,lifescience,medical GPs of see more Peijas ED did not cause an overflow of patients in the office hour general practice. There seems to be no extra work load for the daytime doctor services. Our results are in line with the suggestion

that EDs also have customers of their own and that those patients are not likely to use ordinary day time services of the primary health care system [4]. Inhibitors,research,lifescience,medical The change in the number of visits to the private sector GPs was similar in Vantaa, where the triage was applied, as compared with the control Inhibitors,research,lifescience,medical community Espoo (Figure ​(Figure3).3). There is evidence that there is a correlation between public and private sectors with respect to the need of health care and health care utilization [16]. If the demand for health care is considered to be unsatisfactory in the public sphere patients look for care in private sector institutes [17]. No such shift was seen in the current study. Even though the access Inhibitors,research,lifescience,medical for non-immediate patients to Peijas’ combined ED was made more inconvenient by using ABCDE triage, the patients in Vantaa did not seek help from the private sector more often than those who had unlimited access to the ED in the control city (Espoo). Actually, the use of private sector GPs was more frequent in Espoo where no ABCDE-triage was applied. Patient safety issues are important when applying triage in an ED. The

key player in the present triage model is the nurse who makes the initial assessment of the patient upon arrival. In our previous report, no extra false diagnoses Inhibitors,research,lifescience,medical or complications were observed when non-urgent patients were allocated to the slowest triage group (waiting up to 5-6 hours at worst times [10]). This agrees with the finding that in many EDs around the world triage has been successfully run by experienced nurses [11,13,18]. Furthermore, there are reports suggesting that crotamiton some activities formerly performed by physicians in primary health care were safely performed by trained nurses [19]. The quality of triage must be continuously monitored and the number of incorrect assessments minimized. Right now further studies are ongoing on the safety of the present triage system and on the waiting time changes induced by it. Preliminary data from Vantaa seems promising in safety issues [10] but more detailed studies must be carried out.

The following day, the patient and her http://www.selleckchem.com/products/CI-1033(Canertinib).html family agreed to an exploratory laparotomy to evaluate the etiology of the pneumoperitoneum.

The surgical findings revealed cloudy peritoneal fluid and intraperitoneal air causing increased suspicion of perforation. A segment of small bowel, approximately 15 cm in length, with a gross appearance of pneumatosis intestinalis (Fig 2) was resected, and a primary anastomosis was performed. Figure 2 Gross appearance of small bowel segment intraoperatively showing multilocular cysts covering the serosa and mesentery of the small bowel. A thorough inspection of the abdomen was performed with close attention to the duodenum Inhibitors,research,lifescience,medical and left colon to inspect for other Inhibitors,research,lifescience,medical sources of the free intraperitoneal air. No evidence of duodenal ulcer or diverticular disease was identified. There was no gross evidence of uterine inflammation or pelvic inflammatory disease. The liver capsule was normal without evidence of Fitz-Hugh Curtis syndrome. Following an incidental appendectomy, Inhibitors,research,lifescience,medical her abdomen was copiously irrigated and closed with retention sutures. The patient’s postoperative course was unremarkable. She was slowly advanced to a regular diet and was discharged

to a rehabilitation facility for physical therapy 7 days after initial admission. Two specimens were examined: 1) the appendix and 2) a portion of small intestine. The appendix measured 3.2 cm long by 0.6 cm in diameter with a small Inhibitors,research,lifescience,medical amount of adherent mesoappendiceal fat. The appendix serosa was tan, smooth, and shiny with focal vascular congestion. A fecalith was also noted in the distal lumen. The diagnosis was mild acute periappendicitis with no evidence of perforation. Inhibitors,research,lifescience,medical The small bowel resection consisted of a segment of small intestine 8 cm long by 4 cm in diameter with an attached 6 cm by 2 cm by 0.8 cm fragment of mesenteric fat. The serosal surface

was tan-white and shiny with a 6 cm by 5.5 cm by 1 cm multicystic subserosal lesion in the center. The specimen was opened revealing mucosa that was tan and glistening with the usual mucosal folds. There was no evidence of perforation throughout the specimen. The subserosal tissue was edematous with a discrete, complex, multiloculated, thin-walled cystic lesion. The L-NAME HCl cysts had thin fibrous walls lined by flattened mesothelial cells containing clear serous fluid. No immunohistochemistry was performed as this was an incidental finding with low suspicion. The final pathologic diagnosis of the small bowel partial resection was multicystic peritoneal mesothelioma with no evidence of perforation. Discussion Approximately 150 cases of benign multicystic peritoneal mesothelioma, with various presentations have been reported since it was first described by Mennemeyer and Smith in 1979 (3)-(12).

It has been found to be a reliable, valid (in terms of both content and construct validity), acceptable and suitable tool to be used in endometriosis-related research in these countries.12-16 On the core questionnaire, emotional well-being and pain dimensions had the highest mean and; therefore, the most negative impact on ill health (46.73 and 46.69). As in United States and Australian Inhibitors,research,lifescience,medical reports the scales of self image

had the lowest mean (36.2). In modular sections of our samples, infertility had the highest mean and the most negative impact upon ill health (mean scale score=50.55) that was similar to the United Kingdom and Australian results.12-14,16 In factor analysis, all items loaded on their hypothesized factor except two, which were loaded on other factors. It seems that pain accompanying endometriosis makes patient feel generally unwell and lack of enough social supports yields to be more violent or aggressive. Therefore this version of the questionnaire

has a strong factor structure. Inhibitors,research,lifescience,medical The internal consistency reliability of the questionnaire was high with all scale exceeding the accepted α value of 0.70. Inhibitors,research,lifescience,medical Cronbach’s α ranged between 0.80 to 0.93 for core domain, and between 0.78 and 0.90 for modular domain, which are comparable to the United Kingdom and American settings with Cronbach’s α ranging from 0.83 to 0.93 and 0.84 to 0.91, respectively.13,14 Item total correlation of questionnaire concluded in acceptable correlation in core and modular parts of questionnaire. Higher order factor FTY720 concentration analysis suggests that single-factor solution, which was found in the United Kingdom and United States,13,14 is also applicable in Iranian version. This means that Inhibitors,research,lifescience,medical dimensions can be summed up to create a single index Inhibitors,research,lifescience,medical score. Construct validity of EHP-30 was measured using SF-6, a convenient and previously validated instrument for evaluating the quality of life in women with endometriosis in Iran.9 The findings indicate that there was good correlations in several scales of the two questionnaires (table 6). This

study suffers from a number of limitations. The first limitation was the inability to assess the discriminate validity of the questionnaire using clinical variables, because nearly these variables were not measured prospectively under investigators’ supervision. The second limitation was that the responsiveness was not assessed in the study. The third and main limitation was the relative small sample size of the study. Although our data was consistent with other psychometric evaluation of this instrument, we suggest the use of this questionnaire in future studies with samples of larger size in different clinics of the country. Conclusion The Persian version of EHP-30 demonstrated good reliability and validity. The questionnaire seems to be useful for evaluating the quality of life of women with endometriosis.

More recently, other particulate adjuvants have been licensed

for human use. Emulsions like MF59 or AS03 are components of Fluad and Pandemrix, respectively [24, 25]. Other vaccines such as Epaxal [26] or Inflexal [27] include virosomes. Latest approved systems are composed of combination of adjuvants, such as AS04 (approved for human use in both Europe and USA), which comprises MPL (monophosphoril lipid A) and alum Inhibitors,research,lifescience,medical and is used into Fendrix [28] or AS04 combined with virus like particles (VLPs) used into see more Cervarix [29, 30] and Gardasil [31]. Table 1 Examples of EMA- and/or FDA-approved vaccines based on micro- and nanoparticulated delivery systems. MF59 and AS03 are squalene- and tocopherol-based o/w emulsions, respectively. AS04 is composed of monophosphoril lipid A and alum. Virosomes are composed … This paper summarizes micro- and nanoparticulated delivery systems used in the development of synthetic peptide-based

vaccines. We also discuss various strategies for improving their efficacy in developing an appropriate Inhibitors,research,lifescience,medical immune response (Table 2). Table 2 Schematic view of the mechanism of action and advantages of the different micro- and nanotechnologies for peptide-based vaccine delivery. 2. Inhibitors,research,lifescience,medical Micro- and Nanoparticulated Systems for Synthetic Peptide Vaccine Development 2.1. Alum Aluminium salts (generally, Al(OH)3 and AlPO4), often called alum, have been widely used in humans for more than 80 years, and, until recently, it has been the only adjuvant approved for human use in the USA [32]. Currently, there are many vaccines containing alum, such as Recombivax Inhibitors,research,lifescience,medical HB or Engerix B. Alum adjuvancity is associated with enhanced antibody responses [19]. It has been shown that after OVA-alum administration Th2 effector response is generated, as T helper cells produced IL-4, IL-5, and IL-10 but little IFN-γ [33]. In addition, Li et al. demonstrated that alum enhances the production of IL-10, a Th2 cytokine, and inhibits Inhibitors,research,lifescience,medical that of IP-10 (IFN-γ-inducible protein), a chemokine specific for Th1 cells [34].

It has been shown that alum induces rapid cell recruitment at the injection 17-DMAG (Alvespimycin) HCl site. Kool et al. demonstrated that after an intraperitoneal injection of alum, a local production of chemoatractants like CCL2 and CXCL1 was triggered, as well as a recruitment of neutrophils, eosinophils, monocytes, and subsequently DCs. This study also revealed that following intraperitoneal or intramuscular administration of alum, recruited monocytes migrate to the draining lymph nodes and differenciate into inflammatory DCs capable of priming T cells [33]. Several action mechanisms have been proposed in order to explain alum adjuvancity. Previously, it was thought that alum formed a depot by which the antigen was slowly released and which converted the antigen into a particulate form, facilitating phagocytosis by APCs [35].

6 Endogenous opioid peptides including the endorphins and enkephalins act upon the same CNS this website receptors activated by exogenous opioid molecules such as morphine or heroin. Endogenous opioids exert inhibitory influences on the HPA axis. Naloxone, an opioid receptor antagonist, increases HPA axis activation as evidenced by exaggerated HPA axis response to naloxone. PTSD patients exhibit increased CSF p-endorphin levels, suggesting increased activation of the endogenous opioid system. Alterations in endogenous opioids may be involved in certain

PTSD symptoms such as numbing, stress-induced analgesia, and dissociation. Of additional interest, the nonselective opioid receptor antagonist, naltrexone, appears Inhibitors,research,lifescience,medical to be effective in treating symptoms of dissociation and flashbacks in traumatized persons.19,37 Inhibitors,research,lifescience,medical Further, the administration of morphine has been reported to prevent PTSD.38 Of note, an experiment investigating the hypothesis that PTSD may play an ctiologic role in fostering opioid addiction in an opioiddependent group of subjects rendered negative results.39 Brain circuitry Characteristic changes in brain structure and function have been identified in patients with PTSD using brainimaging methods.40-42 Brain regions that arc altered in patients Inhibitors,research,lifescience,medical with PTSD include the hippocampus and amygdala as well as cortical regions including the anterior cingulate, insula, and orbitofrontal region.

These areas interconnect to form a neural circuit that mediates, among other functions, adaptation to stress and fear conditioning. Changes in these circuits have been proposed Inhibitors,research,lifescience,medical to have a direct link to the development of PTSD.40 Recent work raises the question as to which CNS elements are involved in circuit changes resulting from stress, and suggests a critical role for myelin.43 Similar to PTSD, Inhibitors,research,lifescience,medical brain areas most impacted by TBI include inferior frontal and temporal lobes, and it is likely that myelinated circuits are subject to damage broadly as a result of shear forces. Hippocampus A hallmark

feature of PTSD is reduced hippocampal volume. The hippocampus is implicated in the control of stress responses, declarative memory, and contextual aspects of fear conditioning. Not surprisingly, the hippocampus is one of the most plastic regions in the brain. As mentioned above, prolonged exposure to stress and high levels of glucocorticoids in laboratory animals damages the Thymidine kinase hippocampus, leading to reduction in dendritic branching, loss of dendritic spines, and impairment of neurogenesis.4 Initial magnetic resonance imaging (M.RI) studies demonstrated smaller hippocampal volumes in Vietnam Veterans with PTSD and patients with abuse-related PTSD compared with controls.44-47 Small hippocampal volumes were associated with the severity of trauma and memory impairments in these studies. These findings were generally replicated in most but not all subsequent work.

Buprenorphine responders had all shown some improvement in their depressive symptoms with either SSRIs or clomipramine. The underlying mechanism of opiate-mediated improvement in OCD is probably unknown. A number of earlier studies have suggested the potential importance of the opioid system in OCD and its treatment [Shapira et al. 1997; Warneke, 1997; Goldsmith et al. 1999] and naloxone has

been shown to rapidly worsen OCD symptoms [Insel and Pickar, 1983; Keuler et al. 1996]. Studies in mice suggest that agonist-induced head-twitch behaviour mediated through 5-HT2A Inhibitors,research,lifescience,medical receptors is antagonized by both SSRIs and atypical opiates and that combination treatment with both classes of agents is more effective than either treatment alone, suggesting a convergence between the serotonergic and opiate systems Inhibitors,research,lifescience,medical [Rojas-Corrales et al. 2007]. Consistent with this

is the finding that the partial agonist effect of buprenorphine at the µ-opioid receptor releases central nervous system serotonin and dopamine [Urraca et al. 2004]. These inferences are supported by the observation that patients who did not respond to buprenorphine had not improved with antidepressants active on the serotonin pathways. We believe that further treatment trials of buprenorphine augmentation of Inhibitors,research,lifescience,medical antidepressant treatment in patients with severe OCD are warranted. Footnotes Funding: This RO4929097 research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Conflict of interest statement: The authors declare no conflicts of interest in preparing this article. Contributor Information Malcolm Inhibitors,research,lifescience,medical B. Liddell, Adult Community Mental Health Services, DHHS NW Tasmania, 1 Parkside, Burnie, Tasmania 7320, Australia. Victor Aziz, Mental Health Unit, The Royal Glamorgan

Hospital, Llantrisant, Rhondda Cynon Taff, UK. Patrick Briggs, Mental Health Unit, The Royal Glamorgan Hospital, Inhibitors,research,lifescience,medical Llantrisant, Rhondda Cynon Taff, UK. Nimalee Kanakkehewa, Mental Health Unit, The Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taff, UK. Omar Rawi, Mental Health Unit, The Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taff, UK.
Motor abnormalities are frequently described in patients receiving antipsychotic treatment. However, patients with schizophrenia also Rutecarpine display neurological motor abnormalities prior to the initiation of any psychotropic medication [McCreadie et al. 2005; Honer et al. 2005; Koning et al. 2010]. Honer and colleagues reported that 44.9% of antipsychotic-naïve patients with schizophrenia (and related disorders) had signs and symptoms consistent with basal ganglia dysfunction and 28.1% had at least mild signs of an extrapyramidal disorder, most commonly hypokinesia. Thus, it has been proposed that the abnormal movements occurring with schizophrenia are markers of the neurodysfunction implicated in the pathogenesis of schizophrenia [Pappa and Dazzan, 2009].

Statistical analysis was conducted using SAS Version 9.3. The significance level was set at 0.05. Descriptive statistics for each variable were reported. The unadjusted association of each variable with OS was derived from a Cox proportional hazards

model. The chi-square test was used for categorical covariates and analysis of variance was used for numerical covariates to compare the covariates across the different radiation dose levels. Kaplan-Meier method was Inhibitors,research,lifescience,medical used to generate OS curves and estimate median survival with 95% confidence intervals. Radiation duration and tumor size were Gedatolisib cell line excluded from all multivariate (MV) analysis due to a high number of missing values. The MV survival analysis included dose, stage, facility type, and facility volume. The other covariates were entered in the model subject to a backward variable selection method with an alpha =0.05 Inhibitors,research,lifescience,medical removal criteria.

Propensity Inhibitors,research,lifescience,medical scores were calculated using a nominal logistic regression model to predict radiation dose. Inverse probability of treatment weights (IPTW) were calculated and represented the inverse probability of a participant receiving the observed dose based on their characteristics. IPTW estimates were further stabilized by multiplying them by the marginal probability of receiving the observed dose. The multivariable survival analysis was repeated, weighting by the stabilized IPTW. Weights were normalized to add up to the original sample size. Results A total of 977 analyzable patients were Inhibitors,research,lifescience,medical identified during the time interval assessed meeting inclusion Inhibitors,research,lifescience,medical criteria. There were no significant differences in patient characteristics, other than facility type and volume, between excluded patients and those presented. Median age was 67 years (range, 27-90 years), 49.5% were male, and 85.8% were Caucasian. All patients were treated

with RT and chemotherapy. The staging was 5th edition American Joint Committee on Cancer (AJCC) staging and consisted of 211 AJCC stage II, 148 stage III, 589 stage IVA, and 29 patients had missing stage information. Median tumor size was 4.0 cm (range, 0.3-40 Bumetanide cm) and all patients were negative for distant metastatic disease (M0). Median RT dose was 45 Gy (range, 1.5-65 Gy), and median treatment duration was 40 days (range, 3-109 days). 134 patients (13.7%) received <30 Gy, 72 (7.4%) received ≥30 to <40 Gy, 65 patients (6.7%) received ≥40 Gy to <45 Gy, 295 (30.2%) received ≥45 Gy to <50 Gy, 281 (28.8%) received ≥50 to <55 Gy, and 130 (13.3%) received ≥55 Gy. A detailed summary of patient and treatment characteristics is found in Table 1.