BackgroundDysfunctional mitochondrial processes limit malignant cells ability to use energy from fatty acids and ketones. Animal studies using ketogenic diets for cancer show encouraging results. We tested the diet’s safety and feasibility in cancer patients across a broad variety of solid tumors.MethodsWe recruited 17 advanced cancer patients who were not on chemotherapy. They consumed 20 to 40 g of carbohydrates daily with evaluations performed weekly until week 4, then every 4 weeks until 16 weeks. Quality of life questionnaires monitored for tolerability and compliance. Positron emission/computerized tomography was ordered at baseline, 4,8 and 16 weeks. Student t-testing evaluated differences between baseline and last visit scores for quality of life, weight, body mass index, and serum parameters. Correlations between weight loss and serum ketones, glucose, lipids and creatinine were done. Two-tailed unpaired t-testing of the mean weight loss compared responders against non-responders.ResultsEleven out of seventeen enrolled patients were evaluable. Mean age was 65+/- 11.7 years, weight 203 +/- 4.98 lbs. (92 ± 2.3 kgs.) and previous treatment failures was 1.7, +/- 0.97. All lost significant weight with hematologic, biochemical and lipid tests remaining stable. Quality of life scores slightly improved. At 4,8 and 16 weeks, six (54.5 %), five (45.4 %) and four (36 %) patients were stable or improved. We observed no correlations between serum glucose, ketones or lipids. Clinical response did not correlate with ketosis or glycemia. Responders (stable disease or partial responders) lost statistically more weight than non-responders. Dietary compliance was difficult. Only three patients continued dieting past 16 weeks. Out of these, two patients developed brain metastases and were on steroids. They survived 80 and 116 weeks respectively. The third patient underwent residual tumor resection and has no disease at 131 weeks.ConclusionsModified Atkins diets are safe and feasible in advanced cancer. Quality of life was preserved. Patients who lost at least 10 % of their body weight responded the best. Steroid intake affected optimal ketone and glucose levels. Despite this, survival improved in some melanoma and lung cancer patients. Further studies are recommended.Trial registrationClinicaltrials.gov NCT01716468. Registered on September 18, 2012

This article reports on the dosimetric properties of a new N-isopropylacrylamide, high %T, polymer gel formulation (19.5%T, 23%C), optimized for x-ray computed tomography (CT) polymer gel dosimetry (PGD). In addition, a new gel calibration technique is introduced together with an intensity-modulated radiation therapy (IMRT) treatment validation as an example of a clinical application of the new gel dosimeter. The dosimetric properties investigated include the temporal stability, spatial stability, batch reproducibility and dose rate dependence. The polymerization reaction is found to stabilize after 15 h post-irradiation. Spatial stability investigations reveal a small overshoot in response for gels imaged later than 36 h post-irradiation. Based on these findings, it is recommended that the new gel formulation be imaged between 15-36 h after irradiation. Intra- and inter-batch reproducibility are found to be excellent over the entire range of doses studied (0-28 Gy). A significant dose rate dependence is found for gels irradiated between 100-600 MU min⁻¹. Overall, the new gel is shown to have promising characteristics for CT PGD, however the implication of the observed dose rate dependence for some clinical applications remains to be determined. The new gel calibration method, based on pixel-by-pixel matching of dose and measured CT numbers, is found to be robust and to agree with the previously used region of interest technique. Pixel-by-pixel calibration is the new recommended standard for CT PGD. The dose resolution for the system was excellent, ranging from 0.2-0.5 Gy for doses between 0-20 Gy and 0.3-0.6 Gy for doses beyond 20 Gy. Comparison of the IMRT irradiation with planned doses yields excellent results: gamma pass rate (3%, 3 mm) of 99.3% at the isocentre slice and 93.4% over the entire treated volume.

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We extend our general relativistic analysis of galactic rotation curves with galaxies NGC 2841, NGC 2903 and NGC 5033. As before, we employ the solution of the Einstein field equations of general relativity with an expansion in Bessel functions. As in our earlier studies, the fits to the data are found to be very precise and the calculated baryonic masses are lower than those based upon Newtonian gravity. Also as in our previous studies, the galactic radii at which the optical luminosities terminate are seen to correlate with densities near $10^{-21.75}$ kg$\cdot$m$^{-3}$. This concordance lends further support to the correctness of the procedure as well as providing a potentially valuable piece of information in the understanding of galactic evolution.Comment: 6 figures, 23 page

In this study a new x-ray CT polymer gel dosimetry (PGD) filtering technique is presented for the removal of (i) remnant ring and streak artefacts, and (ii) 'structured' noise in the form of minute, intrinsic gel density fluctuations. It is shown that the noise present within x-ray CT PGD images is not purely stochastic (pixel by pixel) in nature, but rather is 'structured', and hence purely stochastic-based noise-removal filters fail in removing this significant, unwanted noise component. The remnant artefact removal (RAR) technique is based on a class of signal stripping (i.e. baseline-estimation) algorithms typically used in the estimation of unwanted non-uniform baselines underlying spectral data. Here the traditional signal removal algorithm is recast, whereby the 'signal' that is removed is the structured noise and remnant artefacts, leaving the desired polymer gel dose distribution. The algorithm is extended to 2D and input parameters are optimized for PGD images. RAR filter results are tested on (i) synthetic images with measured gel background images added, in order to accurately represent actual noise present in PGD images, and (ii) PGD images of a three-field gel irradiation. RAR results are compared to a top-performing noise filter (adaptive mean, AM), used in previous x-ray CT PGD studies. It is shown that, in all cases, the RAR filter outperforms the AM filter, particularly in cases where either (i) a low-dose gel image has been acquired or (ii) the signal-to-noise ratio of the PG image is low, as in the case when a low number of image averages are acquired within a given experiment. Guidelines for the implementation of the RAR filter are given.