A Critical Review of LET-Based Intensity-Modulated Proton Therapy Plan Evaluation and Optimization for Head and Neck Cancer Management.

In this review article, we review the 3 important aspects of linear-energy-transfer (LET) in intensity-modulated proton therapy (IMPT) for head and neck (H&N) cancer management. Accurate LET calculation methods are essential for LET-guided plan evaluation and optimization, which can be calculated either by analytical methods or by Monte Carlo (MC) simulations. Recently, some new 3D analytical approaches to calculate LET accurately and efficiently have been proposed. On the other hand, several fast MC codes have also been developed to speed up the MC simulation by simplifying nonessential physics models and/or using the graphics processor unit (GPU)-acceleration approach. Some concepts related to LET are also briefly summarized including (1) dose-weighted versus fluence-weighted LET; (2) restricted versus unrestricted LET; and (3) microdosimetry versus macrodosimetry. LET-guided plan evaluation has been clinically done in some proton centers. Recently, more and more studies using patient outcomes as the biological endpoint have shown a positive correlation between high LET and adverse events sites, indicating the importance of LET-guided plan evaluation in proton clinics. Various LET-guided plan optimization methods have been proposed to generate proton plans to achieve biologically optimized IMPT plans. Different optimization frameworks were used, including 2-step optimization, 1-step optimization, and worst-case robust optimization. They either indirectly or directly optimize the LET distribution in patients while trying to maintain the same dose distribution and plan robustness. It is important to consider the impact of uncertainties in LET-guided optimization (ie, LET-guided robust optimization) in IMPT, since IMPT is sensitive to uncertainties including both the dose and LET distributions. We believe that the advancement of the LET-guided plan evaluation and optimization will help us exploit the unique biological characteristics of proton beams to improve the therapeutic ratio of IMPT to treat H&N and other cancers.

Effect of processing and measuring procedures on estimated sizes of bull sperm heads.

Reported estimates of sperm head size within a species vary considerably, partly due to procedural effects. A simple India ink method was developed that provided good contrast without inducing artifacts. Semen from five fertile bulls was smeared on replicate slides and left unfixed or fixed in Carnoys solution, with ink added for background. Other slides were fixed, and sperm were stained by the Feulgen procedure. Sperm head area was measured four ways. These were linear measurements made with the aid of an ocular micrometer and an oil immersion objective, plus three methods of measuring sperm heads projected at magnification 5,000 x. The areas of unfixed and fixed sperm heads did not differ (41.5 microm(2) versus 41.6 microm(2), respectively, P>0.05). The Feulgen-stained head area was smaller (26.2 microm(2), P<0.05). Sperm head areas calculated from ocular micrometer measurements were slightly smaller (P<0.05) than areas measured using projection. Identical results obtained by two technicians were treated as duplicates and approximately half of the variation was biological, due to source of semen. There was an interaction (P<0.05) between the sample source and fixation procedures. Thus, preparative techniques must be carefully controlled, and experiments designed to partition possible interactions between the biological material sampled and procedures used.

Fertility estimation: a review of past experience and future prospects.

Fertility has many components and stages which require that males and females be functionally capable of carrying out all critical stages if each generational reproductive cycle is to be completed. To accomplish this, the male must produce and ejaculate normal fertile sperm. The female must produce, store and ovulate normal fertilizable oocytes. Furthermore, the female must provide a reproductive system compatible with sperm transport, capacitation, and fertilization of the oocytes, embryo and fetal development, and finally birth of healthy young. Reproductive success or failure at several of these points can be estimated quantitatively on a population basis, and in a few situations on an individual basis. It is important that fertility estimates be determined accurately and with precision to be most useful to researchers and managers of animal enterprises. Many studies have underestimated the biological relationship of fertility to other traits because the estimates lacked precision. Many in vitro manipulations of sperm in artificial insemination, of gametes in various assisted reproductive technologies, and of embryos in embryo transfer are utilized in animal breeding programs. Accurate estimation of reproductive efficiency of these in vitro procedures also is important. Conditions surrounding different sets of fertility estimates almost certainly will be different. These conditions should be described as precisely as possible, and appropriate controls included in all experiments. When possible, experiments should be replicated over time and place to determine the repeatability of the various criteria used to estimate fertility and reproductive efficiency. Advances in genomic information and molecular biology should facilitate characterizing more fully inherent potential fertility of animals at birth. In vitro tests will improve, and automated techniques will facilitate making multiple determinations possible on a large scale. Reliability of fertility estimates will increase, with the potential for enhanced animal reproductive performance through more accurate selection, genetic engineering, and enlightened animal care. Simultaneously, it is important to recognize that prediction of future fertility is more hazardous than estimating fertility, as a completely new set of circumstances may occur which are not predictable. Because fertility estimation may be applied under a myriad of conditions, principles and factors affecting fertility will be emphasized in this review as being more useful than a compilation of numerical examples.

Spermicidal effects of amphotericin B and nystatin on bull and rabbit sperm and contraceptive effects in rabbits.

Vaginal contraceptives have potential for controlling reproduction as well as sexually transmitted diseases. Two extensively used fungicides, amphotericin B and nystatin, were found to be highly spermicidal to bull and rabbit sperm even in the presence of organic material found in milk and egg yolk, both excellent components of media designed to preserve sperm. In repeated tests with many samples of bull and rabbit sperm, as little as 0.5 micro g/mL of amphotericin B completely immobilized sperm after prolonged exposure, and 1000 micro g/mL immobiled sperm in less than 1 min. Treatment of rabbit sperm with 1000 micro g of solubilized amphotericin B in 0.4 ml of a glucose-semen mixture before insemination resulted in a total of 2 young born from 9 inseminated Dutch does, compared with 55 young from 9 control does. As this inhibition was achieved without the use of enhancing foams or gels, these results provide promising leads for contraceptive research.

Effects of metronidazole, ipronidazole, and dibromochloropropane on rabbit and human sperm motility and fertility.

Treatment of protozoal pathogens in the reproductive system with chemical agents exposes flagellated sperm cells to potential toxicants. A widely used antiprotozoal agent is metronidazole. Its effect on rabbit and human sperm was compared with a more soluble 5-nitroazole compound, ipronidazole, and with a systemic environmental toxicant, dibromochloropropane (DBCP). The percentages of motile rabbit and human sperm incubated with the compounds, the velocity of sperm, migration of sperm in polyacrylamide gel, young born in rabbits, and penetration of hamster oocytes by treated human sperm were measured in seven experiments. Up to 10mg/ml metronidazole and 1mg/ml DBCP had little effect on most sperm characteristics. However, 10mg/ml metronidazole and 5mg/ml of ipronidazole increased attachment of human sperm to hamster oocytes, but oocyte penetration was unaffected. Rabbit sperm exposed to 5mg/ml ipronidazole were infertile. No oocytes were penetrated by DBCP-treated human sperm.

Effect of high-dose liothyronine on semen quality and recovery following withdrawal in rabbits.

Endocrine aspects of the thyroid in the pituitary-thyroid-gonadal axis have been studied extensively, but few controlled studies have been conducted on sperm output in males with hyperthyroidism. The rabbit was used as a model to study the effects of hyperthyroidism induced with supraphysiologic doses of tri-iodothyronine (T(3)). Semen was collected from 18 sexually mature Dutch rabbits for 9 weeks before the experiment to standardize semen collection procedures, and to provide semen data to equalize treatment groups. Controls were continued on the same regimen for 18 weeks, whereas the treatment group received daily T(3) doses of 10 micro /kg per body weight for 5 weeks, followed by 13 weeks of recovery. Feed consumption was reduced precipitously during T(3) treatment, but it recovered rapidly following termination of T(3) administration. Gradual weight loss and recovery accompanied changes in feed consumption. Loss of libido was not detectable with treatment. Sperm output during 9 weeks following T(3) treatment was 46% of that collected during the standardization period. During the last 4 weeks, sperm output had recovered to 88% of pretreatment values, and subsequently, treated males had normal fertility. Histologic sections showed that the thyroid was inhibited by T(3) treatment and that spermatogenesis was moderately depressed. Both recovered by the termination of the experiment. These studies indicate that effects of induced hyperthyroidism on sperm production are transient.

The influence of cryoprotective media and processing procedures on motility and migration of frozen-thawed human sperm.

AIM: The study was designed to examine the effects of cryoprotective media, and glycerolating and thawing procedures on human sperm motility and gel penetrating ability. METHOD: Fifteen unselected donors provided semen varying in quality that was distributed in a factorial design across three cryoprotectants (glycerol, egg yolk-citrate-glucose-glycerol and egg yolk-tris-glucose-glycerol). Also, glycerol was added at room temperature versus at 4 degrees C. Two thaw temperatures were tested (laboratory air temperature for 10 min versus a 65 degrees C waterbath for 4 seconds). The proportion of total and progressively motile sperm was estimated immediately after thawing and following incubation at 35 degrees C for 2 h. Migration of sperm for 30 min at 37 degrees C through polyacrylamide gel was tested. RESULTS: Donors differed greatly, with post-thaw total motility of sperm ranging from 9 to 44% (P<0.05). Egg yolk-citrate-glucose-glycerol and egg yolk-tris-glucose-glycerol were superior to glycerol alone (post-thaw values of 35, 37 and 21%, respectively, P<0.05). This was due primarily to poor sperm survival when semen was cooled to 4 degrees C without glycerol or egg yolk. The two thaw temperatures gave similar results. Sperm migration tests paralleled the motility results, but were more sensitive in detecting differences. CONCLUSION: Egg yolk, particularly in a tris-based medium that is widely used in domestic animals, improved the cryopreservation of both good and poor quality human semen.

Motility and fertility of bull sperm in whole milk extender containing antioxidants.

Bull sperm are exposed to aerobic conditions during processing before freezing, and they have little endogenous antioxidant to protect them against reactive oxygen species that may be present. Seventeen laboratory studies and two field trials were conducted with 174 semen collections from bulls in an artificial breeding cooperative. More than 250 combinations and concentrations of reduced glutathione (GSH), superoxide dismutase (SOD), ascorbic acid, hypotaurine (HPT), 2,2,6,6-tetramethylpeperidine-1-oxyl (Tempo) and 4-hydroxy-2, 2, 6, 6-tetramethylpeperidine (Tempol) were tested by adding these compounds to fresh semen, and to a whole milk (WM) glycerol extender. Semen packaged in straws in the WM extender was frozen with liquid nitrogen. The motility of frozen-thawed sperm during storage at 25 or 5 degrees C after freezing was compared with semen stored without freezing. Antioxidants generally were not beneficial, except the percentage of motile sperm was improved by 6-11% units (P<0.05) when sperm were stored unfrozen or after freezing when 0.5mM of GSH with or without SOD was added. In two field trials, non-return rates were 71.9, 69.5 and 70.9% (P>0.05) with WM containing 0.0, 0.5 and 1.0mM of GSH, respectively, and 74.0 and 73.9% with WM and WM plus 0.5mM of GSH and 100U/ml of SOD (P>0.05). WM contains an abundant supply of casein which is an antioxidant, and additional antioxidants were ineffective in improving motility of sperm immediately after freezing and thawing or in affecting fertility. However, sperm responses were different in egg yolk-Tris extender. Sperm in this egg yolk extender tolerated substantial concentrations of Tempo and Tempol compared with toxic effects in WM (P<0.05). Therefore, optimal combinations of antioxidants tested here may have more useful applications in organizations using an egg yolk-based semen extender.

Induction of the acrosome reaction and zona-free hamster oocyte penetration by a bull with complete teratospermia versus a half brother with normal sperm.

A fertile bull producing normal sperm and a sterile half brother exhibiting 100% teratospermia were available to study an induced sperm acrosome reaction and oocyte penetration. Pedigree analysis indicated that this condition was inherited. Experiments were undertaken to study the induction of the acrosome reaction using dilaurylphosphatidylcholine (PC12) liposomes, because this procedure was previously established to be highly correlated with bull fertility. The sperm from each bull were incubated with several PC12 concentrations for varying time periods. The initial percentages of sperm from the sterile bull with intact, partially intact, and lost acrosomes were 67%, 18%, and 14%, respectively, vs 82%, 13%, and 5% for the fertile bull (P < .05). After incubation for 15 minutes with 50 microM PC12 liposomes the corresponding values were, respectively, 51%, 26%, and 19%; and 60%, 28%, and 12%. Thus, the differences after induction of the acrosome reaction, although significant (P < .05), were small. The number of sperm adhered to each oocyte averaged 22 and 10, respectively, for the fertile and sterile bulls, whereas 74% of the fertile bull sperm and only 11% of the sterile bull sperm penetrated oocytes. Mixing the sperm-oocyte complex during incubation and increasing the sperm concentration during incubation to compensate for differences in sperm motility did not markedly affect oocyte penetration by teratogenic sperm, which is consistent with this bull being sterile. In other studies, microinjection of this type of sperm was demonstrated to induce fertilization, so the consequences of using sperm with hereditary defects in assisted reproductive programs to overcome human male sterility may be a concern.