Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.

Background : The aim of present study was to evaluate the association between diabetic retinopathy (DR), dietary inflammatory index (DII), and metabolic syndrome (MetS) in patients with type 2 diabetes in a cohort study in Iran. Methods: This cross-sectional study was a part of the large Azar eye cohort study that included 1378 patients with type 2 diabetes. To diagnose DR, two mydriatric fundus photographs were captured using a digital fundus camera. The DR severity was classified as non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR). MetS was determined on the basis of the ATPIII criteria. DII was calculated according to Shivappa et al. method. Results: Of 1378 diabetic patients, 185 (13.4%) had NPDR and 142 (10.3%) had PDR. The risk of NPDR and PDR increased by 2.65-fold and 2.01-fold, respectively, in patients having blood glucose levels that fell outside the recommended range. There was no statistically significant relationship between Mets, Mets components, and DII in NPDR and PDR. Conclusion: The results suggest that intensive glycemic control, rather than conventional control, may help reduce the progression of DR. It seems that longitudinal studies and clinical trials for evaluating role of DII in DR are necessary.