Loss Impairment Research Articles

Is there a relationship between Gilles de la Tourette and psychosis? A case report considering the continuum psychosis perspective and vulnerability model

IntroductionThere has been no evidence so far about significant relationship between Gilles de la Tourette and psychosis. Perhaps a continuum psychosis perspective and the vulnerability model could improve the comprehension of our patients.ObjectivesTo describe a case in which motor and obsessive symptoms evolve to schizophreniform symptoms and important psychosocial deterioration.MethodsSingle case report and literature review.ResultsA 20-year-old man, with clinical record of Gilles de la Tourette, and a psychosis episode 6 months before, is brought by his family with a syndrome consistent in motor retardation, whispered speech, poor visual contact, social withdrawal, hygiene neglect, abulia, apathy and blunted affect. In the one-year tracing conceptual disorganization and poor idea association are in the first place. Within child history, we found symptoms congruent with Gilles de la Tourette, obsessive symptoms and others that may be called mild psychotic symptoms (which did not fit in any diagnosis at that moment). We also found a pathological relationship between his parents and among him, as well as a poor economic and social condition.ConclusionsAccording to the continuum perspective, psychotic symptoms could be found within the obsessive spectrum. Related to the vulnerability model, we found in our case external factors that affected the clinical evolution: family dynamics affected, communication deviation, social and economic impairment, social withdrawal and vital aim loss. These factors should be attended in first place, as they are not only related with the triggering of illness but they also are the main way to recovery.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Effect of K－IFRS Adoption on The Persistence and Market Pricing of Asset Impairment Loss

The Effect of K－IFRS Adoption on The Persistence and Market Pricing of Asset Impairment Loss

Progression of Near Vision Loss and Incidence of Near Vision Impairment in an Adult Chinese Population

To investigate the progression of near vision loss and the cumulative incidence of near vision impairment (NVI) 6 years after initial examination of an urban Chinese cohort. Population-based, prospective cohort study. People aged ≥35 years examined at baseline in the Yuexiu District of Guangzhou, China. Participants examined at baseline were invited for 2-year and 6-year follow-up examinations in 2010 and 2014, respectively. Examinations included noncycloplegic autorefraction and binocular near visual acuity (NVA) with and without current near correction measured at 40 cm using a LogMAR ETDRS near vision tumbling E chart. Those with uncorrected binocular NVA (UCNVA) ≤20/40 underwent subjective refraction to obtain best-corrected binocular NVA (BCNVA). Change in UCNVA between baseline and 2014 follow-up examinations and the 6-year cumulative incidence of vision impairment based on 3 definitions: NVA ≤20/40, ≤20/50, and ≤20/63. Among the 1817 baseline participants, 1595 (87.8%) were reexamined in 2010 and 1427 (78.5%) in 2014. Mean vision loss between baseline and the 2014 follow-up was 1.54 (±1.74) lines of UCNVA. Vision loss was associated with age 80 years or older, less education, and better baseline UCNVA. The 6-year cumulative incidence of uncorrected binocular NVI (UCNVI) across the 3 vision impairment definitions was 55.2% (95% confidence interval [CI], 46.1%-64.3%), 51.3% (95% CI, 44.0%-58.7%), and 42.4% (95% CI, 35.5%-49.3%), respectively. With best-corrected binocular NVI (BCNVI), incidence was 6.89% (95% CI, 4.28%-9.50%), 5.17% (95% CI, 2.89%-7.44%), and 2.62% (95% CI, 1.11%-4.12%), respectively. A higher incidence of UCNVI was associated with worse baseline UCNVA for all 3 impairment definitions. Similarly, incidence of BCNVI was associated with worse baseline BCNVA, but also with older age and education at the primary level or less. Gender was not significant for either UCNVI or BCNVI. Approximately half of those aged 35 years or older develop UCNVI in 6 years, the overwhelming majority of whom can be corrected with spectacles. Cost-effective strategies to provide spectacles to this at-risk population remains an issue requiring further study.

Investigating Microstructural Abnormalities and Neurocognition in Sub-Acute and Chronic Traumatic Brain Injury Patients with Normal-Appearing White Matter: A Preliminary Diffusion Tensor Imaging Study

For a significant percentage of subjects, with chronic traumatic brain injury (TBI), who report persisting cognitive impairment and functional loss, the diagnosis is often impeded by the fact that routine neuroimaging often does not reveal any abnormalities. In this paper, we used diffusion tensor imaging (DTI) to investigate the apparently normal white matter (as assessed by routine magnetic resonance imaging) in the brains of 19 subjects with sub-acute (9) and chronic (10) TBI. We also assessed memory, executive function, and visual-motor coordination in these subjects. Using a voxel-wise approach, we investigated if parameters of diffusion were significantly different between TBI subjects and 17 healthy controls (HC), who were demographically matched to the TBI group. We also investigated if changes in DTI parameters were associated with neuropsychological performance in either group. Our results indicate significantly increased mean and axial diffusivity (MD and AD, respectively) values in widespread brain locations in TBI subjects, while controlling for age, sex, and time since injury. HC performed significantly better than the TBI subjects on tests of memory and executive function, indicating the persisting functional loss in chronic TBI. We found no correlation between diffusion parameters and performance on test of executive function in either group. We found negative correlation between FA and composite memory scores, and positive correlation between RD and visuomotor coordination test scores, in various tracts in both groups. Our study suggests that changes in MD and AD can indicate persisting micro-structure abnormalities in normal-appearing white matter in the brains of subjects with chronic TBI. Our results also suggest that FA in major white matter tracts is correlated with memory in health and in disease, alike; larger and longitudinal studies are needed to discern potential differences in these correlations in the two groups.

Goodwill impairment loss and bond credit rating

PurposeThe purpose of this study is to examine the impact of goodwill impairment losses on bond credit ratings.Design/methodology/approachThe authors use regression analysis to examine the relationship between goodwill impairment losses and bond credit ratings.FindingsThe empirical results show a negative relationship between the amount of goodwill impairment losses and bond credit ratings, suggesting that firms with goodwill impairment losses receive lower credit ratings. The authors perform various additional tests, including subsamples in good or bad market time, changes analysis, first time goodwill impairment firms vs subsequent impairment and the two-stage least squares regression analysis to address potential endogeneity issues. The main results persist.Originality/valueThis paper links and contributes to two streams of literature: goodwill impairment in accounting literature and bond credit ratings in finance literature. Whether a firm’s goodwill impairment losses affect the firm’s bond credit rating remains an interesting question that has not been examined previously. To the best of the authors’ knowledge, this is the first study that directly examines the relationship between goodwill impairment losses and bond ratings at the firm level.

Accessible information.

All organisations that provide NHS or adult social care are legally required to follow the Accessible Information Standard, which aims to ensure that people with a disability, impairment or sensory loss are provided with information they can read or understand easily and with support to help them communicate effectively with health and social care services.

The Association between Goodwill Impairment Loss and Goodwill Impairment Test-Related Disclosures in Australia

We examine the association between goodwill impairment loss and goodwill impairment test-related disclosures in Australia. Using an Australian sample of firm-years with goodwill during 2007-12, we find that firm-years with understated goodwill impairment loss have higher goodwill impairment test-related disclosures in notes and vice versa. This is consistent with goodwill firms using disclosures as a way of enhancing the credibility of the goodwill impairment loss number when it is understated. However, we find no evidence that the stock market prices this goodwill impairment loss-disclosures association.

The combination of vestibular impairment and congenital sensorineural hearing loss predisposes patients to ocular anomalies, including Usher syndrome.

The co-occurrence of hearing impairment and visual dysfunction is devastating. Most deaf-blind etiologies are genetically determined, the commonest being Usher syndrome (USH). While studies of the congenitally deaf population reveal a variable degree of visual problems, there are no effective ophthalmic screening guidelines. We hypothesized that children with congenital sensorineural hearing loss (SNHL) and vestibular impairment were at an increased risk of having USH. A retrospective chart review of 33 cochlear implants recipients for severe to profound SNHL and measured vestibular dysfunction was performed to determine the ocular phenotype. All the cases had undergone ocular examination and electroretinogram (ERG). Patients with an abnormal ERG underwent genetic testing for USH. We found an underlying ocular abnormality in 81.81% (27/33) of cases; of which 75% had refractive errors, and 50% of those patients showed visual improvement with refractive correction. A total of 14 cases (42.42%; 14/33) had generalized rod-cone dysfunction on ERG suggestive of Usher syndrome type 1, confirmed by mutational analysis. This work shows that adding vestibular impairment as a criterion for requesting an eye exam and adding the ERG to detect USH increases the chances of detecting ocular anomalies, when compared with previous literature focusing only on congenital SNHL.

Clinical Practice Guidelines for the Management of Generalised Anxiety Disorder (GAD) and Panic Disorder (PD).

Short description of anxiety disorders Generalized Anxiety Disorder (GAD) Definition: One of the anxiety disorders, where the primary symptoms of anxiety are present at most days for at least several weeks at a time, and usually for several months. The symptoms should usually involve elements of: (a) Apprehension (worries about future misfortunes, feeling “ on edge”, etc) (b) Motor tension (restlessness, inability to relax, trembling) (c) Autonomic over activity (light-headedness, sweating, tachycardia, tachypnea, dry mouth etc) The transient appearance of depressive symptoms, does not rule out the diagnosis of GAD as main diagnosis. The sufferer must not meet the full criteria for depressive episode, phobic disorder, panic disorder or OCD. Patients with generalised anxiety disorder have high anxiety and are worried about intrapsychic conflicts or external environmental events. They have multiple somatic symptoms of anxiety, restlessness, difficulty in concentration, irritability, fatigue, muscular tensions and difficulty in sleeping particularly early insomnia. They have vague apprehension about future events and fear of unknown. Common features observed in anxiety disorders include: Panic Disorder- Episodes of intense fear or discomfort accompanied by severe autonomic activity, palpitations, sweating, dyspnoea, chocking sensation or other somatic symptoms like chest pain, trembling, nausea, discomfort or fluttering sensation in abdomen and impending fear of death. Patient perceives it as a serious medical condition and invariably reaches to a medical emergency setup where after thorough physical evaluation he is declared normal. Phobias- Many patients with GAD suffer from irrational, unrealistic fears and acute autonomic reactions to certain specific situations or extreme fear to certan inanimate objects. They include agarophobia (fear of open spaces) fear of crowds, being out side home alone or traveling in a bus train or car. Some may have fear in closed spaces (claustrophobia) fear of heights (acrophobia) fear of opposite sex (hetero-phobia) fear of sight of blood (erythrophobia) or fear of facing certain social situations (social anxiety disorder) the common feature among all phobias being intense fear, increased autonomic activity and avoidance behavior (avoiding the fearful object or situation). Obsessive compulsive disorder- (OCD) has been seperately dealt with in details in these guidelines however the patients suffering from OCD have recurrent repetitive unwanted intrinsic thoughts (obsessions) or actions (compulsions) or both which lead to extreme distress, loss of time and impairment of functioning of the individual. The obsessious include douts, ideas of contamination, sexual thoughts or religious preoccupations or negative thoughts towards gods/goddess, the compulsions include activities like counting, checking, repeating, washing hoarding and touching objects, some have to and fro movements of body parts. Patient is aware of the irrationality of thoughts/actions but cannot control them, which produces intense anxiety and autonomic arousal with feelings of helplessness and guilt. Post-traumatic stress disorder (PTSD) - Usually it occurs after a terrifying event that involving physical or psychological traumatic event. It may also occure because of witnessing or experiencing a serious harm to other significant persons in life. Patients have terrifying recollections of the event, or nightmares. Some patients have an experience of living the event in an illusionary or imaginary situation with hallucinations, or flashback episodes. The patients suffer from intense psychological or physical distress. Many patients develop loss of interest, estrangement from others, sleep disturbances, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response. This phenomenon may persist for one month or more before it is diagnosed.

Industry Specific and Task Specific Auditing Expertise: The Case of Goodwill Impairment

There is growing interest among academics and auditing regulators on the role of auditing on the quality of accounting estimates including goodwill impairment. Prior research shows that managers exercise discretion when recording goodwill impairment by either delaying the decision to record the impairment, and/or understating the amount of impairment leading to overstatement of earnings. This study examines how auditor industry expertise, measured as within-industry market share, and task specific expertise, measured as the extent of auditor’s prior experience with goodwill impairment, mitigates managerial discretion. We find no evidence of an association between industry expertise and goodwill impairment. We find that task specific expertise reduces managerial discretion related to the impairment. Specifically, prior experience with goodwill impairment is positively associated with both the likelihood of recording impairment loss as well as the amount of impairment. Our findings have implications for ongoing discussions about auditor characteristics affecting the quality of accounting estimates.

Management's means and incentives to manage earnings: an integrated study in the Italian market

This paper provides a methodological contribution to existing research on earnings management. In this context, purpose of our analysis is to understand, through introduction of qualitative variables, how financial performance threshold values (Burgstahler and Dichev, 1997) results in manipulation and creates an incentive for managerial behaviour. The study demonstrates that provisions for liabilities and charges, the assets impairment loss and net deferred tax liability are de facto used to manage earnings. If a firm has a profit (or loss) in year t, it has a tendency to positively (or negatively) manage earnings in same year. Furthermore, starting situation plays a significant role since it becomes a relevant threshold for adoption of earnings management policies. In spite of significance of thresholds considered, their impact on single components analysed is moderate. Moreover, financial crisis was not neutral as regards earnings management.

Management's means and incentives to manage earnings: an integrated study in the Italian market

This paper provides a methodological contribution to the existing research on earnings management. In this context, the purpose of our analysis is to understand, through the introduction of qualitative variables, how financial performance threshold values (Burgstahler and Dichev, 1997) results in manipulation and creates an incentive for managerial behaviour. The study demonstrates that "provisions for liabilities and charges", "the assets impairment loss" and "net deferred tax liability" are de facto used to manage earnings. If a firm has a profit (or loss) in the year t, it has a tendency to positively (or negatively) manage earnings in the same year. Furthermore, the starting situation plays a significant role since it becomes a relevant threshold for the adoption of earnings management policies. In spite of the significance of the thresholds considered, their impact on the single components analysed is moderate. Moreover, the financial crisis was not neutral as regards earnings management.

Compliance with goodwill-related mandatory disclosure requirements and the cost of equity capital

Theory suggests that increased levels of corporate disclosure lead to a decrease in cost of equity via the reduction of estimation risk. We examine compliance levels with International Financial Reporting Standard 3 Business Combinations and International Accounting Standard 36 Impairments of Assets mandated goodwill-related disclosure and their association with firms’ implied cost of equity capital (ICC). Using a sample of European firms for the period 2008–2011, we find a median compliance level of about 83% and significant differences in compliance levels across firms and time. Non-compliance relates mostly to proprietary information and information that reveals managers’ judgement and expectations. Overall, we find a statistically significant negative relationship between the ICC and compliance with mandated goodwill-related disclosure. Further, we split the sample between firms meeting (or not) market expectations about the recognition of a goodwill impairment loss in a given year to study whether variation in compliance levels mainly plays a confirmatory or a mediatory role. We find the latter: higher compliance levels matter only for the sub-sample of firms that do not meet market expectations regarding goodwill impairment. Finally, our results hold only in countries where enforcement is strong.

The role of corporate governance in accounting discretion under IFRS: Goodwill impairment in Australia

A major concern with the adoption of International Financial Reporting Standards (IFRS) is the accounting discretion allowed under the IFRS, and its potential opportunistic use by managers. We examine the role of corporate governance in the accounting discretion inherent in goodwill impairment decisions under the IFRS. More specifically, we investigate whether, in Australia, stronger governance strengthens associations between economic factors and goodwill impairment loss but weakens associations between contracting incentives and goodwill impairment loss. Using data from 2007 to 2012, we find evidence consistent with the notion that stronger governance enhances the associations between economic factors and goodwill impairment loss. However, we find that strong governance cannot completely eliminate the opportunistic use of discretion in an impairment decision, especially when pre-impairment income is negative, and when the impairment occurs in the first year of a CEO's tenure. Our results are robust with regard to alternative measures of the dependent variable, firm performance variables, and the governance variable, even after controlling for potential self-selection biases.

Has SFAS 142 improved the usefulness of goodwill impairment loss and goodwill balances for investors?

Due to the concerns about the annual SFAS 142 impairment test, the FASB has recently added a project to its technical agenda to evaluate potential alternatives for measurement of goodwill. Motivated by the FASB’s consideration of a change in goodwill accounting, I examine the impact of SFAS 142 on the usefulness of goodwill write-offs and goodwill balances. I find that goodwill write-offs and goodwill balances are more strongly associated with stock returns and stock prices respectively after SFAS 142 than before SFAS 142. Furthermore, in the post-SFAS 142 period, I find that the association between stock prices and goodwill is lower for firms that avoid the recognition of the existing goodwill impairments, and that goodwill write-offs are more negatively associated with stock returns for firms where managers have more discretion over the impairment testing process. Overall, the findings suggest that despite the concerns of critics over the reliability of fair value estimates of goodwill, (1) SFAS 142 has improved the usefulness of goodwill numbers from investor perspective, and (2) investors see through the differences in reliability of reported goodwill numbers. These results have implications for standard-setting as the FASB considers new alternatives for goodwill accounting.

PCN226 - Work Productivity Activity Impairment Loss of Patients with HER2 Metastatic Breast Cancer

PCN226 - Work Productivity Activity Impairment Loss of Patients with HER2 Metastatic Breast Cancer

Pharmacologic interventions for treating phantom limb pain.

This is an updated version of the original Cochrane review published in Issue 12, 2011. Phantom limb pain (PLP) is pain that arises in the missing limb after amputation and can be severe, intractable, and disabling. Various medications have been studied in the treatment of phantom pain. There is currently uncertainty in the optimal pharmacologic management of PLP. This review aimed to summarise the evidence of effectiveness of pharmacologic interventions in treating PLP. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library), MEDLINE, and Embase for relevant studies. We ran the searches for the original review in September 2011 and subsequent searches for this update up to April 2016. We sought additional studies from clinical trials databases and reference lists of retrieved papers. We included randomised and quasi-randomised trials studying the effectiveness of pharmacologic interventions compared with placebo, another active treatment, or no treatment, in established PLP. We considered the following outcomes: change in pain intensity, function, sleep, depression or mood, quality of life, adverse events, treatment satisfaction, and withdrawals from the study. We independently assessed issues of study quality and extracted efficacy and adverse event data. Due to the wide variability in the studies, we did not perform a meta-analysis for all the interventions and outcomes, but attempted to pool the results of some studies where possible. We prepared a qualitative description and narrative summary of results. We assessed clinical heterogeneity by making qualitative comparisons of the populations, interventions, outcomes/outcome measures, and methods. We added only one new study with 14 participants to this updated review. We included a 14 studies (10 with low risk of bias and 4 with unclear risk of bias overall) with a total of 269 participants. We added another drug class, botulinum neurotoxins (BoNTs), in particular botulinum toxin A (BoNT/A), to the group of medications reviewed previously. Our primary outcome was change in pain intensity. Most studies did not report our secondary outcomes of sleep, depression or mood, quality of life, treatment satisfaction, or withdrawals from the study.BoNT/A did not improve phantom limb pain intensity during the six months of follow-up compared with lidocaine/methylprednisolone.Compared with placebo, morphine (oral and intravenous) was effective in decreasing pain intensity in the short term with reported adverse events being constipation, sedation, tiredness, dizziness, sweating, voiding difficulty, vertigo, itching, and respiratory problems.The N-methyl D-aspartate (NMDA) receptor antagonists ketamine (versus placebo; versus calcitonin) and dextromethorphan (versus placebo), but not memantine, had analgesic effects. The adverse events of ketamine were more serious than placebo and calcitonin and included loss of consciousness, sedation, hallucinations, hearing and position impairment, and insobriety.The results for gabapentin in terms of pain relief were conflicting, but combining the results favoured treatment group (gabapentin) over control group (placebo) (mean difference -1.16, 95% confidence interval -1.94 to -0.38; 2 studies). However, gabapentin did not improve function, depression score, or sleep quality. Adverse events experienced were somnolence, dizziness, headache, and nausea.Compared with an active control benztropine mesylate, amitriptyline was not effective in PLP, with dry mouth and dizziness as the most frequent adverse events based on one study.The findings for calcitonin (versus placebo; versus ketamine) and local anaesthetics (versus placebo) were variable. Adverse events of calcitonin were headache, vertigo, drowsiness, nausea, vomiting, and hot and cold flushes. Most of the studies were limited by their small sample sizes. Since the last version of this review, we identified another study that added another form of medical therapy, BoNTs, specifically BoNT/A, to the list of pharmacologic interventions being reviewed for clinical efficacy in phantom limb pain. However, the results of this study did not substantially change the main conclusions. The short- and long-term effectiveness of BoNT/A, opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and local anaesthetics for clinically relevant outcomes including pain, function, mood, sleep, quality of life, treatment satisfaction, and adverse events remain unclear. Based on a small study, BoNT/A (versus lidocaine/methylprednisolone) does not decrease phantom limb pain. Morphine, gabapentin, and ketamine demonstrate favourable short-term analgesic efficacy compared with placebo. Memantine and amitriptyline may not be effective for PLP. However, results must be interpreted with caution, as they were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, local anaesthetics, and dextromethorphan needs further clarification. Overall, the efficacy evidence for the reviewed medications is thus far inconclusive. Larger and more rigorous randomised controlled trials are needed for us to reach more definitive conclusions about which medications would be useful for clinical practice.

Stress test based on Oliver Wyman in Bank of Spain: an evaluation

This paper, based on econometric techniques, has done a study to improve the predictions of the stress test, concerning the estimation of impairment losses. The main results obtained are: 1) the impact of the explanatory variables on the impairment loss is different at stages of growth, compared to times of recession; 2) there is a certain inertia of the dependent variable, but this inertia is different in intensity, and even the sign in the growth stages concerning the stages of recession; 3) of the explanatory variables, nominal GDP and equity are those that have a greater impact on the impairment loss; 4) finally, the two dummy variables that assess the impact of adjustment to market value of assets in the process of mergers and acquisitions that occurred in 2010, and regulatory changes implemented in 2012, have been statistically significant and with the expected signs. Keywords: econometric techniques, financial crisis, financial markets, risks. JEL Classification: G21, G32, G17

Cancer cachexia assessment: new tools for oncologists.

The cancer anorexia-cachexia syndrome (CACS) is considered a multifactorial syndrome that leads a general decline of the cancer patient conditions, prognosis and survival, and characterized by progressive loss of body mass and functional impairment, due to marked energy metabolism imbalance and immunological disorders. It is the cause of death in almost one out of five advanced cancer patients. CACS is also accompanied with loss of quality of life, reduced response and tolerance to anticancer therapies and affected outcome. This condition arises by acute-chronic inflammation, hypercatabolism and resulting in an increased energy expenditure, anorexia and negative caloric balance. Although the international scientific community has reached some important findings in last years regarding CACS, a precise definition agreement for CACS in order to a precise patients assessment is still lacking. In light of the advances in pathogenesis and evaluation of CACS, as well as those reached in the therapy, this review aims to draft a list of key points that could be useful for the oncologist to recognize the different signs and symptoms of this syndrome, in order to evaluate and stage the cancer patients in attempt to target an early multimodal pharmacological-nutritional treatment strategy to improve his outcome and his quality of life.

Proton Irradiation with Hyperthermia in Unresectable Soft Tissue Sarcoma.

Unresectable soft tissue sarcomas (STSs) do not usually exhibit significant tumor downstaging with preoperative radiotherapy and/or chemotherapy due to their limited radiosensitivity/chemosensitivity. Limb amputations for tumors of the extremities inevitably lead to considerable loss of function and impairment in quality of life. Local hyperthermia at 39°C to 43°C and proton irradiation combine thermoradiobiological and physical dose distribution advantages, possibly mimicking those of a 12C ion therapy. We report the first 2 patients treated with this unique approach of proton thermoradiotherapy. Both patients had an unresectable STS of the left lower leg (1 grade 2 myxoid fibrosarcoma, 1 grade 3 undifferentiated pleomorphic sarcoma). Both patients had declined the above-knee amputation that had been advised due to their involvement of the neurovascular bundles. They were, therefore recruited to the Hyperthermia and Proton Therapy in Unresectable Soft Tissue Sarcoma (HYPROSAR) study protocol (ClinicalTrials.gov NCT01904565). Local hyperthermia was delivered using radiofrequency waves at 100 Mhz once a week after proton therapy. Proton irradiation was undertaken to a dose of 70 to 72 Gy (relative biological effectiveness) delivered at 2.0 Gy (relative biological effectiveness)/ fraction daily for 7 weeks. Patients tolerated the treatment well with no significant acute or late morbidity. Both primary tumors showed a near complete response on serial magnetic resonance imaging. At a follow-up of 5 and 14 months, the patients were able to carry out indoor and outdoor activities with normal limb function. This is the first report of proton beam irradiation combined with hyperthermia for cancer therapy. Our first experience in 2 consecutive patients with unresectable STSs shows that the approach is safe, feasible, and effective, achieving functional limb preservation with near total tumor control.