The Potential Role of NOD2/CARD15 Genotype as a Prognostic Indicator for Bone Marrow Transplantation Outcomes in Patients With Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia: A Systematic Review.

Hematopoietic stem-cell transplantation (HSCT) has emerged as a groundbreaking therapeutic option for acute myeloid leukemia (AML) and specific subtypes of acute lymphoblastic leukemia (ALL). The prognostic significance of the NOD2/CARD15 gene has been explored alongside various factors, encompassing diverse patient cohorts and gene variants. Siblings and unrelated donors used for stem cell transplantation exhibit significant associations between their genetic variations and graft-versus-host disease incidence. The transplantation of stem cells for leukemia patients involves numerous considerations, including patient survival, relapse rates, disease stage, donor and recipient ages, and compatibility. This study delved into research on the NOD2/CARD15 gene and its mutations to assess its suitability as a screening tool. A comprehensive literature search encompassing PubMed, ScienceDirect, and Google Scholar articles yielded 4,840 articles. After removing duplicates and applying inclusion and exclusion criteria, we narrowed the search results to 876 articles. Subsequent screening of abstracts and titles resulted in the selection of 230 relevant articles. Further exclusion of 198 articles unrelated to the research question led to the scrutinizing of 32 full-text articles, which were assessed against inclusion and exclusion criteria. Emphasis was placed on articles that specifically investigated the role of NOD2/CARD15 as a predictive factor for HSCT outcomes, ultimately resulting in the inclusion of 19 articles in this study. Single nucleotide polymorphisms (SNPs) such as NOD2 and CARD15 have demonstrated their potential as reliable genetic markers for predicting post-transplantation relapse and disease outcomes. Patients positive for these genetic markers have exhibited reduced overall survival and event-free survival and increased transplant-related mortality. Interventions with interferon-gamma and muramyl tripeptide phosphatidylethanolamine have been considered to mitigate the inflammatory effects of these SNPs, thus enhancing the influence of natural killer cells on abnormal cells and potentially extending patient survival. NOD2/CARD15 typing may aid in identifying patients at higher risk for relapse and improving their clinical outcomes after allogeneic stem cell transplant, particularly in ALL patients. However, no remarkable change was observed in AML patients. Additionally, this study underscores the pivotal roles of adaptive and innate immune responses and their interplay in stem cell transplant immunology.

The Benefits of Integrative Medicine for Pain Management in Oncology: A Narrative Review of the Current Evidence.

The aim of this evidence-based study is to narrate and evaluate the current evidence on recommendations for practicing physicians and other healthcare providers regarding integrative approaches to managing pain in patients with cancer. This review will assess the guideline recommendations and analyze the role of integrative medicine in addressing cancer pain in patients. The literature search highlights relevant studies that will inform evidence-based recommendations for practicing physicians, highlighting their relevance and weaknesses. Acupuncture, massage, and hypnosis have intermediate-strength evidence quality and are moderately recommended for various types of cancer pain. Most of the evidence points to acupuncture being recommended for aromatase inhibitor-related joint pain, hypnosis for procedural pain, and massage for palliative care pain. Other practices with lower-quality evidence include yoga and guided imagery with progressive muscle relaxation, mostly recommended for general cancer pain or musculoskeletal pain. Additionally, music therapy is recommended for procedural or surgical pain. Low-quality or inconclusive evidence was found for other mind-body interventions or natural products. Similarly, there is insufficient evidence to provide recommendations for pediatric patients. Further research is required to enhance our understanding of the role of integrative medicine interventions in caring for cancer patients.

Comparison Between Levothyroxine and Lifestyle Intervention on Subclinical Hypothyroidism in Women: A Review.

Subclinical hypothyroidism (SCH) or "mild thyroid failure" is defined as elevated serum thyroid-stimulating hormone (TSH) in the presence of normal free thyroxine (T4). The incidence of SCH is estimated at 4.4-8.5% of the general population and occurs more frequently in women. Given that it falls below the diagnostic threshold, SCH is monitored rather than treated. Its management is a common topic of debate as SCH frequently progresses into overt hypothyroidism and is linked to long-term hyperlipidemia, endothelial dysfunction, cardiovascular disease, heart failure, and cerebrovascular disease. Premature hormone administration and lifestyle interventions have been explored as treatment options to mitigate the symptoms of SCH. Our review compares both modalities' efficacy and potential for standardized clinical practice. A trial of levothyroxine demonstrated significant results in specific SCH demographics, such as patients who are pregnant or trying to conceive, those with goiter, those with thyroid peroxidase (TPO) antibody status, those with steadily increasing TSH, children, and adolescents. All other SCH patients presenting with chronic symptoms may also be reasonably considered for a three- to six-month trial of treatment. Lifestyle modifications through improved sleep hygiene, a diet within the recommended daily allowance (RDA) for iodine and selenium, increased exercise, and smoking cessation also proved efficacious. Our findings indicate that a synergistic approach to treatment is most favorable. Lifestyle modifications neither show adverse effects nor contraindications and can be safely recommended alone or alongside levothyroxine for the treatment of SCH.

Correction: Comparison Between Levothyroxine and Lifestyle Intervention on Subclinical Hypothyroidism in Women: A Review.

[This corrects the article DOI: 10.7759/cureus.38309.].

Treatment of Advanced Metastatic Prostate Cancer Using Molecular-Targeted Therapy: Radioligand Lutetium-177 Prostate-Specific Membrane Antigen.

This study investigates the predicting factors of the biochemical response and survival of patients with advanced metastatic prostate cancer who underwent therapy with radioligand lutetium-177 (177Lu)-prostate-specific membrane antigen (PSMA), often referred to as [177Lu]Lu-PSMA. This study is a review of the previous literature. This study included articles published in the last 10 years in the English language. According to the literature review, treatment with [177Lu]Lu-PSMA has a positive impact on prostate-specific antigen (PSA) within the first cycle and a negative impact on lymph node metastasis. There is a plausible positive impact on PSA after multiple cycles and performance status and a negative impact on visceral metastasis. In conclusion, the reviews show that treatment with [177Lu]Lu-PSMA in patients with castration-resistant prostate cancer is beneficial in reducing PSA and metastasis.

Gene Therapy for Spinal Muscular Atrophy (SMA): A Review of Current Challenges and Safety Considerations for Onasemnogene Abeparvovec (Zolgensma).

Spinal Muscular Atrophy (SMA) is a genetic disease that causes weakness and wasting in the voluntary muscles of infants and children. SMA has been the leading inherited cause of infant death. More specifically, SMA is caused by the absence of the SMN1 gene. In May 2019, the Food and Drug Administration (FDA) approved onasemnogene abeparvovec, SMN1 gene replacement therapy, for all children with SMA younger than two years of age, without end-stage weakness. The objective of the study is to review the safety and efficacy of a novel gene therapy, onasemnogene abeparvovec (Zolgensma), for SMA and assess current challenges for gene therapy. For this, we have conducted a literature search on PubMed, MEDLINE, and Ovid (2019 to 2022) in the English language using the terms SMA, onasemnogene, and gene therapy. The search included articles, websites, and published papers from reputable health organizations, hospitals, and global organizations dedicated to bringing awareness to Spinal Muscular Atrophy. We found the first gene therapy for SMA to be onasemnogene, directly providing the survival motor neuron 1 (SMN1) gene to produce the survival motor neuron (SMN) protein. Onasemnogene is approved by the Food and Drug Administration and has the added benefit of being a one-time dose. On the downside, a major side effect of this treatment is hepatotoxicity. There is substantial evidence that the efficacy of therapy is increased when administered early to children under three months of age. Therefore, we concluded that onasemnogene appears to be an efficacious therapy for younger pediatric patients with SMA type 1. Drug cost and potential hepatotoxicity are major concerns. Long-term benefits and risks have not been determined, but it is more cost-effective and requires less time of treatment compared to the other used drug, nusinersen. Therefore, the combined safety, cost, and effectiveness of onasemnogene abeparvovec make it a reliable treatment option for treating SMA Type 1.

Does habitat heterogeneity influence taxonomic richness and abundance? A case study from a terrestrial protected area in Abu Dhabi, United Arab Emirates.

Biodiversity is under enormous pressure from multiple threats including climate change, land use change, habitat alterations and hunting pressure. One way to ease this pressure on biodiversity and to mitigate the effects of above-mentioned threats, is to establish protected areas. Importance of protected increases many folds in regions that are considered as biodiversity poor regions i.e. deserts. Protected areas have long been a major pillar of biodiversity conservation strategies; the Houbara Protected Area (HPA) is one of the 13 terrestrial protected areas in Abu Dhabi Emirate officially declared in 2017. However, no information regarding the status of biodiversity in the HPA has been communicated to the research fraternity. During the present study, surveys were conducted to fill this gap. The survey area was divided in to 50 grids of 5 × 5 km2 and monitoring surveys were undertaken from January to December 2016. A total of 14 bi-monthly to monthly surveys were conducted within HPA and 196 species of different taxonomical groups were recorded. A year-long survey yielded highly diversified fauna and flora from 19 different habitat types (H) 1.32, (E) 2.28, Shannon Diversity Index). We looked at the influence of habitat breadth and temperature on the species richness and abundance, results shows that in desert setup heterogeneity of habitat is not an important factor in maintaining the biodiversity as total number of individuals as well as species were similar in the grids that have different number of habitat types (df = 34.3, t = -0.472, P = 0.640). However, we did find a positive impact of mean monthly temperature on species richness (df = 154, t = 2.53, P = 0.012). Our study highlights the importance of temperature in driving species abundance and richness in protected area. Abundance and species richness are similar in protected areas indicating that protection is allowing species to explore the heterogenous habitats. Overall, we can conclude that protection is beneficial for species.

Rerouting the Dissection of the Infratemporal and Submandibular Regions.

Introduction Teaching and learning in anatomy are necessarily dependent on cadaveric dissection. Skillful dissection is the tool which helps in proper visualization of structures in a cadaver. Proper understanding about the course of lingual nerve, hypoglossal nerve, nerve to mylohyoid, and relations between structures present in infratemporal and submandibular regions is important for medical students. The aim of this study is to describe a modified technique of dissection and evaluate medical students' and teachers' response to this approach. Methods The comparative observational study was conducted bilaterally on six adult cadavers. We compared the method of dissection given in standard textbooks with the modified method introduced. The validity and reliability of the newer method of dissection for teaching purpose was assessed by first-year undergraduate medical students using a questionnaire-based tool and feedback from postgraduate students and senior residents. Results The modified method was described as less time consuming, easy to perform, and allowed extensive exploration of the structures in the infratemporal and submandibular regions. Conclusions Proper understanding of the course and relations between structures present in infratemporal and submandibular regions is important for medical students.The modified approach to infratemporal and submandibular regions will facilitate better understanding of the human anatomy.

Comparison of motor diagnoses by Chicago Classification versions 2.0 and 3.0 on esophageal high-resolution manometry.

BACKGROUND: The Chicago Classification (CC) uses high-resolution manometry (HRM) software tools to designate esophageal motor diagnoses. We evaluated changes in diagnostic designations between two CC versions, and determined motor patterns not identified by either version. METHODS: In this observational cohort study of consecutive patients undergoing esophageal HRM over a 6-year period, proportions meeting CC 2.0 and 3.0 criteria were segregated into esophageal outflow obstruction, hypermotility, and hypomotility disorders. Contraction wave abnormalities (CWA), and 'normal' cohorts were recorded. Symptom burden was characterized using dominant symptom intensity and global symptom severity. Motor diagnoses, presenting symptoms, and symptom burden were compared between CC 2.0 and 3.0, and in cohorts not meeting CC diagnoses. KEY RESULTS: Of 2569 eligible studies, 49.9% met CC 2.0 criteria, but only 40.3% met CC 3.0 criteria (P<.0001). Between CC 2.0 and 3.0, 82.8% of diagnoses were concordant. Discordance resulted from decreasing proportions of hypermotility (4.4%) and hypomotility (9.0%) disorders, and increase in 'normal' designations (13.0%); esophageal outflow obstruction showed the least variation between CC versions. Symptom burden was higher with CC 3.0 diagnoses (P≤.005) but not with CC 2.0 diagnoses (P≥.1). Within 'normal' cohorts for both CC versions, CWA were associated with higher likelihood of esophageal symptoms, especially dysphagia, regurgitation, and heartburn, compared to truly normal studies (P≤.02 for each comparison). CONCLUSIONS AND INFERENCES: Despite lower sensitivity, CC 3.0 identifies esophageal motor disorders with higher symptom burden compared to CC 2.0. CWA, which are associated with both transit and perceptive symptoms, are not well identified by either version.

TG-43 U1 based dosimetric characterization of model 67-6520 Cs-137 brachytherapy source.

PURPOSE: Brachytherapy treatment has been a cornerstone for management of various cancer sites, particularly for the treatment of gynecological malignancies. In low dose rate brachytherapy treatments, 137Cs sources have been used for several decades. A new 137Cs source design has been introduced (model 67-6520, source B3-561) by Isotope Products Laboratories (IPL) for clinical application. The goal of the present work is to implement the TG-43 U1 protocol in the characterization of the aforementioned 137Cs source. METHODS: The dosimetric characteristics of the IPL 137Cs source are measured using LiF thermoluminescent dosimeters in a Solid Water phantom material and calculated using Monte Carlo simulations with the GEANT4 code in Solid Water and liquid water. The dose rate constant, radial dose function, and two-dimensional anisotropy function of this source model were obtained following the TG-43 U1 recommendations. In addition, the primary and scatter dose separation (PSS) formalism that could be used in convolution/superposition methods to calculate dose distributions around brachytherapy sources in heterogeneous media was studied. RESULTS: The measured and calculated dose rate constants of the IPL 137Cs source in Solid Water were found to be 0.930 (+/-7.3%) and 0.928 (+/-2.6%) cGy h(-1) U(-1), respectively. The agreement between these two methods was within our experimental uncertainties. The Monte Carlo calculated value in liquid water of the dose rate constant was null set=0.948 (+/-2.6%) cGy h(-1) U(-1). Similarly, the agreement between measured and calculated radial dose functions and the anisotropy functions was found to be within +/-5%. In addition, the tabulated data that are required to characterize the source using the PSS formalism were derived. CONCLUSIONS: In this article the complete dosimetry of the newly designed 137Cs IPL source following the AAPM TG-43 U1 dosimetric protocol and the PSS formalism is provided.

Cylindrical coordinate based TG-43U1 parameters for dose calculation around elongated brachytherapy sources.

In 2001, the use of cylindrical coordinates was demonstrated to be more suitable than was the use of polar coordinates for accurate computer calculations during treatment planning for 192Ir intravascular brachytherapy sources. In the present work, we investigated the applicability of cylindrical coordinate-based TG-43U1 parameters for dosimetric evaluation and dose calculations for RadioCoil 103Pd sources (RadioMed Corporation, Tyngsboro, MA) 1.0-cm to 6.0-cm long. For brevity, only the results for sources 1.0-cm, 3.0-cm, and 5.0-cm long are presented here. Dosimetric characteristics of RadioCoil 103Pd sources were calculated in liquid water using the Monte Carlo simulation technique. To demonstrate the suitability of this methodology, the Monte Carlo-simulated dose profiles for a RadioCoil 103Pd source 5.0-cm long at radial distances of 0.5 cm, 0.9 cm, and 1.25 cm were compared with calculated data using TG-43U1 parameters in the polar and cylindrical coordinate systems. In addition, we also used a source 1.0-cm long parameterized using cylindrical coordinates to investigate the application of a linear segmented source (LSS) model originally introduced by our group. The results indicate that, for dose calculation around elongated brachytherapy sources, cylindrical coordinate-based TG-43U1 parameters more accurately represent the dose distribution around an elongated source than the polar coordinate-based parameters. In addition, the LSS model, in conjunction with the cylindrical coordinate-based parameters for a source 1.0-cm long, can be used to replicate the dose distribution around any integral source length. This process eliminates the need to collect and enter data for multiple source lengths into treatment planning systems.

Erratum: "Cylindrical coordinate-based TG-43U1 parameters for dose calculation around elongated brachytherapy sources".

[This corrects the article DOI: 10.1120/jacmp.v9i2.2760.].

TG-43U1 parameterization of elongated RadioCoil 103Pd brachytherapy sources.

Recently, to eliminate problems associated with seed type sources, RadioMed Corporation (Tyngsboro, MA) introduced RadioCoil 103Pd sources for interstitial prostate implants. The RadioCoil sources are available in integral lengths ranging from 1.0 cm to 6.0 cm. In this project, dosimetric characteristics of these sources were determined following the TG-43U1 recommendations, with consideration of our recent publication on the evaluation of two-dimensional anisotropy function for elongated brachytherapy sources. Dosimetric parameters of these sources were determined experimentally in Solid Water (Gammex RMI, Middleton, WI) and theoretically using Monte Carlo simulation in Solid Water and liquid water. Per the TG-43U1 protocol, the consensus of these results would be used for their clinical applications.

Dosimetric evaluation of a newly designed low dose rate brachytherapy applicator for treatment of cervical cancer with extension into the lower vagina.

Currently, patients having cervical cancer with extension into the lower vagina are being treated with a combination of the Fletcher-Suit applicator, which treats the cervix, and a vaginal cylinder, which treats the lower vagina. With this method, patients receive two separate implants-a procedure that creates greater uncertainty in the dose distribution and unnecessary patient inconvenience. To reduce the uncertainty of the dose delivery and to eliminate patient inconvenience, a new applicator was designed and fabricated at the University of Kentucky for treatment of cervical cancer extending into the lower vagina. In addition, the geometric design of the new device allows for treatment of cervical cancer without extension into the lower vagina and simultaneously provides advantages relative to the commonly used Fletcher-Suit applicator. The dosimetric characteristics of this new applicator (hereafter called Meigooni applicator) were determined using experimental procedures. The measurements were performed using tissue-equivalent phantom material (Solid Water: Gammex RMI, Middleton, WI) that was machined to accommodate the applicator and LiF thermoluminescent dosimetry chips. The applicator was loaded with 137Cs brachytherapy sources in a standard loading scheme. A similar experimental procedure was performed using the currently available Fletcher-Suit mini-ovoid applicator. The results obtained with each applicator were compared with the values calculated by two commercially available treatment planning systems. The experiments showed that the Meigooni applicator allows for safe single treatment of cervical cancer that has extended into the lower vagina, eliminating the need for two separate treatment techniques. Moreover, the Meigooni applicator can function as an alternative to the Fletcher-Suit applicator for the treatment of patients with cervical cancer.

Updated Solid Water to water conversion factors for 125I and l03Pd brachytherapy sources.

Dosimetric characteristics of brachytherapy sources are normally determined in water using a Monte Carlo simulation technique and in water equivalent phantom material using both experimental and Monte Carlo simulation techniques. The consensuses of these results are then calculated for clinical applications by converting experimental data obtained in water equivalent material to water using a conversion factor. These conversion factors are normally determined as a ratio of the Monte Carlo-simulated dose rate constant in liquid water to the dose rate constant in a water-equivalent phantom material. However, it has been noted that conversion factors utilized by some investigators have been derived using incorrect phantom material composition and incorrect cross-sectional data information. The impact of errors associated with the cross-sectional data and chemical composition of the phantom material used in dosimetric evaluation of brachytherapy sources has been investigated in this project. Results of these investigations have shown that the use of Solid Water with 1.7% calcium content, as compared to the 2.3% value stated by the manufacturer, may lead to 5% and 9% differences in conversion factors for 125I and 103Pd, respectively.

Feasibility of calibrating elongated brachytherapy sources using a well-type ionization chamber.

Recently, elongated brachytherapy sources (active length >1 cm) have become commercially available for interstitial prostate implants. These sources were introduced to improve the quality of brachytherapy procedures by eliminating the migration and seed bunching associated with loose seed-type implants. However, the inability to calibrate elongated brachytherapy sources with the Wide-Angle Free-Air Chamber (WAFAC) used by the National Institute of Standards and Technology (NIST) hinders the experimental determination of dosimetric parameters of these source types. In order to resolve this shortcoming, an interim solution has been introduced for calibration of elongated brachytherapy sources using a commercially available well-type ionization chamber. The feasibility of this procedure was examined by calibrating RadioCoil 103Pd sources with active lengths ranging from 1 to 7 cm.

Evaluation of TG-43 recommended 2D-anisotropy function for elongated brachytherapy sources.

The original and updated protocols recommended by Task Group 43 from the American Association of Physicists in Medicine (i.e., TG-43 and TG-43U1, respectively), have been introduced to unify brachytherapy source dosimetry around the world. Both of these protocols are based on experiences with sources less than 1.0 cm in length. TG-43U1 recommends that for 103Pd sources, 2D anisotropy function F(r, theta), should be tabulated at a minimum for radial distances of 0.5, 1.0, 2.0, 3.0, and 5.0 cm. Anisotropy functions defined in these protocols are only valid when the point of calculation does not fall on the active length of the source. However, for elongated brachytherapy sources (active length >1 cm), some of the calculation points with r < 1/2 active length and small theta may fall on the source itself and there is no clear recommendation to handle this situation. In addition, the linear interpolation technique recommended by TG-43U1 is found to be valid for seed types of sources as the difference between F(r, theta) for two consecutive radii is <10%. However, in the present investigations it has been found that values of F(r, 5 degrees) for a 5 cm long RadioCoil 103Pd source at radial distances of 2.5, 3.0, and 4.0 cm were 2.95, 1.74, and 1.19, respectively, with differences up to about a factor of 3. Therefore, the validity of the linear interpolation technique for an elongated brachytherapy source with such a large variation in F(r, theta) needs to be investigated. In this project, application of the TG-43U1 formalism for dose calculation around an elongated RadioCoil 103Pd brachytherapy source has been investigated. In addition, the linear interpolation techniques as described in TG-43U1 for seed type sources have been evaluated for a 5.0 cm long RadioCoil 103Pd brachytherapy source. Application of a polynomial fit to F(r, theta) has also been investigated as an alternate approach to the linear interpolation technique. The results of these investigations indicate that the TG-43U1 formalism can be extended for elongated brachytherapy sources, if the two-dimensional (2D) anisotropy function is tabulated at a minimum for radial distances of 0.2, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 4.5, 5.0 cm, L/2, and L/2 +/- 0.2 cm. Moreover, with the addition of recommended radial distances for 2D anisotropy functions, the linear interpolation technique more closely replicates Monte Carlo simulated data than a polynomial fit.

Theoretical and experimental determination of dosimetric characteristics for ADVANTAGE Pd-103 brachytherapy source.

ADVANTAGE Pd-103 brachytherapy source has been recently introduced by IsoAid for prostate permanent implants. Dosimetric characteristics (Dose rate constant, radial dose function, 2D-, and 1D-anisotropy functions) of this source model have been determined using both theoretical and experimental methods, following the updated TG-43U1 protocol. Derivation of the dose rate constant was based on recent NIST WAFAC calibration performed in accordance with the 1999 Standards. Measurements were performed in Solid Water using LiF TLD chips and the theoretical calculations were performed in Solid Water and liquid water phantom materials using PTRAN Monte Carlo code. The results of the Monte Carlo simulation have shown a dose rate constant of 0.69 cGyh(-1) U(-1) in liquid water and 0.67 cGyh(-1) U(-1) in Solid Water medium. The measured dose rate constant in Solid Water was found to be 0.68+/-8% cGyh(-1) U(-1), which is in a good agreement (within +/-5%) to the Monte Carlo simulated data. The 2D- and 1D-anisotropy functions of the ADVANTAGE Pd-103 source were calculated for radial distances ranging from 0.5 to 5.0 cm. Radial dose function was determined for radial distances ranging from 0.2 to 8.0 cm using line source approximation. All these calculations are based on L(eff) equal to 3.61 cm, calculated following TG-43U1 recommendations. The tabulated data for 2D-anisotropy function, 1D-anisotropy function, dose rate constant and radial dose function have been produced for clinical application of this source model.

Treatment planning consideration for prostate implants with the new linear RadioCoil 103Pd brachytherapy source.

Recently, various linear source models, for example, 103Pd RadioCoil, have been introduced to overcome the shortcomings of traditional "seed" type interstitial prostate brachytherapy implants, such as migration and clumping of the seeds. However, the existing prostate treatment-planning systems have not been updated to perform dose calculation for implants with linear sources greater than 1.0 cm in length. In these investigations, two new models are developed for 3D dose calculation for a prostate implant with linear brachytherapy sources using the commercially available treatment-planning systems. The proposed models are referred to as the linear-segmented source (LSS) model and the point-segmented source (PSS) model. The calculated dose distributions obtained by these models for a single linear source have been validated by their comparison with the Monte Carlo-simulated data. Moreover, these models were used to calculate the dose distributions for a multilinear source prostate implant, and the results were compared to "seed" type implants. The results of these investigations show that the LSS model better approximates the linear sources than the PSS model. Moreover, these models have shown a better approximation of the dose distribution from a linear source for 0.5 cm source segments as compared to 1.0 cm source segments. However, for the points close to the longitudinal axis of the source located outside the region bounded by the active length, both models show differences of approximately +/-15%. These deficiencies are attributed to the limitations of the TG43 formalism for elongated sources.