Comparison of SSS and SRS calculated from normal databases provided by QPS and 4D-MSPECT manufacturers and from identical institutional normals

Purpose There is proven evidence for the importance of myocardial perfusion-single-photon emission computed tomography (SPECT) with computerised determination of summed stress and rest scores (SSS/SRS) for the diagnosis of coronary artery disease (CAD). SSS and SRS can thereby be calculated semi-quantitatively using a 20-segment model by comparing tracer-uptake with values from normal databases (NDB). Four severity-degrees for SSS and SRS are normally used: <4, 4–8, 9–13, and ≥14. Manufacturers’ NDBs (M-NDBs) often do not fit the institutional (I) settings. Therefore, this study compared SSS and SRS obtained with the algorithms Quantitative Perfusion SPECT (QPS) and 4D-MSPECT using M-NDB and I-NDB. Methods I-NDBs were obtained using QPS and 4D-MSPECT from exercise stress data (450 MBq ^99mTc-tetrofosmin, triple-head-camera, 30 s/view, 20 views/head) from 36 men with a low post-stress test CAD probability and visually normal SPECT findings. Patient group was 60 men showing the entire CAD-spectrum referred for routine perfusion-SPECT. Stress/rest results of automatic quantification of the 60 patients were compared to M-NDB and I-NDB. After reclassifying SSS/SRS into the four severity degrees, kappa (κ) values were calculated to objectify agreement. Results Mean values (vs M-NDB) were 9.4 ± 10.3 (SSS) and 5.8 ± 9.7 (SRS) for QPS and 8.2 ± 8.7 (SSS) and 6.2 ± 7.8 (SRS) for 4D-MSPECT. Thirty seven of sixty SSS classifications (κ = 0.462) and 40/60 SRS classifications (κ = 0.457) agreed. Compared to I-NDB, mean values were 10.2 ± 11.6 (SSS) and 6.5 ± 10.4 (SRS) for QPS and 9.2 ± 9.3 (SSS) and 7.2 ± 8.6 (SRS) for 4D-MSPECT. Forty four of sixty patients agreed in SSS and SRS (κ = 0.621 resp. 0.58). Conclusion Considerable differences between SSS/SRS obtained with QPS and 4D-MSPECT were found when using M-NDB. Even using identical patients and identical I-NDB, the algorithms still gave substantial different results.     

Linac-based stereotactic radiosurgery and fractionated stereotactic radiotherapy with a micro-multileaf collimator for brain metastasis in the primary motor cortex

This study aimed to assess the clinical outcomes of linear accelerators (linac)-based, stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (fSRT) with a micro-multileaf collimator for brain metastasis in the primary motor cortex (BMPMC). Thirty-five consecutive patients with BMPMC who were treated by linac-based SRS or fSRT between January 2012 and March 2020 were analyzed. BMPMC was defined as a tumor located in the precentral gyrus on gadolinium-enhanced magnetic resonance imaging (MRI) and T2-weghted imaging (T2WI). In total, 35 patients with 37 metastases were analyzed. The median follow-up time was 13 (range: 1–97) months. The tumor volume was 0.05–26.5 (median: 0.62) cm³. All patients were treated with SRS or fSRT using 35 Gy with 7 Gy per fraction daily. The median survival time (MST) was 16.9 months. The pretreatment KPS and RPA class significantly differed in terms of MST on the log-rank tests. Seven symptomatic patients had hemiparesis before SRS or fSRT. All symptomatic patients, except one with facial paresis and one who died within 3 months, experienced improvement at a 3 month follow-up. None of the patients presented with persistent radiation injury at the final follow-up. Two patients presented with grade 3 radiation-related central nervous system necrosis, which was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. In BMPMC, SRS and fSRT had good tumor control and did not cause serious complications. Therefore, they are suitable treatment options with an acceptable safety profile.     

SRS MapCHECK与EDOSE在立体定向放疗计划剂量验证中的对比

目的:使用SRS MapCHECK和EDOSE对立体定向放疗(SRT)计划进行剂量验证,并比较它们的验证结果。方法:首先比较两种系统在不同方野(2 cm×2 cm、4 cm×4 cm、6 cm×6 cm、10 cm×10 cm)的γ通过率(3%/3 mm),然后选择29例SRT计划,分析两种系统在不同γ标准下的绝对剂量通过率,最后分析EDOSE建立的4种不同物理模型对SRT计划剂量验证的影响。结果:SRS MapCHECK在所有方野和29例SRT计划的绝对剂量γ通过率均高于EDOSE,两者的验证结果有统计学差异(P<0.05);SRS MapCHECK及EDOSE在29例SRT计划的γ通过率(2%/2 mm)分别是为98.60%±2.14%和96.53%±2.41%。基于EDOSE的不同物理模型验证结果有统计学差异,平均γ通过率(2%/2 mm)偏差为1.8%～5.1%。结论:SRS MapCHECK和EDOSE系统均满足SRT计划剂量验证的要求,且SRS MapCHECK的剂量验证通过率优于EDOSE;不同的EDOSE物理模型对SRT计划剂量验证有影响。     

椎间植骨融合加SRS 系统治疗腰椎滑脱症

目的 探讨运用Spondylolisthesis Reduction System(SRS)提拉复位系统加环锯取髂骨于椎体间行单侧或双侧植骨融合治疗峡部不连性腰椎滑脱症。方法 临床共治疗43例腰椎峡部不连性滑脱病人，按手术复位，症状改善，骨性融合，内固定材料牢固情况进行疗效评价。结果 43例患者获得1～5年(平均3年2个月)随访，按我们自拟疗效标准，优33例，良7例，可3例，无症状加重病例。完全复位38例。无内固定松动断裂发生。结论 环锯椎间植骨融合加SRS系统，能达到很好的复位及牢固的固定，从而达到椎间的骨性融合。手术操作简便，效果满意，如能采取双侧椎间同时植骨，增加融合面积，效果更佳。     

眼眶肿瘤立体定向放射外科治疗

目的 分析立体定向放射外科(stereotactic radiosurgery，SRS)治疗方法在眼眶肿瘤综合治疗中的作用和适应征。方法 利用γ刀、X刀两种立体定向放射外科治疗方法，对85例眼眶肿瘤病人进行放射治疗，其中，γ刀治疗76例(1995～2001年)，X刀治疗9例(2001年)。通过对31例γ刀治疗和9例X刀治疗患者的随访观察，分析γ刀、X刀中心治疗剂量、边缘剂量、等剂量范围与病变大小、位置和类型等因素对治疗效果的影响。结果 γ刀放射治疗平均边缘剂量36．60Gy(30～45．50Gy)，X刀平均边缘剂量40．67Gy(30．00～50．00Gy)。经γ刀治疗患者，有31例得到随访，平均随访时间24个月(3～120)，γ刀治疗后肿瘤缩小或消失者21例，有效率67．74％，肿瘤得到控制者3例，增大者1例，2例恶性肿瘤患者死亡，未作影像学检查者4例。24例脑膜瘤患者治疗前病变平均最大径为2.54cm，治疗后肿瘤缩小者16例，消失者1例，肿瘤无变化者3例，增大者1例。3例未作影像学检查；行2次γ刀治疗者2例。X刀治疗患者均为术后病人，包括：泪腺腺样囊性癌、腺癌、非何杰金氏淋巴瘤和泪腺混合瘤等，平均随访时间10个月(6～16)，除1例眶缘低分化腺癌治疗后6个月复发外。其余未见复发。结论 立体定向放射外科是眼眶肿瘤综合治疗中一种有效的方法。微侵袭性，并发症少。适用于：(1)眼眶内复杂的静脉性血管瘤；(2)视神经鞘脑膜瘤向视神经管内蔓延。眶内异位脑膜瘤及蝶骨嵴脑膜瘤，手术残留或患者视功能好，或者向颅内蔓延手术危险性大者；(3)眶后部肿瘤，特别是侵及眶尖者，患者对手术有顾虑，或术后瘤变残留者。(4)恶性肿瘤的综合治疗。     

脂质体阿霉素治疗SRS淋巴瘤小鼠的心脏病理变化

将阿霉素包封在多层脂质体中,与游离阿霉素比较,观察治疗SRS淋巴瘤小鼠过程中小鼠心脏的病理改变。当剂量均为15mg/kg时,光镜见游离阿霉素治疗组小鼠心肌组织单核细胞浸润,肌细胞肿胀,广泛空泡变性,易见细胞坏死;而脂质体阿霉素组仅见心肌细胞轻度肿胀,少见空泡变性,未见坏死。电镜观察到游离阿霉素组小鼠心肌细胞线粒体肿胀、破裂,肌丝断裂、溶解。而脂质体阿霉素组仅见局灶性肌丝片段丢失。结果表明,脂质体载药能明显降低阿霉素的心脏毒性。     

SRS淋巴瘤株癌基因表达筛选研究

研究ＳＲＳ鼠白血病／淋巴瘤克隆株（包括ＳＲＳ─８２亲系和ＳＡＣ─ⅡＢ２、ＳＡＣ─ⅡＣ３克隆株）癌基因和癌基因蛋白的表达，筛选此克隆株的癌基因表达谱型，为ＳＲＳ淋巴瘤株的实验性反义核酸治疗提供目标。用ＡＢＣ免疫组织化学方法筛选ＳＲＳ─８２亲系和ＳＡＣ─ⅡＢ２、ＳＡＣ─ⅡＣ３克隆株癌基因表达诺型。在ＳＲＳ克隆株中呈强表达的有ｃ─ｆｏｓ和ｃ─ｍｙｃ。ｃ─ｊｕｎ、ｒａｓ─ｐ２１和ｃ─ｅｒｂＢ─２呈中度表达，Ｐ５３和ｂｃｌ─２则不表达。同时用ＣＤ４和ＣＤ８细胞表面标记进研究，发现ＳＲＳ克隆株属于原始干细胞。结果提示：癌基因谱型的建立对ＳＲＳ淋巴瘤克隆株的实验性反义核酸治疗具有相当重要的作用，ｃ─ｆｏｓ和ｃ─ｍｙｃ可能是反义核酸治疗最好的癌基因靶。     

Analysis of morphological measurements of the trigeminal nerve in the linac stereotactic radiosurgery simulation targeting the root entry zone in trigeminal neuralgia

PurposeTo describe the anatomical measurements of the trigeminal nerve in patients with trigeminal neuralgia (TN) during Linac (linear accelerator)-based stereotactic radiosurgery (SRS) simulation, targeting the root entry zone (REZ), with a 30% isodose line tangential to the pons, using 4-mm and 6-mm collimators.MethodsIn this retrospective study, 53 TN patients, who underwent Fiesta sequence scanning prior to any treatment modality, were assessed. Bilateral measurements were obtained from the cisternal segment of the trigeminal nerve, the trigeminal-pontine angle, and the lateral width of the pontine cistern on the Fiesta MRI sequence. Linac-based SRS simulations were estimated with a radiation dosage of 90 Gy to 30% isodose line tangential to the pons, with both 4- and 6-mm collimators. Distances from the calculated targets to the pons and the Gasserian ganglion were measured for later analysis. The statistical analysis was performed comparing the affected side against the unaffected side.ResultsRight trigeminal nerve was affected in 36 patients (67.9%), and left one in 17 (32.1%) patients. The mean length of the trigeminal nerve was 9.8 mm (range: 4.6–16.8 mm) on the affected side, and 10.5 mm (range: 5.6–18.4 mm) on the unaffected side (p = .02). The mean trigeminal-pontine angle was 12.5° (range: 5.4° to 19.5°) on the affected side, and 10.2° (range: 5.0° to 30.5°) on the unaffected side (p = .01). In the simulations, the distances from the estimated targets to the pons and the Gasserian ganglion were not statistically different between sides. The variation of target-pons and target-ganglion distances was statistically significant on the affected side with the change of collimators (p < .001).ConclusionsIn this anatomical study, significant differences were identified in the length of the affected trigeminal nerve and trigeminal-pontine angle compared to the unaffected side in TN patients in Fiesta sequences prior to surgery or radiosurgery. Significant variation of the target location was found on the REZ between the 4- and 6-collimators during the Linac-based SRS simulations with the estimated radiation dosage of 90 Gy and 30% isodose line tangential to the pons.     

Which U.S. States’ Medicaid Programs Provide Coverage for Gender-Affirming Hormone Therapy and Gender-Affirming Genital Surgery for Transgender Patients?: A State-by-State Review,and a Study Detailing the Patient Experience to Confirm Coverage of Services

BackgroundTo date, a comprehensive state-by-state assessment of transgender transition-related health care coverage for gender-affirming hormone therapy (GAHT) and genital gender-affirming surgery (GAS) has not been reported.AimsThe aims of this study were 1) to verify which U.S. states’ Medicaid systems do/do not cover GAHT and GAS; 2) to assess the ease/difficulty for patients to determine whether GAHT and GAS are Medicaid-covered benefits; and 3) to understand possible state-related predictors of Medicaid coverage for gender-affirming care.MethodsWe reviewed the official Medicaid Handbook and website for all 51 states (+D.C.) and 5 territories to confirm whether GAHT and GAS are covered benefits. When indeterminate, we called the Medicaid office in each state, and for many, Medicaid managed care organizations (MCOs), and individual in-state providers, to confirm coverage. We recorded our experiences, number of, and duration of phone calls to confirm coverage.OutcomesThe main outcome was a definitive answer from the state/territory's Medicaid program or MCOs regarding whether GAHT and GAS are/are not covered benefits. Secondary outcome measures included responses we received and the total number/duration of phone calls necessary to confirm coverage.ResultsOnly 12 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAHT in their Medicaid Handbook/webpages. We confirmed that 34 of 51 state Medicaid programs do cover GAHT, whereas 9 of 51 states' and 2 of 5 territories’ do not. We could not confirm coverage of GAHT in 8 of 51 states and 3 of 5 territories.Only 26 of 51 states and 0 of 5 territories featured their policy regarding coverage for GAS in their Medicaid Handbook/webpages. We confirmed that 25 of 51 state Medicaid programs do cover GAS, whereas 22 of 51 states' and 3 of 5 territories’ do not. We could not confirm coverage of GAS in 4 of 51 states and 2 of 5 territories. Up to 12 calls, lasting up to 125 minutes, were required to confirm coverage for GAHT/GAS.Clinical ImplicationsOur findings indicate that important health care access barriers/disparities exist today and warrant improvement.Strengths & LimitationsTo our knowledge, this is the most comprehensive assessment of transgender transition-related health care coverage. Limitations include possible bias, as it could be that we were more persistent than actual patients would be to determine service coverage, and a lack of specificity regarding which specific hormone formulations or procedures are/are not covered.ConclusionOur findings show that only 34 of 51 (67%) states’ Medicaid programs include GAHT and 25 of 51 (49%) include GAS as covered benefits. Our experience suggests that the process to confirm coverage can be especially time-consuming and frustrating for patients.Zaliznyak M, Jung EE, Bresee C, et al. Which U.S. States’ Medicaid Programs Provide Coverage for Gender-Affirming Hormone Therapy and Genital Gender-Affirming Surgery for Transgender Patients?: A State-by-State Review, and a Study Detailing the Patient Experience to Confirm Coverage of Service. J Sex Med 2021;18:410–422.