Purpose: To assess the safety, efficacy and effectiveness of percutaneous radiofrequency (RF) thermal ablation to reduce symptoms of uterine fibroids. Materials and Methods: 17 premenopausal women with symptomatic ute...Purpose: To assess the safety, efficacy and effectiveness of percutaneous radiofrequency (RF) thermal ablation to reduce symptoms of uterine fibroids. Materials and Methods: 17 premenopausal women with symptomatic uterine fibroids despite conventional medical treatment were included. The assessment of symptoms and characteristics of fibroids by vaginal ultrasound, magnetic resonance imaging (MRI) and contrast enhanced ultrasound (CEUS) was performed before starting treatment and 6 months after the procedure. Successful treatment was clinically considered if patients reported a reduction in symptoms 6 months after RF myolysis. Successful treatment was also considered if the necrosis of the fibroid was greater than 50%, 6 months after treatment. Results: The baseline score on visual analogue scale (VAS) for dysmenorrhea and intermenstrual pain was 5.76 ± 3.31 and 3.0 ± 3.4, respectively. According to a score of 0 - 3, baseline bleeding during menstruation was 2.29 ± 0.92. Six months after RF myolysis, the VAS for dysmenorrhea was 2.75 ± 3.32 (p = 0.004), whereas for intermenstrual pain it was 1.38 ± 2.56 (p = 0.02). Menstrual bleeding was reduced to 1.13 ± 0.89 (p = 0.005). Clinical success of the treatment was evident in 11 (64.7%) of the 17 patients with a 95% CI [38.6%, 84.7%]. Fourteen patients underwent MRI monitoring 6 months post-myolysis. Compared to baseline fibroid volume, ultrasound and MRI volume were 57.38% and 79.66% six months after surgery, respectively. A total of 13 patients (92.86%) had radiological success from the treatment (95% CI [64.2%, 99.6%]). Conclusion: Since percutaneous RF myolysis reduces volume and symptoms of uterine fibroids, it may be considered as a valid treatment for symptomatic fibroids.展开更多
Percutaneous radiofrequency thermal ablation (RFA) is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include live...Percutaneous radiofrequency thermal ablation (RFA) is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn, hypoxemia, pneumothorax, subcapsular hematoma, hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child’s class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the Ⅲ segment. In the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection (PEI), or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.展开更多
AIM:To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).METHODS:Infected livers and lungs from slaughtered animals,10 bovine and two ovine,were ...AIM:To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).METHODS:Infected livers and lungs from slaughtered animals,10 bovine and two ovine,were collected.Cysts were photographed,and their volume,cyst content,germinal layer adhesion status,wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound.Some cysts were treated with RTA at 150 W,80℃,7 min.Temperature was monitored inside and outside the cyst.A second needle was placed inside the cyst for pressure stabilization.After treatment,all cysts were sectioned and examined by histology.Cysts were defined as alive if a preserved germinal layer at histology was evident,and as successfully treated if the germinal layer was necrotic.RESULTS:The subjects of the study were 17 cysts (nine hepatic and eight pulmonary),who were treated with RTA.Pathology showed 100% success rate in both hepatic (9/9) and lung cysts (8/8);immediate volume reduction of at least 65%;layer of host tissue necrosis outside the cyst,with average extension of 0.64 cm for liver and 1.57 cm for lung;and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.CONCLUSION:RTA appears to be very effective in killing hydatid cysts of explanted liver and lung.Bile duct and bronchial wall necrosis,persistence of endocyst attached to pericystium,should help avoid or greatly decrease in vivo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration,injection and reaspiration.In vivo studies are required to confirm and validate this new therapeutic approach.展开更多
Nowadays,hepatocellular carcinoma(HCC) is frequently diagnosed at an early stage,opening good perspectives to radical treatment by means of liver transplantation,surgical resection,or percutaneous ablation.Liver trans...Nowadays,hepatocellular carcinoma(HCC) is frequently diagnosed at an early stage,opening good perspectives to radical treatment by means of liver transplantation,surgical resection,or percutaneous ablation.Liver transplantation is considered the best option,but the lack of liver donors represents a major limitation.Therefore,surgical resection,offering a 5-year-survival rate of over 50%,is considered the first-choice treatment for patients with early stage HCC,whereas percutaneous ablation is usually reserved to patients who are not candidate to surgery.However,in the recent years some trials showed that percutaneous radiofrequency ablation(RFA) can be as effective as surgical resection in terms of overall survival and recurrencefree survival rates in patients with small HCC,and a retrospective comparative study reported 1-,3-,and 5-year overall survival rates and recurrence-free survival rates significantly better in patients with central HCC measuring 2 cm or smaller treated with RFA than in those treated with surgical resection.RFA is less expensive,less invasive,with lower complication rate and shorter hospital stay than surgical resection,and on the basis of the results of these studies it should be considered the first option in the treatment of very early HCC.However,RFA is size-dependent,so at present the need to achieve an adequate safety margin around the tumor limits to about 2 cm the diameter of the nodules that can be ablated with long-term outcomes comparable to or better than surgical resection.The main goal of the next technical developments of the thermal ablation systems should be the achievement of larger ablation areas with a single needle insertion.In this regard,the recent improvements in microwave energy delivery systems seem to open interesting perspectives to percutaneous microwave ablation,which could become the ablation technique of choice in the next future.展开更多
Loco-regional treatments for hepatocellular carcinoma(HCC) are important alternatives to curative transplantation or resection.Among them,radiofrequency ablation(RFA) is accepted as the most popular technique showing ...Loco-regional treatments for hepatocellular carcinoma(HCC) are important alternatives to curative transplantation or resection.Among them,radiofrequency ablation(RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity.The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver,American Association of Study of the Liver Disease and Japanese academic societies.Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival.The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller(< 3 cm) tumors.Currently,the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored.Here we review the ongoing technical advancements of RFA and future potential.展开更多
Many studies suggest that combined multimodality treatments including ablative therapies may achieve better outcomes than systemic chemotherapy alone in patients with colorectal liver metastases. Nevertheless,ablative...Many studies suggest that combined multimodality treatments including ablative therapies may achieve better outcomes than systemic chemotherapy alone in patients with colorectal liver metastases. Nevertheless,ablative therapies are not yet considered as effective options because their efficacy has never been proved by randomized controlled trials(RCT). However, there are in literature no trials that failed in demonstrating the effectiveness of ablative treatments: what are lacking, are the trials. All the attempts to organize phase Ⅲ studies on this topic failed as a result of non accrual. Just one prospective RCT comparing radiofrequency ablation combined with systemic chemotherapy vs chemotherapy alone has been published. It was designed as a phase Ⅲ study, but it was closed early because of slow accrual, and was downscaled to phase Ⅱ study, with the consequent limits in drawing definite conclusions on the benefit of combined treatment. However, the combination treatment met the primary end point of the study and obtained a significantly higher 3-year progression-free survival than systemic chemotherapy alone. It is very unlikely that ultimate efficacy of ablation treatments will ever be tested again, and the best available evidence points toward a benefit for the combination strategy using ablative treatments and chemotherapy.展开更多
The feasibility of using B-mode ultrasound image textures and pattern recognition technique to characterize the thermal coagulation in vitro during radiofrequency ablation was investigated. The changes of ultrasonic t...The feasibility of using B-mode ultrasound image textures and pattern recognition technique to characterize the thermal coagulation in vitro during radiofrequency ablation was investigated. The changes of ultrasonic textures in the different regions of samples varied with the heating time in the in-vitro experiments, which would result in that the coagulated and noncoagulated regions of tissue had different ultrasonic textures. Using support vector machine to extract the ultrasonic texture features and characterize the state of tissue, the size and boundaries of thermal lesions could be detected and measured more exactly than only using the gray scale information of B-mode ultrasound image. The proposed method would be applied to the image-guided radiofrequency ablation (IGRA) procedure for monitoring the thermal coagulation.展开更多
Hepatocellular carcinoma(HCC)is one of most common cancers that cause death in the world.Thermal ablation(TA)is an important alternative treatment method for HCC patients who are not appropriate for surgery or liver t...Hepatocellular carcinoma(HCC)is one of most common cancers that cause death in the world.Thermal ablation(TA)is an important alternative treatment method for HCC patients who are not appropriate for surgery or liver transplantation.Particularly for small and early HCCs,TA can be considered as the first-line curative treatment.However,local and distant recurrence rates are still high even though the TA equipment and technology develop rapidly.Immunotherapy is a novel systemic treatment method to enhance the anti-tumor immune response of HCC patients,which has the potential to reduce the tumor recurrence and metastasis.The combination of local TA and systemic immunotherapy for HCCs may be an ideal treatment for enhancing the efficacy of TA and controlling the recurrence.Herein we summarize the latest progress in TA,immunotherapy,and their combination for the treatment of patients with HCC and discuss the limitations and future research directions of the combined therapy.展开更多
Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,rec...Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,recent studies have reported complications associated with RFA.We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency.Regular surveillance of the patient detected a 3.5 cm HCC lesion.Because the patient had declined surgery,RFA was chosen for therapy.On the third post-procedural day,the laboratory results showed increases in his uric acid and potassium levels,which were compatible with a tumor lysis syndrome. On the 6th post-procedural day,the patient complained of new right knee pain.Subsequent joint aspiration revealed monosodium urate monohydrate crystals.We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation,which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines,the patient's right knee pain subsided andthe uric acid serum level returned to normal.This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency.To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC,early identification of patients at risk is warranted,such as those with a large tumor,rapid tumor growth,and renal insufficiency,and preventative measures should be considered.展开更多
Even with the advent of laparoscopic techniques for liver tumours,classic resections still represent a major undertaking for numerous liver lesions.The avoidance of surgery using ablative techniques has been the aim f...Even with the advent of laparoscopic techniques for liver tumours,classic resections still represent a major undertaking for numerous liver lesions.The avoidance of surgery using ablative techniques has been the aim for over 20 years.Large volumes can now be rapidly treated with low morbidity with the many technical developments and modifications of the delivery probes.Despite these advances recurrences rates remain high with all of the presently available techniques.The biological and pathophysiological basis underlying may help explain their limitations and are important in understanding where they may be appropriately applied and ways in which they may be improved in the future.展开更多
BACKGROUND The results of the heat irrigating effect of radiofrequency ablation(RFA)are uncertain,and the accurate impact of the heat irrigating effect on regional liver tissue is unknown due to a lack of control expe...BACKGROUND The results of the heat irrigating effect of radiofrequency ablation(RFA)are uncertain,and the accurate impact of the heat irrigating effect on regional liver tissue is unknown due to a lack of control experiments.AIM The aim of this study was to determine the influence of the heat irrigating effect of RFA on regional liver tissue in Bama miniature pigs.METHODS Eight Bama miniature pigs were randomly divided into the observation group(group A)and the control group(group B),with 4 pigs/group.An RFA electrode needle was implanted near the hepatic segment vasculature(3-5 mm from the hepatic segment portal vein)under ultrasound guidance in group A.Similarly,an RFA electrode needle was implanted far from the hepatic segment vasculature(8-10 mm from the hepatic segment portal vein)in group B.The left internal lobe and right medial lobe were chosen as RFA sites in each pig.RFA was performed at the left internal lobe on day one in each pig,and at the right medial lobe 7 d later.Each RFA lasted 12 min.The general status of the pigs and serious complications were observed during the perioperative period.The pigs were sacrificed and the livers were removed immediately after RFA on the eighth day.The samples were roughly observed.Hematoxylin-eosin and Ki67 staining,as well as TUNEL detection,were performed on the tissue sections.RESULTS All 8 animals successfully underwent ultrasound-guided RFA.No serious complications,such as massive hemorrhage,biliary fistula,severe pleural effusion,pneumothorax,peripheral organ failure,or renal failure occurred in any of the animals during the perioperative period.The RFA coagulative necrosis lesion was spherical and the surrounding liver tissue showed an inflammatory response.The difference in the Suzuki score of the liver tissue surrounding the ablated portal vein,and its distal area between groups A and B,was statistically significant(P<0.05).More apoptotic cells were seen in liver tissue surrounding the ablated portal vein and its distal area in group A,while fewer apoptotic cells in the same area were seen in group B.The difference in the apoptotic index of the above area between group A and group B was statistically significant(P<0.05).Cells staining positive for Ki67 were observed in liver tissue at the left internal lobe around the ablated portal vein and its distal area in group A.No Ki67 staining positive cells were observed in other tissue sections.The difference in the Ki67 staining positive index in the above area was statistically significant(P<0.05)between group A and group B.CONCLUSION Changes as a result of thermal damage occur in liver tissue around the ablated portal vein and its distal area due to the heat irrigating effect when the RFA electrode tip is close to(<5 mm)the portal vein.展开更多
Tendinosis is now understood as the result of a failed tendon healing process regardless of where it occurs in the body. Current noninvasive therapeutic alternatives are anti-inflammatory in nature and outcomes are un...Tendinosis is now understood as the result of a failed tendon healing process regardless of where it occurs in the body. Current noninvasive therapeutic alternatives are anti-inflammatory in nature and outcomes are unpredictable at best. The benefit of invasive alternatives resides in the induction of the healing response as demonstrated in pre-clinical and clinical studies in cardiology and orthopaedics. A new technology that employs noninvasivemonopolar capacitive-coupled radiofrequency (mcRF), has demonstrated the ability to raise temperatures in tendons and ligaments upwards of 50°C, the temperature threshold for collagen modulation and recruitment of macrophages, fibroblasts and Heat Shock Protein factors—without damaging the overlying structures—resulting in activation of the Wound Healing Response (WHR).展开更多
CEM43 thermal dose is a very common concept in thermal oncology.Thermal dose is the maximum amount of energy that can be transmitted during hyperthermia therapy conducted on temperature-sensitive tissue.Thermal dose i...CEM43 thermal dose is a very common concept in thermal oncology.Thermal dose is the maximum amount of energy that can be transmitted during hyperthermia therapy conducted on temperature-sensitive tissue.Thermal dose is also the maximum value of local energy accumulation in human bodies,which can lead to tissue injury and pain.Thermal dose can also decrease the finishing temperature and reduce the energy to the tolerable range.There are two functions of the individualized hyperthermia treatment plan:it determines the setting and location that can realize the best tumor hyperthermia therapy;at the same time,it can decrease the effect of hyperthermia therapy on healthy tissues.There are four steps in the treatment plan of hyperthermia therapy for tumors:the first step is to establish a three dimensional human body model and its corresponding an atomical structure that can be used in numerical algorithm via medical imaging resources;the second step is to determine the volume of the electromagnetic energy accumulation.Based on the peculiarity of frequency and materials,even full-wave electromagnetic wave or quasi-static technique can be used to determine the tissue distribution.Evaluation of the therapy can be conducted based on thermal dose and the corresponding tissue damage model;the third step is to use Arrhenius model to provide direct evaluation of tissues in the thermal ablation zone,solidification zone,as well as the necrotic area;the last step is the optimization of the treatment plan.展开更多
文摘Purpose: To assess the safety, efficacy and effectiveness of percutaneous radiofrequency (RF) thermal ablation to reduce symptoms of uterine fibroids. Materials and Methods: 17 premenopausal women with symptomatic uterine fibroids despite conventional medical treatment were included. The assessment of symptoms and characteristics of fibroids by vaginal ultrasound, magnetic resonance imaging (MRI) and contrast enhanced ultrasound (CEUS) was performed before starting treatment and 6 months after the procedure. Successful treatment was clinically considered if patients reported a reduction in symptoms 6 months after RF myolysis. Successful treatment was also considered if the necrosis of the fibroid was greater than 50%, 6 months after treatment. Results: The baseline score on visual analogue scale (VAS) for dysmenorrhea and intermenstrual pain was 5.76 ± 3.31 and 3.0 ± 3.4, respectively. According to a score of 0 - 3, baseline bleeding during menstruation was 2.29 ± 0.92. Six months after RF myolysis, the VAS for dysmenorrhea was 2.75 ± 3.32 (p = 0.004), whereas for intermenstrual pain it was 1.38 ± 2.56 (p = 0.02). Menstrual bleeding was reduced to 1.13 ± 0.89 (p = 0.005). Clinical success of the treatment was evident in 11 (64.7%) of the 17 patients with a 95% CI [38.6%, 84.7%]. Fourteen patients underwent MRI monitoring 6 months post-myolysis. Compared to baseline fibroid volume, ultrasound and MRI volume were 57.38% and 79.66% six months after surgery, respectively. A total of 13 patients (92.86%) had radiological success from the treatment (95% CI [64.2%, 99.6%]). Conclusion: Since percutaneous RF myolysis reduces volume and symptoms of uterine fibroids, it may be considered as a valid treatment for symptomatic fibroids.
文摘Percutaneous radiofrequency thermal ablation (RFA) is an effective and safe therapeutic modality in the management of liver malignancies, performed with ultrasound guidance. Potential complications of RFA include liver abscess, ascites, pleural effusion, skin burn, hypoxemia, pneumothorax, subcapsular hematoma, hemoperitoneum, liver failure, tumour seeding, biliary lesions. Here we describe for the first time a case of biliary gastric fistula occurred in a 66-year old man with a Child’s class A alcoholic liver cirrhosis as a complication of RFA of a large hepatocellular carcinoma lesion in the Ⅲ segment. In the light of this case, RFA with injection of saline between the liver and adjacent gastrointestinal tract, as well as laparoscopic RFA, ethanol injection (PEI), or other techniques such as chemoembolization, appear to be more indicated than percutaneous RFA for large lesions close to the gastrointestinal tract.
文摘AIM:To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).METHODS:Infected livers and lungs from slaughtered animals,10 bovine and two ovine,were collected.Cysts were photographed,and their volume,cyst content,germinal layer adhesion status,wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound.Some cysts were treated with RTA at 150 W,80℃,7 min.Temperature was monitored inside and outside the cyst.A second needle was placed inside the cyst for pressure stabilization.After treatment,all cysts were sectioned and examined by histology.Cysts were defined as alive if a preserved germinal layer at histology was evident,and as successfully treated if the germinal layer was necrotic.RESULTS:The subjects of the study were 17 cysts (nine hepatic and eight pulmonary),who were treated with RTA.Pathology showed 100% success rate in both hepatic (9/9) and lung cysts (8/8);immediate volume reduction of at least 65%;layer of host tissue necrosis outside the cyst,with average extension of 0.64 cm for liver and 1.57 cm for lung;and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.CONCLUSION:RTA appears to be very effective in killing hydatid cysts of explanted liver and lung.Bile duct and bronchial wall necrosis,persistence of endocyst attached to pericystium,should help avoid or greatly decrease in vivo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration,injection and reaspiration.In vivo studies are required to confirm and validate this new therapeutic approach.
文摘Nowadays,hepatocellular carcinoma(HCC) is frequently diagnosed at an early stage,opening good perspectives to radical treatment by means of liver transplantation,surgical resection,or percutaneous ablation.Liver transplantation is considered the best option,but the lack of liver donors represents a major limitation.Therefore,surgical resection,offering a 5-year-survival rate of over 50%,is considered the first-choice treatment for patients with early stage HCC,whereas percutaneous ablation is usually reserved to patients who are not candidate to surgery.However,in the recent years some trials showed that percutaneous radiofrequency ablation(RFA) can be as effective as surgical resection in terms of overall survival and recurrencefree survival rates in patients with small HCC,and a retrospective comparative study reported 1-,3-,and 5-year overall survival rates and recurrence-free survival rates significantly better in patients with central HCC measuring 2 cm or smaller treated with RFA than in those treated with surgical resection.RFA is less expensive,less invasive,with lower complication rate and shorter hospital stay than surgical resection,and on the basis of the results of these studies it should be considered the first option in the treatment of very early HCC.However,RFA is size-dependent,so at present the need to achieve an adequate safety margin around the tumor limits to about 2 cm the diameter of the nodules that can be ablated with long-term outcomes comparable to or better than surgical resection.The main goal of the next technical developments of the thermal ablation systems should be the achievement of larger ablation areas with a single needle insertion.In this regard,the recent improvements in microwave energy delivery systems seem to open interesting perspectives to percutaneous microwave ablation,which could become the ablation technique of choice in the next future.
文摘Loco-regional treatments for hepatocellular carcinoma(HCC) are important alternatives to curative transplantation or resection.Among them,radiofrequency ablation(RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity.The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver,American Association of Study of the Liver Disease and Japanese academic societies.Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival.The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller(< 3 cm) tumors.Currently,the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored.Here we review the ongoing technical advancements of RFA and future potential.
文摘Many studies suggest that combined multimodality treatments including ablative therapies may achieve better outcomes than systemic chemotherapy alone in patients with colorectal liver metastases. Nevertheless,ablative therapies are not yet considered as effective options because their efficacy has never been proved by randomized controlled trials(RCT). However, there are in literature no trials that failed in demonstrating the effectiveness of ablative treatments: what are lacking, are the trials. All the attempts to organize phase Ⅲ studies on this topic failed as a result of non accrual. Just one prospective RCT comparing radiofrequency ablation combined with systemic chemotherapy vs chemotherapy alone has been published. It was designed as a phase Ⅲ study, but it was closed early because of slow accrual, and was downscaled to phase Ⅱ study, with the consequent limits in drawing definite conclusions on the benefit of combined treatment. However, the combination treatment met the primary end point of the study and obtained a significantly higher 3-year progression-free survival than systemic chemotherapy alone. It is very unlikely that ultimate efficacy of ablation treatments will ever be tested again, and the best available evidence points toward a benefit for the combination strategy using ablative treatments and chemotherapy.
基金The National Basic Research Program ofChina (973 Program) (No2003CB716103)Key Project of Shanghai Science and Tech-nology Committee (No05DZ19509)
文摘The feasibility of using B-mode ultrasound image textures and pattern recognition technique to characterize the thermal coagulation in vitro during radiofrequency ablation was investigated. The changes of ultrasonic textures in the different regions of samples varied with the heating time in the in-vitro experiments, which would result in that the coagulated and noncoagulated regions of tissue had different ultrasonic textures. Using support vector machine to extract the ultrasonic texture features and characterize the state of tissue, the size and boundaries of thermal lesions could be detected and measured more exactly than only using the gray scale information of B-mode ultrasound image. The proposed method would be applied to the image-guided radiofrequency ablation (IGRA) procedure for monitoring the thermal coagulation.
基金the National Natural Science Foundation of China,No.81801802 and 81725008Shanghai Municipal Health Commission,No.2019LJ21 and No.SHSLCZDZK03502+1 种基金the Science and Technology Commission of Shanghai Municipality,No.19DZ2251100,No.19441903200,and No.18441905500Shanghai“Rising Stars of Medical Talent”Youth Development Program.
文摘Hepatocellular carcinoma(HCC)is one of most common cancers that cause death in the world.Thermal ablation(TA)is an important alternative treatment method for HCC patients who are not appropriate for surgery or liver transplantation.Particularly for small and early HCCs,TA can be considered as the first-line curative treatment.However,local and distant recurrence rates are still high even though the TA equipment and technology develop rapidly.Immunotherapy is a novel systemic treatment method to enhance the anti-tumor immune response of HCC patients,which has the potential to reduce the tumor recurrence and metastasis.The combination of local TA and systemic immunotherapy for HCCs may be an ideal treatment for enhancing the efficacy of TA and controlling the recurrence.Herein we summarize the latest progress in TA,immunotherapy,and their combination for the treatment of patients with HCC and discuss the limitations and future research directions of the combined therapy.
文摘Percutaneous radiofrequency thermal ablation(RFA) is considered an effective technique for providing local control in the majority of Hepatocellular carcinoma(HCC) patients.Although RFA is generally well tolerated,recent studies have reported complications associated with RFA.We describe a case of acute gouty arthritis in a 71-year-old man with chronic renal failure who was treated with RFA for a HCC lesion and who had hepatitis B-associated cirrhosis and mild renal insufficiency.Regular surveillance of the patient detected a 3.5 cm HCC lesion.Because the patient had declined surgery,RFA was chosen for therapy.On the third post-procedural day,the laboratory results showed increases in his uric acid and potassium levels,which were compatible with a tumor lysis syndrome. On the 6th post-procedural day,the patient complained of new right knee pain.Subsequent joint aspiration revealed monosodium urate monohydrate crystals.We made the diagnosis of acute gouty arthritis arising from tumor lysis and liver infarction caused by HCC ablation,which was aggravated by acute renal insufficiency. After adequate hydration and administration of oral colchicines,the patient's right knee pain subsided andthe uric acid serum level returned to normal.This is the first described case of acute gouty arthritis after RFA for a HCC lesion in a patient with underlying chronic renal insufficiency.To avoid hyperuricemia and an acute attack of gout after RFA therapy for HCC,early identification of patients at risk is warranted,such as those with a large tumor,rapid tumor growth,and renal insufficiency,and preventative measures should be considered.
文摘Even with the advent of laparoscopic techniques for liver tumours,classic resections still represent a major undertaking for numerous liver lesions.The avoidance of surgery using ablative techniques has been the aim for over 20 years.Large volumes can now be rapidly treated with low morbidity with the many technical developments and modifications of the delivery probes.Despite these advances recurrences rates remain high with all of the presently available techniques.The biological and pathophysiological basis underlying may help explain their limitations and are important in understanding where they may be appropriately applied and ways in which they may be improved in the future.
文摘BACKGROUND The results of the heat irrigating effect of radiofrequency ablation(RFA)are uncertain,and the accurate impact of the heat irrigating effect on regional liver tissue is unknown due to a lack of control experiments.AIM The aim of this study was to determine the influence of the heat irrigating effect of RFA on regional liver tissue in Bama miniature pigs.METHODS Eight Bama miniature pigs were randomly divided into the observation group(group A)and the control group(group B),with 4 pigs/group.An RFA electrode needle was implanted near the hepatic segment vasculature(3-5 mm from the hepatic segment portal vein)under ultrasound guidance in group A.Similarly,an RFA electrode needle was implanted far from the hepatic segment vasculature(8-10 mm from the hepatic segment portal vein)in group B.The left internal lobe and right medial lobe were chosen as RFA sites in each pig.RFA was performed at the left internal lobe on day one in each pig,and at the right medial lobe 7 d later.Each RFA lasted 12 min.The general status of the pigs and serious complications were observed during the perioperative period.The pigs were sacrificed and the livers were removed immediately after RFA on the eighth day.The samples were roughly observed.Hematoxylin-eosin and Ki67 staining,as well as TUNEL detection,were performed on the tissue sections.RESULTS All 8 animals successfully underwent ultrasound-guided RFA.No serious complications,such as massive hemorrhage,biliary fistula,severe pleural effusion,pneumothorax,peripheral organ failure,or renal failure occurred in any of the animals during the perioperative period.The RFA coagulative necrosis lesion was spherical and the surrounding liver tissue showed an inflammatory response.The difference in the Suzuki score of the liver tissue surrounding the ablated portal vein,and its distal area between groups A and B,was statistically significant(P<0.05).More apoptotic cells were seen in liver tissue surrounding the ablated portal vein and its distal area in group A,while fewer apoptotic cells in the same area were seen in group B.The difference in the apoptotic index of the above area between group A and group B was statistically significant(P<0.05).Cells staining positive for Ki67 were observed in liver tissue at the left internal lobe around the ablated portal vein and its distal area in group A.No Ki67 staining positive cells were observed in other tissue sections.The difference in the Ki67 staining positive index in the above area was statistically significant(P<0.05)between group A and group B.CONCLUSION Changes as a result of thermal damage occur in liver tissue around the ablated portal vein and its distal area due to the heat irrigating effect when the RFA electrode tip is close to(<5 mm)the portal vein.
文摘Tendinosis is now understood as the result of a failed tendon healing process regardless of where it occurs in the body. Current noninvasive therapeutic alternatives are anti-inflammatory in nature and outcomes are unpredictable at best. The benefit of invasive alternatives resides in the induction of the healing response as demonstrated in pre-clinical and clinical studies in cardiology and orthopaedics. A new technology that employs noninvasivemonopolar capacitive-coupled radiofrequency (mcRF), has demonstrated the ability to raise temperatures in tendons and ligaments upwards of 50°C, the temperature threshold for collagen modulation and recruitment of macrophages, fibroblasts and Heat Shock Protein factors—without damaging the overlying structures—resulting in activation of the Wound Healing Response (WHR).
文摘CEM43 thermal dose is a very common concept in thermal oncology.Thermal dose is the maximum amount of energy that can be transmitted during hyperthermia therapy conducted on temperature-sensitive tissue.Thermal dose is also the maximum value of local energy accumulation in human bodies,which can lead to tissue injury and pain.Thermal dose can also decrease the finishing temperature and reduce the energy to the tolerable range.There are two functions of the individualized hyperthermia treatment plan:it determines the setting and location that can realize the best tumor hyperthermia therapy;at the same time,it can decrease the effect of hyperthermia therapy on healthy tissues.There are four steps in the treatment plan of hyperthermia therapy for tumors:the first step is to establish a three dimensional human body model and its corresponding an atomical structure that can be used in numerical algorithm via medical imaging resources;the second step is to determine the volume of the electromagnetic energy accumulation.Based on the peculiarity of frequency and materials,even full-wave electromagnetic wave or quasi-static technique can be used to determine the tissue distribution.Evaluation of the therapy can be conducted based on thermal dose and the corresponding tissue damage model;the third step is to use Arrhenius model to provide direct evaluation of tissues in the thermal ablation zone,solidification zone,as well as the necrotic area;the last step is the optimization of the treatment plan.
