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OBJECTIVE@#To evaluate the correlation of magnetic resonance (MR) T2-weighted image (T2WI) signal characteristics of adenomyosis and the efficacy of high-intensity focused ultrasound (HIFU) ablation.@*METHODS@#Based on the presence or absence of patchy hyperintense foci on preoperative MR T2WI, the patients with adenomyosis undergoing HIFU treatment were divided into homogeneous signal group and heterogeneous signal group, and the heterogeneous group was further divided into heterogeneous hypointense group and heterogeneous isointense group according to signal intensity of the lesions. The patients in heterogeneous signal group were matched with the patients in the homogeneous group at a 1:1 ratio using the propensity score matching, and similarly, the patients in the heterogeneous hypointense group were matched with those in the heterogeneous isointense group at a 1:1 ratio. The non-perfused volume ratio (NPVR) and relief of dysmenorrhea were used to assess the therapeutic efficacy in the 4 groups.@*RESULTS@#A total of 299 patients were enrolled, who had a median preoperative dysmenorrhea score of 7.0 (6.0, 8.0) and a median NPVR of 53.5% (35.4, 70.1)%. After propensity score matching, the NPVR in homogeneous signal group was significantly higher than that in heterogeneous signal group [(60.3 ± 21.8)% vs (44.6±21.6)%, P < 0.05]. At 3, 6 and 12 months after HIFU, dysmenorrhea relief rates were higher in homogeneous signal group than in heterogeneous signal group, and the difference was statistically significant at 12 months (91.1% vs 76.8%, P < 0.05). The NPVR of heterogeneous hypointense group was higher than that of heterogeneous isointense group [(54.0±22.0) % vs (47.3± 22.9) %, P < 0.05]. At 6 months after HIFU, dysmenorrhea relief rate was significantly higher in heterogeneous hypointense group than in heterogeneous isointense group (91.5% vs 80.9%, P < 0.05).@*CONCLUSION@#The signal characteristics of adenomyosis on T2WI are closely related with the outcome of HIFU ablation, and its efficacy is better for homogeneous than for heterogeneous adenomyosis, and better for heterogeneous hypointense adenomyosis than for heterogeneous isointense adenomyosis.
Subject(s)
Female , Humans , Adenomyosis/pathology , Dysmenorrhea , Cohort Studies , Propensity Score , High-Intensity Focused Ultrasound Ablation/methods , Treatment OutcomeABSTRACT
ABSTRACT Objective: To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. Method: Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. Results: The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. Conclusion: The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.
RESUMEN Objetivo: Analizar los costos directos de materiales, medicamentos/soluciones y profesionales de la salud necesarios para tratar a hombres con cáncer de próstata a través de High Intensity Focused Ultrasound. Método: Investigación cuantitativa, exploratoria-descriptiva, tipo estudio de caso único. Los datos se obtuvieron de registros médicos electrónicos/documentación impresa del Centro Quirúrgico de un hospital público de enseñanza e investigación. Los profesionales de la salud estimaron el tiempo respectivo dedicado a las actividades en las siguientes etapas: "Antes de la inducción anestésica", "Antes de realizar la ablación térmica", "Durante la realización de la ablación térmica" y "Después de realizar la ablación térmica". Los costos se calcularon multiplicando el tiempo (estimado) invertido por el costo unitario de la mano de obra directa, sumándolo al costo medido de materiales, medicamentos/soluciones. Resultados: Los costos medidos con materiales correspondieron a US$851,58 (DE = 2,17), con medicamentos/soluciones a US$72,13 (DE = 25,84) y los costos de personal estimados a US$196,03, totalizando US$1119,74/procedimiento. Conclusión: Los resultados económicos obtenidos podrán apoyar a los gestores hospitalarios en el proceso de toma de decisiones respecto a la adopción del High Intensity Focused Ultrasound para el tratamiento del cáncer de próstata.
RESUMO Objetivo: Analisar os custos diretos com materiais, medicamentos/soluções e profissionais de saúde requeridos à realização do tratamento de homens com câncer de próstata via High Intensity Focused Ultrasound. Método: Pesquisa quantitativa, exploratória-descritiva, do tipo estudo de caso único. Coletaram-se os dados em prontuários eletrônicos/documentações impressas do Centro Cirúrgico de um hospital público de ensino e pesquisa. Profissionais de saúde estimaram os respectivos tempos despendidos em atividades constantes das etapas: "Antes da indução anestésica", "Antes da execução da termoablação", "Durante a execução da termoablação" e "Após a execução da termoablação". Calcularam-se os custos multiplicando-se o tempo (estimado) despendido pelo custo unitário da mão de obra direta, somando-se ao custo mensurado dos materiais, medicamentos/soluções. Resultados: Os custos mensurados com materiais corresponderam a US$851,58 (DP = 2,17), com medicamentos/soluções a US$72,13 (DP = 25,84) e os custos estimados com pessoal a US$196,03, totalizando US$1119,74/procedimento. Conclusão: Os resultados econômicos obtidos poderão subsidiar os gestores hospitalares no processo decisório quanto à adoção do High Intensity Focused Ultrasound para o tratamento do câncer de próstata.
Subject(s)
Humans , Male , Prostatic Neoplasms , Costs and Cost Analysis , Direct Service Costs , Ultrasound, High-Intensity Focused, Transrectal , Therapeutic Uses , Hospital CareABSTRACT
Prostate cancer is now the second most common malignancy in men worldwide, with an increasing incidence in China. Most prostate cancer patients receive whole-gland therapy after diagnosis, but patients with localized prostate cancer may not benefit from the treatment due to side effects. With the development of imaging technology and the theory of "index lesion," focal therapy has been greatly developed, which includs high intensity focused ultrasound, focal laser ablation, cryotherapy, irreversible electroporation and photodynamic therapy. This study reviews the clinical trials in recent years and reveals that high intensity focused ultrasound and focal laser ablation have better failure-free survival and postoperative functional control compared with other focal therapy techniques.
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Objective:To prepare the resiquimod-loaded lipid microbubbles R848-MBs, evaluate their enhanced ultrasound imaging and high intensity focused ultrasound (HIFU) ablation effects, and explore their ability to improve tumor immune microenvironment synergize with HIFU.Methods:R848-MBs were prepared by the thin film hydration-mechanical shock method; The basic characteristics and safety of R848-MBs were detected, the HIFU controlled-release characteristics were verified in vitro and the drug metabolism and biological distribution were investigated in vivo. The ability of enhancing ultrasound imaging was observed in vitro and in vivo. To investigate the enhanced HIFU ablation effect of R848-MBs, six EMT6 tumor-bearing mice were randomly divided into HIFU group and R848-MBs+ HIFU group, three mice in each group, the changes in contrast average sound intensity before and after ablation in mouse tumor areas and the change of ultrasound image gray value in tumor area were evaluated, the tumor were resected to observe the coagulative necresis by TTC staining and HE staining. Forty-five tumor-bearing mice were randomly divided into control group, Free R848 group, HIFU group, Blank-MBs+ HIFU group and R848-MBs+ HIFU group, nine mice in each group. On the third day after treatment, 3 mice in each group were randomly selected and killed, to evaluate the ability of R848-MBs to improve tumor immune microenvironment synergize with HIFU. The expression level of CRT on the surface of tumor cells were detected by immunofluorescence staining, the proportion of mature DC in lymph nodes, spleen, and CD8 + T cells in spleen were detected by flow cytometry. The treatment effectiveness of each group( n=6) were evaluated by measuring tumor volume, observing and drawing survival curves. Results:The R848-MBs lipid microbubbles with good safety were successfully prepared, with a concentration of 2.58×10 9/ml, as spherical bubbles under optical microscope and laser confocal microscopy, in a particle size of (1.72±0.11)μm, at a surface potential of (-10.16±0.73)mV. The cumulative drug release was up to 83.44% after HIFU (90 W, 3 s) in vitro. The concentration of R848 in plasma decreased rapidly, and the drug concentration in tumor tissue of the R848-MBs+ HIFU group was higher than that of the R848 group 24 hours after treatment ( P<0.01). The ultrasound imaging of R848-MBs was significantly enhanced in contrast mode in vitro and in vivo; R848-MBs can significantly enhance the HIFU ablation effect, the contrast average sound intensity change in the tumor area before and after ablation in the R848MBs+ HIFU group was greater than that in the R848 group ( P<0.05), and the immediate ultrasound grayscale value change in the HIFU+ R848-MBs group was 46.34±3.21, which was significantly greater than that in the HIFU group (10.67±1.53), with statistical significance ( P<0.000 1). Coagulation necrosis was observed in tumor HE staining and TTC staining. The results of treatment efficacy in vivo showed that R848-MBs+ HIFU group had the strongest therapeutic effect, and R848-MBs combined with HIFU treatment could significantly prolong the survival period of mice compared with intravenous injection of free R848 ( P<0.01). Immunofluorescence staining and flow cytometry results showed an increase in the expression level of CRT on the surface of tumor tissue in the R848-MBs combined with HIFU group, and the percentage of mature DC in tumor draining lymph nodes (58.53±1.04)% were significantly higher than those in the HIFU group (37.56±2.13)% ( P<0.001), and the percentage of mature DC in the spleen (70.65±1.91)% were significantly higher than those in the HIFU group (36.46±3.89)% ( P<0.001), the percentage of CD8 + T cells in the spleen (27.46±3.04)% was significantly higher than that in the HIFU group (18.69±0.29)% ( P<0.01). Conclusions:The HIFU controlled-release lipid microbubbles R848-MBs can not only enhance the efficiency of HIFU ablation, but also improve the tumor immune microenvironment.
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ABSTRACT Purpose: Prostate cancer (PCa) is the second most common oncologic disease among men. Radical treatment with curative intent provides good oncological results for PCa survivors, although definitive therapy is associated with significant number of serious side-effects. In modern-era of medicine tissue-sparing techniques, such as focal HIFU, have been proposed for PCa patients in order to provide cancer control equivalent to the standard-of-care procedures while reducing morbidities and complications. The aim of this systematic review was to summarise the available evidence about focal HIFU therapy as a primary treatment for localized PCa. Material and methods: We conducted a comprehensive literature review of focal HIFU therapy in the MEDLINE database (PROSPERO: CRD42021235581). Articles published in the English language between 2010 and 2020 with more than 50 patients were included. Results: Clinically significant in-field recurrence and out-of-field progression were detected to 22% and 29% PCa patients, respectively. Higher ISUP grade group, more positive cores at biopsy and bilateral disease were identified as the main risk factors for disease recurrence. The most common strategy for recurrence management was definitive therapy. Six months after focal HIFU therapy 98% of patients were totally continent and 80% of patients retained sufficient erections for sexual intercourse. The majority of complications presented in the early postoperative period and were classified as low-grade. Conclusions: This review highlights that focal HIFU therapy appears to be a safe procedure, while short-term cancer control rate is encouraging. Though, second-line treatment or active surveillance seems to be necessary in a significant number of patients.
Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/pathology , Ultrasound, High-Intensity Focused, Transrectal/methods , Treatment Outcome , Salvage Therapy/methods , Neoplasm Recurrence, Local/surgeryABSTRACT
@#AIM: To compare the therapeutic effects of high-intensity focused ultrasound cycloplasty(UCP)and cyclocryotherapy on refractory glaucoma.<p>METHODS:This retrospective study included 45 patients(81 eyes)with refractory glaucoma admitted to the hospital between January 2017 and December 2020. According to the treatment method, patients enrolled were divided into cyclocryotherapy group(22 patients, 40 eyes)and high-intensity UCP group(23 patients, 41 eyes). Changes in intraocular pressure at 1d, 1wk, 1 and 3mo after operation were compared between the two groups. The Numerical Rating Scale(NRS)was used to evaluate eyeball pain. Surgical results and complications in the two groups were compared. <p>RESULTS:The total effective rate of operation in the high-intensity UCP group was significantly higher than that in the control group(<i>P</i><0.05). Generalized estimation equation analysis showed that there were statistically significant differences in intraocular pressure and eyeball pain between the two groups before and after operation(all <i>P</i><0.05). There were statistically significant differences in intraocular pressure and eyeball pain between the two groups at different time points after operation(all <i>P</i><0.05). The incidence rates of complications such as conjunctival hyperemia, corneal edema, anterior chamber inflammatory exudation, reactive intraocular hypertension and hyphema in the high-intensity UCP group were significantly lower than those in the cyclocryotherapy group(<i>P</i><0.05).<p>CONCLUSION: High-intensity UCP is effective in the treatment of refractory glaucoma, with obvious advantages in reducing intraocular pressure, eyeball pain and complications as compared with cyclocryotherapy.
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Objective:To investigate the relationship between the clinical efficacy and the ablated area of endometrium in patients with internal adenomyosis treated with focused ultrasound ablation surgery (FUAS).Methods:From January 2015 to December 2018, 122 patients in Chongqing Haifu Hospital who were diagnosed as internal adenomyosis through history, clinical symptoms and enhanced magnetic resonance imaging (MRI) and treated with FUAS were enrolled in this study. According to the patient′s wishes, patients were given whether to ablate the adenomyotic lesion alone or ablate the adenomyotic lesion and the endometrium that involved in adenomyotic lesions together. The ablated area of adenomyotic lesions and endomitrium were evaluated by post-FUAS enhanced MRI. The adverse events and the changes of dysmenorrhea and menstrual volume at different follow-up points within 24 months were recorded.Results:Among the 122 patients, 32 patients chose to ablate adenomyotic lesion alone, and 90 patients chose to ablate the adenomyotic lesion and the endometrium during FUAS. No major complications such as bowel injury and nerve injury occurred after FUAS. The median non-perfused volume ratio of adenomyotic lesions was 31.7% in the group without endometrial ablation and it was 60.0% in the group with endometrium ablation ( P<0.01). The improvement of dysmenorrhea in the group with endometrium ablation was significantly better than the group without endometrial ablation ( P<0.01). The average menstrual volume score (3.4±0.9) before FUAS in the group with endometrial ablation was higher than that in the group without endometrial ablation (2.5±0.6; P<0.01), but it decreased significantly after FUAS treatment, reaching the similar menstrual volume score of the group without endometrial ablation ( P>0.05). The proportions of abnormal vaginal discharge (34.4%, 31/90) and bleeding (16.7%, 15/90) were significantly higher in the group with endometrium ablation than those in the group without endometrial ablation (all P<0.01). Conclusions:FUAS could be safely and effectively used in the treatment of patients with internal adenomyosis. It seems that ablation of adenomyotic lesion and endometrium together could obtain better therapeutic effects.
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Objective:To investigate the clinical effect of focused ultrasound ablation surgery (FUAS) combined with suction curettage for mass-type cesarean scar pregnancy (CSP) and to analyze the influencing factors of vaginal bleeding and readmission.Methods:From January 2014 to December 2020, 88 patients with mass-type CSP were treated by FUAS combined with suction curettage in the Third Xiangya Hospital of Central South University. The clinical results and the influencing factors of bleeding and readmission for mass-type CSP were analyzed.Results:All the patients underwent one time FUAS treatment successfully. Immediately after FUAS treatment, color Doppler ultrasound showed obvious necrosis and no perfusion area in all lesions, and the blood flow in the mass-type CSP tissue significantly decreased. The median volume of blood loss in the procedure was 20 ml (range: 5-950 ml). Thirteen patients (15%, 13/88) had vaginal bleeding≥200 ml, and 15 patients (17%, 15/88) were hospitalized again. The average time for menstruation recovery was (28±8) days (range: 18-66 days). The average time needed for serum human chorionic gonadotropin-beta subunit to return to normal levels was (22±6) days (range: 7-59 days). The risk of large vaginal bleeding of patients were related to the blood supply of the mass ( OR=5.280, 95% CI: 1.335-20.858, P=0.018) and the largest diameter of the mass ( OR=1.060, 95% CI: 1.010-1.120, P=0.030). The risk of readmission were related to the largest diameter of the mass ( OR=1.055, 95% CI: 1.005-1.108, P=0.030) and the depth of the uterus cavity ( OR=1.583, 95% CI: 1.015-2.471, P=0.043). No serious complications such as intestinal and nerve injury occurred during and after FUAS treatment. Conclusions:FUAS combined with suction curettage is safe and effective in treating patients with mass-type CSP through this preliminary study. The volume of vaginal bleeding are associated with the blood supply of the mass and the largest diameter of the mass, the risk of readmission are related to the largest diameter of the mass and the depth of the uterus cavity.
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Objective:To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids.Methods:A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups.Results:The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups ( χ2 =0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion:Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.
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Objective:To evaluate the effect of different concentrations of sevoflurane inhalation anesthesia on hepatic blood flow in children with hepatoblastoma (HB).Methods:A total of 22 children who underwent radical resection of HB in Shanxi Children's Hospital from January 2019 to August 2021 were perspectively enrolled, including 15 males and 7 females, with an average age of 17±7 months. There were 19 normal children undergoing ultrasound examination without other systemic diseases who received hernia, cryptorchidism, hydrocele of tunica vaginalis surgery during the same period, including 11 males and 8 females, with an average age of 18±5 months. After inhaling different concentrations of sevoflurane preoperatively and intraoperatively, ultrasound apparatus was used to detect the hepatic blood flow (HBF) in HB children. The portal blood flow (PBF), hepatic artery blood flow (HABF), PBF/HABF and HBF were compared between HB children and non-HB children before operation and after inhalation of 1% sevoflurane, 2% sevoflurane.Results:Compared with non-HB children, children with HB had lower PBF [41.9 ml/min (26.8 ml/min, 63.1 ml/min) vs. 66.7 ml/min (41.4 ml/min, 137.2 ml/min), Z = -2.62, P = 0.008], increased HABF [31.2 ml/min (20.4 ml/min, 50.3 ml/min) vs. 12.9 ml/min (5.5 ml/min, 25.0 ml/min), Z = -3.59, P < 0.001], decreased PBF/HABF [1.3 (1.2, 1.4) vs. 6.1 (5.0, 7.5), Z = -5.68, P < 0.001], and the difference in HBF between the both groups was statistically significant ( P>0.05). Compared with the 2% sevoflurane HB group, PBF was reduced [41.1 ml/min (25.0 ml/min, 62.0 ml/min) vs. 63.0 ml/min (40.5 ml/min, 78.3 ml/min), Z = -2.09, P = 0.036] and PBF/HABF was reduced [1.3 (1.1,1.5) vs. 1.8 (1.6, 1.9), Z = -4.01, P<0.001] in the 1% sevoflurane group, and the differences in HABF and HBF were statistically significant (all P>0.05). Conclusion:Relatively low concentration of sevoflurane reduces HBF by reducing PBF for HB children after radical surgery.
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Objective:To evaluate the use of ulthera in carotid body tumor resectionMethods:From Jun 2004 to Jun 2019 at the First Hospital of China Medical University. Forty-three shamblin grade Ⅱ or Ⅲ patients were retrospectively assigned to ulthera assisted carotid body tumor resection (26 cases) and traditional carotid body tumor resection (17 cases).Results:In ulthera assisted group, the average tumor diameter was (4.0±0.6) cm, compared to (3.9±0.9) cm in traditional carotid body tumor surgery group, P=0.875. The operation time of the two group was respectively (117.6±39.8) min and (149.4±55.0) min ( P=0.005), blood loss (145.7±70.6) ml vs. (194.1±80.7) ml ( P=0.006), hospital stay was (16.8±7.5) d vs. (22.7±13.0) d ( P=0.017), and following-up period was between 6 and 180 months. One patient relapsed in ulthera assisted group. The postoperative complications occurred in 8 and 7 cases respectively. Conclusion:Ulthera assisted carotid body tumor resection helps shorten operation time, hospital stay and decrease intraoperative blood loss.
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Tumor-targeted immunotherapy is a remarkable breakthrough, offering the inimitable advantage of specific tumoricidal effects with reduced immune-associated cytotoxicity. However, existing platforms suffer from low efficacy, inability to induce strong immunogenic cell death (ICD), and restrained capacity of transforming immune-deserted tumors into immune-cultivated ones. Here, an innovative platform, perfluorooctyl bromide (PFOB) nanoemulsions holding MnO2 nanoparticles (MBP), was developed to orchestrate cancer immunotherapy, serving as a theranostic nanoagent for MRI/CT dual-modality imaging and advanced ICD. By simultaneously depleting the GSH and eliciting the ICD effect via high-intensity focused ultrasound (HIFU) therapy, the MBP nanomedicine can regulate the tumor immune microenvironment by inducing maturation of dendritic cells (DCs) and facilitating the activation of CD8+ and CD4+ T cells. The synergistic GSH depletion and HIFU ablation also amplify the inhibition of tumor growth and lung metastasis. Together, these findings inaugurate a new strategy of tumor-targeted immunotherapy, realizing a novel therapeutics paradigm with great clinical significance.
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ABSTRACT Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
Subject(s)
Humans , Male , Aged , Prostatic Neoplasms/surgery , Prostatic Neoplasms/diagnostic imaging , Multiparametric Magnetic Resonance Imaging , Retrospective Studies , Ultrasonography , Treatment Outcome , Prostate-Specific AntigenABSTRACT
Objective: To explore the impact of MR T2WI high signal rim sign (T2-rim sign) on the immediate efficacy of high intensity focused ultrasound (HIFU) in treatment of uterine myoma. Methods: Data of 360 uterine myoma patients treated with HIFU were retrospectively analyzed. The ablation effect was judged based on the percentage of non-perfusion area (NPV) of myoma after HIFU treatment and the volume of myoma before treatment (NPV%). According to the exist of preoperative MR T2-rim sign, the patients were divided into T2-rim sign group (with T2-rim sign) and no T2-rim sign group (without T2-rim sign). Univariate and multivariate Logistic analysis were performed to evaluate the impact of NPV%. Results: Immediately after ablation, contrast-enhanced ultrasound showed a marked reduction in blood supply of myoma, with 60 cases NPV%<75% and 300 cases NPV%≥75%, and significant differences of myoma location, irradiation time, treatment intensity, MR T2WI signal intensity and with or without T2-rim sign were found between them (all P<0.05). NPV% was correlated with MR T2WI signal intensity, T2-rim sign, irradiation time and treatment intensity (all P<0.05). The irradiation time, treatment intensity and T2-rim sign were independent risk factors for NPV% (all P<0.05). Compared with no T2-rim sign group, the irradiation time and treatment intensity of T2-rim sign group all increased (both P<0.05) and NPV% decreased (P<0.05). Conclusion: T2-rim sign is one of the impact factors of immediate therapeutic responses of HIFU ablation for uterine myoma. Uterine myoma patients with T2-rim sign are able benefit from HIFU.
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Objective: To explore a method to improve the identification rate of tissue degeneration caused by high intensity focused ultrasound (HIFU) based on ultrasound combining with generalized regression neural network (GRNN). Methods: Totally 300 fresh isolated pork tissue samples were selected and irradiated at different HIFU doses, then 150 denatured and 150 undenatured samples were obtained. Ultrasonic images of the samples were collected before and after irradiation, then ultrasonic subtraction images were obtained. A total of 18 characteristic parameters of ultrasonic subtractive images were extracted using gray-gradient co-occurrence matrix and gray difference statistical methods, and the best characteristic vectors were obtained with P-value significance detection method and Euclidean distance method. Among 300 samples, 198 were taken as training samples and 102 as test samples. After recognition of training samples, the feature vectors eliminated with P-value significance detection method and 2 feature vectors with the smallest Euclidean distance were taken as control group of the best feature vectors, and then were input into GRNN respectively for recognition of tissue denaturation. Correct recognition rate and total recognition rate of test samples were calculated using combining feature vectors with GRNN. Results: The best feature vectors were non-uniformity of gray distribution and non-uniformity of gradient distribution, and the total recognition rate was 90.20% and 91.18% combining with GRNN, respectively, which increased to 98.04% when both 2 best characteristic parameters combined GRNN. The feature vectors eliminated using P-value significance detection method were average value and contrast, and the total recognition rate combining with GRNN was 48.04% and 75.49%, respectively, which became 79.41% when both 2 best characteristic parameters combined GRNN. The feature vectors with the smallest euclide distance were energy and small gradient, and the total recognition rate combining with GRNN was 88.24% and 89.22%, respectively, which remained 89.22% when both 2 of them combined with GRNN. The recognition rate of the optimal feature vectors combined with GRNN for tissue denaturation was significantly higher than that of control group. Conclusion: Based on ultrasonic subtraction images, of pork tissue irradiated with HIFU, non-uniformity of gray distribution and non-uniformity of gradient distribution combined with GRNN can both improve the recognition rate of tissue denaturation, while the combination of them and GRNN is more effective in identifying tissue denaturation induced by HIFU.
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ObjectiveTo evaluate the clinical effect and safety of high-intensity focused ultrasound (HIFU) combined with gemcitabine in the treatment of advanced pancreatic cancer. MethodsSCI, Cochrane Library, Embase, PubMed, Wanfang Data, CNKI, CBM, and VIP were searched for randomized controlled trials (RCTs) of HIFU combined with gemcitabine in the treatment of advanced pancreatic cancer, with the assistance of expanded search, and these RCTs were screened according to the inclusion criteria. Review Manager 5.3 was used to perform the Meta-analysis. A fixed effects model was used for non-heterogeneous data; heterogeneity was explained by subgroup analysis based on intervention methods, and if it could not be explained by subgroup analysis, a random effects model was used. Relative risk (RR) and 95% confidence interval (CI) were used as evaluation indices, and funnel plots were generated based on the outcome measure involved in the highest number of studies. ResultsA total of 8 RCTs with 474 patients were included. The patients in the experimental group received gemcitabine-based chemotherapy and HIFU, and those in the control group received gemcitabine-based chemotherapy alone. Compared with the control group, the experimental group had significantly better results in 3-, 6-, and 12-month survival rates (3-month: RR=1.07, 95%CI: 1.00-1.14, P＜0.05; 6-month: RR=2.19, 95%CI: 1.75-2.75, P＜0.05; 12-month: RR=235, 95%CI: 1.07-5.14, P＜0.05), tumor control (RR=1.64, 95%CI: 1.21-2.24, P=0.002), and pain control (RR=3.15, 95%CI: 2.45-4.05, P＜0.05). There were no significant differences between the two groups in the incidence rates of leukopenia (RR=1.05, 95%CI: 0.85-1.30, P＞0.05), gastrointestinal reactions (RR=0.89, 95%CI: 0.56-1.42, P＞0.05), and liver injury (RR=1.29, 95%CI: 0.95-1.75, P＞0.05). Since the outcome measure of pain control was involved in the highest number of studies, funnel plots were generated and showed no significant risk of bias. ConclusionCompared with gemcitabine alone, HIFU combined with gemcitabine can increase patients’ survival rate and improve their symptoms, with a similar incidence rate of adverse effects. Further studies are needed for this combined therapy.
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@#AIM: To evaluate the efficacy and safety of ultrasound cycloplasty(UCP)in the treatment of neovascular glaucoma(NVG).<p>METHODS: Thirty patients(30 eyes)with NVG who were treated with UCP at our hospital from January 2018 to December 2018 were collected. All patients received comprehensive ophthalmic examination. Visual acuity, best corrected visual acuity(BCVA), intraocular pressure(IOP), pain grade score, ocular surface, number of glaucoma drugs and complications were recorded before and 1, 3d, 1wk and 1, 2, 3, 6mo after operation, and the efficacy and safety were evaluated.<p>RESULTS: The postoperative visual acuity was improved, the pain score was decreased, and the use of intraocular pressure-lowering drugs was decreased and the IOP decreased significantly(<i>P<0.01). </i>The preoperation visual acuity, pain score, use of intraocular pressure-lowering drugs and IOP was \〖1.63±0.59(LogMAR)\〗, \〖2(1,4)\〗, \〖4(4,4)\〗 and(44.19±13.72)mmHg. The postoperative IOP were decreased at different observation time within 6mo, and the differences with preoperative IOP were statistically significant(all <i>P</i><0.01). The IOP decrease rates were 57.32%, 56.45%, 56.82%, 55.64%, 52.37%, 50.20% and 49.18% on 1d, 3d, 1wk, 1mo, 2mo, 3mo and 6mo after surgery respectively. On 6mo after treatment, 8 eyes(31%)IOP were complete controlled, 7 eyes(27%)were partially controlled, 11 eyes(42%)cannot be controlled, and 4 eyes were lost to follow-up. The IOP reduction on 6mo of postoperation was significantly correlated with that of preoperation(<i>r=0.928, P<0.001)</i>. The number of glaucoma drugs and pain scores were decreased, and the differences with that of preoperation were statistically significant(<i>P</i><0.01), and the BCVA were improved, the differences were statistically significant(<i>P</i><0.01). There was no serious complications were occurred in all patients after operation. <p>CONCLUSION: UCP is high safety and few complications for NVG treatment. It has significant effect on reducing IOP, relieving ocular pain. The higher the preoperation IOP, the greater the IOP reduction after surgery. It was a promising anti-glaucoma method.
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Objective: The aim of the study is to evaluate the effectiveness of ultrasound (US)-guided interventional treatments in local tumor control (LTC) for thoracoabdominal wall seeding tumor (TAWST) from hepatocellular carcinoma (HCC), and explore the survival outcomes of the patients underwent surgical resection (SR) and microwave ablation (MWA) for intrahepatic tumor. Materials and Methods: A total of 40 patients with 47 TAWST from HCC were recruited from April 2007 to May 2018. LTC was evaluated by contrast-enchanced image. Long-time survival outcomes were compared. Overall survival (OS), disease-free survival (DFS), and local seeding progress-free survival (LSPFS) were analyzed. Results: One-year LTC rate was 65.2% in all patients; 72%, 0%, 50%, and 0% in the patients who underwent MWA, high-intensity focused US, iodine-125 (125I) brachytherapy and MWA combined with 125I brachytherapy, respectively. The 3-year OS, DFS rates and LSPFS rates were 51.8% and 28.6%, 12.0% and 23.8%, and 10.0% and 10.0% after MWA and SR, respectively. Univariate analysis results showed that age (P = 0.049), Karnofsky performance scale (KPS) (P = 0.002), and chemoradiation (P = 0.032); and multivariate analysis results showed that age (P = 0.045) and KPS (P = 0.010) might be predictors for LCT. While univariate analysis results showed that KPS (P = 0.032), intrahepatic tumor size (P = 0.006), chemoradiation (P = 0.003), preoperative alpha-fetoprotein level (P = 0.007), metastasis (P = 0.049), and albumin-bilirubin grade (P = 0.002), and multivariate analysis results showed that comorbidities (P = 0.004), KPS (P = 0.007), and metastasis (P = 0.009) might be predictors for OS. The pain degree of patients was improved obviously after treatments. Conclusions: US-guided interventional treatments were an effective option in LTC for TAWST from HCC, and MWA could achieve comparable long-time survival outcomes with SR for HCC patients with TAWST
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Objective: The objective of this study is to evaluate the feasibility and safety of high-intensity focused ultrasound (HIFU) for ablation of swine pancreas and to detect the pathological variations in pancreas damage. Materials and Methods: (a) Eight swine were involved and randomly divided into two groups (Group A and B). HIFU was applied on swine in both groups for in vivo ablation of pancreas. The animals were anesthetized, and the artificial acoustic window was built. Then, the irradiation of FEP-BY02 type HIFU on pancreas was applied. (b) Swine in Group A were euthanized immediately after treating with HIFU to examine variations in pancreas. The biochemical evidence of pancreatitis was evaluated by blood samples collected from swine in Group B before and after HIFU. Then, the pancreas of swine in Group B was euthanized on day 5 after treatment to examine the pancreas. All specimens were visually inspected for both ultrasonic focal damage region (UFDR) and pathological routine by a skilled pathologist. Results: (a) The vital signs of all animals were stable during HIFU treatment and recovered well after treatment. (b) UFDR were observed in all HIFU irradiation region of the specimens, without significant size difference between the two groups. The coagulation nucleus pyknosis, cytochylema vacuolation, and nucleus membrane disruption were observed after HIFU in both groups. Membranous structure dissolution and inflammatory cell infiltration were also found after HIFU in swine of Group B. (c) There was no significant difference in the levels of blood amylase in swine of Group B before and after HIFU treatment. Conclusions: It was feasible and safe to use HIFU for ablation of the pancreas in swine
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Objective: To investigate the influence of bifidobacterium combined with cationic lipid nanoparticles with liquid fluorocarbon on HIFU ablation for tumor-bearing mice. Methods: Bifidobacterium was cultured, cationic lipid nanoparticles with liquid fluorocarbon were prepared, and the connection ratio was examined in vitro. Mice models of human breast cancer MDA-MB231 cells were established. A total of 48 tumor-bearing mice were randomly divided into 4 groups (each n=12). Different substances were injected through the tail vein twice (two days apart). Tumor-bearing mice in group A (PBS group) were injected with phosphate buffer (PBS) twice, in group B (bifidobacterium group) were injected with bifidobacterium before PBS injection, in group C (cationic lipid nanoparticles) with PBS before cationic lipid nanoparticles injection and in group D (bifidobacterium+cationic lipid nanoparticle group) with bifidobacterium before cationic lipid nanoparticles injection. Twenty-four hours after the completion of the second injection, HIFU irradiation was performed on the tumor tissue of tumor-bearing mice, and the changes between pre- and post-ablation gray scale of the tumor tissue were analyzed. Histological examination was performed 1 h before HIFU irradiation and 1 day after irradiation, respectively. The tumor targeting of bifidobacterium was observed, and the coagulative necrotic volume of tumor tissues and energy efficiency factor (EEF) of HIFU ablation were measured. Statistical analysis was performed to compare the differences among 4 groups. Results: Gram-stained bifidobacterium longum was manifested as blue-violet long rod with a surface potential of -29 mV. The cationic lipid nanoparticles were spherical and evenly distributed with average particle diameter of (280.21±60.20)nm and a surface potential of 25 mV. The differences of gray scale change (F=143.40), coagulative necrotic volume (F=243.20) and EEF (F=56.33) were statistically significant among 4 groups (all P<0.001). Gray value change and coagulative necrotic volume gradually increased in group A, B, C and D (pairwise comparison: All P<0.05), while EEF trended from high to low in group A, B, C and D (pairwise comparison: All P<0.05). There was no bifidobacterium in heart, liver, spleen, lung and kidney of tumor-bearing mice among 4 groups nor in tumors of group A and C. A quantity of bifidobacterium was found in tumor tissue of group B and D. Conclusion: Bifidobacteriaum combined with cationic lipid nanoparticles with liquid fluorocarbon can enhance the ablation effect of HIFU ablation on tumor tissue in tumor-bearing mice.