Efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation for synovial hyperplasia.

PURPOSE: This study aimed to investigate the efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) for the treatment of synovial hyperplasia in the knee joints of antigen-induced arthritis (AIA) model rabbits. METHODS: Forty Japanese large-eared white rabbits were divided into AIA and control groups. After successful induction of the AIA model, the knee joints were randomly assigned to RFA and non-RFA groups. The RFA group underwent ultrasound-guided RFA to treat synovial hyperplasia in the knee joint. Dynamic observation of various detection indices was conducted to evaluate the safety and effectiveness of the RFA procedure. RESULTS: Successful synovial ablation was achieved in the RFA group, with no intraoperative or perioperative mortality. Postoperative the circumference of the knee joint reached a peak before decreasing in the third week after surgery. The incidence and diameter of postoperative skin ulcers were not significantly different compared to the non-RFA group (p > .05). Anatomical examination revealed an intact intermuscular fascia around the ablated area in the RFA group. The ablated synovial tissue initially presented as a white mass, which subsequently liquefied into a milky white viscous fluid. Gross articular cartilage was observed, along with liquefied necrosis of the synovium on pathological histology and infiltration of inflammatory cells in the surrounding soft tissue. CONCLUSION: The experimental results demonstrated that ultrasound-guided RFA of the knee in the treatment of synovial hyperplasia in AIA model animals was both effective and safe.

Short- and Long-Term Outcomes after Radiofrequency Ablation of Osteoid Osteomas.

The aim of this study was to evaluate treatment of osteoid osteomas using bipolar radiofrequency ablation (RFA) and patients' quality of life before and after therapy. We retrospectively evaluated patients who underwent bipolar RFA of osteoid osteomas between 2001 and 2016. We assessed patients' symptoms before and after treatment (four weeks after treatment and long-term) using a questionnaire including severity and quality of pain on a 10-point scale (1 = no pain, 10 = severe pain), motion restrictions, pain-related sleep disorders, and necessary pain medication. In addition, we evaluated technical success, complications, hospitalization length, and patients' satisfaction with treatment. This study included 62 patients (43 [69.4%] males, 26.2 ± 13.2 years). Average nidus size was 5.7 ± 2.6 mm. The rate of technical success was 100%. All RFAs were performed without any complications. One patient showed a recurrence, resulting in a recurrence rate of 1.6%, which was successfully treated by another session of RFA. Average hospitalization length was 1.5 ± 0.5 days. A total of 36 patients (58.1%) participated in the questionnaire, reporting an average pain severity of 8.2 ± 1.6 before RFA compared to 3.4 ± 3.0 four weeks after and an average of 2.1 ± 2.3, 6.6 years after therapy, (both p < 0.001). After therapy, 31 (86.1%) patients had no pain. The majority of patients (n = 34, 94.4%) had reduced or absent motion restriction after therapy (p < 0.001). Patient satisfaction rate was 91.7%. In conclusion, bipolar RFA is a safe and effective treatment modality for osteoid osteomas and improves quality of life by reducing pain severity and motion restrictions.

Comparison of laparoscopic hepatectomy and percutaneous radiofrequency ablation for the treatment of small hepatocellular carcinoma: a meta-analysis.

AIM: The purpose of this study was to compare the long-term outcomes of laparoscopic hepatectomy (LH) and percutaneous radiofrequency ablation (PRFA) for the treatment of small hepatocellular carcinoma. METHODS: We systematically searched PubMed, Embase, Web of Science, and Medline from January 2000 to May 2022 for literature comparing the efficacy of LH and PRFA in the treatment of small hepatocellular carcinoma (largest tumour diameter ≤ 3 cm, number of intrahepatic tumours ≤3, or diameter of a single intrahepatic lesion ≤5 cm. ). We assessed overall survival (OS), recurrence-free survival (RFS), local recurrence and complication rates. RESULTS: A total of 1886 patients with small HCC were included in the 8 studies included in this study, of which 839 underwent LH and 1047 underwent PRAF. The results of the meta-analysis showed that the two groups had the same 3-year (HR: 0.99, 95% CI: 0.67 to 1.47) and 5-year (HR: 1.30, 95% CI: 0.90 to 1.87) OS rates, and the LH group had better 3-year (HR: 0.58, 95% CI: 0.49 to 0.68) and 5-year (HR: 0.56, 95% CI: 0.37 to 0.85) RFS rates. The LH group had a lower local recurrence rate (OR: 0.19, 95% CI: 0.12 to 0.32), but the PRFA group had a lower complication rate (OR: 2.49, 95% CI: 1.76 to 3.54). CONCLUSION: There was no difference in OS between LH and PRFA in the treatment of small HCC. LH had a higher RFS rate and a lower local recurrence rate, but PRFA had a lower complication rate. In general, the long-term efficacy of LH in the treatment of small HCC is better than that of PRFA. Considering the advantages of less trauma and a low complication rate of PRFA, a large number of RCT studies are needed for further verification in the future.

Effects of different treatment methods on clinical efficacy and fertility outcomes of patients with adenomyosis.

OBJECTIVE: This trial was to investigate the effect of different treatment methods on the clinical efficacy and fertility outcome of patients with adenomyosis. METHODS: In total, 140 patients with adenomyosis were evenly and randomly allocated into group A (laparoscopic surgery), group B (laparoscopic surgery combined with gonadotropin-releasing hormone analogs [GnRH-a]), group C (ultrasound-guided percutaneous radiofrequency ablation), and group D (ultrasound-guided percutaneous radiofrequency ablation combined with GnRH-a). On the 3rd day after surgery, patients in group B and group D were subcutaneously injected with GnRH-a (Leuprorelin Acetate SR for Injection) at 3.75 mg/time, once every 4 weeks, for a total of 3 months. The therapeutic effects of the 4 groups were compared, including menstrual volume, dysmenorrhea score, uterine volume, clinical efficacy, luteinizing hormone (LH), estradiol (E2), and follicle-stimulating hormone (FSH) levels, CA125 levels, recurrence, pregnancy status, and pregnancy outcomes. RESULTS: After treatment, the menstrual volume of 4 groups was lowered, dysmenorrhea, Visual Analog Scale (VAS) score, LH, FSH, E2, and CA125 levels were reduced, and uterine volume was decreased. The menstrual volume, VAS score, levels of LH, FSH, E2, and CA125, and uterine volume were reduced in groups B, C, and D compared with group A, and the decrease was more significant in group D. The total effective rate of group D was 100.00%, which was higher than that of group A (71.43%), group B (80.00%), and group C (82.86%). After one year of drug withdrawal, the recurrence of hypermenorrhea, dysmenorrhea, uterine enlargement, and excessive CA125 in group D was significantly lower than that in groups A, B and C, and the recurrence in groups B and C was significantly lower than that in group A (P < 0.05). Compared with groups A, B, and C, group D had a higher pregnancy rate, natural pregnancy rate, and lower in vitro fertilization-embryo transfer rate (P < 0.05), but showed no significant difference in pregnancy outcomes. CONCLUSION: Ultrasound-guided percutaneous radiofrequency ablation combined with Leuprorelin Acetate is effective in the treatment of adenomyosis, which can effectively relieve clinical symptoms, protect postoperative ovarian function, reduce recurrence rate, alleviate pain, and improve quality of life.

A case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma.

We report a case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. A 60-year-old female was hospitalized for the treatment of thrombasthenia and cirrhosis caused by chronic Hepatitis C, and computed tomography revealed hepatocellular carcinoma, which was treated by percutaneous radiofrequency ablation. After the ablation, hemoperitoneum was suspected because of the low hemoglobin level with abdominal pain. Approximately 6 h after the ablation treatment, the patient suddenly fell into a shock state and died. In this case, medical treatment-related death including malpractice was suspected, and forensic autopsy was performed. The abdominal cavity contained 910 mL of dark red fluid blood and 210 g of soft hemocoagula. Moreover, several puncture marks were observed on the liver surface and diaphragm, and there was no clear damage to the main arteries and veins. Considering the macroscopic and microscopic findings, the cause of death was assumed as hemorrhagic shock due to the hemoperitoneum caused by the damage to the liver by radiofrequency ablation. It is important to consider all the indications and adverse effects of radiofrequency ablation.

Proton Beam Therapy versus Radiofrequency Ablation for Patients with Treatment-Naïve Single Hepatocellular Carcinoma: A Propensity Score Analysis.

Introduction: Proton beam therapy (PBT) is known to be an effective locoregional treatment for hepatocellular carcinoma (HCC). However, few comparative studies in treatment-naïve cases have been reported. The aim of this study was to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC. Methods: Ninety-five consecutive patients with treatment-naïve HCC, a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8 who were treated with PBT at the University of Tsukuba Hospital between 2001 and 2013 were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. Recurrence-free survival (RFS) and overall survival (OS) were compared in 83 patient pairs after propensity score matching. Results: The 1-year, 3-year, and 5-year RFS rates were 86.6%, 49.5%, and 35.5%, respectively, in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group (p = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group (p = 0.16). Regarding adverse effects, no grade 3 or higher adverse events were noted in the PBT; however, two grade 3 adverse events occurred within 30 days of RFA in the RFA group: one hemoperitoneum and one hemothorax. Discussion: After propensity score matching, PBT showed no significant difference in RFS and OS compared to RFA. PBT can be an alternative for patients with solitary treatment-naïve HCC.

Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review.

BACKGROUND: Endoscopic radiofrequency ablation (ERFA), percutaneous radiofrequency ablation (PRFA), and photodynamic therapy (PDT), when used in conjunction with conventional biliary stenting, have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma. AIM: To compare pooled survival outcomes, adverse event rates, and mean stent patency for those undergoing these procedures. METHODS: A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting, biliary stenting alone, PRFA with stenting, and PDT with stenting for unresectable cholangiocarcinoma (CCA). RESULTS: Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone (12.0 ± 0.9 mo vs 6.8 ± 0.3 mo, P < 0.001) as well as statistically improved median survival time (13 mo vs 8 mo, P < 0.001). Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone (P < 0.001 and P = 0.004, respectively). However, when comparing ERFA to PRFA, pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort (12.0 + 0.9 mo vs 8.1 + 2.1 mo, P < 0.0001). Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting (11.3 mo vs 8.5 mo, P = 0.02). CONCLUSION: While further prospective, randomized studies are needed to assess efficacy of ERFA, our meta-analysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation with biliary stenting, and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

Outcomes of laparoscopic radiofrequency ablation versus percutaneous radiofrequency ablation for hepatocellular carcinoma.

BACKGROUND: Few studies have compared the therapeutic outcomes in patients with HCC who underwent laparoscopic radiofrequency ablation (LRFA) versus percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC). Therefore, this study compared the recurrence and survival outcomes of the two RFA methods in patients with HCC. METHODS: Recurrence and overall survival outcomes were evaluated in 307 patients who underwent LRFA (n = 151) or PRFA (n = 156) as a treatment method for de novo HCC. Inverse probability of treatment weighting (IPTW) analysis was performed to reduce the impact of treatment selection bias. RESULTS: There were no significant differences in major baseline characteristics between the LRFA and PRFA groups. However, the proportion of cirrhotic patients was higher in the LRFA group, whereas the LRFA group had more tumors and a more advanced tumor-node-metastasis stage. Moreover, the mean tumor size was significantly larger in the LRFA group than in the PRFA group. In a multivariate analysis, serum albumin level, more than three tumors, and the RFA method were identified as significant predictors of recurrence-free survival. Moreover, for the overall survival of HCC patients, serum albumin levels, days of hospital stay during RFA, and the RFA method were independent predictors. In the IPTW-adjusted analysis, the LRFA group showed significantly higher recurrence-free survival and overall survival. CONCLUSIONS: Our study revealed that compared with PRFA, LRFA was associated with longer recurrence-free survival and favorable overall survival in patients with HCC. Therefore, LRFA should be considered the primary therapy in patients with HCC eligible for RFA.

A case of improved quality of life in a patient with inoperable pancreatic cancer after repeated RFA.

Radiofrequency ablation (RFA) has widespread popularity due to its immune-modulation effects in many cancers. Optimal settings to apply RFA in pancreatic cancer, in which the advanced stage of the tumor at the diagnosis makes various therapeutic approaches fail, are still demanding. We report the case of a patient with unresectable pancreatic cancer in which 3 repetitive RFA has been applied over a period of 3 months. Results revealed an improvement in the patient's clinical condition associated with the reduced incidence of CD4+CD45RO+ T lymphocytes and declined TGF-ß level in serum. The good quality of life and disease-free survival were maintained for the next months. Booster application of RFA procedure might be a promising option to improve the quality of life in pancreatic cancer patients.

Multi-stage puncture path planning algorithm of ablation needles for percutaneous radiofrequency ablation of liver tumors.

This paper designs a multi-stage puncture path planning algorithm of ablation needles for percutaneous radiofrequency ablation of liver tumors, in order to guide or assist clinicians automatically plan the puncture path of ablation needle, and improve the safety and effectiveness of percutaneous radiofrequency ablation for liver cancer. Firstly, the initial feasible puncture paths satisfying the hard constraints are obtained by quantifying different clinical multi-constraint conditions. Then, according to the soft constraints, the risk index of puncture path is designed to realize the first-stage path planning. Secondly, considering the zero potential energy point and multi-tumor puncture, we embed the gravitational additional potential field to improve the traditional artificial potential field, and the second-stage path planning of candidate puncture paths is carried out by calculating the comprehensive potential energy of the paths. Finally, the reliability of the ablation needle trajectory is evaluated based on the relationship between the candidate puncture paths and liver segments, and the third-stage path planning is realized to determine the optimal puncture path. Through the quantitative and qualitative evaluation of the results, it is proved that our algorithm can obtain an optimal puncture path that meets the clinical conditions, which is expected to guide clinicians in the puncture path planning of percutaneous radiofrequency ablation for liver cancer.

Percutaneous radiofrequency ablation for hepatocellular carcinoma developed on non-alcoholic fatty liver disease.

BACKGROUND & AIMS: Long-term outcomes after percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in patients with non-alcoholic fatty liver disease (NAFLD) have been poorly studied. We aim to determine the outcomes after multibipolar RFA in these patients compared to other aetiologies as well as the prognostic impact of metabolic syndrome (MS). METHODS: Patients who underwent multibipolar RFA as the first treatment for HCC within Milan criteria (2008-2018) were enrolled in this multicentre retrospective cohort from four tertiary centres in France. The association of MS and NAFLD with adverse events and outcomes after percutaneous RFA were assessed using Kaplan Meier method, log-rank test and uni/multivariate analysis with the Cox models. RESULTS: Among 520 patients, 390 patients (75%) had at least one component of MS including obesity (30%) and 95% had cirrhosis. Sixty-two patients (12.6%) had NAFLD-HCC, 225 (45.5%) had alcohol-related-HCC, 36 (7.3%) had HBV-HCC and 171 (34.6%) had HCV-HCC. Patients with NAFLD-HCC were significantly older (median age 72.6 years, P < .001), more obese (median BMI 30.3 kg/m2 , P < .001) and had more components of MS. Patients with NAFLD-HCC achieved a median overall survival (OS) of 79 months (1-year, 3-year and 5-year OS of 90%, 71% and 59%). There were no differences in morbidity, tumour recurrence and OS among patients with NAFLD-HCC vs other aetiologies as well as no prognostic impact of metabolic components. CONCLUSIONS: Percutaneous multibipolar RFA is an efficient treatment in HCC patients with NAFLD or metabolic syndrome and achieved similar long-term oncological outcomes compared to other aetiologies.

Risk factors of residual tumor in single small hepatocellular carcinoma after thermal ablation treatment / 中华内科杂志

Objective:To evaluate the risk factors of residual tumor after thermal ablation in patients with small hepatocellular carcinoma.Methods:This was a retrospective study recruiting 107 patients diagnosed as single hepatocellular carcinoma with maximum diameter ≤3 cm from December 2009 to August 2015 in National Cancer Center. The cohort enrolled 81 males and 26 females, including 83 patients younger than 70 years old. All patients were treated with radiofrequency ablation or microwave ablation, and evaluated by CT or MRI after 4-6 weeks compared with baseline data. Potentially related factors were analyzed such as patients′ characteristics, tumor location and adjacent, ablation pattern, hepatitis B/C infection. A multivariate logistic regression analysis was conducted for the independence of risk factors.Results:Six patients (5.6%) with residual tumor was detected in the whole population of 101 cases. Univariate analysis suggested that tumor adjacent to vascular structure, poor differentiation, AFP≥200 μg/L were the risk factors of residue disease (all P<0.05). Multivariate logistic regression suggested that pathological type of poorly differentiated tumor was the only independent risk factor ( HR=2.26,95% CI 0.25-20.50, P=0.030). Conclusions:Poorly differentiated pathology is an independent predictive factor for residual disease in small hepatocellular carcinoma after thermal ablation. Such patients should be routinely followed up after operation.

Comparison of Respiratory Effects between Dexmedetomidine and Propofol Sedation for Ultrasound-Guided Radiofrequency Ablation of Hepatic Neoplasm: A Randomized Controlled Trial.

Patient's cooperation and respiration is necessary in percutaneous radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). We compared the respiratory patterns of dexmedetomidine and propofol sedation during this procedure. Participants were randomly allocated into two groups: the continuous infusions of dexmedetomidine-remifentanil (DR group) or the propofol-remifentanil (PR group). We measured the tidal volume for each patient's respiration during one-minute intervals at five points and compared the standard deviation of the tidal volumes (SDvt) between the groups. Sixty-two patients completed the study. SDvt at 10 min was not different between the groups (DR group, 108.58 vs. PR group, 149.06, p = 0.451). However, SDvt and end-tidal carbon dioxide (EtCO2) level of PR group were significantly increased over time compared to DR group (p = 0.004, p = 0.021; ß = 0.14, ß = -0.91, respectively). Heart rate was significantly decreased during sedation in DR group (p < 0.001, ß = -2.32). Radiologist satisfaction was significantly higher, and the incidence of apnea was lower in DR group (p = 0.010, p = 0.009, respectively). Compared with propofol-remifentanil, sedation using dexmedetomidine-remifentanil provided a lower increase of the standard deviation of tidal volume and EtCO2, and also showed less apnea during RFA of HCC.

Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation.

PURPOSE: To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). MATERIALS AND METHODS: In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS: This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). CONCLUSION: Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.

CT-guided percutaneous minimally invasive radiofrequency ablation for the relief of cancer related pain from metastatic non-small cell lung cancer patients: a retrospective study.

BACKGROUND: Radiofrequency ablation (RFA) is the current gold standard for palliative care of non-small cell lung cancer (NSCLC). Pain relief for advanced metastases of NSCLC is notoriously difficult. Combined RFA therapy may be more effective than palliating therapy alone in management of painful metastatic disease. The effects of RFA on quality of life, particularly pain, as well as long-term outcome studies are not well studied. To study the effectiveness of percutaneous minimal invasive RFA in pain management of NSCLC patients with metastatic chest wall, vertebral bodies and rib, and periphery lung nodule. METHODS: Forty patients with 59 tumors underwent percutaneous computed tomography (CT) or ultrasound-guided RFA for pain management over a 4-week observation. Forty patients were referred to ablation because of persistent severe pain despite using analgesics, chemotherapy or radiotherapy. The tumors were located in the periphery lung, or metastatic to chest wall, rib or vertebral body. Quantitative pain scale values were quantified on a 0-10 scale before, 24 hours, 72 hours, and 4 weeks after RFA. On the basis of changes in pain score and pain medication use, pain was reported with a composite measure as complete, partial, or no pain response. The overall survival (OS) rate was also collected and calculated with Kaplan-Meier method. RESULTS: After 4-week follow-up, complete pain relief (pain scale score ≤1) was observed in 12 patients (30%) and partial pain relief (pain scale score ≤3) in 15 (37.5%) patients; pain relief did not occur in 13 patients (32.5%). There was a significant decrease in pain at 24-hour, 72-hour, and 4-week follow-up compared with pain level at baseline (P<0.01). Opiate use was decreased in 92.5% (37/40) patients, remained unchanged in 7.5% (3/40) at 4 weeks follow-up. There are minor adverse events caused by RFA therapy, including pleural effusion (5/40), post procedural infections (3/40), pneumothorax (2/40) which resolved spontaneously. The OS rates at 6 months in the percutaneous RFA group were 60%, with average OS of 6.5 months in the further follow-up. CONCLUSIONS: Percutaneous RFA resulted in sustained pain relief from in most advanced NSCLC patients with intractable pain and resistant to chemotherapy or radiotherapy. The effect of RFA was satisfactory, and patients can obtain a better life quality with less pain and complications.

A Simple Method to Avoid Bile Duct Injury during Percutaneous Radiofrequency Ablation Therapy for Hepatocellular Carcinoma.

Hepatocellular carcinoma represents a major global health burden. Its treatment is often complicated by the anatomical location of tumors, which can lead to adverse outcomes. Radiofrequency ablation has recently gained attention as a safe method for treating hepatocellular carcinoma, but only in tumors that are not adjacent to bile ducts. Here, we report a new method for cooling the bile duct during radiofrequency ablation therapy, in which the outer jacket of an elastor needle was fixed and flash-cooled with chilled saline. This method was applied in a patient with hepatocellular carcinoma tumors near the main bile duct. The patient underwent successful radiofrequency ablation with bile duct cooling. The advantages of this method include low medical cost, simpler securing of nonexpanded bile ducts, and simultaneous removal upon termination of the radiofrequency ablation therapy. Bile duct complications associated with radiofrequency ablation typically have delayed onset. Computed tomography examination 2 months after treatment showed no bile duct injury in this case.

Percutaneous Radiofrequency Ablation Combined With Transarterial Chemoembolization Plus Sorafenib for Large Hepatocellular Carcinoma Invading the Portal Venous System: A Prospective Randomized Study.

BACKGROUND: Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) portends a worse prognosis. The objective of this study was to compare the efficacy of percutaneous radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) plus sorafenib to that of the most commonly utilized regimen of TACE plus sorafenib in large HCCs with type I/II PVTT. METHODS: An open-label, single-center, prospective, randomized trial of participants with tumors ≥5 cm and type I/II PVTT was performed. Participants with previously untreated HCCs were divided into two groups: RFA + cTACE + sorafenib (study group, n = 40) and cTACE + sorafenib (control group, n = 40). The primary endpoint was the objective response rate (ORR), the secondary endpoints included the overall survival (OS); time to progression (TTP); and toxicity. Prognostic factors were analyzed using cox-regression analysis. RESULTS: 80 patients were enrolled into this study with integrated clinical data. Under a median follow-up of 506 days, the median age was 57.5 years (range: 28-80 years). The ORR of study group was higher than control group (70% vs 22.5%, p<0.001). Furthermore, the median OS of study group was superior to that of control group (468 days vs 219 days, HR: 0.44 [95% CI: 0.25-0.78], P = 0.005). Adverse events occurred with 100% probability in both groups (p>0.99), but no treatment-related deaths were recorded. Tumor encapsulation and attaining treatment response predict favorable OS in a multivariate Cox model. The rates of adverse events in both groups were 100% (p>0.99). There were no treatment-related deaths. CONCLUSIONS: RFA combined with TACE plus sorafenib is a safe, well-tolerated three-modality treatment for large HCCs with types I/II PVTT, and it demonstrated better efficacy than TACE plus sorafenib alone.

Percutaneous radiofrequency ablation is superior to hepatic resection in patients with small hepatocellular carcinoma.

BACKGROUND: It is not known whether percutaneous radiofrequency ablation (PRFA) has the same treatment efficacy and fewer complications than laparoscopic resection in patients with small centrally located hepatocellular carcinoma (HCC). AIM: To compare the effectiveness of PRFA with classical laparoscopic resection in patients with small HCC and document the safety parameters. METHODS: In this retrospective study, 85 patients treated with hepatic resection (HR) and 90 PRFA-treated patients were enrolled in our hospital from July 2016 to July 2019. Treatment outcomes, including major complications and survival data, were evaluated. RESULTS: The results showed that minor differences existed in the baseline characteristics between the patients in the two groups. PRFA significantly increased cumulative recurrence-free survival (hazard ratio 1.048, 95%CI: 0.265-3.268) and overall survival (hazard ratio 0.126, 95%CI: 0.025-0.973); PRFA had a lower rate of major complications than HR (7.78% vs 20.0%, P < 0.05), and hospital stay was shorter in the PRFA group than in the HR group (7.8 ± 0.2 d vs 9.5 ± 0.3 d, P < 0.001). CONCLUSION: Based on the data obtained, we conclude that PRFA was superior to HR and may reduce complications and hospital stay in patients with small HCC.

Usefulness of Morphology-Voltage-P-wave duration (MVP) score as a predictor of atrial fibrillation recurrence after pulmonary vein isolation.

BACKGROUND: Atrial fibrillation (AF) is known to be the most common arrhythmia, and the successful rate of long-term ablation can vary comparatively. Therefore, a clinical scoring system to predict rhythm outcome remains a critical unmet need. The electrocardiographic (ECG) risk score which is named Morphology-Voltage-P-wave duration (MVP) score was reported to be useful for predicting new-onset AF. The goal of the current study was to investigate whether the MVP score was a useful scheme in the prediction of rhythm outcome following pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). METHODS: We retrospectively analyzed baseline characteristics, risk scores, and rates of AF recurrence 12 months postablation in the medical records of 207 consecutive patients with PAF undergoing PVI in General Hospital of Ningxia medical University from 2010 to 2018. RESULTS: Two hundred and seven patients (71 females, median age 58.7 years) with symptomatic PAF underwent PVI. From the cohort, 32.3% (67) had a recurrence of AF within 1 year of the PVI. The area of the MVP score under the curve in the receiver operating characteristics (ROC) analysis was 0.789 (95% CI 0.730-0.840, p < .001). A score cut-off value of >3 showed the best predictive ability for AF recurrence within 1 year after PVI, with sensitivity (53.03%) and specificity (89.87%). CONCLUSIONS: The results of our study suggest that the easy-to-measure ECG MVP score can be used to predict recurrence of PAF after PVI.

Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis.

BACKGROUND: Heel pain is one of the most common complaints in foot and ankle clinic, and one of the leading causes of heel pain is plantar fasciitis. METHODS: A retrospective analysis was carried out in 31 cases (39 feet) of patients with intractable plantar fasciitis. In the enrolled 26 cases, 16 patients (19 feet) received open plantar fascia release, and the other 15 patients (20 feet) received percutaneous radiofrequency ablation. The surgical results were assessed by visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH) before and after surgery in all patients. RESULTS: All 31 patients were followed up successfully, with a mean follow-up time of 58.77 months. There were no differences of patient's demographics and characteristics information between the two groups. The average operative time of the feet in the open plantar fascia release is longer than that in the percutaneous radiofrequency ablation. Furthermore, the percutaneous radiofrequency ablation group had a shorter recovery time to normal activity than the open plantar fascia release group. There were no differences of postoperative VAS scores and the AOFAS-AH scores between the two groups. All patients reported satisfaction after either operation. CONCLUSION: The symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group. The two types of surgical procedures shared the same long-term curative effects. However, percutaneous radiofrequency ablation was a better technique from the point of shorter operative time and postoperative recovery time. TRIAL REGISTRATION: Retrospectively registered.