Thermal ablation

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  • 文章类型: Journal Article
    射频消融(RFA)为良性,自主运作(AFTN),和恶性甲状腺结节。该技术利用高频交流电诱发凝固性坏死,有效破坏目标组织。RFA在门诊环境中在局部麻醉和超声引导下进行。RFA可有效地在良性结节中产生大量体积减少率,并且正在成为AFTN和乳头状甲状腺微癌的有利选择。RFA的优势包括并发症发生率较低,最小的疤痕,与手术相比,生活质量结局得到改善。然而,其在较大和复发性恶性肿瘤中的疗效需要进一步研究.
    Radiofrequency ablation (RFA) offers a minimally invasive solution for benign, autonomously functioning (AFTN), and malignant thyroid nodules. The technique utilizes high-frequency alternating current to induce coagulative necrosis, effectively destroying target tissue. RFA is performed in the outpatient setting with local anesthesia and sonographic guidance. RFA is effective in producing substantial volume reduction rates in benign nodules and is emerging as a favorable option in AFTN and papillary thyroid microcarcinoma. RFA\'s advantages include lower complication rates, minimal scarring, and improved quality-of-life outcomes compared to surgery. However, its efficacy in larger and recurrent malignancies requires further investigation.
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  • 文章类型: Journal Article
    目的:本研究的目的是评估热消融的安全性和有效性,包括射频消融(RFA)和微波消融(MWA),对于I期非小细胞肺癌(NSCLC)患者。
    方法:检索PubMed数据库至2023年11月,以确定相关研究。用R版本3进行统计分析。6.3.
    结果:最终纳入了涉及1400名患者的33项研究。根据我们的研究,60岁以上的I期NSCLC患者的发病率为98%(95%CI[94-100%]);病变主要位于RUL(右上叶)和LUL(左上叶),两个部位的发病率分别为29%(95%CI[23-35%])和27%(95%CI[21-33%]),分别;肺癌的类型主要包括腺癌,鳞癌,大细胞肺癌,其中腺癌占最大比例,为63%(95%CI[56-70%]);死亡原因主要分为癌症相关(57%,95CI[40-74%])和非癌症相关(40%,95CI[23-58%]);术后期间的常见并发症是气胸和疼痛,发病率为33%(95CI[24-44%])和33%(95CI[19-50%]),MWA的术后并发症发生率略高于RFA;局部复发率为23%(95CI[17-29%]),远处复发率为18%(95CI[7-32%]);合并结果显示1-,2-,3-,5年生存率为96%,81%,68%,42%,1、2、3和5年的癌症特异性生存率(CSS)为98%,88%,75%,58%,1、2、3和5年的无病生存率(DFS)为87%,63%,57%,42%,RFA组与MWA组的生存率差异无统计学意义,CSS和DFS。
    结论:消融治疗对I期NSCLC患者安全有效。MWA和RFA的疗效相当,安全,和预后,可推荐用于Ⅰ期NSCLC患者,尤其是对于不能耐受开放手术的患者。
    OBJECTIVE: The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC).
    METHODS: The databases PubMed was searched from inception to November 2023 to identify relevant studies. Statistical analyses were performed with R version 3. 6. 3.
    RESULTS: Thirty-three studies involving 1400 patients were finally included. According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS.
    CONCLUSIONS: Ablation therapy is safe and effective for stage I NSCLC patient. MWA and RFA have comparable efficacy, safety, and prognosis, which could be recommended for patients with stageⅠNSCLC, especially for patients who cannot tolerate open surgery.
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  • 文章类型: Journal Article
    脾转移是在所有转移性癌症的不到1%中发展的罕见临床实体,通常在播散性疾病中。迄今为止,传统上,脾切除术是脾转移患者的一线治疗方法,然而,已经报道了非手术疗法。在这里,我们描述了通过经皮射频消融成功治疗的57岁卵巢癌脾转移患者的病例。此外,我们对热消融治疗的脾转移病例进行了文献系统回顾.
    Splenic metastasis are rare clinical entities developing in less than 1% of all metastatic cancers and usually in the setting of disseminated disease. To date, splenectomy is traditionally the first line therapy in patient with splenic metastasis, however non-surgical therapies have been reported. Here we described the case of a 57-year-old patient with splenic metastasis from ovarian cancer successfully treated by percutaneous radiofrequency ablation. Furthermore, we performed a literature systematic review of the cases of splenic metastases treated by thermal ablation.
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  • 文章类型: Journal Article
    肝肿瘤的微波消融(MWA)面临着诸如消融不足和过度消融的挑战,可能导致肿瘤破坏不足和对健康组织的损害。这项研究旨在开发个性化的三维(3D)模型来模拟肝脏肿瘤的MWA,结合患者特有的特征。主要目标是验证预测的消融区与临床结果的比较,在治疗前提供对MWA的见解,以促进准确的治疗计划。来自三名患者的对比增强CT图像用于创建3D模型。模拟使用耦合电磁波传播和生物传热来估计温度分布,预测肿瘤破坏和消融边缘。研究结果表明,一旦达到足够的边缘,长时间的消融并不能显着改善肿瘤的破坏。虽然它增加了组织损伤。临床消融区和预测消融区之间存在大量重叠。对于患者1,Dice评分为0.73,表明准确性高,灵敏度为0.72,特异性为0.76。对于患者2,Dice评分为0.86,灵敏度为0.79,特异性为0.96。对于患者3,Dice评分为0.8,灵敏度为0.85,特异性为0.74。患者特定的3D模型显示出准确预测消融区域和优化MWA治疗策略的潜力。
    Microwave ablation (MWA) of liver tumors presents challenges like under- and over-ablation, potentially leading to inadequate tumor destruction and damage to healthy tissue. This study aims to develop personalized three-dimensional (3D) models to simulate MWA for liver tumors, incorporating patient-specific characteristics. The primary objective is to validate the predicted ablation zones compared to clinical outcomes, offering insights into MWA before therapy to facilitate accurate treatment planning. Contrast-enhanced CT images from three patients were used to create 3D models. The simulations used coupled electromagnetic wave propagation and bioheat transfer to estimate the temperature distribution, predicting tumor destruction and ablation margins. The findings indicate that prolonged ablation does not significantly improve tumor destruction once an adequate margin is achieved, although it increases tissue damage. There was a substantial overlap between the clinical ablation zones and the predicted ablation zones. For patient 1, the Dice score was 0.73, indicating high accuracy, with a sensitivity of 0.72 and a specificity of 0.76. For patient 2, the Dice score was 0.86, with a sensitivity of 0.79 and a specificity of 0.96. For patient 3, the Dice score was 0.8, with a sensitivity of 0.85 and a specificity of 0.74. Patient-specific 3D models demonstrate potential in accurately predicting ablation zones and optimizing MWA treatment strategies.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    甲状腺髓样癌(MTC)是一种罕见的原发性神经内分泌甲状腺癌,与其他甲状腺或神经内分泌癌不同。大多数MTC病例是零星的,尽管MTC作为多发性内分泌肿瘤综合征的一部分表现出高度的遗传性。在转染(RET)突变过程中重排是主要的致癌驱动因素,分子谱分析的进展表明,MTC富含可药用的改变。早期手术是治愈的唯一机会,但许多患者出现或发展转移。C细胞特异性降钙素轨迹和结构倍增时间是告知预后的关键生物标志物。手术范围,残留疾病的可能性,需要额外的治疗.积极监测作用的最新进展,局部疾病的区域定向治疗,多激酶和RET特异性抑制剂对进展性/转移性疾病的全身治疗显著改善了MTC患者的预后。
    Medullary thyroid carcinoma (MTC) is a rare primary neuroendocrine thyroid carcinoma that is distinct from other thyroid or neuroendocrine cancers. Most cases of MTC are sporadic, although MTC exhibits a high degree of heritability as part of the multiple endocrine neoplasia syndromes. REarranged during Transfection (RET) mutations are the primary oncogenic drivers and advances in molecular profiling have revealed that MTC is enriched in druggable alterations. Surgery at an early stage is the only chance for cure, but many patients present with or develop metastases. C-cell-specific calcitonin trajectory and structural doubling times are critical biomarkers to inform prognosis, extent of surgery, likelihood of residual disease, and need for additional therapy. Recent advances in the role of active surveillance, regionally directed therapies for localized disease, and systemic therapy with multi-kinase and RET-specific inhibitors for progressive/metastatic disease have significantly improved outcomes for patients with MTC.
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  • 文章类型: Journal Article
    背景:超声引导热消融(TA)已成为治疗多器官实体瘤的强大治疗方法,包括甲状腺.然而,其在Graves病(GD)治疗中的疗效和安全性仍有待确定。
    方法:对2017年10月至2021年12月期间接受TA治疗的50例GD患者进行了回顾性研究。像甲状腺体积这样的关键指标,体积减少率(VRR),甲状腺激素,和基础代谢率(BMR)使用配对Wilcoxon检验进行评估。
    结果:在所有术后随访间隔1、3、6和12个月内,超声引导下的TA介入治疗使甲状腺总体积相对于介入前基线有统计学意义的显著减少(p<0.001)。在这些时间点观察到的VRR中位数为17.5%,26.5%,34.4%,和39.8%,分别。在一年的随访里程碑中,96%的患者的甲状腺功能正常状态得到证实。在3例患者中观察到短暂性心动过速和发音障碍,同时注意到一个单独的皮肤麻木病例。至关重要的是,没有记录到喉返神经(RLN)的持续性损伤.
    结论:我们的研究证实超声引导TA是一种实用的,耐受性良好,和GD的安全治疗方式。它有效改善甲状腺功能亢进的症状,导致甲状腺体积大幅减少,并将甲状腺激素和BMR恢复到生理水平。鉴于其良好的安全性,增强美容效果,和微创性质,超声引导下的TA是GD患者甲状腺切除术的一种引人注目的替代方法。
    BACKGROUND: Ultrasound-guided thermal ablation (TA) has emerged as a robust therapeutic approach for treating solid tumors in multiple organs, including the thyroid. Yet, its efficacy and safety profile in the management of Graves\' Disease (GD) remains to be definitively established.
    METHODS: A retrospective study was conducted on 50 GD patients treated with TA between October 2017 and December 2021. Key metrics like thyroid volume, volume reduction rate (VRR), thyroid hormones, and basal metabolic rate (BMR) were evaluated using paired Wilcoxon tests.
    RESULTS: The intervention of ultrasound-guided TA yielded a statistically significant diminution in total thyroid volume across all postoperative follow-up intervals-1, 3, 6, and 12 months-relative to pre-intervention baselines (p < 0.001). The median VRR observed at these time points were 17.5%, 26.5%, 34.4%, and 39.8%, respectively. Euthyroid status was corroborated in 96% of patients at the one-year follow-up milestone. Transient tachycardia and dysphonia were observed in three patients, while a solitary case of skin numbness was noted. Crucially, no instances of enduring injury to the recurrent laryngeal nerve (RLN) were documented.
    CONCLUSIONS: Our investigation substantiates ultrasound-guided TA as a pragmatic, well-tolerated, and safe therapeutic modality for GD. It effectively improves symptoms of hyperthyroidism, engenders a substantial reduction in thyroid volume, and restores thyroid hormone and BMR to physiological levels. Given its favorable safety profile, enhanced cosmetic outcomes, and minimally invasive nature, ultrasound-guided TA is a compelling alternative to thyroidectomy for GD patients.
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  • 文章类型: Journal Article
    高热,肿瘤温度升高(≥39°C),作为癌症治疗的辅助治疗有很大的希望。这篇综述集中在热疗的两个关键方面:其分子和细胞效应及其对免疫系统的影响。热疗对关键的生物过程具有深远的影响。温度升高会抑制DNA修复酶,使癌细胞对化疗和放疗更加敏感。升高的温度还诱导细胞周期停滞并触发凋亡途径。此外,热疗改变了热休克蛋白的表达,在癌症治疗中起着至关重要的作用,包括增强免疫反应。热疗对机体对肿瘤的免疫反应也有显著影响。可能提高免疫检查点抑制剂的疗效。轻度全身热疗(39°C-41°C)模仿发烧,激活免疫细胞和提高代谢率。50℃以上的高温可以释放肿瘤抗原,增强免疫反应。使用用于靶向加热和药物递送的光热纳米颗粒还可以调节免疫应答。当与免疫疗法结合时,热疗是一种具有成本效益且耐受性良好的辅助疗法。这篇全面的综述是选择患者特异性治疗方法和指导未来实验研究的宝贵资源。
    Hyperthermia, the raising of tumor temperature (≥39°C), holds great promise as an adjuvant treatment for cancer therapy. This review focuses on 2 key aspects of hyperthermia: its molecular and cellular effects and its impact on the immune system. Hyperthermia has profound effects on critical biological processes. Increased temperatures inhibit DNA repair enzymes, making cancer cells more sensitive to chemotherapy and radiation. Elevated temperatures also induce cell cycle arrest and trigger apoptotic pathways. Furthermore, hyperthermia modifies the expression of heat shock proteins, which play vital roles in cancer therapy, including enhancing immune responses. Hyperthermic treatments also have a significant impact on the body\'s immune response against tumors, potentially improving the efficacy of immune checkpoint inhibitors. Mild systemic hyperthermia (39°C-41°C) mimics fever, activating immune cells and raising metabolic rates. Intense heat above 50°C can release tumor antigens, enhancing immune reactions. Using photothermal nanoparticles for targeted heating and drug delivery can also modulate the immune response. Hyperthermia emerges as a cost-effective and well-tolerated adjuvant therapy when integrated with immunotherapy. This comprehensive review serves as a valuable resource for the selection of patient-specific treatments and the guidance of future experimental studies.
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  • 文章类型: Journal Article
    目的:通过将血管内成分整合到大隐静脉剥脱术中,血管内静脉辅助内陷剥离(EVIS)旨在使手术微创。进行了一项研究以调查手术干预。方法:使用草图和视频来说明EVIS的技术方面。一项前瞻性队列研究包括20例慢性静脉功能不全(CVI)患者。结果:EVIS作为日间手术进行。技术成功100%,无并发症记录。平均手术时间为45分钟,术中疼痛评分为4.8分,术后48小时疼痛评分为2.5、1.8、1.2、0.5分,1、4和12周,分别。平均失血量为15mL,捆扎的GSV的平均长度为19厘米。后续双链体显示残余GSV残端的直径减小。结论:EVIS是标准技术的组合,在管理CVI中可能被证明是有价值的。
    Objective: By incorporating an endovascular component into Great Saphenous Vein stripping, EndoVenous-assisted Invaginated Stripping (EVIS) aims to make the procedure minimally invasive. A study was conducted to investigate the surgical intervention. Methods: Sketches and videos were used to illustrate the technical aspects of EVIS. A prospective cohort study included 20 patients with chronic venous insufficiency (CVI). Results: EVIS is performed as a day-surgery. Technical success was 100%, and no complications were recorded. The mean operative time was 45 minutes, intraoperative pain score was 4.8, post-operative pain was 2.5, 1.8, 1.2, 0.5 at 48 hours, 1, 4, and 12 weeks, respectively. The mean blood loss was 15 mL, and the mean length of the GSV strapped was 19 cm. The follow-up duplex showed a reduction in the diameter of the residual GSV stump. Conclusions: EVIS is a combination of standard techniques that may prove valuable in managing CVI.
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  • 文章类型: Journal Article
    在这项研究中,使用波长为1064nm,脉冲宽度为100ns的脉冲激光从2024铝合金表面去除油漆。通过实验研究,分析了激光参数对飞机蒙皮表面漆层去除效果的影响,以及激光处理后铝合金基体显微组织的演变过程。通过模拟探索了激光清洗的机理。结果表明,功率密度和扫描速度显着影响清洁质量。值得注意的是,重复频率有明显的损伤阈值和最佳清洁参数,功率密度为178.25MW/cm2,扫描速度为500mm/s,40kHz的重复频率被确定为实现所需清洁效果的主要最佳设置。热烧蚀和热振动被确定为清洁的主要机制。此外,激光加工引起的表面位错和集中应力,伴随着晶粒细化,在铝基板上。
    In this study, a pulsed laser operating at a wavelength of 1064 nm and with a pulse width of 100 ns was utilized for the removal of paint from the surface of a 2024 aluminum alloy. The experimental investigation was conducted to analyze the influence of laser parameters on the efficacy of paint layer removal from the aircraft skin\'s surface and the subsequent evolution in the microstructure of the laser-treated aluminum alloy substrate. The mechanism underlying laser cleaning was explored through simulation. The findings revealed that power density and scanning speed significantly affected the quality of cleaning. Notably, there were discernible damage thresholds and optimal cleaning parameters in repetitive frequency, with a power density of 178.25 MW/cm2, scanning speed of 500 mm/s, and repetitive frequency of 40 kHz identified as the primary optimal settings for achieving the desired cleaning effect. Thermal ablation and thermal vibration were identified as the principal mechanisms of cleaning. Moreover, laser processing induced surface dislocations and concentrated stress, accompanied by grain refinement, on the aluminum substrate.
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