International Journal of Hyperthermia最新文献

Objective: This study aimed to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) combined with coaxial needle biopsy performed in different sequences for treating lung nodules with signs of malignancy.

Methods: A retrospective analysis was conducted on 51 patients (56 lesions) with lung nodules treated with MWA and coaxial needle biopsy between January 2020 and March 2024. Patients were divided into Group A (post-MWA biopsy; 26 patients, 29 lesions) and Group B (pre-MWA biopsy; 25 patients, 27 lesions). Ablation parameters, postoperative complications, prognosis, and pathological diagnosis rates were compared between groups. Patients with malignant pathology findings from both groups (Group C) were analyzed for overall survival (OS) and progression-free survival (PFS).

Results: Technical success for needle biopsy and MWA was 100%. Pneumothorax incidence was 24.14% (7/29) in Group A and 33.33% (9/27) in Group B (p = 0.447). Intrapulmonary hemorrhage occurred in 13.79% (4/29) of Group A patients and 37.04% (10/27) of Group B of patients, showing a significantly higher rate in Group B (p = 0.026). The pathological diagnosis rate was 100% in both the groups, with malignancy rates of 72.41% (21/29) in Group A and 81.48% (22/27) in Group B (p = 0.422). For Group C, the 1-3-year OS rates were 100.00%, 93.75%, and 75.00%, respectively, and the corresponding PFS rates were 97.50%, 84.38%, and 60.00%.

Conclusions: Biopsy post-MWA maintains pathological diagnostic accuracy while significantly reducing the incidence of intrapulmonary hemorrhage compared to pre-MWA biopsy.

Objectives: To investigate the effectiveness and safety of microwave ablation (MWA) in patients with 1-5 colorectal liver metastases (CRLM) versus those with 6-9 CRLM.

Methods: Data from patients with 1-9 CRLM, who underwent ultrasound (US)-guided percutaneous MWA between January 2018 and May 2023, were retrospectively analyzed. Propensity score matching (PSM) at a ratio of 1:2 was used to balance potential bias between the groups.

Results: Data from 264 patients were included in the analysis. After PSM, there were 43 and 75 patients in the CRLM >5 and ≤5 groups, respectively. Even with higher tumor burden and technical difficulty, there was no statistical difference in the local tumor progression (LTP)-free survival (LTPFS) between the groups (p > 0.05). Patients with an ablation margin (AM) ≤5 mm exhibited a significantly higher rate of LTP than those with AM >5 mm in both groups(p < 0.05). Patients with 6-9 CRLM experienced a higher incidence of intrahepatic recurrence (iHR) (p = 0.041) and shorter progression-free survival (PFS) at any site (p < 0.05). CRLM > 5 is an independent risk factor for poor PFS (p = 0.008). The minor complication rate was lower in the CRLM ≤ 5 group (p < 0.05) and the major complication rate showed no difference (p > 0.05).

Conclusions: When the number of CRLM was limited to 9, single-session MWA was feasible and safe for radical local treatment. An AM >5 mm was critical for local tumor control. Compared with patients with 1-5 CRLM, those with 6-9 CRLM experienced inferior PFS at any site, which mainly lies in more iHR.

Objectives: To compare the analgesic efficacy and safety of three anesthetic techniques during microwave ablation (MWA) for subpleural stage I non-small cell lung cancer (NSCLC).

Materials and methods: This prospective, single-center clinical trial enrolled patients with subpleural stage I NSCLC between January 2024 and December 2024. Patients were assigned to one of three anesthesia groups: intercostal nerve block (INB), pleural infiltration anesthesia (PIA), or local anesthesia (LA). The primary endpoints were perioperative visual analog scale (VAS) scores and the incidence of adverse events within 30 days of MWA.

Results: Sixty patients (mean age 73.88 ± 6.44 years; 28 men) were included in the analysis. The PIA group had intraoperative VAS scores comparable to the INB group and significantly lower than the LA group (2.70 ± 1.34 vs. 2.85 ± 1.73 vs. 6.26 ± 1.41, respectively). Postoperatively, VAS scores at 2 h were significantly lower in the PIA and INB groups compared to the LA group; however, no statistically significant difference was observed between the PIA and INB groups (0.80 ± 1.24 vs. 1.35 ± 1.63 vs. 2.25 ± 1.02). There was no significant difference in VAS scores at 24 h post-ablation (0.80 ± 1.24 vs. 1.40 ± 1.57 vs. 1.50 ± 1.64). The technical success and efficacy rates were 100%. No procedure-related deaths occurred within 30 days of MWA, and most adverse events were minor.

Conclusion: INB and PIA significantly reduced perioperative pain compared to LA. No significant difference in adverse events incidence was observed among the three groups.

Objective: To develop a predictive model for assessing massive hemorrhage risk during dilatation and curettage (D&C) after focused ultrasound ablation surgery (FUAS) in Type 2 cesarean scar pregnancy (CSP) patients.

Methods: A retrospective analysis of 405 Type 2 CSP patients treated at Hunan Maternal and Child Health Hospital (2018-2023) was conducted. Multivariable logistic regression identified independent risk factors, and a nomogram was constructed. Model performance was evaluated using AUC, calibration curves, and decision curve analysis (DCA). Ten-fold cross-validation was performed, and external validation was conducted on 327 patients.

Results: Independent risk factors included gestational sac maximum diameter (OR 1.11, 95% CI: [1.07-1.15], p < 0.001), GS blood flow US grade 3 (OR 9.96, 95% CI: [2.65-40.10], p < 0.001), and FUAS-curette time >24 h (OR 17.57, 95% CI: [3.88-84.48], p < 0.001). C-scar thickness and HCG levels were also included in the model as clinically significant factors. The model showed high discriminative ability (AUC 0.910, 95% CI: 0.867-0.953) and was validated through 10-fold cross-validation (mean AUC 0.838). External validation confirmed its robustness (AUC 0.812, 95% CI: 0.742-0.881). Calibration curves and DCA confirmed its accuracy and clinical utility.

Conclusion: The predictive model effectively assesses hemorrhage risk in Type 2 CSP patients post-FUAS, offering valuable clinical utility.

Objective: To explore the value of advanced MRI techniques in predicting the effect of high-intensity focused ultrasound (HIFU) on uterine fibroids and to establish a prediction model.

Methods: This study enrolled 40 patients with 52 uterine fibroids who underwent HIFU at our hospital. All patients were scanned using multiple MRI sequences before HIFU therapy, including non-contrast enhanced MRI, contrast-enhanced MRI, diffusion weighted imaging (DWI), arterial spin labeling (ASL), and T1 mapping. MRI sequences that could predict the HIFU effect were identified, and the predictive performance was evaluated using ROC curves. Univariate and multivariate logistic analyses were employed to investigate independent predictors and establish a prediction model. In addition, we assessed and verified the performance of the model.

Results: Hyperintense on T2 weighted imaging (T2WI), large apparent diffusion coefficient (ADC) values derived from DWI, and high perfusion index derived from ASL were associated with a poor HIFU effect. Univariate and multivariate logistic analyses suggested that uterine position, ADC value and perfusion index were independent predictors for establishing the prediction model. The AUC of the prediction model was 0.939. Both the Hosmer-Lemeshow test and the calibration curve indicated good calibration. The decision curve analysis (DCA) curve showed good clinical benefits, and the leave-one-out cross-validation (LOOCV) revealed that the model had good predictive performance and generalization ability.

Conclusion: ADC values and perfusion index are predictors of the effect of HIFU on uterine fibroids. The prediction model including uterine position, ADC value, and perfusion index as predictors has good predictive performance.

Purpose: To investigate the safety and efficacy of high-intensity focused ultrasound (HIFU) in the treatment of postpartum placenta increta and to analyze the influencing factors of intraoperative blood loss and curettage times.

Methods: From January 2016 to December 2018, a retrospective analysis was conducted on 160 patients with placenta increta treated by HIFU combined with (or without) curettage in our hospital. Intraoperative blood loss and the number of curettage procedures were recorded. The clinical outcomes and the influencing factors of bleeding and the number of curettage procedures were analyzed.

Results: No serious complications occurred during HIFU treatment. The median volume of blood loss during suction curettage was 20 ml (range: 5-600 ml). Blood loss was significantly higher in patients with a large placental diameter (p = 0.007). The risk of requiring multiple curettage procedures was significantly higher in patients with a large placental diameter (p = 0.023). The interval time between HIFU and suction curettage was identified as a protective factor, a longer interval was associated with fewer curettage procedures (p = 0.015).

Conclusion: Based on the results of our large-sample study, HIFU appears to be safe and effective in the treatment of postpartum placenta increta. Blood loss volume is associated with the largest diameter of the placenta. The risk of requiring multiple curettage procedures is related to the largest diameter of the placenta, While the interval time between HIFU and suction curettage is a protective factor for reducing curettage times.

Purpose: This retrospective study aimed to evaluate the feasibility and safety of co-ablation (Co-A) for lung malignancies in patients with usual interstitial pneumonia (UIP).

Materials and methods: We retrospectively reviewed the clinical records of 1,537 consecutive patients treated for malignant lung tumors. UIP was assessed using standard-dose computed tomography (CT). Overall, 14 patients (12 men and two women; mean age ± standard deviation: 71.68 ± 7.83 years, range: 60-87 years) with UIP underwent CT-guided percutaneous Co-A. The mean tumor size was 29.14 mm (standard deviation: 12.60; range: 12-45 mm). Follow-up was performed using CT 1 and 3 months after Co-A. Complications and safety outcomes were also assessed.

Results: The median follow-up duration for all patients was 3 months (range: 1-5 months). The mortality rate was 0% within 30 d of ablation. Major complications, including pneumonia and bronchopleural fistula, occurred in 14.3% (2/14) of patients. The technical success rate was 100%.

Conclusion: Co-A appears to be a safe and effective treatment for lung malignancies in patients with UIP.

Objective: This study aims to explore the neuroprotective effects of inhibiting TLR4 on brain damage resulting from heatstroke (HS) and to clarify the underlying molecular mechanisms involved.

Methods: In this study, we successfully established a HS rat model. The TLR4 antagonist TAK-242 was administered to evaluate its impact on neurological dysfunction, brain edema, learning and memory deficits, and histopathological alterations in the hippocampus.

Results: The inhibition of TLR4 using TAK-242 led to a significant reduction in neurological dysfunction and brain edema in rats subjected to HS. Additionally, TAK-242 improved learning and memory impairments associated with HS and alleviated histopathological changes observed in the hippocampus. The treatment also resulted in a decrease in CD68-positive microglia and reduced expression levels of iNOS and TNF-α, while increasing CD206-positive cells and the expression of Arg-1 and IL-10. Furthermore, TAK-242 effectively reversed the elevated protein levels of TLR4, MyD88, and NF-κB induced by HS.

Conclusion: These findings indicate that TLR4 inhibition through TAK-242 may be a promising therapeutic strategy for neuroprotection in HS by modulating microglial polarization.

Objective: The present study aimed to analyze the relationship between the incidence of complications and tumor size following thermal ablation of benign thyroid nodules (BTNs).

Methods: In this retrospective study, 1198 patients who underwent thermal ablation for unifocal BTN were enrolled. Receiver Operating Characteristic analysis was performed to select the cutoff values of the maximum diameter (MD) for dividing patients into different groups or subgroups. Multivariable logistic regression was performed to identify the risk factors. Propensity score matching (PSM) was employed to control for confounding variables.

Results: The overall complication rate was 3.8% (45/1198). Major complications included hoarseness (2.4%), nodule rupture (0.3%) and delayed hemorrhage (0.1%), whereas minor complications were limited to intraoperative hemorrhage (0.9%). The difference in the overall complication rate between the smaller group (< 3.15 cm) and the larger group (> 3.15 cm) was significant (1.0% vs. 6.5%, p < 0.001). In the subgroup analysis, a significant difference was observed between the 3.15-4.15 cm and > 4.15 cm subgroups (4.2% vs. 8.7%, p = 0.023); however, no significant difference was identified between the < 2.35 and 2.35-3.15 cm subgroups (0.6% vs. 1.6%, p = 0.390). Multivariable logistic regression indicated that MD and the nodule component were associated with complications. After PSM, no significant difference in complication rates was observed between MWA and RFA in either the smaller group (p = 1.000) or the larger group (p = 0.186).

Conclusions: The incidence of complications in thermal ablation is greater for larger thyroid nodules, particularly for predominantly solid nodules with MDs greater than 3.15 cm.

Background: Currently high-intensity focused ultrasound (HIFU) is widely used to treat uterine fibroids (UFs). The aim of this study is to develop a machine learning model that can accurately predict the efficacy of HIFU ablation for UFs, assisting the preoperative selection of suitable patients with UFs.

Methods: This study collected data from 1,000 patients with UFs who underwent ultrasound-guided high-intensity focused ultrasound. The least absolute shrinkage and selection operator (LASSO) regression was used for multidimensional feature screening. Five machine learning algorithms such as logistic regression, random forest, extreme gradient boosting (XGBoost), artificial neural network, and gradient boosting decision tree were utilized to predict ablation efficacy. The efficacy was quantified by the non-perfused volume ratio (NPVR), which was classified into two categories: NPVR <80% and NPVR ≥80%.

Results: The XGBoost model proved to be the most effective, showing the highest AUC of 0.692 (95% CI: 0.622-0.762) in the testing data set. The four key predictors were T2 weighted image, the distance from ventral side of UFs to skin, platelet count, and contrast-enhanced T1 weighted image.

Conclusions: The machine learning prediction model in this study showed significant potential for accurately predicting the preoperative efficacy of HIFU ablation for UFs. These insights were important for clinicians in the preoperative assessment and selection of patients, which could enhance the precision of treatment planning.