Ablation Research Articles

Long-term clinical outcomes of thermal ablation for benign thyroid nodules and unresolved issues: a comprehensive systematic review

Long-term clinical outcomes of thermal ablation for benign thyroid nodules and unresolved issues: a comprehensive systematic review

Safety of local thermal ablation in hepatocellular carcinoma patients with cirrhosis and severe thrombocytopenia.

Generally, invasive treatment is contraindication for patients with severe thrombocytopenia, because it may increase risk of bleeding. However, many early hepatocellular carcinoma (HCC) patients with cirrhosis have platelet counts (PC) less than 50 × 109/L due to hypersplenism. These patients are often accompanied by hepatic insufficiency, which makes hepatectomy impossible, and local thermal ablation (LTA) has become a major treatment. The aim of our study is to investigate the correlation between severe thrombocytopenia and bleeding after LTA in HCC patients with cirrhosis, and evaluate risk factors of bleeding. 473 patients with cirrhosis who underwent LTA for HCC from 2016 to 2020 were enrolled, and 709 ablations were performed in total. Based on preoperative PC, cases were divided into three groups, namely,group A (PC > 50 × 109/L), group B (30 × 109/L < PC ≤ 50 × 109/L) and group C (PC ≤ 30 × 109/L). The incidence of bleeding after LTA was compared among the three groups. Logistic regression was used to explore the risk factors for bleeding after ablation. The overall incidence of bleeding complications was 4.4%, and no significant difference was observed between group A, B, and C (3.9% vs. 6.4% vs. 3.3%, P = 0.410). In multivariate analysis, tumor diameter (OR = 2.657 per 1cm, P < 0.001), and multiple lesions (≥ 3) (OR = 3.723, P = 0.006) were found to be independent predictors of bleeding after LTA. In small HCC patients with cirrhosis and hypersplenism, the PC range 30-50 × 109/L will not increase the risk of bleeding after LTA. Tumor diameter and number of lesions are independent predictors for bleeding after LTA in HCC patients.

ENHANCING TRANSDERMAL DELIVERY OF POORLY WATER-SOLUBLE NSAIDS: EFFECTIVE STRATEGIES

Transdermal drug delivery offers significant advantages for administering non-steroidal anti-inflammatory drugs (NSAIDs) and anti-complementary drugs, particularly those with poor water solubility. This delivery route bypasses first-pass metabolism and gastrointestinal degradation, enhancing bioavailability and patient compliance. However, the stratum corneum, the outermost layer of the skin, poses a formidable barrier to drug permeation. To address this challenge, several innovative strategies have been developed to improve the transdermal delivery of these poorly soluble drugs. Chemical enhancers, such as alcohols, fatty acids, and surfactants, can disrupt the lipid structure of the stratum corneum, increasing drug solubility and permeability. Nanoformulations, including liposomes, niosomes, solid lipid nanoparticles, and nanoemulsions, enhance drug solubility, provide protection against degradation, and facilitate controlled release with deeper skin penetration. Prodrugs, designed to convert into the active drug within the skin, can improve solubility and permeability. Physical methods like microneedles, iontophoresis, and phonophoresis create micropores or use electrical and ultrasound waves to enhance permeation without compromising skin integrity. Cyclodextrins form inclusion complexes with drugs, boosting solubility and stability. Hydrogels and polymer-based formulations create a moist environment for sustained drug release and better absorption. Co-solvents and surfactants, such as ethanol and DMSO, further enhance solubility and disrupt the stratum corneum to facilitate drug penetration. Electroporation and thermal ablation transiently disrupt the skin barrier, significantly improving drug permeation. These strategies, individually or in combination, hold promise for optimizing the transdermal delivery of poorly water-soluble NSAIDs and anticomplementary drugs, ensuring effective therapeutic outcomes and improved patient compliance.

Innovations in intraoperative therapies in neurosurgical oncology: a narrative review.

High-grade gliomas (HGG) represent the most aggressive primary brain tumors in adults, characterized by high recurrence rates due to incomplete resection. This review explores the effectiveness of emerging intraoperative therapies that may extend survival by targeting residual tumor cells. The main research question addressed is: What recent intraoperative techniques show promise for complementing surgical resection in HGG treatment? A comprehensive literature review was conducted, examining recent studies on intraoperative therapeutic modalities that support surgical resection of HGG. Techniques reviewed include laser interstitial thermal therapy (LITT), intraoperative brachytherapy, photodynamic therapy (PDT), sonodynamic therapy (SDT), and focused ultrasound (FUS). Each modality was evaluated based on clinical application, evidence of effectiveness, and potential for integration into standard HGG treatment protocols. Findings indicate that these therapies offer distinct mechanisms to target residual tumor cells: LITT provides localized thermal ablation; intraoperative brachytherapy delivers sustained radiation; PDT and SDT activate cytotoxic agents in tumor cells; and FUS enables precise energy delivery. Each method has shown varying levels of clinical success, with PDT and LITT currently more widely implemented, while SDT and FUS are promising but under investigation. Intraoperative therapies hold potential to improve surgical outcomes for HGG by reducing residual tumor burden. While further clinical studies are needed to optimize these techniques, early evidence supports their potential to enhance the effectiveness of surgical resection and improve patient survival in HGG management.

De novo strategy of organic semiconducting polymer brushes for NIR-II light-triggered carbon monoxide release to boost deep-tissue cancer phototheranostics.

The integration of photoacoustic imaging (PAI) and photothermal therapy (PTT) within the second near-infrared (NIR-II) window, offering a combination of high-resolution imaging and precise non-invasive thermal ablation, presents an attractive opportunity for cancer treatment. Despite the significant promise, the development of this noninvasive phototheranostic nanomedicines encounters challenges that stem from tumor thermotolerance and limited therapeutic efficacy. In this contribution, we designed an amphiphilic semiconducting polymer brush (SPB) featuring a thermosensitive carbon monoxide (CO) donor (TDF-CO) for NIR-II PAI-assisted gas-augmented deep-tissue tumor PTT. TDF-CO nanoparticles (NPs) exhibited a powerful photothermal conversion efficiency (43.1%) and the capacity to trigger CO release after NIR-II photoirradiation. Notably, the liberated CO not only acts on mitochondria, leading to mitochondrial dysfunction and promoting cellular apoptosis but also hinders the overexpression of heat shock proteins (HSPs), enhancing the tumor's thermosensitivity to PTT. This dual action accelerates cellular thermal ablation, achieving a gas-augmented synergistic therapeutic effect in cancer treatment. Intravenous administration of TDF-CO NPs in 4T1 tumor-bearing mice demonstrated bright PAI signals and remarkable tumor ablation under 1064nm laser irradiation, underscoring the potential of CO-mediated photothermal/gas synergistic therapy. We envision this tailor-made multifunctional NIR-II light-triggered SPB provides a feasible approach to amplify the performance of PTT for advancing future cancer phototheranostics.

Comparative study of the therapeutic effects of radiofrequency ablation of ganglionated plexi guided by high-frequency stimulation and anatomical localization methods in the treatment of vagal syncope in young people.

To investigate the differences in safety and efficacy between high-frequency stimulation (HFS) and anatomically guided endocardial catheter ablation (AA) of the ganglionated plexi (GPs) for treating vasovagal syncope (VVS) in individuals engaged in high-intensity physical training. Forty-five patients (age 22.5 ± 4.4 years) undergoing high-intensity physical training were included from January 2020 to January 2023 at our hospital. Patients underwent GP ablation for recurrent syncope. Comprehensive evaluations, including head MRI, cardiac ultrasound, electrocardiogram (ECG), ambulatory ECG (Holter), ambulatory blood pressure monitoring, plate motion tests, and head-up tilt tests (HUT), were conducted to exclude other systemic disorders causing syncope. HFS and AA-guided GP ablation were performed on 10 and 35 patients, respectively, all of whom tested positive for HUT. Differences between the two groups were compared regarding ablation sites, ablation time, safety, and effectiveness. The ablation time was significantly shorter in the AA group compared to the HFS group (P < 0.001). The number of GPs selected for ablation using the AA method was reduced (P < 0.001). All patients in the HFS group experienced palpitations and discomfort, whereas only 31.43% of patients in the AA group reported these symptoms (P = 0.001). Fentanyl analgesia was administered in both groups, and no significant complications arose from the ablation. The longest follow-up duration was 52 months, while the shortest was 15 months. One case of pre-syncope occurred in the HFS group 8 months post-ablation, and one case of pre-syncope and two cases of syncope occurred in the AA group at 1 and 3 months post-ablation, respectively. There were no statistically significant differences in heart rate variability (HRV) and cardiac deceleration capacity (DC) between the two groups after ablation (P > 0.05). Two cases in the AA group still exhibited type II second-degree atrioventricular block during sleep. Both groups of patients were able to complete high-intensity physical training and showed significant symptom improvement post-ablation. Young individuals with VVS engaged in high-intensity physical training can benefit from GP ablation using both HFS and AA methods. The AA method requires relatively simple equipment, shorter procedure time, and results in less discomfort during the ablation.

Optical imaging of the stochastic nucleation kinetics and intrinsic activation energy of single spin-crossover nanoparticles

Cooperative spin crossover (SCO) compounds are one of the most promising molecular bistable solids due to their intriguing thermal hysteresis phenomena around room temperature. It is well known that hysteresis is an essential kinetic effect, however, accurate assessment of the spin transition kinetics of SCO nanomaterials remains scarce. Herein, we developed a thermal-optical methodology to image the thermally induced spin transition kinetics of single SCO nanoparticles in a quantitative, repeatable, and high-throughput manner. Single-particle measurement revealed an intrinsic nucleation-dominated spin transition mechanism, where a highly stochastic nucleation process was clearly observed during the repeatable measurements. By quantifying the dependence of nucleation time on temperature, the activation energy barriers for nucleation were further extracted at a single particle level. Based on this foundation, the high throughput of the optical imaging not only contributed to uncovering the significant nanoparticle-to-nanoparticle heterogeneity, with implications for a negative correlation between apparent activation energy barriers for nucleation and size of the SCO nanoparticles, but also facilitated identifying a minority with high activation energy at least twice the average value. The extraordinary performance was then attributed to the fewer defects within their structures, as confirmed by further results from the in situ creation of defects by thermal ablation, thereby setting the lower limit for the intrinsic activation energy of ideal SCO crystals and promising their potential for future applications in high-performance molecular devices.

Abstract 4136346: A Comparative Analysis of Esophageal Cooling for Preventing Esophageal Injury Post Atrial Fibrillation Catheter Ablation: A Systematic Review and Meta-analysis

Introduction: Thermal injury following atrial fibrillation catheter ablation is a rare but fatal complication. We aim to assess the safety profile of different forms of esophageal cooling methods versus standards of care. Methods: We searched PubMed, Cochrane Library, Scopus, and Web of Science databases for randomized controlled trials and cohort studies comparing esophageal cooling to Luminal esophageal temperature (LET) monitoring regarding esophageal thermal lesions (ETL) post atrial fibrillation ablation. Case reports, case series, reviews, conference abstracts and animal studies were excluded. Review manager software (version 5.4) was used to perform the meta-analysis. Results: We included 10 studies with 25662 patients in total: 14515 patients in the esophageal cooling group and 11147 patients in the LET group. Overall esophageal lesion analysis demonstrated no statistically significant difference between the esophageal cooling group and LET (RR = 0.72, 95% CI = 0.35 to 1.49, p-value = 0.38). Subgroup analysis showed no statistically significant difference for mild/moderate lesions (RR = 1.52, 95% CI = 0.80 to 2.90, p-value = 0.20). However, the subgroup analysis showed a statistically significant association between esophageal cooling and decreased severity of esophageal lesions compared with LET (RR = 0.29, 95% CI = 0.12 to 0.71, p-value = 0.007). Regarding AF recurrence, the pooled analysis showed no statistically significant difference between esophageal cooling group and LET (RR = 1.24, 95% CI = 0.95 to 1.61, p-value = 0.11). Conclusion: In patients undergoing AF catheter ablation, the implementation of esophageal cooling showed statistical significance in decreasing the severity of esophageal lesions compared to the LET group. Also, esophageal cooling demonstrated non-inferiority in AF recurrence compared to LET. Future research should focus on assessing the long-term effects of esophageal cooling during AF catheter ablation.

Abstract 4137964: Electrical Gaps and Outcomes After Redo AF Ablation: Comparative Analysis from the EARNEST-PVI Trial

Introduction: The efficacy of extensive ablation strategies in addition to pulmonary vein (PV) isolation is still controversial in persistent atrial fibrillation (AF) ablation. Gaps in previously ablated lesions can induce arrhythmias, potentially decreasing the effectiveness of extensive ablation. Purpose: To evaluate the incidence of gaps, gap-related reentry, and subsequent recurrence following redo AF ablation in the EARNEST-PVI trial (NCT03514693). Methods: The analysis was performed using the extended data of the EARNEST-PVI trial (N=512), a randomized controlled trial evaluating ablation strategies for persistent AF. Patients were randomized 1:1 to either the PVI-plus or PVI-alone group. During a median follow-up of 47 months, 126 (25%) patients underwent redo AF ablation. Among them, we enrolled patients who underwent PVI-alone (N=69), or PVI-plus left atrial (LA) linear ablations (LA roof and mitral isthmus) (N=46) during the index ablation. Results: In the previous PVI-alone group, electrical PV gaps were observed in 38 (57%) patients. In the previous PVI-plus group, 19 (41%), 10 (22%), and 11 (24%) patients had electrical gaps in the PVs, LA linear lines, or both, respectively. During the redo session, 19 atrial tachycardias (ATs) were observed/induced in 15 patients. ATs were more frequently observed in the PVI-plus group than in the PVI-alone group (23.9% vs. 5.8%, p=0.005). While 7 ATs were not associated with gaps, 2 were related to PV gaps, and 10 were related to gaps in the linear lesions. In the redo AF ablation, PVI was re-completed in all patients, and any induced ATs were eliminated by additional ablation. During a median follow-up of 32 months post-redo, patients with gaps had a lower clinical recurrence rate than those without (44.3 vs. 47.2%, log-rank p=0.033). However, the Cox regression analysis revealed that AF recurrence post-redo was associated only with PV gaps, and not with linear ablation gaps (hazard ratio, 0.57; 95% confidence interval, 0.32–0.99; p = 0.049). Conclusions: In redo AF ablations, electrical gaps were more prevalent in patients who underwent extensive ablation during the index procedure. While all gaps during redo were potentially arrhythmogenic, PV gaps alone were associated with AF recurrence after redo AF ablation.

Abstract 4138281: Relationship of Collagen Metabolism Biomarkers, Left Atrial Fibrosis and Ablation Outcome in Atrial Fibrillation

Introduction: Inflammation and fibrinogenesis in the left atrium are hypothesized to play a major role in the development of atrial fibrillation (AF). We previously showed that collagen metabolism biomarkers (CMB) are significantly elevated in patients with AF compared to healthy controls. Objective: We sought to investigate the relationship between CMB, Left Atrial Fibrosis (LAF) and AF recurrence after ablation. Methods: Patients with AF undergoing ablation evaluation (N= 96) were prospectively enrolled between 2015 – 2020. Plasma samples were collected prior to ablation and analyzed for CMB using commercially available ELISA kits. Sixty-four patients underwent AF ablation and were followed for 6 months for AF recurrence. CMR was performed in 48 patients using cine and 3D high resolution, late gadolinium enhancement imaging on 3T MRI to measure LAF. Patients were classified into 2 groups dichotomized by the median LAF value. Results: Mean age was 60.3 ± 10.3 years, mean BMI 29.7 ± 4.9 kg/m2, mean CHA2DS2-VASc score 1.9 ± 1.4 and 27% were women. Paroxysmal AF was present in 52.5%. The median LAF score was 13.6% (IQR 9.8 – 21.7). High PINP, high CITP and low TIMP-2 were associated with high LAF score (Table 1). High CITP was also associated with recurrence of AF after ablation {4.26 ng/ml (IQR 3.22 - 4.65) vs 3.26 ng/ml (IQR1.92 - 4.25), P = 0.02}. Conclusion: Higher levels of PINP and CITP were significantly associated with higher LAF score in AF patients. TIMP-2 was associated with low LAF. Higher CITP was also associated with AF recurrence after ablation. Further larger studies are needed to better understand the relationship between collagen biomarkers, LA fibrosis and their clinical impact on rhythm control in AF.

A Case of Pneumocephalus Due to an Untreated Atrial-Esophageal Fistula Post-Left Atrial Ablation Therapy

A Case of Pneumocephalus Due to an Untreated Atrial-Esophageal Fistula Post-Left Atrial Ablation Therapy

Abstract 4148095: The Impact of Body-Mass Index on Ventricular Tachycardia Outcomes Post-Catheter Ablation

Background: In recent years, catheter ablation has emerged as a sustainable, first-line therapy for the management of ventricular tachycardia (VT). Given the rise of the “obesity paradox” theory in atrial ablation outcomes, we sought to study the effect of BMI on patients undergoing structural VT ablation. Purpose: To assess the outcomes of VT ablation, specifically VT recurrence, in patients with elevated vs. normal BMI. Methods: Clinical characteristics and demographic data were collected for VT patients who underwent ablation at Mayo Clinic Rochester from 2012-2022. Patient BMI was classified as non-obese (&lt;30 kg/m2), obese (30-40 kg/m2), and morbidly obese (≥40 kg/m2). The endpoint was a composite of initial monomorphic VT recurrence and repeat ablation after adjusting for age, sex, and comorbidities. Results: A total of 399 patients underwent 508 ablations. 51.4% of ablations had a BMI &lt;30, 39.2% were between 30-40, and 9.4% were ≥40. There was a greater prevalence of hypertension and type 2 diabetes mellitus in morbidly obese patients (p &lt;0.01). Morbidly obese individuals also had a significantly increased rate of general anesthesia during ablation and long VT cycle lengths. The Kaplan-Meier curve demonstrates no statistically significant differences in time to VT recurrence among the three BMI groups (p = 0.324). Neither morbid-obesity (aHR= 1.20; CI = 0.94-1.56, p = 0.14) nor nonmorbid-obesity (aHR = 0.92; CI = 0.76-1.10, p = 0.4), compared to non-obesity was a significant independent predictor of VT recurrence or repeat ablation on multivariate regression after adjusting for age, sex and comorbidities. Conclusion: There was no significant association between BMI groups and VT recurrence or repeat ablation, and no difference in complications. We did not find the obesity paradox to be relevant for VT ablation in our patient population. Further study would be needed with larger samples to corroborate these findings.

Effectiveness of minimally invasive methods (laser-induced interstitial thermotherapy and percutaneous ethanol sclerotherapy) in the treatment of Plummer’s disease

Background. The purpose of the study was to investigate the effectiveness of minimally invasive methods, such as laser-induced interstitial thermotherapy (LITT) and its combination with percutaneous ethanol ablation (PEA), in treating toxic thyroid adenomas. To determine the multiplicity of the LITT procedure and parameters of laser radiation to achieve a stable positive therapeutic effect. Materials and methods. Between 2020 and 2024, 24 patients with Plummer's disease who did not receive previous thyrostatic therapy before the LITT session were treated and were divided into 2 groups. Patients of the first group with a predominantly parenchymal structure of the node received LITT monotherapy (16 patients), patients of the second group with an existing cystic component received percutaneous ethanol sclerotherapy followed by LITT (8 patients). Patients underwent ultrasound and hormonal follow-up after laser ablation at 2, 4, and 6 months. Study endpoints: percent nodal volume reduction compared to pretreatment volume (VRR), thyroid-stimulating hormone (TSH), free thyroxine, free triiodthyronine, TSH-receptor antibodies. Results. All patients had a positive result of treatment. The average nodal volume reduction ratio (VRR) for patients in the first group was 88.3 ± 7.9 % (min — 71.5, max — 95.4), and for patients in the second group — 72 % (min — 59.5, max — 85.4). The percen­tage of patients in whom the euthyroid status was recorded after the first session ranged from 100 % for nodes of smaller volume (up to 4 cm3) to 63 % for nodes of maximum volume (up to 13 cm3). After the completed treatment (the maximum number of LITT sessions — 4), all patients had a stable euthyroid status. The effective specific ener­gy for solid nodules is ≈ 900 J/ml, for mixed cystic-parenchymal nodules the specific energy is lower and ≈ 790 J/ml (for the volume of the nodule after PEA). Complications: one case of bleeding was recorded, and a moderate pain syndrome: 6 points on the Visual Analog scale. Conclusions. Laser thermal ablation of toxic thyroid adenomas under ultrasound guidance offers an additional safe and effective minimally invasive treatment option. Reduction of solid thyroid nodules is effective over time if the specific energy exceeds 900 J/ml (for the primary nodule volume). The reduction of mixed cystic-parenchymal nodules is effective under the condition of the effectiveness of ethanol, the specific energy for such nodules is less than ≈ 790 J/ml (for the volume of the nodule after PEA). The total energy for the course of treatment should not be less than the calculated (Е∑ ≈ Espec × Vnode). Clinical outcomes are significantly more favorable in small toxic adenomas than in large nodes

Thermal Ablation for Papillary Thyroid Carcinoma

Image-guided thermal ablation has been administered for patients with T1N0M0 papillary thyroid carcinoma (PTC) who elect to not undergo surgery or receive active surveillance. Considering the indolent nature of PTC, long-term outcomes of ablation are needed. To investigate l0-year outcomes of thermal ablation in treating T1N0M0 PTC. This multicenter study was conducted at 4 university-affiliated hospitals in China and included 179 consecutive patients with T1N0M0 PTC (median [IQR] volume, 88.0 [163.2] mm3) who underwent thermal ablation between June 2010 and March 2014. Patients who were ineligible to undergo surgery or elected not to were included, and patients had PTC tumors that were smaller than 20 mm as confirmed by biopsy; no clinical or imaging evidence of extrathyroidal extension, lymph node metastasis (LNM), or distant metastasis; and no history of neck irradiation. The primary outcomes were disease progression (LNM, newly developed tumors, persistent tumors, and distant metastasis) and disease-free survival (DFS). Secondary outcomes were technical success, volume reduction rate, tumor disappearance, complications, and delayed surgery. DFS was calculated using a Kaplan-Meier analysis. Among the 179 patients, the mean (SD) age was 45.8 (12.7) years, and 118 (65.9%) were female. During a mean (SD) follow-up period of 120.8 (10.8) months, disease progression was found in 11 of 179 patients (6.1%), including LNM in 4 patients (2.2%), newly developed tumors in 6 patients (3.3%), and persistent tumor in 1 patient (0.6%). The 10-year DFS was 93.9%. The technical success, median volume reduction rate, and tumor disappearance rate was 100%, 100%, and 97.2%, respectively. The magnitude of the disease progression (6.1% vs 7.1%; difference, 1.0%; 95% CI, -6.5% to 25.6%) and DFS (93.9% vs 92.9%; difference, 1.0%, 95% CI, -6.5% to 25.6%) between patients with T1a and T1b tumors was small. The difference in the rate of tumor disappearance between T1a and T1b tumors was large (99.4% vs 71.4%; difference, 28.0%; 95% CI, 10.9%-54.0%). One patient experienced transient voice hoarseness (0.6%). Because of anxiety, 1 patient underwent delayed surgery (0.6%). The results of this 10-year multicenter cohort study suggest that thermal ablation is an effective and safe alternative for patients with T1N0M0 PTC who do not undergo surgery or receive active surveillance. For safe and effective treatment, accurate radiologic evaluation, an understanding of ablation techniques, and experienced physicians are recommended.

Outcomes of Thermal Ablation for Papillary Thyroid Carcinoma

Outcomes of Thermal Ablation for Papillary Thyroid Carcinoma

Liver Regeneration Following Thermal Ablation Using Nanocarrier Mediated Targeted Mesenchymal Stem Cell Therapy

Abstract Purpose To test the efficacy of nanocarrier (NC) mediated mesenchymal stem cell (MSC) therapy for liver regeneration following thermal ablation of porcine livers. Materials and Methods Liver radiofrequency ablation was performed in 18 swines divided into MSC, MSC + NC and control groups. The test groups received infusion of MSC or MSC + NC labeled with enhanced green fluorescent protein (eGFP) via hepatic artery. MSC + NC group had MSCs coated with dendrimer nanocarrier complexed with I-Domain of lymphocyte function-associated antigen-1 (LFA-1). Nanocarriers direct homing of MSCs by binding to its counterpart protein, intercellular adhesion molecule-1 (ICAM-1), which is overexpressed at the periablation margins from inflammation. Ablation cavity reduction by CT volumetry was used as surrogate marker for liver regeneration. Cell proliferation was assessed with Ki67 and HepPar-1 stains. GFP identified MSC derived cells. Results Total number of ablations in control animals were 13 across 4 animals. In the MSC group, there were 23 ablations across 6 animals, and in MSC + NC group there were 21 ablations across 6 animals. Ablation cavity volume reduction from day 0 to 30 were 64.4 ± 15.0%, 61.5 ± 12.9% and 80.3 ± 9.4% for control, MSC and MSC + NC groups, respectively (MSC + NC vs MSC: p &lt; 0.001, MSC + NC vs. control: p = 0.001). GFP+ cell count at margins was 426.8 ± 193.2 for MSC group and 498.6 ± 235.2 for MSC + NC group (p = 0.01). The mean Ki67 and HepPar-1 staining at margins were 9.81 ± 4.5% and 6.12 ± 4.2% for MSC + NC group versus 7.59 ± 3.7% and 5.09 ± 3.7% for MSC group, respectively (P &lt; 0.001 and P = 0.09, respectively). Conclusion Nanocarrier-mediated MSC therapy promotes liver regeneration by engrafting MSCs at ablation margins, potentially making liver-directed therapy viable for patients with severe liver dysfunction. This technology may also benefit other solid organs. Graphical Abstract

Luminescence Patterns on Multimillimeter Single-Crystal MAPbBr3 Microplatelets via Thermal Ablation Effects.

The single crystal distinguishes itself as the most outstanding representative of excellent optoelectronic performance among perovskite semiconductors due to its exceptional charge carrier properties, extraordinary optophysics, precise structural geometries, and superior material stabilities. However, it exhibits mediocre performance in light emission, which can be attributed to its excessive carrier diffusion lengths and extremely low recombination rates. To address this challenge, this study puts forward a controllable high-temperature annealing treatment strategy concentrating on multimillimeter-scale MAPbBr3 micrometer-thick platelet single crystals (MPSCs). Through the utilization of thermal ablation effects to convert the surface monocrystalline lattices into polycrystalline perovskite nanocrystals (PNCs) with a remarkably increased specific surface area, the fluorescence intensity arising from the rapid recombination of free carriers on the PNC surface is enhanced by 320 times compared to the pristine MPSC surface. These PNCs produced through surface annealing, with the characteristic of loose adhesion to surfaces, can be mechanically wiped away and regenerated in situ via reannealing the residual MAPbBr3 MPSCs, guaranteeing high intensity, durability, and standard geometric fluorescence. Moreover, by regulating the surface distributions of thermal ablation effects and carrying out embossing annealing treatment or laser direct writing, we can design and fabricate relatively complex, high-contrast (255×), and clearly resolved fluorescence patterns on MPSC surfaces.

Optimization of three-dimensional esophageal tumor ablation by simultaneous functioning of multiple electrodes.

Radiofrequency ablation is a widely accepted minimal-invasive and effective local treatment for tumors. However, its current application in esophageal cancer treatment is limited to targeting thin and superficial lesions, such as Barrett's Esophagus. This study proposes an optimization method using multiple electrodes simultaneously to regulate the temperature field and achieve conformal ablation of tumors. A particle swarm optimization algorithm, coupled with a three-dimensional thermal ablation model, was developed to optimize the status of the functioning electrodes, the optimal voltage (Vopt), and treatment duration (ttre) for targeted esophageal tumors. This approach takes into account both the electrical and thermal interactions of the electrodes. The results indicate that for esophageal cancers at various stages, with thickness (c) ranging from 4.5mm to 10.0mm, major axis (a) ranging from 7.3mm to 27.3mm, and minor axis (b) equaling 7.3mm or 27.3mm, as well as non-symmetrical geometries, complete tumor coverage (over 99.5%) close to conformal can be achieved. This method illustrates possible precise conformal ablation of esophageal cancers and it may also be used for conformal treatments of other intraluminal lesions.

Multi-objective optimization based robotic path planning for interpolation reconstruction model of CT data

Robotic path planning plays a pivotal role in computer-aided liver tumor thermal ablation surgery. However, traditional methods face challenges in terms of low reconstruction efficiency and planning safety. To address these issues, we propose a method for robotic path planning of liver tumor thermal ablation surgery. Firstly, an interlayer interpolation algorithm based on optical flow estimation is utilized to compensate for large interlayer spacing in computed tomography (CT) images by inserting predicted images between sequence images. Secondly, the voxel traversal strategy and patch intersection calculation strategy in the standard marching cube (MC) algorithm is optimized to improve the efficiency of abdominal tissues reconstruction. Finally, comprehensive clinical constraints are summarized to ensure the surgery safety and the strength pareto evolutionary algorithm II (SPEA-II) is leveraged to optimize surgery path, which can obtain even distribution of solutions in high-dimension optimization problems. Extensive experiments conducted on the 3Dircadb and SLIVER07 datasets revealed that our proposed method reduces reconstruction time by 21.5% compared to the standard MC algorithm, while achieving an average overlap rate of 88.25% and an average Hausdorff distance of 15.25 mm between Pareto front points and surgeon's recommended puncture points.

Thermal ablation of soft tissue by a single shock wave sonication of discrete foci within the given volume

New protocols have been developed for shockwave irradiation of soft tissue volumes using trajectories uniformly filled within the given shape by discrete foci, while pulsed millisecond sonication immediately formed a single ablation. The influence of the initial peak power with the same time-average power, the interfocus distance and the geometry of the external contour of the trajectory on the shape, volume and ablation rate was analyzed. The most advantageous is the saturation mode using a trajectory with an interfocus step 1.5 times greater than the transverse size of a single lesion. To obtain volumes of thermal ablation on the order of cubic centimeters, layer-by-layer sonication protocols are proposed, which allow to 2.5 times greater thermal ablation rate compared with protocols used in clinical practice. The advantage of the proposed shockwave protocols is the possibility of obtaining localized and predictable thermal damage without accompanying MRI monitoring.