Ablation Technique Research Articles

Study of water temperature effect on the synthesis of gold nanoparticles by laser ablation technique

Study of water temperature effect on the synthesis of gold nanoparticles by laser ablation technique

Percutaneous Cryotherapy and Radiofrequency Ablation of Renal Masses: Multicenter Comparative Analysis with Minimum 3-Year Follow-up.

Different modalities of percutaneous thermal ablation (PTA) have been used as possible minimally invasive nephron-sparing treatments for small renal masses (SRMs). The present study aimed to compare long-term outcomes of two guidelines-recommended ablative techniques, cryotherapy (CRYO) and radiofrequency ablation (RFA). Data of patients with single cT1 solid renal mass undergoing CRYO or RFA between 2004 and 2020 were retrospectively retrieved from a multi-institutional international database. Oncologic outcomes included "technical success", local recurrence-free survival (RFS), distant metastasis-free survival (MFS), and overall survival (OS). Intraoperative and postoperative complications, length of stay (LOS), and re-admission rate within 30 days were registered. Major complications were defined as CD grade ≥III. Baseline features and treatment outcomes were analyzed using descriptive statistics. RFS, MFS, and OS were estimated using the Kaplan-Meier method. Overall, 643 patients were included, of which 492 (71.2%) underwent CRYO, and 151 (21.8%) RFA, with a median follow-up of 43 and 37 months, respectively (p=0.07). Technical success was achieved in 96.5% of CRYO vs 93.4% of RFA (p=0.09). No difference in terms of overall (CRYO: 10.4% vs RFA: 6%; p=0.1) and "major" (CRYO: 0.8% vs RFA: 1.3; p=0.06) post-operative complications were observed. RFS (CRYO:85.7%; RFA:84.9%, p=0.2), MFS (CRYO: 96.9%; RFA: 95.8%, p=0.4) and OS (CRYO: 89%; RFA: 87.4%; p=0.8) were comparable. CRYO and RFA are both valid minimally invasive options for the treatment of small renal tumors. They are particularly suitable for patients who are not good surgical candidates as they offer very low risk of major procedure-related complications. For the right indication, they both offer favorable mid to long term oncologic outcomes.

Utility of left atrial strain in characterizing patients with reablated atrial fibrillation

Abstract Introduction and Objectives Atrial fibrillation (AF) is a highly prevalent condition, with projections indicating it will increase in the future. Various ablation techniques exist to try to eliminate the arrhythmia, but the problem of recurrences and the need for reinterventions are not uncommon. We need markers to predict which patients will benefit from these procedures and which will recur despite our efforts. Atrial strain techniques have emerged as a novel tool in assessing the function and degree of atrial fibrosis, which could improve patient selection and increase the success of procedures. Methods A retrospective analysis was conducted, including adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 59 healthy patients with no history of cardiovascular disease, labeled as "normal studies" by the examiner, served as the control group, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) of each patient were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups. Results Patients with reablated AF showed significantly lower absolute strain values compared to normal patients in all three analyzed varieties (Reservoir, Conduit, and Pump) with p<0.01 for all comparisons. The mean strain in the control group was 41.80 for reservoir strain, -24.01 for conduit strain, and -17.07 for pump strain; while the mean in the AF group was 17.42, -11.72, and -6.33, respectively. Conclusions We found significant differences in left atrial strain values between normal patients and patients with reablated AF. These findings suggest that left atrial strain could be useful in selecting patients for AF ablation procedures, as those more prone to recurrence exhibit lower absolute strain values, indicating a higher degree of atrial fibrosis where anomalous circuits may establish and perpetuate the arrhythmia over time. Normal Vs Atrial fibrillation

Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors.

Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.

Oral Microalgae-Based Biosystem to Enhance Irreversible Electroporation Immunotherapy in Hepatocellular Carcinoma.

Irreversible electroporation (IRE) is a novel local tumor ablation technique that can potentially stimulate immune responses. However, IRE alone cannot effectively activate the immune system or prevent distant metastases. Therefore, this study utilized the biocompatibility of Chlorella vulgaris (C. vulgaris) and polydopamine (PDA) adhesive properties to encapsulate a PD-1 inhibitor (PI). The PDA coating protects the drug from degradation by stomach acid and enhances its intestinal absorption. This carrier demonstrates excellent in vivo drug release control and biodistribution, significantly increasing the oral bioavailability of PI. Combining IRE with this natural carrier significantly improves the therapeutic efficacy, which increases the local drug concentration and activates the immune system. This system demonstrates significantly improved therapeutic efficacy against local tumors compared with PI or IRE alone and significantly reduces PI-associated side effects. A convenient oral delivery system is developed using this readily available natural micro-carrier that not only improves the therapeutic effect of IRE but also mitigates its adverse effects, indicating significant potential for clinical applications. This discovery offers a new strategy for hepatocellular carcinoma treatment with the potential to improve patient outcomes.

Pacing and Ablation Technique Using Microelectrode for Pulmonary Vein Isolation Using a Local Impedance-Guided Catheter.

The IntellaNav MiFi OI catheter (MiFi) is equipped with a sensor for local impedance (LI) monitoring and three mini-electrodes. In this study, we investigated the target LI values for a successful pulmonary vein isolation (PVI) under the pacing and ablation technique using the MiFi catheter. Twenty-seven patients underwent PVI using the MiFi catheter under mini electrode pacing from the MiFi catheter. The local impedance (LI) changes, generator impedance (GI) changes, and the time to capture loss were evaluated. First-pass isolations were obtained in 15 patients (57.7 %) for right PVs and in 22 patients (84.6 %) for left PVs. At gap sites, the impedance decrease was smaller than at non-gap sites (non-gap sites vs. gap sites; LI drop, 23.2 [±10.3] vs. 15.6 [±7.7] Ω, p < 0.0001; GI drop, 4.8 [±4.1] vs. 2.7 [3.9] Ω, p = 0.0026; %LI drop, -19.3 [±7.4] vs. -13.1 [±6.1] %, p < 0.0001; % GI drop, -5.1 [±4.2] vs. -2.9 [±4.2] %, p = 0.0020), suggesting that changes in impedance could be useful for predicting gaps. The cutoff values for predicting no gaps were identified as 15.0 Ω for the LI drop and -13.74% for the %LI drop. The LI showed greater changes than the GI and was also useful for predicting gaps. The cutoff values of 15.0 Ω for the LI drop and -13.74% for the %LI drop could predict conduction gaps. Under the monitoring of the LI, the pacing and ablation technique proved useful for PVI, even though the MiFi catheter does not have a CF sensor or ablation indices.

Microwave ablation for liver metastases from colorectal cancer: A comprehensive review of clinical efficacy and safety.

Microwave ablation (MWA) is emerging as a highly effective treatment for colorectal liver metastases (CRLMs). This review explores the advantages of MWA compared to other ablative techniques such as radiofrequency ablation and cryoablation and highlights its clinical efficacy, safety, and technical considerations. MWA offers significant benefits, including higher intratumoral temperatures, larger ablation zones, and reduced susceptibility to the heat-sink effect, which make it particularly suitable for tumors near large blood vessels. This review details the patient selection criteria, procedural approaches, and the use of advanced imaging techniques to improve the precision and effectiveness of MWA. Clinical outcomes indicate that MWA achieves high rates of complete tumor ablation and long-term survival with a favorable safety profile. This review is significant because it provides updated insights into the expanding role of MWA in treating unresectable CRLM and its potential as an alternative to surgical resection for resectable tumors. By summarizing recent studies and clinical trials, this review highlights the comparative effectiveness, safety, and integration with systemic therapies of MWA. In conclusion, MWA is a promising treatment option for CRLM and offers outcomes comparable to or better than those of other ablative techniques. Future research should focus on optimizing technical parameters, integrating MWA with systemic therapies, and conducting large-scale randomized controlled trials to establish standardized treatment protocols. Advancing our understanding of MWA will enhance its application and improve long-term survival and quality of life for patients with CRLM.

Novel mapping techniques for ablation of non-pulmonary vein foci using complex signal identification.

The complex signal identification function of CARTO version 8 enables quantitative evaluation of local potential fractionation. We present a case where this advanced technology successfully identified non-pulmonary vein foci associated with fractionated potentials during sinus rhythm.

Cardiology. Rhythmology, hypertension, dyslipidemia and aortic diseases

Atrial fibrillation (AF) is common and its treatment is complex. The new European guidelines emphasize a patient-centered approach, considering the risk factors that contribute to AF and their management in primary and secondary prevention. Recent advances in electrophysiology include the development of new ablation techniques and the implantation of a leadless bicameral pacemaker. Similarly, the management of cardiovascular risk factors is evolving with new recommendations for hypertension and hypercholesterolemia. Finally, new biological markers are included in assessing overall cardiovascular risk. This article reviews recent advances in cardiology, including electrophysiology, cardiovascular prevention, and aortic disease.

Effect of High-Purity Ag@ ZnO Core Shell Nanoparticles Synthesized by Pulse Laser Ablation Technique: Evaluation of Skin Cancer Cells

Effect of High-Purity Ag@ ZnO Core Shell Nanoparticles Synthesized by Pulse Laser Ablation Technique: Evaluation of Skin Cancer Cells

Democratization in abdominal ablation therapies: The impact of percutaneous robotic assistance on accuracy-A systematic review.

Advances in medical technology have revolutionized minimally invasive procedures. This study aims to determine the status of intra-abdominal ablation therapies, focusing on outcomes regarding technique improvement and benefits related to the learning curve. A systematic search in four databases was performed in March 2024 to identify relevant studies. Endpoints included targeting accuracy, organ efficacy, safety, outcomes and technical advantages regardless of physician experience. A total of 40 studies were included. The robotic technique demonstrated significantly higher accuracy (median 1.75mm) compared to the freehand technique (median 4.50mm) (p < 0.05). RFA and MWA were the most frequently used ablation techniques, reaching a rate of 52.5% and liver was the main target organ in 77.5% of the studies. Subgroup analysis showed a median tumor size of 2.30cm, 1.40mm for the readjustments and 3.30mm for accuracy in the freehand technique. For robotic approach, the median tumor size was 1.95cm, readjustments were 0.55mm, and accuracy was 1.85mm, and no statistical difference was identified. Severe adverse events were lower with the robotic approach, and improvement in the learning curve was observed among novice physicians. Robotic-assisted ablation techniques improve accuracy and efficacy compared to freehand techniques and are easier for novices to use. This technology allows novices to achieve similar outcomes to experts, contributing to the democratization of ablation techniques. Nevertheless, more clinical trials and standardized studies are necessary to validate these findings and enable the integration of robotic systems into routine practice.

Flexible Vibration Sensors with Omnidirectional Sensing Enabled by Femtosecond Laser-Assisted Fabrication.

Vibration sensors are integral to a multitude of engineering applications, yet the development of low-cost, easily assembled devices remains a formidable challenge. This study presents a highly sensitive flexible vibration sensor, based on the piezoresistive effect, tailored for the detection of high-dynamic-range vibrations and accelerations. The sensor's design incorporates a polylactic acid (PLA) housing with cavities and spherical recesses, a polydimethylsiloxane (PDMS) membrane, and electrodes that are positioned above. Employing femtosecond laser ablation and template transfer techniques, a parallel groove array is created within the flexible polymer sensing layer. This includes conductive pathways, and integrates stainless-steel balls as oscillators to further amplify the sensor's sensitivity. The sensor's performance is evaluated over a frequency range of 50 Hz to 400 Hz for vibrations and from 1 g to 5 g for accelerations, exhibiting a linear correlation coefficient of 0.92 between the sensor's voltage output and acceleration. It demonstrates stable and accurate responses to vibration signals from devices such as drills and mobile phone ringtones, as well as robust responsiveness to omnidirectional and long-distance vibrations. The sensor's simplicity in microstructure fabrication, ease of assembly, and low cost render it highly promising for applications in engineering machinery with rotating or vibrating components.

Bone lesion cryotherapy: pictorial review and review of current evidence.

Over the last two decades the development of small probes has enabled percutaneous use of cryotherapy. Cryotherapy, also known as cryoablation, enables the treatment of much larger lesions than other thermal ablation techniques, particularly when using multiple evenly spaced probes. Using rapid cooling to as low as -200 degrees Celsius (at the tip of the probe), reliable, and predictable necrosis can be induced. Probes are usually percutaneously inserted under computed tomography (CT) guidance under sedation or general anaesthesia, often as a day case. The procedure is safe with severe complications occurring rarely; the commonest complication is neural injury in lesions closely related to neurovascular bundles. Cryotherapy has been applied to the symptomatic and occasionally curative treatment of bone metastases and a range of primary bone lesions. This review summarises the published evidence base for the use of cryotherapy in metastatic and primary bone lesions and describes the experience with cryotherapy at the Royal Orthopaedic Hospital, Birmingham, a quaternary bone tumour referral hospital, where cryotherapy has been used for 3 years.

Study protocol for a single-centre non-inferior double-blinded randomised controlled trial in China comparing the efficacy and safety of high-frequency irreversible electroporation with transurethral resection of the prostate in treating lower urinary tract symptoms and benign prostatic obstruction (the GIANT trial)

IntroductionTransurethral resection of the prostate (TURP) is the gold standard surgical treatment to lower urinary tract symptoms and benign prostatic obstruction (LUTS/BPO). Although it has been proven to have substantial...

Therapeutic Management of Gastroesophageal Reflux Disease (GERD)-Is There Something Between PPI and Fundoplication? An Overview.

Gastroesophageal reflux disease (GERD) affects millions globally, with traditional treatments like proton pump inhibitors (PPIs) and surgical fundoplication presenting challenges such as long-term medication dependency and disturbing long term side effects following surgery. This review explores emerging, alternative therapies that offer less invasive, personalized alternatives for GERD management. Endoscopic approaches, including Stretta therapy, transoral incisionless fundoplication (TIF), and endoscopic full-thickness plication (EFTP), demonstrate promising but also controversial outcomes in symptom relief and reduced acid exposure. Laparoscopic electrical stimulation therapy (EndoStim®) and the LINX® magnetic sphincter augmentation system address LES dysfunction, while endoscopic anti-reflux mucosectomy and/or ablation techniques aim to construct a sufficient acid barrier. The RefluxStop™ device offers structural solutions to GERD pathophysiology with intriguing results in initial studies. Despite promising results, further research is required to establish long-term efficacy, safety, and optimal patient selection criteria for these novel interventions. This review underscores the importance of integrating emerging therapies into a tailored, multidisciplinary approach to GERD treatment.

From Endoscopic Inspection to Gene-Expression: A Thorough Assessment of the Duodenal Mucosa After Resurfacing-A Prospective Study.

Duodenal Mucosal Resurfacing (DMR) is an endoscopic ablation technique aimed at improving glycemia in patients with type 2 diabetes mellitus (T2DM). Although the exact underlying mechanism is still unclear, it is postulated that the DMR-induced improvements are the result of changes in the duodenal mucosa. For this reason, we assessed macroscopic and microscopic changes in the duodenal mucosa induced by DMR + GLP-1RA. We included 16 patients with T2DM using basal insulin that received a combination treatment of a single DMR and GLP-1RA. Endoscopic evaluation was performed before the DMR procedure and 3month after, and duodenal biopsies were obtained. Histological evaluation was performed and L and K cell density was calculated. In addition, gene-expression analysis and Western blotting was performed. Endoscopic evaluation at 3month showed duodenal mucosa with a normal appearance. In line, microscopic histological evaluation showed no signs of villous atrophy or inflammation and unchanged L and K cell density. Unbiased transcriptome profiling and western blotting revealed that PDZK1 expression was higher in responders at baseline and after DMR. GATA6 expression was significantly increased in responders after DMR compared to non-responders. The absence of macroscopic and microscopic changes after 3month suggest that improvements in glycemic parameters after DMR do not result from significant histological changes in duodenal mucosa. It is more likely that these improvements result from more subtle changes in enteroendocrine signaling. PDZK1 and GATA6 expression might play a role in DMR; this needs to be confirmed in pre-clinical studies.

A new protocolized treatment strategy optimizing medical and surgical care leads to improved healing of Crohn's perianal fistulas.

Crohn's perianal fistula healing rates remain low. We evaluated the efficacy of a protocolized multidisciplinary treatment strategy optimizing care in adults with Crohn's perianal fistulas. A new treatment strategy was established at a single tertiary center. The strategy comprised 3 dynamic stages of care directed toward achieving and maintaining fistula healing. Stage A, active disease, focused on early commencement and proactive escalation of biologic therapies and structured surgical reviews ensuring adequate fistula drainage and conditioning. Stage B, optimized disease with a seton in situ, focused on consideration for seton removal and appropriateness of definitive surgical closure and/or ablative techniques. Stage C, healed disease, focused on proactive care maintenance. Sixty patients were sequentially enrolled and prospectively followed for ≥12 months. Endpoints included clinical healing and radiologic remission in those with clinically active fistulas, and relapse in those with healed fistulas. At baseline, 52% (n = 31) and 48% (n = 29) had clinically active and healed fistulas, respectively. For patients with clinically active fistulas, 71% achieved clinical healing after 22 months, with estimated healing rates of 39% and 84% at 1 and 2 years, respectively. Radiologic remission was achieved in 25%, significantly higher than baseline inclusion rates of 6%. For patients with healed fistulas, 7% experienced clinical relapse after 23 months, with no significant change in radiologic remission, 80% versus 86% at baseline. A protocolized treatment strategy proactively optimizing care resulted in high rates of clinical healing and improved radiologic remission of Crohn's perianal fistulas. Controlled-matched studies are needed.

Integrated Management of Persistent Atrial Fibrillation.

The global incidence of atrial fibrillation is on the rise. Atrial fibrillation, a complex disease, heightens the likelihood of heart failure, stroke, and mortality, necessitating careful attention. Controlling heart rate and rhythm, addressing risk factors, and preventing strokes are fundamental in treating atrial fibrillation. Catheter ablation stands out as the primary approach for atrial fibrillation rhythm control. Nevertheless, the limited success rates pose a significant challenge to catheter ablation, particularly for persistent atrial fibrillation. Various adjunctive ablation techniques are currently under investigation to enhance the effectiveness of catheter ablation. This review provides an overview of the current state of the art and the latest optimized treatments for persistent atrial fibrillation in the areas of rhythm control, heart rate control, and risk factor management.

Ultra-High-Density Catheter Ablation of Purkinje Premature Ventricular Contractions Causing Electrical Storm.

The postacute myocardial infarction electrical storm is a life-threatening entity. Resistance to ischemia in Purkinje fibers may be the origin of short-coupled premature ventricular contractions that trigger severe arrhythmic events. We present a case where the use of emergency catheter ablation, guided by a 3D navigation system and an ultra-high-density mapping catheter, successfully terminated the arrhythmic storm. This case highlights the crucial role of advanced mapping and ablation techniques in managing complex postinfarction arrhythmias and provides valuable insights that may enhance future clinical practice in similar critical situations.

Safety and Feasibility of US-guided Microwave Ablation for the Treatment of Bethesda III Thyroid Nodules with Negative Eight-Gene Panel Mutational Profile.

Purpose To evaluate the safety and efficacy of US-guided thermal ablation in the treatment of Bethesda III thyroid nodules with negative eight-gene panel testing results. Materials and Methods This retrospective single-center study included patients with thyroid nodules diagnosed as Bethesda category III (atypia of undetermined significance) at fine-needle aspiration biopsy and with negative eight-gene testing results who were treated with US-guided microwave ablation (MWA) between July 2020 and September 2023. Incidence of complications, technical success rate (TSR), volume reduction rate (VRR), nodule recurrence, and thyroid function were evaluated over a follow-up period of 2 years. Data before and after MWA were compared using variance analysis and the Cochran-Mantel-Haenszel χ2 test. Results A total of 101 Bethesda III nodules were detected in 95 patients (mean ± SD age, 47.08 years ±14.63; 79 female patients, 16 male patients), all of which were completely ablated (100% TSR). Two patients experienced mild neck swelling and pressure sensation after the minimally invasive operation, and the incidence of postoperative complications was 2% (two of 95). None of the patients experienced tumor recurrence or progression. At 2-year follow-up, the mean VRR of the ablated area was 90.88% ± 13.59 in 15 patients; 87% (13 of 15) of these patients had a 100% VRR. There was no evidence of a difference in thyroid function before and after MWA from 1 to 24 months (P = .15-.99). Conclusion US-guided MWA was safe and effective for the treatment of Bethesda III thyroid nodules with negative eight-gene panel testing results. Keywords: Ablation Techniques, Radiation Therapy/Oncology, Head/Neck, Thyroid, Safety, Observer Performance Published under a CC BY 4.0 license.