High-intensity Focused Ultrasound Research Articles

Whole gland versus partial gland ablation in patients with localized prostate cancer treated by high-intensity focused ultrasound ablation

BackgroundFocal therapy is considered one of the treatment options for localized prostate cancer (PCa), particularly for low or very-low-risk patients. In this study, we compared the mid-term oncological outcomes in localized PCa patients treated with high-intensity focused ultrasound (HIFU). MethodsWe retrospectively analyzed 237 patients who underwent HIFU for localized PCa. Patients were divided into two groups based on ablation type: whole gland ablation (WGA) and partial gland ablation (PGA). Follow-up biopsies were performed after one year postoperatively, and the oncological outcomes were compared between the groups. ResultsAmong the total of 237 patients, 54 subjects were treated by WGA and 183 subjects by PGA. After one year postoperatively, follow-up biopsies were conducted on 199 patients, revealing residual cancer in 21.4% of WGA group and 15.3% of PGA group. Additionally, clinically significant (CS) cancer was observed in 14.3% of WGA group and 8.3% of PGA group. Survival analyses revealed significantly longer failure-free (P < 0.001) and salvage-free survival (P < 0.001) in WGA group than in PGA group. Similarly, in the intermediate—high risk group, WGA group exhibited longer failure-free (P = 0.005) and salvage-free survival (P < 0.001). ConclusionHIFU was performed with acceptable oncological outcomes in localized PCa. Despite higher proportion of high-risk patients in WGA group, WGA was associated with significantly better failure-free survival and salvage-free survival. Further prospective and multi-center studies are warranted.

EMAGRECIMENTO FACIAL NÃO INVASIVO COM ULTRASSOM MICROFOCADO

The demand for non-invasive aesthetic treatments, such as High Intensity Focused Ultrasound (HIFU), has been growing. Therefore, this study aimed to evaluate the effectiveness of HIFU in reducing facial fat. To achieve this, the results of using Ultraformer III technology were observed in a 54-year-old patient over three sessions. Additionally, a literature review was conducted on platforms such as Google Scholar, examining the contributions of authors like Shome et al. (2019), Marques (2016), Montezuma et al. (2023), among others. Based on the research conducted, a significant reduction in facial volume was observed, confirming the safety and effectiveness of the procedure. However, the clinical response to treatment is partially dependent on factors such as pronounced lipodystrophy, nutritional education, and overall health. These factors may necessitate higher energy density during a single treatment or additional treatments to achieve optimal results.

Model based deep learning method for focused ultrasound pathway scanning

The primary purpose of high-intensity focused ultrasound (HIFU), a non-invasive medical therapy, is to precisely target and ablate tumors by focusing high-frequency ultrasound from an external power source. A series of ablations must be performed in order to treat a big volume of tumors, as a single ablation can only remove a small amount of tissue. To maximize therapeutic efficacy while minimizing adverse side effects such as skin burns, preoperative treatment planning is essential in determining the focal site and sonication duration for each ablation. Here, we introduce a machine learning-based approach for designing HIFU treatment plans, which makes use of a map of the material characteristics unique to a patient alongside an accurate thermal simulation. A numerical model was employed to solve the governing equations of HIFU process and to simulate the HIFU absorption mechanism, including ensuing heat transfer process and the temperature rise during the sonication period. To validate the accuracy of this numerical model, a series of tests was conducted using ex vivo bovine liver. The findings indicate that the developed models properly represent the considerable variances observed in tumor geometrical shapes and proficiently generate well-defined closed treated regions based on imaging data. The proposed strategy facilitated the formulation of high-quality treatment plans, with an average tissue over- or under-treatment rate of less than 0.06%. The efficacy of the numerical model in accurately predicting the heating process of HIFU, when combined with machine learning techniques, was validated through quantitative comparison with experimental data. The proposed approach in cooperation with HIFU simulation holds the potential to enhance presurgical HIFU plan.

Combination of US hyperthermia and radiotherapy on a preclinical glioblastoma model

In this work the effect of combining ultrasound (US) hyperthermia (HT) with radiotherapy (RT) was investigated. The treatment was applied to a GBM xenograft nude mouse model obtained by injecting 2×106\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$2 \ imes 10^{6}$$\\end{document} U87 luc+ cells. The combined treatment group received 6 Gy and HT at 43∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$43^\\circ$$\\end{document} for 8 min. The ultrasound field was generated by a closed-loop computationally controlled system, consisting of a High Intensity Focused Ultrasound (HIFU) transducer with centre frequency 3.57 MHz, a power amplifier, a function generator and a MATLAB controller. A mechanical cone adaptor has been designed to use the HIFU beam at a pre-defined post-focal distance. Two thermocouples were placed between the mechanical cone and the mice skin to measure and control the temperature during the HT treatment. Radiotherapy was carried out by using a dedicated small animal image guided radiotherapy system. Measurements of tumor volume performed with a caliper showed good tumor control for the RT-HT group with respect to the RT or control groups for up to 21 days after treatment. The mean value of the normalized (before therapy) tumor volume was almost equal to 0.5 for two weeks after treatment with an increase to 1.5 at sacrifice. The control and HT groups showed a higher value of about 1.5 during the first two weeks and 3.5 at the end of the follow-up period. We concluded that the use of HT as a radiosensitizer can improve the outcome for glioblastoma treatments.

Analysis of factors affecting pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound ablation: a retrospective study

Objectives To investigate all pregnancies and analyze the factors influencing pregnancy outcomes in patients with adenomyosis after high intensity focused ultrasound (HIFU). Materials and methods A total of 231 patients with adenomyosis who completed HIFU and wished to conceive were enrolled. The symptom improvement and information of pregnancy were recorded during the follow-up period. Factors influencing pregnancy outcomes were analyzed using multivariate regression analysis and survival analysis. Results After HIFU, 100 of 231 (43.3%) patients became pregnant within 96 months, including 77 (77/194, 39.7%) in natural and 23 (23/37, 62.2%) in vitro fertilization and embryo transfer (IVF-ET) pregnancies following gonadotropin-releasing hormone agonist (GnRHa). Among the 108 (46.8%, 108/231) infertile patients (defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse, 40 primary infertility and 68 secondary infertility), 31 (28.7%) became pregnant. At the end of the follow-up, 70 successfully delivered 71 healthy babies. No uterine rupture occurred during pregnancy and delivery. Patients with pelvic adhesion and infertility history had a lower pregnancy chance than that of patients without pelvic adhesion and infertility history (OR < 1, p < 0.05). Patients with small adenomyotic lesion volume had a greater pregnancy chance than that of patients with large lesion volume (OR < 1, p < 0.05). IVF-ET following GnRHa had a better pregnancy chance (p < 0.05). Conclusions HIFU seems to have a beneficial effect on fertility of patients with adenomyosis. Pelvic adhesion, infertility history, and large adenomyotic lesion volume have adverse effects on pregnancy, but IVF-ET following GnRHa after HIFU could increase the pregnancy chance.

Synergic fabrication of gold – iron oxide magnetic nanohybrids as a potential agent for thermosensitizing and magnetic resonance-high intensity focused ultrasound (mr-HIFU) treatment in uterine myomas

The major aim of this research hyperthermia and magnetic resonance-high intensity focused ultrasound (MR-HIFU) focused on investigating the potential of aloe vera leaf extract-mediated gold-coated iron oxide nanohybrids (Au-IONPs) as a modern theragnostic material for the treatment of uterine myoma. To assess the cytotoxicity of Au-IONPs, induce hyperthermia, and apply radiotherapy to determine the level of apoptosis in the human ht-UtLM cells. Subsequently, it evaluated the cytotoxicity of the nanoparticles on human ht-UtLM cells by exposing the cells to various concentrations of Au-IONPs for a 4-hour incubation period. Based on the results, concentrations of 10 and 15 µg/mL were selected for further investigation. The MTT assay and flow cytometry results demonstrated that Au-IONPs significantly induce cell apoptosis. It allows the Au-IONPs to turn as an effective development mediator in the ablation of high-intensity focused ultrasound (HIFU) treatment. Finally, it could be suggested to developed material have excellent systemic toxicity, which promises well for treatment of uterine fibroids. HIGHLIGHTS Biosynthesis of gold – iron oxide nanohybrids (Au-IONPs) through a green approach. Physio-chemical properties of Au-IONPs have been characterized through various techniques. Investigating the anti-tumor effects of Au-IONPs in combination with thermo-radiotherapy for uterine myoma. Determine the level of apoptosis in the human myoma cells by inducing hyperthermia and radiotherapy. Observed the correlation behavior between the dose of the cell viability and Au-IONP nanoparticles. Au-IONPs had a significant impact on enhancing the effects of both hyperthermia and radiation therapies.

Ultrasound-Guided High-Intensity Focused Ultrasound of Uterine Fibroids and Adenomyosis: An 11-Year Experience from a Single Center in Hong Kong.

Introduction: This study evaluated the efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) in treating symptomatic uterine fibroids and adenomyosis. Methods: HIFU treatments performed in premenopausal women with symptomatic uterine fibroids and adenomyosis were analyzed retrospectively. Lesion volume reduction, change in symptoms of menstrual pain, and quality of life were examined. Major and minor complications, together with re-intervention rates, were evaluated. Results: Eighty-one HIFU treatments were performed in seventy-nine premenopausal women. The follow-up period was up to 95 months. A total of 65 women underwent treatment for uterine fibroids and 14 were treated for adenomyosis. For patients with uterine fibroids, the baseline fibroid volume median was 190.1 cm3 (18.5-1729.4 cm3). Fibroid volume was reduced by 50.1% (-26.2-97.8, p < 0.0001) at 6 months and 66.9% (-33.7-98.3, p < 0.0001) at 12 months after treatment. The modified Uterine Fibroid Symptom and Quality of Life (UFS-QOL) scores had decreased by 43.5% (0-62.5%, p < 0.0001) at 6 months and 50% (0-73%, p < 0.0001) at 12 months after treatment. In the adenomyosis arm, the median baseline uterine volume was 97.7 cm3 (43.7-367.4 m3). Uterine volume was reduced by 19.6% (range: 1.2-42.0, p = 0.28) at 6 months and 41.9% (18.9-69.2, p = 0.04) at 12 months after treatment. UFS-QOL scores were reduced by 38.1% (6-66.7%, p < 0.0001) at 6 months and 40% (0-70%, p < 0.0001) at 12s month after treatment. Fourteen (21.5%) patients with uterine fibroid and five (35.7%) patients with adenomyosis required subsequent interventions. Conclusions: HIFU provides symptomatic relief to most patients with uterine fibroids and adenomyosis. It is a promising uterus-sparing treatment for patients with these conditions.

Histological characterization of HIFU lesions

Background: High intensity focused ultrasound (HIFU) can destroy tissue by thermal ablation which may be accompanied by acoustic cavitation and/or tissue water boiling, but the biological and histological effects of these treatments have not been fully documented. Here, detailed histological analysis over time using well characterized HIFU exposures in in vivo rat livers is described. Methods: Exposures used invoked either (i) thermal, with acoustic cavitation and/or tissue water boiling or (ii) predominantly thermal damage. Cavitation activity was detected using both active and passive methods. Histological assessment involved hematoxylin and eosin (H&E), picrosirius red and immunohistochemical staining. Results: Distinct concentric damage regions were identified after HIFU exposures. The outermost ring showed a red H&E-stained rim that was characterized by hemorrhage. The adjacent inner band appeared white due to increased extracellular spaces. The morphology of the next zone depended on the exposure. Where there was no tissue acoustic cavitation/water boiling, this was the lesion center, in which heat-fixed cells were seen. Where acoustic cavitation/boiling occurred, a centermost zone with irregular holes up to several hundred microns across was seen. Cleaved caspase-3 and Hsp70 staining in the periphery of both types of HIFU exposures was seen within the outermost ring of hemorrhage, where an inflammatory response was also observed. By day 7, a distinct acellular region in the center of the HIFU lesions had been created. Conclusions: These results identify the morphological effects and elucidate the similarities and differences of HIFU-induced thermal lesions in the presence or absence of acoustic cavitation/tissue water boiling.

High-Intensity Focused Ultrasound (HIFU) Treatment for Prostate Cancer

High-Intensity Focused Ultrasound (HIFU) represents an emerging minimally invasive treatment modality for prostate cancer. This technology employs focused ultrasound waves to ablate prostate tissue, offering a precise and targeted strategy for the management of localized prostate cancer. The present paper aims to deliver a comprehensive review of HIFU, encompassing its technology, advantages, risks, patient selection criteria, and post-treatment monitoring.

Combination Chemical and Mechanical Tumor Immunomodulation Using Cavitating Mesoporous Silica Nanoparticles.

Combinatorial methods to repolarize tumor-associated macrophages from anti-inflammatory to pro-inflammatory phenotypes offers a promising route for cancer immunotherapy. However, most studies examine biochemical combinations alone. Therefore, we studied simultaneous chemical and mechanical stimuli as orthogonal cues for enhanced immunomodulation. We engineered the surfaces of hydrophobically functionalized mesoporous silica nanoparticles (F108-hMSNs) to encapsulate the immunomodulator resiquimod and kill cancer cells through high-intensity focused ultrasound (HIFU)-mediated inertial cavitation, releasing damage-associated molecular patterns (DAMPs) for prolonged macrophage stimulation. The HIFU doses alone did not affect cells, but in combination with F108-hMSNs, achieved significantly higher cancer cell death and DAMP generation. Inflammatory markers (CD86, MHC II, iNOS) were upregulated in tumor-associated-like macrophages treated with F108-hMSNs in the presence of HIFU and experienced the greatest inflammatory phenotypic shift of all conditions tested. This work suggests that chemical and mechanical activation facilitated by engineered nanoparticles offer a promising treatment against immunologically cold tumors.

An improved scheme for passive cavitation imaging in high intensity focused ultrasound

Passive cavitation imaging (PCI) is an effective technique for monitoring high intensity focused ultrasound (HIFU) procedure due to the correlation between cavitation activities and the therapeutic effects. Nevertheless, current PCI techniques are unable to recognize noise signals from non-cavitation situations, and they fail to accurately visualize the highly dynamic cavitation activities due to the lack of a stable baseline reference. In this study, a deep learning-based cavitation detection network (CD-NET) was proposed to determine whether passively received channel signals originated from cavitation activities or were merely noises. Additionally, a cavitation intensity baseline was derived to better display the drastically time-varying cavitation activities. The CD-NET model was trained and validated with data collected from in-vitro and ex-vivo HIFU sonication experiments, and then tested by in-vivo rabbit experiments. Both CD-NET models, trained with data from the in-vitro agar phantoms and ex-vivo bovine liver tissues, successfully distinguished between cavitation and non-cavitation activities from the same study object, achieving accuracies as high as 99.7% and 99.5%, respectively. In addition, the models trained on in-vitro and ex-vivo datasets achieved accuracies of 88.1% and 91.4%, respectively, when detecting cavitation events from unseen in-vivo data. The results demonstrate that the improved PCI scheme, utilizing the CD-NET model and a data-derived cavitation baseline, is resistant to noise from non-cavitation situations and can depict the dynamic characteristics of cavitation more reliably. In conclusion, this study addressed two practical challenges in PCI techniques, allowing for better monitoring of cavitation-related HIFU sonication in clinical applications.

Weighted ultrasound entropy imaging for HIFU ablation monitoring with improved sensitivity and contrast.

Although B-mode imaging has been widely used in ultrasound-guided high-intensity focused ultrasound (HIFU) treatment, challenges remain in improving its quality and sensitivity for monitoring the thermal dose. Recently, quantitative ultrasound (QUS) imaging has been recognized with the potential to better sense the changes in the microstructure of ablated tissues. This study proposed to use a QUS method called weighted ultrasound entropy (WUE) imaging to monitor the HIFU ablation. Based on ex-vivo and in-vivo experiments, WUE images reflecting tissue changes during HIFU treatment under different acoustic power levels (174-308W) were reconstructed with a newly established imaging framework. The performance of the proposed WUE imaging in the monitoring of HIFU treatment was compared with the corresponding B-mode images in terms of their contrast-to-noise ratios (CNRs) between the focal region and the background. It was found that HIFU irradiation with higher power generated larger WUE values in the focal region, and the bright spots grew in size as the acoustic sonication proceeded. Compared with the in-situ B-mode images, the WUE images had higher image quality in indicating lesion formation, with a 39.2%-53.4% improvement in the CNR at different stages. Meanwhile, a correlation (R=0.84) between the damage area estimated in WUE images and that measured from the dissected ex-vivo tissue samples was found. WUE imaging is more sensitive and accurate than B-mode imaging in monitoring HIFU therapy. These findings suggest that WUE imaging could be a promising technique for assisting ultrasound-guided HIFU ablation.

Prospective close monitoring of the effect of vascular-targeted photodynamic therapy and high intensity focused ultrasound of localized prostate cancer by multiparametric magnetic resonance imaging.

The aim of this study is to describe the anatomical and functional changes observed in multiparametric magnetic resonance imaging (mpMRI) during follow-up after focal therapy (FT) for localized prostate cancer (PCa). In this prospective study, we analyzed pre- and postoperatively acquired mpMRI of 10 patients after FT (7days; 3, 6, 9, 12months). 7/10 (70%) patients underwent vascular-targeted photodynamic therapy (VTP). 3/10 (30%) patients underwent high-intensity focused ultrasound (HIFU). MpMR image analysis was performed using a semi-automatic software for segmentation of the prostate gland (PG) and tumor zones. Signal intensities (SI) of T2-weighted (T2w), T1-weighted (T1w),diffusion-weighted (DWI) and dynamic contrast-enhanced (DCE) images as well as volumes of the prostate gland (PGV) and tumor volumes (TV) were evaluated at each time point. The results showed a significant increase of PGV 7days after FT (p = 0.042) and a significant reduction of PGV between 7days and 6, 9 and 12months after FT (p < 0.001). The TV increased significantly 7days after FT (p < 0.001) and decreased significantly between 7days and 12months after FT (p < 0.001). There was a significant increase in SI of the ADC in the ablation zone after 6, 9 and 12months after FT (p < 0.001). 1/9 patients (11%) had recurrent tumor on rebiopsy characterized as a a small focal lesion on mpMRI with strong diffusion restriction (low SI on ADC map and high SI on b-value DWI). MpMRI is able to represent morphologic changes of the ablated zone after FT and might be helpful to detect recurrent tumor.

Salvage Cryoablation for Recurrent Prostate Cancer Following Radiation-A Comprehensive Review.

The treatment options for prostate cancer typically entail active surveillance, surgery, radiation, or a combination of the above. Disease recurrence remains a concern, with a wide range of recurrence rates having been reported in the literature. In the setting of recurrence, the salvage treatment options include salvage prostatectomy, salvage high-intensity focused ultrasound (HIFU), stereotactic body radiotherapy (SBRT), salvage brachytherapy, and salvage cryoablation. In this review, we analyze the currently available data related to salvage cryoablation for recurrent prostate cancer following radiation.

High-intensity focused ultrasound ablation in the treatment of fumarate hydratase-deficient uterine leiomyoma

Objective This study aimed to explore the efficacy and safety of high-intensity focused ultrasound (HIFU) ablation for treating fumarate hydratase (FH)-deficient uterine leiomyomas. Method Ten patients with FH-deficient uterine leiomyomas treated with HIFU ablation at the Third Xiangya Hospital from July 2017 to January 2023 were enrolled in this study. The effectiveness and adverse effects of HIFU were analyzed. Results The median age of the patients who received HIFU was 32.0 years (range: 28–41 years). Only 2 patients had solitary uterine leiomyomas, whereas the remaining 8 patients had multiple uterine leiomyomas. The median diameter of the largest myoma was 56 mm (range: 41–99 mm). Magnetic resonance imaging showed that the FH-deficient uterine leiomyomas of 8 patients presented as mixed intensity on T2WI, that of one patient was hypointense, and that of another patient was hyperintense on T2WI. All patients successfully underwent HIFU ablation in one session without severe adverse effects. The median nonperfusion volume ratio (NPVR) was 40% (30.0%–78.0%) after HIFU treatment. Four patients had NPVR ≥70%. At 3-month follow-up after HIFU ablation, the clinical symptoms of 5 of the 8 patients with symptoms before treatment were relieved. Six months after treatment, 4 of the 8 patients with symptoms were still in remission. All patients received reintervention by March 2024. The reintervention rates were 20%, 70%, and 90% at 12, 24, and 36 months, respectively, after HIFU ablation. Conclusion HIFU is a safe and feasible treatment for FH-deficient uterine leiomyomas, and most patients show effective results in the short term after treatment. However, the reintervention rates are high, and the long-term effects are limited.

Thermoablation Using Radiofrequency and Microwaves of Autonomous Thyroid Nodules: Our Experience

Significant results have been achieved using ultrasound-guided and ultrasound-assisted ablative techniques, such as Laser Thermal Ablation (LTA), Radiofrequency Ablation (RFA), High-Intensity Focused Ultrasound (HIFU), and Microwave Ablation (MWA). These techniques are ideally suited for the treatment of normally functioning benign thyroid nodes with local compressive symptoms or aesthetic problems. These treatments have been applied to hyperfunctioning “hot” nodes. LTA and RFA are the most commonly used. From January 2021 to July 2023 at our Center, a total of 160 patients with benign thyroid nodules were treated, of which 35 had autonomous nodules [1-4]. Our analysis focused on evaluating the locoregional treatment of the latter. Based on the volume and ultrasound-vascular characteristics, patients were selected for thermoablative treatment with either RFA or MWA (Amica Gen HS - Hospital Service) starting in July 2022. No complications were documented. However, one patient was referred for surgery and 1 patient was re-treated with MWA. In the light of personal experience ultrasound-guided thermal ablation treatment with RFA in patients with a single pretoxic or toxic thyroid nodule with or without associated compressive or aesthetic symptoms has proven to be very effective and satisfactory. The treatment must be preceded by adequate information regarding the advantages and disadvantages of the various procedures and the methods of the treatment session. MWA proved to be more effective than RFA with no functional recovery of the treated nodules even if they were relatively larger in size. We obtained the suspension of thyrostatic therapy with normalization of the TSH level in the third month after treatment.

Initial treatment for surgery-naïve desmoid tumors by high intensity focused ultrasound.

Desmoid tumor (DT) is a rare proliferative disease occurring in connective tissues, characterized by high infiltration and recurrence rates. While surgery remains the primary treatment, its recurrence risk is high, and some extra-abdominal desmoid tumors are inoperable due to their locations. Despite attempts with radiotherapy and systemic therapy, the efficacy remains limited. We used low-power cumulative high-intensity focused ultrasound (HIFU) therapy as an initial treatment for desmoid tumor patients either ineligible or unwilling for surgery. Low-power cumulative HIFU employs slower heat accumulation and diffusion, minimizing damage to surrounding tissues while enhancing efficacy. Fifty-seven non-FAP desmoid tumor patients, previously untreated surgically, underwent low-power cumulative HIFU therapy. Among them, 35 had abdominal wall DT, 20 had extra-abdominal DT, and 2 had intra- abdominal DT, with an 85% median ablation ratio. Abdominal wall DT patients showed significantly better response rates (91.4% vs. 86%) and disease control rates (100% vs. 32%) than that of non-abdominal wall DT patients. Median event- free survival time was not reached after a median follow-up duration of 34 months. With its high response rate, durable efficacy, and mild adverse effects, our findings suggest that low-power cumulative HIFU presents a promising novel treatment for desmoid tumors, particularly abdominal wall DT patients.

Effect of High-Intensity Focused Ultrasound on Different Types of Adenomyosis Based on Magnetic Resonance Imaging Classification.

We aimed to analyze the effect of high-intensity focused ultrasound (HIFU) on different types of adenomyosis (AM) based on magnetic resonance imaging (MRI) classification. A total of 206 AM patients who underwent HIFU between January 2017 and December 2021 were included in this retrospective study. The size and location of AM were evaluated based on T2-weighted imaging (T2WI) of MRI. Patients were divided into internal (subtype I), external (subtype II), intramural (subtype III), and full-thickness (subtype IV) AM groups. All patients underwent an MRI examination before and one day after HIFU. After ultrasound-guided HIFU ablation, the parameters of ultrasonic energy input during HIFU treatment among different groups were recorded and compared. The adverse reactions and complications among different groups were compared. The lesion volume in the subtype IV group was significantly larger than the subtype II and III groups (P < .05). The HIFU irradiation time, treatment time, and total energy input in the subtype IV group were significantly higher than the subtype I and III groups (P < .05). The number of cases of abdominal pain and vaginal fluid in the treatment area in the subtype IV group was significantly higher than in the subtype II group. Although HIFU has different treatment strategies and parameters for different subtypes of AM, it can achieve a satisfactory ablation rate, which is safe and effective.

High-Intensity Focused Ultrasound Increases Facial Adipogenesis in a Swine Model via Modulation of Adipose-Derived Stem Cell Cilia.

Decreased medial cheek fat volume during aging leads to loss of a youthful facial shape. Increasing facial volume by methods such as adipose-derived stem cell (ASC) injection can produce facial rejuvenation. High-intensity focused ultrasound (HIFU) can increase adipogenesis in subcutaneous fat by modulating cilia on ASCs, which is accompanied by increased HSP70 and decreased NF-κB expression. Thus, we evaluated the effect of HIFU on increasing facial adipogenesis in swine (n = 2) via modulation of ASC cilia. Expression of CD166, an ASC marker, differed by subcutaneous adipose tissue location. CD166 expression in the zygomatic arch (ZA) was significantly higher than that in the subcutaneous adipose tissue in the mandible or lateral temporal areas. HIFU was applied only on the right side of the face, which was compared with the left side, where HIFU was not applied, as a control. HIFU produced a significant increase in HSP70 expression, decreased expression of NF-κB and a cilia disassembly factor (AURKA), and increased expression of a cilia increasing factor (ARL13B) and PPARG and CEBPA, which are the main regulators of adipogenesis. All of these changes were most prominent at the ZA. Facial adipose tissue thickness was also increased by HIFU. Adipose tissue volume, evaluated by magnetic resonance imaging, was increased by HIFU, most prominently in the ZA. In conclusion, HIFU increased ASC marker expression, accompanied by increased HSP70 and decreased NF-κB expression. Additionally, changes in cilia disassembly and length and expression of adipogenesis were observed. These results suggest that HIFU could be used to increase facial volume by modulating adipogenesis.

Supramolecularly-Cross-Linked Nanogel Assemblies for On-Demand, Ultrasound-Triggered Chemotherapy.

Stimulating the release of small nanoparticles (NPs) from a larger NP via the application of an exogenous stimulus offers the potential to address the different size requirements for circulation versus penetration that hinder chemotherapeutic drug delivery. Herein, we report a size-switching nanoassembly-based drug delivery system comprised of ultrasmall starch nanoparticles (SNPs, ∼20-50 nm major size fraction) encapsulated in a poly(oligo(ethylene glycol) methyl ether methacrylate) nanogel (POEGMA, ∼150 nm major size fraction) cross-linked via supramolecular PEG/α-cyclodextrin (α-CD) interactions. Upon heating the nanogel using a non-invasive, high-intensity focused ultrasound (HIFU) trigger, the thermoresponsive POEGMA-CD nanoassemblies are locally de-cross-linked, inducing in situ release of the highly penetrative drug-loaded SNPs. HIFU triggering increased the release of nanoassembly-loaded DOX from 17 to 37% after 3 h, a result correlated with significantly more effective tumor killing relative to nanoassemblies in the absence of HIFU or drug alone. Furthermore, 1.5× more total fluorescence was observed inside a tumor spheroid when nanoassemblies prepared with fluorophore-labeled SNPs were triggered with HIFU relative to the absence of HIFU. We anticipate this strategy holds promise for delivering tunable doses of chemotherapeutic drugs both at and within a tumor site using a non-invasive triggering approach.