Open Radiofrequency Ablation Research Articles

Review of methods for detecting electrode-tissue contact status during atrial fibrillation ablation

Atrial fibrillation is a common cardiac arrhythmia with an annually increasing global prevalence. Ablation of atrial fibrillation is a minimally invasive procedure that treats atrial fibrillation by using a catheter to deliver radiofrequency energy to heart tissues generating abnormal electrical potentials. The success of this procedure relies significantly on the adhesion between the catheter and the heart tissue, presenting a challenge in accurately assessing the contact force (CF) during surgery. To improve the safety and success rate of surgery, researchers are committed to developing various methods to evaluate or detect catheter-tissue CF. Among these, some studies integrated optical fibers or magnetic elements into the catheter tip to create CF sensing catheters that monitor CF in real time; other studies used impedance measurement, electrical coupling index, local impedance and other methods to evaluate the CF between the catheter and the tissue by measuring changes in electrical signals. These methods have achieved certain success in clinical practice, offering new ways to improve the effectiveness and safety of cardiac radiofrequency ablation surgery.

DECNet: Left Atrial Pulmonary Vein Class Imbalance Classification Network.

In clinical practice, the anatomical classification of pulmonary veins plays a crucial role in the preoperative assessment of atrial fibrillation radiofrequency ablation surgery. Accurate classification of pulmonary vein anatomy assists physicians in selecting appropriate mapping electrodes and avoids causing pulmonary arterial hypertension. Due to the diverse and subtly different anatomical classifications of pulmonary veins, as well as the imbalance in data distribution, deep learning models often exhibit poor expression capability in extracting deep features, leading to misjudgments and affecting classification accuracy. Therefore, in order to solve the problem of unbalanced classification of left atrial pulmonary veins, this paper proposes a network integrating multi-scale feature-enhanced attention and dual-feature extraction classifiers, called DECNet. The multi-scale feature-enhanced attention utilizes multi-scale information to guide the reinforcement of deep features, generating channel weights and spatial weights to enhance the expression capability of deep features. The dual-feature extraction classifier assigns a fixed number of channels to each category, equally evaluating all categories, thus alleviating the learning bias and overfitting caused by data imbalance. By combining the two, the expression capability of deep features is strengthened, achieving accurate classification of left atrial pulmonary vein morphology and providing support for subsequent clinical treatment. The proposed method is evaluated on datasets provided by the People's Hospital of Liaoning Province and the publicly available DermaMNIST dataset, achieving average accuracies of 78.81% and 83.44%, respectively, demonstrating the effectiveness of the proposed approach.

The application of radiofrequency ablation in pancreatic cancer liver-only recurrence after radical pancreatectomy.

To evaluate the safety, feasibility, and survival benefit of radiofrequency ablation in liver-only recurrence pancreatic cancer patients after radical pancreatectomy. The data and follow-up of pancreatic cancer patients who suffered liver-only recurrence after radical pancreatectomy from 2015 to 2021 were retrospectively collected. Finally, 19 liver metastases radiofrequency ablation patients were assigned to radiofrequency ablation group, and 41 patients were to systemic treatment group. (1) the baseline, perioperative characteristics, and pathological outcomes were well-balanced. (2) Recurrence pattern showed there were more multiple (> 3) recurrence tumors in systemic treatment patients (multiple one vs. 19, P = 0.005). (3) Median radiofrequency ablation operation time was 30.0min, median blood loss was 1.0ml, 4 (21.05%) patients suffered postoperative complications, and 94.74% liver metastases tumors got complete necrosis. The first efficacy evaluation showed a significantly better effect of radiofrequency ablation, complete and partial response rate 72.22% vs. 27.78%, P < 0.001. Overall survival from the initial surgery and after liver recurrence was significantly longer in the radiofrequency ablation group (43.0 vs. 22.0months, 29.0 vs. 14.0months, P = 0.003, 0.006, respectively). Progression-free survival after treatment was longer in the radiofrequency ablation group (6.0 vs. 5.0months, P = 0.029). For liver recurrence tumor ≤ 3, overall survival from the initial surgery and after liver recurrence was significantly longer in radiofrequency ablation patients (43.0 vs. 22.0months, 29.0 vs. 14.0months, P = 0.011, 0.013, respectively). Progression-free survival after treatment was longer in the radiofrequency ablation group (7.0 vs. 4.0months, P = 0.042). Radiofrequency ablation could get a curative purpose for patients with liver-only recurrence after pancreatectomy, improve progression-free survival and overall survival, and with minor surgery damage and risk.

Clinical Electrophysiological Features and Radiofrequency Ablation of Patients with Atrial Fibrillation.

This study aimed to investigate electrophysiological features of radiofrequency ablation surgery in patients with the atrial fibrillation (AF). Fifty patients were included in this study and evenly divided, with 25 AF patients in the experiment group and 25 patients with arrhythmias in the control group. General clinical materials in the two groups were collected. Then, patient number of pulmonary vein antrum potential trial, intra-right atrial conduction time, intra-left atrial conduction time, interatrial conduction time, conduction time between atrium, and pulmonary veins trials were utilized to measure the efficacy of radiofrequency ablation surgery in patients with AF and clarify the relationship between AF and electrophysiological features in the atrium and pulmonary veins. Our study findings showed that conduction time interval between the atrium and pulmonary veins trial by radiofrequency ablation surgery were significantly less than those in pre-treatment AF patients. We can conclude that radiofrequency ablation surgery can effectively treat AF patients by relieving the electrophysiological dysfunction, and radiofrequency ablation can be used to prevent the development of AF.

Open Radiofrequency Ablation Combined with Splenectomy and Pericardial Devascularization vs. Liver Transplantation for Hepatocellular Carcinoma Patients with Portal Hypertension and Hypersplenism: A Case-Matched Comparative Study

Aim To compare the short- and long-term treatment outcomes of open radiofrequency ablation combined with splenectomy and pericardial devascularization versus liver transplantation for hepatocellular carcinoma patients with portal hypertension and hypersplenism. Methods During the study period, the treatment outcomes of consecutive HCC patients with portal hypertension and hypersplenism who underwent open radiofrequency ablation, splenectomy and pericardial devascularization (the study group) were compared with the treatment outcomes of a case-matched control group of HCC patients who underwent liver transplantation. Results The study group consisted of 32 patients, and the control group comprised 32 patients selected from 155 patients who were case-matched by tumor size, age, gender, MELD sore, tumor location, TNM classification, degree of splenomegaly and Child–Pugh staging. Baseline data on preoperative laboratory tests and tumor characteristics were comparable between the two groups. The mean follow-up was 43.2 ± 5.3 months and 44.9 ± 5.8 months for the study and control groups, respectively. Although the disease-free survival rates of the control group were better than those of the study group (P < 0.001), there was no significant difference in the cumulative overall survival time or the incidence of portal vein thrombosis between the two groups (P = 0.670, 0.083). Compared with the control group, the study group had significantly less intraoperative blood loss, and lower incidences of postoperative pleural effusion and pneumonia (all P < 0.05). Conclusion Open radiofrequency ablation, splenectomy and pericardial devascularization for small HCCs with portal hypertension and hypersplenism can be an alternative therapy for a subset of carefully selected patients under the shortage of liver donors.

Cost comparison between open thyroid lobectomy and radiofrequency ablation for management of thyroid nodules.

There is an increasing array of treatment options for addressing clinically significant thyroid nodules, including radiofrequency ablation (RFA). While effective, the cost compared to alternative approaches has not been well elucidated. This study involved a retrospective chart review, focusing on variable direct cost (VDC) of each procedure, from April 2016 to January 2020. We analyzed costs for 53 open lobectomies and 16 RFA procedures. Cost effectiveness depended on the simulated cost of the RFA probe. In comparison to open lobectomy, the VDC to perform RFA was $597 (19%) cheaper when the simulated probe cost was $1500 and $403 (13%) more expensive for a probe cost of $2500. Statistical significance was achieved for both these differences. If cost per RFA probe can be less than $2100-the break-even dollar amount between open lobectomy and RFA-there would be considerable cost savings for treating thyroid nodules.

Combination Therapy With Lenvatinib and Radiofrequency Ablation for Patients With Intermediate-Stage Hepatocellular Carcinoma Beyond Up-To-Seven Criteria and Child-Pugh Class A Liver function: A Pilot Study.

BackgroundThe present study aimed to evaluate the efficacy and safety of combined lenvatinib (first-line systemic therapy) and radiofrequency ablation (RFA) therapy in patients with intermediate-stage hepatocellular carcinoma with beyond up-to-seven criteria and Child–Pugh Class A liver function (CP A B2-HCC).MethodsTwenty-two patients with CP A B2-HCC were enrolled in the study. The patients had no history of systemic treatment. For the initial lenvatinib administration in this study, all of the patients had an adequate course of treatment (no less than two weeks) and were administered the recommended dose. Of them, 13 were treated by means of lenvatinib monotherapy (monotherapy group), while the 9 patients with no contraindication to RFA operation and who had consented to RFA received initial lenvatinib plus subsequent RFA (combination group). The clinical outcomes that were considered to evaluate the treatments included tumor response, prognosis (recurrence and survivals), and possible adverse events (serum liver enzymes and clinically visible complications).ResultsThe combination group exhibited a higher object response rate (9/9, 100%) as best tumor response than the monotherapy group (10/13, 76.9%). Longer progression-free survival (PFS) (12.5 months) and overall survival (OS) (21.3) were demonstrated in the combination group than in the monotherapy group (PFS: 5.5 months; OS:17.1 months). The combination group achieved a higher PFS rate (1-year: 74.1%) and OS rate (2-year: 80%) than the monotherapy group (1-year PFS rate: 0%; 2-year OS rate: 25.6%; for PFS, p<0.001; for OS, p=0.022). The treatment strategy was the independent factor for PFS (HR: 18.215 for monotherapy, p =0.010), which was determined by Cox regression analysis, suggesting that a combination strategy may reduce tumor progression when compared to the use of lenvatinib alone. There were no statistically significant intergroup differences that were observed in terms of adverse events, with the exception of ALT elevation (p=0.007) in the combination group.ConclusionOur newly proposed combination therapy may potentially be effective and safe for CP A B2-HCC beyond up-to-seven criteria. A larger scale, multicenter, prospective study is warranted to confirm our findings.

Alterations in Fetal Doppler Parameters Before and Twenty-Four Hours After Radiofrequency Ablation for Twin Reversed Arterial Perfusion Sequence.

ObjectiveTo evaluate alterations in the fetal Doppler parameters of pump fetuses before and 24 h after radiofrequency ablation surgery for twin reversed arterial perfusion sequence (TRAPs).MethodsThis is a retrospective study of 28 pump fetuses in TRAPs and 28 normal control twins between 2016 and 2021. The fetal Doppler parameters, including the umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), middle cerebral artery pulsatility index (MCA-PI), and cerebroplacental ratio (CPR), of the controls, and pump fetuses before and 24 h after surgery were compared.ResultsAn increasing trend and a further increase in the MCA-PSV, MCA-PI, MCA-PSV Z score, and MCA-PI Z score after surgery were observed in pump fetuses with gestational age (GA) ≥20 weeks; however, such changes were not observed in those with a GA of <20 weeks. The UA-PI and CPR before and after surgery were not different between control and pump fetuses, whether the GA was ≥20 or <20 weeks.ConclusionIn the middle second trimester, the pump fetus might suffer from high cardiac output rather than hypoxemia before surgery and congestive heart failure, or hemodilutional anemia after surgery. This may provide some theoretical evidence in favor of early intervention, rather than waiting for a more advanced GA, to avoid unnecessary hemodynamic alterations.

Alleviating Paravertebral Muscle Spasm after Radiofrequency Ablation Treatment of Hypersensitive Basivertebral and Sinuvertebral Nerves for Chronic Discogenic Back Pain

Paraspinal muscle spasm caused by pain from a lumbar degenerative disc is frequently investigated in patients with low back pain. Radiofrequency ablation (RFA) surgery could alleviate paraspinal muscle spasms. We performed RFA surgery on the high-intensity zone (HIZ) and hypersensitive sinuvertebral and basivertebral nerves to evaluate its outcome. The paravertebral muscle cross-sectional area (CSA) was measured on magnetic resonance imaging (MRI) before and after surgery to evaluate the effect of RFA surgery on the paravertebral muscle. Prospective cohort study. A single spine surgery center. A comparative study was performed on 2 different uniportal spinal endoscopic surgery groups; 23 patients who underwent RFA surgery for chronic discogenic back pain and 45 patients who underwent posterior decompression surgery for lumbar spinal stenosis with 12 months of follow-up. Paravertebral muscle cross-sectional area, Schiza grade, Modic type, and HIZ size were measured on pre- and post-operative MRI. An endoscopic video review was performed to evaluate the presence of intraoperative twitching and grade the degree of epidural neovascularization and adhesion. Visual analog scale VAS, modified Oswestry Disability Index, ODI and MacNab's criteria were evaluated for outcome measures. Intraoperative endoscopic video evaluation showed neovascularization and adhesion adjacent to the disc and pedicle. In the RFA surgery group, there were 7 patients (30.43%) with grade 2 and 16 (69.57%) with grade 3 neovascularization; intraoperative twitching was observed in 19 out of 23 patients (82.61%). After performing an RFA on the sinuvertebral and basivertebral nerves for the treatment of discogenic back pain, the results showed significant improvement in pain and disability scores. The mean CSA of the paraspinal muscle in the RFA surgery group was significantly increased after surgery at the L4-L5 and L5-S1 levels (L4-L5: 3901 ± 1096.7 mm² to 4167 ± 1052.1 mm², P = 0.000; L5-S1: 3059 ± 968.5 mm² to 3323 ± 1046.2 mm², P = 0.000) compared to preoperative CSA. This study was limited by its small sample size. Hypersensitive sinuvertebral and basivertebral nerves are strongly associated with epidural neovascularization with adhesion and the pathological pain pathway in degenerative disc disease. Epidural neovascularization with adhesion reflects aberrant neurological connections, which are associated with reflex inhibitory mechanisms of the multifidus muscle, which induces spasm. RFA treatment of the region of epidural neovascularization with adhesion effectively treated chronic discogenic back pain and could induce paraspinal muscle spasm release.

Intelligent Algorithm-Based Computed Tomography Image Features in Diagnosis of the Effect of Radiofrequency Ablation in Liver Cancer

To provide a reference for finding a reasonable evaluation method for treatment effect of radiofrequency ablation (RFA), computed tomography (CT) image optimized by the intelligent segmentation algorithm was utilized to evaluate the liver condition of hepatocellular carcinoma (HCC) patients after RFA and to estimate the patient’s prognosis. Eighty-eight patients with HCC who needed RFA surgery after diagnosis in our hospital were selected. The CT images before optimization were set as the control group; the CT images after optimization were set as the observation group. Comprehensive diagnosis was taken as the gold standard to compare the ablation range and residual lesions under CT scans before and after surgery. The results showed that the consistency of the two sets of CT images was compared with comprehensive diagnosis under different diameters of the lesion. The difference between the two groups was not statistically considerable when the diameter of the lesion was less than 50 mm ( P &gt; 0.05 ). For lesions larger than 50 mm in diameter, the consistency of the observation group (83%) was remarkably higher than that of the control group (40%), and the difference was substantial ( P &lt; 0.05 ). The kappa value of the observation group was 0.84 and that of the control group was 0.78. The kappa value of observation group was better than the control group, with considerable difference ( P &lt; 0.05 ). In conclusion, the diagnostic effect of CT image based on intelligent segmentation algorithm was superior to conventional diagnosis when the diameter of the lesion was larger than 50 mm. Moreover, the overall improvement rate of patients after RFA treatment was far greater than the recurrence rate, indicating that the clinical adoption of RFA was very meaningful.

Open radiofrequency ablation as upfront treatment for locally advanced pancreatic cancer: Requiem from a randomized controlled trial

BackgroundLocal ablation of pancreatic cancer has been suggested as an option to manage locally advanced pancreatic cancer (LAPC) although no robust evidence has been published to date to support its application. The aim of this study is to compare overall survival (OS) and progression-free survival (PFS) in patients receiving both radiofrequency ablation (RFA) and conventional chemoradiotherapy (CHRT) with patients receiving CHRT only. MethodsThis is a multicentre prospective randomized controlled trial (RCT). Patients with LAPC diagnosed by the Pancreas-Ablation-Team-Verona were randomly assigned to open RFA (Group A) or CHRT (Group B). Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at p < 0.05. ResultsOne hundred LAPC patients were enrolled from January 2014 to August 2016. 33% of patients in Group A did not receive the designated procedure because of intraoperative findings of liver (18.7%) or peritoneal metastases (43.8%), or technical contraindications (37.5%). We did not observe any statistically significant survival benefit from RFA compared to CHRT, neither in terms of OS (medians of 14.2 months and 18.1 months, respectively, p = 0.639) nor PFS (medians of 8 months and 6 months respectively, p = 0.570). Mortality was nil and RFA-related morbidity was 15.6%. In 13% of subjects, conversion to surgery occurred (2 after RFA and 11 after CHRT). ConclusionsThis is the first RCT evaluating the impact of upfront RFA in the multimodal treatment of LAPC. Compared to CHRT, RFA alone did not provide any advantage in terms of OS or PFS. It could be considered as a therapeutic option for LAPC within a multimodal context and after neoadjuvant therapies.

Comparison of open liver resection and RFA for the treatment of solitary 3\u20135-cmhepatocellular carcinoma: a retrospective study

BackgroundThe goal of this study was to compare the postoperative results of liver resection and radiofrequency ablation (RFA) for the treatment of small hepatocellular carcinoma (HCC) (3–5 cm).Patients and methodsWe retrospectively collected 122 cases of small solitary HCC treated at our center from Jan 2011 to Dec 2015, with diameters in the range of 3–5 cm. According to the treatment program received at our center, the patients were divided into liver resection (72 patients) and RFA (50 patients) groups.ResultIn comparison with the RFA group, the resection group had a longer operative time, greater intraoperative blood loss (P < 0.01), more hepatic inflow occlusion, and a longer postoperative hospital stay (P < 0.01). The 1-, 3-, and 5-year expected overall survival rates and tumor-free survival rates were comparable between the two groups. Cox regression analysis showed that neither resection nor RFA was a significant risk factor for overall or tumor-free survival in HCC.ConclusionsFor solitary HCC of 3–5 cm in diameter, RFA can achieve better in-hospital clinical results and similar long-term outcomes than resection and can be considered for wide application, especially for central-location cases.

Possible involvement of HSP70 in pancreatic cancer cell proliferation after heat exposure and impact on RFA postoperative patient prognosis

PurposeAs an alleviative treatment measured in patients with unresectable advanced pancreatic cancer, radiofrequency ablation (RFA) needed more clinical data to prove its advantages and to explore limitations in its utilization. This study was determined to observe the efficacy of RFA, and to explore its impact on perioperative periphery carcinoma as well as the normal pancreatic tissues. MethodsClinical data of 32 patients with pancreatic cancer accepted RFA surgery were collected. Followed up patients’ pain degree and the changes in serum tumor markers CA19-9 and CA 242 before and after surgery. Ex vivo, gave human pancreatic cancer cell line PANC-1 heat treatment to simulate the heat exposure condition periphery carcinoma was experienced during RFA surgery, and to observe the proliferation rate and HSP70 expression change compared with control group. ResultsOf the 32 patients, 1 died of upper gastrointestinal hemorrhage, and 29 survived for more than 5 months, 2 of which for more than 16 months. The average CA19-9 and CA 242 levels of the patients were significantly decreased in 3 months after surgery (t = 9.873, 5.978, P < 0.001). During in vitro experiments, the proliferation rate of PANC-1 cells after heating was significantly increased, accompanied with the increased HSP70 expression. The addition of HSP70 inhibitor can inhibit the rise of proliferation after heat therapy. ConclusionUtilizing RFA treat patients with unresectable advanced pancreatic cancer, could effectively relieve the pain, decline jaundice, and deduce tumor marker levels significantly. However, it failed to extend the long-term survival rate of the patients significantly. This study found that a higher proliferative rate accompanied with a higher HSP70 expression level were observed on in vitro cultured pancreatic carcinoma cells after heat treatment, which could be altered by HSP70 inhibitor. And these findings indicated that the heat exposure might impact periphery carcinoma during RFA surgery and HSP70 might play an important role in patients’ prognosis.

Radiofrequency ablation as a concomitant procedure for the treatment of atrial fibrillation during cardiac surgery

Atrial fibrillation is the most common type of arrhythmia with increasing burden for stroke and thromboembolic events. Medical treatment of atrial fibrillation has not shown promising results, so alternative method of treatment is emerging out. Cox-Maze procedure has been used for decades for the treatment of atrial fibrillation. Surgical treatment of atrial fibrillation with traditional Cox-Maze procedure is a complex and technically challenging procedure limiting its use in clinical practice. Recently, radiofrequency ablation is being used as a modification of Cox-Maze procedure. However, its effect in the treatment of atrial fibrillation in not reported uniformly and in large number of patients. Therefore, our aim of study was to assess the impact of concomitant radiofrequency ablation in the treatment of atrial fibrillation during cardiac surgery. We performed literature review on PubMed Central to evaluate effect of concomitant radiofrequency ablation for atrial fibrillation treatment. About 303 papers were found using the reported search, of which 15 represented suitable to fulfill our query. The authors, date, patient group, study type, relevant outcomes and results of these papers are tabulated. We conclude that radiofrequency ablation surgery of left atrium at the time of other cardiac procedures is a comparatively straightforward procedure with satisfactory freedom from atrial fibrillation, acceptable morbidity, mortality, and minor procedure related complications. Careful patients selection by sticking to the - Rule of 5, i.e. left atrial diameter less than 55 mm and atrial fibrillation duration no more than five years, is recommended to optimize the result of atrial fibrillation surgery.

Myoma Imaging by Gynecologic Surgeons Training in Intraoperative Ultrasound Technique

To compare preoperative transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) with intraoperative ultrasound (IOUS) in surgeons first learning to use this technique. A prospective study of IOUS accuracy for mapping the size and location of myomas compared with TVUS or MRI (Canadian Task Force classification II-2). Five University of California academic centers (Davis, Irvine, Los Angeles, San Diego, and San Francisco). Twenty-six premenopausal women seeking uterine-sparing surgical treatment of myomas. Eligible participants could have no more than 6 myomas ≥2 cm and <10 cm and a uterine size no larger than 16 weeks by pelvic examination. Measurement of myomas by IOUS followed by radiofrequency ablation (RFA) of fibroids. Eligible participants had to have imaging with TVUS or MRI within the last year to assess myoma characteristics. During the RFA operation, surgeons who had undergone a 1-day training on RFA and IOUS measured all myomas visualized with IOUS. Surgeons measured more myomas than were reported on MRI (12 on MRI and 16 on IOUS) or TVUS (41 on TVUS and 62 on IOUS) in all positions (anterior, posterior, lateral, and fundal). In particular, they identified more myomas <2 cm (4 on MRI, 9 on IOUS, 1 on TVUS, and 19 on IOUS). They located 2.3 times as many myomas in the anterior position as TVUS. For the myomas ≥2 cm identified by IOUS and MRI or IOUS and TVUS, there was no statistically significant difference in the mean myoma number or the mean myoma diameter measurements. Surgeons first learning to use IOUS detect the same number of myomas ≥2 cm as identified by TVUS and MRI and find a greater number of myomas <2 cm on IOUS compared with radiologist-reported TVUS.

Control study of H-uvulopalatopharyngoplasty combined with tongue base radiofrequency for the treatment of obstructive sleep apnea hypopnea syndrome

Objective: To investigate the effect of H-uvulopalatopharyngoplasty(H-UPPP) combined with tongue base radiofrequency ablation in the treatment of obstructive sleep apnea hypopnea syndrome(OSAHS). Methods: Sixty-two patients with moderate or severe OSAHS, whose obstructive plane located in the oropharynx and tongue base were divided into two groups two groups according to the patient's independent choice under the condition of fully informed before the operation. The control group of 30 cases underwent H-UPPP, while the experimental group of 32 patients underwent improved H-UPPP and tongue base radiofrequency. The clinical efficacy between the two groups was compared. Results: There was no significant difference between the two groups before operation. After the operation, the total effective rate of the experimental group was 71.9%, significantly higher than that of the control group (46.7%, χ(2)=4.09, P<0.05), the difference was statistically significant. After operation, in the control group, AHI was (19.4±8.1)/h, LSaO(2) was 0.767±0.052. In the experimental group, AHI was (17.8±7.8)/h, LSaO(2) was 0.790±0.059. There was significant difference in both groups before and after surgery (P<0.001), with statistical significance. In the experimental group, after operation, the minimum diameter of oropharyngeal cavity was (10.6±2.4) mm, there was obvious increase compared with the diameter of oropharyngeal cavity (9.9±2.2) mm before operation, the difference was statistically significant (t=2.64, P<0.05). In the control group, after operation, the minimum diameter of oropharyngeal cavity was(10.0±2.4) mm, there was no obvious increase compared with the diameter of oropharyngeal cavity (9.9±2.5) mm before operation, the difference was not statistically significant (P>0.05). Compared between control group and experimental group, the differences of AHI, LSaO(2), the minimum anteroposterior diameter of oropharyngeal cavity before and after operation were not statistically significant (P>0.05). Conclusion: The effect of same time H-UPPP and radiofrequency ablation surgery is definitive.

Atorvastatin can ameliorate left atrial stunning induced by radiofrequency ablation for atrial fibrillation.

The objective of this study was to study the functional changes of the left atrium after radiofrequency ablation treatment for atrial fibrillation and the therapeutic effect of atorvastatin. Fifty-eight patients undergoing radiofrequency ablation for atrial fibrillation were randomly divided into non-atorvastatin group and atorvastatin group. Patients in the atorvastatin group were treated with atorvastatin 20 mg p.o. per night in addition to the conventional treatment of atrial fibrillation; patients in the non-atorvastatin group received conventional treatment of atrial fibrillation only. Echocardiography was performed before radiofrequency ablation operation and 1 week, 2 weeks, 3 weeks, and 4 weeks after operation. Two-dimensional ultrasound speckle tracking imaging system was used to measure the structural indexes of the left atrium. Results indicated that there was no significant change for indexes representing the structural status of the left atrium within a month after radiofrequency ablation (P > 0.05); however, there were significant changes for indexes representing the functional status of the left atrium. There were also significant changes in indexes reflecting left atrial strain status: the S and SRs of atorvastatin group were higher than those of non-atorvastatin group (P < 0.05). In summary, atorvastatin could improve left atrial function and shorten the duration of atrial stunning after radiofrequency ablation of atrial fibrillation.

Clinical effect and prognostic factors analysis of intraoperative radiofrequency ablation in treatment of hepatocellular carcinoma with severe cirrhosis

Objective To investigate the clinical effect and prognostic factors of intraoperative radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC) with severe cirrhosis. Methods The retrospective case-control study was conducted. The clinicopathological data of 188 HCC patients with severe cirrhosis who were admitted to the Zhongshan Hospital of Fudan University between January 2009 and December 2013 were collected. According to intraoperative exploration, tumor condition and liver cirrhosis situations, partial hepatectomy combined with intraoperative RFA or single RFA was selected. Observation indicators: (1) operation situations: operation time, volume of intraoperative blood loss, blood transfusion, hepatic inflow occlusion, number of tumors of surgical resection and number of tumors removed by RFA; (2) postoperative recovery situations: postoperative complications and duration of postoperative hospital stay; (3) follow-up; (4) factors analysis affecting tumor-free survival. Follow-up using outpatient examination and telephone interview was performed to detect tumor damage and survival of patients up to March 2016. Measurement data with normal distribution were represented as ±s. The survival rate was calculated by the Kaplan-Meier method. The univariate analysis was done by the the Log-rank test, and multivariate analysis was done using the COX regression model. Results (1) Operation situations: all the 188 HCC patients underwent successful operations, including 74 undergoing partial hepatectomy with intraoperative RFA and 114 undergoing single RFA. Of 188 patients, 11 were combined with cholecystectomy, 6 with right adrenalectomy and 1 with subtotal gastrectomy, without perioperative death. Operation time and volume of intraoperative blood loss in 188 patients were (2.3±1.4)hours and (64±4)mL, without blood transfusion and hepatic inflow occlusion. Numbers of patients with 1 tumor of surgical resection and with 2 tumors of surgical resection and total number of tumors of surgical resection were 61, 13, 87 in 74 patients undergoing partial hepatectomy with intraoperative RFA. Numbers of patients with 1, 2, 3 and 4 tumors removed by RFA and total number of tumors of RFA were 123, 58, 6, 1 and 261 in 114 patients undergoing single RFA. (2) Postoperative recovery situations: of 188 patients, 19 with severe complications were improved by symptomatic treatments, including 7 with massive pleural effusion, 5 with massive intra-abdominal effusion, 3 with intra-abdominal bleeding, 3 with severe local infection and 1 with massive pleural and intra-abdominal effusion. Duration of postoperative hospital stay was (7.61±0.20)days. (3) Follow-up: 182 of 188 patients were followed up for 21-85 months, with a median time of 41 months. Patients received enhanced rescans of magnetic resonance imaging (MRI) at 1 month postoperatively, 174 had complete tumor damage, with a tumor damage rate of 92.55%(174/188). During the follow-up, 46 patients died. The overall median survival time, 1-, 2-, 3-year overall survival rates, median tumor-free survival time and 1-, 2-, 3-year tumor-free survival rates were 38 months, 99%, 96%, 86%, 31 months, 92%, 77% and 41%, respectively. (4) Factors analysis affecting tumor-free survival: results of univariate analysis showed that preoperative alpha-fetoprotein (AFP), number of tumors and surgical procedures were relative factors affecting tumor-free survival of HCC patients with severe cirrhosis (χ2=5.623, 4.744, 7.293, P 20 μg/L and partial hepatectomy with intraoperative RFA were independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA (RR=1.523, 1.615, 95% confidence interval: 1.056-2.198, 1.006-2.594, P<0.05). Conclusions Intraoperative RFA is safe and feasible in treatment of HCC with severe cirrhosis, with advantages of less postoperative complications and rapid recovery, and it can provide better long-term survival for patients. Preoperative AFP>20 μg/L and partial hepatectomy with intraoperative RFA are independent risk factors affecting tumor-free survival of HCC patients with severe cirrhosis after open RFA. Key words: Carcinoma, hepatocellular; Liver cirrhosis; Radiofrequency ablation; Hepatectomy; Prognosis

Random clinical study about application value of oxycodone in radiofrequency ablation of hepatocellular carcinoma

Objective: To evaluate the clinical effect and safety of oxycodone hydrochloride in the anesthesia for percutaneous radiofrequency ablation (PRFA) in hepatocellular carcinoma. Methods: Between March and December 2015, 60 cases of hepatocellular carcinoma patients undergoing percutaneous radiofrequency ablation surgery in Peking University Cancer Hospital were randomly divided into three groups: oxycodone group (group Q), fentanyl group (group F) and dezocine group (group D), 20 cases in each group. Respectively intravenously injection oxycodone 0.1 mg/kg, fentanyl 0.001 mg/kg, dezocine 0.1 mg/kg before surgery. After the surgeon completed puncture administer propofol to maintain anesthesia. Recorded mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) changes in each group at entrance, beginning of radiofrequency ablation (T1), radiofrequency ablation began after 10 minutes (T2), the end of the surgical and awake. Observe the analgesia effect, respiratory depression, nausea, vomit and other complications. Postoperative pain scores were recorded.Using ANOVA, repeated measure variance analysis, SNK test, χ2 test and other tests to evaluate the anesthetic effect indexes. Results: The observation completed in all patients. Patients of three groups had no significant differences in general information. No significant difference between MAP, HR and SpO2 at each time points among the three groups. At the T1 time point (group Q: (11.7±1.6)/min, group D: (12.1±1.7)/min, group F: (10.3±2.3)/min, F=5.068, P=0.009) and T2 time point (group Q: (11.9±1.3)/min, group D: (12.2±1.4)/min, group F: (10.7±1.3)/min, F=7.024, P=0.002), RR in group F were lower than in group Q and group D. Pain visual analogue scores after waking (group Q: 0.2±0.7, group D: 0.3±0.7, group F: 1.7±1.5, F=12.981, P=0.000) and postoperative pain score of 1 hour (group Q: 2.0±0.9, group D: 1.8±0.8, group F: 4.3±0.9, F=42.362, P=0.000) in the group Q and group D were significantly lower than in group F. The body movements in group Q and group D were significantly less than in group F (3 cases, 3 cases, 9 cases, χ2=6.400, P=0.041 ). Intraoperative respiratory depression in group Q and group D were lower than group F (3 cases, 2 cases, 9 cases, χ2=8.012, P=0.018). Conclusions: Oxycodone hydrochloride can be used safely and effectively for radiofrequency ablation. It has favorable hemodynamic stability, lower incidence of respiratory depression, and advantage in terms of postoperative pain.

Perioperative outcomes of laparoscopic versus open radiofrequency ablation for the primary treatment of hepatic malignancies: A population-based appraisal

Perioperative outcomes of laparoscopic versus open radiofrequency ablation for the primary treatment of hepatic malignancies: A population-based appraisal