Radiofrequency Thermal Ablation Research Articles

Ultrasound guided percutaneous radiofrequency thermal ablation of symptomatic uterine fibroids - results from a single center and 52 weeks of follow up.

Uterine fibroids are one of the most common female disorder of the reproductive age and may cause abnormal uterine bleeding (UAB), pain or infertility. Our aim was to evaluate the safety and efficacy of percutaneous radio frequency ablation (RFA) in reducing clinical symptoms, fibroid volume and improving laboratory parameters. Thirty-five symptomatic patients with 54 uterine fibroids were enrolled. Preintervention evaluation was made for each participant and included ultrasonography to assess the volume, largest diameter and location of the fibroid and Visual Analogue Scale (VAS) for quantifying the degree of menstrual pain. The magnitude of menstrual bleeding was scored for each patient by using pictogram. Preprocedural laboratory assessment included hemoglobulin and hematocrit. Treatment efficacy was evaluated at 3, 6 and 12 months after the intervention with ultrasound (US) measurements, symptom scores and laboratory parameters. Pretreatment mean Hb was significantly lower than those at 3, 6 and 12 month post treatment visits (p < 0.001). The pretreatment median volume was significantly higher than the median volumes measured at 3, 6 and 12 months after RFA (p < 0.001). Visual Analogue Score (VAS) for pain was significantly lower than baseline values at 6 and 12 month visits (p < 0.01). Pretreatment bleeding scores and the number of patients in the predefined severe bleeding category were significantly decreased. US guided RF ablation of uterine fibroids is relatively safe and effective procedure. It can be applied to the fibroids with varying localizations and sizes. It reduces the fibroid volume and obviate a need for more invasive treatment.

Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body.

Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) - at baseline, 1 week, 1 month and 3 months - 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group (p <0.001, 0.014, respectively), as did the AQA (p <0.027). Steroid group was the worst. RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.

Thermal Nerve Radiofrequency Ablation for the Nonsurgical Treatment of Knee Osteoarthritis: A Systematic Literature Review.

There are roughly 14 million adults in the United States presenting with symptomatic osteoarthritis (OA) of the knee. Nerve radiofrequency ablation (RFA) is a nonsurgical procedure for the management of knee OA symptoms, and no previous systematic review has been performed comparing geniculate nerve RFA to other nonsurgical treatments. (1) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about pain, function, quality of life, and composite scores? and (2) How does geniculate nerve RFA compare with other nonsurgical modalities for patients with knee OA about adverse events (AEs)? A systematic literature review was conducted within PubMed, EMBASE, and Cochrane Central Register of Controlled Trials to identify all studies from 1966 to 2019 evaluating the relative effectiveness of geniculate nerve thermal (heated or cooled) RFA compared with other nonsurgical treatments for knee OA. Two independent abstractors reviewed and analyzed the literature including comparators such as intra-articular (IA) corticosteroids, IA hyaluronic acid, NSAIDs, acetaminophen (paracetamol), and control/sham procedures. Inclusion was based on the following criteria: English language, human subjects, symptomatic knee OA, and patient-reported outcomes. Five high-quality and two moderate-quality randomized controlled trials (RCTs) met the inclusion criteria for this review. The results showed consistent agreement across all RCTs in favor of geniculate nerve thermal RFA use for nonsurgical treatment of knee OA. One high-quality RCT and one moderate-quality RCT found geniculate nerve RFA to provide statistically significant outcome improvement compared with control or sham procedures regarding pain, function, quality of life, and composite scores. When compared with IA corticosteroids and hyaluronic acid, geniculate nerve RFA also provided notable improvement in pain, function, and composite scores (visual analog scale, Western Ontario, and McMaster Universities Arthritis Index, and Oxford Knee Score). RFA was markedly favored for all pain and composite outcomes (Western Ontario and McMaster Universities Arthritis Index and visual analog scale). The included RCTs did not report any serious AEs related to geniculate nerve RFA. These results demonstrate geniculate nerve thermal RFA to be a superior nonsurgical treatment of knee OA compared with NSAIDs and IA corticosteroid injections. None of the RCTs reported any serious AEs with geniculate nerve thermal RFA, as opposed to known cardiovascular, gastrointestinal, and renal AEs for NSAIDs and accelerated cartilage loss and periprosthetic infection risk for IA corticosteroid injections. Level I.

Thermal ablation assisted laparoscopic partial nephrectomy for clinical T1b renal tumors

Objective To report our preliminary results of thermal ablation, including microwave and radiofrequency ablation assisted laparoscopic partial nephrectomy for cT1b renal tumors. Material and methods A total of 56 patients with cT1b renal tumors who underwent microwave ablation or radiofrequency ablation assisted laparoscopic partial nephrectomy between January 2014 and May 2018 were enrolled. Thirty of them underwent microwave ablation assisted laparoscopic partial nephrectomy (MWA-LPN group), and the other 26 received radiofrequency ablation assisted laparoscopic partial nephrectomy (RFA-LPN group). Baseline, perioperative and follow-up data were compared between the two groups. Results There were no statistical differences with respect to patients’ gender, age, tumor size, RENAL score, BMI and estimated glomerular filtration rate between the MWA-LPN and RFA-LPN group, nor were any differences observed in warm ischemia time, post-operative complications and hospital stay. Patients in the MWA-LPN group had shorter median operative time (p = .012), less estimated blood loss (p = .023). Median follow-up was 36 months (range 12–64). Three-year cancer-specific and progression-free survival was 100% and 96.4%. The overall kidney recurrence rate was 3.6% in the present study. Conclusions Thermal ablation assisted laparoscopic partial nephrectomy is a safe, effective nephron-sparing treatment which provides acceptable results for selective cT1b renal tumors.

Spatiotemporal Thermal Contours mapping of ex-vivo Bovine Liver Radiofrequency Thermal Ablation utilizing Hyperspectral Image and its Associated K-Mean Clustering Algorithm

Significance: Hepatocellular carcinoma (HCC) is considered as worldwide health problem with a poor diagnosis due to limited detection techniques. Thermal ablation is the dominant modality to treat liver tumors for discriminating patients who are not allowed to have surgical intervention. Knowing that, observing or foreseeing the size of the subsequent tissue putrefaction during the Thermal Ablation techniques is a difficult undertaking. Aim: To examine the impacts of ablation zone volume following Radiofrequency ablation (RFA) of an ex-vivo bovine liver to correlate the impacts of thermal ablation with target organ perfusion; by exploiting the unique properties of Hyperspectral Imaging (HSI).where, Vessels may source cooling in the adjacent tumor target (heat‑sink‑effect) with risk of cancer recurrence and the infiltration profundity estimations consider the lessening of the tissue. Materials and Methods: Radiofrequency ablation was perfused on ex-vivo bovine livers at peripheral and central‑vessel‑adjacent locations, and monitored by HSI with a spectral range from 400 to 1000 nm. The system contains k-means clustering (K=8) algorithms combining spectral and spatial information. Labeled spectral signatures datasets were used as training data. Statistical analysis (10 samples) was computed to calculate the highest variance between six spectral images for determining the optimum wavelength for discrimination between the affected regions after thermal ablation (normal, thermal, and ablated liver tissue regions). Results: The change of the optical properties of ex-vivo liver tissues provides different responses to light transmission, scattering, absorption and particularly the reflection over the spectrum range. The spectral reflectance signatures were measured and evaluated using designed K-mean clustering algorithm after image reconstructed. Trials showed that spectral region 650~650 nm was proposed as optimum spectral range. Where, these results successfully distinguishes the Surface Thermal ablation region (x,y-axis),as well as the Thermal penetration Depth (z-axis) for Tissue characterization and Contour mapping for the unwanted thermal damage. Conclusions: Hyperspectral imaging is a powerful tool in real-time monitoring the thermal ablation and more accurate compared to the conventional imaging modality.

Current and Future Surgical and Interventional Management Options for Adenomyosis.

Historically, hysterectomy has been the recommended treatment for patients with adenomyosis. However, in the past two decades, various uterine-sparing treatment methods have emerged. These range from excisional techniques such as adenomyomectomy or wedge resection to uterine artery embolization, radiofrequency thermal ablation, hysteroscopic excision, endometrial ablation, and high-intensity focused ultrasound. While largely investigative for the treatment of adenomyosis, these procedures have demonstrated improvement in symptoms including abnormal uterine bleeding, dysmenorrhea, pelvic pain, and overall quality of life. However, long-term data including fertility and obstetric outcomes are needed. Future research is needed to better understand the impact of these uterine-preserving techniques to expand our armamentarium for the treatment of adenomyosis.

Visual Vignette

Case Presentation: A 69-year-old female presented for follow-up of thyroid cancer and hypothyroidism. Her history was significant for metastatic papillary thyroid cancer, follicular variant. Treatment history included total thyroidectomy, radioactive iodine ablation, thermal radiofrequency ablation of a metastatic lesion, and tyrosine kinase inhibitor therapy. She was being treated with lenvatinib. She reported pain and blistering in the palms of her hands and soles of her feet that had been ongoing since treatment with tyrosine kinase inhibitors (TKIs) was initiated. On physical examination, dry flaking skin with blistering was noted on the palms and soles (Fig. 1 A and B and Fig. 2). A well-healed thyroidectomy scar was seen. Remaining dermatologic, cardio-pulmonary, abdominal, and neurologic exams were unremarkable. What is the diagnosis? Fig. 2 View Large Image Figure Viewer

Effect of endovenous ablation assessment stratified by great saphenous vein size, gender, clinical severity, and patient-reported outcomes

ObjectiveThe policies of insurance carriers have used the truncal vein size as a criterion for coverage. The objective of the present study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on patient presentation and clinical outcomes. MethodsPatients in a national cohort were prospectively captured in the Vascular Quality Initiative Varicose Vein Registry. From January 2015 to October 2017, the Vascular Quality Initiative Varicose Vein Registry database was queried for all patients who had undergone varicose vein procedures. The CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, Venous Clinical Severity Score, and patient-reported outcomes were compared by GSV size (<5 mm, group 1; ≥5 mm, group 2) before and after the procedures. A 2-sample Wilcoxon test was performed to assess the differences between the 2 groups stratified by GSV size. To assess for postoperative improvement, a matched-pairs Wilcoxon signed rank test was performed for each group separately. ResultsDuring the study period, 5757 vein ablation procedures had been performed for GSV: 770 for GSV size <5 mm and 4987 for GSV size ≥5 mm. Patients in group 1 were more likely to be women (81.7% vs 68.4%; P = .001) and older (56.8 vs 55.6 years; P = .012). The CEAP clinical class was more advanced in group 2 than in group 1 (P = .001). The maximal GSV diameter in group 2 was significantly greater than in group 1 (8.32 vs 3.86 mm; P = .001); 64% of group 2 and 59.2% of group 1 had undergone radiofrequency thermal ablation (P = .001). No mortalities occurred in either group. Group 2 had more complications postoperatively (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%, P = .001), developed partial recanalization (0.8% vs 0.3%; P = .001), and missed more work days (2.32 vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but group 1 had a higher rate of paresthesia. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, itching) score. The degree of symptomatic improvement between the 2 groups was similar. ConclusionsAll patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation, regardless of GSV size. Patients with a preoperative GSV size ≥5 mm experienced similar improvement in symptoms but an increased complication rate. Patients with a smaller vein size should not be denied intervention or coverage by vein size.

A comparison of efficacy among different radiofrequency ablation techniques for the treatment of lumbar facet joint and sacroiliac joint pain: A systematic review and meta-analysis

ObjectiveTo compare the efficacy of different radiofrequency techniques (thermal, pulsed, and cooled radiofrequency) for treating lumbar facet joint (LFJ) or sacroiliac joint (SIJ) pain. Patients and methodsThe inclusion criteria were as follows: (1) age > 18 years; (2) patients suffering from LFJ or SIJ pain; and (3) patients receiving radiofrequency treatments. Four electronic databases, including Pubmed, Embase, Cochrane Library, and ISI Web of Knowledge were systematically searched from inception until December 2019 for relevant articles. The search was conducted on 2 January 2020. When the outcomes among articles showed heterogeneity, then a random-effects model was adopted to calculate the effect size; otherwise, a fixed-effects model was adopted. ResultsAll the three techniques showed significant improvements in LFJ or SIJ pain for up to 12 months compared with the baseline level. However, no significant differences among the three techniques were observed at any follow-up visits except for possibly a trend for variance in efficacy. For treating LFJ pain, cooled radiofrequency was the most effective, followed by thermal radiofrequency and then pulsed radiofrequency as the least respectively for the follow-up visit at 6 months. No serious complications were reported after receiving treatment using the three techniques. ConclusionSequentially, cooled radiofrequency followed by thermal radiofrequency and then pulsed radiofrequency for treating LFJ pain were identified as most to least effective at the 6-month follow-up.

Radiofrequency Thermal Ablation of Benign Thyroid Nodules: The Correlation Between Ultrasound Nodule Characteristics and Results.

Background. The aim of this observational study was to investigate for which nodules a better response to radiofrequency thermoablation (RFA) for nonfunctioning benign thyroid nodules is likely. Methods. Aesthetic score, compressive score, and volume of 32 benign nodules from 32 patients were registered during follow-up at baseline, 1, 3, 6, and 12 months. Results. A volume reduction rate (VRR) of 72.56% at 12 months after the procedure (P = .009) was registered. A significant (P < .001) improvement in the compressive and aesthetic scores was observed. Nodules with a baseline volume <20 mL had VRRs at 3 and 6 months that were significantly greater than those with volume >20 mL (P = .037). Conclusions. RFA was shown to be a safe and effective procedure for the management of benign thyroid nodules and that there is a correlation between the initial size of the nodule and the response to treatment.

Effectiveness and safety in radiofrequency ablation of pulmonary metastases from HCC: a five years study.

Hepatocellular carcinoma (HCC) is a frequent tumor that may be treated with radiofrequency thermal ablation (RFA). RFA has been used with success also in treatment of pulmonary metastases from a wide range of primitive tumors, especially colorectal. Previous studies have shown that RFA con be used in treating HCC pulmonary metastases. Purpose of our study was a retrospective evaluation of overall survival and complication rates of percutaneous CT-guided radiofrequency ablation of pulmonary metastases from hepatocellular carcinoma (HCC). Data were collected from 40 CT-guided ablation sessions performed on 42 lesions in 26 patients (16M and 10 F; mean age 62.5years) with pulmonary metastases from HCC (size range 0.3-4cm, mean diameter 1.4 ± 0.98cm) from February 2012 to December 2017. All patients, as in advanced stage of illness (stage C), were treated according to Barcelona Clinic Liver Cancer (BCLC) criteria, with Sorafenib. They had no active HCC foci in the liver and no more than three metastases in the lung. Patients did not discontinue medical therapy with Sorafenib and pulmonary relapses were treated up to three times. In two patients two lesions were treated during the same procedure. Each lesion was ablated under CT guidance. Follow-up contrast-enhanced CT at 1, 3, 6, 12-month and every 6months after treatment were reviewed. A total of 42 metastatic lung lesions from HCC in 26 patients (57% male, 43% female) were treated with CT-guided radiofrequency thermal ablation procedures. Immediate radiofrequency ablation-related complications (subtle pneumothorax) were observed in 9 of 40 procedures (22.5%). Only one patient developed a pneumothorax requiring drainage tube insertion (2.5%). No other major complications occurred. Moreover, no significant worsening of pulmonary function was observed. In all patients the overall survival rates were 88.5% at 1year, 69.8% at 3years and 26.2% at 5years. Our retrospective assessment confirmed that percutaneous CT-guided radiofrequency thermal ablation in 23 patients with pulmonary metastases from HCC represents an effective and safe alternative treatment option in patients not considerable as potential candidates to surgery.

Point defects in BaSi2 thin films for photovoltaic applications studied by positron annihilation spectroscopy

Barium di-silicide (BaSi2) is a very promising absorber material for high-efficiency thin-film solar cells, due to its suitable bandgap, high light absorption coefficient, and long minority-carrier lifetime. In this study, we compare the nanostructure, layer composition, and point defects of BaSi2 thin films deposited by Radio Frequency (RF) sputtering, Thermal Evaporation (TE), and Molecular Beam Epitaxy (MBE), using Doppler Broadening Positron Annihilation Spectroscopy (DB-PAS) depth profiling, Raman spectroscopy, and x-ray diffraction. Our DB-PAS study on thermally annealed RF-sputter deposited and on TE-deposited BaSi2 layers, in a comparison with high quality BaSi2 films produced by MBE, points to the presence of vacancy-oxygen complexes and Si or Ba mono-vacancies, respectively, in the (poly)crystalline BaSi2 films. The degree of near-surface oxidation increases, going from MBE and TE to the industrially applicable RF-sputtered deposition synthesis. The use of a-Si capping layers on the thermally annealed RF-sputtered BaSi2 films leads to a clear reduction in sub-surface oxidation and improves the quality of the BaSi2 films, as judged from DB-PAS.

Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique.

To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques. Comprehensive systematic review. A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief, as well as procedural technique with perpendicular or parallel placement of electrodes. Results varied by selection criteria and procedural technique. At six months, 26% of patients selected via single medial branch block with 50% pain relief and treated via perpendicular technique achieved at least 50% pain relief; 49% of patients selected via dual medial branch blocks with 50% pain relief and treated via parallel technique achieved at least 50% pain relief. The most rigorous patient selection and technique-two diagnostic medial branch blocks with 100% pain relief and parallel electrode placement-resulted in 56% of patients experiencing 100% relief of pain at six months. This comprehensive systematic review found differences in the effectiveness of lumbar medial branch radiofrequency neurotomy when studies were stratified by patient selection criteria and procedural technique. The best outcomes are achieved when patients are selected based on high degrees of pain relief from dual medial branch blocks with a technique employing parallel electrode placement.

Anterior accessory saphenous vein confluence anatomy at the sapheno-femoral junction as risk factor for varicose veins recurrence after great saphenous vein radiofrequency thermal ablation.

Varicose veins recurrence rate remained almost unchanged despite the constant technological advancement in its treatment. The aim of this study is to evaluate the variable accessory saphenous vein (ASV) anatomy at the sapheno-femoral junction (SFJ) as a possible risk factor for recurrent varicose vein (RVV) after great saphenous vein (GSV) radiofrequency thermal ablation (RTA). Two-hundred consecutive patients affected by chronic venous disease (mean age 52.4±10.3 years; 187 women; CEAP C2-C6; 25.2±1.4), underwent to RTA from 2014 to 2016, at our Institute. Preoperatively all patients underwent duplex-ultrasound scanning, reporting the anatomical site, extension of reflux and the ASV anatomy at the SFJ. Duplex ultrasound and physical examination was performed postoperatively at 1, 6 and 12 months, and yearly thereafter. Patients were divided in two groups based on the anatomical site of reflux: group A (N.=187) including GSV and SFJ, group B (N.=82) including SFJ reflux. There was no preoperative statistical difference between the two groups. At a mean follow-up of 29.7±2.4 months, a freedom from recurrent varicose vein and GSV recanalization was: 100% and 100% at 1 month, 95.9% and 99.1% at 1 year, 93.7% and 96.7% at 3 years, respectively. A higher rate of RVV was documented for patients in group A at 3-year of follow-up (P=0.042). Cox regression analysis found, among five potential predictors of outcome, that direct confluence of ASV in SFJ (HR=1.561; 95% CI: 1.0-7.04; P=0.032) was a negative predictors of 1-year RVV. Sapheno-femoral junction morphology may affect recurrent varicose veins formation. In particular, a concomitant incompetence of the accessory saphenous vein or its directly confluence into the SFJ could represent an indication to simultaneous treatment by non-surgical techniques (RTA or laser) and avoid surgical ligation.

Electrothermal Analysis of the Breast-Tumor Model During Electroporation

Short intense electric pulses surpass the capacitance of the cell membrane and leads to permeabilization [electroporation (EP)]. EP can be reversible [electrochemotherapy (ECT)] or irreversible(Treatment). EP-based treatments have gained much importance in recent past. Our work aims in analyzing the electroporated ablation area and comparing it with the existing thermal radiofrequency ablation (RFA) method. For parameter design optimization, a study is conducted to assess the damage induced by the electric field and temperature distribution on the heterogeneous human breast model. The results revealed that the electric field is more localized within the cancerous region with electrodes directly inserted into the tumor with maximum electric field of 6.21×10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">6</sup> V/m. Maximum thermal damage of 5.51×10 <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">-8</sup> is obtained during EP which is less than 1(Ω <; 1) shows EP produces minimal damage. The largest ablation volume of 10136 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sup> is obtained by using 8 electrodes (100 μs), whereas RFA produces 9326 mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">3</sup> ablation volume (3 min), indicates that maximum ablation volume was attained in EP for lower duration with negligible thermal effects which is more advantageous than the existing thermal method. Furthermore, maximum temperature attained during RFA is 20.64% more than EP. Breast composition, location and size of tumor, and thermal conditions have maximum influence on the ablation volume generated during EP.

Hepatocellular carcinoma: An Update

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. The major etiologies and risk factors for the development of HCC are well defined and some of the multiple steps involved in hepatocarcinogenesis have been elucidated in recent years. Despite these scientific advances and the implementation of measures for the early detection of HCC in patients at risk, patient survival has not significantly improved during the last three decades. This is due to the advanced stage of the disease at the time of clinical presentation and the limited therapeutic options. The therapeutic options fall into several categories: (i) surgical interventions including tumor resection and liver transplantation, (ii) percutaneous interventions including ethanol injection and radiofrequency thermal ablation, (iii) transarterial interventions including embolization, chemoembolization and selective internal radiotherapy, (iv) external radiation therapy and (v) systemic strategies with cytotoxic agents and molecularly targeted therapies as well as immunotherapies. These therapeutic strategies have been evaluated in part in randomized controlled clinical trials that are the basis for actual therapeutic recommendations. While surgery, percutaneous and transarterial interventions are effective in patients with limited disease (1-3 lesions, &lt;5 cm in diameter) and compensated underlying liver disease (cirrhosis Child A), at the time of diagnosis more than 80% of patients present with multicentric HCC and advanced liver disease or comorbidities that restrict the therapeutic measures to best supportive care (BSC). In order to reduce the morbidity and mortality from HCC, early diagnosis and the development of novel systemic therapies for advanced disease, including cytotoxic agents, molecular targeted and immunotherapies is most important. New analytical technologies, including gene expression profiling and proteomic analyses and others, should allow to further elucidate the molecular events underlying HCC development and to identify novel diagnostic markers as well as therapeutic and preventive targets.

Impact of combining pulsed and thermal radiofrequency on long-term therapy of idiopathic trigeminal neuralgia: A prospective study

ABSTRACT Background Trigeminal neuralgia (TN) is a painful condition characterized by sudden onset, severe unilateral, brief, stabbing recurrent episodes electric shock like pain in the distribution of one or more branches of the trigeminal nerve. Many approaches were used for treatment of TN as balloon decompression, thermocoagulation radiofrequency (TRF), and pulsed radiofrequency (PRF). Objectives This study evaluated the effectiveness of combined PRF and TRF for long-term therapy of patients with idiopathic TN. Patient and methods Our prospective study was carried out after the approval of ethical committee of Zagazig University Hospital Pain Management Unit from June 2017 to May2019. Overall, 20 adult patients suffering from idiopathic TN who treated with combining PRF and TRF for the gasserian ganglion. PRF (continuous for 20 min, at 42°C) followed by TRF (for 60 s at 70°C, then for 60 s, at 75°C) was performed to the gasserian ganglion. The post-operative pain relief and complications were evaluated at first day, 1, 3, 6, 12, 18, and 24 months after treatment. Results There were significant improvements of pain relief as regards Visual Analog Scale showed baseline VAS [8.65 ± 0.59] and first day, 1, 3, 6, 12, 18, 24 months [3.60 ± 1.09, 2.55 ± 0.69, 1.7 ± 0.65, 1.05 ± 0.68, 0.85 ± 0.67, 0.80 ± 0.69, 0.9 ± 0.69], respectively, facial numbness and postoperative masseter muscle weakness recovered more rapidly in patients receiving combined PRF and TRF therapy. Conclusion Combination of PRF followed by TRF is effective in treating TN pain with minimal postoperative complications.

A study of effect and side effects of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

A study of effect and side effects of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

A study of outcome of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

A study of outcome of thermal radiofrequency nerve ablation of genicular nerves for the management of chronic osteoarthritis of knee joint

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR <50% from those having VRR ≥50% in 85% of cases (accuracy: 0.85; 95% confidence interval [CI]: 0.80–0.90; sensitivity: 0.70; 95% CI: 0.62–0.75; specificity: 0.99; 95% CI: 0.98–1.0; positive predictive value: 0.95; 95% CI: 0.92–0.98; negative predictive value: 0.95; 95% CI: 0.92–0.98). Conclusions: This study demonstrates that a machine learning model can reliably identify those nodules that will have VRR < or ≥50% at 12 months after one RF treatment session. Predicting which nodules will be poor or good responders represents valuable data that may help physicians and patients decide on the best treatment option between thermal ablation and surgery or in predicting if more than one session might be necessary to obtain a significant volume reduction.