Hybrid argon plasma coagulation for the treatment of Barrett’s esophagus:A prospective,multicenter study

BACKGROUND The incidence of Barrett’s esophagus(BE)in China is lower compared to the Western populations.Hence,studies conducted in the Chinese population has been limited.The current treatment options available for BE treatment includes argon plasma coagulation(APC),radiofrequency ablation and cryoablation,all with varying degrees of success.AIM To determine the efficacy and safety of HybridAPC in the treatment of BE.METHODS The study cohort consisted of patients with BE who underwent HybridAPC ablation treatment.These procedures were performed by seven endoscopists from different tertiary hospitals.The duration of the procedure,curative rate,complications and recurrent rate by 1-year follow-up were recorded.RESULTS Eighty individuals were enrolled for treatment from July 2017 to June 2020,comprising of 39 males and 41 females with a median age of 54 years(range,30 to 83 years).The technical success rate of HybridAPC was 100%and the overall curative rate was 98.15%.No severe complications occurred during the operation.BE cases were classified as short-segment BE and long-segment BE.Patients with short-segment BE were all considered cured without complications.Thirty-six patients completed the one-year follow-up without recurrence.Twenty-four percent had mild dysplasia which were all resolved with one post-procedural treatment.The mean duration of the procedure was 10.94±6.52 min.CONCLUSION Treatment of BE with HybridAPC was found to be a simple and quick procedure that is safe and effective during the short-term follow-up,especially in cases of short-segment BE.This technique could be considered as a feasible alternative ablation therapy for BE.

The current role of radiofrequency ablation in the treatment of hepatocellular carcinoma

Local ablative therapy is used in treating liver tumors by either injection of cytotoxic agents（chemicals,radioactive isotopes,hyperthermic agents or chemotherapeutic agents）or application of an energy source to achieve thermal ablation,cryoablation or conformal external beam radiation（Table 1）.

Application of ultrasound-guided percutaneous radiofrequency ablation in treatment of liver cancer.

Objective To investigate the therapeutic efficacy and its influencing factors of ultrasoundguided percutaneous radiofrequency ablation (PRFA) in the treatment of liver carcinoma. Methods With a temperature-controlled multi-electrode needle, ultrasound-guided PRFA was employed to treat forty-seven patients with 67 tumor nodules, with a diameterof 2.6 ± 1.1 cm (1.0 - 5.5 cm). Results A complete ablation (CA) rate of 80. 6% was achieved in the present series, with a CA rate of 91.7 % in the tumors ≤3 cm in diameter,75. 0% in tumors from 3.1 to 4. 0 cm,and 14. 3% in tumors 】4 cm. The CA rate was significantly greater in tumors with a temperature rising up to 70℃ within the initial 2 minutes at ablation as compared with that longer than 2 minutes (P 【 0.05). A markedly higher CA rate was obtained in tumors with an ablation-maintaining temperature of over 80℃ than that between 70℃ and 80℃ ( P 【 0. 01). All patients were followed up with a mean time of 11. 3 months. The local recurrence rate was 9.3% (5/

Percutaneous ablation of pancreatic cancer

Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of nonresectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques(radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.

Recent progress in pulsed electric field ablation for liver cancer

The number of liver cancer patients is likely to continue to increase in the coming decades due to the aging of the population and changing risk factors.Traditional treatments cannot meet the needs of all patients.New treatment methods evolved from pulsed electric field ablation are expected to lead to breakthroughs in the treatment of liver cancer.This paper reviews the safety and efficacy of irreversible electroporation in clinical studies,the methods to detect and evaluate its ablation effect,the improvements in equipment and its antitumor effect,and animal and clinical trials on electrochemotherapy.We also summarize studies on the most novel nanosecond pulsed electric field ablation techniques in vitro and in vivo.These research results are certain to promote the progress of pulsed electric field in the treatment of liver cancer.

Local ablation of pancreatic tumors: State of the art and future perspectives

BACKGROUND Currently,the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation(RFA),microwave ablation,and irreversible(IRE)or reversible electroporation combined with low doses of chemotherapeutic drugs.AIM To report an overview and updates on ablative techniques in pancreatic cancer.METHODS Several electronic databases were searched.The search covered the years from January 2000 to January 2021.Moreover,the reference lists of the found papers were analysed for papers not indexed in the electronic databases.All titles and abstracts were analysed.RESULTS We found 30 studies(14 studies for RFA,3 for microwave therapy,10 for IRE,and 3 for electrochemotherapy),comprising 1047 patients,which were analysed further.Two randomized trials were found for IRE.Percutaneous and laparotomy approaches were performed.In the assessed patients,the median maximal diameter of the lesions was in the range of 2.8 to 4.5 cm.All series included patients unfit for surgical treatment,but Martin et al assessed a subgroup of patients with borderline resectable tumours who underwent resection with margin attenuation with IRE.Most studies administered chemotherapy prior to ablative therapies.However,several studies suggest that the key determinant of improved survival is attributable to ablative treatment alone.Nevertheless,the authors suggested chemotherapy before local therapies for several reasons.This strategy may not only downstage a subgroup of patients to curative-intent surgery but also support to recognize patients with biologically unfavourable tumours who would likely not benefit from ablation treatments.Ablation therapies seem safe based on the 1047 patients assessed in this review.The mortality rate ranged from 1.8%to 2%.However,despite the low mortality,the reported rates of severe post procedural complications ranged from 0%-42%.Most reported complications have been self-limiting and manageable.Median overall survival varied between 6.0 and 33 mo.Regarding the technical success rate,assessed papers reported an estimated rate in the range of 85%to 100%.However,the authors reported early recurrence after treatment.A distinct consideration should be made on whether local treatments induce an immune response in the ablated area.Preclinical and clinical studies have shown that RFA is a promising mechanism for inducing antigen-presenting cell infiltration and enhancing the systemic antitumour T-cell immune response and tumour regression.CONCLUSION In the management of patients with pancreatic cancer,the possibility of a multimodal approach should be considered,and conceptually,the combination of RFA with immunotherapy represents a novel angle of attack against this tumour.

Percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To evaluate the immediate and follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods Fifteen symptomatic, drug-refractory patients with HOCM underwent PTSMA procedures with application of a myocardial contrast echocardiography (MCE) intra-procedure. Before and after the procedure, clinical evaluations were obtained in all patients, who were followed up for a mean period of 8.6±3.8 (6-20) months.Results Immediate left ventricular outflow tract gradient (LVOTG) reduction was achieved (77.93±22?mm?Hg vs 14.8±15?mm?Hg, P【0.0001) after the procedure with a mean decrease of 5.75±2.87?mm?Hg of left ventricular end diastolic pressure (P【0.001). Follow up results revealed that ventricular remodelling occurred mainly 1-3 months after the procedure, but without evidence of ventricular dilation and contract dysfunction. Heart function (NYHA) was greatly improved (3.4±0.5 vs 1.1±0.4, P【0.001) and exercise endurance increased. A renewed increase of LVOTG was found in 2 patients during follow-up. Conclusions LVOTG was greatly decreased in HOCM patients undergoing a PTSMA procedure, and their symptoms were greatly improved without cardiac complications during follow-up. Sub-selection and re-opening of target vessels were the causes of renewed increase of LVOTG, and this can be avoided with the accumulation of experience. This is a promising method for the treatment of symptomatic patients with HOCM.

High-Frequency Induction Heating of Needle-Shaped Mg-Ferrite for Ablation Therapy of Human Cancer

For application as a novel ablation therapy of human cancer,the heating property of a needle-shaped Mg-ferrite prepared by a sintering technique was studied in a high-frequency induction field at 370 kHz.When inserted into cylindrical clay,the increase in temperature(Δ7)was 31.2℃ for the specimen with a 1.5 mm diameter,while the 1.0mm diameter specimen exhibited a ΔT value of 15.7℃ after the induction time of 1200s.The ΔT exhibited a high value of 57.9℃ during the simultaneous insertion of 3 1.5mm diameter specimens.In the computer simulation images, the relatively lower magnetic flux density and concurrent neghgibly low current density were observed from the surface to the internal regions,being different from the behavior of a ferromagnetic Ni-rod with the same size.

Mutual comparative analysis:a new topography-guided custom ablation protocol referencing subjective refraction to modify corneal topographic data

Background:Several planning algorithms have been developed for topography-guided custom ablation treatment(T-CAT),but each has its own deficiencies.The purpose of this study is to demonstrate the potential of a novel mutual comparative analysis(MCA)informed by manifest refraction and corneal topographic data and the patient's subjective perception in correcting ametropia.Methods:This retrospective review included patients with significant preoperative diferences in the power or axis of astigmatism according to the manifest refraction and corneal topographic data(power>0.75 D and/or axis>10°).T-CAT planning was designed using MCA.Follow-ups were conducted for at least 6 months.Results:Seventy-nine patients(121 eyes)were included.The mean preoperative deviation in the astigmatic power and axis were 0.72±0.43 D and 20.18±23.68°,respectively.The average oculus residual astigmatism(ORA)was 0.81±0.32 D(range:0.08-1.66 D).Six months postoperatively,the mean spherical equivalent refraction was 0.04±0.42 D,and the mean cylinder was-0.27±0.24 D.The mean efficacy and safety indices were 1.10 and 1.15,respectively.The uncorrected distance visual acuity in 92%of the eyes was the same or better than the corrected distance visual acuity.The angle of error was±5°in 61%of eyes and±15°in 84%of eyes.Residual astigmatism was≤0.5 D in 91%of eyes.Optical quality and photopic contrast sensitivity did not change significantly(P>0.05),and the scotopic contrast sensitivity decreased at 3,6,and 12 cpd(P<0.05).The vertical coma and horizontal coma of the anterior corneal surface significantly decreased postoperatively but increased during follow-up.Conclusions:The MCA was demonstrated safety,ficacy,accuracy,predictability,and stability and can be used as a complementary and feasible method for T-CAT.

Mutual comparative analysis:a new topography-guided custom ablation protocol referencing subjective refraction to modify corneal topographic data

Background:Several planning algorithms have been developed for topography-guided custom ablation treatment(T-CAT),but each has its own deficiencies.The purpose of this study is to demonstrate the potential of a novel mutual comparative analysis(MCA)informed by manifest refraction and corneal topographic data and the patient’s subjective perception in correcting ametropia.Methods:This retrospective review included patients with significant preoperative differences in the power or axis of astigmatism according to the manifest refraction and corneal topographic data(power>0.75 D and/or axis>10°).T-CAT planning was designed using MCA.Follow-ups were conducted for at least 6 months.Results:Seventy-nine patients(121 eyes)were included.The mean preoperative deviation in the astigmatic power and axis were 0.72±0.43 D and 20.18±23.68°,respectively.The average oculus residual astigmatism(ORA)was 0.81±0.32 D(range:0.08–1.66 D).Six months postoperatively,the mean spherical equivalent refraction was 0.04±0.42 D,and the mean cylinder was−0.27±0.24 D.The mean efficacy and safety indices were 1.10 and 1.15,respectively.The uncorrected distance visual acuity in 92%of the eyes was the same or better than the corrected distance visual acuity.The angle of error was±5°in 61%of eyes and±15°in 84%of eyes.Residual astigmatism was≤0.5 D in 91%of eyes.Optical quality and photopic contrast sensitivity did not change significantly(p>0.05),and the scotopic contrast sensitivity decreased at 3,6,and 12 cpd(p<0.05).The vertical coma and horizontal coma of the anterior corneal surface significantly decreased postoperatively but increased during follow-up.Conclusions:The MCA demonstrated safety,efficacy,accuracy,predictability,and stability and can be used as a complementary and feasible method for T-CAT.