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

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

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

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

Efficacy and safety of C-arm computed tomography-guided microwave ablation with percutaneous osteoplasty for flat bone metastases

BACKGROUND Flat bone metastases are common in patients with advanced cancers,often resulting in severe pain,limited mobility,and reduced quality of life(QOL).Traditional treatment options,such as radiotherapy or systemic therapies,often fail to provide sufficient pain relief or improve functional outcomes in these patients.Microwave ablation(MWA)offers advantages,such as shorter pro-cedure times and larger ablation zones,while percutaneous osteoplasty(PO)enhances bone stability and prevents pathological fractures.Despite these be-nefits,the combination of these techniques for treating flat bone metastases re-mains underexplored.AIM To evaluate the efficacy and safety of C-arm computed tomography(CT)-guided MWA combined with PO for managing painful flat bone metastases,focusing on pain relief,functional improvement,and QOL enhancement.METHODS A total of 45 patients with refractory moderate-to-severe pain resulting from flat bone metastases who underwent C-arm CT-guided MWA combined with PO between January 2015 and January 2021 were included.The efficacy of the pro-cedure was assessed by changes in the visual analog scale(VAS),Oswestry disability index(ODI),and QOL,as well as the occurrence of complications.Tumor response was evaluated using RECIST v1.1 and mRECIST criteria,with overall response rate(ORR)and disease control rate(DCR)as the primary end-points.RESULTS No serious complications were observed in any of the patients.A significant reduction in VAS and ODI was noted at 1 week,1 month,and 3 months post-procedure.A marked improvement in QOL was observed at all follow-up points.Bone cement extravasation was observed in 10 patients;however,none exhibited significant clinical symptoms.Based on RECIST v1.1,the ORR was 26.7%and the DCR was 88.9%.The mRECIST evaluation revealed a higher ORR of 51.1%and DCR of 88.9%.CONCLUSION C-arm CT-guided MWA with PO provides a dependable and effective strategy for managing flat bone metastases.It demonstrates significant pain relief,improved functional outcomes,and enhanced QOL.This treatment combination also shows promising tumor response rates with a low complication profile.

Impact of Linggui Zhugan decoction on microwave ablation outcomes and recurrence in liver cancer

BACKGROUND Liver cancer is one of the most common malignant tumors of the digestive system,and early detection and effective treatment are crucial for improving the prognosis.Microwave ablation(MWA)has shown promising results as a local therapeutic method for liver cancer;however,further improvement of its efficacy remains a key focus of current research.AIM To evaluate the clinical efficacy of Linggui Zhugan decoction combined with MWA for the treatment of primary liver cancer.METHODS Data were collected from 164 patients with primary liver cancer who underwent MWA at our hospital between March 2019 and April 2021.Among them,79 patients(control group)received routine treatments and 85 patients(research group)received Linggui Zhugan decoction in addition to routine treatment.The clinical efficacy,incidence of adverse reactions,and levels of serum alphafetoprotein(AFP),des-γ-carboxy prothrombin(DCP),AFP-L3,total bilirubin(TBil),alanine aminotransferase(ALT),CD4 cell count,CD8 cell count,and CD4/CD8 ratio were compared between the two groups,before and after treatment.The three-year recurrence rates between the two groups were compared,and independent prognostic factors for recurrence were identified.RESULTS The study results revealed that the objective response rate(ORR)in the research group was significantly higher than that in the control group(P=0.005).After treatment,the CD4 cell count and CD4/CD8 ratio significantly increased,whereas the CD8 cell count and TBil,ALT,AFP,DCP,and AFP-L3 Levels were significantly lower in the research group than in the control group(P<0.001).The Cox regression analysis revealed that the treatment regimen(P=0.003),presence of cirrhosis(P=0.019),tumor diameter(P=0.037),Child-Pugh score(P=0.003),pretreatment AFP level(P=0.006),and AFP-L3 Level(P=0.002)were independent prognostic factors for disease-free survival.CONCLUSION The combination of Linggui Zhugan decoction with MWA significantly improved the clinical efficacy and longterm prognosis of patients with primary liver cancer.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Camrelizumab,apatinib and hepatic artery infusion chemotherapy combined with microwave ablation for advanced hepatocellular carcinoma

BACKGROUND Hepatic arterial infusion chemotherapy and camrelizumab plus apatinib(TRIPLET protocol)is promising for advanced hepatocellular carcinoma(Ad-HCC).However,the usefulness of microwave ablation(MWA)after TRIPLET is still controversial.AIM To compare the efficacy and safety of TRIPLET alone(T-A)vs TRIPLET-MWA(TM)for Ad-HCC.METHODS From January 2018 to March 2022,217 Ad-HCC patients were retrospectively enrolled.Among them,122 were included in the T-A group,and 95 were included in the T-M group.A propensity score matching(PSM)was applied to balance bias.Overall survival(OS)was compared using the Kaplan-Meier curve with the log-rank test.The overall objective response rate(ORR)and major complications were also assessed.RESULTS After PSM,82 patients were included both the T-A group and the T-M group.The ORR(85.4%)in the T-M group was significantly higher than that(65.9%)in the T-A group(P<0.001).The cumulative 1-,2-,and 3-year OS rates were 98.7%,93.4%,and 82.0%in the T-M group and 85.1%,63.1%,and 55.0%in the T-A group(hazard ratio=0.22;95%confidence interval:0.10-0.49;P<0.001).The incidence of major complications was 4.9%(6/122)in the T-A group and 5.3%(5/95)in the T-M group,which were not significantly different(P=1.000).CONCLUSION T-M can provide better survival outcomes and comparable safety for Ad-HCC than T-A.

Nomogram predicting the prognosis of primary liver cancer after radiofrequency ablation combined with transcatheter arterial chemoembolization

BACKGROUND The incidence and mortality rates of primary hepatocellular carcinoma(HCC)are high,and the conventional treatment is radiofrequency ablation(RFA)with transcatheter arterial chemoembolization(TACE);however,the 3-year survival rate is still low.Further,there are no visual methods to effectively predict their prognosis.AIM To explore the factors influencing the prognosis of HCC after RFA and TACE and develop a nomogram prediction model.METHODS Clinical and follow-up information of 150 patients with HCC treated using RFA and TACE in the Hangzhou Linping Hospital of Traditional Chinese Medicine from May 2020 to December 2022 was retrospectively collected and recorded.We examined their prognostic factors using multivariate logistic regression and created a nomogram prognosis prediction model using the R software(version 4.1.2).Internal verification was performed using the bootstrapping technique.The prognostic efficacy of the nomogram prediction model was evaluated using the concordance index(CI),calibration curve,and receiver operating characteristic RESULTS Of the 150 patients treated with RFA and TACE,92(61.33%)developed recurrence and metastasis.Logistic regression analysis identified six variables,and a predictive model was created.The internal validation results of the model showed a CI of 0.882.The correction curve trend of the prognosis prediction model was always near the diagonal,and the mean absolute error before and after internal validation was 0.021.The area under the curve of the prediction model after internal verification was 0.882[95%confidence interval(95%CI):0.820-0.945],with a specificity of 0.828 and sensitivity of 0.656.According to the Hosmer-Lemeshow test,χ^(2)=3.552 and P=0.895.The predictive model demonstrated a satisfactory calibration,and the decision curve analysis demonstrated its clinical applicability.CONCLUSION The prognosis of patients with HCC after RFA and TACE is affected by several factors.The developed prediction model based on the influencing parameters shows a good prognosis predictive efficacy.

Radiofrequency ablation combined with transcatheter arterial chemoembolization for recurrent liver cancer

BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.

Nano-silica modified lightweight and high-toughness carbon fiber/phenolic ablator with excellent thermal insulation and ablation performance

Lightweight and high-toughness carbon fiber/phenolic ablator(CFPA)is required as the Thermal Protection System(TPS)material of aerospace vehicles for next-generation space missions.To improve the ablative properties,silica sol with good particle size distribution prepared using tetramethoxysilane(TMOS)was blended with natural rubber latex and deposited onto carbon fiber felt,which was then integrated with phenolic aerogel matrix,introducing nano-silica into the framework of CFPA.The modified CFPA with a low density of 0.28—0.31 g/cm3exhibits strain-in-fracture as high as 31.2%and thermal conductivity as low as 0.054 W/(m·K).Furthermore,a trace amount of nano-silica could effectively protect CFPA from erosion of oxidizing atmosphere in different high-temperature environments.The oxyacetylene ablation test of 3000°C for 20 s shows a mass ablation rate of 0.0225 g/s,a linear ablation rate of 0.209 mm/s for the modified CFPA,which are 9.64%and 24.82%lower than the unmodified one.Besides,the long-time butane ablation test of 1200°C for 200 s shows an insignificant recession with mass and linear ablation rate of 0.079 g/s and 0.039 mm/s,16.84%and 13.33%lower than the unmodified one.Meanwhile,the fixed thermocouple in the test also demonstrates a good thermal insulation performance with a low peak back-face temperature of 207.7°C,12.25%lower than the unmodified one.Therefore,the nano-silica modified CFPA with excellent overall performance presents promising prospects in high-temperature aerospace applications.

Effect of sample temperature on femtosecond laser ablation of copper

We conduct an experimental study supported by theoretical analysis of single laser ablating copper to investigate the interactions between laser and material at different sample temperatures,and predict the changes of ablation morphology and lattice temperature.For investigating the effect of sample temperature on femtosecond laser processing,we conduct experiments on and simulate the thermal behavior of femtosecond laser irradiating copper by using a two-temperature model.The simulation results show that both electron peak temperature and the relaxation time needed to reach equilibrium increase as initial sample temperature rises.When the sample temperature rises from 300 K to 600 K,the maximum lattice temperature of the copper surface increases by about 6500 K under femtosecond laser irradiation,and the ablation depth increases by 20%.The simulated ablation depths follow the same general trend as the experimental values.This work provides some theoretical basis and technical support for developing femtosecond laser processing in the field of metal materials.

Simulation of deuterium pellet ablation and deposition in the EAST tokamak with HPI2 code

Pellet injection is a primary method for fueling the plasma in magnetic confinement devices.For that goal the knowledges of pellet ablation and deposition profiles are critical.In the present study,the pellet fueling code HPI2 was used to predict the ablation and deposition profiles of deuterium pellets injected into a typical H-mode discharge on the EAST tokamak.Pellet ablation and deposition profiles were evaluated for various pellet injection locations,with the aim at optimizing the pellet injection to obtain a deep fueling depth.In this study,we investigate the effect of the injection angle on the deposition depth of the pellet at different velocities and sizes.The ablation and deposition of the injected pellet are mainly studied at each injection position for three different injection angles:0°,45°,and 60°.The pellet injection on the high field side(HFS)can achieve a more ideal deposition depth than on the low field side(LFS).Among these angles,horizontal injection on the middle plane is relatively better on either the HFS or the LFS.When the injection location is 0.468 m below the middle plane on the HFS or 0.40 m above the middle plane of the LFS,it can achieve a similar deposition depth to the one of its corresponding side.When the pre-cooling effect is taken into account,the deposition depth is predicted to increase only slightly when the pellet is launched from the HFS.The findings of this study will serve as a reference for the update of pellet injection systems for the EAST tokamak.

Microstructure and ablation behavior of Zr-based ultra-high-temperature gradient composites

To obtain high-performance Zr-based ultra-high-temperature composites,Zr-based ultra-high-temperature gradient composites were prepared by changing the laying method of the infiltrant via reactive melt infiltration.The effects of different infiltrant laying methods on the microstructure and ablative properties of Zr-based ultrahigh-temperature gradient composites were investigated.The results showed that the gradient structure of the Zr-based ultrahigh-temperature gradient composites differed when the composition ratio of the infiltrant was changed.When the thicknesses of the Zr/Mo/Si layers were 6/4/12 mm and 8/2/12 mm,the SiMoZrC solid solution content in the samples increased and decreased along the infiltration direction,respectively.The gradient samples were ablated in an oxyacetylene flame at 3000°C for 40 s.The ablation resistance of the sample was the highest when the infiltrant was a powder and the thickness of the Zr/Mo/Si layer was 6/4/12 mm.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Benefits and drawbacks of radiofrequency ablation via percutaneous or minimally invasive surgery for treating hepatocellular carcinoma

The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation, and Loop Electrosurgical Excision Procedure for Cervical Treatments among Reproductive Age Women in Zambia

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Most recipients are women of reproductive age who, as reported in the literature, may be at risk of adverse pregnancy outcomes. This study investigated the risk of abortions, prematurity, stillbirths, and prolonged labor among reproductive-age women following Cryotherapy, Thermal ablation, and Loop Electrosurgical Excision Procedure treatments in Zambia. Methods: This cross-sectional study analyzed records of 8000 women aged 15 - 49 years at the Adult Infectious Disease Control Centre using records between January 2010 and December 2020. Women constituting the treatment group were all respondents treated by cryotherapy, thermal ablation, and LEEP, while the control group were VIA negative women. Women from both groups were invited to answer a phone survey. Data were analyzed using Stata version 16;descriptive analysis estimated the prevalence and obtained the frequency distribution of abortion, prematurity, prolonged labor and fresh stillbiths. Chi-square and Fisher’s exact test established the associations of CIN and APOs at 95% Confidence intervals. Univariate and multivariable binary logistic regression estimated the odds of adverse pregnancy outcomes across the three treatments. Results: Adverse pregnancy outcomes were more prevalent in the treatment group (39.2%) compared to the untreated group (16.9%). Across the two groups, normal outcomes were lower in the treated (42.3% vs 57.7%). The treated group accounted for the majority of abortions (74.5% vs 25.5%) and prolonged labor (72.5% vs 27.5%), while the untreated group accounted for higher proportions of stillbirths (66.7% vs 33.3%) and prematurity (53% vs 47%). Adverse pregnancy outcomes were five and two times more likely in women treated with thermal ablation (aOR = 5.05, 95% CI = 4.01 - 6.36, p Conclusion: Cervical treatment among Zambian women increases the risk of abortion and prolongs labor. Therefore, caution should be taken when administered to those of reproductive age. Vigilant monitoring should be maintained during pregnancy, delivery, and postpartum to improve maternal and neonatal health.

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.

High performance micromachining of sapphire by laser induced plasma assisted ablation(LIPAA)using GHz burst mode femtosecond pulses

GHz burst-mode femtosecond(fs)laser,which emits a series of pulse trains with extremely short intervals of several hundred picoseconds,provides distinct characteristics in materials processing as compared with the conventional irradiation scheme of fs laser(single-pulse mode).In this paper,we take advantage of the moderate pulse interval of 205 ps(4.88 GHz)in the burst pulse for high-quality and high-efficiency micromachining of single crystalline sapphire by laser induced plasma assisted ablation(LIPAA).Specifically,the preceding pulses in the burst generate plasma by ablation of copper placed behind the sapphire substrate,which interacts with the subsequent pulses to induce ablation at the rear surface of sapphire substrates.As a result,not only the ablation quality but also the ablation efficiency and the fabrication resolution are greatly improved compared to the other schemes including single-pulse mode fs laser direct ablation,single-pulse mode fs-LIPAA,and nanosecond-LIPAA.

Retrospective Analysis of Radiofrequency Ablation in Patients with Small Solitary Hepatocellular Carcinoma:Survival Outcomes and Development of a Machine Learning Prognostic Model

Background and Objective The effectiveness of radiofrequency ablation(RFA)in improving long-term survival outcomes for patients with a solitary hepatocellular carcinoma(HCC)measuring 5 cm or less remains uncertain.This study was designed to elucidate the impact of RFA therapy on the survival outcomes of these patients and to construct a prognostic model for patients following RFA.Methods This study was performed using the Surveillance,Epidemiology,and End Results(SEER)database from 2004 to 2017,focusing on patients diagnosed with a solitary HCC lesion≤5 cm in size.We compared the overall survival(OS)and cancer-specific survival(CSS)rates of these patients with those of patients who received hepatectomy,radiotherapy,or chemotherapy or who were part of a blank control group.To enhance the reliability of our findings,we employed stabilized inverse probability treatment weighting(sIPTW)and stratified analyses.Additionally,we conducted a Cox regression analysis to identify prognostic factors.XGBoost models were developed to predict 1-,3-,and 5-year CSS.The XGBoost models were evaluated via receiver operating characteristic(ROC)curves,calibration plots,decision curve analysis(DCA)curves and so on.Results Regardless of whether the data were unadjusted or adjusted for the use of sIPTWs,the 5-year OS(46.7%)and CSS(58.9%)rates were greater in the RFA group than in the radiotherapy(27.1%/35.8%),chemotherapy(32.9%/43.7%),and blank control(18.6%/30.7%)groups,but these rates were lower than those in the hepatectomy group(69.4%/78.9%).Stratified analysis based on age and cirrhosis status revealed that RFA and hepatectomy yielded similar OS and CSS outcomes for patients with cirrhosis aged over 65 years.Age,race,marital status,grade,cirrhosis status,tumor size,and AFP level were selected to construct the XGBoost models based on the training cohort.The areas under the curve(AUCs)for 1,3,and 5 years in the validation cohort were 0.88,0.81,and 0.79,respectively.Calibration plots further demonstrated the consistency between the predicted and actual values in both the training and validation cohorts.Conclusion RFA can improve the survival of patients diagnosed with a solitary HCC lesion≤5 cm.In certain clinical scenarios,RFA achieves survival outcomes comparable to those of hepatectomy.The XGBoost models developed in this study performed admirably in predicting the CSS of patients with solitary HCC tumors smaller than 5 cm following RFA.

Subpicosecond laser ablation behavior of a magnesium target and crater evolution:Molecular dynamics study and experimental validation

The micro-ablation processes and morphological evolution of ablative craters on single-crystal magnesium under subpicosecond laser irradiation are investigated using molecular dynamics(MD) simulations and experiments.The simulation results exhibit that the main failure mode of single-crystal Mg film irradiated by a low fluence and long pulse width laser is the ejection of surface atoms,which has laser-induced high stress.However,under high fluence and short pulse width laser irradiation,the main damage mechanism is nucleation fracture caused by stress wave reflection and superposition at the bottom of the film.In addition,Mg[0001] has higher pressure sensitivity and is more prone to ablation than Mg[0001].The evolution equation of crater depth is established using multi-pulse laser ablation simulation and verified by experiments.The results show that,under multiple pulsed laser irradiation,not only does the crater depth increase linearly with the pulse number,but also the quadratic term and constant term of the fitted crater profile curve increase linearly.

Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver

BACKGROUND Resection of hepatic metastasis from neuroendocrine tumors(NETs)improves quality of life and prolongs 5-year survival.Ablation can be utilized with surgery to achieve complete resection.Although several studies report long-term out-comes for patients undergoing ablation,none have explored perioperative effects of ablation in patients with metastatic NETs.AIM To determine if intra-operative ablation during hepatectomy increases risk of ad-verse outcomes such as surgical site infections(SSIs),bleeding,and bile leak.METHODS A retrospective analysis of the hepatectomy National Surgical Quality Impro-vement Program database from 2015-2019 was performed to determine the odds of SSIs,bile leaks,or bleeding in patients undergoing intraoperative ablation when compared to hepatectomy alone.RESULTS Of the 966 patients included in the study,298(30.9%)underwent ablation during hepatectomy.There were 78(11.7%)patients with SSIs in the hepatectomy alone group and 39(13.1%)patients with a SSIs in the hepatectomy with ablation group.Bile leak occurred in 41(6.2%)and 14(4.8%)patients in the two groups,respec-tively;bleeding occurred in 117(17.5%)and 33(11.1%),respectively.After con-trolling for confounding variables,ablation did not increase risk of SSI(P=0.63),bile leak(P=0.34)or bleeding(P=0.07)when compared to patients undergoing resection alone on multivariate analysis.CONCLUSION Intraoperative ablation with hepatic resection for NETs is safe in the perioperative period without significant increased risk of infection,bleeding,or bile leak.Surgeons should utilize this modality when appropriate to a-chieve optimal disease control and outcomes.