Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma:A case report

BACKGROUND Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia.However,an alternative treatment approach is needed for patients who cannot tolerate general anesthesia.We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.CASE SUMMARY A 46-year-old female suffered from abnormal uterine bleeding,severe anemia,and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma.She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency.A new individualized combined treatment,consisting uterine artery embolization(UAE),percutaneous microwave ablation(PMWA)of the pedicle and the endometrium,and transvaginal removal of the leiomyoma by twisting,was performed.The lesion was completely removed successfully under local anesthesia without any major complications.The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.CONCLUSION UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.

Past,present,and future perspectives of ultrasound-guided ablation of liver tumors:Where could artificial intelligence lead interventional oncology?

The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound(US)guidance.Later,radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide.In the past decade,microwave ablation systems have achieved larger ablation areas than radiofrequency ablation,suggesting that the 3-cm barrier could be broken in the treatment of liver tumors.Likewise,US techniques to guide percutaneous ablation have seen important progress.Contrast-enhanced US(CEUS)can define and target the tumor better than US and can assess the size of the ablation area after the procedure,which allows immediate retreatment of the residual tumor foci.Furthermore,fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS.Recently,software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures,aiding in procedure planning,assessing ablation completeness,and targeting the residual viable foci with greater precision than CEUS.Hopefully,this could lead to the ablation of tumors up to 5-7 cm in size.

Percutaneous radiofrequency ablation is superior to hepatic resection in patients with small hepatocellular carcinoma

BACKGROUND It is not known whether percutaneous radiofrequency ablation(PRFA)has the same treatment efficacy and fewer complications than laparoscopic resection in patients with small centrally located hepatocellular carcinoma(HCC).AIM To compare the effectiveness of PRFA with classical laparoscopic resection in patients with small HCC and document the safety parameters.METHODS In this retrospective study,85 patients treated with hepatic resection(HR)and 90 PRFA-treated patients were enrolled in our hospital from July 2016 to July 2019.Treatment outcomes,including major complications and survival data,were evaluated.RESULTS The results showed that minor differences existed in the baseline characteristics between the patients in the two groups.PRFA significantly increased cumulative recurrence-free survival(hazard ratio 1.048,95%CI:0.265-3.268)and overall survival(hazard ratio 0.126,95%CI:0.025-0.973);PRFA had a lower rate of major complications than HR(7.78%vs 20.0%,P<0.05),and hospital stay was shorter in the PRFA group than in the HR group(7.8±0.2 d vs 9.5±0.3 d,P<0.001).CONCLUSION Based on the data obtained,we conclude that PRFA was superior to HR and may reduce complications and hospital stay in patients with small HCC.

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/

Radiofrequency ablation for treatment of hypersplenism: A feasible therapeutic option

We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation(RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

Evaluation of short-and medium-term efficacy and complications of ultrasound-guided ablation for small liver cancer

BACKGROUND To ensure clinical efficacy and prolong patient survival,treatments such as surgery and microwave ablation(MWA)are used for early liver cancer.MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells.However,due to technical limitations,the cancerous liver tissue cannot be completely ablated;therefore,the probability of local tumor recurrence is high.AIM To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.METHODS A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected.Sixty-six patients received ultrasound-guided percutaneous MWA(MWA group)and 52 received laparoscopic surgery(laparoscope group).The operation time,blood loss,hospital stay,and medical expenses of both groups were statistically analyzed.Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),albumin(ALB),alpha fetal protein(AFP),carcinoembryonic antigen(CEA),and peripheral blood regulatory T lymphocytes(Treg)levels were evaluated pre-and post-operatively.The cross-sectional area of tumors measured before and after ablation was analyzed statistically;the therapeutic effect was compared between both groups in terms of surgical complications,2-year progression-free survival rate,and overall survival rate.RESULTS The operation time,blood loss,hospital stay,and medical expenses in the MWA group were lower than those of the laparoscope group,and the differences were significant(P<0.05);these parameters,and ALT,AST,TBIL,and ALB levels were compared preoperatively between both groups,and there was no significance(P>0.05).The operation time,blood loss,hospital stay,and medical expenses for 2 d and 1 wk after surgery,the ALT and AST of the MWA group were lower than those of the laparoscope group,and the difference was significant(P<0.05).The operation time,blood loss,hospital stay,and medical expenses,and serum AFP,CEA,and Treg levels were measured preoperatively and 4 and 8 wk postoperatively,and there were no significant differences between the two groups(P>0.05).Compared with preoperative levels,serum AFP,CEA,and Treg levels in both groups were decreased(P<0.05).The lesion in the MWA group had a maximum area of 4.86±0.90 cm2,1.24±0.57 cm2,and 0.31±0.11 cm2 preoperatively,1 and 3 mo postoperatively,respectively.Fifty-eight of them achieved complete response and eight achieved a partial response.After 2 years of followup,the progression-free and overall survival rates in the MWA group were 37.88%and 66.67%,respectively,compared with 44.23%and 76.92%in the laparoscope group,with no significant difference(P>0.05).CONCLUSION The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery.However,ablation causes less trauma and liver dysfunction.

Main Renal Artery Plus Branch Ablation in the Treatment of Resistant Hypertension with Renal Denervation

Objective:To study the safety and effi cacy of denervation of renal artery branches in the treatment of resistant hy-pertension.Methods:Sixty patients with resistant hypertension were enrolled.The patients were randomly assigned to the main renal artery plus branch ablation group or the main renal artery ablation group.The clinical data and operation-related parameters,including number of ablation points,temperature,and average energy,were recorded.Ambulatory blood pressure was taken for all patients at the baseline and at 6 months after treatment.Offi ce blood pressure was recorded before treatment and after treatment every 3 months for 2 years.Results:Sixty patients with resistant hypertension were enrolled in this study.There were 30 patients in each group.Angiography was performed after ablation.No renal artery complications,such as stenosis and dissection,occurred in the two groups.There was no signifi cant difference in age,sex,BMI,comorbid disease,and medication between the two groups(P>0.05).The number of ablation points for the main renal artery plus branch ablation group was greater than that for the main renal artery ablation group.The offi ce blood pressure and 24-hour blood pressure were signifi cantly lower 6 months after treatment than before treatment in both groups(P<0.05).Offi ce blood pressure in the main renal artery plus branch ablation group was lower than that in the main renal artery ablation group during the 3-12-month follow-up period,with a statistical difference.However,as the follow-up time increased,the difference disappeared.Conclusion:The results of this study show that main renal artery plus branch ablation is a safe interventional method,but there was no obvious advantage on long-term follow-up compared with only main renal artery ablation.

Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review

BACKGROUND Endoscopic radiofrequency ablation(ERFA),percutaneous radiofrequency ablation(PRFA),and photodynamic therapy(PDT),when used in conjunction with conventional biliary stenting,have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma.AIM To compare pooled survival outcomes,adverse event rates,and mean stent patency for those undergoing these procedures.METHODS A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting,biliary stenting alone,PRFA with stenting,and PDT with stenting for unresectable cholangiocarcinoma(CCA).RESULTS Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone(12.0±0.9 mo vs 6.8±0.3 mo,P<0.001)as well as statistically improved median survival time(13 mo vs 8 mo,P<0.001).Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone(P<0.001 and P=0.004,respectively).However,when comparing ERFA to PRFA,pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort(12.0+0.9 mo vs 8.1+2.1 mo,P<0.0001).Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting(11.3 mo vs 8.5 mo,P=0.02).CONCLUSION While further prospective,randomized studies are needed to assess efficacy of ERFA,our metaanalysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone,percutaneous radiofrequency ablation with biliary stenting,and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.

Local injection therapy for hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world and ranks the third most common cause of cancer-related death. Surgical resection, liver transplantation and percutaneous ablation are generally considered the only curative treatment for early stage HCC. Besides the limitations of insufficient organ donors and a long waiting time for liver transplantation, however, resection is applied only to patients with good hepatic reserve and localized tumors, with a resectability of 30%. DATA SOURCES: Local ablation therapy, which is minimally invasive but contributes to the significant improvement of survival in patients with unresectable tumor, hasbeen widely used in treating small HCC. Among the techniques of local therapy, percutaneous ethanol injection (PEI) with a complete response in 80% of HCCs less than 3 cm has been accepted as an alternative to surgery in patients with small HCC. Moreover, percutaneous hepatic quantified ethanol injection (PHQEI) or PEI according to the standard criteria has been confirmed to benefit patients with HCC, especially when quantified ethanol is given at a short interval (QESI, the interval was 2-3 days). RESULT: Several limitations related to local percutaneous methods may result in incomplete therapeutic effect in case of larger HCC nodules (>3 cm). CONCLUSION: The combined use of different methods according to the clinical status of patients or tumors may be essential to the effective treatment of HCC.

Chinese Association for the Study of Pain:Expert consensus on diagnosis and treatment for lumbar disc herniation

Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy

Background： Percutaneous transluminal septal myocardial ablation （PTSMA） and modified Morrow septal myectomy （MMSM） are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy （HCM）. This study aimed to determine the clinical outcome of these two strategies. Methods： From January 2011 to January 2015,226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, alter operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher＇s exact tests. Quantitative variables were compared using the paired samples t-test. Results： lnterventricular septal thickness was significantly reduced in both groups （21.27 ± 4.43 mm vs. 18.72 ±4.13 mm for PTSMA, t = 3.469, P 〈 0.001, and 21.83± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P 〈 0.001, respectively）. The left ventricular outflow tract （LVOT） pressure gradient （PG） significantly decreased after the operations in two groups （70.30 ± 44.79 mmHg vs. 39.78 ±22.07 mmHg for PTSMA, t = 5.041, P 〈 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P 〈 0.001, respectively）. Seven patients （10.29%） in the PTSMA group required a repeat operation in the follow-up. Eight （11.76%） patients were evaluated for New York I-lean Association （NYHA） Ill/IV in the PTSMA group, which was significantly more than the five （3.16%） in the same NYHA classes lbr the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions： Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.

Midterm outcomes of percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medication

Hypertrophic obstructive cardiomyopathy （HOCM） is a genetic disorder characterized by severe asymmetric hypertrophy of the interventricular septum （IVS） in the absence of any other systemic or cardiac diseases. The predominant abnormal haemodynamics are caused by increased left ventricular outflow tract pressure gradient （LVOTG） and abnormal systolic anterior motion of mitral valve.

Percutaneous local tumor ablation vs. stereotactic body radiotherapy for early-stage non-small cell lung cancer: a systematic review and meta-analysis

Background:Percutaneous local tumor ablation(LTA)and stereotactic body radiotherapy(SBRT)have been regarded as viable treatments for early-stage lung cancer patients.The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer(NSCLC).Methods:PubMed,Embase,Cochrane library,Ovid,Google scholar,CNKI,and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1,1991,and May 31,2021.Hazard ratios(HRs)or odds ratios(ORs)with 95%confidence intervals(CIs)were applied to estimate the effect size for overall survival(OS),progression-free survival(PFS),locoregional progression(LP),and adverse events.Results:Five studies with 22,231 patients were enrolled,including 1443 patients in the LTA group and 20,788 patients in the SBRT group.The results showed that SBRT was not superior to LTA for OS(HR=1.03,95%CI:0.87-1.22,P=0.71).Similar results were observed for PFS(HR=1.09,95%CI:0.71-1.67,P=0.71)and LP(HR=0.66,95%CI:0.25-1.77,P=0.70).Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized>2 cm(HR=1.32,95%CI:1.14-1.53,P=0.0003),whereas there was no significant difference in patients with tumors sized≤2 cm(HR=0.93,95%CI:0.64-1.35,P=0.70).Moreover,no significant differences were observed for the incidence of severe adverse events(≥grade 3)(OR=1.95,95%CI:0.63-6.07,P=0.25)between the LTA group and SBRT group.Conclusions:Compared with SBRT,LTA appears to have similar OS,PFS,and LP.However,for tumors>2 cm,SBRT is superior to LTA in OS.Prospective randomized controlled trials are required to determine such findings.

Left ventricular endocardial pacing predicts the reduction of left ventricular outflow tract pressure gradient immediately after percutaneous transseptal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy refractory to medicatio

Background Hypertrophic obstructive cardiomyopathy （HOCM） carries an increased risk for sudden cardiac death. No data regarding the percutaneous transseptal myocardial ablation （PTSMA） and epicardial left ventricular pacing （LVP） were reported. Methods Seven patients with recurrent symptoms and increased resting left ventricular outflow tract pressure gradient （LVOTG） after PTSMA and another 14 patients with HOCM without history of PTSMA were studied. Both resting and dobutamine stress echocardiography, PTSMA and LVP were routinely performed. Results In patients without previous PTSMA procedure, mild reduction of resting LVOTG was detected at 5 minutes after left ventricular pacing, and this reduction became significant at 10 minutes. All patients were divided into successful and unsuccessful groups according to their response to LVP. In contrary to patients in unsuccessful group, resting and R-S2 stimuli-induced LVOTG during PTSMA procedure were decreased dramatically （（9±5） mmHg vs （58±12） mmHg, （12±2） mmHg vs （113±27） mmHg, P〈0.001）. Analysis of Logistic regression demonstrated that only LVOTG level dudng left ventdcular pacing was an independent factor predicting the reduction of LVOTG immediately after PTSMA （odds ratio （OR）, 0.59; 95% CI 2.67 to 5.82; P=0.0002）. Conclusion Left ventricular endocardial temporary pacing plays a critical role in predicting acute effect on the reduction of LVOTG immediately after PTSMA procedure.

Advances in the interventional therapy of hepatocellular carcinoma originating from the caudate lobe

Hepatocellular carcinoma originating from the caudate lobe, also known as segment I hepatocellular carcinoma, is difficult to treat because of its special location, complex vascular supply, and the proximity of important vessels,bile ducts, and organs. This research is conducted to examine the efficacy and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe.Conclusion: Superselective chemoembolization and ablation techniques for the treatment of caudate lobe hepatocellular carcinoma still need to be improved. The combination of multiple interventional methods and the application of multiple imaging techniques can improve the effectiveness and safety of interventional therapy for hepatocellular carcinoma in the caudate lobe. Multidisciplinary treatment is also essential to improve the prognosis of patients with caudate lobe hepatocellular carcinoma.