AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. A...AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9(ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient's gender.RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease(OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men(OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection(OR = 1.31, P < 0.001) or an ablation(OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization(TACE).CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.展开更多
Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally adv...Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.展开更多
BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two...BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two techniques in treatment-naive HCC.AIM To compare the risk of local tumor progression(LTP)according to the technique;secondary endpoints included technique efficacy rate at one-month,overall survival and major complication rate.METHODS A bi-institutional retrospective analysis of patients undergoing treatment-naive HCC ablation by either technique was performed.Inverse probability of treatment weighting was used to compare the two groups.Mixed effects multivariate Cox regression was applied to identify risk factors for LTP.RESULTS A total of 362 patients(mean age,66.1±6.2 years,308 men)were included,of which 242(323 tumors)treated by mbp-RFA and 120(168 tumors)by MWA.After a median follow-up of 27 months,cumulative LTP was 11.4%after mbp-RFA and 25.2%after MWA.Independent risk factors for LTP at multivariate analysis were MWA(hazard ratio=2.85,P<0.001)and tumor size(hazard ratio=1.08,P<0.001).Two-year LTP-free survival was higher after mbp-RFA than MWA regardless of size(<3 cm:96%vs 87.1%,P<0.01;≥3 cm:87.5%vs 74%,P=0.04).Technique efficacy rate was higher after mbp-RFA(94.1%vs 87.5%,P=0.01).No difference was observed in major complication rate(9.5%vs 7.5%,P=0.59),nor 5-year overall survival(63.6%vs 58.3%,P=0.33).CONCLUSION Mbp-RFA leads to better local tumor control of treatment-naïve HCC than MWA regardless of tumor size and has better primary efficacy,while maintaining a comparable safety profile.展开更多
Alkali metal thermochemical ablation is a promising anti-tumor therapy in which tumor tissue can be efficiently destroyed via both heat and hydroxyl ions released from the chemical reaction in tissue between an alkali...Alkali metal thermochemical ablation is a promising anti-tumor therapy in which tumor tissue can be efficiently destroyed via both heat and hydroxyl ions released from the chemical reaction in tissue between an alkali metal and water. Encouraging results have been reported from in vitro and in vivo trials in a previous study. However, the precise process of heat and mass transfer triggered by the above thermochemical reaction in tumor tissue has still remained confusing. Here, to better understand the temperature and p H responses of tumor tissue subject to alkali metal therapy, a theoretical model coupling temperature and concentration field is developed for characterizing the physicochemical reaction and the transport process occurring around the inserted sodium capsule during treatment. Preliminary experiments in tumor tissue are performed to validate the theoretical predictions of temperature, and the results indicate that the bioheat transfer model can predict the temperature responses in the tissues heated by the sodium capsule very well. Furthermore, comprehensive parametric studies are performed to evaluate the effects of either physiological or physicochemical parameters, including ablation time, time lags, and blood perfusion rate. Based on the numerical results, useful instructions are suggested for planning alkali metal tumor ablation treatment.展开更多
Microwave ablation(MWA)is a minimally invasive technique for treating hepatic tumors,necessitating precise monitoring to ensure treatment efficacy and minimize damage to surrounding tissues.This study explores the pot...Microwave ablation(MWA)is a minimally invasive technique for treating hepatic tumors,necessitating precise monitoring to ensure treatment efficacy and minimize damage to surrounding tissues.This study explores the potential of photoacoustic imaging(PAI)in monitoring MWA by examining ex vivo porcine liver tissues.In this study,a comprehensive analysis of photoacoustic signals was performed to compare the main lobe width(MLW)between ablated and normal regions in porcine liver tissue.Histological staining with succinate dehydrogenase(SDH)and shear wave elastography(SWE)were employed to validate the changes in tissue elasticity after ablation.The analysis demonstrated a notable reduction in the MLW of the average A-lines in ablated tissues compared to nonablated regions(p<0.01).This reduction,attributed to increased tissue density and enhanced elasticity,indicates accelerated sound propagation in thermally ablated areas,which then serves as a critical parameter for mapping tissue characteristics.The reconstruction of the MLW distribution successfully delineated the ablated regions,and was consistent with the results of SDH staining and SWE.In addition,MLW-based imaging exhibited higher spatial resolution compared to SWE.Incorporating MLW analysis into PAI may be a promising strategy to improve the accuracy and effectiveness of MWA monitoring in clinical settings.展开更多
Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by ...Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by Hu et al,which evaluated the survival outcomes of patients with metastatic CRC who received image-guided thermal ablation(IGTA).These findings provide valuable clinical evidence supporting IGTA as a feasible,minimally invasive approach and underscore the prognostic significance of metastatic distribution.However,the study by Hu et al has several limitations,including that not all pulmonary lesions were pathologically confirmed,postoperative follow-up mainly relied on dynamic contrast-enhanced computed tomography,no comparative analysis was performed with other local treatments,and the impact of other imaging features on efficacy and prognosis was not evaluated.Future studies should include complete pathological confirmation,integrate functional imaging and radiomics,and use prospective multicenter collaboration to optimize patient selection standards for IGTA treatment,strengthen its clinical evidence base,and ultimately promote individualized decision-making for patients with metastatic CRC.展开更多
Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves ...Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.展开更多
Hafnium carbide(HfC)serves as a critical ablation-resistant coating for C/C composites used on the wing leading edges of high-speed vehicles during atmospheric re-entry[1-3].Under the action of high-temperature,oxidiz...Hafnium carbide(HfC)serves as a critical ablation-resistant coating for C/C composites used on the wing leading edges of high-speed vehicles during atmospheric re-entry[1-3].Under the action of high-temperature,oxidizing gas flow,the HfC coating forms a high-melting-point heterogeneous oxide layer,significantly delaying oxidation of the underlying material and preserving the structural integrity of the C/C composites[4].展开更多
Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but ...Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some patients.In an ideal situation,a treatment that is safe and effective should provide a better outcome for patients with the dilemma.Objective:This article aims to give a comprehensive review of various types of loco-ablative treatment for HCC.Evidence Review:Loco-ablative treatment bridges the gap between surgical resection and transarterial chemotherapy.Various types of ablative therapy have their unique ability,and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their patients.Findings:Radiofrequency ablation(RFA)has a relatively longer history and more evidence to support its effectiveness.Microwave ablation(MWA)is gaining momentum because of its shorter ablation time and consistent ablation zone.High-intensity focused ultrasound(HIFU)ablation is a relatively new technology that provides non-invasive treatment for patients with HCC.It has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver cirrhosis.Conclusion and Relevance:Selective use of different loco-ablative therapies will enhance clinicians’treatment options for treatment of HCC.展开更多
Despite the improvements in surgical and medical therapy for hepatocellular carcinoma(HCC),recurrence still represents a major issue.Up to 70%of patients can experience HCC recurrence after liver resection(LR),as well...Despite the improvements in surgical and medical therapy for hepatocellular carcinoma(HCC),recurrence still represents a major issue.Up to 70%of patients can experience HCC recurrence after liver resection(LR),as well as 20%of them even after liver transplantation(LT).The patterns of recurrence are different according to both the time and the location.Similarly,the risk factors and the management can change not only according to these patterns,but also according to the underlying liver condition and to the first treatment performed.Deep knowledge of such correlation is fundamental,since prevention and effective management of recurrence are undoubtedly the most important strategies to improve the outcomes of HCC treatment.Without adjuvant therapy,maintaining very close monitoring during the first 2 years in order to diagnose curable recurrence and continue this monitoring beyond 5 years because late recurrences exist,remains our only possibility today.Surgery represents the cornerstone treatment for HCC,including both LT and LR.However,new interesting therapeutic opportunities are coming from immunotherapy that has shown encouraging results also in the adjuvant setting.In such a complex and evolutionary scenario,the aim of this review is to summarize current strategies for the management of HCC recurrence,focusing on the different possible scenarios,as well as on future perspectives.展开更多
Multicomponent(Hf-Zr-Ta)B_(2)potentially provides improved ablation resistance compared with silicon-based ceramics.Here we deposited(Hf_(0.5-x/2)Zr_(0.5-x/2)Ta_(x))B_(2)(x=0,0.1,and 0.2)coatings onto C/C com-posites,...Multicomponent(Hf-Zr-Ta)B_(2)potentially provides improved ablation resistance compared with silicon-based ceramics.Here we deposited(Hf_(0.5-x/2)Zr_(0.5-x/2)Ta_(x))B_(2)(x=0,0.1,and 0.2)coatings onto C/C com-posites,and investigated their ablation behaviors under an oxyacetylene torch with a heat flux of 2.4 MW m^(-2).It was observed that the x=0.1 oxide scale bulged but was denser,and the x=0.2 oxide scale was blown away due to the formation of excessive liquid.Based on these findings,we further de-veloped a duplex(Hf-Zr-Ta)B_(2)coating that showed a linear recession rate close to zero(0.11μm s^(-1))after two 120-s ablation cycles.It is identified that the resulting oxide scale is mainly composed of(Hf,Zr)_(6)Ta_(2)O_(17)and(Hf,Zr,Ta)O_(2)by performing aberration-corrected(scanning)transmission electron microscopy.The protective mechanism is related to the peritectic transformation of orthorhombic-(Hf,Zr)_(6)Ta_(2)O_(17)to tetragonal-(Hf,Zr,Ta)O_(2)plus Ta-dominated liquid.This study contributes to the develop-ment of Ta-containing multicomponent UHTC bulk and coatings for ultra-high temperature applications.展开更多
BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver d...BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.展开更多
BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invas...BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.展开更多
Carbon Carbon(C/C)composites in thermal-protection system are exposed to severe thermochemical ablation and mechanical erosion,and their thermal-protection performance is of vital importance to the structural safety a...Carbon Carbon(C/C)composites in thermal-protection system are exposed to severe thermochemical ablation and mechanical erosion,and their thermal-protection performance is of vital importance to the structural safety and flight status of hypersonic vehicles.We numerically analyzes the mesoscopic ablation-erosion of C/C Composites with Inclined Fibers(CCIF).First,a thermochemical ablation model describing the reaction-diffusion coupled problem of C/C composites on mesoscale is employed to analyze ablative process,and the corresponding surface ablation morphology is obtained.Then,the ablation morphology of CCIF is taken as the geometrical model for mechanical erosion analysis,and their damage and failure behavior under high-speed airflow shear is analyzed by using progressive damage method.Moreover,the effects of fiber inclined angle and airflow direction on the mechanical erosion of CCIF are investigated,and the ablationerosion behavior is analyzed and discussed.The results show that the failure modes of mechanical erosion in inner and edge regions are obviously different,showing granular and block erosion phenomena respectively.The mechanical erosion of CCIF in the direction of reverse flow is easier than that in the direction of forward flow.These results can provide a theoretical basis for the design and optimization of thermal protection system materials.展开更多
Air plasma ablation behavior of Cf/(Ti_(0.2)Zr_(0.2)Hf_(0.2)Nb_(0.2)Ta_(0.2))C-SiC composite was studied systematically with the surface temperature above 2000℃ at the ablation center.It presents a linear recession r...Air plasma ablation behavior of Cf/(Ti_(0.2)Zr_(0.2)Hf_(0.2)Nb_(0.2)Ta_(0.2))C-SiC composite was studied systematically with the surface temperature above 2000℃ at the ablation center.It presents a linear recession rate of 0.15μm/s and a mass recession rate of 2.05 mg/s after ablation at 4 MW/m^(2)(2000℃)for 300 s.Associated with the temperature gradient of the ablation surface,the oxidation products at different locations mainly consist of(TiZrHfNbTa)O_(x),(Zr_(x)Hf_(1-x))6(NbyTa_(1-y))_(2)O_(17),Ti(Nb_(x)Ta_(1-x))_(2)O_(7),(Hf_(x)Zr_(1-x))SiO_(4),and SiO_(2).Due to the synergistic effect of the multi-component oxides,oxidation products form a protective structure composed of high melting point oxide skeleton filled with relatively low melting point phases.It retards oxygen inward diffusion and prevents the composite fragmentation caused by plasma mechanical scouring.It is believed that the results would be helpful for further improving the ablation resistance by component design of high entropy ceramics and their composites.展开更多
This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy...This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.展开更多
To improve the compactness and properties of C/C-SiC-ZrC composites produced by precursor infiltration and pyrolysis(PIP)method,the low-temperature reactive melt infiltration(RMI)process was used to seal the composite...To improve the compactness and properties of C/C-SiC-ZrC composites produced by precursor infiltration and pyrolysis(PIP)method,the low-temperature reactive melt infiltration(RMI)process was used to seal the composites using Zr_(2)Cu as the filler.The microstructure,mechanical properties,and ablation properties of the Zr_(2)Cu packed composites were analyzed.Results show that during Zr_(2)Cu impregnation,the melt efficiently fills the large pores of the composites and is converted to ZrCu due to a partial reaction of zirconium with carbon.This results in an increase in composite density from 1.91 g/cm^(3)to 2.24 g/cm^(3)and a reduction in open porosity by 27.35%.Additionally,the flexural strength of Zr_(2)Cu packed C/C-SiC-ZrC composites is improved from 122.78±8.09 MPa to 135.53±5.40 MPa.After plasma ablation for 20 s,the modified composites demonstrate superior ablative resistance compared to PIP C/C-SiC-ZrC,with mass ablation and linear ablation rates of 2.77×10^(−3)g/s and 2.60×10^(−3)mm/s,respectively.The“selftranspiration”effect of the low-melting point copper-containing phase absorbs the heat of the plasma flame,further reducing the ablation temperature and promoting the formation of refined ZrO_(2)particles within the SiO_(2)melting layer.This provides more stable erosion protection for Zr_(2)Cu packed C/C-SiC-ZrC composites.展开更多
Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recent...Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.展开更多
Cryotherapy is a treatment modality that uses extreme cold to destroy unwanted tissue through both immediate and delayed cellular injury.This therapy is increasingly being adopted across various medical specialties du...Cryotherapy is a treatment modality that uses extreme cold to destroy unwanted tissue through both immediate and delayed cellular injury.This therapy is increasingly being adopted across various medical specialties due to its minimally invasive nature and technological advancements that have been made.In the esophagus,cryotherapy is particularly utilized for the management of Barrett esophagus.It has been demonstrated to be effective and safe with potential benefits,such as a reduction in pain,over radiofrequency ablation.Additionally,it might offer a valuable alternative for patients unresponsive to radiofrequency ablation.Cryotherapy is applied for other conditions as well,including esophageal squamous cell neoplasia and malignant dysphagia.More research is needed to gain understanding of the utility in these conditions.Interestingly,cryotherapy has shown the ability to enhance the host’s immune response in reaction to antigens left in situ after treatment.While preclinical data have demonstrated promising results,the immune response is often insufficient to induce tumor regression in the clinical setting.Therefore,there is growing interest in the combination of cryotherapy and immunotherapy where ablation creates an antigen depot,and the immune system is subsequently stimulated.This combination holds promise for the future and potentially opens new doors for a breakthrough in cancer treatment.展开更多
BACKGROUND Atrial fibrillation,affecting approximately 33 million people globally,is the most common sustained arrhythmia,increasing risks of stroke,heart failure,and mortality.Pulmonary vein isolation via catheter ab...BACKGROUND Atrial fibrillation,affecting approximately 33 million people globally,is the most common sustained arrhythmia,increasing risks of stroke,heart failure,and mortality.Pulmonary vein isolation via catheter ablation is a key rhythm control strategy,with cryoballoon ablation(CBA)being a standard thermal method but associated with risks like phrenic nerve palsy(5%-10%),esophageal injury,and vein stenosis.Pulsed field ablation(PFA),a non-thermal technique using electrical pulses for selective electroporation,offers potential for shorter procedures and improved safety.Limited direct comparisons between PFA and CBA necessitate a systematic evaluation of their efficacy and safety.AIM To compare the procedural success,safety,and 1-year arrhythmia-free survival of PFA vs CBA for first-time pulmonary vein isolation in adults with paroxysmal or persistent atrial fibrillation.METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and metaanalysis was conducted,searching PubMed,EMBASE,Web of Science,and other databases up to August 2025 for comparative studies.Pooled mean difference for continuous outcomes and odds ratio(OR)for dichotomous outcomes were calculated using random-effects models.Study quality was assessed with the Newcastle-Ottawa Scale,heterogeneity with I2,and publication bias with funnel plots.RESULTS Seven studies(six cohorts,one randomized controlled trial)were included,with a mean age of approximately 66 years,59%-78%male,and high prevalence of hypertension and diabetes.PFA significantly reduced procedure time(mean difference=-15.24 minutes,95%CI:-16.63 to-13.85,P<0.00001;I2=89%),improved arrhythmia-free survival(OR=1.27,95%CI:1.04-1.55,P=0.02;I2=45%),and lowered phrenic nerve palsy risk(OR=0.17,95%CI:0.04-0.63,P=0.008;I2=0%).No significant differences were found in fluoroscopy time,cardiac tamponade,repeat ablation,or vascular complications.CONCLUSION PFA demonstrates shorter procedure times,reduced phrenic nerve palsy,and better arrhythmia control compared to CBA,with comparable safety profiles.However,evidence is limited by observational study designs,heterogeneity,and potential bias.Large-scale randomized controlled trials with extended follow-up are needed to confirm these findings and guide clinical practice.展开更多
文摘AIM To evaluate disparities in the treatment of hepatocellular carcinoma(HCC) based on gender.METHODS A retrospective database analysis using the Nationwide Inpatient Sample(NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9(ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient's gender.RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease(OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men(OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection(OR = 1.31, P < 0.001) or an ablation(OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization(TACE).CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.
文摘Radiofrequency ablation(RFA),particularly endoscopic ultrasound-guided RFA(EUS-RFA),has emerged as a promising minimally invasive approach for the treatment of pancreatic cancer,especially in patients with locally advanced or unresectable disease.This review outlines recent technological developments in EUS-RFA,including innovations in energy delivery systems,probe design,and real-time thermal monitoring,which have improved the precision and safety of the procedure.Clinical studies combining EUS-RFA with chemotherapy have demonstrated encouraging outcomes,with improvements in overall survival,progression-free survival,tumor necrosis,and symptom control compared to chemotherapy alone.Additionally,RFA-induced tumor antigen release and modulation of the tumor microenvironment suggest a potential synergistic role with immunotherapy.Despite its promise,the widespread adoption of EUS-RFA is limited by a lack of large-scale randomized controlled trials and standardized treatment protocols.
文摘BACKGROUND Data comparing the outcomes of hepatocellular carcinoma(HCC)ablation by multibipolar radiofrequency ablation(mbp-RFA)and microwave ablation(MWA)are lacking.This study compares safety and efficacy of the two techniques in treatment-naive HCC.AIM To compare the risk of local tumor progression(LTP)according to the technique;secondary endpoints included technique efficacy rate at one-month,overall survival and major complication rate.METHODS A bi-institutional retrospective analysis of patients undergoing treatment-naive HCC ablation by either technique was performed.Inverse probability of treatment weighting was used to compare the two groups.Mixed effects multivariate Cox regression was applied to identify risk factors for LTP.RESULTS A total of 362 patients(mean age,66.1±6.2 years,308 men)were included,of which 242(323 tumors)treated by mbp-RFA and 120(168 tumors)by MWA.After a median follow-up of 27 months,cumulative LTP was 11.4%after mbp-RFA and 25.2%after MWA.Independent risk factors for LTP at multivariate analysis were MWA(hazard ratio=2.85,P<0.001)and tumor size(hazard ratio=1.08,P<0.001).Two-year LTP-free survival was higher after mbp-RFA than MWA regardless of size(<3 cm:96%vs 87.1%,P<0.01;≥3 cm:87.5%vs 74%,P=0.04).Technique efficacy rate was higher after mbp-RFA(94.1%vs 87.5%,P=0.01).No difference was observed in major complication rate(9.5%vs 7.5%,P=0.59),nor 5-year overall survival(63.6%vs 58.3%,P=0.33).CONCLUSION Mbp-RFA leads to better local tumor control of treatment-naïve HCC than MWA regardless of tumor size and has better primary efficacy,while maintaining a comparable safety profile.
基金supported by the Strategic Priority Research Program of the Chinese Academy of Sciences (Grant No.XDB1030000)the Beijing United Fund (Grant No.L252063)。
文摘Alkali metal thermochemical ablation is a promising anti-tumor therapy in which tumor tissue can be efficiently destroyed via both heat and hydroxyl ions released from the chemical reaction in tissue between an alkali metal and water. Encouraging results have been reported from in vitro and in vivo trials in a previous study. However, the precise process of heat and mass transfer triggered by the above thermochemical reaction in tumor tissue has still remained confusing. Here, to better understand the temperature and p H responses of tumor tissue subject to alkali metal therapy, a theoretical model coupling temperature and concentration field is developed for characterizing the physicochemical reaction and the transport process occurring around the inserted sodium capsule during treatment. Preliminary experiments in tumor tissue are performed to validate the theoretical predictions of temperature, and the results indicate that the bioheat transfer model can predict the temperature responses in the tissues heated by the sodium capsule very well. Furthermore, comprehensive parametric studies are performed to evaluate the effects of either physiological or physicochemical parameters, including ablation time, time lags, and blood perfusion rate. Based on the numerical results, useful instructions are suggested for planning alkali metal tumor ablation treatment.
基金supported by the National Natural Science Foundation of China(82427808,61875085)the Jiangsu Provincial University Natural Science Foundation(25KJB413004)+1 种基金the Nanjing Health Science and Technology Development Foundation(ZKX24043)the Fundamental Research Funds for the Central Universities(NJ2024029).
文摘Microwave ablation(MWA)is a minimally invasive technique for treating hepatic tumors,necessitating precise monitoring to ensure treatment efficacy and minimize damage to surrounding tissues.This study explores the potential of photoacoustic imaging(PAI)in monitoring MWA by examining ex vivo porcine liver tissues.In this study,a comprehensive analysis of photoacoustic signals was performed to compare the main lobe width(MLW)between ablated and normal regions in porcine liver tissue.Histological staining with succinate dehydrogenase(SDH)and shear wave elastography(SWE)were employed to validate the changes in tissue elasticity after ablation.The analysis demonstrated a notable reduction in the MLW of the average A-lines in ablated tissues compared to nonablated regions(p<0.01).This reduction,attributed to increased tissue density and enhanced elasticity,indicates accelerated sound propagation in thermally ablated areas,which then serves as a critical parameter for mapping tissue characteristics.The reconstruction of the MLW distribution successfully delineated the ablated regions,and was consistent with the results of SDH staining and SWE.In addition,MLW-based imaging exhibited higher spatial resolution compared to SWE.Incorporating MLW analysis into PAI may be a promising strategy to improve the accuracy and effectiveness of MWA monitoring in clinical settings.
文摘Colorectal cancer(CRC)with lung oligometastases,particularly in the presence of extrapulmonary disease,poses considerable therapeutic challenges in clinical practice.We have carefully studied the multicenter study by Hu et al,which evaluated the survival outcomes of patients with metastatic CRC who received image-guided thermal ablation(IGTA).These findings provide valuable clinical evidence supporting IGTA as a feasible,minimally invasive approach and underscore the prognostic significance of metastatic distribution.However,the study by Hu et al has several limitations,including that not all pulmonary lesions were pathologically confirmed,postoperative follow-up mainly relied on dynamic contrast-enhanced computed tomography,no comparative analysis was performed with other local treatments,and the impact of other imaging features on efficacy and prognosis was not evaluated.Future studies should include complete pathological confirmation,integrate functional imaging and radiomics,and use prospective multicenter collaboration to optimize patient selection standards for IGTA treatment,strengthen its clinical evidence base,and ultimately promote individualized decision-making for patients with metastatic CRC.
文摘Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.
基金supported by the National Natural Science Foundation of China(Grant Nos.52302115,52231004)。
文摘Hafnium carbide(HfC)serves as a critical ablation-resistant coating for C/C composites used on the wing leading edges of high-speed vehicles during atmospheric re-entry[1-3].Under the action of high-temperature,oxidizing gas flow,the HfC coating forms a high-melting-point heterogeneous oxide layer,significantly delaying oxidation of the underlying material and preserving the structural integrity of the C/C composites[4].
文摘Importance:Hepatocellular carcinoma(HCC)is usually accompanied by liver cirrhosis,which makes treatment of this disease challenging.Liver transplantation theoretically provides an ultimate solution to the disease,but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some patients.In an ideal situation,a treatment that is safe and effective should provide a better outcome for patients with the dilemma.Objective:This article aims to give a comprehensive review of various types of loco-ablative treatment for HCC.Evidence Review:Loco-ablative treatment bridges the gap between surgical resection and transarterial chemotherapy.Various types of ablative therapy have their unique ability,and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their patients.Findings:Radiofrequency ablation(RFA)has a relatively longer history and more evidence to support its effectiveness.Microwave ablation(MWA)is gaining momentum because of its shorter ablation time and consistent ablation zone.High-intensity focused ultrasound(HIFU)ablation is a relatively new technology that provides non-invasive treatment for patients with HCC.It has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver cirrhosis.Conclusion and Relevance:Selective use of different loco-ablative therapies will enhance clinicians’treatment options for treatment of HCC.
文摘Despite the improvements in surgical and medical therapy for hepatocellular carcinoma(HCC),recurrence still represents a major issue.Up to 70%of patients can experience HCC recurrence after liver resection(LR),as well as 20%of them even after liver transplantation(LT).The patterns of recurrence are different according to both the time and the location.Similarly,the risk factors and the management can change not only according to these patterns,but also according to the underlying liver condition and to the first treatment performed.Deep knowledge of such correlation is fundamental,since prevention and effective management of recurrence are undoubtedly the most important strategies to improve the outcomes of HCC treatment.Without adjuvant therapy,maintaining very close monitoring during the first 2 years in order to diagnose curable recurrence and continue this monitoring beyond 5 years because late recurrences exist,remains our only possibility today.Surgery represents the cornerstone treatment for HCC,including both LT and LR.However,new interesting therapeutic opportunities are coming from immunotherapy that has shown encouraging results also in the adjuvant setting.In such a complex and evolutionary scenario,the aim of this review is to summarize current strategies for the management of HCC recurrence,focusing on the different possible scenarios,as well as on future perspectives.
基金supported by the National Key R&D Pro-gram of China(Grant No.2021YFA0715803)the National Natural Science Foundation of China(Grant Nos.52293373,52130205,and 52302091)+1 种基金the Joint Fund of Henan Province Science and Technol-ogy R&D Program(No.225200810002)the ND Basic Research Funds of Northwestern Polytechnical University(No.G2022WD).
文摘Multicomponent(Hf-Zr-Ta)B_(2)potentially provides improved ablation resistance compared with silicon-based ceramics.Here we deposited(Hf_(0.5-x/2)Zr_(0.5-x/2)Ta_(x))B_(2)(x=0,0.1,and 0.2)coatings onto C/C com-posites,and investigated their ablation behaviors under an oxyacetylene torch with a heat flux of 2.4 MW m^(-2).It was observed that the x=0.1 oxide scale bulged but was denser,and the x=0.2 oxide scale was blown away due to the formation of excessive liquid.Based on these findings,we further de-veloped a duplex(Hf-Zr-Ta)B_(2)coating that showed a linear recession rate close to zero(0.11μm s^(-1))after two 120-s ablation cycles.It is identified that the resulting oxide scale is mainly composed of(Hf,Zr)_(6)Ta_(2)O_(17)and(Hf,Zr,Ta)O_(2)by performing aberration-corrected(scanning)transmission electron microscopy.The protective mechanism is related to the peritectic transformation of orthorhombic-(Hf,Zr)_(6)Ta_(2)O_(17)to tetragonal-(Hf,Zr,Ta)O_(2)plus Ta-dominated liquid.This study contributes to the develop-ment of Ta-containing multicomponent UHTC bulk and coatings for ultra-high temperature applications.
基金Supported by the National Key Research and Development Program,No.2023YFF0713700 and No.2023YFF0713705Common Technology R&D Platform of Shaanxi Province,No.2023GXJS-01-1-2the Cyrus Tang Foundation Chung Ying Young Scholars Program.
文摘BACKGROUND Duodenal mucosal ablation(DMA)using irreversible electroporation(IRE)with a glucagon-like peptide-1 receptor agonist has been clinically shown to reduce liver lipid deposition in non-alcoholic fatty liver disease(NAFLD).However,the specific metabolic contributions of DMA using IRE in NAFLD remain unclear.AIM To assess the feasibility and effectiveness of DMA using IRE in NAFLD rat models.METHODS Seven-week-old male Sprague-Dawley rats underwent DMA using IRE after 8 weeks on a high-fat diet.Two weeks post-treatment,duodenal and liver tissues and blood samples were collected.We evaluated differences in the duodenal wall structure,liver lipid deposition,enteroendocrine,claudin,and zonula ocludens-1 in the duodenal mucosa.RESULTS DMA using IRE could be safely performed in rats with NAFLD without duodenal bleeding,perforation,or stenosis.The duodenum healed well 2 weeks after DMA and was characterized by slimmer villi,narrower and shallower crypts,and thicker myenterons compared with the sham-control setting.Liver lipid deposition was reduced and serum lipid index parameters were considerably improved in the DMA setting.However,these improvements were independent of food intake and weight loss.In addition,enteroendocrine parameters,such as claudin,and zonula ocludens-1 levels in the duodenal mucosa,differed between the different settings in the DMA group.CONCLUSION By altering enteroendocrine and duodenal permeability,simple DMA using IRE ameliorated liver lipid deposition and improved serum lipid parameters in NAFLD rats.
基金Supported by the Peking Union Medical College Hospital Central High-Level Hospital Clinical Research Project,No.2022-PUMCH-B-069。
文摘BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.
基金supported by the National Natural Science Foundation of China(Nos.U2241240,12172045 and 12221002)the Opening Fund of State Key Laboratory of Explosion Science and Technology of Beijing Institute of Technology,China(No.ZDKT23-02)。
文摘Carbon Carbon(C/C)composites in thermal-protection system are exposed to severe thermochemical ablation and mechanical erosion,and their thermal-protection performance is of vital importance to the structural safety and flight status of hypersonic vehicles.We numerically analyzes the mesoscopic ablation-erosion of C/C Composites with Inclined Fibers(CCIF).First,a thermochemical ablation model describing the reaction-diffusion coupled problem of C/C composites on mesoscale is employed to analyze ablative process,and the corresponding surface ablation morphology is obtained.Then,the ablation morphology of CCIF is taken as the geometrical model for mechanical erosion analysis,and their damage and failure behavior under high-speed airflow shear is analyzed by using progressive damage method.Moreover,the effects of fiber inclined angle and airflow direction on the mechanical erosion of CCIF are investigated,and the ablationerosion behavior is analyzed and discussed.The results show that the failure modes of mechanical erosion in inner and edge regions are obviously different,showing granular and block erosion phenomena respectively.The mechanical erosion of CCIF in the direction of reverse flow is easier than that in the direction of forward flow.These results can provide a theoretical basis for the design and optimization of thermal protection system materials.
基金supported by the National Key R&D Program of China(No.2022YFB3707700)the Program of Shanghai Academic/Technology Research Leader(No.23XD1424300)the National Natural Science Foundation of China(No.52332003).
文摘Air plasma ablation behavior of Cf/(Ti_(0.2)Zr_(0.2)Hf_(0.2)Nb_(0.2)Ta_(0.2))C-SiC composite was studied systematically with the surface temperature above 2000℃ at the ablation center.It presents a linear recession rate of 0.15μm/s and a mass recession rate of 2.05 mg/s after ablation at 4 MW/m^(2)(2000℃)for 300 s.Associated with the temperature gradient of the ablation surface,the oxidation products at different locations mainly consist of(TiZrHfNbTa)O_(x),(Zr_(x)Hf_(1-x))6(NbyTa_(1-y))_(2)O_(17),Ti(Nb_(x)Ta_(1-x))_(2)O_(7),(Hf_(x)Zr_(1-x))SiO_(4),and SiO_(2).Due to the synergistic effect of the multi-component oxides,oxidation products form a protective structure composed of high melting point oxide skeleton filled with relatively low melting point phases.It retards oxygen inward diffusion and prevents the composite fragmentation caused by plasma mechanical scouring.It is believed that the results would be helpful for further improving the ablation resistance by component design of high entropy ceramics and their composites.
文摘This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.
基金Open Fund of Zhijian Laboratory,Rocket Force University of Engineering(2024-ZJSYS-KF02-09)National Natural Science Foundation of China(51902028,52272034)+1 种基金Key Research and Development Program of Shaanxi(2023JBGS-15)Fundamental Research Funds for the Central Universities(Changan University,300102313202,300102312406)。
文摘To improve the compactness and properties of C/C-SiC-ZrC composites produced by precursor infiltration and pyrolysis(PIP)method,the low-temperature reactive melt infiltration(RMI)process was used to seal the composites using Zr_(2)Cu as the filler.The microstructure,mechanical properties,and ablation properties of the Zr_(2)Cu packed composites were analyzed.Results show that during Zr_(2)Cu impregnation,the melt efficiently fills the large pores of the composites and is converted to ZrCu due to a partial reaction of zirconium with carbon.This results in an increase in composite density from 1.91 g/cm^(3)to 2.24 g/cm^(3)and a reduction in open porosity by 27.35%.Additionally,the flexural strength of Zr_(2)Cu packed C/C-SiC-ZrC composites is improved from 122.78±8.09 MPa to 135.53±5.40 MPa.After plasma ablation for 20 s,the modified composites demonstrate superior ablative resistance compared to PIP C/C-SiC-ZrC,with mass ablation and linear ablation rates of 2.77×10^(−3)g/s and 2.60×10^(−3)mm/s,respectively.The“selftranspiration”effect of the low-melting point copper-containing phase absorbs the heat of the plasma flame,further reducing the ablation temperature and promoting the formation of refined ZrO_(2)particles within the SiO_(2)melting layer.This provides more stable erosion protection for Zr_(2)Cu packed C/C-SiC-ZrC composites.
文摘Ultrasound-guided percutaneous thermal ablation has gained popularity as treatment for malignant hepatic tumors.It was first introduced as ablation therapy for hepatocellular carcinoma and cirrhosis comorbidity.Recently,this technique has also been used in the treatment of intrahepatic cholangiocarcinoma for patients who are not eligible for surgical resection.There are several types of thermal ablation techniques.Radiofrequency ablation and microwave ablation are two common methods that induce necrosis of the lesions.Irreversible electroporation is a relatively new non-thermal technique and is suitable in cases where thermal ablation would be ineffective or dangerous(e.g.,malignant tumors close to vascular or biliary structures).Irreversible electroporation can induce tumoral necrosis without damage to vascular and biliary structures.The aim of this minireview was to describe the safety,efficacy,and clinical indications of these techniques in the treatment of patients with intrahepatic cholangiocarcinoma who are ineligible for surgery.
文摘Cryotherapy is a treatment modality that uses extreme cold to destroy unwanted tissue through both immediate and delayed cellular injury.This therapy is increasingly being adopted across various medical specialties due to its minimally invasive nature and technological advancements that have been made.In the esophagus,cryotherapy is particularly utilized for the management of Barrett esophagus.It has been demonstrated to be effective and safe with potential benefits,such as a reduction in pain,over radiofrequency ablation.Additionally,it might offer a valuable alternative for patients unresponsive to radiofrequency ablation.Cryotherapy is applied for other conditions as well,including esophageal squamous cell neoplasia and malignant dysphagia.More research is needed to gain understanding of the utility in these conditions.Interestingly,cryotherapy has shown the ability to enhance the host’s immune response in reaction to antigens left in situ after treatment.While preclinical data have demonstrated promising results,the immune response is often insufficient to induce tumor regression in the clinical setting.Therefore,there is growing interest in the combination of cryotherapy and immunotherapy where ablation creates an antigen depot,and the immune system is subsequently stimulated.This combination holds promise for the future and potentially opens new doors for a breakthrough in cancer treatment.
文摘BACKGROUND Atrial fibrillation,affecting approximately 33 million people globally,is the most common sustained arrhythmia,increasing risks of stroke,heart failure,and mortality.Pulmonary vein isolation via catheter ablation is a key rhythm control strategy,with cryoballoon ablation(CBA)being a standard thermal method but associated with risks like phrenic nerve palsy(5%-10%),esophageal injury,and vein stenosis.Pulsed field ablation(PFA),a non-thermal technique using electrical pulses for selective electroporation,offers potential for shorter procedures and improved safety.Limited direct comparisons between PFA and CBA necessitate a systematic evaluation of their efficacy and safety.AIM To compare the procedural success,safety,and 1-year arrhythmia-free survival of PFA vs CBA for first-time pulmonary vein isolation in adults with paroxysmal or persistent atrial fibrillation.METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and metaanalysis was conducted,searching PubMed,EMBASE,Web of Science,and other databases up to August 2025 for comparative studies.Pooled mean difference for continuous outcomes and odds ratio(OR)for dichotomous outcomes were calculated using random-effects models.Study quality was assessed with the Newcastle-Ottawa Scale,heterogeneity with I2,and publication bias with funnel plots.RESULTS Seven studies(six cohorts,one randomized controlled trial)were included,with a mean age of approximately 66 years,59%-78%male,and high prevalence of hypertension and diabetes.PFA significantly reduced procedure time(mean difference=-15.24 minutes,95%CI:-16.63 to-13.85,P<0.00001;I2=89%),improved arrhythmia-free survival(OR=1.27,95%CI:1.04-1.55,P=0.02;I2=45%),and lowered phrenic nerve palsy risk(OR=0.17,95%CI:0.04-0.63,P=0.008;I2=0%).No significant differences were found in fluoroscopy time,cardiac tamponade,repeat ablation,or vascular complications.CONCLUSION PFA demonstrates shorter procedure times,reduced phrenic nerve palsy,and better arrhythmia control compared to CBA,with comparable safety profiles.However,evidence is limited by observational study designs,heterogeneity,and potential bias.Large-scale randomized controlled trials with extended follow-up are needed to confirm these findings and guide clinical practice.
