For patients with extensive bilobar colorectal liver metastases (CRLM), initial surgery may not be feasible and a multimodal approach including microwave ablation (MWA) provides the only chance for prolonged survival....For patients with extensive bilobar colorectal liver metastases (CRLM), initial surgery may not be feasible and a multimodal approach including microwave ablation (MWA) provides the only chance for prolonged survival. Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called “vanishing lesions”, ultimately improving patient outcome. Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple, synchronous, bilobar CRLM. Regular follow-up with computed tomography (CT) allowed for temporal development of the ablation zones. Of the ten lesions detected in a preoperative CT scan, the largest lesion was resected and the others were ablated using an intraoperative navigation system. Twelve months post-surgery a new lesion (Seg IVa) was detected and treated by trans-arterial embolization. Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started. The patient passed away four years after initial diagnosis. For patients with extensive CRLM not treatable by standard surgery, navigated MWA/resection may provide excellent tumor control, improving longer-term survival. Intraoperative navigation systems provide precise, real-time information to the surgeon, aiding the decision-making process and substantially improving the accuracy of both ablation and resection. Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions.展开更多
Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three m...Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.展开更多
Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hyperte...Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.展开更多
Lung cancer is one of the most common malignant tumors. It has the highest incidence and mortality rate of all cancers worldwide. Late diagnosis of nonsmall cell lung cancer(NSCLC) is very common in clinical practice,...Lung cancer is one of the most common malignant tumors. It has the highest incidence and mortality rate of all cancers worldwide. Late diagnosis of nonsmall cell lung cancer(NSCLC) is very common in clinical practice, and most patients miss the chance for radical surgery. Thus, radiotherapy plays an indispensable role in the treatment of NSCLC. Radiotherapy technology has evolved from the classic two-dimensional approach to three-dimensional conformal and intensity-modulated radiotherapy. However, how to ensure delivery of an accurate dose to the tumor while minimizing the irradiation of normal tissues remains a huge challenge for radiation oncologists, especially due to the positioning error between fractions and the autonomous movement of organs. In recent years, image-guided radiotherapy(IGRT) has greatly increased the accuracy of tumor irradiation while reducing the irradiation dose delivered to healthy tissues and organs. This paper presents a brief review of the definition of IGRT and the various technologies and applications of IGRT. IGRT can help ensure accurate dosing of the target area and reduce radiation damage to the surrounding normal tissue. IGRT may increase the local control rate of tumors and reduce the incidence of radio-therapeutic complications.展开更多
A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 201...A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual inkmarking techniques for toric IOL alignment.展开更多
Phototheranostic with highly integrated functions is an attractive platform for cancer management. It remains challenging to develop a facile phototheranostic platform with complementary bimodal imaging and combinatio...Phototheranostic with highly integrated functions is an attractive platform for cancer management. It remains challenging to develop a facile phototheranostic platform with complementary bimodal imaging and combinational therapy capacity. Herein, the small-molecule cyanine IR780 loaded liposomes have been harnessed as a nanoplatform to simultaneously realize photoacoustic(PA)/the second near-infrared window(NIR-Ⅱ) fluorescence imaging and image-guided surgery/adjuvant photothermal therapy(PTT).This nanoplatform exhibits attractive properties like uniform controllable size, stable dispersibility, NIR-Ⅱ fluorescence emission, photothermal conversion, and biocompatibility. Benefiting from the complementary PA/NIR-Ⅱ fluorescence bimodal imaging, this nanoplatform was successfully applied in precise vasculature delineation and tumor diagnosis. Interestingly, the tumor was clearly detected by NIR-Ⅱ fluorescence imaging with the highest tumor-to-normal-tissue ratio up to 12.69, while signal interference from the liver was significantly reduced, due to the difference in the elimination rate of the nanoplatform in the liver and tumor. Under the precise guidance of the image, the tumor was accurately resected, and the simulated residual lesion after surgery was completely ablated by adjuvant PTT. This combined therapy showed improved antitumor efcacy over the individual surgery or PTT. This work develops a facile phototheranostic nanoplatform with great significance in accurately diagnosing and effectively treating tumors using simple NIR light irradiation.展开更多
Technological improvements are crucial in the evolution of surgery.Real-time fluorescence-guided surgery(FGS)has spread worldwide,mainly because of its usefulness during the intraoperative decision-making processes.Th...Technological improvements are crucial in the evolution of surgery.Real-time fluorescence-guided surgery(FGS)has spread worldwide,mainly because of its usefulness during the intraoperative decision-making processes.The success of any gastrointestinal oncologic resection is based on the anatomical identification of the primary tumor and its regional lymph nodes.FGS allows also to evaluate the blood perfusion at the gastrointestinal stumps after colorectal or esophageal resections.Therefore,a reduction on the anastomotic leak rates has been postulated as one of the foreseeable benefits provided by the use of FGS in these procedures.Although the use of fluorescence in lymph node detection was initially described in breast cancer surgery,the technique is currently applied in gastric or splenic flexure cancers,as they both present complex and variable lymphatic drainages.FGS allows also to perform intraoperative lymphograms or sentinel lymph node biopsies.New applications of FGS are being developed to assist in the detection of peritoneal metastases or in the evaluation of the tumor resection margins.The present review aims to provide a general overview of the current status of real-time FGS in gastrointestinal oncologic surgery.We put a special focus on the different applications of FGS,discussing the main findings and limitations found in the contemporary literature and also the promising near future applications.展开更多
Image-guided radiotherapy(IGRT) provides precise positioning for the tumor target, but it may bring extra irradiation dose in the target positioning with a cone beam CT(CBCT) which has been increasingly used in IGRT. ...Image-guided radiotherapy(IGRT) provides precise positioning for the tumor target, but it may bring extra irradiation dose in the target positioning with a cone beam CT(CBCT) which has been increasingly used in IGRT. In this work, we focused on biological effects of the low-dose irradiation in IGRT, which have not been considered so far. Primary human fibroblasts cells from the lung and MRC-5 were irradiated by a CBCT. DNA doublestrand breaks(c-H2 AX foci) and micronucleus frequency of the irradiated samples were analyzed. Compared to the control, the c-H2 AX foci yields of the samples irradiated to 16 m Gy increased significantly, and the micronuclei rate of the samples irradiated for 3 days increased notably. The dose by imaging guidance device can be genotoxic to normal tissue cells, suggesting a potential risk of a secondary cancer. The effects, if confirmed by clinical studies,should be considered prudentially in designing IGRT treatment plans for the radiosensitive population, especially for children.展开更多
In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were ...In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.展开更多
BACKGROUND Image-guided radiotherapy(IGRT)has significantly improved the precision in which radiotherapy is delivered in cancer treatment.Typically,IGRT uses bony landmarks and key anatomical structures to locate the ...BACKGROUND Image-guided radiotherapy(IGRT)has significantly improved the precision in which radiotherapy is delivered in cancer treatment.Typically,IGRT uses bony landmarks and key anatomical structures to locate the tumor.Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue.The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied.However,placement requires expertise and specialized endoscopic ultrasound equipment.This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT.AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients.METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne,Australia was conducted.Up to four liquid fiducials were inserted per patient,each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil(Lipiodol;Aspen Pharmacare)and n-butyl 2-cyanoacrylate(Histoacryl®;B.Braun).A 23-gauge injector(Cook Medical)was used for the injection.All procedures were performed by or under the supervision of a gastroenterologist.Liquid fiducial-based IGRT(LF-IGRT)consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy.Patients received standard-IGRT(S-IGRT)if fiducial visibility was insufficient,consisting of bone match as a surrogate for tumor position.Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments.RESULTS 52 patients were referred for liquid fiducial placement within the study period.A total of 51 patients underwent liquid fiducial implantation.Of these a total of 31 patients received radiotherapy.Among these,the median age was 77.4 years with a range between 57.5 and 88.8,and 64.5%were male.Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT.There were no complications after endoscopic implantation of liquid fiducials in our cohort.The cohort overall survival(OS)post-radiotherapy was 19 mo(range 0 to 87 mo).Whilst the progression-free survival(PFS)post-radiotherapy was 13 mo(range 0 to 74 mo).For those treated with curative intent,the median OS was 22.0 mo(range 0 to 87 mo)with a PFS median of 14.0 mo(range 0 to 74 mo).Grade 3 complication rate post-radiotherapy was 29%.CONCLUSION LF-IGRT is feasible in 87.1%of patients undergoing liquid fiducial placement through standard gastroscopy injection technique.Our cohort has an overall survival of 19 mo and PFS of 13 mo.Further studies are warranted to determine the long-term outcomes of liquid-fiducial based IGRT.展开更多
Purpose To evaluate the performance of diffusion-weighted imaging(DWI) and variable flip angle(VFA) T1 mapping as a supplement to image-guided biopsy in follow-up analysis of liver fibrosis. Materials and Methods This...Purpose To evaluate the performance of diffusion-weighted imaging(DWI) and variable flip angle(VFA) T1 mapping as a supplement to image-guided biopsy in follow-up analysis of liver fibrosis. Materials and Methods This prospective study was approved by the institution's committee on human research, and written informed consent was provided from the enrolled patients. We investigated five MRI parameters of DWI and VFA T1 mapping, collected from 11 patients who underwent serial ultrasound image-guided biopsy with follow-up MRI within 1.5 years after treatment for liver fibrosis/cirrhosis. For each patient, four consecutive MRI examinations were conducted, including baseline MRI before treatment and three follow-up MRI examinations after treatment at each 0.5-year interval. ADC values at four b values and T1 relaxation times were correlated to pathology-confirmed liver fibrosis stages, which were subsequently divided into two groups, stages F2–3 and F4. The receiver operating characteristic(ROC) analysis and repeated measurement analysis of variance were used for statistical analysis. Results Among these ADC parameters, ADC value(b = 500 s/mm^2) was the most consistent in differentiating between stage F2–3 and F4 liver fibrosis. Repeated measurement analysis showed that the intra-group and inter-group differences were 0.447 and 0.024, respectively. T1 relaxation time could not consistently differentiate between the F2–3 and F4 groups; however, it was repeatable, and the intra-group and inter-group differences were 0.410 and 0.042, respectively. Conclusion MRI-ADC value at a b value of 500 s/mm^2 can be a promising biomarker for differentiating stages F2–3 and F4 liver fibrosis. A combination of this biomarker with repeatable T1 relaxation time may function as a non-invasive tool for follow-up liver fibrosis in patients who reject repeated image-guided biopsy.展开更多
Purpose: To evaluate the associations for vaginal dose points of vaginal stricture in image-guided brachytherapy. Materials and Methods: Twenty-six patients of locally advanced cervical cancer were treated with Image-...Purpose: To evaluate the associations for vaginal dose points of vaginal stricture in image-guided brachytherapy. Materials and Methods: Twenty-six patients of locally advanced cervical cancer were treated with Image-Guided Brachytherapy (IGBT) with the dose at least 7 Gy per fraction to the D90 of High-Risk Clinical Target Volume (HR-CTV). The vaginal dose points of recommendations of the American Brachytherapy Society (ABS) were added into the plan and cumulative dose to these points was evaluated in Equivalent Dose of 2 Gy (EQD2) concepts. Results: The mean doses to right vaginal dose point (VR), left vaginal dose point (VL) and average dose of VR/VL ((VR + VL)/2) were 101.5 Gy, 98.2 Gy and 99.8 Gy in EQD2 concepts, respectively. Volume-based planning significantly reduced the cumulative dose in EQD2 concepts at vaginal points. At the median follow-up time of 22 months, grade-2 vaginal stricture was observed in two patients. The incidences of vaginal stricture were not differed between the cumulative dose to vaginal dose points in EQD2 concepts of ≤90 Gy versus >90 Gy (P = 1.000) and ≤100 Gy versus >100 Gy (P = 0.815). Conclusion: No association for cumulative vaginal doses and events of vaginal stricture was found.展开更多
Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients a...Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients and healthcare pro-viders,radiation technology must be applied effectively and safely in clinical practice.Radiation safety may be overlooked by nephrology training curricula.This narrative review discusses the theoretical and practical principles of radiation management in fluoroscopy-guided procedures and is intended as a primer for trainees and nephrologists working in interventional settings.展开更多
Photodynamic therapy(PDT)has emerged as a promising approach for tumor treatment due to its noninvasiveness and high selectivity.However,the off-target activation of phototoxicity and the limited availability of tumor...Photodynamic therapy(PDT)has emerged as a promising approach for tumor treatment due to its noninvasiveness and high selectivity.However,the off-target activation of phototoxicity and the limited availability of tumor-specific biomarkers pose challenges for effective PDT.Here,we present the development of a novel ratiometric near-infrared-II(NIR-II)fluorescent organic nanoprobe,BTz-IC@IR1061,which responds specifically to hypochlorite(HClO)within tumors.This nanoprobe allows ratiometric fluorescence imaging to monitor and guide activated tumor PDT.BTz-IC@IR1061 nanoparticles were synthesized by codoping the small molecule dye BTz-IC,which generates reactive oxygen species(ROS),with the commercial dye IR1061.The presence of HClO selectively activates the fluorescence and photodynamic properties of BTz-IC while destroying IR1061,enabling controlled release of ROS for tumor therapy.We demonstrated the high selectivity of the nanoprobe for HClO,as well as its excellent photostability,photoacoustic imaging capability,and photothermal effects.Furthermore,in vivo studies revealed effective tumor targeting and remarkable tumor growth inhibition through tumor-activated PDT.Our findings highlight the potential of BTz-IC@IR1061 as a promising tool for tumor-specific PDT,providing new opportunities for precise and controlled cancer therapy.展开更多
BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedura...BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.展开更多
BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker...BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.展开更多
In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle asp...In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.展开更多
Rational design of multifunctional nanoplatforms capable of combining therapeutic effects with real-time monitoring of drug distribution and tumor status is emerging as a promising approach in cancer nanomedicine.Here...Rational design of multifunctional nanoplatforms capable of combining therapeutic effects with real-time monitoring of drug distribution and tumor status is emerging as a promising approach in cancer nanomedicine.Here,we introduce pyropheophorbide a-bisaminoquinoline conjugate lipid nanoparticles(PPBC LNPs)as a bimodal system for image-guided phototherapy in bladder cancer treatment.PPBC LNPs not only demonstrate both powerful photodynamic and photothermal effects upon light activation,but also exhibit potent autophagy blockage,effectively inducing bladder cancer cell death.Furthermore,PPBC LNPs possess remarkable photoacoustic(PA)and fluorescence(FL)imaging capabilities,enabling imaging with high-resolution,deep tissue penetration and high sensitivity for tracking drug biodistribution and phototherapy efficacy.Specifically,PA imaging confirms the efficient accumulation of PPBC LNPs within tumor and predicts therapeutic outcomes of photodynamic therapy,while FL imaging confirms their prolonged retention at the tumor site for up to 6 days.PPBC LNPs significantly suppress bladder tumor growth,with several tumors completely ablated following just two doses of the nanoparticles and laser treatment.Additionally,PPBC LNPs were formulated with lipid-based excipients and assembled using microfluidic technology to enhance biocompatibility,stability,and scalability,showing potential for clinical translation.This versatile nanoparticle represents a promising candidate for further development in bladder cancer therapy.展开更多
BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quali...BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.展开更多
Recent advances in high intensity focused ultrasound(HIFU),which was developed in the 1940s as a viable thermal tissue ablation approach,have increased its popularity.In clinics,HIFU has been applied to treat a variet...Recent advances in high intensity focused ultrasound(HIFU),which was developed in the 1940s as a viable thermal tissue ablation approach,have increased its popularity.In clinics,HIFU has been applied to treat a variety of solid malignant tumors in a well-defined volume,including the pancreas,liver,prostate,breast,uterine fibroids,and soft-tissue sarcomas.In comparison to conventional tumor/cancer treatment modalities,such as open surgery,radio-and chemo-therapy,HIFU has the advantages of non-invasion,non-ionization,and fewer complications after treatment.Over 100 000 cases have been treated throughout the world with great success.The fundamental principles of HIFU ablation are coagulative thermal necrosis due to the absorption of ultrasound energy during transmission in tissue and the induced cavitation damage.This paper reviews the clinical outcomes of HIFU ablation for applicable cancers,and then summarizes the recommendations for a satisfactory HIFU treatment according to clinical experience.In addition,the current challenges in HIFU for engineers and physicians are also included.More recent horizons have broadened the application of HIFU in tumor treatment,such as HIFU-mediated drug delivery,vessel occlusion,and soft tissue erosion(“histotripsy”).In summary,HIFU is likely to play a significant role in the future oncology practice.展开更多
文摘For patients with extensive bilobar colorectal liver metastases (CRLM), initial surgery may not be feasible and a multimodal approach including microwave ablation (MWA) provides the only chance for prolonged survival. Intraoperative navigation systems may improve the accuracy of ablation and surgical resection of so-called “vanishing lesions”, ultimately improving patient outcome. Clinical application of intraoperative navigated liver surgery is illustrated in a patient undergoing combined resection/MWA for multiple, synchronous, bilobar CRLM. Regular follow-up with computed tomography (CT) allowed for temporal development of the ablation zones. Of the ten lesions detected in a preoperative CT scan, the largest lesion was resected and the others were ablated using an intraoperative navigation system. Twelve months post-surgery a new lesion (Seg IVa) was detected and treated by trans-arterial embolization. Nineteen months post-surgery new liver and lung metastases were detected and a palliative chemotherapy started. The patient passed away four years after initial diagnosis. For patients with extensive CRLM not treatable by standard surgery, navigated MWA/resection may provide excellent tumor control, improving longer-term survival. Intraoperative navigation systems provide precise, real-time information to the surgeon, aiding the decision-making process and substantially improving the accuracy of both ablation and resection. Regular follow-ups including 3D modeling allow for early discrimination between ablation zones and recurrent tumor lesions.
基金supported by the National Natural Science Foundation of China,No.81060182the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2012211B34the Key Technology Research and Development and Major Program of Xinjiang Uygur Autonomous Region,No.200833116
文摘Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.
文摘Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.
文摘Lung cancer is one of the most common malignant tumors. It has the highest incidence and mortality rate of all cancers worldwide. Late diagnosis of nonsmall cell lung cancer(NSCLC) is very common in clinical practice, and most patients miss the chance for radical surgery. Thus, radiotherapy plays an indispensable role in the treatment of NSCLC. Radiotherapy technology has evolved from the classic two-dimensional approach to three-dimensional conformal and intensity-modulated radiotherapy. However, how to ensure delivery of an accurate dose to the tumor while minimizing the irradiation of normal tissues remains a huge challenge for radiation oncologists, especially due to the positioning error between fractions and the autonomous movement of organs. In recent years, image-guided radiotherapy(IGRT) has greatly increased the accuracy of tumor irradiation while reducing the irradiation dose delivered to healthy tissues and organs. This paper presents a brief review of the definition of IGRT and the various technologies and applications of IGRT. IGRT can help ensure accurate dosing of the target area and reduce radiation damage to the surrounding normal tissue. IGRT may increase the local control rate of tumors and reduce the incidence of radio-therapeutic complications.
文摘A systematic review of the recent literature regarding the current image-guided systems used for cataract surgery or refractive lens exchange was performed based on the PubMed and Google Scholar databases in March 2018. Literature review returned 21 eligible studies. These studies compared image-guided systems with other keratometric devices regarding their accuracy, repeatability and reproducibility in measurement of keratometric values, astigmatism magnitude and axis, as well as in IOL power calculation. Additionally, the image-guided systems were compared with conventional manual ink-marking techniques for the alignment of toric IOLs. In conclusion, image-guided systems seem to be an accurate and reliable technology with measurements of high repeatability and reproducibility regarding the keratometry and IOL power calculation, but not yet interchangeable with the current established and validated keratometric devices. However, they are superior over the conventional manual inkmarking techniques for toric IOL alignment.
基金financially supported in part by the National Natural Science Foundation of China(Nos.62075103,81973488)the Natural Science Foundation of Jiangsu Province(No.BK20211271)+4 种基金the Foundation of Anhui Province Key Laboratory of Pharmaceutical Preparation Technology and Application(No.2021KFKT07)the Training Program of Innovation and Entrepreneurship for College Students in Jiangsu(No.202110312037Z)the Jiangsu Provincial Medical Youth Talent(No.QNRC2016075)the Nanjing Medical Science and Technique Development Foundation(No.ZKX19022)the Jiangsu Provincial High level Health Talent“six one project”(No.LGY2019005)。
文摘Phototheranostic with highly integrated functions is an attractive platform for cancer management. It remains challenging to develop a facile phototheranostic platform with complementary bimodal imaging and combinational therapy capacity. Herein, the small-molecule cyanine IR780 loaded liposomes have been harnessed as a nanoplatform to simultaneously realize photoacoustic(PA)/the second near-infrared window(NIR-Ⅱ) fluorescence imaging and image-guided surgery/adjuvant photothermal therapy(PTT).This nanoplatform exhibits attractive properties like uniform controllable size, stable dispersibility, NIR-Ⅱ fluorescence emission, photothermal conversion, and biocompatibility. Benefiting from the complementary PA/NIR-Ⅱ fluorescence bimodal imaging, this nanoplatform was successfully applied in precise vasculature delineation and tumor diagnosis. Interestingly, the tumor was clearly detected by NIR-Ⅱ fluorescence imaging with the highest tumor-to-normal-tissue ratio up to 12.69, while signal interference from the liver was significantly reduced, due to the difference in the elimination rate of the nanoplatform in the liver and tumor. Under the precise guidance of the image, the tumor was accurately resected, and the simulated residual lesion after surgery was completely ablated by adjuvant PTT. This combined therapy showed improved antitumor efcacy over the individual surgery or PTT. This work develops a facile phototheranostic nanoplatform with great significance in accurately diagnosing and effectively treating tumors using simple NIR light irradiation.
文摘Technological improvements are crucial in the evolution of surgery.Real-time fluorescence-guided surgery(FGS)has spread worldwide,mainly because of its usefulness during the intraoperative decision-making processes.The success of any gastrointestinal oncologic resection is based on the anatomical identification of the primary tumor and its regional lymph nodes.FGS allows also to evaluate the blood perfusion at the gastrointestinal stumps after colorectal or esophageal resections.Therefore,a reduction on the anastomotic leak rates has been postulated as one of the foreseeable benefits provided by the use of FGS in these procedures.Although the use of fluorescence in lymph node detection was initially described in breast cancer surgery,the technique is currently applied in gastric or splenic flexure cancers,as they both present complex and variable lymphatic drainages.FGS allows also to perform intraoperative lymphograms or sentinel lymph node biopsies.New applications of FGS are being developed to assist in the detection of peritoneal metastases or in the evaluation of the tumor resection margins.The present review aims to provide a general overview of the current status of real-time FGS in gastrointestinal oncologic surgery.We put a special focus on the different applications of FGS,discussing the main findings and limitations found in the contemporary literature and also the promising near future applications.
基金supported by the Strategic Priority Research Program of Chinese Academy of Sciences(No.XDA03040000)the National Natural Science Foundation under Grant No.30900386+1 种基金the Anhui Provincial Natural Science Foundation under Grant Nos.090413095 and 11040606Q55the National Natural Science Foundation of Department of Education of Anhui Province under Grant No KJ2010B380
文摘Image-guided radiotherapy(IGRT) provides precise positioning for the tumor target, but it may bring extra irradiation dose in the target positioning with a cone beam CT(CBCT) which has been increasingly used in IGRT. In this work, we focused on biological effects of the low-dose irradiation in IGRT, which have not been considered so far. Primary human fibroblasts cells from the lung and MRC-5 were irradiated by a CBCT. DNA doublestrand breaks(c-H2 AX foci) and micronucleus frequency of the irradiated samples were analyzed. Compared to the control, the c-H2 AX foci yields of the samples irradiated to 16 m Gy increased significantly, and the micronuclei rate of the samples irradiated for 3 days increased notably. The dose by imaging guidance device can be genotoxic to normal tissue cells, suggesting a potential risk of a secondary cancer. The effects, if confirmed by clinical studies,should be considered prudentially in designing IGRT treatment plans for the radiosensitive population, especially for children.
文摘In this study, we sought to assess the safety and accuracy of sacropelvic fixation performed with image-guided sacroiliac screw placement using postoperative computed tomography and X-rays. The sacroiliac screws were placed with navigation in five patients. Intact specimens were mounted onto a six-degrees-of-freedom spine motion simulator. Long lumbosacral constructs using bilateral sacroiliac screws and bilateral S1 pedicle and iliac screws were tested in seven cadaveric spines. Nine sacroiliac screws were well-placed under an image guidance system(IGS);one was placed poorly without IGS with no symptoms. Both fixation techniques significantly reduced range of motion(P<0.05) at L5-S1. The research concluded that rigid lumbosacral fixation can be achieved with sacroiliac screws,and image guidance improves its safety and accuracy. This new technique of image-guided sacroiliac screw insertion should prove useful in many types of fusion to the sacrum, particularly for patients with poor bone quality,complicated anatomy, infection, previous failed fusion and iliac harvesting.
文摘BACKGROUND Image-guided radiotherapy(IGRT)has significantly improved the precision in which radiotherapy is delivered in cancer treatment.Typically,IGRT uses bony landmarks and key anatomical structures to locate the tumor.Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue.The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied.However,placement requires expertise and specialized endoscopic ultrasound equipment.This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT.AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients.METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne,Australia was conducted.Up to four liquid fiducials were inserted per patient,each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil(Lipiodol;Aspen Pharmacare)and n-butyl 2-cyanoacrylate(Histoacryl®;B.Braun).A 23-gauge injector(Cook Medical)was used for the injection.All procedures were performed by or under the supervision of a gastroenterologist.Liquid fiducial-based IGRT(LF-IGRT)consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy.Patients received standard-IGRT(S-IGRT)if fiducial visibility was insufficient,consisting of bone match as a surrogate for tumor position.Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments.RESULTS 52 patients were referred for liquid fiducial placement within the study period.A total of 51 patients underwent liquid fiducial implantation.Of these a total of 31 patients received radiotherapy.Among these,the median age was 77.4 years with a range between 57.5 and 88.8,and 64.5%were male.Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT.There were no complications after endoscopic implantation of liquid fiducials in our cohort.The cohort overall survival(OS)post-radiotherapy was 19 mo(range 0 to 87 mo).Whilst the progression-free survival(PFS)post-radiotherapy was 13 mo(range 0 to 74 mo).For those treated with curative intent,the median OS was 22.0 mo(range 0 to 87 mo)with a PFS median of 14.0 mo(range 0 to 74 mo).Grade 3 complication rate post-radiotherapy was 29%.CONCLUSION LF-IGRT is feasible in 87.1%of patients undergoing liquid fiducial placement through standard gastroscopy injection technique.Our cohort has an overall survival of 19 mo and PFS of 13 mo.Further studies are warranted to determine the long-term outcomes of liquid-fiducial based IGRT.
文摘Purpose To evaluate the performance of diffusion-weighted imaging(DWI) and variable flip angle(VFA) T1 mapping as a supplement to image-guided biopsy in follow-up analysis of liver fibrosis. Materials and Methods This prospective study was approved by the institution's committee on human research, and written informed consent was provided from the enrolled patients. We investigated five MRI parameters of DWI and VFA T1 mapping, collected from 11 patients who underwent serial ultrasound image-guided biopsy with follow-up MRI within 1.5 years after treatment for liver fibrosis/cirrhosis. For each patient, four consecutive MRI examinations were conducted, including baseline MRI before treatment and three follow-up MRI examinations after treatment at each 0.5-year interval. ADC values at four b values and T1 relaxation times were correlated to pathology-confirmed liver fibrosis stages, which were subsequently divided into two groups, stages F2–3 and F4. The receiver operating characteristic(ROC) analysis and repeated measurement analysis of variance were used for statistical analysis. Results Among these ADC parameters, ADC value(b = 500 s/mm^2) was the most consistent in differentiating between stage F2–3 and F4 liver fibrosis. Repeated measurement analysis showed that the intra-group and inter-group differences were 0.447 and 0.024, respectively. T1 relaxation time could not consistently differentiate between the F2–3 and F4 groups; however, it was repeatable, and the intra-group and inter-group differences were 0.410 and 0.042, respectively. Conclusion MRI-ADC value at a b value of 500 s/mm^2 can be a promising biomarker for differentiating stages F2–3 and F4 liver fibrosis. A combination of this biomarker with repeatable T1 relaxation time may function as a non-invasive tool for follow-up liver fibrosis in patients who reject repeated image-guided biopsy.
文摘Purpose: To evaluate the associations for vaginal dose points of vaginal stricture in image-guided brachytherapy. Materials and Methods: Twenty-six patients of locally advanced cervical cancer were treated with Image-Guided Brachytherapy (IGBT) with the dose at least 7 Gy per fraction to the D90 of High-Risk Clinical Target Volume (HR-CTV). The vaginal dose points of recommendations of the American Brachytherapy Society (ABS) were added into the plan and cumulative dose to these points was evaluated in Equivalent Dose of 2 Gy (EQD2) concepts. Results: The mean doses to right vaginal dose point (VR), left vaginal dose point (VL) and average dose of VR/VL ((VR + VL)/2) were 101.5 Gy, 98.2 Gy and 99.8 Gy in EQD2 concepts, respectively. Volume-based planning significantly reduced the cumulative dose in EQD2 concepts at vaginal points. At the median follow-up time of 22 months, grade-2 vaginal stricture was observed in two patients. The incidences of vaginal stricture were not differed between the cumulative dose to vaginal dose points in EQD2 concepts of ≤90 Gy versus >90 Gy (P = 1.000) and ≤100 Gy versus >100 Gy (P = 0.815). Conclusion: No association for cumulative vaginal doses and events of vaginal stricture was found.
文摘Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients and healthcare pro-viders,radiation technology must be applied effectively and safely in clinical practice.Radiation safety may be overlooked by nephrology training curricula.This narrative review discusses the theoretical and practical principles of radiation management in fluoroscopy-guided procedures and is intended as a primer for trainees and nephrologists working in interventional settings.
基金supported by the National Natural Science Foundation of China(Nos.22374040,U21A20287,21974039,21890744)the Key Projects of National Natural Science Foundation of China(No.22234003)+1 种基金the National Key R&D Program of China(No.2019YFA0210100)the Fundamental Research Funds for the Central Universities.
文摘Photodynamic therapy(PDT)has emerged as a promising approach for tumor treatment due to its noninvasiveness and high selectivity.However,the off-target activation of phototoxicity and the limited availability of tumor-specific biomarkers pose challenges for effective PDT.Here,we present the development of a novel ratiometric near-infrared-II(NIR-II)fluorescent organic nanoprobe,BTz-IC@IR1061,which responds specifically to hypochlorite(HClO)within tumors.This nanoprobe allows ratiometric fluorescence imaging to monitor and guide activated tumor PDT.BTz-IC@IR1061 nanoparticles were synthesized by codoping the small molecule dye BTz-IC,which generates reactive oxygen species(ROS),with the commercial dye IR1061.The presence of HClO selectively activates the fluorescence and photodynamic properties of BTz-IC while destroying IR1061,enabling controlled release of ROS for tumor therapy.We demonstrated the high selectivity of the nanoprobe for HClO,as well as its excellent photostability,photoacoustic imaging capability,and photothermal effects.Furthermore,in vivo studies revealed effective tumor targeting and remarkable tumor growth inhibition through tumor-activated PDT.Our findings highlight the potential of BTz-IC@IR1061 as a promising tool for tumor-specific PDT,providing new opportunities for precise and controlled cancer therapy.
文摘BACKGROUND Percutaneous liver biopsies,including coaxial needle biopsy(CNB),are the pre-ferred method for tissue sampling to diagnose or characterize an array of hepatic conditions.Despite the advent of intraprocedural image guidance,and various“plugging”techniques,bleeding remains a frequent and potentially highly mor-bid complication,particularly in patients with bleeding risks.Thus,post-biopsy bleeding risk leads to extended patient monitoring,and in significant cases,ad-ditional imaging,intervention,and even surgery.Very rarely,death has resulted.CASE SUMMARY We report a series of five image-guided liver biopsy cases undertaken due to a variety of clinical conditions followed by the use of a new electrocautery hemo-stasis device called SinglePass Kronos.Indications for the CNB included non-alcoholic steatohepatitis,hepatocellular carcinoma and cirrhosis,abnormal liver function tests with positive autoimmune serologies,abnormal imaging findings,and jaundice.All biopsy procedures were successful with no complications th-rough 30 days following CNB.Post-procedure ultrasound confirmed the absence of bleeding in all five cases.CONCLUSION Hemostasis of CNB tracts using SinglePass Kronos was obtained in all cases.Ad-ditional study of this device is warranted.
基金Supported by the National Natural Science Foundation of China,No.82072034.
文摘BACKGROUND Gastroenteropancreatic neuroendocrine tumors(GEP-NETs)frequently metasta-size to the liver,with heterogeneity in tumor grade impacting patient prognosis and treatment.The Ki-67 index,a key prognostic marker,often varies between primary and metastatic sites;however,routine liver biopsy remains controversial.Although percutaneous computed tomography-guided core needle biopsy(PCT-CNB)is safe and effective for focal lesions,its role in detecting intertumor grading discrepancies and survival implications in GEP-NETs is underexplored.Conflic-ting survival associations with grade shifts have been reported in previous stu-dies.We hypothesized that PCT-CNB could identify clinically significant grading heterogeneity in liver metastases,correlating with survival outcomes,thereby refining risk stratification and therapeutic strategies.METHODS We retrospectively investigated 92 patients with liver metastases from GEP-NETs via PCT-CNB,76 patient samples from the liver and primary sites,and 16 from the liver and secondary liver sites.Ki-67 immunohistochemistry was performed for tissue sampling,and grading classifications were determined.Intertumor grading classification heterogeneity and associated changes in patient survival outcomes were also evaluated.RESULTS No procedure-related mortality was recorded during or after biopsy.In 37/92 patients(40.2%),the grading classi-fications changed:The grading increased from G1 to G2 in 13 patients,from G1 to G3 in 2,and from G2 to G3 in 14;the grading decreased from G2 to G1 in 5 patients,from G3 to G1 in 1,and from G3 to G2 in 2.Patients with G1 or G2 disease had better progression-free survival and overall survival(OS)outcomes than those with G3 disease did(P=0.001 and P<0.001,respectively).The 5-year and 10-year OS rates for stable G2 patients were 67.5%and 26.0%,respectively,decreasing to 46.4%and 23.2%,respectively,among G2 patients whose grade increased(P=0.016).CONCLUSION The PCT-CNB of liver metastases from GEP-NETs differed in grade between the liver tumor and primary site/secondary liver metastases.Additionally,when grading increased from G2,the OS rate significantly de-creased.
文摘In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.
文摘Rational design of multifunctional nanoplatforms capable of combining therapeutic effects with real-time monitoring of drug distribution and tumor status is emerging as a promising approach in cancer nanomedicine.Here,we introduce pyropheophorbide a-bisaminoquinoline conjugate lipid nanoparticles(PPBC LNPs)as a bimodal system for image-guided phototherapy in bladder cancer treatment.PPBC LNPs not only demonstrate both powerful photodynamic and photothermal effects upon light activation,but also exhibit potent autophagy blockage,effectively inducing bladder cancer cell death.Furthermore,PPBC LNPs possess remarkable photoacoustic(PA)and fluorescence(FL)imaging capabilities,enabling imaging with high-resolution,deep tissue penetration and high sensitivity for tracking drug biodistribution and phototherapy efficacy.Specifically,PA imaging confirms the efficient accumulation of PPBC LNPs within tumor and predicts therapeutic outcomes of photodynamic therapy,while FL imaging confirms their prolonged retention at the tumor site for up to 6 days.PPBC LNPs significantly suppress bladder tumor growth,with several tumors completely ablated following just two doses of the nanoparticles and laser treatment.Additionally,PPBC LNPs were formulated with lipid-based excipients and assembled using microfluidic technology to enhance biocompatibility,stability,and scalability,showing potential for clinical translation.This versatile nanoparticle represents a promising candidate for further development in bladder cancer therapy.
基金Supported by the National Natural Science Foundation of China,No.82302332 and No.82272100Guiding Science and Technology Research Project of Quzhou,No.ZD2022020.
文摘BACKGROUND Colorectal cancer(CRC)frequently metastasizes to the lungs,and image-guided thermal ablation(IGTA)has emerged as a promising treatment for oligometastatic colorectal lung metastases(CRLM).However,high-quality multicenter data remain limited,and the prognostic impact of site-specific extrapulmonary metastases is not well defined.AIM To assess IGTA efficacy in potentially curable oligometastatic CRLM and determine prognostic impacts of extrapulmonary metastatic patterns.METHODS This multicenter real-world study analyzed 336 CRLM patients treated with IGTA from 2014 to 2022.Inclusion criteria included pathologically or clinically confirmed oligometastatic CRC,tumor diameter<50 mm,fewer than 5 metastatic lesions,and≤2 organs involved.Kaplan-Meier and Cox regression methods assessed survival outcomes,including local tumor progression-free survival,progression-free survival(PFS),and overall survival(OS).RESULTS The 3-year cumulative local tumor progression rate was 14.0%.Median PFS and OS were 15.6 and 51 months,respectively,with 3-and 5-year OS rates of 59.5%and 41.0%.Poor survival outcomes were associated with a higher tumor burden(larger size and greater number),carcinoembryonic antigen>20 ng/mL,carbohydrate antigen 19-9>37 U/mL,and extrapulmonary metastases.Patients without extrapulmonary metastasis had 1-,3-,and 5-year PFS rates of 65.4%,31.0%,and 27.3%,respectively,which were longer than those of CRLM patients with liver metastasis[hazard ratio(HR)=1.449,P=0.019]and abdominal cavity metastasis(HR=1.864,P=0.010).The 1-,3-,and 5-year OS rates for patients without extrapulmonary metastasis were 96.4%,71.0%,and 53.0%,respectively,which were significantly longer than those for patients with bone metastasis(HR=4.538,P<0.001),abdominal cavity metastasis(HR=4.813,P<0.001),and pelvic cavity metastasis(HR=3.105,P<0.001).CONCLUSION Metastatic patterns significantly influence PFS and OS,emphasizing the need for careful patient selection.Notably,patients with liver-only extrapulmonary metastasis demonstrate comparatively favorable outcomes,suggesting a distinct biological behavior and better prognosis within this subgroup.
文摘Recent advances in high intensity focused ultrasound(HIFU),which was developed in the 1940s as a viable thermal tissue ablation approach,have increased its popularity.In clinics,HIFU has been applied to treat a variety of solid malignant tumors in a well-defined volume,including the pancreas,liver,prostate,breast,uterine fibroids,and soft-tissue sarcomas.In comparison to conventional tumor/cancer treatment modalities,such as open surgery,radio-and chemo-therapy,HIFU has the advantages of non-invasion,non-ionization,and fewer complications after treatment.Over 100 000 cases have been treated throughout the world with great success.The fundamental principles of HIFU ablation are coagulative thermal necrosis due to the absorption of ultrasound energy during transmission in tissue and the induced cavitation damage.This paper reviews the clinical outcomes of HIFU ablation for applicable cancers,and then summarizes the recommendations for a satisfactory HIFU treatment according to clinical experience.In addition,the current challenges in HIFU for engineers and physicians are also included.More recent horizons have broadened the application of HIFU in tumor treatment,such as HIFU-mediated drug delivery,vessel occlusion,and soft tissue erosion(“histotripsy”).In summary,HIFU is likely to play a significant role in the future oncology practice.
