BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surg...BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surgical resection and radiofrequency ablation(RFA),remain controversial.AIM To clarify this issue using sentiment analysis of medical literature alongside a meta-analysis of overall survival(OS).METHODS We included studies comparing liver resection and RFA,excluding case reports,editorials,and studies without relevant outcomes.A systematic search in PubMed and Web of Science identified 197 studies.Abstracts underwent sentiment analysis using Python’s Natural Language Toolkit library,categorizing them as favoring resection,ablation,or neutral.We also performed a meta-analysis using a random-effects model on 11 studies reporting hazard ratios(HRs)for OS.RESULTS Sentiment analysis revealed that 75.1%of abstracts were neutral,14.2%favored resection,and 10.7%favored RFA.The meta-analysis showed a significant survival advantage for liver resection,with a pooled HR of 0.5924(95%confidence interval:0.540-0.649).Heterogeneity was moderate(I²=39.98%).Despite the meta-analysis demonstrating clear survival benefits of liver resection,most abstracts maintained a neutral stance.This discrepancy highlights potential biases or hesitancy in drawing definitive conclusions.CONCLUSION The study emphasizes the need for clinicians to prioritize robust statistical evidence over narrative impressions.Liver resection remains the preferred treatment for HCC in eligible patients.展开更多
Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising ...Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising minimally invasive therapeutic option,aiming to provide targeted treatment with improved patients’outcomes.This review aims to shed light on current evidence about the efficacy,safety,and clinical outcomes of EUS-RFA in the management of pancreatic neoplasms.We conducted a comprehensive search of literature,reviewing studies that document the application of EUS-RFA in pancreatic masses.The key metrics for efficacy included tumor size reduction,pain relief,and overall survival,while safety outcomes focused on procedural complications and post-operative recovery.EUS-RFA has demonstrated potential in effectively managing both benign and malignant pancreatic neoplasms,with several studies reporting significant reductions in tumor size and symptomatic relief.The technique is associated with a favorable safety profile,characterized by a low incidence of major complications.EUS-RFA represents a valuable addition to the therapeutic arsenal for pancreatic neoplasms,offering a viable alternative to surgical interventions,especially in patients with contraindications for surgery.Further studies are needed to establish standardized protocols and long-term outcomes,enhancing its applicability and success in clinical practice.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising t...BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.展开更多
Objective: To evaluate the efficacy of endovenous radiofrequency ablation (RFA) and laser ablation (EVLA) in the treatment of superficial varicose veins of the lower extremities. Methods: Seventy-eight patients with s...Objective: To evaluate the efficacy of endovenous radiofrequency ablation (RFA) and laser ablation (EVLA) in the treatment of superficial varicose veins of the lower extremities. Methods: Seventy-eight patients with superficial varicose veins treated at a hospital between April 2022 and May 2023 were selected and divided into a radiofrequency ablation group (RFA group;39 cases) and a laser ablation group (EVLA group;39 cases) based on the treatment method. Operation time, postoperative recovery duration, venous clinical severity score (VCSS) changes, complication rates, closure rates, and recurrence rates were compared between the groups at 1 month, 3 months, and 12 months postoperatively. The postoperative therapeutic outcomes were comprehensively evaluated. Results: No significant differences in age, gender, disease grade, or disease course were observed between the groups (P > 0.05). The superficial varicose vein closure rate was 100% in both groups at 1 and 3 months postoperatively. At 12 months, the closure rate was 94.87% in the RFA group and 97.43% in the EVLA group, with no statistically significant difference (P > 0.05). No significant differences were observed in VCSS changes or complication incidence between the groups (P > 0.05). Conclusion: Radiofrequency ablation and laser ablation demonstrate comparable efficacy and safety in the treatment of superficial varicose veins of the lower extremities.展开更多
The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associat...The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.展开更多
Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan ...Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.展开更多
BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing...BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing at a rate of 0.5%to 1.0%per year,and it is expected to become the 2nd leading cause of tumor-related deaths in the United States by 2030.More than 50%of pancreatic cancer patients have already developed distant metastases at the time of diagnosis,with the liver being the most common site.Patients with pancreatic cancer with liver metastasis(PCLM)have a worse prognosis than those with locally progressed pancreatic cancer,with a median survival of less than six months.Therefore,the outcome of liver metastases is often a vital determinant of the prognosis of patients with PCLM.There are few successful cases of localized treatment for PCLM patients.Our department recently performed local radiofrequency ablation(RFA)treatment for a PCLM patient through an evidence-based medicine approach,with remarkable therapeutic effects.CASE SUMMARY The patient was admitted to the hospital on May 03,2018,3 weeks after pancreatic cancer surgery.In October 2017,the patient presented with lower back pain.No abnormalities were detected via computed tomography(CT),colonoscopy,or gastroscopy.However,on March 18,2018,the patient was investigated in a foreign hospital via CT,which suggested occupational lesions in the descending part of the duodenum,and magnetic resonance imaging suggested pancreatic occupancy.He was considered to be suffering from pancreatic cancer.He underwent laparoscopic-assisted pancreatic+duodenum+superior mesenteric vein partial resection and reconstruction under general anesthesia on March 26,2018 at The Affiliated Hospital of Xuzhou Medical University.The pancreas and duodenum were partially resected.Postoperative pathology showed adenocarcinoma of the pancreas(moderately differentiated),partly mucinous carcinoma,invading the mucosal layer of the duodenum;the tumor size was 4.5 cm×4 cm×4 cm.There was no apparent nerve or vascular invasion.There was no cancer or involvement of the pancreas section or expected hepatic duct margins.There was no cancer involvement in the gastric and duodenal sections.There was no cancer metastasis to the peripheral lymph nodes of the pancreas(0/9).No metastasis to the gastric lesser curvature or more significant curvature lymph nodes(0/1,0/5)was detected,and the peri-intestinal lymph nodes showed no cancer metastasis(0/4).Although the gallbladder showed signs of chronic cholecystitis,there was no cancer involvement,and the lymph nodes in Groups 12 and 13 also showed no cancer metastasis(0/6,0/1).His postoperative recovery was acceptable.CT was performed on May 2018 at our hospital and found the following:(1)Double lung bronchial vascular bundles slightly heavier than normal;(2)Postoperative changes in the pancreas and a retention tube shadow in front of the head of the pancreas;(3)Small cysts in the right lobe of the liver;(4)Abdominopelvic effusion;and(5)Para splenic enlargement.pTNM stage:PT3N0M0.The patient was in the second stage of postoperative pancreatic cancer,with a potential risk of recurrence considering the patient's postoperative body quality deviation.The patient was unable to tolerate the standard multidrug combination and underwent six cycles of single-agent gemcitabine chemotherapy from May 10,2018 to August 31,2018(the specific drug dosage was 1.4 g/d1/d8 gemcitabine injection,which was repeated every 21 days).Efficacy was determined to be stable disease after 2,4,and 6 cycles.The side effects during treatment were tolerable.CONCLUSION This case suggests that RFA can serve as a viable local treatment modality for selected patients with PCLM,offering a chance for long-term survival.Such localized interventions,when carefully tailored,may complement systemic therapies in controlling metastatic pancreatic cancer.展开更多
BACKGROUND Aging is an inevitable aspect of human life,characterized by the gradual decline in the function of individual cells and structural components,including bones,muscles,and ligaments.AIM To evaluate the clini...BACKGROUND Aging is an inevitable aspect of human life,characterized by the gradual decline in the function of individual cells and structural components,including bones,muscles,and ligaments.AIM To evaluate the clinical effects of radiofrequency technology in treating facial skin wrinkles and laxity.METHODS This study included 60 female patients,aged 36-58 years(mean age 47.71±1.56 years),who received focused radiofrequency technology treatment for facial wrinkles and laxity in the Department of Medical Cosmetology at our hospital between January 2021 and June 2022.Each patient underwent three treatment sessions,one every two months.Facial photographs were taken before treatment and one week after the final session.A single physician assessed wrinkle severity using a standardized wrinkle severity scale,and patients completed a satisfaction questionnaire one week after the last treatment.RESULTS After three consecutive radiofrequency treatments,performed every two months,patients exhibited significantly reduced wrinkles and skin laxity compared to baseline.One week after the third treatment,the mean facial wrinkle severity score had significantly decreased from 3.00±0.79 to 2.71±0.47(t=2.58,P<0.05).Additionally,88.24%of patients reported noticeable improvements in facial wrinkles and skin laxity.No serious adverse reactions occurred during or follow-ing treatment.CONCLUSION Radiofrequency technology demonstrates significant clinical efficacy in improving facial skin wrinkles and laxity.展开更多
Radiofrequency ablation(RFA)is a form of minimally invasive procedure that precisely ablates abnormal lesions or hyperplastic tissues through thermal energy generated by the radiofrequency current at the tip electrode...Radiofrequency ablation(RFA)is a form of minimally invasive procedure that precisely ablates abnormal lesions or hyperplastic tissues through thermal energy generated by the radiofrequency current at the tip electrode of the flexible catheter,which aims to partially or fully restore the function of the corresponding tissues or organs.Accurate prediction and control of thermal fields are crucial for clinical thermal ablation to ensure precise control of the ablation lesion size and prevent excessive burning of healthy tissues.In this study,an axisymmetric analytical model is developed for the electrothermal analysis of RFA in the cambered tissue surface and verified with the finite element analysis(FEA),which incorporates both the thermal field induced by the radiofrequency current and Pennes'biothermal effect.This model utilizes analytically derived electric and thermal fields to accurately predict the increase in the tissue temperature and the time-varying size of ablation lesion in the tissue.Furthermore,the parameters such as the input current density,curvature,and convective heat transfer coefficient of blood have a significant effect on the thermal field and thus the ablation lesion size.This electrothermal analytical model with a large curvature may provide a theoretical foundation and guidance for the future RFA applications on large-curvature biological surfaces,thereby enhancing accuracy,reducing the need for re-ablation,and lowering the costs associated with the design and production of ablation catheters.展开更多
BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that...BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.AIM To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation(RFA)according to the primary tumor location.METHODS This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018.The clinicopathological characteristics,recurrence patterns,and survival outcomes were systematically evaluated.RESULTS A total of 164 patients(mean age:58.0±9.8 years,range:34-83 years)who underwent percutaneous RFA of 325 CLMs(mean size:2.2±1.0 cm,range:0.7-5.0 cm)were included in the study.Eighty-nine(54.3%)patients had wild-type KRAS,and 75(45.7%)patients had mutated KRAS.Compared with wild-type patients,patients with KRAS mutations presented significantly higher local tumor progression rates(30.7%vs 14.6%,P=0.013).Among 126 patients(76.8%)who experienced post-RFA recurrence,61.6%developed intrahepatic metastases,and 53.7%developed extrahepatic metastases.Primary tumor location significantly modified KRASrelated outcomes:Compared with wild-type patients,left-sided colorectal cancer(CRC)patients with KRAS mutations presented higher intrahepatic recurrence rates(77.2%vs 52.5%,P=0.003)and shorter median intrahepatic recurrence-free survival(15 vs 25 months,P=0.007).No significant differences in KRAS expression were detected in right-sided tumors.CONCLUSION KRAS mutation status predicts differential recurrence patterns after CLM ablation,with significant prognostic implications,specifically in left-sided CRCs.These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.展开更多
BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellu...BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellular carcinoma(HCC)who AIM To compare the 3-year recurrence and survival rates among HCC patients receiving these three first-line oral anti-hepatitis B virus(anti-HBV)agents after RFA.METHODS This retrospective cohort study included patients with hepatitis B cirrhosis who were initially diagnosed with HCC at Tianjin Third Central Hospital,China,from August 2018 to December 2020,and had complete clinical data.All patients were followed up for at least 144 weeks.Cox regression analysis was performed to identify independent risk factors for HCC recurrence.Recurrence-free survival was analyzed using Kaplan-Meier curves,and Cox regression models were constructed after adjusting for gamma-glutamyl transferase,alpha-fetoprotein,and Barcelona Clinic Liver Cancer staging.RESULTS A total of 319 patients receiving oral anti-HBV therapy were divided into three groups:ETV group(n=191),TDF group(n=76),and TAF group(n=52).At 6 and 12 months,there were no significant differences in recurrence rates between the groups.However,at 24 and 36 months,the TDF and TAF groups exhibited significantly lower recurrence rates compared with the ETV group[24 months:TDF,hazard ratio(HR)=0.51,95%confidence interval(CI):0.29-0.91,P=0.022;TAF,HR=0.54,95%CI:0.28-1.03,P=0.046;36 months:TDF,HR=0.57,95%CI:0.35-0.93,P=0.025;TAF,HR=0.54,95%CI:0.31-0.96,P=0.037].The 3-year mortality rates were similar across the three groups(ETV:21.47%,TDF:18.42%,TAF:23.08%;P=0.790).CONCLUSION Among patients with hepatitis B cirrhosis-related HCC,TDF and TAF are associated with lower 2-year and 3-year HCC recurrence rates after curative RFA treatment compared with ETV.However,there were no significant differences in 3-year mortality rates between the ETV,TDF,and TAF groups.展开更多
Background Atrial fibrillation(AF)and hypertension are closely related,with hypertension being a significant risk factor for the development of AF.The aim of this study was to investigate the gender differences in the...Background Atrial fibrillation(AF)and hypertension are closely related,with hypertension being a significant risk factor for the development of AF.The aim of this study was to investigate the gender differences in the effects of radiofrequency catheter ablation(RFCA)on blood pressure regulation in patients with paroxysmal atrial fibrilla-tion(PAF)and primary hypertension.Methods This prospective cohort study included 65 patients(44 males,21 females)with PAF and primary hypertension who underwent RFCA.Blood pressure was measured preoperatively and at 3 months postoperatively using 24-hour ambulatory blood pressure monitoring.Changes in blood pressure parameters were compared between male and female patients.Results Significant gender differences were ob-served in 24-hour mean systolic blood pressure(24h SBP)and daytime mean systolic blood pressure(dSBP).In male patients,24h SBP decreased by 5.16 mmHg,and dSBP decreased by 4.30 mmHg,while female patients showed minimal changes,with a decrease of 1.44 mmHg in 24h SBP and 0.39 mmHg in dSBP.These changes were significantly different between genders(P<0.001 for 24h SBP and P=0.005 for dSBP).No significant differences were found between males and females in other blood pressure parameters(P>0.05).Conclusions RFCA signifi-cantly improved blood pressure control in male patients with PAF and primary hypertension,with more pronounced reductions in 24h SBP and dSBP compared to female patients.These findings suggested that gender may influence the effectiveness of RFCA in managing blood pressure in this population,underscoring the importance of consider-ing gender when planning treatment strategies.展开更多
Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment ...Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment is important for improving treatment strategy.This study aimed to identify the critical targets for regulating the efficacy of RFA.Methods:The RFA treatment in hepatocellular carcinoma(HCC)tumor models in vivo,was analyzed by RNA sequencing technology.The heat treatment in vitro for HCC tumor cells was also constructed to explore the mechanism after RFA treatment in tumor cells.Nanoparticles with high affinity to tumor cells were applied as a new therapy to interfere with the expression of maternal embryonic leucine zipper kinase(MELK).Results:It was found that RFA treatment upregulated MELK expression,and MELK inhibition promoted RFA efficacy by immunogenic cell death and the antitumor response,including anti-tumoral macrophage polarization and increased CD8+T cell cytotoxicity in HCC.Mechanically,MELK binds to fatty acid-binding protein 5(FABP5),and affects its ubiquitination through the K48R pathway to increase its stability,thereby activating protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling axis to weaken the RFA-mediated antitumor effect.In addition,the synthesis of arginylglycylaspartic acid(RGD)-lipid nanoparticles(LNPs)targeting tumor cell-intrinsic MELK enhanced RFA efficacy in HCC.Conclusions:MELK is a therapeutic target by regulating RFA efficacy in HCC,and targeting MELK via RGD-LNPs provides new insight into improving RFA efficacy in HCC clinical treatment and combating the malignant progression of liver cancer.展开更多
BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients w...BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.展开更多
The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter ho...The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.展开更多
BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its effic...BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.展开更多
BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving live...BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.展开更多
Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary s...Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.展开更多
BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The ...BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The recurrence after RFCA is considered closely related to inflammation.Systemic immune inflammation index(SII)is a novel inflammation predictor based on neutrophils,platelets,and lymphocytes,and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body.AIM To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF(NVAF).METHODS We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group.We also investigated the predictive role of SII on AF recurrence following RFCA.Finally,we explored and compared the additional predictive value of the SII after combining with the APPLE score.RESULTS After 12 months of follow-up,113(24.7%)patients experienced recurrence.High SII has been demonstrated to be an independent predictor for postoperative AF recurrence.Receiver operating characteristic and decision curve analysis(DCA),as well as net reclassification improvement(NRI)and integrated discrimination improvement(IDI)results,showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone.The area under the curve of the combined model(0.662,95%confidence interval:0.602-0.722)significantly increased compared with that of the SII and APPLE scores alone(P<0.001).The combined model resulted in an NRI of 29.6%and 34.1%and IDI of 4.9%and 3.5%in predicting AF recurrence compared with the SII and APPLE scores alone,respectively(all P<0.001).The SII,APPLE score,and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20–80%risk threshold according to the DCA.CONCLUSION The SII was a predictor of recurrence after RFCA of AF.Moreover,the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence,providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.展开更多
On the basis of continuous improvement in recent years,radiofrequency therapy technology has been widely developed,and has become an effective method for the treatment of various intractable pain.Radiofrequency therap...On the basis of continuous improvement in recent years,radiofrequency therapy technology has been widely developed,and has become an effective method for the treatment of various intractable pain.Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues.In order to standardize the application of radiofrequency technology in the treatment of painful diseases,Chinese Association for the Study of Pain(CASP)has developed a consensus proposed by many domestic experts and scholars.展开更多
文摘BACKGROUND Hepatocellular carcinoma(HCC)is among the most aggressive primary liver cancers,leading to significant global mortality.While early diagnosis improves prognosis,treatment decisions,particularly between surgical resection and radiofrequency ablation(RFA),remain controversial.AIM To clarify this issue using sentiment analysis of medical literature alongside a meta-analysis of overall survival(OS).METHODS We included studies comparing liver resection and RFA,excluding case reports,editorials,and studies without relevant outcomes.A systematic search in PubMed and Web of Science identified 197 studies.Abstracts underwent sentiment analysis using Python’s Natural Language Toolkit library,categorizing them as favoring resection,ablation,or neutral.We also performed a meta-analysis using a random-effects model on 11 studies reporting hazard ratios(HRs)for OS.RESULTS Sentiment analysis revealed that 75.1%of abstracts were neutral,14.2%favored resection,and 10.7%favored RFA.The meta-analysis showed a significant survival advantage for liver resection,with a pooled HR of 0.5924(95%confidence interval:0.540-0.649).Heterogeneity was moderate(I²=39.98%).Despite the meta-analysis demonstrating clear survival benefits of liver resection,most abstracts maintained a neutral stance.This discrepancy highlights potential biases or hesitancy in drawing definitive conclusions.CONCLUSION The study emphasizes the need for clinicians to prioritize robust statistical evidence over narrative impressions.Liver resection remains the preferred treatment for HCC in eligible patients.
文摘Pancreatic neoplasms present a significant therapeutic challenge due to their complex anatomy and poor prognosis.In recent years,endoscopic ultrasound guided radiofrequency ablation(EUS-RFA)has emerged as a promising minimally invasive therapeutic option,aiming to provide targeted treatment with improved patients’outcomes.This review aims to shed light on current evidence about the efficacy,safety,and clinical outcomes of EUS-RFA in the management of pancreatic neoplasms.We conducted a comprehensive search of literature,reviewing studies that document the application of EUS-RFA in pancreatic masses.The key metrics for efficacy included tumor size reduction,pain relief,and overall survival,while safety outcomes focused on procedural complications and post-operative recovery.EUS-RFA has demonstrated potential in effectively managing both benign and malignant pancreatic neoplasms,with several studies reporting significant reductions in tumor size and symptomatic relief.The technique is associated with a favorable safety profile,characterized by a low incidence of major complications.EUS-RFA represents a valuable addition to the therapeutic arsenal for pancreatic neoplasms,offering a viable alternative to surgical interventions,especially in patients with contraindications for surgery.Further studies are needed to establish standardized protocols and long-term outcomes,enhancing its applicability and success in clinical practice.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide.Transarterial chemoembolization(TACE)combined with percutaneous radiofrequency ablation(RFA)has emerged as a promising treatment strategy for patients with unresectable HCC.AIM To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.METHODS A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024,involving 106 patients diagnosed with intermediate to advanced-stage HCC.Patients were divided into two groups:Those receiving TACE alone(n=56)and those undergoing combined TACE and RFA therapy(n=50).Treatment efficacy was assessed based on tumor response rates,serum alphafetoprotein(AFP)levels,and survival outcomes.Statistical analyses,includingχ^(2)tests and Kaplan-Meier survival analysis,were performed to compare the outcomes between the two groups.RESULTS The TACE+RFA group demonstrated significantly higher rates of complete response(15 vs 4,P<0.01)and partial response(23 vs 15,P=0.046)compared to the TACE group.Conversely,the TACE group exhibited higher rates of stable disease(25 vs 7,P<0.01)and progressive disease(12 vs 5,P<0.01).Serum AFP levels decreased over time in the TACE+RFA group,while they increased in the TACE group.Survival analysis revealed superior survival outcomes in the TACE+RFA group,with higher survival rates and a prolonged median survival time compared to the TACE group.CONCLUSION The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone.These findings might support the adoption of multimodal therapeutic approaches,emphasizing the importance of personalized treatment strategies in the management of HCC.
基金supported by the 2024 University Scientific Research Project of Guangzhou Education Bureau(Project No.24312286Certificate No.gd20249983112).
文摘Objective: To evaluate the efficacy of endovenous radiofrequency ablation (RFA) and laser ablation (EVLA) in the treatment of superficial varicose veins of the lower extremities. Methods: Seventy-eight patients with superficial varicose veins treated at a hospital between April 2022 and May 2023 were selected and divided into a radiofrequency ablation group (RFA group;39 cases) and a laser ablation group (EVLA group;39 cases) based on the treatment method. Operation time, postoperative recovery duration, venous clinical severity score (VCSS) changes, complication rates, closure rates, and recurrence rates were compared between the groups at 1 month, 3 months, and 12 months postoperatively. The postoperative therapeutic outcomes were comprehensively evaluated. Results: No significant differences in age, gender, disease grade, or disease course were observed between the groups (P > 0.05). The superficial varicose vein closure rate was 100% in both groups at 1 and 3 months postoperatively. At 12 months, the closure rate was 94.87% in the RFA group and 97.43% in the EVLA group, with no statistically significant difference (P > 0.05). No significant differences were observed in VCSS changes or complication incidence between the groups (P > 0.05). Conclusion: Radiofrequency ablation and laser ablation demonstrate comparable efficacy and safety in the treatment of superficial varicose veins of the lower extremities.
文摘The recurrence of atrial fibrillation(AF)in patients after successful radiofrequency catheter ablation(RFCA)appears to be an unresolved clinical issue and needs to be clearly elucidated.There are many factors associated with AF recurrence,such as duration of AF,male sex,concomitant heart failure,hemodynamic parameters,chronic obstructive pulmonary disease,hypertension,obstructive sleep apnea,hyperthyroidism,smoking and obesity.However,the inflammatory changes are strongly associated with electrical and structural cardiac remodeling,cardiac damage,myocardial fibrotic changes,microvascular dysfunction and altered reparative response.In this context,biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation.The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation(SII)index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE.Furthermore,the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach.In conclusion,the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.
文摘Objective: To assess the predictors of successful inactivation of benign thyroid nodules using radiofrequency ablation (RFA) and the hormonal responses thereafter. Methods: A retrospective study conducted at Zhongnan Hospital of Wuhan University (January 2022 to January 2024) analysed thyroid tumor characteristics using B-mode ultrasound, colour Doppler imaging, and CEUS post-RFA. Thyroid hormone levels were also assessed before RFA and at 1, 3, and 6 months after the procedure. Results: The study involved 72 patients with benign thyroid nodules, comprising 13 males and 59 females, with a mean age of 45.8 ± 12.1 years. Complete inactivation was achieved in 70.8% of nodules, while 29.2% showed partial inactivation. Nodules with complete inactivation exhibited more calcification (p = 0.040), whereas those with partial inactivation demonstrated higher vascularity (p Conclusion: In conclusion, this study found that therapeutic RFA effectively achieves high rates of complete inactivation in benign thyroid nodules, with the degree of inactivation mainly influenced by nodule vascularity and calcifications.
文摘BACKGROUND According to the GLOBCAN2022 database,pancreatic cancer has become the 6th leading cause of cancer-related death worldwide.The latest statistics suggest that the incidence of pancreatic cancer is increasing at a rate of 0.5%to 1.0%per year,and it is expected to become the 2nd leading cause of tumor-related deaths in the United States by 2030.More than 50%of pancreatic cancer patients have already developed distant metastases at the time of diagnosis,with the liver being the most common site.Patients with pancreatic cancer with liver metastasis(PCLM)have a worse prognosis than those with locally progressed pancreatic cancer,with a median survival of less than six months.Therefore,the outcome of liver metastases is often a vital determinant of the prognosis of patients with PCLM.There are few successful cases of localized treatment for PCLM patients.Our department recently performed local radiofrequency ablation(RFA)treatment for a PCLM patient through an evidence-based medicine approach,with remarkable therapeutic effects.CASE SUMMARY The patient was admitted to the hospital on May 03,2018,3 weeks after pancreatic cancer surgery.In October 2017,the patient presented with lower back pain.No abnormalities were detected via computed tomography(CT),colonoscopy,or gastroscopy.However,on March 18,2018,the patient was investigated in a foreign hospital via CT,which suggested occupational lesions in the descending part of the duodenum,and magnetic resonance imaging suggested pancreatic occupancy.He was considered to be suffering from pancreatic cancer.He underwent laparoscopic-assisted pancreatic+duodenum+superior mesenteric vein partial resection and reconstruction under general anesthesia on March 26,2018 at The Affiliated Hospital of Xuzhou Medical University.The pancreas and duodenum were partially resected.Postoperative pathology showed adenocarcinoma of the pancreas(moderately differentiated),partly mucinous carcinoma,invading the mucosal layer of the duodenum;the tumor size was 4.5 cm×4 cm×4 cm.There was no apparent nerve or vascular invasion.There was no cancer or involvement of the pancreas section or expected hepatic duct margins.There was no cancer involvement in the gastric and duodenal sections.There was no cancer metastasis to the peripheral lymph nodes of the pancreas(0/9).No metastasis to the gastric lesser curvature or more significant curvature lymph nodes(0/1,0/5)was detected,and the peri-intestinal lymph nodes showed no cancer metastasis(0/4).Although the gallbladder showed signs of chronic cholecystitis,there was no cancer involvement,and the lymph nodes in Groups 12 and 13 also showed no cancer metastasis(0/6,0/1).His postoperative recovery was acceptable.CT was performed on May 2018 at our hospital and found the following:(1)Double lung bronchial vascular bundles slightly heavier than normal;(2)Postoperative changes in the pancreas and a retention tube shadow in front of the head of the pancreas;(3)Small cysts in the right lobe of the liver;(4)Abdominopelvic effusion;and(5)Para splenic enlargement.pTNM stage:PT3N0M0.The patient was in the second stage of postoperative pancreatic cancer,with a potential risk of recurrence considering the patient's postoperative body quality deviation.The patient was unable to tolerate the standard multidrug combination and underwent six cycles of single-agent gemcitabine chemotherapy from May 10,2018 to August 31,2018(the specific drug dosage was 1.4 g/d1/d8 gemcitabine injection,which was repeated every 21 days).Efficacy was determined to be stable disease after 2,4,and 6 cycles.The side effects during treatment were tolerable.CONCLUSION This case suggests that RFA can serve as a viable local treatment modality for selected patients with PCLM,offering a chance for long-term survival.Such localized interventions,when carefully tailored,may complement systemic therapies in controlling metastatic pancreatic cancer.
文摘BACKGROUND Aging is an inevitable aspect of human life,characterized by the gradual decline in the function of individual cells and structural components,including bones,muscles,and ligaments.AIM To evaluate the clinical effects of radiofrequency technology in treating facial skin wrinkles and laxity.METHODS This study included 60 female patients,aged 36-58 years(mean age 47.71±1.56 years),who received focused radiofrequency technology treatment for facial wrinkles and laxity in the Department of Medical Cosmetology at our hospital between January 2021 and June 2022.Each patient underwent three treatment sessions,one every two months.Facial photographs were taken before treatment and one week after the final session.A single physician assessed wrinkle severity using a standardized wrinkle severity scale,and patients completed a satisfaction questionnaire one week after the last treatment.RESULTS After three consecutive radiofrequency treatments,performed every two months,patients exhibited significantly reduced wrinkles and skin laxity compared to baseline.One week after the third treatment,the mean facial wrinkle severity score had significantly decreased from 3.00±0.79 to 2.71±0.47(t=2.58,P<0.05).Additionally,88.24%of patients reported noticeable improvements in facial wrinkles and skin laxity.No serious adverse reactions occurred during or follow-ing treatment.CONCLUSION Radiofrequency technology demonstrates significant clinical efficacy in improving facial skin wrinkles and laxity.
基金Project supported by the National Natural Science Foundation of China(Nos.U23A20111 and 12372160)。
文摘Radiofrequency ablation(RFA)is a form of minimally invasive procedure that precisely ablates abnormal lesions or hyperplastic tissues through thermal energy generated by the radiofrequency current at the tip electrode of the flexible catheter,which aims to partially or fully restore the function of the corresponding tissues or organs.Accurate prediction and control of thermal fields are crucial for clinical thermal ablation to ensure precise control of the ablation lesion size and prevent excessive burning of healthy tissues.In this study,an axisymmetric analytical model is developed for the electrothermal analysis of RFA in the cambered tissue surface and verified with the finite element analysis(FEA),which incorporates both the thermal field induced by the radiofrequency current and Pennes'biothermal effect.This model utilizes analytically derived electric and thermal fields to accurately predict the increase in the tissue temperature and the time-varying size of ablation lesion in the tissue.Furthermore,the parameters such as the input current density,curvature,and convective heat transfer coefficient of blood have a significant effect on the thermal field and thus the ablation lesion size.This electrothermal analytical model with a large curvature may provide a theoretical foundation and guidance for the future RFA applications on large-curvature biological surfaces,thereby enhancing accuracy,reducing the need for re-ablation,and lowering the costs associated with the design and production of ablation catheters.
基金Supported by Capital Health Development Research Project,No.2020-2-2152National Natural Science Foundation of China,No.82472002.
文摘BACKGROUND KRAS mutation status and primary tumor location serve as critical prognostic factors for colorectal liver metastases(CLMs).Emerging evidence suggests a potential interaction between these two variables that may influence clinical outcomes.AIM To investigate the association of KRAS mutations with recurrence in patients with CLM who underwent radiofrequency ablation(RFA)according to the primary tumor location.METHODS This retrospective study analyzed 164 patients with KRAS-determined CLM treated with percutaneous RFA between January 2012 and December 2018.The clinicopathological characteristics,recurrence patterns,and survival outcomes were systematically evaluated.RESULTS A total of 164 patients(mean age:58.0±9.8 years,range:34-83 years)who underwent percutaneous RFA of 325 CLMs(mean size:2.2±1.0 cm,range:0.7-5.0 cm)were included in the study.Eighty-nine(54.3%)patients had wild-type KRAS,and 75(45.7%)patients had mutated KRAS.Compared with wild-type patients,patients with KRAS mutations presented significantly higher local tumor progression rates(30.7%vs 14.6%,P=0.013).Among 126 patients(76.8%)who experienced post-RFA recurrence,61.6%developed intrahepatic metastases,and 53.7%developed extrahepatic metastases.Primary tumor location significantly modified KRASrelated outcomes:Compared with wild-type patients,left-sided colorectal cancer(CRC)patients with KRAS mutations presented higher intrahepatic recurrence rates(77.2%vs 52.5%,P=0.003)and shorter median intrahepatic recurrence-free survival(15 vs 25 months,P=0.007).No significant differences in KRAS expression were detected in right-sided tumors.CONCLUSION KRAS mutation status predicts differential recurrence patterns after CLM ablation,with significant prognostic implications,specifically in left-sided CRCs.These findings underscore the importance of integrating molecular profiling and primary tumor characteristics in therapeutic decision-making for patients with metastatic CRC.
基金Supported by Tianjin Health Project of China,No.TJWJ2022XK029.
文摘BACKGROUND The impact of entecavir(ETV),tenofovir disoproxil fumarate(TDF),and tenofovir alafenamide fumarate(TAF)on long-term recurrence and overall survival in patients with hepatitis B cirrhosis-related hepatocellular carcinoma(HCC)who AIM To compare the 3-year recurrence and survival rates among HCC patients receiving these three first-line oral anti-hepatitis B virus(anti-HBV)agents after RFA.METHODS This retrospective cohort study included patients with hepatitis B cirrhosis who were initially diagnosed with HCC at Tianjin Third Central Hospital,China,from August 2018 to December 2020,and had complete clinical data.All patients were followed up for at least 144 weeks.Cox regression analysis was performed to identify independent risk factors for HCC recurrence.Recurrence-free survival was analyzed using Kaplan-Meier curves,and Cox regression models were constructed after adjusting for gamma-glutamyl transferase,alpha-fetoprotein,and Barcelona Clinic Liver Cancer staging.RESULTS A total of 319 patients receiving oral anti-HBV therapy were divided into three groups:ETV group(n=191),TDF group(n=76),and TAF group(n=52).At 6 and 12 months,there were no significant differences in recurrence rates between the groups.However,at 24 and 36 months,the TDF and TAF groups exhibited significantly lower recurrence rates compared with the ETV group[24 months:TDF,hazard ratio(HR)=0.51,95%confidence interval(CI):0.29-0.91,P=0.022;TAF,HR=0.54,95%CI:0.28-1.03,P=0.046;36 months:TDF,HR=0.57,95%CI:0.35-0.93,P=0.025;TAF,HR=0.54,95%CI:0.31-0.96,P=0.037].The 3-year mortality rates were similar across the three groups(ETV:21.47%,TDF:18.42%,TAF:23.08%;P=0.790).CONCLUSION Among patients with hepatitis B cirrhosis-related HCC,TDF and TAF are associated with lower 2-year and 3-year HCC recurrence rates after curative RFA treatment compared with ETV.However,there were no significant differences in 3-year mortality rates between the ETV,TDF,and TAF groups.
文摘Background Atrial fibrillation(AF)and hypertension are closely related,with hypertension being a significant risk factor for the development of AF.The aim of this study was to investigate the gender differences in the effects of radiofrequency catheter ablation(RFCA)on blood pressure regulation in patients with paroxysmal atrial fibrilla-tion(PAF)and primary hypertension.Methods This prospective cohort study included 65 patients(44 males,21 females)with PAF and primary hypertension who underwent RFCA.Blood pressure was measured preoperatively and at 3 months postoperatively using 24-hour ambulatory blood pressure monitoring.Changes in blood pressure parameters were compared between male and female patients.Results Significant gender differences were ob-served in 24-hour mean systolic blood pressure(24h SBP)and daytime mean systolic blood pressure(dSBP).In male patients,24h SBP decreased by 5.16 mmHg,and dSBP decreased by 4.30 mmHg,while female patients showed minimal changes,with a decrease of 1.44 mmHg in 24h SBP and 0.39 mmHg in dSBP.These changes were significantly different between genders(P<0.001 for 24h SBP and P=0.005 for dSBP).No significant differences were found between males and females in other blood pressure parameters(P>0.05).Conclusions RFCA signifi-cantly improved blood pressure control in male patients with PAF and primary hypertension,with more pronounced reductions in 24h SBP and dSBP compared to female patients.These findings suggested that gender may influence the effectiveness of RFCA in managing blood pressure in this population,underscoring the importance of consider-ing gender when planning treatment strategies.
基金supported by the National Natural Science Foundation of China(82072025,82072026,82102162,and 82303886)the“Leading Goose”Research and Development Program of Zhejiang Province(2023C03062)+1 种基金the National Natural Science Foundation of Zhejiang Province(LY22H160040 and LQ22H180010)the Key Research and Development Project of Lishui City(2022ZDYF12,2022ZDYF20,and 2022ZDYF20).
文摘Background:Radiofrequency ablation(RFA)is an efficient treatment with unlimited potential for liver cancer that can effectively reduce patient mortality.Understanding the biological process related with RFA treatment is important for improving treatment strategy.This study aimed to identify the critical targets for regulating the efficacy of RFA.Methods:The RFA treatment in hepatocellular carcinoma(HCC)tumor models in vivo,was analyzed by RNA sequencing technology.The heat treatment in vitro for HCC tumor cells was also constructed to explore the mechanism after RFA treatment in tumor cells.Nanoparticles with high affinity to tumor cells were applied as a new therapy to interfere with the expression of maternal embryonic leucine zipper kinase(MELK).Results:It was found that RFA treatment upregulated MELK expression,and MELK inhibition promoted RFA efficacy by immunogenic cell death and the antitumor response,including anti-tumoral macrophage polarization and increased CD8+T cell cytotoxicity in HCC.Mechanically,MELK binds to fatty acid-binding protein 5(FABP5),and affects its ubiquitination through the K48R pathway to increase its stability,thereby activating protein kinase B(Akt)/mammalian target of rapamycin(mTOR)signaling axis to weaken the RFA-mediated antitumor effect.In addition,the synthesis of arginylglycylaspartic acid(RGD)-lipid nanoparticles(LNPs)targeting tumor cell-intrinsic MELK enhanced RFA efficacy in HCC.Conclusions:MELK is a therapeutic target by regulating RFA efficacy in HCC,and targeting MELK via RGD-LNPs provides new insight into improving RFA efficacy in HCC clinical treatment and combating the malignant progression of liver cancer.
文摘BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001(to Peng CM and Liu YJ)Taiwan National Science and Technology Council,No.111-2314-B-035-001-MY3Taichung Armed Forces General Hospital,No.107A42.
文摘The management of early stage hepatocellular carcinoma(HCC)presents significant challenges.While radiofrequency ablation(RFA)has shown safety and effectiveness in treating HCC,with lower mortality rates and shorter hospital stays,its high recurrence rate remains a significant impediment.Consequently,achieving improved survival solely through RFA is challenging,particularly in retrospective studies with inherent biases.Ultrasound is commonly used for guiding percutaneous RFA,but its low contrast can lead to missed tumors and the risk of HCC recurrence.To enhance the efficiency of ultrasound-guided percutaneous RFA,various techniques such as artificial ascites and contrast-enhanced ultrasound have been developed to facilitate complete tumor ablation.Minimally invasive surgery(MIS)offers advantages over open surgery and has gained traction in various surgical fields.Recent studies suggest that laparoscopic intraoperative RFA(IORFA)may be more effective than percutaneous RFA in terms of survival for HCC patients unsuitable for surgery,highlighting its significance.Therefore,combining MIS-IORFA with these enhanced percutaneous RFA techniques may hold greater significance for HCC treatment using the MIS-IORFA approach.This article reviews liver resection and RFA in HCC treatment,comparing their merits and proposing a trajectory involving their combination in future therapy.
文摘BACKGROUND The recurrence rate of liver cancer after surgery is high.Radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)is an effective treatment for liver cancer;however,its efficacy in recurrent liver cancer remains unclear.AIM To investigate the clinical effect of TACE combined with RFA in the treatment of recurrent liver cancer.METHODS Ninety patients with recurrent liver cancer were divided into 2 groups according to treatment plan:Control(RFA alone);and experimental[TACE combined with RFA(TACE+RFA)].The incidence of increased alanine aminotransferase levels,complications,and other indices were compared between the two groups before and after the procedures.RESULTS One month after the procedures,the short-term efficacy rate and Karnofsky Performance Status scores of the experimental group were significantly higher than those of the control group(P<0.05).Alpha-fetoprotein(AFP)and total bilirubin levels were lower than those in the control group(P<0.05);The overall response rate was 82.22%and 66.67%in the experimental and control groups,respectively;The disease control rate was 93.33%and 82.22%in the experimental and control groups,respectively,the differences are statistically significant(P<0.05).And there were no statistical differences in complications between the two groups(P>0.05).CONCLUSION TACE+RFA was effective for the treatment of recurrent liver cancer and significantly reduced AFP levels and improved various indices of liver function.
文摘BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.
文摘Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.
基金grateful for the clinical data provided by the Department of Cardiology of Weifang People’s Hospital.
文摘BACKGROUND Radiofrequency catheter ablation(RFCA)has become an important strategy for treating atrial fibrillation(AF),and postoperative recurrence represents a significant and actively discussed clinical concern.The recurrence after RFCA is considered closely related to inflammation.Systemic immune inflammation index(SII)is a novel inflammation predictor based on neutrophils,platelets,and lymphocytes,and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body.AIM To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF(NVAF).METHODS We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group.We also investigated the predictive role of SII on AF recurrence following RFCA.Finally,we explored and compared the additional predictive value of the SII after combining with the APPLE score.RESULTS After 12 months of follow-up,113(24.7%)patients experienced recurrence.High SII has been demonstrated to be an independent predictor for postoperative AF recurrence.Receiver operating characteristic and decision curve analysis(DCA),as well as net reclassification improvement(NRI)and integrated discrimination improvement(IDI)results,showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone.The area under the curve of the combined model(0.662,95%confidence interval:0.602-0.722)significantly increased compared with that of the SII and APPLE scores alone(P<0.001).The combined model resulted in an NRI of 29.6%and 34.1%and IDI of 4.9%and 3.5%in predicting AF recurrence compared with the SII and APPLE scores alone,respectively(all P<0.001).The SII,APPLE score,and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20–80%risk threshold according to the DCA.CONCLUSION The SII was a predictor of recurrence after RFCA of AF.Moreover,the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence,providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.
文摘On the basis of continuous improvement in recent years,radiofrequency therapy technology has been widely developed,and has become an effective method for the treatment of various intractable pain.Radiofrequency therapy is a technique that uses special equipment and puncture needles to output ultra-high frequency radio waves and accurately act on local tissues.In order to standardize the application of radiofrequency technology in the treatment of painful diseases,Chinese Association for the Study of Pain(CASP)has developed a consensus proposed by many domestic experts and scholars.
