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Sample records for hifu therapy system

  1. High-intensity focused ultrasound (HIFU) array system for image-guided ablative therapy (IGAT)

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    Kaczkowski, Peter J.; Keilman, George W.; Cunitz, Bryan W.; Martin, Roy W.; Vaezy, Shahram; Crum, Lawrence A.

    2003-06-01

    Recent interest in using High Intensity Focused Ultrasound (HIFU) for surgical applications such as hemostasis and tissue necrosis has stimulated the development of image-guided systems for non-invasive HIFU therapy. Seeking an all-ultrasound therapeutic modality, we have developed a clinical HIFU system comprising an integrated applicator that permits precisely registered HIFU therapy delivery and high quality ultrasound imaging using two separate arrays, a multi-channel signal generator and RF amplifier system, and a software program that provides the clinician with a graphical overlay of the ultrasound image and therapeutic protocol controls. Electronic phasing of a 32 element 2 MHz HIFU annular array allows adjusting the focus within the range of about 4 to 12 cm from the face. A central opening in the HIFU transducer permits mounting a commercial medical imaging scanhead (ATL P7-4) that is held in place within a special housing. This mechanical fixture ensures precise coaxial registration between the HIFU transducer and the image plane of the imaging probe. Recent enhancements include development of an acoustic lens using numerical simulations for use with a 5-element array. Our image-guided therapy system is very flexible and enables exploration of a variety of new HIFU therapy delivery and monitoring approaches in the search for safe, effective, and efficient treatment protocols.

  2. Adaptive HIFU noise cancellation for simultaneous therapy and imaging using an integrated HIFU/imaging transducer

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    Jeong, Jong Seob; Cannata, Jonathan Matthew; Shung, K Kirk [Department of Biomedical Engineering, NIH Resource Center for Medical Ultrasonic Transducer Technology, University of Southern California, Los Angeles, CA (United States)], E-mail: jongsjeo@usc.edu

    2010-04-07

    It was previously demonstrated that it is feasible to simultaneously perform ultrasound therapy and imaging of a coagulated lesion during treatment with an integrated transducer that is capable of high intensity focused ultrasound (HIFU) and B-mode ultrasound imaging. It was found that coded excitation and fixed notch filtering upon reception could significantly reduce interference caused by the therapeutic transducer. During HIFU sonication, the imaging signal generated with coded excitation and fixed notch filtering had a range side-lobe level of less than -40 dB, while traditional short-pulse excitation and fixed notch filtering produced a range side-lobe level of -20 dB. The shortcoming is, however, that relatively complicated electronics may be needed to utilize coded excitation in an array imaging system. It is for this reason that in this paper an adaptive noise canceling technique is proposed to improve image quality by minimizing not only the therapeutic interference, but also the remnant side-lobe 'ripples' when using the traditional short-pulse excitation. The performance of this technique was verified through simulation and experiments using a prototype integrated HIFU/imaging transducer. Although it is known that the remnant ripples are related to the notch attenuation value of the fixed notch filter, in reality, it is difficult to find the optimal notch attenuation value due to the change in targets or the media resulted from motion or different acoustic properties even during one sonication pulse. In contrast, the proposed adaptive noise canceling technique is capable of optimally minimizing both the therapeutic interference and residual ripples without such constraints. The prototype integrated HIFU/imaging transducer is composed of three rectangular elements. The 6 MHz center element is used for imaging and the outer two identical 4 MHz elements work together to transmit the HIFU beam. Two HIFU elements of 14.4 mm x 20.0 mm dimensions

  3. HIFU as a Neoadjuvant Therapy in Cancer Treatment

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    Zhong, P.; Xing, F.; Huang, X.; Zhu, H.; Lo, H. W.; Zhong, X.; Pruitt, S.; Robertson, C.

    2011-09-01

    To broaden the application spectrum of HIFU in cancer therapy, we performed a pilot experiment to evaluate the potential of using HIFU as a neoadjuvant therapy prior to surgery. Mice bearing wild-type B16F10 melanoma inoculated subcutaneously were either untreated (control) or treated by HIFU, CPA-7 or HIFU+CPA-7 before surgical resection of the primary tumor two days after HIFU treatment. The animals were then followed for four weeks or up to the humane endpoint to determine local recurrence, distant metastasis, and survival rate. The results demonstrate that animals treated by HIFU+CPA-7 (which is a small molecule that suppresses STAT3 activity) had a significantly lower recurrence rate, and slower growth of the recurrent tumor, with concomitantly higher survival rate, followed by those treated with CPA-7 and HIFU, respectively. Immunological assays revealed that CPA-7 treatment could significantly lower STAT3, and subsequently, Treg activities. In particular, the combination of HIFU and CPA-7 can induce a much stronger anti-tumor immune response than HIFU or surgery alone, as assessed by CTL and IFN-γ secretion. Overall, our results suggest that HIFU in combination with immunotherapy strategies has the potential to be used as a neoadjuvant therapy to prime the host with a strong anti-tumor immune response before surgical resection of the primary tumor. This multimodality, combinational therapy has the potential to greatly broaden the range of HIFU applications in cancer therapy with lower tumor recurrence and improved survival rate.

  4. 2ND International Symposium on HIFU Therapy "HIFU Seattle 2002"

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    2002-12-01

    Drug Delivery, and Sonodynamic Therapy. One can see from this topic coverage that the symposium was largely on HIFU (essentially the first five topics), yet also broad enough to cover most aspects of therapeutic ultrasound.

  5. [Framework design of MRI guided phased HIFU system and software development].

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    Ma, Ruifeng; Shen, Guofeng; Qiao, Shan; Wei, Bo; Chen, Sheng; Chen, Yazhu

    2013-03-01

    This paper introduced a new structure of MRI guided P-HIFU therapy system and software implementation based on the current P-HIFU system and interface provided by MRI vendor. The tests showed that the system's software can achieve the appropriate form of treatment need.

  6. PREVENTION OF DYSURIA AFTER HIFU THERAPY FOR PROSTATE CANCER

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    A. Yu. Shestaev

    2014-07-01

    Full Text Available Objective: to identify factors for the development of dysuria and its prevention in patients with prostate cancer (PC after high-intensity focused ultrasound (HIFU therapy.Subjects and methods. In September 2008 to June 2013, the Clinic of Urology, S.M. Kirov Military Medical Academy, treated 98 patients, by performing HIFU sessions on an Ablatherm apparatus (EDAP, France. All the patients underwent transurethral resection of the prostate (TURP to reduce the volume of the ablated tissue. The patients were divided into 2 groups: 1 29 patients underwent TURP 3 days before HIFU therapy; 2 69 did this 1 month before major surgery. Each group was divided into 2 subgroups: 1 after ultrasound ablation, a urethral catheter was inserted for 10 days; 2 epicystostoma was applied, followed by its overlapping on day 3 postablation and spontaneous urination. The postoperative incidence of dysuria was estimated from subjective (complaints, voiding diary, and Inter-national Prostate Symptom Score and objective (uroflowmetry, small pelvic ultrasonography with determination of residual urine volume criteria.Results. In the patients who had undergone TURP one month before HIFU therapy, grades I–II urinary incontinence and urethral pros-tatic stricture occurred much less infrequently than in those who had undergone this maneuver 3 days prior to major surgery. Urinary in-continence and urethral prostatic stricture occurred 2-fold more frequently after TURP being carried out 3 days before HIFU therapy than after the urethral catheter being inserted. TURP performed one month before HIFU therapy showed no great difference in the incidence complications regardless of the type of bladder drainage.Conclusion. The short interval between TURP and HIFU therapy for PC increases the risk of postoperative dysuric events. The optimal time to perform TURP prior to HIFU therapy is 1 month.

  7. PREVENTION OF DYSURIA AFTER HIFU THERAPY FOR PROSTATE CANCER

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    A. Yu. Shestaev

    2014-01-01

    Full Text Available Objective: to identify factors for the development of dysuria and its prevention in patients with prostate cancer (PC after high-intensity focused ultrasound (HIFU therapy.Subjects and methods. In September 2008 to June 2013, the Clinic of Urology, S.M. Kirov Military Medical Academy, treated 98 patients, by performing HIFU sessions on an Ablatherm apparatus (EDAP, France. All the patients underwent transurethral resection of the prostate (TURP to reduce the volume of the ablated tissue. The patients were divided into 2 groups: 1 29 patients underwent TURP 3 days before HIFU therapy; 2 69 did this 1 month before major surgery. Each group was divided into 2 subgroups: 1 after ultrasound ablation, a urethral catheter was inserted for 10 days; 2 epicystostoma was applied, followed by its overlapping on day 3 postablation and spontaneous urination. The postoperative incidence of dysuria was estimated from subjective (complaints, voiding diary, and Inter-national Prostate Symptom Score and objective (uroflowmetry, small pelvic ultrasonography with determination of residual urine volume criteria.Results. In the patients who had undergone TURP one month before HIFU therapy, grades I–II urinary incontinence and urethral pros-tatic stricture occurred much less infrequently than in those who had undergone this maneuver 3 days prior to major surgery. Urinary in-continence and urethral prostatic stricture occurred 2-fold more frequently after TURP being carried out 3 days before HIFU therapy than after the urethral catheter being inserted. TURP performed one month before HIFU therapy showed no great difference in the incidence complications regardless of the type of bladder drainage.Conclusion. The short interval between TURP and HIFU therapy for PC increases the risk of postoperative dysuric events. The optimal time to perform TURP prior to HIFU therapy is 1 month.

  8. TU-A-210-00: HIFU Therapies - A Primer

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    NONE

    2015-06-15

    High-intensity focused ultrasound (HIFU) has developed rapidly in recent years and is used frequently for clinical treatments in Asia and Europe with increasing clinical use and clinical trial activity in the US, making it an important medical technology with which the medical physics community must become familiar. Akin to medical devices that deliver treatments using ionizing radiation, HIFU relies on emitter geometry to non-invasively form a tight focus that can be used to affect diseased tissue while leaving healthy tissue intact. HIFU is unique in that it does not involve the use of ionizing radiation, it causes thermal necrosis in 100% of the treated tissue volume, and it has an immediate treatment effect. However, because it is an application of ultrasound energy, HIFU interacts strongly with tissue interfaces, which makes treatment planning challenging. In order to appreciate the advantages and disadvantages of HIFU as a thermal therapy, it is important to understand the underlying physics of ultrasound tissue interactions. The first lecture in the session will provide an overview of the physics of ultrasound wave propagation; the mechanism for the accumulation of heat in soft-tissue; image-guidance modalities including temperature monitoring; current clinical applications and commercial devices; active clinical trials; alternate mechanisms of action (future of FUS). The second part of the session will compare HIFU to existing ionization radiation techniques. The difficulties in defining a clear concept of absorbed dose for HIFU will be discussed. Some of the technical challenges that HIFU faces will be described, with an emphasis on how the experience of radiation oncology physicists could benefit the field. Learning Objectives: Describe the basic physics and biology of HIFU, including treatment delivery and image guidance techniques. Summarize existing and emerging clinical applications and manufacturers for HIFU. Understand that thermal ablation with

  9. HIFU therapy for patients with high risk prostate cancer

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    Solovov, V. A.; Vozdvizhenskiy, M. O.; Matysh, Y. S.

    2017-03-01

    Objectives. Patients with high-risk prostate cancer undergoing radical prostatectomy, external beam radiation therapy (EBRT) combined with androgen deprivation therapy (ADT) or ADT alone. The widely accepted definition of high-risk prostate was first proposed by D'Amico based on a pretreatment Gleason score of ≥8, clinical stage T3, PSA level ≥20 ng/mL. There is no trial that compares traditional methods of treatment of such patients with HIFU therapy. Here we explored the effectiveness of the HIFU in multimodal treatment for patients with high risk prostate cancer. Materials & Methods. 701 patients with high risk prostate cancer were treated in our center between September 2007 and December 2013. Gleason score were 8-10, stage T3N0M0, age 69 (58-86) years, mean PSA before treatment 43.3 (22.1-92.9) ng/ml, mean prostate volume - 59.3 (38-123) cc. 248 patients were treated by HIFU. We compare this group of patients with patients who undertook EBRT: number 196, and ADT: number 257. Mean follow-up time 58 months (6-72). Results. The 5-year overall survival rates in patients after HIFU were 73.8 %, after EBRT - 63.0 % and after ADT - 18.1%. Conclusions. Our experience showed that HIFU therapy in combined treatment were successful for high risk prostate cancer.

  10. THE POSSIBILITY OF HIFU THERAPY AT THE PRESENT STAGE

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    E. A. Suleimanov

    2016-01-01

    Full Text Available Writing this article is prompted by growing interest in the technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU, which, in turn, is associated with a wide range of potential points of use, minimal invasiveness of this method, minimal impact on the patient’s body, characterized by a short period of rehabilitation. Also, this treatment method has a high reproducibility, which in turn contributes to the rapid spread of HIFU therapy in practice. The review is devoted to the history of development, study and application of the method of ultrasonic ablation, the modern view on how to conduct HIFU therapy, the currently available technical possibilities for non-invasive high-intensity focused ultrasound therapy as well as demonstrate the effectiveness of this treatment in patients with malignant and benign tumors of different localization, as in a standalone version or in combination with other treatment options (surgery, drug therapy, radiation therapy, an attempt to systematize the early and remote results of treatment. The article represents the data of world and national literature. One of the important directions of the study of the described technique is an expansion of possible application in various malignant pathologies, both local and generalized nature of the lesion. A separate item is the application of HIFU therapy in the treatment of chronic pain syndrome.

  11. Motion tracing system for ultrasound guided HIFU

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    Xiao, Xu; Jiang, Tingyi; Corner, George; Huang, Zhihong

    2017-03-01

    One main limitation in HIFU treatment is the abdominal movement in liver and kidney caused by respiration. The study has set up a tracking model which mainly compromises of a target carrying box and a motion driving balloon. A real-time B-mode ultrasound guidance method suitable for tracking of the abdominal organ motion in 2D was established and tested. For the setup, the phantoms mimicking moving organs are carefully prepared with agar surrounding round-shaped egg-white as the target of focused ultrasound ablation. Physiological phantoms and animal tissues are driven moving reciprocally along the main axial direction of the ultrasound image probe with slightly motion perpendicular to the axial direction. The moving speed and range could be adjusted by controlling the inflation and deflation speed and amount of the balloon driven by a medical ventilator. A 6-DOF robotic arm was used to position the focused ultrasound transducer. The overall system was trying to estimate to simulate the actual movement caused by human respiration. HIFU ablation experiments using phantoms and animal organs were conducted to test the tracking effect. Ultrasound strain elastography was used to post estimate the efficiency of the tracking algorithms and system. In moving state, the axial size of the lesion (perpendicular to the movement direction) are averagely 4mm, which is one third larger than the lesion got when the target was not moving. This presents the possibility of developing a low-cost real-time method of tracking organ motion during HIFU treatment in liver or kidney.

  12. HIFU therapy for local recurrence of prostate cancer after external beam radiotherapy and radical prostatectomy - 5,5 years experience

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    Solovov, V. A.; Vozdvizhenskiy, M. O.; Matysh, Y. S.

    2017-03-01

    Objectives. To evaluate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) for local recurrence of prostate cancer after external beam radiotherapy (EBRT) and radical prostatectomy (RPE). Materials and Methods: During 2007-2013 years 47 patients with local recurrence of prostate cancer after EBRT and RPE undertook HIFU therapy on the system "Ablaterm» (EDAP, France). Relapse arose after an average of 2 years after EBRT and RPE. Median follow-up after HIFU therapy was 38 (12-60) months. The mean age was 68.5 ± 5.8 years. The median PSA level before HIFU - 15.4 (7-48) ng / mL. Results: In 34 patients (72.3%) at six months after treatment the median PSA was 0.4 (0-3.2) ng / mL, in 48 months - 0.9 (0.4-7.5) ng / mL. In 13 patients (27.7%) at 6 months was observed progression of the disease. In general, after a 5-year follow-up 72.3% of the patients had no data for the progression and recurrence. Conclusion: HIFU therapy in patients with local recurrence of prostate cancer after EBRT and RPE is minimally invasive and effective technology.

  13. Segmentation of tumor ultrasound image in HIFU therapy based on texture and boundary encoding

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    Zhang, Dong; Xu, Menglong; Quan, Long; Yang, Yan; Qin, Qianqing; Zhu, Wenbin

    2015-02-01

    It is crucial in high intensity focused ultrasound (HIFU) therapy to detect the tumor precisely with less manual intervention for enhancing the therapy efficiency. Ultrasound image segmentation becomes a difficult task due to signal attenuation, speckle effect and shadows. This paper presents an unsupervised approach based on texture and boundary encoding customized for ultrasound image segmentation in HIFU therapy. The approach oversegments the ultrasound image into some small regions, which are merged by using the principle of minimum description length (MDL) afterwards. Small regions belonging to the same tumor are clustered as they preserve similar texture features. The mergence is completed by obtaining the shortest coding length from encoding textures and boundaries of these regions in the clustering process. The tumor region is finally selected from merged regions by a proposed algorithm without manual interaction. The performance of the method is tested on 50 uterine fibroid ultrasound images from HIFU guiding transducers. The segmentations are compared with manual delineations to verify its feasibility. The quantitative evaluation with HIFU images shows that the mean true positive of the approach is 93.53%, the mean false positive is 4.06%, the mean similarity is 89.92%, the mean norm Hausdorff distance is 3.62% and the mean norm maximum average distance is 0.57%. The experiments validate that the proposed method can achieve favorable segmentation without manual initialization and effectively handle the poor quality of the ultrasound guidance image in HIFU therapy, which indicates that the approach is applicable in HIFU therapy.

  14. Continuous monitoring of pulsed HIFU beams using dual-mode ultrasound array systems

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    Casper, Andrew; Ballard, John; Liu, Dalong; Haritonova, Alyona; Ebbini, Emad

    2012-10-01

    We have previously described several DMUA prototypes with therapeutic and imaging capabilities suited for image-guided surgery. A fully real-time system capable of intermittent therapy/imaging operation to allow for high frame rate imaging during therapeutic has been developed. This approach allows for real-time characterization of echoes from the target region at the focal spot within milliseconds of the initiation of the therapeutic pHIFU beam. For example, at intensity levels of ˜8000 W/cm2 at 1.15 MHz, analysis of echo data preand post-beamforming shows spotty transient activity from within the pHIFU focus, indicative of cavitation. Ex vivo tissue samples were exposed to pHIFU beams of durations s ability to refocus the pHIFU beam at > 1000 updates per second, this approach offers the physician a unique capability of modulating the exposure with millisecond resolution. Examples of monitoring and control of single-and multiple-focus DMUA patterns will be presented and discussed.

  15. A Multifunctional Theranostic Nanoagent for Dual-Mode Image-Guided HIFU/Chemo- Synergistic Cancer Therapy

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    Zhang, Nan; Cai, Xiaojun; Gao, Wei; Wang, Ronghui; Xu, Chunyan; Yao, Yuanzhi; Hao, Lan; Sheng, Danli; Chen, Hangrong; Wang, Zhigang; Zheng, Yuanyi

    2016-01-01

    High-intensity focused ultrasound (HIFU) is deemed to be a promising noninvasive therapeutic modality for cancers as well as non-neoplastic diseases. However, the accuracy of the technique in the diagnosis and treatment of tumors remains unsatisfactory. HIFU, when combined with multifunctional synergistic agents (SAs), has the potential to be of greater diagnostic and therapeutic efficacy. Here we describe a smart and multifunctional hollow mesoporous Prussian blue (HMPBs) theranostic nanoplatform, the hollow structure of which is capable of encapsulating doxorubicin (DOX) and perfluorohexane (HMPBs-DOX/PFH). In vitro and in vivo studies validated that HMPBs-DOX/PFH can be used as an amplifiable dual-mode imaging contrast agent, which can simultaneously enhance ultrasound (US) and photoacoustic (PA) imaging for guiding and monitoring tumor therapy. When exposed to HIFU, this versatile HMPBs-DOX/PFH agent could increase the cavitation effect and use lower HIFU intensity to achieve coagulative necrosis. Furthermore, it significantly accelerated the release of DOX thereby enhancing chemotherapeutic efficacy and avoiding systemic side effects of the drug. Such a novel theranostic nanoplatform is expected to integrate dual-mode guided imaging with greater therapeutic efficacy and fewer side effects and is very promising for the noninvasive synergistic tumor therapy. PMID:26909114

  16. A Multifunctional Theranostic Nanoagent for Dual-Mode Image-Guided HIFU/Chemo- Synergistic Cancer Therapy.

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    Zhang, Nan; Cai, Xiaojun; Gao, Wei; Wang, Ronghui; Xu, Chunyan; Yao, Yuanzhi; Hao, Lan; Sheng, Danli; Chen, Hangrong; Wang, Zhigang; Zheng, Yuanyi

    2016-01-01

    High-intensity focused ultrasound (HIFU) is deemed to be a promising noninvasive therapeutic modality for cancers as well as non-neoplastic diseases. However, the accuracy of the technique in the diagnosis and treatment of tumors remains unsatisfactory. HIFU, when combined with multifunctional synergistic agents (SAs), has the potential to be of greater diagnostic and therapeutic efficacy. Here we describe a smart and multifunctional hollow mesoporous Prussian blue (HMPBs) theranostic nanoplatform, the hollow structure of which is capable of encapsulating doxorubicin (DOX) and perfluorohexane (HMPBs-DOX/PFH). In vitro and in vivo studies validated that HMPBs-DOX/PFH can be used as an amplifiable dual-mode imaging contrast agent, which can simultaneously enhance ultrasound (US) and photoacoustic (PA) imaging for guiding and monitoring tumor therapy. When exposed to HIFU, this versatile HMPBs-DOX/PFH agent could increase the cavitation effect and use lower HIFU intensity to achieve coagulative necrosis. Furthermore, it significantly accelerated the release of DOX thereby enhancing chemotherapeutic efficacy and avoiding systemic side effects of the drug. Such a novel theranostic nanoplatform is expected to integrate dual-mode guided imaging with greater therapeutic efficacy and fewer side effects and is very promising for the noninvasive synergistic tumor therapy.

  17. The role of numerical simulation for the development of an advanced HIFU system

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    Okita, Kohei; Narumi, Ryuta; Azuma, Takashi; Takagi, Shu; Matumoto, Yoichiro

    2014-10-01

    High-intensity focused ultrasound (HIFU) has been used clinically and is under clinical trials to treat various diseases. An advanced HIFU system employs ultrasound techniques for guidance during HIFU treatment instead of magnetic resonance imaging in current HIFU systems. A HIFU beam imaging for monitoring the HIFU beam and a localized motion imaging for treatment validation of tissue are introduced briefly as the real-time ultrasound monitoring techniques. Numerical simulations have a great impact on the development of real-time ultrasound monitoring as well as the improvement of the safety and efficacy of treatment in advanced HIFU systems. A HIFU simulator was developed to reproduce ultrasound propagation through the body in consideration of the elasticity of tissue, and was validated by comparison with in vitro experiments in which the ultrasound emitted from the phased-array transducer propagates through the acrylic plate acting as a bone phantom. As the result, the defocus and distortion of the ultrasound propagating through the acrylic plate in the simulation quantitatively agree with that in the experimental results. Therefore, the HIFU simulator accurately reproduces the ultrasound propagation through the medium whose shape and physical properties are well known. In addition, it is experimentally confirmed that simulation-assisted focus control of the phased-array transducer enables efficient assignment of the focus to the target. Simulation-assisted focus control can contribute to design of transducers and treatment planning.

  18. Development of a High Intensity Focused Ultrasound (HIFU) Hydrophone System

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    Schafer, Mark E.; Gessert, James

    2009-04-01

    The growing clinical use of High Intensity Focused Ultrasound (HIFU) has driven a need for reliable, reproducible measurements of HIFU acoustic fields. We have previously presented data on a reflective scatterer approach, incorporating several novel features for improved bandwidth, reliability, and reproducibility [Proc. 2005 IEEE Ultrasonics Symposium, 1739-1742]. We now report on several design improvements which have increase the signal to noise ratio of the system, and potentially reduced the cost of implementation. For the scattering element, we now use an artificial sapphire material to provide a more uniform radiating surface. The receiver is a segmented, truncated spherical structure with a 10 cm radius; the scattering element is positioned at the center of the sphere. The receiver is made from 25 micron thick, biaxially stretched PVDF, with a Pt-Au electrode on the front surface. In the new design, a specialized backing material provides the stiffness required to maintain structural stability, while at the same time providing both electrical shielding and ultrasonic absorption. Compared with the previous version, the new receiver design has improved the noise performance by 8-12 dB; the new scattering sphere has reduced the scattering loss by another 14 dB, producing an effective sensitivity of -298 dB re 1 microVolt/Pa. The design trade-off still involves receiver sensitivity with effective spot size, and signal distortion from the scatter structure. However, the reduced cost and improved repeatability of the new scatter approach makes the overall design more robust for routine waveform measurements of HIFU systems.

  19. Nanoparticle-enhanced synergistic HIFU ablation and transarterial chemoembolization for efficient cancer therapy

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    You, Yufeng; Wang, Zhigang; Ran, Haitao; Zheng, Yuanyi; Wang, Dong; Xu, Jinshun; Wang, Zhibiao; Chen, Yu; Li, Pan

    2016-02-01

    High-intensity focused ultrasound (HIFU) is being generally explored as a non-invasive therapeutic modality to treat solid tumors. However, the clinical use of HIFU for large and deep tumor-ablation applications such as hepatocellular carcinoma (HCC) is currently entangled with long treatment duration and high operating energy. This critical issue can be potentially resolved by the introduction of HIFU synergistic agents (SAs). Traditional SAs such as microbubbles and microparticles face the problem of large size, short cycle time, damage to mononuclear phagocytic system and unsatisfactory targeting efficiency. In this work, we have developed a facile and versatile nanoparticle-based HIFU synergistic cancer surgery enhanced by transarterial chemoembolization for high-efficiency HCC treatment based on elaborately designed Fe3O4-PFH/PLGA nanocapsules. Multifunctional Fe3O4-PFH/PLGA nanocapsules were administrated into tumor tissues via transarterial injection combined with Lipiodol to achieve high tumor accumulation because transarterial chemoembolization by Lipiodol could block the blood vessels. The high synergistic HIFU ablation effect was successfully achieved against HCC tumors based on the phase-transformation performance of the perfluorohexane (PFH) inner core in the composite nanocapsules, as systematically demonstrated in VX2 liver tumor xenograft in rabbits. Multifunctional Fe3O4-PFH/PLGA nanocapsules were also demonstrated as efficient contrast agents for ultrasound, magnetic resonance and photoacoustic tri-modality imagings, potentially applicable for imaging-guided HIFU synergistic surgery. Therefore, the elaborate integration of traditional transarterial chemoembolization with recently developed nanoparticle-enhanced HIFU cancer surgery could efficiently enhance the HCC cancer treatment outcome, initiating a new and efficient therapeutic protocol/modality for clinic cancer treatment.

  20. Identification of risk factors of prostate adenocarcinoma recurrence after HIFU therapy using immunohistochemical markers

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    Popkov V.M.

    2014-12-01

    Full Text Available The purpose of this study was to identify risk factors for recurrence of prostate adenocarcinoma after HIFU therapy. Material and methods: Material for the study was obtained from patients diagnosed with adenocarcinoma before and after HIFU treatment. Morphological study was conducted using a standard staining, and immunohistochemical markers: PCNA, Amacr, E-cadherin, Bel2, Andr, Estr, VEGF, P53, PCNA. Results: After treatment in 89% of patients with initial prostate volume greater than 50 cc the signs of recurrence of adenocarcinoma were showed. At low risk for D'Amico after treatment the expression of proliferation markers, VEGF, Amacr significantly decreased. With a high degree of risk — increased expression of Bel2. After treatment the expression of the following markers: PCNA, Amacr, VEGF significantly increased in the group of patients with the presence of invasion. Conclusion: Patients with initial prostate volume less than 50 cc, low risk to D'Amico, the lack of perineural and perivascular invasion have a low risk of recurrence after HIFU therapy; patients at high risk for D'Amico, the presence of perineural and perivascular invasion initial and prostate volume greater than 50 cc, low-grade cribriform form of adenocarcinoma have a high risk of recurrence of adenocarcinoma. Recurrence of adenocarcinoma develops independently of the period after HIFU therapy.

  1. A Split-and-Merge-Based Uterine Fibroid Ultrasound Image Segmentation Method in HIFU Therapy.

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    Xu, Menglong; Zhang, Dong; Yang, Yan; Liu, Yu; Yuan, Zhiyong; Qin, Qianqing

    2015-01-01

    High-intensity focused ultrasound (HIFU) therapy has been used to treat uterine fibroids widely and successfully. Uterine fibroid segmentation plays an important role in positioning the target region for HIFU therapy. Presently, it is completed by physicians manually, reducing the efficiency of therapy. Thus, computer-aided segmentation of uterine fibroids benefits the improvement of therapy efficiency. Recently, most computer-aided ultrasound segmentation methods have been based on the framework of contour evolution, such as snakes and level sets. These methods can achieve good performance, although they need an initial contour that influences segmentation results. It is difficult to obtain the initial contour automatically; thus, the initial contour is always obtained manually in many segmentation methods. A split-and-merge-based uterine fibroid segmentation method, which needs no initial contour to ensure less manual intervention, is proposed in this paper. The method first splits the image into many small homogeneous regions called superpixels. A new feature representation method based on texture histogram is employed to characterize each superpixel. Next, the superpixels are merged according to their similarities, which are measured by integrating their Quadratic-Chi texture histogram distances with their space adjacency. Multi-way Ncut is used as the merging criterion, and an adaptive scheme is incorporated to decrease manual intervention further. The method is implemented using Matlab on a personal computer (PC) platform with Intel Pentium Dual-Core CPU E5700. The method is validated on forty-two ultrasound images acquired from HIFU therapy. The average running time is 9.54 s. Statistical results showed that SI reaches a value as high as 87.58%, and normHD is 5.18% on average. It has been demonstrated that the proposed method is appropriate for segmentation of uterine fibroids in HIFU pre-treatment imaging and planning.

  2. A Split-and-Merge-Based Uterine Fibroid Ultrasound Image Segmentation Method in HIFU Therapy.

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    Menglong Xu

    Full Text Available High-intensity focused ultrasound (HIFU therapy has been used to treat uterine fibroids widely and successfully. Uterine fibroid segmentation plays an important role in positioning the target region for HIFU therapy. Presently, it is completed by physicians manually, reducing the efficiency of therapy. Thus, computer-aided segmentation of uterine fibroids benefits the improvement of therapy efficiency. Recently, most computer-aided ultrasound segmentation methods have been based on the framework of contour evolution, such as snakes and level sets. These methods can achieve good performance, although they need an initial contour that influences segmentation results. It is difficult to obtain the initial contour automatically; thus, the initial contour is always obtained manually in many segmentation methods. A split-and-merge-based uterine fibroid segmentation method, which needs no initial contour to ensure less manual intervention, is proposed in this paper. The method first splits the image into many small homogeneous regions called superpixels. A new feature representation method based on texture histogram is employed to characterize each superpixel. Next, the superpixels are merged according to their similarities, which are measured by integrating their Quadratic-Chi texture histogram distances with their space adjacency. Multi-way Ncut is used as the merging criterion, and an adaptive scheme is incorporated to decrease manual intervention further. The method is implemented using Matlab on a personal computer (PC platform with Intel Pentium Dual-Core CPU E5700. The method is validated on forty-two ultrasound images acquired from HIFU therapy. The average running time is 9.54 s. Statistical results showed that SI reaches a value as high as 87.58%, and normHD is 5.18% on average. It has been demonstrated that the proposed method is appropriate for segmentation of uterine fibroids in HIFU pre-treatment imaging and planning.

  3. Noninvasive MR-Guided HIFU Therapy of TSC-Associated Renal Angiomyolipomas

    Science.gov (United States)

    2014-09-01

    delivery (temperature mapping ). MR-guided HIFU first found applications in the clinical management of uterine fibroids. Up to date, over 7000 patients...Philips 3.0 Tesla multi-channel MR imaging system. Real-time reconstruction will be implemented. Four major imaging methods, T1 weighted imaging, T2...Philips 3T MRI scanner. The SNR gain factor was estimated to be ~ 3 over the commercial small-animal coil provided by Philips HealthCare. A mechanic

  4. An Ultrasound Imaging-Guided Robotic HIFU Ablation Experimental System and Accuracy Evaluations

    Directory of Open Access Journals (Sweden)

    Chih Yu An

    2017-01-01

    Full Text Available In recent years, noninvasive thermal treatment by using high-intensity focused ultrasound (HIFU has high potential in tumor treatment. The goal of this research is to develop an ultrasound imaging-guided robotic HIFU ablation system for tumor treatment. The system integrates the technologies of ultrasound image-assisted guidance, robotic positioning control, and HIFU treatment planning. With the assistance of ultrasound image guidance technology, the tumor size and location can be determined from ultrasound images as well as the robotic arm can be controlled to position the HIFU transducer to focus on the target tumor. After the development of the system, several experiments were conducted to measure the positioning accuracy of this system. The results show that the average positioning error is 1.01 mm with a standard deviation 0.34, and HIFU ablation accuracy is 1.32 mm with a standard deviation 0.58, which means this system is confirmed with its possibility and accuracy.

  5. An Ultrasound Imaging-Guided Robotic HIFU Ablation Experimental System and Accuracy Evaluations.

    Science.gov (United States)

    An, Chih Yu; Syu, Jia Hao; Tseng, Ching Shiow; Chang, Chih-Ju

    2017-01-01

    In recent years, noninvasive thermal treatment by using high-intensity focused ultrasound (HIFU) has high potential in tumor treatment. The goal of this research is to develop an ultrasound imaging-guided robotic HIFU ablation system for tumor treatment. The system integrates the technologies of ultrasound image-assisted guidance, robotic positioning control, and HIFU treatment planning. With the assistance of ultrasound image guidance technology, the tumor size and location can be determined from ultrasound images as well as the robotic arm can be controlled to position the HIFU transducer to focus on the target tumor. After the development of the system, several experiments were conducted to measure the positioning accuracy of this system. The results show that the average positioning error is 1.01 mm with a standard deviation 0.34, and HIFU ablation accuracy is 1.32 mm with a standard deviation 0.58, which means this system is confirmed with its possibility and accuracy.

  6. Correlation between Ultrasound Reflection Intensity and Tumor Ablation Ratio of Late-Stage Pancreatic Carcinoma in HIFU Therapy: Dynamic Observation on Ultrasound Reflection Intensity

    Science.gov (United States)

    Ge, Hui-Yu; Miao, Li-Ying; Wang, Jin-Rui; Xiong, Liu-Lin; Yan, Fang; Zheng, Cui-Shan; Jia, Jian-Wen; Cui, Li-Gang; Chen, Wen

    2013-01-01

    The minimally invasive high-intensity focused ultrasound (HIFU) therapy is thermal ablation treatment for late-stage pancreatic carcinoma with widely recognized safety and effectiveness, but there are currently no instant assessment methods for its ablation effect. It is vital to find a real-time high-sensitive assessment method. This research aims to dynamically observe the variation rules of ultrasound reflection intensity, analyze the correlation between ultrasound reflection intensity and tumor ablation ratio, and find out the value of ultrasound reflection intensity in prognosis of HIFU ablation effect. HIFU intermittent therapies were retrospectively analyzed for 31 subjects with late-stage pancreatic carcinoma from March 2007 to December 2009 in the study. The variation rules of the ultrasound reflection intensity during HIFU therapy were summarized and the correlation between ultrasound reflection intensity and tumor ablation ratio was analyzed based on the tumor ablation ratio indicated by CT scanning. The conclusion is that variation of ultrasound reflection intensity can be used for initial assessment of tumor ablation in HIFU therapy and early prognosis of overall HIFU ablation, providing important clinical basis for improving safety and effectiveness of HIFU therapy. Ultrasound can work as a real-time imaging instrument for observation of HIFU ablation effect in treating late-stage pancreatic carcinoma. PMID:24453916

  7. Correlation between Ultrasound Reflection Intensity and Tumor Ablation Ratio of Late-Stage Pancreatic Carcinoma in HIFU Therapy: Dynamic Observation on Ultrasound Reflection Intensity

    Directory of Open Access Journals (Sweden)

    Hui-Yu Ge

    2013-01-01

    Full Text Available The minimally invasive high-intensity focused ultrasound (HIFU therapy is thermal ablation treatment for late-stage pancreatic carcinoma with widely recognized safety and effectiveness, but there are currently no instant assessment methods for its ablation effect. It is vital to find a real-time high-sensitive assessment method. This research aims to dynamically observe the variation rules of ultrasound reflection intensity, analyze the correlation between ultrasound reflection intensity and tumor ablation ratio, and find out the value of ultrasound reflection intensity in prognosis of HIFU ablation effect. HIFU intermittent therapies were retrospectively analyzed for 31 subjects with late-stage pancreatic carcinoma from March 2007 to December 2009 in the study. The variation rules of the ultrasound reflection intensity during HIFU therapy were summarized and the correlation between ultrasound reflection intensity and tumor ablation ratio was analyzed based on the tumor ablation ratio indicated by CT scanning. The conclusion is that variation of ultrasound reflection intensity can be used for initial assessment of tumor ablation in HIFU therapy and early prognosis of overall HIFU ablation, providing important clinical basis for improving safety and effectiveness of HIFU therapy. Ultrasound can work as a real-time imaging instrument for observation of HIFU ablation effect in treating late-stage pancreatic carcinoma.

  8. MatMRI and MatHIFU: software toolboxes for real-time monitoring and control of MR-guided HIFU.

    Science.gov (United States)

    Zaporzan, Benjamin; Waspe, Adam C; Looi, Thomas; Mougenot, Charles; Partanen, Ari; Pichardo, Samuel

    2013-01-01

    The availability of open and versatile software tools is a key feature to facilitate pre-clinical research for magnetic resonance imaging (MRI) and magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) and expedite clinical translation of diagnostic and therapeutic medical applications. In the present study, two customizable software tools that were developed at the Thunder Bay Regional Research Institute are presented for use with both MRI and MR-HIFU. Both tools operate in a MATLAB(®;) environment. The first tool is named MatMRI and enables real-time, dynamic acquisition of MR images with a Philips MRI scanner. The second tool is named MatHIFU and enables the execution and dynamic modification of user-defined treatment protocols with the Philips Sonalleve MR-HIFU therapy system to perform ultrasound exposures in MR-HIFU therapy applications. MatMRI requires four basic steps: initiate communication, subscribe to MRI data, query for new images, and unsubscribe. MatMRI can also pause/resume the imaging and perform real-time updates of the location and orientation of images. MatHIFU requires four basic steps: initiate communication, prepare treatment protocol, and execute treatment protocol. MatHIFU can monitor the state of execution and, if required, modify the protocol in real time. Four applications were developed to showcase the capabilities of MatMRI and MatHIFU to perform pre-clinical research. Firstly, MatMRI was integrated with an existing small animal MR-HIFU system (FUS Instruments, Toronto, Ontario, Canada) to provide real-time temperature measurements. Secondly, MatMRI was used to perform T2-based MR thermometry in the bone marrow. Thirdly, MatHIFU was used to automate acoustic hydrophone measurements on a per-element basis of the 256-element transducer of the Sonalleve system. Finally, MatMRI and MatHIFU were combined to produce and image a heating pattern that recreates the word 'HIFU' in a tissue-mimicking heating phantom. MatMRI and

  9. Basic study of less invasive high-intensity focused ultrasound (HIFU) in fetal therapy for twin reversed arterial perfusion (TRAP) sequence.

    Science.gov (United States)

    Ichizuka, Kiyotake; Matsuoka, Ryu; Aoki, Hiroko; Hasegawa, Junichi; Okai, Takashi; Umemura, Shin-Ichiro

    2016-10-01

    The objective of the present study was to develop a high-intensity focused ultrasound (HIFU) transducer more suitable for clinical use in fetal therapy for twin reversed arterial perfusion (TRAP) sequence. We created a cooling and degassed water-circulating-type HIFU treatment device. HIFU was applied to renal branch vessels in three rabbits. Sequential HIFU irradiation contains a trigger wave, heating wave, and rest time. The duration of HIFU application was 10 s/course. Targeting could be achieved by setting the imaging probe in the center and placing the HIFU beam and imaging ultrasonic wave on the same axis. We confirmed under sequential HIFU irradiation with a total intensity of 1.94 kW/cm(2) (spatial average temporal average intensity) that the vein and artery were occluded in all three rabbits. Simultaneous occluding of the veins and arteries was confirmed with trigger waves and a resting phase using the HIFU transducer treatment device created for this study. Clinical application appears possible and may represent a promising option for fetal therapy involving TRAP sequence.

  10. High intensity focused ultrasound (HIFU) therapy for local treatment of hepatocellular carcinoma: Role of partial rib resection

    Energy Technology Data Exchange (ETDEWEB)

    Zhu Hui; Zhou Kun; Zhang Lian; Jin Chengbin; Peng Song; Yang Wei; Li Kequan; Su Haibing [Clinical Center for Tumor Therapy of 2nd Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); Chen Wenzhi [Clinical Center for Tumor Therapy of 2nd Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); State Key Laboratory, Department of Biomedical Engineering, Chongqing University of Medical Sciences, Chongqing 400037 (China); Bai Jin; Wu Feng [State Key Laboratory, Department of Biomedical Engineering, Chongqing University of Medical Sciences, Chongqing 400037 (China); National Engineering and Research Center for Ultrasound Medicine, Chongqing 401121 (China); Wang, Zhibiao [Clinical Center for Tumor Therapy of 2nd Hospital of Chongqing University of Medical Sciences, Chongqing 400010 (China); State Key Laboratory, Department of Biomedical Engineering, Chongqing University of Medical Sciences, Chongqing 400037 (China); National Engineering and Research Center for Ultrasound Medicine, Chongqing 401121 (China)], E-mail: wangzhibiao@haifu.com.cn

    2009-10-15

    Objective: It has long been known that high intensity focused ultrasound (HIFU) can kill tissue through coagulative necrosis. However, it is only in recent years that practical clinical applications are becoming possible. Since the ribs have strong reflections to ultrasonic beams, they may affect the deposition of ultrasound energy, decreasing the efficacy of HIFU treatment and increasing the chance of adverse events when the intra-abdominal tumours concealed by ribs are treated. The aim of this study was to evaluate the influence of partial rib resection on the efficacy and safety of HIFU treatment. Methods: This prospective study was approved by the ethics committee at Chongqing University of Medical Sciences. An informed consent form was obtained from each patient and family member. A total of 16 patients with hepatocellular carcinoma (HCC), consisting of 13 males and 3 females, were studied. All patients had the successful HIFU treatment. To create a better acoustic pathway for HIFU treatment, all of the 16 patients had the ribs that shield the tumour mass to be removed. Magnetic resonance imaging (MRI) was used to evaluate the efficacy of HIFU treatment. Results: Sixteen cases had 23 nodules, including 12 cases with a single nodule, 1 case with 2 nodules, 3 cases with 3 nodules. The mean diameter of tumours was 7.0 {+-} 2.1 cm (5-10 cm). According to TNM classification, 9 patients were diagnosed as stage II, 4 patients were stage III, and 3 patients were stage IV. Follow-up imaging showed an absence of tumour blood supply and shrinkage of all treated lesions. The survival rates at 1, 2, 3, 4, and 5 years were 100%, 83.3%, 69.4%, 55.6%, and 55.6%, respectively. No serious complications were observed in the patients treated with HIFU. Conclusion: Partial rib resection can create a better acoustic pathway of HIFU therapy. Even though it is an invasive treatment, this measure offers patients an improved prospect of complete tumour ablation when no other treatment

  11. Interference-free ultrasound imaging during HIFU therapy, using software tools

    Science.gov (United States)

    Vaezy, Shahram (Inventor); Held, Robert (Inventor); Sikdar, Siddhartha (Inventor); Managuli, Ravi (Inventor); Zderic, Vesna (Inventor)

    2010-01-01

    Disclosed herein is a method for obtaining a composite interference-free ultrasound image when non-imaging ultrasound waves would otherwise interfere with ultrasound imaging. A conventional ultrasound imaging system is used to collect frames of ultrasound image data in the presence of non-imaging ultrasound waves, such as high-intensity focused ultrasound (HIFU). The frames are directed to a processor that analyzes the frames to identify portions of the frame that are interference-free. Interference-free portions of a plurality of different ultrasound image frames are combined to generate a single composite interference-free ultrasound image that is displayed to a user. In this approach, a frequency of the non-imaging ultrasound waves is offset relative to a frequency of the ultrasound imaging waves, such that the interference introduced by the non-imaging ultrasound waves appears in a different portion of the frames.

  12. Initial investigation of a novel noninvasive weight loss therapy using MRI-Guided high intensity focused ultrasound (MR-HIFU) of visceral fat.

    Science.gov (United States)

    Winter, Patrick M; Lanier, Matthew; Partanen, Ari; Dumoulin, Charles

    2016-07-01

    MRI-guided high intensity focused ultrasound (MR-HIFU) allows noninvasive heating of deep tissues. Specifically targeting visceral fat deposits with MR-HIFU could offer an effective therapy for reversing the development of obesity, diabetes, and metabolic syndrome. Overweight rats received either MR-HIFU of visceral fat, sham treatment, no treatment, or ex vivo temperature calibration. Conventional MR thermometry methods are not effective in fat tissue. Therefore, the T2 of fat was used to estimate heating in adipose tissue. HIFU treated rats lost 7.5% of their body weight 10 days after HIFU, compared with 1.9% weight loss in sham animals (P = 0.008) and 1.3% weight increase in untreated animals (P = 0.004). Additionally, the abdominal fat volume in treated animals decreased by 8.2 mL 7 days after treatment (P = 0.002). The T2 of fat at 1.5 Tesla increased by 3.3 ms per °C. The fat T2 was 103.3 ms before HIFU, but increased to 128.7 ms (P = 0.0005) after HIFU at 70 watts for 16 s and to 131.9 ms (P = 0.0005) after HIFU at 100 watts for 16 s. These experiments demonstrate that MR-HIFU of visceral fat could provide a safe, effective, and noninvasive weight loss therapy for combating obesity and the subsequent medical complications. Magn Reson Med 76:282-289, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  13. A framework for the correction of slow physiological drifts during MR-guided HIFU therapies: Proof of concept

    Energy Technology Data Exchange (ETDEWEB)

    Zachiu, Cornel, E-mail: C.Zachiu@umcutrecht.nl; Moonen, Chrit; Ries, Mario [Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht 3584 CX (Netherlands); Denis de Senneville, Baudouin [Imaging Division, UMC Utrecht, Heidelberglaan 100, Utrecht 3584 CX (Netherlands); Mathematical Institute of Bordeaux, University of Bordeaux, Talence Cedex 33405 (France)

    2015-07-15

    Purpose: While respiratory motion compensation for magnetic resonance (MR)-guided high intensity focused ultrasound (HIFU) interventions has been extensively studied, the influence of slow physiological motion due to, for example, peristaltic activity, has so far been largely neglected. During lengthy interventions, the magnitude of the latter can exceed acceptable therapeutic margins. The goal of the present study is to exploit the episodic workflow of these therapies to implement a motion correction strategy for slow varying drifts of the target area and organs at risk over the entire duration of the intervention. Methods: The therapeutic workflow of a MR-guided HIFU intervention is in practice often episodic: Bursts of energy delivery are interleaved with periods of inactivity, allowing the effects of the beam on healthy tissues to recede and/or during which the plan of the intervention is reoptimized. These periods usually last for at least several minutes. It is at this time scale that organ drifts due to slow physiological motion become significant. In order to capture these drifts, the authors propose the integration of 3D MR scans in the therapy workflow during the inactivity intervals. Displacements were estimated using an optical flow algorithm applied on the 3D acquired images. A preliminary study was conducted on ten healthy volunteers. For each volunteer, 3D MR images of the abdomen were acquired at regular intervals of 10 min over a total duration of 80 min. Motion analysis was restricted to the liver and kidneys. For validating the compatibility of the proposed motion correction strategy with the workflow of a MR-guided HIFU therapy, an in vivo experiment on a porcine liver was conducted. A volumetric HIFU ablation was completed over a time span of 2 h. A 3D image was acquired before the first sonication, as well as after each sonication. Results: Following the volunteer study, drifts larger than 8 mm for the liver and 5 mm for the kidneys prove that

  14. A new FPGA-driven P-HIFU system with harmonic cancellation technique

    Science.gov (United States)

    Wu, Hao; Shen, Guofeng; Su, Zhiqiang; Chen, Yazhu

    2017-03-01

    This paper introduces a high intensity focused ultrasound system for ablation using switch-mode power amplifiers with harmonic cancellation technique eliminating the 3rdharmonic and all even harmonics. The efficiency of the amplifier is optimized by choosing different parameters of the harmonic cancellation technique. This technique requires double driving signals, and specific signal waveform because of the full-bridge topology. The new FPGA-driven P-HIFU system has 200 channels of phase signals that can form 100 output channels. An FPGA chip is used to generate these signals, and each channel has a phase resolution of 2 ns, less than one degree. The output waveform of the amplifier, voltage waveform across the transducer, shows fewer harmonic components.

  15. Non-invasive estimation of temperature using diagnostic ultrasound during HIFU therapy

    Science.gov (United States)

    Georg, O.; Wilkens, V.

    2017-03-01

    The use of HIFU for thermal ablation of human tissues requires safe real-time monitoring of the lesion formation during the treatment to avoid damage of the surrounding healthy tissues and to control temperature rise. Besides MR imaging, several methods have been proposed for temperature imaging using diagnostic ultrasound, and echoshift estimation (using speckle tracking) is the most promising and commonly used technique. It is based on the thermal dependence of the ultrasound echo that accounts for two different physical phenomena: local change in speed of sound and thermal expansion of the propagating medium due to changes in temperature. In our experiments we have used two separate transducers: HIFU exposure was performed using a 1.06 MHz single element focusing transducer of 64 mm aperture and 63.2 mm focal length; the ultrasound diagnostic probe of 11 MHz operated in B-mode for image guidance. The temperature measurements were performed in an agar-based tissue-mimicking phantom. To verify the obtained results, numerical modeling of the acoustic and temperature fields was carried out using KZK and Pennes Bioheat equations, as well as measurements with thermocouples were performed.

  16. HematoPorphyrin Monomethyl Ether polymer contrast agent for ultrasound/photoacoustic dual-modality imaging-guided synergistic high intensity focused ultrasound (HIFU) therapy

    Science.gov (United States)

    Yan, Sijing; Lu, Min; Ding, Xiaoya; Chen, Fei; He, Xuemei; Xu, Chunyan; Zhou, Hang; Wang, Qi; Hao, Lan; Zou, Jianzhong

    2016-08-01

    This study is to prepare a hematoporphyrin monomethyl ether (HMME)-loaded poly(lactic-co-glycolic acid) (PLGA) microcapsules (HMME/PLGA), which could not only function as efficient contrast agent for ultrasound (US)/photoacoustic (PA) imaging, but also as a synergistic agent for high intensity focused ultrasound (HIFU) ablation. Sonosensitizer HMME nanoparticles were integrated into PLGA microcapsules with the double emulsion evaporation method. After characterization, the cell-killing and cell proliferation-inhibiting effects of HMME/PLGA microcapsules on ovarian cancer SKOV3 cells were assessed. The US/PA imaging-enhancing effects and synergistic effects on HIFU were evaluated both in vitro and in vivo. HMME/PLGA microcapsules were highly dispersed with well-defined spherical morphology (357 ± 0.72 nm in diameter, PDI = 0.932). Encapsulation efficiency and drug-loading efficiency were 58.33 ± 0.95% and 4.73 ± 0.15%, respectively. The HMME/PLGA microcapsules remarkably killed the SKOV3 cells and inhibited the cell proliferation, significantly enhanced the US/PA imaging results and greatly enhanced the HIFU ablation effects on ovarian cancer in nude mice by the HMME-mediated sono-dynamic chemistry therapy (SDT). HMME/PLGA microcapsules represent a potential multifunctional contrast agent for HIFU diagnosis and treatment, which might provide a novel strategy for the highly efficient imaging-guided non-invasive HIFU synergistic therapy for cancers by SDT in clinic.

  17. Ultrasound imaging for cavitation detection during HIFU ablation in brain

    Science.gov (United States)

    Long, Tao; Amin, Viren; McClure, Scott; Roberts, Ronald; Wu, Liangshou; Heise, Matthew; Ryken, Timothy

    2007-03-01

    High intensity focused ultrasound (abbreviated as HIFU) has its potential in tumor treatment due to its non-invasive benefits. During HIFU exposure, cavitation (generation of gas bubbles) is often observed, which can be an indication of potential lesion created by HIFU power. Due to a large difference in ultrasound acoustic properties between the gas bubble and surrounding tissues, ultrasonic energy is reflected and scattered at the HIFU focus, thus indicating activity around the focal area and often interfering HIFU dosage delivery. A good understanding and control of cavitation phenomenon could potentially enhance the HIFU delivery and treatment outcomes. Quantifying the onset timing and extent of the cavitation could be potentially used for detecting HIFU effects and therapy guidance. In this paper, we study the relationships among HIFU parameters, the characteristics of cavitation quantified from ultrasound imaging, and characteristics of the final tissue lesion created by HIFU. In our study, we used 12 freshly excised pig brains in vitro for observation and analysis of cavitation activities during HIFU exposure with different HIFU parameters. Final lesions were examined by slicing the brain tissues into thin slices and 3D volume was constructed with segmentation of the lesion. HIFU parameters, cavitation activities through image processing and lesion characterization were correlated. We also present our initial understanding of the process of cavitation activities under certain HIFU parameters and control of such activities that could lead to optimal lesion

  18. MRI-based evaluation of MR-HIFU induced thermal effects

    NARCIS (Netherlands)

    Lam, M.K.

    2016-01-01

    High intensity focused ultrasound (HIFU) is novel technology for non-invasive thermal therapy and can be combined with magnetic resonance imaging (MRI). MRI-guided HIFU (MR-HIFU) allows for real-time acquisition of MRI scans during the HIFU treatment, for planning, monitoring and evaluation. The

  19. Thermal ablation of a confluent lesion in the porcine kidney with a clinically available MR-HIFU system

    Science.gov (United States)

    van Breugel, J. M. M.; de Greef, M.; Wijlemans, J. W.; Schubert, G.; van den Bosch, M. A. A. J.; Moonen, C. T. W.; Ries, M. G.

    2017-07-01

    The incidence of small renal masses (SRMs) sized  lesion in the kidney using respiratory-gated MR-HIFU under clinical conditions in a pre-clinical study and (ii) to evaluate the reproducibility of the MR-HIFU ablation strategy. Healthy pigs (n  =  10) under general anesthesia were positioned on a clinical MR-HIFU system with integrated cooling. A honeycomb pattern of seven overlapping ablation cells (4  ×  4  ×  10 mm3, 450 W, <30 s) was ablated successively in the cortex of the porcine kidney. Both MR thermometry and acoustic energy delivery were respiratory gated using a pencil beam navigator on the contralateral kidney. The non-perfused volume (NPV) was visualized after the last sonication by contrast-enhanced (CE) T 1-weighted MR (T 1 w) imaging. Cell viability staining was performed to visualize the extent of necrosis. Results: a median NPV of 0.62 ml was observed on CE-T 1 w images (IQR 0.58-1.57 ml, range 0.33-2.75 ml). Cell viability staining showed a median damaged volume of 0.59 ml (IQR 0.24-1.35 ml, range 0-4.1 ml). Overlooking of the false rib, shivering of the pig, and too large depth combined with a large heat-sink effect resulted in insufficient heating in 4 cases. The NPV and necrosed volume were confluent in all cases in which an ablated volume could be observed. Our results demonstrated the feasibility of creating a confluent volume of ablated kidney cortical tissue in vivo with MR-HIFU on a clinically available system using respiratory gating and near-field cooling and showed its reproducibility.

  20. HIFU Monitoring and Control with Dual-Mode Ultrasound Arrays

    Science.gov (United States)

    Casper, Andrew Jacob

    The biological effects of high-intensity focused ultrasound (HIFU) have been known and studied for decades. HIFU has been shown capable of treating a wide variety of diseases and disorders. However, despite its demonstrated potential, HIFU has been slow to gain clinical acceptance. This is due, in part, to the difficulty associated with robustly monitoring and controlling the delivery of the HIFU energy. The non-invasive nature of the surgery makes the assessment of treatment progression difficult, leading to long treatment times and a significant risk of under treatment. This thesis research develops new techniques and systems for robustly monitoring HIFU therapies for the safe and efficacious delivery of the intended treatment. Systems and algorithms were developed for the two most common modes of HIFU delivery systems: single-element and phased array applicators. Delivering HIFU with a single element transducer is a widely used technique in HIFU therapies. The simplicity of a single element offers many benefits in terms of cost and overall system complexity. Typical monitoring schemes rely on an external device (e.g. diagnostic ultrasound or MRI) to assess the progression of therapy. The research presented in this thesis explores using the same element to both deliver and monitor the HIFU therapy. The use of a dual-mode ultrasound transducer (DMUT) required the development of an FPGA based single-channel arbitrary waveform generator and high-speed data acquisition unit. Data collected from initial uncontrolled ablations led to the development of monitoring and control algorithms which were implemented directly on the FPGA. Close integration between the data acquisition and arbitrary waveform units allowed for fast, low latency control over the ablation process. Results are presented that demonstrate control of HIFU therapies over a broad range of intensities and in multiple in vitro tissues. The second area of investigation expands the DMUT research to an

  1. Feasibility of laser-integrated high intensity focused ultrasound (HIFU) treatment for bladder tumors: in vitro study (Conference Presentation)

    Science.gov (United States)

    Nguyen, Van Phuc; Park, Suhyun; Oh, Junghwan; Kang, Hyun Wook

    2016-02-01

    Previous studies have shown that photothemal therapy combined with high intensity focused ultrasound (HIFU) can provide a promising method to achieve rapid thermal coagulation during surgical procedures. The current study investigated the feasibility of the laser-integrated high intensity focused ultrasound (HIFU) application to treat bladder tumors by enhancing thermal effects and therapeutic depth in vitro. To generate thermal coagulation, a single element HIFU transducer with a central frequency of 2.0 MHz was used to transmit acoustic energy to 15 fresh porcine bladders injected with an artificial tumor (100 µl gelatin and hemoglobin solution) in vitro. Simultaneously, an 80-W 532-nm laser system was also implemented to induce thermal necrosis in the targeted tissue. The intensity of 570 W/cm2 at the focus of HIFU and laser energy of 0.9 W were applied to all the samples for 40 s. The temperature rise increased up to about 1.6 or 3 folds (i.e., ΔT=32±3.8 K for laser-integrated HIFU, ΔT=20±6.5 K for HIFU only, and ΔT=11±5.6 K for laser only). The estimated lesion depth also increased by 1.3 and 2 folds during the dual-thermal treatment, in comparison with the treatment by either HIFU or laser. The results indicated that the laser-integrated HIFU treatment can be an efficient hyperthermic method for tumor coagulation.

  2. Performance analysis of a dedicated breast MR-HIFU system for tumor ablation in breast cancer patients

    NARCIS (Netherlands)

    Deckers, R.; Merckel, L. G.; de Senneville, B. Denis; Schubert, G.; Koehler, M.; Knuttel, F.M.; Mali, W.P.Th.M.; Moonen, C. T. W.; van den Bosch, Maurice; Bartels, L. W.

    2015-01-01

    MR-guided HIFU ablation is a promising technique for the non-invasive treatment of breast cancer. A phase I study was performed to assess the safety and treatment accuracy and precision of MR-HIFU ablation in breast cancer patients (n = 10) using a newly developed MR-HIFU platform dedicated to

  3. Effect of high intensity focused ultrasound (HIFU) in conjunction with a nanomedicines-microbubble complex for enhanced drug delivery.

    Science.gov (United States)

    Han, Hyounkoo; Lee, Hohyeon; Kim, Kwangmeyung; Kim, Hyuncheol

    2017-09-18

    Although nanomedicines have been intensively investigated for cancer therapy in the past, poor accumulation of nanomedicines in tumor sites remains a serious problem. Therefore, a novel drug delivery system is required to enhance accumulation and penetration of nanomedicines at the tumor site. Recently, high-intensity focused ultrasound (HIFU) has been highlighted as a non-invasive therapeutic modality, and showed enhanced therapeutic efficacy in combination with nanomedicines. Cavitation effect induced by the combination of HIFU and microbubbles results in transiently enhanced cell membrane permeability, facilitating improved drug delivery efficiency into tumor sites. Therefore, we introduce the acoustic cavitation and thermal/mechanical effects of HIFU in conjunction with microbubble to overcome the limitation of conventional drug delivery. The cavitation effect maximized by the strong acoustic energy of HIFU induced the preferential accumulation of nanomedicine locally released from the nanomedicines-microbubble complex in the tumor. In addition, the mechanical effect of HIFU allowed the accumulated nanomedicines to penetrate into deeper tumor region. The preferential accumulation and deeper penetration of nanomedicines by HIFU showed enhanced therapeutic efficacy, compared to low frequency ultrasound (US). These overall results demonstrate that the strategy combined nanomedicines-microbubble complex with HIFU is a promising tools for cancer therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Multi-scale and shape constrained localized region-based active contour segmentation of uterine fibroid ultrasound images in HIFU therapy.

    Directory of Open Access Journals (Sweden)

    Xiangyun Liao

    Full Text Available To overcome the severe intensity inhomogeneity and blurry boundaries in HIFU (High Intensity Focused Ultrasound ultrasound images, an accurate and efficient multi-scale and shape constrained localized region-based active contour model (MSLCV, was developed to accurately and efficiently segment the target region in HIFU ultrasound images of uterine fibroids.We incorporated a new shape constraint into the localized region-based active contour, which constrained the active contour to obtain the desired, accurate segmentation, avoiding boundary leakage and excessive contraction. Localized region-based active contour modeling is suitable for ultrasound images, but it still cannot acquire satisfactory segmentation for HIFU ultrasound images of uterine fibroids. We improved the localized region-based active contour model by incorporating a shape constraint into region-based level set framework to increase segmentation accuracy. Some improvement measures were proposed to overcome the sensitivity of initialization, and a multi-scale segmentation method was proposed to improve segmentation efficiency. We also designed an adaptive localizing radius size selection function to acquire better segmentation results.Experimental results demonstrated that the MSLCV model was significantly more accurate and efficient than conventional methods. The MSLCV model has been quantitatively validated via experiments, obtaining an average of 0.94 for the DSC (Dice similarity coefficient and 25.16 for the MSSD (mean sum of square distance. Moreover, by using the multi-scale segmentation method, the MSLCV model's average segmentation time was decreased to approximately 1/8 that of the localized region-based active contour model (the LCV model.An accurate and efficient multi-scale and shape constrained localized region-based active contour model was designed for the semi-automatic segmentation of uterine fibroid ultrasound (UFUS images in HIFU therapy. Compared with other

  5. Prospective multicenter Phase II-Study on focal therapy (hemiablation) of the prostate with High Intensity focused ultrasound (HIFU).

    Science.gov (United States)

    Ganzer, Roman; Hadaschik, Boris; Pahernik, Sascha; Koch, Daniel; Baumunk, Daniel; Kuru, Timur; Heidenreich, Axel; Stolzenburg, Jens-Uwe; Schostak, Martin; Blana, Andreas

    2017-10-26

    To evaluate Focal therapy (FT) by means of high-intensity focussed ultrasound (HIFU) hemiablation in a prospective trial. Prospective multicentre single arm study in patients with unilateral low/intermediate risk PC, treated from April 2013 through March 2016 in Germany (AUO study protocol AP 68/11). Unilateral PC was assessed by transrectal ultrasound (TRUS)-guided biopsy and multiparametric magnetic resonance imaging (mpMRI). Hemiablation was performed with the Ablatherm or Focal One device. Oncologic outcome was assessed by salvage-treatment rate, mpMRI and re-biopsy at 12 months. Functional outcome, quality of life (QOL), anxiety and depression by validated questionnaires at baseline and every three months. 51 of 54 recruited patients completed ≥ 12 month visits. Mean follow-up was 17.4 ± 4.5 months. Mean PSA dropped from 6.2±2.0 ng/ml to 2.9±1.9 ng/ml at 12 months (ptreatment. Potency was maintained in 21 of 30 preoperatively potent men. There was no increase in incontinence. QOL, anxiety and depression were not changed postoperatively. The study is limited by short follow-up and lack of a control arm. FT hemiablation is safe with little alterations of functional outcome. Oncologic outcome is acceptable on short term follow-up. Follow-up mpMRI performed poorly and should not replace repeat-biopsy. FT has no impact on post-treatment anxiety and depression. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  6. High intensity focused ultrasound (HIFU) applied to hepato-bilio-pancreatic and the digestive system—current state of the art and future perspectives

    Science.gov (United States)

    Diana, Michele; Schiraldi, Luigi; Liu, Yu-Yin; Memeo, Riccardo; Mutter, Didier; Pessaux, Patrick

    2016-01-01

    Background High intensity focused ultrasound (HIFU) is emerging as a valid minimally-invasive image-guided treatment of malignancies. We aimed to review to current state of the art of HIFU therapy applied to the digestive system and discuss some promising avenues of the technology. Methods Pertinent studies were identified through PubMed and Embase search engines using the following keywords, combined in different ways: HIFU, esophagus, stomach, liver, pancreas, gallbladder, colon, rectum, and cancer. Experimental proof of the concept of endoluminal HIFU mucosa/submucosa ablation using a custom-made transducer has been obtained in vivo in the porcine model. Results Forty-four studies reported on the clinical use of HIFU to treat liver lesions, while 19 series were found on HIFU treatment of pancreatic cancers and four studies included patients suffering from both liver and pancreatic cancers, reporting on a total of 1,682 and 823 cases for liver and pancreas, respectively. Only very limited comparative prospective studies have been reported. Conclusions Digestive system clinical applications of HIFU are limited to pancreatic and liver cancer. It is safe and well tolerated. The exact place in the hepatocellular carcinoma (HCC) management algorithm remains to be defined. HIFU seems to add clear survival advantages over trans arterial chemo embolization (TACE) alone and similar results when compared to radio frequency (RF). For pancreatic cancer, HIFU achieves consistent cancer-related pain relief. Further research is warranted to improve targeting accuracy and efficacy monitoring. Furthermore, additional work is required to transfer this technology on appealing treatments such as endoscopic HIFU-based therapies. PMID:27500145

  7. Investigation of therapy improvement using real-time photoacoustic imaging guided high intensity focused ultrasound

    Science.gov (United States)

    Cui, Huizhong

    There are a lot of risks in cancer treatment by invasive surgery, such as bleeding, wound infection, and long recovery time, etc. Therefore, there is great need for minimally- or non-invasive treatment. High intensity focused ultrasound (HIFU) is a rapidly growing and truly non-invasive technology. It has been widely used in therapeutic applications, such as rapid tissue heating and tissue ablation. With proper imaging guidance, HIFU treatment can be performed totally noninvasively. Currently, ultrasound imaging-guided HIFU has been extensively studied. However, ultrasound imaging guidance is less precise because of the relatively low imaging contrast, sensitivity, and specificity for noninvasive detection. In this study, we employed photoacoustic imaging (PAI) technique, which has been developed a novel promising imaging technique for early cancer detection, to guide HIFU treatment. The goal of this study is to investigate the feasibility of PAI to guide, monitor in real time and enhance the HIFU therapy. In this dissertation, as the first step, the integrated PAI and HIFU system had been shown to have the feasibility to guide HIFU both ex vivo and in vivo. Then, the system was improved and developed to a real-time PAI-guided HIFU system. It is demonstrated that the sensitivity of PA detection for HIFU lesion is very high and the saturation of PA signals can be used as the indicator for tissue coagulation. During the temperature measurement using this system, laser-enhanced HIFU heating was found. Thus, we further investigated the laser enhanced technique in both HIFU heating and pulsed HIFU thrombolysis. In the HIFU therapy, laser light was employed to illuminate the sample concurrently with HIFU radiation. The resulting cavitation was detected with a passive cavitation detector. We demonstrated that concurrent light illumination during HIFU has the potential to significantly enhance HIFU by reducing cavitation threshold.

  8. New Experiences of Treatment in Multiple Tumors with HIFU Ablation and Whole Body Hyperthermia

    Science.gov (United States)

    Takeuchi, Akira; Gondo, Hideki; Iijima, Norio; Xia, Yuantian; Takeuchi, Takashi

    2007-05-01

    We have performed some 5000 whole body hyperthermia (WBH) treatments using far-infrared equipment (RHD 7500: Enthermics medical systems, USA) in 1000 cancer patients since 1991 at Luke Hospital & Clinic (Nakano, Japan). Hyperthermia is a natural treatment whereby patients are heated within the fever temperature range of 41-42 C. However, this therapy alone is poorly suited to advanced cancer patients, where regional tumor control is needed. The potential of HIFU therapy for theses cases deserves further investigation. We have treated 20 times in 12 advanced cancer patients, since importing a new HIFU device (Sonic CZ901: Mianyang some electronic Ltd: China) last December and are able to report some interesting results of combination treatment with HIFU and WBH. Our first experience was a 20-year old female pharyngeal cancer patient with lung and multiple liver metastases. Her lung tumor reduced following WBH (given weekly, 4 times in total) and her liver tumor clearly reduced following HIFU treatment. Our second experience of combinative treatment was in a 65-year old male suffering from a neck tumor with bone metastasis. He received WBH after HIFU treatment into 7th lib bone metastasis. After 10 days, his neck tumor grew with evidence of internal necrosis, and finally ruptured. CT images showed necrotic changes in the focus of the neck tumor and also lib bone metastasis. We believe that this new thermal combinative therapy shows great promise.

  9. Pediatric Sarcomas Are Targetable by MR-Guided High Intensity Focused Ultrasound (MR-HIFU): Anatomical Distribution and Radiological Characteristics.

    Science.gov (United States)

    Shim, Jenny; Staruch, Robert M; Koral, Korgun; Xie, Xian-Jin; Chopra, Rajiv; Laetsch, Theodore W

    2016-10-01

    Despite intensive therapy, children with metastatic and recurrent sarcoma or neuroblastoma have a poor prognosis. Magnetic resonance guided high intensity focused ultrasound (MR-HIFU) is a noninvasive technique allowing the delivery of targeted ultrasound energy under MR imaging guidance. MR-HIFU may be used to ablate tumors without ionizing radiation or target chemotherapy using hyperthermia. Here, we evaluated the anatomic locations of tumors to assess the technical feasibility of MR-HIFU therapy for children with solid tumors. Patients with sarcoma or neuroblastoma with available cross-sectional imaging were studied. Tumors were classified based on the location and surrounding structures within the ultrasound beam path as (i) not targetable, (ii) completely or partially targetable with the currently available MR-HIFU system, and (iii) potentially targetable if a respiratory motion compensation technique was used. Of the 121 patients with sarcoma and 61 patients with neuroblastoma, 64% and 25% of primary tumors were targetable at diagnosis, respectively. Less than 20% of metastases at diagnosis or relapse were targetable for both sarcoma and neuroblastoma. Most targetable lesions were located in extremities or in the pelvis. Respiratory motion compensation may increase the percentage of targetable tumors by 4% for sarcomas and 10% for neuroblastoma. Many pediatric sarcomas are localized at diagnosis and are targetable by current MR-HIFU technology. Some children with neuroblastoma have bony tumors targetable by MR-HIFU at relapse, but few newly diagnosed children with neuroblastoma have tumors amenable to MR-HIFU therapy. Clinical trials of MR-HIFU should focus on patients with anatomically targetable tumors. © 2016 Wiley Periodicals, Inc.

  10. In-office rapid volumetric ablation of uterine fibroids under ultrasound imaging guidance: Preclinical and early clinical experience with the Mirabilis transabdominal HIFU treatment system

    Science.gov (United States)

    Leal, José G. Garza; León, Ivan Hernandez; Sáenz, Lorena Castillo; Aguirre, Juan M. Aguilar; Lagos, Joel J. Islas; Parsons, Jessica E.; Darlington, Gregory P.; Lau, Michael P. H.

    2017-03-01

    Mirabilis Medica, Inc. (Bothell, WA, USA) has developed a high-intensity focused ultrasound (HIFU) system for producing rapid transabdominal volumetric ablation of uterine fibroids in an office-based setting. The Mirabilis HIFU Treatment System utilizes integrated ultrasound imaging guidance and short treatment times under 15 minutes. Treatment with the Mirabilis system is generally well tolerated using only oral analgesia without anesthesia or sedation. This paper summarizes certain technical aspects of the Mirabilis HIFU technology, the preclinical development process, and the results of the first in-human clinical study using the Mirabilis system. During preclinical studies, an in vivo transcutaneous porcine lower extremity model was used in a total of 180 adult swine to develop the HIFU treatment regimen parameters. Additionally, 108 excised human uteri with fibroids obtained from scheduled hysterectomies were treated in an ex vivo experimental setup and evaluated. These preclinical activities resulted in a HIFU treatment technique referred to as Mirabilis Shell Ablation, which enables rapid volumetric fibroid ablation by directing the HIFU energy to the outer perimeter of the target volume (the `shell') without insonating its core. This method results in efficient fibroid treatment through a synergistic combination of direct tissue ablation, cooperative heating effects, and indirect ischemic necrosis in the interior of the volume. After refining this technique and performing safety testing in the in vivo porcine model, a clinical pilot study was conducted to assess the initial safety and performance of the Mirabilis HIFU Treatment System for transabdominal treatment of uterine fibroids in eligible women who were scheduled to undergo hysterectomy following treatment with the device. A total of 37 women meeting certain eligibility criteria were treated at two clinical sites in Mexico. Twenty-nine (29) of these 37 women received only prophylactic sublingual

  11. An Ultrasound Image-Based Dynamic Fusion Modeling Method for Predicting the Quantitative Impact of In Vivo Liver Motion on Intraoperative HIFU Therapies: Investigations in a Porcine Model

    Science.gov (United States)

    N'Djin, W. Apoutou; Chapelon, Jean-Yves; Melodelima, David

    2015-01-01

    Organ motion is a key component in the treatment of abdominal tumors by High Intensity Focused Ultrasound (HIFU), since it may influence the safety, efficacy and treatment time. Here we report the development in a porcine model of an Ultrasound (US) image-based dynamic fusion modeling method for predicting the effect of in vivo motion on intraoperative HIFU treatments performed in the liver in conjunction with surgery. A speckle tracking method was used on US images to quantify in vivo liver motions occurring intraoperatively during breathing and apnea. A fusion modeling of HIFU treatments was implemented by merging dynamic in vivo motion data in a numerical modeling of HIFU treatments. Two HIFU strategies were studied: a spherical focusing delivering 49 juxtapositions of 5-second HIFU exposures and a toroidal focusing using 1 single 40-second HIFU exposure. Liver motions during breathing were spatially homogenous and could be approximated to a rigid motion mainly encountered in the cranial-caudal direction (f = 0.20Hz, magnitude >13mm). Elastic liver motions due to cardiovascular activity, although negligible, were detectable near millimeter-wide sus-hepatic veins (f = 0.96Hz, magnitude HIFU exposure in stationary tissues (Dice Similarity Coefficient: DSCHIFU ablations during respiration, either by juxtaposing “cigar-shaped” lesions with spherical HIFU exposures, or by generating one large single lesion with toroidal HIFU exposures (DSC>75%). Fusion modeling predictions were preliminarily validated in vivo and showed the potential of using a long-duration toroidal HIFU exposure to accelerate the ablation process during breathing (from 0.5 to 6 cm3·min-1). To improve HIFU treatment control, dynamic fusion modeling may be interesting for assessing numerically focusing strategies and motion compensation techniques in more realistic conditions. PMID:26398366

  12. Using immunoadjuvant agent glycated chitosan to enhance anti-cancer stem like cell immunity induced by HIFU

    Science.gov (United States)

    Chen, Y.-L.; Chen, W.-R.; Liu, R.-S.; Yang, F.-Y.; Wang, C.-Y.; Lee, Y.-J.

    2013-02-01

    Thermal therapy is based on the observation that tumor cells are sensitive to increased temperature, which is important for tumor control. In this study, the high intensity focused ultrasound (HIFU) system was used to simulate thermal therapy on breast cancer control in the small animal model. Additionally, the immunoadjuvant agent, so called glycated chitosan (GC), was used to enhance the immunological effects on tumor control. The bioluminescent imaging showed that tumor metastasis was apparently suppressed by a combined treatment using HIFU and GC, but not in HIFU or GC alone. Using immunohistochemical (IHC) staining, lung metastasis of 4T1-3R tumor cells further agree the observations obtained from non-invasive in vivo imaging. We also found that plasma collected from mice treated with combined HIFU and GC could significantly suppress the viability of cultured 4T1 cells compared to untreated or single treated group. In summary, these results suggest that the HIFU therapy combined with GC can enhance the tumor immunogenicity and tumor control.

  13. An Ultrasound Image-Based Dynamic Fusion Modeling Method for Predicting the Quantitative Impact of In Vivo Liver Motion on Intraoperative HIFU Therapies: Investigations in a Porcine Model.

    Directory of Open Access Journals (Sweden)

    W Apoutou N'Djin

    Full Text Available Organ motion is a key component in the treatment of abdominal tumors by High Intensity Focused Ultrasound (HIFU, since it may influence the safety, efficacy and treatment time. Here we report the development in a porcine model of an Ultrasound (US image-based dynamic fusion modeling method for predicting the effect of in vivo motion on intraoperative HIFU treatments performed in the liver in conjunction with surgery. A speckle tracking method was used on US images to quantify in vivo liver motions occurring intraoperatively during breathing and apnea. A fusion modeling of HIFU treatments was implemented by merging dynamic in vivo motion data in a numerical modeling of HIFU treatments. Two HIFU strategies were studied: a spherical focusing delivering 49 juxtapositions of 5-second HIFU exposures and a toroidal focusing using 1 single 40-second HIFU exposure. Liver motions during breathing were spatially homogenous and could be approximated to a rigid motion mainly encountered in the cranial-caudal direction (f = 0.20 Hz, magnitude > 13 mm. Elastic liver motions due to cardiovascular activity, although negligible, were detectable near millimeter-wide sus-hepatic veins (f = 0.96 Hz, magnitude 75%. Fusion modeling predictions were preliminarily validated in vivo and showed the potential of using a long-duration toroidal HIFU exposure to accelerate the ablation process during breathing (from 0.5 to 6 cm3 · min(-1. To improve HIFU treatment control, dynamic fusion modeling may be interesting for assessing numerically focusing strategies and motion compensation techniques in more realistic conditions.

  14. Method and system to synchronize acoustic therapy with ultrasound imaging

    Science.gov (United States)

    Owen, Neil (Inventor); Bailey, Michael R. (Inventor); Hossack, James (Inventor)

    2009-01-01

    Interference in ultrasound imaging when used in connection with high intensity focused ultrasound (HIFU) is avoided by employing a synchronization signal to control the HIFU signal. Unless the timing of the HIFU transducer is controlled, its output will substantially overwhelm the signal produced by ultrasound imaging system and obscure the image it produces. The synchronization signal employed to control the HIFU transducer is obtained without requiring modification of the ultrasound imaging system. Signals corresponding to scattered ultrasound imaging waves are collected using either the HIFU transducer or a dedicated receiver. A synchronization processor manipulates the scattered ultrasound imaging signals to achieve the synchronization signal, which is then used to control the HIFU bursts so as to substantially reduce or eliminate HIFU interference in the ultrasound image. The synchronization processor can alternatively be implemented using a computing device or an application-specific circuit.

  15. TU-A-210-01: HIFU Physics and Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Eames, M. [Focused Ultrasound Foundation (United States)

    2015-06-15

    High-intensity focused ultrasound (HIFU) has developed rapidly in recent years and is used frequently for clinical treatments in Asia and Europe with increasing clinical use and clinical trial activity in the US, making it an important medical technology with which the medical physics community must become familiar. Akin to medical devices that deliver treatments using ionizing radiation, HIFU relies on emitter geometry to non-invasively form a tight focus that can be used to affect diseased tissue while leaving healthy tissue intact. HIFU is unique in that it does not involve the use of ionizing radiation, it causes thermal necrosis in 100% of the treated tissue volume, and it has an immediate treatment effect. However, because it is an application of ultrasound energy, HIFU interacts strongly with tissue interfaces, which makes treatment planning challenging. In order to appreciate the advantages and disadvantages of HIFU as a thermal therapy, it is important to understand the underlying physics of ultrasound tissue interactions. The first lecture in the session will provide an overview of the physics of ultrasound wave propagation; the mechanism for the accumulation of heat in soft-tissue; image-guidance modalities including temperature monitoring; current clinical applications and commercial devices; active clinical trials; alternate mechanisms of action (future of FUS). The second part of the session will compare HIFU to existing ionization radiation techniques. The difficulties in defining a clear concept of absorbed dose for HIFU will be discussed. Some of the technical challenges that HIFU faces will be described, with an emphasis on how the experience of radiation oncology physicists could benefit the field. Learning Objectives: Describe the basic physics and biology of HIFU, including treatment delivery and image guidance techniques. Summarize existing and emerging clinical applications and manufacturers for HIFU. Understand that thermal ablation with

  16. Combination of bubble liposomes and high-intensity focused ultrasound (HIFU) enhanced antitumor effect by tumor ablation.

    Science.gov (United States)

    Hamano, Nobuhito; Negishi, Yoichi; Takatori, Kyohei; Endo-Takahashi, Yoko; Suzuki, Ryo; Maruyama, Kazuo; Niidome, Takuro; Aramaki, Yukihiko

    2014-01-01

    Ultrasound (US) is used in the clinical setting not only for diagnosis but also for therapy. As a therapeutic US technique, high-intensity focused ultrasound (HIFU) can be applied to treat cancer in a clinical setting. Microbubbles increased temperature and improved the low therapeutic efficiency under HIFU; however, microbubbles have room for improvement in size, stability, and targeting ability. To solve these issues, we reported that "Bubble liposomes" (BLs) containing the US imaging gas (perfluoropropane gas) liposomes were suitable for ultrasound imaging and gene delivery. In this study, we examined whether BLs and HIFU could enhance the ablation area of the tumor and the antitumor effect. First, we histologically analyzed the tumor after BLs and HIFU. The ablation area of the treatment of BLs and HIFU was broader than that of HIFU alone. Next, we monitored the temperature of the tumor, and examined the antitumor effect. The temperature increase with BLs and HIFU treatment was faster and higher than that with HIFU alone. Moreover, treatment with BLs and HIFU enhanced the antitumor effect, which was better than with HIFU alone. Thus, the combination of BLs and HIFU could be efficacious for cancer therapy.

  17. Combination of the transurethral resection and prostate HIFU ablation at treatment of the localized cancer

    Directory of Open Access Journals (Sweden)

    Popkov V.M.

    2014-09-01

    26 patients were included into HIFU and 74 group in group of the combined treatment (TURP+HIFU. Selection criteria for HIFU ablation were the localized cancer of a prostate concerning which earlier it wasn't carried out treatments, and level of a PSA at the time of statement of the diagnosis 15 ng/ml. All patients corresponding to these by criteria, were considered as candidates for treatment and inclusion in the analysis. The nadir and stability of PSA, the histologic conclusion, IPSS, quality of life and complication were estimated at time of postoperative supervision. Results: Statistically significant influence of a combination TURP+HIFU for the term of transurethral drainage of a bladder (a median of 40 days against 7 days, incontience frequency (15.4% against 6.9%, infections of urinary ways (47.9% against 11.4% and IPSS change during the postoperative period (on the average 8.91 against 3.37 is noted. During the short period of supervision it wasn't observed considerable changes in relation to efficiency: in HIFU group the frequency of repeated sessions made 25%, in TUR/HIFU group 4%. Conclusion: HIFU therapy is modern, minimum invasive method of a cancer therapy of a prostate. The combination of a transurethral resection and HIFU ablation significantly reduces the frequency of the complications connected with treatment. Maintaining the patient after combined TURP and HIFU ablation is comparable with maintaining the patient after usual TURP.

  18. MR-guided transcranial brain HIFU in small animal models

    Energy Technology Data Exchange (ETDEWEB)

    Larrat, B; Pernot, M; Aubry, J-F; Sinkus, R; Fink, M; Tanter, M [Institut Langevin, ESPCI ParisTech, CNRS UMR 7587, INSERM U979, Universite Paris VII, Laboratoire Ondes et Acoustique, 10 rue Vauquelin, 75 231 Paris Cedex 05 (France); Dervishi, E; Boch, A-L [Hopital de la Pitie-Salpetriere-INSERM, U495, 47 Boulevard de l' Hopital, 75651 Paris Cedex 13 (France); Seilhean, D [Hopital de la Pitie-Salpetriere-Neuropathology Department, 47 Boulevard de l' Hopital, 75651 Paris Cedex 13 (France); Marie, Y [Hopital de la Pitie-Salpetriere-Neurosurgery Department, 47 Boulevard de l' Hopital, 75651 Paris Cedex 13 (France)], E-mail: benoit.larrat@espci.fr

    2010-01-21

    Recent studies have demonstrated the feasibility of transcranial high-intensity focused ultrasound (HIFU) therapy in the brain using adaptive focusing techniques. However, the complexity of the procedures imposes provision of accurate targeting, monitoring and control of this emerging therapeutic modality in order to ensure the safety of the treatment and avoid potential damaging effects of ultrasound on healthy tissues. For these purposes, a complete workflow and setup for HIFU treatment under magnetic resonance (MR) guidance is proposed and implemented in rats. For the first time, tissue displacements induced by the acoustic radiation force are detected in vivo in brain tissues and measured quantitatively using motion-sensitive MR sequences. Such a valuable target control prior to treatment assesses the quality of the focusing pattern in situ and enables us to estimate the acoustic intensity at focus. This MR-acoustic radiation force imaging is then correlated with conventional MR-thermometry sequences which are used to follow the temperature changes during the HIFU therapeutic session. Last, pre- and post-treatment magnetic resonance elastography (MRE) datasets are acquired and evaluated as a new potential way to non-invasively control the stiffness changes due to the presence of thermal necrosis. As a proof of concept, MR-guided HIFU is performed in vitro in turkey breast samples and in vivo in transcranial rat brain experiments. The experiments are conducted using a dedicated MR-compatible HIFU setup in a high-field MRI scanner (7 T). Results obtained on rats confirmed that both the MR localization of the US focal point and the pre- and post-HIFU measurement of the tissue stiffness, together with temperature control during HIFU are feasible and valuable techniques for efficient monitoring of HIFU in the brain. Brain elasticity appears to be more sensitive to the presence of oedema than to tissue necrosis.

  19. MR-guided transcranial brain HIFU in small animal models

    Science.gov (United States)

    Larrat, B.; Pernot, M.; Aubry, J.-F.; Dervishi, E.; Sinkus, R.; Seilhean, D.; Marie, Y.; Boch, A.-L.; Fink, M.; Tanter, M.

    2010-01-01

    Recent studies have demonstrated the feasibility of transcranial high-intensity focused ultrasound (HIFU) therapy in the brain using adaptive focusing techniques. However, the complexity of the procedures imposes provision of accurate targeting, monitoring and control of this emerging therapeutic modality in order to ensure the safety of the treatment and avoid potential damaging effects of ultrasound on healthy tissues. For these purposes, a complete workflow and setup for HIFU treatment under magnetic resonance (MR) guidance is proposed and implemented in rats. For the first time, tissue displacements induced by the acoustic radiation force are detected in vivo in brain tissues and measured quantitatively using motion-sensitive MR sequences. Such a valuable target control prior to treatment assesses the quality of the focusing pattern in situ and enables us to estimate the acoustic intensity at focus. This MR-acoustic radiation force imaging is then correlated with conventional MR-thermometry sequences which are used to follow the temperature changes during the HIFU therapeutic session. Last, pre- and post-treatment magnetic resonance elastography (MRE) datasets are acquired and evaluated as a new potential way to non-invasively control the stiffness changes due to the presence of thermal necrosis. As a proof of concept, MR-guided HIFU is performed in vitro in turkey breast samples and in vivo in transcranial rat brain experiments. The experiments are conducted using a dedicated MR-compatible HIFU setup in a high-field MRI scanner (7 T). Results obtained on rats confirmed that both the MR localization of the US focal point and the pre- and post-HIFU measurement of the tissue stiffness, together with temperature control during HIFU are feasible and valuable techniques for efficient monitoring of HIFU in the brain. Brain elasticity appears to be more sensitive to the presence of oedema than to tissue necrosis.

  20. The safety and feasibility of extracorporeal high-intensity focused ultrasound (HIFU) for the treatment of liver and kidney tumours in a Western population

    Science.gov (United States)

    Illing, R O; Kennedy, J E; Wu, F; ter Haar, G R; Protheroe, A S; Friend, P J; Gleeson, F V; Cranston, D W; Phillips, R R; Middleton, M R

    2005-01-01

    High-intensity focused ultrasound (HIFU) provides a potential noninvasive alternative to conventional therapies. We report our preliminary experience from clinical trials designed to evaluate the safety and feasibility of a novel, extracorporeal HIFU device for the treatment of liver and kidney tumours in a Western population. The extracorporeal, ultrasound-guided Model-JC Tumor Therapy System (HAIFU™ Technology Company, China) has been used to treat 30 patients according to four trial protocols. Patients with hepatic or renal tumours underwent a single therapeutic HIFU session under general anaesthesia. Magnetic resonance imaging 12 days after treatment provided assessment of response. The patients were subdivided into those followed up with further imaging alone or those undergoing surgical resection of their tumours, which enabled both radiological and histological assessment. HIFU exposure resulted in discrete zones of ablation in 25 of 27 evaluable patients (93%). Ablation of liver tumours was achieved more consistently than for kidney tumours (100 vs 67%, assessed radiologically). The adverse event profile was favourable when compared to more invasive techniques. HIFU treatment of liver and kidney tumours in a Western population is both safe and feasible. These findings have significant implications for future noninvasive image-guided tumour ablation. PMID:16189519

  1. Non-Invasive Targeted Peripheral Nerve Ablation Using 3D MR Neurography and MRI-Guided High-Intensity Focused Ultrasound (MR-HIFU): Pilot Study in a Swine Model.

    Science.gov (United States)

    Huisman, Merel; Staruch, Robert M; Ladouceur-Wodzak, Michelle; van den Bosch, Maurice A; Burns, Dennis K; Chhabra, Avneesh; Chopra, Rajiv

    2015-01-01

    Ultrasound (US)-guided high intensity focused ultrasound (HIFU) has been proposed for noninvasive treatment of neuropathic pain and has been investigated in in-vivo studies. However, ultrasound has important limitations regarding treatment guidance and temperature monitoring. Magnetic resonance (MR)-imaging guidance may overcome these limitations and MR-guided HIFU (MR-HIFU) has been used successfully for other clinical indications. The primary purpose of this study was to evaluate the feasibility of utilizing 3D MR neurography to identify and guide ablation of peripheral nerves using a clinical MR-HIFU system. Volumetric MR-HIFU was used to induce lesions in the peripheral nerves of the lower limbs in three pigs. Diffusion-prep MR neurography and T1-weighted images were utilized to identify the target, plan treatment and immediate post-treatment evaluation. For each treatment, one 8 or 12 mm diameter treatment cell was used (sonication duration 20 s and 36 s, power 160-300 W). Peripheral nerves were extracted HIFU. Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired, and may also have potential for post-treatment verification of thermal lesions without contrast injection.

  2. High intensity focused ultrasound (HIFU as the alternative method of treatment of oncourological diseases

    Directory of Open Access Journals (Sweden)

    Blyumberg B.I.

    2012-12-01

    Full Text Available Increasing interest devoted to technology of high intensity focused ultrasound (high-intensity focused ultrasound, HIFU, basically, is explained by a wide spectrum of potential fields of application at minimum invasiveness of the given method. In oncourology HIFU is applied in prostate and kidney cancer. In case of tumors of renal parenchyma the given technique is being clinically tested, while HIFU is currently used in the practice of European oncourologists in treatment of prostate cancer. The majority of the references describing the results of HIFU application in prostate cancer is based on data of a number of clinical observations. It has been proved that HIFU is a possible method of treatment of highly — and moderate-differentiated tumors, and local relapses after remote radial therapy.

  3. Adjuvant hormone therapy in patients undergoing high-intensity focused ultrasound therapy for locally advanced prostate cancer

    Directory of Open Access Journals (Sweden)

    A. I. Neimark

    2014-01-01

    Full Text Available Objective: to evaluate the efficiency and safety of using the luteinizing hormone releasing hormone leuprorelin with the Atrigel delivery system in doses of 7.5, 22.5, and 45 mg as an adjuvant regimen in high- and moderate-risk cancer patients who have received high-intensity focused ultrasound (HIFU therapy.Subjects and methods. Moderate- and high-risk locally advanced prostate cancer (PC patients treated with HIFU (n = 28 and HIFU in combination with hormone therapy during 6 months (n = 31 were examined.Results. The investigation has shown that leuprorelin acetate monotherapy used within 6 months after HIFU therapy can achieve the highest reduction in prostate-specific antigen levels and positively affect the symptoms of the disease. HIFU in combination with androgen deprivation substantially diminishes the clinical manifestations of the disease and improves quality of life in HIFU-treated patients with PC, by reducing the degree of infravesical obstruction (according to uroflowmetric findings and IPSS scores, and causes a decrease in prostate volume as compared to those who have undergone HIFU only. Treatment with leuprorelin having the Atrigel delivery system has demonstrated the low incidence of adverse reactions and good tolerability.

  4. TU-A-210-02: HIFU: Why Should a Radiation Oncology Physicist Pay Attention?

    Energy Technology Data Exchange (ETDEWEB)

    Schlesinger, D. [University of Virginia Health Systems (United States)

    2015-06-15

    High-intensity focused ultrasound (HIFU) has developed rapidly in recent years and is used frequently for clinical treatments in Asia and Europe with increasing clinical use and clinical trial activity in the US, making it an important medical technology with which the medical physics community must become familiar. Akin to medical devices that deliver treatments using ionizing radiation, HIFU relies on emitter geometry to non-invasively form a tight focus that can be used to affect diseased tissue while leaving healthy tissue intact. HIFU is unique in that it does not involve the use of ionizing radiation, it causes thermal necrosis in 100% of the treated tissue volume, and it has an immediate treatment effect. However, because it is an application of ultrasound energy, HIFU interacts strongly with tissue interfaces, which makes treatment planning challenging. In order to appreciate the advantages and disadvantages of HIFU as a thermal therapy, it is important to understand the underlying physics of ultrasound tissue interactions. The first lecture in the session will provide an overview of the physics of ultrasound wave propagation; the mechanism for the accumulation of heat in soft-tissue; image-guidance modalities including temperature monitoring; current clinical applications and commercial devices; active clinical trials; alternate mechanisms of action (future of FUS). The second part of the session will compare HIFU to existing ionization radiation techniques. The difficulties in defining a clear concept of absorbed dose for HIFU will be discussed. Some of the technical challenges that HIFU faces will be described, with an emphasis on how the experience of radiation oncology physicists could benefit the field. Learning Objectives: Describe the basic physics and biology of HIFU, including treatment delivery and image guidance techniques. Summarize existing and emerging clinical applications and manufacturers for HIFU. Understand that thermal ablation with

  5. TU-B-210-01: MRg HIFU - Bone and Soft Tissue Tumor Ablation

    Energy Technology Data Exchange (ETDEWEB)

    Ghanouni, P. [Stanford University (United States)

    2015-06-15

    MR guided focused ultrasound (MRgFUS), or alternatively high-intensity focused ultrasound (MRgHIFU), is approved for thermal ablative treatment of uterine fibroids and pain palliation in bone metastases. Ablation of malignant tumors is under active investigation in sites such as breast, prostate, brain, liver, kidney, pancreas, and soft tissue. Hyperthermia therapy with MRgFUS is also feasible, and may be used in conjunction with radiotherapy and for local targeted drug delivery. MRI allows in situ target definition and provides continuous temperature monitoring and subsequent thermal dose mapping during HIFU. Although MRgHIFU can be very precise, treatment of mobile organs is challenging and advanced techniques are required because of artifacts in MR temperature mapping, the need for intercostal firing, and need for gated HIFU or tracking of the lesion in real time. The first invited talk, “MR guided Focused Ultrasound Treatment of Tumors in Bone and Soft Tissue”, will summarize the treatment protocol and review results from treatment of bone tumors. In addition, efforts to extend this technology to treat both benign and malignant soft tissue tumors of the extremities will be presented. The second invited talk, “MRI guided High Intensity Focused Ultrasound – Advanced Approaches for Ablation and Hyperthermia”, will provide an overview of techniques that are in or near clinical trials for thermal ablation and hyperthermia, with an emphasis of applications in abdominal organs and breast, including methods for MRTI and tracking targets in moving organs. Learning Objectives: Learn background on devices and techniques for MR guided HIFU for cancer therapy Understand issues and current status of clinical MRg HIFU Understand strategies for compensating for organ movement during MRgHIFU Understand strategies for strategies for delivering hyperthermia with MRgHIFU CM - research collaboration with Philips.

  6. TU-B-210-02: MRg HIFU - Advanced Approaches for Ablation and Hyperthermia

    Energy Technology Data Exchange (ETDEWEB)

    Moonen, C. [University Medical Center Utrecht (Netherlands)

    2015-06-15

    MR guided focused ultrasound (MRgFUS), or alternatively high-intensity focused ultrasound (MRgHIFU), is approved for thermal ablative treatment of uterine fibroids and pain palliation in bone metastases. Ablation of malignant tumors is under active investigation in sites such as breast, prostate, brain, liver, kidney, pancreas, and soft tissue. Hyperthermia therapy with MRgFUS is also feasible, and may be used in conjunction with radiotherapy and for local targeted drug delivery. MRI allows in situ target definition and provides continuous temperature monitoring and subsequent thermal dose mapping during HIFU. Although MRgHIFU can be very precise, treatment of mobile organs is challenging and advanced techniques are required because of artifacts in MR temperature mapping, the need for intercostal firing, and need for gated HIFU or tracking of the lesion in real time. The first invited talk, “MR guided Focused Ultrasound Treatment of Tumors in Bone and Soft Tissue”, will summarize the treatment protocol and review results from treatment of bone tumors. In addition, efforts to extend this technology to treat both benign and malignant soft tissue tumors of the extremities will be presented. The second invited talk, “MRI guided High Intensity Focused Ultrasound – Advanced Approaches for Ablation and Hyperthermia”, will provide an overview of techniques that are in or near clinical trials for thermal ablation and hyperthermia, with an emphasis of applications in abdominal organs and breast, including methods for MRTI and tracking targets in moving organs. Learning Objectives: Learn background on devices and techniques for MR guided HIFU for cancer therapy Understand issues and current status of clinical MRg HIFU Understand strategies for compensating for organ movement during MRgHIFU Understand strategies for strategies for delivering hyperthermia with MRgHIFU CM - research collaboration with Philips.

  7. High intensity focused ultrasound (HIFU) focal spot localization using harmonic motion imaging (HMI).

    Science.gov (United States)

    Han, Yang; Hou, Gary Yi; Wang, Shutao; Konofagou, Elisa

    2015-08-07

    Several ultrasound-based imaging modalities have been proposed for image guidance and monitoring of high-intensity focused ultrasound (HIFU) treatment. However, accurate localization and characterization of the effective region of treatment (focal spot) remain important obstacles in the clinical implementation of HIFU ablation. Harmonic motion imaging for focused ultrasound (HMIFU) is a HIFU monitoring technique that utilizes radiation-force-induced localized oscillatory displacement. HMIFU has been shown to correctly identify the formation and extent of HIFU thermal ablation lesions. However a significant problem remains in identifying the location of the HIFU focus, which is necessary for treatment planning. In this study, the induced displacement was employed to localize the HIFU focal spot inside the tissue prior to treatment. Feasibility was shown with two separate systems. The 1D HMIFU system consisted of a HIFU transducer emitting an amplitude-modulated HIFU beam for mechanical excitation and a confocal single-element, pulse-echo transducer for simultaneous RF acquisition. The 2D HIFU system consists of a HIFU phased array, and a co-axial imaging phased array for simultaneous imaging. Initial feasibility was first performed on tissue-mimicking gelatin phantoms and the focal zone was defined as the region corresponding to the -3dB full width at half maximum of the HMI displacement. Using the same parameters, in vitro experiments were performed in canine liver specimens to compare the defined focal zone with the lesion. In vitro measurements showed good agreement between the HMI predicted focal zone and the induced HIFU lesion location. HMIFU was experimentally shown to be capable of predicting and tracking the focal region in both phantoms and in vitro tissues. The accuracy of focal spot localization was evaluated by comparing with the lesion location in post-ablative tissues, with a R(2) = 0.821 at p HIFU focal spot without inducing thermal changes during

  8. High intensity focused ultrasound (HIFU) focal spot localization using harmonic motion imaging (HMI)

    Science.gov (United States)

    Han, Yang; Hou, Gary Yi; Wang, Shutao; Konofagou, Elisa

    2015-08-01

    Several ultrasound-based imaging modalities have been proposed for image guidance and monitoring of high-intensity focused ultrasound (HIFU) treatment. However, accurate localization and characterization of the effective region of treatment (focal spot) remain important obstacles in the clinical implementation of HIFU ablation. Harmonic motion imaging for focused ultrasound (HMIFU) is a HIFU monitoring technique that utilizes radiation-force-induced localized oscillatory displacement. HMIFU has been shown to correctly identify the formation and extent of HIFU thermal ablation lesions. However a significant problem remains in identifying the location of the HIFU focus, which is necessary for treatment planning. In this study, the induced displacement was employed to localize the HIFU focal spot inside the tissue prior to treatment. Feasibility was shown with two separate systems. The 1D HMIFU system consisted of a HIFU transducer emitting an amplitude-modulated HIFU beam for mechanical excitation and a confocal single-element, pulse-echo transducer for simultaneous RF acquisition. The 2D HIFU system consists of a HIFU phased array, and a co-axial imaging phased array for simultaneous imaging. Initial feasibility was first performed on tissue-mimicking gelatin phantoms and the focal zone was defined as the region corresponding to the  -3dB full width at half maximum of the HMI displacement. Using the same parameters, in vitro experiments were performed in canine liver specimens to compare the defined focal zone with the lesion. In vitro measurements showed good agreement between the HMI predicted focal zone and the induced HIFU lesion location. HMIFU was experimentally shown to be capable of predicting and tracking the focal region in both phantoms and in vitro tissues. The accuracy of focal spot localization was evaluated by comparing with the lesion location in post-ablative tissues, with a R2 = 0.821 at p  technique to localize the HIFU focal spot without

  9. Increasing the HIFU ablation rate through an MRI-guided sonication strategy using shock waves : feasibility in the in vivo porcine liver

    NARCIS (Netherlands)

    Ramaekers, P; de Greef, M; van Breugel, J M M; Moonen, C T W; Ries, M

    2016-01-01

    This study investigated whether an MR-guided pulsed HIFU ablation strategy could be implemented under clinical conditions, using a transducer designed for uterine fibroid ablation, to obtain an ablation rate that is sufficiently high for clinical abdominal HIFU therapy in highly perfused organs. A

  10. Effects of HIFU induced cavitation on flooded lung parenchyma.

    Science.gov (United States)

    Wolfram, Frank; Dietrich, Georg; Boltze, Carsten; Jenderka, Klaus Vitold; Lesser, Thomas Günther

    2017-01-01

    High intensity focused ultrasound (HIFU) has gained clinical interest as a non-invasive local tumour therapy in many organs. In addition, it has been shown that lung cancer can be targeted by HIFU using One-Lung Flooding (OLF). OLF generates a gas free saline-lung compound in one lung wing and therefore acoustic access to central lung tumours. It can be assumed that lung parenchyma is exposed to ultrasound intensities in the pre-focal path and in cases of misguiding. If so, cavitation might be induced in the saline fraction of flooded lung and cause tissue damage. Therefore this study was aimed to determine the thresholds of HIFU induced cavitation and tissue erosion in flooded lung. Resected human lung lobes were flooded ex-vivo. HIFU (1,1 MHz) was targeted under sonographic guidance into flooded lung parenchyma. Cavitation events were counted using subharmonic passive cavitation detection (PCD). B-Mode imaging was used to detect cavitation and erosion sonographically. Tissue samples out of the focal zone were analysed histologically. In flooded lung, a PCD and a sonographic cavitation detection threshold of 625  Wcm - 2 ( p r  = 4, 3  MPa ) and 3.600  Wcm - 2 ( p r  = 8, 3  MPa ) was found. Cavitation in flooded lung appears as blurred hyperechoic focal region, which enhances echogenity with insonation time. Lung parenchyma erosion was detected at intensities above 7.200  Wcm - 2 ( p r  = 10, 9  MPa ). Cavitation occurs in flooded lung parenchyma, which can be detected passively and by B-Mode imaging. Focal intensities required for lung tumour ablation are below levels where erosive events occur. Therefore focal cavitation events can be monitored and potential risk from tissue erosion in flooded lung avoided.

  11. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer.

    Science.gov (United States)

    Strunk, H M; Henseler, J; Rauch, M; Mücke, M; Kukuk, G; Cuhls, H; Radbruch, L; Zhang, L; Schild, H H; Marinova, M

    2016-07-01

    Evaluation of ultrasound-guided high-intensity focused ultrasound (HIFU) used for the first time in Germany in patients with inoperable pancreatic cancer for reduction of tumor volume and relief of tumor-associated pain. 15 patients with locally advanced inoperable pancreatic cancer and tumor-related pain symptoms were treated by HIFU (n = 6 UICC stage III, n = 9 UICC stage IV). 13 patients underwent simultaneous standard chemotherapy. Ablation was performed using the JC HIFU system (Chongqing, China HAIFU Company) with an ultrasonic device for real-time imaging. Imaging follow-up (US, CT, MRI) and clinical assessment using validated questionnaires (NRS, BPI) was performed before and up to 15 months after HIFU. Despite biliary or duodenal stents (4/15) and encasement of visceral vessels (15/15), HIFU treatment was performed successfully in all patients. Treatment time and sonication time were 111 min and 1103 s, respectively. The applied total energy was 386 768 J. After HIFU ablation, contrast-enhanced imaging showed devascularization of treated tumor regions with a significant average volume reduction of 63.8 % after 3 months. Considerable pain relief was achieved in 12 patients after HIFU (complete or partial pain reduction in 6 patients). US-guided HIFU with a suitable acoustic pathway can be used for local tumor control and relief of tumor-associated pain in patients with locally advanced pancreatic cancer. • US-guided HIFU allows an additive treatment of unresectable pancreatic cancer.• HIFU can be used for tumor volume reduction.• Using HIFU, a significant reduction of cancer-related pain was achieved.• HIFU provides clinical benefit in patients with pancreatic cancer. Citation Format: • Strunk HM, Henseler J, Rauch M et al. Clinical Use of High-Intensity Focused Ultrasound (HIFU) for Tumor and Pain Reduction in Advanced Pancreatic Cancer. Fortschr Röntgenstr 2016; 188: 662 - 670. © Georg Thieme Verlag KG

  12. A New Active Cavitation Mapping Technique for Pulsed HIFU Applications – Bubble Doppler

    Science.gov (United States)

    Li, Tong; Khokhlova, Tatiana; Sapozhnikov, Oleg; Hwang, Joo Ha; Sapozhnikov, Oleg; O’Donnell, Matthew

    2015-01-01

    In this work, a new active cavitation mapping technique for pulsed high-intensity focused ultrasound (pHIFU) applications termed bubble Doppler is proposed and its feasibility tested in tissue-mimicking gel phantoms. pHIFU therapy uses short pulses, delivered at low pulse repetition frequency, to cause transient bubble activity that has been shown to enhance drug and gene delivery to tissues. The current gold standard for detecting and monitoring cavitation activity during pHIFU treatments is passive cavitation detection (PCD), which provides minimal information on the spatial distribution of the bubbles. B-mode imaging can detect hyperecho formation, but has very limited sensitivity, especially to small, transient microbubbles. The bubble Doppler method proposed here is based on a fusion of the adaptations of three Doppler techniques that had been previously developed for imaging of ultrasound contrast agents – color Doppler, pulse inversion Doppler, and decorrelation Doppler. Doppler ensemble pulses were interleaved with therapeutic pHIFU pulses using three different pulse sequences and standard Doppler processing was applied to the received echoes. The information yielded by each of the techniques on the distribution and characteristics of pHIFU-induced cavitation bubbles was evaluated separately, and found to be complementary. The unified approach - bubble Doppler – was then proposed to both spatially map the presence of transient bubbles and to estimate their sizes and the degree of nonlinearity. PMID:25265178

  13. Systemic Cancer Therapy:

    Directory of Open Access Journals (Sweden)

    Michael Ostario Palumbo

    2013-05-01

    Full Text Available In the last half of the century, advances in the systemic therapy of cancer, including chemotherapy, hormonal therapy, targeted therapy and immunotherapy have been responsible for improvements in cancer related mortality in developed countries even as the population continues to age. Although such advancements have yet to benefit all cancer types, systemic therapies have led to an improvement in overall survival in both the adjuvant and metastatic setting for many cancers. With the pressure to make therapies available as soon as possible, the side-effects of systemic therapies, in particular long-term side-effects are not very well characterized and understood. Increasingly, a number of cancer types are requiring long-term and even lifelong systemic therapy. This is true for both younger and older patients with cancer and has important implications for each subset. Younger patients have an overall greater expected life-span, and as a result may suffer a greater variety of treatment related complications in the long-term, whereas older patients may develop earlier side-effects as a result of their frailty. Because the incidence of cancer in the world will increase over the next several decades and there will be more people living with cancer, it is important to have an understanding of the potential side effects of new systemic therapies. As an introductory article, in this review series, we begin by describing some of the major advances made in systemic cancer therapy along with some of their known side-effects and we also make an attempt to describe the future of systemic cancer therapy.

  14. Multi-focal HIFU reduces cavitation in mild-hyperthermia.

    Science.gov (United States)

    Chaplin, Vandiver; Caskey, Charles F

    2017-01-01

    Mild-hyperthermia therapy (40-45 °C) with high-intensity focused ultrasound (HIFU) is a technique being considered in a number of different treatments such as thermally activated drug delivery, immune-stimulation, and as a chemotherapy adjuvant. Mechanical damage and loss of cell viability associated with HIFU-induced acoustic cavitation may pose a risk during these treatments or may hinder their success. Here we present a method that achieves mild heating and reduces cavitation by using a multi-focused HIFU beam. We quantify cavitation level and temperature rise in multi-focal sonications and compare it to single-focus sonications at the transducer geometric focus. Continuous wave sonications were performed with the Sonalleve V2 transducer in gel phantoms and pork at 5, 10, 20, 40, 60, 80 acoustic watts for 30 s. Cavitation activity was measured with two ultrasound (US) imaging probes, both by computing the raw channel variance and using passive acoustic mapping (PAM). Temperature rise was measured with MR thermometry at 3 T. Cavitation and heating were compared for single- and multi-focal sonication geometries. Multi-focal sonications used four points equally spaced on a ring of either 4 mm or 8 mm diameter. Single-focus sonications were not steered. Multi-focal sonication generated distinct foci that were visible in MRI thermal maps in both phantoms and pork, and visible in PAM images in phantoms only. Cavitation activity (measured by channel variance) and mean PAM image value were highly correlated (r > 0.9). In phantoms, cavitation exponentially decreased over the 30-second sonication, consistent with depletion of cavitation nuclei. In pork, sporadic spikes signaling cavitation were observed with single focusing only. In both materials, the widest beam reduced average and peak cavitation level by a factor of two or more at each power tested when compared to a single focus. The widest beam reduced peak temperature by at least 10 °C at powers above 5

  15. HIFU Ultrasound Power Measurements at INRiM

    Energy Technology Data Exchange (ETDEWEB)

    Durando, G; Guglielmone, C; Musacchio, C, E-mail: g.durando@inrim.it [INRIM strada delle cacce 91, 10135 Torino (Italy)

    2011-02-01

    In this work the new system for the ultrasound power measurement of High Intensity Focused Ultrasound transducers realized at INRIM ultrasounds laboratory is presented. The system is based on a submersible load cell that takes the place of the balance. This solution presents essentially two advantages. The first one, of mechanical nature, is relevant to the fact that the target is directly connected to the force transducer, eliminating unwanted target motion at high power. The second, of electric nature, concerns the possibility to reduce the insonation time (the ON period of the electric driving signal to the HIFU transducer) under of 2 s, and is allowed for by the faster response of the force transducer (700 Hz bandwidth). The main components of uncertainty and the overall budget of the measurement system are presented together with the results of measures of conductance, G, carried on a HIFU transducer, at the work frequencies 2.0 MHz and 6.38 MHz, for values of power ranging from 10 W to 100 W. The results of the ultrasonic conductance, G, obtained with the new system are compared with values obtained using the traditional measuring system for low powers (P {<=} 20W).

  16. In vivo preclinical evaluation of the accuracy of toroidal-shaped HIFU treatments using a tumor-mimic model

    Energy Technology Data Exchange (ETDEWEB)

    N' Djin, W A; Melodelima, D; Parmentier, H; Chapelon, J Y [Inserm, U556, Lyon, F-69003 (France); Universite de Lyon, Lyon, F-69003 (France); Rivoire, M [Institute of Experimental Surgery-Centre Leon Berard, Lyon, F-69008 (France); Universite de Lyon, Lyon, F-69003 (France)], E-mail: apoutou.ndjin@inserm.fr

    2010-04-21

    The pig is an ideal animal model for preclinical evaluation of HIFU treatments, especially in the liver. However, there is no liver tumor model available for pigs. In this work, we propose to study an in vivo tumor-mimic model as a tool for evaluating if a sonographycally guided HIFU treatment, delivered by a toroidal-shaped device dedicated for the treatment of liver metastases, is correctly located in the liver. One centimeter tumor-mimics were created in liver tissues. These tumor-mimics were detectable on ultrasound imaging and on gross pathology. Two studies were carried out. First, an in vivo study of tolerance at mid-term (30 days, 10 pigs) revealed that tumor-mimics are suitable for studying HIFU treatments at a preclinical stage, since local and biological tolerances were excellent. The dimensions of the tumor-mimics were reproducible (diameter at day 0: 9.7 {+-} 2.0 mm) and were the same as a function of time (p = 0.64). A second in vivo study was carried out in ten pigs. Tumor mimics were used as targets in liver tissues in order to determine if the HIFU treatment is correctly located in the liver. A procedure of extensive HIFU ablation using multiple HIFU lesions juxtaposed manually was then tested on eight tumor-mimics. In 88% of the cases (seven out of eight), tumor-mimics were treated with negative margins ({>=}1 mm) in all directions. On average, negative margins measured 10.0 {+-} 6.7 mm. These tumor-mimics constitute an excellent reference for studying in vivo the accuracy of HIFU therapy in the liver.

  17. A Novel Combination of Thermal Ablation and Heat-Inducible Gene therapy for Breast Cancer Treatment

    Science.gov (United States)

    2009-04-01

    intensity focused ultrasound ( HIFU ) has been developed as an emerging non-invasive strategy for cancer treatment by thermal ablation of tumor tissue. The...feasibility of synergistic combination of HIFU thermal ablation and HIFU -induced gene therapy is interpreted both in vitro and in vivo using cancer...distribution. This work opens up a new paradigm for synergistic combination of HIFU thermal ablation with heat-induced gene therapy to improve the overall

  18. Non-Invasive Targeted Peripheral Nerve Ablation Using 3D MR Neurography and MRI-Guided High-Intensity Focused Ultrasound (MR-HIFU: Pilot Study in a Swine Model.

    Directory of Open Access Journals (Sweden)

    Merel Huisman

    Full Text Available Ultrasound (US-guided high intensity focused ultrasound (HIFU has been proposed for noninvasive treatment of neuropathic pain and has been investigated in in-vivo studies. However, ultrasound has important limitations regarding treatment guidance and temperature monitoring. Magnetic resonance (MR-imaging guidance may overcome these limitations and MR-guided HIFU (MR-HIFU has been used successfully for other clinical indications. The primary purpose of this study was to evaluate the feasibility of utilizing 3D MR neurography to identify and guide ablation of peripheral nerves using a clinical MR-HIFU system.Volumetric MR-HIFU was used to induce lesions in the peripheral nerves of the lower limbs in three pigs. Diffusion-prep MR neurography and T1-weighted images were utilized to identify the target, plan treatment and immediate post-treatment evaluation. For each treatment, one 8 or 12 mm diameter treatment cell was used (sonication duration 20 s and 36 s, power 160-300 W. Peripheral nerves were extracted < 3 hours after treatment. Ablation dimensions were calculated from thermal maps, post-contrast MRI and macroscopy. Histological analysis included standard H&E staining, Masson's trichrome and toluidine blue staining.All targeted peripheral nerves were identifiable on MR neurography and T1-weighted images and could be accurately ablated with a single exposure of focused ultrasound, with peak temperatures of 60.3 to 85.7°C. The lesion dimensions as measured on MR neurography were similar to the lesion dimensions as measured on CE-T1, thermal dose maps, and macroscopy. Histology indicated major hyperacute peripheral nerve damage, mostly confined to the location targeted for ablation.Our preliminary results indicate that targeted peripheral nerve ablation is feasible with MR-HIFU. Diffusion-prep 3D MR neurography has potential for guiding therapy procedures where either nerve targeting or avoidance is desired, and may also have potential for post

  19. Hybrid ultrasound-MR guided HIFU treatment method with 3D motion compensation.

    Science.gov (United States)

    Celicanin, Zarko; Manasseh, Gibran; Petrusca, Lorena; Scheffler, Klaus; Auboiroux, Vincent; Crowe, Lindsey A; Hyacinthe, Jean-Noel; Natsuaki, Yutaka; Santini, Francesco; Becker, Christoph D; Terraz, Sylvain; Bieri, Oliver; Salomir, Rares

    2017-09-24

    Treatments using high-intensity focused ultrasound (HIFU) in the abdominal region remain challenging as a result of respiratory organ motion. A novel method is described here to achieve 3D motion-compensated ultrasound (US) MR-guided HIFU therapy using simultaneous ultrasound and MRI. A truly hybrid US-MR-guided HIFU method was used to plan and control the treatment. Two-dimensional ultrasound was used in real time to enable tracking of the motion in the coronal plane, whereas an MR pencil-beam navigator was used to detect anterior-posterior motion. Prospective motion compensation of proton resonance frequency shift (PRFS) thermometry and HIFU electronic beam steering were achieved. The 3D prospective motion-corrected PRFS temperature maps showed reduced intrascan ghosting artifacts, a high signal-to-noise ratio, and low geometric distortion. The k-space data yielded a consistent temperature-dependent PRFS effect, matching the gold standard thermometry within approximately 1°C. The maximum in-plane temperature elevation ex vivo was improved by a factor of 2. Baseline thermometry acquired in volunteers indicated reduction of residual motion, together with an accuracy/precision of near-harmonic referenceless PRFS thermometry on the order of 0.5/1.0°C. Hybrid US-MR-guided HIFU ablation with 3D motion compensation was demonstrated ex vivo together with a stable referenceless PRFS thermometry baseline in healthy volunteer liver acquisitions. Magn Reson Med, 2017. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  20. High-intensity focused ultrasound (HIFU for dissolution of clots in a rabbit model of embolic stroke.

    Directory of Open Access Journals (Sweden)

    Alison Burgess

    Full Text Available It is estimated that only 2-6% of patients receive thrombolytic therapy for acute ischemic stroke suggesting that alternative therapies are necessary. In this study, we investigate the potential for high intensity focused ultrasound (HIFU to initiate thrombolysis in an embolic model of stroke. Iron-loaded blood clots were injected into the middle cerebral artery (MCA of New Zealand White rabbits, through the internal carotid artery and blockages were confirmed by angiography. MRI was used to localize the iron-loaded clot and target the HIFU beam for treatment. HIFU pulses (1.5 MHz, 1 ms bursts, 1 Hz pulse repetition frequency, 20 s duration were applied to initiate thrombolysis. Repeat angiograms and histology were used to assess reperfusion and vessel damage. Using 275 W of acoustic power, there was no evidence of reperfusion in post-treatment angiograms of 3 rabbits tested. In a separate group of animals, 415 W of acoustic power was applied and reperfusion was observed in 2 of the 4 (50% animals treated. In the last group of animals, acoustic power was further increased to 550 W, which led to the reperfusion in 5 of 7 (∼70% animals tested. Histological analysis confirmed that the sonicated vessels remained intact after HIFU treatment. Hemorrhage was detected outside of the sonication site, likely due to the proximity of the target vessel with the base of the rabbit skull. These results demonstrate the feasibility of using HIFU, as a stand-alone method, to cause effective thrombolysis without immediate damage to the targeted vessels. HIFU, combined with imaging modalities used to identify and assess stroke patients, could dramatically reduce the time to achieve flow restoration in patients thereby significantly increasing the number of patients which benefit from thrombolysis treatments.

  1. Volumetric MR-HIFU ablation of uterine fibroids

    NARCIS (Netherlands)

    Ikink, M.E.

    2014-01-01

    Over the past two decades, magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) has increasingly been used as a non-invasive treatment option for symptomatic uterine fibroids. In this thesis, a volumetric MR-HIFU ablation technique of uterine fibroids is investigated. The first part

  2. High Intensity Focused Ultrasound (HIFU): a useful alternative choice in prostate cancer treatment. Preliminary results.

    Science.gov (United States)

    Maestroni, Umberto; Ziveri, Marcello; Azzolini, Nicola; Dinale, Francesco; Ziglioli, Francesco; Campaniello, Giovanna; Frattini, Antonio; Ferretti, Stefania

    2008-12-01

    High-Intensity Focused Ultrasound (HIFU) represents an alternative choice in mini-invasive treatment of prostate cancer. The technology of the device used to perform the treatment allows to exactly destroy a pre-selected area and to save all the tissues around it. We report our experience on the effectiveness and complications of this tecnique. From May 2006 to April 2007, 25 patients with prostate cancer were treated through Ablatherm (EDAP France) in spinal anesthesia. In the first six patients HIFU and TUR-P (Trans-Urethral Resection of Prostate) were performed in the same session and a suprapubic catheter was placed. In the other 14 patients HIFU was afterwards performed. In these patients a trans-urethral catheter was placed. All patients were divided into three groups: low risk (17 patients), intermediate risk (6 patients) and high risk (2 patients). The follow-up consisted in PSA evaluation after 1, 3, 6, 9, 12 months and in transrectal biopsy after six months. Complications related to the treatment, and symptomatological and sexual life tests were evaluated before and after the treatment. HIFU overall success rate was 84% (biochemical relapses in only 4 patients out of 25). Success rate was represented as follows: 94.2% in the low risk group, 83.4% in the intermediate risk group and 0% in the high risk group. No complications occurred during the treatment nor in the immediately post-operative time. We demonstrated that HIFU represents a useful alternative choice in mini-invasive therapy of prostate cancer. Particularly, results are remarkable in localized (low-intermediate risk) and low morbility prostate cancer. The role of this procedure in high risk patients needs to be further evaluated. Transrectal HIFU represents a mini-invasive therapeutic option that makes the treatment of prostate cancer possible in 84% of cases. Our results agree with the literature data and demonstrate that the success of the procedure depends on the correct indication of

  3. Modeling pressure distribution and heat in the body tissue and extract the relationship between them in order to improve treatment planning in HIFU

    CERN Document Server

    Hajian, Saeed Reza; Pouladian, Majid; Hemmasi, Gholam Reza

    2016-01-01

    In high intensity focused ultrasound (HIFU) systems using non-ionizing methods in cancer treatment, if the device is applied to the body externally, the HIFU beam can damage nearby healthy tissues and burn skin due to lack of knowledge about the viscoelastic properties of patient tissue and failure to consider the physical properties of tissue in treatment planning. Addressing this problem by using various methods, such as MRI or ultrasound, elastography can effectively measure visco-elastic properties of tissue and fits within the pattern of stimulation and total treatment planning. In this paper, in a linear path of HIFU propagation, and by considering the smallest part of the path, including voxel with three mechanical elements of mass, spring and damper, which represents the properties of viscoelasticity of tissue, by creating waves of HIFU in the wire environment of MATLAB mechanics and stimulating these elements, pressure and heat transfer due to stimulation in the hypothetical voxel was obtained. Throu...

  4. The predictive value of quantitative DCE metrics for immediate therapeutic response of high-intensity focused ultrasound ablation (HIFU) of symptomatic uterine fibroids.

    Science.gov (United States)

    Wei, Chao; Fang, Xin; Wang, Chuan-Bin; Chen, Yu; Xu, Xiao; Dong, Jiang-Ning

    2017-12-04

    The aim of this study was to investigate the value of quantitative DCE-MRI parameters for predicting the immediate non-perfused volume ratio (NPVR) of HIFU therapy in the treatment of symptomatic uterine fibroids. A total of 78 symptomatic uterine fibroids in 65 female patients were treated with US-HIFU therapy. All patients underwent conventional MRI and DCE-MRI scans 1 day before and 3 days after HIFU treatment. Permeability parameters K trans, K ep, V e, and V p and T1 perfusion parameters BF and BV of pretreatment were measured as a baseline, while NPVR was used to assess immediate ablation efficiency. Data were assigned to NPVR ≧ 70% and NPVR HIFU treatment (r = - 0.561, - 0.712, and - 0.528, respectively, p HIFU therapy for symptomatic uterine fibroids, while the pretreatment DCE-MRI parameters could be useful biomarkers for predicting the ablation efficacy in select cases. The software used to calculate DCE-MRI parameters was simpler, quicker, and easier to incorporate into clinical practice.

  5. Multimodality treatment by FOLFOX plus HIFU in a case of advanced pancreatic carcinoma. A case report.

    Science.gov (United States)

    Dimitrov, Dobromir; Andreev, Tihomir; Feradova, Hyuliya; Ignatov, Borislav; Zhou, Kunn; Johnson, Colin; Delijski, Tashko; Gortchev, Grigor; Tomov, Slavcho

    2015-01-31

    Pancreatic cancer is one of the most aggressive malignant diseases in which the survival rate has not improved in the past 40 years. A fifty-one-year-old male patient with inoperable metastatic pancreatic cancer and low response to chemotherapy with gemcitabine as single therapy underwent palliative high intensity focused ultrasound (HIFU) ablation. Continuing chemotherapy with folinic acid, oxaliplatin and 5-fluorouracil (FOLFOX) was made. Tools, provided by the European Organization for Research and Treatment of Cancer (EORTC) were used to evaluate his quality of life. The Global Health Status improved from 25 to 42 out of 100 and the body mass index (BMI) increased from 14.9 to 18.1 kg/m(2). Measured by the visual analog scale, the pain was reduced from 7 to 2 out of 10. Twelve months after the HIFU ablation, CT revealed decreased size of the tumor and liver lesions. FOLFOX plus interventional, physical destruction of the primary tumor by HIFU sufficiently improved the quality of life, reduced pancreatic pain and provided better survival in this case.

  6. Modelling of the acoustic field of a multi-element HIFU array scattered by human ribs

    Energy Technology Data Exchange (ETDEWEB)

    Gelat, Pierre [National Physical Laboratory, Hampton Road, Teddington TW11 0LW (United Kingdom); Ter Haar, Gail [Therapeutic Ultrasound Group, Physics Department, Institute of Cancer Research, Sutton SM2 5NG (United Kingdom); Saffari, Nader, E-mail: Pierre.Gelat@npl.co.uk [Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom)

    2011-09-07

    The efficacy of high-intensity focused ultrasound (HIFU) for the treatment of a range of different cancers, including those of the liver, prostate and breast, has been demonstrated. As a non-invasive focused therapy, HIFU offers considerable advantages over techniques such as chemotherapy and surgical resection in terms of reduced risk of harmful side effects. Despite this, there are a number of significant challenges which currently hinder its widespread clinical application. One of these challenges is the need to transmit sufficient energy through the rib cage to induce tissue necrosis in the required volume whilst minimizing the formation of side lobes. Multi-element random-phased arrays are currently showing great promise in overcoming the limitations of single-element transducers. Nevertheless, successful treatment of a patient with liver tumours requires a thorough understanding of the way in which the ultrasonic pressure field from a HIFU array is scattered by the rib cage. In order to address this, a boundary element approach based on a generalized minimal residual (GMRES) implementation of the Burton-Miller formulation was used in conjunction with phase conjugation techniques to focus the field of a 256-element random HIFU array behind human ribs at locations requiring intercostal and transcostal treatment. Simulations were carried out on a 3D mesh of quadratic pressure patches generated using CT scan anatomical data for adult ribs 9-12 on the right side. The methodology was validated on spherical and cylindrical scatterers. Field calculations were also carried out for idealized ribs, consisting of arrays of strip-like scatterers, demonstrating effects of splitting at the focus. This method has the advantage of fully accounting for the effect of scattering and diffraction in 3D under continuous wave excitation.

  7. Acoustic field characterization of a clinical magnetic resonance-guided high-intensity focused ultrasound system inside the magnet bore.

    Science.gov (United States)

    Kothapalli, Satya V V N; Altman, Michael B; Partanen, Ari; Wan, Leighton; Gach, H Michael; Straube, William; Hallahan, Dennis E; Chen, Hong

    2017-09-01

    With the expanding clinical application of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU), acoustic field characterization of MR-HIFU systems is needed for facilitating regulatory approval and ensuring consistent and safe power output of HIFU transducers. However, the established acoustic field measurement techniques typically use equipment that cannot be used in a magnetic resonance imaging (MRI) suite, thus posing a challenge to the development and execution of HIFU acoustic field characterization techniques. In this study, we developed and characterized a technique for HIFU acoustic field calibration within the MRI magnet bore, and validated the technique with standard hydrophone measurements outside of the MRI suite. A clinical Philips MR-HIFU system (Sonalleve V2, Philips, Vantaa, Finland) was used to assess the proposed technique. A fiber-optic hydrophone with a long fiber was inserted through a 24-gauge angiocatheter and fixed inside a water tank that was placed on the HIFU patient table above the acoustic window. The long fiber allowed the hydrophone control unit to be placed outside of the magnet room. The location of the fiber tip was traced on MR images, and the HIFU focal point was positioned at the fiber tip using the MR-HIFU therapy planning software. To perform acoustic field mapping inside the magnet, the HIFU focus was positioned relative to the fiber tip using an MRI-compatible 5-axis robotic transducer positioning system embedded in the HIFU patient table. To perform validation measurements of the acoustic fields, the HIFU table was moved out of the MRI suite, and a standard laboratory hydrophone measurement setup was used to perform acoustic field measurements outside the magnetic field. The pressure field scans along and across the acoustic beam path obtained inside the MRI bore were in good agreement with those obtained outside of the MRI suite. At the HIFU focus with varying nominal acoustic powers of 10-500 W, the

  8. SU-F-J-215: Non-Thermal Pulsed High Intensity Focused Ultrasound Therapy Combined with 5-Aminolevulinic Acid: An in Vivo Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Wang, B; He, W; Cvetkovic, D; Chen, L; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States)

    2016-06-15

    Purpose: It has recently been shown that non-thermal pulsed high intensity focused ultrasound (pHIFU) has a cell-killing effect. The purpose of the study is to investigate the sonosensitizing effect of 5-Aminolevulinic Acid (5-ALA) in non-thermal pHIFU cancer therapy. Methods: FaDu human head and neck squamous cell carcinoma cells were injected subcutaneously in the flanks of nude mice. After one to two weeks, the tumors reached the volume of 112 ± 8 mm3 and were assigned randomly into a non-thermal pHIFU group (n=9) and a non-thermal sonodynamic therapy (pHIFU after 5-ALA administration) group (n=7). The pHIFU treatments (parameters: 1 MHz frequency; 25 W acoustic power; 0.1 duty cycle; 60 seconds duration) were delivered using an InSightec ExAblate 2000 system with a GE Signa 1.5T MR scanner. The mice in the non-thermal sonodynamic group received 5-ALA tail-vein injection 4 hours prior to the pHIFU treatment. The tumor growth was monitored using the CT scanner on a Sofie-Biosciences G8 PET/CT system. Results: The tumors in this study grew very aggressively and about 60% of the tumors in this study developed ulcerations at various stages. Tumor growth delay after treatments was observed by comparing the treated (n=9 in pHIFU group; n=7 in sonodynamic group) and untreated tumors (n=17). However, no statistically significant differences were found between the non-thermal pHIFU and non-thermal sonodynamic group. The mean normalized tumor volume of the untreated tumors on Day 7 after their first CT scans was 7.05 ± 0.54, while the normalized volume of the treated tumors on Day 7 after treatment was 5.89 ± 0.79 and 6.27 ± 0.47 for the sonodynamic group and pHIFU group, respectively. Conclusion: In this study, no significant sonosensitizing effects of 5-ALA were obtained on aggressive FaDu tumors despite apparent tumor growth delay in some mice treated with non-thermal sonodynamic therapy.

  9. M-HIFU inhibits tumor growth, suppresses STAT3 activity and enhances tumor specific immunity in a transplant tumor model of prostate cancer.

    Directory of Open Access Journals (Sweden)

    Xiaoyi Huang

    Full Text Available In this study, we explored the use of mechanical high intensity focused ultrasound (M-HIFU as a neo-adjuvant therapy prior to surgical resection of the primary tumor. We also investigated the role of signal transducer and activator of transcription 3 (STAT3 in M-HIFU elicited anti-tumor immune response using a transplant tumor model of prostate cancer.RM-9, a mouse prostate cancer cell line with constitutively activated STAT3, was inoculated subcutaneously in C57BL/6J mice. The tumor-bearing mice (with a maximum tumor diameter of 5∼6 mm were treated by M-HIFU or sham exposure two days before surgical resection of the primary tumor. Following recovery, if no tumor recurrence was observed in 30 days, tumor rechallenge was performed. The growth of the rechallenged tumor, survival rate and anti-tumor immune response of the animal were evaluated.No tumor recurrence and distant metastasis were observed in both treatment groups employing M-HIFU + surgery and surgery alone. However, compared to surgery alone, M-HIFU combined with surgery were found to significantly inhibit the growth of rechallenged tumors, down-regulate intra-tumoral STAT3 activities, increase cytotoxic T cells in spleens and tumor draining lymph nodes (TDLNs, and improve the host survival. Furthermore, M-HIFU combined with surgery was found to significantly decrease the level of immunosuppression with concomitantly increased number and activities of dendritic cells, compared to surgery alone.Our results demonstrate that M-HIFU can inhibit STAT3 activities, and when combined synergistically with surgery, may provide a novel and promising strategy for the treatment of prostate cancers.

  10. Rapid HIFU autofocusing using the entire MR-ARFI image

    Energy Technology Data Exchange (ETDEWEB)

    Grissom, William A.; Kaye, Elena; Pauly, Kim Butts; Zur, Yuval; Yeo, Desmond; Medan, Yoav; Davis, Cynthia [Biomedical Engineering, Vanderbilt University, Nashville, Tennessee (United States); Electrical Engineering, Stanford University, Stanford, California (United States); Radiology, Stanford University, Stanford, California (United States); GE Healthcare, Haifa (Israel); GE Global Research, Niskayuna, New York (United States); Biomedical Engineering, Technion IIT, Haifa (Israel); GE Global Research, Niskayuna, New York (United States)

    2012-11-28

    Phase aberrations and attenuations caused by bone can defocus HIFU in the brain and organs behind the ribcage. To refocus the beam, MR-ARFI can be used to measure tissue displacements created by each element in the transducer, and optimize driving signal delays and amplitudes. We introduce a new MR-ARFI-based autofocusing method that requires many fewer image acquisitions than current methods. The method is validated in simulations of bone and brain HIFU transducers, and compared to a conventional method.

  11. Increasing the HIFU ablation rate through an MRI-guided sonication strategy using shock waves: feasibility in the in vivo porcine liver

    Science.gov (United States)

    Ramaekers, P.; de Greef, M.; van Breugel, J. M. M.; Moonen, C. T. W.; Ries, M.

    2016-02-01

    This study investigated whether an MR-guided pulsed HIFU ablation strategy could be implemented under clinical conditions, using a transducer designed for uterine fibroid ablation, to obtain an ablation rate that is sufficiently high for clinical abdominal HIFU therapy in highly perfused organs. A pulsed HIFU ablation strategy, aimed at increasing the energy absorption in the HIFU focal area by local shock wave formation in the non-linear pressure regime, was compared to an energy-equivalent continuous wave sonication strategy in the linear pressure regime. Both ablation strategies were used for transcutaneous sonication of pre-defined treatment cells in the livers of 5 pigs in vivo. Temperature evolution in both the target area as well as the pre-focal muscle layer was monitored simultaneously using MR thermometry. Local energy absorption and thermal dose volumes were shown to be increased using the pulsed ablation strategy, while preserving healthy tissue in the near field of the acoustic beam. Respiratory motion compensation of both acoustic energy delivery and MR thermometry was applied through gating based on MR navigator echoes. Histopathology showed that confluent vacuolated thermal lesions were created when the pulsed ablation strategy was used. Additionally, it was shown that the heat sink effect caused by the presence of larger vessels could be overcome. The pulsed HIFU ablation strategy achieved an ablation rate of approximately 4 ml per hour in the in vivo porcine liver, without causing undesired damage to healthy tissues in the near field.

  12. Utility of a tumor-mimic model for the evaluation of the accuracy of HIFU treatments. results of in vitro experiments in the liver.

    Science.gov (United States)

    N'Djin, William Apoutou; Melodelima, David; Parmentier, Hubert; Chesnais, Sabrina; Rivoire, Michel; Chapelon, Jean Yves

    2008-12-01

    Presented in this article is a tumor-mimic model that allows the evaluation, before clinical trials, of the targeting accuracy of a high intensity focused ultrasound (HIFU) device for the treatment of the liver. The tumor-mimic models are made by injecting a warm solution that polymerizes in hepatic tissue and forms a 1 cm discrete lesion that is detectable by ultrasound imaging and gross pathology. First, the acoustical characteristics of the tumor-mimics model were measured in order to determine if this model could be used as a target for the evaluation of the accuracy of HIFU treatments without modifying HIFU lesions in terms of size, shape and homogeneity. On average (n = 10), the attenuation was 0.39 +/- 0.05 dB.cm(-1) at 1 MHz, the ultrasound propagation velocity was 1523 +/- 1 m.s(-1) and the acoustic impedance was 1.84 +/- 0.00 MRayls. Next, the tumor-mimic models were used in vitro in order to verify, at a preclinical stage, that lesions created by HIFU devices guided by ultrasound imaging are properly positioned in tissues. The HIFU device used in this study is a 256-element phased-array toroid transducer working at a frequency of 3 MHz with an integrated ultrasound imaging probe working at a frequency of 7.5 MHz. An initial series of in vitro experiments has shown that there is no significant difference in the dimensions of the HIFU lesions created in the liver with or without tumor-mimic models (p = 0.3049 and p = 0.8796 for the diameter and depth, respectively). A second in vitro study showed that HIFU treatments performed on five tumor-mimics with safety margins of at least 1 mm were properly positioned. The margins obtained were on average 9.3 +/- 2.7 mm (min. 3.0 - max. 20.0 mm). This article presents in vitro evidence that these tumor-mimics are identifiable by ultrasound imaging, they do not modify the geometry of HIFU lesions and, thus, they constitute a viable model of tumor-mimics indicated for HIFU therapy.

  13. Respiratory-Gated MRgHIFU in Upper Abdomen Using an MR-Compatible In-Bore Digital Camera

    Directory of Open Access Journals (Sweden)

    Vincent Auboiroux

    2014-01-01

    Full Text Available Objective. To demonstrate the technical feasibility and the potential interest of using a digital optical camera inside the MR magnet bore for monitoring the breathing cycle and subsequently gating the PRFS MR thermometry, MR-ARFI measurement, and MRgHIFU sonication in the upper abdomen. Materials and Methods. A digital camera was reengineered to remove its magnetic parts and was further equipped with a 7 m long USB cable. The system was electromagnetically shielded and operated inside the bore of a closed 3T clinical scanner. Suitable triggers were generated based on real-time motion analysis of the images produced by the camera (resolution 640×480 pixels, 30 fps. Respiratory-gated MR-ARFI prepared MRgHIFU ablation was performed in the kidney and liver of two sheep in vivo, under general anaesthesia and ventilator-driven forced breathing. Results. The optical device demonstrated very good MR compatibility. The current setup permitted the acquisition of motion artefact-free and high resolution MR 2D ARFI and multiplanar interleaved PRFS thermometry (average SNR 30 in liver and 56 in kidney. Microscopic histology indicated precise focal lesions with sharply delineated margins following the respiratory-gated HIFU sonications. Conclusion. The proof-of-concept for respiratory motion management in MRgHIFU using an in-bore digital camera has been validated in vivo.

  14. Respiratory-gated MRgHIFU in upper abdomen using an MR-compatible in-bore digital camera.

    Science.gov (United States)

    Auboiroux, Vincent; Petrusca, Lorena; Viallon, Magalie; Muller, Arnaud; Terraz, Sylvain; Breguet, Romain; Montet, Xavier; Becker, Christoph D; Salomir, Rares

    2014-01-01

    To demonstrate the technical feasibility and the potential interest of using a digital optical camera inside the MR magnet bore for monitoring the breathing cycle and subsequently gating the PRFS MR thermometry, MR-ARFI measurement, and MRgHIFU sonication in the upper abdomen. A digital camera was reengineered to remove its magnetic parts and was further equipped with a 7 m long USB cable. The system was electromagnetically shielded and operated inside the bore of a closed 3T clinical scanner. Suitable triggers were generated based on real-time motion analysis of the images produced by the camera (resolution 640 × 480 pixels, 30 fps). Respiratory-gated MR-ARFI prepared MRgHIFU ablation was performed in the kidney and liver of two sheep in vivo, under general anaesthesia and ventilator-driven forced breathing. The optical device demonstrated very good MR compatibility. The current setup permitted the acquisition of motion artefact-free and high resolution MR 2D ARFI and multiplanar interleaved PRFS thermometry (average SNR 30 in liver and 56 in kidney). Microscopic histology indicated precise focal lesions with sharply delineated margins following the respiratory-gated HIFU sonications. The proof-of-concept for respiratory motion management in MRgHIFU using an in-bore digital camera has been validated in vivo.

  15. Image-based numerical modeling of HIFU-induced lesions

    Science.gov (United States)

    Almekkaway, Mohamed K.; Shehata, Islam A.; Haritonova, Alyona; Ballard, John; Casper, Andrew; Ebbini, Emad

    2017-03-01

    Atherosclerosis is a chronic vascular disease affecting large and medium sized arteries. Several treatment options are already available for treatment of this disease. Targeting atherosclerotic plaques by high intensity focused ultrasound (HIFU) using dual mode ultrasound arrays (DMUA) was recently introduced in literature. We present a finite difference time domain (FDTD) simulation modeling of the wave propagation in heterogeneous medium from the surface of a 3.5 MHz array prototype with 32-elements. After segmentation of the ultrasound image obtained for the treatment region in-vivo, we integrated this anatomical information into our simulation to account for different parameters that may be caused by these multi-region anatomical complexities. The simulation program showed that HIFU was able to induce damage in the prefocal region instead of the target area. The HIFU lesions, as predicted by our simulation, were well correlated with the actual damage detected in histology.

  16. Image-Guided High Intensity Focused Ultrasound System for Large Animal Nerve Ablation Studies.

    Science.gov (United States)

    Worthington, Arthur; Peng, Philip; Rod, Kevin; Bril, Vera; Tavakkoli, Jahan

    2016-01-01

    High intensity focused ultrasound (HIFU) is a form of thermal ablation technique, which can treat a variety of medical afflictions. One promising therapeutic use is the permanent destruction of nerves non-invasively in patients with severe spasticity or certain types of pain (e.g., phantom limb pain). To this end, HIFU requires ultrasound guidance, which allows the non-invasive, target-specific deposition of thermal energy to the targeted nerve, thereby blocking axonal conduction. In this paper, a composite system comprising both ultrasound-imaging and HIFU therapy was developed and used to induce localized non-invasive nerve blockage in an in vivo large animal study. Five pigs were used with the femoral nerve as the target. Calibrated needle thermocouples inserted at the target site were employed to monitor the target tissue temperature. The degree of nerve blockage was assessed by measuring compound action potential (CAP) signal with a clinical nerve electrophysiology system before and after HIFU exposures. An average CAP signal amplitude reduction of 49% of baseline with a standard deviation of 9% was observed after 20-30 min post exposure. These results demonstrate the feasibility of the proposed ultrasound-guided HIFU modality as a potential non-invasive nerve ablation method.

  17. Real-time temperature estimation and monitoring of HIFU ablation through a combined modeling and passive acoustic mapping approach

    Science.gov (United States)

    Jensen, C. R.; Cleveland, R. O.; Coussios, C. C.

    2013-09-01

    Passive acoustic mapping (PAM) has been recently demonstrated as a method of monitoring focused ultrasound therapy by reconstructing the emissions created by inertially cavitating bubbles (Jensen et al 2012 Radiology 262 252-61). The published method sums energy emitted by cavitation from the focal region within the tissue and uses a threshold to determine when sufficient energy has been delivered for ablation. The present work builds on this approach to provide a high-intensity focused ultrasound (HIFU) treatment monitoring software that displays both real-time temperature maps and a prediction of the ablated tissue region. This is achieved by determining heat deposition from two sources: (i) acoustic absorption of the primary HIFU beam which is calculated via a nonlinear model, and (ii) absorption of energy from bubble acoustic emissions which is estimated from measurements. The two sources of heat are used as inputs to the bioheat equation that gives an estimate of the temperature of the tissue as well as estimates of tissue ablation. The method has been applied to ex vivo ox liver samples and the estimated temperature is compared to the measured temperature and shows good agreement, capturing the effect of cavitation-enhanced heating on temperature evolution. In conclusion, it is demonstrated that by using PAM and predictions of heating it is possible to produce an evolving estimate of cell death during exposure in order to guide treatment for monitoring ablative HIFU therapy. Portions presented at the 13th International Symposium on Therapeutic Ultrasound, Heidelberg, Germany (2012).

  18. An in vitro study of a phase-shift nanoemulsion: a potential nucleation agent for bubble-enhanced HIFU tumor ablation.

    Science.gov (United States)

    Zhang, Peng; Porter, Tyrone

    2010-11-01

    Phase-shift nanoemulsions have the potential to nucleate bubbles and enhance high-intensity focused ultrasound (HIFU) cancer therapy. This emulsion consists of albumin-coated dodecafluoropentane (DDFP) droplets with a mean diameter of approximately 260 nm at 37°C. It is known that superheated perfluorocarbon droplets can be vaporized with microsecond long ultrasound pulses if the acoustic pressure exceeds a specific threshold. In addition, it is well documented that particles smaller than 400 nm can extravasate through leaky tumor vessels and accumulate in the tumor interstitial space. Thus, nanoemulsions may passively target solid tumors, thus localizing cavitation nuclei for bubble-enhanced HIFU-mediated heating. In this study, we investigate the acoustic droplet vaporization of a DDFP nanoemulsion in tissue-mimicking gels and demonstrate the ability to nucleate inertial cavitation (IC) and enhance HIFU-mediated heating. The nanoemulsion was dispersed throughout albumin-acrylamide gel phantoms and sonicated with microsecond-length HIFU pulses (f = 2 MHz). The pressure threshold needed to vaporize the nanoemulsion was measured as a function of degree of superheat, pulse length and nanoemulsion concentration. It was determined that the vaporization threshold was inversely proportional with degree of superheat and independent of pulse length and concentration within the range of values tested. It was also shown that the bubbles formed from vaporized nanoemulsions reduced the IC threshold in the gel phantoms. Finally, it was demonstrated that cavitation from vaporized nanoemulsions accelerated HIFU-mediated heating. The results from this study demonstrate that phase-shift nanoemulsions can be combined with HIFU to provide a high degree of spatial and temporal control of bubble-enhanced heating. Copyright © 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  19. Cladribine therapy for systemic mastocytosis

    NARCIS (Netherlands)

    Kluin-Nelemans, HC; Oldhoff, JM; van Doormaal, JJ; van 't Wout, JW; Verhoef, G; Gerrits, WBJ; van Dobbenburgh, OA; Pasmans, SG; Fijnheer, R

    2003-01-01

    Patients with systemic mastocytosis (SM) can suffer from disabling symptoms related to mast cell mediator release or mast cell infiltration, requiring mast cell eradication. In the present absence of any curative therapy, a recent case report describing the efficacy of cladribine showed promising

  20. Proton beam therapy control system

    Science.gov (United States)

    Baumann, Michael A.; Beloussov, Alexandre V.; Bakir, Julide; Armon, Deganit; Olsen, Howard B.; Salem, Dana

    2010-09-21

    A tiered communications architecture for managing network traffic in a distributed system. Communication between client or control computers and a plurality of hardware devices is administered by agent and monitor devices whose activities are coordinated to reduce the number of open channels or sockets. The communications architecture also improves the transparency and scalability of the distributed system by reducing network mapping dependence. The architecture is desirably implemented in a proton beam therapy system to provide flexible security policies which improve patent safety and facilitate system maintenance and development.

  1. When does atopic dermatitis warrant systemic therapy?

    DEFF Research Database (Denmark)

    Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten

    2017-01-01

    BACKGROUND: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. OBJECTIVE: To guide those considering use of systemic ...

  2. Systemic antibiotics in periodontal therapy.

    Science.gov (United States)

    Heitz-Mayfield, L J A

    2009-09-01

    Periodontitis is a biofilm infection with a mixed microbial aetiology. Periodontitis is generally treated by non-surgical mechanical debridement and regular periodontal maintenance care. Periodontal surgery may be indicated for some patients to improve access to the root surface for mechanical debridement. A range of systemic antibiotics for treatment of periodontitis has been documented, with some studies showing superior clinical outcomes following adjunctive antibiotics while others do not. This has resulted in controversy as to the role of systemic antibiotics in the treatment of periodontal diseases. Recent systematic reviews have provided an evidence-based assessment of the possible benefits of adjunctive antibiotics in periodontal therapy. This review aims to provide an update on clinical issues of when and how to prescribe systemic antibiotics in periodontal therapy.

  3. T2-based temperature monitoring in abdominal fat during HIFU treatment of patients with uterine fibroids

    Science.gov (United States)

    Ozhinsky, Eugene; Kohi, Maureen; Ghanouni, Pejman; Rieke, Viola

    2017-03-01

    In this study, we have implemented T2-based monitoring of near-field heating in patients undergoing HIFU ablation of uterine fibroids using Insightec ExAblate system. In certain areas, near-field heating can reach 18°C and the tissue may experience sustained heating of more than 10°C for the period of 2 hours or more. This indicates a cumulative thermal dose that may cause necrosis. Our results show the feasibility and importance of measuring near-field heating in subcutaneous fat.

  4. In Vitro Validation of a Sector-Switching HIFU Device for Accelerated Treatment

    Science.gov (United States)

    Petrusca, Lorena; Brasset, Lucie; Cotton, Francois; Salomir, Rares; Chapelon, Jean-Yves

    2009-04-01

    A sector-switching method that increases the HIFU sequence duty-cycle and reduces the equivalent treatment time was tested in vitro. The MR-compatible HIFU device used consisted of 2 symmetric sectors arranged on a truncated spherical cap (focus = 45 mm, long diameter = 57.5 mm, short diameter = 35 mm). A MR-compatible, 2D positioning system provided 0.5 mm accuracy. Two sonication sequences were considered, each with the same pattern for the focal point trajectory and with identical on-state power. First, both sectors radiated simultaneously, with a power duty cycle of 60%. Second, the sectors radiated separately with balanced temporally-interleaved sonication and a power duty cycle of 87.5%. Numerical simulations were performed to predict the shape of the lesion for a given set of sequence parameters, according to a theoretical model. Fast MR thermometry (voxel size: 0.85×0.85×4.25 mm3; temporal resolution: 2 sec) was performed in two orthogonal planes (sagittal and transverse) while the 2D sonication pattern was contained in the coronal plane. Fresh samples of degassed porcine liver were used, and the macroscopic lesions were measured after HIFU. The 14400 s equivalent thermal dose isolevel was compared respectively for the two sonication sequences, both with numerical simulations and experimental MR data. No susceptibility or RF artifacts could be detected on MR data. The lesion's size ratio between reference versus the sector-switched sequence was 1.12 from simulations and 1.25 (±3.2%) from MRI derived TD. Switching the device sectors reduced the treatment time by 20% while the shape and size of the lesions were maintained. In vivo studies are required for pre-clinical validation.

  5. Intra-operative ultrasound hand-held strain imaging for the visualization of ablations produced in the liver with a toroidal HIFU transducer: first in vivo results

    Energy Technology Data Exchange (ETDEWEB)

    Chenot, J; Melodelima, D; N' Djin, W A; Souchon, Remi; Rivoire, M; Chapelon, J Y, E-mail: jeremy.chenot@inserm.f [Inserm, U556, Lyon, F-69003 (France)

    2010-06-07

    The use of hand-held ultrasound strain imaging for the intra-operative real-time visualization of HIFU (high-intensity focused ultrasound) ablations produced in the liver by a toroidal transducer was investigated. A linear 12 MHz ultrasound imaging probe was used to obtain radiofrequency signals. Using a fast cross-correlation algorithm, strain images were calculated and displayed at 60 frames s{sup -1}, allowing the use of hand-held strain imaging intra-operatively. Fourteen HIFU lesions were produced in four pigs. Intra-operative strain imaging of HIFU ablations in the liver was feasible owing to the high frame rate. The correlation between dimensions measured on gross pathology and dimensions measured on B-mode images and on strain images were R = 0.72 and R = 0.94 respectively. The contrast between ablated and non-ablated tissue was significantly higher (p < 0.05) in the strain images (22 dB) than in the B-mode images (9 dB). Strain images allowed equivalent or improved definition of ablated regions when compared with B-mode images. Real-time intra-operative hand-held strain imaging seems to be a promising complement to conventional B-mode imaging for the guidance of HIFU ablations produced in the liver during an open procedure. These results support that hand-held strain imaging outperforms conventional B-mode ultrasound and could potentially be used for the assessment of thermal therapies.

  6. Postoperative monitoring of prostate-specific antigen (PSA after treatment with high-intensive focused ultrasound (HIFU

    Directory of Open Access Journals (Sweden)

    Blyumberg B.I.

    2012-12-01

    Full Text Available Research objective: to estimate efficiency of treatment of prostate cancer using high-intensive focused ultrasound on the basis of laboratory analysis of postoperative level prostate-specific antigen (PSA. Objects of research. Objects of research consisted of 110 patients treated in urological clinic of Hospital n.a. S. R. Mirotvortsev (Saratov State Medical University during the period February, 2009 — March, 2012. Patients took 110 sessions of primary operative treatment of prostate cancer by HIFU therapy method. Technique and research methods. Concentration of PSA in blood changed in all patients every 1,5 month within 6 months after operation, irrespective of its kind (including after repeated HIFU, further — after every 3 month till one year, and later on after 6 months. We were guided by references of the International Consensus, which considers PSA level more than 0,5 ng/ml in blood after 3 months of treatment to be unsatisfactory result. We also headed for PSA level before treatment and oncological risk degree. Results. Median nadir formed 0,5 ng/ml PSA by 3 months after treatment. Patients demonstrated different indicators of PSA dynamics depending on oncological risk, stage and hormonal therapy management. Patients with low oncological risk had initially lower PSA concentration, further PSA concentration reached nadir level faster. At patients with widespread forms of prostate cancer accurate dependence of PSA concentration according to prevalence of process was traced. Time of PSA nadir amount did not differ and was marked as 12-14 weeks on average. At patients received hormonal therapy, lower value of PSA nadir was marked. The conclusion. Monitoring of PSA concentration (PSA nadir by 3 months, dynamics of PSA concentration change is of great importance in early revealing of relapse after prostate HIFU therapy. High level of PSA nadir and PSA growth according to time period are important prognostic factors.

  7. Ten-year Biochemical Disease-free Survival After High-intensity Focused Ultrasound (HIFU) for Localized Prostate Cancer: Comparison with Four Different Generation Devices

    Science.gov (United States)

    Uchida, T.; Nakano, M.; Shoji, S.; Omata, T.; Harano, Y.; Nagata, Y.; Usui, Y.; Terachi, T.

    2010-03-01

    HIFU has been recognized as a minimally invasive treatment option for localized prostate cancer. The purpose of the study was to assess with a long-term outcome of HIFU for prostate cancer. From January 1999, a total of 657 patients who had HIFU with at least 2 year follow-up were treated with four different types of Sonablate® (Focus Surgery, Indianapolis, USA) devices. Thirty-three patients were treated with Sonablate® 200 (S200) from 1999 to 2001, 406 patients with Sonablate® 500 (S500) from 2001 to 2005, 200 patients with Sonablate® 500 version 4 (V4) from 2005-2008 and 19 patients with Sonablate® 500 TCM (TCM) from 2007. Biochemical disease-free survival rate (bDFS) in all patients was 59% in 8 years. bDFS in 8 years in patients with S200 and S500 groups were 55% and 56%, and bDFS in 4 and 2 years in patients with V4 and TCM group were 72% and 84%, respectively. bDFS in low, intermediate, and high risk groups were 75%, 54%, and 43% in S200/S500 and 93%, 72%, and 58% in V4/TCM group. Negative prostate biopsy rate after HIFU was 97% in S200, 79% in S500, 94% in V4 and 100% in TCM group. HIFU as primary therapy for prostate cancer is indicated in patients with low- and intermediate-risk (T1-T2b N0M0 disease, a Gleason score of ⩽7, a PSA level of <20 ng/mL) and a prostate volume of less than 40 mL. The rate of clinical outcome has significantly improved over the years due to technical improvements in the device.

  8. TU-EF-210-01: HIFU, Drug Delivery, and Immunotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ferrara, K. [University of California - Davis (United States)

    2015-06-15

    The use of therapeutic ultrasound to provide targeted therapy is an active research area that has a broad application scope. The invited talks in this session will address currently implemented strategies and protocols for both hyperthermia and ablation applications using therapeutic ultrasound. The role of both ultrasound and MRI in the monitoring and assessment of these therapies will be explored in both pre-clinical and clinical applications. Katherine Ferrara: High Intensity Focused Ultrasound, Drug Delivery, and Immunotherapy Rajiv Chopra: Translating Localized Doxorubicin Delivery to Pediatric Oncology using MRI-guided HIFU Elisa Konofagou: Real-time Ablation Monitoring and Lesion Quantification using Harmonic Motion Imaging Keyvan Farahani: AAPM Task Groups in Interventional Ultrasound Imaging and Therapy Learning Objectives: Understand the role of ultrasound in localized drug delivery and the effects of immunotherapy when used in conjunction with ultrasound therapy. Understand potential targeted drug delivery clinical applications including pediatric oncology. Understand the technical requirements for performing targeted drug delivery. Understand how radiation-force approaches can be used to both monitor and assess high intensity focused ultrasound ablation therapy. Understand the role of AAPM task groups in ultrasound imaging and therapies. Chopra: Funding from Cancer Prevention and Research Initiative of Texas (CPRIT), Award R1308 Evelyn and M.R. Hudson Foundation; Research Support from Research Contract with Philips Healthcare; COI are Co-founder of FUS Instruments Inc Ferrara: Supported by NIH, UCDavis and California (CIRM and BHCE) Farahani: In-kind research support from Philips Healthcare.

  9. Sparse matrix beamforming and image reconstruction for 2-D HIFU monitoring using harmonic motion imaging for focused ultrasound (HMIFU) with in vitro validation.

    Science.gov (United States)

    Hou, Gary Y; Provost, Jean; Grondin, Julien; Wang, Shutao; Marquet, Fabrice; Bunting, Ethan; Konofagou, Elisa E

    2014-11-01

    Harmonic motion imaging for focused ultrasound (HMIFU) utilizes an amplitude-modulated HIFU beam to induce a localized focal oscillatory motion simultaneously estimated. The objective of this study is to develop and show the feasibility of a novel fast beamforming algorithm for image reconstruction using GPU-based sparse-matrix operation with real-time feedback. In this study, the algorithm was implemented onto a fully integrated, clinically relevant HMIFU system. A single divergent transmit beam was used while fast beamforming was implemented using a GPU-based delay-and-sum method and a sparse-matrix operation. Axial HMI displacements were then estimated from the RF signals using a 1-D normalized cross-correlation method and streamed to a graphic user interface with frame rates up to 15 Hz, a 100-fold increase compared to conventional CPU-based processing. The real-time feedback rate does not require interrupting the HIFU treatment. Results in phantom experiments showed reproducible HMI images and monitoring of 22 in vitro HIFU treatments using the new 2-D system demonstrated reproducible displacement imaging, and monitoring of 22 in vitro HIFU treatments using the new 2-D system showed a consistent average focal displacement decrease of 46.7 ±14.6% during lesion formation. Complementary focal temperature monitoring also indicated an average rate of displacement increase and decrease with focal temperature at 0.84±1.15%/(°)C, and 2.03±0.93%/(°)C , respectively. These results reinforce the HMIFU capability of estimating and monitoring stiffness related changes in real time. Current ongoing studies include clinical translation of the presented system for monitoring of HIFU treatment for breast and pancreatic tumor applications.

  10. Determination of cytotoxic thermal dose during HIFU ablation

    Science.gov (United States)

    Nandlall, Sacha D.; Bazán-Peregrino, Miriam; Mo, Steven; Coussios, Constantin-C.

    2012-10-01

    Thermal dose has been proposed for various hyperthermic cancer treatment modalities as a measure of heat-induced cell and tissue damage. However, many of the models that are currently used for calculating thermal dose have not been validated or suitably adapted for the elevated temperatures and rates of heating encountered during ablation by High-Intensity Focused Ultrasound (HIFU). This work quantifies the performance of the widely employed Cumulative Equivalent Minutes at 43°C (CEM43) thermal dose metric under HIFU-relevant heating. A total of 36 agar phantoms were embedded with different human cancer cell lines (PC3, 22RV1, or ZR75.1) as well as calcein AM and propidium iodide assays. The phantoms were cast in sterile molds with internal dimensions of 7 cm × 7 cm × 2 mm. Using a water bath, 12 of the phantoms were treated with mild hyperthermia (43-46°C for up to 60 minutes), while another 12 were subjected to HIFU-relevant temperature profiles (60-80°C peak temperature, 2-3°C/s peak heating rate). In each of the remaining 12 phantoms, 8 HIFU exposures were carried out in a 37°C water tank (1.067 MHz, 95% duty cycle, 3-6 MPa peak rarefaction pressure, 2-20 s exposure duration). Cavitation emissions were monitored passively with a detector transducer that was confocally and co-axially aligned with the HIFU source. Cell death was quantified by measuring the locally averaged fluorescence intensity of the assays relative to unheated and severely heat-shocked phantoms. The results show that the CEM43 dose required to achieve the same level of heat-induced cell death varies considerably across cell lines, and that inertial cavitation can cause significant mechanical damage at ablation-relevant intensities even when no significant thermal dose is delivered (CEM43 < 5 s). These findings demonstrate the need for improved models of cell death at ablation-relevant temperatures.

  11. MR thermometry analysis program for laser- or high-intensity focused ultrasound (HIFU)-induced heating at a clinical MR scanner

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Ju; Jeong, Ki Young; Oh, Seung Jae; Park, Eun Hae; Lee, Young Han; Suh, Jin Suck [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dae Hong [National Cancer Center, Goyang (Korea, Republic of)

    2014-12-15

    Magnetic resonance (MR) thermometry is a noninvasive method for monitoring local temperature change during thermal therapy. In this study, a MR temperature analysis program was established for a laser with gold nanorods (GNRs) and high-intensity focused ultrasound (HIFU)-induced heating MR thermometry. The MR temperature map was reconstructed using the water proton resonance frequency (PRF) method. The temperature-sensitive phase difference was acquired by using complex number subtraction instead of direct phase subtraction in order to avoid another phase unwrapping process. A temperature map-analyzing program was developed and implemented in IDL (Interactive Data Language) for effective temperature monitoring. This one program was applied to two different heating devices at a clinical MR scanner. All images were acquired with the fast spoiled gradient echo (fSPGR) pulse sequence on a 3.0 T GE Discovery MR750 scanner with an 8-channel knee array coil or with a home-built small surface coil. The analyzed temperature values were confirmed by using values simultaneously measured with an optical temperature probe (R{sup 2} = 0.996). The temperature change in small samples induced by a laser or by HIFU was analyzed by using a raw data, that consisted of complex numbers. This study shows that our MR thermometry analysis program can be used for thermal therapy study with a laser or HIFU at a clinical MR scanner. It can also be applied to temperature monitoring for any other thermal therapy based on the PRF method.

  12. On-Demand Drug Release from Dual-Targeting Small Nanoparticles Triggered by High-Intensity Focused Ultrasound Enhanced Glioblastoma-Targeting Therapy.

    Science.gov (United States)

    Luo, Zimiao; Jin, Kai; Pang, Qiang; Shen, Shun; Yan, Zhiqiang; Jiang, Ting; Zhu, Xiaoyan; Yu, Lei; Pang, Zhiqing; Jiang, Xinguo

    2017-09-20

    Glioblastoma is one of the most challenging and intractable tumors with the difficult treatment and poor prognosis. Unsatisfactory traditional systemic chemotherapies for glioblastoma are mainly attributed to the insufficient and nonspecific drug delivery into the brain tumors as well as the incomplete drug release at the tumor sites. Inspired by the facts that angiopep-2 peptide is an acknowledged dual-targeting moiety for brain tumor-targeting delivery and high-intensity focused ultrasound (HIFU) is an ideal trigger for drug release with an ultrahigh energy and millimeter-sized focus ability, in the present study, a novel HIFU-responsive angiopep-2-modified small poly(lactic-co-glycolic acid) (PLGA) hybrid nanoparticle (NP) drug delivery system holding doxorubicin/perfluorooctyl bromide (ANP-D/P) was designed to increase the intratumoral drug accumulation, further trigger on-demand drug release at the glioblastoma sites, and enhance glioblastoma therapy. It was shown that the ANP-D/P was stable and had a small size of 41 nm. The angiopep-2 modification endowed the ANP-D/P with improved blood-brain barrier transportation and specific accumulation in glioblastoma tissues by 17 folds and 13.4 folds compared with unmodified NPs, respectively. Under HIFU irradiation, the ANP-D/P could release 47% of the drug within 2 min and induce the apoptosis of most tumor cells. HIFU-triggered instantaneous drug release at the glioblastoma sites eventually enabled the ANP-D/P to achieve the strongest antiglioblastoma efficacy with the longest median survival time (56 days) of glioblastoma-bearing mice and the minimum vestiges of tumor cells in the pathological slices among all groups. In conclusion, the HIFU-responsive ANP-D/P in this study provided a new way for glioblastoma therapy with a great potential for clinical applications.

  13. Targeted Therapy in Systemic Sclerosis

    Directory of Open Access Journals (Sweden)

    Murray Baron

    2016-10-01

    Full Text Available Targeted therapies use an understanding of the pathophysiology of a disease in an individual patient. Although targeted therapy for systemic sclerosis (SSc, scleroderma has not yet reached the level of patient-specific treatments, recent developments in the understanding of the global pathophysiology of the disease have led to new treatments based on the cells and pathways that have been shown to be involved in the disease pathogenesis. The presence of a B cell signature in skin biopsies has led to the trial of rituximab, an anti-CD20 antibody, in SSc. The well-known properties of transforming growth factor (TGF-β in promoting collagen synthesis and secretion has led to a small trial of fresolimumab, a human IgG4 monoclonal antibody capable of neutralizing TGF-β. Evidence supporting important roles for interleukin-6 in the pathogenesis of SSc have led to a large trial of tocilizumab in SSc. Soluble guanylate cyclase (sGC is an enzyme that catalyzes the production of cyclic guanosine monophosphate (cGMP upon binding of nitric oxide (NO to the sGC molecule. Processes such as cell growth and proliferation are regulated by cGMP. Evidence that sGC may play a role in SSc has led to a trial of riociguat, a molecule that sensitizes sGC to endogenous NO. Tyrosine kinases (TKs are involved in a wide variety of physiologic and pathological processes including vascular remodeling and fibrogenesis such as occurs in SSc. This has led to a trial of nintedanib, a next-generation tyrosine-kinase (TK inhibitor which targets multiple TKs, in SSc.

  14. In vivo photoacoustics and high frequency ultrasound imaging of mechanical high intensity focused ultrasound (HIFU) ablation

    NARCIS (Netherlands)

    Daoudi, K.; Hoogenboom, M.; Brok, M.H. den; Eikelenboom, D.C.; Adema, G.J.; Futterer, J.J.; Korte, C.L. de

    2017-01-01

    The thermal effect of high intensity focused ultrasound (HIFU) has been clinically exploited over a decade, while the mechanical HIFU is still largely confined to laboratory investigations. This is in part due to the lack of adequate imaging techniques to better understand the in-vivo pathological

  15. MR techniques for guiding high-intensity focused ultrasound (HIFU) treatments.

    Science.gov (United States)

    Kuroda, Kagayaki

    2018-02-01

    To make full use of the ability of magnetic resonance (MR) to guide high-intensity focused ultrasound (HIFU) treatment, effort has been made to improve techniques for thermometry, motion tracking, and sound beam visualization. For monitoring rapid temperature elevation with proton resonance frequency (PRF) shift, data acquisition and processing can be accelerated with parallel imaging and/or sparse sampling in conjunction with appropriate signal processing methods. Thermometry should be robust against tissue motion, motion-induced magnetic field variation, and susceptibility change. Thus, multibaseline, referenceless, or hybrid techniques have become important. In cases with adipose or bony tissues, for which PRF shift cannot be used, thermometry with relaxation times or signal intensity may be utilized. Motion tracking is crucial not only for thermometry but also for targeting the focus of an ultrasound in moving organs such as the liver, kidney, or heart. Various techniques for motion tracking, such as those based on an anatomical image atlas with optical-flow displacement detection, a navigator echo to seize the diaphragm position, and/or rapid imaging to track vessel positions, have been proposed. Techniques for avoiding the ribcage and near-field heating have also been examined. MR acoustic radiation force imaging (MR-ARFI) is an alternative to thermometry that can identify the location and shape of the focal spot and sound beam path. This technique could be useful for treating heterogeneous tissue regions or performing transcranial therapy. All of these developments, which will be discussed further in this review, expand the applicability of HIFU treatments to a variety of clinical targets while maintaining safety and precision. 2 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:316-331. © 2017 International Society for Magnetic Resonance in Medicine.

  16. High-intensity focused ultrasound (HIFU) for adenomyosis: Two-year follow-up results.

    Science.gov (United States)

    Shui, Lian; Mao, Shihua; Wu, Qingrong; Huang, Guohua; Wang, Jian; Zhang, Ruitao; Li, Kequan; He, Jia; Zhang, Lian

    2015-11-01

    To evaluate the long-term improvement of clinical symptoms of adenomyosis after treatment with ultrasound-guided high intensity focused ultrasound (USgHIFU). From January 2010 to December 2011, 350 patients with adenomyosis were treated with USgHIFU. Among the 350 patients, 224 of them completed the two years follow-up. The patients were followed up at 3 months, 1 year, and 2 years after HIFU treatment. Adverse effects and complications were recorded. All patients completed HIFU ablation without severe postoperative complications. 203 of the 224 patients who showed varying degrees of dysmenorrhea before treatment had the symptom scores decreased significantly after treatment (PHIFU treatment. With its ability to sustain long-term clinical improvements, HIFU is a safe and effective treatment for adenomyosis. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Design of HIFU Transducers to Generate Specific Nonlinear Ultrasound Fields

    Science.gov (United States)

    Khokhlova, Vera A.; Yuldashev, Petr V.; Rosnitskiy, Pavel B.; Maxwell, Adam D.; Kreider, Wayne; Bailey, Michael R.; Sapozhnikov, Oleg A.

    Various clinical applications of high intensity focused ultrasound (HIFU) have different requirements on the pressure level and degree of nonlinear waveform distortion at the focus. Applications that utilize nonlinear waves with developed shocks are of growing interest, for example, for mechanical disintegration as well as for accelerated thermal ablation oftissue. In this work, an inverse problem of determining transducer parameters to enable formation of shockswith desired amplitude at the focus is solved. The solution was obtained by performing multipledirect simulations of the parabolic Khokhlov-Zabolotskaya-Kuznetsov (KZK) equation for various parameters of the source. It is shown that results obtained within the parabolic approximation can be used to describe the focal region of single element spherical sourcesas well as complex transducer arrays. It is also demonstrated that the focal pressure level at which fully developed shocksare formed mainly depends on the focusing angle of the source and only slightly depends on its aperture and operating frequency. Using the simulation results, a 256-element HIFU array operating at 1.5 MHz frequency was designed for a specific application of boiling-histotripsy that relies on the presence of 90-100 MPa shocks at the focus. The size of the array elements and focusing angle of the array were chosen to satisfy technical limitations on the intensity at the array elements and desired shock amplitudes in the focal waveform. Focus steering capabilities of the array were analysed using an open-source T-Array software developed at Moscow State University.

  18. Evaluation of temperature rise in a tissue mimicking material during HIFU exposure

    Energy Technology Data Exchange (ETDEWEB)

    Maruvada, S; Liu, Y; Herman, B A; Harris, G R, E-mail: subha.maruvada@fda.hhs.gov [Food and Drug Administration, Center for Devices and Radiological Health, 10903 New Hampshire Ave., Bldg., Silver Spring, MD 20993 (United States)

    2011-02-01

    In pre-clinical testing it is essential to characterize clinical high intensity focused ultrasound (HIFU) devices using tissue-mimicking materials (TMMs) with well known characteristics, including temperature rise and cavitation properties. The purpose of this study was to monitor cavitation behavior and correlate its effect with temperature rise in a HIFU TMM containing an embedded thermocouple. A 75-{mu}m fine wire thermocouple was embedded in a hydrogel-based TMM previously developed for HIFU. HIFU at 1.1 and 3.3 MHz was focused at the thermocouple junction. Focal pressures from 1-11 MPa were applied and the temperature profiles were recorded. Three hydrophones were used to monitor cavitation activity during sonication. A hydrophone confocal with the HIFU transducer and a cylindrical hydrophone lateral to the HIFU beam were used as passive cavitation detectors for spectral analysis of signals, and a needle hydrophone placed beyond the HIFU focus was used to record changes in the pressure amplitude due to blockage by bubbles at or near the focus. B-mode imaging scans were employed to visualize bubble presence during sonication. In a separate measurement, schlieren imaging was used to monitor the change in field distribution behind the TMM. All hydrophone methods correlated well with cavitation in the TMM.

  19. Systemic therapy and attachment narratives: Attachment Narrative Therapy.

    Science.gov (United States)

    Dallos, Rudi; Vetere, Arlene

    2014-10-01

    This article outlines an integration of attachment theory with narrative theory and systemic theory and practice: Attachment Narrative Therapy (ANT). This integration offers a more powerful explanatory formulation of the development and maintenance of human distress in relationships, families and communities, and gives direction to psychotherapeutic intervention. © The Author(s) 2014.

  20. Systemic therapies for psoriasis: understanding current and newly emerging therapies.

    Science.gov (United States)

    Sobell, Jeffrey M; Hallas, Stephen J

    2003-09-01

    The treatment of moderate to severe psoriasis is a rapidly expanding area. Recent insights into the pathogenesis of this disease as a T-cell mediated process has led to a greater understanding of the mechanisms of action of conventional FDA-approved systemic therapies such as methotrexate, cyclosporine, acitretin, and psoralen with ultraviolet A phototherapy. It has also led to the development of rationally targeted therapies against key components of the immune process critical in the generation of the psoriatic plaque. Safety and efficacy data from clinical studies of 4 biologic agents furthest along in their development are reviewed. These results are promising, adding to the armamentarium for treating this disease.

  1. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours.

    Science.gov (United States)

    Wijlemans, J W; Bartels, L W; Deckers, R; Ries, M; Mali, W P Th M; Moonen, C T W; van den Bosch, M A A J

    2012-09-28

    Recent decades have seen a paradigm shift in the treatment of liver tumours from invasive surgical procedures to minimally invasive image-guided ablation techniques. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, completely non-invasive ablation technique that has the potential to change the field of liver tumour ablation. The image guidance, using MR imaging and MR temperature mapping, provides excellent planning images and real-time temperature information during the ablation procedure. However, before clinical implementation of MR-HIFU for liver tumour ablation is feasible, several organ-specific challenges have to be addressed. In this review we discuss the MR-HIFU ablation technique, the liver-specific challenges for MR-HIFU tumour ablation, and the proposed solutions for clinical translation.

  2. Characterization of HIFU transducers designed for sonochemistry application: Acoustic streaming.

    Science.gov (United States)

    Hallez, L; Touyeras, F; Hihn, J-Y; Bailly, Y

    2016-03-01

    Cavitation distribution in a High Intensity Focused Ultrasound sonoreactors (HIFU) has been extensively described in the recent literature, including quantification by an optical method (Sonochemiluminescence SCL). The present paper provides complementary measurements through the study of acoustic streaming generated by the same kind of HIFU transducers. To this end, results of mass transfer measurements (electrodiffusional method) were compared to optical method ones (Particle Image Velocimetry). This last one was used in various configurations: with or without an electrode in the acoustic field in order to have the same perturbation of the wave propagation. Results show that the maximum velocity is not located at the focal but shifted near the transducer, and that this shift is greater for high powers. The two cavitation modes (stationary and moving bubbles) are greatly affect the hydrodynamic behavior of our sonoreactors: acoustic streaming and the fluid generated by bubble motion. The results obtained by electrochemical measurements show the same low hydrodynamic activity in the transducer vicinity, the same shift of the active focal toward the transducer, and the same absence of activity in the post-focal axial zone. The comparison with theoretical Eckart's velocities (acoustic streaming in non-cavitating media) confirms a very high activity at the "sonochemical focal", accounted for by wave distortion, which induced greater absorption coefficients. Moreover, the equivalent liquid velocities are one order of magnitude larger than the ones measured by PIV, confirming the enhancement of mass transfer by bubbles oscillation and collapse close to the surface, rather than from a pure streaming effect. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Whole Body Bone Scan Findings after High Intensity Focused Ultrasound (HIFU) Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Ye Young; O, Joo Hyun; Sohn, Hyung Sun; Choi, Eun Kyoung; Yoo, Ik Dong; Oh, Jin Kyoung; Han, Eun Ji; Jung, Seung Eun; Kim, Sung Hoon [The Catholic Univ. of Korea, Seoul (Korea, Republic of)

    2011-12-15

    This study aims to examine the findings of {sup 99mT}c diphosphonate bone scans in cancer patients with a history of HIFU treatment. Bone scan images of patients with a history of HIFU treatment for primary of metastatic cancer from January 2006 to July 2010 were retrospectively reviewed. Cases of primary bone tumor or HIFU treatment reaching only the superficial soft tissue layer were excluded. Bone scan images of 62 patients (26 female, 36 male; mean age 57{+-}9 years) were studied. HIFU treatment was performed in the liver (n=40), pancreas (n=40), pancreas (n=16), and breast (n=6). Mean interval time between HIFU treatment and bone scan was 106{+-}105 days (range: 1-572 days). Of 62 scans, 43 showed diffusely decreased uptake of bone within the path of HIFU treatment: antero axillary and/or posterior arcs of right 5th to 11th ribs in 34 cases after treatment of hepatic lesions; anterior arcs of 2nd to 5th ribs in 5 cases after treatment for breast tumors; and posterior arcs of left 9th to 11th ribs or thoraco lumbar vertebrae in 4 cases after treatment for pancreas tumor. Of 20 patients who had bone scans more than twice, five showed recovered uptake of the radiotracer in the involved ribs in the follow up bone scan. Of 62 bone scans in patients with a history of HIFU treatment for primary of metastatic cancer, 69% presented diffusely decreased uptake in the bone in the path of HIFU treatment.

  4. High-intensity focused ultrasound ablation: an effective bridging therapy for hepatocellular carcinoma patients.

    Science.gov (United States)

    Cheung, Tan To; Fan, Sheung Tat; Chan, See Ching; Chok, Kenneth S H; Chu, Ferdinand S K; Jenkins, Caroline R; Lo, Regina C L; Fung, James Y Y; Chan, Albert C Y; Sharr, William W; Tsang, Simon H Y; Dai, Wing Chiu; Poon, Ronnie T P; Lo, Chung Mau

    2013-05-28

    To analyze whether high-intensity focused ultrasound (HIFU) ablation is an effective bridging therapy for patients with hepatocellular carcinoma (HCC). From January 2007 to December 2010, 49 consecutive HCC patients were listed for liver transplantation (UCSF criteria). The median waiting time for transplantation was 9.5 mo. Twenty-nine patients received transarterial chemoembolization (TACE) as a bringing therapy and 16 patients received no treatment before transplantation. Five patients received HIFU ablation as a bridging therapy. Another five patients with the same tumor staging (within the UCSF criteria) who received HIFU ablation but not on the transplant list were included for comparison. Patients were comparable in terms of Child-Pugh and model for end-stage liver disease scores, tumor size and number, and cause of cirrhosis. The HIFU group and TACE group showed no difference in terms of tumor size and tumor number. One patient in the HIFU group and no patient in the TACE group had gross ascites. The median hospital stay was 1 d (range, 1-21 d) in the TACE group and two days (range, 1-9 d) in the HIFU group (P HIFU-related complication occurred. In the HIFU group, nine patients (90%) had complete response and one patient (10%) had partial response to the treatment. In the TACE group, only one patient (3%) had response to the treatment while 14 patients (48%) had stable disease and 14 patients (48%) had progressive disease (P = 0.00). Seven patients in the TACE group and no patient in the HIFU group dropped out from the transplant waiting list (P = 0.559). HIFU ablation is safe and effective in the treatment of HCC for patients with advanced cirrhosis. It may reduce the drop-out rate of liver transplant candidate.

  5. Gestalt Therapy and General System Theory.

    Science.gov (United States)

    Whitner, Phillip A.

    While General Systems Theory (GST) concepts appear to be applicable in explaining some of the phenomena that occur in a Gestalt Therapy group, research is needed to support this assumption. General Systems Theory may not be a group theory per se. Instead, GST may be a theory about groups. A meta-theory exists where its value and usefulness is…

  6. Verifying therapy safety interlock system with spin

    CSIR Research Space (South Africa)

    Seotsanyana, M

    2009-11-01

    Full Text Available on the successful use of model checking in the design and verification of the Safety Interlock System (SIS) at iThemba LABS. SIS is part of proton therapy control system (TCS) and its main task is to monitor and evaluate the safety conditions in the TCS as a whole...

  7. Kombination aus TUR-P und hochintensiv fokussiertem Ultraschall (HIFU zur Behandlung des lokoregionären Prostatakarzinoms - Erfahrungen mit 70 Patienten

    Directory of Open Access Journals (Sweden)

    Walter B

    2004-01-01

    über der alleinigen HIFU auf eine Woche verkürzen. Auch konnte die Inzidenz der narbigen Blasenauslaßobstruktion im Vergleich zur alleinigen HIFU-Therapie nahezu halbiert werden.

  8. High-intensity focused ultrasound (HIFU) using Sonablate{trade mark, serif} devices for the treatment of localized prostate cancer: 13-year experience

    Science.gov (United States)

    Uchida, Toyoaki; Tomonaga, Tetsuro; Shoji, Sunao; Kim, Hakushi; Nagata, Yoshihiro

    2012-11-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Eight hundred and eighty-four men with prostate cancer treated with Sonablate® (SB) devices were included. All patients were followed for more than 2 years. The patients were divided into three groups: in the first group, 419 patients were treated with SB200/500 from 1999 to 2006; in the second group, 263 patients were treated with SB 500 ver. 4 from 2005 to 2009: in the third group, 202 patients were treated with SB 500 TCM from 2007 up to present. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/ml). The mean age, PSA, Gleason score, operation time, and follow-up period in each group were 68, 66 and 67 years, 11.2, 9.7 and 9.3 ng/ml, 6.2, 6.6 and 6.7, 167, 101 and 106 min, and 56, 48 and 36 months, respectively. The biochemical disease-free rate (bDFR) in each group at 5 years was, respectively, 54%, 61% and 84%, and was 50% at 10 years in the SB200/500 group (p<0.0001). The bDFR in patients in the low-, intermediate-, and high-risk groups in all patients at 10 years were 72% and 58%, 44%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the SB500 TCM group at 5 years were 97%, 83%, and 74% (p=0.0056). The negative prostate biopsy rates in 3 groups were 81%, 92% and 88%, respectively. As post HIFU complications, urethral stricture, acute epididymitis and urinary incontinence were noted in 18.0%, 6.2% and 1.9%, respectively. Rectourethral fistula was occurred in 0.6% in the first HIFU cases, Postoperative erectile dysfunction was noted in 27% of patients at 2 years after HIFU. HIFU therapy appears to be minimally invasive, efficacious, and safe for patients with localized prostate cancer. Technological advances as well as cultural and economic vectors have caused a shift from to minimally invasive techniques.

  9. Experimental investigation of thermal effects in HIFU-based external valvuloplasty with a non-spherical transducer, using high-resolution MR thermometry

    Energy Technology Data Exchange (ETDEWEB)

    Petrusca, Lorena; Salomir, Rares; Milleret, Rene; Pichot, Olivier; Rata, Mihaela; Chapelon, Jean-Yves [Inserm, U556, and Universite de Lyon, Lyon, F-69003 (France); Cotton, Francois [Universite Claude Bernard Lyon 1, Lyon, F-69003 (France)], E-mail: lorena.petrusca@inserm.fr

    2009-09-07

    Real-time image-guided extracorporeal high intensity focused ultrasound (HIFU) has been suggested for minimally invasive treatment of valvular dysfunction in the saphenous vein. Local application of heat on the perimeter of the valve zone was previously reported to induce a partial shrinkage of the collagen, which may correct valvular function. In our study, a novel MR compatible HIFU device has been investigated. This device is based on a non-spherical geometry, with two active elements that create a focusing line which is orthogonal to the beam main axis, aiming to cover the valve longitudinally. The prototype performance was characterized by electro-acoustical measurements of the pressure field and by high-resolution MR thermometry. Pressure and thermal fields were found in good agreement with the theoretical predictions. To investigate the therapeutic potential, fresh samples of excised human veins were filled with an agarose gel, embedded in porcine muscle and exposed to HIFU. The power level applied during a fixed duration of 30 s was varied such that the absolute temperature at focus ranged between 52 deg. C and 83 deg. C. Targeting was achieved under MR guidance using a MR compatible XZ positioning system. A dedicated waterproof miniature loop coil was specifically built to achieve high-resolution MRI image-based targeting (0.25 mm x 0.25 mm x 3 mm voxel) and thermometry (0.4 mm x 0.4 mm x 4 mm voxel). The vein wall was clearly identified on MR images before and after HIFU treatment. The thermal buildup created by the non-spherical transducer could be characterized from MR thermometry data. Shrinkage of the vein wall (above 65 deg. C) was determined by absolute temperature and was not a cumulative thermal dose effect.

  10. Temperature-dependent physical properties of egg white for HIFU applications

    Science.gov (United States)

    Liu, Yunbo; Maruvada, Subha; Herman, Bruce A.; Harris, Gerald R.

    2012-10-01

    Because egg white denatures at elevated temperature due to its protein content, it has the potential for use as a blood coagulation surrogate in pre-clinical evaluations of thermal therapy procedures such as high intensity focused ultrasound (HIFU) surgery. We therefore have measured the relevant physical properties of egg white, including coagulation temperature, frequency-dependent attenuation, sound speed, viscosity, and thermal properties, as a function of temperature (20 - 95°C). Thermal coagulation and attenuation (5-12 MHz) of cow blood, pig blood, and human blood also were assessed and compared with egg white. For a 30 s thermal exposure, both egg white and blood samples started to denature at 65°C and coagulate into an elastic gel at 85°C. The temperature-dependent parameters were found to be similar to that of the blood samples. For example, the attenuation of egg white ranged from 0.23f1.09 to 2.7f0.5 dB/cm over the 20°C - 95°C range. These results suggest that egg white would make a useful blood mimic for bench testing of therapeutic ultrasound devices.

  11. Inhalable drugs for systemic therapy.

    Science.gov (United States)

    Corkery, K

    2000-07-01

    Although oral and injectable drug formulations still dominate the market, interest in pulmonary delivery has been rising steadily. Given patients' desire for an alternative to injections, and recent advances in aerosol science and pulmonary medicine, the potential for improved disease management outcomes by using aerosols for systemic drug delivery should lead the way for a shift to inhalables.

  12. Biological Therapy in Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Mariana Postal

    2012-01-01

    Full Text Available Systemic lupus erythematosus (SLE is a prototypic inflammatory autoimmune disorder characterized by multisystem involvement and fluctuating disease activity. Symptoms range from rather mild manifestations such as rash or arthritis to life-threatening end-organ manifestations. Despite new and improved therapy having positively impacted the prognosis of SLE, a subgroup of patients do not respond to conventional therapy. Moreover, the risk of fatal outcomes and the damaging side effects of immunosuppressive therapies in SLE call for an improvement in the current therapeutic management. New therapeutic approaches are focused on B-cell targets, T-cell downregulation and costimulatory blockade, cytokine inhibition, and the modulation of complement. Several biological agents have been developed, but this encouraging news is associated with several disappointments in trials and provide a timely moment to reflect on biologic therapy in SLE.

  13. Alliance and adherence in a systemic therapy

    NARCIS (Netherlands)

    Lange, A.M.C.; Rijken, R.E.A. van der; Delsing, M.J.M.H.; Busschbach, J.J.V. van; Horn, J.E. van; Scholte, R.H.J.

    2017-01-01

    Background: The client-therapist working alliance is a key contributor to effective adult psychotherapy. However, little is known about its role in family and systemic therapy. Moreover, few studies have assessed alliance longitudinally or have investigated how it interrelates with other process

  14. 21 CFR 892.5300 - Medical neutron radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical neutron radiation therapy system. 892.5300... therapy system. (a) Identification. A medical neutron radiation therapy system is a device intended to generate high-energy neutrons for radiation therapy. This generic type of device may include signal...

  15. Systemic therapy of childhood atopic dermatitis.

    Science.gov (United States)

    Slater, Nathaniel A; Morrell, Dean S

    2015-01-01

    Atopic dermatitis (AD) is a common childhood inflammatory disease that, in a small percentage of cases, can become severe enough to require potent systemic treatment. Many trials have been conducted with systemic agents for the treatment of severe pediatric AD; we review the evidence here. Although corticosteroids are widely used in practice, they are not generally recommended as a systemic treatment option for AD in children. Most patients experience a relatively rapid and robust response to cyclosporine. Treating children with cyclosporine long term is troubling; however, azathioprine, mycophenolate mofetil, and methotrexate are all reasonable alternatives for maintenance therapy in recalcitrant cases. Several additional options are available for the most refractory cases, including interferon-γ, intravenous immunoglobulin, and various biologics. Phototherapy is another modality that can be effective in treating severe AD. Ultimately the choice of agent is individualized. Systemic therapy options are associated with potentially severe adverse effects and require careful monitoring. Nonsystemic approaches toward prevention of flares and long-term control of atopic dermatitis in pediatric patients should be continued in conjunction with systemic therapy. In the future, more targeted systemic treatments hold the potential for effective control of disease with fewer side effects than broadly immunosuppressive agents. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. HIFU treatment time reduction through heating approach optimisation.

    Science.gov (United States)

    Coon, Joshua; Todd, Nick; Roemer, Robert

    2012-01-01

    This study evaluated the HIFU treatment time reductions attainable for several scan paths when optimising the heating approach used (single, discrete pulses versus volumetric scanning) and the paths' focal zone heating locations'; number (N(FZL)), spacings, sequencing order, number of heating cycles (N(CYCLES)), and heating times. Also evaluated were the effects of focal zone size, increased tissue absorptivity due to heating, and optimisation technique. Treatments of homogeneous constant property tumours were simulated for several simple generic tumour shapes and sizes. The concentrated heating approach (which delivered the desired thermal dose to each location in one discrete heating pulse (N(CYCLES) = 1)) was compared to the fractionated heating approach (which dosed the tumour using multiple, shorter pulses repeatedly scanned around the heating path (i.e. 'volumetric scanning' with N(CYCLES) > 1)). Treatment times were minimised using both simultaneous, collective pulse optimisation (which used full a priori knowledge of the interacting effects of all pulses) and sequential, single pulse optimisation (which used only the information from previous pulses and cooling of the current pulse). Optimised concentrated heating always had shorter treatment times than optimised fractionated heating, and concentrated heating resulted in less normal tissue heating. When large, rapid tissue absorptivity changes were present (doubled or quadrupled immediately after heating) the optimal ordering of the scan path's sequence of focal zone locations changed. Concentrated heating yields significant treatment time reductions and less normal tissue heating when compared to all fractionated scanning approaches, e.g. volumetric scanning.

  17. Full acoustic and thermal characterization of HIFU field in the presence of a ribcage model

    Science.gov (United States)

    Cao, Rui; Le, Nhan; Nabi, Ghulam; Huang, Zhihong

    2017-03-01

    In the treatment of abdominal organs using high intensity focused ultrasound (HIFU), the patient's ribs are in the pathway of the HIFU beams which could result in acoustic distortion, occasional skin burns and insufficient energy delivered to the target organs. To provide full characterization of HIFU field with the influence of ribcage, the ribcage phantom reconstructed from a patient's CT images was created by tissue mimicking materials and its effect on acoustic field was characterized. The effect of the ribcage on acoustic field has been provided in acoustic pressure distribution, acoustic power and focal temperature. Measurement result shows focus splitting with one main focus and two secondary intensity maxima. With the presence of ribcage phantom, the acoustic pressure was reduced by 48.3% and another two peak values were observed near the main focus, reduced by 65.0% and 71.7% respectively. The acoustic power was decreased by 47.5% to 52.5%. With these characterization results, the form of the focus, the acoustic power, acoustic pressure and temperature rise are provided before the transcostal HIFU treatment, which are significant to determine the energy delivery dose. In conclusion, this ribcage model and characterization technique will be useful for the further study in the abdominal HIFU treatment.

  18. Salvage high-intensity focused ultrasound ablation for prostate cancer local recurrence after external-beam radiation therapy: prognostic value of prostate MRI.

    Science.gov (United States)

    Rouvière, O; Sbihi, L; Gelet, A; Chapelon, J-Y

    2013-07-01

    To assess the prognostic value of magnetic resonance imaging (MRI) before salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after external-beam radiotherapy (EBRT). Forty-six patients who underwent prostate MRI before salvage HIFU for locally recurrent prostate cancer after EBRT were retrospectively studied. HIFU failure was defined as a prostate-specific antigen (PSA) value >nadir + 2 ng/ml (Phoenix criteria) or positive follow-up biopsy or initiation of any other salvage therapy. The following prognostic parameters were assessed: neoadjuvant hormone therapy, clinical stage and Gleason score of recurrence, PSA level and velocity at HIFU treatment, and six MRI-derived parameters (prostate volume, tumour volume, extracapsular extension, seminal vesicle invasion, tumour extension into the apex or anterior to the urethra). Two factors were significant independent predictors of salvage HIFU failure: the PSA level at HIFU treatment (p HIFU failure for locally recurrent prostate cancer after EBRT. Therefore, MRI may be useful for patient selection before post-EBRT salvage HIFU ablation. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. Development of a high-field MR-guided HIFU setup for thermal and mechanical ablation methods in small animals

    NARCIS (Netherlands)

    Hoogenboom, M.; Amerongen, M.J. van; Eikelenboom, D.C.; Wassink, M.; Brok, M.H. den; Hulsbergen-van de Kaa, C.A.; Dumont, E.; Adema, G.J.; Heerschap, A.; Futterer, J.J.

    2015-01-01

    BACKGROUND: Thermal and mechanical high intensity focused ultrasound (HIFU) ablation techniques are in development for non-invasive treatment of cancer. However, knowledge of in vivo histopathologic and immunologic reactions after HIFU ablation is still limited. This study aims to create a setup for

  20. Intravenous immunoglobulin therapy and systemic lupus erythematosus.

    Science.gov (United States)

    Zandman-Goddard, Gisele; Levy, Yair; Shoenfeld, Yehuda

    2005-12-01

    Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with diverse manifestations. We suggest that intravenous immunoglobulin (IVIg) therapy may be beneficial and safe for various manifestations in SLE. A structured literature search of articles published on the efficacy of IVIg in the treatment of SLE between 1983 and 2005 was conducted. We searched the terms "IVIg," "intravenous immunoglobulin," "lupus," "SLE," and "systemic lupus erythematosus." The various clinical manifestations of SLE that were reported to be successfully treated by IVIg in case reports include autoimmune hemolytic anemia, acquired factor VIII inhibitors, acquired von Willebrand disease, pure red cell aplasia, thrombocytopenia, pancytopenia, myelofibrosis, pneumonitis, pleural effusion, pericarditis, myocarditis, cardiogenic shock, nephritis, end-stage renal disease, encephalitis, neuropsychiatric lupus, psychosis, peripheral neuropathy, polyradiculoneuropathy, and vasculitis. The most extensive experience is with lupus nephritis. There are only a few case series of IVIg use in patients with SLE with various manifestations, in which the response rate to IVIg therapy ranged from 33 to 100%. We suggest that IVIg devoid of sucrose, at a dose of 2 g/kg over a 5-d period given uniformly and at a slow infusion rate in patients without an increased risk for thromboembolic events or renal failure, is a safe and beneficial adjunct therapy for cases of SLE that are resistant to or refuse conventional treatment. The duration of therapy is yet to be established. Controlled trials are warranted.

  1. High-intensity-focused-ultrasound (HIFU) induced homeostasis and tissue ablation

    Science.gov (United States)

    Chauhan, Sunita; Michel, M. S.; Alken, Peter; Kohrmann, K. U.; Haecker, Axel

    2003-06-01

    At high intensity levels, ultrasound energy focused into remote tissue targets in human body has shown to produce thermal necrosis in circumscribed regions with sub-millimeter accuracy. The non-invasive modality known as HIFU has enormous potential for thermal ablation of cancers/tumors of the human body without any adverse effects in the surrounding normal tissue. In this paper, empirical results for parametric assessment and interdependence of several exposure variables are presented for producing thermal necrosis as well as hemostasis. Multiple HIFU transducers in selective spatial configuration have been deployed using a suitably designed experiemntal harness, with and without motorized jig scanning. The pre-planning and on-line procedure for treatment and specified instrumentation is described. Custom designed 25mm aperture HIFU probes resonating at 2 MHz focused at 64 and 80 mm are used. Results have been obtained in ex-vivo animal tissue and in vitro biological phantoms for hemostasis.

  2. High-intensity focused ultrasound (HIFU) for pancreatic carcinoma: evaluation of feasibility, reduction of tumour volume and pain intensity.

    Science.gov (United States)

    Marinova, Milka; Rauch, Maximilian; Mücke, Martin; Rolke, Roman; Gonzalez-Carmona, Maria A; Henseler, Jana; Cuhls, Henning; Radbruch, Lukas; Strassburg, Christian P; Zhang, Lian; Schild, Hans H; Strunk, Holger M

    2016-11-01

    Prognosis of patients with locally advanced pancreatic adenocarcinoma is extremely poor. They often suffer from cancer-related pain reducing their quality of life. This prospective observational study aimed to evaluate feasibility, local tumour response, and changes in quality of life and symptoms in Caucasian patients with locally advanced pancreatic cancer treated by ultrasound-guided high-intensity focused ultrasound (HIFU). Thirteen patients underwent HIFU, five with stage III, eight with stage IV UICC disease. Ten patients received simultaneous palliative chemotherapy. Postinterventional clinical assessment included evaluation of quality of life and symptom changes using standardized questionnaires. CT and MRI follow-up evaluated the local tumour response. HIFU was successfully performed in all patients. Average tumour reduction was 34.2 % at 6 weeks and 63.9 % at 3 months. Complete or partial relief of cancer-related pain was achieved in 10 patients (77 %), five of whom required less analgesics for pain control. Quality of life was improved revealing increased global health status and alleviated symptoms. HIFU treatment was well tolerated. Eight patients experienced transient abdominal pain directly after HIFU. HIFU ablation of pancreatic carcinoma is a feasible, safe and effective treatment with a crucial benefit in terms of reduction of tumour volume and pain intensity. • US-guided HIFU is feasible and safe for patients with unresectable pancreatic cancer. • HIFU can considerably reduce tumour volume and cancer-related pain. • Patients treated with HIFU experienced significant and lasting reduction of pain intensity. • HIFU has a crucial clinical benefit for patients with pancreatic cancer.

  3. Characterization of HIFU ablation using DNA fragmentation labeling as apoptosis stain

    Science.gov (United States)

    Anquez, Jeremie; Corréas, Jean-Michel; Pau, Bernard; Lacoste, François; Yon, Sylvain

    2012-11-01

    The goal of this work was to compare modalities to precisely quantify the extent of thermally induced lesions: gross pathology vs. histopathology vs. devascularization. Liver areas of 14 rabbits were targeted with HIFU and RF ablations in an acute study. Contrast enhanced computorized tomography (CE-CT) scan images were acquired two hours after HIFU and RF treatment to obtain the devascularized volumes of the livers. The animals were then euthanized and deep frozen. The livers were sliced and each slice was photographed and stacked yielding a volume of gross pathology. The volume VGP of the HIFU lesions were derived. The area AGP of the lesions were computed on a particular slice. The lesions were segmented as hypo intense (devascularized) regions on CE-CT images and their volumes VC were computed. The ratios VC/VGP were computed for all the HIFU lesions on all the 14 subjects with a mean value of 1.2. Histology was performed on the livers using Hematoxyline Eosine Staining (HES) and DNA Fragmentation labeling (TUNEL® technology) which characterizes apoptosis. Apoptotic regions of area AT were segmented on the images stained by TUNEL®. No necrosis was identified on the HES data. While TUNEL® did not mark the cores of the RF lesions as apoptotic, the periphery of HIFU and RF lesions was always recognized with TUNEL® as apoptotic. The ratio AGP/AT was computed. The mean value was 0.95 and 0.25 for HIFU and RF lesions respectively. These findings show that the devascularized territory seen on CE-CT scan coincide with the coagulated territories seen with gross pathology. Those actually correspond to cells in apoptosis. It is confirmed that HES stain does not show necrosis 2 hours after thermal ablation. TUNEL® technology for DNA fragmentation labeling appears as a useful marker for thermally induced acute lesions in the liver.

  4. Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer.

    Science.gov (United States)

    Kuru, Timur H; van Essen, Julius; Pfister, David; Porres, Daniel

    2015-01-01

    Overtreatment of prostate cancer (PC) remains one of the main burdens in uro-oncology. Focal therapy may be a reasonable alternative with less side effects and morbidity. Application of high-intensity focused ultrasound (HIFU) induces immediate and irreversible coagulation. The treatment leads to consecutive necrosis with sharply delineated margins, making HIFU a promising tool for the focal therapy of localized PC. Unlike radiation, the treatment leaves no collateral damage outside of the heated tissue, allowing repeated use of HIFU, if necessary. In case of non-organ-confined relapse, additional radical salvage therapy can be performed. This review gives an overview of the existing evidence on focal HIFU. Today, 3 HIFU devices are approved for the treatment of localized PC: Sonablate™, Ablatherm™ and the FocalOne™ device. In summary, the first published results of focal HIFU are promising. The quality of life and potency of the patients are well preserved. Therefore, HIFU treatment, and especially focal ablation of tumor foci, seems to be a safe alternative to standard treatment, with low side effects. The oncologic results seem satisfactory but need further follow-up to validate this practice of PC control. © 2015 S. Karger GmbH, Freiburg.

  5. T2-based temperature monitoring in trabecular bone marrow for MRgHIFU

    Science.gov (United States)

    Ozhinsky, Eugene; Han, Misung; Krug, Roland; Rieke, Viola

    2017-03-01

    Current clinical protocols for HIFU treatment of painful bone metastases rely on measurement of temperature change of adjacent muscle to estimate the temperature of the bone. In this study, we investigated if T2-based temperature mapping could be used to determine the temperature within ex vivo trabecular bone during HIFU ablation. We have shown that T2-based ablation monitoring in the red marrow in trabecular bone is feasible. The linear relationship between T2 change and temperature could be used to quantify the temperature during heating of up to 60°C.

  6. TU-G-210-01: Modeling for Breast and Brain HIFU Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Christensen, D. [University of Utah (United States)

    2015-06-15

    Modeling can play a vital role in predicting, optimizing and analyzing the results of therapeutic ultrasound treatments. Simulating the propagating acoustic beam in various targeted regions of the body allows for the prediction of the resulting power deposition and temperature profiles. In this session we will apply various modeling approaches to breast, abdominal organ and brain treatments. Of particular interest is the effectiveness of procedures for correcting for phase aberrations caused by intervening irregular tissues, such as the skull in transcranial applications or inhomogeneous breast tissues. Also described are methods to compensate for motion in targeted abdominal organs such as the liver or kidney. Douglas Christensen – Modeling for Breast and Brain HIFU Treatment Planning Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Tobias Preusser – TRANS-FUSIMO – An Integrative Approach to Model-Based Treatment Planning of Liver FUS Learning Objectives: Understand the role of acoustic beam modeling for predicting the effectiveness of therapeutic ultrasound treatments. Apply acoustic modeling to specific breast, liver, kidney and transcranial anatomies. Determine how to obtain appropriate acoustic modeling parameters from clinical images. Understand the separate role of absorption and scattering in energy delivery to tissues. See how organ motion can be compensated for in ultrasound therapies. Compare simulated data with clinical temperature measurements in transcranial applications. Supported by NIH R01 HL172787 and R01 EB013433 (DC); EU Seventh Framework Programme (FP7/2007-2013) under 270186 (FUSIMO) and 611889 (TRANS-FUSIMO)(TP); and P01 CA159992, GE, FUSF and InSightec (UV)

  7. Testosterone Replacement Therapy and the Cardiovascular System.

    Science.gov (United States)

    Naderi, Sahar

    2016-04-01

    As testosterone replacement therapy (TRT) has emerged as a commonly prescribed therapy for symptomatic low testosterone, conflicting data have been reported in terms of both its efficacy and potential adverse outcomes. One of the most controversial associations has been that of TRT and cardiovascular morbidity and mortality. This review briefly provides background on the history of TRT, the indications for TRT, and the data behind TRT for symptomatic low testosterone. It then specifically delves into the rather limited data for cardiovascular outcomes of those with low endogenous testosterone and those who receive TRT. The available body of literature strongly suggests that more work, by way of clinical trials, needs to be done to better understand the impact of testosterone and TRT on the cardiovascular system.

  8. 21 CFR 892.5750 - Radionuclide radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radionuclide radiation therapy system. 892.5750... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5750 Radionuclide radiation therapy system. (a) Identification. A radionuclide radiation therapy system is a device intended to permit an...

  9. 21 CFR 892.5840 - Radiation therapy simulation system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiation therapy simulation system. 892.5840... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5840 Radiation therapy simulation system. (a) Identification. A radiation therapy simulation system is a fluoroscopic or radiographic x-ray...

  10. HIFU e nanobolle di ossigeno: due differenti approcci per il trattamento del cancro - HIFU and oxygen load nanobubbles:two different approches for cancer treatment

    Directory of Open Access Journals (Sweden)

    Chiara Magnetto

    2015-07-01

    Full Text Available L’utilizzo di ultrasuoni focalizzati ad alta intensità (HIFU ha ottenuto un rapido consenso in ambito clinico come strumento chirurgico non invasivo per l’ablazione di cellule tumorali. L’impiego di tale tecnologia, applicata simultaneamente a nano-bolle riempite di ossigeno (OLN, realizzate e caratterizzate presso l’INRiM e volte a trattare patologie associate all’ipossia (come i tumori, costituiscono un innovativo strumento terapeutico per la cura del cancro proposto in questo lavoro. ---------- Use of high intensity focused ultrasound (HIFU beam has gained rapid agreement in clinical environment as a tool for non-invasive surgical ablation of tumor cells. This technology, applied simultaneously to nano-bubbles filled with oxygen (OLN, realized and characterized at INRiM with the purpose of treating diseases associated to hypoxia (such as tumors, constitute an innovative therapeutic tool for cancer treatment proposed in this article.

  11. Laser puncture therapy of nervous system disorders

    Energy Technology Data Exchange (ETDEWEB)

    Anishchenko, G.; Kochetkov, V.

    1984-08-29

    The authors discuss experience with treatment of nervous system disorders by means of laser-puncture therapy. Commenting on the background of the selection of this type of treatment, they explain that once researchers determined the biological action of laser light on specific nerve receptors of the skin, development of laser apparatus capable of concentrating the beam in the millimeter band was undertaken. The devices that are being used for laser-puncture are said to operate in the red helium-neon band of light. The authors identify beam parameters that have been selected for different groups of acupuncture points of the skin, and the courses of treatment (in seconds of radiation) and their time intervals. They go on to discuss the results of treatment of over 800 patients categorized in a group with disorders of the peripheral nervous system and a second group with disorders of the central nervous system.

  12. MRI-guided HIFU methods for the ablation of liver and renal cancers

    NARCIS (Netherlands)

    Denis de Senneville, Baudouin; Moonen, Chrit; Ries, Mario

    2016-01-01

    MRI-guided High Intensity Focused Ultrasound (MRI-HIFU) is a promising method for the non-invasive ablation of pathological tissue in many organs, including mobile organs such as liver and kidney. The possibility to locally deposit thermal energy in a non-invasive way opens a path towards new

  13. Initial Experience with the Extracorporeal HIFU Knife with 49 Patients: Japanese Experience

    Science.gov (United States)

    Ganaha, F.; Okuno, T.; Lee, C. O.; Shimizu, T.; Osako, K.; Oka, S.; Lee, K. H.; Chen, W. Z.; Zhu, H.; Park, S. H.; Qi, Z.; Shi, D.; Song, H. S.

    2005-03-01

    Forty nine patients with 63 tumours were treated with the Chongqing Haifu knife, as an adjunct to intra-arterial chemoinfusion. Treatment targets included breast (20 lesions), liver (16), bone (8), lymph-node (6), soft tissue (4), lung and pleura (4), pancreas (2), kidney (2) and adrenal gland (1). Follow-up contrast MRI was performed at 3 weeks to assess the effects of HIFU ablation. All cases completed the planned treatment. Of 25 lesions treated with the intention of complete tumour ablation, complete necrosis was obtained in 19 lesions (76%) including 4 secondary success cases. Among 32 lesions having partial and palliative treatment, tumour size was decreased in 6 lesions (21%), and good pain control was obtained in 6 out of 7 patients (86%). Skin injury was the most common complication after HIFU (16%), and was mostly a superficial dermal burn that did not necessitate any treatment. However, there was one patient with deep skin injury at an operation scar which resulted in skin perforation. Other adverse events included soft tissue swelling, prolonged fever, anorexia, persistent pain, shortness of the breath, sacroiliac joint fracture and prolonged diarrhoea. In our limited experience, superficial lesions (e.g. breast cancer, bone, soft tissue, lymph-node and pleural metastasis) appear to be good candidates for HIFU treatment. There appears to be a role for the HIFU knife in pain control for patients with bone metastasis and pancreatic cancer.

  14. Object detection in ultrasound elastography for use in HIFU treatment of cancer

    Science.gov (United States)

    Huang, Alex; Mankani, Soumya; Choo, Chang

    2014-03-01

    High intensity focused ultrasound (HIFU), has applications in treating various cancers, such as prostate, liver and breast cancer. In order for HIFU to be effective and efficient it needs to be guided by an imaging modality. While there are several options for guiding HIFU treatment, one of the most promising is ultrasound elastography. Current commercial devices use Brightness-Mode (B-mode) imaging or MRI, and are manual processes. Ultrasound elastography, allows complete automation of HIFU treatment due to the enhanced image, that elastography provides. The elastic image provides more information and less noise. To show that segmentation was possible on elastic images, nine algorithms were implemented in matlab and used on three distinct images for object detection. The three images used, have varying properties regarding object intensity and placement, as well as different noise patterns. Using PSNR, to gauge the effectiveness of each algorithm, it was shown that segmentation was possible on all images using different algorithms. The bilateral-shock-bilateral algorithm proved to be an overall effective algorithm in every situation with a PSNR of 83.87db on the phantom image. The segmentation results clearly highlight any object in the images. Future work includes fine tuning the algorithm with different phantom images and in-vivo images to distinguish between noise and desired object.

  15. Epidermal electronic systems for sensing and therapy

    Science.gov (United States)

    Lu, Nanshu; Ameri, Shideh K.; Ha, Taewoo; Nicolini, Luke; Stier, Andrew; Wang, Pulin

    2017-04-01

    Epidermal electronic system is a class of hair thin, skin soft, stretchable sensors and electronics capable of continuous and long-term physiological sensing and clinical therapy when applied on human skin. The high cost of manpower, materials, and photolithographic facilities associated with its manufacture limit the availability of disposable epidermal electronics. We have invented a cost and time effective, completely dry, benchtop "cut-and-paste" method for the green, freeform and portable manufacture of epidermal electronics within minutes. We have applied the "cut-and-paste" method to manufacture epidermal electrodes, hydration and temperature sensors, conformable power-efficient heaters, as well as cuffless continuous blood pressure monitors out of metal thin films, two-dimensional (2D) materials, and piezoelectric polymer sheets. For demonstration purpose, we will discuss three examples of "cut-and-pasted" epidermal electronic systems in this paper. The first will be submicron thick, transparent epidermal graphene electrodes that can be directly transferred to human skin like a temporary transfer tattoo and can measure electrocardiogram (ECG) with signal-to-noise ratio and motion artifacts on par with conventional gel electrodes. The second will be a chest patch which houses both electrodes and pressure sensors for the synchronous measurements of ECG and seismocardiogram (SCG) such that beat-to-beat blood pressure can be inferred from the time interval between the R peak of the ECG and the AC peak of the SCG. The last example will be a highly conformable, low power consumption epidermal heater for thermal therapy.

  16. Compact superconducting synchrocyclotron systems for proton therapy

    Science.gov (United States)

    Blosser, H. G.

    1989-04-01

    Conventional room temperature synchrocyclotrons are widely used as a source for medical proton beams. If the synchrocyclotron is changed to a superconducting design, weight is reduced more than tenfold and the resulting accelerator is beautifully compact and of moderate cost. Engineering studies indicate that the traditional reliability of the synchrocyclotron will not be impinged by the change to a much smaller structure. Design studies for 70 and 250 MeV systems have been made. The 70 MeV machine would be a stond-alone facility for eye treatment, whereas the 250 MeV unit is for general, anywhere-in-the-body proton therapy. The 250 MeV machine is small enough to permit the option of directly mounting the cyclotron on an isocentric gantry, thereby greatly reducing the complexity of the beam transport system.

  17. Effects of oxytocin on high intensity focused ultrasound (HIFU) ablation of adenomysis: A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Xin [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Zou, Min; Zhang, Cai [Department of Obstetrics and Gynecology, Chongqing Haifu Hospital, Chongqing 401121 (China); He, Jia [Department of Obstetrics and Gynecology, Suining Central Hospital, Sichuan 629000 (China); Mao, Shihua [Department of Obstetrics and Gynecology, Three Gorges Central Hospital, Chongqing 404000 (China); Wu, Qingrong [Department of Obstetrics and Gynecology, Fuling Central Hospital, Chongqing 408099 (China); He, Min [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Department of Obstetrics and Gynecology, Suining Central Hospital, Sichuan 629000 (China); Wang, Jian [Department of Obstetrics and Gynecology, Chongqing Haifu Hospital, Chongqing 401121 (China); Department of Obstetrics and Gynecology, Three Gorges Central Hospital, Chongqing 404000 (China); Zhang, Ruitao [Department of Obstetrics and Gynecology, Chongqing Haifu Hospital, Chongqing 401121 (China); Department of Obstetrics and Gynecology, Fuling Central Hospital, Chongqing 408099 (China); Zhang, Lian, E-mail: lianwzhang@yahoo.com [State Key Laboratory of Ultrasound Engineering in Medicine Co-founded by Chongqing and the Ministry of Science and Technology, Chongqing Key laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016 (China); Department of Obstetrics and Gynecology, Chongqing Haifu Hospital, Chongqing 401121 (China)

    2014-09-15

    Objective: To investigate the effects of oxytocin on high-intensity focused ultrasound (HIFU) ablation for the treatment of adenomyosis. Materials and methods: Eighty-six patients with adenomyosis from three hospitals were randomly assigned to the oxytocin group or control group for HIFU treatment. During HIFU treatment, 80 units of oxytocin was added in 500 ml of 0.9% normal saline running at the rate of 2 ml/min (0.32 U/min) in the oxytocin group, while 0.9% normal saline was used in the control group. Both patients and HIFU operators were blinded to oxytocin or saline application. Treatment results, adverse effects were compared. Results: When using oxytocin, the non-perfused volume (NPV) ratio was 80.7 ± 11.6%, the energy-efficiency factor (EEF) was 8.1 ± 9.9 J/mm{sup 3}, and the sonication time required to ablate 1 cm{sup 3} was 30.0 ± 36.0 s/cm{sup 3}. When not using oxytocin, the non-perfused volume ratio was 70.8 ± 16.7%, the EEF was 15.8 ± 19.6 J/mm{sup 3}, and the sonication time required to ablate 1 cm{sup 3} was 58.2 ± 72.7 S/cm{sup 3}. Significant difference in the NPV ratio, EEF, and the sonication time required to ablate 1 cm{sup 3} between the two groups was observed. No oxytocin related adverse effects occurred. Conclusion: Oxytocin could significantly decrease the energy for ablating adenomyosis with HIFU, safely enhance the treatment efficiency.

  18. Effects of oxytocin on high intensity focused ultrasound (HIFU) ablation of adenomysis: a prospective study.

    Science.gov (United States)

    Zhang, Xin; Zou, Min; Zhang, Cai; He, Jia; Mao, Shihua; Wu, Qingrong; He, Min; Wang, Jian; Zhang, Ruitao; Zhang, Lian

    2014-09-01

    To investigate the effects of oxytocin on high-intensity focused ultrasound (HIFU) ablation for the treatment of adenomyosis. Eighty-six patients with adenomyosis from three hospitals were randomly assigned to the oxytocin group or control group for HIFU treatment. During HIFU treatment, 80 units of oxytocin was added in 500ml of 0.9% normal saline running at the rate of 2ml/min (0.32U/min) in the oxytocin group, while 0.9% normal saline was used in the control group. Both patients and HIFU operators were blinded to oxytocin or saline application. Treatment results, adverse effects were compared. When using oxytocin, the non-perfused volume (NPV) ratio was 80.7±11.6%, the energy-efficiency factor (EEF) was 8.1±9.9J/mm(3), and the sonication time required to ablate 1cm(3) was 30.0±36.0s/cm(3). When not using oxytocin, the non-perfused volume ratio was 70.8±16.7%, the EEF was 15.8±19.6J/mm(3), and the sonication time required to ablate 1cm(3) was 58.2±72.7S/cm(3). Significant difference in the NPV ratio, EEF, and the sonication time required to ablate 1cm(3) between the two groups was observed. No oxytocin related adverse effects occurred. Oxytocin could significantly decrease the energy for ablating adenomyosis with HIFU, safely enhance the treatment efficiency. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Pilot study of high-intensity focused ultrasound ablation as a bridging therapy for hepatocellular carcinoma patients wait-listed for liver transplantation.

    Science.gov (United States)

    Chok, Kenneth S H; Cheung, Tan To; Lo, Regina C L; Chu, Ferdinand S K; Tsang, Simon H Y; Chan, Albert C Y; Sharr, William W; Fung, James Y Y; Dai, Wing Chiu; Chan, See Ching; Fan, Sheung Tat; Lo, Chung Mau

    2014-08-01

    The objective of this study was to investigate the outcomes of high-intensity focused ultrasound (HIFU) ablation as a bridging therapy for patients with hepatocellular carcinoma (HCC) who had been wait-listed for deceased donor liver transplantation (DDLT). Adult patients with unresectable and unablatable HCCs within the University of California San Francisco criteria who had been wait-listed for DDLT were screened for their suitability for HIFU ablation as a bridging therapy if they were not suitable for transarterial chemoembolization (TACE). Treatment outcomes for patients receiving HIFU ablation, TACE, and best medical treatment (BMT) were compared. Fifty-one patients were included in the analysis. Before the introduction of HIFU ablation, only 39.2% of the patients had received bridging therapy (TACE only, n = 20). With HIFU ablation in use, the rate increased dramatically to 80.4% (TACE + HIFU, n = 41). The overall dropout rate was 51% (n = 26). Patients in the BMT group had a significantly higher dropout rate (P = 0.03) and significantly poorer liver function as reflected by higher Model for End-Stage Liver Disease scores and higher Child-Pugh grading. Clinically relevant ascites was found in 5 patients in the HIFU group and 2 patients in the BMT group, but none was found in the TACE group (P = 0.01 and P = 0.03, respectively). The TACE and HIFU groups had comparable percentages of tumor necrosis in excised livers (P = 0.35), and both were significantly higher than that in the BMT group (P = 0.01 and P = 0.02, respectively). In conclusion, HIFU ablation was safe even for HCC patients with Child-Pugh C disease. Its adoption increased the percentage of patients receiving bridging therapy from 39.2% to 80.4%. A randomized controlled trial for further validation of its efficacy is warranted. © 2014 American Association for the Study of Liver Diseases.

  20. A 1-MHz 2-D CMUT array for HIFU thermal ablation

    Science.gov (United States)

    Yoon, Hyo-Seon; Vaithilingam, Srikant; Park, Kwan Kyu; Nikoozadeh, Amin; Firouzi, Kamyar; Choe, Jung Woo; Watkins, Ronald D.; Oguz, Huseyin Kagan; Kupnik, Mario; Pauly, Kim Butts; Khuri-Yakub, Pierre

    2017-03-01

    We developed a fully-populated 2-D capacitive micromachined ultrasonic transducer (CMUT) array for high intensity focused ultrasound (HIFU) treatment. The 2-D CMUT array, which consists of 20 × 20 square CMUT elements with an element-to-element pitch of 1 mm, was designed and fabricated using the thick-buried-oxide (BOX) fabrication process. It was then assembled on a custom interface board that can provide various array configurations depending on the desired applications. In this study, the interface board groups the CMUT array elements into eight channels, based on the phase delay from the element to the targeted focal point at a 20-mm distance from the array surface, which corresponds to an F-number of 1. An 8-channel phase generating system supplies continuous waves with eight different phases to the eight channels of the CMUT array through bias-tees and amplifiers. This array aperture, grouped into eight channels, gives a focusing gain of 6.09 according to field simulation using Field II. Assuming a peak-to-peak pressure of 1 MPa at the surface of the array, our custom temperature simulator predicts successful tissue ablation at the focus. During the measurements, each channel was tuned with a series inductor for an operational frequency of 1 MHz. With a CMUT DC bias of 100 V and a 1-MHz AC input voltage of 55 V, we achieved peak-to-peak output pressures of 173.9 kPa and 568.7 kPa at the array surface and at the focus, respectively. The focusing gain calculated from this measurement is 3.27, which is lower than the simulated gain of 6.09 because of the mutual radiation impedance among the CMUT cells. Further optimization of the operating condition of this array and design improvements for reducing the effect of mutual radiation impedance are currently on-going.

  1. Feasibility study of high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver.

    Science.gov (United States)

    Imankulov, S B; Fedotovskikh, G V; Shaimardanova, G M; Yerlan, M; Zhampeisov, N K

    2015-11-01

    This study evaluates the feasibility of using high intensity focused ultrasound (HIFU) for the treatment of hydatid cysts of the liver. HIFU ablation was carried out in 62 patients with echinococcosis of the liver. The mean age of patients was 40.76±14.84 (range: 17-72 years). The effectiveness of the treatment was monitored in real-time by changes in the gray-scale, and by morphological studies, computed tomography, magnetic resonance imaging, and ultrasound. Criteria for evaluating the effectiveness of treatment in real time were outlines. Cytomorphological picture of destructive changes of parasitic elements was presented as well. Loss of embryonic elements of the parasite was observed at the subcellular level after HIFU-ablation and underlines the effectiveness of HIFU. Copyright © 2015. Published by Elsevier B.V.

  2. [OPPORTUNITIES OF HIFU TECHNOLOGY FOR TREATMENT FIBROIDS DISEASES SUCH AS NON-INVASIVE AND ALTERNATIVE METHOD TO SURGERY].

    Science.gov (United States)

    Gincheva, D; Gorchev, G; Tomov, S

    2015-01-01

    Concepts of medical treatment are constantly evolving and improving. This opportunity provides treatment with High Intensity Focused Ultrasound (HIFU). In Europe and Asia more than 10,000 patients with uterine fibroids have been successfully treated with HIFU technology until now. This is completely innovative technology for non-invasive extracorporeal treatment of benign and malignant tumors. Neighboring healthy tissue is not damaged. The main indication in HIFU-Center in Pleven is uterine fibroid. It is the most common solid tumor in the female pelvis and is the leading cause of hysterectomy. The methods of treatment are hysterectomy, myomectomy or embolization of uterine arteries. HIFU-methodology allows non-invasive treatment of fibroids disease.

  3. Effect of hydrodynamic cavitation in the tissue erosion by pulsed high-intensity focused ultrasound (pHIFU)

    Science.gov (United States)

    Zhou, Yufeng; Gao, Xiaobin Wilson

    2016-09-01

    High-intensity focused ultrasound (HIFU) is emerging as an effective therapeutic modality in clinics. Besides the thermal ablation, tissue disintegration is also possible because of the interaction between the distorted HIFU bursts and either bubble cloud or boiling bubble. Hydrodynamic cavitation is another type of cavitation and has been employed widely in industry, but its role in mechanical erosion to tissue is not clearly known. In this study, the bubble dynamics immediately after the termination of HIFU exposure in the transparent gel phantom was captured by high-speed photography, from which the bubble displacement towards the transducer and the changes of bubble size was quantitatively determined. The characteristics of hydrodynamic cavitation due to the release of the acoustic radiation force and relaxation of compressed surrounding medium were found to associate with the number of pulses delivered and HIFU parameters (i.e. pulse duration and pulse repetition frequency). Because of the initial big bubble (~1 mm), large bubble expansion (up to 1.76 folds), and quick bubble motion (up to ~1 m s-1) hydrodynamic cavitation is significant after HIFU exposure and may lead to mechanical erosion. The shielding effect of residual tiny bubbles would reduce the acoustic energy delivered to the pre-existing bubble at the focus and, subsequently, the hydrodynamic cavitation effect. Tadpole shape of mechanical erosion in ex vivo porcine kidney samples was similar to the contour of bubble dynamics in the gel. Liquefied tissue was observed to emit towards the transducer through the punctured tissue after HIFU exposure in the sonography. In summary, the release of HIFU exposure-induced hydrodynamic cavitation produces significant bubble expansion and motion, which may be another important mechanism of tissue erosion. Understanding its mechanism and optimizing the outcome would broaden and enhance HIFU applications.

  4. Effect of hydrodynamic cavitation in the tissue erosion by pulsed high-intensity focused ultrasound (pHIFU).

    Science.gov (United States)

    Zhou, Yufeng; Gao, Xiaobin Wilson

    2016-09-21

    High-intensity focused ultrasound (HIFU) is emerging as an effective therapeutic modality in clinics. Besides the thermal ablation, tissue disintegration is also possible because of the interaction between the distorted HIFU bursts and either bubble cloud or boiling bubble. Hydrodynamic cavitation is another type of cavitation and has been employed widely in industry, but its role in mechanical erosion to tissue is not clearly known. In this study, the bubble dynamics immediately after the termination of HIFU exposure in the transparent gel phantom was captured by high-speed photography, from which the bubble displacement towards the transducer and the changes of bubble size was quantitatively determined. The characteristics of hydrodynamic cavitation due to the release of the acoustic radiation force and relaxation of compressed surrounding medium were found to associate with the number of pulses delivered and HIFU parameters (i.e. pulse duration and pulse repetition frequency). Because of the initial big bubble (~1 mm), large bubble expansion (up to 1.76 folds), and quick bubble motion (up to ~1 m s-1) hydrodynamic cavitation is significant after HIFU exposure and may lead to mechanical erosion. The shielding effect of residual tiny bubbles would reduce the acoustic energy delivered to the pre-existing bubble at the focus and, subsequently, the hydrodynamic cavitation effect. Tadpole shape of mechanical erosion in ex vivo porcine kidney samples was similar to the contour of bubble dynamics in the gel. Liquefied tissue was observed to emit towards the transducer through the punctured tissue after HIFU exposure in the sonography. In summary, the release of HIFU exposure-induced hydrodynamic cavitation produces significant bubble expansion and motion, which may be another important mechanism of tissue erosion. Understanding its mechanism and optimizing the outcome would broaden and enhance HIFU applications.

  5. Cancer in pregnancy: safety and efficacy of systemic therapies.

    Science.gov (United States)

    Boere, Ingrid; Lok, Christianne; Vandenbroucke, Tineke; Amant, Frédéric

    2017-09-01

    Cancer in pregnancy has become increasingly frequent. It has become clear that for specific cancers under well defined circumstances, oncological treatment in pregnancy can be well tolerated and feasible for both mother and fetus. Continued critical assessment of the available literature and registration of cancer in pregnancy cases and outcomes for mother and child are necessary to work toward implementing optimal cancer treatment during pregnancy. Physiologic changes in pregnancy may alter distribution and efficacy of systemic therapy. Data on systemic therapy including, chemotherapy, hormonal therapy, and targeted therapy during pregnancy are available but incomplete. Outcomes of fetuses exposed to chemotherapy in utero are generally reassuring, but new targeted therapies are mostly discouraged in pregnancy. Cancer treatment during pregnancy is possible, depending on type and timing of systemic therapy and treatment modality. Available data are reassuring with a modest increase in complications such as growth restriction and preterm birth. The effect of new targeted therapies is often still unclear and therefore discouraged.

  6. [Ozone therapy combined with sulfasalazine delivered via a colon therapy system for treatment of ulcerative colitis].

    Science.gov (United States)

    Geng, Yan; Wang, Wei; Ma, Qiang; Peng, Li-qiong; Liang, Zhong-hui

    2010-12-01

    To assess the therapeutic effect of ozone therapy combined with sulfasalazine sulfasalazine delivered via a colon therapy system in the treatment of distal ulcerative colitis. This prospective randomized controlled clinical trial involved 54 patients with mild to moderate active distal ulcerative colitis, who were randomize into 3 groups in accordance with the inclusion criteria (n=18). Each group was given sulfasalazine at the daily dose of 2 g, and in colon therapy group and ozone therapy plus sulfasalazine therapy group, sulfasalazine was delivered via a colon therapy system on a daily basis; the control group received sulfasalazine via retention enema only. At 0, 2, and 4 weeks of the treatment, colonoscopy was performed to evaluate the disease activity, and biopsy samples were obtained at 0 and 4 weeks for histological examination. In comparison with colon therapy group and control group, ozone therapy plus colon therapy resulted in more rapid alleviation of the clinical symptoms and better histological improvement without any adverse effects. Ozone therapy combined with sulfasalazine delivered via a colon therapy system is feasible and effective for treatment of ulcerative colitis.

  7. System engineering approach to planning anticancer therapies

    CERN Document Server

    Świerniak, Andrzej; Smieja, Jaroslaw; Puszynski, Krzysztof; Psiuk-Maksymowicz, Krzysztof

    2016-01-01

    This book focuses on the analysis of cancer dynamics and the mathematically based synthesis of anticancer therapy. It summarizes the current state-of-the-art in this field and clarifies common misconceptions about mathematical modeling in cancer. Additionally, it encourages closer cooperation between engineers, physicians and mathematicians by showing the clear benefits of this without stating unrealistic goals. Development of therapy protocols is realized from an engineering point of view, such as the search for a solution to a specific control-optimization problem. Since in the case of cancer patients, consecutive measurements providing information about the current state of the disease are not available, the control laws are derived for an open loop structure. Different forms of therapy are incorporated into the models, from chemotherapy and antiangiogenic therapy to immunotherapy and gene therapy, but the class of models introduced is broad enough to incorporate other forms of therapy as well. The book be...

  8. Hydrophone spatial directivity and the induced difference in HIFU acoustic field test

    Energy Technology Data Exchange (ETDEWEB)

    Chen, T; Zhang, D [Institute of Acoustics, Nanjing University, Nanjing 210093 (China); Hu, J M; Huang, W; Zhang, W, E-mail: Chent_qxs@jsfda.gov.cn [Jiangsu Province Institute for Medical Equipment Testing, Nanjing 210012 (China)

    2011-02-01

    Hydrophone has been widely used in testing ultrasonic field distribution. But the hydrophone has a certain directivity, which may bring error in the actual acoustic field measurements. So it is necessary to meet some requirements about the directivity of hydrophone. In the measurement, the spatial directivities of needle hydrophone, membrane hydrophone and robust hydrophone is measured and a comparison about measured data of HIFU acoustic field with them is given. Experimental results indicate that the asymmetric special directivity of hydrophone is due to manufacturing processes and other reasons. As a result, it is not sufficient to test the directivity of hydrophone along one axis. It is necessary to adjust the direction of the hydrophone when characterizing the HIFU field.

  9. High-Intensity Focused Ultrasound (HIFU) for the Treatment of Localized Prostate Cancer using Sonablate-500

    Science.gov (United States)

    Uchida, Toyoaki; Ohkusa, Hiroshi; Yamashita, Hideyuki; Nagata, Yoshihiro

    2005-03-01

    We evaluated 181 patients with localized prostate cancer treated with high-intensity focused ultrasound (HIFU) for biochemical disease-free rate, safety, morbidity and predictors of biochemical outcome. A total of 181 patients underwent HIFU with the Sonablate-500 and with at least 12 months of follow-up. Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The biochemical disease-free rates at 1, 3 and 5 years in all patients were 84%, 80% and 78%, respectively. The biochemical disease-free rates at 3 years for patients with pretreatment PSA less than 10 ng/ml, 10.01 to 20.0 ng/ml and more than 20.0 ng/ml were 94%, 75% and 35%, respectively (ppatients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/ml.

  10. TU-B-210-00: MR-Guided Focused Ultrasound Therapy in Oncology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    MR guided focused ultrasound (MRgFUS), or alternatively high-intensity focused ultrasound (MRgHIFU), is approved for thermal ablative treatment of uterine fibroids and pain palliation in bone metastases. Ablation of malignant tumors is under active investigation in sites such as breast, prostate, brain, liver, kidney, pancreas, and soft tissue. Hyperthermia therapy with MRgFUS is also feasible, and may be used in conjunction with radiotherapy and for local targeted drug delivery. MRI allows in situ target definition and provides continuous temperature monitoring and subsequent thermal dose mapping during HIFU. Although MRgHIFU can be very precise, treatment of mobile organs is challenging and advanced techniques are required because of artifacts in MR temperature mapping, the need for intercostal firing, and need for gated HIFU or tracking of the lesion in real time. The first invited talk, “MR guided Focused Ultrasound Treatment of Tumors in Bone and Soft Tissue”, will summarize the treatment protocol and review results from treatment of bone tumors. In addition, efforts to extend this technology to treat both benign and malignant soft tissue tumors of the extremities will be presented. The second invited talk, “MRI guided High Intensity Focused Ultrasound – Advanced Approaches for Ablation and Hyperthermia”, will provide an overview of techniques that are in or near clinical trials for thermal ablation and hyperthermia, with an emphasis of applications in abdominal organs and breast, including methods for MRTI and tracking targets in moving organs. Learning Objectives: Learn background on devices and techniques for MR guided HIFU for cancer therapy Understand issues and current status of clinical MRg HIFU Understand strategies for compensating for organ movement during MRgHIFU Understand strategies for strategies for delivering hyperthermia with MRgHIFU CM - research collaboration with Philips.

  11. Echo decorrelation imaging of ex vivo HIFU and bulk ultrasound ablation using image-treat arrays

    Science.gov (United States)

    Fosnight, Tyler R.; Hooi, Fong Ming; Colbert, Sadie B.; Keil, Ryan D.; Barthe, Peter G.; Mast, T. Douglas

    2017-03-01

    In this study, the ability of ultrasound echo decorrelation imaging to map and predict heat-induced cell death was tested using bulk ultrasound thermal ablation, high intensity focused ultrasound (HIFU) thermal ablation, and pulse-echo imaging of ex vivo liver tissue by a custom image-treat array. Tissue was sonicated at 5.0 MHz using either pulses of unfocused ultrasound (N=12) (7.5 s, 50.9-101.8 W/cm2 in situ spatial-peak, temporal-peak intensity) for bulk ablation or focused ultrasound (N=21) (1 s, 284-769 W/cm2 in situ spatial-peak, temporal-peak intensity and focus depth of 10 mm) for HIFU ablation. Echo decorrelation and integrated backscatter (IBS) maps were formed from radiofrequency pulse-echo images captured at 118 frames per second during 5.0 s rest periods, beginning 1.1 s after each sonication pulse. Tissue samples were frozen at -80˚C, sectioned, vitally stained, imaged, and semi-automatically segmented for receiver operating characteristic (ROC) analysis. ROC curves were constructed to assess prediction performance for echo decorrelation and IBS. Logarithmically scaled mean echo decorrelation in non-ablated and ablated tissue regions before and after electronic noise and motion correction were compared. Ablation prediction by echo decorrelation and IBS was significant for both focused and bulk ultrasound ablation. The log10-scaled mean echo decorrelation was significantly greater in regions of ablation for both HIFU and bulk ultrasound ablation. Echo decorrelation due to electronic noise and motion was significantly reduced by correction. These results suggest that ultrasound echo decorrelation imaging is a promising approach for real-time prediction of heat-induced cell death for guidance and monitoring of clinical thermal ablation, including radiofrequency ablation and HIFU.

  12. Numerical Study of Bubble Area Evolution During Acoustic Droplet Vaporization-Enhanced HIFU Treatment.

    Science.gov (United States)

    Xin, Ying; Zhang, Aili; Xu, Lisa X; Brian Fowlkes, J

    2017-09-01

    Acoustic droplet vaporization has the potential to shorten treatment time of high-intensity focused ultrasound (HIFU) while minimizing the possible effects of microbubbles along the propagation path. Distribution of the bubbles formed from the droplets during the treatment is the major factor shaping the therapeutic region. A numerical model was proposed to simulate the bubble area evolution during this treatment. Using a linear acoustic equation to describe the ultrasound field, a threshold range was defined that determines the amount of bubbles vaporized in the treated area. Acoustic parameters, such as sound speed, acoustic attenuation coefficient, and density, were treated as a function of the bubble size distribution and the gas void fraction, which were related to the vaporized bubbles in the medium. An effective pressure factor was proposed to account for the influence of the existing bubbles on the vaporization of the nearby droplets. The factor was obtained by fitting one experimental result and was then used to calculate bubble clouds in other experimental cases. Comparing the simulation results to these other experiments validated the model. The dynamic change of the pressure and the bubble distribution after exposure to over 20 pulses of HIFU are obtained. It is found that the bubble area grows from a grainlike shape to a "tadpole," with comparable dimensions and shape to those observed in experiments. The process was highly dynamic with the shape of the bubble area changing with successive HIFU pulses and the focal pressure. The model was further used to predict the shape of the bubble region triggered by HIFU when a bubble wall pre-exists. The results showed that the bubble wall helps prevent droplet vaporization on the distal side of the wall and forms a particularly shaped region with bubbles. This simulation model has predictive potential that could be beneficial in applications, such as cancer treatment, by parametrically studying conditions

  13. Non-touch, Quick Destruction of the Tracheal Occluding Balloon Using HIFU

    OpenAIRE

    OSAWA Shunsuke:筆頭著者; SATO Tomoo; YAMASHITA Hiromasa; MOCHIZUKI Takashi; KITAZUMI Gontaro; JANI Jacques; TOKI Akira; CHIBA Toshio

    2017-01-01

    The technique of fetal endoscopic tracheal occlusion (FETO) was developed to totally occlude the fetal trachea using an intratracheal balloon in the treatment of congenital diaphragmatic hernia with lung hypoplasia. To improve this approach, we developed a method for non-contact, rapid destruction of the balloon using high intensity focused ultrasound (HIFU), a specific balloon injection fluid, and euthanized rabbits (1kg). In an initial experiment (5rabbits), we inflated an intratracheal bal...

  14. Augmentation of HIFU-induced heating with fibers embedded in a phantom.

    Science.gov (United States)

    Labuda, Cecille Pemberton; Church, Charles C

    2011-03-01

    The effect of fibers on the rate of heat deposition in the focal region of high-intensity focused ultrasound (HIFU) beams was investigated. Nylon, stainless steel and copper fibers of diameters 0.23-0.25, 0.33 and 0.51-0.53 mm embedded in a phantom were exposed to HIFU. The total energy deposited was quantified by measuring the volumes of the lesions formed. The average volumes of the lesions normalized to the average volume of control lesions were 1.19±0.19, 1.43±0.19 and 2.67±0.21 for increasing nylon fiber diameter, indicating an augmented rate of heating. The maximum normalized volume of lesions at the metal fibers was 0.655. These results are consistent with the material properties, which suggest that the mechanism is increased acoustic absorption along with reduction of heat loss by the nylon fiber. The study supports the possibility of improving the efficacy of HIFU-induced hemostasis in vivo by use of a specially designed, nylon fiber-based medical appliance. Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

  15. Design of HIFU CMUT Arrays for Treatment of Liver and Renal Cancer

    Science.gov (United States)

    Wong, Serena H.; Ergun, Arif Sanli; Yaralioglu, Goksen G.; Oralkan, Omer; Kupnik, Mario; Pauly, Kim Butts; Khuri-Yakub, B. T.

    2007-05-01

    We present the development of a capacitive micromachined ultrasonic transducer (CMUT) array for noninvasive focused ultrasound ablation of lower abdominal cancers under MR-guidance. While piezoelectric transducers have been traditionally used for HIFU, recent advances in CMUT design have made them highly competitive. Not only are CMUTs cost effective, they allow fabrication flexibility and advantages in efficiency and bandwidth. Current imaging CMUTs have shown capability of HIFU operation through high power and continuous wave operation. In this paper, we will present the development of CMUT membranes designed specifically for HIFU. These membranes are piston-like membranes fabricated by placing a thick layer of silicon or gold at the center of the membrane. The width of the piston layer is usually 60-85% of the membrane width and allows the membrane mass and elasticity to be controlled independently. It also increases the average displacement and average output pressure of the membrane. We patterned these CMUT membranes into an 8 element, 3.5 cm concentric array. We simulated the heating patterns of this array to show it is capable of producing lesions of 5 mm in diameter within 20-30 seconds, which can be imaged using our MR detection software.

  16. Rapid 3D human ribcage and kidney modeling for transcostal HIFU surgery

    Science.gov (United States)

    Cao, Rui; Gao, Jing; Melzer, Andreas; Nabi, Ghulam; Huang, Zhihong

    2012-11-01

    A rapid modeling technique for constructing human ribcage and kidney models for high intensity focused ultrasound through the ribcage is proposed and tested. In this study, a 3D model reconstructed from a patient's CT images provides solutions for the conversion of 3D image data into multi-part volumetric models of kidney and ribcage. The model was imported into PZFlex for simulation of acoustic field analysis. Tissue mimicking materials for the phantom were selected based on the acoustic characterisation result. The effect of the ribcage on HIFU sonication and acoustic pressure distribution were measured in the focal plane. Porcine ribcage sample was used in experiments for comparison. Results showed that with the presence of the ribcage phantom, the maximum temperature at the focus was reduced by approximately 60-70% and the maximum pressure at the focal zone was halved. Focus splitting with the ribcage in place was demonstrated both in experiments and simulations. The development of this model provides basis for using patient's data for transcostal HIFU research and maximise the efficiency of the HIFU surgery.

  17. Modeling HMI measurement of HIFU lesion formation with temperature-dependent tissue properties

    Science.gov (United States)

    Draudt, Andrew B.; Cleveland, Robin O.

    2012-10-01

    Monitoring tissue stiffness changes during HIFU lesion formation may be possible by measuring the motion induced by the amplitude-modulation of the HIFU beam. As a lesion forms both the stiffness and the acoustic absorption increase. Nominally the increase in tissue stiffness results in less motion, whilst the increase in acoustic absorption results in more forcing and hence more displacement. To investigate whether these two effects cancel out, a finite element model was developed which allowed the temperature dependence of absorption and shear modulus to affect the simultaneous evolution of the acoustic, thermal, and displacement fields. For the displacement the tissue surface was assumed to be in contact with water and was therefore free to move. Measurements of bovine liver and chicken breast indicated that after lesion formation attenuation increased by 200-500% and stiffness increased by 230% for chicken, and by a factor of 40 for liver. The model results showed that, until the lesion grew well outside of the focal region, the increase in attenuation dominated and the displacement increased by 30% after lesion formation. Experimental measurement of displacement vs depth in excised bovine liver and chicken breast subject to 1.1 MHz HIFU were consistent with the predictions of the model. However, sample-to-sample variation in displacement was greater than the predicted change due to lesion formation, suggesting that changes may be difficult to detect in practice. [Work supported in part by NSF through award EEC-9986821

  18. 10 CFR 35.457 - Therapy-related computer systems.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Therapy-related computer systems. 35.457 Section 35.457 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.457 Therapy-related computer systems. The licensee shall perform acceptance testing on the treatment planning...

  19. A review of immune therapy in cancer and a question: can thermal therapy increase tumor response?

    Science.gov (United States)

    Bull, Joan M C

    2017-11-03

    Immune therapy is a successful cancer treatment coming into its own. This is because checkpoint molecules, adoptive specific lymphocyte transfer and chimeric antigen T-cell (CAR-T) therapy are able to induce more durable responses in an increasing number of malignancies compared to chemotherapy. In addition, immune therapies are able to treat bulky disease, whereas standard cytotoxic therapies cannot treat large tumour burdens. Checkpoint inhibitor monoclonal antibodies are becoming widely used in the clinic and although more complex, adoptive lymphocyte transfer and CAR-T therapies show promise. We are learning that there are nuances to predicting the successful use of the checkpoint inhibitors as well as to specific-antigen adoptive and CAR-T therapies. We are also newly aware of a here-to-fore unrealised natural force, the status of the microbiome. However, despite better understanding of mechanisms of action of the new immune therapies, the best responses to the new immune therapies remain 20-30%. Likely the best way to improve this somewhat low response rate for patients is to increase the patient's own immune response. Thermal therapy is a way to do this. All forms of thermal therapy, from fever-range systemic thermal therapy, to high-temperature HIFU and even cryotherapy improve the immune response pre-clinically. It is time to test the immune therapies with thermal therapy in vivo to test for optimal timing of the combinations that will best enhance tumour response and then to begin to test the immune therapies with thermal therapy in the clinic as soon as possible.

  20. Novel Viral Vector Systems for Gene Therapy

    Directory of Open Access Journals (Sweden)

    Daniel Stone

    2010-04-01

    Full Text Available Over the last three decades, interest in the field of gene therapy seems to have fluctuated between hot and cold. Encouraging pre-clinical and clinical data has demonstrated the potential of genetic therapies and yet setbacks in clinical trials have cast doubts in some minds over the clinical future of gene therapy [1-3]. In the last two years, a number of studies have demonstrated therapeutic benefits in clinical trials aimed towards specific monogenetic disorders [4-6], and this has brought renewed optimism to the field. [...

  1. Segmentation Method for Magnetic Resonance-Guided High-Intensity Focused Ultrasound Therapy Planning

    Directory of Open Access Journals (Sweden)

    A. Vargas-Olivares

    2017-01-01

    Full Text Available High-intensity focused ultrasound (HIFU is a minimally invasive therapy modality in which ultrasound beams are concentrated at a focal region, producing a rise of temperature and selective ablation within the focal volume and leaving surrounding tissues intact. HIFU has been proposed for the safe ablation of both malignant and benign tissues and as an agent for drug delivery. Magnetic resonance imaging (MRI has been proposed as guidance and monitoring method for the therapy. The identification of regions of interest is a crucial procedure in HIFU therapy planning. This procedure is performed in the MR images. The purpose of the present research work is to implement a time-efficient and functional segmentation scheme, based on the watershed segmentation algorithm, for the MR images used for the HIFU therapy planning. The achievement of a segmentation process with functional results is feasible, but preliminary image processing steps are required in order to define the markers for the segmentation algorithm. Moreover, the segmentation scheme is applied in parallel to an MR image data set through the use of a thread pool, achieving a near real-time execution and making a contribution to solve the time-consuming problem of the HIFU therapy planning.

  2. Minimally invasive local therapies for liver cancer.

    Science.gov (United States)

    Li, David; Kang, Josephine; Golas, Benjamin J; Yeung, Vincent W; Madoff, David C

    2014-12-01

    Primary and metastatic liver tumors are an increasing global health problem, with hepatocellular carcinoma (HCC) now being the third leading cause of cancer-related mortality worldwide. Systemic treatment options for HCC remain limited, with Sorafenib as the only prospectively validated agent shown to increase overall survival. Surgical resection and/or transplantation, locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments, providing improved survival outcomes for both primary and metastatic tumors. Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors. For patients with low volume disease, these therapies have now been established into consensus practice guidelines. This review highlights technical aspects and outcomes of commonly utilized, minimally invasive local therapies including laparoscopic liver resection (LLR), radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and stereotactic body radiation therapy (SBRT). In addition, the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.

  3. Presence in Virtual Reality Exposure Therapy Systems

    NARCIS (Netherlands)

    Ling, Y.

    2014-01-01

    Experiencing anxiety is essential for virtual reality exposure therapy (VRET) to be effective in curing patients suffering from anxiety disorders. However, some patients drop out in VRET due to the lack of feeling anxiety. Presence - which refers to the feeling of being in the virtual environment -

  4. Utility of adjuvant systemic therapy in melanoma.

    NARCIS (Netherlands)

    A.M.M. Eggermont (Alexander); A. Testori (Alessandro); J. Marsden (Jeremy); P. Hersey (Peter); I. Quirt (Ian); T. Petrella; H. Gogas (Helen); R.M. MacKie; A. Hauschild (Axel)

    2009-01-01

    textabstractThe lack of effective drugs in stage IV melanoma has impacted the effectiveness of adjuvant therapies in stage II/III disease. To date, chemotherapy, immunostimulants and vaccines have been used with minimal success. Interferon (IFN) has shown an effect on relapse-free survival (RFS) in

  5. Systemic therapy for patients with colorectal cancer

    DEFF Research Database (Denmark)

    Pfeiffer, Per; Qvortrup, Camilla; Tabernero, Josep

    2015-01-01

    and 10–15 % in stage III. Targeted therapy is not recommended in the adjuvant setting. Treatment options in patients with non- resectable CRC are based on the extent of disease (resectable/potential resectable/non-resectable) and symptoms. Surgery fi rst or chemotherapy fi rst in patients...

  6. EFFECTS OF ELECTROCONVULSIVE THERAPY ON CARDIOVASCULAR SYSTEM

    OpenAIRE

    CHAUDHARY, S; RAJURIA, SS

    1995-01-01

    Effects of electroconvulsive therapy on the pulse rate, blood pressure and electrocardiogram were studied in forty consecutive physically healthy inpatients undergoing ECT for their psychiatric disabilities. Tachycardia and elevated blood pressure occurred frequently. Sinus arrhythmias, atrial and ventricular premature beats and minor ST-T changes were also observed. All these changes reversed within thirty minutes.

  7. Harnessing Endogenous Systems for Cancer Therapy

    DEFF Research Database (Denmark)

    Klauber, Thomas Christopher Bogh

    In the recent decade, two strategies in particular have attracted attention due to the prospect of significantly improving cancer treatment: Gene silencing therapy and immunotherapy. Both strategies work by manipulating endogenous mechanisms and theoretically promise very strong effect on the dis......In the recent decade, two strategies in particular have attracted attention due to the prospect of significantly improving cancer treatment: Gene silencing therapy and immunotherapy. Both strategies work by manipulating endogenous mechanisms and theoretically promise very strong effect...... immunotherapy (Project II). Transfer into the clinic of therapies based on gene silencing by siRNA delivered by synthetic vectors has yet to happen. A major reason is the lack of efficiency in the delivery process, partly due to insufficient understanding of cellular uptake and processing of the si...... to the conventional PEIs. However, lipid conjugation did not sufficiently reduce the inherent toxicity associated with high molecular weight PEI, and lipid conjugation of bPEI did also not change the ability of bPEI to affect lysosomal pH as a function of time. In contrast to gene silencing therapy, cancer...

  8. Systemic family therapy can be manualized: research process and findings

    National Research Council Canada - National Science Library

    Pote, H; Stratton, P; Cottrell, D; Shapiro, D; Boston, P

    2003-01-01

    .... This can limit their validity and applicability to standard clinical practice. In addition, no manuals exist which reflect less structured forms of family therapy aimed at incorporating systemic, post...

  9. Ultrasound guided high intensity focused ultrasound (USgHIFU) ablation for uterine fibroids: Do we need the microbubbles?

    Science.gov (United States)

    Orsi, Franco; Monfardini, Lorenzo; Bonomo, Guido; Krokidis, Miltiadis; Della Vigna, Paolo; Disalvatore, Davide

    2015-05-01

    The aim of this study was to assess the safety and effectiveness of contrast-enhanced ultrasound (CEUS) on ultrasound guided high intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. Thirty-three patients (37 fibroids) were randomly assigned to two groups: group A (17 patients, 20 fibroids) in which CEUS was used before, during and after HIFU treatment, and group B (16 patients, 17 fibroids) in which CEUS was not administered at all. Follow-up including contrast-enhanced magnetic resonance imaging (MRI) and a clinical questionnaire was performed, and technical success, ablation efficacy, volume reduction and complications were assessed. Technical success was 100% in both groups. CEUS revealed residual enhancement in 40% of the patients in group A and the treatment was continued until the completion of ablation. MRI at 1 month after treatment revealed significant difference in the relative fibroid volume reduction rate between the two groups: 16.1% in group A versus 4.8%, in group B (p = 0.01). There was no statistically significant relative volume reduction rate for the results at 3, 6 and 12 months and no significant changes in the quality of life results or the complication rate. CEUS was safe and effective in enhancing US guidance during HIFU ablation of uterine fibroids. Moreover, the use of CEUS during HIFU sonication increased the ablation efficacy, leading to a more relevant fibroid volume reduction at 1 and 3 months. This gap disappeared after 6 months, when there were no differences between the two groups of patients at MRI. However, in our experience, USgHIFU represented a very effective method for the treatment of uterine fibroids, and the use of CEUS during HIFU procedure reduced the treatment time and treatment repetitions for incomplete fibroid ablation.

  10. Liquid-solid phase-inversion PLGA implant for the treatment of residual tumor tissue after HIFU ablation.

    Directory of Open Access Journals (Sweden)

    Juan Li

    Full Text Available HIFU has been shown to be a more suitable alternative for the treatment of primary solid tumors and metastatic diseases than other focal heat ablation techniques due to its noninvasive and extracorporeal nature. However, similar to other focal heat ablation techniques, HIFU is still in need of refinements due to tumor recurrence.In this work, we investigated the effectiveness of an adjunct treatment regimen using doxorubicin (DOX-loaded, injectable, in situ-forming, and phase-inverting PLGA as the second line of defense after HIFU ablation to destroy detrimental residual tumors and to prevent tumor recurrence. All of the statistical analyses were performed using the Statistical Package for the Social Sciences 18.0 (SPSS, Inc., Chicago, IL, USA, and p<0.05 was considered statistically significant. All of the results are presented as the means ± STDEV (standard deviation. For multiple comparisons, ANOVA (differences in tumor volumes, growth rates, apoptosis, proliferation indexes, and Bcl-2 and Bax protein levels was used when the data were normally distributed with homogenous variance, and rank sum tests were used otherwise. Once significant differences were detected, Student-t tests were used for comparisons between two groups.Our results revealed that DOX diffused beyond the ablated tissue regions and entered tumor cells that were not affected by the HIFU ablation. Our results also show that HIFU in concert with DOX-loaded PLGA led to a significantly higher rate of tumor cell apoptosis and a lower rate of tumor cell proliferation in the areas beyond the HIFU-ablated tissues and consequently caused significant tumor volume shrinkage (tumor volumes:0.26±0.1,1.09±0.76, and 1.42±0.9 cm3 for treatment, sham, and no treatment control, respectively.From these results, we concluded that the intralesional injection of DOX-loaded PLGA after HIFU ablation is significantly more effective than HIFU alone for the treatment of solid tumors.

  11. Cavitation enhances coagulated size during pulsed high-intensity focussed ultrasound ablation in an isolated liver perfusion system.

    Science.gov (United States)

    Zhao, Lu-Yan; Liu, Shan; Chen, Zong-Gui; Zou, Jian-Zhong; Wu, Feng

    2016-11-24

    To investigate whether cavitation enhances the degree of coagulation during pulsed high-intensity focussed ultrasound (HIFU) in an isolated liver perfusion system. Isolated liver was treated by pulsed HIFU or continuous-wave HIFU with different portal vein flow rates. The cavitation emission during exposure was recorded, and real-time ultrasound images were used to observe changes in the grey scale. The coagulation size was measured and calculated. HIFU treatment led to complete coagulation necrosis and total cell destruction in the target regions. Compared to exposure at a duty cycle (DC) of 100%, the mean volumes of lesions induced by 6 s exposure at DCs of 50% and 10% were significantly larger (P cavitation activity for the pulsed-HIFU (P > .05). For continuous-wave HIFU exposure, there was a significant decrease in the necrosis volume and cavitation activity for exposure times of 1, 2, 3, 4, and 6 s with increasing portal perfusion rates. Perfusion flow rates negatively influence cavitation activity and coagulation volume. Ablation is significantly enhanced during pulsed HIFU exposure compared with continuous-wave HIFU.

  12. Therapy Decision Support Based on Recommender System Methods

    Directory of Open Access Journals (Sweden)

    Felix Gräßer

    2017-01-01

    Full Text Available We present a system for data-driven therapy decision support based on techniques from the field of recommender systems. Two methods for therapy recommendation, namely, Collaborative Recommender and Demographic-based Recommender, are proposed. Both algorithms aim to predict the individual response to different therapy options using diverse patient data and recommend the therapy which is assumed to provide the best outcome for a specific patient and time, that is, consultation. The proposed methods are evaluated using a clinical database incorporating patients suffering from the autoimmune skin disease psoriasis. The Collaborative Recommender proves to generate both better outcome predictions and recommendation quality. However, due to sparsity in the data, this approach cannot provide recommendations for the entire database. In contrast, the Demographic-based Recommender performs worse on average but covers more consultations. Consequently, both methods profit from a combination into an overall recommender system.

  13. Therapy Decision Support Based on Recommender System Methods.

    Science.gov (United States)

    Gräßer, Felix; Beckert, Stefanie; Küster, Denise; Schmitt, Jochen; Abraham, Susanne; Malberg, Hagen; Zaunseder, Sebastian

    2017-01-01

    We present a system for data-driven therapy decision support based on techniques from the field of recommender systems. Two methods for therapy recommendation, namely, Collaborative Recommender and Demographic-based Recommender, are proposed. Both algorithms aim to predict the individual response to different therapy options using diverse patient data and recommend the therapy which is assumed to provide the best outcome for a specific patient and time, that is, consultation. The proposed methods are evaluated using a clinical database incorporating patients suffering from the autoimmune skin disease psoriasis. The Collaborative Recommender proves to generate both better outcome predictions and recommendation quality. However, due to sparsity in the data, this approach cannot provide recommendations for the entire database. In contrast, the Demographic-based Recommender performs worse on average but covers more consultations. Consequently, both methods profit from a combination into an overall recommender system.

  14. Drug Delivery Systems for Imaging and Therapy of Parkinson's Disease

    Science.gov (United States)

    Gunay, Mine Silindir; Ozer, A. Yekta; Chalon, Sylvie

    2016-01-01

    Background: Although a variety of therapeutic approaches are available for the treatment of Parkinson’s disease, challenges limit effective therapy. Among these challenges are delivery of drugs through the blood brain barier to the target brain tissue and the side effects observed during long term administration of antiparkinsonian drugs. The use of drug delivery systems such as liposomes, niosomes, micelles, nanoparticles, nanocapsules, gold nanoparticles, microspheres, microcapsules, nanobubbles, microbubbles and dendrimers is being investigated for diagnosis and therapy. Methods: This review focuses on formulation, development and advantages of nanosized drug delivery systems which can penetrate the central nervous system for the therapy and/or diagnosis of PD, and highlights future nanotechnological approaches. Results: It is esential to deliver a sufficient amount of either therapeutic or radiocontrast agents to the brain in order to provide the best possible efficacy or imaging without undesired degradation of the agent. Current treatments focus on motor symptoms, but these treatments generally do not deal with modifying the course of Parkinson’s disease. Beyond pharmacological therapy, the identification of abnormal proteins such as α-synuclein, parkin or leucine-rich repeat serine/threonine protein kinase 2 could represent promising alternative targets for molecular imaging and therapy of Parkinson's disease. Conclusion: Nanotechnology and nanosized drug delivery systems are being investigated intensely and could have potential effect for Parkinson’s disease. The improvement of drug delivery systems could dramatically enhance the effectiveness of Parkinson’s Disease therapy and reduce its side effects. PMID:26714584

  15. Dexamethasone-cyclophosphamide pulse therapy in systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Dhabhai Ravindra

    2005-01-01

    Full Text Available BACKGROUND AND AIMS: Therapy systemic lupus erythematosus (SLE has been generally discouraging. Methyl-prednisolone pulse therapy has been used for various connective tissue disorders. We used intravenous dexamethasone cyclophosphamide pulse therapy to treat SLE. METHODS: Fourteen patients (10 females and 4 males between the age of 15-48 years with definite or classical clinical criteria laid by American Rheumatism Association criteria were treated by Dexamethasone-Cyclophosphamide pulse (DCP therapy at our center. RESULTS: It was possible to induce a complete clinical remission with DCP therapy in most of the patients thereby offering them life free from disease and drugs. The side effects commonly observed with conventional daily dose regimen of corticosteroids were not present or were mild. CONCLUSIONS: Almost all patients had good response after 3-4 pulses to allow them a normal life style. Fever, malar rash and oral ulceration responded early but photosensitivity, discoid rash, alopecia and joint pains took some more time.

  16. Genetic therapy for the nervous system.

    Science.gov (United States)

    Bowers, William J; Breakefield, Xandra O; Sena-Esteves, Miguel

    2011-04-15

    Genetic therapy is undergoing a renaissance with expansion of viral and synthetic vectors, use of oligonucleotides (RNA and DNA) and sequence-targeted regulatory molecules, as well as genetically modified cells, including induced pluripotent stem cells from the patients themselves. Several clinical trials for neurologic syndromes appear quite promising. This review covers genetic strategies to ameliorate neurologic syndromes of different etiologies, including lysosomal storage diseases, Alzheimer's disease and other amyloidopathies, Parkinson's disease, spinal muscular atrophy, amyotrophic lateral sclerosis and brain tumors. This field has been propelled by genetic technologies, including identifying disease genes and disruptive mutations, design of genomic interacting elements to regulate transcription and splicing of specific precursor mRNAs and use of novel non-coding regulatory RNAs. These versatile new tools for manipulation of genetic elements provide the ability to tailor the mode of genetic intervention to specific aspects of a disease state.

  17. Melanoma patient imaging in the era of effective systemic therapies.

    Science.gov (United States)

    Stodell, M; Thompson, J F; Emmett, L; Uren, R F; Kapoor, R; Saw, R P M

    2017-08-01

    Imaging plays a critical role in the current multi-disciplinary management of patients with melanoma. It is used for primary disease staging, surgical planning, and surveillance in high-risk patients, and for monitoring the effects of systemic or loco-regional therapies. Several different imaging modalities have been utilised in the past. Contemporary imaging practises vary geographically depending on clinical guidelines, physician preferences, availability and cost. Targeted therapies and immunotherapies have revolutionised the treatment of patients with metastatic melanoma over the last few years. With this have come new patterns of disease that were not observed after conventional therapies, and new criteria to assess therapeutic responses. In this article we review the role of imaging for patients with melanoma in the era of effective systemic therapies and discuss likely future developments. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  18. Nonviral Delivery Systems For Cancer Gene Therapy: Strategies And Challenges.

    Science.gov (United States)

    Shim, Gayong; Kim, Dongyoon; Le, Quoc-Viet; Park, Gyu Thae; Kwon, Taekhyun; Oh, Yu-Kyoung

    2018-01-19

    Gene therapy has been receiving widespread attention due to its unique advantage in regulating the expression of specific target genes. In the field of cancer gene therapy, modulation of gene expression has been shown to decrease oncogenic factors in cancer cells or increase immune responses against cancer. Due to the macromolecular size and highly negative physicochemical features of plasmid DNA, efficient delivery systems are an essential ingredient for successful gene therapy. To date, a variety of nanostructures and materials have been studied as nonviral gene delivery systems. In this review, we will cover nonviral delivery strategies for cancer gene therapy, with a focus on target cancer genes and delivery materials. Moreover, we will address current challenges and perspectives for nonviral delivery-based cancer gene therapeutics. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. First Experience Of Application Of High-Intensity Focused Ultrasonic Ablation (Hifu In Prostate Cancer Treatment

    Directory of Open Access Journals (Sweden)

    A.V. Stativko

    2009-12-01

    Full Text Available The scientific article points out that 40 sessions of HIFU prostate ablation have been performed for estimation of clinical efficiency. Average frequency of influences presents 628±164 impulses; average volume of tissues subjected to influence during one procedure is 33,8±16,3 smi (132 % of prostate volume; average operation time constitutes 150 minutes (from 90 to 200 minutes. During the operation no complications have been occurred. In the first days after the session of HIFU there was a peak of PSA increase and then during 1,5-3 months there was decrease to the lowest index. Minimal PSA level was reached in 10-12 weeks after treatment and it constituted from 0,04 till 1,1 ngml depending on the disease state. Reduction of prostate volume occurred in average from the 30th day of postoperative period and lasted for 6 months, reaching in average 50 % from initial volume. Postoperative period varied from 10 till 16 days and constituted in average 12±0,8 days. Thus application of high-intensity focused ultrasonic ablation allows treating successfully various stages of prostate cancer with minimal number of side-effects and makes possible the early estimation of treatment efficiency

  20. The correlation between bubble-enhanced HIFU heating and cavitation power.

    Science.gov (United States)

    Farny, Caleb H; Glynn Holt, R; Roy, Ronald A

    2010-01-01

    It has been established that while the inherent presence of bubbles increases heat generation due to scattering and absorption, inertial cavitation is responsible for elevated heating during high-intensity focused ultrasound (HIFU) application. The contribution of bubble-induced heating can be an important factor to consider, as it can be several times greater than the expected heat deposition from absorption of energy from the primary ultrasound field. The temperature and cavitation signal near the focus were measured for 5.5-s continuous-wave 1.1-MHz HIFU sonications in tissue mimicking phantoms. The measured temperature was corrected for heating predicted from the primary ultrasound absorption to isolate the temperature rise from the bubble activity. The temperature rise induced from cavitation correlates well with a measurement of the instantaneous "cavitation power" as indicated by the mean square voltage output of a 15-MHz passive cavitation detector. The results suggest that careful processing of the cavitation signals can serve as a proxy for measuring the heating contribution from inertial cavitation.

  1. Patient QA systems for rotational radiation therapy

    DEFF Research Database (Denmark)

    Fredh, Anna; Scherman, J.B.; Munck af Rosenschöld, Per Martin

    2013-01-01

    The purpose of the present study was to investigate the ability of commercial patient quality assurance (QA) systems to detect linear accelerator-related errors.......The purpose of the present study was to investigate the ability of commercial patient quality assurance (QA) systems to detect linear accelerator-related errors....

  2. Multifunctional pulse generator for high-intensity focused ultrasound system

    Science.gov (United States)

    Tamano, Satoshi; Yoshizawa, Shin; Umemura, Shin-Ichiro

    2017-07-01

    High-intensity focused ultrasound (HIFU) can achieve high spatial resolution for the treatment of diseases. A major technical challenge in implementing a HIFU therapeutic system is to generate high-voltage high-current signals for effectively exciting a multichannel HIFU transducer at high efficiencies. In this paper, we present the development of a multifunctional multichannel generator/driver. The generator can produce a long burst as well as an extremely high-voltage short pulse of pseudosinusoidal waves (trigger HIFU) and second-harmonic superimposed waves for HIFU transmission. The transmission timing, waveform, and frequency can be controlled using a field-programmable gate array (FPGA) via a universal serial bus (USB) microcontroller. The hardware is implemented in a compact printed circuit board. The test results of trigger HIFU reveal that the power consumption and the temperature rise of metal-oxide semiconductor field-effect transistors were reduced by 19.9% and 38.2 °C, respectively, from the previous design. The highly flexible performance of the novel generator/driver is demonstrated in the generation of second-harmonic superimposed waves, which is useful for cavitation-enhanced HIFU treatment, although the previous design exhibited difficulty in generating it.

  3. Epigallocatechin Gallate Nanodelivery Systems for Cancer Therapy

    Directory of Open Access Journals (Sweden)

    Andreia Granja

    2016-05-01

    Full Text Available Cancer is one of the leading causes of morbidity and mortality all over the world. Conventional treatments, such as chemotherapy, are generally expensive, highly toxic and lack efficiency. Cancer chemoprevention using phytochemicals is emerging as a promising approach for the treatment of early carcinogenic processes. (−-Epigallocatechin-3-gallate (EGCG is the major bioactive constituent in green tea with numerous health benefits including anti-cancer activity, which has been intensively studied. Besides its potential for chemoprevention, EGCG has also been shown to synergize with common anti-cancer agents, which makes it a suitable adjuvant in chemotherapy. However, limitations in terms of stability and bioavailability have hampered its application in clinical settings. Nanotechnology may have an important role in improving the pharmacokinetic and pharmacodynamics of EGCG. Indeed, several studies have already reported the use of nanoparticles as delivery vehicles of EGCG for cancer therapy. The aim of this article is to discuss the EGCG molecule and its associated health benefits, particularly its anti-cancer activity and provide an overview of the studies that have employed nanotechnology strategies to enhance EGCG’s properties and potentiate its anti-tumoral activity.

  4. Epigallocatechin Gallate Nanodelivery Systems for Cancer Therapy.

    Science.gov (United States)

    Granja, Andreia; Pinheiro, Marina; Reis, Salette

    2016-05-20

    Cancer is one of the leading causes of morbidity and mortality all over the world. Conventional treatments, such as chemotherapy, are generally expensive, highly toxic and lack efficiency. Cancer chemoprevention using phytochemicals is emerging as a promising approach for the treatment of early carcinogenic processes. (-)-Epigallocatechin-3-gallate (EGCG) is the major bioactive constituent in green tea with numerous health benefits including anti-cancer activity, which has been intensively studied. Besides its potential for chemoprevention, EGCG has also been shown to synergize with common anti-cancer agents, which makes it a suitable adjuvant in chemotherapy. However, limitations in terms of stability and bioavailability have hampered its application in clinical settings. Nanotechnology may have an important role in improving the pharmacokinetic and pharmacodynamics of EGCG. Indeed, several studies have already reported the use of nanoparticles as delivery vehicles of EGCG for cancer therapy. The aim of this article is to discuss the EGCG molecule and its associated health benefits, particularly its anti-cancer activity and provide an overview of the studies that have employed nanotechnology strategies to enhance EGCG's properties and potentiate its anti-tumoral activity.

  5. Epigallocatechin Gallate Nanodelivery Systems for Cancer Therapy

    Science.gov (United States)

    Granja, Andreia; Pinheiro, Marina; Reis, Salette

    2016-01-01

    Cancer is one of the leading causes of morbidity and mortality all over the world. Conventional treatments, such as chemotherapy, are generally expensive, highly toxic and lack efficiency. Cancer chemoprevention using phytochemicals is emerging as a promising approach for the treatment of early carcinogenic processes. (−)-Epigallocatechin-3-gallate (EGCG) is the major bioactive constituent in green tea with numerous health benefits including anti-cancer activity, which has been intensively studied. Besides its potential for chemoprevention, EGCG has also been shown to synergize with common anti-cancer agents, which makes it a suitable adjuvant in chemotherapy. However, limitations in terms of stability and bioavailability have hampered its application in clinical settings. Nanotechnology may have an important role in improving the pharmacokinetic and pharmacodynamics of EGCG. Indeed, several studies have already reported the use of nanoparticles as delivery vehicles of EGCG for cancer therapy. The aim of this article is to discuss the EGCG molecule and its associated health benefits, particularly its anti-cancer activity and provide an overview of the studies that have employed nanotechnology strategies to enhance EGCG’s properties and potentiate its anti-tumoral activity. PMID:27213442

  6. Passive cavitation detection during pulsed HIFU exposures of ex vivo tissues and in vivo mouse pancreatic tumors.

    Science.gov (United States)

    Li, Tong; Chen, Hong; Khokhlova, Tatiana; Wang, Yak-Nam; Kreider, Wayne; He, Xuemei; Hwang, Joo Ha

    2014-07-01

    Pulsed high-intensity focused ultrasound (pHIFU) has been shown to enhance vascular permeability, disrupt tumor barriers and enhance drug penetration into tumor tissue through acoustic cavitation. Monitoring of cavitation activity during pHIFU treatments and knowing the ultrasound pressure levels sufficient to reliably induce cavitation in a given tissue are therefore very important. Here, three metrics of cavitation activity induced by pHIFU and evaluated by confocal passive cavitation detection were introduced: cavitation probability, cavitation persistence and the level of the broadband acoustic emissions. These metrics were used to characterize cavitation activity in several ex vivo tissue types (bovine tongue and liver and porcine adipose tissue and kidney) and gel phantoms (polyacrylamide and agarose) at varying peak-rare factional focal pressures (1-12 MPa) during the following pHIFU protocol: frequency 1.1 MHz, pulse duration 1 ms and pulse repetition frequency 1 Hz. To evaluate the relevance of the measurements in ex vivo tissue, cavitation metrics were also investigated and compared in the ex vivo and in vivo murine pancreatic tumors that develop spontaneously in transgenic KrasLSL.G12 D/+; p53 R172 H/+; PdxCretg/+ (KPC) mice and closely re-capitulate human disease in their morphology. The cavitation threshold, defined at 50% cavitation probability, was found to vary broadly among the investigated tissues (within 2.5-10 MPa), depending mostly on the water-lipid ratio that characterizes the tissue composition. Cavitation persistence and the intensity of broadband emissions depended both on tissue structure and lipid concentration. Both the cavitation threshold and broadband noise emission level were similar between ex vivo and in vivo pancreatic tumor tissue. The largest difference between in vivo and ex vivo settings was found in the pattern of cavitation occurrence throughout pHIFU exposure: it was sporadic in vivo, but it decreased rapidly and stopped

  7. Uses of nanoparticles for central nervous system imaging and therapy.

    Science.gov (United States)

    Provenzale, J M; Silva, G A

    2009-08-01

    Applications of nanotechnology to medicine are leading to novel means of imaging living systems and of delivering therapy. Much nanotechnology research is focused on methods for imaging central nervous system functions and disease states. In this review, the principles of nanoparticle design and function are discussed with specific emphasis on applications to neuroradiology. In addition to innovative forms of imaging, this review describes therapeutic uses of nanoparticles, such as drug delivery systems, neuroprotection devices, and methods for tissue regeneration.

  8. Non-invasive MR-guided HIFU Therapy of TSC-Associated Renal Angiomyolipomas

    Science.gov (United States)

    2013-07-01

    the ability to monitor thermal delivery (temperature mapping ). However, an intrinsic drawback of MR is the slow data acquisition speed limited by...artifacts in free-breathing mice. Specifically, the optimization will be performed to improve four major imaging methods, T1 weighted 3.0 Tesla MRI...Philips 3T scanner. (c) A mechanic stage was constructed for holding/stabilizing the mouse and the coil within the MRI scanner. Inside the stage

  9. Spatiotemporal filtering of MR-temperature artifacts arising from bowel motion during transurethral MR-HIFU

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Alain, E-mail: aschmitt@sri.utoronto.ca [Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 (Canada); Mougenot, Charles [Philips Healthcare, 281 Hillmount Road, Markham, Ontario L6C 2S3 (Canada); Chopra, Rajiv [Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canadaand Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9061 (United States)

    2014-11-01

    Purpose: Transurethral MR-HIFU is a minimally invasive image-guided treatment for localized prostate cancer that enables precise targeting of tissue within the gland. The treatment is performed within a clinical MRI to obtain real-time MR thermometry used as an active feedback to control the spatial heating pattern in the prostate and to monitor for potential damage to surrounding tissues. This requires that the MR thermometry measurements are an accurate representation of the true tissue temperature. The proton resonance frequency shift thermometry method used is sensitive to tissue motion and changes in the local magnetic susceptibility that can be caused by the motion of air bubbles in the rectum, which can impact the performance of transurethral MR-HIFU in these regions of the gland. Methods: A method is proposed for filtering of temperature artifacts based on the temporal variance of the temperature, using empirical and dynamic positional knowledge of the ultrasonic heating beam, and an estimation of the measurement noise. A two-step correction strategy is introduced which eliminates artifact-detected temperature variations while keeping the noise level low through spatial averaging. Results: The filter has been evaluated by postprocessing data from five human transurethral ultrasound treatments. The two-step correction process led to reduced final temperature standard deviation in the prostate and rectum areas where the artifact was located, without negatively affecting areas distal to the artifact. The performance of the filter was also found to be consistent across all six of the data sets evaluated. The evaluation of the detection criterion parameter M determined that a value of M = 3 achieves a conservative filter with minimal loss of spatial resolution during the process. Conclusions: The filter was able to remove most artifacts due to the presence of moving air bubbles in the rectum during transurethral MR-HIFU. A quantitative estimation of the filter

  10. Angioedema due to Systemic Isotretinoin Therapy

    Directory of Open Access Journals (Sweden)

    Pelin Üstüner

    2014-01-01

    Full Text Available Angioedema is the swelling of the mucosal membranes as a variant of urticaria induced by hereditary C1 esterase inhibitor enzyme deficiency, certain foods, or drugs. Herein, we report the case of a 23-year-old woman, with mild-moderate acne presenting with widespread facial angioedema on the 2nd day of systemic isotretinoin treatment. The patient had taken no drugs other than isotretinoin in the preceding days and had no known food allergy. Her angioedema was resolved after the isotretinoin was discontinued. We want to draw the attention of dermatologists to this rare adverse allergic effect of isotretinoin which is frequently used in the treatment of acne vulgaris.

  11. An Application of General System Theory (GST) to Group Therapy.

    Science.gov (United States)

    Matthews, Charles O.

    1992-01-01

    Demonstrates the compatibility of General System Theory (GST) with the traditional counseling literature in explicating a therapy group's progression through Tuckman's (1965, 1977) developmental stages (forming, storming, norming, performing, and adjourning). Description uses both traditional group literature and GST concepts. (Author/NB)

  12. Systemic vs. Topical Therapy for the Treatment of Vulvovaginal Candidiasis

    Directory of Open Access Journals (Sweden)

    Sebastian Faro

    1994-01-01

    Full Text Available It is estimated that 75% of all women will experience at least 1 episode of vulvovaginal candidiasis (VVC during their lifetimes. Most patients with acute VVC can be treated with short-term regimens that optimize compliance. Since current topical and oral antifungals have shown comparably high efficacy rates, other issues should be considered in determining the most appropriate therapy. It is possible that the use of short-duration narrow-spectrum agents may increase selection of more resistant organisms which will result in an increase of recurrent VVC (RVVC. Women who are known or suspected to be pregnant and women of childbearing age who are not using a reliable means of contraception should receive topical therapy, as should those who are breast-feeding or receiving drugs that can interact with an oral azole and those who have previously experienced adverse effects during azole therapy. Because of the potential risks associated with systemic treatment, topical therapy with a broad-spectrum agent should be the method of choice for VVC, whereas systemic therapy should be reserved for either RVVC or cases where the benefits outweigh any possible adverse reactions.

  13. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  14. 21 CFR 892.5050 - Medical charged-particle radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical charged-particle radiation therapy system...-particle radiation therapy system. (a) Identification. A medical charged-particle radiation therapy system...) intended for use in radiation therapy. This generic type of device may include signal analysis and display...

  15. [General system therapy--considerations on a universal therapy theory and its use on psychotherapy practice].

    Science.gov (United States)

    Glatzel, P M

    1995-02-01

    The cybernetic model of interaction of the early system therapy was derived from the concept of feedback mechanisms. It is based upon the assumption that living beings interact with each other as open systems and thereby exchange information. The model can easily be used for the description and explanation of the therapeutic interactions in all schools of psychotherapy, but it is very abstract. In contrast, in the biosystem theory of Maturana living beings as autopoietic systems are operationally and cognitively closed. Exchange of information among them is not possible. Together with the so-called "radical constructivism" this theory has increasingly influenced system therapy over the past ten years and stimulated the development of an alternative model by which the interaction between therapist and client can be described differently and explained in a new way. The model does not only allow the pragmatic integration of all methods of psychotherapy, but also the design of a therapeutic approach including all schools, which is roughly sketched here and called "general system therapy".

  16. A TR-induced algorithm for hot spots elimination through CT-scan HIFU simulations

    Science.gov (United States)

    Leduc, Nicolas; Okita, Kohei; Sugiyama, Kazuyasu; Takagi, Shu; Matsumoto, Yoichiro

    2011-09-01

    Although nowadays widely spread for imaging and treatments uses, HIFU techniques are still limited by the distortion of the wavefront due to refraction and reflection on the inhomogeneous media inside the human body. CT-scan Time Reversal (TR) procedure has risen as a promising candidate for focus control. A finite difference time domain parallelized code is used to provide simulations of TR-enhanced propagation through elements of the human body and implement a simple algorithm to address the issue of grating lobes, i.e secondary peaks of pressure due to natural diffraction by phased arrays and enhanced by medium heterogeneity. Using an iterative, progressive process combining secondary sound sources and independent signal summation, the primary peak is strengthened while secondary peaks are increasingly obliterated. This method supports the feasibility of precise modification and enhancement of the pressure profile in the targeted area through Time Reversal based solutions.

  17. Self-System Therapy as an Intervention for Self-Regulatory Dysfunction in Depression: A Randomized Comparison with Cognitive Therapy

    Science.gov (United States)

    Strauman, Timothy J.; Vieth, Angela Z.; Merrill, Kari A.; Kolden, Gregory G.; Woods, Teresa E.; Klein, Marjorie H.; Papadakis, Alison A.; Schneider, Kristin L.; Kwapil, Lori

    2006-01-01

    Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST…

  18. Prognostic factors in the estimation of HIFU treatment efficiency in patients with localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Popkov V.M.

    2013-03-01

    Full Text Available Research objective: To study the role of prognostic factors in the estimation of risk development of recurrent prostate cancer after treatment by high-intensive focused ultrasound (HIUF. Objects and Research Methods: The research has included 102 patients with morphologically revealed localized prostate cancer by biopsy. They have been on treatment in Clinic of Urology of the Saratov Clinical Hospital n.a. S. R. Mirotvortsev. 102 sessions of initial operative treatment of prostate cancer by the method of HIFU have been performed. The general group of patients (n=102 has been subdivided by the method of casual distribution into two samples: group of patients with absent recurrent tumor and group of patients with the revealed recurrent tumor, by morphological research of biopsy material of residual prostate tissue after HIFU. The computer program has been used to study the signs of outcome of patients with prostate cancer. Results: Risk of development of recurrent prostate cancer has grown with the PSA level raise and its density. The index of positive biopsy columns <0,2 has shown the recurrence of prostate cancer in 17% cases while occurrence of prostate cancer in 59% cases has been determined by the index of 0,5 and higher. The tendency to obvious growth of number of relapses has been revealed by the sum of Glison raise with present perineural invasion. Cases of recurrent prostate cancer have been predominant in patients with lymphovascular invasions. In conclusion it has been worked out that the main signs of recurrent prostate cancer development may include: PSA, PSA density, the sum of Glison, lymphovascular invasion, invasion.

  19. Influence of the docetaxel administration period (neoadjuvant or concomitant) in relation to HIFU treatment on the growth of Dunning tumors: results of a preliminary study.

    Science.gov (United States)

    Paparel, P; Chapelon, J Y; Bissery, A; Chesnais, S; Curiel, L; Gelet, A

    2008-01-01

    The objective of this study was to evaluate mechanisms of the synergy between high intensity-focused ultrasound (HIFU) and docetaxel and to determine the best sequence of chemotherapy administration in relation to HIFU treatment for obtaining optimum control of tumoral growth. A total of 15 days after s.c. implantation of the tumor, 52 Copenhagen rats studied were randomized in 4 groups of 13: controls, docetaxel alone (group 1), HIFU and docetaxel concomitant (group 2) and HIFU and docetaxel administered 24 h before treatment (group 3). The number of HIFU shots was calculated in order to cover 75% of the tumor volume. The effects of docetaxel, HIFU and their interaction on tumor volumes were analyzed using a linear regression. The distributions of the tumor volumes were significantly greater in the control group than in the group 1 (P=0.002) and than in both groups 2 and 3 (P < 0.0001 and P = 0.0001). These volumes were also significantly greater in group 1 than in both groups 2 and 3 and there was no difference between the groups 2 and 3. The tumor doubling times were 7.8 days for the group 1, 43.8 days for the group 2, 16.1 days for the group 3 and 5.9 days for the controls. The mechanism of the synergy between HIFU and docetaxel on the growth of Dunning tumors is apparently multifaceted. The results are encouraging because in the two groups of rats treated with the combination of HIFU and docetaxel, the percentage of complete remission was approximately 30%.

  20. Twelve years' experience with high-intensity focused ultrasound (HIFU) using sonablate™ devices for the treatment of localized prostate cancer

    Science.gov (United States)

    Uchida, Toyoaki; Nakano, Muyura; Shoji, Sunao; Nagata, Yoshihiro; Usui, Yukio; Terachi, Toshiro

    2012-10-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Patients with clinical Stage T1c-T3N0M0, biopsy proven, localized prostate cancer, with a serum prostate specific antigen (PSA) level of Gleason score were included. All patients underwent HIFU using the Sonablate™ (S) device and were required to have a minimal follow-up of 2 years after the last HIFU session to be included in this analysis. Four different generation HIFU devices, S200, S500, S500 version 4 and S500 TCM, have been used for this study. Biochemical failure was defined according to the Phoenix definition (PSA nadir+2ng/ml). Seven hundred and fifty-three men with prostate cancer were included. The patients were divided into two groups: in the Former group, 421 patients were treated with S200 and 500 from 1990 to 2005; in the Latter group, 332 patients were treated with S500 ver. 4 and TCM from 2005 to 2009. The mean age, PSA, Gleason score, operation time, and follow-up period in the Former and Latter groups were 68 and 67 years, 11.3 and 9.7 ng/ml, 6.2 and 6.6, 167 and 101 min, and 49 and 38 months, respectively. The biochemical disease-free rate (BDFR) in the groups at 5 years was, respectively, 67% and 53%, and was 50% at 10 years in the Former group (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Former group at 5 and 10 years were 68% and 65%, 52% and 48%, and 43% and 40%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Latter group at 5 years were 83%, 76%, and 42% (p<0.0001). The negative prostate biopsy rate in the Former and Latter groups was 81% and 93%, respectively. Postoperative erectile dysfunction was noted in 45%, 38%, and 24% of patients at 6 months, 12 months, and 2 years after HIFU. The results after long-term follow-up have indicated that HIFU is an efficient and safe treatment for patients with localized prostate

  1. Pancreatic Cancer Gene Therapy: From Molecular Targets to Delivery Systems

    Energy Technology Data Exchange (ETDEWEB)

    Fillat, Cristina, E-mail: cristina.fillat@crg.es; Jose, Anabel; Ros, Xavier Bofill-De; Mato-Berciano, Ana; Maliandi, Maria Victoria; Sobrevals, Luciano [Programa Gens i Malaltia, Centre de Regulació Genòmica-CRG, UPF, Parc de Recerca Biomedica de Barcelona-PRBB and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona (Spain)

    2011-01-18

    The continuous identification of molecular changes deregulating critical pathways in pancreatic tumor cells provides us with a large number of novel candidates to engineer gene-targeted approaches for pancreatic cancer treatment. Targets—both protein coding and non-coding—are being exploited in gene therapy to influence the deregulated pathways to facilitate cytotoxicity, enhance the immune response or sensitize to current treatments. Delivery vehicles based on viral or non-viral systems as well as cellular vectors with tumor homing characteristics are a critical part of the design of gene therapy strategies. The different behavior of tumoral versus non-tumoral cells inspires vector engineering with the generation of tumor selective products that can prevent potential toxic-associated effects. In the current review, a detailed analysis of the different targets, the delivery vectors, the preclinical approaches and a descriptive update on the conducted clinical trials are presented. Moreover, future possibilities in pancreatic cancer treatment by gene therapy strategies are discussed.

  2. Why Targeted Therapies are Necessary for Systemic Lupus Erythematosus

    Science.gov (United States)

    Durcan, Laura; Petri, Michelle

    2016-01-01

    Systemic lupus erythematosus (SLE) continues to have important morbidity and accelerated mortality despite therapeutic advances. Targeted therapies offer the possibility of improved efficacy with fewer side-effects. Current management strategies rely heavily on non-specific immunosuppressive agents. Prednisone, in particular, is responsible for a considerable burden of later organ damage. There are a multitude of diverse mechanisms of disease activity, immunogenic abnormalities and clinical manifestations to take into consideration in SLE. Many targeted agents with robust mechanistic pre-clinical data and promising early phase studies have ultimately been disappointing in phase III randomized controlled studies. Recent efforts have focused on B cell therapies, in particular given the success of belimumab in clinical trials, with limited success. We remain optimistic regarding other specific therapies being evaluated including interferon alpha blockade. It is likely that in SLE, given the heterogeneity of the population involved, precision medicine is needed, rather than expecting that any single biologic will be universally effective. PMID:27497251

  3. Systemic relational therapy and the case from the clinical practice

    Directory of Open Access Journals (Sweden)

    Tatjana Rožič

    2003-06-01

    Full Text Available In the present article are represented the principal guidelines of the systemic relational model of psychotherapy and an example of clinical practice where the pacient was incluced in this kind of therapy. In the essence of systemic relational model there is a person which is captured in the repetition of old patterns in spite of its painfulness and hardness. Captured and helpless in old patterns, the person not only repeats but also recreates them, because they promise safety, belonging and connectedness. From the review of the therapy it is evident that behind the pacient's concrete problems stands her family system to which she is loyal in the way that only deepens her distress. By the increasing the responsability for herself, for her feelings and her acts, it increases the pacient's funcionality, too.

  4. Locally ablative therapies for primary and metastatic liver cancer.

    Science.gov (United States)

    Li, David; Kang, Josephine; Madoff, David C

    2014-08-01

    Locally ablative therapies have an increasing role in the effective multidisciplinary approach towards the treatment of both primary and metastatic liver tumors. In patients who are not considered surgical candidates and have low volume disease, these therapies have now become established into consensus practice guidelines. A large range of therapeutic options exist including percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, percutaneous laser ablation (PLA), irreversible electroporation (IRE), stereotactic body radiation therapy (SBRT) and high intensity focused ultrasound (HIFU); each having benefits and drawbacks. The greatest body of evidence supporting clinical utility in the liver currently exists for RFA, with PEI having fallen out of favor. MWA, IRE, SBRT and HIFU are relatively nascent technologies, and outcomes data supporting their use is promising. Future directions of ablative therapies include tandem approaches to improve efficacy in the treatment of liver tumors.

  5. Oral immune therapy: targeting the systemic immune system via the gut immune system for the treatment of inflammatory bowel disease

    OpenAIRE

    Ilan, Yaron

    2016-01-01

    Inflammatory bowel diseases (IBD) are associated with an altered systemic immune response leading to inflammation-mediated damage to the gut and other organs. Oral immune therapy is a method of systemic immune modulation via alteration of the gut immune system. It uses the inherit ability of the innate system of the gut to redirect the systemic innate and adaptive immune responses. Oral immune therapy is an attractive clinical approach to treat autoimmune and inflammatory disorders. It can in...

  6. High-Intensity Focused Ultrasound (HIFU) Using Sonablate-500 for the Treatment of Localized Prostate Cancer: 6-year experience

    Science.gov (United States)

    Uchida, Toyoaki; Shoji, Sunao; Nagata, Yoshihiro

    2006-05-01

    We evaluated 281 patients of localized prostate cancer treated with high-intensity focused ultrasound (HIFU) for biochemical disease-free rate, safety, morbidity and predictors of biochemical outcome. A total of 281 patients underwent HIFU with the use of Sonablate-500 and with at least 12 months of follow-up. Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The biochemical disease-free rates at 1, 3 and 5 years in all patients were 78%, 74% and 72%, respectively. The biochemical disease-free rates at 5 years for patients with pretreatment PSA less than 10 ng/ml, 10.01 to 20.0 ng/ml and more than 20.0 ng/ml were 88%, 70% and 17%, respectively (ppatients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/ml.

  7. [Bone metastases : New aspects of pathogenesis and systemic therapy].

    Science.gov (United States)

    Rachner, T D; Jakob, F; Hofbauer, L C

    2016-07-01

    The occurrence of bone metastases, in particular secondary to breast and prostate cancer, represents a complex medical condition that is debilitating for affected patients. In order to provide an efficient and personalized therapy, an interdisciplinary treatment approach is mandatory; therefore, systemic pharmacological therapy represents a core element of the overall treatment concept. In terms of pathophysiology, the cancer cells cause a massive disturbance of the local bone microenvironment, which as a rule leads to activation of bone resorbing osteoclasts. In addition to bisphosphonates, which can be considered classical antiresorptive agents, the monoclonal receptor activator of nuclear factor-kappa B ligand (RANKL) antibody denosumab has been in use in clinical practice since 2011. The alpha-emitting radioisotope Alpharadin was also recently approved for the treatment of metastatic prostate cancer. This article provides a summary of the most recent knowledge on the pathogenesis of how cancer cells alter the bone microenvironment as well as a review of established and future systemic treatment options.

  8. Quality of Intensity Modulated Radiation Therapy Treatment Plans Using a (60)Co Magnetic Resonance Image Guidance Radiation Therapy System

    DEFF Research Database (Denmark)

    Wooten, H Omar; Green, Olga; Yang, Min

    2015-01-01

    PURPOSE: This work describes a commercial treatment planning system, its technical features, and its capabilities for creating (60)Co intensity modulated radiation therapy (IMRT) treatment plans for a magnetic resonance image guidance radiation therapy (MR-IGRT) system. METHODS AND MATERIALS...

  9. Pharmacokinetic modeling of therapies for systemic lupus erythematosus

    OpenAIRE

    Yang, Xiaoyan; Sherwin, Catherine MT; Yu, Tian; Yellepeddi, Venkata K.; Brunner, Hermine I; Vinks, Alexander A.

    2015-01-01

    With the increasing use of different types of therapies in treating autoimmune diseases such as systemic lupus erythematosus (SLE), there is a need to utilize pharmacokinetic (PK) strategies to optimize the clinical outcome of these treatments. Various PK analysis approaches, including population PK modeling and physiologically based PK modeling, have been used to evaluate drug PK characteristics and population variability or to predict drug PK profiles in a mechanistic manner. This review ou...

  10. Improvement of different vaccine delivery systems for cancer therapy

    Directory of Open Access Journals (Sweden)

    Safaiyan Shima

    2011-01-01

    Full Text Available Abstract Cancer vaccines are the promising tools in the hands of the clinical oncologist. Many tumor-associated antigens are excellent targets for immune therapy and vaccine design. Optimally designed cancer vaccines should combine the best tumor antigens with the most effective immunotherapy agents and/or delivery strategies to achieve positive clinical results. Various vaccine delivery systems such as different routes of immunization and physical/chemical delivery methods have been used in cancer therapy with the goal to induce immunity against tumor-associated antigens. Two basic delivery approaches including physical delivery to achieve higher levels of antigen production and formulation with microparticles to target antigen-presenting cells (APCs have demonstrated to be effective in animal models. New developments in vaccine delivery systems will improve the efficiency of clinical trials in the near future. Among them, nanoparticles (NPs such as dendrimers, polymeric NPs, metallic NPs, magnetic NPs and quantum dots have emerged as effective vaccine adjuvants for infectious diseases and cancer therapy. Furthermore, cell-penetrating peptides (CPP have been known as attractive carrier having applications in drug delivery, gene transfer and DNA vaccination. This review will focus on the utilization of different vaccine delivery systems for prevention or treatment of cancer. We will discuss their clinical applications and the future prospects for cancer vaccine development.

  11. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases

    Energy Technology Data Exchange (ETDEWEB)

    Lester-Coll, Nataniel H., E-mail: nataniel.lester-coll@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Rutter, Charles E.; Bledsoe, Trevor J. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Goldberg, Sarah B. [Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut (United States); Decker, Roy H.; Yu, James B. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2016-06-01

    Introduction: Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. Methods and Materials: A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. Results: In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). Conclusions: Video-assisted thoracic

  12. DUAL THERAPY WITH BIOLOGICALS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    A. A. Mesnyankina

    2016-01-01

    Full Text Available Objective: to determine the efficiency of dual anti-B cell therapy in patients with active systemic lupus erythematosus (SLE.Subjects and methods. The clinic of the V.A. Nasonova Research Institute of Rheumatology followed up three patients with significant SLE, who took rituximab (RTM at a dose of 500–1000 mg, three months after completion of RTM infusions they received belimumab (BLM calculated with reference to 10 mg/kg once monthly, a total of 8 infusions. The follow-up lasted 1 year. The efficiency and tolerability of the therapy and the concentrations of autoantibodies, complement, and B-lymphocyte subpopulations were estimated at baseline and then every 3 months.Results and discussion. During dual anti-B cell therapy, there was considerable clinical improvement, no signs of recurrent SLE throughout the follow-up period, as well as normalization of laboratory markers for disease activity (the concentrations of antibodies against native DNA and complement components C3 and CD4 and persistent depletion of autoreactive B lymphocytes, plasma cells in particular. In all patients, the dose of glucocorticoids (GC could be decreased to 7.5 mg/day calculated with reference to prednisolone at 2 months after the therapy was completed.Conclusion. Dual anti-B cell therapy is a novel promising treatment for active SLE. This treatment regimen contributes to rapid suppression of disease activity, to long-term persistence of the obtained effect, and to reduced risk of severe irreversible organ damages, by minimizing the dose of GCs.

  13. Prototype demonstration of radiation therapy planning code system

    Energy Technology Data Exchange (ETDEWEB)

    Little, R.C.; Adams, K.J.; Estes, G.P.; Hughes, L.S. III; Waters, L.S. [and others

    1996-09-01

    This is the final report of a one-year, Laboratory-Directed Research and Development project at the Los Alamos National Laboratory (LANL). Radiation therapy planning is the process by which a radiation oncologist plans a treatment protocol for a patient preparing to undergo radiation therapy. The objective is to develop a protocol that delivers sufficient radiation dose to the entire tumor volume, while minimizing dose to healthy tissue. Radiation therapy planning, as currently practiced in the field, suffers from inaccuracies made in modeling patient anatomy and radiation transport. This project investigated the ability to automatically model patient-specific, three-dimensional (3-D) geometries in advanced Los Alamos radiation transport codes (such as MCNP), and to efficiently generate accurate radiation dose profiles in these geometries via sophisticated physics modeling. Modem scientific visualization techniques were utilized. The long-term goal is that such a system could be used by a non-expert in a distributed computing environment to help plan the treatment protocol for any candidate radiation source. The improved accuracy offered by such a system promises increased efficacy and reduced costs for this important aspect of health care.

  14. Microneedles As a Delivery System for Gene Therapy

    Science.gov (United States)

    Chen, Wei; Li, Hui; Shi, De; Liu, Zhenguo; Yuan, Weien

    2016-01-01

    Gene delivery systems can be divided to two major types: vector-based (either viral vector or non-viral vector) and physical delivery technologies. Many physical carriers, such as electroporation, gene gun, ultrasound start to be proved to have the potential to enable gene therapy. A relatively new physical delivery technology for gene delivery consists of microneedles (MNs), which has been studied in many fields and for many molecule types and indications. Microneedles can penetrate the stratum corneum, which is the main barrier for drug delivery through the skin with ease of administration and without significant pain. Many different kinds of MNs, such as metal MNs, coated MNs, dissolving MNs have turned out to be promising in gene delivery. In this review, we discussed the potential as well as the challenges of utilizing MNs to deliver nucleic acids for gene therapy. We also proposed that a combination of MNs and other gene delivery approaches may lead to a better delivery system for gene therapy. PMID:27303298

  15. Microneedles as a Delivery System for Gene Therapy

    Directory of Open Access Journals (Sweden)

    Wei eChen

    2016-05-01

    Full Text Available Gene delivery systems can be divided to two major types: vector-based (either viral vector or non-viral vector and physical delivery technologies. Many physical carriers, such as electroporation, gene gun, ultrasound start to be proved to have the potential to enable gene therapy. A relatively new physical delivery technology for gene delivery consists of microneedles (MNs, which has been studied in many fields and for many molecule types and indications. Microneedles can penetrate the stratum corneum, which is the main barrier for drug delivery through the skin with ease of administration and without significant pain. Many different kinds of MNs, such as metal MNs, coated MNs, dissolving MNs have turned out to be promising in gene delivery. In this review, we discussed the potential as well as the challenges of utilizing MNs to deliver nucleic acids for gene therapy. We also proposed that a combination of MNs and other gene delivery approaches may lead to a better delivery system for gene therapy.

  16. Pharmacokinetic modeling of therapies for systemic lupus erythematosus

    Science.gov (United States)

    Yang, Xiaoyan; Sherwin, Catherine MT; Yu, Tian; Yellepeddi, Venkata K; Brunner, Hermine I; Vinks, Alexander A

    2017-01-01

    With the increasing use of different types of therapies in treating autoimmune diseases such as systemic lupus erythematosus (SLE), there is a need to utilize pharmacokinetic (PK) strategies to optimize the clinical outcome of these treatments. Various PK analysis approaches, including population PK modeling and physiologically based PK modeling, have been used to evaluate drug PK characteristics and population variability or to predict drug PK profiles in a mechanistic manner. This review outlines the PK modeling of major SLE therapies including immunosuppressants (methotrexate, azathioprine, mycophenolate and cyclophosphamide, among others) and immunomodulators (intravenous immunoglobulin). It summarizes the population PK modeling, physiologically based PK modeling and model-based individualized dosing strategies to improve the therapeutic outcomes in SLE patients. PMID:26143647

  17. Acoustic Droplet Vaporization for the Enhancement of Ultrasound Thermal Therapy

    Science.gov (United States)

    Zhang, Man; Fabiilli, Mario; Carson, Paul; Padilla, Frederic; Swanson, Scott; Kripfgans, Oliver; Fowlkes, Brian

    2011-01-01

    Acoustic droplet vaporization (ADV) is an ultrasound method for converting biocompatible microdroplets into microbubbles. The objective is to demonstrate that ADV bubbles can enhance high intensity focused ultrasound (HIFU) therapy by controlling and increasing energy absorption at the focus. Thermal phantoms were made with or without droplets. Compound lesions were formed in the phantoms by 5-second exposures with 5-second delays. Center to center spacing of individual lesions was 5.5 mm in either a linear pattern or a spiral pattern. Prior to the HIFU, 10 cycle tone bursts with 0.25% duty cycle were used to vaporize the droplets, forming an “acoustic trench” within 30 seconds. The transducer was then focused in the middle of the back bubble wall to form thermal lesions in the trench. All lesions were imaged optically and with 2T MRI. With the use of ADV and the acoustic trench, a uniform thermal ablation volume of 15 cm3 was achieved in 4 minutes; without ADV only less than 15% of this volume was filled. The commonly seen tadpole shape characteristic of bubble-enhanced HIFU lesions was not evident with the acoustic trench. In conclusion, ADV shows promise for the spatial control and dramatic acceleration of thermal lesion production by HIFU. PMID:21804749

  18. A systems biology analysis of autophagy in cancer therapy.

    Science.gov (United States)

    Shi, Zheng; Li, Chun-yang; Zhao, Si; Yu, Yang; An, Na; Liu, Yong-xi; Wu, Chuan-fang; Yue, Bi-song; Bao, Jin-ku

    2013-09-01

    Autophagy, which degrades redundant or damaged cellular constituents, is intricately relevant to a variety of human diseases, most notably cancer. Autophagy exerts distinct effects on cancer initiation and progression, due to the intrinsic overlapping of autophagic and cancer signalling pathways. However, due to the complexity of cancer as a systemic disease, the fate of cancer cells is not decided by any one signalling pathway. Numerous autophagic inter-connectivity and cross-talk pathways need to be further clarified at a systems level. In this review, we propose a systems biology perspective for the comprehensive analysis of the autophagy-cancer network, focusing on systems biology analysis in autophagy and cancer therapy. Together, these analyses may not only improve our understanding on autophagy-cancer relationships, but also facilitate cancer drug discovery. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. 21 CFR 892.5900 - X-ray radiation therapy system.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false X-ray radiation therapy system. 892.5900 Section... (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5900 X-ray radiation therapy system. (a) Identification. An x-ray radiation therapy system is a device intended to produce and control x...

  20. Clinically important ocular reactions to systemic drug therapy.

    Science.gov (United States)

    Rennie, I G

    1993-09-01

    Many systemically administered drugs produce ocular adverse effects. Fortunately, relatively few are capable of causing significant, irreversible visual impairment. It is the responsibility of every clinician when prescribing systemic therapeutic agents to be aware of potential adverse ocular reactions, to appreciate their significance, and to inform the patient of the potential risks of treatment. In instances where serious adverse reactions relate to the cumulative effects of prolonged treatment, it is the responsibility of the prescribing physician to institute appropriate methods of visual screening. In this respect, it is most important to obtain the necessary individual baseline measurements before treatment is commenced. Chloroquine retinopathy is probably the most feared of all adverse ocular reactions to systemic drug therapy. However, it occurs only rarely if the daily dosage of chloroquine does not exceed 250mg. Regular screening using automated perimetry is mandatory if prolonged therapy is contemplated. Amiodarone almost inevitably produces corneal deposits. These rarely produce symptoms, and resolve upon withdrawal of the drug. Optic neuropathy has recently been described with amiodarone. Systemic anticoagulant therapy may be associated with intraocular hemorrhage in patients with pre-existing disciform macular degeneration, and such agents should be used with caution in affected individuals. Systemic corticosteroids produce posterior subcapsular cataracts in susceptible individuals which may profoundly affect visual acuity. Although elevated intraocular pressure may also result from systemic therapy, the relationship between the pressure rise and development of glaucomatous changes remains unclear. Ethambutol may produce optic neuropathy if the daily dosage exceeds 15 mg/kg. The changes are usually reversible within a few weeks of stopping treatment. High doses of tamoxifen may produce a maculopathy with loss of visual acuity, if given for prolonged

  1. Carbohydrate-based amphiphilic nano delivery systems for cancer therapy.

    Science.gov (United States)

    Liu, Kegang; Jiang, Xiaohua; Hunziker, Patrick

    2016-09-15

    Nanoparticles (NPs) are novel drug delivery systems that have been attracting more and more attention in recent years, and have been used for the treatment of cancer, infection, inflammation and other diseases. Among the numerous classes of materials employed for constructing NPs, organic polymers are outstanding due to the flexibility of design and synthesis and the ease of modification and functionalization. In particular, NP based amphiphilic polymers make a great contribution to the delivery of poorly-water soluble drugs. For example, natural, biocompatible and biodegradable products like polysaccharides are widely used as building blocks for the preparation of such drug delivery vehicles. This review will detail carbohydrate based amphiphilic polymeric systems for cancer therapy. Specifically, it focuses on the nature of the polymer employed for the preparation of targeted nanocarriers, the synthetic methods, as well as strategies for the application and evaluation of biological activity. Applications of the amphiphilic polymer systems include drug delivery, gene delivery, photosensitizer delivery, diagnostic imaging and specific ligand-assisted cellular uptake. As a result, a thorough understanding of the relationship between chemical structure and biological properties facilitate the optimal design and rational clinical application of the resulting carbohydrate based nano delivery systems for cancer therapy.

  2. Engineered CRISPR Systems for Next Generation Gene Therapies.

    Science.gov (United States)

    Pineda, Michael; Moghadam, Farzaneh; Ebrahimkhani, Mo R; Kiani, Samira

    2017-09-15

    An ideal in vivo gene therapy platform provides safe, reprogrammable, and precise strategies which modulate cell and tissue gene regulatory networks with a high temporal and spatial resolution. Clustered regularly interspaced short palindromic repeats (CRISPR), a bacterial adoptive immune system, and its CRISPR-associated protein 9 (Cas9), have gained attention for the ability to target and modify DNA sequences on demand with unprecedented flexibility and precision. The precision and programmability of Cas9 is derived from its complexation with a guide-RNA (gRNA) that is complementary to a desired genomic sequence. CRISPR systems open-up widespread applications including genetic disease modeling, functional screens, and synthetic gene regulation. The plausibility of in vivo genetic engineering using CRISPR has garnered significant traction as a next generation in vivo therapeutic. However, there are hurdles that need to be addressed before CRISPR-based strategies are fully implemented. Some key issues center on the controllability of the CRISPR platform, including minimizing genomic-off target effects and maximizing in vivo gene editing efficiency, in vivo cellular delivery, and spatial-temporal regulation. The modifiable components of CRISPR systems: Cas9 protein, gRNA, delivery platform, and the form of CRISPR system delivered (DNA, RNA, or ribonucleoprotein) have recently been engineered independently to design a better genome engineering toolbox. This review focuses on evaluating CRISPR potential as a next generation in vivo gene therapy platform and discusses bioengineering advancements that can address challenges associated with clinical translation of this emerging technology.

  3. Systemic anti-infective periodontal therapy. A systematic review.

    Science.gov (United States)

    Haffajee, Anne D; Socransky, Sigmund S; Gunsolley, John C

    2003-12-01

    Periodontal diseases are infections and thus systemically administered antibiotics are often employed as adjuncts for their control. There are conflicting reports as to whether these agents provide a therapeutic benefit. The purpose of this systematic review is to determine whether systemically administered antibiotics improve a primary clinical outcome measure, periodontal attachment level change. In patients with periodontitis, what is the effect of systemically administered antibiotics as compared to controls on clinical measures of attachment level? The Pub/Med database was searched from 1966 to May 2002. Searches were limited to human studies published in English. Hand searches were performed on the Journal of Clinical Periodontology, Journal of Periodontology, and Journal of Periodontal Research. References in relevant papers and review articles were also examined. Trials were selected if they met the following criteria: randomized controlled clinical trials, quasi-experimental studies, and cohort studies of > 1 month duration with a comparison group; subjects with aggressive, chronic, or recurrent periodontitis and periodontal abscess; use of a single or a combination of systemically administered antibiotics(s) versus non-antibiotic therapy; and a primary outcome of mean attachment level change (AL). Studies involving the use of low-dose doxycycline, combinations of locally plus systemic antibiotics, or where the control group included a systemically administered antibiotic were excluded. A mean difference in AL between groups was available for all papers used in the meta-analysis. A standard deviation (SD) for the difference was used if provided or calculated from the SD or standard error of the mean (SEM) when provided for single measurements. Data were subset by antibiotic employed, type of adjunctive therapy, and disease type. Results were assessed with both fixed-effects and random-effects models. 1. Twenty-nine studies, 26 RCTs and 3 quasi

  4. Genetically engineered bifidobacterium as a drug delivery system for systemic therapy of metastatic breast cancer patients.

    Science.gov (United States)

    Fujimori, Minoru

    2006-01-01

    A fundamental obstacle in systemic therapy for metastatic breast cancer patients is specific targeting of therapy directly to a solid tumor. Hypoxic or necrotic regions are characteristic of solid tumors in many murine and human tumors, including the majority of primary tumors of the breast. A strain of anaerobic bacteria such as Bifidobacterium or Clostridium selectively localizes to and proliferates in solid tumors after systemic application. Another approach uses attenuated Salmonella strains that need tumor-specific nutrients to selectively proliferate and is a potential gene delivery system. We constructed a plasmid, pBLES100-S-eCD, which included the cytosine deaminase gene. Transfected Bifidobacterium longum produced cytosine deaminase in the hypoxic tumor. Enzyme/pro-drug therapy was confirmed to be effective for systemic administration.

  5. Pancreatic Cancer Gene Therapy: From Molecular Targets to Delivery Systems

    Directory of Open Access Journals (Sweden)

    Maria Victoria Maliandi

    2011-01-01

    Full Text Available The continuous identification of molecular changes deregulating critical pathways in pancreatic tumor cells provides us with a large number of novel candidates to engineer gene-targeted approaches for pancreatic cancer treatment. Targets—both protein coding and non-coding—are being exploited in gene therapy to influence the deregulated pathways to facilitate cytotoxicity, enhance the immune response or sensitize to current treatments. Delivery vehicles based on viral or non-viral systems as well as cellular vectors with tumor homing characteristics are a critical part of the design of gene therapy strategies. The different behavior of tumoral versus non-tumoral cells inspires vector engineering with the generation of tumor selective products that can prevent potential toxic-associated effects. In the current review, a detailed analysis of the different targets, the delivery vectors, the preclinical approaches and a descriptive update on the conducted clinical trials are presented. Moreover, future possibilities in pancreatic cancer treatment by gene therapy strategies are discussed.

  6. The Cocreation of Crazy Patchworks: Becoming Rhizomatic in Systemic Therapy.

    Science.gov (United States)

    Sermijn, Jasmina; Loots, Gerrit

    2015-09-01

    In the field of systemic therapy, there has been much discussion recently about the narrative self. This concept refers to the idea that the self is narratively constructed in and through the stories which someone tells about him/herself. The story is thereby not only viewed as a metaphor for selfhood: Selfhood is not compared to a story, it is a story. But what kind of story are we talking about here? If the self is a story, what does that story look like? These questions are explored in this article. Starting from the possibilities and limitations of traditional and postmodern visions on the self as a story, an alternative vision is illustrated. By considering the self as a rhizomatic story, we not only create a useful view of the way narrative selfhood is constructed within a therapy context, but we also stimulate therapists to coconstruct-together with their clients-patchworks of self-stories. By using story fragments of our own practice, we illustrate the rhizomatic thinking and its possibilities in therapy. © 2015 Family Process Institute.

  7. EXPERIENCE WITH A HISTOSCANNING APPARATUS USED IN THE DIAGNOSIS OF RECURRENT PROSTATE CANCER AFTER HIFU ABLATION

    Directory of Open Access Journals (Sweden)

    P. V. Glybochko

    2012-01-01

    Full Text Available The new potentialities of 3D transrectal ultrasound study were realized in a HistoScanning diagnostic unit. It has been used at the R.M. Fronshtein Urology Clinic, Research Institute of Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, since September 2011. A study of the sensitivity and specificity of the technique enrolled patients undergoing high-intensity focused ultrasound (HIFU ablation of the prostate of for its (PC in the period 1 to 7 years. Prostate biopsy study with subsequent histology was made to confirm the results of histoscanning. Statistical processing of the obtained data showed that the sensitivity and specificity of histoscanning were 96 −100 and 87.5 −100%, respectively. These results allow one to appreciate histoscanning as a highly sensitive technique that advantageously differs in its significance level and informative value from now routinely used methods. The study on the possibility of planning and monitoring patients after focal treatments for PC opens up great prospects in achieving a balance between the radicality of performed surgery and the maintenance of quality of life in patients.

  8. Calibration of HIFU intensity fields measured using an infra-red camera

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, A [Acoustics and Ionising Radiation Division, National Physical Laboratory, Teddington TW11 0LW (United Kingdom); Khokhlova, V; Bobkova, S [Department of Acoustics, Physics Faculty, Moscow State University, Moscow 119991 (Russian Federation); Gavrilov, L [N.N. Andreev Acoustics Institute, 117036 Moscow (Russian Federation); Hand, J, E-mail: vera@acs366.phys.msu.ru [Imaging Sciences Department, Imperial College London (Hammersmith Hospital Campus), London W12 0NN (United Kingdom)

    2011-02-01

    A trend in HIFU technologies is to use 2D phased arrays that offer electronic steering of a single focus and formation of patterns of multiple foci. Conventional methods to characterize array fields using scanned hydrophone would be prohibitively slow given the potentially large number of focusing conditions. An alternative technique for rapid qualitative assessment of intensity distributions was recently developed. The method is based on infrared camera measurements of the temperature rises induced by low amplitude short ultrasonic bursts in a thin absorber. Here, the method is extended to estimate the absolute values of intensity in a field of a 2D 1-MHz randomized phased array. Two approaches were implemented. In the first approach it was assumed that the measured temperature rise at the surface of the absorber is proportional to the free field intensity. The second approach correlated the temperature rise measured in an absorber and calculated from the modelled acoustic field and the heat transfer equation. Corresponding correction factors between the free field intensity and temperature was obtained and introduced in the conversion of temperature images to intensity. Free field distributions in water and focusing through ribs were recorded and simulated. Good correlation between the measured and modeled results in both spatial distributions and the absolute values of intensity was demonstrated.

  9. EXPERIENCE WITH A HISTOSCANNING APPARATUS USED IN THE DIAGNOSIS OF RECURRENT PROSTATE CANCER AFTER HIFU ABLATION

    Directory of Open Access Journals (Sweden)

    P. V. Glybochko

    2014-08-01

    Full Text Available The new potentialities of 3D transrectal ultrasound study were realized in a HistoScanning diagnostic unit. It has been used at the R.M. Fronshtein Urology Clinic, Research Institute of Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, since September 2011. A study of the sensitivity and specificity of the technique enrolled patients undergoing high-intensity focused ultrasound (HIFU ablation of the prostate of for its (PC in the period 1 to 7 years. Prostate biopsy study with subsequent histology was made to confirm the results of histoscanning. Statistical processing of the obtained data showed that the sensitivity and specificity of histoscanning were 96 −100 and 87.5 −100%, respectively. These results allow one to appreciate histoscanning as a highly sensitive technique that advantageously differs in its significance level and informative value from now routinely used methods. The study on the possibility of planning and monitoring patients after focal treatments for PC opens up great prospects in achieving a balance between the radicality of performed surgery and the maintenance of quality of life in patients.

  10. A New Model of Thermal Propagation in Human Tissue by Using HIFU Application

    CERN Document Server

    Hajian, Saeed Reza; Pouladian, Majid; Hemmasi, Gholam Reza

    2016-01-01

    In outside the body HIFU treatment that focused ultrasound beams hit severely with cancer tissue layer especially the soft one, at the time of passage of the body different layers as long as they want to reach tumor, put their own way components under mechanical and even thermal influence and they can cause skin lesions. To reduce this effect a specific mechanical model can be used that means body tissue is considered as a mechanical model, it is affected when passing sound mechanical waves through it and each layer has an average heat. Gradually sound intensity decreases through every layer passage, finally in one direction a decreased intensity sound reach tumor tissue. If sound propagated directions increase, countless waves with decreased intensity are gathered upon the tumor tissue that causes a lot of heat focus on tumor tissue. Depending on the kind and mechanical properties of the tissue, intensity of each sound wave when it passes through tissue can be controlled to reduce damages outside the tumor t...

  11. Development of drug delivery systems for radionuclide therapy using a combination therapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, On Hee; Choi, Sun Ju [Korea Atomic Energy Research Institute, Taejon (Korea, Republic of)

    2005-07-01

    For the development of new controlled drug delivery systems, the application of combination therapy using angiogenesis inhibitor and tumor static agents has drawn great attention. This approach would be very beneficial for cancer treatment especially when a new drug deliver system utilizing biodegradable polymers is developed. Therefore, the present study for the combination therapy of angiogenesis inhibitor and chemotherapeutic agents was to carry out prior to the development of the novel drug delivery. In present study, the ability of inhibition on cell growth was investigated with treatment of anti-angiogenetic agent and anticancer agent. Thalidomide was used as an antivasculatory agents and Doxorubicine was treated as a chemotherapeutic agent. To demonstrate apoptotic process in in-vitro study, TUNEL assay was carried out. Also, the alteration of p53 level was examined by using western blotting. For the cell lines, NIH:OVCAR3, MKN45, SNU719, C6, L929, T98G, Hep3B and Calu6 were applied. Results showed that Thalidomide inhibited cell growth in tumor cell lines in a dose-dependent manner and Doxorubicin as well. A significant synergistic effect on the apoptotic was noticed in the combination treatment of Thalidomide and Doxorubicin compared to a single treatment of either drug. Therefore, it can be concluded that the mechanism of cytotoxicity was due to the enhancement of apoptosis in early cell death with combination treatment in tumor cell lines.

  12. A novel diode laser system for photodynamic therapy

    DEFF Research Database (Denmark)

    Samsøe, E.; Andersen, P. E.; Petersen, P.

    2001-01-01

    In this paper a novel diode laser system for photodynamic therapy is demonstrated. The system is based on linear spatial filtering and optical phase conjugate feedback from a photorefractive BaTiO3 crystal. The spatial coherence properties of the diode laser are significantly improved. The system...... provides an almost diffraction limited output which is efficiently coupled into a 50 mum core diameter fiber. The optical power transmitted through the fiber is increased by a factor of six when the feedback is applied to the diode laser. 85 percent of the power from the freely running laser diode...... is extracted in a high-quality beam and 80 percent of the output power is extracted through the fiber. The power transmitted through tile fiber scales linearly with the power of the laser diode. which means that a laser diode emitting 1.7 W multi-mode radiation would provide 1 W of optical power through a 50...

  13. Gas-filled phospholipid nanoparticles conjugated with gadolinium play a role as a potential theragnostics for MR-guided HIFU ablation.

    Directory of Open Access Journals (Sweden)

    Se-Young Choi

    Full Text Available To develop a long-circulating theragnostics, meaning therapeutics and diagnostics for MR-guided HIFU ablation, we designed and prepared Gd-C(5F(12-phospholipid nanobubbles (PLNs 30-100 nm in diameter. The biochemical and physical characterization of Gd-C(5F(12-PLNs were performed. Since Gd-C(5F(12-PLN-50 (Φ = 50 nm and Gd-C(5F(12-PLN-100 (Φ = 100 nm enhanced the hyperthermal effect of HIFU size- and concentration-dependently in a tissue-mimicking phantom, its circulation, distribution, tumor accumulation and tumor ablation were examined in tumor-bearing mice. The plasma-half life of Gd-C(5F(12-PLNs was longer than 1.5 hrs. Gd-C(5F(12-PLNs mainly accumulated in the liver and the spleen, suggesting that they are slowly secreted through the hepatobiliary pathway. Monitored by the T1 signal intensity of MR, Gd-C(5F(12-PLNs accumulated in tumor tissues for 8 hours in mice. HIFU with Gd-C(5F(12-PLN-100 showed the increased tumor ablation area as compared with HIFU alone. The results suggest that Gd-C(5F(12-PLNs exhibit a potential theragnostics for MR-guided HIFU ablation.

  14. B-cell-depleting Therapy in Systemic Lupus Erythematosus

    Science.gov (United States)

    Ramos-Casals, Manuel; Sanz, Iñaki; Bosch, Xavier; Stone, John H.; Khamashta, Munther A.

    2014-01-01

    The emergence of a new class of agents (B-cell-depleting therapies) has opened a new era in the therapeutic approach to systemic lupus erythematosus, with belimumab being the first drug licensed for use in systemic lupus erythematosus in more than 50 years. Four agents deserve specific mention: rituximab, ocrelizumab, epratuzumab, and belimumab. Controlled trials have shown negative results for rituximab, promising results for epratuzumab, and positive results for belimumab. Despite these negative results, rituximab is the most-used agent in patients who do not respond or are intolerant to standard therapy and those with life-threatening presentations. B-cell-depleting agents should not be used in patients with mild disease and should be tailored according to individual patient characteristics, including ethnicity, organ involvement, and the immunological profile. Forthcoming studies of B-cell-directed strategies, particularly data from investigations of off-label rituximab use and postmarketing studies of belimumab, will provide new insights into the utility of these treatments in the routine management of patients with systemic lupus erythematosus. PMID:22444096

  15. System supporting behavioral therapy for children with autism

    Directory of Open Access Journals (Sweden)

    Małgorzata Jȩdrzejewska-Szczerska

    2015-05-01

    Full Text Available In this paper, a system supporting behavioral therapy for autistic children is presented. The system consists of sensors network, base station and a brooch indicating person's emotional states. The system can be used to measure values of physiological parameters that are associated with changes in the emotional state. In the future, it can be useful to inform the autistic child and the therapist about the emotional state of the interlocutor objectively, on the basis of performed measurements. The selected physiological parameters were chosen during the experiment which was designed and conducted by authors. In this experiment, a group of volunteers under controlled conditions was exposed to a stressful situation caused by the picture or sound. For each of the volunteers, a set of physiological parameters, was recorded, including: skin conductance, heart rate, peripheral temperature, respiration rate and electromyography. The bio-statistical analysis allowed us to discern the proper physiological parameters that are most associated to changes due to emotional state of a patient, such as: skin conductance, temperatures and respiration rate. This allowed us to design electronic sensors network for supporting behavioral therapy for children with autism.

  16. Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids : a pilot study

    NARCIS (Netherlands)

    Vaessen, Hermanus H B; Knuttel, F M; van Breugel, J M M|info:eu-repo/dai/nl/413639975; Ikink, M E; Dieleman, J M|info:eu-repo/dai/nl/304817902; van den Bosch, Maurice|info:eu-repo/dai/nl/182981630; Knape, J T A|info:eu-repo/dai/nl/071757481

    2017-01-01

    BACKGROUND: Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing

  17. Desmoid fibromatosis: MRI features of response to systemic therapy

    Energy Technology Data Exchange (ETDEWEB)

    Sheth, Pooja J.; Subhawong, Ty K. [University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Radiology, Miami, FL (United States); Del Moral, Spencer; Wilky, Breelyn A.; Trent, Jonathan C. [University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, Miami, FL (United States); Cohen, Jonathan [Oncology and Radiation Associates, Miami, FL (United States); Rosenberg, Andrew E. [University of Miami Miller School of Medicine, Department of Pathology, Miami, FL (United States); Temple, H.T. [Center for Orthopedic Innovations, Miami, FL (United States)

    2016-10-15

    Imaging criteria for measuring the response of desmoid fibromatosis to systemic therapy are not well established. We evaluated a series of patients with desmoids who underwent systemic therapy to document magnetic resonance imaging (MRI) features associated with a positive clinical response. This Institutional Review Board-approved retrospective study included 23 patients (mean age 40.5) with 29 extra-abdominal tumors. Therapeutic regimens included cytotoxic chemotherapy (n = 19), targeted therapy (n = 3), and nonsteroid anti-inflammatory drugs (NSAIDS; n = 1). Clinical effects were categorized as progressive disease, stable, or partial response. Maximum tumor dimension (D{sub max}), approximate tumor volume (V{sub Tumor}), and quantitative tumor T2 hyperintensity and contrast enhancement (relative to muscle) for pre- and post-treatment MRIs were compared. Three lesions progressed, 5 lesions were stable, whereas 21 showed a clinical response. D{sub max} decreased more in responders (mean -11.0 %) than in stable/progressive lesions (mean -3.6 and 0 % respectively, p = 0.28, ANOVA); by Response Evaluation Criteria in Solid Tumors (RECIST 1.1) 27 out of 29 lesions were ''stable,'' including the 3 progressive lesions. In responders, V{sub Tumor} change averaged -29.4 %, but -19.2 % and +32.5 % in stable and progressive lesions respectively (p = 0.002, ANOVA); by 3D criteria 14 out of 29 lesions showed a partial response. T2 hyperintensity decreased by 50-54 % in partial response/stable disease, but only by 10 % in progressive lesions (p = 0.049, t test). Changes in contrast enhancement ranged from -23 % to 0 %, but were not statistically significant among response groups (p = 0.37). Change in T2 hyperintensity showed a positive correlation with volumetric change (r = 0.40). Decreases in volume and T2 hyperintensity reflect the positive response of desmoid fibromatosis to systemic therapy; RECIST 1.1 criteria are not sensitive to clinically

  18. Systemic family psychotherapy in China: a qualitative analysis of therapy process.

    Science.gov (United States)

    Liu, Liang; Miller, John K; Zhao, Xudong; Ma, Xiquan; Wang, Jikun; Li, Wentian

    2013-12-01

    Although the procedure of systemic family therapy has been extensively researched in Western culture, few studies on this subject have been conducted in China. The aim of this study was to specify the therapy-delivered interventions in Chinese systemic family therapy and to explore how Western-imported systemic therapy model is delivered in Chinese culture. A qualitative and exploratory research approach was taken in which thematic analysis was used to analyse the transcribed psychotherapy videotapes with Chinese families. Twenty-six hours of video-recorded systemic family therapy sessions from 14 Chinese family cases were sampled. Thematic analysis was used to analyse the transcriptions of therapy sessions and identify therapist-generated interventions in therapy. Frequencies of different interventions were counted, and correspondence analysis (CA) was used to reveal the corresponding relationships between different interventions. Analysis led to two main themes related to therapists-delivered interventions: Therapist's intention and therapy technique. Results revealed 15 types of therapist's intentions and 16 categories of therapy techniques. CA indicated that therapists' intentions changed across different therapy stages and specific techniques were used to achieve corresponding intentions. Interventions delivered in Chinese systemic therapy are mainly adherent with Milan and post-Milan systemic models. Due to the shortage in systemic therapy service in China and Chinese culture advocating reverence to authority, components of psycho-education, guidance, and metaphor are adopted in Chinese systemic practice. Some directions for future research are suggested. © 2012 The British Psychological Society.

  19. Modeling and predicting tissue movement and deformation for high intensity focused ultrasound therapy.

    Directory of Open Access Journals (Sweden)

    Xiangyun Liao

    Full Text Available In ultrasound-guided High Intensity Focused Ultrasound (HIFU therapy, the target tissue (such as a tumor often moves and/or deforms in response to an external force. This problem creates difficulties in treating patients and can lead to the destruction of normal tissue. In order to solve this problem, we present a novel method to model and predict the movement and deformation of the target tissue during ultrasound-guided HIFU therapy.Our method computationally predicts the position of the target tissue under external force. This prediction allows appropriate adjustments in the focal region during the application of HIFU so that the treatment head is kept aligned with the diseased tissue through the course of therapy. To accomplish this goal, we utilize the cow tissue as the experimental target tissue to collect spatial sequences of ultrasound images using the HIFU equipment. A Geodesic Localized Chan-Vese (GLCV model is developed to segment the target tissue images. A 3D target tissue model is built based on the segmented results. A versatile particle framework is constructed based on Smoothed Particle Hydrodynamics (SPH to model the movement and deformation of the target tissue. Further, an iterative parameter estimation algorithm is utilized to determine the essential parameters of the versatile particle framework. Finally, the versatile particle framework with the determined parameters is used to estimate the movement and deformation of the target tissue.To validate our method, we compare the predicted contours with the ground truth contours. We found that the lowest, highest and average Dice Similarity Coefficient (DSC values between predicted and ground truth contours were, respectively, 0.9615, 0.9770 and 0.9697.Our experimental result indicates that the proposed method can effectively predict the dynamic contours of the moving and deforming tissue during ultrasound-guided HIFU therapy.

  20. Mathematical aspects of nutrition systems projecting for dietary therapy

    Directory of Open Access Journals (Sweden)

    G. Krutovyi

    2017-04-01

    Full Text Available The mathematical toolkit created and used for the design of durable nutrition systems aimed at the prevention and therapy of the diseases caused by calcium deficiency is analyzed. In particular, these are: the complex of mathematical models of the expendable diets and methods of the ingredients content optimization in them, mathematical model of daily diets optimization, and formalizationed method of fast and light determination of a diet’s biological value.The ways for the improvement of the developed mathematical toolkit aimed at the creation of the nutrition systems with higher level of both nutrients balance and provision of daily needs in them on the basis of using unconventional floury products enriched with the deficient nutrients, functionals for balancing the connected groups of nutrients are determined, as well as the introduction of aggregated restrictions on these groups of nutrients to the models (both products and rations.

  1. Anti-TNF-Alpha Therapy and Systemic Vasculitis

    Directory of Open Access Journals (Sweden)

    Pierre-André Jarrot

    2014-01-01

    Full Text Available TNF-α is a pleiotropic cytokine, which plays a major role in the pathogenesis of numerous autoimmune and/or inflammatory systemic diseases. Systemic vasculitis constitutes a group of rare diseases, characterized by inflammation of the arterial or venous vessel wall, causing stenosis and thrombosis. Treatment of the different type of vasculitis mainly relies on steroids and immunosuppressive drugs. In case of refractory or relapsing diseases, however, a second line of treatment may be required. Anti-TNF-α drugs have been used in this setting during the last 15 years with inconsistent results. We reviewed herein the use of anti-TNF-α therapy in different kind of vasculitis and concluded that, except for Behcet’s disease, this therapeutic option has not demonstrated significant improvement in the treatment of vasculitis.

  2. Cancer Therapy Based on Nanomaterials and Nanocarrier Systems

    Directory of Open Access Journals (Sweden)

    Weili Qiao

    2010-01-01

    Full Text Available Targeted delivery of drug molecules to tumor tissue is one of the most interesting and challenging endeavors faced in pharmaceutical field, due to the critical and pharmacokinetically specific environment that exists in tumor. Over these years, cancer targeting treatment has been greatly improved by new tools and approaches based on nanotechnology. The review firstly introduces the specific physical and chemical properties of a serial of nanomaterials, such as nanoparticles, micelles, dendrimers, carbon nanotubes, quantum dots, and nanofibers. It then places great emphasis on their application in the field of cancer therapy when they are used as nanocarrier systems. Based on the current status, the paper further discusses the unsolved problems and makes a perspective for the future prospects of the nanocarrier systems.

  3. Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression

    Directory of Open Access Journals (Sweden)

    Yongmei Hou

    2014-03-01

    Full Text Available Objective: To explore the effect of cognitive behavioral therapy (CBT in combination with systemic family therapy (SFT on mild to moderate postpartum depression and sleep quality. Methods: 249 primiparous women with mild to moderate postpartum depression were recruited and randomly assigned to a control group (n=128, which received conventional postpartum care, or to a psychological intervention group (n=121, which received conventional postpartum care combined with psychological intervention. The Edinburgh Postnatal Depression Scale (EPDS and Pittsburgh Sleep Quality Index (PSQI were employed to evaluate depression and sleep quality, respectively. Results: 104 patients in the intervention group and 109 in the control group completed the study. After intervention, the EPDS score, PSQI score, sleep quality score, sleep latency score, sleep duration score, habitual sleep efficiency score, sleep disturbance score, and daytime dysfunction score were significantly lower in the intervention group than in the control group. The EPDS and PSQI scores of each group at different time points after intervention were markedly decreased compared with those before intervention, and the reduction in the intervention group was more evident than that in the control group. Conclusion: CBT in combination with SFT can improve depression and sleep quality in patients with mild to moderate postpartum depression.

  4. The GYMSSA trial: a prospective randomized trial comparing gastrectomy, metastasectomy plus systemic therapy versus systemic therapy alone

    Directory of Open Access Journals (Sweden)

    Berger Ann

    2009-12-01

    Full Text Available Abstract Background The standard of care for metastatic gastric cancer (MGC is systemic chemotherapy which leads to a median survival of 6-15 months. Survival beyond 3 years is rare. For selected groups of patients with limited MGC, retrospective studies have shown improved overall survival following gastrectomy and metastasectomies including peritoneal stripping with continuous hyperthermic peritoneal perfusion (CHPP, liver resection, and pulmonary resection. Median survival after liver resection for MGC is up to 34 months, with a five year survival rate of 24.5%. Similarly, reported median survival after pulmonary resection of MGC is 21 months with long term survival of greater than 5 years a possibility. Several case reports and small studies have documented evidence of long-term survival in select individuals who undergo CHPP for MGC. Design The GYMSSA trial is a prospective randomized trial for patients with MGC. It is designed to compare two therapeutic approaches: gastrectomy with metastasectomy plus systemic chemotherapy (GYMS versus systemic chemotherapy alone (SA. Systemic therapy will be composed of the FOLFOXIRI regimen. The aim of the study is to evaluate overall survival and potential selection criteria to determine those patients who may benefit from surgery plus systemic therapy. The study will be conducted by the Surgery Branch at the National Cancer Institute (NCI, National Institutes of Health (NIH in Bethesda, Maryland. Surgeries and followup will be done at the NCI, and chemotherapy will be given by either the local oncologist or the medical oncology branch at NCI. Trial Registration ClinicalTrials.gov ID. NCT00941655

  5. Can radiation therapy treatment planning system accurately predict surface doses in postmastectomy radiation therapy patients?

    Science.gov (United States)

    Wong, Sharon; Back, Michael; Tan, Poh Wee; Lee, Khai Mun; Baggarley, Shaun; Lu, Jaide Jay

    2012-01-01

    Skin doses have been an important factor in the dose prescription for breast radiotherapy. Recent advances in radiotherapy treatment techniques, such as intensity-modulated radiation therapy (IMRT) and new treatment schemes such as hypofractionated breast therapy have made the precise determination of the surface dose necessary. Detailed information of the dose at various depths of the skin is also critical in designing new treatment strategies. The purpose of this work was to assess the accuracy of surface dose calculation by a clinically used treatment planning system and those measured by thermoluminescence dosimeters (TLDs) in a customized chest wall phantom. This study involved the construction of a chest wall phantom for skin dose assessment. Seven TLDs were distributed throughout each right chest wall phantom to give adequate representation of measured radiation doses. Point doses from the CMS Xio® treatment planning system (TPS) were calculated for each relevant TLD positions and results correlated. There were no significant difference between measured absorbed dose by TLD and calculated doses by the TPS (p > 0.05 (1-tailed). Dose accuracy of up to 2.21% was found. The deviations from the calculated absorbed doses were overall larger (3.4%) when wedges and bolus were used. 3D radiotherapy TPS is a useful and accurate tool to assess the accuracy of surface dose. Our studies have shown that radiation treatment accuracy expressed as a comparison between calculated doses (by TPS) and measured doses (by TLD dosimetry) can be accurately predicted for tangential treatment of the chest wall after mastectomy. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  6. MO-AB-210-02: Ultrasound Imaging and Therapy-Hands On Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Sammet, S. [University of Chicago Medical Center (United States)

    2015-06-15

    The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS

  7. MO-AB-210-01: Ultrasound Imaging and Therapy-Hands On Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Z. [University of Chicago (United States)

    2015-06-15

    The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS

  8. Prostate cancer transrectal HIFU ablation: detection of local recurrences using T2-weighted and dynamic contrast-enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Rouviere, Olivier; Lyonnet, Denis [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Lyon (France); Universite de Lyon, Lyon (France); Universite de Lyon 1, Faculte de medecine Lyon Nord, Lyon (France); Inserm, U556, Lyon (France); Girouin, Nicolas; Glas, Ludivine; Ben Cheikh, Alexandre [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Lyon (France); Universite de Lyon, Lyon (France); Universite de Lyon 1, Faculte de medecine Lyon Nord, Lyon (France); Gelet, Albert [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Urology, Lyon (France); Inserm, U556, Lyon (France); Mege-Lechevallier, Florence [Hopital Edouard Herriot, Hospices Civils de Lyon, Department of Pathology, Lyon (France); Rabilloud, Muriel [Hospices Civils de Lyon, Department of Biostatistics, Lyon (France); Universite de Lyon 1, UMR CNRS, Laboratoire Biostatistiques-Sante, Pierre-Benite (France); Chapelon, Jean-Yves [Inserm, U556, Lyon (France)

    2010-01-15

    The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies (''routine biopsies''); operator 2 obtained up to three cores per suspicious lesion on MRI (''targeted biopsies''). Seventy-seven suspicious lesions were detected on DCE images (n=52), T2w images (n=2) or both (n=23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p=0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p<0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue. (orig.)

  9. Design and Fabrication of a Wide-Aperture HIFU Annular Array Transducer for the Treatment of Deep-Seated Tumors

    Science.gov (United States)

    Chen, Gin-Shin; Chang, Hsu; Kuo, Yi-Yuan; Lin, Winli; Chen, Wen-Shiang; Tseng, Wen-Yih

    2011-09-01

    In HIFU treatment applications, the annular array transducer is a feasible solution for the clinical/engineering requirements which are as follows: ablation of tumors deep inside body, electronic dynamic focusing in the depth direction, simple configuration/operation, and lower cost due to fewer elements/channels of amplifier. A 12 cm-diameter, 12 cm-radius-of-curvature annular array transducer has been developed in this study. The pseudo-inverse method was adopted to calculate the desired phase of each element for focusing, and the Rayleigh-Summerfield integral was used to obtain the ultrasonic pressure field. In the simulation, the operating frequency was 0.9 MHz, and the acoustic medium was water. A piece of 1-3 piezocomposite was fabricated using the dice and fill technique for the pilot test. The dimension of the sample was 4×2 cm, and it was thermally shaped using a spherical mold of 12 cm in radius. The results of the simulation showed that the focus could not be moved electronically in the depth direction until the number of elements (annuli) was equal to or higher than 5, and the dynamic focusing range increased as the number of elements increased. The intensity at the acoustic window or skin was also estimated from the simulated results and was only 0.03% of the intensity at focus. The curved composite sample was tested using an impedance analyser and a radiation force balance. The resonant frequency and electro-acoustic efficiency were measured to be 0.914 MHz and 65%, respectively. The results of the simulation can provide a design guideline for the development of different-size HIFU annular array transducers. A prototype of the HIFU annular array transducer designed is being fabricated in-house.

  10. Brachytherapy with an improved MammoSite Radiation Therapy System

    Science.gov (United States)

    Karthik, Nanda; Keppel, Cynthia; Nazaryan, Vahagn

    2007-03-01

    Accelerated partial breast irradiation treatment utilizing the MammoSite Radiation Therapy System (MRTS) is becoming increasingly popular. Clinical studies show excellent results for disease control and localization, as well as for cosmesis. Several Phase I, II, and III clinical trials have found significant association between skin spacing and cosmetic results after treatment with MRTS. As a result, patients with skin spacing less then 7 mm are not recommended to undergo this treatment. We have developed a practical innovation to the MammoSite brachytherapy methodology that is directed to overcome the skin spacing problem. The idea is to partially shield the radiation dose to the skin where the skin spacing is less then 7 mm, thereby protecting the skin from radiation damage. Our innovation to the MRTS will allow better cosmetic outcome in breast conserving therapy (BCT), and will furthermore allow more women to take advantage of BCT. Reduction in skin radiation exposure is particularly important for patients also undergoing adjuvant chemotherapy. We will present the method and preliminary laboratory and Monte Carlo simulation results.

  11. Evaluation of HIFU-induced lesion region using temperature threshold and equivalent thermal dose methods

    Science.gov (United States)

    Chang, Shihui; Xue, Fanfan; Zhou, Wenzheng; Zhang, Ji; Jian, Xiqi

    2017-03-01

    Usually, numerical simulation is used to predict the acoustic filed and temperature distribution of high intensity focused ultrasound (HIFU). In this paper, the simulated lesion volumes obtained by temperature threshold (TRT) 60 °C and equivalent thermal dose (ETD) 240 min were compared with the experimental results which were obtained by animal tissue experiment in vitro. In the simulation, the calculated model was established according to the vitro tissue experiment, and the Finite Difference Time Domain (FDTD) method was used to calculate the acoustic field and temperature distribution in bovine liver by the Westervelt formula and Pennes bio-heat transfer equation, and the non-linear characteristics of the ultrasound was considered. In the experiment, the fresh bovine liver was exposed for 8s, 10s, 12s under different power conditions (150W, 170W, 190W, 210W), and the exposure was repeated 6 times under the same dose. After the exposures, the liver was sliced and photographed every 0.2mm, and the area of the lesion region in every photo was calculated. Then, every value of the areas was multiplied by 0.2mm, and summed to get the approximation volume of the lesion region. The comparison result shows that the lesion volume of the region calculated by TRT 60 °C in simulation was much closer to the lesion volume obtained in experiment, and the volume of the region above 60 °C was larger than the experimental results, but the volume deviation was not exceed 10%. The volume of the lesion region calculated by ETD 240 min was larger than that calculated by TRT 60 °C in simulation, and the volume deviations were ranged from 4.9% to 23.7%.

  12. Ex Vivo Characterization of Canine Liver Tissue Viscoelasticity Following High Intensity Focused Ultrasound (HIFU) Ablation

    Science.gov (United States)

    Shahmirzadi, Danial; Hou, Gary Y.; Chen, Jiangang; Konofagou, Elisa E.

    2014-01-01

    Elasticity imaging has shown great promise in detecting High Intensity Focused Ultrasound (HIFU) lesions based on their distinct biomechanical properties. However, quantitative mechanical properties of the tissue and the optimal intensity for obtaining the best contrast parameters remain scarce. In this study, fresh canine livers were ablated using combinations of ISPTA intensities of 5.55, 7.16 and 9.07 kW/cm2 and time durations of 10 and 30 s ex vivo; leading to six groups of ablated tissues. Biopsy samples were then interrogated using dynamic shear mechanical testing within the range of 0.1-10 Hz to characterize the post-ablation tissue viscoelastic properties. All mechanical parameters were found to be frequency dependent. Compared to the unablated cases, all six groups of ablated tissues showed statistically-significant higher complex shear modulus and shear viscosity. However, among the ablated groups, both complex shear modulus and shear viscosity were found to monotonically increase in groups 1-4 (5.55 kW/cm2 for 10 s, 7.16 kW/cm2 for 10 s, 9.07 kW/cm2 & 10 s, and 5.55 kW/cm2 & 30 s, respectively), but decrease in groups 5 and 6 (7.16 kW/cm2 for 30 s, and 9.07 kW/cm2 for 30 s, respectively). For groups 5 and 6, the temperature was expected to exceed the boiling point, and therefore, the decreased stiffening could be due to the compromised integrity of the tissue microstructure. Future studies are needed to estimate the tissue mechanical properties in vivo and perform real-time monitoring of tissue alterations during ablation. PMID:24315395

  13. A feasibility study of soft embalmed human breast tissue for preclinical trials of HIFU- preliminary results

    Science.gov (United States)

    Joy, Joyce; Yang, Yang; Purdie, Colin; Eisma, Roos; Melzer, Andreas; Cochran, Sandy; Vinnicombe, Sarah

    2017-03-01

    Breast cancer is the commonest cancer in women in the UK, accounting for 30% of all new cancers in women, with an estimated 49,500 new cases in 20101. With the widespread negative publicity around over-diagnosis and over-treatment of low risk breast cancers, interest in the application of non-invasive treatments such as magnetic resonance imaging (MRI) guided high intensity focused ultrasound (HIFU) has increased. Development has begun of novel US transducers and platforms specifically designed for use with breast lesions, so as to improve the range of breast lesions that can be safely treated. However, before such transducers can be evaluated in patients in clinical trials, there is a need to establish their efficacy. A particular issue is the accuracy of temperature monitoring of FUS with MRI in the breast, since the presence of large amounts of surrounding fat can hinder temperature measurement. An appropriate anatomical model that imposes similar physical constraints to the breast and that responds to FUS in the same way would be extremely advantageous. The aim of this feasibility study is to explore the use of Thiel embalmed cadaveric tissue for these purposes. We report here the early results of laboratory-based experiments sonicating dissected breast samples from a Thiel embalmed soft human cadaver with high body mass index (BMI). A specially developed MRI compatible chamber and sample holder was developed to secure the sample and ensure reproducible sonications at the transducer focus. The efficacy of sonication was first studied with chicken breast and porcine tissue. The experiments were then repeated with the dissected fatty breast tissue samples from the soft-embalmed human cadavers. The sonicated Thiel breast tissue was examined histopathologically, which confirmed the absence of any discrete lesion. To investigate further, fresh chicken breast tissue was embalmed and the embalmed tissue was sonicated with the same parameters. The results confirmed the

  14. Adverse events of extracorporeal ultrasound-guided high intensity focused ultrasound therapy.

    Directory of Open Access Journals (Sweden)

    Tinghe Yu

    Full Text Available BACKGROUND: High-intensity focused ultrasound (HIFU is considered to be an alternative to surgery. Extracorporeal ultrasound-guided HIFU (USgFU has been clinically used to treat solid tumors. Preliminary trials in a small sample of a Western population suggested that this modality was safe. Most trials are performed in China thereby providing comprehensive data for understanding the safety profile. The aim of this study was to evaluate adverse events of USgFU therapy. METHODS AND FINDINGS: Clinical data were searched in 2 Chinese databases. Adverse events of USgFU were summarized and compared with those of magnetic resonance-guided HIFU (MRgFU; for uterine, bone or breast tumor and transrectal ultrasound-guided HIFU (for prostate cancer or benign prostate hyperplasia. USgFU treatment was performed using 7 types of device. Side effects were evaluated in 13262 cases. There were fewer adverse events in benign lesions than in malignant lesions (11.81% vs. 21.65%, p<0.0001. Rates of adverse events greatly varied between the disease types (0-280%, p<0.0001 and between the applied HIFU devices in both malignant (10.58-44.38%, p<0.0001 and benign lesions (1.67-17.57%, p<0.0001. Chronological analysis did not demonstrate a decrease in the rate of adverse events. Based upon evaluable adverse events, incidences in USgFU were consistent with those in MRgFU or transrectal HIFU. Some side effects frequently occurred following transrectal HIFU were not reported in USgFU. Several events including intrahepatic metastasis, intraoperative high fever, and occlusions of the superior mesenteric artery should be of particular concern because they have not been previously noted. The types of adverse events suggested that they were ultrasonic lesions. CONCLUSION: The frequency of adverse events depended on the location of the lesion and the type of HIFU device; however, side effects of USgFU were not yet understood. USgFU did not decrease the incidence of adverse events

  15. Successful treatment of recurrent pancreatitis secondary to systemic lupus erythematosus with B-cell depletion therapy.

    Science.gov (United States)

    Al-Musawi, Zakiya S; Nabar, Umesh J

    2011-01-01

    Recurrent pancreatitis secondary to systemic lupus erythematosus is a rare entity of unknown etiology. We report an adolescent with systemic lupus erythematosus and recurrent attacks of acute pancreatitis, which were poorly controlled with conventional therapy for approximately four years. Rituximab, a chimeric anti-CD20 monoclonal antibody therapy resulted in remission of symptoms for more than two years without major toxicity of treatment. Based on tolerability and high efficiency of rituximab therapy, we would suggest using B-cell depletion therapy as an alternative therapy for refractory pancreatitis secondary to systemic lupus erythematosus.

  16. SERA - An Advanced Treatment Planning System for Neutron Therapy

    Energy Technology Data Exchange (ETDEWEB)

    C. A. Wemple; C. L. Albright; D. W. Nigg; D. W. Wessol; F. J. Wheeler; G. J. Harkin; M. B. Rossmeirer; M. T. Cohen; M. W. Frandsen

    1999-06-01

    The technology for computational dosimetry and treatment planning for Boron Neutron Capture Therapy (BNCT) has advanced significantly over the past few years. Because of the more complex nature of the problem, the computational methods that work well for treatment planning in photon radiotherapy are not applicable to BNCT. The necessary methods have, however, been developed and have been successfully employed both for research applications as well as human trials. Computational geometry for BNCT applications can be constructed directly from tomographic medical imagery and computed radiation dose distributions can be readily displayed in formats that are familiar to the radiotherapy community. The SERA system represents a significant advance in several areas for treatment planning. However further improvements in speed and results presentation are still needed for routine clinical applications, particularly when optimizations of dose pattern is required.

  17. Genetically engineered biological agents in therapy for systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Elena Aleksandrovna Aseeva

    2013-01-01

    Full Text Available Systemic lupus erythematosus (SLE is a prototype for chronic autoimmune disease. Its prevalence is 20 to 70 cases per 100,000 women and varies by race and ethnicity. Despite considerable progress in traditional therapy, many problems associated with the management of these patients need to be immediately solved: thus, 50-80% are found to have activity signs and/or frequent exacerbations and about 30% of the patients have to stop work; Class IV lupus nephritis increases the risk of terminalrenal failure. In the past 20 years great progress has been made in studying the pathogenesis of SLE: biological targets to affect drugs have been sought and fundamentally new therapeutic goals defined. Belimumab is the first genetically biological agent specially designed to treat SLE, which is rightly regarded as one of the most important achievements of rheumatology in the past 50 years.

  18. Regenerative Therapies for Central Nervous System Diseases: a Biomaterials Approach

    Science.gov (United States)

    Tam, Roger Y; Fuehrmann, Tobias; Mitrousis, Nikolaos; Shoichet, Molly S

    2014-01-01

    The central nervous system (CNS) has a limited capacity to spontaneously regenerate following traumatic injury or disease, requiring innovative strategies to promote tissue and functional repair. Tissue regeneration strategies, such as cell and/or drug delivery, have demonstrated promising results in experimental animal models, but have been difficult to translate clinically. The efficacy of cell therapy, which involves stem cell transplantation into the CNS to replace damaged tissue, has been limited due to low cell survival and integration upon transplantation, while delivery of therapeutic molecules to the CNS using conventional methods, such as oral and intravenous administration, have been limited by diffusion across the blood–brain/spinal cord-barrier. The use of biomaterials to promote graft survival and integration as well as localized and sustained delivery of biologics to CNS injury sites is actively being pursued. This review will highlight recent advances using biomaterials as cell- and drug-delivery vehicles for CNS repair. PMID:24002187

  19. Progress in Psoriasis Therapy via Novel Drug Delivery Systems.

    Science.gov (United States)

    Vincent, Nitha; Ramya, Devi D; Vedha, Hari Bn

    2014-02-17

    Psoriasis is a lifelong condition which is caused by the negative signals produced by immune system, which leads to hyper proliferation and other inflammatory reactions on the skin. In this case, keratinocytes which are the outermost layer of skin possess shortened life cycle and results in the alteration of desquamation process where the cytokines will come out through lesions of affected patients and as a result, scaling marks appears on the skin. These conditions may negatively affect the patient's quality of life and lead to psychosocial stress. Psoriasis can be categorized as mild, moderate and severe conditions. Mild psoriasis leads to the formation of rashes, and when it becomes moderate, the skin turns into scaly. In severe conditions, red patches may be present on skin surface and becomes itchy. Topical therapy continues to be one of the pillars for psoriasis management. Drug molecules with target effect on the skin tissues and other inflammations should be selected for the treatment of psoriasis. Most of the existing drugs lead to systemic intoxication and dryness when applied in higher dose. Different scientific approaches for topical delivery are being explored by researches including emollient, modified gelling system, transdermal delivery, spray, nanogels, hydrogels, micro/nano emulsion, liposomes, nano capsules etc. These topical dosage forms are evaluated for various physico chemical properties such as drug content, viscosity, pH, extrudability, spreadability, toxicity, irritancy, permeability and drug release mechanism. This review paper focus attention to the impact of these formulation approaches on various anti-psoriasis drugs for their successful treatment.

  20. A portable, disposable system for negative-pressure wound therapy.

    Science.gov (United States)

    Brandon, Tanya

    Negative-pressure wound therapy (NPWT) imparts a number of clinical effects that promote a healing response and, as such, is a well-established means of treating a variety of wound types. Historically, the technique has been primarily used in the hospital setting; however, the introduction of more portable devices has led to an increase in the use of NPWT in the homecare setting, thereby facilitating early discharge of patients from hospital and continuity of care in the community. Portable NPWT devices also have the potential to impact positively on patients' quality of life, allowing increased mobility and freedom to undertake normal activities of daily living. Following the development of its standard Avance® NPWT system and associated dressing kits, Mölnlycke Health Care (Gothenburg, Sweden) has introduced a single-patient-use, disposable NPWT system; Avance Solo. This has been developed with a view to maximising patient freedom and mobility, providing a single-patient-use NPWT solution for multi-week treatment to allow quick and easy discharge of patients from hospital to home, and reducing some of the challenges of logistics and administration associated with the provision of NPWT for the caregiver. As with the standard NPWT system, the single-patient use system is supplied with a number of products incorporating Safetac® adhesive technology to minimise the risk of patients suffering unnecessary pain and trauma associated with dressing changes. This article presents a series of case studies describing procedures and outcomes following the application of the Avance Solo single-patient-use system.

  1. Systemic Antibiotic Therapy for Chronic Osteomyelitis in Adults

    Science.gov (United States)

    Lipsky, Benjamin A.

    2012-01-01

    The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy. However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis. Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms. Addition of adjunctive rifampin to other antibiotics may improve cure rates. The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4–6 weeks improves outcomes compared with shorter regimens. In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs. PMID:22157324

  2. Numerical study and ex vivo assessment of HIFU treatment time reduction through optimization of focal point trajectory

    Science.gov (United States)

    Grisey, A.; Yon, S.; Pechoux, T.; Letort, V.; Lafitte, P.

    2017-03-01

    Treatment time reduction is a key issue to expand the use of high intensity focused ultrasound (HIFU) surgery, especially for benign pathologies. This study aims at quantitatively assessing the potential reduction of the treatment time arising from moving the focal point during long pulses. In this context, the optimization of the focal point trajectory is crucial to achieve a uniform thermal dose repartition and avoid boiling. At first, a numerical optimization algorithm was used to generate efficient trajectories. Thermal conduction was simulated in 3D with a finite difference code and damages to the tissue were modeled using the thermal dose formula. Given an initial trajectory, the thermal dose field was first computed, then, making use of Pontryagin's maximum principle, the trajectory was iteratively refined. Several initial trajectories were tested. Then, an ex vivo study was conducted in order to validate the efficicency of the resulting optimized strategies. Single pulses were performed at 3MHz on fresh veal liver samples with an Echopulse and the size of each unitary lesion was assessed by cutting each sample along three orthogonal planes and measuring the dimension of the whitened area based on photographs. We propose a promising approach to significantly shorten HIFU treatment time: the numerical optimization algorithm was shown to provide a reliable insight on trajectories that can improve treatment strategies. The model must now be improved in order to take in vivo conditions into account and extensively validated.

  3. Singapore Cancer Network (SCAN) Guidelines for Systemic Therapy of Colorectal Cancer.

    Science.gov (United States)

    2015-10-01

    The SCAN colorectal cancer systemic therapy workgroup aimed to develop Singapore Cancer Network (SCAN) clinical practice guidelines for systemic therapy for colorectal cancer in Singapore. The workgroup utilised a modified ADAPTE process to calibrate high quality international evidence-based clinical practice guidelines to our local setting. Five international guidelines were evaluated-those developed by the National Comprehensive Cancer Network for colon (2014) and rectal (2014) cancer, the European Society of Medical Oncology for advanced (2012) and early (2013) cancer and the National Institute of Clinical Excellence (2011). Recommendations on systemic therapy in colorectal cancer were produced. These adapted guidelines form the SCAN Guidelines 2015 for systemic therapy of colorectal cancer.

  4. Securing Communication in Ambient Networks for Speech Therapy Systems

    Directory of Open Access Journals (Sweden)

    ZAHARIA, M. H.

    2007-11-01

    Full Text Available One of the most present issues of computer wireless networks is the security. Comparing with their wired counterpart, the wireless networks not only accentuate some of the well-known security vulnerabilities but they are subject of new and specific ones. Among the existing wireless networks the ad hoc ones are the most exposed to attacks and collusions due to the absence of any centralized control. The most efficient way to ensure the communication secrecy, inclusively for ad hoc wireless networks, is the cryptography. From many reasons, following from specific operating conditions, the employment of asymmetric key techniques and Public Key Infrastructure is not a realistic choice. In the networks with a large number of nodes, as wireless sensor networks, a large number of secret keys are involved in order to ensure the communication secrecy. While dynamicity is one of the essential features of mobile wireless networks, when nodes may leave or join the network and in the absence of a centralized control entity, the management of secret keys is crucial. The paper presents the main aspects of mobile wireless networks security and focuses on the key management issue in ad-hoc wireless networks.In this paper the problem of securing mobile devices used in ambient networks for speech therapy is presented. The main target consists in making various mobile devices involved in speech therapy to maintain both the confidentiality of personal data of the patient and also to avoid interference when simultaneous communicate with the control center. Due to non-technical type of user all password management will be made automatic by the control system. As result the mobile device will have a user transparent security layer added. The problem of people from isolated community treatment is also solved by this approach.

  5. Genetic Predictors of Response to Systemic Therapy in Esophagogastric Cancer.

    Science.gov (United States)

    Janjigian, Yelena Y; Sanchez-Vega, Francisco; Jonsson, Philip; Chatila, Walid K; Hechtman, Jaclyn F; Ku, Geoffrey Y; Riches, Jamie C; Tuvy, Yaelle; Kundra, Ritika; Bouvier, Nancy; Vakiani, Efsevia; Gao, Jianjiong; Heins, Zachary J; Gross, Benjamin E; Kelsen, David P; Zhang, Liying; Strong, Vivian E; Schattner, Mark; Gerdes, Hans; Coit, Daniel G; Bains, Manjit; Stadler, Zsofia K; Rusch, Valerie W; Jones, David R; Molena, Daniela; Shia, Jinru; Robson, Mark E; Capanu, Marinela; Middha, Sumit; Zehir, Ahmet; Hyman, David M; Scaltriti, Maurizio; Ladanyi, Marc; Rosen, Neal; Ilson, David H; Berger, Michael F; Tang, Laura; Taylor, Barry S; Solit, David B; Schultz, Nikolaus

    2018-01-01

    The incidence of esophagogastric cancer is rapidly rising, but only a minority of patients derive durable benefit from current therapies. Chemotherapy as well as anti-HER2 and PD-1 antibodies are standard treatments. To identify predictive biomarkers of drug sensitivity and mechanisms of resistance, we implemented prospective tumor sequencing of patients with metastatic esophagogastric cancer. There was no association between homologous recombination deficiency defects and response to platinum-based chemotherapy. Patients with microsatellite instability-high tumors were intrinsically resistant to chemotherapy but more likely to achieve durable responses to immunotherapy. The single Epstein-Barr virus-positive patient achieved a durable, complete response to immunotherapy. The level of ERBB2 amplification as determined by sequencing was predictive of trastuzumab benefit. Selection for a tumor subclone lacking ERBB2 amplification, deletion of ERBB2 exon 16, and comutations in the receptor tyrosine kinase, RAS, and PI3K pathways were associated with intrinsic and/or acquired trastuzumab resistance. Prospective genomic profiling can identify patients most likely to derive durable benefit to immunotherapy and trastuzumab and guide strategies to overcome drug resistance. Significance: Clinical application of multiplex sequencing can identify biomarkers of treatment response to contemporary systemic therapies in metastatic esophagogastric cancer. This large prospective analysis sheds light on the biological complexity and the dynamic nature of therapeutic resistance in metastatic esophagogastric cancers. Cancer Discov; 8(1); 49-58. ©2017 AACR. See related commentary by Sundar and Tan, p. 14 See related article by Pectasides et al., p. 37 This article is highlighted in the In This Issue feature, p. 1 . ©2017 American Association for Cancer Research.

  6. Oral Nano-Delivery Systems for Colon Targeting Therapy.

    Science.gov (United States)

    Zhang, Tianxu; Zhu, Guanyin; Lu, Boyao; Peng, Qiang

    2017-01-01

    Targeting drug delivery is an attractive research area, as it enables localized treatment, improves the efficacy of therapeutics and reduces systemic toxicity. Colon targeting delivery is particularly beneficial to the treatment of colon diseases, such as inflammatory bowel disease and colon cancer, due to the improved local drug concentrations. The traditional strategies for colon targeting delivery include time-dependent and pH-dependent technologies, etc. In recent years, nanotechnology has emerged as a novel and efficient tool for targeting drug delivery. After oral administration, nano-based formulations are able to protect drug from the harsh gastrointestinal environment and selectively increase the drug concentration at the disease site. Various orally administered drug-loaded nano-systems for colon targeting delivery have been well documented and shown great potentials in colon disease therapy. In this work, we aim to provide a comprehensive understanding of the recent progress in the area of colon targeting delivery in combination with introduction of the pathophysiological changes of diseased colon sites and the obstacles for drug delivery. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  7. Lab-on-a-chip systems for photodynamic therapy investigations.

    Science.gov (United States)

    Chudy, Michał; Tokarska, Katarzyna; Jastrzębska, Elżbieta; Bułka, Magdalena; Drozdek, Sławomir; Lamch, Łukasz; Wilk, Kazimiera A; Brzózka, Zbigniew

    2018-03-15

    In recent years photodynamic therapy (PDT) has received widespread attention in cancer treatment due to its smaller surgical trauma, better selectivity towards tumor cells, reduced side effects and possibility of repeatable treatment. Since cancer is the second cause of death worldwide, scientists constantly seek for new potential therapeutic agents including nanotechnology-based photosensitizers used in PDT. The new-designed nanostructures must be carefully studied and well characterized what require analytically useful and powerful tools that enable real progress in nanoscience development. This review describes the current status of PDT investigations using microfluidic Lab-on-a-Chip systems, including recent developments of nanoparticle-based PDT agents, their combinations with different drugs, designs and examples of in vitro applications. This review mainly lays emphasis on biological evaluation of FDA approved photosensitizing agents as well as newly designed nanophotosensitizers. It also highlights the analytical performances of various microfluidic Lab-on-a-chip systems for PDT efficacy analysis on 3D culture and discusses microsystems designs in detail. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Radiant{trademark} Liquid Radioisotope Intravascular Radiation Therapy System

    Energy Technology Data Exchange (ETDEWEB)

    Eigler, N.; Whiting, J.; Chernomorsky, A.; Jackson, J.; Knapp, F.F., Jr.; Litvack, F.

    1998-01-16

    RADIANT{trademark} is manufactured by United States Surgical Corporation, Vascular Therapies Division, (formerly Progressive Angioplasty Systems). The system comprises a liquid {beta}-radiation source, a shielded isolation/transfer device (ISAT), modified over-the-wire or rapid exchange delivery balloons, and accessory kits. The liquid {beta}-source is Rhenium-188 in the form of sodium perrhenate (NaReO{sub 4}), Rhenium-188 is primarily a {beta}-emitter with a physical half-life of 17.0 hours. The maximum energy of the {beta}-particles is 2.1 MeV. The source is produced daily in the nuclear pharmacy hot lab by eluting a Tungsten-188/Rhenium-188 generator manufactured by Oak Ridge National Laboratory (ORNL). Using anion exchange columns and Millipore filters the effluent is concentrated to approximately 100 mCi/ml, calibrated, and loaded into the (ISAT) which is subsequently transported to the cardiac catheterization laboratory. The delivery catheters are modified Champion{trademark} over-the-wire, and TNT{trademark} rapid exchange stent delivery balloons. These balloons have thickened polyethylene walls to augment puncture resistance; dual radio-opaque markers and specially configured connectors.

  9. [Systemic approach in therapy and counselling with adolescents].

    Science.gov (United States)

    Eggemann-Dann, Hans-Werner; Fryszer, Andreas

    2010-01-01

    To work with adolescents and their contexts usually means to face certain problems: Parents or teacher want the adolescent to do a counselling or a therapy, the adolescent is not motivated or does not have much of an idea what this means. The problem often causes conflicts between the adolescent and the persons of his context. Typical conflict communication develops that blocks good solution-finding and constructive developments and usually is re-enacted in the therapeutic or counselling session. The systemic methods presented are useful to block dysfunctional conflict communications. In a conflict-ridden situation, the members of the family usually try to form coalitions with the professional or at least try to find out witch party the counsellor might join. To avoid traps like these and enhance productive change there are a number of very useful methods developed or adapted by the authors. The use of these special methods in the communication with the adolescent or the adolescent and his system is discussed in the article. The Authors also describe which attitudes are useful in the role of a counsellor or a therapist.

  10. Pancreatic cancer: systemic combination therapies for a heterogeneous disease.

    Science.gov (United States)

    Melisi, Davide; Calvetti, Lorenzo; Frizziero, Melissa; Tortora, Giampaolo

    2014-01-01

    Pancreatic cancer is the only human malignancy for which patients' survival has not improved substantially during the past 30 years. Despite advances in the comprehension of the molecular mechanisms underlying pancreatic carcinogenesis, current systemic treatments offer only a modest benefit in tumor-related symptoms and survival. Over the past decades, gemcitabine and its combination with other standard cytotoxic agents have been the reference treatments for advanced pancreatic cancer patients. The recent introduction of the three-drug combination regimen FOLFIRINOX or the new taxane nab-paclitaxel represent key advances for a better control of the disease. Novel agents targeting molecular mechanisms involved in cancer development and maintenance are currently under clinical investigation. This review describes the most important findings in the field of systemic combination therapies for the treatment of pancreatic cancer. We discuss the emerging evidences for the clinical activity of combination treatments with standard chemotherapy plus novel agents targeting tumor cell-autonomous and tumor microenvironment signaling pathways. We present some of the most important advances in the comprehension of the molecular mechanisms responsible for the chemoresistance of pancreatic cancer and the emerging therapeutic targets to overcome this resistance.

  11. Progress in psoriasis therapy via novel drug delivery systems

    Directory of Open Access Journals (Sweden)

    Nitha Vincent

    2014-09-01

    Full Text Available Psoriasis is a lifelong condition which is caused by the negative signals produced by immune system, which leads to hyper proliferation and other inflammatory reactions on the skin. In this case, keratinocytes which are the outermost layer of skin possess shortened life cycle and results in the alteration of desquamation process where the cytokines will come out through lesions of affected patients and as a result, scaling marks appears on the skin. These conditions may negatively affect the patient’s quality of life and lead to psychosocial stress. Psoriasis can be categorized as mild, moderate and severe conditions. Mild psoriasis leads to the formation of rashes, and when it becomes moderate, the skin turns into scaly. In severe conditions, red patches may be present on skin surface and becomes itchy. Topical therapy continues to be one of the pillars for psoriasis management. Drug molecules with target effect on the skin tissues and other inflammations should be selected for the treatment of psoriasis. Most of the existing drugs lead to systemic intoxication and dryness when applied in higher dose. Different scientific approaches for topical delivery are being explored by researches including emollient, modified gelling system, transdermal delivery, spray, nanogels, hydrogels, micro/nano emulsion, liposomes, nano capsules etc. These topical dosage forms are evaluated for various physico chemical properties such as drug content, viscosity, pH, extrudability, spreadability, toxicity, irritancy, permeability and drug release mechanism. This review paper focus attention to the impact of these formulation approaches on various anti-psoriasis drugs for their successful treatment.

  12. [Addiction and brief-systemic therapy: working with compulsion].

    Science.gov (United States)

    Cottencin, O; Doutrelugne, Y; Goudemand, M; Consoli, S M

    2009-06-01

    In our daily practice in public hospitals, we are regularly confronted with the paradox of helping patients, who do not ask for help. Although the French law is clearly defined to allow us to treat patients suffering from psychiatric conditions, who are unable to give their consent, it is not the case for those with addictive disorders. In fact, their disorder does not always (or does not yet) justify treatment without their consent, according to the 1990 law (psychiatric treatment without the patient's consent). However, many of them are referred to us because a third party has forced them (spouse, general practitioner, treatment order) and even though some patients consult spontaneously, they often do so more "for others" than for themselves. Because of this, the therapist (doctor, psychologist or nurse), in addition to the paradox of treating patients who do not ask for treatment, find themselves in a situation with two-fold compulsion, fixed by the social (or family) setting, both as a helper and as a coercive agent, thus, putting the fundamental concepts of treatment into question. A therapeutic agreement, free-will and motivation are in jeopardy when the pressure is strong, which removes the therapist from his mission of treating. Although we would not question the necessity for psychiatric treatment in patients who do not ask for it (addictions are a major public-health problem), we should not forget that motivation is one of the essential elements for making any changes in behavior. Although compulsion (external or internal) is recognized by everyone as a limiting factor, we would like to show here how much it can be a lever for change, as long as this compulsion is identified right from the first meeting with the patient, who consults in an addiction centre. Brief systemic therapy may be of interest for these patients, since it reinforces the motivating approach, which is recommended today and since the compulsive nature of the request for treatment is not

  13. Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy

    OpenAIRE

    Kelkar, Aditya; Kelkar, Jai; Kelkar, Shreekant; Bhirud, Shilpa; Biswas, Jyotirmoy

    2011-01-01

    Aim The purpose of this study is to report a rare case of cytomegalovirus (CMV) retinitis in a seronegative patient with systemic lupus erythematosus (SLE) on immunosuppressive therapy. Methods A seronegative patient with SLE who was on immunosuppressive therapy developed CMV retinitis. The immunosuppressive therapy was tapered, and the patient was given intravitreal ganciclovir and foscarnet in addition to systemic ganciclovir. The follow-up visits were documented. Result The patient respond...

  14. Real-time Monitoring of High Intensity Focused Ultrasound (HIFU) Ablation of In Vitro Canine Livers Using Harmonic Motion Imaging for Focused Ultrasound (HMIFU).

    Science.gov (United States)

    Grondin, Julien; Payen, Thomas; Wang, Shutao; Konofagou, Elisa E

    2015-11-03

    Harmonic Motion Imaging for Focused Ultrasound (HMIFU) is a technique that can perform and monitor high-intensity focused ultrasound (HIFU) ablation. An oscillatory motion is generated at the focus of a 93-element and 4.5 MHz center frequency HIFU transducer by applying a 25 Hz amplitude-modulated signal using a function generator. A 64-element and 2.5 MHz imaging transducer with 68kPa peak pressure is confocally placed at the center of the HIFU transducer to acquire the radio-frequency (RF) channel data. In this protocol, real-time monitoring of thermal ablation using HIFU with an acoustic power of 7 W on canine livers in vitro is described. HIFU treatment is applied on the tissue during 2 min and the ablated region is imaged in real-time using diverging or plane wave imaging up to 1,000 frames/second. The matrix of RF channel data is multiplied by a sparse matrix for image reconstruction. The reconstructed field of view is of 90° for diverging wave and 20 mm for plane wave imaging and the data are sampled at 80 MHz. The reconstruction is performed on a Graphical Processing Unit (GPU) in order to image in real-time at a 4.5 display frame rate. 1-D normalized cross-correlation of the reconstructed RF data is used to estimate axial displacements in the focal region. The magnitude of the peak-to-peak displacement at the focal depth decreases during the thermal ablation which denotes stiffening of the tissue due to the formation of a lesion. The displacement signal-to-noise ratio (SNRd) at the focal area for plane wave was 1.4 times higher than for diverging wave showing that plane wave imaging appears to produce better displacement maps quality for HMIFU than diverging wave imaging.

  15. Levonorgestrel intrauterine system versus medical therapy for menorrhagia.

    Science.gov (United States)

    Gupta, Janesh; Kai, Joe; Middleton, Lee; Pattison, Helen; Gray, Richard; Daniels, Jane

    2013-01-10

    Menorrhagia is a common problem, yet evidence to inform decisions about therapy is limited. In a pragmatic, multicenter, randomized trial, we compared the levonorgestrel-releasing intrauterine system (levonorgestrel-IUS) with usual medical treatment in women with menorrhagia who presented to their primary care providers. We randomly assigned 571 women with menorrhagia to treatment with levonorgestrel-IUS or usual medical treatment (tranexamic acid, mefenamic acid, combined estrogen-progestogen, or progesterone alone). The primary outcome was the patient-reported score on the Menorrhagia Multi-Attribute Scale (MMAS) (ranging from 0 to 100, with lower scores indicating greater severity), assessed over a 2-year period. Secondary outcomes included general quality-of-life and sexual-activity scores and surgical intervention. MMAS scores improved from baseline to 6 months in both the levonorgestrel-IUS group and the usual-treatment group (mean increase, 32.7 and 21.4 points, respectively; Pmenorrhagia who presented to primary care providers, the levonorgestrel-IUS was more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life. (Funded by the National Institute of Health Research Health Technology Assessment Programme; ECLIPSE Controlled-Trials.com number, ISRCTN86566246.).

  16. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

    NARCIS (Netherlands)

    Simpson, E.L.; Bruin-Weller, M. de; Flohr, C.; Ardern-Jones, M.R.; Barbarot, S.; Deleuran, M.; Bieber, T.; Vestergaard, C.; Brown, S.J.; Cork, M.J.; Drucker, A.M.; Eichenfield, L.F.; Foelster-Holst, R.; Guttman-Yassky, E.; Nosbaum, A.; Reynolds, N.J.; Silverberg, J.I.; Schmitt, J.; Seyger, M.M.B.; Spuls, P.I.; Stalder, J.F.; Su, J.C.; Takaoka, R.; Traidl-Hoffmann, C.; Thyssen, J.P.; Schaft, J. van der; Wollenberg, A.; Irvine, A.D.; Paller, A.S.

    2017-01-01

    BACKGROUND: Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. OBJECTIVE: To guide those considering use of systemic

  17. Metallic Taste in Cancer Patients Treated with Systemic Therapy : A Questionnaire-based Study

    NARCIS (Netherlands)

    IJpma, Irene; Timmermans, Erik R.; Renken, Remco J.; Horst, ter Gert; Reyners, Anna K. L.

    2017-01-01

    A metallic taste is reported by cancer patients as a side effect of systemic therapy. Despite the high prevalence, this taste alteration has received limited attention. The present study investigated: 1) the prevalence of metallic taste in cancer patients treated with systemic therapy; 2) possible

  18. Volumetric MR-HIFU ablation of uterine fibroids: Role of treatment cell size in the improvement of energy efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young-sun [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Keserci, Bilgin [Philips Healthcare, Seoul (Korea, Republic of); Partanen, Ari [Philips Healthcare, Cleveland, OH (United States); Rhim, Hyunchul, E-mail: rhimhc@skku.edu [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Lim, Hyo K.; Park, Min Jung [Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Koehler, Max O. [Philips Healthcare, Vantaa (Finland)

    2012-11-15

    Purpose: To evaluate the energy efficiency of differently sized volumetric ablations in MR-guided high-intensity focused ultrasound (MR-HIFU) treatment of uterine fibroids. Materials and methods: This study was approved by the institutional review board and informed consent was obtained from all participants. Ten symptomatic uterine fibroids (mean diameter 8.9 cm) in 10 women (mean age 42.2) were treated by volumetric MR-HIFU ablation under binary feedback control. The energy efficiency (mm{sup 3}/J) of each sonication was calculated as the volume of lethal thermal dose (240 equivalent minutes at 43 Degree-Sign C) per unit acoustic energy applied. Operator-controllable parameters and signal intensity ratio of uterine fibroid to skeletal muscle on T2-weighted MR images were tested with univariate and multivariate analyses to discern which parameters significantly correlated with the ablation energy efficiency. Results: We analyzed a total of 236 sonications. The energy efficiency of the ablations was 0.42 {+-} 0.25 mm{sup 3}/J (range 0.004-1.18) with energy efficiency improving with the treatment cell size (4 mm, 0.06 {+-} 0.06 mm{sup 3}/J; 8 mm, 0.29 {+-} 0.12 mm{sup 3}/J; 12 mm, 0.58 {+-} 0.18 mm{sup 3}/J; 16 mm, 0.91 {+-} 0.17 mm{sup 3}/J). Treatment cell size (r = 0.814, p < 0.001), distance of ultrasound propagation (r = -0.151, p = 0.020), sonication frequency (1.2 or 1.45 MHz; p < 0.001), and signal intensity ratio (r = -0.205, p = 0.002) proved to be significant by univariate analysis, while multivariate analysis revealed treatment cell size (B = 0.075, p < 0.001), US propagation distance (B = -6.928, p < 0.001), and signal intensity ratio (B = -0.024, p = 0.001) to be independently significant. Conclusion: Energy efficiency in volumetric MR-HIFU ablation of uterine fibroids improves with increased treatment cell size, independent of other significant contributors such as distance of ultrasound propagation or signal intensity of the tumor on T2-weighted MR

  19. Systemic therapy in younger and elderly patients with advanced biliary cancer

    DEFF Research Database (Denmark)

    McNamara, Mairéad Geraldine; Bridgewater, John; Lopes, Andre

    2017-01-01

    BACKGROUND: Outcomes in younger (elderly (≥70 years) patients with advanced biliary cancer (ABC) receiving palliative chemotherapy are unclear. This study assessed outcomes in those receiving monotherapy or combination therapy in thirteen prospective systemic-therapy trials. METHODS...... = 0.58, P = 0.66) or OS (P = 0.18, P = 0.75). CONCLUSIONS: In ABC, younger patients are rare, and survival in elderly patients in receipt of systemic therapy for advanced disease, whether monotherapy or combination therapy, is similar to that of non-elderly patients, therefore age alone should...

  20. Stereotactic Radiosurgery: Treatment of Brain Metastasis Without Interruption of Systemic Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Shen, Colette J.; Kummerlowe, Megan N.; Redmond, Kristin J. [Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland (United States); Rigamonti, Daniele [Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland (United States); Johns Hopkins Aramco Healthcare, Dhahran (Saudi Arabia); Lim, Michael K. [Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland (United States); Kleinberg, Lawrence R., E-mail: kleinla@jhmi.edu [Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland (United States)

    2016-06-01

    Purpose: To evaluate the prevalence, outcomes, and toxicities of concurrent delivery of systemic therapy with stereotactic radiosurgery (SRS) for treatment of brain metastases. Methods and Materials: We conducted a retrospective review of 193 patients treated at our institution with SRS without prior whole-brain radiation therapy (WBRT) for brain metastases between 2009 and 2014. Outcome metrics included administration of concurrent systemic therapy, myelosuppression, neurotoxicity, and survival. Results: One hundred ninety-three patients with a median age of 61 years underwent a total of 291 SRS treatments. Thirty-seven percent of SRS treatments were delivered concurrently with systemic therapy, of which 46% were with conventional myelosuppressive chemotherapy, and 54% with targeted and immune therapy agents. Myelosuppression was minimal after treatment with both systemic therapy and SRS, with 14% grade 3-4 toxicity for lymphopenia and 4-9% for leukopenia, neutropenia, anemia, and thrombocytopenia. Neurotoxicity was also minimal after combined therapy, with no grade 4 and <5% grade 3 toxicity, 34% dexamethasone requirement, and 4% radiation necrosis, all similar to treatments with SRS alone. Median overall survival was similar after SRS alone (14.4 months) versus SRS with systemic therapy (12.9 months). In patients with a new diagnosis of primary cancer with brain metastasis, early treatment with concurrent systemic therapy and SRS correlated with improved survival versus SRS alone (41.6 vs 21.5 months, P<.05). Conclusions: Systemic therapy can be safely given concurrently with SRS for brain metastases: our results suggest minimal myelosuppression and neurotoxicity. Concurrent therapy is an attractive option for patients who have both intracranial and extracranial metastatic disease and may be particularly beneficial in patients with a new diagnosis of primary cancer with brain metastasis.

  1. Non-Invasive Targeted Peripheral Nerve Ablation Using 3D MR Neurography and MRI-Guided High-Intensity Focused Ultrasound (MR-HIFU) : Pilot Study in a Swine Model

    NARCIS (Netherlands)

    Huisman, Merel; Staruch, Robert M; Ladouceur-Wodzak, Michelle; van den Bosch, Maurice A; Burns, Dennis K; Chhabra, Avneesh; Chopra, Rajiv

    2015-01-01

    PURPOSE: Ultrasound (US)-guided high intensity focused ultrasound (HIFU) has been proposed for noninvasive treatment of neuropathic pain and has been investigated in in-vivo studies. However, ultrasound has important limitations regarding treatment guidance and temperature monitoring. Magnetic

  2. An MR-compliant phased-array HIFU transducer with augmented steering range, dedicated to abdominal thermotherapy

    Science.gov (United States)

    Auboiroux, Vincent; Dumont, Erik; Petrusca, Lorena; Viallon, Magalie; Salomir, Rares

    2011-06-01

    A novel architecture for a phased-array high intensity focused ultrasound (HIFU) device was investigated, aiming to increase the capabilities of electronic steering without reducing the size of the elementary emitters. The principal medical application expected to benefit from these developments is the time-effective sonication of large tumours in moving organs. The underlying principle consists of dividing the full array of transducers into multiple sub-arrays of different resonance frequencies, with the reorientation of these individual emitters, such that each sub-array can focus within a given spatial zone. To enable magnetic resonance (MR) compatibility of the device and the number of output channels from the RF generator to be halved, a passive spectral multiplexing technique was used, consisting of parallel wiring of frequency-shifted paired piezoceramic emitters with intrinsic narrow-band response. Two families of 64 emitters (circular, 5 mm diameter) were mounted, with optimum efficiency at 0.96 and 1.03 MHz, respectively. Two different prototypes of the HIFU device were built and tested, each incorporating the same two families of emitters, but differing in the shape of the rapid prototyping plastic support that accommodated the transducers (spherical cap with radius of curvature/aperture of 130 mm/150 mm and, respectively, 80 mm/110 mm). Acoustic measurements, MR-acoustic radiation force imaging (ex vivo) and MR-thermometry (ex vivo and in vivo) were used for the characterization of the prototypes. Experimental results demonstrated an augmentation of the steering range by 80% along one preferentially chosen axis, compared to a classic spherical array of the same total number of elements. The electric power density provided to the piezoceramic transducers exceeded 50 W cm-2 CW, without circulation of coolant water. Another important advantage of the current approach is the versatility of reshaping the array at low cost.

  3. An MR-compliant phased-array HIFU transducer with augmented steering range, dedicated to abdominal thermotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Auboiroux, Vincent [Inserm, U556, Lyon, F-69003 (France); Dumont, Erik [Image Guided Therapy, Pessac, Bordeaux (France); Petrusca, Lorena; Salomir, Rares [Faculty of Medicine, University of Geneva (Switzerland); Viallon, Magalie, E-mail: vincent.auboiroux@unige.ch [Radiology Department, University Hospital of Geneva, Geneva (Switzerland)

    2011-06-21

    A novel architecture for a phased-array high intensity focused ultrasound (HIFU) device was investigated, aiming to increase the capabilities of electronic steering without reducing the size of the elementary emitters. The principal medical application expected to benefit from these developments is the time-effective sonication of large tumours in moving organs. The underlying principle consists of dividing the full array of transducers into multiple sub-arrays of different resonance frequencies, with the reorientation of these individual emitters, such that each sub-array can focus within a given spatial zone. To enable magnetic resonance (MR) compatibility of the device and the number of output channels from the RF generator to be halved, a passive spectral multiplexing technique was used, consisting of parallel wiring of frequency-shifted paired piezoceramic emitters with intrinsic narrow-band response. Two families of 64 emitters (circular, 5 mm diameter) were mounted, with optimum efficiency at 0.96 and 1.03 MHz, respectively. Two different prototypes of the HIFU device were built and tested, each incorporating the same two families of emitters, but differing in the shape of the rapid prototyping plastic support that accommodated the transducers (spherical cap with radius of curvature/aperture of 130 mm/150 mm and, respectively, 80 mm/110 mm). Acoustic measurements, MR-acoustic radiation force imaging (ex vivo) and MR-thermometry (ex vivo and in vivo) were used for the characterization of the prototypes. Experimental results demonstrated an augmentation of the steering range by 80% along one preferentially chosen axis, compared to a classic spherical array of the same total number of elements. The electric power density provided to the piezoceramic transducers exceeded 50 W cm{sup -2} CW, without circulation of coolant water. Another important advantage of the current approach is the versatility of reshaping the array at low cost.

  4. Sonochemiluminescence observation and acoustic detection of cavitation induced by pulsed HIFU at a tissue-fluid interface.

    Science.gov (United States)

    Cao, Hua; Yin, Hui; Qiao, Yangzi; Zhang, Shusheng; Wan, Mingxi

    2013-11-01

    The aim of this study is to investigate the mechanism of the erosion process induced by 1.2 MHz pulsed high-intensity focused ultrasound (pulsed HIFU). By using Sonochemiluminescence (SCL) photograph, the initiation and maintenance of active cavitation were observed. In order to understand the role of both inertial cavitation and stable cavitation, a passive cavitation detection (PCD) transducer was used. Since the exposure variables of HIFU are important in the controlled ultrasound tissue erosion, the influence of pulse length (PL) and duty cycle (DC, Ton:Toff) has been examined. The results of tissue hole, SCL observation and acoustic detection revealed that the erosion was highly efficient for shorter PL. For higher DCs, the area of SCL increased with increasing PL. For lower DCs, the area of SCL increased with increasing PL from 10 to 20 μs and then kept constant. For all PLs, the intensity of SCL decreased with lower DC. For all DCs, the intensity of SCL per unit area (the ratio of SCL intensity to SCL area) also decreased with increasing PL from 10 to 80 μs, which suggested that the higher the intensity of SCL is, the higher the efficiency of tissue erosion is. At DC of 1:10, the position of the maximum pixel in SCL pictures was distant from the tissue-fluid interface with the increasing PL because of shielding effect. By the comparison of inertial cavitation dose (ICD) and the stable cavitation dose (SCD), the mechanisms associated with inertial cavitation are very likely to be the key factor of the erosion process. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. Ilaj bil hijamah (cupping therapy) in the Unani system of medicine: anecdotal practice to evidence based therapy.

    Science.gov (United States)

    Abbas Zaidi, S M; Jameel, S S; Jafri, Kehkashan; Khan, Shariq A; Ahmad, Ehsan

    2016-08-01

    Cupping (Hijamah) therapy is very well documented as a result of several thousand years of clinical experiences in Unani medicine. In this procedure, suction is created by various means either with or without bloodletting. Though this therapy is being widely practiced across the globe for treating many chronic and intractable ailments but many reports reveal its unscientific and improper practices which results in many complications. Therefore to develop standard operative procedures and to propose protocols of cupping therapy in various diseases is the need of hour. A thorough literature review of relevant journals and textbooks was performed to gather the maximum available data on cupping therapy. This paper seeks to introduce the general concepts of cupping therapy in Unani medicine and other traditional systems of medicine, shortcomings and limitations of the currently published studies and suggest ways to improve these technical/methodological flaws. In addition, the authors have also attempted to provide the cupping related materials, hypotheses, observations which will provide the researchers the base for evaluating their usefulness in future clinical trials.

  6. Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial.

    Science.gov (United States)

    Ashtiani, Mohammadtaghi Khorsandi; Firouzi, Farzad; Bastaninejad, Shahin; Dabiri, Sasan; Nasirmohtaram, Sevil; Saeedi, Niloufar; Ghazavi, Hossein; Sahebi, Leyla

    2017-11-17

    The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies. Triple-blind randomized clinical trial. Tertiary referral hospital. A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy. Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9). This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss. 1b.

  7. Timing of radiotherapy in breast-conserving therapy: a large prospective cohort study of node-negative breast cancer patients without adjuvant systemic therapy

    NARCIS (Netherlands)

    Jobsen, J.J.; van der Palen, Jacobus Adrianus Maria; Baum, M.; Brinkhuis, M.; Struikmans, H.

    2013-01-01

    Background: To investigate the issue of timing of radiation therapy (RT) after lumpectomy in relation to recurrences and outcome. Methods: Analysis was done on 1107 breast-conserving therapies (BCT) with 1070 women, all without lymph node metastasis and without any adjuvant systemic therapy. Timing

  8. The effectiveness of family therapy and systemic interventions for child-focused problems

    OpenAIRE

    CARR, ALAN

    2009-01-01

    This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either ...

  9. The evidence-base for family therapy and systemic interventions for child-focused problems

    OpenAIRE

    CARR, ALAN

    2014-01-01

    This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventio...

  10. MO-AB-210-00: Diagnostic Ultrasound Imaging Quality Control and High Intensity Focused Ultrasound Therapy Hands-On Workshop

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    The goal of this ultrasound hands-on workshop is to demonstrate advancements in high intensity focused ultrasound (HIFU) and to demonstrate quality control (QC) testing in diagnostic ultrasound. HIFU is a therapeutic modality that uses ultrasound waves as carriers of energy. HIFU is used to focus a beam of ultrasound energy into a small volume at specific target locations within the body. The focused beam causes localized high temperatures and produces a well-defined regions of necrosis. This completely non-invasive technology has great potential for tumor ablation and targeted drug delivery. At the workshop, attendees will see configurations, applications, and hands-on demonstrations with on-site instructors at separate stations. The involvement of medical physicists in diagnostic ultrasound imaging service is increasing due to QC and accreditation requirements. At the workshop, an array of ultrasound testing phantoms and ultrasound scanners will be provided for attendees to learn diagnostic ultrasound QC in a hands-on environment with live demonstrations of the techniques. Target audience: Medical physicists and other medical professionals in diagnostic imaging and radiation oncology with interest in high-intensity focused ultrasound and in diagnostic ultrasound QC. Learning Objectives: Learn ultrasound physics and safety for HIFU applications through live demonstrations Get an overview of the state-of-the art in HIFU technologies and equipment Gain familiarity with common elements of a quality control program for diagnostic ultrasound imaging Identify QC tools available for testing diagnostic ultrasound systems and learn how to use these tools List of supporting vendors for HIFU and diagnostic ultrasound QC hands-on workshop: Philips Healthcare Alpinion Medical Systems Verasonics, Inc Zonare Medical Systems, Inc Computerized Imaging Reference Systems (CIRS), Inc. GAMMEX, Inc., Cablon Medical BV Steffen Sammet: NIH/NCI grant 5R25CA132822, NIH/NINDS grant 5R25NS

  11. Towards system-level modeling and characterization of components for intravenous therapy

    NARCIS (Netherlands)

    Alveringh, Dennis; Wiegerink, Remco J.; Lötters, Joost Conrad

    2014-01-01

    Problems occur regularly with intravenous therapy, especially with the flow behavior. A mechanical model can predict which components of intravenous therapy systems introduce non-ideal effects in the flow. This study concentrates on gaining quantitative information of each separate component for

  12. Catheter-directed therapy for submassive pulmonary embolism after unsuccessful systemic thrombolysis.

    Science.gov (United States)

    Dong, Chang; Jiang, Shufen; Ji, Donghua; Ji, Yingqun; Zhang, Zhonghe

    2018-01-01

    Catheter-directed therapy (CDT) has emerged as an important treatment for pulmonary embolism (PE). We present a patient with life-threatening submassive PE with transient hypotension, progressive right ventricular dysfunction, and respiratory failure who failed anticoagulation and had little improvement with systemic thrombolysis, but responded well to catheter-directed therapy.

  13. Development of an Effective Special Therapy Bed Management System at Walter Reed Army Medical Center.

    Science.gov (United States)

    1991-12-01

    18 Organizational Structure - The DMAA ....... 18 History of Special Therapy Bed Management at WRAMC...Structure - the DMAA Review of the organizational structure in which the special therapy bed management system now operates involved examination of...the Directorate of Medical Activities Administration ( DMAA ). This unique organizational structure provides health care administrative support to all

  14. Iatrogenic systemic air embolism treated with hyperbaric oxygen therapy

    DEFF Research Database (Denmark)

    Jørgensen, Thomas Bech; Sørensen, Allan Martini Ibsen; Jansen, Erik C.

    2008-01-01

    to the arterial circulation through a shunt, it may cause cerebral emboli with neurological symptoms. We present two cases with venous air emboli and concurrent cerebral arterial emboli. Both patients were successfully treated with hyperbaric oxygen therapy Udgivelsesdato: 2008/4...

  15. [Bilateral tibial osteonecrosis secondary to systemic corticosteroid therapy].

    Science.gov (United States)

    Froberg, Lonnie; Ejsted, Rolf

    2007-06-11

    Osteonecrosis is an adverse effect of corticosteroid therapy. We describe a 64-year-old woman with progressive bilateral knee pain and advanced osteonecrosis. Her symptoms developed after treatment with high-dose corticosteroids seven years earlier. The patient was ultimately treated with bilateral total knee arthroplasties.

  16. Effciency of acne therapy with small doses of systemic retinoids

    Directory of Open Access Journals (Sweden)

    Kravchenya S.S.

    2012-06-01

    Full Text Available

    The study aimed to research an effciency and safety of isotretinoin usage in small doses in patients with recurrent acne of moderate severity. Materials and methods 40 patients (18 – 27 years with acne were examined (25 women. All of the patients have had different therapy earlier. To estimate the severity and prevalence of the disease Acne Dermatology Index (ADI was used. All the patients were ordered isotretinoin (Roaccutane at a standard dose of 10 mg per day for 3 months. Concentrations of triglycerides, cholesterin, ALT and AST in blood serum have been researched before and during the isotretinoin therapy. After 3-months isotretinoin monotherapy there was a prospective 6-months observation. There have been 40 healthy people examined in a control group. Results. After 3 months of isotretinoin therapy comedones, papules, pustules disappeared in most of the patients, ADI ran to 0,6±0,01 (р<0,001. Isotretinoin in the whole is tolerable, side effects were minimal. By the end of a 3-months therapy laboratory ranges (AST, ALT, triglycerides, etc. have become comparable with control parameters. Conclusion. Small doses of isotretinoin can quickly solve the problem of an eruption in patients with acne of moderate severity, prevent a recurrence, minimize side effects risk.

  17. Group Milieu in systemic and psychodynamic group therapy

    DEFF Research Database (Denmark)

    Lau, Marianne Engelbrecht; Kristensen, Ellids

    Objectives: A recent meta-analysis also concluded that psychotherapeutic approaches are beneficial for adult with a history of CSA and maintained for at least six months follow-up. The results suggest that different characteristics of therapy moderate the therapeutic outcome. We found in a random...

  18. Group Milieu in systemic and psychodynamic group therapy

    DEFF Research Database (Denmark)

    Lau, Marianne Engelbrecht

    2012-01-01

    Objectives: A recent meta-analysis also concluded that psychotherapeutic approaches are beneficial for adult with a history of CSA and maintained for at least six months follow-up. The results suggest that different characteristics of therapy moderate the therapeutic outcome. We found in a random...

  19. A systematic review on reminder systems in physical therapy.

    Science.gov (United States)

    Jangi, Majid; Ferandez-de-Las-Penas, Cesar; Tara, Mahmoud; Moghbeli, Fateme; Ghaderi, Fariba; Javanshir, Khodabakhsh

    2018-01-01

    The main goal of physical therapy is to help the patient gain a better health status. Several studies have investigated the use of reminders to prevent such failures on the patients' side. This article presents a systematic review of the literature concerning reminders in physical therapy. Databases were searched until May 2017 and literatures were found from April 1992 until 2017. The literature recruitment strategy was based on applying several keywords and Medical Subject Heading (MeSH) combination running against title and abstract, including concepts such as reminder, physical therapy. The finally selected articles were categorized through reminder aspects such as how, who feedback. Data were extracted according to PRISMA guidelines. In 47% of studies, the reminder was sent to the patients, 29% to the physical therapists and 12% to the caretaker team. In 24% of the studies, paper-based letters were main medium for reminders while the rest were various types of media like emails and SMS mobile text messages. 35% of the articles showed positive effects of the reminders. Many reminder methods consisted of SMS, phone calls, letters, emails and notices on the wall were used in physical therapy. Reminders may be used to improve patients' adherence to exercise programs.

  20. Treatment of Psoriasis with Fumarates and other Systemic Therapies

    NARCIS (Netherlands)

    S. Fallah Arani (Shiva)

    2017-01-01

    markdownabstractIn this era of expensive biologics, which have gained popularity among dermatologists as effective treatments for chronic, moderate to severe plaque psoriasis, there is a great need for an effective, safe, long-term and low-cost therapy such as fumarates. In this book the authors

  1. Electrochemotherapy - Supplementary Treatment for Loco-regional Metastasized Breast Carcinoma Administered to Concomitant Systemic Therapy.

    Science.gov (United States)

    Grischke, Eva-Maria; Röhm, Carmen; Stauß, Eva; Taran, Florin-Andrei; Brucker, Sara Y; Wallwiener, Diethelm

    2017-09-01

    Electrochemotherapy (ECT) is an established procedure for treating breast cancer loco-regional recurrences following surgical intervention and/or radiotherapy. Limited information is available on ECT application as a concomitant procedure to systemic therapy in recurrent breast cancer. The primary objective of this study was to determine if the application of ECT in close temporal relation to systemic chemotherapy could lead to increased local and/or systemic side effects. For this purpose we evaluated the safety of ECT as a supplemental local therapy to systemic therapy. ECT local and systemic toxicity and side effects were recorded and whether the anticipated local therapeutic effect of ECT would be influenced by the concomitant use of systemic therapies was investigated. This is an observational study. Thirty three patients with loco-regional metastasized breast carcinoma were treated and observed over a period of three years with 46 ECT applications for local tumour control in addition to established systemic therapy. A specific timeline for ECT administration was not fixed up, but was generally performed one week before the following chemotherapy administration with the aim to avoid the so called nadir, this means the peak period with risk of neutropenia. Data was collected over a period of three years on a population of 33 metastatic patients. Fifteen patients, received neo-adjuvant therapy as part of their primary treatment, but still had an advanced stage tumour. Some patients received repeated ECT applications. Objective tumour response was observed in 90% of the treated patients. Patients showed no increased local toxicity, especially no higher dermal toxicity, e.g. formation of local necrosis. ECT proved to be an effective supplement to a cytotoxic systemic therapy, especially for high-risk patients who did not respond well to systemic therapy of loco-regional metastases, without creating any greater systemic or loco-regional toxicities.

  2. Electrochemotherapy – Supplementary Treatment for Loco-regional Metastasized Breast Carcinoma Administered to Concomitant Systemic Therapy

    Science.gov (United States)

    Röhm, Carmen; Stauß, Eva; Taran, Florin-Andrei; Brucker, Sara Y.; Wallwiener, Diethelm

    2017-01-01

    Abstract Background Electrochemotherapy (ECT) is an established procedure for treating breast cancer loco-regional recurrences following surgical intervention and/or radiotherapy. Limited information is available on ECT application as a concomitant procedure to systemic therapy in recurrent breast cancer. The primary objective of this study was to determine if the application of ECT in close temporal relation to systemic chemotherapy could lead to increased local and/or systemic side effects. For this purpose we evaluated the safety of ECT as a supplemental local therapy to systemic therapy. ECT local and systemic toxicity and side effects were recorded and whether the anticipated local therapeutic effect of ECT would be influenced by the concomitant use of systemic therapies was investigated. Patients and methods This is an observational study. Thirty three patients with loco-regional metastasized breast carcinoma were treated and observed over a period of three years with 46 ECT applications for local tumour control in addition to established systemic therapy. A specific timeline for ECT administration was not fixed up, but was generally performed one week before the following chemotherapy administration with the aim to avoid the so called nadir, this means the peak period with risk of neutropenia. Results Data was collected over a period of three years on a population of 33 metastatic patients. Fifteen patients, received neo-adjuvant therapy as part of their primary treatment, but still had an advanced stage tumour. Some patients received repeated ECT applications. Objective tumour response was observed in 90% of the treated patients. Patients showed no increased local toxicity, especially no higher dermal toxicity, e.g. formation of local necrosis. Conclusions ECT proved to be an effective supplement to a cytotoxic systemic therapy, especially for high-risk patients who did not respond well to systemic therapy of loco-regional metastases, without creating any

  3. The evidence-base for couple therapy, family therapy and systemic interventions for adult-focused problems

    OpenAIRE

    Carr, Alan

    2014-01-01

    This review updates similar articles published in JFT in 2000 and 2009. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of couple and family therapy for adults with various relationship and mental health problems. The evidence supports the effectiveness of systemic interventions, either alone or as part of multi-modal programmes, for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mo...

  4. Development of system technology for radiation cancer therapy with the dexterous auto lesions tracking

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seungho; Jeong, Kyungmin; Jung, Seungho; Lee, Namho; and others

    2013-01-15

    The project objectives are to establish the fundamental core technologies for precise auto lesions tracking radiation cancer therapy and developing related system technology as well. Radiation cancer therapy apparatus should be domestically produced to reduce medical expenses, hence advanced technologies are suggested and developed to make cost down medical expenses and save expenditure for importing 10 million dollars/set from overseas. To achieve these targets, we have carried out reviewing of domestic and foreign technology trend. Based on review of state-of-the-art technology, radiation sensory system is studied. 3m high precise image processing technique and intelligent therapy planning software are developed. Also precedent study on the redundant robot for dexterous motion control system has been performed for developing of radiation cancel therapy robot system.

  5. mTHPC Mediated, Systemic Photodynamic Therapy (PDT) for Nonmelanoma Skin Cancers : Case and Literature Review

    NARCIS (Netherlands)

    Horlings, Rudolf K.; Terra, Jorrit B.; Witjes, Max J. H.

    2015-01-01

    Background and Objective: Patients with multiple nonmelanoma skin cancers (NMSCs), like immunosuppressed or nevoid basal cell carcinomas, offer a therapeutic challenge. Photodynamic therapy (PDT) using the systemic photosensitizer meta-tetrahydroxyphenylchlorin (mTHPC) has the ability to treat

  6. Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy.

    Science.gov (United States)

    Kelkar, Aditya; Kelkar, Jai; Kelkar, Shreekant; Bhirud, Shilpa; Biswas, Jyotirmoy

    2011-09-01

    The purpose of this study is to report a rare case of cytomegalovirus (CMV) retinitis in a seronegative patient with systemic lupus erythematosus (SLE) on immunosuppressive therapy. A seronegative patient with SLE who was on immunosuppressive therapy developed CMV retinitis. The immunosuppressive therapy was tapered, and the patient was given intravitreal ganciclovir and foscarnet in addition to systemic ganciclovir. The follow-up visits were documented. The patient responded to the treatment and there was complete resolution. CMV retinitis is a rapidly progressive condition and patients on immunosuppressive therapy should be referred to an ophthalmologist for periodic check-up for early diagnosis and treatment of this devastating ophthalmic condition. For clinically resistant CMV retinitis in seronegative patients with SLE, a combination therapy of intravitreal foscarnet with oral and intravenous ganciclovir is useful.

  7. Major Changes in Systemic Therapy for Advanced Melanoma.

    Science.gov (United States)

    Thompson, John A

    2016-05-01

    Over the past 5 years, a host of new agents have radically changed the therapeutic landscape in advanced melanoma; gone are the days when the only active agents were interferon and dacarbazine. Nearly 25 years ago, few patients with stage IV melanoma reached 2-year survival; today, these survival curves have risen substantially. At the NCCN 21st Annual Conference, John A. Thompson, MD, discussed updates with longer duration of patient follow-up for immune checkpoint therapies. He also reviewed some of the newer approvals in advanced melanoma, including the combination of ipilimumab and nivolumab, high-dose ipilimumab, the oncolytic virus therapy talimogene laherparepvec, and the molecularly targeted combination of the BRAF and MEK inhibitors vemurafenib and cobimetinib. Copyright © 2016 by the National Comprehensive Cancer Network.

  8. Fast lesion mapping during HIFU treatment using harmonic motion imaging guided focused ultrasound (HMIgFUS) in vitro and in vivo

    Science.gov (United States)

    Han, Yang; Wang, Shutao; Payen, Thomas; Konofagou, Elisa

    2017-04-01

    The successful clinical application of high intensity focused ultrasound (HIFU) ablation depends on reliable monitoring of the lesion formation. Harmonic motion imaging guided focused ultrasound (HMIgFUS) is an ultrasound-based elasticity imaging technique, which monitors HIFU ablation based on the stiffness change of the tissue instead of the echo intensity change in conventional B-mode monitoring, rendering it potentially more sensitive to lesion development. Our group has shown that predicting the lesion location based on the radiation force-excited region is feasible during HMIgFUS. In this study, the feasibility of a fast lesion mapping method is explored to directly monitor the lesion map during HIFU. The harmonic motion imaging (HMI) lesion map was generated by subtracting the reference HMI image from the present HMI peak-to-peak displacement map, as streamed on the computer display. The dimensions of the HMIgFUS lesions were compared against gross pathology. Excellent agreement was found between the lesion depth (r 2  =  0.81, slope  =  0.90), width (r 2  =  0.85, slope  =  1.12) and area (r 2  =  0.58, slope  =  0.75). In vivo feasibility was assessed in a mouse with a pancreatic tumor. These findings demonstrate that HMIgFUS can successfully map thermal lesions and monitor lesion development in real time in vitro and in vivo. The HMIgFUS technique may therefore constitute a novel clinical tool for HIFU treatment monitoring.

  9. Optimization of real-time acoustical and mechanical monitoring of high intensity focused ultrasound (HIFU) treatment using harmonic motion imaging for high focused ultrasound (HMIFU).

    Science.gov (United States)

    Hou, Gary Y; Marquet, Fabrice; Wang, Shutao; Konofagou, Elisa E

    2013-01-01

    Harmonic Motion Imaging (HMI) for Focused Ultrasound (HMIFU) is a recently developed high-intensity focused ultrasound (HIFU) treatment monitoring method with feasibilities demonstrated in silica, in vitro and in vivo. Its principle is based on emission of an Amplitude-modulated therapeutic ultrasound beam utilizing a therapeutic transducer to induce an oscillatory radiation force while tracking the focal tissue mechanical response during the HIFU treatment using a confocally-aligned diagnostic transducer. In order to translate towards the clinical implementation of HMIFU, a complete assessment study is required in order to investigate the optimal radiation force threshold for reliable monitoring the local tissue mechanical property changes, i.e., the estimation HMIFU displacement under thermal, acoustical, and mechanical effects within focal medium (i.e., boiling, cavitation, and nonlinearity) using biological specimen. In this study, HMIFU technique is applied on HIFU treatment monitoring on freshly excised ex vivo canine liver specimens. In order to perform the multi-characteristic assessment, the diagnostic transducer was operated as either a pulse-echo imager or Passive Cavitation Detector (PCD) to assess the acoustic and mechanical response, while a bare-wire thermocouple was used to monitor the focal temperature change. As the acoustic power of HIFU treatment was ranged from 2.3 to 11.4 W, robust HMI displacement was observed across the entire range. Moreover, an optimized range for high quality displacement monitoring was found to be between 3.6 to 5.2W, where displacement showed an increase followed by significant decrease, indicating a stiffening of focal medium due to thermal lesion formation, while the correlation coefficient was maintained above 0.95.

  10. Fast lesion mapping during HIFU treatment using harmonic motion imaging guided focused ultrasound (HMIgFUS) in vitro and in vivo.

    Science.gov (United States)

    Han, Yang; Wang, Shutao; Payen, Thomas; Konofagou, Elisa

    2017-04-21

    The successful clinical application of high intensity focused ultrasound (HIFU) ablation depends on reliable monitoring of the lesion formation. Harmonic motion imaging guided focused ultrasound (HMIgFUS) is an ultrasound-based elasticity imaging technique, which monitors HIFU ablation based on the stiffness change of the tissue instead of the echo intensity change in conventional B-mode monitoring, rendering it potentially more sensitive to lesion development. Our group has shown that predicting the lesion location based on the radiation force-excited region is feasible during HMIgFUS. In this study, the feasibility of a fast lesion mapping method is explored to directly monitor the lesion map during HIFU. The harmonic motion imaging (HMI) lesion map was generated by subtracting the reference HMI image from the present HMI peak-to-peak displacement map, as streamed on the computer display. The dimensions of the HMIgFUS lesions were compared against gross pathology. Excellent agreement was found between the lesion depth (r 2   =  0.81, slope  =  0.90), width (r 2   =  0.85, slope  =  1.12) and area (r 2   =  0.58, slope  =  0.75). In vivo feasibility was assessed in a mouse with a pancreatic tumor. These findings demonstrate that HMIgFUS can successfully map thermal lesions and monitor lesion development in real time in vitro and in vivo. The HMIgFUS technique may therefore constitute a novel clinical tool for HIFU treatment monitoring.

  11. Castration-resistant prostate cancer: systemic therapy in 2012

    Directory of Open Access Journals (Sweden)

    Fernando C. Maluf

    2012-01-01

    Full Text Available Prostate cancer is the most common non-cutaneous neoplasm in the male population worldwide. It is typically diagnosed in its early stages, and the disease exhibits a relatively indolent course in most patients. Despite the curability of localized disease with prostatectomy and radiation therapy, some patients develop metastatic disease and die. Although androgen deprivation is present in the majority of patients with metastatic prostate cancer, a state of androgen resistance eventually develops. Castration-resistant prostate cancer, defined when there is progression of disease despite low levels of testosterone, requires specialized care, and improved communication between medical and urologic oncologists has been identified as a key component in delivering effective therapy. Despite being considered a chemoresistant tumor in the past, the use of a prostate-specific antigen has paved the way for a new generation of trials for castration-resistant prostate cancer. Docetaxel is a life-prolonging chemotherapy that has been established as the standard first-line agent in two phase III clinical trials. Cabazitaxel, a novel taxane with activity in cancer models resistant to paclitaxel and docetaxel, is the only agent that has been compared to a chemotherapy control in a phase III clinical trial as a second-line therapy; it was found to prolong the overall survival of patients with castration-resistant prostate cancer previously treated with docetaxel when compared to mitoxantrone. Other agents used in this setting include abiraterone and sipuleucel-T, and novel therapies are continually being investigated in an attempt to improve the outcome for patients with castration-resistant prostate cancer.

  12. Castration-resistant prostate cancer: systemic therapy in 2012

    Science.gov (United States)

    Maluf, Fernando C.; Smaletz, Oren; Herchenhorn, Daniel

    2012-01-01

    Prostate cancer is the most common non-cutaneous neoplasm in the male population worldwide. It is typically diagnosed in its early stages, and the disease exhibits a relatively indolent course in most patients. Despite the curability of localized disease with prostatectomy and radiation therapy, some patients develop metastatic disease and die. Although androgen deprivation is present in the majority of patients with metastatic prostate cancer, a state of androgen resistance eventually develops. Castration-resistant prostate cancer, defined when there is progression of disease despite low levels of testosterone, requires specialized care, and improved communication between medical and urologic oncologists has been identified as a key component in delivering effective therapy. Despite being considered a chemoresistant tumor in the past, the use of a prostate-specific antigen has paved the way for a new generation of trials for castration-resistant prostate cancer. Docetaxel is a life-prolonging chemotherapy that has been established as the standard first-line agent in two phase III clinical trials. Cabazitaxel, a novel taxane with activity in cancer models resistant to paclitaxel and docetaxel, is the only agent that has been compared to a chemotherapy control in a phase III clinical trial as a second-line therapy; it was found to prolong the overall survival of patients with castration-resistant prostate cancer previously treated with docetaxel when compared to mitoxantrone. Other agents used in this setting include abiraterone and sipuleucel-T, and novel therapies are continually being investigated in an attempt to improve the outcome for patients with castration-resistant prostate cancer. PMID:22522765

  13. Targeting the Cholinergic System to Develop a Novel Therapy for Huntington's Disease.

    Science.gov (United States)

    D'Souza, Gary X; Waldvogel, Henry J

    2016-12-15

    In this review, we outline the role of the cholinergic system in Huntington's disease, and briefly describe the dysfunction of cholinergic transmission, cholinergic neurons, cholinergic receptors and cholinergic survival factors observed in post-mortem human brains and animal models of Huntington's disease. We postulate how the dysfunctional cholinergic system can be targeted to develop novel therapies for Huntington's disease, and discuss the beneficial effects of cholinergic therapies in pre-clinical and clinical studies.

  14. Magnetic resonance imaging of the liver after loco-regional and systemic therapy.

    Science.gov (United States)

    Corona-Villalobos, Celia Pamela; Zhang, Yan; Zhang, Wei-Dong; Kamel, Ihab R

    2014-08-01

    Assessment of tumor response is crucial in determining the effectiveness of loco-regional and systemic therapy, and for determining the need for subsequent treatment. The ultimate goal is to improve patient's survival. Changes in tumor size and enhancement after therapy may not be detected early by the traditional response criteria. Tumor response is better assessed in the entire tumor volume rather than in a single axial plane. The purpose of this article is to familiarize the reader with early treatment response assessed by anatomic and volumetric functional magnetic resonance imaging metrics of the liver after loco-regional and systemic therapy. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. A Study On the Effectiveness of Emotionally Focused Couple Therapy and Integrated Systemic Couple Therapy on reducing Intimacy Anxiety

    Directory of Open Access Journals (Sweden)

    هاجر فلاح زاده

    2015-04-01

    Full Text Available This study examined the effectiveness of emotionally focused couple therapy (EFT and integrated systemic couple therapy (IST on resolving intimacy anxiety. For this purpose, 30 couples were randomly selected and based on their pretests were assigned into two experimental and one control groups. Research instruments were Fear of Intimacy Scale (FIS (Descutner & Thelen, and the Dyadic Adjustment Scale (DAS (Spanier, 1976. A Nine-session of EFT was conducted for one experiment group and eight sessions of IST for the other. The control group did not receive any treatment. These three groups completed post test at the end of the experiment, and follow-up test 3 months later. Results indicated that EFT and IST significantly decreased intimacy anxiety in couples, and the treatment effect was consistent after 3 months follow-up.

  16. Microbeam radiation therapy. Physical and biological aspects of a new cancer therapy and development of a treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Bartzsch, Stefan

    2014-11-05

    Microbeam Radiation Therapy (MRT) is a novel treatment strategy against cancer. Highly brilliant synchrotron radiation is collimated to parallel, a few micrometre wide, planar beams and used to irradiate malignant tissues with high doses. The applied peak doses are considerably higher than in conventional radiotherapy, but valley doses between the beams remain underneath the established tissue tolerance. Previous research has shown that these beam geometries spare normal tissue, while being effective in tumour ablation. In this work physical and biological aspects of the therapy were investigated. A therapy planning system was developed for the first clinical treatments at the European Synchrotron Radiation Facility in Grenoble (France) and a dosimetry method based on radiochromic films was created to validate planned doses with measurements on a micrometre scale. Finally, experiments were carried out on a cellular level in order to correlate the physically planned doses with the biological damage caused in the tissue. The differences between Monte Carlo dose and dosimetry are less than 10% in the valley and 5% in the peak regions. Developed alternative faster dose calculation methods deviate from the computational intensive MC simulations by less than 15% and are able to determine the dose within a few minutes. The experiments in cell biology revealed an significant influence of intercellular signalling on the survival of cells close to radiation boundaries. These observations may not only be important for MRT but also for conventional radiotherapy.

  17. Timing of renal replacement therapy initiation by AKIN classification system

    Science.gov (United States)

    2013-01-01

    Introduction Previous studies using Acute Kidney Injury Network (AKIN)/RIFLE criteria to classify early initiation of renal replacement therapy (RRT) have defined it as the therapy started in less severe AKIN/RIFLE stages. Generally, these studies failed in demonstrating measurable benefits. Methods We compared RRT initiation in critically ill patients and defined early or late RRT in reference to timing after stage 3 AKIN was met: patients beginning RRT within 24 hours after acute kidney injury (AKI) stage 3 were considered early starters. AKIN criteria were evaluated by both urine output (UO) and serum creatinine (sCr) and patients with acute-on-chronic kidney disease were excluded. A propensity score methodology was used to control variables. Results A total of 358 critically ill patients were submitted to RRT. Only 150 patients with pure AKI at stage 3 were analyzed. Mortality was lower in the early RRT group (51.5 vs. 77.9%, P = 0.001). After achieving balance between the groups using a propensity score, there was a significant 30.5 (95% confidence interval [CI] 14.4 to 45.2%, P = 0.002) relative decrease of mortality in the early RRT group. Moreover, patients on the early RRT group had lower duration of mechanical ventilation, time on RRT and a trend to lower intensive care unit (ICU) length of stay. Conclusions For the first time, AKIN was used with UO criterion to evaluate early and late RRT. Using a time-based approach could be a better parameter to access the association between RRT initiation and outcomes in patients with AKI. PMID:23548002

  18. [Cost of therapy for neurodegenerative diseases. Applying an activity-based costing system].

    Science.gov (United States)

    Sánchez-Rebull, María-Victoria; Terceño Gómez, Antonio; Travé Bautista, Angeles

    2013-01-01

    To apply the activity based costing (ABC) model to calculate the cost of therapy for neurodegenerative disorders in order to improve hospital management and allocate resources more efficiently. We used the case study method in the Francolí long-term care day center. We applied all phases of an ABC system to quantify the cost of the activities developed in the center. We identified 60 activities; the information was collected in June 2009. The ABC system allowed us to calculate the average cost per patient with respect to the therapies received. The most costly and commonly applied technique was psycho-stimulation therapy. Focusing on this therapy and on others related to the admissions process could lead to significant cost savings. ABC costing is a viable method for costing activities and therapies in long-term day care centers because it can be adapted to their structure and standard practice. This type of costing allows the costs of each activity and therapy, or combination of therapies, to be determined and aids measures to improve management. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. Safety of conventional systemic therapies for psoriasis on reproductive potential and outcomes.

    Science.gov (United States)

    Yiu, Zenas Z N; Warren, Richard B; Mrowietz, Ulrich; Griffiths, Christopher E M

    2015-01-01

    The effects of conventional systemic therapies for psoriasis on pregnancy outcomes, lactation, male fertility and mutagenicity are common concerns in the clinical setting. There is relatively little evidence to guide clinician and patient. In this study, we review the safety profile of the commonly used conventional systemic therapies used for psoriasis in individuals of reproductive potential. Safety data are derived from large-scale registries, adverse-event reporting databases, clinical trials and case reports. We assess the effect of each therapy on adverse pregnancy outcomes, including congenital malformations, and lactation with maternal administration. We also assess the effect of the therapies on male fertility and potential mutagenicity with paternal administration. We provide applicable guidance to inform clinician and patient before and after conception.

  20. [Anaerobic bacteria as a gene delivery system for breast cancer therapy].

    Science.gov (United States)

    Fujimori, Minoru

    2008-06-01

    A fundamental obstacle in systemic therapy for metastatic breast cancer patients is specific targeting of therapy directly to a solid tumor. Hypoxic or necrotic regions are characteristic of solid tumors in many murine and human tumors, including the majority of primary tumors of the breast. A strain of anaerobic bacteria such as Bifidobacterium or Clostridium selectively localizes to and proliferates in solid tumors after systemic application. Another approach uses attenuated Salmonella strains that need tumor-specific nutrients to selectively proliferate and is a potential gene delivery system. We constructed a plasmid, pBLES100-S-eCD, which included the cytosine deaminase gene. Transfected Bifidobacterium longum produced cytosine deaminase in the hypoxic tumor. Enzyme/pro-drug therapy was confirmed to be effective for systemic administration.

  1. Three-dimensional spatial and temporal temperature control with MR thermometry-guided focused ultrasound (MRgHIFU).

    Science.gov (United States)

    Mougenot, Charles; Quesson, Bruno; de Senneville, Baudouin Denis; de Oliveira, Philippe Lourenco; Sprinkhuizen, Sara; Palussière, Jean; Grenier, Nicolas; Moonen, Chrit T W

    2009-03-01

    High-intensity focused ultrasound (HIFU) is an efficient noninvasive technique for local heating. Using MRI thermal maps, a proportional, integral, and derivative (PID) automatic temperature control was previously applied at the focal point, or at several points within a plane perpendicular to the beam axis using a multispiral focal point trajectory. This study presents a flexible and rapid method to extend the spatial PID temperature control to three dimensions during each MR dynamic. The temperature in the complete volume is regulated by taking into account the overlap effect of nearby sonication points, which tends to enlarge the heated area along the beam axis. Volumetric temperature control in vitro in gel and in vivo in rabbit leg muscle was shown to provide temperature control with a precision close to that of the temperature MRI measurements. The proposed temperature control ensures heating throughout the volume of interest of up to 1 ml composed of 287 voxels with 95% of the energy deposited within its boundaries and reducing the typical average temperature overshoot to 1 degrees C.

  2. First clinical experience with a dedicated MRI-guided high-intensity focused ultrasound system for breast cancer ablation

    Energy Technology Data Exchange (ETDEWEB)

    Merckel, Laura G.; Knuttel, Floor M.; Peters, Nicky H.G.M.; Mali, Willem P.T.M.; Bosch, Maurice A.A.J. van den [University Medical Center Utrecht, Department of Radiology, HP E 01.132, Utrecht (Netherlands); Deckers, Roel; Moonen, Chrit T.W.; Bartels, Lambertus W. [University Medical Center Utrecht, Image Sciences Institute, Utrecht (Netherlands); Dalen, Thijs van [Diakonessenhuis Utrecht, Department of Surgery, Utrecht (Netherlands); Schubert, Gerald [Philips Healthcare, Best (Netherlands); Weits, Teun [Diakonessenhuis Utrecht, Department of Radiology, Utrecht (Netherlands); Diest, Paul J. van [University Medical Center Utrecht, Department of Pathology, Utrecht (Netherlands); Vaessen, Paul H.H.B. [University Medical Center Utrecht, Department of Anesthesiology, Utrecht (Netherlands); Gorp, Joost M.H.H. van [Diakonessenhuis Utrecht, Department of Pathology, Utrecht (Netherlands)

    2016-11-15

    To assess the safety and feasibility of MRI-guided high-intensity focused ultrasound (MR-HIFU) ablation in breast cancer patients using a dedicated breast platform. Patients with early-stage invasive breast cancer underwent partial tumour ablation prior to surgical resection. MR-HIFU ablation was performed using proton resonance frequency shift MR thermometry and an MR-HIFU system specifically designed for breast tumour ablation. The presence and extent of tumour necrosis was assessed by histopathological analysis of the surgical specimen. Pearson correlation coefficients were calculated to assess the relationship between sonication parameters, temperature increase and size of tumour necrosis at histopathology. Ten female patients underwent MR-HIFU treatment. No skin redness or burns were observed in any of the patients. No correlation was found between the applied energy and the temperature increase. In six patients, tumour necrosis was observed with a maximum diameter of 3-11 mm. In these patients, the number of targeted locations was equal to the number of areas with tumour necrosis. A good correlation was found between the applied energy and the size of tumour necrosis at histopathology (Pearson = 0.76, p = 0.002). Our results show that MR-HIFU ablation with the dedicated breast system is safe and results in histopathologically proven tumour necrosis. (orig.)

  3. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

    OpenAIRE

    Liu, Dora; Ahmet, Alexandra; Ward, Leanne; Krishnamoorthy, Preetha; Mandelcorn, Efrem D.; Leigh, Richard; Brown, Jacques P; Cohen, Albert; Kim, Harold

    2013-01-01

    Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing?s syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article ...

  4. The proton therapy system for the NPTC: Equipment description and progress report

    Science.gov (United States)

    Jongen, Y.; Laycock, S.; Abs, M.; Amelia, J.-C.; Beeckman, W.; Kleeven, W.; Ladeuze, M.; Lannoye, G.; Leyman, D.; Poreye, V.; Vandeplassche, D.; Zaremba, S.; Hurn, T.; Nissley, L.; Hubbard, E.; Heiberger, M.; Tabor, M.; Silke, C.; Tachikawa, Toshiki; Sano, Masami; Takayama, Takeshi; Ohtomo, Kiyotaka; Satoh, Takemi

    1996-06-01

    Proton therapy is widely acknowledged as one of the most effective methods in the selective destruction of cancer cells. Its development has, however, been hampered by the complexity, the size and the cost of the necessary equipment, which were up to now not adapted to the hospital environment. Things are changing in this regard. At the beginning of 1994, the Massachusetts General Hospital (MGH) of the Harvard Medical School in Boston, MA, USA, a pioneer in proton therapy since 1959, selected a team led by IBA to supply the proton therapy equipment of its new Northeast Proton Therapy Centre (NPTC). The present paper presents the integrated system being build for the NPTC. This equipment includes a compact 235 MeV isochronous cyclotron, a short energy selection system transforming the fixed energy beam extracted from the cyclotron into a variable energy beam, one or more isocentric gantries fitted with a nozzle, one or more horizontal beam lines, a global control system including an accelerator control unit and several independent but networked therapy control stations, a global safety management system, and a robotic patient positioning system.

  5. Evaluative comparison of systemic aspirin therapy effects on gingival bleeding in post non-surgical periodontal therapy individuals

    Directory of Open Access Journals (Sweden)

    Elanchezhiyan Sundram

    2012-01-01

    Full Text Available Background: Gingival bleeding is considered as an important clinical sign for diagnosis of periodontal disease pathogenesis. Immune inflammatory reactions caused by local factors are considered as essential reasons for gingival bleeding, as also for the systemic bleeding disorders. In disease-free conditions of gingiva, the bleeding disorders are considered to be the main contender for bleeding. Other than these variables, many systemic drugs including systemic aspirin could also cause gingival bleeding. The main aim of the study was to evaluate the effect of buffered aspirin therapy on gingival bleeding. Materials and Methods: Totally, 36 systemically healthy individuals were included in the 15-day randomized, double-blinded, placebo-controlled clinical trial. The 15 days were divided as: control period for the first 7 days and study period for the following 7 days. On the 1 st day, all individuals were given oral prophylaxis after recording gingival parameters such as Plaque Index, probing depth, and Bleeding Index, and then blood samples were collected for hematological investigations. Then, all individuals were administered placebo capsules for 1 week as once daily dose. On the 8 th day, all procedures were repeated and the individuals were prescribed with 325 coated aspirin capsules for 1 week. On the 15 th day, all parameters were repeated and the results were statistically analyzed. Results: In the study period, the parameters such as Bleeding Index, bleeding time, and prothrombin time were increased significantly, compared to the control period. Conclusion: The variables such as systemic drug therapy should be considered for the examination of gingiva while the diagnosis is considered mainly based on gingival bleeding.

  6. Quality of Intensity Modulated Radiation Therapy Treatment Plans Using a {sup 60}Co Magnetic Resonance Image Guidance Radiation Therapy System

    Energy Technology Data Exchange (ETDEWEB)

    Wooten, H. Omar, E-mail: hwooten@radonc.wustl.edu; Green, Olga; Yang, Min; DeWees, Todd; Kashani, Rojano; Olsen, Jeff; Michalski, Jeff; Yang, Deshan; Tanderup, Kari; Hu, Yanle; Li, H. Harold; Mutic, Sasa

    2015-07-15

    Purpose: This work describes a commercial treatment planning system, its technical features, and its capabilities for creating {sup 60}Co intensity modulated radiation therapy (IMRT) treatment plans for a magnetic resonance image guidance radiation therapy (MR-IGRT) system. Methods and Materials: The ViewRay treatment planning system (Oakwood Village, OH) was used to create {sup 60}Co IMRT treatment plans for 33 cancer patients with disease in the abdominal, pelvic, thorax, and head and neck regions using physician-specified patient-specific target coverage and organ at risk (OAR) objectives. Backup plans using a third-party linear accelerator (linac)-based planning system were also created. Plans were evaluated by attending physicians and approved for treatment. The {sup 60}Co and linac plans were compared by evaluating conformity numbers (CN) with 100% and 95% of prescription reference doses and heterogeneity indices (HI) for planning target volumes (PTVs) and maximum, mean, and dose-volume histogram (DVH) values for OARs. Results: All {sup 60}Co IMRT plans achieved PTV coverage and OAR sparing that were similar to linac plans. PTV conformity for {sup 60}Co was within <1% and 3% of linac plans for 100% and 95% prescription reference isodoses, respectively, and heterogeneity was on average 4% greater. Comparisons of OAR mean dose showed generally better sparing with linac plans in the low-dose range <20 Gy, but comparable sparing for organs with mean doses >20 Gy. The mean doses for all {sup 60}Co plan OARs were within clinical tolerances. Conclusions: A commercial {sup 60}Co MR-IGRT device can produce highly conformal IMRT treatment plans similar in quality to linac IMRT for a variety of disease sites. Additional work is in progress to evaluate the clinical benefit of other novel features of this MR-IGRT system.

  7. Statin therapy inhibits remyelination in the central nervous system

    DEFF Research Database (Denmark)

    Miron, Veronique E; Zehntner, Simone P; Kuhlmann, Tanja

    2009-01-01

    Remyelination of lesions in the central nervous system contributes to neural repair following clinical relapses in multiple sclerosis. Remyelination is initiated by recruitment and differentiation of oligodendrocyte progenitor cells (OPCs) into myelinating oligodendrocytes. Simvastatin, a blood...

  8. "Suicide" Gen Therapy for Malignant Central Nervous System Tumors

    NARCIS (Netherlands)

    A.J.P.E. Vincent (Arnoud)

    1998-01-01

    textabstractDespite development in surgical techniques, chemotherapy and radiotherapy, most malignancies of the central nervous system are still devastating tumors with a poor prognosis. For example, median survival of patients with malignant gliomas (astrocytoma, oligodendroglioma or mixed rype) is

  9. Digestive system dysfunction in cystic fibrosis: challenges for nutrition therapy.

    Science.gov (United States)

    Li, Li; Somerset, Shawn

    2014-10-01

    Cystic fibrosis can affect food digestion and nutrient absorption. The underlying mutation of the cystic fibrosis trans-membrane regulator gene depletes functional cystic fibrosis trans-membrane regulator on the surface of epithelial cells lining the digestive tract and associated organs, where Cl(-) secretion and subsequently secretion of water and other ions are impaired. This alters pH and dehydrates secretions that precipitate and obstruct the lumen, causing inflammation and the eventual degradation of the pancreas, liver, gallbladder and intestine. Associated conditions include exocrine pancreatic insufficiency, impaired bicarbonate and bile acid secretion and aberrant mucus formation, commonly leading to maldigestion and malabsorption, particularly of fat and fat-soluble vitamins. Pancreatic enzyme replacement therapy is used to address this insufficiency. The susceptibility of pancreatic lipase to acidic and enzymatic inactivation and decreased bile availability often impedes its efficacy. Brush border digestive enzyme activity and intestinal uptake of certain disaccharides and amino acids await clarification. Other complications that may contribute to maldigestion/malabsorption include small intestine bacterial overgrowth, enteric circular muscle dysfunction, abnormal intestinal mucus, and intestinal inflammation. However, there is some evidence that gastric digestive enzymes, colonic microflora, correction of fatty acid abnormalities using dietary n-3 polyunsaturated fatty acid supplementation and emerging intestinal biomarkers can complement nutrition management in cystic fibrosis. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  10. RNA Systems Biology for Cancer: From Diagnosis to Therapy.

    Science.gov (United States)

    Amirkhah, Raheleh; Farazmand, Ali; Wolkenhauer, Olaf; Schmitz, Ulf

    2016-01-01

    It is due to the advances in high-throughput omics data generation that RNA species have re-entered the focus of biomedical research. International collaborate efforts, like the ENCODE and GENCODE projects, have spawned thousands of previously unknown functional non-coding RNAs (ncRNAs) with various but primarily regulatory roles. Many of these are linked to the emergence and progression of human diseases. In particular, interdisciplinary studies integrating bioinformatics, systems biology, and biotechnological approaches have successfully characterized the role of ncRNAs in different human cancers. These efforts led to the identification of a new tool-kit for cancer diagnosis, monitoring, and treatment, which is now starting to enter and impact on clinical practice. This chapter is to elaborate on the state of the art in RNA systems biology, including a review and perspective on clinical applications toward an integrative RNA systems medicine approach. The focus is on the role of ncRNAs in cancer.

  11. Molecular pathology and targeted therapy of common tumors in central nervous system

    Directory of Open Access Journals (Sweden)

    Fei YANG

    2014-12-01

    Full Text Available It is difficult to cure central nervous system tumors using traditional method, due to chemotherapy drugs lack of specificity. They kill the tumor cells, and damage normal tissues and organs at the same time. The latest hotspot is targeted therapy on the specific molecules in the molecular pathway of central nervous system tumor cells. This review introduces the relationship between molecularly biological characteristics of medulloblastoma, oligodendrocytoma, glioblastoma and the prognosis in the view of critical intracellular pathway and genetic mutation. Furthermore, it reviews the current situation and progress of targeted therapy of tumors. As a consequence, it offers some new information for the individualized therapy of central nervous system tumors. doi: 10.3969/j.issn.1672-6731.2014.12.017

  12. Outcome assessment of patients with metastatic renal cell carcinoma under systemic therapy using artificial neural networks.

    Science.gov (United States)

    Buchner, Alexander; Kendlbacher, Martin; Nuhn, Philipp; Tüllmann, Cordula; Haseke, Nicolas; Stief, Christian G; Staehler, Michael

    2012-03-01

    The outcome of patients with advanced renal cell carcinoma (RCC) under systemic therapy shows remarkable variability, and there is a need to identify prognostic parameters that allow individual prognostic stratification and selection of optimal therapy. Artificial neural networks (ANN) are software systems that can be trained to recognize complex data patterns. In this study, we used ANNs to identify poor prognosis of patients with RCC based on common clinical parameters available at the beginning of systemic therapy. Data from patients with RCC who started systemic therapy were collected prospectively in a single center database; 175 data sets with follow-up data (median, 36 months) were available for analysis. Age, sex, body mass index, performance status, histopathologic parameters, time interval between primary tumor and detection of metastases, type of systemic therapy, number of metastases, and metastatic sites were used as input data for the ANN. The target variable was overall survival after 36 months. Logistic regression models were constructed by using the same variables. Death after 36 months occurred in 26% of the patients in the tyrosine kinase inhibitors group and in 37% of the patients in the immunotherapy group (P = .22). ANN achieved 95% overall accuracy and significantly outperformed logistic regression models (78% accuracy). Pathologic T classification, invasion of vessels, and tumor grade had the highest impact on the network's decision. ANN is a promising approach for individual risk stratification of patients with advanced RCC under systemic therapy, based on clinical parameters, and can help to optimize the therapeutic strategy. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. High-dose intravenous immunoglobulin therapy for systemic capillary leak syndrome (Clarkson disease).

    Science.gov (United States)

    Xie, Zhihui; Chan, Eunice C; Long, Lauren M; Nelson, Celeste; Druey, Kirk M

    2015-01-01

    Systemic capillary leak syndrome is a highly rare disorder of unknown cause. The disease is characterized by episodes of transient vascular collapse, which leads to hypotensive shock and anasarca. Previous treatment of this potentially devastating condition has been largely ineffective. We evaluated intravenous immunoglobulin prophylactic therapy in a cohort of 29 patients with systemic capillary leak syndrome in a longitudinal follow-up study. All patients received treatments at the discretion of their primary providers and retrospectively via questionnaire-recorded symptoms beginning with their first documented episode of systemic capillary leak syndrome to May 31, 2014. A total of 22 of 29 patients responded to the questionnaire, and 18 of the 22 respondents received monthly prophylaxis with intravenous immunoglobulin during the study period for a median interval of 32 months. The median annual attack frequency was 2.6 per patient before intravenous immunoglobulin therapy and 0 per patient after initiation of intravenous immunoglobulin prophylaxis (P = .0001). A total of 15 of 18 subjects with a history of 1 or more acute systemic capillary leak syndrome episodes experienced no further symptoms while taking intravenous immunoglobulin therapy. Intravenous immunoglobulin prophylaxis is associated with a dramatic reduction in the occurrence of systemic capillary leak syndrome attacks in most patients, with minimal side effects. A prospective, randomized trial may be necessary to fully assess the benefits of intravenous immunoglobulin for systemic capillary leak syndrome and to determine the optimal dosage and duration of therapy. Published by Elsevier Inc.

  14. Childhood central nervous system leukemia: historical perspectives, current therapy, and acute neurological sequelae

    Energy Technology Data Exchange (ETDEWEB)

    Laningham, Fred H. [St. Jude Children' s Research Hospital, Division of Diagnostic Imaging, Department of Radiological Sciences, Memphis, TN (United States); University of Tennessee Health Sciences Center, Memphis, TN (United States); Kun, Larry E. [St. Jude Children' s Research Hospital, Division of Radiation Oncology, Department of Radiological Sciences, Memphis, TN (United States); University of Tennessee Health Sciences Center, Memphis, TN (United States); Reddick, Wilburn E.; Ogg, Robert J. [St. Jude Children' s Research Hospital, Division of Translational Imaging Research, Department of Radiological Sciences, Memphis, TN (United States); Morris, E.B. [St. Jude Children' s Research Hospital, Department of Oncology, Memphis, TN (United States); Pui, Ching-Hon [St. Jude Children' s Research Hospital, Department of Oncology, Memphis, TN (United States); University of Tennessee Health Sciences Center, Memphis, TN (United States)

    2007-11-15

    During the past three decades, improvements in the treatment of childhood leukemia have resulted in high cure rates, particularly for acute lymphoblastic leukemia (ALL). Unfortunately, successful therapy has come with a price, as significant morbidity can result from neurological affects which harm the brain and spinal cord. The expectation and hope is that chemotherapy, as a primary means of CNS therapy, will result in acceptable disease control with less CNS morbidity than has been observed with combinations of chemotherapy and radiotherapy over the past several decades. In this review we discuss the poignant, historical aspects of CNS leukemia therapy, outline current methods of systemic and CNS leukemia therapy, and present imaging findings we have encountered in childhood leukemia patients with a variety of acute neurological conditions. A major objective of our research is to understand the neuroimaging correlates of acute and chronic effects of cancer and therapy. Specific features related to CNS leukemia and associated short-term toxicities, both disease- and therapy-related, are emphasized in this review with the specific neuroimaging findings. Specific CNS findings are similarly important when treating acute myelogenous leukemia (AML), and details of leukemic involvement and toxicities are also presented in this entity. Despite contemporary treatment approaches which favor the use of chemotherapy (including intrathecal therapy) over radiotherapy in the treatment of CNS leukemia, children still occasionally experience morbid neurotoxicity. Standard neuroimaging is sufficient to identify a variety of neurotoxic sequelae in children, and often suggest specific etiologies. Specific neuroimaging findings frequently indicate a need to alter antileukemia therapy. It is important to appreciate that intrathecal and high doses of systemic chemotherapy are not innocuous and are associated with acute, specific, recognizable, and often serious neurological

  15. Application of CRISPR-Cas system in gene therapy: Pre-clinical progress in animal model.

    Science.gov (United States)

    Guan, Lihong; Han, Yawei; Zhu, Shaoyi; Lin, Juntang

    2016-10-01

    The clustered regularly interspaced short palindromic repeats (CRISPRs) and their associated proteins (Cas) belong to the crucial adaptive immune system, which exist in archaea and bacteria. Currently, CRISPR-Cas9 system has been modified and widely used to edit genome. In this review, we summarized the discovery, classification and mechanism of CRISPR-Cas system and further discussed the application of CRISPR-Cas9 in gene therapy, mainly in disease models. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Intravenous immunoglobulin therapy for hypocomplementemic urticarial vasculitis associated with systemic lupus erythematosus in a child.

    Science.gov (United States)

    Yamazaki-Nakashimada, Marco A; Duran-McKinster, Carola; Ramírez-Vargas, Nadia; Hernandez-Bautista, Victor

    2009-01-01

    Hypocomplementemic urticarial vasculitis is a type of urticarial vasculitis with multisystemic involvement and poor prognosis, sometimes associated with systemic lupus erythematosus. Several therapies have been attempted with no consensus on an effective therapeutic regimen. Intravenous immunoglobulin has been used in severe manifestations of systemic lupus erythematosus and recently in hypocomplementemic urticarial vasculitis. We present a 7-year-old girl with hypocomplementemic urticarial vasculitis associated with systemic lupus erythematosus and pneumonia who responded favorably to intravenous immunoglobulin.

  17. EGFR transactivation: mechanisms, pathophysiology and potential therapies in cardiovascular system

    Science.gov (United States)

    Forrester, Steven J.; Kawai, Tatsuo; Elliott, Katherine J.; O’Brien, Shannon; Thomas, Walter; Harris, Raymond C.; Eguchi, Satoru

    2017-01-01

    Accumulating studies suggest that the epidermal growth factor receptor (EGFR) activation is associated with the physiology and pathophysiology of the cardiovascular system, and inhibition of EGFR activity is emerging as a potential therapeutic strategy to treat diseases, including hypertension, cardiac hypertrophy, renal fibrosis and abdominal aortic aneurysm. The capacity of G protein-coupled receptor (GPCR) agonists, such as angiotensin II (AngII), to promote EGFR signaling is well described – a process termed EGFR “transactivation” – yet delineating the molecular processes and functional relevance of this crosstalk has been challenging. Moreover, these critical findings are dispersed among many different fields. The aim of our review is to highlight the recent advancement of the signaling cascades and downstream consequences of EGFR transactivation within the cardiovascular renal system in vitro and in vivo. We will also focus on linking EGFR transactivation to animal models of the disease as well as the potential therapeutic applications. PMID:26566153

  18. Ultraviolet-A1 irradiation therapy for systemic lupus erythematosus

    Science.gov (United States)

    2017-01-01

    Systemic lupus erythematosus (lupus, SLE) is a chronic autoimmune disease characterized by the production of autoantibodies, which bind to antigens and are deposited within tissues to fix complement, resulting in widespread systemic inflammation. The studies presented herein are consistent with hyperpolarized, adenosine triphosphate (ATP)-deficient mitochondria being central to the disease process. These hyperpolarized mitochondria resist the depolarization required for activation-induced apoptosis. The mitochondrial ATP deficits add to this resistance to apoptosis and also reduce the macrophage energy that is needed to clear apoptotic bodies. In both cases, necrosis, the alternative pathway of cell death, results. Intracellular constituents spill into the blood and tissues, eliciting inflammatory responses directed at their removal. What results is “autoimmunity.” Ultraviolet (UV)-A1 photons have the capacity to remediate this aberrancy. Exogenous exposure to low-dose, full-body, UV-A1 radiation generates singlet oxygen. Singlet oxygen has two major palliative actions in patients with lupus and the UV-A1 photons themselves have several more. Singlet oxygen depolarizes the hyperpolarized mitochondrion, triggering non-ATP-dependent apoptosis that deters necrosis. Next, singlet oxygen activates the gene encoding heme oxygenase (HO-1), a major governor of systemic homeostasis. HO-1 catalyzes the degradation of the oxidant heme into biliverdin (converted to bilirubin), Fe, and carbon monoxide (CO), the first three of these exerting powerful antioxidant effects, and in conjunction with a fourth, CO, protecting against injury to the coronary arteries, the central nervous system, and the lungs. The UV-A1 photons themselves directly attenuate disease in lupus by reducing B cell activity, preventing the suppression of cell-mediated immunity, slowing an epigenetic progression toward SLE, and ameliorating discoid and subacute cutaneous lupus. Finally, a combination of

  19. Graphene Oxide-Gallic Acid Nanodelivery System for Cancer Therapy

    OpenAIRE

    Dorniani, D.; Saifullah, B.; Barahuie, F.; Arulselvan, P.; Hussein, M.Z.; Fakurazi, S; Twyman, L.J.

    2016-01-01

    Despite the technological advancement in the biomedical science, cancer remains a life-threatening disease. In this study, we designed an anticancer nanodelivery system using graphene oxide (GO) as nanocarrier for an active anticancer agent gallic acid (GA). The successful formation nanocomposite (GOGA) was characterized using XRD, FTIR, HRTEM, Raman, and UV/Vis spectroscopy. The release study shows that the release of GA from the designed anticancer nanocomposite (GOGA) occurs in a sustained...

  20. A Review of Thermo- and Ultrasound-Responsive Polymeric Systems for Delivery of Chemotherapeutic Agents

    Directory of Open Access Journals (Sweden)

    Az-Zamakhshariy Zardad

    2016-10-01

    Full Text Available There has been an exponential increase in research into the development of thermal- and ultrasound-activated delivery systems for cancer therapy. The majority of researchers employ polymer technology that responds to environmental stimuli some of which are physiologically induced such as temperature, pH, as well as electrical impulses, which are considered as internal stimuli. External stimuli include ultrasound, light, laser, and magnetic induction. Biodegradable polymers may possess thermoresponsive and/or ultrasound-responsive properties that can complement cancer therapy through sonoporation and hyperthermia by means of High Intensity Focused Ultrasound (HIFU. Thermoresponsive and other stimuli-responsive polymers employed in drug delivery systems can be activated via ultrasound stimulation. Polyethylene oxide/polypropylene oxide co-block or triblock polymers and polymethacrylates are thermal- and pH-responsive polymer groups, respectively but both have proven to have successful activity and contribution in chemotherapy when exposed to ultrasound stimulation. This review focused on collating thermal- and ultrasound-responsive delivery systems, and combined thermo-ultrasonic responsive systems; and elaborating on the advantages, as well as shortcomings, of these systems in cancer chemotherapy. The mechanisms of these systems are explicated through their physical alteration when exposed to the corresponding stimuli. The properties they possess and the modifications that enhance the mechanism of chemotherapeutic drug delivery from systems are discussed, and the concept of pseudo-ultrasound responsive systems is introduced.

  1. Studying circular questioning "in situ": discourse analysis of a first systemic family therapy session.

    Science.gov (United States)

    Diorinou, Maria; Tseliou, Eleftheria

    2014-01-01

    The present article focuses on the study of circular questioning "in situ," that is, in the context of the discursive arena of an actual first systemic family therapy session. Two typical circular questions are selected, and discourse analysis heavily drawing from the discursive action model is deployed with the aim to highlight their function in the context of therapist and family members' problem talk. The analysis demonstrates the gradual building of two respective patterns, which both exhibit signs of shifts toward the instillment of a systemic epistemology in relation to problem talk: a shift from homogeneity to heterogeneity in family members' voices, which legitimizes the existence of different viewpoints within a system, and a shift from the construction of an accusation toward its deconstruction, which challenges the linear perception of causality underlying the accusation, thus introducing a more circular perspective. Implications are discussed in relation to contemporary, constructionist systemic family therapy practice, and reference is made to the methodological "promises" and challenges of the deployment of discourse analysis for the scrutiny of systemic family therapy therapeutic techniques and tools under a discursively informed light. © 2012 American Association for Marriage and Family Therapy.

  2. Systematic review of innovative ablative therapies for the treatment of locally advanced pancreatic cancer.

    Science.gov (United States)

    Rombouts, S J E; Vogel, J A; van Santvoort, H C; van Lienden, K P; van Hillegersberg, R; Busch, O R C; Besselink, M G H; Molenaar, I Q

    2015-02-01

    Locally advanced pancreatic cancer (LAPC) is associated with a very poor prognosis. Current palliative (radio)chemotherapy provides only a marginal survival benefit of 2-3 months. Several innovative local ablative therapies have been explored as new treatment options. This systematic review aims to provide an overview of the clinical outcomes of these ablative therapies. A systematic search in PubMed, Embase and the Cochrane Library was performed to identify clinical studies, published before 1 June 2014, involving ablative therapies in LAPC. Outcomes of interest were safety, survival, quality of life and pain. After screening 1037 articles, 38 clinical studies involving 1164 patients with LAPC, treated with ablative therapies, were included. These studies concerned radiofrequency ablation (RFA) (7 studies), irreversible electroporation (IRE) (4), stereotactic body radiation therapy (SBRT) (16), high-intensity focused ultrasound (HIFU) (5), iodine-125 (2), iodine-125-cryosurgery (2), photodynamic therapy (1) and microwave ablation (1). All strategies appeared to be feasible and safe. Outcomes for postoperative, procedure-related morbidity and mortality were reported only for RFA (4-22 and 0-11 per cent respectively), IRE (9-15 and 0-4 per cent) and SBRT (0-25 and 0 per cent). Median survival of up to 25·6, 20·2, 24·0 and 12·6 months was reported for RFA, IRE, SBRT and HIFU respectively. Pain relief was demonstrated for RFA, IRE, SBRT and HIFU. Quality-of-life outcomes were reported only for SBRT, and showed promising results. Ablative therapies in patients with LAPC appear to be feasible and safe. © 2014 BJS Society Ltd. Published by John Wiley & Sons, Ltd.

  3. Building Community Pharmacy Work System Capacity for Medication Therapy Management

    Directory of Open Access Journals (Sweden)

    Jon C. Schommer, Ph.D.

    2012-01-01

    Full Text Available Questions within and outside of the pharmacy profession frequently arise about a community pharmacy’s capacity to provide patient-care services and maximize contributions to public health. It is surmised that community pharmacy locations must possess specific attributes and have identifiable resources within the location to effectively initiate and optimize their capacity to deliver patient care services in conjunction with medication distribution and other services. The purpose of this paper is to describe three research domains that can help pharmacies make the transition from “traditional” business models to “patient care centered” practices: (1 Work System Design, (2 Entrepreneurial Orientation, and (3 Organizational Flexibility. From these research domains, we identified 21 Work System Design themes, 4 dimensions of Entrepreneurial Orientation, and 4 types of Organizational Flexibility that can be used in combination to assist a practice location in transforming its business model to a “patient care centered” practice. The self-assessment tools we described in this paper could help realign an organization’s activities to initiate and optimize capacity for patient care.

  4. Vocal cord paresis following single-session high intensity focused ablation (HIFU) treatment of benign thyroid nodules: incidence and risk factors.

    Science.gov (United States)

    Lang, Brian H H; Woo, Yu-Cho; Chiu, Keith Wan-Hang

    2017-06-06

    Vocal cord paresis (VCP) may occur following high intensity focused ultrasound (HIFU) of thyroid nodules. We hypothesised its occurrence relates to the distance of the focus point (FP) of the HIFU beams from the recurrent laryngeal nerve (RLN) and the thermal power that this point received. Their relationships were examined. One hundred and three patients who underwent HIFU for symptomatic benign thyroid nodule from October 2015 to March 2017 were analysed. All treatment images were captured and were later watched by 2 reviewers to identify three FPs closest to the tracheoesophageal groove (TEG) on transverse sonographic view. TEG was taken as the RLN position. After identifying these FPs, their distance (mm) from the TEG, thermal power (W) used and depth from skin (mm) were recorded. These parameters were compared between those with and without VCP. VCP was defined as a cord with reduced or no movement. Four (3.9%) patients suffered from a unilateral VCP afterwards but they all recovered fully within 6 weeks. There were no significant differences in baseline characteristics and treatment efficacy between the two groups. The distance from TEG (OR = 1.706, 95%CI = 1.001 to 2.915, p = 0.050) was the only significant factor for VCP. None of the other variables including thermal power were significant. The incidence of VCP was 3.9% (4/103) and they completely recovered within 6 weeks. The distance between the FP and the TEG was the only related factor for VCP. The safe distance between FP and TEG should be ≥1.1 cm.

  5. Combined Intratympanic and Systemic Steroid Therapy for Poor-Prognosis Sudden Sensorineural Hearing Loss

    Directory of Open Access Journals (Sweden)

    Shima Arastou

    2012-12-01

    Full Text Available Introduction: The aim of this study was to evaluate the efficacy of combined intratympanic and systemic steroid therapy compared with systemic steroid therapy alone in idiopathic sudden sensorineural hearing loss (ISSNHL patients with poor prognostic factors.     Materials and Methods: Seventy-seven patients with sudden sensorineural hearing loss (SSNHL who had at least one poor prognostic factor (age greater than 40 years, hearing loss more than 70 db, or greater than a 2-week delay between the onset of hearing loss and initiation of therapy were included in this study. Patients were randomized to the intervention group (combined intratympanic and systemic steroid therapy or the control group (systemic steroid therapy alone. All patients received oral treatment with systemic prednisolone (1 mg/kg/day for 10 days, acyclovir (2 g/day for 10 days, divided into four doses, triamterene H (daily, and omeprazole (daily, during steroid treatment, and were advised to follow a low salt diet. The intervention group also received intratympanic dexamethasone injections (0.4 ml of 4 mg/ml dexamethasone two times a week for two consecutive weeks (four injections in total. A significant hearing improvement was defined as at least a 15-db decrease in pure tone average (PTA.  Results: Among all participants, 44 patients (57.14% showed significant improvement in hearing evaluation. More patients showed hearing improvement in the intervention group than in the control group (27 patients (75% versus 17 patients (41.4%, respectively; P = 0.001.  Conclusion:  The combination of intratympanic dexamethasone and systemic prednisolone is more effective than systemic prednisolone alone in the treatment of poor-prognosis SSNHL.

  6. Graphene Oxide-Gallic Acid Nanodelivery System for Cancer Therapy

    Science.gov (United States)

    Dorniani, Dena; Saifullah, Bullo; Barahuie, Farahnaz; Arulselvan, Palanisamy; Hussein, Mohd Zobir Bin; Fakurazi, Sharida; Twyman, Lance J.

    2016-11-01

    Despite the technological advancement in the biomedical science, cancer remains a life-threatening disease. In this study, we designed an anticancer nanodelivery system using graphene oxide (GO) as nanocarrier for an active anticancer agent gallic acid (GA). The successful formation nanocomposite (GOGA) was characterized using XRD, FTIR, HRTEM, Raman, and UV/Vis spectroscopy. The release study shows that the release of GA from the designed anticancer nanocomposite (GOGA) occurs in a sustained manner in phosphate-buffered saline (PBS) solution at pH 7.4. In in vitro biological studies, normal fibroblast (3T3) and liver cancer cells (HepG2) were treated with different concentrations of GO, GOGA, and GA for 72 h. The GOGA nanocomposite showed the inhibitory effect to cancer cell growth without affecting normal cell growth. The results of this research are highly encouraging to go further for in vivo studies.

  7. Counseling and physical therapy as treatment for myofascial pain of the masticatory system.

    Science.gov (United States)

    De Laat, Antoon; Stappaerts, Karel; Papy, Sven

    2003-01-01

    To prospectively evaluate the effectiveness of a treatment regimen comprising counseling and physical therapy in patients with myofascial pain of the masticatory system, and to explore whether the duration of the physical therapy offered (4 vs 6 weeks) would influence the treatment result. Twenty-six patients were randomly distributed over 2 groups. All patients received reassuring information, advice regarding relaxation of the jaws, avoiding parafunctions, and limited use of the jaws. In addition, a physical therapy program (heat application, massage, ultrasound and muscle stretching) was initiated 2 weeks after the start of the study (group I, receiving 4 weeks of physical therapy) or immediately from the start of the study (group II, receiving 6 weeks of physical therapy). The following parameters were taken at baseline, 2, 4, and 6 weeks: visual analog scale (VAS) scores of present pain; lowest and highest pain over the past period; percentage of pain relief; jaw function assessment by the Mandibular Function Impairment Questionnaire (MFIQ); and pressure pain thresholds (PPTs) of the masseter, temporalis, and thumb muscles. Statistical analysis used a linear mixed model and corrected for multiple testing (Tukey test). Pain and MFIQ scores decreased while PPTs increased in both groups. Only after 4 and 6 weeks, significant differences were present for the PPT of the masseter in group I (P myofascial pain. A controlled study will be necessary to elucidate the specific effectiveness of physical therapy over counseling or no treatment.

  8. A VIRTUAL REALITY EXPOSURE THERAPY FOR PTSD PATIENTS CONTROLLED BY A FUZZY LOGIC SYSTEM

    Directory of Open Access Journals (Sweden)

    Rosa Maria Esteves Moreira da Costa

    2014-06-01

    Full Text Available This paper describes the main characteristics of two integrated systems that explore Virtual Reality technology and Fuzzy Logic to support and to control the assessment of people with Post-Traumatic Stress Disorder during the Virtual Reality Exposure Therapy. The integration of different technologies, the development methodology and the test procedures are described throughout the paper.

  9. Systemic Family Therapy Using the Reflecting Team: The Experiences of Adults with Learning Disabilities

    Science.gov (United States)

    Anslow, Katharine

    2014-01-01

    This research aimed to illuminate the experiences of adults with learning disabilities of the reflecting team, in the context of their systemic family therapy. Five adults with learning disabilities were recruited from one community learning disability team. A qualitative design using interpretative phenomenological analysis (IPA) was appropriate…

  10. Lessons Learned from Gemcitabine: Impact of Therapeutic Carrier Systems and Gemcitabine's Drug Conjugates on Cancer Therapy.

    Science.gov (United States)

    Dyawanapelly, Sathish; Kumar, Animesh; Chourasia, Manish K

    2017-01-01

    Currently, drug delivery systems have a high impact in cancer therapy and are receiving more attention than conventional cancer treatment modalities. Compared with current cancer therapies, gemcitabine (2', 2'-difluoro-2'-deoxycytidine) has been proven to be an effective chemotherapeutic agent against pancreatic, colon, bladder, breast, ovarian, non-small-cell lung, and head and neck cancers in combination with other anticancer agents. To improve the safety and efficacy of cytotoxic drugs, several drug delivery systems have been explored. This review outlines the recent work directed toward gemcitabine delivery systems for cancer therapy, including aerosols, polymeric nanoparticles, liposomes, microparticles, carbon nanotubes, and multifunctional theranostic nanomedicines. It also provides insight into the design and development of gemcitabine conjugation for safe and effective cancer therapy. Despite the clinical promises of gemcitabine, many therapeutic challenges remain. Specifically, its therapeutic use in cancer chemotherapy is impeded by a short biological half-life, caused by its rapid metabolism, and resistance due to increased expression of ribonucleotide reductase. In our opinion, many research investigations have contributed to improve the selectivity and efficacy of gemcitabine. This combined approach of drug delivery systems and gemcitabine conjugates has shown promising efficacy in preclinical models and significant potential for future clinical cancer-therapeutic applications. Also, these strategies overcome most of the aforementioned limits of gemcitabine.

  11. The Therapy Process Observational Coding System for Child Psychotherapy Strategies Scale

    Science.gov (United States)

    McLeod, Bryce D.; Weisz, John R.

    2010-01-01

    Most everyday child and adolescent psychotherapy does not follow manuals that document the procedures. Consequently, usual clinical care has remained poorly understood and rarely studied. The Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) is an observational measure of youth psychotherapy procedures…

  12. The shrinking lung syndrome in systemic lupus erythematosus: improvement with corticosteroid therapy

    NARCIS (Netherlands)

    Oud, K. T. M.; Bresser, P.; ten Berge, R. J. M.; Jonkers, R. E.

    2005-01-01

    Respiratory manifestations of systemic lupus erythematosus (SLE) are frequent. The 'shrinking lung syndrome' (SLS) represents a rare complication of SLE. The pathogenesis and therapy of the SLS remains controversial. We report a series of five consecutive cases with the SLS of which we provide a

  13. Palliative systemic therapy for women with recurrent epithelial ovarian cancer: current options

    Directory of Open Access Journals (Sweden)

    Elit L

    2013-02-01

    Full Text Available Laurie Elit,1,2 Hal Hirte21Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; 2Department of Oncology, McMaster University, Hamilton, Ontario, CanadaObjectives: To review the available systemic treatments for women with recurrent ovarian cancer.Methods: A literature review was conducted for recurrent ovarian cancer articles in English, including randomized trials, Phase II trials, or reviews.Results: We discuss the efficacy and toxicity outcomes associated with systemic therapy for platinum-sensitive and platinum-resistant ovarian cancer. Clearly, platinum-based combination systemic therapy shows a prolonged progression-free interval compared with single-agent chemotherapy with a low toxicity profile. No clear superior management strategy exists for platinum-resistant/refractory disease. Novel targeted antiangiogenic agents (eg, bevacizumab, angiopoeitin inhibitors (eg, AMG 386, and poly ADP ribose polymerase inhibitors (eg, olaparib are reviewed.Conclusion: Although combination platinum-based chemotherapy has shown benefits for women with platinum-sensitive recurrent ovarian cancer, the optimal treatment strategy for those with platinum-resistant or platinum-refractory disease is not clear. Molecular and genetic targeted therapies may provide opportunities for those women with tumor profiles that show sensitivity for specific agents.Keywords: ovarian cancer, systemic therapy, biologic agents

  14. Intensive Speech and Language Therapy for Older Children with Cerebral Palsy: A Systems Approach

    Science.gov (United States)

    Pennington, Lindsay; Miller, Nick; Robson, Sheila; Steen, Nick

    2010-01-01

    Aim: To investigate whether speech therapy using a speech systems approach to controlling breath support, phonation, and speech rate can increase the speech intelligibility of children with dysarthria and cerebral palsy (CP). Method: Sixteen children with dysarthria and CP participated in a modified time series design. Group characteristics were…

  15. A Systems Approach to Understanding Occupational Therapy Service Negotiations in a Preschool Setting

    Science.gov (United States)

    Silverman, Fern; Kramer, Paula; Ravitch, Sharon

    2011-01-01

    The purpose of this study was to use a systems approach to examine informal communications, meaning those occurring outside of scheduled meetings, among stakeholders in a preschool early intervention program. This investigation expands the discussion of how occupational therapy treatment decisions are made in educational settings by using a…

  16. Systemic therapy for head and neck squamous cell carcinoma: Historical perspectives and recent breakthroughs.

    Science.gov (United States)

    Blasco, Michael A; Svider, Peter F; Raza, S Naweed; Jacobs, John R; Folbe, Adam J; Saraf, Pankhoori; Eloy, Jean Anderson; Baredes, Soly; Fribley, Andrew M

    2017-11-01

    Despite dramatic developments in drugs established for other malignancies, historically there have been few novel systemic agents available for the management of head and neck squamous cell carcinoma (HNSCC). However, the last decade has observed increased interest in targeted therapies for HNSCC. In 2006, cetuximab became the first major drug for HNSCC to gain Food and Drug Administration (FDA) approval in 3 decades. Recently, both pembrolizumab and nivolumab gained FDA approval for treatment of recurrent or metastatic HNSCC, and trials for other indications in HNSCC are actively underway. As older agents including cisplatin and 5-fluorouracil continue to play a significant role in the management of advanced HNSCC, an understanding of their legacy is paramount. This historical review is not meant to exhaustively catalog every finding relating to HNSCC systemic therapy, but rather is meant to highlight important advances. Case series and clinical trials available in the literature. Historically significant series and trials evaluating HNSCC systemic therapy were evaluated. Standard regimens employed today are largely comprised of drugs discovered over 4 decades ago, although a number of recent phase III clinical trials have shown great promise, leading to the adoption of several new chemotherapeutic agents and treatment strategies. These findings reinforce the importance of supporting further HNSCC drug discovery as modern treatment strategies using systemic therapy have resulted in measurable improvements in oncologic outcomes. Laryngoscope, 127:2565-2569, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System.

    NARCIS (Netherlands)

    Mast, M.R.; Walraven, L.; Hoekstra, T.; Jansen, A.P.D.; Heijden, A.A.W.A. van der; Elders, P.J.M.; Heine, R.J.; Dekker, J.M.; Nijpels, G.; Hugtenburg, J.G.

    2016-01-01

    Aims To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy. Methods The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion

  18. Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System

    NARCIS (Netherlands)

    Mast, M.R.; Walraven, I.; Hoekstra, T.; Jansen, A P D; van der Heijden, A.A.W.A.; Elders, Petra J M; Heine, Robert J; Dekker, J M; Nijpels, G.; Hugtenburg, J.G.

    AIMS: To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy. METHODS: The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion

  19. The Formal Elements Art Therapy Scale: A Measurement System for Global Variables in Art

    Science.gov (United States)

    Gantt, Linda M.

    2009-01-01

    The Formal Elements Art Therapy Scale (FEATS) is a measurement system for applying numbers to global variables in two-dimensional art (drawing and painting). While it was originally developed for use with the single-picture assessment ("Draw a person picking an apple from a tree" [PPAT]), researchers can also apply many of the 14 scales of the…

  20. Predictors of community therapists' use of therapy techniques in a large public mental health system.

    Science.gov (United States)

    Beidas, Rinad S; Marcus, Steven; Aarons, Gregory A; Hoagwood, Kimberly E; Schoenwald, Sonja; Evans, Arthur C; Hurford, Matthew O; Hadley, Trevor; Barg, Frances K; Walsh, Lucia M; Adams, Danielle R; Mandell, David S

    2015-04-01

    Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of

  1. Fiber-array based optogenetic prosthetic system for stimulation therapy

    Science.gov (United States)

    Gu, Ling; Cote, Chris; Tejeda, Hector; Mohanty, Samarendra

    2012-02-01

    Recent advent of optogenetics has enabled activation of genetically-targeted neuronal cells using low intensity blue light with high temporal precision. Since blue light is attenuated rapidly due to scattering and absorption in neural tissue, optogenetic treatment of neurological disorders may require stimulation of specific cell types in multiple regions of the brain. Further, restoration of certain neural functions (vision, and auditory etc) requires accurate spatio-temporal stimulation patterns rather than just precise temporal stimulation. In order to activate multiple regions of the central nervous system in 3D, here, we report development of an optogenetic prosthetic comprising of array of fibers coupled to independently-controllable LEDs. This design avoids direct contact of LEDs with the brain tissue and thus does not require electrical and heat isolation, which can non-specifically stimulate and damage the local brain regions. The intensity, frequency, and duty cycle of light pulses from each fiber in the array was controlled independently using an inhouse developed LabView based program interfaced with a microcontroller driving the individual LEDs. While the temporal profile of the light pulses was controlled by varying the current driving the LED, the beam profile emanating from each fiber tip could be sculpted by microfabrication of the fiber tip. The fiber array was used to stimulate neurons, expressing channelrhodopsin-2, in different locations within the brain or retina. Control of neural activity in the mice cortex, using the fiber-array based prosthetic, is evaluated from recordings made with multi-electrode array (MEA). We also report construction of a μLED array based prosthetic for spatio-temporal stimulation of cortex.

  2. System and method for dose verification and gamma ray imaging in ion beam therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mihailescu, Lucian

    2017-12-26

    This disclosure provides systems, methods, and apparatus related to ion beam therapy. In one aspect, a system includes a position sensitive detector and a collimator. The position sensitive detector configured to detect gamma rays generated by an ion beam interacting with a target. The collimator is positioned between the target and the position sensitive detector. The collimator includes a plurality of knife-edge slits, with a first knife-edge slit intersecting with a second knife-edge slit.

  3. Genetic variation in the endocannabinoid system and response to cognitive behavior therapy for child anxiety disorders

    OpenAIRE

    Lester, Kathryn J; Coleman, Jonathan R I; Roberts, Susanna; Keers, Robert; Breen, Gerome; Bögels, Susan; Creswell, Cathy; Hudson, Jennifer L; McKinnon, Anna; Nauta, Maaike; Rapee, Ronald M; Schneider, Silvia; Silverman, Wendy K; Thastum, Mikael; Waite, Polly

    2017-01-01

    Extinction learning is an important mechanism in the successful psychological treatment of anxiety. Individual differences in response and relapse following Cognitive Behavior Therapy may in part be explained by variability in the ease with which fears are extinguished or the vulnerability of these fears to re?emerge. Given the role of the endocannabinoid system in fear extinction, this study investigates whether genetic variation in the endocannabinoid system explains individual differences ...

  4. Bacterial Cellulose Membranes as a Potential Drug Delivery System for Photodynamic Therapy of Skin Cancer

    OpenAIRE

    Peres,Maristela F. S.; Nigoghossian,Karina; Primo,Fernando L.; Saska,Sybele; Capote,Ticiana S. O.; Caminaga,Raquel M. S.; Messaddeq,Younes; Ribeiro,Sidney J. L.; Tedesco,Antonio C.

    2016-01-01

    The development of drug delivery systems for photodynamic therapy (PDT) is increasingly demanded due to the hydrophobicity presented by most of photosensitizers molecules. Bacterial cellulose (BC), a highly pure cellulose produced by bacteria, possesses the essential features for applications in drug delivery systems, such as large surface area and excellent loading capacity. BC membranes prepared containing a photosensitizer, chloroaluminum phthalocyanine (ClAlPc), were tested aiming applica...

  5. Benchmark IMRT evaluation of a Co-60 MRI-guided radiation therapy system.

    Science.gov (United States)

    Wooten, H Omar; Rodriguez, Vivian; Green, Olga; Kashani, Rojano; Santanam, Lakshmi; Tanderup, Kari; Mutic, Sasa; Li, H Harold

    2015-03-01

    A device for MRI-guided radiation therapy (MR-IGRT) that uses cobalt-60 sources to deliver intensity modulated radiation therapy is now commercially available. We investigated the performance of the treatment planning and delivery system against the benchmark recommended by the American Association of Physicists in Medicine (AAPM) Task Group 119 for IMRT commissioning and demonstrated that the device plans and delivers IMRT treatments within recommended confidence limits and with similar accuracy as linac IMRT. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Central Nervous System Strongyloidiasis and Cryptococcosis in an HIV-Infected Patient Starting Antiretroviral Therapy

    Directory of Open Access Journals (Sweden)

    Mónica Rodríguez

    2012-01-01

    Full Text Available We report a case of Strongyloides stercoralis hyperinfection syndrome with central nervous system involvement, in a patient with late human immunodeficiency virus (HIV infection starting antiretroviral therapy, in whom Strongyloides stercoralis larvae and Cryptococcus neoformans were isolated antemortem from cerebrospinal fluid. Our patient was not from an endemic region for the parasite, so strongyloidiasis was not originally suspected. For this reason, we conclude that Strongyloides stercoralis infection should be suspected in HIV-infected patients starting antiretroviral therapy in order to avoid potential fatal outcomes.

  7. Continuous Drug Infusion for Diabetes Therapy: A Closed-Loop Control System Design

    Directory of Open Access Journals (Sweden)

    Jiming Chen

    2008-03-01

    Full Text Available While a typical way for diabetes therapy is discrete insulin infusion based on long-time interval measurement, in this paper, we design a closed-loop control system for continuous drug infusion to improve the traditional discrete methods and make diabetes therapy automatic in practice. By exploring the accumulative function of drug to insulin, a continuous injection model is proposed. Based on this model, proportional-integral-derivative (PID and fuzzy logic controllers are designed to tackle a control problem of the resulting highly nonlinear plant. Even with serious disturbance of glucose, such as nutrition absorption at meal time, the proposed scheme can perform well in simulation experiments.

  8. A simple method for determining the coagulation threshold temperature of transparent tissue-mimicking thermal therapy gel phantoms: Validated by magnetic resonance imaging thermometry.

    Science.gov (United States)

    Brodin, N Patrik; Partanen, Ari; Asp, Patrik; Branch, Craig A; Guha, Chandan; Tomé, Wolfgang A

    2016-03-01

    Tissue-mimicking thermal therapy phantoms that coagulate at specific temperatures are valuable tools for developing and evaluating treatment strategies related to thermal therapy. Here, the authors propose a simple and efficient method for determining the coagulation threshold temperature of transparent thermal therapy gel phantoms. The authors used a previously published gel phantom recipe with 2% (w/v) of bovine serum albumin as the temperature-sensitive protein. Using the programmable heating settings of a polymerase chain reaction (PCR) machine, the authors heated 50 μl gel samples to various temperatures for 3 min and then imaged them using the BioRad Gel Doc system to determine the coagulation temperature using an opacity quantification method. The estimated coagulation temperatures were then validated for gel phantoms prepared with different pH levels using high-intensity focused ultrasound (HIFU) heating and magnetic resonance imaging (MRI) thermometry methods on a clinical MR-HIFU system. The PCR heating method produced consistent and reproducible coagulation of gel samples in precise correlation with the set incubation temperatures. The resulting coagulation threshold temperatures for gel phantoms of varying pH levels were found to be 44.1 ± 0.1, 53.4 ± 0.9, and 60.3 ± 0.9 °C for pH levels of 4.25, 4.50, and 4.75, respectively. This corresponded well with the coagulation threshold temperatures determined by MR-thermometry, with coagulation defined as a 95% decrease in T2 relaxation time, which were estimated at 53.6 ± 1.9 and 62.9 ± 2.4 °C for a pH of 4.50 and 4.75, respectively. The opacity quantification method provides a fast and reproducible estimate of the coagulation threshold temperature of transparent temperature-sensitive gel phantoms. The temperatures determined using this method were well within the range of temperatures estimated using MR-thermometry. Due to the specific heating capabilities of the PCR machine, and the robust

  9. Numerical Study on Focusing of Ultrasounds in Microbubble-enhanced HIFU

    Science.gov (United States)

    Matsumoto, Yoichiro; Okita, Kohei; Takagi, Shu

    2011-11-01

    The injection of microbubbles into the target tissue enhances tissue heating in High-Intensity Focused Ultrasound therapy, via inertial cavitation. The control of the inertial cavitation is required to achieve the efficient tissue ablation. Microbubbles between a transducer and a target disturb the ultrasound propagation depending on the conditions. A method to clear such microbubbles has been proposed by Kajiyama et al. [Physics Procedia 3 (2010) 305-314]. In the method, the irradiation of intense ultrasounds with a burst waveform fragmentize microbubbles in the pathways before the irradiation of ultrasounds for tissue heating. The vitro experiment using a gel containing microbubbles has showed that the method enables to heat the target correctly by controlling the microbubble distribution. Following the experiment, we simulate the focusing of ultrasounds through a mixture containing microbubbles with considering the size and number density distributions in space. The numerical simulation shows that the movement of the heating region from the transducer side to the target by controlling the microbubble distributions. The numerical results elucidate well the experimental ones.

  10. The nervous system and metabolic dysregulation: emerging evidence converges on ketogenic diet therapy

    Directory of Open Access Journals (Sweden)

    David N. Ruskin

    2012-03-01

    Full Text Available A link between metabolism and brain function is clear. Since ancient times, epileptic seizures were noted as treatable with fasting, and historical observations of the therapeutic benefits of fasting on epilepsy were confirmed nearly 100 years ago. Shortly thereafter a high-fat, low-carbohydrate ketogenic diet debuted as a therapy to reduce seizures. This strict regimen could mimic the metabolic effects of fasting while allowing adequate caloric intake for ongoing energy demands. Today, ketogenic diet therapy, which forces predominantly ketone-based rather than glucose-based metabolism, is now well-established as highly successful in reducing seizures. More recently, cellular metabolic dysfunction in the nervous system has been recognized as existing side-by-side with nervous system disorders - although often with much less obvious cause-and-effect as the relationship between fasting and seizures. Rekindled interest in metabolic and dietary therapies for brain disorders complements new insight into their mechanisms and broader implications. Here we describe the emerging relationship between a ketogenic diet and adenosine as a way to reset brain metabolism and neuronal activity and disrupt a cycle of dysfunction. We also provide an overview of the effects of a ketogenic diet on cognition and recent data on the effects of a ketogenic diet on pain, and explore the relative time course quantified among hallmark metabolic changes, altered neuron function and altered animal behavior assessed after diet administration. We predict continued applications of metabolic therapies in treating dysfunction including and beyond the nervous system.

  11. PREPARATION AND CHARACTERIZATION OF A NEAR-INFRARED LIGHT RESPONSIVE MICROCAPSULE SYSTEM FOR CANCER THERAPY

    Directory of Open Access Journals (Sweden)

    YINGFENG DI

    2014-01-01

    Full Text Available A novel near-infrared light responsive microcapsule system, gold nanorod-covered DOX-loaded hollow CaCO3 microcapsule (AuNR-HM-DOX is developed for cancer therapy. The hollow CaCO3 microcapsules were prepared based on the self-assembly between chitosan and sodium alginate on CaCO3 particles via layer-by-layer technique, and then covered with gold nanorods to obtain the microcapsule system. Upon near-infrared (NIR irradiation, microcapsule with gold nanorods can convert the absorbed NIR light into heat. Meanwhile, doxorubicin (DOX, a chemotherapy drug, is loaded into the microcapsule system via electrostatic adsorption for combined photothermal therapy and chemotherapy. Properties of AuNR-HM-DOX including grain diameter, optical spectra were characterized. Confocal fluorescence imaging was performed to observe the morphology of the capsules and existence of DOX in the core, confirming the successful loading of DOX. The release of DOX from the capsules under continuous NIR irradiation was investigated to evaluate the temperature responsiveness of AuNR-HM-DOX. Results indicate that AuNR-HM-DOX microcapsules possess uniform particle size and high light responsiveness. The combination of chemical and physical therapy of AuNR-HM-DOX features great potential as an adjuvant therapeutic alternative material for combined cancer therapy.

  12. The Nervous System and Metabolic Dysregulation: Emerging Evidence Converges on Ketogenic Diet Therapy

    Science.gov (United States)

    Ruskin, David N.; Masino, Susan A.

    2012-01-01

    A link between metabolism and brain function is clear. Since ancient times, epileptic seizures were noted as treatable with fasting, and historical observations of the therapeutic benefits of fasting on epilepsy were confirmed nearly 100 years ago. Shortly thereafter a high fat, low-carbohydrate ketogenic diet (KD) debuted as a therapy to reduce seizures. This strict regimen could mimic the metabolic effects of fasting while allowing adequate caloric intake for ongoing energy demands. Today, KD therapy, which forces predominantly ketone-based rather than glucose-based metabolism, is now well-established as highly successful in reducing seizures. Cellular metabolic dysfunction in the nervous system has been recognized as existing side-by-side with nervous system disorders – although often with much less obvious cause-and-effect as the relationship between fasting and seizures. Rekindled interest in metabolic and dietary therapies for brain disorders complements new insight into their mechanisms and broader implications. Here we describe the emerging relationship between a KD and adenosine as a way to reset brain metabolism and neuronal activity and disrupt a cycle of dysfunction. We also provide an overview of the effects of a KD on cognition and recent data on the effects of a KD on pain, and explore the relative time course quantified among hallmark metabolic changes, altered neuron function and altered animal behavior assessed after diet administration. We predict continued applications of metabolic therapies in treating dysfunction including and beyond the nervous system. PMID:22470316

  13. A Safeguard System for Induced Pluripotent Stem Cell-Derived Rejuvenated T Cell Therapy

    Directory of Open Access Journals (Sweden)

    Miki Ando

    2015-10-01

    Full Text Available The discovery of induced pluripotent stem cells (iPSCs has created promising new avenues for therapies in regenerative medicine. However, the tumorigenic potential of undifferentiated iPSCs is a major safety concern for clinical translation. To address this issue, we demonstrated the efficacy of suicide gene therapy by introducing inducible caspase-9 (iC9 into iPSCs. Activation of iC9 with a specific chemical inducer of dimerization (CID initiates a caspase cascade that eliminates iPSCs and tumors originated from iPSCs. We introduced this iC9/CID safeguard system into a previously reported iPSC-derived, rejuvenated cytotoxic T lymphocyte (rejCTL therapy model and confirmed that we can generate rejCTLs from iPSCs expressing high levels of iC9 without disturbing antigen-specific killing activity. iC9-expressing rejCTLs exert antitumor effects in vivo. The system efficiently and safely induces apoptosis in these rejCTLs. These results unite to suggest that the iC9/CID safeguard system is a promising tool for future iPSC-mediated approaches to clinical therapy.

  14. Carbon nanotubes as a novel drug delivery system for anticancer therapy: a review

    Energy Technology Data Exchange (ETDEWEB)

    Kushwaha, Swatantra Kumar Singh; Ghoshal, SauravI; Rai, Awani Kumar, E-mail: swatantrakushwaha@yahoo.co.in [Pranveer Singh Institute of Technology, Kanpur (India); Singh, Satyawan [Saroj Institute of Technology and Management, Lucknow (India)

    2013-10-15

    Carbon nanotubes (CNTs) were discovered in 1991 and shown to have certain unique physicochemical properties, attracting considerable interest in their application in various fields including drug delivery. The unique properties of CNTs such as ease of cellular uptake, high drug loading, thermal ablation, among others, render them useful for cancer therapy. Cancer is one of the most challenging diseases of modern times because its therapy involves distinguishing normal healthy cells from affected cells. Here, CNTs play a major role because phenomena such as EPR, allow CNTs to distinguish normal cells from affected ones, the Holy Grail in cancer therapy. Considerable work has been done on CNTs as drug delivery systems over the last two decades. However, concerns over certain issues such as biocompatibility and toxicity have been raised and warrant extensive research in this field. (author)

  15. Cosmetic outcome 1-5 years after breast conservative surgery, irradiation and systemic therapy.

    Science.gov (United States)

    Kelemen, Gyöngyi; Varga, Zoltán; Lázár, György; Thurzó, László; Kahán, Zsuzsanna

    2012-04-01

    The late side-effects of the local therapy of early breast cancer depend on many patient- and therapy-related parameters. We aimed at investigating the factors that influence the cosmetic and functional outcomes among our breast cancer patients after breast-conserving surgery and conformal radiotherapy, with or without adjuvant systemic therapy. A study was made of the association of the cosmetic outcome after a median follow-up time of 2.4 years and the clinical data on 198 patients extracted from a prospectively compiled database. Breast tenderness occurred more frequently among patients ≤50 years old (p cosmetic outcome after breast-conserving surgery and postoperative radiotherapy.

  16. Carbon nanotubes as a novel drug delivery system for anticancer therapy: a review

    Directory of Open Access Journals (Sweden)

    Swatantra Kumar Singh Kushwaha

    2013-12-01

    Full Text Available Carbon nanotubes (CNTs were discovered in 1991 and shown to have certain unique physicochemical properties, attracting considerable interest in their application in various fields including drug delivery. The unique properties of CNTs such as ease of cellular uptake, high drug loading, thermal ablation, among others, render them useful for cancer therapy. Cancer is one of the most challenging diseases of modern times because its therapy involves distinguishing normal healthy cells from affected cells. Here, CNTs play a major role because phenomena such as EPR, allow CNTs to distinguish normal cells from affected ones, the Holy Grail in cancer therapy. Considerable work has been done on CNTs as drug delivery systems over the last two decades. However, concerns over certain issues such as biocompatibility and toxicity have been raised and warrant extensive research in this field.

  17. Human-animal bonds II: the role of pets in family systems and family therapy.

    Science.gov (United States)

    Walsh, Froma

    2009-12-01

    The vast majority of pet owners regard their companion animals as family members, yet the role of pets in family systems and family therapy has received little attention in research, training, and practice. This article first notes the benefits of family pets and their importance for resilience. It then examines their role in couple and family processes and their involvement in relational dynamics and tensions. Next, it addresses bereavement in the loss of a cherished pet, influences complicating grief, and facilitation of mourning and adaptation. Finally, it explores the ways that clients' pets and the use of therapists' companion animals in animal-assisted therapy can inform and enrich couple and family therapy as valuable resources in healing.

  18. Human gene therapy: novel approaches to improve the current gene delivery systems.

    Science.gov (United States)

    Cucchiarini, Magali

    2016-06-01

    Even though gene therapy made its way through the clinics to treat a number of human pathologies since the early years of experimental research and despite the recent approval of the first gene-based product (Glybera) in Europe, the safe and effective use of gene transfer vectors remains a challenge in human gene therapy due to the existence of barriers in the host organism. While work is under active investigation to improve the gene transfer systems themselves, the use of controlled release approaches may offer alternative, convenient tools of vector delivery to achieve a performant gene transfer in vivo while overcoming the various physiological barriers that preclude its wide use in patients. This article provides an overview of the most significant contributions showing how the principles of controlled release strategies may be adapted for human gene therapy.

  19. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis

    Science.gov (United States)

    Marti, Christophe; John, Gregor; Konstantinides, Stavros; Combescure, Christophe; Sanchez, Olivier; Lankeit, Mareike; Meyer, Guy; Perrier, Arnaud

    2015-01-01

    Aim Thrombolytic therapy induces faster clot dissolution than anticoagulation in patients with acute pulmonary embolism (PE) but is associated with an increased risk of haemorrhage. We reviewed the risks and benefits of thrombolytic therapy in the management of patients with acute PE. Methods and results We systematically reviewed randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. Fifteen trials involving 2057 patients were included in our meta-analysis. Compared with heparin, thrombolytic therapy was associated with a significant reduction of overall mortality (OR; 0.59, 95% CI: 0.36–0.96). This reduction was not statistically significant after exclusion of studies including high-risk PE (OR; 0.64, 95% CI: 0.35–1.17). Thrombolytic therapy was associated with a significant reduction in the combined endpoint of death or treatment escalation (OR: 0.34, 95% CI: 0.22–0.53), PE-related mortality (OR: 0.29; 95% CI: 0.14–0.60) and PE recurrence (OR: 0.50; 95% CI: 0.27–0.94). Major haemorrhage (OR; 2.91, 95% CI: 1.95–4.36) and fatal or intracranial bleeding (OR: 3.18, 95% CI: 1.25–8.11) were significantly more frequent among patients receiving thrombolysis. Conclusions Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. The decrease in overall mortality is, however, not significant in haemodynamically stable patients with acute PE. Thrombolytic therapy is associated with an increase of major and fatal or intracranial haemorrhage. PMID:24917641

  20. To what extent does ozone therapy need a real biochemical control system? Assessment and importance of oxidative stress.

    Science.gov (United States)

    Hernández, Frank Antonio

    2007-07-01

    Ozone therapy is not officially allowed in many countries, but private medical services are using this therapy worldwide. However, appropriate control systems to assess the benefits and risks of systemic ozone therapy are not always used and in such cases the treatment is based on anecdotal reports. Oxidative stress phenomenon is becoming a highlighted biological process for ozone therapy because it is deeply involved in its mechanism of action. On the contrary, ozone therapy is an efficient regulator of the oxidative stress processes. In terms of therapeutic effects, it is convenient to know the metabolic status of the organism to face new oxidative challenges before and during ozone therapy applications. Oxidative stress is also important because it is involved as a cause or effect of many diseases. Since the 1990s, there has been the necessity of developing reliable systems for measuring oxidative stress in humans. In this sense, we have proposed a system for oxidative stress diagnosis that can serve as a control system for systemic ozone therapy applications. The system is based on the blood measurement of eight biomarkers (GSH, GPx, GST, SOD, CAT, DC, SRATB, and HPT) and the interpretation of these values by a computer-developed algorithm yielding four new indices (total antioxidant activity, total prooxidant activity, redox index and grade of oxidative stress). The system shows the patient's redox status and estimation of the oxidative stress level, with this information being relevant regarding implications on dosage and therapeutic effectiveness of ozone therapy.

  1. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.

    Science.gov (United States)

    Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten; Ardern-Jones, Michael R; Barbarot, Sebastien; Deleuran, Mette; Bieber, Thomas; Vestergaard, Christian; Brown, Sara J; Cork, Michael J; Drucker, Aaron M; Eichenfield, Lawrence F; Foelster-Holst, Regina; Guttman-Yassky, Emma; Nosbaum, Audrey; Reynolds, Nick J; Silverberg, Jonathan I; Schmitt, Jochen; Seyger, Marieke M B; Spuls, Phyllis I; Stalder, Jean-Francois; Su, John C; Takaoka, Roberto; Traidl-Hoffmann, Claudia; Thyssen, Jacob P; van der Schaft, Jorien; Wollenberg, Andreas; Irvine, Alan D; Paller, Amy S

    2017-10-01

    Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Our work is a consensus statement, not a systematic review. The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies. Copyright © 2017 American Academy of Dermatology, Inc. All rights reserved.

  2. Overview of resistance to systemic therapy in patients with breast cancer.

    Science.gov (United States)

    Gonzalez-Angulo, Ana Maria; Morales-Vasquez, Flavia; Hortobagyi, Gabriel N

    2007-01-01

    Breast cancer is the most common cancer and the second leading cause of cancer death in American women. It was the second most common cancer in the world in 2002, with more than 1 million new cases. Despite advances in early detection and the understanding of the molecular bases of breast cancer biology, about 30% of patients with early-stage breast cancer have recurrent disease. To offer more effective and less toxic treatment, selecting therapies requires considering the patient and the clinical and molecular characteristics of the tumor. Systemic treatment of breast cancer includes cytotoxic, hormonal, and immunotherapeutic agents. These medications are used in the adjuvant, neoadjuvant, and metastatic settings. In general, systemic agents are active at the beginning of therapy in 90% of primary breast cancers and 50% of metastases. However, after a variable period of time, progression occurs. At that point, resistance to therapy is not only common but expected. Herein we review general mechanisms of drug resistance, including multidrug resistance by P-glycoprotein and the multidrug resistance protein family in association with specific agents and their metabolism, emergence of refractory tumors associated with multiple resistance mechanisms, and resistance factors unique to host-tumor-drug interactions. Important anticancer agents specific to breast cancer are described. Breast cancer is the most common type of cancer and the second leading cause of cancer death in American women. In 2002, 209,995 new cases of breast cancer were registered, and 42,913 patients died of it. In 5 years, the annual prevalence of breast cancer will reach 968,731 cases in the United States. World wide, the problem is just as significant, as breast cancer is the most frequent cancer after nonmelanoma skin cancer, with more than 1 million new cases in 2002 and an expected annual prevalence of more than 4.4 million in 5 years. Breast cancer treatment currently requires the joint efforts

  3. D-amino acid oxidase-nanoparticle system: a potential novel approach for cancer enzymatic therapy.

    Science.gov (United States)

    Bava, Adriana; Gornati, Rosalba; Cappellini, Francesca; Caldinelli, Laura; Pollegioni, Loredano; Bernardini, Giovanni

    2013-11-01

    The authors propose a new magnetic nanoparticle-enzyme system for cancer therapy capable of targeting the enzyme and consequently decreasing the adverse effects, meanwhile improving the patient's life quality. The authors have functionalized Fe3O4 nanoparticles with 3-amino-propyltriethoxysilane (APTES) and conjugated it to yeast D-amino acid oxidase (DAAO) by coupling this with glutaraldehyde. The authors have tested the Fe3O4-APTES-DAAO system on three tumor cell lines. Exposed cells show, at the electron microscope level, nanoparticles on the surface of the plasma membrane and inside endocytic vesicles. Fe3O4-APTES-DAAO caused a substantial decrease of cell viability greatly augmented when D-alanine, a DAAO substrate, was added. Fe3O4-APTES-DAAO was demonstrated to be more effective than free DAAO, confirming the validity of the system in cancer therapy.

  4. Contemporary Proton Therapy Systems Adequately Protect Patients from Exposure to Stray Radiation

    Science.gov (United States)

    Newhauser, Wayne D.; Fontenot, Jonas D.; Taddei, Phillip J.; Mirkovic, Dragan; Giebeler, Annelise; Zhang, Rui; Mahajan, Anita; Kornguth, David; Stovall, Marilyn; Yepes, Pablo; Woo, Shiao; Mohan, Radhe

    2009-03-01

    Proton beam therapy has provided safe and effective treatments for a variety of adult cancers. In recent years, there has been increasing interest in utilizing proton therapy for pediatric cancers because it allows better sparing of healthy tissues. Minimizing exposures of normal tissues is especially important in children because they are highly susceptible to consequential late effects, including the development of a radiogenic second cancer, which may occur years or even decades after treatment of the first cancer. While the dosimetric advantage of therapeutic proton beams is well understood, relatively little attention has been paid to the whole-body exposure to stray neutron radiation that is inherent in proton therapy. In this report, we review the physical processes that lead to neutron exposures, discuss the potential for mitigating these exposures using advanced proton beam delivery systems, and present a comparative analysis of predicted second cancer incidence following various external beam therapies. In addition, we discuss uncertainties in the relative biological effectiveness of neutrons for carcinogenesis and the impact that these uncertainties have on second-cancer risk predictions for survivors of adult and childhood cancer who receive proton therapy.

  5. SU-E-T-211: Peer Review System for Ensuring Quality of Radiation Therapy Treatments.

    Science.gov (United States)

    Kapoor, R; Kapur, P; Kumar, S A; Alex, D; Ranka, S; Palta, J

    2012-06-01

    To demonstrate a Web-based electronic peer review system that has the potential to improve quality of care for radiation therapy patients. The system provides tools that allow radiation oncologists to seek peer review of target and critical structure delineation, treatment plans, and share clinical data with peers to optimize radiation therapy treatments. Peer review of radiation therapy treatment planning data prior to its initiation improves the quality of radiation therapy and clinical outcomes. Web-based access to radiation therapy treatment planning data and medical records mitigate existing geographical and temporal constraints. With internet access, the healthcare provider can access the data from any location and review it in an interactive and collaborative manner. Interoperability standard like DICOM-RT and IHE-RO compliant RT Systems have facilitated the design and implementation of PRS with Silverlight Web technology, .net Framework and SQL Server. Local DICOM-RT archive and cloud based services are deployed to facilitate remote peer reviews. To validate the PRS system, we tested the system for 100 patients with Philips Pinnacle v 9.0 and Varian Eclipse v 8.9 treatment planning system (TPS). We transmitted the DICOM RT data from the TPS to the cloud based services via the PRS local DICOM RT Archive. Various CT simulation based parameters such as orientation of CT, properties of RT structures etc. were compared between the TPS and PRS system. Data integrity of other parameters such as patient demographics (patient name, ID, attending physician etc.) and dose volume related parameters were also evaluated. Such rigorous testing allowed us to optimize the functionalities and clinical implementation of the PRS. We believe that the PRS will improve the quality and safety of a broad spectrum of radiation therapy patients treated in underserved areas while discouraging the overutilization of expensive radiation treatment modalities. This research and

  6. An intelligent nanotheranostic agent for targeting, redox-responsive ultrasound imaging, and imaging-guided high-intensity focused ultrasound synergistic therapy.

    Science.gov (United States)

    Wang, Xia; Chen, Hangrong; Zhang, Kun; Ma, Ming; Li, Faqi; Zeng, Deping; Zheng, Shuguang; Chen, Yu; Jiang, Lixin; Xu, Huixiong; Shi, Jianlin

    2014-04-09

    A novel multifunctional nanotheranostic agent with targeting, redox-responsive ultrasound imaging and ultrasound imaging-guided high-intensity focused ultrasound (HIFU) therapy (MSNC-PEG-HA(SS)-PFH, abbreviated as MPH(SS)-PFH) capabilities is developed. The redox-responsive guest molecule release and ultrasound imaging functions can be both integrated in such a "smart" theranostic agent, which is accomplished by the redox-triggered transition from the crosslinking state to retrocrosslinking state of the grafted polyethylene glycol-disulfide hyaluronic acid molecules on the particle surface when reaching a reducing environment in vitro. More importantly, under the tailored ultrasound imaging guiding, in vivo Hela tumor-bearing nude mice can be thoroughly and spatial-accurately ablated during HIFU therapy, due to the targeted accumulation, responsive ultrasound imaging guidance and the synergistic ablation functions of nanotheranostic agent MPH(SS)-PFH in the tumors. This novel multifunctional nano-platform can serve as a promising candidate for further studies on oncology therapy, due to its high stability, responsive and indicative ultrasound imaging of tumors, and enhanced HIFU therapeutic efficiency and spatial accuracy under ultrasound-guidance. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  7. Role of rheolytic thrombectomy in massive pulmonary embolism with contraindication to systemic thrombolytic therapy.

    Science.gov (United States)

    Arzamendi, Dabit; Bilodeau, Luc; Ibrahim, Reda; Noble, Stephane; Gallo, Richard; Lavoie-L'allier, Philippe; Gosselin, Gilbert; Deguise, Pierre; Ly, Hung; Tanguay, Jean-François; Doucet, Serge

    2010-01-01

    Mortality of massive pulmonary embolism remains exceedingly high despite thrombolytic therapy. Despite initial encouraging results, rheolytic thrombectomy has not been considered the first choice of treatment in the current European Guidelines for massive pulmonary embolism, even in cases of major contraindication to thrombolysis. Our objective was to assess the efficacy of rheolytic thrombectomy in the specific treatment of massive pulmonary embolism with contraindication to systemic thrombolytic therapy. Between January 2003 and April 2008 a total of 10 patients with massive pulmonary embolism referred for rheolytic thrombectomy were included. Clinical data including medical history, haemodynamic status, procedural characteristic, in-hospital complications and survival were collected. Seven patients survived after undergoing the procedure, three patients died in during their initial hospitalisation however, two of these deaths were not attributable to the pulmonary embolism or the procedure. Rheolytic thrombectomy resulted in reduction of mean pulmonary artery pressures from 34.6+/-13.1 mmHg to 26.9+/-8.2 mmHg immediately following the procedure. Additionally, the Miller index improved from 22.4+/-2.8 to 9.8+/-2.7. There were no periprocedural bleeding complications associated with the procedure. Rheolytic thrombectomy might be an effective and safe treatment for massive pulmonary embolism when systemic thrombolytic therapy is contraindicated. These data form the basis for further clinical investigation of this novel therapy among patients with massive pulmonary embolism.

  8. Systems Pharmacology Approaches for Optimization of Antiangiogenic Therapies: Challenges and Opportunities

    Directory of Open Access Journals (Sweden)

    Satish eSharan

    2015-02-01

    Full Text Available Targeted therapies have become an important therapeutic paradigm for multiple malignancies. The rapid development of resistance to these therapies impedes the successful management of advanced cancer. Due to the redundancy in angiogenic signaling, alternative proangiogenic factors are activated upon treatment with anti-VEGF agents. Higher doses of the agents lead to greater stimulation of compensatory proangiogenic pathways that limit the therapeutic efficacy of VEGF-targeted drugs and produce escape mechanisms for tumor. Evidence suggests that dose intensity and schedules affect the dynamics of the development of this resistance. Thus, an optimal dosing regimen is crucial to maximizing the therapeutic benefit of antiangiogenic agents and limiting treatment resistance. A systems pharmacology approach using multiscale computational modeling can facilitate a mechanistic understanding of these dynamics of angiogenic biomarkers and their impacts on tumor reduction and resistance. Herein, we discuss a systems pharmacology approach integrating the biology of VEGF-targeted therapy resistance, including circulating biomarkers, and pharmacodynamics to enable the optimization of antiangiogenic therapy for therapeutic gains.

  9. Systemic and local antimicrobial use in periodontal therapy in England and Wales.

    Science.gov (United States)

    Choudhury, M; Needleman, I; Gillam, D; Moles, D R

    2001-09-01

    The aim of this study was to investigate antimicrobial use during periodontal therapy in dental practice in England & Wales. This was a postal questionnaire survey of 800 dentists, 400 general dental practitioners (GDP) in National Health Service practice and 400 members of the British Society of Periodontology (Periodontal Society) primarily in dental practice. We designed and piloted a questionnaire to evaluate both systemic and local antibiotic use with periodontal therapy as well as factors affecting their prescription. In addition, we also investigated the potential use of antibiotic sensitivity testing, since this has been recommended prior to prescribing antibiotics. Two follow-up mailings were used to encourage non-responders. The useable return rate for the questionnaires was 587/800 (73%). Systemic antibiotics were used by 7.4% Periodontal Society members and 18.4% GDP for untreated adult periodontitis patients (pSociety members in early onset (52.7%) and refractory periodontitis patients (49.6%), and this was highly statistically significantly greater usage than GDP (pSociety 8.9% and GDP 5.4%. Higher usage of local antimicrobials was found both for the treatment of recurrent pocketing in adult periodontitis (Periodontal Society 26.3%, GDP 14.8%, pSociety 30.8%, GDP 15.2%, pSociety 83% & 70.4% and GDP 76% & 51.2%. 33% of Periodontal Society members and 3.8% of GDP spent at least 45 min per quadrant on root planing and Periodontal Society members had a greater exposure to lectures on both systemic and local drug therapy compared with GDP (ptypes. Whilst local antimicrobial therapy for periodontitis was not widespread, a substantial minority of dentists use this form of therapy and most believe that it is more effective than root debridement alone.

  10. Gesture Therapy: A Vision-Based System for Arm Rehabilitation after Stroke

    Science.gov (United States)

    Sucar, L. Enrique; Azcárate, Gildardo; Leder, Ron S.; Reinkensmeyer, David; Hernández, Jorge; Sanchez, Israel; Saucedo, Pedro

    Each year millions of people in the world survive a stroke, in the U.S. alone the figure is over 600,000 people per year. Movement impairments after stroke are typically treated with intensive, hands-on physical and occupational therapy for several weeks after the initial injury. However, due to economic pressures, stroke patients are receiving less therapy and going home sooner, so the potential benefit of the therapy is not completely realized. Thus, it is important to develop rehabilitation technology that allows individuals who had suffered a stroke to practice intensive movement training without the expense of an always-present therapist. Current solutions are too expensive, as they require a robotic system for rehabilitation. We have developed a low-cost, computer vision system that allows individuals with stroke to practice arm movement exercises at home or at the clinic, with periodic interactions with a therapist. The system integrates a web based virtual environment for facilitating repetitive movement training, with state-of-the art computer vision algorithms that track the hand of a patient and obtain its 3-D coordinates, using two inexpensive cameras and a conventional personal computer. An initial prototype of the system has been evaluated in a pilot clinical study with promising results.

  11. A portable automatic pressure delivery system for scar compression therapy in large animals

    Science.gov (United States)

    Ghassemi, Pejhman; Shupp, Jeffrey W.; Travis, Taryn E.; Gravunder, Andrew J.; Moffatt, Lauren T.; Ramella-Roman, Jessica C.

    2015-01-01

    Compression therapy has long been a standard treatment for hypertrophic scar prevention. However, due to the lack of objective, quantitative assessments, and measurements of scar severity, as well as the lack of a self-operated, controllable, and precise pressure delivery technique, limited concrete evidence exists, demonstrating compression therapy's efficacy. We have designed and built an automatic pressure delivery system to apply and maintain constant pressure on scar tissue in an animal model. A force sensor positioned on a compression plate reads the imposed force in real-time and sends the information to a feedback system controlling two position actuators. The actuators move accordingly to maintain a preset value of pressure onto the skin. The system was used in an in vivo model of compression therapy on hypertrophic scar/span>s. It was shown that the system was capable of delivering a constant pressure of 30 mmHg on scar wounds for a period of two weeks, and that phenotypic changes were seen in the wounds.

  12. Management considerations for childhood-onset systemic lupus erythematosus patients and implications on therapy.

    Science.gov (United States)

    Silva, Clovis Artur; Aikawa, Nadia Emi; Pereira, Rosa Maria Rodrigues; Campos, Lucia Maria Arruda

    2016-01-01

    Childhood-onset systemic lupus erythematosus (cSLE) is a chronic inflammatory and autoimmune disease that may involve various organs and systems. This narrative review focuses on the recent evidence relating to cSLE management. The general management considerations of cSLE patients require the use of validated classification criteria, disease and health-related quality of life tools evaluation, as well as assessments of lupus nephritis biomarkers and cSLE quality indicators. The drug treatment for cSLE patients includes general supportive care and immunosuppressive therapy. Important implications on cSLE therapy are also updated such as infection, vaccination, infertility, pregnancy, contraception, dyslipidemia, physical activity, cancer, bone health, drug pharmacokinetics, adherence, academic outcomes, transition to adult care and cumulative organ damage.

  13. Evolving lessons on nanomaterial-coated viral vectors for local and systemic gene therapy.

    Science.gov (United States)

    Kasala, Dayananda; Yoon, A-Rum; Hong, Jinwoo; Kim, Sung Wan; Yun, Chae-Ok

    2016-07-01

    Viral vectors are promising gene carriers for cancer therapy. However, virus-mediated gene therapies have demonstrated insufficient therapeutic efficacy in clinical trials due to rapid dissemination to nontarget tissues and to the immunogenicity of viral vectors, resulting in poor retention at the disease locus and induction of adverse inflammatory responses in patients. Further, the limited tropism of viral vectors prevents efficient gene delivery to target tissues. In this regard, modification of the viral surface with nanomaterials is a promising strategy to augment vector accumulation at the target tissue, circumvent the host immune response, and avoid nonspecific interactions with the reticuloendothelial system or serum complement. In the present review, we discuss various chemical modification strategies to enhance the therapeutic efficacy of viral vectors delivered either locally or systemically. We conclude by highlighting the salient features of various nanomaterial-coated viral vectors and their prospects and directions for future research.

  14. First tests for an online treatment monitoring system with in-beam PET for proton therapy

    CERN Document Server

    Kraan, Aafke C; Belcari, N; Camarlinghi, N; Cappucci, F; Ciocca, M; Ferrari, A; Ferretti, S; Mairani, A; Molinelli, S; Pullia, M; Retico, A; Sala, P; Sportelli, G; Del Guerra, A; Rosso, V

    2014-01-01

    PET imaging is a non-invasive technique for particle range verification in proton therapy. It is based on measuring the beta+ annihilations caused by nuclear interactions of the protons in the patient. In this work we present measurements for proton range verification in phantoms, performed at the CNAO particle therapy treatment center in Pavia, Italy, with our 10 x 10 cm^2 planar PET prototype DoPET. PMMA phantoms were irradiated with mono-energetic proton beams and clinical treatment plans, and PET data were acquired during and shortly after proton irradiation. We created 1-D profiles of the beta+ activity along the proton beam-axis, and evaluated the difference between the proximal rise and the distal fall-off position of the activity distribution. A good agreement with FLUKA Monte Carlo predictions was obtained. We also assessed the system response when the PMMA phantom contained an air cavity. The system was able to detect these cavities quickly after irradiation.

  15. Anti-B cell therapy in patients with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    M. E. Tsanyan

    2017-01-01

    Full Text Available The paper presents an analytical literature review of the use of rituximab (RTM in patients with systemic lupus erythematosus (SLE. It considers current views on the mechanisms of action of RTM, its efficacy in different organ damages in patients with SLE, particularly in those with lupus nephritis and central nervous system involvement. There is evidence suggesting that it is expedient to use RTM in patients with high activity of SLE, especially when the latter is refractory to standard therapy with glucocorticoids and cytostatics. Attention is paid to the steroidsparing effect of RTM and to the reduction of the risk of irreversible organ damages associated with high-dose prednisone. The paper discusses the possibility of using a RTM biosimilar (Acellbia and prospects of RTM therapy for early SLE. 

  16. Systemic-constructivist couple therapy (SCCT): Description of approach, theoretical advances, and published longitudinal evidence.

    Science.gov (United States)

    Reid, David W; Doell, Faye K; Dalton, E Jane; Ahmad, Saunia

    2008-12-01

    The systemic-constructivist approach to studying and benefiting couples was derived from qualitative and quantitative research on distressed couples over the past 10 years. Systemic-constructivist couple therapy (SCCT) is the clinical intervention that accompanies the approach. SCCT guides the therapist to work with both the intrapersonal and the interpersonal aspects of marriage while also integrating the social-environmental context of the couple. The theory that underlies SCCT is explained, including concepts such as we-ness and interpersonal processing. The primary components of the therapy are described. Findings described previously in an inaugural monograph containing extensive research demonstrating the long-term utility of SCCT are reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

  17. Sleeping Beauty transposon system for genetic etiological research and gene therapy of cancers

    Science.gov (United States)

    Hou, Xiaomei; Du, Yan; Deng, Yang; Wu, Jianfeng; Cao, Guangwen

    2015-01-01

    Carcinogenesis is etiologically associated with somatic mutations of critical genes. Recently, a number of somatic mutations and key molecules have been found to be involved in functional networks affecting cancer progression. Suitable animal models are required to validate cancer-promoting or -inhibiting capacities of these mutants and molecules. Sleeping Beauty transposon system consists of a transposon that carries gene(s) of interest and a transposase that recognizes, excises, and reinserts genes in given location of the genome. It can create both gain-of-function and loss-of-function mutations, thus being frequently chosen to investigate the etiological mechanisms and gene therapy for cancers in animal models. In this review, we summarized current advances of Sleeping Beauty transposon system in revealing molecular mechanism of cancers and improving gene therapy. Understanding molecular mechanisms by which driver mutations contribute to carcinogenesis and metastasis may pave the way for the development of innovative prophylactic and therapeutic strategies against malignant diseases. PMID:25455252

  18. Redox Homeostasis and Cellular Antioxidant Systems: Crucial Players in Cancer Growth and Therapy

    Directory of Open Access Journals (Sweden)

    Barbara Marengo

    2016-01-01

    Full Text Available Reactive oxygen species (ROS and their products are components of cell signaling pathways and play important roles in cellular physiology and pathophysiology. Under physiological conditions, cells control ROS levels by the use of scavenging systems such as superoxide dismutases, peroxiredoxins, and glutathione that balance ROS generation and elimination. Under oxidative stress conditions, excessive ROS can damage cellular proteins, lipids, and DNA, leading to cell damage that may contribute to carcinogenesis. Several studies have shown that cancer cells display an adaptive response to oxidative stress by increasing expression of antioxidant enzymes and molecules. As a double-edged sword, ROS influence signaling pathways determining beneficial or detrimental outcomes in cancer therapy. In this review, we address the role of redox homeostasis in cancer growth and therapy and examine the current literature regarding the redox regulatory systems that become upregulated in cancer and their role in promoting tumor progression and resistance to chemotherapy.

  19. Systemic Therapy Outcomes in Adult Patients with Ewing Sarcoma Family of Tumors

    OpenAIRE

    Mario Valdes; Garth Nicholas; Shailendra Verma; Timothy Asmis

    2017-01-01

    Background: The Ewing sarcoma family of tumors (ESFT) is a rare but curable bone neoplastic entity. The current standard of care involves chemotherapy and local disease control with surgery or radiation regardless of the extent of disease at presentation. Data that document the effectiveness of the current approach in the adult patient population are limited. Methods: We performed a retrospective review including all ESFT patients older than 19 years of age who received systemic therapy betwe...

  20. MRI-guided prostate focal laser ablation therapy using a mechatronic needle guidance system

    Science.gov (United States)

    Cepek, Jeremy; Lindner, Uri; Ghai, Sangeet; Davidson, Sean R. H.; Trachtenberg, John; Fenster, Aaron

    2014-03-01

    Focal therapy of localized prostate cancer is receiving increased attention due to its potential for providing effective cancer control in select patients with minimal treatment-related side effects. Magnetic resonance imaging (MRI)-guided focal laser ablation (FLA) therapy is an attractive modality for such an approach. In FLA therapy, accurate placement of laser fibers is critical to ensuring that the full target volume is ablated. In practice, error in needle placement is invariably present due to pre- to intra-procedure image registration error, needle deflection, prostate motion, and variability in interventionalist skill. In addition, some of these sources of error are difficult to control, since the available workspace and patient positions are restricted within a clinical MRI bore. In an attempt to take full advantage of the utility of intraprocedure MRI, while minimizing error in needle placement, we developed an MRI-compatible mechatronic system for guiding needles to the prostate for FLA therapy. The system has been used to place interstitial catheters for MRI-guided FLA therapy in eight subjects in an ongoing Phase I/II clinical trial. Data from these cases has provided quantification of the level of uncertainty in needle placement error. To relate needle placement error to clinical outcome, we developed a model for predicting the probability of achieving complete focal target ablation for a family of parameterized treatment plans. Results from this work have enabled the specification of evidence-based selection criteria for the maximum target size that can be confidently ablated using this technique, and quantify the benefit that may be gained with improvements in needle placement accuracy.

  1. CENTRAL NERVOUS SYSTEM INVOLVEMENT IN ADULT ACUTE LYMPHOBLASTIC LEUKEMIA: DIAGNOSTIC TOOLS, PROPHYLAXIS AND THERAPY

    Directory of Open Access Journals (Sweden)

    Maria Ilaria Del Principe

    2014-11-01

    Full Text Available In adult patients with acute lymphoblastic leukemia (ALL, Central Nervous System (CNS involvement is associated with a very poor prognosis. The diagnostic assessment of this condition relies on the use of neuroradiology, conventional cytology (CC and flow cytometry (FCM. Among these approaches, which is the gold standard it is still a matter of debate. Neuroradiology and CC have a limited sensitivity with a higher rate of false negative results. FCM demonstrated a superior sensitivity over CC, particularly when low levels of CNS infiltrating cells are present. Although prospective studies of large series of patients are still awaited, a positive finding by FCM appears to anticipate an adverse outcome even if CC shows no infiltration. Current strategies for adult ALL CNS-directed prophylaxis or therapy involve systemic and intrathecal chemotherapy and radiation therapy. Actually, early and frequent intrathecal injection of cytostatic combined with systemic chemotherapy is the most effective strategy to reduce the frequency of CNS involvement. In patients with CNS overt ALL, at diagnosis or upon relapse, allogenic hematopoietic stem cell transplantation might be considered. This review will discuss risk factors, diagnostic techniques for identification of CNS infiltration and modalities of prophylaxis and therapy to manage it.

  2. Long-term safety aspects of systemic therapy with fumaric acid esters in severe psoriasis.

    Science.gov (United States)

    Hoefnagel, J J; Thio, H B; Willemze, R; Bouwes Bavinck, J N

    2003-08-01

    Therapy with fumaric acid esters (FAE) has been shown to be safe and effective in patients with severe psoriasis in several clinical studies with limited follow-up periods. In view of the chronic character of psoriasis, long-term safety aspects are of major importance in determining the suitability of a drug during prolonged periods of treatment. To investigate adverse events of therapy with systemic FAE with follow-up periods of up to 14 years, in order to determine safety aspects of their long-term use in patients with severe psoriasis. Current and/or past therapeutic use of FAE was reviewed in 66 patients with severe psoriasis. Forty-one of 66 patients had received FAE for at least 1 year, and 12 of these 41 patients had received FAE for between 10 and 14 years. Adverse events were reported in 73% of the patients. These were usually mild and mainly consisting of flushing (55%), diarrhoea (42%), nausea (14%), tiredness (14%) and stomach complaints (12%). A relative lymphocytopenia was observed in 76% of patients during therapy with FAE, resulting in a permanent discontinuation of therapy with FAE in four patients. A transient eosinophilia and moderate liver enzyme elevations were observed in 14% and 25% of patients, respectively. The present study indicates that FAE can be considered as a safe long-term treatment in patients with severe psoriasis.

  3. Outcomes of Patients with Renal Cell Carcinoma and Sarcomatoid Dedifferentiation Treated with Nephrectomy and Systemic Therapies: Comparison between the Cytokine and Targeted Therapy Eras.

    Science.gov (United States)

    Keskin, Sarp K; Msaouel, Pavlos; Hess, Kenneth R; Yu, Kai-Jie; Matin, Surena F; Sircar, Kanishka; Tamboli, Pheroze; Jonasch, Eric; Wood, Christopher G; Karam, Jose A; Tannir, Nizar M

    2017-09-01

    We studied overall survival and prognostic factors in patients with sarcomatoid renal cell carcinoma treated with nephrectomy and systemic therapy in the cytokine and targeted therapy eras. This is a retrospective study of patients with sarcomatoid renal cell carcinoma who underwent nephrectomy and received systemic therapy at our center in the cytokine era (1987 to 2005) or the targeted therapy era (2006 to 2015). Multivariate regression models were used to determine the association of covariables with survival. Of the 199 patients with sarcomatoid renal cell carcinoma 167 (83.9%) died (median overall survival 16.5 months, 95% CI 15.2-20.9). Survival of patients with clear cell histology was significantly longer vs those with nonclear cell histology (p = 0.034). Patients with synchronous metastatic disease had significantly shorter survival than patients with metachronous metastatic disease (median 12.1 vs 23.3 months, p = 0.0064). Biopsy of the primary tumor or a metastatic site could detect the presence of sarcomatoid features in only 7.5% of cases. Although a significant improvement in survival rate was observed in the first year in patients treated in the targeted therapy era (p = 0.011), this effect was attenuated at year 2, disappeared at years 3 to 5 after diagnosis and was not evident in patients with poor risk features. Patients with sarcomatoid renal cell carcinoma still have poor prognosis with no clear long-term benefit of targeted therapy. This underscores the need to develop more effective systemic therapies for these patients. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer.

    Science.gov (United States)

    Poff, Angela M; Ari, Csilla; Seyfried, Thomas N; D'Agostino, Dominic P

    2013-01-01

    Abnormal cancer metabolism creates a glycolytic-dependency which can be exploited by lowering glucose availability to the tumor. The ketogenic diet (KD) is a low carbohydrate, high fat diet which decreases blood glucose and elevates blood ketones and has been shown to slow cancer progression in animals and humans. Abnormal tumor vasculature creates hypoxic pockets which promote cancer progression and further increase the glycolytic-dependency of cancers. Hyperbaric oxygen therapy (HBO₂T) saturates tumors with oxygen, reversing the cancer promoting effects of tumor hypoxia. Since these non-toxic therapies exploit overlapping metabolic deficiencies of cancer, we tested their combined effects on cancer progression in a natural model of metastatic disease. We used the firefly luciferase-tagged VM-M3 mouse model of metastatic cancer to compare tumor progression and survival in mice fed standard or KD ad libitum with or without HBO₂T (2.5 ATM absolute, 90 min, 3x/week). Tumor growth was monitored by in vivo bioluminescent imaging. KD alone significantly decreased blood glucose, slowed tumor growth, and increased mean survival time by 56.7% in mice with systemic metastatic cancer. While HBO₂T alone did not influence cancer progression, combining the KD with HBO₂T elicited a significant decrease in blood glucose, tumor growth rate, and 77.9% increase in mean survival time compared to controls. KD and HBO₂T produce significant anti-cancer effects when combined in a natural model of systemic metastatic cancer. Our evidence suggests that these therapies should be further investigated as potential non-toxic treatments or adjuvant therapies to standard care for patients with systemic metastatic disease.

  5. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer.

    Directory of Open Access Journals (Sweden)

    Angela M Poff

    Full Text Available INTRODUCTION: Abnormal cancer metabolism creates a glycolytic-dependency which can be exploited by lowering glucose availability to the tumor. The ketogenic diet (KD is a low carbohydrate, high fat diet which decreases blood glucose and elevates blood ketones and has been shown to slow cancer progression in animals and humans. Abnormal tumor vasculature creates hypoxic pockets which promote cancer progression and further increase the glycolytic-dependency of cancers. Hyperbaric oxygen therapy (HBO₂T saturates tumors with oxygen, reversing the cancer promoting effects of tumor hypoxia. Since these non-toxic therapies exploit overlapping metabolic deficiencies of cancer, we tested their combined effects on cancer progression in a natural model of metastatic disease. METHODS: We used the firefly luciferase-tagged VM-M3 mouse model of metastatic cancer to compare tumor progression and survival in mice fed standard or KD ad libitum with or without HBO₂T (2.5 ATM absolute, 90 min, 3x/week. Tumor growth was monitored by in vivo bioluminescent imaging. RESULTS: KD alone significantly decreased blood glucose, slowed tumor growth, and increased mean survival time by 56.7% in mice with systemic metastatic cancer. While HBO₂T alone did not influence cancer progression, combining the KD with HBO₂T elicited a significant decrease in blood glucose, tumor growth rate, and 77.9% increase in mean survival time compared to controls. CONCLUSIONS: KD and HBO₂T produce significant anti-cancer effects when combined in a natural model of systemic metastatic cancer. Our evidence suggests that these therapies should be further investigated as potential non-toxic treatments or adjuvant therapies to standard care for patients with systemic metastatic disease.

  6. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.

    Science.gov (United States)

    Liu, Dora; Ahmet, Alexandra; Ward, Leanne; Krishnamoorthy, Preetha; Mandelcorn, Efrem D; Leigh, Richard; Brown, Jacques P; Cohen, Albert; Kim, Harold

    2013-08-15

    Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.

  7. Systemic thrombolytic therapy alone and in combination with mechanical revascularization in acute ischemic stroke in two children

    DEFF Research Database (Denmark)

    Modrau, B; Sørensen, L; Bartholdy, N J

    2011-01-01

    Thrombolytic therapy is not recommended for acute ischemic stroke (AIS) in patients under the age of 18 and published experience is limited. In this case report, we describe two children treated with systemic thrombolytic therapy. One child received additional mechanical revascularization...

  8. Positioning device for MRI-guided high intensity focused ultrasound system

    Energy Technology Data Exchange (ETDEWEB)

    Damianou, Christakis [Frederick Institute of Technology (FIT), Limassol (Cyprus); MEDSONIC, LTD, Limassol (Cyprus); Ioannides, Kleanthis [Polikliniki Igia, Limassol (Cyprus); Milonas, Nicos [Frederick Institute of Technology (FIT), Limassol (Cyprus)

    2008-04-15

    A prototype magnetic resonance imaging (MRI)- compatible positioning device was used to move an MRI-guided high intensity focused ultrasound (HIFU) transducer. The positioning device has three user-controlled degrees of freedom that allow access to various targeted lesions. The positioning device was designed and fabricated using construction materials selected for compatibility with high magnetic fields and fast switching magnetic field gradients encountered inside MRI scanners. The positioning device incorporates only MRI compatible materials such as piezoelectric motors, plastic sheets, brass screws, plastic pulleys and timing belts. The HIFU/MRI system includes the multiple subsystems (a) HIFU system, (b) MR imaging, (c) Positioning device (robot) and associate drivers, (d) temperature measurement, (e) cavitation detection, (f) MRI compatible camera, and (g) Soft ware. The MRI compatibility of the system was successfully demonstrated in a clinical high-field MRI scanner. The ability of the robot to accurately move the transducer thus creating discrete and overlapping lesions in biological tissue was tested successfully. A simple, cost effective, portable positioning device has been developed which can be used in virtually any clinical MRI scanner since it can be sited on the scanner's table. The propagation of HIFU can use either a lateral or superior-inferior approach. Discrete and large lesions were created successfully with reproducible results. (orig.)

  9. MRI findings in Tolosa-Hunt syndrome before and after systemic corticosteroid therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cakirer, Sinan E-mail: scakirer@yahoo.com

    2003-02-01

    Tolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia due to a granulomatous inflammation in the cavernous sinus. Corticosteroid therapy dramatically resolves both the clinical and radiological findings of THS. We present MRI findings of six patients with a clinical history of at least one episode of unilateral or bilateral orbital-periorbital pain, clinical findings of associated paresis of one or more of 3rd, 4th, 5th or 6th cranial nerves. All of the patients revealed an enlargement of the symptomatic cavernous sinus on magnetic resonance imaging (MRI) scans. Five patients revealed total resolution of the clinical findings within 1-8 weeks, following systemic corticosteroid treatment. One patient revealed only minor regression of clinical findings within 2 weeks after the initiation of the treatment, so the cavernous sinus lesion was reevaluated as meningioma on MRI, and the patient underwent surgical resection of the mass with resultant histopathological finding of cavernous sinus meningioma. A follow-up MRI scan was performed for five patients at the end of 8-weeks of steroid therapy. Three of these five patients showed total resolution of the cavernous sinus lesions whereas two of them revealed a partial regression of the cavernous sinus lesions. MRI findings before and after systemic corticosteroid therapy are important diagnostic criteria to put the definitive diagnosis of THS and to differentiate it from other cavernous sinus lesions that simulate THS both clinically and radiologically.

  10. Thermography Improves Clinical Assessment in Patients with Systemic Sclerosis Treated with Ozone Therapy

    Directory of Open Access Journals (Sweden)

    Danuta Nowicka

    2017-01-01

    Full Text Available Objective. Treatment of scleroderma is challenging and limited. The aim of our study was to evaluate the usefulness of thermography in assessment of the clinical condition (joints movability and skin thickness in clinically advanced patients with systemic sclerosis before and after ozone therapy. Method. The study included 42 patients aged 32 to 73 years with advanced systemic sclerosis hospitalized in the university clinic between 2003 and 2006. Thermography and clinical examinations were conducted at baseline and after two series of bath in water with ozone. Results. The comparison of results showed significant increase in skin temperature by 2.5°C, significant increase in interphalangeal joints movability by 18 degrees, and significant decrease in skin score by 14.7 points. The skin temperature was correlated with skin score (r=-0.59 and joints movability (r=+0.8. Conclusions. Ozone therapy shows positive effect on clinical parameters and skin temperature as measured with thermography. The study indicated possibility of introducing ozonotherapy as an independent therapy in cases with low level of progression or during remission periods and as additional treatment in patients with advanced disease requiring immunosuppressive treatment. Thermography is useful in assessment of skin condition showing strong correlation between skin temperature and clinical parameters.

  11. Eddy current analysis and optimization of fast scanning magnet for a proton therapy system

    Science.gov (United States)

    Liu, Xu; Qin, Bin; Liu, Kaifeng; Chen, Wei; Liang, Zhikai; Chen, Qushan; Chen, Dezhi; Fan, Mingwu

    2017-08-01

    Proton therapy is now recognized as one of the most effective radiation therapy methods for cancers. A proton therapy facility with multiple gantry treatment rooms is under development in HUST (Huazhong University of Science and Technology), which is based on isochronous superconducting cyclotron scheme. In the beam line, the scanning system spreads out the proton beam on the target according to the complex tumour shape by two scanning magnets for horizontal and vertical scanning independently. Since these two magnets are excited by alternating currents and the maximum repetition frequency is up to 100 Hz, eddy currents and losses are expected to be significant. Slits are proven to be an effective way to reduce the eddy currents. To evaluate the heat distribution due to eddy losses in the pole end of the scanning magnet, the transient electromagnetic analysis and steady-state thermal analysis are performed. This paper describes design considerations of the scanning system and mainly analyses the eddy current effect of the scanning magnets. Different coil shapes and slit arrangements are simulated and compared to obtain the optimal configuration. The maximum temperatures of two magnets are optimized below 70 °C. In addition, the lag effect due to eddy currents is also discussed.

  12. Selection of physiological parameters for optoelectronic system supporting behavioral therapy of autistic children

    Science.gov (United States)

    Landowska, A.; Karpienko, K.; Wróbel, M.; Jedrzejewska-Szczerska, M.

    2014-11-01

    In this article the procedure of selection of physiological parameters for optoelectronic system supporting behavioral therapy of autistic children is proposed. Authors designed and conducted an experiment in which a group of 30 health volunteers (16 females and 14 males) were examined. Under controlled conditions people were exposed to a stressful situation caused by the picture or sound (1kHz constant sound, which was gradually silenced and finished with a shot sound). For each of volunteers, a set of physiological parameters were recorded, including: skin conductance, heart rate, peripheral temperature, respiration rate and electromyography. The selected characteristics were measured in different locations in order to choose the most suitable one for the designed therapy supporting system. The bio-statistical analysis allowed us to discern the proper physiological parameters that are most associated to changes due to emotional state of a patient, such as: skin conductance, temperatures and respiration rate. This allowed us to design optoelectronic sensors network for supporting behavioral therapy of children with autism.

  13. Near "real" time magnetic resonance images as a monitoring system for interstitial laser therapy: experimental protocols

    Science.gov (United States)

    Castro, Dan J.; Farahani, Keyvan; Soudant, Jacques; Zwarun, Andrew A.; Lufkin, Robert B.

    1992-06-01

    The failure rate of cancer treatment remains unacceptably high, still being a leading cause of mortality in adults and children despite major advances over the past 50 years in the fields of surgery, radiation therapy and, more recently, chemo and immunotherapy. Surgical access to some deep tumors of the head and neck and other areas often require extensive dissections with residual functional and cosmetic deformities. Repeated treatment is not possible after maximum dose radiotherapy and chemotherapy is still limited by its systemic toxicity. An attractive solution to these problems would be the development of a new adjunctive method combining the best features of interstitial laser therapy for selective tumor destruction via minimally invasive techniques for access and 3-D magnetic resonance imaging (MRI) as a monitoring system for laser-tissue interactions. Interstitial laser therapy (ILT) via fiberoptics allow laser energy to be delivered directly into deeper tissues. However, this concept will become clinically useful only when noninvasive, accurate, and reproducible monitoring methods are developed to measure energy delivery to tissues. MRI has numerous advantages in evaluating the irreversible effects of laser treatment in tissues, since laser energy includes changes not only in the thermal motions of hydrogen protons within the tissue, but also in the distribution and mobility of water and lipids. These techniques should greatly improve the use of ILT in combination with MRI to allow treatment of deeper, more difficult to reach tumors of head and neck and other anatomical areas with a single needle stick.

  14. The peer review system (PRS) for quality assurance and treatment improvement in radiation therapy

    Science.gov (United States)

    Le, Anh H. T.; Kapoor, Rishabh; Palta, Jatinder R.

    2012-02-01

    Peer reviews are needed across all disciplines of medicine to address complex medical challenges in disease care, medical safety, insurance coverage handling, and public safety. Radiation therapy utilizes technologically advanced imaging for treatment planning, often with excellent efficacy. Since planning data requirements are substantial, patients are at risk for repeat diagnostic procedures or suboptimal therapeutic intervention due to a lack of knowledge regarding previous treatments. The Peer Review System (PRS) will make this critical radiation therapy information readily available on demand via Web technology. The PRS system has been developed with current Web technology, .NET framework, and in-house DICOM library. With the advantages of Web server-client architecture, including IIS web server, SOAP Web Services and Silverlight for the client side, the patient data can be visualized through web browser and distributed across multiple locations by the local area network and Internet. This PRS will significantly improve the quality, safety, and accessibility, of treatment plans in cancer therapy. Furthermore, the secure Web-based PRS with DICOM-RT compliance will provide flexible utilities for organization, sorting, and retrieval of imaging studies and treatment plans to optimize the patient treatment and ultimately improve patient safety and treatment quality.

  15. Thermography Improves Clinical Assessment in Patients with Systemic Sclerosis Treated with Ozone Therapy.

    Science.gov (United States)

    Nowicka, Danuta

    2017-01-01

    Objective. Treatment of scleroderma is challenging and limited. The aim of our study was to evaluate the usefulness of thermography in assessment of the clinical condition (joints movability and skin thickness) in clinically advanced patients with systemic sclerosis before and after ozone therapy. Method. The study included 42 patients aged 32 to 73 years with advanced systemic sclerosis hospitalized in the university clinic between 2003 and 2006. Thermography and clinical examinations were conducted at baseline and after two series of bath in water with ozone. Results. The comparison of results showed significant increase in skin temperature by 2.5°C, significant increase in interphalangeal joints movability by 18 degrees, and significant decrease in skin score by 14.7 points. The skin temperature was correlated with skin score (r = -0.59) and joints movability (r = +0.8). Conclusions. Ozone therapy shows positive effect on clinical parameters and skin temperature as measured with thermography. The study indicated possibility of introducing ozonotherapy as an independent therapy in cases with low level of progression or during remission periods and as additional treatment in patients with advanced disease requiring immunosuppressive treatment. Thermography is useful in assessment of skin condition showing strong correlation between skin temperature and clinical parameters.

  16. Boosting high-intensity focused ultrasound-induced anti-tumor immunity using a sparse-scan strategy that can more effectively promote dendritic cell maturation

    Directory of Open Access Journals (Sweden)

    Zhong Pei

    2010-01-01

    Full Text Available Abstract Background The conventional treatment protocol in high-intensity focused ultrasound (HIFU therapy utilizes a dense-scan strategy to produce closely packed thermal lesions aiming at eradicating as much tumor mass as possible. However, this strategy is not most effective in terms of inducing a systemic anti-tumor immunity so that it cannot provide efficient micro-metastatic control and long-term tumor resistance. We have previously provided evidence that HIFU may enhance systemic anti-tumor immunity by in situ activation of dendritic cells (DCs inside HIFU-treated tumor tissue. The present study was conducted to test the feasibility of a sparse-scan strategy to boost HIFU-induced anti-tumor immune response by more effectively promoting DC maturation. Methods An experimental HIFU system was set up to perform tumor ablation experiments in subcutaneous implanted MC-38 and B16 tumor with dense- or sparse-scan strategy to produce closely-packed or separated thermal lesions. DCs infiltration into HIFU-treated tumor tissues was detected by immunohistochemistry and flow cytometry. DCs maturation was evaluated by IL-12/IL-10 production and CD80/CD86 expression after co-culture with tumor cells treated with different HIFU. HIFU-induced anti-tumor immune response was evaluated by detecting growth-retarding effects on distant re-challenged tumor and tumor-specific IFN-γ-secreting cells in HIFU-treated mice. Results HIFU exposure raised temperature up to 80 degrees centigrade at beam focus within 4 s in experimental tumors and led to formation of a well-defined thermal lesion. The infiltrated DCs were recruited to the periphery of lesion, where the peak temperature was only 55 degrees centigrade during HIFU exposure. Tumor cells heated to 55 degrees centigrade in 4-s HIFU exposure were more effective to stimulate co-cultured DCs to mature. Sparse-scan HIFU, which can reserve 55 degrees-heated tumor cells surrounding the separated lesions, elicited an

  17. SU-F-J-196: A Prototype System for Portal Imaging for Intensity Modulated Neutron Therapy

    Energy Technology Data Exchange (ETDEWEB)

    St James, S; Argento, D; DeWitt, D; Miyaoka, R; Stewart, R [University of Washington, Seattle, WA (United States); Moffitt, G [University of Utah, Salt Lake City, UT (United States)

    2016-06-15

    Purpose: Fast neutron therapy is offered at the University of Washington Medical Center for treatment of selected cancers. The hardware and control systems of the UW Clinical Neutron Therapy System are undergoing upgrades to enable delivery of IMNT. To clinically implement IMNT, dose verification tools need to be developed. We propose a portal imaging system that relies on the creation of positron emitting isotopes ({sup 11}C and {sup 15}O) through (n, 2n) reactions with a PMMA plate placed below the patient. After field delivery, the plate is retrieved from the vault and imaged using a reader that detects the annihilation photons. The pattern of activity produced in the plate provides information to reconstruct the neutron fluence map that can be compared to fluence maps from Monte Carlo (MCNP) simulations to verify treatment delivery. We have previously performed Monte Carlo simulations of the portal imaging system (GATE simulations) and the beam line (MCNP simulations). In this work, initial measurements using a prototype system are presented. Methods: Custom electronics were developed for BGO detectors read out with photomultiplier tubes (previous generation PET detectors from a CTI ECAT 953 scanner). Two detectors were placed in coincidence, with a detector separation of 2 cm. Custom software was developed to create the crystal look up tables and perform a limited angle planar reconstruction with a stochastic normalization. To test the initial capabilities of the system, PMMA squares were irradiated with neutrons at a depth of 1.5 cm and read out using the prototype system. Doses ranging from 10–200 cGy were delivered. Results: Using the prototype system, dose differences in the therapeutic range could be determined. Conclusion: The prototype portal imaging system is capable of detecting neutron doses as low as 10–50 cGy and shows great promise as a patient QA tool for IMNT.

  18. Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Holtzman, Adam L. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Hoppe, Bradford S., E-mail: bhoppe@floridaproton.org [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Letter, Haley P.; Bryant, Curtis; Nichols, Romaine C.; Henderson, Randal H.; Mendenhall, William M.; Morris, Christopher G. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Williams, Christopher R. [Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida (United States); Li, Zuofeng; Mendenhall, Nancy P. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States)

    2016-05-01

    Purpose: Local recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. This article reviews a single institution's experience using PT for salvage of local recurrent disease after HIFU or CS. Methods and Materials: We reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(relative biological effectiveness [RBE]; range: 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy with radiation therapy. Patients were evaluated for quality of life (QOL) by using the Expanded Prostate Index Composite questionnaire and toxicity by using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually. Results: Median follow-up was 37 months (range: 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year grade 3 toxicity rate was 17%; however, 2 of these patients had pre-existing grade 3 GU toxicities from their HIFU/CRYO prior to PT. At 1 year, bowel summary, urinary incontinence, and urinary obstructive QOL scores declined, but only the bowel QOL score at 12 months met the minimally important difference threshold. Conclusions: PT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT functions. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

  19. Thermal ablation of a confluent lesion in the porcine kidney with a clinically available MR-HIFU system

    NARCIS (Netherlands)

    van Breugel, Johanna Maria Mijntje|info:eu-repo/dai/nl/413639975; de Greef, Martijn; Wijlemans, JW; Schubert, Gerald|info:eu-repo/dai/nl/413971465; van den Bosch, Maurice|info:eu-repo/dai/nl/182981630; Moonen, Chrit|info:eu-repo/dai/nl/216691974; Ries, Mario|info:eu-repo/dai/nl/413970833

    2017-01-01

    BACKGROUND: The incidence of small renal masses (SRMs) has increased over the past decades. Currently, partial nephrectomy (PN) or watchful waiting is advised in these patients. Ultimately, 80-90% of these SRMs require surgical treatment and PN is associated with a 15% complication rate. In this

  20. White paper on guidelines concerning enteric nervous system stem cell therapy for enteric neuropathies⋆

    Science.gov (United States)

    Burns, Alan J.; Goldstein, Allan M.; Newgreen, Donald F.; Stamp, Lincon; Schäfer, Karl-Herbert; Metzger, Marco; Hotta, Ryo; Young, Heather M.; Andrews, Peter W.; Thapar, Nikhil; Belkind-Gerson, Jaime; Bondurand, Nadege; Bornstein, Joel C.; Chan, Wood Yee; Cheah, Kathryn; Gershon, Michael D.; Heuckeroth, Robert O.; Hofstra, Robert M.W.; Just, Lothar; Kapur, Raj P.; King, Sebastian K.; McCann, Conor J.; Nagy, Nandor; Ngan, Elly; Obermayr, Florian; Pachnis, Vassilis; Pasricha, Pankaj J.; Sham, Mai Har; Tam, Paul; Berghe, Pieter Vanden

    2016-01-01

    Over the last 20 years, there has been increasing focus on the development of novel stem cell based therapies for the treatment of disorders and diseases affecting the enteric nervous system (ENS) of the gastrointestinal tract (so-called enteric neuropathies). Here, the idea is that ENS progenitor/stem cells could be transplanted into the gut wall to replace the damaged or absent neurons and glia of the ENS. This White Paper sets out experts’ views on the commonly used methods and approaches to identify, isolate, purify, expand and optimize ENS stem cells, transplant them into the bowel, and assess transplant success, including restoration of gut function. We also highlight obstacles that must be overcome in order to progress from successful preclinical studies in animal models to ENS stem cell therapies in the clinic. PMID:27059883

  1. Stimuli responsive drug delivery systems based on nano-graphene for cancer therapy.

    Science.gov (United States)

    Yang, Kai; Feng, Liangzhu; Liu, Zhuang

    2016-10-01

    Nano-graphene as a class of two-dimensional sp2 carbon nanomaterial has attracted tremendous attentions in various fields in the past decade. Utilizing its unique physical and chemical properties, nano-graphene has also shown great promises in the area of biomedicine, for application in biosensing, imaging and therapy. In particular, with all atoms exposed on its surface, nano-graphene exhibits ultra-high surface area available for efficient binding/loading of various biomolecules of interests, and has been widely used as multifunctional nano-carriers for drug and gene delivery. In this review article, we will summarize the recent advances in the development of nano-graphene as stimuli-responsive nano-carriers for drug delivery, as well as the applications of these smart systems for cancer therapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Providing therapy to children and families in foster care: a systemic-relational approach.

    Science.gov (United States)

    Lewis, Catherine

    2011-12-01

    Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.

  3. Ventricular fibrillation after bortezomib therapy in a patient with systemic amyloidosis

    Directory of Open Access Journals (Sweden)

    Satoshi Yamasaki

    2013-09-01

    Full Text Available A 64-year-old female was diagnosed with systemic amyloidosis associated with multiple myeloma. Bortezomib and dexamethasone-therapy was initiated; however, she developed lethal ventricular fibrillation (VF and cardiac arrest after 84 hours of therapy. Cardiopulmonary resuscitation using direct current shocks with epinephrine and amiodarone was initiated but failed to receive cardiac function. Although her arterial pulsations recovered immediately after the injection of vasopressin, she died of heart failure 8 hours after the onset of VF. Cardiac amyloidosis was verified by autopsy. Although the direct association of bortezomib with lethal VF remained to be clarified in our patient, the current report emphasizes on bortezomib as a substantial risk factor for cardiomyocyte damage. The potential risk of lethal events associated with cardiac amyloidosis should be carefully considered during bortezomib treatment for patients with AL amyloidosis.

  4. Phase II Study of Olaparib (AZD-2281) After Standard Systemic Therapies for Disseminated Colorectal Cancer.

    Science.gov (United States)

    Leichman, Lawrence; Groshen, Susan; O'Neil, Bert H; Messersmith, Wells; Berlin, Jordan; Chan, Emily; Leichman, Cynthia G; Cohen, Steven J; Cohen, Deirdre; Lenz, Heinz-Josef; Gold, Philip; Boman, Bruce; Fielding, Anitra; Locker, Gershon; Cason, Ronald C; Hamilton, Stan R; Hochster, Howard S

    2016-02-01

    Effective new agents for patients with colorectal cancer (CRC) with disease progression during standard therapy regimens are needed. We hypothesized that poly ADP ribose polymerase (PARP) inhibitor therapy in patients with CRC and inefficient tumor DNA repair mechanisms, such as those with high-level microsatellite instability (MSI-H), would result in synthetic lethality. This was an open-label phase II trial testing olaparib 400 mg p.o. b.i.d. for patients with disseminated, measurable CRC failing standard therapies with centrally confirmed tumor MSI status. The primary endpoint was the tumor response, assessed by RECIST, version 1.0. The secondary endpoints were safety/toxicity, progression-free survival (PFS), and overall survival (OS). Thirty-three patients (20 microsatellite stable [MSS], 13 MSI-H) were enrolled. The median age for all patients was 57 years and for MSS and MSI-H patients was 51 and 61 years, respectively. All patients received at least one 28-day cycle of olaparib. No patient had a complete or partial response. Nausea (48%), fatigue (36%), and vomiting (33%) were the most commonly reported treatment-related adverse events. The median PFS for all patients was 1.84 months. No statistically significant differences were found in the median PFS or OS for the MSS group compared with the MSI-H group. Single-agent olaparib delivered after failure of standard systemic therapy did not demonstrate activity for CRC patients, regardless of microsatellite status. Future trials, testing PARP inhibitors in patients with CRC should focus on the use of DNA-damaging chemotherapy and/or radiation therapy, combined with PARP inhibitors, remembering the toxicity reported in the present study. Microsatellite instability (MSI-H) colorectal tumors exhibit hypermethylation in tumor mismatch repair genes, or have mutations in one or more of these genes resulting from a germ-line defect (Lynch syndrome). PARP inhibitors such as olaparib are most effective in tumors

  5. [Successful treatment of neuroaspergillosis in a patient with acute lymphoblastic leukemia: role of surgery, systemic antifungal therapy and intracavitary therapy].

    Science.gov (United States)

    Ozçelik, Tülay; Ozkalemkaş, Fahir; Kocaeli, Hasan; Altundal, Yildiz; Ener, Beyza; Ali, Ridvan; Ozkocaman, Vildan; Hakyemez, Bahattin; Tunali, Ahmet

    2009-07-01

    Cerebral aspergillosis is a rare condition that generally exhibits a poor response to conventional antifungal drugs. We report here a case of cerebral aspergillosis in a 34-years-old man with acute lymphoblastic leukaemia who was successfully treated with a combination of aggressive neurosurgery, intracavitary instillation of amphotericin B and voriconazole. We aimed to emphazise the roles of surgery, intracavitary therapy and antifungal therapy in the management of neuroaspergillosis. Under amphotericin-B therapy, the patient developed dysarthria and paralysis of the right side of his body. Brain magnetic resonance imaging demonstrated a lesion in the left parieto-occipital region, measuring 7 cm in the greatest dimension. Diagnostic surgery was interrupted due to abundant bleeding. The culture of the aspirate from the lesion yielded Aspergillus flavus. The therapy was switched to voriconazole and caspofungin combination. Due to disease progression during combination therapy, the patient had a second surgical resection resulting in a 75% reduction in lesion size. Following surgical intervention, intracavitary instillation of amphotericin B (0.3 mg/day for 15 days) was performed alongside with combination therapy (voriconazole and caspofungin). Caspofungin was stopped after 42 days, whereas the patient was continued on voriconazole for a total of 100 days. At this point, his brain lesion resolved almost completely. However, leukemia relapsed. The patient died during his treatment course because of neutropenic typhilitis occurring in the aplastic phase. It is stated that in patients with neuroaspergillosis radical neurosurgery leads to better outcomes if performed at an earlier stage. Antifungal treatment of cerebral aspergillosis requires that the drug must cross the blood brain barrier. Voriconazole has the ability to cross the blood brain barrier. The therapy should be prolonged beyond the resolution of all lesions and until reversal of the underlying

  6. Ethical Tensions Related to Systemic Constraints: Occupational Alienation in Occupational Therapy Practice.

    Science.gov (United States)

    Durocher, Evelyne; Kinsella, Elizabeth Anne; McCorquodale, Lisa; Phelan, Shanon

    2016-09-03

    Ethical tensions arise daily in health care practice and are frequently related to health care system structures or policies. Collective case study methodology was adopted to examine ethical tensions reported by occupational therapists practicing in different settings in Southwestern Ontario, Canada. Inductive analysis involving multiple layers of coding was conducted. This article focuses on tensions related to systemic constraints. Participants reported ethical tensions related to balancing client priorities with those of health care services. Four themes related to systemic constraints were identified including imposed practices, ineffective processes, resource limitations, and lack of services. Therapists' aims could be seen to align with an "ethic of care" and were seen to be in tension in light of systemic constraints. The findings raise issues related to occupational justice, particularly related to occupational alienation in occupational therapy practice, and open conversations related to neoliberalist health care agendas. © The Author(s) 2016.

  7. Targeted Delivery System of Nanobiomaterials in Anticancer Therapy: From Cells to Clinics

    Directory of Open Access Journals (Sweden)

    Su-Eon Jin

    2014-01-01

    Full Text Available Targeted delivery systems of nanobiomaterials are necessary to be developed for the diagnosis and treatment of cancer. Nanobiomaterials can be engineered to recognize cancer-specific receptors at the cellular levels and to deliver anticancer drugs into the diseased sites. In particular, nanobiomaterial-based nanocarriers, so-called nanoplatforms, are the design of the targeted delivery systems such as liposomes, polymeric nanoparticles/micelles, nanoconjugates, norganic materials, carbon-based nanobiomaterials, and bioinspired phage system, which are based on the nanosize of 1–100 nm in diameter. In this review, the design and the application of these nanoplatforms are discussed at the cellular levels as well as in the clinics. We believe that this review can offer recent advances in the targeted delivery systems of nanobiomaterials regarding in vitro and in vivo applications and the translation of nanobiomaterials to nanomedicine in anticancer therapy.

  8. Physical evaluation system to determine medical risk and indicated dental therapy modifications.

    Science.gov (United States)

    McCarthy, F M; Malamed, S F

    1979-08-01

    The physical evaluation system allows the practitioner to rapidly classify each patient according to medical risk and thus to provide dental treatment comfortably and safely. The evaluation system serves as a guide to the level of dental therapy, deisions of management, and modification of treatment for the medically compromised patient. Extensive use of the ADA physical status classification system in dentistry would allow meaningful studies of morbidity and mortality that are related to various management protocols and could conceivably have an impact on insurance schedules associated with psychosedation modalities and general anethesia on an out patient basis. A physical evaluation system cannot substitute for knowledge and good judgment. Recommended categories of physical status and modification of treatment should not be considered as absolutes, but as guides. Wheras the guidelines may appear to be inflexible, they should not be considered as such. Deviation from recommendations is often justified and is expected.

  9. Scaling up antiretroviral therapy in Uganda: using supply chain management to appraise health systems strengthening.

    Science.gov (United States)

    Windisch, Ricarda; Waiswa, Peter; Neuhann, Florian; Scheibe, Florian; de Savigny, Don

    2011-08-01

    Strengthened national health systems are necessary for effective and sustained expansion of antiretroviral therapy (ART). ART and its supply chain management in Uganda are largely based on parallel and externally supported efforts. The question arises whether systems are being strengthened to sustain access to ART. This study applies systems thinking to assess supply chain management, the role of external support and whether investments create the needed synergies to strengthen health systems. This study uses the WHO health systems framework and examines the issues of governance, financing, information, human resources and service delivery in relation to supply chain management of medicines and the technologies. It looks at links and causal chains between supply chain management for ART and the national supply system for essential drugs. It combines data from the literature and key informant interviews with observations at health service delivery level in a study district. Current drug supply chain management in Uganda is characterized by parallel processes and information systems that result in poor quality and inefficiencies. Less than expected health system performance, stock outs and other shortages affect ART and primary care in general. Poor performance of supply chain management is amplified by weak conditions at all levels of the health system, including the areas of financing, governance, human resources and information. Governance issues include the lack to follow up initial policy intentions and a focus on narrow, short-term approaches. The opportunity and need to use ART investments for an essential supply chain management and strengthened health system has not been exploited. By applying a systems perspective this work indicates the seriousness of missing system prerequisites. The findings suggest that root causes and capacities across the system have to be addressed synergistically to enable systems that can match and accommodate investments in

  10. pH-sensitive nano-systems for drug delivery in cancer therapy.

    Science.gov (United States)

    Liu, Juan; Huang, Yuran; Kumar, Anil; Tan, Aaron; Jin, Shubin; Mozhi, Anbu; Liang, Xing-Jie

    2014-01-01

    Nanotechnology has been widely used in the development of new strategies for drug delivery and cancer therapy. Compared to traditional drug delivery systems, nano-based drug delivery system have greater potential in a variety of areas, such as multiple targeting functionalization, in vivo imaging, combined drug delivery, extended circulation time, and systemic control release. Nano-systems incorporating stimulus-responsive materials have remarkable properties which allow them to bypass biological barriers and achieve targeted intracellular drug delivery. As a result of the active metabolism of tumor cells, the tumor microenvironment (TME) is highly acidic compared to normal tissues. pH-Sensitive nano-systems have now been developed in which drug release is specifically triggered by the acidic tumor environment. Studies have demonstrated that novel pH-sensitive drug delivery systems are capable of improving the efficiency of cancer treatment. A number of these have been translated from bench to clinical application and have been approved by the Food and Drug Administration (FDA) for treatment of various cancerous diseases. Herein, this review mainly focuses on pH-sensitive nano-systems, including advances in drug delivery, mechanisms of drug release, and possible improvements in drug absorption, with the emphasis on recent research in this field. With deeper understanding of the difference between normal and tumor tissues, it might be possible to design ever more promising pH-responsive nano-systems for drug delivery and cancer therapy in the near future. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  11. Concurrent Chemotherapy and Pulsed High-Intensity Focused Ultrasound Therapy for the Treatment of Unresectable Pancreatic Cancer: Initial Experiences

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Choi, Byung Ihn; Ryu, Ji Kon; Kim, Yong Tae; Kim, Se Hyung; Han, Joon Koo [Seoul National University Hospital, Seoul (Korea, Republic of); Hwang, Joo Ha [University of Washington Medical Center, Seattle (United States)

    2011-04-15

    This study was performed to evaluate the potential clinical value of concurrent chemotherapy and pulsed high intensity focused ultrasound (HIFU) therapy (CCHT), as well as the safety of pulsed HIFU, for the treatment of unresectable pancreatic cancer. Twelve patients were treated with HIFU from October 2008 to May 2010, and three of them underwent CCHT as the main treatment (the CCHT group). The overall survival (OS), the time to tumor progression (TTP), the complications and the current performance status in the CCHT and non-CCHT groups were analyzed. Nine patients in the non-CCHT group were evaluated to determine why CCHT could not be performed more than twice. The OS of the three patients in the CCHT group was 26.0, 21.6 and 10.8 months, respectively, from the time of diagnosis. Two of them were alive at the time of preparing this manuscript with an excellent performance status, and one of them underwent a surgical resection one year after the initiation of CCHT. The TTP of the three patients in the CCHT group was 13.4, 11.5 and 9.9 months, respectively. The median OS and TTP of the non-CCHT group were 10.3 months and 4.4 months, respectively. The main reasons why the nine patients of the non-CCHT group failed to undergo CCHT more than twice were as follows: pancreatitis (n = 1), intolerance of the pain during treatment (n = 4), palliative use of HIFU for pain relief (n = 1) and a poor physical condition due to disease progression (n = 3). No major complications were encountered except one case of pancreatitis. This study shows that CCHT is a potentially effective and safe modality for the treatment of unresectable pancreatic cancer

  12. Confirming, Validating, and Norming the Factor Structure of Systemic Therapy Inventory of Change Initial and Intersession.

    Science.gov (United States)

    Pinsof, William M; Zinbarg, Richard E; Shimokawa, Kenichi; Latta, Tara A; Goldsmith, Jacob Z; Knobloch-Fedders, Lynne M; Chambers, Anthony L; Lebow, Jay L

    2015-09-01

    Progress or feedback research tracks and feeds back client progress data throughout the course of psychotherapy. In the effort to empirically ground psychotherapeutic practice, feedback research is both a complement and alternative to empirically supported manualized treatments. Evidence suggests that tracking and feeding back progress data with individual or nonsystemic feedback systems improves outcomes in individual and couple therapy. The research reported in this article pertains to the STIC(®) (Systemic Therapy Inventory of Change)-the first client-report feedback system designed to empirically assess and track change within client systems from multisystemic and multidimensional perspectives in individual, couple, and family therapy. Clients complete the STIC Initial before the first session and the shorter STIC Intersession before every subsequent session. This study tested and its results supported the hypothesized factor structure of the six scales that comprise both STIC forms in a clinical outpatient sample and in a normal, random representative sample of the U.S. This study also tested the STIC's concurrent validity and found that its 6 scales and 40 of its 41 subscales differentiated the clinical and normal samples. Lastly, the study derived clinical cut-offs for each scale and subscale to determine whether and how much a client's score falls in the normal or clinical range. Beyond supporting the factorial and concurrent validity of both STIC forms, this research supported the reliabilities of the six scales (Omegahierarchical ) as well as the reliabilities of most subscales (alpha and rate-rerate). This article delineates clinical implications and directions for future research. © 2015 Family Process Institute.

  13. Non-surgical periodontal therapy supplemented with systemically administered azithromycin: a systematic review of RCTs.

    Science.gov (United States)

    Buset, Sabrina L; Zitzmann, Nicola U; Weiger, Roland; Walter, Clemens

    2015-11-01

    Azithromycin may be an alternative adjunctive systemic antibiotic in non-surgical periodontal therapy. This study aims to identify randomized controlled trials evaluating non-surgical periodontal treatment of chronic and/or aggressive periodontitis supplemented with systemically administered azithromycin. A systematic literature search was performed for publications published by 31 March 2014 using electronic databases and hand search. Randomized controlled trials published in English or German language, with a follow-up ≥6 months were included. From 231 titles identified, nine publications were eligible for inclusion. Among the studies included, showing some risk of bias, seven reported on patients with chronic periodontitis and two with aggressive periodontitis. Minor adverse events were described in five studies. A synthesis of results using a vote counting method was applied. Significant (p azithromycin were shown in six studies for probing depth changes and in five studies for clinical attachment level changes. In contrast to aggressive periodontitis patients, data from this analysis indicate a potential benefit of systemic azithromycin as adjunctive to non-surgical periodontal therapy in chronic periodontitis patients. When contraindications for the standard antibiotics are present, azithromycin (AZM) may be considered as alternative systemically administered antibiotic drug in selected cases of chronic periodontitis.

  14. A systems approach to reducing errors in insulin therapy in the inpatient setting.

    Science.gov (United States)

    Hellman, Richard

    2004-01-01

    To highlight the importance of insulin-related medical errors in causing poor outcomes in a hospital setting and to propose a systems approach for improvement. Evidence reported in the medical literature has identified insulin therapy errors as a large and clinically important problem. Insulin has been labeled as one of the top five "high-risk medications" in the inpatient setting. Although insulin therapy can be lifesaving in the hospital setting, it can be life-threatening if used inappropriately. Widespread major systemic problems, such as heavy patient loads for physicians and nurses, absence of backup checks in critical areas, defective communication and coordination, illegible handwriting, and unawareness of the importance of blood glucose control, create obstacles to appropriate and safe care of patients receiving insulin in the hospital. With thorough analysis of the setting, additional training, collective establishment of goals focused on patient safety, insertion of backup checks in areas susceptible to errors, encouragement of sharing of key clinical information, and, where possible, implementation of electronic medical records, systemic and knowledge-based problems will be minimized and outcomes will improve in insulin-treated hospitalized patients. Analysis and redesign of systems to develop a "culture of safety" will ultimately reduce insulin-related medical errors, provide a safe inpatient environment, and yield better outcomes.

  15. A software tool for advanced MRgFUS prostate therapy planning and follow up

    Science.gov (United States)

    van Straaten, Dörte; Hoogenboom, Martijn; van Amerongen, Martinus J.; Weiler, Florian; Issawi, Jumana Al; Günther, Matthias; Fütterer, Jurgen; Jenne, Jürgen W.

    2017-03-01

    US guided HIFU/FUS ablation for the therapy of prostate cancer is a clinical established method, while MR guided HIFU/FUS applications for prostate recently started clinical evaluation. Even if MRI examination is an excellent diagnostic tool for prostate cancer, it is a time consuming procedure and not practicable within an MRgFUS therapy session. The aim of our ongoing work is to develop software to support therapy planning and post-therapy follow-up for MRgFUS on localized prostate cancer, based on multi-parametric MR protocols. The clinical workflow of diagnosis, therapy and follow-up of MR guided FUS on prostate cancer was deeply analyzed. Based on this, the image processing workflow was designed and all necessary components, e.g. GUI, viewer, registration tools etc. were defined and implemented. The software bases on MeVisLab with several implemented C++ modules for the image processing tasks. The developed software, called LTC (Local Therapy Control) will register and visualize automatically all images (T1w, T2w, DWI etc.) and ADC or perfusion maps gained from the diagnostic MRI session. This maximum of diagnostic information helps to segment all necessary ROIs, e.g. the tumor, for therapy planning. Final therapy planning will be performed based on these segmentation data in the following MRgFUS therapy session. In addition, the developed software should help to evaluate the therapy success, by synchronization and display of pre-therapeutic, therapy and follow-up image data including the therapy plan and thermal dose information. In this ongoing project, the first stand-alone prototype was completed and will be clinically evaluated.

  16. Radiation-force-based estimation of acoustic attenuation using harmonic motion imaging (HMI) in phantoms and in vitro livers before and after HIFU ablation.

    Science.gov (United States)

    Chen, Jiangang; Hou, Gary Y; Marquet, Fabrice; Han, Yang; Camarena, Francisco; Konofagou, Elisa

    2015-10-07

    Acoustic attenuation represents the energy loss of the propagating wave through biological tissues and plays a significant role in both therapeutic and diagnostic ultrasound applications. Estimation of acoustic attenuation remains challenging but critical for tissue characterization. In this study, an attenuation estimation approach was developed using the radiation-force-based method of harmonic motion imaging (HMI). 2D tissue displacement maps were acquired by moving the transducer in a raster-scan format. A linear regression model was applied on the logarithm of the HMI displacements at different depths in order to estimate the acoustic attenuation. Commercially available phantoms with known attenuations (n = 5) and in vitro canine livers (n = 3) were tested, as well as HIFU lesions in in vitro canine livers (n = 5). Results demonstrated that attenuations obtained from the phantoms showed a good correlation (R² = 0.976) with the independently obtained values reported by the manufacturer with an estimation error (compared to the values independently measured) varying within the range of 15-35%. The estimated attenuation in the in vitro canine livers was equal to 0.32   ±   0.03 dB cm(-1) MHz(-1), which is in good agreement with the existing literature. The attenuation in HIFU lesions was found to be higher (0.58   ±   0.06 dB cm(-1) MHz(-1)) than that in normal tissues, also in agreement with the results from previous publications. Future potential applications of the proposed method include estimation of attenuation in pathological tissues before and after thermal ablation.

  17. Radiation-force-based estimation of acoustic attenuation using harmonic motion imaging (HMI) in phantoms and in vitro livers before and after HIFU ablation

    Science.gov (United States)

    Chen, Jiangang; Hou, Gary Y.; Marquet, Fabrice; Han, Yang; Camarena, Francisco; Konofagou, Elisa

    2015-10-01

    Acoustic attenuation represents the energy loss of the propagating wave through biological tissues and plays a significant role in both therapeutic and diagnostic ultrasound applications. Estimation of acoustic attenuation remains challenging but critical for tissue characterization. In this study, an attenuation estimation approach was developed using the radiation-force-based method of harmonic motion imaging (HMI). 2D tissue displacement maps were acquired by moving the transducer in a raster-scan format. A linear regression model was applied on the logarithm of the HMI displacements at different depths in order to estimate the acoustic attenuation. Commercially available phantoms with known attenuations (n=5 ) and in vitro canine livers (n=3 ) were tested, as well as HIFU lesions in in vitro canine livers (n=5 ). Results demonstrated that attenuations obtained from the phantoms showed a good correlation ({{R}2}=0.976 ) with the independently obtained values reported by the manufacturer with an estimation error (compared to the values independently measured) varying within the range of 15-35%. The estimated attenuation in the in vitro canine livers was equal to 0.32   ±   0.03 dB cm-1 MHz-1, which is in good agreement with the existing literature. The attenuation in HIFU lesions was found to be higher (0.58   ±   0.06 dB cm-1 MHz-1) than that in normal tissues, also in agreement with the results from previous publications. Future potential applications of the proposed method include estimation of attenuation in pathological tissues before and after thermal ablation.

  18. Intravenous immunoglobulin therapy leading to dramatic improvement in a patient with systemic juvenile idiopathic arthritis and severe pericarditis resistant to steroid pulse therapy.

    Science.gov (United States)

    Aizawa-Yashiro, Tomomi; Oki, Eishin; Tsuruga, Kazushi; Nakahata, Tohru; Ito, Etsuro; Tanaka, Hiroshi

    2012-05-01

    A 7-year-old Japanese boy with a 4-month history of systemic juvenile idiopathic arthritis (s-JIA) experienced disease flare with spiking fever, exanthema and arthralgia. He then developed progressive dyspnea due to severe pericarditis, and proinflammatory hypercytokinemia was suspected. Methylprednisolone pulse therapy was ineffective and echocardiography showed massive pericardial effusion had persisted. Alternatively, subsequent intravenous immunoglobulin (IVIG) therapy resulted in dramatic resolution of the pericardial effusion, and his general condition significantly improved within a few days. This case report may lend further support the use of IVIG for selected patients with s-JIA and severe pericarditis.

  19. Overall Survival and Response to Systemic Therapy in Metastatic Extrauterine Leiomyosarcoma.

    Science.gov (United States)

    Shoushtari, A N; Landa, J; Kuk, D; Sanchez, A; Lala, B; Schmidt, N; Okoli, C; Chi, P; Dickson, M A; Gounder, M M; Keohan, M L; Crago, A M; Tap, W D; D'Angelo, S P

    2016-01-01

    Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy. Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) in N = 113 was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26-0.79, p = 0.005). Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.

  20. Impact of breast MRI on surgical treatment, axillary approach, and systemic therapy for breast cancer.

    Science.gov (United States)

    Mameri, Claudia S; Kemp, Claudio; Goldman, Suzan M; Sobral, Luiz A; Ajzen, Sergio

    2008-01-01

    The purpose of this study is to determine how often breast magnetic resonance imaging (MRI) brings additional information that influences management of patients with breast cancer concerning surgical treatment, axillary lymph node approach, and systemic therapy. From July 2004 to July 2005, 99 patients recently diagnosed with breast cancer in clinical stages 0, I, and II were prospectively evaluated about their therapeutic plans, at first based on usual protocol (physical examination, mammography and ultrasound) and next going through bilateral breast MR. Examinations were carried out at 1.5 T on five sequences of FSPGR 3D for 90 seconds (four post-gadolinium diethylenetriaminepenta acetic acid 0.16 mM/Kg). Parameters analyzed on MRI were extension of primary lesion; detection of multifocality, multicentricity, or contra lateral lesion; muscular or skin involvement; and presence of lymph node involvement. Pathologic confirmation of additional lesions was achieved by core or excisional biopsy. MRI made 69 additional findings in 53 patients. Fifty-one findings were true-positives (51/69 = 73.9%) including 16 larger single lesions; 18 cases of multifocality; 7 cases of multicentricity; 3 cases of contra lateral lesion; 5 cases of lymph node involvement (one of them involved medial thoracic chain); 1 with muscular involvement; 1 with skin involvement. MRI has changed previous management plans in 44.4% of 99 patients. We observed increase in mastectomies (26.8%) on axillary lymph node dissection (25%) and changes on systemic therapy (20.2%), all because of additional MRI true-positive findings. Breast MRI alters significantly the rate of mastectomy, the approach of axillary chain for staging, and the use of systemic therapy because of its accuracy in evaluating breast cancer local extent.

  1. An update on applications of nanostructured drug delivery systems in cancer therapy: a review.

    Science.gov (United States)

    Aberoumandi, Seyed Mohsen; Mohammadhosseini, Majid; Abasi, Elham; Saghati, Sepideh; Nikzamir, Nasrin; Akbarzadeh, Abolfazl; Panahi, Yunes; Davaran, Soodabeh

    2017-09-01

    Cancer is a main public health problem that is known as a malignant tumor and out-of-control cell growth, with the potential to assault or spread to other parts of the body. Recently, remarkable efforts have been devoted to develop nanotechnology to improve the delivery of anticancer drug to tumor tissue as minimizing its distribution and toxicity in healthy tissue. Nanotechnology has been extensively used in the advance of new strategies for drug delivery and cancer therapy. Compared to customary drug delivery systems, nano-based drug delivery method has greater potential in different areas, like multiple targeting functionalization, in vivo imaging, extended circulation time, systemic control release, and combined drug delivery. Nanofibers are used for different medical applications such as drug delivery systems.

  2. Performances of the scanning system for the CNAO center of oncological hadron therapy

    Energy Technology Data Exchange (ETDEWEB)

    Giordanengo, S., E-mail: giordane@to.infn.i [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Donetti, M. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); CNAO - Centro Nazionale di Adroterapia Oncologica Foundation, Milano (Italy); Marchetto, F. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Ansarinejad, A. [Department of Physics, University of Torino, Torino (Italy); Attili, A. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Bourhaleb, F. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Department of Physics, University of Torino, Torino (Italy); Burini, F. [OCEM SpA, Bologna (Italy); Cirio, R. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Department of Physics, University of Torino, Torino (Italy); Fabbricatore, P. [INFN - Istituto Nazionale di Fisica Nucleare, Genova (Italy); Voelker, F. [CERN, Geneve (Switzerland); Garella, M.A. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Incurvati, M. [OCEM SpA, Bologna (Italy); Monaco, V. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Department of Physics, University of Torino, Torino (Italy); Pardo, J. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Peroni, C.; Russo, G.; Sacchi, R. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy); Department of Physics, University of Torino, Torino (Italy); Taddia, G. [OCEM SpA, Bologna (Italy); Zampieri, A. [INFN - Istituto Nazionale di Fisica Nucleare, Torino (Italy)

    2010-02-01

    In hadron therapy one of the most advanced methods for beam delivery is the active scanning technique which uses fast scanning magnets to drive a narrow particle beam across the target. The Centro Nazionale di Adroterapia Oncologica (CNAO) will treat tumours with this technique. The CNAO scanning system includes two identical dipole magnets for horizontal and vertical beam deflection, each one connected to a fast power supply. The dose delivery system exploits a set of monitor chambers to measure the fluence and position of the beam and drives the beam during the treatment by controlling the sequence of currents set by the power supplies. A test of the dynamic performance of the scanning system has been performed using a Hall probe to measure the field inside the magnet and the results are presented in this paper.

  3. Use and Adoption of an Assisted Cognition System to Support Therapies for People with Dementia

    Directory of Open Access Journals (Sweden)

    René F. Navarro

    2016-01-01

    Full Text Available The cognitive deficits in persons with dementia (PwD can produce significant functional impairment from early stages. Although memory decline is most prominent, impairments in attention, orientation, language, reasoning, and executive functioning are also common. Dementia is also characterized by changes in personality and behavioral functioning that can be very challenging for caregivers and patients. This paper presents results on the use and adoption of an assisted cognition system to support occupational therapy to address psychological and behavioral symptoms of dementia. During 16 weeks, we conducted an in situ evaluation with two caregiver-PwD dyads to assess the adoption and effectiveness of the system to ameliorate challenging behaviors and reducing caregiver burden. Evaluation results indicate that intervention personalization and a touch-based interface encouraged the adoption of the system, helping reduce challenging behaviors in PwD and caregiver burden.

  4. Nanotechnology-Based Drug Delivery Systems for Photodynamic Therapy of Cancer: A Review.

    Science.gov (United States)

    Calixto, Giovana Maria Fioramonti; Bernegossi, Jéssica; de Freitas, Laura Marise; Fontana, Carla Raquel; Chorilli, Marlus

    2016-03-11

    Photodynamic therapy (PDT) is a promising alternative approach for improved cancer treatment. In PDT, a photosensitizer (PS) is administered that can be activated by light of a specific wavelength, which causes selective damage to the tumor and its surrounding vasculature. The success of PDT is limited by the difficulty in administering photosensitizers (PSs) with low water solubility, which compromises the clinical use of several molecules. Incorporation of PSs in nanostructured drug delivery systems, such as polymeric nanoparticles (PNPs), solid lipid nanoparticles (SLNs), nanostructured lipid carriers (NLCs), gold nanoparticles (AuNPs), hydrogels, liposomes, liquid crystals, dendrimers, and cyclodextrin is a potential strategy to overcome this difficulty. Additionally, nanotechnology-based drug delivery systems may improve the transcytosis of a PS across epithelial and endothelial barriers and afford the simultaneous co-delivery of two or more drugs. Based on this, the application of nanotechnology in medicine may offer numerous exciting possibilities in cancer treatment and improve the efficacy of available therapeutics. Therefore, the aim of this paper is to review nanotechnology-based drug delivery systems for photodynamic therapy of cancer.

  5. Nanotechnology-Based Drug Delivery Systems for Photodynamic Therapy of Cancer: A Review

    Directory of Open Access Journals (Sweden)

    Giovana Maria Fioramonti Calixto

    2016-03-01

    Full Text Available Photodynamic therapy (PDT is a promising alternative approach for improved cancer treatment. In PDT, a photosensitizer (PS is administered that can be activated by light of a specific wavelength, which causes selective damage to the tumor and its surrounding vasculature. The success of PDT is limited by the difficulty in administering photosensitizers (PSs with low water solubility, which compromises the clinical use of several molecules. Incorporation of PSs in nanostructured drug delivery systems, such as polymeric nanoparticles (PNPs, solid lipid nanoparticles (SLNs, nanostructured lipid carriers (NLCs, gold nanoparticles (AuNPs, hydrogels, liposomes, liquid crystals, dendrimers, and cyclodextrin is a potential strategy to overcome this difficulty. Additionally, nanotechnology-based drug delivery systems may improve the transcytosis of a PS across epithelial and endothelial barriers and afford the simultaneous co-delivery of two or more drugs. Based on this, the application of nanotechnology in medicine may offer numerous exciting possibilities in cancer treatment and improve the efficacy of available therapeutics. Therefore, the aim of this paper is to review nanotechnology-based drug delivery systems for photodynamic therapy of cancer.

  6. Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer.

    Science.gov (United States)

    Cuomo, Roberto; Nisi, Giuseppe; Grimaldi, Luca; Brandi, Cesare; D'Aniello, Carlo

    2017-10-23

    The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.

  7. Systemic Corticosteroids Therapy in the Management of Acute Zonal Occult Outer Retinopathy

    Directory of Open Access Journals (Sweden)

    San-Ni Chen

    2015-01-01

    Full Text Available Purpose. To report the efficacy of systemic steroid in treating acute zonal occult outer retinopathy (AZOOR. Methods. Retrospective study of 9 consecutive patients of AZOOR, who received systemic steroid therapy in Changhua Christian Hospital from 2005 to 2013, is presented. The duration of therapy was at least 3 months. Patients were evaluated with best corrected visual acuity (BCVA, optical coherence tomography (OCT, fluorescein angiography (FA, indocyanine green angiography (ICG, visual field test, and electroretinography (ERG. Results. At the initial visit, visual field defect was noted in all patients and impaired visual acuity was noted in 4 eyes. OCT examination revealed disrupted ellipsoid zone at the macular area in 8 eyes and outer nuclear layer (ONL loss in 1 eye. At the end of follow-up, all patients had improvement of visual field. The 4 eyes with initial impaired visual acuity had BCVA recovering to 20/20. Follow-up OCT showed partial or complete recovery of the ellipsoid zone at the macular area in the 8 eyes with initial disrupted ellipsoid zone and stable condition in the eye with ONL loss. The mean follow-up duration was 47.11±26.65 months. Conclusion. Visual improvement was achieved in most cases of recent onset AZOOR after systemic steroid treatment.

  8. Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy.

    Science.gov (United States)

    Aguilar-Raab, Corina; Grevenstein, Dennis; Gotthardt, Linda; Jarczok, Marc N; Hunger, Christina; Ditzen, Beate; Schweitzer, Jochen

    2017-06-28

    We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects. © 2017 Family Process Institute.

  9. Online monitoring for proton therapy: A real-time procedure using a planar PET system

    Energy Technology Data Exchange (ETDEWEB)

    Kraan, A.C. [Department of Physics, University of Pisa and INFN, Pisa (Italy); Battistoni, G. [INFN Sezione di Milano, Milano (Italy); Belcari, N.; Camarlinghi, N. [Department of Physics, University of Pisa and INFN, Pisa (Italy); Ciocca, M. [Fondazione CNAO, Pavia (Italy); Ferrari, A. [CERN, Geneva (Switzerland); Ferretti, S. [Department of Physics, University of Pisa and INFN, Pisa (Italy); Mairani, A.; Molinelli, S.; Pullia, M. [Fondazione CNAO, Pavia (Italy); Sala, P. [INFN Sezione di Milano, Milano (Italy); Sportelli, G.; Del Guerra, A. [Department of Physics, University of Pisa and INFN, Pisa (Italy); Rosso, V., E-mail: valeria.rosso@pi.infn.it [Department of Physics, University of Pisa and INFN, Pisa (Italy)

    2015-06-21

    In this study a procedure for range verification in proton therapy by means of a planar in-beam PET system is presented. The procedure consists of two steps: the measurement of the β{sup +}-activity induced in the irradiated body by the proton beam and the comparison of these distributions with simulations. The experimental data taking was performed at the CNAO center in Pavia, Italy, irradiating plastic phantoms. For two different cases we demonstrate how a real-time feedback of the delivered treatment plan can be obtained with in-beam PET imaging.

  10. Online monitoring for proton therapy: A real-time procedure using a planar PET system

    CE