WorldWideScience

Sample records for hifu treatment time

  1. Development of HIFU Treatment for Lower Extremity Varicose Veins

    Science.gov (United States)

    Senoo, Naohiko; Ushijima, Hiroyuki; Suzuki, Jun; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    High-intensity focused ultrasound (HIFU) has recently been developed as a noninvasive therapeutic method. In our study, a novel noninvasive therapy with HIFU was proposed for occlusion of lower extremity varicose veins. The temperature increase caused by HIFU is used to occlude varicose veins. Occluded veins became fibrotic, resulting in complete recovery. Our final goal is the medical application of HIFU treatment for varicose veins. In this study, we attempted to occlude the veins of rabbits. Prior to venous occlusion experiments, the area heated by HIFU was investigated using bovine serum albumin (BSA) gel, which denatures at >70 °C. The results indicate that the size of the heated area mainly depends on intensity at the focal point and the exposure time. A tendency was also seen for the heated area to extend toward the transducer with increasing exposure time. In animal experiments, skin burns during HIFU exposure represented a critical problem. We therefore examined the safe range of HIFU intensities in abdominal exposure experiments before conducting venous occlusion experiments. The ultrasound frequency was 1.7 MHz. Intensity at the focal point was 900 W/cm2, and the exposure time was 20 s. Rabbits underwent chemical depilation and echo gel was applied to the exposed skin to fill the boundary gap. Target veins were compressed during HIFU exposure to avoid thermal dissipation, and hyaluronan water solution was injected between the veins and skin to maintain the distance between the skin and veins at ≥5 mm. Veins were then exposed to HIFU and occluded. The capability of HIFU treatment to occlude lower extremity varicose veins was verified by the present study.

  2. Measurements of HIFU-induced Lesions in BSA Gel Phantoms for HIFU Treatment of Varicose Veins of Lower Extremity

    Science.gov (United States)

    Ushijima, Hiroyuki; Senoo, Naohiko; Suzuki, Jun; Ichiyanagi, Mitsuhisa; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2011-09-01

    HIFU treatment has been developed for various diseases because of its minimal invasiveness, and we are now developing a HIFU treatment for varicose veins of the lower extremity. Previous studies have succeeded in occluding rabbit's veins with HIFU, but the success rate was low (about 10%). Failures were mainly caused by skin burns. When the heating lesion comes close to skin, the absorbed ultrasound energy may cause skin burns. Therefore, it is necessary to study the relationships between HIFU lesions and skin burns to improve the success rate. To visualize heating lesions from HIFU, we used tissue-mimicking BSA gel phantoms. We tried various concentrations of BSA in gels, and determined 14% BSA as the most suitable for phantoms for experiments. The attenuation coefficient of the gel was 0.73 dB/cm, and the denaturation temperature was 70 °C. We put the BSA gel phantom in a water tank in which the temperature was kept at 39 °C, and used HIFU exposures at various intensities and irradiation times. After irradiation, we measured the sizes and positions of HIFU-induced lesions, and the results indicate that the sizes of lesion become larger when the intensitiy rises or irradiation time becomes longer. Furthermore, when the intensity rises and irradiation time becomes longer, the heating lesions move closer to upper surface of the gel, which means skin easily gets burned. Thus we have investigated relationships between HIFU parameters and heated lesions that can be used for further research into HIFU treatment of varicose veins of the lower extremity.

  3. Intercostal HIFU Treatment: A Tissue Phantom

    Science.gov (United States)

    Illing, Rowland O.; Kennedy, James E.; ter Haar, Gail R.

    2005-03-01

    High-intensity focused ultrasound (HIFU) when used clinically to treat liver and kidney tumours is often directed between the ribs. This paper details the construction of a tissue phantom, incorporating ribs, and its use to assess the clinical safety of HIFU exposures. The prefocal, acoustic side-lobes of the ultrasonic beam were studied with and without rib interference, and thermocouples used to assess in-situ temperature changes. The results show that there are implications in regards to the safety of clinical treatment, should the operator be unaware of the characteristics of the transducer being used.

  4. 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.

  5. HIFU as a Neoadjuvant Therapy in Cancer Treatment

    Science.gov (United States)

    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.

  6. 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.

  7. A new HIFU probe for the treatment of the superficial venous insufficiency and varicose veins

    Science.gov (United States)

    Pichardo, Samuel; Curiel, Laura; Milleret, René; Pichot, Olivier; Lacoste, François; Chapelon, Jean-Yves

    2006-05-01

    A previous work showed the feasibility of inducing a localized partial shrinkage of venous tissues with High Intensity Focused Ultrasound (HIFU). A partial shrinkage of the vein wall is proposed to correct the valvular dysfunction on the saphenous vein that is responsible of the superficial venous insufficiency and varicose veins. In the present study, a new real-time imaging HIFU probe is presented which is suited for this type of treatment. The probe is composed of two HIFU elements that focus sound uniformly over a line of 7 mm-length. Geometry of the HIFU elements was calculated by numerical optimization and allows positioning of the focal line 15 mm in-depth from the skin. The probe is compatible with commercial imaging devices used currently in vascular medicine. Once coupled with an imaging probe, the imaging system shows the central perpendicular plan to the focal line. A validation of the compatibility with a commercial ultrasound imaging system was achieved using a precise model fabricated by stereo-lithography. Construction of the probe is underway.

  8. Immune System Modulation with LOFU And HIFU Treatment of Prostate Cancer

    Science.gov (United States)

    Guha, C.; Huagang, Z.; Chen, W.; Carlosn, R.; Sanghvi, N. T.

    2011-09-01

    High intensity focused ultrasound (HIFU) results in instantaneous coagulative tissue necrosis. In contrast, "low" energy focused ultrasound (LOFU) induces membrane perturbation while maintaining cell viability. This report explores the tumor immunomodulatory roles of LOFU and HIFU combination treatment. We hypothesized that administration of repeated cycles of LOFU, followed by HIFU would release tumor-derived peptide-heat shock protein complexes in the blood and induce systemic tumor-specific immune response that would enhance tumor control of both local and systemic disease.

  9. 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 pur

  10. 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.

  11. 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

  12. Magnetic Resonance-Guided High-Intensity Focused Ultrasound (MRgHIFU) for Treatment of Symptomatic Uterine Fibroids: An Economic Analysis

    Science.gov (United States)

    Babashov, V; Palimaka, S; Blackhouse, G; O'Reilly, D

    2015-01-01

    combination of UAE and hysterectomy, and myomectomy was strictly dominated by MRgHIFU and UAE. In the scenario where only MRgHIFU-eligible patients were considered, MRgHIFU was the cost-effective option for a willingness-to-pay threshold of $50,000. In the scenario where only MRgHIFU-eligible patients were considered and where UAE was eliminated as a treatment option (due to its low historic utilization in Ontario), MRgHIFU was cost-effective with an incremental cost of $39,250 per additional QALY. The budgetary impact of funding MRgHIFU for treatment of symptomatic uterine fibroids was estimated at $1.38 million in savings when funded to replace all types of procedures at 2 centres, and $1.14 million when funded to replace only uterine-preserving procedures at 2 centres. The potential savings increase to $4.15 million when MRgHIFU is funded at 6 centres to treat all women eligible for the procedure. Potential savings at 6 centres decrease slightly, to $3.42 million, when MRgHIFU is funded to replace uterine-preserving procedures only. Conclusions Our findings suggest that MRgHIFU may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds, after examining the uncertainty in model parameters and several likely scenarios. In terms of budget impact, the implementation of MRgHIFU could potentially result in one-year savings of $1.38 million and $4.15 million in the scenarios where MRgHIFU is implemented in 2 or 6 centres, respectively. From a patient perspective, it is important to consider that MRgHIFU is the least invasive of all fibroid treatment options for women who have not responded to pharmaceuticals; it is the only one that is completely noninvasive. Also important, from a societal point of view, is the potential benefit from faster recovery times. Despite these benefits, implementation of MRgHIFU beyond the 2 centres which currently offer the treatment faces logistical challenges (for example, competing demands for use of existing equipment), as

  13. High-Intensity Focused Ultrasound (Hifu) Treatment For Thyroid Nodules: Experimental And First Clinical Studies

    Science.gov (United States)

    Esnault, Olivier; Franc, Brigitte; Leenhardt, Laurence; Rouxel, Agnès; Ménégaux, Fabrice; Lacoste, François

    2007-05-01

    OBJECTIVE: Thyroid nodules are common and can only be removed by surgery. High-intensity focused ultrasound (HIFU) could be a possible minimally invasive alternative treatment. The aim of this study was to assess the feasibility of using HIFU to precisely ablate thyroid nodules without affecting neighbouring structures. METHODS: HIFU was generated by a 3-MHz spherical piezocomposite transducer moved across the target in a stepwise fashion. In a first clinical study 25 patients had their nodules treated with HIFU 2 weeks prior to planned thyroidectomy, using increasing energy. The last patients received a local anesthesia. The lesions were assessed by the pathologist. RESULTS: The histological lesions were clearly visible in most of the fully treated patients, particularly those who received higher energy. Superficial and reversible skin blisters were observed in 7 patients. The design of the treatment head was subsequently modified to eliminate such risk. CONCLUSION: The patient trials confirmed the precision of the targeting and set the energy levels for safe thyroid nodule ablation with HIFU. Further study is needed to assess nodule's changes at longer follow-up.

  14. Dependence of Boiling Histotripsy Treatment Efficiency on HIFU Frequency and Focal Pressure Levels.

    Science.gov (United States)

    Khokhlova, Tatiana D; Haider, Yasser A; Maxwell, Adam D; Kreider, Wayne; Bailey, Michael R; Khokhlova, Vera A

    2017-09-01

    Boiling histotripsy (BH) is a high-intensity focused ultrasound (HIFU)-based method of mechanical tissue fractionation that utilizes millisecond-long bursts of HIFU shock waves to cause boiling at the focus in milliseconds. The subsequent interaction of the incoming shocks with the vapor bubble mechanically lyses surrounding tissue and cells. The acoustic parameter space for BH has been investigated previously and an inverse dependence between the HIFU frequency and the dimensions of a BH lesion has been observed. The primary goal of the present study was to investigate in more detail the ablation rate and reliability of BH in the frequency range relevant to treatment of deep abdominal tissue targets (1-2 MHz). The second goal was to investigate the effect of focal peak pressure levels and shock amplitude on BH lesion formation, given a constant duty factor, a constant ratio of the pulse duration to the time to reach boiling and a constant number of BH pulses. A custom-built 12-element sector array HIFU transducer with F-number = 1.05 was used in all experiments. BH pulses at 5 different frequencies (1, 1.2, 1.5, 1.7 and 1.9 MHz) were delivered to optically transparent polyacrylamide gel phantoms and ex vivo bovine liver and myocardium tissue to observe cavitation and boiling bubble activity with high-speed photography and B-mode ultrasound imaging, correspondingly. In gel phantoms, a cavitation bubble cloud was shown to form prefocally and to shield the focus in all exposures at 1 and 1.2 MHz and in the highest amplitude exposures at 1.5-1.7 MHz; shielding was not observed at 1.9 MHz. In ex vivo tissue, this shielding effect was observed in 25% of exposures when peak negative in situ pressure exceeded 10.2 MPa at 1 MHz and 14.5 MPa at 1.5 MHz. When shielding occurred, the exposures resulted in mild tissue disruption in the prefocal region, but not liquefaction. The dimensions of liquefied lesions followed the inverse proportionality trend with

  15. Contrast Agent Ultrasonography before and after HIFU Treatment of Parathyroid Glands

    Science.gov (United States)

    Kovatcheva, Roussanka; Arnaud, Françoise; Lacoste, François

    2010-03-01

    OBJECTIVES: To observe changes in the parathyroid tissue treated by extracorporeal HIFU. MATERIAL AND METHODS: 5 patients were treated for primary hyperparathyroidism by thermally ablating enlarged parathyroid glands using an external HIFU applicator. The treated glands were visualized with B-Mode and contrast enhanced ultrasonography (CEUS) before, 1 week and 4 weeks post HIFU. Serum iPTH, calcium, and phosphorus levels were monitored before and after the treatment. RESULTS: The initial results showed a correlation between contrast agent uptake of treated parathyroid tissue, the reduction of volume of the gland and the decrease of iPTH levels. CONCLUSIONS These results show it is possible to use CEUS to monitor the thermal ablation of parathyroid glands.

  16. 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.

  17. Drift correction for accurate PRF-shift MR thermometry during mild hyperthermia treatments with MR-HIFU.

    Science.gov (United States)

    Bing, Chenchen; Staruch, Robert M; Tillander, Matti; Köhler, Max O; Mougenot, Charles; Ylihautala, Mika; Laetsch, Theodore W; Chopra, Rajiv

    2016-09-01

    There is growing interest in performing hyperthermia treatments with clinical magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) therapy systems designed for tissue ablation. During hyperthermia treatment, however, due to the narrow therapeutic window (41-45 °C), careful evaluation of the accuracy of proton resonant frequency (PRF) shift MR thermometry for these types of exposures is required. The purpose of this study was to evaluate the accuracy of MR thermometry using a clinical MR-HIFU system equipped with a hyperthermia treatment algorithm. Mild heating was performed in a tissue-mimicking phantom with implanted temperature sensors using the clinical MR-HIFU system. The influence of image-acquisition settings and post-acquisition correction algorithms on the accuracy of temperature measurements was investigated. The ability to achieve uniform heating for up to 40 min was evaluated in rabbit experiments. Automatic centre-frequency adjustments prior to image-acquisition corrected the image-shifts in the order of 0.1 mm/min. Zero- and first-order phase variations were observed over time, supporting the use of a combined drift correction algorithm. The temperature accuracy achieved using both centre-frequency adjustment and the combined drift correction algorithm was 0.57° ± 0.58 °C in the heated region and 0.54° ± 0.42 °C in the unheated region. Accurate temperature monitoring of hyperthermia exposures using PRF shift MR thermometry is possible through careful implementation of image-acquisition settings and drift correction algorithms. For the evaluated clinical MR-HIFU system, centre-frequency adjustment eliminated image shifts, and a combined drift correction algorithm achieved temperature measurements with an acceptable accuracy for monitoring and controlling hyperthermia exposures.

  18. Significant skin burns may occur with the use of a water balloon in HIFU treatment

    Science.gov (United States)

    Ritchie, Robert; Collin, Jamie; Wu, Feng; Coussios, Constantin; Leslie, Tom; Cranston, David

    2012-10-01

    HIFU is a minimally-invasive therapy suitable for treating selected intra-abdominal tumors. Treatment is safe although skin burns may occur due to pre-focal heating. HIFU treatment of a renal transplant tumor located in the left lower abdomen was undertaken in our centre. Treatment was performed prone, requiring displacement of the abdominal wall away from the treatment field using a water balloon, constructed of natural rubber latex and filled with degassed water. Intra-operatively, ultrasound imaging and physical examination of the skin directly over the focal region was normal. Immediately post-operative, a full-thickness skin burn was evident at the periphery of the balloon location, outside the expected HIFU path. Three possibilities may account for this complication. Firstly, the water balloon may have acted as a lens, focusing the HIFU to a neo-focus off axis. Secondly, air bubbles may have been entrapped between the balloon and the skin, causing heating at the interface. Finally, heating of the isolated water within the balloon may have been sufficient to cause burning. In this case, the placement of a water balloon caused a significant skin burn. Care should be taken in their use as burns, situated off axis, may occur even if the overlying skin appears normal.

  19. 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

  20. 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.

  1. Multimodality Treatment by FOLFOX plus HIFU in a Case of Advanced Pancreatic Carcinoma. A Case Report

    Directory of Open Access Journals (Sweden)

    Dobromir Dimitrov

    2015-01-01

    Full Text Available Context Pancreatic cancer is one of the most aggressive malignant diseases in which the survival rate has not improved in the past 40 years. Case report 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/m2. 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. Conclusion 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.

  2. 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.

  3. Blood coagulation using High Intensity Focused Ultrasound (HIFU)

    Science.gov (United States)

    Nguyen, Phuc V.; Oh, Junghwan; Kang, Hyun Wook

    2014-03-01

    High Intensity Focused Ultrasound (HIFU) technology provides a feasible method of achieving thermal coagulation during surgical procedures. One of the potential clinical benefits of HIFU can induce immediate hemostasis without suturing. The objective of this study was to investigate the efficiency of a HIFU system for blood coagulation on severe vascular injury. ngHIFU treatment was implemented immediately after bleeding in artery. The ultrasound probe was made of piezoelectric material, generating a central frequency of 2.0 MHz as well as an ellipsoidal focal spot of 2 mm in lateral dimension and 10 mm in axial dimension. Acoustic coagulation was employed on a perfused chicken artery model in vitro. A surgical incision (1 to 2 mm long) was made with a scapel on the arterial wall, and heparinized autologous blood was made to leak out from the incision with a syringe pump. A total of 5 femoral artery incisions was treated with the HIFU beam. The intensity of 4500 W/cm2 at the focus was applied for all treatments. Complete hemostasis was achieved in all treatments, along with the treatment times of 25 to 50 seconds. The estimated intraoperative blood loss was from 2 to 5 mL. The proposed HIFU system may provide an effective method for immediate blood coagulation for arteries and veins in clinical applications.

  4. 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...

  5. 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 (prisk groups in all patients at 10 years were 72% and 58%, 44%, respectively (prisk 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.

  6. Experimental Validation of a Novel MRI-Compatible HIFU Device for the Treatment of Superficial Venous Insufficiency

    Science.gov (United States)

    Salomir, Rares; Pichardo, Samuel; Petrusca, Lorena; Angel, Yves; Lacoste, François; Chapelon, Jean-Yves

    2007-05-01

    A novel High Intensity Focused Ultrasound (HIFU) probe has been designed for minimally-invasive treatment of valvular dysfunction in the saphenous vein, which is known to be the cause of superficial venous insufficiency (SVI) and varicose veins. Treating SVI with HIFU is possible, since venous tissue undergoes localized partial shrinkage when subjected to high temperature elevation. In a previous study in vitro we demonstrated that diameter shrinkage should be sufficient to restore valvular function, as this is done in the more aggressive approach known as external valvuloplasty. Numerical optimization using fast simulations of pressure field have led to a non-spherically shaped probe design with two HIFU elements that focus ultrasound uniformly over a line of length 7 mm, at a depth of 15 mm from the skin. A MR-compatible prototype of the probe has been constructed and this was characterized 1). by electroacustical mapping of the pressure field in water, and 2). by fast, high resolution MR thermal mapping ex vivo on fresh meat samples. Results were in good agreement with those predicted by an analytical approach and numerical simulations. Available experimental data suggest that a short sonication (less than 10 sec duration) should permit sufficient temperature elevation to obtain vein shrinkage. Further studies will be performed on surgically excised samples of human veins under MR thermal mapping in order to determine the optimal sonication parameters (duration and power level).

  7. A study of three-dimensional tumor figure creating and treatment trail in HIFU

    Institute of Scientific and Technical Information of China (English)

    HOU zhen-xiu; ZHAO Yong-ping; CHEN Xin-liang; CHEN Shi-zhe; JIN Chang-shan

    2006-01-01

    This paper introduces a method in which a series of parallel B-ultrasonic tumor section images is recombined into a three-dimensional picture in HIFU (High Intensity Focus Ultrasonic) therapy. The experiments show that the recombining three-dimensional tumor is anastomose with the trim size, that the method is usable and accurate in the operation. It has a certain consulting value.

  8. 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.

  9. Emerging HIFU applications in cancer therapy.

    Science.gov (United States)

    Maloney, Ezekiel; Hwang, Joo Ha

    2015-05-01

    High intensity focused ultrasound (HIFU), is a promising, non-invasive modality for treatment of tumours in conjunction with magnetic resonance imaging or diagnostic ultrasound guidance. HIFU is being used increasingly for treatment of prostate cancer and uterine fibroids. Over the last 10 years a growing number of clinical trials have examined HIFU treatment of both benign and malignant tumours of the liver, breast, pancreas, bone, connective tissue, thyroid, parathyroid, kidney and brain. For some of these emerging indications, HIFU is poised to become a serious alternative or adjunct to current standard treatments--including surgery, radiation, gene therapy, immunotherapy, and chemotherapy. Current commercially available HIFU devices are marketed for their thermal ablation applications. In the future, lower energy treatments may play a significant role in mediating targeted drug and gene delivery for cancer treatment. In this article we introduce currently available HIFU systems, provide an overview of clinical trials in emerging oncological targets, and briefly discuss selected pre-clinical research that is relevant to future oncological HIFU applications.

  10. 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.

  11. 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.

  12. Intra-operative Hemostasis of Punctured Femoral Artery Using HIFU: A Survival Study

    Science.gov (United States)

    Zderic, Vesna; Keshavarzi, Amid; Noble, Misty L.; Paun, Marla; Sharar, Sam R.; Crum, Lawrence A.; Martin, Roy W.; Vaezy, Shahram

    2005-03-01

    The objective was to investigate the long-term efficacy of hemostasis and healing of arteries after HIFU application. The femoral arteries of 22 adult rabbits were surgically exposed. Fifteen arteries were punctured with a needle and treated with HIFU, and 7 arteries were sham-treated (no puncture or HIFU was applied). The tip of the HIFU applicator was positioned on the bleeding site, and HIFU energy was applied until hemostasis was achieved. The focal intensity was approximately 3,000 W/cm2, at the resonant frequency of 9.6 MHz. Serial ultrasound images, blood and tissue samples were collected immediately and on days 1, 3, 7, 14, 28, and 60 after the treatment. Eleven of the arteries were patent after the treatment, and four arteries were occluded, as confirmed using Doppler imaging. One of the occluded arteries reopened at day 14. HIFU exposure time to achieve hemostasis was 27 ±17 seconds for patent arteries and 101±38 seconds for the occluded arteries. The blood flow velocities were not statistically different between HIFU-treated patent vessels and sham-treated vessels. The tunica adventitia and media, disrupted and coagulated immediately after the treatment, recovered to normal appearance within 28 days, with localized thinning of the tunica media observed up to day 60. Neo-intimal hyperplasia was observed in the arteries at days 14 and 28. HIFU produced an effective and long-term (up to 60 days) hemostasis of injured femoral arteries while preserving a normal blood flow and vessel wall structure in the majority of vessels.

  13. Feasibility of real-time treatment feedback using novel filter for eliminating therapeutic ultrasound noise with high-speed ultrasonic imaging in ultrasound-guided high-intensity focused ultrasound treatment

    Science.gov (United States)

    Takagi, Ryo; Jimbo, Hayato; Iwasaki, Ryosuke; Tomiyasu, Kentaro; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    In the conventional ultrasonic monitoring of high-intensity focused ultrasound (HIFU) treatment, a significant interval between HIFU shots is required when monitoring target tissue to avoid interference between HIFU noise and RF echo signals. In our previous study, a new filtering method to eliminate only HIFU noise while maintaining tissue signals intact was proposed, and it was shown that the thermal coagulation could be detected during simultaneous HIFU irradiation through off-line processing. In this study, the filtering method and a real-time coagulation detection algorithm were implemented in an ultrasound imaging system, whose use for sequential exposure with multiple foci was demonstrated similarly to a commercial HIFU ablation system. The coagulation was automatically detected by the proposed method during real-time simultaneous HIFU irradiation, and the HIFU exposure time was controlled according to the changes in the tissue. The results imply that ultrasonic monitoring with the filtering and detection methods is useful for true real-time detection of changes in the tissue due to thermal coagulation during HIFU exposure.

  14. Safety Issues for HIFU Transducer Design

    Science.gov (United States)

    Fleury, Gérard; Berriet, Rémi; Chapelon, Jean Yves; ter Haar, Gail; Lafon, Cyril; Le Baron, Olivier; Chupin, Laurent; Pichonnat, Fabrice; Lenormand, Jérôme

    2005-03-01

    In contrast with most ultrasound modalities for medical applications, (especially ultrasound imaging), High Intensity Focused Ultrasound (HIFU) involves technologies and procedures which may present risk to the patient. These risks, resulting from the high power levels required for effective therapy, should be taken into account at the earliest stages in the design of a system dedicated to HIFU treatment. An understanding of these risks must thus be shared amongst the many players in the field of therapy using high power ultrasound. Moreover, since the number of applications of HIFU has increased appreciably over recent years and the technology is ready to move from the research to the industrial level, it is worth now considering solutions that should be put in place to guarantee the safety of the patient during HIFU treatment. This paper reports thoughts on this, identifies some risks to the patient that must be taken into consideration in the design of HIFU transducers, and proposes some solutions that could prevent the deleterious consequences of transducer misuse or failure. For the main risks identified, such as exceeding the desired acoustic power or poor control of tissue targeting, a description of transducer performance that could potentially result in problems is systematically sought. This allows proposals for precautions to be taken during operation to be made. Parameters which should be monitored to ensure safe use are also suggested. This type of approach, which should be undertaken for the different components of a therapeutic system, highlights the challenges that must be faced in the immediate future for the development and safe exploitation of HIFU systems. The necessity for standard definitions of the parameters to be checked or monitored during HIFU treatments is crucial in this approach, as is the availability of reliable dedicated measurement devices. Co-ordinated action on these topics in the HIFU community would contribute to the

  15. Motion tracing system for ultrasound guided HIFU

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  17. Sonablate-500TM Transrectal High-intensity Focused Ultrasound (HIFU) for Benign Prostatic Hyperplasia Patients

    Institute of Scientific and Technical Information of China (English)

    L(U) Jun; HU Weilie; WANG Wei; ZHANG Yuanfeng; CHEN Zhaoyang; YE Zhangqun

    2007-01-01

    To evaluate the safety and efficacy of transrectal high-intensity focused ultrasound (HIFU) in the treatment of benign prostatic hyperplasia (BPH), serial studies were conducted in 150 BPH pa- tients before and 30 min, 1, 2, 6 and 12 month(s) after Sonablate-500TM HIFU treatment. A sili- con-coated indwelling 16F latex catheter was placed during the determination of the therapy zone. Preoperative and postoperative evaluations were made by using the international prostate symptom score (IPSS), quality of life (QOL), uroflowmetric findings and transrectal ultrasound, and incidence of complications. The cystourethrography was done in 23 patients within 1 year postoperatively. The results showed that after HIFU treatment, IPSS and QOL scores were significantly decreased at 1, 2, 6 and 12 month(s) (P<0.01). Maximum urine flow rate (6.0 to 17.2 mL/s, P<0.01), PVR (75.0 to 30.3,P<0.01) and prostatic volume (65.0 to 38.1 mL, P<0.05) were significantly improved 12 months after the operation. Recurrent urinary retention (n=2) and urethrorectal fistula (n=1) occurred at the 15th postoperative day. The duration of the HIFU prostate ablation was 25-90 rain. The mean time for an indwelling catheter was 3-19 days. These data demonstrate that treatment of BPH with Sonab- late-500TM HIFU is safe and effective.

  18. 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.

  19. Modeling and simulation of HIFU induced lesions using different treatment pattern

    Science.gov (United States)

    Qiao, Shan; Shen, Guofeng; Bai, Jingfeng; Chen, Yazhu

    2012-10-01

    Long heating time is needed to ablate a large area using high intensity focused ultrasound, while multiple-focus pattern or single-focus scan is used. This process may cause unexpected temperature rise in pre-focal regions, which can distort acoustic propagation and affect lesion formations. This article simulates this process by using a thermo-acoustic model, which is based on linear acoustic equations and the heat transfer equation, considering parameter variations due to temperature rising of media on the propagation path. Perfect matched layer (PML) technique is introduced for the absorb boundary condition. Finite difference time-domain (FDTD) method is applied to solve the thermo-acoustic model. The simulations that describe lesion formations in multiple-layer media with different treatment patterns-single focus, multiple-focus and single-focus scan are investigated respectively. These simulations indicate that distortions can be serious with single-focus scan method. Additionally, the single-focus scan patterns applying different interval time length are also simulated. The results imply that the proper interval time can minimize the ultrasound distribution distortion caused by pre-focal heating.

  20. Cavitation and the relationship between cavitation, echo and the thermal effects of HIFU treatment%高强度聚焦超声治疗中的空化及其与回声、热效应之间的关系

    Institute of Scientific and Technical Information of China (English)

    陈杰; 易华容; 王彬; 李发琪

    2009-01-01

    High intensity focused ultrasound (HIFU) is a new and exciting medical treatment. Cavitation is the focus in the field of HIFU research. Cavitation and the relationship between cavitation, echo and the thermal effects of HIFU treatment were reviewed in this article.%高强度聚焦超声(HIFU)正在成为医学上一种新兴的治疗技术.HIFU治疗中的空化一直是HIFU研究中的热点问题.本文介绍HIFU治疗中的空化及其与回声、热效应之间的关系.

  1. Development of Noninvasive Vascular Occlusion Method with HIFU

    Science.gov (United States)

    Senoo, Naohiko; Suzuki, Jun; Yoshinakaa, Kiyoshi; Deguchi, Juno; Takagia, Shu; Miyata, Tetsuro; Matsumotoa, Yoichiro

    2010-03-01

    HIFU treatment with microbubbles is investigated in the present study. It is well known that microbubbles have the potential to enhance the heating effect in an ultrasound field. In the present study, the heat produced by microbubble oscillation was used to occlude varicose veins. The heated area by HIFU irradiation was initially investigated with white-egg gel, which denatures at over 70° C. The heated area mainly depends on the frequency of the ultrasound, the intensity at focus, and the irradiation time. The attenuation coefficient was also measured in order to confirm that attenuation at the skin is such that HIFU energy can reach the vein. Then, we conducted an animal experiment. We completely dehaired a rabbit and washed the exposed skin with soap and degassed water in order to eliminate bubbles (which interfere with the passage of ultrasound) from the boundary face. The frequency of the ultrasound was 1.7 MHz. The intensity at focus was 1,800 W/cm2, and the irradiation time was 20 s. We chose the contrast agent Levovist® for the microbubbles, and set the void fraction (the ratio of total gas volume to liquid) in the blood vessel to 10-5. Levovist® was dissolved into normal saline and injected into the vein. The vein was clasped on one side using forceps and compressed in order to avoid thermal dissipation. Furthermore, hypodermic water was injected as coolant for skin. Then, the external jugular vein of rabbit was occluded. The capability of HIFU treatment to occlude lower extremity varicose veins was verified in the present study.

  2. Design of a HIFU array for the treatment of deep venous thrombosis: a simulation study

    Science.gov (United States)

    Smirnov, Petr; Hynynen, Kullervo

    2017-08-01

    Deep venous thrombosis of the iliofemoral veins is a common and morbid disease, with the recommended interventional treatment carrying a high risk of hemorrhaging and complications. High intensity focused ultrasound delivered with a single element transducer has been shown to successfully precipitate thrombolysis non-invasively in vitro and in vivo. However, in all previous studies damage to the veins or surrounding tissue has been observed. Using a simulation model of the human thigh, this study investigated whether a phased array device could overcome the large focal region limitations faced by single transducer treatment devices. Effects of the size, shape and frequency of the array on its focal region were considered. It was found that a λ/2 spaced array of 7680 elements operating at 500 kHz could consistently focus to a region fully contained within the femoral vein. Furthermore, it is possible to reduce the number of elements required by building arrays operating at lower frequencies. The results suggest that phased transducer arrays hold potential for developing a safe, non-invasive treatment of thrombolysis.

  3. Cavitation damage in blood clots under HIFU

    Science.gov (United States)

    Weiss, Hope; Ahadi, Golnaz; Hoelscher, Thilo; Szeri, Andrew

    2010-11-01

    High Intensity Focused Ultrasound (HIFU) has been shown to accelerate thrombolysis, the dissolution of blood clots, in vitro and in vivo, for treatment of ischemic stroke. Cavitation in sonothrombolysis is thought to play an important role, although the mechanisms are not fully understood. The damage to a blood clot associated with bubble collapses in a HIFU field is studied. The region of damage caused by a bubble collapse on the fibrin network of the blood clot exposed to HIFU is estimated, and compared with experimental assessment of the damage. The mechanical damage to the network caused by a bubble is probed using two independent approaches, a strain based method and an energy based method. Immunoflourescent fibrin staining is used to assess the region of damage experimentally.

  4. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  6. MR Guidance, Monitoring and Control of Brain HIFU Therapy in Small Animals: In Vivo Demonstration in Rats

    Science.gov (United States)

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

    2010-03-01

    In the framework of HIFU transcranial brain therapy, it is mandatory to develop techniques capable of assessing the focusing quality and location before the treatment. Monitoring heat deposition in real time and verifying the extension of the treated area are also important steps. In this study, an imaging protocol is proposed to:1/ locate the US radiation force induced displacement in tissues and quantify the acoustic pressure at focus prior to HIFU; 2/ monitor the temperature rise during HIFU; and 3/ assess the changes in elasticity in the treated area. A 7T MRI scanner was equipped with a home-made stereotactic frame for rats and a US focused transducer working at 1.5 MHz. Such a tool is key for the evaluation of the biological effects of HIFU on brain tissue and tumors. The proposed protocol was successfully tested on 12 rats with and without injected tumors. The accurate localization of the focal point prior to HIFU was demonstrated in vivo. Furthermore, the pressure estimation in situ allowed to accurately simulate the heat deposition at focus and to plan the treatment (electrical power, duration). The temperature measurements were in good accordance with the predicted curves. The elasticity maps showed significant changes after treatment in some cases.

  7. 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.

  8. Real-time monitoring of high-intensity focused ultrasound thermal therapy using the manifold learning method.

    Science.gov (United States)

    Rangraz, Parisa; Behnam, Hamid; Sobhebidari, Pooya; Tavakkoli, Jahan

    2014-12-01

    High-intensity focused ultrasound (HIFU) induces thermal lesions by increasing the tissue temperature in a tight focal region. The main ultrasound imaging techniques currently used to monitor HIFU treatment are standard pulse-echo B-mode ultrasound imaging, ultrasound temperature estimation and elastography-based methods. The present study was carried out on ex vivo animal tissue samples, in which backscattered radiofrequency (RF) signals were acquired in real time at time instances before, during and after HIFU treatment. The manifold learning algorithm, a non-linear dimensionality reduction method, was applied to RF signals whichconstruct B-mode images to detect the HIFU-induced changes among the image frames obtained during HIFU treatment. In this approach, the embedded non-linear information in the region of interest of sequential images is represented in a 2-D manifold with the Isomap algorithm, and each image is depicted as a point on the reconstructed manifold. Four distinct regions are chosen in the manifold corresponding to the four phases of HIFU treatment (before HIFU treatment, during HIFU treatment, immediately after HIFU treatment and 10-min after HIFU treatment). It was found that disorganization of the points is achieved by increasing the acoustic power, and if the thermal lesion has been formed, the regions of points related to pre- and post-HIFU significantly differ. Moreover, the manifold embedding was repeated on 2-D moving windows in RF data envelopes related to pre- and post-HIFU exposure data frames. It was concluded that if mean values of the points related to pre- and post-exposure frames in the reconstructed manifold are estimated, and if the Euclidean distance between these two mean values is calculated and the sliding window is moved and this procedure is repeated for the whole image, a new image based on the Euclidean distance can be formed in which the HIFU thermal lesion is detectable.

  9. High-Intensity Focused Ultrasound (HIFU) Using Sonablate® Devices for the Treatment of Benign Prostatic Hyperplasia and Localized Prostate Cancer: 18-year experience

    Science.gov (United States)

    Uchida, Toyoaki

    2011-09-01

    From 1993 to 2010, we have treated 156 patients benign prostatic hyperplasia (BPH) and 1,052 patients localized prostate cancer high-intensity focused ultrasound (HIFU). Four different HIFU devices, SonablateR-200, SonablateR-500, SonablateR-500 version 4 and Sonablate® TCM, have been used for this study. Clinical outcome of HIFU for BPH did not show any superior effects to transurethral resection of the prostate, laser surgery or transurethral vapolization of the prostate. However, HIFU appears to be a safe and minimally invasive therapy for patients with localized prostate cancer, especially low- and intermediate-risk patients. The rate of clinical outcome has significantly improved over the years due to technical improvements in the device.

  10. 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.

  11. 高强度聚焦超声治疗晚期胰腺癌21例效果观察及护理%Observation on the effect of HIFU in the treatment of 21 cases of advanced pancreatic cancer and nursing care

    Institute of Scientific and Technical Information of China (English)

    徐亚玲; 李士红; 魏民

    2011-01-01

    Objective: To explore the effect of high intensity focused ultrasound ( HIFU ) therapy in the treatment of ad vancod pancreatic cancer and nursing methods. Methods: 36 patients were randomly divided into treatment group ( n = 21 ) and control group ( n = 15 ). The patients were treated with type FEP - BY02 HIFU tumor therapy machine in the treatment group and the patients in the control group received supportive therapy. The treatment effectiveness and safety were observed by comparing the clinical symptoms, laboratory test results, imaging changes, complications, etc. , between the two groups. Results: The pain was obviously relieved in 90.5 % ( 19/21 ) of the patients and CAI 9 -9 decreased in the treatment group; the treated local tumor tissues were evidently necrotic and the life time was significantly longer compared with the control group ( P < 0.05 ). Such com plications as skin buros, pancreatitis and gastrointestinal tract perforation did not occur in the treatment group. Conclusion: HI FU therapy can reduce the symptoms, improve quality of life and prolong the life time of the patients with advanced pancreatic cancer%目的:探讨高强度聚焦超声(HIFU)治疗晚期胰腺癌患者的疗效与护理方法.方法:将36例晚期胰腺癌患者随机分为治疗组21例和对照组15例,治疗组应用 FEP-BY02 型 HIFU 肿瘤治疗机治疗,对照组实施支持疗法.通过比较两组临床症状、实验室检查、影像学变化、并发症等情况,观察HIFU的治疗效果和安全性.结果:治疗组90.5% (19/21)的患者疼痛症状明显缓解,CA19-9降低,HIFU治疗区域肿瘤组织明显坏死,患者生存期较对照组明显延长(P<0.05);治疗组患者未发生皮肤烧伤、胰腺炎、胃肠道穿孔等并发症.结论:HIFU能减轻晚期胰腺癌患者症状,改善生活质量,延长生存期.

  12. PREVENTION OF DYSURIA AFTER HIFU THERAPY FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    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.

  13. PREVENTION OF DYSURIA AFTER HIFU THERAPY FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    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.

  14. 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 tissue ablation and can be fully integrated into any HMI

  15. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure

    NARCIS (Netherlands)

    Shah, T T; Peters, M; Kanthabalan, A; McCartan, N; Fatola, Y; van der Voort van Zyp, J; van Vulpen, M; Freeman, A; Moore, C M; Arya, M; Emberton, M; Ahmed, H U

    2016-01-01

    BACKGROUND: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. METHODS: An independent HIFU registry collated consecutive cases of HIFU. Betwe

  16. Extracorporeal High-Intensity Focused Ultrasound Treatment for Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    HuiZhu; FengWu; WenzhiChen; YoudeCao; JinBai; ZhibiaoWang

    2004-01-01

    OBJECTIVE To evaluate the clinical safety and efficacy of using highintensity focused ultrasound (HIFU) therapy, for breast cancer, and to select the appropriate methods in evaluating the therapeutic effects.METHODS A total of 24 patients with breast cancer underwent HIFU treatment 1-2 weeks before receiving modified radical mastectomy. During and after HIFU therapy, changes in blood pressure, breath, pulse and peripheral blood oxygen saturation were monitored. At the same time, the damage of the skin and tissue produced by HIFU at the target region was evaluated as well. Surgically excised samples were used for pathological examinations to evaluate the HIFU-induced destruction of the targeted tissue. Three patients received Tc-ECT and 1 MRI examinations before and after HIFU.RESULTS HIFU treatment had no apparent influence on either the tissue nearby the target or on vital signs of the patients. Pathological, tc-ECT and MRI examinations demonstrated that targeted tissue showed complete coagulative necrosis.CONCLUSION Under the guidance of real-time ultrasonic imaging, HIFU can effectively and safely destroy the breast cancer mass and 99MTc-ECT and MRI examination can be utilized to evaluate the therapeutic effects.HIFU may become one of the options for breast cancer therapy in the future.

  17. Development of HIFU Therapy System for Lower Extremity Varicose Veins

    Science.gov (United States)

    Ota, Ryuhei; Suzuki, Jun; Yoshinaka, Kiyoshi; Deguchi, Juno; Takagi, Shu; Miyata, Tetsuro; Matsumoto, Yoichiro

    2009-04-01

    High-intensity focused ultrasound (HIFU) treatment utilizing microbubbles was investigated in the present study. It is known that microbubbles have the potential to enhance the heating effects of an ultrasound field. In this study, the heat accompanying microbubble oscillation was used to occlude varicose veins. Alteration of veins was observed after ultrasound irradiation. Veins were resected by stripping. In this study, two vein conditions were adopted during HIFU irradiation; non-compressed and compressed. Compressing the vein was expected to improve occlusion by rubbing the altered intima under compressed conditions. The frequency of the ultrasound was 1.7 MHz, the intensity at the focus was 2800 W/cm2, and the irradiation time was 20 s. In this study, the contrast agent Levovist® was chosen as a microbubble source, and the void fraction (ratio of total gas volume to liquid) in the vein was fixed at 10-5. Under non-compressed conditions, changes were observed only at the adventitia of the vein anterior wall. In contrast, under compressed conditions, changes were observed from the intima to the adventitia of both the anterior and posterior walls, and they were partly stuck together. In addition, more experiments with hematoxylin-eosin staining suggested that the changes in the vein were more substantial under the latter conditions. From these results, it was confirmed that the vein was occluded more easily with vein compression.

  18. Real-time monitoring of high-intensity focused ultrasound treatment using axial strain and axial-shear strain elastograms.

    Science.gov (United States)

    Xia, Rongmin; Thittai, Arun K

    2014-03-01

    Axial strain elastograms (ASEs) have been found to help visualize sonographically invisible thermal lesions. However, in most studies involving high-intensity focused ultrasound (HIFU)-induced thermal lesions, elastography imaging was performed separately later, after the lesion was formed. In this article, the feasibility of monitoring, in real time, tissue elasticity variation during HIFU treatment and immediately thereafter is explored using quasi-static elastography. Further, in addition to ASEs, we also explore the use of simultaneously acquired axial-shear strain elastograms (ASSEs) for HIFU lesion visualization. Experiments were performed on commercial porcine liver samples in vitro. The HIFU experiments were conducted at two applied acoustic power settings, 35 and 20 W. The experimental setup allowed us to interrupt the HIFU pulse momentarily several different times during treatment to perform elastographic compression and data acquisition. At the end of the experiments, the samples were cut along the imaging plane and photographed to compare size and location of the formed lesion with those visualized on ASEs and ASSEs. Single-lesion and multiple-lesion experiments were performed to assess the contribution of ASEs and ASSEs to lesion visualization and treatment monitoring tasks. At both power settings, ASEs and ASSEs provided accurate location information during HIFU treatment. At the low-power setting case, ASEs and ASSEs provide accurate lesion size in real-time monitoring. Lesion appearance in ASEs and ASSEs was affected by the cavitation bubbles produced at the high-power setting. The results further indicate that the cavitation bubbles influence lesion appearance more in ASEs than in ASSEs. Both ASEs and ASSEs provided accurate size information after a waiting period that allowed the cavitation bubbles to disappear. The results indicate that ASSEs not only improve lesion visualization and size measurement of a single lesion, but, under certain

  19. Rapid motion correction in MR-guided high-intensity focused ultrasound heating using real-time ultrasound echo information.

    Science.gov (United States)

    de Oliveira, Philippe Lourenço; de Senneville, Baudouin Denis; Dragonu, Iulius; Moonen, Chrit T W

    2010-11-01

    The objective of this study was to evaluate the feasibility of integrating real-time ultrasound echo guidance in MR-guided high-intensity focused ultrasound (HIFU) heating of mobile targets in order to reduce latency between displacement analysis and HIFU treatment. Experiments on a moving phantom were carried out with MRI-guided HIFU during continuous one-dimensional ultrasound echo detection using separate HIFU and ultrasound imaging transducers. Excellent correspondence was found between MR- and ultrasound-detected displacements. Real-time ultrasound echo-based target tracking during MR-guided HIFU heating is shown with the dimensions of the heated area similar to those obtained for a static target. This work demonstrates that the combination of the two modalities opens up perspectives for motion correction in MRI-guided HIFU with negligible latency.

  20. Feasibility of monitoring HIFU prostate cancer therapy using elastography

    Science.gov (United States)

    Souchon, Remi; Chapelon, Jean Y.; Bertrand, Michel J.; Kallel, Faouzi; Ophir, Jonathan

    2001-05-01

    The objective of this study is to investigate the feasibility of elastographic monitoring of High Intensity Focused Ultrasound (HIFU) therapy of prostate cancer. Elastography is an imaging technique based on strain estimation in soft tissues under quasi-static compression. Since pathological tissues and HIFU-induced lesions exhibit different elastic properties than normal tissues, elastography is potentially able to achieve these goals. An ultrasound scanner was connected to a PC to acquire RF images. This setup is compatible with a HIFU device used for prostate cancer therapy by transrectal route. The therapy transducer and the biplane-imaging probe are covered with a balloon filled with a coupling liquid. Compression of the prostate is applied by inflating the balloon, while imaging sector scans of the prostate. In-vivo elastograms of the prostate were acquired before HIFU treatment. Problems inherent to in-vivo acquisitions are reported, such as undesired tangential displacements during the radial compression. This study shows the potential for in-vivo elastogram acquisition of HIFU-induced lesions in the human prostate.

  1. Combination treatment of HIFU and rehabilitation on phantom limb pain after amputation%聚焦超声联合常规康复治疗对截肢后幻肢痛的疗效

    Institute of Scientific and Technical Information of China (English)

    唐映; 刘杰文; 许晓光

    2015-01-01

    目的:探讨聚焦超声联合常规康复对幻肢痛的治疗效果。方法将32例存在幻肢痛的患者分为治疗组和对照组,各16例,治疗组采用聚焦超声联合常规康复治疗,对照组单纯采用常规康复方法治疗。治疗30天后,以简明McGill疼痛问卷表评分作为评价指标,观察两组治疗效果。结果治疗组总有效率93.8%,对照组总有效率56.3%,两组比较差异有显著性意义(P<0.05);两组治疗前与治疗后SF-MPQ评分比较,差异均有显著性意义(P<0.05);治疗后组间SF-MPQ评分比较,差异有显著性意义(P<0.05)。结论聚焦超声和常规康复治疗联合运用对幻肢痛有很好的疗效。%Objective To study the effect of high intensity focus ultrasound ( HIFU) and rehabilitation treatment on phan-tom limb pain.Methods With randomized and controlled clinical research method, 32 cases of phantom limb pain were randomly divided into study group ( HIFU and rehabilitation therapy) and control group ( Rehabilitation therapy) with 16 patients in each group.After 30 days of treatment, a concise questionnaire SF-MPQ score was used as the evaluation in-dex of the therapeutic effect.Results The total effective rate of treatment group was 93.8%, compared to 56.3 % in the control group (P<0.05).The SF-MPQ score were significantly different before and after the treatment in both study group and control group (P<0.05).Comparison of SF-MPQ score between the two groups after treatment indicated sig-nificant difference (P<0.05).Conclusion HIFU and rehabilitation treatment have a good efficacy on limb pain.The combination of HIFU and rehabilitation treatment presents better results.

  2. Processing ultrasound backscatter to monitor high-intensity focused ultrasound (HIFU) therapy

    Science.gov (United States)

    Kaczkowski, Peter J.; Anand, Ajay; Bailey, Michael R.

    2005-09-01

    The development of new noninvasive surgical methods such as HIFU for the treatment of cancer and internal bleeding requires simultaneous development of new sensing approaches to guide, monitor, and assess the therapy. Ultrasound imaging using echo amplitude has long been used to map tissue morphology for diagnostic interpretation by the clinician. New quantitative ultrasonic methods that rely on amplitude and phase processing for tissue characterization are being developed for monitoring of ablative therapy. We have been developing the use of full wave ultrasound backscattering for real-time temperature estimation, and to image changes in tissue backscatter spectrum as therapy progresses. Both approaches rely on differential processing of the backscatter signal in time, and precise measurement of phase differences. Noise and artifacts from motion and nonstationary speckle statistics are addressed by constraining inversions for tissue parameters with physical models. We present results of HIFU experiments with static point and scanned HIFU exposures in which temperature rise can be accurately mapped using a new heat transfer equation (HTE) model-constrained inverse approach. We also present results of a recently developed spectral imaging method that elucidates microbubble-mediated nonlinearity not visible as a change in backscatter amplitude. [Work supported by Army MRMC.

  3. 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

  4. Effects of N2 O on the content of FHb and ICAM-1 in HIFU treatment patients%氧化亚氮对HIFU治疗患者FHb及ICAM-1含量的影响

    Institute of Scientific and Technical Information of China (English)

    陈佳; 但伶; 田泽丹; 黄燕; 周瑜; 张昭莉

    2014-01-01

    Objective To observe the effect of nitrous oxide (N2O) on the content of serum free hemoglobin ,and intercellular adhesion molecule‐1 (ICAM‐1) of patients with HIFU Therapy ,and investigate its action of tissue damage mechanism .Methods 50 patients with primary liver cancer undergoing HIFU surgery (ASA Ⅰ - Ⅱ class) were randomly divided into control group (group C) and experimental group(group N) ,25 patients of each group .General anesthesia method was used in both two groups , group C was by total intravenous anesthesia ,group N was adopted intravenous‐inhalation anesthesia .both two groups was adopted the same anesthesia induction method .anesthesia maintain of group N was joined N2 O on the basis of group C .both two groups were draw blood from the radial artery at the points of before anesthesia (T1 ) ,before operation (T2 ) ,1 h (T3 ) ,2 h (T4 ) ,3 h (T5 ) after intraoperative ,and 24 h after operation (T6 ) ,peroxidase reaction test and double antibody sandwich ELISA method were a‐dopted to detect the content of Fhb value and ICAM‐1 ;ultrasonography system of HIFU therapeutic instrument was used to meas‐ure the abdominal wall thickness of patients before and after operation .Results The content of FHb and ICAM‐1 in serum were significantly increased after operation than before with the anesthesia time (P<0 .05);compared with group C ,group N increased obviously at the same point in time (P<0 .05);preoperative and postoperative abdominal wall thickness value of group N was in‐creased significantly (P< 0 .05) .Conclusion It may be connected with N2 O enhanced ultrasound cavitation effect that the body produces more FHb and ICAM‐1 of group N in HIFU treatment ,and induces abdominal wall skin markedly swollen .%目的:观察氧化亚氮(N2O)对高强度聚焦超声(HIFU)治疗患者血清游离血红蛋白(FHb)及细胞间黏附分子1(ICAM‐1)含量的影响,探讨其组织损伤的作用机制。方法将50

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Development of a HIFU Phantom

    Science.gov (United States)

    King, Randy L.; Herman, Bruce A.; Maruvada, Subha; Wear, Keith A.; Harris, Gerald R.

    2007-05-01

    The field of high intensity focused ultrasound (HIFU) is developing rapidly. For basic research, quality control, and regulatory assessment a reusable phantom that has both thermal and acoustic properties close to that of soft tissue is critical. A hydrogel-based tissue mimicking material (TMM) has been developed that shows promise for such a phantom. The acoustic attenuation, speed of sound, B/A, thermal diffusivity and conductivity, as well as the cavitation threshold, were measured and found to mimic published values for soft tissue. The attenuation of 0.53f1.04 from 1 MHz to 8 MHz, as well as the sound speed of 1565 m/s and the tissue-like image quality, indicate the usefulness of the TMM for ultrasound imaging applications. These properties along with the thermal conductivity of 0.58 W/m- °C, diffusivity of 0.15 (mm2)/s, and the ability to withstand temperatures above 95 °C make this material appropriate for HIFU applications. The TMM also allows for the embedding of thermocouples and the formation of wall-less vessels that do not deteriorate as a result of continuous flow of blood mimicking fluids through the material. Tissue characteristics are strongly dependent on the fabrication technique, and care must be taken to achieve reproducible results. Note: This research was supported by the Defense Advanced Research Projects Agency (DARPA).

  7. HIFU Hemostasis of Liver Injuries Enhanced by Ultrasound Contrast Agents

    Science.gov (United States)

    Zderic, Vesna; Vaezy, Shahram; Brayman, Andrew A.; Matula, Thomas J.; O'Keefe, Grant E.; Crum, Lawrence A.

    2005-03-01

    Our objective was to investigate whether High-Intensity Focused Ultrasound (HIFU) hemostasis can be achieved faster in the presence of ultrasound contrast agents (UCA). Incisions (3 cm long and 0.5 cm deep) were made in surgically exposed rabbit liver. Optison at a concentration of 0.18 ml/kg was injected into the mesenteric vein, immediately before the incision was made. The HIFU applicator (frequency of 5.5 MHz, and intensity of 3,700 W/cm2) was scanned manually over the incision (at an approximate rate of 1 mm/s) until hemostasis was achieved. The times to complete hemostasis were measured and normalized with the initial blood loss. The hemostasis times were 59±23 s in the presence of Optison and 70±23 s without Optison. The presence of Optison produced a 37% reduction in the normalized hemostasis times (phemostasis of internal organ injuries.

  8. 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.

  9. The effect of pulsed HIFU on the porosity and permeability of collagen gels: An in vitro study

    Science.gov (United States)

    Vipulanandan, Geethanjali; O'Neill, Brian E.

    2012-10-01

    Pulsed HIFU is hypothesized to alter permeability of the extracellular matrix by altering the collagen network. In this study, the ability of HIFU to disrupt the extracellular matrix, particularly Type I collagen, in vitro, was investigated in order to enhance the drug delivery to highly collagenous tumors. This was tested in vitro in two ways, first using dye penetration, and second, by confocal reflection microscopy. Based on the analyses, it was concluded that there was at least a three-fold increase in porosity of the collagen gels after HIFU treatment.

  10. 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.

  11. A continuous tri-phase transition effect for HIFU-mediated intravenous drug delivery.

    Science.gov (United States)

    Zhang, Kun; Chen, Hangrong; Li, Faqi; Wang, Qi; Zheng, Shuguang; Xu, Huixiong; Ma, Ming; Jia, Xiaoqing; Chen, Yu; Mou, Juan; Wang, Xia; Shi, Jianlin

    2014-07-01

    Aiming at substantially enhanced efficacy and biosafety of clinical HIFU therapy, a natural solid medium, L-menthol (LM), characteristic of mild and controllable "solid-liquid-gas" (SLG) tri-phase transition, was adopted, instead of those conventional explosive liquid-gas (LG) bi-phase transitional media, in constructing a multifunctional theranostic system. Owing to the continuous and controllable characteristics of SLG tri-phase transition, such a novel tri-phase transition-based theranostic system has been demonstrated of the repeatedly enhanced HIFU efficacy ex vivo and in vivo under once intravenous injection and the significantly improved treatment precision, controllability and biosafety when comparing to the traditional bi-phase transition medium, perfluorohexane (PFH), thus promising great application potential in clinical HIFU treatment. Moreover, this theranostic system has been demonstrated a long blood-circulation lifetime and continuous accumulation in tumor in 24 h, which is very beneficial for the enhanced tumor ablation in vivo along with SLG tri-phase transition. More importantly, after loading multiple model drugs and real drug, such a theranostic system presents a HIFU-mediated temperature-responsive drug release property, and depending on the versatile miscibility of LM, co-loadings with hydrophobic and hydrophilic drugs are also achieved, which provides the possibility of synergistic treatment combining HIFU therapy and chemotherapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. The Efficacy of High-Intensity Focused Ultrasound (HIFU) in Advanced Pancreatic Cancer

    Institute of Scientific and Technical Information of China (English)

    Bo Xie; Jiajun Ling; Weiming Zhang; Xueqin Huang; Jihua Zhen; Yanzhe Huang

    2008-01-01

    OBJECTIVE To observe the efficacy of high-intensity focused ultrasound (HIFU)in the treatment of late-stage pancreatic cancer.METHODS Sixteen patients with advanced pancreatic cancer received HIFU therapy.Evaluation of efficacy was made on the basis of changes in clinical symptoms and variations in the tumor echo and size.RESULTS Clinical symptoms such as pain were significantly alleviated,echo of the tumor was enhanced with B-US and the quality of life such as eating,sleeping and mental status was markedly improved;no serious complications were observed.CONCLUSION The use of HIFU in the treatment of advanced pancreatic cancer is feasible and safe.It is effective in killing the carcinoma cells and alleviaring pain.This technique may offer non-invasive therapy for the treatment of patients with late-stage pancreatic cancer.

  13. 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.

  14. 11C choline PET guided salvage radiotherapy with volumetric modulation arc therapy and hypofractionation for recurrent prostate cancer after HIFU failure: preliminary results of tolerability and acute toxicity.

    Science.gov (United States)

    Alongi, Filippo; Liardo, Rocco L E; Iftode, Cristina; Lopci, Egesta; Villa, Elisa; Comito, Tiziana; Tozzi, Angelo; Navarria, Pierina; Ascolese, Anna M; Mancosu, Pietro; Tomatis, Stefano; Bellorofonte, Carlo; Arturo, Chiti; Scorsetti, Marta

    2014-10-01

    The purpose of this work was to evaluate tolerance, feasibility and acute toxicity in patients undergoing salvage radiotherapy after high-intensity focused ultrasound (HIFU) failure. From 2005 to 2011 a total of 15 patients were treated with HIFU as primary radical treatment. Between July 2011 and February 2013, all 15 patients presented biochemical relapse after HIFU and 11C choline PET documenting intrapostatic-only failure. Salvage EBRT was performed with moderate hypofractionation schedule in 28 fractions with volumetric modulation arc therapy (VMAT). Genito-urinary (GU) and rectal and bowel toxicity were scored by common terminology criteria for adverse events version 4 (CTCAE V.4) scale. Biochemical response was assessed by ASTRO Phoenix criteria. Median age of patients was 67 years (range: 53-85). The median Gleason score was 7 (range: 6-9). The median prostate specific antigen (PSA) at the time of biochemical relapse after HIFU was 5.2 ng/mL (range: 2-64.2). Seven of the 15 patients received androgen deprivation therapy (ADT) started after HIFU failure, interrupted before 11C choline PET and radiotherapy. Median prescribed dose was 71.4 Gy (range: 71.4-74.2 Gy) in 28 fractions. No radiation related major upper gastrointestinal (GI), rectal and GU toxicity were experienced. GU, acute grade 1 and grade 2 toxicities were recorded in 7/15 and 4/15 respectively; bowel acute grade 1 and grade 2 toxicities in 4/15 and 1/15; rectal acute grade 1 and grade 2 toxicities in 3/15 and 2/15 respectively. No grade 3 or greater acute or late toxicities occurred. Biochemical control was assessed in 12/15 (80%) patients. With a median follow up of 12 months, three out of 15 patients, with biochemical relapse, showed lymph-nodal recurrence. Our early clinical results and biochemical data confirm the feasibility and show a good tolerance of the 11C choline PET guided salvage radiation therapy after HIFU failure. The findings of low acute toxicity is encouraging, but longer

  15. 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

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

    Science.gov (United States)

    Petrusca, Lorena; Salomir, Rares; Milleret, Réné; Pichot, Olivier; Rata, Mihaela; Cotton, François; Chapelon, Jean-Yves

    2009-09-01

    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 °C and 83 °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 × 0.25 mm × 3 mm voxel) and thermometry (0.4 mm × 0.4 mm × 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 °C) was determined by absolute temperature and was not a cumulative thermal dose effect.

  17. 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.

  18. A Pulsatile Flow Phantom for Image-Guided HIFU Hemostasis of Blood Vessels

    Science.gov (United States)

    Greaby, Robyn; Vaezy, Shahram

    2005-03-01

    A pulsatile flow phantom for studying ultrasound image-guided acoustic hemostasis in a controlled environment has been developed. An ex vivo porcine carotid artery was attached to the phantom and embedded in a visually and ultrasonically transparent gel. Heparinized porcine blood was pumped through the phantom. Power-Doppler and B-mode ultrasound were used to remotely target the HIFU focus to the site of a needle puncture. In nine trials, complete hemostasis was achieved after an average HIFU application of 55 +/- 34 seconds. The vessels remained patent after treatment. With this phantom, it will be possible to do controlled studies of ultrasound image-guided acoustic hemostasis.

  19. Real-time feedback control for high-intensity focused ultrasound system using localized motion imaging

    Science.gov (United States)

    Sugiyama, Ryusuke; Kanazawa, Kengo; Seki, Mika; Azuma, Takashi; Sasaki, Akira; Takeuchi, Hideki; Fujiwara, Keisuke; Itani, Kazunori; Tamano, Satoshi; Yoshinaka, Kiyoshi; Takagi, Shu; Matsumoto, Yoichiro

    2015-07-01

    High-intensity focused ultrasound (HIFU) is one of the noninvasive treatment for tumors. Visualizing the treated area inside the human body is necessary to control the HIFU exposure. Localized motion imaging (LMI) using ultrasound to induce and detect tissue deformation is one technique to detect a change in tissue stiffness caused by thermal coagulation. In experiments with porcine liver, LMI has shown to detect deformation with less than 20% accuracy. We have developed a prototype feedback control system using real-time LMI. In this system, coagulation size was measured every 1 s and controlled to correspond to a targeted size. The typical size error was reduced to 14% from 35%. LMI displacements in normal and coagulated tissues were sufficiently different to discriminate between coagulated areas and noncoagulated ones after HIFU sonication and to visualize treated areas after HIFU treatment.

  20. 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

  1. 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.

  2. 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.

  3. 高强度聚焦超声(HIFU)肿瘤热消融技术的关键问题简析%Analysis of key problem of high intensity focused ultrasound (HIFU) thermal ablation technique

    Institute of Scientific and Technical Information of China (English)

    李发琪

    2011-01-01

    目的 1988年,王智彪萌发了用高强度聚焦超声(high intensity focused ultrasound,HIFU)从体外对体内肿瘤进行非侵入切除的灵感.在之后的10年中,他和他的团队在该领域提出了"生物学焦域"、"超声治疗剂量学"、"组织声环境"等概念.在实时超声监控、治疗系统优化、远程医疗系统、临床方案等方面突破了相应的关键技术壁垒.将HIFU治疗技术成功运用于外科治疗,在国际上积累了数量最多的临床病例.在该领域的设备研制、临床应用及若干基础研究方面走在了世界前列.%In 1988, Zhibiao Wang had an inspiration of ablating tumor in vivo non-invasively by high intensity focused ultrasound (HIFU). In the following 10 years, he and his team first proposed concepts such as "biological focal region", "ultrasound therapy dosimetry", "acoustic environment in tissue" and so on. They had broken down the key technical barriers in real-time ultrasound monitoring, treatment system optimization, telemedicine system, clinical protocols and other aspects, making HIFU therapy successfully applied to surgery and accumulated the largest number of clinical cases internationally. They have been playing a leading role around the world in equipment development, clinical application and some basic research in this field.

  4. Qualitative research of the relationship between occurrence time of coagulation necrosis and cavitation during HIFU exposures%HIFU辐照离体牛眼晶状体致凝固性坏死出现时间与空化关系的定性研究

    Institute of Scientific and Technical Information of China (English)

    王琦; 王静; 李雅芬; 李发琪; 艾慧坚; 钟明松; 王智彪

    2013-01-01

    Objective: To study the relationship between occurrence time of coagulation necrosis and cavitation during HTFU exposures qualitatively. Methods: The bovine lens were exposed to HIFU with various parameters (100w - 6s, 200w - 3s, 300w - 2s and 600w - ls) after fixed using a homemade bracket. The high - speed photography device was used to record the formation process of coagulation necrosis in the bovine lens. Acoustic emissions were also detected by a passive cavitation detection (PCD) system and then processed with a program which was written on Lab VIEW previously. The lens after irradiations were observed and photographed. Results: Coagulation necrosis were observed in all bovine lens during HIFU exposures while the occurrence time differentiated. The mean appear time of coagulation necrosis in bovine lens was 1.921, 1.109, 0.627and 0.240 s respectively after HIFU with the acoustic powers of 100, 200, 300 and 600 W. Under naked eye, the volumes and shapes of lesions were similar after all exposures with different powers and times. Cavitation behaviors were detected during 200, 300 and 600 W acoustic powers HIFU irradiations, and the greater power, the more severe cavitation. Conclusions: Coagulation necrosis in the bovine lens were affected by cavitation during HIFU exposures, and the more severe cavitation, the shorter the occurrence time of coagulation necrosis.%目的:研究高强度聚焦超声(high intensity fcused ultrasound,HIFU)辐照离体牛眼睛所致热凝固性坏死出现的时间与空化的关系.方法:使用自制支架固定牛眼晶状体,使用不同辐照参数(100w-6s、200w-3s、300w-2s、600w-1s)的HIFU辐照离体牛眼晶状体,辐照过程中使用高速摄影系统摄录晶状体中凝固性坏死的形成过程,并用被动空化检测(passive cavitation detection,PCD)系统对辐照中牛眼晶状体中发出的声散射信号(acoustic emissions)进行检测后在LabVIEW开发平台上编程对其量化分析.辐照结束后,观

  5. 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.

  6. Tissue Erosion Using Shock Wave Heating and Millisecond Boiling in HIFU Fields

    Science.gov (United States)

    Canney, Michael S.; Khokhlova, Tatiana D.; Khokhlova, Vera A.; Bailey, Michael R.; Ha Hwang, Joo; Crum, Lawrence A.

    2010-03-01

    A wide variety of treatment protocols have been employed in high intensity focused ultrasound (HIFU) treatments, and the resulting bioeffects observed include both mechanical as well as thermal effects. In recent studies, there has been significant interest in generating purely mechanical damage using protocols with short, microsecond pulses. Tissue erosion effects have been attained by operating HIFU sources using short pulses of 10-20 cycles, low duty cycles (<1%), and pulse average intensities of greater than 20 kW/cm2. The goal of this work was to use a modified pulsing protocol, consisting of longer, millisecond-long pulses of ultrasound and to demonstrate that heating and rapid millisecond boiling from shock wave formation can be harnessed to induce controlled mechanical destruction of soft tissue. Experiments were performed in excised bovine liver and heart tissue using a 2-MHz transducer. Boiling activity was monitored during exposures using a high voltage probe in parallel with the HIFU source. In situ acoustic fields and heating rates were determined for exposures using a novel derating approach for nonlinear HIFU fields. Several different exposure protocols were used and included varying the duty cycle, pulse length, and power to the source. After exposures, the tissue was sectioned, and the gross lesion morphology was observed. Different types of lesions were induced in experiments that ranged from purely thermal to purely mechanical depending on the pulsing protocol used. Therefore, shock wave heating and millisecond boiling may be an effective method for reliably generating significant tissue erosion effects.

  7. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation.

    Science.gov (United States)

    Klatte, Tobias; Kroeger, Nils; Zimmermann, Uwe; Burchardt, Martin; Belldegrun, Arie S; Pantuck, Allan J

    2014-06-01

    Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. A PubMed wide the literature search of was conducted. International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. Ablative techniques pose a valid treatment option in selected patients.

  8. High-intensity focused ultrasound: noninvasive treatment for local unresectable recurrence of osteosarcoma.

    Science.gov (United States)

    Yu, Wenxi; Tang, Lina; Lin, Feng; Yao, Yang; Shen, Zan; Zhou, Xiaohui

    2015-03-01

    Local unresectable recurrence of osteosarcoma is one of the most challenging tumors to treat. High-intensity focused ultrasound (HIFU) is a new, noninvasive technique with potential to ablate and inactivate tumors. Treatment of solid tumors with HIFU has been reported. In this study, we assessed safety and efficacy of HIFU in treating local unresectable recurrence of osteosarcoma. We performed a retrospective analysis of 27 patients who had local unresectable recurrence of osteosarcoma from 2006 to 2010. Changes of biochemical markers and pain rating, response rate, disease control rate, local disease progression-free survival, progression-free survival (PFS) and overall survival (OS) were used to evaluate efficacy of HIFU treatment. HIFU resulted in a significant change in alkaline phosphatase and lactic acid dehydrogenase and a remarkably relief in pain rating, without severe side effects. According to MRI examination 4-6 weeks after HIFU treatment, 2 (7.4%) patients had complete response (CR), 12 (44.4%) had partial response (PR), 9 (33.3%) had stable disease (SD) and 4 (14.8%) had progression disease (PD). The response rate was 51.8% and the local disease control rate was 85.2%. The 1-, 2-, and 3-year local disease control rates were 59.2%, 40.7% and 33.1%, respectively. The median local disease progression-free time was 14 months, the median progression-free time was 13 months and the median over-all survival time was 21 months. Patients without pulmonary metastasis had a better local disease control rate at 1-,2-,3-year and a longer local disease progression-free time, progression-free time, over-all survival time than patients with pulmonary metastasis. HIFU is a safe and noninvasive treatment for local unresectable recurrence of osteosarcoma, with good local control and without severe complications. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Research on the positioning problem in HIFU surgery platform application

    Institute of Scientific and Technical Information of China (English)

    XIANG Lin-qing; GAO Xue-guan; XU Jian-bo; MA Pei-sun

    2006-01-01

    For describing the positioning process of High Intensity Focused Ultrasound (HIFU) Surgery Platform in the application in tumor treatment, a simplified representation of the shape and location of the positioning target tumor in the workspace of the platform by the Positioning Volume Ellipsoid is designed; and the Nearest Neighbor Search method is used to find the closest center point of the simplified ellipsoid tumor model in a selected patient body surface point set determined by the motion parameter of the platform. By the query result the goal positioning path configuration and an intermediate positioning path configuration for the positioning motion are determined for the positioning motion planning. Three new criterions using distance change between Positioning Volume Ellipsoid and the Ultrasound Focus Ellipsoid are proposed to evaluate the result of the whole positioning procedure.

  10. 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.

  11. High Intensity Focused Ultrasound versus Brachytherapy for the Treatment of Localized Prostate Cancer: A Matched-Pair Analysis

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-01-01

    Full Text Available Purpose. To evaluate postoperative morbidity and long term oncologic and functional outcomes of high intensity focused ultrasound (HIFU compared to brachytherapy for the treatment of localized prostate cancer. Material and Methods. Patients treated by brachytherapy were matched 1 : 1 with patients who underwent HIFU. Differences in postoperative complications across the two groups were assessed using Wilcoxon’s rank-sum or χ2 test. Kaplan-Meier curves, log-rank tests, and Cox regression models were constructed to assess differences in survival rates between the two groups. Results. Brachytherapy was significantly associated with lower voiding LUTS and less frequent acute urinary retention (p<0.05. Median oncologic follow-up was 83 months (13–123 months in the HIFU cohort and 44 months (13–89 months in the brachytherapy cohort. Median time to achieve PSA nadir was statistically shorter in the HIFU. Biochemical recurrence-free survival rate was significantly higher in the brachytherapy cohort compared to HIFU cohort (68.5% versus 53%, p<0.05. No statistically significant difference in metastasis-free, cancer specific, and overall survivals was observed between the two groups. Conclusion. HIFU and brachytherapy are safe with no significant difference in cancer specific survival on long term oncologic follow-up. Nonetheless, a randomized controlled trial is needed to confirm these results.

  12. Assessment of HIFU lesions by shear-wave elastography: Initial in-vivo results

    Science.gov (United States)

    Anquez, Jeremie; Corréas, Jean-Michel; Criton, Aline; Lacoste, François; Yon, Sylvain

    2012-11-01

    The aim of this work was to evaluate Shear Wave Elastography (SWE) as a tool to visualize HIFU lesions in an acute in-vivo setting. Extracorporeal HIFU sonications of liver were performed on 14 rabbits in 19 consecutive, adjacent pulses, with in situ energies between 75 J and 228 J. A set of images of the sonicated area was acquired prior and post HIFU ablation: 2 orthogonal SWE images (transverse and sagittal) and contrast enhanced CT scan. SWE images were acquired with theAixplorer® device (SuperSonic Imagine, Aix, France). Prior to the treatment, the liver elasticity appeared homogeneous, with a elasticity comprised between 5 and 11 kPa. The lesion extents were manually segmented on post-treatment SWE images and their areas A(SWE)T (transverse) and A(SWE)S (sagittal) were computed. On 3D CT the lesions were segmented as a hypo intense (devascularized) region on 3D CT images, and considered as "ground truth". The transverse and sagittal planes passing by their centers of mass were extracted. The lesion areas were computed for each plane, respectively A(CT)T and A(CT)S. The ratios A(CT)T/A(SWE)T and A(CT)S/A(SWE)S were computed for all the 14 cases. SWE appear to underestimate the lesion extent in the sagittal orientation with respect to CT images, while a good matching is obtained in the transverse orientation.

  13. MRgHIFU: Feedback temperature control with automatic deduction of BHT tissue parameters

    Science.gov (United States)

    Mougenot, Charles; Kabongo, Luis; Quesson, Bruno; Moonen, Chrit T. W.

    2009-04-01

    The Bio Heat Transfer Equation (BHTE) has been shown to be an efficient tissue representation during HIFU heating. This model requires knowledge of the following tissue parameters: ultrasound absorption, thermal diffusion and perfusion. The proposed technique, comparing BHTE simulation with MR thermal map, provides in real time an accurate and stable measurement of the ultrasound absorption and thermal diffusion and can be used to measure also perfusion. Therefore, temperature feedback control is significantly improved with more stable and faster convergence of the temperature.

  14. Beam localization in HIFU temperature measurements using thermocouples, with application to cooling by large blood vessels.

    Science.gov (United States)

    Dasgupta, Subhashish; Banerjee, Rupak K; Hariharan, Prasanna; Myers, Matthew R

    2011-02-01

    Experimental studies of thermal effects in high-intensity focused ultrasound (HIFU) procedures are often performed with the aid of fine wire thermocouples positioned within tissue phantoms. Thermocouple measurements are subject to several types of error which must be accounted for before reliable inferences can be made on the basis of the measurements. Thermocouple artifact due to viscous heating is one source of error. A second is the uncertainty regarding the position of the beam relative to the target location or the thermocouple junction, due to the error in positioning the beam at the junction. This paper presents a method for determining the location of the beam relative to a fixed pair of thermocouples. The localization technique reduces the uncertainty introduced by positioning errors associated with very narrow HIFU beams. The technique is presented in the context of an investigation into the effect of blood flow through large vessels on the efficacy of HIFU procedures targeted near the vessel. Application of the beam localization method allowed conclusions regarding the effects of blood flow to be drawn from previously inconclusive (because of localization uncertainties) data. Comparison of the position-adjusted transient temperature profiles for flow rates of 0 and 400ml/min showed that blood flow can reduce temperature elevations by more than 10%, when the HIFU focus is within a 2mm distance from the vessel wall. At acoustic power levels of 17.3 and 24.8W there is a 20- to 70-fold decrease in thermal dose due to the convective cooling effect of blood flow, implying a shrinkage in lesion size. The beam-localization technique also revealed the level of thermocouple artifact as a function of sonication time, providing investigators with an indication of the quality of thermocouple data for a given exposure time. The maximum artifact was found to be double the measured temperature rise, during initial few seconds of sonication.

  15. 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...

  16. 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.

  17. Improved intercostal HIFU ablation using a phased array transducer based on Fermat's spiral and Voronoi tessellation: A numerical evaluation.

    Science.gov (United States)

    Ramaekers, Pascal; Ries, Mario; Moonen, Chrit T W; de Greef, Martijn

    2017-03-01

    beamsteering, comparing the best performing clinical phased array in this study to an equivalent VTFS transducer, the maximum intensity in the focal point was increased from 19.0 to 27.0 W/mm(2) for the sonication 30 mm behind the ribs, while the rib area exposed to ≥20 J/cm(2) was reduced from 0.88 to 0.14 cm(2) . For the sonication 50 mm behind the ribs, the maximum focal point intensity was increased from 13.4 to 21.5 W/mm(2) , while the rib area exposed to ≥40 J/cm(2) was lowered from 2.71 to 0.01 cm(2) . The thermal simulations showed that for a circular sonication cell of 4 mm diameter in the transversal plane, sonication times for sonications 30/50 mm behind the ribs were reduced from 13.9 to 8.38 s/38.2 to 17.4 s, respectively. Energy density levels in the skin for these sonications were decreased from 5.28 to 2.22/9.45 to 3.78 J/mm(2) . VTFS transducers are expected to provide improvement for intercostal HIFU applications compared to currently available clinical transducers, as they reduce both the energy density in the pre-focal zone and the energy exposure of the ribs. These characteristics allow for increasing either the re-sonication rate or the treatment volume per sonication. © 2017 American Association of Physicists in Medicine.

  18. 高强度聚焦超声用于晚期胰腺癌病人的止痛作用研究%Researeh on Painkilling of HIFU in the Treatment to Late Adenocarcinoma of Pancreas

    Institute of Scientific and Technical Information of China (English)

    彭晶晶; 张涛

    2005-01-01

    目的探讨高强度聚焦超声(HIFU)对晚期胰腺癌止痛的疗效、并发症及安全性.方法应用FEP-BYO1高能聚焦超声肿瘤热疗机对42例晚期胰腺癌患者进行热疗,治疗时采用HIFU治疗病灶及腹腔神经丛的方法,观察治疗前后患者疼痛改变情况.结果 42例患者治疗后疼痛消失5例(11.9%),疼痛减轻21例(50.0%),疼痛无改变7例(16.6%),治疗前后均无疼痛9例(21%).JAMES评分:治疗前后评分差异存在显著意义(P<0.05).结论 HIFU治疗能有效的缓解晚期胰腺癌患者的疼痛.

  19. Effect of ribs in HIFU beam path on formation of coagulative necrosis in goat liver

    Science.gov (United States)

    Li, Faqi; Gong, Xiaobo; Hu, Kai; Li, Chongyan; Wang, Zhibiao

    2006-05-01

    The motives of the work are to explore the effect of ribs in HIFU beam path on HIFU ablation goat liver. A model-JC Focused Ultrasound Tumor Therapeutic System was used. A 0.75 MHz focused transducer with 150mm aperture and 120mm focal length was used in all experiment. Acoustical power can be adjusted. 30 goats were divided into control group (HIFU beam through rib cage, HIFU alone), experiment group 1(HIFU beam through rib cage, HIFU combined with microbubble) and experiment group 2(Ribs in HIFU beam path were surgically removed, HIFU alone). 20 targeted regions at 5cm away from skin surface were applied for creating necrosis with linear scanning of 15mm length using HIFU in 3 groups. All animals were sacrificed two days later and exposed organs were dissected. After obtaining the maximal section, the volumes of the necrotic regions were measured, then to calculate Energy Efficiency Factor (EEF). Researched results showed that Ribs in HIFU beam path affected the formation of coagulative necrosis and enhanced EEF in control group. HIFU combined with microbubble could enhance the formation of coagulative necrosis and decrease EEF.

  20. Variational method for estimating the effects of continuously varying lenses in HIFU, sonography, and sonography-based cross-correlation methods.

    Science.gov (United States)

    Alaniz, Alex; Kallel, Faouzi; Hungerford, Ed; Ophir, Jonathan

    2002-01-01

    The effects of high intensity focused ultrasound (HIFU)-induced continuously varying thermal gradients on sound ray propagation were modeled theoretically. This modeling was based on Fermat's variational principle of least time for rays propagating in a continuously varying thermal gradient described by a radially symmetric heat equation. Such thermal lenses dynamically affect HIFU beam focusing, and simultaneously create ultrasonic geometric and intensity distortions and artifacts in monitoring devices. Techniques which are based upon ultrasonic cross-correlation methods, such as elastography and two-dimensional temperature estimation, also suffer distortion effects and generate artifacts.

  1. MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs.

    Science.gov (United States)

    Hectors, Stefanie J C G; Jacobs, Igor; Moonen, Chrit T W; Strijkers, Gustav J; Nicolay, Klaas

    2016-01-01

    Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-guided HIFU system. The MR-based evaluation of HIFU treatment is most often restricted to contrast-enhanced T1 -weighted imaging, while it has been shown that the non-perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU-induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been-or could be-used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI-based evaluation of HIFU treatment.

  2. Experimental Study on the Effect of High-intensity Focused Ultrasound (HIFU) Using Sonablate-500 in the Ablation of Canine Prostate

    Institute of Scientific and Technical Information of China (English)

    LU Jun; YE Zhangqun; WANG Wei; CHEN Zhaoyang; ZHANG Yuanfeng; HU Weilie

    2007-01-01

    To investigate the safety, feasibility and effectiveness of transrectal high-intensity focused ultrasound (HIFU) in the ablation of canine prostate, 20 dogs were divided randomly into 5 groups.Sixteen canine prostates were treated with the third-generation transrectal HIFU device (Sonablate-500 TM). Transrectal ultrasound images of the prostate and prostatic urethra were observed preoperatively and postoperatively. Serial study was performed 30 min, 30 days, 60 days and 180 days after the therapy. The rectum, periprostatic tissues, and prostate were excised en bloc and the tissues were fixed for gross and histological analysis. Our results showed that the average maximal diameter of prostatic urethra was 0.59±0.11 cm before the operation and 2.57±0.98 cm 60 days after the operation. The volume of prostate was 6.5±3.12 cm3 before the treatment while the volume was 4.13±0.23 cm3 60 days after the treatment and the differences were statistically significant (P<0.05).Histologically, there was a clear demarcation between the necrotic area of the treated tissues and the unaffected surrounding tissues. All the necrotic tissues in the targeted zone broke off and the prostatic urethra became cavitary 60 days later. The more frequent complications were urinary retention and frequency and hematuria. No rectal injury occurred during the treatment. It is concluded that the third-generation transrectal HIFU is capable of destroying prostatic tissue, substantially increasing the width of the prostatic urethra without causing injury to the adjacent tissues. The risk of postoperative complications associated with HIFU was low. HIFU may become a safe, effective and minimally invasive alternative for the treatment of prostatic diseases..

  3. A History of the Sonocare CST-100: The First FDA-approved HIFU Device

    Science.gov (United States)

    Muratore, Robert

    2006-05-01

    The Sonocare CST-100 Therapeutic Ultrasound System, designed for the treatment of glaucoma, was developed in the 1980s and became the first high intensity focused ultrasound (HIFU) device to receive Food and Drug Administration approval. The system arose from studies done by F.L. Lizzi, Eng.Sc.D., of Riverside Research Institute and D.J. Coleman, M.D., of Cornell Medical Center/New York Hospital on the safety of ultrasound diagnosis of the eye. As safety limits were probed, therapeutic regimes were discovered. Optimization of operational parameters, clinical experience, and engineering design came together through a spin-off company, Sonocare, Inc., formed to produce and market the ophthalmic device. Various precedents were set during the approval process, including the acceptance by the FDA of radiation momentum imparted to an absorber as a measure of acoustic power. Many devices were sold, but the laser industry, grandfathered into the therapeutic field, eventually out-marketed Sonocare. The CST-100 remains as a model of elegant industrial design, and existing units are used daily in HIFU laboratory experiments.

  4. Magnetic resonance image-guided versus ultrasound-guided high-intensity focused ultrasound in the treatment of breast cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Pei-Hong Wu

    2013-01-01

    Image-guided high-intensity focused ultrasound (HIFU) has been used for more than ten years,primarily in the treatment of liver and prostate cancers.HIFU has the advantages of precise cancer ablation and excellent protection of healthy tissue.Breast cancer is a common cancer in women.HIFU therapy,in combination with other therapies,has the potential to improve both oncologic and cosmetic outcomes for breast cancer patients by providing a curative therapy that conserves mammary shape.Currently,HIFU therapy is not commonly used in breast cancer treatment,and efforts to promote the application of HIFU is expected.In this article,we compare different image-guided models for HIFU and reviewed the status,drawbacks,and potential of HIFU therapy for breast cancer.

  5. 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

    2016-01-01

    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. PMID:27535093

  6. 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.

  7. Transrectal high-intensity focused ultrasound ablation of prostate cancer: Effective treatment requiring accurate imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rouviere, Olivier [Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Pavillon P Radio, Hopital Edouard Herriot, F-69437 Lyon cedex 03 (France); Universite de Lyon, Lyon F-69003 (France); Universite de Lyon 1, Faculte de Medecine Lyon Nord, Lyon F-69003 (France); INSERM, Unit 556, 151 cours Albert Thomas, F-69424 Lyon cedex 03 (France)], E-mail: Olivier.rouviere@netcourrier.com; Souchon, Remi [INSERM, Unit 556, 151 cours Albert Thomas, F-69424 Lyon cedex 03 (France)], E-mail: souchon@lyon.inserm.fr; Salomir, Rares [INSERM, Unit 556, 151 cours Albert Thomas, F-69424 Lyon cedex 03 (France)], E-mail: salomir@lyon.inserm.fr; Gelet, Albert [Hospices Civils de Lyon, Department of Urology, Pavillon P Radio, Hopital Edouard Herriot, F-69437 Lyon cedex 03 (France)], E-mail: Albert.gelet@chu-lyon.fr; Chapelon, Jean-Yves [INSERM, Unit 556, 151 cours Albert Thomas, F-69424 Lyon cedex 03 (France)], E-mail: chapelon@lyon.inserm.fr; Lyonnet, Denis [Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Pavillon P Radio, Hopital Edouard Herriot, F-69437 Lyon cedex 03 (France); Universite de Lyon, Lyon F-69003 (France); Universite de Lyon 1, Faculte de Medecine Lyon Nord, Lyon F-69003 (France); INSERM, Unit 556, 151 cours Albert Thomas, F-69424 Lyon cedex 03 (France)], E-mail: Denis.lyonnet@chu-lyon.fr

    2007-09-15

    Transrectal HIFU ablation has become a reasonable option for the treatment of localized prostate cancer in non-surgical patients, with 5-year disease-free survival similar to that of radiation therapy. It is also a promising salvage therapy of local recurrence after radiation therapy. These favourable results are partly due to recent improvements in prostate cancer imaging. However, further improvements are needed in patient selection, pre-operative localization of the tumor foci, assessment of the volume treated and early detection of recurrence. A better knowledge of the factors influencing the HIFU-induced tissue destruction and a better pre-operative assessment of them by imaging techniques should improve treatment outcome. Whereas prostate HIFU ablation is currently performed under transrectal ultrasound guidance, MR guidance with real-time operative monitoring of temperature will be available in the near future. If this technique will give better targeting and more uniform tissue destruction, its cost-effectiveness will have to be carefully evaluated. Finally, a recently reported synergistic effect between HIFU ablation and chemotherapy opens possibilities for treatment in high-risk or clinically advanced tumors.

  8. 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

  9. 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.

  10. 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.

  11. Tumor characterization and treatment monitoring of postsurgical human breast specimens using harmonic motion imaging (HMI).

    Science.gov (United States)

    Han, Yang; Wang, Shutao; Hibshoosh, Hanina; Taback, Bret; Konofagou, Elisa

    2016-05-09

    High-intensity focused ultrasound (HIFU) is a noninvasive technique used in the treatment of early-stage breast cancer and benign tumors. To facilitate its translation to the clinic, there is a need for a simple, cost-effective device that can reliably monitor HIFU treatment. We have developed harmonic motion imaging (HMI), which can be used seamlessly in conjunction with HIFU for tumor ablation monitoring, namely harmonic motion imaging for focused ultrasound (HMIFU). The overall objective of this study was to develop an all ultrasound-based system for real-time imaging and ablation monitoring in the human breast in vivo. HMI was performed in 36 specimens (19 normal, 15 invasive ductal carcinomas, and 2 fibroadenomas) immediately after surgical removal. The specimens were securely embedded in a tissue-mimicking agar gel matrix and submerged in degassed phosphate-buffered saline to mimic in vivo environment. The HMI setup consisted of a HIFU transducer confocally aligned with an imaging transducer to induce an oscillatory radiation force and estimate the resulting displacement. 3D HMI displacement maps were reconstructed to represent the relative tissue stiffness in 3D. The average peak-to-peak displacement was found to be significantly different (p = 0.003) between normal breast tissue and invasive ductal carcinoma. There were also significant differences before and after HMIFU ablation in both the normal (53.84 % decrease) and invasive ductal carcinoma (44.69 % decrease) specimens. HMI can be used to map and differentiate relative stiffness in postsurgical normal and pathological breast tissues. HMIFU can also successfully monitor thermal ablations in normal and pathological human breast specimens. This HMI technique may lead to a new clinical tool for breast tumor imaging and HIFU treatment monitoring.

  12. Real-time RNN-based acoustic thermometry with feedback control

    Science.gov (United States)

    Hsu, Stephen J.; Nam, Joana H.; Fan, Liexiang; Brunke, Shelby S.; Sekins, K. Michael

    2017-03-01

    estimated from the ultrasound data. The ability of each method to deliver a controlled, therapeutic dose was compared. The feedback controlled dosing both created effective lesions (an indicator of assured cell death), and also sustained the integrity of the ultrasound image signal features, producing acceptably accurate temperature estimates. While thermocouple measured focal temperatures were more precise than the temperature estimates derived from RNN-based acoustic thermometry, effective therapeutic doses resulted from RNN guided treatment which maintained ultrasound feature quality. This approach to incorporating feedback in real-time RNN-based acoustic thermometry appears promising as a potential method of HIFU therapy monitoring and control.

  13. Multi-parametric monitoring and assessment of high-intensity focused ultrasound (HIFU) boiling by harmonic motion imaging for focused ultrasound (HMIFU): an ex vivo feasibility study.

    Science.gov (United States)

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

    2014-03-07

    Harmonic motion imaging for focused ultrasound (HMIFU) is a recently developed high-intensity focused ultrasound (HIFU) treatment monitoring method with feasibilities demonstrated in vitro and in vivo. Here, a multi-parametric study is performed to investigate both elastic and acoustics-independent viscoelastic tissue changes using the Harmonic Motion Imaging (HMI) displacement, axial compressive strain and change in relative phase shift during high energy HIFU treatment with tissue boiling. Forty three (n = 43) thermal lesions were formed in ex vivo canine liver specimens (n = 28). Two-dimensional (2D) transverse HMI displacement maps were also obtained before and after lesion formation. The same method was repeated in 10 s, 20 s and 30 s HIFU durations at three different acoustic powers of 8, 10, and 11 W, which were selected and verified as treatment parameters capable of inducing boiling using both thermocouple and passive cavitation detection (PCD) measurements. Although a steady decrease in the displacement, compressive strain, and relative change in the focal phase shift (Δϕ) were obtained in numerous cases, indicating an overall increase in relative stiffness, the study outcomes also showed that during boiling, a reverse lesion-to-background displacement contrast was detected, indicating potential change in tissue absorption, geometrical change and/or, mechanical gelatification or pulverization. Following treatment, corresponding 2D HMI displacement images of the thermal lesions also mapped consistent discrepancy in the lesion-to-background displacement contrast. Despite the expectedly chaotic changes in acoustic properties with boiling, the relative change in phase shift showed a consistent decrease, indicating its robustness to monitor biomechanical properties independent of the acoustic property changes throughout the HIFU treatment. In addition, the 2D HMI displacement images confirmed and indicated the increase in the thermal lesion size with

  14. Multi-parametric monitoring and assessment of High Intensity Focused Ultrasound (HIFU) boiling by Harmonic Motion Imaging for Focused Ultrasound (HMIFU): An ex vivo feasibility study

    Science.gov (United States)

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

    2014-01-01

    Harmonic Motion Imaging for Focused Ultrasound (HMIFU) is a recently developed high-intensity focused ultrasound (HIFU) treatment monitoring method with feasibilities demonstrated in vitro and in vivo. Here, a multi-parametric study is performed to investigate both elastic and acoustics-independent viscoelastic tissue changes using the Harmonic Motion Imaging (HMI) displacement, axial compressive strain and change in relative phase-shift during high energy HIFU treatment with tissue boiling. Forty three (n=43) thermal lesions were formed in ex vivo canine liver specimens (n=28). Two dimensional (2D) transverse HMI displacement maps were also obtained before and after lesion formation. The same method was repeated in 10-s, 20-s and 30-s HIFU durations at three different acoustic powers of 8, 10, and 11W, which were selected and verified as treatment parameters capable of inducing boiling using both thermocouple and Passive Cavitation Detection (PCD) measurements. Although a steady decrease in the displacement, compressive strain, and relative change in the focal phase shift (Δφ) were obtained in numerous cases, indicating an overall increase in relative stiffness, the study outcomes also showed that during boiling, a reverse lesion-to-background displacement contrast was detected, indicating potential change in tissue absorption, geometrical change and/or, mechanical gelatification or pulverization. Following treatment, corresponding 2D HMI displacement images of the thermal lesions also mapped consistent discrepancy in the lesion-to-background displacement contrast. Despite unpredictable changes in acoustic properties with boiling, the relative change in phase shift showed a consistent decrease, indicating its robustness to monitor biomechanical properties independent of the acoustic property change throughout the HIFU treatment. In addition, the 2D HMI displacement images confirmed and indicated the increase in the thermal lesion size with treatment duration

  15. Study on Enhancement Effect of Cavitation Caused by HIFU Piezoelectricity Transducer

    Institute of Scientific and Technical Information of China (English)

    Xinnan Fan; Changping Zhu; Shichuan He; Minglei Shan; Jiacai Chen

    2006-01-01

    An orthogonal ultrasonic irradiation system consisting of HIFU with frequency at 1.05 MHz combined with ultrasound with frequency at 28 kHz was applied in this paper. Effect of cavitation was detected by pH-value measurement and conductance measurement. The result shows that the effect of cavitation caused by ultrasound with frequency at 28 kHz is greatly enhanced by HIFU piezoelectricity transducer with frequency at 1.05 MHz.

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

    Science.gov (United States)

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

    2015-03-07

    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.

  17. Case Report: Use of reinforced buccal mucosa graft over gracilis muscle flap in management of post high intensity focused ultrasound (HIFU) rectourethral fistula

    Science.gov (United States)

    Jai, Shrikant; Ganpule, Arvind; Singh, Abhishek; Vijaykumar, Mohankumar; Bopaiah, Vinod; Sabnis, Ravindra; Desai, Mahesh

    2017-01-01

    High intensity focused ultrasound (HIFU) has come forward as alternative treatment for carcinoma of the prostate. Though minimally invasive,HIFUhas potential side effects. Urethrorectal fistula is one such rare side effect. Management of these fistulas has been described by Vanni et al. This case report describes points of technique that will help successful management of resilient rectourethral fistula. Urinary and faecal diversion in the form of suprapubic catheter and colostomy is vital. Adequate time between stoma formation, fistula closure and then finally stoma closure is needed. Lithotomy position and perineal approach gives best exposure to the fistula. The rectum should be dissected 2cm above the fistula; this aids in tension free closure of the rectal defect. Similarly buccal mucosal graft was used on the urethra to achieve tension free closure. A good vascular pedicle gracilis muscle flap is used to interpose between the two repairs. This not only provides a physical barrier but also provides a vascular bed for BMG uptake. Perfect haemostasis is essential, as any collection may become a site of infection thus compromising results.  We strongly recommend rectourethral fistula be directly repaired with gracilis muscle flap with reinforced buccal mucosa graft without attempting any less invasive repairs because the “first chance is the best chance”. PMID:28299181

  18. MRI methods for the evaluation of high intensity focused ultrasound tumor treatment : Current status and future needs

    NARCIS (Netherlands)

    Hectors, Stefanie J C G; Jacobs, Igor; Moonen, Chrit T W; Strijkers, Gustav J; Nicolay, Klaas

    2016-01-01

    Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-gui

  19. A new experimental study on noninvasive thermometry in HIFU

    Institute of Scientific and Technical Information of China (English)

    侯珍秀; 徐祯祥; 金长善

    2002-01-01

    The measurement of temperature at the heated point is very important and difficult for the treatmentof tumor using HIFU( High intensity focused ultrasound). According to the theory that the gray scale value va-ries with the ultrasound transmitting through different tissues at different temperatures, a set of experiment e-quipment was designed to describe the temperature field in tissues by using the characteristics of the ultrasonicimage, and an experiment was carried out with fresh liver and muscle tissues of pigs in a temperature arrange of26 ℃ to 64 ℃. The statistical curve of the experiment demonstrates: ( 1 ) The gray scales vary in accordancewith the changes in the temperature of tissue and it is feasible to measure the temperature at the heated point bymaking use of the gray scale variations; (2) Non-linearity is the characteristics of temperature changes and thegray scale of tissues at different temperature phases. Moreover, the gray scale varies from up to down phase atthe same temperature phase; ( 3 ) The gray scale for the same temperature range varies with different tissues. Anexperimented formula is proposed for the measurement of fresh liver and muscle tissues of pigs.

  20. 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.

  1. 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

  2. Statistical Treatment of Looking-Time Data

    Science.gov (United States)

    Csibra, Gergely; Hernik, Mikolaj; Mascaro, Olivier; Tatone, Denis; Lengyel, Máté

    2016-01-01

    Looking times (LTs) are frequently measured in empirical research on infant cognition. We analyzed the statistical distribution of LTs across participants to develop recommendations for their treatment in infancy research. Our analyses focused on a common within-subject experimental design, in which longer looking to novel or unexpected stimuli is…

  3. 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

  4. [Clinical study of high intensity focused ultrasound ablation combined with GnRH-a and LNG-IUS for the treatment of adenomyosis].

    Science.gov (United States)

    Ye, M Z; Deng, X L; Zhu, X G; Xue, M

    2016-09-25

    Objective: To investigate the clinical effect of dysmenorrhea in patients with adenomyosis treated by high intensity focused ultrasound(HIFU)ablation combined with gonadotropin-releasing hormone agonist(GnRH-a)and levonorgestrel-releasing intrauterine system(LNG-IUS). Methods: From April 2012 to December 2015, 477 cases of adenomyosis patients with dysmenorrhea were treated by HIFU in the Third Xiangya Hospital. Among them, some patients were treated with HIFU alone, some of them were treated with HIFU combined with GnRH-a and(or)LNG-IUS, thus were classified as H group, H+G group, H+M group and H+G+M group. The improvements of clinical results were compared among the four groups and the influencing factors of HIFU treatment for adenomyosis were also analyzed. Results: During the follow-up period, the overall effective rates of the treatment decreased with time, 3 months 89.4%(345/386), 12 months 84.0%(221/263), 24 months 74.2%(98/132), and the overall recurrence rate was 12.9%(39/303). The significant difference in the curative at 3 months[H group 83.7%(170/203), H+M group 95.0%(95/100), H+G group 100.0%(43/43), H+G+M group 96.8%(30/31)], 12 months[H group 79.4%(123/155), H+M group 93.2%(69/74), H+G group 11/12, H+G+M group 15/17], and 24 months[H group 68.0%(51/75), H+M group 96.4%(27/28), H+G group 6/12, H+G+M group 15/15]after HIFU treatment and recurrence rate[H group 19.0%(29/153), H+M group 3.3%(3/90), H+G group 19.4%(6/31), H+G+M group 4.5%(1/22)]were observed among the four groups(PLNG-IUS could improve the treatment effect in relief of dysmenorrhea. Based on our results, individual treatment protocol should be selected for different patients.

  5. Report on research of calculus fragmentation by HIFU-induced cavitation in Tsinghua University: 1. Effects of tissue-mimicking phantom

    Science.gov (United States)

    Zuo, Z. G.; Liu, S. H.

    2012-11-01

    Study of the acoustic attenuation through human tissues was carried out, in order to accurately evaluate the damaging power of the generated cavitation cloud. Tissue phantom was made, with acoustic properties (acoustic speed and acoustic attenuation factor) similar to human tissues. Preliminary results show that, with the increase of intensity and acting time of the HIFU acoustic waves, the depths of the craters increase rapidly, while the radii of the craters increase mildly. Mass loss of the artificial stones in phantom is less than in water (about 50%), indicating considerable energy dissipation in tissues.

  6. 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.

  7. Advantage of annular focus generation by sector-vortex array in cavitation-enhanced high-intensity focused ultrasound treatment

    Science.gov (United States)

    Jimbo, Hayato; Takagi, Ryo; Taguchi, Kei; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    High-intensity focused ultrasound (HIFU) is a noninvasive method for cancer treatment. One of the disadvantages of this method is that it has a long total treatment time because of the smallness of the treatment volume by a single exposure. To solve this problem, we have proposed a method of cavitation-enhanced heating, which utilized the heat generated by oscillating the cavitation bubbles, in combination with the method of lateral enlargement of a HIFU focal zone to minimize the surface volume ratio. In a previous study, focal spot scanning at multiple points was employed for the enlargement. This method involves nonlinear propagation and absorption due to the high spatial-peak temporal-peak (SPTP) intensity in addition to the cavitation-enhanced heating. However, it is difficult to predict the size and position of the coagulation volume because they are significantly affected by the nonlinear parameters of the tissue. In this study, a sector vortex method was employed to directly synthesize an annular focal pattern. Since this method can keep the SPTP intensity at a manageably low level, nonlinear propagation and absorption can be minimized. Experimental results demonstrate that the coagulation was generated only in the region where both the cavitation cloud and the heating ultrasound were matched. The proposed method will make the cavitation-enhanced HIFU treatment more accurate and predictable.

  8. Evidence for a new mechanism behind HIFU-triggered release from liposomes.

    Science.gov (United States)

    Oerlemans, Chris; Deckers, Roel; Storm, Gert; Hennink, Wim E; Nijsen, J Frank W

    2013-06-28

    A promising approach for local drug delivery is high-intensity focused ultrasound (HIFU)-triggered release of drugs from stimuli-responsive nanoparticles such as liposomes. The aim of this study was to investigate whether another release mechanism is involved with HIFU-triggered release from liposomes beside cavitation and temperature. Furthermore, it was studied whether this new release mechanism allows the release of lipophilic compounds. Therefore, both a lipophilic (Nile red) and a hydrophilic (fluorescein) compound were loaded into thermosensitive (TSL) or non-thermosensitive liposomes (NTSL) and the liposomes were subjected both to continuous wave (CW)- and pulsed wave (PW)-HIFU. The mean liposome size varied from 97 to 139 nm with a polydispersity index (PDI)≤0.06 for the different formulations. The Tm of the phospholipid bilayer of the TSL was around 42°C. Approximately 80% of fluorescein was released within 15 min from TSL at temperatures≥42°C. In contrast, no fluorescein release from NTSL and NR release from both TSL and NTSL was observed at temperatures up to 60 °C. CW-HIFU exposure of TSL resulted in rapid temperature elevation up to 52°C and subsequently almost quantitative fluorescein release. Fluorescein release from NTSL was also substantial (~64% after 16 min at 20 W). Surprisingly, CW-HIFU exposure (20W for 16 min) resulted in the release of NR from TSL (~66% of the loaded amount), and this was even higher from NTSL (~78%). PW-HIFU exposure did not result in temperatures above the Tm of TSL. However, nearly 85% of fluorescein was released from TSL after 32 min at 20W of PW-HIFU exposure, whereas the release from NTSL was around 27%. Interestingly, NR release from NTSL was~30% after 2 min PW-HIFU exposure and increased to~70% after 32 min. Furthermore, addition of microbubbles to the liposomes prior to PW-HIFU exposure did not result in more release, which suggests that cavitation can be excluded as the main mechanism responsible for the

  9. 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%.

  10. Usefulness of ultrasonic strain measurement-based mechanical properties imaging technique: toward realization of short time diagnosis/treatment

    Science.gov (United States)

    Sumi, Chikayoshi; Kubota, Mitsuhiro; Wakabayashi, Gou; Tanabe, Minoru

    2003-06-01

    For various soft tissues (e.g., liver, breast, etc.), we are developing the ultrasonic strain measurement-based mechanical properties (shear modulus, visco-shear modulus, etc.) reconstruction/imaging technique. To clarify the limitation of our quantitative reconstruction/imaging technique as a diagnostic tool for differentiating malignancies, together with improving the spatial resolution and the dynamic range we are collecting the clinical reconstruction image data. Furthermore, we are applying our technique as a monitoring technique for the effectiveness of chemical therapy (e.g., anticancer drug, ethanol, etc.), thermal therapy (e.g., micro, and rf electromagnetic wave, HIFU, LASER, etc.), and cryotherapy. As soft tissues are deformed in 3-D space due to externally situated quasi-static and/or low frequency mechanical sources, multidimensional signal processing improves strain measurement accuracy and reduces inhomogeneity-dependent modulus reconstruction artifacts. These have been verified by us through simulations and phantom/animal in vitro experiments. Briefly, here we discuss the limitations of low dimensional signal processing. Moreover, we exhibit the superiority both on differential diagnosis for these human in vivo malignancies and monitoring for these therapies of our quasi-real time imaging (using conventional US equipment) to conventional B-mode imaging. Our technique is available as a clinical visualization technique both for diagnosis and treatment, and monitored mechanical properties data can also be effectively utilized as the measure for controlling the therapy, i.e., the exposure energy, the foci, the exposure interval, etc. In the near future, suitable combination of various simple and low-invasive therapy techniques with our imaging technique will open up a new clinical style allowing diagnosis and the subsequently immediate treatment. This must substantially reduce the total medical expenses.

  11. Single application of high-intensity focused ultrasound as primary therapy of localized prostate cancer: Treatment-related predictors of biochemical outcomes

    Directory of Open Access Journals (Sweden)

    Dietrich Pfeiffer

    2015-01-01

    Conclusion: Success in a single HIFU session depends not merely on tumor characteristics, but also on treatment-related factors. Ablation is more efficacious with the technically advanced A2 HIFU device. Heat-induced prostate edema might adversely affect the outcome.

  12. 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.

  13. HIGH-INTENSITY FOCUSED ULTRASOUND FOR TREATMENT OF UNRESECTABLE TUMORS LOCATED IN THE WALLS OF CHEST AND ABDOMEN IN 10 PATIENTS

    Institute of Scientific and Technical Information of China (English)

    郑国强; 郭峰; 霍苓; 李正

    2003-01-01

    Objective: To present our results of high-intensity focused ultrasound (HIFU) treatment in 10 patients with unresectable tumors involved in the walls of chest and abdomen. Methods: Tumors located in the walls of the chest and abdomen in 10 patients were treated by HIFU, including local recurrence of fibrosarcoma in 1 case and local invasion or metastases in 9 cases. All of the 10 patients had received anti-cancer treatments before HIFU, 3 patients were complicated with intercostal neuralgia. Results: Partial responses were obtained in 2 patients, minor response in 1 patient, stable disease in 4, progressive disease in 2 after HIFU treatments. All the intercostal neuralgia in 3 patients was disappeared after HIFU. Bone scan showed that site of rib metastasis before HIFU became normal after HIFU in one patient. Conclusion: Our preliminary results showed that HIFU could get good results for patients with malignant tumors located in the walls of chest and abdomen if they are focal tumors, even if they are complicated with rib metastasis.

  14. Monitoring of high-intensity focused ultrasound treatment by shear wave elastography induced by two-dimensional-array therapeutic transducer

    Science.gov (United States)

    Iwasaki, Ryosuke; Takagi, Ryo; Nagaoka, Ryo; Jimbo, Hayato; Yoshizawa, Shin; Saijo, Yoshifumi; Umemura, Shin-ichiro

    2016-07-01

    Shear wave elastography (SWE) is expected to be a noninvasive monitoring method of high-intensity focused ultrasound (HIFU) treatment. However, conventional SWE techniques encounter difficulty in inducing shear waves with adequate displacements in deep tissue. To observe tissue coagulation at the HIFU focal depth via SWE, in this study, we propose using a two-dimensional-array therapeutic transducer for not only HIFU exposure but also creating shear sources. The results show that the reconstructed shear wave velocity maps detected the coagulated regions as the area of increased propagation velocity even in deep tissue. This suggests that “HIFU-push” shear elastography is a promising solution for the purpose of coagulation monitoring in deep tissue, because push beams irradiated by the HIFU transducer can naturally reach as deep as the tissue to be coagulated by the same transducer.

  15. Cardiac Ventricular HIFU: Convergence of Experiment and Theory in the Canine Model

    Science.gov (United States)

    Muratore, Robert; Abe, Yukio; Homma, Shunichi; Bernardi, Richard; Kalisz, Andrew; Feleppa, Ernest J.

    2007-05-01

    OBJECTIVE: HIFU is a promising technique for treating cardiac ventricular diseases such as sustained ventricular tachycardia. Ablations can potentially destroy arrhythmogenic foci and block reentrant circuits. Towards this end, we have learned to control HIFU lesions in the canine model in vivo. METHODS: Experiment — Thoracotomies were performed on anesthetized dogs, following IACUC guidelines. In this open-chest configuration, a polyethylene water-filled bag was coupled to the myocardium with degassed ultrasound gel. The transducer was lowered into the water. Ventricular locations were targeted and insonified with multiple 200-ms HIFU bursts of 60-W acoustic power; the bursts were triggered with the electrocardiogram QRS complex. The therapeutic transducer was a 35-mm focal length, 33-mm diameter PZT annular array, excited at 5.25 MHz. Its -3dB focal region dimensions were 2.5 mm axially and 0.3 mm transversely. A confocal diagnostic transducer was used for aiming and for recording backscattered radiofrequency ultrasound data. Theory — A comprehensive acoustic model has been developed. Individual modules numerically simulate physical processes such as ultrasound beam propagation, energy transfer, and heat flow within tissue. One set of modules simulates HIFU ablation in moving tissue. Tissue motion was obtained from digitized B-mode videos of transverse cross sections of a beating canine heart. Epicardial and endocardial surface positions were extracted from the video frames. Additional simulations of static tissue compared linear and nonlinear propagation models. RESULTS: Significant agreement between simulated and measured lesion sizes and between linear and nonlinear propagation models was demonstrated.

  16. Numerical study on the effective heating due to inertial cavitation in microbubble-enhanced HIFU therapy

    Science.gov (United States)

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

    2015-10-01

    The enhancement of heating due to inertial cavitation was focused in high-intensity focused ultrasound (HIFU) therapy. The influences of the rectified diffusion on microbubble-enhanced HIFU were examined numerically. A bubble dynamics equation in consideration of the spherical shell bubble and the elasticity of surrounding tissue was employed. Mass and heat transfer between the surrounding medium and the bubble were considered. The basic equations were discretized by finite difference method. The mixture phase and bubbles are coupled by the Euler-Lagrange method to take into account the interaction between ultrasound and bubbles. The mass transfer rate of gas from the surrounding medium to the bubble was examined as function of the initial bubble radius and the driving pressure amplitude. As the results, the pressure required to bubble growth was decreases with increasing the initial bubble radius. Thus, the injection of microbubble reduces the cavitation threshold pressure. On the other hand, the influence of the rectified diffusion on the triggered HIFU therapy which generates cavitation bubbles by high-intensity burst and induces the localized heating owing to cavitation bubble oscillation by low-intensity continuous waves. The calculation showed that the localized heating was enhanced by the increase of the equilibrium bubble size due to the rectified diffusion.

  17. Temperature-dependent Physical Properties of a HIFU Blood Mimicking Fluid

    Science.gov (United States)

    Liu, Yunbo; Maruvada, Subha; King, Randy L.; Herman, Bruce A.; Wear, Keith A.

    2009-04-01

    A blood mimicking fluid (BMF) has been developed and characterized in a temperature dependent manner for high intensity focused ultrasound (HIFU) ablation devices. The BMF is based on a degassed and de-ionized water solution dispersed with low density polyethylene micro-spheres, nylon particles, gellan gum and glycerol. A broad range of physical parameters, including frequency dependent ultrasound attenuation, speed of sound, viscosity, thermal conductivity and diffusivity were characterized as a function of temperature (20° C to 70° C). The nonlinear parameter B/A and backscatter coefficient were also measured at room temperature. The attenuation coefficient is linearly proportional to the frequency (2 MHz-8 MHz) with a slope of about 0.2 dB cm-1 MHz-1 in the 20° C to 70° C range as has been reported for human blood. All the other temperature dependent physical parameters are also close to the reported values in human blood. These properties make the BMF a useful HIFU research tool for developing standardized exposimetry techniques, validating numerical models, and determining the safety and efficacy of HIFU ablation devices.

  18. TIME LINE OF HISTORY OF HYPERTENSION TREATMENT

    Directory of Open Access Journals (Sweden)

    Mohammad Golam Saklayen

    2016-02-01

    Full Text Available It is surprising that only about 50 years ago hypertension was considered an essential malady and not a treatable condition. Introduction of thiazide diuretics in late 50’s made some headway in successful treatment of hypertension and ambitious multicenter VA co-operative study (phase 1 and 2 started in 1964 for diastolic hypertension ranging between 90 to 129 mmHg and completed by 1971 established for the first time that treating diastolic hypertension reduced CV events like stroke and heart failure and improved mortality. In the following decade these results were confirmed for the wider US and Non-US population, including women and goal oriented BP treatment to diastolic 90 became the standard therapy recommendation. But isolated systolic hypertension (accounting for two thirds of the 70 million hypertensive population in USA alone was not considered treatable until 1991 when SHEP study (systolic hypertension in elderly program was completed and showed tremendous benefits of treating systolic BP over 160 mmHg using only a simple regimen using small dose Chlorthalidone with addition of Atenolol if needed. In the next 2 decades ALLHAT and other studies examined the comparability of outcomes with use of different classes and combinations of antihypertensive drugs. While diastolic BP goal was established as 90 in late 70’s and later confirmed by HOT study, the goal BP for systolic hypertension was not settled until very recently with completion of SPRINT study. ACCORD study showed no significant difference in outcome with sys 140 vs 120 in diabetics . But recently completed SPRINT study with somewhat similar protocol as in ACCORD but in nondiabetic, showed almost one quarter reduction in all-cause mortality and one-third reduction of CV events with systolic BP goal 120.

  19. HIGH INTENSITY FOCUSED ULTRASOUND FOR TREATMENT UNRESECTABLE MALIGNANT TUMORS IN 75 PATIENTS

    Institute of Scientific and Technical Information of China (English)

    郑国强

    2004-01-01

    Objective: To study preliminary experience of high intensity focused ultrasound (HIFU) for unresectable malignant tumors in 75 patients. Methods: The clinical data of 75 patients with unresectable tumor was analyzed retrospectively. Results: Among 75 patients, ten out of 57 cases achieved good local control in short-term, 5 patients liver tumor, 4 patients with tumor in the chest wall and one patient with bone matestics. Seven patients had skin burn and 2 patients developed intestinal perforations. Conclusion: HIFU is a novel tool for local tumor treatment. HIFU treatment for patients with unresectable tumor in the chest wall is effective.

  20. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    OpenAIRE

    2012-01-01

    Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU) treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since...

  1. 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 p

  2. 高强度聚焦超声治疗胰腺癌的研究进展%Advances of High-intensity Focused Ultrasound on the Treatment of Pancreatic Cancer

    Institute of Scientific and Technical Information of China (English)

    陈依静(综述); 许青(审校)

    2015-01-01

    High-intensity focused ultrasound( HIFU) is a non-invasive technique used for thermal abla-tion in multiple benign and malignant solid tumors. Pancreatic cancer has a dismal prognosis, and most patients are diagnosed at an inoperable stage. Chemotherapy and radiation therapy is not satisfactory enough. So,there is an urge need for new treatments to improve the situation. Clinical trials suggest that HIFU,as part of the comprehensive treatment for patients with pancreatic cancer,may increase the effective rate,median survival time,1-year survival rate and improve the quality of life.%高强度聚焦超声(HIFU)是一种无创局部热消融技术,适用于多种良恶性实体肿瘤的治疗。胰腺癌起病隐匿,恶性程度高,多数患者确诊时已失去手术机会,且化疗、放疗效果欠佳,故需要新的治疗手段改善现状。临床研究显示,HIFU作为综合治疗手段可能提高胰腺癌患者的治疗有效率、中位生存期及1年生存率,改善患者的生活质量。

  3. TWSTFT Data Treatment for UTC Time Transfer

    Science.gov (United States)

    2009-11-01

    in [UTC-UTC(k)],” Metrologia , 43, 278-286. [4] BIPM Circular T 244, Section 6, May 2008, http://www.bipm.org [5] D. Piester, A. Bauch, L... Metrologia , 45, 185-198. [6] F. Arias, Z. Jiang, G. Petit, and W. Lewandowski, 2005, “BIPM Comparison of Time Transfer Techniques,” in Proceedings...of Navigation and Observation, 2008, 1-8. [10] Z. Jiang, 2008, “Towards a TWSTFT Network Time Transfer,” Metrologia , 45, S6-11. [11] Z. Jiang and

  4. TINEA CAPITIS– SIGNIFICANCE OF TIMELY TREATMENT TO PREVENT SCARRING ALOPECIA

    Directory of Open Access Journals (Sweden)

    Sandrina Carvalho

    2016-09-01

    Conclusion: The treatment of tinea capitis is simple and effective. Timely identification and treatment are essential to prevent the formation of a cicatricial alopecia, often disturbing for the patient.

  5. Leveraging respiratory organ motion for non-invasive tumor treatment devices: a feasibility study

    Science.gov (United States)

    Möri, Nadia; Jud, Christoph; Salomir, Rares; Cattin, Philippe C.

    2016-06-01

    In noninvasive abdominal tumor treatment, research has focused on minimizing organ motion either by gating, breath holding or tracking of the target. The paradigm shift proposed in this study takes advantage of the respiratory organ motion to passively scan the tumor. In the proposed self-scanning method, the focal point of the HIFU device is held fixed for a given time, while it passively scans the tumor due to breathing motion. The aim of this paper is to present a treatment planning method for such a system and show by simulation its feasibility. The presented planning method minimizes treatment time and ensures complete tumor ablation under free-breathing. We simulated our method on realistic motion patterns from a patient specific statistical respiratory model. With our method, we achieved a shorter treatment time than with the gold-standard motion-compensation approach. The main advantage of the proposed method is that electrically steering of the focal spot is no longer needed. As a consequence, it is much easier to find an optimal solution for both avoiding near field heating and covering the whole tumor. However, the reduced complexity on the beam forming comes at the price of an increased complexity on the planning side as well as a reduced efficiency in the energy distribution. Although we simulate the approach on HIFU, the idea of self-scanning passes over to other tumor treatment modalities such as proton therapy or classical radiation therapy.

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

    NARCIS (Netherlands)

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

    2015-01-01

    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 lengt

  7. Treatment of hepatic tumors by thermal versus mechanical effects of pulsed high intensity focused ultrasound in vivo

    Science.gov (United States)

    Peng, Song; Zhou, Ping; He, Wei; Liao, Manqiong; Chen, Lili; Ma, C.-M.

    2016-09-01

    The purpose of this study is to comparatively assess the thermal versus mechanical effects of pulsed high intensity focused ultrasound (HIFU) treatment on hepatic tumors in vivo. Forty-five rabbits with hepatic VX2 tumors were randomly separated into three groups (15 animals per group) before HIFU ablation. The total HIFU energy (in situ) of 1250 J was used for each tumor for three groups. In groups I and II, animals were treated with 1 MHz pulsed ultrasound at 1 Hz pulsed repetition frequency (PRF), 0.5 duty cycle (0.5 s on and 0.5 s off) and10 s duration for one spot sonication. For group II, in addition to HIFU treatment, microbubbles (SonoVue, Bracco, Milan, Italy) were injected via vein before sonication acting as a synergist. In group III, animals were treated with 1 MHz pulsed ultrasound at 10 Hz PRF, 0.1 duty cycle (0.1 s on and 0.9 s off) and 10 s duration for one sonication. The total treatment spots were calculated according to the tumor volume. Tumors were examined with contrast-enhanced computed tomography (CECT) immediately prior to and post HIFU treatment. Histopathologic assessment was performed 3 h after treatment. Our study showed that all animals tolerated the HIFU treatment well. Our data showed that mechanical HIFU could lead to controlled injury in rabbit hepatic tumors with different histological changes in comparison to thermal HIFU with or without microbubbles.

  8. Single-session primary high-intensity focused ultrasonography treatment for localized prostate cancer: biochemical outcomes using third generation-based technology.

    Science.gov (United States)

    Pinthus, Jehonathan H; Farrokhyar, Forough; Hassouna, Magdy M; Woods, Edward; Whelan, Kaitlyn; Shayegan, Bobby; Orovan, William L

    2012-10-01

    What's known on the subject? and What does the study add? The experience with HIFU as a minimally invasive treatment for localized prostate cancer is relatively new and most reports are from European centres. Our study is unique in five regards: 1. Data was collected prospectively. 2. All patients were treated with contemporary technology. 3. Outcomes are reported after a single HIFU session using two definitions of biochemical failure that have the ability to predict longer-term clinical failure after primary ablative therapies for prostate cancer (Stuttgart definition for HIFU and Horwitz definition for radiation). 4. All patients were treated in a single centre. 5. No patients underwent peri-HIFU TURP. The present study represents the largest North American prospective cohort of primary HIFU for prostate cancer with mid-term oncological outcome data. To assess 4-year biochemical failure (BCF) rates in patients after high-intensity focused ultrasonography (HIFU) treatment using the Horwitz and Stuttgart definitions. A total of 447 consecutive patients were treated with a single session of HIFU between May 2005 and December 2010. Follow-up included prostate-specific antigen (PSA) measurement every 3 months during the first year and every 6 months thereafter. Patients who had previously received radiation, androgen deprivation or HIFU therapy, and patients with 0.5 ng/mL were the predictors of BCF using both definitions. Primary HIFU appears to result in promising 4-year BCF-free rates in individuals with low- and intermediate-risk prostate cancer who achieve PSA nadir <0.5 ng/mL. A prostate volume <30 mL is associated with PSA nadir levels of <0.5 ng/mL suggesting a potential role for pretreatment volume reduction (medically or surgically) in larger prostates. © 2012 BJU INTERNATIONAL.

  9. Time difference based measurement of ultrasonic cavitations in wastewater treatment

    Institute of Scientific and Technical Information of China (English)

    朱昌平

    2016-01-01

    Intensity of cavitation is significant in ultrasonic wastewater treatment, but is complicated to measure.A time difference based method of ultrasonic cavitation measurement is proposed.The time differences at different powers of 495kHz ultrasonic are measured in experiment in comparison with conductimetric method.Simulation results show that time difference and electrical conductivity are both approximately positive proportional to the ultrasonic power.The degradation of PNP solution verifies the availability in wastewater treatment by using ultrasonic.

  10. 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.

  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. Factors related to orthodontic treatment time in adult patients

    Directory of Open Access Journals (Sweden)

    Ana Camila Esteves de Oliveira Melo

    2013-10-01

    Full Text Available INTRODUCTION: The length of time that it takes an orthodontist to treat adult patients varies widely. OBJECTIVE: The aim of this study was to investigate how different variables influence treatment time. METHODS: Seventy clinical case reports of successfully treated adult patients were examined. The patients were selected from 4,723 records held by three experienced orthodontists. The influence exerted by the following variables on treatment time was assessed: age, sex, facial pattern, severity of malocclusion (measured by the PAR index, sagittal relationship of canines, type of brackets (ceramic or metal, tooth extractions, missed appointments and orthodontic appliance issues/breakages, the latter being the dependent variable. Assessment was performed by multiple linear regression analysis, followed by the stepwise method with P < 0.05. RESULTS: The number of times a patient missed their appointment (no-show (R² = 14.4%, p < 0.0001 and the number of appliance issues/breakages (R² = 29.71%, p = 0.0037 significantly affected variability in treatment time, and these two variables together can predict 43.75% (R² total of the overall variability in treatment time. Other factors, such as canine relationship at the beginning of treatment, bracket type (metal or ceramic, tooth extractions, age at start of treatment, severity of the initial malocclusion, sex and facial pattern had no significant bearing on treatment time. CONCLUSIONS: The duration of orthodontic treatment in adults, when performed by experienced orthodontists, is mainly influenced by factors related to patient compliance. However, several factors which were not included in this study may contribute to variability in orthodontic treatment time.

  13. Timing of Autism Diagnosis Tied to Choice of Treatment

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_160279.html Timing of Autism Diagnosis Tied to Choice of Treatment Kids diagnosed ... Aug. 5, 2016 (HealthDay News) -- Children diagnosed with autism before age 4 are more likely to get ...

  14. 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.

  15. Inpatient treatment time across disciplines in spinal cord injury rehabilitation

    Science.gov (United States)

    Whiteneck, Gale; Gassaway, Julie; Dijkers, Marcel; Backus, Deborah; Charlifue, Susan; Chen, David; Hammond, Flora; Hsieh, Ching-Hui; Smout, Randall J.

    2011-01-01

    Background/objective Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs. Methods Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. Results Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics. Conclusions Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with

  16. Time to Treatment: Measuring Quality Breast Cancer Care.

    Science.gov (United States)

    Polverini, Amy C; Nelson, Rebecca A; Marcinkowski, Emily; Jones, Veronica C; Lai, Lily; Mortimer, Joanne E; Taylor, Lesley; Vito, Courtney; Yim, John; Kruper, Laura

    2016-10-01

    To optimize breast cancer care, several organizations have crafted guidelines to define best practices for treating breast cancer. In addition to recommended therapies, 'timeliness of treatment' has been proposed as a quality metric. Our study evaluates time to surgical treatment and its effect on overall survival (OS). The National Cancer Data Base (NCDB) was used to identify women diagnosed with invasive breast cancer between 2004 and 2012. Time from diagnosis to surgical treatment was calculated and grouped according to predetermined time intervals. Univariate and multivariate Cox proportional hazard models were used to assess patient and treatment factors related to OS. Overall, 420,792 patients initially treated with surgery were identified. Increased time to surgical treatment >12 weeks was associated with decreased OS [hazard ratio (HR) 1.14, 95 % confidence interval (CI) 1.09-1.20]. When stratified by pathologic stage, stage I patients treated at 8 to HR 1.07, 95 % CI 1.02-1.13) and >12 weeks (HR 1.19, 95 % CI 1.11-1.28), as well as stage II patients treated at >12 weeks (HR 1.16, 95 % CI 1.08-1.25), had decreased OS compared with patients treated at <4 weeks. Other variables associated with decreased survival were treatment at a community cancer program, Medicaid or Medicare insurance, Black race, increasing age, mastectomy, moderately and poorly differentiated tumor grade, increasing T and N stage, and higher Charlson Index Group. The survival benefit of expedited time to initial surgical treatment varies by stage and appears to have the greatest impact in early-stage disease. Prior to establishing standard metrics, further quantification of the impact on patient outcomes is needed.

  17. Time Selection of Acupuncture Treatment for Facial Paralysis

    Institute of Scientific and Technical Information of China (English)

    SHE Li-xia; SHAO Ming-hai

    2007-01-01

    Objective: To investigate the optimal time for treating facial paralysis with acupuncture therapy. Methods: Eighty-six patients with facial paralysis in different disease durations were treated with same needling technique. Patients of the treatment group at the developing stage were dealt with moderate stimulation, and at the stationary stage and the recovery stage with strong stimulation. Patients of the control group at the developing stage were treated with drugs improving micro-circulation and nerve functions, and glucocorticoids, at the stationary stage and the recovery stage with the same methods as in the treatment group.Results: The cure rate in the treatment group and the control group were 88.1% and 68.2%respectively, and the former has shorter treatment course. Conclusion: Acupuncture therapy has better effect on facial paralysis than routine Westem medicine, and shorter treatment course.

  18. Physical therapy treatment time during inpatient spinal cord injury rehabilitation

    Science.gov (United States)

    Taylor-Schroeder, Sally; LaBarbera, Jacqueline; McDowell, Shari; Zanca, Jeanne M.; Natale, Audrey; Mumma, Sherry; Gassaway, Julie; Backus, Deborah

    2011-01-01

    Background/objective To describe the nature and distribution of activities during physical therapy (PT) delivered in inpatient spinal cord injury (SCI) rehabilitation and discuss predictors (patient and injury characteristics) of the amount of time spent in PT for specific treatment activities. Methods Six hundred patients from six inpatient SCI centers were enrolled in the SCIRehab study. Physical therapists documented details, including time spent, of treatment provided during 37 306 PT sessions that occurred during inpatient SCI rehabilitation. Ordinary least squares regression models associated patient and injury characteristics with time spent in specific PT activities. Results SCIRehab patients received a mean total of 55.3 hours of PT over the course of their rehabilitation stay. Significant differences among four neurologic groups were seen in the amount of time spent on most activities, including the most common PT activities of strengthening exercises, stretching, transfer training, wheelchair mobility training, and gait training. Most PT work (77%) was provided in individual therapy sessions; the remaining 23% was done in group settings. Patient and injury characteristics explained only some of the variations seen in time spent on wheelchair mobility, transfer and bed mobility training, and range of motion/stretching. Conclusion Analysis yielded both expected and unexpected trends in SCI rehabilitation. Significant variation was seen in time spent on PT activities within and among injury groups. Providing therapeutic strengthening treatments consumed the greatest proportion of PT time. About one-quarter of all PT services were provided in group settings. Details about services provided, including time spent, will serve as a starting point in detailing the optimal treatment delivery for maximal outcomes. PMID:21675354

  19. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: Vera.Froeling@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Meckelburg, K., E-mail: Katrin.Meckelburg@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Schreiter, N.F., E-mail: Nils.Schreiter@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Scheurig-Muenkler, C., E-mail: Christian.Scheurig@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Kamp, J., E-mail: Julia.Kamp@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Maurer, M.H., E-mail: Martin.Maurer@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Beck, A., E-mail: Alexander.Beck@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Hamm, B., E-mail: Bernd.Hamm@charite.de [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); and others

    2013-12-01

    Objectives: To compare the long-term outcome after uterine artery embolization (UAE) versus magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Seventy-seven women (median age, 39.3 years; range, 29.2–52.2 years) with symptomatic uterine fibroids, equally eligible for UAE and MR-g HIFU based on our exclusion criteria underwent treatment (UAE, N = 41; MR-g HIFU, N = 36) from 2002 to 2009 at our institution. Symptom severity (SS) and total health-related quality of life (Total HRQoL) scores were assessed by the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire before treatment and at long-term follow-up after UAE (median 61.9 months) and after MR-g HIFU (median: 60.7 months). Re-intervention rates were assessed for each therapy and compared. Results: Re-intervention was significantly lower after UAE (12.2%) than after MR-g HIFU (66.7%) at long-term follow-up (p < 0.001). After UAE changes in SS (50 pre-treatment vs. 6.3 post-treatment) and Total HRQoL (57.8 pre-treatment vs. 100 post-treatment) were significantly better than changes in SS (42.2 pre-treatment vs. 26.6 post-treatment) and Total HRQoL score (66.4 pre-treatment vs. 87.9 post-treatment) after MR-g HIFU (p = 0.019 and 0.049 respectively). Conclusions: Improvement of SS and Total HRQoL scores was significantly better after UAE resulting in a significant lower re-intervention rate compared to MR-g HIFU.

  20. Time issues in multilevel interventions for cancer treatment and prevention.

    Science.gov (United States)

    Alexander, Jeffrey; Prabhu Das, Irene; Johnson, Timothy P

    2012-05-01

    The concept of time introduces important complexities in estimating intervention effects, program and evaluation design, and measurement and analysis of individual change in multilevel interventions (MLIs). Despite growing recognition that time is a critical element for assessing both individual-level outcomes and higher-level changes in organizational, community, and policy contexts, most MLI designs and evaluations have not addressed these issues. In this chapter we discuss 1) conceptualizing disease life-course and treatment theory in MLIs, 2) approaches to incorporating time in research and program design for MLIs in cancer treatment and prevention, 3) analysis of time-varying multilevel data in the context of cancer treatment and prevention, and 4) resource considerations and trade-offs of incorporating time as a dimension of MLIs and analysis. Although analytic techniques for analyzing time-related phenomena are becoming more available and powerful, there has not been corresponding progress made in the development of theory to guide the application of these techniques in program design and implementation.

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

    Science.gov (United States)

    Shaw, A.; Khokhlova, V.; Bobkova, S.; Gavrilov, L.; Hand, J.

    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.

  2. Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time

    Energy Technology Data Exchange (ETDEWEB)

    Wild, Esther, E-mail: e.wild@dkfz.de; Bangert, Mark [Department of Medical Physics in Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg (Germany); Nill, Simeon [Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG (United Kingdom); Oelfke, Uwe [Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, United Kingdom and Department of Medical Physics in Radiation Oncology, German Cancer Research Center, Im Neuenheimer Feld 280, D-69120 Heidelberg (Germany)

    2015-05-15

    Purpose: The authors investigated the potential of optimized noncoplanar irradiation trajectories for volumetric modulated arc therapy (VMAT) treatments of nasopharyngeal patients and studied the trade-off between treatment plan quality and delivery time in radiation therapy. Methods: For three nasopharyngeal patients, the authors generated treatment plans for nine different delivery scenarios using dedicated optimization methods. They compared these scenarios according to dose characteristics, number of beam directions, and estimated delivery times. In particular, the authors generated the following treatment plans: (1) a 4π plan, which is a not sequenced, fluence optimized plan that uses beam directions from approximately 1400 noncoplanar directions and marks a theoretical upper limit of the treatment plan quality, (2) a coplanar 2π plan with 72 coplanar beam directions as pendant to the noncoplanar 4π plan, (3) a coplanar VMAT plan, (4) a coplanar step and shoot (SnS) plan, (5) a beam angle optimized (BAO) coplanar SnS IMRT plan, (6) a noncoplanar BAO SnS plan, (7) a VMAT plan with rotated treatment couch, (8) a noncoplanar VMAT plan with an optimized great circle around the patient, and (9) a noncoplanar BAO VMAT plan with an arbitrary trajectory around the patient. Results: VMAT using optimized noncoplanar irradiation trajectories reduced the mean and maximum doses in organs at risk compared to coplanar VMAT plans by 19% on average while the target coverage remains constant. A coplanar BAO SnS plan was superior to coplanar SnS or VMAT; however, noncoplanar plans like a noncoplanar BAO SnS plan or noncoplanar VMAT yielded a better plan quality than the best coplanar 2π plan. The treatment plan quality of VMAT plans depended on the length of the trajectory. The delivery times of noncoplanar VMAT plans were estimated to be 6.5 min in average; 1.6 min longer than a coplanar plan but on average 2.8 min faster than a noncoplanar SnS plan with comparable

  3. Noncoplanar VMAT for nasopharyngeal tumors: Plan quality versus treatment time.

    Science.gov (United States)

    Wild, Esther; Bangert, Mark; Nill, Simeon; Oelfke, Uwe

    2015-05-01

    The authors investigated the potential of optimized noncoplanar irradiation trajectories for volumetric modulated arc therapy (VMAT) treatments of nasopharyngeal patients and studied the trade-off between treatment plan quality and delivery time in radiation therapy. For three nasopharyngeal patients, the authors generated treatment plans for nine different delivery scenarios using dedicated optimization methods. They compared these scenarios according to dose characteristics, number of beam directions, and estimated delivery times. In particular, the authors generated the following treatment plans: (1) a 4π plan, which is a not sequenced, fluence optimized plan that uses beam directions from approximately 1400 noncoplanar directions and marks a theoretical upper limit of the treatment plan quality, (2) a coplanar 2π plan with 72 coplanar beam directions as pendant to the noncoplanar 4π plan, (3) a coplanar VMAT plan, (4) a coplanar step and shoot (SnS) plan, (5) a beam angle optimized (BAO) coplanar SnS IMRT plan, (6) a noncoplanar BAO SnS plan, (7) a VMAT plan with rotated treatment couch, (8) a noncoplanar VMAT plan with an optimized great circle around the patient, and (9) a noncoplanar BAO VMAT plan with an arbitrary trajectory around the patient. VMAT using optimized noncoplanar irradiation trajectories reduced the mean and maximum doses in organs at risk compared to coplanar VMAT plans by 19% on average while the target coverage remains constant. A coplanar BAO SnS plan was superior to coplanar SnS or VMAT; however, noncoplanar plans like a noncoplanar BAO SnS plan or noncoplanar VMAT yielded a better plan quality than the best coplanar 2π plan. The treatment plan quality of VMAT plans depended on the length of the trajectory. The delivery times of noncoplanar VMAT plans were estimated to be 6.5 min in average; 1.6 min longer than a coplanar plan but on average 2.8 min faster than a noncoplanar SnS plan with comparable treatment plan quality. The authors

  4. Longer incubation times for yeast fungemia: importance for presumptive treatment.

    Science.gov (United States)

    Paugam, André; Ancelle, Thierry; Lortholary, Olivier; Bretagne, Stéphane

    2014-10-01

    Isolation rates of Candida glabrata at ≤2 days were 8.9% and 34.8% at >2 days; for Cryptococcus neoformans, they were 0.9% and 8.6%, respectively (1741 fungemia analyzed). An incubation time >2 days supports candins as presumptive treatment for C. glabrata, keeping in mind the risk of Cryptococcus fungemia.

  5. Time of default in tuberculosis patients on directly observed treatment

    Directory of Open Access Journals (Sweden)

    Geeta S Pardeshi

    2010-01-01

    Full Text Available Background: Default remains an important challenge for the Revised National Tuberculosis Control Programme, which has achieved improved cure rates. Objectives: This study describes the pattern of time of default in patients on DOTS. Settings and Design: Tuberculosis Unit in District Tuberculosis Centre, Yavatmal, India; Retrospective cohort study. Materials and Methods: This analysis was done among the cohort of patients of registered at the Tuberculosis Unit during the year 2004. The time of default was assessed from the tuberculosis register. The sputum smear conversion and treatment outcome were also assessed. Statistical Analysis: Kaplan-Meier plots and log rank tests. Results: Overall, the default rate amongst the 716 patients registered at the Tuberculosis Unit was 10.33%. There was a significant difference in the default rate over time between the three DOTS categories (log rank statistic= 15.49, P=0.0004. Amongst the 331 smear-positive patients, the cumulative default rates at the end of intensive phase were 4% and 16%; while by end of treatment period, the default rates were 6% and 31% in category I and category II, respectively. A majority of the smear-positive patients in category II belonged to the group ′treatment after default′ (56/95, and 30% of them defaulted during re-treatment. The sputum smear conversion rate at the end of intensive phase was 84%. Amongst 36 patients without smear conversion at the end of intensive phase, 55% had treatment failure. Conclusions: Patients defaulting in intensive phase of treatment and without smear conversion at the end of intensive phase should be retrieved on a priority basis. Default constitutes not only a major reason for patients needing re-treatment but also a risk for repeated default.

  6. Waiting Time Increases Risk of Attrition in Gambling Disorder Treatment

    DEFF Research Database (Denmark)

    Linnet, Jakob; Pedersen, Anders Sune

    2014-01-01

    completion in gambling disorder. We compared 48 gambling disorder sufferers with a 56% completion rate (21 non-completers and 27 completers). Binomial logistic regression analysis showed that waiting time from initial contact to the first session with a therapist was a significant predictor of risk...... of attrition: longer waiting times were associated with increased risk of attrition. Age, gender, or comorbidity was not associated with an increased risk of attrition. These data suggest that gambling disorder sufferers benefit from fast access to treatment, and that longer waiting time increases the risk...

  7. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation

    Science.gov (United States)

    Foy, Teresa; Perritt, Ginger; Thimmaiah, Deepa; Heisler, Lauren; Offutt, Jennifer Lookingbill; Cantoni, Kara; Hseih, Ching-Hui; Gassaway, Julie; Ozelie, Rebecca; Backus, Deborah

    2011-01-01

    Background Occupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously. Objective To describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities. Methods Six inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables. Results SCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of ‘therapeutic activities’ that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM

  8. Minimising time to treatment: targeted strategies to minimise time to thrombolysis for acute ischaemic stroke.

    Science.gov (United States)

    Tai, Y J; Yan, B

    2013-11-01

    Time to thrombolysis is a critical determinant of favourable outcomes in acute ischaemic stroke. It is not infrequent that patient outcomes are compromised due to out-of-hospital and in-hospital time delays. On the other hand, time delays could be minimised through the identification of barriers and the implementation of targeted solutions. This review outlines the different strategies in minimising treatment delays and offers recommendations. Literature search in PubMed, Medline and EBSCO Host was conducted to identify studies that are relevant to reduction of time to treatment from January 1995 to December 2012. Strategies to reduce time to thrombolysis are categorised into pre-hospital strategies, in-hospital strategies and post-treatment decision strategies. Proposed pre-hospital strategies include public education on stroke symptoms awareness, prioritising stroke by emergency medical services, increasing ease of access to medical records, pre-hospital notification, and mobile computed tomography scanning. In-hospital strategies include a streamlined code stroke system, computed tomography scanner co-location with emergency department, 24/7 availability of stroke physicians, point-of-care laboratory testing and access to expert neuroimaging interpretation. Post-decision strategies include increasing availability of intravenous thrombolysis and simplification of informed consent procurement. Time to thrombolysis delays is multifactorial. Effective reduction of time delays for acute ischaemic stroke requires the correct identification of and targeted strategies to overcome time barriers. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  9. A method for verification of treatment times for high-dose-rate intraluminal brachytherapy treatment

    Directory of Open Access Journals (Sweden)

    Muhammad Asghar Gadhi

    2016-06-01

    Full Text Available Purpose: This study was aimed to increase the quality of high dose rate (HDR intraluminal brachytherapy treatment. For this purpose, an easy, fast and accurate patient-specific quality assurance (QA tool has been developed. This tool has been implemented at Bahawalpur Institute of Nuclear Medicine and Oncology (BINO, Bahawalpur, Pakistan.Methods: ABACUS 3.1 Treatment planning system (TPS has been used for treatment planning and calculation of total dwell time and then results were compared with the time calculated using the proposed method. This method has been used to verify the total dwell time for different rectum applicators for relevant treatment lengths (2-7 cm and depths (1.5-2.5 cm, different oesophagus applicators of relevant treatment lengths (6-10 cm and depths (0.9 & 1.0 cm, and a bronchus applicator for relevant treatment lengths (4-7.5 cm and depth (0.5 cm.Results: The average percentage differences between treatment time TM with manual calculation and as calculated by the TPS is 0.32% (standard deviation 1.32% for rectum, 0.24% (standard deviation 2.36% for oesophagus and 1.96% (standard deviation 0.55% for bronchus, respectively. These results advocate that the proposed method is valuable for independent verification of patient-specific treatment planning QA.Conclusion: The technique illustrated in the current study is an easy, simple, quick and useful for independent verification of the total dwell time for HDR intraluminal brachytherapy. Our method is able to identify human error-related planning mistakes and to evaluate the quality of treatment planning. It enhances the quality of brachytherapy treatment and reliability of the system.

  10. 高强聚焦超声(HIFU)加热活体组织中的温度分布%Temperature distribution in vivo tissues heated by high intensity focused ultrasound(HIFU)

    Institute of Scientific and Technical Information of China (English)

    钱祖文

    2010-01-01

    在高强聚焦超声(HIFU)加热的情况下,利用多针射频(RF)测温装置测量活体组织内的温度分布,结果表明,温度梯度依赖于局部温度,温度越商,梯度越大.此外,本文还研究了血流对温度梯度的影响,结果似乎证实了理论预测,即血流(或血液灌注)减缓了温度(梯度)的变化.

  11. NEW TECHNOLOGIES IN THE DIAGNOSIS AND REHABILITATION TREATMENT OF DYSURIA AFTER SURGICAL TREATMENT FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    T. G. Markosyan

    2014-07-01

    Full Text Available The paper deals with the latest neurophysiological technologies for the recognition and treatment of neurogenic disorders of urination and erection in a group of patients operated on for prostate cancer (PC. Acicular electromyography of pelvic floor muscles with transcranial magnetic stimulation of micturition and erectile centers has been put into practice to examine this category of patients. The basic neurophysiological parameters of the muscles examined (cortical and segmental evoked motor response the latency, central motor conduction time (CMCT, and motor unit potential (MUP amplitude and duration were estimated. To develop a normative base, the neurophysiological features of the pelvic floor were studied in healthy volunteers (n = 12 who formed a control group. Examinations were made in 17 patients who had undergone operations for PC at Moscow hospitals 3 to 18 months before, such as retropubic prostatectomy (n = 11 and transurethral resection plus high-intensity focused ultrasound (HIFU ablation (n = 6. Spontaneous urination was absent in 4 (23.5% of cases; urinary incontinence was observed in 6 (35.2% patients. The study group patients were found to have significant disorders of corticospinal tract conduction and those of perineal muscle contraction as potential fibrillation and positive pointed waves, as well as considerable CMCM prolongation and MUP polyphasia. Denervation alterations in PC patients after surgery and delayed reinnervation processes, nerve control recovery are determined by not only the surgery itself, but also by the features of the course of the underlying cancer process. Pelvic floor muscle studies indicated that HIFU was a very traumatic treatment for PC due to the fact that physical exposure spread outside the prostate to the neuromuscular structures. The denervation alterations detected in the pelvic floor muscles became essential in the elaboration of adequate treatment policy. The use of agents improving the

  12. NEW TECHNOLOGIES IN THE DIAGNOSIS AND REHABILITATION TREATMENT OF DYSURIA AFTER SURGICAL TREATMENT FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    T. G. Markosyan

    2012-01-01

    Full Text Available The paper deals with the latest neurophysiological technologies for the recognition and treatment of neurogenic disorders of urination and erection in a group of patients operated on for prostate cancer (PC. Acicular electromyography of pelvic floor muscles with transcranial magnetic stimulation of micturition and erectile centers has been put into practice to examine this category of patients. The basic neurophysiological parameters of the muscles examined (cortical and segmental evoked motor response the latency, central motor conduction time (CMCT, and motor unit potential (MUP amplitude and duration were estimated. To develop a normative base, the neurophysiological features of the pelvic floor were studied in healthy volunteers (n = 12 who formed a control group. Examinations were made in 17 patients who had undergone operations for PC at Moscow hospitals 3 to 18 months before, such as retropubic prostatectomy (n = 11 and transurethral resection plus high-intensity focused ultrasound (HIFU ablation (n = 6. Spontaneous urination was absent in 4 (23.5% of cases; urinary incontinence was observed in 6 (35.2% patients. The study group patients were found to have significant disorders of corticospinal tract conduction and those of perineal muscle contraction as potential fibrillation and positive pointed waves, as well as considerable CMCM prolongation and MUP polyphasia. Denervation alterations in PC patients after surgery and delayed reinnervation processes, nerve control recovery are determined by not only the surgery itself, but also by the features of the course of the underlying cancer process. Pelvic floor muscle studies indicated that HIFU was a very traumatic treatment for PC due to the fact that physical exposure spread outside the prostate to the neuromuscular structures. The denervation alterations detected in the pelvic floor muscles became essential in the elaboration of adequate treatment policy. The use of agents improving the

  13. A real-time treatment guidance system for Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Liang, Xing; Sandell, Julia; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Cengel, Keith; Friedberg, Joseph; Hahn, Stephen M; Glatstein, Eli

    2015-01-01

    Intrapleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have reported previously the success of using IR camera to passively monitor the light fluence rate distribution. In this study, the real-time feedback has been implemented in the current system prototype, by transferring data from the IR camera to a computer at a rate of 20 Hz, and by calculation/displaying using Matlab. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings. Preliminary data from a phantom showed superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown using the correction method dose model. PMID:26005245

  14. A real-time treatment guidance system for pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Liang, Xing; Sandell, Julia; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Cengel, Keith; Friedberg, Joseph; Hahn, Stephen M.; Glatstein, Eli

    2012-02-01

    Intrapleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have reported previously the success of using IR camera to passively monitor the light fluence rate distribution. In this study, the real-time feedback has been implemented in the current system prototype, by transferring data from the IR camera to a computer at a rate of 20 Hz, and by calculation/displaying using Matlab. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings. Preliminary data from a phantom showed superior light uniformity using this method. Light fluence uniformity from patient treatments is also shown using the correction method dose model.

  15. 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.)

  16. Effectiveness of combined intermittent preventive treatment for children and timely home treatment for malaria control

    Directory of Open Access Journals (Sweden)

    Seakey Atsu K

    2009-12-01

    Full Text Available Abstract Background Whiles awaiting for the arrival of an effective and affordable malaria vaccine, there is a need to make use of the available control tools to reduce malaria risk, especially in children under five years and pregnant women. Intermittent preventive treatment (IPT has recently been accepted as an important component of the malaria control strategy. This study explored the potential of a strategy of intermittent preventive treatment for children (IPTC and timely treatment of malaria-related febrile illness in the home in reducing the parasite prevalence and malaria morbidity in young children in a coastal village in Ghana. Methods The study combined home-based delivery of IPTC among six to 60 months old and home treatment of suspected febrile malaria illness within 24 hours. All children between six and 60 months of age received intermittent preventive treatment using amodiaquine and artesunate, delivered by community assistants every four months (three times in 12 months. Malaria parasite prevalence surveys were conducted before the first and after the third dose of IPTC. Results Parasite prevalence was reduced from 25% to 3% (p Conclusion The evaluation result indicates that IPTC given three times in a year combined with timely treatment of febrile malaria illness, impacts significantly on the parasite prevalence. The marked reduction in the parasite prevalence with this strategy points to the potential for reducing malaria-related childhood morbidity and mortality, and this should be explored by control programme managers.

  17. HIFU经颅治疗中降低颅骨声压的仿真研究%Simulation Study on Reducing Acoustic Pressure on Skull During HIFU Transcranial Therapy

    Institute of Scientific and Technical Information of China (English)

    王意喆; 张千; 周文征; 菅喜岐

    2014-01-01

    During the transcranial therapy by using high-intensity focused ultrasound ( HIFU) , the hot spot with a peak acoustic pressure and a high temperature rise might be induced on the skull, which can injure the skull and the surrounding tissue. In this paper, the approximation of the Westervelt formula and Pennes bio-heat conduction e-quation were applied to the simulation model which was based on spherical eight annular phased array transducer and CT data of a human skull and combined with time reversal method in order to analyze and discuss the acoustic pres-sure and temperature distribution of transcranial HIFU. The results show that, when the acoustic pressure and temper-ature of the hot spot in skull were reduced, it can focus at the target region through the skull. In this simulation mod-el, it reduced the acoustic pressure and temperature of hot spot in the one-dimensional focusing range of the spherical eight annular phased array transducer.%研究颅骨超声治疗声压和温度预测问题,高强度聚焦超声( high-intensity focused ultrasound, HIFU)经颅脑肿瘤治疗中,由于在颅骨处可能形成声压和温度较高的热点,引起颅骨及周边组织损伤。为解决上述问题,利用Westervelt声传播方程近似式及Pennes生物热传导方程,以凹球面八圆环相控换能器和人体头颅CT数据建立的仿真模型为例,结合时间反转法,分析讨论经颅HIFU形成的声压场和温度场。研究结果表明,降低热点声压及温升的同时可实现在颅内目标靶区中聚焦;在该数值仿真模型中,在凹球面八圆环相控换能器的一维可变焦范围内均可实现颅内聚焦和颅骨热点处声压和温升的降低。

  18. Real-time treatment feedback guidance of Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Kim, Michele M.; Liang, Xing; Liu, Baochang; Meo, Julia L.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles B.; Cengel, Keith; Friedberg, Joseph S.

    2015-01-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma with remarkable results. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have improved the GUI of the light dose calculation engine to provide real-time light fluence distribution suitable for guiding the surgery to delivery light more uniformly. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings using both direct and scatter light models. An improved measurement device is developed to automatically acquire laser position for the point source. Comparison of the effects of the guidance is presented in phantom study. PMID:25999647

  19. Real-time treatment feedback guidance of Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Kim, Michele M.; Liang, Xing; Liu, Baochang; Meo, Julia L.; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Simone, Charles; Cengel, Keith; Friedberg, Joseph

    2013-03-01

    Pleural photodynamic therapy (PDT) has been used as an adjuvant treatment with lung-sparing surgical treatment for mesothelioma with remarkable results. In the current intrapleural PDT protocol, a moving fiber-based point source is used to deliver the light and the light dose are monitored by 7 detectors placed in the pleural cavity. To improve the delivery of light dose uniformity, an infrared (IR) camera system is used to track the motion of the light sources. A treatment planning system uses feedback from the detectors as well as the IR camera to update light fluence distribution in real-time, which is used to guide the light source motion for uniform light dose distribution. We have improved the GUI of the light dose calculation engine to provide real-time light fluence distribution suitable for guiding the surgery to delivery light more uniformly. A dual-correction method is used in the feedback system, so that fluence calculation can match detector readings using both direct and scatter light models. An improved measurement device is developed to automatically acquire laser position for the point source. Comparison of the effects of the guidance is presented in phantom study.

  20. Psychological influences on the timing of orthodontic treatment.

    Science.gov (United States)

    Tung, A W; Kiyak, H A

    1998-01-01

    Debates about the "ideal" timing of orthodontic treatment have focused on issues of biologic development and readiness. In this article we examine psychologic issues that should be considered in the decision to initiate orthodontics in the younger child or to wait until adolescence or later. Psychologic development during the preadolescent and adolescent stages may influence the child's motive for, understanding of, and adherence to treatment regimens. Results of a study of some personality characteristics, motives, and aesthetic values of young phase I patients are presented. Questionnaires were completed by 75 children (mean age 10.85 years, 52.1% female, 84% white) and their parents. Children's perceived reasons for treatment were consistent with their parents' reports (chi 2 = 76.08, p crowded teeth (56%) and overbite (17.3%). Although body image and self-concept scores were within the normal range, both children and their parents expected the most improvement in self-image and oral function, with greater expectations by parents on self-image (p crowded teeth (p < .02), overbite (p < .02), and diastema (p < .01) more negatively than did ethnic minorities. These results suggest that younger children are good candidates for Phase I orthodontics, have high self-esteem and body-image, and expect orthodontics to improve their lives. White children who have been referred for Phase I orthodontics appear to have a narrower range of aesthetic acceptability than minority children.

  1. Research on AIDS patients’ survival time after highly active antiretroviral therapy, treatment effect and treatment modes

    Directory of Open Access Journals (Sweden)

    Riying Lv

    2016-05-01

    Full Text Available To fully define clinical efficacy of highly active antiretroviral therapy for AIDS, analyze patients’ survival time and treatment mode after receiving treatment, and provide scientific theory to guide improvement of antiviral therapy, this paper selected 3100 cases of patients diagnosed with AIDS during April 2006 and April 2014 as object of this study. All patients were treated with highly active antiretroviral therapy. The main analysis contents of this study include CD4 + T lymphocyte count, viral load changes, incidence of opportunistic infections, specific cause of death and the like. The results show that patients’ CD4 + T lymphocyte levels are significantly increased 3, 18, and 24 months after treatment, difference between the situation after and before receiving treatment, P < 0.05, with statistically significant difference. Analyzed from effective inhibition of virus, effective inhibition rate is 72.58.0% (2250/3100. Main causes of death in patients is usually respiratory failure. It thus can be concluded that highly active antiretroviral therapy for AIDS is with good clinical effect, which can effectively improve survival time of patients. So it enjoys application value of being widely used in clinical treatment of AIDS.

  2. The rise of high intensity focused ultrasound (HIFU) non-invasive therapy for solid tumors%高强聚焦超声(HIFU)无创治疗肿瘤技术的崛起

    Institute of Scientific and Technical Information of China (English)

    冯若; 朱辉; 李发琪; 苏海兵; 陈迅

    2011-01-01

    20世纪40年代,美国学者首次提出了高强聚焦超声治疗技术的概念,并进行了初步的工程和临床研究.70、80年代间,治疗肿瘤的温热疗法曾盛行一时.90年代之后,高强聚焦超声外科肿瘤治疗技术在国际上重新崛起,我国率先推出了大型高强聚焦超声肿瘤治疗系统,并成功地应用于临床治疗乳腺癌、骨肿瘤、肝癌等多种实体肿瘤.迄今,该"JC型高强聚焦超声肿瘤治疗系统"已出口到英国、意大利、西班牙、日本、韩国等许多欧亚国家,在诸如欧洲肿瘤治疗中心等20多个医疗中心运行,治疗肿瘤患者达数万例.我国持续保持着引领世界超声无创治疗技术发展的领先地位.%In the 40 years of last centry American scientists put forward a concep of high intensity focused ultrasound (HIFU) therapeutic technique and had done some technical and clinical studies. Since 90 years the HIFU surgery technique treating tumors anew rised abruptly in the world. China firstly put out a comprehensive HIFU tumor treating sistem and successfully treated many solid tumors such as breast cancer, bone tumor, liver cancer etc.. Now the treating sistem has already exported to England, Italy,Spain, Japan, Colea etc. and treated tens thousands tumor patients. In the field of noninvasive ultrasound treating tumor technique China has continually kept the leading position in the world.

  3. ANOXIA, Treatment by Oxygen Deprivation, Optimizing Treatment Time of Museum Objects

    CERN Document Server

    Gunn, M; Naffah, C; Ziaeepour, H; Gunn, Michele; Merizzi, Fabrice; Naffah, Christitiane; Ziaeepour, Houri

    2006-01-01

    ANOXIA, treatment by oxygen deprivation is largely used for decontamination and disinfestation of cellulose and protein-based organic materials. More specifically this method is applied to more than one hundred thousand of objects destinated for a new museum in Paris, "Musee du Quai Branly". We describe the anoxia installation in this museum and report the result of a study regarding the efficiency of this method and the optimum treatment time, crucial for treating a large collection. We show that the standard 21 days of exposure is not always the optimal choice. Temperature plays a crucial role for hastening the death of insects found within objects. At a temperature of 25C, it is entirely possible to reduce exposure times to 10 or 15 days for the insect species commonly found in museums. The oxygen drop times is between 1 and 2 days for most objects, depending on type and porosity of materials. This corresponds to a treatment time between 15 and 16 days. The effect of humidity is less clear. It can increase...

  4. Short treatment time and excellent treatment outcome in accelerated hyperfractionated radiotherapy for T1 glottic cancer.

    Science.gov (United States)

    Tamaki, Yukihisa; Hieda, Yoko; Yoshida, Rika; Yoshizako, Takeshi; Fuchiwaki, Takafumi; Aoi, Noriaki; Sekihara, Kazumasa; Kitajima, Kazuhiro; Kawauchi, Hideyuki; Kitagaki, Hajime; Sasaki, Ryohei; Inomata, Taisuke

    2015-11-01

    Accelerated hyperfractionated radiotherapy was performed as treatment for patients with T1 glottic cancer, and its utility was evaluated based on treatment outcomes and adverse effects. Fifty-eight men who had undergone radiotherapy were retrospectively reviewed. Tumor classification was Tis in 4 patients, T1a in 38, and T1b in 16. Histological examination revealed squamous cell carcinoma in 55 patients. Travel time from home to hospital was 0-1 hour for 24 patients, 1-2 hours for 9, and >2 hours for 25. Laser vaporization was performed prior to radiotherapy in 38 patients, and 19 patients received concurrent chemotherapy with an agent such as S-1. Patients were irradiated twice daily using an irradiation container. Most patients received a dose of 1.5 Gy/fraction up to a total of 60 Gy. The median overall treatment time was 30 days, with a median observation period of 59.6 months. A complete response was observed in all patients. The 5-year overall survival, disease-free survival, and local control rates were 97.2%, 93.2%, and 97.8%, respectively. Although grade 3 pharyngeal mucositis was observed in 2 patients, there were no other grade 3 or higher acute adverse events. As late toxicity, grade 2 laryngeal edema and grade 1 laryngeal hemorrhage were observed in 1 patient each, but no serious events such as laryngeal necrosis or laryngeal stenosis were observed. In conclusion, this treatment method brings excellent outcome and will substantially reduce the treatment duration among patients who need to stay at nearby hotels while undergoing treatment at hospitals in rural areas.

  5. Acute ischemic stroke treatment, part 2: TreatmentRoles of Capillary Index Score, Revascularization and Time

    Directory of Open Access Journals (Sweden)

    Firas eAL-ALI

    2015-06-01

    Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.

  6. A system for EPID-based real-time treatment delivery verification during dynamic IMRT treatment

    Energy Technology Data Exchange (ETDEWEB)

    Fuangrod, Todsaporn [Faculty of Engineering and Built Environment, School of Electrical Engineering and Computer Science, the University of Newcastle, NSW 2308 (Australia); Woodruff, Henry C.; O’Connor, Daryl J. [Faculty of Science and IT, School of Mathematical and Physical Sciences, the University of Newcastle, NSW 2308 (Australia); Uytven, Eric van; McCurdy, Boyd M. C. [Division of Medical Physics, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9 (Canada); Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Department of Radiology, University of Manitoba, Winnipeg, Manitoba R3T 2N2 (Canada); Kuncic, Zdenka [School of Physics, University of Sydney, Sydney, NSW 2006 (Australia); Greer, Peter B. [Faculty of Science and IT, School of Mathematical and Physical Sciences, the University of Newcastle, NSW 2308, Australia and Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Locked Bag 7, Hunter region Mail Centre, Newcastle, NSW 2310 (Australia)

    2013-09-15

    Purpose: To design and develop a real-time electronic portal imaging device (EPID)-based delivery verification system for dynamic intensity modulated radiation therapy (IMRT) which enables detection of gross treatment delivery errors before delivery of substantial radiation to the patient.Methods: The system utilizes a comprehensive physics-based model to generate a series of predicted transit EPID image frames as a reference dataset and compares these to measured EPID frames acquired during treatment. The two datasets are using MLC aperture comparison and cumulative signal checking techniques. The system operation in real-time was simulated offline using previously acquired images for 19 IMRT patient deliveries with both frame-by-frame comparison and cumulative frame comparison. Simulated error case studies were used to demonstrate the system sensitivity and performance.Results: The accuracy of the synchronization method was shown to agree within two control points which corresponds to approximately ∼1% of the total MU to be delivered for dynamic IMRT. The system achieved mean real-time gamma results for frame-by-frame analysis of 86.6% and 89.0% for 3%, 3 mm and 4%, 4 mm criteria, respectively, and 97.9% and 98.6% for cumulative gamma analysis. The system can detect a 10% MU error using 3%, 3 mm criteria within approximately 10 s. The EPID-based real-time delivery verification system successfully detected simulated gross errors introduced into patient plan deliveries in near real-time (within 0.1 s).Conclusions: A real-time radiation delivery verification system for dynamic IMRT has been demonstrated that is designed to prevent major mistreatments in modern radiation therapy.

  7. Efficient generation of cavitation bubbles and reactive oxygen species using triggered high-intensity focused ultrasound sequence for sonodynamic treatment

    Science.gov (United States)

    Yasuda, Jun; Yoshizawa, Shin; Umemura, Shin-ichiro

    2016-07-01

    Sonodynamic treatment is a method of treating cancer using reactive oxygen species (ROS) generated by cavitation bubbles in collaboration with a sonosensitizer at a target tissue. In this treatment method, both localized ROS generation and ROS generation with high efficiency are important. In this study, a triggered high-intensity focused ultrasound (HIFU) sequence, which consists of a short, extremely high intensity pulse immediately followed by a long, moderate-intensity burst, was employed for the efficient generation of ROS. In experiments, a solution sealed in a chamber was exposed to a triggered HIFU sequence. Then, the distribution of generated ROS was observed by the luminol reaction, and the amount of generated ROS was quantified using KI method. As a result, the localized ROS generation was demonstrated by light emission from the luminol reaction. Moreover, it was demonstrated that the triggered HIFU sequence has higher efficiency of ROS generation by both the KI method and the luminol reaction emission.

  8. Midterm Results after Uterine Artery Embolization Versus MR-Guided High-Intensity Focused Ultrasound Treatment for Symptomatic Uterine Fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: vera.froeling@charite.de; Meckelburg, K., E-mail: katrin.meckelburg@charite.de; Scheurig-Muenkler, C., E-mail: christian.scheurig-muenkler@charite.de; Schreiter, N. F., E-mail: nils.schreiter@charite.de; Kamp, J., E-mail: julia.kamp@charite.de; Maurer, M. H., E-mail: martin.maurer@charite.de; Beck, A., E-mail: alexander.beck@charite.de; Hamm, B., E-mail: bernd.hamm@charite.de; Kroencke, T. J., E-mail: Thomas.kroencke@charite.de [Charite-Universitaetsmedizin Berlin, Department of Radiology (Germany)

    2013-12-15

    Purpose: To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment. SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. Results: The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). Conclusion: UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.

  9. Modeling prostate anatomy from multiple view TRUS images for image-guided HIFU therapy.

    Science.gov (United States)

    Penna, Michael A; Dines, Kris A; Seip, Ralf; Carlson, Roy F; Sanghvi, Narendra T

    2007-01-01

    Current planning methods for transrectal high-intensity focused ultrasound treatment of prostate cancer rely on manually defining treatment regions in 15-20 sector transrectal ultrasound (TRUS) images of the prostate. Although effective, it is desirable to reduce user interaction time by identifying functionally related anatomic structures (segmenting), then automatically laying out treatment sites using these structures as a guide. Accordingly, a method has been developed to effectively generate solid three-dimensional (3-D) models of the prostate, urethra, and rectal wall from boundary trace data. Modeling the urethra and rectal wall are straightforward, but modeling the prostate is more difficult and has received much attention in the literature. New results presented here are aimed at overcoming many of the limitations of previous approaches to modeling the prostate while using boundary traces obtained via manual tracing in as few as 5 sector and 3 linear images. The results presented here are based on a new type of surface, the Fourier ellipsoid, and the use of sector and linear TRUS images. Tissue-specific 3-D models will ultimately permit finer control of energy deposition and more selective destruction of cancerous regions while sparing critical neighboring structures.

  10. Umbilical cord blood cells for treatment of cerebral palsy; timing and treatment options.

    Science.gov (United States)

    McDonald, Courtney A; Fahey, Michael C; Jenkin, Graham; Miller, Suzanne L

    2017-09-22

    Cerebral palsy is the most common cause of physical disability in children, and there is no cure. Umbilical cord blood (UCB) cell therapy for the treatment of children with cerebral palsy is currently being assessed in clinical trials. While there is much interest in the use of UCB stem cells for neuroprotection and neuroregeneration, the mechanisms of action are not fully understood. Further, UCB contains many stem and progenitor cells of interest, and we will point out that individual cell types within UCB may elicit specific effects. UCB is a clinically proven source of hemotopoietic stem cells (HSCs). It also contains mesenchymal stromal cells (MSCs), endothelial progenitor cells (EPCs) and immunosupressive cells such as regulatory T cells (Tregs) and monocyte-derived supressor cells. Each of these cell types may be individual candidates for the prevention of brain injury following hypoxic and inflammatory events in the perinatal period. We will discuss specific properties of cell types in UCB, with respect to their therapeutic potential and the importance of optimal timing of administration. We propose that tailored cell therapy and targeted timing of administration will optimise results for future clinical trials in the neuroprotective treatment of perinatal brain injury.Pediatric Research accepted article preview online, 22 September 2017. doi:10.1038/pr.2017.236.

  11. Gestational diabetes mellitus-right person, right treatment, right time?

    Science.gov (United States)

    Lindsay, Robert S; Mackin, Sharon T; Nelson, Scott M

    2017-08-28

    Personalised treatment that is uniquely tailored to an individual's phenotype has become a key goal of clinical and pharmaceutical development across many, particularly chronic, diseases. For type 2 diabetes, the importance of the underlying clinical heterogeneity of the condition is emphasised and a range of treatments are now available, with personalised approaches being developed. While a close connection between risk factors for type 2 diabetes and gestational diabetes has long been acknowledged, stratification of screening, treatment and obstetric intervention remains in its infancy. Although there have been major advances in our understanding of glucose tolerance in pregnancy and of the benefits of treatment of gestational diabetes, we argue that far more vigorous approaches are needed to enable development of companion diagnostics, and to ensure the efficacious and safe use of novel therapeutic agents and strategies to improve outcomes in this common condition.

  12. Timing of pathogen adaptation to a multicomponent treatment.

    Directory of Open Access Journals (Sweden)

    Romain Bourget

    Full Text Available The sustainable use of multicomponent treatments such as combination therapies, combination vaccines/chemicals, and plants carrying multigenic resistance requires an understanding of how their population-wide deployment affects the speed of the pathogen adaptation. Here, we develop a stochastic model describing the emergence of a mutant pathogen and its dynamics in a heterogeneous host population split into various types by the management strategy. Based on a multi-type Markov birth and death process, the model can be used to provide a basic understanding of how the life-cycle parameters of the pathogen population, and the controllable parameters of a management strategy affect the speed at which a pathogen adapts to a multicomponent treatment. Our results reveal the importance of coupling stochastic mutation and migration processes, and illustrate how their stochasticity can alter our view of the principles of managing pathogen adaptive dynamics at the population level. In particular, we identify the growth and migration rates that allow pathogens to adapt to a multicomponent treatment even if it is deployed on only small proportions of the host. In contrast to the accepted view, our model suggests that treatment durability should not systematically be identified with mutation cost. We show also that associating a multicomponent treatment with defeated monocomponent treatments can be more durable than associating it with intermediate treatments including only some of the components. We conclude that the explicit modelling of stochastic processes underlying evolutionary dynamics could help to elucidate the principles of the sustainable use of multicomponent treatments in population-wide management strategies intended to impede the evolution of harmful populations.

  13. Synergistic effect of high-intensity focused ultrasound and low-fluence Q-switched Nd:YAG laser in the treatment of the aging neck and décolletage.

    Science.gov (United States)

    Nam, Jae-Hui; Choi, Young-Jun; Lim, Jae Yun; Min, Joon Hong; Kim, Won-Serk

    2017-01-01

    High-intensity focused ultrasound (HIFU) is regarded as an effective skin-lifting device; however, literature regarding treatment of the aging neck and décolletage with HIFU is scarce. Our study aimed to evaluate the efficacy of combination with HIFU and low-fluence Q-switched Nd:YAG (LQSNY) laser on the aging neck and décolletage. Nineteen women were assessed. HIFU at two visits and LQSNY laser at six visits were used to irradiate the neck and chest. At week 16, improvements were rated using the Dedo classification, Fabi/Bolton Chest Wrinkle Scale (FBCWS), and Global Aesthetic Improvement Scales (GAIS). Erythema and melanin indices (EMIs) and cervicomental angle were measured. Subject GAIS and satisfaction were evaluated at follow-up visits. At week 16, neck sagging and chest rhytides were improved on Dedo classification and FBCWS, respectively. Pigmentation and rhytides of the neck and chest were rated as improved in 30 % or more of the subjects by physician GAIS and in approximately 80 % of the subjects by subject GAIS. The above differences seemed to be attributable to the initial expectation level and mild severity pertaining to dress custom in Korea. Eighty-four percent of subjects were satisfied with treatment outcomes. EMIs were decreased on the chest. The combination of HIFU and LQSNY is an effective treatment option to mitigate rhytides and pigmentation of the neck and décolletage.

  14. 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.

  15. Time to treatment with intravenous alteplase and outcome in stroke

    DEFF Research Database (Denmark)

    Lees, Kennedy R; Bluhmki, Erich; von Kummer, Rüdiger

    2010-01-01

    to treatment with intravenous rt-PA (alteplase) on therapeutic benefit and clinical risk by adding recent trial data to the analysis. METHODS: We added data from ECASS III (821 patients) and EPITHET (100 patients) to a pool of common data elements from six other trials of alteplase for acute stroke (2775...

  16. Characteristics Analysis on Acupuncture Treatment of Stranguria in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    LIU Li-gong; GU Jie; XIAO Yuan-chun

    2003-01-01

    This paper makes a statistical analysis on the acupuncture treatment of stranguria recorded in 62 ancient books with computer. The statistics show that the frequently treated meridians are Conception Vessel,three yin meridians of foot, and Bladder Meridian; the commonly treated areas are lower abdomen, midial aspects of legs, and lower back; the commonly used techniques are moxibustion, and needling.

  17. This is an exciting time in the treatment of lymphoma.

    Science.gov (United States)

    ... why patients who seemed to have the same type of cancer under the microscope responded differently to similar treatments. The genius of the three NCI colleagues combined to solve the mystery and create a new way to ... are many different types of lymphoma," says Dr. Wilson. "Currently, we have ...

  18. Bone metastasis treatment using magnetic resonance-guided high intensity focused ultrasound

    NARCIS (Netherlands)

    Yeo, Sin Yuin; Elevelt, Aaldert; Donato, Katia; van Rietbergen, Bert; ter Hoeve, Natalie D.; van Diest, Paul J.; Grüll, Holger

    2015-01-01

    Objectives: Bone pain resulting from cancer metastases reduces a patient's quality of life. Magnetic Resonance-guided High Intensity Focused Ultrasound (MR-HIFU) is a promising alternative palliative thermal treatment technique for bone metastases that has been tested in a few clinical studies. Here

  19. Directionality Time - New Analytical Treatment of Directionally Biased, Crawling Motility

    Science.gov (United States)

    Tang, Jay; Loosley, Alexander

    Insights on crucial biological functions often emerge from measuring how animal cells crawl on surfaces, particularly in response to gradients of external cues that cause directionally biased motion. Most existing metrics commonly used to characterize directional migration, such as straightness index (or chemotactic index), persistence time, and turning angle distribution, tend to be sensitive to relatively large errors at short sampling times. In contrast, we recently introduced a new metric, called directionality time, to define the onset time by which a seemingly random motion becomes directionally biased (O'Brien et al., J Leukocyte Biol, 2014, 95:993-1004 Loosley et al., PLOS ONE, 2015, 10.1371). Directionality time is obtained by fitting the mean squared displacement as a function of time interval, in log-log coordinates, to a fit function based on biased and persistent random walk processes. We show that the fit function is approximately model invariant and is applicable to a variety of directionally biased motions. Simulations are performed to show the robustness of the directionality time model and its decoupling from measurement errors. Finally, we demonstrate as an example how to usefully apply the directionality time fit to trajectories of chemotactic neutrophils.

  20. Interventional treatments for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yong-Song Guan; Yuan Liu

    2006-01-01

    BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most frequent primary malignant tumors in the world. Hepatic resection and liver transplantation are considered optimal for potential treatment of HCC. However, only 20%of HCCs can be surgically treated. And most of surgically-noneligible patients have to receive interventional managements including local ablation and transarterial chemoembolization (TACE). In this paper, we review the interventional treatments of HCC. DATA SOURCES:A literature search of PubMed database was conducted and research articles were reviewed. RESULTS: Percutaneous ethanol injection (PEI) is usually applied to small HCC for a complete necrosis. Radiofrequency ablation, an alternative to PEI, also causes tumor necrosis and needs fewer times of ablation. Other methods such as acetic acid injection, laser, microwave, etc have enriched local ablation for HCC. High intensity focus ultrasound (HIFU) is thought to be promising. TACE, another common modality, can improve the survival rate of patients with HCC. The newly developed embolic agents and adjuvant rAd-p53 gene therapy are well reported. CONCLUSIONS:Surgically-noneligible HCC can be treated with interventional procedures. Each method has its advantages and disadvantages. However, it is still pressing to develop ablative methods as well as new embolic agents for a better prognosis of HCC.

  1. Time of Default in Tuberculosis Patients on Directly Observed Treatment

    OpenAIRE

    Pardeshi, Geeta S

    2010-01-01

    Background: Default remains an important challenge for the Revised National Tuberculosis Control Programme, which has achieved improved cure rates. Objectives: This study describes the pattern of time of default in patients on DOTS. Settings and Design: Tuberculosis Unit in District Tuberculosis Centre, Yavatmal, India; Retrospective cohort study. Materials and Methods: This analysis was done among the cohort of patients of registered at the Tuberculosis Unit during the year 2004. The time of...

  2. Geographic Variations and Time Trends in Cancer Treatments in Taiwan.

    Science.gov (United States)

    Hsu, Jason C; Chang, Sheng-Mao; Lu, Christine Y

    2017-08-02

    Targeted therapies have become important treatment options for cancer care in many countries. This study aimed to examine recent trends in utilization of antineoplastic drugs, particularly the use of targeted therapies for treatment of cancer, by geographic region in Taiwan (northern, midwestern, southern, and eastern regions and the outer islands). This was a retrospective observational study of antineoplastic agents using 2009-2012 quarterly claims data from Taiwan's National Health Insurance Research Database. Yearly market shares by prescription volume and costs for targeted therapies among total antineoplastic agents by region were estimated. We used multivariate regression model and ANOVA to examine variations in utilization of targeted therapies between geographic regions and used ARIMA models to estimate longitudinal trends. Population-adjusted use and costs of antineoplastic drugs (including targeted therapies) were highest in the southern region of Taiwan and lowest in the outer islands. We found a 4-fold difference in use of antineoplastic drugs and a 49-fold difference in use of targeted therapies between regions if the outer islands were included. There were minimal differences in use of antineoplastic drugs between other regions with about a 2-fold difference in use of targeted therapies. Without considering the outer islands, the market share by prescription volume and costs of targeted therapies increased almost 2-fold (1.84-1.90) and 1.5-fold (1.26-1.61) respectively between 2009 and 2012. Furthermore, region was not significantly associated with use of antineoplastic agents or use of targeted therapies after adjusting for confounders. Region was associated with costs of antineoplastic agents but it was not associated with costs of targeted therapies after confounding adjustments. Use of antineoplastic drugs overall and use of targeted therapies for treatment of cancer varied somewhat between regions in Taiwan; use was notably low in the outer

  3. [Gout and its manifestations, description and treatment in ancient times].

    Science.gov (United States)

    Alušík, Tomáš; Alušík, Štefan

    2015-01-01

    Gout is a very old disease, which exists for thousands of years. The first descriptions interpreted as the symptoms of gout can be found already in the Egyptian medical papyri dating to the 3rd mill. BC. In the Ancient world, many physicians dealt with the causes, diagnostics and the treatments of gout, such as Hippocrates of Cos, Diocles of Carystus or Claudios Galenos. A personified gout (as the goddess Podagra) is also to be found in the Ancient mythology and culture. Several human remnants of the people suffering from gout are preserved from the Antiquity as well.

  4. Marijuana: a time-honored but untested treatment for epilepsy.

    Science.gov (United States)

    McLachlan, Richard S

    2015-03-01

    The biology of the endocannabinoid system in the brain provides a possible basis for a beneficial pharmacological effect of marijuana on seizures. However, evidence for efficacy of cannabis treatment of epilepsy is anecdotal because no acceptable randomized controlled trials have been done. Proper dosage and means of administration remain unknown. Cannabis is safer than other controlled substances, including tobacco or alcohol, and appears to be relatively safe compared with most pharmaceuticals used to treat epilepsy. This is a review of this topic from a Canadian perspective.

  5. Characteristics of Acupuncture Treatment of Dementia in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    LIU Li-gong; GU Jie; XIAO Yuan-chun

    2003-01-01

    This paper makes a statistical analysis on the acupuncture treatment of dementia recorded in 93 ancient books. The statistics show that the common acupoints are Shenmen ( HT 7), Shaoshang ( LU 11 ),Dazhong ( KI4), Yinbai ( SP 1 ), Houxi ( SI 3 ), Xinshu (BL 15), Yongquan (KI 1), Jiuwei (CV 15) and Baihui (GV 20); the common meridians are the Heart Meridian, Bladder Meridian and Kidney Meridian; the common areas are palm, medial side of leg, upper back and head; the acupoints of the heart meridian are frequently used, especially those in the distal end;heavy moxibustion functions to open orifices and needling to regulate qi.

  6. [Waiting time for treatment shall be calculated correctly].

    Science.gov (United States)

    Pedersen, Jørgen Ejler

    2011-05-23

    Every system is perfectly designed to achieve the results it gets and in the Danish health care system there is a significant waiting time for the patients. If we want this result to change, we have to change something in the system, but before we do that, we need to understand the system. With queuing theory as a frame of reference, the anatomy and physiology of waiting time is illuminated in order to bring additional knowledge into the design of systems in health care.

  7. 组织声学特性对高强度聚焦超声温度场的影响%Effect of tissue acoustic properties on HIFU temperature field

    Institute of Scientific and Technical Information of China (English)

    张晓静; 张平; 朱元光; 孙武军; 菅喜岐; 李智华

    2010-01-01

    目的 数值仿真组织声学特性对高强度聚焦超声(HIFU)焦域处温度场的影响,为HIFU治疗安全性和可靠性提供理论依据.方法 以实测新鲜离体猪肝组织不同温度下的声速和衰减系数为依据,利用时域有限差分(FDTD)法数值仿真研究HIFU治疗过程中组织内声速、衰减系数的变化和温度场的分布,分析讨论声速和衰减系数变化对60 ℃以上可治疗区域大小、位置的影响.结果 随着照射时间的延长,焦域处肝组织温升增大,声速下降,声衰减系数增大.随着声速的变化,形成的可治疗区域变大,焦点位置向远离换能器方向移动;随着声衰减系数的变化,焦域大小和焦点位置几乎不变.结论 猪肝组织内声速的变化对可治疗焦域的位置和大小影响较大;声衰减系数的变化对焦域的影响较小.%Objective To improve the safety and reliability in high intensity focused ultrasound(HIFU)therapy, the effects of tissue acoustic properties on the high intensity focused ultrasound temperature field were investigated. Methods Based on the measured data of sound velocity and attenuation coefficient at different temperature, the variation of sound velocity and attenuation coefficient, and the temperature distribution in tissue during HIFU therapy was simulated using FDTD method. Moreover, the effects of the two variable acoustic parameters on the therapeutic region above 60 ℃ were evaluated. Results Tissue temperature raise, sound speed decreased and the attenuation coefficient increased in the focal region, along with the passage of the exposure time. Therapeutic region increased slightly and the focal point slightly moved away from the transducer when the sound velocity varied. There were negligible changes in the therapeutic region and the position of focal point when the attenuation coefficient changed alone in the study. Conclusion The variation of sound velocity can affect the size and location of the focal

  8. 体部γ刀立体定向放疗联合高强聚焦超声治疗中晚期胰腺癌12例临床分析%Body gamma knife combined with high intensity focused ultrasound in the treatment of advanced pancreatic cancer in 12 cases

    Institute of Scientific and Technical Information of China (English)

    杜海峰; 魏长宏; 王作志; 赵永生; 卞晓山; 傅振强

    2015-01-01

    目的 观察体部γ刀立体定向放疗(stereotactic body radiation therapy,SBRT)联合高强聚焦超声(high intensity focused ultrasound,HIFU)治疗中晚期胰腺癌的近期疗效及安全性.方法 中晚期胰腺癌患者12例,给予SBRT联合HIFU治疗.SBRT取等剂量线为50%~60%,肿瘤单次周边剂量3.0~4.0 Gy,总剂量35~48 Gy,8~12次,1次/d,5次/周;SBRT期间,SBRT后2~4 h行HIFU治疗,1次/周,靶区温度控制在42℃以上,共3~5次.观察近期临床疗效及不良反应发生情况.结果 治疗结束后2~3个月,肿瘤完全缓解1例,部分缓解8例,无变化1例,恶化2例,近期总有效率75.0%;治疗后11例伴疼痛者疼痛缓解9例,8例合并黄疸者黄疸消退6例;治疗期间出现恶心、呕吐10例,白细胞下降7例,血小板降低5例,均经对症治疗恢复正常.结论 SBRT联合HIFU治疗中晚期胰腺癌疗效满意,不良反应可耐受.%Objective To observe the short-term effect and safety of stereotactic body radiation therapy (SBRT) combined with high intensity focused ultrasound (HIFU) in the treatment of advanced pancreatic cancer.Methods Twelve patients with advanced pancreatic cancer received SBRT plus HIFU.The isodose curve of SBRT was 50% to 60%,tumor single peripheral dose was 3 to 4.0 Gy,and the total dose was 35 to 48 Gy,once a day for 8 to 12 times,five times per week.In 2 to 4 hours after SBRT,the patients received HIFU,once a week,totally for 3 to 5 times at the target zone temperature of over 42 ℃.The short-term effect and adverse reaction were observed.Results After 2-to 3-month treatment,complete remission occurred in 1 patient,partial remission in 8,no change in 1,and deterioration in 2,with the total short-term effective rate of 75.0%.After treatment,11 patients with pain were relieved in 9,and 8 with jaundice were subsided jaundice in 6.The adverse reactions included nausea and vomiting in 10 patients,leukocyte decrease in 7,and decreased platelet in 5,which became

  9. Timing of testing and treatment for asymptomatic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Kırkızlar, Eser [State Univ. of New York (SUNY), Plattsburgh, NY (United States); Faissol, Daniel M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Griffin, Paul M. [Pennsylvania State Univ., State College, PA (United States); Swann, Julie L. [Georgia Inst. of Technology, Atlanta, GA (United States)

    2010-07-01

    Many papers in the medical literature analyze the cost-effectiveness of screening for diseases by comparing a limited number of a priori testing policies under estimated problem parameters. However, this may be insufficient to determine the best timing of the tests or incorporate changes over time. In this paper, we develop and solve a Markov Decision Process (MDP) model for a simple class of asymptomatic diseases in order to provide the building blocks for analysis of a more general class of diseases. We provide a computationally efficient method for determining a cost-effective dynamic intervention strategy that takes into account (i) the results of the previous test for each individual and (ii) the change in the individual’s behavior based on awareness of the disease. We demonstrate the usefulness of the approach by applying the results to screening decisions for Hepatitis C (HCV) using medical data, and compare our findings to current HCV screening recommendations.

  10. Simultaneous comparisons of treatments at multiple time points

    DEFF Research Database (Denmark)

    Pallmann, Philip; Pretorius, Mias; Ritz, Christian

    2017-01-01

    that is measured repeatedly over time and contrast two basic modeling strategies: fitting a joint model across all occasions (with random effects and/or some residual covariance structure to account for heteroscedasticity and serial dependence), and a novel approach combining a set of simple marginal, i...... hypotheses as well as a global test decision. We compare via simulation the powers of multiple contrast tests based on a joint model and multiple marginal models, respectively, and quantify the benefit of incorporating longitudinal correlation, i.e. the advantage over Bonferroni. Practical application...

  11. Analysis of Acupuncture Treatment Characteristics of Insomnia in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    刘立公; 顾杰; 黄琴峰

    2007-01-01

    Statistical analysis was made through computer on the information of insomnia treated by acupuncture in 93 ancient medical books. Statistical results showed that 65 acupoints were used in ancient times, up to 108 times in frequency. The common acupoints are as follows:Gongsun (SP 4), Danshu (BL 19), Yinbai (SP 1), Qihai (CV 6), Tianfu (LU 3), Sanyinjiao (SP 6),Yinlingquan (SP 9), Feishu (BL 13), Yemen (TE 2), Guanyuan (CV 4), Yinjiao (GV 28) et al.The common meridians are Bladder Meridian, Spleen Meridian, Conception Vessel, Stomach Meridian, et al.%运用计算机对93种古医籍中用针灸治疗失眠的内容进行统计,统计结果显示,古代治疗本证共涉及穴位65个,总计108穴次.常用穴位为公孙、胆俞、隐白、气海、天府、三阴交、阴陵泉、肺俞、液门、关元、阴交等.常用经络为膀胱经、脾经、任脉、胃经等.

  12. Effect of treatment time on characterization and properties of nanocrystalline surface layer in copper induced by surface mechanical attrition treatment

    Indian Academy of Sciences (India)

    Farzad Kargar; M Laleh; T Shahrabi; A Sabour Rouhaghdam

    2014-08-01

    Nanocrystalline surface layers were synthesized on pure copper by means of surface mechanical attrition treatment (SMAT) at various treatment times. The microstructural features of the surface layers produced by SMAT were systematically characterized by optical microscopy (OM), transmission electron microscopy (TEM) and X-ray diffraction (XRD) analysis. Hardness and surface roughness measurements were also carried out. It is found that the thickness of the deformed layer increased from 50 to 500 m with increasing treatment time from 10 to 300 min, while the average grain size of the top surface layer decreased from 20 to 7 nm. Hardness of the all SMATed samples decreased with depth. Furthermore, the hardness of the top surface layer of the SMATed samples was at least two times higher than that of the un-treated counterpart. Surface roughness results showed different trend with treatment time. Amounts of PV and a values first sharply increased and then decreased.

  13. Pain assessment in time to get pain treatment on time – patients’ perspective of time during pain assessment after spine surgery

    DEFF Research Database (Denmark)

    Kaptain, Kirsten; Bregnballe, Vibeke; Dreyer, Pia

    Background: Despite advances in medicine, pharmaceutical and technical knowledge, patients still have postop-erative pain after spine surgery. Studies show that patient participation has positive effect on treatment outcomes and patients require quick individual and efficient pain treatment. Obje...... an efficient and individual pain treatment on time. Knowl-edge about how time affect patients pain assessment is important for nurses in order to make patients participate in pain assessment.......Background: Despite advances in medicine, pharmaceutical and technical knowledge, patients still have postop-erative pain after spine surgery. Studies show that patient participation has positive effect on treatment outcomes and patients require quick individual and efficient pain treatment...... was difficult to use for the patients during activity as intensity of pain changed within seconds in the postoperative phase. The patients elucidated how anaesthesia affected their ability to assess pain and they described how pain medicine and severe pain over time caused variation in ability to communicate...

  14. Delay in surgical treatment of patients with hilar cholangiocarcinoma: does time impact outcomes?

    Science.gov (United States)

    Ruys, Anthony T; Heuts, Simon G; Rauws, Eric A; Busch, Olivier R C; Gouma, Dirk J; Gulik, Thomas M

    2014-01-01

    Background Substantial time elapses before patients with hilar cholangiocarcinoma (HCC) receive surgical treatment because of time-consuming preoperative staging and other interventions, including biliary drainage and portal vein embolization. Prolonged times potentially lead to unresectability and the formation of metastases, yet these issues have not been investigated previously in HCC. This study aimed to evaluate the time between onset of symptoms and the provision of ultimate treatment in patients with HCC and the impact of the length of time on outcomes. Methods Delays in the treatment of consecutive patients with HCC were evaluated by contacting general practitioners (GPs) and extracting data from hospital files. Time periods were correlated with resectability, occurrence of metastasis, tumour stage and survival using logistic and Cox regression analyses. Results Treatment times in 209 consecutive HCC patients were evaluated. The median time from first GP visit until presentation at the tertiary centre was 35 days. Time until treatment was longer when initial symptoms did not include jaundice (non-specific symptoms, P < 0.001). Duration of workup and preoperative biliary drainage at the tertiary centre prior to final surgical treatment resulted in an additional median time of 74 days. No correlation was found between treatment time in weeks and resectability [odds ratio (OR) 1.010, 95% confidence interval (CI) 0.985–1.036], metastasis (OR = 0.947, 95% CI 0.897–1.000), tumour stage (OR = 1.006, 95% CI 0.981–1.031) or survival in resected patients (hazard ratio = 0.996, 95% CI 0.975–1.018). Conclusions The time that elapses between the presentation of symptoms and final treatment in patients with HCC is substantial, especially in patients with non-specific symptoms. This time, however, does not affect resectability, metastasis, tumour stage or survival, which suggests that preoperative optimization should not be omitted because of potential delays in

  15. High-intensity Focused Ultrasound Ablation of Soft-tissue Tumors and Assessment of Treatment Response with Multiparametric Magnetic Resonance Imaging: Preliminary Study Using Rabbit VX2 Tumor Model

    Directory of Open Access Journals (Sweden)

    Kyung Won Kim

    2014-06-01

    Conclusion: Extracorporeal HIFU treatment for soft-tissue tumor may be a feasible approach with adjustment of input energy level. For post-treatment assessment, functional MRI techniques including DCE-MRI and ADC map may be useful and complementary to conventional MRI.

  16. A flexible parametric approach for estimating continuous-time inverse probability of treatment and censoring weights.

    Science.gov (United States)

    Saarela, Olli; Liu, Zhihui Amy

    2016-10-15

    Marginal structural Cox models are used for quantifying marginal treatment effects on outcome event hazard function. Such models are estimated using inverse probability of treatment and censoring (IPTC) weighting, which properly accounts for the impact of time-dependent confounders, avoiding conditioning on factors on the causal pathway. To estimate the IPTC weights, the treatment assignment mechanism is conventionally modeled in discrete time. While this is natural in situations where treatment information is recorded at scheduled follow-up visits, in other contexts, the events specifying the treatment history can be modeled in continuous time using the tools of event history analysis. This is particularly the case for treatment procedures, such as surgeries. In this paper, we propose a novel approach for flexible parametric estimation of continuous-time IPTC weights and illustrate it in assessing the relationship between metastasectomy and mortality in metastatic renal cell carcinoma patients. Copyright © 2016 John Wiley & Sons, Ltd.

  17. Multivariable Model for Time to First Treatment in Patients With Chronic Lymphocytic Leukemia

    Science.gov (United States)

    Wierda, William G.; O'Brien, Susan; Wang, Xuemei; Faderl, Stefan; Ferrajoli, Alessandra; Do, Kim-Anh; Garcia-Manero, Guillermo; Cortes, Jorge; Thomas, Deborah; Koller, Charles A.; Burger, Jan A.; Lerner, Susan; Schlette, Ellen; Abruzzo, Lynne; Kantarjian, Hagop M.; Keating, Michael J.

    2011-01-01

    Purpose The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram—a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials. PMID:21969505

  18. Use of high-intensity focused ultrasound in the treatment of both benign and malignant prostatic disease

    Science.gov (United States)

    Kernen, Kenneth M.; Miles, Brian J.

    2000-05-01

    Prostate cancer, the most common malignancy in men in the United States, accounts for more than 29% of all male cancers diagnosed and 13% of all cancer deaths. This translates into approximately 200,000 men diagnosed and 37,000 men who will die from the disease this year in this country. A significant number of patients ultimately choose external beam radiation or interstitial radioactive implants (brachytherapy) combined with external beam radiotherapy as their primary treatment. Approximately 25 - 35% of external beam irradiation patients and 20 - 30% of interstitial implants combined with external beam radiotherapy will fail within 10 years. The treatment options for patients with localized radiorecurrent disease include watchful waiting, endocrine therapy, salvage radiotherapy, and salvage radical prostatectomy, cryotherapy and now high intensity focused ultrasound therapy (HIFU). Although some studies regarding watchful waiting demonstrated comparable results to formal treatment for early prostate cancer, other studies have shown metastatic and mortality rates that are significantly higher, and that radiorecurrent patients would have even greater rates of metastasis and progression to death. Prostate cancer cure by means of endocrine therapy is highly unlikely and its role is still one of palliation with a side effect profile which includes hot flashes, osteoporosis, fatigue, loss of muscle mass, anemia, loss of libido and potency. The role of salvage radiotherapy may offer local control, however long term efficacy has yet to be determined. In a recent series, only 50% of the patients were controlled for a mean of four years with salvage radiotherapy. Salvage prostatectomy has the advantage of providing excellent local control and even a cure if the cancer is confined to the prostate or within the surrounding periprostatic tissue. Historically, salvage prostatectomy is technically demanding and fraught with higher complications. In one large series

  19. Waiting time disparities in breast cancer diagnosis and treatment: a population-based study in France.

    Science.gov (United States)

    Molinié, F; Leux, C; Delafosse, P; Ayrault-Piault, S; Arveux, P; Woronoff, A S; Guizard, A V; Velten, M; Ganry, O; Bara, S; Daubisse-Marliac, L; Tretarre, B

    2013-10-01

    Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France.

  20. Single High Intensity Focused Ultrasound Session as a Whole Gland Primary Treatment for Clinically Localized Prostate Cancer: 10-Year Outcomes

    Directory of Open Access Journals (Sweden)

    Ksenija Limani

    2014-01-01

    Full Text Available Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU for patients with localized prostate cancer (PCa. Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score. Results. At a median follow-up of 94months, 48 (44.4% and 50 (46.3% patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%. Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.

  1. Treatment programs for severe night-time fears: a methodological note.

    Science.gov (United States)

    Friedman, A G; Ollendick, T H

    1989-06-01

    A multiple baseline design across subjects was used to examine the efficacy of a treatment package consisting of relaxation, reinforcement, and cognitive self-instruction in the reduction of severe night-time fears in six children. Although the disruptive bedtime behaviors of five of the six children were reduced, the multiple baseline analysis revealed that changes were not solely due to treatment. For children with extended baselines, improvement preceded treatment. The implications of these findings for the treatment of fear of the dark and multicomponent treatment programs are discussed.

  2. Tumor growth rate determines the timing of optimal chronomodulated treatment schedules.

    Directory of Open Access Journals (Sweden)

    Samuel Bernard

    2010-03-01

    Full Text Available In host and cancer tissues, drug metabolism and susceptibility to drugs vary in a circadian (24 h manner. In particular, the efficacy of a cell cycle specific (CCS cytotoxic agent is affected by the daily modulation of cell cycle activity in the target tissues. Anti-cancer chronotherapy, in which treatments are administered at a particular time each day, aims at exploiting these biological rhythms to reduce toxicity and improve efficacy of the treatment. The circadian status, which is the timing of physiological and behavioral activity relative to daily environmental cues, largely determines the best timing of treatments. However, the influence of variations in tumor kinetics has not been considered in determining appropriate treatment schedules. We used a simple model for cell populations under chronomodulated treatment to identify which biological parameters are important for the successful design of a chronotherapy strategy. We show that the duration of the phase of the cell cycle targeted by the treatment and the cell proliferation rate are crucial in determining the best times to administer CCS drugs. Thus, optimal treatment times depend not only on the circadian status of the patient but also on the cell cycle kinetics of the tumor. Then, we developed a theoretical analysis of treatment outcome (TATO to relate the circadian status and cell cycle kinetic parameters to the treatment outcomes. We show that the best and the worst CCS drug administration schedules are those with 24 h intervals, implying that 24 h chronomodulated treatments can be ineffective or even harmful if administered at wrong circadian times. We show that for certain tumors, administration times at intervals different from 24 h may reduce these risks without compromising overall efficacy.

  3. Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment

    DEFF Research Database (Denmark)

    Simonsen, Sofie; Andresen, Morten; Michelsen, Lene;

    2014-01-01

    BackgroundEffective treatment of stroke is time dependent. Pre-hospital management is an important link in reducing the time from occurrence of stroke symptoms to effective treatment. The aim of this study was to evaluate time used by emergency medical services (EMS) for stroke patients during...... a five-year period in order to identify potential delays and evaluate the reorganization of EMS in Copenhagen in 2009.MethodsWe performed a retrospective analysis of ambulance records from stroke patients suitable for thrombolysis from 1 January 2006 to 7 July 2011. We noted response time from dispatch...... of the ambulance to arrival at the scene, on-scene time and transport time to the hospital¿in total, alarm-to-door time. In addition, we noted baseline characteristics.ResultsWe reviewed 481 records (58% male, median age 66 years). The median (IQR) alarm-to-door time in minutes was 41 (33¿52), of which 18 (12...

  4. Syllable-Timed Speech Treatment for School-Age Children Who Stutter: A Phase I Trial

    Science.gov (United States)

    Andrews, Cheryl; O'Brian, Sue; Harrison, Elisabeth; Onslow, Mark; Packman, Ann; Menzies, Ross

    2012-01-01

    Purpose: This clinical trial determined the outcomes of a simple syllable-timed speech (STS) treatment for school-age children who stutter. Method: Participants were 10 children, ages 6-11 years, who stutter. Treatment involved training the children and their parents to use STS at near normal speech rates. The technique was practiced in the clinic…

  5. How to study optimal timing of PET/CT for monitoring of cancer treatment

    DEFF Research Database (Denmark)

    Vach, Werner; Høilund-Carlsen, Poul Flemming; Fischer, Barbara Malene Bjerregaard

    2011-01-01

    Purpose: The use of PET/CT for monitoring treatment response in cancer patients after chemo- or radiotherapy is a very promising approach to optimize cancer treatment. However, the timing of the PET/CT-based evaluation of reduction in viable tumor tissue is a crucial question. We investigated how...

  6. How to study optimal timing of PET/CT for monitoring of cancer treatment

    DEFF Research Database (Denmark)

    Vach, Werner; Høilund-Carlsen, Poul Flemming; Fischer, Barbara Malene Bjerregaard;

    2011-01-01

    Purpose: The use of PET/CT for monitoring treatment response in cancer patients after chemo- or radiotherapy is a very promising approach to optimize cancer treatment. However, the timing of the PET/CT-based evaluation of reduction in viable tumor tissue is a crucial question. We investigated how...

  7. The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method

    DEFF Research Database (Denmark)

    Keall, Paul J.; Aun Ng, Jin; O'Brien, Ricky;

    2015-01-01

    system. A 120° pretreatment kV imaging arc was acquired to build the patient-specific 2D to 3D motion correlation. The kV imager was activated during the megavoltage (MV) treatment, a dual arc VMAT prostate treatment, to estimate the 3D prostate position in real-time. All necessary ethics, legal...

  8. Front-end specialists reduce time to a treatment plan for patients with acute abdomen

    DEFF Research Database (Denmark)

    Schultz, Helen; Backer Mogensen, Christian; Pedersen, Birthe D

    2013-01-01

    Emergency departments (EDs) are replacing acute specialised wards in Denmark. The aim was to compare time to a treatment plan for patients with acute abdomen at a surgical assessment unit (SAU) and at an ED, respectively.......Emergency departments (EDs) are replacing acute specialised wards in Denmark. The aim was to compare time to a treatment plan for patients with acute abdomen at a surgical assessment unit (SAU) and at an ED, respectively....

  9. Front-end specialists reduce time to a treatment plan for patients with acute abdomen

    DEFF Research Database (Denmark)

    Schultz, Helen; Backer Mogensen, Christian; Pedersen, Birthe D

    2013-01-01

    Emergency departments (EDs) are replacing acute specialised wards in Denmark. The aim was to compare time to a treatment plan for patients with acute abdomen at a surgical assessment unit (SAU) and at an ED, respectively.......Emergency departments (EDs) are replacing acute specialised wards in Denmark. The aim was to compare time to a treatment plan for patients with acute abdomen at a surgical assessment unit (SAU) and at an ED, respectively....

  10. How to study optimal timing of PET/CT for monitoring of cancer treatment

    DEFF Research Database (Denmark)

    Vach, Werner; Høilund-Carlsen, Poul Flemming; Fischer, Barbara Malene Bjerregaard

    2011-01-01

    Purpose: The use of PET/CT for monitoring treatment response in cancer patients after chemo- or radiotherapy is a very promising approach to optimize cancer treatment. However, the timing of the PET/CT-based evaluation of reduction in viable tumor tissue is a crucial question. We investigated how...... to plan and analyze studies to optimize this timing. Methods: General considerations about studying the optimal timing are given and four fundamental steps are illustrated using data from a published study. Results: The optimal timing should be examined by optimizing the schedule with respect...... to predicting the overall individual time course we can observe in the case of dense measurements. The optimal timing needs not to and should not be studied by optimizing the association with the prognosis of the patient. Conclusions: The optimal timing should be examined in specific ‘schedule optimizing...

  11. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management.

    Science.gov (United States)

    Fiaschetti, Valeria; Manenti, Guglielmo; Di Poce, Isabelle; Fornari, Maria; Ricci, Aurora; Finazzi Agrò, Enrico; Simonetti, Giovanni

    2012-01-01

    Colovesical fistula (CVF) is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF) is a possible but extremely rare complication of treatment of prostate cancer with "transrectal High-Intensity Focused Ultrasound (HIFU) treatment." We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan-with MPR, MIP, and VR reconstruction-before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  12. A Rectourethral Fistula due to Transrectal High-Intensity Focused Ultrasound Treatment: Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Valeria Fiaschetti

    2012-01-01

    Full Text Available Colovesical fistula (CVF is an abnormal connection between the enteric and the urinary systems. The rectourethral fistula (RUF is a possible but extremely rare complication of treatment of prostate cancer with “transrectal High-Intensity Focused Ultrasound (HIFU treatment.” We present a case of CVF due to HIFU treatment of recurrent prostate cancer. The case was assessed with cystography completed with a pelvic CT scan—with MPR, MIP, and VR reconstruction—before emptying the bladder. Since the CT scan confirmed that the fistula involved solely the urethra and excluded even a minimal involvement of the bladder, it was possible to employ a conservative treatment by positioning a Foley catheter of monthly duration, in order to allow the urethra to rest. Still today, after 6 months, the patient is in a good clinical condition and has not shown yet signs of a recurrence of the fistula.

  13. Numerical Simulation of Vacuum Heat Treatment Thermal Hysteresis Time of GH4169 Superalloy Workpiece

    Institute of Scientific and Technical Information of China (English)

    WANGMing-wei; ZHANGLi-wen; JIANGGuo-dong; ZHANGFan-yun; LiChen-hui; ZHANGLi-sheng; ZHANGZun-li

    2004-01-01

    A nonlinear finite element model of vacuum heat treatment process was developed. In this model, influence of many factors, such as nonlinear heat radiation, temperature-dependent thermal physical properties of material are considered. The temperature field of GH4169 alloy workpiece during vacuum heat treatment process was calculated using finite element software MSC.Marc, and the thermal hysteresis time of the workpiece was predicted. An experiment of vacuum heat treatment of GH4169 superalloy workpiece was carried out to verify the calculation. The experimental results of temperature profile agree well with the simulated results. This work lays a theoretical foundation for optimizing technical parameter of vacuum heat treatment process.

  14. Alzheimer’s Disease: Differences of Transdermal versus Oral Treatment on Caregiving Time

    Directory of Open Access Journals (Sweden)

    O. Riedel

    2012-11-01

    Full Text Available Background: Data on indirect effects of dementia treatment on caregiver burden obtained from naturalistic studies are still lacking. We explored differences between patients with oral and transdermal application of acetylcholine esterase inhibitors regarding caregiver’s time burden and psychopathology. Methods: A cross-sectional naturalistic cohort study of 403 patients in outpatient care with three treatment groups (none, oral, and transdermal was conducted. Assessments included a standardized clinical burden questionnaire and a standardized caregiver interview. Results: Any treatment was associated with lower burden in most measures. Transdermal treatment was superior regarding (1 administration time (p Conclusions: Benefits associated with transdermal treatment do not translate into a better ‘generic quality of life’ of the caregiver. The substantially different perceptions of patients’ improvements need to be considered in future studies.

  15. Time to move from presumptive malaria treatment to laboratory-confirmed diagnosis and treatment in African children with fever.

    Directory of Open Access Journals (Sweden)

    Valérie D'Acremont

    2009-01-01

    Full Text Available BACKGROUND TO THE DEBATE: Current guidelines recommend that all fever episodes in African children be treated presumptively with antimalarial drugs. But declining malarial transmission in parts of sub-Saharan Africa, declining proportions of fevers due to malaria, and the availability of rapid diagnostic tests mean it may be time for this policy to change. This debate examines whether enough evidence exists to support abandoning presumptive treatment and whether African health systems have the capacity to support a shift toward laboratory-confirmed rather than presumptive diagnosis and treatment of malaria in children under five.

  16. Temperature elevation by HIFU in ex vivo porcine muscle: MRI measurement and simulation study

    Energy Technology Data Exchange (ETDEWEB)

    Solovchuk, Maxim A., E-mail: solovchuk@gmail.com [Center for Advanced Study in Theoretical Sciences (CASTS), National Taiwan University, Taipei 10617, Taiwan (China); Hwang, San Chao; Chang, Hsu [Medical Engineering Research Division, National Health Research Institute, Miaoli 35053, Taiwan (China); Thiriet, Marc [Sorbonne Universités, UPMC Univ Paris 06, UMR 7598, Laboratoire Jacques-Louis Lions, F-75005, Paris (France); Sheu, Tony W. H., E-mail: twhsheu@ntu.edu.tw [Department of Engineering Science and Ocean Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei 10617, Taiwan, Republic of China and Center for Advanced Study in Theoretical Sciences (CASTS), National Taiwan University, Taipei 10617, Taiwan (China)

    2014-05-15

    Purpose: High-intensity focused ultrasound is a rapidly developing medical technology with a large number of potential clinical applications. Computational model can play a pivotal role in the planning and optimization of the treatment based on the patient's image. Nonlinear propagation effects can significantly affect the temperature elevation and should be taken into account. In order to investigate the importance of nonlinear propagation effects, nonlinear Westervelt equation was solved. Weak nonlinear propagation effects were studied. The purpose of this study was to investigate the correlation between the predicted and measured temperature elevations and lesion in a porcine muscle. Methods: The investigated single-element transducer has a focal length of 12 cm, an aperture of 8 cm, and frequency of 1.08 MHz. Porcine muscle was heated for 30 s by focused ultrasound transducer with an acoustic power in the range of 24–56 W. The theoretical model consists of nonlinear Westervelt equation with relaxation effects being taken into account and Pennes bioheat equation. Results: Excellent agreement between the measured and simulated temperature rises was found. For peak temperatures above 85–90 °C “preboiling” or cavitation activity appears and lesion distortion starts, causing small discrepancy between the measured and simulated temperature rises. From the measurements and simulations, it was shown that distortion of the lesion was caused by the “preboiling” activity. Conclusions: The present study demonstrated that for peak temperatures below 85–90 °C numerical simulation results are in excellent agreement with the experimental data in three dimensions. Both temperature rise and lesion size can be well predicted. Due to nonlinear effect the temperature in the focal region can be increased compared with the linear case. The current magnetic resonance imaging (MRI) resolution is not sufficient. Due to the inevitable averaging the measured

  17. Capillary Suction Time. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

    Science.gov (United States)

    Wooley, John F.

    Capillary suction time is time required for the liquid phase of a treated sludge to travel through 1 centimeter of media (blotter or filter paper). Designed for individuals who have completed National Pollutant Discharge Elimination System (NPDES) level 1 laboratory training skills, this module provides waste water treatment plant operators with…

  18. Investigation of parameters affecting treatment time in MRI-guided transurethral ultrasound therapy

    Science.gov (United States)

    N'Djin, W. A.; Burtnyk, M.; Chopra, R.; Bronskill, M. J.

    2010-03-01

    MRI-guided transurethral ultrasound therapy shows promise for minimally invasive treatment of localized prostate cancer. Real-time MR temperature feedback enables the 3D control of thermal therapy to define an accurate region within the prostate. Previous in-vivo canine studies showed the feasibility of this method using transurethral planar transducers. The aim of this simulation study was to reduce the procedure time, while maintaining treatment accuracy by investigating new combinations of treatment parameters. A numerical model was used to simulate a multi-element heating applicator rotating inside the urethra in 10 human prostates. Acoustic power and rotation rate were varied based on the feedback of the temperature in the prostate. Several parameters were investigated for improving the treatment time. Maximum acoustic power and rotation rate were optimized interdependently as a function of prostate radius and transducer operating frequency, while avoiding temperatures >90° C in the prostate. Other trials were performed on each parameter separately, with the other parameter fixed. The concept of using dual-frequency transducers was studied, using the fundamental frequency or the 3rd harmonic component depending on the prostate radius. The maximum acoustic power which could be used decreased as a function of the prostate radius and the frequency. Decreasing the frequency (9.7-3.0 MHz) or increasing the power (10-20 W.cm-2) led to treatment times shorter by up to 50% under appropriate conditions. Dual-frequency configurations, while helpful, tended to have less impact on treatment times. Treatment accuracy was maintained and critical adjacent tissues like the rectal wall remained protected. The interdependence between power and frequency may require integrating multi-parametric functions inside the controller for future optimizations. As a first approach, however, even slight modifications of key parameters can be sufficient to reduce treatment time.

  19. Time to cardiac death after withdrawal of life-sustaining treatment in potential organ donors.

    Science.gov (United States)

    Suntharalingam, C; Sharples, L; Dudley, C; Bradley, J A; Watson, C J E

    2009-09-01

    Organ donation after cardiac death (DCD) is increasing markedly, allowing more patients to benefit from transplantation. The time to cardiac death following withdrawal of life-supporting treatment varies widely and is an important determinant of whether organ donation occurs. A prospective multicenter study of potential DCD donors was undertaken to evaluate the time to death and identify associated factors. One hundred and ninety-one potential adult DCD donors at nine UK centers were studied. Treatment withdrawal comprised stopping ventilator support and inotropes. Demographics and physiological variables at the time of death were recorded. Following treatment withdrawal, all potential donors died, with median time to death of 36 min (range 5 min to 3.3 days). Eighty-three potential donors (43.5%) remained alive 1 h after treatment withdrawal, and 69 (36.1%) and 54 (28.3%) at 2 and 4 h, respectively. Univariate analysis revealed that age, cause of death, ventilation mode, inotrope use, systolic blood pressure, FiO2 and arterial pH at treatment withdrawal were all associated with time to death. Multivariable analysis showed that younger age, higher FiO2 and mode of ventilation were independently associated with shorter time to death. This information may aid planning and resourcing of DCD organ recovery and help maximize DCD donor numbers.

  20. Care package for anxiety disorders: no-show and dropout of standardised, time restricted treatment

    DEFF Research Database (Denmark)

    Tranberg, Hanne; Mortensen, Erik Lykke; Lau, Marianne Engelbrecht

    of treatment characterised by standardisation, time restriction and pre-coordination. Currently, the impact of care packages on patient non-attendance remains unknown. Objectives: The aim was to study the influence of care packages treatment organisation on non-attendance for treatment for anxiety disorders...... and if demographic and clinical variables were predictors for no-show and dropout. Methods: The study was a quasi-experimental pre-post study in a naturalistic setting in the Mental Health Services, Capital Region of Denmark. Two samples of patients, aged above 18 years and referred for treatment for anxiety......Background: Psychotherapy has shown to be efficacious but therapy effectiveness in mental health services is compromised by patients who fail to show up for assessment, treatment start and stay in treatment. Predictors for patient non-attendance (no-show and dropout) have been identified as patient...

  1. Time reversal for ultrasonic transcranial surgery and echographic imaging

    Science.gov (United States)

    Tanter, Mickael; Aubry, Jean-Francois; Vignon, Francois; Fink, Mathias

    2005-09-01

    High-intensity focused ultrasound (HIFU) is able to induce non-invasively controlled and selective destruction of tissues by focusing ultrasonic beams within organs, analogous to a magnifying glass that concentrates enough sunlight to burn a hole in paper. The brain is an attractive organ in which to perform ultrasonic tissue ablation, but such an application has been hampered by the strong defocusing effect of the skull bone. Our group has been involved in this topic for several years, providing proofs of concept and proposing technological solutions to this problem. Thanks to a high-power time-reversal mirror, presented here are in vivo thermal lesions induced through the skull of 12 sheep. Thermal lesions were confirmed by T2-weighted magnetic resonance post-treatment images and histological examination. These results provide striking evidence that noninvasive ultrasound brain surgery is feasible. A recent approach for high-resolution brain ultrasonic imaging will also be discussed with a skull aberration correction technique based on twin arrays technology. The correction of transcranial ultrasonic images is implemented on a new generation of time-reversal mirrors relying on a fully programmable transmit and receive beamformer.

  2. Time course and predictors of use of erectile dysfunction treatment in a Veterans Affairs medical center.

    Science.gov (United States)

    Clavijo, R I; Daskivich, T; Kwan, L; Bassett, J; Keller, T; Bennett, C

    2016-09-01

    The objective of this study was to define the pattern and time course of use of ED treatments in a Veterans Affairs (VA) medical center and to identify clinical or demographic variables that are associated with the use of second- or third-line ED treatments. We identified 702 men treated for ED at the Greater Los Angeles Veterans Affairs between 2007 and 2013. We extracted demographics, Charlson co-morbidity score, pertinent surgical/medication history as well as use of ED treatments from medical records. On multivariate analysis, age over 65 (OR 1.83, 95% CI: 1.31-2.56) and Charlson co-morbidity score of 1 (OR 1.77, 95% CI: 1.13-2.77) and 2+ (OR 2.07, 95% CI: 1.28-3.36) were significantly associated with use of medicated urethral suppositories for erection (MUSE)/intracorporal injections (ICI) compared with PDE5i/erection devices. Across all men who used second- or third-line treatments, median time until receiving MUSE was 0.6 years and median time until receiving ICI/implant was 2 years. We conclude that men who will ultimately use more invasive ED treatments, such as men with more co-morbidities, tend to have a prolonged treatment course. This information may be incorporated into a shared decision-making model for more efficient treatment of ED.

  3. [Analysis of evidence-based clinical practices on timing factor in acupuncture treatment for facial paralysis].

    Science.gov (United States)

    Zhang, Chong; Wan, Jun

    2011-01-01

    By using the evidence-based medicine approach to analyze the optimum timing in acupuncture treatment for facial paralysis, to provide the scientific evidence for acupuncture clinical practices. Computer searches were conducted in the CNKI literature database from January 1994 to August 2009, using the keywords "facial paralysis", "acupuncture" and "acupuncture timing/treatment timing". According to the standard of Cochrane, the literatures were retrieved and conducted with evidence-based analysis. The SPSS 13.0 Software was used for the statistical analysis. Among the 133 retrieved literatures which met the inclusion criteria of the study, there were 11 literatures on the effect of acupuncture or electroacupuncture treatment in acute phase observation group and conventional medical treatment group. Using Mann-Whitney U test, the difference of treatment effect is statistically significant (P acupuncture treatment for facial paralysis in acute phase can improve the efficacy and promote neurological recovery. In the acute phase, animal experiments and clinical observations provide evidence to support the application of electric needle and traditional acupuncture treatments.

  4. Time dependent pre-treatment EPID dosimetry for standard and FFF VMAT.

    Science.gov (United States)

    Podesta, Mark; Nijsten, Sebastiaan M J J G; Persoon, Lucas C G G; Scheib, Stefan G; Baltes, Christof; Verhaegen, Frank

    2014-08-21

    Methods to calibrate Megavoltage electronic portal imaging devices (EPIDs) for dosimetry have been previously documented for dynamic treatments such as intensity modulated radiotherapy (IMRT) using flattened beams and typically using integrated fields. While these methods verify the accumulated field shape and dose, the dose rate and differential fields remain unverified. The aim of this work is to provide an accurate calibration model for time dependent pre-treatment dose verification using amorphous silicon (a-Si) EPIDs in volumetric modulated arc therapy (VMAT) for both flattened and flattening filter free (FFF) beams. A general calibration model was created using a Varian TrueBeam accelerator, equipped with an aS1000 EPID, for each photon spectrum 6 MV, 10 MV, 6 MV-FFF, 10 MV-FFF. As planned VMAT treatments use control points (CPs) for optimization, measured images are separated into corresponding time intervals for direct comparison with predictions. The accuracy of the calibration model was determined for a range of treatment conditions. Measured and predicted CP dose images were compared using a time dependent gamma evaluation using criteria (3%, 3 mm, 0.5 sec). Time dependent pre-treatment dose verification is possible without an additional measurement device or phantom, using the on-board EPID. Sufficient data is present in trajectory log files and EPID frame headers to reliably synchronize and resample portal images. For the VMAT plans tested, significantly more deviation is observed when analysed in a time dependent manner for FFF and non-FFF plans than when analysed using only the integrated field. We show EPID-based pre-treatment dose verification can be performed on a CP basis for VMAT plans. This model can measure pre-treatment doses for both flattened and unflattened beams in a time dependent manner which highlights deviations that are missed in integrated field verifications.

  5. Time dependent pre-treatment EPID dosimetry for standard and FFF VMAT

    Science.gov (United States)

    Podesta, Mark; Nijsten, Sebastiaan M. J. J. G.; Persoon, Lucas C. G. G.; Scheib, Stefan G.; Baltes, Christof; Verhaegen, Frank

    2014-08-01

    Methods to calibrate Megavoltage electronic portal imaging devices (EPIDs) for dosimetry have been previously documented for dynamic treatments such as intensity modulated radiotherapy (IMRT) using flattened beams and typically using integrated fields. While these methods verify the accumulated field shape and dose, the dose rate and differential fields remain unverified. The aim of this work is to provide an accurate calibration model for time dependent pre-treatment dose verification using amorphous silicon (a-Si) EPIDs in volumetric modulated arc therapy (VMAT) for both flattened and flattening filter free (FFF) beams. A general calibration model was created using a Varian TrueBeam accelerator, equipped with an aS1000 EPID, for each photon spectrum 6 MV, 10 MV, 6 MV-FFF, 10 MV-FFF. As planned VMAT treatments use control points (CPs) for optimization, measured images are separated into corresponding time intervals for direct comparison with predictions. The accuracy of the calibration model was determined for a range of treatment conditions. Measured and predicted CP dose images were compared using a time dependent gamma evaluation using criteria (3%, 3 mm, 0.5 sec). Time dependent pre-treatment dose verification is possible without an additional measurement device or phantom, using the on-board EPID. Sufficient data is present in trajectory log files and EPID frame headers to reliably synchronize and resample portal images. For the VMAT plans tested, significantly more deviation is observed when analysed in a time dependent manner for FFF and non-FFF plans than when analysed using only the integrated field. We show EPID-based pre-treatment dose verification can be performed on a CP basis for VMAT plans. This model can measure pre-treatment doses for both flattened and unflattened beams in a time dependent manner which highlights deviations that are missed in integrated field verifications.

  6. Bayesian Nonparametric Estimation for Dynamic Treatment Regimes with Sequential Transition Times.

    Science.gov (United States)

    Xu, Yanxun; Müller, Peter; Wahed, Abdus S; Thall, Peter F

    2016-01-01

    We analyze a dataset arising from a clinical trial involving multi-stage chemotherapy regimes for acute leukemia. The trial design was a 2 × 2 factorial for frontline therapies only. Motivated by the idea that subsequent salvage treatments affect survival time, we model therapy as a dynamic treatment regime (DTR), that is, an alternating sequence of adaptive treatments or other actions and transition times between disease states. These sequences may vary substantially between patients, depending on how the regime plays out. To evaluate the regimes, mean overall survival time is expressed as a weighted average of the means of all possible sums of successive transitions times. We assume a Bayesian nonparametric survival regression model for each transition time, with a dependent Dirichlet process prior and Gaussian process base measure (DDP-GP). Posterior simulation is implemented by Markov chain Monte Carlo (MCMC) sampling. We provide general guidelines for constructing a prior using empirical Bayes methods. The proposed approach is compared with inverse probability of treatment weighting, including a doubly robust augmented version of this approach, for both single-stage and multi-stage regimes with treatment assignment depending on baseline covariates. The simulations show that the proposed nonparametric Bayesian approach can substantially improve inference compared to existing methods. An R program for implementing the DDP-GP-based Bayesian nonparametric analysis is freely available at https://www.ma.utexas.edu/users/yxu/.

  7. Timing of decontamination and treatment in case of percutaneous VX poisoning: a mini review.

    Science.gov (United States)

    Joosen, Marloes J A; van der Schans, Marcel J; Kuijpers, Willem C; van Helden, Herman P M; Noort, Daan

    2013-03-25

    Low volatile organophosphorous nerve agents such as VX, will most likely enter the body via the skin. The pharmacokinetics of drugs such as oximes, atropine and diazepam, are not aligned with the variable and persistent toxicokinetics of the agent. Repeated administration of these drugs showed to improve treatment efficacy compared to a single injection treatment. Because of the effectiveness of continuous treatment, it was investigated to what extent a subchronic pretreatment with carbamate (pyridostigmine or physostigmine combined with either procyclidine or scopolamine) would protect against percutaneous VX exposure. Inclusion of scopolamine in the pretreatment prevented seizures in all animals, but none of the pretreatments affected survival time or the onset time of cholinergic signs. These results indicate that percutaneous poisoning with VX requires additional conventional treatment in addition to the current pretreatment regimen. Decontamination of VX-exposed skin is one of the most important countermeasures to mitigate the effects of the exposure. To evaluate the window of opportunity for decontamination, the fielded skin decontaminant Reactive Skin Decontaminant Lotion (RSDL) was tested at different times in hairless guinea pigs percutaneously challenged with 4× LD50 VX in IPA. The results showed that RSDL decontamination at 15 min after exposure could not prevent progressive blood cholinesterase inhibition and therefore would still require additional treatment. A similar decontamination regimen with RSDL at 90 min showed that it still might effectively increase the time window of opportunity for treatment. In conclusion, the delay in absorption presents a window of opportunity for decontamination and treatment. The continuous release of VX from the skin presents a significant challenge for efficacious therapy, which should ideally consist of thorough decontamination and continuous treatment.

  8. 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.

  9. Time and motion study for alternative mixed low-level waste treatment systems

    Energy Technology Data Exchange (ETDEWEB)

    Biagi, C.; Vetromile, J.; Teheranian, B.

    1997-02-01

    The time and motion study was developed to look at time-related aspects of the technologies and systems studied in the Integrated Thermal Treatment Systems (ITTS) and Integrated Nonthermal Treatment Systems (INTS) studies. The INTS and ITTS studies combined technologies into systems and subsystems for evaluation. The system approach provides DOE a method of measuring advantages and disadvantages of the many technologies currently being researched. For example, technologies which are more likely to create secondary waste or require extensive pretreatment handling may be less desirable than technologies which require less support from other processes. The time and motion study was designed to address the time element in the INTS and ITTS systems studies. Previous studies have focused on material balance, cost, technical effectiveness, regulatory issues, community acceptance, and operability. This study looks at system dynamics by estimating the treatment time required for a unit of waste, from receipt to certification for shipping. Labor estimates are also developed, based on the time required to do each task for each process. This focus on time highlights critical path processes and potential bottlenecks in the INTS and ITTS systems.

  10. Part-time versus full-time occlusion therapy for treatment of amblyopia: A meta-analysis.

    Science.gov (United States)

    Yazdani, Negareh; Sadeghi, Ramin; Momeni-Moghaddam, Hamed; Zarifmahmoudi, Leili; Ehsaei, Asieh; Barrett, Brendan T

    2017-06-01

    To compare full-time occlusion (FTO) and part-time occlusion (PTO) therapy in the treatment of amblyopia, with the secondary aim of evaluating the minimum number of hours of part-time patching required for maximal effect from occlusion. A literature search was performed in PubMed, Scopus, Science Direct, Ovid, Web of Science and Cochrane library. Methodological quality of the literature was evaluated according to the Oxford Center for Evidence Based Medicine and modified Newcastle-Ottawa scale. Statistical analyses were performed using Comprehensive Meta-Analysis (version 2, Biostat Inc., USA). The present meta-analysis included six studies [three randomized controlled trials (RCTs) and three non-RCTs]. Pooled standardized difference in the mean changes in the visual acuity was 0.337 [lower and upper limits: -0.009, 0.683] higher in the FTO as compared to the PTO group; however, this difference was not statistically significant (P = 0.056, Cochrane Q value = 20.4 (P = 0.001), I(2) = 75.49%). Egger's regression intercept was 5.46 (P = 0.04). The pooled standardized difference in means of visual acuity changes was 1.097 [lower and upper limits: 0.68, 1.513] higher in the FTO arm (P < 0.001), and 0.7 [lower and upper limits: 0.315, 1.085] higher in the PTO arm (P < 0.001) compared to PTO less than two hours. This meta-analysis shows no statistically significant difference between PTO and FTO in treatment of amblyopia. However, our results suggest that the minimum effective PTO duration, to observe maximal improvement in visual acuity is six hours per day.

  11. Ultrasound contrast agents for bleeding detection and acoustic hemostasis

    Science.gov (United States)

    Zderic, Vesna; Luo, Wenbo; Brayman, Andrew; Crum, Lawrence; Vaezy, Shahram

    2005-04-01

    Objective: To investigate the application of ultrasound contrast agents (UCA) in improving both therapeutic and diagnostic aspects of ultrasound-guided High Intensity Focused Ultrasound (HIFU) therapy. Methods: Incisions (3 cm long, 0.5 cm deep) were made in rabbit livers (in anterior surface for HIFU treatment, or posterior surface for bleeding detection). UCA Optison (~0.1 ml/kg) was injected into mesenteric vein or ear vein. A HIFU applicator (5.5 MHz, 6400 W/cm2) was scanned manually over the incision until hemostasis was achieved. Occult bleeding was monitored with Doppler ultrasound. Results: The presence of Optison produced 37% reduction in hemostasis times normalized to initial bleeding rates. Gross and histological observations showed similar appearance of HIFU lesions produced in the presence of Optison and control HIFU lesions. The temperature reached 100°C in both HIFU only and HIFU+UCA treatments. Tension strength of hemostatic liver incisions was 0.9+/-0.5 N. Almost no bleeding could be detected before Optison injection. First appearance of contrast enhancement localized at the bleeding site was 15 s after Optison injection, and lasted for ~50 s. Conclusion: The presence of UCA during HIFU treatment of liver incisions resulted in shortening of HIFU application times and better visualization of bleeding sites.

  12. Local Stability of AIDS Epidemic Model Through Treatment and Vertical Transmission with Time Delay

    Science.gov (United States)

    Novi W, Cascarilla; Lestari, Dwi

    2016-02-01

    This study aims to explain stability of the spread of AIDS through treatment and vertical transmission model. Human with HIV need a time to positively suffer AIDS. The existence of a time, human with HIV until positively suffer AIDS can be delayed for a time so that the model acquired is the model with time delay. The model form is a nonlinear differential equation with time delay, SIPTA (susceptible-infected-pre AIDS-treatment-AIDS). Based on SIPTA model analysis results the disease free equilibrium point and the endemic equilibrium point. The disease free equilibrium point with and without time delay are local asymptotically stable if the basic reproduction number is less than one. The endemic equilibrium point will be local asymptotically stable if the time delay is less than the critical value of delay, unstable if the time delay is more than the critical value of delay, and bifurcation occurs if the time delay is equal to the critical value of delay.

  13. Timing of growth hormone treatment affects trabecular bone microarchitecture and mineralization in growth hormone deficient mice.

    Science.gov (United States)

    Kristensen, Erika; Hallgrímsson, Benedikt; Morck, Douglas W; Boyd, Steven K

    2010-08-01

    Growth hormone (GH) is essential in the development of bone mass, and a growth hormone deficiency (GHD) in childhood is frequently treated with daily injections of GH. It is not clear what effect GHD and its treatment has on bone. It was hypothesized that GHD would result in impaired microarchitecture, and an early onset of treatment would result in a better recovery than late onset. Growth hormone deficient homozygous (lit/lit) mice of both sexes were divided into two treatment groups receiving daily injections of GH, starting at an early (21 days of age) or a late time point (35 days of age, corresponding to the end of puberty). A group of heterozygous mice with normal levels of growth hormone served as controls. In vivo micro-computed tomography scans of the fourth lumbar vertebra were obtained at five time points between 21 and 60 days of age, and trabecular morphology and volumetric BMD were analyzed to determine the effects of GH on bone microarchitecture. Early GH treatment led to significant improvements in bone volume ratio (p=0.006), tissue mineral density (p=0.005), and structure model index (p=0.004) by the study endpoint (day 60), with no detected change in trabecular thickness. Trabecular number increased and trabecular separation decreased in GHD mice regardless of treatment compared to heterozygous mice. This suggests fundamental differences in the structure of trabecular bone in GHD and GH treated mice, reflected by an increased number of thinner trabeculae in these mice compared to heterozygous controls. There were no significant differences between the late treatment group and GHD mice except for connectivity density. Taken together, these results indicate that bone responds to GH treatment initiated before puberty but not to treatment commencing post-puberty, and that GH treatment does not rescue the structure of trabecular bone to that of heterozygous controls. Copyright 2010 Elsevier Inc. All rights reserved.

  14. Timing of Intravenous Immunoglobulin Treatment and Risk of Coronary Artery Abnormalities in Children with Kawasaki Disease

    Directory of Open Access Journals (Sweden)

    Aswine K. Bal

    2014-10-01

    Conclusion: The results of this study suggest that although IVIG treatment within 10 days is important to minimize development of cardiac pathology, neither occurrence of CA lesions in IVIG-treated children nor the time frame for resolution of established CA abnormalities was associated with the timing of IVIG administration. Age 40 mm/hour predict a delay in resolution of CA lesions among children with KD.

  15. Impact of Time-Varying Treatment Exposures on the Risk of Venous Thromboembolism in Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Joshua D. Brown

    2016-12-01

    Full Text Available Multiple myeloma (MM has one of the highest risks of venous thromboembolism (VTE of all cancers due to pathologic changes and treatment-related exposures. This study assessed the one-year incidence of VTE in newly diagnosed MM and to determine the baseline and time-varying treatment-related factors associated with VTE risk in a U.S.-based cohort. MM patients were identified and age, gender, and baseline comorbidities were determined. Treatment-related exposures included thalidomide derivatives (IMIDs, proteasome inhibitors, cytotoxic chemotherapy, steroids, erythropoietin-stimulating agents (ESAs, stem cell transplants (SCT, hospitalizations, infection, and central venous catheters (CVC. Multiple statistical models were used including a baseline competing risks model, a time-varying exposure Cox proportional hazard (CPH model, and a case-time-control analysis. The overall incidence of VTE was 107.2 per 1000 person-years with one-half of the VTEs occurring in the first 90 days. The baseline model showed that increasing age, heart failure, and hypertension were associated with one-year incidence of VTE. MM-specific IMID treatment had lower than expected associations with VTE based on prior literature. Instead, exposure to ESAs, SCT, CVC, and infection had higher associations. Based on these results, VTE risk in MM may be less straightforward than considering only chemotherapy exposures, and other treatment-related exposures should be considered to determine patient risk.

  16. Computational modeling and real-time control of patient-specific laser treatment of cancer.

    Science.gov (United States)

    Fuentes, D; Oden, J T; Diller, K R; Hazle, J D; Elliott, A; Shetty, A; Stafford, R J

    2009-04-01

    An adaptive feedback control system is presented which employs a computational model of bioheat transfer in living tissue to guide, in real-time, laser treatments of prostate cancer monitored by magnetic resonance thermal imaging. The system is built on what can be referred to as cyberinfrastructure-a complex structure of high-speed network, large-scale parallel computing devices, laser optics, imaging, visualizations, inverse-analysis algorithms, mesh generation, and control systems that guide laser therapy to optimally control the ablation of cancerous tissue. The computational system has been successfully tested on in vivo, canine prostate. Over the course of an 18 min laser-induced thermal therapy performed at M.D. Anderson Cancer Center (MDACC) in Houston, Texas, the computational models were calibrated to intra-operative real-time thermal imaging treatment data and the calibrated models controlled the bioheat transfer to within 5 degrees C of the predetermined treatment plan. The computational arena is in Austin, Texas and managed at the Institute for Computational Engineering and Sciences (ICES). The system is designed to control the bioheat transfer remotely while simultaneously providing real-time remote visualization of the on-going treatment. Post-operative histology of the canine prostate reveal that the damage region was within the targeted 1.2 cm diameter treatment objective.

  17. The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method

    Energy Technology Data Exchange (ETDEWEB)

    Keall, Paul J., E-mail: paul.keall@sydney.edu.au; O’Brien, Ricky; Huang, Chen-Yu [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Camperdown, New South Wales 2006 (Australia); Aun Ng, Jin [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Camperdown, New South Wales 2006, Australia and School of Physics, University of Sydney, Camperdown, New South Wales 2006 (Australia); Colvill, Emma [Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Camperdown, New South Wales 2006, Australia and Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales 2065 (Australia); Rugaard Poulsen, Per; Fledelius, Walther [Department of Oncology, Aarhus University Hospital, 8000 Aarhus C, Denmark and Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C (Denmark); Juneja, Prabhjot; Booth, Jeremy T. [School of Physics, University of Sydney, Camperdown, New South Wales 2006, Australia and Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales 2065 (Australia); Simpson, Emma; Bell, Linda; Alfieri, Florencia; Eade, Thomas; Kneebone, Andrew [Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales 2065 (Australia)

    2015-01-15

    Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time image guidance method that uses widely available radiotherapy technology, i.e., a gantry-mounted x-ray imager. The authors report on the geometric and dosimetric results of the first patient treatment using KIM which occurred on September 16, 2014. Methods: KIM uses current and prior 2D x-ray images to estimate the 3D target position during cancer radiotherapy treatment delivery. KIM software was written to process kilovoltage (kV) images streamed from a standard C-arm linear accelerator with a gantry-mounted kV x-ray imaging system. A 120° pretreatment kV imaging arc was acquired to build the patient-specific 2D to 3D motion correlation. The kV imager was activated during the megavoltage (MV) treatment, a dual arc VMAT prostate treatment, to estimate the 3D prostate position in real-time. All necessary ethics, legal, and regulatory requirements were met for this clinical study. The quality assurance processes were completed and peer reviewed. Results: During treatment, a prostate position offset of nearly 3 mm in the posterior direction was observed with KIM. This position offset did not trigger a gating event. After the treatment, the prostate motion was independently measured using kV/MV triangulation, resulting in a mean difference of less than 0.6 mm and standard deviation of less than 0.6 mm in each direction. The accuracy of the marker segmentation was visually assessed during and after treatment and found to be performing well. During treatment, there were no interruptions due to performance of the KIM software. Conclusions: For the first time, KIM has been used for real-time image guidance during cancer radiotherapy. The measured accuracy and precision were both submillimeter for the first treatment fraction. This clinical translational research milestone paves the way for the broad implementation of real-time image guidance to facilitate the detection and correction of geometric and

  18. Shortening treatment time in robotic radiosurgery using a novel node reduction technique

    Energy Technology Data Exchange (ETDEWEB)

    Water, Steven van de; Hoogeman, Mischa S.; Breedveld, Sebastiaan; Heijmen, Ben J. M. [Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Groene Hilledijk 301, 3075 EA Rotterdam (Netherlands)

    2011-03-15

    Purpose: The fraction duration of robotic radiosurgery treatments can be reduced by generating more time-efficient treatment plans with a reduced number of node positions, beams, and monitor units (MUs). Node positions are preprogramed locations where the robot can position the focal spot of the x-ray beam. As the time needed for the robot to travel between node positions takes up a large part of the treatment time, the aim of this study was to develop and evaluate a node reduction technique in order to reduce the treatment time per fraction for robotic radiosurgery. Methods: Node reduction was integrated into the inverse planning algorithm, developed in-house for the robotic radiosurgery modality. It involved repeated inverse optimization, each iteration excluding low-contribution node positions from the planning and resampling new candidate beams from the remaining node positions. Node reduction was performed until the exclusion of a single node position caused a constraint violation, after which the shortest treatment plan was selected retrospectively. Treatment plans were generated with and without node reduction for two lung cases of different complexity, one oropharyngeal case and one prostate case. Plan quality was assessed using the number of node positions, beams and MUs, and the estimated treatment time per fraction. All treatment plans had to fulfill all clinical dose constraints. Extra constraints were added to maintain the low-dose conformality and restrict skin doses during node reduction. Results: Node reduction resulted in 12 residual node positions, on average (reduction by 77%), at the cost of an increase in the number of beams and total MUs of 28% and 9%, respectively. Overall fraction durations (excluding patient setup) were shortened by 25% (range of 18%-40%), on average. Dose distributions changed only little and dose in low-dose regions was effectively restricted by the additional constraints. Conclusions: The fraction duration of robotic

  19. Rapid phase-correlated rescanning irradiation improves treatment time in carbon-ion scanning beam treatment under irregular breathing

    Science.gov (United States)

    Mori, Shinichiro; Furukawa, Takuji

    2016-05-01

    To shorten treatment time in pencil beam scanning irradiation, we developed rapid phase-controlled rescanning (rPCR), which irradiates two or more isoenergy layers in a single gating window. Here, we evaluated carbon-ion beam dose distribution with rapid and conventional PCR (cPCR). 4 dimensional computed tomography (4DCT) imaging was performed on 12 subjects with lung or liver tumors. To compensate for intrafractional range variation, the field-specific target volume (FTV) was calculated using 4DCT within the gating window (T20-T80). We applied an amplitude-based gating strategy, in which the beam is on when the tumor is within the gating window defined by treatment planning. Dose distributions were calculated for layered phase-controlled rescanning under an irregular respiratory pattern, although a single 4DCT data set was used. The number of rescannings was eight times. The prescribed doses were 48 Gy(RBE)/1 fr (where RBE is relative biological effectiveness) delivered via four beam ports to the FTV for the lung cases and 45 Gy(RBE)/2 fr delivered via two beam ports to the FTV for the liver cases. In the liver cases, the accumulated dose distributions showed an increased magnitude of hot/cold spots with rPCR compared with cPCR. The results of the dose assessment metrics for the cPCR and rPCR were very similar. The D 95, D max, and D min values (cPCR/rPCR) averaged over all the patients were 96.3  ±  0.9%/96.0  ±  1.2%, 107.3  ±  3.6%/107.1  ±  2.9%, and 88.8  ±  3.2%/88.1  ±  3.1%, respectively. The treatment times in cPCR and rPCR were 110.7 s and 53.5 s, respectively. rPCR preserved dose conformation under irregular respiratory motion and reduced the total treatment time compared with cPCR.

  20. Adding liraglutide to oral antidiabetic drug therapy: onset of treatment effects over time

    DEFF Research Database (Denmark)

    Gallwitz, B; Vaag, A; Falahati, A;

    2010-01-01

    AIM: To investigate the onset of treatment effects over time observed for liraglutide in combination with oral antidiabetic drugs (OADs). METHODS: This analysis included patients from three phase 3, 26-week, randomised, double-blind, parallel-group trials. Prior to randomisation, patients underwent...

  1. Factors Associated with Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana

    Science.gov (United States)

    Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard

    2016-01-01

    Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…

  2. Effect of solution heat treatment time on a rheocast Al-Zn-Mg-Cu alloy

    CSIR Research Space (South Africa)

    Mazibuko, NE

    2011-06-01

    Full Text Available During rheo-high pressure die casting (R-HPDC) of Al-Zn-Mg-Cu alloys a coarse eutectic phase is formed. This eutectic phase is difficult to take into solution because of its size and it would require longer solution heat treatment times...

  3. A Comparison of Constant Time Delay Instruction with High and Low Treatment Integrity

    Science.gov (United States)

    Tekin Iftar, Elif; Kurt, Onur; Cetin, Ozlem

    2011-01-01

    Time delay (TD) procedure is an effective procedure in teaching various skills to children with developmental disabilities. Moreover, research has shown that it is used with high treatment integrity (HTI). However, there are several barriers which may prevent delivery instruction with HTI. Therefore, this study was designed to compare the…

  4. Time Course of Treatment Effect of OROS[R] Methylphenidate in Children with ADHD

    Science.gov (United States)

    Armstrong, Robert B.; Damaraju, C. V.; Ascher, Steve; Schwarzman, Lesley; O'Neill, James; Starr, H. Lynn

    2012-01-01

    Objective: The authors evaluated the time course of the treatment effect of Osmotic-Release Oral System methylphenidate (OROS[R] MPH) HCl (Concerta[R], Raritan, NJ) CII in children with ADHD. Method: Data were combined from two double-blind, randomized, placebo-controlled, cross-over, analog classroom studies in children (9-12 years) with ADHD.…

  5. Comparison of time required for traditional versus virtual orthognathic surgery treatment planning.

    Science.gov (United States)

    Wrzosek, M K; Peacock, Z S; Laviv, A; Goldwaser, B R; Ortiz, R; Resnick, C M; Troulis, M J; Kaban, L B

    2016-09-01

    Virtual surgical planning (VSP) is a tool for predicting complex surgical movements in three dimensions and it may reduce preoperative laboratory time. A prospective study to compare the time required for standard preoperative planning versus VSP was conducted at Massachusetts General Hospital from January 2014 through January 2015. Workflow data for bimaxillary cases planned by both standard techniques and VSP were recorded in real time. Time spent was divided into three parts: (1) obtaining impressions, face-bow mounting, and model preparation; (2) occlusal analysis and modification, model surgery, and splint fabrication; (3) online VSP session. Average times were compared between standard treatment planning (sum of parts 1 and 2) and VSP (sum of parts 1 and 3). Of 41 bimaxillary cases included, 20 were simple (symmetric) and 21 were complex (asymmetry and segmental osteotomies). Average times for parts 1, 2, and 3 were 4.43, 3.01, and 0.67h, respectively. The average time required for standard treatment planning was 7.45h and for VSP was 5.10h, a 31% time reduction (Porthognathic surgery cases.

  6. Monitoring changes in anti-tuberculosis treatment: associated factors determined at the time of diagnosis.

    Science.gov (United States)

    Altet, M N; Vidal, R; Milá, C; Rodrigo, T; Casals, M; Mir, I; Ruiz-Manzano, J; Jiménez-Fuentes, M A; Sánchez, F; Maldonado, J; Blanquer, R; de Souza-Galväo, M L; Solsona, J; Azlor, E; Díaz, D; Calpe, J L; Caylá, J A

    2013-11-01

    To determine predictive factors for changes in standard anti-tuberculosis chemotherapy at the time of diagnosis. A prospective study was performed among tuberculosis (TB) patients treated at specialised centres during 2008-2009. Treatment outcome was monitored per standard guidelines. Treatment was considered successful if the patient was cured or completed treatment. Factors associated with treatment modification were analysed at the bivariate and multivariate levels using logistic regression. A total of 427 patients were included in the study. The initial standard treatment regimen was retained for 249 patients (58.3%), extended to 9 months for 36 (8.4%) and changed for 142 (33.3%). Factors associated with a change of regimen at the multivariate level were female sex, age ≥ 50 years, human immunodeficiency virus infection, comorbidities, alcoholism, hospitalisation and culture-positive sputum. Drug resistance and toxicity were analysed independently. Treatment outcome was successful in 97.2% of cases without a regimen change and in 87.3% of those with a changed regimen (P tuberculosis regimen should be considered for rigorous follow-up. Results obtained through individualised treatment provided by specialists were good despite the complexity of the cases treated.

  7. Management of Forgotten Ureteral Stents: Relationship Between Indwelling Time and Required Treatment Approaches.

    Science.gov (United States)

    Polat, Hacı; Yücel, Mehmet Özgür; Utangaç, Mehmet M; Benlioğlu, Can; Gök, Alper; Çift, Ali; Kalyenci, Bedreddin; Lök, Uğur; Gülaçtı, Umut

    2017-08-04

    Double-J stents are widely used in urology practice, and removal of these stents can sometimes be forgotten. To investigate whether indwelling time of double-J stent can predict which treatment modality is required for removal of the stent from the body. A multicentre, retrospective observational study. The data of 57 patients who were treated for forgotten ureteral stents between January 2007 and December 2014 were evaluated retrospectively. Patients were classified into four groups according to indwelling time of the stents: 6-12 months, 13-24 months, 25-36 months, and forgotten double-J stents. Transurethral procedures are sufficient for the treatment of patients with double-J stent indwelling times less than 30 months.

  8. Theoretical Prediction and Experimental Determination of Heating Time During High-Temperature Heat Treatment of Wood

    Directory of Open Access Journals (Sweden)

    LIU Xin-you

    2011-06-01

    Full Text Available Theoretical prediction provides basic understanding and guidance to correctly implement a certaintechnology in the production process. The present study uses a differential equation to predict the heattransfer time between the surface and core layer of wood during the heat treatment, with applicability inestimating the duration of heat treatments at high temperatures. The obtained prediction was compared withthe result of an experimental study performed on Chinese poplar wood with various thicknesses (20, 40 and60mm. During this experiment, the time necessary for the core of wood to reach a temperature of 100°C,130°C and finally 180°C was monitored and the recorded values were compared with the predicted ones.The result of this comparison proved that the experimental values matched the theoretically predicted times,validating thus the applicability of the proposed equation as prediction tool.

  9. Alzheimer's Disease: Differences of Transdermal versus Oral Treatment on Caregiving Time

    Science.gov (United States)

    Riedel, O.; Emmrich, A.; Klotsche, J.; Dodel, R.; Förstl, H.; Maier, W.; Reichmann, H.; Wittchen, H.-U.

    2012-01-01

    Background Data on indirect effects of dementia treatment on caregiver burden obtained from naturalistic studies are still lacking. We explored differences between patients with oral and transdermal application of acetylcholine esterase inhibitors regarding caregiver's time burden and psychopathology. Methods A cross-sectional naturalistic cohort study of 403 patients in outpatient care with three treatment groups (none, oral, and transdermal) was conducted. Assessments included a standardized clinical burden questionnaire and a standardized caregiver interview. Results Any treatment was associated with lower burden in most measures. Transdermal treatment was superior regarding (1) administration time (p < 0.001); (2) rates of administration problems (p = 0.031); (3) burden in activities of daily living (p = 0.008), and (4) caregiver anxiety (OR 0.25; 95% CI 0.05–0.99). Caregivers did not report better quality of life regarding mental/physical health. Physicians’ and caregivers’ ratings of patients’ improvements were not associated (κ = 0.01–0.06). Conclusions Benefits associated with transdermal treatment do not translate into a better ‘generic quality of life’ of the caregiver. The substantially different perceptions of patients’ improvements need to be considered in future studies. PMID:23277781

  10. Treatment of open hand injuries: does timing of surgery matter? A single-centre prospective analysis.

    Science.gov (United States)

    Juon, Bettina H; Iseli, Michelle; Kreutziger, Janett; Constantinescu, Mihai A; Vögelin, Esther

    2014-10-01

    The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.

  11. [Better AVK treatment with self monitoring. Dosage can be regulated in time].

    Science.gov (United States)

    Stigendal, L; André, U; Christenson, B

    1999-05-19

    As long-term anticoagulant treatment, with warfarin for instance, is associated with a risk of both thrombotic and thrombolytic complications, blood testing for dose regulation is necessary at 3-8-week intervals, which is expensive and inconvenient for patients who must take time off work and travel to and fro. A new technique, using small portable monitors designed for home use by patients, makes self-management of anticoagulant treatment possible. In Germany, over 25,000 patients had their own monitor by the end of 1998. After appropriate instruction, the German patients are able to monitor their prothrombin time and adjust their anticoagulant treatment accordingly. In case of problems they contact their GP. In a two-year pilot study conducted at the Anticoagulation Clinic of Sahlgrenska University Hospital, Gothenburg, in 1996-98, where 51 patients on long-term anticoagulant treatment were trained in self-management, the results of over 1,000 patient-hours of treatment showed self-management to be at least as safe as management by the clinic. The level of patient satisfaction is high, in terms of safety and freedom from regular hospital attendance during working hours, and the convenience of self-monitoring on holiday or business trips. As the patients do their testing once a week, the risk of complications is also reduced.

  12. Effects of plasma treatment time on modification of acrylic denture material

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective:To study the relationship between plasma treatment time and efficacy. Methods:Test specimens were prepared from an acrylic resin denture material in the size of 2 mm × 10 mm × 10 mm. Plasma treatment was carried out on the surface of Polymethyl methacrylate(PMMA) at different time. XPS studies, IR spectra studies and measurement of wetting angle were performed. Results: XPS showed the peak corresponding to C-O getting higher as the treatment proceeded, however at 120 seconds, the peak did not increase any longer and partly crossed with the peak at the duration of 60 seconds. IR spectra showed the wave corresponding to C-H was reduced as O2-plasma treatment proceeded, and then changed little. Wetting angle initially decreased dramatically, however, as the reaction proceeded, wetting angle increased slightly. Conclusion:Equilibrium was reached for introducing oxygen-containing groups and changing of C-H. As the treatment proceeded, wetting angle increased slightly.

  13. Clinical significance of cumulative biological effective dose and overall treatment time in the treatment of carcinoma cervix

    Directory of Open Access Journals (Sweden)

    Mandal Abhijit

    2007-01-01

    Full Text Available The purpose of this retrospective study is to report the radiotherapy treatment response of, and complications in, patients with cervical cancer on the basis of cumulative biologic effective dose (BED and overall treatment time (OTT. Sixty-four (stage II - 35/64; stage III - 29/64 patients of cervical cancer were treated with combination of external beam radiotherapy (EBRT and low dose rate intracavitary brachytherapy (ICBT. The cumulative BED was calculated at Point A (BED 10 ; and bladder, rectal reference points (BED 2.5 using the linear-quadratic BED equations. The local control (LC rate and 5-year disease-free survival (DFS rate in patients of stage II were comparable for BED 10 < 84.5 and BED 10 > 84.5 but were much higher for BED 10 > 84.5 than BED 10 < 84.5 ( P < 0.01 in stage III patients. In the stage II patients, The LC rate and 5-year DFS rate were comparable for OTT < 50 days and for OTT> 50 days but were much higher in stage III patients with OTT < 50 than OTT> 50 days ( P < 0.001. It was also observed that patients who received BED 2.5 < 105 had lesser rectal ( P < 0.001 and bladder complications than BED 2.5 > 105. Higher rectal complication-free survival (CFS R rate, bladder complication-free survival (CFS B rate and all-type late complication-free survival rate were observed in patients who received BED 2.5 < 105 than BED 2.5 > 105. A balanced, optimal and justified radiotherapy treatment schedule to deliver higher BED 10 (>84.5 and lower BED 2.5 (< 105 in lesser OTT (< 50 days is essential in carcinoma cervix to expect a better treatment outcome in all respects.

  14. Effect of lactic acid bacteria probiotic culture treatment timing on Salmonella Enteritidis in neonatal broilers.

    Science.gov (United States)

    Higgins, J P; Higgins, S E; Wolfenden, A D; Henderson, S N; Torres-Rodriguez, A; Vicente, J L; Hargis, B M; Tellez, G

    2010-02-01

    In the present study, a series of experiments were conducted to evaluate the ability of a combination of 3 ATCC lactobacilli (LAB3) or a commercially available probiotic culture (PROB) to reduce Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) in broiler chicks. Additionally, we varied the timing of PROB administration in relationship to Salmonella challenge and determined the influence on recovery of enteric Salmonella. In experiments 1 to 3, chicks were randomly assigned to treatment groups and were then challenged via oral gavage with Salmonella Enteritidis. Chicks were treated 1 h after Salmonella Enteritidis challenge with LAB3 or PROB. Twenty-four hours posttreatment, cecal tonsils were collected for recovery of enteric Salmonella. In experiments 4 to 7, day-of-hatch chicks were randomly assigned to treatment groups and were then treated with PROB via oral gavage and placed into pens. Chicks were challenged with Salmonella Enteritidis 24 h after treatment via oral gavage. At 24 h after Salmonella Enteritidis challenge, cecal tonsils were collected and recovery of enteric Salmonella was determined. In experiments 8 to 10, 1-d-old chicks were randomly assigned to treatment groups and were then challenged via oral gavage with Salmonella Enteritidis and placed into pens. Chicks were treated 24 h after challenge with PROB via oral gavage. Twenty-four hours post PROB treatment, cecal tonsils were collected and enriched as described above. It was found that PROB significantly reduced cecal Salmonella Enteritidis recovery 24 h after treatment as compared with controls or LAB3-treated chicks in experiments 1 to 3 (PSalmonella Enteritidis challenge significantly reduced recovery of Salmonella Enteritidis in 2 out of 4 experiments and no reduction in cecal Salmonella Enteritidis was observed when chicks were challenged with Salmonella Enteritidis and treated 24 h later with PROB. These data demonstrate that PROB more effectively reduced Salmonella

  15. Intracranial aneurysms that repeatedly reopen over time after coiling: imaging characteristics and treatment outcome

    Energy Technology Data Exchange (ETDEWEB)

    Rooij, Willem J. van; Sprengers, Marieke E.; Sluzewski, Menno [St Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Beute, Guus N. [St Elisabeth Ziekenhuis, Department of Neurosurgery, Tilburg (Netherlands)

    2007-04-15

    We report imaging and clinical characteristics of patients with aneurysms that repeatedly reopened over time and were coiled three times or more during a follow-up period of 2-11 years. At angiographic follow-up of 624 of 827 aneurysms coiled between 1995 and 2005, 74 aneurysms (8.9%) reopened and were additionally coiled. During an extended follow-up, 12 aneurysms (1.5%) in 12 patients repeatedly reopened and were repeatedly coiled. Initial aneurysm sizes ranged from 15 to 30 mm. Four aneurysms contained intraluminal thrombus. Eight aneurysms were associated with subarachnoid hemorrhage and two with a mass effect, and two were incidentally discovered. The locations of aneurysms were basilar artery (eight), carotid artery (two), anterior communicating artery (one) and middle cerebral artery (one). Altogether, 49 coil treatments were performed in the 12 aneurysms, ranging from three to six coil treatments per aneurysm. Of the 49 coil treatments, 20 (41%) were performed with a supporting device. There were no procedural complications (0%, 97.5% CI 0-5.7%). The mean clinical follow-up period was 70.6 months (median 60, range 25-135 months). All 12 patients are neurologically doing well (GOS 5). Reopening was by compaction in nine aneurysms and by migration of coils into intraluminal thrombus in three aneurysms. In two aneurysms, late regrowth became apparent at 76 and 95 months after the previous coiling. Aneurysms that reopen over time and need to be coiled for a second time should be imaged at regular intervals to detect repeated reopening or regrowth. The treatment strategy of regular follow-up and additional treatments when necessary is effective and safe. (orig.)

  16. Time to discontinuation of atypical versus typical antipsychotics in the naturalistic treatment of schizophrenia

    Directory of Open Access Journals (Sweden)

    Swartz Marvin

    2006-02-01

    Full Text Available Abstract Background There is an ongoing debate over whether atypical antipsychotics are more effective than typical antipsychotics in the treatment of schizophrenia. This naturalistic study compares atypical and typical antipsychotics on time to all-cause medication discontinuation, a recognized index of medication effectiveness in the treatment of schizophrenia. Methods We used data from a large, 3-year, observational, non-randomized, multisite study of schizophrenia, conducted in the U.S. between 7/1997 and 9/2003. Patients who were initiated on oral atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine, or ziprasidone or oral typical antipsychotics (low, medium, or high potency were compared on time to all-cause medication discontinuation for 1 year following initiation. Treatment group comparisons were based on treatment episodes using 3 statistical approaches (Kaplan-Meier survival analysis, Cox Proportional Hazards regression model, and propensity score-adjusted bootstrap resampling methods. To further assess the robustness of the findings, sensitivity analyses were performed, including the use of (a only 1 medication episode for each patient, the one with which the patient was treated first, and (b all medication episodes, including those simultaneously initiated on more than 1 antipsychotic. Results Mean time to all-cause medication discontinuation was longer on atypical (N = 1132, 256.3 days compared to typical antipsychotics (N = 534, 197.2 days; p Conclusion In the usual care of schizophrenia patients, time to medication discontinuation for any cause appears significantly longer for atypical than typical antipsychotics regardless of the typical antipsychotic potency level. Findings were primarily driven by clozapine and olanzapine, and to a lesser extent by risperidone. Furthermore, only clozapine and olanzapine therapy showed consistently and significantly longer treatment duration compared to perphenazine, a medium

  17. Quantifying and Valuing Community Health Worker Time in Improving Access to Malaria Diagnosis and Treatment.

    Science.gov (United States)

    Castellani, Joëlle; Mihaylova, Borislava; Ajayi, IkeOluwapo O; Siribié, Mohamadou; Nsungwa-Sabiiti, Jesca; Afonne, Chinenye; Sermé, Luc; Balyeku, Andrew; Kabarungi, Vanessa; Kyaligonza, Josephine; Evers, Silvia M A A; Paulus, Aggie T G; Petzold, Max; Singlovic, Jan; Gomes, Melba

    2016-12-15

     Community health workers (CHWs) are members of a community who are chosen by their communities as first-line, volunteer health workers. The time they spend providing healthcare and the value of this time are often not evaluated. Our aim was to quantify the time CHWs spent on providing healthcare before and during the implementation of an integrated program of diagnosis and treatment of febrile illness in 3 African countries.  In Burkina Faso, Nigeria, and Uganda, CHWs were trained to assess and manage febrile patients in keeping with Integrated Management of Childhood Illness recommendations to use rapid diagnostic tests, artemisinin-based combination therapy, and rectal artesunate for malaria treatment. All CHWs provided healthcare only to young children usually <5 years of age, and hence daily time allocation of their time to child healthcare was documented for 1 day (in the high malaria season) before the intervention and at several time points following the implementation of the intervention. Time spent in providing child healthcare was valued in earnings of persons with similar experience.  During the high malaria season of the intervention, CHWs spent nearly 50 minutes more in daily healthcare provision (average daily time, 30.2 minutes before the intervention vs 79.5 minutes during the intervention; test for difference in means P < .01). On average, the daily time spent providing healthcare during the intervention was 55.8 minutes (Burkina Faso), 77.4 minutes (Nigeria), and 72.2 minutes (Uganda). Using the country minimum monthly salary, CHWs' time allocated to child healthcare for 1 year was valued at US Dollars (USD) $52 in Burkina Faso, USD $295 in Nigeria, and USD $141 in Uganda.  CHWs spend up to an hour and a half daily on child healthcare in their communities. These data are informative in designing reward systems to motivate CHWs to continue providing good-quality services.  ISRCTN13858170. © 2016 World Health Organization; licensee

  18. Analysis of Acupuncture Treatment Characteristics of Epigastric Pain in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    LIU Li-gong; GU Jie; XIAO Yuan-chun

    2005-01-01

    @@ Epigastric pain involves the inflammation, ulcer,spasm and tumor in the stomach, esophagus,diaphragm and the like. The heart, liver, gallbladder and spleen are near to the epigastrium, so the pain associated with these organs is mistakenly taken as epigastric pain. Consequently, some of these organs' disorders are inevitably included in this study. With the help of computer, we have statistically analyzed the information concerning the treatment of epigastric pain by acupuncture in 93 ancient medical books. Results show that 66 pieces of information and 60 acupoints (139 times in frequency) are involved in the treatment of epigastric pain.

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

    Science.gov (United States)

    2009-04-01

    11. Khokhlova, V.A., et al., Effects of nonlinear propagation, cavitation , and boiling in lesion formation by high intensity focused ultrasound in...intensity focused ultrasound (HIFU) has been developed as an emerging non-invasive strategy for cancer treatment by thermal ablation of tumor tissue. The...Concepts, Seattle, WA) operating at its fundamental frequency (1.1 MHz) or its third harmonics (3.3 MHz). The ultrasound imaging system was a 5/7

  20. Effectiveness of streamlined admissions to methadone treatment: a simplified time-series analysis.

    Science.gov (United States)

    Dennis, M L; Ingram, P W; Burks, M E; Rachal, J V

    1994-01-01

    Increasing the availability of, and streamlining the admissions process to, methadone treatment have consistently been the focus of national plans to address the acquired immune deficiency syndrome (AIDS) epidemic. This article uses simplified time-series analysis to evaluate one of the first methadone treatment Waiting List Reduction Demonstration Grants. The demonstration grant significantly increased both the number of people requesting intake appointments from 35 to 100 per month and the percentage of kept appointments from 33% to 54%. An additional 100 slots (an entire year's waiting list) were filled in fewer than three months and actually resulted in a net increase in the length of the waiting list. Relative to the preceding two years, new clients during the grant period were significantly more likely to be 41 or older, African-American, unemployed, daily opioid users, daily cocaine users, and dependent on public assistance to finance treatment. Controlling for the source of treatment financing (a case-mix adjustment), there were no significant changes in retention rates. The program's static client capacity rose from 310 prior to the grant to a peak of 449 during the grant, with a leveling to 410 after the grant. Given that it is clearly more humane and less expensive to treat people who want treatment rather than wait for them to commit a crime and be arrested or even executed, this study strongly suggests the need to make more treatment available on demand.

  1. Enhancement of High-Intensity Focused Ultrasound Heating by Short-Pulse Generated Cavitation

    Directory of Open Access Journals (Sweden)

    Shin Yoshizawa

    2017-03-01

    Full Text Available A target tissue can be thermally coagulated in high-intensity focused ultrasound (HIFU treatment noninvasively. HIFU thermal treatments have been clinically applied to various solid tumors. One of the problems in HIFU treatments is a long treatment time. Acoustically driven microbubbles can accelerate the ultrasonic heating, resulting in the significant reduction of the treatment time. In this paper, a method named “trigger HIFU exposure” which employs cavitation microbubbles is introduced and its results are reviewed. A trigger HIFU sequence consists of high-intensity short pulses followed by moderate-intensity long bursts. Cavitation bubbles induced in a multiple focal regions by rapidly scanning the focus of high-intensity pulses enhanced the temperature increase significantly and produced a large coagulation region with high efficiency.

  2. Variation in ultrasonic frequency and time as pre-treatments to air-drying of carrot

    Directory of Open Access Journals (Sweden)

    Ernest Ekow Abano

    2013-03-01

    Full Text Available Vegetable drying is an alternative method to curb post harvest decay of vegetables and a process to produce dried vegetables, which can be directly consumed or used as ingredients for the preparation of soups, stews, baby foods, cakes, puddings, and many other foods. In this study, the effect of ultrasound frequency and sonication time as pre-treatment prior to air drying at 70°C at an air velocity of 0.5 m/s, on carrot drying kinetics, flavour, colour, and non-enzymatic browning was investigated using a 3-level factorial response surface method. The result showed that an increase in sonication frequency and time did not significantly increase moisture diffusivity but in comparison with the control, water diffusivity increased after ultrasound application and the overall drying time was reduced. Application of the ultrasound pre-treatment in distilled water resulted in water gain and sugar loss, indicating that the ultrasonic pre-treatment can be an important step to produce low sugar content dried products. The brightness and redness to yellowness values of the ultrasonically pre-treated dried carrots were better than those without ultrasound application. In comparison with the flavour of the control, the ultrasound pre-treated samples recorded higher flavour response signals, indicating that the application of ultrasound improved the flavour of the dried carrot. The variation in sonication frequency and time did not significantly affect the non-enzymatic browning index of the dried products but were better than the control.

  3. Daily treatment time and functional gains of stroke patients during inpatient rehabilitation.

    Science.gov (United States)

    Wang, Hua; Camicia, Michelle; Terdiman, Joseph; Mannava, Murali K; Sidney, Stephen; Sandel, M Elizabeth

    2013-02-01

    To study the effects of daily treatment time on functional gain of patients who have had a stroke. A retrospective cohort study. An inpatient rehabilitation hospital (IRH) in northern California. Three hundred sixty patients who had a stroke and were discharged from the IRH in 2007. Average minutes of rehabilitation therapy per day, including physical therapy, occupation therapy, speech and language therapy, and total treatment. Functional gain measured by the Functional Independence Measure, including activities of daily living, mobility, cognition, and the total of the Functional Independence Measure (FIM) scores. The study sample had a mean age of 64.8 years; 57.4% were men and 61.4% were white. The mean total daily therapy time was 190.3 minutes, and the mean total functional gain was 26.0. A longer daily therapeutic duration was significantly associated with total functional gain (r = .23, P = .0094). Patients who received a total therapy time of therapy, occupational therapy, and speech and language therapy also was significantly associated with corresponding subscale functional gains. In addition, hemorrhagic stroke, left brain injury, earlier IRH admission, and a longer IRH stay were associated with total functional improvement. The study demonstrated a significant relationship between daily therapeutic duration and functional gain during IRH stay and showed treatment time thresholds for optimal functional outcomes for patients in inpatient rehabilitation who had a stroke. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  4. Continuous online monitoring of ionic dialysance allows modification of delivered hemodialysis treatment time.

    Science.gov (United States)

    Chesterton, Lindsay J; Priestman, William S; Lambie, Stewart H; Fielding, Catherine A; Taal, Maarten W; Fluck, Richard J; McIntyre, Christopher W

    2006-10-01

    Considerable intrinsic intrapatient variability influences the actual delivery of Kt/V. The aim of this study is to examine the feasibility of using continuous online assessment of ionic dialysance measurements (Kt/V(ID)) to allow dialysis sessions to be altered on an individual basis. Ten well-established chronic hemodialysis (HD) patients without significant residual renal function were studied (mean age 65+/-4.3 [38-81] years, mean length of time on dialysis 66+/-18 [14-189] months). These patients had all been receiving thrice-weekly 4-hr dialysis using Integra dialysis monitors. Dialysis monitors were equipped with Diascan modules permitting measurement of Kt/V(ID). Predicted treatment time required to achieve a Kt/V(ID) > or = 1.1 (equivalent to a urea-based method of 1.2) was calculated from the delivered Kt/V(ID) at 60 and 120 min. Treatment time was reprogrammed at 2 hr (ensuring all planned ultrafiltration would be accommodated into the new modified session duration). Owing to practical issues, and to avoid excessively short dialysis times, these changes were censored at no more than+/-10% of the usual 240-min treatment time (210-265 min). Data were collected from a total of 50 dialysis sessions. Almost all sessions (47/50) required modification of the standard treatment time: 13/50 sessions were lengthened and 34/50 shortened (mean length of session 232.2+/-2.5 [210-265] min). A Kt/V(ID) of > or = 1.1 was achieved in 39/50 sessions. The difference in mean urea-based Kt/V poststudy (1.3+/-0.05 [1.1-1.6]) and mean achieved Kt/V(ID) (1.16+/-0.02 [0.7-1.37]) was significant (p = 0.002). The use of individualized variable dialysis treatment time using online ionic dialysance measurements of Kt/V(ID) appears both practicable and effective at ensuring consistently delivered adequate dialysis.

  5. Psychometric properties of the adjective rating scale for withdrawal across treatment groups, gender, and over time.

    Science.gov (United States)

    Barbosa-Leiker, Celestina; McPherson, Sterling; Mamey, Mary Rose; Burns, G Leonard; Roll, John

    2014-02-01

    The adjective rating scale for withdrawal (ARSW) is commonly used to assess opiate withdrawal in clinical practice and research. The aims of this study were to examine the factor structure of the ARSW, test measurement invariance across gender and treatment groups, and assess longitudinal measurement invariance across the clinical trial. Secondary data analysis of the National Drug Abuse Treatment Clinical Trials Network 000-3, a randomized clinical trial comparing two tapering strategies, was performed. The ARSW was analyzed at baseline, end of taper and 1-month follow-up (N=515 opioid-dependent individuals). A 1-factor model of the ARSW fit the data and demonstrated acceptable reliability. Measurement invariance was supported across gender and taper groups. Longitudinal measurement invariance was not found across the course of the trial, with baseline assessment contributing to the lack of invariance. If change over time is of interest, change from post-treatment through follow-up may offer the most valid comparison.

  6. Time course and mechanisms of the anti-hypertensive and renal effects of liraglutide treatment

    DEFF Research Database (Denmark)

    von Scholten, B J; Lajer, M; Goetze, J P

    2015-01-01

    AIMS: Glucagon-like peptide-1 receptor agonist studies have revealed clinically significant reductions in systolic blood pressure (SBP). The aim was to investigate the time course of the anti-hypertensive effect of liraglutide treatment and potential underlying mechanisms. METHODS: We used an open...... weeks of maximum dose. Reductions in ECV and MR-proANP may explain the anti-hypertensive potential. Liraglutide treatment was associated with reversible reductions in albuminuria and GFR, which has to be confirmed in randomized trials.......-four-h SBP increased by 10 mmHg on day 3 (P = 0.008) and 7 mmHg on day 7 (P = 0.033, 0.6 mg/day). On day 29, (1.8 mg/day), 24-h SBP was 7 mmHg lower compared with baseline (P = 0.11). Following the treatment period (day 49) and after washout (day 70), 24-h BP was equivalent to baseline. In addition...

  7. Timing of prostaglandin F2α treatment in an estrogen-based protocol for timed artificial insemination or timed embryo transfer in lactating dairy cows.

    Science.gov (United States)

    Pereira, M H C; Sanches, C P; Guida, T G; Rodrigues, A D P; Aragon, F L; Veras, M B; Borges, P T; Wiltbank, M C; Vasconcelos, J L M

    2013-05-01

    Objectives were to investigate progesterone concentrations and fertility comparing 2 different intervals from PGF(2α) treatment and induced ovulation in an estrogen-based ovulation synchronization protocol for timed artificial insemination (TAI) or timed embryo transfer (TET) in lactating dairy cows. A total of 1,058 lactating Holstein cows [primiparous (n=371) and multiparous (n=687)], yielding 34.1 ± 0.33 kg of milk/d at various days in milk were randomly assigned to receive treatment with PGF(2α) on either d 7 or 8 of the following protocol: d 0: 2mg of estradiol benzoate + controlled internal drug release device; d 8: controlled internal drug release device removal + 1.0mg of estradiol cypionate; d 10: TAI or d 17: TET. Only cows with a corpus luteum at d 17 received an embryo and all cows received GnRH at TET. Pregnancy diagnoses were performed by detection (transrectal ultrasonography) of an embryo on d 28 or a fetus on d 60. Fertility [pregnancy per artificial insemination (P/AI) or pregnancy per embryo transfer (P/ET)] was affected by breeding technique (AI vs. ET) and time of PGF(2α) treatment (d 7 vs. 8) at the 28-d pregnancy diagnosis for TAI [32.9% (238) vs. 20.6% (168)] and TET cows [47% (243) vs. 40.7% (244)] and at the 60-d pregnancy diagnosis for TAI [30% (238) vs. 19.2% (168)] and TET cows [37.9% (243) vs. 33.5% (244)]. The progesterone (P4) concentration at d 10 altered fertility in TAI cows, with higher P/AI in cows with P4 concentration <0.1 ng/mL compared with cows with P4 concentration ≥ 0.1 ng/mL, and in ET cows, with higher P/ET in cows with P4 concentration <0.22 ng/mL compared with cows with P4 concentration ≥ 0.22 ng/mL. Prostaglandin F(2α) treatment at d 7 increased the percentage of cows with P4 <0.1 ng/mL on d 10 [39.4 (85) vs. 23.2 (54)]. Reducing the period between PGF(2α) and TAI from 72 to 48 h in dairy cows resulted in a clear reduction in fertility in cows bred by TAI and a subtle negative effect in cows that received

  8. APPLICATION OF TIME-VARYING VISCOUS GROUT IN GRAVEL- FOUNDATION ANTI-SEEPAGE TREATMENT*

    Institute of Scientific and Technical Information of China (English)

    CHENG Peng-da; LI Lu; TANG Ju; WANG Dao-zeng

    2011-01-01

    The time-varying viscosity of common grout and the controllable grout are measured with a rotation viscometer in experiments. The time-varying viscosity of grout is analyzed according to the characteristics in the process of anti-seepage treatment for gravel foundation. The principle of effective stress for porous medium is applied to analyzes the fluid-structure coupling in grouting. In the consideration of coupling physical variables, dynamic models of porosity, permeability and viscosity are constructed.The difiusion radius can thus be defined by the foundational porosity. The distribution of holes in field experiments is designed according to the diffusion radius of grout. Then, the permeability test is designed to verify the grout effect. The calculated diffusion radius coincides with experimental results, and the permeability meets the requirements of the project, which is valuable for the anti-seepage treatment in gravel foundation.

  9. CLINICAL OBSERVATION ON TREATMENT OF STUBBORN HICCUP BY ACUPUNCTURE WITH DIFFERENT NEEDLE RETAINING TIME

    Institute of Scientific and Technical Information of China (English)

    包飞; 梁中; 王凤琴

    2003-01-01

    Purpose:Observe the effect of different duration of needle-retention on acupuncture treatment of stub-born hiccup. Methods: 85 cases of stubborn hiccup patients are randomly divided into control group (n=40) and treat-rment grcup(n=45) according to their visiting time. For patients of control group, acupuncture needles (in both scalppoints and body acupoints) are retained for 30 min, While for patients of treatment group, the needles inserted in thebody acupoints are retained for 1 hr, and that inserted in scalp-point is retained for more than 6 hrs. The treatment isconducted once daily, continuously for 5 times. Results: The cure rate of treatment group is 88.9% (that for deficiencysyndrome is 85.3%), and that of control group is 65% (that for deficiency syndrome is 53.3% ). There is a significantdifference between two groups in the cure rate (P<0.05). The cure rates for excess syndrome of two groups both are100%. Conclusion: Longer retention of acupuncture needle has a better therapeutic effect for deficiency-syndrome typehiccup.

  10. Treatment timing of MARA and fixed appliance therapy of Class II malocclusion.

    Science.gov (United States)

    Ghislanzoni, Luis Tomas Huanca; Baccetti, Tiziano; Toll, Douglas; Defraia, Efisio; McNamara, James A; Franchi, Lorenzo

    2013-06-01

    The objective of this study is to evaluate the effect of timing on Mandibular Anterior Repositioning Appliance (MARA) and fixed appliance treatment of Class II malocclusion in a prospective clinical trial. The treated sample consisted of 51 consecutively treated patients at prepubertal (n = 21), pubertal (n = 15), and postpubertal (n = 15) stages of development. Control groups for the three treated groups were generated from growth data of untreated Class II subjects. Lateral cephalograms were digitized and superimposed via cephalometric software at T1 (pre-treatment) and T2 (after comprehensive treatment). The T1-T2 changes in the treated groups were compared to those in their corresponding control groups with Mann-Whitney tests with Bonferroni correction. Mandibular elongation was greater at the pubertal stage (Co-Gn +2.6 mm, with respect to controls). Headgear effect on the maxilla was greater in the pre-peak sample (Co-A -1.9 mm, with respect to controls). Dentoalveolar compensations (proclination of lower incisors, extrusion and mesialization of lower molars, and reduction in the overbite) were significant in the pre-peak and post-peak groups. Optimal timing for Class II treatment with MARA appliance is at the pubertal growth spurt, with enhanced mandibular skeletal changes and minimal dentoalveolar compensations.

  11. MICROSTRUCTURAL AND MECHANICAL STUDY OF ALUMINIUM ALLOYS SUBMITTED TO DISTINCT SOAKING TIMES DURING SOLUTION HEAT TREATMENT

    Directory of Open Access Journals (Sweden)

    Valmir Martins Monteiro

    2014-12-01

    Full Text Available This work studies the microstructural characteristics and mechanical properties for different aluminium alloys (1100, 3104 and 8011 hot rolled sheets that were subjected to a solution heat treatment with distinct soaking times, in order to promote microstructural and mechanical changes on these alloys with solute fractions slightly above the maximum solubility limit. Scanning Electronic Microscopy (SEM / Energy Dispersive Spectroscopy X-Ray (EDS, X-Ray Diffraction (XRD and Hardness Tests were employed to observe the microstructural / compositional and mechanical evaluation. For the 1100 and 8011 alloys the more suitable soaking time occur between 1 and 2 hours, and for the 3104 alloy occurs between 2 and 3 hours.

  12. Focused ultrasound for treatment of uterine myoma: From experimental model to clinical practice

    Directory of Open Access Journals (Sweden)

    Terzić Milan

    2008-01-01

    Full Text Available It is well known that focused ultrasound has a biologic effect on tissue. High intensity focused ultrasound (HIFU on a small target area raises the temperature of the tissue enough to denaturate proteins and cause irreversible cell damage. The tight focus of the ultrasound energy allows delivery of the intended dose to a very precise location. The resulting coagulation necrosis is relatively painless. The application of this method in the human clinical setting has required pilot studies on an animal model. Although the treatment had a high success rate, there was a significant percentage of complications, mainly attributed to the technical drawbacks of the procedure. Therefore, this method has been modified for use in humans, and the HIFU is now guided, monitored and controlled by magnetic resonance imaging (MRI. In October 2004, Food and Drug Adiministration (FDA approved MRI guided focused ultrasound treatment of uterine fibroids in humans. Since then, successful treatment of uterine myomas by HIFU has been performed in thousands of women.

  13. Treatment time with self-ligating orthodontic brackets: a literature review

    OpenAIRE

    Claudino, Dikson; Philippi, Victor May

    2016-01-01

    AIM: The aim of this study was carry out a literature review on the self-ligating brackets (SLB), identifying publications which evaluated the treatment time with these systems comparing them to the conventional brackets (CB). MATERIAL AND METHODS: The following indexing bases were researched: Medline (Medicine online – International Literature on Health Sciences), LILACS (Latin-American and Caribbean Literature on Health Science), IBECS (Spanish Bibliographic on Health Sciences), SciELO (Sci...

  14. Effect of timing of count events on estimates of sea lice abundance and interpretation of effectiveness following bath treatments.

    Science.gov (United States)

    Gautam, R; Vanderstichel, R; Boerlage, A S; Revie, C W; Hammell, K L

    2017-03-01

    Effectiveness of sea lice bath treatment is often assessed by comparing pre- and post-treatment counts. However, in practice, the post-treatment counting window varies from the day of treatment to several days after treatment. In this study, we assess the effect of post-treatment lag time on sea lice abundance estimates after chemical bath treatment using data from the sea lice data management program (Fish-iTrends) between 2010 and 2014. Data on two life stages, (i) adult female (AF) and (ii) pre-adult and adult male (PAAM), were aggregated at the cage level and log-transformed. Average sea lice counts by post-treatment lag time were computed for AF and PAAM and compared relative to treatment day, using linear mixed models. There were 720 observations (treatment events) that uniquely matched pre- and post-treatment counts from 53 farms. Lag time had a significant effect on the estimated sea lice abundance, which was influenced by season and pre-treatment sea lice levels. During summer, sea lice were at a minimum when counted 1 day post-treatment irrespective of pre-treatment sea lice levels, whereas in the spring and autumn, low levels were observed for PAAM over a longer interval of time, provided the pre-treatment sea lice levels were >5-10.

  15. Timing underpins the benefits associated with injectable collagen biomaterial therapy for the treatment of myocardial infarction.

    Science.gov (United States)

    Blackburn, Nick J R; Sofrenovic, Tanja; Kuraitis, Drew; Ahmadi, Ali; McNeill, Brian; Deng, Chao; Rayner, Katey J; Zhong, Zhiyuan; Ruel, Marc; Suuronen, Erik J

    2015-01-01

    Injectable hydrogel biomaterials are promising therapies to promote repair and regeneration post-myocardial infarction (MI). However, the timing of delivery and the mechanisms through which biomaterial treatments confer their benefits are translational issues that remain to be addressed. We assessed the efficacy of an injectable collagen matrix at 3 different delivery time points post-MI. Infarcted mice received the matrix or control (saline) treatment at 3 h, 1 week or 2 weeks after MI. The earlier treatment delivery better prevented negative ventricular remodeling and long-term deterioration of cardiac function (up to 3 months), whereas waiting longer to administer the matrix (1 and 2 weeks post-MI) reduced the therapeutic effects. Collagen matrix delivery did not stimulate an inflammatory response acutely and favorably modulated inflammation in the myocardium long-term. We found that the matrix interacts with the host tissue to alter the myocardial cytokine profile, promote angiogenesis, and reduce fibrosis and cell death. This work highlights that the timing of delivery can significantly affect the ability of an injectable hydrogel to protect the post-MI environment, which will be an important consideration in the clinical translation of cardiac biomaterial therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Adjuvant Chemoradiation Therapy for Cervical Cancer and Effect of Timing and Duration on Treatment Outcome.

    Science.gov (United States)

    Jhawar, Sachin; Hathout, Lara; Elshaikh, Mohamed A; Beriwal, Sushil; Small, William; Mahmoud, Omar

    2017-08-01

    Worse treatment outcomes can be expected with prolongation of the overall treatment time (OTT) during definitive chemoradiation therapy (CRT) for cervical cancer. In the adjuvant setting, data on the relative importance of the OTT and the importance of RT and chemotherapy synchronization are scarce. Using the National Cancer Database, we evaluated the effect of these treatment variables on overall survival in the adjuvant CRT setting. The present analysis included nonmetastatic cervical cancer patients undergoing hysterectomy followed by adjuvant CRT. The proportional hazard model was used to estimate the effect of prognostic factors (age, comorbidity, race, tumor size, tumor grade, tumor histologic type, number of high-risk pathologic factors) and time-related variables (surgery to RT start interval [SR], OTT [RT start to end dates], package time [from diagnosis date to CRT end date] and optimum CRT synchronization [whether chemotherapy and RT start dates coincided]) on survival. Of 3051 patients, 60% finished RT within 7 weeks and 85% received optimum CRT. Among other factors, univariate analysis identified longer OTT (hazards ratio [HR] 1.33; P7 weeks remained a significant factor even after propensity score matching (P=.04). The results of our analysis suggest that prolongation of the adjuvant CRT duration >7 weeks is associated with poor survival and SR of <8 weeks should be attempted whenever clinically feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Hemiepiphysiodesis: similar treatment time for tension-band plating and for stapling

    Science.gov (United States)

    2013-01-01

    Background In children with angulating deformities of the lower limbs, hemiepiphysiodesis can be used to guide growth to achieve better alignment at skeletal maturity. Traditionally, this has been performed with staples. The tension-band plating technique is new and it has been advocated because it is believed to reduce the risk of premature closure of the growth plate compared to stapling. The benefit of the tension-band plating technique has not yet been proven in experimental or randomized clinical studies. Methods We performed a randomized clinical trial in which 26 children with idiopathic genu valgum were allocated to stapling or tension-band plating hemiepiphysiodesis. Time to correction of the deformity was recorded and changes in angles on long standing radiographs were measured. Pain score using visual analog scale (VAS) was recorded for the first 72 h postoperatively. Analgesics taken were recorded by the parents. Results Mean treatment times for stapling hemiepiphysiodesis (n = 10) and for tension-band plating hemiepiphysiodesis (n = 10) were similar. Postoperative VAS scores and consumption of analgesics were also similar in both groups. No hardware failure or wound-related infection was observed. Interpreatation Treatment time for the 2 treatment modalities was not significantly different in this randomized clinical trial. Tension-band plating and stapling appeared to have a similar effect regarding correction of genu valgum. We cannot rule out type-II error and the possibility that our study was underpowered. ClinicalTrials.gov Identifier: NCT01641354. PMID:23485073

  18. Correlation of p63 immunohistochemistry with histology and contrast enhanced MRI in characteristic lesions induced by minimally invasive thermal treatments in a dog prostate

    Science.gov (United States)

    Pascal, A.; Butts-Pauly, K.; Plata, J.; Sommer, G.; Daniel, B.; Bouley, D. M.

    2017-03-01

    Thermal ablation techniques are important tools to treat low grade tumors in the prostate gland. The use of Magnetic Resonance Imaging (MRI) has been an excellent tool to visualize and assess the thermally ablated areas in real time. In this study slides from dog prostates previously treated with cryoablation or High Intensity Focal Ultrasound (HIFU) were immunohistochemically stained with the biomarker p63, in order to determine if this marker would be helpful for differentiatiating between viable, sub lethally damaged and normal glands. Digitized slides were analyzed using Sedeen Viewer software, and compared with corresponding representative H&E slides and MR images. p63 staining in the cryoablated acute duration prostates was negative in the coagulation necrosis zone (region of interest subjected to the coldest temperatures). In acute duration HIFU treated prostates, the central heat-fixed zone (region of interest subjected to the hottest temperatures) still displayed + p63 staining. Cryoablated or HIFU subacute duration treated prostates were very hemorrhagic, but presented the same stain pattern in the treated areas as the acute duration prostates, and in chronic duration prostates, whether treated with cryo or HIFU, glands displayed robust p63 staining most prevalent in the outer edges of the lesion where there was extensive glandular regeneration. In conclusion, this study demonstrates the value of p63 IHC and its usefulness in detecting viable prostate basal cells in normal dog prostates following either cryoablation of HIFU. Our results suggest that the portions of the lesion with complete loss of p63 staining correspond well to the non-enhancing region in cryoablated prostates, as viewed with MRI. However, p63 staining in the heat-fixed zone in acute harvested HIFU treated prostates remains positive, suggesting either inadequate heat to destroy basal cells, or heat-fixation of the p63 antigen and false positive staining. Therefore p63 staining does not

  19. Weight variation over time and its association with tuberculosis treatment outcome: a longitudinal analysis.

    Directory of Open Access Journals (Sweden)

    Antonio Bernabe-Ortiz

    Full Text Available OBJECTIVE: Weight variation during therapy has been described as a useful marker to predict TB treatment outcome. No previous study has used longitudinal analysis to corroborate this finding. The goal of this study was to evaluate change and trends of patients' bodyweight over time depending on TB treatment outcome. METHODS AND FINDINGS: A retrospective cohort study with all TB cases diagnosed from 2000 to 2006 was carried out. Information from 5 public tuberculosis treatment facilities at Pampas de San Juan de Miraflores, Lima, Peru was analyzed. Poor outcome was defined as failure or death during TB therapy, and compared to good outcome defined as cured. Longitudinal analysis with a pre-specified marginal model was fitted using Generalized Estimating Equations to compare weight trends for patients with good and poor outcome adjusting for potential confounders. A total of 460 patients (55.4% males, mean age: 31.6 years were included in the analysis: 42 (9.1% had a poor outcome (17 failed and 25 died. Weight at baseline was not different comparing outcome groups (p = 0.17. After adjusting for age, gender, type of TB, scheme of treatment, HIV status and sputum variation during follow-up, after the first month of treatment, patients with good outcome gained, on average, almost 1 kg compared to their baseline weight (p<0.001, whereas those with poor outcome lost 1 kg (p = 0.003. Similarly, after 4 months, a patient with good outcome increased 3 kg on average (p<0.001, while those with poor outcome only gained 0.2 kg (p = 0.02. CONCLUSIONS: Weight variation during tuberculosis therapy follow-up can predict treatment outcome. Patients losing weight during TB treatment, especially in the first month, should be more closely followed as they are at risk of failure or death.

  20. A novel image-guided high-intensity focused ultrasound system for tumor treatment

    Science.gov (United States)

    Wu, Zhiqiang; Wu, Puwei; Chen, Bojie; Guan, Jian; Huang, Zheng

    2004-07-01

    A novel ultrasonography-guided high intensity focused ultrasound (HIFU) system (FS-100; Force Electronics Co. Ltd, Chongqing, China) was developed for non-invasive thermal ablation of tumor. The proprietary therapy delivery system is an integration of the digital image progressing, automatic control and the high intensity focused ultrasound thermal ablation devices. The therapeutic ultrasound probe (φ = 240 mm) consists of eight circular HIFU transducers with a curved surface of a diameter of 60 mm. Dual focused beams generated from the probe were used in this system for thermal delivery. The probe has the maximal resonance frequency of 1 MHz, a maximal treatment depth of 160 mm and focal spot diameter of 3 mm. The maximal intensity at the focal spot is 10,000 W/cm2. The imaging and HIFU components are located on top of the device, therefore, the focused ultrasound beams can be delivered to the patient in a supine position. The motion, targeting and localization of the probe are controlled by a PMAC-PC motion controller and an 8-independent-axis mechanical device. The linear motion error of the probe localization is <= 0.1 mm. The ultrasonographic image information is used for treatment planning and therapeutic interventions, such as target definition and registration, visualization of the three-dimensional anatomy of desired target(s), automatic positioning the thermal beams on targets, controlling thermal delivery, and rapid evaluation of target response post-treatment. The preclinical experimental results will be presented. The safety, feasibility and effectiveness of this novel HIFU system will be tested.

  1. Assessing time to pulmonary function benefit following antibiotic treatment of acute cystic fibrosis exacerbations

    Directory of Open Access Journals (Sweden)

    O'Riordan Mary A

    2010-10-01

    Full Text Available Abstract Background Cystic Fibrosis (CF is a life-shortening genetic disease in which ~80% of deaths result from loss of lung function linked to inflammation due to chronic bacterial infection (principally Pseudomonas aeruginosa. Pulmonary exacerbations (intermittent episodes during which symptoms of lung infection increase and lung function decreases can cause substantial resource utilization, morbidity, and irreversible loss of lung function. Intravenous antibiotic treatment to reduce exacerbation symptoms is standard management practice. However, no prospective studies have identified an optimal antibiotic treatment duration and this lack of objective data has been identified as an area of concern and interest. Methods We have retrospectively analyzed pulmonary function response data (as forced expiratory volume in one second; FEV1 from a previous blinded controlled CF exacerbation management study of intravenous ceftazidime/tobramycin and meropenem/tobramycin in which spirometry was conducted daily to assess the time course of pulmonary function response. Results Ninety-five patients in the study received antibiotics for at least 4 days and were included in our analyses. Patients received antibiotics for an average of 12.6 days (median = 13, SD = 3.2 days, with a range of 4 to 27 days. No significant differences were observed in mean or median treatment durations as functions of either treatment group or baseline lung disease stage. Average time from initiation of antibiotic treatment to highest observed FEV1 was 8.7 days (median = 10, SD = 4.0 days, with a range of zero to 19 days. Patients were treated an average of 3.9 days beyond the day of peak FEV1 (median = 3, SD = 3.8 days, with 89 patients (93.7% experiencing their peak FEV1 improvement within 13 days. There were no differences in mean or median times to peak FEV1 as a function of treatment group, although the magnitude of FEV1 improvement differed between groups. Conclusions Our

  2. Time-dependent theoretical treatments of the dynamics of electrons and nuclei in molecular systems

    Science.gov (United States)

    Deumens, E.; Diz, A.; Longo, R.; Öhrn, Y.

    1994-07-01

    An overview is presented of methods for time-dependent treatments of molecules as systems of electrons and nuclei. The theoretical details of these methods are reviewed and contrasted in the light of a recently developed time-dependent method called electron-nuclear dynamics. Electron-nuclear dynamics (END) is a formulation of the complete dynamics of electrons and nuclei of a molecular system that eliminates the necessity of constructing potential-energy surfaces. Because of its general formulation, it encompasses many aspects found in other formulations and can serve as a didactic device for clarifying many of the principles and approximations relevant in time-dependent treatments of molecular systems. The END equations are derived from the time-dependent variational principle applied to a chosen family of efficiently parametrized approximate state vectors. A detailed analysis of the END equations is given for the case of a single-determinantal state for the electrons and a classical treatment of the nuclei. The approach leads to a simple formulation of the fully nonlinear time-dependent Hartree-Fock theory including nuclear dynamics. The nonlinear END equations with the ab initio Coulomb Hamiltonian have been implemented at this level of theory in a computer program, ENDyne, and have been shown feasible for the study of small molecular systems. Implementation of the Austin Model 1 semiempirical Hamiltonian is discussed as a route to large molecular systems. The linearized END equations at this level of theory are shown to lead to the random-phase approximation for the coupled system of electrons and nuclei. The qualitative features of the general nonlinear solution are analyzed using the results of the linearized equations as a first approximation. Some specific applications of END are presented, and the comparison with experiment and other theoretical approaches is discussed.

  3. Outside-of-school time obesity prevention and treatment interventions in African American youth.

    Science.gov (United States)

    Barr-Anderson, D J; Singleton, C; Cotwright, C J; Floyd, M F; Affuso, O

    2014-10-01

    Outside-of-school time (OST; i.e. before/after-school hours, summer time), theory-based interventions are potential strategies for addressing increased obesity among African American youth. This review assessed interventions across multiple settings that took place during OST among African American youth aged 5-18 years old. Seven databases were searched for studies published prior to October 2013; 28 prevention and treatment interventions that assessed weight or related behaviours as a primary or secondary outcome were identified. Overall, these studies reported heterogeneous intervention length, theoretical frameworks, methodological quality, outcomes, cultural adaption and community engagement; the latter two attributes have been identified as potentially important intervention strategies when working with African Americans. Although not always significant, generally, outcomes were in the desired direction. When examining programmes by time of intervention (i.e. after-school, summer time, time not specified or multiple time periods), much of the variability remained, but some similarities emerged. After-school studies generally had a positive impact on physical activity, fruit/vegetable consumption and caloric intake, or body composition. The single summer time intervention showed a trend towards reduced body mass index. Overall findings suggest that after-school and summer programmes, alone or perhaps in combination, offer potential benefits for African American youth and could favourably influence diet and physical activity behaviour.

  4. Effect of real-time teledermatology on diagnosis, treatment and clinical improvement.

    Science.gov (United States)

    Al Quran, Hanadi A; Khader, Yousef Saleh; Ellauzi, Ziad Mohd; Shdaifat, Amjad

    2015-03-01

    We assessed the effect of real-time teledermatology consultations on diagnosis and disease management, patients' quality of life and time- and cost-savings. All consecutive patients with skin diseases attending teledermatology clinics at two rural hospitals in Jordan were included in the study. Patients were interviewed at their initial visit and again after eight weeks. Various questionnaires and forms, including quality of life questionnaires, were used to collect the data. Ninety teledermatology consultations were performed for 88 patients between September 2013 and January 2014. A diagnosis was established as part of the teledermatology consultation in 43% of patients and changed from that of the referring provider in 19% of patients. The treatment plan was established for 67% of patients and changed for 9% patients. The mean SF-8 score increased significantly (P < 0.005). The mean DLQI score decreased significantly (P < 0.005) indicating that there had been an improvement in the patients' quality of life since baseline. Most patients perceived that the visit to the teledermatology clinic required less travel time (96%), shorter waiting time (83%) and less cost (96%) than a visit to the specialist clinic at the main hospital. The patients' mean satisfaction score was 90.5 (SD 8.5), indicating a high level of satisfaction. Teledermatology resulted in changes in the patients' diagnosis and treatment plan, and was associated with improved health state and quality of life.

  5. Radiotherapy beyond cancer: Target localization in real-time MRI and treatment planning for cardiac radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Ipsen, S. [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006, Australia and Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Blanck, O.; Rades, D. [Department of Radiation Oncology, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Oborn, B. [Illawarra Cancer Care Centre (ICCC), Wollongong, New South Wales 2500, Australia and Centre for Medical Radiation Physics (CMRP), University of Wollongong, Wollongong, New South Wales 2500 (Australia); Bode, F. [Medical Department II, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Liney, G. [Ingham Institute for Applied Medical Research, Liverpool Hospital, Liverpool, New South Wales 2170 (Australia); Hunold, P. [Department of Radiology and Nuclear Medicine, University of Luebeck and University Medical Center Schleswig-Holstein, Campus Luebeck, Luebeck 23562 (Germany); Schweikard, A. [Institute for Robotics and Cognitive Systems, University of Luebeck, Luebeck 23562 (Germany); Keall, P. J., E-mail: paul.keall@sydney.edu.au [Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 (Australia)

    2014-12-15

    Purpose: Atrial fibrillation (AFib) is the most common cardiac arrhythmia that affects millions of patients world-wide. AFib is usually treated with minimally invasive, time consuming catheter ablation techniques. While recently noninvasive radiosurgery to the pulmonary vein antrum (PVA) in the left atrium has been proposed for AFib treatment, precise target location during treatment is challenging due to complex respiratory and cardiac motion. A MRI linear accelerator (MRI-Linac) could solve the problems of motion tracking and compensation using real-time image guidance. In this study, the authors quantified target motion ranges on cardiac magnetic resonance imaging (MRI) and analyzed the dosimetric benefits of margin reduction assuming real-time motion compensation was applied. Methods: For the imaging study, six human subjects underwent real-time cardiac MRI under free breathing. The target motion was analyzed retrospectively using a template matching algorithm. The planning study was conducted on a CT of an AFib patient with a centrally located esophagus undergoing catheter ablation, representing an ideal case for cardiac radiosurgery. The target definition was similar to the ablation lesions at the PVA created during catheter treatment. Safety margins of 0 mm (perfect tracking) to 8 mm (untracked respiratory motion) were added to the target, defining the planning target volume (PTV). For each margin, a 30 Gy single fraction IMRT plan was generated. Additionally, the influence of 1 and 3 T magnetic fields on the treatment beam delivery was simulated using Monte Carlo calculations to determine the dosimetric impact of MRI guidance for two different Linac positions. Results: Real-time cardiac MRI showed mean respiratory target motion of 10.2 mm (superior–inferior), 2.4 mm (anterior–posterior), and 2 mm (left–right). The planning study showed that increasing safety margins to encompass untracked respiratory motion leads to overlapping structures even in the

  6. Time Windows of Interneuron Development: Implications to Our Understanding of the Aetiology and Treatment of Schizophrenia

    Directory of Open Access Journals (Sweden)

    Zarina Greenberg

    2015-11-01

    Full Text Available Schizophrenia is a devastating neuropsychiatric disorder widely believed to arise from defects during brain development. Indeed, dysfunction in the formation and function of GABAergic cortical interneurons has been implicated as a central pathogenic mechanism in this, and other, neurodevelopmental disorders. Understanding the coordination and timing of interneuron development including the complex processes of specification, proliferation, migration and their incorporation into finely tuned cortical networks is therefore essential in determining their role in neurodevelopmental disease. Studies using mouse models have highlighted the functional relevance of transcription factor networks and common signalling pathways in interneuron development but have faced challenges in identifying clear time windows where these factors are essential. Here we discuss recent developments highlighting critical time frames in the specification and migration of cortical interneurons and the impact of aberrant development to aetiology and treatments of schizophrenia.

  7. Treatment time of ultrasound therapy interferes with the organization of collagen fibers in rat tendons

    Directory of Open Access Journals (Sweden)

    Thiago S. Farcic

    2013-06-01

    Full Text Available BACKGROUND: The application time of therapeutic ultrasound is an infrequently studied dosimetric variable that affects tissue repair. OBJECTIVES: The aim of this study was to evaluate the effects of different treatment times of therapeutic ultrasound (US on the organization of collagen fibers in the tendons of rats. METHOD: Forty Wistar rats were selected (300±45 g, and the rats were divided into five groups (n=8 for each group: Control, without tenotomy or any treatment; tenotomy group, with tenotomy and without treatment; US groups (US1, US2, and US3, subjected to tenotomy and treated with US for one, two, or three minutes per area of the transducer, respectively. The animals were sacrificed on the 12th post-operative day, and the tendons were surgically removed for analyses of the collagen fiber organization by means of birefringence analysis. RESULTS: The collagen fibers exhibited better aggregation and organization in the US3 group compared with the tenotomy group (p<0.05. CONCLUSIONS: The findings suggest that US applied for three minutes per treated area improves the organization of collagen fibers during rat tendon repair.

  8. Temperature and Time Requirements for Controlling Bed Bugs (Cimex lectularius under Commercial Heat Treatment Conditions

    Directory of Open Access Journals (Sweden)

    Stephen A. Kells

    2011-08-01

    Full Text Available Developing effective alternative approaches for disinfesting bed bugs from residential spaces requires a balance between obtaining complete insect mortality, while minimizing costs and energy consumption. One method of disinfestation is the application of lethal high temperatures directly to rooms and contents within a structure (termed whole-room heat treatments. However, temperature and time parameters for efficacy in whole-room heat treatments are unknown given the slower rate of temperature increase and the probable variability of end-point temperatures within a treated room. The objective of these experiments was to explore requirements to produce maximum mortality from heat exposure using conditions that are more characteristic of whole-room heat treatments. Bed bugs were exposed in an acute lethal temperature (LTemp trial, or time trials at sub-acute lethal temperatures (LTime. The lethal temperature (LTemp99 for adults was 48.3 °C, while LTemp99 for eggs was 54.8 °C. Adult bed bugs exposed to 45 °C had a LTime99 of 94.8 min, while eggs survived 7 h at 45 °C and only 71.5 min at 48 °C. We discuss differences in exposure methodologies, potential reasons why bed bugs can withstand higher temperatures and future directions for research.

  9. Temperature and Time Requirements for Controlling Bed Bugs (Cimex lectularius) under Commercial Heat Treatment Conditions.

    Science.gov (United States)

    Kells, Stephen A; Goblirsch, Michael J

    2011-08-29

    Developing effective alternative approaches for disinfesting bed bugs from residential spaces requires a balance between obtaining complete insect mortality, while minimizing costs and energy consumption. One method of disinfestation is the application of lethal high temperatures directly to rooms and contents within a structure (termed whole-room heat treatments). However, temperature and time parameters for efficacy in whole-room heat treatments are unknown given the slower rate of temperature increase and the probable variability of end-point temperatures within a treated room. The objective of these experiments was to explore requirements to produce maximum mortality from heat exposure using conditions that are more characteristic of whole-room heat treatments. Bed bugs were exposed in an acute lethal temperature (LTemp) trial, or time trials at sub-acute lethal temperatures (LTime). The lethal temperature (LTemp99) for adults was 48.3 °C, while LTemp99 for eggs was 54.8 °C. Adult bed bugs exposed to 45 °C had a LTime99 of 94.8 min, while eggs survived 7 h at 45 °C and only 71.5 min at 48 °C. We discuss differences in exposure methodologies, potential reasons why bed bugs can withstand higher temperatures and future directions for research.

  10. Individualizing Opioid Use Disorder (OUD Treatment: Time to Fully Embrace a Chronic Disease Model

    Directory of Open Access Journals (Sweden)

    Richard Gustin

    2015-02-01

    Full Text Available The current opioid epidemic in the United States is changing our perceptions of the face of addiction. Opioid Use Disorder (OUD has become pervasive and is affecting all ethnicities, races, socioeconomic classes, the young and the old. In 2015, 46 people will lose their life each day to a chronic brain disease that is going unnoticed and undertreated. Over the last five decades, numerous scientific and clinical breakthroughs have allowed for a better understanding of the mechanisms underlying addiction, and the development of medications that can help support a patient’s long-term recovery. All of those that have contributed to these advancements have aided in redefining addiction as a primary, chronic disease of the brain reward, motivation, memory and related circuitry; however, our treatment strategies have not necessarily advanced to the same extent as our current understanding of the disease. This commentary will explore how personal philosophies can bias treatments strategies and definitions of treatment success, and prevent adoption of chronic disease treatment models that would significantly improve the quality of life of those suffering with OUD. This is a challenge to consider how our views and stigma can impact a patient’s recovery. We are currently losing a battle with a disease that is taking the lives of 46 individuals daily; it is time to fully embrace a chronic disease model which comprises an integrated pharmacopsychosocial approach for treating the biopsychosocial disorder that is addiction to reverse these trends.

  11. SU-E-T-629: Prediction of the ViewRay Radiotherapy Treatment Time for Clinical Logistics

    Energy Technology Data Exchange (ETDEWEB)

    Liu, S; Wooten, H; Wu, Y; Yang, D [Washington University in St Louis, St Louis, MO (United States)

    2015-06-15

    Purpose: An algorithm is developed in our clinic, given a new treatment plan, to predict treatment delivery time for radiation therapy (RT) treatments of patients on ViewRay magnetic resonance-image guided radiation therapy (MR-IGRT) delivery system. This algorithm is necessary for managing patient treatment appointments, and is useful as an indicator to assess the treatment plan complexity. Methods: A patient’s total treatment delivery time, not including time required for localization, may be described as the sum of four components: (1) the treatment initialization time; (2) the total beam-on time; (3) the gantry rotation time; and (4) the multileaf collimator (MLC) motion time. Each of the four components is predicted separately. The total beam-on time can be calculated using both the planned beam-on time and the decay-corrected delivery dose rate. To predict the remaining components, we quantitatively analyze the patient treatment delivery record files. The initialization time is demonstrated to be random since it depends on the final gantry angle and MLC leaf positions of the previous treatment. Based on modeling the relationships between the gantry rotation angles and the corresponding rotation time, and between the furthest MLC leaf moving distance and the corresponding MLC motion time, the total delivery time is predicted using linear regression. Results: The proposed algorithm has demonstrated the feasibility of predicting the ViewRay treatment delivery time for any treatment plan of any patient. The average prediction error is 0.89 minutes or 5.34%, and the maximal prediction error is 2.09 minutes or 13.87%. Conclusion: We have developed a treatment delivery time prediction algorithm based on the analysis of previous patients’ treatment delivery records. The accuracy of our prediction is sufficient for guiding and arranging patient treatment appointments on a daily basis. The predicted delivery time could also be used as an indicator to assess the

  12. Local relapse of prostate cancer after primary definitive treatment: the management.

    Science.gov (United States)

    Palermo, Giuseppe; Foschi, Nazario; D'Agostino, Daniele; Sacco, Emilio; Bassi, Pierfrancesco; Pinto, Francesco

    2016-06-01

    Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and the second leading cause of cancer-related death in industrialized countries. Even if the healing chances are very high after definitive treatment of localized disease, 20-30% of patients experience recurrence. A review of the literature on the management of local recurrent prostate cancer was conducted using the Medline and Embase electronic databases. Search terms included "biochemical relapse", "PSA recurrence", "prostate cancer", "prostate cancer recurrence", "prostate salvage therapy", "radiorecurrent prostate cancer", "Re-HIFU", "post HIFU", "post cryoablation", "postradiation", and "postprostatectomy salvage". The search was restricted to English-language articles. The websites of guidelines organizations (EAU, AUA, NICE) were consulted in order to identify evidence-based practice guidelines. The present role of salvage prostatectomy and radiation therapy was studied and today's outcomes and tomorrow perspectives of salvage focal therapies as cryoablation and HIFU have been analyzed. Although the treatment landscape for patients with biochemical recurrence prostate cancer remains challenging, new research is helping to identify patient populations suitable for specific therapies. Further evaluation in prospective clinical trials will hopefully confirm the role of therapeutic options in clinical practice and the impact on the long-term survival.

  13. SO2 gas adsorption by modified kaolin clays: influence of previous heating and time acid treatments.

    Science.gov (United States)

    Volzone, Cristina; Ortiga, Jose

    2011-10-01

    Modified kaolin clays were used as adsorbents for SO(2) gas adsorptions. The clays were heated up to 900 °C previous to acid treatments with 0.5 N sulfuric acid solutions at boiling temperature during different times up to 1440 min. Equilibrium adsorption at 25 °C and 0.1 MPa was carried out by using a volumetric apparatus. The samples were characterized by chemical analysis, X-ray diffraction and infrared analysis. The heating of the clays followed by acid treatment improved the adsorption capacity of the kaolin clays. The presence of amorphous silica and hydroxyl in the final products improved SO(2) adsorption capacity. Better properties for SO(2) adsorption were found in kaolin rich in not well ordered kaolinite clay mineral. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Drug regimens identified and optimized by output-driven platform markedly reduce tuberculosis treatment time

    Science.gov (United States)

    Lee, Bai-Yu; Clemens, Daniel L.; Silva, Aleidy; Dillon, Barbara Jane; Masleša-Galić, Saša; Nava, Susana; Ding, Xianting; Ho, Chih-Ming; Horwitz, Marcus A.

    2017-01-01

    The current drug regimens for treating tuberculosis are lengthy and onerous, and hence complicated by poor adherence leading to drug resistance and disease relapse. Previously, using an output-driven optimization platform and an in vitro macrophage model of Mycobacterium tuberculosis infection, we identified several experimental drug regimens among billions of possible drug-dose combinations that outperform the current standard regimen. Here we use this platform to optimize the in vivo drug doses of two of these regimens in a mouse model of pulmonary tuberculosis. The experimental regimens kill M. tuberculosis much more rapidly than the standard regimen and reduce treatment time to relapse-free cure by 75%. Thus, these regimens have the potential to provide a markedly shorter course of treatment for tuberculosis in humans. As these regimens omit isoniazid, rifampicin, fluoroquinolones and injectable aminoglycosides, they would be suitable for treating many cases of multidrug and extensively drug-resistant tuberculosis. PMID:28117835

  15. Visual outcomes in relation to time to treatment in neovascular age-related macular degeneration

    DEFF Research Database (Denmark)

    Rasmussen, Annette; Bloch, Sara Brandi; Fuchs, Josefine;

    2015-01-01

    1185 eyes in 1099 patients who began vascular endothelial growth factor inhibitor treatment for nAMD during four separate periods in 2007, 2009, 2011 and 2012 using a fixed loading-dose regimen of three ranibizumab injections. RESULTS: Mean best-corrected visual acuity (BCVA) at presentation remained......PURPOSE: To study the relation between the interval from diagnosis to initiation of intravitreal injection therapy and visual outcome in neovascular age-related macular degeneration (nAMD) and to report changes over time in fellow-eye status. METHODS: Retrospective chart review. The study included....... CONCLUSION: In this study, 2-week-earlier injection was associated with the equivalent of a 5-Early Treatment Diabetic Retinopathy Study letter-gain in mean visual acuity at 3 months after presentation. The difference is larger than expected from the 2-week-longer duration of disease at the study end...

  16. Intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyradiculoneuropathy, a time to start and a time to stop.

    Science.gov (United States)

    Adrichem, Max E; Eftimov, Filip; van Schaik, Ivo N

    2016-09-01

    Intravenous immunoglobulin (IVIg) is often used as preferred treatment in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Several studies highlighted the short-term efficacy of IVIg for CIDP yet many patients need maintenance therapy. Notwithstanding the fact IVIg has been used for over 30 years in CIDP, there is only limited evidence to guide dosage and interval during maintenance treatment. The variation in disease course, lack of biomarkers, and fear of deterioration after stopping IVIg makes long-term treatment challenging. Recent studies suggest a proportion of patients receive unnecessary IVIg maintenance treatment. This review provides an overview of the use of IVIg for CIDP treatment, focusing on evidence for long-term IVIg use.

  17. Gentamicin-induced ototoxicity and nephrotoxicity vary with circadian time of treatment and entail separate mechanisms.

    Science.gov (United States)

    Blunston, Mary A; Yonovitz, Al; Woodahl, Erica L; Smolensky, Michael H

    2015-01-01

    The aminoglycoside antibiotic gentamicin can cause both ototoxicity and nephrotoxicity, the severity of which varies with circadian time of daily treatment. However, it is not yet resolved if such drug-induced adverse effects are independent or interdependent phenomena. Two groups of 9 female Sprague-Dawley rats (200-250 g), each housed separately and entrained to a 12 h light (06:00-18:00 h) - 12 h dark cycle, received a daily subcutaneous injection of 100 mg/kg gentamicin. One group was treated at the beginning of the activity span, 2 Hours After Lights On (HALO), and the other at the beginning of the rest span, 14 HALO. Global toxicity was gauged by both body weight loss relative to the pre-treatment baseline and number of deaths. Ototoxicity, i.e., hearing loss, was assessed by changes in auditory brainstem response (ABR) for pure tone stimuli of 8, 16, 24, and 32 kHz before and after 2 and 4 weeks of gentamicin treatment. Renal toxicity was evaluated by changes in urinary N-acetyl-β-glucosaminidase (NAG)/creatinine (CR) concentration ratio before and after each week of treatment. In a complementary substudy of separate but comparable 2 and 14 HALO groups of rats, blood samples were obtained before and 30, 60, 120, and 240 min post-subcutaneous injection of 100 mg/kg gentamicin. Number of animal deaths was greater in the 2 (4 deaths) than 14 HALO (1 death) group, mirroring more severe initial (first two weeks of treatment) body weight losses from baseline, being more than 2-fold greater in animals of the 2 than 14 HALO group. Ototoxicity progressively worsened during the treatment; although, the extent of hearing loss varied according to circadian time of treatment across all frequencies (p ototoxicity. The mean urinary NAG/CR ratio peaked after the first week of treatment, averaging 13.64-fold greater than baseline for the 2 HALO-treated animals compared to 7.38-fold greater than baseline for the 14 HALO-treated ones. Ratio values declined

  18. Coiling vs. clipping. Hospital stay and procedure time in intracranial aneurysm treatment

    Energy Technology Data Exchange (ETDEWEB)

    Brunken, Martin; Kehler, U. [Abt. fuer Neurochirurgie, Asklepios-Klinik Altona (Germany); Fiehler, J. [Neuroradiology, Universitaetskrankenhaus Hamburg-Eppendorf (Germany); Leppien, A.; Eckert, B. [Fachbereich Neuroradiologie, Asklepios-Klinik Altona (Germany)

    2009-10-15

    Purpose: evaluation of hospital resource allocation in intracranial aneurysm treatment in a medium-volume neurovascular center. Materials and methods: retrospective data analysis included 653 procedures performed on 598 patients with 667 aneurysms (A) from 1990 to 2004. 515 treatments were carried out in ruptured A (clip: n = 370; coil: n = 145) and 138 procedures in non-ruptured A (clip: n = 51, coil: n = 87). Patient management data included procedure time (min), length of stay in the intensive care unit (days), total length of hospital stay (days), and discharge to home ratio. Results: clinical admission grade (rupt. A: Hunt and Hess grade 1-3: clip: 73% coil: 72%) and clinical outcome at discharge (good neurological outcome/mortality rate: rupt. A: clip: 51.1/13.8% coil: 45.5/10.3% non-rupt. A: 88.2/0% coil: 88.5/1.3%) were similar for both treatment modes. The coil procedure time was found to be significantly shorter (rupt. A: coil: 145 min; clip: 203 min; p < 0.01; non-rupt. A: coil: 164 min, clip: 200 min; p < 0.01). Coiling reduced the length of stay in the ICU (rupt. A: coil: 5.3 d; clip: 6d, p < 0.01; non-rupt. A: coil: 1.5d; clip: 2d; p = 0.21) and coiling significantly reduced the length of hospital stay (rupt. A: coil: 21.4d; clip: 26.8 d, p < 0.01; non-rupt. A: coil: 9.2d; clip: 17.5d; p = 0.01). The discharge to home ratio did not differ (rupt. A: clip: 31.6% coil: 29.7% nonrupt. A: clip: 74.5% coil: 80.5%). Conclusion: in a medium-volume neurovascular center, coiling significantly reduced the procedure time, the stay in the ICU, and the length of hospital stay suggesting favorable resource allocation in endovascular therapy. (orig.)

  19. HARDENING OF CRANE RAILS BY PLASMA DISCRETE-TIME SURFACE TREATMENT

    Directory of Open Access Journals (Sweden)

    S. S. Samotugin

    2017-01-01

    Full Text Available Crane wheels and rails are subjected to intensive wear in the process of operation. Therefore, improvement of these components’ performance can be considered a task of high importance. A promising direction in this regard is surface treatment by highly concentrated energy flows such as laser beams or plasma jets. This thesis suggests that the use of gradient plasma surface treatment can improve the performance of crane rails. A research was conducted, according to which hardened zones were deposited on crane rails under different treatment modes. Microhardness was measured both at the surface and in depth using custom-made microsections. The article includes the results of study of plasma surface hardening effects on wear resistance of crane rails. Change of plasma surface treatment parameters (current, plasma torch movement speed, argon gas flow rate allows for desired steel hardness and structure, while the choice of optimal location for hardened zones makes it possible to significantly improve wear resistance and crack resistance. As a result of plasma surface hardening, the fine-grained martensite structure is obtained with mainly lamellar morphology and higher hardness rate compared toinduction hardening or overlaying. Wear test of carbon steels revealed that plasma surfacing reduces abrasive wear rate compared to the irinitial state by 2 to 3 times. Enough sharp boundary between hardened and non-hardened portions has a positive effect on the performance of parts under dynamic loads, contributing to the inhibition of cracks during the transition from solid to a soft metal. For carbon and low alloy rail steels, the properties achieved by plasma surface hardening can effectively replace induction hardening or overlaying.The mode range for plasma surface treatment that allow sobtaining a surface layer with certain operating properties has been determined.

  20. Numerical Simulation of Focal Shape of Annular HIFU Transducer%环状HIFU换能器焦域形态的数值模拟研究

    Institute of Scientific and Technical Information of China (English)

    张樯; 许坚毅; 冯若; 王耀俊; 王芷龙; 王智彪

    2001-01-01

    Objective andMethods:The numerical simulation of the focal shape of an annular HIFU transducer and its relation to the designed parameters has been studied.Results and Conclusions:Our simulations show that in order to improve the focal shape,the outer diameter of the annulus must be as large but the radius of acoustic lens must be as small as possible.The focal region is found to become smaller with increase of frequency.%目的与方法:对环状HIFU换能器焦域形态与其设计参数之间的关系进行了数值模拟研究。结果与结论:为了改善椭球焦域长短轴之比,环状外径应尽量取大,声透镜半径应尽量取小;且随频率增高,焦域变小,但其形状几乎不变。

  1. Cancer and treatment distress psychometric evaluation over time: A BMT CTN 0902 secondary analysis.

    Science.gov (United States)

    Syrjala, Karen L; Sutton, Steven K; Jim, Heather S L; Knight, Jennifer M; Wood, William A; Lee, Stephanie J; Jacobsen, Paul B; Abidi, Muneer H; Yi, Jean C

    2017-04-15

    Routine monitoring of cancer-related distress is recognized as essential to quality care and mandated by a major accrediting organization. However, to the authors' knowledge, few cancer-specific measures have been developed to date to assess the multiple cancer-related factors contributing to this distress. In the current study, the authors examined the psychometric properties of the Cancer and Treatment Distress (CTXD) measure over time in hematopoietic cell transplantation (HCT) recipients. As a secondary analysis of a multicenter randomized controlled clinical trial, adult patients undergoing autologous or allogeneic HCT completed patient-reported outcomes including the CTXD and the Medical Outcomes Study Short Form-36 (SF-36) before transplantation and 100 days and 180 days after HCT. Across 21 transplantation centers, a total of 701 patients consented, underwent transplantation, and were included in the current analyses, 645 of whom were alive at 100 days and 618 of whom were alive at 180 days. Internal consistency reliability was found to be strong for the overall CTXD at the 3 time points: Cronbach alphas (α) were .94, .95, and .95, respectively. Subscale reliability met hypothesized levels of an α>.70 across time, with the lowest reliability noted for the Identity subscale at 180 days (α = .77). Correlations with the SF-36 Mental Health subscale were higher than with the Physical Functioning subscale at each time point, thereby supporting convergent and discriminant validity. Strong correlations of the pretransplantation CTXD with the posttransplantation CTXD and SF-36 Mental Health subscale supported predictive validity. The CTXD is reliable and valid as a measure of cancer distress both before and after HCT. It may be a useful tool for measuring dimensions of distress and for defining those patients requiring treatment for distress during and after transplantation. Cancer 2017;123:1416-1423. © 2016 American Cancer Society. © 2016 American Cancer

  2. Diffusion-sensitive optical coherence tomography for real-time monitoring of mucus thinning treatments

    Science.gov (United States)

    Blackmon, Richard L.; Kreda, Silvia M.; Sears, Patrick R.; Ostrowski, Lawrence E.; Hill, David B.; Chapman, Brian S.; Tracy, Joseph B.; Oldenburg, Amy L.

    2016-03-01

    Mucus hydration (wt%) has become an increasingly useful metric in real-time assessment of respiratory health in diseases like cystic fibrosis and COPD, with higher wt% indicative of diseased states. However, available in vivo rheological techniques are lacking. Gold nanorods (GNRs) are attractive biological probes whose diffusion through tissue is sensitive to the correlation length of comprising biopolymers. Through employment of dynamic light scattering theory on OCT signals from GNRs, we find that weakly-constrained GNR diffusion predictably decreases with increasing wt% (more disease-like) mucus. Previously, we determined this method is robust against mucus transport on human bronchial epithelial (hBE) air-liquid interface cultures (R2=0.976). Here we introduce diffusion-sensitive OCT (DS-OCT), where we collect M-mode image ensembles, from which we derive depth- and temporally-resolved GNR diffusion rates. DS-OCT allows for real-time monitoring of changing GNR diffusion as a result of topically applied mucus-thinning agents, enabling monitoring of the dynamics of mucus hydration never before seen. Cultured human airway epithelial cells (Calu-3 cell) with a layer of endogenous mucus were doped with topically deposited GNRs (80x22nm), and subsequently treated with hypertonic saline (HS) or isotonic saline (IS). DS-OCT provided imaging of the mucus thinning response up to a depth of 600μm with 4.65μm resolution, over a total of 8 minutes in increments of >=3 seconds. For both IS and HS conditions, DS-OCT captured changes in the pattern of mucus hydration over time. DS-OCT opens a new window into understanding mechanisms of mucus thinning during treatment, enabling real-time efficacy feedback needed to optimize and tailor treatments for individual patients.

  3. Winery and distillery wastewater treatment by constructed wetland with shorter retention time.

    Science.gov (United States)

    Mulidzi, A R

    2010-01-01

    The rationale for using constructed wetlands for treating wastewater is that wetlands are naturally among the most biological active ecosystem on earth. The aim of the study was to determine the impact of shorter retention time on the performance of constructed wetland in terms of Chemical Oxygen Demand (COD) and other elements removal. The application of wastewater with retention time of seven days as well as the evaluation of water quality after treatment at Goudini experimental wetland was carried out throughout the year. The results had shown an overall average COD removal of 60% throughout the year. Results also showed reasonable removal of other elements namely; potassium, pH, nitrogen, electrical conductivity, calcium, sodium, magnesium and boron from the wastewater by constructed wetlands. The results showed low COD removal during July until September after which it improved tremendously. The reason for low COD removal during first three months could be attributed to the fact that there was no gradual increase of wastewater application to the wetlands i.e. from 4,050 litres per day to 8,100 litres per day. The results had showed that constructed wetland as a secondary treatment system is effective in terms of COD and other elements removal from winery and distillery wastewater. COD removal throughout the year was 60% with seven days retention time. When compared with previous studies that showed 80% COD removal within 14 days retention time, therefore the 60% removal is very critical to wine industries as more wastewater will be applied to the system.

  4. Characterization of the microbunch time structure of proton pencil beams at a clinical treatment facility

    Science.gov (United States)

    Petzoldt, J.; Roemer, K. E.; Enghardt, W.; Fiedler, F.; Golnik, C.; Hueso-González, F.; Helmbrecht, S.; Kormoll, T.; Rohling, H.; Smeets, J.; Werner, T.; Pausch, G.

    2016-03-01

    Proton therapy is an advantageous treatment modality compared to conventional radiotherapy. In contrast to photons, charged particles have a finite range and can thus spare organs at risk. Additionally, the increased ionization density in the so-called Bragg peak close to the particle range can be utilized for maximum dose deposition in the tumour volume. Unfortunately, the accuracy of the therapy can be affected by range uncertainties, which have to be covered by additional safety margins around the treatment volume. A real-time range and dose verification is therefore highly desired and would be key to exploit the major advantages of proton therapy. Prompt gamma rays, produced in nuclear reactions between projectile and target nuclei, can be used to measure the proton’s range. The prompt gamma-ray timing (PGT) method aims at obtaining this information by determining the gamma-ray emission time along the proton path using a conventional time-of-flight detector setup. First tests at a clinical accelerator have shown the feasibility to observe range shifts of about 5 mm at clinically relevant doses. However, PGT spectra are smeared out by the bunch time spread. Additionally, accelerator related proton bunch drifts against the radio frequency have been detected, preventing a potential range verification. At OncoRay, first experiments using a proton bunch monitor (PBM) at a clinical pencil beam have been conducted. Elastic proton scattering at a hydrogen-containing foil could be utilized to create a coincident proton-proton signal in two identical PBMs. The selection of coincident events helped to suppress uncorrelated background. The PBM setup was used as time reference for a PGT detector to correct for potential bunch drifts. Furthermore, the corrected PGT data were used to image an inhomogeneous phantom. In a further systematic measurement campaign, the bunch time spread and the proton transmission rate were measured for several beam energies between 69 and 225

  5. A Time-Limited Behavioral Group for Treatment of Obsessive- Compulsive Disorder

    Science.gov (United States)

    Van Noppen, Barbara L.; Pato, Michele T.; Marsland, Richard; Rasmussen, Steven A.

    1998-01-01

    In vivo exposure with response prevention is an effective treatment for obsessive-compulsive disorder (OCD) either alone or combined with pharmacotherapy. Widespread application of this technique has been limited by lack of trained therapists and the expense of intensive individual behavioral therapy. This report describes a time-limited 10-session behavioral therapy group for OCD whose key elements are exposure, response prevention, therapist and participant modeling, and cognitive restructuring. In a naturalistic open trial of 90 patients meeting DSM-III-R criteria for OCD who completed the 10-session group, self-administered Yale-Brown Obsessive-Compulsive Scale scores (mean ± SD) were 21.8 ± 5.6 at baseline and 16.6 ± 6.4 after the 10-week treatment, a significant decrease. A descriptive analysis of the therapeutic elements of the group and its advantages over individual behavioral treatment are presented. (The Journal of Psychotherapy Practice and Research 1998; 7:272–280) PMID:9752638

  6. Reducing time-to-treatment in underserved Latinas with breast cancer: the Six Cities Study.

    Science.gov (United States)

    Ramirez, Amelie; Perez-Stable, Eliseo; Penedo, Frank; Talavera, Gregory; Carrillo, J Emilio; Fernández, María; Holden, Alan; Munoz, Edgar; San Miguel, Sandra; Gallion, Kipling

    2014-03-01

    The interaction of clinical and patient-level challenges following a breast cancer diagnosis can be a significant source of health care disparities. Failure to address specific cultural features that create or exacerbate barriers can lead to less-than optimal navigation results, specifically in Hispanic/Latino women. To address these disparities, the study leaders in San Antonio, Texas, and 5 other regional partners of the federally-funded Redes En Acción: The National Latino Cancer Research Network developed a culturally-tailored patient navigation intervention model for Latinas with breast cancer. Compared with control patients, a higher percentage of navigated subjects initiated treatment within 30 days (69.0% versus 46.3%, P = .029) and 60 days (97.6% versus 73.1%, P = .001) following their cancer diagnosis. Time from cancer diagnosis to first treatment was lower in the navigated group (mean, 22.22 days; median, 23.00 days) than controls (mean, 48.30 days; median, 33.00 days). These results were independent of cancer stage at diagnosis and numerous characteristics of cancer clinics and individual participants. Successful application of patient navigation increased the percentage of Latinas initiating breast cancer treatment within 30 and 60 days of diagnosis. This was achieved through navigator provision of services such as accompaniment to appointments, transportation arrangements, patient telephone support, patient-family telephone support, Spanish-English language translation, and assistance with insurance paperwork. © 2013 American Cancer Society.

  7. A time series evaluation of the treatment of histrionic personality disorder with cognitive analytic therapy.

    Science.gov (United States)

    Kellett, Stephen

    2007-09-01

    The central aim of this study was to assess the effectiveness of cognitive analytic therapy (CAT) with a patient presenting with Histrionic Personality Disorder (HPD). The methodology employed an A/B single case time-series experimental design, with additionally 6 months of continuous follow-up in the experimental measures. Five HPD experimental variables were collected on a daily basis, creating 357 days of continual data for analysis, across various phases of assessment baseline (A), treatment (B) and follow-up. The therapy contract was 24 sessions of CAT, with 4 additional follow-up sessions, spread over the 6-month's post-therapy period. Three out of the five HPD experimental variables (focus on physical appearance, emptiness and child inside) displayed statistically significant phase of treatment effects. Graphing of such data indicated that a 'sudden deterioration' occurred at the point of termination, with eventual recovery and maintenance of the progress made during the intervention. A battery of validated clinical measures were also completed at assessment, termination and final follow-up sessions; analysis of the general measures illustrated clinically significant change, indexing personality integration and reductions to depression. The study is discussed in terms of methodological and clinical limitations, the central importance of process issues and effective termination in HPD, plus the potential utility of CAT in the treatment of HPD presentations.

  8. Isolated fallopian tube torsion: A challenge for the timely diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Jokić Radoica

    2015-01-01

    Full Text Available Introduction. Isolated torsion of the fallopian tube is a rare cause of acute lower abdominal pain and infrequent indication for surgical treatment. Case Outline. A 16-year-old girl was referred to the hospital due to the non-specific symptoms over period of a few months and pain acutization in the right infraumbilical region lasting for two days. Complete laboratory analyses were normal. Ultrasound examination revealed a round mass (23Ч14 mm within the right fallopian tube with color Doppler whirlpool sign, normal ovary, and a simple ipsilateral paratubal cyst (50x40 mm. Laparoscopy showed a dilated and two times torquated right fallopian tube, as well as signs of chronic appendicitis. The tube was twisted about its longitudinal axis and it was livid, but not gangrenous. After appendectomy, fallopian tube was detorquated, cyst extracted and preservation of the tube was performed. Postoperatively, antibiotic therapy was administered based on antibiogram. On follow-up examinations within the next four months postoperative course was uneventful. Conclusion. Since there are no pathognomonic symptoms, clinical or laboratory findings, diagnosis of this condition is challenging. Familiarity with Doppler whirlpool sign can enable a timely diagnosis and treatment of isolated fallopian tube torsions. However, the diagnosis is rarely made before operation. Unlike in our case, surgery is often performed too late, and delay of intervention may result in failure to save the fallopian tube.

  9. Tricuspid regurgitation following left-sided valve surgery: echocardiographic evaluation and optimal timing of surgical treatment.

    Science.gov (United States)

    Izumi, Chisato

    2015-03-01

    Severe tricuspid regurgitation may often appear and progress late after left-sided valve surgery without left-sided valve dysfunction, significant left heart failure, and pulmonary hypertension. The clinical features, echocardiographic evaluation, treatment, and prognosis of this disease entity have been discussed, but data is limited compared with left-sided valve diseases. Tricuspid annular dilatation associated with atrial fibrillation and right ventricular dysfunction strongly relate to development of isolated tricuspid regurgitation late after left-sided valve surgery. Three-dimensional evaluation may be useful in evaluating tricuspid valve anatomy in more detail. Better prognosis in patients undergoing surgical treatment for severe isolated tricuspid regurgitation than those who were treated medically has been reported; however, the timing of isolated tricuspid valve surgery is often too late. Right ventricular function is a key word for determining the timing of isolated tricuspid valve surgery; however, it is difficult to evaluate by conventional echocardiography. One of the serious issues in the future will be how to accurately evaluate right ventricular function.

  10. Volumetric modulated arc therapy for spine SBRT patients to reduce treatment time and intrafractional motion

    Directory of Open Access Journals (Sweden)

    Ahmad Amoush

    2015-01-01

    Full Text Available Volumetric modulated arc therapy (VMAT is an efficient technique to reduce the treatment time and intrafractional motion to treat spine patients presented with severe back pain. Five patients treated with spine stereotactic body radiation therapy (SBRT using 9 beams intensity modulated radiation therapy (IMRT were retrospectively selected for this study. The patients were replanned using two arcs VMAT technique. The average mean dose was 104% ± 1.2% and 104.1% ± 1.0% in IMRT and VMAT, respectively (p = 0.9. Accordingly, the average conformal index (CI was 1.3 ± 0.1 and 1.5 ± 0.3, respectively (p = 0.5. The average dose gradient (DG distance was 1.5 ± 0.1 cm and 1.4 ± 0.1 cm, respectively (p = 0.3. The average spinal cord maximum dose was 11.6 ± 1.0 Gy and 11.8 ± 1.1 Gy (p = 0.8 and V10Gy was 7.4 ± 1.4 cc and 8.6 ± 1.7 cc (p = 0.4 for IMRT and VMAT, respectively. Accordingly, the average number of monitor units (MUs was 6771.7 ± 1323.3 MU and 3978 ± 576.7 MU respectively (p = 0.02. The use of VMAT for spine SBRT patients with severe back pain can reduce the treatment time and intrafractional motion.

  11. An IR navigation system for real-time treatment guidance of Pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Liang, Xing; Chang, Chang; Sandell, Julia; Finlay, Jarod C.; Dimofte, Andreea; Rodrigeus, Carmen; Cengel, Keith; Friedberg, Joseph; Glatstein, Eli; Hahn, Stephen M.

    2015-01-01

    Uniform light fluence distribution for patients undergoing photodynamic therapy (PDT) is critical to ensure predictable PDT outcome. However, common practice uses a point source to deliver light to the pleural cavity with the light uniformity monitored by 7 detectors placed within the pleural cavity. To improve the uniformity of light fluence rate distribution, we have used a real-time infrared (IR) tracking camera to track the movement of the light point source. The same tracking device is used to determine the surface contour of the treatment area. This study examines the light fluence (rate) delivered between the measurement and calculation in phantom studies. Isotropic detectors were used for in-vivo light dosimetry. Light fluence rate in the pleural cavity is calculated and compared with the in-vivo calculation. Phantom studies show that the surface contour can be determined with an accuracy of 2 mm, with maximum deviation of 5 mm. We can successfully match the calculated light fluence rates with the in-vivo measurements. Preliminary results indicate that the light fluence rate can have up to 50% deviation compared to the prescription in phantom experiments. The IR camera has been used successfully in pleural PDT patient treatment to track the motion of light source in real-time. We concluded that it is feasible to develop an IR camera based system to guide the motion of the light source to improve the uniformity of light distribution. PMID:26005244

  12. Exercise as a Time-conditioning Effector in Chronic Disease: a Complementary Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Luis F. B. P. Costa Rosa

    2004-01-01

    Full Text Available Exercise has been widely believed to be a preventive and therapeutic aid in the treatment of various pathophysiological conditions such as cardiovascular disease and cancer. A common problem associated with such pathologies is cachexia, characterized by progressive weight loss and depletion of lean and fat body mass, and is linked to poor prognosis. As this syndrome comprises changes in many physiological systems, it is tempting to assume that the modulation of the psychoneuroimmunoendocrine axis could attenuate or even prevent cachexia progression in cancer patients. Cancer cachexia is characterized by a disruption in the rhythmic secretion of melatonin, an important time-conditioning effector. This hormone, secreted by the pineal gland, transmits circadian and seasonal information to all organs and cells of the body, synchronizing the organism with the photoperiod. Considering that exercise modulates the immune response through at least two different mechanisms—metabolic and neuroendocrine—we propose that the adoption of a regular exercise program as a complementary strategy in the treatment of cancer patients, with the exercise bouts regularly performed at the same time of the day, will ameliorate cachexia symptoms and increase survival and quality of life.

  13. Temperature, plant species and residence time effects on nitrogen removal in model treatment wetlands.

    Science.gov (United States)

    Allen, C R; Stein, O R; Hook, P B; Burr, M D; Parker, A E; Hafla, E C

    2013-01-01

    Total nitrogen (TN) removal in treatment wetlands (TWs) is challenging due to nitrogen cycle complexity and the variation of influent nitrogen species. Plant species, season, temperature and hydraulic loading most likely influence root zone oxygenation and appurtenant nitrogen removal, especially for ammonium-rich wastewater. Nitrogen data were collected from two experiments utilizing batch-loaded (3-, 6-, 9- and 20-day residence times), sub-surface TWs monitored for at least one year during which temperature was varied between 4 and 24 °C. Synthetic wastewater containing 17 mg/l N as NH4 and 27 mg/l amino-N, 450 mg/l chemical oxygen demand (COD), and 13 mg/l SO4-S was applied to four replicates of Carex utriculata, Schoenoplectus acutus and Typha latifolia and unplanted controls. Plant presence and species had a greater effect on TN removal than temperature or residence time. Planted columns achieved approximately twice the nitrogen removal of unplanted controls (40-95% versus 20-50% removal) regardless of season and temperature. TWs planted with Carex outperformed both Typha and Schoenoplectus and demonstrated less temperature dependency. TN removal with Carex was excellent at all temperatures and residence times; Schoenoplectus and Typha TN removal improved at longer residence times. Reductions in TN were not accompanied by increases in NO3, which was consistently below 1 mg/l N.

  14. Time to Response to Citalopram Treatment for Agitation in Alzheimer Disease.

    Science.gov (United States)

    Weintraub, Daniel; Drye, Lea T; Porsteinsson, Anton P; Rosenberg, Paul B; Pollock, Bruce G; Devanand, Devangere P; Frangakis, Constantine; Ismail, Zahinoor; Marano, Christopher; Meinert, Curtis L; Mintzer, Jacobo E; Munro, Cynthia A; Pelton, Gregory; Rabins, Peter V; Schneider, Lon S; Shade, David M; Yesavage, Jerome; Lyketsos, Constantine G

    2015-11-01

    Agitation is a common and significant problem in Alzheimer disease (AD). In the recent Citalopram for Agitation in Alzheimer's Disease (CitAD) study, citalopram was efficacious for the treatment of AD agitation. Here we examined the time course and predictors of response to treatment. Response in CitAD was defined as a modified Alzheimer Disease Cooperative Study Clinical Global Impression of Change (CGIC) score of 1 or 2 or a Neurobehavioral Rating Scale agitation subscale (NBRS-A) score reduction ≥ 50% from baseline. "Stable early response" was defined as meeting the aforementioned criteria at both weeks 3 and 9, "late response" was response at week 9 but not at week 3, and "unstable response" was response at week 3 but not at week 9. In the primary analyses, citalopram was superior to placebo on both the CGIC and the NBRS-A response measures. Little between-group differences were found in response rates in the first 3 weeks of the study (21% versus 19% on the CGIC). Citalopram patients were more likely than placebo patients to be a late responder (18% versus 8% on CGIC, Fisher's exact p = 0.09; 31% versus 15% on NBRS-A, Fisher's exact p = 0.02). Approximately half of citalopram responders (45%-56%) at end of study achieved response later in the study compared with 30%-44% of placebo responders. Treatment with citalopram for agitation in AD needs to be at least 9 weeks in duration to allow sufficient time for full response. Study duration is an important factor to consider in the design of clinical trials for agitation in AD. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  15. [Clinical study on acupuncture intervention time for treatment of peripheral facial paralysis].

    Science.gov (United States)

    Shen, Te-li; Cao, Lian-ying; Zhang, Wei; Li, Yan; Wu, Qing-hong; Yao, Mei-jin; Gu, Lu-yan

    2009-05-01

    To observe effects of intervention time of local acupuncture at the affected side on the facial nerve injury and the therapeutic effect at acute stage of peripheral facial paralysis. Two hundred and seventy-nine cases within 3 days of attack were randomly divided into 4 groups, group A (n=74), group B (n=70), group C (n=74) and control group (n=61). The 4 groups were treated with Prednisone on the third day after attack, and acupuncture was added in the group A, B and C, with Fengchi (GB 20), Yangbai (GB 14), Taiyang (EX-HN 5), Sibai (ST 2), Yingxiang (LI 20), etc. on the affected side and bilateral Hegu (LI 4) selected, and with superficial insertion method used for acupoints on the ear-face parts without manipulating the needles, and electroacupuncture was added from the fifth session of the treatment, and uniform reinforcing-reducing method was used for the distal acupoints selected. The needles were retained for 20 min and the treatment was given for 25 sessions, once other day. The therapeutic effects, the mean therapeutic courses for the cured patients and changes of electroneurography (ENoG) were compared among the groups. The clinical total effective rate was 98.6%, 95.7%, 94.6% and 72.1% in the group A, B, C and the control group, respectively, with a significant difference (P 0.05). Acute stage is the best opportunity for acupuncture treatment of peripheral facial paralysis, and the earlier the intervention time, the better the therapeutic effect and the shorter the therapeutic course.

  16. Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, X; Yuan, Y; Zhuang, T; O' Daniel, J; Thongphiew, D; Wu, Q J; Das, S K; Yoo, S; Yin, F F [Department of Radiation Oncology, Duke University, Durham, NC (United States); Bourland, J D [Department of Radiation Oncology, Wake Forest University, Winston-Salem, NC (United States)], E-mail: xiaofeng.zhu@duke.edu

    2009-09-07

    This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 deg. C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii {approx}1.5 cm and length {approx}4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders. (note)

  17. NOTE: Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment

    Science.gov (United States)

    Zhu, X.; Bourland, J. D.; Yuan, Y.; Zhuang, T.; O'Daniel, J.; Thongphiew, D.; Wu, Q. J.; Das, S. K.; Yoo, S.; Yin, F. F.

    2009-09-01

    This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 °C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii ~1.5 cm and length ~4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.

  18. Tradeoffs of integrating real-time tracking into IGRT for prostate cancer treatment.

    Science.gov (United States)

    Zhu, X; Bourland, J D; Yuan, Y; Zhuang, T; O'Daniel, J; Thongphiew, D; Wu, Q J; Das, S K; Yoo, S; Yin, F F

    2009-09-07

    This study investigated the integration of the Calypso real-time tracking system, based on implanted ferromagnetic transponders and a detector array, into the current process for image-guided radiation treatment (IGRT) of prostate cancer at our institution. The current IGRT process includes magnetic resonance imaging (MRI) for prostate delineation, CT simulation for treatment planning, daily on-board kV and CBCT imaging for target alignment, and MRI/MRS for post-treatment assessment. This study assesses (1) magnetic-field-induced displacement and radio-frequency (RF)-induced heating of transponders during MRI at 1.5 T and 3 T, and (2) image artifacts caused by transponders and the detector array in phantom and patient cases with the different imaging systems. A tissue-equivalent phantom mimicking prostate tissue stiffness was constructed and implanted with three operational transponders prior to phantom solidification. The measurements show that the Calypso system is safe with all the imaging systems. Transponder position displacements due to the MR field are minimal (<1.0 mm) for both 1.5 T and 3 T MRI scanners, and the temperature variation due to MRI RF heating is <0.2 degrees C. The visibility of transponders and bony anatomy was not affected on the OBI kV and CT images. Image quality degradation caused by the detector antenna array is observed in the CBCT image. Image artifacts are most significant with the gradient echo sequence in the MR images, producing null signals surrounding the transponders with radii approximately 1.5 cm and length approximately 4 cm. Thus, Calypso transponders can preclude the use of MRI/MRS in post-treatment assessment. Modifications of the clinical flow are required to accommodate and minimize the substantial MRI artifacts induced by the Calypso transponders.

  19. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study.

    Science.gov (United States)

    Hermida, Ramón C; Ayala, Diana E; Mojón, Artemio; Fernández, José R

    2010-09-01

    Clinical studies have documented morning-evening, administration-time differences of several different classes of hypertension medications in blood pressure (BP)-lowering efficacy, duration of action, safety profile, and/or effects on the circadian BP pattern. In spite of these published findings, most hypertensive subjects, including those under combination therapy, are instructed by their physicians and pharmacists to ingest all of their BP-lowering medications in the morning. The potential differential reduction of cardiovascular (CVD) morbidity and mortality risk by a bedtime versus upon-awakening treatment schedule has never been evaluated prospectively. The prospective MAPEC study was specifically designed to test the hypothesis that bedtime chronotherapy with ≥1 hypertension medications exerts better BP control and CVD risk reduction than conventional therapy, i.e., all medications ingested in the morning. A total of 2156 hypertensive subjects, 1044 men/1112 women, 55.6 ± 13.6 (mean ± SD) yrs of age, were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h. Physical activity was simultaneously monitored every min by wrist actigraphy to accurately determine the beginning and end of daytime activity and nocturnal sleep. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Despite lack of differences in ambulatory BP between groups at baseline, subjects ingesting medication at bedtime showed at their last available evaluation significantly lower mean sleep-time BP, higher sleep-time relative BP decline, reduced prevalence of non-dipping (34% versus 62%; p risk of total CVD events than those ingesting all medications upon awakening (0.39 [0.29-0.51]; number of events 187 versus 68; p risk of major events (including

  20. Deep brain stimulation effects in dystonia: time course of electrophysiological changes in early treatment.

    Science.gov (United States)

    Ruge, Diane; Tisch, Stephen; Hariz, Marwan I; Zrinzo, Ludvic; Bhatia, Kailash P; Quinn, Niall P; Jahanshahi, Marjan; Limousin, Patricia; Rothwell, John C

    2011-08-15

    Deep brain stimulation to the internal globus pallidus is an effective treatment for primary dystonia. The optimal clinical effect often occurs only weeks to months after starting stimulation. To better understand the underlying electrophysiological changes in this period, we assessed longitudinally 2 pathophysiological markers of dystonia in patients prior to and in the early treatment period (1, 3, 6 months) after deep brain stimulation surgery. Transcranial magnetic stimulation was used to track changes in short-latency intracortical inhibition, a measure of excitability of GABA(A) -ergic corticocortical connections and long-term potentiation-like synaptic plasticity (as a response to paired associative stimulation). Deep brain stimulation remained on for the duration of the study. Prior to surgery, inhibition was reduced and plasticity increased in patients compared with healthy controls. Following surgery and commencement of deep brain stimulation, short-latency intracortical inhibition increased toward normal levels over the following months with the same monotonic time course as the patients' clinical benefit. In contrast, synaptic plasticity changed rapidly, following a nonmonotonic time course: it was absent early (1 month) after surgery, and then over the following months increased toward levels observed in healthy individuals. We postulate that before surgery preexisting high levels of plasticity form strong memories of dystonic movement patterns. When deep brain stimulation is turned on, it disrupts abnormal basal ganglia signals, resulting in the absent response to paired associative stimulation at 1 month. Clinical benefit is delayed because engrams of abnormal movement persist and take time to normalize. Our observations suggest that plasticity may be a driver of long-term therapeutic effects of deep brain stimulation in dystonia. Copyright © 2011 Movement Disorder Society.

  1. A novel method for real-time skin impedance measurement during radiofrequency skin tightening treatments.

    Science.gov (United States)

    Harth, Yoram; Lischinsky, Daniel

    2011-03-01

    The thermal effects of monopolar and bipolar radiofrequency (RF) have been proven to be beneficial in skin tightening. Nevertheless, these effects were frequently partial or unpredictable because of the uncontrolled nature of monopolar or unipolar RF and the superficial nature of energy flow for bipolar or tripolar configurations. One of the hypotheses for lack or predictability of efficacy of the first-generation RF therapy skin tightening systems is lack of adaptation of delivered power to differences in individual skin impedance. A novel multisource phase-controlled system was used (1 MHz, power range 0-65 W) for treatment and real-time skin impedance measurements in 24 patients (EndyMed PRO™; EndyMed, Cesarea, Israel). This system allows continuous real-time measurement of skin impedance delivering constant energy to the patient skin independent of changes in its impedance. More than 6000 unique skin impedance measurements on 22 patients showed an average session impedance range was 215-584 Ohm with an average of 369 Ohm (standard deviation of 49 Ohm). Analyzing individual pulses (total of 600 readings) showed a significant decrease in impedance during the pulse. These findings validate the expected differences in skin impedance between individual patients and in the same patients during the treatment pulse. Clinical study on 30 patients with facial skin aging using the device has shown high predictability of efficacy (86.7% of patients had good results or better at 3 months' follow-up [decrease of 2 or more grades in Fitzpatrick's wrinkle scale]). The real-time customization of energy according to skin impedance allows a significantly more accurate and safe method of nonablative skin tightening with more consistent and predictable results. © 2011 Wiley Periodicals, Inc.

  2. Unknotting night-time muscle cramp: a survey of patient experience, help-seeking behaviour and perceived treatment effectiveness

    OpenAIRE

    Blyton Fiona; Chuter Vivienne; Burns Joshua

    2012-01-01

    Abstract Background Night-time calf cramping affects approximately 1 in 3 adults. The aim of this study was to explore the experience of night-time calf cramp; if and where people seek treatment advice; and perceived treatment effectiveness. Methods 80 adults who experienced night-time calf cramp at least once per week were recruited from the Hunter region, NSW, Australia through newspaper, radio and television advertisements. All participants completed a pilot-tested survey about muscle cram...

  3. Calibration of ultrasound backscatter temperature imaging for high-intensity focused ultrasound treatment planning.

    Science.gov (United States)

    Civale, John; Rivens, Ian; Ter Haar, Gail; Morris, Hugh; Coussios, Constantin; Friend, Peter; Bamber, Jeffrey

    2013-09-01

    High-intensity focused ultrasound (HIFU) is rapidly gaining acceptance as a non-invasive method for soft tissue tumor ablation, but improvements in the methods of treatment delivery, planning and monitoring are still required. Backscatter temperature imaging (BTI) uses ultrasound to visualize heating-induced echo strain and may be used to indicate the position of the HIFU focal region using low-power "sub-lesioning" exposure. The technique may also provide a quantitative tool for assessing the efficacy of treatment delivery if apparent strain measurements can be related to the underlying temperature rise. To obtain temperature estimates from strain measurements, the relationship between these variables has to be either measured or otherwise assumed from previous calibrations in similar tissues. This article describes experimental measurements aimed at deriving the relationship between temperature rise and apparent strain in the laboratory environment using both ex vivo bovine liver tissue samples and normothermically perfused porcine livers. A BTI algorithm was applied to radiofrequency ultrasound echo data acquired from a clinical ultrasound scanner (Z.One, Zonare Medical Systems, Mountain View, CA, USA) where the imaging probe was aligned with the focal region of a HIFU transducer. Temperature measurements were obtained using needle thermocouples implanted in the liver tissue. A series of "non-ablative" HIFU exposures giving peak temperatures below 10°C were made in three separate ex vivo bovine livers, yielding an average strain/temperature coefficient of 0.126 ± 0.088 percentage strain per degree Celsius. In the perfused porcine livers at a starting temperature of 38°C (normal body temperature) the strain/temperature coefficients were found to be 0.040 ± 0.029 percentage strain per degree Celsius. The uncertainty in these results is directly linked to the precision of the strain measurement, as well as the naturally occurring variance between different

  4. PATHOMORPHISM OF PROSTATE CANCER DURING HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT

    Directory of Open Access Journals (Sweden)

    R. N. Fomkin

    2014-07-01

    Full Text Available The purpose of the study was to evaluate the efficiency of prostate cancer (PC treatment using high-intensity focused ultrasound (HIFU on the basis of morphometric and immunohistochemical (IHC analyses of postoperative prostate biopsy specimens. The study subjects were 40 patients with localized and locally advanced PC. The postoperative morphological analysis was made on the basis of standard hematoxylineosin staining and morphometric and IHC studies using the following antibodies: PCNA, Bcl-2, AMACR, Е-cadherin, and ANDR (Dako. Pre- and post-HIFU therapy histological examination of the routinely hematoxylin-eosin-stained specimens showed that the therapeutic pathomorphism of the tumor corresponded to grades III and IV. It was established that the IHC study should be used as an additional crite-rion for the efficiency of PC therapy after HIFU ablation. In spite of positive clinical, laboratory, instrumental, and objective changes, the patients with high AMACR and Bcl-2 levels and decreased Е-cadherin expression may be considered as a group at risk for prolonged malignant growth or recurrent PC.

  5. Tumor Hyperthermia and Ablation in Rats using a Clinical MR-HIFU System Equipped with a Dedicated Small Animal Setup

    NARCIS (Netherlands)

    Hijnen, N.M.; Heijman, E.; Köhler, M.; Ylihautala, M.; Simonetti, A.W.; Grull, H.

    2012-01-01

    Purpose: Treatment of malignant tumors by either hyperthermia induced drug delivery or thermal ablation requires complete coverage of the treatment area and precise control of the thermal dose.Both can be achieved by volumetric ultrasonic heating in combination with simultaneous MR-based temperature

  6. Sci—Thur PM: Planning and Delivery — 06: Real-Time Interactive Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Q; Mestrovic, A [BC Cancer Agency - Vancouver Island Centre (Canada); Otto, K [Physics and Astronomy, University of British Columbia (Canada)

    2014-08-15

    Purpose: To describe and evaluate a novel system for generalized Real-Time Interactive Planning (RTIP) applied to head and neck (H and N) VMAT. Methods: The clinician interactively manipulates dose distributions using DVHs, isodoses, or rate of dose fall-off, which may be subjected to user-defined constraints. Dose is calculated using a fast Achievable Dose Estimate (ADE) algorithm, which simulates the limits of what can be achieved during treatment. After each manipulation contributing fluence elements are modified and the dose distribution updates in effectively real-time. For H and N VMAT planning, structure sets for 11 patients were imported into RTIP. Each dose distribution was interactively modified to minimize OAR dose while constraining target DVHs. The resulting RTIP DVHs were transferred to the Eclipse™ VMAT optimizer, and conventional VMAT optimization was performed. Results: Dose calculation and update times for the ADE algorithm ranged from 2.4 to 22.6 milliseconds, thus facilitating effectively real-time manipulation of dose distributions. For each of the 11 H and N VMAT cases, the RTIP process took ∼2–10 minutes. All RTIP plans exhibited acceptable PTV coverage, mean dose, and max dose. 10 of 11 RTIP plans achieved substantially improved sparing of one or more OARs without compromising dose to targets or other OARs. Importantly, 10 of the 11 RTIP plans required only one or two post-RTIP optimizations. Conclusions: RTIP is a novel system for manipulating and updating achievable dose distributions in real-time. H and N VMAT plans generated using RTIP demonstrate improved OAR sparing and planning efficiency. Disclosures: One author has a commercial interest in the presented materials.

  7. Time series analysis of patients seeking orthodontic treatment at Seoul National University Dental Hospital over the past decade.

    Science.gov (United States)

    Lim, Hyun-Woo; Park, Ji-Hoon; Park, Hyun-Hee; Lee, Shin-Jae

    2017-09-01

    This paper describes changes in the characteristics of patients seeking orthodontic treatment over the past decade and the treatment they received, to identify any seasonal variations or trends. This single-center retrospective cohort study included all patients who presented to Seoul National University Dental Hospital for orthodontic diagnosis and treatment between January 1, 2005 and December 31, 2015. The study analyzed a set of heterogeneous variables grouped into the following categories: demographic (age, gender, and address), clinical (Angle Classification, anomaly, mode of orthodontic treatment, removable appliances for Phase 1 treatment, fixed appliances for Phase 2 treatment, orthognathic surgery, extraction, mini-plate, mini-implant, and patient transfer) and time-related variables (date of first visit and orthodontic treatment time). Time series analysis was applied to each variable. The sample included 14,510 patients with a median age of 19.5 years. The number of patients and their ages demonstrated a clear seasonal variation, which peaked in the summer and winter. Increasing trends were observed for the proportion of male patients, use of non-extraction treatment modality, use of ceramic brackets, patients from provinces outside the Seoul region at large, patients transferred from private practitioners, and patients who underwent orthognathic surgery performed by university surgeons. Decreasing trends included the use of metal brackets and orthodontic treatment time. Time series analysis revealed a seasonal variation in some characteristics, and several variables showed changing trends over the past decade.

  8. Bayesian and frequentist two-stage treatment strategies based on sequential failure times subject to interval censoring.

    Science.gov (United States)

    Thall, Peter F; Wooten, Leiko H; Logothetis, Christopher J; Millikan, Randall E; Tannir, Nizar M

    2007-11-20

    For many diseases, therapy involves multiple stages, with the treatment in each stage chosen adaptively based on the patient's current disease status and history of previous treatments and clinical outcomes. Physicians routinely use such multi-stage treatment strategies, also called dynamic treatment regimes or treatment policies. We present a Bayesian framework for a clinical trial comparing two-stage strategies based on the time to overall failure, defined as either second disease worsening or discontinuation of therapy. Each patient is randomized among a set of treatments at enrollment, and if disease worsening occurs the patient is then re-randomized among a set of treatments excluding the treatment received initially. The goal is to select the two-stage strategy having the largest average overall failure time. A parametric model is formulated to account for non-constant failure time hazards, regression of the second failure time on the patient's first worsening time, and the complications that the failure time in either stage may be interval censored and there may be a delay between first worsening and the start of the second stage of therapy. Four different criteria, two Bayesian and two frequentist, for selecting a best strategy are considered. The methods are applied to a trial comparing two-stage strategies for treating metastatic renal cancer, and a simulation study in the context of this trial is presented. Advantages and disadvantages of this design compared to standard methods are discussed.

  9. Predictors of Staff Turnover and Turnover Intentions within Addiction Treatment Settings: Change Over Time Matters

    Science.gov (United States)

    Garner, Bryan R; Hunter, Brooke D

    2014-01-01

    This study examined the extent to which changes over time in clinicians’ responses to measures of work attitude (eg, job satisfaction) and psychological climate (eg, supervisor support) could predict actual turnover and turnover intentions above and beyond absolute levels of these respective measures. Longitudinal data for this study were collected from a sample of clinicians (N = 96) being trained to implement an evidence-based treatment for adolescent substance use disorders. Supporting findings from a recent staff turnover study, we found job satisfaction change was able to predict actual turnover above and beyond average levels of job satisfaction. Representing new contributions to the staff turnover literature, we also found that change over time in several other key measures (eg, job satisfaction, role manageability, role clarity) explained a significant amount of variance in turnover intentions above and beyond the absolute level of each respective measure. A key implication of the current study is that organizations seeking to improve their ability to assess risk for staff turnover may want to consider assessing staff at multiple points in time in order to identify systematic changes in key employee attitudes like turnover intentions and job satisfaction. PMID:25336960

  10. Progress in prevention and treatment of skin lesions caused by the treatment of liver cancer by high intensity focused ultrasound%高强度聚焦超声治疗肝癌中皮肤损伤防治进展

    Institute of Scientific and Technical Information of China (English)

    白愿; 陈锦云

    2016-01-01

    Liver cancer is one of the most common malignant tumour,High intensity focused ultrasound (HIFU) as a new type of treatment,is capable of ablating the tumor tissue safely,precisely,and efficiently without damaging the peripheral normal tissue,thus it’s more and more widely used in the treatment of malignant tumor.However, in clinical practice, medical workers found that there are some complications and adverse reactions in the treatment of liver cancer with HIFU, among which the skin lesions are more common.This paper reviews the progress in prevention and treatment of skin lesions caused by the treatment of liver cancer by HIFU.%肝癌是常见的恶性肿瘤,高强度聚焦超声(HIFU)作为一种新型治疗手段。因其具有无创性、安全性、有效性、无放射性等优点,使其在恶性肿瘤的临床治疗中日趋常见。然而在临床实践中,HIFU治疗肝癌也出现一些并发症及不良反应,其中以皮肤损伤较为多见,本文就HIFU治疗肝癌皮肤损伤的发生机理、临床表现及预防治疗做一综述。

  11. A Time-Limited and Partially Reversible Model of Hypoganglionosis Induced by Benzalkonium Chloride Treatment.

    Science.gov (United States)

    Yu, Hui; Pan, Weikang; Wang, HuaiJie; Gao, Ya

    2016-05-01

    Serosal application of benzalkonium chloride (BAC) has been previously applied to produce a model of aganglionosis; however, confusion remains regarding the extent of chemical ablation of enteric myenteric plexus after BAC treatment. The time sequence of BAC-induced effects on the myenteric plexus of the rat colon was determined and followed the morphologic changes. After sacrifice of animals 7, 14, 28, 56, 84 or 168 days postintervention, colonic tissue samples were removed, fixed in formalin, and cut into 5-μm longitudinal sections for histological analysis. The neural analysis was used to re-evaluate BAC treatments for the appropriate model. Compared with rats in sham groups, rats in 0.1 %-30-min BAC group maintained only 15.27 ± 4.80 % of ganglia per section in a 1-cm/5-μm slice and 11.76 ± 2.30 % of ganglionic cells after 28 days, the lower and stable number of ganglionic cells between Day 7 and 84 (from 11.67 ± 2.10 to 19.05 ± 5.10 %). Although an increase, ganglionic cell numbers did not recover at Day168 when compared with the numbers in sham groups. The results showed that characteristics of rats in the 0.1 %-30-min BAC group between Day 7 and 84 most closely kept in stable state, suggesting that these treatment parameters are ideal for producing a hypoganglia model of hypoganglionosis.

  12. Wear-time recording during early Class III facemask treatment using TheraMon chip technology.

    Science.gov (United States)

    Stocker, Bruce; Willmann, Jan H; Wilmes, Benedict; Vasudavan, Sivabalan; Drescher, Dieter

    2016-09-01

    Successful intervention in a developing Class III malocclusion with facemask protraction therapy depends on a patient's ability to adhere to the recommendations for duration of appliance wear. In this article, we report the introduction of a novel approach for tracking of the duration of application of a protraction facemask, with the incorporation of a "FaceMon" sensor (TheraMon, microelectronic system; MC Technology GmbH, Hargelsberg, Austria) to track wear time. A 9-year-old boy with a Class III malocclusion was successfully treated with a modified alternate rapid maxillary expansion and constriction protocol and intermittent application of a hybrid hyrax-protraction facemask combination. The average duration of wear of the facemask was measured at 10.8 hours per day. The use of an objective measuring device may have implications for the development of treatment strategies, since patient responses may be able to calibrated in relation to compliance.

  13. High-Intensity Focused Ultrasound in the Treatment of Hepatic Metastases from Colorectal Cancer of 18 Patients

    Institute of Scientific and Technical Information of China (English)

    HuiZhu; WenzhiChen; FengWu; KequanLi; JianzhongZou; ZhibiaoWang

    2004-01-01

    OBJECTIVE To evaluate the safety and effectiveness of treatment of hepatic metastases from colorectal cancer using high-intensity focused ultrasound (HIFU). METHODS Thirty-one lesions in 18 patients with hepatic metastases from colorectal cancer after colectomy were treated with HIFU therapy. The vital signs, function of the vital organs, complications and pathological outcome were studied using imaging examinations such as CT or MRI. RESULTS The vital signs of all patients remained stable and their liver and kidney functions normal. Two of the 18 patients were not followed-up. After a mean follow-up of 16.1 months (6-38 months), 13 survived. The survival rates at the 12th and 18th months were 83.3% and 66.7%, respectively. The median survival rate was 16 months. Among the 25 lesions followed-up, 17 shrank over 50%, 5 grew new metastases and superficial degree II skin injury occurred in 8. CONCLUSION HIFU is a safe, effective and non-invasive option for the treatment of hepatic metastases from colorectal cancer.

  14. Dose- and Time-Dependent Response of Human Leukemia (HL-60 Cells to Arsenic Trioxide Treatment

    Directory of Open Access Journals (Sweden)

    Paul B. Tchounwou

    2006-06-01

    Full Text Available The treatment of acute promyelocytic leukemia (APL has been based on the administration of all-trans retinoic acid plus anthracycline chemotherapy, which is very effective as first line therapy; however 25 to 30% of patients will relapse with their disease becoming refractory to conventional therapy. Recently, studies have shown arsenic trioxide to be effective in the treatment of acute promyelocytic leukemia. In this study, we used the human leukemia (HL-60 cell line as a model to evaluate the cytoxicity of arsenic trioxide based on the MTT assay. Data obtained from this assay indicated that arsenic trioxide significantly reduced the viability of HL-60 cells, showing LD50 values of 14.26 + 0.5μg/mL, 12.54 + 0.3μg/mL, and 6.4 + 0.6μg/mL upon 6, 12, and 24 hours of exposure, respectively; indicating a dose- and time-dependent response relationship. Findings from the present study indicate that arsenic trioxide is highly cytotoxic to human leukemia (HL-60 cells, supporting its use as an effective therapeutic agent in the management of acute promyelocytic leukemia.

  15. An IR navigation system for real-time treatment guidance of pleural PDT

    Science.gov (United States)

    Zhu, Timothy C.; Liang, Xing; Chang, Chang; Sandell, Julia; Finlay, Jarod C.; Dimofte, Andreea; Rodriguez, Carmen; Cengel, Keith; Friedberg, Joseph; Glatstein, Eli; Hahn, Stephen M.

    2011-02-01

    Uniform light fluence distribution for patients undergoing photodynamic therapy (PDT) is critical to ensure predictable PDT outcome. However, common practice uses a point source to deliver light to the pleural cavity with the light uniformity monitored by 7 detectors placed within the pleural cavity. To improve the uniformity of light fluence rate distribution, we have used a real-time infrared (IR) tracking camera to track the movement of the light point source. The same tracking device is used to determine the surface contour of the treatment area. This study examines the light fluence (rate) delivered between the measurement and calculation in phantom studies. Isotropic detectors were used for in-vivo light dosimetry. Light fluence rate in the pleural cavity is calculated and compared with the in-vivo calculation. Phantom studies show that the surface contour can be determined with an accuracy of 2 mm, with maximum deviation of 5 mm. We can successfully match the calculated light fluence rates with the in-vivo measurements. Preliminary results indicate that the light fluence rate can have up to 50% deviation compared to the prescription in phantom experiments. The IR camera has been used successfully in pleural PDT patient treatment to track the motion of light source in realtime. We concluded that it is feasible to develop an IR camera based system to guide the motion of the light source to improve the uniformity of light distribution.

  16. Influence of timing of endectocidic antiparasitic treatment on its efficacy in overwintering reindeer

    Directory of Open Access Journals (Sweden)

    A. Oksanen

    1996-01-01

    Full Text Available To find out if timing of endectocidic antiparasitic treatment is critical for its efficacy in overwintering reindeer, 72 hinds of the Kaamanen Experimental Reindeer Herd were randomly allocated to four groups. Three groups received ivermecrin mixture orally once at a dose of 200 pg/kg, either in September, December, or February, and one group was left untreated. Antiparasitic efficacy was evaluated by counting Hypoderma tarandi and Cephenemyia trompe larvae in April, and by faecal examinanon for trichostrongylid nematode eggs in March and April. Production efficacy consequences were assessed by comparing animal weight development from November to April, and calf birth weights. No difference could be seen in the antiparasitic efficacy of the treatments; all were 100 % efficient against H. tarandi larvae (warbles and C. trompe larvae (throat bors, and reduced the trichostrongylid egg output by 62 to 74%. Weight gains of the groups were not significantly different, however the calf birrh weights differed nearly significantly (P = 0.057. On average, smallest calves were produced by the untreated group.

  17. Camera selection for real-time in vivo radiation treatment verification systems using Cherenkov imaging

    Energy Technology Data Exchange (ETDEWEB)

    Andreozzi, Jacqueline M., E-mail: Jacqueline.M.Andreozzi.th@dartmouth.edu; Glaser, Adam K. [Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire 03755 (United States); Zhang, Rongxiao [Department of Physics and Astronomy, Dartmouth College, Hanover, New Hampshire 03755 (United States); Jarvis, Lesley A.; Gladstone, David J. [Department of Medicine, Geisel School of Medicine and Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766 (United States); Pogue, Brian W., E-mail: Brian.W.Pogue@dartmouth.edu [Thayer School of Engineering and Department of Physics and Astronomy, Dartmouth College, Hanover, New Hampshire 03755 (United States)

    2015-02-15

    Purpose: To identify achievable camera performance and hardware needs in a clinical Cherenkov imaging system for real-time, in vivo monitoring of the surface beam profile on patients, as novel visual information, documentation, and possible treatment verification for clinicians. Methods: Complementary metal-oxide-semiconductor (CMOS), charge-coupled device (CCD), intensified charge-coupled device (ICCD), and electron multiplying-intensified charge coupled device (EM-ICCD) cameras were investigated to determine Cherenkov imaging performance in a clinical radiotherapy setting, with one emphasis on the maximum supportable frame rate. Where possible, the image intensifier was synchronized using a pulse signal from the Linac in order to image with room lighting conditions comparable to patient treatment scenarios. A solid water phantom irradiated with a 6 MV photon beam was imaged by the cameras to evaluate the maximum frame rate for adequate Cherenkov detection. Adequate detection was defined as an average electron count in the background-subtracted Cherenkov image region of interest in excess of 0.5% (327 counts) of the 16-bit maximum electron count value. Additionally, an ICCD and an EM-ICCD were each used clinically to image two patients undergoing whole-breast radiotherapy to compare clinical advantages and limitations of each system. Results: Intensifier-coupled cameras were required for imaging Cherenkov emission on the phantom surface with ambient room lighting; standalone CMOS and CCD cameras were not viable. The EM-ICCD was able to collect images from a single Linac pulse delivering less than 0.05 cGy of dose at 30 frames/s (fps) and pixel resolution of 512 × 512, compared to an ICCD which was limited to 4.7 fps at 1024 × 1024 resolution. An intensifier with higher quantum efficiency at the entrance photocathode in the red wavelengths [30% quantum efficiency (QE) vs previous 19%] promises at least 8.6 fps at a resolution of 1024 × 1024 and lower monetary

  18. Gastric Juice-Based Real-Time PCR for Tailored Helicobacter Pylori Treatment: A Practical Approach.

    Science.gov (United States)

    Peng, Xianhui; Song, Zhiqiang; He, Lihua; Lin, Sanren; Gong, Yanan; Sun, Lu; Zhao, Fei; Gu, Yixin; You, Yuanhai; Zhou, Liya; Zhang, Jianzhong

    2017-01-01

    A gastric juice-based real-time polymerase chain reaction (PCR) assay was established to identify Helicobacter pylori infection, clarithromycin susceptibility and human CYP2C19 genotypes and to guide the choice of proton pump inhibitor (PPI), clarithromycin and amoxicillin treatment for tailored H. pylori eradication therapy. From January 2013 to November 2014, 178 consecutive dyspeptic patients were enrolled for collection of gastric biopsy samples and gastric juice by endoscopy at the Peking University Third Hospital; 105 and 73 H. pylori-positive and -negative patients, respectively, were included in this study. H. pylori infection was defined as samples with both a strongly positive rapid urease test (RUT) and positive H. pylori histology. A series of primers and probes were distributed into four reactions for identifying the H. pylori cagH gene coupled with an internal control (Rnase P gene), A2142G and A2143G mutants of the H. pylori 23S rRNA gene, and single-nucleotide polymorphisms (SNPs) G681A of CYP2C19*2 and G636A of CYP2C19*3. The E-test and DNA sequencing were used to evaluate the H. pylori clarithromycin susceptibility phenotype and genotype. The SNPs CYP2C19*2 and CYP2C19*3 were also evaluated by nucleotide sequencing. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of this gastric juice-based real-time PCR assay were evaluated by comparing with the same measures obtained through gastric biopsy-based PCR and culture. The H. pylori diagnostic sensitivities of the culture, PCR, and gastric biopsy- and gastric juice-based real-time PCR assays were 90.48% (95/105), 92.38% (97/105), 97.14% (102/105) and 100% (105/105), respectively; the specificities of the above methods were all 100%. Higher false-negative rates were found among the gastric biopsy samples assessed by culture (10.48%, 11/105), PCR (7.62%, 8/105) and real-time PCR (2.86%, 3/105) than in gastric juice by real-time PCR. Regarding

  19. Murine cysticercosis model: influence of the infection time and the time of treatment on the cysticidal efficacy of albendazole and praziquantel.

    Science.gov (United States)

    Palomares-Alonso, Francisca; Palencia Hernández, Guadalupe; Rojas-Tomé, Irma Susana; Jung-Cook, Helgi; Pinzón-Estrada, Enrique

    2015-02-01

    In the search of new alternatives for neurocysticercosis treatment, Taenia crassiceps ORF strain cysticerci have been used instead of T. solium for in vitro studies. Up to date, the main criteria for the use of the murine cysticercosis model for drug efficacy evaluation have not been assessed. The aim of the present study was to evaluate the influence of two of the main variables related to the in vivo efficacy: the length of drug treatment and the starting time of treatment after experimental infection, using albendazole (ABZ) and praziquantel (PZQ) as test drugs. Additionally, the relationship between the number of cysts and the parasite weight was assessed. For the study, female BALB/c mice were experimentally infected with T. crassiceps cysts. Three different post-infection periods (10, 20 and 30 days) and three different lengths of treatment with ABZ or PZQ (10, 20 and 30 days) were selected. The efficacy of each treatment was evaluated by comparison with a control group. Our results show that for in vivo efficacy studies, the best time to start the drug treatment is 10 days post-infection and that a minimum of 20 days of treatment is required when ABZ or PZQ are used as positive control. Moreover, in this model the parasite weight can be used as a rapid tool to measure the in vivo drug activity.

  20. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

    Directory of Open Access Journals (Sweden)

    Ioannis Polyzois

    2016-04-01

    Full Text Available Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA, the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i Natural history of primary shoulder dislocation ii Effect of surgical intervention on natural history iii Risk of long term osteoarthritis with and without surgical intervention iv Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.

  1. Time- and Site-Dependent Life Cycle Assessment of Thermal Waste Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Hellweg, Stefanie; Hofstetter, Thomas B.; Hungerbuehler, Konrad [Swiss Federal Inst. of Technology (ETH), Zuerich (Switzerland). Chemical Engineering Dept.

    2002-12-01

    The high living standard of many industrial countries has directly lead to an increase in the amount of municipal solid waste generated. Parallel to this increase in waste, there has been a raising demand for environmentally benign waste treatment processes. In Switzerland, the predominant way of treatment is incineration. Since the environmental impact of waste incineration depends on the technology used, a comprehensive assessment of the different thermal processes is necessary. In order to determine the environmental impact, we propose a model that quantifies the emissions and resource use resulting from the incineration of waste using different technologies, the landfills for the incineration residues, the transport of waste, related infrastructure, as well as the production of ancillary products. Using the Life-Cycle Assessment (LCA) methodology, we performed a case study that compared the conventional grate technology to new high temperature processes recovering metals and vitrifying the incineration residues. The results show that if the plant is equipped with a modern gas purification system the incineration process itself is not a key environmental problem of the system considered. Using the energy gained from waste incineration as the functional unit, the environmental impacts of incineration plants are comparable to that of a conventional power plant. If long-term time horizons are considered, the critical aspect is the release of heavy metals from the landfilled incineration residues. Due to the better quality of the solid outputs new technologies have a lower potential for environmental impact than the conventional grate technology. This, however, depends on the time horizon considered. With a temporal system boundary of 100 years, the grate technology appears better, because new technologies generally use more energy and short-term emissions are of minor importance no matter what technology is used. The evaluation of waste incineration technologies

  2. First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment

    Science.gov (United States)

    Flórez, Gerardo; López-Durán, Ana; Triñanes, Yolanda; Osorio, Jesús; Fraga, Jaime; Fernández, José Manuel; Becoña, Elisardo; Arrojo, Manuel

    2015-01-01

    Background The purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain. Methods A cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral. Results Four clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications. Conclusion Cluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial

  3. Use of queue modelling in the analysis of elective patient treatment governed by a maximum waiting time policy

    DEFF Research Database (Denmark)

    Kozlowski, Dawid; Worthington, Dave

    2015-01-01

    Many public healthcare systems struggle with excessive waiting lists for elective patient treatment. Different countries address this problem in different ways, and one interesting method entails a maximum waiting time guarantee. Introduced in Denmark in 2002, it entitles patients to treatment at...... by hospital planners and strategic decision makers....... at a private hospital in Denmark or at a hospital abroad if the public healthcare system is unable to provide treatment within the stated maximum waiting time guarantee. Although clearly very attractive in some respects, many stakeholders have been very concerned about the negative consequences of the policy...... on the utilization of public hospital resources. This paper illustrates the use of a queue modelling approach in the analysis of elective patient treatment governed by the maximum waiting time policy. Drawing upon the combined strengths of analytic and simulation approaches we develop both continuous-time Markov...

  4. Shortening delivery times of intensity modulated proton therapy by reducing proton energy layers during treatment plan optimization

    NARCIS (Netherlands)

    S. van de Water (Steven); H.M. Kooy; B.J.M. Heijmen (Ben); M.S. Hoogeman (Mischa)

    2015-01-01

    textabstractPurpose To shorten delivery times of intensity modulated proton therapy by reducing the number of energy layers in the treatment plan. Methods and Materials We have developed an energy layer reduction method, which was implemented into our in-house-developed multicriteria treatment

  5. Shortening delivery times of intensity modulated proton therapy by reducing proton energy layers during treatment plan optimization

    NARCIS (Netherlands)

    S. van de Water (Steven); H.M. Kooy; B.J.M. Heijmen (Ben); M.S. Hoogeman (Mischa)

    2015-01-01

    textabstractPurpose To shorten delivery times of intensity modulated proton therapy by reducing the number of energy layers in the treatment plan. Methods and Materials We have developed an energy layer reduction method, which was implemented into our in-house-developed multicriteria treatment plann

  6. Adjuvant Radiation Therapy Treatment Time Impacts Overall Survival in Gastric Cancer

    Energy Technology Data Exchange (ETDEWEB)

    McMillan, Matthew T. [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Ojerholm, Eric [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Roses, Robert E., E-mail: Robert.Roses@uphs.upenn.edu [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Plastaras, John P.; Metz, James M. [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Mamtani, Ronac [Department of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Karakousis, Giorgos C.; Fraker, Douglas L.; Drebin, Jeffrey A. [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Stripp, Diana; Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States); Datta, Jashodeep [Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (United States)

    2015-10-01

    Purpose: Prolonged radiation therapy treatment time (RTT) is associated with worse survival in several tumor types. This study investigated whether delays during adjuvant radiation therapy impact overall survival (OS) in gastric cancer. Methods and Materials: The National Cancer Data Base was queried for patients with resected gastric cancer who received adjuvant radiation therapy with National Comprehensive Cancer Network–recommended doses (45 or 50.4 Gy) between 1998 and 2006. RTT was classified as standard (45 Gy: 33-36 days, 50.4 Gy: 38-41 days) or prolonged (45 Gy: >36 days, 50.4 Gy: >41 days). Cox proportional hazards models evaluated the association between the following factors and OS: RTT, interval from surgery to radiation therapy initiation, interval from surgery to radiation therapy completion, radiation therapy dose, demographic/pathologic and operative factors, and other elements of adjuvant multimodality therapy. Results: Of 1591 patients, RTT was delayed in 732 (46%). Factors associated with prolonged RTT were non-private health insurance (OR 1.3, P=.005) and treatment at non-academic facilities (OR 1.2, P=.045). Median OS and 5-year actuarial survival were significantly worse in patients with prolonged RTT compared with standard RTT (36 vs 51 months, P=.001; 39 vs 47%, P=.005); OS worsened with each cumulative week of delay (P<.0004). On multivariable analysis, prolonged RTT was associated with inferior OS (hazard ratio 1.2, P=.002); the intervals from surgery to radiation therapy initiation or completion were not. Prolonged RTT was particularly detrimental in patients with node positivity, inadequate nodal staging (<15 nodes examined), and those undergoing a cycle of chemotherapy before chemoradiation therapy. Conclusions: Delays during adjuvant radiation therapy appear to negatively impact survival in gastric cancer. Efforts to minimize cumulative interruptions to <7 days should be considered.

  7. The impact of skin decontamination on the time window for effective treatment of percutaneous VX exposure.

    Science.gov (United States)

    Joosen, M J A; van den Berg, R M; de Jong, A L; van der Schans, M J; Noort, D; Langenberg, J P

    2017-04-01

    The main goal of the present study was to obtain insight into depot formation and penetration following percutaneous VX poisoning, in order to identify an appropriate decontamination window that can enhance or support medical countermeasures. The study was executed in two phases, using the hairless guinea pig as an animal model. In the first phase the effect of various decontamination regimens on levels of free VX in skin and plasma were studied as well as on blood cholinesterase levels. Animals were exposed to 0.5 mg/kg VX and were not decontaminated (control), decontaminated with RSDL once at 15 or 90 min after exposure or three times at 15, 25 and 35 (10-min interval) or 15, 45 and 75 min after exposure (30-min interval). There was no significant effect of any of the decontamination regimens on the 6-h survival rate of the animals. However, all animals that had been decontaminated 15 min after exposure, showed a survival rate of more than 90%, compared to 50-60% in animals that were not decontaminated or decontaminated at 90 min after exposure. In the second phase of the study, hairless guinea pigs were exposed to 1 mg/kg VX on the shoulder, followed either by decontamination with RSDL (10 min interval), conventional treatment on indication of clinical signs or a combination thereof. It appeared that a thorough, repeated decontamination alone could not save the majority of the animals. A 100% survival rate was observed in the group that received a combination of decontamination and treatment. In conclusion, the effects of VX exposure could be influenced by various RSDL decontamination regimens. The results in freely moving animals showed that skin decontamination, although not fully effective in removing all VX from the skin and skin depot is crucial to support pharmacological intervention.

  8. Predictors of lost time from work among nursing personnel who sought treatment for back pain.

    Science.gov (United States)

    Pompeii, Lisa A; Lipscomb, Hester J; Dement, John M

    2010-01-01

    To examine possible predictors of lost workdays among nurses and nurses' aides who sought treatment for work-related back pain. Nursing staff employed at a tertiary care medical center over a 13-year time period (1994 through 2006). We used existing data from clinic surveys administered to nursing personnel during their initial treatment visit to the hospital's occupational health clinic. Predictors of losing ≤ 7 and ≥ 8 workdays was examined. 589 of 708 (83%) nursing personnel with complaints of work-related back pain completed the survey, with 31% resulting in lost workdays. Experiencing sudden onset of pain (RR:1.9; 95% CI: 1.1, 3.1), a combination of severe pain with numbness and tingling in the back/legs (RR: 7.4; 95% CI: 2.9, 18.6), severe pain only (RR: 4.4; 95% CI: 1.8, 11.1), numbness and tingling in the back/legs only (RR: 3.5; 95% CI: 1.0, 12.2), and working < 5 years at the hospital (RR: 2.3; 95% CI: 1.2, 4.7) were predictive of losing ≥ 8 workdays. Job title, work demands, work conflicts, and most psychosocial factors were not predictive. Severe pain, neurologic symptoms and sudden onset of pain were predictive of delayed return-to-work; however, these symptoms alone should not be considered indicators of poor outcomes given that most workers who reported these symptoms returned to work in less than 8~days. Among these health care workers, lost workdays appear to be related to more severe pathology rather than workplace characteristics.

  9. First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment

    Directory of Open Access Journals (Sweden)

    Flórez G

    2015-09-01

    Full Text Available Gerardo Flórez,1,2 Ana López-Durán,3 Yolanda Triñanes,4 Jesús Osorio,5 Jaime Fraga,5 José Manuel Fernández,5 Elisardo Becoña,3 Manuel Arrojo5 1Addictive Disorders Assistance Unit, Complejo Hospitalario, Ourense, Spain; 2Center for Biomedical Research in Mental Health (CIBERSAM, Oviedo, Spain; 3Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain; 4Galician Agency for Health Technology Assessment, Directorate General for Innovation and Management of Public Health, Galicia, Spain; 5Directorate General of Health Assistance, Galician Health Service, Galicia, Spain Background: The purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain. Methods: A cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral. Results: Four clusters were obtained in the main analysis. Cluster 1 (34.01% consisted of young males, cluster 2 (16.19% consisted of not-so-young males, cluster 3 (32.62% consisted mainly of older males and a small group of females, and cluster 4 (17.18% was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73% without medicolegal complications and cluster 2 (27% with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92% with hardly any medicolegal complications and cluster 2 (46.08% with

  10. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.

    Science.gov (United States)

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-26

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).

  11. 4D dosimetry and its applications to pre-treatment quality control and real-time in vivo dosimetry of VMAT treatments

    Science.gov (United States)

    Nordström, F.; Wetterstedt, S. af; Bäck, S. Å. J.

    2013-06-01

    In this study, a 4D dosimetry concept was developed. This concept included a method for calculation of 3D reference absorbed dose matrices at every control point of the delivery using a clinical treatment planning system (TPS). Further, the gamma evaluation method was extended to incorporate the 4th dimension of the TPS calculated dose distributions. The applications of the 4D dosimetry concept on pre-treatment quality control and real-time in vivo dosimetry were investigated.

  12. SU-E-P-27: Efficient Process for AccuBoost Planning and Treatment Delivery to Minimize Patient Compression Time

    Energy Technology Data Exchange (ETDEWEB)

    Iftimia, I; Talmadge, M; Halvorsen, P [Lahey Clinic, Burlington, MA (United States)

    2015-06-15

    Purpose: To implement an efficient and robust process for AccuBoost planning and treatment delivery that can be safely performed by a single Physicist while minimizing patient’s total session time. Methods: Following a thorough commissioning and validation process, templates were created in the brachytherapy planning system for each AccuBoost applicator. Tables of individual and total nominal dwell times for each applicator as a function of separation were generated to streamline planning while an Excel-based nomogram provided by the vendor functions as a secondary verification of the treatment parameters. Tables of surface dose as a function of separation and applicator, along with concise guidance documents for applicator selection, are readily available during the planning process. The entire process is described in a set of detailed Standard Operating Procedures which, in addition to the items described above, include a verbal time-out between the primary planner and the individual performing the secondary verification as well as direct visual confirmation of applicator placement using an articulated mirror. Prior to treatment initiation, a final time-out is conducted with the Radiation Oncologist. Chart documentation is finalized after the patient is released from compression following completion of the treatment. Results: With the aforementioned procedures, it has been possible to consistently limit the time required to prepare each treatment such that the patient is typically under compression for less than 10 minutes per orientation prior to the initiation of the treatment, which is particularly important for APBI cases. This process can be overseen by a single physicist assisted by a dosimetrist and has been optimized during the past 16 months, with 180 treatment sessions safely completed to date. Conclusion: This work demonstrates the implementation of an efficient and robust process for real-time-planned AccuBoost treatments that effectively minimizes

  13. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002

    DEFF Research Database (Denmark)

    Lyhne, N M; Christensen, A; Alanin, M C

    2013-01-01

    BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the pot......BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time...... and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. METHODS: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed...

  14. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke : A Randomized Clinical Trial

    NARCIS (Netherlands)

    Fransen, Puck S S; Berkhemer, Olvert A; Lingsma, Hester F; Beumer, Debbie; van den Berg, Lucie A; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke J H; van Walderveen, Marianne A A; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, L Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van den Berg, J S Peter; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, H Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2016-01-01

    Importance: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. Objective: To evaluate the influe

  15. Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke : A Randomized Clinical Trial

    NARCIS (Netherlands)

    Fransen, Puck S S; Berkhemer, Olvert A; Lingsma, Hester F; Beumer, Debbie; van den Berg, Lucie A; Yoo, Albert J; Schonewille, Wouter J; Vos, Jan Albert; Nederkoorn, Paul J; Wermer, Marieke J H; van Walderveen, Marianne A A; Staals, Julie; Hofmeijer, Jeannette; van Oostayen, Jacques A; Lycklama À Nijeholt, Geert J; Boiten, Jelis; Brouwer, Patrick A; Emmer, Bart J; de Bruijn, Sebastiaan F; van Dijk, Lukas C; Kappelle, L Jaap; Lo, Rob H; van Dijk, Ewoud J; de Vries, Joost; de Kort, Paul L M; van den Berg, J S Peter; van Hasselt, Boudewijn A A M; Aerden, Leo A M; Dallinga, René J; Visser, Marieke C; Bot, Joseph C J; Vroomen, Patrick C; Eshghi, Omid; Schreuder, Tobien H C M L; Heijboer, Roel J J; Keizer, Koos; Tielbeek, Alexander V; den Hertog, Heleen M; Gerrits, Dick G; van den Berg-Vos, Renske M; Karas, Giorgos B; Steyerberg, Ewout W; Flach, H Zwenneke; Marquering, Henk A; Sprengers, Marieke E S; Jenniskens, Sjoerd F M; Beenen, Ludo F M; van den Berg, René; Koudstaal, Peter J; van Zwam, Wim H; Roos, Yvo B W E M; van Oostenbrugge, Robert J; Majoie, Charles B L M; van der Lugt, Aad; Dippel, Diederik W J

    2016-01-01

    IMPORTANCE: Intra-arterial treatment (IAT) for acute ischemic stroke caused by intracranial arterial occlusion leads to improved functional outcome in patients treated within 6 hours after onset. The influence of treatment delay on treatment effect is not yet known. OBJECTIVE: To evaluate the influe

  16. Diffusion-weighted magnetic resonance imaging using different b-value combinations for the evaluation of treatment results after volumetric MR-guided high-intensity focused ultrasound ablation of uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Ikink, Marlijne E.; Voogt, Marianne J.; Bosch, Maurice A.A.J. van den; Nijenhuis, Robbert J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Keserci, Bilgin [Samsung Medical Center, High-intensity Focused Ultrasound (HIFU) Center, Seoul (Korea, Republic of); Philips Healthcare, Advanced Science and Development, Seoul (Korea, Republic of); Kim, Young-sun [Samsung Medical Center, High-intensity Focused Ultrasound (HIFU) Center, Seoul (Korea, Republic of); Samsung Medical Center, Sunkyunkwan University, Department of Radiology and Center for Imaging Science, Seoul (Korea, Republic of); Vincken, Koen L.; Bartels, Lambertus W. [University Medical Center Utrecht, Department of Radiology and Image Sciences Institute, Utrecht (Netherlands)

    2014-09-15

    To assess the value of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) mapping using different b-value combinations for treatment evaluation after magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) of uterine fibroids. Fifty-six patients with 67 uterine fibroids were treated with volumetric MR-HIFU. Pre-treatment and post-treatment images were obtained using contrast-enhanced T1-weighted MRI (CE-T1WI) and DWI using b = 0, 200, 400, 600, 800 s/mm{sup 2}. ADC maps were generated using subsets of b-values to investigate the effects of tissue ablation on water diffusion and perfusion in fibroids treated with MR-HIFU. Four combinations of b-values were used: (1) all b-values; (2) b = 0, 200 s/mm{sup 2}; (3) b = 400, 600, 800 s/mm{sup 2}; and (4) b = 0, 800 s/mm{sup 2}. Using the lowest b-values (0 and 200 s/mm{sup 2}), the mean ADC value in the ablated tissue reduced significantly (p < 0.001) compared with baseline. Calculating the ADC value with the highest b-values (400, 600, 800 s/mm{sup 2}), the ADC increased significantly (p < 0.001) post-treatment. ADC maps calculated with the lowest b-values resulted in the best visual agreement of non-perfused fibroid tissue detected on CE images. Other b-value combinations and normal myometrium showed no difference in ADC after MR-HIFU treatment. A decrease in contrast agent uptake within the ablated region on CE-T1WI was correlated to a significantly decreased ADC when b = 0 and 200 s/mm{sup 2} were used. (orig.)

  17. INFLUENCE OF REACTION TEMPERATURE AND REACTION TIME ON PRODUCT FROM HYDROTHERMAL TREATMENT OF BIOMASS RESIDUE

    Directory of Open Access Journals (Sweden)

    Jakaphong Kongpanya

    2014-01-01

    Full Text Available Thailand is facing with problems associated with biomass residue such as palm oil residues (oil palm trunks, oil palm fronds, empty fruit bunches, shells and fibers. Biomass is promising source for the production of an array of energy-related produts including, liquid, solid and gaseous fuels, heat, chemicals electricity and other materials. Therefore, the use of biomass for energy is not still fully utilization due to the high moisture content, lower heating value of the energy unit or low bulk density and the problems withtar. While Thailand has high potential because the reisa lot of biomass that has not been utilizedfor example biomass residues from palm oil industry. About 2 million tons of empty fruit bunches in Thailand have great potential. This amount will continue increase with the rapid growth in the Thailand, the largest crude palm oil producer in the world. This amount will continue increase with the rapid growth in the Thailand palm oil industry. Therefore, a better method to manage such biomass residues is highly desired. One of the potential ways for alternative utilization of biomass is thermo-chemical process. Hydrothermal treatment is a process for making a homogenizinged, carbon rich and energy-dense solid fuel, called hydrochar. The objective of the study was to identify the effect of reaction temperature and reaction time for hydrothermal treatment of Empty Fruit Bunches (EFB. Influence of temperature 100°C, 150°C and 200°C for 30 to 90 min and active biogas process on 1.00-15.538 bars, within 1,000 mL stainless steel 316 batch-type reactor with a stirrer and there is an automatic temperature controller. Results showed that the highest chemical and physical properties of hydrochar product was achieved when operated on 200°C for 90 min. Maximum heating value was found that 5678 cal/g for EFB9. The result showed that the chemical and physical properties increased progressively with higher temperature. The results was

  18. Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS.

    Science.gov (United States)

    Saran, R; Bragg-Gresham, J L; Levin, N W; Twardowski, Z J; Wizemann, V; Saito, A; Kimata, N; Gillespie, B W; Combe, C; Bommer, J; Akiba, T; Mapes, D L; Young, E W; Port, F K

    2006-04-01

    Longer treatment time (TT) and slower ultrafiltration rate (UFR) are considered advantageous for hemodialysis (HD) patients. The study included 22,000 HD patients from seven countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Logistic regression was used to study predictors of TT > 240 min and UFR > 10 ml/h/kg bodyweight. Cox regression was used for survival analyses. Statistical adjustments were made for patient demographics, comorbidities, dose of dialysis (Kt/V), and body size. Europe and Japan had significantly longer (P V increased concomitantly with TT in all three regions with the largest absolute difference observed in Japan. TT > 240 min was independently associated with significantly lower relative risk (RR) of mortality (RR = 0.81; P = 0.0005). Every 30 min longer on HD was associated with a 7% lower RR of mortality (RR = 0.93; P V and TT (P = 0.007) toward mortality reduction. UFR > 10 ml/h/kg was associated with higher odds of intradialytic hypotension (odds ratio = 1.30; P = 0.045) and a higher risk of mortality (RR = 1.09; P = 0.02). Longer TT and higher Kt/V were independently as well as synergistically associated with lower mortality. Rapid UFR during HD was also associated with higher mortality risk. These results warrant a randomized clinical trial of longer dialysis sessions in thrice-weekly HD.

  19. Time course of treatment dropout in cognitive-behavioral therapies for posttraumatic stress disorder.

    Science.gov (United States)

    Gutner, Cassidy A; Gallagher, Matthew W; Baker, Aaron S; Sloan, Denise M; Resick, Patricia A

    2016-01-01

    A substantial minority of people drop out of cognitive-behavioral therapies (CBTs) for posttraumatic stress disorder (PTSD). There has been considerable research investigating who drops out of PTSD treatment; however, the question of when dropout occurs has received far less attention. The purpose of the current study was to examine when individuals drop out of CBT for PTSD. Women participants (N = 321) were randomized to 1 of several PTSD treatment conditions. The conditions included prolonged exposure (PE), cognitive processing therapy (CPT), CPT-cognitive only (CPT-C), and written accounts (WA). Survival analysis was used to examine temporal pattern of treatment dropout. Thirty-nine percent of participants dropped out of treatment, and those who dropped out tended to do so by midtreatment. Moreover, the pattern of treatment dropout was consistent across CBT conditions. Additional research is needed to examine if treatment dropout patterns are consistent across treatment modalities and settings.

  20. Re-designing the everyday; The use and perception of time among cancer patients combining work and treatment

    DEFF Research Database (Denmark)

    Hauge, Bettina

    2016-01-01

    cancer patients performing their jobs while going through demanding treatment programs found time as their main motive for working while being seriously ill. Actions at work point to a time ahead, so by taking part in the time at the workplace they were inscribed in a future presently under pressure...... towards recovery by re-establishing links to a well-known life-world, the workplace....

  1. Protein-functionalized magnetic iron oxide nanoparticles: time efficient potential-water treatment

    Energy Technology Data Exchange (ETDEWEB)

    Okoli, Chuka [Royal Institute of Technology (KTH), Environmental Microbiology (Sweden); Boutonnet, Magali; Jaeras, Sven [Royal Institute of Technology (KTH), Chemical Technology (Sweden); Rajarao-Kuttuva, Gunaratna, E-mail: gkr@kth.se [Royal Institute of Technology (KTH), Environmental Microbiology (Sweden)

    2012-10-15

    Recent advances in nanoscience suggest that the existing issues involving water quality could be resolved or greatly improved using nanomaterials, especially magnetic iron oxide nanoparticles. Magnetic nanoparticles have been synthesized for the development and use, in association with natural coagulant protein for water treatment. The nanoparticles size, morphology, structure, and magnetic properties were characterized by transmission electron microscope, X-ray diffraction, and superconducting quantum interference device magnetometry. Purified Moringa oleifera protein was attached onto microemulsions-prepared magnetic iron oxide nanoparticles (ME-MION) to form stable protein-functionalized magnetic nanoparticles (PMO+ME-MION). The turbidity removal efficiency in both synthetic and surface water samples were investigated and compared with the commonly used synthetic coagulant (alum) as well as PMO. More than 90 % turbidity could be removed from the surface waters within 12 min by magnetic separation of PMO+ME-MION; whereas gravimetrically, 70 % removal in high and low turbid waters can be achieved within 60 min. In contrast, alum requires 180 min to reduce the turbidity of low turbid water sample. These data support the advantage of separation with external magnetic field (magnetophoresis) over gravitational force. Time kinetics studies show a significant enhancement in ME-MION efficiency after binding with PMO implying the availability of large surface of the ME-MION. The coagulated particles (impurities) can be removed from PMO+ME-MION by washing with mild detergent or cleaning solution. To our knowledge, this is the first report on surface water turbidity removal using protein-functionalized magnetic nanoparticle.

  2. Protein-functionalized magnetic iron oxide nanoparticles: time efficient potential-water treatment

    Science.gov (United States)

    Okoli, Chuka; Boutonnet, Magali; Järås, Sven; Rajarao-Kuttuva, Gunaratna

    2012-10-01

    Recent advances in nanoscience suggest that the existing issues involving water quality could be resolved or greatly improved using nanomaterials, especially magnetic iron oxide nanoparticles. Magnetic nanoparticles have been synthesized for the development and use, in association with natural coagulant protein for water treatment. The nanoparticles size, morphology, structure, and magnetic properties were characterized by transmission electron microscope, X-ray diffraction, and superconducting quantum interference device magnetometry. Purified Moringa oleifera protein was attached onto microemulsions-prepared magnetic iron oxide nanoparticles (ME-MION) to form stable protein-functionalized magnetic nanoparticles (PMO+ME-MION). The turbidity removal efficiency in both synthetic and surface water samples were investigated and compared with the commonly used synthetic coagulant (alum) as well as PMO. More than 90 % turbidity could be removed from the surface waters within 12 min by magnetic separation of PMO+ME-MION; whereas gravimetrically, 70 % removal in high and low turbid waters can be achieved within 60 min. In contrast, alum requires 180 min to reduce the turbidity of low turbid water sample. These data support the advantage of separation with external magnetic field (magnetophoresis) over gravitational force. Time kinetics studies show a significant enhancement in ME-MION efficiency after binding with PMO implying the availability of large surface of the ME-MION. The coagulated particles (impurities) can be removed from PMO+ME-MION by washing with mild detergent or cleaning solution. To our knowledge, this is the first report on surface water turbidity removal using protein-functionalized magnetic nanoparticle.

  3. MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases

    Energy Technology Data Exchange (ETDEWEB)

    Chang, J. [New York Weill Cornell Medical Ctr (United States)

    2015-06-15

    The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequential events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi

  4. SU-E-J-61: Monitoring Tumor Motion in Real-Time with EPID Imaging During Cervical Cancer Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Mao, W; Hrycushko, B; Yan, Y; Foster, R; Albuquerque, K [UT Southwestern Medical Center, Dallas, TX (United States)

    2015-06-15

    Purpose: Traditional external beam radiotherapy for cervical cancer requires setup by external skin marks. In order to improve treatment accuracy and reduce planning margin for more conformal therapy, it is essential to monitor tumor positions interfractionally and intrafractionally. We demonstrate feasibility of monitoring cervical tumor motion online using EPID imaging from Beam’s Eye View. Methods: Prior to treatment, 1∼2 cylindrical radio opaque markers were implanted into inferior aspect of cervix tumor. During external beam treatments on a Varian 2100C by 4-field 3D plans, treatment beam images were acquired continuously by an EPID. A Matlab program was developed to locate internal markers on MV images. Based on 2D marker positions obtained from different treatment fields, their 3D positions were estimated for every treatment fraction. Results: There were 398 images acquired during different treatment fractions of three cervical cancer patients. Markers were successfully located on every frame of image at an analysis speed of about 1 second per frame. Intrafraction motions were evaluated by comparing marker positions relative to the position on the first frame of image. The maximum intrafraction motion of the markers was 1.6 mm. Interfraction motions were evaluated by comparing 3D marker positions at different treatment fractions. The maximum interfraction motion was up to 10 mm. Careful comparison found that this is due to patient positioning since the bony structures shifted with the markers. Conclusion: This method provides a cost-free and simple solution for online tumor tracking for cervical cancer treatment since it is feasible to acquire and export EPID images with fast analysis in real time. This method does not need any extra equipment or deliver extra dose to patients. The online tumor motion information will be very useful to reduce planning margins and improve treatment accuracy, which is particularly important for SBRT treatment with long

  5. Time to unsuccessful tuberculosis treatment outcome, Cambodia, China, and Viet Nam

    DEFF Research Database (Denmark)

    Hoa, N B; Sokun, C; Wei, C

    2012-01-01

    OBJECTIVE: To determine the frequency and characteristics of patients with unsuccessful tuberculosis (TB) treatment. METHODS: Random selection of TB case registers among all treatment units in Cambodia, two provinces in China, and Viet Nam. The data of two calendar years were analyzed to assess u...

  6. Cooperation versus Coordination: Using Real-time Telemedicine for Treatment at Home of Diabetic Footulcers

    DEFF Research Database (Denmark)

    Clemensen, Jane; Larsen, Simon Bo

    2007-01-01

    In conventional treatment the patient with a diabetic foot ulcer travels to hospital for consultations with the experts. We conducted an organizational analysis of the cooperation taking place when telemedicine was used for treatment at home instead. In a pilot study, five patients were offered...

  7. Simultaneous delivery time and aperture shape optimization for the volumetric-modulated arc therapy (VMAT) treatment planning problem

    Science.gov (United States)

    Mahnam, Mehdi; Gendreau, Michel; Lahrichi, Nadia; Rousseau, Louis-Martin

    2017-07-01

    In this paper, we propose a novel heuristic algorithm for the volumetric-modulated arc therapy treatment planning problem, optimizing the trade-off between delivery time and treatment quality. We present a new mixed integer programming model in which the multi-leaf collimator leaf positions, gantry speed, and dose rate are determined simultaneously. Our heuristic is based on column generation; the aperture configuration is modeled in the columns and the dose distribution and time restriction in the rows. To reduce the number of voxels and increase the efficiency of the master model, we aggregate similar voxels using a clustering technique. The efficiency of the algorithm and the treatment quality are evaluated on a benchmark clinical prostate cancer case. The computational results show that a high-quality treatment is achievable using a four-thread CPU. Finally, we analyze the effects of the various parameters and two leaf-motion strategies.

  8. The Impact of a Line Probe Assay Based Diagnostic Algorithm on Time to Treatment Initiation and Treatment Outcomes for Multidrug Resistant TB Patients in Arkhangelsk Region, Russia

    Science.gov (United States)

    Eliseev, Platon; Balantcev, Grigory; Nikishova, Elena; Gaida, Anastasia; Bogdanova, Elena; Enarson, Donald; Ornstein, Tara; Detjen, Anne; Dacombe, Russell; Gospodarevskaya, Elena; Phillips, Patrick P. J.; Mann, Gillian; Squire, Stephen Bertel; Mariandyshev, Andrei

    2016-01-01

    Background In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. Study Aim The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. Methods A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and Löwenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. Results Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, p<0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p<0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes

  9. Predicting outgrowth and inactivation of Clostridium perfringens in meat products during low temperature long time heat treatment

    DEFF Research Database (Denmark)

    Duan, Zhi; Holst Hansen, Terese; Hansen, Tina Beck

    ), was developed from literature data (215 isothermal growth data), and was combined with a linear inactivation model developed from data at 53°C from this study for completely predicting fate of Cl. perfringens during LTLT treatment. RESULTS Very short lag times were observed in most of the challenge tests......, a new growth model and a new inactivation model were developed and combined to predict the overall fate of Cl. Perfringens during LTLT profiles at 53°C. However, predicted lag time was still much longer than the observed lag time in our challenge tests, which caused a general underestimation of growth...... of meats. Very short lag times were observed during LTLT treatments, which were not observed in isothermal or cooling conditions previously. The reason for short lag time during slowly increasing temperature conditions, and how to predict it, should be interesting for future studies....

  10. The Nordic Maintenance Care Program - Time intervals between treatments of patients with low back pain: how close and who decides?

    OpenAIRE

    Leboeuf-Yde Charlotte; Bjørnstad Charlotte; Sandnes Kjerstin F; Hestbaek Lise

    2010-01-01

    Abstract Background The management of chiropractic patients with acute and chronic/persistent conditions probably differs. However, little is known on this subject. There is, for example, a dearth of information on maintenance care (MC). Thus it is not known if patients on MC are coerced to partake in a program of frequent treatments over a long period of time, or if they are actively involved in designing their own individualized treatment program. Objectives It was the purpose of this study...

  11. High-intensityfocusedultrasoundtreatmentfor patientswithunresectablepancreaticcancer

    Institute of Scientific and Technical Information of China (English)

    Peng-Zhou Li; Shai-Hong Zhu; Wei He; Li-Yong Zhu; Sheng-Ping Liu; Yan Liu; Guo-Hui Wang; Fei Ye

    2012-01-01

    BACKGROUND: High-intensity focused ultrasound (HIFU) is a non-invasive method of solid tissue ablation therapy. However, only a few studies have reported the effect of HIFU for unresectable pancreatic cancer. This study aimed to evaluate the clinical beneifts, survival time and complications associated with the use of HIFU ablation in patients with unresectable pancreatic cancer. METHODS: Twenty-ifve patients with unresectable pancreatic cancer were enrolled in our study. All patients received HIFU therapy for tumors at least once. The therapeutic effects of HIFU was evaluated in terms of Karnofsky performance status (KPS) scores, pain relief, serum CA19-9, and imaging by B-US and CT before and after the therapy. We also recorded median overall survival time and complications caused by the treatment. RESULTS: In the 25 patients, KPS scores were above 60, and increased KPS was observed in 23 patients after treatment. Pain relief occurred in 23 patients. Serum CA19-9 levels were signiifcantly reduced one month after HIFU treatment and became negative in 5 patients. B-US revealed enhanced tumor echogenicity in 13 patients and decreased tumor blood supply in 9. Tumor necrosis was conifrmed by CT in 8 patients one month after HIFU treatment. The median overall survival time was 10 months, and the 1-year survival rate was 42%. No severe complications were observed after HIFU treatment. CONCLUSION: HIFU can effectively relieve pain, increase KPS, decrease tumor growth and prolong the survival time of patients with unresectable pancreatic cancer.

  12. Targeted ultrasound-mediated delivery of nanoparticles: on the development of a new HIFU-based therapy and imaging device.

    Science.gov (United States)

    Seip, Ralf; Chin, Chien Ting; Hall, Christopher S; Raju, Balasundar I; Ghanem, Alexander; Tiemann, Klaus

    2010-01-01

    Ultrasound-mediated delivery (USMD) is an active research topic, as researchers develop applications for therapeutic ultrasound in addition to thermal ablation. In USMD, ultrasound is used in conjunction with microbubbles and drugs, nanoparticles, siRNA, pDNA, stem cells, etc., to facilitate their cellular delivery and uptake using pressure and temperature-mediated mechanisms to bring about a desired therapeutic effect. To investigate the potential of targeted USMD of nanoparticles, pDNA, and stem cells for cardiovascular and other applications, a general-purpose preclinical research tool, therapy imaging probe system (TIPS) was designed. It consists of a wideband annular array, a small-animal acoustic coupler, a motorized positioning system, integrated control software for ultrasound image-guided treatment planning and execution, and triggering electronics that allow ECG and respiration-gated ultrasound exposures. TIPS was then used to enhance delivery of nanoparticles into the murine myocardium and heart vessel walls to demonstrate the feasibility of the technology, pave the way for additional basic research in cardiovascular USMD, and begin to explore the requirements that USMD devices will have to meet to be useful in a clinical setting.

  13. The Influence of Heat Treatment Time and Temperature on the Physical Properties of Assab-Corax Steel

    Directory of Open Access Journals (Sweden)

    A.K. Jahja

    2005-07-01

    Full Text Available X-ray diffraction experiment was carried out on commercial Assab-Corax steel sample. The polished samples are then heated to various temperature for different holding time; 200 oC for 4 hours, 300 oC for 4 hours, 400oC for 6-, 8-, 12- and 16 hours, 500 oC for 4 hours and 600 oC for 4 hours. The refinement of the diffraction intensity was carried out using the Im3m model, and the results show that the Carbon atoms are distributed among the base position in the body centered cubic unit cell at the eight-fold octahedral interstitial sites. Using the refined structural parameters, thermo-physical properties such as Debye temperature and coefficient of thermal expansion are calculated. From the results of the analysis it could be concluded that Debye temperature in Assab-Corrax steels tend to decrease with increasing heat-treatment time but tend to increase with heat treatment temperature. The coefficients of linear expansion also tend to decrease with increasing heat-treatment time and tend to increase with heat treatment temperature. Although the patterns are different, for example when the Debye temperature reaches its peak value for heat treatment time of 8 hours, the coefficient of linear expansion would reach its low point at this time. Therefore, the general finding is that both treatment-temperature and – time are influential to the physical properties of Assab-Corrax steels and x-ray diffraction methods could be utilized in elucidating these important findings.

  14. Effect of Stabilization Heat Treatment on Time-Dependent Polarization Losses in Sintered Nd-Fe-B Permanent Magnets

    Directory of Open Access Journals (Sweden)

    Tuominen S.

    2013-01-01

    Full Text Available Some companies in the motor and generator industry utilizing sintered NdFeB magnets have adopted pre-ageing heat treatment in order to improve the stability of the magnets. The parameters of this stabilization heat treatment are based mainly on assumptions rather than on any published research results. In this work, the effects of pre-ageing treatment on the time-dependent polarization losses of two different types of commercial sintered NdFeB magnets were studied. The material showing the squarer J(H curve did not benefit from the pre-ageing treatment, since it seems to be stable under a certain critical temperature. In contrast, a stabilizing effect was observed in the material showing rounder J(H curve. After the stabilization heat treatment, the polarization of the magnets was found to be at lower level, but unchanged over a certain period of time. The length of this period depends on the temperature and the duration of the pre-ageing treatment. In addition, our analysis reveals that the stabilization heat treatment performed in an open circuit condition does not stabilize the magnet uniformly.

  15. Effect of Treatment Time on the Microstructure of Austenitic Stainless Steel During Low-Temperature Liquid Nitrocarburizing

    Science.gov (United States)

    Wang, Jun; Lin, Yuanhua; Zhang, Qiang; Zeng, Dezhi; Fan, Hongyuan

    2014-09-01

    The effect of treatment time on the microstructure of AISI 304 austenitic stainless steel during liquid nitrocarburizing (LNC) at 703 K (430 °C) was investigated using X-ray diffraction (XRD), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Experimental results revealed that the modified layer was covered with the alloy surface and the modified layer depth increased extensively from 2 to 33.4 μm with increasing treatment time. SEM and XRD showed that when the 304 stainless steel sample was subjected to LNC at 703 K (430 °C) for less than 4 hours, the main phase of the modified layer was expanded austenite. When the treatment time was prolonged to 8 hours, the abundant expanded austenite was formed and it partially transformed into CrN and ferrite subsequently. With the increased treatment time, more and more CrN precipitate transformed in the overwhelming majority zone in the form of a typical dendritic structure in the nearby outer part treated for 40 hours. Still there was a single-phase layer of the expanded austenite between the CrN part and the inner substrate. TEM showed the expanded austenite decomposition into the CrN and ferrite after longtime treatment even at low temperature.

  16. Time Trends and Variations in Electroconvulsive Treatment in Denmark 2008 to 2014

    DEFF Research Database (Denmark)

    Hundrup, Eva; Osler, Merete; Jørgensen, Martin Balslev

    2017-01-01

    OBJECTIVE: The aim of this study was to determine status and variations in the practice of electroconvulsive treatment (ECT) in Denmark in patient characteristics, indications, treatment patterns, and hospital region. METHOD: All 140,627 ECTs registered in the Danish National Patient Registry...... the study period. The rate was highest in women and increased with age. There were modest, however, stable regional differences in rates (extremal quotient = 1.4). Electroconvulsive treatment was most commonly used in patients with depression with (19.4%) or without (54.9%) psychotic symptoms. The median...

  17. Nanoparticle Albumin Bound Paclitaxel in the Treatment of Human Cancer: Nanodelivery Reaches Prime-Time?

    Directory of Open Access Journals (Sweden)

    Iole Cucinotto

    2013-01-01

    Full Text Available Nanoparticle albumin bound paclitaxel (nab-paclitaxel represents the first nanotechnology-based drug in cancer treatment. We discuss the development of this innovative compound and report the recent changing-practice results in breast and pancreatic cancer. A ground-breaking finding is the demonstration that nab-paclitaxel can not only enhance the activity and reduce the toxicity of chromophore-diluted compound, but also exert activity in diseases considered refractory to taxane-based treatment. This is the first clinical demonstration of major activity of nanotechnologically modified drugs in the treatment of human neoplasms.

  18. Nanoparticle Albumin Bound Paclitaxel in the Treatment of Human Cancer: Nanodelivery Reaches Prime-Time?

    Science.gov (United States)

    Cucinotto, Iole; Fiorillo, Lucia; Gualtieri, Simona; Arbitrio, Mariamena; Ciliberto, Domenico; Staropoli, Nicoletta; Grimaldi, Anna; Luce, Amalia; Tassone, Pierfrancesco; Caraglia, Michele; Tagliaferri, Pierosandro

    2013-01-01

    Nanoparticle albumin bound paclitaxel (nab-paclitaxel) represents the first nanotechnology-based drug in cancer treatment. We discuss the development of this innovative compound and report the recent changing-practice results in breast and pancreatic cancer. A ground-breaking finding is the demonstration that nab-paclitaxel can not only enhance the activity and reduce the toxicity of chromophore-diluted compound, but also exert activity in diseases considered refractory to taxane-based treatment. This is the first clinical demonstration of major activity of nanotechnologically modified drugs in the treatment of human neoplasms. PMID:23738077

  19. Synchronous Oscillations Intrinsic to Water: Applications to Cellular Time Keeping and Water Treatment

    Directory of Open Access Journals (Sweden)

    D. James Morré

    2015-05-01

    Full Text Available A homodimeric, growth-related and time-keeping hydroquinone oxidase (ENOX1 of the eukaryotic cell surface capable of oxidizing intracellular NADH exhibits properties of the ultradian driver of the biological 24 h circadian clock by exhibiting a complex 2 + 3 set of oscillations of copper salts and appear to derive from periodic variations in the ratio of ortho and para nuclear spins of the paired hydrogen atoms of the elongated octahedral structure of the ENOX1 protein bound copper II hexahydrates. A corollary of these observations is that the ortho/para oscillations must occur in a highly synchronized matter. Our findings suggest that water molecules communicate with each other via very low frequency electromagnetic fields and that these fields also appear to be generated by the energetics of the synchronous ortho to para interconversions of the nuclear spin pairs of the water hydrogens. Further evidence for energy absorbed and emitted by water and correlated with ortho/para oscillations of ortho/para spin pairs of water hydrogens is indicated from the auto-oscillations in water luminescence. The emissions oscillate with period lengths of 18.8 min that agree with our previously found period of oscillation of about 18 min for pure water, reflective of ortho to para spin isomers based on measurements of redox potential. The period length of pure water (increased by about 25% in D2O and varies depending on the dominant cation present (copper salts in solution are unique in that the period length is exactly 24 min. Synchrony is maintained through generation of and response to LFEMF generated by the ortho-para spin pairs. Changes in redox potential sufficient to catalyze NADH oxidation were used to monitor synchronous water oscillations that appear to extend indefinitely over great distances in contiguous bodies of either still or flowing water. Adjacent out-of-phase water samples contained in thin plastic cuvettes auto-synchronize in a matter of

  20. Chronic Pain Following Spinal Cord Injury: The Role of Immunogenetics and Time of Injury Pain Treatment

    Science.gov (United States)

    2014-10-01

    RNSH. Kathy is a registered nurse and Francesca has many years clinical trials experience. Kathy and Francesca have continued the job sharing...Questionnaire Q4 September 2012 • Treatment Algorithm for Autonomic Dysreflexia ( Hypertensive Crisis) in Spinal Cord (10 April2006) CURRENT • Treatment...Algorithm for Autonomic Dysreflexia ( Hypertensive Crisis) in Spinal Cord Injury (2010) CURRENT Approval 20/2/2013 • Protocol Version 4 dated 12

  1. Are we giving biologics too much time? When should we stop treatment?

    Institute of Scientific and Technical Information of China (English)

    Edouard Louis; J Belaiche; C Reenaers

    2008-01-01

    The optimal duration of biological treatment, particularly anti-TNF, in inflammatory bowel disease (IBD) is a very important question both for patients and physicians. There is no published evidence to clearly and definitely answer this question. However data on natural history of IBD, long term safety of biologics, immunosuppressors (IS) cessation and some preliminary studies on biologics cessation may help us to discuss this topic. The decision to stop a biological treatment is currently based on a compromise between the benefits and risks associated with the prolongation of this treatment. IBD, more particularly CD, are characterized by the development of complications and the need for recurrent hospitalizations and surgeries in approximately 2/3 of cases. In these patients potentially in need of biological treatments, it is probable that, as it has been demonstrated for IS, the longer a stable remission has be achieved under treatment, the lower the risk of relapse is after treatment cessation. Further prospective studies should now aim at disclosing patient characteristics associated with a low risk of relapse to implement this strategy.

  2. Increasing prevalence of HIV infection among first time clients in Italian drug treatment services - is it sexual transmission?

    Science.gov (United States)

    Cruciani, Mario; Wiessing, Lucas; Serpelloni, Giovanni; Genetti, Bruno; Andreotti, Alessandra; Iulia, Carpignano; Zermiani, Monica; Suligoi, Barbara

    2015-04-30

    Over the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining. This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. We report nationwide trends in the prevalence of HIV and HCV among tested clients in charge to drug addiction services from 2005 to 2011. Data on the prevalence of HIV and HCV among drug users from public drug treatment services across Italy were collected and analyzed for the period from 2005 to 2011. Prevalence of HIV and HCV were compared between clients returning to treatment and those entering treatment for the first time, and by gender. Due to the high percentage of missing data, the "inverse probability weight" method was used. Trends in testing uptake were also analysed. A significant decrease of HIV and HCV prevalence is observed among all PDUs entering treatment (from 14.7% to 11.1% and from 61.6% to 50%, respectively, in 2005-2011). By contrast, among those entering the services for the first time, after an initial decline the prevalence of HIV infection steadily increased in both sexes, from 2.2% in 2009 to 5.3% in 2011. Self-reported injecting rates in this group decreased over time, and in 2011 the proportion reporting drug injecting was lower among new clients than in people returning to services (14.5 vs. 34.4%). We also observed a progressive and significant reduction in HIV and HCV testing in drug treatment services. Changes in injection practice and type of drugs used, coupled with a concurrent reduction in HCV prevalence, do not support drug injection as the main explanation for an increased HIV transmission in people entering drug treatment services for the first time. While reductions in testing rates raise concerns over data quality, the possibility of increased sexual transmission needs to be considered.

  3. Synchronization of oestrus and ovulation by short time combined FGA, PGF(2α), GnRH, eCG treatments for natural service or AI fixed-time.

    Science.gov (United States)

    Martemucci, G; D'Alessandro, A G

    2011-01-01

    Two experiments were conducted in ewes in order to develop an oestrus-ovulation short time synchronization protocol based on combined FGA, PGF(2α), GnRH, eCG treatments, for use in dairy sheep before natural service (Experiment 1) or for fixed-time artificial insemination (Experiment 2), during the breeding season. In Experiment 1 seventy-five non-lactating dairy ewes were subdivided into 5 treatment groups (N=15): (1) Group Fe - control, which received FGA vaginal sponges (14 days)+eCG (Day 14); (2) Group FPe, FGA (5 days)+PGF(2α) (Day 5)+eCG (Day 5); (3) Group PFe, PGF(2α) (Day 0)+FGA (5 days)+eCG (Day 5); (4) Group PFG, PGF(2α) (Day 0)+FGA (5 days)+GnRH (30h after sponge removal, s.r.); (5) Group GPe, GnRH (Day 0)+PGF(2α) (Day 5)+eCG (Day 5). Ewes were checked for oestrus and hand-mated. Time of ovulation was recorded by laparoscopy for 10 animals from each treatment. The percentages of female in oestrus and the interval to oestrus (h after treatment), fertility and prolificacy rate were recorded. There were no treatment differences in the percentage of females in oestrus. The interval to oestrus was earlier in Fe Group and delayed in FPe Group (P<0.01). Ovulation time was earlier in GPe Group compared to FPe Group (P<0.05). Fertility rates were significantly different (P<0.05) between the PFe and the FPeG Groups compared with the PFG Group. No significant differences were observed in prolificacy among the treatments. In Experiment 2, sixty dry ewes were subdivided (N=20) into the following three experimental treatment groups: (1) Group FP, FGA (5 days)+PGF(2α) (Day 5); (2) Group FPG, FGA (5 days)+PGF(2α) (Day 5)+GnRH (30hs.r.); (3) Group FPeG, FGA (5 days)+PGF(2α) (Day 5)+eCG (Day 5)+GnRH (30hs.r.). These were further subdivided into two groups (N=10) corresponding to 52 and 60hs.r. fixed-time insemination. Laparoscopic intrauterine insemination was performed with frozen semen (80×10(6)spermatozoa/dose) and ovulation time was recorded in a subgroup (N

  4. Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy

    NARCIS (Netherlands)

    Balvert, M.; Gorissen, B.L.; den Hertog, D.; Hoffmann, A.L.

    2015-01-01

    Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell

  5. Investigation of pitch and jaw width to decrease delivery time of helical tomotherapy treatments for head and neck cancer.

    Science.gov (United States)

    Moldovan, Monica; Fontenot, Jonas D; Gibbons, John P; Lee, Tae Kyu; Rosen, Isaac I; Fields, Robert S; Hogstrom, Kenneth R

    2011-01-01

    Helical tomotherapy plans using a combination of pitch and jaw width settings were developed for 3 patients previously treated for head and neck cancer. Three jaw widths (5, 2.5, and 1 cm) and 4 pitches (0.86, 0.43, 0.287, and 0.215) were used with a (maximum) modulation factor setting of 4. Twelve plans were generated for each patient using an identical optimization procedure (e.g., number of iterations, objective weights, and penalties, etc.), based on recommendations from TomoTherapy (Madison, WI). The plans were compared using isodose plots, dose volume histograms, dose homogeneity indexes, conformity indexes, radiobiological models, and treatment times. Smaller pitches and jaw widths showed better target dose homogeneity and sparing of normal tissue, as expected. However, the treatment time increased inversely proportional to the jaw width, resulting in delivery times of 24 ± 1.9 min for the 1-cm jaw width. Although treatment plans produced with the 2.5-cm jaw were dosimetrically superior to plans produced with the 5-cm jaw, subsequent calculations of tumor control probabilities and normal tissue complication probabilities suggest that these differences may not be radiobiologically meaningful. Because treatment plans produced with the 5-cm jaw can be delivered in approximately half the time of plans produced with the 2.5-cm jaw (5.1 ± 0.6 min vs. 9.5 ± 1.1 min), use of the 5-cm jaw in routine treatment planning may be a viable approach to decreasing treatment delivery times from helical tomotherapy units. Copyright © 2011 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  6. Time-series analysis in imatinib-resistant chronic myeloid leukemia K562-cells under different drug treatments.

    Science.gov (United States)

    Zhao, Yan-Hong; Zhang, Xue-Fang; Zhao, Yan-Qiu; Bai, Fan; Qin, Fan; Sun, Jing; Dong, Ying

    2017-08-01

    Chronic myeloid leukemia (CML) is characterized by the accumulation of active BCR-ABL protein. Imatinib is the first-line treatment of CML; however, many patients are resistant to this drug. In this study, we aimed to compare the differences in expression patterns and functions of time-series genes in imatinib-resistant CML cells under different drug treatments. GSE24946 was downloaded from the GEO database, which included 17 samples of K562-r cells with (n=12) or without drug administration (n=5). Three drug treatment groups were considered for this study: arsenic trioxide (ATO), AMN107, and ATO+AMN107. Each group had one sample at each time point (3, 12, 24, and 48 h). Time-series genes with a ratio of standard deviation/average (coefficient of variation) >0.15 were screened, and their expression patterns were revealed based on Short Time-series Expression Miner (STEM). Then, the functional enrichment analysis of time-series genes in each group was performed using DAVID, and the genes enriched in the top ten functional categories were extracted to detect their expression patterns. Different time-series genes were identified in the three groups, and most of them were enriched in the ribosome and oxidative phosphorylation pathways. Time-series genes in the three treatment groups had different expression patterns and functions. Time-series genes in the ATO group (e.g. CCNA2 and DAB2) were significantly associated with cell adhesion, those in the AMN107 group were related to cellular carbohydrate metabolic process, while those in the ATO+AMN107 group (e.g. AP2M1) were significantly related to cell proliferation and antigen processing. In imatinib-resistant CML cells, ATO could influence genes related to cell adhesion, AMN107 might affect genes involved in cellular carbohydrate metabolism, and the combination therapy might regulate genes involved in cell proliferation.

  7. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

    Science.gov (United States)

    Salgaonkar, Vasant A.; Prakash, Punit; Rieke, Viola; Ozhinsky, Eugene; Plata, Juan; Kurhanewicz, John; Hsu, I.-C. Joe; Diederich, Chris J.

    2017-03-01

    Here, operational modifications to a commercial MR-guided ultrasound phased array designed for prostate ablation (part of ExAblate 2100, InSightec Ltd) are presented for the delivery of protracted mild (40 - 45°C) hyperthermia to large contiguous target volumes in the prostate. This high-intensity focused ultrasound phased array is already in clinical trials for prostate ablation, and can be potentially fast-tracked for clinical hyperthermia treatments. As a part of this preliminary feasibility study, patient-specific numerical simulations were performed using Pennes bioheat model and acoustic field calculations were conducted using the rectangular radiator method for the ExAblate prostate array (2.3 MHz, 2.3×4.0 cm2, ˜1000 channels). Thermal solutions were computed using 3D finite element methods (FEM) implemented using Comsol Multiphysics (Comsol Inc). The patient-specific geometries were created through manual segmentation of anatomical structures from representative patient MRIs and 3D rendering (Mimics 15.01, Materialise) and generation of finite element meshes (3-Matic 7.01, Materialise). Array beamforming was employed and acoustic fields were synthesized (Matlab 2010a, MathWorks) to deliver protracted continuous wave hyperthermia to focal prostate cancer targets identified in the patient-specific models. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Sonication strategies explored during modeling were implemented on the ExAblate prostate array and preliminary experiments were conducted in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). Therapeutic temperatures (40 - 45 °C) could be established conformably in focal cancer volumes in a single prostate quadrant using focused heating patterns and hemi-gland heating was possible using diffused heating patterns (iso-phase or diverging). T>41 °C was calculated in 13

  8. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

    Energy Technology Data Exchange (ETDEWEB)

    Salgaonkar, Vasant A., E-mail: salgaonkarv@radonc.ucsf.edu; Hsu, I-C.; Diederich, Chris J. [Thermal Therapy Research Group, Radiation Oncology, University of California San Francisco, 1600 Divisadero Street, Suite H-1031, San Francisco, California 94143 (United States); Prakash, Punit [Department of Electrical and Computer Engineering, Kansas State University, 2077 Rathbone Hall, Manhattan, Kansas 66506 (United States); Rieke, Viola; Ozhinsky, Eugene; Kurhanewicz, John [Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143 (United States); Plata, Juan [Department of Radiology, Stanford University, 1201 Welch Road, Stanford, California 94305 (United States)

    2014-03-15

    Purpose: Feasibility of targeted and volumetric hyperthermia (40–45 °C) delivery to the prostate with a commercial MR-guided endorectal ultrasound phased array system, designed specifically for thermal ablation and approved for ablation trials (ExAblate 2100, Insightec Ltd.), was assessed through computer simulations and tissue-equivalent phantom experiments with the intention of fast clinical translation for targeted hyperthermia in conjunction with radiotherapy and chemotherapy. Methods: The simulations included a 3D finite element method based biothermal model, and acoustic field calculations for the ExAblate ERUS phased array (2.3 MHz, 2.3 × 4.0 cm{sup 2}, ∼1000 channels) using the rectangular radiator method. Array beamforming strategies were investigated to deliver protracted, continuous-wave hyperthermia to focal prostate cancer targets identified from representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Preliminary experiments included beamformed sonications in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). Results: Acoustic intensities considered during simulation were limited to ensure mild hyperthermia (T{sub max} < 45 °C) and fail-safe operation of the ExAblate array (spatial and time averaged acoustic intensity I{sub SATA} < 3.4 W/cm{sup 2}). Tissue volumes with therapeutic temperature levels (T > 41 °C) were estimated. Numerical simulations indicated that T > 41 °C was calculated in 13–23 cm{sup 3} volumes for sonications with planar or diverging beam patterns at 0.9–1.2 W/cm{sup 2}, in 4.5–5.8 cm{sup 3} volumes for simultaneous multipoint focus beam patterns at ∼0.7 W/cm{sup 2}, and in ∼6.0 cm{sup 3} for curvilinear (cylindrical) beam patterns at 0.75 W/cm{sup 2}. Focused heating patterns may be practical for treating focal disease in a single posterior

  9. SU-E-T-755: Timing Characteristics of Proton and Carbon Ion Treatments Using a Synchrotron and Modulated Scanning

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, J [Fudan university Shanghai Cancer center, Shanghai, Shanghai (China); Li, Y; Huang, Z; Deng, Y [Shanghai Proton and Heavy Ion Center, Shanghai, Shanghai (China); Sun, L [Fudan University Shanghai Cancer Center, Shanghai, Shanghai (China); Moyers, M [Shanghai Proton and Heavy Ion Center, Colton, CA (China); Hsi, W [Shanghai Proton and Heavy Ion Center, Shanghai (China); Wu, X [University of Iowa, Iowa City, Iowa (United States)

    2015-06-15

    Purpose: The time required to deliver a treatment impacts not only the number of patients that can be treated each day but also the accuracy of delivery due to potential movements of patient tissues. Both macroscopic and microscopic timing characteristics of a beam delivery system were studied to examine their impacts on patient treatments. Methods: 35 patients were treated during a clinical trial to demonstrate safety and efficacy of a Siemens Iontris system prior to receiving approval from the Chinese Food and Drug Administration. The system has a variable cycle time and can provide proton beams from 48 to 221 MeV/n and carbon ions from 86 to 430 MeV/n. A modulated scanning beam delivery technique is used where the beam remains stationary at each spot aiming location and is not turned off while the spot quickly moves from one aiming location to the next. The treatment log files for 28 of the trial patients were analyzed to determine several timing characteristics. Results: The average portal time per target dose was 172.5 s/Gy for protons and 150.7 s/Gy for carbon ions. The maximum delivery time for any portal was less than 300 s. The average dwell time per spot was 12 ms for protons and 3.0 ms for carbon ions. The number of aiming positions per energy layer varied from 1 to 258 for protons and 1 to 621 for carbon ions. The average spill time and cycle time per energy layer were 1.20 and 2.68 s for protons and 0.95 and 4.73 s for carbon ions respectively. For 3 of the patients, the beam was gated on and off to reduce the effects of respiration. Conclusion: For a typical target volume of 153 cc as used in this clinical trial, the portal delivery times were acceptable.

  10. The Effects of Short-Time Solution Treatment and Short-Time Aging on Mechanical Properties of Ti-6Al-4V for Orthopaedic Applications

    Directory of Open Access Journals (Sweden)

    Abdul Ajiz

    2015-01-01

    Full Text Available The Ti-6Al-4Valloy is currently utilized as structural materials in artificial hip and knee joints, bone plates and screws, and artificial dental roots. It is mainly used in implants that replace hard tissue because has a high strength, good corrosion resistance, high biocompatibility compared to other conventional metallic biomaterials such as stainless steel and Co-Cr-Moalloys.The Ti-6Al-4V alloy with low Young’s modulus equivalent  to that of the cortical  bone is a simultaneously required in order to inhibit  bone absorption.Byshort-time solution treatment and subsquent short-time aging, the mechanical properties of  Ti–6Al–4V alloy can be improvedwhile maintaining a low Young’s modulus. The result showed optimum heat treatments were solution treatment at930 oC (1203 K for 60 sand subsquent aging at 530 oC (803 K for 40 s; the yield strength and tensile strength improved without reduction in ductility. Their maximum improvement rates of reached 21,6% and 21,1%, respectively and the Young’s modulus reduced  with maximum rates of reached 12%.

  11. Small doses of arginine vasopressin in combination with norepinephrine "buy" time for definitive treatment for uncontrolled hemorrhagic shock in rats.

    Science.gov (United States)

    Liu, Liangming; Tian, Kunlun; Xue, Mingying; Zhu, Yu; Lan, Dan; Peng, Xiaoyong; Wu, Yue; Li, Tao

    2013-11-01

    Implementation of fluid resuscitation and blood transfusion are greatly limited in prehospital or evacuation settings after severe trauma or war wounds. With uncontrolled hemorrhagic shock rats, we investigated if arginine vasopressin (AVP) in combination with norepinephrine (NE) is independent (or slightly dependent) of fluid resuscitation and can "buy" time for the subsequently definitive treatment of traumatic hemorrhagic shock in the present study. The results showed that AVP (0.4 U/kg) alone or with NE (3 μg/kg) with one-eighth and one-fourth volumes of total blood volume of lactated Ringer's infusion significantly increased and maintained the mean arterial pressure. Among all groups, 0.4 U/kg of AVP + NE (3 μg/kg) with one-eighth volume of lactated Ringer's infusion had the best effect: it significantly increased and maintained hemodynamics and prolonged the survival time. This early treatment strategy significantly improved the effects of subsequently definitive treatments (after bleeding controlled): it increased the subsequent survival, improved the hemodynamic parameters, improved the cardiac function, and increased the tissue blood flow and oxygen delivery. These results suggested that early application of small doses of AVP (0.4 U/kg) + NE before bleeding control can "buy" time for the definitive treatment of uncontrolled hemorrhagic shock, which may be an effective measure for the early treatment of traumatic hemorrhagic shock.

  12. Effect of acid concentration and treatment time on acid-alcohol modified jackfruit seed starch properties.

    Science.gov (United States)

    Dutta, Himjyoti; Paul, Sanjib Kumar; Kalita, Dipankar; Mahanta, Charu Lata

    2011-09-15

    The properties of starch extracted from jackfruit (Artocarpus heterophyllus Lam.) seeds, collected from west Assam after acid-alcohol modification by short term treatment (ST) for 15-30min with concentrated hydrochloric acid and long term treatment (LT) for 1-15days with 1M hydrochloric acid, were investigated. Granule density, freeze thaw stability, solubility and light transmittance of the treated starches increased. A maximum decrease in the degree of polymerisation occurred in ST of 30min (2607.6). Jackfruit starch had 27.1±0.04% amylose content (db), which in ST initially decreased and then increased with the severity of treatment; in LT the effect was irregular. The pasting profile and granule morphology of the treated samples were severely modified. Native starch had the A-type crystalline pattern and crystalline structure increased on treatment. FTIR spectra revealed slight changes in bond stretching and bending. Colour measurement indicated that whiteness increased on treatment. Acid modified jackfruit seed starch can have applications in the food industry.

  13. Peroral endoscopic myotomy: Time to change our opinion regarding the treatment of achalasia?

    Science.gov (United States)

    Tantau, Marcel; Crisan, Dana

    2015-03-16

    Peroral endoscopic myotomy (POEM) is a new endoscopic treatment for achalasia. Compared to the classical surgical myotomy, POEM brings at least the advantage of minimal invasiveness. The data provided until now suggest that POEM offers excellent short-term symptom resolution, with improvement of dysphagia in more than 90% of treated patients, with encouraging manometric outcomes and low incidence of postprocedural gastroesophageal reflux. The effectiveness of this novel therapy requires long-term follow-up and comparative studies with other treatment modalities for achalasia. This technique requires experts in interventional endoscopy, with a learning curve requiring more than 20 cases, including training on animal and cadaver models, and with a need for structured proctoring during the first cases. This review aims to summarize the data on the technique, outcomes, safety and learning curve of this new endoscopic treatment of achalasia.

  14. Global HIV-1 transmitted drug resistance in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

    DEFF Research Database (Denmark)

    Baxter, J D; Dunn, D; White, E;

    2015-01-01

    of resistance testing in START trial participants. METHODS: In the Strategic Timing of AntiRetroviral Treatment (START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based...

  15. Intravenous artesunate reduces parasite clearance time, duration of intensive care, and hospital treatment in patients with severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu;

    2015-01-01

    Intravenous artesunate improves survival in severe malaria, but clinical trial data from nonendemic countries are scarce. The TropNet severe malaria database was analyzed to compare outcomes of artesunate vs quinine treatment. Artesunate reduced parasite clearance time and duration of intensive...

  16. Disinfection of fresh chicken breast fillets with in-package atmospheric cold plasma: effect of treatment voltage and time

    Science.gov (United States)

    Effects of treatment voltage and time of in-package atmospheric cold plasma (ACP) were studied on ozone formation, microbiological quality, surface color, and pH of fresh chicken fillets. Samples were sealed in food trays in air, treated with a dielectric-barrier-discharge (DBD) ACP system, and stor...

  17. Time Trends in the Incidence and Treatment of Extra-Abdominal and Abdominal Aggressive Fibromatosis: A Population-Based Study

    NARCIS (Netherlands)

    D.L.M. van Broekhoven (Danique); D.J. Grunhagen (Dirk Jan); M.A. den Bakker (Michael); T. van Dalen (Thijs); C. Verhoef (Kees)

    2015-01-01

    textabstractBackground: Aggressive fibromatosis (AF) is a locally infiltrating soft-tissue tumor. In a population-based study in the Netherlands, we evaluated time trends for the incidence and treatment of AF. Methods: In PALGA: Dutch Pathology Registry, all patients diagnosed between 1993 and 2013

  18. Significance of Timing on Effect of Metaphylactic Toltrazuril Treatment against Eimeriosis in Calves

    DEFF Research Database (Denmark)

    Enemark, Heidi; Dahl, Jan; Enemark, Jörg Matthias Dehn

    2015-01-01

    of Eimeria bovis and Eimeria zuernii. Three commercial herds and a total of 71 calves, aged 48 – 135 days, were included. Treatment with a single oral dose of toltrazuril (15 mg/kg) was given after relocation to common pens and one week before expected outbreak of eimeriosis. The effect of treatment...... was followed by weekly faecal sampling and weighing initially and at the end of a study period of 8 weeks. In Herd 2 and 3 toltrazuril treated calves gained on average 7.95 kg more than placebo treated calves (p = 0.007), and both oocyst excretion and prevalence of Eimeria spp. were significantly reduced...

  19. [Experiences in prevention and treatment of human rabies with acupuncture and moxibustion in ancient time].

    Science.gov (United States)

    Li, Dao-Pi; Chen, Jia-Zhi

    2011-03-01

    By consulting the literatures relevant with the prevention and treatment of human rabies from Tang Dynasty to Qing Dynasty, it was discovered that rabies was caused by wind toxin in mad dog injuring human being. The pathogenesis of rabies was the invasion of dog toxin into the heart. The latent period was ranged from 7 to 100 days. Acupuncture-moxibustion, bloodletting, cupping and other therapies could be used in treatment. But of those different therapies, the various moxibustion methods achieved unique efficacy on the disease.

  20. Epoch Analysis of On-Treatment Disability Progression Events over Time in the Tysabri Observational Program (TOP)

    Science.gov (United States)

    Wiendl, Heinz; Butzkueven, Helmut; Kappos, Ludwig; Trojano, Maria; Pellegrini, Fabio; Paes, Dominic; Zhang, Annie; Belachew, Shibeshih

    2016-01-01

    Objective To evaluate the effect of natalizumab on disability progression beyond 2 years of treatment in clinical practice. Methods Analyses included the 496 relapsing-remitting multiple sclerosis (RRMS) patients among 5122 patients in the Tysabri Observational Program (TOP) who had completed 4 continuous years of natalizumab treatment and had baseline (study enrollment) and postbaseline Expanded Disability Status Scale (EDSS) assessments. Proportions of patients with 6-month or 12-month confirmed ≥1.0-point EDSS progression relative to baseline were compared in treatment months 1–24 and 25–48. Sensitivity analyses compared progression rates in months 13–24 and 25–36. Results Baseline characteristics appeared similar between the overall TOP population (N = 5122), patients who had completed 4 years of natalizumab treatment (n = 469), and patients eligible to complete 4 years in TOP who had discontinued natalizumab after 2 years of treatment (n = 514). Among 4-year completers, the proportion of patients with 6-month and 12-month confirmed EDSS progression decreased between months 1–24 and 25–48 of natalizumab treatment by 42% (from 10.9% to 6.3%; p EDSS progression in both epochs (0.6% and 0.2%, respectively). Between months 13–24 and 25–36 of treatment, the proportion of patients with 6-month and 12-month confirmed EDSS progression decreased by 60% (from 7.5% to 3.0%; p EDSS progression over time. PMID:26771747

  1. Interdisciplinary orthodontic treatment for a patient with generalized aggressive periodontitis: Assessment of IgG antibodies to identify type of periodontitis and correct timing of treatment.

    Science.gov (United States)

    Ishihara, Yoshihito; Tomikawa, Kazuya; Deguchi, Toru; Honjo, Tadashi; Suzuki, Koji; Kono, Takayuki; Kuboki, Takuo; Kamioka, Hiroshi; Takashiba, Shogo; Yamashiro, Takashi

    2015-06-01

    Aggressive periodontitis is a great challenge to clinicians when providing orthodontic treatment because of the potential for progression of periodontal disease. In this article, we report the successful comprehensive orthodontic treatment of bimaxillary protrusion and severe crowding in an adult with generalized aggressive periodontitis. A woman, aged 22 years 7 months, with a chief complaint of incisal crowding was diagnosed with a skeletal Class I malocclusion associated with severe anterior crowding, possibly worsened by generalized aggressive periodontitis. In addition to a periodontal examination, a blood IgG antibody titer analysis and microbiologic examination for periodontal pathogens were used to diagnose the type of periodontal disease and determine the proper timing to initiate orthodontic treatment. The total active treatment period was 28 months, followed by periodontal prostheses and regeneration therapy. Consequently, satisfactory facial profile, occlusion, and periodontal health were maintained for at least 36 months. These results indicate that efficient screening is important for providing successful orthodontic treatment in patients with advanced periodontal disease. This report also demonstrates the diagnostic importance of blood IgG antibody titer assays and microbiologic examinations to detect periodontal pathogens.

  2. Time limited psychodynamic group therapy: Predictors of patients seeking additional treatment

    DEFF Research Database (Denmark)

    Jensen, Hans Henrik; Mortensen, Erik Lykke; Lotz, Martin

    2010-01-01

    were the Symptom Check List 90 Revised (SCL-90-R), Millon Clinical Multiaxial Inventory II (MCMI-II), non-symptomatic Psychodynamic Focus, retrospective outcome evaluations, and socio-demographic and psychiatric variables. At follow-up, 57.6% of the patients had been seeking additional treatment...

  3. Time perception and illness acceptance among remitting-relapsing multiple sclerosis patients under treatment

    Directory of Open Access Journals (Sweden)

    Joanna Król

    2015-10-01

    Avoiding contemplation of negative past and concentrating on hedonistic future constitute significant predictors of illness acceptance. These results may be of importance in terms of holistic approach to treatment of RR-MS patients. In the initial stage of the disease progression, patients might benefit from psychological support due to change in temporal orientation.

  4. The impact of skin decontamination on the time for effective treatment of low volatile nerve agent

    NARCIS (Netherlands)

    Joosen, M.J.A.; Schans, M.J. van der; Noort, D.

    2013-01-01

    Low volatile organophosphorous (OP) nerve agents such as VX, will most likely enter the body via the skin. In previous investigations conducted in hairless guinea pigs, it was shown that skin exposure to VX resulted in a slow and variable onset of observable signs of toxicity. Repeated treatments

  5. Post-fire erosion and the effectiveness of emergency rehabilitation treatments over time

    Science.gov (United States)

    Lee H. MacDonald; Peter R. Robichaud

    2008-01-01

    High-severity wildfires can increase runoff and erosion rates by one or more orders of magnitude, and these increases can threaten life and property as well as severely degrading water quality and aquatic ecosystems. Each year millions of dollars are spent on emergency postfire rehabilitation treatments to minimize flood runoff and soil erosion. Few data have been...

  6. The impact of skin decontamination on the time for effective treatment of low volatile nerve agent

    NARCIS (Netherlands)

    Joosen, M.J.A.; Schans, M.J. van der; Noort, D.

    2013-01-01

    Low volatile organophosphorous (OP) nerve agents such as VX, will most likely enter the body via the skin. In previous investigations conducted in hairless guinea pigs, it was shown that skin exposure to VX resulted in a slow and variable onset of observable signs of toxicity. Repeated treatments ad

  7. The Debate over Time-Limited Treatment in College Counseling Centers

    Science.gov (United States)

    Ghetie, Dora

    2007-01-01

    The use of time limits in psychotherapy with college students has become a commonly used strategy in counseling centers that are faced with increased demand for services and decreasing resources. However, this has been a controversial issue and there is no consensus at present as to whether or not the use of time limits with college students is…

  8. Rise Time. Operational Control Tests for Wastewater Treatment Facilities. Instructor's Manual [and] Student Workbook.

    Science.gov (United States)

    Carnegie, John W.

    The rise time test (along with the settleometer procedure) is used to monitor sludge behavior in the secondary clarifier of an activated sludge system. The test monitors the effect of the nitrification/denitrification process and aids the operator in determining optimum clarifier sludge detention time and, to some extent, optimum degree of…

  9. Turnaround times in breast cancer: From screening to diagnosis to treatment

    Directory of Open Access Journals (Sweden)

    Kaylene J Logan

    2013-01-01

    Discussion: The CCBCC ranks at the 75%ile in overall turnaround times; however, this turnaround time included an interval of MRI, not previously measured in NQMBC benchmark. Rate-limiting steps were identified as the time from screening mammogram to diagnostic mammogram, and biopsy to surgery-specifically, the sub-interval MRI to surgery. Since 2009, the CCBCC has already improved the process for obtaining insurance approval and preauthorization for MRIs; and has added an additional breast surgeon to share the burden of benign cases, and a nurse practitioner to see post-op and follow up patients, improving the accessibility to the primary breast surgeon specialist. Consideration should be given to future time interval studies that evaluate breast cancer turnaround time including MRI to help establish benchmarks.

  10. Influence of the length of progestagen treatment and the time of oestradiol benzoate application on the ovulatory follicle size and ovulation time in anoestrous and cyclic beef cows.

    Science.gov (United States)

    Manes, J; Aller, J F; Callejas, S S; Hozbor, F; Alberio, R H

    2012-06-01

    Previous research from our laboratory in beef cattle suggests that the pre-ovulatory follicle size, maturity and subsequent susceptibility to gonadotropin are influenced by the length of progestagen treatment in artificial insemination programme in beef cows. To test this hypothesis, two experiments were conducted. In experiment 1, 35 anoestrous beef cows received an intravaginal sponge containing 200 mg of medroxyprogesterone acetate. The treatment lasted for 7 (n = 12), 8 (n = 11) or 9 (n = 12) days. Half of the animals in each group were injected with 0.7 mg of oestradiol benzoate (EB) at device removal (0 h) and the other half 24 h later. In experiment 2, 38 cycling beef cows were treated with the same protocols as in experiment 1. Ultrasound examinations were performed to determine the follicular diameter at device removal (dominant follicle), interval to ovulation and ovulatory follicle diameter. The dominant follicle of anoestrous cows with progestagen for 7 days (8.4 ± 1.6 mm) resulted smaller (p time after device removal was longer (p withdrawal than at 0 h in anoestrous cows (EB0 = 52.7 ± 4.0 h; EB24 = 70.8 ± 6.2 h) and in cyclic cows (EB0 = 50.0 ± 21.0 h; EB24 = 73.0 ± 20.0 h). In anoestrous cows, the treatment with progestagen for 9 days and EB at 24 h increased the diameter of the ovarian follicle (p = 0.033) but did not affect the diameter of the ovulatory follicle in cyclic cows. In conclusion, increasing the length of progestagen treatment for 8 or 9 days compared to 7 days increased the diameter of the dominant follicle, in anoestrous and cyclic beef cows. Oestradiol benzoate administered at device removal resulted in a shorter interval from device removal to ovulation compared with EB injection 24 h after the end of a progestagen treatment.

  11. Knowledge of treatment group does not bias assessment of time to seizure in an animal model of cocaine poisoning.

    Science.gov (United States)

    Heard, Kennon J; Krier, Shay; Cleveland, Nathan R

    2010-07-01

    Blinded outcome assessment decreases bias in human clinical trials. The necessity of blinded outcome assessment on animal studies is unknown. The authors determined the effect of knowledge of treatment group on assessment of time to seizure in an animal model of cocaine poisoning. Four subjects observed 20 animal experiments where all animals were administered a high dose of cocaine and placebo. For each experiment, two of the observers were told the animal had been treated with placebo and two were told the animal had been treated with a medication expected to delay the onset of seizures. Each observer recorded the time from cocaine administration to onset of seizure. The median time to seizure was compared between observers told the animal received placebo and those told the animal received active treatment. Seizures were reported by all subjects in 12 animals and by no subjects in five animals, and there was disagreement in three animals. The reported median time to seizure was similar for observers told that the animals were treated with placebo and those told they were treated with study medication. It is feasible to determine whether unblinded assessments are biased in an animal study. Knowledge of treatment group did not bias the assessment of time to seizure in this animal model. 2010 by the Society for Academic Emergency Medicine

  12. The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR.

    Science.gov (United States)

    Booth, Jeremy T; Caillet, Vincent; Hardcastle, Nicholas; O'Brien, Ricky; Szymura, Kathryn; Crasta, Charlene; Harris, Benjamin; Haddad, Carol; Eade, Thomas; Keall, Paul J

    2016-10-01

    Real time adaptive radiotherapy that enables smaller irradiated volumes may reduce pulmonary toxicity. We report on the first patient treatment of electromagnetic-guided real time adaptive radiotherapy delivered with MLC tracking for lung stereotactic ablative body radiotherapy. A clinical trial was developed to investigate the safety and feasibility of MLC tracking in lung. The first patient was an 80-year old man with a single left lower lobe lung metastasis to be treated with SABR to 48Gy in 4 fractions. In-house software was integrated with a standard linear accelerator to adapt the treatment beam shape and position based on electromagnetic transponders implanted in the lung. MLC tracking plans were compared against standard ITV-based treatment planning. MLC tracking plan delivery was reconstructed in the patient to confirm safe delivery. Real time adaptive radiotherapy delivered with MLC tracking compared to standard ITV-based planning reduced the PTV by 41% (18.7-11cm(3)) and the mean lung dose by 30% (202-140cGy), V20 by 35% (2.6-1.5%) and V5 by 9% (8.9-8%). An emerging technology, MLC tracking, has been translated into the clinic and used to treat lung SABR patients for the first time. This milestone represents an important first step for clinical real-time adaptive radiotherapy that could reduce pulmonary toxicity in lung radiotherapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Impact of introducing the line probe assay on time to treatment initiation of MDR-TB in Delhi, India.

    Directory of Open Access Journals (Sweden)

    Neeta Singla

    Full Text Available SETTING: National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute in Delhi, India. OBJECTIVES: To evaluate before and after the introduction of the line Probe Assay (LPA a the overall time to MDR-TB diagnosis and treatment initiation; b the step-by-step time lapse at each stage of patient management; and c the lost to follow-up rates. METHODS: A retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009-2012 under Revised National Tuberculosis Control Programme at the institute. RESULTS: Following the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127-200 to 38 days (IQR 30-79. This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA. CONCLUSION: Introduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory.

  14. The Effect of Isothermal Heat Treatment Time on the Microstructure and Properties of 2.11% Al Austempered Ductile Iron

    Science.gov (United States)

    Erfanian-Naziftoosi, H. R.; Haghdadi, N.; Kiani-Rashid, A. R.

    2012-08-01

    In this article, the bainitic transformation during austempering was studied for a 2.11% Al containing ductile iron under different isothermal holding times. The austenitizing time and temperature were selected to be 60 min and 920 °C, respectively, referring to previous studies. The isothermal austempering heat treatments were performed at 350 °C for different durations. Microstructures have been examined by optical microscopy, scanning electron microscopy, and transmission electron microscopy. Microstructural investigations revealed that austempering treatment at 350 °C for durations up to 100 min results in microstructures consisting of carbide-free bainitic ferrite with considerable amounts of retained austenite while the extension of isothermal transformation time leads to precipitation of carbides. Hardness measurements were also carried out the results of which were shown to be consistent with microstructural evolutions.

  15. Ongoing treatment with non-steroidal anti-inflammatory drugs at time of admission is associated with poorer prognosis in patients with first-time acute myocardial infarction

    DEFF Research Database (Denmark)

    Lamberts, Morten; Fosbøl, Emil L; Olsen, Anne-Marie S

    2013-01-01

    was significantly increased in patients receiving rofecoxib (hazard ratio [HR] 1.15; CI 1.04-1.27), celecoxib (HR 1.13; CI 1.01-1.26), diclofenac (HR 1.12; CI 1.04-1.20) or any NSAID use (HR 1.05; CI 1.02-1.09). No association was found for naproxen or ibuprofen. CONCLUSION: Ongoing treatment with NSAIDs...... and in particular the cyclooxygenase-2-selective inhibitors rofecoxib, celecoxib, and diclofenac is associated with worsened prognosis in patients admitted with first-time MI....

  16. Turnaround times in breast cancer:From screening to diagnosis to treatment

    Institute of Scientific and Technical Information of China (English)

    Kaylene J Logan; Patrice M. Weiss; Catherine Hagan-Aylor; Bob Herbertson

    2013-01-01

    Objective: To compare our institution with national benchmark times, and identify rate-limiting steps in the process by conducte a retrospective review of the turnaround times in 2009 at the Carilion Clinic Breast Care Center (CCBCC). To evaluate patient satisfaction with the turn around times. Methods: A retrospective chart review was performed to evaluate the time intervals from abnormal screening mammogram to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to MRI, and MRI to surgery of all patients seen for breast cancer in 2009. A patient survey was mailed out to all patients (131) managed from abnormal screening to surgery in 2009, assessing their satisfaction with the turnaround times from screening mammogram to call back, call back to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to results call, biopsy result to MRI appointment, MRI appointment to surgery consult, and surgery consult to surgery; and assessing possible reasons why patients may perceive the process to be delayed. The MEANS procedure was applied to evaluate the turnaround times, and a Box and Whisker Plot statistical comparison was made between patient satisfaction and turnaround times. Results: The mean turnaround time at the CCBCC in 2009 from abnormal screening mammogram to surgery was 45 d. This falls within the 75th %ile of the National Quality Measures for Breast Centers (NQMBC), established by the National Consortium of Breast Centers (NCBC). Of 131 surveys mailed out, 57 were returned (44%). The patient satisfaction rates for each interval ranged from 96%-100%, with an overall satisfaction rate of 98% for abnormal screening mammogram to surgery. Discussion:The CCBCC ranks at the 75%ile in overall turnaround times; however, this turnaround time included an interval of MRI, not previously measured in NQMBC benchmark. Rate-limiting steps were identified as the time from screening mammogram to diagnostic mammogram, and biopsy to surgery-specifically, the sub

  17. Peroral endoscopic myotomy: Time to change our opinionregarding the treatment of achalasia?

    Institute of Scientific and Technical Information of China (English)

    Marcel Tantau; Dana Crisan

    2015-01-01

    Peroral endoscopic myotomy (POEM) is a new endoscopictreatment for achalasia. Compared to the classicalsurgical myotomy, POEM brings at least the advantageof minimal invasiveness. The data provided until nowsuggest that POEM offers excellent short-term symptomresolution, with improvement of dysphagia in more than90% of treated patients, with encouraging manometricoutcomes and low incidence of postprocedural gastroesophagealreflux. The effectiveness of this noveltherapy requires long-term follow-up and comparativestudies with other treatment modalities for achalasia.This technique requires experts in interventionalendoscopy, with a learning curve requiring more than 20cases, including training on animal and cadaver models,and with a need for structured proctoring during thefirst cases. This review aims to summarize the data onthe technique, outcomes, safety and learning curve ofthis new endoscopic treatment of achalasia.

  18. Diagnostic Criteria, Classification and Treatment Goals in Multiple Sclerosis: The Chronicles of Time and Space.

    Science.gov (United States)

    Ntranos, Achilles; Lublin, Fred

    2016-10-01

    Multiple sclerosis (MS) is one of the most diverse human diseases. Since its first description by Charcot in the nineteenth century, the diagnostic criteria, clinical course classification, and treatment goals for MS have been constantly revised and updated to improve diagnostic accuracy, physician communication, and clinical trial design. These changes have improved the clinical outcomes and quality of life for patients with the disease. Recent technological and research breakthroughs will almost certainly further change how we diagnose, classify, and treat MS in the future. In this review, we summarize the key events in the history of MS, explain the reasoning behind the current criteria for MS diagnosis, classification, and treatment, and provide suggestions for further improvements that will keep enhancing the clinical practice of MS.

  19. Hubble trial: time to stick to basics for treatment of haemorrhoids?

    Science.gov (United States)

    Brown, S R

    2017-01-01

    The results of the Hubble trial, a randomised controlled trial comparing haemorrhoidal artery ligation with rubber band ligation for early-grade prolapsing haemorrhoids, are discussed. The difficulties in defining treatment success are debated along with the trial design highlighting the pitfalls of previous research. A finding that haemorrhoidal artery ligation is not necessarily superior to cheap alternatives has implications for current practice and future commissioning of surgeons.

  20. Analyses of the Characteristics of Diarrhea by Acupuncture Treatment in Ancient Times

    Institute of Scientific and Technical Information of China (English)

    LIU Li-gong; GU Jie; XIAO Yuan-chun

    2003-01-01

    The data concerning the treatment of diarrhea by acupuncture in 62 ancient books are computerized and thus show that the ancient acupuncturists primarily used the acupoints of the conception vessel, stomach meridian, bladder meridian, and the foot yin meridians.As to the location, the acupoints on the abdomen, back,exterior side of leg and the hands and feet are used. The common techniques are moxibustion, hot compression,needling, blood letting, navel application and so on.

  1. Is cannabis treatment for anxiety, mood, and related disorders ready for prime time?

    Science.gov (United States)

    Turna, Jasmine; Patterson, Beth; Van Ameringen, Michael

    2017-06-21

    Anxiety and related disorders are the most common mental conditions affecting the North American population. Despite their established efficacy, first-line antidepressant treatments are associated with significant side effects, leading many afflicted individuals to seek alternative treatments. Cannabis is commonly viewed as a natural alternative for a variety of medical and mental health conditions. Currently, anxiety ranks among the top five medical symptoms for which North Americans report using medical marijuana. However, upon careful review of the extant treatment literature, the anxiolytic effects of cannabis in clinical populations are surprisingly not well-documented. The effects of cannabis on anxiety and mood symptoms have been examined in healthy populations and in several small studies of synthetic cannabinoid agents but there are currently no studies which have examined the effects of the cannabis plant on anxiety and related disorders. In light of the rapidly shifting landscape regarding the legalization of cannabis for medical and recreational purposes, it is important to highlight the significant disconnect between the scientific literature, public opinion, and related policies. The aim of this article is to provide a comprehensive review of the current cannabis treatment literature, and to identify the potential for cannabis to be used as a therapeutic intervention for anxiety, mood, and related disorders. Searches of five electronic databases were conducted (PubMed, MEDLINE, Web of Science, PsychINFO, and Google Scholar), with the most recent in February 2017. The effects of cannabis on healthy populations and clinical psychiatric samples will be discussed, focusing primarily on anxiety and mood disorders. © 2017 Wiley Periodicals, Inc.

  2. Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study

    Science.gov (United States)

    dos Santos, Rafael Caire de Oliveira; Goulart, Alessandra Carvalho; Kisukuri, Alan Loureiro Xavier; Brandão, Rodrigo Martins; Sitnik, Debora; Staniak, Henrique Lane; Bittencourt, Marcio Sommer; Lotufo, Paulo Andrade; Bensenor, Isabela Martins; Santos, Itamar de Souza

    2016-01-01

    Background To the best of our knowledge, there are no studies evaluating the influence of the unit of the first contact on the frequency and time of pharmacological treatment during an acute coronary syndrome (ACS) event. Objectives The main objective was to investigate if the unit of first contact influenced the frequency and time of aspirin treatment in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods We analyzed the pharmacological treatment time in 830 ERICO participants - 700 individuals for whom the hospital was the unit of first contact and 130 who initially sought primary care units. We built logistic regression models to study whether the unit of first contact was associated with a treatment time of less than three hours. Results Individuals who went to primary care units received the first aspirin dose in those units in 75.6% of the cases. The remaining 24.4% received aspirin at the hospital. Despite this finding, individuals from primary care still had aspirin administered within three hours more frequently than those who went to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for non ST-elevation ACS and ST-elevation myocardial infarction, respectively). In adjusted models, individuals coming from primary care were more likely to receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval: 2.06-6.51). Conclusions In our setting, individuals from primary care were more likely to receive aspirin earlier. Enhancing the ability of primary care units to provide early treatment and safe transportation may be beneficial in similar settings. PMID:27849262

  3. Treatment outcome and factors affecting time to recovery in children with severe acute malnutrition treated at outpatient therapeutic care program

    Directory of Open Access Journals (Sweden)

    Melkamu Merid Mengesha

    2016-07-01

    Full Text Available Background: The outpatient therapeutic care program (OTP of children with severe acute malnutrition (SAM has been decentralized to health post level in Ethiopia since 2008–2009. However, there is a lack of evidence regarding treatment outcomes and factors related to the duration of stay on treatment after its decentralization to health post level. Objective: This study was aimed to assess treatment outcome and factors affecting time to recovery in children with SAM treated at OTP. Design: Health facility–based retrospective cohort study was conducted using data from 348 patient cards. The outcome variable was time to recovery. Descriptive analysis was done using percentages for categorical data and mean/median for continuous variables. A robust method of analyzing time to event data, the Cox proportional-hazard regression, was used. All statistical tests in this study are declared significant at p<0.05. Result: 89.1% of children with kwashiorkor and 69.4% of children with marasmus were recovered. Of the total children studied, 22% were readmitted cases. The median time of recovery was 35 days for children with kwashiorkor and 49 days for children with marasmus. Children older than 3 years were 33% less likely to achieve nutritional recovery [adjusted hazard ratio, AHR=0.67, 95% confidence interval, CI (0.46, 0.97]. Similarly, marasmic children stayed longer on treatment [AHR=0.42, 95% CI (0.32, 0.56]. However, children who gained Mid-Upper Arm Circumference (MUAC ≥ 0.24 mm/day were 59% more likely to recover faster [AHR=1.59, 95% CI (1.23, 2.06]. Conclusions: Close monitoring of weight and MUAC gain to assess nutritional improvement with due emphasis given to children with lower admission weight, children of age 3 years and above and marasmic children will have a positive effect on treatment duration and outcome.

  4. Real-time MRI-guided hyperthermia treatment using a fast adaptive algorithm.

    Science.gov (United States)

    Stakhursky, Vadim L; Arabe, Omar; Cheng, Kung-Shan; Macfall, James; Maccarini, Paolo; Craciunescu, Oana; Dewhirst, Mark; Stauffer, Paul; Das, Shiva K

    2009-04-01

    Magnetic resonance (MR) imaging is promising for monitoring and guiding hyperthermia treatments. The goal of this work is to investigate the stability of an algorithm for online MR thermal image guided steering and focusing of heat into the target volume. The control platform comprised a four-antenna mini-annular phased array (MAPA) applicator operating at 140 MHz (used for extremity sarcoma heating) and a GE Signa Excite 1.5 T MR system, both of which were driven by a control workstation. MR proton resonance frequency shift images acquired during heating were used to iteratively update a model of the heated object, starting with an initial finite element computed model estimate. At each iterative step, the current model was used to compute a focusing vector, which was then used to drive the next iteration, until convergence. Perturbation of the driving vector was used to prevent the process from stalling away from the desired focus. Experimental validation of the performance of the automatic treatment platform was conducted with two cylindrical phantom studies, one homogeneous and one muscle equivalent with tumor tissue (conductivity 50% higher) inserted, with initial focal spots being intentionally rotated 90 degrees and 50 degrees away from the desired focus, mimicking initial setup errors in applicator rotation. The integrated MR-HT treatment platform steered the focus of heating into the desired target volume in two quite different phantom tissue loads which model expected patient treatment configurations. For the homogeneous phantom test where the target was intentionally offset by 90 degrees rotation of the applicator, convergence to the proper phase focus in the target occurred after 16 iterations of the algorithm. For the more realistic test with a muscle equivalent phantom with tumor inserted with 50 degrees applicator displacement, only two iterations were necessary to steer the focus into the tumor target. Convergence improved the heating efficacy (the

  5. Real-time MRI-guided hyperthermia treatment using a fast adaptive algorithm

    Science.gov (United States)

    Stakhursky, Vadim L.; Arabe, Omar; Cheng, Kung-Shan; MacFall, James; Maccarini, Paolo; Craciunescu, Oana; Dewhirst, Mark; Stauffer, Paul; Das, Shiva K.

    2009-04-01

    Magnetic resonance (MR) imaging is promising for monitoring and guiding hyperthermia treatments. The goal of this work is to investigate the stability of an algorithm for online MR thermal image guided steering and focusing of heat into the target volume. The control platform comprised a four-antenna mini-annular phased array (MAPA) applicator operating at 140 MHz (used for extremity sarcoma heating) and a GE Signa Excite 1.5 T MR system, both of which were driven by a control workstation. MR proton resonance frequency shift images acquired during heating were used to iteratively update a model of the heated object, starting with an initial finite element computed model estimate. At each iterative step, the current model was used to compute a focusing vector, which was then used to drive the next iteration, until convergence. Perturbation of the driving vector was used to prevent the process from stalling away from the desired focus. Experimental validation of the performance of the automatic treatment platform was conducted with two cylindrical phantom studies, one homogeneous and one muscle equivalent with tumor tissue (conductivity 50% higher) inserted, with initial focal spots being intentionally rotated 90° and 50° away from the desired focus, mimicking initial setup errors in applicator rotation. The integrated MR-HT treatment platform steered the focus of heating into the desired target volume in two quite different phantom tissue loads which model expected patient treatment configurations. For the homogeneous phantom test where the target was intentionally offset by 90° rotation of the applicator, convergence to the proper phase focus in the target occurred after 16 iterations of the algorithm. For the more realistic test with a muscle equivalent phantom with tumor inserted with 50° applicator displacement, only two iterations were necessary to steer the focus into the tumor target. Convergence improved the heating efficacy (the ratio of integral

  6. Relationships between the antibacterial activity of sodium hypochlorite and treatment time and biofilm age in early Enterococcus faecalis biofilms.

    Science.gov (United States)

    Chau, N P T; Chung, N H; Jeon, J G

    2015-08-01

    To determine the relationships between the antibacterial activity of NaOCl and treatment time and biofilm age in early Enterococcus faecalis biofilms using a linear fitting procedure. Enterococcus faecalis biofilms were formed on hydroxyapatite discs. To investigate the relationship between the antibacterial activity of NaOCl and biofilm age, 22-, 46-, 70- and 94-h-old biofilms were exposed to NaOCl (0-3%) for 5 min. To investigate the relationship between the antibacterial activity of NaOCl and treatment time, 70-h-old biofilms were exposed to NaOCl (0-3%) for 1, 3, 5 and 7 min. After treatment, colony-forming units (CFUs) were counted. To determine the relationships between these variables, linear fitting was performed. The change in the minimum biofilm eradication concentration (MBEC) of NaOCl followed a linear pattern of biofilm age (R = 0.941, R(2)  = 0.886) or treatment time dependence (R = -0.948, R(2)  = 0.898). Below the MBEC, the fitting lines for bacterial CFU count versus NaOCl concentration (R ≤ -0.973, R(2)  ≥ 0.948) in the 22-, 46-, 70- and 94-h-old biofilms implied that the antibacterial activity of NaOCl decreased as the biofilm age increased. The fitting lines for bacterial CFU count versus NaOCl concentration (R ≤ -0.970, R(2)  ≥ 0.942) in the 1-, 3-, 5- and 7-min treatments implied that the antibacterial activity of NaOCl increased with treatment time. These results suggest that the antibacterial activity of NaOCl against early E. faecalis biofilms in root canals may follow a linear pattern depending on biofilm age or treatment time. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  7. Effect of time of day for harvest and postharvest treatments on the sugar metabolism of broccoli (Brassica oleracea var. italica

    Directory of Open Access Journals (Sweden)

    Joaquin Hasperue

    2014-02-01

    Full Text Available     Loss of sugars contributes to accelerate postharvest senescence of broccoli. Several treatments have been developed to delay senescence, but in many cases their effects on sugar metabolism were not analyzed. We studied the effect of harvest at different times of day (08:00, 13:00 and 18:00 h and of several postharvest treatments as heat treatment (HT, modified atmosphere (MA and 1-methylcylcopropene (1-MCP on sugar levels and activities of enzymes related to sucrose and starch degradation. Harvesting at the end of day delayed the loss of chlorophylls and caused the lowest decrement in sugars, although no differences in invertase, sucrose synthase and β-amylase activities were detected among samples. Treatments of MA and 1-MCP caused a lower loss of glucose and fructose, while HT caused a lower decrement of sucrose. Treated samples maintained higher levels of chlorophylls. The treatments reduced the activity of invertase and sucrose synthase and induced higher levels of β-amylase activity. Harvesting at the end of day and performing simultaneously a MA treatment could be a good combination to maintain the green color of the inflorescence and sugar levels during postharvest of broccoli.

  8. The possible role of TP53 mutation status in the treatment of squamous cell carcinomas of the head and neck (HNSCC) with radiotherapy with different overall treatment times

    DEFF Research Database (Denmark)

    Eriksen, Jesper Grau; Alsner, Jan; Steiniche, Torben;

    2005-01-01

    for the outcome of radiotherapy. PATIENTS AND METHODS: DNA extracted from 180 paraffin-embedded formalin-fixed pretreatment biopsies of HNSCC was screened for mutations in exon 4C-10 by denaturing high-pressure liquid chromatography (DHPLC) followed by sequencing. Treatment was 66-68Gy, 2Gy/fx with overall...... treatment times of 6.5 and 5.5 weeks according to the DAHANCA-guidelines. Endpoints were local control at T-site, disease-specific and crude survival. RESULTS: 125 of 180 carcinomas (69%) carried in total 176 mutations. 72 carcinomas were WT (40%) and 108 carcinomas (60%) carried mutations giving...... dysfunctional p53. Overall, mutations in TP53 were not associated with the endpoints. However, when dichotomising according to TP53 status and evaluating the effect of the overall treatment time then tumours with mutant TP53 did benefit from 6 instead of 5fx/wk regarding local control, P=0.005; RR: 0.33 (C.I 95...

  9. A retrospective comparison of microwave ablation and high intensity focused ultrasound for treating symptomatic uterine fibroids

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Wen-Peng, E-mail: zwp215@163.com; Han, Zhi-Yu, E-mail: hanzhiyu301@hotmail.com; Zhang, Jing, E-mail: zjbch@sina.com; Liang, Ping, E-mail: liangping301@hotmail.com

    2015-03-15

    Highlights: •Both HIFU and PMWA are thermal ablation techniques and they all provide safe and reliable alternative treatment methods for uterine fibroids. •However, whether there are obvious difference between these two kinds of approaches in improving symptom, treatment time, ablation rate, regression rate and adverse events, until now, there are no clinical trials which have been performed to compare the therapeutic effects of HIFU and PMWA. •In this research, we retrospectively compare the results of these two treatment methods. •To our knowledge, our study is the first directly comparing long-term outcome after PMWA and HIFU in patients with uterine fibroids. -- Abstract: Objectives: To retrospectively compare the effectiveness and safety of percutaneous microwave ablation (PMWA) and ultrasound-guided high-intensity focused ultrasound (USgHIFU) for treating symptomatic uterine fibroids. Methods: Seventy-three women with symptomatic uterine fibroids who met the inclusion criteria were enrolled in our study from September 2012 to December 2013. Thirty-one patients with forty uterine fibroids underwent PMWA, and forty-two patients with fifty-one uterine fibroids underwent USgHIFU. A contrast-enhanced MRI was performed before and after treatment, and all patients were followed up for 6 months. Assessment endpoints included symptom severity scores (SSS), treatment time, ablation rate, fibroid regression rate and adverse events. Results: The mean age of the patients in our study was 35.4 ± 6.2 years (range, 21–49 years), and the median volume of uterine fibroids was 95.7 cm{sup 3} (60.3–131.5 cm{sup 3}). The ablation rate of uterine fibroids was 79.8 ± 18.2% and 77.1 ± 14.9% in the PMWA group and the USgHIFU group, respectively, and showed no significant difference between the groups. Changes in SSS after PMWA were similar in the PMWA group (47.7 pre-treatment vs. 29.9 post-treatment) and USgHIFU group (42.1 pre-treatment vs. 24.6 post-treatment). The

  10. Time dependent argon glow discharge treatment of Al-alloy samples

    Indian Academy of Sciences (India)

    Sunanda J Karandikar; S V Gogawale; A K Dua; K K Kutty

    2001-05-01

    Aluminium alloy ultra-high vacuum system provides a convenient tool to access the UHV region due to short pump down time, its reduced weight, low cost etc. For UHV systems, aluminium and its alloys are preferred materials to stainless steel. A cylindrical discharge chamger of SS 304 with various ports on it, evacuated by turbomoleculer pumping unit is used in the experimental system. A hollow cathode de glow discharge in argon for different time durations is used to treat chemically cleaned ASA 6063 aluminium alloy samples, keeping all other parameters constant. The scanning electron microscope (SEM) is used to examine processed surfaces and to study topographical features. The energy dispersive microanalysis by X-rays (EDX) is used to determine the elemental composition of the samples. The results indicate the physical sputtering taking place in Ar GDC. The etched area increases with discharge time duration. The EDX spectrum shows the inconsistency in weight percentage of various elements of Al-alloy.

  11. Timing of IUI Treatment after hCG Administration 1-48 h Affecting Pregnancy Rate

    Institute of Scientific and Technical Information of China (English)

    Fan YANG; Zu-mei SHI; Hui JIN; Li-ping ZHU; Kun-ming LI; Jian-zhi YANG; Zhi-qin CHEN; Xiao-ming TENG; Hui-fen CHEN; Yu WANG

    2008-01-01

    Objective To compare the different time of administration of hCG affecting pregnancy rate of IUI. Methods A total of 189 infertile couples underwent 331 cycles of IUI with husband’s sperm.They were separated into 3 groups according to the time of hCG administration in IUI:hCG 1-23 h(group A):hCG 24-36 h (group B);hCG 37—48 h(group C). Results There were no statistical differences among 3 groups.None of the other relative factors,such as the female age,the different methods of ovulation a