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To investigate the feasibility, efficacy and safety of one-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome. From 5 January 2017 to 16 April 2019, 64 patients who underwent ultrasound-guided thermal ablation with a total of 75 liver malignant tumors located in the hepatic dome were enrolled in the present study. One-lung ventilation was employed to improve the acoustic window and protect the lung and diaphragm. If the one-lung ventilation was unsuccessful, artificial pleural effusion was added. The technical efficacy was confirmed by contrast-enhanced computed tomography/magnetic resonance imaging (CT/MRI) 1 month later. After that, CT/MRI was performed every 3–6 months. Among the enrolled patients, the technical success rate of one lung ventilation was 92.2% (59/64). The visibility scores of tumors were improved significantly after one-lung ventilation compared to those before one-lung ventilation (p <.001). Finally, 78.6% (55/70) of the tumors achieved clinical success of one-lung ventilation to become clearly visible and underwent thermal ablation. Fourteen of the remaining 15 tumors achieved a satisfactory acoustic window after combination of artificial pleural effusion. One lesion remained inconspicuous and partly affected by pulmonary gas. The follow-up period was 8 months (3–30 months). The technical efficacy rate was confirmed to be 100% (75/75). During the follow-up period, local tumor progression occurred in 2 patients (2/75, 2.7%). Major complications occurred in two patients (2/64, 3.1%) receiving one-lung ventilation. One-lung ventilation is a promising noninvasive method for the thermal ablation of hepatic dome tumors due to its efficacy and safety. [ABSTRACT FROM AUTHOR]

Purpose: To compare the applicability of fusion imaging between contrast-enhanced ultrasound (CEUS) and computed tomography (CT) or magnetic resonance imaging (MRI) (CT/MRI-CEUS fusion imaging) and fusion imaging between CEUS and ultrasound (US-CEUS fusion imaging) in the assessment of treatment response during liver cancer ablation. Methods: From August to December 2015, patients who underwent US-guided thermal ablation of liver tumors at our hospital with available CT/MRI images were enrolled consecutively. Both CT/MRI-CEUS and US-CEUS fusion imaging were performed in all patients to evaluate treatment responses. The applicable rate, success rate of registration and duration time were recorded. Complications were monitored in the follow-up period, and CECT/MRI within three months were taken as the standard reference of technical efficacy. Results: A total of 157 liver tumors (19 ± 8 mm, range 8-55 mm) in 115 patients (54 ± 11 years old, range 2 7∼ 84 years old) were enrolled. The applicable rate of US-CEUS fusion imaging was 61.1% (96/157) because of inconspicuous lesions in US, lower than that of CT/MRI-CEUS fusion imaging (99.7% (155/157)) (p < .05). However, the success rate of registration in US-CEUS fusion imaging (93.8% (90/96)) was superior to that of CT/MRI-US fusion imaging (81.3% (126/155)) (p < .05), especially for cases combined with alternative preablation surgeries or procedures (p < .05). The technical efficacy rate was 99.3% (150/151) according to the CECT/CEMRI. Conclusions: Both CT/MRI-CEUS and US-CEUS fusion imaging are feasible means for intraprocedural immediate evaluation of treatment response for liver thermal ablation. US-CEUS fusion imaging is preferred because of its convenience and higher success rate of registration. [ABSTRACT FROM AUTHOR]

Introduction The stiffness of large arteries and the presence or absence of plaque are associated with coronary heart disease ( CHD). Because arterial walls are biologically heterogeneous, the standard deviation of Young's modulus ( YM-std) of the large arteries may better predict coronary atherosclerosis. However, the role of YM-std in the occurrence of coronary events has not been addressed so far. Therefore, this study investigated whether the carotid YM-std and the presence or absence of plaque improved CHD risk prediction. Methods One hundred and three patients with CHD (age 66 ± 11 years) and 107 patients at high risk of atherosclerosis (age 61 ± 7 years) were recruited. Carotid YM was measured by the vessel texture matching method, and YM-std was calculated. Carotid intima-media thickness was measured by the MyLab 90 ultrasound Platform employed dedicated software RF-tracking technology. Results In logistic regression analysis, YM-std ( OR = 1·010; 95% CI = 1·003-1·016), carotid plaque ( OR = 16·759; 95% CI = 3·719-75·533) and YM-std plus plaque ( OR = 0·989; 95% CI = 0·981-0·997) were independent predictors of CHD. The traditional risk factors ( TRF) plus YM-std plus plaque model showed a significant improvement in area under the receiver-operating characteristic curve ( AUC), which increased from 0·717 ( TRF only) to 0·777 (95% CI for the difference in adjusted AUC: 0·010-0·110). Conclusions Carotid YM-std is a powerful independent predictor of CHD. Adding plaque and YM-std to TRF improves CHD risk prediction. [ABSTRACT FROM AUTHOR]

This study sought to investigate the feasibility of using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) fusion imaging navigation (FIN) with needle tail intelligent positioning (NTIP) to guide puncture in percutaneous transforaminal endoscopic discectomy (PTED). First, in a pig experiment, we found that puncture errors in lumbar intervertebral foramen (LIF) puncture using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) FIN with NTIP for experienced and novice operators were 2.00 ± 1.00 and 2.57 ± 0.98 mm, respectively (p = 0.231), suggesting this technique was minimally dependent on experience. Then, two experienced surgeons agreed (inter-observer agreement к=0.801) that the quality of MR-MR fusion images was good or sufficient. Finally, we performed PTED in eight patients using MR-MR-US FIN with NTIP, and no significant complications were reported during LIF puncture. Overall, MR-MR-US FIN with NTIP may be a potential application for guiding puncture in PTED, but more clinical studies with a larger sample size are required to further evaluate the advantages of MR-MR-US FIN with NTIP. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate the accuracy of ultrasound-ultrasound (US-US) fusion imaging for evaluating the ablation effect via phantom-simulated liver tumors. Twenty special phantom models were established, ablated and divided into a complete ablation group (n = 10) and an incomplete ablation group (n = 10). US-US fusion imaging was performed to evaluate the ablation effect. Gross specimens were observed as a standard reference. In this US-US fusion imaging study, the registration success rate was 100% (20/20), and the assessment time was 3.8 ± 0.9 min. The accuracy rate of the evaluation was 100% (20/20). There was no significant difference in the residual pseudo-tumoral area between the evaluation with US-US fusion imaging and gross specimen observation (p = 0.811), and the measurement error was 1.1 ± 0.6 mm. In conclusion, the feasibility and accuracy of US-US fusion imaging when evaluating the ablation effect can be investigated with this phantom-simulated liver tumor ablation model in an ideal state. [ABSTRACT FROM AUTHOR]

This study assessed the diagnostic accuracy of 2-D shear wave elastography (2-D-SWE) for the non-invasive staging of liver fibrosis and compared the findings with those for biochemical markers (the aspartate aminotransferase-to-platelet index and fibrosis-4 index) of liver fibrosis in patients with elevated alanine aminotransferase (ALT) levels (>5 × the upper limit of normal). Patients with chronic liver diseases and elevated ALT levels who underwent liver biopsy were consecutively included. Receiver operating characteristic (ROC) curves were constructed to assess overall accuracy and to identify optimal cutoff values. After exclusions, data from 105 patients were analyzed. The areas under the ROC curves (AUROCs) for significant fibrosis, severe fibrosis and cirrhosis were 0.83, 0.86 and 0.91, respectively. The optimal cutoff values for predicting significant fibrosis, severe fibrosis and cirrhosis were 10.6, 13.2 and 17.6 kPa, respectively. The AUROCs of 2-D-SWE were significantly higher than those of biochemical markers for predicting significant fibrosis, severe fibrosis and cirrhosis (all p values < 0.05). Therefore, the diagnostic performance of 2-D-SWE in assessing liver fibrosis stages in patients with elevated ALT levels was promising. The optimal cutoff values were increased but appropriate for this cohort because the baseline levels of liver stiffness measurements were increased in these patients, even in the absence of fibrosis. [ABSTRACT FROM AUTHOR]

Abstract: Drug resistance is a big problem in systemic chemotherapy of hepatocellular carcinoma (HCC), and nanomedicines loaded with both chemotherapeutic agents (e.g. paclitaxel, PTX) and siRNA's targeting antiapoptosis genes (e.g. BCL-2) possess the advantages to simultaneously overcome the efflux pump-mediated drug resistance and antiapoptosis-related drug resistance. However, tumor-penetrating drug delivery with this type of nanomedicines is extremely difficult due to their relatively big size compared to the single drug-loaded nanomedicines. Aiming at address this problem, US-responsive nanobubbles encapsulating both anti-cancer drug paclitaxel (PTX) and siRNA (PTX–NBs/siRNA) for HCC treatment were developed by hetero-assembly of polymeric micelles and liposomes in the present study. Utilizing an external low-frequency US force imposed to the tumor site, effective tumor-penetrating codelivery of siRNA and PTX was achieved via tail vein injection of PTX–NBs/siRNA into nude mice bearing human HepG2 xerografts. Consequently, the PTX treatment-inducible antiapoptosis in HepG2 cells was effectively suppressed by the codelivered siRNA targeting an antiapoptosis gene (BCL-2 siRNA) during chemotherapy. Owing to the synergistic anti-cancer effect of two therapeutic agents, tumor growth was completely inhibited using low-dose PTX in animal study. Our results highlight the great potential of this type of US-responsive hetero-assemblies carrying both anti-cancer drug and siRNA as an effective nanomedicinal system for HCC therapy. [Copyright &y& Elsevier]

Abstract: Ultrasound (US)-sensitive nanobubble (NB) which may utilize the physical power of US exposure to improve delivery efficiency to target cells is emerging as one of the most promising nanocarriers for drug delivery. On the basis of successfully fabricating NBs with the ability of passively accumulating in tumor tissue, in this study we synthesized a US-sensitive NB bearing siRNA (siRNA-NB) for tumor therapy via a hetero-assembling strategy using the siRNA-complexed polymeric micelles and gas-cored liposomes. The US exposure-aided siRNA transfection effectively enhanced the gene silencing effect of siRNA-NBs both in vitro and in vivo, which resulted in much elevated level of cancer cell apoptosis. Consequently, significantly improved therapeutic effect was achieved in a nude mouse glioma model, using siRNA-NBs bearing siRNA to target the anti-apoptosis gene sirtuin 2 (SIRT2). These results show that, with the aid of US exposure, the US-sensitive siRNA-NB may be an ideal delivery vector to mediate highly effective RNA interference for tumor treatment. [Copyright &y& Elsevier]

Purpose: Evaluating degree of hepatic steatosis is of great value for prognosis of liver transplantation. There is an urgent need for a non-invasive method to assess hepatic steatosis grade of donor livers. Purpose of our study was to evaluate diagnostic accuracy of attenuation coefficient estimation (ACE) by reference frequency method (RFM) in detecting hepatic steatosis of donor livers.Method: We retrospectively enrolled 62 potential liver donors which underwent ACE by RFM ex-vivo, in-vivo or both. We acquired raw data of B-mode images of liver parenchyma and offline-processes for attenuation estimation. Finally, we calculated and compared diagnostic performance of ACEs for steatosis grade detection and used histological results as the gold standard.Results: ACEs with none, mild and moderate hepatic steatosis were 0.57, 0.73 and 0.80 dB/cm/MHz in potential donor livers. The cutoff value to diagnose mild hepatic steatosis was 0.63 dB/cm/MHz and 0.77 dB/cm/MHz for moderate hepatic steatosis, and values for the area under the receiver operating characteristic curve for diagnosis of mild and moderate hepatic steatosis were 0.92 and 0.90, respectively.Conclusions: According to our results, ACE by RFM is an accurate non-invasive method in detecting hepatic steatosis, which may be of great help for clinical evaluation of donor livers before liver transplantation. [ABSTRACT FROM AUTHOR]