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Stewart JK, Myers E, Petrozza J, Kaufman C, Golzarian J, Kohi MP, Chiang A, Carlos R, Spies J, Abi-Jaoudeh N, Salazar G. Reproductive Outcomes of Patients Undergoing Uterine Artery Embolization for Uterine Fibroids: Proceedings from The Dr. James B. Spies Summit for Uterine Fibroid Research-A Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2024; 35:1288-1295. [PMID: 38825179 DOI: 10.1016/j.jvir.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024] Open
Abstract
Reproductive outcomes after uterine artery embolization (UAE) for the treatment of uterine fibroids are challenging to study, leaving several unanswered questions surrounding the future fertility of patients undergoing the procedure. Subject matter experts from interventional radiology, diagnostic radiology, obstetrics and gynecology, and reproductive medicine participated in a Society of Interventional Radiology (SIR) Foundation Research Consensus Panel to discuss and prioritize critical research topics focusing on fertility and reproductive outcomes in patients undergoing UAE for symptomatic uterine fibroids. After presentations and discussion of research ideas, the panelists prioritized the following topics for further investigation: (a) a prospective study of factors that influence implantation and gene expression in patients undergoing UAE or myomectomy over 1 year; (b) refinement of a classification system for uterine fibroids that can allow for more focused study design, which may include burden of fibroid disease; and (c) conjoint analysis/discrete choice experiments to better characterize those patients for whom fertility preservation is a high priority.
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Affiliation(s)
- Jessica K Stewart
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - John Petrozza
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Yawkey Center for Outpatient Care, Boston, Massachusetts
| | - Claire Kaufman
- Dotter Interventional Institute, Oregon Health & Science University, Portland, Oregon
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alex Chiang
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Santa Monica, California
| | - Ruth Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - James Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Gloria Salazar
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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2
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Gupta A, Balk EM, Lenger SM, Yang LC, Misal M, Balgobin S, Chang OH, Sharma V, Stuparich M, Behbehani S, Nihira M, Alas A, Jampa A, Sheyn D, Meriwether K, Antosh DD. Changes in Pelvic Floor Symptoms After Procedural Interventions for Uterine Leiomyomas: A Systematic Review. Obstet Gynecol 2023; 142:319-329. [PMID: 37411023 DOI: 10.1097/aog.0000000000005260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To conduct a systematic review to evaluate the effect of procedural interventions for leiomyomas on pelvic floor symptoms. DATA SOURCES PubMed, EMBASE, and ClinicalTrials.gov were searched from inception to January 12, 2023, searching for leiomyoma procedures and pelvic floor disorders and symptoms, restricted to primary study designs in humans. METHODS OF STUDY SELECTION Double independent screening for studies of any study design in all languages that reported pelvic floor symptoms before and after surgical (hysterectomy, myomectomy, radiofrequency volumetric thermal ablation) or radiologic (uterine artery embolization, magnetic resonance-guided focused ultrasonography, high-intensity focused ultrasonography) procedures for management of uterine leiomyomas. Data were extracted, with risk-of-bias assessment and review by a second researcher. Random effects model meta-analyses were conducted, as feasible. TABULATION, INTEGRATION, AND RESULTS Six randomized controlled trials, one nonrandomized comparative study, and 25 single-group studies met criteria. The overall quality of the studies was moderate. Only six studies, reporting various outcomes, directly compared two procedures for leiomyomas. Across studies, leiomyoma procedures were associated with decreased symptom distress per the UDI-6 (Urinary Distress Inventory, Short Form) (summary mean change -18.7, 95% CI -25.9 to -11.5; six studies) and improved quality of life per the IIQ-7 (Incontinence Impact Questionnaire, Short Form) (summary mean change -10.7, 95% CI -15.8 to -5.6; six studies). There was a wide range of resolution of urinary symptoms after procedural interventions (7.6-100%), and this varied over time. Urinary symptoms improved in 19.0-87.5% of patients, and the definitions for improvement varied between studies. Bowel symptoms were inconsistently reported in the literature. CONCLUSION Urinary symptoms improved after procedural interventions for uterine leiomyomas, although there is high heterogeneity among studies and few data on long-term outcomes or comparing different procedures. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021272678.
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Affiliation(s)
- Ankita Gupta
- Division of Female Pelvic Medicine & Reconstructive Surgery, University of Louisville Health, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology, & Women's Health, University of Louisville School of Medicine, Louisville, Kentucky; the Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island; the Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois; the Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, and the Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals, Cleveland, Ohio; the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, the Department of OBGYN, Division of Urogynecology, UT Health Science Center at San Antonio, San Antonio, and the Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; the Department of Obstetrics and Gynecology, Jacobi Medical Center, and the Albert Einstein College of Medicine, Bronx, New York; the Department of Obstetrics and Gynecology, University of California, Riverside School of Medicine, Riverside, and KPC Healthcare, Hemet, California; the Jawaharlal Nehur Medical College, Belgaum, India; and the Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico
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Jia G, Van Valkenburgh J, Chen AZ, Chen Q, Li J, Zuo C, Chen K. Recent advances and applications of microspheres and nanoparticles in transarterial chemoembolization for hepatocellular carcinoma. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1749. [PMID: 34405552 PMCID: PMC8850537 DOI: 10.1002/wnan.1749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
Transarterial chemoembolization (TACE) is a recommended treatment for patients suffering from intermediate and advanced hepatocellular carcinoma (HCC). As compared to the conventional TACE, drug-eluting bead TACE demonstrates several advantages in terms of survival, treatment response, and adverse effects. The selection of embolic agents is critical to the success of TACE. Many studies have been performed on the modification of the structure, size, homogeneity, biocompatibility, and biodegradability of embolic agents. Continuing efforts are focused on efficient loading of versatile chemotherapeutics, controlled sizes for sufficient occlusion, real-time detection intra- and post-procedure, and multimodality imaging-guided precise treatment. Here, we summarize recent advances and applications of microspheres and nanoparticles in TACE for HCC. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Guorong Jia
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China
| | - Juno Van Valkenburgh
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Austin Z. Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Quan Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jindian Li
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
| | - Kai Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
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Brandão P, Ceschin N, Bellver J, Ferro J. Embolic microspheres observed during metroplasty. Gynecol Minim Invasive Ther 2022; 11:131-133. [PMID: 35746915 PMCID: PMC9212177 DOI: 10.4103/gmit.gmit_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/05/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
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Sharma K, Porat Z, Gedanken A. Designing Natural Polymer-Based Capsules and Spheres for Biomedical Applications-A Review. Polymers (Basel) 2021; 13:4307. [PMID: 34960858 PMCID: PMC8708131 DOI: 10.3390/polym13244307] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 12/12/2022] Open
Abstract
Natural polymers, such as polysaccharides and polypeptides, are potential candidates to serve as carriers of biomedical cargo. Natural polymer-based carriers, having a core-shell structural configuration, offer ample scope for introducing multifunctional capabilities and enable the simultaneous encapsulation of cargo materials of different physical and chemical properties for their targeted delivery and sustained and stimuli-responsive release. On the other hand, carriers with a porous matrix structure offer larger surface area and lower density, in order to serve as potential platforms for cell culture and tissue regeneration. This review explores the designing of micro- and nano-metric core-shell capsules and porous spheres, based on various functions. Synthesis approaches, mechanisms of formation, general- and function-specific characteristics, challenges, and future perspectives are discussed. Recent advances in protein-based carriers with a porous matrix structure and different core-shell configurations are also presented in detail.
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Affiliation(s)
- Kusha Sharma
- Department of Chemistry, Bar-Ilan Institute for Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan 52900, Israel;
| | - Ze’ev Porat
- Department of Civil and Environmental Engineering, Ben-Gurion University of the Negev, Be’er Sheva 84105, Israel
- Department of Chemistry, Nuclear Research Center-Negev, Be’er Sheva 84190, Israel
| | - Aharon Gedanken
- Department of Chemistry, Bar-Ilan Institute for Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan 52900, Israel;
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Sato H, Sonomura T, Onishi S, Koike M, Tanaka R, Ueda S, Okuhira R, Kamisako A, Koyama T, Shima N, Yamamoto S, Sakai Y, Murata SI, Ikoma A. Comparison of Uterine Necrosis After Uterine Artery Embolization with Soluble Gelatin Sponge Particles or Tris-acryl Gelatin Microspheres in Swine. Cardiovasc Intervent Radiol 2021; 44:1780-1789. [PMID: 34231005 DOI: 10.1007/s00270-021-02905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the recanalization of the uterine arteries and uterine necrosis after uterine artery embolization (UAE) using either soluble gelatin sponge particles (SGS), which dissolve in saline, or tris-acryl gelatin microspheres (MS), which are permanent embolic materials, in swine. METHODS Fourteen uteri in seven swine were divided into two groups for embolization with either 500-1000 µm SGS (SGS group) or 500-700 µm MS (MS group) (seven uteri per group). The uterine arteries were embolized using SGS or MS, and angiography was performed to evaluate recanalization of the uterine arteries immediately, 1, 2, 3, 4, 5, and 6 h, and 3 days after embolization. On day 3, the uteri were removed to determine the macroscopic necrosis rate and for histopathologic examination. RESULTS In the SGS group, four uterine arteries were completely recanalized, two were partially recanalized, and one was still occluded 5 h after embolization. In contrast, all seven uterine arteries in the MS group were still occluded 6 h after embolization. The complete recanalization rate at 3 days was significantly greater in the SGS group than in the MS group (100.0% vs. 14.3%, respectively; P = .0047). The mean uterine necrosis rate was not significantly different between the SGS and MS groups (15.0 ± 15.7% vs. 26.8 ± 13.3%, respectively; P = .096). The mean smallest arterial diameter containing embolic materials was 48.2 ± 22.0 μm (range 21-109 μm) for SGS and 446.7 ± 107.0 μm (range 352-742 μm) for MS (P < .0001). CONCLUSION The uterine arteries recanalized earlier in the SGS group than in the MS group and the uterine necrosis rates were similar in both groups. SGS have the potential for a more distal penetration in comparison with MS.
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Affiliation(s)
- Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan.
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Saeko Onishi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Masataka Koike
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Ryota Tanaka
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Shota Ueda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Ryuta Okuhira
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Takao Koyama
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | - Nozomu Shima
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
| | | | - Yasuo Sakai
- Technical Center, Jellice Co., Ltd, Miyagi, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, Wakayama, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-8510, Japan
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Çakır Ç, Kılınç F, Deniz MA, Karakaş S. Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas? Turk J Med Sci 2021; 51:1380-1387. [PMID: 33550765 PMCID: PMC8283489 DOI: 10.3906/sag-2012-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background/aim Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Fatih Kılınç
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Muhammed Akif Deniz
- Department of Internal Medical Sciences, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sema Karakaş
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
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Dong Z, Meng X, Yang W, Zhang J, Sun P, Zhang H, Fang X, Wang DA, Fan C. Progress of gelatin-based microspheres (GMSs) as delivery vehicles of drug and cell. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111949. [PMID: 33641932 DOI: 10.1016/j.msec.2021.111949] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Gelatin has various attractive features as biomedical materials, for instance, biocompatibility, low immunogenicity, biodegradability, and ease of manipulation. In recent years, various gelatin-based microspheres (GMSs) have been fabricated with innovative technologies to serve as sustained delivery vehicles of drugs and genetic materials as well as beneficial bacteria. Moreover, GMSs have exhibited promising potentials to act as both cell carriers and 3D scaffold components in tissue engineering and regenerative medicine, which not only exhibit excellent injectability but also could be integrated into a macroscale construct with the laden cells. Herein, we aim to thoroughly summarize the recent progress in the preparations and biomedical applications of GMSs and then to point out the research direction in future. First, various methods for the fabrication of GMSs will be described. Second, the recent use of GMSs in tumor embolization and in the delivery of cells, drugs, and genetic material as well as bacteria will be presented. Finally, several key factors that may enhance the improvement of GMSs were suggested as delivery vehicles.
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Affiliation(s)
- Zuoxiang Dong
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China; Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xinyue Meng
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Wei Yang
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China
| | - Jinfeng Zhang
- Department of Surgery, Songshan Hospital of Qingdao University, Qingdao 266021, Shandong, China
| | - Peng Sun
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Huawei Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong, China
| | - Xing Fang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Dong-An Wang
- Department of Biomedical Engineering, City University of Hong Kong, Kowloon, Hong Kong Special Administrative Region; Shenzhen Research Institute, City University of Hong Kong, Shenzhen Hi-tech Industrial Park, Shenzhen, Guangdong 518057, China; Karolinska Institute Ming Wai Lau Centre for Reparative Medicine, HKSTP, Sha Tin, Hong Kong Special Administrative Region.
| | - Changjiang Fan
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao 266000, Shandong, China.
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Farrell TP, Garvey C, Adams NC, Mulholland D, Ryan JM, Guiney M, McEniff N. Comparison of outcomes and cost-effectiveness of trisacryl gelatin microspheres alone versus combined trisacryl gelatin microspheres and gelatin sponge embolization in uterine fibroid embolization. Acta Radiol 2020; 61:1287-1296. [PMID: 31955609 DOI: 10.1177/0284185119898660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Uterine fibroid embolization (UFE) is an effective treatment for uterine leiomyomata. Optimizing the choice of embolic agents is imperative to achieve better patient outcomes with maximum resource utilization. PURPOSE To evaluate the efficacy and cost-effectiveness of trisacryl gelatin microspheres (TAGM) versus combined TAGM and gelatin sponge (GS) embolization in the treatment of symptomatic uterine leiomyomata. MATERIAL AND METHODS Between July 2007 and December 2010, 106 consecutive patients underwent UFE with TAGM. Between January 2011 and December 2016, 123 consecutive patients underwent UFE with a combination of TAGM/GS. The primary outcomes were successful infarction rate (≥90% infarction) of the dominant leiomyoma and percentage reduction in uterine and dominant leiomyoma volume on MRI at six months. Secondary outcomes included adverse event rates, pain scores, and change in clinical symptoms at six months. The embolic agents utilized per procedure were recorded and a cost-effectiveness analysis was performed. RESULTS Baseline characteristics of both groups were similar. Successful infarction was achieved in 93.2% of the TAGM group and 94.6% of the TAGM/GS group (P = 0.52). Reduction in uterine volume (TAGM 40.7%, TAGM/GS 44.4%, P = 0.16) and dominant leiomyoma volume (TAGM 47.6%, TAGM/GS 50.1%, P = 0.29) at six months was similar. No significant difference was observed in symptom improvement at six months (P = 0.8). The mean number of TAGM vials utilized and cost per procedure was 6.3 and $1688.40 for TAGM embolization and 3.6 and $979.50 for TAGM/GS embolization, respectively. CONCLUSION Primary and secondary outcomes were comparable when performing UFE with TAGM versus combined TAGM/GS. The combined use of TAGM/GS reduced the mean cost of embolic agents by 42%.
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Affiliation(s)
| | - Chris Garvey
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Niamh C Adams
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | | | - J Mark Ryan
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Michael Guiney
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Niall McEniff
- Department of Radiology, St James’s Hospital, Dublin, Ireland
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Chen G, Wei R, Huang X, Wang F, Chen Z. Synthesis and assessment of sodium alginate-modified silk fibroin microspheres as potential hepatic arterial embolization agent. Int J Biol Macromol 2020; 155:1450-1459. [DOI: 10.1016/j.ijbiomac.2019.11.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/04/2019] [Accepted: 11/13/2019] [Indexed: 02/07/2023]
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Wang CY, Hu J, Sheth RA, Oklu R. Emerging Embolic Agents in Endovascular Embolization: An Overview. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2020; 2:012003. [PMID: 34553126 PMCID: PMC8455112 DOI: 10.1088/2516-1091/ab6c7d] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Courtney Y. Wang
- The University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., Hourson, TX 77030, USA
| | - Jingjie Hu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, AZ 85259, USA
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Management of Hemodynamic Collapse After Liver Transplantation From Native Bile Duct Stump Hemorrhage with Gelfoam. ACG Case Rep J 2019; 6:e00254. [PMID: 31832474 PMCID: PMC6855557 DOI: 10.14309/crj.0000000000000254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022] Open
Abstract
Spontaneous hemobilia is a rare complication after liver transplantation and is largely secondary to the formation of an arteriobiliary fistula, which is generally treated by vascular interventional radiology embolization. We present a case of hemorrhagic shock secondary to arterial hemorrhage at an oversewn bile duct stump after liver transplantation, which failed vascular interventional radiology embolization, and was subsequently controlled using an endoscopic application of a gelatin sponge slurry (Gelfoam). We present this unique approach and review the history of this surgical and interventional hemostasis tool that has not been previously described for endoscopic use.
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Zhang M, Tang Y, Zhu Z, Zhao H, Yao J, Sun D. Paclitaxel and etoposide-loaded Poly (lactic-co-glycolic acid) microspheres fabricated by coaxial electrospraying for dual drug delivery. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2018; 29:1949-1963. [PMID: 29920151 DOI: 10.1080/09205063.2018.1485816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In this study, we fabricated paclitaxel (PTX) and etoposide (ETP) loaded Poly (lactic-co-glycolic acid) (PLGA) microspheres with core-shell structures and particle sizes ranging from 1 to 4 µm by coaxial electrospraying. The microspheres were analyzed by scanning electron microscopy (SEM), transmission electron microscopy (TEM). The drug loading rate and entrapment efficiency of the microspheres were detected by high performance liquid chromatograph (HPLC). Moreover, the drug release profiles and degradation of drug-loaded PLGA microspheres in vitro were investigated, respectively. The distinct layered structure that existed in the manufactured core-shell microspheres can be observed by TEM. The in vitro release profiles indicated that the PLGA/PTX + ETP (PLGA/PE) microspheres exhibited the controlled release of two drugs in a sequential manner. Cell Counting Kit-8 was used to detect the toxic and side effects of the microspheres on bone tumor cells. PTX and ETP for combination drug therapy loaded microspheres had more cytotoxic effect on saos-2 osteosarcoma cells than the individual drugs. In conclusion, core-shell PLGA microspheres by electrospraying for combination drug therapy is promising for medicine applications, the PLGA/PE microspheres have some potential for osteosarcoma treatment.
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Affiliation(s)
- Mei Zhang
- a Alan G. MacDiarmid Laboratory, College of Chemistry , Jilin University , Changchun , China
| | - Yajun Tang
- a Alan G. MacDiarmid Laboratory, College of Chemistry , Jilin University , Changchun , China
| | - Zhenhua Zhu
- b Norman Bethune First Hospital, Jilin University , Changchun , China
| | - He Zhao
- a Alan G. MacDiarmid Laboratory, College of Chemistry , Jilin University , Changchun , China
| | - Jihang Yao
- b Norman Bethune First Hospital, Jilin University , Changchun , China
| | - Dahui Sun
- b Norman Bethune First Hospital, Jilin University , Changchun , China
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Five-year clinical outcomes of uterine artery embolization for symptomatic leiomyomas: An analysis of risk factors for reintervention. Eur J Radiol 2018; 109:83-87. [PMID: 30527317 DOI: 10.1016/j.ejrad.2018.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the five-year reintervention rate of uterine artery embolization (UAE) for symptomatic leiomyomas and to identify potential predictive factors of reintervention. METHODS From March 2011 to February 2012, 92 consecutive women (mean age 41.9 years, range 28-55 years) underwent bilateral UAE. Contrast-enhanced magnetic resonance imaging (MRI) was performed at three-month follow-up. After annual follow-up, a survey on clinical outcome and reintervention incidences was performed at five-year follow-up. Potential predictive factors of reintervention were evaluated. RESULTS Of the 67 patients, menorrhagia and/or bulk-related symptoms were resolved after UAE in all but one patient (98.5%). At median follow-up of 60 months (range, 5-60 months), reintervention rate was 10.4%, with seven reintervention cases (five myomectomy and two hysterectomy cases). Complete (100%) or near complete (90-99%) infarction rate of the dominant leiomyoma was 96.4% (54 of 56). Independent factors of reintervention on multivariate logistics regression analysis included near complete or partial (<90%) infarction of the dominant leiomyoma (odds ratio [OR] 22.238; 95% confidence interval [CI] 2.405-205.620; p = 0.006), as well as the presence of non-dominant viable leiomyomas (OR 12.134; 95% CI 1.213-121.409; p = 0.034). CONCLUSION UAE provides excellent and sustained symptom improvement of symptomatic leiomyomas with a low reintervention rate at five-year follow-up. In addition to near complete or partial infarction of the dominant leiomyoma on follow-up MRI, the presence of viable non-dominant leiomyomas indicates a higher risk of reintervention.
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Katsumori T, Asai S, Yokota H, Miura H. Volume of embolic agents in uterine artery embolization for leiomyoma: relation to baseline MRI. MINIM INVASIV THER 2018; 28:186-193. [DOI: 10.1080/13645706.2018.1513408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Shunsuke Asai
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University, Graduate School of Medicine, Chiba, Japan
| | - Hiroshi Miura
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Abstract
OBJECTIVE The purpose of this study was to compare the outcomes of second uterine artery embolization (UAE) with those of first UAE for symptomatic uterine leiomyoma. MATERIALS AND METHODS In this single-institution retrospective study, between December 1997 and May 2016 first UAE was performed on 423 consecutively registered patients and second UAE on 11 consecutively registered patients to treat leiomyoma. The primary endpoint was infarction of all tumor tissue as seen at postprocedural contrast-enhanced MRI. The secondary endpoints were angiographic findings, embolization, MRI, and clinical outcomes 1 year after UAE. The outcomes were compared between the two groups. Multivariable linear regression analysis was performed to assess independent correlations with tumor infarction. RESULTS Most of the baseline demographic features and technical outcomes in the two groups were similar. In the second UAE group, all but one uterine artery was reopened. More collateral vessels were observed at the second UAE (1.1/patient versus 0.23/patient, p = 0.043). Contrast-enhanced MRI after UAE revealed that the tumor infarction rate was significantly lower in the second UAE group (69.8 ± 33.9% vs 96.8 ± 9.0%, p = 0.025). The difference remained significant after adjustments for possible confounders (p < 0.001). Whether UAE was a first or a second procedure was significantly associated with tumor infarction rate (p < 0.001). The uterine volume reduction rate 1 year after UAE was significantly lower in the second UAE group (33.4 ± 18.1% versus 46.9 ± 16.6%, p = 0.008). No other 1-year outcomes were significantly different between the groups. CONCLUSION Second UAE was effective but inferior to first UAE in that it resulted in less tumor infarction at contrast-enhanced MRI and had a lower uterine volume reduction rate.
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Katsumori T, Arima H, Asai S, Hayashi N, Miura H. Comparison of Pain Within 24 h after Uterine Artery Embolization with Tris-Acryl Gelatin Microspheres Versus Gelatin Sponge Particles for Leiomyoma. Cardiovasc Intervent Radiol 2017; 40:1687-1693. [DOI: 10.1007/s00270-017-1691-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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