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Zheng B, Zhang P, Lv Q, Wu T, Liu Y, Tang J, Ma Y, Cheng L, Xu L, Wang Y, Xue Y, Liu J, Ren J. Development and preclinical evaluation of multifunctional hydrogel for precise thermal protection during thermal ablation. Bioact Mater 2024; 31:119-135. [PMID: 37637083 PMCID: PMC10448243 DOI: 10.1016/j.bioactmat.2023.08.010] [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: 06/05/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Image-guided thermal ablation (TA), which is less invasive, has been widely applied for treating various kinds of tumors. However, TA still poses the potential risk of thermal damage to sensitive tissue nearby. Therefore, an adjunctive thermoprotective hydrodissection technique with constant injection of 5% glucose (5% Glu) has currently been adopted for clinical application, but this may be hazardous to humans. In this study, a multifunctional hyaluronic acid-based hydrogel (HA-Dc) was developed for hydrodissection. Compared with 5% Glu (the most clinically used solution) and the previously reported F127 hydrogel, the HA-Dc hydrogel was studied in vitro in a porcine liver model and in vivo in a rabbit model and showed good injectability and better tissue retention, stability, and thermoprotective properties throughout the TA procedure. Furthermore, in the preclinical evaluation in a Macaca fascicularis (M. fascicularis) model, HA-Dc showed excellent performance in terms of stricter neuroprotection compared with 5% Glu. In addition, the HA-Dc hydrogel with good biocompatibility and controllable degradation behavior in vivo could be a promising platform for thermal protection during clinical TA procedures.
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Affiliation(s)
- Bowen Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Peng Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Qijun Lv
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Tao Wu
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yadong Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Junjie Tang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yanping Ma
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Lili Cheng
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Langtao Xu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Yizhen Wang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
| | - Yifan Xue
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Liu
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, No.66, Gongchang Road, Shenzhen, Guangdong, 518107, PR China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Province Key Laboratory of Hepatology Research, Multiple Disciplinary Team Center of Thyroid Diseases, No. 600, Tianhe Road, Guangzhou, Guangdong, 510630, PR China
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Efficacy on radiofrequency ablation according to the types of benign thyroid nodules. Sci Rep 2021; 11:22270. [PMID: 34782643 PMCID: PMC8593160 DOI: 10.1038/s41598-021-01593-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
Percutaneous radiofrequency ablation (RFA) has been recommended as minimally invasive treatment for patients with symptomatic benign thyroid nodules (BTNs) because of the large number of clinical applications. This retrospective observational study sought to evaluate the clinical outcomes of RFA for BTNs. From 2014 to 2019, a sample size of 1289 patients treated by RFA were 262 ones with solid nodules and 1027 ones with cystic-solid nodule, respectively. The efficacy including the nodule maximal diameter reduction ratio (MDRR), the volume reduction ratio (VRR) and the cosmetic scores reduction ratio (CSRR). The results of the nodule MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month, and the CSRR in the two groups showed statistically significant difference at the 3rd month. In a word, RFA is an effective method for symptomatic benign solid or cystic-solid nodules. The achieved MDRR and VRR in the cystic-solid nodule group were significantly better than those in the solid nodule group at the 3rd and 6th month.
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Ma Y, Wu T, Yao Z, Zheng B, Tan L, Tong G, Lian Y, Baek JH, Ren J. Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure. Eur Thyroid J 2021; 10:495-503. [PMID: 34956921 PMCID: PMC8647085 DOI: 10.1159/000519625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Small-volume hydrodissection liquid dissipates rapidly and confers only short-term protection during radiofrequency ablation (RFA) of benign thyroid nodules. The aim of this study was to establish a safe method for continuous, large-volume hydrodissection. METHODS A long needle was inserted and positioned outside the thyroid capsule; 5% glucose was injected to maintain a 3- to 5-mm continuous safety buffer. From October 2015 to July 2020, 166 patients underwent hydrodissection with different volumes, and ablation efficacy and complications associated with different liquid volumes (≤40 mL vs. >40 mL) were compared at 1-month postprocedure. Moreover, 20 mL liquid (equivalent to 250 mL in the human body) was injected around the thyroid of a rhesus monkey, after which CT scans were used to visualize the liquid's fate and verify its safety. RESULTS The 51 patients with 10-40 mL injections and 116 patients with larger injections (45-450 mL) showed similar complete ablation rates (88.46% vs. 90.44%, p = 0.582), comparable 6-month VRR (82.79% vs. 76.62%, p = 0.079), and complication incidences, although the latter group had larger nodules (9.11 mL vs. 13.79 mL, p = 0.003), more energy delivered (3.44 kcal vs. 6.04 kcal, p < 0.001), and longer operation times (51.37 min vs. 69.2 min, p < 0.001). In the animal experiment, the 20 mL of liquid diffused quickly (within 10 min) from the vicinity of the thyroid to the mediastinum and retropharyngeal space. It was observed in the kidneys at 10 min and disappeared from the neck and chest space by 24 h. CONCLUSIONS Continuous, large-volume hydrodissection can protect the delicate structures around the thyroid throughout the RFA procedure and might be beneficial in large thyroid nodule ablation.
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Affiliation(s)
- Yanping Ma
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
- *Jung Hwan Baek, , Jie Ren,
| | - Tao Wu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Zhicheng Yao
- General Surgery Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Bowen Zheng
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Lei Tan
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Ge Tong
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Yufan Lian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- *Jung Hwan Baek, , Jie Ren,
| | - Jie Ren
- Department of Medical Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou City, China
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Familiar Casado C, Merino Menendez S, Ganado Diaz T, Pallarés Gasulla R, Pazos Guerra M, Marcuello Foncillas C, Calle Pascual A. Single-session treatment of benign thyroid nodules with radiofrequency ablation: Results at 6 months in 24 patients. ACTA ACUST UNITED AC 2019; 67:164-171. [PMID: 31439500 DOI: 10.1016/j.endinu.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/04/2019] [Accepted: 06/07/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of one single-session of radiofrequency ablation (RFA) performed in thyroid benign and predominantly solid nodules. PATIENTS AND METHOD Unicentric retrospective study in usual clinical setting that included patients with solid and benign thyroid nodules treated with one single session of RFA and with folllow-up of at at least 6 months after the procedure. RFA was performed as an alternative to surgery in cases of pressure symptoms or nodular growth evidence. Patients were evaluated basally and at one, 3 and 6 months after RFA and also at 12 months if the follow-up was available. In each evaluation efficacy variables were recorded (percentual change from basal volume, percentage of nodules reaching a volume reduction above 50% from baseline, patients with disappearance of pressure symptoms and the possibility of antithyroid drug withdrawal) and safety variables were also registered including minor complications (pain needing analgesic drugs, hematoma) and major complications (voice changes, braquial plexus injury, nodule rupture and thyroid dysfunction). RESULTS Twenty-four patients with a follow-up of at least 6 months after RFA were included, 16 of them with more than 12 months of follow-up. Mean nodule volume changed from 25.4±15.5ml basally to 10.7±9.9ml at month 6 (P<.05) and to 9.9±10,4ml at month 12 in 16 nodules. Six months after RFA mean volumetric reduction was 57.5±24% and 65% of the nodules reached a volume reduction above 50% from baseline. Median percentage of reduction at month 6 was 50.4±25.8% for nodules with a basal volume above 20ml (n=13) and 65.3±20.1% for nodules with a lower basal volume (n=11). Pressure symptoms reported in 12 patients disappeared in all cases. Antithyroid drugs could be stopped in 3 of 4 cases treated before RFA. A mild and transient pain responsive to conventional analgesic drugs was recorded in 9 patients during the 24h after the procedure and in 7 a small perithyroid and transient hematoma was observed in the 48 following hours. One major complication was described as a nodule rupture that recovered spontaneously. There were no changes in hormonal values in euthyroid cases. CONCLUSION A single session of RFA seems to be an effective and safe procedure in patients with solid thyroid nodules with pressure symptoms or relevant growth evidence. As an outpatient and scarless procedure with no need of general anaesthesia it could become an useful alternative to lobectomy when surgery is refused or in patients at high surgical risk.
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Affiliation(s)
- Cristina Familiar Casado
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Carlos, Madrid, España.
| | | | - Tomás Ganado Diaz
- Servicio de Radiodiagnóstico, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Raquel Pallarés Gasulla
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Mario Pazos Guerra
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Carlos, Madrid, España
| | | | - Alfonso Calle Pascual
- Servicio de Endocrinología y Nutrición, Hospital Universitario Clínico San Carlos, Madrid, España
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