ObjectiveTo compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.MethodsBetween June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.ResultsExcept that the operation time of group B was significantly longer than that of group A (t=–2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal ?uid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=–2.716, P=0.007).ConclusionPosterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.
Focused low-intensity pulsed ultrasound (FLIPUS), as a non-invasive physical therapy, is widely used in orthopedics, neurosurgery, urology, rehabilitation medicine and other clinical specialties. More and more studies have found that FLIPUS can treat knee osteoarthritis (KOA) by promoting tissue regeneration, relieving pain and inhibiting inflammation, improve the common clinical symptoms of KOA, such as joint pain or stiffness, limited joint activity and decreased walking function, and improve the quality of life of patients to a certain extent. This article mainly reviews the effect and biophysical mechanism of FLIPUS in the treatment of KOA, as well as related clinical research, in order to provide a reference for clinical workers who carry out research in this field.
Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1st 2005 to February 15th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.
ObjectiveTo explore the application value of high intensity focused ultrasound (HIFU) in the treatment of advanced pancreatic cancer.MethodThe domestic and foreign literatures about studies of HIFU treating advanced pancreatic cancer in recent years were retrieved and summarized.ResultsHIFU could prolong the survival time, control pain, and enhance the body’s immune function in patients with advanced pancreatic cancer. There were no obvious serious complications during the treatment process. The combined treatment with radiotherapy, chemotherapy, and traditional Chinese medicine could obviously prolong the survival time and improve the quality of life for the patients with advanced pancreatic cancer.ConclusionsHIFU is an important component in the comprehensive treatment of advanced pancreatic cancer. However, because there is no uniform standard for the dosage of HIFU treatment, the sample size of many related studies is small, so the research results have certain limitations, so more studies are needed to improve their understanding of advanced pancreatic cancer in order to better serve clinical workin future.
Numerical simulation is one of the most significant methods to predict the temperature distribution in high-intensity focused ultrasound (HIFU) therapy. In this study, the adopted numerical simulation was used based on a transcranial ultrasound therapy model taking a human skull as a reference. The approximation of the Westervelt formula and the Pennes bio-heat conduction equation were applied to the simulation of the transcranial temperature distribution. According to the temperature distribution and the Time Reversal theory, the position of the treatable focal region was corrected and the hot spot existing in the skull was eliminated. Furthermore, the influence of the exposure time, input power and the distance between transducer and skull on the temperature distribution was analyzed. The results showed that the position of the focal region could be corrected and the hot spot was eliminated using the Time Reversal theory without affecting the focus. The focal region above 60℃ could be formed at the superficial tissue located from the skull of 20 mm using the hot spot elimination method and the volume of the focal region increases with the exposure time and the input power in a nonlinear form. When the same volume of the focal region was obtained, the more power was inputted, the less the exposure time was needed. Moreover, the volume of the focal region was influenced by the distance between the transducer and the skull.
Objective To explore the effectiveness and appropriate energy parameters of high-intensity focused ultrasound (HIFU) in treating infant hemangiomas. Methods Between January 2009 and September 2010, 60 infants with hemangioma were treated. There were 23 boys and 37 girls, aged from 3 to 30 months with an average of 10 months. These hemangiomas were located at head and face (24 cases), trunk (15 cases), l imb (16 cases), buttocks (2 cases), perineum (1 case),and multiple lesions (cervix, abdomen, and upper l imbs, 2 cases). The size of hemangiomas ranged from 0.8 cm × 0.6 cm to 6.0 cm × 5.0 cm. The 60 infants were randomly divided into 3 groups: groups A, B, and C (n=20) based on different ultrasound energies used in treatment. The lesion surface was irradiated with 3-5 mm/second for 5 continuously by ultrasonic therapeutic apparatus at a frequency of 9 MHz, impulse of 1 000, and 10% of scanning overlap; the powers of 3.5, 4.0, and 4.5 W were used in groups A, B, and C, respectively, 3 times as a course of treatment with 1 month interval. The effect and ulcer and scar risk in irradiation region were observed after 6 months of treatment. Results All cases were treated for one course. After 6 months of treatment, no significant difference in the effect was found among 3 groups based on hemangioma treatment judging criterion (P gt; 0.05). Neither ulcer nor scar occurred in group A; ulcer occurred in 4 cases (20%) of group B with superficial scars, and in 7 cases (35%) of group C with obvious scars. The rates of ulcer and scar in groups B and C were significantly higher than that in group A (P lt; 0.05). Conclusion HIFU irradiating is one of effective methods for treating infant hemangioma, but the appropriate energy was below 3.5 W.
bjectiveTo evaluate the efficacy and limits of high intensity focused ultrasound (HIFU) in tumor treatment. MethodsThe references about the application of HIFU in tumor treatment in recent years were reviewed.ResultsHIFU caused localized hyperthermia at predictable depth in a few seconds to make the tumor tissue coagulative necrosis without injuring surrounding tissue. HIFU treatment had the advantages of low morbidity, noninvasiveness, avoidance of systemic side effects, and repeatitiveness. However, the utilization of HIFU sometimes could be limited by some factors such as imaging technique, organ movement, incomplete tissue destruction, etc.ConclusionHIFU is a promising noninvasive therapy for tumor treatment, though there are lots of problems to be further studied.
To improve the cavitation-to-tissue ratio (CTR) of cavitation imaging during the treatment with high-intensity focused ultrasound (HIFU), we proposed a pulse inversion based broadband subharmonic cavitation imaging method (PIBSHI). Due to the fact that the subharmonic signal is a unique nonlinear vibration characteristic of cavitation bubbles, we extracted the broadband subharmonic signal to get a high-CTR cavitation imaging. The simulation showed that the subharmonic signal produced by cavitating bubbles with different sizes varied, and the signal was stronger than other subharmonics when the bubbles’ resonant frequency was close to 1/2 subharmonic frequency. Further experiment results demonstrated that compared with the conventional B-mode images, broadband subharmonic cavitation imaging (BSHI) has improved the CTR by 5.7 dB, and the CTR was further improved by 3.4 dB when combined with pulse inversion (PI) technology. Moreover, when the bandwidth was set to 100%~140% of the 1/2 subharmonic frequency in PIBSHI, the CTR was the highest and the imaging showed the optimal quality. The study may have reference value for the development of precise cavitation imaging during HIFU treatment, and contribute to improve the safety of HIFU treatment.
A miniaturized, low-cost high-intensity focused ultrasound device is developed for the problems of cross-contamination and uneven sample fragmentation in conventional ultrasound devices. This device generates ultrasonic waves through a concave spherical self-focusing piezoelectric ceramic piece, and creates a cavitation effect in the focusing area to achieve sample fragmentation. The feasibility of the device is demonstrated by physical simulation, then a driving circuit with adjustable power is designed and manufactured to generate 0 ~ 22.4 W acoustic power, and finally paraffin-embedded sample dewaxing experiments are performed to verify the validation of the device. The experimental results show that the dewaxing efficiency and safety of the high-intensity focused ultrasound device is significantly better than those of traditional chemical methods, and this device is comparable with commercial ultrasonic instruments. In summary, the high-intensity focused ultrasound device is expected to be applied in automated nucleic acid extraction and purification equipment and has a broad application prospect in the field of sample pre-processing.
Objective To study the mechanism of high intensity focused ultrasound (HIFU) and discuss its clinical significance in the treatment of mid-late stage liver cancer. Methods The patients with mid-late stage liver cancer were treated with HIFU. The changes of photography, pathology and immunology after operation were evaluated. Results It was shown that the results of the photographic, pathologic and immunologic examinations changed during the treatment of the patients with HIFU. Conclusion HIFU is effective and safe for the treatment of mid-late stage liver cancer.
