Search Results (455)

Background: Proton beam therapy (PBT) provides excellent tumor control with minimal hepatic toxicity in patients with unresectable hepatocellular carcinoma (HCC), by minimizing radiation exposure to non-cancerous liver tissue. Progressive skeletal muscle loss, often seen in cirrhosis and HCC, can negatively impact treatment outcomes and survival. This study compared the efficacy and safety of PBT with transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in patients with unresectable HCC. Methods: A total of 91 patients (PBT/TACE+RFA, n = 41/50) ineligible for surgery or RFA alone were retrospectively analyzed, with propensity score matching applied to adjust for differences in baseline characteristics, resulting in matched groups of 33 patients each. The cross-sectional area of the psoas muscle at the third lumbar vertebra was assessed using computed tomography. Results: PBT resulted in longer overall survival (OS) and fewer hepatic and systemic adverse events compared to TACE+RFA, with no grade 3 or higher toxicities observed in the PBT group. Importantly, psoas muscle size remained stable after PBT, even in patients with tumors ≥ 3 cm, whereas TACE+RFA led to significant muscle loss regardless of tumor size, which was associated with poorer prognosis. These findings suggest that, for patients with unresectable HCC not adequately controlled by RFA alone, PBT may improve OS and help preserve muscle mass, while offering lower toxicity and more favorable clinical outcomes than TACE+RFA. Conclusions: Overall, PBT may represent an effective strategy for managing unresectable HCC. Full article

This study investigates the fracture behavior of recycled aggregate concrete by integrating fractal theory and empirical modeling to quantify how recycled coarse aggregates (RCAs) and recycled fine aggregates (RFAs) influence crack complexity and maximum crack width under varying content and loads. The results reveal distinct scale-dependent behaviors between RCA and RFA. For RCA, moderate dosages enhance fractal complexity (a measure of surface roughness) by promoting micro-crack proliferation, while excessive RCA reduces complexity due to matrix homogenization. In contrast, RFA significantly increases both fractal complexity and crack width under equivalent loads, reflecting its susceptibility to micro-scale interfacial transition zone (ITZ) degradation. Non-linear thresholds are identified: RCA’s fractal complexity plateaus at high loads as cracks coalesce into fewer dominant paths, while RFA’s crack width growth decelerates at extreme dosages due to balancing effects like particle packing. Empirical models link aggregate dosage and load to fractal dimension and crack width with high predictive accuracy (R² > 0.85), capturing interaction effects such as RCA’s load-induced complexity reduction and RFA’s load-driven crack width amplification. Secondary analyses further demonstrate that fractal dimension correlates with crack width through non-linear relationships, emphasizing the coupled nature of micro- and macro-scale damage. These findings challenge conventional design assumptions by differentiating the impacts of RCA (macro-crack coalescence) and RFA (micro-crack proliferation), providing actionable thresholds for optimizing mix designs. The study also advances sustainable material design by offering a scientific basis for updating standards to accommodate higher recycled aggregate percentages, supporting circular economy goals through reduced carbon emissions and waste diversion, and laying the groundwork for resilient, low-carbon infrastructure. Full article

Background: Contrast-enhanced computed tomography (CECT) is considered the gold standard for assessing therapeutic response in hepatocellular carcinoma (HCC) following locoregional treatments. More recently, contrast-enhanced ultrasound (CEUS) has emerged as a promising, cost-effective alternative, although evidence supporting its use in this context remains limited. This study aimed to evaluate the diagnostic performance of CEUS compared to CECT in assessing local response of HCC nodules treated with radiofrequency ablation (RFA). Methods: We retrospectively analyzed a consecutively enrolled cohort of patients undergoing RFA for HCC at IRCCS San Matteo Hospital, Pavia, between January 2017 and January 2022. Follow-up imaging included both CEUS and CECT at predefined time points. Imaging follow-up, MRI, and/or histological results were used as the reference standard to compare CEUS and CECT. Results: A total of 55 patients (mean age 74 years, 64% male) with 79 HCC nodules were included. Complete response was observed in 57 nodules (72%), all correctly identified by CEUS, whereas 4 cases were misclassified by CECT. Among the 22 nodules (28%) with residual disease, CEUS correctly identified 15 cases, while 17 were detected by CECT; notably, CEUS identified 4 lesions missed by CECT, which identified 6 missed at CEUS. Combined, the two modalities detected 21 (96%) out of 22 residual tumors. CEUS showed a sensitivity of 68.1%, specificity of 100%, and diagnostic accuracy of 91.1%, compared to 68.0%, 98.1%, and 88.6%, respectively, for CECT, with no significant differences. Conclusions: CEUS is a reliable, non-inferior, and complementary modality to CECT for evaluating treatment response of HCC following RFA. Larger prospective studies are warranted to further define its role in clinical practice. Full article

Cholangiocarcinoma (CCA) is an aggressive malignancy originating from the epithelial lining of the intrahepatic or extrahepatic bile ducts. Although rare globally, its mortality closely mirrors incidence due to late-stage presentation of the disease and limited curative options. While surgical resection and liver transplantation remain the cornerstone treatments for those with resectable disease, endoscopic techniques have emerged as versatile tools for diagnosis, therapy, and palliation. In recent years, there have been major advancements in endoscopic therapies, including radiofrequency ablation (RFA), intraluminal brachytherapy (ILBT), and photodynamic therapy (PDT). The current narrative review serves to provide an overview of current and emerging endoscopic strategies for CCA, emphasizing diagnostic capabilities, therapeutic approaches, palliative interventions, and future directions. Full article

Background: Chronic pain is a major contributor to a reduced quality of life in the United States, with chronic shoulder pain comprising a sizeable portion of complaints. Multiple techniques are utilized in the treatment of chronic shoulder pain, but many patients report significant pain refractory to these modalities. For these patients, the suprascapular nerve’s radiofrequency ablation (RFA) offers a potential long-lasting solution. Methods: This retrospective analysis used data from UW Health HealthLink records of patients who received suprascapular RFA from June 2017 to May 2024. Data were collected across 31 procedures, covering demographics, RFA technique, procedure efficacy, duration of relief, adverse events, and relevant medical history. The data were analyzed using a paired t-test. Results: The average pre-RFA pain score was 6.08/10, and the average post-RFA pain score was 2.95/10. The average percentage improvement was 63.3%, with a mean duration of improvement of 3.12 months. Five procedures yielded no improvement in pain. Conclusions: This study demonstrated that RFA is an effective alternative therapy for chronic shoulder pain refractory to conventional pain management strategies, with a potential for long-term relief. Limitations of this study are due to the inherent challenges of retrospective analyses. Full article

Background/Objectives: Malignant biliary diseases still represent a therapeutic challenge given its poor prognosis, and limited response to the available curative treatments. Recently, endobiliary radiofrequency ablation (RFA) has been increasingly reported as an adjunct therapeutic option for biliary diseases, especially malignant biliary obstruction (MBO), due to potentially improving survival and stent patency. Methods: Herein, we provide a comprehensive review article discussing the indication, procedural details, safety, and comparative efficacy of endobiliary RFA to aid in providing an in-depth understanding of the clinical indications and future implications of this specific option. Results: Overall, endobiliary RFA is technically feasible, being associated with a high safety profile, significantly improving biliary stent patency, and having a potential benefit in extending the survival of patients with MBO who were treated with endobiliary RFA combined with biliary stenting vs. stenting alone. Moreover, it has a promising role in the treatment of intraductal extension of ampullary tumors. Conclusions: Endobiliary RFA had a beneficial therapeutic effect in biliary strictures, with potential impact on patients outcome and survival. Full article

Soybean mosaic virus (SMV) is a major viral pathogen that causes significant yield losses and a reduction in seed quality in susceptible soybean cultivars. Resistance breeding is the most effective, economical, and eco-friendly strategy for prevention of SMV-induced damage. Accurate and convenient assessment of SMV resistance is an essential prerequisite for resistance breeding. In this study, we constructed a green fluorescent protein (GFP)-tagged SMV recombinant virus (SMV-GFP) by yeast homologous recombination technology. It was proved that the recombinant virus can not only be used to track the viral infection process in Nicotiana benthamiana and soybean, but also to quantify the viral load based on relative fluorescence area (RFA) value. Using this recombinant virus, the resistance of 286 soybean germplasms from Northeast China to SMV was evaluated. A genome-wide association study (GWAS) was conducted using the RFA values of the 286 soybean accessions to find possible SMV-resistance genes. The results revealed 72 single nucleotide polymorphism (SNP) loci on chromosome 13 closely associated with SMV resistance, and a total of 40 genes were discovered within the candidate regions. By integrating the results of gene functional annotation and haplotype analysis, Glyma.13g176600 encoding a membrane attack complex/perforin (MACPF) domain-containing protein and Glyma.13g177000 encoding a DUF761-containing protein were identified as the most probable candidate genes associated with SMV resistance. Overall, the GFP-based rapid evaluation system developed in this study will facilitate breeding for resistance to SMV in soybean. Full article

Objective: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study is to identify predictors of suboptimal volume reduction (SVR), defined as failure to achieve a volume reduction greater than 5% between 6 and 12 months after procedure and persistence of symptoms. Methods: A retrospective single-center analysis of consecutive patients who underwent a single RFA procedure for benign thyroid at Verona University Hospital between 2020 and 2023 was conducted. Clinical data, including nodule volume and compressive symptoms, were collected preoperatively and at 1, 6, and 12 months post-RFA. Regression analysis was performed to identify predictors of SVR and persistence of symptoms. Results: A total of 50 patients were included. Baseline nodule volume, higher ACR-TIRADS score, and higher body mass index (BMI) were identified as independent predictors of SVR (p < 0.05). At 12 months, 18.4% of patients reported persistent compressive symptoms; however, no significant predictors of symptom persistence were identified. Conclusions: RFA is effective in reducing benign thyroid nodule volume, with a minority of patients experiencing persistent symptoms. Baseline nodule volume, ultrasonographic characteristics, and BMI significantly influence RFA outcomes, suggesting the need for additional procedures. Further studies are required to identify predictors of treatment response, enhancing patient selection and optimizing therapeutic efficacy. Full article

Deep learning-based landslide detection in optical remote sensing images has been extensively studied. However, several challenges remain. Over time, factors such as vegetation cover and surface weathering can weaken the distinct characteristics of landslides, leading to blurred boundaries and diminished texture features. Furthermore, obtaining landslide samples is challenging in regions with low landslide frequency. Expanding the acquisition range introduces greater variability in the optical characteristics of the samples. As a result, deep learning models often struggle to achieve accurate landslide identification in these regions. To address these challenges, we propose a multi-scale target attention YOLO model (MSTA-YOLO). First, we introduced a receptive field attention (RFA) module, which initially applies channel attention to emphasize the primary features and then simulates the human visual receptive field using convolutions of varying sizes. This design enhances the model’s feature extraction capability, particularly for complex and multi-scale features. Next, we incorporated the normalized Wasserstein distance (NWD) to refine the loss function, thereby enhancing the model’s learning capacity for detecting small-scale landslides. Finally, we streamlined the model by removing redundant structures, achieving a more efficient architecture compared to state-of-the-art YOLO models. Experimental results demonstrated that our proposed MSTA-YOLO outperformed other compared methods in landslide detection and is particularly suitable for wide-area landslide monitoring. Full article

Radiofrequency ablation (RFA) and pulsed radiofrequency (PRF) are non-pharmacological techniques employed in humans for chronic pain, but their veterinary application is unexplored. This pilot study evaluated clinical effects of RFA and PRF in twenty-four horses with chronic distal forelimb lameness. Ultrasound-guided RFA (N = 8; 60–90 °C, 2–8 min) or PRF (N = 16; 42 °C; 12 min) was applied to palmar digital nerves. Lameness was scored (American Association of Equine Practitioners scale) at baseline and monthly for six months (T1-T6). At T2, partial- and non-responders in both groups received PRF. Complications and return to previous work were recorded. At T2, the PRF group had significantly lower lameness scores (1, 0–3) than the RFA group (3, 2–4; p < 0.001) and significantly improved from baseline (3, 2–4; p < 0.01). RFA caused more complications (N = 6) than PRF (N = 1; p < 0.001), including increased lameness and allodynia. Sixteen horses (RFA: N = 7; PRF: N = 9) were retreated at T2. Overall, lameness significantly improved from T2 (2, 0–4) to T6 (0, 0–3; p < 0.001). At T6, 83% (19/23) of horses resumed previous work. RFA was ineffective and caused complications, whereas PRF appeared safer and more effective. Two PRF treatments yielded better outcomes with fewer side effects and may help manage lameness and associated pain for up to six months. Full article

Background/Objectives: Sarcopenia is defined by the progressive loss of muscle mass, strength, and/or physical performance associated with aging. Radiofrequency ablation (RFA) of the medial branch nerves is a well-established and effective treatment for lumbar facetogenic pain. While sarcopenia is associated with poor outcomes following epidural steroid injections and lumbar spine surgeries, its impact on clinical outcomes in patients undergoing RFA for facetogenic pain remains unexplored. This study aims to evaluate the influence of sarcopenia on treatment outcomes in this patient cohort. Methods: Patients were classified into sarcopenia (n = 35) and non-sarcopenia groups (n = 67) based on predefined psoas muscle index (PMI) thresholds. The primary outcomes included changes in back pain intensity and the proportion of responders at 1, 3, and 6 months following RFA. The secondary outcome was to identify demographic, clinical, and sarcopenia-related factors predictive of treatment response at each follow-up interval. Results: Both groups demonstrated statistically significant improvements in pain scores compared to baseline at all follow-up points. However, the median pain scores at 3 months post-RFA remained significantly higher in the sarcopenia group. Despite this, the proportion of responders did not differ significantly between the two groups at any time point. At 3 months, the absence of prior spinal surgery was identified as a significant predictor of treatment response. At 6 months, favorable outcomes were significantly associated with the absence of diabetes, no history of spinal surgery, and a higher PMI. Conclusions: Sarcopenia may influence the extent of pain improvement following medial branch nerve RFA. Additionally, patient-specific factors, such as diabetes, prior spinal surgery, and PMI, should be considered when predicting treatment outcomes. Full article

Lipopolysaccharide (LPS), the defining outer membrane component of Gram-negative bacteria, is a potent immunostimulant recognized by Toll-like receptor 4 (TLR4). While extensively studied for its roles in immune activation and barrier disruption, the potential function of LPS as a developmental cue remains largely unexplored. By leveraging Caenorhabditis elegans and its genetic and gnotobiotic advantages, we screened a panel of Escherichia coli LPS biosynthesis mutants. This screen revealed that the loss of outer core glycosylation in the ∆rfaG mutant causes significant developmental delay independent of bacterial metabolism. Animals exhibited developmental delay that was rescued by exogenous LPS or amino acid supplementation, implicating that LPS triggers nutrient-sensing signaling. Mechanistically, this developmental arrest was mediated by the host FOXO transcription factor DAF-16, which is the key effector of insulin/IGF-1 signaling (IIS). Our findings uncover an unprecedented role for microbial LPS as a critical regulator of host development, mediated through conserved host IIS pathways, fundamentally expanding our understanding of host–microbe crosstalk. Full article

Despite advances in surgery, chemotherapy, and radiation treatments for pancreatic ductal adenocarcinoma (PDAC), 5-year survival rates remain at nearly 11%. Cholangiocarcinoma, while not as severe, also possesses similar survival rates. Fewer than 20% of patients are surgical candidates at time of diagnosis; therefore, it is imperative that alternative therapies are effective for non-surgical patients. There are several thermal ablative techniques, including radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), microwave ablation (MWA), alcohol ablation, stereotactic body radiotherapy (SBRT), cryoablation, irreversible electroporation (IRE), biliary intraluminal brachytherapy, and biliary photodynamic therapy (PDT). Emerging literature in animal models and human patients has demonstrated that endoscopic ultrasound (EUS)-guided RFA (EUS-RFA) prevents tumor progression through coagulative necrosis, protein denaturation, and activation of anticancer immunity in local and distant tumor tissue (abscopal effect). RFA treatment has been shown to not only reduce tumor-associated immunosuppressive cells but also increase functional T cells in distant tumor cells not treated with RFA. The remarkable ability to reduce tumor progression and promote tumor microenvironment (TME) remodeling makes RFA a very promising non-surgical therapy technique that has the potential to reduce mortality in this patient population. EUS-RFA offers superior precision and safety compared to other ablation techniques for pancreatic and biliary cancers, due to real-time imaging capabilities and minimally invasive nature. Future research should focus on optimizing RFA protocols, exploring combination therapies with chemotherapy or immunotherapy, and expanding its use in patients with metastatic disease. This review article will explore the current data and underlying pathophysiology of EUS-RFA while also highlighting the role of ablative therapies as a whole in immune activation response. Full article

Background and aims: Epicardial RFA is often required when ventricular tachyarrhythmias originate from epicardial or subepicardial substrates that cannot be effectively ablated endocardially. Our objective was to evaluate the impact of intrapericardial fluid accumulation on the lesion size in the myocardium and the extent of thermal damage to adjacent structures, particularly the lung. Methods: An in silico model of epicardial RFA was developed, featuring an irrigated-tip catheter placed horizontally on the epicardium. A 50 W–30 s RF pulse was simulated. Temperature distributions and resultant thermal lesions in both the myocardium and lung were computed. Results: An increase in pericardial space from 2.5 mm to 4.5 mm resulted in a reduction of myocardial lesion depth by up to 1 mm, while the volume of lung damage decreased from 200 to 300 mm³ to nearly zero, irrespective of myocardial or epicardial fat thickness. Myocardial lesion size was markedly influenced by the thickness of the epicardial fat layer. In the absence of fat and with a narrow pericardial space, lesions reached up to 262 mm³ in volume and 6.1 mm in depth. With 1 mm of fat, lesion volume decreased to below 100 mm³ and depth to 3 mm; with 2 mm, to under 40 mm³ and 2 mm; and with 3 mm, to less than 16 mm³ and 1.2 mm. Lung damage increased moderately with greater fat thickness. Cooling the irrigation fluid from 37 °C to 5 °C reduced lung damage by up to 51%, while myocardial lesion size decreased by only 15%. Conclusions: Intrapericardial fluid accumulation can limit myocardial lesion formation while protecting adjacent structures. Cooling the irrigation fluid may reduce collateral damage without compromising myocardial lesion depth. Full article

For the airfoil in freestream, the pressure difference between the upper and lower surfaces and the variations in pressure gradients are significant at its leading edge area. Under reasonable deflections, the active leading edge can effectively change airfoil aerodynamic loads, which helps to improve the rotor aerodynamic performance. In this paper, a modeling method for an airfoil with an active leading edge was developed to calculate its aerodynamic loads. The pitch motion of the rotor blade and the leading edge deflections were taken into account. Firstly, simulations of steady and unsteady flow for the airfoil with an active leading edge were conducted under different boundary conditions and with different leading edge deflection movement. Secondly, the rational function approximation (RFA) was employed to establish the relationship between aerodynamic loads and airfoil/active leading edge deflections. Then, coefficient matrices of the RFA approach were identified based on a limited number of high-fidelity computational fluid dynamics (CFD) results. Finally, an aerodynamic model of the airfoil with an active leading edge was developed, and its accuracy was validated by comparing it to the high-fidelity CFD results. Comparative results reveal that the developed model can calculate the aerodynamic loads of an airfoil with an active leading edge accurately and efficiently when applied appropriately. The modeling method can be used in aerodynamic load calculations and the aeroelastic coupling analysis of a rotor with active control devices. Full article