Radiofrequency-responsive black phosphorus nanogel crosslinked with cisplatin for precise synergy in multi-modal tumor therapies.

Radiofrequency-responsive nanoparticles (RFNPs) have drawn increasingly attentions as RF energy absorbing antenna to enhance antitumor efficacy of radiofrequency ablation (RFA). However, it remains a huge challenge for inorganic RFNPs to precisely synergize RFA with other antitumor modes in a clinically acceptable way on bio-safety and bio-compatibility. In this work, RF-responsive black phosphorus (BP) nanogel (BP-Pt@PNA) was successfully fabricated by crosslinking coordination of cisplatin with BP and temperature sensitive polymer PNA. BP-Pt@PNA exhibited strong RF-heating effect and RF-induced pulsatile release of cisplatin. Under RF irradiation, BP-Pt@PNA exhibited cytotoxic enhancement on 4T1 cells. By the synergistic effect of BP and cisplatin, BP-Pt@PNA achieved RF-stimulated systemic immune effect, thus induced enhance suppression on tumor growth and metastasis. Moreover, BP-Pt@PNA realized long-term drug retention in tumor and favorable embolization to tumor-feeding arteries. With high drug loading capacity and favorable bio-safety and bio-degradability, BP-Pt@PNA is expected as an ideal RFNP for precisely synergizing RFA with other antitumor modes in clinical application.

Orientation of birds in radiofrequency fields in the absence of the Earth's magnetic field: a possible test for the radical pair mechanism of magnetoreception.

The magnetic compass sense of migratory songbirds is thought to derive from magnetically sensitive photochemical reactions in cryptochromes located in photoreceptor cells in the birds' retinas. More specifically, transient radical pairs formed by light-activation of these proteins have been proposed to account for the birds' ability to orient themselves using the Earth's magnetic field and for the observation that radiofrequency magnetic fields, superimposed on the Earth's magnetic field, can disrupt this ability. Here, by means of spin dynamics simulations, we show that it may be possible for the birds to orient in a monochromatic radiofrequency field in the absence of the Earth's magnetic field. If such a behavioural test were successful, it would provide powerful additional evidence for a radical pair mechanism of avian magnetoreception.

A novel guided approach to radiofrequency ablation of thyroid nodules: the Toronto Sunnybrook experience.

Introduction: Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique. Methods: The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically. Results: The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules. Discussion: Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules.

Comparison of percutaneous microwave/radiofrequency ablation liver partition and portal vein embolization versus transarterial chemoembolization and portal vein embolization for planned hepatectomy with insufficient future liver remnant.

BACKGROUND: In China, both percutaneous microwave/radiofrequency ablation liver partition plus portal vein embolization (PALPP) and transarterial chemoembolization (TACE) plus portal vein embolization (PVE) have been utilized in planned hepatectomy. However, there is a lack of comparative studies on the effectiveness of these two techniques for cases with insufficient future liver remnant (FLR). METHODS: Patients were categorized into either the PALPP group or the TACE + PVE group. Clinical data, including FLR growth rate, complications, secondary resection rate, and overall survival rate, were compared and analyzed for both groups retrospectively. RESULTS: Between December 2014 and October 2021, a total of 29 patients underwent TACE + PVE (n = 12) and PALPP (n = 17). In the TACE + PVE group, 7 patients successfully underwent two-stage hepatectomy, while in the PALPP group, 13 patients underwent the procedure (two-stage resection rate: 58.3% vs. 76.5%, P = 0.42). There were no significant differences in postoperative complications of one-stage procedures (11.8% vs. 8.3%, P > 0.05) and second-stage resection complication (0% vs. 46.2%, P = 0.05) between the TACE + PVE and PALPP groups. However, the PALPP group demonstrated a shorter time to FLR volume growth for second-stage resection (18.5 days vs. 66 days, P = 0.001) and KGR (58.5 ml/week vs. 7.7 ml/week, P = 0.001). CONCLUSIONS: Compared with TACE + PVE, PALPP results in a more significant increase in FLR volume and a higher rate of two-stage resection without increasing postoperative complications.

Comparison of one-year outcomes and quality of life between radiofrequency ablation and microwave ablation in the treatment of lower extremity varicose veins: A retrospective cohort study.

OBJECTIVE: This study compared the outcomes of radiofrequency ablation (RFA) and microwave ablation (EMA) for treating lower limb varicose veins. METHODS: Patients who underwent RFA (n = 240) or EMA (n = 209) at our institute from December 2020 to August 2022 were included in this retrospective investigation. Follow-up outcomes included active vein occlusion rate, Venous Clinical Severity Score (VCSS), the Aberdeen Varicose Vein Questionnaire (AVVQ), and Chronic Insufficiency Venous Quality of Life questionnaire-14 (CIVIQ-14)score. RESULTS: There was no significant difference in the active vein occlusion rate between the two groups after the operation (p > .05). Compared to pre-surgery scores, both groups showed substantial improvement in VCSS, AVVQ, and CIVIQ-14 scores(p < .05), there was no significant difference in these scores in either group (p > .05). CONCLUSION: Intravenous radiofrequency and microwave ablation effectively improve the quality of life for patients with lower limb varicose veins, with low post-operative complication and recurrence rates.

Relationships between biatrial substrate and recurrence after radiofrequency ablation in patients with persistent atrial fibrillation.

BACKGROUND: Global longitudinal strain (GLS) and atrial voltage are acknowledged markers for worse rhythm outcome after ablation of persistent atrial fibrillation (PeAF). The majority of research efforts have been directed towards the left atrium (LA), with relatively fewer studies focusing on the right atrium (RA). The aim of this study was to investigate the effect of the biatrial substrate on the outcome following radiofrequency catheter ablation (RFCA). METHODS: All patients underwent two-dimensional speckle tracking echocardiography (2D-STE) and high-density mapping (HDM) on LA and RA in preoperative and postoperative stages of RFCA. Atrial substrate was assessed by GLS, average voltage, and low voltage zone (LVZ). RESULTS: This retrospective study enrolled 48 patients. With a follow-up of 385.98 ± 161.78 days, 22.92% (11/48) of all patients had AF recurrence and 63.64% in low strain group. Left atrial-low voltage zone (LA-LVZ) prior to RFCA was 67.52 ± 15.27% and 54.21 ± 20.07%, respectively, in the recurrence group and non-recurrence group. Multivariate regression analysis showed that preoperative LA-GLS (OR 0.047, 95%CI 0.002-0.941, p = .046) was independent predictors of AF recurrence. Biatrial average voltage in preoperative and postoperative stages were positively correlated (preoperative: r = 0.563 p < .001; postoperative: r = 0.464 p = .002). There was no significant difference in the proportion of RA in the recurrence group except the septum in preoperative and postoperative stages. CONCLUSIONS: Low LA-GLS and high LA-LVZ may be predictors of RFCA recurrence in PeAF patients. Biatrial average voltage were positively correlated in preoperative and postoperative stages.

Anatomic obstacles in cavotricuspid isthmus detected by modified 2D transthoracic echocardiography and long-term outcomes in radiofrequency ablation of typical atrial flutter.

BACKGROUND: Although radiofrequency ablation of the cavotricuspid isthmus (CTI), responsible for sustaining atrial flutter, is a highly effective procedure, in extended patients' observations following this procedure, more than every tenth becomes unsuccessful. Therefore, this study aimed to provide helpful information about the anatomy of the CTI in transthoracic echocardiography, which can aid in better planning of the CTI radiofrequency ablation in patients with typical atrial flutter. MATERIALS AND METHODS: 56 patients with typical atrial flutter after radiofrequency ablation were evaluated at the end of the 24-month observation period. With substernal modified transthoracic echocardiographic (mTTE) evaluation, we identified four main anatomical obstacles impeding radiofrequency ablation. These obstacles were tricuspid annular plane systolic excursion, cavotricuspid isthmus length, cavotricuspid isthmus morphology, and the presence of a prominent Eustachian ridge/Eustachian valve. All intraprocedural radiofrequency ablation data were collected for analysis and correlated with anatomical data. RESULTS: In the 24-month observation period, freedom from atrial flutter was 67.86%. The mean length of the isthmus was 30.34 ± 6.67 mm. The isthmus morphology in 56 patients was categorized as flat (n = 27; 48.2%), concave (n = 10; 17.85%), and pouch (n = 19, 33.9%). A prominent Eustachian ridge was observed in 23 patients (41.1%). Lack of anatomical obstacles in mTTE evaluation resulted in 100% efficacy, while the presence of at least two obstacles significantly increased the risk of unsuccessful ablation with more than two (OR 12.31 p = 0.01). Generally, 8 mm electrodes were the most effective for non-difficult CTI, while 3.5 mm electrodes used with a 3D system had highest performance for complex CTI. Notably, aging was the only factor that worsened the long-term outcome (OR 1.07 p = 0.044). CONCLUSIONS: Preoperative usage of mTTE evaluation helps predict difficulty in cavotricuspid isthmus radiofrequency ablation, thus allowing better planning of the radiofrequency ablation strategy using the most accurate radiofrequency ablation electrode.

Ten-kHz Spinal Cord Stimulation vs Radiofrequency Ablation of Splanchnic Nerves: A Single-Site Retrospective Comparison of 12-Month Outcomes.

OBJECTIVES: A prospective study on 10-kHz spinal cord stimulation (SCS) for various causes of chronic abdominal pain (CAP) showed robust improvements in subjects' pain and function. Radiofrequency ablation of splanchnic nerves (snRFA) has been used in advanced pain management treatment algorithms for CAP. This analysis was designed to provide what we believe is the first comparison of the efficacy of these two therapies. Propensity-score matched analysis (PMA) was performed to compare pain relief and decrease in medication usage in snRFA and SCS for treating refractory CAP. MATERIALS AND METHODS: Medical records were extracted for consecutive patients with CAP treated from June 2015 to June 2021 who underwent either snRFA or SCS at the Carolinas Pain Institute after positive diagnostic splanchnic block. The patients' diagnoses included gastroparesis, chronic pancreatitis, postsurgical CAP, and other dysmotility syndromes. PMA was performed to produce matched pairs in terms of baseline clinical status, reported pain, and opioid use over 12 months, after treatment was compared in the groups. RESULTS: PMA produced two well-balanced groups (n = 31) for SCS and snRFA. Analysis showed significant improvement in pain scores in both groups through 12 months, but the mean reduction in reported numerical rating scale points was significantly greater for the SCS group, averaging 4.7 vs 3.0 points for the snRFA group (p < 0.01). Responder rates (≥50% pain relief) similarly diverged at 12 months, with 67.7% vs 30.0% responders in the SCS and snRFA groups, respectively (p = 0.017). Opioid usage did not change in the snRFA group but was reduced in the SCS group at 12 months (p = 0.004). CONCLUSIONS: SCS provided longer pain relief than did snRFA in this propensity-matched study. Pain scores and opioid usage were significantly less at 12-month follow-up when SCS was used for control of CAP.

Comparison of the effectiveness of ultrasound-guided radiofrequency ablation and conventional open thyroidectomy in the treatment of benign thyroid nodules.

Objective: To compare the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) and conventional open thyroidectomy (OT) in the treatment of benign thyroid nodules (BTN). Methods: Medical records of 103 patients with BTN undergoing surgical treatment at The Affiliated Jiangning Hospital of Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Records show that 53 patients underwent US-guided RFA (observation group) and 50 patients underwent conventional OT (control group). Perioperative indicators (operation duration, intraoperative blood loss, postoperative hospital stay, incision length, and VAS score 12h and 24h after surgery), complications, thyroid function, and nodule recurrence in both groups were compared and analyzed. Results: Perioperative indicators of patients in the observation group were better, and the visual analogue scale (VAS) scores at 12 and 24 hours after the surgery were lower than those of the control group (p<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). There was no statistically significant difference in the preoperative levels of thyroid-stimulating hormone (TSH), serum free thyroxine (FT4) and serum free triiodothyronine (FT3) between the two groups (p>0.05). The postoperative TSH levels in the observation group increased compared to the preoperative levels and were higher than those in the control group, while FT4 and FT3 levels decreased after surgery and were lower than those in the control group (p<0.05). Conclusions: Compared to conventional open thyroidectomy, US-guided RFA is associated with less trauma, faster recovery, fewer complications, and less impact on thyroid function in the treatment of patients with BTN.

Radiofrequency Ablation (RFA) for Osteoid Osteoma in an 11-Year-Old Male Child With Sickle Cell Trait: A Case Report.

Osteoid osteoma is a benign bone tumor that typically presents with nocturnal pain alleviated by nonsteroidal anti-inflammatory medications. The coexistence of osteoid osteoma with sickle cell anemia, a hereditary hemoglobinopathy characterized by vaso-occlusive crises and bone infarcts, poses diagnostic and therapeutic challenges due to overlapping clinical and radiological features. This condition primarily involves the long bones of the lower extremities, particularly the femur and tibia. Despite its benign nature, osteoid osteoma can significantly impact a patient's quality of life due to persistent and intense pain, often leading to substantial sleep disturbances and functional limitations.

Numerical simulation in magnetic resonance imaging radiofrequency dosimetry.

Magnetic Resonance Imaging (MRI) employs a radiofrequency electromagnetic field to create pictures on a computer. The consequences of radiofrequency (RF) absorption include the heating of the tissue and the patient's capacity to remove excess heat. The prospective biological consequences of exposure to radiofrequency electromagnetic fields (RF EMFs) have not yet been demonstrated, and there is not enough evidence on biological hazards to offer a definite response concerning possible RF health dangers. Therefore, it is crucial to research the health concerns in reaction to RF EMFs, considering the entire exposure in terms of patients receiving MRI. Monitoring increases in temperature in-vivo throughout MRI is extremely invasive and has resulted in a rise in the utilization of computational methods to estimate distributions of temperatures. The purpose of this study is to estimate the absorbed power of the brain exposed to RF in patients undergoing brain MRI. A three-dimensional Penne's bio-heat equation was modified to computationally analyze the effects of RF radiation at frequencies exceeding 100 kHz exposures on the brain. The instantaneous temperature distributions of the in-vivo tissue in the brain temperatures measured at a time, t = 20.62 seconds is 0.2 °C and t = 30.92 seconds is 0.4 °C, while the highest temperatures recorded at 1.03 minutes and 2.06 minutes were 0.4 °C and 0.6 °C accordingly. From the temperature distributions of the in-vivo tissue in the brain temperatures measured, there is heat build-up in patients who are exposed to electromagnetic frequency ranges, and, consequently, temperature increases within patients are difficult to prevent. The study has, however, indicated that lengthier imaging duration appears to be related to increasing body temperature. .

Evaluation of radiofrequency identification tag accuracy using bronchoscopy with fluoroscopy and virtual navigation guidance before segmentectomy.

BACKGROUND: The use of sublobar resection has increased with advances in imaging technologies. However, it is difficult for thoracic surgeons to identify small lung tumours intraoperatively. Radiofrequency identification (RFID) lung-marking systems are useful for overcoming this difficulty; however, accurate placement is essential for maximum effectiveness. METHODS: We retrospectively reviewed patients who underwent RFID tag placement via fluoroscopic bronchoscopy under virtual bronchoscopic navigation (VBN) guidance before our institution's sublobar resection of lung lesions. Thirty-one patients with 31 lung lesions underwent RFID lung-marking with fluoroscopic bronchoscopy under VBN guidance. RESULTS: Of the 31 procedures, 26 tags were placed within 10 mm of the target site, 2 were placed more than 10 mm away from the target site, and 3 were placed in a different area from the target bronchus. No clinical complications were associated with RFID tag placement, such as pneumothorax or bleeding. The contribution of the RFID lung-marking system to surgery was high, particularly when the RFID tag was placed at the target site and tumour was located in the intermediate hilar zone. CONCLUSIONS: An RFID tag can be placed near the target site using fluoroscopic bronchoscopy in combination with VBN guidance. RFID tag placement under fluoroscopic bronchoscopy with VBN guidance is useful for certain segmentectomies.

Impact of Catheter Ablation of Electrical Storm on Survival: A Propensity Score-Matched Analysis.

BACKGROUND: Electrical storm (ES) is a life-threatening condition, associated with substantial early and subacute mortality. Catheter ablation (CA) is a well-established therapy for ES. However, data regarding the impact of CA on the short-term and midterm survival of patients admitted for ES remain unclear. OBJECTIVES: This multicenter study aimed to investigate the impact of CA of ES on survival outcomes, while accounting for key patient characteristics associated with treatment selection. METHODS: A propensity score-matching (PSM) analysis was performed on 780 consecutive patients admitted for ES in 4 tertiary centers. PSM (1:1) based on the main characteristics associated with the use of CA or medical therapy alone was performed, resulting in 2 groups of 288 patients. RESULTS: After PSM, patients who underwent CA (n = 288) and those treated with medical therapy alone (n = 288) did not present any significant differences in the main demographic characteristics, ES presentation, and management. Compared with medical therapy alone, CA was associated with a significantly lower rate of ES recurrence at 1 year (5% vs 26%; P < 0.001). Similarly, CA was associated with a higher 1-year (91% vs 81%; P < 0.001) and 3-year (78% vs 71%; P = 0.017) survival after discharge. In subgroup analyses, effect of ablation therapy remained consistent in patients older than 70 years of age (HR: 0.39; 95% CI: 0.24-0.66), with substantial efficacy in patients with a LVEF <35% (HR: 0.39; 95% CI: 0.27-0.59). CONCLUSIONS: In propensity-matched analyses, this large study shows that CA-based management of patients admitted for ES is associated with a reduction in mortality compared with medical treatment, particularly in patients with a low ejection fraction.

Multicenter and inter-software evaluation of ablative margins after thermal ablation of colorectal liver metastases.

PURPOSE: To assess the association between minimal ablative margin (MAM) and local tumor progression (LTP) following CT-guided thermal ablation of colorectal liver metastases (CRLM) in a multicenter cohort and across two confirmation software. MATERIALS AND METHODS: This multicenter retrospective study included patients who underwent CT-guided radiofrequency or microwave ablation for CRLM between 2009 and 2021 in three institutions. Three-dimensional (3D) MAM was retrospectively assessed using dedicated ablation confirmation software by automatic non-rigid (Ablation-fit) or semi-automatic rigid co-registration (SAFIR) of intraprocedural pre- and post-ablation contrast-enhanced CT scans by two independent reader teams blinded to patient outcomes. LTP was assessed on a per-tumor basis. Factors associated with LTP-free survival were assessed using multivariable Cox regression analysis. RESULTS: Overall, 113 patients (mean age: 67 ± 10 years; 78 men) who underwent thermal ablation for 189 CRLM (mean diameter: 1.9 ± 1.1 cm) met the inclusion criteria. 173/189 (92%) CRLM could be successfully analyzed using both software. Over a median follow-up of 31 months (IQR: 22-47), 21 of 173 CRLM (12.1%) developed LTP. On multivariable analysis, 3D MAM was independently associated with LTP in both software (Ablation-fit: HR 0.47, 95% CI: 0.36-0.61, p < 0.001; SAFIR: HR 0.42, 95% CI: 0.32-0.55, p < 0.001). No LTP was observed in CRLM ablated with MAM ≥ 4 mm (Ablation-fit) and ≥ 5 mm (SAFIR). The per-tumor median absolute difference in MAM quantification between both software was 2 mm (IQR: 1-3). CONCLUSION: MAM was independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software. Ablations achieving a MAM ≥ 5 mm were associated with local control in both software. CLINICAL RELEVANCE STATEMENT: MAMs from intraprocedural contrast-enhanced CT were independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software, with a margin ≥ 5 mm associated with local control in both software. KEY POINTS: Sufficient ablative margins are critical for local control following thermal ablation of CRLM. Intraprocedural CT-derived MAM was the only independent factor associated with LTP across two confirmation software. No LTP was observed in CRLM ablated with a MAM ≥ 5 mm.

Morphometry of left atrial appendage isthmus and mitral isthmus: implications for atrial fibrillation catheter ablation.

BACKGROUND: Radiofrequency catheter ablation (RFA) targets the left atrial appendage isthmus (LAA isthmus) and mitral isthmus for treatment of atrial fibrillation. However, proximity of left circumflex artery (LCxA) and great cardiac vein (GCV) in the isthmuses poses fatal risks during ablation. METHODS: This study investigated relationships of LCxA and GCV across three lines in the LAA and mitral isthmus, using 15 human cadaveric hearts. Distances between the vessels and the endocardium, myocardium, and perivascular fat thickness were measured. RESULTS: The results showed that LCxA was mostly consistently located in lower atrial segments and GCV was in lower/upper atrial segments, with change of course mainly observed in the middle of the LAA. The LCxA was found as close as 3-5 mm from the lower border of the LAA isthmus in 80% of specimens, at a depth of 2-3 mm within the LAA isthmus, where 1 mm consisted of myocardium and the remainder was fat, which may not provide adequate protection due to the possibility of liquefaction of fat with heat application. The effective myocardial thickness was consistently 1 mm across all cases in both isthmuses. LCxA was 2 mm in second and third sections of LAA isthmus ("careful segment"). LCxA distances from left inferior pulmonary vein opening was 5 to 12 mm, occasionally dangerously close as <1 mm in 16% of cases. CONCLUSION: This study measured LCxA and GCV in the LAA and mitral isthmus across three lines for the first time in the Indian population, aiding surgeons in RFA planning.

Radiofrequency ablation via catheter and transpapillary access in patients with cholangiocarcinoma (ACTICCA-2 trial) - a multicenter, randomized, controlled, open-label investigator-initiated trial.

BACKGROUND: Despite the recent advances in cancer treatment, the therapeutic options for patients with biliary tract cancer are still very limited and the prognosis very poor. More than 50% of newly diagnosed patients with biliary tract cancer are not amenable to curative surgical treatment and thus treated with palliative systemic treatment. Malignant bile duct obstructions in patients with perihilar and/or ductal cholangiocarcinoma (CCA) represents one of the most important challenges in the management of these patients, owning to the risk represented by developing life-threatening cholangitis which, in turn, limits the use of systemic treatment. For this reason, endoscopic stenting and/or bile duct decompression is the mainstay of treatment of these patients. Data on efficacy and safety of adding radiofrequency ablation (RFA) to biliary stenting is not conclusive. The aim of this multicenter, randomized trial is to evaluate the effect of intraductal RFA prior to bile duct stenting in patients with unresectable perihilar or ductal CCA undergoing palliative systemic therapy. METHODS/DESIGN: ACTICCA-2 is a multicenter, randomized, controlled, open-label, investigator-initiated trial. 120 patients with perihilar or ductal CCA with indication for biliary stenting and systemic therapy will be randomized 1:1 to receive either RFA plus bile duct stenting (interventional arm) or bile duct stenting alone (control arm). Patients will be stratified by trial site and tumor location (perihilar vs. ductal). Both arms receive palliative systemic treatment according to the local standard of care determined by a multidisciplinary tumorboard. The primary endpoint is time to first biliary event, which is determined by an increase of bilirubin to > 5 mg/dl and/or the occurrence of cholangitis leading to premature stent replacement and/or disruption of chemotherapy. Secondary endpoints include overall survival, safety according to NCI CTCAE v5, quality of life assessed by questionnaires (EORTC QLQ-C30 and QLQ-BIL21), clinical event rate at 6 months after RFA and total days of over-night stays in hospital. Follow-up for the primary endpoint will be 6 months, while survival assessment will be continued until end of study (maximum follow-up 30 month). All patients who are randomized and who underwent endoscopic stenting will be used for the primary endpoint analysis which will be conducted using a cause-specific Cox proportional hazards model with a frailty for trial site and fixed effects for the treatment group, tumor location, and stent material. DISCUSSION: ACTICCA-2 is a multicenter, randomized, controlled trial to assess efficacy and safety of adding biliary RFA to bile duct stenting in patients with CCA receiving palliative systemic treatment. TRIAL REGISTRATION: The study is registered with ClinicalTrials.gov (NCT06175845) and approved by the local ethics committee in Hamburg, Germany (2024-101232-BO-ff). This manuscript reflects protocol version 1 as of January 9th, 2024.

Link between Wi-Fi, cordless devices, mobile phone usage patterns, and behavioral problems among Japanese children: A prospective cohort study.

BACKGROUND: With the recent advent of technology, it is important to confirm the health and safety of the youth. This study aimed to prospectively evaluate the relationship between Wi-Fi, cordless phones, and mobile phone usage patterns and behavioral problems. METHODS: This study involved 2,465 children aged 8-17 years from the Hokkaido Study on Environment and Children's Health from October 2020 to January 2021, with a follow-up from September 2021 to March 2022. The mother-child dyad provided information on the presence of residential Wi-Fi and cordless phones, cordless phone call duration, and mobile phone usage pattern (duration of calls using mobile network and internet, online audio streaming, online video streaming, and playing online games) via a baseline questionnaire. Based on the scores on Strength and Difficulties Questionnaire at baseline and follow-up,the children were categorized into four groups: normal, persistent, improved, and concurrent. RESULTS: No significant association was found between Wi-Fi, mobile phone calls via mobile networks, and behavioral problems. Cordless phone at home had higher odds for improvement in total difficulty scores, and cordless phone for calling more than 4 minutes per week had lower odds of persistent problematic prosocial behavior. Longer duration of mobile phone calling via the internet (>40 min/week) had higher odds of concurrent total difficulties. Mobile phone calling via mobile network for <5 minutes per week had higher odds for improved total difficulty scores. Audio streaming via mobile phones for 60-120 minutes had lower odds of persistent total difficulties. CONCLUSION: Our results showed sporadic findings between residential RF-EMF indoor sources and mobile phone usage pattern. These observed findings could be affected by residual confounding and chance findings. Ongoing follow-up studies are necessary to further explore this association through detailed exposure assessment and addressing the potential limitations of our study.

Interventional Strategies for Alleviating Severe Abdominal Pain in Chronic Pancreatitis and Abdominal Cancer: A Case Report on the Use of Splanchnic Nerve Radiofrequency Ablation and Erector Spinae Plane Block.

A cancer diagnosis marks the beginning of a difficult path filled with a profound battle against the excruciating pain associated with the illness. Cancer-related pain, which is complex and emotionally distressing, presents unique challenges in terms of treatment. Abdominal cancers and metastases frequently result in severe and unmanageable pain that does not respond well to traditional medications. In such situations, interventions like neurolysis and radiofrequency ablation of the splanchnic nerves and celiac plexus have emerged as effective strategies, providing enhanced pain relief and reducing the need for narcotic painkillers. In this case report, we describe a case of a 38-year-old man with a longstanding history of chronic pancreatitis with a polypoid growth close to the ampulla in the duodenal bulb. The patient was given pain medications to alleviate the pain, but the severe stomach pain, vomiting, and fever persisted. Imaging tests supported the diagnosis and showed chronic pancreatitis, a continuing inflammatory process, and a periampullary adenocarcinoma. The patient had significant pain while being positioned prone for the diagnostic block, hence an erector spinae plane block was done before the radiofrequency ablation. The patient received radiofrequency ablation at the T11 and T12 levels after receiving a diagnostic splanchnic nerve block, significantly reducing pain. The effectiveness of these interventional procedures in enhancing the patient's quality of life and decreasing their dependence on narcotic drugs was highlighted by follow-up visits at two, four, and six months that revealed little to no discomfort. This instance emphasizes the importance of considering neurolysis and radiofrequency ablation as essential alternatives for treating severe abdominal pain brought on by chronic pancreatitis and abdominal cancer.

Nano-Pulse Stimulation Therapy in Oncology.

Background: Nano-Pulse Stimulation (NPS) therapy applies electric pulses in the nanosecond domain to initiate regulated cell death in the treated tissues. This nonthermal therapy has been used to treat a wide range of murine tumors and has been shown to activate the immune system to inhibit the growth of rechallenge tumors, as well as untreated, abscopal tumors when accompanied by the injection of immune system stimulants into the treated tumors. Clinical trials have begun using NPS to treat basal cell carcinoma and hepatocellular carcinoma. Methods: Murine tumors can be easily imaged when the tumor cells are injected intradermally so that they grow within the mouse skin. Pulling the skin over a translucent light post shines light through the skin and makes it easy to treat the tumor and identify the treatment zone. Results: Original research using murine tumor models is described, including melanoma, squamous cell carcinoma, lung carcinoma, breast carcinoma, and pancreatic carcinoma. The energy required to ablate these tumors has been determined with pancreatic carcinoma and lung carcinoma exhibiting 90% ablation with 240 mJ/mm3, lung carcinoma and squamous cell carcinoma requiring 360 mJ/mm3, and melanoma requiring 480 mJ/mm3. NPS therapy initiated a variable immune response indicated by the rejection of injected rechallenge tumor cells with melanoma and hepatocellular carcinoma exhibiting the strongest response and lung carcinoma, the weakest response. Following the original research data, a review of human clinical trials using NPS therapy is presented. Conclusions: NPS therapy offers a nonthermal, drug-free approach for oncology, which is limited only by applying energy to the tumor. This new immunogenic modality is just beginning to be applied in the clinic. The 87% efficacy of the first large clinical trial conducted by several medical personnel is impressive and indicates that NPS is an effective new modality for cancer treatment.