OBJECTIVE: Precise control over the ultrasound field parameters experienced by biological samples during sonication experiments in vitro may be quite challenging. The main goal of this work was to outline an approach to construction of sonication test cells that would minimize the interaction between the test cells and ultrasound. METHODS: Optimal dimensions of the test cell were determined through measurements conducted in a water sonication tank using 3D-printed test objects. The offset of local acoustic intensity variability inside the sonication test cell was set to value of ±50% of the reference value (i.e., local acoustic intensity measured at last axial maximum in the free-field condition). The cytotoxicity of several materials used for 3D printing was determined using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide) assay. RESULTS: The sonication test cells were 3D printed from polylactic acid material, which was not toxic to the cells. Silicone membrane HT-6240, which was used to construct the bottom of the test cell, was found to reduce ultrasound energy minimally. Final ultrasound profiles inside the sonication test cells indicated the desired variability of local acoustic intensity. The cell viability in our sonication test cell was comparable to that of commercial culture plates with bottoms constructed with silicone membrane. CONCLUSION: An approach to construction of sonication test cells minimizing the interaction of the test cell and ultrasound has been outlined.
Cíle: Cílem práce je porovnat výsledky měření objemu prostaty pomocí transrektálního ultrazvuku (TRUS) a magnetické rezonance (MR) mezi urology s různou mírou zkušeností a vlivu těchto rozdílů na PSA denzitu. Metody: Soubor obsahuje pacienty, kterým byla mezi únorem 2015 a listopadem 2018 změřena prostata před odběrem punkční biopsie. Všichni pacienti před TRUS absolvovali multiparametrickou MR prostaty na 1,5T přístroji Signa HDXT GE s endorektální cívkou. Sonografické měření bylo provedeno na přístroji Toshiba Applio 500 pomocí end fire transrektální sondy. TRUS měření prostaty prováděli tři urologové s dvaceti, sedmi a dvěma lety zkušeností v oboru. Velikost prostaty byla u TRUS i MR vypočtena z měření největších rozměrů ve třech rovinách pomocí vzorce "šířka x výška x hloubka x 0,523". Ze zjištěných velikostí prostaty byla následně dopočítána PSA denzita (PSA/velikost prostaty v ml). Výsledky: Celkově bylo hodnoceno 582 pacientů. Průměrný věk pacientů byl 62,86 let (31-91), průměrné PSA bylo 8,70ng/ml (0,53-75,00). Průměrný rozdíl velikosti mezi TRUS a MR měřením prostaty byl +8,41 ml, u vyšetřujícího s dvaceti lety praxe potom +3,66ml, u vyšetřujícího se sedmi lety praxe +11,19ml a u vyšetřujícího se dvěma lety praxe +8,12 ml. Průměrný rozdíl v PSA denzitě mezi TRUS a MR byl -0,025ng/ml/ml. Při použití hraniční hodnoty PSA denzity k indikaci biopsie 0,15ng/ml/ml a 0,20ng/ml/ml by bylo při TRUS měření bioptováno o 8 % respektive o 6 % méně pacientů než při použití MR. Závěr: Transrektální ultrasonografie v našem souboru ve srovnání s magnetickou rezonancí velikost prostaty nadhodnocovala. Tento rozdíl, promítnutý do PSA denzit by znamenal 6-8% rozdíl v indikacích biopsií prostaty na základě PSA denzity v závislosti na použité hraniční hodnotě.
Aim: The aim of this study is to compare prostate volumes and calculated PSA densities measured by transrectal ultrasound performed by urologists with different levels of experience, and prostate volumes calculated based on magnetic resonance measurements. Methods: The study comprises patients who underwent transrectal needle biopsy between February 2015 and November 2018. All of these patients underwent a multiparametric prostate MR using 1,5T Signa HDXT GE with endorectal coil beforehand. The ultrasound measurement, done using the Toshiba Applio 500 device with end‑fire endorectal probe, was performed by three urologists with two, seven and 20 years of clinical experience. Prostate volume was in all patients calculated by using the largest diameters in three perpendicular axes in the "width x height x length x 0.523 "formula. PSA density was then calculated as total PSA/prostate volume in millilitres. Results: A total of 582 were evaluated. The mean age was 62.86 years (31-91), average PSA was 8.70 ng/ml (0.53-75.00). The mean difference between TRUS and MR measurement was +8.41 ml. The difference was +3.66 ml for the examiner with twenty years of experience, +11.19 ml for the examiner with seven years of experience and +8.12 ml for the examiner with two years of experience. The average difference in PSA density between TRUS and MR was ‑0.025 ng/ml/ml. Using the PSA density cut‑off value of 0.15 ng/ml/ml and 0.20 ng/ ml/ml to indicate prostate biopsy, 8 % or 6 % less patients would have undergone prostate biopsy when using TRUS than with MR respectively. Conclusion: In this cohort, transrectal ultrasonography yielded larger prostate volume estimates than magnetic resonance imaging; subsequently 6 % or 8 % less biopsies would have been performed when using PSA density as the only criterion for prostate biopsy.
- Klíčová slova
- velikost prostaty, PSA denzita,
- MeSH
- dospělí MeSH
- klinická studie jako téma MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- prostata * diagnostické zobrazování MeSH
- prostatický specifický antigen MeSH
- senioři MeSH
- transrektální ultrazvuk o vysoké intenzitě metody MeSH
- velikost orgánu MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- práce podpořená grantem MeSH
OBJECTIVES: The aim of this double-blind, randomized, sham-controlled study was to verify the blood pressure (BP)-lowering efficacy of externally delivered focused ultrasound for renal denervation (RDN). BACKGROUND: Nonrandomized, first proof-of-concept study and experimental evidence suggested that noninvasive techniques of RDN emerged as an alternative approach of RDN to invasive technologies. METHODS: WAVE IV, an international, randomized (1 : 1) sham-controlled, double-blind prospective clinical study, was prematurely stopped. Patients were enrolled if office BP was at least 160 mmHg and 24-h ambulatory BP was at least 135 mmHg, while taking three or more antihypertensive medications. The treatment consisted of bilateral RDN using therapeutic levels of ultrasound energy and the sham consisted of bilateral application of diagnostic levels of ultrasound energy. RESULTS: In the 81 treated patients neither changes in office BP at 12 and 24 weeks, nor changes in 24-h ambulatory BP at 24-week follow-up visit differed between the two groups significantly. Of note, no safety signal was observed. Adherence analysis disclosed full adherence in 77% at baseline and 82% at 6 months' follow-up visit. Post hoc analysis revealed that stricter criteria for stabilization of BP at baseline were associated with a numerically greater change in 24-h ambulatory BP in the RDN group than in the sham group. CONCLUSION: Our data did not prove that antihypertensive efficacy of the externally delivered focused ultrasound for RDN was greater than the sham effect. Stabilization of BP at baseline was identified as an important determinant of BP changes.
- MeSH
- ablace intenzivním ultrazvukovým paprskem * MeSH
- antihypertenziva terapeutické užití MeSH
- denervace * MeSH
- dvojitá slepá metoda MeSH
- hypertenze chirurgie MeSH
- krevní tlak MeSH
- ledviny inervace MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- předčasné ukončení klinických zkoušek MeSH
- prospektivní studie MeSH
- senioři MeSH
- terapie neúspěšná MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- randomizované kontrolované studie MeSH
Důvodem k výzkumu alternativních epileptochirurgických metod jsou invazivita a vedlejší účinky zavedených postupů. V klinické epileptologii byly použity metody radiochirurgické, radiofrekvenční, laserové a ultrazvukové ablace. Článek shrnuje dosavadní literární data a v případech radiochirurgie a radiofrekvenční ablace prezentuje i vlastní zkušenosti.
The reason for introduction of novel therapies in epilepsy surgery is invasiveness and adverse effects of existing therapies. Inclinical epileptology, radiosurgical, radiofrequency, laser, and ultrasound ablations have been used. The article summarizescontemporary literary data and, in case of radiosurgery and radiofrequency ablations, personal experience with these methods.
PURPOSE: High intensity focused ultrasound (HIFU) provides a non-invasive salvage treatment option for patients with recurrence after external beam radiation therapy (EBRT). As part of EBRT the prostate is frequently implanted with permanent fiducial markers. To date, the impact of these markers on subsequent HIFU treatment is unknown. The objective of this work was to systematically investigate, using computational simulations, how these fiducial markers affect the delivery of HIFU treatment. METHODS: A series of simulations was performed modelling the propagation of ultrasound pressure waves in the prostate with a single spherical or cylindrical gold marker at different positions and orientations. For each marker configuration, a set of metrics (spatial-peak temporal-average intensity, focus shift, focal volume) was evaluated to quantify the distortion introduced at the focus. An analytical model was also developed describing the marker effect on the intensity at the focus. The model was used to examine the marker's impact in a clinical setting through case studies. RESULTS: The simulations show that the presence of the marker in the pre-focal region causes reflections which induce a decrease in the focal intensity and focal volume, and a shift of the maximum pressure point away from the transducer's focus. These effects depend on the shape and orientation of the marker and become more pronounced as its distance from the transducer's focus decreases, with the distortion introduced by the marker greatly increasing when placed within 5 mm of the focus. The analytical model approximates the marker's effect and can be used as an alternative method to the computationally intensive and time consuming simulations for quickly estimating the intensity at the focus. A retrospective review of a small patient cohort selected for focal HIFU after failed EBRT indicates that the presence of the marker may affect HIFU treatment delivery. CONCLUSIONS: The distortion introduced by the marker to the HIFU beam when positioned close to the focus may result in an undertreated region beyond the marker due to less energy arriving at the focus, and an overtreated region due to reflections. Further work is necessary to investigate whether the results presented here justify the revision of the patient selection criteria or the markers' placement protocol.
Závěrečná zpráva o řešení grantu Interní grantové agentury MZ ČR
1 svazek : ilustrace, tabulky ; 30 cm
Accurate clinical staging is crucial for the management of patients in early stages of cervical cancer. Ultrasound examination has certain advantages compared to a golden standard of magnetic resonance imaging: dynamic tests combined with functional Doppler display. Ultrasound allows for very accurate local staging and subsequent individualization of treatment. Accuracy of ultrasound is comparable to magnetic resonance imaging, ultrasound, however, requires considerable level of erudition. The proposed project is exploring whether the erudition is transferable, in which parameters and under what conditions, and it sets rules and conditions for obtaining and maintaining erudition in ultrasound of the cervix. This issue is currently widely discussed and is crucial for the introduction of ultrasound into clinical practice in oncogynecology.
Přesný klinický staging je klíčový pro management pacientek v časných stádiích karcinomu děložního hrdla. Ultrazvukové vyšetření má oproti dosud standardně využívané magnetické rezonanci výhodu dynamického vyšetření kombinovaného s funkčním dopplerovským zobrazením, umožňuje velmi přesný lokální staging s následnou individualizací léčby. Přesnost ultrazvuku je srovnatelná s magnetickou rezonancí, ultrazvukové vyšetření však vyžaduje značnou erudici vyšetřujícího. Navrhovaný projekt zkoumá, zda je tato erudice přenositelná, v jakých parametrech a za jakých podmínek, a stanovuje pravidla a podmínky pro získání a udržení erudice v ultrazvukovém vyšetření děložního hrdla. Tato problematika je v současnosti široce diskutována a je klíčová pro zavedení ultrazvuku do běžné klinické praxe v onkogynekologii.
- MeSH
- individualizovaná medicína MeSH
- karcinom diagnóza MeSH
- nádory děložního čípku diagnóza MeSH
- staging nádorů MeSH
- transrektální ultrazvuk o vysoké intenzitě MeSH
- ultrasonografie MeSH
- ženy MeSH
- Konspekt
- Gynekologie. Porodnictví
- NLK Obory
- gynekologie a porodnictví
- onkologie
- NLK Publikační typ
- závěrečné zprávy o řešení grantu IGA MZ ČR
OBJECTIVES: The aim of this study was to assess clinical safety and efficacy outcomes of renal denervation executed by an externally delivered, completely noninvasive focused therapeutic ultrasound device. BACKGROUND: Renal denervation has emerged as a potential treatment approach for resistant hypertension. METHODS: Sixty-nine subjects received renal denervation with externally delivered focused ultrasound via the Kona Medical Surround Sound System. This approach was investigated across 3 consecutive studies to optimize targeting, tracking, and dosing. In the third study, treatments were performed in a completely noninvasive way using duplex ultrasound image guidance to target the therapy. Short- and long-term safety and efficacy were evaluated through use of clinical assessments, magnetic resonance imaging scans prior to and 3 and 24 weeks after renal denervation, and, in cases in which a targeting catheter was used to facilitate targeting, fluoroscopic angiography with contrast. RESULTS: All patients tolerated renal denervation using externally delivered focused ultrasound. Office blood pressure (BP) decreased by 24.6 ± 27.6/9.0 ± 15.0 mm Hg (from baseline BP of 180.0 ± 18.5/97.7 ± 13.7 mm Hg) in 69 patients after 6 months and 23.8 ± 24.1/10.3 ± 13.1 mm Hg in 64 patients with complete 1-year follow-up. The response rate (BP decrease >10 mm Hg) was 75% after 6 months and 77% after 1 year. The most common adverse event was post-treatment back pain, which was reported in 32 of 69 patients and resolved within 72 h in most cases. No intervention-related adverse events involving motor or sensory deficits were reported. Renal function was not altered, and vascular safety was established by magnetic resonance imaging (all patients), fluoroscopic angiography (n = 48), and optical coherence tomography (n = 5). CONCLUSIONS: Using externally delivered focused ultrasound and noninvasive duplex ultrasound, image-guided targeting was associated with substantial BP reduction without any major safety signals. Further randomized, sham-controlled trials will be needed to validate this unique approach.
- MeSH
- ablace intenzivním ultrazvukovým paprskem přístrojové vybavení MeSH
- angiografie MeSH
- antihypertenziva terapeutické užití MeSH
- arteria renalis inervace MeSH
- autonomní denervace přístrojové vybavení metody MeSH
- časové faktory MeSH
- chirurgické vybavení MeSH
- design vybavení MeSH
- duplexní dopplerovská ultrasonografie MeSH
- hypertenze diagnóza patofyziologie chirurgie MeSH
- krevní tlak * účinky léků MeSH
- ledviny krevní zásobení MeSH
- léková rezistence MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Austrálie MeSH
- Evropa MeSH
- Nový Zéland MeSH
Current medicine uses a variety of high-tech devices to obtain maximum results with minimally invasive procedures. Our goal was to determine the benefits of laser medicine in tonsillectomy in comparison with traditional tonsillectomy, harmonic scalpel and radio frequency scalpel. Forty adult patients with chronic tonsillitis, scheduled for bilateral tonsillectomy, were divided into four groups in a prospective study. The left side tonsillectomy was performed using a traditional technique. The right side tonsillectomy was performed using four different methods: Ho:YAG laser, Er,Cr:YSGG laser, radiofrequency scalpel and harmonic scalpel. Peroperative bleeding and operation time were evaluated by the surgeon, development of pain during the healing period was evaluated by the patients and also histological examination of the resecates was performed. The results showed a significant increase of postoperative pain after the Ho:YAG and Er,Cr:YSGG laser procedure in comparison to traditional tonsillectomy. No significant differences in postoperative pain were found after the use of radiofrequency scalpel and harmonic scalpel. Average operation time and peroperative bleeding differed partially in all methods. In conclusion, all the tested methods offer a safe, uncomplicated alternative to traditional tonsillectomy; however, they do not bring any substantial benefit for the patient in reduction of pain during the postoperative period.
- Klíčová slova
- pulzní radiofrekvenční terapie,
- MeSH
- ablace intenzivním ultrazvukovým paprskem metody trendy využití MeSH
- dospělí MeSH
- financování organizované MeSH
- histologické techniky metody využití MeSH
- laserová terapie * metody trendy využití MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * metody přístrojové vybavení trendy MeSH
- pooperační komplikace MeSH
- prospektivní studie MeSH
- statistika jako téma MeSH
- tonzilektomie * metody trendy využití MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
