Search Results (185)

High-Intensity Focused Ultrasound (HIFU) is a non-invasive technology widely used in aesthetic dermatology for skin tightening and facial rejuvenation. This study aimed to evaluate the safety and efficacy of a modified HIFU device, More Young, compared to the standard 7D HIFU system through a randomized, single-blinded clinical trial. The More Young device features enhanced focal depth precision and energy delivery algorithms, including nine pre-programmed stabilization checkpoints to minimize treatment risks. A total of 100 participants with facial wrinkles and skin laxity were randomly assigned to receive either More Young or 7D HIFU treatment. Skin improvements were assessed at baseline and one to six months post-treatment using the VISIA^® Skin Analysis System (7th Generation), focusing on eight key parameters. Patient satisfaction was evaluated through the Global Aesthetic Improvement Scale (GAIS). Data were analyzed using paired and independent t-tests, with effect sizes measured via Cohen’s d. Both groups showed significant post-treatment improvements; however, the More Young group demonstrated superior outcomes in wrinkle reduction, skin tightening, and texture enhancement, along with higher satisfaction and fewer adverse effects. No significant differences were observed in five of the eight skin parameters. Limitations include the absence of a placebo group, limited sample diversity, and short follow-up duration. Further studies are needed to validate long-term outcomes and assess performance across varied demographics and skin types. Full article

Bacteria-mediated cancer therapy represents a novel and promising strategy for targeted drug delivery to solid tumors. Multiple studies have demonstrated that various Bifidobacterium species can selectively colonize the hypoxic microenvironments characteristic of solid tumors. Leveraging this property, Bifidobacterium has been explored as a delivery vector for a range of anti-cancer approaches such as immunotherapy, nanoformulated chemotherapeutics, and gene therapy. Notably, anti-angiogenic genes such as endostatin and tumstatin have been successfully delivered to colorectal tumors using Bifidobacterium infantis and Bifidobacterium longum, respectively. Additionally, Bifidobacterium bifidum has been employed to transport doxorubicin and paclitaxel nanoparticles to breast and lung tumor sites. Furthermore, both Bifidobacterium longum and Bifidobacterium bifidum have been utilized to deliver nanoparticles that act as synergistic agents for high-intensity focused ultrasound (HIFU) therapy, significantly enhancing tumor ablation, particularly in triple-negative breast cancer (TNBC) models. While these pre-clinical findings are highly encouraging, further clinical research is essential. Specifically, studies are needed to investigate the colonization dynamics of different Bifidobacterium species across various tumor types and to evaluate their potential in delivering diverse cancer therapies in human patients. 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

(1) Background: Esthetic regenerative medicine is increasingly in demand for facial and neck rejuvenation due to its proven efficacy, safety profile, and minimal downtime. This study aimed to evaluate the role of standardized assessment tools in optimizing the outcomes of non-invasive regenerative esthetic technologies, both during the treatment course and in follow-up. (2) Methods: A literature review of the main articles published in peer-reviewed journals was conducted to identify high-quality studies addressing the use of validated esthetic scales and questionnaires (patient-reported outcomes) for evaluating the effectiveness of non-invasive regenerative treatments for the face and neck using accessible clinical tools such as photographs and 3D facial scanning. (3) Results: Clinician-reported outcomes (CROs) can be collected using standardized and reproducible photographic documentation and facial scans. The esthetic scales and classifications target both specific facial areas (e.g., upper third, perioral, periorbital) and overall skin appearance. Furthermore, advanced software allows overlay facial scan analysis and wrinkle mapping for precise quantification of improvements. In addition to objective CROs, patient-reported outcomes (PROs) offer essential insights into perceived esthetic changes, satisfaction, and emotional well-being, completing a multidimensional evaluation of treatment efficacy. (4) Conclusions: Standardized evaluation protocols based on accessible tools such as clinical photographs, 3D facial scans, and validated PRO questionnaires are essential for guiding effective, personalized regenerative treatments. Their integration into routine practice enhances clinical decision-making and patient satisfaction. While advanced tools like dermal probes may further refine assessments, they require specific expertise and resources and may be less practical for daily clinical use. Full article

Background/Objectives: Focal therapy (FT) for prostate cancer (PCa) is an alternative to radical treatments that aims to balance cancer control and quality of life preservation in well-selected patients. Understanding its general principles and outcomes is key for its widespread adoption and proper implementation. Methods: The International Consultation on Urological Diseases nominated a committee to review the literature on FT for PCa. A comprehensive PubMed search was conducted to identify articles focused on the different aspects of FT, including patient selection, imaging techniques, treatment modalities, cancer control and safety outcomes, integration with other approaches and future perspectives. Results: FT for PCa was introduced in the 1990s with cryotherapy and high-intensity focused ultrasound (HIFU) as pioneering modalities. Though initially guided by transrectal ultrasound (TRUS) and large biopsy templates, FT implementation expanded significantly with the advent of multiparametric magnetic resonance imaging (MRI) and the validation of the index lesion concept. Appropriate patient selection is key for FT and relies on prostate-specific antigen (PSA) metrics, MRI findings and targeted biopsy information. Multiple energy sources are now available, each with specific technical characteristics. Cancer control rates vary by energy modality, tumor characteristics, and institutional experience, demonstrating comparable outcomes to radical treatments in well-selected patients. The safety profile is excellent, with high rates of urinary continence and sexual function preservation. Post-treatment surveillance integrates PSA measurements, imaging, and histological assessment. Future directions for further FT adoption include the availability of long-term data, protocol standardization and technological improvements to enhance patient selection and treatment planning and delivery. Conclusions: FT is a valuable therapeutic option for selected patients with localized PCa, demonstrating promising oncological outcomes and better functional preservation compared to radical treatments. Understanding its principles and technical aspects is essential for offering comprehensive PCa care. Full article

Background/Objectives: The degree of vascularization of myomas plays an important role in both diagnosis and the selection of appropriate treatment. This is particularly relevant for minimally invasive therapies such as uterine artery embolization (UAE), high-intensity focused ultrasound (HIFU), or radiofrequency ablation (RFA) in uterine myomas, as their effectiveness is highest in well-vascularized lesions. This study aimed to analyze the perfusion of uterine myomas using dynamic contrast-enhanced magnetic resonance imaging and to develop a new quantitative classification of lesion vascularization, referencing the Funaki classification. Methods: The study included 56 female patients. Three parameters were determined for each lesion: the maximum signal enhancement (Ratio), time to peak, and mean signal intensity (Mean). A KMeans cluster analysis (k = 3) was performed, dividing the data into three groups corresponding to Funaki types I–III. Results: Significant differences were observed between the groups. Type III myomas were found only in older patients, which may be relevant when qualifying patients for vascularization-targeted therapies such as HIFU or radiofrequency ablation. Conclusions: The proposed classification may serve as a basis for automating the assessment of myomas and supporting clinical decision-making. Full article

Background/Objectives: Focal therapy (FT) and technology are closely connected. Advanced imaging allows for precise identification of the index lesion, enabling the targeted use of various thermal and non-thermal energy sources through different approaches, with specific techniques tailored to lesion location and operator expertise. This personalized approach enhances both safety and effectiveness, facilitating customized treatment planning. Methods: The International Consultation on Urological Diseases formed a committee to review the current literature on FT for prostate cancer (PCa), focusing specifically on the technique. Following in-depth discussions, the committee chose a “by lesion” approach rather than the traditional “by energy” approach to structure the review. A comprehensive PubMed search was conducted to gather relevant articles on the various energy modalities and procedural approaches used in FT for PCa. Results: Lesions in the apex, anterior, and posterior regions of the prostate can be accessed through several FT approaches, each associated with specific energy modalities and techniques. The transrectal approach utilizes high-intensity focused ultrasound (HIFU) and focal laser ablation (FLA), while the transperineal approach is compatible with energy sources such as cryotherapy, irreversible electroporation (IRE), brachytherapy, and FLA. The transurethral approach supports methods such as transurethral ultrasound ablation (TULSA). Each approach offers distinct advantages based on lesion location, treatment area, and energy modality. The choice of technique evaluated the safety and efficacy of each energy source and approach based on specific treatment areas within the prostate, highlighting the need for robust research across lesion locations and modalities, rather than focusing solely on each modality for a specific region. Conclusions: FT is rapidly advancing with new energy sources, technological improvements, and increasing operator expertise. To further optimize FT, research should prioritize evaluating the safety and effectiveness of different energy sources for various lesion locations, focusing on the treatment area rather than the energy modality itself. Full article

Background/Objectives: Adenomyosis (AM) is a hormone-dependent gynecological disorder that negatively impacts the quality of life and fertility of reproductive-age women. This study aimed to evaluate the effectiveness of herbal medicine (HM) as a post-treatment strategy following high-intensity focused ultrasound (HIFU) therapy. Methods: English, Chinese, and Korean databases were systematically searched up to 24 March 2025. Eligible randomized controlled trials (RCTs) compared HM administration after HIFU therapy with HIFU therapy alone. Statistical analyses included mean difference (MD), standardized mean difference (SMD), and risk ratio (RR) with 95% confidence intervals (CIs). Evidence quality was assessed using GRADE approach. The protocol was registered with INPLASY (No.: INPLASY202530088). Results: Fourteen RCTs involving 1259 patients were included in the review. HM administration after HIFU therapy showed superior efficacy over HIFU therapy alone in reducing uterine volume (MD = −11.84, 95% CI: −13.74 to −9.95; p < 0.00001), adenomyotic lesion volume (MD = −2.86, 95% CI: −3.29 to −2.43; p < 0.00001), serum CA125 levels (SMD = −1.49, 95% CI: −2.41 to −0.58; p < 0.00001), serum estradiol (E2) levels (SMD = −1.28, 95% CI: −1.54 to −1.03; p < 0.0001), and improvements in dysmenorrhea (MD = −0.54, 95% CI: −1.06 to −0.02; p < 0.00001) Conclusions: HM may be an effective and safe adjunct to HIFU for managing AM. However, further high-quality RCTs with long-term follow-up are needed to validate these findings. Full article

This manuscript examines the role of artificial intelligence (AI) in the diagnosis and treatment of uterine fibroids and uterine sarcomas, offering a comprehensive assessment of AI-supported diagnostic and therapeutic techniques. Through the use of radiomics, machine learning, and deep neural network models, AI shows promise in identifying benign and malignant uterine lesions, directing therapeutic decisions, and improving diagnostic accuracy. It also demonstrates significant capabilities in the timely detection of fibroids. Additionally, AI improves surgical precision, real-time structure detection, and patient outcomes by transforming surgical techniques such as myomectomy, robot-assisted laparoscopic surgery, and High-Intensity Focused Ultrasound (HIFU) ablation. By helping to forecast treatment outcomes and monitor progress during procedures like uterine fibroid embolization, AI also offers a fresh and fascinating perspective for improving the clinical management of these conditions. This review critically assesses the current literature, identifies the advantages and limitations of various AI approaches, and provides future directions for research and clinical implementation. Full article

High-intensity focused ultrasound (HIFU) is a non-invasive technology widely used for facial and body rejuvenation, skin tightening, and fat reduction. It stimulates collagen production and induces apoptosis in fat cells, offering an effective alternative to surgical procedures with minimal downtime and reduced recovery periods. As a result, HIFU has become an increasingly popular choice for patients seeking non-surgical esthetic enhancements. A comprehensive literature search was conducted using PubMed, Scopus, and SpringerLink to assess HIFU-related complications. Twenty-two studies published between 2010 and 2025 were identified, all involving female participants. The findings confirm that HIFU is generally safe and effective, with most complications being mild and transient, such as temporary erythema, swelling, and discomfort. These side effects typically resolve within a few hours to days without requiring medical intervention. However, rare but significant complications like fat atrophy, nerve irritation, and hyperpigmentation have been linked to improper device settings, inadequate practitioner expertise, and insufficient patient assessment. Ensuring proper training, adherence to standardized treatment protocols, and individualized patient evaluations can significantly minimize these risks and optimize patient outcomes. Long-term follow-up studies and further research on standardized safety protocols, optimal energy settings, and patient selection criteria are essential for enhancing the effectiveness, predictability, and safety of HIFU in esthetic medicine. Full article

Background: Echocardiography is crucial to understanding cardiac function in the Intensive Care Unit (ICU), often by measuring the left ventricular ejection fraction (LVEF). Traditionally, measures of LVEF are completed as part of a comprehensive examination by an expert sonographer or cardiologist, but front-line practitioners increasingly perform focused point-of-care estimates of LVEF while managing life-threatening illness. The two main echocardiographic windows used to grossly estimate LVEF are parasternal and apical windows. Artificial intelligence (AI) algorithms have recently been developed to assist non-experts in obtaining and interpreting point-of-care ultrasound (POCUS) echo images. We tested the feasibility, accuracy and reliability of novice users estimating LVEF using POCUS-AI echo. Methods: A total of 30 novice users (most never holding an ultrasound probe before) received 2 h of instruction, then scanned ICU patients (10 patients, 80 scans) using the Exo Iris POCUS probe with AI guidance tool. They were permitted up to 5 min to attempt parasternal long axis (PLAX) and apical 4 chamber (A4C) views. AI-reported LVEF results from these scans were compared to gold-standard LVEF obtained by an expert echo sonographer. To further assess accuracy, this sonographer also scanned another 65 patients using Exo Iris POCUS-AI vs. conventional protocol. Results: Novices obtained images sufficient to estimate LVEF in 96% of patients in <5 min. Novices obtained PLAX views significantly faster than A4C (1.5 min vs. 2.3 min). Inter-rater reliability of LVEF estimation was very high (ICC 0.88–0.94) whether images were obtained by novices or experts. In n = 65 patients, POCUS-AI LVEF was highly specific for a decreased LVEF ≤ 40% (SP = 90% for PLAX) but only moderately sensitive (SN = 56–70%). Conclusions: Estimating cardiac LVEF from AI-enhanced POCUS is highly feasible even for novices in ICU settings, particularly using the PLAX view. POCUS-AI LVEF results were highly consistent whether performed by novice or expert. When AI detected a decreased LVEF, it was highly accurate, although a normal LVEF reported by POCUS-AI was not necessarily reassuring. This POCUS-AI tool could be clinically useful to rapidly confirm a suspected low LVEF in an ICU patient. Further improvements to sensitivity for low LVEF are needed. Full article

Background: The blood–brain barrier (BBB) plays an important role in regulating homeostasis of the central nervous system (CNS), and it is an obstacle for molecules with a molecular weight higher than 500 Da seeking to reach it, making many drugs ineffective simply because they cannot be delivered to where they are needed. As a result, crossing the BBB remains the rate-limiting factor in brain drug delivery during the treatment of brain diseases, specifically tumors such as diffuse intrinsic pontine glioma (DIPG), a highly aggressive pediatric tumor with onset in the pons Varolii, the middle portion of the three contiguous parts of the brainstem, located above the medulla and below the midbrain. Methods: Currently, radiotherapy (RT) relieves DIPG symptoms but chemotherapy drugs do not lead to significant results as they do not easily cross the BBB. Focused ultrasound (FUS) and microbubbles (MBs) can temporarily open the BBB, facilitating radiotherapy and the entry of drugs into the CNS. A patient-derived xenograft DIPG model exposed to high-intensity focalized ultrasound (HIFU) or low-intensity focalized ultrasound (LIFU) combined with MBs was treated with doxorubicin, panobinostat, olaparib, ONC201 (Dordaviprone^®) and anti-PD1. Panobinostat has also been used in children with diffuse midline glioma, a broad class of brain tumors to which DIPG belongs. Results: Preliminary studies were performed using FUS to temporarily open the BBB and allow a milder use of radiotherapy and facilitate the passage of drugs through the BBB. The data collected show that after opening the BBB with FUS and MBs, drug delivery to the CNS significantly improved. Conclusions: FUS associated with MBs appears safe and feasible and represents a new strategy to increase the uptake of drugs in the CNS and therefore enhance their effectiveness. This review reports pre-clinical and clinical studies performed to demonstrate the usefulness of FUS in patients with DIPG treated with some chemotherapy. The papers reviewed were published in PubMed until the end of 2024 and were found using a combination of the following keywords: diffuse intrinsic pontine glioma (DIPG), DIPG H3K27-altered, blood–brain barrier and BBB, focused ultrasound (FUS) and radiotherapy (RT). Full article

Background: COVID-19 can cause acute pulmonary hypertension (PH), worsening outcomes in critically ill elderly patients. Point-of-care ultrasound (POCUS), assessing right ventricular hemodynamics, predicts short-term outcomes. This study examines the long-term impact of acute PH on mortality in elderly COVID-19 patients. Methods: This retrospective long-term study analyzed data from patients over 70 years old with severe COVID-19 pneumonia admitted to a mixed 25-bed, level 3 intensive care unit (ICU). POCUS focused on systolic pulmonary artery pressure (sPAP) at admission. Mortality was evaluated 1000 days post-admission. Results: The study included 130 patients, comprising 30 long-term survivors and 100 non-survivors, with a cumulative long-term mortality rate of 77%. Non-survivors had significantly higher sPAP values (39.1 ± 12.8 vs. 30.4 ± 9.2, p = 0.04), which were associated with long-term mortality in survival analysis. Conclusion: Acute pulmonary hypertension (PH), reflected by elevated systolic pulmonary artery pressure (sPAP), is strongly associated with long-term mortality in elderly critically ill COVID-19 patients. Early assessment of sPAP via POCUS may help identify high-risk patients and guide management strategies to improve outcomes. Full article

Fumarate hydratase (FH) deficiency is a rare, yet impactful metabolic disorder caused by mutations in the FH gene, affecting the Krebs cycle, leading to the accumulation of fumarate and pseudohypoxic states. This metabolic shift promotes cell signaling alterations that can drive tumorigenesis, as heterozygous germline mutations in the FH gene, resulting in hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome. FH-deficient uterine leiomyomas show peculiar histological features that may lead to misdiagnosis STUMP (smooth muscle tumor of uncertain malignant potential) and uLMS (uterine leiomyosarcoma). Definitive diagnosis involves clinical evaluation, imaging, and histopathological examination, with immunohistochemistry for FH protein being a key diagnostic tool. Management of FH-deficient leiomyomas may involve conventional treatments like surgery and hormonal therapy but also requires careful monitoring and genetic counseling for associated malignancies. High-intensity focused ultrasound (HIFU) has emerged as a promising treatment option for fibroids, although long-term efficacy remains a concern also because of its inability to obtain tissue for a pathological diagnosis. Fumarate hydratase deficiency (FHD) represents a significant challenge in gynecologic oncology due to its association with an increased risk of hereditary leiomyomatosis and renal cell carcinoma. Nevertheless, to the best of our knowledge, there is a lack of studies demonstrating the potential role of FH deficiency in increased risk of leiomyosarcomatosus transformation. Early detection, genetic screening, and personalized treatment approaches are critical for improving patient outcomes. The aim of this review is to develop a narrative overview of the implications of FHD in gynecological diseases and its correlation with cancer risk. For the first time, this review offers an overview of the necessity for studies to address the possible correlation between FH deficiency and the risk of developing leiomyosarcoma, focusing on new perspectives that can be explored in the field of better FH deficiency knowledge and cancer risk. Full article

Background: Developmental dysplasia of the hip (DDH) is a prevalent issue in infants, with ultrasound crucial for early detection. Existing automatic diagnostic models lack precision due to noise, but 3D technology may enhance it. This study aimed to create and assess a deep-learning-based model for automated DDH diagnosis by using 3D transformation technology on two-dimensional ultrasound images. Methods: A retrospective study of 417 infants at risk of DDH used ultrasound images, combining convolutional neural networks and image processing. The images were analyzed using algorithms such as HigherHRNet-W48. The approach included apex point estimation, signal heterogeneity analysis of ilium, which focused on the bony area with high intensity and evaluate ilium rotation, alpha angle creation, and the establishment of a comprehensive method for DDH diagnosis. Results: Key findings include: (1) Superior accuracy in apex point estimation by the HigherHRNet-W48 model, even better than orthopedic residents. (2) Thorough quality assessments of ultrasound images, leading to qualified and disqualified categories, with qualified images displaying notably lower error rates. (3) The AUC of the model for DDH detection in the qualifying images was 0.92, exceeding the diagnostic accuracy of the resident, indicating the diagnostic capability of the tool. Conclusions: The study developed a deep-learning-based model for DDH detection in infants, melding 3D technology with deep learning to address challenges like noise and rotation in ultrasound images. The study’s innovation demonstrated a comparative accuracy to specialized evaluations, even with non-specialist images, highlighting its potential to assist novice sonographers and enhance diagnostic precision. Full article