Bin Huang

Clinical efficacy of the novel heat-balance technique in ultrasound-guided percutaneous microwave ablation for uterine fibroids: A retrospective study

To evaluate the clinical efficacy of the novel Heat-Balance Technique (HB type) in Ultrasound-Guided Percutaneous Microwave Ablation for Uterine Fibroids (PMWA). According to the inclusion and exclusion criteria, 40 patients who underwent PMWA between June 2022 and June 2024 were selected. These patients were divided into two groups based on the specific surgical technique: one using the conventional technique and the other using a novel PMWA (HB-type). Relevant clinical data of the patients were retrospectively analyzed, and all patients were followed up postoperatively to assess the clinical efficacy of the two groups. All cases achieved effective ablation. Among them, 15 cases (93.75 %) in the HB-type group and 14 cases (87.5 %) in the conventional ablation group achieved marked efficacy, with no significant statistical difference between the two groups. Both modalities significantly improved patients' clinical symptoms (p < 0.001). The HB-type group showed significantly shorter surgical duration (8 [6-12] min vs. 25 [20-30] min; p < 0.001) and fewer antenna placements (1 [1,2] vs. 5 [3,5]; p < 0.001) than the conventional group. The HB-type technique in PMWA achieves comparable ablation effects and clinical efficacy to conventional ablation methods for uterine fibroids, while offering distinct advantages: shortened surgical duration, reduced number of antenna placements, and lowered the complication rates.

One-stage Surgery for Intracardiac Leiomyomatosis

Intracardiac leiomyomatosis is a rare, histologically benign, but biologically aggressive tumor developed from uterus. This study aimed to summarize our experience with one-stage surgery for intracardiac leiomyomatosis. We retrospectively reviewed seven patients who underwent surgical treatment for intracardiac leiomyomatosis between May 2016 and November 2021. All seven patients were female, aged 35 to 57 years. All lesions in the veins and cardiac chambers were removed entirely. Four of the seven patients received tumor thrombectomy through an abdominal approach. The other three patients received median sternotomy and cardiopulmonary bypass. No perioperative deaths or serious complications occurred during the observation period. The mean operation time in the abdominal approach group was shorter than that in the cardiopulmonary bypass group (308.9 ± 93.2 minutes vs. 486.3 ± 108.6 minutes; P=0.031). Blood loss during surgery in the abdominal approach group was less than that in the cardiopulmonary bypass group (1625 ± 216 mL vs. 2500 ± 1080 mL; P=0.148). All seven patients were free from tumor recurrence or death during the follow-up. For patients with intracardiac intravenous leiomyomatosis single-stage operation through an abdominal approach under the surveillance of intraoperative transesophageal echocardiography without the need for cardiopulmonary bypass for specified patients is feasible. Patients in the abdominal approach group can benefit from a shorter operation time and less blood loss. In our small series of varied presentations and tumor extent, we have been able to avoid two-stage surgery, because even short-term interval between the two operations may result in recurrence.

Health Care Access Dimensions and Racial Disparities in End-of-Life Care Quality among Patients with Ovarian Cancer

Abstract This study investigated the association between health care access (HCA) dimensions and racial disparities in end-of-life (EOL) care quality among non-Hispanic Black (NHB), non-Hispanic White (NHW), and Hispanic patients with ovarian cancer. This retrospective cohort study used the Surveillance, Epidemiology, and End Results–linked Medicare data for women diagnosed with ovarian cancer from 2008 to 2015, ages 65 years and older. Health care affordability, accessibility, and availability measures were assessed at the census tract or regional levels, and associations between these measures and quality of EOL care were examined using multivariable-adjusted regression models, as appropriate. The final sample included 4,646 women [mean age (SD), 77.5 (7.0) years]; 87.4% NHW, 6.9% NHB, and 5.7% Hispanic. In the multivariable-adjusted models, affordability was associated with a decreased risk of intensive care unit stay [adjusted relative risk (aRR) 0.90, 95% confidence interval (CI): 0.83–0.98] and in-hospital death (aRR 0.91, 95% CI: 0.84–0.98). After adjustment for HCA dimensions, NHB patients had lower-quality EOL care compared with NHW patients, defined as: increased risk of hospitalization in the last 30 days of life (aRR 1.16, 95% CI: 1.03–1.30), no hospice care (aRR 1.23, 95% CI: 1.04–1.44), in-hospital death (aRR 1.27, 95% CI: 1.03–1.57), and higher counts of poor-quality EOL care outcomes (count ratio:1.19, 95% CI: 1.04–1.36). HCA dimensions were strong predictors of EOL care quality; however, racial disparities persisted, suggesting that additional drivers of these disparities remain to be identified. Significance: Among patients with ovarian cancer, Black patients had lower-quality EOL care, even after adjusting for three structural barriers to HCA, namely affordability, availability, and accessibility. This suggests an important need to investigate the roles of yet unexplored barriers to HCA such as accommodation and acceptability, as drivers of poor-quality EOL care among Black patients with ovarian cancer.