Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia.
Optimizing ethyl cellulose-ethanol delivery towards enabling ablation of cervical dysplasia.
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DOI：
10.1038/s41598-021-96223-9
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发表时间：
2021-08-19
影响因子：
4.6
通讯作者：
Ramanujam N
中科院分区：
文献类型：
--
作者：
Mueller JL;Morhard R;DeSoto M;Chelales E;Yang J;Nief C;Crouch B;Everitt J;Previs R;Katz D;Ramanujam N
在低收入国家，高达80%被诊断为宫颈发育不良的妇女没有返回接受后续护理，主要原因是无法获得治疗。在这里，我们描述了一种适合这种情况的低成本、便携式治疗方法的发展。它是基于注射乙基纤维素(EC)-乙醇来消融os周围的转化区，这是受发育不良影响最大的部位。EC是一种聚合物，当注射到组织中时，它将乙醇隔离在规定的体积内，这是由注射体积和输送参数（针规、斜角方向、插入速率、深度和输液速率）调节的。突出注射为基础的交付参数是不同的切除猪服务。用宽视场荧光成像装置或计算机断层扫描成像所得的注射分布体积。27G的针头和10mm /s的插入速度达到了理想的组织插入深度。针头斜角朝向宫颈外缘，输液量≤500µL，最大限度地减少渗漏到非靶组织。这些结果指导了定制手持式注射器的开发，该注射器用于在体内定位和消融猪宫颈上象限，没有不良事件或宿主温度或心率的变化。24 h后，检测到明显的坏死区域覆盖了大部分（> 75%）的宫颈上象限，表明四次注射可以有效地覆盖整个宫颈。本研究为后续的大型动物体内研究（如猪）提供了依据，以进一步评估ec -乙醇宫颈消融术的安全性和有效性。
In low-income countries, up to 80% of women diagnosed with cervical dysplasia do not return for follow-up care, primarily due to treatment being inaccessible. Here, we describe development of a low-cost, portable treatment suitable for such settings. It is based on injection of ethyl cellulose (EC)-ethanol to ablate the transformation zone around the os, the site most impacted by dysplasia. EC is a polymer that sequesters the ethanol within a prescribed volume when injected into tissue, and this is modulated by the injected volume and delivery parameters (needle gauge, bevel orientation, insertion rate, depth, and infusion rate). Salient injection-based delivery parameters were varied in excised swine cervices. The resulting injection distribution volume was imaged with a wide-field fluorescence imaging device or computed tomography. A 27G needle and insertion rate of 10 mm/s achieved the desired insertion depth in tissue. Orienting the needle bevel towards the outer edge of the cervix and keeping infusion volumes ≤ 500 µL minimized leakage into off-target tissue. These results guided development of a custom hand-held injector, which was used to locate and ablate the upper quadrant of a swine cervix in vivo with no adverse events or changes in host temperature or heart rate. After 24 h, a distinct region of necrosis was detected that covered a majority (> 75%) of the upper quadrant of the cervix, indicating four injections could effectively cover the full cervix. The work here informs follow up large animal in vivo studies, e.g. in swine, to further assess safety and efficacy of EC-ethanol ablation in the cervix.
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影响因子：
3.7
作者：
Casanova F;Carney PR;Sarntinoranont M
通讯作者：
Sarntinoranont M
影响因子：
4.6
作者：
Morhard R;Nief C;Barrero Castedo C;Hu F;Madonna M;Mueller JL;Dewhirst MW;Katz DF;Ramanujam N
通讯作者：
Ramanujam N
DOI：
10.1111/j.1471-0528.2006.01107.x
发表时间：
2007-01-01
影响因子：
5.8
作者：
Bruinsma, F.;Lumley, J.;Quinn, M.
通讯作者：
Quinn, M.
DOI：
10.1016/j.ijgo.2007.07.009
发表时间：
2008-01-01
影响因子：
3.8
作者：
Mariategui, J.;Santos, C.;Castle, P. E.
通讯作者：
Castle, P. E.
DOI：
10.1016/s0950-3552(05)80363-3
发表时间：
1995-03-01
期刊：
BAILLIERES CLINICAL OBSTETRICS AND GYNAECOLOGY
影响因子：
--
作者：
DUNCAN, ID
通讯作者：
DUNCAN, ID