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Irreversible electroporation

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in general usually use local recurrences and functional outcome (quality of life) as endpoint. In that regard, the clinical results collected so far and listed in Table 3 shown encouraging results and uniformly state IRE as a safe and effective treatment (at least for focal ablation) but all warrant further studies. The largest cohort presented by Guenther et al. with up to 6-year follow-up is limited as a heterogeneous retrospective analysis and no prospective clinical trial. Therefore, despite that several hospitals in Europe have been employing the method for many years with one private clinic even listing more than one thousand treatments as of June 2020, IRE for prostate cancer is currently not recommended in treatment guidelines.
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there were still islands of viable tumor cells within ablated regions. This suggests that tumor tissue may respond differently to IRE than healthy parenchyma. The mechanism of cell death following IRE relies on cellular apoptosis, which results from pore formation in the cellular membrane. Tumor cells, known to be resistant to apoptotic pathways, may require higher thresholds of energy to be adequately treated. However, the recurrence rated found in clinical studies suggest a rather low recurrence rate and often superior overall survival when compared with other ablation modalities.
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ducts were all preserved. As IRE targets the bilipid membranes of cells, structures mainly consisting of proteins like vascular elastic and collagenous structures, as well as peri-cellular matrix proteins are not affected by the currents. Vital and scaffolding structures (like large blood vessels, urethra or intrahepatic bile ducts) are conserved. The electrically insulating myelin layer, surrounding nerve fibers, protects nerve bundles from the IRE effects to a certain degree. Up to what point nerves stay unaffected or can regenerate is not completely understood.
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trial was stopped prematurely. Complications included pneumothoraces (11 of 23 patients), alveolar hemorrhage not resulting in significant hemoptysis, and needle tract seeding was found in 3 cases (13%). Disease progression was seen in 14 of 23 patients (61%). Stable disease was found in 1 (4%), partial remission in 1 (4%) and complete remission in 7 (30%) patients. The authors concluded that IRE is not effective for the treatment of lung malignancies. Similarly poor treatment outcomes have been observed in other studies.
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needles are then connected to the IRE-generator, which then proceeds to sequentially build up a potential difference between two electrodes. The geometry of the IRE-treatment field is calculated in real time and can be influenced by the user. Depending on the treatment-field and number of electrodes used, the ablation takes between 1 and 10 minutes. In general muscle relaxants are administered, since even under general anesthetics, strong muscle contractions are induced by excitation of the motor end-plate.
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importance. The first generation of IRE for clinical use, in the form of the NanoKnife System, became commercially available for research purposes in 2009, solely for the surgical ablation of soft tissue tumors. Cancerous tissue ablation via IRE appears to show significant cancer specific immunological responses which are currently being evaluated alone and in combination with
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using this device. The Nanoknife system transmits a low-energy direct current from a generator to electrode probes placed in the target tissues for the surgical ablation of soft tissue. In 2011, AngioDynamics received an FDA warning letter for promoting the device for indications for which it had not received approval.
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treatment with FOLFIRINOX (a combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) (median OS, 12–14months). However, IRE appears to be more effective in conjunction with systemic therapy and is not suggested as first-line treatment. Despite that IRE makes adjuvant tumor mass reduction therapy for
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often limited by accessibility and precision. Surgery is also associated with a long healing time and high rate of side effects. Using IRE, the urethra, bladder, rectum and neurovascular bundle and lower urinary sphincter can potentially be included in the treatment field without creating (permanent) damage.
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Whilst there are no studies comparing IRE to other ablative therapies yet, thermal ablations have shown a higher efficacy in that matter with around 96% progression free survival. Therefor Bart et al. concluded that IRE should currently only be performed for only truly unresectable and non-ablatable tumors.
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Later phase 2 prospective trials showed good results in terms of safety and feasibility for small renal masses but the cohort was limited in numbers (7 and 10 patients respectively), hence efficacy is not yet sufficiently determined. IRE appears safe for small renal masses up to 4 cm. However,
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are notoriously hard to assess for prostate cancer, as the trials require more than a decade and usually several treatment types are performed during the years making treatment-specific survival advantages difficult to quantify. Therefore, the results of ablation-based treatments and focal treatments
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Local environment - The electric fields of IRE are strongly influenced by the conductivity of the local environment. The presence of metal, for example with biliary stents, can result in variances in energy deposition. Various organs, such as the kidneys, are also subject to irregular ablation zones,
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In a prospective, single-arm, multi-center, phase II clinical trial, the safety and efficacy of IRE on lung cancers were evaluated. The trial included patients with primary and secondary lung malignancies and preserved lung function. The expected effectiveness was not met at interim analysis and the
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Sharp ablation zone margins- The transition zone between reversible electroporated area and irreversible electroporated area is accepted to be only a few cell layers. Whereas, the transition areas as in radiation or thermal based ablation techniques are non-existent. Further, the absence of the heat
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When an electrical field of more than 0.5 V/nm is applied to the resting trans-membrane potential, it is proposed that water enters the cell during this dielectric breakdown. Hydrophilic pores are formed. A molecular dynamics simulation by Tarek illustrates this proposed pore formation in two steps:
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It should be stated that even though the ablation method is generally accepted to be apoptosis, some findings seem to contradict a pure apoptotic cell death, making the exact process by which IRE causes cell death unclear. In any case, all studies agree that the cell death is an induced one with the
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First observations of IRE effects go back to 1754. Nollet reported the first systematic observations of the appearance of red spots on animal and human skin that was exposed to electric sparks. However, its use for modern medicine began in 1982 with the seminal work of Neumann and colleagues. Pulsed
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Incomplete ablation within targeted tumors - The originally threshold for IRE of cells was approximately 600 V/cm with 8 pulses, a pulse duration of 100 μs, and a frequency of 10 Hz. Qin et al. later discovered that even at 1,300 V/cm with 99 pulses, a pulse duration of 100 μs, and 10 Hz,
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It is proposed that as the applied electrical field increases, the greater is the perturbation of the phospholipid head groups, which in turn increases the number of water filled pores. This entire process can occur within a few nanoseconds. Average sizes of nanopores are likely cell-type specific.
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One specific device for the IRE procedure is the NanoKnife system manufactured by AngioDynamics, which received FDA 510k clearance on October 24, 2011. The NanoKnife system has also received an Investigational Device Exemption (IDE) from the FDA that allows AngioDynamics to conduct clinical trials
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A number of electrodes, in the form of long needles, are placed around the target volume. The point of penetration for the electrodes is chosen according to anatomical conditions. Imaging is essential to the placement and can be achieved by ultrasound, magnetic resonance imaging or tomography. The
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While nephron-sparing surgery is the gold standard treatment for small, malignant renal masses, ablative therapies are considered a viable option in patients who are poor surgical candidates. Radiofrequency ablation (RFA) and cryoablation have been used since the 1990s; however, in lesions larger
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The concept of treating prostate cancer with IRE was first proposed by Gary Onik and Boris Rubinsky in 2007. Prostate carcinomas are frequently located near sensitive structures which might be permanently damaged by thermal treatments or radiation therapy. The applicability of surgical methods is
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Hepatic IRE appears to be safe, even when performed near vessels and bile ducts with an overall complication rate of 16%, with most complications being needle related (pneumothorax and hemorrhage).The COLDFIRE-2 trial with 50 patients showed 76% local tumor progression-free survival after 1 year.
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Absence of thermally induced necrosis - The short pulse lengths relative to the time between the pulses prevents joule heating of the tissue. Hence, by design, no necrotic cell damage is to be expected (except possibly in very close proximity to the needle). Therefore, IRE has none of the typical
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Irreversible electroporation (IRE): After a certain degree of damage to the cell membranes by electroporation, the leakage of intracellular contents is too severe or the resealing of the cellular membrane is too slow, leaving healthy and/or cancerous cells irreversibly damaged. They die by either
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Tissue selectivity - conservation of vital structures within the treatment field. Its capability of preserving vital structures within the IRE-ablated zone. In all IRE ablated liver tissues, critical structures, such as the hepatic arteries, hepatic veins, portal veins and intrahepatic bile
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The first human studies have proven the safety of IRE for the ablation of renal masses; however, the effectiveness of IRE through histopathological examination of an ablated renal tumor in humans is yet to be known. Wagstaff et al. have set out to investigate the safety and effectiveness of IRE
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A secondary described mode of cell death was described to be from a breakdown of the membrane due to transmembrane transfer of electrolytes and adenosine triphosphate. Other effects like heat or electrolysis were also shown to play a role in the currently clinically applied IRE pulse protocols.
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induced by either membrane disruption or secondary breakdown of the membrane due to transmembrane transfer of electrolytes and adenosine triphosphate. The main use of IRE lies in tumor ablation in regions where precision and conservation of the extracellular matrix, blood flow and nerves are of
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Animal studies have shown the safety and efficacy of IRE on pancreatic tissue. The overall survival rates in studies on the use of IRE for pancreatic cancer provide an encouraging nonvariable endpoint and show an additive beneficial effect of IRE compared with standard-of care chemotherapeutic
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A major obstacle of IRE in the lung is the difficulty in positioning the electrodes; placing the probes in parallel alignment is made challenging by the interposition of ribs. Additionally, the planned and actual ablation zones in the lung are dramatically different due to the differences in
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IRE has been in use against prostate cancer since 2011, partly in form of clinical trials, compassionate care or individualized treatment approach. As for all other ablation technologies and also most conventional methods, no studies employed a randomized multi-center approach or targeted
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Reversible electroporation (RE): Temporary and limited pathways for molecular transport via nanopores are formed, but after the end of the electric pulse, the transport ceases and the cells remain viable. Medical applications are, for example, local introduction of intracellular cytotoxic
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ablation of renal masses and to evaluate the efficacy of ablation using MRI and contrast-enhanced ultrasound imaging. In accordance with the prospective protocol designed by the authors, the treated patients will subsequently undergo radical nephrectomy to assess IRE ablation success.
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electric fields were used to temporarily permeabilize cell membranes to deliver foreign DNA into cells. In the following decade, the combination of high-voltage pulsed electric fields with the chemotherapeutic drug bleomycin and with DNA yielded novel clinical applications:
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Wendler JJ, Pech M, Köllermann J, Friebe B, Siedentopf S, Blaschke S, et al. (March 2018). "Upper-Urinary-Tract Effects After Irreversible Electroporation (IRE) of Human Localised Renal-Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Ablate-and-Resect Study".
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delivers trains of high-voltage ultra-rapid electrical pulses that form irreversible pores in cell membranes, resulting in cell death. It is thought to allow better selectivity than the previous techniques, which used heat or cold to kill larger volumes of muscle.
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Vogel JA, Rombouts SJ, de Rooij T, van Delden OM, Dijkgraaf MG, van Gulik TM, et al. (September 2017). "Induction Chemotherapy Followed by Resection or Irreversible Electroporation in Locally Advanced Pancreatic Cancer (IMPALA): A Prospective Cohort Study".
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Geboers B, Scheffer HJ, Graybill PM, Ruarus AH, Nieuwenhuizen S, Puijk RS, et al. (May 2020). "High-Voltage Electrical Pulses in Oncology: Irreversible Electroporation, Electrochemotherapy, Gene Electrotransfer, Electrofusion, and Electroimmunotherapy".
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Hosein PJ, Echenique A, Loaiza-Bonilla A, Froud T, Barbery K, Rocha Lima CM, et al. (August 2014). "Percutaneous irreversible electroporation for the treatment of colorectal cancer liver metastases with a proposal for a new response evaluation system".
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Belfiore G, Belfiore MP, Reginelli A, Capasso R, Romano F, Ianniello GP, et al. (March 2017). "Concurrent chemotherapy alone versus irreversible electroporation followed by chemotherapy on survival in patients with locally advanced pancreatic cancer".
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The shortly pulsed, strong electrical fields are induced through thin, sterile, disposable electrodes. The potential differences are calculated and applied by a computer system between these electrodes in accordance to a previously planned treatment field.
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Niessen C, Igl J, Pregler B, Beyer L, Noeva E, Dollinger M, et al. (May 2015). "Factors associated with short-term local recurrence of liver cancer after percutaneous ablation using irreversible electroporation: a prospective single-center study".
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Maor et el have demonstrated the safety and efficiency of IRE as an ablation modality for smooth muscle cells in the walls of large vessels in rat model. Therefore, IRE has been suggested as preventive treatment for coronary artery re-stenosis after
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Siddiqui IA, Kirks RC, Latouche EL, DeWitt MR, Swet JH, Baker EH, et al. (June 2017). "High-Frequency Irreversible Electroporation: Safety and Efficacy of Next-Generation Irreversible Electroporation Adjacent to Critical Hepatic Structures".
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Frühling P, Nilsson A, Duraj F, Haglund U, Norén A (April 2017). "Single-center nonrandomized clinical trial to assess the safety and efficacy of irreversible electroporation (IRE) ablation of liver tumors in humans: Short to mid-term results".
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Flak RV, Stender MT, Jensen TM, Andersen KL, Henriksen SD, Mortensen PB, et al. (February 2019). "Treatment of locally advanced pancreatic cancer with irreversible electroporation - a Danish single center study of safety and feasibility".
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Ricke J, Jürgens JH, Deschamps F, Tselikas L, Uhde K, Kosiek O, De Baere T (April 2015). "Irreversible electroporation (IRE) fails to demonstrate efficacy in a prospective multicenter phase II trial on lung malignancies: the ALICE trial".
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Current evidence on the safety and efficacy of irreversible electroporation for treating primary lung cancer and metastases in the lung is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of
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Paiella S, Butturini G, Frigerio I, Salvia R, Armatura G, Bacchion M, et al. (2015). "Safety and feasibility of Irreversible Electroporation (IRE) in patients with locally advanced pancreatic cancer: results of a prospective study".
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Niessen C, Beyer LP, Pregler B, Dollinger M, Trabold B, Schlitt HJ, et al. (April 2016). "Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients".
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van den Bos W, Jurhill RR, de Bruin DM, Savci-Heijink CD, Postema AW, Wagstaff PG, et al. (August 2016). "Histopathological Outcomes after Irreversible Electroporation for Prostate Cancer: Results of an Ablate and Resect Study".
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Newer generations of Electroporation-based ablation systems are being developed specifically to address the shortcomings of the first generation of IRE but, as of June 2020, none of the technologies are available as a medical device.
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In 2013, the UK National Institute for Health and Clinical Excellence issued a guidance that the safety and efficacy of the use of irreversible electroporation of the treatment of various types of cancer has not yet been established.
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sink effect, which is a cause of many problems and treatment failures, is advantageous and increases the predictability of the treatment field. Geometrically, rather complex treatment fields are enabled by the multi-electrode concept.
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Narayanan G, Hosein PJ, Beulaygue IC, Froud T, Scheffer HJ, Venkat SR, et al. (March 2017). "Percutaneous Image-Guided Irreversible Electroporation for the Treatment of Unresectable, Locally Advanced Pancreatic Adenocarcinoma".
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Martin RC, Kwon D, Chalikonda S, Sellers M, Kotz E, Scoggins C, et al. (September 2015). "Treatment of 200 locally advanced (stage III) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy".
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Scheffer HJ, Nielsen K, van Tilborg AA, Vieveen JM, Bouwman RA, Kazemier G, et al. (October 2014). "Ablation of colorectal liver metastases by irreversible electroporation: results of the COLDFIRE-I ablate-and-resect study".
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Short treatment time - A typical treatment takes less than 5 minutes. This does not include the possibly complicated electrode placement which might require the use of many electrode and re-position of the electrodes during the
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Potential organ systems, where IRE might have a significant impact due to its properties include the pancreas, liver, prostate and the kidneys, which were the main focus of the studies listed in Table 1-3 (state: June 2020).
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These water channels continue to grow in length and diameter and expand into water-filled pores, at which point they are stabilized by the lipid head groups that move from the membrane-water interface to the middle of the
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Buijs M, Zondervan PJ, de Bruin DM, van Lienden KP, Bex A, van Delden OM (March 2019). "Feasibility and safety of irreversible electroporation (IRE) in patients with small renal masses: Results of a prospective study".
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Månsson C, Brahmstaedt R, Nilsson A, Nygren P, Karlson BM (September 2016). "Percutaneous irreversible electroporation for treatment of locally advanced pancreatic cancer following chemotherapy or radiochemotherapy".
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Zhang Y, Shi J, Zeng J, Alnagger M, Zhou L, Fang G, et al. (February 2017). "Percutaneous Irreversible Electroporation for Ablation of Locally Advanced Pancreatic Cancer: Experience From a Chinese Institution".
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Deodhar A, Monette S, Single GW, Hamilton WC, Thornton RH, Sofocleous CT, Maybody M, Solomon SB (December 2011). "Percutaneous irreversible electroporation lung ablation: preliminary results in a porcine model".
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Tabaja, Chadi; Younis, Arwa; Hussein, Ayman A.; Taigen, Tyler L.; Nakagawa, Hiroshi; Saliba, Walid I.; Sroubek, Jakub; Santangeli, Pasquale; Wazni, Oussama M. (September 2023). "Catheter-Based Electroporation".
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Strong muscle contractions - The strong electric fields created by IRE, due to direct stimulation of the neuromuscular junction, cause strong muscle contractions requiring special anesthesia and total body
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Kluger MD, Epelboym I, Schrope BA, Mahendraraj K, Hecht EM, Susman J, et al. (May 2016). "Single-Institution Experience with Irreversible Electroporation for T4 Pancreatic Cancer: First 50 Patients".
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Lee EW, Wong D, Prikhodko SV, Perez A, Tran C, Loh CT, Kee ST (January 2012). "Electron microscopic demonstration and evaluation of irreversible electroporation-induced nanopores on hepatocyte membranes".
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than 3 cm, their efficacy is limited. The newer ablation modalities, such as IRE, microwave ablation (MWA), and high-intensity focused ultrasound, may help overcome the challenges in tumor size.
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Utilizing ultra short pulsed but very strong electrical fields, micropores and nanopores are induced in the phospholipid bilayers which form the outer cell membranes. Two kinds of damage can occur:
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Thomson KR, Cheung W, Ellis SJ, Federman D, Kavnoudias H, Loader-Oliver D, Roberts S, Evans P, Ball C, Haydon A (May 2011). "Investigation of the safety of irreversible electroporation in humans".
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Pandit H, Hong YK, Li Y, Rostas J, Pulliam Z, Li SP, Martin RC (March 2019). "Evaluating the Regulatory Immunomodulation Effect of Irreversible Electroporation (IRE) in Pancreatic Adenocarcinoma".
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Kingham TP, Karkar AM, D'Angelica MI, Allen PJ, Dematteo RP, Getrajdman GI, et al. (September 2012). "Ablation of perivascular hepatic malignant tumors with irreversible electroporation".
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Blazevski A, Amin A, Scheltema MJ, Balakrishnan A, Haynes AM, Barreto D, et al. (April 2021). "Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE)".
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cells dying over a varying time period of hours to days and does not rely on local extreme heating and melting of tissue via high energy deposition like most ablation technologies (see
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Garcia PA, Rossmeisl JH, Neal RE, Ellis TL, Olson JD, Henao-Guerrero N, Robertson J, Davalos RV (July 2010). "Intracranial nonthermal irreversible electroporation: in vivo analysis".
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None of the potential organ systems, which may be treated for various conditions and tumors, are covered by randomized multicenter trials or long-term follow-ups (state. June 2020).
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Real time monitoring - The treatment volume can be to a certain degree be visualized, both during and after the treatment. Possible visualization methods are ultrasound, MRI, and CT.
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Silk MT, Wimmer T, Lee KS, Srimathveeravalli G, Brown KT, Kingham PT, et al. (January 2014). "Percutaneous ablation of peribiliary tumors with irreversible electroporation".
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Thomson KR, Cheung W, Ellis SJ, Federman D, Kavnoudias H, Loader-Oliver D, et al. (May 2011). "Investigation of the safety of irreversible electroporation in humans".
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Immunological response - IRE appears to provoke a stronger immunological response than other ablation methods which is currently being studied for use in conjunction with
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Orlowski S, Belehradek J, Paoletti C, Mir LM (December 1988). "Transient electropermeabilization of cells in culture. Increase of the cytotoxicity of anticancer drugs".
6443:"Non-thermal irreversible electroporation (N-TIRE) and adjuvant fractionated radiotherapeutic multimodal therapy for intracranial malignant glioma in a canine patient" 3773:"Irreversible electroporation of hepatocellular carcinoma and colorectal cancer liver metastases: A nationwide multicenter study with short- and long-term follow-up" 4899:"Percutaneous Irreversible Electroporation in Locally Advanced and Recurrent Pancreatic Cancer (PANFIRE-2): A Multicenter, Prospective, Single-Arm, Phase II Study" 2179:"Irreversible electroporation of locally advanced pancreatic cancer transiently alleviates immune suppression and creates a window for antitumor T cell activation" 1885:"High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity" 6727:
Fini M, Tschon M, Alberghini M, Bianchi G, Mercuri M, Campanacci L, et al. (2011). "Cell electroporation in bone tissue.". In Lee E, Kee S, Gehl J (eds.).
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Srimathveeravalli G, Wimmer T, Silk M, et al. (2013). "Treatment planning considerations for IRE in the lung: placement of needle electrodes is critical".
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Shahrouki P, Lee EW (October 2021). "Irreversible Electroporation: A Novel Treatment Modality in Locally Advanced and Unresectable Pancreatic Adenocarcinoma".
4595:"Treatment of locally advanced pancreatic cancer by percutaneous and intraoperative irreversible electroporation: general hospital cancer center experience" 3118:
Neal RE, Davalos RV (December 2009). "The feasibility of irreversible electroporation for the treatment of breast cancer and other heterogeneous systems".
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Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B (July 2006). "In vivo results of a new focal tissue ablation technique: irreversible electroporation".
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Numerous studies in animals have demonstrated the safety and efficiency of IRE as a non-thermal ablation modality for pulmonary veins in the context of
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After the application of an electrical field, water molecules line up in single file and penetrate the hydrophobic center of the bilayer lipid membrane.
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Lavee J, Onik G, Mikus P, Rubinsky B (2007). "A novel nonthermal energy source for surgical epicardial atrial ablation: irreversible electroporation".
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Meijerink MR, Scheffer HJ, de Bree R, Sedee RJ (August 2015). "Percutaneous Irreversible Electroporation for Recurrent Thyroid Cancer--A Case Report".
4973:"Irreversible Electroporation for Nonthermal Tumor Ablation in Patients with Locally Advanced Pancreatic Cancer: Initial Clinical Experience in Japan" 71:
to create permanent and hence lethal nanopores in the cell membrane, to disrupt cellular homeostasis. The resulting cell death results from induced
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Wong D, Lee EW, Kee ST (2011). "Translational research on irreversible electroporation: VX2 rabbit head and neck.". In Lee E, Kee S, Gehl J (eds.).
5204:"Systematic Review of Resection Rates and Clinical Outcomes After FOLFIRINOX-Based Treatment in Patients with Locally Advanced Pancreatic Cancer" 3828:"Evaluation of tolerability and efficacy of irreversible electroporation (IRE) in treatment of Child-Pugh B (7/8) hepatocellular carcinoma (HCC)" 5159:
Lee EW, Shahrouki P, Peterson S, Tafti BA, Ding PX, Kee ST (October 2021). "Safety of Irreversible Electroporation Ablation of the Pancreas".
6850: 6761: 6736: 5360: 4205:"Irreversible electroporation ablation (IRE) of unresectable soft tissue tumors: learning curve evaluation in the first 150 patients treated" 3703: 3306:
Qin Z, Jiang J, Long G, Lindgren B, Bischof JC (March 2013). "Irreversible electroporation: an in vivo study with dorsal skin fold chamber".
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Successful ablations in animal tumor models have been conducted for lung, brain, heart, skin, bone, head and neck cancer, and blood vessels.
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Onik G, Rubinsky B (2010). "Irreversible Electroporation: First Patient Experience Focal Therapy of Prostate Cancer". In Rubinsky B (ed.).
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Klein N, Mercadal B, Stehling M, Ivorra A (June 2020). "In vitro study on the mechanisms of action of electrolytic electroporation (E2)".
4940:"Ablation of locally advanced pancreatic carcinoma by percutaneous irreversible electroporation: Results of the phase I/II PANFIRE-study" 4031:
Narayanan G, Bhatia S, Echenique A, Suthar R, Barbery K, Yrizarry J (December 2014). "Vessel patency post irreversible electroporation".
5814:"The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol" 4412:"Colorectal liver metastatic disease: efficacy of irreversible electroporation--a single-arm phase II clinical trial (COLDFIRE-2 trial)" 101:, respectively. The use of irreversible electroporation for therapeutic applications was first suggested by Davalos, Mir, and Rubinsky. 2379:
Daud AI, DeConti RC, Andrews S, Urbas P, Riker AI, Sondak VK, Munster PN, Sullivan DM, Ugen KE, Messina JL, Heller R (December 2008).
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Garcia PA, Pancotto T, Rossmeisl JH, Henao-Guerrero N, Gustafson NR, Daniel GB, Robertson JL, Ellis TL, Davalos RV (February 2011).
138: 4343:"Irreversible electroporation (Nanoknife® treatment) in the field of hepatobiliary surgery: Current status and future perspectives" 2317:
Okino M, Mohri H (December 1987). "Effects of a high-voltage electrical impulse and an anticancer drug on in vivo growing tumors".
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possible, IRE remains, in its current state, a high risk procedure requiring additional safety data before it can be used widely.
5525:"Initial assessment of safety and clinical feasibility of irreversible electroporation in the focal treatment of prostate cancer" 2138:"Irreversible Electroporation versus Radiofrequency Ablation: A Comparison of Local and Systemic Effects in a Small-Animal Model" 4148:"Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors" 5466:"Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments" 2025:
for "Outcomes of Ablation of Unresectable Pancreatic Cancer Using the NanoKnife Irreversible Electroporation (IRE) System" at
3599:"Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences?" 2510:
Golberg A, Yarmush ML (March 2013). "Nonthermal irreversible electroporation: fundamentals, applications, and challenges".
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Study only focused on apical lesions (difficult to treat with other methods without causing impotence and incontinence).
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Mir LM, Belehradek M, Domenge C, Orlowski S, Poddevin B, Belehradek J, Schwaab G, Luboinski B, Paoletti C (1991). "".
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Ben-David E, Ahmed M, Faroja M, Moussa M, Wandel A, Sosna J, Appelbaum L, Nissenbaum I, Goldberg SN (December 2013).
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Maor E, Rubinsky B (March 2010). "Endovascular nonthermal irreversible electroporation: a finite element analysis".
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Wagstaff PG, de Bruin DM, Zondervan PJ, Savci Heijink CD, Engelbrecht MR, van Delden OM, et al. (March 2015).
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Schoellnast H, Monette S, Ezell PC, Maybody M, Erinjeri JP, Stubblefield MD, Single G, Solomon SB (February 2013).
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van Gemert MJ, Wagstaff PG, de Bruin DM, van Leeuwen TG, van der Wal AC, Heger M, van der Geld CW (February 2015).
6639:"In vivo MRI follow-up of murine tumors treated by electrochemotherapy and other electroporation-based treatments" 5066:"A Single-institution Experience with Open Irreversible Electroporation for Locally Advanced Pancreatic Carcinoma" 4636:"Percutaneous irreversible electroporation with systemic treatment for locally advanced pancreatic adenocarcinoma" 1814:
IRE has also been investigated in ex-vivo human eye models for treatment of uveal melanoma and in thyroid cancer.
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Neumann E, Kakorin S, Toensing K (February 1999). "Fundamentals of electroporative delivery of drugs and genes".
5574:"Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control" 6875: 3877:"Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures" 335:
Mean Overall Survival : 27.0 months (95% CI 22.2–31.8 months), and 35.0 months (95% CI 13.8–56.2 months),
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Gissel H, Lee RC, Gehl J (2011). "Electroporation and Cellular Physiology". In Kee ST, Gehl J, Lee EW (eds.).
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Ringel-Scaia VM, Beitel-White N, Lorenzo MF, Brock RM, Huie KE, Coutermarsh-Ott S, et al. (June 2019).
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6499: 3457:"Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties" 3406:"Irreversible Electroporation: Background, Theory, and Review of Recent Developments in Clinical Oncology" 3216:"High-frequency irreversible electroporation (H-FIRE) for non-thermal ablation without muscle contraction" 3127: 1973:"Molecular and histological study on the effects of non-thermal irreversible electroporation on the liver" 4726:"Percutaneous Irreversible Electroporation as First-line Treatment of Locally Advanced Pancreatic Cancer" 6678:
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treatment. In 2023, irreversible electroporation is being widely used and evaluated in humans, as
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Electrode configuration completely enveloped ablation, leaving no viable cells in 15 patients
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the consensus is that current evidence is still inadequate in quality and quantity.
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Focal ablation using IRE for PCa in the distal apex appears safe and feasible.
6513: 6411: 6368: 5965: 5877: 5830: 5219: 5034: 4956: 4939: 4915: 4898: 4742: 4725: 4563: 4475: 4428: 4276: 4044: 3843: 3374: 3319: 3267:"Irreversible electroporation: a new ablation modality--clinical implications" 3141: 3086: 3026: 2800: 2523: 2480: 2154: 2137: 2058: 2043:"The promising alliance of anti-cancer electrochemotherapy with immunotherapy" 1836:"Irreversible electroporation: a new ablation modality--clinical implications" 6655: 6638: 6458: 5082: 3796: 3772: 3656: 3232: 3184: 2897: 2880: 2396: 4652: 3771:
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pharmaceuticals such as bleomycin (electroporation and electrochemotherapy).
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In swine livers, they average around 340-360 nm, as found using
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Table 3: Irreversible Electroporation Clinical Data in the Prostate
1130:
and local recurrence (n = 10), 4.0 cm (68% after chemotherapy)
738:
Table 2: Irreversible Electroporation Clinical Data in the Pancreas
3071:"Irreversible electroporation: a novel image-guided cancer therapy" 2434:
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Table 1: Irreversible Electroporation Clinical Data in the Liver
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to kill very small areas of heart muscle. This is done to treat
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1607:
only one histologic verification. Out-of-field recurrence, NS
5755: 1660:
out-of-fieldrecurrence, n = 5 (with histologic verification)
254:
Max ablation volume using two electrodes: 4 × 3 × 2 cm³
2693:"Membrane electroporation: a molecular dynamics simulation" 2553:
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short and long term side-effects associated with necrosis.
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CRLM (n = 23), CCC (n = 2), other (n = 22); 3.8 cm
5705:
Kasivisvanathan V, Emberton M, Ahmed HU (August 2013).
613:
CRLM (n = 16), CCC (n = 6), other (n = 4); 2.3 cm
581:
CRLM (n = 22), CCC (n = 5), other (n = 5); 2.4 cm
549:
CRLM (n = 16), CCC (n = 6), other (n = 4); 1.7 cm
2428:
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1768:
conductivity between tumor, lung parenchyma, and air.
6684:
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1699:
incontinence 2% (study only focused apical lesions);
2789:
Medical & Biological Engineering & Computing
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1664:
Good oncological control achieved with low toxicity
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33: 23: 18: 6580:"Tumor ablation with irreversible electroporation" 1939:. New York, NY: Springer New York. pp. 9–17. 251:Current: ca. 50 A (tissue- and geometry dependent) 6321:Journal of Vascular and Interventional Radiology 5997:Journal of Vascular and Interventional Radiology 4820:Journal of Vascular and Interventional Radiology 4377:Journal of Vascular and Interventional Radiology 4308:Journal of Vascular and Interventional Radiology 4113:Journal of Vascular and Interventional Radiology 4077:Journal of Vascular and Interventional Radiology 3963:Journal of Vascular and Interventional Radiology 3506:"Irreversible electroporation: state of the art" 2754:Journal of Vascular and Interventional Radiology 1392:urinary incontinence 0% erectile dysfunction 0% 235:Typical parameters (1st generation IRE system): 1439:complete fibrosis or necrosis of ablation zone 830:(88% after chemotherapy or radiation therapy) 392:(n = 28), open (n = 14), laparoscopic (n = 2) 6731:. New York, NY.: Springer. pp. 115–127. 6643:Technology in Cancer Research & Treatment 6447:Technology in Cancer Research & Treatment 5670:Technology in Cancer Research & Treatment 3553: 3551: 3271:Technology in Cancer Research & Treatment 3265:Rubinsky B, Onik G, Mikus P (February 2007). 2885:Technology in Cancer Research & Treatment 1840:Technology in Cancer Research & Treatment 1834:Rubinsky B, Onik G, Mikus P (February 2007). 8: 3173:IEEE Transactions on Bio-Medical Engineering 2512:IEEE Transactions on Bio-Medical Engineering 6777:Maor E, Ivorra A, Rubinsky B (2009-01-01). 6680:"Ablation of bone cells by electroporation" 6400:CardioVascular and Interventional Radiology 6357:CardioVascular and Interventional Radiology 6106:Maor E, Ivorra A, Rubinsky B (2009-03-09). 5954:CardioVascular and Interventional Radiology 5866:CardioVascular and Interventional Radiology 5664:Onik G, Mikus P, Rubinsky B (August 2007). 4033:CardioVascular and Interventional Radiology 3998:Journal of the American College of Surgeons 706:CRLM (n = 15), other (n = 31); 2.5 cm 386:CRLM (n = 20), Other (n = 10); 2.5 cm 245:Intermission between pulses: 100 to 1000 ms 222:due to the increased conductivity of urine. 2604:Annals of the New York Academy of Sciences 2580:11370/d8724ecd-cef4-4c40-a688-14c45ce87547 485:CRLM (n = 21), other (n = 5); 1.0 cm 418:CRLM (n = 23), other (n = 7); 2.4 cm 6812: 6802: 6695: 6654: 6613: 6603: 6503: 6466: 6295: 6285: 6200: 6190: 6141: 6131: 6055: 5839: 5829: 5730: 5681: 5589: 5548: 5499: 5489: 5429: 5276: 5227: 5091: 5081: 4996: 4955: 4914: 4741: 4661: 4651: 4610: 4437: 4427: 4238: 4228: 4179: 3892: 3851: 3747: 3614: 3531: 3521: 3480: 3431: 3421: 3282: 3241: 3231: 3131: 3094: 3069:Lee EW, Thai S, Kee ST (September 2010). 3034: 2896: 2855: 2724: 2578: 2404: 2266: 2202: 2153: 2066: 1996: 1908: 1851: 111:Electroporation § Physical mechanism 4508:Scandinavian Journal of Gastroenterology 2559:Journal of the American Chemical Society 1321: 736: 517:CRLM (n = 20), CCC (n = 5); 2.7 cm 290: 28:Non-thermal irreversible electroporation 1826: 6756:. Berlin: Springer. pp. 231–236. 5578:Prostate Cancer and Prostatic Diseases 5529:Prostate Cancer and Prostatic Diseases 5459: 5457: 170:Potential advantages and disadvantages 15: 4688:European Journal of Surgical Oncology 3927:European Journal of Surgical Oncology 3777:European Journal of Surgical Oncology 3717: 3715: 3603:Diagnostic and Interventional Imaging 3355: 3353: 3351: 3349: 3347: 3345: 3064: 3062: 2746: 2744: 2686: 2684: 2655:Bioelectrochemistry and Bioenergetics 7: 4640:Journal of Gastrointestinal Oncology 3404:Aycock KN, Davalos RV (2019-12-01). 2976:Journal of Biomechanical Engineering 2131: 2129: 2036: 2034: 1966: 1964: 1930: 1928: 1063:(after chemo- or radiation therapy) 6754:Clinical Aspects of Electroporation 6729:Clinical aspects of electroporation 2319:Japanese Journal of Cancer Research 1937:Clinical Aspects of Electroporation 1402:Adequate flow in NVB postoperative 42: 2624:10.1111/j.1749-6632.1994.tb30442.x 2259:10.1002/j.1460-2075.1982.tb01257.x 1779:percutaneous coronary intervention 754:and Median Largest Tumor Diameter 239:Number of pulses per treatment: 90 14: 4010:10.1016/j.jamcollsurg.2012.04.029 139:High-intensity focused ultrasound 67:technique using short but strong 6227:JACC: Clinical Electrophysiology 4989:10.2169/internalmedicine.0861-18 3308:Annals of Biomedical Engineering 3120:Annals of Biomedical Engineering 2945:10.1016/j.bioelechem.2020.107482 2469:Annals of Biomedical Engineering 1611:Average ablation volume of 12mL 1560:out-of-field recurrence, n = 27 6492:The Journal of Membrane Biology 4782:(3): 486–94, discussion 492–4. 2230:. Paris: Guerin & Delatour. 2041:Calvet CY, Mir LM (June 2016). 1605:Local residual disease, n = 6; 1489:out-of-field recurrence, n = 4 1398:out-of-field occurrence, n = 1 3565:. AngioDynamics. 13 June 2013. 1799:irregularities of heart rhythm 1654:erectile dysfunction, unknown 1: 6697:10.1302/0301-620X.92B11.24664 5922:10.1016/j.urolonc.2018.11.008 5269:10.1016/S0140-6736(10)62307-0 4520:10.1080/00365521.2019.1575465 3220:BioMedical Engineering OnLine 2667:10.1016/s0302-4598(99)00008-2 2195:10.1080/2162402X.2019.1652532 2047:Cancer and Metastasis Reviews 1028:chemo- or radiation therapy) 326:CRLM (n = 87), HCC (n = 62) 6804:10.1371/journal.pone.0004757 6605:10.1371/journal.pone.0001135 6287:10.1371/journal.pone.0071789 6192:10.1371/journal.pone.0144833 6133:10.1371/journal.pone.0004757 5783:10.1097/mou.0b013e328355ecf5 5491:10.1371/journal.pone.0215093 5353:10.1007/978-3-642-05420-4_10 5345:Irreversible Electroporation 5314:10.1097/MPA.0000000000001915 5173:10.1097/MPA.0000000000001916 5130:10.1097/mpa.0000000000000703 4788:10.1097/sla.0000000000001441 4230:10.1371/journal.pone.0076260 3881:Journal of Surgical Oncology 3696:10.1007/978-3-319-32886-7_93 2446:10.1016/0167-4781(91)90162-f 2385:Journal of Clinical Oncology 2358:10.1016/0006-2952(88)90344-9 1707:out-of-field recurrence, NS 1530:radiation therapy (n = 28), 248:Field strength: 1500 volt/cm 57:Irreversible electroporation 19:Irreversible electroporation 6239:10.1016/j.jacep.2023.03.014 5391:10.1016/j.juro.2016.02.2977 5208:Annals of Surgical Oncology 5023:Annals of Surgical Oncology 4552:Annals of Surgical Oncology 3688:Handbook of Electroporation 2717:10.1529/biophysj.104.050617 2092:Annals of Surgical Oncology 1945:10.1007/978-1-4419-8363-3_2 1901:10.1016/j.ebiom.2019.05.036 303:Tumor Type and median size 6907: 6333:10.1016/j.jvir.2015.05.004 6093:10.1016/j.jvir.2013.01.047 6009:10.1016/j.jvir.2010.12.014 5771:Current Opinion in Urology 5723:10.1016/j.clon.2013.05.002 5683:10.1177/153303460700600405 5635:10.1007/s00345-020-03275-z 4832:10.1016/j.jvir.2016.10.023 4700:10.1016/j.ejso.2016.01.024 4389:10.1016/j.jvir.2013.10.012 4320:10.1016/j.jvir.2010.12.014 4125:10.1016/j.jvir.2015.12.025 4089:10.1016/j.jvir.2015.02.001 3975:10.1016/j.jvir.2014.04.007 3939:10.1016/j.ejso.2016.12.004 3789:10.1016/j.ejso.2023.107046 3616:10.1016/j.diii.2017.07.007 3284:10.1177/153303460700600106 2766:10.1016/j.jvir.2011.09.020 2104:10.1245/s10434-018-07144-3 1989:10.1016/j.bbrc.2018.04.132 1853:10.1177/153303460700600106 1557:local recurrence, n = 20; 1346:Adverse events, 1/2/3/4/5 994:LAPC, 3.0 cm (before 784:Downstaging Caused by IRE 300:No. of Patients / Lesions 108: 6514:10.1007/s00232-010-9284-z 6412:10.1007/s00270-010-0091-9 6369:10.1007/s00270-011-0143-9 5966:10.1007/s00270-014-1049-0 5878:10.1007/s00270-017-1795-x 5831:10.1186/s12885-015-1189-x 5220:10.1245/s10434-016-5373-2 5035:10.1245/s10434-017-5900-9 4957:10.1016/j.hpb.2016.02.269 4916:10.1148/radiol.2019191109 4743:10.21873/anticanres.13371 4564:10.1245/s10434-015-5034-x 4476:10.1007/s12032-017-0887-4 4429:10.1186/s12885-015-1736-5 4277:10.1007/s00330-014-3259-x 4045:10.1007/s00270-014-0988-9 3844:10.1016/j.hpb.2016.03.609 3375:10.1148/radiol.2020192190 3320:10.1007/s10439-012-0686-1 3142:10.1007/s10439-009-9796-9 3087:10.5009/gnl.2010.4.s1.s99 3027:10.1007/s00330-012-2610-3 2801:10.1007/s11517-005-0020-2 2524:10.1109/TBME.2013.2238672 2481:10.1007/s10439-005-8981-8 2155:10.1148/radiol.2015151166 2059:10.1007/s10555-016-9615-3 1731:Cancer-specific mortality 1727:cancer-specific mortality 1658:Local recurrence, n = 0; 1548:urinary incontinence 0%; 1525:Pretreated with: radical 1487:Local recurrence, n = 7; 1483:erectile dysfunction 23% 1480:urinary incontinence 0%; 1466:Concurrent TURP (n = 10) 1396:Local recurrence, n = 0; 1165:(52% after chemotherapy) 1026:LAPC, 2.8 cm (after 927:LAPC, 3.5 cm (after 43: 6871:Interventional radiology 6656:10.7785/tcrt.2012.500270 6459:10.7785/tcrt.2012.500181 5623:World Journal of Urology 5083:10.4103/0366-6999.195476 3657:10.1177/1553350617692202 3233:10.1186/1475-925x-10-102 3185:10.1109/TBME.2006.873745 2898:10.1177/1533034615601549 2397:10.1200/JCO.2007.15.6794 2346:Biochemical Pharmacology 1795:cardiac ablation therapy 1785:Cardiac ablation therapy 1701:erectile dysfunction 6% 1669:Blazevski et al. (2020) 1601:erectile dysfunction 5% 1551:erectile dysfunction 3% 1527:prostatectomy (n = 21), 1061:LAPC, 3.2 cm 6 1.3 315:Secondary efficacy (%) 6545:The Heart Surgery Forum 6036:Medical Science Monitor 5070:Chinese Medical Journal 4653:10.21037/jgo.2018.01.14 3740:10.1148/radiol.14132958 3510:OncoTargets and Therapy 3473:10.1148/radiol.13122590 836:(n = 32), open (n = 1) 491:(n = 6), open (n = 22) 227:Use in medical practice 201:cancer immunotheraputic 131:radiofrequency ablation 6557:10.1532/hsf98.20061202 5379:The Journal of Urology 4612:10.4149/213_150611n326 3423:10.1089/bioe.2019.0029 3081:(Suppl. 1): S99–S104. 2019:Clinical trial number 1705:Local recurrence, n=1 1425:Radical prostatectomy 772:Overall Survival (mo) 360:laparoscopic (n = 20) 312:Primary efficacy (%) 309:Median follow-up (mo) 3584:Public Health Service 2691:Tarek M (June 2005). 1649:At 6 months: urinary 1596:At 6 months: urinary 1342:Concurrent Treatment 900:percutaneous (n = 2) 866:LAPC T4, 3.0 cm 320:Frühling et al. 2023 109:Further information: 6845:. Berlin: Springer. 6081:J Vasc Interv Radiol 5916:(3): 183.e1–183.e8. 5591:10.1038/pcan.2015.47 5541:10.1038/pcan.2014.33 242:Pulse length: 100 μs 208:Disadvantages of IRE 99:gene electrotransfer 82:cancer immunotherapy 6881:Vascular procedures 6841:Rubinsky B (2009). 6795:2009PLoSO...4.4757M 6596:2007PLoSO...2.1135A 6278:2013PLoSO...871789M 6183:2015PLoSO..1044833X 6124:2009PLoSO...4.4757M 6048:10.12659/msm.882888 5482:2019PLoSO..1415093G 5253:"Pancreatic cancer" 4730:Anticancer Research 4221:2013PLoSO...876260P 4164:2017NatSR...743687N 3969:(8): 1233–1239.e2. 3645:Surgical Innovation 2933:Bioelectrochemistry 2709:2005BpJ....88.4045T 2697:Biophysical Journal 2616:1994NYASA.720..141W 1791:atrial fibrillation 1546:At >=12 months: 1493:Safe and effective 1448:Van den Bos et al. 1437:15 patients showed 1407:Van den Bos et al. 1355:Oncologic Efficacy 1349:Functional Outcome 1324: 739: 293: 95:electrochemotherapy 6891:Medical technology 4265:European Radiology 4152:Scientific Reports 3523:10.2147/OTT.S88086 3015:European Radiology 2848:10.1002/pros.22913 2226:Nollet JA (1754). 2027:ClinicalTrials.gov 1427:4 weeks after IRE 1366:Onik and Rubinsky 1357:(no. of patients) 1322: 1288:LAPC, 3.0 cm 1259:LAPC, 4.2 cm 1198:LAPC, 2.9 cm 1175:17.0 (diagnosis), 1163:LAPC, 4.0 cm 1140:17.0 (diagnosis), 1105:15.3 (diagnosis), 1096:LAPC, 3.0 cm 1038:23.2 (diagnosis), 971:17.9 (diagnosis), 895:LAPC, 3.9 cm 843:18.5 (diagnosis), 828:LAPC, 3.0 cm 737: 506:Narayanan et al., 291: 135:microwave ablation 6886:Surgical oncology 6852:978-3-642-05419-8 6763:978-1-4419-8362-6 6738:978-1-4419-8362-6 5910:Urologic Oncology 5711:Clinical Oncology 5431:10.1111/bju.13983 5418:BJU International 5362:978-3-642-05419-8 5263:(9791): 607–620. 5214:(13): 4352–4360. 5076:(24): 2920–2925. 4983:(22): 3225–3231. 4977:Internal Medicine 4868:10.1159/000375323 4856:Digestive Surgery 4776:Annals of Surgery 4350:Journal of B.U.On 4172:10.1038/srep43687 3894:10.1002/jso.23280 3705:978-3-319-32885-0 2988:10.1115/1.4001035 2891:(5): NP95–NP103. 2571:10.1021/ja029504i 1954:978-1-4419-8362-6 1772:Coronary arteries 1718: 1717: 1651:incontinence 0%; 1598:incontinence 0%; 1307: 1306: 1210:17.5 (diagnosis) 1203:percutaneous, NS 1189:Sugimoto et al., 1154:Scheffer et al., 1006:13.3 (diagnosis) 790:Belfiore et al., 752:Stage of Disease 726: 725: 666:Scheffer et al., 407:Frühling et al., 343:Bhutiani et al., 175:Advantages of IRE 69:electrical fields 63:is a soft tissue 54: 53: 6898: 6856: 6827: 6826: 6816: 6806: 6774: 6768: 6767: 6749: 6743: 6742: 6724: 6718: 6717: 6699: 6675: 6669: 6668: 6658: 6634: 6628: 6627: 6617: 6607: 6575: 6569: 6568: 6540: 6534: 6533: 6507: 6487: 6481: 6480: 6470: 6438: 6432: 6431: 6395: 6389: 6388: 6351: 6345: 6344: 6316: 6310: 6309: 6299: 6289: 6257: 6251: 6250: 6233:(9): 2008–2023. 6221: 6215: 6214: 6204: 6194: 6177:(12): e0144833. 6162: 6156: 6155: 6145: 6135: 6103: 6097: 6096: 6076: 6070: 6069: 6059: 6027: 6021: 6020: 5992: 5986: 5985: 5948: 5942: 5941: 5904: 5898: 5897: 5860: 5854: 5853: 5843: 5833: 5809: 5803: 5802: 5766: 5760: 5759: 5751: 5745: 5744: 5734: 5702: 5696: 5695: 5685: 5661: 5655: 5654: 5629:(4): 1107–1114. 5618: 5612: 5611: 5593: 5569: 5563: 5562: 5552: 5520: 5514: 5513: 5503: 5493: 5461: 5452: 5451: 5433: 5409: 5403: 5402: 5373: 5367: 5366: 5340: 5334: 5333: 5297: 5291: 5290: 5280: 5248: 5242: 5241: 5231: 5199: 5193: 5192: 5167:(9): 1281–1286. 5156: 5150: 5149: 5112: 5106: 5105: 5095: 5085: 5061: 5055: 5054: 5029:(9): 2734–2743. 5017: 5011: 5010: 5000: 4968: 4962: 4961: 4959: 4935: 4929: 4928: 4918: 4894: 4888: 4887: 4850: 4844: 4843: 4814: 4808: 4807: 4770: 4764: 4763: 4745: 4736:(5): 2509–2512. 4721: 4712: 4711: 4682: 4676: 4675: 4665: 4655: 4631: 4625: 4624: 4614: 4590: 4584: 4583: 4546: 4540: 4539: 4502: 4496: 4495: 4464:Medical Oncology 4458: 4452: 4451: 4441: 4431: 4407: 4401: 4400: 4372: 4366: 4365: 4347: 4338: 4332: 4331: 4303: 4297: 4296: 4259: 4253: 4252: 4242: 4232: 4200: 4194: 4193: 4183: 4143: 4137: 4136: 4107: 4101: 4100: 4071: 4065: 4064: 4028: 4022: 4021: 3993: 3987: 3986: 3957: 3951: 3950: 3921: 3915: 3914: 3896: 3872: 3866: 3865: 3855: 3823: 3817: 3816: 3768: 3762: 3761: 3751: 3719: 3710: 3709: 3683: 3677: 3676: 3639: 3633: 3632: 3618: 3594: 3588: 3587: 3581: 3573: 3567: 3566: 3555: 3546: 3545: 3535: 3525: 3501: 3495: 3494: 3484: 3452: 3446: 3445: 3435: 3425: 3401: 3395: 3394: 3357: 3340: 3339: 3303: 3297: 3296: 3286: 3262: 3256: 3255: 3245: 3235: 3211: 3205: 3204: 3168: 3162: 3161: 3135: 3115: 3109: 3108: 3098: 3066: 3057: 3056: 3038: 3006: 3000: 2999: 2971: 2965: 2964: 2928: 2919: 2918: 2900: 2876: 2870: 2869: 2859: 2827: 2821: 2820: 2784: 2778: 2777: 2748: 2739: 2738: 2728: 2688: 2679: 2678: 2650: 2644: 2643: 2599: 2593: 2592: 2582: 2550: 2544: 2543: 2507: 2501: 2500: 2464: 2458: 2457: 2425: 2419: 2418: 2408: 2391:(36): 5896–903. 2376: 2370: 2369: 2341: 2335: 2334: 2314: 2308: 2307: 2287: 2281: 2280: 2270: 2247:The EMBO Journal 2238: 2232: 2231: 2223: 2217: 2216: 2206: 2174: 2168: 2167: 2157: 2133: 2124: 2123: 2087: 2081: 2080: 2070: 2038: 2029: 2017: 2011: 2010: 2000: 1968: 1959: 1958: 1932: 1923: 1922: 1912: 1880: 1874: 1873: 1855: 1831: 1803:cardiac catheter 1735:overall survival 1555:after up to 6y: 1498:Guenther et al. 1351:(% of patients) 1340:Pretreatment or 1325: 1087:Paiella et al., 1073:27 (diagnosis), 985:Månsson et al., 959:LAPC, NS (after 950:Månsson et al., 886:Lambert et al., 740: 695:Thomson et al., 634:Philips et al., 602:Niessen et al., 570:Niessen et al., 538:Niessen et al., 474:Kingham et al., 294: 47:edit on Wikidata 16: 6906: 6905: 6901: 6900: 6899: 6897: 6896: 6895: 6876:Medical physics 6861: 6860: 6859: 6853: 6840: 6836: 6834:Further reading 6831: 6830: 6776: 6775: 6771: 6764: 6751: 6750: 6746: 6739: 6726: 6725: 6721: 6690:(11): 1614–20. 6677: 6676: 6672: 6636: 6635: 6631: 6577: 6576: 6572: 6542: 6541: 6537: 6489: 6488: 6484: 6440: 6439: 6435: 6397: 6396: 6392: 6353: 6352: 6348: 6318: 6317: 6313: 6259: 6258: 6254: 6223: 6222: 6218: 6164: 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3874: 3873: 3869: 3825: 3824: 3820: 3770: 3769: 3765: 3721: 3720: 3713: 3706: 3685: 3684: 3680: 3641: 3640: 3636: 3596: 3595: 3591: 3579: 3575: 3574: 3570: 3557: 3556: 3549: 3503: 3502: 3498: 3454: 3453: 3449: 3403: 3402: 3398: 3359: 3358: 3343: 3305: 3304: 3300: 3264: 3263: 3259: 3213: 3212: 3208: 3170: 3169: 3165: 3133:10.1.1.679.1068 3126:(12): 2615–25. 3117: 3116: 3112: 3068: 3067: 3060: 3008: 3007: 3003: 2973: 2972: 2968: 2930: 2929: 2922: 2878: 2877: 2873: 2829: 2828: 2824: 2786: 2785: 2781: 2750: 2749: 2742: 2690: 2689: 2682: 2652: 2651: 2647: 2601: 2600: 2596: 2552: 2551: 2547: 2509: 2508: 2504: 2466: 2465: 2461: 2427: 2426: 2422: 2378: 2377: 2373: 2352:(24): 4727–33. 2343: 2342: 2338: 2325:(12): 1319–21. 2316: 2315: 2311: 2289: 2288: 2284: 2240: 2239: 2235: 2225: 2224: 2220: 2189:(11): 1652532. 2176: 2175: 2171: 2135: 2134: 2127: 2089: 2088: 2084: 2040: 2039: 2032: 2018: 2014: 1970: 1969: 1962: 1955: 1934: 1933: 1926: 1882: 1881: 1877: 1833: 1832: 1828: 1823: 1812: 1787: 1774: 1761: 1744: 1569:Valerio et al. 1533:TURP (n = 17), 1518:5+3/3+5: n = 3 1320: 1239:16 (diagnosis) 1119:Ruarus et al., 1017:Martin et al., 898:Open (n = 19), 857:Kluger et al., 778:Recurrence (%) 735: 675:CRLM (n = 10), 651:(NS) open (NS) 451:CRLM (n = 58), 442:Hosein et al., 375:Cannon et al., 358:Open (n = 10), 289: 277: 229: 210: 177: 172: 113: 107: 90: 50: 12: 11: 5: 6904: 6902: 6894: 6893: 6888: 6883: 6878: 6873: 6863: 6862: 6858: 6857: 6851: 6837: 6835: 6832: 6829: 6828: 6769: 6762: 6744: 6737: 6719: 6670: 6629: 6570: 6535: 6505:10.1.1.679.527 6482: 6433: 6390: 6363:(6): 1278–87. 6346: 6311: 6252: 6216: 6157: 6098: 6071: 6022: 5987: 5943: 5899: 5872:(3): 466–476. 5855: 5804: 5761: 5746: 5697: 5676:(4): 295–300. 5656: 5613: 5564: 5515: 5453: 5424:(5): 716–724. 5404: 5368: 5361: 5335: 5308:(9): e79–e80. 5292: 5243: 5194: 5151: 5124:(2): e12–e14. 5107: 5056: 5012: 4963: 4930: 4909:(1): 212–220. 4889: 4845: 4826:(3): 342–348. 4809: 4765: 4713: 4677: 4646:(2): 275–281. 4626: 4585: 4558:(5): 1736–43. 4541: 4514:(2): 252–258. 4497: 4453: 4402: 4367: 4356:(1): 141–149. 4333: 4298: 4254: 4215:(11): e76260. 4195: 4138: 4102: 4083:(5): 694–702. 4066: 4023: 3988: 3952: 3933:(4): 751–757. 3916: 3867: 3818: 3783:(11): 107046. 3763: 3711: 3704: 3678: 3651:(3): 276–283. 3634: 3609:(9): 609–617. 3589: 3568: 3547: 3496: 3447: 3416:(4): 214–234. 3410:Bioelectricity 3396: 3369:(2): 254–272. 3341: 3298: 3257: 3206: 3179:(7): 1409–15. 3163: 3110: 3058: 3001: 2966: 2920: 2871: 2822: 2779: 2740: 2703:(6): 4045–53. 2680: 2645: 2594: 2565:(21): 6382–3. 2545: 2502: 2459: 2420: 2371: 2336: 2309: 2282: 2233: 2218: 2183:Oncoimmunology 2169: 2125: 2098:(3): 800–806. 2082: 2030: 2012: 1983:(3): 665–670. 1960: 1953: 1924: 1875: 1825: 1824: 1822: 1819: 1811: 1808: 1786: 1783: 1773: 1770: 1760: 1757: 1743: 1740: 1716: 1715: 1709: 1703: 1697: 1695:Grade 3–5: 0% 1688: 1685: 1673: 1670: 1666: 1665: 1662: 1656: 1647: 1645:Grade 3–5: 0% 1638: 1635: 1623: 1620: 1613: 1612: 1609: 1603: 1594: 1591: 1588: 1576: 1573: 1566: 1565: 1562: 1553: 1544: 1541: 1523: 1505: 1502: 1495: 1494: 1491: 1485: 1478:At 12 months: 1476: 1474:Grade 3–5: 0% 1467: 1464: 1455: 1452: 1445: 1444: 1441: 1435: 1432: 1429: 1423: 1414: 1411: 1404: 1403: 1400: 1394: 1388: 1385: 1382: 1373: 1370: 1363: 1362: 1359: 1353: 1347: 1344: 1338: 1337:Gleason Score 1335: 1329: 1319: 1316: 1305: 1304: 1301: 1298: 1295: 1292: 1289: 1286: 1283: 1279:Zhang et al., 1276: 1275: 1272: 1269: 1266: 1263: 1260: 1257: 1254: 1247: 1246: 1243: 1240: 1237: 1234: 1231: 1228: 1225: 1221:Vogel et al., 1218: 1217: 1214: 1211: 1208: 1205: 1199: 1196: 1193: 1186: 1185: 1182: 1179: 1173: 1170: 1167: 1161: 1158: 1151: 1150: 1147: 1144: 1138: 1135: 1132: 1128:LAPC (n = 40) 1126: 1123: 1116: 1115: 1112: 1109: 1103: 1100: 1097: 1094: 1091: 1084: 1083: 1080: 1077: 1071: 1068: 1065: 1059: 1056: 1049: 1048: 1045: 1042: 1036: 1033: 1030: 1024: 1021: 1014: 1013: 1010: 1007: 1004: 1001: 998: 996:chemotherapy) 992: 989: 982: 981: 978: 975: 969: 966: 963: 961:chemotherapy) 957: 954: 947: 946: 943: 940: 937: 934: 931: 929:chemotherapy) 925: 922: 915: 914: 911: 908: 905: 902: 896: 893: 890: 883: 882: 879: 876: 873: 870: 867: 864: 861: 854: 853: 850: 847: 841: 838: 832: 826: 823: 816: 815: 812: 809: 806: 803: 800: 797: 794: 787: 786: 780: 774: 768: 759: 756: 750: 744: 734: 731: 724: 723: 720: 717: 714: 708: 704:HCC (n = 17), 702: 699: 692: 691: 688: 685: 682: 681:Open (n = 10) 679: 673: 670: 663: 662: 659: 656: 653: 647: 643:HCC (n = 13), 641: 638: 631: 630: 627: 624: 621: 615: 611:HCC (n = 31), 609: 606: 599: 598: 595: 592: 589: 583: 579:HCC (n = 33), 577: 574: 567: 566: 563: 560: 557: 551: 547:HCC (n = 22), 545: 542: 535: 534: 531: 528: 525: 519: 515:HCC (n = 35), 513: 510: 503: 502: 499: 496: 493: 487: 481: 478: 471: 470: 467: 464: 461: 455: 449: 446: 439: 438: 435: 433:(at 6 months) 429: 426: 420: 414: 411: 404: 403: 400: 397: 394: 388: 384:HCC (n = 14), 382: 379: 372: 371: 368: 365: 362: 356: 352:HCC (n = 30), 350: 347: 340: 339: 336: 333: 330: 327: 324: 321: 317: 316: 313: 310: 307: 304: 301: 298: 288: 285: 276: 273: 256: 255: 252: 249: 246: 243: 240: 228: 225: 224: 223: 219: 215: 209: 206: 205: 204: 197: 194: 190: 186: 182: 176: 173: 171: 168: 155: 154: 150: 126: 125: 121: 106: 103: 89: 86: 52: 51: 44: 41: 40: 37: 31: 30: 25: 21: 20: 13: 10: 9: 6: 4: 3: 2: 6903: 6892: 6889: 6887: 6884: 6882: 6879: 6877: 6874: 6872: 6869: 6868: 6866: 6854: 6848: 6844: 6839: 6838: 6833: 6824: 6820: 6815: 6810: 6805: 6800: 6796: 6792: 6788: 6784: 6780: 6773: 6770: 6765: 6759: 6755: 6748: 6745: 6740: 6734: 6730: 6723: 6720: 6715: 6711: 6707: 6703: 6698: 6693: 6689: 6685: 6681: 6674: 6671: 6666: 6662: 6657: 6652: 6649:(6): 561–70. 6648: 6644: 6640: 6633: 6630: 6625: 6621: 6616: 6611: 6606: 6601: 6597: 6593: 6590:(11): e1135. 6589: 6585: 6581: 6574: 6571: 6566: 6562: 6558: 6554: 6551:(2): E162-7. 6550: 6546: 6539: 6536: 6531: 6527: 6523: 6519: 6515: 6511: 6506: 6501: 6498:(1): 127–36. 6497: 6493: 6486: 6483: 6478: 6474: 6469: 6464: 6460: 6456: 6452: 6448: 6444: 6437: 6434: 6429: 6425: 6421: 6417: 6413: 6409: 6405: 6401: 6394: 6391: 6386: 6382: 6378: 6374: 6370: 6366: 6362: 6358: 6350: 6347: 6342: 6338: 6334: 6330: 6327:(8): 1180–2. 6326: 6322: 6315: 6312: 6307: 6303: 6298: 6293: 6288: 6283: 6279: 6275: 6272:(9): e71789. 6271: 6267: 6263: 6256: 6253: 6248: 6244: 6240: 6236: 6232: 6228: 6220: 6217: 6212: 6208: 6203: 6198: 6193: 6188: 6184: 6180: 6176: 6172: 6168: 6161: 6158: 6153: 6149: 6144: 6139: 6134: 6129: 6125: 6121: 6117: 6113: 6109: 6102: 6099: 6094: 6090: 6086: 6082: 6075: 6072: 6067: 6063: 6058: 6053: 6049: 6045: 6042:(6): CS43-7. 6041: 6037: 6033: 6026: 6023: 6018: 6014: 6010: 6006: 6003:(5): 611–21. 6002: 5998: 5991: 5988: 5983: 5979: 5975: 5971: 5967: 5963: 5959: 5955: 5947: 5944: 5939: 5935: 5931: 5927: 5923: 5919: 5915: 5911: 5903: 5900: 5895: 5891: 5887: 5883: 5879: 5875: 5871: 5867: 5859: 5856: 5851: 5847: 5842: 5837: 5832: 5827: 5823: 5819: 5815: 5808: 5805: 5800: 5796: 5792: 5788: 5784: 5780: 5777:(5): 379–84. 5776: 5772: 5765: 5762: 5757: 5750: 5747: 5742: 5738: 5733: 5728: 5724: 5720: 5717:(8): 461–73. 5716: 5712: 5708: 5701: 5698: 5693: 5689: 5684: 5679: 5675: 5671: 5667: 5660: 5657: 5652: 5648: 5644: 5640: 5636: 5632: 5628: 5624: 5617: 5614: 5609: 5605: 5601: 5597: 5592: 5587: 5583: 5579: 5575: 5568: 5565: 5560: 5556: 5551: 5546: 5542: 5538: 5534: 5530: 5526: 5519: 5516: 5511: 5507: 5502: 5497: 5492: 5487: 5483: 5479: 5475: 5471: 5467: 5460: 5458: 5454: 5449: 5445: 5441: 5437: 5432: 5427: 5423: 5419: 5415: 5408: 5405: 5400: 5396: 5392: 5388: 5384: 5380: 5372: 5369: 5364: 5358: 5354: 5350: 5346: 5339: 5336: 5331: 5327: 5323: 5319: 5315: 5311: 5307: 5303: 5296: 5293: 5288: 5284: 5279: 5274: 5270: 5266: 5262: 5258: 5254: 5247: 5244: 5239: 5235: 5230: 5225: 5221: 5217: 5213: 5209: 5205: 5198: 5195: 5190: 5186: 5182: 5178: 5174: 5170: 5166: 5162: 5155: 5152: 5147: 5143: 5139: 5135: 5131: 5127: 5123: 5119: 5111: 5108: 5103: 5099: 5094: 5089: 5084: 5079: 5075: 5071: 5067: 5060: 5057: 5052: 5048: 5044: 5040: 5036: 5032: 5028: 5024: 5016: 5013: 5008: 5004: 4999: 4994: 4990: 4986: 4982: 4978: 4974: 4967: 4964: 4958: 4953: 4949: 4945: 4941: 4934: 4931: 4926: 4922: 4917: 4912: 4908: 4904: 4900: 4893: 4890: 4885: 4881: 4877: 4873: 4869: 4865: 4861: 4857: 4849: 4846: 4841: 4837: 4833: 4829: 4825: 4821: 4813: 4810: 4805: 4801: 4797: 4793: 4789: 4785: 4781: 4777: 4769: 4766: 4761: 4757: 4753: 4749: 4744: 4739: 4735: 4731: 4727: 4720: 4718: 4714: 4709: 4705: 4701: 4697: 4694:(9): 1401–6. 4693: 4689: 4681: 4678: 4673: 4669: 4664: 4659: 4654: 4649: 4645: 4641: 4637: 4630: 4627: 4622: 4618: 4613: 4608: 4605:(2): 269–73. 4604: 4600: 4596: 4589: 4586: 4581: 4577: 4573: 4569: 4565: 4561: 4557: 4553: 4545: 4542: 4537: 4533: 4529: 4525: 4521: 4517: 4513: 4509: 4501: 4498: 4493: 4489: 4485: 4481: 4477: 4473: 4469: 4465: 4457: 4454: 4449: 4445: 4440: 4435: 4430: 4425: 4421: 4417: 4413: 4406: 4403: 4398: 4394: 4390: 4386: 4382: 4378: 4371: 4368: 4363: 4359: 4355: 4351: 4344: 4337: 4334: 4329: 4325: 4321: 4317: 4314:(5): 611–21. 4313: 4309: 4302: 4299: 4294: 4290: 4286: 4282: 4278: 4274: 4270: 4266: 4258: 4255: 4250: 4246: 4241: 4236: 4231: 4226: 4222: 4218: 4214: 4210: 4206: 4199: 4196: 4191: 4187: 4182: 4177: 4173: 4169: 4165: 4161: 4157: 4153: 4149: 4142: 4139: 4134: 4130: 4126: 4122: 4118: 4114: 4106: 4103: 4098: 4094: 4090: 4086: 4082: 4078: 4070: 4067: 4062: 4058: 4054: 4050: 4046: 4042: 4039:(6): 1523–9. 4038: 4034: 4027: 4024: 4019: 4015: 4011: 4007: 4004:(3): 379–87. 4003: 3999: 3992: 3989: 3984: 3980: 3976: 3972: 3968: 3964: 3956: 3953: 3948: 3944: 3940: 3936: 3932: 3928: 3920: 3917: 3912: 3908: 3904: 3900: 3895: 3890: 3886: 3882: 3878: 3871: 3868: 3863: 3859: 3854: 3849: 3845: 3841: 3837: 3833: 3829: 3822: 3819: 3814: 3810: 3806: 3802: 3798: 3794: 3790: 3786: 3782: 3778: 3774: 3767: 3764: 3759: 3755: 3750: 3745: 3741: 3737: 3734:(1): 241–60. 3733: 3729: 3725: 3718: 3716: 3712: 3707: 3701: 3697: 3693: 3689: 3682: 3679: 3674: 3670: 3666: 3662: 3658: 3654: 3650: 3646: 3638: 3635: 3631: 3626: 3622: 3617: 3612: 3608: 3604: 3600: 3593: 3590: 3585: 3578: 3572: 3569: 3564: 3563:Press Release 3560: 3554: 3552: 3548: 3543: 3539: 3534: 3529: 3524: 3519: 3516:: 2437–2446. 3515: 3511: 3507: 3500: 3497: 3492: 3488: 3483: 3478: 3474: 3470: 3467:(3): 738–47. 3466: 3462: 3458: 3451: 3448: 3443: 3439: 3434: 3429: 3424: 3419: 3415: 3411: 3407: 3400: 3397: 3392: 3388: 3384: 3380: 3376: 3372: 3368: 3364: 3356: 3354: 3352: 3350: 3348: 3346: 3342: 3337: 3333: 3329: 3325: 3321: 3317: 3314:(3): 619–29. 3313: 3309: 3302: 3299: 3294: 3290: 3285: 3280: 3276: 3272: 3268: 3261: 3258: 3253: 3249: 3244: 3239: 3234: 3229: 3225: 3221: 3217: 3210: 3207: 3202: 3198: 3194: 3190: 3186: 3182: 3178: 3174: 3167: 3164: 3159: 3155: 3151: 3147: 3143: 3139: 3134: 3129: 3125: 3121: 3114: 3111: 3106: 3102: 3097: 3092: 3088: 3084: 3080: 3076: 3075:Gut and Liver 3072: 3065: 3063: 3059: 3054: 3050: 3046: 3042: 3037: 3032: 3028: 3024: 3021:(2): 375–80. 3020: 3016: 3012: 3005: 3002: 2997: 2993: 2989: 2985: 2982:(3): 031008. 2981: 2977: 2970: 2967: 2962: 2958: 2954: 2950: 2946: 2942: 2938: 2934: 2927: 2925: 2921: 2916: 2912: 2908: 2904: 2899: 2894: 2890: 2886: 2882: 2875: 2872: 2867: 2863: 2858: 2853: 2849: 2845: 2841: 2837: 2833: 2826: 2823: 2818: 2814: 2810: 2806: 2802: 2798: 2795:(1–2): 5–14. 2794: 2790: 2783: 2780: 2775: 2771: 2767: 2763: 2760:(1): 107–13. 2759: 2755: 2747: 2745: 2741: 2736: 2732: 2727: 2722: 2718: 2714: 2710: 2706: 2702: 2698: 2694: 2687: 2685: 2681: 2676: 2672: 2668: 2664: 2660: 2656: 2649: 2646: 2641: 2637: 2633: 2629: 2625: 2621: 2617: 2613: 2610:(1): 141–52. 2609: 2605: 2598: 2595: 2590: 2586: 2581: 2576: 2572: 2568: 2564: 2560: 2556: 2549: 2546: 2541: 2537: 2533: 2529: 2525: 2521: 2518:(3): 707–14. 2517: 2513: 2506: 2503: 2498: 2494: 2490: 2486: 2482: 2478: 2475:(2): 223–31. 2474: 2470: 2463: 2460: 2455: 2451: 2447: 2443: 2439: 2435: 2431: 2424: 2421: 2416: 2412: 2407: 2402: 2398: 2394: 2390: 2386: 2382: 2375: 2372: 2367: 2363: 2359: 2355: 2351: 2347: 2340: 2337: 2332: 2328: 2324: 2320: 2313: 2310: 2305: 2301: 2298:(13): 613–8. 2297: 2293: 2286: 2283: 2278: 2274: 2269: 2264: 2260: 2256: 2252: 2248: 2244: 2237: 2234: 2229: 2222: 2219: 2214: 2210: 2205: 2200: 2196: 2192: 2188: 2184: 2180: 2173: 2170: 2165: 2161: 2156: 2151: 2148:(2): 413–24. 2147: 2143: 2139: 2132: 2130: 2126: 2121: 2117: 2113: 2109: 2105: 2101: 2097: 2093: 2086: 2083: 2078: 2074: 2069: 2064: 2060: 2056: 2053:(2): 165–77. 2052: 2048: 2044: 2037: 2035: 2031: 2028: 2024: 2023: 2016: 2013: 2008: 2004: 1999: 1994: 1990: 1986: 1982: 1978: 1974: 1967: 1965: 1961: 1956: 1950: 1946: 1942: 1938: 1931: 1929: 1925: 1920: 1916: 1911: 1906: 1902: 1898: 1894: 1890: 1886: 1879: 1876: 1871: 1867: 1863: 1859: 1854: 1849: 1845: 1841: 1837: 1830: 1827: 1820: 1818: 1815: 1809: 1807: 1804: 1800: 1796: 1792: 1784: 1782: 1780: 1771: 1769: 1765: 1758: 1756: 1752: 1748: 1741: 1739: 1736: 1732: 1729:as endpoint. 1728: 1722: 1714: 1710: 1708: 1704: 1702: 1698: 1696: 1693: 1689: 1686: 1684: 1681: 1678: 1674: 1671: 1668: 1667: 1663: 1661: 1657: 1655: 1652: 1648: 1646: 1643: 1642:Grade 2: 29% 1640:Grade 1: 35% 1639: 1636: 1634: 1631: 1628: 1624: 1621: 1619: 1615: 1614: 1610: 1608: 1604: 1602: 1599: 1595: 1592: 1589: 1587: 1584: 1581: 1577: 1574: 1572: 1568: 1567: 1563: 1561: 1558: 1554: 1552: 1549: 1545: 1542: 1540: 1539:ADT (n = 29) 1537: 1536:HIFU (n = 8) 1534: 1531: 1528: 1524: 1522: 1521:>4+4 = 42 1519: 1516: 1513: 1510: 1506: 1503: 1501: 1497: 1496: 1492: 1490: 1486: 1484: 1481: 1477: 1475: 1472: 1471:Grade 2: 11% 1469:Grade 1: 24% 1468: 1465: 1463: 1460: 1456: 1453: 1451: 1447: 1446: 1442: 1440: 1436: 1433: 1430: 1428: 1424: 1422: 1419: 1415: 1412: 1410: 1406: 1405: 1401: 1399: 1395: 1393: 1390:At 6 months: 1389: 1386: 1383: 1381: 1378: 1374: 1371: 1369: 1365: 1364: 1360: 1358: 1354: 1352: 1348: 1345: 1343: 1339: 1336: 1334: 1330: 1328:Author, Year 1327: 1326: 1317: 1315: 1313: 1302: 1299: 1296: 1293: 1291:Percutaneous 1290: 1287: 1284: 1282: 1278: 1277: 1273: 1270: 1267: 1264: 1261: 1258: 1255: 1253: 1249: 1248: 1244: 1241: 1238: 1235: 1232: 1229: 1226: 1224: 1220: 1219: 1215: 1212: 1209: 1206: 1204: 1200: 1197: 1194: 1192: 1188: 1187: 1183: 1180: 1178: 1174: 1171: 1169:Percutaneous 1168: 1166: 1162: 1159: 1157: 1153: 1152: 1148: 1145: 1143: 1139: 1136: 1134:Percutaneous 1133: 1131: 1127: 1124: 1122: 1118: 1117: 1113: 1110: 1108: 1104: 1101: 1098: 1095: 1092: 1090: 1086: 1085: 1081: 1078: 1076: 1072: 1069: 1067:Percutaneous 1066: 1064: 1060: 1057: 1055: 1054:et al., 2016 1051: 1050: 1046: 1043: 1041: 1037: 1034: 1031: 1029: 1025: 1022: 1020: 1016: 1015: 1011: 1008: 1005: 1002: 1000:Percutaneous 999: 997: 993: 990: 988: 984: 983: 979: 976: 974: 970: 967: 965:Percutaneous 964: 962: 958: 955: 953: 949: 948: 944: 941: 938: 935: 933:Percutaneous 932: 930: 926: 923: 921: 918:Leen et al., 917: 916: 912: 909: 906: 903: 901: 897: 894: 891: 889: 885: 884: 880: 877: 874: 871: 868: 865: 862: 860: 856: 855: 851: 848: 846: 842: 839: 837: 834:Percutaneous 833: 831: 827: 824: 822: 819:Flak et al., 818: 817: 813: 810: 807: 804: 802:Percutaneous 801: 798: 795: 793: 789: 788: 785: 781: 779: 775: 773: 769: 767: 764: 760: 757: 755: 751: 749: 745: 743:Author, Year 742: 741: 732: 730: 721: 718: 715: 713: 710:Percutaneous 709: 707: 703: 700: 698: 694: 693: 689: 686: 683: 680: 678: 674: 671: 669: 665: 664: 660: 657: 654: 652: 649:Percutaneous 648: 646: 642: 639: 637: 633: 632: 628: 625: 622: 620: 617:Percutaneous 616: 614: 610: 607: 605: 601: 600: 596: 593: 590: 588: 585:Percutaneous 584: 582: 578: 575: 573: 569: 568: 564: 561: 558: 556: 553:Percutaneous 552: 550: 546: 543: 541: 537: 536: 532: 529: 526: 524: 521:Percutaneous 520: 518: 514: 511: 509: 505: 504: 500: 497: 494: 492: 489:Percutaneous 488: 486: 483:HCC (n = 2), 482: 479: 477: 473: 472: 468: 465: 462: 460: 457:Percutaneous 456: 454: 450: 447: 445: 441: 440: 436: 434: 430: 427: 425: 422:Percutaneous 421: 419: 416:HCC (n = 8), 415: 412: 410: 406: 405: 401: 398: 395: 393: 390:Percutaneous 389: 387: 383: 380: 378: 374: 373: 369: 366: 363: 361: 357: 355: 351: 348: 346: 342: 341: 337: 334: 331: 328: 325: 322: 319: 318: 314: 311: 308: 305: 302: 299: 297:Author, Year 296: 295: 286: 284: 281: 275:Clinical data 274: 272: 268: 264: 260: 253: 250: 247: 244: 241: 238: 237: 236: 233: 226: 220: 216: 212: 211: 207: 202: 198: 195: 191: 187: 183: 179: 178: 174: 169: 167: 163: 161: 151: 148: 147: 146: 142: 140: 136: 132: 122: 118: 117: 116: 112: 104: 102: 100: 96: 87: 85: 83: 78: 74: 70: 66: 62: 58: 48: 38: 36: 32: 29: 26: 22: 17: 6842: 6789:(3): e4757. 6786: 6782: 6772: 6753: 6747: 6728: 6722: 6706:11380/646548 6687: 6683: 6673: 6646: 6642: 6632: 6587: 6583: 6573: 6548: 6544: 6538: 6495: 6491: 6485: 6453:(1): 73–83. 6450: 6446: 6436: 6406:(2): 391–5. 6403: 6399: 6393: 6360: 6356: 6349: 6324: 6320: 6314: 6269: 6265: 6255: 6230: 6226: 6219: 6174: 6170: 6160: 6118:(3): e4757. 6115: 6111: 6101: 6084: 6080: 6074: 6039: 6035: 6025: 6000: 5996: 5990: 5960:(2): 401–8. 5957: 5953: 5946: 5913: 5909: 5902: 5869: 5865: 5858: 5821: 5817: 5807: 5774: 5770: 5764: 5754:Stehling M. 5749: 5714: 5710: 5700: 5673: 5669: 5659: 5626: 5622: 5616: 5584:(1): 46–52. 5581: 5577: 5567: 5535:(4): 343–7. 5532: 5528: 5518: 5473: 5469: 5421: 5417: 5407: 5385:(2): 552–9. 5382: 5378: 5371: 5344: 5338: 5305: 5301: 5295: 5260: 5256: 5246: 5211: 5207: 5197: 5164: 5160: 5154: 5121: 5117: 5110: 5073: 5069: 5059: 5026: 5022: 5015: 4980: 4976: 4966: 4947: 4943: 4933: 4906: 4902: 4892: 4859: 4855: 4848: 4823: 4819: 4812: 4779: 4775: 4768: 4733: 4729: 4691: 4687: 4680: 4643: 4639: 4629: 4602: 4598: 4588: 4555: 4551: 4544: 4511: 4507: 4500: 4467: 4463: 4456: 4419: 4415: 4405: 4383:(1): 112–8. 4380: 4376: 4370: 4353: 4349: 4336: 4311: 4307: 4301: 4268: 4264: 4257: 4212: 4208: 4198: 4158:(1): 43687. 4155: 4151: 4141: 4119:(4): 480–6. 4116: 4112: 4105: 4080: 4076: 4069: 4036: 4032: 4026: 4001: 3997: 3991: 3966: 3962: 3955: 3930: 3926: 3919: 3887:(5): 544–9. 3884: 3880: 3870: 3838:(7): 593–9. 3835: 3831: 3821: 3780: 3776: 3766: 3731: 3727: 3687: 3681: 3648: 3644: 3637: 3628: 3606: 3602: 3592: 3583: 3571: 3562: 3513: 3509: 3499: 3464: 3460: 3450: 3413: 3409: 3399: 3366: 3362: 3311: 3307: 3301: 3277:(1): 37–48. 3274: 3270: 3260: 3223: 3219: 3209: 3176: 3172: 3166: 3123: 3119: 3113: 3078: 3074: 3018: 3014: 3004: 2979: 2975: 2969: 2936: 2932: 2888: 2884: 2874: 2842:(3): 332–5. 2839: 2836:The Prostate 2835: 2825: 2792: 2788: 2782: 2757: 2753: 2700: 2696: 2658: 2654: 2648: 2607: 2603: 2597: 2562: 2558: 2548: 2515: 2511: 2505: 2472: 2468: 2462: 2440:(1): 131–4. 2437: 2433: 2423: 2388: 2384: 2374: 2349: 2345: 2339: 2322: 2318: 2312: 2295: 2291: 2285: 2253:(7): 841–5. 2250: 2246: 2236: 2227: 2221: 2186: 2182: 2172: 2145: 2141: 2095: 2091: 2085: 2050: 2046: 2020: 2015: 1980: 1976: 1936: 1892: 1889:eBioMedicine 1888: 1878: 1846:(1): 37–48. 1843: 1839: 1829: 1816: 1813: 1810:Other organs 1788: 1775: 1766: 1762: 1753: 1749: 1745: 1723: 1719: 1712: 1706: 1700: 1694: 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2866:25327875 2809:16929916 2774:22137466 2735:15764667 2675:10228565 2640:32594522 2589:12785774 2540:16034684 2532:23314769 2497:11325715 2489:15771276 2415:19029422 2213:31646081 2164:27429143 2120:57428676 2112:30610562 2077:26993326 2007:29678581 1919:31130474 1870:46010434 1862:17241099 1512:n = 225 1504:429/471 1318:Prostate 1201:Open or 733:Pancreas 701:25 / 63 672:10 / 10 640:60 / 62 608:71 / 64 576:34 / 59 544:25 / 59 480:28 / 65 448:28 / 58 413:30 / 38 381:44 / 48 349:30 / 30 153:bilayer. 77:necrosis 65:ablation 39:oncology 6814:2650260 6791:Bibcode 6615:2065844 6592:Bibcode 6468:4527477 6428:1233259 6297:3764134 6274:Bibcode 6202:4687652 6179:Bibcode 6143:2650260 6120:Bibcode 6057:3560719 5894:5024881 5841:4376341 5732:4042323 5608:6206548 5550:4227889 5501:6464181 5478:Bibcode 5278:3062508 5229:5090009 5093:5198526 4998:6287993 4663:5934146 4439:4619419 4293:8251595 4240:3815199 4217:Bibcode 4181:5339813 4160:Bibcode 3853:4925804 3749:4263618 3673:4056858 3533:4853139 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A 1759:Lung 1312:LAPC 1102:7.6 1023:150 872:8,7 97:and 6809:PMC 6799:doi 6702:hdl 6692:doi 6651:doi 6610:PMC 6600:doi 6553:doi 6510:doi 6496:236 6463:PMC 6455:doi 6408:doi 6365:doi 6329:doi 6292:PMC 6282:doi 6235:doi 6197:PMC 6187:doi 6138:PMC 6128:doi 6089:doi 6052:PMC 6044:doi 6005:doi 5962:doi 5918:doi 5874:doi 5836:PMC 5826:doi 5779:doi 5727:PMC 5719:doi 5678:doi 5631:doi 5586:doi 5545:PMC 5537:doi 5496:PMC 5486:doi 5426:doi 5422:121 5387:doi 5383:196 5349:doi 5310:doi 5273:PMC 5265:doi 5261:378 5224:PMC 5216:doi 5169:doi 5126:doi 5088:PMC 5078:doi 5074:129 5031:doi 4993:PMC 4985:doi 4952:doi 4944:HPB 4911:doi 4907:294 4864:doi 4828:doi 4784:doi 4780:262 4738:doi 4696:doi 4658:PMC 4648:doi 4607:doi 4560:doi 4516:doi 4472:doi 4434:PMC 4424:doi 4385:doi 4316:doi 4273:doi 4235:PMC 4225:doi 4176:PMC 4168:doi 4121:doi 4085:doi 4041:doi 4006:doi 4002:215 3971:doi 3935:doi 3889:doi 3885:107 3848:PMC 3840:doi 3832:HPB 3785:doi 3744:PMC 3736:doi 3732:273 3692:doi 3653:doi 3611:doi 3528:PMC 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