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dc.contributor.authorShaw, CJen_US
dc.contributor.authorRivens, Ien_US
dc.contributor.authorCivale, Jen_US
dc.contributor.authorBotting, KJen_US
dc.contributor.authorTer Haar, Gen_US
dc.contributor.authorGiussani, DAen_US
dc.contributor.authorLees, CCen_US
dc.coverage.spatialEnglanden_US
dc.date.accessioned2019-02-15T15:57:59Z
dc.date.issued2018-09-11en_US
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/30206278en_US
dc.identifier10.1038/s41598-018-31914-4en_US
dc.identifier.citationSci Rep, 2018, 8 (1), pp. 13631 - ?en_US
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/3052
dc.identifier.eissn2045-2322en_US
dc.identifier.doi10.1038/s41598-018-31914-4en_US
dc.description.abstractPre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3-4.4 kW.cm-2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3-3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was not different between sham and treatment groups. We report the first successful application of fully non-invasive HIFU for occlusion of placental blood flow in a pregnant sheep model, with a low risk of significant complications. This proof of concept study demonstrates the potential of this technique for clinical translation.en_US
dc.format.extent13631 - ?en_US
dc.languageengen_US
dc.language.isoengen_US
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.titleTrans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound.en_US
dc.typeJournal Article
dcterms.dateAccepted2018-06-28en_US
rioxxterms.versionofrecord10.1038/s41598-018-31914-4en_US
rioxxterms.licenseref.startdate2018-09-11en_US
rioxxterms.typeJournal Article/Reviewen_US
dc.relation.isPartOfSci Repen_US
pubs.issue1en_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Therapeutic Ultrasound
pubs.publication-statusPublished onlineen_US
pubs.volume8en_US
pubs.embargo.termsNot knownen_US
icr.researchteamTherapeutic Ultrasounden_US
dc.contributor.icrauthorCivale, Johnen_US
dc.contributor.icrauthorRivens, Ianen_US
dc.contributor.icrauthorTer Haar, Gailen_US


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