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      Safety, tolerability, and efficacy evaluation of the SlimME device for circumference reduction

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          Abstract

          Objective

          To assess the short‐ and long‐term thermal impact of subclinical and clinical regimens of a single, non‐invasive uniform ultrasound treatment session on subcutaneous adipose tissue (SAT).

          Study Design

          Prospective, open‐label, single‐arm, split‐side study.

          Methods

          Patients ( n = 17) were subjected to uniform ultrasound treatment, delivered in a single session with the SlimME device. The device was set to one of four treatment regimens, which differed in their durations and energy fluences during the raise and maintenance phases. Up to six abdominal regions were treated, with six patients receiving a different treatment on each side of the abdomen. Safety was assessed by measuring skin surface temperature, evaluating expected skin responses immediately and 30 min after treatment and via patient ratings of pain and discomfort. Efficacy of raising and then maintaining SAT temperatures at 48°C, was determined by routinely measuring SAT temperatures during the treatment session and by histological analysis of samples collected 7 ( n = 13) or 90 ( n = 4) days after treatment.

          Results

          Trace to mild erythema was observed in up to 48% of the treated zones, which, in most cases, resolved within 30 minutes. No significant rise in mean skin surface temperature (≤26.5°C) was recorded following any of the four tested regimens. Overall, patients reported tolerability to treatment, with the highest mean pain score registered for the moderate and high intensity regimens (4.4 ± 1.5 and 4.9 ± 1.4, respectively). Mean SAT temperatures did not exceed 48.4 ± 2.5°C and were effectively maintained throughout the maintenance phase of the treatment session. Low‐energy fluence led to localized fat coagulative necrotic lesions, surrounded by subacute rim of inflammation, while high‐energy fluence induced fat coagulative necrosis alongside granulomatous panniculitis, which resolved within 90 days.

          Conclusion

          The tested uniform ultrasound regimens elicited SAT temperature elevations, with a subsequent energy‐dependent increase in degree of fat necrosis. At the same time, the unique design spared the surrounding tissue from thermal damage and was associated with minimal discomfort. Taken together, the SlimME device constitutes an effective tool for destruction of stubborn hypodermal fat deposits. Lasers Surg. Med. 50:745–754, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

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          Most cited references25

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          High intensity focused ultrasound: surgery of the future?

          For 50 years, high intensity focused ultrasound (HIFU) has been a subject of interest for medical research. HIFU causes selective tissue necrosis in a very well defined volume, at a variable distance from the transducer, through heating or cavitation. Over the past decade, the use of HIFU has been investigated in many clinical settings. This literature review aims to summarize recent advances made in the field. A Medline-based literature search (1965-2002) was conducted using the keywords "HIFU" and "high intensity focused ultrasound". Additional literature was obtained from original papers and published meeting abstracts. The most abundant clinical trial data comes from studies investigating its use in the treatment of prostatic disease, although early research looked at applications in neurosurgery. More recently horizons have been broadened, and the potential of HIFU as a non-invasive surgical tool has been demonstrated in many settings including the treatment of tumours of the liver, kidney, breast, bone, uterus and pancreas, as well as conduction defects in the heart, for surgical haemostasis, and the relief of chronic pain of malignant origin. Further clinical evaluation will follow, but recent technological development suggests that HIFU is likely to play a significant role in future surgical practice.
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            Extracorporeal high intensity focused ultrasound ablation in the treatment of 1038 patients with solid carcinomas in China: an overview.

            The ideal treatment of localized cancer should directly cause an irreversible and complete death of tumor cells without damage to surrounding normal tissue. High intensity focused ultrasound (HIFU) is such a potential treatment, which induces a complete coagulative necrosis of a tumor at depth through the intact skin. The idea that using an extracorporeal source of therapeutic ultrasound was introduced more than 50 years ago [J. Gen. Physiol. 26 (1942) 179]. However, up to now, most of the studies on HIFU have been dealing with animal experiments because this extracorporeal technique is very complicated in clinical applications. The purpose of this study is to introduce Chinese clinical experience of using extracorporeal HIFU for the treatment of patients with various kinds of solid tumor. From December 1997 to October 2001, a total of 1038 patients with solid tumors underwent HIFU ablation in China. Among them, 313 patients were treated at the Chongqing University of Medical Sciences, China. Pathological examination showed that the target region presented clear evidence of cellular destruction. Small blood vessels less than 2 mm in diameter were severely damaged. Follow-up diagnostic imaging revealed that there was no, or reduced, blood supply, and no uptake of radioisotope in the treated tumor after HIFU, both indicating a positive therapeutic response and an absence of viable tumor. Imaging at 6-12 months showed obvious regression of the lesion. Four-year follow-up data were significantly observed in patients with hepatocellular carcinoma, osteosarcoma, and breast cancer. An extremely low major complication rate was noted. It is concluded that HIFU ablation is a safe, effective, and feasible modality for the ablation of carcinomas.
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              Selective cryolysis: a novel method of non-invasive fat removal.

              Excess fat poses a host of local and systemic problems. Various energy sources, for example, laser, ultrasound, and radiofrequency electric current have been studied as potential non-invasive treatments aimed at local destruction of subcutaneous fat. Cryosurgery at very low temperatures is routinely used for non-specific tissue destruction, however the potential for tissue-specific cold injury has not been investigated. This study describes non-invasive cold-induced selective destruction of subcutaneous fat. Black Yucatan pigs under general anesthesia were exposed within test sites to preset temperatures of 20, -1, -3, -5, and -7 degrees C for 10 minutes. Gross and histological assessments were performed immediately, 1 day, 2, 7, 14 and 28 days post-cold exposure for four pigs, and up to 3.5 months for one pig. Additionally, six pigs were exposed between -5 degrees C and -8 degrees C for 10 minutes, at sites covering approximately 15% body surface area, followed by serum lipid level determinations at various time points up to 3 months. A lobular panniculitis was induced by cooling, followed for some test sites by grossly obvious loss of several mm of subcutaneous fat occurring gradually during the 3.5 months study period. Loss of adipocytes, the appearance of lipid-laden mononuclear inflammatory cells, and local thickening of fibrous septae were noted. Typically there was no clinical or histological evidence of injury to skin, and no scarring. Serum lipids were not significantly increased. Prolonged, controlled local skin cooling can induce selective damage and subsequent loss of subcutaneous fat, without damaging the overlying skin. Selective cryolysis warrants further study as a local treatment for removal of adipose tissue. (c) 2008 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                docferrando@gmail.com
                Journal
                Lasers Surg Med
                Lasers Surg Med
                10.1002/(ISSN)1096-9101
                LSM
                Lasers in Surgery and Medicine
                John Wiley and Sons Inc. (Hoboken )
                0196-8092
                1096-9101
                07 February 2018
                September 2018
                : 50
                : 7 ( doiID: 10.1002/lsm.v50.7 )
                : 745-754
                Affiliations
                [ 1 ] Queen Anne Street Medical Centre 18‐22 Queen Anne St Marylebone W1G 8HU London
                Author notes
                [*] [* ] Correspondence to: Giovanni Ferrando, MD, Queen Anne Street Medical Centre, 18‐22 Queen Anne St, Marylebone W1G 8HU, London. E‐mail: docferrando@ 123456gmail.com

                Article
                LSM22796
                10.1002/lsm.22796
                6120542
                29411402
                054d3884-f492-42c5-b5b5-bdf5da5f2ec4
                © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 10 January 2018
                Page count
                Figures: 5, Tables: 4, Pages: 10, Words: 5198
                Funding
                Funded by: Lumenis Ltd.
                Categories
                Clinical Reports
                Clinical Reports
                Custom metadata
                2.0
                lsm22796
                September 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.7.1 mode:remove_FC converted:03.09.2018

                slimme,non‐invasive,ultrasound,fat reduction,fat cell destruction,subcutaneous fat,subcutaneous adipose tissue,lipolysis

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