Background: Irreversible electroporation (IRE) is a relatively new approach to the management of multiple types of locally advanced soft tissue tumors. Unique peri-procedural anesthetic management is needed in the safe and effective delivery of this therapy.Objectives: This study analyzed IRE therapy in relation to anesthetic management for our initial cohort and then established and validated a set of best practical guidelines for general anesthesia in patients undergoing IRE for abdominal tumors.Patients and Methods: An IRB-approved prospective data collection outcome protocol was utilized. This study was broken up into two cohorts as follows: the initial 38 patients (pts) undergoing IRE in which anesthetic management was not defined or optimized and then a 40-pt validation cohort to establish the most efficacious anesthetic protocols.Results: During IRE delivery, a deeper neuromuscular blockade is required to ensure that all retroperitoneal muscle excitation was minimized. In the initial 38-pt cohort, attempts to treat hypertension (median SBP 190, range 185-215 and median diastolic 98, range 91-115) were made with various types of anti-hypertensives with minimal-to-insufficient effects. The established inhalation was sevoflurane with an approximate median dose of 8.0 volume percentage. Analgesic management of continuous remifentanil was utilized with epidural management, which optimized HTN and tolerance to IRE therapy.Conclusions: Anesthetic management for IRE of soft tissue deviates from standard anesthetic medical therapy in regards to depth of neuromuscular blockade and analgesic management during IRE energy delivery. However, minor modifications in anesthesia management allow for a safe and efficient patient procedure.

Background: Irreversible electroporation (IRE) is a novel tumor ablation technique. IRE is associated with high electrical fields and is often reported in conjunction with thermal damage caused by Joule heating. For good response to surgery it is crucial to produce minimum thermal damage in both tumoral and healthy tissues named Non-Thermal Irreversible Electroporation (NTIRE). Non-thermal irreversible electroporation attempts have concentrated on tumor ablation with strong electric field with producing minimum thermal damage.Objective: To establish a Multi Objective Genetic Algorithm (MOGA) for IRE treatment planning.Methods: Numerical modeling and genetic programming were coupled to optimize thermal and electrical distribution in tissue. A 3D MRI based model was established and treatment parameters such as electrode thickness, electrode insertion, distance between electrode and applied voltage were optimized.Results: Prefect tumor ablation with IRE surgery with relatively little electrical and thermal damage on healthy tissue can be achieved by using genetic algorithm optimization. Such optimization can trade off between perfect tumor coverage and damage to healthy tissue. Concerning the thermal aspect of IRE surgery.Conclusion: The established multi-objective genetic algorithm based treatment planning system, can optimize both geometric and electric parameters in IRE surgery. Such optimization result in prefect tumor ablation as well as minimum thermal damage to both normal and tumoral tissue.

Introduction: I rreversible electroporation (IRE) is a process in which the membrane of the cancer cells are irreversibly damaged with the use of high-intensity electric pulses, which in turn leads to cell death. The IRE is a non-thermal way to ablate the cancer cells. This process relies on the distribution of the electric field, which affects the pulse amplitude, width, and electrical conductivity of the tissues. The present study aimed to investigate the relationship of the pulse width and intensity with the conductivity changes during the IRE using simulation.Materials and Methods: For the purpose of the study, the COMSOL 5 software was utilized to predict the conductivity changes during the IRE. We used 4, 000 bipolar and monopolar pulses with the frequency of 5 kHz and 1 Hz, width of 100 ms, and electric fields of low and high intensity. Subsequently, we built three-dimensional numerical models for the liver tissue.Results: The results of our study revealed that the conductivity of tissue increased during the application of electrical pulses. Additionally, the conductivity changes increased with the elevation of the electric field intensity.Conclusion: As the finding of this study indicated, the IRE with high-frequency and low electric field intensity could change the tissue conductivity. Therefore, the IRE was recommended to be applied with high frequency and low voltage.

Introduction: Regular interval training with adaption volume regulated genes expression in diabetic pations and reduced cardiomyopathy. Background: The purpose of this study was Comparison Comparison the Effect of Two types of High-Intensity Interval Training on the Expression Genes of IRS-1 and IRE-1α,in the Cardiomyocytes type 2 diabetes of Obes Male Rats. Methods: 36 male Wistar rats were divided into 4 groups: type1 highintensity interval training (HIIT1: 1), type2 high-intensity interval training (HIIT2: 1), diabetic control (DC), and nondiabetic control (NC) trained fo 4 weeks and 5 days/week. Plasma glucose concentration was measured by the glucose oxidase method. ELISA method was used to measure the insulin levels and the HOMA-IR method was used to measure insulin resistance index. A real-time PCR technique was used to evaluate the gene expression of the IRS-1 and IRE-1α,genes. Results were analyzed with one-way ANOVA and Tukey post hoc tests at the alpha level of 0/05. Diabetes induced by STZ in diabetic groups. Results: gene expression of IRS-1 in both groups of HIIT2: 1(p= 0. 002) and HIIT1: 1(p= 0. 006) showed a significant decrease compared to the DC group and in HIIT2: 1(P=0/043) showed a significant decrease compared to the HIIT1: 1 group. a gene of IRE-1α,in both groups of HIIT2: 1(p= 0. 005) and HIIT1: 1(p= 0. 007) showed a significant decrease compared to the DC group and in HIIT2: 1(P=0/001) showed a significant decrease compared to the HIIT1: 1 group. The mean weight values and insulin resistance index in the HIIT1: 1 group and glucose were significantly lower in the HIIT2: 1 group. Conclusion: 4 weeks High-intensity interval training type 2 with a higher effect on decreasing IRS-1 and IRE-1α,genes expression in cardiomyocytes of obese diabetic rats may it can improve gene dysregulation.

Introduction: Regular interval training with adaption volume regulated genes expression in diabetic pations and reduced cardiomyopathy. Background: The purpose of this study was Comparison Comparison the Effect of Two types of High-Intensity Interval Training on the Expression Genes of IRS-1 and IRE-1α,in the Cardiomyocytes type 2 diabetes of Obes Male Rats. Methods: 36 male Wistar rats were divided into 4 groups: type1 highintensity interval training (HIIT1: 1), type2 high-intensity interval training (HIIT2: 1), diabetic control (DC), and nondiabetic control (NC) trained fo 4 weeks and 5 days/week. Plasma glucose concentration was measured by the glucose oxidase method. ELISA method was used to measure the insulin levels and the HOMA-IR method was used to measure insulin resistance index. A real-time PCR technique was used to evaluate the gene expression of the IRS-1 and IRE-1α,genes. Results were analyzed with one-way ANOVA and Tukey post hoc tests at the alpha level of 0/05. Diabetes induced by STZ in diabetic groups. Results: gene expression of IRS-1 in both groups of HIIT2: 1(p= 0. 002) and HIIT1: 1(p= 0. 006) showed a significant decrease compared to the DC group and in HIIT2: 1(P=0/043) showed a significant decrease compared to the HIIT1: 1 group. a gene of IRE-1α,in both groups of HIIT2: 1(p= 0. 005) and HIIT1: 1(p= 0. 007) showed a significant decrease compared to the DC group and in HIIT2: 1(P=0/001) showed a significant decrease compared to the HIIT1: 1 group. The mean weight values and insulin resistance index in the HIIT1: 1 group and glucose were significantly lower in the HIIT2: 1 group. Conclusion: 4 weeks High-intensity interval training type 2 with a higher effect on decreasing IRS-1 and IRE-1α,genes expression in cardiomyocytes of obese diabetic rats may it can improve gene dysregulation.