Research advances in thermal ablation for lung cancer / 中国胸心血管外科临床杂志

@#Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.

Resultados del aislamiento eléctrico de las venas pulmonares en pacientes menores y mayores de 70 años / Outcomes of pulmonary vein electrical isolation in patients younger than and older than 70 years

Resumen Introducción y objetivos: Comparar las características clínicas y los resultados de cohortes contemporáneas de pacientes menores y mayores de 70 años que han sido sometidos a ablación de fibrilación auricular (FA) mediante catéter. Métodos: Se llevó a cabo un estudio de cohortes retrospectivo en pacientes sometidos a ablación con catéter debido a la presencia de FA refractaria. Se realizó un seguimiento mínimo de 12 meses por paciente. Resultados: En el estudio se incluyeron un total de 239 pacientes sometidos a ablación de FA, de los cuales 171 (71,5%) pertenecían al grupo de edad < 70 años y 68 (28,5%) al grupo de edad > 70 años. La edad promedio de la población estudiada fue de 62,4 años (desviación estándar [DE] = 10,87). El grupo < 70 años presentó una edad promedio de 58,03 años (DE = 9,71), mientras que el grupo > 70 años tuvo una edad promedio de 73,4 años (DE = 3,05). Además, se observó una mayor prevalencia de FA paroxística en el grupo de pacientes menores de 70 años, mientras que en el grupo de pacientes mayores de 70 años se encontró una mayor prevalencia de FA persistente. Estas diferencias fueron estadísticamente significativas en ambos casos. Las tasas de recurrencia después del primer procedimiento de ablación fueron similares entre los dos grupos (21,43% en el grupo menor de 70 años frente a 23,53% en el grupo mayor de 70 años, p = 0,79). No se encontraron diferencias significativas en cuanto a complicaciones. El grupo menor de 70 años experimentó 18 complicaciones, mientras que el grupo mayor de 70 años tuvo 5 complicaciones, con un valor de p de 0,472. Conclusión: Los pacientes mayores de 70 años sometidos al primer procedimiento de ablación de FA por catéter presentan resultados clínicos similares a los pacientes menores de 70 años.

Abstract Introduction and objectives: The objective of this study is to compare the clinical characteristics and outcomes of contemporary cohorts of patients undergoing catheter ablation for atrial fibrillation (AF), stratified by age (< 70 years and ≥ 70 years). Methods: This retrospective cohort study included patients who underwent catheter ablation for refractory AF. The minimum follow-up duration per patient was 12 months. Results: A total of 239 patients were included in the study, with 171 (71.5%) in the < 70 years group and 68 (28.5%) in the ≥ 70 years group. The mean age of the study population was 62.4 years (SD 10.87). The < 70 years group had a mean age of 58.03 years (SD 9.71), while the ≥ 70 years group had a mean age of 73.4 years (SD 3.05). Furthermore, a higher proportion of paroxysmal AF was observed in patients < 70 years, whereas a higher proportion of persistent AF was found in patients ≥ 70 years. These differences were statistically significant. The recurrence rates after the initial ablation procedure were similar between the two groups (21.43% in the < 70 years group vs. 23.53% in the ≥ 70 years group, p = 0.79). Additionally, there were no significant differences in terms of complications. The < 70 years group experienced 18 complications, while the ≥ 70 years group had 5 complications (p = 0.472). Conclusion: The findings of this study suggest that patients aged 70 years and older who undergo their first catheter ablation procedure for AF demonstrate similar clinical outcomes compared to patients younger than 70 years.

Eficácia da reabilitação perineal combinada com biofeedback e diatermia por radiofrequência (RDF) em síndromes de dor funcional anorretal associadas à contração paradoxal dos músculos elevadores do ânus. Um estudo prospectivo / Effectiveness of perineal pelvis rehabilitation combined with biofeedback and radiofrequency diathermy (rdf) in anorectal functional pain syndromes associated with paradoxical contraction of the levator ani muscles. a prospective study

ABSTRACT Background: Anorectal functional pain syndrome, also called chronic proctalgia, represents a neglected clinical entity and often confused with other syndromes such as vulvodynia or acute proctalgia. It is a very often disabling disease with a consequent significant negative impact on the patient's quality of life. Chronic proctalgia, in many patients, is secondary to the paradoxical contraction of the pelvic floor and associated with a dissynergy between the thorax-abdomen and the pelvic floor. To improve symptoms in functional anorectal pain syndromes, various rehabilitation techniques are used with the aim of promoting relaxation of the pelvic floor; however, to improve defecatory dynamics in patients with levator ani syndrome, only biofeedback has shown efficacy in a randomized study. The aim of this work is to evaluate whether a rehabilitation protocol with manometric biofeedback and radiofrequency diathermy (mt100 Fremslife emotion Tecar) reduces pain and paradoxical contraction of the levator ani and improves the quality of life in patients with anorectal pain syndromes. functional. Methods: This was a prospective study on 30 patients (20 women and 10 men) with anorectal functional pain syndrome and paradoxical contraction of the pelvic floor enrolled at the UOC of General, Minimally Invasive, Oncological and Obesity Surgery of the AOU "Luigi Vanvitelli" of Naples, Italy, from September 2021 to May 2022. All patients were evaluated with a coloproctological specialist visit followed by anorectal manometry and evaluation of altered clinical physiatric parameters (Brusciano Score). The protocol consisted of 10 rehabilitation sessions of the pelvic floor once a week and lasting approximately 45 minutes. During the sessions the patients were subjected to diathermy / radiofrequency treatment (10 minutes) with a static resistive electrode on the diaphragm, during which they were required to breathe diaphragmatically and to become aware of the perineal muscles, under the supervision of a physiotherapist; followed by application of diathermy with static capacitive (5 minutes) and resistive (10 minutes) electrode at the lumbar level. This was followed by the use of manometric biofeedback (15 minutes of tonic / phasic exercises) in order to instruct the patient on the reflex mechanism to obtain a voluntary relaxation of the external anal sphincter. The variables evaluated were Pain (VAS 0-10) and the questionnaire on the impact of colorectal and anal pathologies on the quality of life (CRAIQ-7) at the beginning, after 3 months and at the end of the treatment. Results: After 10 weeks, the rehabilitation treatment combined with diathermy and manometric biofeedback proved effective in the short term with a reduction in the scores of the Vas scale and CRAIQ-7 questionnaire and an increase in the percentage of release of the anal muscles on anorectal manometry. Conclusion: The use of radiofrequency diathermy with a system of static electrodes associated with biofeedback represents a valid rehabilitation option for those patients suffering from anorectal functional pain syndrome because it reduces pain and paradoxical contraction of the levator ani and improves quality of life of the patient.

RESUMO Contexto: A síndrome de dor funcional anorretal, também conhecida como proctalgia crônica, representa uma entidade clínica negligenciada e frequentemente confundida com outras síndromes, como vulvodinia ou proctalgia aguda. Trata-se de uma doença frequentemente incapacitante, com um consequente impacto negativo significativo na qualidade de vida do paciente. A proctalgia crônica, em muitos pacientes, é secundária à contração paradoxal do assoalho pélvico e está associada a uma dissinergia entre o tórax-abdômen e o assoalho pélvico. Para melhorar os sintomas em síndromes de dor anorretal funcional, são utilizadas diversas técnicas de reabilitação com o objetivo de promover o relaxamento do assoalho pélvico. No entanto, para melhorar a dinâmica de evacuação em pacientes com síndrome do elevador do ânus, apenas o biofeedback demonstrou eficácia em um estudo randomizado. Objetivo: O objetivo deste trabalho é avaliar se um protocolo de reabilitação com biofeedback manométrico e diatermia por radiofrequência (mt100 Fremslife emotion Tecar) reduz a dor e a contração paradoxal do elevador do ânus e melhora a qualidade de vida em pacientes com síndromes de dor anorretal funcional. Métodos: Realizado estudo prospectivo com 30 pacientes (20 mulheres e 10 homens) com síndrome de dor anorretal funcional e contração paradoxal do assoalho pélvico inscritos na UOC de Cirurgia Geral, Minimamente Invasiva, Oncológica e de Obesidade da AOU "Luigi Vanvitelli" de Nápoles, Itália, de setembro de 2021 a maio de 2022. Todos os pacientes foram avaliados com uma consulta especializada em coloproctologia, seguida de manometria anorretal e avaliação dos parâmetros fisiátricos clínicos alterados (Escore de Brusciano). O protocolo consistiu em 10 sessões de reabilitação do assoalho pélvico, uma vez por semana, com duração aproximada de 45 minutos. Durante as sessões, os pacientes foram submetidos a tratamento de diatermia / radiofrequência (10 minutos) com um eletrodo resistivo estático no diafragma, durante o qual foram solicitados a respirar através do diafragma e a tomar consciência dos músculos perineais, sob a supervisão de um fisioterapeuta; seguido pela aplicação de diatermia com eletrodo capacitivo estático (5 minutos) e resistivo (10 minutos) no nível lombar. Isso foi seguido pelo uso de biofeedback manométrico (15 minutos de exercícios tônicos /fásicos) com o objetivo de instruir o paciente sobre o mecanismo reflexo para obter um relaxamento voluntário do esfíncter anal externo. As variáveis avaliadas foram Dor (EVA 0-10) e o questionário sobre o impacto das patologias colorretais e anais na qualidade de vida (CRAIQ-7) no início, após 3 meses e no final do tratamento. Resultados: Após 10 semanas, o tratamento de reabilitação combinado com diatermia e biofeedback manométrico mostrou-se eficaz a curto prazo, com uma redução nos escores da escala VAS e do questionário CRAIQ-7, e um aumento na porcentagem de relaxamento dos músculos anais na manometria anorretal. Conclusão: O uso de diatermia por radiofrequência com um sistema de eletrodos estáticos associado ao biofeedback representa uma opção de reabilitação válida para pacientes que sofrem com a síndrome de dor anorretal funcional, pois reduz a dor e a contração paradoxal do elevador do ânus, melhorando a qualidade de vida do paciente.

Tratamiento de la dermatochalasis con cirugía de ondas de radio

Objetivo: Describir los resultados de la blefaroplastia de los párpados superiores realizada con radiocirugía a pacientes con dermatochalasis del párpado superior. Métodos: Se realizó un estudio descriptivo longitudinal con pacientes del servicio de Oftalmología en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en el período entre enero de 2021 a diciembre de 2022. Después de aplicar los criterios de selección la muestra quedó constituida por los primeros 50 pacientes que asistieron de forma consecutiva. Resultados: Predominaron los pacientes entre los 60 a 79 años de edad, el sexo femenino y los de color de piel blanca (p > 0,05). Se logró una reducción completa de la piel redundante en más de un 50 %. El tiempo quirúrgico promedio con radiofrecuencia fue de 35.9 min. La satisfacción de los pacientes fue buena en un 96 %. Las complicaciones posoperatorias se manifestaron en un 32 % de los pacientes, solo en dos pacientes fueron serias, las cuales no dejaron secuelas. Conclusiones: La cirugía con ondas de radios para el tratamiento de la dermatochalasis permite alcanzar el resultado estético que se desea, con satisfacción tanto para el médico, como para los pacientes quienes logran mejorar su calidad de vida.

Objective: To describe the results of upper eyelid blepharoplasty performed with radiosurgery in patients with upper eyelid dermatochalasis. Methods: A longitudinal descriptive study was carried out with patients from the ophthalmology service at Hospital Clínico Quirúrgico Hermanos Ameijeiras, from January 2021 to December 2022. After applying the selection criteria, the sample was made up of the first 50 patients who attended consecutively. Results: Patients aged 60-79 years predominated, as well as the female sex and the white skin color (p > 0.05). A complete reduction of redundant skin was achieved in more than 50 %. The average surgical time with radiofrequency was 35.9 min. Patient satisfaction was good in 96 %. Postoperative complications were present in 32 % of patients, only in two patients were they serious, but did not leave any sequelae. Conclusions: Radiowave surgery for treating dermatochalasis allows to achieve the desired aesthetic outcome, with satisfaction for both the physician and the patients, who achieve an improvement in their quality of life.

Comparative efficacy and safety of six photoelectric therapies for the atrophic acne scars: A network meta-analysis

Objectives: This network meta-analysis assessed the relative efficacy and safety of six common photoelectric therapies including 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG), fractional carbon dioxide laser(FSCO2), fractional micro-plasma radiofrequency(Plasma), micro-needling fractional radiofrequency (MRF), 1550nm or 1540nm erbium-glass non-ablative fractional laser (NAFL) fractional erbium-doped yttrium aluminum garnet (Er: YAG). Methods: A comprehensive search to identify relevant studies was conducted using four electronic databases. Outcome measures were extracted based on subjective and objective indexes, including the dermatologists’ evaluation(DE), the patients’ overall satisfaction(PS), VAS score, and Postinflammatory hyperpigmentation (PIH). Results: Eleven published clinical research studies, involving 405 patients were included in this study. Ranking of DE from large to small is as follows: Nd: YAG, FSCO2, Er: YAG, Plasma, NAFL, MRF. In terms of PS, the rand from high to low can be described as follows: Er: YAG, Nd: YAG, FSCO2, Plasma, NAFL, MRF. In connection with the sequencing of adverse events, pain severity from slight to severe as follows: Er:YAG, Nd:YAG, FSCO2, NAFL, MRF, Plasma. The probability of having PIH are presented in order from lowest to highest as follows: MRF, Plasma, Nd: YAG, NAFL, Er: YAG, FSCO2. Conclusion: FSCO2 remains the mainstream of potentially curative treatment, then again Nd: YAG and Er: YAG require greater efforts to prove their superior effectiveness. NAFL might be appropriate for mild and moderate improvement with its strengths of good tolerance while Plasma fits into patients with higher pain thresholds but an expectation of higher results. MRF has not given expression on absolute predominance for the present. Registration: PROSPERO CRD42021242160(available from https://www.crd.york.ac.uk/PROSPERO)

Arrhythmia in Adult Congenital Heart Disease

This case report highlights the significance of a multidisciplinary approach in the management of patients with repaired membranous ventricular septal defect (VSD) who develop postoperative arrhythmias. We present the case of a young female who experienced symptomatic episodes of supraventricular tachycardia following VSD repair. Through electrophysiological study and radiofrequency ablation, multiple tachycardia substrates were identified and successfully ablated. This report underscores the importance of combining surgical repair, electrophysiological evaluation and intervention to achieve optimal outcomes in this specific patient population.

Lumbar Facet Syndrome and the Use of Radiofrequency Ablation Technique as an Alternative Therapy: A Systematic Review / Síndrome facetária lombar e a utilização da técnica de ablação por radiofrequência como terapia alternativa: uma revisão sistemática

Abstract Lumbar facet syndrome stands out as a significant cause for the increasing prevalence of back pain complaints. Alternatives such as radiofrequency (RF) ablation may be a therapeutic option to relieve the chronic pain associated with this condition. It is critical to analyze the effectiveness of lumbar facet syndrome treatment using the traditional RF ablation technique and the relief generated by it in chronic low back pain (CLBP). This study is a systematic review using the following inclusion criteria: title, observational studies, clinical trials, controlled clinical trials, clinical studies, and publications over the last 17 years (from 2005 to 2022). The exclusion criteria included papers addressing other themes and review articles. The databases used for data collection included the Medical Literature Analysis and Retrieval System Online (Medline), PubMed, Scientific Electronic Library Online (SciELO), Lilacs, and Biblioteca Virtual em Saúde (Virtual Health Library in Portuguese). The query used the following terms: facet, pain, lumbar, and radiofrequency. The application of these filters yielded 142 studies, and 12 were included in this review. Most studies indicated that the traditional RF ablation technique was beneficial in relieving CLBP refractory to conservative treatment.

Resumo Em um contexto de aumento da prevalência de queixas de dores na coluna, a síndrome facetária se destaca como um importante causador. Alternativas como a ablação por radiofrequência (RF) podem ser uma opção de terapia para alívio da dor crônica que essa patologia pode causar. É necessário analisar a eficácia do tratamento da síndrome facetária pela técnica de ablação por radiofrequência tradicional e o alívio gerado nas dores lombares crônicas (DLC). O presente estudo trata-se de uma revisão sistemática cujo os critérios de inclusão para análise foram: título; estudos observacionais; ensaios clínicos; ensaio clínico controlado; estudos clínicos e publicação nos últimos dezessete anos (2005-2022). Já os critérios de exclusão foram: artigos que abordavam outras temáticas e artigos de revisão. As bases utilizadas para coleta de dados incluíram Medical Literature Analysis and Retrieval System online (Medline), Pubmed, Scientific Electronic Library Online (SciELO), Lilacs, Biblioteca Virtual em Saúde. Os termos utilizados para a pesquisa foram: facet; pain; lumbar; radiofrequency. Aplicando-se os filtros foram encontrados 142 estudos, 12 foram incluídos. Os estudos em sua maioria apontaram ser benéfica a técnica de ablação por radiofrequência tradicional no alívio das dores lombares crônicas refratárias ao tratamento conservador.

The effect of early radiofrequency turbinate reduction, intranasal steroid, and antihistamine H-1 on persistent allergic rhinitis: a randomized clinical trial

Abstract Objective: We aimed to evaluate the effect of radiofrequency turbinate reduction as an initial treatment on clinical improvement, inflammatory mediators, and remodeling process. Methods: Between July 2018- February 2020, 32 patients with moderate-severe persistent AR were randomly divided into 2 groups. Intervention group received radiofrequency turbinate reduction followed by intranasal steroid and Antihistamine H-1 (AH-1), control group received intranasal steroid and AH-1. Both groups were evaluated for clinical improvement (using visual analogue scale based on total nasal symptoms score, peak nasal inspiratory flow, and turbinate size using imageJ) after 4 and 8 weeks of treatment. Inflammatory mediators (ELISA from nasal secretions was performed to measure ECP, IL-5, and HSP-70) and remodeling markers (nasal biopsy followed by immunohistochemistry examination was performed to evaluate MMP-9, TIMP-1, and PAI-1) were evaluated in week 4. Results: Three patients dropped out of the study, resulting in 16 patients in intervention group and 13 patients in control group. At week 4, clinical response improved significantly in the intervention group compared to control group (Chi-Square test, p<0.05). Compared to control, intervention group experienced a reduction of IL-5 and no significant change in ECP level (Mann Whitney test, p>0.05). Reduction in the ratio of MMP-9/TIMP-1 were significantly higher in intervention group (unpaired t-test, p< 0,05). Meanwhile, increase in HSP-70 in the intervention group was slightly lower than in control group, but the difference with control group was not significant (Mann Whitney test, p>0.05). Conclusion: Early radiofrequency turbinate reduction followed by pharmacotherapy given to persistent moderate-severe AR patients give more improvement only in early clinical symptoms and reduce MMP-9/TIMP-1 ratio, thus it might be suggested as one of the adjuvant therapies for the management of moderate-severe persistent AR. However, further investigation with a larger sample size and longer follow-up period is needed. Level of evidence: 1B.

The success rate of radiofrequency catheter ablation in Wolff-Parkinson-White-Syndrome patients: A systematic review and meta-analysis

Introduction: radiofrequency catheter ablation (RFA) is the first-line therapy for symptomatic Wolff Parkinson White (WPW) patients according to the American Heart Association. We conducted this study to assess the success rate, recurrence rate, and rate of complications associated with the utilization of radiofrequency catheter ablation for managing patients with WPW. Method: We searched PubMed, Cochrane library, Web of Science and Scopus databases using all identified keywords and index terms through 4 January 2022. We included all studies conducted on WPW patients who were treated with ablation. We conducted the analysis using Open Meta Analyst and MedCalc version 19.1. Results: Among 2268 unique articles identified, only 11 articles met our inclusion criteria. The pooled effect estimates showed high success rate (94.1%[95%CI:92.3e95.9], p < 0.001)), low recurrence rate (6.2% [95%CI:4.5e7.8, p < 0.001]) and low rate of complications (1%[95%CI:0.4e1.5, p < 0.001]). Conclusion: RFA showed a high success rate, low recurrence rate and low rate of complications in WPW patients

Applicability of vaginal energy-based devices in urogynecology: evidence and controversy

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial

Abstract Objectives: To evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. Methods: This was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). Results: One hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. Conclusions: Radiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.

Endoscopic ablation combined with fundoplication plus acid suppression-duodenal diversion procedure for long segment barrett´s esophagus: early and long-term outcome / Ablação endoscópica combinada com fundoplicatura associada a diversão duodenal no esôfago de barrett longo: resultados precoce e de longo prazo

ABSTRACT BACKGROUND: The addition of endoscopic ablative therapy plus proton pump inhibitors or fundoplication is postulated for the treatment of patients with long-segment Barrett´s esophagus (LSBE); however, it does not avoid acid and bile reflux in these patients. Fundoplication with distal gastrectomy and Roux-en-Y gastrojejunostomy is proposed as an acid suppression-duodenal diversion procedure demonstrating excellent results at long-term follow-up. There are no reports on therapeutic strategy with this combination. AIMS: To determine the early and long-term results observed in LSBE patients with or without low-grade dysplasia who underwent the acid suppression-duodenal diversion procedure combined with endoscopic therapy. METHODS: Prospective study including patients with endoscopic LSBE using the Prague classification for circumferential and maximal lengths and confirmed by histological study. Patients were submitted to argon plasma coagulation (21) or radiofrequency ablation (31). After receiving treatment, they were monitored at early and late follow-up (5-12 years) with endoscopic and histologic evaluation. RESULTS: Few complications (ulcers or strictures) were observed after the procedure. Re-treatment was required in both groups of patients. The reduction in length of metaplastic epithelium was significantly better after radiofrequency ablation compared to argon plasma coagulation (10.95 vs 21.15 mms for circumferential length; and 30.96 vs 44.41 mms for maximal length). Intestinal metaplasia disappeared in a high percentage of patients, and histological long-term results were quite similar in both groups. CONCLUSIONS: Endoscopic procedures combined with fundoplication plus acid suppression with duodenal diversion technique to eliminate metaplastic epithelium of distal esophagus could be considered a good alternative option for LSBE treatment.

RESUMO RACIONAL: A adição de terapia ablativa endoscópica associado a inibidores da bomba de prótons ou fundoplicatura tem sido postulada para o tratamento de pacientes com esôfago de Barrett de segmento longo (EBSL), no entanto, essa conduta não evita o refluxo ácido/biliar nesses pacientes. A fundoplicatura com gastrectomia distal e gastrojejunostomia em Y de Roux (FGD-Y) foi proposta como procedimento de supressão de ácido, demonstrando excelentes resultados no seguimento a longo prazo. Não há relatos na literature com a combinação dessa estratégia terapêutica. OBJETIVOS: Determinar os resultados precoces e a longo prazo observados em pacientes com EBSL com ou sem dysplasia de baixo grau, submetidos a FGD-Y, combinado com terapia endoscópica. MÉTODOS: Estudo prospectivo incluindo pacientes com EBSL, empregando a classificação de Praga, sendo o comprimento circunferencial (C) e máximo (M) e confirmado por estudo histológico. Os pacientes foram submetidos à coagulação com plasma de argônio (CPA, 21 pacientes) ou ablação por radiofrequência (ARF, 31 pacientes). Após o tratamento, eles foram seguidos precoce e tardiamente (5-12 anos), mediante avaliação endoscópica e histológica. RESULTADOS: Foram observadas poucas complicações após o procedimento (úlcera ou estenose). Re-tratamento foi necessário em ambos os grupos de pacientes. A redução do comprimento do epitélio metaplásico foi significativamente melhor após ARF em comparação com CPA (10,95 versus 21,15 mm para C e 30,96 versus 44,41 mm para M). A metaplasia intestinal desapareceu em elevada porcentagem de pacientes, e os resultados histológicos a longo prazo foram bastante semelhantes em ambos os grupos. CONCLUSÕES: Procedimentos endoscópicos combinados com fundoplicatura e gastrectomia distal e gastrojejunostomia em Y de Roux, para eliminar o epitélio metaplásico do esôfago distal podem ser considerados uma boa opção alternativa para o tratamento da EBSL.

Development of adenocarcinoma after radiofrequency ablation of barrett's esophagus associated to fundoplication and suppression-duodenal diversion procedure: a lesson to be learned / Adenocarcinoma em esôfago de barrett após ablação por radiofrequência associada a fundoplicatura e diversão duodenal

ABSTRACT Despite endoscopic eradication therapy being an effective and durable treatment for Barrett's esophagus-related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require ongoing routine examinations. Failure of radiofrequency ablation and argon plasma coagulation is reported in 10-20% of cases.

RESUMO Apesar de a terapia de erradicação endoscópica ser um tratamento eficaz e durável para a neoplasia relacionada ao esôfago de Barrett (BE), mesmo após a erradicação inicial bem-sucedida, esses pacientes permanecem em risco de recorrência e requerem exames de rotina contínuos. A falha na ablação por radiofrequência e na coagulação com plasma de argônio é relatada em 10-20% dos casos.

Use of radiofrequency in the treatment of acne: a systematic review / Uso de la radiofrecuencia en el tratamiento del acné: una revisión sistemática / Uso da radiofrequência no tratamento da acne: uma revisão sistemática

ABSTRACT Acne, of great prevalence and impact, presents many forms that can be treated by hygiene, topical medications, and manual alternative interventions such as skin cleansing and electrotherapy. The use of radiofrequency in the treatment of acne aims to increase the temperature in the cutaneous tissue, causing several metabolic and structural reactions, such as stimulating neocollagenesis. This study aimed to investigate the use of high-frequency current as an adjunctive treatment for acne. This is a non-systematic review of indexed databases (MEDLINE, SciELO, LILACS). A total of 18 studies were included in this review and most of them related different treatment for acne associated with radiofrequency. Radiofrequency presents few complications and good results, besides having as an additional advantage the possibility of the patient returning to the routine immediately after application.

RESUMEN Con gran prevalencia e impacto, el acné puede tener muchas formas, las cuales pueden ser tratadas por medio de medidas de higiene, medicamentos tópicos e intervenciones manuales alternativas, como la limpieza de la piel y el uso de electroterapia. La radiofrecuencia en el tratamiento de esta afección tiene como objetivo aumentar la temperatura en el tejido de la piel, provocando diversas reacciones metabólicas y estructurales, como la estimulación de la neocolagénesis. Este trabajo pretendió investigar el uso de corriente de alta frecuencia como coadyuvante en el tratamiento del acné. Esta es una revisión no sistemática en las bases de datos indexadas (MEDLINE, SciELO, LILACS). En esta revisión se incluyeron 18 estudios, la mayoría de ellos abordaban diferentes recursos para el tratamiento del acné asociados al uso de la radiofrecuencia. Se encontró que la radiofrecuencia tiene pocas complicaciones y buenos resultados, además de la ventaja adicional de permitir al paciente volver a la rutina inmediatamente después de su aplicación.

RESUMO De grande prevalência e impacto, a acne apresenta muitas formas, que podem ser tratadas por meio de medidas de higienização, medicamentos tópicos e intervenções alternativas manuais, como limpeza de pele e uso de eletroterapia. A radiofrequência no tratamento da condição tem por objetivo produzir o aumento da temperatura no tecido cutâneo, ocasionando diversas reações metabólicas e estruturais, como o estímulo à neocolagênese. Este trabalho buscou investigar o uso da corrente de alta frequência como coadjuvante no tratamento da acne. Trata-se de uma revisão não sistemática de bases de dados indexadas (MEDLINE, SciELO, LILACS). Foram incluídos 18 estudos nesta revisão, a maioria deles relaciona diferentes recursos de tratamento para acne associados ao uso da radiofrequência. Verificou-se que a radiofrequência apresenta poucas complicações e bons resultados, além de ter como vantagem adicional a possibilidade de o paciente retornar à rotina imediatamente após a aplicação.

O Volume do Apêndice Atrial Esquerdo Prediz a Recorrência de Fibrilação Atrial após Ablação por Cateter de Radiofrequência: Uma Metanálise / Left Atrial Appendage Volume Predicts Atrial Fibrillation Recurrence after Radiofrequency Catheter Ablation: A Meta-Analysis

Resumo Fundamento A influência do volume do apêndice atrial esquerdo (VAAE) na recorrência de fibrilação atrial (FA) após ablação por cateter de radiofrequência permanece obscura. Objetivos Realizamos uma metanálise para avaliar se o VAAE é um preditor independente de recorrência de FA após ablação por cateter de radiofrequência. Métodos Os bancos de dados PubMed e Cochrane Library foram pesquisados até março de 2022 para identificar publicações avaliando o VAAE em associação com a recorrência de FA após ablação por cateter por radiofrequência. Foram encontrados 7 estudos que preencheram os critérios especificados de nossa análise. Usamos a Escala de Newcastle-Ottawa para avaliar a qualidade dos estudos. Os efeitos agrupados foram avaliados dependendo das diferenças médias padronizadas (DMPs) ou hazard ratios (HRs) com intervalos de confiança (ICs) de 95%. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados Um total de 1.017 pacientes de 7 estudos de coorte com um seguimento médio de 16,3 meses foram incluídos na metanálise. Dados de 6 estudos (943 indivíduos) comparando VAAE mostraram que o VAAE basal foi significativamente maior em pacientes com recorrência de FA em comparação com aqueles sem FA (DMP: −0,63; IC de 95%: −0,89 a −0,37; todos os valores de p < 0,05; I 2 = 62,6%). Além disso, maior VAAE foi independentemente associado a um risco significativamente maior de recorrência de FA após ablação por cateter de radiofrequência (HR: 1,10; IC de 95%: 1,02 a 1,18). Conclusões A metanálise mostrou que existe uma correlação significativa entre o VAAE e a recorrência de FA após ablação por cateter de radiofrequência, e o papel do VAAE em pacientes com FA não deve ser ignorado na prática clínica.

Abstract Background The influence of left atrial appendage volume (LAAV) on the recurrence of atrial fibrillation (AF) following radiofrequency catheter ablation remains unclear. Objectives We performed a meta-analysis to assess whether LAAV is an independent predictor of AF recurrence following radiofrequency catheter ablation. Methods The PubMed and the Cochrane Library databases were searched until March 2022 to identify publications evaluating LAAV in association with AF recurrence after radiofrequency catheter ablation. Seven studies that fulfilled the specified criteria of our analysis were found. We used the Newcastle-Ottawa Scale to evaluate the quality of the studies. The pooled effects were evaluated depending on standardized mean differences (SMDs) or hazard ratios (HRs) with 95% confidence intervals (CIs). P values < 0.05 were considered statistically significant. Results A total of 1017 patients from 7 cohort studies with a mean follow-up 16.3 months were included in the meta-analysis. Data from 6 studies (943 subjects) comparing LAAV showed that the baseline LAAV was significantly higher in patients with AF recurrence compared to those without AF (SMD: −0.63; 95% CI: −0.89 to −0,37; all p values < 0.05; I2= 62.6%). Moreover, higher LAAV was independently associated with a significantly higher risk of AF recurrence after radiofrequency catheter ablation (HR: 1.10; 95% CI: 1.02 to 1.18). Conclusions The meta-analysis showed that there is a significant correlation between LAAV and AF recurrence after radiofrequency catheter ablation, and the role of LAAV in AF patients should not be ignored in clinical practice.

Strategy of the diagnosis and treatment for epistaxis and guideline for clinical application of MasterPillar / 临床耳鼻咽喉头颈外科杂志

Epistaxis is a common otorhinolaryngological emergency with complex etiological factors and varied clinical manifestations. The key to epistaxis treatment is accurate diagnosis and adequate hemostasis. Electrocoagulation is a reliable, safe and effective treatment for epistaxis. However, there are still several deficiencies in application of the commonly used electrocoagulation surgical products. This paper introduces a new type of radiofrequency head incorporating the dynamic circulatory functions of drip, irrigation, hemostasis and aspiration. We aim to achieve noninvasive, effective and accurate hemostasis in the treatment of epistaxis or nasal sinus surgery.

Analysis of influencing factors for complications during percutaneous radiofrequency ablation of pulmonary tumor / 中国胸心血管外科临床杂志

@# Objective    To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods    We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results    A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion    Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.

Atrial septal defect with atrial fibrillation treated by one-stop radiofrequency ablation and transthoracic closure under total endoscopy: A case report / 中国胸心血管外科临床杂志

@#Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.

Clinical effect of radiofrequency introduction of tranexamic acid combined with Q-switched laser in the treatment of moderate to severe melasma / 中华医学美学美容杂志

Objective:To observe the clinical effect of tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment of moderate to severe melasma.Methods:From December 2019 to September 2021, ninety-six female patients with melasma [age 24-59 years old, average age (37.8±6.0) years old] were admitted to the Plastic and Aesthetic Department of the First Affiliated Hospital of Henan University of Chinese Medicine. They were divided into the Q-switched laser group and the combined group by random number table method, with 48 cases respectively. The Q-switched laser group received Q-switched laser therapy, while the combined group received tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive therapy. The melasma area and severity index (MASI) scores were compared between the two groups before and after treatment. The clinical efficacy, adverse reactions and recurrence rates of the two groups were compared.Results:The MASI scores of the Q-switched laser group and the combined treatment group were (28.28±1.24) points and (28.52±4.25) points respectively before treatment, and (13.38±7.96) points and (9.11±5.48) points respectively after treatment. The MASI scores of the two groups were decreased after treatment, which of the combined group was lower than that of the Q-switched laser group ( t=3.06, P<0.05). The total clinical effective rate of the combination group (93.75%) was higher than that of the Q-switched laser group (79.17%) (χ 2=4.36, P<0.05). The incidence rate of hyperpigmentation (2.08%) and recurrence rate (2.08%) of the combination group were lower than those of the Q-switched laser group (14.58%, 16.67%) (χ 2=6.01, P<0.05). Conclusions:Tranexamic acid radiofrequency introduction combined with Q-switched laser comprehensive treatment can improve skin lesions and clinical efficacy in patients with moderate to severe melasma, and reduce pigmentation and recurrence.

Effects of fat suction combined with bipolar radiofrequency on facial and neck rejuvenation / 中华医学美学美容杂志

Objective:To investigate the efficacy and safety of fat suction combined with bipolar radiofrequency on face and neck rejuvenation.Methods:A total of 115 patients with face and neck fat deposits and skin laxity underwent fat suction combined with bipolar radiofrequency between December 2021 and October 2022 by the same surgeon in Changsha My Like Medical Cosmetology Hospital. There were 3 men and 112 women in this research. The mean age was 36.1 years (range, 26-55 years) and the mean body mass index was 21.4 (range, 16.8-27.7 kg/cm 2). Postoperative patient satisfaction surveys were conducted and 2 independent doctors evaluated clinical effect with preoperative and postoperative photographs at 3-6 months postoperatively. Results:The mean amount of fat aspirated was 44.5 ml (range, 10-92 ml) and the mean energy delivered was 4.5 kJ (range, 2.1-8.9 ml). 88.7% of patients were satisfied with their postoperative effect (102/115 patients). 92.2% of doctors were satisfied with the postoperative effect (106/115 patients). Four out of 115 patients (3.5%) developed irregularity by fat suction.Conclusions:Fat suction combined with bipolar radiofrequency can effectively reduce the fat accumulation of facial and neck and significantly improve skin relaxation. It is an effective method to rejuvenate facial and neck.