"Leverage pry-off method" for effective prevention of thermal injury during microwave ablation of benign thyroid nodules / 南方医科大学学报

OBJECTIVE@#To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules.@*METHODS@#From July, 2017 to September, 2019, a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation. For protecting from thermal injury during the ablation, "hydrodissection technique" was used in 174 of the patients (admitted from July, 2017 to August, 2018) and "leverage pry-off method" in the other 174 patients (admitted from September, 2018 to September, 2019). All the patients were followed up for 1 to 12 months after the operation for observation of severe complications and nodular residues.@*RESULTS@#Ultrasound-guided microwave ablation was completed in all the 348 patients. The most common severe complication associated with the ablation was voice change, occurring in 3 cases (1.7%) in "hydrodissection technique" group and in 4 (2.3%) in the "leverage pry-off method" group, showing no significant difference between the two groups (P>0.05). During the follow-up, no significant difference was found in the rate of nodular residues between the "hydrodissection technique" group and "hydrodissection technique" group (9.8% vs 10.9% (P>0.05).@*CONCLUSIONS@#The "leverage pry-off method" is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.

Expert consensus on microwave ablation for benign breast nodules / 中华内科杂志

Because mammary glands are regulated by endocrine factors, they are prone to various abnormalities and disorders. Breast nodules are common and occur frequently in clinical practice. The clinical management of breast nodules mainly includes follow-up observation, lesion biopsy, and surgical intervention, and surgical intervention is an effective treatment. Ultrasound-guided percutaneous microwave ablation is a new minimally invasive treatment technology developed in recent years. It has the advantages of short operation time, no scarring, less damage to the lactiferous duct, quick recovery, and good curative effects without bleeding. The establishment of an expert consensus on microwave ablation for benign breast nodules aims to provide a reliable clinical basis for microwave ablation of benign breast nodules, standardize the treatment process, and improve treatment efficacy, so as to serve as a reference for physicians in clinical practice.

Cirugía por radiofrecuencia una alternativa terapéutica en la Insuficiencia Venosa Crónica / Radiofrequency surgery a therapeutic alternative in Chronic Venous Insufficiency / Cirurgia de Radiofrequência uma alternativa terapêutica na Insuficiência Venosa Crônica

La insuficiencia venosa crónica es una patología caracterizada por dificultar el retorno venoso hacia el corazón, se estima que el 90% de la población, padecerá de esta patología en algún momento de la vida, no obstante, su impacto toca la esfera socioeconómica, laboral e inclusive estética del paciente. Clínicamente se manifiesta con telangiectasias, venas varicosas e inclusive úlceras venosas por estasis, el cuadro se acompaña de dolor, cansancio, sensación de pesadez a nivel de miembros inferiores. Objetivo. Establecer los beneficios de la ablación por radiofrecuencia en el tratamiento de la insuficiencia venosa crónica estadificada de acuerdo con la CEAP (Clasificación clínica, etiológica, anatómica, fisiopatológica) en el Hospital Instituto Ecuatoriano de Seguridad Social en la ciudad de Riobamba, en el período 2018-2020. Materiales y Métodos. Se presenta un estudio retrospectivo de corte transversal, realizado en 75 pacientes intervenidos con radiofrecuencia en el Instituto Ecuatoriano de Seguridad Social (IESS) Riobamba, en el período 2018-2020 quienes voluntariamente decidieron participar en el estudio. Resultados. Se obtuvo que esta patología se presenta en un 68% en el sexo femenino y en un 32% en el sexo masculino, de la población total el 60% presentó sobrepeso y el 40% presentó obesidad, mediante la clasificación CEAP se categorizó en C3 al 58.7 % seguido de C2 al 32%, los pacientes de esta última categoría mostraron mejoría dentro de los 6 meses posteriores a la intervención. Conclusiones. La ablación por radiofrecuencia es una técnica quirúrgica efectiva en el tratamiento de los troncos safenos insuficientes, con excelentes resultados postquirúrgicos y en la calidad de vida del paciente.

Chronic venous insufficiency is a pathology characterized by hindering venous return to the heart, it is estimated that 90% of the population will suffer from this pathology at some point in life, however, its impact touches the socioeconomic, labor and even aesthetic sphere of the patient. Clinically it manifests with telangiectasias, varicose veins and even venous stasis ulcers, the picture is accompanied by pain, fatigue, feeling of heaviness in the lower limbs. Objective. To establish the benefits of radiofrequency ablation in the treatment of chronic venous insufficiency staged according to the CEAP (Clinical, etiological, anatomical, pathophysiological classification) in the Hospital Instituto Ecuatoriano de Seguridad Social in the city of Riobamba, in the period 2018-2020. Materials and Methods. A retrospective cross-sectional study is presented, performed in 75 patients intervened with radiofrequency at the Instituto Ecuatoriano de Seguridad Social (IESS) Riobamba, in the period 2018-2020 who voluntarily decided to participate in the study. Results. It was obtained that this pathology is presented in 68% in the female sex and 32% in the male sex, of the total population 60% presented overweight and 40% presented obesity, by CEAP classification was categorized in C3 to 58.7% followed by C2 to 32%, the patients of this last category showed improvement within 6 months after the intervention. Conclusions. Radiofrequency ablation is an effective surgical technique in the treatment of insufficient saphenous trunks, with excellent post-surgical results and in the patient's quality of life.

A insuficiência venosa crônica é uma patologia caracterizada pela dificuldade de retorno venoso ao coração. Estima-se que 90% da população sofrerá desta patologia em algum momento de suas vidas; entretanto, seu impacto afeta a esfera sócio-econômica, ocupacional e até estética do paciente. Clinicamente, manifesta-se com telangiectasias, varizes e até mesmo úlceras de estase venosa, acompanhadas de dor, cansaço e uma sensação de peso nos membros inferiores. Objetivo. Estabelecer os benefícios da ablação por radiofreqüência no tratamento da insuficiência venosa crônica encenada de acordo com a CEAP (classificação clínica, etiológica, anatômica, fisiopatológica) no Hospital Instituto Ecuatoriano de Seguridad Social na cidade de Riobamba, no período de 2018-2020. Materiais e métodos. É apresentado um estudo transversal retrospectivo, realizado em 75 pacientes que intervieram com radiofreqüência no Instituto Equatoriano de Seguridade Social (IESS) Riobamba, no período de 2018-2020, que voluntariamente decidiram participar do estudo. Resultados. Obteve-se que esta patologia ocorre em 68% no sexo feminino e 32% no sexo masculino, da população total 60% apresentava sobrepeso e 40% apresentava obesidade, pela classificação CEAP foi categorizada em C3 a 58,7% seguido por C2 a 32%, os pacientes desta última categoria apresentaram melhora em 6 meses após a intervenção. Conclusões. A ablação por radiofrequência é uma técnica cirúrgica eficaz no tratamento de troncos de safena insuficientes, com excelentes resultados pós-cirúrgicos e na qualidade de vida do paciente.

Cardioneuroablación como tratamiento del síncope reflejo: reporte de un caso

Resumen: El síncope mediado neuralmente es un trastorno causado por un reflejo autónomo anormalmente amplificado que involucra componentes tanto simpáticos como parasimpáticos. Es la causa más frecuente de síncope en personas jóvenes y su tratamiento sigue siendo un desafío, ya que no se ha demostrado que alguna terapia farmacológica prevenga por completo su recurrencia. En los últimos años ha surgido una técnica denominada cardioneuroablación, que consiste en la ablación por radiofrecuencia de los plexos ganglionares (PG) parasimpáticos, con buenos resultados a corto y largo plazo en la prevención de síncope recurrente, según los diferentes grupos de investigación. Presentamos el primer caso en Chile de un hombre joven con síncopes mediados neuralmente recurrentes que fue tratado con esta técnica en el Hospital Regional de Concepción.

Abstract: Cardioneuroablation is a novel method that can be used to treat reflex syncope. Although the experience with this technique is relatively limited it provides a more physiological way to treat this condition. The first case in Chile is herein reported along with a discussion of the subject.

ablación de fibrilación auricular como tratamiento de primera línea: revisión de la literatura / Ablation as a first line treatment for atrial fibrillation: a review

RESUMEN La ablación con radiofrecuencia (RF) o con Criobalón (CRIO) en pacientes con fibrilación auricular (FA) paroxística y persistente es un tratamiento seguro y eficaz en pacientes seleccionados. Datos recientes demuestran que la ablación proporciona mejores resultados en comparación con fármacos antiarrítmicos (FAA) en el tratamiento de la FA temprana. Los estudios que comparan RF y CRIO mostraron una eficacia y seguridad comparables en el aislamiento de venas pulmonares (PVI) para pacientes con FA paroxística sintomática. OBJETIVOS: Revisar estudios clínicos que comparan el tratamiento de la FA con ablación versus FAA como terapia de primera línea en pacientes con FA sin tratamiento previo. La eficacia y la seguridad se compararán entre las dos cohortes y entre los subgrupos. MÉTODO: Se incluye un total de 6 estudios en los que participaron 1212 pacientes con FA: 609 pacientes fueron aleatorizados a ablación de FA y 603 a tratamiento farmacológico En comparación con el tratamiento con FAA, la ablación se asoció con una reducción en la recurrencia de arritmias auriculares (32,3 % frente a 53 %; riesgo relativo [RR], 0,62; IC del 95 %, 0,51-0,74; P < 0,001; I 2 = 40 %, NNT: 5). El uso de ablación también se asoció con una reducción de las arritmias auriculares sintomáticas (11,8 % frente a 26,4 %; RR, 0,44; IC del 95 %, 0,27-0,72; P = 0,001; I 2 = 54%) y hospitalización (5,6% vs 18,7%; RR, 0,32; IC 95%, 0,19-0,53; P< 0,001) sin diferencias significativas en los eventos adversos graves entre los grupos (4,2 % frente a 2,8 %; RR, 1,52; IC del 95 %, 0,81-2,85; P = 0,19). CONCLUSIÓN: En pacientes con FA paroxística, una estrategia de control precoz del ritmo cardíaco, se asocia con una mayor probabilidad de supervivencia, menos procedimientos repetidos, menos hospitalizaciones y, probablemente, una disminución en la progresión a FA persistente.

INTRODUCTION: Radiofrequency (RF) or cryoballoon (CRYO) ablation in patients with paroxysmal and persistent atrial fibrillation (AF) are safe and effective treatments in selected patients. Recent data show that ablation provides better results compared to antiarrhythmic drugs (AAD) in the treatment of early AF. Studies comparing RF and CRYO showed comparable efficacy and safety in pulmonary vein isolation (PVI) for patients with symptomatic paroxysmal AF. OBJETIVES: Review of clinical trials comparing treatment of AF with ablation versus AAD as first-line therapy in patients with AF with no previous treatment. Efficacy and safety are compared between the two cohorts and between subgroups. METHODS: A total of 6 studies involving -212 AF patients were included: 609 were randomized to AF ablation and 603 to pharmacological treatment. Ablation, compared with AAD, was associated with a reduction in recurrence of atrial arrhythmias (32.3% vs. 53%; relative risk [RR], 0.62; 95% CI, 0.51-0.74, P< 0.001, I2 = 40%, NNT: 5). The use of ablation was also associated with a reduction in symptomatic atrial arrhythmias (11.8% vs. 26.4%; RR, 0.44; 95% CI, 0.27-0.72; P= 0.001; I2 = 54%) and hospitalization (5.6% vs 18.7%; RR, 0.32; 95% CI, 0.19-0.53; P <0.001) with no significant differences in major adverse events (4.2% vs. 2.8%; RR, 1.52; 95% CI, 0.81-2.85; P=0.19). CONCLUSION: In patients with paroxysmal AF, an early cardiac rhythm control with ablation is associated with a higher probability of survival, fewer repeat procedures, fewer hospitalizations, and probably a decrease in progression to persistent AF.

Clinical value of ultrasound-guided radiofrequency ablation in the treatment of retroperitoneal tumors / 中华肿瘤杂志

Objective: To explore the clinical value of ultrasound-guided radiofrequency ablation in the treatment of retroperitoneal tumors. Methods: The clinical data of 13 patients with retroperitoneal tumors treated with ultrasound-guided radiofrequency ablation in the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were analyzed retrospectively. The ablation effect was evaluated and the postoperative complications were observed. The changes of tumor volume before and after radiofrequency ablation were compared. Results: The symptoms of pain and dyspepsia were significantly improved after radiofrequency ablation, and the hospital stay was (9.2±2.9) days. The tumor was ablated completely in 10 cases, tumor residual in 1 case and tumor metastasis in 2 cases. One patient had postoperative duodenal perforation complicated with intra-abdominal infection, and no serious complications occurred in other patients. There were 20 lesions in 13 patients. The maximum diameter of 20 lesions before operation and 1, 3, 6 months after operation were (39.5±15.9) mm, (30.6±4.9)mm, (15.6±7.7) mm and (9.9±3.1) mm, respectively, the maximum diameters of 1, 3 and 6 months after operation were smaller than that before operation (P<0.05). Conclusion: Ultrasound-guided radiofrequency ablation is a real-time, accurate, safe and effective minimally invasive treatment with few complications, and has a high clinical value for retroperitoneal tumors.

Radiofrequency ablation of thyroid nodules: prospective cost-effectiveness analysis in comparison to conventional thyroidectomy

ABSTRACT Objective: The objective of this study is to compare the total costs of surgery and radiofrequency (RF) ablation for the treatment of benign thyroid nodules. Materials and methods: This is a prospective randomized study comparing cases treated with US-guided RF ablation (cases) and surgery (control). They were selected and allocated to groups (thyroidectomy or radioablation) by permuted block randomization in blocks of five cases each. Results: Five cases of RF Ablation were compared with five cases of thyroidectomies conducted in the same period. Similar complication rates were observed in both groups. Shorter operating time and hospital stay were observed for the RF group. In the evaluation of the total cost between procedures, radioblation represented 76% of the cost of partial thyroidectomy. Conclusion: This study demonstrated that radioablation has a competitive cost, making it an effective alternative in the treatment of benign thyroid nodules.

Evaluation of the radiofrequency ablation of lumbar sympathetic ganglia in lower limb ischemic ulcers in indian population: radio frequency ablation and lower limb ischemic ulcers / Evaluación de la ablación por radiofrecuencia de los ganglios simpáticos lumbares en las úlceras isquémicas de las extremidades inferiores en la población de la India: ablación por radiofrecuencia y úlceras isquémicas de las extremidades inferiores

Background:Lumbar sympathectomy through radio ablation is a useful treatment of peripheral ischemia. However, clinical efficacy with respect to lower limb ulcers is not adequately established in the Indian population. The study was conducted to evaluate the role of radiofrequency ablation (RFA) of the lumbar sympathetic ganglia in healing of ischemic ulcers of the lower limb.Method:The prospective study with 63 patients registered in the General surgery department with lower limb ischemic ulcers between December 2017­ July2019 were treated with RFA. Patients with cardiopulmonary disease, pregnant, congenital malformation, or skin infection at the site of intervention, or suffering from bleeding disorders, were excluded from the study. Clinical investigation of the wound was performed, and demographic data was collected. Comparative reduction in wound size was assessed through Friedman`s ANOVA (P<0.001). Difference in pain score, hospital stay, and walking distance were evaluated using Wilcoxon matched pair test (P<0.001), Unpaired t-test, and Paired t-test (P<0.05).Result:Majority of the patients were male (n=40) with a mean age of 60.93 SD14.34 years. Significant reduction in wound size, pain scores and hospital stay were observed post procedure(P<0.001). Number of RFA sessions was significantly associated with the size of the ulcer and Fontaine's classification 2 and 3 (P<0.0001).Conclusion:RFA of lumbar sympathetic ganglia is a potential treatment modality for lower limb ischemic ulcers.

Antecedentes: La simpatectomía lumbar a través de la ablación por radiofrecuencia es un tratamiento útil de la isquemia periférica. Sin embargo, la eficacia clínica con respecto a las úlceras en las extremidades inferiores no está adecuadamente establecida en la población india. El estudio se llevó a cabo para evaluar el papel de la ablación por radiofrecuencia (RFA) de los ganglios simpáticos lumbares en la curación de las úlceras isquémicas de la extremidad inferior. Método: El estudio prospectivo con 63 pacientes registrados en el departamento de cirugía general con úlceras isquémicas de las extremidades inferiores entre diciembre de 2017 y julio de 2019 fueron tratados con RFA. Los pacientes con enfermedad cardiopulmonar, malformación embarazada, congénita o infección de la piel en el lugar de la intervención, o que sufren de trastornos hemorrágicos, fueron excluidos del estudio. Se realizó una investigación clínica de la herida y se recopilaron datos demográficos. La reducción comparativa en el tamaño de la herida se evaluó a través del ANOVA de Friedman (P<0.001).Resultado: La diferencia en la puntuación del dolor, la estancia en el hospital y la distancia a pie se evaluaron mediante la prueba de par coincidente de Wilcoxon (P<0.001), la prueba t no emparejada y la prueba t emparejada (P<0.05). La mayoría de los pacientes eran varones (n-40) con una edad media de 60,93 SD14,34 años. Se observó una reducción significativa en el tamaño de la herida, las puntuaciones de dolor y la estancia hospitalaria (P<0.001). El número de sesiones de RFA se asoció significativamente con el tamaño de la úlcera y las clasificaciones 2 y 3 de Fontaine (P<0.0001).Conclusión: LA RFA de los ganglios simpáticos lumbares puede constituir una opción terapéutica para las úlceras isquémicas de las extremidades inferiores.

Monitoring microwave ablation using ultrasound backscatter homodyned K imaging: Comparison of estimators / 生物医学工程学杂志

The feasibility of ultrasound backscatter homodyned K model parametric imaging (termed homodyned K imaging) to monitor coagulation zone during microwave ablation was investigated. Two recent estimators for the homodyned K model parameter, RSK (the estimation method based on the signal-to-noise ratio, the skewness, and the kurtosis of the amplitude envelope of ultrasound) and XU (the estimation method based on the first moment of the intensity of ultrasound,

Value of Ultrasound-guided Core-needle Biopsy for Evaluating the Performance of Radiofrequency Ablation for Low-risk Papillary Thyroid Microcarcinoma / 中国医学科学院学报

Objective To investigate the clinical value of core-needle biopsy(CNB)for low-risk papillary thyroid microcarcinoma(PTMC)after radiofrequency ablation(RFA). Methods A total of 190 patients(including 142 females and 48 males,20-74 years old)with unifocal low-risk PTMCs[mean volume of(106.29±96.15)mm

Validated Nomogram Predicting Clinical Outcome after Radiofrequency Ablation in the Treatment of Papillary Thyroid Microcarcinoma / 中国医学科学院学报

Objective To establish a prediction model for the short-term efficacy of percutaneous ultrasound-guided radiofrequency ablation(RFA)in the treatment of papillary thyroid microcarcinoma(PTMC). Methods We retrospectively analyzed the preoperative and follow-up data of 159 patients with PTMC who underwent percutaneous ultrasound-guided RFA treatment in the Department of Ultrasound,the First Medical Center of Chinese PLA General Hospital from January to December in 2018.The association with 12-month tumor status(end event)was evaluated by multivariate logistic regression model.A nomogram was built to predict the risk of tumors which did not disappear completely within 12 months after RFA. Results We found that gender(

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

Feasibility and safety of intracardiac ultrasound-assisted atrial septal puncture during radiofrequency ablation for atrial fibrillation / 中华心血管病杂志

Objective: To explore the feasibility and safety of intracardiac ultrasound-assisted atrial septal puncture (ASP) during radiofrequency ablation for atrial fibrillation. Methods: We enrolled 241 consecutive patients scheduled to radiofrequency ablation for atrial fibrillation in Beijing Anzhen Hospital from July to September 2020. Inclusion criteria: patients aged over 18 years with a clear electrocardiogram record of atrial fibrillation. Patients were divided into 2 groups: ASP with ultrasound-assisted X-ray (ultrasound group, n=123), ASP under X-ray alone (X-ray group, n=118). Clinical features of patients including age, sex, percent of paroxysmal atrial fibrillation, and repeat ablation, CHA2DS2-VASc score and past history (hypertension, diabetes mellitus, coronary artery disease, stroke/transient ischemic attack (TIA), valve diseases) and echocardiographic parameters (left atrial dimension, left ventricular ejection fraction, left ventricular end-diastolic dimension) were obtained and compared. The first-pass rate, radiation exposure time, duration of ASP, and complications of ASP were also compared between the two groups. Results: The age of patients in this cohort was (62.5±8.0) years, and the proportion of males was 57.0% (n=138). Among them, the proportion of paroxysmal atrial fibrillation was 56.0% (n=135), and the ratio of repeat ablation was 17.8% (n=43). Age, sex, percent of paroxysmal atrial fibrillation, history of hypertension, diabetes mellitus were similar between the two groups. The first-pass rate was significantly higher in the ultrasound group than in the X-ray group (94.3% (116/123) vs. 79.7% (94/118), P=0.001); the exposure time of X-ray was significantly shorter in the ultrasound group than in the X-ray group ((31.3±7.9) s vs. (124.8±35.7) s, P<0.001), while the duration of ASP was longer in the ultrasound group ((10.1±1.8) minutes vs. (8.2±1.3) minutes, P<0.001). In terms of complications, the incidence of puncture into the pericardium was lower in the ultrasound group (0 vs.3.4% (4/118), P=0.039); the rate of transient ST-segment elevation post ASP was similar between the ultrasound group and X-ray group (2.4% (3/123) vs. 1.7% (2/118), P=0.999). Conclusion: Intracardiac ultrasound-assisted atrial septal puncture can effectively improve the accuracy of atrial septal puncture, shorten the radiation exposure time, and reduce the complications related to atrial septal puncture.

Radiofrequency Ablation for Lung Ground-glass Nodule / 中国肺癌杂志

BACKGROUND@#With the wide application of computed tomography (CT) in the screening of early lung cancer, more and more ground glass nodules (GGNs) have been found. Early intervention is helpful to improve the survival rate of lung cancer patients. Radiofrequency ablation (RFA) is an alternative option to manage primary or metastatic lung malignancies. The purpose of this study is to review the safety and clinical efficacy for lung GGN treated by RFA.@*METHODS@#From June 2016 to March 2021, 24 patients with a total of 28 lung GGNs in our hospital underwent 28 sessions of RFA. There were 13 males and 11 females with an average age of (69.4±11.1) years. The size of GGN receiving RFA was (1.30±0.56) cm; The ablation range was (2.50±0.63) cm and ablation time was (15.00±8.68) min.@*RESULTS@#The procedure of all RFAs went smoothly, no perioperative deaths occurred and no serious complications during the operation. The median follow-up was 25 months. One case died of myocardial infarction 2 months after operation. All 28 GGNs showed no evidence of local progression and the local control rate was 100.0%. Kaplan-Meier analysis showed that the 1-year and 2-year overall survival rates were 95.8% and 95.8%; the tumor specific survival rates were 100.0% and 100.0%, respectively.@*CONCLUSIONS@#RFA is a safe, effective and minimally invasive technique for the treatment of lung GGNs.

Oclusión de la vena safena con cianocrilato, una alternativa para el tratamiento de insuficiencia venosa crónica. Experiencia inicial en el Instituto Guatemalteco de Seguridad Social ­ IGSS / Occlusion of the saphenous vein with cyanoacrylate, an alternative for the treatment of chronic venous insufficiency. Initial experience at the Guatemalan Social Security Institute - IGSS

Las técnicas de termo ablación han revolucionado el tratamiento de la insuficiencia venosa crónica, siendo actualmente el estándar de tratamiento. Con el avance tecnológico han surgido nuevas técnicas quirúrgicas, no térmicas, no tumescentes; como el uso de cianocrilato para la oclusión venosa, el cual ha demostrado ser seguro y eficaz en el tratamiento, y tener menos complicaciones posoperatorias. Objetivo: Describir la experiencia en nuestro hospital con el uso de cianocrilato para la oclusión de vena safena mayor para el tratamiento de insuficiencia venosa crónica. Describir la eficacia a corto y mediano plazo del cierre, las complicaciones y la mejoría de la sintomatología utilizando el cuestionario CIVIQ-20 y EVA. Material y métodos: Estudio retrospectivo observacional. Entre enero y diciembre de 2019 que incluye a pacientes con insuficiencia de unión safeno femoral, sintomáticos. Con diagnóstico mediante clasificación CEAP y ultrasonido Doppler. Seguimiento clínico y ecográfico valorando oclusión de los segmentos tratados y presencia de venas varicosas a los 3 y 6 meses. Se trataron 5 pacientes con oclusión venosa con cianocrilato (100% mujeres). Valoramos la calidad de vida mediante cuestionario CIVIQ-20 y EVA (Escala Analógica Visual) previo y un mes después del procedimiento. También se describe la tasa de éxito y complicaciones inmediatas y tardías. Resultados: La totalidad de los procedimientos se realizaron con anestesia local, siendo bien tolerados. Con un éxito inmediato del 100 % sin necesidad de conversión. Solo se presentó como complicación urticaria en un paciente en el trayecto de la vena tratada con cianocrilato, la cual se trató con esteroides y resolvió. El CIVIQ-20 mostró mejoría global pasando de 35 a 29 puntos en promedio; siendo el parámetro de actividad física el que mostró una mejoría mayor. EVA demostró que la pesadez (principal síntoma) se redujo un 67%. Durante el seguimiento, ningún caso presento repermeabilización o recanalizaciones segmentarias. Conclusiones: El tratamiento endovenoso de la insuficiencia venosa crónica con las nuevas técnicas no térmicas, no tumescentes es seguro y efectivo. A corto-mediano plazo ofrecen resultados similares a las técnicas termoablativas obviando el inconveniente de la tumescencia y el uso de medias compresivas en el posoperatorio, evitando lesiones térmicas y observándose mejoría en la sintomatología. (AU)

Thermo ablation techniques have revolutionized the treatment of chronic venous insufficiency, being currently the standard of treatment. With technological advancement, new non-thermal, non-tumescent surgical techniques have emerged; such as the use of cyanoacrylate for venous occlusion, which has been shown to be safe and effective in treatment, and have fewer postoperative complications. Objective: To describe the experience in our hospital with the use of cyanoacrylate for occlusion of the greater saphenous vein for the treatment of chronic venous insufficiency. Describe the shortand medium-term efficacy of closure, complications, and symptom improvement using the CIVIQ-20 questionnaire and VAS. Material and methods: Retrospective observational study. Between January and December 2019 that includes patients with symptomatic saphenous femoral junction insufficiency. With diagnosis by CEAP classification and Doppler ultrasound. Clinical and ultrasound follow-up evaluating occlusion of the treated segments and the presence of varicose veins at 3 and 6 months. 5 patients with venous occlusion were treated with cyanoacrylate (100% women). We assessed the quality of life using the CIVIQ-20 questionnaire and VAS (Visual Analogue Scale) before and one month after the procedure. The immediate and late success rate and complications are also described. Results: All the procedures were performed under local anesthesia, being well tolerated. With immediate 100% success without the need for conversion. Urticaria only presented as a complication in a patient in the path of the vein treated with cyanoacrylate, which was treated with steroids and resolved. The CIVIQ-20 showed global improvement, going from 35 to 29 points on average; being the physical activity parameter the one that showed the greatest improvement. VAS showed that heaviness (main symptom) was reduced by 67%. During follow-up, no case presented segmental recanalization or recanalization. Conclusions: Endovenous treatment of chronic venous insufficiency with new non-thermal, non-tumescent techniques is safe and effective. In the short-medium term, they offer results similar to thermoablative techniques, avoiding the inconvenience of tumescence and the use of compression stockings in the postoperative period, avoiding thermal injuries and observing improvement in symptoms. (AU)

Radiomic analysis of mri to predict sustained complete response after radiofrequency ablation in patients with hepatocellular carcinoma - a pilot study

OBJECTIVES: To investigate whether quantitative textural features, extracted from pretreatment MRI, can predict sustained complete response to radiofrequency ablation (RFA) in patients with hepatocellular carcinoma (HCC). METHODS: In this IRB-approved study, patients were selected from a maintained six-year database of consecutive patients who underwent both pretreatment MRI imaging with a probable or definitive imaging diagnosis of HCC (LI-RADS 4 or 5) and loco-regional treatment with RFA. An experienced radiologist manually segmented the hepatic nodules in MRI arterial and equilibrium phases to obtain the volume of interest (VOI) for extraction of 107 quantitative textural features, including shape and first- and second-order features. Statistical analysis was performed to evaluate associations between textural features and complete response. RESULTS: The study consisted of 34 patients with 51 treated hepatic nodules. Sustained complete response was achieved by 6 patients (4 with single nodule and 2 with multiple nodules). Of the 107 features from the arterial and equilibrium phases, 20 (18%) and 25 (23%) achieved AUC >0.7, respectively. The three best performing features were found in the equilibrium phase: Dependence Non-Uniformity Normalized and Dependence Variance (both GLDM class, with AUC of 0.78 and 0.76, respectively) and Maximum Probability (GLCM class, AUC of 0.76). CONCLUSIONS: This pilot study demonstrates that a radiomic analysis of pre-treatment MRI might be useful in identifying patients with HCC who are most likely to have a sustained complete response to RFA. Second-order features (GLDM and GLCM) extracted from equilibrium phase obtained highest discriminatory performance.

Ablación por radiofrecuencia versus crosectomía safenofemoral más oclusión endovascular distal en pacientes con insuficiencia de la vena safena mayor / Radiofrequency ablation versus sapheno-femoral crosectomy plus distal

Introducción: Actualmente se prefieren procedimientos mínimamente invasivos como las técnicas endovasculares para el tratamiento de la insuficiencia de vena safena mayor que pueden ser por ablación térmica, química o mecánica. Éstos tienen la ventaja de ser ambulatorios, presentar menos complicaciones postoperatorias, una rápida incorporación laboral y mejores resultados estéticos. El objetivo de este estudio es evaluar los resultados del tratamiento con radiofrecuencia versus crosectomía safenofemoral más oclusión endovascular distal. Material y Métodos: Estudio descriptivo prospectivo que incluyó a todos los pacientes con diagnóstico de insuficiencia de la vena safena mayor de enero 2017 a octubre 2019. La elección de la técnica a utilizar se hizo al azar. Resultados: El 77% correspondió al género femenino, con edad media 49 años, el estadío C:2 de la clasificación clíica CEAP fue la más frecuente (57%) y el shunt tipo 3 (63%). La ablación por radiofrecuencia se realizó con mayor frecuencia (83%). El dolor y parestesias (fueron las complicaciones más frecuentes en ambos grupos sin diferencias estadísticamente significativas (p = 0.1470). No hubo diferencias estadísticamente significativo entre las dos técnicas quirúrgicas realizadas en resultado estético (p = 0.4456), el retorno de actividades cotidianas (p = 0.992) ni las laborales (p = 0.901). Conclusiones: Tanto la ablación por radiofrecuencia de la vena safena mayor como la crosectomía safenofemoral más oclusión endovascular distal se consideran dos métodos seguros y efectivos para tratar insuficiencia de vena safena mayor; ya que los resultados finales fueron similares para ambas técnicas quirúrgicas.

Introduction: Minimally invasive endovascular procedures like thermal, chemical or mechanical ablation are currently preferred for the treatment of the great saphenous vein insufficiency, because have the advantage of being outpatient, with minimal postoperative complications, a faster incorporation to work and better aesthetic results. This study persuit to evaluate the results of radiofrequency treatment versus sapheno-femoral crosectomy plus distal endovascular occlusion. Methods: The study included all the patients with a diagnosis of great saphenous vein insufficiency from January 2017 to October 2019. The technic was chosen randomly. Results: 77% of patients was female , with a mean age of 49 , the C2 stage of the CEAP classification is present in 57% and the type 3 shunt in 63%. Radiofrequency ablation was performed in 83% of the cases. Pain and paresthesia were the most frequent complications, without statistically signification between both technics (p = 0.1470). The aesthetic result, the return to daily activities (p = 0.992) and to work (p = 0.901) had not statistically significant differences between the two surgical techniques. Conclusions: Both, radiofrequency ablation of the greater saphenous vein and sapheno-femoral crosectomy plus distal endovascular occlusion are considered safe and effective methods to treat great saphenous vein insufficiency because the final results were similar for both surgical techniques.

Application of hyperbolic heat transfer model in atrial fibrillation microwave ablation / 生物医学工程学杂志

The effect of relaxation time in hyperbolic heat transfer model on the temperature field of microwave ablation of atrial fibrillation was investigated. And the results were compared with those calculated by Pennes model. A three-dimensional model of microwave ablation of atrial fibrillation was constructed. The relaxation time (