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Background/Objectives: Structural incomplete response (SIR) (persistence/recurrence) may occur in 2–6% of low-risk differentiated thyroid cancer (DTC)-cases and in 67–75% of high risk. Regarding locoregional disease, surgery is the optimal therapeutic modality if the smallest dimension of the targeted node is ≥8 mm or ≥10 mm (central or lateral compartment). In the presence of smaller nodes, contraindications or the patient's unwillingness for reoperation, active surveillance (AS) or minimally invasive treatments (MITs) may be considered. Methods: We retrospectively studied eight DTC patients with SIR confirmed by ultrasound (U/S)-guided fine-needle aspiration cytology (FNAC) and the measurement of Thyroglobulin (Tg) in the washout fluid. Fourteen malignant lesions were ablated by radiofrequency (RF). We assessed prior to RF ablation (RFA) and consecutively at one month, three months and, then, every three months the volume of each lesion, serum Tg and Anti-Tg antibodies and calculated the volume reduction ratio (VRR). Results: Patients were followed for a mean period of 13.25 months (range: 4–24) after RFA was performed. The targeted lesions reduced significantly from a median volume of 0.24 mL (range: 0.09–0.9) to 0.02 mL (range: 0–0.03) (p < 0.05), with a median VRR of 94.5% (range: 78–100%) and concomitant significant biochemical remission (decrease in serum Tg from a median of 1.05 ng/mL to 0.2 ng/mL, p < 0.05). In one patient with an aggressive radioiodine (RAI)-refractory histological variant, re-recurrence was documented, which was successfully re-ablated by RF. In two patients, Horner syndrome was diagnosed as an RFA complication, which was totally resolved within six months. Conclusions: RFA may be considered as an effective and safe MIT in selective DTC patients with SIR, especially in cases of smaller lesions. Additional prospective studies are needed, including aggressive DTC histological variants towards a tailored therapeutic approach. [ABSTRACT FROM AUTHOR]

A high-power ultrasonic transducer for minimally invasive treatments is proposed, capable of treating areas inaccessible by high-intensity focused ultrasound treatments. This transducer employs two elliptical reflectors that efficiently focus ultrasound waves into a thin waveguide by utilizing mode conversion. Additionally, a slit structure is introduced to suppress wave diffraction, further enhancing the focusing capabilities of the transducer. Finite element analysis demonstrates that the proposed transducer achieves an impressive energy density magnification factor of 325, with an energy efficiency of 24.2 %. This efficiency is 3.4 times higher than that of a conventional transducer, Double Parabolic refLector wave-guided Ultrasonic transducer. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 led to the adoption of containment measures including the temporary closure of dental clinics. However, dental emergencies have not ceased during this pandemic. Thus, the aim of this study was to analyze patient profiles and the offered management options to pediatric patients presenting with dental emergencies during a COVID-19 lockdown. Method and materials: Retrospective analysis was performed of patient records of children seeking emergency dental treatment during a 7-week lockdown period in 2020 in a university pedodontic clinic in Germany, and compared to a similar cohort from 2019. Data on patient, tooth, and session level were collected. Results: The 2020 cohort consisted of 83 patients, and the 2019 cohort included 46 patients, showing a 45% greater need for emergency treatment in 2020. The most common chief complaint was plaque-induced gingivitis/oral mucosal conditions in 2020 (26.4%), and irreversible pulpitis in 2019 (25.5%). Dental caries (without spontaneous pain) was the second most common chief complaint in both cohorts (20.7% and 23.4%, respectively). Most interventions in 2020 were minimally invasive treatments (eg, Hall Technique, silver diammine fluoride; 20.3%), which were in 2019 not considered at all; followed by pharmacologic treatment (16.9%), which was in 2019 also highly used (35.9%). Conclusion: The COVID-19 pandemic led to an increase in emergency pediatric dental visits and shifted treatment options towards less invasive procedures. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is one of the most challenging diseases for physicians as its etiology and manifestations can be extremely varied. Many guidelines have been published and many therapeutic options are nowadays available for the different types of pain. Given the enormous amount of information that healthcare providers must handle, it is not always simple to keep in mind all the phases and strategies to manage pain. We here present the acronym PATIENT (P: patient's perception; A: assessment; T: tailored approach; I: iterative evaluation; E: education; N: non-pharmacological approach; T: team), a bundle which can help to summarize all the steps to follow in the management of chronic pain. Methods: We performed a PubMed search with a list of terms specific for every issue of the bundle; only English articles were considered. Results: We analyzed the literature investigating these topics to provide an overview of the available data on each bundle's issue; their synthesis lead to an algorithm which may allow healthcare providers to undertake every step of a patient's evaluation and management. Discussion: Pain management is very complex; our PATIENT bundle could be a guide to clinicians to optimize a patient's evaluation and treatment. [ABSTRACT FROM AUTHOR]

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Objective: To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and Methods: We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta‐analysis. Results: We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short‐term (3‐month) follow‐up, PUL had the highest likelihood of being the most efficacious for retreatment. Conclusions: Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short‐term follow‐up. [ABSTRACT FROM AUTHOR]

Background: Although there are different treatments for benign prostate hyperplasia, their efficacy and safety differ. We are currently exploring a new minimally invasive interventional therapy for benign prostatic hyperplasia (BPH). Purpose: To determine the feasibility, effectiveness, and safety of ultrasound-guided transperineal laser ablation (US-TPLA) for the treatment of BPH. Material and Methods: Twenty patients with BPH (mean age = 73.9 ± 9.2 years) who underwent US-TPLA from June 2018 to January 2020 with a subsequent six-month follow-up were retrospectively reviewed. After local anesthesia, a 21-G trocar was inserted into the prostate tissue under ultrasound monitoring, followed by 1064 nm diode laser irradiation. Changes in international prostate symptom score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume, and complications were evaluated six months after surgery. Results: All patients underwent the operation successfully without serious complications. After six months, the average IPSS improved from 22.7 ± 5.3 to 9.1 ± 3.2 (P < 0.001), the QoL improved from 4.9 ± 1.7 to 2.3 ± 1.3 (P < 0.001), the Qmax improved from 8.5 ± 3.0 to 15.2 ± 4.8 mL/s (P < 0.001), the PVR increased from 78.7 ± 58.8 to 30.3 ± 34.2 (P < 0.05), and the mean prostate volume ranged from 70.8 ± 23.8 to 54.7 ± 20.9 mL (P < 0.05). Conclusion: US-TPLA is safe and feasible for the treatment of BPH. An evaluation at the six-month follow-up is effective. [ABSTRACT FROM AUTHOR]

Purpose:To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules. Materials and methods:Institutional review board approval was obtained, and patients’ consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57 ± 14 years) with LA and 152 (107 females, age 57 ± 14 years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12 months and complications were evaluated. Results:No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12 months was −67 ± 19% vs. −57 ± 21% (p < 0.001) − 70 ± 19% vs. −62 ± 22% (p= 0.001) in LA group and in RFA group, respectively. Nodules with volume >30 mL had significantly higher percentage volume reduction at 6 and 12 months (−69 ± 19 vs. −50 ± 21,p = 0.001) and (−73 ± 18 vs. −54 ± 23 8,p = 0.001) in the LA group than in the RFA group, respectively. In both groups, operator’s skills affected the results. Major complications occurred in 4 cases in each group (p = 0.116) Conclusions:LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator’s skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique. [ABSTRACT FROM PUBLISHER]

Purpose: To assess the feasibility and safety of transperineal laser ablation (TPLA) for treating benign prostatic hyperplasia (BPH).Materials and Methods: Institutional review board approval was obtained for this prospective non-randomized trial. Eightteen patients (age 71.7 ± 9.4 years) with urinary symptoms secondary to BPH underwent TPLA under local anesthesia. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. Primary endpoints were technical success and safety of TPLA. Secondary endpoints included operation time, ablation time, energy deployed, hospitalization time, catheterization time, and change in International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak urinary flow rate (Q max), post-void residual (PVR), and prostatic volume at 3 months. χ 2 and Fisher exact tests were used.Results: All procedures were technically successful. No complications occurred. Mean operation time was 43.3 ± 8.7 min, mean ablation time 15.9 ± 3.9 min, mean energy deployed 10,522 ± 3290.5 J, mean hospital stay 1.5 ± 0.4 days, and mean catheterization time 17.3 ± 10.0 days. At 3 months, IPSS improved from 21.9 to 10.7 (P < 0.001), QoL from 4.7 ± 0.6 to 2.1 ± 1.2 (P < 0.001), Q max from 7.6 to 13.3 mL/s (P = 0.001), PVR from 199.9 ± 147.3 to 81.5 ± 97.8 (P < 0.001), and mean prostate volume from 69.8 to 54.8 mL (P < 0.001).Conclusions: TPLA is feasible and safe in the treatment of BPH, providing significant clinical results at 3 months.Level Of Evidence: Case series, Level IV. [ABSTRACT FROM AUTHOR]

Background: The liver is involved in about half of patients with metastatic breast cancer. Unfortunately systemic chemotherapy as the treatment of choice is limited. Due to multifocality and/or insufficient remnant liver volume, the majority of liver metastases are also unresectable. Currently, thermal ablations are used in these patients with acceptable impact. Methods: We reviewed studies on radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave ablation (MWA) regarding local tumour response, progression and survival indexes in patients with breast cancer liver metastases (BCLM). Results: The reviewed literature showed positive response rates of 63 % to 97 % in RF-ablated lesions, 98.2 % in LITT-treated lesions and 34.5-62.5 % in MW-ablated lesions. Median survival was 10.9-60 months using RFA, 51-54 months after LITT and 41.8 months using MWA. Five-year survival rates were 27-30 %, 35 % and 29 %, respectively. Local tumour progression ranged from 13.5 % to 58 % using RFA, 2.9 % with LITT and 9.6 % with MWA. Conclusion: The reviewed literature demonstrated that ablation therapies either as single therapy or combined with other locoregional therapies are a good alternative as an adjunction to resection in patients with resectable lesions or with positive response using chemotherapy. However, multicentre randomised studies should be conducted to obtain further evidence of the benefits of these treatments in patients with BCLM. Key points: • Thermal ablation is an alternative treatment for hepatic metastases from breast cancer • This review assesses thermal ablation therapies and local chemoembolisation techniques • It helps prioritise treatment options for managing hepatic metastases from breast cancer [ABSTRACT FROM AUTHOR]

The optimal treatment strategy for esophageal cancer continues to be a topic of debate. Improvements in chemotherapy drugs, surgical techniques, and radiotherapy planning and delivery have led to the design of treatment approaches that are specific to both the stage of the tumor and the overall performance status of the patient. Surgery continues to be the standard treatment option for localized disease, but multimodality treatments that include radiation and chemotherapy with surgery are increasingly used. The next few years will continue to see improvements in radiation techniques, especially proton beam treatment; the development of additional minimally invasive surgical approaches to minimize postoperative side effects; and the discovery of molecular biomarkers to help specifically target treatment of esophageal cancer in individual patients. [ABSTRACT FROM AUTHOR]

Pain represents a foremost feature of neurogenic thoracic outlet syndrome (NTOS). Similar to other persistent pain conditions, the physical discomfort associated with NTOS can cause severe and often debilitating symptoms. In fact, those suffering from the syndrome report a quality of life impacted as significantly as those with chronic heart failure. This evidence-based literature review focuses on the classification, etiology, clinical presentation, diagnostic measures, and surgical treatment of NTOS, with a focus on nonoperative therapies such as physical modalities, pharmacological therapies, and more contemporary minimally invasive intramuscular treatments with botulinum toxin. [ABSTRACT FROM AUTHOR]

Introduction/objective. The isthmocele represents a discontinuity of the anterior uterine wall that appears as a result of a deficient healing at the level of hysterorraphy after caesarean section, which involved both gynecological and obstetric complications. Depending on the thickness of the overlying myometrium, there may be a large defect, affecting more than 50% of it, or a small defect with an interest of less than 50% or a thickness of more than 3 mm of the myometrium. This classification is important in the therapeutic decision to establish a hysteroscopic or laparoscopic treatment. Methodology. The present paper aims to present the case of a 27-year-old patient who presents to the clinic for secondary infertility, dysmenorrhea, intermenstrual spotting and severe dyspareunia. Ultrasound examination reveals a wide niche after caesarean section. Results. The patient undergoes laparoscopic correction of the isthmocele. The follow-up at six weeks postoperatively showed a significant improvement of symptoms and a normal ultrasound examination, with the disappearance of the niche. Discussion and conclusions. Although a still incompletely understood entity, the diagnosis of isthmocele is constantly increasing, which is why the treatment should be chosen depending on the presence of symptoms, the size of the defect, the secondary infertility and the desire to conceive. [ABSTRACT FROM AUTHOR]

Introduction/objective. The isthmocele represents a discontinuity of the anterior uterine wall that appears as a result of a deficient healing at the level of hysterorraphy after caesarean section, which involved both gynecological and obstetric complications. Depending on the thickness of the overlying myometrium, there may be a large defect, affecting more than 50% of it, or a small defect with an interest of less than 50% or a thickness of more than 3 mm of the myometrium. This classification is important in the therapeutic decision to establish a hysteroscopic or laparoscopic treatment. Methodology. The present paper aims to present the case of a 27-year-old patient who presents to the clinic for secondary infertility, dysmenorrhea, intermenstrual spotting and severe dyspareunia. Ultrasound examination reveals a wide niche after caesarean section. Results. The patient undergoes laparoscopic correction of the isthmocele. The follow-up at six weeks postoperatively showed a significant improvement of symptoms and a normal ultrasound examination, with the disappearance of the niche. Discussion and conclusions. Although a still incompletely understood entity, the diagnosis of isthmocele is constantly increasing, which is why the treatment should be chosen depending on the presence of symptoms, the size of the defect, the secondary infertility and the desire to conceive. [ABSTRACT FROM AUTHOR]

Benign prostatic hyperplasia is one of the most common diseases of aging men and can be associated with bothersome lower urinary tract symptoms that affect quality of life by interfering with normal daily activities and sleep patterns. Standardized methodologies for diagnosis and assessment of symptom severity to direct treatment selection have been promulgated. Patients with bothersome lower urinary tract symptoms are more likely to benefit from intervention with either medical, surgical or one of the emerging minimally invasive therapies. Medical therapy is the first line of therapy for symptomatic patients, reserving surgical intervention for patients with complications from benign prostatic hyperplasia or for those desiring more definitive initial therapy. Phytotherapeutic (herbal supplement) therapies are very popular around the world and many men take them without a prescription. Minimally invasive therapies seek to emulate the results of surgical resection, while avoiding the morbidity. [ABSTRACT FROM AUTHOR]

Respiratory tract fistulas (or fistulae) are abnormal communications between the respiratory system and the digestive tract or the adjacent organs. The origin can be congenital or, more frequently, iatrogenic and the clinical presentation is heterogeneous. Respiratory tract fistulas can lead to severely reduced health-related quality of life and short survival. Therapy mainly relies on endoscopic surgical interventions but patients often require prolonged hospitalization and may develop complications. Therefore, more conservative regenerative medicine approaches, mainly based on lipotransfer, have also been investigated. Adipose tissue can be delivered either as unprocessed tissue, or after enzymatic treatment to derive the cellular stromal vascular fraction. In the current narrative review, we provide an overview of the main tissue/cell-based clinical studies for the management of various types of respiratory tract fistulas or injuries. Clinical experience is limited, as most of the studies were performed on a small number of patients. Albeit a conclusive proof of efficacy cannot be drawn, the reviewed studies suggest that grafting of adipose tissue-derived material may represent a minimally invasive and conservative treatment option, alternative to more aggressive surgical procedures. Knowledge on safety and tolerability acquired in prior studies can lead to the design of future, larger trials that may exploit innovative procedures for tissue processing to further improve the clinical outcome. [ABSTRACT FROM AUTHOR]