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Objective. To retrospectively evaluate the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) in the treatment of papillary thyroid microcarcinoma (PTMC) through a follow-up study of continuous postoperative surveillance and large-sample data. Methods. The efficacy of ultrasound-guided RFA was evaluated by measuring the tumor volume reduction rate (VRR), tumor disappearance rate, and disease progression in 358 patients with low-risk unifocal PTMC who underwent ultrasound-guided RFA at Hangzhou Weja Hospital, while the safety was evaluated by measuring their complications. Results. The VRR was −745.69 ± 1012.69 (%), −150.35 ± 395.5 (%), 46.47 ± 138.74 (%), 92.95 ± 27.88 (%), 97.78 ± 10.99 (%), and 99.27 ± 3.82 (%), respectively, at 1, 3, 6, 12, 18, and 24 months after RFA. The corresponding tumor disappearance rate was 1.68%, 9.78%, 43.85%, 82.68%, 92.59%, and 95.63%, respectively. No local recurrence, new tumors, lymph node metastasis, distant metastasis, and deaths caused by recurrent/metastatic PTMC were found at the last follow-up. Except for 3 cases (0.84%) with thickening or hoarseness of voice and 3 cases (0.84%) with coughing during drinking water, no other complications were found. Conclusions. Ultrasound-guided RFA has good efficacy and safety for the treatment of low-risk unifocal PTMC and can be promoted for use in patients who meet the required indications. [ABSTRACT FROM AUTHOR]

Background. Catheter ablation failure poses a clinical challenge for epicardial or intramural ventricular arrhythmia (VA); however, guidewire ablation within the coronary venous system (CVS) may be effective and safe for targeting VAs. Methods. The ex vivo phase included four steps. In step 1, the steam pop incidence rates during guidewire ablation at power settings of 5, 10, 15, 20, and 25 W were analyzed using 10 mm- and 20 mm-tip guidewires. In step 2, guidewire ablation was performed for application durations of 10, 20, 30, 40, 50, 60, and 90 s, and the lesion size was measured. In step 3, the effects of saline infusion (0, 1, 2, 3, and 4 mL/min) on lesion dimensions and steam pop formation were examined. In step 4, an orthogonal array was constructed to obtain the optimal guidewire ablation parameters. In the in vivo phase, guidewire ablation within the CVS was performed in three dogs, and the lesion features in 10 days after ablation were observed. Results. In step 1, the steam pop incidence rates at 5, 10, 15, 20, and 25 W were 0%, 0%, 12.5%, 62.5%, and 100% using the 10 mm-tip guidewires and 0%, 0%, 0%, 25%, and 75% using the 20 mm-tip guidewires, respectively. In step 2, we found that the lesion areas increased with an increase in the ablation duration (the maximum lesion diameters at 30, 60, and 90 s were 4.9 ± 0.4, 7.0 ± 0.8, and 9.2 ± 0.7 mm in the 10 mm group and 3.2 ± 0.5, 4.5 ± 0.4, and 5.3 ± 0.7 mm in the 20 mm-tip group, respectively). In step 3, we observed that saline infusion was negatively correlated with ablation lesions but had a lower risk of steam pop. The optimal parameters for the 20 mm-tip guidewire ablation were 15 W, 50 s, and 2 mL/min or 20 W, 70 s, and 2 mL/min. In the in vivo phase, effective ablation lesions with maximum and minimum diameters of 3.2 ± 0.3 and 2.8 ± 0.5 mm, respectively, were created by the guidewires during the 10-day observation period after ablation. Conclusion. This novel radiofrequency guidewire ablation technique can feasibly create effective lesions within the CVS, which may improve the efficacy of catheter ablation for challenging epicardial or intramural VA. [ABSTRACT FROM AUTHOR]

Background. Recent studies have shown a bidirectional relationship between atrial fibrillation (AF) and psychological depression. However, little is known about the prevalence of postprocedure depression (PPD) in patients with AF at the time of radiofrequency (RF) ablation. Objective. To describe the prevalence and identify risk factors for PPD. Methods. This was a prospective cohort study, including 428 AF patients who were willing to undergo the first catheter ablation in our hospital from 1st April to 30th December 2019. The primary outcome was PPD, which was determined by Hospital Anxiety and Depression Scale-Depression. Results. The prevalence of PPD was 16.8% (72/428) in our cohort, without difference between men (16.0%, 41/256) and women (18.0%, 31/172) (P = 0.586) but with a great difference among different age groups (P = 0.016). On the univariable binary logistic regression analysis, age, a history of coronary heart disease, Observer's Assessment of Alertness/Sedation (OAA/S) score when ablating at the specific position, and OAA/S score when pulling out the catheter sheath were associated with PPD. Subsequent multivariable logistic regression analysis indicated only age (OR 0.96, 95% CI: 0.94–0.99, P < 0.01) and OAA/S score when ablating at the specific position (OR 0.58, 95% CI: 0.39–0.88, P = 0.01) were independently associated with PPD. Conclusion. PPD is common in patients with AF after RF ablation. Younger age and lower OAA/S score when ablating at the specific position are its most significant risk factors. Intensive management of sedation may be of great importance for reducing PPD. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR2200057810). [ABSTRACT FROM AUTHOR]

Background. There is controversy regarding whether patients with single hepatocellular carcinoma (HCC) should be offered radiofrequency ablation (RFA) as a first-line treatment option. Thus, this study compared overall survival after surgical resection (SR) and RFA for single HCC. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was used for this retrospective study. The study included 30- to 84-year-old patients diagnosed with HCC from 2000 to 2018. Selection bias was reduced via propensity score matching (PSM). The study compared the overall survival (OS) and cancer-specific survival (CSS) of patients with single HCC who were treated with SR and RFA. Results. Before and after PSM, the median OS and median CSS were significantly longer in the SR group than in the RFA group (p < 0.05). In the subgroup analysis, the median OS and median CSS for male and female patients with male and female patients with tumor sizes <3, 3–5, and>5 cm, age at diagnosis between 60 and 84 years, and grades I–IV tumors were longer than in the SR group than in the RFA group (p < 0.05). Similar results were reported for patients who received chemotherapy (p < 0.05). Univariate and multivariate analyses revealed that compared with RFA, SR was an independent favorable factor for OS and CSS (p < 0.05) before and after PSM. Conclusion. Patients with SR who had a single HCC showed higher OS and CSS compared with patients who received RFA. Hence, SR should be used as a first-line treatment in cases of single HCC. [ABSTRACT FROM AUTHOR]

Objective. Radiofrequency coblation (RFC) is a relatively new method that has opened up new perspectives in treating oropharyngeal squamous cell carcinoma (OPSCC). Our study was designed to explore the feasibility and effectiveness of RFC-assisted transoral surgery (RFC-TOS) for primary OPSCC. Methods. Sixty-nine cases of OPSCC from February 2005 to November 2020 were retrospectively analyzed, including 31 in the RFC-TOS group and 38 in the open surgery group. No difference was observed in demographic and oncological characteristics. Results. The significance between the RFC-TOS group and the open surgery group was proved in intraoperative bleeding volume (34.10 ± 10.10 ml vs. 193.68 ± 21.00 ml, P < 0.001), durations of surgery (79.58 ± 8.45 min vs. 217.87 ± 17.65 min, P < 0.001), time to resume oral feeding (1.64 ± 0.41 d vs. 11.58 ± 1.41 d, P < 0.001), duration of hospitalization (7.84 ± 0.66 d vs. 15.66 ± 1.62 d, P < 0.001), and the total costs (22846.22 ± 1821.55¥ vs. 41792.24 ± 4150.86¥, P < 0.001). The rates of 5-year overall survival (OS), 5-yeardisease-specific survival (DSS), and 5-year local control rate (LC) were 69.1%, 71.7%, and 75.7%, respectively, in the RFC-TOS group and 71.0%, 73.4%, and 73.7% in the open surgery group (P > 0.05). Conclusions. RFC-TOS is a feasible alternative transoral approach for OPSCC. The reported perioperative and oncologic outcomes are satisfactory. [ABSTRACT FROM AUTHOR]

Background and Aims. Radiofrequency ablation is a commonly used treatment for paroxysmal atrial fibrillation (AF), but postoperative rehabilitation exercises are needed to reverse left ventricular structural and functional abnormalities. This meta-analysis aimed to evaluate the intervention effect of exercise training in patients with AF after radiofrequency ablation. Methods. A systematic literature search was conducted to identify articles in PubMed, MEDLINE, EMBASE, and the Cochrane Library from January 1, 2010 to December 1, 2021. The mean difference with 95% CI was pooled for continuous variables. We used Review Manager 5.3 for the standard meta-analysis. This study followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results. Ten randomized controlled trials (RCTs) were included, with a total of 892 patients with AF. The quality of one study was grade A, and the rest were grade B. The results of the meta-analysis showed that the improvement of 6 min walking distance (MD = 34.42, 95% CI: 3.20 to 65.63, P = 0.03), peak oxygen uptake (MD = 1.96, 95% CI: 1.14 to 2.78, P < 0.001), left ventricular ejection fraction (LVEF) (MD = 0.09, 95% CI:0.01–0.17, P = 0.02), resting heart rate (MD = −4.50, 95% CI: −8.85 to −0.14, P = 0.04), and physical component summary (PCS) (MD = 3.00, 95% CI: 0.46 to 5.54, P = 0.02) in the experimental group was significantly better than that of the control group, and the difference was statistically significant. Conclusion. Exercise training can improve the level of exercise endurance and cardiac function in patients. However, the results were limited by the quantity and quality of the studies. Large samples and high-quality studies are still needed to verify its long-term efficacy. [ABSTRACT FROM AUTHOR]

Objectives. To investigate the procedural efficiency, efficacy, and safety of high-power, short-term radiofrequency ablation delivered by the SmartTouch Surround Flow (STSF) catheter for paroxysmal atrial fibrillation (AF). Methods. We retrospectively analyzed a total of 72 patients who were admitted with paroxysmal AF, and who underwent radiofrequency catheter ablation (RFCA) for the first time. Of these patients, 36 cases underwent low-power, long-duration (LPLD, (30–35 W/20–40 s) pulmonary vein isolation (PVI) delivered by an SmartTouch (ST) catheter (control group), and the other 36 cases underwent high-power, short-duration (HPSD, (45–50 W/10–20 s) PVI delivered by a STSF catheter (study group). The baseline data, duration of PVI, procedural time, fluoroscopy time, the rate of first-pass isolation, irrigation perfusion, eschar and steam pop occurrences, intraoperative complications, and the rate of stable sinus rhythm maintenance following a blanking period of three months were analyzed between the two groups. Results. The isolation time of bilateral PVI and procedural time in the study group were markedly less than in controls (p < 0.01). The rate of first-pass isolation in the study group was significantly higher than in the control group (95.8% vs. 84.7%, p = 0.023), while the fluid perfusion in the study group was approximately 20% less than that in the control group (767 ± 171 vs. 966 ± 227 ml, p < 0.001). We observed no severe complications in any patients. The rate of freedom from AF recurrences following a blanking period of three months showed a tendency to be higher than in controls (93.9% vs. 87.1%, p = 0.348). Conclusions. The HPSD strategy delivered by the STSF catheter was superior to conventional LPLD ablation through the ST catheter with respect to efficiency, acute procedural effectiveness, short-term safety, and the risk of heart failure in patients with paroxysmal AF. [ABSTRACT FROM AUTHOR]

Objective. To explore the predictive value of magnetic resonance imaging (MRI) with serum lectin-reactive alpha-fetoprotein (AFP-L3) for liver cancer recurrence after percutaneous radiofrequency ablation (RFA). Methods. This study included 94 liver cancer patients admitted for RFA treatment and 82 healthy subjects. MRI was performed to record the apparent diffusion coefficient (ADC). The serum concentrations of AFP-L3 were quantified in all participants. The correlation of the AFP-L3 serum level and ADC value with clinical efficacy following RFA was analyzed. Moreover, the prognostic factors affecting liver cancer recurrence were analyzed, as well as the predictive effect of the ADC value and AFP-L3 on liver cancer recurrence. Results. The serum AFP-L3 level was higher in liver cancer patients than the healthy controls with a lower ADC value. Besides, the patients with tumor residuals had lower ADC values and higher serum AFP-L3 levels than those with complete ablated tumor. The combined detection of the ADC value and serum AFP-L3 level had a sensitivity of 87.50% and a specificity of 87.18% for diagnosing complete ablation after RFA treatment. The number of tumor nodules, tumor diameter, AFP, AFP-L3, and the presence of liver cirrhosis are all independent risk factors for liver cancer recurrence within one year. Meanwhile, the combined detection of the ADC value and serum AFP-L3 level had a good predictive effect on liver cancer recurrence with the sensitivity of 92.86% and a specificity of 69.62%. Conclusion. The ADC values combined with serum AFP-L3 detection had good predictive effects on complete ablation and recurrence of liver cancer after RFA treatment. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to investigate the feasibility of the percutaneous radiofrequency (RF) excision system (BLES) as a primary method of diagnosis and removal of small breast masses. Methods. Ninety-six lesions in 95 patients with 50.5 ± 8.4 years of age were treated in a five-year period by a single operator. Inclusion criteria were as follows: size (<20 mm), depth (>10 mm), and indeterminate or suspicious radiological features (74 BI-RADS 3 and 22 BI-RADS 4). The procedure was performed under ultrasound (US) guidance using 6 G retriever probes with 12-, 15-, and 20-mm baskets. Results. Lesions were between 5 and 20 (12.3 ± 3.8) mm in length. They were removed at the first attempt in all but one case. The technical success rate was 98.95%, and the diagnostic success rate was 100%. Ninety-one lesions were histologically benign and five were neoplastic. Two lesions that were previously classified as BI-RADS 3 were diagnosed as neoplasia (atypical lobular hyperplasia), and nineteen lesions that were previously classified as BI-RADS 4a were diagnosed as benign. The complete excision rate (presence of tumor-free negative surgical margin) was 40% in neoplastic lesions. There were no major complications. The minor complication rate was 1.58%. No recurrence was observed during 18 months of follow-up. Conclusion. BLES delivers surgical quality specimens for confident histopathological examination and is a safe alternative to surgical resection in lesions with suitable size. [ABSTRACT FROM AUTHOR]

We aimed to study the long-term sinus reversion rate and recovery of left atrial function after modified surgical radiofrequency ablation for permanent atrial fibrillation caused by mitral valve disease. From March 2014 to May 2020, 35 patients who underwent modified surgical radiofrequency ablation during cardiac valve surgery in our hospital were selected as the study group, and 25 normal individuals without cardiac structural changes were selected as the control group. The time of modified surgical radiofrequency ablation and long-term sinus reversion rate were measured, and left atrial anteroposterior, superoinferior, left and right diameters, left atrial ejection fraction, left atrial filling index, and left atrial ejection force were measured before and 6 months after surgery. The mean ablation time was 23.2 min, and the long-term sinus reversion rate was 80.0%. The left atrium diameter decreased and the left atrium ejection fraction increased after the operation (P < 0.05). The left atrium filling index and ejection force were significantly increased in 28 patients with sinus reversion (P < 0.05). The decrease in left atrial diameter and the increase in left atrial ejection fraction were correlated with sinus conversion after surgery (P < 0.05). The modified operation is simple, the curative effect is definite, and the sinus reversion rate is high, which is beneficial to the restoration of left atrial structure, ejection function, and hemodynamic function. [ABSTRACT FROM AUTHOR]

Introduction. To compare the actual 10-year survival outcomes of early single hepatocellular carcinoma (HCC) patients between 3 first-line treatments: radiofrequency ablation (RFA), surgical resection (SR), or transplantation (LT). Methods. A total of 1255 early single HCC patients retrieved from the Surveillance Epidemiology and End Results (SEER) database were included. Patients survived ≥10 years, and patients died <10 years were compared. Significant predictors associated with 10-year survival were identified by multivariate logistic regression analysis. The 10-year survival outcomes of 3 treatments were compared using multivariate model risk adjustment and inverse probability of treatment weighted (IPTW) adjustment. Results. Of the 1255 patients, 472 patients underwent SR, 259 patients underwent LT, and 524 patients underwent RFA. 149 patients achieved 10-year survival. Multivariate logistic regression analysis showed that age, race, treatment, and fibrosis score were significant predictors for 10-year survival, and LT had the best advantage of 10-year survival, followed by SR. Comparable 10-year survival outcomes were found between SR and RFA after IPTW. Then, a subgroup analysis was performed based on the tumor size, and the results showed that for ≤50 mm tumor, SR showed no significant advantages over RFA for 10-year survival. Conclusions. Estimates of the observational association of different treatments with 10-year survival are sensitive to the analytic method. LT showed the best outcomes for patients. No significant differences for 10-year survival were found between SR and RFA in the IPTW cohort. Subgroup analysis showed that for >50 mm tumor, SR showed significant advantages over RFA after IPTW. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the predictive value of demographic and clinical factors in changes in quality of life (QoL) in liver cancer (LC) patients over time. Methods: We performed a prospective cohort study in 128 patients who had 4 time point data newly diagnosed with LC at two hospitals in Taiwan. Different functional QoL was measured by QLQ‐C30. Specific characteristics were predictors for distinct functional QoL, estimated by a generalised estimating equation (GEE). Results: Patients who received liver resection or radiofrequency ablation therapy (RFA) versus transarterial chemoembolisation (TACE) or transcatheter arterial embolisation (TAE) experienced a decrease in physical function from baseline to 1 month. In addition, patients who underwent liver resection versus RFA experienced a significant recovery in cognitive functioning from baseline to 6 months. Patients with advanced stage compared to those in early stage had a reduction in physical functioning from baseline to 1 month. The alcohol intake, hepatitis C infection and the job also affected the changes in physical and cognitive functioning. Conclusion: Healthcare professionals should pay attention to changes after treatment in the short term; additionally, they need to provide health education to modifiable factors such as alcohol intake attributed to the deterioration in QoL. [ABSTRACT FROM AUTHOR]