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Introduction: Treatment of reflux has been shown to improve time to healing of Venous Leg Ulcers (VLU). Terminal Interruption of the Reflux Source (TIRS) treats reflux within the plexus of veins around an active VLU using foam sclerotherapy. The efficacy of TIRS in managing VLU has never been tested. Methods: We performed a pragmatic, single centre, assessor-blinded, randomised controlled trial comparing endovenous ablation of the axial superficial veins (Axial Ablation-AA) vs TIRS. Patients of any age with VLU of any duration were eligible. Results: 98 Participants were randomised to AA or TIRS. 39/55, 70.9% (95%CI; 57.1-82.37) healed their VLU in the AA group, while 29/39, 74.36% (95%CI; 57.87-86.96) healed their VLU in the TIRS group, P = 0.45.4 were lost to follow-up. Median time to ulcer healing was 84 days (95%CI; 74.67-93.33) in the axial ablation group and 84 days (95%CI; 73.02-94.98) in the TIRS group. Hazard Ratio for ulcer healing with AA vs TIRS was 0.96 (95%CI 0.59-1.56). There were no significant quality of life differences. Conclusion: The AAVTIRS trial did not show that axial ablation was superior to TIRS in the primary outcome of number of VLU healed in 6 months, or time to VLU healing. This trial is not powered to show non-inferiority. TIRS is a viable option for treatment of VLU. Further investigation is necessary before it can be recommended as an alternative to axial ablation. Trial registered at clinicaltrials.gov NCT04484168. [ABSTRACT FROM AUTHOR]

Introduction: Alzheimer’s disease (AD) is the leading cause of dementia, and currently, no effective treatments are available to reverse or halt its progression in clinical practice. Although a plethora of studies have highlighted the benefits of physical exercise in combating AD, elder individuals often have limited exercise capacity. Therefore, mild physical exercise and nutritional interventions represent potential strategies for preventing and mitigating neurodegenerative diseases. Our research, along with other studies, have demonstrated that platycodin D (PD) or its metabolite, platycodigenin, derived from the medicinal plant Platycodon grandiflorus, exerts neuroprotective effects against amyloid β (Aβ)-induced neuroinflammation. However, the combined effects of PD and physical exercise on alleviating AD have yet to be explored. The current study aimed to investigate whether combined therapy could synergistically ameliorate memory deficits and AD pathology in 5 × FAD mice. Methods: Five-month-old 5 × FAD mice were randomly assigned to four groups, and received either PD (5 mg/kg/day, p.o.), voluntary running, or a combination of both for 47 days. Nest building test, locomotion test, and Morris water maze test were used to evaluate the cognitive function. Immunohistochemical and ELISA analysis was performed to determine Aβ build-up, microglia and astrocytes hyperactivation, and survival neurons in the hippocampus and perirhinal cortex. Real-time quantitative PCR analysis was used to assess the polarization of microglia and astrocytes. HPLC analysis was performed to measure monoamine neurotransmitters in the hippocampus. Results and discussion: The combination of PD and voluntary running synergistically restored nest-building behavior, alleviated recognition and spatial memory deficits, and showed superior effects compared to monotherapy. In addition, the PD and voluntary running combination reduced Aβ build-up, decreased hyperactivation of microglia and astrocytes in the hippocampus and perirhinal cortex, promoted the polarization of inflammatory M1 microglia and reactive astrocytes toward beneficial phenotypes, and lowered systemic circulating pro-inflammatory cytokines while increasing anti-inflammatory cytokines in 5 × FAD mice. Furthermore, combined therapy effectively protected neurons and increased levels of 5-hydroxytryptamine (5-HT) and dopamine (DA) in the hippocampus of 5 × FAD mice. In conclusion, the combination of PD and voluntary running holds great potential as a treatment for AD, offering promise for delaying onset or progression of AD. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion The CASTLE‐HTx trial showed the benefit of atrial fibrillation (AF) ablation compared to medical therapy in decreasing mortality, need for left ventricular assist device implantation or heart transplantation (HTx) in patients with end‐stage heart failure (HF). Herein we describe the effects of catheter ablation on AF burden, arrhythmia recurrences, and ventricular function in end‐stage HF.The CASTLE‐HTx protocol randomized 194 patients in end‐stage HF with AF to catheter ablation and medical therapy or medical therapy alone. AF burden, left ventricular ejection fraction (LVEF), and type of AF were assessed at baseline and at each follow‐up visit. Overall, 97 patients received ablation; 66 patients (68%) underwent pulmonary vein isolation (PVI) and 31 patients (32%) were treated with PVI and additional ablation. Electroanatomic mapping showed the extent of left atrial low voltage (cardiomyopathy) >10% in 31 (31.9%) patients. At 12 months post‐ablation, persistent AF was present in 31/89 patients (34.8%), which was significantly less frequent compared to baseline (p = 0.0001). Median AF burden reduction was 36.3 (interquartile range 13.6–63.3) percentage points at 12 months and LVEF improved from 29.2 ± 6.2% to 39.1 ± 8.3% (p < 0.001) following ablation. AF burden reduction <50% was significantly associated with LVEF improvement ≥5% at 12 months after ablation (p = 0.017).Atrial fibrillation ablation in end‐stage HF leads to a substantial decrease in AF burden, a regression from persistent to paroxysmal AF and notably improved LVEF. Favourable ablation outcomes were observed in patients regardless of the presence or absence of signs indicating left atrial cardiomyopathy. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion Despite the generally favourable long‐term prognosis of low‐risk differentiated thyroid cancer (DTC), questions remain about disease‐free survival (DFS) after initial treatment, particularly regarding the use of radioactive iodine (RAI). Although there are RCT trial confirming that RAI ablation therapy is not superior to follow‐up in terms of the 3‐year DFS rate in low‐risk thyroid cancer, its longer‐term prognosis remains to be established. The objective of this study was to assess the impact of RAI ablation on the presence of structural persistent/recurrent disease in patients with low‐risk DTC.We retrospectively identified 720 low‐risk DTC patients who had undergone total or near‐total thyroidectomy (TT) at a tertiary medical centre between January 2008 and July 2018. Propensity scores were calculated using a multivariable logistic regression model that accounted for age, sex, tumour size, neck dissection, multifocality, capsular invasion and lymph node (LN) metastasis. We compared DFS between patients who received RAI and those who did not using log‐rank tests and multivariate Cox analyses. Subgroup analyses were also conducted.Of the total cohort, 180 (25.0%) patients received RAI, while 540 (75.0%) did not before matching. The median follow‐up duration was 59.5 months. After matching, the RAI group comprised 135 (39.8%) patients and the non‐RAI group comprised 204 (60.2%) patients. In the entire cohort, the 5‐year DFS rate was 97.6% for patients receiving RAI compared to 96.8% for those not receiving RAI (p = 0.704). In the matched cohort, the rates were 98.5% and 95.6%, respectively (p = 0.090). Matched multivariate Cox analysis demonstrated that RAI was neither significantly nor independently associated with DFS (hazard ratio [HR] = 0.29; 95% CI 0.06–1.37; p = 0.118). Further subgroup analyses reaffirmed that RAI ablation did not significantly reduce the risk of developing structural persistent/recurrent disease.Administering RAI ablation following TT did not result in improved DFS for low‐risk DTC patients. Our findings suggest that decisions regarding RAI should be made judiciously to avoid overtreatment in this clinical scenario. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Methods Results Conclusion In addition to well‐documented tachycardias involving twin atrioventricular (AV) nodes, tachycardias involving a single node have been clinically experienced in right atrial isomerism (RAI). This study aimed to characterize the AV node involvement patterns and evaluate the outcome of ablation therapy in RAI patients with tachycardias.We retrospectively analyzed the medical records of 16 RAI patients who underwent catheter ablation of tachycardias involving twin or single AV nodes at our center between April 2006 and March 2020.A total of 22 ablation procedures were performed in 16 patients. The median age and body weight were 2 years (range 20 months–31 years) and 11.2 kg (range 7.4–42 kg), respectively. Two QRS complexes were confirmed in 11/16 patients, and a single QRS complex in 5/16. The dominant AV node was anterior in 7/16. Four patterns of tachycardias were identified: tachycardias reciprocating between two AV nodes with retrograde conduction through the anterior AV node (3/16) or through the posterior AV node (4/16); and reentrant tachycardias involving the anterior AV node only (3/16) or posterior AV node only (6/16). Ablation successfully eliminated the tachycardias in 15/16 patients (93.8%). Recurrence was reported in 7/16 (44%) during a median follow‐up period of 96.5 months. Five of those 7 patients underwent additional ablation, and the tachycardias were eliminated in 3/5 patients. None of the patients developed ventricular asynchrony after ablation.Transcatheter ablation was effective in RAI patients with tachycardias involving twin or single AV nodes, and deterioration of the cardiac function was rare. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma (RCC) is the most common primary renal malignancy. Prevalence of RCC in developed countries has slowly increased. Although partial or total nephrectomy has been the first-line treatment for early-stage RCC, improved or similar safety and treatment outcomes with locoregional therapies have challenged this paradigm. In this review, we explore locoregional techniques for early-stage RCC, including radiofrequency ablation, cryoablation, and microwave ablation with a focus on procedural technique, patient selection, and safety/treatment outcomes. Furthermore, we discuss future advances and novel techniques, including radiomics, combination therapy, high-intensity focused ultrasound, and catheter-directed techniques. [ABSTRACT FROM AUTHOR]

Aims: To develop multiple machine learning (ML) models based on the prognostic nutritional index (PNI) and determine the optimal model for predicting long‐term survival outcomes in hepatocellular carcinoma (HCC) patients after local ablation. Methods: From January 2009 to December 2019, we analyzed data from 848 primary HCC patients who underwent local ablation. ML models were constructed and evaluated using the concordance index (C‐index), concordance‐discordance area under curve (C/D AUC), and Brier scores. The optimal ML model was interpreted using the partial dependence plot (PDP) and SHapley Additive exPlanations (SHAP) framework. Additionally, the prognostic performance of our model was compared with other models. Results: Alkaline phosphatase, preoperation alpha‐fetoprotein level, PNI, tumor number, and tumor size were identified as independent prognostic factors for ML model construction. Among the 19 ML algorithms tested, the Aorsf model showed superior performance in both the training cohort (C/D AUC: 0.733; C‐index: 0.736; Brier score: 0.133) and validation cohort (C/D AUC: 0.713; C‐index: 0.793; Brier score: 0.117). The time‐dependent AUC of the Aorsf model for predicting overall survival was as follows: 1‐, 3‐, 5‐, 7‐, and 9‐year were 0.828, 0.765, 0.781, 0.817, and 0.812 in the training cohort, 0.846, 0.859, 0.824, 0.845, and 0.874 in the validation cohort, respectively. The PDP and SHAP algorithms were employed for visual interpretation. Furthermore, time‐AUC and decision curve analysis demonstrated that the Aorsf model provided superior clinical benefits compared to other models. Conclusion: The PNI‐based Aorsf model effectively predicts long‐term survival outcomes after ablation therapy, making a significant contribution to HCC research by improving surveillance, prevention, and treatment strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Following technological advancements, there has been a rise in the early detection of pulmonary nodules, with more patients found to have multiple lesions. These lesions may indicate benign or malignant stages, each requiring careful evaluation and management. Multiple treatment strategies can be followed while ensuring patient comfort and minimizing complications. Thus, our study aims to provide an example of single-stage management for multiple lung lesions, using percutaneous ablation and thoracoscopic resection in a hybrid operating room (HOR). These combined procedures in a single stage and setting allows for a minimally invasive experience for patients, with minimal complications and a shorter operation time. In addition to personalized therapy, there is more flexibility for managing complications in the HOR. Thus, these initial results indicate a feasible and safe single-stage workflow and an alternative way to manage multiple pulmonary lesions in patients. Background: Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). Methods: We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. Results: A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. Conclusions: The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions. [ABSTRACT FROM AUTHOR]

Electrical cardioversion (ECV) a widely utilized intervention for persistent atrial fibrillation (AF) aimed at restoring sinus rhythm. However, ECV can be ineffective, raising questions about subsequent treatment options. This study aimed to compare the outcomes of non-ablation therapy versus ablation therapy following unsuccessful ECV. A total of 125 consecutive patients with persistent AF who underwent unsuccessful ECV between November 2017 and August 2023 was included in this retrospective analysis. Of these, 51.2% received only medical therapy (non-ablation therapy group, n = 64), while 48.8% underwent AF ablation (ablation therapy group, n = 61). Various ablation methods were employed, including catheter and thoracoscopic ablation. Ablation therapy was associated with significantly better AF-free survival compared to non-ablation therapy [hazard ratio (HR), 0.37; 95% confidence interval (CI) 0.22–0.61; p < 0.01]. There was no difference of AF-free survival between catheter ablation and thoracoscopic ablation groups (HR 0.79, 95% CI 0.34–1.83; p = 0.58). AF duration > 5 year (HR 1.51; 95% CI 0.930–2.437; p = 0.10), BMI ≤ 25 kg/m2 (HR 1.61; 95% CI 1.004–2.581; p = 0.05) and diabetes (HR 2.38; 95% CI 0.902–6.266; p = 0.08) were considerable as predictor of AF recurrence. Ablation therapy following unsuccessful ECV was associated with maintaining sinus rhythm, regardless of the specific ablation method utilized. [ABSTRACT FROM AUTHOR]

Key content: All patients with ovarian endometriosis should be offered an individualised, shared decision‐making approach informed by clinical history, symptoms and fertility status.Surgical management of ovarian endometriosis can be effective in treating endometriosis‐associated pelvic pain and infertility, but there is no current evidence that surgery for ovarian endometriosis increases the success of in vitro fertilisation (IVF) treatment.Ovarian reserve tests should be considered before any ovarian surgery and can help guide the patient towards the optimal treatment.The Endometriosis Fertility Index should be incorporated into pre‐operative consultations as a validated tool that estimates the likelihood of spontaneous conception following surgical intervention.Surgeons should be trained in different surgical techniques, types of diathermy and haemostatic agents that can minimise the risk of inadvertent injury to normal ovarian cortex. Learning objectives: To facilitate informed decision‐making regarding the treatment of ovarian endometriosis.To gain insight into the possible surgical techniques available to manage ovarian endometriosis and the evidence behind them.To understand the impact of each technique on endometriosis‐associated pain, fertility outcomes and recurrence rates. Ethical considerations: Should fertility preservation be offered to all women of reproductive age with fertility aspirations and a diagnosis of endometriomas?Should integrated care boards (ICBs) devise specific criteria to offer funding for fertility preservation as an option before surgery for ovarian endometriosis? [ABSTRACT FROM AUTHOR]

Venous thromboembolic disease (VTE) occupies an important place as a cause of morbidity and mortality in surgical patients in all specialties. Despite the existence of guidelines for thrombo prophylaxis in surgery, it is not clear due to the lack of current evidence, how to develop antithrombotic prophylaxis in varicose vein surgery and many questions arise when the surgeon is faced with a patient to be operated on. A comprehensive review of the literature was conducted to examine the evidence about the prevention of the venous thromboembolism in varicose veins surgery patients, and aims to guide the reader through questions that arise in daily practice, discussing the different scenarios presented in the literature for the choice of the most appropriate prophylaxis for each case. The lack of conclusive literature determines that risk should be individualized using available scales and other procedure-related factors, so that the type and duration of prophylaxis can be determined on a case-by-case basis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the association between inflammatory markers and the occurrence of post-atrial fibrillation (AF) ablation pericarditis (PAP), while also examining the PAP's incidence and contributing factors. Methods: A retrospective cohort study was conducted between January 2021 and November 2023, including patients who underwent successful AF ablation. Inflammatory markers of interest included the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Results: Among the 231 patients examined, 22 (9.52%) were classified as suspected PAP, and 14 (6.06%) as definitive PAP. The median age was 58 years, with no age difference between groups. Males comprised 51.52% of the sample, with male sex frequency significantly higher in the suspected PAP group relative to the other groups (p = 0.007). Multivariable logistic regression indicated that AF duration (p = 0.026) and cavotricuspid isthmus (CTI) ablation (p = 0.001) were associated with definitive PAP, whereas analysis for any pericarditis (suspected or definitive PAP) revealed independent relationships with CTI ablation (p = 0.003) and sleep apnea (p = 0.008). SII, NLR, and PLR were not associated with PAP. Conclusions: Prolonged AF duration, CTI ablation, and sleep apnea are risk factors for PAP. The inflammatory markers (SII, NLR, and PLR) showed no association, warranting further investigation into other markers. [ABSTRACT FROM AUTHOR]

Background/Objectives: Adenomyosis is a debilitating gynecologic condition that affects both multiparous older women and nulliparous younger women, inducing a variety of symptoms such as dysmenorrhea, menorrhagia, and infertility. Thermal ablation techniques are new procedures that have been proposed for the treatment of adenomyosis. They include high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and radiofrequency ablation (RFA). Because thermal ablation techniques are minimally invasive or noninvasive, fertility is not impaired while symptoms improve. In addition, hospital stays and financial costs are generally reduced, increasing the interest in these alternative management options. Methods: In this narrative review, we conducted a thorough literature search of PubMed/Medline from the database inception to September 2022. In our search, we focused on noninvasive treatment methods such as HIFU ablation, RFA ablation, and PMWA as well as adenomyosis-specific terms and noninvasive techniques (ultrasonography, ultrasound, or magnetic resonance imaging). The queries were a combination of MeSH terms and keywords. The search was limited to the English language. Abstracts were screened according to their content, and relevant articles were selected. Results: Overall, the results showed that the above-mentioned ablation techniques are effective and safe in providing adenomyosis treatment. Lesion size and uterus volume are reduced, leading to considerable symptom alleviation with all three methods. Positive results concerning safety and fertility preservation have been described as well. Conclusions: Nonetheless, more research is required in this field to compare the efficacy and safety of different ablation techniques with traditional therapies. Such research will help improve these procedures and their associated decision-making processes. [ABSTRACT FROM AUTHOR]

Radiofrequency ablation (RFA) under endoscopic ultrasound (EUS) guidance has been developed and utilized over the last decade to provide the loco-regional treatment of solid and cystic pancreatic neoplastic lesions. The advantage of this approach relies on the close proximity of the EUS transducer to the target pancreatic lesion, which, coupled with the development of specifically designed RFA ablation devices, has made the procedure minimally invasive, with a clear reduction in adverse events as compared to the high morbidity of the surgical approach. EUS-RFA has been applied so far to pancreatic functional and non-functional neuroendocrine neoplasms, pancreatic ductal adenocarcinoma or metastases to the pancreas, and pancreatic neoplastic cysts. Excluding neuroendocrine tumors, for other indications, most of these procedures have been performed in patients who refused surgery or were at high surgical risk. More studies evaluating EUS-RFA in selected patients, not at surgical risk, are gradually becoming available and will pave the road to extend the indications for this therapeutic approach, also in association with other oncological therapies. The present manuscript will critically review the available evidence in the field of the EUS-guided RFA of solid and cystic pancreatic neoplasms. [ABSTRACT FROM AUTHOR]

Background and aims: Successful left atrial posterior wall isolation (LAPWI) using only the cryoballoon (CB) is technically challenging for the treatment of atrial fibrillation (AF). This study aimed to evaluate the efficacy of the cross‐over technique, wherein an overlapped ablation is performed by placing the CB from both directions in contact with the LAPW. Methods: This was a single‐center, retrospective, observational study of 194 consecutive patients with persistent atrial fibrillation (PerAF) who underwent a first‐time procedure of pulmonary vein isolation (PVI) + PWI (108 patients) or PVI‐only (86 patients) using the CB. The cross‐over technique was applied in all LAPWI. Results: For ablation of the LA roof and bottom, respectively, a mean of 8.6 ± 1.0 (right to left [R→L] 4.3 ± 1.1 and left to right [L→R] 4.3 ± 1.1) and 9.1 ± 1.2 (R→L 4.6 ± 1.6 and L→R 4.5 ± 1.2) CB applications were delivered. LAPW was successfully isolated solely using the CB in 99.1% of patients. Although the PVI + PWI group had significantly longer procedure time, no severe adverse events were observed in either group. During a median follow‐up of 19 months, freedom from recurrence of all atrial tachyarrhythmias was achieved in 93.5% of the PVI + PWI group and 72.9% of the PVI‐only group (p =.011). Conclusions: LAPWI performed solely with the CB using the cross‐over technique is feasibly, safe, and was independently associated with a significantly higher freedom from recurrence of atrial tachyarrhythmias compared with PVI alone in patients with PerAF. [ABSTRACT FROM AUTHOR]

Introduction: Management of patients with long‐standing persistent atrial fibrillation (LSPAF) presents a clinical challenge. Hybrid convergent ablation has been shown to have superior efficacy compared to endocardial‐only ablation. However, data on concomitant left atrial appendage (LAA) management along with hybrid ablation is sparse. Methods: We aimed to evaluate the effectiveness of concomitant hybrid convergent ablation and LAA clipping in patients with LSPAF. We conducted a retrospective analysis of all patients with LSPAF who underwent hybrid surgical ablation with LAA clipping at our institution. The primary endpoint was a recurrence of atrial arrhythmias at 12 months. Further, the durability of surgical left atrial posterior wall ablation was examined during the endocardial catheter ablation using standing electrophysiological criteria. Results: A total of 79 patients were included. Mean age was 63.5 ± 9.6 years, and 71% were males. LAA clipping was performed in 99% of patients. The mean time between the surgical and endocardial stages of the procedure was 2.6 ± 1.7 months. Persistent posterior wall activity was observed in 34.2% (n = 27/79) patients during the endocardial phase of the procedure. Cardiac implantable electronic device was used in 74% of patients for monitoring of recurrence of atrial fibrillation (AF). The primary effectiveness of AF freedom at 12 months was 73.8% (45/61). Over a 12‐month follow‐up period, 11.4% (9/79) of patients required repeat catheter ablation, of which 88.9% (8/9) had evidence of persistent posterior wall activity. Conclusion: Concomitant hybrid convergent ablation and LAA exclusion with an atrial clip provides reasonable long‐term AF‐free survival in patients with LSPAF. Persistent posterior wall activity is seen commonly in patients presenting with recurrent AF following hybrid convergent AF ablation. [ABSTRACT FROM AUTHOR]

Introduction: Cardioneuroablation (CNA) has proven effectiveness in addressing hypervagotonia symptoms, such as neurocardiogenic syncope. Methods and Results: In this case, we present the first‐time application of CNA in a case of vago‐glossopharyngeal neuralgia (VGPN). A 59‐year‐old female with near‐syncope, sinus bradycardia, and sinus pauses triggered by recurrent right‐sided neck pain was diagnosed with VGPN. The patient underwent successful treatment with carbamazepine and CNA. Subsequent follow‐up revealed the sustained absence of sinus bradycardia or pauses, even upon neck pain resurgence after discontinuing carbamazepine. Conclusion: In this patient, CNA successfully prevented pauses associated with VGPN, avoiding permanent pacemaker implantation. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide and remains a major cause of morbidity and mortality. Unfortunately, a significant proportion of patients have persistent AF, for which conventional catheter ablation is less effective. However, convergent ablation has emerged in recent years as a hybrid treatment targeting both the epicardium and endocardium in a multidisciplinary joint cardiothoracic and electrophysiology procedure, with promising efficacy outcomes in recent studies. This treatment is increasingly being performed in the United Kingdom. This review article discusses the rationale and evidence behind convergent ablation, along with factors that need to be considered when setting up a successful ablation service. [ABSTRACT FROM AUTHOR]

Background: Ablation is an effective, parenchymal-sparing treatment for primary liver cancer and liver metastases. The purpose of this study was to report our initial experience with laparoscopic microwave ablation regarding postoperative complications, rate of conversions to open procedure, and technical efficacy. Methods: This was a quality improvement project carried out at a tertiary care center in Denmark. Patients ≥ 18 years old with liver malignancies, not available for percutaneous ablation, and treated with ultrasound-guided laparoscopic ablation were included. Results: From March 2023 to December 2023, 39 patients were referred for laparoscopic ablation after a multidisciplinary team conference. Of these, two procedures were converted to open procedures due to adhesion and tumor progression. Three patients rejected the sharing of medical information, two procedures were canceled and in one case the strategy was changed perioperatively. Therefore, 32 procedures in 31 patients were available for analysis. Complete ablation was evaluated after 1 month and was achieved in 100% of the procedures. None of the patients died, and no complications were reported in 21 cases (65.6%). Most patients with complications had a grade 1 complication based on the Clavien–Dindo classification, which among others included abdominal and shoulder pain, atrial fibrillation, and subcutaneous hematoma. Two patients had a complication grade 2 (wound infection and decompensated cirrhosis) and one had a grade 4b (sepsis due to pneumonia and urinary tract infection). The median Comprehensive Complication Index was 12.2 (interquartile range 8.7–24.2). Furthermore, univariable logistic regression showed that ≥ 2 tumors treated were associated with a higher risk of complications (odds ratio 6.37, 95% confidence interval [1.20;33.85], p-value = 0.0297). Conclusion: Ultrasound-guided laparoscopic microwave ablation of liver malignancies is feasible and safe with little risk for complications, a high technical efficacy, and a low rate of conversions to open procedures. [ABSTRACT FROM AUTHOR]

Background: To evaluate the safety and efficacy of percutaneous biopsy and microwave ablation (B + MWA) in patients with pulmonary nodules (PNs) who are receiving antithrombotic therapy by rivaroxaban as bridging therapy. Methods: The study comprised 187 patients with PNs who underwent 187 B + MWA sessions from January 1, 2020, to December 31, 2021. The enrolled patients were divided into two groups: Group A, who received antithrombotic therapy five days before the procedure and received rivaroxaban as a bridging drug during hospitalization, and group B, who had no antithrombotic treatment. Information about the technical success rate, positive biopsy rate, complete ablative rate, and major complications were collected and analyzed. Results: Group A comprised 53 patients and group B comprised 134 patients. The technical success rate was 100% in both groups. The positive biopsy rates were 88.68% and 91.04%, respectively (p = 0.6211, X2 = 0.2443). In groups A and B, the complete ablative rates at 6, 12, and 24 months were 100.0% versus 99.25%, 96.23% versus 96.27%, and 88.68% versus 89.55%, respectively. There were no significant differences in bleeding and thrombotic complications between the two groups. No grade 5 complications occurred. Conclusions: It is generally considered safe and effective that patients who are on antithrombotic therapy by rivaroxaban as bridging to undergo B + MWA for treating PNs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy, safety, and improvement of symptoms by ultrasound-guided microwave ablation (MWA) for patients with large benign thyroid nodules (BTNs). Methods: Eighty-seven patients with 87 BTNs (≥ 4 cm) treated with MWA between April 2015 and March 2021 were enrolled in this retrospective multicenter study, with clinical and ultrasound examinations performed at the 1st, 3rd, 6th, and 12th months. A multivariable linear mixed effects model was employed to explore the alterations in volume and volume reduction ratio (VRR), as well as the potential factors associated with VRR. Results: The mean age of the 87 patients was 45.69 ± 14.21 years (range 18–76 years), and the ratio of men to women was 1:4.8. The mean volumes were much decreased at the 12th month after ablation compared to the initial volumes (p <.001). The mean VRR was 76.09% at the 12th month. The technique efficacy (VRR > 50%) was 90.80% at the 12th month. A multivariate analysis revealed that VRR was related to the initial volume (p =.015), annular flow (p =.010), and nodule composition (p =.024). The mean symptomatic score decreased from 4.40 ± 0.28 to 0.26 ± 0.06 at the 12th month (p <.001). At the same time, the mean cosmetic score decreased from 3.22 ± 0.10 to 1.31 ± 0.08 (p <.001). Conclusion: MWA could serve as a safe and effective therapy for large BTNs, significantly reducing the volume of BTNs and significantly improving compressive symptoms and appearance problems. Clinical relevance statement: Microwave ablation could serve as a safe and effective therapy for large benign thyroid nodules, leading to significant volume reduction and satisfied symptom and cosmetic alleviation period. Key Points: • This multicenter study investigated the feasibility and safety of microwave ablation for large benign thyroid nodules. • After ablation, the nodule volume was significantly reduced, and patients' symptoms and appearance problems were significantly improved. • Microwave ablation is feasible for large benign thyroid nodules and has been a supplement treatment. [ABSTRACT FROM AUTHOR]

Background: Pulsed‐field ablation (PFA) has emerged as an innovative alternative to radiofrequency (RF) and cryoablation because it selectively targets myocardial tissue. Thus, we aim to estimate the efficacy and safety of PFA versus thermal ablation for atrial fibrillation (AF) ablation. Methods: A systematic review and meta‐analysis were retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through September 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). PROSPERO ID: CRD42023480321 Results: We included 17 studies with a total of 2255 patients. PFA was significantly associated with a decreased incidence of AF recurrence (RR: 0.66 with 95% CI [0.51, 0.87], p =.003). However, there was no significant difference between PFA and thermal ablation in arrhythmia recurrence (RR: 0.92 with 95% CI [0.74, 1.46], p =.42). PFA was significantly associated with decreased total procedure time (MD: −15.15 with 95% CI [−20.23, −10.07], p <.00001), decreased heart rate change (MD: −7.39 with 95% CI [−12.16, −2.62], p =.002), decreased phrenic nerve palsy (RR: 0.38 with 95% CI [0.15, 0.98], p =.05), and reduced esophageal lesions (RR: 0.09 with 95% CI [0.01, 0.69], p =.02). On the contrary, PFA was significantly associated with increased pericardial tamponade (RR: 6.14 with 95% CI [1.43, 26.33], p =.01). Conclusion: PFA was significantly associated with decreased AF recurrence, total procedure time, heart rate change, phrenic nerve palsy, esophageal lesion, and increased incidence of pericardial tamponade compared with thermal ablation. [ABSTRACT FROM AUTHOR]

Introduction: Femoral venous access is routinely used for radiofrequency catheter ablation (RFA) procedures. Deep vein thrombosis (DVT), which is often sub‐clinical, is uncommon following RFCA. Point‐of‐care ultrasound (POCUS) is a cost‐effective way to diagnose DVT. Identification of DVT incidence, especially if sub‐clinical, can direct change in practice to reduce DVT and lay ground for cost‐effective screening strategies postprocedures. The aim of our study is to determine the incidence of DVT after right‐sided radiofrequency cardiac catheter ablation using POCUS. Methods: We conducted a single‐center prospective cross‐sectional study in patients undergoing right‐sided RFCA. Within 24 h postprocedure, the participants underwent compression venous duplex ultrasonography using POCUS to look for evidence of DVT in cannulated limb. The contralateral limb that was not cannulated was scanned as a control. Results: A total of 194 patients were scanned post‐right‐sided RFCA procedures. Average age was 43.5 ± 13.2 years and 131 (67.5%) were women. A total of 148 (76.3%) patients underwent AVNRT ablation. Ten (5.2%) patients developed DVT, of which nine had sub‐clinical DVT. Age (>53 years), greater sum of sheaths used (>3) and longer duration of bed rest maintained (up to 4.0 h vs. >4.0 h, p = 0.006) were identified as risk factors. Conclusion: Most of the DVTs after right‐sided catheter ablation are sub‐clinical. Routine scanning for DVT after right‐sided catheter ablation as well as reducing number of sheaths and bed rest should be considered. [ABSTRACT FROM AUTHOR]

The Alma Hybrid™ not only bridges the gap between traditional ablative and non-ablative laser treatments but also introduces enhanced transdermal delivery through the Impact Handpiece, utilising ultrasound technology. This integration allows for the effective treatment of a wide range of dermatological concerns, including scar revision, skin rejuvenation, and resurfacing (Arellano-Huacuja, 2023; Arellano et al, 2023b). This article aims to provide an examination of the clinical evidence supporting the Alma Hybrid™ system, with a focus on its integration into treatment plans for aesthetic and dermatological practices. Through an analysis of patient case studies and a review of the literature, this paper will demonstrate how the Alma Hybrid™ can be employed to enhance patient outcomes, particularly in challenging cases such as hypertrophic and atrophic scars. Furthermore, we will explore the system's efficacy across diverse patient demographics, with an emphasis on its safety profile in treating different Fitzpatrick skin types. [ABSTRACT FROM AUTHOR]

Background Image-guided therapies (IGTs) are commonly used in oncology, but their role in adrenocortical carcinoma (ACC) is not well defined. Materials and Methods A retrospective review of patients with ACC treated with IGTs. We assessed response to therapy using RECIST v1.1, time to next line of systemic therapy, disease control rate (DCR), local tumor progression-free survival (LTPFS), and complications of IGTs (based on the Common Terminology Criteria for Adverse Events [CTCAE] version 5.0). Results Our cohort included 26 patients (median age 56 years [range 38-76]; n  = 18 female) who had 51 IGT sessions to treat 86 lesions. IGTs modalities included cryoablation (n  = 49), microwave ablation (n  = 21), combined microwave and bland trans-arterial embolization (n  = 8), bland trans-arterial embolization alone (n  = 3), radio-embolization (n  = 3), and radiofrequency ablation (n  = 2). DCR was 81.4% (70 out of 86), of which 66.3% of tumors showed complete response, 18.6% showed progressive disease, 8.1% showed partial response, and 7.0% showed stable disease. LTPFS rates were 73% and 63% at 1 and 2 years, respectively. Fourteen lesions underwent re-ablation for incomplete response on initial treatment. Sixteen patients (61.5%) received new systemic therapy following IGTs, with a median time to systemic therapy of 12.5 months (95% CI: 8.6 months upper limit not reached). There was 1 reported CTCAE grade 3 adverse event (biloma) following IGT. Conclusions IGT use in properly selected patients with ACC is safe and associated with prolonged disease control and delay in the need for systemic therapy. [ABSTRACT FROM AUTHOR]

Interventional procedures for the recanalization of blood vessels to treat deep vein thrombosis carry a high risk of vessel wall injuries or hemorrhaging. Focused ultrasound (FUS) has been used to non-invasively break down blood clots that occlude the vessels in both in vitro and in vivo studies. Previous studies have either used thrombolytic drugs or ultrasound contrast agents (e.g., microbubbles) in combination with FUS. Several studies have applied very high peak-negativepressures (PNP) during FUS treatment to achieve successful thrombolysis without the use of contrast agents. In the current study, we demonstrated that cavitation activity could be significantly enhanced by placing a nitinol wire, whose surface was roughed by laser etching, in the focal region of a FUS field. We demonstrated in vitro in a mock thrombosis that the thrombolysis efficacy of a 500 kHz FUS transducer was significantly enhanced using a surface-etched nitinol wire as compared to an unetched nitinol wire, whereas FUS-alone at the same pressure level did not result in any thrombolysis. These results suggest that a surface modified nitinol catheter exposed to FUS can result in intense cavitation activities leading to enhanced thrombolysis without the use of additional pharmacological or contrast agents. [ABSTRACT FROM AUTHOR]

Improving health-related quality of life (QoL) is crucial for managing Parkinson's disease. However, QoL outcomes after deep brain stimulation (DBS) of the subthalamic nucleus (STN) vary considerably. Current approaches lack integration of demographic, patient-reported, neuroimaging, and neurophysiological data to understand this variability. This study used explainable machine learning to analyze multimodal factors affecting QoL changes, measured by the Parkinson's Disease Questionnaire (PDQ-39) in 63 patients, and quantified each variable's contribution. Results showed that preoperative PDQ-39 scores and upper beta band activity (>20 Hz) in the left STN were key predictors of QoL changes. Lower initial QoL burden predicted worsening, while improvement was associated with higher beta activity. Additionally, electrode positions along the superior-inferior axis, especially relative to the z = −7 coordinate in standard space, influenced outcomes, with improved and worsened QoL above and below this marker. This study emphasizes a tailored, data-informed approach to optimize DBS treatment and improve patient QoL. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to use machine learning to conduct in-depth analysis of key factors affecting the recurrence of HCC patients with high preoperative systemic immune-inflammation index (SII) levels after receiving ablation treatment, and based on this, construct a nomogram model for predicting recurrence-free survival (RFS) of patients. Methods: This study included clinical data of 505 HCC patients who underwent ablation therapy at Beijing You'an Hospital from January 2014 to January 2020, and accepted 65 HCC patients with high SII levels from Beijing Ditan Hospital as an external validation cohort. 505 patients from Beijing You'an Hospital were divided into low SII and high SII groups based on the optimal cutoff value of SII scores. The high SII group was further randomly divided into training and validation cohorts in a 7:3 ratio. eXtreme Gradient Boosting (XGBoost), random survival forest (RSF), and multivariate Cox regression analysis, were used to explore the factors affecting the post-ablation RFS of HCC patients. Based on the identified key factors, a nomogram model were developed to predict RFS in HCC patients, and their performance were evaluated using the concordance index (C index), receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA). The optimal cutoff value for nomogram scores was used to divide patients into low- and high-risk groups, and the effectiveness of the model in risk stratification was evaluated using Kaplan-Meier (KM) survival curves. Results: This study confirmed that age, BCLC stage, tumor number, and GGT level were independent risk factors affecting RFS in HCC patients. Based on the selected risk factors, an RFS nomogram was successfully constructed. The Cindex, ROC curve, calibration curve, and DCA curve each demonstrated the discrimination, accuracy, and decision-making utility of the nomogram, indicating that it has good predictive performance. KM curve revealed the nomogram could significantly differentiate patient populations with different recurrence risk. Conclusion: We developed a reliable nomogram that can accurately predict the 1-, 3-, and 5-year RFS for HCC patients with high SII levels following ablation therapy. [ABSTRACT FROM AUTHOR]

Simple Summary: The majority of newly diagnosed prostate cancer patients are eligible for active surveillance, and those at moderate to high risk frequently receive definitive treatments such as radiotherapy or radical prostatectomy. A considerable proportion of patients will experience biochemical recurrence, as well as localized and distant metastatic recurrence following definitive treatment. Salvage cryotherapy has emerged as a safe and effective alternative for treating localized recurrence. This review examines the oncologic and functional outcomes of whole-gland and focal salvage cryotherapy, as well as the crucial role of multiparametric prostate MRI and PSMA-targeted PET imaging. The outcomes of cryotherapy compared to those of other salvage ablation techniques like high-intensity focused ultrasound (HIFU) are also explored. Prostate cancer is the most common non-cutaneous malignancy in men, with the majority of newly diagnosed patients eligible for active surveillance. Despite definitive treatment, a considerable percentage of men will experience biochemical recurrence and even regional and distant metastatic recurrence after radiation therapy or radical prostatectomy. Salvage prostatectomy, while oncologically effective, poses significant morbidity with poor functional outcomes. Salvage cryotherapy has emerged as a promising alternative for localized recurrence, demonstrating safety and efficacy. This review examines the oncologic and functional outcomes of whole-gland and focal salvage cryotherapy, including disease-free survival, cancer-specific survival, and overall survival. The crucial role of multiparametric prostate MRI and evolving role of next-generation PSMA-targeted PET imaging are also examined. The comparison of outcomes of cryotherapy to other salvage ablation modalities, such as high-intensity focused ultrasound (HIFU), is also explored. [ABSTRACT FROM AUTHOR]

Thermal agents (TAs) have exhibited promise in clinical tests when utilized in cancer thermal therapy (TT). While rapid degradation of TAs may address safety concerns, it limits the thermal stability required for effective treatment. TAs, which possess exceptional thermal stability, experience gradual deterioration. There are few approaches that effectively address the trade-off between improving thermal stability and simultaneously boosting material deterioration. Here, we control the thermal character of tungsten disulfide (WS2)-based 2D materials by utilizing an M13 phage through Joule heating (the M13–WS2–PEG nanostructures were generated and termed a tripartite (T) nanostructure), and developed a T nanostructure-driven TT platform (we called it T-TT) for efficient thermal ablation of clinically relevant MCF-7 cells. A relative cell viability of ~59% was achieved, as well as onset time of degradation of ~0.5 week. The T-TT platform also discloses an energy density of 5.9 J/mL. Furthermore, the phage-conjugated WS2 can be utilized to achieve ultrasound imaging for disease monitoring. Therefore, this research not only presents a thermal agent that overcomes TA limitations, but also demonstrates a practical application of WS2-type material system in ultra-energy efficient and effective cancer therapy. [ABSTRACT FROM AUTHOR]

Featured Application: A guide to construct and operate an experimental cardiac ablation simulator for interventional electrophysiology training. Cardiac ablation (CA) is an interventional electrophysiological procedure used to disrupt arrhythmic substrates in the myocardium by inducing localized scarring. Current CA training relies on the master–apprentice model. In different fields of medicine including CA, virtual and physical simulators have proven to enhance, and even outperform, conventional training modalities while providing a risk-free learning environment. Despite the benefits, high costs and operational difficulties limit the widespread use of interventional simulators. Our previous research introduced a low-cost CA simulator using a 3D-printed biatrial cardiac model, successfully recording ten ablation lesions on the phantom myocardium. In this work, we present and evaluate an enhanced version: compared to the previous version, the cardiac phantom's electrical behavior and ablation settings were optimized to produce consistent lesions, while 3D-printed components improved the haptic and radiographic properties of the simulator. Seven cardiologists compared the experimental simulator's performance to the leading commercial system from Heartroid in a 24-question survey on a 5-point Likert scale. The four following areas of fidelity were considered: catheter entry, anatomical correctness, radiographic appearance, and mapping and ablation. The experimental simulator significantly outperformed the commercial system (p < 0.01), particularly in radiographic appearance (p < 0.01). The results show the potential for the experimental simulator in routine CA training. [ABSTRACT FROM AUTHOR]

Purkinje‐related ventricular arrhythmias have been increasingly reported, and with the development of catheter ablation techniques, intervention for Purkinje‐related arrhythmias has been shown to be effective. The characteristics of Purkinje fibres orientation in the 12 canine left ventricles were observed at a gross level by staining the endocardium with Lugol's solution. Purkinje fibres were observed microscopically by HE, Masson's, PAS glycogen, and Cx40 immunohistochemical staining. Staining was successful, and the transverse orientation characteristics of Purkinje fibres were observed by Lugol's staining, and the longitudinal distribution was observed microscopically. The distribution of Purkinje fibres in the canine left ventricle is 'graded', 'layered', and 'networked', which can guide catheter ablation of Purkinje‐related ventricular arrhythmia. [ABSTRACT FROM AUTHOR]

Purpose: To explore the plasma proteomic changes of rabbit lung VX2 tumors treated by microwave ablation, and to explore the molecular pathway mechanisms that may be involved. Methods: New Zealand white rabbits were inoculated with VX2 tumor cell suspension in the right lower lung and treated with microwave ablation after 2-3 weeks of tumor formation. Blood was collected at 5 time points (TP1~TP5) before and after ablation by cardiac blood sampling and pre-treated before proteomic analysis. The plasma proteome was analyzed by Data-Independent Acquisition (DIA). Results: Different molecular pathways were activated at different time points:(i) TP1vsTP2: more proteins were down-regulated and enrichment analysis showed that the proteasome pathway was activated. The abnormal protein folding process involved in this pathway is closely related to the process of tumor development. (ii) TP2vsTP3: more proteins were up-regulated although the number of differentially differentiated proteins was lower and enrichment analysis showed that the phagosome pathway was activated. After microwave ablation inactivates tumor cells, it activates the phagosomal pathway for immune clearance of necrotic tumor tissue. (iii) TP3vsTP4: more down-regulated proteins, enrichment analysis showed that cysteine and methionine metabolism pathway was activated. Decreased metabolism of these amino acids suggests that cancer progression may be blocked after microwave ablation therapy. (iv) TP4vsTP5: the number of differential proteins was less and more down-regulated proteins, enrichment analysis showed that glutathione metabolism and metabolism of xenobiotics by cytochrome P450 pathway were activated. The down-regulated proteins in this pathway may suggest that microwave ablation may have reduced resistance to certain chemotherapeutic agents following. Conclusions: In the process of lung cancer treatment by microwave ablation, the changes of proteins on the possible molecular pathways at each time point are related to lung cancer, and not only involve some simple inflammatory reactions, and some of the proteins released by destroying the tumor cells can be used as possible drug binding sites and reduce drug resistance. [ABSTRACT FROM AUTHOR]

Introduction: Radiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse's fetlock and pastern, ex vivo. Methods: After assessing the US anatomy of lateral and medial PDNs in fetlock and pastern in vivo (n = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs (n = 10) applying four different settings with increasing invasiveness (n = 40 total treatments): 60°C, 6 min (GROUP LOW); 70°C, 4 min (GROUP MEDIUM); 90°C, 2 min (GROUP HIGH); 80°C, 8 min (GROUP VERY HIGH). Needle-tip-to-nerve proximity was assessed with US and methylene blue, injected through the port of the RF needle. Nerves were collected for microscopical assessment. Results: Transverse palmaro-lateral and palmaro-medial US images of fetlock and pastern detected PDNs consistently, close to the palmar digital artery. With in-plane US technique, RFA was performed at target in 31/40 cases, with significantly higher number of failures in fetlock (p = 0.008). PDNs histology identified thermal injury/coagulation with axonal degeneration and collagen homogenation. Nuclear smearing of arterial leyomyocytes was also observed. Nerve coagulation was significantly associated with treatment (p = 0.03) and needle-tip-to-nerve proximity (US distance: p = 0.009; blue distance: p = 0.04). Discussion: The PDNs were easily visualized and reached with the RF needle by US in-plane-guided technique. RFA produced axonal thermal damage and intensity-related coagulation effectiveness. To ensure effective nerve coagulation, it is crucial that the needle is accurately positioned in close proximity to the target nerve. Based on the histopathological findings, HIGH and VERY HIGH RFA treatments might be worth of being tested in vivo in clinical studies aimed at treating chronic lameness of the distal forelimb in horses. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphos-phataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts. [ABSTRACT FROM AUTHOR]

Objective: By incorporating an endovascular component into Great Saphenous Vein stripping, EndoVenous-assisted Invaginated Stripping (EVIS) aims to make the procedure minimally invasive. A study was conducted to investigate the surgical intervention. Methods: Sketches and videos were used to illustrate the technical aspects of EVIS. A prospective cohort study included 20 patients with chronic venous insufficiency (CVI). Results: EVIS is performed as a day-surgery. Technical success was 100%, and no complications were recorded. The mean operative time was 45 minutes, intraoperative pain score was 4.8, post-operative pain was 2.5, 1.8, 1.2, 0.5 at 48 hours, 1, 4, and 12 weeks, respectively. The mean blood loss was 15 mL, and the mean length of the GSV strapped was 19 cm. The follow-up duplex showed a reduction in the diameter of the residual GSV stump. Conclusions: EVIS is a combination of standard techniques that may prove valuable in managing CVI. [ABSTRACT FROM AUTHOR]

Simple Summary: Single small primary liver cancers are curable with treatments such as surgical resection, ablation, and liver transplant; however, many patients initially receive trans-arterial chemo-embolisation (TACE), which is generally not considered a curative treatment in itself, and often go on to receive further follow-up treatments. Little is known regarding the outcomes of such patients compared to those who receive upfront ablation. Our real-world multi-centre study demonstrates that key survival outcomes are similar between those initially undergoing TACE and those receiving ablation after controlling for other key clinical variables and allowing for subsequent individualised treatment selection. Percutaneous ablation is recommended in Barcelona Clinic Liver Cancer (BCLC) stage 0/A patients with HCC ≤3 cm as a curative treatment modality alongside surgical resection and liver transplantation. However, trans-arterial chemo-embolisation (TACE) is commonly used in the real-world as an initial treatment in patients with single small HCC in contrast to widely accepted clinical practice guidelines which typically describe TACE as a treatment for intermediate-stage HCC. We performed this real-world propensity-matched multi-centre cohort study in patients with single HCC ≤ 3 cm to assess for differences in survival outcomes between those undergoing initial TACE and those receiving upfront ablation. Patients with a new diagnosis of BCLC 0/A HCC with a single tumour ≤3 cm first diagnosed between 1 January 2016 and 31 December 2020 who received initial TACE or ablation were included in the study. A total of 348 patients were included in the study, with 147 patients receiving initial TACE and 201 patients undergoing upfront ablation. After propensity score matching using key covariates, 230 patients were available for analysis with 115 in each group. There were no significant differences in overall survival (log-rank test p = 0.652) or liver-related survival (log-rank test p = 0.495) over a median follow-up of 43 months. While rates of CR were superior after ablation compared to TACE as a first treatment (74% vs. 56%, p < 0.004), there was no significant difference in CR rates when allowing for further subsequent treatments (86% vs. 80% p = 0.219). In those who achieved CR, recurrence-free survival and local recurrence-free survival were similar (log rank test p = 0.355 and p = 0.390, respectively). Our study provides valuable real-world evidence that TACE when offered with appropriate follow-up treatment is a reasonable initial management strategy in very early/early-stage HCC, with similar survival outcomes as compared to those managed with upfront ablation. Further work is needed to better define the role for TACE in BCLC 0/A HCC. [ABSTRACT FROM AUTHOR]

Simple Summary: Soft tissue sarcomas (STSs) are rare cancers, making up less than 1% of all adult malignancies. Traditionally, the primary treatment for STS has been surgical resection. However, non-surgical approaches are becoming increasingly important in specific clinical situations. In this review, we explore the role of non-surgical treatments in managing STS, including their use as a bridge to surgery, as alternatives to surgery, for improving surgical outcomes, and for managing cases where surgery is not an option. Our findings highlight the effectiveness of these strategies in enhancing patient care and outcomes, providing a more personalized and less invasive approach to STS treatment. This review aims to advance the understanding and application of non-surgical methods in the treatment of soft tissue sarcomas. Mesenchymal tumors originate from mesenchymal cells and can be either benign or malignant, such as bone, soft tissue, and visceral sarcomas. Surgery is a cornerstone treatment in the management of mesenchymal tumors, often requiring complex procedures performed in high-volume referral centers. However, the COVID-19 pandemic has highlighted this need for alternative non-surgical approaches due to limited access to surgical resources. This review explores the role of non-surgical treatments in different clinical scenarios: for improving surgical outcomes, as a bridge to surgery, as better alternatives to surgery, and for non-curative treatment when surgery is not feasible. We discuss the effectiveness of active surveillance, cryoablation, high-intensity focused ultrasound, and other ablative techniques in managing these tumors. Additionally, we examine the use of tyrosine kinase inhibitors in gastrointestinal stromal tumors and hypofractionated radiotherapy in soft tissue sarcomas. The Sarculator tool is highlighted for its role in stratifying high-risk sarcoma patients and personalizing treatment plans. While surgery remains the mainstay of treatment, integrating advanced non-surgical strategies can enhance therapeutic possibilities and patient care, especially in specific clinical settings with limitations. A multidisciplinary approach in referral centers is vital to determine the optimal treatment course for each patient. [ABSTRACT FROM AUTHOR]

In this investigation, the laser marker ablation technique was employed on Cu-coated glass to fabricate micro-nanostructured antifog glass. The resulting surfaces exhibited a quasi-periodic micron hillock-hollow structure with dispersed nanoparticles distributed throughout, which played a role in the antifog property and superhydrophilicity. However, airborne organic pollutant deposition degraded the superhydrophilicity of ablated glass surfaces and, therefore, their antifog performance, which cannot be circumvented. Conventionally, furnace annealing for at least 1 h was used to decompose the organic pollutants and restore the superhydrophilicity, limiting the throughput and application scenario. Remarkably, the rapid regeneration of this property was achieved through either a 5 min rapid thermal treatment at 400 °C or a 1 s flame treatment. These are interventions that are hitherto unreported. Such short and simple treatment methods underscore the potential of laser-ablated glass for diverse practical applications. [ABSTRACT FROM AUTHOR]

Introduction: Recurrence after microwave ablation (MWA) has not been extensively studied. We aimed to investigate the patterns, treatments, and survival of patients with hepatocellular carcinoma (HCC) who experienced early and late recurrence after MWA. Methods: This retrospective study included patients with HCC recurrence after MWA as the initial treatment from January 2008 to December 2021. Recurrence patterns, treatments, and outcomes between patients with early and late HCC recurrence were compared. Prognostic factors of post-recurrence survival (PRS) were identified by multivariable Cox regression analyses. Results: Among 222 patients, 128 developed early recurrence (≤2 years after MWA) and 94 had late recurrence (>2 years). Majority of the recurrent HCC were intrahepatic-only recurrence, within the Milan criteria, and received potentially curative treatment. No significant differences in the recurrence patterns, vascular invasion, tumor staging, post-recurrence treatments, or median PRS (35.0 vs. 33.0 months, p = 0.523) were identified between patients with early and late recurrence. Multivariable analyses suggested that multiple tumor number (hazard ratio [HR]: 1.54; 95% CI: 1.03–2.30, p = 0.038), extrahepatic recurrence (HR: 2.14, 95% CI: 1.16–3.92, p = 0.015), vascular invasion (HR: 2.37, 95% CI: 1.18–4.76, p = 0.038), and higher ALBI grade (HR: 2.18, 95% CI: 1.54–3.08, p < 0.001) were independent risk factors of worse PRS, while curative treatment after recurrence (HR: 0.59, 95% CI: 0.38–0.92, p = 0.020) was associated with better PRS. Conclusions: No differences in recurrence patterns, post-recurrence treatments, or PRS were found between HCC patients with early and late recurrence following MWA. Tumor burden and patients' liver function reserve should be considered to decide the optimal post-recurrence treatment after MWA. [ABSTRACT FROM AUTHOR]

Although significant strides have been made in non-pharmacologic management of atrial fibrillation (AF), these treatments remain a work in progress. While catheter ablation is often effective for management of paroxysmal AF, it is less successful in patients with persistent or longstanding persistent AF. This review was undertaken to clarify the risks, benefits, and alternatives to catheter ablation for non-pharmacologic AF management. In order to clarify the roles of surgical and hybrid ablation, this narrative review was undertaken by searching MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, review articles, and other clinically relevant studies. The search was limited to English-language reports published between 1960 and 2023. Atrial fibrillation was searched using the terms surgical ablation, catheter ablation, hybrid ablation, stroke prevention, left atrial occlusion, and atrial excision. Google and Google Scholar, as well as bibliographies of identified articles, were also reviewed for additional references. The Cox-maze surgical approach is still the most efficacious non-pharmacological treatment for AF. Hybrid ablation, combining cardiac surgical and catheter ablation techniques, has become an attractive option for persistent or longstanding persistent AF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation of minimal ablative margin (MAM) quantification using biomechanical deformable (DIR) versus intensity-based rigid image registration (RIR) with local outcomes following colorectal liver metastasis (CLM) thermal ablation. Methods: This retrospective single-institution study included consecutive patients undergoing thermal ablation between May 2016 and October 2021. Patients who did not have intraprocedural pre- and post-ablation contrast-enhanced CT images for MAM quantification or follow-up period less than 1 year without residual tumor or local tumor progression (LTP) were excluded. DIR and RIR methods were used to quantify the MAM. The registration accuracy was compared using Dice similarity coefficient (DSC). Area under the receiver operating characteristic curve (AUC) was used to test MAM in predicting local tumor outcomes. Results: A total of 72 patients (mean age 57; 44 men) with 139 tumors (mean diameter 1.5 cm ± 0.8 (SD)) were included. During a median follow-up of 29.4 months, there was one residual unablated tumor and the LTP rate was 17% (24/138). The ranges of DSC were 0.96–0.98 and 0.67–0.98 for DIR and RIR, respectively (p < 0.001). When using DIR, 27 (19%) tumors were partially or totally registered outside the liver, compared to 46 (33%) with RIR. Using DIR versus RIR, the corresponding median MAM was 4.7 mm versus 4.0 mm, respectively (p = 0.5). The AUC in predicting residual tumor and 1-year LTP for DIR versus RIR was 0.89 versus 0.72, respectively (p < 0.001). Conclusion: Ablative margin quantified on intra-procedural CT imaging using DIR method outperformed RIR for predicting local outcomes of CLM thermal ablation. Clinical relevance statement: The study supports the role of biomechanical deformable image registration as the preferred image registration method over rigid image registration for quantifying minimal ablative margins using intraprocedural contrast-enhanced CT images. Key Points: • Accurate and reproducible image registration is a prerequisite for clinical application of image-based ablation confirmation methods. • When compared to intensity-based rigid image registration, biomechanical deformable image registration for minimal ablative margin quantification was more accurate for liver registration using intraprocedural contrast-enhanced CT images. • Biomechanical deformable image registration outperformed intensity-based rigid image registration for predicting local tumor outcomes following colorectal liver metastasis thermal ablation. [ABSTRACT FROM AUTHOR]

Objectives: To study the relationship between the ablation range and applied energy of laser ablation (LA) and microwave ablation (MWA) in papillary thyroid microcarcinoma (PTMC). Methods: A total of 201 PTMC patients were treated with LA (n = 102) or MWA (n = 99) with single-applicator fixed ablation. The ablation range was determined by contrast-enhanced ultrasound. The ratios of ablation volume, longitudinal diameter, and orthogonal diameter to ablation energy (RAV/E, RAL/E, RAO/E) were analyzed and compared between MWA and LA. The effects of PTMC characteristics and Hashimoto's thyroiditis (HT) on ablation efficiency were evaluated by linear regression. Results: The RAV/E was 0.72 (0.65–0.84) mm3/J for MWA and 0.48 (0.39–0.54) mm3/J for LA. HT was significantly correlated with RAV/E of LA (coefficient = − 0.367, p < 0.0001). RAL/E did not differ significantly between MWA and LA (MWA 0.026 mm/J, LA 0.025 mm/J; p = 0.957). However, MWA had a greater RAO/E than LA (MWA 0.014 mm/J, LA 0.012 mm/J; p < 0.0001). The plateau values of MWA and LA on the ablation orthogonal diameter were 10.7 mm and 8.69 mm, respectively. Conclusions: MWA showed a higher RAV/E than LA. More intuitively, MWA had a better ablation performance than LA on the orthogonal axis rather than the longitudinal axis. Theoretically, MWA and LA could achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin. HT had a negative effect on LA but not on MWA. Clinical relevance statement: This study establishes strong connections between ablation energy and ablation range in papillary thyroid microcarcinoma (PTMC) in vivo, possibly contributing to the supplementation of the PTMC Ablation Consensus or Guidelines and providing a scientific basis for choosing clinical ablation parameters in PTMC. Key Points: • Both microwave ablation (MWA) and laser ablation (LA) have excellent performance on the ablation longitudinal axis (easily exceeding 10 mm) for papillary thyroid microcarcinoma (PTMC). • MWA performed much better than LA on the ablation orthogonal axis. • MWA and LA are expected to achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the incidence and clinical implications of bile duct changes following multibipolar radiofrequency ablation (mbpRFA) for hepatocellular carcinoma (HCC). Materials and methods: Radiological, clinical, and biological data from consecutive cirrhotic patients who underwent first-line mbpRFA between 2007 and 2014 for uninodular HCC ≤ 5 cm were retrospectively collected. Follow-up imaging was reviewed to identify bile duct changes and factors associated with biliary changes were assessed using multivariable analysis. Baseline and 6-month liver function tests were compared in patients with and without bile duct changes. Complications, cirrhosis decompensation, and survival rates were compared in both groups. Results: A total of 231 patients (mean age 68 years [39-85], 187 men) underwent 266 mbpRFA sessions for uninodular HCC (mean size 26 mm). Of these, 76 (33%) developed bile duct changes (upstream bile duct dilatations and/or bilomas) with a mean onset time of 3 months. Identified risk factors for these changes were the infiltrative aspect of the tumor (p = 0.035) and its location in segment VIII (p < 0.01). The average increase in bilirubin at 6 months was higher in the group with biliary changes (+2.9 vs. +0.4 µg/mL; p = 0.03). There were no significant differences in terms of complications, cirrhosis decompensation at 1 year (p = 0.95), local and distant tumor progression (p = 0.91 and 0.14 respectively), and overall survival (p = 0.4) between the two groups. Conclusion: Bile duct changes are common after mbpRFA for HCC, especially in tumors with an infiltrative aspect or those located in segment VIII. These changes do not appear to negatively impact the course of cirrhosis at 1 year or overall survival. Clinical relevance statement: Bile duct changes following mbpRFA for HCC are relatively common. Nevertheless, they do not raise clinical concerns in terms of complications, deterioration in liver function, or survival rates. Consequently, specific monitoring or interventions for these bile duct changes are not warranted. Key Points: • Bile duct changes are frequently observed after multibipolar radiofrequency ablation for hepatocellular carcinoma, occurring in 33% of cases in our study. • Patients with bile duct changes exhibited a higher increase in bilirubin levels at 6 months but no more cirrhosis decompensation or liver abscesses. • Biliary changes following multibipolar radiofrequency ablation for hepatocellular carcinoma are not alarming and do not necessitate any specific monitoring or intervention. [ABSTRACT FROM AUTHOR]

BACKGROUND: Colorectal cancer (CRC) is the third most common cause of cancer mortality worldwide. Of these, approximately 25% will have liver metastasis. We performed 394 microwave ablations (MWAs) and analyzed outcomes for survival and ablation failure. STUDY DESIGN: We conducted a retrospective review of patients who underwent a surgical MWA at a single-center high-volume institution from October 2006 to September 2022 using a prospectively maintained database. The primary outcome was overall survival. RESULTS: A total of 394 operations were performed on 328 patients with 842 tumors undergoing MWA. Median tumor size was 1.5 cm (range 0.4 to 7.0 cm), with the median number of tumors ablated per operation being 1 (range 1 to 11). A laparoscopic approach was used 77.9% of the time. Concomitant procedures were performed 63% of the time, most commonly hepatectomy (22.3%), cholecystectomy (17.5%), and colectomy (6.6%). Clavien-Dindo grade III or IV complication occurred in 12 patients (3.6%), and all of these patients had undergone concomitant procedures. Mortality within 30 days occurred in 4 patients (1.2%). The rate of incomplete ablation was 1.5% per tumor. Local recurrence occurred at a rate of 6.3% per tumor. Black patients were found to have a higher incidence of incomplete ablation and local recurrence. One-year survival probability was 91% (95% CI 87.9 to 94.3), with a mean overall survival of 57.6 months (95% CI 49.9 to 65.4 months). CONCLUSIONS: Surgical MWA offers a low-morbidity approach to treatment of colorectal liver metastasis, with low rate of failure. This large series reviews the outcomes of MWA as definitive treatment for colorectal liver metastasis. [ABSTRACT FROM AUTHOR]

Simple Summary: Colorectal cancer (CRC) remains a leading cancer-related mortality cause. More than a third of CRC patients develop liver metastases during the course of the disease, contributing to poor prognosis. Thermal ablation techniques are currently recommended as a local curative option for selected small liver metastases. Thermal ablation (TA) includes a wide variety of different modalities, like radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation (CRA). This comprehensive review outlines the role of image-guided ablation in the treatment of colorectal liver metastatic (CLM) disease. Colorectal cancer is a major cause of cancer-related mortality, with liver metastases occurring in over a third of patients, and is correlated with poor prognosis. Despite surgical resection being the primary treatment option, only about 20% of patients qualify for surgery. Current guidelines recommend thermal ablation either alone or combined with surgery to treat limited hepatic metastases, provided that all visible disease can be effectively eradicated. Several ablation modalities, including radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation and histotripsy, are part of the percutaneous ablation armamentarium. Thermal ablation, including radiofrequency, microwave ablation and cryoablation, can offer local tumor control rates comparable to limited resection for selected tumors that can be ablated with margins. This review aims to encapsulate the current clinical evidence regarding the efficacy and oncologic outcomes after percutaneous ablation for the treatment of colorectal liver metastatic disease. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common arrhythmia in cardiovascular disease, and it often coexists and interacts with sick sinus syndrome. In the past, pacemaker implantation combined with antiarrhythmic drugs was preferred for symptomatic atrial fibrillation with long interval treatment. However, in recent years, more and more studies have shown that compared with pacemaker implantation, radiofrequency ablation can reduce the hospitalization rate related to tachycardia, effectively control atrial fibrillation, and improve patient prognosis and hospitalization rate of heart failure. However, some patients present intrinsic sinus node dysfunction (SND), and SND may progress and worsen in some patients with atrial fibrillation. Therefore, the first-line treatment strategy for patients with atrial fibrillation with long interval remains controversial. This article reviews the selection of long-term intermittent treatment strategies for atrial fibrillation.

Low-intensity histotripsy (LIH) is a novel and safe technique for tissue ablation. This study aimed to explore the effects of LIH on canine prostate tissue and identify the degree of acute injury to the gland. We constructed and evaluated two types of acoustically responsive droplet (ARD) emulsions using either perfluoropentane (PFP) with a lipid shell or perfluoromethyl-cyclopentane (PFMCP) with lauromacrogol (L) injection. Twenty beagles were assigned to four experimental groups: ultrasound (US) + PFP (n = 6), US + PFMCP-L (n = 6), PFMCP-L (n = 5) and PFP (n = 3). The ARDs were injected transcutaneously and transabdominally into normal canine prostates under US-guided imaging. Subsequently, focused therapeutic US was employed to induce acoustic droplet vaporization and bubble cloud cavitation. The mechanical damage to canine prostate tissue was evaluated using gross and histological examination. Gross specimens showed that the injured area was dark brown. Hematoxylin and eosin-stained tissue sections of the damage zone showed significant cavity formation and interstitial edema. The total tissue damage scores in the US + PFP group were compared to those of the other three experimental groups. No statistically significant differences were observed in the extent of tissue damage and total scores among the US + PFMCP-L, PFMCP-L and PFP groups. We achieved significant mechanical tissue damage in the canine prostate using PFP ARD-based LIH that proved to be superior to that using PFMCP ARDs with LIH. [ABSTRACT FROM AUTHOR]

Despite substantial advances in the management of hypertrophic cardiomyopathy, advanced heart failure remains a major cause of morbidity in this patient population. This narrative review presents the case of a patient with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation to frame a discussion of modern therapies for hypertrophic cardiomyopathy. The current treatment landscape includes medications, both old and new, and surgical and procedural interventions to relieve mechanical obstruction. Several promising new modalities for relieving obstruction are in the nascent stages of development.

Abstract In this article, the multidisciplinary team of the Taiwan Academy of Tumor Ablation, who have expertise in treating lung cancer, present their perspectives on percutaneous image‐guided thermal ablation (IGTA) of lung tumors. The modified Delphi technique was applied to reach a consensus on clinical practice guidelines concerning ablation procedures, including a comprehensive literature review, selection of panelists, creation of a rating form and survey, and arrangement of an in‐person meeting where panelists agreed or disagreed on various points. The conclusion was a final rating and written summary of the agreement. The multidisciplinary expert team agreed on 10 recommendations for the use of IGTA in the lungs. These recommendations include terms and definitions, line of treatment planning, modality, facility rooms, patient anesthesia settings, indications, margin determination, post‐ablation image surveillance, qualified centers, and complication ranges. In summary, IGTA is a safe and feasible approach for treating primary and metastatic lung tumors, with a relatively low complication rate. However, decisions regarding the ablation technique should consider each patient's specific tumor characteristics.