Comparison of the efficacy of continuous radiofrequency thermocoagulation, pulsed radiofrequency denervation applications, and TENS therapies for lumbar facet syndrome: A single-blind randomized controlled trial.

OBJECTIVES: We aimed to compare the effectiveness of TENS, used in physical therapy departments, and continuous radiofrequency thermocoagulation (CRF) and pulsed radiofrequency denervation (PRF), used in algology departments, in patients with lumbar facet syndrome (LFS). METHODS: Subjects were selected from patients with LFS visiting outpatient clinics of physical therapy and algology departments at Ege University School of Medicine, whose pain was refractory to medical treatment for at least 3 months. Subjects were randomized into 3 groups. A total of 60 patients, with 20 in each group, were enrolled. The first group received CRF, the second group received TENS for 30 minutes a day for 15 days, and the third group received PRF. Patients were assessed at baseline, at the end of the first and sixth months, for a total of three times. RESULTS: Improvements at month 1 and month 6 were found to be statistically significant in all three treatment groups with respect to their pain scores, Oswestry Disability Indexes, hand-floor distance measurements, 20-meter walking times, 6-min walking distances, Beck Depression Inventory, and most of the SF-36 domain scores (p<0.05). A comparison of the treatment groups showed no superiority of any group over the others in any assessment parameters (p>0.05). CONCLUSION: We suggest that it might be more appropriate to use TENS, a non-invasive treatment, before trying more invasive procedures like CRF and PRF in these patients. However, it has been stated that further studies involving a larger patient sample are needed.

Treatment vegetable oil refinery wastewater by sequential electrocoagulation-electrooxidation process.

In the present study a sequential process composed of electrocoagulation (EC) followed by electrooxidation (EO) was utilized at the laboratory scale to remove the chemical oxygen demand (COD) from wastewater generated in Iraqi vegetable oil refinery plant.in the EC, impacts of operating variables such as current density (10-30 mA cm-2) and pH (4-10),and EC time (30-90 min) on the COD removal (RE%) were investigated using response surface methodology (RSM) based on Box- Behnken design(BBD). a mathematical correlation that relates the operating factors with RE% was developed and its regression coefficient was 99.02% confirming the significant of the model. Response surface plots showed that RE% increased with increasing current density and time while it decreased with increasing pH. The optimum removal with a lower cost for EC process were achieved at current density of 30mA/cm2, pH of 4, and electrolysis time of 90 min in which RE% of 69.19% was obtained with requirement of 0.513kWh/kg COD as specific energy consumption (SEC). The effluent exit from EC was treated by EO for a period of 240min at a current density of 30mA/cm2 and an initial pH value of 4 to obtain RE% of 96% at SEC of 1.554 kWh/kg COD. Combining EC with EO resulted in a total RE% of 98.72% and a total SEC of 2.067 kWh/kg COD. Based on the results of present study, the applicability of a sequential electrocoagulation-electrooxidation process for treatment vegetable oil wastewaters is feasible.

Study on influencing parameters and long-term operation of electrocoagulation phosphorus removal from small rural domestic sewage.

Excessive discharge of phosphorus can produce eutrophication in aquatic environments, damaging public health, the living environment, and the economy. The conventional mechanical-biological phosphorus removal methods are not suitable for small rural domestic sewage due to the features of small scale, scattered distribution, intermittent emission, and large fluctuation. This work evaluated electrocoagulation (EC) with industrial steel as electrodes on small rural domestic sewage. Results showed that the best performance was achieved at a current density of 1 mA/cm2, electrode distance of 2 cm, electrode number of 2, pH of 7, and Hydraulic Retention Time of 30 min, respectively. Under optimum conditions, the EC process removed 93.91% phosphorus while consuming around 0.25 kWh/m3 of electricity. In addition, the electrode passivation of EC was further investigated; the long-term research found that the phosphorus removal efficiency only decreased by 4.34% after 10 days of continuous flow operation, and the operational energy consumption was 0.07 kWh/m3 at a Cl- concentration of 500 mg/L.

Efficient removal of tannins from anaerobically-treated palm oil mill effluent using protein-tannin complexation in conjunction with electrocoagulation.

Despite the significant removal of chemical oxygen demand (COD) by anaerobic digestion, anaerobically-treated palm oil mill effluent (POME) still contains tannins and other phenolic compounds, resulting in residual COD and a brownish color. In this study, we investigated the removal of tannins from anaerobically treated POME using protein-tannin complexation in conjunction with electrocoagulation. The amino acid composition of the protein, aqueous pH, and protein: tannin ratios were found to be important parameters affecting the tannin removal efficiency. Pig blood protein was superior to casein protein in removing tannins, possibly because it had aspartic acid as the major amino acid component. At an optimal condition with a pig blood protein: tannin ratio of 0.33 (w/w), a current density of 30 mA/cm2, pH 5, and an electrolysis time of 10 min, the removals of tannins, COD, and color were 93%, 96%, and 97%, respectively.

Application of Box-Behnken design to mineralization and color removal of palm oil mill effluent by electrocoagulation process.

In this study, palm oil mill effluent (POME) was treated using electrocoagulation, whereby the influencing factors including voltage, electrolysis time, and electrolyte amount were optimized to achieve the highest chemical oxygen demand (COD) and color removal efficiencies. Graphite was selected as electrode material due to its performance better compared to aluminum and copper. Response surface methodology (RSM) was carried out for optimization of the electrocoagulation operating parameters. The best model obtained using Box-Behnken design (BBD) were quadratic for COD removal (R2 = 0.9844), color reduction (R2 = 0.9412), and oil and grease removal (R2 = 0.9724). The result from the analysis of variance (ANOVA) was obtained to determine the relationship between factors and treatment efficiencies. The experimental results under optimized conditions such as voltage 14, electrolysis time of 3 h, and electrolyte amount of 13.41 g/L show that the electrocoagulation process effectively reduced the COD (56%), color (65%), and oil and grease (99%) of the POME treatment. Graphical abstract.

A comprehensive review on green perspectives of electrocoagulation integrated with advanced processes for effective pollutants removal from water environment.

The rapidly expanding global energy demand is forcing a release of regulated pollutants into water that is threatening human health. Among various wastewater remediating processes, electrocoagulation (EC) has scored a monumental success over conventional processes because it combines coagulation, sedimentation, floatation and electrochemical oxidation processes that can effectively decimate numerous stubborn pollutants. The EC processes have gained some attention through various academic and industrial publications, however critical evaluation of EC processes, choices of EC processes for various pollutants, process parameters, mechanisms, commercial EC technologies and performance enhancement via other degradation processes (DPs) integration have not been comprehensively covered to date. Therefore, the major objective of this paper is to provide a comprehensive review of 20 years of literature covering EC fundamentals, key process factors for a reactor design, process implementation, current challenges and performance enhancement by coupling EC with pivotal pollutant DPs including, electro/photo-Fenton (E/P-F), photocatalysis, sono-chemical treatment, ozonation, indirect electrochemical/advanced oxidation (AO), and biosorption that have substantially reduced metals, pathogens, toxic compound BOD, COD, colors in wastewater. The results suggest that the optimum treatment time, current density, pulse frequency, shaking speed and spaced electrode improve the pollutants removal efficiency. An elegant process design can prevent electrode passivation which is a critical limitation of EC technology. EC coupling (up or downstream) with other DPs has resulted in the removal of organic pollutants and heavy metals with a 20% improved efficiency by EC-EF, removal of 85.5% suspended solid, 76.2% turbidity, 88.9% BOD, 79.7% COD and 93% color by EC-electroflotation, 100% decolorization by EC-electrochemical-AO, reduction of 78% COD, 81% BOD, 97% color by EC-ozonation and removal of 94% ammonia, 94% BOD, 95% turbidity, >98% phosphorus by aerated EC and peroxicoagulation. The major wastewater purification achievements, future potential and challenges are described to model the future EC integrated systems.

A Special Approach for Stereotactic Radiofrequency Thermocoagulation of Hypothalamic Hamartomas With Bilateral Attachments to the Hypothalamus: The Transthird Ventricular Approach to the Contralateral Attachment.

BACKGROUND: Disconnection surgery for the treatment of epileptic hypothalamic hamartomas (HHs) is strategically difficult in cases with complex-shaped HHs, especially with bilateral hypothalamic attachments, despite its effectiveness. OBJECTIVE: To evaluate the feasibility of a new approach for stereotactic radiofrequency thermocoagulation (SRT) using penetration of the third ventricle (SRT-TT) aiming to disconnect bilateral hypothalamic attachments in a single-staged, unilateral procedure. METHODS: Ninety patients (median age at surgery, 5.0 years) who had HHs with bilateral hypothalamic attachments and were followed for at least 1 year after their last SRT were retrospectively reviewed. RESULTS: Thirty-three patients underwent SRT-TT as initial surgery. Of the 58 patients after mid-2013 when SRT-TT was introduced, 33 underwent SRT-TT and 12 (20.7%) required reoperation (ReSRT), whereas 20 of 57 patients (35.1%) without SRT-TT underwent reoperation. Reoperation was required in significantly fewer patients after mid-2013 (n = 12 of 58, 20.7%) than before mid-2013 (n = 15 of 32, 46.9%) ( P = .01). Final seizure freedoms were not different between before and after mid-2013 (gelastic seizure freedom, n = 30 [93.8%] vs n = 49 [84.5%] and other types of seizure freedom, n = 21 of 31 [67.7%] vs n = 32 of 38 [84.2%]). Persistent complications were less in SRT-TT than in ReSRT using the bilateral approach, but not significantly. However, hormonal replacement was required significantly more often in ReSRT using the bilateral approach (4 of 9, 44.4%) than in SRT-TT (3 of 32, 9.4%) ( P = .01). CONCLUSION: SRT-TT enabled disconnection of bilateral attachments of HHs in a single-staged procedure, which reduced the additional invasiveness of reoperation. Moreover, SRT-TT reduced damage to the contralateral hypothalamus, with fewer endocrinological complications than the bilateral approach.

Electrocoagulation treatment of raw palm oil mill effluent: Optimization process using high current application.

In the electrocoagulation wastewater treatment process, extremely polluted water treatment requires an effective technique, and using high current is one of those. This study aims to optimize electrocoagulation parameters such as operation time, electrodes gap and the initial pH by applying high current intensity to treat palm oil mill effluent (POME) via Box-Behnken design (BBD) method. Chemical oxygen demand (COD), biological oxygen demand (BOD), and suspended solids (SS) were used as the response variables in the quadratic polynomial model. Most of the selected models in the analysis of variance (ANOVA) have shown significant results. A high connection between the parameters and dependent variables was surprisingly discovered in this study which the obtained value of R2 for removal percentage of COD, BOD and SS were 0.9975, 0.9984 and 0.9979 respectively. Optimal removal was achieved at 19.07 A of current intensity (equivalent to 542 mA/cm2 of current density), 44.97 min of treatment time, 8.60 mm of inter-electrode distance and 4.37 of pH value, resulted in 97.21%, 99.26% and 99.00% of COD, BOD and SS removal respectively. This optimized scheme of operating parameters combination offers an alternate choice for enhancing the treatment efficiency of POME and also can be a benchmark for other researchers to treat highly polluted wastewater.

Treatment of vegetable oil wastewater by a conventional activated sludge process coupled with electrocoagulation process.

The present work aims to study chemical oxygen demand (COD), oil-grease, and color removal from vegetable oil wastewater by combined electrocoagulation and activated sludge processes. For this purpose, the sample was pretreated using electrocoagulation by various optimization parameters such as electrode type (Al-Al and Fe-Fe), current density (100-400 A/m2 ), pH (2-8), and electrolysis time (15-180 min). The results showed that 89.3% of COD, 100% of oil-grease, and 66.2% of color were removed by electrocoagulation under the conditions of 300-A/m2 current density, pH 2, and 180-min reaction time with Al-Al electrode pairs. Then, the effluent of electrocoagulation was treated by an activated sludge process. The results depicted that the activated sludge process was also effective for vegetable oil wastewater treatment and it enhanced 98.9% COD and 79.2% color removal efficiency. The effluent of the combined process was very clear, and its quality exceeded the direct discharge standard of the water pollution control regulation. The laboratory-scale test results indicate that the combined electrocoagulation and activated sludge process is feasible for the treatment of vegetable oil wastewater. PRACTITIONER POINTS: Vegetable oil wastewater was treated by combination of electrocoagulation and activated sludge processes. The combined electrocoagulation and activated sludge processes supplied 99.9% COD, 100% oil-grease, and 93.0% color removal efficiency. The laboratory-scale test results indicate that the combined EC-SBR processes were feasible for the treatment of vegetable oil wastewater.

Successful stereoelectroencephalography-guided radiofrequency thermocoagulation in the treatment of a patient with mesial frontal region-originated mirthful gelastic seizure.

Gelastic seizures (GS), characterized by automatic bouts of unnatural stereotyped laughter and commonly recognized as the hallmark of hypothalamic hamartoma, is rarely associated with cortical epileptogenic focus. Whether there is a dissociation of the motor program of laughter and the experience of mirth and the symptomatogenic zone for ictal laughter with or without mirth are still unclear. We report a patient with drug-resistant mirthful GS who receive a comprehensive investigation of stereoelectroencephalography recording and electrocortical stimulation. Mirthful GS were confirmed to originate from the mesial region of the right superior frontal gyrus, not involving the mesial temporal lobe structures. The patient has been entirely seizure-free after stereoelectroencephalography-guided radiofrequency thermocoagulation. We conclude that the superior frontal gyrus serves as the symptomatogenic zone of ictal laughter and GS with or without mirth share a common neural network.

The clinical research of 5 steps sequential method for whole treatment of hemorrhagic radiation cystitis in china.

Background: Curing hemorrhagic cystitis remains a challenge. We explore a continuous and effective treatment for hemorrhagic radiation cystitis. Methods: The data of patients in 6 provincial cancer hospital urology departments between April 2015 and December 2019 was reviewed retrospectively. Patients were classified as moderate and severe groups. The 5-steps sequential method was adopted. Two groups were initiated with step 1 and step 3 respectively. Step 1 was symptomatic treatment. Thrombin solution or sodium hyaluronate was administrated for bladder irrigation in step 2. Step 3 was transurethral electrocoagulation. Step 4 was interventional embolization. Step 5 was HBO therapy. OABSS was used to assess the improvement of patients' symptoms. The outcome was evaluated after at least 6 months of follow-up. Results: A total of 650 patients (56 men and 594 women), mean age 71.2 years, were enrolled in the 5 steps sequential method. 582 patients were classified as moderate and 68 severe group. In moderate group, the cure rate of step 1 was 61.2% (356/582), 80.4% (468/582) after step 2, 93.1% (542/582) after step 3, 96.2% (560/582) after step 4, and 99.8% (581/582) after step 5. In severe group, the cure rate was 54.4% (37/68) after step 3, 76.5% (52/68) after step 4, and 94.1% (64/68) after the step 5 respectively. The mean OABSS scores of both groups significantly decreased after 5 steps sequential method treatment (P<0.01). Conclusions: Our results show hemorrhagic radiation cystitis can be cured in 5 steps, and the 5 steps sequential method is welcomed and effective. Therapy efficacy depends on the number of steps adopted and the severity of hematuria.

Evaluation of a Minimally Invasive Bipolar Coagulation System for the Treatment of Grade I and II Internal Hemorrhoids.

BACKGROUND: Hemorrhoids are common and affect mainly the young and middle-aged populations. Current guidelines recommend treating grade I and II hemorrhoids with office-based procedures. These therapies usually require multiple applications. Hemorrhoid energy therapy treats the hemorrhoids at 1 treatment session. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of hemorrhoid energy therapy. DESIGN: This was a prospective pilot study evaluating patients with symptomatic grade I and II internal hemorrhoids. SETTINGS: The study was conducted at a tertiary academic center. PATIENTS: Patients over the age of 18 years with chronic, symptomatic grade I and II internal hemorrhoids who failed 2 weeks of conservative therapy were enrolled between July 2015 and January 2019. Exclusion criteria included patients with grade III or IV internal hemorrhoids, external hemorrhoids, nonhemorrhoidal GI bleeding, active proctitis, and IBD. INTERVENTIONS: Hemorrhoid energy therapy was administered in clinic, and 2 postprocedure visits were completed. A pretreatment hemorrhoid symptom score was obtained from each patient. A visual analog score was assessed posttreatment. MAIN OUTCOME MEASURES: The primary end point was to evaluate the effect of hemorrhoid energy therapy on hemorrhoid symptoms and its safety. The secondary end point was evaluation of postprocedural pain. RESULTS: A total of 35 patients were enrolled. The mean duration of hemorrhoid symptoms was 3.3 ± 6.4 years, and rectal bleeding and hemorrhoidal prolapse were the most common symptoms. After the procedure, patient hemorrhoid symptom scores decreased from mean 5.5 to 1.4. The mean immediate postprocedural visual analog score was 2.4 ± 2.1 and decreased to <1.0 after 14 days. LIMITATIONS: The limitations include lack of comparative groups, single-center design, and small cohort of patients. CONCLUSIONS: The application of hemorrhoid energy therapy in the treatment of grade I and II internal hemorrhoids is safe and results in reduction of symptoms, low rate of short-term complications, and minimal pain. See Video Abstract at http://links.lww.com/DCR/B491. EVALUACIÓN DE UN SISTEMA DE COAGULACIÓN BIPOLAR MÍNI-INVASIVA PARA EL TRATAMIENTO DE HEMORROIDES INTERNAS GRADOS I Y II: La enfermedad hemorroidal es muy común y afecta principalmente poblaciones jóvenes y de mediana edad. Las guías actuales recomiendan tratar las hemorroides de grado I y II con procedimientos en el consultorio. Estos tratamientos suelen requerir múltiples aplicaciones. La aplicación de energía para tratar las hemorroides requiere de una sola sesión.Evaluar la seguridad y eficacia del tratamiento hemorroidal con una fuente de energía.Estudio piloto prospectivo que evalúa los pacientes con hemorroides internas de grado I y II sintomáticas.El estudio se realizó en un centro académico terciario.Entre julio de 2015 y enero de 2019 se inscribieron pacientes mayores de 18 años con hemorroides intomáticas internas crónicas grado I y II que fracasaron luego de 2 semanas de tratameinto conservador. Los criterios de exclusión incluyeron pacientes con hemorroides internas de grado III o IV, hemorroides externas, sangrado de orígen gastrointestinal no hemorroidal, proctitis activa y enfermedad inflamatoria intestinal.Se realizó la aplicación de energía sobre las hemorroides en el consultorio y se completó el procedimiento con dos visitas posteriores. Se obtuvo una puntuación analógica de síntomas hemorroidarios en cada paciente antes del tratamiento. Se evaluó la puntuación analógica visual luego del procedimiento.El principal criterio final fué evaluar el efecto de la terapia energética hemorroidaria con relación a los síntomas y la seguridad del dispositivo. El segundo criterio final fué el evaluar el dolor posoperatorio.Se registraron un total de 35 pacientes. La duración media de los síntomas hemorroidarios fué de 3,3 ± 6,4 años, el sangrado rectal y el prolapso hemorroidal fueron los síntomas más frecuentes. Después del procedimiento, las puntuaciones de los síntomas hemorroidarios disminuyeron en una media de 5,5 a 1,4. La puntuación analógica visual media inmediatamente posterior al procedimiento fue de 2,4 ± 2,1 y disminuyó a <1 después de 14 días.Las limitaciones incluyen la falta de grupos comparativos, el diseño de un solo centro y una pequeña cohorte de pacientes.La aplicación de energía como tratamiento de la enfermedad hemorroidal interna grado I y II es segura y da como resultados la reducción de los síntomas, una baja tasa de complicaciones a corto plazo y mínimo dolor. Consulte Video Resumen en http://links.lww.com/DCR/B491. (Traducción-Dr Xavier Delgadillo).

Laparoscopic surgery for endometriosis.

BACKGROUND: Endometriosis is associated with pain and infertility. Surgical interventions aim to remove visible areas of endometriosis and restore the anatomy. OBJECTIVES: To assess the effectiveness and safety of laparoscopic surgery in the treatment of pain and infertility associated with endometriosis. SEARCH METHODS: This review has drawn on the search strategy developed by the Cochrane Gynaecology and Fertility Group including searching the Cochrane Gynaecology and Fertility Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, reference lists for relevant trials, and trial registries from inception to April 2020. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) that compared the effectiveness and safety of laparoscopic surgery with any other laparoscopic or robotic intervention, holistic or medical treatment, or diagnostic laparoscopy only. DATA COLLECTION AND ANALYSIS: Two review authors independently performed selection of studies, assessment of trial quality and extraction of relevant data with disagreements resolved by a third review author. We collected data for the core outcome set for endometriosis. Primary outcomes included overall pain and live birth. We evaluated the quality of evidence using GRADE methods. MAIN RESULTS: We included 14 RCTs. The studies randomised 1563 women with endometriosis. Four RCTs compared laparoscopic ablation or excision with diagnostic laparoscopy only. Two RCTs compared laparoscopic excision with diagnostic laparoscopy only. One RCT compared laparoscopic ablation or excision with laparoscopic ablation or excision and uterine suspension. Two RCTs compared laparoscopic ablation and uterine nerve transection with diagnostic laparoscopy only. One RCT compared laparoscopic ablation with diagnostic laparoscopy and gonadotropin-releasing hormone (GnRH) analogues. Two RCTs compared laparoscopic ablation with laparoscopic excision. One RCT compared laparoscopic ablation or excision with helium thermal coagulator with laparoscopic ablation or excision with electrodiathermy. One RCT compared conservative laparoscopic surgery with laparoscopic colorectal resection of deep endometriosis infiltrating the rectum. Common limitations in the primary studies included lack of clearly described blinding, failure to fully describe methods of randomisation and allocation concealment, and poor reporting of outcome data. Laparoscopic treatment versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic treatment on overall pain scores compared to diagnostic laparoscopy only at six months (mean difference (MD) 0.90, 95% confidence interval (CI) 0.31 to 1.49; 1 RCT, 16 participants; very low quality evidence) and at 12 months (MD 1.65, 95% CI 1.11 to 2.19; 1 RCT, 16 participants; very low quality evidence), where a positive value means pain relief (the higher the score, the more pain relief) and a negative value reflects pain increase (the lower the score, the worse the increase in pain). No studies looked at live birth. We are uncertain of the effect of laparoscopic treatment on quality of life compared to diagnostic laparoscopy only: EuroQol-5D index summary at six months (MD 0.03, 95% CI -0.12 to 0.18; 1 RCT, 39 participants; low quality evidence), 12-item Short Form (SF-12) mental health component (MD 2.30, 95% CI -4.50 to 9.10; 1 RCT, 39 participants; low quality evidence) and SF-12 physical health component (MD 2.70, 95% CI -2.90 to 8.30; 1 RCT, 39 participants; low quality evidence). Laparoscopic treatment probably improves viable intrauterine pregnancy rate compared to diagnostic laparoscopy only (odds ratio (OR) 1.89, 95% CI 1.25 to 2.86; 3 RCTs, 528 participants; I2 = 0%; moderate quality evidence). We are uncertain of the effect of laparoscopic treatment compared to diagnostic laparoscopy only on ectopic pregnancy (MD 1.18, 95% CI 0.10 to 13.48; 1 RCT, 100 participants; low quality evidence) and miscarriage (MD 0.94, 95% CI 0.35 to 2.54; 2 RCTs, 112 participants; low quality evidence). There was limited reporting of adverse events. No conversions to laparotomy were reported in both groups (1 RCT, 341 participants). Laparoscopic ablation and uterine nerve transection versus diagnostic laparoscopy We are uncertain of the effect of laparoscopic ablation and uterine nerve transection on adverse events (more specifically vascular injury) compared to diagnostic laparoscopy only (OR 0.33, 95% CI 0.01 to 8.32; 1 RCT, 141 participants; low quality evidence). No studies looked at overall pain scores (at six and 12 months), live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. Laparoscopic ablation versus laparoscopic excision There was insufficient evidence to determine whether there was a difference in overall pain, measured at 12 months, for laparoscopic ablation compared with laparoscopic excision (MD 0.00, 95% CI -1.22 to 1.22; 1 RCT, 103 participants; very low quality evidence). No studies looked at overall pain scores at six months, live birth, quality of life, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy, miscarriage and adverse events. Helium thermal coagulator versus electrodiathermy We are uncertain whether helium thermal coagulator compared to electrodiathermy improves quality of life using the 30-item Endometriosis Health Profile (EHP-30) at nine months, when considering the components: pain (MD 6.68, 95% CI -3.07 to 16.43; 1 RCT, 119 participants; very low quality evidence), control and powerlessness (MD 4.79, 95% CI -6.92 to 16.50; 1 RCT, 119 participants; very low quality evidence), emotional well-being (MD 6.17, 95% CI -3.95 to 16.29; 1 RCT, 119 participants; very low quality evidence) and social support (MD 5.62, 95% CI -6.21 to 17.45; 1 RCT, 119 participants; very low quality evidence). Adverse events were not estimable. No studies looked at overall pain scores (at six and 12 months), live birth, viable intrauterine pregnancy confirmed by ultrasound, ectopic pregnancy and miscarriage. AUTHORS' CONCLUSIONS: Compared to diagnostic laparoscopy only, it is uncertain whether laparoscopic surgery reduces overall pain associated with minimal to severe endometriosis. No data were reported on live birth. There is moderate quality evidence that laparoscopic surgery increases viable intrauterine pregnancy rates confirmed by ultrasound compared to diagnostic laparoscopy only. No studies were found that looked at live birth for any of the comparisons. Further research is needed considering the management of different subtypes of endometriosis and comparing laparoscopic interventions with lifestyle and medical interventions. There was insufficient evidence on adverse events to allow any conclusions to be drawn regarding safety.

Computed Tomography-Guided Radiofrequency Thermocoagulation of the Gasserian Ganglion Using an Alternative to Hartel Anterior Approach: A Bicentral Study.

BACKGROUND: Trigeminal neuralgia (TN) is associated with multiple mechanisms involving peripheral and central nervous system pathologies. Among percutaneous treatments offered, radiofrequency thermocoagulation (RFT) is associated with longer duration of pain relief. Mostly due to anatomic variation, cannulation of the foramen ovale using the Hartel approach has a failure rate of 5.17%. OBJECTIVES: To report safety and efficacy of continuous RFT with an alternative to Hartel anterior approach under computed tomography (CT) guidance in patients with classic TN. STUDY DESIGN: Retrospective institutional database review; bicentral study. SETTING: Although this was a retrospective database research, institutional review board approval was obtained. METHODS: Institutional database review identified 10 patients (men 8, women 2) who underwent CT-guided RFT of the Gasserian ganglion. Preoperational evaluation included physical examination and magnetic resonance imaging. Under anesthesiology control and local sterility measures, a radiofrequency needle was advanced, and its approach was evaluated with sequential CT scans. Motor and sensory electrostimulation tests evaluated correct electrode location. Pain prior, 1 week, 1, 3, and 6 months after were compared by means of a numeric visual scale (NVS) questionnaire. RESULTS: Mean self-reported pain NVS score prior to RFT was 9.2 ± 0.919 units. One week after the RFT mean NVS score was 1.10 ± 1.287 units (pain reduction mean value of 8.1 units). At 3 and 6 months after thermocoagulation the mean NVS score was 2.80 ± 1.549 units and 2.90 ± 1.370 units, respectively. There were no postoperative complications. Three patients experienced facial numbness, which gradually resolved over a period of 1 month. LIMITATIONS: Retrospective nature; small number of patients; lack of a control group undergoing a different treatment of TN. CONCLUSIONS: Percutaneous CT-guided RFT of the Gasserian ganglion constitutes a safe and efficacious technique for the treatment of TN, with significant pain relief and minimal complication rates improving life quality in this group of patients. KEY WORDS: Trigeminal nerve, neuralgia, pain, radiofrequency, ablation, percutaneous, computed tomography, imaging.

Electrochemical treatment of sunflower oil refinery wastewater and optimization of the parameters using response surface methodology.

Combined electrocoagulation (EC) + electrooxidation (EO) process was compared with electrochemical peroxidation (ECP) treatment process to treat sunflower oil refinery wastewater. The effect of applied current density, pH/H2O2 dosage, and operation time in the removal of chemical oxygen demand (COD), soluble COD, total organic carbon, and dissolved organic carbon (DOC) were studied using Box Behnken Design. In EC process, decrease in organic concentration was observed as the time and current density increased. The optimized conditions for EC process were achieved at pH 6.07 when a current density of 5.69 mA cm-2 was applied for 18 min. The EO removed about 90% of DOC at an optimized pH of 5.27 and current density of 11.56 mA cm-2 when operated for 400 min. The combined EC + EO process was successful compare to ECP process in removing between 90 and 95% of organic pollutant from the sunflower oil refinery wastewater. The energy consumption was calculated to compare between the process efficiency of EC + EO and ECP and found that EC + EO was more efficient process. The reaction rate followed a first order kinetics validated with a high R2 value (0.96).

Effect of unilateral amygdalotomy and hypothalamotomy in patients with refractory aggressiveness.

BACKGROUND: Neurosurgical treatment, although controversial, is considered a useful resource in the treatment of chronic psychiatric diseases such as refractory aggressiveness. OBJECTIVE: To evaluate the clinical results and side effects of posteromedial hypothalamotomy associated with amygdalotomy in patients with refractory aggressiveness. METHOD: A clinical trial was conducted in patients with chronic aggressiveness and refractory to pharmacological treatment. A central amygdalotomy associated with posteromedial hypothalamotomy was performed using thermo-coagulation by radiofrequency. The degree of aggressiveness was quantified by the Yudofsky's global scale of aggression. Postoperative changes in aggressive behavior continued to be evaluated every 6 months for at least 36 months. RESULTS: A statistically significant change in aggressive behavior was observed during 36 months of follow-up. The collateral effects of the association of both procedures are described, the most frequent being drowsiness and some cases of reduction in sexual behavior. CONCLUSION: Symmetric and simultaneous unilateral lesions of the central nucleus of the amygdala and the posteromedial hypothalamus contralateral to motor dominance give the same clinical effect in the reduction of the pathological aggression that the bilateral lesions.

Reduced bleeding with DRY CUT® transurethral resection of the prostate (TURP) compared to standard TURP.

Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP.Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004-2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011-2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated.Results: The median bleeding was 300 ml (IQR = 100-645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30-268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72-5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient.Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.

Treatment of canola-oil refinery effluent using electrochemical methods: A comparison between combined electrocoagulation + electrooxidation and electrochemical peroxidation methods.

A comparative study of combined electrocoagulation (EC) + electrooxidation (EO) and electrochemical peroxidation (ECP) treatment processes were carried out to treat canola oil refinery (COR) wastewaters. The effect of applied current density and operation time in the removal of organic pollutants were investigated and discussed. Total chemical oxygen demand (TCOD), soluble chemical oxygen demand (sCOD), total organic carbon (TOC), dissolved organic carbon (DOC) and total suspended solids (TSS) were measured. Using only EC process was found to be significantly successful in removing suspended and colloidal pollutants and could remove more than 90% TCOD and 80% of TOC at current densities between 0.91 and 13.66 mA cm-2. From the statistical model, the optimized conditions for TCOD at a current density of 7.61 mA cm-2 and TOC at 7.99 mA cm-2 under 40 min operation, validated to remove 93.45% and 94.5% respectively. However, the maximum removal of dissolved organic pollutants was relatively low in EC process and reported to be 75% for sCOD and 74% for DOC. Therefore, EC + EO process were run to increase the removal of sCOD and DOC to 99 and 95%, respectively. On the other hand, treatment using ECP process achieved a removal of sCOD and DOC between 77 and 86%. TSS were removed completely in both EC + EO and ECP processes. A statistical model was applied to compare the performance of two methods and found that the combined EC + EO process provided lightly better treatment compared to ECP method.

Outpatient curettage and electrocautery as an alternative to primary surgical closure for pediatric gastrocutaneous fistulae.

BACKGROUND: The development of a gastrocutaneous fistula (GCF) after gastrostomy tube removal is a frequent complication that occurs 5%-45% of the time. Conservative therapy with chemical cauterization is frequently unsuccessful, and surgical GCF repair with open primary layered closure of the gastrotomy is often required. We describe an alternative approach of GCF closure that is an outpatient, less invasive procedure that allows patients to avoid the comorbidities of general endotracheal anesthesia and intraabdominal surgery. METHODS: This is an Institutional Review Board approved retrospective review of all patients who underwent GCF closure from January 2010 to July 2016 at a tertiary care children's hospital. Demographics including age, weight, body mass index, comorbidities, and initial indication for gastrostomy tube were recorded. Operative details such as ASA score, operative duration, type of anesthesia, and airway were noted. Based on surgeon preference, two types of operative closure were used during that time frame: primary layered closure or curettage and cautery (C&C). The latter is a procedure in which the fistula tract is first scraped with a fine curette, and then the fistula opening and tract are cauterized circumferentially. Finally, the presence of a persistent fistula and the need for formal reoperation were determined. RESULTS: Sixty-five unique patients requiring GCF closure were identified. Of those, 44 patients (67.6%) underwent primary closure and 21 patients (32.3%) underwent C&C. The success rate of primary closure was 97% with one patient experiencing wound breakdown with persistent fistula. The overall success rate of C&C was 66.7% (14/21). Among those 14 patients, 11 (52.4%) GCF patients were closed by 1 mo. An additional two patients' gastrocutaneous fistulae were closed by 4 mo (61.9%). One GCF was successfully closed with a second C&C procedure. Seven of the 21 patients (33.3%) required subsequent formal layered surgical closure. C&C had significantly shorter operative times (13.5 ± 14.7 min versus 93.4 ± 61.8, P <0.0001) and significantly shorter times in the postanesthesia care unit (101.8 ± 42.4 min versus 147 ± 86, P <0.0001). Patients were intubated with an endotracheal tube 88.6% of the time for primary closure and 23.8% of the time for C&C.Among patients admitted for an elective procedure, the average length of stay for primary closure was 1.9 d as compared to 0 d for the C&C group. Among patients who underwent C&C with a persistent fistula, there were no significant differences in time since initial creation of gastrostomy, age, body mass index, or ASA score. CONCLUSIONS: Our study verifies that primary closure remains the gold standard for persistent GCF. However, C&C is a safe, outpatient procedure that effectively treats a GCF the majority of the time in children. We suggest that in select patients, it may be an appropriate initial and definitive procedure for GCF closure.