Radiofrequency ablation as a novel modality in Ecuador for treating toxic thyroid nodules: a case series.

Background: Treating hyperthyroidism induced by autonomously functioning thyroid nodules (AFTNs) through radioactive iodine and surgery often results in undesirable hypothyroidism. Radiofrequency ablation (RFA) has arisen as a favorable option. European guidelines recommend RFA for small AFTN in young patients, aiming to restore normal thyroid function and avoid irradiation. The procedure, costing between 500 and 1,000 euros, is conducted in outpatient clinics and takes 15 to 40 minutes. We aimed to describe the clinical outcomes of AFTN patients treated with RFA in Ecuador. Case Description: We included eight patients with toxic thyroid nodules suppressed thyroid-stimulating hormone (TSH), with symptomatic hyperthyroidism. The mean age was 41.63 years [standard deviation (SD): 14.97 years]. The median follow-up time was 8 months. Nodules were solid (37.5%) or predominantly solid (62.5%). The mean volume pre-RFA was 5.27 mL [interquartile range (IQR), 0.70-9.66 mL]. After ablation, the median volumes at 1, 3, and 6 months were [2.25 (SD: 1.67; P<0.12), 1.28 (SD: 1.1; P=0.013), and 1.37 (SD: 1; P=0.23) mL], respectively. The volume reduction (VR) was 45.8%, 75.1%, and 69.7% at 1-, 3-, and 6-month follow-up, respectively. Conclusions: RFA holds promise as a potential therapeutic approach for managing AFTNs. The success and the feasibility of RFA in this series are consistent with other studies as a treatment option in young patients with small AFTN. However, more research is needed to establish comprehensive guidelines and protocols to maximize the benefits of RFA in AFTNs.

Ablación por radiofrecuencia de nódulos tiroideos; a propósito de un caso exitoso en un hospital público en Perú / Radiofrequency ablation of thyroid nodules: a successful case in a public hospital in Perú

RESUMEN Se expone los resultados que sugieren la viabilidad de la ablación con radiofrecuencia (ARF) como una posible estrategia terapéutica efectiva en el caso de una mujer de 56 años con un nódulo tiroideo benigno en lugar de la cirugía tradicional en un Hospital Público del Perú. El seguimiento a los 6 meses reveló una reducción significativa en el tamaño del nódulo y reducción del 70% del volumen; además de mejorar la calidad de vida, mejora en los síntomas y función tiroidea normal. Este caso destaca la evolución en el tratamiento de nódulos tiroideos benignos, con la ARF como una posible opción mínimamente invasiva y segura, la cual se ofrece una alternativa prometedora a las intervenciones quirúrgicas convencionales para el manejo de nódulos tiroideos, marcando un cambio significativo en la práctica clínica, ya que es el primer hospital del MINSA (Ministerio de Salud) en realizar este tipo de procedimientos y que ofrece múltiples enfoques de tratamiento de nódulos tiroideos: ARF, tiroidectomía endoscópica transoral, tiroidectomía convencional y vigilancia activa.

ABSTRACT The results are presented, suggesting the viability of radiofrequency ablation (RFA) as an effective therapeutic strategy in the case of a 56-year-old woman with a benign thyroid nodule instead of traditional surgery at a Public Hospital in Peru. The 6-month follow-up revealed a significant reduction in the size of the nodule and a 70% reduction in volume; in addition to improved quality of life, symptom improvement, and normal thyroid function. This case highlights the evolution in the treatment of benign thyroid nodules, with RFA as a possible minimally invasive and safe option, offering a promising alternative to conventional surgical interventions for the management of thyroid nodules, marking a significant change in clinical practice. This is because it is the first hospital of the MINSA (Ministry of Health) to perform such procedures, offering multiple treatment approaches for thyroid nodules: RFA, transoral endoscopic thyroidectomy, conventional thyroidectomy, and active surveillance.

Radiofrequency ablation for ampullary neoplasia with intraductal extension after endoscopic papillectomy: Systematic review and meta-analysis.

Background and study aims Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy. Patients and methods The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence. Results Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I 2 = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I 2 = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I 2 < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I 2 < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I 2 < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I 2 = 23.484). Conclusions RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.

Carbonation Behavior of Mortar Made from Treated Recycled Aggregates: Influence of Diammonium Phosphate.

This research aims to improve the quality of recycled concrete fine aggregates (RFA) by using diammonium hydrogen phosphate (DAP). We aimed to understand the effect of DAP treatment on durability performance due to the carbonation action of mortars with the partial and total substitution of treated RFA. The results showed a maximum reduction in the RFA water absorption of up to 33% using a minimum DAP concentration due to a pore refinement as a consequence of the formation of calcium phosphates such as hydroxyapatite (HAP). The carbonation phenomenon did not have a significant effect on the durability of mortars with DAP-treated RFA, as we did not find a decrease in the compressive strength; the carbonation depth of the mortars with 100% treated RFA decreased up to 90% and 63% for a w/c of 0.45 and 0.50, in comparison with mortars with 0% treated RFA. An inversely proportional relationship was found between the accelerate carbonation and the compressive strength, showing that higher percentages of treated RFAs in the mortar promoted an increase in compressive strength and a decrease in the carbonation rate, which is behavior associated with a lower permeability of the cement matrix as one of the consequences of the microstructural densification by DAP treatment.

Wide-field ESD for Barrett's adenocarcinoma at the gastroesophageal junction: technical approaches to facilitate en bloc R0 resection.

Video 1Wide-field ESD for Barrett's adenocarcinoma.

Novel EUS-guided microwave ablation of an unresectable pancreatic neuroendocrine tumor.

Video 1EUS-guided microwave ablation of an unresectable pancreatic mass using a novel generator platform and a specialized 19.5-gauge needle antenna.

Lung radiofrequency ablation: post-procedure imaging patterns and late follow-up.

PURPOSE: To describe expected imaging features on chest computed tomography (CT) after percutaneous radiofrequency ablation (RFA) of lung tumors, and their frequency over time after the procedure. METHODS: In this double-center retrospective study, we reviewed CT scans from patients who underwent RFA for primary or secondary lung tumors. Patients with partial ablation or tumor recurrence during the imaging follow-up were not included. The imaging features were assessed in pre-defined time points: immediate post-procedure, ≤4 weeks, 5-24 weeks, 25-52 weeks and ≥52 weeks. Late follow-up (3 and 5 years after procedure) was assessed clinically in 48 patients. RESULTS: The study population consisted of 69 patients and 144 pulmonary tumors. Six out of 69 (9%) patients had primary lung nodules (stage I) and 63/69 (91 %) had metastatic pulmonary nodules. In a patient-level analysis, immediately after lung RFA, the most common CT features were ground glass opacities (66/69, 96 %), consolidation (56/69, 81 %), and hyperdensity within the nodule (47/69, 68 %). Less than 4 weeks, ground glass opacities (including reversed halo sign) was demonstrated in 20/22 (91 %) patients, while consolidation and pleural thickening were detected in 17/22 patients (77 %). Cavitation, pneumatocele, pneumothorax and pleural effusions were less common features. From 5 weeks onwards, the most common imaging features were parenchymal bands. CONCLUSIONS: Our study demonstrated the expected CT features after lung RFA, a safe and effective minimally invasive treatment for selected patients with primary and secondary lung tumors. Diagnostic and interventional radiologists should be familiar with the expected imaging features immediately after RFA and their change over time in order to avoid misinterpretation and inadequate treatments.

Comparison of Noninvasive High-Intensity Focused Ultrasound with Radiofrequency Ablation of Osteoid Osteoma.

OBJECTIVE: To evaluate clinical feasibility and safety of magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU) treatment of symptomatic osteoid osteoma and to compare clinical response with standard of care treatment. STUDY DESIGN: Nine subjects with radiologically confirmed, symptomatic osteoid osteoma were treated with MR-HIFU in an institutional review board-approved clinical trial. Treatment feasibility and safety were assessed. Clinical response was evaluated in terms of analgesic requirement, visual analog scale pain score, and sleep quality. Anesthesia, procedure, and recovery times were recorded. This MR-HIFU group was compared with a historical control group of 9 consecutive patients treated with radiofrequency ablation. RESULTS: Nine subjects (7 male, 2 female; 16 ± 6 years) were treated with MR-HIFU without technical difficulties or any serious adverse events. There was significant decrease in their median pain scores 4 weeks within treatment (6 vs 0, P < .01). Total pain resolution and cessation of analgesics were achieved in 8 of 9 patients after 4 weeks. In the radiofrequency ablation group, 9 patients (8 male, 1 female; 10 ± 6 years) were treated in routine clinical practice. All 9 demonstrated complete pain resolution and cessation of medications by 4 weeks with a significant decrease in median pain scores (9 vs 0, P < .001). One developed a second-degree skin burn, but there were no other adverse events. Procedure times and treatment charges were comparable between the 2 groups. CONCLUSION: This pilot study shows that MR-HIFU treatment of osteoid osteoma refractory to medical therapy is feasible and can be performed safely in pediatric patients. Clinical response is comparable with standard of care treatment but without any incisions or exposure to ionizing radiation. TRIAL REGISTRATION: ClinicalTrials.govNCT02349971.

Assessment of the correlation between insertion torque and resonance frequency analysis of implants placed in bone tissue of different densities.

The primary stability of dental implants is fundamental for osseointegration. Therefore, this study aimed to assess the correlation between insertion torque (IT) and resonance frequency analysis (RFA) of implants placed in mandibles and maxillas of different bone densities. Eighty dental implants were placed in maxillas and mandibles, and IT and the implant stability quotient (ISQ) were measured at the time of implant insertion. Bone density was assessed subjectively by the Lekholm and Zarb index. The type I and II densities were grouped together (group A)as were the type III and IV densities (group B). The IT in group A was higher (Student t test, P = .0013) than in group B (46.27 ± 18.51 Ncm, 33.62 ± 14.74 Ncm, respectively). The implants placed in group A showed higher ISQ (Student t test, P = .0004) than those placed in group B (70.09 ± 7.50, 63.66 ± 8.00, respectively). A significant correlation between IT and the ISQ value was observed for group A (Pearson correlation test; r = 0.35; P = .0213) and for group B (r = 0.37; P = .0224). Within the limitations of this study, it was possible to conclude that there is a correlation between IT and RFA of implants placed in mandibles and maxillas of different bone densities.

Structurally conserved C-RFa revealed prolactin releasing activity in vitro and gene expression changes in pituitary of seasonally acclimatized carp

Here we show the cloning and characterization of a novel homolog of prepro C-RFa cDNA from Cyprinus carpió. The deduced preprohormone precursor of 115 amino acids leads to a mature bioactive peptide of 20 amino acids with identical sequence to other teleost C-RFa. Modeling of the mature C-RFa peptide highlighted significant similarity to homologous human PrRP20, specifically the conserved amphipathic system defined by the C-terminal alpha-helix. Clearly, the synthetic C-RFa peptide stimulated prolactin release from primary cultured fish pituitary cells. For the first time, significant variation was shown in C-RFa mRNA and protein levels in the hypothalamus and pituitary between summer- and winter-acclimatized carp. Furthermore, C-RFa protein distribution in carp central nervous tissue was visualized by immunodetection in fibers and cells in hypothalamus, olfactory tract, cerebellum and pituitary stalk. In conclusion, we demonstrated the structure conservation of C-RFa in teleosts and mammals and immunopositive cells and fibers for C-RFa in brain areas. Finally, the increase of C-RFa expression suggests the participation of this hypothalamic factor in the mechanism of modulation in PRL expression in carp.

Changes in structural attributes of Tifton 85 bermudagrass canopies induced by N rates, during the pasture establishment / Mudanças em atributos estruturais de dosséis do capim-Tifton 85 na fase de estabelecimento, induzidas pela adubação nitrogenada

Strategies of nitrogen fertilization management in Tifton 85 bermudagrass pastures, based on monitoring changes in sward structural attributes demands previous definition of those more appropriate ones. With this purpose an experiment was carried out at the experimental campus of the Rural Federal University, Seropédica, RJ, from October 2006 to January 2007. Treatments consisted of N fertilization at zero; 50; 100 and 150kg N-urea ha-1, in a single application, several sampling dates, during the pasture establishment, according to an entirely randomized design, with four replications. Treatments were allocated in experimental plots of 4 x 4m, and sampling dates (days after planting, DAP) in sub-plots. The variables studied were: frequency of plants occurrence; sward height, leaf area index (LAI) and interception of photosynthetically active radiation (PAR). The results showed that frequency of occurrence, sward height and PAR interception varied temporally according to a logistic pattern, whose parameters were modified, to a greater or lesser degree, by the nitrogen doses added. Similarly, at 87 DAP, LAI values responded in the same way. It was concluded that the application of increasing doses of N during the establishment of Tifton 85, was a limited experimental strategy for induction of quantitative changes during the time course of structural development of swards. However

A definição de estratégias de adubação nitrogenada em pastagens de Tifton 85, baseadas no monitoramento de alterações nos atributos estruturais dos dosséis, exige a definição pré- via daqueles mais apropriados. Para tal, foi desenvolvido um experimento no campo experimental da Universidade Federal Rural do Rio de Janeiro, município de Seropédica, RJ, entre os meses de outubro de 2006 a janeiro de 2007. Os tratamentos consistiram de doses de N (0; 50; 100 e 150kg ha-1), aplicadas na forma de uréia e sem parcelamento, e de datas de amostragem, durante a fase de estabelecimento da pastagem. Utilizou-se um delineamento experimental em blocos inteiramente casualizados, em parcelas subdivididas, com quatro repetições. Os tratamentos foram alocados em parcelas de 4 x 4m, enquanto as datas de amostragem (dias após plantio, DAP) foram alocadas em sub-parcelas. As variáveis estudadas foram: freqüência de ocorrência de plantas, altura do dossel, índice de área foliar (IAF) e interceptação de radiação fotossinteticamente ativa (RFA). Os resultados obtidos mostraram que a freqüência de ocorrência; altura e a interceptação de RFA variaram temporalmente de acordo a um padrão logístico, cujos parâmetros foram modificados, pelas doses de N adicionadas. Aos 87 DAP, os valores de IAF responderam similarmente. Foi concluído que a aplicação de doses crescentes de N, durante a fase de estabeleciment

Changes in structural attributes of Tifton 85 bermudagrass canopies induced by N rates, during the pasture establishment / Mudanças em atributos estruturais de dosséis do capim-Tifton 85 na fase de estabelecimento, induzidas pela adubação nitrogenada

Strategies of nitrogen fertilization management in Tifton 85 bermudagrass pastures, based on monitoring changes in sward structural attributes demands previous definition of those more appropriate ones. With this purpose an experiment was carried out at the experimental campus of the Rural Federal University, Seropédica, RJ, from October 2006 to January 2007. Treatments consisted of N fertilization at zero; 50; 100 and 150kg N-urea ha-1, in a single application, several sampling dates, during the pasture establishment, according to an entirely randomized design, with four replications. Treatments were allocated in experimental plots of 4 x 4m, and sampling dates (days after planting, DAP) in sub-plots. The variables studied were: frequency of plants occurrence; sward height, leaf area index (LAI) and interception of photosynthetically active radiation (PAR). The results showed that frequency of occurrence, sward height and PAR interception varied temporally according to a logistic pattern, whose parameters were modified, to a greater or lesser degree, by the nitrogen doses added. Similarly, at 87 DAP, LAI values responded in the same way. It was concluded that the application of increasing doses of N during the establishment of Tifton 85, was a limited experimental strategy for induction of quantitative changes during the time course of structural development of swards. However

A definição de estratégias de adubação nitrogenada em pastagens de Tifton 85, baseadas no monitoramento de alterações nos atributos estruturais dos dosséis, exige a definição pré- via daqueles mais apropriados. Para tal, foi desenvolvido um experimento no campo experimental da Universidade Federal Rural do Rio de Janeiro, município de Seropédica, RJ, entre os meses de outubro de 2006 a janeiro de 2007. Os tratamentos consistiram de doses de N (0; 50; 100 e 150kg ha-1), aplicadas na forma de uréia e sem parcelamento, e de datas de amostragem, durante a fase de estabelecimento da pastagem. Utilizou-se um delineamento experimental em blocos inteiramente casualizados, em parcelas subdivididas, com quatro repetições. Os tratamentos foram alocados em parcelas de 4 x 4m, enquanto as datas de amostragem (dias após plantio, DAP) foram alocadas em sub-parcelas. As variáveis estudadas foram: freqüência de ocorrência de plantas, altura do dossel, índice de área foliar (IAF) e interceptação de radiação fotossinteticamente ativa (RFA). Os resultados obtidos mostraram que a freqüência de ocorrência; altura e a interceptação de RFA variaram temporalmente de acordo a um padrão logístico, cujos parâmetros foram modificados, pelas doses de N adicionadas. Aos 87 DAP, os valores de IAF responderam similarmente. Foi concluído que a aplicação de doses crescentes de N, durante a fase de estabeleciment