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Background: Percutaneous microwave ablation (pMWA) is a minimally invasive procedure that uses a microwave antenna placed at the tip of a needle to induce lethal tissue heating. It can treat cancer and other diseases with lower morbidity than conventional surgery, but one major limitation is the lack of control over the heating region around the ablation needle. Superparamagnetic iron oxide nanoparticles have the potential to enhance and control pMWA heating due to their ability to absorb microwave energy and their ease of local delivery. Purpose: The purpose of this study is to experimentally quantify the capabilities of FDA‐approved superparamagnetic iron oxide Feraheme nanoparticles (FHNPs) to enhance and control pMWA heating. This study aims to determine the effectiveness of locally injected FHNPs in increasing the maximum temperature during pMWA and to investigate the ability of FHNPs to create a controlled ablation zone around the pMWA needle. Methods: PMWA was performed using a clinical ablation system at 915 MHz in ex‐vivo porcine liver tissues. Prior to ablation, 50 uL 5 mg/mL FHNP injections were made on one side of the pMWA needle via a 23‐gauge needle. Local temperatures at the FHNP injection site were directly compared to equidistant control sites without FHNP. First, temperatures were compared using directly inserted thermocouples. Next, temperatures were measured non‐invasively using magnetic resonance thermometry (MRT), which enabled comprehensive four‐dimensional (volumetric and temporal) assessment of heating effects relative to nanoparticle distribution, which was quantified using dual‐echo ultrashort echo time (UTE) subtraction MR imaging. Maximum heating within FHNP‐exposed tissues versus control tissues were compared at multiple pMWA energy delivery settings. The ability to generate a controlled asymmetric ablation zone using multiple FHNP injections was also tested. Finally, intra‐procedural MRT‐derived heat maps were correlated with gold standard gross pathology using Dice similarity analysis. Results: Maximum temperatures at the FHNP injection site were significantly higher than control (without FHNP) sites when measured using direct thermocouples (93.1 ± 6.0°C vs. 57.2 ± 8.1°C, p = 0.002) and using non‐invasive MRT (115.6 ± 13.4°C vs. 49.0 ± 10.6°C, p = 0.02). Temperature difference between FHNP‐exposed and control sites correlated with total energy deposition: 66.6 ± 17.6°C, 58.1 ± 8.5°C, and 20.8 ± 9.2°C at high (17.5 ± 2.2 kJ), medium (13.6 ± 1.8 kJ), and low (8.8 ± 1.1 kJ) energies, respectively (all pairwise p < 0.05). Each FHNP injection resulted in a nanoparticle distribution within 0.9 ± 0.2 cm radially of the injection site and a local lethal heating zone confined to within 1.1 ± 0.4 cm radially of the injection epicenter. Multiple injections enabled a controllable, asymmetric ablation zone to be generated around the ablation needle, with maximal ablation radius on the FHNP injection side of 1.6 ± 0.2 cm compared to 0.7 ± 0.2 cm on the non‐FHNP side (p = 0.02). MRT intra‐procedural predicted ablation zone correlated strongly with post procedure gold‐standard gross pathology assessment (Dice similarity 0.9). Conclusions: Locally injected FHNPs significantly enhanced pMWA heating in liver tissues, and were able to control the ablation zone shape around a pMWA needle. MRI and MRT allowed volumetric real‐time visualization of both FHNP distribution and FHNP‐enhanced pMWA heating that was useful for intra‐procedural monitoring. This work strongly supports further development of a FHNP‐enhanced pMWA paradigm; as all individual components of this approach are approved for patient use, there is low barrier for clinical translation. [ABSTRACT FROM AUTHOR]

Although near‐infrared (NIR) light‐based photothermal therapies have shown therapeutic potential for infected wounds, the attenuation of NIR light intensity in tissue has severely limited the usage in deep bacterial infections. Herein, magneto‐thermal responsive bilayer microneedles (Fe‐Se‐HA MNs) consisting of functionalized hyaluronic acid (HA), ferro‐ferric oxide (Fe3O4), and micelle‐protected selenium nanoparticles (SeNPs@LAS) are constructed to overcome this challenge based on a self‐designed disk‐shaped electromagnetic field device (Disk‐ZVS). The electromagnetic field generated by the Disk‐ZVS shows virtually no intensity attenuation in living tissue. Finite element simulations showed that the field intensity and electromagnetic loss are concentrated on the tips of Fe‐Se‐HA MNs. The MNs are able to puncture hard scabs, penetrate into bacterial biofilms, and perform effective magnetic‐thermal conversion for deep hyperthermia sterilization. Following, the Fe‐Se‐HA MNs can be gradually degraded by excessive hyaluronidase in diabetic wound to release SeNPs, which reduce reactive oxygen species (ROS) to regulate wound redox homeostasis. Meanwhile, the SeNPs are beneficial to angiogenesis, which facilitates blood vessel formation and promotes wound repair. Therefore, various functions can be achieved for the Fe‐Se‐HA MNs, such as magneto‐thermal disinfection, deep and non‐invasive tissue penetration, anti‐inflammation, and pro‐angiogenesis, which shows great potential as an adjunctive therapy for infected diabetic wounds. [ABSTRACT FROM AUTHOR]

Objective: Acromioclavicular joint dislocation is one of the most common shoulder injuries in young men. With the advancement of minimally invasive technology, arthroscopy of acromioclavicular joint dislocation has been recognized for its good curative effect. This study aimed to explore the technical details and clinical efficacy of a modified minimally invasive endoscopic treatment for acromioclavicular joint dislocation. Methods: Clinical data of patients receiving the three‐incision endoscopic treatment were retrospectively reviewed between July 2013 and July 2019. A total of 72 patients with acromioclavicular joint dislocation of Rockwood type III (n = 42) and type V (n = 30) were included in this study. Postoperative routine radiography was performed to evaluate acromioclavicular joint reduction and fixation. In addition, functional recovery of the shoulder joint was assessed using the American Shoulder and Elbow Surgeons (ASES) and Constant–Murley scores. Differences between the preoperative and postoperative data were compared using paired t‐tests. Results: All patients underwent loop plate elastic fixation under endoscopy during 24 to 48 months of follow‐up. Postoperative radiography showed that the acromioclavicular joint achieved anatomical reduction. The ASES score (91.1 ± 4.2) was significantly improved compared to the preoperative ASES score (62.4 ± 3.1) (t = 46.65, P < 0.0001). The Constant–Murley score (93.1 ± 4.6) was also significantly higher than that before the operation (40.7 ± 6.4) (t = 56.41, P < 0.0001). No postoperative complications occurred. During follow‐up, four patients had mild acromioclavicular joint degeneration but no obvious pain symptoms. Conclusion: The modified three‐incision endoscopic technique optimizes the surgical incision, reduces trauma, is minimally invasive, and provides rapid rehabilitation with satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical efficacy and safety of arthroscopic internal drainage for the treatment of unicameral popliteal cysts with or without cyst wall resection. Methods: This was a retrospective case–control study of 73 patients diagnosed with unicameral popliteal cysts from January 2012 to January 2019 who received arthroscopic treatment. The study included 38 cases with cyst wall resection (CWR group) and 35 cases with cyst wall preservation (CWP group). The CWR group consisted of 14 men and 24 women with an average age of 51.8 years, while the CWP group consisted of 13 men and 22 women with an average age of 52.0 years. All patients were examined for intra‐articular lesions and communicating ports by magnetic resonance imaging (MRI) prior to surgery, and recurrence of cysts was evaluated at the last follow‐up examination. Rauschning and Lindgren grade (R–L grade) and Lysholm score were used to evaluate clinical outcomes. In addition, operation time and complications were recorded. Results: The average length of follow‐up was 24.2 months (range, 16 to 32 months). There were no considerable differences in age, gender, cyst size, Lysholm score, R–L grade and concomitant intra‐articular cases between the CWR group and CWP group prior to surgery (P > 0.05). The last follow‐up MRI scans showed that in the CWR group, the cyst disappeared in 25 cases and shrunk in 13 cases. In the CWP group, the cyst disappeared in 22 cases, shrunk in 12 cases and persisted in one case. There was no obvious difference in recurrence rate between the two groups (0% vs 2.9%, P = 0.899). At the last follow‐up, there were no differences in the R–L grade (P = 0.630) and Lysholm score (88.3 ± 5.6 points vs 90.1 ± 3.8 points, P = 0.071) between the two groups. Compared with the CWP group, operation time was significantly prolonged in the CWR group (38.3 ± 3.1 min vs 58.3 ± 4.4 min, P < 0.05). In the CWR group, three cases occurred fluid infiltration under the gastrocnemius muscle, which improved after pressure bandaging and cold compress. In another three cases, hematoma was found. The incidence of complications in the CWR group was markedly higher than that in the CWP group (15.8% vs 0%, P < 0.05). During the follow‐up period, none of the patients developed serious complications such as neurovascular injury, deep venous thrombosis, or infection. Conclusion: For unicameral popliteal cysts, arthroscopic internal drainage combined with resection of the cyst wall did not further improve the clinical outcomes or reduce the recurrence rate, while prolonging the operation time and increasing the possibility of complications. [ABSTRACT FROM AUTHOR]

Background: Epidermoid cyst (EC) is a common and benign tumor, which can occur anywhere on the skin. Surgical excision is usually considered as the first‐line treatment. However, linear scars arising after excision for EC remain a cosmetic problem. Objective: To evaluate the efficacy and safety of EC removal assisted with CO2 laser fenestration. Methods: All patients diagnosed with EC and treated with CO2 laser fenestration, content extrusion, and removal of the cyst wall between January 1, 2016, and December 31, 2018, were included in this study. After a follow‐up period ranging from 6 to 27 months, scarring, recurrence, complications, and satisfaction were assessed and analyzed. Results: Forty‐three of the 47 patients have been cured by a single operation. The recurrence rate was 8.5%, which was not significantly correlated with tumor sizes or locations. 46.8% of the patients had no obvious scar after treatment. No infections or complications were observed in any of these cases. 89.4% of the patients were satisfied with the effectiveness of the treatment, while 95.7% and 87.2% were satisfied with the comfort and the cosmetic results, respectively. Conclusions: CO2 laser fenestration‐assisted removal procedure is effective for the treatment of ECs with good aesthetic outcome. [ABSTRACT FROM AUTHOR]

The article discusses the possibility that the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) could negatively impact the utilization of non-invasive and minimally invasive paediatric dental treatments for issues such as dental caries. It discusses the Hall technique (HT) in mixed caries treatment, attempting to minimize the risk of infection and transmission, and the use of traditional treatment.

When a traumatic dental injury affects the deciduous teeth, the main management is to regularly review the patient until the successor permanent tooth erupts to avoid further consequences to the affected tooth and, especially, sequelae in the tooth germs of the successor permanent tooth. This report describes a case of a tooth extrusion in a 4-year-old male treated with a minimally invasive approach. After 4 years of follow-up, there was a mild disturbance (demarcated opacity in the vestibular surface) and a satisfactory result with normal eruption of the permanent successor tooth. [ABSTRACT FROM AUTHOR]

Aim: In patients who have undergone a polypectomy of a malignant rectal polyp without histopathological risk factors other than an involved or unclear resection margin, additional local excision is often performed. Evidence to support this approach is lacking. The aim of this systematic review and meta‐analysis was to determine the outcome in terms of local recurrence, disease‐free survival (DFS) and overall survival (OS) of additional local excision following incomplete polypectomy for low risk T1 rectal cancer. Methods: A comprehensive search for published studies was performed. Only studies in which there was incomplete (or ≤ 1 mm) removal of pT1 rectal polyps or in which the resection plane could not be assessed were included. For each included study data on tumour stage, histological factors, surgical technique, local recurrence rate, 5‐year DFS and 5‐year OS were extracted. The PROSPERO registration number is CRD42017062702. Results: A total of 580 studies were retrieved by the search in the MEDLINE database, Embase and the Cochrane Library. After careful appreciation, four studies were included in the analysis, comprising 102 patients of whom the majority had undeterminable (Rx) resection margins. Local excision via transanal endoscopic microsurgery was reported most frequently. Only 1% of patients developed a local recurrence. One study reported 5‐year DFS and 5‐year OS of 96% and 87% respectively. Conclusion: This study supports the use of additional local excision techniques for rectal cancer patients who underwent an incomplete polypectomy for a malignant rectal polyp in the absence of risk factors other than an uncertain resection margin. [ABSTRACT FROM AUTHOR]

Background Pilonidal disease ( PD) is a common inflammatory disease of the gluteal fold, resulting in recurrent acute/chronic infection at the level of the natal cleft. In this study, endoscopic pilonidal sinus treatment ( EPSiT), a new endoscopic minimally invasive procedure, was evaluated for its effectiveness in treating PD. Methods Two hundred and fifty prospective patients with chronic PD were enrolled in a prospective multicentre study conducted at a secondary and tertiary colorectal surgery centre. The primary end-point of this study was wound healing, and the short-/long-term outcomes such as healing time, morbidity rate and recurrence rate were analysed. The secondary end-point of this study was quality of life (QoL). Results The complete wound healing rate was 94.8%, and the mean complete wound healing time was 26.7 ± 10.4 days. The incomplete healing rate (5.2%) was significantly related to the number of external openings ( P = 0.01). There was no difference in the failure rate when EPSiT was performed as the first-line treatment for PD or when it was used after unsuccessful procedures ( P = n.s.). Recurrence occurred in 12 cases (5%). The QoL significantly increased from preoperative levels 15 days after the EPSiT procedure (45.3 vs 7.9; P < 0.0001). Conclusions The EPSiT procedure is a safe and effective technique for treating PD. It provides better short- and long-term outcomes than various other techniques that are more invasive. EPSiT is a minimally invasive outpatient procedure, which is associated with a quick recovery and a good QoL outcome. [ABSTRACT FROM AUTHOR]

What's known on the subject? and What does the study add? Previous studies have retrospectively compared functional and oncological outcomes between robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP), reporting non-inferior or superior outcomes associated with the use of the robotic approach., The study demonstrates that baseline selection biases makes comparisons of RARP and RRP problematic. Patients treated with RARP may have significantly better baseline characteristics than patients treated with RRP. Indeed, when both facilities are available within the same centre, patients with the most favourable clinical and cancer profile are inherently selected to RARP. In the absence of a prospective randomized trial, the decision to prefer one approach over another should be tailored according to each single patient and surgeon., Objective To evaluate the trend in robot-assisted radical prostatectomy ( RARP) and open retropubic radical prostatectomy ( RRP) use over time and to compare preoperative and pathological characteristics of patients treated with RARP or RRP at a single centre., Patients and Methods Between 2006 and 2010, 2511 consecutive patients treated with RP, with or without pelvic lymph node dissection ( PLND), for prostate cancer ( PCa) at a single tertiary care centre were analysed., Baseline patient characteristics and PCa risk distribution were compared according to treatment type ( RRP vs RARP) in the overall population, as well as in three surgeons' initial 50 RARP and three surgeons' initial 50 RRP cases ( n = 300)., We used a chi-squared trend test to evaluate the differences in treatment type administration over time according to PCa characteristics. Logistic regression analyses focused on the prediction of PLND and adjuvant radiotherapy ( RT) use., Results Overall, 1873 (74.6%) and 638 (25.4%) patients underwent RRP and RARP, respectively., Men treated with RARP were younger (mean age: 62 vs 65 years), less obese (mean BMI: 24.8 vs 26.4 kg/ m2), healthier (Charlson comorbidity index = 0: 68.7 vs 53.3%) and more likely to harbour clinical low-risk PCa (51 vs 30%) than their RRP counterparts (all P < 0.001). Similar findings were observed in sub-analyses focusing on six surgeons' 50 initial patients (all P ≤ 0.02)., A significant increase in the rate of patients with low-risk PCa treated with RARP vs RRP was reported over time (5 vs 95% and 66 vs 34% in 2006 and 2010, respectively). Conversely, 76% of patients with high risk PCa were still treated with RRP in 2010., Patients treated with RARP were less likely to receive PLND at RP and adjuvant RT (all P ≤ 0.01), even after adjusting for clinical and PCa characteristics., Conclusions The introduction of a robotic training programme at a high volume centre led to significant patient selection in terms of clinical and PCa characteristics., When both RRP and RARP facilities are available within the same centre, patients with the most favourable clinical and cancer profile are selected to undergo RARP., Use of RARP negatively influenced the rates and the extent of PLND as well as the use of adjuvant RT after surgery. Thus, baseline patient selection, surgical and treatment biases make any comparisons of RARP with RRP problematic. [ABSTRACT FROM AUTHOR]

The current treatment philosophy is to prevent and detect dental disease at the earliest stage in order to avoid invasive treatment. With the current understanding of the nature of dental disease and its process, the treatment philosophy is now changing to a more conservative approach and the concept of minimal intervention is gaining popularity in modern dentistry throughout the world. It is now established that demineralized but non-cavitated enamel and dentine can be healed and traditional surgical approach of drilling and filling may no longer be necessary as this only treats the symptoms of the disease and not the cause. However, when surgical intervention is indicated, the least invasive techniques such as preventive resin restoration and minimal cavity preparation are utilized. The aim of this article is to give dental professionals an overview of the concepts of minimal intervention dentistry and recent innovations in dental technology in both the diagnosis and treatment of dental caries. [ABSTRACT FROM AUTHOR]

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To analyse the factors predicting the mortality and need for nephrectomy in patients with emphysematous pyelonephritis (EPN). PATIENTS AND METHODS Clinical features, laboratory variables, imaging studies, management strategy and the final outcomes were analysed in 39 consecutive patients with EPN. The mean (sd) age was 57 (7.2) years and the male to female ratio was 2:11. The baseline risk factors (clinical, laboratory and radiological) were compared among three groups; group 1, survived with renal salvage (26); group 2, survived after nephrectomy (eight); and group 3, died (five). RESULTS The overall survival rate was 87% (34/39) and the kidney was salvaged in 67% (26) patients at a median follow-up of 18 months. Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation were significantly associated with mortality rate. There was no significant difference in final outcome based on radiological classification. Extensive renal parenchymal destruction of >50% (based on computed tomography) significantly predicted the need for nephrectomy ( P < 0.001) and death ( P = 0.02). Early (<1 week) nephrectomy resulted in a higher mortality rate (three of seven patients) than initial conservative management. There were no deaths in selected patients who received antibiotics alone or had delayed nephrectomy (four patients each). Of 24 patients who had minimally invasive treatment alone, two (8%) died. Minimally invasive treatment resulted in high renal salvage (22/24, 92%). CONCLUSION Altered mental status, thrombocytopenia, renal failure and severe hyponatremia at presentation are associated with higher mortality rates, whereas extensive renal parenchymal destruction is associated with a need for nephrectomy. Early nephrectomy is associated with higher mortality rates than is initial conservative management. [ABSTRACT FROM AUTHOR]

Background and Aim: The purpose of this study was to assess the therapeutic efficacy and safety of percutaneous radiofrequency (RF) ablation for hepatocellular adenoma. Methods: We performed percutaneous RF ablation in 10 patients with pathologically proven hepatocellular adenomas. Eight patients were asymptomatic and two patients had a recurrent tumor after surgical resection. The size of the tumors was 2.25 ± 0.76 cm (range: 1.5–4.5 cm) in the largest diameter. All ablation procedures were percutaneously performed with an internally cooled RF electrode system under ultrasound (US) guidance. We evaluated the therapeutic efficacy and safety of the procedure by clinical follow-up data with regular follow-up computed tomography (CT) for 2–35 months (mean, 17.5 months). Results: All patients well tolerated percutaneous RF ablation procedure without any incident. Contrast-enhanced CT ( n = 7) or contrast-enhanced US ( n = 3) obtained immediately (<24 h) after the procedure revealed complete ablation of the tumor in all cases. There was no case of local tumor progression or new recurrence during the follow-up period. We found neither procedure-related mortality nor major complication requiring specific treatment. Conclusion: Percutaneous RF ablation of hepatocellular adenoma without overt complication can be a new potential alternative to close imaging follow-up or elective surgery. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe a unique case of vaginal injury with peritoneal perforation from a water-jet accident that was treated by laparoscopic assisted operation. SubjectA woman was transferred to our unit with a vaginal laceration caused by impact of water flow to the perineum after falling off of the back seat of a Jet-ski. A part of the appendix epiploica was seen in the vagina. InterventionsIn this particular case, by using a laparoscope and washing and draining the pelvic cavity, it was confirmed by the surgeon that there was no intestinal injury despite part of the colon having entered the vagina. The perforated vaginal wound was sutured transvaginally while draining the abdominal cavity. Compared with what would have been the case with laparotomy, the patient's need for pain killers and her recovery time were greatly reduced. ConclusionsPatients with vaginal lacerations are often encountered in the emergency room. In treatment it is necessary to stop the bleeding and prevent infection. In the case of vaginal perforation, it is also important to check for intestinal or pelvic injury. Usually, open surgery is performed for these reasons. However, the authors managed to treat the woman using a laparoscopically assisted approach, and therefore the treatment was minimally invasive. [ABSTRACT FROM AUTHOR]