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espanolLa puncion lumbar (PL), un metodo utilizado tanto para fines diagnosticos como terapeuticos, y sigue siendo hoy un procedimiento ampliamente utilizado. Una de sus complicaciones mas frecuentes es la cefalea post puncion lumbar. Una de sus complicaciones mas frecuentes es la cefalea post puncion lumbar. La incidencia de esta complicacion varia y puede ocurrir hasta en 40% 48 h posteriores al procedimiento. El presente articulo describe y compara diferentes literaturas sobre Cefalea post puncion lumbar. Para ello, se recolecta esta informacion de diferentes fuentes bibliograficas adquiridas de bases de datos (SCOPUS, PubMed, Biblioteca Cochrane, Google Scholar) valorando la calidad y veracidad de la informacion recopilada, asi como la actualidad del contenido. Los que nos indica la bibliografia consultada es que pareciera ser muy recurrente la presencia de cefalea a causa de una puncion post lumbar. Sin embargo la presencia de la misma por lo general puede aparecer en mujeres en proceso de dar a luz como consecuencia de la administracion de la epidural. Sin embargo estos factores no solo estan asociados a la presencia de la cefalea, sino que el calibre, tamano de la aguja e incluso la forma y direccion al momento de insertarla es determinante. En este particular estudios han confirmado que a menor calibre de la aguja tiene mas probabilidades de que por la puncion se genere una cefalea. El diagnostico se realiza mas que todo por la clinica o sintomatologia del paciente, siendo casos extremos la realizacion de examenes imagenologicos a menos que la cefalea sea muy excesiva y se puedan presentar problemas neurologicos y en cuanto a lo que tiene que ver el tratamiento se recomienda tratamientos no invasivos, como reposo, hidratacion y analgesicos no opioides y cafeina. Hay tratamientos invasivos como la colocacion de un parche epidural. EnglishLumbar puncture (LP), a method used for both diagnostic and therapeutic purposes, and remains a widely used procedure today. One of its most frequent complications is post-lumbar puncture headache. One of its most frequent complications is post-lumbar puncture headache. The incidence of this complication varies and can occur in up to 40% 48 hours after the procedure. This article describes and compares different literatures on post lumbar puncture headache. To do this, this information is collected from different bibliographic sources acquired from databases (SCOPUS, PubMed, Cochrane Library, Google Scholar), assessing the quality and veracity of the information collected, as well as the timeliness of the content. What the consulted bibliography indicates is that the presence of headache due to a post-lumbar puncture seems to be very recurrent. However, the presence of the same can usually appear in women in the process of giving birth as a result of the administration of the epidural. However, these factors are not only associated with the presence of the headache, but the gauge, size of the needle and even the shape and direction at the time of insertion is decisive. In this particular study, they have confirmed that the smaller the gauge of the needle, the more likely a headache is generated by the puncture. The diagnosis is made mainly by the clinical or symptomatology of the patient, being extreme cases the realization of imaging tests unless the headache is very excessive and neurological problems may occur and as for what the treatment has to do, it is ecommended Non-invasive treatments, such as rest, hydration, and non-opioid pain relievers and caffeine. There are invasive treatments such as the placement of an epidural patch.

BACKGROUND Minimally invasive treatments as soft tissue filler injections can enhance the appearance of the jawline. This prospective, single-center study investigated aesthetic outcome, patient satisfaction, adverse events, and volume changes after jawline contouring using standardized reporting scales and objectifiable 3D surface analysis. METHODS A total of 30 patients (1 male and 29 females, mean age: 57.2 (±8.7) years) were investigated. Patients underwent jawline augmentation using a highly cross-linked hyaluronic acid-based soft tissue filler. Three-dimensional surface imaging was performed after 2 weeks, and 3, 6, 9, and 12 months. Furthermore, the aesthetic results and the occurrence of complications were investigated after two weeks, and 3, 6, 9, and 12 months. RESULTS The surface-volume coefficient (SVC) had an average of 1.10 ± 0.2 after 14 days, 0.95 ± 0.1 after 3 months, 0.83 ± 0.1 after 6 months, 0.74 ± 0.1 after 9 months, and 0.63 ± 0.1 after 12 months. A significant correlation was revealed between time of measurement and measured SVC with rp = -0.761, p

The elderly account for the majority of medical spending in many countries, raising concerns about potentially unnecessary spending, especially during the final months of life. Using a well-defined starting point (hospitalization for an initial acute myocardial infarction) with evidence-based postevent treatments, we examined age trends in treatments in the US and Norway, two countries with high levels of per capita medical spending. After accounting for comorbidities, we found marked decreases within both countries in the use of invasive treatments with age (for example, less use of percutaneous coronary interventions and surgery) and the use of relatively inexpensive medications (for example, less use of anticholesterol [statin] drugs for which generic versions are widely available). The treatment decreases with age were larger in Norway compared with those in the US. The less frequent treatment of the oldest of the old, without even use of basic medications, suggests potential age-related bias and a disconnect with the evidence on treatment value. Hospital organization and payment in both countries should incentivize greater equity in treatment use across ages.

Introduction. Effective delivery of ophthalmic drugs is challenging. The eye has a number of protective systems and physiological barriers, which is why ophthalmic dosage forms have a low bioavailability, usually not exceeding 5 %. Topical drug administration is relatively easy to use and is most commonly prescribed by physicians for the treatment of ophthalmic diseases, especially the anterior segment of the eye. However, when using traditional delivery systems, a number of problems arise: patients' violation of the drug administration technique, and, as a consequence, a decrease in treatment compliance, restriction of drug delivery to the target eye tissues due to low epithelial permeability and rapid clearance after drug administration. Maintaining a constant therapeutic drug level is another challenge that traditional delivery systems often fail to cope with.Text. The article discusses the types of ophthalmic delivery systems. Traditional ones are represented by such dosage forms as eye drops, ointments, gels. Modern ophthalmic dosage forms are represented by: eye films, contact lenses and eye implants. The characteristics, advantages and disadvantages of each type of delivery systems and their promising directions of development, as well as modern developments in this area are given.Conclusion. Currently, most of the scientific research on the development of ophthalmic delivery systems is devoted to obtaining dosage forms capable of maintaining a constant concentration of the drug in the target tissue, providing the transport of active ingredients to them. This is achieved by using modern advances in nanotechnology and polymer chemistry. Receive liquid and soft dosage forms with micro-, nano- and micro-nano-carriers. Polymeric delivery systems such as films, lenses and implants are being actively developed and studied. The development of modern technological approaches opens up new possibilities for the treatment of a wide range of ophthalmic diseases by reducing the side effects often induced by the intrinsic toxicity of molecules, reducing the frequency of the administered dose and maintaining the pharmacological profile of the drug. Thus, the use of modern ophthalmic delivery systems can significantly limit the use of invasive treatments.

BACKGROUND In the treatment of adult congenital heart disease (ACHD), the transfer of patients from pediatric cardiologists to ACHD cardiologists is of relevance. However, little is known about the clinical courses of ACHD patients that have been referred by non-CHD-specialized doctors (n-CSDs). METHODS This retrospective cohort study included 230 patients (average age: 37 ± 15.2 years, male: 97) who were referred to a single specialized ACHD center between April 2016 and July 2019. We compared the characteristics and clinical courses between patients referred by n-CSDs and those referred by CHD-specialized-doctors (CSDs). RESULTS Overall, 121 (53%) patients were referred by n-CSDs. Among them, 91 (75%) patients were referred by adult cardiologists. Univariate analysis showed that the patients referred by n-CSDs were older than those referred by CSDs (41.6 ± 16.3 vs. 32.0 ± 12.0 years, p

Untreated dental caries remains a challenge in young children and adolescents. Invasive treatments in very young children and children with special health care needs require advanced pharmacological behaviour management strategies. A minimally invasive treatment modality to arrest caries is by application of 38% Silver Diamine Fluoride (SDF). Besides its efficacy to arrest decay, SDF is favoured by its inexpensiveness. This review enlightens the evolution, historical background, mechanism of action, clinical considerations, advantages and disadvantages of Silver Diamine Fluoride.

Renal cell carcinoma (RCC) is the most common malignancy of the kidney that accounts 85% of all renal tumors and 2-3% of all adult malignancies . The etiology of RCC associated with smoking , obesity, anti-hypertensive therapy, coffee and tea, Western diet (high fat and protein and low fruits and vegetables). However, the detection of small renal masses has been increased because of widespread use of sonography, computed tomography and magnetic resonance imaging techniques in recent years, but one-third of the patients with RCC still present with large, locally advanced or metastatic disease. Surgery is the main treatment for renal cell carcinoma and minimal invasive treatments such as laproscopy and robotic approaches is very popular in the world after the widespread use of technological instruments and technology.

To compare Medicare coverage patterns for treatments of knee osteoarthritis (OA) to those of temporomandibular joint (TMJ) OA.The International Classification of Diseases (ICD)-10 codes were used to identify knee OA, TMJ OA, and related diagnoses. The AAPC Coder was utilized to search for Medicare insurance coverage by state/district for the indicated CPT codes. The coverage for treatments of TMJ OA and knee OA was analyzed by Fisher's exact test.There was a statistically significant difference in the coverage of physical therapy, massage therapy, and arthrocentesis for TMJ OA and knee OA. The current study showed that arthrocentesis was covered 100% in all states/districts for knee OA and 0% for TMJ OA.Medicare covers TMJ OA treatments to a lesser degree than knee treatments. Documentation of this discrepancy serves as an important first step in advocating for improvements in coverage, and subsequently, in access to care.

Amaç: Lomber disk hernisi (LDH) toplumda giderek artan bir hastalık olarak karşımıza çıkmaktadır. Günümüzde minimal invaziv tedaviler hem maliyet hem de zaman açısından önemini artırmıştır. Bizde çalışmamızda LDH olan hastalarda minimal invaziv tedavilerden biri olan intradiskal ozon enjeksiyon tedavisinin retrospektif olarak radiküler ağrıda kısa ve uzun dönemde etkilerini incelendik.Gereç ve Yöntemler: Kafkas Üniversitesinde Ağustos 2015-Kasım 2016 tarihleri arasında, LDH sebebiyle ağrı polikliniğimize başvuran ve ameliyathanede C kollu floroskopi eşliğinde intradiskal ozon uygulanan 40 hastanın (13 erkek, 27 kadın) dosyaları geriye dönük olarak incelendi. Bulgular:İşlem öncesi vizuel analog skala (VAS), direk bacak kaldırma testi (DBKT) ve el parmak zemin mesafesi (EPZM) değerleri ile 1. ay ve 6. ay VAS, DBKT VE EPZM değerleri karşılaştırıldığında istatistiksel olarak anlamlı fark saptandı. Sonuç: Günümüzde disk hernilerinde cerrahi tedavi en son alternatif olarak düşünülmekte olup minimal invaziv yöntemler ön plana çıkmıştır. İntradiskal medikal ozon enjeksiyon tedavisinin kısa ve uzun dönemde etkin olduğu ve bu nedenle LDH olan hastalarda tercih edilebilecek bir tedavi yöntemi olduğunu düşünmekteyiz.

Ultrasound associated with ultrasound contrast agents has witnessed ever-growing innovations and applications for disease-targeted diagnosis and therapy. With these state-of-the-art technologies, brand-new invasive or minimally invasive treatments are on the way to be clinically translated. This mini-review focuses on the ultrasound and ultrasound-related micro/nanobubbles as multifunctional agents for drug/gene delivery and multi-modality treatments, e.g. photodynamic, sonodynamic and photothermal therapies in a precise and visualized manner.

Over the past 60 years, a growing body of research has investigated the psychological aspects of cosmetic surgery and related minimally-invasive treatments. While the earliest studies were influenced by psychoanalytic thinking, much of the work over the past several decades has been influenced by Thomas Cash's cognitive-behavioral theory of body image and has focused on the appearance concerns of patients who seek these procedures. The majority of individuals interested in the procedures report heightened dissatisfaction typically focused on the feature being considered for treatment. Studies from around the world also have suggested that between 5-15% of patients who present for cosmetic procedures meet diagnostic criteria for body dysmorphic disorder (BDD). While individuals with BDD typically do not report a reduction in their BDD symptoms following a cosmetic procedure, the great majority of patients without the disorder do report improvement in body image. The paper reviews this literature and also discusses the role of body image in three newer areas of plastic surgery-body contouring after massive weight loss, genital procedures (either for cosmetic purposes or as part of gender reassignment), and vascularized composite allotransplantation, including face and hand transplantation.

INTRODUCTION AND OBJECTIVES:Nephrolithiasis has a multifactorial etiology, wherein, besides metabolic factors, the anatomy of the pelvicalyceal system might play a role. Using 3D-reconstructions of CT-urography (CT-U), we studied the morphometric properties of pelvicalyceal anatomy affecting kidney stone formation and compared those with existing literature on their effect on minimally invasive treatment techniques for renal calculi.METHODS: CT-U's were made between 01-01-2017 and 30-09-2018. Patients were chronologically included in two groups: a nephrolithiasis group when ≥ 1 calculus was present on the CT-U and a control group of patients with both the absence of calculi on the CT-U and no medical history of urolithiasis. Patients with a medical history of diseases leading to higher risks on urolithiasis were excluded. In the nephrolithiasis group affected kidneys were measured. In the control group, left and right kidneys were alternately measured.RESULTS: Twenty kidneys were measured in both groups. Mean calyceopelvic tract width was significantly larger in the lower segments of affected kidneys (3.9 vs. 2.7 mm). No significant differences between the groups were found in number of calyces, infundibular length, infundibular width, calyceopelvic angle, upper-lower angle and diameters of the pelvis. Transversal calyceal orientation in hours was significantly smaller in the upper and lower segments of the nephrolithiasis group (7.69 vs. 8.52 and 8.08 vs. 9.09 h), corresponding with more dorsally located calyces in stone-forming kidneys.CONCLUSION: Pelvicalyceal anatomy differs between stone-forming and non-stone-forming kidneys. Understanding the pelvicalyceal system and etiology of stone formation can improve development of endourological techniques.

Purpose: The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment. Method: Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived. Each measure was subsequently divided into three categories by severity: absence, small degree, or large degree. Nonparametric statistics tested associations between severity and treatment recommendations as well as potential follow-through. Results: Noninvasive treatments (observation/voice therapy) were marginally associated with no glottal gap ( p = .09). More invasive treatments (injection/bilateral thyroplasty) were associated with glottal gaps being present ( p = .026), but bilateral thyroplasty recommendations were not significantly associated with the largest gaps. Treatment modalities were not characterized by specific severity categories for any of the objective measures. No significant differences were found for any of the three objective measures between those who followed through with recommended treatment and those who did not. Discussion: Results demonstrated some support for current hypotheses on how degrees of severity of objective measures relate to treatment recommendations. Of the three measures, NGGA appears to be more informative regarding treatment recommendations and follow-through, but due to low power, larger sample sizes are needed to confirm clinical relevance.

BACKGROUND Children with molar incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly few studies have evaluated the clinical success of such interventions. AIM To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH. DESIGN This in-vitro study used digital clinical images of 23 children aged 8-16 years with MIH who underwent microabrasion and/or resin infiltration for management of incisor opacities. Standard images were taken pre- and six-months post-treatment. Image software (Image-Pro Plus®V7) was employed to convert 24-bit RGB images to 16-bit grey-scale and 45% magnification. Measurement repeatability was assessed using Intra-class Correlation Coefficients (ICC). Post-treatment changes in visible opacity area (mm2 ) and brightness (greyscale value) were tested using Wilcoxon Signed Rank Test for Related-Samples. RESULTS Mean total opacity surface area significantly reduced from 14.3mm2 (SD=7.5) to 9.4mm2 (SD=9.0) post-treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD=10.5) to 14.7% (SD=12.7). Mean maximum opacity brightness significantly reduced from 53066 greyscale value (SD=4740) to 49040 (SD=3796). ICC was good/excellent (0.75-1.0). CONCLUSION Minimally invasive treatment is effective in reducing size and brightness of discrete incisor opacities. Future research should compare objective findings with patient-reported outcomes.

AIMS We aimed to describe the effectiveness of Onabotulinumtoxin A (Botox) in children with neurogenic bladder (NGB) unresponsive to medical therapy to determine urodynamic parameters predictive of success. METHODS Children receiving Botox for refractory NGB, between 2008 and 2019, from a single academic center, were included in this study. Botox success was defined as improvement of incontinence and/or urodynamic parameters. RESULTS Of 34 patients who received Botox, 13 (38.2%) had a positive response from their first injection, with improvement in capacity by a median of 35% of expected capacity for age compared to only a 9% increase in those who did not respond clinically. When patients were divided into groups by baseline urodynamic parameters, high-pressure (Pdetmax > 20 cm H2 O) patients had significantly greater improvement in compliance compared with low-pressure patients (p = 0.017). Low compliance patients (

Abdominoscrotal hydrocele is an uncommon condition characterized by an hourglass-shaped scrotal hydrocele with an intra-abdominal component connected by an isthmus within the inguinal canal. We report a rare case of an adult patient with giant abdominoscrotal hydrocele. Despite recent trends toward less invasive treatments, in this case, the surgical approach through an inguinal incision was the better therapeutic option with a satisfactory outcome.

Objective: Frailty is a clinically recognizable state of increased vulnerability common in critical medicine. When underrecognized, it may lead to invasive treatments that do not serve the patients’ best interest. Our aim was to evaluate the use of both palliative care consultation and invasive interventions in frail patients admitted to Intensive Care Units in Portugal. Methods: This was a prospective, observational study. All consecutive adult patients admitted for more than 24h, over a 15-day period were enrolled. Twenty-three Portuguese Intensive Care Units were included. Informed consent was obtained from all patients or their surrogate. The doctor and nurse in charge calculated the Clinical Frailty Score as well as the reference family member Results: A total of 335 patients were included in the study (66% male). Mean age was 63.2 + 16.8 and SAPS II score was 41.8 + 17.4. Mean Clinical Frailty Score value was 3.5 + 1.7. Frailty prevalence (mean score 5) was 20.9%. Frail patients were offered organ support therapy (64,3% invasive mechanical ventilation; 24,3% renal replacement therapy; 67,1% vasopressors) more often than non-frail patients. Nevertheless, limitation of therapeutic effort or a do not resuscitate order (p < 0.001) were more common in frail patients. Mortality rate by 6 months was higher among frail patients (50% vs. 32.3%, p < 0.001). Palliative Care was offered to only 15% of frail patients (3.9% overall). Conclusions: The authors suggest that palliative care should be universally consulted once frailty is identified in critical patients. info:eu-repo/semantics/publishedVersion

Hypertrophic cardiomyopathy (HCM) is common, inherited and characterised by unexplained thickening of the myocardium. The British Society of Echocardiography (BSE) has recently published a minimum dataset for transthoracic echocardiography detailing the core views needed for a standard echocardiogram. For patients with confirmed or suspected HCM, additional views and measurements are necessary. This guideline, therefore, supplements the minimum dataset and describes a tailored, stepwise approach to the echocardiographic examination, and echocardiography's position in the diagnostic pathway, before advising on the imaging of disease complications and invasive treatments.

Pain is a frequent and disabling non-motor feature of Parkinson's disease (PD). The recently proposed PD Pain Classification System (PD-PCS) allows for an association of pain with PD to be determined before being allocated to the main pain mechanism (i.e. nociceptive, neuropathic, and nociplastic). In this article, previous studies on treatments for pain in PD are summarized according to the pain mechanisms. A mechanistic approach to treatment is discussed. We suggest that the first step should be optimizing dopaminergic therapy before other therapy is started. When these treatments remain unsuccessful, further causes of pain must be considered. The role of drugs, invasive treatments, and physiotherapeutic interventions are discussed with a focus on older PD patients and considering polypharmacy, altered pharmacokinetics, and comorbidities.

Invasive procedures commonly cause recurring pain in preterm infants. Noninvasive pain management is an essential part of nursing intervention in the Neonatal Intensive Care Unit (NICU). The study’s aim is to identify the impact of touch therapy on pain in premature infants undergoing invasive treatments. The method was a quasi- experiment with 63 premature infants. The premature infants were classified into four groups: i) Mother’s touch Therapy (MTT), ii) Mother’s Voice Stimulus (MVS), iii) a combination of MTT and MVS, and iv) routine care. The observed infants’ pain scores were determined through a multiple regression model using the Generalized Estimating Equation (GEE) method. The GEE test showed that the combination of touch and sound therapy significantly reduced pain in premature infants undergoing invasive measures (p

Cosmetic procedures, especially cosmetic minimally invasive treatments, are rising in popularity, despite societal perception that these procedures may not improve patient health. The purpose of this study was to conduct a systematic review and controlled meta-analysis to compare the effects of cosmetic procedures and antidepressant treatment on health-related quality-of-life improvement. The PubMed database was queried in two independent searches to identify peer-reviewed cosmetic and antidepressant articles published between 1996 and 2017 that prospectively assessed the impact of the treatment on quality of life. All results were screened using defined exclusion and inclusion criteria and data were extracted using a standardized protocol. The meta-analysis was performed using a random-effects model. Five of 2,788 cosmetic studies and eight of 2,312 antidepressant studies met all inclusion criteria and utilized the 36-Item Short Form Health Survey (SF-36) measure. Except for the physical functioning scale, when compared with the cosmetic studies, antidepressant studies had significantly lower median baseline and post-treatment follow-up scale scores with larger median score improvement (p

El silicato tricalcico (Biodentine)®, induce el desarrollo de dentina reparativa y logra el mantenimiento de la vitalidad y función del tejido, evitando así tratamientos mas invasivos como pulpectomias o exodoncias. Objetivo: Describir el comportamiento clínico y radiográfico de la pul-pa expuesta al silicato tricalcico (Biodentine)® usado en pulpotomias como tratamiento de molares deciduas. Resultados: A las evaluaciones de 3, 6 y 9 meses se evidenció éxito clínico y radiográfico de todos los procedimientos. Conclusiones: Se evidenció que el Biodentine® puede ser usado o considerado un medicamento efectivo y prometedor en tratamiento de pulpotomías en dientes deciduos. Sin embargo, es necesario realizar más estudios clínicos a largo plazo para tener conclusiones más exactas.

Achilles tendon rupture is a common injury to the lower extremity that requires appropriate treatment to minimize functional deficit. Available treatments of Achilles tendon ruptures include nonoperative, open surgical repair, percutaneous repair, and minimally invasive repair. Open surgical repair obtains favorable functional outcomes with significant potential for deep soft tissue complications, calling into question the value of open repair. Percutaneous repair is an alternative option with comparable functional results and minimal soft tissue complications; however, sural nerve injury is a complication. Minimally invasive Achilles repair offers optimal results with superior functional outcomes with minimal soft tissue complications and sural nerve injury.

Background: The purpose of this study was to examine how frequently invasive intensive care unit (ICU) treatments are delivered to critically ill patients despite clinicians’ impressions that ICU care may be nonbeneficial. Methods: Patients admitted to the medical ICU of an academic public hospital were prospectively categorized according to guidelines from the Society of Critical Care Medicine which classifies patients based on severity of illness and likelihood of recovery (categories 1-4). Clinical data and use of ICU treatments in patients with high (category 1) and low (category 3) likelihoods of benefit were collected by chart review. Multivariable regression analyses examined associations between use of invasive treatments and patient categories, and clinical factors associated with receiving invasive ICU treatments despite low likelihood of benefit. Results: There were 533 patients (369 in category 1 and 164 in category 3) in the study. A total of 19.8%, 29.9%, and 28.9% of patient-days on mechanical ventilation, vasopressors, and renal replacement therapy, respectively, were delivered to patients who were considered unlikely to benefit from ICU treatments (category 3) and ultimately did not survive hospitalization. These patients also received 35.2% of cardiopulmonary resuscitation attempts and 22.6% of central venous catheter placements. Clinicians’ impressions of likelihood of benefit (category 1 vs 3) were not associated with odds of receiving invasive ICU treatments. Clinical characteristics associated with greater odds of receiving potentially nonbeneficial treatments included older age, presence of dementia or malignancy, and higher Acute Physiologic Assessment and Chronic Health Evaluation score. Conclusions: Invasive ICU treatments are frequently delivered to patients who are not expected to benefit from ICU care and die during hospitalization. These findings highlight the need to improve utilization of ICU services among patients with advanced medical illnesses.

Patients are increasingly seeking uterus-preserving, minimally invasive treatments for symptomatic uterine fibroids. This has led to a greater use of nonresective treatments such as uterine artery embolization (UAE), focused ultrasound (FUS) and more recently, radiofrequency ablation (RFA) of fibroids. This systematic review, following PRISMA guidelines, examines the change in uterine and fibroid volumes associated with UAE, FUS, and RFA. Pubmed and MedlinePlus databases were searched from 1956 to 2016. The keywords used were ‘radiofrequency ablation,’ ‘magnetic resonance guided focused ultrasound,’ ‘ultrasound guided focused ultrasound’, ‘uterine artery embolization,’ ‘uterine fibroid embolization,’ and ‘leiomyoma’ or ‘fibroid’. Publications with at least 20 patients were included. Data were collected and analyzed using Microsoft Excel® (Microsoft Corporation, Redmond, WA) software. Eighty-one relevant papers were identified: 52 related to UAE, 11 to RFA, 17 to FUS, 1 compared UAE and FUS. We report the published uterine volume and fibroid volume changes seen in these studies at 1 to 36 months. The pooled fibroid volume reductions at six months seen with RFA were 70%, UAE 54% and FUS 32%. All three types of nonresective treatment result in fibroid volume reduction. However, fibroid volume reduction is most marked with RFA, with UAE resulting in the next most volume reduction. Additional larger cohort studies, including those that are randomized and/or comparative, would enable definitive conclusions. This is the first systematic review comparing uterine and fibroid volume reduction after RFA, UAE and MRgFUS.

The degenerative spine changes, and its costs, have increased with high rates of work absenteeism and difficult clinical management. The search for minimally invasive treatments, with better results and early patients recover, with rapid hospital discharge are alternatives for these problems. The percutaneous endoscopic lumbar interbody fusion (PELIF) is a new and advanced option.

Various treatments for the management of facial aging have been performed among which noninvasive radio-frequency (RF; i.e., thermage) treatment and minimally invasive treatments are on the rise. The purpose of this study was to analyze trends of the treatment of facial aging in Korea and to investigate relationships between the use of noninvasive RF and minimally invasive treatments. A retrospective analysis conducted on data from 4021 patients showed that thermage treatment increased by 134.9% over 5 years. As a person ages, the rate of facial treatment with both the botulinum toxin (for the masseter and lines of the glabella, lateral canthus, and forehead) and the PDO thread lift increases. The use of the treatments, nasolabial fold filler and Silhouette Soft Thread, however, was not associated with aging. The patients receiving thermage treatment were less likely to undergo any of the other treatments including PDO thread lift, Silhouette Soft Thread, nasolabial fold filler, or any of the botulinum toxin treatments. Overall, the results showed that patients who had received noninvasive RF tended to receive less minimally invasive treatment.

Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional restorative treatment. Noninvasive treatments, that are in accordance with the patients' expectations, should be the first therapeutic alternative. If the deciduous tooth is present, minimally invasive dental extraction followed by immediate dental implant placement and provisional restoration is indicated. In this restorative treatment, an adequate emergency profile can be achieved by peri‐implant soft‐tissue‐conditioning techniques. Moreover, the association of restorative materials, such as composite resins and dental ceramics, provides more predictable esthetic results. Clinical Considerations The present case report presents a rehabilitation of bilateral congenital absence of maxillary lateral incisors through a multidisciplinary approach. Dental implants, long‐term provisional restoration, tooth bleaching, minimally veneered high‐translucent monolithic zirconia crowns, feldspathic veneers, and composite restorations were used by the dental team to achieve the expected functional and esthetic outcomes. Conclusions Different treatment modalities are available for the rehabilitation of congenital absence of teeth. However, it is important that a dental team consider performing minimally invasive treatments, as many of these treatments are done on young patients. Clinical Significance Patient‐centered treatments involving minimally invasive approaches in a multidisciplinary environment would be appropriate in order to achieve predictable results.

Dupuytren disease (DD) is a fibroproliferative disorder that originates at the palmar fascia and results in flexion contracture of the digits. The gold standard treatment for DD has been surgery. Surgical treatment of DD can be done with various methods, from percutaneous needle fasciotomy to dermatofasciectomy. The most commonly used surgical treatment is limited fasciectomy (LF). The potential complications of limited fasciectomy include long recovery time, scarring, neurovascular injury, and tendon injury. Minimally invasive treatment for DD, which is simple and allows for rapid return of function, has gained popularity amongst both patients and surgeons. Currently, minimally invasive treatments for DD include percutaneous needle fasciotomy (PNF) and collagenase clostridium histolyticum (CCH). In this review, we provide an overview of the minimally invasive treatments for Dupuytren disease and summarize the current evidence regarding these minimally invasive treatments.

Tooth whitening can be considered as one of the simplest, quickest and minimally invasive treatments for the aesthetic improvement of darkened teeth, in addition to presenting a low cost when compared to other restorative aesthetic alternatives...

OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.

In the last few years, image-guided minimally invasive treatments are been introduced in the treatment guidelines for thyroid benign nodules in order to spare thyroidectomy. Different ablative techniques are available. In this chapter, an overview of the different available ablative techniques will be provided, with a particular focus on indications to treatment and clinical results.

Pre-eruptive enamel lesions occur during tooth formation and include fluorosis, traumatic hypomineralization, and molar incisor hypomineralization. Minimally invasive treatment approaches, such as microabrasion, should be considered for these cases. This article presents a case series of three patients with pre-eruptive enamel defects in esthetically compromised tooth regions which were treated with the microabrasion technique: two fluorosis cases, moderate and advanced, and one hypomineralization case of traumatic etiology. In Cases 1 and 3, there was a significant improvement in esthetics with a total resolution of the enamel defects. However, a slight yellowish coloration may be detected at close observation. In Case 2 (advanced fluorosis), although there was no full resolution of the white spots, there was a clear improvement in esthetics. Microabrasion is a safe and effective, minimally invasive treatment for pre-eruptive enamel lesions. It does not require local anesthesia, it is less destructive than restorative interventions, and allows good esthetic outcomes with no significant postoperative sensitivity. Its efficacy is directly related to the lesions’ severity and depth. Although there are some limitations, further improvement can be achieved with dental bleaching. More invasive treatments might be considered if results are still unsatisfactory.

The cervical region has layers that consist of the skin, the subcutaneous or fat layer, and the superficial and deep fascia covering muscles and visceral structures (Fig. 7.1). Understanding the fascial layer and compartments is critical in a clinical setting since infectious and inflammatory spreading can be caused by invasive treatments.

Cardiovascular diseases (CVDs) are the leading cause of death globally, taking an estimated 17.9 million lives each year, representing one third of global mortality. As existing therapies still have limited success, due to the inability to control the biodistribution of the currently approved drugs, the quality of life of these patients is modest. The advent of nanomedicine has brought new insights in innovative treatment strategies. For this reason, several novel nanotechnologies have been developed for both targeted and prolonged delivery of therapeutics to the cardiovascular system tο minimize side effects. In this regard, nanoparticles made of natural and/or synthetic nanomaterials, like liposomes, polymers or inorganic materials, are emerging alternatives for the encapsulation of already approved drugs to control their delivery in a targeted way. Therefore, nanomedicine has attracted the attention of the scientific community as a potential platform to deliver therapeutics to the injured heart. In this review, we discuss the current types of biomaterials that have been investigated as potential therapeutic interventions for CVDs as they open up a host of possibilities for more targeted and effective therapies, as well as minimally invasive treatments.

Background The two available interventional treatment of patients with hypertrophic obstructive cardiomyopathy aresurgical myectomy (SM) and Alcohol septal ablation (ASA). The aim of this meta-analysis was to assess the efficacity of these two invasive strategies in relieving symptoms and left ventricular outflow tract obstruction (LVOTO). Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until February 2020 for RCTs and cohorts comparing clinical outcomes with alcohol septal ablation (ASA) vs surgical myectomy (SM) in patients with HCM. The endpoints were relieving symptoms, reduced left ventricular outflow tract obstruction (LVOTO) and the need for reintervention. Results We included 20 studies (n=4547; 3 RCTs and 17 cohorts) comparing ASA vs MS for a mean follow-up 5.2±2.1 year. Baseline mean LVOT gradient was not different between the ASA and the MS patient groups with weighted mean difference (WMD) = 1.50 [−3.47 to 6.46, p=0.56]. During follow-up, SM patients showed greater reduction in the LVOT gradient compared to ASA WMD = −9.61 [CI, 4.71 to 14.50, p=0.0001]. In addition, SM group had greater resolution of clinical symptoms compared to ASA (NYHA class III/IV, 17% vs. 6.2% R: 2.76, CI, 1.64 to 4.64, p Conclusion Compared with alcohol septal ablation, septal myectomy treatment of hypertrophic obstructive cardiomyopathy is associated with greater resolution of clinical symptoms and less need for reintervention. Funding Acknowledgement Type of funding source: None

The Endodontic world is often flooded with new productsand protocols, generally with a strong commercial appeal,ensuring improvements in the outcomes of root canal treatment.These new techniques have often been labeled as being lessinvasive or more biology-reliant and have been indicated toreplace scientifically and clinically supported therapies. The mostrecent and widely discussed examples in the endodontic scenarioare the minimally invasive treatments (especially minimallyinvasive endodontic access cavities), the so-called “natural”disinfection therapies such as ozone therapy, and new “biologicalmiraculous” root canal sealers. The Endodontic world is often flooded with new products and protocols, generally with a strong commercial appeal, ensuring improvements in the outcomes of root canal treatment. These new techniques have often been labeled as being less invasive or more biology-reliant and have been indicated to replace scientifically and clinically supported therapies. The most recent and widely discussed examples in the endodontic scenario are the minimally invasive treatments (especially minimally invasive endodontic access cavities), the so-called “natural” disinfection therapies such as ozone therapy, and new “biological miraculous” root canal sealers.

Pectus Excavatum (PE) is a congenital anomaly of the ribcage, at the level of the sterno-costal plane, which consists of an inward angle of the sternum, in the direction of the spine. PE is the most common of all thoracic malformations, with an incidence of 1 in 300-400 people. To monitor the progress of the pathology, severity indices, or thoracic indices, have been used over the years. Among these indices, recent studies focus on the calculation of optical measures, calculated on the optical scan of the patient's chest, which can be very accurate without exposing the patient to invasive treatments such as CT scans. In this work, data from a sample of PE patients and corresponding doctors' severity assessments have been collected and used to create a decision tool to automatically assign a severity value to the patient. The idea is to provide the physician with an objective and easy to use measuring instrument that can be exploited in an outpatient clinic context. Among several classification tools, a Probabilistic Neural Network was chosen for this task for its simple structure and learning mode.

Scars vary from mature linear scars to abnormal excessive scars such as hypertrophic scars and keloid scars. Keloid scars are fibro-proliferative disease entities that reflect an abnormal process of wound healing. They can cause pain, itching, stiffness, and psychological distress, all of which can affect quality of life. Various treatment options have been advocated as ways to prevent and treat keloid scars. These include noninvasive treatments such as use of silicone gel sheeting and compression therapy, and invasive treatments such as intralesional corticosteroid injections, surgery, and radiotherapy. Novel treatments include chemotherapy, immunotherapy, and anti-inflammatory therapies. Unfortunately, keloids continue to pose a significant challenge due to the lack of efficacious treatments. Therefore, clinicians should be familiar with various therapeutic options and apply the most suitable treatment plan for patients. In this review, we introduce the current therapeutic options for the management of keloid scars.

Objective: This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications after newer minimally invasive surgical therapy (MIST) of Aquablatio...

Reporters have been widely used to visualize gene expression, protein localization, and other cellular activities, but the commonly used reporters require special equipment, expensive chemicals, or invasive treatments. Here, we construct a new reporter RUBY that converts tyrosine to vividly red betalain, which is clearly visible to naked eyes without the need of using special equipment or chemical treatments. We show that RUBY can be used to noninvasively monitor gene expression in plants. Furthermore, we show that RUBY is an effective selection marker for transformation events in both rice and Arabidopsis. The new reporter will be especially useful for monitoring cellular activities in large crop plants such as a fruit tree under field conditions and for observing transformation and gene expression in tissue culture under sterile conditions.

Chronic foot pain constitutes a large portion of the chronic pain burden in the overall population. Plantar fasciitis is one of the most common and most easily identifiable causes of chronic foot pain. The syndrome has been estimated to cause 11 to 15% of foot pain visits, requiring professional care. Moreover, studies have suggested that 1 in 10 people will develop plantar fasciitis at some point in their life. Conservative management has been shown to be effective and considered first-line treatment. Minimally invasive treatment options are typically reserved for those who fail conservative management. With the advent of new techniques and improvements in current therapeutic options, there has been an expansion of available minimally invasive treatment options. The purpose of this review is to provide a comprehensive update on the current understanding of minimally invasive treatments of plantar fasciitis. This review shows that conservative management continues to be the first-line therapy, whereas other treatment options were those who failed conservative management using modern techniques that have shown improving effectiveness, with successful restoration of patient functionality, recovery, and satisfaction. However, a multitude of these minimally invasive treatment options are evolving. While conservative management continues to be the mainstay of treatment for plantar fasciitis, multiple minimally invasive treatment options are emerging with potential effectiveness in reducing pain and improving the function.

The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other (“kissing implants”) are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.