Persius/hicric huggingface dataset:
Percutaneous venoplasty for chronic cerebrospinal venous insufficiency in multiple sclerosis

Evidence-based recommendations on percutaneous venoplasty for chronic cerebrospinal venous insufficiency in people with multiple sclerosis. This involves inserting an inflatable balloon into veins in the neck and chest in an attempt to widen them.

# Recommendations
Current evidence on percutaneous venoplasty for chronic cerebrospinal venous insufficiency in multiple sclerosis shows that there are serious complications and that it provides no benefit. Therefore, this procedure should not be used in the management of multiple sclerosis.# The condition, current treatments and procedure

# The condition
Multiple sclerosis is a disease of the central nervous system, which usually starts in early adult life. It is characterised by neurological symptoms caused by episodes of inflammation and scarring in the white matter of the brain or spinal cord. It causes a range of symptoms including problems with vision, arm or leg movement, sensation or balance. Muscle spasms, pain, fatigue, and emotional problems or depression may also occur. Symptoms may vary over time and some people become profoundly disabled. The 3 most common types of multiple sclerosis are: relapsingremitting, in which periods of good health or remission are followed by sudden onset of symptoms or relapses; secondary progressive, in which symptoms gradually worsen with fewer remissions; and primary progressive, which involves a gradual, continuous worsening of symptoms.

# Current treatments
Current treatment for multiple sclerosis includes specialist neurological rehabilitation, and medication aimed at symptom control and preventing disease progression (see NICE's guideline on multiple sclerosis in adults).

# The procedure
The aim of percutaneous venoplasty for chronic cerebrospinal venous insufficiency is to relieve multiple sclerosis symptoms by improving cerebrospinal venous drainage. However, the full mechanism of action is not currently understood.
Percutaneous needle puncture of the femoral vein is done under local anaesthesia and a vascular sheath inserted using a standard needle, guidewire and catheter technique. The guidewire is advanced into the superior vena cava under fluoroscopic control. Selective venography of veins, including but not limited to the internal jugular and azygos, is used to identify any abnormal luminal narrowing and collateral circuits. Intravascular ultrasound may also be used. Abnormally narrowed segments are dilated with a standard angioplasty balloon. Sometimes a stent is left in place after the angioplasty. Further venography or ultrasound, or both, are used to assess the outcome of the intervention before the guidewire and sheath are removed.
Bronchial thermoplasty for severe asthma

Evidence-based recommendations on bronchial thermoplasty for severe asthma in adults. This involves applying heat to the inside walls of the airways.

# Recommendations
Current evidence on the safety and efficacy of bronchial thermoplasty for severe asthma is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
The procedure should only be done by a multidisciplinary team in specialist centres with on-site access to intensive care. It should only be done by clinicians with training in the procedure and experience in managing severe asthma.
Clinicians should enter details of all patients who have the procedure onto the UK Severe Asthma Registry.
Further research should report details of patient selection and longterm safety and efficacy outcomes.# The condition, current treatments and procedure

# The condition
Asthma is a long-term condition of the airways in the lungs that affects children, young people and adults. It consists of inflammation and constriction of the smooth muscle in the airway walls (bronchoconstriction). This is triggered by increased responsiveness of the airways to various allergic stimuli, leading to airflow obstruction. Symptoms include recurring episodes of wheezing, breathlessness, chest-tightness and coughing.
Asthma is diagnosed and its severity assessed on the basis of symptoms and objective tests of lung function.

# Current treatments
Treatment, including advice about lifestyle changes, aims to reduce the frequency and severity of attacks, allowing the person to lead a normal and active life. In the UK, treatment for asthma follows NICE's guideline on asthma and guidelines from the Global Initiative for Asthma.

# The procedure
The aim of bronchial thermoplasty for severe asthma is to reduce the smooth muscle mass lining the airways, decreasing their ability to constrict.
The procedure is usually done using sedation or general anaesthesia. A catheter is introduced into the bronchial tree. Short pulses of radiofrequency energy are applied circumferentially to sequential portions of the airway wall, moving from the distal to the proximal bronchi. Treatment is usually delivered in 3 sessions with an interval of at least 3 weeks between each session. After the first session, treated airways are evaluated by bronchoscopy before proceeding with further treatment.
Transcranial MRI-guided focused ultrasound thalamotomy for neuropathic pain

Evidence-based recommendations on transcranial MRI-guided focused ultrasound thalamotomy for neuropathic pain in adults. This involves delivering focused ultrasound to a small part of the brain (in the thalamus) responsible for transmitting pain signals to destroy it.

# Recommendations
Current evidence on the safety of transcranial MRI-guided focused ultrasound thalamotomy for neuropathic pain shows there are serious safety concerns. There is very limited evidence of efficacy. Therefore, this procedure should not be used. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.# The condition, current treatments and procedure

# The condition
Neuropathic pain results from dysfunction of sensory nerves and pathways in the nervous system. It can occur in a heterogeneous group of disorders, including painful diabetic neuropathy, post-herpetic neuralgia and trigeminal neuralgia. People with neuropathic pain may have altered pain sensation, areas of numbness or burning, and continuous or intermittent evoked or spontaneous pain. Neuropathic pain is an unpleasant sensory and emotional experience that can have a significant effect on a person's quality of life.

# Current treatments
A range of different drugs are used to manage neuropathic pain, including antidepressants, anti-epileptic drugs, opioids, and topical treatments such as capsaicin and lidocaine (see NICE's clinical guideline on neuropathic pain in adults: pharmacological management in non-specialist settings). Neuropathic pain is often difficult to treat, because it can be refractory to many medications and because of the adverse effects associated with some drug treatments.
For neuropathic pain that is refractory to drug treatment, other options include percutaneous electrical nerve stimulation, spinal cord stimulation and deep brain stimulation.

# The procedure
Transcranial MRI-guided focused ultrasound thalamotomy for neuropathic pain is done with the patient lying supine inside an MRI scanner. The patient's head is shaved and a stereotactic head frame is attached. Patients are awake so they can report any improvement or adverse events to the operator during the procedure. However, they may be offered light sedation. Continuous MRI and thermal mapping are used to identify the target area of the brain and monitor treatment. Low-power ultrasound is delivered to confirm the chosen location. Then, high-power focused ultrasound pulses are administered to irreversibly ablate the target tissue. Chilled water is circulated around the outside of the head during the treatment to prevent thermal damage to the scalp caused by the increase in bone temperature. The procedure takes about 3 hours and pain relief should occur within a day of the procedure.
Superior rectal artery embolisation for haemorrhoids

Evidence-based recommendations on superior rectal artery embolisation for haemorrhoids in adults. This involves blocking the blood vessels supplying the haemorrhoids with tiny plastic particles or metal coils.

# Recommendations
Current evidence on the safety and efficacy of superior rectal artery embolisation for haemorrhoids is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should report details of patient selection, and followup efficacy (including symptom relief), need for subsequent treatments, quality of life and safety outcomes for at least 1 year.# The condition, current treatments and procedure

# The condition
Haemorrhoids occur when the vascular anal cushions become enlarged. Some patients may be asymptomatic but others have symptoms of bleeding, itching or discomfort. Goligher's classification is commonly used to grade haemorrhoids from I to IV. Small symptomatic haemorrhoids are classified as grade I and they do not prolapse. Larger haemorrhoids may prolapse out of the anus. Prolapsed haemorrhoids may reduce spontaneously after defaecation (grade II), may need to be reduced digitally (grade III), or they may not be reducible and remain prolapsed (grade IV).

# Current treatments
Grade I and II haemorrhoids may be managed by changes in diet or using laxatives, or treated by topical applications (such as corticosteroid creams or local anaesthetics). Established interventional treatments include rubber band ligation, sclerosant injections, infrared coagulation or electrocoagulation.
Established treatments for symptomatic grade III and IV haemorrhoids include haemorrhoidectomy, stapled haemorrhoidopexy, haemorrhoidal artery ligation and electrocoagulation.

# The procedure
Superior rectal artery embolisation for haemorrhoids is done under local anaesthesia. A catheter is passed into the inferior mesenteric artery through an introducer sheath in a large artery (usually the femoral artery). A microcatheter is then passed into the superior rectal arteries using Xray fluoroscopy to confirm correct placement and to identify the branches of the superior rectal artery. Small coils (about 2 mm to 3 mm in diameter) or particles are placed into the most distal branches of the superior rectal arteries, to occlude the blood supply to the haemorrhoids.
The aim is to occlude permanently the branches that feed the haemorrhoidal plexuses and relieve the symptoms associated with haemorrhoids, such as pain and bleeding.
Low-intensity pulsed ultrasound to promote healing of fresh fractures at low risk of non-healing

Evidence-based recommendations on low-intensity pulsed ultrasound to promote healing of fresh fractures at low risk of non-healing in adults. This involves using an ultrasound probe on the skin at the site of the fracture.

# Recommendations
The evidence for low-intensity pulsed ultrasound to promote healing of fresh fractures at low risk of non-healing raises no major safety concerns. However, current evidence does not show efficacy. Therefore, this procedure should not be used for this indication. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.# The condition, current treatments and procedure

# The condition
Fractures are a common result of trauma, and are usually described as either closed (skin over the fracture site is intact) or open (involves an open wound). They may vary in complexity from a single break (transverse or oblique) to comminuted, in which the bone has broken into several pieces.

# Current treatments
Fractures usually heal within a few weeks after treatment by closed or open reduction, and immobilisation using a cast or internal fixation. Sometimes, healing may be delayed or not happen at all (non-union). There is no agreed precise definition of a fracture non-union but, typically, it is considered to be when bony union has failed 6 to 9 months after the fracture. Risk factors for non-union of fractures include: systemic medical conditions (for example, diabetes, malnutrition, osteoporosis); smoking; use of non-steroidal anti-inflammatory drugs; local factors such as infection; vascular problems; magnitude of injury (for example, fracture location and gap, traumatic fractures); advanced age; and other iatrogenic factors. Treatment of non-union may need complex and prolonged management with implications for the patient's quality of life and functional capacity.

# The procedure
The aim of low-intensity pulsed ultrasound is to reduce fracture healing time and avoid non-union by delivering micro-mechanical stress to the bone to stimulate bone healing.
An ultrasound probe is positioned on the skin over the fracture and patients self-administer low-intensity pulsed ultrasound daily, usually for 20 minutes. If a patient's limb is immobilised in a cast, a hole is cut into the cast for the ultrasound probe. The probe delivers acoustic radiation and coupling gel is used on the skin to aid conduction of the ultrasound signal. An operating frequency of 1.5 MHz, pulse width of 200 microseconds, repetition rate of 1 kHz, and a temporal average power of 30 milliwatts/cm2 is typically used. The exact treatment protocol and duration of treatment may vary.
Progress towards fracture healing is usually assessed radiographically. Treatment duration ranges from a few weeks to several months.
Low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing

Evidence-based recommendations on low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing in adults. This involves using an ultrasound probe on the skin at the site of the fracture.

# Recommendations
The evidence for low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing raises no major safety concerns. The current evidence on efficacy is very limited in quantity and quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.# The condition, current treatments and procedure

# The condition
Fractures are a common result of trauma, and are usually described as either closed (skin over the fracture site is intact) or open (involves an open wound). They may vary in complexity from a single break (transverse or oblique) to comminuted, in which the bone has broken into several pieces.

# Current treatments
Fractures usually heal within a few weeks after treatment by closed or open reduction, and immobilisation using a cast or internal fixation. Sometimes, healing may be delayed or not happen at all (non-union). There is no agreed precise definition of a fracture non-union but, typically, it is considered to be when there is failure of bony union 6 to 9 months after the fracture. Risk factors for non-union of fractures include: systemic medical conditions (for example, diabetes, malnutrition, osteoporosis); smoking; use of non-steroidal anti-inflammatory drugs; local factors such as infection; vascular problems; magnitude of injury (for example, fracture location and gap, traumatic fractures); advanced age; and other iatrogenic factors. Treatment of non-union may need complex and prolonged management with implications for the patient's quality of life and functional capacity.

# The procedure
The aim of low-intensity pulsed ultrasound is to reduce fracture healing time and avoid non-union by delivering micro-mechanical stress to the bone to stimulate bone healing.
An ultrasound probe is positioned on the skin over the fracture and patients self-administer low-intensity pulsed ultrasound daily, usually for 20 minutes. If a patient's limb is immobilised in a cast, a hole is cut into the cast for the ultrasound probe. The probe delivers acoustic radiation and coupling gel is used on the skin to aid conduction of the ultrasound signal. An operating frequency of 1.5 MHz, pulse width of 200 microseconds, repetition rate of 1 kHz, and a temporal average power of 30 milliwatts/cm2 is typically used. The exact treatment protocol and duration of treatment may vary.
Progress towards fracture healing is usually assessed radiographically. Treatment duration ranges from a few weeks to several months.
Superior capsular augmentation for massive rotator cuff tears

Evidence-based recommendations on superior capsular augmentation for massive rotator cuff tears in adults. This involves using a graft to stabilise the shoulder joint, reduce pain and improve shoulder function.

# Recommendations
Current evidence on the safety and efficacy of superior capsular augmentation for massive rotator cuff tears is limited in quantity and inadequate in quality. Therefore, this procedure should only be used in the context of research. Find out what only in research means on the NICE interventional procedures guidance page.
Research should address patient selection, type of graft and technique used, long-term outcomes including shoulder function, and patient-reported outcome measures.# The condition, current treatments and procedure

# The condition
Patients with rotator cuff tears may have shoulder pain and weakness accompanied by functional limitation leading to a reduced quality of life. Rotator cuff tears can be caused by an injury or can develop gradually. They can be minor or severe depending on the degree of damage to the tendon. Minor tears to the rotator cuff are very common and may not cause any symptoms at all. Diagnosis is usually by ultrasound or MRI.

# Current treatments
Conservative treatment may include physiotherapy, pharmacological treatments (including pain relief and topical or oral non-steroidal anti-inflammatory drugs) and corticosteroid injections. If the tear is severe or has not responded to other treatments, surgical interventions such as debridement, rotator cuff repair, bridging rotator cuff reconstruction, subacromial smoothing, tendon transfer, or shoulder arthroplasty may be needed.

# The procedure
Superior capsular augmentation aims to improve pain symptoms and shoulder function in patients with massive and otherwise irreparable rotator cuff tears. The intention is to reduce superior gleno-humeral translation and restore superior stability with minimal re-tear rates. The optimal repair uses the patient's own rotator cuff muscles and tendons, but if the tear is too large augmentation with other tissue may be needed.
Superior capsular augmentation is done arthroscopically or by open surgery, with the patient either in the lateral decubitus position, or the 'beach-chair' position, and under general anaesthesia. It involves using a fascia lata autograft, an allograft or a regenerative tissue matrix. The arm of the patient is kept in neutral abduction and in neutral rotation. The supraspinatus and infraspinatus are repaired as much as possible and a biceps tenotomy or tendonesis are done on any biceps tear or instability. The superior glenoid and greater tuberosity are debrided to prepare for reconstruction. Using suture anchors, the graft is attached medially to the glenoid superior tubercle and laterally to the greater tuberosity. Side-to-side sutures between the graft and the infraspinatus tendon, as well as between the graft and the residual anterior supraspinatus or subscapularis may also be added to improve force coupling. Post-operative rehabilitation is essential and can be long and difficult.
Transaxial interbody lumbosacral fusion for severe chronic low back pain

Evidence-based recommendations on transaxial interbody lumbosacral fusion for low back pain in adults. This involves removing a damaged disc through a small cut at the base of the spine, and replacing it with an artificial implant.

# Recommendations
Evidence on the safety of transaxial interbody lumbosacral fusion for severe chronic low back pain shows that there are serious but well-recognised complications. Evidence on efficacy is adequate in quality and quantity. Therefore, this procedure may be used provided that standard arrangements are in place for clinical governance, consent and audit. Find out what standard arrangements mean on the NICE interventional procedures guidance page.
This procedure should only be done by a surgeon with specific training in the procedure, who should carry out their initial procedures with an experienced mentor.
Clinicians should enter data onto the British Spine Registry.# The condition, current treatments and procedure

# The condition
Chronic low back pain may result from degenerative changes in the intervertebral discs or spinal facet joints.

# Current treatments
Conservative treatments include pain relief, non steroidal anti-inflammatory medication and manual therapy (see NICE's guideline on low back pain and sciatica). For people with severe, lifestyle-limiting, chronic low back pain that does not respond to conservative treatments, surgery may be appropriate. This may include bony fusion of vertebrae (to immobilise segments of the vertebral column thought to be responsible for back pain, using either a posterior or anterior approach) or inserting a prosthetic intervertebral disc (which preserves lumbar mobility to reduce the risk of degenerative changes in adjacent intervertebral disc spaces). Other surgical alternatives include nonrigid stabilisation techniques.

# The procedure
Transaxial interbody lumbosacral fusion is done with the patient under general anaesthesia. A small incision is made lateral to the coccyx and a guide-pin introducer is inserted under fluoroscopic guidance. Air insufflation may be used to improve visualisation of the rectum during fluoroscopy. The guide-pin introducer is advanced over the sacrum's midline anterior surface towards the L5S1 space. A reamer is then passed over the guidewire to the endplate of S1. As with conventional spinal fusion, the disc is removed through the canal created by the reamer. A mixture typically consisting of commercially available bone graft material, patient's own bone extracted from the surgical site and blood is prepared in the operating theatre and injected into the disc space. A special rod is screwed between the L5 and S1 vertebrae along the canal created by the reamer to maintain segmental height and alignment. Using a posterior approach, pedicle or facet joint screws may be used to provide extra stabilisation.
The potential benefits of the transaxial approach include faster recovery and less postoperative morbidity compared with conventional spinal fusion surgery.