Raul Valencia Alvarado

Background: Thyroidectomy is a cornerstone treatment for thyroid pathologies but carries risks including recurrent laryngeal nerve injury, hypoparathyroidism, and cervical haematomas. Non-thermal plasma (NTP) may improve local haemostasis and tissue healing, although its safety within the cervical neurovascular axis requires human validation. Methods: This prospective, interventional, single-arm pilot study evaluated the feasibility, reproducibility and early postoperative safety of integrating atmospheric-pressure NTP (0.5 W/cm²) into the standard thyroidectomy workflow in 30 patients. Safety endpoints included the absence of thermal injury, neurovascular complications, or surgical-site morbidity. We assessed healing and aesthetic outcomes using the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS). Results: NTP integration achieved 100% technical feasibility, without reactor failures, gas-delivery interruptions, or thermal anomalies. No major acute complications occurred, including obstructive haematomas, recurrent laryngeal nerve injuries, or severe postoperative hypocalcaemia (0/30; 0.0%). Early incisional assessments showed favourable scores (median VSS: 1.2, IQR: 1.0–2.0; median POSAS overall opinion: 1.1, IQR: 1.0–1.5), reported descriptively at the 14-day postoperative milestone. Intraoperative biophysical evaluations and postoperative clinical tracking revealed no overt thermal anomalies or deep structural alterations, supporting high biological safety. Conclusions: Integration of NTP into the endocrine neck surgery workflow demonstrates technical feasibility, logistical efficiency, and a favourable early postoperative safety profile. The intervention is associated with a favourable early incisional healing profile without compromising adjacent vital structures. These preliminary findings support NTP as a reproducible, reliable surgical adjunct and provide a robust clinical and methodological basis for endocrine surgical practice.

The antimicrobial resistance crisis necessitates innovative systems for delivering oxidising agents. This study reports the development of a Carbopol^® 940 hydrogel functionalised with plasma-activated water (PAW) for the stabilisation and controlled release of reactive oxygen species (ROS). PAW was synthesised using a dielectric barrier discharge (DBD) reactor with continuous flow of water. The hydrogel’s architecture was characterised via SEM and FTIR, revealing a self-organised nanoporous structure (~1433 nm) that acts as a chemical reservoir. This architecture resulted in 100% retention of O₃ and H₂O₂ for 90 min, significantly extending the biological activity window compared with liquid PAW, and maintaining therapeutic concentrations (3 ppm of H₂O₂) beyond 45 h. In vitro antibacterial potency against Escherichia coli was validated, yielding a clear 25 mm inhibition zone. Subsequently, a clinical proof-of-concept was conducted in a patient with a recalcitrant Wagner Grade 2 diabetic foot ulcer (DFU). The hydrogel as monotherapy—without systemic antibiotics—achieved complete infection remission and full wound closure within 60 days. While this n = 1 case demonstrates translational feasibility, further validation through an ongoing controlled clinical trial is required. In conclusion, the PAW–Carbopol^® 940 hydrogel is a disruptive, low-cost therapeutic platform that effectively eradicates infection and promotes tissue repair through oxidative eustress, positioning it as a sustainable alternative for the advanced management of complex chronic wounds and regenerative medicine.

Background/Objectives: Recurrent oral ulcers (ROUs) are a common condition that significantly impacts patients’ quality of life. This pilot study was conducted to evaluate the feasibility and preliminary results of using non-thermal plasma (NTP) compared to low-level laser therapy (LLLT) and placebo to treat these ulcers. Methods: A prospective, controlled, randomised, parallel-group pilot study was conducted using a convenience sample of 50 patients with ROUs. Patients were randomly assigned (2:2:1) to one of three groups: NTP (n = 20), LLLT (n = 20), and placebo (n = 10). Feasibility and preliminary data acquisition were the primary goals. Exploratory outcomes included ulcer size reduction and safety profile. This was a single-blinded trial, where participants and outcome assessors were masked to group assignment. Ulcer size, pain perception, and time to complete healing were measured. For statistical analysis, ANOVA was used, with a p-value ≤ 0.05. Results: The groups were comparable at baseline. Exploratory results suggest that NTP demonstrated a promising trend in accelerating healing, with a mean healing time difference of 5.5 days compared to LLLT (2.5 ± 1.9 days vs. 8.0 ± 4.3 days) and 7.1 days compared to placebo (2.5 ± 1.9 days vs. 9.6 ± 5.3 days) (p < 0.001). Regarding pain, NTP provided significant and sustained relief. Patients in the NTP group were asymptomatic on day 2, unlike the LLLT and placebo groups, where pain persisted significantly (NTP VAS score at 1 h: 1.1 ± 2.1 vs. LLLT/Placebo VAS score at 1 h: 3.4 ± 2.4 and 7.3 ± 1.9, respectively) (p < 0.001). NTP was well tolerated, and no adverse events were reported. Conclusions: This pilot study suggests that NTP is a potentially safe and effective therapy for recurrent oral ulcers. Preliminary results indicate that it may accelerate healing and offer superior pain relief, warranting a large-scale clinical trial to confirm these findings.

A flexible low-temperature plasma (LTP) source device was developed utilizing a radiofrequency (RF) generator coupled to a coaxial cable through a homemade L-shape matching network and a supple plastic hose that conveys a gas flow and shields the coaxial cable up to the reactors nozzle. The impedance matching network provides an electric power transfer of minimum of 94.11% operating under normal conditions. The LTP device arrangement is described, and later characterized via optical emission spectroscopy and electric power consumption. This procedure is essential to determine the adequate application of the generated plasma over heat-sensitive materials, primarily organic matter, to provide adequate information about its physicochemical activity. The produced LTP interacts with surrounding air particles, generating reactive oxygen and nitrogen species (RONS) that exhibit bactericidal and antiseptic properties due to their strong biochemical reactivity. The electromagnetic irradiation, ultraviolet (UV) emission, and thermal surface effect produced under normal working conditions of the LTP source device are safe to apply to heat-sensitive matter. The devices inactivation property was validated through qualitative deactivation trials of Escherichia coli and Enterococcus faecalis and quantitative deactivation trials of Escherichia coli. The device inactivated 99.996% of E. coli at a concentration of 3.6106 colony forming units per mL (CFU/mL) in 180 s at 16 W, this result corresponds to a 4.43-log10 reduction in E. coli viability.

The effective treatment of severe burns in pediatric patients is essential for minimizing complications and promoting optimal recovery. This study investigates the use of non-thermal atmospheric pressure plasma (NTAPP) as an adjuvant therapy in combination with Epifast^® for the experimental group, compared to standard care involving early excisions and Epifast^® for the control group. A randomized controlled trial was conducted with 40 pediatric patients suffering from superficial partial-thickness and deep dermal burns. The experimental group that received NTAPP daily demonstrated a significant reduction in the need for skin grafts, requiring only 10% compared to 40% in the control group (p = 0.02). Although there were no statistically significant differences in the length of hospital stay, the experimental group showed a trend toward shorter stays (9.85 days vs. 11.65 days; p = 0.38) and lower analgesic consumption (13.01 doses vs. 21.15 doses; p = 0.09). Additionally, the infection rate in the NTAPP-treated group was significantly lower at 25%, compared to 37.95% in the control group (p < 0.05). These findings suggest that NTAPP enhances wound healing while reducing surgical morbidity and the risk of infections. In conclusion, this study highlights the transformative potential of NTAPP as an innovative strategy in pediatric burn management. It combines clinical efficacy with a less invasive approach, representing a significant advance in regenerative medicine and opening new avenues for research into advanced therapies.

Anastomotic leaks remain a significant challenge in intestinal surgery, often leading to severe complications. This study investigated a novel approach to enhance anastomotic healing and reduce the risk of leaks by combining traditional suturing and stapling techniques with non-thermal atmospheric pressure plasma (NTAPP) application. NTAPP, a cold atmospheric plasma generated through the ionization of ambient air, has been shown to possess antimicrobial, hemostatic, and wound-healing properties. NTAPP promotes sterilization, coagulation, and tissue regeneration by generating reactive oxygen and nitrogen species, potentially strengthening anastomotic union. This pilot study evaluated the efficacy of NTAPP in three patients undergoing intestinal anastomosis. Following the standard surgical procedure, NTAPP was applied directly to the anastomotic site. Postoperative outcomes were monitored for six months, including anastomotic leaks and healing rates. Preliminary results demonstrated promising outcomes. All three patients exhibited successful sealing of the anastomosis, with no evidence of leakage during the follow-up period, providing reassurance and confidence in the potential of sutures, staples, and NTAPP. These findings suggest that NTAPP can significantly improve the safety and efficacy of intestinal surgeries by reducing the incidence of anastomotic leaks. While further research with a larger sample is necessary to confirm these initial findings, the results of this study provide a strong foundation for exploring the potential of NTAPP as a valuable adjunct to conventional surgical techniques for preventing anastomotic leaks. This innovative approach could reduce postoperative complications, improve patient outcomes, and enhance the overall quality of care in intestinal surgery.

Anal fistula, characterized by abnormal tracts between the perianal skin and the anal canal, presents challenges in treatment because of its diversity and complexity. This study investigates the use of non-thermal plasma as a postsurgical therapy for anal fistula, aiming to promote healing and tissue regeneration. A specialized plasma reactor was designed to apply non-thermal plasma within the anorectal cavity practically. Non-thermal plasma treatment was administered to 20 patients including 10 undergoing fistulectomies and 10 undergoing fistulotomies. The average duration of non-thermal plasma application in the operating room was shorter for fistulotomies. The pain reported the day after surgery was similar in both groups. Improvements in the number of evacuations starting from the day after surgery, as well as the assessment of stool quality using the Bristol scale, indicated satisfactory intestinal recovery. Fistulotomy patients exhibited faster wound healing times. These findings underscore the efficacy of non-thermal plasma as a postoperative therapy for anal fistula, enhancing healing and recovery outcomes without increasing complication risks.

(1) Background: This study aims to evaluate the efficacy and safety of non-thermal plasma (NTP) therapy in accelerating wound healing in patients who have undergone laparoscopic and open surgeries. (2) Methods: NTP was applied using a needle-type reactor with an irradiance of 0.5 W/cm² on the surgical wounds of fifty patients after obtaining informed consent. Three NTP treatments, each lasting three minutes, were administered hourly. (3) Results: The pilot study showed that NTP-treated surgical wounds healed completely without any signs of infection, dehiscence, pain, or itching. Notably, patients reported minimal pain after the NTP treatment. Visual assessments conducted twenty-four hours after surgery revealed no redness or fluid discharge. Comparisons with traditionally sutured wounds indicated that NTP-treated wounds healed at a rate equivalent to seven days. (4) Conclusions: The application of NTP in laparoscopic and open wounds proved safe and effective, expediting the wound healing process and eliminating clinical risks post-surgery. Significantly, NTP facilitated a healing rate within twenty-four hours, equivalent to seven days for suture-treated wounds, significantly reducing the hospitalization time to a single day. These findings highlight the potential of NTP to be a transformative approach for promoting postoperative recovery.

Non-thermal plasmas (NTPs), known as cold atmospheric plasmas (CAPs), hold great potential for diverse medical applications, including dentistry. However, traditional linear and rigid dielectric barrier discharge reactors used for NTP generation encounter limitations in accessing oral cavities and root canals. To address this issue, we have developed an innovative NTP reactor featuring an angled end for improved accessibility. The central copper electrode, with a 0.59 mm diameter and adjustable length for desired angulation, is coated with zircon powder (ZrSiO₄) to ensure stable NTP generation. This central electrode is housed within a stainless steel tube (3 mm internal diameter, 8 mm external diameter, and 100 mm length) with a 27° angle at one end, making it ergonomically suitable for oral applications. NTP generation involves polarizing the reactor electrodes with 13.56 MHz radio frequency signals, using helium gas as a working medium. We introduce plasma-treated water (PTW) as an adjunctive therapy to enhance biofilm eradication within root canals. A synergistic approach combining NTP and PTW is employed and compared to the gold standard (sodium hypochlorite, NaOCl), effectively neutralizing Enterococcus faecalis bacteria, even in scenarios involving biofilms. Moreover, applying NTP in both gaseous and liquid environments successfully achieves bacterial inactivation at varying treatment durations, demonstrating the device’s suitability for medical use in treating root canal biofilms. The proposed NTP reactor, characterized by its innovative design, offers a practical and specific approach to plasma treatment in dental applications. It holds promise in combatting bacterial infections in root canals and oral cavities.