Various Aetiologies of Non-Traumatic Coccydynia Cause Pain in the Posterior Sacrococcygeal Leg of the Pelvic Tripod: A Burden on the Healthcare Sector

Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the errors of the unevacuated rectum, non-dynamic standing views, improper X-ray exposure and refuge by insurance companies to approve the much needed but multiple views in radiological investigation (Stress X-ray), MRI scan, lack of awareness by the clinician, all lead to missed diagnosis with its repercussions as congenital variations in morphology, acquired changes in structure/mobility, pathologies like tumours like congenital teratoma & adult onset chordoma, Tarlov cysts, pilonidal sinus or infections—even tuberculosis, dural syndrome, stiff coccyx due to ankylosing spondylitis and many others like relation to neurosis have all been documented. Treatment options are outside the scope of this research topic, as only the differential diagnosis is being stressed here, so that the clinician and the patient do not overlook the varying aetiology, which is the first step to timely and appropriate treatment. Conclusion: Level 3 evidence is available pointing towards many aetiologies causing non-traumatic coccydynia, and in this study of 100 patients by Krushi O W S, a non-profit organisation, the results were as follows: 1) Coccydynia is more common in Type II coccyx and bony spicules. 2) Coccydynia is more prevalent when the sacrococcygeal joints are not fused. 3) Coccydynia is more prevalent when there is subluxation at the intercoccygeal joints. 4) Coccydynia is more when the sacral angle is lower. 5) Coccydynia is associated with higher sacrococcygeal curved length. 6) Coccydynia is associated with a lower sacrococcygeal curvature index. 7) Gender variations: The coccygeal curvature index was lower in females with coccydynia;the intercoccygeal angle was lower in males. 8) Both obese and thin individuals can get affected due to different weight-bearing mechanics in play.

Induced pluripotent stem cell-related approaches to generate dopaminergic neurons for Parkinson's disease

The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.

Enhancing perianal disease management with integrated physical and psychological approaches

This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

Chyle leak following root of mesentery dissection in pancreaticoduodenectomy with inferior infracolic superior mesenteric artery first approach

BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.

Etiology of non-traumatic acute abdomen in pediatric emergency departments

Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, HenochSchnlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt

BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system.They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality.Hence,early treatment of these patients is vital and increases the likelihood of a good outcome.AIM To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital.METHODS This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness(DLOC)at the Emergency Department.RESULTS The mean age of the studied patients was 60.5±13.6 years.Among them,60%were males and 40%were females.The most common cause of acute non-traumatic DLOC was systemic infection,such as sepsis and septic shock(25.3%),followed by respiratory causes(24.1%)and neurological causes(18.4%).CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.

A FLEXIBLE OBJECTIVE-CONSTRAINT APPROACH AND A NEW ALGORITHM FOR CONSTRUCTING THE PARETO FRONT OF MULTIOBJECTIVE OPTIMIZATION PROBLEMS

In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.

Epidemiological, Clinical and Etiological Aspects of Non-Traumatic Comas in Children at the Pediatric Teaching Hospital in Bangui

Background: Non-traumatic coma is the most common pediatric medical emergency. Its clinical diagnosis is easy. The difficulty lies in finding the etiology. Objective: To determine the prevalence and clinical profiles of non-traumatic Coma at the Centre Hospitalier Universitaire Pédiatrique de Bangui (CHUPB). Methodology: This was a descriptive and analytical cross-sectional study conducted between January 1 and June 31, 2021, at CHUPB. Children aged 1 month to 15 years, admitted to the emergency room with a Glasgow score less than or equal to 8 without any traumatism were included. The variables studied were sociodemographic, clinical and paraclinical. Data were entered and analyzed using SPSS 20.0 statistical software. The statistical test used was Pearson’s chi2, any p-value Results: Of 8551 children hospitalized during the study period, 370 were hospitalized for non-traumatic coma: 4.32%. They were divided into 57.5% (n = 213) boys and 42.44% (n = 157) girls, giving a sex ratio of 1.35. Their mean age was 35.95 ± 27.21 months. Children aged 1 to 24 months represented 54.59% (n = 202) of cases. The mean time to the consultation was 2.91 days ± 1.8. Fever 86.48% (n = 320) and convulsions 80% (n = 296) were the main reasons for consultation. Coma stages II - III and IV represented 52.44% (n = 194), 42.97% (n = 159) and 4.59% (n = 17) respectively. Neuromalaria (29.72%;n = 110), meningitis-meningoencephalitis-encephalitis (30%;n = 111), sepsis (19.72%;n = 73) and acidosis Coma (5.40%;n = 20) were the main etiologies. Conclusion: Non-traumatic coma is common at CHUPB. Infections were the main etiology, particularly cerebral malaria. The reduction of its frequency requires, among others, the strengthening of the national monitoring malaria program. The strengthening of the technical platform for a good etiological diagnosis constitutes the other axis of prevention.

Epidemiological and Diagnostic Features of Non-Traumatic Gonalgia in Adults in Bouake (Ivory Coast): About 140 Patients

Background: Non traumatic gonalgia is the second most common reason for rheumatology consultations and accounted for 15.6% of rheumatological disorders in Abidjan. Objective: The aim of this work was to study the epidemiological and diagnostic features of non-traumatic gonalgia (NTG) in a black adult population from sub-Saharan Africa. Patients and Methods: This was a five-year retrospective descriptive study (January 2014 to December 2018) of black sub-Saharan African adult patients with non traumatic gonalgia seen in the rheumatology department of the Bouake University Hospital in Côte d’Ivoire. Results: Of 2198 patients seen for rheumatological conditions, 140 had non traumatic gonalgia (6.4%). The mean age of patients was 56.13 ± 13.3 years (extremes 20 and 87 years), and the sex ratio was 0.43 (42 men and 98 women). Gonalgia without swelling was observed in 33.6% of cases. Symptoms were predominantly progressive (97.1%), chronic (82.1%) and bilateral (50%). The causes of TNM were gonarthrosis (85%), septic arthritis (7.1%), reactive arthritis (2.9%), gout (2.9%), rheumatoid arthritis (1.4%) and chondrocalcinosis (0.7%). Gonarthrosis (119/140) was bilateral in 65 patients, bi- or tri-compartmental in 83, radiographic stage (Kellgren and Lawrence) III in 80 and IV in 15. A germ was isolated in two cases of septic arthritis (methicillin-sensitive Staphylococcus aureus and Streptococcus pneumoniae). Conclusion: GNT is common in rheumatology practice in Bouake, and mainly affects women in their fifties. It is most often a chronic bilateral gonalgia, with gonarthrosis as the main etiology.

Effect of Tongluo Shenggu Prescription on ARCO Stage Ⅱ non-traumatic femoral head necrosis: A prospective study

Objective:To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.To observe the clinical results and therapeutic characteristics of Tongluo Shenggu Decoction in the treatment of ARCOⅡnon-traumatic femoral head necrosis.Methods:120 patients with ARCOⅡnon-traumatic femoral head necrosis from January 2016 to January 2017 were studied by prospective matched and controlled design.60 cases in the treatment group were treated with Tongluo Shenggu Formula.The control group(60 cases)received high energy extracorporeal shock wave therapy.The imaging stability rate,Harris score and SF-36 score were used as clinical efficacy indicators,followed up for 24 months,and the follow-up results were statistically analyzed.Results:Among the 120 patients,5 fell off and the rest were followed up.The imaging stability rate is heavy.The imaging stability rate of the patients in the treatment group is 78.95%,while that in the control group is 72.41%.The two groups have the same stability rate(P>0.05).In Harris score,the Harris score of the patients in the treatment group was 92.678.45 points,significantly higher than that of the control group(80.3924.65 points),the difference was statistically significant(p<0.05),and the pain degree,joint function and joint deformity score of the treatment group were better than those of the control group(p<0.05).In the SF-36 score,the scores of physiological function,physiological function,physical pain,overall health,social function and emotional function in the treatment group were significantly higher than those in the control group,the difference was statistically significant(p<0.05).the incidence of adverse events in the treatment period of the two groups was lower and the patients could relieve themselves in the later stage.Conclusion:Tongluo Shenggu prescription has definite curative effect in treating ARCOⅡnon-traumatic femoral head necrosis,especially in improving hip joint function,relieving hip joint pain and improving quality of life.

Potential impact of early physiotherapy in the emergency department for non-traumatic neck and back pain

BACKGROUND: Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department(ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment(EPET) vs. standard care(SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain.METHODS: A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index(NDI), Modifi ed Oswestry Low Back Pain Disability Questionnaire(MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit.RESULTS: We identifi ed a total of 125 patients. EPET group comprised 62 patients(mean age, 45 years; men, 63%) and SC group comprised 63 patients(mean age, 45 years; men, 43%). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their fi rst ED visit. EPET patients had signifi cantly lower levels of disability(9.0% vs. 33.4%, Welch t-test, P<0.001) and pain(median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients.CONCLUSION: Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefi t from it.

Ten Years of Epidemiological and Diagnostic Aspects of Non-Traumatic Anterior Uveitis at Campus Teaching Hospital of Lome-Togo

Background: Uveitis is a serious disease which dangerous complications can jeopardize the visual prognosis. Anterior uveitis (AU) is the inflammation of the anterior uvea which is composed of the iris and the ciliary body. The objective of the study was to identify the epidemiological and etiological determinants of non-traumatic anterior uveitis at the Campus Teaching Hospital of Lomé. Materials and methods: Retrospective cross-sectional study of the records of patients diagnosed with anterior uveitis (AU) without a notion of trauma in the ophthalmology department of CHU Campus of Lomé from January 1, 2010 to December 31, 2019 (10 years). Results: 141 cases of uveitis, representing a prevalence of 0.18%. Female predominance, with a sex ratio of 0.76. Mean age was 34.74 ± 13.20 years. Decreased visual acuity was the primary complaint (34.40%), followed by ocular pain (28%). Non-traumatic anterior uveitis was unilateral in 87.2% of cases. Retro-corneal precipitates were present in all patients. 61.60% of patients had Tyndall in the anterior chamber. The etiology of non-traumatic AU was undetermined in 76.80% of cases. Toxoplasmosis, tuberculosis and syphilis were the main etiologies found. Conclusion: Non-traumatic anterior uveitis is relatively rare but serious, often affecting young subjects. It is a pathology that engages eye health professionals, not only because of the difficulties involved in diagnosing the etiology, but also because of its progression which sometimes leads to blindness.

Exploring an eco-friendly approach to improve soil tensile behavior and cracking resistance

Soil tensile strength is a critical parameter governing the initiation and propagation of tensile cracking.This study proposes an eco-friendly approach to improve the tensile behavior and crack resistance of clayey soils.To validate the feasibility and efficacy of the proposed approach,direct tensile tests were employed to determine the tensile strength of the compacted soil with different W-OH treatment concentrations and water contents.Desiccation tests were also performed to evaluate the effectiveness of W-OH treatment in enhancing soil tensile cracking resistance.During this period,the effects of W-OH treatment concentration and water content on tensile properties,soil suction and microstructure were investigated.The tensile tests reveal that W-OH treatment has a significant impact on the tensile strength and failure mode of the soil,which not only effectively enhances the tensile strength and failure displacement,but also changes the brittle failure behavior into a more ductile quasi-brittle failure behavior.The suction measurements and mercury intrusion porosimetry(MIP)tests show that W-OH treatment can slightly reduce soil suction by affecting skeleton structure and increasing macropores.Combined with the microstructural analysis,it becomes evident that the significant improvement in soil tensile behavior through W-OH treatment is mainly attributed to the W-OH gel's ability to provide additional binding force for bridging and encapsulating the soil particles.Moreover,desiccation tests demonstrate that W-OH treatment can significantly reduce or even inhibit the formation of soil tensile cracking.With the increase of W-OH treatment concentration,the surface crack ratio and total crack length are significantly reduced.This study enhances a fundamental understanding of eco-polymer impacts on soil mechanical properties and provides valuable insight into their potential application for improving soil crack resistance.

Ten Years of Epidemiological and Diagnostic Aspects of Non-Traumatic Anterior Uveitis at Campus Teaching Hospital of Lome-Togo

Background: Uveitis is a serious disease which dangerous complications can jeopardize the visual prognosis. Anterior uveitis (AU) is the inflammation of the anterior uvea which is composed of the iris and the ciliary body. The objective of the study was to identify the epidemiological and etiological determinants of non-traumatic anterior uveitis at the Campus Teaching Hospital of Lomé. Materials and methods: Retrospective cross-sectional study of the records of patients diagnosed with anterior uveitis (AU) without a notion of trauma in the ophthalmology department of CHU Campus of Lomé from January 1, 2010 to December 31, 2019 (10 years). Results: 141 cases of uveitis, representing a prevalence of 0.18%. Female predominance, with a sex ratio of 0.76. Mean age was 34.74 ± 13.20 years. Decreased visual acuity was the primary complaint (34.40%), followed by ocular pain (28%). Non-traumatic anterior uveitis was unilateral in 87.2% of cases. Retro-corneal precipitates were present in all patients. 61.60% of patients had Tyndall in the anterior chamber. The etiology of non-traumatic AU was undetermined in 76.80% of cases. Toxoplasmosis, tuberculosis and syphilis were the main etiologies found. Conclusion: Non-traumatic anterior uveitis is relatively rare but serious, often affecting young subjects. It is a pathology that engages eye health professionals, not only because of the difficulties involved in diagnosing the etiology, but also because of its progression which sometimes leads to blindness.

Management of Non-Traumatic Urological Emergencies at Souro Sanou University Teaching Hospital of Bobo-Dioulasso (Burkina Faso)

Background: Generally, urological emergencies are assumed not to be very common, however, recent reports showed that they constitute an important aspect of the day-to-day urological practice. If not well and promptly managed, they may lead to serious morbidity or mortality. Objectives: To study the pattern of presentation, diagnosis and outcome of management of non-traumatic urological emergencies seen at the Emergency Department of Souro Sanou University Hospital in Bobo-Dioulasso. Patients and Methods: This was a retrospective and descriptive study over four years. It included patients of all ages and both sexes, admitted for non-traumatic urological emergencies in the surgical emergency department of Souro Sanou University Hospital. It took place from January 1, 2017 to December 31, 2020. Results: A total of 584 patients were reviewed in our study. Non-traumatic urological emergencies account for 6.3% of all surgical emergencies seen during the study period. The male-to-female ratio was 9.2 to 1. The mean age of the patients was 51.9 ± 23.9 years. Forty-five per cent of the patients presented within 48 hours of symptoms. The vast majority of the patients presented with difficulties with passing urine (41.6%), followed by cases of hematuria (18.4%). On admission, 154 patients (26.4%) presented with severe conditions such as anemia as seen in 40.9% of the cases and deterioration in the general health condition as seen in 34.4% of the patients. Leukocytosis was noted in 18.7% of the patients and anemia in 17.9%. Urine culture was positive in 15.4% of the patients and Escherichia coli was the most common pathogen found (40.6%). Ultrasound was the most requested examination (81.2%), followed by a computerized tomography (CT) scan (22%). The most frequent diagnoses were urine retention (42.9%), hematuria (16.9%) and renal colic (10.1%). Emergency interventions were carried out in 525 patients (89.9%) who include bladder catheterization (46.1%), bladder lavage and/or bladder irrigation (20.9%) and suprapubic cystocatheterization (10.1%). Most of the patients (61.3%) were discharged after a mean stay in the hospital of about 5.1 ± 7.5 days. A mortality rate of 3.8% was also recorded among the patients studied. Conclusion: Non-traumatic urological emergencies are common and are an important aspect of daily urological practice. The majority of the patient presents late with usually a severe form of the disease, which adversely affects the outcome even after treatment.

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)techniques.The indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of LH.While laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its outcomes.important anatomical markers,surgical skills,and ICG staining methods.METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed.The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH.The surgical methods,as well as intra-and post-surgical data,were recorded and analyzed.Our hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,respectively.The overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were reported.CONCLUSION LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

The role and research progress of PI3K/AKT signaling pathway in non-traumatic osteonecrosis of the femoral head

Non-traumatic osteonecrosis of the femoral head(NONFH)is one of the most common orthopedic diseases,influenced by multiple signaling pathways and inflammatory factors.The PI3K/AKT signaling pathway is closely related to various biological processes such as apoptosis,autophagy,and metabolism in cells.Increasing evidence suggests that it plays an important role in the development of femoral head necrosis.This paper aims to explore the mechanism of the PI3K/AKT signaling pathway in the pathogenesis of NONFH by analyzing its regulation of lipid metabolism,cell apoptosis and autophagy,and intravascular coagulation.This study provides new insights for the research of NONFH.

A Qualitative Study of the Triage of Patients with Non-Traumatic Acute Abdomen

Objective: To explore the work experience of medical staff in the emergency department of a general hospital in the triage of patients with non-traumatic acute abdomen to formulate corresponding intervention measures and branch evaluation tools. Methods: With descriptive phenomenology as the research method, semi-structured interviews were conducted with the medical staff in a tertiary hospital in Nanjing from February 1st to 10th, 2023, and Colaizzi seven-step analysis was used to analyze the data. Results: A total of 17 emergency medical staff were interviewed in this study. Four themes were derived from the analysis of the data: the etiology of acute abdomen is complex, so it is difficult to categorize them: acute abdomen requires immediate treatment, but the treat will be delayed if the categorization is inaccurate;the high pressure of nurses and the accuracy in categorizing the patients are problems that should be addressed. Conclusion: The categorization of patients with non-traumatic acute abdomen is challenging. Therefore, it is necessary to carry out corresponding intervention and formulate appropriate departmental evaluation tools to improve the accuracy of categorization of patients with acute abdomen.