Novel approach for pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia

IntroductionCoccydynia is a multifactorial complex clinical challenge. A multimodal approach with both conservative measures and procedural interventions is often recommended. We described a novel approach of radiofrequency (RF) ablation for the management of coccydynia.MethodsThree patients with known history of coccydynia refractory to conservative therapy were referred to our clinic. All received different types of RF ablation before: one with anterior bipolar lesion with no analgesia benefit, one with posterior stripped lesion with good benefit but only after 8 weeks of pain flare and one received anterior monopolar lesion with 50% pain reduction for 2–3 months. All subjects underwent a novel RF ablation to the anterior surface of the sacrococcygeal and intercoccygeal joints with two bipolar lesions using multi-tined needles under fluoroscopy guidance. One bipolar lesion was between two needles: one in the sacrococcygeal and another in the intercoccygeal (between first and second coccyx) joints. Another bipolar lesion was between needles on both side of the sacrococcygeal joint.ResultsAll experienced at least 65% pain relief for 6 months. The sitting endurance increased from less than 5 min to an average of 70 min. No adverse effect was observed in two and in the patient who used to have pain flare after lesioning, the pain flare lasted only for 2 weeks.DiscussionThe configuration of the two bipolar lesions with multi-tined needles in this case series stimulates the thinking of new approach for the ablation technique for pain from coccyx. Further prospective large case cohort study is needed.

Simulation study reveals factors that affect the predominance of SARS-CoV-2 novel variant

The novel variants of the SARS-CoV-2 are a great global concern for the ongoing COVID-19 pandemic. However, how the novel variants predominate and replace existing strains remains elusive. In this study, I simulated the infection spread to investigate what kinds of viral, immunological, and epidemiological factors affect the predominance of SARS-CoV-2 novel variants. The results showed that the increase of the transmissibility of the novel variant substantially enhanced the predominance probability. In addition, the increasing trend of the infection spread, the large case number of the epidemic, and the ability of immune escape of the novel variant increased the predominance probability. A small number of cases and a decreasing trend of an entire epidemic, including not only the novel variant but also earlier strains, are especially important to reduce the chance of the predominance of the novel variant and delay the process. Good control of the COVID-19 epidemic could make the disease burden small and sequester the spread of the SARS-CoV-2 novel variants.

Aspetti positivi e limiti della telemedicina: esperienze di lavoro in Neuropsichiatria infantile in tempo di Covid-19

Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.

Il digiuno del bambino prima di una sedazione procedurale

Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.

The Emergence of Collective Dreams: An Exploration of Community Development Based Collaborative Landscape Design

<p>This thesis explores the nature of a landscape design process that could ensure the resilience and sustainability of suburban public space. Utilising a literature review and two large case study projects, the research presents an argument that: • public landscapes must be seen as multi-dimensional complex systems emerging from the co-evolution of different players in the landscape community with the dynamics of their wider ecosystem; and • the sustainable design of these spaces is dependent on collaborative decision-making, the engagement and empowerment of the local community, and the restoration of ongoing responsive interaction with the site. This approach is referred to as 'deep landscape design' and is expanded through the presentation of a number of guiding principles which it is hoped will support designers, council staff and community leaders to implement it. These guiding principles describe a facilitated, nested and iterative model of design in which: • the physical, ecological and cultural dimensions of landscape can be integrated holistically; • multiple engagement methods are established enabling the inclusion of a large range of community partners; and • those engaged in the design of the space are able to reflect on the impacts of their decisions and make changes accordingly. The research suggests that through the inclusion of deep design principles, small projects with a specific focus can initiate a process of increasing community knowledge, skill, and ownership in the design and maintenance of landscapes. A process which is necessary for the sustainability and resilience of public spaces.</p>

The Emergence of Collective Dreams: An Exploration of Community Development Based Collaborative Landscape Design

<p>This thesis explores the nature of a landscape design process that could ensure the resilience and sustainability of suburban public space. Utilising a literature review and two large case study projects, the research presents an argument that: • public landscapes must be seen as multi-dimensional complex systems emerging from the co-evolution of different players in the landscape community with the dynamics of their wider ecosystem; and • the sustainable design of these spaces is dependent on collaborative decision-making, the engagement and empowerment of the local community, and the restoration of ongoing responsive interaction with the site. This approach is referred to as 'deep landscape design' and is expanded through the presentation of a number of guiding principles which it is hoped will support designers, council staff and community leaders to implement it. These guiding principles describe a facilitated, nested and iterative model of design in which: • the physical, ecological and cultural dimensions of landscape can be integrated holistically; • multiple engagement methods are established enabling the inclusion of a large range of community partners; and • those engaged in the design of the space are able to reflect on the impacts of their decisions and make changes accordingly. The research suggests that through the inclusion of deep design principles, small projects with a specific focus can initiate a process of increasing community knowledge, skill, and ownership in the design and maintenance of landscapes. A process which is necessary for the sustainability and resilience of public spaces.</p>