Periodic Clinical Examinations Research Articles

Resting Body Temperature and Long-Term Survival in Older Adults at a Mental Health Center: Cross-Sectional and Longitudinal Data

Background/Objectives: Elevated body temperature is a well-established biomarker of infection, increased disease risk, and adverse health outcomes. However, the relationship between resting body temperature and long-term survival in older individuals is complex. Emerging evidence suggests that higher basal body temperature is associated with reduced survival and accelerated aging in non-obese older adults. This study aimed to compare body temperatures across different age groups in hospitalized older adults. Methods: Data were retrospectively collected from 367 physically healthy residents of a mental health center. Longitudinal data from 142 individuals (68 men and 74 women), aged 45 to 70 years and monitored continuously over 25 years, were compared with cross-sectional data from 225 individuals (113 men and 112 women) who underwent periodic clinical examinations with temperature measurements. The cross-sectional sample was stratified into four survival categories. Resting oral temperatures were measured under clinical conditions to ensure protocol consistency. Age-related changes in both sexes were evaluated using standard regression analysis, Student’s t-tests, ANOVA, and Generalized Linear Models. Results: Longitudinal analysis revealed an increase in body temperature with age among women, while cross-sectional analysis showed that long-lived residents generally had lower body temperatures compared to their shorter-lived counterparts. Conclusions: These findings support the hypothesis that lower lifetime steady-state body temperature is associated with greater longevity in physically healthy older adults. However, further research is needed to determine whether the lower body temperature observed in long-lived individuals is linked to specific health advantages, such as enhanced immune function, absence of detrimental factors or diseases, or a reduced metabolic rate potentially influenced by caloric restriction.

Balo concentric sclerosis, an emerging variant of multiple sclerosis: A case-series and literature review.

Balo concentric sclerosis (BCS) is a rare demyelinating disease. This study aims to follow up on patients initially diagnosed with BCS and MS or presented with BCS in the context of MS. This study was conducted at an MS clinic center in Isfahan, monitoring 2600 MS patients, among which 10 cases were related to BCS. These 10 patients were assessed clinically and radiologically during 2013-2024, with consecutive MRIs and periodic clinical examinations. Among the 10 patients, BCS was either the inaugural presentation of MS or occurred in the context of the disease. The most common Symptoms included limb weakness and paresthesia. All patients exhibited characteristic onion-like lesions in the periventricular white matter, with two showing tumefactive demyelination. CSF analysis was abnormal in all patients, revealing positive oligoclonal bands (OCB), which were categorized as type 2 in all patients. Treatment mainly involved rituximab, which indicated plausible results. Our study highlights the variability in BCS clinical presentations and supports its classification as a variant of MS due to overlapping characteristics. Additionally, our findings contribute to understanding BCS's distinct clinical and radiologic profiles and emphasize the importance of further investigation into its pathophysiology and treatment.

Preventive oral healthcare for children: towards appropriate care

In recent decades, oral healthcare has shifted from curation to prevention. Preventive oral healthcare for children consists mainly of oral health education to improve health behaviors and clinical prevention such as fissure sealants, application of fluoride varnish, removal of supragingival plaque and dental polishing. In addition, the periodic clinical examination is an important preventive instrument. These 5 preventive interventions for children up to 12 years of age can be discussed using the principles of 'appropriate care'. Appropriate care is an approach of the Dutch government to ensure the accessibility, quality and affordability of care in the Netherlands. Central to the approach are the effectiveness, efficiency and patient-centeredness of care. This article describes to what extent preventive oral healthcare meets these principles based on literature, care consumption data and recommendations from the clinical guidelines 'Oral care for children: prevention and treatment of dental caries' and the 'Advice on Caries Prevention' by the Ivory Cross, a Dutch scientific association for oral health. Appropriate oral healthcare is best served by care that is tailored to both the individual oral disease burden of the patient and their risk of disease as well as to the wishes of the patient.

Virtual reality: a game-changer in the diagnosis and surgical planning of astrocytoma grade III: a case report

BackgroundIn the dynamic realm of modern medicine, the advent of virtual reality technology heralds a transformative era, reshaping the contours of diagnosis and surgical planning with its immersive prowess. This study delves into the groundbreaking application of virtual reality in the intricate dance of neurosurgery, particularly spotlighting its role in the management of astrocytoma grade III—a cerebral challenge of significant complexity.Case presentationA 30-year-old Middle Eastern man from Syria grappled with the invisible tendrils of pain, manifesting as persistent headaches and a numbing sensation that crept into his neck and extremities. For two relentless months, the morning sun brought not hope but an intensification of his agony, rendering him unable to partake in the daily dance of life. The usual sentinels of relief, analgesic drugs, stood defeated, offering no respite. The neurological examination was normal, there were no pathological findings on sensory and motor examination, and he exhibited normal reflexes and neither meningeal nor cerebellar signs. He showed a family history of breast cancer. The initial foray into the enigmatic depths of his brain via computed tomography and magnetic resonance imaging imaging unveiled a finding in the right temporal lobe, a lesion that suggested something more sinister. Previous medical interventions included analgesic medications prescribed for persistent headaches, but they offered no relief. No other therapeutic interventions were administered prior to the current diagnosis. It was here that virtual reality technology emerged not as a mere tool but as a beacon of precision, casting a three-dimensional light on the shadowy intruder. This technological marvel allowed for meticulous measurement 21.8 × 14.5 mm and localization within the temporal theater, setting the stage for what was to come. With the path laid clear, the patient embarked on a surgical odyssey, a quest to excise the unwelcome guest. The operation was a triumph, a testament to human ingenuity and the symbiotic relationship between flesh and machine. The postoperative verdict was delivered through the lens of histopathology, confirming the presence of an astrocytoma grade III, a cerebral interloper known for its rapid proliferation. The battle, however, was far from over. Complementary radiotherapy and chemotherapy were enlisted as allies in this ongoing war, their potent forces working in concert to stave off the cellular insurgence. The patient’s journey through the healing arts was charted by periodic clinical and neurological examinations, with laboratory tests and the vigilant gaze of brain magnetic resonance imaging ensuring a watchful eye was kept on any potential resurgence.ConclusionsIn this narrative of resilience and technological prowess, we witness the harmonious fusion of human touch and digital precision, a partnership that redefines the boundaries of medicine and the art of healing, by use of virtual reality technology in the diagnosis of astrocytoma and enhancing the accuracy, effectiveness, and safety of neurosurgical procedures, which can ultimately benefit patients with brain tumors.

DEPENDENCE OF THE DURATION OF SURGICAL INTERVENTION AND FUNCTIONAL ACTIVITY OF THE PATIENT IN THE POSTOPERATIVE PERIOD ON THE TECHNICAL PARAMETERS FOR PARTIAL RESECTION OF THE MEDIAL MENISCUS OF THE KNEE JOINT

Introduction. The study of the duration of surgery and the course of the postoperative period in 38 patients with damage to the medial meniscus of the knee joint who underwent partial meniscus resection in the traditional way was conducted and the analysis of the dependence of the duration of surgery and patient activity in the postoperative period on such technical parameters as the number of resection cycles and the frequency of intraoperative instrument change was performed.
 The aim of the study. To determine the dependence of the duration of surgery and functional activity of the patient in the postoperative period on the technical parameters of partial resection of the knee meniscus.
 Materials and methods. The study involved 38 patients aged 21 to 53 years with unstable damage to the medial meniscus of the knee joint of III or IV degree according to Stoller, who underwent partial meniscus resection. To assess functional activity, patients underwent periodic clinical examination and questionnaires using the Tegner activity scale from the first day to 6 weeks after surgery. Statistical processing of the study data was performed using the licensed software IBM SPSS Statistics Base v 22. MedCalc (Healthcare Technology, USA).
 Results. A direct strong correlation (ρ=0.857) was found between the number of meniscus resection cycles performed during surgery and the number of intraoperative instrument change (p<0.05). A direct strong correlation (ρ=0.725) was found between the number of meniscus resection cycles performed during surgery and the duration of surgery (p<0.05), as well as a direct strong correlation (ρ=0.723) between the number of intraoperative instrument changes and the duration of surgery (p<0.05). There was no correlation between the duration of surgery and the subjective assessment of activity according to the Tegner scale in the period from 0 to 6 weeks postoperatively (ρ is not statistically significantly different from zero, p>0.05).
 Conclusions. The need for intraoperative instrument change is directly related to the number of resection cycles required to perform partial resection of the medial meniscus. The duration of the surgical intervention is related to the need for intraoperative instrument change and the number of resection cycles required for partial resection of the medial meniscus. However, the functional activity of the patient in the early and medium-term postoperative period is not directly related to the duration of the operation.

Hematological and Biochemical Parameters in Prepubescent Water Buffaloes (Bubalus bubalis)

Water buffaloes are bred in Europe, Australia, North America, South America, and some African countries. European water buffaloes are all of the river type and are considered to be of the same breed named the Mediterranean water buffalo. This species plays a key role in milk production in Italy. Buffalo breeding for milk production has represented an important economic value in recent years, even in Italian regions where this activity was not historically rooted. Therefore, it is very important to monitor animal health and welfare by performing periodical clinical examinations combined with different hematological and biochemical tests. However, there are few studies regarding these aspects, as well as research aimed at establishing the reference ranges for species. This study aims to define hematological and biochemical parameters in a population of healthy water buffalo in controlled conditions for over a year in Italy.

Evaluation of Some Immunological Parameters in with Men Diabetic Nephropathy

The Aim: The study aims to the possibility of depending on some immunological criteria (monocyte chemoattractant protein (MCP-1, MCP-3) and interleukin-18).
 Study Design: The study is indicators for early diagnosis of diabetic nephropathy in patients with type 2 diabetes and avoiding its development to advanced stages.
 Place and Duration of Study: Endocrinology Center / Al-Sadr Medical City and also Al-Manathira General Hospital / Al-Najaf Governorate, their ages ranged between (30- 60) years old, and the study continued for the period from 1/10/2022 to 31/3/2023 after obtaining the consent of the two study groups.
 Methodology: The study included the follow-up of (90) men, (30) healthy individuals and (60) patients with type 2 diabetes mellitus to periodic clinical examination ,the estimation of glycosylated hemoglobin ratio (HbA1c) and evaluation of immunological parameters represented in levels of monocyte chemoattractant protein (MCP-1 , MCP-3 ) and interleukin-18 .
 Results: The study diagnosed a significant increase (P < 0.05) in glycosylated hemoglobin ratio, monocyte chemoattractant protein MCP-1, MCP-3) and interleukin-18 ,and in contrast to a significant decrease (P < 0.05) in the glomerular filtration rate (GFR) in men with diabetes mellitus type II compared to healthy men.
 The study also showed a significant effect (P < 0.05) for the age groups on the glycosylated hemoglobin ratio and monocyte chemoattractant protein (MCP-3), and conversely a significant decline in the glomerular filtration rate (GFR) ,while no significant differences appeared (P > 0.05) in levels of monocyte chemoattractant protein (MCP-1) and interleukin-18. Also, a notable impact (P < 0.05) was observed for the duration of diabetes mellitus on the levels of monocyte chemoattractant protein (MCP-1 , MCP-3 ),whereas no substantial differences appeared (P > 0.05) in levels of glycosylated hemoglobin ratio, glomerular filtration rate (GFR) and interleukin-18.
 In addition to the foregoing, the trial recorded a significant influence (P < 0.05) of body mass index on the levels of monocyte chemoattractant protein (MCP-3),while no noticeable differences appeared (P > 0.05)in, the glycosylated hemoglobin ratio , glomerular filtration rate(GFR),and monocyte chemoattractant protein (MCP-1).
 Moreover, a significant effect (P < 0.05) for stages of diabetic nephropathy was diagnosed on the glycosylated hemoglobin ratio, monocyte chemoattractant protein (MCP-1, MCP-3), interleukin-18 and glomerular filtration rate (GFR).
 Conclusion: It is possible to depend on the increased levels of some immunological indicators especially MCP-1, MCP-3 and interleukin-18 as predictive biomarkers to diagnose the progression to advance stages of the diabetic nephropathy if this coincides with a decrease in the glomerular filtration rate.

The importance of follow-up examinations in chronic rhinosinusitis with nasal polyposis

PurposeClinical examinations following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) are critical for physicians to assess results of the intervention and to early identify recurrences. However, no clear consensus on the frequency and timing of clinical examinations following surgery exists. The aim of this study was to analyze CRSwNP recurrences after FESS with a specific focus on the adherence to follow-up examinations. Materials and methodsSixty patients who underwent FESS for CRSwNP were enrolled. Clinical parameters were recorded. Adherence to follow-up examinations with nasal fiber optic endoscopy and regular administration of nasal steroids were analyzed. ResultsAdherence to periodic clinical examinations and regular treatment with nasal steroids was 25 %. CRSwNP recurrence was observed in 56.7 % of cases at the last follow-up examination. No statistically significant difference concerning nasal symptoms was observed between patients with and without current recurrence (p > 0.05). Subjects who underwent regular examinations and prompt treatment of small recurrences had a lower probability of relapse at their last examination (7.7 % versus 38.2 %, respectively; p < 0.001). Polyp grade > 2 in patients with or without adherence were seen in 15.4 % and 42.9 % of cases, respectively (p < 0.05). ConclusionsAdherence to follow-up examinations with nasal optic fiber endoscopy is crucial to early identify recurrence after surgery and promptly treat it with medical therapy.

Effect of initial levothyroxine dose on neurodevelopmental and growth outcomes in children with congenital hypothyroidism

ObjectivesWe designed a multicentre open prospective randomized trial to evaluate the risk-benefit profile of two different initial treatment schemes with levothyroxine (L-T4), 10-12.5 μg/kg/day vs 12.6-15 μg/kg/day, on growth and neurodevelopmental outcomes in children with congenital hypothyroidism (CH) detected by neonatal screening to identify the best range dose to achieve optimal neurocognitive development.Design, patients and methodsChildren detected by neonatal screening were randomly assigned to receive an initial L-T4 dose of 10-12.5 μg/kg/day (Low) or 12.6-15 μg/kg/day (High). All patients underwent periodical clinical examination with measurement of growth parameters and measurement of TSH and FT4. Neurocognitive development was evaluated at the age of 24 months using Griffiths Mental Development Scales (GMDS) and cognitive and behavioral assessment was performed at 48 months of age using Wechsler Preschool and Primary scale of Intelligence (WIPPSI-III). The study was registered with clinicaltrials.gov (NCT05371262).ResultsTreatment schemes below or above 12.5 μg/kg/day were both associated with rapid normalization of TSH and thyroid hormone levels in most patients with no differences in the risk of over- and under-treatment episodes in the first months of life. Growth parameters were normal and comparable between the two groups. Developmental quotients at 24 months of age were normal in both groups (Low 100.6 ± 15.5 vs High 96.9 ± 16.6). Likewise, at 4 years of age IQ and subtest scores were comparable between patients from Low and High (Total IQ 104.2 ± 11.4 vs 101.0 ± 20.3, Verbal IQ 103.9 ± 11.5 vs 98.7 ± 15.1, Performance IQ 105.3 ± 10.4 vs 100.3 ± 19.8). 6/45 CH patients (13.3%) showed a total IQ below 85 (73.7 ± 5.9) regardless of age at diagnosis, L-T4 starting dose, time of FT4 and TSH normalization and episodes of over and undertreatment. Worse socioeconomic status and delayed bone age at diagnosis were the only predictors of an increased risk of having suboptimal IQ at 24 and IQ at 48 months.ConclusionsOur results indicate that initial treatment with L-T4, 10-12.5 μg/kg/day vs 12.6-15 μg/kg/day, are both associated with normal growth and neurodevelopmental outcomes in children with CH detected by neonatal screening. Further studies with a long-term follow-up on a larger number of patients are needed to confirm these results.Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT05371262?term=NCT05371262&draw=2&rank=1 identifer NCT05371262.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults.

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5-60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Effect of Omega-3 Polyunsaturated Fatty Acids on Lipid Metabolism in Patients With Metabolic Syndrome and NAFLD.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. n‐3 polyunsaturated fatty acids (n‐3‐PUFAs) have been reported to ameliorate the progression of NAFLD in experimental studies; however, clinical trials have yielded contradictory results. The aim of our study was to assess the effects of n‐3‐PUFA administration on lipid metabolism and the progression of NAFLD in patients with metabolic syndrome. Sixty patients with metabolic syndrome and NAFLD were randomized in a double‐blind placebo‐controlled trial (3.6 g/day n‐3‐PUFA vs. placebo). During the 1‐year follow‐up, the patients underwent periodic clinical and laboratory examinations, liver stiffness measurements, magnetic resonance spectroscopy of the liver, and plasma lipidomic analyses. After 12 months of n‐3‐PUFA administration, a significant decrease in serum GGT activity was recorded compared with the placebo group (2.03 ± 2.8 vs. 1.43 ± 1.6; P < 0.05). Although no significant changes in anthropometric parameters were recorded, a significant correlation between the reduction of liver fat after 12 months of treatment—and weight reduction—was observed; furthermore, this effect was clearly potentiated by n‐3‐PUFA treatment (P < 0.005). In addition, n‐3‐PUFA treatment resulted in substantial changes in the plasma lipidome, with n‐3‐PUFA‐enriched triacylglycerols and phospholipids being the most expressed lipid signatures. Conclusion: Twelve months of n‐3‐PUFA treatment of patients with NAFLD patients was associated with a significant decrease in GGT activity, the liver fat reduction in those who reduced their weight, and beneficial changes in the plasma lipid profile.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5–60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5–60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Development of a DDH Care Pathway for India: A Study Methodology to Guide Similar Efforts in Other Countries and for Other Conditions

PurposeIn India and other Global South countries, developmental dysplasia of the hip (DDH) is often diagnosed after walking age, leading to more invasive surgeries and long-term disability. DDH care pathways aim to enhance early detection and must be tailored to meet a country’s needs and diverse practice settings. We describe a multi-phase methodology for context-specific DDH care pathway development, demonstrating its use in India.MethodsIn Phase I, Orthopaedic surgeons, Pediatricians/Neonatologists, and Radiologists in India were surveyed regarding DDH screening. Seven relevant Indian organizations partnered together and assembled a multidisciplinary working group, which then met fortnightly to establish an evidence base and prepare for the subsequent consensus-building phase. During Phase II, panelists participated in a modified Delphi process to reach consensus on a list of DDH screening statements. Phase III applied the statements to develop the care pathway.ResultsThe Delphi process concluded after a preliminary survey and two Delphi rounds, reaching consensus on 47 statements, which were condensed into 35. The developed care pathway for India features periodic clinical hip examinations integrated with the country’s immunization schedule and selective imaging screening, providing flexibility in the timing and modality of imaging.Discussion/ConclusionIn Global South countries, there is a need for DDH care pathways specific to local contexts. Successful care pathway development requires accounting for cultural differences in healthcare and strategies to facilitate engagement and to address country-specific barriers. This methodology was feasible in India and can be applied to other conditions and/or countries wishing to establish care pathways.Level of EvidenceLevel III.

Concomitant chronic subdural hematomas and arachnoid cysts in young adults.

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5-60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

Point of view: Wearable systems for at-home monitoring of motor complications in Parkinson's disease should deliver clinically actionable information

Parkinson’s disease (PD) affects over six million people globally. PD leads to devastating chronic motor manifestations such as bradykinesia/akinesia, rigidity, gait disturbance, and tremor. PD symptoms are managed by adjusting the schedule and dose of PD medications such as levodopa and dopamine agonists. However, PD patients at mid- and advanced-stages of the disease frequently experience additional treatment-related motor complications such as troubling motor fluctuations between mobile (ON) and akinetic (OFF) states and abnormal, involuntary dyskinetic movements [1]. At this stage, effective medication adjustments require accurate knowledge about the nature of patients’ motor complications over a typical day. The current clinical protocol entails obtaining this information through periodic clinical examinations and patient interviews. However, patient interviews can be unreliable and limited by recall bias [2]. Clinical examinations may only provide a snapshot of motor functioning, hence failing to capture an accurate picture of motor complications [3]. Rapid advancements in sensing technologies provide user-friendly wearables with a long battery life that can be worn by PD patients and used to unobtrusively assess motor symptoms during activities of daily living (ADL). Such sensing technologies can be tailored for use in monitoring PD patients at home to generate clinically actionable information that can be provided to the treating physician to make individualized therapeutic recommendations (Table 1) [4,5]. Commercially available wearable devices such as Kinesia360™ (Great Lakes NeuroTechnologies), Personal KinetiGraph® (PKG®) (Global Kinetics Corporation Ltd.), REMPARK (Sense4Care), and PERFORM [6] have various characteristics and deliverables to assess motor complications, but adoption and implementation in clinical practice have been slow and limited [7]. Contributing factors to such inconsistency might include delays in patient acceptance and adherence to wearing new technology, clinician acceptance, or issues with cost and insurance coverage. However, in an attempt to look beyond the technology life cycle to better understand this inconsistency, we sought to review the current status of these devices and explore possible gaps between the capabilities of their underlying algorithms compared to the requirements for an accurate motor complication monitoring system that can facilitate effective therapeutic adjustments. It is our view that a major factor contributing to slow adoption of at-home monitoring systems of motor complications is based on the practical utility of the existing deliverables from such devices, which are mainly determined by their underlying algorithms. We propose that if revised algorithms can be used to generate data that can be interpreted more reliably in the context of widely accepted and understood clinical measures, this would create more convincing evidence for the clinicians to utilize these devices and the insurance companies to support coverage. Table 1 Clinically actionable information required for precise identification of therapeutic goals and example medication adjustments to optimize PD control.

Indications for removal of impacted mandibular third molars and associated pathologies

Introduction: The purpose of this study was to assess the various indications of impacted mandibular third molar removal and pathologies associated with it.&#x0D; Methods: A retrospective cross-sectional study was conducted in the Department of Oral Surgery, Gandaki Medical College. The clinical case records from September 2016 to August 2019 were retrieved, reviewed, and analyzed. Surgically removed impacted mandibular third molars for which orthopantomogram were available and the lesions verified histologically were included in the study. Orthopantomograms were studied to determine the angular position of the impacted mandibular third molars and associated pathology. The data was entered in SPSS 20 and descriptive statistics was applied.&#x0D; Results: A total of 1344 impacted mandibular third molars (Male-709, 52.8%; Female - 635, 47.2%) were surgically extracted during the three-year period. The majority of patients (36.5%) were in the age groups of 25 - 34 years with a higher incidence of mesioangular impaction (33%). Recurrent pericoronitis (62.9%) was the most common indication followed by caries (11.7%). The radiographically detectable lesion was seen in 471 (35%) cases out of which 304 (64.5%) were symptomatic at the time of extraction. Among137 histopathologically diagnosed cases, chronic inflammatory lesion (76, 55.9%) was the most common finding.&#x0D; Conclusion: Awareness of the indications for removal of impacted mandibular third molars helps in proper management and prevention of future complications associated with retention and delayed extraction of such teeth. So, regular and periodic clinical and radiographic examination is required for patients with impacted mandibular third molars.

Safety and Efficacy of a New Synthetic Material Based on Monetite, Silica Gel, PS-Wallastonite, and a Hydroxyapatite Calcium Deficient: A Randomized Comparative Clinic Trial.

Background and Objectives: Maxillary bone defects related to post-extraction alveolar ridge resorption are usual. These defects may lead to failure in further surgical implant phases given the lack of bone volume to perform the dental implant. The objective of this clinical assay was to evaluate the safety and efficacy of an experimental synthetic bone substitute in the preservation of post-extraction maxillary alveoli. Materials and Methods: 33 voluntary patients who had at least one maxillary premolar tooth that was a candidate for exodontia (n = 39) and subsequent implant rehabilitation participated. The regenerated alveoli were monitored by means of periodic clinical examinations (days 9 ± 1, 21 ± 4, 42 ± 6, and 84 ± 6), measuring the height and width of the alveolar crest (days 0 and 180 ± 5), measurement of radiodensity using tomographic techniques (days 0–5 and 175 ± 5), and histological examination of biopsies collected at 180 ± 5 days. Results: No significant differences were observed during the entire follow-up period between the two groups with respect to the safety variables studied. A variation in width of −0.9 ± 1.3 mm and −0.6 ± 1.5 mm, and a variation in height of −0.1 ± 0.9 mm and −0.3 ± 0.7 mm was observed for experimental material Sil-Oss® and Bio-Oss®, respectively. The radiodensity of the alveoli regenerated with the experimental material was significantly lower than that corresponding to Bio-Oss®. However, the histological study showed greater osteoid matrix and replacement of the material with newformed bone in the implanted beds with the experimental material. Conclusions: Both materials can be used safely and proved equally effective in maintaining alveolar flange dimensions, they are also histologically biocompatible, bioactive and osteoconductive. The experimental material showed the advantage of being resorbable and replaced with newformed bone, in addition to promoting bone regeneration.

Abstract OT2-01-05: A randomized controlled trial comparing post-operative intensive follow-up with standard follow-up in high-risk breast cancer patients (JCOG1204: INSPIRE)

Abstract Background: The standard follow-up after surgery for breast cancer includes periodic interviews, clinical examinations, and mammography, but many institutions are conducting intensive follow-up including periodic computed tomography(CT), magnetic resonance imaging(MRI), and bone scintigraphy in the world, despite the lack of evidence to support this approach. While intensive follow-up may contribute to prolonged survival through earlier diagnosis and treatment of relapse, it has the disadvantages of high effort and costs placed on patients(pts) and healthcare workers, radiation exposure for imaging examinations, and overtreatment owing to false-positive results. Although past two randomized trials could not show significant difference in overall survival (OS), as imaging methods have remarkably improved, leading to the earlier detection of relapse, and medical therapies have remarkably improved in recent years, randomized controlled trials are needed to confirm whether intensive follow-up can really prolong survival sufficiently to offset these disadvantages in high-risk breast cancer pts. Trial design: This study is a multi-institutional two-arm open label randomized controlled phase III trial being conducted with the participation of 42 hospitals belonging to the Breast Cancer Study Group of Japan Clinical Oncology Group. Eligible pts are randomized either to the intensive follow-up group or to the standard follow-up group; the former will undergo physical examination, bone scintigraphy, chest and abdominal CT, brain MRI/CT and frequent tumor markers, whereas the latter will undergo physical examination at the same frequency and tumor markers will be evaluated once a year. Mammography once a year is planned for both groups. This trial has been registered at the UMIN Clinical Trials Registry as UMIN000012429. Eligibility criteria: High-risk breast cancer pts, who are expected to have recurrence rates of over 30% within 5 years after surgery. The main inclusion criteria are as follows: four or more axillary nodal metastases in the estrogen receptor (ER) positive pts without neoadjuvant chemotherapy(NC)., axillary node metastases in ER-negative pts without NC, axillary nodal metastases in ER-positive pts with NC, histologically proven residual invasive cancer in the breast or axilla in ER-negative with NC. Specific Aims: The primary endpoint is OS, and secondary endpoints are disease-free survival, relapse-free survival, distant metastasis–free survival, OS in intrinsic subtypes, actual number of implemented examinations, compliance with pre-specified examinations, and adverse events. Statistical methods: The primary endpoint will require a total of 538 events to be assessed in order to obtain a statistical power of 80% with a one-sided significance level of 0.05. Thus, the planned sample size to compare the two survival curves is set at 1500 pts, assuming an accrual time of 6 years and a follow-up time of 7 years according to the Schoenfeld and Richter's method. Present accrual and target accrual: The trial was activated in November 2013. 773 pts have been enrolled by the end of June 2018. Contact: Principal investigator Takashi Hojo MD tahojo@east.ncc.go.jp Citation Format: Hojo T, Masuda N, Shibata T, Mizutani T, Shien T, Kinoshita T, Iwatani T, Kanbayashi C, Kitagawa D, Tsuneizumi M, Iwata H. A randomized controlled trial comparing post-operative intensive follow-up with standard follow-up in high-risk breast cancer patients (JCOG1204: INSPIRE) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-01-05.

Intra-articular fracture distal end radius external fixation versus locking volar radius plate: A comparative study

Introduction: The purpose of the present study was to compare the results obtained by management of intra-articular fractures of distal end radius with closed reduction and external fixation versus open reduction and internal fixation with locking distal radius volar plate. Material and Method: The present study included 60 patients of distal intra-articular radius fractures. Patients were randomly divided into two groups: group I (close reduction and external fixator) and group II (open reduction and internal fixation with volar plating). Periodic clinical examination and x-ray review was carried out to find out functional outcome,range of motion, radiological outcome and complication. Patients were followed up for 6 month. Mean of all the quantitative variables was compared between two groups by unpaired 'T' test. Functional outcome was measured with Quick DASH score. Result: In present study palmer tilt,radial length and radial inclination was significantly greater in volar plate group.ulnar varience was more(-1.18mm) in volar plate group than external fixator group(-1.28mm). The mean QuickDASH scores and time to return to work were similar in patients treated with a locking plate and external fixator (QuickDASH score 2.4 ± 3.0 and 2.9 ± 5.4; 1.9 ± 0.5 months and 2.1 ± 0.7 months, respectively; P > 0.05).In present study Quick DASH score in ext fix group was 9.71 compaired to volar plating group 6.79 at the final followup. Complication rate were higher in close reduction and external fixation group as compared to open reduction and volar plating group. Conclusion: Open reduction and internal fixation with plate fixation had better functional outcome with less complication rate than close reduction and external fixation in management of intra-articular fractures distal end radius.