Periodic Physical Examination Research Articles

Incidental discovery of unilateral hydronephrosis unveiling psoas major desmoid-type fibromatosis in a 24-year-old male: A case report with a 5-year follow-up.

Desmoid-type fibromatosis (DTF), also known as aggressive fibromatosis, is a rare neoplasm originating from the fascial or musculoaponeurotic tissues. While benign and characterized by slow growth, it exhibits local aggressiveness and lacks specific clinical characteristics. However, in a considerable percentage of patients, it could be asymptomatic and discovered by accident during routine clinical examinations. Only a few cases of DTF arising from the psoas major muscle have been reported in the medical literature. A 24-year-old male, asymptomatic and without significant personal or family medical history, was diagnosed with grade 2 hydronephrosis by abdominal ultrasonography during a routine physical examination. This diagnosis was made 15 days after undergoing uncomplicated open-heart surgery to repair an atrial septal defect. Intravenous pyelogram revealed hydronephrosis with dilation of the pelvicalyceal system. Ureteroscopy ruled out any intrinsic lesions of the ureter. Contrast-enhanced computed tomography identified a 3.5 × 2 × 5.2 cm mass in the retroperitoneum, closely associated with the psoas muscle and enveloping the ureter adjacent to the iliac artery. Postoperative pathological analysis confirmed a definitive diagnosis of sporadic DTF. The patient underwent exploratory abdominal surgery, during which the tumor was resected without any intraoperative complications. After close monitoring over a 5-year follow-up period, which included periodic physical examinations, magnetic resonance imaging, and ultrasonography, no local recurrence was detected. Achieving an accurate preoperative diagnosis presents a challenge in cases involving retroperitoneal tumors originating from the psoas major muscle and encasing the ureter. However, the insertion of a double J stent is deemed a crucial step in the surgical process, facilitating the dissection and isolation of the ureter from the tumor while preserving kidney function.

Glenohumeral internal rotation deficit: insights into pathologic, clinical, diagnostic, and therapeutic characteristics.

Overhead athletes undergo significant biomechanical adaptations due to repetitive overhead movements, primarily affecting the glenohumeral joint. These adaptations can lead to glenohumeral internal rotation deficit (GIRD), which is characterized by posterior capsule stiffness that results in glenohumeral joint translation and a shift in the center of gravity. The severity of GIRD is dependent upon the presence of asymmetry between gained external and lost internal rotation, which is defined clinically as an asymmetry exceeding 20º; this reduces the total range of motion compared to the unaffected limb or baseline measurements. Diagnosis is challenging, as it can be mistaken for chronic scapular adaptations. To mitigate misdiagnosis, a high clinical suspicion is crucial in overhead athletes, especially those who began performing forceful overhead movements before closure of growth plates. Periodic physical examinations should establish baseline values for glenohumeral rotation and track changes in glenohumeral motion to aid in diagnosis. Symptoms of GIRD include shoulder pain, stiffness, and decreased force exertion. Magnetic resonance imaging is the preferred imaging method for evaluating GIRD and assessing concomitant soft tissue pathologies. Untreated GIRD can lead to rotator cuff strength imbalances. Treatment mainly involves conservative measures, such as physical therapy, to improve internal rotation and alleviate posterior tightness. Surgical interventions are considered when symptoms persist despite conservative treatment with physical therapy or in the presence of concomitant pathologies.

Educating the upcoming generation of Sports Doctors

The SEMS Journal and the SEMS Education Committee publish an annual “Special Education Issue”. These issues are based on the contents of the individual eight SEMS postgraduate education courses and intend to serve as a reference body of work for all doctors treating athletes. The topics of each course are defined by the education committee. In Nottwil, we traditionally focus on topics of internal medicine such as sports cardiology, pneumology/allergology and sports, gastrointestinal aspects in sport as well as sports haematology and endocrinology. The periodic physical examination of athletes (PPE, or SPU in Swiss German part), with hands-on workshops with athletes, is a major topic in this course.

Nursing Care with A Medical Diagnosis of Non-hemorrhagic Stroke in High Care Unit of Banjarnegara Islamic Hospital: A Case Study

Objective: The purpose of this study was to determine the development of non-hemorrhagic stroke patients by maximizing the implementation of ROM during treatment. Method: The method used is descriptive method with a case study approach in non-haemorrhagic stroke patients with decreased consciousness. The case study process was carried out by finding patient data and classified according to continued inclusion criteria. interviews (to the family) and secondary data collection from medical records, observation of the patient's condition and periodic physical examinations. After obtaining the data, further documentation of the nursing process is carried out from assessment, data analysis, nursing problems, nursing interventions, nursing implementation and evaluation. Result: Nursing problems that arise include: risk of ineffective cerebral perfusion related to hypertension, ineffective airway clearance related to retained secretions and impaired physical mobility associated with decreased muscle strength, Three nursing problems have not been resolved because stroke is a brain tissue damage that is characterized by irreversible (cannot be returned) and it takes a long time for the recovery process.

Functional Classification Spaces according to walking speed in self-sufficient Chilean older adults: A complement to the Periodic Physical Examination.

Walking speed is related to functionality in daily activities. Preventive Medicine Examination of the Chilean older adults is a vital prevention program for Chilean community- dwelling older adults. However, this evaluation does not include speed in its battery of tests. To evaluate the functional classification spaces for threshold, reference, and categorization val-ues of self- selected and maximum walking speed applied to self- sufficient older adults. Seventy- two self- sufficient older adults participated in this observational, exploratory, and cross- sectional study. Each participant was asked to walk naturally and then at full speed for three minutes. Through a dispersion graph between self- selected walking speed (axis "x") and maximum walking speed (axis "y"), functional classification spaces were constructed according to documented values for i) thresholds of basic functionality, ii) referential for the instrumental spectrum and iii) functional categorization for "household walker" (< 0.4 meters per second, m/s), "limited community ambulator" (0.40 to 0.80 m/s), "community ambulator" (0.81 to 1.3 m/s), and "cross street safely" (> 1.3 m/s). The relative frequency (%) of older adults who meet each established quadrant was determined. The threshold was reached by 100% of the participants (basic daily activities). About 80% of the older adults have a functional classification space below the reference limit (instrumental and advanced daily activities). It was also found that 81% of women and 69% of men are "efficient in the community", and 31% of men and 14% of women reach the minimum value for "effec-tive street crossing" (advanced daily activities). The exploration of functional classification spaces according to self- selected walking speed and maximum walking speed applied to a group of self- sufficient older adults reveals that this pop-ulation is at risk of deteriorating instrumental and advanced activities of daily living.

Differential diagnosis and comorbid physical illness of schizophrenia

Background: Schizophrenia is a neurodevelopmental disorder that generally develops during adolescence or early adulthood. However, differentiating it from psychosis caused by a physical illness is difficult due to the phenotypebased diagnostic system. In this review, differential diagnosis of schizophrenia and the comorbid physical illnesses of patients with schizophrenia will be discussed.Current Concepts: Psychotic symptoms can be caused by various physical illnesses, and patients with schizophrenia have many physical comorbidities. Symptoms of psychosis can also be expressed by physical illness including brain tumors, encephalitis, temporal lobe epilepsy, autoimmune disease, and genetic disease. For the differential diagnosis of other physical illnesses that can cause psychosis, biological tests are essential. Depending on the cause, antipsychotics and treatment of physical diseases are required. In addition, patients with schizophrenia have many comorbid medical conditions such as obesity, diabetes, cardiovascular disease, but the diagnosis rate is low, and the mortality is higher than that of the general population due to untreated medical diseases.Discussion and Conclusion: The differential diagnoses of schizophrenia and physical illness causing psychosis are important. To decrease the high mortality of patients with schizophrenia, periodic physical condition examinations and mental status examinations should be conducted.

Durability, household usage and washing pattern of DuraNet© and Interceptor® long-lasting insecticidal nets in long-term field trials in India.

Universal coverage of population with long-lasting insecticidal nets (LLINs) living in endemic areas inhabited by ethnic tribal communities or in difficult to reach areas was found effective for disease control where other interventions such as indoor residual spraying have limited success because of operational issues. Evaluation of different LLINs with varied insecticides and fabrics are being evaluated to meet the demand of new products. This study was undertaken on two brands of LLINs, DuraNet© and Interceptor® that varied in fabric and manufacturing technologies to assess the usability in field conditions for atleast three years. In large-scale field trials DuraNet©, alpha cypermethrin incorporated polyethylene net, was evaluated in Odisha state while, Interceptor® net, alpha cypermethrin coated polyester net was evaluated in Chhattisgarh and Gujarat states for a period of three years following WHO guidelines. Durability, usage pattern and washing behavior were monitored through periodic surveys and physical examination of nets. Survivorship of both the nets was 84-100% and every night usage rate was >62% in all seasons. Washing frequency was largely within the prescribed limits. The proportion of DuraNet© with holes was 26.7% in year one 74% in year three. In Gujarat, proportion of Interceptor® nets with holes at six months was 33.3% increased to 87% in year three and in Chhattisgarh, 6.7% after six months to 93.3% after three years of use respectively. Both the nets revealed a useful life of three years under the field condition.

A LONG PROSPECTIVE OBSERVATIONAL STUDY ON PREVALENCE OF ATOPIC DERMATITIS IN EARLY CHILDHOOD TO ADOLESCENCE

There are few prospective observational studies on the prevalence of atopic dermatitis (AD) in children. We aimed to prospectively investigate the dynamics of change in the prevalence of AD from early childhood to adolescence. We conducted a survey with a modified questionnaire to diagnose AD based on The International Study of Asthma and Allergies in Childhood questionnaire with 1230 13-year-old children who were born in the Minami ward, Yokohama City between May 2004 and June 2005 and had undergone physical examinations by dermatologists at 3 years of age. Among the 422 children who answered the questionnaire, 210 had undergone periodic physical examinations by dermatologists from 4 months to 3 years of age (Cohort 1), whereas 212 had undergone physical examinations only at 3 years of age (Cohort 2). The prevalence of AD was 16.9% in 422 children at 13 years of age, with 22.9%, 16.6%, 20.0% and 18.3% prevalence at 4 months, 18 months, 3 years and 13 years of age, respectively, in children who were followed up long-term. The frequency of AD occurrence per year decreased after the age of 3 years; a history of AD at this age was significantly related to AD at 13 years of age (Fisher's exact test, p<0.001). In conclusion, it was suggested that AD in 3-year-old children is one of the risk factors for the development of AD in 13-year-old children.

Relationship of Perceived Social Support With the Activities of Daily Living in Older Adults Living in Rural Communities in Iran

Objectives: The increasing trend in aging population raises the need to pay attention to the daily activities of the elderly and their social support as an effective factor in promoting their health. This study aims to investigate the correlation of perceived social support and demographic variables with the Activities of Daily Living (ADL) in older adults living in rural communities in Iran. Methods &amp; Materials: This is a descriptive-analytical study with cross-sectional design conducted on 430 elderly people aged ≥60 years living in a rural community in Iran (Bayza county located 45 km away from Shiraz city) who were selected using a convenience sampling method. Procidano &amp; Heller’s Perceived Social Support - Family Scale (PSS-Fa) and the ADL scale for the elderly were used for data collection. The ADL questionnaire’s internal consistency by calculating Cronbach’s alpha coefficient was obtained 0.96. The PSS-Fa with a Cronbach’s alpha coefficient ranging from 0.88 to 0.91 has acceptable internal consistency. The reliability of its Persian version using Cronbach’s alpha coefficient was obtained 87%. Data were analyzed in SPSS V. 25 software using multivariate ANOVA and regression analysis. Results: The mean±SD age of the participants was 69.67±7.067 years. The mean score of PSS-Fa and the ADL scale was reported 16.55± 5.16 and 55.10±3.07, respectively. Perceived social support, education and age had significant effect correlation with the ability to perform ADL in the elderly (P&lt;0.001), while marital status and gender showed no significant correlation (P&gt;0.05). The age factor was inversely correlated with the ability to perform ADL; hence, the independence of older adults decreases with the increase of age. Conclusion: Many demographic variables and social support affect the ability to perform ADL in the elderly. Social support can be used as a social investment to improve the quality of life of the elderly. Therefore, considering that one of the duties of health care providers is to improve the health status of the elderly, it is necessary for health care providers to increase social support and maintain and promote a healthy and active life for them through educational programs and periodic physical examinations.

Four Way Safety Valve Tester Design for Heavy Vehicle Brake Systems

In our country, tractors are required to undergo a periodic physical ex-amination every three years after the first three years, cars and motorcy-cles every two years after the first three years, and heavy and light com-mercial vehicles every year after the first one. In the physical examina-tions of vehicles, vehicle description, lighting system, brake system, steering system, superstructure, etc. many systems and parts are checked. Although the vehicles use braking systems of various types and different technologies, the main purpose is to provide safe, slow driving and stop-ping of vehicles in traffic. Air braking systems are used in vehicles with heavy loads carrying cargo and passengers. In the event of any leakage that may occur in the brake system during the cruise, the part called Four-way Safety Valve is used in order to eliminate the possibility of the air tanks emptying and the vehicle to be left without brakes. Its task is to prevent the parking brake, front axle and rear axle brakes from being stored in separate air tanks and preventing the leak line from affecting solid lines in the event of an air leak. Air brake system Four-way safety valve test is carried out during the physical examination of vehicles. In this study, it is aimed to automate the manual safety valve test using a microcontroller card, solenoid valve, pressure transmitter and PC soft-ware. Thanks to the test device and software to be developed, it will be ensured to eliminate non-ergonomic movements performed by the tech-nician during the test, increase the reliability of the test and eliminate the environmental polluting elements during the test.

Abstract CT243: A first-in-human phase 1 ascending, multiple dose, safety and tolerance study of Vaxinia (CF33-hNIS), a novel chimeric oncolytic poxvirus, administered intratumorally or intravenously in adult patients with mixed advanced solid tumors (MAST)

Abstract Introduction and Objective: CF33-hNIS is a novel, chimeric orthopoxvirus with robust anti-tumor activity at relatively low titers and with a low multiple of infectivity (MOI) in a variety of pre-clinical models. This is a Phase 1, open-label, dose escalation study in adult patients with selected advanced or metastatic solid tumors to evaluate the safety and tolerance of CF33-hNIS administered intratumorally (IT) or intravenously (IV). Secondary objectives include assessment of immune activation, tumor infectivity, viral kinetics, anti-tumor activity and identification of a RP2D. Methods: This is a Phase 1, open-label, dose escalation study in sequential cohorts of 3 to 6. Patients with advanced or metastatic melanoma and triple negative breast cancer (TNBC) with superficial lesions accessible for injection will receive IT dosing. Patients with metastatic melanoma, TNBC, urothelial cancer and non-small cell lung cancer (NSCLC) in organs or deep tissues will receive IV infusions of CF33-hNIS. Dose escalation will occur separately for IT and IV dosing. Successive cohorts of 3 patients will be enrolled at each dose level starting with 105 and ascending to 106, 107, 108 and 109 PFU for IT and IV routes. Treatment is given on days 1 and 8 of cycle 1 and day 1 of cycles 2 through 6 every 21 days. Dose escalation will occur if no DLTs are observed among the first 3 patients in a cohort. If 1 DLT occurs, 3 additional patients will be enrolled at that dose. If &amp;lt 2 of 6 patients experience a DLT dose escalation will proceed. Patients with an ongoing objective response will be followed on study by periodic imaging or physical examination at 3 month intervals. Patients will undergo serial sampling of blood and urine and oral and rectal swabs at specified times after each dose for evaluation of viral titers by viral plaque assay (VPA) and PCR. Immunophenotyping and cytokine analysis for immune response will be performed for analysis of lymphocyte subsets and cytokines including interferon gamma, tumor necrosis factor alpha (TNFα), interleukin-1 (IL-1) and interleukin-6 (IL-6). In selected patients, tumor biopsies will be obtained for histological examination and viral titers. hNIS based imaging (SPECT) will be conducted 24 to 96 hours after the first dose. Safety and tolerance will be assessed by physical examination, vital signs, electrocardiogram (ECG), clinical laboratories, ECOG performance status and adverse events. Results: Pending. Conclusions: Pending. Citation Format: Seymour Fein, Lisa Guttman, Mark T. Marino, Yuman Fong. A first-in-human phase 1 ascending, multiple dose, safety and tolerance study of Vaxinia (CF33-hNIS), a novel chimeric oncolytic poxvirus, administered intratumorally or intravenously in adult patients with mixed advanced solid tumors (MAST) [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT243.

Analysis of health risk and respiratory complaints on footwear craftsman exposed to Toluene vapour.

Background: The primary effect of toluene on the respiratory tract following inhalation is irritation. This study was conducted to analyze the level of health risks and respiratory complaints due to toluene exposure by footwear craftsmen, in order to get scientific reference for Maximum Contaminant Level and working tenure restriction.Design and Methods: A total of 51 footwear craftsmen from eight factories participated in this study. The toluene concentration in the work environment was measured according to National Institute of Occupational Safety and Health 1501. Moreover, data were collected using an American Thoracic Society standardized questionnaire to assess respiratory health effects. A characterization of risk model was to analyze the toluene exposure risk and suggest improvements.Results: The results showed toluene levels were over the Threshold Limit Value 20 ppm (138.88 ppm). The most commonly observed respiratory symptoms included coughing by 81.3% and cold by 85.7%, Symptoms of respiratory irritation by 72.7%, higher among workers who were highly exposed to toluene above the median. This is observed from the opportunity value (P-value) of toluene exposure with the characteristics the workers of each variable which was less than 0.05 work station and working tenure. Maximum Contaminant Level of toluene is 4.59 ppm, a safe working tenure restriction for toluene exposure is maximum 25 years.Conclusions: The recommended risk control measures include ventilation improvements, personal hygiene and protection of workers through periodic physical examinations.Significance for public healthToluene levels over the Threshold Limit Value can cause irritative respiratory tract diseases. Therefore, it is recommended that workplaces are separated from domestic activities whenever possible and the workers are protected from unnecessary exposure. This study describes the level of health risks and respiratory complaints due to toluene exposure by footwear craftsmen in footwear industry.

Oral administration of voriconazole with surgical fungal plaque debridement for the treatment of sinonasal aspergillosis with cribriform plate lysis in three dogs.

3 dogs with chronic sinonasal signs (sneezing, nasal discharge, or epistaxis [or a combination of signs]) were examined. For all 3 dogs, CT revealed variable degrees of nasal turbinate destruction and frontal sinus involvement with cribriform plate lysis. Fungal plaques were detected during rhinoscopy or sinusoscopy. Results of fungal culture (2 dogs) or cytologic examination of a plaque specimen (1 dog) supported a diagnosis of sinonasal aspergillosis. All dogs underwent surgical rhinotomy or sinusotomy (or both) for fungal plaque debridement followed by oral treatment with voriconazole and periodic physical examinations, clinicopathologic analyses, and assessments of serum drug concentrations for a period ≥ 22 weeks. All dogs had considerable to complete reduction of their clinical signs and tolerated voriconazole treatment with minimal adverse effects. Adverse effects included development of reversible neurotoxicosis (associated with high serum voriconazole concentration) and mildly high serum liver enzyme activities. The dosage of voriconazole administered to achieve therapeutic serum concentrations (2.5 to 3.3 mg/kg [1.1 to 1.5 mg/lb], PO, q 12 h) was substantially lower than dosages suggested by previously published studies in dogs. The 3 dogs remained clinically normal or had mild clinical signs after voriconazole discontinuation for follow-up times of 6 to 15 months. Findings in these 3 dogs indicated that surgical fungal plaque debridement followed by oral treatment with voriconazole may be an effective treatment option for dogs with sinonasal aspergillosis and cribriform plate lysis. Further evaluation of this treatment regimen with repeated CT examinations and longer follow-up times is warranted.

Association Between Push-up Exercise Capacity and Future Cardiovascular Events Among Active Adult Men

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Robust evidence indicates an association of increased physical fitness with a lower risk of CVD events and improved longevity; however, few have studied simple, low-cost measures of functional status. To evaluate the association between push-up capacity and subsequent CVD event incidence in a cohort of active adult men. Retrospective longitudinal cohort study conducted between January 1, 2000, and December 31, 2010, in 1 outpatient clinics in Indiana of male firefighters aged 18 years or older. Baseline and periodic physical examinations, including tests of push-up capacity and exercise tolerance, were performed between February 2, 2000, and November 12, 2007. Participants were stratified into 5 groups based on number of push-ups completed and were followed up for 10 years. Final statistical analyses were completed on August 11, 2018. Cardiovascular disease-related outcomes through 2010 included incident diagnoses of coronary artery disease and other major CVD events. Incidence rate ratios (IRRs) were computed, and logistic regression models were used to model the time to each outcome from baseline, adjusting for age and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared). Kaplan-Meier estimates for cumulative risk were computed for the push-up categories. A total of 1562 participants underwent baseline examination, and 1104 with available push-up data were included in the final analyses. Mean (SD) age of the cohort at baseline was 39.6 (9.2) years, and mean (SD) BMI was 28.7 (4.3). During the 10-year follow up, 37 CVD-related outcomes (8601 person-years) were reported in participants with available push-up data. Significant negative associations were found between increasing push-up capacity and CVD events. Participants able to complete more than 40 push-ups were associated with a significantly lower risk of incident CVD event risk compared with those completing fewer than 10 push-ups (IRR, 0.04; 95% CI, 0.01-0.36). The findings suggest that higher baseline push-up capacity is associated with a lower incidence of CVD events. Although larger studies in more diverse cohorts are needed, push-up capacity may be a simple, no-cost measure to estimate functional status.

Aile hekimlerinin periyodik muayene rehberine yönelik bilgi tutum ve davranışlarının değerlendirilmesi

Although the causes of mortality and morbidity vary among countries, geographies, cultures and races, today the disease structure has been differentiated and in the 21st century the first order received noncommunicable diseases. In non-communicable disease protection primary protection is 4 times more effective than secondary and tertiary protection. The basis of primary prevention is the periodic health examinations, mainly immunization and counseling. In this context, one of the most important methods recommended for the implementation of preventive health services is periodical health examinations with standards set by various national and international organizations. Periodic health check-up is defined as regular health check-up in order to contribute to the preservation of health through healthy screening, examination and laboratory testing, counseling and health education of healthy persons who are not yet showing signs of illness. In primary prevention measures, it is emphasized that the role of service providing units is very important. With this research, it is aimed that the knowledge, attitude and behaviours of family physicians providing primary healthcare service throughout the country towards “Periodic Health and/or Physical Examinations and Healthcare Screening Guidelines Proposed in the Family Medicine Practice”, which is advisory, are defined. The questionnaire formulated on the basis of the recommended screening guide in Turkey was uploaded online on the Family Medicine Distance Learning Platform (in Tr. abbr. AHUZEM) and 20,518 registered family physicians in AHUZEM were asked to respond to the form. The family physician responded to the questionnaire on AHUEM for 23 days from 2014 to 13 February 2014 for 20 days. At the end of the study, general knowledge average of family physicians was calculated as 3,28, attitude average of 3,47 and behavior average of 2,65. In addition, it was evaluated that family physicians' knowledge concerning the periodic health examination and health screening guidelines proposed for our country is at almost medium-level and even if the level for their attitudes is higher than their knowledge level, they do not turn on the same plane into behaviour.

Pharmacokinetics of ketamine and norketamine following intramuscular administration combined with ketamine in tigers (Panthera tigris)

In zoo practice, for physical examination or medical procedure in captive tigers, chemical immobilization is needed and ketamine (KET) in association with sedatives is an option frequently used (Clark-Price et al., 2015). Aims of the study is the assessment of the pharmacokinetics of KET and its main metabolite, norketamine (NORKET), after its intramuscular administration in combination with dexmedetomidine in tigers.Nineteen adult captive tigers, from different zoos, were scheduled for periodic physical examination or diagnostic procedures at the Milan University facilities. All animals were administered with a combination of KET at 2 mg/kg and dexmedetomidine at 10 µg/kg, given intramuscularly through blowpipe darts. If necessary, tigers where re-administered with variable doses of KET and dexmedetomidine or other drugs. When animals were sufficiently sedated, blood samples were collected every 5-10 min for the time tigers were safely approachable. Nine animals were assigned to standard protocol group (KET 2 mg/kg and dexmedetomidine 10 µg/kg) and ten animals to non-standard protocol group (tigers administered with different doses of KET, 2 – 2.5 mg/kg, and dexmedetomidine 10 – 30 µg/kg or with any other necessary drug, such as titrate-to-effect propofol and isoflurane, respectively for anaesthesia induction and maintenance). Ketamine and NORKET were extracted from plasma according to a validated HPLC-UV method (Zonca et al., 2012). For pharmacokinetic assessment, KET and NORKET concentrations were analysed with a noncompartmental approach (Phoenix® 7.0, Pharsight). Differences in the pharmacokinetic parameters between groups were statistically analysed (SPSS 25.0, SPSS Inc.).This is the first study that evaluates the pharmacokinetics of KET and NORKET in tigers. Due to the harmful attitude of these animals, samples collection was limited to the period of sedation, a short time for a complete pharmacokinetic evaluation. Nevertheless, we observed a favorable kinetic profile of KET and NORKET and, from a clinical point of view, all animals showed a good recovery, no adverse effects and a good level of sedation. Standard Protocol (mean ± s.d.)Non-Standard protocol (mean ± s.d.) KetamineHL_Lambda_zmin77.62 ± 54.5076.14 ± 67.32 Tmaxmin27.78 ± 7.9049.70 ± 29.64 Cmaxug/mL0.63 ± 0.170.67 ± 0.19 AUClastmin*ug/mL23.84 ±6.40*35.97 ± 12.84* AUMClastmin*min*ug/mL802.24 ± 331.03*2054.97 ± 1018.88* MRTlastmin32.88 ± 5.71*54.38 ± 19.71* NorketamineTmaxmin51.89 ± 8.95*77.10 ± 24.41* Cmaxug/mL0.24 ± 0.070.23 ± 0.09 AUClastmin*ug/mL7.30 ± 3.9811.07 ± 5.46 AUMClastmin*min*ug/mL291.94 ± 227.01*701.87 ± 424.80* MRTlastmin36.95 ± 7.32*58.65 ± 19.58*HL_Lambda_z = Elimination Half-Life; Tmax = Time to Maximum concentration; Cmax = Maximum Concentration; AUClast = Area Under the Curve to the last concentration; AUMClast = Area under the first Moment Curve to the last concentration ;MRTlast = Mean Residence Time to the last concentration Tab.1: Pharmacokinetic parameters of ketamine and norketamine in nineteen adult captive tigers after intramuscular administration of 2 mg/kg of ketamine, with or without variation from the standard protocol, in combination with dexmedetomidine (with * are indicated results with p < 0.05).

Options for Adjuvant Therapy for Uterine Leiomyosarcoma.

Uterine leiomyosarcoma (uLMS) is a rare disease; in the data from the SEER database, 3165 cases of uLMS were diagnosed between January 2000 and December 2012. While a majority of patients (60%) are diagnosed with early stage disease, recurrence rates are high. Five-year disease-specific survival is 76% for patients with FIGO stage I and 60% for patients with FIGO stage II disease. Adjuvant treatments, including radiation therapy, chemotherapy, and combined modality approaches, have been explored with the goal of demonstrating improved survival. However, heterogeneous patient populations, small sample sizes, and lack of no-treatment control arms have limited the interpretation and reliability of the results from these studies. A randomized trial of adjuvant pelvic radiation compared to no additional treatment showed that adjuvant radiation did not improve recurrence or survival outcomes for early-stage uterine LMS. To date, no prospective, randomized trial has been completed comparing adjuvant chemotherapy to observation. A recent well-designed retrospective study showed that women treated with adjuvant gemcitabine-docetaxel had no improvement in progression-free or overall survival compared to women who received no additional treatment. Thus, current data support our recommendation against adjuvant radiation or chemotherapy treatment for patients with non-morcellated, completely resected, and uterine-confined leiomyosarcoma. We recommend that these patients be observed with periodic surveillance imaging and physical examinations.

MON-P272: Analysis of Periodic Physical Examination Status in Infant from a Township Hospital in Poor Regions of Yunnan Province

MON-P272: Analysis of Periodic Physical Examination Status in Infant from a Township Hospital in Poor Regions of Yunnan Province

Therapeutic experience with oral finasteride for androgenetic alopecia in female-to-male transgender patients

Androgenic treatment of female-to-male transgender patients may result in androgenetic alopecia (AGA). Use of 5-alpha-reductase inhibitors are useful as oral treatment of AA in men. There are no previous studies of the use of finasteride in transgender men as treatment of AGA. To evaluate the effectiveness and safety of an oral 5α-reductase inhibitor (finasteride) for AA developed in transgender men. This single-centre retrospective study enrolled female-to-male transgender patients with a clinical diagnosis of AGA to receive 1 mg of an oral type II 5α-reductase inhibitor for at least 12 months. In all, 10 patients were included in the study. All the patients received a clinical diagnosis of male-pattern AGA, with 90% classified as stage IV on the Norwood-Hamilton scale. Mean onset of AGA was 3.25 years after the introduction of androgenic treatment, and 70% of the patients had a family history of AGA. All the patients improved one grade on the Norwood-Hamilton scale after a mean of 5.5 months (range 4-6 months) since the start of finasteride treatment. Two patients stopped treatment for economic reasons and one stopped due to dyspepsia. No sexual or other adverse effects were observed. Patients were given periodic physical and analytical examinations by endocrinologists without any significant finding. Mean follow-up of patients was 16.2 months. AA in transgender men has a delayed onset, and is clinically and therapeutically similar to the common male-pattern-AGA in cis-gender men.

The impact of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis.

BackgroundThe aim of this study is to assess the impact of routine MRI surveillance to detect tumour recurrence in children with no new neurological signs or symptoms compared with alternative follow-up practices, including periodic clinical and physical examinations and the use of non-routine imaging upon presentation with disease signs or symptoms.MethodsStandard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases have been searched, and further citation searching and reference checking will be employed. Randomised and non-randomised controlled trials assessing the impact of routine surveillance MRI to detect tumour recurrence in children with no new neurological signs or symptoms compared to alternative follow-up schedules including imaging upon presentation with disease signs or symptoms will be included.The primary outcome is time to change in therapeutic intervention. Secondary outcomes include overall survival, surrogate survival outcomes, response rates, diagnostic yield per set of images, adverse events, quality of survival and validated measures of family psychological functioning and anxiety. Two reviewers will independently screen and select studies for inclusion. Quality assessment will be undertaken using the Cochrane Collaboration’s tools for assessing risk of bias. Where possible, data will be summarised using combined estimates of effect for time to treatment change, survival outcomes and response rates using assumption-free methods. Further sub-group analyses and meta-regression models will be specified and undertaken to explore potential sources of heterogeneity between studies within each tumour type if necessary.DiscussionAssessment of the impact of surveillance imaging in children with CNS tumours is methodologically complex. The evidence base is likely to be heterogeneous in terms of imaging protocols, definitions of radiological response and diagnostic accuracy of tumour recurrence due to changes in imaging technology over time. Furthermore, the delineation of tumour recurrence from either pseudo-progression or radiation necrosis after radiotherapy is potentially problematic and linked to the timing of follow-up assessments. However, given the current routine practice of MRI surveillance in the follow-up of children with CNS tumours in the UK and the resource implications, it is important to evaluate the cost-benefit profile of this practice.Systematic review registrationPROSPERO CRD42016036802Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0318-1) contains supplementary material, which is available to authorized users.