Can auditory and vestibular findings differentiate vestibular migraine and meniere’s disease?

Background and Objectives: Besides evaluating the auditory and vestibular systems of patients with vestibular migraine (VM) and Meniere's disease (MD), this study aimed to examine the clinical overlaps between these two conditions by detailed evaluation of the patient's symptoms. Subjects and Methods: The ears of the patients with VM and MD were evaluated and patients' vestibular and auditory complaints were questioned particularly. Pure tone audiometry, vestibular evoked myogenic potential (VEMP) responses, and caloric test results were evaluated for objective measurements. Results: The VM group had better air-conduction and bone conduction threshold and speech reception threshold and speech discrimination score test values (p<0.05). Regarding the interaural N1-P1 asymmetry ratio, the cervical VEMP between the groups had significant differences (p=0.019). The MD group had more unilateral tinnitus and ear fullness complaints and canal paresis results (p<0.01). The VM group had more motion sickness complaints (p<0.01). Conclusions: If only ears with hearing loss are evaluated; there was no significant difference between VM and MD, but regardless of hearing level or only the patients with normal hearing were evaluated, the VM group had better hearing levels. It should be considered that patients with VM may have VM-independent hearing loss, and patient complaints should be sufficiently detailed to make an accurate distinction from MD.J Audiol Otol

Güzel sanatlar liselerinde temel tasarım dersinin gerekliliği ve önemi

Art comprises every way that leads to a person’s revealing any perceived situation. As for design, it is an image which is generated in the mind either of an object with a plan or in the object’s generation stage. In arts education, in order to direct the intended creativity light, certain methods are needed to be taught. These methods can be introduced with the Basic Design Lesson. The purpose of the Basic Design Lesson is to gain skills of recognition of techniques, tools and materials which are needed to be used in the beginning of the design stage until the end and regulation of these instruments to attain an appearance. This lesson aims to provide the means of discipline for the individuals who will make a design with accurate observation, research, and easy problem-solving skills. Additionally, Basic Design Lesson is an important tool for individuals to develop skills under the guidance of certain rules and with an artistic disposition, providing them with vision and awareness of visuality and use these together accordingly. The sooner an individual who is educated in arts meets the required basic training, the quicker this individual will reveal the talent inside, advancing in the development and reflect his/her own light. Due to lack of Basic Design Lessons in existing Fine Arts High Schools in Turkey, the graduates of these schools may have to face difficulties in design on their future educations. However, it’s obvious that the sooner the basis of design is established, the better it becomes. The lack of Basic Design Lessons in Fine Arts High Schools in Turkey constitutes the problem of this study. The study is attempted to be described via scanning of indexes and abstracts of scientific publications. In the light of the findings acquired from the scientific data, the result of the necessity of the Basic Design Lesson is deduced and relevant suggestions are made.Sanat eğitimi yaratıcılık eğitimidir.Okutulan derslerde genel olarak öğrencilerin yaratıcılığını ön plana çıkarmaya çalışmak,güzel sanatlar eğitimi için bir ilke olmalıdır.Genel olarak tasarım ve mimarlık gibi fakültelerde okutulan temel tasarım dersini alan öğrencilerin,güzel sanatlar liselerinde böyle bir dersle karşılaşmadıkları için yaşadıkları sorun azımsanamayacak kadar büyüktür. Yaratıcılığın içinde, sanatta yeni ve özgün bir şey yaratmak bütünselliğine ulaşmak için algı da önemli rol oynar Wernher Von Braun “bilinen şeyleri, yeni biçimde kullanmak, şimdiye kadar olduğundan başka biçimde birleştirmektir” diyor. Bundan şu anlaşılıyor ki yaratıcılık üzerine araştırma yapanlar farklı sözcükler de kullansalar içerik olarak birbirine yakın tanımlar yapıyorlar. Temel tasarım dersinde kullanılan materyaller aslında günlük hayatta hemen herkesin karşılaştığı objelerdir.Amaç bu tarz bilinen objelerden düşüncelerinizi yansıtacak yeni bir şey yaratmaktır.Ve bu aktif hayal gücünü ve yaratıcılığı geliştirmektedir.Ancak Güzel sanatlar liselerinde böyle bir dersin yer almaması bir sorundur.Bu sorunun nasıl çözüleceği ile ilgili kapsamlı bir araştırma yapılmış ve çözüm odaklı yapılması gerekenler sıralanmıştır

The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis

Propensity score-matched analysis comparing dose-escalated intensity-modulated radiation therapy versus external beam radiation therapy plus high-dose-rate brachytherapy for localized prostate cancer

Purpose: Dose-escalated external beam radiation therapy (EBRT) and EBRT + high-dose-rate brachytherapy (HDR-BT) boost are guideline-recommended treatment options for localized prostate cancer. The purpose of this study was to compare long-term outcome and toxicity of dose-escalated EBRT versus EBRT + HDR-BT boost. Methods: From 2002 to 2019, 744 consecutive patients received either EBRT or EBRT + HDR-BT boost, of whom 516 patients were propensity score matched. Median follow-up was 95.3 months. Cone beam CT image-guided EBRT consisted of 33 fractions of intensity-modulated radiation therapy with simultaneous integrated boost up to 76.23 Gy (DMean). Combined treatment was delivered as 46 Gy (DMean) EBRT, followed by two fractions HDR-BT boost with 9 Gy (D90%). Propensity score matching was applied before analysis of the primary endpoint, estimated 10-year biochemical relapse-free survival (bRFS), and the secondary endpoints metastasis-free survival (MFS) and overall survival (OS). Prognostic parameters were analyzed by Cox proportional hazard modelling. Genitourinary (GU)/gastrointestinal (GI) toxicity evaluation used the Common Toxicity Criteria for Adverse Events (v5.0). Results: The estimated 10-year bRFS was 82.0% vs. 76.4% (p = 0.075) for EBRT alone versus combined treatment, respectively. The estimated 10-year MFS was 82.9% vs. 87.0% (p = 0.195) and the 10-year OS was 65.7% vs. 68.9% (p = 0.303), respectively. Cumulative 5‑year late GU ≥ grade 2 toxicities were seen in 23.6% vs. 19.2% (p = 0.086) and 5‑year late GI ≥ grade 2 toxicities in 11.1% vs. 5.0% of the patients (p = 0.002); cumulative 5‑year late grade 3 GU toxicity occurred in 4.2% vs. 3.6% (p = 0.401) and GI toxicity in 1.0% vs. 0.3% (p = 0.249), respectively. Conclusion: Both treatment groups showed excellent long-term outcomes with low rates of severe toxicity. Keywords: Dose escalation; High-dose-rate brachytherapy boost; Long-term outcome; Propensity score matching; Toxicity

Diyabetik Bir Olguda Orbital Sellülitin Nadir Bir Komplikasyonu: Kavernöz Sinüs Trombozu

Diyabetin çeşitli enfeksiyonlara ve tromboza eğilimi artırdığı iyi bilinmektedir. Diyabette doğal, hücresel ve humoral bağışıklık mekanizmalarının çeşitli basamaklarında bozukluklar beklenir. Trombosit fonksiyonlarındaki, koagülasyon faktörlerindeki ve damar yapısındaki bozukluklar da tromboza eğilimi artırır. Hem enfeksiyonların hem de trombotik olayların diyabetteki seyri diyabetik olmayan olgulara göre daha ciddidir. Bu yazıda orbital sellülit gelişip kavernöz sinüs trombozu ile komplike olan 94 yaşında diyabetik erkek olgu sunuldu. Olgu orbital sellülit, idrar yolu enfeksiyonu, hiperozmolar non ketotik durum, akut böbrek yetersizliği ve üremiye sekonder kompanse metabolik asidoz tanıları ile endokrinoloji servisine yatırıldı. Antibiyoterapisine ve hidrasyonuna vakit kaybetmeksizin başlanıp gerekli tedavisi yapılan olgu, mortalitesi yüksek kavernöz sinüs trombozu sonrası tedaviye cevap vermeyerek kaybedildi. Özellikle diyabetik olgularda orbital enfeksiyonların komşuluk yoluyla kavernöz sinüse yayılıp septik tromboza yol açarak ölümcül seyredebileceği göz önüne alınarak erken tanı ve tedavisi yapılmalıdırIt is that diabetes mellitus increases tendency to develop infections and thrombosis. Impairment of various mechanisms and agents of humoral and cellular immune systems can be expected. Disturbances of platelet function, coagulation factors, and vascular structure predispose diabetics to thrombotic events. The course of both infections and thrombotic events is often worse than in non-diabetic patients. Presently described is 94-year-old male patient with diabetes who had orbital cellulitis that became complicated with cavernous sinus thrombosis (CST). He was admitted to endocrinology clinic with diagnoses of orbital cellulitis, urinary tract infection, hyperosmolar non-ketotic state, acute renal failure, and compensated metabolic acidosis secondary to uremia. Despite immediate antibiotherapy, hydration, and additional required treatment, patient did not respond and died as a result of CST. There must be awareness, especially for diabetic patients, that orbital infections may spread to nearby cavernous sinuses and cause potentially lethal septic CST. Early diagnosis and immediate treatment are essentia

Wpływ dystrybucji tkanki tłuszczowej oraz wybranych adipokin na insulinooporność w stanie przedcukrzycowym

  Introduction: The risk of developing insulin resistance and metabolic syndrome is particularly high in central obesity. In this study we evaluated the effects of fat distribution and some adipokines on insulin resistance in prediabetic patients. Material and methods: Eighty-seven age- and sex-matched patients were divided into three groups according to their 75-gram oral glucose tolerance test results as follows: impaired fasting glucose group, impaired glucose tolerance group, and normal glucose tolerance group. Fasting insulin levels were measured. Homeostatic model assessment of insulin resistance was calculated. Body fat mass measurements were assessed by bioelectric impedance analyser and abdominal fat thicknesses (subcutaneous, visceral, and preperitoneal) by ultrasonography. The fasting serum levels of several adipokines [adiponectin, leptin, resistin, vaspin, visfatin, retinol-binding protein-4 (RBP-4), tumour necrosis factor-alpha (TNF-alpha)] were measured by ELISA method. Results: The mean body mass index, fat mass measurements, and abdominal fat thicknesses of the groups were similar. There were no differences between groups in terms of the mean fasting insulin, vaspin, RBP-4, leptin, resistin, and TNF-alpha. In comparison of the prediabetic and normal groups, the levels of adiponectin (p &lt; 0.001) and visfatin (p &lt; 0.001) were lower in the prediabetic group. Furthermore, we found that high body mass index (p &lt; 0.01) and fat mass (p &lt; 0.01) and low adiponectin (p &lt; 0.05) levels have roles in the development of insulin resistance in the prediabetic group. Conclusions: We suggested that in the prediabetic period not only obesity but also decreased adiponectin levels play some role in the pathogenesis of insulin resistance. (Endokrynol Pol 2016; 67 (3): 277–282)    Wstęp: Ryzyko rozwoju insulinooporności i zespołu metabolicznego zwiększa się zwłaszcza u osób z otyłością centralną. W niniejszym badaniu oceniono wpływ dystrybucji tkanki tłuszczowej i wybranych adipokin na insulinooporność u osób ze stanem przedcukrzycowym. Materiał i metody: Osiemdziesięciu siedmiu chorych dobranych pod względem wieku I płci podzielono na 3 grupy w zależności od wyniku testu doustnego obciążenia 75 g glukozy: osoby z nieprawidłową glikemią na czczo, osoby z nieprawidłową tolerancją glukozy i osoby z prawidłową tolerancją glukozy. Zmierzono stężenie insulin na czczo. Do oszacowania insulinooporności zastosowano model homeostazy. Masę tkanki tłuszczowej oceniono za pomocą analizatora bioimpedancji elektrycznej, a grubość brzusznej tkanki tłuszczowej (podskórnej, trzewnej i przedotrzewnowej) zmierzono metodą ultrasonograficzną. Stężenie na czczo w surowicy kilku adipokin (adiponektyna, leptyna, rezystyna, waspina, wisfatyna, białko wiążące retinol-4 [RBP-4], czynnik martwicy nowotworów alfa [TNF-alfa]) zmierzono, stosując metodę ELISA. Wyniki: Średni wskaźnik masy ciała, masa tkanki tłuszczowej I grubość brzusznej tkanki tłuszczowej były podobne we wszystkich grupach. Nie stwierdzono różnic między grupami pod względem średniego stężenia insuliny na czczo ani stężeń waspiny, RBP-4, leptyny, rezystyny i TNF-alfa. W porównaniu grup ze stanem cukrzycowym i grupy z prawidłową tolerancją glukozy wykazano, że stężenia adiponektyny (p &lt; 0,001) i wisfatyny (p &lt; 0,001) były niższe u osób ze stanem przedcukrzycowym. Ponadto stwierdzono, że wysoki wskaźnik masy ciała (p &lt; 0,01) i duża masa tkanki tłuszczowej (p &lt; 0,01) oraz niskie stężenie adiponektyny (p &lt; 0,05) przyczyniają się do rozwoju insulinooporności u osób ze stanem przedcukrzycowym. Wnioski: Autorzy sugerują, że nie tylko otyłość, ale również obniżenie stężenia adiponektyny odgrywają pewną rolę w patogenezie insulinooporności w okresie przedcukrzycowym. (Endokrynol Pol 2016; 67 (3): 277–282)

Semi-robotic 6 degree of freedom positioning for intracranial high precision radiotherapy; first phantom and clinical results

<p>Abstract</p> <p>Background</p> <p>To introduce a novel method of patient positioning for high precision intracranial radiotherapy.</p> <p>Methods</p> <p>An infrared(IR)-array, reproducibly attached to the patient via a vacuum-mouthpiece(vMP) and connected to the table via a 6 degree-of-freedom(DoF) mechanical arm serves as positioning and fixation system. After IR-based manual prepositioning to rough treatment position and fixation of the mechanical arm, a cone-beam CT(CBCT) is performed. A robotic 6 DoF treatment couch (HexaPOD™) then automatically corrects all remaining translations and rotations. This absolute position of infrared markers at the first fraction acts as reference for the following fractions where patients are manually prepositioned to within ± 2 mm and ± 2° of this IR reference position prior to final HexaPOD-based correction; consequently CBCT imaging is only required once at the first treatment fraction.</p> <p>The preclinical feasibility and attainable repositioning accuracy of this method was evaluated on a phantom and human volunteers as was the clinical efficacy on 7 pilot study patients.</p> <p>Results</p> <p>Phantom and volunteer manual IR-based prepositioning to within ± 2 mm and ± 2° in 6DoF was possible within a mean(± SD) of 90 ± 31 and 56 ± 22 seconds respectively. Mean phantom translational and rotational precision after 6 DoF corrections by the HexaPOD was 0.2 ± 0.2 mm and 0.7 ± 0.8° respectively. For the actual patient collective, the mean 3D vector for inter-treatment repositioning accuracy (n = 102) was 1.6 ± 0.8 mm while intra-fraction movement (n = 110) was 0.6 ± 0.4 mm.</p> <p>Conclusions</p> <p>This novel semi-automatic 6DoF IR-based system has been shown to compare favourably with existing non-invasive intracranial repeat fixation systems with respect to handling, reproducibility and, more importantly, intra-fraction rigidity. Some advantages are full cranial positioning flexibility for single and fractionated IGRT treatments and possibly increased patient comfort.</p

Perioperative changes in osteopontin and TGFβ1 plasma levels and their prognostic impact for radiotherapy in head and neck cancer

Background: In head and neck cancer little is known about the kinetics of osteopontin (OPN) expression after tumor resection. In this study we evaluated the time course of OPN plasma levels before and after surgery. Methods: Between 2011 and 2013 41 consecutive head and neck cancer patients were enrolled in a prospective study (group A). At different time points plasma samples were collected: T0) before, T1) 1 day, T2) 1 week and T3) 4 weeks after surgery. Osteopontin and TGFβ1 plasma concentrations were measured with a commercial ELISA system. Data were compared to 131 head and neck cancer patients treated with primary (n = 42) or postoperative radiotherapy (n = 89; group B1 and B2). Results: A significant OPN increase was seen as early as 1 day after surgery (T0 to T1, p < 0.01). OPN levels decreased to base line 3-4 weeks after surgery. OPN values were correlated with postoperative TGFβ1 expression suggesting a relation to wound healing. Survival analysis showed a significant benefit for patients with lower OPN levels both in the primary and postoperative radiotherapy group (B1: 33 vs 11.5 months, p = 0.017, B2: median not reached vs 33.4, p = 0.031). TGFβ1 was also of prognostic significance in group B1 (33.0 vs 10.7 months, p = 0.003). Conclusions: Patients with head and neck cancer showed an increase in osteopontin plasma levels directly after surgery. Four weeks later OPN concentration decreased to pre-surgery levels. This long lasting increase was presumably associated to wound healing. Both pretherapeutic osteopontin and TGFβ1 had prognostic impact

Cesarean Section in a Gazel (Gazella gazelle) with Dystocia

Bir yaşında, ilk kez doğum yapacak olan bir ceylan, güç doğum şikayetiyle Ankara Üniversitesi Veteriner Fakültesi Acil Kliniğine getirildi. Yapılan ultrasonografik muayene sonucu; yavruların viabilitesinin çok zayıf olması ve yavru sularının azalmasının belirlenmesi nedeniyle sezaryen operasyonuna karar verildi. Operasyonla her kornu ayrı ayrı ensize edilerek, iki ölü yavru alındı.A one-year old, nulliparious gazelle was admitted to the clinic of the department of obstetrics and gynaecology, faculty of veterinary medicine, Ankara University with dystocia. The surgical treatment was performed, because of low foetal viability and foetal fluid loss was determined by ultrasonographic examination. Two dead foetuses were removed by cesarean section with seperate incisions on each uterine horn