Clinical and neuroimaging determinants of minimally conscious and persistent vegetative states after acute stroke

Emre Kumral,Fatma Ece Bayam,Bedriye Köken,Can Emre Erdoğan 대한신경집중치료학회 2019 대한신경집중치료학회지 Vol.12 No.1

Background: Patients with persistent vegetative state (PVS) show no evidence of awareness of self or their environment, and those with minimally conscious state (MCS) have severely impaired consciousness with minimal but definite behavioral evidence of self or environmental awareness after stroke. Neuroimaging and clinical characteristics separating these two close consciousness states after stroke were insufficiently studied. Methods: We conducted a hospital-based cohort study of all patients with stroke (2011 to 2017) who underwent 3T magnetic resonance imaging and consciousness assessment after 3 months of inclusion. Univariate and multivariate regression analyses were used to estimate the relative risk of neuroimaging markers for differentiation of PVS and MCS. Results: Of 3,600 eligible subjects, 323 patients (0.09%) had PVS and 93 (0.02%) had MCS (mean age, 62.25±13.4 years). Higher stroke volume was strongly associated with PVS compared to MCS (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98 to 1.00; P=0.001). On univariate analysis, cingulate gyrus (OR, 2.7; 95% CI, 1.62 to 4.36; P=0.001) and corpus callosum (OR, 2.1; 95% CI, 1.28 to 3.44; P=0.003) involvement was significantly associated with PVS. However, on multivariate analysis, only cingulate gyrus involvement was independently associated with PVS (OR, 2.2; 95% CI, 1.33 to 3.72; P=0.002). Conclusion: Our results indicate that PVS and MCS are different consciousness states according to clinical and neuroimaging findings. To predict outcome, cognitive performance of these patients should be well questioned after stroke.

Efficacy of Trimetazidine Dihydrochloride for Relieving Chronic Tinnitus: A Randomized Double-Blind Study

Tolgar Lütfi Kumral,Güven Yıldırım,Güler Berkiten,Ziya Saltürk,Enes Ataç,Yavuz Atar,Yavuz Uyar 대한이비인후과학회 2016 Clinical and Experimental Otorhinolaryngology Vol.9 No.3

Objectives: To evaluate the efficacy of trimetazidine dihydrochloride as a treatment for chronic tinnitus. Methods: A total of 97 chronic tinnitus patients were evaluated in this randomized, prospective, double-blind, placebo-controlled trial. After assessing for eligibility, 82 patients were randomly assigned into placebo or trimetazidine groups according to the medication. The trimetazidine group received 20×3 mg/day per oral trimetazidine dihydrochloride and the placebo group received 20×3 mg/day per oral placebo for 3 months. Tinnitus handicap inventory (THI), visual analogue scale (VAS) questionnaires and audiometric results were used to determine the effectiveness of trimetazidine treatment. Results: The study group comprised 82 tinnitus subjects, 42 (51%) of whom received trimetazidine dihydrochloride and 40 (49%) who received placebo. There was no significant difference between placebo and trimetazidine groups in THI grade and VAS (both pre- and posttreatment scores) (P>0.05) and no significant improvement was observed in subjective loudness score in either group (P>0.05). Additionally there was no significant difference between groups in pre- and posttreatment pure tone hearing thresholds at all measured frequencies (P>0.05). Conclusion: Trimetazidine dihydrochloride therapy was ineffective for relieving chronic tinnitus.

High-fat Diet Enhances Gastric Contractility, but Abolishes Nesfatin-1-induced Inhibition of Gastric Emptying

( Zarife N Özdemir-kumral ),( Türkan Koyuncuoğlu ),( Sevil Arabacı-tamer ),( Özlem T Çilingir-kaya ),( Ayça K Köroğlu ),( Meral Yüksel ),( Berrak Ç Yeğen ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.2

Background/Aims Gastrointestinal motility changes contribute to development and maintenance of obesity. Nesfatin-1 (NES-1) is involved in central appetite control. The aim is to elucidate effects of NES-1 and high-fat diet (HFD) on gastrointestinal motility and to explore myenteric neuron expressions of tyrosine hydroxylase (TH), vasoactive intestinal peptide (VIP), and neuronal nitric oxide synthase (nNOS) in HFD-induced oxidative injury. Methods Sprague-Dawley rats were fed with normal diet (ND) or HFD. Gastric emptying rate was measured following NES-1 (5 pmol/rat, intracerebroventricular) preceded by subcutaneous injections of glucagon-like peptide 1 (GLP-1), cholecystokinin 1 (CCK-1), and gastrin/CCK-2 receptor antagonists. In carbachol-contracted gastric and ileal strips, contractile changes were recorded by adding NES- 1 (0.3 nmol/L), GLP-1, CCK-1, and gastrin/CCK-2 antagonists. Results Neither HFD nor NES-1 changed methylcellulose emptying, but NES-1 delayed saline emptying in cannulated ND-rats. Inhibitory effect of NES-1 on gastric emptying in ND-rats was reversed by all antagonists, and abolished in HFD-rats. In HFD-rats, carbachol-induced contractility was enhanced in gastric, but inhibited in ileal strips. HFD increased body weight, while serum triglycerides, alanine transaminase, aspartate aminotransferase, glucose, and levels of malondialdehyde, glutathione, myeloperoxidase activity, and luminol-chemiluminescence in hepatic, ileal, and adipose tissues were similar in ND- and HFD-rats, but only lucigenin-chemiluminescence was increased in HFD-rats. Vasoactive intestinal peptide (VIP) and TH immunoreactivities were depressed and nNOS immunoreactivity was increased in gastric tissues of HFD-rats, while VIP and TH were enhanced, but nNOS was reduced in their intestines. Conclusions HFD caused mild systemic inflammation, disrupted enteric innervation, enhanced gastric contractility, inhibited ileal contractility, and eliminated inhibitory effect of NES-1 on gastric motility. (J Neurogastroenterol Motil 2021;27:265-278)

Reconstruction of the Orbit With a Temporalis Muscle Flap After Orbital Exenteration

Yavuz Uya,Tolgar Lütfi Kumral,Güven Yıldırım,Mustafa Kuzdere,Hamdi Arbağ,Chary Jorayev,Mehmet Vefa Kılıç,Said Serdar Gümrükçü 대한이비인후과학회 2015 Clinical and Experimental Otorhinolaryngology Vol.8 No.1

Objectives. This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration. Methods. A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented. Results. The study included 13 patients (nine men, four women; age range, 30–82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasonsConclusion. The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence.

Rare earth elements (REEs) investigation of fly ash placers in southwestern Taurides: footprints of alkaline potassic Gölcük volcanism, Turkey

Ali Tugcan Unluer,Zeynep Doner,Mustafa Kaya,Huseyin Kocaturk,Amr Abdelnasser,Mustafa Kumral,Murat Budakoglu,Mehmet Sezai Kirikoglu 한국지질과학협의회 2023 Geosciences Journal Vol.27 No.4

The importance of Rare Earth Elements (REE) is consistently rising for industrialized countries due to their widespread usage in various applications. Production of REE heavily relies on carbonatite-ijolite complexes and other alkaline magmatic products. With this perspective, the potassic-alkaline volcanism related fly ash placers in Burdur and Isparta regions (SW, Turkey) are considered as a valuable prospecting target for REE. This work primarily focuses on the REE enrichment features (geochemistry, mineralogy, provenance and alteration processes) of Burdur and Isparta fly ash placers for construing the REE behaviour. At last, formation modeling of studied deposits was established and the similarities between studied deposits and some World class REE deposits were presented. Main REE-bearing minerals of studied deposits were identified as chevkinite, britholite and fluorapatite with considerable amounts of LREE as well as Th, Fe and Ti. The geochemical analysis results show that most of ΣREE values (up to 1109 and 1233 ppm, respectively) were comprised by La, Ce, Nd and Pr elements. The smaller grain size is a key factor in REE enrichment by the effectof combined factors such as REE-bearing mineral’s average crystal size, distribution, and higher intensity weathering process. The interference of Ca from meta-sedimentary carbonate rocks have a negative effect on REE accumulation. Because of the good response for ore purification methods and promising results for some of the critical REE, Burdur and Isparta fly ash placers might be feasible in the future in case of tighter supply and increasing global demand.

Structure-Function Relationship Between the Bruch Membrane Opening-based Minimum Rim Width and Visual Field Defects in Advanced Glaucoma

Imamoglu, Serhat,Celik, Nimet Burcu,Sevim, Mehmet S.,Pekel, Gokhan,Ercalik, Nimet Yesim,Turkseven Kumral, Esra,Bardak, Handan Wolters Kluwer Health, Inc. All rights reserved. 2017 Journal of glaucoma Vol.26 No.6

PURPOSE:: To investigate the relationship between the Bruch membrane opening-minimum rim width (BMO-MRW) (global and temporal) parameters with spectral-domain optical coherence tomography (SD-OCT) and visual field (VF) sensitivity on the 10-2 test in patients with advanced glaucoma. MATERIALS AND METHODS:: This cross-sectional, observational study included a total of 33 eyes of 29 patients. To evaluate VF sensitivity, automated white-on-white perimetry was performed using a Humphrey field analyzer. The mean deviation (MD) and pattern SD values were used to characterize the degree of functional damage. BMO-MRW and peripapillary retinal nerve fiber layer thickness were obtained with SD-OCT. According to the Garway-Heath map and fovea and BMO axis, the 90 degrees temporal sector of the optic disc corresponding to the central VF was divided into upper and lower parts. RESULTS:: The upper and lower temporal BMO-MRW parameters showed stronger correlations with the MD parameters of their corresponding VFs when compared with both global and temporal MRW parameters. Global and temporal retinal nerve fiber layer thickness parameters were also correlated with global MD parameters. CONCLUSIONS:: BMO-MRW measurements in the upper and lower parts of the 90 degrees temporal sector of the optic nerve head by SD-OCT and their corresponding VF sensitivity on the 10-2 test were found highly correlated. These BMO-MRW measurements could offer a means of predicting the status of visual hemifields in patients who are unable to undergo VF testing. Further longitudinal studies with larger series evaluating BMO-MRW parameters with SD-OCT are also needed to monitor progression in advanced glaucoma.