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Background: Two fundamental challenges in the current therapeutic approach for central nervous system tumors are the tumor heterogeneity and the absence of specific treatments and biomarkers that selectively target the tumor tissue. Therefore, we aimed to investigate the potential relationship between discoidin domain receptor 1 (DDR1) expression and the prognosis and characteristics of glioma patients., Materials and Methods: Tissue and serum samples from 34 brain tumor patients were evaluated for DDR1 messenger ribonucleic acid levels in comparison to 10 samples from the control group, and Kaplan-Meier survival analysis has performed., Results: DDR1 expression was observed in both tissue and serum samples of the patient and control groups. DDR1 expression levels in tissue and serum samples from patients were higher in comparison to the control group, although not statistically significant (P > 0.05). A significant correlation between tumor size and DDR1 serum measurements at the level of 0.370 was reported (r = 0.370; P = 0.034). The levels of DDR1 in serum showed a positive correlation with the increasing size of tumor. The results of the 5-year survival analysis depending on the DDR1 tissue levels showed a significantly higher survival rate (P = 0.041) for patients who have DDR1 tissue levels above cutoff value., Conclusions: DDR1 expression was significantly higher among brain tumor tissues and serum samples and its levels showed a positive correlation with the increased size of tumor. This study can be a starting point, since it investigated and indicated, for the first time, that DDR1 can be a novel therapeutic and prognostic target for aggressive high-grade gliomas., Competing Interests: None

Background: The relationship between superior cervical ganglia (SCG) ischemia due to bilateral common carotid artery ligation (BCCAL) and basilar artery (BA) reconfiguration was investigated., Methods: Twenty-three rabbits were randomly divided into 3 groups: group III rabbits underwent BCCAL (n = 13), group II rabbits were sham-operated controls (n = 5), and group I rabbits did not undergo surgery (n = 5). Degenerated neuron densities (DND) within the SCG were correlated with the BA vasodilatation index (VDI)., Results: Mean live and DND in SCG of group I rabbits were 11.235 ± 982/μm 3 and 11 ± 3/μm 3 , respectively, with a mean heart rate of 294 ± 21 beats/min. Mean SCG DND and heart rates were 213 ± 42/μm 3 and 242 ± 17 beats/min for the sham group (group II) rabbits and 1743 ± 285/μm 3 and 199 ± 19 beats/min for the study group (group III) rabbits, respectively. The BA VDI values in the sham group (group II) (1.32 ± 0.10) and the study group (group III) (0.976 ± 0.112) significantly differed from those in the control group (group I) (1.65 ± 0.12; P < 0.005) versus the sham group (group II) (P < 0.0001) versus the BCCAL applied group (group III) and between group II and group III (P < 0.005)., Conclusions: A meaningful and paradoxic correlation was detected between the BA VDI values and degenerated neuron density of SCG after BCCAL. Although a low degenerated neuron density within SCG may provoke excessive sympathetic activity and prevent excessive BA dilatation with steno-occlusive carotid artery diseases, a high degenerated neuron density may cause dangerous vasodilatation of BA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: To determine if sorafenib, an antineoplastic agent, could prevent the development of spinal epidural fibrosis (EF)., Methods: The study used CD105 and osteopontin antibodies in an immunohistochemical approach to quantify EF that occurred as a consequence of laminectomy in rats. Wistar albino rats ( n = 16) were divided into two groups: control (L1-2 level laminectomy only) and sorafenib treatment (L1-2 level laminectomy + topical sorafenib). The animals were euthanatized after 6 wk, and the EF tissues were examined for histopathological changes after immunohistochemical staining. The EF grades were assigned to the tissues, and the treatment and control groups were compared., Results: The EF thickness, inflammatory cell density, and arachnoid adherences determined by light microscopy were significantly higher in the control group compared to the sorafenib-treated group. Based on fibrosis scores, the extent of EF in the treatment group was significantly lower than in the controls. Immunohistochemical staining for CD105 to identify microvessels revealed that the EF grades based on vessel count were significantly lower in the treatment group. Staining for osteopontin did not show any significant differences between the groups in terms of the extent of EF. The staging of EF based on vascular counts observed after immunohistochemical staining for CD105, but not for osteopontin, was compatible with conventional staging methods. Neither toxic effects on tissues nor systemic side effects were observed with the use of sorafenib., Conclusion: Local administration of sorafenib significantly reduced post-laminectomy EF. Decreased neovascularization in spinal tissue may be due to the sorafenib-induced inhibition of vascular endothelial growth factor., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Objective: This study examined the relationship between neuron density in the stellate ganglion and the severity of basilar artery (BA) enlargement after bilateral common carotid artery ligation., Methods: Rabbits (n = 24) were randomly divided into 3 groups: unoperated control group (n = 4), experimental group subjected to bilateral common carotid artery ligation (n = 15), and sham-operated control group (n = 5). Histologic examination of the BAs and stellate ganglia was performed 2 months later. Permanent bilateral common carotid artery ligation was induced by ligation of common carotid arteries at prebifurcation levels as a model for steno-occlusive carotid artery disease., Results: Mean BA volume and neuron density in stellate ganglia for all animals were 4200 μm 3 ± 240 and 8325 μm 3 ± 210. In sham-operated animals, the mean values were 4360 μm 3 ± 340 and 8250 mm 3 ± 250. For the experimental group, mean volume and density in animals with slight dilatation of the BA (n = 6) were 4948 μm 3 ± 680 and 10,321 mm 3 ± 120, whereas in animals with severe dilatation (n = 9), the values were 6728 μm 3 ± 440 and 6300 mm 3 ± 730. An inverse association was observed between degree of BA enlargement and stellate ganglia neuronal density., Conclusions: High neuron density in stellate ganglia may protect against steno-occlusive carotid artery disease by preventing BA dilatation and aneurysm formation in the posterior circulatory arteries., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Stenoocclusive carotid artery disease causes important histomorphologic changes in all craniocervical vasculatures, such as luminal enlargement, vascular wall thinning, elongation, convolutions, and aneurysm formation in the posterior circulation. Although increased pressure, retrograde blood flow, and biochemical factors are described in the pathogenesis of vascular remodelisation, the vasoregulatory role of the autonomic nervous system has not been investigated thus far. We investigated the relationship between the sympathetic nervous system and the severity of histomorphologic alterations of basilar arteries after bilateral common carotid artery ligation (BCCAL)., Material and Methods: This study was conducted on 21 rabbits. The rabbits were randomly divided into three groups: baseline group (n = 5), sympathectomy non-applied group (SHAM; n = 8), and sympathectomy applied group (n = 8) before bilateral common carotid artery ligation. Permanent ligation of the prebifurcations of the common carotid arteries was performed to replicate stenoocclusive caroid artery disease. Basilar artery volumes were measured after ligation. Volumes of the basilar arteries were estimated by stereologic methods and compared between groups., Results: Luminal enlargement, wall thinning, elongation, convolutions, and doligoectatic configurations were detected in the majority of basilar arteries. The mean basilar arterial volume was 4.27 ± 0.22 mm3 in the baseline group; 5.28 ± 0.67 mm(3) in the SHAM group, and 8.84 ± 0.78 mm3 in the study group. The severity of basilar enlargement was significantly higher in the study group compared with the SHAM (p < 0.005) and baseline groups (p < 0.001)., Conclusions: Sympathectomy causes basilar artery enlargment, which is beneficial for maintaining cerebral blood flow; however, it also causes wall thinning, elongation, convolution, and aneurysm formation, which may be hazardous in stenoocclusive carotid artery disease. Sympathectomy can prevent new vessel formation and hyperthyrophic changes at the posterior circulation. Neovascularisation is not detected adequately in sympathectomised animals.

Objective: To examine whether or not there is a possible relationship between the neuron density of trigeminal ganglion (TGG) and the severity of posterior communicating artery (PComA) vasodilation values after permanent bilateral common carotid artery ligation (BCCAL)., Study Design: This study included 25 rabbits. Both the common carotid arteries of 20 rabbits were explored and denervated. Five animals served as controls. Permanent BCCAL was applied in 15 of the 20 rabbits, and the other 5 were used as the SHAM group without ligation. All animals were followed for 2 months and then sacrificed. Their brains and cranial nerves were extracted and fixed in 10% formalin solution. The relationship between PComA vasodilation values and TGG neuron densities were compared., Results: Elongation, convolution and enlargement were detected in all the basilar arteries of all ligated animals and 2 from the SHAM group. On histopathogical examination vascular wall thinning, luminal enlargement, flattened inner elastic membrane, flattened vessel muscle cells, endothelial desquamation and intimal erosions were detected. An inverse relationship was discovered between the neuron density of TGG and the severity of PComA vasodilation index., Conclusion: BCCAL may lead to important beneficial and hazardous histomorphological changes at the posterior communicating artery. The high neuron density of TGG may provide a beneficial effect by facilitating PComA enlargement via its vasodilatory properties for the increase of decreased cerebral circulation, although this situation may be hazardous for certain subjects with congenital or acquired cerebrovascular pathologies.

Purpose: This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma., Methods: We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome., Results: The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively., Conclusions: The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

Aim: To investigate the role of erythrocyte free radical scavenging enzyme activities (FRSE), carbonic anhydrase (CA) activity and malondialdehyde (MDA) in infants with myelomeningocele (MM)., Material and Methods: We compared antioxidant enzyme activities and MDA level in 40 individuals (10 infants with MM, 10 healthy infants; and mothers of these two groups) with age-matched subjects. Erythrocyte FRSE included catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPX) and glutathione-S- transferase (GST)., Results: CA, CAT, SOD, GPX and GST concentrations were lower in all of the infants with MM compared to healthy infants. The mothers of infants with MM also had lower CA, CAT, SOD, GPX and GST activities than healthy mothers. It was also found out that the MDA level as a marker of oxidative damage was higher in infants with MM and their mothers than in healthy infants and their mothers., Conclusion: Lower FRSE activities indicate an increased frequency of MM. Free radicals (FRs) such as MDA may play a significant role in the etiology of MM.

Background: The role of neuron density (of the stellate ganglion) in basilar artery vasospasm after subarachnoid hemorrhage (SAH) has not previously been investigated. This subject was studied., Methods: This study was conducted on 24 rabbits. Four of them were used as the baseline control group. Experimental SAH was applied to the 15 animals; the remaining five of them were used as a sham group injecting by the serum physiologic saline (PS) and followed up twenty days later. Stellate ganglion neuron densities were estimated stereologically. Vasospasm index (VSI) was used to assess the severity of vasospasm. The value of VSI between 1 and 1.5 was accepted as no vasospasm, 1.5-2 was accepted as light vasospasm and 2 or greater than 2 was accepted as severe vasospasm. Results were compared statistically., Results: The mean basilar artery VSI in the control group (n: 4) was calculated as 1.24±0.39 and the neuron density of stellate ganglion was calculated as 8320±675/mm(3). These values in the PS group (n: 5) were calculated as 1.26±0.37 and 8380±680/mm(3). In animals with light basilar artery vasospasm (n: 6), the basilar artery VSI and neuron density of stellate ganglion were 1.65±0.37, 9210±460/mm(3) consecutively, but the basilar artery VSI was 2.07±0.40 and neuron density was 12,075±950/mm(3) in animals with severe vasospasm (n: 9)., Conclusion: The neuron density of stellate ganglion may play an important role in the development of basilar artery vasospasm. The beneficial effect of sympathectomy for the prevention of cerebral vasospasm may be explained through this mechanism., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Small meningomylocele defects can be closed primarily. Other repair techniques are required for closure of meningomyelocele defects of >5 cm. In this anomaly, in which random or musculocutaneous flaps are usually used, the technique for skin defect closure should have the following criteria: a safely harvested flap with good blood supply; minimal morbidity in the donor site; closure with adequate thickness to protect the underlying neural structure; and a repair to prevent leakage of cerebrospinal fluid. The dorsal intercostal artery perforator flap is a new perforator flap with a large skin island that can be used safely in the dorsal region. In this article, repair of large skin defects due to myelomeningocele has been attempted using a dorsal intercostal artery perforator flap, and the results are discussed.

Aim: Timing of shunt insertion in infants with myelomeningocele (MM) and hydrocephalus (HCP) has been debated. Many authors have suggested to perform the repair of MM and shunt insertion during same operation. However, there is also an opposite view., Material and Methods: We analyzed retrospectively 166 patients who underwent MM Sac repair to evaluate whether there are difference between these two methods in terms of shunt infection rate., Results: In the same session, V-P (ventriculoperitoneal) shunt placement was performed onto 65 infants within the first 48 hours of postnatal and 36 infants were operated 48 hours after birth. In separate sessions, repair of MM were performed onto 29 infants within the first 48 hours of postnatal and shunting was peformed 7 days after sac repair. 14 infants were performed MM sac repair 48 hours after birth, then shunt was applied 7 days after closure of MM. Shunt infection rate in concurrently operated groups was markedly high (12.3 % in early surgery, 33.3% in late surgery); in separatedly operated groups' shunt infection rate was lower (3.44% in early surgery, 14.29% in late surgery)., Conclusion: We propose to perform V-P shunt placement and MM repair in separate sessions.

Introduction: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare., Case Report: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief., Discussion: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.