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The tonsils represent a circular band of mucosa associated with lymphoid tissues, Waldeyer’s ring, which is located at the entrance of the upper aerodigestive tract, with a significant role in the immune defense system. Waldeyer’s ring is composed of the pharyngeal, tubal, palatine, and lingual tonsils acting as secondary lymphoid tissues. Particularly, the palatine tonsils are the largest of the tonsils with deep branching crypts and contain B and T lymphocytes and M cell which plays a role in the uptake and transport of antigens. Because of the tonsil enlargement during childhood, upper airway obstruction and obstructive sleep apnea syndrome are mostly seen. Knowledge of the surgical anatomy of the tonsils and variations of the neurovascular and muscular structures around it allows optimal choice of surgical technique to avoid iatrogenic complications during tonsillectomy. Recent medical studies reported that a detailed understanding of the anatomic risk factors in upper airway obstruction allows to predict treatment response to surgical intervention. Due to the penetration of benign or malign lesions of the tonsil into the lateral wall of the pharynx, transoral robotic approach to this region is necessary to identify the surgical anatomic landmarks which are required to perform safe and effective surgical intervention.

Kurumsal Sürdürülebilirlik, işletmelerde uzun vadeli değer yaratmak amacıyla, ekonomik, çevresel ve sosyal faktörlerin işletme faaliyetlerine yansıtılması olarak açıklanmaktadır. İşletmelerde sürdürülebilirlik faaliyetlerine genellikle üst düzey yönetim tarafından karar verilmektedir. Bu doğrultuda, bu çalışmanın amacı; üst kademe teorisi dâhilinde BISTSürdürülebilirlik Endeksinde yer alan işletmelerin yönetici özelliklerinin incelenmesidir. Bu kapsamda, sürdürülebilirlik endeksinde yer alma konusunda istekli olan ve endekse girme hakkı bulunurken endekste yer almayan işletmelerin yöneticilerinin Üst Kademe Teorisi’nde belirtilen demografik verileri karşılaştırmalı olarak incelenmiştir. Elde edilen sonuçlara göre; katılımcıların yaş ortalaması ve kadro süreleri arasında anlamlı bir farklılık yokken eğitim seviyeleri arasında anlamlı bir farklılık olduğu görülmüştür.&nbsp, Corporate sustainability is an organizational approach that creates long -term shareholder value by embracing opportunities and managing the risks associated with economic, environmental, and social developments. Sustainability operations are generally decided by the top management. From this perspective, this study aims to analyze businesses with using the Upper Echelons Theory and BIST Sustainability Index criteria. The demographical variables of the top managers of volunteer businesses and the businesses which has already right to be in the index but not indexed were compared. The results show that while there were no significant differences in mean age and tenure, there was a significant difference in education level between the two groups.&nbsp

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Congress of the European-Society-of-Cardiology (ESC) -- AUG 29-SEP 02, 2015 -- London, ENGLAND, WOS: 000361205106594, …, European Soc Cardiol

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Turkish Anaesthesiology and Intensive Care Society, Objectives: We investigated the effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular function in the long term using tissue Doppler imaging. Study design: Twenty-seven patients who underwent successful PMBV were enrolled in the study. Echocardiographic examination, including color tissue Doppler imaging, was done from the lateral tricuspid annulus 24 hours before the intervention, and the examination was repeated 24 hours and 6 months after the intervention. Results: At 24 hours after the intervention, S wave velocity and A' wave velocity were seen to have increased significantly (9.52±1.85 cm/s vs. 10.92±1.20 cm/s, p=0.012; -10.44±2.64 cm/s vs. -11.73±2.05 cm/s, p=0.029, respectively). E' wave velocity and E'/A' ratio did not change significantly (p>0.05 for both). In the late period, S wave velocity was similar to the value in the early period and significantly higher than the basal level (9.52±1.85 cm/s vs. 10.69±1.72 cm/s, p=0.023). However, A' wave velocity in the late period was decreased compared to the early period and was not different from the basal level (-10.44±2.64 cm/s vs. -10.74±2.63 cm/s, p>0.05). The increase in E' wave velocity in the late period when compared to the basal level was found to be statistically significant (-7.85±1.54 cm/s vs. -9.21±1.81 cm/s, p=0.046). Conclusion: Right ventricular systolic function improved in the early period, and this improvement was seen to continue in the late period of PMBV. Diastolic function did not improve in the early period, but did improve in the late period. Right atrium systolic function improved in the early period; however, in the late period, levels were similar to the basal levels. © 2014 Türk Kardiyoloji Derne?i., Kaya, Z.; Şanliurfa E?itim ve Araştirma Hastanesi, Kardiyoloji Klini?i, 63000 Şanliurfa, Turkey; email: drzekeriyakaya@yahoo.com

Background: The pedunculopontine nucleus has recently been proposed as an alternative target for deep brain stimulation for the treatment of medically intractable Parkinson's disease. The suggested indication for pedunculopontine nucleus deep brain stimulation is severe and medically intractable axial symptoms such as gait and postural impairment. Objective: Our goal in this study was to describe the effects of subthalamic nucleus stimulation on pedunculopontine nucleus electrophysiological activity. Methods: Fourteen male Wistar rats were divided into a sham stimulation group and an experimental group. In both groups, electrodes were implanted bilaterally into the subthalamic nucleus and into the right pedunculopontine nucleus. Microelectrode recordings were carried out in both groups prior to and during sub thalamic nucleus stimulation. Results: Subthalamic nucleus stimulation produced no clear inhibition of neuronal firing in the pedunculopontine nucleus. However, we found that stimulation of the subthalamic nucleus at 60 Hz produces some entrainment of pedunculopontine nucleus neuronal firing and a shift of subthalamic nucleus firing patterns to more tonic and random patterns. These results are consistent with the effects of deep brain stimulation on neuronal activity in the subthalamic nucleus and globus pallidus internus. Conclusion: The result of this study provides additional evidence to improve our understanding of the mechanism of subthalamic nucleus-deep brain stimulation, and its physiological consequences. (C) 2016 S. Karger AG, Basel

BACKGROUND: The pedunculopontine nucleus has recently been proposed as an alternative target for deep brain stimulation for the treatment of medically intractable Parkinson's disease. The suggested indication for pedunculopontine nucleus deep brain stimulation is severe and medically intractable axial symptoms such as gait and postural impairment. OBJECTIVE: Our goal in this study was to describe the effects of subthalamic nucleus stimulation on pedunculopontine nucleus electrophysiological activity. METHODS: Fourteen male Wistar rats were divided into a sham stimulation group and an experimental group. In both groups, electrodes were implanted bilaterally into the subthalamic nucleus and into the right pedunculopontine nucleus. Microelectrode recordings were carried out in both groups prior to and during subthalamic nucleus stimulation. RESULTS: Subthalamic nucleus stimulation produced no clear inhibition of neuronal firing in the pedunculopontine nucleus. However, we found that stimulation of the subthalamic nucleus at 60 Hz produces some entrainment of pedunculopontine nucleus neuronal firing and a shift of subthalamic nucleus firing patterns to more tonic and random patterns. These results are consistent with the effects of deep brain stimulation on neuronal activity in the subthalamic nucleus and globus pallidus internus. CONCLUSION: The result of this study provides additional evidence to improve our understanding of the mechanism of subthalamic nucleus-deep brain stimulation, and its physiological consequences.

WOS: 000387634400002 PubMed: 29727120 Objectives: Asymmetric tonsillar hypertrophy is a condition, confirmed by physical examination, that can be found in every age group. The aim of this study was to compare each tonsil through macroscopic and microscopic assessment of specimens and reveal the reasons that cause one tonsil to grow more than the other. Methodology: The study was carried out with 93 patients who wereindicated for tonsillectomy in the authors' Clinic. Of these 93 patients, seven cases who had clinically asymmetric but pathologically symmetric tonsils were excluded from the study. The presence of microscopicintraepithelial abscess, Helicobacter pylori with Giemsa stain, Coccobacillus, fungus, Actinomyces with Pas-Grocott stain, dysplasia or hyperplasia, malignancy and reactive changes in the epithelium were evaluated. Results: The study was conducted with 86 patients aged between two and 35, of whom 32 were women (37.2%) and 54 were men (62.8%). The mean age of cases was 8.37 +/- 5.95. The mean difference between two tonsils ranged from 1 to 12 mm, mean 3.67 +/- 2.56 mm. When the findings were examined, the presence of H. pylori, Coccobacillus, fungus and Actinomyces, reactive changes in the epithelium, pattern of hyperplasia, intraepithelial abscess and macroscopic presence of pus did not reveal any statistically significant changes. Conclusion: The reasons behind asymmetric tonsil hypertrophies and how they are related to malignancies have not yet been clarified. There is no statistically significant difference between the evaluated parameters in the present study. This study has brought a new point of view to the subject by comparing different-sized tonsils in the same person, thus paving the way for future studies with a broader scope

WOS: 000325204300007, PubMed ID: 23893183, BACKGROUND: Non-invasive prediction of paroxysmal atrial fibrillation (PAF) is one of the most recent interests of cardiology. AIM: The current study investigates the relationship between the atrial electromechanical coupling time (EMCT) and PAF. PATIENTS AND METHODS: A group of 35 patients with PAF was compared with a group of 37 subjects without PAF. Pulsed wave tissue Doppler evaluations of atrial walls were performed from apical four chambers view under ECG monitoring. The time intervals from the onset of P wave to the onset of late diastolic wave (A') at right atrial wall (P-RA), interatrial septum (P-IAS), and left atrial wall (P-LA, maximum EMCT) were measured. The right atrial EMCT (P-RA minus P-IAS), left atrial EMCT (P-LA minus PIAS) and interatrial EMCT (P-LA minus P-RA) were computed. A' wave velocities were measured from each atrial wall. RESULTS: RA (16.0+/-13.1 vs. -8.7+/-18.6 ms, p < 0.001) and maximum (91.5+/-32.6 vs. 72.0+/-23.1 ms, p = 0.001) EMCT were longer, RA A' velocity was higher in the patient group. There were no differences between the groups in LA and interatrial EMCT, and septal and LA A' velocities. Regression analysis revealed that only RA [OR: 1.148 (1.041-1.267), p = 0.006] and maximum [OR: 1.099 (1.009-1.197), p = 0.031] EMCT were independent variables for PAF. In order to predict patients with PAF, we have chosen +7.5 msn for the RA EMCT which yielded 69% sensitivity and 71.4% specificity to predict patients. CONCLUSIONS: Delayed RA lateral EMCT relative to septal one and delayed maximum EMCT detected by tissue Doppler could be a valuable method for identifying patients with PAF.

… Turkish Soc Cardiol

External laryngeal trauma is a relatively rare-encountered and sometimes life-threatening emergency condition. Recognition of laryngeal injury related to either blunt or penetrating trauma is important for both initial preservation of life as well as long-term airway and vocal function. Treatment options include medical management with observation and open surgical treatment with or without tracheotomy. We, herein, describe a 23-year-old male case who sustained external penetrating trauma to lateral aspect of neck. The etiology, clinical manifestations, investigation modalities and management of penetrating neck trauma were discussed in the light of the literature data.

AIM:The molecular mechanism of epileptogenesis in temporal lobe epilepsy is still unclear. Experimental studies have suggested that matrix metalloproteinases have important roles in this process, but human studies are limited. The aim of this study was to assess the expression of MMP-9, MMP-2 and their tissue inhibitors (TIMP-1 and TIMP-2) in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS).

AIM: The molecular mechanism of epileptogenesis in temporal lobe epilepsy is still unclear. Experimental studies have suggested that matrix metalloproteinases have important roles in this process, but human studies are limited. The aim of this study was to assess the expression of MMP-9, MMP-2 and their tissue inhibitors (TIMP-1 and TIMP-2) in patients with temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). MATERIAL AND METHODS: The tissue samples from temporal neocortex and hippocampus were obtained from patients with temporal lobe epilepsy with hippocampal sclerosis who had undergone anterior temporal lobectomy for recurrent medically resistant seizures. Immunohistochemical methods were used to determine the expression of MMP-9, MMP-2 and their tissue inhibitors. Tissue samples were also analyzed with transmission electron microscopy. RESULTS: The immunoreactivity for MMP-9 both in hippocampal and temporal neocortical neurons was stronger than that of MMP-2. Additionally, there was a mild reaction for its tissue inhibitor TIMP-1 as with TIMP-2. The TEM analysis of the hippocampus revealed that there was apparent ultra-structural damage on the pericarya and neuropil of some neurons. There was obvious damage in the mitochondria and the nuclear membrane. CONCLUSION: The preliminary results of this study revealed that MMP-9 may have a role in patients with drug resistant TLE-HS.

BACKGROUND: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.OBJECTIVES: The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization.METHODS: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold.RESULTS: A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief.CONCLUSIONS: FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.

AIM: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for patients with Parkinson's disease (PD) associated with motor complications of long term L-dopa treatment. MATERIAL AND METHODS: Here we report two cases with DBS- induced manic episode, focusing on the functional and anatomic correlates of psychiatric adverse effects of STN stimulation. RESULTS: We present two cases of PD with motor complications due to long term L-dopa treatment that developed their first episodes of mania with psychotic symptoms after bilateral STN-DBS implantation. DBS-induced psychiatric adverse effects may be attributable either to limbic connections and STN-specific oscillations or stimulation of the medial forebrain bundle.

INTRODUCTION: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by tremor, rigidity and bradykinesia. Gait and postural difficulties supersede tremor, rigidity and bradykinesia as drivers of disease burden in patients with advanced PD. The aim of this study was to describe the effects of deep brain stimulation of the subthalamic nucleus on gait ability and balance performance in patients with PD. MATERIAL AND METHODS: We studied 19 consecutive patients who underwent bilateral stimulation of the subthalamic nucleus. Patients were evaluated preoperatively and at the 5(th) day and 6(th) month after surgery. Timed Up and Go Test, 12 m Walking Test, Chair Stand Test and Berg Balance Scale (BBS) were used to assess mobility and balance performance. Unified Parkinson's Disease Rating Scale (UPDRS III) and Hoehn and Yahr Scale were also used. RESULTS: All the patients' mobility ability and balance performance improved after surgery (p < 0.05). At the 6th month after surgery, the Timed Up and Go Test scores were decreased from 56.05 ±42.52 to 21.47 ±20.36, the 12 m Walking Test scores were decreased from 100.44 ±66.44 to 28.84 ±19.79, the Chair Stand Test scores were increased from 4.00 ±4.66 to 11.68 ±4.43 and the BBS score was increased from 12.84 ±6.89 to 38.89 ±8.79. UPDRS total scores were significantly improved 6 months after surgery (p < 0.001). UPDRS total scores were decreased from 98.26 ±37.69 to 39.36 ±18.85. The Hoehn and Yahr Scale score was significantly decreased after surgery (p < 0.05). CONCLUSIONS: Surgical therapy is an effective treatment to improve gait ability and balance performance in Parkinson's patients.

Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by tremor, rigidity and bradykinesia. Gait and postural difficulties supersede tremor, rigidity and bradykinesia as drivers of disease burden in patients with advanced PD. The aim of this study was to describe the effects of deep brain stimulation of the subthalamic nucleus on gait ability and balance performance in patients with PD. Material and methods: We studied 19 consecutive patients who underwent bilateral stimulation of the subthalamic nucleus. Patients were evaluated preoperatively and at the 5th day and 6th month after surgery. Timed Up and Go Test, 12 m Walking Test, Chair Stand Test and Berg Balance Scale (BBS) were used to assess mobility and balance performance. Unified Parkinson's Disease Rating Scale (UPDRS Ill) and Hoehn and Yahr Scale were also used. Results: All the patients' mobility ability and balance performance improved after surgery (p < 0.05). At the 6th month after surgery, the Timed Up and Go Test scores were decreased from 56.05 +/- 42.52 to 21.47 +/- 20.36, the 12 m Walking Test scores were decreased from 100.44 +/- 66.44 to 28.84 +/- 19.79, the Chair Stand Test scores were increased from 4.00 +/- 4.66 to 11.68 +/- 4.43 and the BBS score was increased from 12.84 +/- 6.89 to 38.89 +/- 8.79. UPDRS total scores were significantly improved 6 months after surgery (p < 0.001). UPDRS total scores were decreased from 98.26 +/- 37.69 to 39.36 +/- 18.85. The Hoehn and Yahr Scale score was significantly decreased after surgery (p < 0.05). Conclusions: Surgical therapy is an effective treatment to improve gait ability and balance performance in Parkinson's patients.

A 59-year-old female patient was referred to our Ear, Nose and Throat Department at Haseki Training and Research Hospital complaining of neck swelling for the past three months. Physical examination revealed a palpable anterior neck mass measuring 1.5x1 cm in the thyroid gland. The mass was moving with swallowing. Laboratory tests, such as fT3, fT4, TSH and calcium were normal. Ultrasonography showed four-five nodules with the biggest one measuring 12x8 mm. Fine needle aspiration biopsy was done and a few thyrocyte clusters were detected. Thyroidectomy was done with the pre-diagnosis of multinodular goiter. On postoperative examination, the vocal cords were mobile and native bilaterally. Calcium values were normal and the patient was discharged with necessary recommendations. Six-month followup was uneventful. Schwannoma can be misdiagnosed as thyroid nodule. Although schwannoma is frequently seen in the head and neck region, it is rarely observed in the thyroid gland. © 2014, Haseki Training and Research Hospital. All rights reserved.

Aim: To retrospectively evaluate indications for surgery, histopathological results and surgery complications in patients who underwent submandibular gland excision.Methods: We retrospectively analyzed indications for surgery, age, sex, histopathological results, and surgery complications in 43 patients who underwent submandibular gland excision in our hospital between 2008 and 2012.Results: A total of 43 patients [30 male (69.7%), 13 female (30.2%)] were included in the study. The minimum postoperative follow-up period was 6 months. The mean age of the patients was 42.4 years, ranging from 11 to 86 years. 30 (69.7%) had painless swelling, 10 (23.2%) had painful swelling after eating, and three (6.9%) patients had infections frequently with pus spilling into the mouth. According to the histopathological results, 39 benign and four malign materials were excised and, sialadenitis was the most frequent benign pathology. As complications of the surgery; marginal mandibular nerve injury was seen in 4 patients (1 patient with persistent and three patients with transient nerve damage) and 2 patients had hematoma after surgery.Conclusion: The distribution of submandibular gland materials according to the histopathological types was similar to that in the literature. Although marginal facial nerve injury is the most common complication of submandibular gland excision, it was observed in our cases that only one patient experienced permanent nerve damage. Therefore, we assume that submandibular gland excision is a safe surgical procedure. © 2014, Haseki Training and Research Hospital. All rights reserved.

Background: Hardware-related infection after deep brain stimulation (DBS) is one of the most serious complications and may need additional interventions. Objectives:To reuse the internal pulse generator (IPG) after DBS infection and to reduce the economic costs. Methods: A database of 102 patients who underwent DBS surgery was used in the study. The incidence, clinical characteristics and management of infections while reusing the IPG after DBS-related infection were analyzed and reported. Results: The overall infection rate was 5.9% (6 of 102 patients). Management consisted of total hardware removal followed by intravenous antibiotics. The IPG was at first kept in a solution, then rinsed with water and dried following sterilization with ethylene oxide gas at 38 degrees C for 18 h. When the treatment of the infection was finished, we reused the IPG and reimplanted the DBS. No hardware-related infection or other complications were observed after reimplantation. Conclusions: Management of hardware-related infections can be challenging. The medical and economic costs associated with these infections are enormous. The IPG can often be saved in infected patients. Thus, a significant cost burden is eliminated. Properly executed, reuse of IPG should markedly reduce the costs of these devices. (C) 2014 S. Karger AG, Basel

AIM: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapy for patients with Parkinson's disease (PD) associated with motor complications of long term L-dopa treatment.

Delay-Tolerant/Disruption-Tolerant Networking (DTN) architecture will be used in future deep space missions, to enable autonomous networking operations and disruption-tolerant data communications. Therefore, it is worth analyzing the performance of the DTN Bundle Protocol (BP) in a realistic deep space environment, reproducing the characteristics of Mars missions. After a comprehensive introduction on data communications between Mars and Earth, the paper presents the essential features of both the BP DTN architecture and the Licklider Transmission Protocol (LTP), adopted here as BP convergence layer on deep space links, thanks to its ability to cope with the very long delays typical of this environment. The focus of our experiments is on analysis of the bundle flow from a Mars lander to an Earth control center through an intermediate relay node, for which two configurations are considered, inspired to Odyssey and Mars Reconnaissance Orbiter missions, respectively. Results are obtained by means of a test bed consisting of some GNU/Linux personal computers running either Interplanetary Overlay Network (ION) or DTN2 BP implementations. The analysis of results aims to highlight the role played by BP and LTP in tackling the challenges of Mars to Earth communications. Copyright © 2013 John Wiley & Sons, Ltd. The paper focuses on the experimental validation of the Delay Tolerant Network (DTN)/Bundle Protocol architecture, for which, a dedicated testbed has been developed. The presented study revisits the cases of ongoing Odyssey and Mars Reconnaissance Orbiter scientific missions consisting in data transfer from Mars to Earth. The conducted performance assessment confirms the added value of Bundle Protocol and Licklider Transmission Protocol in enabling automatic data transfer over long distance even in the presence of very large latency and link intermittencies.

This paper is not a survey related to generic wireless sensor networks (WSNs), which have been largely treated by Akyildiz et al. in [1], and later in a number of survey papers addressing more focused issues; rather, it specifically addresses architectural aspects related to WSNs in some way connected with a satellite link, a topic that presents challenging interworking aspects. The main objective is to provide an overview of the potential role of a satellite segment in the future wireless sensor networks. In this perspective, requirements of the most meaningful WSN applications have been drawn and matched to characteristics of various satellite/space systems in order to identify suitable integrated configurations.

It is thought that lack of concentration and reduction of the cognitive function parallel to insomnia during the night time affect the performance of the sportsman directly. The aim of this study is to examine the relation between sleeping quality within the competition environment and the success level of the most elite sportsmen of wrestling. Study group composed of Men's Turkish National team of Freestyle wrestling that participated in the Freestyle wrestling World cup held in Teheran city of Iran in 2013 (X age=25,86 ± 3,436). To obtain the results of the study Pittsburgh Sleeping Quallity Scale was used. Kolmogrov-Smirnov test, Man whitney u, Pearson corelation analysis was used to analyze and interpret the data and meaningfulness of P