Mustafa Tansel Kendirli

The effect of obstructive sleep apnea on olfactory functions.

The aim of this study was to investigate the effect of obstructive sleep apnea (OSA) on the parameters of olfactory functions (odor threshold, odor discrimination, and odor identification tests) for orthonasal olfaction, retronasal olfactory testing, and olfactory bulb (OB) volumes.

Cross-culturally modified University of Pennsylvania Smell Identification Test for a Turkish population.

Background The University of Pennsylvania Smell Identification Test (UPSIT) is a well-developed and popular olfactory test, which has been validated in various populations. However, there was only one study in a Turkish population, and this study indicated that the North American version of the UPSIT was not enough to evaluate the olfactory functions of Turkish population. So, we developed a cross-cultural adaptation of the UPSIT, the UPSIT-Turkish (UPSIT-T). Thus, the goal of this study was to investigate the applicability of the UPSIT-T in healthy Turkish subjects. Material and Methods The study included 51 healthy individuals who reported having normal olfactory function. The participants were administered the North American version of the UPSIT firstly, and then, after a day UPSIT-T was applied to the participants. The results of two smell tests were compared, and the applicability of UPSIT-T was evaluated. Results The mean (standard deviation) value for correctly identified odors was 27.2 ± 5.7 (range, 14–38) with the UPSIT application, whereas the mean (standard deviation) value for correctly identified odors was 35.9 ± 3.1 for UPSIT-T. There was a statistically significant increase in the scores of the participants when UPSIT-T was performed (p < 0.001). The identification rates of 10 test odorants were <80% for our study group, and 2 of 10 were <70% for the UPSIT-T. Conclusion The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.

Targeted mesenchymal stem cell and vascular endothelial growth factor strategies for repair of nerve defects with nerve tissue implanted autogenous vein graft conduits

Peripheral nerve gaps exceeding 1 cm require a bridging repair strategy. Clinical feasibility of autogenous nerve grafting is limited by donor site comorbidity. In this study we investigated neuroregenerative efficacy of autogenous vein grafts implanted with tissue fragments from distal nerve in combination with vascular endothelial growth factor (VEGF) or mesenchymal stem cells (MSCs) in repair of rat peripheral nerve defects. Six‐groups of Sprague‐Dawley rats (n = 8 each) were evaluated in the autogenous setting using a 1.6 cm long peroneal nerve defect: Empty vein graft (group 1), Nerve graft (group 2), Vein graft and nerve fragments (group 3), Vein graft and nerve fragments and blank microspheres (group 4), Vein graft and nerve fragments and VEGF microspheres (group 5), Vein graft and nerve fragments and MSCs (group 6). Nerve fragments were derived from distal segment. Walking track analysis, electrophysiology and nerve histomorphometry were performed for assessment. Peroneal function indices (PFI), electrophysiology (amplitude) and axon count results for group 2 were −9.12 ± 3.07, 12.81 ± 2.46 mV, and 1697.88 ± 166.18, whereas the results for group 5 were −9.35 ± 2.55, 12.68 ± 1.78, and 1566 ± 131.44, respectively. The assessment results did not reveal statistical difference between groups 2 and 5 (P > 0.05). The best outcomes were seen in group 2 and 5 followed by group 6. Compared to other groups, poorest outcomes were seen in group 1 (P ≤ 0.05). PFI, electrophysiology (amplitude) and axon count results for group 1 were −208.82 ± 110.69, 0.86 ± 0.52, and 444.50 ± 274.03, respectively. Vein conduits implanted with distal nerve‐derived nerve fragments improved axonal regeneration. VEGF was superior to MSCs in facilitating nerve regeneration.

Are Right to Left Shunts Underdiagnosed in the Etiology of Migraine Headache

We read with interest the article “To be or not to be: The relationship between migraine and patent foramen ovale” by Eren et al. As the authors discussed, intrapulmonary shunts – either small or large – are the novel issues that should be sought in the etiology of right to left shunts. Pulmonary shunting can be associated with neurologic complications such as cryptogenic stroke, migraine headache, as well as hypoxic states such as platypnea-orthodeoxy syndromes. Anatomic (eg, diameter) and physiological properties (eg, dynamics of pulmonary vasculature during hypoxia) of intrapulmonary shunts are closely associated with the paradoxic embolism. However, Eren et al stated that 5 cardiac cycles were observed for the appearance of microbubbles in left atrium in order to evaluate and not to overlook right to left shunt (RLS) due to intrapulmonary shunts in addition to patent foramen ovale (PFO). As it is recommended prolonging the observation period until the 8th to 10th cardiac cycles to detect and discriminate the origin of RLS in our Aviation Examination Center, this approach could have been increased the prevalence of RLS in their study population with migraine headache. As the authors discussed, prevalence of intrapulmonary shunts may reach up to 5% or higher in patients with RLS. Additionally in the methods section, they stated that RLS was evaluated at rest and with Valsalva maneuvering (VM). Effectiveness of VM can be enhanced by ordering the patient to repeat the VM at least 3 times. During VM, intrathoracic pressure increases and venous return to the right atrium decreases. Transiently, venous blood congestion develops around the inferior vena cava until the release of VM, which allows the increased venous blood to rush to the right atrium and surge the right atrial pressure. Three repetitive VM before the injection of contrast material or agitated saline will certainly increase the venous return and raise the right atrial pressure. This approach increases the sensitivity of the contrast echocardiography (CE) and also the prevalence of PFO in subjects with migraine headache. Thus performance of Valsalva maneuvering is clinically important. CE is a clinically applicable and reproducible method to evaluate the functionality of right to left shunts, which present anatomic versatility. Since RLS anatomically varies from a single aperture to a tunnel or slit-like passage between two layers of primum and secundum septums, functional evaluation of RLS under pressure gradient between right and left atrial chambers is clinically important. All of the interventions to increase the atrial pressure and venous return of right atrium will enhance the probability of RLS and also detection of signs of RLS on CE. This mechanism is the reason why the sensitivity of multidetector computerized tomography (MDCT) angiography can achieve a higher sensitivity and specificity in detection of PFO. Since 80 to 100 mL volume of contrast material is flushed within several seconds from the antecubital vein during MDCT angiography, such a volume at a short period effectively raises the right atrial pressure enough to allow the passage of contrast material from RLS. So MDCT angiography can be used as further imaging testing in evaluation of patients with severe migraine headache or recurrent cryptogenic strokes and high suspicion of index for PFO despite it not being documented by CE or transesophageal echocardiography.

Diagnostic Role of ECG Recording Simultaneously With EEG Testing

Arrhythmia is not uncommon in the etiology of syncope which mimics epilepsy. Data about the epilepsy induced vagal tonus abnormalities have being increasingly reported. So we aimed to evaluate what a neurologist may gain by a simultaneous electrocardiogram (ECG) and electroencephalogram (EEG) recording in the patients who underwent EEG testing due to prediagnosis of epilepsy. We retrospectively evaluated and detected ECG abnormalities in 68 (18%) of 376 patients who underwent EEG testing. A minimum of 20 of minutes artifact-free recording were required for each patient. Standard 1-channel ECG was simultaneously recorded in conjunction with the EEG. In all, 28% of females and 14% of males had ECG abnormalities. Females (mean age 49 years, range 18-88 years) were older compared with the male group (mean age 28 years, range 16-83 years). Atrial fibrillation was more frequent in female group whereas bradycardia and respiratory sinus arrhythmia was higher in male group. One case had been detected a critical asystole indicating sick sinus syndrome in the female group and treated with a pacemaker implantation in the following period. Simultaneous ECG recording in conjunction with EEG testing is a clinical prerequisite to detect and to clarify the coexisting ECG and EEG abnormalities and their clinical relevance. Potentially rare lethal causes of syncope that mimic seizure or those that could cause resistance to antiepileptic therapy could effectively be distinguished by detecting ECG abnormalities coinciding with the signs and abnormalities during EEG recording.

Migren hastalarında atak olmayan dönemde koku tanımlama testi ile koku fonksiyonunun değerlendirilmesi

Objective: Despite the fact that there are many studies about the osmo- phobia and migraine, we have very little knowledge about the olfactory abilities of migraineurs during the period between the attacks. So, the aim of this study was to evaluate the olfactory function of migraineurs during the period without headaches with odor identification test. Methods: Two hundred and ninety healthy people aged 16 to 65 years (152 female, 138 male) and 84 migraine patients aged 18 to 55 years (47 female, 37 male) were studied. The participants with migraine were selected from the patients who applied to headache outpatient clinic for assessment. Participants, appropriate to the study, were physically and neurologically examined in detail and then they were taken to the test room in order to be screened with Short Smell Test Battery of GATA Haydarpafla (GULTEST). Results: The mean GULTEST score of the migraine group was less than the healthy group and the difference was significant. The effect of gender, cigarette smoking and disease status (migraine) on GULTEST scores was evaluated by linear regression model. It was found that females had higher odor identification scores than males in both migraineurs and controls. On the other hand, cigarette smoking had a significant negative effect on GULTEST scores. Furthermore, migraine had a significant negative effect on GULTEST scores. Conclusion: Our study showed that even during the headache-free peri- od, migraineurs might have reduced olfactory abilities.

Loop Nerve Graft Prefabrication in Peripheral Nerve Defect Reconstruction.

MATERIALS AND METHODS: Two minipigs were each implanted with tissue expanders under tattooed skin grids, with unexpanded patches as internal controls. One pig was expanded maximally over 35 days (slow protocol), and the second over 15 days (rapid protocol). Multiview stereo was used to create 3-dimensional models of skin patches in vivo and ex vivo. Isogeometric analysis was performed to calculate skin growth due to expansion and purely elastic deformation (stretch). Epidermal/dermal thickness was evaluated by histology. Immunohistochemistry was performed to assess cellular proliferation (Ki-67), vascularity (CD31), and activation of ERK1/2, a biomarker implicated in mechanotransduction.

Is cognitive processing affected in adults with hypospadias?: P300 study

Abstract Background: Hypospadias is a common urogenital system disorder. The frenulum, which is the most sensitive area of the glans penis, is not present in patients with hypospadias. This may lead to a failure in sexual and ejaculatory function, and cause emotional problems affecting cognitive processes. Aim: We aimed to study auditory Event Related Potentials (ERP) in patients with hypospadias to understand the status of cognitive function. Materials and Methods: Seventeen patients with hypospadias who presented to the Urology Outpatient Clinic of Çanakkale Military Hospital, and 11 healthy individuals of similar age were chosen. The auditory oddball paradigm with ERP from the Cz and Fz head regions were studied. The latency and amplitude of the P300 wave were measured. Results: Both, the study and control groups consisted of young males. Although the study group had a longer P300 latency and lower P300 amplitude when compared to control group, the results were not statistically significant (p: 0.059 and 0.346 respectively). Conclusion: Although the results are not statistically significant, our findings indicate that there may be cognitive changes in patients with hypospadias. Further studies of larger sample size and older patient cohorts are needed.