Effects of glucagon as a neurohormone on the central nervous system and glucose homeostasis.

OBJECTIVE: This study aimed to elucidate the possible effects of the acute/long-term infusion of glucagon in the brain as the regulatory role on the endocrine secretions of the pancreas. MATERIALS AND METHODS: Ninety male Wistar albino rats were divided as Control, artificial Cerebrospinal Fluid (aCSF) (120 min), Glucagon (120 min), pancreatic denervation (PD)+aCSF (120 min), PD+Glucagon (120 min), aCSF (7 days), Glucagon (7 days), PD+aCSF (7 days) and PD+Glucagon (7 days). Glucagon and solvent (aCSF) were administered after pancreatic denervation (PD) by Hamilton syringe and osmotic mini pump (1 µg/10 µl/min) in the third ventricle of the brain. RESULTS: Acute intracerebroventricular (icv) administration of glucagon resulted in an elevation of glucagon levels and a concurrent reduction in blood glucose levels. Furthermore, in both the PD+aCSF (7 days) and PD+Glucagon (7 days) groups, there was a notable decrease in propiomelanocortin (POMC) and agouti-related protein (AgRP). Significant changes were observed in feed consumption and body weight, as well as pancreatic glucagon levels, with a simultaneous decrease in insulin levels in the PD (7 days), Glucagon (7 days), and PD+Glucagon (7 days) groups. These alterations were statistically significant when compared to the control group (p<0.05). CONCLUSIONS: The research outcomes established that pancreas-secreted glucagon functions as a neurohormone within the brain, activating central pathways linked to blood glucose regulation. The presence of glucagon led to a decrease in POMC levels. Surprisingly, this reduction in POMC resulted in the suppression of AgRP. Contrary to expectations, the suppression of AgRP led to an increase in food intake rather than a decrease. As already highlighted in the results section, it was emphasized that POMC may play a more significant role than AgRP in influencing feeding behavior.

[COVID-19: neurological manifestations-update : What we know so far]. / COVID-19: neurologische Manifestationen ­ Update : Was wir bisher wissen.

Beyond pulmonary presentation, COVID-19 infection can manifest with a variety of both acute and chronic neurologic and neuropsychiatric (concomitant) symptoms and diseases. Nonspecific symptoms such as headache, fatigue, olfactory and gustatory disturbance have been reported more frequently, and severe disease such as encephalopathy, encephalitis, and cerebrovascular events have been reported relatively rarely. The heterogeneity of neurologic and neuropsychiatric presentations is large, as well as the range of recorded prevalences. Older patients, pre-existing neurologic and non neurologic comorbidities and severe COVID-19 disease were associated with increased risk of severe neurologic complications and higher in-hospital mortality. Probable neurotropic pathomechanisms of SARS-CoV­2 have been discussed, but a multifactorial genesis of neurologic/neuropsychiatric symptoms and disease beyond these is likely.

A new and reliable landmark in parotid surgery: tragomastoid groove (Akil Groove).

OBJECTIVE: Parotid surgery is a frequently performed surgery in otorhinolaryngology practice with many possible complications. Due to the high ratio of facial paralysis during parotid surgery, we defined a new landmark for identifying and protecting the facial nerve as early as possible during surgery. MATERIALS AND METHODS: The study was designed as a prospective anatomical method. The important details and relationship of the tragomastoid groove to the facial nerve truncus were examined during surgery on 30 patients. In addition, the demographics of the patients, the type of surgery and the pathological results of surgeries were evaluated. RESULTS: The mean distance of the tragomastoid groove to the facial nerve truncus was 20.53±1.71 mm, the mean deepness of the tragomastoid groove was 1.91±0.26 mm, and the mean superficial part of the tragomastoid groove was 0.83±0.23 mm. The tragomastoid groove was situated either across from the facial nerve at the place where the facial nerve truncus exits the stylomastoid foramen or just inferior to the truncus in all patients. CONCLUSIONS: The tragomastoid groove was defined for the first time in the literature as a reliable landmark for identifying the facial nerve truncus easily during parotid surgery.

[Nonaccidental traumatic brain injury in infants and children]. / Nichtakzidentelles Schädel-Hirn-Trauma bei Säuglingen und Kleinkindern.

Violent traumatic brain injury (TBI) can cause brain dysfunction and injury. Accidental and nonaccidental trauma are still the leading cause of childhood death worldwide. It is assumed that about 20% of TBI in children under 2 years of age are nonaccidentally caused. In all cases, nonaccidental TBI is caused by the violent impact on the brain and spinal cord by the massive shaking of the child held by the upper arms or body. This can lead to a rupture of blood vessels, especially bridge veins, as well as axonal shear injuries to the nerve connections and brain swelling. Involvement of the brain stem can lead to initial short-term respiratory arrest. The resulting clinical symptoms include poor drinking, drowsiness, apathy, cerebral seizures, breathing disorders, temperature disorders, and vomiting as a result of increased intracranial pressure. Long-term disorders can include neurological and neuropsychological disorders, hearing disorders, visual disorders up to blindness, and poor school performance. In addition, there are metaphyseal fractures and rib fractures of various forms, also of different ages. Since shaking trauma has a poor prognosis, preventive measures are useful: education!

[Spontaneous craniocervical dissection]. / Spontane Dissektionen der hirnversorgenden Arterien.

Spontaneous craniocervical dissection is one of the main causes of stroke in juvenile and middle-aged patients. It is caused by intramural hematoma which may result in stenosis or even occlusion of the artery. Clinical manifestation varies from local pain to ischemic complications. The imaging modality of choice is magnetic resonance imaging (MRI) which is able to detect all characteristic signs of dissection. Intramural hematoma is detected with thin slice fat-saturated 3D black-blood images. However, with the use of special imaging techniques, questionable findings can be clarified and especially the more difficult to detect intradural dissection can be accurately diagnosed. Acute treatment depends on the severity of neurological symptoms and their duration. Factors like the location of the dissection, cerebral infarction or hemorrhage influence the choice of medication for primary and secondary prophylaxis. Resorption of the intramural hematoma often leads to spontaneous recanalization within a few months.

A rare case of raoultella planticola peritonitis in a chronic ambulatory peritoneal dialysis patient and review of the literature.

Peritonitis is a common and serious complication of peritoneal dialysis and often primary factor of change over to hemodialysis treatment. Raoultella planticola is known as as environmental bacterium and rarely causes infections in humans. We present a case of peritoneal dialysis related peritonitis due to Raoultella planticola and review the clinical manifestations and treatment options of this microorganism. As far as we know, this is the third case of Raoultella planticola peritonitis in the literature.

The role of miRNAs targeting K-ras and APC genes in colorectal cancer.

OBJECTIVES: The occurrence of abnormal expression patterns in different types of cancer suggests that micro RNAs (miRNAs) may play an important role in tumorigenesis. The aim of this study was to examine the expression levels of miRNAs known to be associated with the regulation of the expression levels of the APC and K-ras, which are important in the development of colorectal cancer (CRC). METHODS: The expression levels of miR-27, miR-663, miR-217, miR-181d, APC and K-ras in the serum, tumor and adjacent tumor-free (healthy) tissues of the patients and serum of the healthy controls were investigated with qRT-PCR. RESULTS: Expression levels of miR-217, mR-181d, miR-663, miR-27 and K-ras were found to be higher in CRC tissues than in adjacent tumor-free tissues of the patients. In patient serum samples, miR-663 levels were statistically more elevated than in controls. In patient tumor tissues, miR-217, miR-181d and miR-27 expressions were found to be higher. CONCLUSIONS: Increased miR-181d and miR-217 expression levels are associated with increased K-ras expression in the tumor tissues, and the expression of K-ras, which takes part as an oncogene in the CRC development, might be regulated by these miRNAs (Tab. 4, Ref. 33).

Brain death confirmation.

The number of patients waiting for a new organ has continuously decreased in recent years. Brain death confirmation plays an important role in the clinical routine concerning a possible organ transplantation. In many countries a strictly defined protocol prescribes the required neurological examination and ancillary test criteria. Therefore, many years of experience and expertise is absolutely necessary for neurologists and neuroradiologists. Pitfalls can sometimes be very challenging for the treating physicians.

Evaluation of two different CAD-CAM inlay-onlays in a split-mouth study: 2-year clinical follow-up.

OBJECTIVE: To evaluate the clinical performance of hybrid ceramic inlay-onlay restorations over a 2-year period. CLINICAL CONSIDERATIONS: A total of 30 lithium disilicate glass ceramic (LDC; control group) and 30 hybrid ceramic (HC; test group) inlay/onlay restorations were performed in 14 patients. Clinical evaluations were performed after 1 week, 6 months, 1 year, and 2 years of cementation according to the modified United States Public Health Service (USPHS) criteria, gingival index, and plaque index. The Friedman test was used for the significant difference in time and Wilcoxon signed-rank test was used for the determination of differences. The clinical parameters, gingival and plaque indexes differences in time were analyzed with Chi-square test. No statistically significant difference (P > .05) was found between the two groups in the modified USPHS, gingival index, and plaque index evaluations, whether statistically significant differences were found within groups. The total survival rate was 100% for both groups after 2 years. CONCLUSION: Based on the 2-year data, the tested HC can be considered a reliable material for inlay/onlay restorations. CLINICAL SIGNIFICANCE: The results of this in vivo study suggest that both resin nanoceramic materials and LDC materials have been successfully incorporated in treatments of inlay and onlay restorations. Short-term results showed that resin nanoceramic materials can be counted as a good choice in inlay and onlay restorations in an effort to reduce the treatment time associated with ceramic firing processes.

[Anatomy of the petrous portion of the temporal bone]. / Anatomie des Felsenbeins.

CLINICAL METHOD: The complexity of the anatomy of the petrous portion of the temporal bone with the crossing nerval, vascular, and muscular structures together with the important parts of the human vestibulocochlear organ poses challenges in clinical routine, especially in the preoperative diagnostic workup. In particular, the presence of standard anatomical variations bears a higher risk of intraoperative injuries. STANDARD RADIOLOGICAL METHOD: MRI and CT examinations are important image-based diagnostic methods in the detection of neoplastic, traumatic and inflammatory lesions of the petrous part of the temporal bone. These kinds of methods are absolutely necessary for the identification of the entity of the lesion, the extent of the infiltration, possible bone involvement or the presence of standard anatomical variations.

[Differential diagnoses of ischemic stroke using imaging]. / Differenzialdiagnosen des ischämischen Schlaganfalls in der Bildgebung.

Diffusion-weighted imaging enables us to detect acute ischemic stroke early and with high sensitivity and specificity. Its signal changes are based on decreased diffusion of water molecules that is caused by cytotoxic edema. Several different neurological diseases can also cause restricted diffusion and therefore mimic stroke. These can generally be reliably distinguished from ischemic stroke based on location, morphology and signal behavior in other magnetic resonance imaging sequences.

Histopathologic and immunohistochemical investigations of dental abscess formed in maxillofacial area.

BACKGROUND: An abscess is a pocket of pus that forms around the root of an infected tooth. In this study, we aimed to investigate the extracellular matrix proteases ADAMTS1, ADAMTS4, osteonectin, and osteopontin expressions in abscess fluid cells in jaws after implantation and prosthesis operation. MATERIALS AND METHODS: In this clinical study, abscess fluids belonging to 17 patients who applied to the Department of Oral and Maxillofacial Surgery were examined histopathologically and immunohistochemically. In the histopathological examination of the abscess fluid, separation of chromatin bridges in the nuclei of neutrophil cells, pyknosis and apoptotic changes in the nucleus, degenerative change in the cytoplasm, and occasional vacuolar structures were observed. RESULTS: The positive reaction of ADAMTS1 was observed in fibroblast cells, plasma cells, and macrophage cells. The positive reaction of ADAMTS4 was observed in fibroblast cells, osteoclast cells, and some apoptotic leukocyte cells. Osteopontin expression in osteoclastic cells and polymorphonuclear cells was defined as positive. Osteonectin expression was positive in polymorphonuclear leukocytes and hypertrophic fibroblast cells. CONCLUSIONS: ADAMTS1 and ADAMTS4 may induce bone destruction with its distinctive property in alveolar bone resorption, which promotes the activation of osteoclasts, which can accelerate the destruction of the extracellular matrix in the acute phase. Furthermore, osteoclastic activity increased with the increase of osteonectin and osteopontin protein expression due to inflammation in the abscess cases.

Is there a new pathway relationship between melatonin and FEZ1 in experimental rat model of Alzheimer's disease?

Alzheimer's disease (AD) is a progressive neurodegenerative disease. This study was performed to determine the possible relationship between melatonin, which is known to play a role in the neuro-protective mechanism in AD, and fasciculation and elongation protein zeta 1 (FEZ1). Thirty male rats were included and separated into 3 groups (n = 10) as vehicle (artificial cerebrospinal fluid), streptozotocin (STZ) and STZ+melatonin (MLT). Two intracerebroventricular (icv) injections of 3 mg/kg STZ were made 48 hours apart. MLT injections were implemented for 14 days (ip; 10mg/kg/day). The Morris Water Maze (MWM) test was performed and rats were sacrificed to assess FEZ1 gene expression and protein levels from the hippocampus tissues and serum levels of noradrenaline (NA), dopamine and serotonin were determined from the blood samples. It was determined that the FEZ1/ß-actin protein ratio in the STZ group was significantly higher than that of the Vehicle group (p < 0.05) and in the MLT­administered group, the protein levels were decreased to the levels observed in the Vehicle group. Serum NA levels of STZ and STZ+MLT groups were found to be lower than those in the Vehicle group, while no difference was found regarding dopamine and serotonin levels. These findings show that reversal of increased FEZ1 levels in AD-induced rats with melatonin administration is the evidence of the effect of melatonin through FEZ1 in AD (Tab. 2, Fig. 5, Ref. 67). Keywords: FEZ1, Alzheimer's disease, melatonin, rat, microtubules, mitochondria.

[Metabolic induced changes of the central nervous system]. / Metabolisch verursachte Veränderungen des Zentralnervensystems.

CLINICAL ISSUE: The diagnosis of metabolic disorders of the central nervous system (CNS) can be very challenging for radiologists because of the nonspecific white matter lesions of the brain, the rarity of these diseases, and the variety of possible differential diagnoses. RADIOLOGICAL STANDARD METHODS: Standard for the evaluation of the metabolic disorders is cranial MRI. The MRI spectroscopy can additionally help to reduce the possible differential diagnoses.

[Fetal magnetic resonance imaging]. / Fetale Magnetresonanztomographie.

CLINICAL ISSUE: The most important prenatal screening method for the detailed assessment of the fetus is ultrasound, which is often combined with colour-coded Doppler sonography. In case of sonographically diagnosed fetal pathologies or technical limitations of the ultrasound, supplementary diagnostics may be necessary. STANDARD RADIOLOGICAL METHODS: With fast MRI sequences, fetal MRI screening provides important additional information especially with regard to the most common congenital pathologies-central nervous system (CNS) pathologies (agenesis of the corpus callosum, ventriculomegaly, arachnoid cyst, pathologies of the posterior cranial fossa, dysfunction of the gyrification). Knowledge of the developmental stages of the CNS is very important for accurate clinical assessment and interpretation.

Prognostic value of primary tumor SUVmax on pre-treatment 18F-FDG PET/CT imaging in patients with stage iii non-small cell lung cancer. / Valor pronóstico del SUVmáx del tumor primario pretratamiento con PET/TC con 18F-FDG en pacientes con cáncer de pulmón no microcítico en estadio iii.

OBJECTIVES: Concomitant chemoradiotherapy (CCRT) is widely used in the treatment of patients with stage iii non-small cell lung carcinoma (NSCLC). The early identification of patients with poor prognosis is the premise of personalized treatment for patients. The aim of the study was to evaluate the prognostic value of clinical parameters and primary tumor SUVmax on pre-treatment 18F-FDG PET/CT in patients with stage iii NSCLC. MATERIAL AND METHODS: Clinical records of 79 stage iii-NSCLC patients with pre-treatment 18F-FDG PET/CT imaging, treated with definitive CCRT were retrospectively reviewed. The clinical endpoints in terms of progression-free survival (PFS) and overall survival (OS) were correlated with the median pre-treatment primary tumor SUVmax. Furthermore, other factors influencing patient outcome were analyzed. RESULTS: The median age of patients was 58 years (range, 45-71) with 72 (91%) males. Squamous cell carcinoma (73%) was the most common histologic type. Performance status was very good (ECOG 0) in 64.5% of patients. Sixty (79%) patients had died at the time of this analysis. Median OS and PFS were 22.5 and 12.0 months, respectively. Patients were dichotomized according to pre-treatment primary tumor SUVmax≤15.0 vs.>15.0. There was no statistically significant difference for OS and PFS in both arms. Multivariate analysis showed that pre-treatment SUVmax was not a significant predictor of OS (HR 1.099, P=0.726) and PFS (HR 1.022, P=0.941). CONCLUSIONS: SUVmax with threshold value of 15.0 on the primary tumor before treatment had no prognostic value in our patient group with stage iii NSCLC treated with definitive CCRT.

[Magnetic resonance cisternography]. / Magnetresonanz-Zisternographie.

CLINICAL/METHODICAL ISSUE: Conventional MRI can be insufficient to depict certain pathologies of the cerebrospinal fluid (CSF)-filled spaces. STANDARD RADIOLOGICAL METHODS: 3-D T2-weighted sequences and phase-contrast imaging have a high sensitivity for pathologies of the CSF-filled spaces, but are susceptible to artifacts in some cases. METHODICAL INNOVATIONS/PERFORMANCE: Magnetic resonance (MR) cisternography directly depicts the connection between CSF-filled spaces.

Evaluation of the academic productivity of the top 100 worldwide physicians in the field of otorhinolaryngology and head and neck surgery using the Google Scholar h-index as the bibliometrics ranking system.

OBJECTIVE: The top 100 physicians of otorhinolaryngology and head and neck surgery worldwide were investigated using the Google Scholar h-index. METHOD: Although there are various bibliometrics ranking systems that present the academic quantity and quality of scientists' published articles, the h-index is the most popular and widely accepted. In this study, Google Scholar was used to search all the keywords involving all the subspecialties of otorhinolaryngology and head and neck surgery, with the aim of identifying as many physicians as possible. Obtaining the Google Scholar h-index and citations is not possible for scientists who do not have Google Scholar accounts. Thus, only those with Google Scholar accounts were included. RESULTS: The average h-index of all 100 physicians enrolled in the study was 37.83, with a range of 25-81. CONCLUSION: The current study details the academic impact of otorhinolaryngology and head and neck surgery physicians worldwide based on the Google Scholar h-index.

[Stroke in children and adolescents]. / Schlaganfall bei Kindern und Jugendlichen.

The occurrence of a stroke in children and adolescents constitutes a rare, critical event that is associated with substantial morbidity and mortality. In addition to the individual suffering for the young patient and the medical burden for the affected family, a stroke is also associated with high follow-up costs for the health system because of the necessary long-term rehabilitative treatment. Establishing an early and prompt diagnosis is of great therapeutic importance. Because of the rarity of the illness and the plethora of clinical manifestations, diagnosis is often delayed. The most frequent clinical presentation is an acute focal-neurological deficit, usually in the form of hemiparesis, but headache, seizures or alteration of consciousness may also be seen. Nowadays, the prompt performance of diffusion-weighted, blood-sensitive magnetic resonance imaging (MRI) constitutes the gold standard. The most relevant risk factors for the occurrence of a stroke in this age cohort are vasculopathies, infections, pathological cardiac conditions or coagulopathies. Recurrence of stroke is dependent on the underlying risk factors. In a substantial percentage of patients, residual neurological deficits are seen.Owing to a lack of randomized controlled trials in children and adolescents with stroke, the optimal treatment approach is still under debate. In addition to anti-platelet medication and heparinization, systematic intravenous thrombolysis and endovascular thrombectomy are other potentially effective treatment options. The long-term prognosis in children is dependent on establishing a correct, early diagnosis.