There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.

Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …

I and i

Excess intra-abdominal adipose tissue accumulation, often termed visceral obesity, is part of a phenotype including dysfunctional subcutaneous adipose tissue expansion and ectopic triglyceride storage closely related to clustering cardiometabolic risk factors. Hypertriglyceridemia; increased free fatty acid availability; adipose tissue release of proinflammatory cytokines; liver insulin resistance and inflammation; increased liver VLDL synthesis and secretion; reduced clearance of triglyceride-rich lipoproteins; presence of small, dense LDL particles; and reduced HDL cholesterol levels are among the many metabolic alterations closely related to this condition. Age, gender, genetics, and ethnicity are broad etiological factors contributing to variation in visceral adipose tissue accumulation. Specific mechanisms responsible for proportionally increased visceral fat storage when facing positive energy balance and weight gain may involve sex hormones, local cortisol production in abdominal adipose tissues, endocannabinoids, growth hormone, and dietary fructose. Physiological characteristics of abdominal adipose tissues such as adipocyte size and number, lipolytic responsiveness, lipid storage capacity, and inflammatory cytokine production are significant correlates and even possible determinants of the increased cardiometabolic risk associated with visceral obesity. Thiazolidinediones, estrogen replacement in postmenopausal women, and testosterone replacement in androgen-deficient men have been shown to favorably modulate body fat distribution and cardiometabolic risk to various degrees. However, some of these therapies must now be considered in the context of their serious side effects. Lifestyle interventions leading to weight loss generally induce preferential mobilization of visceral fat. In clinical practice, measuring waist circumference in addition to the body mass index could be helpful for the identification and management of a subgroup of overweight or obese patients at high cardiometabolic risk.

Pathophysiology of Human Visceral Obesity: An Update

http://www.mag2health.com/wp-content/uploads/CLINPH-Guidelines-rTMS.pdf

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)

https://biblio.ugent.be/publication/8650534/file/8672654.pdf

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018)

On tumors of the salivary glands.

To compare external and endoscopic dacryocystorhinostomy outcomes in patients with chronic dacryocystitis, a total of 103 patients with the complaint of epiphora and diagnosed as chronic dacryocystitis were included in the study. We performed external dacryocystorhinostomy on 55 patients under local anesthesia and endoscopic dacryocystorhinostomy on 48 patients under general anesthesia by means of drill and placed silicon stents to all the patients. The patients were examined endoscopically, at postoperative intervals of 1 week, first month, third month, sixth month and the first year. The patency of the tubes and nasolacrimal ducts were evaluated by irrigation and complaints of the patients were noted. Silicon stents were harvested at the sixth week postoperatively. Outcomes were classified as successful when epiphora diminished, no recurrent infection was noted and minimal or no reflux from the canaliculis during or after lacrimal irrigation was seen. A prospective endoscopic surgery group was compared to a prospective control group (external dacryocystorhinostomy). Full success was achieved in 69.9% of the patients with external dacryocystorhinostomy group whereas the full success rate of endoscopic dacryocystorhinostomy was 89.7%. Recently popularized endoscopic dacryocystorhinostomy is a safe and reliable procedure with high success rates.

External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

The aim of this study was to investigate frequency and degree of ED in patients with severe sleep apnea and to evaluate the results of only continuous positive airway pressure (CPAP) therapy on ED in patients with severe obstructive sleep apnea syndrome (OSAS). This was a prospective clinical trial study. Patients with severe sleep apnea (40) were randomized into two groups. Multiple questionnaire investigation and laboratory evaluation were performed for ED, severity of OSAS and psychological status. Group 1 was treated with CPAP and group 2 was treated with only antidepressant medication for at least 1 month. Patients were evaluated after 1 month of therapy and compared with initial ones. Before CPAP, the International Index of Erectile Function (IIEF)-5 scores were significantly correlated only with body mass index (BMI; P=0.007) and not correlated significantly with Epworth Sleepiness Scale scores (P=0.286), lowest SaO(2) (P=0.182), Beck's Depression Inventory scores (P=0.302) and apnea/hypopnea index (P=0.279). After 1 month of regular CPAP usage, mean value of IIEF-5 score was 15.71+/-5.12 before CPAP and were improved up to 19.06+/-3.94, statistically significant. All subjects responded positively to the CPAP treatment and their erection status was improved positively. We have found a correlation between severe OSAS and ED. CPAP is effective in improvement of sexual performance of these patients.

Erectile dysfunction in severe sleep apnea patients and response to CPAP

The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty

PURPOSE To analyze the clinical outcomes of external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) with dacryocystorhinostomy (DCR). METHODS Ninety-two patients with primary acquired nasolacrimal duct obstruction were enrolled (divided into EX-DCR [n = 33], EN-DCR [n = 30], and TC-DCR groups [n = 29]) in this prospective study. Primary outcome measures were the anatomical and functional success of operations at the last control examination. Secondary outcome measures were the ostium size, surgical time, and complications. RESULTS The difference in mean surgical time among the 3 groups was statistically significant (p < 0.0001). External DCR required the longest surgical time (46.6 ± 15.3 minutes), while TC-DCR was the shortest (20.3 ± 7.7 minutes). There were no significant differences between the groups regarding anatomical (81.8%, 75.9%, and 76.7% in EX-, EN-, and TC-DCR groups, respectively; p = 0.824) and functional success rates (81.8%, 72.4%, and 73.3% in EX-, EN-, and TC-DCR groups, respectively; p = 0.626). Final ostium size was the largest with EX-DCR (33.7 ± 17.4 mm) and smallest with EN-DCR (19.0 ± 8.9 mm; p = 0.001). The complication rate was similar in all groups. The most common complications were the formation of granulation tissue (16.3%) and intranasal synechiae (9.8%), all of which led to surgical failure and were more frequent in the EN- and TC-DCR groups. CONCLUSIONS External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.

Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

SOMMAIRE Objectifs: L'etude avait pour objectifs d'examiner le lien entre la gravite des apnees du sommeil et la resistance a l'insuline ainsi que les taux de leptine, de proteines de liaison aux acides gras dans l'adipose (PLAG-A) et de visfatine, et d'evaluer le role confusionnel de l'obesite. Type d'etude: Il s'agit d'une etude prospective. Methodes: L'etude a ete menee chez des personnes obeses, dirigees au laboratoire de sommeil. Les patients ont ete divises en deux groupes d'apres l'index apnees hypopnees (IAH). Il y a eu mesure du poids, de la taille, de la pression arterielle, du tour de taille (TT) et du tour de cou (TC), le soir de l'etude. Des prelevements sanguins ont ete effectues apres la polysomnographie. La resistance a l'insuline a ete estimee a l'aide de l'indice d'evaluation par le modele homeostatique (EMH). Resultats: Le groupe A comptait 34 patients atteints du syndrome des apnees obstructives du sommeil (SAOS), et le groupe B comptait 19 patients qui en etaient exempts. Ceux qui souffraient du syndrome avaient un taux significativement plus eleve de visfatine que ceux qui n'en souffraient pas, mais les autres parametres etaient similaires. Les taux de leptine et de PLAG-A etaient en correlation etroite avec l'indice de masse corporelle (IMC) dans les deux groupes. Les patients atteints du SAOS presentaient un TC et un TT passablement plus eleves que ceux qui en etaient exempts, et ce, malgre un IMC comparable a celui du groupe B, et de fortes correlations ont ete etablies entre ces deux variables et l'EMH. Le taux de visfatine etait plus eleve dans le groupe A que dans le groupe B. Conclusions: La resistance a l'insuline n'etait pas associee directement a l'IMC ou a l'IAH, mais elle etait aggravee par l'hypoxemie nocturne causee par les apnees. Le tour de cou s'est egalement revele un bon facteur previsionnel de resistance a l'insuline, et on ne devrait pas negliger cet element dans le choix des traitements chez les patients atteints du SAOS. Enfin, la visfatine pourrait jouer un role de marqueur de depistage du SAOS.

Umit Taskin

Papers

External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

Erectile dysfunction in severe sleep apnea patients and response to CPAP

The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty

Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

Obesity and obstructive sleep apnea syndrome.