2021 - Cilt 5 - Sayı 2
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Öğe A point to evaluate in the COVID-19 pandemic process: Frailty(2021) Yüceler Kaçmaz, Hatice; Döner, Ayser; Ceyhan, ÖzlemGlobally, as of September 16, 2020, COVID-19 had infected approximately 29 million people and caused the death of 930 thousand people around the world. While the whole world is at risk of COVID-19 infection, the elderly in particular represent the highest risk group. Those who are very old and frail and have cognitive impairment and multi-comorbidity, are the most vulnerable to the severe consequences of this infection. Frailty is a less well-known and often overlooked issue compared to other factors. In the world, the prevalence of frailty is seen to rise with the increase of the aging population, and the prevalence of frailty among the elderly people living in society is thought to be 4 to 59%. The COVID-19 pandemic, which has affected the entire world, leads to the necessity of taking care of elderly individuals in nursing homes and care centers. The fact that most persons in such facilities are advanced in age, frail and have multi-comorbidity, makes the management of the care even more difficult. It is thought that there may be a potential relationship between frailty and the course of COVID-19 and deaths resulting from the infection. The need for a holistic assessment of not only the age of the patient but also the state of frailty, is emphasized to ensure the triage of elderly persons and resource allocation during COVID-19 pandemic process. This review was performed to raise awareness of the healthcare professionals on the importance of frailty among the elderly during the COVID-19 pandemic process and to provide general information about the instruments that can be used to measure the frailty status of the elderly, when managing the COVID-19 pandemic process.Öğe Can superficial veins be used as a drainage path in deep venous injuries?(2021) Etli, Mustafa; Gürsu, ÖzgürPeripheral vascular injuries are frequently encountered traumas that require emergency intervention. Rapid recognition of vascular injury, fluid replacement, blood transfusion, and early revascularization are very critical in the potential prevention of mortality, extremity loss, and functional defect. In the present report, we aimed to emphasize the importance of arterial and superficial venous and also deep venous revascularizations on the mortality and morbidity of a patient with burts vascular injuries.Öğe A rare case of Munchausen syndrome: foreign body ingestion(2021) Uysal, Emin; Karacam, Hatice; Aydemir Dikici, SerapMunchausen Syndrome (MS) is characterized by mental or physical diseases intentionally induced by the patients. In this case report, we aimed to present MS and review current literature. A 36-year-old female patient was admitted to the emergency room with the complaint of abdominal pain that developed after swallowing stitch needles. Physical examination revealed minimal tenderness in the abdomen with palpation. The plain abdominal X-ray revealed more than ten needle-shaped opacities. During the anamnesis, the patient was incoherent and too determined to have a surgical intervention, which gave rise to a suspicion of MS. A psychiatrist consultation was conducted, she was diagnosed with MS and hospitalization of the patient was planned. Clinical suspicion and detailed anamnesis are the key for the diagnosis. Physicians should bring to mind the diagnosis of MS and seek psychiatric support in patients with frequent hospital admissions, incompatibility between their complaints and a history and examination findingsÖğe Comparing the outcomes of arthroscopic tenodesis versus tenotomy for the treatment of the long head of biceps tendon pathologies during supraspinatus tendon repair(2021) Özçamdallı, Mustafa; Eken, Gökay; Günay, Mahmut; Yetiş, Mehmet; Kızkapan, Turan BilgeAim: Long head of the biceps tendon pathologies are frequently accompanied by full-thickness rotator cuff tear. The purpose of this study was to compare functional scores, complication rates and time to return to work after tenotomy and tenodesis who underwent arthroscopic supraspinatus repair (ASR). Methods: Overall, 129 patients who underwent ASR surgery were divided into 2 groups. Group 1 consisted of 62 patients who underwent biceps tenodesis and group 2 consisted of 67 patients who underwent biceps tenotomy. We evaluated demographic data, clinical findings, complications and American Shoulder and Elbow Surgeons, Constant Murley, Visual analogue scale and 36-item Short Form subscale scores. Results: Mean follow-up time was 13.68±4.22 months. Mean postoperative and preoperative-postoperative differences of ASES, CM, VAS and SF-36 subscale scores were not significantly different between the two groups. Popeye sign was positive for 13 (19.4%) patients in group 2, however, none of patients in group 1 was positive (p<0.001). Other complications were not significantly different between two groups. Conclusion: The results show that arthroscopic biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding similar clinical outcomes in the context of concomitant rotator cuff repair. Tenotomy can be chosen instead of tenodesis, which is technically more difficult and expensiveÖğe Does race have a role in the effect of fingerprint on gender?(2021) Avnioğlu, Seda; Dikici, Rumeysa; Yılmaz, HalilAim: Fingerprint is one of the personal and reliable physical features. The fingerprint has an important role in forensics, and it is used in the detection of criminals and identity checks. Studies on different races have been conducted, but no interracial comparison has been found in the literature. In this study, we have investigated the effect of race on finger ridge using the same method on 5 different races. Methods: In our study, the right thumb prints of 355 (148 female, 207 male) students aged 17-25 years in our school were taken with an ink pad (stamp) and recorded along with their ages, sexes, and races. Data were analysed by sex and race. Results: In the comparison by sex, the finger ridge counts of male (11.94±2.08) and female (12.76±2.02) participants were found to be statistically significantly different (p<0.001). Participants were classified as Turkish, Arab, Russian, Turkmen, and African. The difference in finger ridge counts between Turkish-Africans was found to be statistically significant in the comparison by races (p<0.05). Conclusion: Comparison of finger ridge counts by sex has been studied on many races, but each study has been conducted with a different method. In our study, we aimed to contribute to the literature by examining how the finger ridge counts of men and women differ in 5 different races by using the same method. Although the data we obtained are compatible with the literature for the Turkish race, there are differences for other races.Öğe Copy number variation analysis in Turkish patients with congenital bilateral absence of vas deferens(2021) Demir Ekşi, Durkadın; Yılmaz, Elanur; Akın, Yiğit; Usta, Mustafa Faruk; Başar, Mehmet Murad; Kahraman, Semra; Erman, Munire; Alper, Özgül M.Objective: Congenital Bilateral Absence of the Vas Deferens (CBAVD) is a developmental abnormality that causes infertility in males. According to the literature, up to 88% of CBAVD cases have at least one pathogenic Cystic Fibrosis Transmembrane Conductance Regulator gene (CFTR) mutation. However, based on our previous data, this rate was 15.90% in Turkish patients with CBAVD. We aimed to identify genomic copy number variations (CNV) and candidate genomic regions which could related to the CBAVD in Turkish population. Methods: CNV analysis was performed in 19 Turkish CBAVD patients normal karyotypes and a wild type CFTR genotype. We suggested that the DAD1 gene may be a candidate gene related to CBAVD by reviewing online databases and analyzing CNV findings. Sanger sequencing of the DAD1 gene exons was performed in 22 patients. Results: We identified 11 CNVs that most likely related with the disease in nine of 19 (47.3%) patients. As the most common CNV, 14q11.2 deletions were detected in there (15.79%) of the patients. There was only DAD1 gene in the sharing genomic region of two of the 14q11.2 deletions. No sequence variation was detected in the DAD1 gene of the patients. Conclusion: The 14q11.2 chromosomal region and the DAD1 gene may be associated with CBAVD. Further studies are needed to indentify the contribution of CNVs and DAD1 gene to CBAVD etiologyÖğe Ultrasound evaluation of the temporomandibular joint in healthy children and adolescents(2021) Arıöz Habibi, Hatice; Bayramoğlu, Zuhal; Çalışkan, Emine; Öztürk, MehmetObjectives: The purpose of this study was to investigate normative values of the distance between the most lateral point of the articular capsule and the most lateral point of the mandibular condyle (LCCD), in children and adolescents. Since the disc is not always visible on ultrasound, LCCD measurement is a very practical indirect indicator for evaluating TMJ. Methods: This prospective study evaluated 141 temporomandibular joints distance of 141 pediatric individuals with a median age of 9 years (5-13) for boys and 11 years (6.5-14) for girls, comprising 69 boys and 72 girls. LCCD measurements were made with the participants in the closed mouth position, and the relationship of these values with weight, height, age, gender and body mass index (BMI) was evaluated. Results: Median LCCD values in age groups 2 and 3 were significantly higher than the age group 1 (p=0.001). There was no significant difference between median LCCD values in age group 2 and age group 3 (p=0.5). No significant difference was found among the median LCCD values of the males 1.5 mm (1.2-1.8) and females 1.4 mm (1.1-1.6). Conclusion: LCDD values increased with age, but no significant difference shown among the genders. However, a negative relation was detected with BMI. This study provides the normative quantitative values of TMJ distance which could be a reference point for upcoming studies. US is a diagnostic method that can be used in the follow-up and screening of children with TMD risk and general population. Since it does not include radiation, it can be safely repeated.Öğe Investigation of compatibility between serological tests used in laboratory diagnosis of brucellosis(2021) Ay, Selma; Güzel, Bensu; Duman, YücelAim: In the diagnosis of brucellosis, the production of microorganisms in blood or bone marrow culture is considered the gold standard. But it is not always possible to produce the microorganism. For this reason, serological tests are used to diagnose brucellosis. Rose Bengal test (RB), Standard Tube Agglutination test (STA), Coombs Test (CT) and 2-Mercaptoethanol (2-ME) tests are common methods. Immunocapture-agglutination test (ICA) and Brucella Coombs Gel test (BCGT) are tests that can detect blocking antibodies along with total antibodies. The aim of our study was to determine whether there is compatibility between the tests used in diagnosis and the ICA and BCGT tests. Material and Methods: Serum samples were taken from patients with a preliminary diagnosis of brucellosis. RBT testing was performed primarily on all samples. Forty RBT positive and 40 RBT negative sera were included in the study. All serum samples were studied by STA, CT, 2-ME, ICA and BCGT methods. The compatibility between the tests were determined by using the kappa (?) coefficient with the Cohen kappa analysis method. Results: 28 of 40 patients with RBT positive were detected as positive with STA and 2-ME and 30 of them were positive with CT. BCGT and ICA test results were found positive in all RBT positive samples. All tests results were found to be negative in 40 RBT negative samples. Cohen Kappa analysis found that compliance between RBT and BCGT and ICA (Kappa 1.0 <0.001) was excellent. Compliance between STA, BCGT and ICA tests was found to be good (Kappa 0.7 p< 0.001). CT testing showed a very good level of compatibility between ICA and BCGT (Kappa 0.8 p<0.001). There is a very good compatibility between the 2ME test, ICA and BCGT tests (kappa 0.7 0.001), Compliance between BCGT and ICA was also found to be very good (Kappa 1.0, p<0.001). Conclusion: According to these results, with the use of ICA and BCGT tests, both the number of tests will be reduced and the time to receive results will be reduced. But further studies are needed to determine the sensitivity and specificity of these tests based on culture results. But after that, we believe it can be used as a diagnostic testÖğe Ramelteon used to treat insomnia can reduce the occurrence of osteoporosis(2021) Köse, Duygu; Köse, Ahmet; Halıcı, Zekai; Gürbüz, Muhammet Ali; Maman, Adem; Yayla, MuhammedAim: Melatonin promoted osteoblast differentiation and causes an increase in levels of markers of bone differentiation and proliferation. Ramelteon (RAMEL) activates melatonin receptors and binds to these receptors as non-selective. In this study, we investigated the preventive effects of the melatonin agonist RAMEL on osteoporosis by radiological, histological, and molecularly. Methods: Groups 1: Control, Group 2: Osteoporosis: Overectomized group (OP), Group 3: OP + ramelteon 2 mg/kg, Group 4: OP + ramelteon 4 mg/kg. 24 animals underwent bilateral ovariectomy. RAMEL was administered orally once a day in the prophylactic treatment mode for 8 weeks, 6 weeks after ovariectomy. Results: Fourteen weeks after ovariectomy, there was a significant reduction in femoral bone mineral density (BMD) (g/cm2) in the OP group compared to the control group. Compared to the OP group, RAMEL treatment significantly increased the BMD level (p<0.05). Bone matrix protein 2 (BMP2) and runt-related transcription factor 2 (RUNX2) mRNA levels were significantly lower in the OP group than in the control group (p<0.05). RUNX2 and BMP2 mRNA levels were significantly higher in the RAMEL treatment groups than in the OP group (p<0.05). Conclusion: To take advantage of the peripheral effects of melatonin, RAMEL, a peripheral melatonin agonist, can be used to prevent osteoporosis.Öğe The relationship of gastrointestinal complications and ventilator related status with gastric residual volume in intensive care patients(Acta Medica Alanya, 2021) Kaçmaz, Mustafa; Şahin Kocaöz, Fazilet; Destegül, Dilek; Yüksel Turan, Zeynep; Bayraktar, MuhammetAim: Our study aimed primarily to determine whether there was a relationship between total gastric residual volume (GRV) amounts and two different GRV thresholds and the development of gastrointestinal intolerance in patients on mechanical ventilation in the intensive care unit (ICU) and secondarily, to determine the effects of different GRV quantities on ventilator-related conditions (VAC). Methods: Seventy patients above the age of 18 who were scheduled to be fed with enteral nutrition (EN) for at least three days, were divided into two groups including 35 patients according to GRV threshold values of 250 ml and 500 ml. The total amounts of GRV of the patients who did not exceed any of the two GRV thresholds during the follow-up period of 72 hours were recorded and calculated. For all patients, necessary data was recorded and high gastric residual volume rates (HGRV), times to reach target calories, mean GRV amounts, abdominal distension, vomiting, diarrhea, VAC and infection-related ventilator-related complications (IVAC) were all observed. Results: Although there were statistically significant differences between the groups in terms of the HGRV rates and the HGRV rates exceeding the determined threshold values [p <0.05], there was no significant difference between the groups in terms of abdominal distension, vomiting, diarrhea, VAC and IVAC (p> 0.05). Conclusion: The results of this study suggest that measuring the amount of GRV in intensive care patients fed by EN via the nasogastric tube in order to decide on gastrointestinal motility function and to reduce the complication rate, is not necessary.Öğe Comparison between R2CHA2DS2-VASc Score and CHA2DS2- VASc Score to Predict Acute Stent Thrombosis in Patients with After Primary Percutaneous Coronary Intervention(2021) Zorlu, Çağrı; Kurmuş, ÖzgeAim: Acute stent thrombosis (AST) is an important complication resulting from sudden vascular occlusion after stent implantation, especially in patients with STsegment elevation myocardial infarction (STEMI). It occurs in about 1% of the patients after primary percutaneous coronary intervention. The CHA2DS2-VASc score is easily applied in daily practice and the components of this score are similar to common risk factors of the AST. Chronic renal disease has a hypercoagulable state and this condition is associated with an increased risk of AST in STEMI. Since the CHA2DS2-VASc score is insufficient to assess the risk of AST in patients with renal dysfunction, we aimed to investigate the prognostic significance of the modified score, R2CHA2DS2-VASc score in patients with AST. Methods:This cross-sectional study retrospectively included 56 patients withAST and 1493 patients without AST after STEMI. The CHA2DS2-VASc and R2CHA2DS2- VASc scores were compared between the two groups. Results:The median CHA2DS2-VASc and R2CHA2DS2-VASc scores were significantly higher in the AST group (P <0.001, P <0.001, respectively). The R2CHA2DS2-VASc score ?2 was used as a predictor of the AST with a sensitivity of 65% and specificity of 89%. Conclusions: The R2CHA2DS2-VASc score is a simple, cheap, and easily accessible score that can predict AST.Öğe The relationship of inflammatory indicators and metabolic syndrome with gonarthrotic cartilage degeneration: A novel glance(2021) Atik, Aziz; Altun, ErenObjective: The combination of a number of metabolic abnormalities such as high body mass index (BMI), central obesity, low high-density lipoprotein (HDL), high triglycerides, high blood pressure, and hyperglycemia is defined as metabolic syndrome (MetS). This study aimed to clarify the effect of metabolic syndrome components on joint degeneration and investigate the relationship between systemic inflammatory response and end-stage osteoarthritis clinical course. Material and Methods: Fifty-seven patients, who underwent total knee arthroplasty due to primary knee osteoarthritis, were classified according to metabolic syndrome diagnosis criteria. Their medial and lateral tibial plateau specimens were graded histopathologically according to Osteoarthritis Research Society International scoring system (OARSI). Results: 33 patients were performed right total arthroplasty (57.9%), 24 were performed left (42.1%). The mean age was 68.46 ± 6.88 (range 57 to 85). The mean BMI value was 30.31 ± 5.26 (range 20.2 to 48). According to the International Diabetes Foundation (IDF) 2005 metabolic syndrome (MetS) diagnostic criteria; 31.5% (n = 18) of the patients did not have MetS, while 68.4% (n = 39) had. There was no statistically significant relationship between tibial plateau OARSI scores and metabolic syndrome (p> 0.05). Besides, these OARSI scores and the operation side, hypertension, and BMI had no statistically significant relationship (p> 0.05). Conclusions: Metabolic syndrome components may play a role in initiating the osteoarthritic process via adipokines, but we could not identify certain effects of pro-inflammatory mediator components on tibial plateau cartilage degeneration with histopathological scores till end-stage arthritic progress.Öğe Alzheimer's Disease Mortality Trends in Turkey, 2009-2018(2021) Doğan, Nurhan; Doğan, İsmetAim: World population has aged as a result of developments and improvements in the living conditions, care and health services. The most important risk factor of Alzheimer's disease is age, and with the aging of the population, both prevalence and mortality rates increase. The study aimed to determine the trend of mortality rates due to Alzheimer's disease over the years according to gender and age groups, between 2009-2018. Methods: Alzheimer's disease-related data was obtained from the Turkish Statistical Institute death database. Age-standardized mortality rates were calculated through the direct method to the World Standard Population. Joinpoint Regression Analysis was used to estimate annual percentage change, average annual percentage change, and 95% confidence intervals. Results: Over the period observed, more than 95 000 persons died due to Alzheimer's disease (37 961 males and 57 936 females). Joinpoint Regression Analysis indicated that the trend in Alzheimer's mortality rates a significant increase of 13.3% (95% CI: 10.6;16.2; p<0.001) every year from 2009 to 2015, and a non-significant decrease of 0.5% % (95% CI: -5.3;4.7; p=0.82), from 2015 to the end of the period. When evaluated according to gender, both in females and males, mortality rates showed a significant increase from 2009 to 2015. And then until the end of the period a nonsignificant decrease in males and a non-significant increase in females. Conclusion: The findings from this study can provide information about current and future health planning and policy development in medicine, social work, public policy and public health.Öğe Antibacterial effects of leukocyte and platelet-rich fibrin against Escherichia coli and Enterococcus faecalis(Acta Medica Alanya, 2021) Bilgin Çetin, Mehtap; Sezgin, Yasemin; Evren, Ebru; Bulut, ŞuleAim: The main goal of this research was to explore the in-vitro antibacterial characteristics of leukocyte and platelet-rich fibrin (L-PRF) against Escherichia coli (E. Coli) and Enterococcus faecalis (E. Faecalis). Materials and methods: The study was conducted on 21 patients (10 females, 11 males, age range 21-32 years). L-PRF was prepared from the participants’ own blood. Antibacterial activity of L-PRF against E. coli and E. faecalis ATCC standard strains was analyzed using the Kirby Bauer disk diffusion method. Results: The inhibition zones with PRF had not been detected even though the results obtained using control discs were in accordance with the expectations. Conclusion: L-PRF demonstrated no inhibition zone against E. coli and E. faecalis.Öğe Evaluation of the effect of cryotherapy in limbal conjunctival autograft technique in pterygium surgery(2021) Dağ, Umut; Çağlayan, Mehtap; Vardar, Süleyman; Alakuş, Fuat; Öncül, Hasan; Yıldırım, YusufAim: To compare the complication and recurrence rates in patients undergoing limbal conjunctival autograft with or without adjuvant cryotherapy for primary or recurrent pterygia. Methods: All information about the cases operated between January 2014 and January 2019 was scanned from the electronic database. Fifty-three eyes undergoing limbal conjunctival autograft combined with cryotherapy were classified as Group 1, and 47 eyes undergoing only limbal conjunctival autograft were classified as Group 2. Any development of new fibrovascular tissue from the limbus to the cornea after surgery was considered a recurrence. Any complications occurring during and after surgery were noted. Results: In Group 1, 45 of the 53 patients had primary and eight had recurrent pterygia. In Group 2, 41 of the 47 patients had primary and six had recurrent pterygia. Both groups were similar in terms of age and gender (p=0.880 and p=0.835, respectively). The mean follow-up period was 27.0±8.6 months in Group 1 and 28.7±7.8 months in Group 2 (p=0.287). No recurrences were observed during the follow-up period in Group 1, while the recurrence rate in Group 2 was 10.6% (p=0.02). All relapses occurred within the first year. No complications were observed during surgery in either group. Graft oedema was observed in the early post-operative period in four patients in Group 1 and three patients in Group 2. Conclusion: Limbal conjunctival graft technique combined with cryotherapy is a successful and reliable method in the treatment of primary and recurrent pterygium.Öğe The relationship between the changes in inflammatory parameters and response to treatment in major depression patients starting antidepressant treatment(2021) Uygur, Abdullah Burak; Çankaya, ŞeydaAim: Changes in inflammatory parameters such as cytokines, stress hormones and C reactive protein that occur in depression, are important in understanding the pathophysiology of depression and developing new treatment approaches. The main purpose of this study was to determine the changes in inflammatory markers in patients with major depression, before and after antidepressant treatment, as well as to determine the effect of antidepressant treatment types on these changes. Methods: This study was a single center, retrospective study. According to the retrospective records of the last five years in the psychiatry outpatient clinic of Alanya Alaaddin Keykubat University Training and Research Hospital, the patients diagnosed with Major Depressive Disorder (MDD), started on single antidepressant treatment for the first time and who used antidepressant treatment for at least 6-8 weeks, were included in the study. Patients whose Hamilton Depression Rating Scale (HDRS), complete blood count, C reactive protein and cortisol values were reached from the system during MDD treatment, constituted the sample of the study. Results: In the present study, after the antidepressant treatment, while HDRS scores decreased significantly in patients with Major Depression compared to before treatment (p<0,001), no significant correlation was found between the changes in inflammatory parameters and the response to treatment (p>0,05). This condition was independent of the type of antidepressant used in the treatment (p>0,05 in the SSRI treatment group, p>0,05 in the SNRI treatment group). In addition, it was observed that the decrease in depression scores was not associated with the type of antidepressant (p=0,001, in the SSRI treatment group, p=0,005, in the SNRI treatment group). Conclusion: Results to support the inflammatory hypothesis in Major Depressive Disorder were not conclusive in this study. Considering that the pathophysiology of depression is quite complex, it could be argued that a single group of blood tests may not be sufficient to explain the link between inflammation and depression. Considering all the limitations of the study, a future a prospective study to prove the inflammatory hypothesis in MDD, including the detailed blood, BOS tests, along with more comprehensive neuroimaging parameters on the brain pathways, might provide more effective resultsÖğe Preliminary study about a significant and treatable cause of epileptic encephalopathy: GRIN2D mutation(2021) Kutluk, Gültekin; Randa, Nadide CemreAim: The GRIN2D gene mutation causes severe forms of epileptic encephalopathy. NMDAR antagonists and magnesium sulfate could be useful as adjunctive therapy to control seizures in individuals with GRIN2D encephalopathy. The aim of this study was to describe the clinical features and treatment options of GRIN2D encephalopathy. Methods: Patients followed up with epileptic encephalopathy in our pediatric neurology clinic were investigated for genetic etiology using next-generation sequencing (NGS)-based tests. Patients with the GRIN2D mutation were overviewed for clinical and genetic characteristics. Results: A total of 53 patients were screened and GRIN2D mutations (c.3684_3685insGA, c.3248_3254del, c.1579G>T, c.47_49del) were detected in four patients. Occipital epileptic activity was frequently detected among our patients. Three patients received memantine treatment for intractable epilepsy and remained seizure-free. Conclusion: GRIN2D encephalopathy is a treatable epileptic encephalopathy, and its recognition is important in terms of outcomes. Occipital epilepsy is generally benign, but developmental and epileptic encephalopathies such as GRIN2D encephalopathy should be considered in the presence of concomitant developmental delay.Öğe Transcranial magnetic stimulation in psychiatry: Past, current and future(2021) Yuluğ, Burak; Aslan, AhmetTranscranial Magnetic Stimulation (rTMS) is a novel non-invasive neuromodulation method applied via a coil to the skull surface of the patient stimulating relevant brain regions. Replicating data suggest the therapeutic role of repetitive transcranial magnetic stimulation (rTMS) in many psychiatric diseases though there are limited human neuroprotective data. Here we aimed to evaluate the therapeutic role of rTMS from a multifaceted perspective, including its effects on the neuroplasticity and neuroprotection processes. As a conclusion, rTMS seems to offer a potential for neuroprotective therapy.
