Superior Part Research Articles

Comparative feeding ecology of four syntopic Hypostomus species in a Brazilian southeastern river.

Though their broad distribution in most Brazilian rivers, scarce studies concerning ecological interactions on Hypostomus species are available. This study observes the diet, the trophic interactions and some morphological aspects of four syntopic species of Hypostomus. These fishes were studied at the superior part of the Corumbataí river, at São Paulo state, southeastern Brazil. Analyses focused feeding patterns, their amplitude and whether there happens some food items overlap among the species. Fish were caught using cast nets at some points of the river. Species were chosen according to their local abundance and, so there were four main species: H. albopunctatus, H. ancistroides, H. regani and H. strigaticeps. Nine food items were found: sediments, fungi, diatoms, green algae, Tecamoeba, vegetal debris and invertebrates. There were not significant differences for the feeding pattern among the four Hypostomus species. The feeding niche amplitude has been larger for H. albopunctatus influenced by a larger amount of vegetal debris and invertebrates. Elevated niche overlap was found to happen among the species and also for their trophic morphology. Results may suggest that there is a similar pattern in food taken between four species of Hypostomus analyzed since all consume similar environmental resources and have similar anatomical features. However, a different intake insect larvae and plant material in H. albopunctatus diet indicate differences in local and how this species may be exploring their food compared to the others.

Social representations and contextual adjustments as two distinct components of the Theory of Mind brain network: Evidence from the REMICS task

Theory of mind (ToM) refers to the ability to infer the mental states of others. Behavioral measures of ToM usually present information about both a character and the context in which this character is placed, and these different pieces of information can be used to infer the character's mental states. A set of brain regions designated as the ToM brain network is recognized to support (ToM) inferences. Different brain regions within that network could however support different ToM processes.This functional magnetic resonance imaging (fMRI) study aimed to distinguish the brain regions supporting two aspects inherent to many ToM tasks, i.e., the ability to infer or represent mental states and the ability to use the context to adjust these inferences. Nineteen healthy subjects were scanned during the REMICS task, a novel task designed to orthogonally manipulate mental state inferences (as opposed to physical inferences) and contextual adjustments of inferences (as opposed to inferences that do not require contextual adjustments).We observed that mental state inferences and contextual adjustments, which are important aspects of most behavioral ToM tasks, rely on distinct brain regions or subregions within the classical brain network activated in previous ToM research. Notably, an interesting dissociation emerged within the medial prefrontal cortex (mPFC) and temporo-parietal junctions (TPJ) such that the inferior part of these brain regions responded to mental state inferences while the superior part of these brain regions responded to the requirement for contextual adjustments.This study provides evidence that the overall set of brain regions activated during ToM tasks supports different processes, and highlights that cognitive processes related to contextual adjustments have an important role in ToM and should be further studied.

Pressure Pain Sensitivity Maps of the Neck-Shoulder Region in Breast Cancer Survivors.

The aim of the present study was to report pressure pain sensitivity topographical maps of the frontal and dorsal parts of the shoulder region, and locate the pressure pain sensitive areas in breast cancer survivors compared with matched healthy control subjects. Twenty-two breast cancer survivors (BCS) and 22 matched control subjects participated. A numeric pain rating scale of the neck-shoulder area and pressure pain thresholds (PPTs) was assessed bilaterally over 28 points in the frontal and dorsal neck-shoulder area. Topographical pain sensitivity maps of the upper trapezius, pectoral, and anterior deltoid areas were computed. A three-way analysis of variance was carried out to evaluate the differences in PPTs. The BCS reported spontaneous neck pain (mean ± SD 3.6 ± 2.8), pain in the affected shoulder (4.3 ± 2.7), and pain in the non-affected shoulder (0.9 ± 1.8). Additionally, the BCS exhibited bilaterally lower PPTs in all the measurement points as compared with the control subjects (P < 0.05). The PPTs were lower at the superior part of the trapezius muscle (P < 0.001), the musculotendinous insertion, the anterior part of the deltoid muscle (P < 0.001), and the tendon of the pectoral muscle (P < 0.001) as compared with the control subjects. The results suggest the sensitization processes in the BCS and give preliminary evidence to most sensitive areas in the superior part of the upper trapezius and musculotendinous insertion of the pectoral muscle.

Functional anatomy of the accessory nerve studied through intraoperative electrophysiological mapping.

OBJECTIVE Classically the 11th cranial nerve (CN XI, or accessory nerve) is described as having a cranial and a spinal root, the latter arising from the upper segments of the spinal cord through a number of very fine rootlets. According to classical knowledge, the cranial root gives motor innervation to the vocal cords, whereas the spinal root provides the motor innervation of the sternocleidomastoid muscle (SCM) and of the upper portions of the trapezius muscle (TZ). The specific function of each of the rootlets of the spinal component is not well known. Therefore the authors aimed to map, using intraoperative direct electrical stimulation and electromyographic (EMG) recordings, the innervation territory of these rootlets in relation to their exit level from the CNS. METHODS Forty-nine patients undergoing surgery with intradural exposure at the craniocervical junction were enrolled in the study. The EMG recordings included the sternal and clavicular parts of the SCM (SCM-S and SCM-C), the superior and middle parts of the TZ (TZ-S and TZ-M), and whenever possible the vocal cords. The main trunk of CN XI, its roots (both cranial and spinal), and when possible the fine cervical rootlets, were stimulated at predetermined locations, from the jugular foramen down to the lowest cervical level exposed. The EMG responses were collected, and a map of the responses was drawn up. RESULTS Monitoring and stimulation of the spinal root were performed in all cases, whereas for the cranial root this was possible in only 19 cases. A total of 262 stimulation sites were explored: 70 at the common trunk of the nerve, 19 at the cranial root, 136 at various levels on the spinal root, and 37 at the cervical rootlets. A vocal cord response was obtained by stimulation of the cranial root in 84.2% (16/19); absence of response was considered to have a technical origin. In no case did the vocal cords respond to the stimulation of the spinal root or rootlets. Stimulation of the cervical rootlets yielded responses that differed according to the level of stimulation: at C-1 the SCM-S responded 95.8% of the time (23/24); at C-2 the SCM-C responded 90.0% of the time (9/10); at C-3 the TZ-S responded 66.6% of the time (2/3); and below that level only the TZ-M responded. The spinal root stimulated at its various levels responded accordingly. CONCLUSIONS The function of each of the rootlets of CN XI appears to be specific. The cranial root contributes, independently of the spinal root, to the innervation of the vocal cords, which makes it a specific entity. The spinal root innervates the SCM and TZ with a cranio-caudal motor organization of its cervical rootlets.

Shear-wave elastography of the testis in the healthy man - determination of standard values.

Real-time shear-wave elastography (SWE) is a newly developed technique for the sonographic quantification of tissue elasticity, which already is used in the assessment of breast and thyroid lesions. Due to limited overlying tissue, the testes are ideally suited for assessment using shear wave elastography. To our knowledge, no published data exist on real-time SWE of the testes. Sixty six male volunteers (mean age 51.86±18.82, range 20-86) with no known testicular pathology underwent normal B-mode sonography and multi-frame shear-wave elastography of both testes using the Aixplorer® ultrasound system (SuperSonic Imagine, Aix en Provence, France). Three measurements were performed for each testis; one in the upper pole, in the middle portion and in the lower pole respectively. The results were statistically evaluated using multivariate analysis. Mean shear-wave velocity values were similar in the inferior and superior part of the testicle (1.15 m/s) and were significantly lower in the centre (0.90 m/s). These values were age-independent. Testicular stiffness was significantly lower in the upper pole than in the rest of the testis with increasing volume (p = 0.007). Real-time shear-wave elastography proved to be feasible in the assessment of testicular stiffness. It is important to consider the measurement region as standard values differ between the centre and the testicular periphery. Further studies with more subjects may be required to define the normal range of values for each age group. Useful clinical applications could include the diagnostic work-up of patients with scrotal masses or male infertility.

Cage subsidence after anterior cervical discectomy and fusion using a cage alone or combined with anterior plate fixation.

To compare the extent of cage subsidence after anterior cervical discectomy and fusion (ACDF) using a cage alone or combined with anterior plate fixation, and to assess the effect of end plate removal on cage subsidence. Records of 23 men and 13 women aged 32 to 82 (mean, 54) years who underwent ACDF for 61 levels using the Solis cage alone (n=46) or combined with anterior plate fixation (n=15) were reviewed. The extent of cage subsidence was determined by comparing immediately postoperative (within one week) with final follow-up radiographs. Cage subsidence was defined as the sum subsidence of the superior and inferior part of the cage into the vertebral body. Mild and major cage subsidence was defined as ≤2 mm and >2 mm, respectively. Patients who underwent ACDF using a cage alone or combined with anterior plate fixation were comparable in terms of age, gender, follow-up duration, and number of levels decompressed. Cage subsidence occurred in 33 (54%) of the 61 levels decompressed. In the cage alone group, the extent of cage subsidence was greater (1.68 vs. 0.57 mm, p=0.039) and the rate of major cage subsidence was higher (28% vs. 7%, p=0.08). The inferior part of the cage was more vulnerable to subsidence compared with the superior part (median subsidence: 3.0 vs. 1.4 mm, p<0.0001). Cage subsidence occurred more often when the end plate was removed rather than preserved (58% vs. 18%, p<0.002). The extent of cage subsidence was greater after ACDF with cage alone. Cage subsidence occurred more often when the end plate was removed. Additional anterior plate fixation is recommended when the end plate is removed.

An Enlarged Anatomical Model of Ear in Wax (Tramond, Paris), late 19th century

A wax ear model was observed in its anatomical veracity and its structures detailed by a CT‐scan examination. It was 13 cm high, 17 cm long and 17 cm high. The three parts of the ear were represented. The auricle (11,7 cm high, 8 cm antero‐posterior, 5 cm transversal) represented the cartilaginous part and several muscles, the external auditory conduct ; the middle ear represented the tympanic membrane, the malleus and the uncus, the facial nerve and the tympanic cord ; the internal ear represented the superior part of the cochleo‐vestibular apparatus. The temporal bone was represented with its squamous part, the petrous pyramid and the tympanal bone. The end of the internal carotid artery ( 5 cm long, 1 cm in diameter) was represented in red as the middle meningeal artery on the the endocranial face of the squamous part of the temporal bone covered by a thin transparent layer of wax representing the dura mater. The lateral part of the Eustachian tube was represented (6 cm long, 1,3 cm in diameter). Not any element could be removed from its adjacent parts, this was dued to the construction in wax. The CT‐scan (Siemens somatom definition) proved that the anatomical part in wax was made by two joined elements. An internal metallic wire attached it to the plaster foot (12 cm high, 12 cm wide). The basis in wood was 29 cm in diameter and comprised two labels : one metallic and one in paper authentifying Tramond as the craftman. He was active late in the 19th century and during the beginning of the 20th century.

Arthroscopic-assisted latissimus dorsi transfer for subscapularis deficiency.

Few salvage procedures have been described in case of irreparable subscapularis tear and with variable outcomes. Latissimus dorsi transfer has been widely proposed as a transfer for irreparable posterio-superior rotator cuff tear with good outcomes. The anatomic feasibility of the latissimus dorsi to reconstruct the antero-superior irreparable rotator cuff tear has been suggested, but no clinical study has ever been published. We hypothesized that it was possible to use an arthroscopic-assisted latissimus dorsi transfer to reconstruct the subscapularis function. Five patients were enrolled. A 5-7-cm axillary incision was performed to release the latissimus dorsi tendon from its humeral insertion, the teres major muscle and the apex of the scapula. Afterwards, under arthroscopic control, a 7-mm-diameter tunnel was drilled at the anterior and superior part of the humeral head with an oblique inferior and posterior direction. The tubularized latissimus dorsi tendon was introduced into the tunnel and fixed with a ZipLoop on the posterior humeral cortex. The authors show overall good experience with this technique. Level IV-a, case series.

The relationship of patent foramen ovale location with severity of stroke: A new risk factor for paradoxical embolism

Objective: Patent foramen ovale (PFO) is a common developmental anomaly and is well associated with paradoxical embolism and cryptogenic stroke. The aim of this study was to investigate the relationship of PFO location with severity of cryptogenic stroke.Materials and methods: Fifty patients with cryptogenic stroke and echocardiographically proven PFO were classified according to the severity of stroke. In order to define the location of PFOs, an imaginary line dividing the length of interatrial septum vertically into two equal parts was drawn manually at axial plane on cardiac multidetector computed tomography. PFOs located at superior part of this imaginary line was defined as superiorly located PFO, while PFOs located at inferior part of this imaginary line was defined as inferiorly located PFO.Results: Fourteen patients (28%) revealed mild, 20 patients (40%) revealed moderate and 16 patients (32%) had severe stroke. Based on PFO location, there were 34 patients (68%) with superiorly (group 1), and 16 patients (32%) with inferiorly (group 2) located PFO. It was found that patients of group 1 had significantly higher frequency of moderate or severe stroke compared to those of group 2 (p < 0.005)Conclusion: In conclusion, the patients with superiorly located PFO had higher frequency of severe stroke compared to the patients with inferiorly located PFO. Since this is a preliminary study, clinical application and importance of this finding necessitates further large-scale interventional studies.

A new look at the shoulder anterior capsuloligamentous complex complementing the insertion of the subscapularis tendon—Anatomical, histological and ultrasound studies of the lesser tuberosity enthesis

PurposeThe aim of this study was to examine the relation between the anterior capsuloligamentous complex (ACLC – recognized as a single structure composed of the anterior capsule and its ligaments: medial glenohumeral ligament and anterior bundle of inferior glenohumeral ligament) and the subscapularis tendon with their footprints on the lesser tuberosity. MethodsIn this study, 19 fresh cadaveric shoulder specimens were examined: 13 in morphometric measurements and 6 were examined in a histological study. The subscapularis tendon and the ACLC were dissected until their insertion onto lesser tuberosity. Measurements of both dissected structures and their footprints on the lesser tuberosity were taken with a standard caliper. Six shoulders for histological examination were dissected without separation of the subscapularis tendon from the ACLC and longitudinal and transverse section samples were taken. Additionally, two of these six shoulders underwent ultrasound assessment before final sample preparation. ResultsTwo well-isolated structures were clearly identifiable: muscle with its tendinous chords and the ACLC, forming together the anterior wall of the joint. The ACLC insertion complemented the tendon insertion – superiorly the thickest part of the tendon stayed in contact with the thinnest part of the ACLC and inferiorly the relation was opposite – the ACLC insertion reached its maximum transverse length. This reciprocal relation was similar to superior and posterior rotator cuff tendon-capsule complex.The footprint on the lesser tuberosity, being purely fibrocartilage enthesis, was composed in 45% of the ACLC insertion. Also the fibers run of the tendon and the ACLC were different: histologic assessment confirmed the tight fusion of the tendon and the ACLC, though those two layers were easily identified as their fibers never mixed. Clinical relevanceBetter understanding of the anterior shoulder compartment anatomy simplifies an understanding of some arthroscopic procedures. The shape of the footprint, an importance of a broad superior part of the subscapularis tendon and its relation to the ACLC could be an anatomic proof and explanation for already existing surgical activities: subscapularis release and repair and soft tissue or bony procedures (Latarjet) in anterior shoulder instability.We declare that the experiments comply with the current law of the country in which they were performed (i.e. Polish law).

A novel three-dimensional smile analysis based on dynamic evaluation of facial curve contour.

The influence of three-dimensional facial contour and dynamic evaluation decoding on factors of smile esthetics is essential for facial beauty improvement. However, the kinematic features of the facial smile contour and the contribution from the soft tissue and underlying skeleton are uncharted. Here, the cheekbone-maxilla contour and nasolabial fold were combined into a “smile contour” delineating the overall facial topography emerges prominently in smiling. We screened out the stable and unstable points on the smile contour using facial motion capture and curve fitting, before analyzing the correlation between soft tissue coordinates and hard tissue counterparts of the screened points. Our finding suggests that the mouth corner region was the most mobile area characterizing smile expression, while the other areas remained relatively stable. Therefore, the perioral area should be evaluated dynamically while the static assessment outcome of other parts of the smile contour contribute partially to their dynamic esthetics. Moreover, different from the end piece, morphologies of the zygomatic area and the superior part of the nasolabial crease were determined largely by the skeleton in rest, implying the latter can be altered by orthopedic or orthodontic correction and the former better improved by cosmetic procedures to improve the beauty of smile.

Histopathological case report of high grade salivary duct carcinoma

The case of a 39-year-old man with slowly growing mass in the superior part of left parotid region is described. Patient presented neurological symptoms including hypomobility of lower left eyelid and inability of complete closure of left side eyelids resulting in conjunctivitis and hyperlacrimation. Routine physical examination supported by image and laboratory tests was performed. Pathomorphological results of hematoxylin and eosin staining as well immunohistochemical examination in view of clinical presentation pointed to diagnosis of high grade salivary duct carcinoma. Rare incidence, histological view similar to breast cancer and body localization are sufficient reasons for further analyses and descriptions of this type of lesions.

0029: Redo-ablations of atrial fibrillation: procedural characteristics depending on the choice of cryoenergy or radiofrequency ablation as the first line therapy

Pulmonary vein (PV) isolation has become a cornerstone therapy for symptomatic paroxysmal AF refractory to anti-arrhythmic drugs. Nowadays, the most common energies used to achieve PV isolation are cryoenergy and radiofrequency (RF). However, approximately one third of the patients have recurrences, mainly due to PV reconnections. Little is known about the characteristics of the redo procedure, depending on the choice of the initial energy. Patients referred to our center for a RF redo ablation procedure of symptomatic paroxysmal AF (PxAF) between 2010 and 2014 were retrospectively enrolled. Demographic data and characteristics of the initial ablation, i.e. cryoenergy or RF ablations, were collected. Number and location of PV gaps, and redo characteristics were reviewed. 74 patients scheduled for a redo ablation of AF were included, 38 and 36 using RF or cryoablation for the first procedure, respectively. For the initial ablation, procedural and fluoroscopy times were significantly shorter when using cryoenergy (147.8±52.6 vs. 226.6±64.3 min, p<0.001, and 37.0±17.7 vs. 50.8±22.7 min, p=0.005, respectively). Overall, an identical number of gaps were found during redo procedures of cryo and RF ablations. However, a significantly higher number of gaps were located in the right superior PV (RSPV) for patient first ablated with RF (0.9±1.0 vs. 0.5±0.9, p=0.009). The location of gaps was different, predominantly found in the anterior and superior parts of the left superior PV (LSPV), the anterior and inferior part of the left inferior PV (LIPV), the superior part of the right superior PV (RSPV), and in the postero-inferior part of the right inferior PV (RIPV) when using RF as the initial energy. For patient first ablated with cryoenergy, gaps were predominantly found in the anterior part of the left PV, evenly distributed in the RSPV, and in the postero-inferior part of the RIPV. Although not significant, redo procedures of cryoablations were slightly shorter and needed less RF duration times to achieve PV isolation (160.0±55.7 vs. 175.7±59.1 min, p=NS, and 954.1±796.7 vs. 1476.7±1269.6, p=NS). During redo procedures, gaps location pattern is different for patients first ablated with cryo or RF energy, and RSPV reconnections occur more frequently after RF ablation, probably due to poor contact in this region. Procedural characteristics of the redo ablation are similar. Abstract 0029 – Figure: Localization of gaps, during the redo procedure

Quantitative Anatomy of the Trapezius Muscle in the Human Fetus.

The trapezius muscle consists of three parts that are capable of functioning independently. Its superior part together with the levator scapulae and rhomboids elevate the shoulder, the middle part retracts the scapula, while the inferior part lowers the shoulder. The present study aimed to supplement numerical data and to provide growth dynamics of the trapezius in the human fetus. Using methods of anatomical dissection, digital image analysis (NIS Elements AR 3.0), and statistics (Student's t-test, regression analysis), we measured the length, the width and the surface area of the trapezius in 30 fetuses of both sexes (13™ k,17™ ) aged 13-19 weeks. Neither sex nor laterality differences were found. All the studied parameters of the trapezius increased proportionately with age. The linear functions were computed as follows: y = -103.288 + 10.514 × age (r = 0.957) for total length of the trapezius muscle, y = -67.439 + 6.689 × age (r = 0.856) for length of its descending part, y = -8.493 + 1.033 × age (r = 0.53) for length of its transverse part, y = -27.545 + 2.802 × age (r = 0.791) for length of its ascending part, y = -19.970 + 2.505 × age (r = 0.875) for width of the trapezius muscle, and y = -2670.458 + 212.029 × age (r = 0.915) for its surface area. Neither sex nor laterality differences exist in the numerical data of the trapezius muscle in the human fetus. The descending part of trapezius is the longest, while its transverse part is the shortest. The growth dynamics of the fetal trapezius muscle follows proportionately.

Differential interactions between Curtobacterium flaccumfaciens pv. flaccumfaciens and common bean.

Bacterial wilt of common bean caused by Curtobacterium flaccumfaciens pv. flaccumfaciens is an important disease in terms of economic importance. It reduces grain yield by colonizing xylem vessels, subsequently impeding the translocation of water and nutrients to the superior plant parts. The existence of physiological races in C. flaccumfaciens pv. flaccumfaciens has not so far been reported. The objective of the present investigation was to identify physiological races, evaluate differential interaction, and select resistant genotypes of common bean. Initially, 30 genotypes of common bean were inoculated with eight isolates exhibiting different levels of aggressiveness, under controlled greenhouse conditions. Disease was assessed 15 days after inoculation. The existence of differential interactions between C. flaccumfaciens pv. flaccumfaciens isolates and common bean genotypes were identified by utilizing partial diallel analysis. The most aggressive isolates were BRM 14939 and BRM 14942 and the least aggressive isolates were BRM 14941 and BRM 14946. The genotypes IPA 9, Ouro Branco, and Michelite were selected as more resistant among the test isolates. The genotypes IAC Carioca Akytã, BRS Notável, Pérola, IAC Carioca Aruã, and Coquinho contributed more to the isolate x genotype interaction according to the ecovalence method of estimation, and were, therefore, indicated as differentials. Based on these results, it was possible to conclude that physiological races of the pathogen exist, to select resistant genotypes, and to propose a set of differentials.

Comparative evaluation of the most reliable posterior reference point of Camper′s plane in relation with hamular notch-incisive papilla plane with change in gender of edentulous subjects: A cephalometric study

Statement of the Problem: Camper's plane is widely used to orient occlusal plane in edentulous patients, but the most reliable posterior reference point of Camper's plane is controversial. Purpose: The purpose of this study was to evaluate the most reliable posterior reference point of Camper's plane in relation with hamular notch-incisive papilla (HIP) plane with change in gender of edentulous subjects. Materials and Methods: The study was performed on 20 males and 20 females in the age group of 50-65 years. The conventional method of primary and secondary impression making was followed. The deepest point of the right hamular notch and the center of the incisive papilla was marked with an indelible marker on the master casts. Two spherical metal ball bearings of 3.1 mm were attached to the cast at the marked points, using cyanoacrylate resin. Autopolymerizing acrylic resin was adapted over the cast to construct the temporary denture base. Three spherical metal ball bearings were attached to superior, middle, and inferior part of the tragus and one at the ala of nose. A lateral cephalogram was made placing the temporary denture base in position intraorally. Cephalometric image analysis was done using Adobe Photoshop CS5. Results: Descriptive statistics of the data showed, in males, Camper's plane with superior point on tragus has a mean score of 8.71 ± 4.45, with middle point on tragus has 4.35 ± 3.17 and an inferior point on tragus has 4.01 ± 2.23. In females, Camper's plane with superior point on tragus has a mean score of 5.65 ± 2.64, with middle point on tragus has mean score of 2.71 ± 2.51, and inferior has 5.72 ± 3.09. Conclusion: Within the limitations of the study, it was concluded that in males, Camper's plane with posterior reference point as inferior border of tragus was the most parallel to HIP plane and in females, middle border of tragus was most parallel as the posterior reference point of Camper's plane in relation to HIP plane.

Cooperative Learning in Turkey: A Content Analysis of Theses

Advancements in science and technology affect our lives in all areas. The needs and expectations of individuals and the marketplace continue to evolve in the areas of renewal, advancement and learning. As Meder (2001) states, information society causes a great transformation since it hardly keeps the pace of the whole world. In a modern society knowledge became the main source for production and continuous learning, and therefore, change and development became inevitable for individuals and societies to survive.These changes and developments have triggered new efforts for strengthening and developing the education system in Turkey and have led administrators and educators to seek new approaches to learning. Key adjustments were made since 2005 in order to raise individuals who can meet the necessities of our age, think analytically, make syntheses, be solution-oriented, be able to find information efficiently, and communicate effectively. Specifically, curricula were improved in the context of approaches and models and a student centred education atmosphere was created in place of a teacher centred educational approach.Student centred learning methods are classified as active learning applications. Active learning does not accept teachers as main information givers and changes the learning atmosphere into an operational process in which students learn actively and teachers monitor the process. Active learning processes contributes to students' acquiring high level skills that can be used in life and in developing intellectual entrepreneurship (Akpinar & Gezer, 2010). In active learning students seek out relevant resources, learn to acquire information from different sources, organize and present the information they found, take and share responsibilities in individual and group projects, share their knowledge, and interactively cooperate to form a collective knowledge (Akar, 2012). Learners have active roles in learning and the teaching environment; thus, researchers and educators develop and enact learning environments in which learners are active. One approach in which the students are active is Cooperative Learning.Cooperative learning is a form of group work which aims to increase the learning skills of the students and their peers in the group for shared goals using different methods. This learning method has earned respect worldwide, especially in the USA. Increasing numbers of studies on this topic, the variety of student and educational activities, and the number of individuals taking part in these activities are all the indicators of this respect (Timur, 2006). Cooperative learning is also well respected in education media at all levels as an alternative for instruction strategies. The reason for this high level of respect is the fact that students can learn from each other while making descriptions, decisions and cooperating in strategies and problem solving methods (Doymuc, §imcek, & §imcek, 2005; Koc, 2014).Cooperative learning shines out when compared to conventional methods in many aspects. One superior part of cooperative learning method against other methods is that the attention of the teacher is not only on one student but on the whole group formed (Panitz, 1999). In this method the students are active and the teacher is a guide. The academic assignment given to the group isn't done by just one student; there is an issue of sharing (Gillies, 2004). The students not only interact with the teacher only but also among themselves (Yacar, 1993, p. 431). Therefore a media of socialization for students is achieved. Cooperative learning gives students opportunities to actively get involved with the teaching and learning process and improve their skills of sharing, having feedbacks of their own learning, interacting with friends, using their own skills, being responsible and helping their friends to learn, solving problems, and thinking critically (Yildiz, 1998).In the literature, studies concerning cooperative learning increased in numbers beginning in the 1960's, but this increase was only seen in Turkey in the 2000's. …

Arteries and Veins of the Sylvian Fissure and Insula: Microsurgical Anatomy.

We present a vascular anatomical study of the arteries and veins of the sylvian fissure and insula.A good knowledge of the sylvian fissure, the insula, and their vascular relationship would seem mandatory before performing surgery in this area, whatever the type of surgery (aneurysms, arteriovenous malformations, insular tumors).We start with the sylvian fissure and insula morphology, followed by the MCA description and its perforators, with special attention paid to the insular perforators. We demonstrate that the long insular perforators penetrating in the superior part of the posterior short gyrus and long gyri vascularize, respectively, the corticonuclear and corticospinal fasciculi. We particularly insist too on three anatomical constants regarding the vascularization of the insula, already described in the literature: The superior periinsular sulcus is the only sulcus on the lateral surface of the brain without an artery along its axis; the superior branch of the MCA supplies the anterior insular pole and both the anterior and middle short gyri in 100 % of cases; in at least 90 % of cases, the artery that supplied the central insular sulcus continued on to become the central artery.We end with the anatomical study of the veins and cisterns.

A Rare Case of An Atypical Solitary Fibrous Tumour of Orbit

Solitary fibrous tumours are of mesenchymal origin and comprise of uncommon spindle cell neoplasias. Most commonly the lesions arise from pleura but other rarer sites include lungs, peritoneum, pericardium, nasal cavities, thyroid, parotid gland and orbit. We report the case of a 41-year-old male patient who presented to us with a painless, progressive growth of a mass in the superior part of left orbit with proptosis and inferotemporal displacement of the left eye. Computed Tomography (CT) scan revealed homogeneous enhancing lesion in the superior compartment of left orbit in the extraconal region, extending intraconally and distorting the globe. Upon imaging, the differential diagnosis were lacrimal gland tumour, atypical cavernous haemangioma and nerve sheath tumour. Surgical treatment included complete excision of the mass with the intraoperative finding of mass extending upto the superior oblique tendon, a part of which was excised. Histopathological examination revealed CD34 positive, Bcl-2 and MIC-2 positive tumour with the diagnosis of a solitary fibrous tumour with atypical features but no malignant features. After a follow-up of 18 months, no recurrence was detected.

Nylon Hang Back Sutures in the Repair of Secondary Ptosis Following Overcorrected Dysthyroid Upper Eyelid Retraction.

Repair of blepharoptosis secondary to surgical overcorrection of thyroid related primary upper eyelid retraction (secondary ptosis) can be unpredictable. This study describes the long-term results of "hang-back" nylon sutures, for an anterior approach surgical repair of secondary ptosis. This was a retrospective consecutive case note review of patients referred with secondary ptosis (after prior upper eyelid lowering for thyroid eye disease), under the care of a single surgeon at Moorfields Eye Hospital & subsequently at Barking Havering Redbridge University Hospitals NHS Trust (SSD). In accordance with hospital trust policy, this audit was registered and all patient data was anonymized, ethical approval was not required. Patients with secondary ptosis underwent surgery under local anesthesia through an upper eyelid skin-crease incision. The anterior portion of the levator muscle was freed from all scar tissues and its action re-established on the superior part of the upper tarsal plate, using two 6-0 nylon hang-back sutures placed centrally and medially. The margin reflex distance 1 (MRD1), skin crease height, eyelid contour, symmetry of eyelid position (difference in margin reflex distance 1 <1 mm in both eyes) and degree of lagophthalmos were assessed from clinical notes preoperative and postoperatively at 1, 3, and 12 months. Surgery was undertaken in 14 eyelids in 13 patients (3 males; 23%), with 9/14 (65%) eyelids having undergone attempted repair of ptosis prior to referral; in 7 of the 8 (88%) eyelids with previous failed ptosis repair, the referring surgeon had used soluble hang-back sutures. As compared with an average preoperative margin reflex distance 1 of 0.9 mm (median 1, range: -1 to 2 mm), the average margin reflex distance 1 at 3 months was 3.0 mm (median 3, range: 2.5-4 mm; p < 0.0001) and 2.8 mm at 12-month follow up (median 3, range: 2-4mm; p < 0.0001). The upper eyelid central skin crease height changed from a preoperative mean of 9.8 mm (median 9, range: 5-15 mm) to 8.7 mm at 3 months (median 8, range: 7-12 mm; p = 0.1412) and 8.9 mm at 12-month follow up (median 9, range: 7-11 mm; p = 0.2930). Only 3 patients had postoperative lagophthalmos (one patient 3 mm and two patients 1 mm) at 3 months after surgery, this resolving by the 12-month postoperative visit. Thirteen cases (93%) had a good functional, symmetrical, and aesthetic result at 12 month follow up, with a late recurrence of ptosis in 1 patient (7%). The "hang-back" semi-permanent suture technique for repair of over-corrected upper eyelid lowering in thyroid eye disease appears to provide an excellent and predictable long-term result with a low incidence of late recurrence of ptosis.