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Öğe A Case of Sporadic Creutzfeldt-Jakob Disease That Developed With Psychiatric Symptoms(Turkiye Sinir Ve Ruh Sagligi Dernegi, 2015) Ozkan, Adile; Aydin Canturk, Ilknur; Candan, Fatma; Isik, Nihal; Ozisik Karaman, Handan IsinCreutzfeldt-Jakob disease (CJD) is a fairly rare prion sickness characterized by rapidly progressive dementia and neuropsychiatric symptoms. The diversity of clinical characteristics of the disease causes difficulties during diagnosis. The first finding of the disease might be psychiatric symptoms. The male patient who was diagnosed with CJD after dementia, ataxia, and myoclonus developed rapidly following psychiatric symptoms, was presented in order to draw attention to the onset with psychiatric symptoms in CJD.Öğe A Wandering Intravascular Scalpel Fragment After Lumbar Discectomy: A Case Report(Turkish Neurosurgical Soc, 2014) Aras, Adem Bozkurt; Ozkan, Omer Faruk; Alar, Timucin; Ozkan, Adile; Arik, M. Kasim; Kosar, Sule; Kirilmaz, BahadirVascular complications after lumbar discectomy are rarely seen. We present a unique and potentially life-threatening postoperative complication from this procedure. A 27-year-old man was admitted to our emergency vascular unit 1 day after a lumbar discectomy, during which a scalpel blade fragmented and a part was lost. Radiological images of the patient were performed and a broken scalpel blade was located anterior to the sacrum. An anterior laparotomy was performed which identified a mass within the left iliac vein that migrated suddenly to the inferior vena cava. An emergency angiography was performed, by which time the scalpel blade had ascended to the right-sided inferior pulmonary artery. It was subsequently removed via a right lateral thoracotomy.Öğe Affective Temperament Profiles in Patients with Multiple Sclerosis: Association with Mood Disorders(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2016) Ozkan, Adile; Altinbas, Kursat; Koc, Emine Rabia; Sen, Halil Murat; Karaman, Handan Isin ozisikIntroduction: The aim of the present study was to screen for bipolarity and to investigate the affective temperaments of patients with multiple sclerosis (MS) and the possible association between the clinical and demographic characteristics of MS patients and temperament profiles. Methods: A total of 65 patients with MS and 66 healthy volunteers completed the 32-item hypomania checklist (HCl-32), the Mood Disorder Questionnaire (MDQ), and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) tests. The HCl-32, MDQ, and TEMPS-A scores were compared between the patients and healthy volunteers. Results: MS patients had significantly higher scores for the depressive, cyclothymic, irritable, and anxious domains of the TEMPS-A scale than the control group, whereas relapsing remitting MS (RRMS) patients had higher MDQ and TEMPS-A hyperthymia scores than secondary progressive MS patients. MS patients who were being treated with interferon beta 1-b therapy had significantly higher MDQ scores than those being treated with interferon beta 1-a, glatiramer acetate, or who were without medication. Expanded Disability Status Scale (EDSS) scores were positively correlated with TEMPS-A depressive and hyperthymic temperaments. Conclusion: Our results suggest that higher scores for affective temperament in MS patients indicate subclinical manifestations of mood disorders. Higher hyperthymia scores and manic symptoms detected in the RRMS group could shed light on the relationship between bipolarity and MS. Thus, the screening of bipolarity and affective temperament profiles in MS patients could help clinicians predict future mood episodes and decrease their impact on disease severity.Öğe An Etiological Cause of Epilepsia Partialis Continua that Should Not be Forgotten: Hyperglycemia(Kare Publ, 2014) Sen, Halil Murat; Ozkan, Adile; Karaman, Handan Isin OzisikEpilepsia partialis continua is generally epileptic seizures, resistant to treatment, consisting of clonic jerks localized to one side of the body that may last from hours to months. In the adult population, brain ischemic lesions, extensive lesions and infections should be ruled out of the etiology. The etiology of easier-to-diagnose metabolic disorders, especially hyperosmolar nonketotic hyperglycemia, should not be forgotten. This is because a significant number of nonketotic hyperglycemia cases develop epilepsia partialis continua; in fact in some patients without diabetes diagnosis, it may be the first finding of diabetes.Öğe Concurrent demyelinizing central nervous system involvement in a case of Familial Mediterranean Fever with the M694V mutation(Yuzuncu Yil Universitesi Tip Fakultesi, 2014) Ozkan, Adile; Kosar, Sule; Uludağ, Ahmet; Haznedaroglu, Mete; Karaman, Handan Isın OzısıkFamilial Mediterranean Fever (FMF) is a hereditary disease seen mainly around the Mediterranean. The most common mutations are M694V, M680I, V726A and E148. Neurological findings and magnetic resonance imaging (MRI) abnormalities resembling multiple sclerosis have been reported in a few cases. We present a case where an M694V mutation was found together with familial Mediterranean fever and multiple sclerosis-type demyelinizing disease as this combination is rarely seen. © 2014, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.Öğe Early and Late Onset Seizures After Cerebrovascular Disease(Kare Publ, 2015) Ozkan, Adile; Gokceer, Sevda Yildiz; Isik, Nihal; Canturk, Ilknur Aydin; Candan, FatmaObjectives: This study aimed to compare seizure types, clinical and demographic features, treatment response and prognosis among patients with early and late onset post-stroke seizures. Methods: A retrospective evaluation was made of the data of 46 patients admitted to our clinic between January 2000 and April 2006 diagnosed with cerebrovascular disease, and who had post-stroke epileptic seizures. Two types of post-stroke seizures were defined; 'early onset' (occurring within 14 days post-stroke) and ` late onset' (occurring after the 14th day). Results: Among the 46 patients, 15 (32.6%) had early onset and 31 (67.3%) had late onset seizures. The early onset post-stroke seizures occurred more frequently after hemorrhagic stroke, while the late onset were more often seen in ischemic stroke. Ischemic strokes occurred mostly in the middle cerebral artery area, whereas lobar cortical hematomas were observed in the hemorrhagic stroke patients. The early onset seizures had statistically significant left hemisphere lesions, while those which were late onset had right hemisphere lesions (p<0.038). Secondary generalized seizures were the most common type in both groups. The seizures were well controlled with monotherapy in both groups, but seizure recurrence was found to be higher in the late onset seizure group. Conclusion: This study found significant left hemisphere lesions in the patients with early onset seizures, while in those with late onset seizures, lesions were present in the right hemisphere. In both groups, cortical involvement played an important role. Secondary generalized seizures were the most frequently occurring, and these were treated with antiepileptic monotherapy.Öğe Effects of Tannic Acid on the Ischemic Brain Tissue of Rats(Springer/Plenum Publishers, 2015) Sen, Halil Murat; Ozkan, Adile; Guven, Mustafa; Akman, Tarik; Aras, Adem Bozkurt; Sehitoglu, Ibrahim; Alacam, HasanMany studies of brain ischemia have shown the role played by massive ischemia-induced production of reactive oxygen species, the main mechanism of neuronal death. However, currently, there is no treatment choice to prevent cell death triggered by reactive oxygen species. In our study, we researched the effects of tannic acid, an antioxidant, on the ischemic tissue of rats with induced middle cerebral artery occlusion. The animals were divided into three groups of eight animals. The sham group were only administered 10 % ethanol intraperitoneally, the second group had middle cerebral artery occlusion induced and were given 10 % ethanol intraperitoneally, while the third group had middle cerebral artery occlusion with 10 mg/kg dose tannic acid dissolved in 10 % ethanol administered within half an hour intraperitoneally. The rats were sacrificed 24 h later, and brain tissue was examined biochemically and histopathologically. Biochemical evaluation of brain tissue found that comparing the ischemic group with no treatment with the tannic acid-treated ischemia group; the superoxide dismutase (SOD) levels were higher, malondialdehyde (MDA) levels were lower, and nuclear respiratory factor-1 (NRF-1) was higher in the tannic acid-treated group. Histopathological examination showed that the histopathological results of the tannic acid group were better than the group not given tannic acid. Biochemical and histopathological results showed that tannic acid administration had an antioxidant effect on the negative effects of ischemia in brain tissue.Öğe Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis(Sage Publications Inc, 2015) Adam, Gurhan; Kocak, Erdem; Ozkan, Adile; Resorlu, Mustafa; Cinar, Celal; Bozkaya, Halil; Kurt, TolgaPlatelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.Öğe Evaluation of the Thalamic Region with Proton Magnetic Resonance Spectroscopy in Patients with Essential Tremor(Turkish Neurological Soc, 2015) Ozkan, Adile; Candan, Fatma; Isik, Nihal; Canturk, Ilknur Aydin; Ari, Semra; Cakmak, Ozgur Oztop; Ayaz, TunahanObjective: Although essential tremor (ET) is the most common movement disorder, its pathogenesis is poorly understood. It is suggested that the ventral intermediate (VIM) nucleus of the thalamus is important in the pathophysiology disease. Materials and Methods: The present study aimed to evaluate N-acetylaspartate (NAA), choline (cho), and creatinine (Cr) values via proton magnetic resonance spectroscopy (H-1 MRS) of the VIM of the thalamus in 16 control patients and 42 patients with ET. Results: The mean NAA/Cr and NAA/Cho values of the thalamus VIM nucleus region in patients with ET was statistically significantly lower than the control group (p=0.001, p=0.005, respectively). In patients with ET, no significant relation was found between NAA/Cr, NAA/Cho values, and age, family history, disease duration, tremor severity, dominant extremity localization of tremor, and history of drug use (p>0.05). Conclusion: Low NAA values in the thalamus region of patients with ET indicate neuron loss and cell death. Neuron loss in the thalamus region has been suggested to play a part in the pathophysiology of the disease, and may indicate that ET is a neurodegenerative disease.Öğe Experiences in an Epilepsy Polyclinic: Epilepsy in the Elderly(Kare Publ, 2015) Ozkan, Adile; Candan, Fatma; Canturk, Ilknur Aydin; Gokceer, Sevda Yildiz; Isik, Nihal; Karaman, Handan Isin OzisikObjectives: Epilepsy is one of the most common serious neurological disorders in the elderly. In this study the demographic and clinical features, etiological factors, seizure types and response ratios to treatment are presented for a group of patients aged 60 years and over diagnosed with epilepsy. Results: Twenty-five patients aged 60 years and over who applied to the epilepsy polyclinic were retrospectively investigated. Results: Average patient age was 75.0 +/- 7.1 years and average disease duration was 2.32 +/- 1.8 years. Sixteen patients were male and 9 female. Among the patients, cerebrovascular disease (17 patients), brain tumor (1 patient), arachnoid cyst (1 patient), aneurysm (1 patient) and myocardial infarction (1 patient) were considered as the underlying factors in seizure development. In the remaining 4 cases, no etiological cause was determined. Seizure types were; secondary generalized tonic-clonic seizure (20 patients), simple partial seizure (2 patients), status epilepticus seizure (2 patients), and complex partial seizure (1 patient). EEG findings were abnormal in 32% of the patients (n=8). When evaluated for treatment, 18 patients received monotherapy; 6 patients used double, and 1 patient used triple drugs. The follow-up period in 21 cases was without seizure. Conclusion: In the study, the most common etiological cause of epilepsy seen in the elderly was cerebrovascular disease. Seizure type was mainly secondary generalized tonic-clonic. The patients responded well to monotherapy and prognosis was improved.Öğe Headache Could Be Finding of Sinus Vein Thrombosis in Behcets Patients(Derman Medical Publ, 2014) Sen, Halil Murat; Ozkan, Adile; Balci, Cagdas; Karaman, Handan Isin OzisikGlobally Behcet's disease (BD) is most frequently seen in Turkey and takes its name from the Turkish dermatologist Hulusi Behbet. Basic findings of the disease are the triad of genital ulcers, oral ulcers and uveiti's. Neurological involvement in BD appears an average of 5 years after the beginning of disease, or the first appearance of the disease may be neurological findings. Sinus vein thrombosis (SVT) is among neurological involvements observed in BD. However diagnosis of SVT is difficult and it is a situation that may cause disability or mortality. Our case was a 24-year old female patient with diagnosed SVT who had a diagnosis of BD from 5 years. In spite of the patient frequently applying to health services, SVT diagnosis was delayed until 15 days after the initial symptoms. BD can cause SVT and SVT may cause disability or mortality but SVT may be diagnosed late, just as in our case. Therefore we present this case to increase awareness of this disease.Öğe Insulinoma May Present as Epilepsy: A Case Report(Derman Medical Publ, 2014) Sen, Halil Murat; Balci, Cagdap; Ozkan, Adile; Karaman, Handan Isin OzisikHypoglycemia developing linked to insulinoma may present with clinical findings similar to epileptic seizures and electroencephalography findings may be in accordance with epilepsy. As a result some insulinoma patients are followed as epilepsy resistant to treatment for years. Our case was a 20-year old female patient and was followed for epilepsy. The blood tests indicated hypoglycemia and the result of examination, the patient diagnosis was insulinoma. We present this case with the aim of emphasizing the importance of not forgetting insulinoma as an etiology in epilepsy resistant to treatment.Öğe Neuroprotective Effect of Humic Acid on Focal Cerebral Ischemia Injury: an Experimental Study in Rats(Springer/Plenum Publishers, 2015) Ozkan, Adile; Sen, Halil Murat; Sehitoglu, Ibrahim; Alacam, Hasan; Guven, Mustafa; Aras, Adem Bozkurt; Akman, TarikStroke is still a major cause of death and permanent neurological disability. As humic acids are well-known antioxidant molecules, the purpose of this study was to investigate the potential neuroprotective effects of humic acid in a focal cerebral ischemia model. Twenty-four rats were divided equally into three groups. A middle cerebral artery occlusion model was performed in this study where control (group II) and humic acid (group III) were administered intraperitoneally following an ischemic experimental procedure. Group I was evaluated as sham. Malondialdehyde (MDA), superoxide dismutase (SOD), and nuclear respiratory factor-1 (NRF-1) levels were analyzed biochemically on the right side of the ischemic cerebral hemisphere, while ischemic histopathological studies were completed on the left side to investigate the antioxidant status. Biochemical results showed that SOD and NRF-1 levels were significantly increased in the humic acid group (III) compared with the control group (II) while MDA levels were significantly decreased. On histopathological examination, cerebral edema, vacuolization, degeneration, and destruction of neural elements were decreased in the humic acid group (III) compared with the control group (II). Cerebral ischemia was attenuated by humic acid administration. These observations indicate that humic acid may have potential as a therapeutic agent in cerebral ischemia by preventing oxidative stress.Öğe Neuroprotective effect of p-coumaric acid in rat model of embolic cerebral ischemia(Mashhad Univ Med Sciences, 2015) Guven, Mustafa; Aras, Adem Bozkurt; Akman, Tarik; Sen, Halil Murat; Ozkan, Adile; Salis, Osman; Sehitoglu, IbrahimObjective(s): Stroke poses a crucial risk for mortality and morbidity. Our study aimed to investigate the effect of p-coumaric acid on focal cerebral ischemia in rats. Material and Methods: Rats were randomly divided into four groups, namely Group I (control rats), Group II (ischemia rats), Group III (6 hr ischemia + p-coumaric acid rats) and Group IV (24 hr ischemia + p-coumaric acid rats). Cerebral ischemia was induced via intraluminal monofilament occlusion model. In all groups, the brain was removed after the procedure and rats were sacrificed. Malondialdehyde, superoxide dismutase and nuclear respiratory factor-1 were measured in the ischemic hemisphere. The histopathological changes were observed in the right hemisphere within the samples. Functional assessment was performed for neurological deficit scores. Results: Following the treatment, biochemical factors changed significantly. Histopathologically, it was shown that p-coumaric acid decreased the oxidative damage. The neurological deficit scores of p-coumaric acid-treated rats were significantly improved after cerebral ischemia. Conclusion: Our results showed that p-coumaric acid is a neuroprotective agent on account of its strong anti-oxidant and anti-apoptotic features. Moreover, p-coumaric acid decreased the focal ischemia. Extra effort should be made to introduce p-coumaric acid as a promising therapeutic agent to be utilized for treatment of human cerebral ischemia in the future.Öğe Neuroprotective effects of daidzein on focal cerebral ischemia injury in rats(Shenyang Editorial Dept Neural Regeneration Res, 2015) Aras, Adem Bozkurt; Guven, Mustafa; Akman, Tarik; Ozkan, Adile; Sen, Halil Murat; Duz, Ugur; Kalkan, YildirayDaidzein, a plant extract, has antioxidant activity. It is hypothesized, in this study, that daidzein exhibits neuroprotective effects on cerebral ischemia. Rat models of middle cerebral artery occlusion were intraperitoneally administered daidzein. Biochemical and immunohistochemical tests showed that superoxide dismutase and nuclear respiratory factor 1 expression levels in the brain tissue decreased after ischemia and they increased obviously after daidzein administration; malondialdehyde level and apoptosis-related cysteine peptidase caspase-3 and caspase-9 immunoreactivity in the brain tissue increased after ischemia and they decreased obviously after daidzein administration. Hematoxylin-eosin staining and luxol fast blue staining results showed that intraperitoneal administration of daidzein markedly alleviated neuronal damage in the ischemic brain tissue. These findings suggest that daidzein exhibits neuroprotective effects on ischemic brain tissue by decreasing oxygen free radical production, which validates the aforementioned hypothesis.Öğe Parotid Abscess with Involvement of Facial Nerve Branches(Coll Physicians & Surgeons Pakistan, 2015) Ozkan, Adile; Ors, Ceyda Hayretdag; Kosar, Sule; Karaman, Handan Isin OzisikFacial nerve paresis is only rarely seen with benign diseases of the parotid gland. A 22-year male had muscle loss in the preauricular region of the right side of his face that extended towards the mandibular angle for the last 6 months. The neurological examination did not reveal any pathology other than right preauricular region muscle atrophy that was limited by the mandibular angle. The Electroneuronography (EnoG) provided a ratio of 55.38%, compared the affected side to left side. Ultrasonography of the defined region showed two mass lesions 13.5 x 7 mm and 10 x 5 mm in size in the anteromedial section of the right parotid gland that were close to each other, without internal calcific foci, and heterogenous hyperechogenic structure without internal vascularization. Fine needle aspiration obtained many polymorphonuclear leukocytes, cell debris, a few mononuclear inflammatory cells and many crystalloid structures: The lesion was diagnosed as a parotid abscess. Antibiotic treatment was started for the parotid gland abscess.Öğe Parotid abscess with involvement of facial nerve branches(College of Physicians and Surgeons Pakistan, 2015) Ozkan, Adile; Ors, Ceyda Hayretdag; Kosar, Sule; Karaman, Handan Isin OzisikFacial nerve paresis is only rarely seen with benign diseases of the parotid gland. A 22-year male had muscle loss in the preauricular region of the right side of his face that extended towards the mandibular angle for the last 6 months. The neurological examination did not reveal any pathology other than right preauricular region muscle atrophy that was limited by the mandibular angle. The Electroneuronography (EnoG) provided a ratio of 55.38%, compared the affected side to left side. Ultrasonography of the defined region showed two mass lesions 13.5 x 7 mm and 10 x 5 mm in size in the anteromedial section of the right parotid gland that were close to each other, without internal calcific foci, and heterogenous hyperechogenic structure without internal vascularization. Fine needle aspiration obtained many polymorphonuclear leukocytes, cell debris, a few mononuclear inflammatory cells and many crystalloid structures. The lesion was diagnosed as a parotid abscess. Antibiotic treatment was started for the parotid gland abscess.Öğe Radioprotective effects of nigella sativa oil against oxidative stress in liver tissue of rats exposed to total head irradiation(Informa Healthcare, 2014) Cikman, Oztekin; Ozkan, Adile; Aras, Adem Bozkurt; Soylemez, Omer; Alkis, Hilal; Taysi, Seyithan; Karaayvaz, MuammerObjective: Many cancer patients treated with radiotherapy suffer severe side effects during and after their treatment. The aim of this study was to investigate the effects of irradiation and the addition of Nigella sativa oil (NSO) on the oxidant/antioxidant system in the liver tissue of irradiated rats. Methods: A total of 24 Sprague-Dawley rats were randomly distributed into three groups of equal numbers. The control group received neither NSO nor irradiation but received 1-ml saline orally. The irradiation group (IR) received total head 5 gray (Gy) of gamma irradiation as a single dose, plus 1-ml saline orally. The IR plus NSO group received both total head 5 Gy of gamma irradiation as a single dose and 1 g/kg/day NSO orally through an orogastric tube starting one hour before irradiation and continuing for 10 days. Results: While liver tissue total oxidant status (TOS), lipid hydroperoxide (LOOH) level, and oxidative stress index (OSI) were significantly increased in the IR group compared to the control group, total antioxidant status (TAS), sulfhydryl (-SH) levels, and PON activity were significantly decreased. Cp activity in the IR plus NSO and IR groups was higher than in the control group. ARYL activity in the IR plus NSO supplemented group was higher than that in other groups. Conclusions: NSO reduces oxidative stress markers and has antioxidant effects, which also augments the antioxidant capacity in the liver tissue of rats. © 2014 Informa Healthcare USA, Inc.Öğe Relationship between genetic polymorphisms MTHFR (C677T, A1298C), MTR (A2756G) and MTRR (A66G) genes and multiple sclerosis: a case-control study(Termedia Publishing House Ltd, 2019) Cakina, Suat; Ocak, Ozgul; Ozkan, Adile; Yucel, Selma; Karaman, Handan Isin OzisikRecent studies have reported elevated plasma homocysteine and reduced folate and vitamin B levels in patients with multiple sclerosis (MS). In this study, we aimed to investigate the association between MS and the following four DNA polymorphisms: MTR A[2756]G, MTHFR C[677]T, MTHFR A[1298]C and MTRR A[66]G. The DNA polymorphisms were genotyped in 80 patients with confirmed MS and 80 healthy control age- and gender-matched subjects using PCR-RFLP approach. Our results show that the frequency of the T/T genotype homozygotes for the MTHFR C[677]T polymorphism was significantly higher in patients than in controls (p = 0.04, OR: 3.16, 95% CI: 1.23-8.17). In turn, the A/A genotype of the MTHFR A[1298]C polymorphism was more frequent in controls than in patients (41.3% vs. 32.5%, p = 0.04). There were no differences in distribution of genotypes for the MTR A[66]G and MTR A[2756]C polymorphisms between patients with MS and controls (p > 0.05). Our findings suggested that the MTHFR C[677]T and MTHFR A[1298] C gene polymorphisms might be associated with MS as genetic factors influencing the risk of the disease.Öğe Sleep disturbance among women with chronic pelvic pain(Elsevier Ireland Ltd, 2014) Cosar, Emine; Gungor, Aysenur Cakir; Gencer, Meryem; Uysal, Ahmet; Hacivelioglu, Servet O.; Ozkan, Adile; Sen, Halil MuratObjective: To investigate the effect of chronic pelvic pain (CPP), a debilitating condition, on sleep quality. Methods: The present case-control study enrolled women older than 18 years attending the Gynecology Clinic of Canakkale Onsekiz Mart University Hospital, Canakkale, Turkey, with CPP between August 2011 and August 2012. The control group was selected from women attending the clinic for another complaint. Sleep quality was evaluated via the Pittsburgh Sleep Quality Index, and differences between the groups were compared by t and chi(2) tests. Results: During the study period, 157 women were enrolled. Seventy-two had CPP symptoms, and 85 attended the clinic for other complaints. Poor sleep quality was found in 80% (n = 58) of the women with CPP, and 55% (n = 47) of the control group (P < 0.05). Conclusion: Women with CPP were found to have poor sleep quality. Sleep education should be recommended in psychiatry and neurology clinics to increase the awareness of sleeping problems among these women. (C) 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
