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Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Background/Objectives: Hypercapnic respiratory failure (HRF) is a primary cause of admittance to the intensive care unit (ICU). This study aimed to investigate the factors that affect the length of hospital stay in HRF patients. Methods: This study was designed as a retrospective, cross-sectional analysis of patients who were admitted to the ICU because of HRF between 2022 and 2024. The demographic and clinical characteristics of the patients and laboratory results were recorded. The Charlson Comorbidity Index (CCI) was calculated. The relationship between these parameters and the length of hospital stay was assessed. Results: A total of 138 patients were included in the study. The average length of hospital stay was 11.45 days, and 37% of the patients were included in the long-term hospitalization group. The degree of hypercapnia was not associated with the length of hospital stay. It was determined that the patients' albumin levels and CCI were significant determinants of the length of hospital stay. The combined assessment of these two parameters was found to be superior compared to their separate evaluations. Conclusions: In our study, hypoalbuminemia and a higher CCI were identified as predictors of a prolonged ICU stay in HRF patients. Albumin levels of <3.25 g/dL and CCI scores of ≥5 were linked to longer stays, with this combined evaluation offering greater predictive value. These factors can guide patient management.

Introduction/aims: The hand-held dynamometer (HHD) is a reliable and portable tool for quantitatively assessing muscle strength. However, a number of variables, including the strength of the tester, the adequacy of stabilization, and the selected testing position, can affect the reliability of the device. The objective of the present study was to examine the reproducibility and inter-rater reliability of strength assessments using HHD with and without a stabilization device., Methods: Strength assessments were conducted with and without the stabilization device by two independent raters. Healthy volunteers with no history of musculoskeletal disorders were included in the study. The strength of the shoulder flexion, scapula elevation, knee extension, and hip abduction muscle groups was evaluated using HHD. The reliability of the measurements was evaluated using intra-class correlation (ICC), standard error of measurement, and minimal detectable change., Results: Fifty-two healthy volunteers (age 21.51 ± 2.02 years) participated in the study. The reproducibility was found to be excellent (ICC = 0.89-0.99). While reliability between the assessors was good to excellent (ICC = 0.85-0.93), reliability between assessors and device was found moderate to good (ICC = 0.48-0.78)., Discussion: The strength values obtained for all directions of movement with the stabilization device were found to be significantly higher than those obtained without fixation of the HHD. It can be concluded that the data obtained from the assessors and HHD with stabilization device are not comparable. Moreover, the utilization of a stabilization device may serve to enhance the reliability of the measurements by eliminating the rater effect., (© 2024 Wiley Periodicals LLC.)

Chronic obstructive pulmonary disease (COPD) frequently results in hospital readmission and contributes to increased morbidity and mortality. This multicenter prospective study aimed to identify factors that increase the risk of readmission within 30 to 90 days of severe COPD exacerbation. A total of 415 patients admitted to the emergency department (ED) or general pulmonology ward after discharge due to severe exacerbations from 13 tertiary centers in Turkey were included. Of the participants, 346 (83.4%) were male and 69 (16.6%) were female, with an average age of 69.0 ± 9.1 years. Readmissions within 30 and 90 days after the initial hospitalization occurred in 176 (42.4%) and 191 (46%) patients, respectively. Prospective data collection focused on exacerbation severity, disease severity, and the utility of initial admissions. Factors for 30 to 90 day readmission were analyzed using univariate and multivariate regression models. A 30-day readmission correlated significantly with Hospital Anxiety Depression Scale scores above 16 [odds ratio [OR] 95% confidence intervals [CI]: 1.9 (1.1-3.6); P = .042], severe exacerbation history in the previous year [OR 95% CI: 1.7 (1.1-2.9); P = .038], hospital-acquired pneumonia [OR 95% CI: 1.9 (1-4.1); P = .049)], and frequent antibiotic use in the previous year [OR 95% CI: 1.8 (1.2-2.7); P = .007]. Risk factors for 90-day readmissions included: Grades 3 to 4 tricuspid regurgitation [OR 95% CI: 2.2 (1.1-4.4); P = .024], 2 or more moderate COPD exacerbations [OR 95% CI: 1.9 (1.2-3.1); P = .010], severe exacerbation history in the previous year [OR 95% CI: 2.5 (1.5-4.2); P = .001], immunosuppression [OR 95% CI: 2.7 (1.2-5.7); P = .013], frequent antibiotic use the previous year [OR 95% CI: 1.5 (1-2.4); P = .048], hospitalization via the ED [OR 95% CI: 1.6 (1.1-2.6); P = .028]. To mitigate complications and readmissions, patients with a history of frequent severe COPD exacerbations, high anxiety and depression scores, frequent antibiotic requirements, immunosuppression, tricuspid regurgitation, hospital-acquired pneumonia, and those admitted to the ED should be prioritized for remote monitoring after initial discharge., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To determine the effect of Easy-Flex as an adjunct to standard inpatient rehabilitation on clinical and functional outcomes., Design: Prospective randomized controlled trial., Setting: Outpatient clinic and research laboratory., Participants: A total of 44 patients were randomized to the Easy-Flex Group (EFG) or Control Group (CG)., Interventions: A rehabilitation program averaging 50-60 minutes per day was implemented for the patients with CG. In the EFG, in addition to 30-40 minutes of exercise with the Easy-Flex, the rehabilitation program applied to the CG was integrated with reduced sets and repetitions, with an average duration of 20 minutes. All interventions were performed under the supervision of a physiotherapist during hospitalization. After discharge, both groups received the same home exercise program., Main Outcome Measures: The primary outcome is the flexion and extension range of motion (ROM). The secondary outcomes include the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Five Times Sit-to-Stand Test (5-TSST), 10-Meter Walking Test (10-MWT), Short Form (SF)-12v2, and Global Rating of Change scale., Results: After 6 weeks, the overall group-by-time interaction for the 2 × 3 mixed-model analysis of variance was found to be significant for flexion ROM (P=.005), NPRS-rest (P=.04), NPRS-activity (P=.01), 10-MWT (P=.003), WOMAC (P=.021), and SF-12 physical component summary (PCS) (P=.032) in favor of EFG exercising with Easy-Flex in addition to standard rehabilitation. The between-group differences in favor of the EFG were -8.0° knee ROM, 1.35-1.5 points for pain intensity, and 0.12 m/s for gait speed. Furthermore, differences favoring EFG in NPRS-rest, 10-MWT speed, and SF-12 PCS were greater than the reported minimum clinically important difference., Conclusions: Incorporating Easy-Flex into standard physical therapy can be a beneficial, safe, and effective approach in clinical practice, as patients undergoing total knee arthroplasty typically prioritize improving their quality of life by reducing pain and increasing ROM., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Additive manufacturing (AM) techniques have the potential to produce complex parts, and many of these techniques require the use of support structures to prevent deformations and to minimize thermal effects during the printing process, particularly when building overhangs and internal cavities. However, removing the support structures through postprocessing incurs additional costs and time penalties. Unlike other AM techniques, support structures are not used in directed energy deposition (DED) technique due to its working principle. Therefore, special multiaxis complex path-planning strategies for DED are adopted to print relatively simple overhang geometries. Nevertheless, printing internal channels using this technique can still be challenging or nearly impossible. In this work, a novel DED process using graphite as a support material is proposed for additively manufacturing simple and complex internal channels. The support material is easily removed without requiring extensive machining processes. The results demonstrated that the support material did not negatively impact part quality, and in fact, the presence of different carbides at the interaction zone increased hardness and Young's modulus. Moreover, there were no cracks and or porosity at the support material-part interface. This study is the first of its kind to demonstrate the potential for using graphite as a support material for DED processes in additively manufacturing parts with complex internal channels and overhangs and highlights the need for further research in this area., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Background: Despite the availability of numerous treatment modalities for frozen shoulder, spanning from nonsurgical approaches to surgical interventions, a consensus regarding the most effective treatment remains elusive. Current studies emphasize that pain in frozen shoulder affects central nervous system activity and leads to changes in cortical structures, which are responsible for processing sensory information (like pain) and controlling motor functions (like movement). These cortical changes highlight the importance of including the central nervous system in the management of frozen shoulder. It is therefore recommended that treatment should provide more effective management by focusing not only on the shoulder region but also on the cortical areas thought to be affected., Questions/purposes: Among patients treated nonsurgically for frozen shoulder, is graded motor imagery added to a multimodal physical therapy program more effective than multimodal physical therapy alone in terms of (1) Shoulder Pain and Disability Index (SPADI) scores, (2) pain with activities and QuickDASH (Q-DASH) scores, and (3) ROM after 8 weeks of treatment?, Methods: In this randomized clinical trial, we considered the following as eligible for inclusion: (1) ROM < 50% compared with the unaffected shoulder, (2) clinically and radiologically confirmed primary frozen shoulder, and (3) 30% loss of joint ROM in at least two planes compared with the unaffected shoulder. Diagnosis of patients was based on patient history, symptoms, clinical examination, and exclusion of other conditions. A total of 38 patients with frozen shoulder were randomly assigned to either the graded motor imagery group (n = 19) or the multimodal physiotherapy group (n = 19). The groups did not differ in age, height, weight, gender, and dominant and affected side. In both groups, there were no losses to follow-up during the study period, and there was no crossover between groups. The multimodal physiotherapy program encompassed a variety of treatments, including stretching exercises, ROM exercises, joint-oriented mobilization techniques, scapular mobilization, strengthening exercises, and the application of cold agents. The graded motor imagery program, as an addition to the multimodal physiotherapy program, included the following steps: (1) left-right discrimination (identifying left and right body parts), (2) motor imagery (mentally visualizing movements), and (3) mirror therapy training (using mirrors to trick the brain into thinking the affected part is moving). Both groups of patients participated in a program of 12 sessions, each lasting approximately 45 minutes, twice a week for 6 weeks. Participants were assessed at baseline, after 6 weeks, and at 8 weeks. The primary outcome was the SPADI score, which ranges from 0 to 100, with higher values denoting greater disability. The minimum clinically important difference (MCID) for SPADI scores is reported to be 13.2 points. Secondary outcomes were shoulder ROM, Numeric Pain Rating Scale activity score (scored from 0 points, indicating "no pain," to 10 points, indicating "worst pain imaginable"), and Q-DASH score (ranging from 0 to 100 points, with a higher score indicating higher functional disability). Repeated-measures analysis of variance was used to compare means between one or more variables based on repeated observations., Results: After 8 weeks of treatment, patients treated with graded motor imagery plus multimodal physical therapy experienced greater mean ± SD improvement from baseline in terms of SPADI scores than did the multimodal physical therapy group (65 ± 9 versus 55 ± 12, mean difference 10 points [95% confidence interval 4 to 17 points]; p = 0.01). Graded motor imagery when added to standard therapy did not produce a clinically important difference in pain scores with activity compared with physical therapy alone (7.0 ± 1.3 versus 5.9 ± 1.4, mean difference 1 point [95% CI 0.2 to 2.0 points], which was below our prespecified MCID; p = 0.04). However, improvements in Q-DASH score at 8 weeks were superior in the graded motor imagery group by a clinically important margin (58 ± 6 versus 50 ± 10, mean difference 9 points [95% CI 3 to 14 points], which was below our prespecified MCID; p = 0.01). ROM was generally better in the group that received the program augmented by graded motor imagery, but the differences were generally small., Conclusion: Adding graded motor imagery to a multimodal physiotherapy program was clinically superior to multimodal physiotherapy alone in improving function in patients with frozen shoulder. However, no clinically superior scores were achieved in ROM or activity-related pain. Additionally, the follow-up period was short, considering the tendency of frozen shoulder to recur. Although adding graded motor imagery provides superiority in many scores and does not require high-budget equipment, the disadvantages such as the difference in some scores being sub-MCID and the need for expertise and experience should not be ignored. Consequently, while graded motor imagery shows promise, further research with longer follow-up periods is recommended to fully understand its benefits and limitations in the treatment of frozen shoulder., Level of Evidence: Level I, therapeutic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

Phages are ubiquitous in freshwater, seawater, soil, the human body, and sewage water. They are potent biopharmaceuticals against antimicrobial-resistant bacteria and offer a promising alternative for treating infectious diseases. Also, combining phages with antibiotics enhances the antibiotics' efficacy. This study focused on two Pseudomonas aeruginosa phages isolated from lake and sewage water samples and one of them selected for further investigation. Isolated phages PA-56 and PA-18 infected 92 % and 86 % of the tested 25 clinical Pseudomonas aeruginosa strains, respectively. PA-56 with strong activity was chosen for detailed characterization, antimicrobial studies, and genome analysis. Combining PA-56 with ciprofloxacin or meropenem demonstrated phage-antibiotic synergism and increased antibiofilm efficacy. Genome analysis revealed a GC ratio of 54 % and a genome size of 42.761 bp, with no virulence or antibiotic resistance genes. Notably, PA-56 harboured the toxin-antitoxin protein, MazG. Overall, this study suggests that PA-56 holds promise for future applications in industry or medicine., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Sarcopenia, a musculoskeletal disease characterized by the progressive loss of skeletal muscle mass, strength, and physical performance, presents significant challenges to global public health due to its adverse effects on mobility, morbidity, mortality, and healthcare costs. This comprehensive review explores the intricate connections between sarcopenia and low birth weight (LBW), emphasizing the developmental origins of health and disease (DOHaD) hypothesis, inflammatory processes (inflammaging), mitochondrial dysfunction, circadian rhythm disruptions, epigenetic mechanisms, and genetic variations revealed through genome-wide studies (GWAS). A systematic search strategy was developed using PubMed to identify relevant English-language publications on sarcopenia, LBW, DOHaD, inflammaging, mitochondrial dysfunction, circadian disruption, epigenetic mechanisms, and GWAS. The publications consist of 46.2% reviews, 21.2% cohort studies, 4.8% systematic reviews, 1.9% cross-sectional studies, 13.4% animal studies, 4.8% genome-wide studies, 5.8% epigenome-wide studies, and 1.9% book chapters. The review identified key factors contributing to sarcopenia development, including the DOHaD hypothesis, LBW impact on muscle mass, inflammaging, mitochondrial dysfunction, the influence of clock genes, the role of epigenetic mechanisms, and genetic variations revealed through GWAS. The DOHaD theory suggests that LBW induces epigenetic alterations during foetal development, impacting long-term health outcomes, including the early onset of sarcopenia. LBW correlates with reduced muscle mass, grip strength, and lean body mass in adulthood, increasing the risk of sarcopenia. Chronic inflammation (inflammaging) and mitochondrial dysfunction contribute to sarcopenia, with LBW linked to increased oxidative stress and dysfunction. Disrupted circadian rhythms, regulated by genes such as BMAL1 and CLOCK, are associated with both LBW and sarcopenia, impacting lipid metabolism, muscle mass, and the ageing process. Early-life exposures, including LBW, induce epigenetic modifications like DNA methylation (DNAm) and histone changes, playing a pivotal role in sarcopenia development. Genome-wide studies have identified candidate genes and variants associated with lean body mass, muscle weakness, and sarcopenia, providing insights into genetic factors contributing to the disorder. LBW emerges as a potential early predictor of sarcopenia development, reflecting the impact of intrauterine exposures on long-term health outcomes. Understanding the complex interplay between LBW with inflammaging, mitochondrial dysfunction, circadian disruption, and epigenetic factors is essential for elucidating the pathogenesis of sarcopenia and developing targeted interventions. Future research on GWAS and the underlying mechanisms of LBW-associated sarcopenia is warranted to inform preventive strategies and improve public health outcomes., (© 2024 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Background: Knee osteoarthritis is a leading cause of disability with substantial healthcare costs, and efficient nonsurgical treatment methods are still needed. Platelet-rich plasma (PRP) injections and exercise therapy are used frequently in clinical practice. Whether PRP or PRP combined with exercise is more effective than exercise alone is unclear., Questions/purposes: (1) Which treatment relieves knee osteoarthritis pain better: PRP alone, exercise, or PRP combined with exercise? (2) Does PRP alone, exercise, or PRP combined with exercise yield better results in terms of the WOMAC score, performance on the 40-m fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score?, Methods: In this randomized, controlled, three-arm clinical trial, we recruited patients with mild-to-moderate (Kellgren-Lawrence Grade II or III) knee osteoarthritis with a minimum of 3 points on the 11-point numeric rating scale for pain. During the study period, 157 patients with a diagnosis of knee osteoarthritis were screened and 84 eligible volunteers were enrolled in the study. Patients were randomly allocated (1:1:1) into either the exercise group (28), PRP group (28), or PRP + exercise group (28). Follow-up proportions were similar between the groups (exercise: 89% [25], PRP: 86% [24], PRP + exercise: 89% [25]; p = 0.79). All patients were analyzed in an intention-to-treat manner. There were no between-group differences in age, gender, arthritis severity, and baseline clinical scores (pain, WOMAC, functional performance tests, and health-related quality of life). The exercise group underwent a 6-week structured program consisting of 12 supervised individual sessions focused on strengthening and functional exercises. Meanwhile, the PRP group received three weekly injections of fresh, leukocyte-poor PRP. The PRP + exercise group received a combined treatment with both interventions. The primary outcome was knee pain over 24 weeks, measured on an 11-point numeric rating scale for pain (ranging from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2). The secondary outcome measures included the WOMAC index (ranging from 0 to 100, with lower scores indicating a lower level of disability and an MCID of 12), the durations of the 40-meter fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score. For the a priori sample size calculation, we used the numeric rating scale score for pain at 24 weeks as the primary outcome variable. The MCID for the numeric rating scale was deemed to be 2 points, with an estimated standard deviation of 2.4. Based on sample size calculations, a sample of 24 patients per group would provide 80% power to detect an effect of this size between the groups at the significance level of p = 0.05., Results: We found no clinically important differences in improvements in pain-defined as ≥ 2 points of 10-at 24 weeks when comparing exercise alone to PRP alone to PRP + exercise (1.9 ± 0.7 versus 3.8 ± 1.8 versus 1.4 ± 0.6; mean difference between PRP + exercise group and exercise group -0.5 [95% confidence interval -1.2 to 0.4]; p = 0.69). Likewise, we found no differences in WOMAC scores at 24 weeks of follow-up when comparing exercise alone to PRP alone to PRP + exercise (10 ± 9 versus 26 ± 20 versus 7 ± 6; mean difference between PRP + exercise group and exercise group -3 [95% CI -12 to -5]; p = 0.97). There were no differences in any of the other secondary outcome metrics among the PRP + exercise and exercise groups., Conclusion: PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. Despite the additional costs and endeavors related to PRP products, the combination of PRP and exercise did not differ from exercise alone. The results of this randomized controlled trial do not support the use of PRP injections in the treatment of patients diagnosed with mild-to-moderate knee osteoarthritis. Consequently, exercise alone is the recommended treatment for reducing pain and enhancing function throughout this timeframe., Level of Evidence: Level I, therapeutic study., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2024 by the Association of Bone and Joint Surgeons.)

Objectives: Carotid arterial stenosis could be treated by surgical or percutaneous stenting. In this study, we aimed to investigate the effectiveness of the carotid council on the outcomes of patients with carotid artery disease., Methods: In this retrospective study, we analyzed the patients who had undergone carotid arterial revascularization from April 2014 to July 2022 in our hospital. All patients were evaluated in carotid council, which is constituted by neurologist, cardiologist and cardiovascular surgeon. Patient-specific treatment procedure was decided in the council. Demographics and early-term follow-up results of the patients were evaluated., Results: Totally 95 procedures in 85 patients were analyzed during the study period. 27.4 % of the patients had significant contralateral carotid arterial stenosis. In 88 (92.6%) procedures, patients were treated by carotid endarterectomy, and 5 procedures were performed under regional anesthesia. Shunt usage was 6.0% during the surgery, and arteriotomy was repaired with primary sutures in 87.3%. Stent implantation was performed in 7 patients. There were 5 neurological adverse events after the carotid endarterectomy and 2 neurological events were after carotid arterial stenting. In each treatment group, one patient died after the procedure. In the follow-up period, restenosis was observed just in a patient who was treated with carotid endarterectomy and primary repair., Conclusion: Although carotid artery disease could be treated in accordance with the guidelines, treatment procedures should be patient-specific. Carotid councils might be helpful in giving patient-specific decisions, thereby providing the patient-based treatment procedure and improving the outcomes of the patients with carotid artery disease., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background and Purpose: Physical examination (PE) is an important element used in the diagnostic process. This cross-sectional and methodological study was conducted methodologically to test cross-cultural and linguistic adaptation of the Turkish version of the Physical Examination Attitudes and Practices Scale (PEAPS) and to test the reliability and validity of Turkish nurses. Methods: The study was carried out with a methodological, cross-sectional design, with 372 nurses working in different departments at a state hospital. Results: The content validity index was found to be .87. Item-total score correlation coefficients were above .30; Cronbach's alpha was found to be .89. Conclusions: The instrument is an acceptable, valid, and reliable tool in Turkish for evaluating the attitudes and practices toward PE. Attitudes toward PE can be examined by health professionals working in different fields and cultures., (© 2023 Springer Publishing Company.)

The growing phenomenon of population aging is redefining demographic dynamics, intensifying age-related conditions, especially dementia, projected to triple by 2050 with an enormous global economic burden. This study investigates visual arts-mediated Cognitive Activation Therapy (CAT) as a non-pharmacological CAT intervention targets both biological aging [leukocyte telomere length (LTL), DNA methylation age (DNAmAge)] and cognitive functionality. Aligning with a broader trend of integrating non-pharmacological approaches into dementia care. The longitudinal study involved 20 patients with mild to moderate neurocognitive disorders. Cognitive and functional assessments, and biological aging markers -i.e., LTL and DNAmAge- were analyzed before and after CAT intervention. Change in LTL was positively correlated with days of treatment ( p =0.0518). LTL significantly elongated after intervention ( p =0.0269), especially in men ( p =0.0142), correlating with younger age ( p =0.0357), and higher education ( p =0.0008). DNAmAge remained instead stable post-treatment. Cognitive and functional improvements were observed for Copy of complex geometric figure, Progressive Silhouettes, Position Discrimination, Communication Activities of Daily Living-Second edition, Direct Functional Status ( p < 0.0001) and Object decision ( p =0.0594), but no correlations were found between LTL and cognitive gains. Visual arts-mediated CAT effectively mitigates cellular aging, especially in men, by elongating LTL. These findings underscore the potential of non-pharmacological interventions in enhancing cognitive and functional status and general well-being in dementia care. Further research with larger and longer-term studies is essential for validation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Campisi, Cannella, Celik, Gabelli, Gollin, Simoni, Ruaro, Fantinato and Pavanello.)

Over the past years, inflammatory bowel disease (IBD) treatment has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. During the treatment process prevention and management of viral infections hold significant importance. The protective role of favipiravir on enterocytes which are affected by inflammation is still unknown. We aim to analyze the effects of favipiravir on enterocytes after an inflammatory condition. We conducted a 2,5-diphenyl-2H-tetrazolium bromide (MTT) assay to assess the cytotoxicity of favipiravir on intestinal epithelioid cells (IEC-6). To mimic the inflammation model in cell culture conditions, we exposed IEC-6 cells to tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ). The cells were categorized into four groups: control, inflammation model, application of favipiravir before inflammation (prophylactic), and application of favipiravir after inflammation (treatment). We assessed the presence and distribution of caspase 1, caspase 3, interleukin 6 (IL6), interleukin 8 (IL8), mixed lineage kinase domain-like protein (MLKL), receptor-interacting protein kinase 1 (RIPK1), and TNF-α using indirect immunoperoxidase staining. TNF-α and IL8 levels were analyzed with enzyme-linked immunosorbent assay (ELISA) in a culture medium. Caspase 1 was observed to be strong (+++) in the treatment group and weak (+) in the prophylactic group compared to the inflammation group. Caspase 3 was weak (+) in the inflammation group, and it was strong (+++) in the prophylactic and treatment group, the increase in the treatment group was significant. Therefore administering favipiravir before inducing inflammation appears to control the inflammatory caspase pathway in intestinal enterocytes, protecting them from inflammatory responses, while the caspase 3-dependent apoptotic pathway may not be active in enterocytes during inflammation. IL6 and IL8 were negative (-) in control, IL6 was weak (+) in inflammation and favipiravir treated groups; IL8 increased significantly in favipiravir groups compared to control and inflammation groups. Consequently, favipiravir may trigger IL6 release, initiating the inflammatory pathway and potentially enhancing IL8 interactions with other cytokines. TNF-α immunoreactivity was strong (+++) in the inflammation group, while it was moderate (++) in favipiravir-administered groups. MLKL immunoreactivity was strong (+++) in all groups, RIPK1 was weak (+) in control, strong (+++) in the inflammation and treatment group, moderate (++) in the prophylactic group, and the increase in inflammation and treatment group was significant compared to control. Our findings suggest that in the treatment group, necroptosis was triggered by increased MLKL and RIPK1, key players in inflammation and cell death. After immunocytochemical evaluation, our findings suggest that, after the onset of inflammation, favipiravir may play a role in cell death by increasing necroptosis rather than apoptosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ozgurbuz et al.)

Objective: The aim of this study was to present an analysis of platelet-rich plasma obtained from patients with knee osteoarthritis and reveal the factors affecting its features., Methods: A total of 62 patients (mean age: 56.68 ± 7.13 years) with symptomatic knee osteoarthritis were included in this study. Age (years), gender, height (m), weight (kg), body mass index (kg/m2), duration of symptoms, smoking status, smoking index, general health status, and physical activity scores were recorded. Whole blood and platelet-rich plasma cell counts were performed with a hematology analyzer. White blood cell, red blood cell, and platelet counts were recorded. According to the dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation classification, dose of platelets, efficiency of the procedure (platelet recovery rate, %), and purity of the obtained platelet-rich plasma product (relative composition in platelets, %) were calculated. Correlation analysis between the features of platelet-rich plasma and the patient-related variables, including age, gender, body mass index, smoking status, smoking index, presence of other health conditions, physical activity scores, duration of symptoms, and pain levels, was performed., Results: Dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation analysis showed that the dose of injected platelets was 3.25 billion, the efficiency of the process was 77%, and the purity rate of the platelet-rich plasma was 98.4%. Platelet-rich plasma platelet count was correlated with whole blood platelet count (r = 0.81, P < .001), whole blood white blood cell count (r = 0.39, P = .002), smoking status (r = 0.56, P = .03), smoking index (r = -0.63, P = .002), and the presence of hypertension (r = -0.31, P=.04). Platelet-rich plasma white blood cell and purity of platelet-rich plasma were correlated with the smoking status of the patients (r = 0.52, P = .01; r = 0.64, P = .003, respectively)., Conclusion: This study has demonstrated that high dose and very pure platelet-rich plasma with medium efficiency was yielded with this platelet-rich plasma preparation procedure; whole blood platelet count, the presence of hypertension, and the smoking status of patients affect the features of the obtained platelet-rich plasma., Level of Evidence: Level IV, Diagnostic Study.

This study explores the influence of individual and relational predictors on bullying perpetration/victimization among semi-professional team sport players in North Cyprus. Three variables reflect on an individual's level characteristics (e.g., gender, age, and nationality), and another one, representing the relational level factor (e.g., negative coaching behavior). The current paper obtained data from athletes through convenient sampling technique and online survey utilization. A total of 190 sports players with an average age of 24.77 (SD = 4.52) participated. All participants were club athletes from 16 diverse nations, competing in four different sports disciplines: football, volleyball, handball, and basketball. Hierarchical regression analysis was implemented to evaluate the above underlying linkages. It was found that age, nationality, and the coach's negative personal rapport significantly predicted bullying victimization dynamics among athletes. Bullying perpetration was only predicted by negative personal rapport with the coach but not by any of the individual level predictors. The moderation analysis showed that negative personal rapport with the coach significantly predicted the level of bullying victimization, the age and the nationality of the athlete moderated the relationship between the negative personal rapport and bullying victimization. In other words, the negative personal rapport had a higher effect on bullying victimization for the younger athletes and for international ones. Such findings have the potential to shape the base for further ongoing works, which could underline the critical demand for more emphasis and analysis of nationality, gender, age, and coach's negative rapport on bullying perpetration or victimization. The significance of the study's findings, its limits, and potential paths for further interpersonal violence research are addressed.

Background: The aim of this study was to evaluate the effects of melatonin (MLT) and paricalcitol (PRC) on the healing of the extraction socket following tooth extraction in rats with cyclosporine-A (CsA)., Material and Methods: 76 male Wistar rats were divided into five different groups, one of which was a control (C) group. All groups other than the control group were applied CsA (10 mg/kg/daily) intraperitoneally 7 days before the tooth extraction. The left upper incisors were extracted on day 8 and CsA injections were continued in all groups until sacrification. Starting from the day of tooth extraction, in group 1 (CsA) were given CsA, in group 2 (CsA+MLT) were applied intraperitoneal MLT injection in a dose of 4 mg/kg, in group 3 (CsA+PRC) were applied intraperitoneal PRC injection in a dose of 200 ng/kg, and in group 4 (CsA+MLT+PRC) were applied intraperitoneal PRC injection and intraperitoneal MLT until the day of sacrification of all groups. The subjects were sacrificed on day 7 and 14 following tooth extraction. For histopathological examination, the subjects stained Hemotoxylin-Eosin and evaluated histologically under the light microscope. The intensity of inflammation in extraction socket was scored based on a four-grade system., Results: The level of inflammation was found to be lower in group C on day 7, while the inflammation value was found to be higher in the group 1 on day 14 (p>0.05). Statistically significant differences were found in the ossification values on day 7 between the groups(p<0.05). The percentage of ossification on day 7 was significantly lower in the group 1 than in the C and group 3, and significantly lower in the group 2 than in the group 3. The percentage of ossification on day 14 in the group 1 was significantly lower than in group C (p<0.05)., Conclusions: CsA has a negative effect on bone healing. The application of MLT and PRC following the toxicity produced by CsA was found to positively affect the healing of the socket that develops after tooth extraction.

Purpose: To present an evidence-based overview of the current utilization and the effectiveness of therapeutic Electromyographic Biofeedback (EMG-BF) in rehabilitation after orthopedic knee surgeries., Materials and Methods: This systematic review was conducted according to the PRISMA statement. MEDLINE (PubMed), PEDro, The Cochrane Library, and Web of Science databases were searched from their inception to June 20, 2020., Results: Eight RCTs investigating effectiveness of the EMG-BF in rehabilitation after orthopedic knee surgeries were identified. The quality scores for included studies ranged from 6 to 8 on PEDro Scale. Most of the included studies reported that EMG-BF was more effective compared to home exercises, standard rehabilitation program or electrical stimulation for improving quadriceps strength or activation. Besides, EMG-BF was revealed positive results in functional assessments except gait velocity and IKDC. Only two studies reported knee ROMs were significantly improved in favour of EMG-BF., Conclusions: This systematic review shows that EMG-BF seems to control pain and improve quadriceps femoris strength and functionality. However, the results are inconclusive regarding knee ROMs. Although available high-quality evidence is limited, EMG-BF might be a part of the rehabilitation after knee surgeries.Implications for rehabilitationThis paper reviews the effectiveness of the therapeutic EMG-BF as a potential option in rehabilitation after orthopedic knee surgeries.It is recommended EMG-BF can be used to control pain and to improve quadriceps strength and function.There is insufficient evidence to support EMG-BF to improve the range of motion.

Background Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Bulut et al.)

The hypoxic microenvironment caused by oral pathogens is the most important cause of the disruption of dynamic hemostasis between the oral microbiome and the immune system. Periodontal infection exacerbates the inflammatory response with increased hypoxia and causes vascular changes. The chronicity of inflammation becomes systemic as a link between oral and systemic diseases. The vascular network plays a central role in controlling infection and regulating the immune response. In this review, we focus on the local and systemic vascular network change mechanisms of periodontal inflammation and the pathological processes of inflammatory diseases. Understanding how the vascular network influences the pathology of periodontal diseases and the systemic complication associated with this pathology is essential for the discovery of both local and systemic proactive control mechanisms.

Background: Total knee arthroplasty (TKA) is one of the most commonly performed orthopedic surgeries in the lower extremity. However, patient dissatisfaction and functional disability are mostly experienced because of pain and limited range of motion (ROM). Although manual therapy is commonly implemented to improve ROM and modulate pain in the management of musculoskeletal disorders, there is a lack of evidence about its clinical effectiveness on postoperative TKA rehabilitation., Objective: To investigate the effectiveness of an exercise program combined with manual therapy compared with an exercise program only for pain, ROM, function, quality of life, and patient satisfaction outcomes., Design: A randomized controlled clinical trial., Setting: Rehabilitation unit of a university hospital., Participants: Forty-two patients (68.45 ± 6.3 years) scheduled for unilateral TKA as a treatment of severe osteoarthritis., Interventions: Joint and soft tissue mobilizations in addition to exercise therapy were provided to the mobilization group (n = 21) while the control group received exercise therapy only (n = 21)., Main Outcome Measures: The outcome measures were numeric pain-rating scale, knee ROMs, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, 10-meter walk test (10MWT), 5-times sit to stand test (5SST), and Short Form-12 (SF-12)., Results: Improvements in pain outcomes were significantly higher in the mobilization group than in the control group (P = .001, F [3, 33] = 7.06) and the between-group difference in change score was 1.3 points (P = .001). Although the between-group difference in change score was 12.8° for knee flexion at 2 months (P = .001), the overall group-by-time interactions were not significant for flexion and extension ROMs (P = .175, F [3, 33] = 1.75 and P = .57, F [2, 34] = 0.56, respectively). Additionally, there were statistically meaningful group-by-time interactions on total WOMAC score (P = .006, F [2, 34] = 5.29), 10MWT (P = .002, F [3, 33] = 5.98), and SF-12 mental component summary (P = .01, F [2, 34] = 4.92) favoring the mobilization group. Also, patient satisfaction was higher in the mobilization group (P = .02)., Conclusions: A structured exercise program combined with manual therapy can be more beneficial in improving pain, function, and patient satisfaction compared to exercise program alone for postoperative TKA patients., (© 2020 American Academy of Physical Medicine and Rehabilitation.)

Purpose: The purpose of the present study was to investigate the effect of the different irrigant combinations used in final irrigation on the push-out bond strength of root canal sealers that have different compositions., Materials and Methods: In total 60 dentinal slices in 1 mm thickness were collected from 15 extracted mandibular premolar teeth; 4 slices from each tooth. 3 canal-like artificial cavities were opened on each dentinal slice. Samples were divided into 4 experimental groups, each of which consisted of 15 samples. In group 1, samples were immersed in 5.25% NaOCl and 17% EDTA solutions respectively; in group 2, immersed in 5.25% NaOCl and 2% CHX solutions respectively; in group 3, immersed in 5.25% NaOCl, 17% EDTA and 2% CHX solutions respectively; and in group 4 immersed in distilled water. After drying with absorbent papers, each cavity in dentinal slice sample was filled with different sealer (Endoseal MTA, Tech Biosealer Endo or AH Plus). Two days later, the push-out bond examination was performed., Results: AH Plus showed higher push-out bond strength value in two combinations (group 2 and 3) in which final irrigants contained CHX (p<0.001). Dentinal push-out bond strengths of root canal sealers from Endoseal MTA and Tech BioSealer Endo were not affected by final irrigant (p=0.965)., Conclusion: Using CHX after NaOCl in final irrigant increases push-out strength of epoxy resinbased sealer but, did not create any difference in dentinal push-out bond strength of calcium silicate-based sealers., (Copyright © 2021 European Oral Research.)

Objectives: There are studies in the literature showing the clinical importance of fragmented QRS (fQRS) in many systemic diseases. In this study, we aimed to investigate the frequency and prognostic value of fQRS on electrocardiogram (ECG) in patients with acute ischemic stroke., Materials and Methods: We prospectively enrolled 241 patients with acute ischemic stroke between January 2018 and January 2020. ST depression and elevation, QRS duration, PR interval, RR interval, QTc interval, QTc dispersion (QTcd), T negativity, Q wave, and fQRS were evaluated on ECG. Brain computed tomography (CT) and diffusion magnetic resonance imaging (MRI) images were obtained in the acute period and the National Institute of Health Stroke Scale (NIHSS) score was calculated for each patient. Patients were followed up for a period of two years., Results: The 241 patients comprised 121 (50.2%) men and 120 (49.8%) women with a mean age of 67.52 ± 13.00 years. In Cox regression analysis, age, NIHSS, QTcd, and fQRS were found to be independent predictors of mortality (age, hazard ratio [HR]: 1.063, p < 0.001; NIHSS, HR: 1.116, p = 0.006; QTcd, HR: 1.029, p = 0.042; fQRS, HR: 2.048, p = 0.037). Two-year mortality was higher in patients with fQRS than in patients without fQRS (31% vs. 9%, p = 0.001)., Conclusions: The fQRS is associated with poor prognosis in patients with acute ischemic stroke., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The coronavirus disease 2019 (COVID-19) pandemic can be identified as a source of traumatic stress. Previous studies have shown that post-traumatic stress and intolerance of uncertainty are associated with aggressive behaviour., Objective: In the present study, we aimed to test a serial mediation model, considering rumination and post-traumatic stress symptoms (PTSS) as mediators that link intolerance of uncertainty and aggression, while controlling the confounding effect of crisis-induced health and socioeconomic stressors during the COVID-19 pandemic., Method: A total of 714 participants [533 (74.6%) females, 176 (24.7%) males, aged 18-64 years ( M age  = 25.16, SD age  = 9.34)] completed the following self-reported scales: Aggression Scale, COVID-19 stressors checklist, Short Version of the Intolerance of Uncertainty Scale, Impact of Event Scale with Modifications for COVID-19, and Ruminative Thought Style Questionnaire., Results: The results revealed that there was an association between intolerance of uncertainty and aggressive behaviours. Moreover, the results of serial mediation analysis showed that intolerance of uncertainty predicts aggressive behaviours via rumination and PTSS. Besides, socioeconomic stressors are significantly associated with the level of PTSS and aggression, while health stressors are not significantly association with the level of PTSS and aggression., Conclusions: The findings provide several contributions to understand the link between intolerance of uncertainty and aggressive behaviours during the COVID-19 pandemic, and confirm the importance of early psychological intervention, especially for those who are more likely to ruminate and suffer from PTSS, to prevent aggression and violence in the long run. In addition to health-related regulations, it is important to take the social and economic aspects of the crisis into account and develop intervention strategies accordingly. Nevertheless, the limitations of cross-sectional mediation analysis in explaining causal relationships should be kept in mind, and future studies should extend these findings using longitudinal data., Competing Interests: No potential conflict of interest was reported by the authors., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background and Objectives: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms., Methods: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features., Results: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively)., Conclusion: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity., Competing Interests: Conflict of Interest: None., (Copyright: © Pakistan Journal of Medical Sciences.)

Nanotechnology can offer a number of options against coronavirus disease 2019 (COVID-19) acting both extracellularly and intracellularly to the host cells. Here, the aim is to explore graphene oxide (GO), the most studied 2D nanomaterial in biomedical applications, as a nanoscale platform for interaction with SARS-CoV-2. Molecular docking analyses of GO sheets on interaction with three different structures: SARS-CoV-2 viral spike (open state - 6VYB or closed state - 6VXX), ACE2 (1R42), and the ACE2-bound spike complex (6M0J) are performed. GO shows high affinity for the surface of all three structures (6M0J, 6VYB and 6VXX). When binding affinities and involved bonding types are compared, GO interacts more strongly with the spike or ACE2, compared to 6M0J. Infection experiments using infectious viral particles from four different clades as classified by Global Initiative on Sharing all Influenza Data (GISAID), are performed for validation purposes. Thin, biological-grade GO nanoscale (few hundred nanometers in lateral dimension) sheets are able to significantly reduce copies for three different viral clades. This data has demonstrated that GO sheets have the capacity to interact with SARS-CoV-2 surface components and disrupt infectivity even in the presence of any mutations on the viral spike. GO nanosheets are proposed to be further explored as a nanoscale platform for development of antiviral strategies against COVID-19., (© 2021 The Authors. Small published by Wiley-VCH GmbH.)

Background: Pre-competition massage is usually used to improve athletic performance and reduce risk of injury. Despite its usual use, the effects of pre-competition massage on neuromuscular function have barely been studied. The aim of this study is to evaluate the effects of the pre-competition massage over the gastrocnemius neuromuscular function., Method: The study is a quasi-experimental clinical trial thirty healthy athletes were enrolled in the study. Subjects received an intervention in one leg (experimental), consisting of a massage, and no intervention in the opposite leg (control). From all values of neuromuscular function, the following were analyzed: contraction time (Tc) and maximal displacement (Dm) by tensiomyography, and stiffness and tone by myotonometry., Results: Main effects of pre-competition massage on neuromuscular function include a significant ( p < 0.05) increase in Tc and Dm variables, as well as a reduction in stiffness and tone., Conclusion: Data shows an increase in Tc and maximal radial displacement (Dm) variables, as well as a reduction in stiffness and tone. More quality studies are needed to draw clear conclusions about the effects of pre-competition massage.

Background: Lumbar puncture's (LP) success is dependent on the skill of the physician, anatomy, size, and posture of the patient. Aims : The purpose of this study was to describe a method that could be used to help estimate the correct depth of needle (Y) insertion in children based on age, weight (W), and height (H). Methods: The study consisted of 200 children American Society of Anesthesiologist class I-II aged 0-12 years who underwent spinal block for orthopedic, pediatric, and genitourinary surgery. The distance from the skin entry point to the tip of the spinal needle was measured after the LP was performed. The relationship between the Y and W, H and body mass index (BMI) was calculated. Predictive statistical models were used to determine the LP needle depth. A paired sample t -test was conducted to compare the findings of the developed model with those of earlier models. Results: The patients were aged 2-144 months, with H and W of 43-154 cm and 2.5-48 kg, respectively. The BMI was 10.75-37.72 kg/m 2 . Before the Y was estimated, the relationship between the independent variables and the depth variable, which was the dependent variable, was examined. According to the obtained results, the model consists of strong relationships with H, W, and H + W. The formula for predicting Y based on W plus H was as follows: for all patients: Y (cm) = 0.861 + 0.012 × H (cm) + 0.035 × W (kg). Based on H, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 0.393 + 0.023 × H (cm). Based on W, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 1.460 + [0.067 × W (kg)]. Conclusion: The formula may provide a more reliable estimate of the required LP depth in children than that obtained using current models. However, larger studies are needed to standardize the formula.

Objective: To evaluate the effects of kinesio taping on shoulder disorders, as a single treatment modality or as conjunction to other treatments., Data Sources: MEDLINE, PEDro (Physiotherapy Evidence Database), The Cochrane Library, Web of Science, Embase and OpenGrey databases were searched for trials published before 5 February 2020., Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Randomized controlled trials published in English or Turkish were included. The methodological quality of the studies was assessed with the Physiotherapy Evidence Database scale. For analysis of continuous data, mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used. The I 2 statistics was used to measure the heterogeneity., Results: Fourteen studies were included with 680 participants. Kinesio taping did not produce better results on pain compared to sham (MD by -0.77 (95% CI = -1.77, 0.22), P  = 0.13), exercises (MD by -0.51 (95% CI = -1.41, 0.39), P  = 0.27), or passive treatments (MD by -0.29 (95% CI = -0.77, 0.19), P  = 0.24). Similarly, kinesio taping did not found superior to sham kinesio taping (SMD by -0.01 (95% CI = -0.31, 0.29), P  = 0.94), exercises (SMD by 0.41 (95% CI = -0.25, 1.07), P  = 0.22), or passive treatments on function (SMD by -0.02 (95% CI = -0.19, 0.15), P  = 0.82). There was no significant SMD on range of motion (ROM) by -0.07 (95% CI = -0.47, 0.33, P  = 0.74) compared to sham kinesio taping and -0.06 (95% CI = -0.20, 0.09, P  = 0.46) compared to passive treatment. Overall, effect size was found small to moderate., Conclusion: Despite reported positive effects in some studies, there is no firm evidence of any benefit of kinesio taping on shoulder disorders.

Objective: If systemic inflammation in relation with obesity causes asthma, the detection of increased airway inflammation among obese individuals who do not have any respiratory symptoms can be also beneficial in indentifying obese patients who are at risk of developing asthma. The aim of this study was to evaluate the systemic and airway inflammation of asymptomatic obese and non-obese individuals., Materials and Methods: Obese and non-obese individuals with no respiratory symptoms were included. Inflammatory biomarkers such as C-reactive protein (CRP), exhaled breath condensate (EBC) interleukin-6 (IL-6), EBC leukotriene B-4 (LTB-4), and EBC nitric oxide (NO) levels of obese and non-obese individuals were determined., Results: Forty-five obese individuals (body mass index [BMI]≥30) and 31 non-obese individuals (BMI≤25) as a control group were included in this study. The mean age of the obese group (38.7±11.4 years) was significantly higher than the one of the non-obese group (29.5±8.6 years; p<0.001). There was no significant relationship between gender and BMI (χ 2 =1.471, p=0.225). CRP levels were significantly higher in the obese group (6.94±8.28) than the non-obese group (3.29±0.39; p<0.001). The levels of EBC IL-6 in obese and non-obese group were found as 22.61±12.53 and 21.08±14.39, respectively (p=0.624). There was no significant difference between EBC NO levels of the obese group and non-obese group (24.35±10.9 vs. 21.56±7.83; p=0.226). No significant difference was found between the EBC LTB-4 level in the obese group and the non-obese group (36.39±89.82 vs. 16.64±17.45; p=0.231)., Conclusion: Increased systemic inflammation in obese individuals who had no respiratory symptoms might indicate the tendency of asthma. However, airway inflammation was not significantly different between groups. Therefore the relationship between obesity and asthma should be investigated in future large-scale studies determining the direct effects of adipokines on airways., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (©Copyright 2020 by the Atatürk University School of Medicine - Available online at www.eurasianjmed.com.)

Background: Patellofemoral pain (PFP) is one of the most common disorders of the knee. Neuromuscular electrical stimulation (NMES) is often assumed by clinicians to be an effective adjunctive therapy to quadriceps strengthening., Objective: The aim of this study was to assess the efficacy of superimposed NMES combined with strengthening exercises to improve the recovery of quadriceps strength and function in patients with PFP., Methods: This study was planned as a single blind randomized controlled pilot study. A total of twenty-seven patients diagnosed with PFP were randomly assigned into 2 groups. Patients received superimposed NMES in addition to the standardized program (Group I) or only the standardized program (Group II). The patients in both groups were treated 3 times a week for 6 weeks and followed at 12 weeks. Primary outcome measure was quadriceps isokinetic muscle strength. The changes in dependent variables before treatment, 6th, and 12th weeks were analyzed using a 2 × 3 mixed-model analysis of variance., Results: There were significant improvements in the within groups statistics of all parameters for both groups (p< 0.05). No differences in quadriceps strength, Kujala and Lysholm scores between groups were found at the different time points [F (2, 21) = 0.86; p= 0.12, F (2, 21) = 0.001; p= 0.97, F (2, 21) = 0.12; p= 0.73, respectively]., Conclusions: The results indicate that superimposed NMES combined with the standardized rehabilitation program has no clinically significant superiority to standardized rehabilitation program alone.

Objectives: The ceragenins, or CSAs, were designed to mimic the activities of antimicrobial peptides and represent a new class of antimicrobial agent. The aim of this study was to comparatively investigate the antimicrobial activities of first/second generation ceragenins and various antibiotics against multidrug-resistant (MDR) Klebsiella pneumoniae , including colistin-resistant bacteria. Also, the synergistic effects of two ceragenins with colistin or meropenem were investigated with six K. pneumoniae strains presenting different resistant patterns., Methods: Minimal inhibition concentrations (MICs) were determined by the microdilution method according to the CLSI. Antibiotic combination studies were evaluated by the time-kill curve method., Results: MIC 50 and MIC 90 values of tested ceragenins ranged from 8 to 32 mg/L and 16 to 128 mg/L. Overall, among the ceragenins tested, CSA-131 showed the lowest MIC 50 and MIC 90 values against all microorganisms. The MICs of the ceragenins were similar or better than tested antibiotics, except for colistin. Synergistic activities of CSA-131 in combination with colistin was found for strains both at 1× MIC and 4× MIC. No antagonism was observed with any combination., Conclusions: First-generation ceragenins CSA-13 and CSA-44 and second-generation ceragenins CSA-131, CSA-138 and CSA-142 have significant antimicrobial effects on MDR K. pneumoniae . Mechanisms allowing resistance to clinical comparator antibiotics like colistin did not impact the activity of ceragenins. These results suggest that ceragenins may play a role in treating infections that are resistant to known antibiotics.

Objective : To compare the effects of photobiomodulation therapy (PBMT) and extracorporeal shock wave therapy (ESWT) on lateral epicondylitis (LE). Background : Although several authors have investigated the effects of PBMT and ESWT on LE, only one study to date has compared ESWT with PBMT. Ours is also the first study assessing patient satisfaction levels and quality of life in addition to comparing the two methods. Methods : Forty-three patients were randomly divided into two groups: 23 (mean age: 48.2 ± 9.4; 17 female, 6 male) were included in the PBMT group and 20 (mean age: 48.0 ± 9.9; 15 female, 5 male) in the ESWT group. PBMT was applied three times a week for 4 weeks, and ESWT once a week for 4 weeks. Stretching and eccentric strengthening exercises were also given to both groups as a home program. The Mayo Elbow Performance Score and disabilities of the arm, shoulder, and hand (DASH) were used for evaluating upper extremity functions. Pain intensity was evaluated using a visual analog scale (VAS), and muscle strengths were also assessed using a hand-held dynamometer. The 12-Item Short Form (SF-12) Survey Physical and Mental Component Scales were used to evaluate quality of life, and the global rating of change scale to evaluate patient satisfaction. Patients were assessed before treatment and at 12-week follow-up. Results : Improvements for elbow extension and shoulder flexion strength and for VAS movement were observed only in the PBMT group, whereas improvement of handgrip strength was present in both groups ( p  < 0.05). However, handgrip strength was superior in the PBMT group than in the ESWT group ( p  = 0.02). Conclusions : Both PBMT and ESWT are useful and can be used in the treatment of LE.

The Foot and Ankle Ability Measure is a valid, reliable, and widely used self-reported questionnaire for the foot. It has been adapted and validated for a Turkish-speaking population. The purpose of this study was to provide evidence for validity and reliability of the Turkish version of the Foot and Ankle Measure (FAAM-T) in patients with chronic ankle instability (CAI). A total of 316 patients with CAI were enrolled. The internal consistency and test-retest reliability were evaluated. Validity was examined using correlations with the Short Form Health Survey version 2.0 (SF-36v2) questionnaire. Cronbach's alpha scores were 0.94 and 0.96 for the the FAAM-T ADL (Activities of Daily Living) and FAAM-T Sports subscales, respectively, indicating high internal consistency. For the second administration, Cronbach's alpha was found to be 0.96 for both subscales of the FAAM-T. The test-retest reliability of the FAAM-T was very high for both subscales with an intraclass correlation coefficient of 0.97 and 0.94, respectively (p < .001). The standard error of the mean and minimal detectable change were determined to be 2.5 and 6.7 for the FAAM-T ADL and 6.9 and 18.5 for the FAAM-T Sport. The FAAM-T ADL and Sport subscales were strongly correlated with the SF-36v2 PF (physical functioning; r = 0.51, r = 0.40, respectively; p = .001) and SF-36v2 PCS (physical component scale; r = 0.64, r = 0.55, respectively; p = .001). The weakest associations between the FAAM-T ADL and Sport and the SF-36v2 were noted for the mental health subscale (r = 0.08 and r = 0.03) and the SF-36v2 MCS (mental component scale; r = .05 and r = .006, respectively). This study provides evidence for validity, internal consistency, and test-retest reliability for the FAAM-T to evaluate patients with CAI., (Copyright © 2018. Published by Elsevier Inc.)

Background: Studies have emphasized the importance of the presence of myofascial trigger points (MTrPs) in patients with rotator cuff pathologies and the high frequency of MTrPs in rotator cuff muscles., Objective: Evaluate the effectiveness of the treatment of active MTrPs in patients with rotator cuff pathologies., Methods: Fifty-three patients with rotator cuff tear were randomized into two groups. All patients received the same standard conservative treatment twice a week for 6 weeks. Patients in Group 1 additionally received ischemic compression (IC) of MTrPs. Pain, range of motion (ROM), function, and anxiety and depression were assessed. MTrPs in rotator cuff muscles were assessed manually, and the number of MTrPs on the shoulder complex was counted., Results: There were no significant differences between the groups in terms of changes in resting/activity/night pain, ROM, function, or anxiety and depression (p> 0.05). Pain scores improved only in Group 1. However, the total number of MTrPs was significantly decreased in Group 1 (p= 0.001)., Conclusion: A six-week course of IC helps treat active MTrPs. A standard conservative treatment program reduced pain and increased function; the addition of MTrP treatment did not improve clinical outcomes in patients with rotator cuff pathologies.

Objective:: To investigate the effect of setting expectations verbally on the effectiveness of kinesiotape application in patients with a rotator cuff tear., Design:: Randomized controlled, double-blind study., Setting:: Department of Physiotherapy and Rehabilitation., Subjects:: Eighty-nine patients with rotator cuff tear., Intervention:: Patients were randomized according to the verbal input given to patients about the effectiveness of kinesiotaping; Group 1 (there is no evidence that kinesiotaping is effective), Group 2 (there is limited evidence that kinesiotaping is effective), and Group 3 (there is evidence that kinesiotaping has an excellent effect)., Main Measures:: Resting pain, activity pain, and night pain were assessed by visual analog scale. Range of motion was assessed by a universal goniometer. Function was evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form before and 24 hours after kinesiotape application. Only resting pain and activity pain were assessed after 30 minutes., Results:: There were no statistically significant differences (ANOVA) between any groups at the three assessment points. The intragroup assessment showed that in Group 2, only resting pain after 30 minutes improved (3.2 ± 2.9 to 2.6 ± 2.8; P  = 0.02 ). An improvement in resting pain both after 30 minutes and after 24 hours was found in the third group (4.1 ± 2.4 to 2.3 ± 2.3, P  = 0.001; 4.1 ± 2.4 to 2.2 ± 2.3, P  = 0.001, respectively). Activity pain and night pain were improved in all groups after 24 hours., Conclusion:: Setting positive expectations verbally about kinesiotaping might be effective in reducing pain in patients with rotator cuff tear.

Long non-coding RNAs (lncRNAs) have been implicated in numerous biological processes, including epigenetic regulation, cell-cycle control, and transcriptional/translational regulation of gene expression. Differential expression of lncRNAs and disruption of the regulatory processes are recognized as critical steps in cancer development. The role of lncRNAs in hepatitis B virus (HBV) infection is not well understood. Here we analyzed the expression of 135 lncRNAs in plasma samples of 82 HBV patients (classified as chronic patients, inactive carriers, or resolved patients) at diagnosis and at 12 months of treatment in relation to control group (81 healthy volunteers). We also investigated the effect of small interfering RNA (siRNA)-mediated silencing of lincRNA-SFMBT2 on HBV-positive human liver cancer cell line. lncRNA expression was analyzed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Chemically synthesized siRNAs were transfected into the cell lines using Lipofectamine 2000 Reagent (Thermo Fisher Scientific). HBV DNA and HBsAg and HBeAg were detected in transfected cultures by real-time PCR and ELISA, respectively, using commercial kits. We observed changes in lncRNA expression in all three HBV groups, compared to control group. Most notably, the expression of anti-NOS2A, lincRNA-SFMBT2, and Zfhx2as was significantly increased and expression of Y5 lncRNA was decreased in chronic HBV patients. A decreased Y5 expression and increased lincRNA-SFMBT2 expression were observed in inactive HBsAg carriers. The expression of HOTTIP, MEG9, and PCAT-32 was increased in resolved HBV patients, and no significant change in the expression of Y5 was observed, compared to control group. siRNA-mediated inhibition of lincRNA-SFMBT2 decreased the level of HBV DNA in human liver cancer cells. Further research is needed to confirm the prognostic as well as therapeutic role of these lncRNAs in HBV patients.

Juvenile giant fibroadenoma is a benign breast tumor and rare variant of the fibroadenomas. Clinical presentation is usually a painless, solitary and unilateral breast mass. It accounts for 0.5%-2% of all fibroadenomas and exact etiology is not known; however, hormonal influences are thought to be contributing factors. We present a case of a 20 cm diameter giant juvenile fibroadenoma of the breast in a 14-year-old girl. The patient was suffering from a painless, progressively enlarging mass for 1 year. Ultrasound revealed fibroadenoma and total surgical excision was performed. The patient is doing well in ten months of follow up., (Sociedad Argentina de Pediatría.)

We sought to translate and culturally adapt the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AHFS) into Turkish and determine the selected psychometric properties of the translated version. The AOFAS-AHFS is widely used to evaluate disability associated with foot and ankle injuries but has not yet been translated or culturally adapted for Turkish-speaking individuals. The AOFAS-AHFS was translated into Turkish using the Beaton guidelines. The measurement properties of the Turkish AOFAS-AHFS (internal consistency, construct validity, and floor and ceiling effects) were tested in 72 patients (94 feet, 50 [69.4%] females; average ± SD age 44.88 ± 16.30 years) with a variety of foot and ankle pathologic features. Construct validity was analyzed using the Turkish version of the Foot and Ankle Ability Measure (FAAM) and the Medical Outcomes Study short-form 12-item survey (SF-12). The Turkish version of the AOFAS-AHFS showed excellent test-retest reliability (intraclass correlation coefficient 0.91). The correlation coefficients between the AOFAS-AHFS and the FAAM activities of daily living and FAAM sport were r = 0.41, p = .01 and r = 0.37, p = .03, respectively. The correlation coefficients between the AOFAS-AHFS and the SF-12 physical component scale was r = 0.27, p = .08. The weakest correlation was found between the AOFAS-AHFS and the SF-12 mental component scale (r = -0.03, p = .73). The Turkish version of the AOFAS-AHFS has sufficient reliability and validity to measure patient-reported outcomes for Turkish-speaking individuals with a variety of foot and ankle disorders., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate ex vivo the incidence of microcracks in root dentine after canal preparation with ProTaper Universal (PTU), RaCe or Safesider instrumentation systems using microcomputed tomography (micro-CT)., Methodology: Thirty freshly extracted mandibular molars with two separate mesial canals and foramina were used. The roots were allocated into three similar groups according to curvature angles and radii of the canals and lengths of the roots. Distal roots were removed and mesial roots were embedded in acrylic resin and instrumented with the PTU, RaCe or Safesider systems up to size 30 (F3 for PTU, size 30, 0.04 taper for RaCe and Safesider) for all instrumentation groups. Dentinal microcracks were evaluated on micro-CT images of the apical 10 mm of the roots with 1-mm intervals. Two experienced observers evaluated the images twice in a blinded fashion. The presence of dentinal microcracks (complete/incomplete cracks and craze lines) was noted and analysed statistically using McNemar and chi-square tests (P = 0.05)., Results: There were microcracks on uninstrumented root sections. All instrumentation systems significantly increased the number of dentinal microcracks when compared to preoperative specimens (P < 0.05). There were new microcracks on the postoperative samples. The PTU system (42%) led to greater number of post-instrumentation microcracks than Safesider (35%) and RaCe (25%) systems, respectively. The difference between PTU and RaCe system was significant (P < 0.05)., Conclusions: All instrumentation systems significantly increased the number of microcracks compared with preoperative specimens. The PTU system generated more post-instrumentation dentinal microcracks than the RaCe system., (© 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Background: This study compared the effectiveness of joint mobilization combined with stretching exercises (JM&Str) vs steroid injection (SI) in the treatment of plantar fasciitis (PF)., Methods: A total of 43 patients (mean age, 45.5 ± 8.5 years; range, 30-60 years; 23 females) with PF were randomly assigned to receive either JM&Str (n = 22) or SIs (n = 21). JM&Str was applied 3 times per week for 3 weeks for a total of 9 visits. The SI group received 1 injection at baseline. The patients' functional scores were assessed using the Foot and Ankle Ability Measure (FAAM), and pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were captured at baseline and at 3-week, 6-week, 12-week, and 1-year follow-ups. The primary aim was examined using a mixed-model analysis of variance (ANOVA). Pairwise comparisons were performed to examine differences between the baseline and follow-up periods using Bonferroni equality at an alpha level of 0.05., Results: Age, sex, body mass index, and dorsiflexion range of motion did not significantly impact pain relief or functional outcome (P > .05) at the 3-, 6- or 12-week follow-ups compared to baseline. Planned pairwise comparisons demonstrated significant improvements in pain relief and functional outcomes in both groups (P < .05) at the 3-, 6-, and 12-week follow-ups compared to baseline. However, at the 12-week and 1-year follow-ups, pain and functional outcomes were significantly improved in only the JM&Str group (P = .002). The overall group-by-time interaction was statistically significant for both FAAM (P = .001; F = 7.0) and VAS (P = .001; F = 8.3) scores. Between-group differences favored the SI group at the 3-week (P = .001, P = .001), 6-week (P = .002, P = .001), and 12-week (P = .008, P = .001) follow-ups for pain relief and functional outcomes. However, no significant differences (P = .62, P = .57) were detected in the measured outcomes at the 1-year follow-up., Conclusion: Our study demonstrated that while both groups achieved significant improvements at the 3-, 6-, and 12-week follow-ups, the SI group exhibited better outcomes at all 3 time points. The noted improvements continued in only the JM&Str group for a period of time ranging from 12 weeks to 1 year., Level of Evidence: Level II, comparative study., (© The Author(s) 2015.)

Background/aims: The aim of this study is to investigate the utility of clinical [age, gender, mean arterial pressure (MAP)] and laboratory parameters [eGFR, hemoglobin (Hgb), serum levels of creatinine, uric acid, albumin, proteinuria, hematuria] and also histopathological lesions (Oxford classification parameters, crescents, intensity and pattern of staining for C3, C1Q, IgA, IgG, IgM) as progression markers in patients with IgA Nephropathy (IgAN)., Methods: A total of 111 IgAN patients with a follow-up period >1 year or who reached kidney failure [GFR category G5 chronic kidney disease (CKD)] <1 year were investigated. Primary endpoint was the development of kidney failure or eGFR decline ≥50% from the baseline. Kaplan-Meier and Cox proportional hazards analyses were performed., Results: Mean follow-up period was 33±29 months. Thirty-seven (33.3%) patients progressed to kidney failure and 4 (3.6%) patients developed eGFR decline ≥50% from the baseline after a median of 23 and 65 months, respectively. In multivariate Cox regression analysis, baseline levels of Hgb (HR:0.782, 95% CI 0.559-0.973, p=0.037), serum uric acid (HR:1.293, 95% CI 1.023-1.621, p=0.046), eGFR (HR:0.966, 95% CI 0.947-0.984, p=0.004) and intensity of C3 staining (HR:1.550, 95% CI 1.198-1.976, p=0.049) predicted primary endpoint. Serum uric acid level was associated independently with T score (β=0.303, p=0.005) in patients with eGFR>30 ml/min/m2., Conclusions: Hyperuricemia and the deposition of C3 are independent risk factors for IgAN progression., (© 2016 The Author(s) Published by S. Karger AG, Basel.)

Aim: To determine the rural-urban differences in primary care practice, hospital inpatient care and total services., Methods: This cross-sectional study used data from Zenica-Doboj Canton in Federation of Bosnia and Herzegovina (FBiH). The overall sample size for the study was 1,995. Individual interviews were conducted in one randomly selected day of the week, except Monday and Friday, on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire., Results: Out of total number (n=1 995), 47.9% was urban population and median of age was 42 years for both populations. The most of urban residents (81.4%) had finished high school or higher education compared with rural residents (58.5%) (p < 0.001). There are significant differences in employment status between rural and urban population (p < 0.001). Rural residents are more likely to travel more than 15 minutes to see their health facilities compared with urban residents (61.7% vs. 24.4%, respectively). Median of distance (kilometers) from residence location to the nearest hospital was statistically significantly higher in rural Me = 8.0 (5.0 do 14.5) km compared to urban population Me = 1.5 (1.0 to 3.0) km (p < 0.001). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001)., Conclusion: There are significant differences in the overall health care assessment of rural populations as compared to urban populations.

Aims: The aim of this study was to evaluate the shaping effects of two M-wire and two traditional nickel-titanium (NiTi) rotary systems in simulated S-shaped resin canals., Subjects and Methods: Forty simulated S-shaped canals in resin blocks were instrumented with two traditional (ProTaper, Sendoline S5) and two M-wire (WaveOne, GT series X) NiTi systems according to the manufacturers' instructions. Ten resin blocks were used for each system. Pre- and post-instrumentation images were captured using a stereomicroscope and superimposed with an image program. Canal transportation, material removal, and aberrations were evaluated and recorded as numeric parameters., Statistical Analysis Used: Data were analyzed using one-way ANOVA and post-hoc Tukey tests with a 95% confidence interval., Results: There were significant differences between systems in terms of transportation and material removal (P<0.05). Coronal danger zone was the most common aberration., Conclusions: Within the limits of this ex vivo study, it was found that the manufacturing methods (M-wire or traditional NiTi) and kinematics (rotary or reciprocating motion) did not affect the shaping abilities of the systems. The extended file designs of highly tapered NiTi systems (ProTaper, WaveOne) resulted in greater deviations from the original root canal trace and more material removal when compared to less tapered systems (Sendoline S5, GT series X).

Purpose: To test the measurement properties of Turkish version of the Anterior Cruciate Ligament Quality of Life (ACL-QOL) questionnaire., Methods: One hundred and nineteen patients with ACL reconstruction (ACL-R) completed internal consistency, agreement, construct validity, floor and ceiling effect analyses. Eighty out of 119 patients with ACL-R completed Turkish version of the ACL-QOL questionnaire twice for the test-retest reliability. A subgroup of thirty-nine patients undergoing physiotherapy were also asked to answer the ACL-QOL questionnaire, the Lysholm Knee Scale (LKS), Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and the short form 36 (SF-36) at pre-operative, 16th week and 2 years post-operatively to assess responsiveness., Results: The questionnaire had high internal consistency (Cronbach's α = 0.95). The paired t test showed no significant difference between the test-retest means. The intraclass correlation was excellent for reliability and agreement in five domains and overall score (ICC 0.95, 0.95, 0.97, 0.95, 0.96 and 0.95; p < 0.001). The standard error of measurement and the minimum detectable change (MDC95) were found to be 3.1 points and 8.7 points, respectively. The questionnaire showed a fair correlation (r = 0.23) with LKS and a poor correlation (r = 0.14) with KOS-ADLS; good and very good construct validity (r = 0.51, r = 0.62) with SF-36 physical component score and mental component score, respectively. No ceiling and floor effects were observed except the subdomain of 'work-related concerns' (22.9 %). A dramatic effect size was demonstrated at the 16th week (2.1) and 2 years (1.1) of follow-up., Conclusion: Turkish version of the ACL-QOL questionnaire is a reproducible and responsive instrument that can be used in clinical studies., Level of Evidence: Diagnostic study, Level I.

Purpose: The Achilles tendon Total Rupture Score (ATRS) is a questionnaire designed to evaluate pain, symptoms, function and physical activity after Achilles tendon rupture. The purpose of this study was to translate and culturally adapt the ATRS into Turkish and to determine its reliability and validity., Methods: The ATRS was translated into Turkish in accordance with the stages recommended by Beaton. Seventy-four patients (73 male; average age: 42.3 ± 7.6; range 27-63 years) suffering from previous Achilles tendon ruptures were included for the study. The ATRS-Turkish was administered twice at 7-14 days intervals with 52 of the 74 patients (51 male, average age: 41.8 ± 7.8) to assess the test-retest reliability. Cronbach's α was used for internal consistency, and the inter-rater correlation coefficient (ICC) was used to calculate the test-retest reliability. The Turkish Short-Form-12 (SF-12) and the Foot and Ankle Outcome Score (FAOS) were employed for validity estimation., Results: The internal consistency (Cronbach's α = 0.95) and the test-retest reliability (ICC = 0.98) were excellent. The mean interval between the two tests was 7.1 ± 3.1 days. The mean and standard deviation of the first and second assessment of the ATRS were 78.1 ± 23.1 and 79.1 ± 22.5, respectively. The correlation coefficient between the ATRS-Turkish and the FAOS subscales (pain, symptoms, activities of daily living, sports and recreational activities, and quality of life) were determined (r = 0.82, r = 0.66, r = 0.79, r = 0.83 and r = 0.60, respectively, p < 0.0001). The ATRS-Turkish displayed good correlation with the SF-12 physical component score (r = 0.63, p < 0.001) and no correlation with the SF-12 mental component score (r = 0.22, p = 0.06)., Conclusion: The ATRS-Turkish was found to be reliable and valid for outcome evaluation after Achilles tendon ruptures., Level of Evidence: II.