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Aim: To demonstrate the demographic data, subgroup distributions, responses to treatment and outcomes of long-term follow-up in patients who were followed up and treated in our clinics with a diagnosis of juvenile idiopathic arthritis, and to compare these data with national and international data. Material and Methods: The files of 116 patients who had been diagnosed as having juvenile idiopathic arthritis, were initiated on treatment and presented for regular follow-up visits between January 2012 and January 2018, were examined. Their demographic findings, treatments, active/inactive disease states (on-medication and off-medication) and treatment response states were evaluated. Results: According to the International League of Associations for Rheumatology criteria, the subtypes were specified as enthesitis-related arthritis (n=38), oli go articular (n=37), rheumatoid factor (-) polyarticular (n=17), systemic (n=15), rheumatoid factor (+) polyarticular (n=5), and psoriatic juvenile idiopathic arthritis (n=4). In total, the female/male ratio was found to be 1.5. The mean delay time between the first complaint and the diagnosis was found to be 5.7 +/- 5.2 months. The patients with systemic type were diagnosed at the earliest, while the patients with polyarticular and enthesitis-related subtypes were diagnosed at the latest. Thirty-two percent of the patients were treated with methotrexate alone, and 38% were given additional biologic drugs. In both treatment groups, the time to achieve inactive disease was the shortest in the oligoarticular group and the longest in the enthesitis-related arthritis group. In the study period, 38 patients were in remission off-medication (the highest rate (53.3%) was observed in the systemic group) and 71 patients were in remission on-medication (the highest rate (70.2%) was observed in the oligoarticular group). Remission was obtained in 94% of the patients. Conclusion: Enthesitis which is the remarkable finding of enthesitis-related arthritis, should not be overlooked in routine physical examination. Awareness of enthesitis can contribute to the prevention of diagnostic delay in children with enthesitis-related arthritis. C1 [Yener, Gulcin Otar; Tekin, Zahide Ekici; Yuksel, Selcuk] Pamukkale Univ, Dept Pediat, Div Pediat Rheumatol, Fac Med, Denizli, Turkey. [Girisgen, Ilknur; Yuksel, Selcuk] Pamukkale Univ, Dept Pediat, Div Pediat Nephrol, Fac Med, Denizli, Turkey. [Cetin, Ebru Nevin] Pamukkale Univ, Dept Opthalmol, Fac Med, Denizli, Turkey. [Akdag, Beyza] Pamukkale Univ, Dept Biostat, Fac Med, Denizli, Turkey.

Introduction: We aimed to assess whether the vasodilator effect of oral dipyridamole on the left ventricular systolic function in patients with suspected CAD is different from that of intravenous (IV) dipyridamole using Tc-99m MIBI myocardial perfusion gated SPECT. Methods: Eighty-nine patients (17 male, 72 female; 61 +/- 10 years) were enrolled in this study. The patients underwent a dipyridamole stress test for the gating study. Forty-one patients were given oral dipyridamole (OD), and 48 patients were given intravenous dipyridamole (ID). Each group was divided into two subgroups according to whether they had normal or abnormal myocardial perfusion scintigraphy (MPS) findings (reversible perfusion defect). A two-day dipyridamole pharmacologic stress-rest Tc-99m MIBI myocardial perfusion gated SPECT protocol was performed in all patients. The LV ejection fraction (EF), end diastolic volume (EDV) and end systolic volume (ESV) were calculated from the gated data. Results: In the ID group, LV myocardial perfusion was normal in 28 cases and abnormal in 20 cases. In abnormal ID cases, a significant difference between rest and stress EDV was detected (P = 0.017). In the OD group, the LV myocardial perfusion was normal in 20 and abnormal in 21 cases. In the OD normal cases, the rest EF (P = 0.012) and EDV (P = 0.029) were significantly different from the stress cases. Conclusion: The effect of ID test continues during gated SPECT and results in LV diastolic dysfunction in patients with abnormal myocardial perfusion. Oral administration is also highly effective for detecting real myocardial ischemia that causes LV systolic and diastolic dysfunction.

Neural tube defects (NTD) are among the most common congenital abnormalities, with an incidence of 3 per 1000 live births in Turkey. In a study of major congenital abnormalities in the city of Denizli, Turkey, abnormalities of the central nervous system are particularly common (31.1%). The objective of this study was to develop a registry of cases with NTDs in Denizli. Cases that had been diagnosed with NTD between January 2004 and September 2010 in State Hospitals of Central Denizli were retrospectively examined. The diagnoses were established based on the ICD-10 criteria. A total of 250 subjects with NTD were identified, including 123 (49.2%) females and 127 (50.8%) males with a mean age of 13.72 +/- 15.62 years (age range 1-81 years). Interestingly, spina bifida constituted a significant percentage of the cases (149 cases; 59.6%). In addition, 10 (4.0%) cases had hydrocephalus plus spina bifida. The second most common diagnosis was microcephaly, which included 70 cases (28.0%). Encephalocele was observed in only 2 cases (0.8%). Development of NTD is influenced by nutrition, socioeconomic factors, and the use of folic acid during the peri-conceptional period. Studies examining the effect of these factors on NTD in Turkey and a review of primary prevention measures are necessary.

We examined genotoxic damage and frequency of micronuclei in people living in the Bekilli and Suller districts of Denizli city who had been diagnosed with pleural plaques as a result of environmental exposure to asbestos. Peripheral blood samples were obtained from 30 volunteer patients 59-86 years old who did not smoke or consume alcohol and who were diagnosed with calcified pleural plaques. We also examined 30 healthy controls with similar features, who also lived in downtown Denizli. Micronucleus frequencies, nuclear division index, and mitotic index were determined. Micronucleus frequency, nuclear division index, and mitotic index were significantly higher in patients who had been exposed to asbestos than in the controls. We conclude that asbestos had a genotoxic effect, resulting in an increase in micronucleus frequency and other changes in patients diagnosed with pleural plaques secondary to asbestos exposure.

Purpose: To find out how resistin and leptin levels were affected in patients with acromegaly and whether there is a relation between resistin levels and cardiac parameters. We also aimed to investigate whether resistin and leptin may be a link between insulin resistance and cardiac functions as well as these affected cardiac functions in the patients with acromegaly. Methods: We included 30 subjects (15 men and 15 women) who had a diagnosis of acromegaly and 30 healthy (10 men and 20 women) subjects. Serum glucose, insulin, growth hormone, insulinlike growth factor 1 (IGF-1), resistin, and leptin levels were obtained, and insulin resistance of subjects were calculated. Echocardiographic studies of the subjects were performed. Results: Resistin levels of the patients with acromegaly were found lower than controls. This difference was statistically significant (P = 0.001). Leptin levels were lower in the patients with acromegaly than in the controls, but this difference was not statistically significant. Resistin and leptin levels were not correlated with growth hormone, IGF-1, and with insulinlike growth factor binding protein 3 levels. Homeostasis model assessment of insulin resistance was positively correlated with resistin levels. (P = 0.03; r = 0.531) but not correlated with leptin levels. There was a positive correlation between body mass index and leptin levels in the patients with acromegaly (P = 0.007; r = 0.482). Interventricular septum thickness, posterior wall thickness, left ventricle mass index, peak early mitral inflow velocity-peak late mitral inflow velocity ratio, deceleration time, ejection time, isovolumetric relaxation time, velocity propagation, and left ventricular end-systolic volume values were significantly greater in the patients with acromegaly. Leptin levels in the acromegalic patients were not correlated with any of them. Conclusions: We found biventricular hypertrophy and impairment of diastolic and systolic function in the patients with acromegaly. We conclude that changes in resistin and leptin levels are unlikely to account for the insulin resistance of acromegaly. They do not also seem to be contributing factors of cardiovascular changes in patients with acromegaly.

Oral clefts are one of the most common birth defects in humans. However, few population-based studies of these defects have been carried out in Turkey. Our objective was to determine the registries of cases of cleft lip and palate. All cases of cleft lip and palate referred to central state hospitals in Denizli between January 2000 and May 2010 were investigated retrospectively. Anomalies were determined and classified according to the ICD-10 coding system. A total of 194 cases were identified consisting of 92 females (47.4%), 100 males (51.6%), and 2 subjects of undetermined gender (1%) with an age range of 1 to 65 years. Among the 194 cases, 127 subjects (65.5%) had isolated cleft palate, including 63 females and 64 males; 42 (21.6%) subjects had cleft lip, including 17 females and 25 males; and 25 subjects (12.9%) had cleft lip and palate, including 12 females and 13 males. Studies of oral cleft prevalence are insufficient in Turkey owing to the incompleteness of registries, and the chromosome analysis rate has reached a reasonable level only in recent years.

PURPOSE: To find out how resistin and leptin levels were affected in patients with acromegaly and whether there is a relation between resistin levels and cardiac parameters. We also aimed to investigate whether resistin and leptin may be a link between insulin resistance and cardiac functions as well as these affected cardiac functions in the patients with acromegaly. METHODS: We included 30 subjects (15 men and 15 women) who had a diagnosis of acromegaly and 30 healthy (10 men and 20 women) subjects. Serum glucose, insulin, growth hormone, insulinlike growth factor 1 (IGF-1), resistin, and leptin levels were obtained, and insulin resistance of subjects were calculated. Echocardiographic studies of the subjects were performed. RESULTS: Resistin levels of the patients with acromegaly were found lower than controls. This difference was statistically significant (P = 0.001). Leptin levels were lower in the patients with acromegaly than in the controls, but this difference was not statistically significant. Resistin and leptin levels were not correlated with growth hormone, IGF-1, and with insulin-like growth factor binding protein 3 levels. Homeostasis model assessment of insulin resistance was positively correlated with resistin levels. (P = 0.03; r = 0.531) but not correlated with leptin levels. There was a positive correlation between body mass index and leptin levels in the patients with acromegaly (P = 0.007; r = 0.482). Interventricular septum thickness, posterior wall thickness, left ventricle mass index, peak early mitral inflow velocity-peak late mitral inflow velocity ratio, deceleration time, ejection time, isovolumetric relaxation time, velocity propagation, and left ventricular end-systolic volume values were significantly greater in the patients with acromegaly. Leptin levels in the acromegalic patients were not correlated with any of them. CONCLUSIONS: We found biventricular hypertrophy and impairment of diastolic and systolic function in the patients with acromegaly. We conclude that changes in resistin and leptin levels are unlikely to account for the insulin resistance of acromegaly. They do not also seem to be contributing factors of cardiovascular changes in patients with acromegaly.

BACKGROUND: We compared the number of incisions, surgical procedures, hospital duration, and complications in hydatid cyst patients with unilateral or bilateral thoracic involvement and concomitant involvement of the extrathoracic organs. METHODS: A total of 76 hydatid cyst cases surgically treated between the years 2007 and 2012 were divided into three groups according to radiological evidence of other organ involvement and surgical procedures: group 1 had only unilateral thoracic involvement and a single incision; group 2 had additional involvement of the contralateral thoracic side or extrathoracic organs and at most two incisions were performed at the same session; and group 3 had two or more incisions performed at separate sessions in addition to the involvement features of group 2. RESULTS: We had 46 (60.5 %) cases with only thoracic involvement and 30 others (39.5 %) with extrathoracic organ involvement. Complications were seen in only one patient each in the first and second groups, and in 6 patients in the third group. Duration of hospital stay was 7.04 ± 0.86 (5-9) days in group 1.8.33 ± 1.87 (7-13) days in group 2, and 13.95 ± 2.03 (9-18) days in group 3. CONCLUSIONS: Although multiple session surgery is used to decrease the risk of complications, contamination, and infection in multiple or bilateral pulmonary hydatid cyst cases, or in patients with other organ involvement, single-session surgery can be used in selected cases taking into account the operative trauma, financial consequences, and psychological profile.

We compared the number of incisions, surgical procedures, hospital duration, and complications in hydatid cyst patients with unilateral or bilateral thoracic involvement and concomitant involvement of the extrathoracic organs. A total of 76 hydatid cyst cases surgically treated between the years 2007 and 2012 were divided into three groups according to radiological evidence of other organ involvement and surgical procedures: group 1 had only unilateral thoracic involvement and a single incision; group 2 had additional involvement of the contralateral thoracic side or extrathoracic organs and at most two incisions were performed at the same session; and group 3 had two or more incisions performed at separate sessions in addition to the involvement features of group 2. We had 46 (60.5 %) cases with only thoracic involvement and 30 others (39.5 %) with extrathoracic organ involvement. Complications were seen in only one patient each in the first and second groups, and in 6 patients in the third group. Duration of hospital stay was 7.04 +/- A 0.86 (5-9) days in group 1.8.33 +/- A 1.87 (7-13) days in group 2, and 13.95 +/- A 2.03 (9-18) days in group 3. Although multiple session surgery is used to decrease the risk of complications, contamination, and infection in multiple or bilateral pulmonary hydatid cyst cases, or in patients with other organ involvement, single-session surgery can be used in selected cases taking into account the operative trauma, financial consequences, and psychological profile.

Down syndrome (DS) is the most frequent chromosome abnormality among live births. Its prevalence increases with maternal age, and can be diagnosed by antenatal screening. We examined prevalence variations of DS in Denizli, Turkey, through a retrospective study. Sixteen years of survey data were retrieved from the two main state hospital registries from records between 1994 and 2010. We identified 113 DS live births in Denizli for 16 years. The prevalence of DS was 9.07 per 10,000 live births before the year 2000 and 9.90 after 2000. The prevalence did not change significantly. The population in Turkey is still young; the fertility rate is high in women under 35 years old and prenatal screening programs are extensively applied; for these reasons, the prevalence of DS has remained stable during these 16 years.

Background: Low back pain (LBP) is a common disease among people under the age of 20. To the best of our knowledge few studies have been carried out on LBP among school children in Turkey, and none of them studied the correlation between pain intensity and related variables with LBP. Material/Methods: This cross-sectional study was carried out to investigate the risk factors and their correlations with pain intensity among 222 school children (106 girls and 116 boys) aged 10-18 years in the city of Denizli. A self-reported questionnaire was used to collect the data. The regression tree method (RTM) was used to determine the risk factors by using the STATISTICA program package. Pain intensity was the outcome variable, and 8 independent variables (body mass index (BMI), sex, regular exercise habit, studying posture, transportation to/from school, duration of studying, bag handling, and type of bed) were used to detect their effect on pain intensity. Results: The results showed that pain intensity is significantly affected by 4 independent variables: duration of studying, type of bed, transportation to/from school, and BMI. The overall mean and standard deviation of pain intensity was 2.58 +/- 0.86 (minimum = 1, maximum = 5). Conclusions: Results from the literature, as well as our study, show that taking parents' and teachers' concerns seriously is of vital importance. Our results indicate that parents and teachers should be informed about duration of studying, type of bed, transportation and obesity as risk factors predicting NLBP in school children.

This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(298)Asp gene polymorphism and hemorheological parameters. Red blood cell (RBC) deformability, aggregation were measured using an ectacytometry, whole blood, plasma viscosities were determined by a viscometer. Restriction fragment length polymorphism was used to detect polymorphism. Plasma nitrite, nitrate concentrations were determined by Griess method. The genotype distribution of the control group was as follows: 50 (67.5%) GG, 21 (28.4%) GT, 3 (4.1%) TT. A 48 (57.8%) of the patients with CAD had GG, 28 (33.7%) GT, 7 (8.5%) of them TT genotype. RBC aggregation index of CAD patients with G allele was higher and t(1/2) lower compared to controls carrying the same allele. The amplitude of RBC aggregation of healthy subjects with T allele, who are under increased cardiovascular risk was lower compared to control subjects with G allele. The results of this study indicate that, alterations in RBC aggregation seem to be a consequence of CAD, more than being a preexisting cause. Additionally, some compensatory mechanisms by causing decrements in RBC aggregation, may help regulation of circulation in healthy individuals with high cardiovascular risk.

Objective: To determine the proportion of adolescent births in Van, Turkey, and to identify characteristics and related outcomes. Methods: Mothers who gave birth at three maternity centers in Van, Turkey, were chosen randomly and were invited to complete a face-to-face questionnaire. Participants were asked for demographic information and pregnancy history. Pregnancy outcomes were obtained from the birth records. Results: Of 1872 mothers who completed the questionnaires, 211 (11.3%) were younger than 19 years. Adolescent mothers showed significantly more inappropriate education for age (82.5% vs 70.1; P

Aortoiliac occlusive disease is a frequently encountered occlusive arterial disease. Different surgical approaches to the infrarenal abdominal aorta have been reported. We retrospectively studied the postoperative outcomes of patients who were treated for aortoiliac occlusive disease via a retroperitoneal versus a transperitoneal surgical approach.From January 2005 through May 2009, 47 patients underwent surgery at our hospital for the correction of aortoiliac occlusive disease: 30 via a paramedian incision and retroperitoneal approach, and 17 via a midline sternotomy and transperitoneal approach. In the retroperitoneal group, the surgical procedures involved iliofemoral bypass in 15 patients, aortofemoral bypass in 12, aortoiliac bypass in 2, and aortobifemoral bypass in 1. All 17 patients in the transperitoneal group underwent aortobifemoral bypass. The preoperative characteristics and perioperative data of the patients were analyzed. We believe that the retroperitoneal aortoiliac approach with a paramedian incision may be considered as a surgical option for aortoiliac revascularization.

Aortoiliac occlusive disease is a frequently encountered occlusive arterial disease. Different surgical approaches to the infrarenal abdominal aorta have been reported. We retrospectively studied the postoperative outcomes of patients who were treated for aortoiliac occlusive disease via a retroperitoneal versus a transperitoneal surgical approach. From January 2005 through May 2009, 47 patients underwent surgery at our hospital for the correction of aortoiliac occlusive disease: 30 via a paramedian incision and retroperitoneal approach, and 17 via a midline sternotomy and transperitoneal approach. In the retroperitoneal group, the surgical procedures involved iliofemoral bypass in 15 patients, aortofemoral bypass in 72, aortoiliac bypass in 2, and aortobifemoral bypass in 1. All 17 patients in the transperitoneal group underwent aortobifemoral bypass. The preoperative characteristics and perioperative data of the patients were analyzed. We believe that the retroperitoneal aortoiliac approach with a paramedian incision may be considered as a surgical option for aortoiliac revascularization. (Tex Heart Inst J 2010;37(1):70-4)

This study aimed to investigate the relationship between endothelial nitric oxide synthase Glu(298)Asp gene polymorphism and hemorheological parameters. Red blood cell (RBC) deformability, aggregation were measured using an ectacytometry, whole blood, plasma viscosities were determined by a viscometer. Restriction fragment length polymorphism was used to detect polymorphism. Plasma nitrite, nitrate concentrations were determined by Griess method. The genotype distribution of the control group was as follows: 50 (67.5%) GG, 21 (28.4%) GT, 3 (4.1%) TT. A 48 (57.8%) of the patients with CAD had GG, 28 (33.7%) GT, 7 (8.5%) of them TT genotype. RBC aggregation index of CAD patients with G allele was higher and tA1/2 lower compared to controls carrying the same allele. The amplitude of RBC aggregation of healthy subjects with T allele, who are under increased cardiovascular risk was lower compared to control subjects with G allele. The results of this study indicate that, alterations in RBC aggregation seem to be a consequence of CAD, more than being a preexisting cause. Additionally, some compensatory mechanisms by causing decrements in RBC aggregation, may help regulation of circulation in healthy individuals with high cardiovascular risk.

The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-α, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 ± 5.5 years and 33 healthy controls with a mean age of 61.8 ± 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-α, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15 of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p 0.046). CRP and TNF-α were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerve's sensory nerve action potential amplitude was correlated positively with FEV1 (r 0.425; p 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements. © Copyright © 2010 Informa Healthcare USA, Inc.

Objectives: To investigate the relationship between physical functioning, non-physical functioning, and upper extremity functional abilities in patients with multiple sclerosis (MS) and healthy subjects. Methods: A total of 63 patients with MS [Expanded Disability Status Scale (EDSS) score; 3-8] and 52 healthy subjects attending the Pamukkale University, School of Physical Therapy and Rehabilitation in Denizli, Turkey were studied in the period from February 2006 to June 2006. To allow further evaluation, 63 individuals with MS were divided into 2 groups according to their ambulation ability level. The physical functioning was assessed with the Functional Independence Measure (FIM), the Purdue Pegboard Test, and the Jebsen Hand Function Test, and the non-physical functioning was assessed with the Beck Depression Inventory (BDI). Results: Depressive symptoms were significantly elevated in the MS group versus the control group based on the BDI (p

The effects of aging and gender on balance performance (BP) among ambulatory adults were investigated in the current work. If there was a relation between the BP and a history of falling, this was also detected. Two hundred and forty ambulatory subjects were divided into two groups depending on their age: (1) 125 middle-aged subjects (50-64 years); (2) 115 elderly subjects (65-75). The functional reach (FR) test, the timed up and go (TUG) test, the sit to stand (STS) test and the step test (ST) were used to evaluate the BP. The fall rate (1-2 in the last year) was 8% for the middle-aged group and was 13.9% for the elderly group. Middle-aged adults had better scores on all tests in comparison to the elderly people. There have been differences found between genders regarding the BP in both groups, except the FR scores in the middle-aged group. The FR distance of the faller subjects was rather low in comparison to non-faller elderly subjects. However, there were no significant differences between the faller and non-faller subjects in both groups regarding other tests' scores. The results of this study indicate that aging affects the BP year by year. The information in this paper can provide normative data to be used as a comparison to clinically obtained information. (c) 2007 Elsevier Ireland Ltd. All rights reserved.

The effects of aging and gender on balance performance (BP) among ambulatory adults were investigated in the current work. If there was a relation between the BP and a history of falling, this was also detected. Two hundred and forty ambulatory subjects were divided into two groups depending on their age: (1) 125 middle-aged subjects (50-64 years); (2) 115 elderly subjects (65-75). The functional reach (FR) test, the timed up and go (TUG) test, the sit to stand (STS) test and the step test (ST) were used to evaluate the BP. The fall rate (1-2 in the last year) was 8% for the middle-aged group and was 13.9% for the elderly group. Middle-aged adults had better scores on all tests in comparison to the elderly people. There have been differences found between genders regarding the BP in both groups, except the FR scores in the middle-aged group. The FR distance of the faller subjects was rather low in comparison to non-faller elderly subjects. However, there were no significant differences between the faller and non-faller subjects in both groups regarding other tests' scores. The results of this study indicate that aging affects the BP year by year. The information in this paper can provide normative data to be used as a comparison to clinically obtained information.

Objectives: To investigate the relationship between physical functioning, non-physical functioning, and upper extremity functional abilities in patients with multiple sclerosis (MS) and healthy subjects. Methods: A total of 63 patients with MS [Expanded Disability Status Scale (EDSS) score; 3-8] and 52 healthy subjects attending the Pamukkale University, School of Physical Therapy and Rehabilitation in Denizli, Turkey were studied in the period from February 2006 to June 2006. To allow further evaluation, 63 individuals with MS were divided into 2 groups according to their ambulation ability level. The physical functioning was assessed with the Functional Independence Measure (FIM), the Purdue Pegboard Test, and the Jebsen Hand Function Test, and the non-physical functioning was assessed with the Beck Depression Inventory (BDI). Results: Depressive symptoms were significantly elevated in the MS group versus the control group based on the BDI (p

OBJECTIVE: To investigate the relationship between physical functioning, non-physical functioning, and upper extremity functional abilities in patients with multiple sclerosis (MS) and healthy subjects. METHODS: A total of 63 patients with MS [Expanded Disability Status Scale (EDSS) score; 3-8] and 52 healthy subjects attending the Pamukkale University, School of Physical Therapy and Rehabilitation in Denizli, Turkey were studied in the period from February 2006 to June 2006. To allow further evaluation, 63 individuals with MS were divided into 2 groups according to their ambulation ability level. The physical functioning was assessed with the Functional Independence Measure (FIM), the Purdue Pegboard Test, and the Jebsen Hand Function Test, and the non-physical functioning was assessed with the Beck Depression Inventory (BDI). RESULTS: Depressive symptoms were significantly elevated in the MS group versus the control group based on the BDI (p

Objective: Identification of specific origin of lipid accumulation in the liver of patients with non-alcoholic fatty liver disease (NAFLD) is the most important step in preventing this condition. Because liver steatosis, in the obese patients without any systemic disease, can be graded easily by ultrasonography (US), we aimed to demonstrate the degree of liver steatosis and abdominal fat distribution by US, furthermore evaluate biochemical, anthropometrical measurements, and define the possible relationship between these parameters in obese women with different grades of liver steatosis. Methods: In this controlled clinical study, according to US evaluation of liver steatosis, the patients were divided into four groups: control (no steatosis), mild, moderate and severe steatosis groups. Demographic, biochemical and anthropometric measurements were done. Insulin resistance was determined by using homeostasis model assessment (HOMA-IR). Liver steatosis and abdominal fat distributions were evaluated by US. Results: The subcutaneous and preperitoneal fat layer measurements did not show any significant difference between the groups. The visceral fat layer thickness was significantly higher in severe liver steatosis group compared to the control and steatosis groups. The highest serum fasting insulin, uric acid levels and HOMA-IR index were observed in the severe liver steatosis group. Visceral fat thickness was positively correlated with serum UA levels and HOMA-IR Conclusions: This study suggests that visceral adipose tissue, HOMA-IR and serum uric acid levels are the main determinants of NAFLD in obese patients.

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52 +/- 8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p < 0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67 +/- 7.16 cm) than among women (18.77 +/- 6.59 cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging. (C) 2006 Elsevier Ireland Ltd. All rights reserved. C1 Pamukkale Univ, Sch Phys Therapy, TR-20100 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Biostat, TR-20100 Denizli, Turkey.

Background. The tumour suppressor gene product, p16, is often inactivated during melanoma malignant progression. Although the importance of p16 in melanomas is well documented, its relationship with cyclin D1, beta-catenin and ultraviolet radiation (UVR) remains unclear. Aim.To determine the role of these cell cycle-related proteins and high-risk sun exposure in the biological behaviour of melanocytic lesions. Methods.We used immunohistochemistry to examine 28 melanocytic naevi (MN; 9 congenital and 19 acquired types) and 24 primary cutaneous malignant melanomas (CMM; 19 nodular melanomas, 3 lentigo maligna melanomas, 1 acral lentiginous melanoma and 1 superficial spreading melanoma) for the presence of p16, cyclin D1 and beta-catenin. The melanocytic lesions were classified into two groups to examine the effects of UVR on these three proteins: high risk of sun exposure (chronically sun damaged; CSD), or low risk of sun exposure (nonchronically sun damaged; non-CSD). We evaluated the relationship between the production of these proteins and the histopathological and clinical characteristics of the lesions. Results. Production of p16 was repressed in most CMM, but not in MN (P < 0.0001). Cyclin D1 was overproduced in CMM but not in MN, and beta-catenin was frequently overproduced both in MN and CMM. Overproduction of beta-catenin was not common in CSD melanocytic lesions, but was more frequent in non-CSD melanocytic lesions (P = 0.027). Conclusion. An immunohistochemical panel including melanocytic markers enriched by p16 and cyclin D1 could be used to differentiate some borderline melanocytic lesions. In addition, the Wnt/beta-catenin pathway was more frequently activated in non-CSD than in CSD melanocytic lesions. C1 Pamukkale Univ, Sch Med, Dept Pathol, Denizli, Turkey. Pamukkale Univ, Sch Med, Dept Biostat, Denizli, Turkey. State Hosp Denizli, Dept Pathol, Denizli, Turkey. Inst Curie, CNRS, UMR 146, F-75231 Paris, France.

Background. The tumour suppressor gene product, p16, is often inactivated during melanoma malignant progression. Although the importance of p16 in melanomas is well documented, its relationship with cyclin D1, beta-catenin and ultraviolet radiation (UVR) remains unclear. Aim.To determine the role of these cell cycle-related proteins and high-risk sun exposure in the biological behaviour of melanocytic lesions. Methods.We used immunohistochemistry to examine 28 melanocytic naevi (MN; 9 congenital and 19 acquired types) and 24 primary cutaneous malignant melanomas (CMM; 19 nodular melanomas, 3 lentigo maligna melanomas, 1 acral lentiginous melanoma and 1 superficial spreading melanoma) for the presence of p16, cyclin D1 and beta-catenin. The melanocytic lesions were classified into two groups to examine the effects of UVR on these three proteins: high risk of sun exposure (chronically sun damaged; CSD), or low risk of sun exposure (nonchronically sun damaged; non-CSD). We evaluated the relationship between the production of these proteins and the histopathological and clinical characteristics of the lesions. Results. Production of p16 was repressed in most CMM, but not in MN (P < 0.0001). Cyclin D1 was overproduced in CMM but not in MN, and beta-catenin was frequently overproduced both in MN and CMM. Overproduction of beta-catenin was not common in CSD melanocytic lesions, but was more frequent in non-CSD melanocytic lesions (P = 0.027). Conclusion. An immunohistochemical panel including melanocytic markers enriched by p16 and cyclin D1 could be used to differentiate some borderline melanocytic lesions. In addition, the Wnt/beta-catenin pathway was more frequently activated in non-CSD than in CSD melanocytic lesions.

Objective: Identification of specific origin of lipid accumulation in the liver of patients with non-alcoholic fatty liver disease (NAFLD) is the most important step in preventing this condition. Because liver steatosis, in the obese patients without any systemic disease, can be graded easily by ultrasonography (US), we aimed to demonstrate the degree of liver steatosis and abdominal fat distribution by US, furthermore evaluate biochemical, anthropometrical measurements, and define the possible relationship between these parameters in obese women with different grades of liver steatosis. Methods: In this controlled clinical study, according to US evaluation of liver steatosis, the patients were divided into four groups: control (no steatosis), mild, moderate and severe steatosis groups. Demographic, biochemical and anthropometric measurements were done. Insulin resistance was determined by using homeostasis model assessment (HOMA-IR). Liver steatosis and abdominal fat distributions were evaluated by US. Results: The subcutaneous and preperitoneal fat layer measurements did not show any significant difference between the groups. The visceral fat layer thickness was significantly higher in severe liver steatosis group compared to the control and steatosis groups. The highest serum fasting insulin, uric acid levels and HOMA-IR index were observed in the severe liver steatosis group. Visceral fat thickness was positively correlated with serum UA levels and HOMA-IR Conclusions: This study suggests that visceral adipose tissue, HOMA-IR and serum uric acid levels are the main determinants of NAFLD in obese patients. © I. Holzapfel Publishers 2007.

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p

Purpose: The purpose of this study was to assess the educational needs of physicians relating to genetics and genetic counseling in the Denizli region of Turkey. Methods: Data were collected by questionnaire about physicians' approaches to genetics and genetic counseling. Results: A total of 60 (60.0%) of 100 physicians working in Denizli province returned a questionnaire. Physicians described "their most knowledgeable subjects" in basic genetic information as chromosome abnormalities (41.8%), in genetic disorders as xeroderma pigmentosum (80.0%), and in genetic counseling as directing the parents of and couples with a risk for having a child affected by a genetic disease to an expert or a genetic counseling center (94.8%). Only 20.7% knew the ethical regulations and techniques related to genetic counseling. Physicians thought that they did not have sufficient knowledge about genetics or genetic counseling, and 83.9% would like to attend an educational course. Conclusions: As a result of this study, a genetics course is planned for physicians so they can actively participate in the prevention and early diagnosis of genetic diseases.

The purpose of this study was to examine gender differences in older people living at a rest home in terms of functional independence, mental status and mobility level and to describe the relationship among the three outcome variables. One hundred and thirty-three elderly people (60 women, 73 men), aged 65 years and above were included in the study. The average age was 75.3 +/- 6.7 years (range, 65-90 years). Mental status was assessed using the Hodkinson Mental Test (HMT). Functional independence was measured using Functional Independence Measurement (FIM). Mobility level was evaluated using the Rivermead Mobility Index (RMI). Elderly women had lower scores regarding all the outcome variables when compared to older men. The older men had higher cognitive performance than women. In addition, women were at low level of mobility and depended upon the daily living activities (p < 0.05). Both genders showed a significant negative correlation between mental status and functional independence or mobility level, while the correlation between functional independence and mobility level was significantly positive. The data showed that mental impairment decreases both functional status and mobility level of the institutionalized elderly people. Gender difference was found to be an important factor affecting the outcome variables of the study.

BACKGROUND: The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women. METHODS: One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-alpha, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis. RESULTS: There was a positive correlation between serum IL-6 and TNF-alpha (r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) (r = .43; p = .0001), waist circumference (r = .41; p = .0001), and visceral fat layer (r = .33; p = .0001) measurements and HOMA-IR index (r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed (r = .320; p = .0001). TNF-alpha was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters. CONCLUSIONS: There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-alpha levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.

The purpose of this study was to examine gender differences in older people living at a rest home in terms of functional independence, mental status and mobility level and to describe the relationship among the three outcome variables. One hundred and thirty-three elderly people (60 women, 73 men), aged 65 years and above were included in the study. The average age was 75.3 +/- 6.7 years (range, 65-90 years). Mental status was assessed using the Hodkinson Mental Test (HMT). Functional independence was measured using Functional Independence Measurement (FIM). Mobility level was evaluated using the Rivermead Mobility Index (RMI). Elderly women had lower scores regarding all the outcome variables when compared to older men. The older men had higher cognitive performance than women. In addition, women were at low level of mobility and depended upon the daily living activities (p < 0.05). Both genders showed a significant negative correlation between mental status and functional independence or mobility level, while the correlation between functional independence and mobility level was significantly positive. The data showed that mental impairment decreases both functional status and mobility level of the institutionalized elderly people. Gender difference was found to be an important factor affecting the outcome variables of the study. (C) 2005 Elsevier Ireland Ltd. All rights reserved. C1 Pamukkale Univ, Sch Phys Therapy, Eski Saglik Koleji Binasi, TR-20100 Denizli, Turkey. Govt Rest Home & Rehabil Ctr Elderly, TR-20100 Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Biostat, TR-20100 Denizli, Turkey.

All over the world, the increased awareness of the importance of early diagnosis of genetic diseases has given them priority in primary health care. However, more recent surveys indicate that genetics content is still lacking in nursing curricula. This survey aimed to measure the current status of primary care nurses' knowledge about genetics and genetic counseling, and the educational needs of nurses related to human genetics in the Denizli region of Turkey. This area in western Turkey has an 11.7% rate of consanguineous marriages; about 3.5% of the population are hemoglobinopathies carrier and 3.2% are thalassemia carriers. Data were collected on forms that aimed to obtain information about nurses' approaches to genetics and genetic counseling. A total of 86 of 106 nurses working in Denizli province returned the questionnaire (response rate of 81.1%). Phenylketonuria, at 61.5%, and Cooley's anemia, at 60.0%, were identified as the subjects these nurses were most knowledgeable about in terms of genetic disorders. A high percentage of nurses admitted they had insufficient knowledge about the genetic basis of diseases (96.4%), inheritance patterns (98.9%), ethical and legal issues (100.0%), genetic counseling (100.0%), gene testing (95.9%), and genetic engineering (97.9%). About 67% of nurses stated they would like to attend a training course on these subjects. As a result of this study a genetics course is planned for nurses so they can actively participate in the prevention and early diagnosis of genetic diseases.

Background: Physiologic adaptations in an athlete's heart include increased left and right ventricular chamber size, left ventricular wall thickness and mass. Angiotensin-converting enzyme ( ACE) is a key enzyme in angiotensin II production causing cardiac hypertrophy. The cloning of the ACE gene has made it possible to identify a deletion (D)-insertion (I) polymorphism that appears to affect the level of serum ACE activity. Therefore, the ACE genes, which have been shown to be polymorphic, could be candidate genes for large-artery stiffness. Methods: 56 endurance athletes and 46 sedentary subjects were included in this study, and they underwent both complete echocardiographic examination, and analysis of ACE insertion (I) and deletion (D) allele frequencies in peripheral blood. The aortic diameter was recorded by M-mode echocardiography at a level 3 cm above the aortic valve. Aortic systolic diameter was measured at the time of full opening of the aortic valve, and diastolic diameter was measured at the peak of QRS. Aortic strain, stiffness index and distensibility were calculated. Results: Left ventricular mass index and left ventricular ejection fraction were significantly higher in athletes than controls (p < 0.001). The aortic distensibility index and strain were significantly greater in athletes compared with controls (respectively: 5.8 +/- 2.7 vs. 4.7 +/- 1.8 cm(-2) dyn(-1) 10(-6), p = 0.017; 12.3 +/- 2.4 vs. 9.3 +/- 3.1, p < 0.001). The aortic stiffness index was significantly lower in athletes than in controls (4.8 +/- 1.9 vs. 6.1 +/- 2.1, p < 0.001). The aortic distensibility index and strain were statistically different in ACE DD vs. DI groups and DD vs. II groups of athletes. The aortic stiffness index was statistically different in ACE DD vs. II groups of athletes. Aortic parameters were similar according to ACE genotypes in controls. Conclusion: The results of this study indicate that aortic distensibility was increased by prolonged training in endurance athletes, particularly in those with the ACE II genotype. This effect represents an extracardiac adaptation to chronic prolonged training in athletes. Copyright (c) 2005 S. Karger AG, Basel. C1 Pamukkale Univ, Fac Med, Dept Cardiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Physiol, Denizli, Turkey. Pamukkale Univ, Fac Med, Dept Biostat, Denizli, Turkey. Pamukkale Univ, Res Ctr Genet Engn & Biotechnol, Denizli, Turkey.

BACKGROUND: Aerobic exercise enhances endothelium-dependent vasodilation in healthy individuals. It is thought that exercise increases nitric oxide (NO) production and decreases NO inactivation, leading to an increase in NO bioavailability. Angiotensin II and NO have important roles in maintaining vascular tone. There are polymorphisms of the angiotensin converting enzyme (ACE) gene and the presence of the deletion (D) allele has been associated with higher concentrations of circulating and tissue ACE. In this study, the relationship between endothelial function and ACE gene polymorphisms was investigated in athletes and sedentary subjects. METHODS AND RESULTS: The study group comprised 56 endurance athletes and 46 sedentary subjects who underwent brachial artery ultrasonographic examination. ACE insertion (I) and D allele frequencies were analyzed in all patients. Baseline brachial artery diameter and resting blood flow were similar in athletes and controls (p > 0.05). The flow-mediated dilation (FMD) was 8.48+/-3.65% in athletes and 5.16+/-2.5% in controls (p = 0.0001). FMD was significantly different between ACE genotypes in the athletes (p < 0.0001): it was higher in ACE II (10.5+/-1.6%) subjects than in the DI (8.4+/-2.3%) or DD (7+/-1.2%) subgroups. CONCLUSION: Regular isotonic exercise can improve endothelium-dependent vasodilation especially in those with the ACE II genotype.

Background Aerobic exercise enhances endothelium-dependent vasodilation in healthy individuals. It is thought that exercise increases nitric oxide (NO) production and decreases NO inactivation, leading to an increase in NO bioavailability. Angiotensin II and NO have important roles in maintaining vascular tone. There are polymorphisms of the angiotensin converting enzyme (ACE) gene and the presence of the deletion (D) allele has been associated with higher concentrations of circulating and tissue ACE. In this study, the relationship between endothelial function and ACE gene polymorphisms was investigated in athletes and sedentary subjects. Methods and Results The study group comprised 56 endurance athletes and 46 sedentary subjects who underwent brachial artery ultrasonographic examination. ACE insertion (1) and D allele frequencies were analyzed in all patients. Baseline brachial artery diameter and resting blood flow were similar in athletes and controls (p > 0.05). The flow-mediated dilation (FMD) was 8.48 +/- 3.65 % in athletes and 5.16 +/- 2.5 % in controls (p=0.0001). FMD was significantly different between ACE genotypes in the athletes (p < 0.0001): it was higher in ACE It (10.5 +/- 1.6 %) subjects than in the DI (8.4 +/- 2.3 %) or DD (7 +/- 1.2 %) subgroups. Conclusion Regular isotonic exercise can improve endothelium-dependent vasodilation especially in those with the ACE It genotype. C1 Pamukkale Univ, Dept Cardiol, Sch Med, Denizli, Turkey. Pamukkale Univ, Dept Radiol, Sch Med, Denizli, Turkey. Pamukkale Univ, Dept Physiol, Sch Med, Denizli, Turkey. Pamukkale Univ, Res Ctr Genet Engn & Biotechnol, PAMGEN, Denizli, Turkey. Pamukkale Univ, Sch Med, Dept Bioistat, Denizli, Turkey.

For the study 1000 families were interviewed during 1996 in the city of Denizli, which is situated in Western Anatolia and has a population of 79 211 families. The overall rate of consanguinity was 11.7%, with a mean inbreeding coefficient of 0.00873. The principal type of consanguineous marriage recorded was between first cousins, which accounted for 49.6% of all unions. For both sexes, a significant negative association was observed between consanguinity and mean age at marriage and level of education.