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Amaç: Çalışmanın amacı, kronik bel ağrısı tanısı almış sağlık çalışanlarında, kayropraktik manipülasyon ve mulligan mobilizasyon tekniği yöntemlerinin ağrı ve fonksiyonellik üzerine etkinliğini karşılaştırmaktır. Araçlar ve Yöntem: Kronik bel ağrılı, 20-50 yaşları arasındaki (Mulligan grubu 27.70±6.57, Kayropraktik grubu 31.15±8.15) gönüllü 40 birey çalışmaya dahil edilmiştir. Tüm olgular antropometrik olarak değerlendirildikten sonra randomize olarak kayropraktik manipülasyon grubu (KMG) (n:20; 11 kadın, 9 erkek) ve mulligan mobilizasyon grubu (MMG) (n:20; 17 kadın, 3 erkek) olmak üzere 2 gruba ayrılmıştır. Tedavi öncesinde bütün gruplar numerik ağrı skalası (NAS) ve Oswerty bel ağrısı engellilik anketi ile değerlendirilmiştir ve ardından gonyometre ile kalça ve belin normal eklem hareket açıklığına bakılmıştır. Haftada 2 kez, 4 hafta süresince KMG’ye kayropraktik manipülasyon, MMG’ye ise mulligan mobilizasyon tekniği uygulanmıştır. Katılımcılara bu uygulamalar dışında ekstra hiçbir tedavi uygulanmamıştır ve ilave bir aktivite içinde bulunmamalarına özen gösterilmiştir. Bulgular: Tedavi öncesi ve sonrası olmak üzere 2 farklı zaman diliminde yapılan testlerle uygulamaların etkinlikleri karşılaştırılmıştır. Antropometrik ölçüm değerleri açısından gruplar arasında bir farklılık bulunmamıştır (p>0.05). Grup içi analiz sonuçlarında her iki grupta bütün değerlendirme parametrelerinde anlamlı farklılıklar bulunmuş olup olumlu yönde bir iyileşme görülmüştür (p0.05). Sonuç: Kronik bel ağrısı tedavisinde kayropraktik manipülasyon ve mulligan mobilizasyon tekniği yöntemleri arasında başarılı sonuçlar açısından bir üstünlük bulunamamıştır. Kronik bel ağrılı hastalarda her iki yöntemin de uygun koşullara göre kullanımı kabul görülmektedir., Purpose: This study was to compare the effectiveness of chiropractic manipulation and mulligan mobilization on pain and functionality in health care workers diagnosed with chronic low back pain.Material and Methods: Forty volunteers aged 20-50 years (Mulligan group (MMG) 27.70±6.57, chiropractic group (CMG) 31.15± 8.15) who were diagnosed with chronic low back pain were included in the study. All cases were randomly divided into two groups as CMG (n:20; 11 females, 9 males) and MMG (n:20; 17 females, 3 males). All treatment groups were evaluated with a numerical pain scale, Oswestry questionnaire, and goniometer. Chiropractic manipulation was applied to CMG and mulligan mobilization was applied to MMG twice a week for 4 weeks. No extra application has been made other than these treatments. Results: Evaluation was done before and after treatment. There is no difference between groups in terms of anthropometrics. (p>0.05). In-group analysis results showed significant differences in all evaluation parameters in both groups and showed a positive improvement (p0.05). Conclusion: There was no superiority between chiropractic manipulation and mulligan mobilization techniques in terms of successful results in the treatment of chronic low back pain. The use of both methods according to appropriate conditions is accepted in patients with chronic low back pain.

Objective:The aim of this study is to determine the relationship between cervical and lumbar range of motions, pain and postural problems with the time spent in the occupation in dentists.Methods:A total of 56 dentists (27 males, 29 females), participated in this research as a volunteer (age=29.55±9.5 years). Firstly, the participants were divided into 3 groups according to the working years in their life and the time spent at unit during the day; they were also divided into 2 groups according to the intermittent or uninterrupted working conditions during the day. Cervical and lumbar joint range of motions were measured to determine limitations. The McGill pain scale survey was used to evaluate the pain. Kruskal Wallis and Mann-Whitney U tests with a posthoc Bonferroni test were used for all statistical analyses.Results:It was seen that the cervical and lumbar joint range of motions decreased, and the postural deformities in the spine and knee were observed and the level of pain increased significantly in comparatively to the excess of the time spent in the profession. However, in the analysis according to the time spent at the unit during the day, only the decrease in the range of motion of the regions was determined with the increase of the time spent at the unit during the day.Conclusion:With the increase in the working years in the dentists, it was revealed that the limitation of the range of motion increased and posture disorders and pain were formed. It is thought that all these problems will be caused by working in non-ergonomic environments for a long time. In this respect, it is important to include experts in the field of physiotherapy in the courses given under the name of preventive medicine. As a result, it can be said that the health problems encountered with the increase in time spent in the profession have increased.

Kinesio tape and proprioceptive exercises are both used for increasing balance in dancers. The purposes of this study were to: a) determine the acute effect of kinesio tape (KT) application on the ankle joint on balance performance, b) investigate the effects of an 8-week proprioceptive-neuromuscular (PN) training program on balance performance, and c) compare their effects vs modern dance technique classes alone. Thirty-three trained, university-level modern dance students (9 male, 24 female) were divided randomly into three groups: kinesio tape (KT, n=11), proprioceptive-neuromuscular (PN, n=11), or control (n=11). Static (turn-out passé-opened eyes/relevé and turn-out passé-closed eyes/flat foot), semi-dynamic (airplane), and dynamic balance (monopodalic-straight and -transverse in a turn-out passé-eyes opened/flat foot) tests were performed before and after the intervention. One day after pre-tests, KT mechanical correction technique was applied to the left ankle joint (supporting leg) in the KT group, and tests were repeated to determine the acute effect of KT. The PN group participated in an 8-week balance training program (2 days/wk, 60 min/day) involving exercises using stable and unstable surfaces. Significant improvements were observed for all static and dynamic balance tests in the PN group; semi-dynamic airplane and dynamic monopodalic-straight and transverse tests improved in the KT group; and only semi-dynamic airplane test scores changed significantly for the control group (p

Objective High altitude and hypoxic preconditioning have cardioprotective effects by increasing coronary vascularity, reducing post-ischemic injury, and improving cardiac function. Our purpose was to examine if intermittent hypoxia treatment has any restoring effects related to the possible role of the HIF-1/VEGF pathway on diabetic cardiomyopathy. Methods Wistar Albino male rats (n=34) were divided into four groups: control (C), intermittent hypoxia (IH), diabetes mellitus (DM), and diabetes mellitus plus intermittent hypoxia (DM+IH). Following a streptozotocin (STZ) injection (50 mg/kg, i.p.), blood glucose levels of 250 mg/dL and above were considered as DM. IH and DM+IH groups were exposed to hypoxia 6 h/day for 42 days at a pressure corresponding to 3000 m altitude. Twenty-four hours after the IH protocol, hearts were excised. Hematoxylin and eosin-stained apical parts of the left ventricles were evaluated. Hypoxia inducible factor-1 (HIF-1), vascular endothelial growth factor 164 (VEGF164), and VEGF188 polymerase chain reaction products were run in agarose gel electrophoresis. Band density analysis of UV camera images was performed using Image J. The data were compared by one-way ANOVA, repeated measures two-way ANOVA, and the Kruskal-Wallis test. Results The percent weight change was lower in the DM group than in the controls (p=0.004). The tissue injury was the highest in the DM group and the least in the IH group. Diabetes decreased, whereas the IH treatment increased the vascularity. A decrease was observed in the VEGF188 mRNA levels in the DM+IH group compared with the C group, but there were no difference in HIF-1α and VEGF164 mRNA levels between the groups. Conclusion The IH treatment restored the diabetic effects on the heart by reducing tissue injury and increasing the capillarity without transcriptional changes in HIF-1/VEGF correspondingly.

It is important to expose the risk factor in injury in the context of the health and the careers of dancers. Female are at greater risk of developing anemia than men, yet scarce data exist on anemia associated outcomes in female dancers. The aim of the present study was to investigate the relationships between bilateral isokinetic knee extensor and flexor muscles strength, and biochemical hematologic parameters in female modern dancers. Concentric isokinetic peak torque [(PT)-N.m], peak torque % body weight [(PT%BW)-N.m.kg-1], average peak torque [(AVGPT)-N.m] and total work [(TW)-J)] of the knee extensor and flexor muscles were measured at a velocity of 60º, 180º and 300ºs-1. To determine hematological parameters [red blood cell count (RBC), hematocrit (Hct), and Hb] were determined. The dancers of LHG and HHG had significant differences (p ≤ 0.05) for hematological parameters. HHG dancers’ strength production in extensors muscles of PT, TW and AVGPT in non-dominant left leg (p ≤ 0.05) were significantly higher than LHG dancers. There were significant (p ≤ 0.05) negative correlations between TW (300ºs-1) of left leg extensor muscles and RBC, Hct and Hb variables. Isokinetic knee muscular strength is associated with hematologic variables in female modern dancers. The current study provides evidence that the low-level hematologic parameters has decreased performance on torque production of extensors knee muscles in non-dominant leg during isokinetic muscle strength endurance in female modern dancers. This work was supported by the Marmara University Scientific Research Project Committee (project no: SAG-B- 060510-0116).

Spirometric obstruction is a prevalent problem in older adults and related to life-style risk factors. Symptoms related to chronic-obstructive-pulmonary-disease (COPD) are also prevalent symptoms with diverse etiologies - not limited to pulmonary obstruction. Older adults may have unrecognized airway obstruction due to functional limitations or symptoms mis-attributed to age/other co-morbidities. Therefore, spirometric obstruction may clinically be over/under diagnosed. Over last few decades, the burden of smoking-related diseases has increased in older adults. Additional evidence regarding older adults is required. We aimed to study frequency of spirometric obstruction, its over/under diagnosis and tobacco exposure in a group of male nursing-home residents. For spirometric obstruction diagnosis, two different thresholds [(fixed value: 0.70) versus (age-corrected value: 0.65 in residents65 years of age)] were compared for better clinical practice. One hundred and three residents with 71.4 ± 6.3 years-of-age included. Spirometric obstruction prevalences were 39.8 and 29.1% with fixed and age-corrected FEV1/FVC thresholds, respectively. Age-corrected FEV1/FVC threshold underdiagnosed COPD in 1.9% while fixed threshold overdiagnosed spirometric obstruction in 8.7%. Active smokers were 64.1%, ex-smokers 23.3% and non-smokers 12.6%. Our study suggests high prevalences of spirometric obstruction and smoking in male nursing-home residents in Turkey. We suggest the use of age-corrected FEV1/FVC threshold practicing better than the use of fixed FEV1/FVC threshold in this patient group.

Objective: The objective was to determine whether knee osteoarthritis (OA) reduces exercise ambulatory capacity and impairs quality of life (QOL) in obese individuals. Research Methods and Procedures: There were 56 subjects, with and without knee OA, who were obese. The subjects were evaluated with anthropometric measurements, a body composition assessment, maximal cardiopulmonary exercise test, 6-minute walk test (6-MWT), perceived exertion (RPE), self-reported disability [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)], and the Medical Outcomes Study Short Form 36 (SF-36). Results: VO2peak was significantly higher in the controls when compared with the patients (mean ± standard deviation, 1.584 ± 0.23 L/kg per min vs. 0.986 ± 0.20 L/kg per min; p < 0.001). Obese subjects without knee OA walked a significantly longer distance in the 6-MWT than obese patients with knee OA (p < 0.001). We also observed significant negative correlation between Vo2max and RPE, WOMAC pain and physical limitation, and bodily pain and general health domains of short-form 36. Discussion: Knee OA reduces exercise and ambulatory capacity and impairs QOL in obese individuals. RPE, WOMAC pain, and SF-36 items might provide information about exercise capacity in the obese subjects with knee OA. Our study confirms that exercise capacity and QOL might be improved by energetic and intensive treatment of pain resulting from knee OA.

Chronic systemic hypoxia (SH) enhances myocardial ischemic tolerance in mammals. We studied the delayed cardioprotection caused by acute SH and associated signaling mechanism. Conscious adult male mice were exposed to one or two cycles of hypoxia (H; 10% O2) or normoxia (21% O2) for various durations (30 min, 2 h, 4 h) followed by 24 h of reoxygenation. Hearts were isolated 24 h later and subjected to ischemia-reperfusion in a Langendorff model. Infarct size was reduced in mice pretreated with one (H4h) or two cycles (H4hx2) of 4 h SH compared with normoxia mice ( P < 0.05), which was abolished by an inducible nitric oxide synthase (NOS2) inhibitor ( S-methylisothiourea, 3 mg/kg) given before SH or ischemia. H4hx2 also failed to reduce infarct size in NOS2 knockout mice. Cyclooxygenase-2 (COX-2) inhibitor (NS-398, 10 mg/kg) did not block the protection given either before H4hx2 or ischemia. A two- to three fold increase in myocardial NOS2 expression was observed in H4h, H2hx2, and H4hx2 ( P < 0.05), whereas endothelial NOS (NOS3) or COX-2 remained unchanged. We conclude that acute SH induces delayed cardioprotection, which is triggered and mediated by NOS2, but not by NOS3 or COX-2.

SUMMARY A new approacb to platelet functions in beta-thalassemia major In spite of clinical observations that indicate increased frequency of thromboembolic events and autopsy findings in patients with Beta-Thalassemia Major, several studies ali of vvhich were performed in platelet rich plasma samples have reported that response of platelet aggregation to agonists is reduced in these cases. In the present study, responses of platelet aggregation and secretion were examined in the whole blood samples from 21 patients with Beta-Thalassemia Major and 13 age-matched healty individuals using 3 different agonists (collagen, ADP and thrombin). Platelet aggregation that was evaluated as maximal rate of aggregation and maximal extent of aggregation was significantly higher (p

Background: Alterations in platelet function and antioxidant status in children with iron-deficiency anemia (IDA) have been reported previously. The present study was performed to better understand possible interactions between these two systems. Methods: Erythrocyte superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) activity and platelet function were evaluated in 15 children (aged 11/2–15 years) with IDA. The antioxidant enzyme activity was determined spectrophotometrically. Platelet aggregation and secretion studies were performed using impedance and bioluminescence methods, respectively. Ten age-matched healthy children were included as a control group. Results: There were no differences in SOD and CAT activities between patients and controls. However, GSH-Px activity was significantly lower in the iron-deficient children. Platelet aggregation responses to collagen and ADP were also significantly higher in iron-deficient children than in controls. Conclusions: Decreased antioxidant defense in IDA may cause increased oxidant stress, which, in turn, may result in a tendency towards platelet aggregation.

Whole body hyperthermia (WBH) is a distinctive pathophysiological condition with significant impact on tissue metabolism and organ functions. WBH has been investigated as a promising adjunct therapy to the conventional chemo- or radiotherapy for treating certain types of cancer. Numerous studies have shown that WBH is associated with induction of heat shock proteins (HSPs), which in turn modulate cellular survival or death. A brief period of WBH (40-42 degrees C; 15-20 min) can induce delayed protection against lethal endotoxemia as well as various forms of injury in brain, heart, liver, lungs, small intestine, and skeletal muscle. This review article focuses on discussing the WBH-induced myocardial protection against ischemia/reperfusion injury. Most recently, possible involvement of protein kinase C, mitogen-activated protein kinases, nitric oxide, ATP-sensitive potassium channels, and neural peptides in the signal transduction pathways has been demonstrated. On the other hand, whether HSPs or antioxidant enzymes are the primary end-effector of the cardioprotection continues to be a matter of ongoing debates. It has also been recognized that the complex nature of WBH may be the responsible factor for the discordant results among various studies, especially across different animal species or strains, in terms of the time course and potency of WBH-induced cardioprotection. Nevertheless, a better understanding of the WBH-elicited myocardial ischemic resistance may have a wide spectrum of clinical implications as well as insightful inputs into the hyperthermic biology.

The aim of this study was to determine maximal voluntary peak torque (PT), PT% body weight (PT%BW), total work (TW), and hamstring/quadriceps ratio (HQR) for bilateral and unilateral thigh muscle strength during isokinetic muscle contractions in modern dancers in relation to their experience level. METHODS: Twenty-two female dancers were divided into two groups: intermediate dancers (ID, n=11) and advanced dancers (AD, n=11). Strength tests were performed using the Biodex System-III Pro Multijoint System isokinetic dynamometer to determine three joint angular velocities (60, 180, 300°/s). RESULTS: During extension, ADs exhibited higher ratios in the HQR (p=0.016) on right leg at 300°/s, IDs generated greater TW (p=0.042), and within groups, there was a significant left-to-right difference in the HQR at 300°/s for ADs (p=0.042). During flexion, within groups, the ADs exhibited significant differences between legs for both PT (p=0.026) and PT%BW (p=0.022) at 300°/s. CONCLUSION: For both groups, the average HQR in all angular velocities was not within the recommended range, which is required to prevent injuries; at the same time, unilateral muscular imbalances existed. Lower extremities of ADs exhibited asymmetric strength patterns at a certain level. Further research should be done to confirm the findings of this pilot study.

The application of genetics to the understanding of neurology has been highly successful over the past several decades. During the past 10 years, tools were developed to begin genetic investigations into more common disorders such as Alzheimer disease, multiple sclerosis, autism, and Parkinson disease. The era of genomic medicine now has begun and will have an increasing effect on the daily care of common neurologic diseases. Thus it is important for neurologists to have a basic understanding of genomic medicine and how it differs from the traditional clinical genetics of the past. This article provides some basic information about genomic medicine and pharmacogenetics in neurology to help neurologists to begin to adopt these principles into their practice.

Atherosclerosis is a common pathologic condition that is affecting millions of people in their large and small arteries, including the aorta, coronary, and cerebral arteries. Atherosclerotic lesions are characterized by focal thickening of the vascular tunica intima, through the accumulation of fatty deposits, platelets, and leukocytes in the endothelial cell layer, which eventually form the fatty streaks and plaques inside vascular walls. The subsequent ulceration and rupture of plaques could trigger the formation of thrombi that may partially or completely obstruct blood circulation and cause devastating consequences impairing the function and survival of vital organs. Therefore, atherosclerosis represents a distinguished basis of cardiac, cerebral, and peripheral vascular diseases. This chapter is aimed at providing a comprehensive and non-biased overview on the updated evidence of both detrimental and beneficial effects of intermittent hypoxia in the pathological process of atherosclerosis. Collectively, there is a remarkably abundant body of evidence for an atherogenic role played by chronic and severe intermittent hypoxia. On the other hand, a number of studies originated predominantly by Russian/Ukrainian scientists also demonstrated paradoxical anti-atherosclerosis prophylactic and therapeutic effects, which could be elicited by some well-controlled training/conditioning regimens with often mild or moderate levels of intermittent hypoxia. Considering these most updated evidence and divergent points of view, we have further discussed the possible molecular signaling pathways for both detrimental and protective mechanisms of IH. Nevertheless, many seemingly controversial areas require further investigations, which will undoubtedly bring new insights into the fundamental issue of prevention and treatment of atherosclerosis-associated ­cardiovascular diseases.

OBJECTIVE Hypoxia-inducible factor-1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) are involved in signaling mechanisms of cellular responses to hypoxia. These factors have been investigated in tissue samples by simulating different altitudes by changing the percentage of oxygen. We aimed first to evaluate the effect of normobaric, systemic hypoxia (11% O2) on HIF-1α and VEGF mRNA levels in the heart muscle; secondly, to compare the levels of HIF-1α and VEGF mRNA in the left and right ventricle muscles. METHODS In this experimental study, 33 New Zealand male rabbits were assigned to control, acute hypoxia (4 hours) and intermittent hypoxia (4 hours/day for 14 days) groups (n=11/group). Total RNA was isolated from right and left ventricles of the heart. The expressions of HIF-1α and VEGF mRNAs were investigated by using Reverse Transcription Polymerase Chain Reaction (RT-PCR) method. The obtained data were compared by using ANOVA and paired t-test. RESULTS The results indicated that left ventricle VEGF mRNA expressions in both acute and intermittent hypoxia groups (1.08 ± 0.15 and 1.03 ± 0.19, respectively) were higher than that in the control group (0.88 ± 0.15) (p=0.03). Hypoxia treatments did not significantly alter HIF-1α mRNA in both ventricles (p=0.60 and p=0.51 for left and right ventricles, respectively). CONCLUSION Since systemic hypoxia results in induction of VEGF mRNA up-regulation only in left ventricle, it could be related to its higher metabolic activity and oxygen utilization. Hypoxia induced changes in the expression of HIF-1α mRNA may not be the only determining factor for HIF-1/VEGF pathway induction or the observed VEGF induction could be through other hypoxia sensitive pathways.

We determined the role of p38 mitogen-activated protein kinase (MAPK), 72-kDa heat shock protein (HSP72), and antioxidant enzymes in whole body heat stress (HS)-induced cardioprotection in mouse hearts. Adult male mice were treated with either HS or anesthesia only. At 0.5, 48, 72, or 120 h later, the hearts were subjected to 20 min of global ischemia and 30 min of reperfusion in Langendorff mode. A significant protection against ischemia-reperfusion injury was observed 48 h after HS as demonstrated by: 1) reduction in infarct size; 2) decrease in leakage of lactate dehydrogenase; and 3) enhanced postischemic ventricular contractile function. No such protection was observed at other post-HS time points. HS caused an ∼25% increase in phosphorylated c-Jun NH2-terminal kinase (JNK) but not p38 MAPK in the heart during the first 2-h post-HS time period. Cardioprotection was abolished by the MAPK inhibitor SB-203580, which also partially suppressed the HS-induced JNK phosphorylation. The protective effect was associated with a two- to threefold increase in HSP72 protein accumulation, but not antioxidant enzyme activities (catalase and Cu/Zn and Mn SOD) in the myocardium. Although HSP72 levels remained high 72 h after HS, the cardioprotection had already disappeared. We conclude that HS induces a transient delayed cardioprotection at 48 h after thermal stress in mice which appears to be mediated via a MAPK-signaling pathway.

Asthma is a disease characterized by chronic airway inflammation. Generation of oxygen free radicals by activated inflammatory cells produces many of the pathophysiologic changes associated with asthma and may contribute to its pathogenesis. However, the activities of antioxidant enzymes and their relation with asthma have not been well defined. This study was performed to examine the activities of major intracellular antioxidants in mild asthmatic patients. Twelve asymptomatic mild asthmatic patients who never used any antiasthma medication and 13 age- and sex-matched healthy control subjects were selected. The activities of erythrocyte antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT), and glutathione-peroxidase (GSH-Px) were measured spectrophotometrically. The mean SOD activity of asthmatic patients was found to be significantly lower than that of the controls (p0.05). There was no significant difference in CAT and GSH-Px activities between patients and controls (p0.05). Although the mechanisms underlying the association between asthma and antioxidant system are unclear, according to our findings, decreased antioxidant protection may contribute to the pathogenesis of mild asthma.

Downsizing is a process whereby human relations manage ment emerges as a critical skill in its effective management. This pa per is about perceptions of employees of a small-sized Turkish firm who survived successive downsizing decisions. It was found that downsizing affected the organizational justice-related perceptions of survivors. The questionnaire used to explore organizational justice-related perceptions involved three dimensions and was developed by Saunders and Thornhill (1999). Procedural, interactional and distributive justice-related percep tions of survivors were influenced by the way management handled the process. Management credibility, communication and commitment were other variables studied. The findings supported the view that downsizing not only affects the victims but also the survivors.