Sarcopenia, frailty prevalence, and related factors in patients with stroke: A cross-sectional analytical study from Turkey.

BACKGROUND: Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. OBJECTIVE: To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. METHODS: This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test (4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. RESULTS: The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n= 9). In the sarcopenic group, female sex (p= 0.005) was more frequent, 4-MWT was longer (p= 0.003), chair stand test results were lower (p< 0.001), the clinical frailty scale (CFS) was higher (p< 0.001), fall risk was higher compared with the BBS (p< 0.001), there was lower HG strength (p= 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p< 0.001), and lower lymphocyte counts (p= 0.037). EAT-10 scores and dysphagia presence (p= 0.026), the presence of malnutrition (p< 0.021) and Nottingham Health Profile score (p< 0.001) were higher in the sarcopenic group. CONCLUSION: Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life.

Evaluation of visual reaction time in patients with fibromyalgia syndrome.

Fibromyalgia syndrome (FMS) has previously been linked to cognitive dysfunction. The aim of this study was to compare visual reaction time (RT) between FMS patients and healthy subjects. The relationship was examined between RT and clinical parameters in FMS patients, and it was aimed to evaluate the effect of drugs used in the treatment of FMS on RT. A total of 112 FMS patients and 110 healthy volunteers were included in this cross-sectional research. Cognitive performance was evaluated with visual RT measurements. FMS patients were assessed using the Fibromyalgia impact questionnaire (FIQ), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS) and Pittsburgh Sleep Quality Index (PSQI). The drugs used in the treatment of FMS were recorded. Significantly prolonged visual RT measurements were detected in FMS patients (p < 0.001). There was no significant difference in RT measurements between the patients who did not use drugs and those who were treated with serotonin noradrenaline reuptake inhibitor, gabapentinoid and combination therapy (p > 0.05). RT was significantly correlated with FIQ, BDI and PSQI scores in FMS patients (rho: 0.290, p = 0.002 for FIQ; rho: 0.253, p = 0.007 for BDI and rho: 0.312, p = 0.001 for PSQI). No significant correlation was detected between RT scores and FSS values (p > 0.05). Visual RT measurements were seen to be deteriorated in FMS patients. As the disease severity, depression level, and sleep disturbance increased, so the impairment in visual RT values became more prominent. The drugs used in the FMS treatment did not influence the RT scores. Cognitive performance tests should be incorporated in the physical examination and follow-up courses of FMS patients.

Assessment of retinal nerve fiber thickness and optic nerve head blood flow in female patients diagnosed with fibromyalgia syndrome / Avaliação da espessura da camada de fibras nervosas da retina e fluxo sanguíneo da cabeça do nervo óptico em pacientes do sexo feminino com diagnóstico de síndrome de fibromialgia

ABSTRACT Purpose: Numerous neuroimaging and ophthalmic studies suggest optic nerve involvement in fi­bromyalgia syndrome. To further elucidate the etiopathogenesis of fibromyalgia syndrome, we compared optic nerve head blood flow area and retinal nerve fiber layer thickness between patients and controls and investigated the associations of these measures with fibromyalgia syndrome severity. Methods: Participants were divided into the following three groups according to Fibromyalgia Impact Questionnaire score: mild-moderate fibromyalgia syndrome (Group 1, n=47), severe fibromyalgia syndrome (Group 2, n=38), and healthy controls (Group 3, n=38). The optic nerve head blood flow area and retinal nerve fiber layer thickness were measured by optical coherence tomography angiography and compared among groups by ANOVA. Associations with fibromyalgia syndrome severity were evaluated by Spearman's correlation analysis. Results: Optic nerve head blood flow area did not differ between fibromyalgia syndrome Groups 1 and 2 (1.61 ± 0.08 vs.1.63 ± 0.09 mm2), but it was significantly lower in control Group 3 (1.49 ± 0.10 mm2, all p=0.001). Average retinal nerve fiber layer thickness values were significantly lower in Group 2 (101.18 ± 6.03 mm) than in Group 1 (103.21 ± 10.66 mm) and Group 3 (106.51 ± 8.88 mm) (p=0.041 and 0.020, respectively). The inferotemporal (134.36 ± 12.19 mm) and inferonasal (109.47 ± 16.03 mm) quadrant retinal nerve fiber layer thickness values were significantly lower in Group 2 than in Group 1 [inferotemporal (142.15 ± 17.79 mm), inferonasal (117.94 ± 20.53 mm)] and Group 3 [inferotemporal (144.70 ± 16.25 mm), inferonasal (118.63 ± 19.01 mm)] [inferotemporal, p=0.017 and 0.010, respectively; inferonasal, p=0.047 and 0.045, respectively]. The nasal-superior quadrant retinal nerve fiber layer thickness value was higher in Group 3 (91.08 ± 12.11 mm) than in Group 1 (84.34 ± 13.09 mm) and Group 2 (85.26 ± 13.11 mm) (p=0.031 and 0.038, respectively). A weak correlation was detected between disease severity and optic nerve head blood flow area. Conclusion: Neural and vascular structures of the eye are altered in fibromyalgia syndrome, particularly among severe cases. Therefore, optical coherence tomography angiography may provide valuable information for the diagnosis and elucidation of fibromyalgia syndrome pathophysiology.

RESUMO Objetivo: Numerosos estudos de neuroimagem e oftalmologia sugerem o acometimento do nervo óptico na síndrome de fibromialgia. Para esclarecer a etiopatogenia da síndrome de fibromialgia, comparamos a área de fluxo sanguíneo da cabeça do nervo óptico e a espessura da camada de fibras nervosas da retina entre pacientes e o grupo controle, e examinamos as associações dessas medidas com a severidade da síndrome de fibromialgia. Métodos: Os participantes foram divididos em três grupos de acordo com a pontuação no Questionário de Impacto da Fibromialgia: síndrome de fibromialgia leve a moderada (Grupo 1, n=47), síndrome de fibromialgia grave (Grupo 2, n=38) e controles saudáveis (Grupo 3, n=38). A área de fluxo sanguíneo da cabeça do nervo óptico e a espessura da camada de fibras nervosas da retina foram medidas por angiotomografia de coerência óptica e comparadas entre os grupos por ANOVA. As associações com a severidade da síndrome de fibromialgia foram avaliadas pela análise de correlação de Spearman. Resultados: A área de fluxo sanguíneo da cabeça do nervo óptico não diferiu entre os Grupos 1 e 2 da síndrome de fibromialgia (1,61 ± 0,08 contra 1,63 ± 0,09 mm2), mas foi significativamente menor no Grupo 3, de controle (1,49 ± 0,10 mm2, todos com p=0,001). Os valores médios da espessura da camada de fibras nervosas da retina foram significativamente menores no Grupo 2 (101,18 ± 6,03 mm) em comparação com o Grupo 1 (103,21 ± 10,66 mm) e o Grupo 3 (106,51 ± 8,88 mm) (p=0,041, p=0,020). Os valores da espessura da camada de fibras nervosas no quadrante inferotemporal (134,36 ± 12,19 mm) e inferonasal (109,47 ± 16,03 mm) foram significativamente menores no Grupo 2 em comparação com o Grupo 1 (inferotemporal 142,15 ± 17,79 mm, inferonasal 117,94 ± 20,53 mm) e o Grupo 3 (inferotemporal 144,70 ± 16,25 mm, inferonasal 118,63 ± 19,01 mm) Para o quadrante inferotemporal, foram obtidos p=0,017 e p=0,010 para o Grupo 2 em comparação respectivamente com os Grupos 1 e 3, e para o quadrante inferonasal, p=0,047 e p=0,045, respectivamente para os mesmos grupos. A espessura da camada de fibra nervosa da retina no quadrante nasal superior foi maior no Grupo 3 (91,08 ± 12,11 mm) que no Grupo 1 (84,34 ± 13,09 mm) e no Grupo 2 (85,26 ± 13,11 mm); p=0,031 e p=0,038. Houve uma correlação fraca entre a severidade da doença e a área de fluxo sanguíneo na cabeça do nervo óptico. Conclusão: As estruturas neurais e vasculares do olho estão alteradas na síndrome da fibromialgia, principalmente nos casos graves. Assim, a angiografia por tomografia de coerência óptica pode fornecer informações valiosas para o diagnóstico e elucidação da fisiopatologia da síndrome de fibromialgia.

The relationship between cervical proprioception and balance in patients with fibromyalgia syndrome.

Proprioceptive abnormalities, balance, and postural disorders have been previously reported in fibromyalgia syndrome (FMS). Unlike previous research, the aim of this study was to compare the proprioception of the cervical region of patients with FMS with a healthy control group. The relationship between cervical proprioception impairment and loss of balance was also examined. A total of 96 female FMS patients and 96 female healthy control subjects were enrolled in this case-control study. The cervical joint position error test (CJPET) was administered to the patient and control groups for cervical proprioception evaluation. FMS patients were assessed with a visual analogue scale (VAS), fibromyalgia impact questionnaire (FIQ), and fatigue severity scale (FSS). Balance tests were applied to both groups. FMS patients had significantly impaired CJPET results in all directions (p < 0.001). There were significant positive correlations between FIQ scores and CJPET results (r = 0.542 and p < 0.001 for right rotation; r = 0.604 and p < 0.001 for left rotation; r = 0.550 and p < 0.001 for flexion; r = 0.612 and p < 0.001 for extension). Significant correlations were found between CJPET measurements and balance tests (for sit-to-stand test; r = 0.510 and p < 0.001 for right rotation; r = 0.431 and p < 0.001 for left rotation; r = 0.490 and p < 0.001 for flexion; r = 0.545 and p < 0.001 for extension), (for timed up and go test; r = 0.469 and p < 0.001 for right rotation; r = 0.378 and p < 0.001 for left rotation; r = 0.410 and p < 0.001 for flexion; r = 0.496 and p < 0.001 for extension) and (for one-legged balance test; r = -0.479 and p < 0.001 for right rotation; r = -0.365 and p < 0.001 for left rotation; r = -0.392 and p < 0.001 for flexion; r = -0.469 and p < 0.001 for extension). Cervical proprioception and balance were impaired in FMS patients. As the disease activity and fatigue level increased, so the deterioration in cervical proprioception became more evident. There were correlations that demonstrated an association between impaired cervical proprioception and poor balance tests. Therefore, proprioception and balance assessments should be integrated into the physical examination processes of FMS patients.

Assessment of retinal nerve fiber thickness and optic nerve head blood flow in female patients diagnosed with fibromyalgia syndrome.

PURPOSE: Numerous neuroimaging and ophthalmic studies suggest optic nerve involvement in fi-bromyalgia syndrome. To further elucidate the etiopathogenesis of fibromyalgia syndrome, we compared optic nerve head blood flow area and retinal nerve fiber layer thickness between patients and controls and investigated the associations of these measures with fibromyalgia syndrome severity. METHODS: Participants were divided into the following three groups according to Fibromyalgia Impact Questionnaire score: mild-moderate fibromyalgia syndrome (Group 1, n=47), severe fibromyalgia syndrome (Group 2, n=38), and healthy controls (Group 3, n=38). The optic nerve head blood flow area and retinal nerve fiber layer thickness were measured by optical coherence tomography angiography and compared among groups by ANOVA. Associations with fibromyalgia syndrome severity were evaluated by Spearman's correlation analysis. RESULTS: Optic nerve head blood flow area did not differ between fibromyalgia syndrome Groups 1 and 2 (1.61 ± 0.08 vs.1.63 ± 0.09 mm2), but it was significantly lower in control Group 3 (1.49 ± 0.10 mm2, all p=0.001). Average retinal nerve fiber layer thickness values were significantly lower in Group 2 (101.18 ± 6.03 mm) than in Group 1 (103.21 ± 10.66 mm) and Group 3 (106.51 ± 8.88 mm) (p=0.041 and 0.020, respectively). The inferotemporal (134.36 ± 12.19 mm) and inferonasal (109.47 ± 16.03 mm) quadrant retinal nerve fiber layer thickness values were significantly lower in Group 2 than in Group 1 [inferotemporal (142.15 ± 17.79 mm), inferonasal (117.94 ± 20.53 mm)] and Group 3 [inferotemporal (144.70 ± 16.25 mm), inferonasal (118.63 ± 19.01 mm)] [inferotemporal, p=0.017 and 0.010, respectively; inferonasal, p=0.047 and 0.045, respectively]. The nasal-superior quadrant retinal nerve fiber layer thickness value was higher in Group 3 (91.08 ± 12.11 mm) than in Group 1 (84.34 ± 13.09 mm) and Group 2 (85.26 ± 13.11 mm) (p=0.031 and 0.038, respectively). A weak correlation was detected between disease severity and optic nerve head blood flow area. CONCLUSION: Neural and vascular structures of the eye are altered in fibromyalgia syndrome, particularly among severe cases. Therefore, optical coherence tomography angiography may provide valuable information for the diagnosis and elucidation of fibromyalgia syndrome pathophysiology.

The relationship between disease severity and defense mechanisms in fibromyalgia syndrome.

OBJECTIVES: The aim of the present study was to investigate the possible relationship between the disease severity and defense mechanisms in fibromyalgia syndrome (FMS) and to contribute to the clarification of the etiopathogenesis of FMS. PATIENTS AND METHODS: A total of 103 female patients (mean age: 42.6±10.0 years; range, 20 to 67 years) diagnosed with primary FMS based on the 2016 revised American College of Rheumatology (ACR) diagnostic criteria and without any psychiatric diagnosis were included in the study. A semi-structured sociodemographic and clinical data form was used. The Fibromyalgia Impact Questionnaire (FIQ), Defense Style Questionnaire-40 (DSQ-40), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to all patients. Based on the FIQ scores, the patients were divided into two groups as mild-moderate (<70) and severe (≥70) FMS groups. RESULTS: There were 56 patients in the mild-moderate FMS group and 47 patients in the severe FMS group. As FIQ scores increased, sublimation (r=-0.204, p=0.030) and mature factor (r=-0.229, p=0.020) scores decreased, and projection (r=0.210, p=0.033) and somatization (r=0.287, p=0.003) scores increased. Pseudoaltruism (p=0.043), displacement (p=0.026), and somatization (p=0.021) scores were higher in the severe FMS group. The BDI and BAI scores were also higher in the severe FMS group, compared to the mild-moderate FMS group (p=0.001 and p=0.002, respectively). CONCLUSION: Our study results show that there is a significant correlation between the increased disease severity, decreased mature defense mechanisms, and increased immature defense mechanisms in FMS patients.

Subclinical cardiac structural and electrical abnormalities in fibromyalgia syndrome

Background/aim: In the literature, there is a paucity of data about the effects of fibromyalgia syndrome (FMS) on myocardial function and electrophysiological properties of atrium and ventricles. In this study, we investigated cardiac functions and noninvasive predictors of arrhythmias in patients with FMS. Materials and methods: The study included 43 female patients diagnosed with FMS and 30 age- and sex-matched healthy subjects. The presence of fragmented QRS (fQRS) morphology, P dispersion, QT dispersion, inter- and intraatrial electromechanical delay was evaluated in the groups with 12-lead ECG and standard and tissue Doppler echocardiography. Results: Among electrocardiographic parameters, P dispersion, QT dispersion, and the ratio of presence of fQRS morphology were found to be significantly higher in the study group as compared to the control group. In lateral and septal, the ratio of the early transmitral flow velocity to the early diastolic tissue velocity (E/Em) was significantly higher in the study group. Additionally, intra- and interatrial electromechanical delay was found significantly prolonged in the study group. Conclusion: FMS is found to be associated with significant cardiac electrical alterations that may indicate the increased risk of atrial and ventricular arrhythmias in this group of patients.

Relationship of leptin, growth hormone, and insulin-like growth factor levels with body mass index and disease severity in patients with fibromyalgia syndrome.

OBJECTIVE: A high prevalence of obesity in fibromyalgia syndrome (FMS) predisposes patients to metabolic changes. It is not clear how the clinical manifestations of the disease affect metabolism. This study aimed to investigate leptin, growth hormone (GH), and insulin-like growth factor (IGF-1) levels in FMS, and their relationship with body mass index (BMI) and disease severity. METHOD: This case-control study included 60 patients with FMS and 42 age- and sex-matched healthy controls. BMIs were recorded for all participants. The disease severity was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and a visual analog scale (VAS). The serum levels of leptin, GH, and IGF-1 of all participants were measured using specific enzyme-linked immunosorbent assays. RESULTS: Both groups had similar age (p = 0.058), sex (p = 0.25), and BMI (p = 0.29) distribution. The mean age of the FMS and the control groups was 40.7 ± 10.8 years and 36.2 ± 13.6 years, respectively. The mean BMI was 26.7 kg/m2 in the FMS group. The GH (p = 0.037) and IGF-1 (p = 0.002) levels were statistically lower, and leptin (p = 0.002) levels were considerably higher in the FMS group than in the control group. The leptin values were positively correlated with age (p = 0.001; r = 0.386) and BMI (p < 0.001; r = 445). Insulin-like growth factor levels were negatively correlated with age (p < 0.001; r = - 0.605) and BMI (p < 0.001; r = - 0.564). Similarly, GH levels were negatively correlated with age (p = 0.040; r = - 0.243) and BMI (p < 0.001; p = - 0.420). None of the three hormones were associated with FIQ and VAS. CONCLUSION: We found that leptin (high), GH (low), and IGF-1 (low) levels were statistically different, together with being independent of disease severity (FIQ, VAS), and correlated with BMI in the FMS group. These findings may be related with hypothalamo-pituitary axis dysfunction, BMI, and energy metabolism.

The Acute Effects of High-Intensity Cycling Exercise on Arterial Stiffness in Adolescent Wrestlers.

The aim of this study was to determine the acute effects of high-intensity cycling exercise on the variables of carotid artery compliance, distensibility and beta stiffness index in elite adolescent wrestlers. The subjects were elite athletes competing in national, European and World Championships, who attended a training camp in the province of Kahramanmaras organized by the Turkish Centre for Olympic Preparation. The study sample comprised 31 male elite wrestlers with a mean age of 15.90 ± 0.87 years, body height of 165.97 ± 9.7 cm and body mass of 66.3 ± 18.45 kg. The arterial stiffness variables of the wrestlers were measured with high-resolution Doppler ultrasonography before and 5 min after 30 s of high-intensity cycling exercise (the Wingate Anaerobic Cycling test). The results showed a statistically significant correlation between mean power performance and carotid artery compliance at the 5th min after a single cycling sprint exercise (p < 0.05). No correlation was determined between peak power and the arterial stiffness variables (p > 0.05). The study results indicate that acute changes in arterial stiffness variables are associated with the performance level of high-intensity cycling exercise in a group of elite adolescent wrestlers.

Evaluation of the relationship between osteoporosis, balance, fall risk, and audiological parameters.

The aim of the study is to investigate the factors such as balance and audiology parameters and bone mineral density (BMD), which were thought to be associated with the increased risk of fall in osteoporotic patients. Ninety-nine female patients between the ages of 40 and 75 were included in the study. Noise exposure, tinnitus, and vertigo were investigated. BMD measurement, Berg Balance Scale (BBS), Timed Up and Go (TUG), and stabilometry tests were applied to the patients. Patients were divided into three groups according to BMD measurements. Patients with a T score of - 1 and below were considered normal (control) (group 1), those with a T score of - 1 to - 2.5 were considered osteopenic (group 2), and those with a T score of - 2.5 and above were considered osteoporotic (OP) (group 3). BBS was 42.06 ± 5.00, 47.74 ± 5.18, and 51.65 ± 3.64 in groups1, 2, and 3, respectively. The difference between the groups was statistically significant (p = 0.001). OP patients had higher oscillation values in all measurements compared with the control group. However, the difference was statistically significant especially on mobile platforms (p < 0.05). Mean tones of pure tone thresholds at 500-8000 Hz for ears were significantly different in patients with OP compared with controls (p < 0.05 for 500-2000 Hz, p < 0.01 for 4000-8000 Hz). This study demonstrated that BMD reduction was correlated with balance parameters and audiological measurements. Therefore, it can be concluded that OP may affect the risk of fracture occurrence not only by decreasing BMD but also by increasing the risk of falling. KEY POINTS: • In the present study, the effects of balance and audiology parameter measurements on osteoporosis (OP) were investigated. In addition, the associations between vertigo, tinnitus, history of falling, body made index, vitamin D, and calcium values and osteoporosis were evaluated. • We determined that bone mineral density (BMD) reduction was related to balance and audiological parameters. It can be speculated that OP may affect the risk of fracture occurrence not only by decreasing BMD but also by increasing the risk of falling. We think that early diagnosis, appropriate treatment, and rehabilitation of hearing loss and OP may decrease the incidence of falling and improve the quality of life of the affected individuals.

YouTube as a source of patient information for ankylosing spondylitis exercises.

INTRODUCTION/OBJECTIVES: Ankylosing spondylitis (AS) is a rheumatic disorder characterized by structural impairments and postural deformities which restrict daily life activities. Nonpharmacologic methods, particularly exercise therapies, play a key role in the treatment. Obtaining online health-related information has become increasingly popular. We aimed to assess the quality of the most viewed YouTube videos on AS exercises. METHOD: We searched for the key words "ankylosing spondylitis exercise," "ankylosing spondylitis rehabilitation," "ankylosing spondylitis physical therapy," and "ankylosing spondylitis physiotherapy" on YouTube on October 10th, 2018. The educational quality of YouTube videos was evaluated according to the Global Quality Scale, and three groups were formed: high quality, intermediate, and low quality. Video parameters were compared between the groups. RESULTS: Of the 56 videos evaluated, 48.2% (n = 27) were of high quality, 17.9% (n = 10) were of intermediate quality, and 33.9% (n = 19) were of low quality. When video parameters compared among the groups, no significant differences were found in the number of views per day, likes per day, and comments per day (p > 0.05). Significant differences were found in the number of dislikes per day and DISCERN scores between the groups (p = 0.02, p < 0.001, respectively). CONCLUSIONS: YouTube can be considered as an important source of high-quality videos. Nearly half of the videos were of high quality. Physicians should inform patients about the importance of video resources during the use of YouTube and should guide patients to the accurate sources of information.

The Importance of G-protein Coupled Estrogen Receptor in Patients With Fibromyalgia.

OBJECTIVES: This study aims to analyze the G-protein coupled estrogen receptor (GPER/GPR30) activity in patients with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: We enrolled 40 female patients with FMS (mean age 42.9±11.2 years; range, 18 to 64 years) diagnosed according to the 2010 American College of Rheumatology classification criteria and 30 age- and body mass index-matched female healthy controls (mean age 43.7±13.6 years; range, 19 to 64 years). Sex hormones of patients (morning) including estradiol, follicle stimulating hormone, luteinizing hormone, and prolactin (PRL) were recorded. FMS severity was assessed by Fibromyalgia Impact Questionnaire (FIQ). Serum GPER levels were measured by using a quantitative sandwich enzyme-linked immunosorbent assay method with a commercial kit. RESULTS: G-protein coupled estrogen receptor levels were 0.11 (0.02-0.9) ng/mL in the FMS patients and 0.059 (0.01-0.13) ng/mL in controls, with a statistically significant difference (p=0.037). GPER levels were positively correlated with age and negatively correlated with PRL, while they were not correlated with FIQ. Differential diagnosis for FMS with receiver operating characteristic (ROC) analysis for the serum GPER levels was statistically significant (area under the ROC curve: 0.653, confidence interval: 0.522-0.785, p=0.029). High values indicated FMS, with a threshold of >0.075, sensitivity of 60%, and specificity of 60%. CONCLUSION: The GPER levels of FMS patients were higher than those of the controls. Thus, GPER levels may be considered as a biomarker in the diagnosis of FMS independent of disease severity.

Comparison of vascular arterial stiffness parameters of adolescent wrestlers with healthy subjects: Is heavy training harmful for wrestlers?

BACKROUND: The effect of different exercise modalities on the vascular structure has been the subject of clinical trials but there is not enough data about wrestlers. OBJECTIVE: This study aimed to compare the arterial stiffness parameters in adolescent wrestlers with those of age-matched sedentary controls to show the effects of long and heavy training. METHODS: This study was carried out as a case-control study. Thirty three (N= 33) elite male adolescent wrestlers (12-18 years) and 35 age and sex-matched control subjects (P= 0.438) with a sedentary lifestyle were included the study. The data was obtained by using sonography and a sphygmomanometer. Systolic and diastolic diameters and intima media thickness (IMT) measurements were performed from the carotid arteries of the subjects. The arterial tension was measured in the same session, and arterial stiffness parameters were calculated using specific formulas. RESULTS: The mean age range was 15.9 ± 0.9 years and 16.0 ± 0.8 years for the wrestlers and control subjects, respectively (P= 0.43). Statistically, the Body Mass Index (BMI) was significantly higher in wrestlers (mean = 23.7 ± 4.0 kg/m2; P= 0.00). The groups had no difference in height (P= 0.80) and weight (P= 0.05). The systolic blood pressure (SBP) was significantly higher in wrestlers (mean = 120 ± 13.4 mmHg; P= 0.00); the pulse was significantly lower in wrestlers (mean = 69.61 ± 17.2 beats/min; P= 0.00); the IMT was significantly lower in wrestlers (IMT mean = 0.288 ± 0.1 mm; P= 0.01); the diastolic wall stress (DWS) was significantly higher in wrestlers (DWS mean = 933.64 ± 298.0 mmHg; P= 0.03) than controls. No significant differences were found in the elastic modulus (P= 0.11), compliance (P= 0.86), and distensibility (P= 0.86) parameters between the groups. CONCLUSION: Bradycardia is an expected condition for athletes. SBP and DWS were found to be high in wrestlers, suggesting that arterial tissue is more susceptible to stress. The low IMT indicates the protective effect of regular exercise against atherosclerosis. It is known that regular exercise is good for the vascular structure while heavy exercise puts a load on the vascular structure. The fact that the elastic modulus, compliance, and distensibility do not differ between the groups suggests that structural changes in the adolescents have no effect on the vascular wall.

Comparison of Lumbosacral Alignment in Geriatric and Non-Geriatric patients suffering low back pain.

OBJECTIVE: Lumbosacral alignment is a crucial factor for an appropriate spinal function. Changes in spinal alignment lead to diminished body biomechanics. Additionally, lumbosacral alignment may affect quality of life, sagittal balance and fall risk in elderly. In this study, we aimed to compare lumbosacral alignment in geriatric and non-geriatric patients suffering from low back pain. METHODS: A total of 202 (120 male and 82 female) patients who visited to physical medicine and rehabilitation clinic with low back pain between January 2017 and August 2017 were enrolled in this study. Standing lateral lumbar radiographs were obtained from the electronic hospital database. Lumbar lordosis angle, sacral tilt, lumbosacral angle and lumbosacral disc angle were calculated on lateral standing lumbar radiographs. RESULTS: The mean age of the non-geriatric group was 43.02 ± 13.20 years, the geriatric group was 71.61 ± 6.42 years. In geriatric patients, lumbar lordosis angle, sacral tilt and lumbosacral disc angle were significantly smaller (p = 0.042, p = 0.017 and p = 0.017). No significant differences were observed in lumbosacral angle between the groups (p = 0.508). CONCLUSION: Our study indicates the specific changes in lumbosacral alignment with aging. Identifying these changes in lumbosacral alignment in the geriatric population will enable to create proper rehabilitation strategies.

Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value?

Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.

Ultrasound elastography findings in piriformis muscle syndrome.

BACKGROUND: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. OBJECTIVE: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. MATERIALS AND METHODS: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. RESULTS: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24-62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774-0.981] and 0.768 (95% CI 0.622-0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. CONCLUSION: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.