Search results for: neuromuscular exercises

Authors: Khadija Rafi, Neha Jamil, Laiba Khalid, Meerub Nawaz, Mahwish Farooq

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Speech articulation is a complex process to produce intelligible sounds with the help of precise movements of various structures within the vocal tract. All these structures in the vocal tract are named as articulators, which comprise lips, teeth, tongue, and palate. These articulators work together to produce a range of distinct phonemes, which happen to be the basis of language. It starts with the airstream from the lungs passing through the trachea and into oral and nasal cavities. When the air passes through the mouth, the tongue and the muscles around it form such coordination it creates certain sounds. It can be seen when the tongue is placed in different positions- sometimes near the alveolar ridge, soft palate, roof of the mouth or the back of the teeth which end up creating unique qualities of each phoneme. We can articulate vowels with open vocal tracts, but the height and position of the tongue is different every time depending upon each vowel, while consonants can be pronounced when we create obstructions in the airflow. For instance, the alphabet ‘b’ is a plosive and can be produced only by briefly closing the lips. Articulation disorders can not only affect communication but can also be a hurdle in speech production. To improve articulation skills for such individuals, doctors often recommend speech therapy, which involves various kinds of exercises like jaw exercises and tongue twisters. However, this disorder is more common in children who are going through developmental articulation issues right after birth, but in adults, it can be caused by injury, neurological conditions, or other speech-related disorders. In short, speech articulation is an essential aspect of productive communication, which also includes coordination of the specific articulators to produce different intelligible sounds, which are a vital part of spoken language.

Keywords: linguistics, speech articulation, speech therapy, language learning

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Authors: Özge Çeliker Tosun, Melda Başer Secer, İsmail Düşmez, Sedat Çapar, İlkay Kozak, Melahat Aktaş, Furkan Can Şimşek, Gökhan Tosun

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Purpose: Portable innovative balance room system with digital game program; It was created to be able to be divided into small areas, such as inside the house, garden, balcony, to enable the person to enter and perform both evaluation and exercise safely, and to ensure that these results can be stored and sent to the therapist live or later when desired. The aim is to compare the effectiveness of the exercise program applied by the elderly within this system and the exercise program implemented under the supervision of a physiotherapist on balance and urinary incontinence symptoms. Materials and Methods: The study was conducted in a randomized controlled manner on 63 people with urinary incontinence (mean age: 75.5 years) at Narlıdere Nursing Home Elderly Care and Rehabilitation Center. Elderly people participating in the study were divided into 3 groups: 1. Group, an exercise program consisting of pelvic floor muscle training and OTOGA exercises, 2. Group, only pelvic floor muscle training, and 3. Group, pelvic floor muscle training and Otoga exercises in the form of a digital game program in a portable balance room system. (self-administered) for 12 weeks. Pelvic floor distress inventory (PTDE-20) and bladder diary were used to evaluate the incontinance symptoms of the cases. Pelvic floor muscle function was evaluated with superficial EMG. Berg, Fall Effectiveness Scale (FES) and Functional Status Evaluations (Chair Stand Test, Eight (8) Food Up and Go Test, Chair Sit and Reach Test, Two Minutes Step Test) were used to evaluate balance. The existence of differences between groups was analyzed using Krusskal Wallis analysis of variance, and the difference between before and after exercise was analyzed with Wilcoxon tests. Results: After treatment, PTDE-20, daily urinary incontinence and toilet visits values decreased significantly in all three groups (p < 0.001). While there was a statistically significant increase in pelvic floor muscle EMG values in the 2nd and third groups after treatment, there was no change in the other group (2nd Group PFM average EMG before-after: 5.5 (4.15-10.95) - 10.95 (8.68-13.68), P=0.05, 3 Group PFM average EMG before-after: 6.5 (4.28-11.55) - 11.75 (8.67-14.26), p=0.04). While BERG score, Chair Stand Test, Eight (8) Food Up and Go Test, and Two Minutes Step Test values increased in all groups (p<0.05), Fall Effectiveness Scale (FES) values did not change after treatment. Conclusion: Although pelvic floor muscle training combined with balance exercises reduces symptoms, it may not lead to a positive improvement in the functions of the pelvic floor muscles. For this reason, recovery lasts for a short time, and then symptoms may reoccur in the future. However, thanks to the new system, when balance exercises are combined with a game program for the pelvic floor muscles, a double effect can be achieved with a single application and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on this subject. However, thanks to the new system, a double effect can be achieved with a single application, and both incontinence and balance problems can be treated in a safe environment where the person can do it himself. But more work needs to be done on new system

Keywords: fall, urinary incontinance, balance, elderly

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Authors: Che Hsiu Chen, Kuo Wei Tseng, Zih Jian Huang, Hon Wen Cheng

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A typical warm-up contains both stretching exercises and jogging. The static stretching prior to training or competition may cause detrimental effects to athletic performance. However, it is unclear whether different types of dynamic stretching exercises had different acute effects on knee flexors stiffness, flexibility, and strength. The purpose of this study was to analyze the knee flexors stiffness, flexibility, and strength gains after dynamic straight leg raise (DSLR) and dynamic modified toe-touch (MTT) stretching. Sixteen healthy university active men (height 176.27 ± 4.03 cm; weight 72.27 ± 8.90 kg; age 22.09 ± 2.31 years). After 5 minutes (8km/h) of running subjects performed 2 randomly ordered stretching protocols: DSLR and MTT stretching protocols. There were a total of six, 30 seconds bouts of dynamic stretching (15 repetitions) with 30seconds rest between bouts. The outcome measures were maximal voluntary isokinetic concentric hamstring strength (60°/s), muscle flexibility test by passive straight leg raise (PSLR), active straight leg raise (ASLR), and muscle stiffness using ultrasound Acoustic Radiation Forced Impulse (ARFI) elastography before and immediately after stretching. The muscle stiffness and concentric strength decreased significantly (p < .05), the flexibility no significant change after DSLR protocol (p > .05). The concentric strength decreased significantly (p < .05), the flexibility and muscle stiffness no significant change after MTT protocol (p > .05), whereas no significant differences were found for the DSLR and MTT. Our findings suggest that dynamic stretching (30s x 6 bouts) resulted in change in muscle stiffness or may be induced slack in the musculotendinous unit thereby, reducing force production. Therefore, 30s x 6 bouts of dynamic stretching adversely affects efforts of hamstring muscle maximal concentric strength.

Keywords: sport injury, ultrasound, eccentric exercise, performance

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Authors: Alireza Barari, Ahmad Abdi

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Regular body trainings cause adaption in various system in body. One of the important effect of body training is its effect on immune system. It seems that cytokines usually release after long period exercises or some exercises which cause skeletal muscular damages. If some of the cytokines which cause responses such as inflammation of cells in skeletal muscles, with manipulating of training program, it can be avoided or limited from those exercises which induct cytokines release. Ginger plant is a kind of medicinal plants which is known as a anti inflammation plant. This plant is as most precedence medicinal plants in medicine science especially in inflammation cure. The aim of the present study was the effect of selected resistance training and consumption of ginger extract on IL-1α and TNFα untrained young women. The population includes young women interested in participating in the study with the average of 30±2 years old from Abbas Abad city among which 32 participants were chosen randomly and divided into 4 four groups, resistance training (R), resistance training and ginger consumption(RG), Ginger consumption(G)and Control group(C). The training groups performed circuit resistance training at the intensity of 65-75% one repeat maximum, 3 days a week for 6 weeks. Besides resistance training, subjects were given either ginseng (5 mg/kg per day) or placebo. Prior to and 48 hours after interventions body composition was measured and blood samples were taken in order to assess serum levels of IL-1α and TNFα. Plasma levels of cytokines were measured with commercially available ELISA Kits.IL-1α kit and TNFα kit were used in this research. To demonstrate the effectiveness of the independent variable and the comparison between groups, t-test and ANOVA were used. To determine differences between the groups, the Scheffe test was used that showed significant changes in any of the variables. we observed that circuit resistance training in R and RG groups can significant decreased in weight and body mass index in untrained females (p<0.05). The results showed a significant decreased in the mean level of IL-1α levels before and after the training period in G group (p=0.046) and RG group (p=0.022). Comparison between groups also showed there was significant difference between groups R-RG and RG-C. Intergroup comparison results showed that the mean levels of TNFα before and after the training in group G (p=0.044) and RG (p=0.037), significantly decreased. Comparison between groups also showed there was significant difference between groups R–RG , R-G ,RG-C and G-C. The research shows that circuit resistance training with reducing overload method results in systemic inflammation had significant effect on IL-1α levels and TNFα. Of course, Ginger can counteract the negative effects of resistance training exercise on immune function and stability of the mast cell membrane. Considerable evidence supported the anti-inflammatory properties of ginger for several constituents, especially gingerols, shogaols, paradols, and zingerones, through decreased cytokine gene TNF α and IL-1Α expression and inhibition of cyclooxygenase 1 and 2. These established biological actions suggest that ingested ginger could block the increase in IL-1α.

Keywords: resistance training, ginger, IL-1α , TNFα

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Authors: Amira A. A. Abdallah, Amir A. Beltagi

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Background: Core stability training has recently attracted attention for improving muscle balance and optimizing performance in healthy and unhealthy individuals. Purpose: This study investigated the effect of beginner’s core stability exercises on trunk flexors’/extensors’ peak torque ratio and trunk flexors’ and extensors’ peak torques. Methods: Thirty five healthy individuals participated in the study. They were randomly assigned to two groups; experimental “group I, n=20” and control “group II, n=15”. Their mean age, weight and height were 20.7±2.4 vs. 20.3±0.61 years, 66.5±12.1 vs. 68.57±12.2 kg and 166.7±7.8 vs. 164.28 ±7.59 cm. for group I vs. group II. Data were collected using the Biodex Isokinetic system. The participants were tested twice; before and after a 6-week period during which group I performed a core stability training program. Results: The 2x2 Mixed Design ANOVA revealed that there were no significant differences (p>0.025) in the trunk flexors’/extensors’ peak torque ratio between the pre-test and post-test conditions for either group. Moreover, there were no significant differences (p>0.025) in the trunk flexion/extension ratios between both groups at either condition. However, the 2x2 Mixed Design MANOVA revealed significant increases (p<0.025) in the trunk flexors’ and extensors’ peak torques in the post-test condition compared with the pre-test in group I with no significant differences (p>0.025) in group II. Moreover, there was a significant increase (p<0.025) in the trunk flexors’ peak torque only in group I compared with group II in the post-test condition with no significant differences in the other conditions. Interpretation/Conclusion: The improvement in muscle performance indicated by the increase in the trunk flexors’ and extensors’ peak torques in the experimental group recommends including core stability training in the exercise programs that aim to improve muscle performance.

Keywords: core stability, isokinetic, trunk muscles, muscle balance

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Authors: Mohamed Aly, Aliaa Rehan Youssef, Emad Sawerees, Mounir Guirgis

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Relevance: Osteoarthritis (OA) is the most common degenerative disease seen in all populations. It causes disability and substantial socioeconomic burden. Evidence supports that exercise are the most effective conservative treatment for patients with OA. Therapists experience and clinical judgment play major role in exercise prescription and scientific evidence for this regard is lacking. The development of clinical prediction rules to identify patients who are most likely benefit from exercise may help solving this dilemma. Purpose: This study investigated whether body mass index and functional ability at baseline can predict patients’ response to a selected exercise program. Approach: Fifty-six patients, aged 35 to 65 years, completed an exercise program consisting of open kinetic chain strengthening and passive stretching exercises. The program was given for 3 sessions per week, 45 minutes per session, for 6 weeks Evaluation: At baseline and post treatment, pain severity was assessed using the numerical pain rating scale, whereas functional ability was being assessed by step test (ST), time up and go test (TUG) and 50 feet time walk test (50 FTW). After completing the program, global rate of change (GROC) score of greater than 4 was used to categorize patients as successful and non-successful. Thirty-eight patients (68%) had successful response to the intervention. Logistic regression showed that BMI and 50 FTW test were the only significant predictors. Based on the results, patients with BMI less than 34.71 kg/m2 and 50 FTW test less than 25.64 sec are 68% to 89% more likely to benefit from the exercise program. Conclusions: Clinicians should consider the described strengthening and flexibility exercise program for patents with BMI less than 34.7 Kg/m2 and 50 FTW faster than 25.6 seconds. The validity of these predictors should be investigated for other exercise.

Keywords: clinical prediction rule, knee osteoarthritis, physical therapy exercises, validity

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Authors: M. Volpini, D. Alves, A. Horta, M. Borges, P. Reis

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The gait pattern in people that present motor limitations foment the demand for auxiliary locomotion devices. These artifacts for movement assistance vary according to its shape, size and functional features, following the clinical applications desired. Among the ortheses of lower limbs, the ankle-foot orthesis aims to improve the ability to walk in people with different neuromuscular limitations, although they do not always answer patients' expectations for their aesthetic and functional characteristics. The purpose of this study is to explore the possibility of using new design in additive manufacturer to reproduce the shape and functional features of a ankle-foot orthesis in an efficient and modern way. Therefore, this work presents a study about the performance of the mechanical forces through the analysis of finite elements in an ankle-foot orthesis. It will be demonstrated a study of distribution of the stress on the orthopedic device in orthostatism and during the movement in the course of patient's walk.

Keywords: additive manufacture, new designs, orthoses, finite elements

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Authors: Maryam Kakavand, Samira Entezari, Sara Khoshjamalfekri, Raghad Mimar

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The objective of this study is 1) to compare elite female and beginner taekwondo players in terms of plantar pressure distribution, vertical ground reaction force, contact area, mean pressure, and right and left longitudinal arches, and 2) to compare preferred and non-preferred limbs among elite players. To the best of authors’ knowledge, as of yet, there is no information available about the plantar pressure distribution and arch index among taekwondo players. Material and Methods: An analytical-comparative research method is applied. Therefore seven elite athletes and eight novice athletes were selected. The emed-C50 platform was used to assess plantar pressure distribution, vertical ground reaction force, contact area, mean pressure of different areas, and planter longitudinal arch in a second step protocol. Independent t-test and dependent t-test were used at a level of 0.05 to compare the elites and beginners' right and left feet, and preferred and non-preferred limbs among elite athletes, respectively. Results: In comparing the right and left limbs of elite and beginner groups, findings indicate that there is only a significant difference in the mean pressure of the first metatarsal of the right foot. Findings also showed a significant difference in the contact area of the toes 3, 4, 5 regions between elites’ preferred and non-preferred limbs. However, no significant difference was found between the two groups’ right and left limbs and elites’ preferred and non-preferred limbs in terms of pressure distribution, vertical ground reaction force, and arch index. Conclusion: It seems that taekwondo exercises have affected pressure distribution patterns among advanced players causing some differences in their planter pressure distribution pattern when compared to that of beginners. Therefore, taekwondo exercises may be a factor contributing to asymmetry performance in preferred and non-preferred limbs.

Keywords: planter pressure, arch index, taekwondo, elite

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Authors: M. Rezki, A. Belaidi

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This paper deals with a method of learning to solve a real problem in biomedical engineering from a technical study of muscle fatigue. Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles (viewpoint: anatomical and physiological). EMG is used as a diagnostics tool for identifying neuromuscular diseases, assessing low-back pain and muscle fatigue in general. In order to study the EMG signal for detecting fatigue in a muscle, we have taken a real problem which touches the tramway conductor the handle bar. For the study, we have used a typical autonomous platform in order to get signals at real time. In our case study, we were confronted with complex problem to do our experiments in a tram. This type of problem is recurring among students. To teach our students the method to solve this kind of problem, we built a similar system. Through this study, we realized a lot of objectives such as making the equipment for simulation, the study of detection of muscle fatigue and especially how to manage a study of biomedical looking.

Keywords: EMG, health platform, conductor’s tram, muscle fatigue

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Authors: Ayça Utkan Karasu, Elif Balevi Batur, Gülçin Kaymak Karataş

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The aim of this study was to examine the efficiency of virtual reality exercises with Nintendo Wii system on balance and independence in motor functions. This randomized controlled assessor-blinded study included 23 stroke inpatients with hemiparesis all within 12 months poststroke. Patients were randomly assigned to control group (n=11) or experimental group (n=12) via block randomization method. Control group participated in a conventional balance rehabilitation programme. Study group received a four-week balance training programme five times per week with a session duration of 20 minutes in addition to the conventional balance rehabilitation programme. Balance was assessed by the Berg’s balance scale, the functional reach test, the timed up and go test, the postural assessment scale for stroke, the static balance index. Also, displacement of centre of pressure sway and centre of pressure displacement during weight shifting was calculated by Emed-SX system. Independence in motor functions was assessed by The Functional Independence Measure (FIM) ambulation and FIM transfer subscales. The outcome measures were evaluated at baseline, 4th week (posttreatment), 8th week (follow-up). Repeated measures analysis of variance was performed for each of the outcome measure. Significant group time interaction was detected in the scores of the Berg’s balance scale, the functional reach test, eyes open anteroposterior and mediolateral center of pressure sway distance, eyes closed anteroposterior center of pressure sway distance, center of pressure displacement during weight shifting to effected side, unaffected side and total centre of pressure displacement during weight shifting (p < 0.05). Time effect was statistically significant in the scores of the Berg’s balance scale, the functional reach test, the timed up and go test, the postural assessment scale for stroke, the static balance index, eyes open anteroposterior and mediolateral center of pressure sway distance, eyes closed mediolateral center of pressure sway distance, the center of pressure displacement during weight shifting to effected side, the functional independence measure ambulation and transfer scores (p < 0.05). Virtual reality exercises with Nintendo Wii system combined with a conventional balance rehabilitation programme enhances balance performance and independence in motor functions in stroke patients.

Keywords: balance, hemiplegia, stroke rehabilitation, virtual reality

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Authors: A. Pallavi, N. Vijay Mohan

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A nation can be economically progressive only when the citizens have sufficient capacity to work efficiently to increase the productivity. So, good health must be regarded as a primary need of the community. This helps the growth and development of the body and the mind, which in turn leads to progress and prosperity of the nation. An optimum growth is a necessity for an efficient existence in a biologically adverse and economically competitive world. It is also necessary for the execution of daily routine work. Yoga is a method or a system for the complete development of the personality in a human being. It can be further elaborated as an all-around and complete development of the body, mind, morality, intellect and soul of a being. Sri Aurobindo defines yoga as 'a methodical effort towards self-perfection by the development of the potentialities in the individual.' Aerobic exercise as any activity that uses large muscle groups, can be maintained continuously, and is rhythmic I nature. It is a type of exercise that overloads the heart and lungs and causes them to work harder than at rest. The important idea behind aerobic exercise today, is to get up and get moving. There are more activities that ever to choose from, whether it is a new activity or an old one. Find something you enjoy doing that keeps our heart rate elevated for a continuous time period and get moving to a healthier life. Middle aged selected and served as the subjects for the purpose of this study. The selected subjects were in the age group of 30 to 40 years. By going through the literature and after consulting the experts in yoga and aerobic training, the investigator had chosen the variables which are specifically related to the middle-aged men. The selected physiological variables are pulse rate, diastolic blood pressure, systolic blood pressure; percent body fat and vital capacity. The selected psychological variables are job anxiety, occupational stress. The study was formulated as a random group design consisting of aerobic exercise and yogic exercises groups. The subjects (N=60) were at random divided into three equal groups of twenty middle-aged men each. The groups were assigned the names as follows: 1. Experimental group I- aerobic exercises group, 2. Experimental group II- yogic exercises, 3. Control group. All the groups were subjected to pre-test prior to the experimental treatment. The experimental groups participated in their respective duration of twenty-four weeks, six days in a week throughout the study. The various tests administered were: prior to training (pre-test), after twelfth week (second test) and twenty-fourth weeks (post-test) of the training schedule.

Keywords: pulse rate, diastolic blood pressure, systolic blood pressure; percent body fat and vital capacity, psychological variables, job anxiety, occupational stress, aerobic exercise, yogic exercise

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Authors: Mahmoud S. Zaghloul, Mohammed M. Khalaf, Wael N. Thabet, Haidy N. Asham

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Background. Hypertrophic scarring is a difficult problem for burn patients, and scar management is an essential aspect of outpatient burn therapy. Post-burn pathologic scars involve functional and aesthetic limitations that have a dramatic influence on the patient’s quality of life. The aim was to investigate the use of extracorporeal shock wave therapy (ESWT), which targets the fibroblasts in scar tissue, as an effective modality for scar treatment in burn patients. Subjects and methods: forty patients with post-burn scars were assigned randomly into two equal groups; their ages ranged from 20-45 years. The study group received ESWT and traditional physical therapy program (deep friction massage, stretching exercises). The control group received traditional physical therapy program (deep friction massage, stretching exercises). All groups received two sessions per week for six successful weeks. The data were collected before and after the same period of treatment for both groups. Evaluation procedures were carried out to measure scar thickness using ultrasonography and Vancouver Scar Scale (VSS) was completed before and after treatment. Results: Post-treatment results showed that there was a significant improvement difference in scar thickness in both groups in favor of the study group. Percentage of improvement in scar thickness in the study group was 42.55%, while it was 12.15% in the control group. There was also a significant improvement difference between results obtained using VSS in both groups in favor of the study group. Conclusion: ESWT is effective in management of pathologic post burn scars.

Keywords: extracorporeal shock wave therapy, post-burn scars, ultrasonography, Vancouver scar scale

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Authors: Jiahui Song, Ravindra P. Joshi

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The use of high-intensity, short-duration electric pulses is a promising development with many biomedical applications. The uses include irreversible electroporation for killing abnormal cells, reversible poration for drug and gene delivery, neuromuscular manipulation, and the shrinkage of tumors, etc. High intensity, short-duration electric pulses result in the creation of high-density, nanometer-sized pores in the cellular membrane. This electroporation amounts to localized modulation of the transverse membrane conductance, and effectively provides a voltage shunt. The electrically controlled changes in the trans-membrane conductivity could be used to affect neural traffic and action potential propagation. A rat was taken as the representative example in this research. The simulation study shows the pathway from the sensorimotor cortex down to the spinal motoneurons, and effector muscles could be reversibly blocked by using high-intensity, short-duration electrical pulses. Also, actual experimental observations were compared against simulation predictions.

Keywords: action potential, electroporation, high-intensity, short-duration

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Authors: Negin Parsamanesh, Saman Ameri-Mahabadi, Ali Nikfar, Mojdeh Mansouri, Hossein Chiti, Gita Fatemi Abhari

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Duchenne muscular dystrophy (DMD) is a severe progressive X-linked neuromuscular illness that affects movement through mutations in dystrophin gene. The mutation leads to insufficient, lack of or dysfunction of dystrophin. The cause of DMD was determined in an Iranian family. Exome sequencing was carried out along with a complete physical examination of the family. In silico methods were applied to find the alteration in the protein structure. The homozygous variant in DMD gene (NM-004006.2) was defined as c.2732-2733delTT (p.Phe911CysfsX8) in exon 21. In addition, phylogenetic conservation study of the human dystrophin protein sequence revealed that phenylalanine 911 is one of the evolutionarily conserved amino acids. In conclusion, our study indicated a new deletion in the DMD gene in the affected family. This deletion with an X-linked inheritance pattern is new in Iran. These findings could facilitate genetic counseling for this family and other patients in the future.

Keywords: duchenne muscular dystrophy, whole exome sequencing, iran, metabolic syndrome

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Authors: Milan N. A. Van Der Kuil, Anne M. A. Visser-Meily, Andrea W. M. Evers, Ineke J. M. Van Der Ham

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Navigation ability is essential for autonomy and mobility in daily life. In patients with acquired brain injury, navigation impairment is frequently impaired; however, in this study, we tested the effectiveness of a serious gaming training protocol as a tool for cognitive rehabilitation to reduce navigation impairment. In total, 38 patients with acquired brain injury and subjective navigation complaints completed the experiment, with a partially blind, randomized control trial design. An objective navigation test was used to construct a strengths and weaknesses profile for each patient. Subsequently, patients received personalized compensation training that matched their strengths and weaknesses by addressing an egocentric or allocentric strategy or a strategy aimed at minimizing the use of landmarks. Participants in the experimental condition received psychoeducation and a home-based rehabilitation game with a series of exercises (e.g., map reading, place finding, and turn memorization). The exercises were developed to stimulate the adoption of more beneficial strategies, according to the compensatory approach. Self-reported navigation ability (wayfinding questionnaire), participation level, and objective navigation performance were measured before and after 1 and 4 weeks after completing the six-week training program. Results indicate that the experimental group significantly improved in subjective navigation ability both 1 and 4 weeks after completion of the training, in comparison to the score before training and the scores of the control group. Similarly, goal attainment showed a significant increase after the first and fourth week after training. Objective navigation performance was not affected by the training. This navigation training protocol provides an effective solution to address navigation impairment after acquired brain injury, with clear improvements in subjective performance and goal attainment of the participants. The outcomes of the training should be re-examined after implementation in a clinical setting.

Keywords: spatial navigation, cognitive rehabilitation, serious gaming, acquired brain injury

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Authors: Amir A. Beltagi, Ahmed R. Abdelbaki

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Background: Core stability training has recently attracted attention for optimizing performance and improving muscle balance for healthy and unhealthy individuals. The purpose of this study was to investigate the effect of beginner’s core stability exercises on the trunk flexors’/extensors’ peak torque ratio and trunk flexors’ and extensors’ peak torques. Methods: Thirty five healthy individuals, randomly assigned into two groups; experimental (group I) and control (group II), participated in the study. Group I involved 20 participants (10 male & 10 female) with mean ±SD age, weight, and height of 20.7±2.4 years, 66.5±12.1 kg and 166.7±7.8 cm respectively. Group II involved 15 participants (6 male & 9 female) with mean ±SD age, weight, and height of 20.3±0.61 years, 68.57±12.2 kg and 164.28 ±7.59 cm respectively. Data were collected using the Biodex Isokinetic system. The participants were tested twice; before and after a 6-week period during which the experimental group performed a core stability training program. Findings: Statistical analysis using the 2x2 Mixed Design ANOVA revealed that there were no significant differences in the trunk flexors’/extensors’ peak torque ratio between the ‘pre’ and ‘post’ tests for either group (p > 0.025). Moreover, there were no significant differences in the trunk flexors’/extensors’ ratios between both groups at either test (p > 0.025). Meanwhile, the 2x2 Mixed Design MANOVA revealed that there were significant differences in the trunk flexors’ and extensors’ peak torques between the ‘pre’ and ‘post’ tests for group I (p < 0.025), while there were no significant differences inbetween for group II (p > 0.025). Moreover, there were no significant differences between both groups for the tested muscles’ peak torques at either test except for that of the trunk flexors at the ‘post’ test only (p < 0.025). Interpretation: The improvement in muscle performance indicated by the increase in the trunk flexors’ and extensors’ peak torques in the experimental group recommends including core stability training in the exercise programs that aim to improve muscle performance.

Keywords: core stability, isokinetic, trunk muscles, muscle balance

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Authors: Kenji Tanaka, Kazumi Sugita, Yuto Mizushima

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This paper introduces a noteworthy form of English communication training for the officers and operators of the Osaka-Bay Marine Traffic Information Service (Osaka MARTIS) of the Japan Coast Guard working in the congested area at the Akashi Strait in Hyogo Prefecture, Japan. The authors of this paper, Marine Technical College’s (MTC) English language instructors, have been holding about forty lectures and exercises in basic and normal Maritime English (ME) for several groups of MARTIS personnel at Osaka MARTIS annually since they started the training in 2005. Trainees are expected to be qualified Maritime Third-Class Radio Operators who are responsible for providing safety information to a daily average of seven to eight hundred vessels that pass through the Akashi Strait, one of Japan’s narrowest channels. As of 2022, the instructors are conducting 55 remote lessons at MARTIS. One lesson is 90 minutes long. All 26 trainees are given oral and written assessments. The trainees need to pass the examination to become qualified operators every year, requiring them to train and maintain their linguistic levels even during the pandemic of Corona Virus Disease-19 (COVID-19). The vessel traffic information provided by Osaka MARTIS in Maritime English language is essential to the work involving the use of very high frequency (VHF) communication between MARTIS and vessels in the area. ME is the common language mainly used on board merchant, fishing, and recreational vessels, normally at sea. ME was edited and recommended by the International Maritime Organization in the 1970s, was revised in 2002, and has undergone continual revision. The vessel’s circumstances are much more serious at the strait than those at the open sea, so these vessels need ME to receive guidance from the center when passing through the narrow strait. The imminent and challenging situations at the strait necessitate that textbooks’ contents include the basics of the phrase book for seafarers as well as specific and additional navigational information, pronunciation exercises, notes on keywords and phrases, explanations about collocations, sample sentences, and explanations about the differences between synonyms especially those focusing on terminologies necessary for passing through the strait. Additionally, short Japanese-English translation quizzes about these topics, as well as prescribed readings about the maritime sector, are include in the textbook. All of these exercises have been trained in the remote education system since the outbreak of COVID-19. According to the guidelines of ME edited in 2009, the lowest level necessary for seafarers is B1 (lower individual users) of The Common European Framework of Reference for Languages: Learning, Teaching, Assessment (CEFR). Therefore, this vocational ME language training at Osaka MARTIS aims for its trainees to communicate at levels higher than B1. A noteworthy proof of improvement from this training is that most of the trainees have become qualified marine radio communication officers.

Keywords: akashi strait, B1 of CEFR, maritime english communication training, osaka martis

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Authors: Inayat Shah, Muhammad Omar Malik, Ghareeb Alshuwaier, Ronald H. Baxendale

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Background: The balance between angiogenesis and angiostasis is important in growth and developmental processes in the body. Angiogenic and angiostatic mediators control this balance. Endostatin is one of the prominent angiostatic mediators. The marked angiostatic effect of endostatin includes inhibiting endothelial cell migration, proliferation and apoptosis. Physical activity decreases the risk and development of many angiogenesis related health problems including atherosclerosis and numerous cancers. Physiological influences of different physical activities on plasma endostatin concentration are controversial and not completely clear. Moreover, correlation of physical characteristics and metabolic predictors during physical activity on circulating endostatin is indistinct and poorly speculated. The study aimed to determine the effects of mild, moderate and vigorous exercise on the concentration of endostatin in plasma. Methodology: 22 participants, 16 males (age = 30.6 ± 7.8 years) and 6 females (age = 26.5 ± 5 years) were recruited. Weekly session of different intensities exercise based on the predicted maximum heart of the participants [60%(low), 70% (moderate) and 80% (vigorous)] were carried out. The duration and work rate for each participant was determined through sub-maximal exercise. Standardization of the session was done on total energy expenditure of the participants per session. One pre exercise and two post exercise samples were taken at intervals of 10 and 60 minutes. Results: Pre-exercise mean endostatin was 101 ± 20 ng/dl. Low intensity exercise insignificantly decreased the endostatin concentration in plasma at 10 and 60 minutes 97 ± 20 ng/dl (p= 0.5), 98 ± 23 ng/dl (p= 0.8)). However, moderate (p= 0.022, 0.004) and vigorous intensities (p ≤ 0.001, 0.02) increased the endostatin concentrations significantly at both 10 and 60 minutes intervals respectively. The effects were not significantly influenced by gender, exercise mode (walking vs. running), components of exercise (HR, Speed, Gradients, distance, duration) or metabolism during exercise (VO₂ max, VCO₂, RER, energy expenditure, rate of carbohydrate or fats oxidation). Conclusion: Low intensity exercises did not influence endostatin concentration. However, moderate to high intensity exercises significantly increase endostatin concentration and may have potential benefits.

Keywords: angiogenesis, exercise, endostatin, physical activity

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Authors: Jesse Rafeiro

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This paper discusses worldbuilding as a pedagogical approach to the first-year architectural design studio. The studio ran for three consecutive terms between 2016-2018. Taking its departure from the fifty-five city narratives in Italo Calvino’s Invisible Cities, students collectively designed in a “nowhere” space where intersecting and diverging narratives could be played out. Along with Calvino, students navigated between three main exercises and their imposed limits to develop architectural insight at three scales simulating the considerations of architectural practice: detail, building, and city. The first exercise asked each student to design and model a ruin based on randomly assigned incongruent fragments. Each student was given one plan fragment and two section fragments from different Renaissance Treatises. The students were asked to translate these in alternating axonometric projection and model-making explorations. Although the fragments themselves were imposed, students were free to interpret how the drawings fit together by imagining new details and atypical placements. An undulating terrain model was introduced in the second exercise to ground the worldbuilding exercises. Here, students were required to negotiate with one another to design a city of ruins. Free to place their models anywhere on the site, the students were restricted by the negotiation of territories marked by other students and the requirement to provide thresholds, open spaces, and corridors. The third exercise introduced new life into the ruined city through a series of design interventions. Each student was assigned an atypical building program suggesting a place for an activity, human or nonhuman. The atypical nature of the programs challenged the triviality of functional planning through explorations in spatial narratives free from preconceived assumptions. By contesting, playing out, or dreaming responses to realities taught in other coursework, this third exercise actualized learnings that are too often self-contained in the silos of differing course agendas. As such, the studio fostered an initial worldbuilding space within which to sharpen sensibility and criticality for subsequent years of education.

Keywords: architectural pedagogy, critical pedagogy, Italo Calvino, worldbuilding

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Authors: Hassan Almoslim

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Background: The machine resistance training is an exercise that uses the equipment as loads to strengthen and condition the musculoskeletal system and improving muscle tone. The machine resistance training is easy to use, allow the individual to train with heavier weights without assistance, useful for beginners and elderly populations and specific muscle groups. Purpose: The purpose of this study was to examine the impact of nine weeks of machine resistance training on maximum strength among lean and normal weight male college students. Method: Thirty-six male college students aged between 19 and 21 years from King Fahd University of petroleum & minerals participated in the study. The subjects were divided into two an equal groups called Lean Group (LG, n = 18) and Normal Weight Group (NWG, n = 18). The subjects whose body mass index (BMI) is less than 18.5 kg / m2 is considered lean and who is between 18.5 to 24.9 kg / m2 is normal weight. Both groups performed machine resistance training nine weeks, twice per week for 40 min per training session. The strength measurements, chest press, leg press and abdomen exercises were performed before and after the training period. 1RM test was used to determine the maximum strength of all subjects. The training program consisted of several resistance machines such as leg press, abdomen, chest press, pulldown, seated row, calf raises, leg extension, leg curls and back extension. The data were analyzed using independent t-test (to compare mean differences) and paired t-test. The level of significance was set at 0.05. Results: No change was (P ˃ 0.05) observed in all body composition variables between groups after training. In chest press, the NWG recorded a significantly greater mean different value than the LG (19.33 ± 7.78 vs. 13.88 ± 5.77 kg, respectively, P ˂ 0.023). In leg press and abdomen exercises, both groups revealed similar mean different values (P ˃ 0.05). When the post-test was compared with the pre-test, the NWG showed significant increases in the chest press by 47% (from 41.16 ± 12.41 to 60.49 ± 11.58 kg, P ˂ 001), abdomen by 34% (from 45.46 ± 6.97 to 61.06 ± 6.45 kg, P ˂ 0.001) and leg press by 23.6% (from 85.27 ± 15.94 to 105.48 ± 21.59 kg, P ˂ 0.001). The LG also illustrated significant increases by 42.6% in the chest press (from 32.58 ± 7.36 to 46.47 ± 8.93 kg, P ˂ 0.001), the abdomen by 28.5% (from 38.50 ± 7.84 to 49.50 ± 7.88 kg, P ˂ 0.001) and the leg press by 30.8% (from 70.2 ± 20.57 to 92.01 ± 22.83 kg, P ˂ 0.001). Conclusion: It was concluded that the lean and the normal weight male college students can benefit from the machine resistance-training program remarkably.

Keywords: body composition, lean, machine resistance training, normal weight

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Authors: Lingling Li, Peng Zhao, Runze Guan, Alice Jones, Tao Yu

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Background: Shoulder pain and weakness are associated with complex pathologies and often precludes weightlifters from participation in training. The role and mode of exercise training in weightlifters with shoulder pathology remains unclear. Objectives: This case report described an exercise program in management of an elite weightlifter with primary complaint of right shoulder pain and weakness. Methods: A 22-year-old weightlifter presented with 2-year duration of right shoulder pain and weakness which was worsened by routine weightlifting training, and symptoms were not relieved with steroid injection, manual therapy nor usual physiotherapy. There was a limitation in all active range of motion especially horizontal extension (13ᵒ) and external rotation (41ᵒ) with pain intensity at 4/10 and 10/10 (numeric pain rating score) respectively. Muscle weakness was most significant at supraspinatus and teres minor, 38% and 27% respectively compared to his left shoulder (hand-held dynamometry, Micro FET2). An exercise training program focusing on improving mobility was designed for this athlete following a comprehensive physical assessment. Exercises included specific stretching, muscle activating and scapular stability training; once per day, and for 60 minutes each session. All exercises were completed under instruction as pain allowed. Quantitative assessment was conducted at the end of each week for 3 weeks. Outcomes: After the program, the athlete was pain-free in all movements except the O’Brien active compression internal rotation test, the pain was however reduced from 10/10 to 3/10. The horizontal extension and external rotation range increased to 79ᵒ to 120ᵒ respectively, and strength of all rotator cuff muscles returned to normal. At 1-month follow up, the athlete was totally pain-free and had returned to normal function and weightlifting training activities. The outcomes sustained through 6-month and one year. Conclusion: This case report supports the use of a mobility-focused exercise program for management of shoulder pain and weakness in an elite weightlifter athlete.

Keywords: exercise training, mobility, rehabilitation, shoulder pain, weightlifting

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Authors: Ivan Traina, Luigi Sangalli, Fabio Tognon, Angelo Lascioli

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Currently, challenges regarding preschooler children are mainly focused on a sedentary lifestyle. Also, motor activity in infancy is seen as a tool for the separate acquisition of cognitive and socio-emotional skills rather than considering neuromotor development as a tool for improving learning abilities. The paper utilized an observational research method to shed light on the results of practicing neuromotor exercises in preschool children with disability as well as provide implications for practice.

Keywords: children with disability, learning abilities, inclusion, neuromotor development

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Authors: Lillian M. Seo, Curtis L. Petersen, Ryan J. Halter, David Kotz, John A. Batsis

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Background: Resistance-based exercises effectively enhance muscle strength, which is especially important in older populations as it reduces the risk of disability. Our group developed a Bluetooth-enabled handle for resistance exercise bands that wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar device. The system has the potential to measure home-based exercise interventions, allowing health professionals to monitor compliance. Its feasibility has already been demonstrated in both clinical and field-based settings, but it remained unclear whether the system’s usability persisted upon repeated use. The current study sought to assess the usability of this system and its users’ satisfaction with repeated use by deploying the device among younger adults to gather formative information that can ultimately improve the device’s design for older adults. Methods: A usability study was conducted in which 32 participants used the above system. Participants executed 10 repetitions of four commonly performed exercises: bicep flexion, shoulder abduction, elbow extension, and triceps extension. Each completed three exercise sessions, separated by at least 24 hours to minimize muscle fatigue. At its conclusion, subjects completed an adapted version of the usefulness, satisfaction, and ease (USE) questionnaire – assessing the system across four domains: usability, satisfaction, ease of use, and ease of learning. The 20-item questionnaire examined how strongly a participant agrees with positive statements about the device on a seven-point Likert scale, with one representing ‘strongly disagree’ and seven representing ‘strongly agree.’ Participants’ data were aggregated to calculate mean response values for each question and domain, effectively assessing the device’s performance across different facets of the user experience. Summary force data were visualized using a custom web application. Finally, an optional prompt at the end of the questionnaire allowed for written comments and feedback from participants to elicit qualitative indicators of usability. Results: Of the n=32 participants, 13 (41%) were female; their mean age was 32.4 ± 11.8 years, and no participants had a physical impairment. No usability questions received a mean score < 5 of seven. The four domains’ mean scores were: usefulness 5.66 ± 0.35; satisfaction 6.23 ± 0.06; ease of use 6.25 ± 0.43; and ease of learning 6.50 ± 0.19. Representative quotes of the open-ended feedback include: ‘A non-rigid strap-style handle might be useful for some exercises,’ and, ‘Would need different bands for each exercise as they use different muscle groups with different strength levels.’ General impressions were favorable, supporting the expectation that the device would be a useful tool in exercise interventions. Conclusions: A simple usability assessment of a Bluetooth-enabled resistance exercise band supports a consistent and positive user experience among young adults. This study provides adequate formative data, assuring the next steps can be taken to continue testing and development for the target population of older adults.

Keywords: Bluetooth, exercise, mobile health, mHealth, usability

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Authors: Geum Yeon Sim, Tyler Pigott, Julio Vasquez

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A 38-year-old obese female with no apparent past medical history presented with left knee pain. Six months ago, she sustained a left knee dislocation in a motor vehicle accident that was managed with a skin graft over the left lower extremity without any reconstructive surgery. She developed persistent pain and stiffness in her left knee that worsened with walking and stair climbing. Examination revealed healed extensive skin graft over the left lower extremity, including the left knee. Palpation showed moderate tenderness along the superior border of the patella, exquisite tenderness over MCL, and mild tenderness on the tibial tuberosity. There was normal sensation, reflexes, and strength in her lower extremities. There was limited active and passive range of motion of her left knee during flexion. There was instability noted upon the valgus stress test of the left knee. Left knee magnetic resonance imaging showed high-grade (grade 2-3) injury of the proximal superficial fibers of the MCL and diffuse thickening and signal abnormality of the cruciate ligaments, as well as edema-like subchondral marrow signal change in the anterolateral aspect of the lateral femoral condyle weight-bearing surface. There was also notable extensive scarring and edema of the skin, subcutaneous soft tissues, and musculature surrounding the knee. The patient was managed with left knee immobilization for five months, which was complicated by limited knee flexion. Physical therapy consisting of quadriceps, hamstrings, gastrocnemius stretching and strengthening, range of motion exercises, scar/soft tissue mobilization, and gait training was given with marked improvement in pain and range of motion. The patient experienced a further reduction in pain as well as an improvement in function with home exercises consisting of continued strengthening and stretching.

Keywords: ligamentous injury, trauma, rehabilitation, knee pain

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Authors: Katarzyna Kwiatkowska, Izabela Walasik, Katarzyna Kosińska-Kaczyńska, Olga Płaza, Kinga Żebrowska

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Introduction Adequate physical activity of a pregnant woman has been proven to decrease the risk of pregnancy complications. The knowledge of women regarding physical exercise in pregnancy is a part of conscious motherhood, while a lack of it may lead to not taking up any form of physical activity during pregnancy. Aim: The aim of the study was to assess the knowledge and experience of women regarding physical activity during their latest pregnancy. Material and methodology: An anonymous questionnaire, consisting of 57 questions, was completed electronically in 2018 by women who gave birth at least once. The respondents were qualified as 'physically active during pregnancy' if they performed physical exercises such as regular walks, marching, jogging, working out at a gym, swimming, yoga, pilates, fitness, exercise-ball workouts or home gymnastics. Results: The study group consisted of 9345 women. 52% of them performed exercises during pregnancy. The main reasons for the lack of physical activity were: lack of interest in physical activity (45%), lack of energy (40%), lack of knowledge regarding proper exercise during pregnancy (34%), lack of time (27%) and medical contraindications (25%). Non-active respondents suffered from gestational hypertension (6,7% vs 9,2%; p<00,1) and gave birth prematurely (11% vs 15%; p < 001) to newborns with a lower birth weight significantly more often ( < 2500g vs > 2500g; p < 0,001). Physically active women reported suffering from pregnancy-related ailments such as fatigue, back pain or constipation significantly less often. 22% of all respondents were unable to identify reliable sources of information regarding exercise during pregnancy. A majority of the exercising women used the Internet to obtain gain information on physical activity during pregnancy (69,1%). 4% of women thought that exercising during pregnancy is forbidden, while 20% thought it is not allowed in the 3rd trimester. Physically active women had vaginal delivery more often (61% vs 55%; p < 0,05). Episiotomy was performed most often on non-active primiparous respondents (77,5% vs 71% active primiparous, p < 0,001). 13% of women felt discriminated due to their physical activity during pregnancy. 22% of respondents’ physical activity was not accepted by their environment. 39,1% of the women were told by others to stop physical exercise because it was bad for the baby’s health. Conclusion: The knowledge of Polish women regarding proper physical activity during pregnancy is insufficient, which may influence a lack of will to initiate such activity among pregnant women. Physical activity of a pregnant woman may have an impact on the course of pregnancy and birth.

Keywords: childbirth, discrimination, physical activity, pregnancy

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Authors: Lancer Scott

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Purpose: High quality clinical disaster medicine requires providers working collaboratively to care for multiple patients in chaotic environments; however, many providers lack adequate training. To address this deficit, we created a competency-based, 5-hour Emergency Preparedness Training (EPT) curriculum using didactics, small-group discussion, and kinetic learning. The goal was to evaluate the effect of a short course on improving provider knowledge, confidence and skills in disaster scenarios. Methods: Diverse groups of medical university students, health care professionals, and community members were enrolled between 2011 and 2014. The course consisted of didactic lectures, small group exercises, and two live, multi-patient mass casualty incident (MCI) scenarios. The outcome measures were based on core competencies and performance objectives developed by a curriculum task force and assessed via trained facilitator observation, pre- and post-testing, and a course evaluation. Results: 708 participants completed were trained between November 2011 and August 2014, including 49.9% physicians, 31.9% medical students, 7.2% nurses, and 11% various other healthcare professions. 100% of participants completed the pre-test and 71.9% completed the post-test, with average correct answers increasing from 39% to 60%. Following didactics, trainees met 73% and 96% of performance objectives for the two small group exercises and 68.5% and 61.1% of performance objectives for the two MCI scenarios. Average trainee self-assessment of both overall knowledge and skill with clinical disasters improved from 33/100 to 74/100 (overall knowledge) and 33/100 to 77/100 (overall skill). The course assessment was completed by 34.3% participants, of whom 91.5% highly recommended the course. Conclusion: A relatively short, intensive EPT course can improve the ability of a diverse group of disaster care providers to respond effectively to mass casualty scenarios.

Keywords: clinical disaster medicine, training, hospital preparedness, surge capacity, education, curriculum, research, performance, training, student, physicians, nurses, health care providers, health care

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Authors: A. Abdi, A. Abbasi Daloee, A. Barari

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Aim: The adaptations that occur in human body after doing exercises training are a factor to help healthy people stay away from certain diseases. One of the main adaptations is a change in blood circulation, especially in vessels. The increase of capillary density is dependent on the balance between angiogenic and angiostatic factors. Most studies show that the changes made to angiogenic developmental factors resulted from physical exercises indicate the low level of stimulators compared with inhibitors. It is believed that the plasma level of VEGF-A, the important angiogenic factor, is reduced after physical exercise. Findings indicate that the extract of crataegus plant reduces the platelet-derived growth factor receptor (PDGFR) autophosphorylation in human's fibroblast. More importantly, crataegus (1 to 100 mg in liter) clearly leads to the inhibition of PDGFR autophosphorylation in vascular smooth muscle cells (VSMCs). Angiogenesis is a process that can be classified into physiological and pathophysiological forms. collagen XVIII is a part of extracellular protein and heparan sulfate proteoglycans in vascular epithelial and endothelial basement membrane cause the release of endostatin from noncollagenous collagen XVIII. Endostatin inhibits the growth of endothelial cells, inhibits angiogenesis, weakens different types of cancer, and the growth of tumors. The purpose of the current study was to investigate the effect of intensive aerobic running with or without aqueous extraction of black Crataegus elbursensis on Collagen XVIII in male rats. Design: Thirty-two Wistar male rats (4-6 weeks old, 125-135 gr weight) were acquired from the Pasteur's Institute (Amol, Mazandaran), and randomly assigned into control (n = 16) and training (n = 16) groups. Rats were further divided into saline-control (SC) (n=8), saline-training (ST) (n=8), crataegus pentaegyna extraction -control (CPEC) (n=8), and crataegus pentaegyna extraction - training (CPET) (n=8). The control (SC and CPEC) groups remained sedentary; whereas the training groups underwent a high running exercise program. plasma were excised and immediately frozen in liquid nitrogen. Statistical analysis was performed using a one way analysis of variance and Tukey test. Significance was accepted at P = 0.05. Results: The results show that aerobic exercise group had the highest concentration collagen XVIII compared to other groups and then respectively black crataegus, training-crataegus and control groups. Conclusion: In general, researchers in this study concluded that the increase of collagen XVIII (albeit insignificant) as a result of physical activity and consumption of black crataegus extract could possibly serve as a regional inhibitor of angiogenesis and another evidence for the anti-cancer effects of physical activities. Since the research has not managed in this study to measure the amount of plasma endostatin, it is suggested that both indices are measured with important angiogenic factors so that we can have a more accurate interpretation of changes to angiogenic and angiostatic factors resulted from physical exercises.

Keywords: aerobic running, Crataegus elbursensis, Collagen XVIII

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Authors: Harim Mohsin, Afshan Channa, Beena Saad

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The Kocher Debre Semelaigne Syndrome (KDSS) is known as cretinism muscular hypertrophy. It is an unusual presentation in intellectually deficit children, commonly associated with congenital or iatrogenic hypothyroidism. The creatinine phosphokinase (CPK) is usually elevated and it’s commonly found in males, consanguineous marriage and ages 18 months to 10 years. It might be misdiagnosed without the classical features of hypothyroidism at first presentation. We present a case of 15 year old intellectually deficit female with epilepsy managed on phenytoin. She had rigidity, myxedema, calf muscle hypertrophy and agitation. The patient was managed as Neuroleptic Malignant Syndrome due to raised CPK of 40,680 IU/L and mixed presentation. Nevertheless, no improvement was noticed and thyroid profile was done to exclude alternative resources. Thyroid stimulating hormone (TSH) was 74.5 IU, Free T3 1.22 ng/dl, and Free T4 0.43 ng/dl. Thyroxine was started along with change in antiepileptic leading to recovery. This case report highlights the inconsistent finding of KDSS. The female gender, non-consanguineous marriage, delayed onset with primarily neuromuscular symptoms, and raised CPK is a rare demonstration in KDSS. Additionally, thyroid profile is not routinely done, which can lead to misdiagnosis and mismanagement.

Keywords: cretinism, hypothyroidism, intellectual deficit, KDSS

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Authors: Jong Yeop Kim, Jong Bum Choi, Hyun Jeong Kwak, Sook Young Lee

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Background: Each supraglottic airway requires different anesthetic depth because it has a specific structure and different compressive force in the oropharyngeal cavity. We designed the study to investigate remifentanil effect-site concentration (Ce) in 50% of patients (EC50) for successful insertion of i- gel, and to compare it with that for laryngeal mask airway (LMA) insertion during propofol target-controlled infusion (TCI). Methods: Forty-one female patients were randomized to the i-gel group (n=20) or the LMA group (n=21). Anesthesia induction was performed using propofol Ce of 5 μg/ml and the predetermined remifentanil Ce, and i-gel or LMA insertion was attempted 5 min later. The remifentanil Ce was estimated by modified Dixon's up-and-down method (initial concentration: 3.0 ng/ml, step size: 0.5 ng/ml). The patient’s response to device insertion was classified as either ‘success (no movement)’ or ‘failure (movement)’. Results: Using the Dixon’s up and down method, EC50 of remifentanil Ce for i-gel (1.58 ± 0.41 ng/ml) was significantly lower than that for LMA (2.25 ± 0.55 ng/ml) (p=0.038). Using isotonic regression, EC50 (83% CI) of remifentanil in the i-gel group [1.50 (1.37-1.80) ng/ml] was statistically lower than that in the LMA group [2.00 (1.82-2.34) ng/ml]. EC95 (95% CI) of remifentanil in the i-gel group [2.38 (1.48-2.50) ng/ml] was statistically lower than that in the LMA group [3.35 (2.58-3.48) ng/ml]. Conclusion: We found that EC50 of remifentanil Ce for i-gel insertion (1.58 ng/ml) was significantly lower than that for LMA insertion (2.25 ng/ml), in female patients during propofol TCI without neuromuscular blockade.

Keywords: i-gel, laryngeal mask airway, propofol, remifentanil

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Authors: Nezihe Şengün, Ragip Pala

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To prevent overweight and obesity, individuals need to consume food and beverages according to their nutritional needs, engage in regular exercises, and regularly monitor their body weight. This study aimed to examine the effects of exercise, diet, or combined intervention on changes in blood lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) and the level of malondialdehyde (MDA), a marker of oxidative stress, in parallel with the increase in body weight due to poor nutrition and sedentary lifestyle conditions. The study included a total of 48 female students aged 18-28 years with a BMI between 25.0 and 29.9 kg/m². They were divided into four groups: control (C), exercise (Ex), diet (D), and exercise+diet (Ex+D). Those in the exercise groups received aerobic exercises at 60-70% intensity (10 minutes warm-up, 30 minutes running, 10 minutes cool-down), while those in the diet groups were provided with a diet program based on the calculation of energy needs considering basal metabolic rate, physical activity level, age, and BMI. The students’ body weight, body fat mass, Body Mass Index (BMI), and waist-hip ratios were measured at the beginning (day 1) and end (day 60) of the 8-week intervention period. Their total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and MDA levels were evaluated and analyzed, considering a statistical significance level of p<0.05. As a result, female students in the Ex+D group had the largest difference in body weight, body fat mass, BMI, and waist-hip ratios, and this difference was statistically significant. Except for those in the C group, those in the other groups experienced a decrease in their total cholesterol, LDL cholesterol, and triglyceride levels and an increase in their HDL cholesterol levels. The decrease in total cholesterol, LDL cholesterol, and triglyceride levels was statistically significant for those in the D group, and the increase in HDL cholesterol level was statistically significant for those in the Ex+D group (p<0.05). A decrease in MDA level was found in all groups except those in the C group, and this decrease was significantly higher in the Ex group. In conclusion, our study revealed that the most effective way to achieve weight loss is through a combination of exercise and diet. The application of Ex+D is considered to balance blood lipid levels and suppress oxidative stress.

Keywords: obesity, exercise, diet, body mass index, blood lipids

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