Doktora Tezleri

Permanent URI for this collection

Browse

Recent Submissions

Now showing 1 - 5 of 35
  • Item
    Open Access
    Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda yaratıcı dans temelli egzersiz eğitiminin solunum, denge ve kognitif fonksiyonlar, solunum ve periferik kas kuvveti ve fonksiyonel kapasite üzerine etkisi
    KAYA, Meltem; GÜRSES, Hülya Nilgün
    Chronic obstructive pulmonary disease (COPD) is one of the main causes of high mortality and morbidity all over the world; which is a common, treatable and preventable disease characterized by progressive and irreversible airflow limitation and has systemic effects besides respiratory system involvement. In patients, increased work of breathing, decreased of pulmonary function, peripheral and respiratory muscle strengths and functional capacity are as important contributors to exercise intolerance. Additionally; other extrapulmonary system problems focused on patients with COPD are affecting balance and cognitive functions. In the guidelines; the importance of multidisciplinary pulmonary rehabilitation (PR) programs for the management of the disease is emphasized and individualized exercise training is an essential component of these programs. In the literature; although there are many studies showing the beneficial effects of traditional exercise training programs in patients with COPD, it is reported that the participation and attendance rates of patients in these programs are low. Despite the potential benefits of creative dance-based exercise training, which is an alternative and innovative approach to increase the compliance and motivation of patients with the exercise program, have been shown in the literature, no study was found in which creative dance was used as an exercise training method in patients with COPD. Therefore; we planned this study to investigate the effects of creative dance-based exercise training on pulmonary, balance and cognitive functions, respiratory and peripheral muscle strength and functional capacity. Our study included 24 patients who were followed up with the diagnosis of COPD in Bezmialem Vakıf University, Faculty of Medicine, Department of Chest Diseases, who met the inclusion criteria and agreed to participate in the study on a voluntary basis. Patients were randomized into two groups as experimental and control. Body composition, pulmonary function test, Modified Medical Research Council Dyspnea Scale, COPD Assessment Test (CAT), BODE index, postural stability, limits of stability and sensory integration tests with Biodex Balance System® (BBS), Montreal Cognitive Assessment (MoCA), respiratory muscle strength, six-minute walking test (6MWT) and peripheral muscle strength measurements were performed of all patients. A home based chest physiotherapy program including diaphragmatic, chest and bilateral segmental breathing exercises, incentive spirometry (Triflo®), breathing control, relaxation positions and effective coughing techniques and physical activity recommendations was given to be repeated twice a day, five days a week for eight weeks to the patients in the experimental and control groups. In addition to this program, the patients in the experimental group received creative dance-based exercise training in Pulmonary Rehabilitation Education and Research Laboratory for eight weeks two days a week under the supervision of a physiotherapist who received creative dance instructor training. All evaluations were repeated at the end of eight weeks. SPSS v.26 program was used for data analysis. Shapiro-Wilk test was used to analyze whether the data showed a normal distribution. Analysis of qualitative variables was interpreted with the χ2-test. For numerical data with normal distribution: Paired Sample T-test was used for intragroup comparisons and Independent Samples T-test was used for intergroup comparisons. For non-normally distributed or ordinal data :Wilcoxon test for intragroup comparisons and Mann Whitney U test was used for intergroup comparisons. The significance level for all statistical tests was set at p<0,05. After eight weeks of training in the experimental group; CAT, BODE index and MoCA scores, all both measured and percent expected values of the pulmonary function test, maximum inspiratory and expiratory pressures (MIP-MEP), right and left M. Quadriceps and M. Biceps muscle strengths, and dominant and non-dominant hand grip strength, 6MWT distance and all parameters of postural stability,limits of stability and sensory integration tests of BBS significantly improved (p<0,05). In the control group; CAT, BODE index and MoCA scores, MIP and MEP values, 6MWT distance, only "medial/lateral" parameter of postural stability test and only "backward/left" parameter of limits of stability test of BBS significantly improved (p<0,05). In the intergroup comparisons of the tests; CAT and MoCA scores, all parameters of pulmonary function test, MEP value, all parameters of peripheral muscle strength, 6MWT distance, all parameters of postural stability and sensory integration tests and all parameters of the limits of stability test except for the right, forward/left and backward/left parameters was higher in the experimental group compared to the control group (p<0,05). As a result; we think that creative dance-based exercise training in COPD patients can be preferred as an alternative to traditional exercise training, as it is an enjoyable and interesting approach that increases motivation and participation rate. In addition, it shows that creative dance-based exercise training can be preferred as an aerobic exercise training method because of it does not require equipment and has exercise variety.
  • Item
    Open Access
    Sıçanlarda siyatik sinirin ezilme yaralanması sonrası yüksek yoğunluklu lazer biyostimülasyon tedavisinin rejeneratif etkilerinin değerlendirilmesi
    BAYBURT, Kemal Atakan; DOLANMAZ, Doğan
    In complications that may occur as a result of surgical procedures performed in the maxillofacial region; Neurosensory disorders such as loss of function in nerves, paresthesia, hypoesthesia, neuropathic pain can be observed due to peripheral or central nervous system injury. The time of initiation of treatment varies according to the type of damage and the area where it is located. Invasive, noninvasive and conventional treatments are applied as treatment methods. Although there are studies showing the regenerative effect of the nerve by applying many treatment methods after degenerative and traumatic injury of the peripheral nervous system, there is no study in the literature on high-intensity laser therapy. The left sciatic nerves of all rats were crushed with a surgical clamp for 30 s to create nerve damage. Following the nerve crush injuries of sciatic nerve, thirty-three rats were randomly divided into three groups as control, Low-level laser theraphy (LLLT), and HILT groups. The injured sciatic nerve of rats in the control group were left to heal spontaneously, whereas HILT (120J/session and wavelength 1024 nm) and LLLT (2.4J/session and 650 nm) were started immediately after surgery and performed once every 3 days during the postoperative period. Regeneration was investigated by sciatic functional index (SFI), electrophysiological evaluations and histomorphometric evaluations. On the 23th day of the healing period the HILT group presented better SFI results when compared with control group(p=,012) whereas there was no statisticaly significant differences between HILT-LLLT (p=,473) and LLLT-control(p=,270) groups. At the end of 30 days healing period significanlty better SFI scores were noted in the HILT group compared with LLLT and control groups (p=,002, p=,000) whereas there was no statistically significant differences between the LLLT and control groups(p=,419). There was no statisticaly significant differences between three groups regarding the amplitude values of the electrophysiological evaluations. Latency and duration values revealed that HILT group has statisticaly significant differences between LLLT(p=,002, p=,014) and control(p=,003, p=,000) groups that was no statisticaly differences between LLLT and control groups (p=1.000, p=,162). Histological evaluations revealed that LLLT group has statisticaly higher schwann cell numbers compared to HILT (p=,048) and control (p=,003) groups whereas there was no statisticaly significant differences between HILT and control groups (p=,59). G-ratio evaluation revealed that, the number of nerve fibers with ranges of 0,55–0.69 has higher in the HILT group than other groups. According to functional, histomorphometric and electrophysiological investigations HILT revealed better results than LLLT on peripheral nerve regeneration after crush injury. HILT seems to be supperior than LLLT regarding to higher penetration depth and efficacy during peripheral nerve regeneration.
  • Item
    Open Access
    Atopik astımlı çocuklarda lomber stabilizasyon egzersizlerinin solunum fonksiyonları, solunum kas gücü, astım kontrolü ve fonksiyonel kapasite üzerine etkisi
    HEYBET, Safa; GÜRSES, Hülya Nilgün
    Asthma is a chronic inflammatory disease characterized by increased bronchial airway sensitivity and reversible air obstruction with different stimuli, which can resolve by itself or with treatment. Recurrent inflammations of the airways increase the frequency of asthma attacks in children and decrease physical performance. Due to the pressure exerted by intense exercise on the airways, asthmatic children stay away from exercise, this time, their functional capacity is reduced and their daily qualifications are limited. In the light of all these data, this study aims to evaluate functional capacity, respiratory parameters, respiratory muscle strength and asthma control by giving lumbar stabilization exercise training to children with atopic asthma. The study included children aged 7-17 diagnosed with atopic asthma in the Department of Pediatric Chest Diseases, Bezmialem Vakıf University Hospital, and referred to the Cardiopulmonary Physiotherapy and Rehabilitation Department, Division of Physiotherapy and Rehabilitation. A total of 24 children, 12 in the study group and 12 in the control group, participated in the study. Demographic and clinical information of the subjects in the study and control groups were recorded at the beginning of the study, followed by respiratory muscle strength, with mouth pressure measurements (MIP and MEP), respiratory functions with spirometric pulmonary function test, asthma control with asthma control test and functional capacities with six minute walk test (6MWT). While the control group continued to take the standard medical treatment of the pediatric pulmonologist, the study group received training for eight weeks of lumbar stabilization as well as medical therapy. After eight weeks, the same tests were repeated for both groups. Core (body) stabilization exercise training protocol was applied to the study group. Paired Sample T-test or Wilcoxon test; For comparisons between groups, Independent Samples T-test or Mann Whitney U test was used. The significance level was accepted as p <0.05 for all analyzes. Demographic characteristics were not associated with asthma control (p> 0.005). While no significant improvement was observed in respiratory functions of the study group who applied lumbar stabilization exercises, a significant improvement was observed in respiratory muscle strength (p = 0.002) and functional capacity (p = 0.041). After eight weeks of treatment, a significant improvement was observed in the asthma control in both groups (p = 0.002 and p = 0.036). Benefit from regular and controlled exercise and sports activities was observed children with atopic asthma. Therefore, children with asthma should be encouraged to do so.
  • Item
    Open Access
    Mandibulanın cerrahi olarak saatin tersi yönünde rotasyonundan sonra posterior açılı kondil üzerinde oluşan streslerin değerlendirilmesi
    ÇAKILTAŞ, Sevim; KÜTÜK, Nükhet
    In our study, posterior angular condyle stress was evaluated after conterclockwise rotation and advancement of mandible with Sagittal Ramus Osteotomy (SSRO) technique, which is widely used in orthognathic surgery. In this study, Finite Element Analysis (SEA) method, which is supported by literature, has been used. The aim of the study was determine the maximum stress areas in the condyle and the stability and relapse problems after 5 different amounts mandibular advancement. In our study computed tomography image of a patient with an anterior open bite has been computerized and mandible model was created by using Finite Element Analysis method. By operating bilateral sagittal split ramus osteotomy on the mandible model, 2 different advancements (5 and 10 mm) and counter-clockwise movement operations, also models which the lower limit of the proximal segment was correctedand left passively in place during fixation of bone segments, were developed. The pressure, tension and Von Mises stresses on the posterior angular mandibular condyle were evaluated by the SEA method. Stress intensity of mandibular condyle varies according to the amount of advancement of the mandible. As the amount of advancement increases, the amount of stress increases in the posterior and lateral sides of the condyle. The mandible may show angular changes and deplase depending on the amount of condyle advancement and fixation. The posterior angulation of the condyle in the rigid fixation stage affects the amount and intensity of the stress. The posterior angulation of the condyle increases the intensity of stress. In cases with mandibular progression and counter-clockwise rotation, the amount of stress on the condyle increases as the amount of mandibular advancement increases. When the mandibular condyle is not retained its original position and in angular posterior during fixation, the amount of stress increases. When the condylar is exposed to overload, its feeding from the synovial fluid begins to decrease and resorption develops. Excessive advancements are not suitable for TMJ tissues.
  • Item
    Open Access
    Ex vivo gen terapisiyle hipoparatiroidizm tedavisi modeli oluşturma
    ZEYBEK, Öykü; AKBAŞ, Fahri
    Hypoparathyroidism (hypo-PT) is a disease, caused by the lack of parathormone (PTH) and accompanied by a decrease in the calcium and an increase in the phosphate levels in serum. Lifelong use of high doses of oral Ca and vitamin D supplements are mandatory in the conventional treatment of chronic hypo-PT. Although the conventional treatment is symptomatic but not curative, it may cause very serious side effects in long-term use. Therefore, the necessity of developing new alternative therapies for hypo-PT is clearly seen. Gene therapy is a therapy method that can be preferred especially for the diseases that do not have a curative or effective treatment. Both its reliability and effectiveness have been increased in recent years due to the renewed gene transfer vector designs. Therefore it's aimed to show that it is possible to create an ex vivo gene therapy method for hypo-PT treatment on rats Our study is both the "first ex vivo gene therapy using autologous primary cells" and the "first study using lentiviral vectors for gene delivery" in the treatment of hypo-PT. Even if, in vivo gene therapy studies for hypo-PT have been performed before, "ex vivo method" which is preferred in our study, is more safer and manageable than "in vivo method". In our study, it was also aimed to prevent immune rejection by using autologous primary cells. In our thesis, seperate skin biopsies were excised from experimental animals and seperate autologous cell cultures were created for each animal. At the same time, lentiviral vector particles which are carrying "hPTH therapeutic gene" was constructed and then the autologous cells were transduced by lentiviral vectors to integrate the therepeutic gene hPTH into their genomes. Following transduction, high amounts of biologically active hPTH production and secretion from autologous cells was confirmed by both flourescent microscope images and biochemical tests. Thereafter therapeutic cells were injected subcutaneously into the rat body and hPTH production was confirmed in all experimental animals, demonstrating that "treatment of hypo-PT with ex vivo gene therapy in rats" may be feasible. However, it is observed that the hPTH values measured from the serum of rats after the therapy, remained below the physiological PTH reference range, it is estimated that the reason for this is that only a small amount of the therapeutic cells could engraft in the body after the injection, and the vast majority of them are removed due to the fact that they couldn't engraft into the body. As a result, due to the inadequate engraftment ratios of therapeutic cells, it is thought that hPTH levels remained below the physiological PTH reference ranges. In our future studies, it is planned to optimize the study protocol and to apply the injection of therapeutic cells with a suitable cellular matrix, thereby increasing the engraftment ratios of therapeutic cells into the rat body and thus the amount of hPTH production.