Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Cinsiyet Farklılığının Alt Ekstremite Kas Kuvveti ve Kas Mekanik Özelliklerinde Oluşturduğu DeğişikliklerBir Pilot Çalışma
Changes Caused by Sex Differences in Lower Extremity Muscle Strength and Muscle Mechanical Properties-A Pilot Study
Tülay ÇEVİK SALDIRANa, Emine ATICIb, Özgül ÖZTÜRKc, Derya AZİM REZAEİb
aBitlis Eren Üniversitesi Sağlık Yüksek Okulu, Fizyoterapi ve Rehabilitasyon Bölümü, Bitlis, TÜRKİYE
bİstanbul Okan Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul, TÜRKİYE
cAcıbadem Mehmet Ali Aydınlar Üniversitesi Sağlık Bilimleri Fakültesi, Fizyoterapi ve Rehabilitasyon Bölümü, İstanbul,TÜRKİYE
Turkiye Klinikleri J Health Sci. 2020;5(3):530-7
doi: 10.5336/healthsci.2019-72554
Article Language: TR
Full Text
ÖZET
Amaç: Araştırmanın amacı, alt ekstremite kas gruplarında kas tonusu, kompliyans, elastisite ve kas kuvvetinde cinsiyet ilişkili farklılıkları incelemekti. Gereç ve Yöntemler: Araştırmaya yaş ortalaması 19-24 yıl arasında değişen 53 (erkek= 25, kadın= 28) sağlıklı katılımcı dâhil edildi. Bilateral alt ekstremite diz ekstansörü (m. quadriceps), ayak bileği plantar (m. gastrocnemius) ve dorsifleksör (m. tibialis anterior) kaslarının mekanik özellikleri (tonus, kompliyans ve elastisite) myotonometre [MyotonPRO (Myoton Ltd., Estonya)] kullanılarak ölçüldü. Dinamometre (Lafayette) ile bilateral olarak diz ekstansör, ayak bileği plantar ve dorsifleksör kas gruplarından kas kuvveti değerlendirmesi yapıldı. Cinsiyet farklılıkları bağımsız örneklem karşılaştırmaları ile analiz edildi. Bulgular: Bilateral olmak üzere ayak bileği plantar fleksörlerinin istirâhat kas tonusu ve kuvveti, erkek katılımcılarda daha yüksekti (p˂0,05). Diz ekstansörlerinin istirâhat kas tonusu ve kuvveti erkeklerde daha yüksekti (p˂0,05). Sağ (p=0,009) ve sol (p=0,034) ayak bileği dorsi fleksörlerinin kas kuvveti erkeklerde daha yüksekti. Sol ekstremitede ayak bileği dorsi fleksörlerinin kas tonusu erkeklerde daha yüksek iken (p=0,028) kompliyans daha azdı (p=0,028). Alt ekstremite kaslarının elastisite özelliği cinsiyet faktöründen etkilenmedi (p˃0,05). Sonuç: Araştırma sonuçlarımıza göre cinsiyet değişkeni, elastisiteden bağımsız olarak, kas kuvveti, istirâhat kas tonusu, kompliyansında farklılık etmenidir. Ayak bileği plantar fleksörlerinde her 2 alt ekstremitede cinsiyet değişkeni farklılık oluşturdu. Erkeklerin ayak bileği plantar fleksörlerinin istirâhat kas tonusu ve kuvveti kadınlardan daha yüksekti.

Anahtar Kelimeler: Cinsiyet farklılığı; kas tonusu; kompliyans; elastisite; kas kuvveti
ABSTRACT
Objective: The aim of the study was to investigate sexrelated differences in muscle tone, compliance, elasticity and muscle strength in lower extremity muscle groups. Material and Methods: Fifty-three healthy participants (male=25, female=28) with a mean age of 19-24 years were included in the study. Mechanical properties (muscle tone, compliance and elasticity) of bilateral lower extremity knee extensor (m. quadriceps), ankle plantar (m. gastrocnemius) and dorsiflexor (m. tibialis anterior) muscles were measured using myotonometer [MyotonPRO (Myoton Ltd., Estonia)]. Muscle strength was evaluated bilaterally by dynamometer (Lafayette) from knee extensor, ankle plantar and dorsiflexor muscle groups. Gender differences were analyzed by independent sample comparisons. Results: Resting muscle tone and strength of ankle plantar flexors, bilaterally, were higher in male participants (p˂0.05). Resting muscle tone and strength of knee extensors were higher in males (p˂0.05). Muscle strength of the right (p=0.009) and left (p=0.034) ankle dorsi flexors was higher in men. The muscle tone of the ankle dorsi flexors in the left extremity was higher in males (p=0.028) while the compliance was less (p=0.028). The elasticity of the lower extremity muscles was not affected by the sex factor (p˃0.05). Conclusion: According to the study results, regardless of elasticity, sex difference is the cause of changes in muscle strength, resting muscle tone and muscle compliance. Muscle properties of ankle plantar flexors in both lower extremities were affected by sex differences. Resting muscle tone and muscle strength of the ankle plantar flexors of men were higher than women.

Keywords: Sex differences; muscle tone; compliance; elasticity; muscle strength
REFERENCES:
  1. Bloem BR, Allum JH, Carpenter MG, Honegger F. Is lower leg proprioception essential for triggering human automatic postural responses? Exp Brain Res. 2000;130(3):375-91.[Crossref] [PubMed] 
  2. Gribble PA, Hertel J. Effect of lower-extremity muscle fatigue on postural control. Arch Phys Med Rehabil. 2004;85(4):589-92.[Crossref] [PubMed] 
  3. Bosco C, Cardinale M, Tsarpela O. Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles. Eur J Appl Physiol Occup Physiol. 1999;79(4):306-11.[Crossref] [PubMed] 
  4. Narici MV, Maffulli N, Maganaris CN. Ageing of human muscles and tendons. Disabil Rehabil. 2008;30(20-22):1548-54.[Crossref] [PubMed] 
  5. Zajac FE. How musculotendon architecture and joint geometry affect the capacity of muscles to move and exert force on objects: a review with application to arm and forearm tendon transfer design. J Hand Surg Am. 1992;17(5):799-804.[Crossref] [PubMed] 
  6. Kubo K, Kanehisa H, Fukunaga T. Gender differences in the viscoelastic properties of tendon structures. Eur J Appl Physiol. 2003;88(6):520-6.[Crossref] [PubMed] 
  7. Laffaye G, Wagner PP, Tombleson TI. Countermovement jump height: gender and sport-specific differences in the force-time variables. J Strength Cond Res. 2014;28(4):1096-105.[Crossref] [PubMed] 
  8. Perez-Gomez J, Rodriguez GV, Ara I, Olmedillas H, Chavarren J, González-Henriquez JJ, et al. Role of muscle mass on sprint performance: gender differences? Eur J Appl Physiol. 2008;102(6):685-94.[Crossref] [PubMed] 
  9. Wickiewicz TL, Roy RR, Powell PL, Perrine JJ, Edgerton VR. Muscle architecture and force-velocity relationships in humans. J Appl Physiol Respir Environ Exerc Physiol. 1984;57(2):435-43.[Crossref] [PubMed] 
  10. Feng YN, Li YP, Liu CL, Zhang ZJ. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep. 2018;8(1):17064.[Crossref] [PubMed] [PMC] 
  11. Mooney K, Warner M, Stokes M. Symmetry and within-session reliability of mechanical properties of biceps brachii muscles in healthy young adult males using the MyotonPRO device. Work Pap Heal Sci. 2013;1(3):1-11.[Link] 
  12. Gubler-Hanna C, Laskin J, Marx BJ, Leonard CT. Construct validity of myotonometric measurements of muscle compliance as a measure of strength. Physiol Meas. 2007;28(8):913-24.[Crossref] [PubMed] 
  13. Agyapong-Badu S, Warner M, Samuel D, Stokes M. Measurement of ageing effects on muscle tone and mechanical properties of rectus femoris and biceps brachii in healthy males and females using a novel hand-held myometric device. Arch Gerontol Geriatr. 2016 ;62:59-67.[Crossref] [PubMed] 
  14. Aird L, Samuel D, Stokes M. Quadriceps muscle tone, elasticity and stiffness in older males: reliability and symmetry using the MyotonPRO. Arch Gerontol Geriatr. 2012;55(2):e31-9.[Crossref] [PubMed] 
  15. Havuç S, Aydeniz A, Başaran S. [The effectiveness of electrical stimulation on muscle tone, elasticity and stiffness of gastrocnemius muscle in children with spastic cerebral palsy].Cukurova Medical Journal. 2018;43(1):56-62.[Crossref] 
  16. Stratford PW, Balsor BE. A comparison of make and break tests using a hand-held dynamometer and the Kin-Com. J Orthop Sports Phys Ther. 1994;19(1):28-32.[Crossref] [PubMed] 
  17. Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua YH, Williams GP, et al. Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study. PLoS One. 2015;10(10):e0140822.[Crossref] [PubMed] [PMC] 
  18. McBride JM, Deane R, Nimphius S. Effect of stretching on agonist-antagonist muscle activity and muscle force output during single and multiple joint isometric contractions. Scand J Med Sci Sports. 2007;17(1):54-60.[Crossref] [PubMed] 
  19. An SY, Yeo SM, Cheong IY, Hwang JH. Mechanical properties of muscles around shoulder in breast cancer patients: Intra-and inter-reliability and symmetry using MyotonPRO. Annals of Physical and Rehabilitation Medicine. 2018;61:435-557.[Crossref] 
  20. Viir R, Laiho K, Kramarenko J, Mikkelsson M. Repeatability of trapezius muscle tone assessment by a myometric method. Journal of Mechanics in Medicine and Biology. 2006;6(02):215-228.[Crossref] 
  21. Taş S, Salkın Y. An investigation of the sex-related differences in the stiffness of the Achilles tendon and gastrocnemius muscle: Inter-observer reliability and inter-day repeatability and the effect of ankle joint motion. Foot (Edinb). 2019;41:44-50.[Crossref] [PubMed] 
  22. Kocur P, Grzeskowiak M, Wiernicka M, Goliwas M, Lewandowski J, Łochyński D. Effects of aging on mechanical properties of sternocleidomastoid and trapezius muscles during transition from lying to sitting position-A cross-sectional study. Arch Gerontol Geriatr. 2017;70:14-8.[Crossref] [PubMed] 
  23. Mullix, James, Martin Warner, and Maria Stokes. Testing muscle tone and mechanical properties of rectus femoris and biceps femoris using a novel hand held MyotonPRO device: relative ratios and reliability. Working Papers in Health Sciences 1.1 (2012):1-8.[Link] 
  24. Huang J, Qin K, Tang C, Zhu Y, Klein CS, Zhang Z, et al. Assessment of Passive Stiffness of Medial and Lateral Heads of Gastrocnemius Muscle, Achilles Tendon, and Plantar Fascia at Different Ankle and Knee Positions Using the MyotonPRO. Med Sci Monit. 2018;24:7570-6.[Crossref] [PubMed] [PMC] 
  25. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76(3):248-59.[Crossref] [PubMed] 
  26. Ahtiainen JP, Pakarinen A, Alen M, Kraemer WJ, Häkkinen K. Muscle hypertrophy, hormonal adaptations and strength development during strength training in strength-trained and untrained men. Eur J Appl Physiol. 2003;89(6):555-63.[Crossref] [PubMed] 
  27. Lieber RL, Fridén J. Functional and clinical significance of skeletal muscle architecture. Muscle Nerve. 2000;23(11):1647-66.[Crossref] [PubMed] 
  28. Miller AE, MacDougall JD, Tarnopolsky MA, Sale DG. Gender differences in strength and muscle fiber characteristics. Eur J Appl Physiol Occup Physiol. 1993;66(3):254-62.[Crossref] [PubMed] 
  29. Wüst RC, Morse CI, de Haan A, Jones DA, Degens H. Sex differences in contractile properties and fatigue resistance of human skeletal muscle. Exp Physiol. 2008;93(7):843-50.[Crossref] [PubMed] 
  30. Higbie EJ, Cureton KJ, Warren GL 3rd, Prior BM. Effects of concentric and eccentric training on muscle strength, cross-sectional area, and neural activation. J Appl Physiol (1985). 1996;81(5):2173-81.[Crossref] [PubMed] 
  31. Zatsiorsky VM, Prilutsky BI. Biomechanics of Skeletal Muscles. Human Kinetics; 2012.[Crossref] 
  32. Narici MV, Maffulli N. Sarcopenia: characteristics, mechanisms and functional significance. Br Med Bull. 2010;95:139-59.[Crossref] [PubMed] 
  33. Mustalampi S, Häkkinen A, Kautiainen H, Weir A, Ylinen J. Responsiveness of muscle tone characteristics to progressive force production. J Strength Cond Res. 2013;27(1):159-65.[Crossref] [PubMed] 
  34. Wang D, De Vito G, Ditroilo M, Fong DT, Delahunt E. A comparison of muscle stiffness and musculoarticular stiffness of the knee joint in young athletic males and females. J Electromyogr Kinesiol. 2015;25(3):495-500.[Crossref] [PubMed] 
  35. Eby SF, Cloud BA, Brandenburg JE, Giambini H, Song P, Chen S, et al. Shear wave elastography of passive skeletal muscle stiffness: influences of sex and age throughout adulthood. Clin Biomech (Bristol, Avon). 2015;30(1):22-7.[Crossref] [PubMed] [PMC] 

.: Up To Date

Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com